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Cleveland Clinic Abu Dhabi is now hiring Critical Care Nurses - Interviews on the 20th-22nd of October The intensive care unit is an exciting and challenging environment at CCAD, offering world class innovative experiences and opportunities for nurses. You will be challenged with high acuity critical patients, work with a world class team and receive support to provide patient centered care. While patients are complex, CCAD will support your professional growth and offer mentorship.

Come and meet us! CCAD representatives will be attending the ANZICS ACCCN Annual Scientific Meeting at Perth Convention and Exhibition Centre. Concurrent to the conference, CCAD will be holding interviews on the 20th-22nd of October. Please bring an updated CV if you are interested in job opportunities at CCAD. Skype interviews are also available for nurses located in other cities in Australia and New Zealand. Please contact CCM for more information. Cleveland Clinic Abu Dhabi (CCAD), part of Mubadala’s network of world-class healthcare facilities, is a multispecialty hospital on Al Maryah Island in Abu Dhabi, UAE. CCAD is a unique and unparalleled extension of US-based Cleveland Clinic’s model of care, specifically designed to address a range of complex and critical care requirements unique to the Abu Dhabi population. Benefits: In addition to being part of an international clinical team, successful applicants will receive accommodation, a transportation allowance, health insurance, annual travel allowance to their home country and a generous annual leave package. To apply, please email: Dawn at dawn@ccmrecruitment.com.au or Raquel at raquel@ccmrecruitment.com.au or by phone at Free Phone AUS: 1800 818 844, Free Phone NZ: 0800 700 839 www.ccmrecruitment.com

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Directory 02 Editorial 03 News 04 World 15 Feature 16 Research 20


Industrial 21 Working life


Ethics 23 Clinical update


Focus – Primary/Community healthcare 27

Books 44 Calendar 45 Mail 46 Sally 48


22 48 anmf.org.au

August 2016 Volume 24, No. 2  1


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

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Melbourne & ANMJ

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Australian Capital Territory Branch Secretary Jenny Miragaya Office address 2/53 Dundas Court, Phillip ACT 2606 Postal address PO Box 4, Woden ACT 2606 Ph: (02) 6282 9455 Fax: (02) 6282 8447 E: anmfact@anmfact.org.au

Northern Territory

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Branch Secretary Yvonne Falckh

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Branch Secretary Lisa Fitzpatrick

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

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



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 2016 Volume 24, No. 2




Based on ANMJ 2014 member survey pass on rate Circulation: 93,185 BCA audit, March 2016



Editorial Lee Thomas, ANMF Federal Secretary My message highlighted the challenges facing the aged care workforce and – the worrying trend that shows it is READ not uncommon for one registered MORE ON nurse to be responsible for the care ASSISTED DYING of 100 residents or more. ON PAGE 5 – The problem will only worsen unless we quickly restore funding, improve the regulation of staff and providers, and work towards mandated staffing levels. Addressing the National Press Club I outlined a three point plan I believe holds the answer to fixing the sector’s shortcomings.

After a nail-biting finish to last month’s federal election the final result has now been declared, with the Coalition government returned to power, albeit narrowly. The substantial swing to the Labor Party and rise of Independents and minor parties prove the people of Australia regard health as their top priority. The ANMF ran a resolute election campaign titled If you don’t care we can’t care which identified four key priorities – restoring $57 billion in cuts to public hospitals, protecting Medicare and penalty rates, and overturning $1.8 billion slashed from the aged care sector. While the campaign is over our commitment to tackling these core issues remains unwavering. Aged care is firmly on the agenda and last month I had the privilege of speaking at a forum held by the National Press Club in Canberra examining the developing crisis threatening the sector.

Primarily, change requires a sustainable funding model that includes additional investment in aged care, a comprehensive workforce strategy for now and the future, and wide-ranging safeguards to ensure consumers of care and their families are guaranteed quality and peace of mind.


Elsewhere on my travels, last month I attended and spoke at the Queensland Nurses Union’s (QNU) Annual Conference held in Brisbane.

The focus section of the journal this month looks at some of the amazing work and research being undertaken within primary and community healthcare.

While there I was moved by the story of a young openly gay male nurse named Josh who bravely spoke about his experience with sexism and ageism after entering the profession.

Issues include student perceptions of primary healthcare, the inadequate management of deteriorating patients, and the value of health promotion programs for older people with chronic conditions.

His uplifting account is covered in this month’s news section and provides an important insight into a problematic issue commonly swept under the carpet.

On a final note, while the election may be over the fight to protect our healthcare system carries on. As frontline nurses and midwives we know how important health is and we won’t stop until major investment is put on the table. Make no mistake, people are listening, and together we can make a difference to the lives of all Australians.

Other news items include an article on Andrew Denton’s push for legally assisted dying, a hot topic at the moment. An article published in the ANMJ last month on euthanasia and posted on the ANMF’s Facebook page received 1,200 likes, illustrating the level of interest in the issue. On a different note, this month’s feature explores the future of advanced practice nursing and considers recent groundbreaking research that states the speciality field can be described as a level of practice rather than simply a role or title.



APNs are categorised as nurses who work at the top of the registered nurse practice scope and this in-depth article examines defining their role and work value, establishing career paths, and potential future implications.



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NEW TOOLS AID HEALTH PROFESSIONALS DELIVERING END OF LIFE CARE Nurses and other health professionals faced with delivering end-of-life care in acute hospitals around Australia will now have access to an online package of education resources designed to better equip them to deal with the challenging and obligatory part of the job. Funded by the Federal Department of Health, the new resources, End-of-Life Essentials, were developed by CareSearch at Flinders University in Adelaide, and feature e-learning modules and implementation resources for hospital clinicians.

SUPER TO BE PAID DURING MATERNITY LEAVE In a major step forward, Victorian nurses and midwives will be paid super contributions from their employer while on maternity leave. State Minister for Health Jill Hennessy made the announcement at the recent ANMF Victorian Branch Delegates’ conference held in Melbourne. “It is unfair that people who take maternity leave are not currently paid superannuation as well. It’s a great challenge when parents take maternity leave. People may think they are living the life of Riley watching Netflix and eating BBQ shapes while someone else is looking after their children. “It is a productive time where they are contributing to the broader community and broader society and should be paid and remunerated in that way.” A Senate report into women’s economic security in retirement found that on average Australian women retire with around half the amount of super as men. One in three women retire with no super at all. Minister Hennessy said the statistics were 4  August 2016 Volume 24, No. 2


bleak, with many women forced into near poverty in retirement. The Minister congratulated nurses and midwives for their outstanding commitment over 15 years to patient outcomes in fighting for nurse to patient ratios ahead of wage increases. The recent EBA addressed this with public sector Victorian nurses and midwives securing wage parity with their NSW colleagues, she said. A resolution of vote of thanks to Minister Hennessy was moved from the floor and overwhelmingly passed by delegates. The Victorian government also committed to further work on bullying and unacceptable behaviour in the workplace. “It is a significant and serious issue and we will continue to get all recommendations of the taskforce in place. We will get change and hold management accountable,” the Minister said.

The e-learning package, which draws upon the Australian Commission on Safety And Quality in Health Care’s National Consensus Statement: Essential elements for safe and high-quality end-of-life care, is free and can be accessed from anywhere around the country. The package consists of six web-based learning modules and an implementation toolkit, with the core aim of the project to assist health professionals in developing skills in recognising end-of-life, increasing communication approaches, and gaining confidence in the care management of patients who cannot be cured. The modules cover a range of clinically relevant and evidence based learning materials through quizzes, evidence links, and educational videos. The first three modules were launched in late June at the Flinders Centre for Innovation in Cancer, with the remaining three modules to be released in October. Health professionals are encouraged to examine their own practice and build on their individual expertise by accessing the widerange of learning opportunities on offer. The modules cover managing end-of-life issues in acute care hospitals, effective patient-centred communication, recognising end-of-life and starting the conversation with patients and families, planning for endof-life care, managing concern, and working collaboratively with all healthcare teams involved. The End-of-Life Essentials online learning package is now available at: www.caresearch.com.au/EndofLifeEssentials



DENTON CALLS ON NURSES TO JOIN PUSH FOR LEGALLY ASSISTED DYING Media personality Andrew Denton has encouraged nurses to support the controversial introduction of assisted dying laws in Australia. Addressing the Australian Nursing and Midwifery Federation’s (ANMF Victorian Branch) recent Annual Delegates’ Conference, Mr Denton implored nurses to speak out in the wake of a recent Victorian Parliamentary Inquiry that handed down a report backing assisted dying for adults suffering incurable conditions. “You are the ones that see the suffering. You are the ones that hear your patients’ pleas for help to die,” Mr Denton said. “An assisted dying law will not only offer choice and dignity to your patients, it will offer protection to you and clear guidelines as you negotiate good palliation with doctors.” Mr Denton became an advocate for legally assisted dying following the traumatic death of his father from heart failure at age 67. “Watching him die remains the most profoundly shocking experience of my life.” About 16 months ago Mr Denton began exploring the issue by conducting research both locally and abroad, where assisted anmf.org.au

dying laws exist in countries such as Belgium and the Netherlands. He turned countless hours of interviews with nurses, doctors, politicians, academics, and palliative care specialists from both sides of the debate into a podcast series released this year titled Better Off Dead. Mr Denton told delegates the series is his way of “informing and inflaming” the debate in Australia. “[I found] long-running robust systems based on years of open research and debate with multiple safeguards and overwhelming acknowledgement that they do work across the spectrum.”


Mr Denton stressed figures show minimal people use the system – with assisted dying counting for less than 2% of all annual deaths in Belgium and less than 4% in the Netherlands. “What these laws do quite simply is to give them a choice and some degree of control over how hard that dying needs to be.” Mr Denton cited the recent Victorian

report, arguing it represents the “best chance yet” for assisted dying laws to be introduced in Australia. He said the report’s findings created a compelling reason for change, outlining six key areas within the document to reinforce the assessment, including doctors already practicing unlawful assisted dying, the limitations of palliative care, and the widespread acceptance of palliative sedation. Alarmingly, the report also showed many people experiencing incurable illnesses were resorting to taking their own lives in a desperate bid to ease pain, Mr Denton said. As part of evidence delivered to the Inquiry the Victorian Coroner stated that between January 2009 and December 2013, 2,879 suicides took place in Victoria, and that of those more than 200 were people experiencing an irreversible deterioration of physical health due to disease. The highest demographic affected were people aged over 65 and half the cases involved cancer, including a 75-year-old man with prostate cancer who shot himself with a nail gun. The Coroner estimated that one person each week takes their own life under these circumstances. Other evidence within the report showed many people were choosing to refuse food and water in a bid to expedite their death. “It still amazes me that we live in a society where it is legally and ethically acceptable for a dying patient to choose a slow, psychologically painful death by starvation, but legally and ethically unacceptable for that same dying patient to choose a death that is quick and painless.” August 2016 Volume 24, No. 2  5

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DEVELOPMENT BEGINS ON NEW MIDWIFERY STANDARDS FOR PRACTICE A research team of midwifery and standards experts has been assembled to develop new Midwife standards for practice that will provide contemporary benchmarks for the country’s 33,000 midwives. The 18-month long project will be led by Deakin University and involve a range of experts consisting of academics from six universities, the Australian Nursing and Midwifery Federation (ANMF) and the Mercy Hospital for Women. ANMF Senior Federal Professional Officer Julianne Bryce was invited to join the team to provide her detailed knowledge and experience in developing national standards documents across numerous settings within the health sector. In the past Ms Bryce has participated as a research team member for the development of standards, including, those commissioned by the Nursing and Midwifery Board of Australia (NMBA): the national nurse practitioner and registered nurse standards for practice. Ms Bryce welcomed the review of the current NMBA National competency standards for the midwife (2006) and the opportunity

SPECIALIST CHILDREN’S IMMUNISATION SERVICE LAUNCHED IN QUEENSLAND Queensland children and young people with complex immunisation needs will have access to greater protection against life-threating vaccine-preventable diseases following the launch of a new specialist immunisation service. The Queensland Specialist Immunisation Service, which will be funded annually


to create new standards for midwifery practice. “The new standards will provide greater clarity of the expected standard for midwives, not only for midwives themselves, but for other health professionals and the community as well. “We want the standards for practice to reflect contemporary midwifery practice. The focus is on the midwife and the care that the midwife is providing.” The project begins this month and is expected to finish by late 2017. The standards will reflect the scope of midwifery practice in all models of care across Australia, in both clinical and non-clinical settings. The review will involve comprehensive observation of midwifery practice to validate the new standards.


Ms Bryce emphasised that ANMF midwife members would have the opportunity to significantly shape their standards for practice. “We’ll be communicating with our members throughout the project and making sure that they’re aware of the opportunities to contribute as these arise in various forms, such as by taking part in online surveys and making submissions to the draft standards as they are produced.”

by the state government at a cost of $1.6 million, aims to target children with complex health issues or at risk of an adverse event following immunisation. The service, to be based at the Lady Cilento Children’s Hospital, will also provide immunisation services to hospital patients. The state’s latest data shows that 93.3% of Queensland children at one year have been immunised, 91.9% at two years, and 92.7% at five years. Queensland’s Health and Ambulance Services Minister, Cameron Dick, said the specialist service would fill an important gap in the state’s existing immunisation rollout by capturing children who have not been vaccinated in traditional community settings due to complex medical problems or access issues. “Immunisation is essential for children whose immunity has been

CHRONIC DISEASE ADDING UNNECESSARY PRESSURE TO HEALTH SYSTEM Latest research shows one in two Australians have a chronic disease, according to Australia’s Health Tracker. The Tracker, developed by the Australian Health Policy Collaboration (AHPC), shows almost one third of chronic disease could be prevented by removing risk factors such as smoking, alcohol use, physical inactivity and high body mass. “The results are particularly shocking with almost 30% of Australians either obese or overweight and 19.5% of Australians are not doing enough physical activity. Now more than ever the elected government needs to implement measures to stop the rise in chronic disease in its tracks,” said Public Health Association of Australia CEO Michael Moore. Mr Moore said the government only invests 1.5% into prevention for chronic disease. “Chronic diseases are on the rise putting enormous pressure on the health system and costing the taxpayer more and more to support those in hospital. A lot of promises were made before the election to fight chronic disease. What we need to see is action from the elected government as this issue is affecting half of the population.”

compromised by a health condition, such as cancer, cystic fibrosis, or cerebral palsy. “This leaves them at risk of contracting vaccine-preventable diseases and/or having complications from such a disease.” Mr Dick said the goal was to reach 95% immunisation. He added that the service and its team of infectious disease specialists and immunisation nurses would offer timely advice to any clinician treating a child with immunisation challenges, including via telehealth and a dedicated telephone hotline. “This service is an important step towards achieving and maintaining this goal, and will ensure Queensland’s most vulnerable children and young people, regardless of where they live, can access the protection they need against vaccine preventable diseases.”

August 2016 Volume 24, No. 2  7


STRATEGIC PUSH TO BOOST INDIGENOUS NURSING NUMBERS A multi-pronged line of attack involving governments, the tertiary sector, and community groups is essential in order to increase Indigenous nursing numbers, a leading academic has stated. Speaking via live video link from the United States, Linda Deravin-Malone, a Lecturer in Nursing in the School of Nursing, Midwifery and Indigenous Health at Charles Sturt University, addressed the topic of creating pathways to increase Indigenous nursing numbers at a special event convened by the Institute of Health and Nursing Australia (IHNA) during NAIDOC week last month.

Ms Deravin-Malone’s article revealed how Indigenous people employed in health most commonly fill positions within auxiliary and support services rather than clinical type roles such as nursing and midwifery. She wrote that the establishment of the Aboriginal Health Worker role had failed to encourage people into nursing and that a review of education pathways and recognition of prior learning were strategies that could lead to Indigenous people embracing nursing. “It’s all about creating more choices and more opportunities to expand their professional roles,” Ms Deravin-Malone explained during the NAIDOC week discussion. “Not everybody wants to become a nurse and that’s fine. But for those people that might consider expanding their roles, I believe that we need to support that. “I would really like to see more Indigenous people not only looking after their own communities, but extending that and going into the broader range of healthcare.”

The event was triggered by an article published in the ANMJ in March this year where Ms Deravin-Malone explored the shortage of Indigenous nursing numbers as part of the journal’s wider focus on Indigenous health.

In response to the gap, IHNA, a registered training organisation (RTO) which offers a Diploma of Nursing leading towards qualifying as an Enrolled Nurse, will attempt to recruit Indigenous Health Workers and provide them with a seamless pathway into nursing.


who is already conducting groundbreaking research to stop recurrence in breast cancer and other aggressive cancers. The project will commence its initial clinical trial phase within the ACT in coming months.

Researchers from the University of Canberra will join forces with a pharmaceutical company to investigate the effectiveness of using medicinal cannabis to treat melanoma. The two-year $1 million research project aims to produce an innovative combination therapy treatment program to help some of the 50,000 Australians living with melanoma. The project will be led by University of Canberra’s Professor Sudha Rao, an expert in molecular and cellular biology,

8  August 2016 Volume 24, No. 2

Professor Rao said the clinical trials would help determine the benefits of medical cannabis-based treatments for melanoma. “Australians have the highest rate of melanoma in the world, with estimates of more than 13,000 new cases to be diagnosed in 2016 alone. “When you consider that melanoma is the third most common cancer in Australia and New Zealand, and almost 1,800 people will die as a result of this cancer this year, we need to work harder at finding effective treatments.” Professor Rao’s team within the university’s Health Research Institute is already leading innovative research into aggressive cancers, such as breast cancer, and developing treatments to stop cancer re-occurring.

IHNA will look to fast-track prospective students by investigating all opportunities for credits through recognised prior learning, thereby shortening the course. It has also formed a new partnership with RMIT University that will facilitate entry into a Bachelor of Nursing for students who wish to pursue the path to becoming an RN. “It’s time we reviewed these pathways and did something about it and that’s what we plan to do,” said IHNA Director of Studies Russell Freemantle. Ms Deravin-Malone said establishing easier pathways could lead to a rise in nursing numbers. “Indigenous Health Workers have a level of skill and they should be recognised for those skills and for the success that they have already achieved.” Ms Deravin-Malone acknowledged that Indigenous people face greater hurdles in accessing study and said that innovative solutions needed support, such as employing mentors or delivering education in unique ways. “Why not take the classroom out to where people live? Why is it that everybody has to come in to a major centre? That can be quite restrictive for people in rural areas, Indigenous and Non-Indigenous, to have to leave their communities or their families or their support. We need to look at how we can better manage that.”


Earlier this year, the federal parliament introduced landmark legislation that will allow the legal cultivation of cannabis for medicinal or scientific purposes. ACT Greens Minister Shane Rattenbury said the university’s clinical trial of medicinal cannabis was an important step in a long fight towards making the drug available to sufferers of conditions such as epilepsy, Multiple Sclerosis, and a range of different cancers. “We believe that medicinal cannabis should be available to sick and dying patients who need it, and have been driving this issue at both a local and national level.”



NATIONAL HEART FOUNDATION OF AUSTRALIA APPOINTS NEW CEO Long-serving ANMF member Professor John Kelly AM has secured the role as the new Chief Executive Officer of the National Heart Foundation of Australia.

background that features extensive clinical and management experience in the health and aged care sector, as well as governance expertise at a national level and solid advocacy and stakeholder representation across various national professional associations. His background extends to philanthropic work, specifically, nine years as part of the Smith Family Board. Professor Kelly holds academic appointments with the Sydney Nursing School at Sydney University and the Faculty of Health at UTS in Sydney and his legal background and experience as a Partner in national law firms position him with an excellent opportunity to provide governance insight at the Heart Foundation as well as with the Federation.

Professor Kelly moves on from a four-year term as CEO of Aged & Community Services Australia (ACSA), the peak national body for not-for-profit providers of community and residential aged care, where he successfully led significant sector reform.

Professor Kelly, who was awarded the Member of the Order of Australia in 2009 and held the position of the Commonwealth Aged Care Commissioner in 2010, said he was looking forward to using his wealth of experience to continue the vital work of the Heart Foundation.

Professor Kelly, who served on the National Council of the Australian Nursing Federation, as it was known back in 1975, possesses strong leadership skills and a wide-ranging

“There has never been a more important time for the Heart Foundation to increase the awareness of Heart Health initiatives throughout the community,” Professor Kelly



Ms Houston, who lives in Scotland and worked as a nurse for many years, was diagnosed with early-onset Alzheimer’s disease a decade ago at age 57. She recalled doctors believing her symptoms could have been a tumour and her own relief when dementia was finally pinpointed. “I just thought ‘Thank God!’. Now we can go on with living and doing something about it.” Ms Houston found reassurance after joining the Scottish Dementia Working Group, a anmf.org.au

said. “There is a significant role available for nurses in general, and specialist nurse practitioners in particular, to advance Heart Health Initiatives. Cardiovascular disease is clearly identified as a national health priority and the Heart Foundation is well placed across Australia to play a leading role in the education and research agenda.” dementia is looking to their carer to know what to do.” Ms Houston has developed neurological vision impairment as a result of her dementia and the loss of vision sparked her into writing a book documenting the real-life stories of people living with dementia with a focus on examining sensory impacts. Her tireless work also saw her honoured with a Member of the Most Excellent Order of the British Empire (MBE) award for Services to People with Dementia.

A global dementia awareness campaigner living with the disorder has identified acceptance and resilience as the solutions to moving on with life post diagnosis. Speaking at HammondCare’s recent International Dementia Conference in Sydney, Vice Chair of the European Person With Dementia Working Group, Agnes Houston, told delegates that there was light at the end of the tunnel for dementia sufferers.


lobby group based on organising campaigns and investigating ways to shape future policy for people living with dementia. “They taught me to make mistakes. To stop apologising and start accepting. Having to ask for help was very humbling.” Ms Houston’s daughter and carer Donna, also spoke at the conference, and echoed the sentiment of taking things one day at a time. “Try to get to acceptance as quickly as possible because once you’ve accepted it you can move on. “You have to learn patience. Lots of patience. Arguing with someone with dementia; just don’t do it. A person with

Ms Houston’s husband Alan also has dementia and the pair live in separate houses due to the constraints of the condition, but they phone each other every day and meet up for lunch. Ms Houston said the course of events is an example of how one needs to reassess their life when dementia hits. “Yes, there’s life. Just don’t look for it to be the same life you anticipated.” The International Dementia Conference featured a variety of speakers addressing the question “Are We There Yet?” in regards to winning the war on dementia. Federal Health Minister Sussan Ley described dementia as “one of the biggest global health challenges confronting us” and said 83,000 Australians are admitted to hospital each year with dementia. Ms Ley said better support was needed and outlined one new strategy, $7.5 million in funding to establish specialist dementia care units. August 2016 Volume 24, No. 2  9




Almost one-third of people admitted to hospital as a result of poisoning were under the age of 24, the latest research from the Australian Institute of Health and Welfare (AIHW) has revealed.

HIV is a sleeping giant that could infiltrate the young Indigenous population unless more work is done to curb the cluster of sexually transmissible infections (STIs) and rise in injecting drug use plaguing the demographic, an Aboriginal health researcher has warned. Speaking as part of the Peter Doherty Institute for Infection and Immunity’s public lecture series, Associate Professor James Ward, Head of Infectious Diseases Research and Aboriginal Health at the South Australian Health and Medical Research Institute (SAHMRI), said the mainstream system had failed to address the significant health issue. A longstanding campaigner for Aboriginal health, Professor Ward said STIs were relatively easy to treat but shortcomings in the health response among the Indigenous population had contributed to the problematic issue faced today. Highlighting the prevalence of STIs such as gonorrhoea, chlamydia, and syphilis, Professor Ward explained how 50% of Aboriginal and Torres Strait Islander people under the age of 25 contract STIs, with women more susceptible than men. “Unfortunately, it’s not looking good for future generations if we don’t have some major breakthroughs in this area.” Attempting to pinpoint reasons behind the avoidable high incidence of STIs and offer solutions to address the problem, Professor Ward suggested weaknesses in primary healthcare, particularly in comprehensive testing and education, is one of the core reasons. “Ten thousand to 13,000 cases of testing are happening each year in remote communities but we’re not making any impact on the prevalence. It really says something’s wrong with the guidelines.” While HIV has yet to penetrate the young Indigenous community, Professor Ward fears it’s only a matter of time given the prevalence of STIs and worryingly, a gradual rise each year in rates of injecting drug use. “HIV is going to get into our communities. It will go [spread] because our primary care clinicians aren’t doing the job they’re supposed to be doing.” 10  August 2016 Volume 24, No. 2


The report, Poisoning in Children and Young People 2012-13, was undertaken by Dr Sophie Pointer, of the Research Centre for Industry Studies at Flinders University, which operates AIHW’s National Injury Surveillance Unit.


Professor Ward outlined several strategies being canvassed to tackle STIs, such as the mass treatment of communities, opportunistic testing, and testing twice a year. He said mass screening programs would require a skilled workforce to carry out the scheme, a prospect he questions. Currently, Professor Ward is in the process of trying to establish a national set of STI indicators for primary care so that mandatory reporting takes place, as it does for chronic disease and child and maternal health. As part of his ongoing research, he will team with Aboriginal health bodies across the country to set up a national surveillance network in numerous remote communities in order to conduct studies into STIs in the hope of generating better health outcomes for the population. Professor Ward also said he will engage with the federal health minister in a bid to improve sex education in schools, bolster primary care, and raise awareness. “We’ve got a long way to go. We need heaps of change and a major investment.”

