ANMJ Dec 2015 / Jan 2016

V O LU M E 2 3 , N O. 6 / D E C E M B E R 2 0 1 5 / J A N U A RY 2 0 1 6

A FORCE TO BE RECKONED WITH A YE A R I N R E V I E W www.anmf.org.au

Over 33,000 good reasons to order your 2016 AMH resource now

This year, the AMH would like to support you.

The pharmacist, the doctor, the nurse.

All you have to do is pre-purchase the 2016 AMH book or any current resource - between November 17 and December 31 - and you will receive an automatic entry to win one of these great rewards to help you further in your quest for knowledge and excellence*.

Prizes include attending a conference related to your profession, business equipment and/or office supplies and future editions of AMH resources.

National Winner A major prize comprising flights, accommodation, conference tickets and meal vouchers for up to 2 people to attend an Australian conference in their field, to the maximum value of $6,000. The national prize winner will also receive the regional prize for their location as well, valued at $2,500.

Regional Winners (SA, VIC, NSW, WA, QLD, TAS, NT/ACT) 7 x first prizes of $2,500 worth of office supplies or equipment from a supplier approved by AMH. Each region will also have 6 secondary runners-up who will receive a free copy of the next edition of Australian Medicines Handbook (Book or Online) valued at $200 each. Each region will also have 3 supplementary runners-up who will receive a free copy of the next edition of the AMH Children’s Dosing Companion (Book or Online) valued at up to $99 each.

Maximum total prize pool of $33,979*

*Terms & Conditions Apply. For full details and conditions of entry and to order your AMH resource, just go to www.amh.net.au.

NSW Permit No. LTPS/15/08153. ACT Lic. No: TP 15/07798. SA Lic. No: T15/1860 The promoter is Australian Medicines Handbook, Level 1, 231 North Tce, Adelaide SA 5000. The random prize draw will take place at L1, 231 North Tce. Adelaide 10am on 11/1/16. Winners will be notified by email by 12/1/16 and draw results published on AMH website on 13/1/16.

CONTENTS

20

Directory 02

A FORCE

Editorial 03 News 04 Feature – Year in Review 20

TO BE RECKONED WITH

Professional

A Y EAR IN R EV IEW

27

Issues – Case study 28 Legal 29 Clinical update

30

World 34 Reflections 35 Issues – Gonski report 36 Research 37 Focus – Primary / Community Care 38 Calendar 53 Mail 54 Maree 56

04

30 38

anmf.org.au

December 2015 / January 2016 Volume 23, No. 6 1

Canberra

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

Front cover: Victorian Delegate Liz Barton Photograher: Greg Adams Imagestix Photography

Editorial

Melbourne & ANMJ

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

Federal Secretary Lee Thomas

Assistant Federal Secretary Annie Butler

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

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

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

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

Northern Territory

South Australia

Victoria

Branch Secretary Yvonne Falckh

Branch Secretary Elizabeth Dabars

Branch Secretary Lisa Fitzpatrick

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

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

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

The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia.

Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement.

All rights reserved. Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrang­ement with the Australian Nursing & Midwifery Federation Federal Office Note: ANMJ is indexed in the cumulative index to nursing and allied health literature and the international nursing index ISSN 2202-7114

Moving state? Transfer your ANMF membership

If you are a financial member of the ANMF, QNU or NSWNMA, you can transfer your membership by phoning your union branch.

Don’t take risks with your ANMF membership – transfer to the appropriate branch for total union cover. It is important for members to consider that nurses who do not transfer their membership are probably not covered by professional indemnity insurance.

New South Wales

Queensland

Tasmania

Western Australia

Branch Secretary Brett Holmes

Branch Secretary Beth Mohle

Branch Secretary Neroli Ellis

Branch Secretary Mark Olson

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

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

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

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

2 December 2015 / January 2016 Volume 23, No. 6

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144,175

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EDITORIAL

Editorial Lee Thomas, ANMF Federal Secretary The end of a year can be cause to celebrate. It’s a time to reflect on past achievements, evaluate lessons learnt and a chance to look forward to the opportunities the New Year will bring.

MOST SIGNIFICANTLY I AM PLEASED TO REPORT THAT THE ANMF IS OFFICIALLY THE LARGEST UNION IN AUSTRALIA WITH A RECORD MEMBERSHIP TOTALLING 249,000.

Reflecting back on the accomplishments of the ANMF over the past 12 months, I am proud to say we have much to celebrate.

Most significantly I am pleased to report that the ANMF is officially the largest union in Australia with a record membership totalling 249,000.

The unprecedented growth of 12% across all sectors and in all states and territories is a significant milestone and by no means a small feat, particularly considering the overall decline in membership of other unions across the country, and the difficult climate we have worked in.

So why has ANMF membership grown?

I simply believe it is a reflection of how the ANMF has stepped up the fight for Australia’s nursing and midwifery workforce and for the healthcare needs of the community.

With much vigour the ANMF has consistently voiced out and campaigned on significant issues that matter most to the professions. In many cases we have been triumphant, while in others we continue to fight the good fight.

Important campaigns that have occurred throughout the year have included the protection of penalty rates for nurses and midwives and the fight against proposed changes to the current paid parental leave scheme.

Some of our greatest wins for the professions during 2015 will go down in history, such as the nursing and midwifery ratios Bill that was passed in Victoria.

While Queensland seems on track to do the same, let’s hope the rest of the country will soon follow suit.

@AustralianNursingandMidwiferyFederation

anmf.org.au

@anmfbetterhands

One of the major highlights of the year was the ANMF’s 12th Biennial National conference where members had an opportunity to set the future agenda for the union.

Given the gusto that was generated over the recent two day event in Adelaide, we are excited and enthused by the direction we will take and by what we will achieve during 2016.

You can be sure ANMF will be a force to be reckoned with across health, aged care, industrial and professional arenas on behalf of its members.

Some of the major highlights that were discussed at the Biennial conference feature in this month’s journal. We also bring you a roundup of how the year unfolded for the ANMF, our members and for the professions.

In closing I take this opportunity to thank you for all your hard work in 2015 - for the care of your patients, and for the activism of your professions and of the ANMF. I extend warm season’s greetings to you and your family.

www.anmf.org.au

December 2015 / January 2016 Volume 23, No. 6 3

NEWS

Campaign priorities prior to election Penalty rates and aged care have been identified as key campaign priorities for nurses and midwives, before the next federal election.

Research recently conducted for the ANMF analysed major issues for nurses and midwives, enrolled nurses and assistants in nursing in various sectors.

Marketing researcher and analyst Tony Mitchelmore presented the findings at the ANMF’s 12th Biennial National Conference held in Adelaide. “Nurses feel under constant threat and are deeply worried at the thought of losing penalty rates. For many it would be a sudden and dramatic pay cut.”

Working groups were held in NSW, Queensland, South Australia and Tasmania; along with general public groups. Feedback revealed strong concerns over penalty rates and aged care. Many relied on penalty rates and for compensation for working night shifts and missing out on time with family and friends on weekends and public holidays. Nurses were already grappling with increased workloads, higher acuity of patients, more paperwork, greater responsibility and ‘doing more and more

with less’. “To effectively have a pay cut is deeply unfair,” one participant said.

Practical issues were raised if penalty rates were taken away.

Some participants said they would struggle without penalty rates. “It’s what’s left on the table after the bills are paid.”

Particular concern was raised for AINs “on terrible pay”. “They absolutely need these penalty rates to live.”

“Everyone thinks the pay in aged care is appalling, both staff that work in the area and those that don’t,” Mr Mitchelmore said.

The public strongly supported penalty rates as “only fair” for nurses.

The research showed a surprising level of understanding and concern in aged care, not just those working in the sector but amongst nurses in all areas, Mr Mitchelmore said. “Nurses and midwives were aware of serious understaffing and cost cutting pressures, poorly paid staff and inadequate skill mix.”

The public were also largely aware of the issues in aged care, many of whom had parents and grandparents in facilities.

The variability of care in different facilities was of concern, as well as not enough facilities, and cost.

There was despair from those working in aged care about the quality of care they are able to provide due to cutting skill levels, “terrible” ratios, a lack of RNs,

carers being given more and more to do and a simple lack of numbers.

Aged care workers described being “rushed off their feet” struggling to get through the basics and being incredibly time poor. Examples of poor management practices included carers being upgraded to give medicines, staff not being replaced and the use of cheap wound products.

Those working in aged care and nurses in general considered aged care as a ‘hidden problem’, and “feel that many in the public don’t realise how bad it is”, Mr Mitchelmore said. “However awareness in the public focus groups was surprisingly good and many knew the issues fairly well. It’s not about education - it is about getting it on the political agenda. There is a good groundswell but it’s not a top political issue.”

General concerns around healthcare and hospitals remained strong with nurses and midwives and the general public. “The system is overstretched and underfunded and staff overworked,” Mr Mitchelmore said. Key concerns were waiting lists, a lack of beds and a lack of doctors and nurses.

At its core, Medicare remains cherished, the research found. “Nurses and the public do not want it to change, they would regret it if it was to disappear,” Mr Mitchelmore said.

the Act was a difficult, cumbersome and slow process Mr Edgerton said.

“There are enormous hoops in order to talk to the public. Those who have spoken out have actively defied, almost dared the government to use this Act. It’s a dangerous tactic. I’d much rather change the law than someone risk jail for us to determine the parameters.”

One of the six who worked for Save the Children provided information relied on for The Forgotten Children 2014 report. Mr Edgerton was the legal advisor for the Commission’s Inquiry.

“There were many serious allegations that might not have seen the light of day,” Mr Edgerton said. “But the Border Force Act puts it on you to make that

judgement call. We need to campaign to have these laws repealed: it is not reasonable to put the onus on you.”

The Border Force Act affected consultants, contractors and employees, Mr Edgerton said. This included nurses working in detention centres to a midwife working in Darwin delivering a baby from a woman who had been flown in from Nauru.

ANMF Federal Secretary Lee Thomas said it was outrageous that nurses and midwives could be locked up for “just doing their job”. “Nurses and midwives must be able to carry out their duty of care by reporting any instances of sub-standard care or abuse on places like Manus Island and Nauru.”

Campaign to repeal gag orders on nurses and midwives Nurses and midwives need to continue to campaign against the ‘gag order’ against them speaking out about conditions in Australian and offshore detention centres, amid the imminent threat of a jail term.

The warning came as ANMF delegates protested against the Australian Border Force Act 2015 introduced this year at their 12th Biennial National Conference.

The Act could see nurses and midwives imprisoned for two years for speaking out in public about conditions they witness.

While no one has been prosecuted since the laws came in on 1 July, some health professionals have very publicly spoken out. Six cases had been brought by the Federal Police against people working on Nauru, Australian Human Rights Commission Senior Lawyer Graeme Edgerton told delegates.

The public disclosure defence in

4 December 2015 / January 2016 Volume 23, No. 6

anmf.org.au

NEWS

Detention is damaging for children Sydney Children’s Hospital Consultant Paediatrician and expert consultant on children in immigration detention Elizabeth Elliott had just spent three gruelling days at Wickham Point Detention Centre in the NT when she addressed ANMF delegates in Adelaide. “There were few hopes; many fears that pervade people every waking moment.”

As of 30 September, 113 children were in Australian detention centres, 92 of those on Nauru, she said.

“Australia is the only country that detains children as a first action. It’s mandatory and indefinite,” Ms Elliott said. “They live in a three by three room with no windows and no privacy.

They have to leave the door open or the air conditioning doesn’t work. It’s overcrowded and cramped.”

DETAINING CHILDREN DOES NOT STOP PEOPLE COMING TO AUSTRALIA. Ms Elliott is an expert consultant to the Australian Human Rights Commission and has visited Christmas Island and mainland detention centres. Adults and children suffered current gastroenteritis and recurrent respiratory infections.

Many children had infections, hearing problems, dental caries, mental health issues, speech impairment, limited access to vaccinations, and difficulty seeing.

There was limited play for children and no paediatrician or psychologist. “They usually wait for 50-60 people to fly back to Australia,” Ms Elliott said. “Children in detention are Australia’s responsibility and we are damaging them.”

The average length in detention was 221.5 days.

Mothers were in distress, mostly due anmf.org.au

to the conditions their children were living in. Three women had terminated their pregnancies as they thought their babies wouldn’t survive the harsh conditions, Ms Elliott said. Women were on 24hour suicide watch with the most common attempts cutting, ingestions, burns, hanging, and jumping.

There was a pervasiveness of hopelessness and depression, she said.

The Forgotten Children report found 34% of children had moderate to very severe mental health problems compared to less than 2% of Australian children.

There had been 128 incidents of actual self-harm in children, Ms Elliott said.

“There is a level of need for child and mother health in terms of self-harm but they are not being seen by a psychologist or psychiatrist. There is a lack of compassion.

“Detaining children does not stop people coming to Australia. Children are asking for our help but we cannot do that if they cannot speak out.”

Nurses and midwives protested against children held in detention outside Sydney Children’s Hospital while rallies were held simultaneously nationwide.

NSW Nurses and Midwives’ Association (NSWNMA, ANMF NSW Branch) General Secretary Brett Holmes said members who had worked in some of the immigration centres had witnessed extremely distressing scenes. “Scenes of children in desperate need of nurture and comfort but instead are living in a torturous situation.”

What delegates said “I don’t know about anyone else but I just want to go to the airport, get on a plane and go scoop them all up. I don’t have any room in my home but I’ll make room.“ Jodi Knoop, SA “A lot of us feel helpless and do not know what else we can do. A lot of our problems we can vote out of government but this is bipartisan and feel there’s nothing we can do.”

Annette Alldrick, NSW “Four years ago we went to Java, my son was 8yrs old. In his year 6 class he was asked why refugees go on to the boats. He said: “because they are not safe on the land”. It saddens me “ Dave Corstorphan, VIC “There is still the demonising and vilifying of refugees and asylum seekers. We recently convened a social justice and refugee rally in South Australia.”

Marisa Bell, SA “Health services in detention centres in the NT operate 9am-5pm Monday to Friday. After hours if something happens it takes 45 minutes for an ambulance to arrive and then they cannot access or take records as they are locked away. They are taken blind to the hospital. NT detention centres should provide 24 hours, seven day a week medical care to refugees in detention.”

Yvonne Falckh, ANMF NT Branch Secretary

December 2015 / January 2016 Volume 23, No. 6 5

NEWS

Nurses and midwives stand by Rosie Batty

ONE IN THREE WOMEN IS AFFECTED

BY VIOLENCE. ONE IN FOUR CHILDREN IS PERMANENTLY DAMAGED BY FAMILY VIOLENCE

Coming to the end of her term as Australian of the Year 2015, family violence campaigner Rosie Batty was inundated by support from nurses and midwives at the ANMF’s recent 12th National Biennial Conference.

“It has been an incredible year. As Australian of the Year my intention was to stand by victims,” Rosie said. “It has had a ripple effect and gained momentum.

Thank you for watching my back. We have become a powerful voice.”

The ANMF has been a founding partner of the Luke Batty Foundation’s Never Alone campaign to stand alongside victims of family since its launch in June.

The Never Alone campaign has so far over 40,000 members.

Rosie has spoken at 300 events and reached up to 70,000 people this year. “I never thought I would be seen as a leader and I still struggle with that.”

The federal government’s recent $100 million family violence package was encouraging, she said. “People who have worked in family violence for decades are seeing things happening they never thought would have seen the light of day.”

At the conference NSW Midwife Annette Alldrick said her area had been identified with increased family violence.

“We do routine DV screening but very few have done the training. There is no dedicated social worker and no cover on weekends. The responsibility is being put more and more on midwives.”

Everyone should have the minimal amount of training, Rosie said. “It’s not hard to get the training and refer to family violence units. The 1800 RESPECT line links

Calling on all grad nurses and midwives The Australian Nursing and Midwifery Federation (ANMF) is calling on new graduate nurses and midwives to reveal their stories of securing or struggling to find employment.

The ANMF is committed to helping new graduate nurses and midwives land a job post study and plans to use the detailed information as a platform to tackle ongoing workforce issues.

Initially, the ANMF is simply asking new graduate nurses and midwives to sign up to its grads group by entering one’s name, email address, and state.

More than 500 people have already signed up to the cause and strong support for the strategy has also been

www.neveralone.com.au

women to services in their area.”

Victorian delegate Megan Hayes told Rosie within days of hearing her speech at the ANMF Victorian Branch conference in July she encountered a woman in a domestic violence relationship who had just left her partner. “Because of the conference I went on to the website and was able to give this woman some resources. Keep teaching us, it is going to empower us to help our patients.”

Two women a week are murdered when they choose to leave their partner. One in three women are affected by violence. One in four children is permanently damaged by family violence. “I look at the long journey ahead: so much change needs to happen to reduce those statistics,” Rosie said. “We are starting to understand gender equality and the link to family violence.

Due to public pressure a women’s shelter that had been shut down had reopened in May, however the DHHS had used it to house homeless women, one delegate said. “The shelter has turned 100 women [family violence victims] away because mentally ill women are in those beds. These women seeking refuge need specialised support with the complexities with what they are going through.” expressed via social media channels.

Over the next few months the ANMF will contact participants to examine their personal situation.

Key considerations will include whether new graduate nurses and midwives have found a job or are still looking for work.

Another relevant point will question whether some graduates have secured the job they want or have been forced to settle for an inferior position.

The ANMF will pool together the information and use it to work towards helping the next generation of nurses and midwives find jobs.

In February last year, the ANMF conducted a similar survey in a bid to obtain a snapshot of information on employment opportunities for new graduate nurses and midwives.

6 December 2015 / January 2016 Volume 23, No. 6

Safety for these women is incredibly important,” Rosie said. “There needs to be links to specialised services to talk about risk assessment tools to help women make the choices they need to make.”

Victorian nurse Dave Corstophan said his wife became burnt out after working in the Gulf of Carpentaria witnessing family violence. There were also issues of reporting in terms of backlash, he said.

“In remote communities it is incredibly difficult. Aboriginal women are 34 times more likely to be hospitalised for family violence,” Rosie said. “There is fear of Aboriginal women from the police response and then the ramifications.”

Myths needed to be defied, Rosie said.

“It isn’t caused by drugs, mental illness, alcohol – they contribute to domestic violence but violence is a choice.

“Look at your own workplace or organisation: what processes and procedures are embedded to address family violence? What is the culture of your workplace?”

Rosie encouraged nurses and midwives to go on to the Never Alone website and “join me on my journey.”

“I feel hopeful and am convinced we can reduce this epidemic.”

Dominant themes included not being offered a job due to lack of experience, a widespread lack of jobs for new graduates, and new graduates applying for more than 30 positions without success.

The survey coincided with a 2014 Graduate Nurse and Midwife Roundtable led by the ANMF that brought together more than 30 nursing and midwifery leaders and key stakeholders to dissect the problem.

Positively, a working party was formed to help find solutions to the problem and trigger real change.

A second Graduate Nurse and Midwife Roundtable will be held in February next year.

To sign up go to - http://action.anf. org.au/page/s/graduate-nurses-andmidwives anmf.org.au

Regional health shines at primary health care awards The recent HESTA Primary Health Care Awards had a distinctly regional feel with all three winners working to improve the health outcomes of Australians living and working in rural and regional areas.

The winners included an outstanding individual improving Indigenous health across Australia; a team of regional podiatrists working to prevent diabetes related amputations; and a rural NSW ambulance paramedic specialist driving greater care through mentoring, training and improving processes for paramedics.

HESTA CEO, Debby Blakey said this year’s winners show the diversity of disciplines necessary to deliver outstanding levels of care, and better health outcomes.

Winners Don Palmer, Amy Freeman representing Boab Health Services Podiatry and Matthew Simpson

“We are pleased to support professionals demonstrating exceptional leadership and commitment to improving patient care and access to services across Australia, while also having a positive impact on communities,” Ms Blakey said.

The winner of the 2015 Individual Distinction Award, Don Palmer, founder and chief executive of the Malpa Project was recognised for starting an initiative that trains Indigenous children to be health ambassadors in their communities and bringing back traditional medicine to strengthen Aboriginal communities.

The Boab Health Podiatry team from Boab Health Services in Broome were awarded the 2015 Team Excellence Award for their work with preventing

diabetes related amputations – the regional podiatrists provide the only podiatry service to the Kimberley Health Region in Western Australia.

Matthew Simpson from Ambulance Service of NSW was given the 2015 Young Leader Award for his work in driving greater patient care through mentoring, training and improving processes for paramedics – he is involved in the delivery of contemporary outof-hospital clinical care to patients.

This year marked the third HESTA Primary Health Care Awards, a bi-annual event recognising the dedication and professionalism of those working on the frontline in health care, including physiotherapists, dentists, pharmacists, therapists, GPs, rehabilitation professionals, health educators and medical practice managers.

The Young Leader and the Individual Distinction Award winners each received a $5,000 ME EveryDay transaction account and $5,000 towards further education.

The Team Excellence Award winner received a $10,000 development grant.

The 2015 HESTA Primary Health Care Awards is a HESTA initiative, proudly sponsored by the bank owned by industry super funds, ME. To learn more, visit hestaawards.com.au With more than 25 years of experience and $32 billion in assets, more people in health and community services choose HESTA for their super.

Finalists from left to right: Sonia Waters of The Malpa Project, Michelle von Muralt of Hear and Say, Dr Mehdi Sanati pour, Dana Ieraci, Jo van Dort of Manningham Community Health Services, Amy Freeman of Boab Health Service Podiatry, Don Palmer, Matthew Simpson, Megan Swann, Greg Poynter representing Rebecca Cause, Kylie Robb, Dr Jilen Patel, Laura Handscombe of Boab Health Services – Closing the Gap.

Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 791 749 321. Before making a decision about HESTA products you should read the relevant Product Disclosure Statement (call 1800 813 327 or visit hesta.com.au for a copy), and consider any relevant risks (hesta.com.au/understandingrisk).

NEWS

Butler’s baby boomer book Baby boomers have arguably done more than any other generation to help reshape Australia and will continue to be at the forefront of change in the future.

Federal Member for Port Adelaide Mark Butler spoke with members and signed copies of his new book Advanced Australia: The Politics of Ageing, at the ANMF’s 12th Biennial National Conference held in Adelaide.

