ANMJ July 2016

V O LU M E 2 4 , N O. 1 / J U LY 2 0 1 6

GROUND

ZERO

STANDING UP AGAINST VIOLENCE IN OUR HEALTHCARE SECTOR

www.anmf.org.au

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CONTENTS Directory 02

GROUND

Editorial 03

ZERO

News 04 World 16 World Profile

17

Feature 18

STANDING UP AGAINST VIOLENCE IN OUR HEALTHCARE SECTOR

Clinical Update

24

Issues – Voluntary euthanasia 27 Research 28 Professional 29 Viewpoint – Mental health palliative care

30

Legal 31 Education – Falls prevention 32

18

Issues – RN in 20 weeks 34 Reflection – PKU 35 Focus – Women’s health 36 Calendar 45 Mail 46 Maree 48

04 17 36 anmf.org.au

July 2016 Volume 24, No. 1 1

Canberra

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

Cover image: Belinda Hughes, Royal Brisbane and Women’s Hospital.

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 0811 Ph: (08) 8920 0700 Fax: (08) 8985 5930 E: info@anmfnt.org.au

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

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

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

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

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

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

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

New South Wales

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 July 2016 Volume 24, No. 1

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

135,863

TOTAL READERSHIP

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

anmf.org.au

EDITORIAL

Editorial Lee Thomas, ANMF Federal Secretary Post-election, no matter which political party is in power, I cannot stress enough the importance of ongoing lobbying and campaigning on these issues until our healthcare and aged care systems provide all Australians with the care that they need and deserve.

– READ MORE ON ASSISTED DYING ON PAGE 27 –

By the time you read this editorial a new or returned government will have been decided for the next three years.

While the impact of this government on the everyday lives of Australians and the future of our country is yet to be seen, it’s fair to say the state of our healthcare and aged care systems will remain on shaky ground.

Leading up to the election the ANMF campaigned and lobbied politicians on vital issues important to the professions and to healthcare. Reading the ANMJ over the past few months you would know these included cuts to health funding, changes to Medicare and reductions to rebates, an attack on penalty rates and, of extreme concern, the erosion of funding and services to aged care.

To support this ongoing campaign the ANMF conducted a national aged care phone and online survey last month, where many of you told your stories and highlighted the major issues occurring in the facilities you work in. This information has been invaluable in revealing the crisis the sector is actually in. It paints a picture our government must not and cannot ignore any longer. Urgent funding and better conditions are needed immediately to protect the sector for the sake of vulnerable residents in aged care. To this end the ANMF will continue to speak out and lobby the government until this happens. Watch this space for updates as they occur.

Alarmingly, violent assaults against our workforce are increasing in a variety of healthcare settings. Often these attacks are fuelled by the escalating use of drugs and alcohol in our communities. The feature this month delves into why violence in our health facilities is increasing and the move towards a culture of zero tolerance.

Also making news is the endorsement of a Victorian Parliamentary Inquiry investigating end of life choices and improved advanced care planning, which includes an assisted dying framework. Additionally, the South Australian Parliament tabled a voluntary euthanasia Bill only a couple months ago.

Page 27 of the journal has a discussion on the issue, encouraging nurses and midwives to get involved and participate in the broader debate from whatever viewpoint.

As nurses and midwives you are the largest health workforce caring for those with a terminal illness or an incurable disease and your voices are not only valuable and powerful but incredibly influential in this debate. No doubt you will hear more about this issue in the upcoming months and I encourage you to consider what your position is on end of life choice and have your say on the matter.

Though assisted dying is a complex issue that must be debated the ANMF supports calls for reform to end of life choices and advanced care planning, whereby nurses respect a person’s right to selfdetermination, identification of quality of life, and compassion for those who suffer.

Our position also acknowledges that assisted dying is currently an illegal act and that nurses are obliged by law and professional codes to operate within those boundaries of the law.

@AustralianNursingandMidwiferyFederation

anmf.org.au

THOUGH ASSISTED DYING IS A COMPLEX ISSUE THAT MUST BE DEBATED THE ANMF SUPPORTS CALLS FOR REFORM TO END OF LIFE CHOICES AND ADVANCED CARE PLANNING, WHEREBY NURSES RESPECT A PERSON’S RIGHT TO SELF-DETERMINATION, IDENTIFICATION OF QUALITY OF LIFE, AND COMPASSION FOR THOSE WHO SUFFER.