Dr Pointer examined all hospitalisations from poisoning in Australia during 2012-13 and found that of the 37,417 people hospitalised, 12,451 of them were children or young people under the age of 24. Her analysis also uncovered that almost two-thirds (63%) of hospitalisations from poisoning among young people aged 10-24 were caused by intentional self-harm. “Girls and young women had a higher rate of intentional self-harm hospitalisation than boys and young men, especially at ages 15-17,” Dr Pointer said. “Girls and young women (aged 0-24) were hospitalised at a rate of 223 cases per 100,000, compared with 109 for boys and young men, and that almost half (6,084) of those hospitalised were aged 20-24.” Pharmaceutical drugs and medications (10,620 cases) headed the list of the main types of substances triggering hospitalisation poisoning among children and young people. Nonopioid analgesics such as ibuprofen and paracetamol caused 37% of hospitalised pharmaceutical poisoning, while psychotic drugs, including anti-depressants, accounted for 30% of cases. In 15% of all hospitalised poisoning cases for children or young people during 2012-13, the substance involved was not pharmaceutical, but rather sparked by inhaling gases such as carbon monoxide, contacting venomous animals, or ingesting substances like alcohol. Overall, less than 1% of cases of hospitalised poisoning in children and young people were considered life-threatening.



QLD RATIOS LEGISLATION TO HELP PROVE LINK BETWEEN STAFFING AND BETTER PATIENT OUTCOMES Researchers will use the recent implementation of legislated nurse and midwife to patient ratios in Queensland to add to global data that proves how adequate staffing and resources translates to better patient outcomes. Speaking at the Queensland Nurses Union’s (QNU, ANMF Queensland Branch) annual conference last month, the University of Pennsylvania’s Dr Matthew McHugh outlined a partnership with Queensland Health and the Queensland University of Technology that will examine whether ratios have improved patient outcomes. Encouragingly, a baseline survey conducted earlier this year received 9,000 responses from nurses across the state.



“Nurses are the eyes and ears of the institution. You see the patient the moment they enter the healthcare setting to the moment they’re discharged,” Dr McHugh said. “So we think nurses are excellent barometers of cultures and patient safety within the institution.” Dr McHugh’s research into the area was sparked by a landmark 1999 US report titled To Err Is Human: Building A Safer Health System that found as many as 98,000 people die in hospitals each year as a result of preventable medical errors.

Researchers will analyse the initial findings and use the data as a springboard for a follow-up to the study earmarked for May next year that will evaluate the impact of the ratios implementation.

He believes the nurse work environment has long been neglected and that investment in its improvement could deliver the answer to fixing the ongoing patient safety crisis. He argued that a good clinical work environment, typified by adequate staffing and resources, is the key to improving patient safety and ensuring manageable nurse workloads.

Similar studies have been conducted across almost a dozen countries globally and the Queensland findings are expected to provide new evidence showing a clear relationship between good clinical work environments and better patient safety.

Dr McHugh said Queensland was well positioned to add to research pinpointing how the implementation of policy systems can improve care. “If staffing is improved, if there is a relationship, we would expect that those hospitals would see greater

MATILDAS FIGHT FOR PAY Former Matildas’ captain Melissa Barbieri sold all her memorabilia to raise funds to continue to play for the national women’s soccer team. Ms Barbieri told delegates at the recent ANMF Victorian Branch Annual Delegates’ conference of the toll of the pay dispute between the Matildas and the Football Federation Australia (FFA) in 2015.


“There is no prouder moment than slipping on the green and gold and hearing the national anthem play. What became apparent was the amount of sacrifices I would have to make in order to pursue the dream to become a fulltime Matilda.” Despite increasing success on the field, pay negotiations broke down between the parties in 2015. Two months after their contracts had lapsed, girls were not even getting paid, Ms Barbieri said. “How can we contend with the best of the world if we cannot afford to make ends meet at home?” The Matildas withdrew from their training camp and a tour to the US was cancelled.

improvement in terms of patient outcomes.” Dr McHugh admitted staffing wasn’t the sole issue and that other considerations, such as skill mix, culture, and resources, were undeniable influences on potential end benefit. “We’re trying to consider all of these factors to identify what is the combination for the patient’s benefit, for the hospital’s benefit, for the nurse’s benefit. “We would hypothesise that when there are more nurses available that have manageable workloads, they’re simply able to do the job that they’re supposed to be doing. They’re able to deliver all the vital care functions expected in high quality nursing.” Dr McHugh emphasised that health organisations could not expect to see gains in terms of patient safety without investing properly in frontline nursing. He said the challenge moving forward was to illustrate the benefits of good clinical work environments and to make them the norm, rather than the exception. “Every patient should be able to go to their hospital and know that they’re going to get the same fundamental level of care. But that’s not the case.”

“It was a historic act and unprecedented in sport; there was a media storm. We were scrutinised, it was one of the hardest times in my life. We stood strong and united.” Weeks later a pay deal was reached which included doubling of match payments and a 12 month contract. “Since then the game has flourished. We are now fifth in the world; we have qualified for the Olympics in Rio,” Ms Barbieri said. “Pay parity is not reached; even fair pay has not been reached but the burdens are not as strong. Australia is behind in how it treats women in sport but a light has been shone on women in sport.”

August 2016 Volume 24, No. 2  11


Influencing Behaviour Change This 2 day program in creative behaviour coaching will assist health professionals to work with behaviour change coaching principles to help people better manage their conditions and achieve better health outcomes and improved quality of life. 4 – 5 August Asthma Educator’s Course A three day program covering the latest advances in asthma care management and delivery, enabling professionals to work effectively to improve health outcomes. 16 – 18 November Respiratory Course A 5 day program for individuals wanting to update and develop their skills and knowledge of respiratory care and the holistic management of respiratory illness.


17 – 18 August (Module B) Managing COPD A course for professionals to improve their understanding and knowledge of current treatments and management of COPD. 6 – 7 October Smoking Cessation Course This evidence based program aims to give participants the knowledge and skills to treat and manage nicotine dependency to help people addicted to smoking to quit. 24 – 25 November Spirometry Principles & Practice This extensive course aims to develop an individual’s knowledge & skills to enable them to perform spirometry to internationally recognised best practice. 18 – 19 August 24 – 25 October

Lung Health Promotion Centre at The Alfred P: (03) 9076 2382 E: lunghealth@alfred.org.au W: www.lunghealth.org.au

“We have taken a leap of faith and decided to apply to all behaviour,” Ms Connors said. “Someone gets reported. The triage team makes an assessment. Care messengers who are peers from different craft groups have a coffee conversation. ‘You’ve been reported. Would you like to reflect on that?’ “It’s not an investigation, an opportunity for people to reflect, to have a discussion.”

A multi-layered program to tackle unprofessional conduct, including bullying has seen staff uptake at the Royal Melbourne Hospital (RMH).

There is a formal HR process for anyone who interferes with the process or anonymity. “For people to use the system there has to be the level of trust required for it to work,” Ms Connors said.

A new We Care system allows staff to report any unprofessional behaviour anonymously online.

The RMH had received 47 reports since the end of March. “In the last 6 to 8 months we have seen some traction,” Ms Connors said.

“It’s largely a cultural transformation with a safety culture program,” Executive Director of People and Culture Bridgid Connors said. “We recognise we cannot take Melbourne Health culture where we want to unless we tackle the barriers we have identified. Anti-bullying has been identified system-wide. We have 15 formal complaints a year.”

Acute care nurse Jo Martin is one of 11 safety champions at RMH. She is part of the ‘Speak Up for Safety’ training which helps teach people ways of communicating effectively and to maintain respect and convey concerns for a particular patient or situation. “We teach people to speak up and train people to listen. We know that can be challenging, some people find it easier than others for varying reasons.”

The new We Care system is the safety net, Ms Connors said. “If staff do not feel they can do so directly to a person or management, they can raise an issue related to patient safety or unprofessional behaviour – this is the safety net. Staff can report what they have observed or experienced.” The system is based on the US Vanderbilt University’s program used to address hand hygiene.

Twelve hundred staff have done training so far, with all 9,000 RMH staff to have completed training over the next 18 months at Melbourne Health’s 31 sites. The program is funded for the next three years. “It’s a long term cultural change, we need to be realistic,” Ms Connors said.

“What they found was that 90% of people do not get reported. Of those remaining, for most it only takes one conversation to change behaviour; 7-8% are recalcitrant; it takes a few reminders; 1-2% never come on board,” Ms Connors said.

“Anecdotally there is a small percentage in the workplace that cannot change. It allows us to set clear expectations, for the majority to adapt or find their voice and the small percentage who cannot change we can support with targeted intervention.”

The RMH, with the Cognitive Institute, has broadened the US program to four areas: two behavioural and two clinical (hand hygiene and VTE).

It’s going to be a three to five year journey – we do not expect to make a culture change overnight. Cultural change is a lasting change.”





A young male nurse lifted the lid on sexism and ageism in the workplace during an emotional and inspiring address to delegates at the Queensland Nurses Union’s (QNU) annual conference in Brisbane last month. A recent graduate, 24-year-old Registered Nurse Josh Simmons-Bliss (pictured) said he felt compelled to open the dialogue surrounding issues of discrimination against junior nurses after responding to a call by the QNU asking graduates to share their positive and negative experiences entering the profession. In a passionate address, Mr SimmonsBliss also touched on broader issues surrounding bullying and being personally discriminated against for being openly gay. He claimed graduates were looked down upon due to a perceived lack of experience and disregarded when attempting to draw attention to errors occurring within workplaces. Significantly, Mr Simmons-Bliss said sexism in nursing was a genuine issue and that just two months ago, a senior nurse on his ward told him to erase any ambitions of becoming a clinical nurse because of his gender. “My gender, my sexuality, how old I am or how I look, has no impact on how I work on the ward. It shouldn’t be considered. Yet that’s what I was being judged on. Not how well I worked as a team player. Not how competent I was. But I got profiled as a certain character and that’s what I was judged on.” Similarly, he added that openly identifying as a male gay nurse had caused him issues personally. “Sometimes it cannot be heard or seen, it can only be felt,” he said of the discrimination. Mr Simmons-Bliss believes the saying “nurses eat their young” rings true, with infighting and undermining rife, and added that change was long overdue. “It was strongly felt between all graduates that because of our juniority, people were making snide remarks, people were looking down upon us, not respecting us, and they were open about it. They didn’t want to work with us. They thought we were a liability,” he recounted of his experiences.



“It [change] needs to start with how we treat our junior nurses. That’s where it needs to begin. It will be nurses like myself who in 20 years’ time will be here directing and aligning the union’s agenda and who will be in leadership roles at hospitals. We have an obligation to groom our junior nurses to be strong and caring and to work together and be united because at the moment we just want to kill each other.” As part of his speech, Mr Simmons-Bliss also advocated for increased student education days for graduates and improved communication between young nurses and department managers. Mr Simmons-Bliss’ visible passion for shedding light on the often unspoken issue received widespread support from delegates of the conference, with dozens of people seeking him out afterwards to express their support. He counts himself as a leader within his workplace and said the support has spurred him on to continue to push for change and help empower new graduates in becoming self-assured, confident, and resilient nurses. “It’s made me more motivated to speak up about it because it strongly resonated with people. People have told me that they’ve been crying. They’ve come up to me and said I have a gay son, he’s also a nurse, or I’m a male nurse. It had a very positive response. I didn’t think that would happen but obviously I’ve touched something.”

The Victorian state government is funding $8 million in refurbishments to public sector residential aged care facilities across rural and regional Victoria. The upgrades will modernise facilities, as well as provide better and safer environments that will enhance residence wellbeing and privacy. Projects will include small extensions, improvements to common areas, bedrooms and bathrooms as well as better and more accessible outdoor areas. Other projects planned include new nurse-call systems, overhead lifting systems and secure dementiafriendly areas.

ROYAL COMMISSION ON ABORIGINAL SUICIDE Aboriginal health services have called on all political parties to back a Royal Commission into the suicide rate among Aboriginal and Torres Strait Islander people. As many as one in 10 deaths of Indigenous people are suicide. Suicide rates in West Australia’s Kimberly region doubled over the past decade, research in the recent Medical Journal of Australia shows. Of the 125 people who took their life, 102 were Indigenous: 71% were young Indigenous men; with 27% in their teens.

MULTIVITAMIN STUDY A midwifery study will assess multivitamin use by women before, during and after pregnancy. It will include what multivitamins women take, general health, food intake and influences on supplement choices. For women who give birth, information will include birth weight of baby and whether women laboured spontaneously. “These are the sorts of things that we believe could be influenced by supplement usage but have never actually been thoroughly researched before,” Gold Coast University Hospital midwife Janelle McAlpine said.

August 2016 Volume 24, No. 2  13




Health organisations have called on the federal government to once and for all dismiss any plans for GP copayments in the future.

The federal government is poised to appoint the first ever National Rural Health Commissioner in a bid to help shape rural health policies which lead to better access to critical services and improved patient outcomes.

A backlash followed the AMA’s suggestion to consider giving GPs discretionary ability to charge co-payments for patient visits last month. Australians already faced some of the highest out-of-pocket costs for healthcare in the OECD, Consumers Health Forum CEO Leanne Wells said. “People are hurting. The message from the electorate is that GP copayments would be a financial burden that affects the community’s most vulnerable.”

VOTERS HAVE SHOWN THEY WANT A FAIR AND EQUITABLE HEALTH SYSTEM, NOT ONE WHERE YOU CAN ONLY RECEIVE CARE IF YOU CAN AFFORD TO PAY FOR IT. “Healthcare should be available to all who need it regardless of income and a Medicare co-payment undermines that principle,” ACOSS CEO Dr Cassandra Goldie said. Public Health Association of Australia CEO Michael Moore said any action to undermine Medicare was simply unacceptable. “The last thing we need in Australia is a government

HISTORY TO JUDGE AUSTRALIA ON REFUGEES World Vision’s CEO Tim Costello says Australia should be ashamed of itself for intentional cruelty of refugees. “I am appalled at what we are doing as a nation. History will judge us very severely,” he told ANMF Victorian Branch delegates at their recent annual conference. “Those sent to Manus Island or Nauru because they came the wrong way are

14  August 2016 Volume 24, No. 2

seeking to undermine basic human rights – the right to health and equitable right to treatment.” The National Aboriginal Community Controlled Health Organisation remained totally opposed to Medicare co-payments of any kind, CEO Pat Turner said. “Quite simply, if people cannot afford to go to the doctor, they will not go.” Instead of resurrecting the co-payment, there should be appropriate funding commitments to support primary, acute, aged and disability care, Australian Healthcare and Hospitals Association Chief Executive Alison Verhoeven said. “GP copayments impact affordability of care and emergency department use and were rightly abandoned.” ANMF Federal Secretary Lee Thomas said the Australian people had sent a very strong message to the government. “Voters have shown they want a fair and equitable health system, not one where you can only receive care if you can afford to pay for it.”

subjected to psychological torture. “What we do know is that ‘turning back the boats’ policy does work. It takes the sugar off the table. For those coming to Australia whose only crime is to flee for their lives is to be locked up forever to send a message to others. Is it what we call humane treatment of individuals?” The Pacific Solution was set up by the Howard government in 2001. “At least if they were found to be refugees they were resettled [in Australia],” Mr Costello said. Humans are always an end in themselves not a means to an end, he said. “Every human carries the image of God.” Mr Costello praised nurses and midwives for their advocacy, activism and key role in the provision of healthcare around the world.

Aimed at improving access to essential health services in the bush, the National Rural Health Commissioner will work with rural, regional, and remote communities, as well as the health sector, universities, and specialist training colleges. The appointment has also triggered plans for a National Rural Generalist Pathway to address the lack of highlyskilled medical professionals in rural, regional and remote areas. Rural Health Minister Fiona Nash said the newly created Rural Health Commissioner would collaborate with the health sector and training providers to clearly define the role of Rural Generalist. “We need to get the right medical professionals with the risk skills in the right places,” Minister Nash said.

“You have an uncanny and well-honed knack to see the deeper toils of the human soul. There is a sense of mission nurses and midwives have about their work.” Australian nurses and midwives deserved the respect they had in the community and needed to be listened to, Mr Costello said. “Your collective voice should not be ignored.” “We still need midwives to have equal status around the provision of childbirth. Research shows midwives are not being used to their full capacity.” “The quality of healthcare we have in Australia we take for granted. With nursing and midwifery come tremendous responsibility and a high level of stress and challenging working conditions.”




New Zealand project set to tackle nursing fatigue The New Zealand Nurses Organisation (NZNO) will be represented on an expert stakeholder advisory group overseeing a three-year $890,000 research project that hopes to find ways of managing fatigue in hospital-based nurses. NZNO principal researcher Dr Leonie Walker will work on the project with Professor Philippa Gander and Dr Karyn O’Keeffe from the Sleep/Wake Research Centre, and Professor Annette Huntington from Massey’s School of Nursing. “The research is the first of its kind in New Zealand and follows on from Dr Gander’s previous research in the airline industry,” Dr Walker said. “Her work with the industry revolutionised the way airlines and pilots work together to reduce the risks of fatigue.” Dr Walker explained that the links between shift work and an increase in the risk of fatigue-related errors were well known and said that the project was a great opportunity to address the problem. “The opportunity to create safer and healthier work environments for nurses and other shift workers will create flow on benefits for patients and employers.”


Canadian nurses urge caution ahead of marijuana green light Canada’s nursing union has reinforced the need for safeguards and tools to raise awareness about the potential adverse effects of marijuana as movement towards the drug being legalised gains momentum. The country’s taskforce on marijuana legalisation and regulation has begun work on developing a federal legislative framework for the legalisation of the drug, anmf.org.au

expected in 2017. In the US, both Colorado and Washington legalised marijuana in 2013. The Canadian Nurses Association (CNA) held talks with Health Minister Jane Philpott last month, expressing its view that legalisation discussions should involve open and transparent engagement regarding the potential harms. “Registered nurses (RNs) and Nurse Practitioners (NPs) are often the first point of contact for patients and clients,” the association said. “They recognise the impact marijuana use can have. That is why the taskforce on marijuana legalisation and regulation needs to meet with CNA and its members.” The taskforce is expected to release its report by November.


Irish Nurses and Midwives Organisation welcomes funding The Irish Nurses and Midwives Organisation (INMO) has welcomed a longoverdue $750 million funding injection to help boost its public health service. The INMO said the funding would allow existing service levels to be maintained and further support critical areas such as homecare and disability services. It also noted that part of the funding had been earmarked for a winter initiative targeted at addressing the problematic issue of overcrowding across the country’s emergency departments. The INMO believed the significant contribution of funding clearly indicates ongoing support for the recruitment of nurses and midwives to vacant posts, as well as recruiting additional staff to ensure safe patient care and manageable workloads. INMO General Secretary Liam Doran said the health service faced increasing levels of demand and that the funding would help alleviate pressing issues. “It is imperative that the Health and Safety Executive (HSE) immediately recommences

recruitment to frontline nursing and midwifery posts,” Mr Doran said. “The additional allocation, particularly earmarked funding for a renewed winter initiative, must now be subject to early discussions with the ED Implementation Group. This will ensure the system utilises this additional resource efficiently and effectively, in the frontline, in the interests of patient care and standards of service.”


Nursing voice cuts The International Council of Nurses (ICN) has slammed the recent decision by the UK’s Department of Health (DH) to remove its Nursing, Midwifery and Allied Health Professions Policy Unit. The ICN underlined the importance of governments receiving expert advice, leadership, and guidance on policy from the nursing profession. “It is difficult to understand why decision makers do not understand the significant knowledge and research nursing has to bring to the table to deal with financial, economic, social and clinical benefit,” ICN President Dr Judith Shamian said. The cutback forms part of the “DH 2020” drive to slash 700 posts from UK’s DH in a bid to reduce costs by 30% over the next five years. The loss of the nursing policy unit arrives just three years after Sir Robert Francis QC criticised the absence of a strong nursing voice in the National Health Service (NHS) and called for the profession’s contribution to be strengthened. Janet Davies, Chief Executive and General Secretary of the Royal College of Nurses, labelled the decision “extremely worrying”. “Unless nursing advice and leadership is put back at the heart of government and given the prominence and respect that it deserves, then the profession will be in the permanent position of trying to shape and alter policy from the outside, which is not only bad for nursing, but also for patients.” August 2016 Volume 24, No. 2  15




16  August 2016 Volume 24, No. 2




A summit of Australian nursing leaders was recently held in Melbourne to discuss the future of advanced practice nursing.

were also presented. Early results showed that data from direct observation of advanced practice nurses provide distinct patterns of practice according to the work context.

The attendees included officers and representatives from leading colleges, regulatory bodies, chief nursing and midwifery offices, the Council of the Deans of Nursing, the ANMF and state/territory branches and university researchers.

“Whilst APNs work across all domains, their work patterns vary according to the practice contexts, this has far-reaching implications,” says University of Technology, Sydney and co-author Professor Christine Duffield. Where in the country are APNs to be used? And how do we decide what level of nurse we need? These questions were put to the floor of nursing leaders at the summit.

The purpose of the summit was to discuss the potential applications and outputs from the findings from recent ground breaking research that shows advanced practice nursing (APN) can be recognised and described as a level of practice rather than a role or title. The study’s lead investigator, Professor Glenn Gardner of the Queensland University of Technology presented the findings from two recent Australian studies to the summit. The first was a national survey of the nursing workforce, funded by the ANMF and QUT. A US model that delineates the practice of nurse practitioners and Clinical Nurse Specialist (CNS) was adapted for the Australian context and used to survey the nursing population. Of the 5,662 RN participants, over half worked in hospitals, one third in the community, and 6% in aged care. Almost one third worked in rural or remote communities. On average, nurses had been registered 22 years, most between 11-33 years. And on average, most had been in their current position for more than six years. The study showed that in Australia, nurses who worked in clinical nurse consultant roles (CNC) were likely to be practicing at an advanced level. “APN are those nurses who work at the top of the registered nurse practice scope; they are statistically delineated from both the registered nurse (RN) and nurse practitioner (NP) levels of practice,” Professor Gardner says. Results showed nurses who practiced at an advanced level had high mean scores across five domains of advanced practice direct care; support of systems; education; research; and professional leadership. “We have a much better understanding of the practice profile of the Australian nursing workforce. This allows for standardisation of the Australian nursing workforce,” says Professor Gardner. The results of a recently completed Australian Research Council funded study anmf.org.au

Decisions about the use of an APN depend on the nature of the work, nursing leaders argue: it’s not about the role; it is where and how they are practising that will decide this. The APN role is about the complexity of what they do and is not dependent on the setting.


There needs to be a focus on meeting the needs of the future, according to nursing leaders. The focus should be on what is needed within healthcare service planning, including aged and community care. The US was cited as an example at the summit of service planning – where an increase in the primary healthcare sector for aged care services has decreased hospitalisations. “One of the things I think is really exciting about this work is in the future how we can extend this to sectors like aged care, primary care and mental health,” ANMF Federal Secretary Lee Thomas says. “This is a launching pad for nursing spheres,” the summit proposes. “Nurses can work differently but remain under the same ‘umbrella’.”

Role and work value

The summit raises the issue of nurses

currently working as APN however their practice not valued as advanced. Public service roles are strongly tied with pay points/pay structures. It shouldn’t matter what the job is called, what matters is what the individual does, nursing leaders argue. Work value is what is important, not the title. “I think it’s very important nursing directors and nursing executives and the profession understand the profile,” says ANMF Federal Secretary Lee Thomas. Employers will now have the knowledge and ability to place NPs and APNs into appropriate services, the summit suggests. “This research provides the nursing (practice profile) domains and demonstrates the importance of research irrespective of sector.”

Career path

The research spans across and builds on all previous knowledge of career structure and advancements, irrespective of the location or area of the nurse. A clear and measurable definition of APN is essential for nursing graduates to understand career directions, nursing leaders surmise. Historically, education pathways for nurses were clear. There is some confusion of career pathways and career standards which is feeding into low numbers for Masters’ intake. There is also the current issue of having different types of nurses, such as specialists, APNs and NPs in postgraduate studies. The summit highlights the need for nurse leaders and APNs to be available as role models for undergraduate students. The research findings have the potential to inform both career pathways and postgraduate curriculum design to support the career structures. Nursing leaders agree that a clear definition of what is an APN is needed and more support for nursing roles is essential. The research can help develop an evidence informed definition of APN. From it a tool of APN for use by all clinicians could be developed. The research and findings from the summit provides evidence based definitions, frameworks and tools that have potential to achieve clarity in the discipline and improve utility of service and practice across all areas and levels of nursing. “In this room are the leaders who need to work together as drivers for change. It is essential that the APN role be legitimised and a proactive and innovative approach with service and design for nurses working within their scope.” August 2016 Volume 24, No. 2  17



general paediatrics, before the move into paediatric oncology. He also worked for five years in paediatric oncology at the Women’s and Children’s Hospital in Adelaide as an Associate Clinical Service Coordinator. One of Chris’ roles in PICS is to support the regional outreach shared care program. The Childrens Cancer Centres at the RCH and Monash Children’s participate in a shared model of care with nine regional hospitals in Victoria: Ballarat, Bendigo, Albury-Wodonga, Geelong, Warrnambool, Traralgon, Shepparton, Frankston and Wangaratta. “I spend two to three days a week in a nurse consultant role providing medical and nursing education and support for those centres, both on the wards and in the Emergency.