The book highlighted a more positive approach to ageing and the continuing contribution made by older Australians.

Baby boomers had driven cultural change and social justice for over 50 years, the former Minister for Mental Health and Ageing said. The generation was responsible for concepts such as ‘adolescence’ and ‘working families’.

The average Australian’s life expectancy has increased by 25 years over the past century from mid 50s to early 80s. By 2030 the number of those aged over 65 will increase from three to six million. Within two decades this figure will increase to nine million.

There was deep hostility and the sense

ANMF FEDERAL SECRETARY LEE THOMAS, MP MARK BUTLER, ANMF ASSISTANT FEDERAL SECRETARY ANNIE BUTLER AND ANMF FEDERAL PRESIDENT SALLY-ANNE JONES

that ageing was going to “wreck the economy”, Mr Butler said. “The tipping point was in 2011 when many baby boomers turned 65 and started to retire and accessed the old aged pension.

It was a significant shift in our population profile.”

Ageing will touch almost every area of policy – retirement incomes, housing, employment, urban design, and health.

“This is not a calamity,” Mr Butler said.

“Australia is better placed than any other country to meet this challenge”.

While our older Australians had made great contributions to Australia, many lived on the edge financially. “They live precariously,” Mr Butler said. “We have one of the lowest age pensions: it is very, very meagre.” Most baby boomer women aged 50-64 will have less than $30,000 superannuation when they turn 65. Those in their late 60s have zero superannuation.

“The challenge is how we make sure our older Australians have good active lives where they don’t feel like a burden.”

NEWS

National registration for paramedics

Latest research grants

Sleep study for night shift-workers

Paramedics will be nationally registered under the same regulatory body as nursing and midwifery in what has been hailed as a landmark move by the profession.

Currently 14 professions come under the Australian Health Practitioner Regulation Agency, including nursing and midwifery.

Health ministers voted to move towards a national registration accreditation system for paramedics at the last Council of Australian Governments (COAG) meeting held in Adelaide. Ministers agreed work would need to be done, including around the scope of the paramedic workforce and development of vocational as well as tertiary pathways.

Paramedics Australasia (PA) lauded it as an historic day for paramedics.

“November 6, 2015 will go down in history as the landmark day it was agreed for Australian paramedics to be nationally registered,” PA President Associate Professor Peter Hartley said.

“This is a defining development for our profession and has only come about due to the sustained, strategic and proficient advocacy campaign PA has undertaken over a 10 year period.”

The move has been to regulate the

How and if sleep can be used strategically to cope with night shift will be explored in one of the latest Australian Research Council (ARC) grants.

around 18,000 paramedics working across Australia in the public and private sectors.

“In the course of their day to day work paramedics conduct invasive procedures, administer scheduled drugs and often work in dangerous, uncontrolled and unsupervised settings. The community expects that these professionals are held to appropriate standards of training and performance,” Mr Hartley said.

National registration for paramedics would not be in place until 2017.

Government has been tasked with developing policy around Paramedic National Registration by March 2016.

Regulation will only apply in states and territories that choose to include paramedics in the scheme. NSW has reserved its right to participate so far.

CQ University Adelaide has secured an ARC major grant of $310,000 over four years to identify sleep strategies shiftworkers can use to minimise cognitive impairment during night shifts.

More than one million Australians regularly work at night, CQ Uni researcher Dr Charli Sargent said. “In the second half of night shifts, the combination of sleep loss, extended wake, and time of day causes a level of cognitive impairment similar to that associated with a blood alcohol concentration of 0.5%.”

The project will investigate whether the timing of daytime sleep between consecutive night shifts can be used to increase the duration of sleep and/or reduce the length of wake time prior to work, Dr Sargent said. “The strategies could then be translated into policy and practice to reduce the economic and social costs associated with night work,” he said.

Simulator to help flight nurses deliver first-rate patient care The nation’s first nurse-led flight simulator lab has been unveiled at the New South Wales Ambulance’s aeromedical services fixed-wing base at Mascot.

The lab simulates patient scenarios including cardiac arrest, child birth, seizures, and paediatric trauma. It also simulates flight emergencies such as rapid cabin decompression or fire.

Developed in a bid to help flight nurses bridge the gap between theory and practice, the simulator lab places the state’s flight nurses at the forefront of training and technology.

The NSW Ambulance fixed-wing fleet operates out of Mascot, Dubbo, and Broken Hill, covering a 1,400 kilometre stretch of NSW coastline.

In 2014, its five aircraft based at Mascot helped transport more than 5,000 patients. Senior Flight Nurse Margaret Tabone, who has been an anmf.org.au

A FLIGHT NURSE WORKING AT THE SIMULATOR LAB – FLIGHT NURSE

integral part of the service for 17 years, said rural and regional people who require aeromedical retrieval for illness or injury can feel confident that flight nurses possess the appropriate skill-set to tackle any challenge.

“This simulator is invaluable because dealing with a scenario in a space restricted cabin, by yourself, with only two hands and no immediate help available is very different to what happens on the ground.”

December 2015 / January 2016 Volume 23, No. 6 9

NEWS

Technology sector implored to help prevent violence against women New and emerging technology will be utilised in a bid to help prevent violence against women under a joint initiative between the Commonwealth and South Australian governments.

Stronger flu protection on the cards A stronger flu vaccine will be introduced in Australia in 2016 in response to a record number of cases of the virus this year.

The federal government will upgrade its National Immunisation Program (NIP) to include a new influenza vaccine for 2016 that covers four flu strains – up from three this year.

The new vaccine will include the Brisbane and Phuket strains of the influenza virus, which contributed to a record 90,000 reported flu cases in Australia in 2015, a considerable 25,000 more than the previous record reported last year.

The strains to be included in next year’s four strain vaccine align with the World Health Organization’s (WHO) recommendations for the southern hemisphere.

The government currently spends upwards of $40 million immunising Australians against the flu.

In a bid to ensure full coverage of the population, two vaccines will be offered in 2016 – one for people aged three years and over and one that is specifically tailored to children under three.

The NIP is designed to protect population groups most at risk, including the elderly, Aboriginal and Torres Strait Islander people who are younger than five and older than 15 years, and pregnant women.

The 2016 four strain vaccine will cover two A strains of influenza (California and Hong Kong) and two B strains of influenza (Brisbane and Phuket).

Influenza B viruses are estimated to have accounted for about 62% of flu cases in Australia in 2015.

Violence against women will be the focus of South Australia’s next D3 Digital Challenge, a scheme which calls on the Information Communiations Technology (ICT) sector to discuss, design, and create innovative solutions to longstanding social issues.

The Commonwealth government has contributed $60,000 in funding to the program.

Ideas could include digital solutions that: support women who are experiencing or at risk of violence; enable women’s support networks including counselling; and challenge and eliminate attitudes that continue to perpetuate violence against women.

Federal Minister for Social Services, Christian Porter, said he was confident the government’s funding was supporting a worthy initiative.

“We need to explore new options for protecting women,” he said. “It is a terrible fact that one in six Australian women has experienced violence from a current or former partner, so these types of practical paths to innovation are very welcome.”

10 December 2015 / January 2016 Volume 23, No. 6

Mobile dementia squads now on call A mobile national workforce of clinical experts has been put into operation to help aged care providers manage residents with severe behavioural and psychological symptoms of dementia.

The $54.5 million federal government initiative, run by HammondCare, establishes Severe Behaviour Response Teams (SBRTs) that provide an added safety net for aged care providers.

The response teams, which include nurse practitioners, psychiatrists, and GPs, will operate from 7am to 7pm and can be contacted via the Dementia Behaviour Management Advisory Service (DBMAS) 24-hour helpline.

Following a referral, response teams will attempt to contact the aged care provider within four hours to determine an immediate strategy, and will then hold a more detailed conference with the resident and provider within 48 hours to assess long-term care needs and map out strategies.The service will be available to all Commonwealth funded residential aged care providers throughout Australia.

HammondCare Chief Executive, Dr Stephen Judd, welcomed the overdue national approach to dementia support. “As the number of Australians with dementia continues to rise and the complexity of their health needs increases, this further development in our national response is vital.”

Director of HammondCare’s Dementia Centre, Associate Professor Colm Cunningham, concurred. “I’m confident a specialist team working closely nationally can offer a significant contribution both to the immediate needs of people in this situation and to the future direction of service delivery and models.”

Federal Health and Aged Care Minister Sussan Ley said the new initiative would provide additional support for residents in crisis situations.

The implementation of the mobile dementia squads marks the first phase of the scheme, with phase two focussed on learning from the lessons uncovered during the rollout. anmf.org.au

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Dementia programs fall short An independent analysis of the government’s dementia services has uncovered worrying gaps, unmet needs across several consumer cohorts, and a lack of consistency and coordination of workforce education and training opportunities.

Released last month, the report, undertaken by KPMG, paints a troubling picture of the nation’s system and indicates an immediate need for a more structured approach to the design, development, funding, and rollout of dementia programs and services.

The Department of Social Services fund a number of activities to support people affected by dementia including education and training for the health and aged care workforce, as well as families of people with dementia.

Critically, the report found unmet needs within several consumer cohorts, including people from Aboriginal and

AHPRA watching thousands of health professionals to protect public Thousands of health professionals, including nurses and midwives, are being monitored by Australia’s health practitioner regulation body because they have a criminal history, drug problem, struggle speaking English, or fall short in carrying out their job.

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Torres Strait Islander backgrounds, people in rural and remote areas with poor health literacy, and people at risk of homelessness.

Further, it revealed overlapping in support services for people affected by dementia and subsequently recommends several opportunities for consolidation be strongest considered.

The number of Australians with dementia is predicted to grow to more than one million people in the next 40 years.

The report identifies key gaps across most programs and services in regional, rural and remote accessibility and suggests fund allocation should be reconsidered to more appropriately maximise coverage.

It also noted an ongoing need to promote earlier detection across the primary sector.

Despite the shortfall in services, the report did find carers and consumers value support services available, particularly when they are delivered face-to-face and during the early onset

of dementia.

Many stakeholders questioned throughout the analysis advocated for a one-stop-shop for dementia care in a bid to reduce system complexity among carers and consumers and the report views the scenario as potentially achievable and beneficial.

While the report makes a number of recommendations regarding the path forward, Federal Health Minister Sussan Ley said the government will consult with the aged care sector before announcing its response by the end of the year.

Minister Ley acknowledged there was much work to be done and that older people with dementia and their carers deserve the same level of care no matter where they live. “The aged care sector must play a part in the development of any policies and work hand-in-hand with government to develop a truly national approach to improve their national alignment, coordination, and effectiveness.

A similarly focused report on

The data, contained in the Australian Health Practitioner Regulation Agency’s (AHPRA) recently released annual report for 2014/15, reveals 5,702 health professionals were watched over the past financial year due to concerns regarding non-compliance.

Nurses accounted for 1,245 of the cases monitored, running second only to doctors on 2,020, while 117 midwives were tracked.

The leading reasons behind monitoring a nurse involved health, which covers having a mental illness, disability, or drug problem, as well as suitability/eligibility, which includes lacking English skills and

not being appropriately qualified for the job.

Almost 200 nurses were monitored due to issues relating to conduct, which takes into consideration any criminal history or prior examples of sub-standard professional conduct.

Positively, AHPRA established an expert panel in 2014 to help it uncover greater drug and alcohol misuse among health professionals and has since increased its range of drug screening.

The annual report also showed 8,426 notifications were made last year nationally.

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NEWS dementia, undertaken by Griffith University, explored the role and needs of the family carer across acute settings.

Funded by the Dementia Collaborative Research Centre, 30 families and 30 acute care staff were interviewed from across Queensland, Victoria, and Tasmania.

The study found families felt they were often being ignored and could have been used much better as a resource to improve the relationship between their relative and medical and nursing staff.

The study uncovered a significant need for an increased focus in the family as a resource to improve communication.

“Many of the families interviewed believed their role was to provide emotional and physical support to their family member; however they felt there was often a barrier to providing this support with medical and nursing staff often unaware of the needs of older patients with dementia.”

A ‘notification’ denotes a complaint made against a registered health practitioner and can involve health impairments, sexual misconduct, or boundary violation.

The number of notifications received fell by 1.4% from the previous year, with doctors once again receiving the highest proportion of complaints among professions.

In 2014/15, 28.8% of notifications were made directly by a patient, with a further 14% received via a health complaints entity.

Across the 370,000 strong nursing and midwifery workforce, 1,131 notifications

ANMF slams proposed GST hike The Australian Nursing and Midwifery Federation (ANMF) has warned that a proposed increase in the GST should not extend to include basic health services that everyday Australians rely upon.

Reports surfaced early last month that the federal government is strongly considering raising the GST from 10% to 15% and expanding it to health, food, and education.

ANMF Federal Secretary Lee Thomas said the move would cripple some of the most vulnerable people in our society by hurting the hip pocket of low income earners, youth, and struggling families. “Australians already suffer some of the highest out of pocket expenses for healthcare in the world.

Any increase in the current GST to cover health would see people all across the community forking out even more for their basic, everyday healthcare.”

were received (excluding NSW) against nurses, and 65 versus midwives.

Victorian nurses received the most complaints than any other state, with 349 notifications, followed by Queensland on 276. Of the more than 1,000 nursing notifications received, just 362 were subject to a further investigation.

Of these, 176 resulted in conditions being imposed, 161 resulted in cautions being issued, and 12 resulted in the cancellation or suspension of registration.

Critically, AHPRA, also successfully prosecuted nine health professionals in court over serious crimes in breach of

The ANMF is now urging the government to abandon what it labels yet another cost-shifting exercise on to health consumers.

“What Australia needs is a stronger, sustainable universal system of healthcare under Medicare, which can deliver efficiency savings to the government, whilst providing the proper funding to health and aged care to allow nurses and midwives to deliver quality care to their patients,” Ms Thomas said.

National Law during the past financial year.

Completed prosecutions included the case of Queensland woman Sherri Carter, who pleaded guilty in the Brisbane Magistrates’ Court earlier this year of pretending to be a registered nurse.

Ms Carter was found to have wrongfully used the titles ‘nurse’, ‘registered nurse’ and ‘nurse practitioner’ over the past three years. In court, she conceded while she had completed some nursing training in New South Wales and Victoria, she did not hold any formal qualifications. Ms Carter was ordered to pay $7,000 in fines.

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NSW Inquiry backs need for registered nurses in aged care A much anticipated report into the role of registered nurses within residential aged care facilities in New South Wales has deemed they are essential to quality care and recommended retaining current laws that require at least one RN be on duty at all times.

The Legislative Council Committee’s findings justify a long and passionate campaign run by the New South Wales Nurses and Midwives’ Association (NSWNMA ANMF NSW Branch) to protect the role and importance of registered

nurses in nursing homes.

NSWNMA General Secretary Brett Holmes welcomed the report’s verdict and said he was hopeful its 17 recommendations will now be adopted by the NSW government.

Aside from keeping registered nurses, other key recommendations include: retaining minimum staffing ratios in aged care; forcing aged care facilities to disclose information about their staffing set-up publicly; increased funding for the training and engagement of registered nurses; clearer guidelines for lodging complaints; and regular unannounced spot checks of facilities.

“The volume of evidence supporting the minimum requirement for registered nurses to be on duty around the clock in

facilities with high care residents speaks for itself,” Mr Holmes said.

The four-month Inquiry, which received more than 160 submissions from community groups and aged care workers, also found that shifts led by a registered nurse were more likely to reduce unnecessary hospitalisations and increased the quality of care.

The NSW government will now make a final decision on the back of the findings by the end of the year.

The Australian Nursing and Midwifery Federation (ANMF) has called on the federal government to develop an Aged Care Workforce Strategy immediately or else the amount of quality care delivered to the elderly will continue to be compromised.

Call to boost quality palliative care in the bush Building strong palliative care networks in remote areas empowers people living in the bush by affording them the right to die at home, a remote area nurse (RAN) has stated.

Speaking at the recent CRANAplus Conference in Alice Springs, Sue Carroll recounted the story of a 98-year-old terminally ill man named Charlie and his decision to bypass treatment and let nature take its course.

Ms Carroll is the nurse manager at Swifts Creek Bush Nursing Centre in Victoria, a small farming town with a population of 420 that sits an hour and a half from the nearest hospital.

Charlie had moved to the town more than 60 years ago and ran the general store for 20 years.When Charlie was diagnosed with cancer, he elected not to undergo treatment. His three children, who had looked after him since his late wife passed away five years ago, took it upon themselves to be by his side on a rotating basis following the diagnosis.

Ms Carroll said the Bush Nursing Centre was approached early on.

“Charlie’s condition began to deteriorate fairly rapidly and the family came and approached the RAN to discuss what they could do.”

Ms Carroll undertook an assessment and found palliative care was required.

“As his dependency increased, he needed 24-hour-care and family were there to do that and I would just go in to assist them.”

Pain management emerged as a significant issue, however, the service controlled the situation by employing anmf.org.au

HIS CHILDREN SAID THEY WERE SO HAPPY TO KEEP HIM AT HOME AND BE THERE WHEN HE TOOK HIS LAST BREATH

a palliative care nurse practitioner, and communicating with an oncologist in Melbourne to discuss pain relief.

Charlie’s pain medication was increased as his situation deteriorated.

Last year, the Bush Nursing Centre received funding for a palliative bed that can be moved around the house so family can be amongst their loved ones in the lounge room - Charlie took up the option.

“Funding is a major issue. The Bush Nursing Centre does not get any palliative funding from the federal government. We’re funded by the state government and it’s just funding for Monday to Friday nine to five,” Ms

Carroll said. “But we choose to give 24hour a day care to our patients because we believe that people should have the right to choose to die at home.”

After six weeks, Charlie passed away in the company of family.

“His children said they were so happy to keep him at home and be there when he took his last breath,” said Ms Carroll.

Ms Carroll said the experience illustrated the benefits of creating quality palliative care networks in remote areas.

She said the cost of a palliative bed in a hospital is $491 per day, and if that patient was kept at home for six weeks, then it would save the government more than $20,000.

Sustainable funding models were essential if these types of services were to become valued and widely available in remote areas, said Ms Carroll. “Seven million people live outside the main cities. Not everybody lives in cities and access to acute services decreases the further away you are and not everybody wants to travel away from home for palliative care.”

December 2015 / January 2016 Volume 23, No. 6 15

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NEWS

Strategy to increase number of Indigenous nurses in NT The Northern Territory government hopes to secure a new generation of Aboriginal nurses through targeted strategies focused on attracting and retaining a substantial workforce.

Speaking at the recent CATSINaM conference, Nurse Advisor Ted Murphy, from the Northern Territory Department of Health’s Office of the Chief Nursing and Midwifery Officer, outlined the government’s plans to increase Indigenous employment.

The Indigenous Employment and Career Development Strategy 2015-20 (IECDS) pledges to boost Indigenous employment figures to 16% by 2020.

This also includes a 10% target for Indigenous participation in senior management and executive roles.

About 30% of the Northern Territory’s population is Aboriginal and Torres Strait Islander, with Indigenous people using 70% of the Northern Territory Public Sector’s (NTPS) services in health, education, and the judicial system.

Engaging rural and remote health leaders of tomorrow The next generation of rural and remote health leaders are being captured through high school visits conducted by dozens of student-led university Rural Health Clubs from across Australia.

The program is run by the National Rural Health Student Network (NRHSN) and facilitated by more than 9,000 members who belong to 28 university Rural Health Clubs.

It involves university students from nursing, medical, and allied health courses, engaging rural and remote high schools to promote health careers in a bid to address workforce shortages in the bush.

NRHSN Vice Chair Rebecca Irwin told delegates at the recent CRANAplus Conference in Alice Springs how evidence shows that growing up in a rural area is a strong trigger to taking up rural and remote practice in the future.

Consequently, high schools visits have become an important strategy to encourage youth from rural and remote backgrounds to consider health careers.

Each club undertakes two or more rural anmf.org.au

Despite this, Indigenous employees in the NTPS make up just 8.7% of the workforce.

Mr Murphy said the stats indicate a clear under-representation.

The workforce strategy encompasses four key themes including targets for Indigenous employment and participation, engagement and support, attraction and retention of Indigenous people, and ongoing career development to ensure progression and pathways.

Mr Murphy said the strategy would help address the disparity that exists in attracting and retaining Aboriginal nurses. “We need to establish pathways and tell people how you get from here to here. Spell it out with clarity and then give people support to get there.”

Mr Murphy said the government had committed to helping make inroads to increase the amount of Aboriginal nurses over the next five years.

He said he held high hopes that the Aboriginal nursing workforce could be built-up significantly, suggesting that the presence of Aboriginal nurses in communities will help spark growth and contribute to others viewing it as a realistic option. and remote high school visits per year.

At rural high school visits, one of the common features is a model named Bob, a 60-year-old farmer who is experiencing weakness in his left arm and leg, and slurred speech. Bob is used to illustrate the diverse health scenarios that can play out, from the paramedics that arrive on scene, through to the community nurses on discharge, and all the medical nurses and allied health professionals in between.

“It’s really exciting when we introduce them to a whole new career that they had never even thought about,” Ms Irwin said.

“The whole session is a fantastic way to connect with students and the unique thing about it is that rural health club members are typically only a few years ahead in that journey so it’s easy to relate to.”

Ms Irwin said another crucial component of the visits involves discussing perceived barriers many rural and remote youth hold regarding pursuing a health career.

Significant issues include moving away from home, funding university and accommodation during study, and maintaining the motivation to complete the course.

Ms Irwin said most barriers could be overcome with support.

Last year, 264 rural health club members visited 96 rural and remote high

Commonwealth Department of Health’s Director Innovation and Reform Section, Health Workforce Division Karen Cook, who also spoke at the conference, said tackling the shortfall of nurses required a combination of strategies. She said one key area that should be focused on was the current student attrition rate for registered nurses, which sits at 34%. She said if the figure could be cut to 29% then it would likely remedy the shortage of nurses.

In terms of the Aboriginal nursing workforce, Ms Cook said there had been good growth in numbers. “Aboriginal and Torres Strait Islander nurses have increased. That’s a great thing, but it doesn’t for a moment mean that we can become complacent about it. We do not have enough Aboriginal and Torres Strait Islander nurses and midwives to do the work that needs to be done.”