@anmfbetterhands

www.anmf.org.au

July 2016 Volume 24, No. 1 3

NEWS

SAMANTHA BROUGHTON, VICTORIAN MENTAL HEALTH NURSE

VICTORIA’S MENTAL HEALTH NURSES TAKE INDUSTRIAL ACTION Victorian public sector mental health nurses raised the stakes in the fight for better pay last month by undertaking protected industrial action in a bid to unlock stalled negotiations.

The state’s mental health nurses are calling for the introduction of mandatory nurse-topatient ratios and a boost in pay to match the recent victory of their counterparts in the public hospital system, who secured increases of between 4% and 20% over the next four years back in May. Key points include implementing a ratio of one nurse to two patients for high dependency beds, ratios of one nurse to four patients in morning shifts and one nurse to seven patients in afternoon shifts for adult acute beds, and similar ratios for forensic care acute beds and youth beds.

Public sector mental health nurses began their campaign in May by wearing red T-shirts emblazoned with the slogan Value, Recognise, Reward, and imploring clients, 4 July 2016 Volume 24, No. 1

VICTORIAN MENTAL HEALTH NURSES STATEWIDE MEETING

friends, and family to support their cause.

Industrial action kicked off last month across 12 of the state’s mental health services and involved speaking out in the media, bans on working overtime, refusing to be redeployed to other areas, the collection of non-clinical and administrative data, and refusing to carry out any workplace or system change proposed by management.

“NURSES ONLY TAKE INDUSTRIAL ACTION AS A LAST RESORT BUT THEY WANT TO SEND PARTIES A STRONG MESSAGE TO FOCUS ON REACHING A NEW AGREEMENT THAT ADDRESSES NURSES’ WORKLOAD, PATIENT CARE, SAFETY AND PAY ISSUES, AND THAT PUBLIC SECTOR MENTAL HEALTH NURSES ARE JUST AS IMPORTANT AS PUBLIC SECTOR GENERAL NURSES.”

The ANMF (Victorian Branch) is negotiating a new agreement with the Victorian government, the employers’ representative, the Victorian Hospitals’ Industrial Association (VHIA), and the Health and Community Services Union.

The agreement expired earlier this year in

March, with the parties meeting more than a dozen times since negotiations began back in February to reach a consensus, but to no avail.

The VHIA and Victorian government have so far offered a 2.5% increase per year plus 0.5% for service delivery improvements.

Further negotiations continued throughout June, facilitated by former Fair Work Commissioner Deputy President Greg Smith.

ANMF Victorian Branch Assistant Secretary Pip Carew said the negotiations had been “painfully slow” due to the lack of presence from other parties involved, adding that the stalemate was already threatening the prospect of mental health nurses receiving back pay dated from 1 April.

As well as industrial action, mental health nurses have commenced a petition in the hope of making employers take notice and are keeping active via social media channels.

“ANMF is available day and night, seven days a week and wants to work hard to achieve a new agreement that addresses mental health nurses’ claims,” Ms Carew said.

Ms Carew stressed that bans on overtime and all other action would not impact on patient care. “Nurses only take industrial action as a last resort but they want to send parties a strong message to focus on reaching a new agreement that addresses nurses’ workload, patient care, safety and pay issues, and that public sector mental health nurses are just as important as public sector general nurses.” anmf.org.au

NEWS

COUNSELLING FUNDING FOR MURDERED NURSE’S COLLEAGUES The Aboriginal health service where murdered nurse Gayle Woodford was employed has received $1.5 million largely to retain its staff.

Gayle Woodford, 56, was found dead in a roadside grave four days after she went missing in the remote community of Fregon on 23 March.

The Commonwealth-funded Nganampa Health Council runs eight clinics in South Australia’s APY Lands. The federal government has provided Nganampa Health Council with $1.5 million funding since the death of Ms Woodford.

While some of the federal funding was to improve safety and security, the lion’s share was for grief counselling, a government spokesperson said. “People needed counselling. We couldn’t have a mass exodus of staff – the service would have fallen over.”

ASSISTED DYING LAWS MOVE STEP CLOSER Victoria could become the first Australian state to legalise assisted dying for terminally ill people following the endorsement of a highly anticipated Parliamentary Inquiry investigating end of life choices.