Regional Outreach Nurse Chris Williams juggles multiple roles from clinical and education to support systems management and quality improvement initiatives. A Nurse Consultant with the Paediatric Integrated Cancer Service (PICS) at the Royal Children’s Hospital Melbourne, Chris supports programs in regional outreach shared care. “I see the impact on families dealing with critical events in their life doing whatever they have to do. Some people travel 25,000 kilometres during their child’s treatment. Some people are willing to relocate to be closer to services. “Our philosophy is to provide safe care as close to home as possible. A child who is treated for leukaemia also has five years’ follow up and will need to continue to travel for surveillance. These are significant trips for families who may come from Port Fairy or Albury/Wodonga for a 5 to10-minute appointment and simple chemotherapy. If we can get it done locally with an expert on the other end of the line it’s the best outcome.” Chris spent ten years with Central Coast Health in Gosford Hospital as a Clinical Nurse Specialist in paediatrics in the ward and rotating through the emergency department. “I was in the ED asking myself: ‘how do we manage these kids with cancer?’ We had a knowledge gap. We had high risk patients at risk of sepsis, kids on chemo: I wanted to learn more about that area.” “My philosophy is about providing quality care to people to the best of my ability. How can we do that unless we can define what quality care is?” Chris completed a postgraduate certificate in paediatric oncology and another in acute paediatrics. He completed ten years in 18  August 2016 Volume 24, No. 2

“We have support systems in place. We set up new chemotherapy standards to do low complexity chemo; risk managing the unwell patient; management of the neutropenic patient, central line training. “There’s also a lot of work in the background in management of the service capability.” The other day or two is spent on service improvement projects for quality care in oncology. “We are developing an optimal care pathway for children with leukaemia for the DOH.” Chris says the work is collaborative. “It’s very much a multidisciplinary approach – doctors, nurses, physiotherapists, pharmacists, social work – it’s making sure all these people are involved and engaged.” One day a week is allotted to bedside clinical care on the day oncology OPD at the RCH. “A lot of APNs are based in the office and sometimes there is a disconnect from bedside nursing,” says Chris. “Particularly as my other work has me engaging in other areas, it’s very valuable to have rapport with colleagues at the clinical bedside. And a day a week keeps me honest. It defines what this is all about - the crux of why we do this work for our patients and their families.” Chris is part of an international group of nurses involved in a research grant to look at improving the nurses’ ability to assess children with cancer prior to chemotherapy. He is also doing a minor thesis across paediatric oncology centres in Victoria looking at the information provided to families when delivering nurse-led telephone triage and advice. “Looking at what algorithms we should use and if they are across all centres - to get consensus on the approach we use when families call from home. We all have basic clinical guidelines, but we need to make sure we are consistent in what we say.” A large part of the role is advocacy says Chris. “I really enjoy the outreach. I look at the bigger picture – the time to critically think and get things done.”

LOOKING FOR THE RED HERRING Jo Magyar “As RNs we are good at pattern recognition after we’ve seen things lots of times. APN clinicians look for the odd thing out.” Emergency paediatric nurse Jo Magyar has been at the Royal Children’s Hospital (RCH) in Melbourne for 11 years. “As an RN in triage I would like to think I had diagnostic skills but it’s not until you make the transition how much more you consider and look for. You are always looking for the red herring.” “As an APN you take on board more detail and start to think further about what’s wrong with this patient. What else am I missing? Jo completed a postgraduate certificate in paediatric nursing ER stream and became a CN Specialist five years ago. She is currently a NP candidate.


“Prior to my candidacy I took on the role of education in the Clinical Support Nurse on the floor for four years. I had my first baby, when I came back to the department I definitely wanted to contribute more and went into education.” The Clinical Support Nurse as opposed to an educator within the ED is designed to be a more clinical role working side by side staff on the floor and also involves in-service training. Jo’s APN repertoire also involves research. She has had three papers published, two on debriefing clinical incidents in the ED in 2009. “A colleague and I felt there wasn’t formal support for staff after a large resus, so we sought out funding to explore that.” Since then there have been several developments in the RCH ED. “It has raised awareness and has become an important part of our practice with links to a program we now use in debriefing in the ED – it has become engrained.” anmf.org.au

FEATURE A further paper on psychosocial care for seriously injured children and their families was published in 2014. Jo says her time now in nursing as an APN has been the most enjoyable and largest learning curve of her career. “Even in post-grad and under-grad study, it’s very hard to see where it fits in until you come across it even years down the track. It’s that ‘you don’t quite know what you don’t know yet’. “I think in advanced practice you develop more honed advanced critical thinking skills and diagnostic profiling. “And I think that’s the point of difference - we do the same sort of things as other clinicians. But what led me to being an APN and becoming a NP is still what drives me as a nurse - a sense of helping and resolving issues for families and patients. The clinical management of the patient and building strong rapport with families and it’s the little details that matter. The work we are doing, I get a lot of satisfaction. “Those in APN roles tend to stay in those roles, you get that continuity – we are a consistent force – which is of great benefit. The sky’s the limit. JO MAGYAR PREPARING TO APPLY A PLASTER OF PARIS


A key role of the AP is to help by, for example, coordinating the entire multidisciplinary (MD) team so that the right people are in play, says Kara. “I provide comprehensive assessment and coordinate others. This is part of my nursing expertise.

Kara Graser

“I might need to get everyone together and I might keep a watching brief – so for the case above, the team included the GP, oncology, palliative care, speech therapy, neurology - that they are all in place; and make sure communication between the boundaries flow nicely for everyone and for better end of life care for the patient.

“Your solutions often have to be creative. You have to be able to negotiate and your management needs to be effective. And you need to have a sixth sense about clinical scenarios,” says Kara Graser (pictured). Kara is an APN at residential aged care provider BaptistCare in WA which has 14 facilities both metro and remote. She works with older adults in the management of chronic disease and palliative care symptoms across several facilities, both metro and remote.

“What’s important is networking across service sectors - that’s the difference. “Networking is about knowing where to go to get the right sort of skills for the patient.”

“I deal with people with cognitive impairment, the elderly, dementia and psychological problems of the over 65s. I might care for cancer patients who also suffer multiple other medical symptoms.”

“I had a person with what the staff believed were overt cognitive dementia symptoms, but none of the cognitive tests supported that diagnosis. What was going on? We eventually found out he had a brain tumour – the tumour was contributing to his unusual behaviours. It wasn’t dementia; the symptoms related to where the mass was situated.”

“People over 65 experience so many chronicities and co-morbidities and pharmacies and it is about finding out where the problems are. I get referrals to help RNs work out what’s going on.”

The acuity in RAC is higher now with multiple chronic co-morbidities much more complex than they used to be, says Kara with 27 years nursing experience including in coronary care, medical and rehabilitation.


“Sometimes you’ve thought of 20 variables and it’s the 21st that gets you – that’s why you need a MD team to work things through. This is the value of working with rather than working on your own. Working as an APN is being in a state of constant learning, says Kara. “You need to understand your scope of practice. Being able to say ‘this is not my area of expertise’ is really important but also to be able to stand firm and equally say ‘this is my area of nursing expertise and I recommend this’ and be heard. August 2016 Volume 24, No. 2  19




Western Australian public and private hospitals are increasingly turning to the arts in clinical settings in a bid to improve health education and outcomes for patients, research shows.

Up to a third of young Australian women experience episodes of binge or overeating, with socially disadvantaged women facing a higher risk, research has revealed. Researchers from the University of Queensland, together with Stockholm University and the Karolinska Institutet in Sweden found 4% of women aged between 18 and 23 reported symptoms of bulimia nervosa. Furthermore, the study found a higher incidence among milder eating disorders, with 17% of women reporting episodes of overeating, 16% reporting binge eating, and 10% indicating compensatory behaviours such as vomiting, using laxatives, or fasting. University of Queensland’s School of Public Health, Professor Gita Mishra said the results highlighted the large burden of undiagnosed forms of eating disorders within the demographic. The study analysed data from more than 6,800 participants in the Australian Longitudinal Study on Women’s Health (ALSWH), and built on the earlier examination of the social and early life causes of eating disorders by the Centre for Health Equity Studies (CHESS) in Sweden. CHESS’ Professor Ilona Koupil said the research showed a risk of increased binge eating or overeating among socially disadvantaged women. The researchers believe social patterns could be used to identify at-risk groups and those requiring early diagnosis and prevention. They found a higher risk of binge eating and bulimia among women of European origin and in those who had been overweight or obese in childhood. “There was also an increased risk among young women who reported smoking and binge drinking, suggesting a possible overlap between substance abuse and eating disorders,” Professor Koupil said.

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ALZHEIMER’S GENETICS POINTS TO NEW RESEARCH DIRECTION A University of Adelaide analysis of genetic mutations that cause earlyonset Alzheimer’s disease indicates a new focus for research into the causes of the disease is needed. Previous research has revolved around the notion that accumulation in the brain of a small, sticky protein fragment, amyloid beta, causes Alzheimer’s disease. But growing concern exists among some researchers that the idea is failing to adequately advance global understanding of the disease and lead to successful treatments. Scientists at the University of Adelaide, in collaboration with researchers from several other Australian universities, claim their latest analysis points to a new theory about how mutations of a particular gene, PSEN1, can trigger early-onset Alzheimer’s disease.

The report, Use of the Arts to Improve Health and Healing in Western Australian Hospitals, highlights current levels of arts activity in clinical environments across the state. A total of 20 metropolitan public and private hospitals, and six of seven WA Country Health Service regions representing 60 hospitals, were invited to take part in the survey, which netted a 90% response rate. Around 75% of respondents reported delivering arts and health activities and incorporating it into the system of care. WA Arts Minister John Day said the positive impact of arts in health is already occurring in areas such as music therapy for oncology patients to artists in residency programs. Mr Day said a noteworthy example illustrating the benefits was the Western Desert Kidney Health Project, which tailors healthcare to the community and individuals in need as well as using the arts and storytelling to make health education and prevention both meaningful and successful. The report found arts and health practice most evident in paediatrics, mental health, aged care, and Aboriginal health. It made five key recommendations which focus on the potential of policy development and improved coordination to promote arts and health practices across Western Australia.

“Most of the mutations that cause Alzheimer’s disease before retirement age are found in the PSEN1 gene,” said study lead, Associate Professor Michael Lardelli, School of Biological Sciences. “Fortunately, this early-onset form of Alzheimer’s disease accounts for only about 1% of all disease cases. Nevertheless, a huge research effort has focused on these mutations in the hope that advanced genetic analysis techniques might shed light on the still mysterious origins of both early and late onset Alzheimer’s disease.”



MEMBER ONLY COLLECTIVE AGREEMENTS: WHY NOT? Nick Blake, Senior Federal Industrial Officer

For those active in industrial relations there is quite a well-known book titled From the Folks Who Brought You the Weekend: A Short, Illustrated History of Labor in the United States. The books’ thesis or focus was firstly to remind readers of the many struggles in the USA by trade unions to obtain and protect basic working conditions American workers, now take for granted, and secondly to reinforce the important and enduring relationship between unions and their members.

In Australia all employees are entitled to the protection of labour law and most enjoy benefits such as annual leave, parental leave, minimum wages, superannuation, days off, and the list goes on. However it is easy to forget that these universal benefits we all now expect and enjoy were not freely given. In many cases they were only achieved after long and bitter campaigns by unions, and importantly supported by employees who built union membership at their workplaces and pursued and achieved workplace improvements. The relationship between unions and their members was raised recently by Professor Ron McCallum at a national conference on industrial law. Professor McCallum, widely regarded as the doyen of Australian labour law, has suggested trade unions, if they so choose, should be able to negotiate enterprise agreements that would only apply to members of the union.

WHILE MEMBERS OF THE ANMF RECEIVE MANY BENEFITS BEYOND COLLECTIVE BARGAINING, YOUR UNION ALONG WITH MOST OTHERS, FIGHTS HARD TO INTRODUCE COLLECTIVE AGREEMENTS AT EVERY WORKPLACE BECAUSE THEY ARE THE BEST AND OFTEN ONLY WAY OF PROTECTING BASIC EMPLOYMENT CONDITIONS SUCH AS HOURS OF WORK, PENALTY PAYMENTS, WORKPLACE SAFETY, WORKLOAD TOOLS AND WAGES. Not surprisingly these comments polarised the views of many. Collective bargaining and award systems in Australia have for the most part applied consistently for an occupation, group of employers or across an industry. For example when anmf.org.au

the ANMF secures an agreement with an employer it typically covers all nursing staff of that employer whether they are members of the ANMF or not. In fact under the Fair Work Act it is illegal for trade union members to receive any benefit not available to a non-member. This system differs from most comparable countries. For example in New Zealand collective agreements are made between trade unions and employers and the agreement can only provide wages and conditions for members of the union who are employed by the employer. Nonunion members may only negotiate individual contracts with their employer. Similarly in parts of the USA and the EU collective bargaining is undertaken by unions on behalf of their financial members only. Those supporting union member only agreements point out that trade union members pay union dues which contribute to the substantial campaigning and representation costs invariably associated with enterprise bargaining. Non-union members (often referred to as free riders) contribute nothing and receive the benefits secured by their union colleagues, and this is unfair. Further by being able to enjoy all the benefits of an enterprise agreement it is little wonder many employees choose not to join trade unions. Finally member only agreements would see an immediate and sustained increase in the number of people in unions, thereby reducing the costs for everyone. Opponents argue that the labour movement has a broad responsibility to assist all workers, particularly those in casual and precarious employment who often do not belong to a union. Enterprise agreements that do not discriminate between trade union members and non-members strengthen the industrial minima and protect union members by preventing

employers from employing non-union members at cheaper wage rates. Finally Australia’s non-discriminatory approach discourages “union busting” organisations who are established by groups of employers solely to disrupt the role and activities of trade unions, as is now commonplace in the UK, USA and elsewhere. While there are sound arguments on both sides of the debate it is undeniable that trade unions exist to represent the collective interests of members in specific industries and occupations, and thankfully in nursing at least most employees still find that union membership is the best way of representing their industrial and workplace interests because they lack the knowledge and resources to represent themselves effectively. While members of the ANMF receive many benefits beyond collective bargaining, your union along with most others, fights hard to introduce collective agreements at every workplace because they are the best and often only way of protecting basic employment conditions such as hours of work, penalty payments, workplace safety, workload tools and wages. However with the declining levels of union membership in many industries, how long can financial members of trade unions be expected to carry those who don’t pay? As Professor McCallum maintained “the primary reason for the establishment of trade unions is to obtain improved wages and better conditions of employment for trade union members”. If one accepts all nursing employees’, members and non-members as well as the profession more generally, benefits from the commitment and active involvement of members of the ANMF, perhaps the real question is: is it fair to continue to ask financial members to subsidise others who choose not to contribute? August 2016 Volume 24, No. 2  21


CAREER CHANGE INTO NURSING REAPS REWARD By Robert Fedele Queensland graduate nurse Paul Kaczykowski holds no regrets about giving up a lifestyle as a vagabond circus performer for a career in nursing caring for patients. After finishing high school back in 2000 and studying criminology for a year at the University of Queensland Paul decided he wanted to take a break and go travelling around the world. The life-changing choice saw him stumble into a gig with a travelling circus in the US where he would become adept at everything from the flying trapeze to trick roller skating. After travelling for more than a decade and hitting the age of 30 Paul decided to return home to Australia and embark on pursuing a steadier career. It seemed natural to head into nursing given his mum’s history in the profession. “She’s been doing it ever since I was born and never ever had a bad word to say about it,” Paul says. “She really encouraged me to go into nursing because I enjoy working with people and helping people. There’s also always that ability to travel down the track and that’s something I’d love to do.” Growing up, Paul believed nursing was purely a woman’s domain and had never contemplated it as a career. But in later life 22  August 2016 Volume 24, No. 2

the idea grew on him and his passion was undoubtedly evident throughout undertaking a nursing degree at the University of the Sunshine Coast as a mature-age student. Earlier this year, Paul was awarded the university’s Chancellor’s Medal, which recognises a graduate’s outstanding contribution to the local or wider community as well as academic achievement. The honour followed national recognition in 2015 when Paul was named one of five Emerging Nurse Leaders by the Australian College of Nursing and secured a place in their three-year development program.

“NOTHING CAN PREPARE YOU. UNIVERSITY IS GREAT TO GIVE YOU THE BASICS AND THE BACKGROUND BUT NOTHING CAN PREPARE YOU FOR THE REAL WORLD. THERE’S NEVER ENOUGH CLINICAL PRACTICE IN UNIVERSITY I DON’T THINK.” The program involves networking, collaborating with other nurses in the program, leadership development, and working with an established mentor within the industry. After graduating from university Paul entered the industry earlier this year, taking up his first post in February at the Nambour General Hospital working in the general surgical ward. Paul hopes to become a leader in the profession and wants to encourage more men to pursue nursing. “It is good to be only one of two male nurses in the Emerging Nurse Leaders program. I’d like to take more of a focus on men in nursing and making it

more of an encouraging and assisting job role for younger people. Coming in and taking the stigma away from that, as it still exists.” Asked to elaborate, Paul says while male nurses are common nowadays, out-dated attitudes tend to still exist across older and younger demographics. “Some of the older people that come into the hospital still find it unusual that men are nurses. They often think you’re a doctor. So that gender barrier still exists. “When I was younger, a teenager, I certainly would never have thought of becoming a nurse. Certainly now that I’m in the industry there’s no barrier that I can see. All my friends think it’s a cool thing. But for younger people there is still that stigma.” Paul is currently in the thick of his grad year and enjoying the challenge of transitioning from university to hands-on nursing. “Nothing can prepare you. University is great to give you the basics and the background but nothing can prepare you for the real world. There’s never enough clinical practice in university I don’t think.” While still learning the ropes, Paul said he is relishing his newfound career as a nurse and is looking forward to seeing where it can take him. “Providing care is great but when you have the time to have that one-on-one conversation and really make their time in hospital more bearable and enjoyable, that’s where my skills are. My knowledge is further growing, there’s still so much to learn.” As for his life in the circus, those days are most likely over, however the travel bug still remains. “It’s always a part of me and the idea was to do some travelling with nursing. It’s hard. I’m at a crossroads where you need to stay here and you need to work five years to really become grounded in a profession before you take it elsewhere.” anmf.org.au


Megan-Jane Johnstone

References Battin, M.P, Francis, L.P, Jacobson, J.A. & Smith, C.B. 2009. The patient as victim and vector: Ethics and infectious disease. Oxford University Press, New York. Fukuda, K. 2014. Foreword. Antimicrobial resistance: global report on surveillance. WHO, Geneva, p.ix. Johnstone, M-J. 2016. Editorial: The moral significance of antimicrobial resistance and the rise of ‘apocalyptic superbugs’. Journal of Clinical Nursing. Epub ahead of print: doi: 10.1111/ jocn.13350 Littmann, J. & Viens, A.M. 2015. The ethical significance of antimicrobial resistance. Public Health Ethics 8(3): 1-16. World Health Organization. 2014. Antimicrobial resistance: global report on surveillance, WHO, Geneva.

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

THE MORAL SIGNIFICANCE OF ANTIMICROBIAL RESISTANCE On 14 April 2016, ABC News and The 7.30 Report both reported the case of a 46 year old man who died from hepatitis B believed to have been contracted from another patient while on dialysis at a Melbourne hospital (http:// www.abc.net.au/7.30/ content/2015/s4443575.htm). These media reports focused primarily on the Victorian Health Department’s investigation into the case (hepatitis B is a notifiable disease), which ‘ruled out’ that the man could have contracted the disease from any other source and that the dialysis unit was the likely source of transmission. The Department also reported that it ‘could not identify any breaches in infection controls at the hospital’s dialysis unit’ even though this contradicted the family’s account of the standards of infection prevention and control they had reportedly witnessed. There is no question that important patient safety lessons can be learned from this tragic case. It is also understandable that over time the patient and his family reportedly lost trust in the hospital concerned. Overlooked in the melee of reportage about who or what were to ‘blame’ for the transmission of the hepatitis B virus, however, was an arguably even more sombre story, notably that the patient’s tragic journey began with a simple chronic foot blister that had become infected. Following surgical treatment for his infected foot blister the patient acquired an infection caused by staphylococcus aureus. The powerful antibiotic regimen used to treat this infection had a catastrophic side effect on his kidney function, leaving him dependent on renal dialysis. There is scope to suggest that the full ramifications of the trajectory of this case and its sequelae have yet to be considered. For instance, rather than being a one-off unusual event there is room to speculate that, as the world enters into what is now widely called the ‘post-antibiotic era’, tragic trajectories stemming from untreatable infections (beginning, as

in this case, with something as small as an infected foot blister) are likely to become all too common. As the WHO has warned: ‘A post-antibiotic era - in which common infections and minor injuries can kill - far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century’ (Fukuda, 2014 p.ix). This prospect is underscored in a recent UK report Tackling drug-resistant infections globally (http://amr-review.org/) which estimates that antimicrobial resistance could kill as many as 10 million people a year by 2050 – being ‘one person every three seconds’ – at a cumulative cost of $US100 trillion.

A question of nursing ethics

Antimicrobial resistant (AMR) refers to the resistance of microorganisms (eg. bacteria, fungi, viruses and parasites) to antimicrobial drugs (eg. antibiotics, antifungals, antivirals, and antimalarials) that were originally effective for treatment of infections caused by these organisms (WHO, 2014). Here it is pertinent to ask: What is the moral significance of AMR given that it is prima facie a clinical and technical problem? To what extent, if at all, does it involve a moral issue?

is not just a clinical or technical problem. Notably among them are the difficult questions that AMR poses in regard to: first, how best to promote and protect people’s wellbeing and welfare interests in the face of the growing threat to human health and life posed by apocalyptic superbugs; second, how to respond justly to the competing needs and moral interests of different people – including future generations – as AMR grows and the supply of effective antimicrobials declines; and finally how best to decide and justify courses of action that ‘normally’ would not be morally acceptable eg. apply what are referred to in the public health emergency literature as ‘altered standards of care’ when the therapeutic expectations of antimicrobials can no longer be met (Johnstone, 2016).

The moral significance of AMR

Equally serious is the question of whether nurse education and nursing ethics are up to the task of cultivating the moral competencies nurses need in order to address the moral concerns and quandaries raised by AMR and motivating the moral action necessary to ensure a morally just approach to the apocalyptic superbug problem in the community.

There are several reasons why AMR constitutes an ethical issue and

As has been argued elsewhere: ‘AMR is a moral problem that requires a new way of thinking - not just about the nature of the ethical issues it raises, but about how best to address them’ (Johnstone, 2016). Significantly, nursing codes and standards including the ICN (2004) position statement ‘Antimicrobial resistance’ (http://www.icn.ch/) have tended to be silent on the ethical guidelines nurses will need in order to assist them navigate the moral challenges posed by AMR. It is time this silence was redressed and that substantive AMR ethics guidelines are developed by nursing organisations around the world.

AMR is not just a clinical or technical issue. It is also a significant moral issue (Littmann & Viens, 2015; Johnstone, 2016). What makes AMR particularly problematic from a moral point-of-view is not just that it is a ‘serious, immediate, multifaceted, and world-wide’ issue (Battin et al. 2009, p.230), but that it stands to challenge many of our most basic assumptions about the appropriateness, adequacy and reliability of the moral values and systems that have been used conventionally to guide ethical professional conduct in healthcare settings (Johnstone, 2016).

August 2016 Volume 24, No. 2  23



In today’s demanding clinical environments it is challenging for nurses to undertake research. Barriers include time, limited self-belief and confidence, commitment, limited knowledge of the research process, and lack of administrative support. Yet nurses are curious and many have ideas to improve clinical care and patient outcomes.

Denise Cummins, Kurt Andersson-Noorgard, Linda Foley, Jeana Nurmeiyati and This paper discusses how a community nursing Ivanka Komusanac

service, Sydney District Nursing, has developed a congenial and collegial process to improve the culture of nursing research, and to support its nurses to undertake research and develop quality improvement projects.

24  August 2016 Volume 24, No. 2


CLINICAL UPDATE Background/Overview

Research often evokes dread in nurses as misconceptions abound (SawatzkyDickinson, 2008; Raines, 2012). Many nurses prioritise clinical care and place the idea of research as a lower priority (Gagan and Taylor, 2004). Some nurses view research as distinct from nursing practice (Raines, 2012), yet quality care is based on the relationship between nursing care and patient outcomes with evidence-based practice an essential component. Questioning the role of nursing in clinical practice, implementation of change, evaluating outcomes and sharing information are important processes which lead to improvement in nursing care (Raines, 2012). Nurses deliver evidence-based practice each day, whether knowingly or not. Combining the best research evidence available with clinical expertise drives accountability to the patient and the quality of care provided. It is problem solving in approach, with a systematic search to answer a clinical question using critical appraisal of evidence (Leufer and Cleary-Holdforth, 2009). Nurses also undertake quality improvement (QI) activities to evaluate work processes, monitor work practice and patient outcomes while identifying areas for improvement. QI is often related directly to performance measures, established benchmarks and clinical indicators (Raines, 2012). Research and QI require intellectual curiosity to ask questions and find the answers through research questions or improvement projects. Different sets of skills are required to complete a QI or research project such as project planning, literature review, ethics submission, formulating a research question, analysing results, implementing results into practice, disseminating findings through publication and conference presentation (Lancaster, 2005).