Ms Cook said the government would soon establish a National Nursing and Midwifery Advisory Network consisting of a group of educators, regulators, and employers, to provide advice to government on what policies need to be implemented to reduce the shortage of nurses.

REBECCA IRWIN

schools and delivered career advice to almost 3,000 secondary school students.

Ms Irwin believes the program is making a real difference. “The research currently available and our NRHSN case studies indicate these students will be significantly more likely to return to rural and remote areas when qualified, therefore building the next rural and remote health workforce.”

December 2015 / January 2016 Volume 23, No. 6 17

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New wound management course for healthcare professionals The Australian Nursing and Midwifery Education Centre (ANMEC), based in South Australia, is now accepting enrolments for its new Graduate Certificate in Wound Management developed in partnership with the William Light Institute.

The course will provide healthcare practitioners with advanced knowledge and skills for specialised practice related to wound care and management.

ANMEC Education Lead Jo Wagner said the course was developed by leading wound management experts with extensive and current experience

CATSINaM breaks the ice on alarming drug Valuable information sourced from a yarning circle examining the wideranging negative effects of the drug Ice will be used by CATSINaM officials to frame the core of the organisation’s recommendations to the government’s National Ice Taskforce.

A breakout session at this year’s conference explored the early impact of Ice on Aboriginal and Torres Strait Islander communities and looked at identifying and discussing effective treatment strategies and, education, and community involvement.

CATSINaM’s Victorian Director, Ben Gorrie, said Indigenous people anmf.org.au

in wound management across a diverse range of healthcare settings. “This course will provide healthcare professionals with a solid theoretical foundation for contemporary wound care practice.

Students are also provided with an opportunity to explore topics of interest or specialty practice from a range of elective units.”

The Graduate Certificate in Wound Management is a nationally-recognised qualification which incorporates the Australian Wound Management Associations’ Standards for Wound Management, providing students with evidence-based knowledge on assessment, care planning, interventions, healing and documentation skills related to specialised or advanced wound management.

“These standards are based on best practice, ensuring that students will graduate with up to date and

were particularly vulnerable to Ice. “In terms of the Aboriginal and Torres Strait Islander population, we have this historical drug and alcohol disproportionate amount of use and harm. So it is impacting our communities a lot more.”

Mr Gorrie said Ice, which has a stimulant effect and can cause psychosis, insomnia, and stroke, had begun infiltrating Indigenous communities. “It is growing. There are more people that are using the drug on a regular, problematic basis.

“There are some remote communities where it hasn’t hit yet but the people in those communities are pretty certain it will.”

CATSINaM Chief Executive Officer Janine Mohamed said limited research existed about the drug and that it was

credible knowledge and the skills needed to advance their careers in wound management,” Ms Wagner said.

“Better still, the part-time course is delivered almost completely online so we can accept enrolments from students Australia-wide.”

The course, which starts 29 February 2016 will be conducted over 12 months part-time online delivery, with some faceto-face clinical workshops.

Entry into this course requires an undergraduate degree in one of the following health professions: nursing, podiatry, physiotherapy or medicine; along with registration with the Australian Health Practitioner Regulation Agency or enrolled nurses, with advanced diploma, registered with the Nursing and Midwifery Board of Australia.

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imperative that culturally informed approaches build on and extend existing programs that work.

There were numerous reasons why the drug posed a higher risk to the Aboriginal and Torres Strait Islander communities. Specifically, Aboriginal people had a higher burden of heart disease, are prone to acute/chronic hypertension, are unlikely to meet the national standards for oral hygiene, and suffer from higher rates of mental illness, psychosis, and depression.

In 2013, 2,522 people died of suicide, with four out of five of those Aboriginal. Strategies to tackle the problem aired during the session included counselling, education, providing family respite, and creating access to culture in order to foster a meaningful sense of community.

December 2015 / January 2016 Volume 23, No. 6 19

FEATURE

A FORCE TO BE RECKONED WITH A YEAR IN R EV IEW

“In 2015, we are putting the government on notice: the ANMF and its state and territory branches will continue to work with other unions, with community groups, with church groups and with thousands of ordinary Australians to stand up for what we value and a return to a fairer society,” ANMF Federal Secretary Lee Thomas and Assistant Federal Secretary Annie Butler said.

True to their word the ANMF worked tirelessly throughout 2015 to protect the interests of nurses, midwives, and the health needs of all Australians.

20 December 2015 / January 2016 Volume 23, No. 6

anmf.org.au

JANUARY

JANUARY

ANMF welcomed the federal government’s decision to scrap changes to Medicare rebates. The $20 reduction in subsidies paid to doctors for patient consultations under 10 minutes, would have resulted in more out of pocket costs passed on to patients.

The Productivity Commission released five issues papers for consultation in a review of the entire industrial relations system.

A contentious issue was penalty rates. “To this end we have warned the government that stripping away penalty rates and other allowances will clearly compromise healthcare provided to Australians,” ANMF Federal Secretary Lee Thomas warned.

The ANMF response was informed by an online survey from members nationwide.

Working party announced following an unprecedented roundtable with key industry stakeholders, including over 30 nursing and midwifery leaders, to discuss ways of securing employment opportunities for more than 3,000 nursing and midwifery graduates out of work.

1

2 1. ANMF ASSISTANT FEDERAL SECRETARY ANNIE BUTLER WITH GRADUATE CIARA RAFFERTY 2. KEY INDUSTRY STAKEHOLDERS

FEBRUARY

JANUARY

1

NSW Nurses and Midwives’ Association (NSWNMA, ANMF NSW Branch) Patient before Profits campaign aired highlighting the effects of what a heavily privatised, American-style health system would have on the state.

SA nurse Nat Cook starts work as MP for Fisher after winning surprise by-election which gave Labor the majority to govern the state.

Federal government announced $54.5 million investment over four years to establish Severe Behaviour Response Teams, known as ‘dementia flying squads’. The ANMF welcomed the move but urged the government to do more across the whole aged care sector.

2

ANMF has support of Senator Glenn Lazarus formerly of the Palmer United Party (PUP) to support the union’s fight for mandated staffing levels in aged care and ongoing campaign to save Australia’s universal healthcare system.

1. SA NURSE NAT COOK WITH HER FAMILY 2. SUPPORT FOR SAFE STAFFING LEVELS IN AGED CARE SENATOR GLEN LAZARUS WITH ANMF ASSISTANT FEDERAL SECRETARY ANNIE BUTLER AND FEDERAL SECRETARY LEE THOMAS.

anmf.org.au

December 2015 / January 2016 Volume 23, No. 6 21

MARCH Thousands of nurses rallied around the country to fight for workers’ rights. The recent full scale Productivity Commission inquiry into industrial relations showed it could cut penalty rates, abolish the minimum wage and bring back unfair individual contracts.

A national survey of more than 13,000 nurses, midwives and assistants in nursing showed an overwhelming 93% warned they would take action to protect their penalty rates. The ANMF reiterated penalty rates would remain among the union’s key agenda issues in 2015.

ANMF welcomed the government’s backflip on its proposed GP tax. “The government must commit to ceasing its attacks on universal healthcare,” ANMF Federal Secretary Lee Thomas said.

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This month elections were held for ANMF Federal Secretary and Assistant Secretary, President and Vice President.

Outgoing President Coral Levett, who chose not to run after 12 years in the position, was acknowledged for her significant contribution to the ANMF, in particular for her strength, commitment, and determination.

2 1. NURSES AND MIDWIVES RALLY AGAINST CUTS TO PENALTY RATES 2.CORAL LEVETT

1. LEE THOMAS 2. CATSINAM CALL FOR MORE INDIGENOUS NURSES

APRIL ANMF welcomed plans for a review of the Medicare Benefits Schedule (MBS) but urged nurses and midwives be included in consultations and the union represented on the Primary Health Care Advisory Group.

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Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) called for more efforts to recruit, graduate and retain more of its peoples to nursing and midwifery at a lobbying day at Parliament House in Canberra. A staggering 12,727 Aboriginal and Torres Strait Islander nurses were needed around Australia. “There are simply not enough of us to meet the health needs of our people,” CATSINaM CEO Janine Mohamed said.

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Australia’s first Chief Nurse and Midwifery Officer Dr Rosemary Bryant retired after almost seven years in the position and a career spanning 52 years.

MAY Tributes paid to nurses and midwives in celebrations held around the country and worldwide on International Day of the Midwife on 5 May and International Nurses’ Day on 12 May. A Force for Change: Care, Effective, Cost Effective was the International Council of Nurses’ theme for 2015 and Midwives: for a better tomorrow by the International Confederation of Midwives.

The federal Budget 2015-16 saw a total spend of $69.4 billion, a reported decrease of $2 billion. Unions, health and welfare organisations slammed the budget as bare-boned with those on low incomes still reeling from the 2014 budget. ANMF Federal Secretary Lee Thomas said the axing of aIN HARM’S further $2 billion from health and aged care WAY added insult to injury on the $57 billion already ripped from the public health system.

ANMF lashed out at a proposed $967.7 million cut to the publicly funded paid parental leave scheme. Up to 100,000 nurses and midwives set to lose access to the full $11,500 under the existing PPL scheme from July 2016.

JUNE

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The ANMJ May features violence towards nurses occurring at an alarming and increasing rate and what action needs to be taken.

3 A U S T R A L I A N N U R S I N G & M I D W I F E RY J O U R N A L VOLUME 22, NO. 10

M AY 2 0 1 5

Violence in our health sector

ANMF warned the federal government’s decision to allow private health insurers to run some of the country’s new Primary Health Networks as a step towards a twotiered Americanised healthcare system.

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1. TRIBUTE TO NURSES AND MIDWIVES 2. DR ROSEMARY BRYANT AO 3. OCCUPATIONAL VIOLENCE

1. ROSIE BATTY WITH ANMF 2. CAROL FRIDAY 3. SENATE INQUIRY 457, ANMF ASSISTANT FEDERAL SECRETARY ANNIE BUTLER, RENI FERRERAS, DELY ALFERAZ AND SENIOR FEDERAL INDUSTRIAL OFFICER NICK BLAKE.

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ANMF is a founding partner of Australian of the Year Rosie Batty’s Never Alone campaign to support women and children who have experienced family violence. Nurses and midwives jump on board to help support the campaign.

ANMF Victorian Branch called for action against occupational violence to nurses and midwives following a scathing report by the state auditor-general.

The Branch re-iterated its call for implementation of its 10-point plan to end workplace violence and aggression.

ANMF called for changes to the 457 scheme to safeguard employment of local graduates and for greater protection against migrant worker exploitation before a Senate Inquiry into the impact of temporary work visas.

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An annual Victorian maternal and child nursing scholarship established in the name of Carol Friday, a MCHN for the City of Casey, who was killed along with her son aboard Germanwings flight 4UE 9525.

Unions, including the ANMF rally against the China Free Trade Agreement in states and territories throughout June, July and August.

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December 2015 / January 2016 Volume 23, No. 6 23

JULY ANMF condemned the new Australian Border Force Act in which health professionals, including nurses and midwives, working in immigration detention facilities face imprisonment of up to two years if they speak out about conditions. ANMF members led

by Assistant Federal Secretary Annie Butler rallied with doctors, social workers and allied health professionals in Melbourne protest against the legislation.

Queensland is set to become just the second Australian state to legislate nurse to patient ratios under plans announced by the state government to make it mandatory to provide one nurse to every four patients during the day and evening shifts. Legislation expected to be introduced into Parliament in months.

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Chief Executive Officer of the Australian College of Nursing Debra Thoms appointed as the new Commonwealth Chief Nurse and Midwifery Officer.

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Queensland nurse Maria Sevilla given reprieve and allowed to remain in Australia after facing deportation because her 10-yearold son with autism was deemed a financial burden on the health system. It followed a lengthy campaign by The Queensland Nurses’ Union (QNU, ANF Queensland Branch).

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1. ANMF SLAMS NEW LAWS SILENCING NURSES AND MIDWIVES BORDER FORCE PROTEST RALLY 2. QLD SET FOR RATIOS 3. DEB THOMS 4. MARIA SEVILLA AND TYRONE

AUGUST Draft report of the Productivity Commission’s review of the industrial relations system recommends cuts to penalty rates in the retail and hospitality sectors; with reduction of Sunday rates to Saturday rates along with the removal of public holiday rates.

Australian Institute of Health and Welfare report shows 9,100 nurses and midwives unemployed in Australia; an increase from 8,200 in 2013 and 4,500 in 2011. While estimated about 30-40% of nurse and midwife graduates nationwide are unable to find permanent jobs, a Graduate Career Australia report showed almost 20% of 2014 graduate nurses and midwives had not yet found full time employment.

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NSW Nurses and Midwives’ Association (NSWNMA, NSW ANMF Branch) defended current laws that require at least one registered nurse be on duty in high-care residential aged care facilities during an Upper House Inquiry examining the future of the regulation.

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1. NSWNMA DEFENDS RNS IN NURSING HOMES 2. 9,100 NURSES AND MIDWIVES UPEMPLOYED IN AUSTRALIA

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SEPTEMBER

1. ANMF GIVES EVIDENCE AT PPL SENATE INQUIRY 2. ANMF AT PRODUCTIVITY COMMISSION 3. L TO R ANITA STIRLING WITH ANGUS ANNIE PHOEBE MCDONAGH HOLDING TWINS SUMMER AND SYDNEY

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ANMF gave evidence at a Senate Inquiry in Canberra about detrimental effects of proposed changes to the current paid parental leave (PPL) scheme. Potential cuts could leave some 80,000 out of pocket by up to $11,000 forcing them back to work sooner than planned. ANMF Federal Secretary Lee Thomas urged the Senate to reject the changes on the basis the existing system allowed nurses and midwives crucial time to bond with their newborns.

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ANMF took part in Productivity Commission consultation hearings in Melbourne on the draft report of the Workplace Relations Framework. The ANMF raised ongoing concerns of the impact of cuts to minimum wages, penalty rates and other conditions on the health and aged care workforce.

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ANMF congratulated Malcolm Turnbull on his appointment as Prime Minister and called on him to commit to advocacy, starting with rejection of the new paid parental bill. “Next, and critically for nurses and midwives, we are asking the new PM to advocate for the health of all Australians,” ANMF Federal Secretary Lee Thomas said.

OCTOBER

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The Australian Nursing and Midwifery Federation officially became Australia’s largest union with a 12% increase in membership and a record 249,000 members. ANMF Federal Secretary Lee Thomas attributed the rise in membership growth to the ANMF’s successful campaigns.

“It’s putting the federal government and governments across the country on notice – that we are a force to be reckoned with.”

1 1. MANDATED RATIOS VIC NURSES AND MIDWIVES CELEBRATE WIN 2. ANMF FEDERAL SECRETARY LEE THOMAS

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Victorian nurses and midwives celebrated their long-fought ratios being legislated. The Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Bill 2015 passed unopposed through the state Parliament’s Upper House. anmf.org.au

The ANMF held its 12th Biennial Conference in Adelaide. True to its theme We will not be silenced: the power of nurses and midwives, nurses and midwives spoke out on important professional, industrial and social justice issues affecting the professions. The ANMF, in conjunction with the Luke Batty Foundation’s Never Alone campaign against domestic violence called for nurses and midwives to be specifically trained in domestic violence.

ANMF delegates continued their campaign against the Australian Border Force Act which carries the threat of a two-year prison term for health professionals who speak out about poor conditions in detention centres in a show of protest.

December 2015 / January 2016 Volume 23, No. 6 25

NOVEMBER

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The ANMJ shines the spotlight on aged care in November. Following the publication it was highlighted as a key priority by members at the ANMF’s 12th Biennial conference. The feature looks at conditions, wages, workloads, skill mix and regulation for those that work in the sector under intense pressure.

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ANMF warned an increase in GST must not be extended to include basic health services as it would hurt the most vulnerable such as low and fixed-income earners and young, struggling families. It followed reports of a Turnbull Government proposal to increase GST from 10% to 12% and extend it to health, food and education.

1. NURSE KYLIE BENNETT WITH ONE OF THE RESIDENTS FROM SOUTHERN CROSS AGED CARE HOBART 2. ANMF VIC BRANCH SECRETARY LISA FITZPATRICK WITH ANMF FEDERAL SECRETARY LEE THOMAS AND ASSISTANT FEDERAL SECRETARY ANNIE BUTLER.

DECEMBER Despite widespread opposition and rallies held around the country, the China Free Trade Agreement was passed in the Senate. Unions warned the deal would make it easier for employers to bring in overseas workers under new labour agreements without having to advertise jobs to local workers. The ANMF raised concerns that qualifications other than Australian standards may be acceptable.

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1. RALLIES HELD AROUND THE COUNTRY AGAINST THE CHINA FREE TRADE AGREEMENT 2. NSW REPORT SUPPORTS RNS IN NURSING HOMES

A much anticipated report into the role of registered nurses within residential aged care facilities in New South Wales has deemed they are essential to quality care and recommended retaining current laws that require at least one RN be on duty at all times.

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PROFESSIONAL

A fairer Medicare for all Recently the ANMF made a submission in response to a public consultation paper from the Medicare Benefits Schedule (MBS) Review Taskforce (the Taskforce), chaired by Dr Bruce Robinson.

Julianne Bryce

Elizabeth Foley

Julie Reeves ANMF Federal Professional Officers

As it is over 20 years since the current MBS was introduced, the ANMF agrees it is imperative all 5,769 MBS items be reviewed for their relevance and contemporary evidence base for healthcare practice.

We consider there are parts of the MBS that are out-of date.

Of particular note is the language which currently focusses on medical practitioners. This needs to be reflective of current practice by encompassing the full range of health professionals eligible to access Medicare items, which in terms of the nursing and midwifery professions means nurse practitioners (NPs) and eligible midwives.

The ANMF has remained a staunch advocate of universal health insurance coverage for all Australians since the introduction of Medibank in 1975, later revamped as Medicare in 1984. The philosophical underpinning of the nursing and midwifery professions is that all people, regardless of socio-economic status, should be able to access healthcare services appropriate to their needs. That is, access to healthcare services should always be based on clinical need and not on ability to pay.

WITH THE INCREASING AGE OF OUR POPULATION AND GROWING RATES OF CHRONIC AND COMPLEX DISEASE, WE NEED TO RE-THINK THE WAY HEALTHCARE IS DELIVERED.

In our submission we argued it is essential this opportunity for reform of the MBS does not perpetuate more of what we have now. We need change which will enable innovation. With the increasing age of our population and growing rates of chronic and complex disease, we need to re-think the anmf.org.au

way healthcare is delivered. NPs and eligible midwives are key to this change, and the Medicare system needs to provide the option for them to contribute their expertise, delivered in the way that best meets the expectations and needs of individuals and the community.

During the consultative phase of the review the Taskforce has sought guidance on examples where the MBS seems to be failing to support delivery of best value healthcare; and, recommended improvements to the surrounding ‘rules’, processes and systems that support the MBS. From the perspective of the nursing and midwifery professions, the ANMF response highlights two essential areas to contemporise the MBS. These are: • to remove the out-moded item based funding model of nurses in general practice providing services ‘for and on behalf’ of the medical practitioner, and • to more appropriately accommodate the services provided by NPs and eligible midwives.

Specifically we pointed out to the Taskforce the fact that the original intent of the Practice Nurse Incentive Program (PNIP) funding was to enhance the role of nurses working in general practice. The retention of some Medicare items for nurses has meant that this intent has not been fully achieved.

This has perpetuated a model whereby employers and/or practice managers direct nurses to focus care only on those activities that can be billed through Medicare, severely limiting their ability to determine the care required.

These remaining Medicare items for nurses must be removed, and instead, funding for the PNIP increased. We argue this from our firmly held position that nurses and midwives, as regulated health professionals, are not ‘supervised by’ nor do they provide care ‘for and on behalf of’ any other healthcare professional. Rather we see that all healthcare is a collaborative effort focused on positive outcomes for individuals

and groups.

With regard to NPs and eligible midwives, the ANMF considers the current health funding models in Australia create serious barriers and limit their effectiveness in terms of equity, access and value for money in healthcare delivery. We have, therefore, called on the Taskforce to recommend NPs and eligible midwives be granted more scope to order diagnostic investigations (particularly imaging) and initiate (rather than just continuing) prescribing under the MBS rules; to allow NPs to be eligible for PNIP funding; to enable NPs to employ other nurses under the PNIP funding; for there to be access to ‘request and refer’ MBS provider numbers for NPs and eligible midwives in the public sector, as is the case for medical interns; and, for there to be a substantial increase in payment for MBS items for NPs and eligible midwives in private practice to enable them to establish a viable and sustainable practice.

For a copy of the ANMF submission to the MBS Review Taskforce go to: http://anmf.org.au/pages/ professional-submissions

As 2015 ends….

The ANMF Federal Office Professional Team wish all ANMF members a safe and happy festive season. We look forward to continuing to work with you to influence policy development at the federal government level, and in raising awareness of the critical role nurses and midwives play in the provision of health and aged care, improving health outcomes for all people in Australia.

We also wish to publically thank our Professional Officer colleagues from the ANMF state and territory Branches, for their support and assistance throughout the past year. We wish them a great Christmas and productive New Year.

December 2015 / January 2016 Volume 23, No. 6 27

ISSUES

Cytotoxic chemotherapy administration in the community: A case study

By Sandra Ridings, Tracey Doherty, Amanda Smith, Bel Morris and Kate Cameron Cytotoxic drugs are associated with occupational health and safety risks to those involved in preparation, administration and handling.

Safety Data Sheets (SDS), prepared by manufacturers, enable end users to identify the hazards, implement safe handling and storage, and safely manage emergency spills and waste disposal Safe administration of cytotoxics relies upon appropriate procedures throughout, from prescribing through to preparation and administration. Nurses and midwives must be able to identify cytotoxic drugs, access safe handling policies, procedures and guidelines developed from SDS and apply these to nursing care provided.

This case study narrates one nurse’s learning about the risks associated with administration of intramuscular methotrexate in primary practice, the steps they took to empower themselves with knowledge and subsequent steps taken to change processes to ensure they and their colleagues were safe at work.