After 10 months of examination that encompassed several public hearings and the accounts of more than 1,000 submissions, the Victorian Parliament’s Legal and Social Issues Committee handed down its final report last month, tabling 49 recommendations with overarching support for allowing adults suffering incurable conditions to have the choice to end their life.

The report, which states most Victorians express a wish to die at home but only 14% do, proposes implementing an assisted dying framework, establishing a new body called End of Life Care Victoria to oversee the process, and ratifying new legislation

anmf.org.au

CRANAplus CEO Christopher Cliffe said colleagues would have been “quite understandably traumatised”.

There has been an outpouring of grief and support from the Fregon and RAN communities and the public in on an online petition.

THE FEDERAL GOVERNMENT HAS PROVIDED NGANAMPA HEALTH COUNCIL WITH $1.5 MILLION FUNDING SINCE THE DEATH OF MS WOODFORD. Comments included:

“I work in Fregon and my heart is broken for the community and for Gayle Woodford, who tragically lost her life.” BP “I worked on the same lands as Gayle, drove the same ambulance, nursed in the same clinic and stayed in the same house a few years ago….I enjoyed it. But RANs face immense hardship and cannot speak out.”

Louise Johnston wrote.

“Gayle is a friend and should never have been in this situation….” Jenny Treloar.

“We are all Gayle…” Alphos Chuma said.

CRANAplus has been granted $240,000 in

Commonwealth funding to develop a suite of resources, including national guidelines, a handbook and to host a national conversation on the rural health workforce.

“We need a formal national discussion talking to communities about safety and security, and it’s not just about [the number of] clinicians, but infrastructure, educational preparation and behaviour. It’s not just about nurses in the bush,” Mr Cliffe said.

Mr Cliffe encouraged RANs affected by Gayle’s death to access the organisation’s bush telephone counselling service.

The ANMF nationally has sought changes to staffing arrangements for RANS for several years. Resolutions to end single nurse posts to better provide for safety in remote locations were supported at the ANMF’s National Delegates’ conference last year.

“The best way to honour Gayle is to ensure that we have a system in place in future that prevents this kind of tragedy occurring again,” ANMF (SA Branch) Secretary/CEO Adjunct Associate Professor Elizabeth Dabars said.

Federal Rural Health Minister Fiona Nash convened a roundtable in March. COAGs lapsed Rural Workforce taskforce would be reinstated and the federal government would continue talks with state and territories on the issue if re-elected, the government spokesperson said.

under a Future Health Bill 2016.

regarding end of life choices.

“The introduction of assisted dying laws should form part of a much broader reform that gives greater prominence to end of life care,” Committee Chair Edward O’Donohue said. “This is essential to a patient centred approach with choices for those who need it and comfort for all.”

The Victorian government now has six months to respond to the Inquiry.

Key findings to emerge from the report included the palliative care sector being overburdened and requiring more government support, widespread confusion over existing end of life care legislation, and banning assisted dying leading to some people in great pain taking their own lives.

The extensive list of 49 recommendations advocate a community based approach to palliative care and improved advanced care planning.

They include encouraging the integration of palliative care with other health services, clearly outlining criteria for referral to specialist palliative care, the development of an education package on end of life care for residential aged care workers, and undertaking awareness and education campaigns for both the community and health sector to improve understanding

Lobby group, Dying with Dignity Victoria (DWDV), who have been pushing for assisted dying and made a submission to the Inquiry, hailed the report a major step forward.

“The report cannot be ignored, particularly since public opinion is strongly in favour of changing legislation,” Vice-President Dr Rodney Syme said. “It is now time to move forward and have the decision translated into legislation.”

During the past 15 years attempts to introduce voluntary euthanasia legislation have consistently failed across the country.

Most recently, in NSW, the Rights of the Terminally Ill Bill 2013 was defeated, while in the Northern Territory, its Rights of the Terminally Ill Act 1995 was repealed two years later.

South Australia this year introduced the Voluntary Euthanasia Bill 2016 into the discussion and the legislation is currently being determined.

July 2016 Volume 24, No. 1 5

NEWS

HOSPITAL RE-ADMISSION TRIGGERED BY SKIPPING FOLLOWUP HEALTH CHECKS Patients who delay or ignore recommended follow-up health checks after a stint in hospital face greater risk of ending up back where they began, a primary healthcare expert has warned.