Background on Sydney District Nursing

Sydney Local Health District (SLHD) covers a land area of approximately 127 square kilometres in Sydney, Australia. SLHD has an ethnically diverse community with 51.5% of the population speaking a language other than English at home. Sydney District Nursing (SDN) is a key service of SLHD and is distributed throughout the district in five separate community health centres. The goal of the service is to provide culturally appropriate nursing care in either a patient’s home or in a clinic setting. SDN works in close partnership with hospitals as well as other health professionals such as allied health, anmf.org.au

general practitioners and community/ consumer organisations. Expert nursing care is provided in the areas of: • Acute and chronic wound care assessment and management • Hospital in The Home (HiTH) – for hospital type care in the home including intravenous and subcutaneous medication management • Palliative care including symptom management and end of life care. • Advanced care planning • HIV and HIV mental health specialist care • Continence care assessment and management • Care for chronic medical conditions

Foundational activities

SLHD Community Health was committed to increase research across all of its directorates. SDN has only fairly recently engaged in comprehensive research projects, for example the service is currently involved in a large National Health & Medical Research Council funded Chemotherapy Project with the Cancer Council Australia and Sydney University. In addition, there has been a low incidence of nurses initiating and leading research projects. That certainly changed in late 2014, when senior nurses were asked by the General Manager of Community Health to make a commitment to raise the research profile in SDN. Several meetings were arranged between key SDN staff (Director of Nursing, two Clinical Nurse Consultants), the Executive Clinical Director Community Health and the Faculty of Sydney University, Sydney Nursing School with the aim of creating a central group within SDN for the promotion and support of nursing research. Formal plans clarified the goals of the group with a focus on developing and promoting nurse engagement. The time commitments of senior nurses were reviewed and a decision made to replace two existing committees (education and policy) with a new Quality and Research group (the group). Prior to the initial meeting of the group, the two Clinical Nurse Consultants (CNCs) developed an educational session titled “Research for the Uninitiated”. A forum was held between SDN and Sydney University, School of Nursing, where senior nurses were asked to consider potential projects or research questions. The expectation was that SDN would develop four to five research questions around

their specialty nursing care areas. We undertook group work in clinical specialties (eg. palliative care, wound care and HiTH) with university research staff facilitating each group to reflect on questions that were of interest to them.

The travelling education session: ‘Research for the uninitiated’

This educational session provided at each of the five centres by the two CNCs was to demystify the research process and engage the wider group of SDN nurses (and potential group members) with the goal of stimulating thinking around ideas for research and QI projects The session was intentionally kept brief (45 minutes) to be non-threatening and introduce some basic concepts without overwhelming the nurses. The session content included: the types of research, clinical reasoning of and need for research, the QI process and available assistance. A pre/post education survey was completed and evaluated. Forty one nurses attended and completed pre/ post surveys (100%). Large gains in knowledge were exhibited between pre and post surveys in all areas questioned. The largest increase was seen in participants’ knowledge of the process of creating a QI project from 19% (n=8) to 90% (n=37). The percentage of nurses with an idea for a research/QI project increased from 14% (n=6) to 59% (n=24). Importantly, we found that nurses identified a clinical question they were curious about increased from 29% (n=12) to 51% (n=21). The positive response was doubled when participants were asked about ‘curiosity’ as opposed to ‘research’. This insight may be of assistance in encouraging and promoting QI and research projects for SDN in the future. Table 1: Pre and post questions • Are you aware of the difference

between qualitative and quantitative research?

• Do you know the process for

creating a QI Project?

• Do you have an idea/ideas for a

research or QI Project?

• Is there a clinical question that

you are curious about?

Forming the group

The group was made up of senior nurses within SDN such as Clinical Nurse Consultants, Clinical Nurse Educators, Clinical Nurse Specialists, and Nursing Unit Managers from

References Gagan, M and Hewitt-Taylor, J. 2004. The issues for nurses involved in implementing evidence in practice. British Journal of Nursing. Vol 13 no 20 1216-1220 Lancaster, L. 2005. Bonding of nursing practice and education through research. Nursing Education Perspectives September/October Vol 26 no 5 294-296. Leufer T, ClearyHoldforth J. 2009. Evidence-based practice: improving patient outcomes. Nursing Standard. 23, 32, 35-39. Raines, D.A. 2012. Quality improvement, evidence-based practice, and nursing research…Oh My! Neonatal Network July/ August Vol 31 no 4. 262-264 Sawatzky-Dickson, D.M. and Clarke, D.E. 2008. Increasing understanding of nursing research for general duty nurses: an experimental strategy. The Journal of Continuing Education in Nursing March Vol 39 no 3 105-109

August 2016 Volume 24, No. 2  25

CLINICAL UPDATE each centre and was open to any other nurse who was interested in research. The Director of Nursing and Operational Nurse Manager also attended to reinforce complete SDN executive support for the group. This support also included a commitment to provide resources for the group to meet monthly and for staff to develop projects providing protected time to undertake the projects, which is critical in ensuring engagement and progression of the quality and research agenda. Many of the nurses in the group had limited experience undertaking research and QI projects and were unfamiliar with stages of and process of research. They could not articulate what skill set they needed and were anxious about their limited skills, but with ongoing support and education, realised they were able to start a project.

The meetings of the group: Strategy

There was a conscious decision to not name the group a committee, with the negative implications that word can engender. Meetings are held monthly with an agenda that is semi-structured, with flexibility to adjust as needed. Each meeting is co-chaired by the two CNCs and includes academic representatives from Sydney University. Agenda items include updates on projects and resources required by project groups. A ‘hands up for help’ agenda item finishes the meeting: this is space where any other issues can be discussed. These issues could include ethics applications, project plans or difficulties with literature reviews. The group then makes suggestions or offers assistance, this can occur due to the broad range of knowledge within the group. The group itself is a collegial, nurturing and supportive environment that allows the nurses to bring up any issues, queries or roadblocks without concerns about how they would appear to other group members. Once we had agreed on the style and format of the group, we then discussed what education was required or would be of interest; this was a less formalised needs assessment. Initially group members decided on education based around completion of ethics submissions and how to conduct a basic literature review. A representative of the SLHD Research, Ethics and Governance Office was invited to provide education in an accessible format and a member of the library department provided guidance on how to complete a literature review including 26  August 2016 Volume 24, No. 2

supports available.

Group members who had more experience in an area would assist others by mentoring them one on one. Sharing knowledge and experience is the key to these endeavours, as each person has something to learn and something to share. It is about a collaboration of minds to help each other along the research process. In addition, each project group is mentored by an experienced researcher from SDN or the university, and this has proven to be a valuable support, especially for those doing research for the first time.

group of people to brainstorm ideas and support, mentor and teach each other. The group’s experience shows that establishing partnerships with academics has been beneficial on many levels, individually and from a service perspective. The collegial support and generosity of staff in the group who share and mentor each other has been invaluable. At the beginning, members were uncertain of the expectations and whether they would be able to deliver projects with all the other demands of their roles. However, with the Nursing Executive’s pledge guaranteeing time to undertake projects, having the support of the group and opportunity for skill acquisition, individuals have gained the confidence to follow their curiosity into practice through research projects. Nurses want to provide excellent care to the patient with the best possible outcomes, and now through the group nurses feel better equipped to do this through evidence based practice, some which they have initiated themselves. This also makes their role more enjoyable through achievement, as nurses develop other skills such as presenting their work to a wider audience and publishing to disseminate their findings.



To maintain contact and ensure availability of documentation between meetings, a shared drive (digital repository) with remote access was created so all nurses could access information and add information from any of the centres. Contained in this repository were templates for ethics and quality applications, registers of projects (to keep track of who was doing what and the project progress), minutes of meetings and submitted and approved applications of all current projects so that examples would be available to nurses beginning a project.

After 12 months (or nine meetings), SDN have established 16 projects; eight research projects and eight quality projects which represent the diversity of clinical activities that nurses within SDN undertake including palliative care, wound management, medication management and care for those with HIV infection. Nurses from the group have presented at local, national and international conferences showcasing information from projects, some for the first time.


When the group began, many members focussed on barriers they perceived would inhibit their capacity to undertake research or quality improvement. These barriers included time, ability and knowledge of the research process and skills to undertake a project (Lancaster,2005; Raines, 2012). Establishing what skills and information nurses required, and providing targeted education assisted in enhancing their skills and gave them more confidence to undertake a research or QI project. Lancaster (2005) noted that undertaking research requires a

Initiating and maintaining a change in culture takes consistent focus, time and commitment, all of which is ongoing. The nurses in the group are encouraged to discuss their clinical questions or curiosities, which lead to the development of a QI or research project. These are closely aligned to quality care of the patient, improving patient outcomes and informing all of these, expert and compassionate nursing care. Through a collaborative approach and establishing partnerships with key services we have been able to enhance individual skills, confidence and opportunity to conduct research. Initiation of the group has shown that attitudes can change, as there is now a wide commitment to leading research and quality projects in SDN. Nurses also have a sense of self achievement, enhanced skills and confidence to undertake research and QI projects as the group has provided a safe and collegial environment. Knowledge about the work of other nurses within our diverse specialties has led to a stronger connection between the nurses. We have also become part of a larger network of experts with growing links to ethics committees, librarians, academics and other key individuals within the District and beyond.

Denise Cummins is a Clinical Nurse Consultant HIV Disease at Sydney District Nursing, Community Health, Sydney Local Health District, NSW Kurt AnderssonNoorgard is a Clinical Nurse Consultant Mental Health and HIV Disease at Sydney District Nursing, Community Health, Sydney Local Health District, NSW Linda Foley is an acting Palliative Care CNC at Sydney District Nursing, Community Health, Sydney Local Health District, NSW Jeana Nurmeiyati is an acting Clinical Nurse Consultant Infection Control Ivanka Komusanac is a Director of Nursing at Sydney District Nursing, Community Health, Sydney Local Health District, NSW anmf.org.au

Primary/community healthcare FOCUS


References Anderson, J. K., Croxon, L., & McGarry, D. E. 2015. Identifying student knowledge and perception of what is valuable to professional practice: A mixed method study. Nurse Education Today, 35(12), 1240-1245. doi: http:// dx.doi.org/10.1016/j. nedt.2015.04.007

Reviews of undergraduate nursing courses reveal variability in what is being taught regarding primary healthcare (Betony & Yarwood, 2013; Keleher et al. 2010). In an investigation of the perceptions of final year students and recent graduates about underlying conceptual frameworks, Anderson et al. (2015) found students and graduates value primary healthcare as part of their curriculum. This article reports specifically on how these students and graduates perceived primary healthcare. A small mixed method study was designed to identify the strengths and weaknesses of the conceptual framework. It encouraged students to indicate what aspects of the curriculum they valued most and to explore their perceptions of what this meant. Ethics approval was provided by the university ethics committee. In total 128 responses were received, 86.7% (n=111) from graduated students and 13.3% (n=17) from students in their final year of study. The percentage of females was 91.4% which was consistent with the student profile. From the responses 73.8% felt they were prepared for practice. Primary healthcare was the curriculum theme which students and graduates valued most after evidence based practice. One graduate described how significant she felt it was and how it impacted on other aspects of nursing: “It provides the basis for all nursing … primary healthcare is something that’s applicable to every single member of the community, whereas secondary and tertiary are more applicable to people that are actually sick or have something wrong with them. So it’s anmf.org.au

important to learn about primary healthcare so that we can keep our communities healthy so that we have less patients in hospital,” (Jane). Similarly, Angie saw primary healthcare as a challenge, but one that she considered of major importance in healthcare overall: “Primary healthcare is empowering them to take control of their own healthcare ... that’s one of the biggest challenges,” (Angie). Toni provided a different perspective, but one more aligned with the literature (Betony and Yarwood, 2013; Keleher et al. 2010) that indicates change is required to provide effective primary healthcare. “I certainly see that [primary healthcare] is what nursing as a profession is aiming towards and is gearing itself towards, but not what I see in practical day to day... [However,] it is a great place to go,” (Toni). As Toni indicates not only do we need to ensure that newly graduated nurses are prepared for their primary healthcare, but also to ensure that they have the skills to implement change in an environment that is not as well prepared as we would like it to be.


Many universities survey student satisfaction and perceptions about their courses (Milton-Wildey et al. 2014; Roxburgh, 2014; Sundler et al. 2014) but this does not give them a voice in the conceptual structure of course design. Students and graduate nurses in this study demonstrated a sound understanding of the philosophy of primary healthcare and of its relevance to nursing practice. They viewed it as an evolving aspect of nursing where there was potential for nurses to expand their practice (Anderson et al. 2015). Dr Judith Anderson is the Course Director in the Faculty of Science at Charles Sturt University Lyn Croxon is a Lecturer in the School of Nursing, Midwifery and Indigenous Health at Charles Sturt University

Betony, K., & Yarwood, J. 2013. What exposure do student nurses have to primary healthcare and community nursing during the New Zealand undergraduate Bachelor of Nursing programme? Nurse Education Today, 33(10), 1136-1142. doi: http:// dx.doi.org/10.1016/j. nedt.2012.12.007 Keleher, H., Parker, R., & Francis, K. 2010. Preparing nurses for primary healthcare futures: how well do Australian nursing courses perform? Australian Journal of Primary Health, 16(3), 211-216. Milton-Wildey, K., Kenny, P., Parmenter, G., & Hall, J. 2014. Educational preparation for clinical nursing: The satisfaction of students and new graduates from two Australian universities. Nurse Education Today, 34(4), 648-654. doi: http:// dx.doi.org/10.1016/j. nedt.2013.07.004 Roxburgh, M. 2014. Undergraduate student nurses’ perceptions of two practice learning models: A focus group study. Nurse Education Today, 34(1), 40-46. doi: http:// dx.doi.org/10.1016/j. nedt.2013.02.017 Sundler, A. J., Björk, M., Bisholt, B., Ohlsson, U., Engström, A. K., & Gustafsson, M. 2014. Student nurses’ experiences of the clinical learning environment in relation to the organization of supervision: A questionnaire survey. Nurse Education Today, 34(4), 661-666. doi: http://dx.doi. org/10.1016/j. nedt.2013.06.023

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By Edwin Pascoe

By Cathy Kezelman

Australia’s first study of gay men with type 2 diabetes is underway at Victoria University.

Trauma comes in many guises – from accidents, natural disasters (single incident trauma) to complex trauma such as child abuse and growing up with domestic violence. Illness, medical procedures, treatments and hospitalisation are themselves often traumatic, with recent traumas compounding those experienced previously.

Conducted by RN and diabetes educator Edwin Pascoe, it will explore the lived life of gay men as they navigate this chronic health condition. References

Prior research in the United Kingdom has explored unique challenges of non-heterosexual men’s experiences (Jowett et al. 2012) highlighting the need for further research in this area. Isolation/loneliness (Kuyper and Fokkema, 2010), excess drinking, smoking, drug use as well as eating disorders and anxiety/depression (Leonard et al. 2012) seen in disproportionate higher levels in gay men all have the potential to effect the management of diabetes. For example a third of gay men compared to a fifth of straight men smoke (Wilkins, 2015) which becomes a factor exacerbating the complications of diabetes and indeed increasing risk for type 2 diabetes (Piatti et al. 2014). The results of this study will be used to create a model of culturally appropriate diabetes education for gay men with type 2 diabetes. If you identify as a gay man or are a diabetes educator who has looked after gay men with type 2 diabetes and are interested in participation please contact Edwin Pascoe on email: edwin.pascoe@live.vu.edu.au

The study For the first time in Australia, the lived life of gay men with type 2 diabetes will be researched. The aim is to find out if there are unique issues that may need to be addressed when planning their care. Selection criteria: • Gay men with type 2 diabetes (HIV neg) – 46 questions • Gay men with type 2 diabetes (HIV positive) – three questions • Gay men with no diabetes – five questions Participants will be asked to: 1. Complete an online survey study: https://vuau.qualtrics. com/SE/?SID=SV_1Y6w3j J51TF7DCZ 2. Participate in an in-depth interview (optional).

28  August 2016 Volume 24, No. 2

Jowett, A., Peel, E. and Shaw, R. L. 2011. Sex and diabetes: A thematic analysis of gay and bisexual men’s accounts. Journal of Health Psychology 17 no. 3: 409-18. Kuyper, L. and Fokkema, T. 2009. Loneliness among older lesbian, gay, and bisexual adults: The role of minority stress. Archives of Sexual Behavior 39, no. 5: 1171-180. Leonard, W., Pitts, M., Mitchell, A., Lyons, A., Smith, A., Patel, S., Couch, M. and Barrett, A. 2012. Private lives 2: The second national survey of the health and wellbeing of gay, lesbian, bisexual and transgender (GLBT) Australians. Report. Series 86. Melbourne: Australian Research Centre in Sex, Health & Society, Latrobe University. Piatti, P., Setola, E., Galluccio, E., Costa, S., Fontana, B., Stuccillo, M., Crippa, V., Cappelletti, A., Margonato, A., Bosi, E. and Monti, L.D. 2014. Smoking is associated with impaired glucose regulation and a decrease in insulin sensitivity and the disposition index in first-degree relatives of type 2 diabetes subjects independently of the presence of metabolic syndrome. Acta Diabetol Acta Diabetologica 51, no. 5: 793-99. Wilkins, R. 2015. Household asset portfolio diversification: Evidence from the household, income and labour dynamics in Australia (HILDA) survey. University of Melbourne. Commonwealth of Australia. www. melbourneinstitute. com/hilda

Edwin Pascoe is a Master in Education student at Victoria University

In trauma, a person’s usual coping mechanisms are often overwhelmed, in response to real or perceived threat. The experience of trauma and extremes of stress activate a ‘normal’ survival response, which is `fight’ or ‘flight’. When the threat can’t be escaped it leads to a ‘freeze’ or shut down response. If these responses do not resolve following the event/s which precipitated them, the person can remain on ‘high alert’ and be easily triggered by seemingly minor stress in the future. That’s because patterns of learning which are fear-based often become entrenched. Triggers such as thoughts, feelings, behaviours or a current event reminiscent of past trauma can readily precipitate such a stress response, even in the absence of current danger. The response often feels as if the trauma is occurring in the present. Despite trauma being a major public health challenge it is frequently unrecognised, unacknowledged, and unaddressed within current systems. Many of those experiencing traumatic stress are inadvertently re-traumatised in systems of care which lack the requisite knowledge and training around the particular sensitivities, vulnerabilities and triggers trauma survivors experience. Trauma-informed care and practice is a strengths-based framework which is founded on five core principles: safety, trustworthiness, choice, collaboration and empowerment as well as respect for diversity. Trauma-informed services do no harm ie. they do not re-traumatise or blame victims for trying to manage their traumatic reactions, and they embrace a message of hope and optimism that recovery is possible. They focus on what happened to the person rather than what is wrong with them. Trauma-informed care and practice is a win-win for patients, staff and

services alike. Trauma-informed training and a process of cultural and philosophical change is highly recommended across all levels of any health or human service or system, and especially one so critical as nursing.


Blue Knot Foundation, formerly Adults Surviving Child Abuse (ASCA), is the leading national organisation working to improve the lives of one in four adult Australians (5 million) who have experienced childhood trauma. Blue Knot Foundation is a policy and practice leader in both clinical and traumainformed responses to complex trauma. We provide short term phone counselling support, information, resources, tools and workshops to help survivors and their friends, families, partners and loved ones live better lives. Blue Knot Foundation also provides professional development training, supervision, consultancy and other services to practitioners, organisations and diverse personnel who work with survivors across sectors.

Dr Cathy Kezelman AM is President of Blue Knot Foundation anmf.org.au

Primary/community healthcare FOCUS

References Adetunji, J. 2012. Leading questions: Helen Bevan, NHS Institute for Innovation In The Guardian. Available from http:// www.theguardian. com/public-leadersnetwork/2012/oct/31/ helen-bevan-nhsleading-questions Accessed 21 March 2016 Bevan, H. and Freer, M. 2015. ‘A One Day School for Health Care Radicals - Melbourne Slide Set, Department of Health and Human Services, Victoria. Available from http:// www.slideshare.net/ CarynHamburger/ school-for-health-andcare-radicals-melbourneslide-set Accessed 30 March 2016 Casella, E. and Mills, J. 2014. Social media and nursing practice: Changing the balance between the social and technical aspects of work. Collegian. 21(2), 121-126

REGIONAL WOUNDS VICTORIA By Donna Nair, on behalf of RWV collaborative Regional Wounds Victoria (RWV) are a collaborative of nine nurse consultants who cover 96% of Victoria’s land mass that services 30% of Victoria’s home and community care clients. They work alongside staff in the District Nursing Services and high level care Public Sector Residential Aged Care Services, targeting all aspects of the management of chronic and complex wounds. As a strategy to support clinicians often isolated in rural areas and to bridge common gaps in wound care, RWV utilise the reach of social media via an interactive Facebook page. This is a unique approach in the Australian wound management community and based on other successful social media mediums in the UK and US. The professional use of Social Media (SoMe) in contemporary healthcare has become accepted practice and a proven enabler. The current generation of new graduates have never known a time without the internet, and the generation after that will not know a world without social media. Despite scepticism around the use of SoMe, the onus is on clinical leaders to embrace the well-established online world. RWV considers its intentional use of SoMe to have many positive and lasting impacts as a medium that is readily available across all levels from clinicians to managers and operates independently of health service culture and traditional education constraints. Social connections ensure more effective knowledge transfer. In a recent selfanmf.org.au

reported survey of RWV Facebook users, 89% were aged between 35 and 64, and indicated that 78% of followers had learned new information. The page is moderated and followers are encouraged to participate. The RWV interactions posted, align with the Victorian Department of Human Services and AHPRA social media policies. Ensuring that professionalism, respectful communication and confidentiality are maintained. All original clinical content is scrutinised by the RWV team to ensure relevance to Australian followers working with people with chronic wounds.

bandaging at the same degree for six months, then changing to medical-grade compression garments. • Ceasing compression bandaging immediately to prevent further damage. • Immediately changing from compression bandaging to compression garments.

The following is a multi-choice question posted on the page earlier this year.

Visit the RWV Facebook page to view the answer and reference for further reading: facebook.com/ regionalwoundsvictoria RWV receives funding from the Commonwealth and Victorian governments under the HACC program. The RWV website and further resources can be found at www.grhc. org.au/vic-wound-man-cnc-project

After a venous leg ulcer has healed, Australian guidelines recommend: • Maintaining compression bandaging at the same degree for two to four weeks before changing to medical-grade compression garments. • Maintaining compression

Donna Nair is Regional Wound Management Clinical Nurse Consultant, Ballarat Subregion, Service Workforce and Development, Department of Health and Human Services Grampians Region in Victoria.