Recently graduated registered nurse Rosie was asked by the local general practitioner (GP) to administer patient Bob his injection of methotrexate for rheumatoid arthritis.

While Rosie agreed, she felt a bit uncertain about her knowledge of methotrexate. She consulted the MIMs and found the dose required was at the lower end of the spectrum, appropriate for indication.

Bob had been on the drug for six months and treatment was recorded as “effective with no adverse symptoms”. Rosie also noted that methotrexate was classified as an antimetabolite cytotoxic and the product information included risk of foetal death and/or congenital abnormalities.

Rosie became nervous, especially as she was trying to get pregnant.

Approaching the GP with her concerns, she was advised to “follow usual precautions and wear gloves”.

The patient-named methotrexate vial was retrieved from storage, and the prescribed dose drawn up, administered and documented.

Rosie thought little more of the episode until, in tea room discussion, another nurse from the clinic, currently pregnant, commented that

they had spilt some methotrexate on themselves and hadn’t been wearing gloves.

Concerned, Rosie began a search to find out more about methotrexate. Nothing was available at the worksite and an online google search yielded more than nine million results; too many to review for relevance and quality of evidence.

Rosie was not deterred and took a more direct approach and contacted the CSC of a Chemotherapy Unit, who forwarded her enquiry to the Nurse Educator.

A series of emails ensued between specialist oncology pharmacists, the nurse educator and SA Cancer Service. It was imperative that Rosie was provided with correct information to progress local resolution of the OH&S issue and there was concern in the advisory group that other practice nurses might be in the same situation.

Rosie was provided with links to the State OH&S Safe Handling Guidelines for Cytotoxic Drugs www. sahealth.sa.gov.au/hazardousdrugs and the eviQ professional education course on Antineoplastic Drug Administration for the non-cancer setting: www.eviq.org.au/eviQEd/ ADACforthenoncancersetting.aspx After reviewing the information, Rosie used electronic communication within the clinic to raise concern about nurses

drawing up and administering methotrexate without appropriate risk management strategies.

Varied responses were received: “Don’t give enough to worry”; “be careful what you call cytotoxic drugs” and a glimmer of hope, “be persistent, everyone has a right to safety in the workplace”.

Rosie raised the concern at a practice meeting where the clinical director vocalised support for the nurses and the “right to safety”.

Purple cytotoxic waste bins, a spill kit and PPE items were purchased.

A local policy and procedure folder was created.

The local pharmacy then engaged the services of a manufacturing pharmacy certified to reconstitute and prepare individual doses of cytotoxic drugs so the clinic had access to pre-prepared methotrexate. The risks of personal contamination via aerosol and contact during drawing up were thus eliminated and appropriate PPE and waste receptacles made available to enable safe practice (Figure 1).

Other nurses in the practice were encouraged to undertake the eviQ education.

Rosie showed that one, early career nurse can make a difference and effect practice change through persistence, clinical enquiry, collaboration with colleagues in specialist tertiary settings and effective communication.

Primary care health professionals are encouraged to seek out local and state cytotoxic safe handling guidelines and actively collaborate with tertiary centres to facilitate the safe provision of patient care.

This case study has demonstrated that administration of cytotoxic drugs in the community setting can be performed safely when risks are identified and managed appropriately.

FIGURE 1: CYTOTOXIC DRUG PREPARATION IN CLEAN ROOM PRODUCTION AND ADMINISTRATION USING CYTOTOXIC PPE

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Sandra Ridings is Nurse Education Facilitator, Flinders Medical Centre Tracey Doherty is Service Director, SA Cancer Service Amanda Smith is Primary Care Nurse, Blakeview Medical Centre Bel Morris is Lead Cancer Pharmacist, Country Health SA Local Health Network Kate Cameron is Professional Nurse Lead, SA Cancer Service; and Lecturer, School of Nursing, University of Adelaide anmf.org.au

LEGAL

Workplace, culture – how safe is your practice when giving medications?

The right to participate in the management of therapeutic substances in patient care is underpinned by significant responsibility and accountability in law and patient advocacy.

Linda Starr

Reference Aubusson K. 2014, Aged Care ‘culture’ drives antibiotic overuse. Australian Doctor 21July 2014.

Ching J, Kwong M, Stuart R, Buising K, Friedman N, Bennett N, Cheng A, Peleg A, Marshall C, Kong D. 2014. Antibiotic prescribing practice in residential aged care facilities- health care provider’s perspectives.

Medical Journal of Australia; 201: 101-105.

HCCC v Saldevar [2015] NSWCATOD 96 Woodhead M 2015, 6 questions patients have about antibiotics.

Australian Doctor 27 October 2015.

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

A failure to meet the requisite standard of conduct may not only have serious consequences on the outcomes for the patient but also the practitioner. There are well established guidelines for the management and administration of medications, however, these are too frequently overlooked.

The appropriate use of telephone orders, witnessing patients actually taking their medication, adequate assessment of patients and obtaining patients consent are some frequent omissions in practice. Factors such as staff shortages, workloads, fatigue and inexperience are raised in mitigation when poor practice in medication administration and management results in error.

Whilst there may be some truth to these claims there is a risk that a failure to address these issues can result in a culture of covert acceptance of these poor standards through a sense of inability to establish sustainable change. These issues are explored in this article.

Medical treatment includes prescribing medication, however, there is evidence that suggests there is a failure to provide sufficient information to patients about their medications, which could mean a deficit in the consenting process.

For example, from 2002-2010 there were 8,700 calls to the NPS Medicines Line from consumers seeking information about commonly used antibiotics they were prescribed. Whilst there were six common questions, alarmingly one was – ‘what is this drug – what does it do’ - particularly from older people (Woodhead 2015). It is not unreasonable to suspect that this lack of understanding applies to many other medications as well.

This question is loaded – not only does it raise questions as to how adequately the patient has been informed about their treatment (relating to consent) it raises concerns as to what risks this lack of knowledge has exposed these patients too.

A recent study on the overprescribing of antibiotics in residential aged care facilities

(RACF) has led to a suggestion that both workplace and cultural practices in RACF’s are key issues (Aubusson K 2014). In a study by Ching Jou et al (2014) there were a number of challenges and barriers identified in the optimal prescribing of antibiotics. Of these, two clearly raise concerns about the standard of care underpinning these practices.

The first relates to telephone orders.

Ordinarily telephone orders should not be used outside of emergencies and clearly not for convenience.

However, in this study antibiotics were commonly prescribed over the phone even in cases of minor and recurrent infections. Furthermore, it was revealed that these phone orders were often not followed up by on site reviews. One participant, a GP, revealed that he had been asked to sign off on an old telephone order for antibiotics for a resident with a UTI who had not been reviewed by their doctor for more than four months – something this GP claimed to be fairly common. Best practice would have any patient reviewed by a medical officer where there is any change in their health status that caused concern. A failure to review and complete the required telephone order through signing and authorising this within the prescribed timeframe – usually within 24 to 48 hours clearly falls below the expected standard of the treating practitioner. This also unfairly places additional burden on nursing staff who may not be adequately prepared to manage these infections and risks them acting beyond the scope of their practice.

The second area of concern relates to the revelation that some GPs’ felt pressured into prescribing antibiotics by nursing staff and the resident’s family and claimed that some nurses over reported symptoms in order to secure an antibiotic order for residents (Aubusson 2014). Neither of these actions serve as sound grounds for clinical decision making and call into question the practitioners level of knowledge and skill and their standard of care. Indeed such information may be used in evidence

in cases where poor practice in medication management come to the attention of authorities as demonstrated in the following case.

A failure to adequately assess and manage patients, poor documentation and a failure to comply with legislative requirements in relation to prescribing S8 drugs was considered in HCCC v Saldevar (2015). This case concerned an experienced GP who had ‘inherited’ a number of patients who were either drug dependent or in chronic pain - an area of practice that he claimed to have little experience.

However, despite this claim evidence was given that the MO had in fact been involved in a range of discussions around managing these clients particularly with respect to their responsibilities in prescribing narcotics in the general practice. An investigation revealed that the practitioner had prescribed more than 2,000 drugs of addiction during a two year period, with 589 of these being dispensed to 29 patients. One patient received prescriptions for 25 100mg Fentanyl patches over a 19 day period – a dose that should have lasted 75 days. Whilst the practitioner hypothesised as to why these prescriptions were given he could not satisfactorily explain his actions.

Excessive prescribing, failing to meet legislative requirements in prescribing S8 medications for drug dependent patients, failing to assess, keep adequate and accurate records were all issues considered in finding the practitioner guilty of professional misconduct and a range of conditions being imposed upon his practice including restrictions on prescribing rights.

As the New Year begins take time to reflect on your own practice in drug administration. What role do you have to ensure your patients are informed about their medication by their treating practitioner? Are you familiar with your organisation’s policy on telephone orders and standing orders? Do you witness your patient taking medication before signing for it? There are too many cases where patients have suffered harm and/or practitioners have faced disciplinary action for poor practice in medication management.

Ultimately work practices and cultural attitudes underpin many of these incidences – but are unlikely to be a defence where practice falls below the reasonable standard expected.

December 2015 / January 2016 Volume 23, No. 6 29

CLINICAL UPDATE

A constructivist grounded theory study of mental health clinicians’ boundary maintenance Dr Andrew Gardner and Professor Helen McCutcheon Abstract This study sought to understand how mental health clinicians (MHC) establish and maintain the professional boundary in their everyday practice. The findings indicate the establishment and maintenance of the professional boundary and the continual process of engaging the client are inextricably linked. Furthermore the use of interpersonal and professional skills are necessary to establish and maintain the professional boundary on an ongoing basis. A basic social process of engaging clients emerged from the analysis and indicated that a broader understanding of establishing and maintaining boundaries within the mental health context was warranted.

Introduction The Constructivist Grounded Theory approach (Charmaz 2006) was chosen for this research

because it had a close alignment to the ethics and principles that underpin mental health clinical practice in a contemporary postmodern therapeutic era (Laugharne and Laugharne 2002, Laugharne 2004).

Where mental health services are oriented more towards the clients’ interpretation of recovery as MHCs create a space for recovery focused care (Walsh et al. 2008).

In addition there appeared to be an alignment between the Constructivists’ Grounded Theory approach and the type of question that the researcher was seeking to answer – How do experienced mental health clinicians establish and maintain the professional boundary in their day to day clinical practice?

Using skills to establish and maintain the professional boundary The core category of engaging clients, a basic social process

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(Glaser and Strauss 1967) occurs when MHCs use their skills repertoire to involve the client in the process of mental health recovery. This social process is continuous and organic with the MHC continuously assessing the level of engagement with each client contact to inform their therapeutic interactions. Mental health clinicians describe the concept of engaging clients as being an ongoing and continual process, describing how they are constantly assessing the level of engagement. If the clinician becomes aware that the client is disengaging or identifies that the level of engagement is minimal they will use their skills to reengage the client in the therapeutic relationship.

Yvonne, a Mental Health Nurse with 26 years experience, discussed the need to join with clients and families in order to develop trust and make people feel comfortable.

“I think you have to actually join with somebody somewhere.

You can’t just go in straight away and go straight to this deep and difficult stuff’...’It is about making the person comfortable, joining with the family, all that initial sort of joining with people. I think that

References Allenbach, A. S, and Steinmiller, E. A, 2004, Waiting together: Translating the Principles of Therapeutic Relationships One Step Further, JSPN, 9(1): 24-31.

Bedi, R, Davis, M, and Williams, M, 2005, Critical incidents in the formation of the therapeutic alliance from the client’s perspective, Psychotherapy: Theory, Research, Practice, Training, 42(3): 311–323.

Charmaz, K, 2006, Constructing Grounded Theory A Practical Guide Through Qualitative Analysis.

Sage, Thousand Oaks, California.

Cutcliffe, J, and Happell, B, 2009, Psychiatry, mental health nurses, and invisible power: Exploring a preturbed relationship within contemporary mental healthcare, International Journal of Mental Health Nursing. 18: 116-125.

anmf.org.au

CLINICAL UPDATE is very difficult to get that and build up trust and make them comfortable without that” (Yvonne).

Engaging clients in mental health services has been identified in the professional literature by Tait et al. (2002) who attempted to measure levels of engagement of consumers with community based mental health services. In addition Jensen (2011) argues when MHCs are conducting assessment interviews they are more likely to engage the patient in a collaborative relationship when using a narrative approach to therapy. Mental health clinicians recognised that they had to address the power imbalance (Cutcliffe and Happell 2009), that exists in professional relationships in order to engage the client on a more even position where power is more evenly shared.

The purpose of engaging the client from the MHCs perspective is to develop a therapeutic relationship and form an alliance (Bedi et al. 2005), to facilitate working together more effectively.

This begins with the initial contact where the MHC demonstrates a friendly professional approach, previously identified as therapeutic friendliness (Gardner et al. 2010).

The professional boundary is an essential component of the therapeutic relationship, as it allows therapeutic work to be conducted in a safe space where both the client and MHC can manoeuvre within the boundaries of the therapeutic relationship.

In this research engaging clients has been established as the basic social process of establishing and maintaining the professional boundary with clients accessing a mental health service. Maintaining the therapeutic relationship cannot be achieved without the judicial use of finely honed professional and interpersonal skills. To establish and maintain the professional boundary MHCs use a variety of interpersonal and professional skills which are combined to negotiate the professional boundary throughout the therapeutic relationship. Mental health clinicians also recognised the important skill of being able to regulate their own emotional state which emerged as a code in this research labeled Being emotionally tidy, which we view as a mixture between a professional skill and an anmf.org.au

interpersonal skill.

When discussing the use of interpersonal skills, MHCs specifically recognised the importance of being able to regulate their emotional state when working closely with clients.

Regulation of emotions originally identified by Salovey and Mayer (1990), includes maintaining an outwardly controlled persona whilst at the same time tuning into one’s own emotional state. Mental health clinicians discussed concepts such as self-monitoring and being aware of one’s own personal values and self-awareness skills that are used to keep themselves in check.

Millie, a psychologist with five years’ experience, describes the interpersonal process of selfmonitoring being aware of what she might bring into a session and managing her personal emotional state and levels of stress.

‘In terms of interpersonal awareness. It is about being sensitive, being very sensitive to what I might bring into a session but as well as what others might bring in. I try and manage myself in terms of self-care and emotional stability, managing my stress, practice what I preach in other words’ (Millie).

This heightened sense of self is used by the MHC to monitor their emotional state and to ensure that they are being emotionally tidy during interactions with a client.

This research has reinforced the importance of a strong sense of self and well developed interpersonal skills are vital components for all mental health clinicians. It is also important that each MHC has a professional framework that informs their practice and the way they should ethically conduct themselves. This includes professional practice models and the professions code of ethics and conduct.

Regulation of emotions and building personal resilience has been previously discussed by Tugade and Fredrickson (2007). As MHCs continue to work with clients over periods of time healthcare settings are constantly changing, therefore building personal resilience is recognised as an important skill. So too is the use of clinical supervision in clinical practice. When MHCs realise that a particular client raises issues in

themselves or they find that it is more difficult to be ‘emotionally tidy’ with a certain client they would often make use of appropriate clinical supervision to discuss their feelings and possible conflicts (White and Winstanley 2011).

Establishing and maintaining the professional boundary (Boundary maintenance) As MHCs work with clients using their skills through the engagement process, boundaries are re-defined over time acknowledging that a degree of flexibility exists in the way that boundaries are maintained.

Occasionally a level of tension exists in relation to changing conditions (changing health status of the client) or contexts (providing care in different settings). This can also be related to a number of factors; including the physical environment, the personality nature of the client and length of time involved with the service.

The Grounded Theory model of using skills to maintain the professional boundary Clinicians reported that they would constantly use both interpersonal and professional skills to engage or re-engage the client, and to manage the professional boundary.

This was then interpreted as a quintessential skill required by all mental health clinicians. The importance of engaging clients is to ensure that a therapeutic relationship can mature over time and the establishment and continual maintenance of the professional boundary fosters a safe space for the therapeutic alliance (Bedi, et al. 2005) to develop further.

Findings from this research indicates that the establishment and maintenance of the professional boundary and the continual process of engaging the client are inextricably linked and cannot be easily separated.

The application of interpersonal and professional skills are needed to establish and maintain the professional boundary on an ongoing basis.

Figure 1 provides a diagrammatic representation of the theory of how MHCs establish and maintain the professional boundary to ensure that a therapeutic relationship exists and to facilitate an appropriate level of engagement with the client. Concentric shapes are used to indicate the process

Gardner, A, McCutcheon. H, and Fedoruk, M, 2010, Therapeutic friendliness and the Development of Therapeutic Leverage

by Mental Health Nurses in Community Rehabilitation settings, Contemporary Nurse, 34(2): 140-148.

Glaser, B. G, and Strauss, A. L, 1967, The discovery of grounded theory, Aldine, Chicago.

Jensen, P. E, 2011, Why should psychiatrists learn about narrative therapy?, The Australian and New Zealand Journal of Psychiatry, 45(9): 709-11.

Laugharne, R, 2004, Psychiatry in the future: The next 15 years: postmodern challenges and opportunities for psychiatry, Psychiatric Bulletin, 28(9): 317-318.

Laugharne, R, and Laugharne, J, 2002, Psychiatry, postmodernism and postnormal science, Journal of the Royal Society of Medicine, 95: 207-210.

Luft, J, and Ingham, H, 1955, The Johari window, a graphic model of interpersonal awareness, Proceedings of the western training laboratory in group development (Los Angeles: UCLA).

Nursing and Midwifery Board of Australia, 2010, A nurses guide to professional boundaries, Rebranded (2013), Melbourne. http://www. nursingmidwiferyboard. gov.au/documents/ default.x?record=WD10 %2F1347&dbid=AP& chksum=bes7sYtZAW nmggO%2FzV0uBQ%3 D%3D

December 2015 / January 2016 Volume 23, No. 6 31

CLINICAL UPDATE

Using interpersonal skills Boundary maintenance Therapeutic relationship

Engagement

Figure 1: Using interpersonal and professional skills to maintain boundaries and the therapeutic relationship and process of engaging the client.

of establishing the therapeutic boundary and therapeutic engagement.

The outer shape labelled, Using interpersonal and professional skills indicates that the MHC uses both interpersonal and professional skills to engage with a client and to establish the professional boundary. The next shape, Boundary maintenance acknowledges that the MHC works at establishing and maintaining the professional boundary through the use of their skills and to provide a safe space for the therapeutic relationship to flourish. The next shape Therapeutic relationship identifies that a therapeutic relationship is developed through the use of interpersonal skills and with the establishment of the professional boundary. The inner shape Engagement is represented by a square acknowledging that engagement can sometimes be fuzzy and difficult to define.

Engagement is encapsulated by the therapeutic relationship, boundary maintenance and the use of interpersonal and professional skills. This acknowledges that a formulae exists consisting of these three elements that facilitate

the development of therapeutic engagement where the client remains safe and the actions of the clinician can always be justified in terms of the direct benefit for the client. This model has relevance for all professionals who are required to maintain a professional boundary and establish a therapeutic relationship with clients.

Reflection on professional standards and codes of conduct Nursing and midwifery have clearly articulated standards of practice as part of the competency framework for nursing and midwifery in Australia, including the National Competency Standards for the registered nurse and a nurse’s guide to professional boundaries.

Despite these standards nurses, midwives and other healthcare professionals continue to breach professional boundaries in their therapeutic relationships. The majority of breaches are related to poor knowledge and awareness of competency standards, or poor insight into their own behaviour.

There are however some breaches in professional conduct that are more predatory in nature. These

32 December 2015 / January 2016 Volume 23, No. 6

cases are more easily dealt with by the Board, usually finding a case of misconduct and censuring the professional or placing restrictions on their practice. The Johari Window on the next page (Luft and Ingham 1955) is an attempt by the authors to explicate some of the possible issues in relation to – competent and non-competent knowledge and practice with regard to the management of the professional boundary.

Understanding and interpreting the professional standards Sawyer and Prescott (2011) describe how the legal rights of vulnerable populations such as mental health clients are protected through the various professions’ regulatory frameworks and espoused codes of conduct and ethics. The codes of conduct and standards of practice referred to above describe the concept of professional boundaries within the therapeutic relationship.

However the decision making skills, attitudes and behaviours that health practitioners use in negotiating and maintaining professional boundaries from a clinical practice perspective

Nursing and Midwifery Board of Australia, 2006, National competency standards for the Registered Nurse, Rebranded (2013), Melbourne. http://www. nursingmidwiferyboard. gov.au/CodesGuidelines-Statements/ Codes-Guidelines. aspx#competencysta ndards Salovey, P, and Mayer. J, D,1990, Emotional Intelligence, Imagination, cognition and personality, 9: 185-211.

Sawyer, S, and Prescott, D, 2011, Boundaries and Relationships, Sexual Abuse: A Journal of Research and Treatment, 23(3): 365-380.

Sheets, V, 2000, Staying in the lines, Nursing Management, 31(8): 6.

Tait, L, Birchwood, M, and Trower, P, 2002, A new scale (SES) to measure engagement with community mental health services, Journal of Mental Health, 11 (2): 191-198.

Tugade, M. M, and Fredrickson, B. L, 2007, Regulation of positive emotions: Emotion regulation strategies that promote resilience, Journal of Happiness studies, 8: 311-333.

Walsh, J., Stevenson, C., Cutcliffe, J. R. and Zinck, K. (2008). Creating a space for recovery focused psychiatric nursing care. Nursing Inquiry, 15, 251-259.

White, E and Winstanley J, 2011, Clinical Supervision for mental health professionals: the evidence base’.

Commissioned for Special Edition Current Trends in Mental Health Services. Social Work and Social Sciences Review, 14(3): 73-90

anmf.org.au

CLINICAL UPDATE

Competent

Knowledge

Practice

Sound knowledge and awareness of competency standards of practice.

Manages boundaries well in day to day clinical practice.

Sound knowledge and a good sense of self-awareness.

Recognises when boundaries are being contested or when they themselves are being drawn into contesting a boundary and acts to rectify the situation.

Deals with boundary issues appropriately in clinical supervision.

Non-competent

Poor knowledge and awareness of competency standards of practice.