University of New South Wales’ senior researcher, Associate Professor Elizabeth Comino, believes timely and important GP care following hospitalisation can

significantly improve health outcomes.

At-risk patients discharged from hospital are normally advised to visit their GP within seven days for important ongoing treatment but Professor Comino, who is investigating ways to better integrate care between the hospital and primary health services, suggests investigations paint a different picture. “Preliminary findings from our research indicate only about one-third of the study group get follow-up health checks within two weeks.

“Timely follow-up in the community may improve post-hospital care and reduce the risk of unnecessary hospitalisation as there are alternative pathways to seeking healthcare.”

Associate Professor Comino, a senior research fellow within the UNSW’s Centre for Primary Healthcare and Equity, unveiled the findings in the lead up to last month’s Primary Healthcare (PHC) Research Conference, held in Canberra, which focused on reform and innovation within the sector.

She said the problematic issue had turned

critical and that patients ignoring proper procedure were placing a greater burden on public hospitals.

She proposed several ways to improve integrated care between hospitals and the community, including better discharge communication between all hospital staff, as well as the development of advanced communication systems between hospital staff and GPs. “Our preliminary study has contributed to discussion about effective discharge planning as they start to talk about more effective integrated care between all levels and layers of healthcare – both in the hospitals as well as in the community.”

Also speaking at the conference Dr Cassandra Goldie, CEO of the Australian Council of Social Service (ACOSS), said addressing poverty was one area essential in improving health outcomes. “Health reform must be approached through a collaborative approach between governments, researchers, and practitioners and community, with the goal of achieving quality, equity and sustainability.”

TIME FOR NURSING TO STAND UP AND BE COUNTED Registered Nurse and CEO of Cancer Council Australia Professor Sanchia Aranda (pictured) has flagged “outing” nurses in leadership positions no longer working in the profession in a bid to help reclaim identity and spark renewed inner value of the impact of nursing roles.

Speaking at a meeting of the Coalition of National Nursing & Midwifery Organisations (CoNNMO) in Melbourne in late May, Professor Aranda implored some of the country’s foremost nursing leaders to find a voice and foster the importance of the nursing role within the community as well as among each other. “Nurses touch every aspect of every person’s life in every setting.

I think that we don’t understand in health how powerful it is. We still need to work to bring the nursing voice to the fore.”

Professor Aranda referred to several texts within her keynote address, including a book by Suzanne Gordon titled From Silence to Voice – What Nurses Know and Must Communicate to the Public, in order to illustrate how nurses often downplay the extraordinary roles they carry out each day.

“She talks about the fact that we must start saying to our patients who we are. We have to say ‘I’m Amanda. I’m a Registered Nurse

6 July 2016 Volume 24, No. 1

MY QUESTION IS, WHY IS IT THAT WHEN SO MANY NURSES MOVE INTO ROLES THAT ARE NONNURSING THAT THEY LEAVE THEIR IDENTITY BEHIND? and managing these things’.”

Professor Aranda said nurses’ own perception of themselves required a complete overhaul, adding that nurses who have gone on to become leaders in other fields often remain silent. “My question is, why is it that when so many nurses move into roles that are non-nursing that they leave their identity behind? What are we ashamed of and why does it happen?

“If you don’t keep your identity as a nurse I think there’s a real danger of being systematically written out of the conversation.”

Professor Aranda’s career has included a role as a research fellow at the Peter

MacCallum Cancer Centre, where she was instrumental in developing a new model of leadership that triggered the growth of the hospital’s graduate nurse program.

Despite sitting on various boards, she admitted that nurses were largely underrepresented in positions shaping policy, and that nursing culture needs to be stronger in order for the profession to be widely recognised and respected.

She labelled CoNNMO, established by the Australian Nursing and Midwifery Federation (ANMF) in 1991, as “potentially incredibly powerful” in spreading a unified message that continually reinforces the value of nursing within the community.