Milton, N. 2014. Why knowledge transfer through discussion is 14 times more effective than writing In Knoco Stories, From the knowledge management front-line’ Available from http://www.nickmilton. com/2014/10/whyknowledge-transferthrough.html Accessed 21 March 2016 Moorhead, S.A. and Hazlett, D.E. 2013. A new dimension of healthcare: Systematic review of the uses, benefits, and limitations of social media for health communication. Journal of Medical Internet Research.15(4): e85 Moorley, C. and Chinn, T. 2016. Developing nursing leadership in social media. Journal of Advanced Nursing. 72(1), 1-7 Watson, B., Cooke, M. and Walker, R. 2016. Using Facebook to enhance commencing student confidence in clinical skill development: A phenomenological hermeneutic study. Nurse Education Today. 36, 64-69 Wilson, R., Ranse, J., Cashin, A. and McNamara, P. 2014. Nurses and Twitter: The good, the bad, and the reluctant. Collegian. 21(2), 111-119

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THE VALUE OF HEALTH PROMOTION PROGRAMS FOR OLDER PEOPLE WITH CHRONIC CONDITIONS IN THE COMMUNITY By Rebekkah Middleton, Lorna Moxham and Dominique Parrish The Ottawa Charter of Health Promotion (WHO,1996) advocates that health promotion occurs when people are able to improve and practice more successful control over their health. The concept of health promotion was founded on the notion of community action, raising awareness and instilling community accountability and involvement in one’s own actions. In 2007, the World Health Organization (WHO) also promoted person-centred approaches to healthcare: “the overall vision for peoplecentred healthcare is one in which individuals, families and communities are served by and are able to participate in trusted systems that respond to their needs in humane and holistic ways,” (WHO, 2007). Despite this international charter and framework, community interventions and in particular community health promotion programs involving exercise for older people with chronic health conditions are underdeveloped, certainly in Australia. Health promotion programs have proven to be effective in promoting self-care and increasing levels of exercise in people with chronic illnesses, particularly when implemented in community settings outside the home environment, such as local halls or gyms (Desveaux et al. 2013). The literature establishes that older people benefit physically, cognitively and socially from being engaged in community recreational activities (Huang et al. 2015; March et al. 2015; Nishiguchi et al. 2015; Patil et al. 2015). Community health promotion programs ‘support healthy ageing’ (Young et al. 2015). They are excellent means of enabling older people to participate in community programs, allowing them ‘to be more productive, useful members of society and more independent in their life choices, while at the same time reducing the level of community expenditure and burden,’ (Stumbo et al. 2015). Stumbo et al. (2015) also asserts that older people with chronic conditions participating in health promotion programs in the community experience opportunities that allow them to maintain abilities, contribute to a cause, draw on past roles and skills, and improve their self-belief. Community based health promotion programs have demonstrated benefit to older adults, with key considerations being to help regain function, stability and/or independence (Zabriskie et al. 2005), and to promote selfmanagement and facilitative behaviours to maintain a healthy lifestyle and thereby prevent potential comorbidities and bring general improvement in quality of life (March et al. 2015; Rowan et al. 2013). Cogswell and Negley (2011) advocate that by increasing opportunities to support individual 30  August 2016 Volume 24, No. 2

COMMUNITY INTERVENTIONS AND IN PARTICULAR COMMUNITY HEALTH PROMOTION PROGRAMS INVOLVING EXERCISE FOR OLDER PEOPLE WITH CHRONIC HEALTH CONDITIONS ARE UNDERDEVELOPED, CERTAINLY IN AUSTRALIA autonomy, the potential to increase internal motivation for improving healthy lifestyles can occur. Community based health promotion programs should encourage participants to take responsibility for their own wellness and thereby foster an internal locus of control and an increased ability to manage change (Stumbo & Peterson, 2009). Even where a program is fairly prescriptive, the individual needs to be encouraged to be as autonomous as possible, so as to promote the outcomes of the program. When personal choice is increased within a program, life and leisure satisfaction is enhanced and participants are far more likely to benefit and see results (Stumbo & Peterson, 2009). Drawing on the lead authors PhD research, the following major findings were identified that supports the literature outlined in this paper. Shifting the focus to the person involved, self-management and self-determination are encouraged, bringing a positive conception of health and empowerment to the individual. Such person-centredness enhances the aims community health promotion programs strive to achieve. Rebekkah Middleton is Lecturer and PhD Candidate; Professor Lorna Moxham is Professor in Mental Health. Both are in the School of Nursing at the University of Wollongong Dominique Parrish is Associate Dean Education in the Faculty of Science, Medicine and Health at the University of Wollongong

References Cogswell, J. & Negley, S.K. 2011. The effect of autonomy-supportive therapeutic recreation programming on integrated motivation for treatment among persons who abuse substances. Therapeutic Recreation Journal. 45(1):47-61. Desveaux, L., Beauchamp, M., Goldstein, R. & Brooks, D. 2013. Communitybased exercise programs as a strategy to optimize function in chronic disease: A systematic review. Medical Care. 52(3):216226. Huang, T.T., Liu, C.B., Tsai, Y.H., Chin, Y.F. & Wong, C.H. 2015. Physical fitness exercise versus cognitive behavior therapy on reducing the depressive symptoms among community-dwelling elderly adults: A randomized controlled trial. International Journal of Nursing Studies. 52(10):15421552. March, S., Torres, E., Ramos, M., Ripoll, J., Garcia, A., Bulilete, O., Medina, D., Vidal, C., Cabeza, E., Llull, M., Zabaleta-Del-Olmo, E., Aranda, J.M., Sastre, S. & Llobera, J. 2015. Adult community healthpromoting interventions in primary healthcare: A systematic review. Preventative Medicine. 76(Suppl1):S94-S104. Nishiguchi, S., Yamada, M., Tanigawa, T., Sekiyama, K., Kawagoe, T., Suzuki, M., Yoshikawa, S., Abe, N., Otsuka, Y., Nakai, R., Aoyama, T. & Tsuboyama, T. 2015. A 12-week physical and cognitive exercise program can improve cognitive function and neural efficiency in community-dwelling older adults: A randomized controlled trial. Journal of the American Geriatric Society. 63(7):1355-63. Patil, R., Uusi-Rasi, K., Tokola, K., Karinkanta, S., Kannus, P. & Sievanen, H. 2015. Effects of a multimodal exercise program on physical function, falls, and injuries in older women: A 2-year community-based, randomized controlled trial. Journal of the American Geriatric Society. 63(7):13061313.

Rowan, C., Riddell, M. & Jamnick, V. 2013. The prediabetes detection and physical activity intervention delivery (PRE-PAID) program. Canadian Journal of Diabetes. 37(6):415-419. Stumbo, N. & Peterson, C. 2009. Therapeutic recreation program design. Principles and procedures. 5th edn. San Francisco: Pearson. Stumbo, N.J., Wilder, A., Zahl, M., Devries, D., Pegg, S., Greenwood, J. & Ross, J.E. 2015. Community integration: Showcasing the evidence for therapeutic recreation services. Therapeutic Recreation Journal. 49(1):35-60. World Health Organization (WHO) 1996. Ottawa charter of health promotion. Toronto, Canada: OMS. World Health Organization (WHO) 2007. People-centred healthcare: A policy framework. Geneva: WHO. Young, J., Angevaren, M., Rusted, J. & Tabet, N. 2015. Aerobic exercise to improve cognitive function in older people without known cognitive impairment. Cochrane Database of Systematic Reviews. 4:1-3. Zabriskie, R.B., Lundberg, N.R. & Groff, D.G. 2005. Quality of life and identity: The benefits of a community-based therapeutic recreation and adaptive sports program. Therapeutic Recreation Journal. 39(3):176-191.


Primary/community healthcare FOCUS


RE-ENGINEERING PRIMARY HEALTHCARE NURSING AS A FIRST CAREER CHOICE By Emily Wheeler and Linda Govan In line with international models and critical to the primary healthcare nursing workforce, the Australian Primary Health Care Nursing Association (APNA) has been funded by the Commonwealth Department of Health to develop an Education and Career Framework and Toolkit for primary healthcare nurses. The aim of the project is to improve the recruitment and retention of nurses and to re-engineer primary healthcare as a first choice career option. The project, due for completion in mid-2018, is being undertaken by the APNA Nursing in Primary Health Care Program and involves extensive stakeholder consultation, currently underway. Consultations with nurses and their colleagues to date has illuminated the breadth of opportunities, nursing roles and expanded scope of practice nurses in primary healthcare settings have. Concerning however are the complaints of stigma and discrimination that nurses in primary healthcare settings experience from their nursing colleagues in other settings. Primary healthcare nursing is often considered a ‘step down’ or a ‘job to help you transition to retirement,’ requiring fewer skills and an ‘easier workload’. According to the nurses who have anmf.org.au

participated in the consultation, this inaccurate perception along with the professional isolation nurses outside hospitals may face can impact negatively on nurses considering a career in primary healthcare and, for nurses within primary healthcare, a perceived lack of career progression continues to impact on nurses staying or advancing in this setting. Other similar concerns revealed through the Education and Career Framework’s consultation phase include the limited opportunities for undergraduate nurses to experience primary healthcare, the challenge in navigating a career outside hospital settings, poor understanding of the role of the nurse and scope of practice, and the suggestion that traditional nursing education prepared nurses predominantly



for a career in a hospital. Existing documents guiding nursing practice will form the basis of the APNA Education and Career Framework and Toolkit, such as the APNA Education and Career Framework for Nurses in General Practice (APNA, 2015) and the Australian Nursing and Midwifery Federation (ANMF) National Practice Standards for Nurses in General Practice (ANMF, 2015), acknowledging the significant work already completed. The APNA Education and Career Framework and Toolkit will describe a range of primary healthcare career pathways and their education underpinnings, highlighting and articulating the breadth of nursing expertise required in multiple primary care settings. This will be achieved through collaboration with individuals and professional nursing and nonnursing organisations representing health professionals across the health sector, supported by the developing evidence base of nursing knowledge and skills in primary healthcare. Primary healthcare nursing is a rewarding career choice and the Education and Career Framework and Toolkit will enable nurses to actively choose primary healthcare and be rewarded with a dynamic and evolving career. To join the discussion, please contact Emily Wheeler (emily.wheeler@apna.asn.au)

References Australian Primary Health Care Nurses Association (APNA). 2015. Australian Education and Career Framework for Nurses in General Practice. Melbourne. APNA. Australian Nursing & Midwifery Federation (ANMF). 2015. National Practice Standards for Nurses in General Practice. Melbourne. ANMF.

Emily Wheeler is Project Manager, Education and Career Framework at APNA Linda Govan is Senior Project Officer, Education and Career Framework at APNA

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IMPORTANCE OF PREVENTATIVE HAND HYGIENE PRACTICES IN COMMUNITY NURSING WOUND MANAGEMENT By Linda Raymond on behalf of Regional Wounds Victoria (RWV) collaborative Hand hygiene, when undertaken correctly, is the most effective preventative measure in reducing the spread of microorganisms that cause healthcare associated infections (WHO, 2009; NICE, 2012). These infections are a major risk to clients and increase both mortality and the financial burden on the health care system (WHO, 2009). Effective hand hygiene is therefore essential in a hospital environment, and is equally important in the community setting. Health Care Workers (HCWs), the client, other members of the household, including pets, and the home environment are reservoirs of microorganisms. Ineffective hand hygiene practices can easily lead to the transmission of microorganisms from one environment to another. Over the past 20 years, there has been a shift in healthcare provision. An increasing proportion of complex care, previously undertaken by HCWs in an acute care setting, is now provided in the community, in clients’ homes. Providing that same level of infection control practice in the community setting can be quite challenging for HCWs. The environment is not controlled and home hygiene standards are not usually at a hospital standard. This does not mean, however, that care in the community should be compromised. What it does necessitate is some strategic management in order to provide clean, safe and competent care to which all persons in community care are entitled (Felemban et al. 2015; Stephen-Haynes, 2014; Swanson and Jeanes, 2011). This scenario, conveyed to me by a nurse, illustrates the infection control, occupational health and safety, socioeconomic and environmental issues the community HCW must be prepared for: My last patient for the day required a wound dressing to his foot. I finally arrived at the farm. First, I had to contend with the gate, in the rain, trying to work out how to operate the wire handle, avoiding the cowpats. When I finally got to the old 1930’s house, I found Mr M, an elderly man living alone, with early Parkinson’s disease, slumped in his chair, his foot propped on a low stool. The dogs were running about 32  August 2016 Volume 24, No. 2

the kitchen greeting me, (despite phoning earlier to put the dogs away) the room was poorly lit and made darker by the grey skies and only a single bulb hanging from the 14ft ceiling. After shooing out the dogs, I tried to set up what I needed on the cluttered kitchen table. The wound was located on the underside of his heel – but the stool was way too low and I had to squat, which isn’t good for my knees.


So, with his agreement, we shuffled to his bedroom, where he was eventually able to position his body on the bed so that I was able to see and treat his wound. This time, I was sitting on a low plastic stool I’d brought in with me, jammed between the bed and the wall, I found the only place to set up was on the bedside table behind me which required me to twist awkwardly, I lost my balance and steadied myself by placing my hand on the floor. I completed the dressing in this cramped position then assisted Mr M back to the kitchen. According to the literature there is a lack of hand hygiene compliance worldwide (Felemban et al. 2015; Kilpatrick et al. 2013; WHO, 2009; Sax et al. 2007). The literature cites

forgetfulness, fear of skin damage, lack of time, scarce and inconvenient access to hand hygiene equipment all as contributing to this epidemic of poor practice (Felemban et al. 2012; Sax et al. 2007). However, most significant is the lack of training and information explaining how, when and why to attend to hand hygiene in a wide range of care activities and healthcare settings (Felemban et al. 2012; Swanson and Jeanes, 2011; Sax et al. 2007). The World Health Organization (2006) developed the ‘five moments of hand hygiene’. This approach aims to clarify and simplify when hand hygiene is to occur and to standardise compliance audits. Organisations providing community care should have policies that support the compliance and auditing of hand hygiene. Hand hygiene education should also be a regular component of all professional development schedules and should be contextualised to the community setting. A range of educational approaches including targeted scenarios has been shown to improve practice. (Kilpatrick et al. 2013; Sax, 2007). This type of learning provides a safe environment for community HCWs to consider how they can operationalise hand hygiene. So I ask you: how many pairs of gloves would you have used in the scenario above? How many times would you have used alcoholic hand rub? How would you wash the dirt from your hands? If you can’t answer these questions, is your hand hygiene meeting standards of infection control in the community setting? RWV receives funding from the Commonwealth and Victorian governments under the HACC program. The RWV website and further resources can be found at www.grhc.org.au/vic-wound-mancnc-project Linda Raymond is Regional Wound Management Clinical Nurse Consultant - Gippsland Region, Latrobe Community Health Service

References Felemban, O., St. John, W., & Shaban, R.Z. 2015. Infection prevention and control in home nursing: case study of four organisations in Australia. British Journal of Community Nursing. 16(6):451-457. Felemban, O., St. John, W., & Shaban, R.Z. 2012. Hand hygiene practices of home visiting community nurses. Home Healthcare Nurse. 30(3):152-161. Kilpatrick, C., Hosie, L., & Storr, J. 2013. Hand Hygiene – when and how should it be done? Nursing Times. 109(38):16-18. Sax, H., Allegranzi, B., Uckay, I., Larson, E., Boyce, & J., Pittet, D. 2007. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. Journal of Hospital Infection. 67:9-21. Stephen-Haynes, J. 2014. How to ensure better infection control in the patient’s home. Journal of Community Nursing. 28(3):76-80. Swanson, J., & Jeanes, A. 2011. Infection control in the community: a pragmatic approach. British Journal of Community Nursing. 16(6)282-288. United Kingdom: National Institute for Health and Care Excellence. 2012. Healthcare associated infections: prevention and control in primary and community care. Manchester. World Health Organization. 2009. Health Care Associated Infection and evidence of the importance of hand hygiene. Geneva. World Health Organization. 2006. Your 5 moments of hand hygiene. Geneva.


Primary/community healthcare FOCUS

THE GLAMOROUS ROLE OF A COMMUNITY STOMAL THERAPIST By Trish Griffin Stomal therapy nursing is rarely described as glamorous. Indeed sometimes the stomal therapist is referred to as “The BAG” lady – a label I personally hold in high regard. Every day we are privileged to see our patients transform from a state of crisis, distress and fear for their future to people independent, confident and ready to face the challenges of life. Without a doubt it is one of the most rewarding experiences for a nurse working in the primary and community health setting – simply because we are making a tangible difference to people in dire need of assistance. There are many reasons people require a stoma. Often it is due to cancer, acute injury or a debilitating chronic illness. The surgery is life saving and, at the same time, life challenging. To see a part of your internal organ protruding from your abdomen with bodily waste draining is very confronting and impacts the person on many levels. The physical, psychological and cultural changes are often layered with hidden shame and isolation. The barriers are many and as people overcome the various hurdles and gradually find independence an inner strength is highlighted. I am one of six RDNS stomal therapy nurses who visit people in their homes in the Melbourne metropolitan area. Often our first visit is the day after discharge from hospital when the shock and reality of a stoma is at the forefront of people’s distress. With the ever increasing demands for bed space and rapid discharges from hospital, the demand on our community-based service is becoming increasingly apparent to help relieve the distress of stoma patients once they are home. There are also the often forgotten anmf.org.au

people with stomas – the aged, people with complex and chronic illness and the disabled. There is a need to support and problem-solve stoma complications that can potentially cause distress and often rehospitalisation if intervention is not prompt or forthcoming. Everyone deserves the opportunity to have specialist care at home where they can feel safe and their dignity can remain intact. The stomal therapist will often only be required until independence can be resumed or one of the general nursing staff can continue care.

THERE IS A NEED TO SUPPORT AND PROBLEMSOLVE STOMA COMPLICATIONS THAT CAN POTENTIALLY CAUSE DISTRESS AND OFTEN REHOSPITALISATION IF INTERVENTION IS NOT PROMPT OR FORTHCOMING Stomas do not discriminate. Age, ethnicity, socio-economic or demographics are not factors. Whether it is a visit to a stoma patient in hospital, a homeless shelter, a million dollar mansion or an overcrowded hospital ward in Africa, the common denominator is knowledge-sharing, compassion and providing a solution to facilitate an improved future and positive outcome.

Product accessibility, reassurance and practical solutions are the main requirements. There is no script to follow and often no standard procedure as needs can be so diverse. At times it will take a variety of interventions working as a team to find solutions to bring about a positive result.


The aim is to provide our stoma clients (and those whom the stoma impacts) with specialist knowledge and the tools so they can confidently remain at home, reducing the chance of readmission to hospital or an institution. We cannot change the diagnosis or prognosis; we can provide reassurance that life can go forward despite the stoma. In collaboration with our clients we work through optimal solutions to suit their needs. The daily battles with chemotherapy, radiation therapy, decreased mobility and many other coexisting medical issues already have an impact on people’s lives. To leave the sanctuary of the home is often a challenge; to visit people in their home provides us with insight into the reality of their life challenge. The essence of the stomal therapy nurse’s role is as complicated and layered as the people we visit. It is far more than just cutting a hole in a bag and sticking it on. It is very fortunate that RDNS continues to value the specialist nurse roles and, as a consequence, I believe that our nursing staff in the community can not only continue to provide optimal care to our stoma clients but also see the glamour in a job they adore. RDNS nurse Trish Griffin: making a difference from Melbourne to Africa https://youtu.be/Wh5Jagui9ys

Trish Griffin RN is Clinical Nurse Consultant Stomal Therapy at RDNS in Melbourne

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MAKING THE MOVE TO PRIMARY HEALTHCARE – UNEARTHING THE EXPERIENCES OF ACUTE CARE NURSES TRANSITIONING TO PHC EMPLOYMENT By Christine Ashley There wouldn’t be a nurse who hasn’t experienced that sinking feeling when waking up on the day they are about to start work in a new position. Transitioning to a new area in the hospital or an exciting position in a different environment is part and parcel of belonging to a profession which is unique in the multitude of professional opportunities on offer. Yet what do we know about the transitioning process of nurses moving from acute care settings to primary healthcare roles? What enables nurses to quickly ‘hit the ground running’? What elements of an orientation make a difference to the positive or negative perceptions of a new role in primary healthcare? Perhaps of particular importance, what incidents and ‘near misses’ occur in those early days in new roles due to lack of professional support and inexperience? These questions and many more are being researched by Christine Ashley, a doctoral student at the University of Wollongong’s School of Nursing under the guidance of Australia’s only Professor of Primary Healthcare Nursing, Dr Elizabeth Halcomb, and Associate Professor Angela Brown, Head of School.


Christine is undertaking a mixed methods study which explores the experiences of registered nurses who have transitioned to primary healthcare nursing within the last five years. A national survey has already provided a plethora of quantitative findings, and a series of interviews are being undertaken with selected survey participants to help answer the research questions.

In light of the number of nurses who are moving to primary healthcare roles from acute care settings, (according to the latest statistics from the NMBA, one in eight nurses identify as working in primary healthcare) it is surprising that there has been very limited published work about the experiences of these nurses. Christine’s study aims to fill this knowledge gap.


“Even when I undertook an international review of the literature, (Ashley et al. 2016) I was able to identify less than 10 peer reviewed papers which explored this specific issue – yet the new graduate transitioning experience has been well documented,” Christine said. “If we know so little about the experience, how can we plan evidence based transition and orientation programs to assist acute care nurses moving to primary healthcare roles?” The research will be completed by mid-2017. It is anticipated that the outcomes from the study will provide evidence for the development of a transitioning framework which in turn will provide guidance to individual nurses thinking about moving to primary healthcare, and to employers wanting to attract the right people to their organisations. It is also likely to be of value to educators and academics preparing and delivering primary healthcare programs, and policy makers keen to ensure that funding for recruitment and retention of nurses provide the best return on their investment. More information about Christine’s study can be obtained from: cma130@uowmail.edu.au

Reference Ashley, C., Halcomb, E. & Brown, A. 2016. Transitioning from acute to primary healthcare nursing: an integrative review of the literature. J Clin Nurs. DOI: 10.1111/ jocn.13185

Christine Ashley is an RN and a Doctoral Candidate in the School of Nursing, Faculty of Science, Medicine and Health at the University of Wollongong

Primary/community healthcare FOCUS

THE NEED FOR MORE OCCUPATIONAL HEALTH NURSING RESEARCH IN AUSTRALIAN INDUSTRY By Robyn Stone, Wendy Cross and Cheryle Moss Occupational Health Nurse Robyn Stone is researching health outcomes from worker health assessment and worker health intervention programs in an Australian manufacturing industry. Her research is being supervised by Professor Wendy Cross and Associate Professor Cheryle Moss at Monash University. Occupation Health Nursing (OHN) began in the 19th century under the umbrella of community or public health nursing and began when factories employed nurses to oversee the health of their workers (Burgel & Childre, 2012). Initially this was referred to as industrial nursing because of the work location. Today Occupational Health Nurses (OHNs) are employed in countries around the world including USA, United Kingdom, Europe, Japan and Australia (Hanna & Campbell, 2012). They work in a variety of different workplaces including manufacturing, retail, hospitality and health and are the largest group of health professionals associated with the workplace (Oakley, 2008). Whilst the educational qualifications and job descriptions may vary slightly between countries (Staun, 2012), the aim of the OHN remains to care for the health and wellbeing of the worker. OHNs are involved in a wide range of duties which include not only the traditional emergency care of the injured worker, advice on policy and anmf.org.au

procedure, case management, and the health surveillance and health promotion of workers (Oakley, 2008). Both nationally and internationally, OHNs undertake health promotion activities in the workplace to improve the health and wellbeing of the workers. Much is written about health promotion topics including weight loss, physical activity, nutrition, blood pressure (BP), cholesterol levels and smoking. Currently one of the main topics of interest in health promotion is preventable, chronic, non-communicable diseases such as heart disease and diabetes. Available statistics show that each year millions of dollars are spent in healthcare treating chronic illnesses, such as these (Lal et al. 2012). Universally a number of predisposing factors increase the risk for chronic health conditions and these factors include obesity, lack of physical exercise, poor nutrition, smoking and hypertension (Redmond & Kalina, 2009). However, very little OHN research is undertaken in Australia. The majority of the literature concerning health promotion programs and the activities of the OHN in the workplace comes from the USA, UK and Europe. Often the benefits obtained from

these programs are not immediate and are difficult to measure and quantify in a short term timeframe. What is successful in one industry or country may not necessarily translate successfully into another workplace or country as all worksites are different dependent on type of industry, location, culture and legislation (Oakley, 2008). From an Australian perspective more research needs to be conducted into the impact that the OHN can have on workers’ health and wellbeing with the use of health promotion programs.


Robyn Stone is an Occupational Health Nurse, and a PhD student at Monash University Professor Wendy Cross and Associate Professor Cheryle Moss are academics who work in the School of Nursing and Midwifery at Monash University

References Burgel, B. J., & Childre, F. 2012. The occupational health nurse as the trusted clinician in the 21st century. Workplace Health & Safety, 60(4), 143-150. doi:http://dx.doi. org/10.3928/2165079920120328-24 Hanna, J. K., & Campbell, K. N. 2012. Occupational health nursing around the world. Workplace Health & Safety, 60(6), 251252. doi:http://dx.doi. org/10.3928/2165079920120529-03 Lal, A., Moodie, M., Ashton, T., Siahpush, M., & Swinburn, B. 2012. Health care and lost productivity costs of overweight and obesity in New Zealand. Australian and New Zealand Journal of Public Health, 36( 6), 550-556. Oakley, K. (2008). Occupational Health Nursing (3rd ed.). Chichester, West Sussex, England: John Wiley and Sons Ltd. Redmond, M., & Kalina, C. 2009. A successful occupational health nurse-driven health promotion program to support corporate sustainability. AAOHN Journal, 57(12), 507-514. doi:10.3928/0891016220091116-02 Staun, J. M. 2012. Occupational health nursing and the European dimension. Workplace Health & Safety, 60 (3), 122-126. doi:http://dx.doi. org/10.3928/2165079920120216-02

August 2016 Volume 24, No. 2  35

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Discover your Personal and Professional Potential in Canberra with Mental Health, Justice Health, and Alcohol & Drug Services (MHJHADS)



By Catherine Stephen

Are you a Registered Nurse, Social Worker, Occupational Therapist, Psychologist or Medical Officer? Do you have a specialist range of skills in the areas of Mental Health, Justice Health or Alcohol or Drug Services? If you have answered yes to the questions above then we want to hear from you as we are recruiting now. The range of specialist services include Programs in the following areas; • Adult Acute Mental Health Services • Adult Community Mental Health Services • Alcohol and Drug Services • Child and Adolescent Mental Health Services • Justice Health Services • Rehabilitation and Speciality Mental Health Services Do you know that Canberra is now rated as the Number 1 City in the world to live? The Canberra community has diverse culture and a population of 379,000 people with all the amenities of a city but without the stress. Now for a little about us; the ACT Health Division of Mental Health, Justice Health and Alcohol & Drug Services (MHJHADS) delivers a broad range of acute and community services delivered through partnerships with community and other government organisations. There is a major focus on Consumer & Carer participation in all aspects of service planning and delivery. Our innovative Models of Care have been developed utilising a population health framework and are informed through extensive consultation, and designed to embrace best evidence practice to meet National Standards and the principles of Person Centred Care. For more information, please go to www.health.act.gov.au and click on: Employment – Current vacancies Jodie Bowden Manager - Service Development Mental Health, Justice Health and Alcohol & Drug Services Phone: 02 6207 6279 Mobile: 0407207800 Email: jodie.bowden@act.gov.au www.health.act.gov.au For more information visit http://www.canberrayourfuture.com.au www.actmentalhealthjobs.com

36  August 2016 Volume 24, No. 2

Hypertension is currently the most frequently seen condition in Australian general practice (Britt et al. 2015). Of the 4.6 million Australians living with hypertension, many struggle to keep their blood pressure under control and are at increased risk of renal failure, cardiovascular disease and premature death (Australian Institute of Health and Welfare, 2015; Cadilhac et al. 2012). The General Practice Nurse (GPN) has a significant role to play in supporting self-management and lifestyle risk factor reduction. The Impress study sought to test a general practice nurse-led intervention for hypertension management in general practice. During 2014/15 ten general practices in Sydney NSW participated in the study, with 90 consumers with uncontrolled hypertension taking part. Consumer participants received consultations and/or telephone support by the

GPN for six months. During these consultations GPNs provided tailored lifestyle advice, action planning, health monitoring and motivational counselling. Ms Catherine Stephen is undertaking the analysis of the process evaluation interviews with participating GPNs, GPs and consumers from this study for her Bachelor of Nursing (Honours) course. These interviews revealed the intervention was feasible and acceptable. Despite initial time and workload issues, the intervention highlighted the potential of GPN as a ‘coach’. Consumers valued the GPNs approach to care, reporting enhanced motivation to make lifestyle changes and maintain health goals. Data indicated the GPN role could be optimised through the development of motivational counselling skills, enhanced collaborative practice and offering frequent consumer follow up. These findings emphasise the potential of the GPN to significantly contribute to improved consumer health outcomes in general practice. Project Team: Professor Nicholas Zwar, Mr Oshana Hermitz and Professor Elizabeth Halcomb

References Australian Institute of Health and Welfare. 2015. Cardiovascular disease, diabetes and chronic kidney disease. Series no. 4. Cat. no. CDK 4. AIHW, Canberra. Britt, H., Miller, G.C., Henderson, J., Bayram, C., Harrison, C., Valenti, L., Wong, C., Gordon, J., Pollack, A.J., Pan, Y. & J. C. 2015. General practice activity in Australia 2014–15 (Sydney Uo ed.). Sydney University Press, Sydney, NSW. Cadilhac, D.A., Carter, R., Thrift, A.G. & Dewey, H.M. 2012. Organized blood pressure control programs to prevent stroke in Australia: Would they be costeffective? Stroke (00392499) 43, 13701375 1376p.