May also relate to personal vulnerabilities or personal issues that have not been acknowledged or addressed.

Poor decision making in relation to managing boundaries – either their own or when a patient or family member contests a boundary.

Poor boundary maintenance in clinical practice.

Does not address contested boundary behaviour either in themselves or on behalf of a patient.

OR Poor insight into their own behaviour in relation to their own boundaries or of their professional responsibility to manage boundaries within the therapeutic relationship.

Does not access clinical supervision to work through the possible boundary problems.

Figure 2: Competent and non-competent knowledge and practice regarding the management of the professional boundary. are not clearly described or understood. Previously nurses have expressed difficulty in translating standards into meaningful practice (Allenbach and Steinmiller 2004).

In addition the understanding of professional boundaries is often context specific (Sheets 2000). It would appear that boundaries are constructed phenomena that are open to interpretation not only by professionals but by the general public as well.

The Australian Nursing and Midwifery Council (2010) released the nurse’s guide to professional boundaries as a companion document to the codes of ethics and professional conduct for nurses.

The guide forms a component of the ANMC Professional Practice Framework and is more specific – offering a definition of professional boundaries and discussing some of the issues around professional boundaries such as; levels of involvement, therapeutic relationships and dual relationships.

Professional boundaries are defined in the guide as;

professional’s power and the client’s vulnerability, that is they are the borders that mark the edges between a professional, therapeutic relationship and a non-professional or personal relationship between a nurse and a person in their care’ (ANMC 2010).

‘Professional boundaries in nursing are defined as limits which protect the space between the

Conclusion

anmf.org.au

Professional boundaries are constructed social phenomena that are open to interpretation; individuals within a defined professional group may have different interpretations and expectations to their colleagues.

This may be a part of the problem that all professionals and those groups that regulate the professions have to struggle with, as there will be inherent differences in professional opinion of what constitutes a breach of professional boundaries. This is especially so when it comes to boundary crossings but less so in relation to boundary violations as they appear to be more clearly understood by all professional disciplines represented in this research.

This research explored the social phenomena of professional

boundaries in therapeutic practice.

The emergent theory of how mental health clinicians establish, negotiate and maintain the professional boundary in order to preserve the therapeutic relationship has revealed the important and continual process of engaging the mental health client on an ongoing basis.

The emergent theory has also identified the development and use of professional and interpersonal skills and the importance of selfawareness as a mental health clinician. One of the interpersonal skills that seemed to have significant importance for mental health clinicians was the ability for self-regulation, in particular being emotionally tidy.

The findings in this research indicate that mental health clinicians recognise the importance of establishing and maintaining the professional boundary in their day to day practice and the judicial use of both interpersonal and professional skills. In addition mental health clinicians acknowledge their roles in managing the professional boundary as a professional requirement and responsibility.

Dr Andrew Gardner is a Lecturer at the School of Nursing and Midwifery, University of South Australia.

Professor Helen McCutcheon is Head of School of Nursing, Midwifery and Social Work, University of Queensland.

December 2015 / January 2016 Volume 23, No. 6 33

WORLD

CHINA

China ends one-child policy Chinese families will finally be able to have two children after the country’s strict and controversial one-child policy was abolished last month after 35 years.

The policy came into effect in 1980, with authorities restricting most couples to a single offspring in a bid to drive China’s economic boom. Decades on, the historic change to the country’s family planning restrictions is being rationalised by an urgent need to counter the challenges of an ageing population.

China’s population sits at 1.37 billion, the world’s highest, but it is ageing rapidly and its workforce shrinking.

Over the years the country’s contentious one-child policy, which has triggered fines for violators and forced abortions, has often come under fire from humanitarian groups.

News of the policy being relaxed has largely been met with support, but some critics have claimed the shift has arrived too late.

Senior Lecturer in China Studies from the China Studies Centre at the University of Sydney Dr Beatriz Carrillo Garcia, said the announcement had been on the cards following a gradual relaxation of the policy over the past two decades. “The background to this is consistently declining birth rates across the board, but especially in the city, with some cities like Shanghai experiencing negative birth rates.”

SCOTLAND

Scottish researchers investigate maternal death A study to identify the most effective practice surrounding maternal death surveillance and response, and maternal death reviews, is being undertaken by a research team based

at Robert Gordon University in Scotland.

The project, which is backed by the World Health Organization (WHO), will aim to critically evaluate current practices before providing clear guidelines to assist future policy and legislation on a global scale.

An online survey is being conducted to assess the current levels of awareness regarding maternal death surveillance and response (MDSR) and maternal death reviews (MDR) and to determine contemporary practices.

Case studies will be taken from a selection of countries within each of the six (WHO) regions.

The findings will be compiled in a report and published in due course.

To take part in the survey visit: www.surveymonkey.com/r/ MaternalDeathReviewSurvey

USA

California nurses push to curb workplace violence Nurses in California, the United States (US), have welcomed progress regarding longstanding calls for workplace violence prevention plans to protect health workers.

Proposed regulations were released in early November by the Division of Occupational Safety and Health (DOSH) board and cover healthcare workers across all health facilities.

The California Nurses Association (CNA) and its 86,000 registered nurse members have lobbied passionately since early this year to put a stop to workplace violence.

“Hospitals and other employers must take proactive steps to prevent workplace violence and the proposed regulations lay the groundwork for that,” said Zenei Cortez, Co-President of the CNA.

34 December 2015 / January 2016 Volume 23, No. 6

“When implemented, these new rules will help RNs completely focus on the health and healing of our patients without feeling vulnerable because we work in a workplace that is unprepared.”

The proposed regulations will act as a national model and define workplace violence broadly to encompass both physical attacks and threats.

Employers will be required to implement a Workplace Violence Prevention Plan that identifies patient specific risk factors, procedures to correct workplace violence, and procedures for post-incident response and investigation.

Initially, training will be required for all employees in order to recognise the potential for violence and how to counter factors that lead to increased violence.

Healthcare workers were almost five times more likely to be the victim of a nonfatal assault or violent act than the average worker in all other major industries, according to the US Bureau of Labor Statistics.

A 2007 report commissioned by the National Institute of Occupational and Environmental Health found nurses suffer the highest rate of victimisation among healthcare occupations.

SWITZERLAND

Tuberculosis deaths cut in half The fight against tuberculosis is being won, with global death rates nearly half what they were back in 1990.

Despite the inroads, 1.5 million people still died from TB in 2014.

Most of the deaths could have been prevented, according to the World Health Organization (WHO), which released its Global Tuberculosis Report 2015 in Washington last month.

To reduce the overall burden of TB, detection and treatment gaps need to be closed, funding shortfalls filled, and new drugs and vaccines developed, the report states.

Much of the progress has come since 2000 when the Millennium Development Goals (MDGs) were established, with effective diagnosis and treatment helping save 43 million lives between 2000 and 2015.

“These advances are heartening but if the world is to end this epidemic it needs to scale up services and, critically, invest in research,” WHO Director-General Margaret Chan said.

Globally, TB incidence has fallen 1.5% per year since 2000, for a total reduction of 18%. Nevertheless, the disease ranks alongside HIV as a leading killer worldwide, with 4,400 people dying every day from the disease, including 890,000 men and 480,000 women who died last year. anmf.org.au

REFLECTIONS

Bullying, relational aggression and nursing

By Dr Amanda Ruler Peace and freedom from discrimination and harassment is essential for everybody to flourish. Positive identification and developed individuality are highly desirable traits.

However, it is widely recognised that there is a bullying culture within nursing. In a 2010 Victorian study (with 30% response rate to 5,000 surveys), 52% reported some form of workplace aggression in their most recent four working weeks.

Thirty six percent reported bullying mostly from patients/ visitors/relatives and 32% experienced bullying mostly from colleagues or from their managers/supervisors. Staff were less concerned by patient initiated aggression than workplace violence from colleagues. Respondents desired better, more realistic training and enforcement of policies and support to address these issues (Farrell & Shafiei 2012).

Some consider bullying, covertly or overtly, as essential for survival.

Here, there are only winners and losers. They need to do whatever it takes to win and their main limitation is their inability to emphasise and see a different viewpoint. Others must be charmed, manipulated, controlled or eliminated. Formations of cooperative, reciprocal and win/win relationships are absent (Crowley & Elster 2013 and Holiday and Rosenberg, 2009).

The way people bully can be in some cases related to gender. Girls primarily mature through forging relationships rather than separating from them, making a failure for women to connect so problematic.

When there is a persistent failure to bond, be heard and understood, girls learn unhealthy relational patterns that can last. This can become relational aggression (which is the term used for people who tease, intimidate, insult, maliciously gossip, and play cruel games against others).

It explains why it is more common (but not exclusive) to women across the lifespan (Crowley & Elster, 2013).

Men, on the other hand, tend to compete in an overt manner, jockeying for position and fighting to be crowned ‘winners.’ In contrast, anmf.org.au

women often compete more covertly and behind the scenes (Crowley & Elster, 2013).

Additionally, women are often unprepared to support one another as some are vying for public power.

They are often harshly critiqued by their own gender and held to double standards. Directing male employees is reportedly easier than directing females. These behaviours must be unlearnt to give true equal opportunity a fair go (Crowley & Elster, 2013, Holiday & Rosenberg, 2009, Heim & Murphy, 2001).

Low self-esteem is also suggested as the cause of relational aggression.

The process of giving or accepting emotional abuse is about one’s self view. Described as internally motivated and driven by a sense of fear, threat and lack of confidence, it is used primarily by women as a behavioural dynamic, where they feel better by hurting others.

Because women traditionally have had little power and their roles are continually evolving along with contemporary equal opportunity legislation, it has been suggested that the instant there is a perceived threat, aggression occurs as a protective mechanism (Crowley & Elster 2013; Holiday & Rosenberg, 2009, Heim & Murphy, 2001).

Dealing with an aggressive person Identify the basic values and goals that are most important to you. Protect yourself; maintain a neutral alliance as well as a solid, professional demeanour despite any personal insults (Crowley & Elster 2013; Heim & Murphy, 2001).

Sometimes staying put or addressing the situation with guided, supportive advice and mediation is worthwhile. It can be very surprising what happens when your needs are communicated clearly and carefully.

Otherwise, if you, as the victim, are being exploited and harassed to the point of carrying anger and resentment home every day - or if you as a bully are so tense and threatened you always carry your behaviour with you - ask yourself whether you are better off staying or leaving in a situation that not only hurts you and others (Crowley & Elster 2013; Holiday & Rosenberg 2009).

Bullying and relational aggression are learnt behaviours.

With help, they can be unlearnt and more positive relationship skills

adopted. Organisations geared to help show that there are ways to nurture a kinder, gentler breed of leader who is able to use power in positive ways, leaving their relational aggression behind.

For many people, it has been very empowering to free oneself from anxiety, driven aggression and develop genuine, positive, and influential relationships. For those who have never had positive relationships with their peers or for those who live lives of fear over possible victimisation, freedom from such destructive patterns can be a remarkable experience.

There is a commonly upheld and basic ethic in all health professions to avoid doing harm. Additionally, becoming comfortable with oneself and interactions with others brings peace to day-to-day life and opens doors to new opportunities. A new peace will change your relationships for the better: starting with your friends, expanding outwards to family, colleagues and the community. Win-win relationships and conflict resolution skills allow everyone to feel recognised, empowered and positive, allowing a better, more balanced and peaceful world to eventuate.

Dr Amanda Ruler is a Registered Nurse, Adjunct Research Fellow at UniSA, and National Vice President for the Medical Association for Prevention of War (http://mapw. org.au/ for more information).

52% 52% REPORTED SOME FORM OF WORKPLACE AGGRESSION IN THEIR MOST RECENT FOUR WORKING WEEKS.

References Crowley K, and Elster, K. (2013) Mean Girls at Work. McGraw – Hill, New York.

Farrell, G and Shafiei, T. (2012) Workplace aggression, including bullying in nursing and midwifery: A descriptive survey (the SWAB study).

International Journal of Nursing Studies, Vol 49, pp 1423-1431.

Heim, P and Murphy, S. A. (2001) In the Company of Women. Penguin Books, New York.

Holiday, E and Rosenberg, J. (2009) Mean Girls and Meaner Women.

Amazon Books, NY.

December 2015 / January 2016 Volume 23, No. 6 35

ISSUES

IN THOSE STATES WHERE IT HAS BEEN DELIVERED, STUDENTS ARE ALREADY BENEFITING FROM EXTRA PROGRAMS FOR LITERACY AND NUMERACY, SMALLER CLASS SIZES AND GREATER SUPPORT.

Why teachers are giving a Gonski

By Australian Education Union Federal President Correna Haythorpe Bennett Road Public School in western Sydney received its first Gonski funding in 2014 and chose to invest it in intensive literacy programs and resources. By 2015 its reading and writing scores had lifted dramatically to close to the state average, with further improvement likely as its programs get established.

Bennett Road students had the ability, its teachers had the dedication, but until extra resources and expertise were provided directly to the school that potential went untapped.

The way this school, and others like it, are generating life-changing improvements from extra investment in their students is why the Australian Education Union (AEU) will be campaigning hard for Gonski funding across Australia in the leadup to the next election.

Gonski sees extra funding delivered to all schools over six years, with the biggest increases going to the schools which educate the most disadvantaged students It is needs-based and sector-blind, not discriminating between public and private schools.

Gonski sees schools in regional areas; with high numbers of students from poor households; with disabilities or learning difficulties; with English as a second language, and Indigenous students get the biggest increases in funding.

Funding started to flow in 2014, but under the agreements signed between the federal government and the states, over half of the extra funding is to be delivered in the last two years – making the current federal government’s plan to stop Gonski funding after four years a major issue.

We believe Gonski should be embraced by anyone who believes in the value of education, and in an equitable society that wants all children to succeed.The AEU is employing local coordinators in 18 marginal

seats in the lead up to the next election, to work with schools and local communities to show the benefits of Gonski, and the need for the full six years of funding.

These coordinators are working to make Gonski an election issue and help ensure that both major parties are committed to the full six years of increased funding our schools need.

Gonski recognises both the power of education to change lives and the fact that educational opportunities are not shared evenly.

Needs-based Gonski funding is about equity because it aims to ensure all students have the chance to reach their potential, no matter what their background.

But it is also about laying a platform for Australia’s future prosperity by ensuring that all students are equipped for work.

Gonski is making a difference – but the job is still only half done. We need every state to get on board and follow the example of NSW, SA, Qld and Victoria (from 2016) which are providing extra resources straight to schools.In those states where it has been delivered, students are already benefiting from extra programs for literacy and numeracy, smaller class sizes and greater support. Schools are reporting better retention rates, higher scores on literacy tests and better Year 12 results as a result of Gonski.

Gonski should be supported by both sides of politics, and the AEU is currently campaigning for bipartisan support for the full six years of the Gonski agreements.

36 December 2015 / January 2016 Volume 23, No. 6

But we still don’t have support at a federal level.

The Coalition’s existing policy of indexing school funding to inflation after 2017 would exacerbate existing inequities and mean that some under-resourced schools would never catch up.

While Labor leader Bill Shorten has expressed support for Gonski and needsbased funding in principle, the ALP is yet to fully commit to funding the full six years.

The reason we need six years of Gonski funding is because it will take that long to get all schools up to the resource standard they need to give all their students a quality education.

In the years leading up to the Gonski reforms, up until 2013, government funding to private schools was growing significantly faster than to public schools, as proponents of ‘choice’ won out over those concerned with equity.

At the same time, Australia’s performance in international education rankings fell, in comparison to countries whose school funding systems emphasised equity.

The result is gaps in resources that will take time to close.

It’s not just teachers who recognise the importance of needs-based funding.

August’s National Reform Summit saw a collection of business and community groups join unions in unanimously supporting needs-based funding and the concept of all schools operating on a minimum resource standard.

This is a recognition that quality education for all students will be essential if Australia is to be competitive in the 21st century and that Gonski is not just about equity but about our economic future.

Making sure schools like Bennett Road get the resources they need to overcome the barriers that stop their students learning is in all our interests, and politicians from all parties need to understand that and deliver Gonski in full. anmf.org.au

RESEARCH

Value of watchhouse nurses tested The value of providing 24-hour emergency nursing care for people held in police watchhouses is the focus of a new $116,000 research project.

Healthcare equality for prisoners Prisoners are missing out on the same healthcare as everyday Australians, researchers have found.

Research conducted by the University of Melbourne, University of New South Wales, and Griffith University, indicates prisoners are missing out on certain treatments and medications because they are too expensive to provide without access to Medicare.

Under current legislation, prisoners are excluded from Medicare, with responsibility for their healthcare shifted to state and territory governments.

The research found that despite prisoners experiencing some of the highest rates of mental illness and communicable diseases, Medicare exclusion results in rarely being able to access appropriate health services before re-entering the community.

Consequently, researchers have proposed a new funding model to provide prisoners with the same healthcare as other Australians in a bid to address disparities.

“Prisons are uniquely placed to detect health problems, initiate care and promote health, and this has important health benefits for the communities to which prisoners return. But this does not always occur,” said lead researcher Professor Stuart Kinner.

Professor Kinner added the current system heavily impacts Aboriginal and Torres Strait Islander people with mental illness who are overrepresented in prisons.

Researchers have proposed a mixed funding model, suggesting cost sharing between states, territories and the Commonwealth is likely to achieve better health outcomes.

Its findings now call on the Federal Health Minister to grant an exemption to end prisoners’ exclusion from Medicare.

“As an example, we estimate the cost of delivering an Indigenous-specific health assessment to each Indigenous prisoner in Australia per year would be less than 0.01% of the annual $20 billion Medicare budget. This is a drop in the ocean for the federal health budget but would have substantial benefit for Indigenous Australians, who are 13 times more likely than nonIndigenous people to be incarcerated.” anmf.org.au

Funded by the Queensland Emergency Medicine Research Foundation (QEMRF), the research acts on recommendations of a 2012 coronial inquiry into the death in custody of Herbert John Mitchell, which found it ‘inappropriate’ for police to make medical decisions about watchhouse detainees.

QEMRF researcher and Griffith University Associate Professor Julia Crilly said the aim was to determine whether

Pinpointing breast cancer in young women Detailed information and statistics on breast cancer development in young women aged 20-39 has been collated for the first time in a new report released by the Australian Institute of Health and Welfare (AIHW).

The report, Breast cancer in young women: Key facts about breast cancer in their 20s and 30s, found younger women have a higher proportion of very large breast cancers diagnosed, over 55mm, at 8%, compared to 6% in

24-hour on-site nursing care reduced the need and cost of transferring prisoners to a hospital emergency department for medical attention.

The research involved a trial of Gold Coast Health emergency nurses at Southport watchhouse.

The watchhouse is normally staffed a few hours per day by nurses trained in community care, but ED nurses with specialist skills were added as part of the trial to provide 24-hour care. The boost allowed treatment of more health issues on-site, including drug addiction, wounds, alcohol poisoning, and mental illness.

It costs more than $900 each time a prisoner needs to be transported to the ED, which requires two police officers and two ambulance officers as well as hospital resources.

Findings from the research are due next year.

older women.

Further to this , while smaller breast cancers tend to be associated with greater treatment options and improved survival, younger women experience a lower survival rate (93%) than women aged 40 and over (99%).

In 2015, 795 women are expected to be diagnosed with breast cancer and 65 will die as a result, the report states.

It found from 2007-11, women aged 20-39 had an 88% chance of surviving for five years after diagnosis compared to the 90% survival rate for women aged 40 and over. The figures mark an improvement from 1982-86, when five-year survival for this age group was 72%.

Cancer Australia CEO Professor Helen Zorbas said the report confirms the impact of breast cancer among young women nationally and reinforces efforts to improve survival.“These young women are at a life stage in which they are building careers, establishing relationships and planning for a family.

Issues such as infertility, early menopause and body image as well as time away from work and family can have a substantial impact, with long-term physical, psychological and social effects.”

December 2015 / January 2016 Volume 23, No. 6 37

FOCUS

Primary / Community Care

If you can’t engage them they won’t attend

By Rebekkah Middleton, Lorna Moxham and Dominique Parrish Diabetes is a prevalent and chronic disease both in Australia and internationally, affecting 347 million people worldwide. Estimates suggest diabetes will be the seventh leading cause of death by 2030 (WHO 2015).

There is strong evidence to suggest physical activity improves diabetes outcomes by assisting glucose control, promoting weight management and preventing related complications (Hu et al.

2014), as well as improving an individual’s overall health and wellness (Law et al. 2013).

Despite the evidence, there is reportedly still a lack of compliance and adherence to exercise regimens by people with diabetes (Jennings et al. 2013). An important measure in addressing this deficiency is to establish why people with diabetes engage (or not) with health promotion programs. Gaining this understanding can inform and guide the design, promotion and delivery of future health promotion programs in a specific, targeted, and disease appropriate manner so that people want to attend. If you don’t engage with them, they won’t attend.

The author’s research explored the meaning that older people with diabetes attribute to being involved in a health promotion program. A qualitative hermeneutic phenomenological methodology was adopted to capture information. Semi-structured interviews and focus groups were conducted with participants of the ‘Beat It’ diabetes program, which incorporated physical activity and lifestyle education over a 12 week period. The primary goal of the intervention was to enhance the health and wellness of people with diabetes. A number of themes emerged from the analysis of participant interview and focus group transcripts. The overarching theme, and critical point of difference, for effective health promotion programs, is person-

THERE IS STRONG EVIDENCE TO SUGGEST PHYSICAL ACTIVITY IMPROVES DIABETES OUTCOMES

BY ASSISTING GLUCOSE CONTROL, PROMOTING WEIGHT MANAGEMENT AND PREVENTING RELATED COMPLICATIONS

centredness. Person-centred program efficacy is seen as key to ensuring the effective design, promotion and delivery of health promotion programs for older people with diabetes.

As RN/RMs, our delivery of care and referral to programs needs to be mindful of the expertise of

38 December 2015 / January 2016 Volume 23, No. 6

the person with lived experience on their own journey. Valuing lived experience enhances delivery of care and referral of services to be contextualised through the lens of the participants. Personcentredness becomes embedded.