“We do ourselves a disservice by not being unified and not being valued. The solution is complex. We’ve got to be educating the public. There has to be changes to the education system. It’s actually got to be about some people being prepared to take a stand in physical conversations. It requires leadership.”

anmf.org.au

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VACANCIES: Ophthalmic Techs, Wound/Stoma Nurses, Critical Care, Ambulatory Care Critical Care: This is an exciting challenging environment at CCAD offering world class innovative experiences and opportunities for nurses. You will be challenged with high acuity critical patients, work with a world class team and receive support to provide patient centered care. While patients are complex, CCAD will support your professional growth and offer mentorship. The team is growing and as they expand over this year they would like you to join them in Abu Dhabi.

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Four Steps to Building Dementia Practice in Primary Care Free online learning. Promoting an evidence-based approach to dementia detection, diagnosis and support in a primary care setting.

TO UPre e

F P D BagRrSy! 4C ia OU HD &

Modules

How to access the education?

• Step 1: Building dementia knowledge

It’s easy! Follow the simple steps below and if you get stuck APNA is just a phone call or email away.

1. Head to www.apna.asn.au/onlinelearning 2. Under ‘Courses Available Online’ click ‘View Courses’

• Step 2: Building a process towards dementia diagnosis • Step 3: Building an approach to dementia support • Step 4: Building sustainable dementia practice www.apna.asn.au/onlinelearning admin@apna.asn.au | 1300 303 184 The Supporting GPs and Practice Nurses in the Timely Diagnosis of Dementia Project is funded by the Australian Government. It is delivered by a partnership between Alzheimer’s Australia, the Australian Primary Health Care Nurses Association, Alzheimer’s Australia Victoria, Dementia Training Study Centres, and the Australian Primary Health Care Research Institute.

Existing APNA Users

New APNA Users

3. Under ‘Existing APNA Users’ click ‘Login Now’ 4. Enter in your username and password (call APNA if you have forgotten these details) 5. Scroll down the page until you find all four Building Dementia Practice in Primary Care modules 6. Click ‘Buy’ on all four modules 7. Once all four modules are in your Shopping Cart (at the top of your page) click on ‘Proceed to Checkout’ 8. The transaction should be complete and you can access the education by clicking on ‘My Training’ at the top of the page

3. Under ‘New Users’ click ‘Start Shopping’ 4. On the left hand side of the page click on ‘All Courses’ 5. Scroll down the page until you find all four Building Dementia Practice in Primary Care modules 6. Click ‘Buy’ on all four modules 7. Once all four modules are in your Shopping Cart (at the top of your page) click on ‘Proceed to Checkout’ 8. You will then be asked to register your account, please complete the fields required and then click on ‘Next Step’ 9. The transaction should be complete after this step and you can access the education by clicking on ‘My Training’ at the top of the page

NEWS

VET AGED CARE TRAINING HAPHAZARD Evidence at a Senate Inquiry into aged care bolsters the ANMF’s campaign for better education and minimum standards for all workers in the sector.

About 10% of the entire vocational education and training (VET) sector in aged care has been deregistered since 2011.

Chief Commissioner and Chief Executive Officer of the Australian Skills Quality Authority (ASQA) Christopher Robinson told the Senate Inquiry hearing in Melbourne there was a big variety in the quality of training. ASQA is the national VET regulator of aged care courses. “I do not think there is a regulator you would find anywhere that would have deregistered 10% of the providers in the

TAX TIPS FOR NURSES AND MIDWIVES Tax time has arrived and it is essential nurses and midwives are well informed on their entitlements when claiming tax deductions on work-related expenses.

Like any profession, nursing and midwifery is unique. Carrying out the job often involves performing diverse tasks, travel and being on-call, and ongoing education.

If you are employed as a nurse you could be entitled to claim a tax deduction for work-related expenses including uniforms, self-education, and phone usage.

Australian Tax Office Commissioner Graham Whyte encouraged the workforce to claim everything they’re entitled to. “Generally speaking, if you claim a deduction you need to remember three golden rules. One, make sure you spent the money yourself and were not reimbursed. Two, make sure it’s related to your job and three, you need a record to prove it.”

When it comes to car expenses and travel, nurses should claim a deduction for the cost of using their car for work-

anmf.org.au

sector in four and a half years.”

Over 80% of training providers were not fully compliant with required standards when initially audited. That reduced to under a quarter being fully compliant after given 20 days to rectify problems.

Mr Robinson said there was a priority on aged-care training. “When we audit a training provider we do not necessarily audit all of their courses, but when we audit a provider that has aged care on its books, we always look at the aged-care program in particular because we have found that there have been quite a lot of issues with it.”