Catherine Stephen is a Nursing Honours Candidate at the University of Wollongong in NSW anmf.org.au

Primary/community healthcare FOCUS

References Braun, V. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology 3(2): 77-101.


Crettenden, I. F., McCarty, M. V., Fenech, B. J., Heywood, T., Taitz, M. C. and Tudman, S. 2014. How evidence-based workforce planning in Australia is informing policy development in the retention and distribution of the health workforce. Human Resources for Health 12: 7.

By Susan McInnes It is anticipated that over the next decade, demand for primary care services will exceed the capacity of the general practice workforce (Crettenden et al. 2014). Collaboration may help alleviate workforce stressors by ensuring that the most appropriate team member delivers care in an efficient and timely manner (Wagner et al. 2001). However, the literature suggests that general practitioners and nurses do not routinely collaborate in general practice (McInnes, 2015). The research described in this article presents findings from a qualitative study conducted by Susan McInnes, a PhD Candidate at the University of Wollongong. Susan’s study explores the nature of collaboration between general practitioners and registered nurses who work in general practice. Insight into these issues has the potential to increase the role of general practice nurses and inform strategies that enhance the coordination of care in this somewhat unique workplace.


Fourteen registered nurses and eight general practitioners participated in individual face to face interviews between February and May 2015. Participants were purposefully recruited from two primary health networks in NSW. Maximum variation

was sought by including city, metropolitan and rural practices as well as solo through to large group practices. Interviews were transcribed and underwent an inductive process of thematic analysis (Braun and Clarke, 2006).


Findings suggest that the fee for service funding arrangement, dominant in Australian general practice, did not promote collaboration between general practitioners and registered nurses. Rather than supporting the cocoordination of care, this funding arrangement appeared to promote co-consultations which generate income. It was also apparent that GPs did not always have a full appreciation of the registered nurses scope of practice and this limited collaboration and the nurse’s role within the team. Factors that supported collaboration included structured clinical meetings, educational opportunities, a nonhierarchical environment and positive team dynamics. Research team: Susan McInnes, Professor Elizabeth Halcomb, Professor Andrew Bonney and Associate Professor Kath Peters

McInnes, S., Peters, K., Bonney, A., Halcomb, E. 2015. An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. Journal of Advanced Nursing 71(9): 1973-1985. Wagner, E. H., Austin, B. T., Davis, C., Hindmarsh, M. and et al. 2001. Improving chronic illness care: Translating evidence into action. Health Affairs 20(6): 64-78.

Susan McInnes is a PhD Candidate in the School of Nursing, Faculty of Science, Medicine & Health at the University of Wollongong

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The care of older people at the end of life is a key element of primary and community care. The Decision Assist – Palliative Care Linkages project aimed to improve end of life care given to older Australians through establishing linkages between aged care and specialist palliative care services. One strategy to achieve this is the link nurse role, whose responsibility it is to coordinate the interactions between services in providing this care. Various approaches to the role have been identified (Blackford & Street, 2001; Byron et al. 2007; Epiphaniou et al. 2014; Hasson et al. 2008; Meier et al. 2004; Morin et al. 2007), and when successfully implemented, it can improve access to specialist services for clinicians, promote greater cooperation between services, and enable improved continuity of care to clients. The Linkages project saw 10 demonstration sites pilot this role. The link nurse role was not to simply ‘do the work’ of aged care nurses. Instead, it builds the capacity of the aged care workforce to provide end of life care for older persons in their usual place of residence. One participant said the link nurse “helped us make sure we are asking the right questions”. Designed to provide a coordinated and proactive approach to care, the nurses’ responsibilities varied. Their expertise included overseeing advance care planning; recognising


dying; planning care; initiating and conducting family meetings; symptom control; enabling more appropriate referrals to specialist palliative care; providing one-on-one or small group training on site; offering staff debriefing; and engaging external stakeholders. A suite of tools to guide clinical decision making was developed and implemented by link nurses in many sites. Differing levels of success and sustainability were achieved. Success factors for the link nurse role included strong management support, clear expectations of the role, receptiveness to the role in the workplace, and the skill set of the link nurse. Some care staff and other members of the care team resisted the role, however with some improved outcomes for clients, the potential for improved care was seen. Sustainable change to practice was evident across the 10 sites; as one demonstration site stated, “This is now part of our core business.” Dr John Rosenberg is a Research Fellow at the Queensland University of Technology

Blackford, J., & Street, A. 2001. The role of the palliative care nurse consultant in promoting continuity of end-of-life care. International Journal of Palliative Nursing, 7(6), 273-278. Byron, S., Moriarty, D., & O’Hara, A. 2007. Macmillan nurse facilitators: establishing a palliative resource nurse network in primary care. International Journal of Palliative Nursing, 13(9), 438-444. Epiphaniou, E., Shipman, C., Harding, R., Mason, B., Murray, S. A., Higginson, I. J., & Daveson, B. A. 2014. Coordination of end-oflife care for patients with lung cancer and those with advanced COPD: are there transferable lessons? A longitudinal qualitative study. Primary Care Respiratory Journal, 23, 46-51. Hasson, F., Kernohan, W. G., Waldron, M., Whittaker, E., & McLaughlin, D. 2008.

The palliative care link nurse role in nursing homes: Barriers and facilitators. Journal of Advanced Nursing, 64(3), 233-242. Meier, D. E., Thar, W., Jordan, A., Goldhirsch, S. L., Siu, A., & Morrison, R. S. 2004. Integrating case management and palliative care. Journal of Palliative Medicine, 7(1), 119-134. Morin, D., Saint-Laurent, L., Bresse, M. P., Dallaire, C., & Fillion, L. 2007. The benefits of a palliative care network: a case study in Quebec, Canada. International Journal of Palliative Nursing, 13(4), 190-196.

The Australasian Rehabilitation Nurse’s Association is proud to announce their


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Primary/community healthcare FOCUS

HOW’S YOUR HEART? SEIZING OPPORTUNITIES TO ENGAGE NURSES IN COMMUNITY HEALTH PROMOTION EARLY IN THEIR CAREERS By Suzzanne Owen and Julie Shaw Opportunities for student nurses to consolidate their new clinical skills and engage in health promotion in the community setting at the beginning of their careers are not common. Yet clinical placements for student nurse practice are becoming more difficult to access, while opportunities for the general public to engage in health promotion activities at no cost to themselves in the non-clinical environment are rare. In addressing these issues Griffith Health initiated health promotion projects that coincided with university events and consumer driven health promotion activities for example, Healthy Heart and Healthy Kidney weeks, during 2012-2014.

were assessed both manually and with automatic monitors. Community participants were informed of their blood pressure measurements and if found to have an aberrant reading a further assessment was undertaken by the supervising registered nurse. Those found to be in the prehypertensive or hypertensive states as per the Guide to Hypertension (National Heart Foundation Australia [NHFA], 2012) were advised to seek further medical advice.

Over the three year period a total of 124 first year student nurses, supervised by nine volunteer registered nurses, provided basic health assessments for 6,094 community members who volunteered to participate in the project.

Information collected included the number of participants, participant blood pressure per age group, plus student nurse satisfaction with participation in the projects gained from student surveys taken at the end of individual student participation. Griffith University Human Ethics Committee granted ethical approval for these projects.

Student nurses obtained all participants’ consent, health history, weight and vital signs. Vital signs

The practical outcomes of these projects were that students: appreciated the importance of seizing

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

THE PRACTICAL OUTCOMES OF THESE PROJECTS WERE THAT STUDENTS: APPRECIATED THE IMPORTANCE OF SEIZING THE OPPORTUNITY TO PROMOTE HEALTH BY UNDERTAKING HEALTH ASSESSMENT IN NON-CLINICAL ENVIRONMENTS the opportunity to promote health by undertaking health assessment in non-clinical environments; valued the opportunity to ‘feel like’ real nurses; recognised the impact and benefits of a quality health assessment in the community; gained a clearer understanding of the relevance of health promotion by nurses in the community; appreciated the benefits of using health promotion opportunities to engage with and inform the public on their general health as student nurses discovered that participants were interested in but some were unaware of their health status. In fact 42% of the public participants, under 55 years, were considered high risk for hypertension (NHFA, 2012). Community participants acknowledged their appreciation of finding out about their health status sooner rather than later. Importantly additional opportunities for clinical placement were identified and trialled and students became more confident in their clinical assessment and communication skills.

Reference National Heart Foundation of Australia [NHFA]. 2010. Guide to management of hypertension 2008. Updated December 2010. Melbourne: NHFA. Retrieved from http //heartfoundation. org.au/publications#F 23 April 2016.

Associate Professor Suzzanne Owen is in the Health Executive and Ms Julie Shaw is in the School of Nursing & Midwifery at Griffith University, both are members of the Menzies Health Institute Queensland

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FOCUS Primary/community healthcare

PRIMARY MENTAL HEALTHCARE FOR AUSTRALIANS: MENTAL HEALTH NURSES LEADING THE WAY By Christopher Patterson and Lorna Moxham In 2008, the World Health Organization (WHO) released a report on integrating primary health into primary care. The key message of the report was ‘integrating mental health services into primary care is the most viable way of ensuring that people get the mental healthcare they need’ (WHO, 2008, p1). WHO (2008) argued that a renewal and reinvigoration of primary care for mental health was important, now more than ever. Indeed, the report evokes the Declaration of Alma-Ata (WHO, 1978) which declared primary healthcare as essential for people to attain holistic health and key to any comprehensive national health system. Primary mental healthcare is personcentred; an approach that underpins nursing care and values. Effective primary mental healthcare involves early intervention for people with mental illness and research shows that early intervention is necessary. Such an approach means putting prevention strategies in place and ensuring healthcare professionals, including nurses who make up the majority of the healthcare workforce, who work in primary care have the appropriate knowledge and skills to apply key psychosocial and behavioural interventions. So where are we up to in Australia? In December 2014 the National Mental Health Commission (NMHC) submitted its national review of mental health programs and services, titled Contributing Lives, Thriving Communities - Review of Mental Health Programmes and Services to the Commonwealth government. The Commission reported a mental health system in need of revitalisation; one that is fragmented, that does not see the whole person and one that uses resources poorly (NMHC, 2014). The greatest level of funding for the mental health system is targeted toward areas such as acute care in-patient facilities, failing to prevent avoidable complications in people’s lives (NMHC, 2014); a core primary health focus. To achieve a truly person-centred approach, the NMHC (2014) argued that what is needed is a mental health system that enables a person and 40  August 2016 Volume 24, No. 2

their families to look after themselves. To achieve this there needs to be a shift in funding and resources, to rebalance the system towards prevention, early intervention, recovery and participation, and reduce ED presentations, acute admissions and avoidable readmissions.


In late 2015 the Australian government released its response to the NMHC’s review (Commonwealth of Australia, 2015). Here the Australian government agreed with the NMHC the need for system reform, focusing care towards early intervention and away from acute and crisis intervention. Key points the government declared it needed to achieve were to: focus on promotion and prevention; increase early intervention; provide and promote access to lower cost, lower intensity services; and, improve access to primary mental healthcare intervention to promote recovery (Commonwealth of Australia, 2015, p. 9). At the forefront of these primary mental healthcare plans was enhancing services delivered by mental health nurses.

The Mental Health Nurse Incentive (MHNIP) program is an exemplar. An independent evaluation of the MHNIP (Department of Health and Ageing, 2012) found the following: Appropriateness: MHNIP provides support to a sizeable group in the community – people with severe and persistent mental health illness who are primarily reliant for their treatment on GPs and psychiatrists in the private sector (around 0.6% of the adult population). The model of care involving clinical treatment and support provided by mental health nurses received strong endorsement from patients, carers, medical practitioners and relevant peak bodies. Effectiveness: people receiving treatment and support under MHNIP benefitted from improved levels of care due to greater continuity of care, greater follow-up, timely access to support, and increased compliance with treatment plans. There was evidence of an overall reduction in average hospital admission rates and reduced hospital lengths of stay where admissions did occur. People supported by MHNIP had increased levels of employment and improved family and community connections. MHNIP has had a positive impact on medical practitioner workloads by increasing their time available to treat other patients and improve patient throughput. Efficiency: Cost analysis suggests that savings on hospital admissions attributable to MHNIP were on average around $2,600 per patient per annum. This was roughly equivalent to the average direct subsidy levels of providing MHNIP. There are a large number of un-costed and intangible benefits associated with MHNIP, including the impacts of improved consumer outcomes, enhanced relationships with carers and family members, and the effects on carer social security outlays. The evaluation findings suggest a comprehensive economic analysis would find these benefits to be positive. What does this all mean? Given that the model of care underpinning MHNIP is well regarded and has positive outcomes, perhaps we need to see more MHNIP nurses. After all, nurses can and are proving to make a difference. A copy of the Evaluation of the MHNIP can be found at www.health.gov.au/internet/main/ publishing.nsf/Content/mentalpubs-e-evalnurs

References Commonwealth of Australia. 2015. Australian government response to contributing lives, thriving communities – Review of mental health programmes and services, Commonwealth of Australia, Canberra Department of Health and Ageing. 2012. Evaluation of the Mental Health Nurse Incentive Program: Final Report, Healthcare Management Advisors National Mental Health Commission. 2014. Contributing Lives, Thriving Communities - Review of Mental Health Programmes and Services, National Mental Health Commission, Sydney World Health Organization. 1978. Primary health care: Report of the international conference on primary health care, Alma-Ata, USSR World Health Organization. 2008. Integrating mental health into primary care: A global perspective, World Health Organization and World Organization of Family Doctors, WHO Press, Switzerland

Christopher Patterson is a Lecturer, Mental Health First Aid Instructor in the School of Nursing at the University of Wollongong Lorna Moxham is Professor of Mental Health Nursing at the University of Wollongong anmf.org.au


RESEARCH: PATIENT DETERIORATION PATIENT SAFETY By Catherine Chung, Simon Cooper, Leigh Kinsman, Lisa Evans and Angela Cahill Inadequate management of deteriorating patients is of international concern. In order to tackle this issue there has been an increasing effort to upskill nursing and medical staff (Australian Commission on Safety and Quality in Healthcare, 2012). Mandatory ‘track and trigger’ coloured observation charts make recognition of patients’ vital signs and clinical abnormalities clearer. However, little is known about the impact of these contemporary approaches and the degree to which they influence the recording of vital signs and influence help seeking behaviour. The Victorian government has supported a patient safety project that aims to test the clinical and financial impact of the First2Act web based and face-to-face patient deterioration programs with partners at St John of God, Central Gippsland Health Service, Latrobe Regional Hospital and Monash Health. Either the web based or the face-to-face program will be delivered to medical ward nursing staff. The key objective is to measure and compare the cost-effectiveness and clinical impact of each intervention measuring learning outcomes, associated costs and clinical impact which will primarily be achieved through the review of 2,000 vital signs charts. anmf.org.au

Details of the First2Act programs are available at http://first2actweb.com The face-to-face program runs for two hours for a team of three participants and includes simulations with patient actors (Buykx et al. 2012). The 1.5 hour web based program is available free on the website and includes interactive video based scenarios which to date have been completed by 16,000 participants from across the world. The study is due to be completed in December 2016 with final reports available in the new-year. For further information please contact: Professor Simon Cooper s.cooper@federation. edu.au or Project Manager Catherine Chung catherine.chung@federation. edu.au Acknowledgement - Federation University acknowledges the support of the Victorian government. Catherine Chung is a Lecturer and Project Manager – Impact

of face-to-face and web-based simulation on patient safety in the School of Nursing, Midwifery and Healthcare, Faculty of Health at Federation University Australia, Gippsland Campus Professor Simon Cooper is Professor of Emergency Care and Research Development in the School of Nursing, Midwifery and Healthcare, Faculty of Health at Federation University Australia, Gippsland Campus Professor Leigh Kinsman is Professor of Healthcare Improvement in the School of Health Sciences, Faculty of Health at the University of Tasmania Lisa Evans is Director of Nursing at St John of God Berwick Hospital in Victoria Angela Cahill is Deputy Director of Nursing at St John of God Bendigo Hospital in Victoria and the First2Act Impact team

References Australian Commission on Safety and Quality in Health Care. 2012. Quick-start Guide to Implementing National Safety and Quality Health Service Standard 9: Recognising and responding to clinical deterioration in acute health care. Sydney ACSQHC. Buykx, P. Cooper, S., Kinsman, L., Endacott, R., Scholes, J., McConnell-Henry, T., Cant, R. 2012. Patient deterioration simulation experiences: Impact on teaching and learning. Collegian 19(3):125-129.

August 2016 Volume 24, No. 2  41

FOCUS Primary/community healthcare


LARCs include intrauterine devices (IUDs) and progesterone implants. National and global clinical guidelines recommend increased use and promotion of LARCs for optimal health outcomes. The national Bettering the Education and Care of Health (BEACH) data from general practice has shown that despite these global recommendations, a shift towards prescribing LARCs is yet to occur in Australian general practice (Mazza et al. 2012). Furthermore, another recent study has shown that the proportion of LARC use in Australia was only 7%, well behind United States (10%) and Europe (10–32%) (Eeckhaut et al. 2014).

By Linda Sweet Effective primary healthcare (PHC) is meant to support people to manage their health issues in the community, resulting in less hospitalisation, fewer health inequalities and better health outcomes for all people. This being said, unplanned pregnancy remains an urgent and pressing key health issue in Australia.


In South Australia alone, approximately 19% of reported pregnancies ended as terminations in 2013 (Scheil et al. 2013), with an estimated 80,000 terminations being performed nationally (Australian Healthcare and Hospitals Association, 2016). Why are we failing women in managing their fertility and family planning? CHOICE cites a national survey, arguing that despite 70% of women using contraception, 50% of women in Australia experience an unplanned pregnancy (Seftalovich and Gruber, 2015). This means that there are a significant number of hospitalisations (for terminations) that can be avoided

with more effective family planning. One potential solution is getting more women to use long-acting reversible contraceptives (LARCs), because unlike other forms of contraception, human error has little impact on the effectiveness of LARCs. The most common contraceptive used in Australia continues to be the combined oral contraceptive pill. As a method however, ‘the pill’ involves significant potential user error, requiring daily action by women to remain effective. Despite the popularity of the pill, we know that apart from abstinence and sterilisation, the most effective forms of contraception are LARCs.

LARCs require insertion by a trained healthcare clinician. Historically in Australia, this has been the domain of the general practitioner or specialist doctor, limiting their accessibility – but this does not need to be the case. Nurses and midwives are appropriately educated to undertake the insertion training and offer LARC insertion for women. However, our current primary healthcare models, and the concomitant funding models limit this being a reality, and thus we are failing to meet universal accessibility of LARCs for women in Australia. Until we have improved funding models and broader scope of practice for nurses and midwives in PHC, women’s reproductive health and family planning will continue to be undermanaged resulting in less than optimal health.

References Scheil, W., Jolly, K., Scott, J., Catcheside, B., Sage L., Kennare, R. 2015. Pregnancy outcome in South Australia 2013. Pregnancy Outcome (Statistics) Unit. Adelaide, government of South Australia Australian Healthcare and Hospitals Association. 2016. A health system that supports contraceptive choice2016. http:// ahha.asn.au/sites/ default/files/docs/page/ final_report_ahha__a_health_system_that_ supports_contraceptive_ choice_-_results_and_. pdf (accessed 2 June 2016). Sheftalovich, Z., Gruber, I. 2015. Contraception options go beyond the pill. www.choice.com. au/health-and-body/ reproductive-health/ contraception/buyingguides/contraception (accessed 2 June 2016). Mazza, D., Harrison, C., Taft, A., et al. 2012. Current contraceptive management in Australian general practice: An analysis of BEACH data. Medical Journal of Australia 197(2): 110-4. Eeckhaut, M.C.W., Sweeney, M.M., Gipson, J.D. 2014. Who is using long-acting reversible contraceptive methods? Findings from nine low-fertility countries. Perspectives on Sexual and Reproductive Health 46(3): 149-55.

Associate Professor Linda Sweet is in the School of Nursing and Midwifery at Flinders University

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CALL OR EMAIL US NOW 42  August 2016 Volume 24, No. 2


Primary/community healthcare FOCUS

References Kemp, L., Harris, E., McMahon, C., Matthey, S., Vimpani, G., Anderson, T., & Schmied, V. 2008. Miller early childhood sustained home-visiting (MECSH) trial: design, method and sample description. BMC Public Health. 8:424. doi: 10.1186/1471-24588-424. Kemp, L., Harris, E., McMahon, C., Matthey, S., Vimpani, G., Anderson, T., Schmied, V., Aslam, H., & Zapart, S. 2011. Child and family outcomes of a long-term nurse home visitation program: a randomised controlled trial. Archives of Disease in Childhood. 96(6): 533-540. doi: 10.1136/ adc.2010.196279.


US Department of Health and Human Services. 2014. Home visiting evidence of effectiveness. http:// homvee.acf.hhs.gov Accessed 20 May 2016.

By Lynn Kemp, Tracey Bruce and Fiona Byrne Nurse led home visiting programs as an intervention to invest in children’s health and wellbeing is considered a useful and effective way to deliver a health and parenting service (US Department of Health and Human Services, 2014). The Maternal Early Childhood Sustained Home-visiting (MECSH) intervention is an Australian program that evolved from a research trial conducted in a disadvantaged community in south western Sydney, NSW (Kemp et al. 2008). The MECSH trial found that new mothers had improved confidence in parenting and improved self-reported health; children were breastfed for longer and were living in a more developmentally nurturing environment (Kemp et al. 2011). MECSH is embedded into the local universal child and family service system. The components of the program are delivered through at least 25 home visits by the same nurse where the relationship is ideally established during pregnancy and sustained until the child reaches two years of age. Families also participate in group activities and are linked into community services and supports. A primary goal of the MECSH program is to develop and promote parents’ aspirations for themselves and their anmf.org.au

children. This involves modelling and supporting parental skills in problem solving day to day issues, being future focussed for themselves and their child/ren, promoting the capacity of parents to support their child/ren’s health and development, and parent effectively despite all the difficulties they face in their lives. The knowledge and skills parents gain from MECSH can lead to positive long term outcomes for families and their children (Zapart, et al. 2016). We recently received a message from a participant involved in the original trial illustrating this point. Names have been changed to protect identities. When this mum entered the MECSH program she was a victim of family violence, suffered from agoraphobia, had a baby and her older child, Sianna, was seven years old and not attending school regularly. Hey [Julie], [Sianna] has been accepted to uni to study speech therapy, [I’m] immensely proud and not allowed to brag about it on facebook. However I wanted you to know you played a

role in her success and the success of my family unit. I know it may seem like a million years ago and [Louise] is turning 11 next week but the effects of that time and your visits, support and advocacy still ripple through my life. Support that the program offered does pay off, and situations can change for people and families and it certainly had positive benefits for my mental health, which has definitely benefited my children and will continue to do so. Thank you so much, you’ll never know how much. Message from a MECSH program mum (11 years on from the program). The MECSH work with families is complex requiring training in the advanced practice principles of working collaboratively with families to focus on how families can adapt and self-manage within their context to realise their, and their children’s, health potential. Note: The TReSI Group is a member of the Ingham Institute for Applied Medical Research

Zapart, S., Knight, J., & Kemp, L. 2016. ‘It was easier because I had help’: Mothers’ reflections on the longterm impact of sustained nurse home visiting. Maternal and Child Health Journal. 20(1): 196-204. doi: 10.1007/ s10995-015-1819-6.