Whether someone will engage in recovery or in additional services is determined by the person themselves. Results from this research, can lead to better understanding of how engagement, particularly of older people, in health promotion programs can be enhanced.

Rebekkah Middleton is a Lecturer and PhD Candidate and Professor Lorna Moxham is Professor in Mental Health.

Both are located 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

CONNECTING AND ENGAGING IN HEALTH PROMOTION SPENCER WALTON AND BOB MCDONALD (PARTICIPANTS).

References Hu, J., Wallace, D.C., McCoy, T.P. and Amirehsani, K.A. 2015. A family-based intervention for Hispanic adults and their family members. Diabetes Educator. 40:48-59.

Law, K.H., How, C.H., Ng, C.S. and Ng, M.C.W. 2013.

Prescribing health: exercise. Singapore Medical Journal. 54:303308.

World Health Organization. 2015.

Diabetes facts sheet 312. www.who.int/ mediacentre/factsheets/ fs312/en/ Accessed 25 August 2015.

anmf.org.au

Primary / Community Care

Improving community nursing care services through the academic nursing centre model

By Neti Juniarti, Lana Zannettino, Jeffrey Fuller and Julian Grant This paper shows that an overseas academic Nursing Centre (NC) model can be used in the Australian context to improve community nursing care. The NC is an integrated model of community care and nursing. This model, which has been recognised globally, aims to integrate health services, nursing education and research within the community.

A PhD study of the NC model in West Java Indonesia, which involved qualitative interviews with a range of stakeholders, showed that the NC has made a positive change in community health nursing practice as well as clients’ knowledge and attitudes towards health promotion activities.

Knowledge sharing and reciprocity, which are key aspects of the NC model, have been shown to increase the capacity of nurses to engage in community nursing care and primary healthcare (Kurtzman and Kizer, 2005). By orienting nurses toward community health, nurses can take a pivotal role in empowering people to remain healthy through health education and disease prevention, which can then reduce the need for hospitalisation (Swiadek, 2009).

These findings have relevance for Australia. A review of the literature suggests that Primary Healthcare (PHC) is now commonly

associated with services provided by practice nurses in Australia (Henderson et al. 2014). However, nurses’ contribution towards PHC are ‘constrained by both the general practice setting and their educational preparation’ (Keleher and Parker, 2013). Through the NC model, nursing schools can provide training for future nurses, as well as work together with health service stakeholders to improve community nursing practice and primary healthcare.

Neti Juniarti is a PhD candidate in the School of Nursing and Midwifery at Flinders University and in the Faculty of Nursing Universitas Padjadjaran in Indonesia Dr Lana Zannettino, Professor Jeffrey Fuller and Associate Professor Julian Grant are all in the School of Nursing and Midwifery at Flinders University

FOCUS References Henderson, J. Koehne, K. Verrall, C. Kristine, G. and Fuller, J. 2014. How is primary healthcare conceptualised in nursing in Australia? A review of the literature.

Health & Social Care in the Community. 22 (4):337-351.

Keleher, H. and Parker, R. 2013. Health promotion by primary care nurses in Australian general practice.

Collegian. 20 (4):215221.

Kurtzman, E.T, and Kizer, K.W. 2005. Evaluating the performance and contribution of nurses to achieve an environment of safety.

Nursing Administration Quarterly. 29 (1):14-23.

Swiadek, J.W. 2009. The impact of healthcare issues on the future of the nursing profession: the resulting increased influence of communitybased and public health nursing. Nursing Forum.

44 (1):19-24.

Resource packs to facilitate exercise on dialysis

By Paul Bennett Deakin University School of Nursing and Midwifery and Western Health nursing researchers have launched an Australian-first exercise program to help fight the debilitating physical side-effects suffered by people undergoing dialysis treatment.

Currently there are over 12,000 Australians receiving dialysis treatment for end-stage kidney disease. According to Deakin and Western Health Professor in Nursing Paul Bennett the combination of chronic kidney disease and sitting on dialysis – for four to five hours, three times a week – causes people to deteriorate physically at an alarming rate. Despite this loss in physical functioning the importance of exercise is often overlooked.

Exercise has been shown to improve physical function, quality of life, muscle condition and the dialysis treatment in patients with kidney disease, as well as decreasing depression, cardiovascular risk and a range of other negative outcomes of kidney disease. Forty percent of all people receiving hemodialysis treatment have a significant fallsrelated injury each year, with 54% of these resulting in fractures. A recent Cochrane Review confirmed that exercising at least three times per week for greater than 30 minutes per session for people with end stage kidney disease was effective for improving physical fitness, walking anmf.org.au

capacity, blood pressure and healthrelated quality of life.

Dialysis exercise programs in the past have often involved stationary cycling which can improve cardiovascular outcomes but do not address the physical strength loss that commonly occurs with people on dialysis. Physical strength improvement requires resistance training to improve muscle strength and function. Resistance training is most commonly associated with gymnasium weight training. Elastic resistance bands can be used in place of weight machines to replace the resistance component of the program.

The kits that support this program use resistance elastic bands that can help improve the strength of important muscle groups which can assist everyday activities.

The kits include resistance bands, an exercise instruction guide, health professional and patient brochures, a DVD and prompt cards. All resources visually demonstrate up to 20 separate exercises patients can do while on the dialysis machine.

The kits are being sent to over

Further information and resources can be found on the Kidney Health Australia website at kidney.org.au

300 dialysis units across Australia to help equip exercise professionals, nurses and patients with what they need to start and sustain a gentle resistance exercise program that will encourage patients to exercise training during their dialysis treatment. The exercise program is designed to be repeated up to three times a week at every dialysis treatment.

For detailed information regarding packs please contact Professor Paul Bennett at p.bennett@ deakin.edu.au Professor Paul Bennett is located at Deakin University and Western Health Nursing Research Centre

December 2015 / January 2016 Volume 23, No. 6 39

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Primary / Community Care

RDNS and Bowls Australia team up to provide health education

By John Allin Thousands of people in all states will be able to access health and wellness sessions from RDNS nurses and educators courtesy of a unique partnership with Bowls Australia.

Not-for-profit aged care service provider RDNS has partnered with Bowls Australia, the governing body for the sport of bowls in Australia, to share with bowlers and the broader community information on key health issues including skin care, first aid and CPR, nutrition and positive ageing.

The innovative alliance will see RDNS visit bowls clubs in every state, talking with groups to promote better health and wellbeing.

Australian bowls is one of the largest sports within Australia’s sport and recreation industry, with over 600,000 regular participants annually and 180,000 playing members across 1,927 clubs around the nation.

“This is a unique way to share important health information with people in a relaxed environment anmf.org.au

outside the formal health system,” said RDNS Executive General Manager Dan Woods. “It is a massive sharing-of-knowledge initiative, designed to help people learn how to stay healthy, look after the people around them, and continue to get the most out of life as they grow older.”

Initial session topics include, Feed Your Brain, Fuelling Your Body, First Aid and CPR, Mastering Your Mind, Positive Ageing and Are You Drinking Enough Fluids?

AUSTRALIAN BOWLS IS ONE OF THE LARGEST SPORTS WITHIN AUSTRALIA’S SPORT AND RECREATION INDUSTRY, WITH OVER 600,000 REGULAR PARTICIPANTS ANNUALLY Bowls Australia CEO Neil Dalrymple said the sessions would represent great opportunity for members, players and other community members keen to stay healthy and be better informed – not just for themselves but in some cases for those in their care.

“More than 600,000 people play bowls regularly around Australia

each year and more than half of those are aged over 60,” Mr Dalrymple said. “Bowls Australia wants them to be fit and healthy for years to come.

“Participating in sport is a great first step but there are lots of other things we can do to stay in good shape. By implementing this RDNS partnership and the health and wellness training sessions, I hope there will be a greater understanding about the importance of keeping healthy and active as we age.”

RDNS’ Dan Woods said the information in the sessions had the potential to enrich people’s lives – mentally and physically. Each session will be packed with practical advice and everyday strategies to maximise health knowledge and support participants to get the most out of life.

“We will offer a session on skin health, which is so important for those of us who spend time in the sun. The session will talk about how skin changes over time and how to prevent and manage skin tears,” Mr Woods said. “Other sessions will cover nutrition, positive ageing, bladder health and how to maintain a fit brain. Research shows brain games can help ward off dementia, so we’ll look at the sort of activities that can keep us staying sharp as we age.”

The innovative partnership was formally launched at Broadbeach Bowls and Community Club last month.

FOCUS

RDNS NURSE SAMANTHA CARSON RN CHATS WITH MEMBERS OF THE MALVERN BOWLS CLUB ABOUT HEALTH, WELLBEING AND POSITIVE AGEING

John Allin is Media and Communication Specialist at RDNS

December 2015 / January 2016 Volume 23, No. 6 41

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Primary / Community Care

The health of Australian nomads

By Elizabeth Halcomb, Kelly Langford and Moira Stephens Many older Australians, ‘grey nomads’, take to the road to follow the sun and warmer weather on retirement (Hillman, 2013).

In 2011, Australia’s grey nomad population was estimated to be about 450,000 people which is around 2% of the total population (Davies, 2011). The transient nature of the grey nomad life provides challenges for both receiving and delivering healthcare to support healthy ageing. Yet it is at this point in their lives that interventions to

Primary healthcare nursing workforce development

By Christina Aggar, Christopher Gordon and Jacqueline Bloomfield The focus of health reform on ageing and chronic disease has seen the implementation of primary healthcare (PHC) as an integral component of Australian pre-registration nursing curricula. However, attracting newly qualified nurses to work in PHC is challenging due to a lack of career development opportunities and educational support.

Australia is currently experiencing a surplus of graduates and a corresponding lack of placement and employment opportunities for them in the acute care sector, presenting a timely opportunity to encourage newly graduated nurses towards a career in PHC (Bloomfield et al. 2015).

Traditionally, transition to professional practice programs have been operating in Australia since 1987, and have focused on the acute care sector, providing nurses with structured support in their first year of practice. The programs have been successful as a recruitment anmf.org.au

improve lifestyle risk factors and minimise the impact of chronic conditions can enhance quality of life and longer term health outcomes.

Additionally, younger couples and young families are also travelling for long periods of time, away from regular healthcare providers and health services.

This prompted the University of Wollongong’s School of Nursing to embark on a project to explore the health planning and health needs of Australian travelling nomads.

This study is using a national online survey of Australian nomads travelling for more than three months in a 12 month period, to scope the issues around the health, health needs, health service use and health planning in this geographically dispersed population. A series of in depth qualitative interviews will be conducted with those individuals

who have nominated that they wish to take part to explore further their experiences and health needs whilst travelling.

The potential impact of this study is that we will have a better understanding of the Australian nomads’ perceptions of health planning and experiences of managing health whilst travelling.

This knowledge will inform future policy and health interventions to enhance self-management during travel.

tool and provide hospitals with a way of attracting high caliber graduates. There is however, a lack of evidence about transition programs for new graduate nurses in general practices and community health settings. It is our view that programs to support newly qualified registered nurses entering directly into PHC must be implemented and evaluated.

Academics at Sydney Nursing School have been working on a number of initiatives in this area.

In collaboration with Northern Sydney Medicare Local (now the Sydney North Health Network and Primary and Community Care Services Ltd), a 12-month transition to practice program for newly graduated nurses is currently being piloted. The first of its kind in Australia, this has been designed for new graduate registered nurses entering primary care directly from university (Gordon et al. 2014). Through employment in general practices, the new graduates are supported to develop independent primary care nursing practice, furthering chronic disease management clinical and communication skills, within a vibrant multidisciplinary primary care team.

In collaboration with Northern Sydney Local Health District (NSLHD), an innovative model of support for graduate nurses’ to transition directly into the

community health workforce has been designed. This program seeks to expand on the existing transitional program for graduate nurses and has been specifically designed to equip graduates to work effectively in the complex area of community health. The new workforce development model will be implemented and evaluated in 2016 in Northern Sydney Local Health District. The program will recruit graduate nurses to undertake a transition to professional practice program focusing on community services, aged care and rehabilitation. As a workforce development model, the program aligns with state and federal initiatives by increasing nurses’ capacity to respond to community need, in terms of the ageing population, chronic illness and disability.

An evidence-based framework is needed to inform understanding of these programs in primary healthcare. This has implications for primary healthcare nursing workforce career development and educational support. Whilst the current pilot programs are still in progress, we already have sufficient evidence to support their expansion and are working on a national roll out in 2016/17. The aim of the national program is to support the government to achieve its goals of fostering a strong, responsive and sustainable healthcare system.

Professor Elizabeth Halcomb is Professor of Primary Healthcare, Ms Kelly Langford is Research Assistant and Dr Moira Stephens is Senior Lecturer - on behalf of the Australian Nomads Research Team, School of Nursing, University of Wollongong

FOCUS

References Davies, A. 2011. On constructing ageing rural populations: ‘Capturing’ the grey nomad. Journal of Rural Studies 27(2): 191-199.

Hillman, W. 2013. Grey nomads travelling in Queensland, Australia: Social and health needs.

Ageing and Society 33(4): 579-597.

References Bloomfield J, Aggar C, Williams A, Gordon C. 2015. Nursing students’ intentions to enter primary healthcare as a career option: findings from a national survey. Collegian. 22(2), 161-167.

Gordon C, Aggar C, Williams A, Walker L, Wilcox S & Bloomfield J. 2014. A transition program to primary healthcare for new graduate nurses: a strategy towards building a sustainable primary healthcare nurse workforce? BMC Nursing. 13:34.

Dr Christina Aggar is Senior Lecturer and PHC Post Graduate Coordinator, Christopher Gordon is Senior Lecturer and Jacqueline Bloomfield is Associate Dean Learning and Teaching.

All are in the Sydney Nursing School at the University of Sydney

December 2015 / January 2016 Volume 23, No. 6 43

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Primary / Community Care

FOCUS

Weenthunga – helping future generations to make healthy decisions

By Tracy Smith For Aboriginal and Torres Strait Islander people to benefit from the same health outcomes as other Australians, it is widely acknowledged that a greater Indigenous healthcare workforce is needed to improve the quality of culturally respectful services offered in our health services.

Weenthunga Health Network, based in Victoria, is demonstrating how collaboratively it has been contributing to strategies promoting equity in health so as to help improve the health and wellbeing of First Australians.

Weenthunga has achieved this through its key objectives, including: • increasing the number of First Australian school leavers to uptake a career in health; • improving knowledge, competencies and collaboration of the Victorian health workforce working with First Australians so as to better equip them to provide culturally sensitive services.

One key strategy in meeting these objectives are Weenthunga’s Women’s Talk health days.

The health days are run in regional and metropolitan areas, which provide an opportunity for young First Australian female students to raise their awareness of healthy living and see the abundance of possibilities when choosing a career in health.

These events offer young women the opportunity to meet and listen to a range of First Australian female health professionals who can help influence a better understanding and decision making process related to their own health and career ideas.

“The First Australian girls involved in the health day events and our broader programs, are building strength, resilience and confidence, with the aim of making post school choices of higher education. Some will in turn choose health careers which will ultimately contribute to better health services for First Australians,” said Weenthunga Health’s Network and Education Consultant Stephanie Armstrong.

In August 2015 a health day was run in Melbourne which was attended by 17 young women considering a future career in the health industry. A number of these young women came from remote anmf.org.au

communities in the Northern Territory and Western Australia, making this opportunity quite unique.

The morning was spent at the Victorian Aboriginal Community Controlled Health Organisation Inc (VACCHO) where the group were warmly welcomed to country

by Wurundjeri Elder Aunty Di Kerr, who regaled her times past, spent growing up in outer Melbourne and later living in the community of Coranderrk. This speech worked as a powerful reminder to the young women, about the importance of where they have come from and who they are striving to be.

Several speakers representing local health/allied health services spoke of their vocational and at times personal journeys, many of whom identified as First Australians.

Cindy Scott from the Victorian Aboriginal Health Service, shared stories of the pregnant women, families and babies she cares for in her role within the Koori Maternity Service as did a young Medical Scientist Tamika Meeks who spoke about her convoluted yet rewarding pathway to her current role as a pathologist.

The Royal Children’s Hospital Foundation provided a space for the afternoon, and again the students listened to a range of inspiring speakers including Marley Stewart who discussed her pathway into nursing, including the areas that inspired her and how she has a large variety of fields to choose from as part of her Indigenous cadetship and Pam MacCalaman who shared stories about her work under the same cadetship program but as a direct entry midwife working at the Royal Women’s Birth Centre in which she is extremely happy and feels very well supported.

Weenthunga had previously hosted their first regional health day in Bendigo in May 2015 where eight young women from Bendigo and Castlemaine enthusiastically participated in a day full of interesting presentations from local

health professionals, many of whom were First Australians.

Lodden Mallee Murray Medicare Local warmly hosted the girls for the morning, while St John of God Healthcare (SJOG) were hosts for the afternoon.

Both health days in Melbourne and Bendigo wrapped up with celebratory dinners. At the Bendigo dinner scholarships were presented to three young first Australian students funded by SJOG to support their future studies.

Important themes emanate from these health days, reinforcing to the girls messages such as: • celebrating Aboriginal identity and culture; • the value of education; • yarning with mob about ideas and aspirations; • there are varied pathways that people can take in their journey to health; • the importance of strong mentors and people who believe in you; • adapting to mainstream culture while staying true to who you are; • you will have knocks in your journey, and you don’t have to be popular with everyone; • you have skills that you won’t realise you have until you are in a role that brings them out.

Weenthunga remains in contact with the schools and students offering support and connection to mentors.

Weenthunga has a very inclusive approach to membership – accepting First Australians and Australians in any health role. People working in the health industry are encouraged to join Weenthunga at www.weenthunga.com.au

Weenthunga means ‘hear / understand’ in Woiwurrung, language of the Wurundjeri people of the Kulin Nation Tracy Smith is Communications Manager at Weenthunga, Victoria

December 2015 / January 2016 Volume 23, No. 6 45

FOCUS TOPICS FOR 2016 Wound / Infection Control

FOCUS

FOCUS

Education: Part 2

Education: Part 2

FOCUS

FOCUS

Education: Part 2

FOCUS

Education: Part 2

Flexible learning in midwifery and nursing education

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

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

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

By Sara Geale and Elisabeth Jacob

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

References Alexis O. (2009).

Providing best practice in manual blood pressure measurement.

BJN. 18(7), 410-415.

Healthy healing and wound prevention

By K Price, A Dyer, T Rando and P Hickman Critical to achieving best outcomes in any clinical setting is ensuring decision making in wound prevention and healthy healing of a wound, has successful client centred outcomes.

The Wound Management Innovation CRC (WMI CRC) was formed on 1 July 2010 to: alleviate suffering of people with chronic wounds; improve wound prevention; deliver clinical resources of national importance; develop next generation wound management products; educate researchers and healthcare providers; and reduce the cost of healthcare to people with wounds. www.woundcrc.com/ Among the critical indicators of quality services and resident satisfaction in residential aged care as legislated in the Aged Care Act 1997 is the prevalence of pressure injuries and skin tears.

A service delivery model is under

evaluation that incorporates healthy healing and wound prevention approaches. The model is aimed to provide near zero incidences of preventable pressure injury or skin tears resulting in significant benefits in resident quality of life, staff productivity, cost savings and accreditation processes.

In collaboration with Southern Cross Care (SA&NT), the WMI CRC is working with the University of South Australia undertaking a research project. The project uses descriptive methodology to identify processes implemented by staff to increase the focus on ensuring healthy healing and wound prevention of residents; and to deliver quality outcomes in an efficacious manner in aged care settings. The research is not focused on any one specific staff member or resident, rather on the value of the processes being used to collect information and improve resident outcomes. www. southerncrosscare.com.au/ As an inaugural member of the South Australian Innovation Hub funded by the Commonwealth government, Southern Cross Care (SA&NT) acknowledges healthy healing and wound prevention as an essential component of its service delivery model. Involvement

anmf.org.au

32_43_ANMJ Sep15_Research_Focus.indd 33

MAR APR MAY JUNE JULY

with the Wound CRC may assist other approved providers in the implementation of a systematic approach to wound prevention and healthy healing for all residents, informed by best available evidence.

The research project has four phases: Phase 1: What is happening now? A descriptive account of everyday activities that involves a triangulation of data collection methods including: Wound Prevalence Survey; Wound Prevention and Management Audit; and EQ 5D Quality of Life survey.

Phase 2: Education, training and service provision where SCC staff have access to wound experts and wound products, online education resources and access to a telehealth Wound Advisory Service (Wounds West).

Phase 3: A repeat of data collection tools from Phase 1.

Phase 4: Analysis, reporting and sustainability of the approach.

Findings will be available in early 2016. www.dss.gov.au/ ourresponsibilities/ ageingandagedcare/ ensuring qualitythesouthaustralian innovationhubtrial

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

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

Associate Professor K Price and T Rando are in the School of Nursing and Midwifery at the University of SA A Dyer is Research Director, Wound Management Innovation Collaboration Research Centre P Hickman is Group Manager, Strategy (Research and Development), Southern Cross Care (SA&NT)

September 2015 Volume 23, No. 3

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

Historically in Australian schools of nursing, students are taught to do a preliminary palpatory systolic determination (PPSD) prior to a complete BP reading (Tollefson, 2010). Students are directed to palpate a brachial pulse with the BP cuff insitu. They then pump up the cuff until they cannot longer feel a brachial pulse. The student is advised that they have now palpated the systolic BP. They lower the cuff, wait two to three minutes and reinflate the cuff to 30 to 40mmHg above the systolic BP that they had initially palpated. The 34

August 2015 Volume 23, No. 2

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

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

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

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

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

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

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

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

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

Turnover intention in new graduate nurses: a multivariate analysis.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bachelor of Nursing students.

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

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

The author is seeking NG nurses

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

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

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

anmf.org.au

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

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

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

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

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

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

August 2015 Volume 23, No. 2

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INDIGENOUS HEALTH DIABETES HEALTH MENTAL HEALTH WOMEN’S HEALTH WOUND/INFECTION CONTROL

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

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AUG SEP OCT NOV DEC-JAN

Education options

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

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

Our suite of CPD short courses, webinars and workshops are practical and engaging, relevant 40

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

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

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

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

We also offer child family and

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

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

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

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

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

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

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

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

Incorporating emotional intelligence in nursing and midwifery education

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

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

August 2015 Volume 23, No. 2

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

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

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

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

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

More recently, the attributes of EI have been deemed central to nursing practice, influencing 36

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

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

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

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

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

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

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

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

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

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

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

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

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

References Akerjordet, K & Severinsson, E 2007.