There are currently about 650 providers of aged-care training Australia-wide, up from 500 in 2013. La Trobe University Healthy Ageing Research Group Professor Yvonne Wells told the hearing the standards of training courses were “very inconsistent and often not very good. People in the aged care sector complain constantly about the lack of skills and the lack of knowledge of people coming into the sector.”

Of concern was the 25% of providers offering

related travel if travelling between two separate workplaces, such as hospitals, or if travelling from one’s normal workplace to an alternative workplace and back, such as attending a different hospital for a meeting.

Make sure to include expenses for using taxis, short-term car hire, parking fees and tolls, and for travel to undertake self-education, but only if your employer has not already reimbursed you for the expenses.

courses too short, the Senate Inquiry heard.

There are no mandatory requirements for how long a course should be.

“We discovered that 33% of the offerings in this sector were under 15 weeks…”

“We are concerned that some of the courses being offered are too short for people to get properly skilled,” Mr Robinson said.

ANMF Federal Secretary Lee Thomas said minimum education standards were required for all workers in aged care.

“Currently care workers do not have effective regulatory requirements. They are not required to work with any professional standards. To ensure people receive quality care, minimum standards must be in place.”

“Good quality care requires a stable workforce, adequate staffing and an appropriate staff mix, as well as working conditions that would allow workers to develop and maintain key relationships with the elderly and importantly to be able to use their skills,” RMIT University Professor Sara Charlesworth told the Senate Inquiry.

seminars, conferences, and education workshops or training courses related to nursing, midwifery or health.

The study must maintain or improve specific skills or knowledge currently used in the person’s job.

The Australian Tax Office provides several examples that qualify, including Carmel, an RN working in a rural hospital and currently studying to specialise in paediatrics.

For clothing, nurses can claim a deduction for the cost of buying, hiring, repairing and cleaning certain work-related uniforms, occupation specific clothing, and protective clothing.

Carmel is eligible to claim her selfeducation expenses for the course because her studies will maintain and improve her existing skills and knowledge that she needs to perform her current duties, which include caring for children.

A compulsory uniform required by the workplace can allow deductions for shoes, socks, and stockings, if they are an essential part of the uniform.

Further claims for self-education can include costs for textbooks, stationery, and student union fees, as well as home office and travel expenses.

You can also claim a deduction for the cost of laundering and dry-cleaning work clothes, with a claim for laundry expenses of $150 or less not requiring written evidence.

Other common expenses claimed by nurses and midwives include the cost of renewing annual registration, depreciation in equipment used for work including computers, first aid training courses if the designated first aid officer, overtime meal expenses, the purchase of technical publications such as journals related to nursing, work-related telephone calls, and repairing tools and equipment for work.

Noteworthy for nursing and midwifery, self-education expenses related to a course provided by an educational institution that is undertaken to gain qualifications for use in carrying on the profession, can be claimed.

Tax deductions can include attending

Nurses and midwives can also claim a deduction for union and professional association fees.

July 2016 Volume 24, No. 1 9

NEWS

ONE IN FOUR KIDS HAS UNTREATED TOOTH DECAY

NURSE ‘CORA’ APP TO SAVE LIVES

One quarter of Australian children aged 10 and under has untreated tooth decay, latest data shows.

A mobile app game which features a nurse on the warning signs of heart disease is being tested in clinical trials in South Australia.

On average, Australian kids aged five to 10 years have 1.5 baby teeth with decay.

While the National Oral Health Plan’s target was for all children to visit a dentist one in nine children had never made a dental visit.

The preliminary findings were presented at a two-day workshop held in Adelaide recently. The National Child Oral Health Survey 2012-2014 involved data from 24,000 children aged 5-14 years in each state and territory.

“We found that tooth decay affected a significant proportion of children: over 40% of children aged 5-10 years had decay in their baby teeth,” University of Adelaide Professor Loc Do and workshop presenter said. “One quarter of children in that same age group had never received treatment for their tooth decay.”

More than one third of children aged six to14 years had decay in their permanent teeth. One in seven children of those had not been treated for decay of permanent teeth.

The study, funded by the National Health and Medical Research Council, was one of the largest worldwide.