Lynn Kemp is Professor of Nursing and Director, Translational Research and Social Innovation (TReSI) Group Tracey Bruce is the MECSH Implementation Nurse Consultant, TReSI Group Fiona Byrne is MECSH Project Officer, TReSI Group All are in the School of Nursing and Midwifery at Western Sydney University

August 2016 Volume 24, No. 2  43







OUR VIETNAM NURSES: Compelling Australian stories of heroism, friendship and lives changed forever








ISBN: 978-0-7295

ISBN: 978-0-14-379702-9

In 2013, when interviewing nurses for her previous bestselling book Nurses of the Outback someone asked Annabelle Brayley if she knew any nurses who had gone to the Vietnam War. While she recalled the anti-war vitriol aimed at veterans she didn’t remember any nurses. The gap led her to penning Our Vietnam Nurses, a profoundly moving and vitally important collection of stories celebrating the previously unacknowledged contribution of all Australian nurses and medical staff, including volunteer civilians, conscripts, Army and RAAF members, who served during the Vietnam War. At times exhilarating and other poignant, the compelling collection includes the story of a civilian nurse trembling with fear in the foyer of a provincial hospital as a Vietnamese soldier jammed an assault rifle in her chest; and another account which involves a young Army nurse coming to terms with the realisation the dead soldier on the dustoff chopper is her friend. Each of the stories in Our Vietnam Nurses delivers a rare insight into the incredible courage, resilience and resourcefulness of all Australian nurses and medics who cared for almost 60,000 Australian military personnel and the South Vietnamese people during the Vietnam War. 44  August 2016 Volume 24, No. 2

ISBN: 978-1-92-1421754

Bioethics: A Nursing Perspective 6e is an essential resource for both undergraduate and post graduate students and registered nurses to develop new insights and moral wisdom around ethical issues they will face in daily clinical practice. Written by Megan-Jane Johnstone, Professor of Nursing at the School of Nursing and Midwifery, Faculty of Health, at Deakin University in Melbourne, the 6th Edition continues to set the standard for bioethical issues in nursing practice. The highly respected text features in-depth analysis of ethical issues, particularly those concerned with ethical conduct, unprofessional conduct and professional misconduct and ‘morality politics’. Case scenarios and critical questions are employed to encourage students and registered nurses to reflect on key issues relating to their own practice. The latest edition includes new chapters focussing on several areas, such as professional obligations in reporting harmful behaviours, particularly when concerning impaired practitioners, child abuse and elder abuse. A new concept, ‘cultural humility’, is also introduced, while content on palliative sedation and preventing ethical conflicts is also explored. The latest edition also highlights future ethical difficulties concerning climate change, pandemic influenza, antimicrobial resistance and health inequalities.

Nobody expects their parents to get dementia and nobody can prepare for it. Author Meredith Sindel knows the feeling first-hand and when her mother was diagnosed with dementia she decided to become her full-time carer for the next three years. Caring for Somebody with Dementia describes Sindel’s experiences of life with dementia over those three years. During that time, the presence of dementia took its toll and brought with it visible symptoms of anxiety, delusions, depression, and memory loss. Caring for Somebody with Dementia details the causes of dementia, mechanisms for dealing with the symptoms, and offers advice for carers on how to deliver care appropriately. It also gives crucial insight into the issue regarding how to maintain communication with somebody who suffers dementia. Written with compassion, humour, and love, Caring for Somebody with Dementia offers a wealth of practical information to others living or working with people with dementia and puts a human face to the illness that can empower others to face dayto-day challenges head on.

If you’ve ever wondered about what it takes to become a skilled, caring and understanding psychiatric nurse then look no further than One flew Over the Kookaburra’s Nest. The gripping book is written by former mental health nurse Kevin Moylan, a brave whistle-blower who challenged the health system in north-west Tasmania after what he saw as totally unacceptable levels of care, safety, and respect for human rights. Moylan lifts the lid on his experiences in “an unsafe workplace”, specifically recounting being lethally attacked by two psychotic patients, an episode which left him traumatised and unable to continue in the job. One flew Over the Kookaburra’s Nest examines the sequence of events that led to Moylan suffering the significant injuries that led to him losing his career, identity, and home, and importantly, how he received totally inadequate compensation for the events that transpired and the life-changing losses. Described as amazingly tenacious and having a clear and unwavering sense of right and wrong by former Australian Nursing Federation (ANF) Secretary Jill Iliffe, Moylan’s novel is one of struggle and perseverance that deserves praise.



AUGUST Lung Health Promotion Centre at The Alfred 4-5 August – Influencing Behaviour Change – a formula 17-18 August – Respiratory Course (Module B) 18-19 August - Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au International Day of the World’s Indigenous People 9 August Cystic Fibrosis Australia and New Zealand (CFANZ) Nurses Conference 10-12 August, Grand Chancellor Hotel, Launceston, Tasmania. Contact gaylene. bassett@ths.tas.gov.au Hyperbaric Technicians and Nurses Association 24th Annual Scientific Meeting 10-14 August, Hamilton Island, Queensland. http://htna.com.au/ moodle/ ANMF SA Branch Annual Professional Conference 17-18 August, Adelaide Convention Centre. https://www.anmfsa.org.au/

11th Conference of the Australian College of Nurse Practitioners (incorporating NursePrac ED) The centre of care 30 August-2 September, Alice Springs Convention Centre, Alice Springs. www.dcconferences.com.au/acnp2016/ home

SEPTEMBER How to Cope with Change – and be a Team Player 1-2 September, The Lakes Resort Hotel, Adelaide. www.ausmed.com.au/ Midwives on Board! Education at Sea Riding the waves of contemporary practice and innovation 3-16 September, NCL Jade: Greek Island cruise departing Venice. www.educationatsea.com.au/ conferences/midwives-on-board-2016 Deakin University School of Nursing and Midwifery invites you to hear about our innovative postgraduate degrees 6 September, 5.00-6.30pm, Melbourne Burwood Campus. www.deakin.edu.au/nursing-midwifery/ upcoming-events or Ph: (03) 9244 3059

ANMF Vic Branch - Working Hours, Shifts and Fatigue Conference 18 August, Carson Conference Centre, Melbourne. www.anmfvic.asn.au/eventsand-conferences

Enrolled Nurse Professional Association Conference I can and I will. Watch me! 8-9 September, Novatel North Beach Hotel, Wollongong NSW. www.enpansw.org/

Endocrine Nurses Society of Australasia Annual Symposium Endocrinology: Transition through the ages 22 August, Gold Coast Convention Centre, Qld. www.ensa.org.au

ANMF Vic Branch - Australian Nurses and Midwives Conference 8-9 September, Melbourne Convention and Exhibition Centre. www.anmfvic.asn.au/events-andconferences

Healthcare Leaders Forum 23-24 August 2016, Menzies Hotel, Sydney. http://healthcareleaders.com.au/

Acute Care: Seriously Ill Patients 8-9 September, The Lakes Resort Hotel, Adelaide. www.ausmed.com.au/

28th Aeromed Australasia & College of Air & Surface Transplant Nurses Aiming higher reaching further 24-26 August, Queenstown New Zealand. www.aeromedconference. com/ or www.flightnursesaustralia.com. au/our-events-1

Australasian Neuroscience Nurses Association Conference The jewel in the crown: keeping it safe in our hands 9-11 September, The Novotel, Brisbane. www.anna.asn.au

NETWORK Royal Women’s Hospital, ‘theatre staff’, 1980-1990 reunion Interested? Contact Leesa Samarin. E: samarinl@optusnet.com.au Mercy Maternity Midwifery Group August 1976, 40-year reunion 20 August. Contact Carole Ellis E: ellisfam2003@yahoo.com.au or Marie Smith (nee Allen) E: mmars_20@ hotmail.com Ballarat University, Diploma of Applied Science 1986-1988, 30-year reunion 18 September, George Hotel, 27 Lydiard Street, North Ballarat from 2pm onwards. Contact Paul Smith M: 0410 561 421 E: pcsmithrn@hotmail. com


Palliative Care Nurses Australia 6th Biennial Conference 11-12 September, Canberra ACT. www.pcna.org.au/conference

Woden Valley Hospital, L Group, 35-year reunion 1-3 October. Contact Murray Harper M: 0448 211 059 E: dodgerlily21@ bigpond.com or search Facebook page Woden Valley Hospital L Group Princess Alexandra Hospital, Group 59C 30-year reunion 7-8 October. Contact Jenny Whittle (nee Dredge) E: jennydredge@hotmail. com or search Facebook page 59C Princess Alexandra Hospital Group Royal Melbourne Hospital, October 1976, 40-year reunion 8 October, Naughtons Parkville Hotel. Contact mezzarankin@gmail.com or Kris Alderson (nee McGuigan) E: pjka@ ozemail.com.au or Jane Beetham (nee Collyer) E: beethams@mmnet.com.au

XIX International Congress for Tropical Medicine and Malaria 18–22 September, Brisbane Convention & Exhibition Centre. http://tropicalmedicine2016.com/ Australasia-Pacific Post-Polio Conference Polio: Life stage matters 20–22 September. Four Seasons Hotel, Sydney. This conference will facilitate better care and build international connections by bringing together health care providers, researchers, polio survivors, their caregivers and patient organisation representatives. www.postpolioconference.org.au IARMM General Assembly jointly with 5th World Congress of Clinical Safety 21-23 September, Harvard University Medical School, Boston, Massachusetts, USA. www.iarmm.org Australian College of Neonatal Nurses Conference 22-24 September, Rydges on Swanston, Melbourne. www.acnn.org. au/news-and-events/acnn-nationalconference/ Improving Patient Flow in Emergency Departments Innovative patient-centred models to improve outcomes 28–30 September, Crowne Plaza, Melbourne. https://akolade.com.au/ events/patient-flow-in-emergency/

OCTOBER Lung Health Promotion Centre at The Alfred 6-7 October – Managing COPD 24-25 October – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au Anti-Poverty Week 16-22 October. http://www.antipovertyweek.org.au/ about/about-anti-poverty-week Australian Disease Management Association 12th Annual National Conference Person centred healthcare: Achievements & challenges 20-21 October, Melbourne Convention Centre (MCEC). www.adma.org.au/ E: info@adma.org.au T: (03) 9076 4125

Australian Women’s Health Nurse Association 30-year anniversary inservice and reunion dinner 17-18 November, Carrington Hotel Katoomba (17 and 18 November inservice/18 November reunion dinner). E: Jenny.Bath@hnehealth.nsw. gov.au Prince Henry’s Hospital 25-year reunion 22 October, 3-9pm, Bells Hotel, 157 Moray Street, South Melbourne. Cost $38 per head (includes finger food and a complimentary drink, security and venue hire). Drinks at bar prices. Bookings essential. Dress is smart casual. To book go to http:// www.trybooking.com/JVEX Prince Henry’s Memorial Page reunion. This reunion is in honour of the hospital’s closure and demolition in 1991 (25 years ago). Go to Prince Henry’s memorial page: https://www.facebook.

18th South Pacific Nurses Forum Through nursing excellence for universal health 31 October-4 November, Honiara, Solomon Islands. Contact Edward Iuhanisuna E: spnfsina@gmail.com or www.spnf.org.au

NOVEMBER Hospital in the Home 9th Annual Scientific Meeting Bridging the GAP – Governance, Accountability, Partnerships 2-4 November, Stamford Grand, Glenelg SA. https://hithsociety. wildapricot.org/Conference Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) Annual Conference 8-10 November, Melbourne Convention Centre. http://catsinam.org. au/conference/conference-catsinam The Lowitja Institute Indigenous Health and Wellbeing Conference 8-10 November, Melbourne Convention Centre. www.lowitja.org.au/ conference 9th European Public Health Conference All for health -health for all 9-12 November, ACV, Vienna, Austria. www.ephconference.org/futureconferences-128 11th National Australian Wound Management Association Conference State of play 9-12 November, Melbourne Convention and Exhibition Centre. www.awma2016.com.au 25th National Conference on Incontinence 9–12 November, Adelaide Convention Centre. South Australia. www.continence.org.au/nationalconference.php Lung Health Promotion Centre at The Alfred 16-18 November – Asthma Educator’s Course 24-25 November - Smoking Cessation Facilitator’s Course P: (03) 9076 2382 E: lunghealth@alfred.org.au

com/Princehenryshospital/ to share memories and old photos. RAH, group 772, 40-year reunion February 2017. Interested? Contact Bronwyn Glitheroe (nee Deed), AnneMarie McBride (nee Rogers), Helen Kirby (nee Osborn) or Rhona Edwards (nee McGarrigle) E: rah772reunion@ gmail.com or search Facebook page Rah772

Email cathy@anmf.org.au if you would like to place a reunion notice August 2016 Volume 24, No. 2  45



Well, it’s finally over after eight long weeks. The campaign trail has come to an end. The media scrutiny, claim and counter claim, street walks, policy debates, all over. We can all go back to our normal lives and learn to live with the new government; but who won? I am not sure given this article was submitted well before the 2 July federal election poll. But what is certain is that as you read this article, the plight of refugees on Nauru and Manus islands will remain unchanged.

We are signatories to the United Nations Refugee Convention. We have obligations under the convention to offer a safe haven for people seeking refuge, but rather than comply with our obligations, we have politicised the future of these people and have turned our collective backs on them. Many have likened the conditions for refugees on Manus and Nauru to those of concentration camps. During the ANMF Victorian Branch Delegates Conference in 2015, Marianne Evers moved the delegates to tears when she spoke of her experiences working on Nauru. She spoke about a man who came to her sobbing in the middle of

just in dollar terms, but in our humanity. We are a generous people. On 18 May 2016 the editorial in The Age, highlighted the lack of integrity in Minister Dutton’s arguments, noting that while the refugee situation is indeed complex, resorting to punishing those fleeing war and persecution by traumatising them further in offshore detention centres is inhumane. This editorial further clarified the cost of holding one refugee in detention at $400,000 per year as opposed to living in the community at a cost of $12,000 per year.


The fiscal argument is simple. Why is it that the compassionate, humanistic argument is so much harder to understand? The tragic events surrounding the death of Reza Barati during the Manus Island riots; the rape of a young Somali woman and subsequent failure to provide a termination of the resulting pregnancy; the delayed transfer of a pregnant woman with pre-eclampsia and critical outcome for both mother and baby; the countless suicide attempts and incidents of selfharm; are stories which have leaked out of a system designed to keep the public in the dark. The tight controls over media access to both Manus and Nauru Islands are reminiscent of police states. We cannot deny refugees in our care, the human rights that we demand for ourselves.

IN THE YEARS TO COME, AUSTRALIA WILL BE HELD TO ACCOUNT FOR OUR INHUMANE RESPONSE TO THE REFUGEE PROBLEM. IT IS NOT A DEFENCE TO PROUDLY PROCLAIM THAT WE HAVE ‘STOPPED THE BOATS’ IN THE HOPE OF REDUCING THE DROWNING AT SEA. While we wait for the announcements of a new cabinet, anticipate the impacts of the budget on our day to day lives, look forward to the upcoming AFL finals, wonder about the USA presidential election outcome, plan for Christmas and holidays, real people are languishing, without hope for their futures, punished for attempting to seek refuge in another country. 48

the night. As he lay in his stretcher, in a hot, vermin infested tent, a rat had bitten his big toe, its tooth piercing the nail and the bone. He wept with pain and grief, not just from the injury, but from despair at his life. Marianne found it difficult to comfort him and balance her role as a nurse, providing healthcare in an environment in which there was no care. As I write, Immigration Minister Peter Dutton has been vitriolic in demonising refugees as illiterate, innumerate, likely to take Australian jobs and/or likely to extend the dole queues. He has found the refugee debate an easy card to play. It appeals to our collective fear as a nation, that we have limited resources and that we will be overrun by refugees. This is nonsense, but plays out in the media and press as though it were a real threat. We have the resources not

In the years to come, Australia will be held to account for our inhumane response to the refugee problem. It is not a defence to proudly proclaim that we have ‘stopped the boats’ in the hope of reducing the drowning at sea. It is not a defence to ‘turn the boats back’ towards the persecution and fear from which they fled. It is not a defence to deny refugees a safe haven from well-founded fear of political, religious and racial persecution. It is not a defence that in a country with rich resources that we shift our responsibilities to our regional neighbours. It is not a defence that in their time of need, we turned our backs. I implore this new government to restore the humane treatment of refugees in our region. To increase the intake of refugees languishing in refugee camps in Indonesia and Malaysia and restore the hope and dignity of people in our care.

July 2016 Volume 24, No. 1

48_OBC_ANMJ July16_Maree.indd 48


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It is so refreshing and so heartening to see such a topic finally coming to light and gaining attention. As a fertility educator I see the problem of fertility awareness firsthand and that saddens me; but I also see firsthand the satisfaction, the joy and most importantly the empowerment of women once they get this knowledge of understanding and recognising their fertility, not only to postpone or achieve pregnancy but also to safeguard their reproductive health during all stages of their reproductive life.

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REFUGEES KEPT ON THE RADAR Congratulations to Maree Burgess on her article ‘The plight of refugees’ in last month’s ANMJ. They are my sentiments exactly and those of many I know. Thank goodness for the likes of Julian Burnside and Sarah Hanson-Young in speaking out and providing leadership on this issue. Thank you to ANMF for keeping this shameful subject on the radar. Margaret Brauer RN and RM, Vic

DIGITAL HEALTH RECORD OBLIGATION AMENDMENT I read with interest your article ‘Digital Health Record Obligation Impacting General practice’ I have worked as a practice nurse and manager for the past 19 years so feel I can comment on this article with my experience during this time. I do not disagree with the fundamental storyline. However, I feel I must point out that to receive the PIP we DO NOT have to upload the digital health data for at least half of our patient cohort each quarter to qualify for the PIP. In fact it is 0.5% calculated using the practice’s “Standardised Whole Patient Equivalent” (SWPE). This number is calculated by Medicare and sent with a report on a quarterly basis. For our practice this equates to approximately a minimum of 21 shared health summary uploads per quarter.

46  August 2016 Volume 24, No. 2

I refer to the article “Assisting Women to Conceive: A Clinical Update On Fertility-Awareness” written by Dr Kerry Hampton and Dr Jennifer Newton in the July issue of the ANMJ. I am a Registered Nurse working in a hospital setting and I am also an accredited teacher with the Billings Ovulation Method®, the most natural and researched fertility management method in the world.

22/06/2016 4:48 pm

Jill McPhie, Practice Manager/Nurse, Vic


I agree with the authors wholeheartedly; the problem of lack of fertility awareness is widespread especially in the western world. I also agree that Australia lacks such intervention in the general practice and much more needs to be addressed and done to help primary general practitioners and primary health care nurses and midwives to learn and be able to deliver such education for women in general practice. I happen to work in a unique clinical setting where Billings teachers and primary general practitioners have a collaborative arrangement working side by side to deliver a holistic natural approach to fertility and health. The Billings teachers teach couples how to identify the fertile times in the cycle to optimise their chances of achieving a pregnancy while GPs guide investigations and treatment options to assess and improve general health and fertility using the Billings Ovulation Method® chart as a diagnostic resource. Fertility awareness is so important in the assessment of the woman’s general health. More of these centres are needed and more collaborations between healthcare practitioners is essential to tackle the problem but I am hopeful and feel that there is a change towards the right direction as more and more women and couples are seeking such knowledge and such natural treatment.


The article begins by definin ‘fertility-aware g ness’, then the main finding outlines s of a recentl completed y fertility-aware ness study (Hampton, 2014), recommendatio and concludes with use of fertility ns for practice on -awareness methods in assisting women to conceive.