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

16(8):1405-1416.

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

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

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

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

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

Evidence Based Midwifery.

9(2):53-60.

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

August 2015 Volume 23, No. 2

anmf.org.au

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PRIMARY/COMMUNITY HEALTH EDUCATION NURSING MIDWIFERY RURAL AND REMOTE NURSING MEN’S HEALTH DRUG AND ALCOHOL NURSING

The deadline for submissions for focus is the 6th of the month prior to publication eg. March contribution due 6 February.

Send submissions to cathy@anmf.org.au

2016 Seminars

for Health Professionals Perth March 2nd • Adelaide March 4th • Sydney March 5th • Brisbane March 17th • Melbourne March 18th • Hobart March 19th and also broadcast online…

FeAturing: Professor Paula Meier (USA) Dr Shoo Lee (Canada) Nancy Williams (USA) Dr Kelly Dombroski (NZ) Dr Susan Tawia (Australia)

Breastfeeding: Making Connections

For more information and to register go to: www.breastfeedingconferences.com.au Australian Breastfeeding Association in partnership with Breastfeeding Conferences

www.breastfeeding.asn.au

The Australian Breastfeeding Association is a not-for-profit organisation. All income from these seminars is used to support the free mother-to-mother services that ABA provides in the community.

22/07/2015 5:11 pm

Primary / Community Care

has resulted in patients and their carers frequently managing the physical and psychological effects of chemotherapy at home (Mitchell, 2007). These patients often feel overwhelmed, unprepared and have significant unmet needs.

In collaboration with Sydney

District Nursing (community health nurses), a team of nurse researchers at Sydney University have developed a shared care model for cancer patients receiving chemotherapy. Community nurses are well placed to review patients in the community. When they make regular home visits they provide ‘a strong sense of security’ and a degree of confidence in patients and their families with cancer who are managing self-care (McKenzie et al. 2007).

The shared care, community nurse delivered model provides a care pathway to assess patients in their home, provide tailored education and ongoing support.

During home visits community nurses assess patients’ symptoms and transfers the information back to the cancer centre and the patients’ general practitioner. The shared care model was piloted and was found feasible and well received by patients. Participants welcomed community nursing visits and found that: “…it felt really comforting to know there was someone coming along on to check”.

The model is currently being tested in a large, multicentre, NHMRC funded study in Inner West Sydney.

and everyone donating corneas is a universal donor.

Following discussions our Palliative Care team decided to explore the possibility of our unit informing and promoting corneal donations to our cohort of patients.

The Northern Health Nurse Donation Specialist (NDS) of Organ and Tissue was contacted for advice and direction.

Education was provided by the NDS by way of inservicing to most of the nursing staff and some medical staff. Interested staff volunteered to be responsible for raising awareness and explored further education completing an online package from Donate Life on Eye and Tissue donation. A highly visible area was dedicated to information regarding corneal donations and pamphlets were distributed where families and visitors gather. The staff were encouraged to discuss donations on admission where appropriate.

Whilst there are some criteria for suitability most causes of death do not render people as incompatible for corneal donation.

A formalised relationship was established with the Lions Eye Bank who are responsible for retrieval of corneal donations and they provided clear and efficient advice and guidance. Within six months from February 2015, 13 patients have generously donated their corneas, facilitated by the staff at McKenna House. Patients’ families received a follow-up letter of thanks with the outcome of the generous donation from the Lions Eye Bank providing them with ongoing emotional support and advice.

Because eye donation is a sensitive issue the relationship that the palliative care nurses have with their patients and families enables us to explore and sponsor the possibility of donation. Our belief at McKenna House is that everyone has the right to be offered the opportunity to decide whether to become a donor or not.

We have received encouraging feedback as to the success of the donated corneas and our involvement with the Lions Eye Bank and the Nurse Donation Specialist will continue to grow.

Supporting individuals receiving chemotherapy in their home

By Kate White Improvement in managing side effects of chemotherapy has enabled an estimated 70% of treatment to be delivered in an outpatient setting.

Australian research has highlighted a significant proportion of patients receiving chemotherapy continue to experience distressing side effects and require unscheduled visits to hospital (McKenzie et al. 2011).

The transition of chemotherapy delivery to outpatient settings

Raising awareness of the corneal donation program

By Philippa Sweeney and Mark Rees McKenna House is a 28 bed Palliative Care Unit at Broadmeadows Health Service a sub-acute campus of Northern Health caring for the North Western region of Melbourne. Our main focus is symptom management and respite care for life limiting illnesses and end of life care.

At the Barwon Health Palliative Conference in March 2014 I was made aware of the opportunity for our patients to donate their corneas for transplant and research.

A corneal transplant is a surgical procedure which replaces a patient’s cornea with a healthy donor cornea.

Around 1,700 corneal transplants are performed annually with a >90% success rate. Donated tissue can prevent blindness, restore sight anmf.org.au

FOCUS COMMUNITY NURSE MARGARET O’SULLIVAN FROM SYDNEY DISTRICT NURSING CONDUCTING A HOME VISIT

References McKenzie, H., M. Boughton, L. Hayes, S. Forsyth, M. Davies, E. Underwood, and P. McVey. 2007. A sense of security for cancer patients at home: the role of community nurses. Health Soc Care Community 15 (4):352-9.

McKenzie, H., L. Hayes, K. White, K. Cox, J. Fethney, M. Boughton, and J. Dunn.

2011. Chemotherapy outpatients’ unplanned presentations to hospital: a retrospective study.”

Support Care Cancer 19 (7):963-9.

Mitchell, T. 2007. The social and emotional toll of chemotherapy patients’ perspectives.

European Journal of Cancer Care 16 (1):39-47.

Professor Kate White on behalf of the ESCAPI team and Chair of Cancer Nursing at the University of Sydney

Philippa Sweeney is ANUM and Mark Rees is CNS, both are located at McKenna House Palliative Care Unit at Broadmeadows Health Service in Victoria

December 2015 / January 2016 Volume 23, No. 6 47

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Primary / Community Care attitudes and values that shape the judgments essential for interprofessional collaborative practice and include: inter-professional communication, patient/client/ family/community centred care, role clarification, team functioning, collaborative leadership and interprofessional conflict resolution.

Elements of collaboration include respect, trust, shared decision making and partnerships.

With this in mind Blue Care and the University of the Sunshine Coast set up the Wound Solutions Clinic.

CLINIC PODIATRIST AND NURSING STUDENT ELEANOR

Our Partnership

Coffee and conversation: Creation of a wound clinic

By Eleanor Horton, Amanda Besci, Allison Vallejo, Paul Burrows, Bronwyn Doyle and Marianne Wallis In late 2010 discussions began, over coffee, between three nurses with aged care experience, about how two organisations could work together and engage students to enhance their knowledge and skill development with community practicums.

Early discussions were focused on researching models of care that would provide the best client outcomes, the best student learning opportunities, a platform for research, as well as be sustainable

long term. What type of clinic would be able to meet all of our objectives?

Research into inter-professional competency domains helped identify the knowledge skills,

Blue Care is a not-for-profit provider of health, community and social care. It is a subsidiary of the Uniting Church, with a mission to improve the health and wellbeing of individuals, families and communities.

Blue Care has been a community care provider for over 60 years and provides a range of services to support people in their homes, local community centres, residential aged care facilities and retirement villages, with clinics staffed by a range of health professionals, including nurses and allied health professionals.

Prior to our coffee meeting University of the Sunshine Coast (USC) health professional students (nurses, occupational therapists, exercise scientists) attended off campus Blue Care facilities for clinical placements but were not exposed to higher level of wound treatments provided by Blue Care specialist staff.

A strategy to correct this shortfall was the development of an on-campus Wound Clinic which benefits the USC through the provision of further on-campus clinical placement opportunities and capacity, the development of teaching and research partnerships,

Dr Eleanor Horton is Senior Lecturer and Co-chair Steering Committee USC/Bluecare Wound Solutions Clinic, School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast Amanda Besci is Cochair Steering Committee USC/Bluecare Wound Solutions Clinic, Care Support Officer, Sunshine Coast Cluster, Blue Care, Adjunct Associate Professor University of the Sunshine Coast

Table 1 OBJECTIVES

KEY PERFORMANCE INDICATORS (KPIS)

ALIGNMENT WITH USC STRATEGIC GOALS

To increase student placement capacity

Increased student clinical placement hours

Learning and teaching program development Supports increase in student enrolments

To establish and sustain an inter-professional clinical learning setting

Student learning outcomes

Learning and teaching student attributes

To provide further community engagement activities

Client numbers referral sources

Community engagement regional engagement

To develop research opportunities

Number of publications, research grants and applications HDR enrolments and completions

Increased research outputs

To provide opportunity for academic staff to participate in clinical practice

Number of equivalent clinical hours practice by academic

Staff development

48 December 2015 / January 2016 Volume 23, No. 6

anmf.org.au

Primary / Community Care and an increased community involvement, particularly in the area of healthcare in the community.

The benefits to students include enhanced access to clinical placement and inter-professional learning opportunities and research.

The benefits for Blue Care are increased opportunities to partner with tertiary education in service delivery, research, community engagement and access to a modern clinic space specifically designed for the conduct of community based care. There are many models of clinics on university campuses to enhance student clinical placements for a wide variety of disciplines. The model that is used at the Wound Solutions Clinic has proved itself to be able to meet the clinic objectives.

Objectives The objectives of the Wound Solutions Clinic are summarised in table 1.

Daily Operations The Wound Clinic is staffed by dedicated, Blue Care health professionals including two registered nurses, a podiatrist and a dietician. Clients are transported from their residential addresses to USC via a Blue Care bus or private transport. Most clients are Blue Care clients and all communication is through Blue Care. The University provides the venue for the clinic and coordinates clinical placements for students. There is a steering committee consisting of representatives of both organisations and all the relevant discipline groups, as well as a researcher. This steering committee oversees the governance of the clinic in conjunction with the General Manager of all the USC Health Clinics.

The clinic is currently being evaluated and early qualitative feedback provided in interviews with staff, clients and students endorses the Blue Care Innovation Award given to the clinic in 2014 for ‘Living the Values’.

With an ageing population and an increase in chronic wounds the clinic is expected to provide a key element of care for people with chronic wounds on the Sunshine Coast, in addition, by actively engaging a variety of health professional students we are successfully developing the experts of the future. Not a bad outcome for the price of a cup of coffee. anmf.org.au

Yvonne K Parry

Pauline Hill

Applying psychosocial theories for nursing students Allison Vallejo RN USC/Blue Care Wound Solutions Clinic, Blue Care Paul Burrows is Podiatrist/ Allied Health Coordinator Blue Care, Sunshine Coast, USC/ Blue Care Wound Solutions Clinic Bronwyn Doyle RN M Mid, Faculty of Science, Health, Education and Engineering Health Clinics Manager, Project Manager Clinical Training Funding, University of the Sunshine Coast Professor Marianne Wallis is Professor of Nursing, University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine

There is an increasing awareness about the importance of community based placements for nursing students given their work with vulnerable, unwell groups (Baglin and Rugg, 2010; Gerber, 2013).

The placement of students studying nursing has traditionally focused on acute care providing the student with important clinical skills.

However, opportunities for students to apply their understanding about the impact psychosocial issues and social determinants of health has outside the acute care sector is also warranted, as it better enables them to be informed about what those influences are on health, illness, recovery and wellness.

Furthermore, with the increasing provision of home visiting and community based healthcare services, there is an evolving need for more community based placements with a variety of population groups.

Teaching nursing students about the broader population through community based placements with disadvantaged groups increases the students’ confidence in dealing with the variety of people they will encounter in the acute care setting (Baglin and Rugg, 2010; Anderson, 2009 and Murphy et al. 2012).

Psychosocial theories, such as those of Bronfenbrenner and Erikson, provide nursing students with a theoretical knowledge of the impact of psychological and social factors on clients’ health and recovery. The psychosocial assessment of a patient is an extremely important part of nursing care, but often under-prioritised in preference to immediate physical care requirements (Baglin and

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Rugg, 2010; Anderson, 2009 and Murphy et al. 2012). The application of developmental psychosocial theories to clinical practice and assessment techniques can be difficult to achieve in traditional acute care placements (Baglin and Rugg, 2010; Anderson, 2009 and Murphy et al. 2012).

In the Bachelor of Nursing curriculum, community based experiences are provided in each year level to develop students’ understandings about the psychosocial aspects of people in their care. The extent to which this is successful is unknown, but important for the profession to research if we wish to improve patient care.

TEACHING NURSING STUDENTS ABOUT THE BROADER POPULATION THROUGH COMMUNITY BASED PLACEMENTS WITH DISADVANTAGED GROUPS INCREASES THE STUDENTS’ CONFIDENCE IN DEALING WITH THE VARIETY OF PEOPLE THEY WILL ENCOUNTER IN THE ACUTE CARE SETTING

References Baglin, M. and S. Rugg. 2010. Student nurses’ experiences of community-based practice placement learning: a qualitative exploration. Nurse Education in Practice. 10(3): p. 144-152.

Gerber, L. Bringing home effective nursing care for the homeless. 2013. Nursing. 43(3): p. 32-38.

Anderson, E. 2009. Learning pathways in contemporary primary care settings - student nurses’s views. Nurse Education Today. 29(8): p. 835-839.

Murphy, F., et al. 2012. Nursing students’ experiences and preferences regarding hospital and community placements. Nurse Education in Practice. 12(3): p. 170-175.

Dr Yvonne K Parry and Pauline Hill are both Senior Lecturers at Flinders University School of Nursing and Midwifery

December 2015 / January 2016 Volume 23, No. 6 49

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Primary / Community Care

Hepatitis B antenatal care in the community

By Emma Day

With the Second National Hepatitis B Strategy setting a target of 95% hepatitis B (HBV) childhood vaccination coverage plus increased monitoring and care of pregnant women with HBV, it is clear that primary care, in particular antenatal care, plays a pivotal role in reducing the burden of HBV in Australia (Second National Hepatitis B Strategy, 2014-2017).

References Commonwealth of Australia, Second National Hepatitis B Strategy 2014-2017 Hepatitis B Mapping Project: Estimates of chronic hepatitis B diagnosis, monitoring and treatment by Medicare Local, 2012/13 – National Report, 2015 Nguyen V.T., Razali K., Amin J., Law M.G., and Dore G.J. 2008. Estimates and projections of hepatitis B-related hepatocellular carcinoma in Australia among people born in Asia-Pacific countries. J Gastroenterol Hepatol Jun; 23(6): 922-9.

Without access to appropriate care, around 15-25% of the 218,000 people living with chronic HBV in Australia will die from their condition (Hepatitis B Mapping Project, 2015); screening and clinical management within the community saves lives.

HBV disproportionately affects Aboriginal and Torres Strait Islander people and populations from high prevalence countries, such as Asia and Sub-Saharan Africa. For many migrants, primary care is the first point of entry into Australia’s healthcare system. Nurses,

A study into suicide attempt aftercare

By Jakqui Barnfield

Jakqui Barnfield is a PhD candidate and Program Nursing Director Mental Health Program, Acting Operations Director/ Director of Nursing, Kingston Centre & Satellites at Monash Health in Victoria anmf.org.au

When a colleague disclosed that she had made a suicide attempt requiring treatment in hospital and then described the phases of her journey through her admission, I will admit to being intrigued by how she perceived the nursing staff attitudes towards herself and her situation.

My colleague would be described as an intelligent, articulate, professional woman who reasoned that her sense of self was diminished when during the nursing handover, she heard one nurse say, “She’s been a naughty girl”. It was this phrase and my colleague’s experience that set me on my path to undertake my PhD. I had heard stories of nurses who portrayed negative sentiments towards people who had made suicide attempts, but had never before heard it from the patient’s perspective.

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midwives, and GPs working in the community are ideally placed to test, vaccinate, treat, and monitor those who are at risk.

This is particularly true for health professionals providing women with antenatal care. For some, antenatal screening will be the first time they learn of their HBV status.

The most common mode of transmission of HBV is mother-tochild during childbirth and without interventions, up to 90% of children born to HBV positive women acquire the infection. Thankfully, there are a number of steps health professionals can take during pregnancy, delivery and post-partum to support mothers and babies.

All pregnant women should be offered a HBV screening test at the first antenatal visit, regardless of previous testing or vaccination. All pregnant women who are hepatitis B surface antigen positive should be referred to a specialist clinician, as treatment may be indicated for the mother’s health and/or to reduce the risk of transmission to the baby.

Infants born to HBV positive mothers should be given HBV immunoglobulin (HBIG) within 12 hours of birth; which, in combination with the vaccine at birth, reduces the risk of

transmission by up to 95%.

All newborns, regardless of their mothers HBV status, should receive four doses of HBV vaccination (at birth, two months, four months, and either six or 12 months). Babies born to HBV positive mothers should be tested three months after the final dose to ensure they are protected.

Breastfeeding does not increase the risk of HBV transmission and should not be discouraged.

Importantly, all women with HBV following delivery should be referred for ongoing HBV management and care.

It is projected that incidences of HBV will continue to increase over the next 10 years (Nguyen et al. 2008), as such, there is a clear need for all primary health professionals, particularly those providing antenatal care, to be aware of testing and vaccination interventions in order to prevent new cases of HBV and to increase the monitoring and treatment of those affected.

The study is titled, ‘An investigation into the attitudes, behaviours and interactions of nurses in acute care settings when providing suicide attempt aftercare’ and is being undertaken at Monash University, with Professor Wendy Cross and Dr Kay McCauley as supervisors.

The study explores the experiences of some of this vulnerable group who have attempted suicide and required treatment and care from within the generalist hospital setting.

It also identifies the attitudes, behaviours and outcomes of some of the nurses who provide suicide aftercare and also attempts to explain why these exist. The Human Research Ethics Committee has granted ethics approval.

There are three phases to the study: survey, observation and interview, which is being conducted across six medical/surgical wards.

All registered and enrolled nurses employed on the participating wards are invited to participate, with surveys distributed to all. The observation phase entails nurses

who choose to participate and are providing nursing suicide attempt aftercare. Interview participation is throughout the nursing hierarchy, including frontline nurses, Nurse Unit Managers, Nurse Educators, Directors of Nursing and the Chief Nursing and Midwifery Officer.

Interviews are also planned to include people who have received suicide attempt aftercare.

Preliminary findings to date are in keeping with much of the literature on this topic; that nurses don’t know what to say, or are fearful of saying the wrong thing.

They want mental health clinician involvement. Interestingly, these findings also show that nurses believe that people are entitled to their privacy and that attempted suicide is a private experience.

Therefore they are reluctant to discuss the conditions that led to the suicide attempt, the person’s current thoughts and feelings about dying and whether they will try again. Nurses appear anxious about these matters therefore early indications are that support and education needs to be provided.

Emma Day is Project Officer, National Policy and Education Division at the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM)

December 2015 / January 2016 Volume 23, No. 6 51

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Primary / Community Care

Achieving health equity for people with disabilities: a call to action

By Nick Arnott The Survey of Disability, Ageing and Carers conducted by the Australian Bureau of Statistics (ABS) classifies people with a disability as any person with a health condition or impairment that limits or restricts their activities of daily living (ADLs) for a period of six months or more (ABS, 2010; VicHealth, 2012). Based on this classification, approximately one in five Australians has a disability, with the proportion increasing with age from 7% of under15-year-olds to 52% of those aged 65 and over (ABS, 2010).

People with long-term cognitive, physical or sensory disability, whether present at birth or acquired later in life, are among the most disadvantaged and marginalised groups in our community. They experience poorer health than the general population, have unequal access to healthcare services and often have unmet healthcare needs (VicHealth, 2012; WHO, 2011; AIHW, 2010).

Recent Australian research on the National Health Priority Areas (NHPAs) of cancer, cardiovascular disease, diabetes, arthritis, osteoporosis, asthma, injuries and mental disorders, revealed a high prevalence of multiple co-morbidities for people with disabilities. 53% of people aged 15-64 years with severe or profound disability had two or more long-term conditions from the NHPAs, and 23% had three or more, compared to only 5 and 1% of people without disability, respectively (AIHW, 2011). People with disabilities often experience earlier onset and premature mortality associated with these conditions, yet paradoxically, they frequently have to contend with missed, late or underdiagnosis, and deep-seated disparities in addressing their care needs. Research has also shown that widening inequalities and inferior social, living and working conditions are major contributors to the poorer health of people with disabilities. They are more likely to live in poverty; have inadequate or insecure housing; have low levels of education and workforce participation; experience discrimination, violence, abuse or neglect; be socially excluded, segregated or marginalised; and face significant barriers to accessing appropriate healthcare, transport and other important community infrastructure or services (Coulson-Barr, 2012; VicHealth, 2012; WHO, 2011; Bigby, 2008).

The Australian healthcare reform agenda aims to provide universal healthcare to the entire population and to encourage and 52 December 2015 / January 2016 Volume 23, No. 6

support everyone to achieve their maximum health potential, regardless of their age or whether they have a chronic illness or disability (Australian Government, 2009).

Community and primary healthcare nurses are particularly well placed to support a shift in focus from illness, impairment and disability - to ability, function and health (LarsonMcNeal et al. 2002). To this end, the World Health Organization (WHO) has promoted a ‘bio-psycho-social model’ of disability (WHO, 2011, 2001), which recognises that many people with disabilities will need, and benefit from, medically-derived solutions for problems arising from their health conditions or impairments, but that they also require sustained and collaborative action to remove or mitigate the barriers and inequities that contribute to poorer health outcomes (VicHealth, 2012; WHO, 2011).

In the spirit of the Alma-Ata Declaration on Primary Healthcare (WHO & UNICEF, 1978), this article presents a ‘call to action’ for all nurses to contribute to endeavours that: • promote an enabling health system, rather than a fundamentally disabling one; • empower people to take greater control of their own health; • address the social and environmental determinants of poor health; • reduce the high rates of hospitalisation or medical intervention for people with disabilities, through improved access to quality primary healthcare in the community; • enhance and protect the rights of people with disabilities and their carers and families; • promote their equal inclusion and participation in society; and, • facilitate primary prevention efforts to avoid or remove the causes of potentially disabling health conditions, environments or attitudes before they arise (Katterl & Bywood, 2011; International Council of Nurses, 2010; Larson-McNeal et al. 2002; Newell, 2005).

Nick Arnott is Lecturer in the School of Health Sciences, Faculty of Health at the University of Tasmania

References Australian Bureau of Statistics (ABS).

2010. Disability, ageing and carers, Australia: summary of findings, 2009 (4430.0).

Canberra:.

Australian government.

2009. A healthier future for all Australians. Final report of the National Health and Hospitals Reform Commission (NHHRC). Canberra: Commonwealth of Australia.

Australian Institute of Health and Welfare.

2010. Health of Australians with a disability: health status and risk factors (Bulletin no. 83). Canberra: Commonwealth of Australia.

Australian Institute of Health and Welfare.

2011. The use of health services among Australians with disability (Bulletin no. 91). Canberra: Commonwealth of Australia.

Bigby, C. (2008). Known well by no one: Trends of the informal social networks of people with intellectual disability five years after moving to the community.

Journal of Intellectual and Developmental Disabilities, 33(2), 148-157.

Coulson-Barr, L. 2012. Safeguarding people’s right to be free from abuse: Key considerations for preventing and responding to alleged staff to client abuse in disability services.

Occasional Paper No. 1.

Office of the Disability Services Commissioner.

Melbourne: Government of Victoria.

International Council of Nurses. (2010).

Prevention of disability and the care of people with disabilities. Position Statement. Geneva.

Katterl, R., & Bywood, P. (2011). Primary healthcare for people with intellectual disabilities. Research Roundup, 17. Primary Healthcare Research & Information Service.

Larson-McNeal, M. A., Carrothers, L., & Premo, B. (2002). Providing primary healthcare for people with physical disabilities: A survey of California physicians.

Pomona, CA: Centre for Disability Issues and the Health Profession.

Newell, C. (2005).

Towards an enabling health system: Reimagining health and disability. Health Issues, 42, 35-37.

VicHealth. 2012.

Disability and health inequalities in Australia: Research summary.

Melbourne: Victorian Health Promotion Foundation.

WHO & UNICEF. 1978.

Primary healthcare: Report of the international conference on primary healthcare.

Alma Ata, USSR, 6-12 September 1978.

World Health Organization. 2001.

The International classification of functioning, disability and health. Geneva.

World Health Organization. 2011.

World report on disability. Geneva.

anmf.org.au

CALENDAR National Disability Services Conference 18-19 February 2016, Hilton Hotel, Sydney. www.nds.org.au/ events/1413497081

DECEMBER Australian and New Zealand Mental Health Association “Stop Domestic Violence” Conference 7-9 December, Canberra, ACT. www.stopdomesticviolence.com.au Human Rights Day 10 December. www.un.org

2016 FEBRUARY Ovarian Cancer Awareness Month February 2016. www.womenscancerfoundation.org.au/ World Cancer Day We Can. I Can. 4 February 2016. www.worldcancerday.org/ Chinese New Year 8 February 2016 Anniversary of the Apology (2008) 13 February 2016 Lung Health Promotion Centre at The Alfred 11-12 February 2016 - Spirometry Principles & Practice 25-26 February 2016 - Managing COPD 29 February-4 March - Respiratory Course P: (03) 9076 2382 E: lunghealth@alfred.org.au

NETWORK Royal Adelaide Hospital, class of 756, 40-year reunion Contact Karen Braithwaite or Frances Woodcock on M: 0422 812 187 or E: woodcock7@gmail.com Box Hill Hospital, group 99, 30-year reunion Contact Clare D’Arcy-Evans E: clarebears21@icloud.com or M: 0416 399 881 Box Hill and Eastern Health, group 101, 30-year reunion 30 January 2016, The Upton Room, Box Hill RSL. Gourmet food and entertainment: $28 per head.

Contact Ken Gaffney M: 0409 901 889 St Vincent’s Hospital Melbourne, February 1986, 30-year reunion 6 February 2016. Contact Angelina Speranza E: aelentini@ bigpond.com or Catherine Valeri Facebook page

anmf.org.au

4th National Elder Abuse Conference Ageism, rights and innovation 23-25 February 2016, Pullman Melbourne on the Park. http:// elderabuseconference.org.au/ Women’s Cancer Foundation – Ovarian Cancer Institute We Can Walk it Out 28 February 2016, In aid of ovarian cancer research and awareness. this is a day for the entire family - even the pet pooch! As well as the 4km walk, and the 4km and 8km runs, there will be family entertainment, a free BBQ, fruit and water for all to enjoy. www. womenscancerfoundation.org.au/

MARCH Australasian Cardiovascular Nursing College Conference Celebrating 10 years 4-5 March 2016, Melbourne Convention & Exhibition Centre, Southbank, Melbourne. www.acnc.net.au/ Lung Health Promotion Centre at The Alfred 3-4 March 2016 - Respiratory Course (Module B) 10-11 March 2016 - Smoking Cessation Course 15 March 2016 - Allergy Day 16-18 March 2016 - Asthma Educator’s Course P: (03) 9076 2382 E: lunghealth@alfred.org.au

Royal Melbourne Hospital, group 186, 30-year reunion 6 February 2016, venue TBC. Contact: Deb E: clare.debra@gmail. com or Anne-Marie E: acairns29@ yahoo.com.au or search Facebook page Royal Melbourne Hospital Group 186 Royal Hobart Hospital PTS 2/1986, 30 year reunion 6 February 2016, Prince of Wales Hotel, Battery Point from 5pm, search Facebook page PTS 2/86 or contact M’Lynda on M: 0418 471 771 or Jo S M: 0439 357 939

Australian Dermatology Nurses’ Association Minor Skin Surgery 5-6 March 2016, Southern Cross University, Gold Coast, Qld. www. dnea.com.au/gold-coast-5th-6thmarch-2016-minor-skin-surgery/ ADMA Evidence-based Primary & Secondary Prevention of Chronic Disease Seminar 11 March 2016, AMREP Lecture Theatre, The Alfred Hospital, Melbourne. http://www.adma. org.au/ E: info@adma.org.au T: 0390764125 3rd Commonwealth Nurses and Midwives Conference Toward 2020: Celebrating nursing and midwifery leadership 12-13 March 2016, London UK. www.commonwealthnurses.org/ conference2016/ Australian Pain Society 36th Annual Scientific Meeting Pain: Meeting the Challenge 13-16 March 2016, Perth Convention and Exhibition Centre, WA. www.dcconferences.com.au/ aps2016/ 21st World Council of Enterostomal Therapists Biennial Congress Embrace the circle of life 13-16 March 2016, Cape Town South Africa. www.wcet2016.com/ 6th Florence Nightingale Foundation Annual Conference 17-18 March 2016, Queen Elizabeth II Conference Centre, London. www.florence-nightingalefoundation.org.uk/ National Close the Gap Day 17 March 2016

at The Mile End Hotel, 30 Henley Beach Road, Mile End. Please BYO name tag, memento &/or decoration. RSVP to Kate M: 0403 996 094 or E: jokape56@yahoo.com. au or P: (08) 8443 4756 Ballarat Base Hospital, class 76A, 40-year reunion 20 February 2016. Contact Mandy van Leeuwen (nee Akers) E:timmandy@bigpond.net.au M: 0437 002 658

Royal Hobart Hospital, Ward 2A reunion 13 February 2016, Derwent Sailing Squadron, Sandy Bay, Tasmania. Contact: Jennifer Summers (Nee Greenwood) E: jennifera.summers@ths.tas.gov.au

LaTrobe University, LaTrobe/ Bendigo Campus nursing group (1988-1991), 25-year reunion 20 February 2016, Bendigo.

Contact Steven Graham E: sgraham@bendigohealth.org.au or Sarah Shipp (nee Prudham) E: sshipp@bendigohealth.org.au or search Facebook page LaTrobe 1991 reunion

Royal Adelaide Hospital, 12/01/1976, group 761, 40-year reunion 19 February 2016, 1600 onwards

Geelong Hospital Nurses League (Barwon Health) annual reunion 19 March 2016. All members, past

APRIL World Health Day 7 April 2016. www.who.int/ campaigns/world-health-day/ World Indigenous Cancer Conference 12-14 April 2016, Brisbane Convention and Exhibition Centre, Qld. www.menzies.edu.au/ Lung Health Promotion Centre at The Alfred 18-19 April 2016 - Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au

MAY Australian Primary Health Care Nurses Association (APNA) National Conference Nurses | the heart of primary healthcare 5-7 May 2016, Pullman Melbourne, Albert Park. The conference for nurses working in primary healthcare. www.apnaconference.asn.au Lung Health Promotion Centre at The Alfred 9 May 2016 - Paediatric Respiratory Update 31 May 2016 - Respiratory Update P: (03) 9076 2382 E: lunghealth@alfred.org.au National Sorry Day 26 May 2016. www.nsdc.org.au/ Anniversary of the 1967 Referendum 27 May 2016 National Reconciliation Week 27 May-3 June 2016. www.reconciliation.org.au/nrw/

trainees and current staff are invited to attend. Contact Secretary Bev Lodge E: terrylodge@bigpond.com P: (03) 5243 7794 M: 0419 107 995 St Vincent’s Hospital, February 1976, 40-year reunion 19 March 2016. Contact Mary Hibble (nee Ross) E: maryhibble@ yahoo.com.au or Ra Cunningham (nee Savaris) E: vtcunningham@ hotmail.com or Seach Facebook page: St Vincents Hospital Nurses Class of 1976 St Vincent’s Hospital, Melbourne, August 1986, 30-year reunion 5 August 2016, Melbourne, Venue TBA. Contact Celia Kenny (nee Murphy) E: paulandcelia@hotmail. com or search Facebook page AUGUST 86 30YR REUNION 2016

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

December 2015 / January 2016 Volume 23, No. 6 53

MAIL

Dignity and self-respect in the face of bullying

Responsibility to uphold ethical and professional standards

As I once again prepare to depart from a role I love, with no employment to step into, I reflect on bullying in healthcare and my personal experience. Reflection has enabled me to learn lessons from the past, but I need to learn lessons from the present.

I am writing in response to Garry Trethewey’s letter regarding legislation affecting nurses and midwives in detention centres.

Current legislation means that nurses and midwives adhering to the Codes of Ethics and Professional Practice Standards while working in detention centres may be jailed.

I have been involved in two bullying situations over my professional career. Both have occurred in clinical education departments and both have taken their toll on multiple registered nurse (RN) employees, not just me.

The first occurred three years ago in a public hospital. The RN Head of Department was replaced with a non-clinical business manager and the cascade of destruction commenced. The hospital eventually acted and the perpetrator was removed, but not before four experienced RNs were forced to resign.

Employers – please hear my words. The consequence of bullying never goes away for the victim. It lives within as and is part of us, always.

I now find myself packing my bags again.

I am one of the last standing, most of my RN colleagues gone as they too could not tolerate the ongoing aggression and intimidation. The RN senior manager has been replaced with a nonclinical CEO. This time it’s a private RTO where RN educators train EENs. This week I was able to give my students a living lesson in workplace bullying and harassment.

As I prepared to start my teaching day, following yet another torrent of abuse, the students embraced me with a hug and wiped the tears from my face. My students had become the carers- I had taught them well.

When will it end? How do strong, intelligent, experienced and street wise practitioners find themselves enmeshed in these situations? How does bullying creep up on us like an invasive malignancy and we become deeply involved without even realising it? Why do employers turn a blind eye to the conduct of some of their staff effectively enabling widespread destruction and ripple effect consequence for the departing employee? I don’t have the answers, I wish I did. I will rest my battled soul, dust myself off and try to find a functional and respectful workplace where I can help educate the next generation of nurses.

Reflection from my first experience three years ago did teach me one lesson.

This time I did do something different. When my manager was being yelled at and humiliated by the new CEO at a team meeting, I stood up and said to the CEO “Stop it, this is inappropriate, unprofessional and we won’t tolerate it”.

I can leave with my dignity and self-respect intact.

Name supplied RN, Melbourne

54 December 2015 / January 2016 Volume 23, No. 6

Garry’s suggestion that the standards should be changed in response to the new legislation is abhorrent. Nurses, and all other health professionals, have a responsibility to uphold ethical and professional standards, particularly when caring for marginalised and disadvantaged groups. It is inexcusable that a government has made this illegal. I firmly believe we all need to fight against this legislation, rather than simply accepting it.

I admire the actions of the staff of the Royal Children’s Hospital (Victoria) for refusing to discharge children back into detention centres and intend to fight for my right, and the rights of others, to maintain appropriate ethical and professional standards.

Julie Moltmann RN, TAS

Discrimination For the most part I agree with Lee Thomas’ comments about discrimination (ANMJ Editorial Oct, 2015).

However I disagree with the comment about marriage equality.

For many people, myself included, the definition of marriage is a deeply held moral belief. It is not about discrimination. Indeed, it is discriminatory to expect me to change what I believe. For me to change what I believe marriage to be ie. a sacred, lifelong covenant relationship between one man and one woman; is like asking me to believe that a fish is a creature which climbs trees and eats bananas.

I hope this helps others to see a different viewpoint.

Christine Schreiber RN, SA

Clinical Leadership What a first rate analysis by Niko Leka in the October2015 journal.

Nurses, doctors, engineers, and other professionals all have a personal responsibility to maintain professional standards. Where they allow their acceptable standards to be compromised so as to save the accountant from having to exercise his or her professional judgement, then they are surely working well beyond their scope of practice.

Clinical leadership comes about when the leader of a clinical team works with her or his team to make the best use of all the talent in the team so that the most effective evidence based therapy is put in place.

If this creates a budget dilemma, then the responsibility for reducing throughput or accepting what clinical research deems to be a second or third rate option should not be dumped on the nurse.

Mick Hawkins, MHN, SA anmf.org.au

MAIL CDC Guidelines www.cdc.gov/vhf/ ebola/healthcare-us/ppe/guidance. html and the Australian Guidelines For The Prevention And Control Of Infection In Healthcare www.nhmrc. gov.au/guidelines-publications/cd33.

The WHO posters show removal of gown and glove in one movement. The Australian government site entitled: Safe Use of Personal Protective Equipment (PPE) found at: www.health.gov.au/ internet/main/publishing.nsf/Content/ safe-use-dvd has a short video that shows the gloves being removed first.

None of the guidelines show leaving gloves on until last or after the gown etc.

Doffing and donning debate I have a query regarding the article on infection control on page 39 ANMJ, Sep 2015.

As a theatre nurse I was taught to remove my gown before my gloves at the end of a procedure or when a change of gown is required. However, in the article Infection control: it’s not just what you wear – it’s how you take it off, recommendations for doffing of PPE requires the gloves to be removed first. To me this seems rather backward when the procedure to remove PPE is to reduce the amount of contamination to oneself as much as possible. I was led to believe that by taking your gloves off first, you are exposing your hands to whatever is on the sleeves of your gown when you remove it. It is how the graduate students and trainee doctors are taught if they are in the theatre with me.

So am I wrong?

Name supplied

Answer:

Thank you for your question regarding the article from the ANMJ regarding Infection Control and Doffing and Donning. One of the important roles that the ANMJ plays in our profession is opening of dialogue on best practice.

The article Infection control: it’s not just what you wear-it’s how you take it off was written with references to anmf.org.au

The devil is in the detail. The gloves are contaminated and are usually one of the most contaminated items. The gloves go on last and cover the sleeves of the gown. Once the gloves are off the face mask followed by the gown are removed carefully from the back and touching the inside only. Infection control standards were reviewed when several healthcare workers became contaminated with the Ebola Virus. The issue seemed to be in the removal of the PPE rather than lack of use or donning of PPE. CDC have come out with standards that require use of PPE, ensuring healthcare workers have sufficient time to don and doff PPE and they have gone so far as to suggest that high risk situations require a dedicated trained observer to watch closely and provide coaching for each donning and each doffing procedure to ensure adherence to donning and doffing protocols. CDC also say that PPE must be removed slowly and deliberately in the correct sequence to reduce the possibility of self-contamination or other exposure to Ebola.

While ACORN nurses run low risks of Ebola and other viruses in their daily workplace, infection control standards need to remain high. It might be useful for you to review current practices in light of recent reviews of practice. By leaving your gloves on when you remove other PPE you run the risk of contaminating the protected area under the gown etc. with the contaminated gloves. The crucial point in all infection control remains adherence to hand hygiene.

Gina Mata and Sara Geale Authors of article Infection control: it’s not just what you wear-it’s how you take it off, ANMJ Sep 2015 Vol 3 Lecturers at the School of Nursing and Midwifery Faculty of Health, Engineering and Science Edith Cowan University, WA

Letter of the month

Working in aged care Sitting down reading ANMJ’s article ‘The Age Of Reason’, took me back to my job in aged care.

I write to you as a nurse but also as a daughter who has a father in aged care.

I agree not enough is done to encourage new graduates to pursue their first year in aged care.

My graduate year was completed in aged care. It allowed me to obtain not only my certificate after completing that first difficult year, but it allowed me, most importantly, to have skills to assess, communicate as well as have the basic nursing skills to wash and dress someone and care for those who have so much to offer.

I learnt so much in the time that I spent there, and I still use those skills today.

New graduates are at times so fixated on complex clinical skills or hospital based work such as antibiotics and intravenous care that they forget it’s the basic nursing skills that patients look forward to.

My father, an aged care resident, has experienced lack of care provided by overseas workers that are simply not skilled enough to care or assess him.

It is not their fault, they come to Australia for promise of work. It is the management who fail to provide the proper training to allow the staff to do a good job. This is all that is needed, to ensure a good job is done.

Thankfully he is now in a Blue Cross residence where the staff are equipped with knowledge and skills to provide the care that is deserved by a generation with so much to offer.

Karolina RN, Vic

Letter of the month 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.

December 2015 / January 201 Volume 23, No. 6 55

MAREE

Maree Burgess, ANMF Vice President

PHOTO: RACING VICTORIA

The Melbourne Cup is truly the ‘race that stops the nation’.

As in the previous 154 years, on the first Tuesday in November, the running of the Cup was scheduled for a 3pm start. With radios tuned, televisions on and a hush descending on the thousands at the track, a field of twenty four horses were at the barrier for the start of the 155th Melbourne Cup.

The race held its usual excitement as the horses and their jockeys raced over the 3,200 metre course.

As they approached the home straight for the final time, a horse emerged from the pack that had not been favoured to win. Indeed, its odds had been long and not really considered a chance.

As it happens, the jockey had also been at long odds of even maintaining a ride on this steed.

The two combined their efforts and miraculously surged past the

56 December 2015 / January 2016 2015 Volume 23, No. 6

winners’ post, taking the Cup in what was initially viewed as a boilover.

As the media scrambled to recover details of the horse and its rider, the mounted interviewer pulled alongside the horse and jockey to gain the first of many interviews. What unfolded next has become the feature story in much of the media.

The jockey was none other than Michelle Payne who proceeded to detail her journey throughout the race, moving seamlessly through the technical aspects of the trainer’s race strategy, to the race journey itself, the challenges and opportunities that presented within the race and then to the final surge as she worked with her horse to the winning post.

The horse, Prince of Penzance was at long odds and trained

by Darren Weir. Darren had, as explained by Michelle, shown faith in her to offer her the ride in the Cup, given that she had performed well with the horse in the lead up events. As the horse and jockey returned to the winners’ area, the strapper emerged from the crowd.

His name, Stevie Payne, Michelle’s much loved brother. Incidentally, Stevie is also a person with Down Syndrome. He is a dedicated, skilful strapper and took control of Prince of Penzance as Michelle dismounted.

What an amazing story. Michelle became the first woman to win a Melbourne Cup in what is a male dominated field. Her brother Stevie, working as a strapper despite his associated Down Syndrome. The trainer, Darren Weir demonstrated his commitment to Michelle in offering her the mount, despite societal and perhaps industry expectations, that a male jockey would be the preferred option. And of course, Prince of Penzance rises to the occasion and even though participating in a brilliant field of thoroughbreds, stays the race and wins a miraculous Melbourne Cup. This was no boilover, it was a cup of dreams.

Michelle took to the dais to receive her trophy and at the same time, dispel some of the myths about women in racing. She explained that against all odds, she had come back from serious injury to resume her riding career. She felt compelled to reflect on those in the racing industry who make life difficult for women jockeys. She

described racing as a chauvinistic industry and entertained the crowd by saying “they could all get stuffed”. While some commentators have been taken aback by this colloquial description of rebellion, there are many, many supporters.

Stevie took his turn at the microphone and thanked all in attendance and urged everyone to enjoy the rest of the day. Michelle gave him a huge hug and the crowd roared. Darren Weir then spoke from the heart of the win, his charge, the jockey and the strapper.

The crowd roared again.

So why is this story so relevant for nurses, midwives and carers? As we strive in life both personally and professionally, the spirit displayed on this day, Melbourne Cup 2015, gives hope to all in our struggles.

MICHELLE TOOK TO THE DAIS TO RECEIVE HER TROPHY AND AT THE SAME TIME, DISPEL SOME OF THE MYTHS ABOUT WOMEN IN RACING.

ANMF Victorian Branch Secretary Lisa Fitzpatrick, similarly stood on a dais in Queens Hall in our State Government Building on a warm November evening in 2015.

She spoke of the struggle and determination to achieve the Safe Patient Care (nurse to patient and midwife to patient) ratios Bill 2015 - A journey that has been 15 years in the making, and a fight that has seen several state governments push the Branch, our leadership and members to the legal brink.

As with Michelle Payne, we would not back down. It was indeed a moment of sweet victory when the Bill was finally passed. We now continue to support our colleagues across Australia in their push for Safe Patient Care Ratios.

The parallels between sport and life are evident. Perhaps that is why Australians so love their sport.

I look forward to hearing more about Michelle and Stevie Payne, Darren Weir and the great Prince of Penzance. I can’t wait for the movie! anmf.org.au

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