clinics – their knowledge ‘fertile period of ’ only increas the without side-ef up from 2% ed slightly, to with the religioufects, and compatible main source 13% respectively. The s of values of those s or philosophical were the interne women’s information treatment or who cannot use ART general practiti t, books, and choose treatment (ESHRE not to use ART unanimity existsoners. We found that Capri Worksh Group, 2004; op and 92%) and among women (95% ESHRE Task Defining fertilit their Ethics Law, Force on s, T PHC practiti Murayamas, (89%) 2009). y-awa that oners’ Fertility-aware women’s fertility reness T Saito, ness is genera should be enhancHashimoto, -aware K Shimizu, K Saito, T ness defined as lly Below, an overvie ed when a woman’s Y Suda. and first reporting trouble Norzawa, ability to w of fertility identify the state awareness conceiv The present 1987. fertile Similarly, both ing. methods is menstrual cycle. period of the utilization of NFP presen GPsofand together with PHCNs nominate nurses There are three the advantages ted techniques fertility-(93%) methods of limitations and methods. and midwiv fertility awareness most preferr of each method es as (rhythm, temper -awareness ed practiti Journal of the for guiding Japanese oners such educat ature, and mucus) timed interco when used Hammarberg, K., to deliver 31 and Sterility however, all Fertility ion T. for urse. ; women Setter, R. J. vary practice (Hamp (1):65-71. in general Norman, to identify the in their capacity C. A. Holden, ton 2014; Hampt Fertility-aw ‘fertile period al. 2016). areness metho on J. Michelmo example, rhythm ’. For Odeblad, E. 1994. Theet re, Mucus metho ds and L. Johnson. is accurat discovery of the different d than one-th The mucus 2013. Knowledg ird of women e for less of cervical mucus. Consistent method is the e a regular monthl who have about factors with thesetypes accurate and of the Natural most Bulletin that finding temperature y menstrual s, both influence fertility most useful Council (Fehring et Family Planning and awareness fertilityal. 2006), wherea cycle among Australian the most accurate fertility mucus, 21 (3):1-34. method to of Victoria s temperature s both guide of reproduct -aware timed ness and mucus intercourse, ive age: were poorly method and a populatio are highly accurate (Pallon as this method understood n-based Pallone, Stephen R,s, by R Bergus. 2009. prospectively indicat and their PHC survey. Fertility Temperature e and Bergus, 2009). Georgewomen and es the entire fertile period Sterility 99 and awarenessCorrespondin practitioners (2):502Fertilityalike. of known as ‘moder mucus are now 507. doi: 10.1016/j gly, by the presen the menstrual cycle methods: based , the accurate fertility rhythm n fertility-aware least fertnstert.2012.10.0. ce of fertile-t methods’, to Another option for at the vulva. ness ype mucus 31. help was the most -awareness method Fertile-type planning. Journal from the outdat distinguish them , frequentlyfamily mucus Hampton, Kerry is released the American Board method in oftaught from the cervix 2014. Informing D. accurate rhythmed and much less Family Medicine 22 present for and is of e limitationsgeneral practic the andand methodAdvantages development (57%) an average most frequen . of a six consumption, late leading up significantly tly used(2):147-157. new model by infertile method Rhythm calculations to the day of days of care to elevated include alcohol Fertili sleep, improve the the ‘fertile ovulation in the menstrual ty-awarene degrees Celsius that remains (51.9%) duration ofwomen oversleeping, disrupted B., D B. Dunson, the fertilityScarpa, nights, resortin before is overestimate BBT cycle. awarenes ss . The g to assiste study We conduc stress, Over s of sub-fertile and E. Giacchi. 2007. a sensati until next menstruation d fertility ted four-ye period’, necessitating travel, time zone differences, women in primary on at the vulva these days, at ARTintercourse treatme selection of the body clinics. Bayesian ar fertility awaren (Palloneaand nt of moist health care. PhD Departme the resting temperature to wet to wet/slip changes from illness, and medicationess study with the to occur- daily or second daily over rules for timing optimal hours six nt to informing a of General aim of pery, then back to drynes pregnancy is a Practice after a minimum of four than intercourse to conceive future primary many Bergus, 2009). more daysOur Monash University study highlig must be s or an unchan model (Hamp care 2009). by using calandar andsensati hts and Bergus, of sleep. The temperature ging (ethesis-20141120on of slight ton, 2014). possibility (Pallone in the Fertility and gap mucus. primary for a critical thermometer Primary care 133 interventions moistness. 130). fertile-type taken with an ovulation of infertile may be difficultcare that include This approach Rhythm method Sterility 88 (4):915-924. women mucus is observ When from the and(Scarpa awareness the rhythm also an et clear, shiny, ed, it is on waking each morning opportunity have reduce d fertility to maintain As previously mentioned, Hampton, Kerry for and stringy some couples expanded scope or vaginally. fertility- d referral for assisted Stanford, J B., Tracey D., in appear for others The s Jennifer M. same site, either orally of practic reprod method is the least accurate PHCNs to redress Newton, A. Parnell, al. 2007) and unsatisfactory e for and Phil C. last day fertile-type mucus ance. Rhian Parker, at the (ART) This methoductive techno sensed or observ of correctly this gap inBoyle. 2008. Outcomes Ovulation usually occurs and certain is nt by assistin whology awareness method.treatme initial wish to be Danielle Mazza. the assessm et al. 2002). BBT rise. ed at the vulva of called sponta fertile g of theconcep 2016. A neous timing and care offrom treatmentnatural bottom of the sustained (Stanford ent qualitative the peak day is estimates the women timed intercourse with infertile study of the BBTs infertility in less al.menstrual genera of fertility, as cycle by tion (Stanfo 2008; Tham onebarriers and thanl practic is the most rd et is accurate for Three consecutive elevated enablers this period of the et al.to2012). Rhythm e. procreative technology likely day of to fertility-aw six confirm the no one Howev such previous ovulati general regular a lower in Irish a areness calculations: intervention er, in an the menstrual over who have on applying two Curre education in of women of the ly third (Colombo cycle. Austral general trend al. practice. Journalfertile days’ andcurrent exists in menstrual nt safe (Wilcox s inetthe ‘earlyian practice. Journal cycle occurrence of ovulation genera period, sensati Outside the estimate the of infert l practic care monthly the American Board days’.es, despite the healthc ile coupl safe Advanced Nursingof on at the vulva the ‘late by women one21of drynes used and Masarotto, 2000). are system es of Family Medicine other to estimate Infertilibe and cannot is s or a slight Mar 9. doi: ty (the failurecycle the’s transiti 2000) aperiod’ preventive 10.1111/ comprises to menstrual whose model of healthc on jan.12931. conceive(5):375-384. moistness. When mucus unchanging The ‘fertilereduce after (around 27%) [Epub ahead 12 months daystolong) the calculated are is observed of print]. reliance to between trying) occursStanford, J B., at Advantages and limitations more the 36of G this time, it (ie., in days that fall on costly specialis irregular one is a dense six Austral in method, treatment, 2004). H. ist (Depar L. White, and colour With the temperature al. 2008). ian couples (Loxton (Odeblad, 1994). white/creamy Kamphuis ‘safe days’(Fehring andetLucke, are , Esme I, S Ageing, 2010). tment of Health(Maheshwari 2009). Hatasaka. 2002. Timing and Bhattacharya, consecutive fertility charts trouble conceiv Couples who report F. van intercourse to achieve intercourse in der Veen, B are based on ing in genera Advantages needed to guide timed W and conclusion pregnancy: current These calculations are increas l practic and limitat Summary and A TempletoJ Mol, Intercourse Theand ingly being e Obstetrics possible study latest ions The mucus theused n. evidence. an anticipation of ovulation. provided referre earliest 2014. has the a clinics. method enable Are we overusing d to&ART 100 just prior ART treatme methodsThis paper in Gynecology design and might mixed entire ‘fertile IVF? British s ovulation involveoccur within the three-day period overview tontfertilityand Medical costly, d the women introduction period’ to be the highly invasive is, however,(6):1333-1341. the chance of time that and their Journal 348 as well asboth irrespective observed, cycle (g252). primary to the BBT rise optimises and associa the menstrual withand highlighted the healthc 10.1136/bmj.g252. doi: of whethe ted Bergus, 2009). practiti and are (PHC)awareness, increases in Tham, Elizabeth cycle, Karen onersof– sperm critical morbid lifespan pregnancy (Pallone and is monthly and r the menstrual of basing this general practiti maximum mortali Joseph (GPs) and for both mucusity and Schliep, and regular or Loxton, Deborah, calculations, onersimportance ty irregula primary Based on these for women on mother ovum. (PHCN babies s and their B Stanford. 2012. r (Odeblad, and healthc Jayne Lucke. women know 1994). to 24are nurseseducation . In additio six to 2009. s). Conco is days n, concer Natural procreative period Only in retrospect can not rhythm, Reproductive the fertile mounting about rdant with n is and temperature, was for international health: arepublished technology safe days’ Interco the possibl Findings from conception. The ‘earlyresearc for certain that intercourse urse timed recurrent overus inclusive. and spontaneous e the h, infertility assist e we method of ART treatmeand within the threethat women found Australian longitudin ‘21’ from dayOutcomes period just by subtracting correctly timed with this ’s unders,tanding nt (Kamphuismiscarriage: et al. 2014). education estimated study on women’s al With appropriate prior to ovulati 2000). the fertile family of cycle recorded in a Canadian optimis menstrual period of on (Colombo and Masarotto, and midwives health. Australian the shortest the menstr Canadianes the chance of of the practice. cycle is genera (ie.ual resourcing, nurses months: government a pregna With The retrospective nature 58 mucus the previous six to 12 Department greater role in fertilityin the poor across Family Physician play a ts couldBenefi method, women ncy. of Health and an obvious reproductive1-5lly of fertilit consideredthe can know for Ageing. for women temperature method is y-awainrenes (May):e267-e274. 21= 6: days lifeare Intercoeducation 27 - et course (Hamm certain awareness urse Bergus, safe that s al. safe days’). within the ‘late arberg of intercourse was correct Lundsberg, LundsbThe limitation (Pallone and ‘early2013; the Similar practice. Lisbet ly timed for erg et al. 2014). the A. J., D. general menstrual cycle fertile period Wilcox, with S., Lubna Pal, Wome ly, we found by subtracting and D. 2009). Ideally, it is combined the calculated Aileen n D. is essential who may find pregnancy. a pregancy days’are that women M. Gariepy, for Dunson, practitioners occurs (Wilcox Xiao Xu, ’s PHC 2000. The timing menstrual challen the in2000) Baird. mucus, and when this are genera Micheline C. ging include this method Hamptonetisal. from the longest may ‘10’women Dr Kerry help some and Chu, lly aware “fertile window” as the of the those who six of at Jessica L. Illuzzi. and from couplesPractice ’s low in the previous dysmo method becomes known suffer levels cycle: recorded of General to overcome in the infertility whethe cycle menstrual 2014. rphic body of = 24: days Department (Colombo Knowledge, on this aspect dge disorder or haveestimates - 10 knowle r the cause attitudes, 34their symptom-thermal method a history of 12 months (ie.of or female University tohealth. and practices is a male day specific Monash reprod sexual abuse. factor This double ‘late regarding the uctive a prospective Infectio conception and Masarotto, 2000). ns of the al. 2008; Tham problem (Stanford et from 25 onwards are considered and study. British Medical helpful can fertility: a populatio et al. 2012). impair (7271):1259- vulva or vagina will Jennifer check method is especially days’). These calculations known Journal 321accurat safe nA lesser Associate e observation/s based survey benefitProfessor Althou irregular of correctlyof Nursing among of mucus gh women few women who doi: 10.1136/ and 1262. ensation reproduct for women who have an confusing, intercourse changes. is in the School ’s interes seem timed Newton ive-age United and awareness t inapply is bmj.321.7271.1259. fertility (Colombo that actually cycle States University it rises rhythm may women. Fertility menstrual using at Monash halve the sharply when usual report Midwifery & time to pregna that can experience and Sterility Temperatu al. 1987).they 101 (3):767ncy, with 85% troubleetconceiv Masarotto, 2000). Factors couples being them (Murayamas 774. doi: 10.1016/j re method increas s inaccurate of ing – pregna . ing from 37% The temper fertnstert. render BBT measurement nt anmf.org.au at rather than 2013.12.006. ature method among who attend at 12 months six months most accurat is the next general practic women (Colombo and Masaro e Maheshwari, among women e to 87% tto, Abha, method. This fertility-awareness who attend Mark Hamilton, 2003). Propon 2000; Gnoth et al. No. 1 method retrosp July 2016 Volume 24, and ART 26 ents have long indicates the Siladitya Bhattacha that the knowle argued timing of ovulati ectively rya. 2008. Effect dge is low cost, the menstrual of female on in anmf.org.au age on the cycle by a basal diagnostic temperature body categories 5:06 pm 22/06/2016 (BBT) of infertility. rise of 0.2 to Human Reproduc 0.5 tion 23 (3):538-54 24-27_ANMJ July16_Clinical




To learn more about the Billings Ovulation Method® please visit www.billings.life or call 1800 335 860 for your nearest teaching centre.The Ovulation Method Research and Reference Centre of Australia is accredited by the RACGP, ACRRM, ATMS and MidPLUS 24-27_ANMJ


July 2016 Volume



24, No. 1



5:06 pm

Inaam Abiad RN, Vic





ENOUGH PLACEMENT HOURS? I write in response to the article titled “A Registered Nurse in 20 weeks”, by Elizabeth Miller and Simon Cooper in July’s ANMJ.


By Elizabeth Miller and Simon Coop er

This paper raises conce rns issues relate d to the adequ and of nursing students’ clinica acy placement l hours. There are signific ant workforce demands as the ages, and graduanursing workforce te retention coupled with reduces, the predicted shortagfact that there is a e of 109,000 in Australia nurses by Australia 2012).2025 (Health Workforce UK: 2,300


South Africa:

Retention rates 2,800 (of which 300 are influenced poor prepar can simulated practicebe ation for healthc by Australia: 800 false gradua ) te nurse expect are roles, New Zealand unrealistic deman 1,100 to 1,500 ations and hours leading to attritio ds by employers divide), and n rates as high 20% in the to as first deep unders develop skills and a (Dept of Health two years of practice tanding of empath Simulated wards cultural and etic, could be one Howe, 2012). , 2014; Healy and inter-pr approa ofessional Concerns over ch with practice. The care have also quality Australian Nursing prioritise, makestudents learning to been reporte and Midwife (Darbyshire d ry Accreditation in teams (Liaw decisions and work and (ANMAC) reiterat Council there are signific McKenna, 2013), and practice may et al. 2014). Simulated should be “conside clinical practice also reduce concerns relatingant international errors medical ered (Sears, 2010) essential for promoting to patient safety (Buykx et al. cultural acclima of patient actors and the use 2012). the workpla ce and preven tisation to manikins) does (as opposed to shock’ that ting ‘culture increase the Hours acros leads to high the experie reality of attrition rates”. Also nce (Buykx These issues s the world that placem et al. 2012). are set against ents should be early to backdrop of sustain studen Conclusion reduced clinical a t interest and that final hours, which training year blocks Australia needs vary across should uninter be more highly rupted and the world. For a competent facilitat bachelor level developed to work nurses yet studenskilled (ANMAC, 2009). e transition (usually three degree only placed ts are years) prescrib in practice practice hours ed clinical for 20 weeks. Simulation in Australia However, as may New Zealand are Coyle (2007) takes to reach reduce the time it 1,100 to 1,500 800, there sugges compe are ts 2,300 (of which numero hours, UK tency but should it be used to questions about us unanswered replace clinical practice), and 300 can be simulated placements practice? in including the Original decisio South Africa 2,800. length, type Where should References ns on the adequa of experience and variety of clinical training required to lie? As in Chinanurses competencies supplied on cy competency reach hours is a mystery should the but appear and becom be on skills, request to have e ‘safe’. All of which is personal attribufocus UK requirements come from the made more ability to care tes comple by individual of 1,000 hours (Karstadt, 2011), and trade appren student’s needs x for India a curricu or in ticeships, eg. learning styles. Elizabeth and lum mechanics, plumbers, However we but with care S) rich in the science electricians Miller is a the length s know that YEAR directed by E (Coyle, 2007). Placement and THRE quality staff medical hours in Austral of placement second year does influen dt, 2012b). (USUALLY (Karsta the lowest in ia, ce DEGREE HOURS the developed one of student nurse belongingnes studen TICE R LEVEts’L degreePRAC of tend to be world, s HELO with Curren evidence that concentrated tly we have and Simon A BAC short placements ED CLINICAL FOR in few years of a mixture of approaches study with only the latter these Cooper is PRESCRIB are filled with the requirements but a blocks of two short of compromise? is this too much of a to Professor ‘fitting in’ (Levettorientation and of first year. This three weeks in the apprenticeshipPerhaps an academic Emergency is Further, gradua -Jones et al. 2009). model would where studen compared to the UK te better nurses be ts are placed (The Nation Care. Both do not feel work ready 700 hours in for up to are and experie Nursing Educat al Nursing and their first year at the School nced report that 2009). Howev (Karstadt, limited placem nurses We have clearly ion Taskforce, 2006). er, of Nursing, and genera ents constantly battleAustralian universities lised questions than raised many more Midwifery enable achieve education do not to find placem we have answer and the costs and ment of gradua it is time for ed are high – clinical ents Health but compe a serious debate care, te tencies (Missen and adequacy of Millelyrcharge et al. 2016). Federation hnormal $60 a day per venues clinical placem on the studen ess ents. By Elizabet regardl University per of the supervision model. t Learning through simul As authors, Australia, Learning throug we need to and ation Simon Coo Objecconc acknowledge our biases. h simulation tiveserns Victori s and improv Elizabe may adeq a. e preparation r raise th Miller clinical place uacy uacy of second year for practice This pape Object and reduce the adeqments student who is a ed toives the weeks clinical gained two cal educat clinical competency, time it takes to reach ’ofclini issues relatinclude experience This article ion but can simulat care in her students in aged the need replace the first ion is based on of nursing(overco full remit of s. the to embed knowledge essenti a UK hospita year. Simon Cooper is skills that are nt hourming theory practic l trained nurse the views al for clinical placeme e 1980s where, and from the work (Coope al. 2012)? in addition research of r et to theory blocks, he comple t workforce the 34 force July 2016 Volume significan author(s) and ted 4,347 : 2,800 ng work 24, No.es, (109 weeks) There are in eight special hours South Africa reduc 1 as the nursi has not been 800 ities. demands graduate retention is a Australia: peer there and reviewed. , hours ages fact that 00 nurses to 1,500 with the nd 1,100 coupled shortage of 109,0 New Zeala Workforce be UK: 2,300 icted (Health 300 can pred 34-35_ANMJ by 2025 (of which practice) anmf.org.au alia sues_Reflection.ind in Austr July16_Is be one simulated d 34 2012). s could to alia ing ward Austr nts learn by Simulated with stude ions and work influenced , and a approach rates are healthcare roles lop skills , make decis Simulated Retention and to deve of empathetic prioritise, al. 2014). aration for expectations and cal divide), (Liaw et poor prep rstanding al reduce medi in teams oyers uate nurse deep unde inter-profession ng 22/06/2016 may also and the use false grad demands by empl 4:43 pm and practice high as alian Nursi cultural s, 2010) sed to unrealistic attrition rates as The Austr ditation Council errors (Searactors (as oppo reality of practice to practice. years of nt ice leading ifery Accre ase the of patie first two ; Healy and clinical pract for and Midw does incre x et al. 2012). 20% in the 2014 tial reiterate manikins) quality Health, (ANMAC) “considered essen ion to rience (Buyk erns over (Dept of expe Conc atisat be ). the acclim should re reported ), and Howe, 2012 cultural nting ‘cultu also been 2013 promoting ion y skilled and preve care have and McKenna, on clus highl place al attriti Con work more ation high the nts are needs (Darbyshire ficant intern safety leads to s should Australia nurses yet stude weeks. signi nt shock’ that that placement 20 to patie there are interest competentd in practice for relating rates”. Alsosustain student time it concerns ld be to only place may reduce the al. 2012). should blocks shou ition be early (Buykx et trans final year etency but ice? Simulation d References and that ted and facilitate reach comp al pract on ss the worl takes to to replace clinic supplied a 2009). uninterrup against Hours acro (ANMAC, it be used s are set request ies al training to work ests These issue reduced clinic loped s competenc of (2007) sugg ld nurse s the deve focus backdrop vary acros ver, as Coyle unanswered Where shou should the utes and Elizabeth degree which Howe , level rous China hours s nume attrib a clinical lie? As in a bachelor personal Miller is there are about placement ), or in variety ) prescribed800, world. For year be on skills, (Karstadt, 2011 sciences tions type and are three years h, second ques lly alia care lengt the (usua Austr in the nurse ability to to reach hours, UK hours in ulum rich student including medical e required practice nd 1,100 to 1,500 n ‘safe’. All ated India a curric directed by and Simo a of experiency and become be simul . care can New Zeala lex is but with which 300 2012b). Cooper of competencmade more comp and Africa 2,800 2,300 (of (Karstadt, s is and in Souththe adequacy nt’s need Professor of which that staff of these on practice), cy idual stude ver we know a mixture a decisions a mystery Emergen by indiv we have much of ment are Original hours is styles. Howe the Currently s but is this too training Care. Both ol learning and quality of placeee of academic of clinical to have come from for ache an h ps degr appro ar hours at the Scho the lengt nce students’ e? Perha d be but appe of 1,000 ing, nce that compromisship model woul and rements plumbers, of Nurs does influe ess with evide the ing UK requi and ntice ships, eg. e, 2007). with Nurs ifery gingn ntice appre filled Midw belon 2006). National trade appre, electricians (Coyl one of ments are e, and better (The ation Taskforce, more Healthcar n short placents of orientation 2009). mechanics hours in Australia,world, ing Educ raised many al. et Nurs ratio reme but nes Fede requi ered clearly Placement in the developed not feel (Levett-Jo y We have than we have answ on the t the latter nurses do nurses Universit ‘fitting in’ the lowes concentrated in tions debate graduate ed us ques er, ralia, short rienc serio be Aust Furth for a ments. with only in the tend to s and expe it is time of clinical place of study Victoria. work ready limited placement not weeks few years uacy UK do to three that the adeq rt ge ation two to of repo wled ared blocks ralised educof graduate to ackno This is comp d for up to le and gene rs, we need r is a vement first year. This artic al. 2016). nts are place (Karstadt, As autho Elizabeth Mille on d two enable achieies (Missen et s. s where stude their first year is based and nt who gaine our biase in s universitie competenc n year stude rience in aged 700 hours ver, Australian the view is second ments simulatio of the al expe find place venues n Cooper 2009). Howe through lation may research and weeks clinicfirst year. Simo al battle to simu Learning from the constantly ice high – clinic student author(s) through care in her ital trained nurse costs are been n for pract Learning theory a day per and the has not preparatio it takes to reach a UK hosp e, in addition to hours wed. n model. charge $60 improve normally of the supervisio peer revie e the time lation 1980s whercompleted 4,347 s. and reduc y, but can simu that are he ialitie regardless s, spec block quacy of competenc full remit of skills per et s) in eight the (Coo anmf.org.au s and ade (109 week replace al work nts clinic Objective eme for plac essential clinical of clinical education d knowledge al. 2012)? Objectives need to embe ice the y pract include ng the theor 016 (overcomi



I thought it was a really important article as it couched an age old debate concerning the merits of hospital trained registered nurses compared to tertiary trained registered nurses in a language that was not only palpable but tangible.


July 2016


24, No.



PATIENT ADVOCACY After reading in the May ANMJ the article ‘Guilty’ R v Peters 2013, I again feel so sorry for the victims and families at the hands of Dr Peters and am not surprised at the statement by his Honour that ‘the practitioner had shown no sign of remorse.’

4:43 pm

It still upsets me to read about this ‘monster’ as I had the misfortune to work with him as did many of my colleagues. Many of us remain traumatised by his actions and the way he treated us with such arrogance and intimidation.

It powerfully documented the great differences in placement hours not only between countries but between types of registered nurse training. By drawing attention to the massive reduction in clinical hours between hospital and tertiary educated nurses a meaningful debate can emerge regarding our own profession and its emerging failure to provide for the next generation of nurses and midwives.

Unfortunately, when working in small facilities with only one operating theatre, these medicos are sometimes practising solo and in the absence of their colleagues ‘fly under the radar’. Importantly, as nurses, we have the role of acting as the patient’s advocate when they are at their most vulnerable being anaesthetised on an operating table. Often we become the ‘whistleblower’ which in itself is a stressful situation.

If over a 30 year timeframe nursing has reduced the amount of clinical contact hours from 166 weeks to 20 weeks what realistically can we expect our student nurses to learn in such a short time?

At the end of the day we did our best to report Dr Peters and I wish that his demise had been a lot quicker which may have saved some of the suffering he inflicted on his victims and their families.

I am a hospital trained registered nurse from the UK who trained in the late 80s and completed 166 weeks of full time placement. I was exposed to eight different specialties including obstetrics and mental health. Each block of placement was followed up by two weeks of full time study in the classroom. Topics ranged from pharmacology to human behaviour in illness and developmental psychology. After three years of training everything boiled down to a single exam. The exam was a simple pass or fail. Failing the exam three times destroyed any hope of ever becoming a registered nurse.

I understand you may chose not to publish my letter or edit it significantly as my anger is apparent. Hopefully I can come to terms with this emotion. Reading this article in the ANMJ has highlighted to me that it’s time to talk to someone about these events.

In the 21st century we do so much more with our time. Study is a great deal more flexible and contact hours at university greatly reduced. Undergraduate nurses hold down jobs, are part of a diverse cultural, social and technological existence but does that justify such a huge reduction in placement hours?

Jenny Bond, RN Vic





34 ion.indd

I am by no means advocating a return to some idealised apprenticeship model of training but there is no doubt that the current tertiary model of educating our next generation of registered nurses is buckling under the pressure. Placement hours are drastically reduced, the quality and appropriateness of placements sub-optimal and the current copious amounts of paper based assessment tools can and do obliterate meaningful learning.

On a much brighter and positive note, your last two editions have contained some interesting and informative articles. Congratulations to your staff and I look forward to reading next month’s issue.

The winner of the ANMJ best letter competition receives a $50 Coles Myer voucher. If you would like to submit a letter to the ANMJ email anmj@anmf. org.au Letters may be edited for clarity and space.

As such it should come as no surprise that as a profession we lack the authority to describe ourselves as meaningful and valuable, let alone appropriately trained in 20 weeks. Marie Maddox, Clinical Nurse, RN, BA (Soc.Sci), Masters of Nursing, Post grad - ICU, Post grad - Retrieval Nursing, Bachelor of Midwifery (student), SA


August 2016 Volume 24, No. 2  47

SALLY currently being discussed to make new laws in South Australian Parliament, is considered unethical by many. Conversely, other acts may be illegal and still debated as ethical such as euthanasia. Other examples would include debates over abortion, capital punishment, and the common ethical theme involving honesty in interactions with the patient and genuine informed consent.


Increasing media coverage in Australia on issues normally attributed to the realms of academic moral debate such as medical marijuana, assisted suicide and de-criminalisation of abortion have made me reflect on how much society has changed. These are debates that would never have made it to TV, radio or newspapers years ago and supporters would have been few and reserved. As robust discussion on these topics raises their public profile, and support gathers momentum, I think about the role of the nurse and midwife as the strongest advocate of patient choice and how nurses and midwives often find themselves in ethically questionable situations that conflict with their personal and professional morals.

ETHICS ARE A BRANCH OF PHILOSOPHY THAT FOCUSES ON THE MORAL LIFE, ADJUSTING TO THE EVER CHANGING SOCIAL CUSTOMS Moral courage is the willingness to stand up for and act according to one’s ethical beliefs when moral principles are threatened, regardless of the perceived or actual risks (such as stress, anxiety, isolation from colleagues, or threats to employment). Moral distress occurs when nurses feel powerless to act after witnessing improper behaviour, and if organisational constraints make doing the right thing difficult or impossible. Scholars have debated the various meanings of ‘courage’ 48  August 2016 Volume 24, No. 2

over the centuries. Ancient Greek philosophers, such as Plato and Aristotle, frequently used the term in reference to character on the battlefield. While the ancient Greeks described courage as a desired response to physical danger, contemporary scholars more frequently address courage as the commitment to stand up for/ act upon one’s ethical beliefs – an essential virtue for all healthcare professionals today. This type of courage, called moral courage, is vital to the willingness of individuals to take hold of, and fully support, ethical responsibilities essential to professional nursing and midwifery values. There is also much debate over the difference between public and private morals. Nurses and midwives accept the values of the profession, integrating them with their personal value system. In the literature, nurses and midwives report being directly involved in an ethical and/or human rights issue between one-to-four times per week. The most frequent and disturbing ethical issues reported by the nurses responding in a number of research studies around the world were: protecting patients’ rights and human dignity, providing care with possible risk to their own health, informed consent, staffing patterns that limited patient access to nursing care, the use of physical/chemical restraints, prolonging the dying process with inappropriate measures, working with unethical/ impaired colleagues, caring for patients/families who are misinformed, not considering a patient’s quality of life, and poor working conditions. Ethics are a branch of philosophy that focuses on the moral life, adjusting to the ever changing social customs, norms and rules that help define right and wrong, which then guides the formation of societal law. However, it is possible to have legal actions that are considered unethical by some groups. Point in case: assisted suicide,

Nursing and midwifery practice emphasises a collaborative effort with the patient (family, client), providing the best care possible at the patient’s own autonomy level. As such, one special role of the nurse or midwife is to act as an advocate for the interests of the people in their care, armed with knowledge about their patient’s choices. This supports ethical principles such as informed consent where a person fully understands the implications of having or refusing a treatment and is free to make his or her own decision based on that information. The last important aspect of ethical debate to note is conscientious objection. Conscientious objection supports the right of persons to refuse to participate in acts that they deem unethical. Value statement one of the Nursing and Midwifery Board of Australia’ s Code of Ethics for Nurses in Australia and the Code of Ethics for Midwives in Australia states that nurses and midwives are entitled to conscientiously refuse to participate in care and treatment they believe on religious or moral grounds to be unacceptable (‘conscientious objection’). Nurses and midwives who exercise this right must still ensure that the patient is not abandoned and his or her wishes are able to be met. In an organisation whose culture supports moral courage, communication is open at all levels, policies and procedures support ethical practice, and leaders practice staff empowerment where crucial conversations are welcomed and practiced amongst all healthcare team members. A crucial conversation is a discussion between two or more people where the stakes are high, opinions vary, and emotions run strong. Nurses’ and midwives’ moral and ethical codes are strongly supported by union values – human rights, dignity, access to health to name a few. Whilst there is increasing public discussion and debate about ethical issues, it becomes the opportunity for nurses and midwives to understand their personal ethical and moral views and reflect on their role as patient advocate in choice. anmf.org.au

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ANMJ August 2016  

August issue of the Australian Nursing & Midwifery Journal

ANMJ August 2016  

August issue of the Australian Nursing & Midwifery Journal