The prevalence of tooth decay is similar to

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The avatar-based app developed for the Flinders University School of Nursing and Midwifery and being trialled at Flinders Medical Centre is aimed for rollout in 2017.

WE FOUND THAT TOOTH DECAY AFFECTED A SIGNIFICANT PROPORTION OF CHILDREN: OVER 40% OF CHILDREN AGED 5-10 YEARS HAD DECAY IN THEIR BABY TEETH.

other comparable countries such as the United States and New Zealand. However the amount of untreated decay is higher in Australia, Professor Do said.

Children from Queensland and from the Northern Territory had the highest prevalence and severity of tooth decay. “Children of low socioeconomic background and Indigenous children had significantly higher rates of dental decay, unfavourable general health behaviours and unfavourable dental visiting patterns,” Professor Do said.

Interactive computerised nurse ‘Cora’ assesses patients’ knowledge and responses to acute heart disease symptoms through a series of easy-to-follow instructions.

In a six-month trial in 2015, knowledge increased by more than 15% and symptom recognition by more than 24% of app users.

The majority (87%) of participants also reported a high level of satisfaction of the app developed by animation studio Monkeystack.

Flinders University Professor of Nursing Robyn Clark said the app could provide more flexible and effective ways to educate patients, including the reported 47% of Australians who had “functional illiteracy”. “Retention of information is far greater with an interactive app than with a printed brochure.”

Patients who have had a heart attack will be loaned a tablet device with the app before discharge and for several months to review and refresh their knowledge on cardiac symptoms. “By using the app we hope to improve knowledge, responses and ultimately save lives,” Professor Clark said.

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NEWS SLAVA GRIGORYAN

Grigoryan, will play for patients, residents and visitors in health facilities in a new Resonance initiative of the festival.

There was a growing understanding of music’s role in health, wellbeing and recovery, Mr Grigoryan said. “The real message behind Resonance, beyond wanting to share music and provide a health service is we want to reach out and share the festival experience with listeners who can’t make it to the venues.”

BEING ABLE TO HAVE THE EXPERIENCE BROUGHT TO PEOPLE WHO ARE UNABLE TO GO TO THE FESTIVAL IS REALLY A BEAUTIFUL THING

A panel of experts will discuss the links between music and health and wellbeing in a free event on 12 August.

MUSIC TO THE WARDS FOR GUITAR FESTIVAL

“Being able to have the experience brought to people who are unable to go to the festival is really a beautiful thing,” said Dr Catherine Crock of the Royal Children’s Hospital in Melbourne and one of the panellists.

Musicians will tour hospital wards and nursing homes as part of the Adelaide Guitar Festival next month.

Dr Crock is Founder and Chair of Hush Music Foundation which uses a compilation of soothing music in 12 children’s hospitals around Australia. “Music has such an ability to affect your emotions. If you have the right sort of music, it can really help with the healing process.”

More than 300 artists will perform at the largest festival of its kind in the Southern Hemisphere held from 11-14 August.

Musicians, including Festival Director Slava

STILLBIRTH AND NEWBORN DEATHS AVOIDABLE Eleven potentially avoidable deaths have been identified in a review of a Victorian maternity service for failures in clinical care.

The review of stillbirths and neonatal deaths at Djerriwarrh Health Services in Bacchus Marsh goes back to 2001.

A total of 38 stillbirth or newborn deaths from 2001 until now were identified - 11 potentially avoidable.

“This is 11 lives lost that could potentially have been avoidable,” Victorian Health Minister Jill Hennessy said. The ANMF Victorian Branch alerted the DHHS and management in early 2014 about highly questionable practices at the maternity service. A first investigation took place in 2013 and 2014. “The most concerning risk was the apparent practice of accepting higher risk deliveries at 34 weeks, which were over the capability of the unit,” the review found. The entire board of Djerriwarrh Health Services was replaced and new governance introduced, the health minister said.

The state government announced funding in the 2016/17 budget for better quality and safety in rural and regional health services.

For more information visit www.adelaideguitarfestival.com.au/

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References: 1. Autret-Leca E et al. Curr Med Res Opin 2007;23:2205–11. 2. Walson PD et al. Am J Dis Child 1992;146:626–32. 3. Schachtel BP and Thoden MA Clin Pharmacol Ther 1993;53:593–601. 4. Celebi S et al. Indian J Pediatr 2009;76:287–91.

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20/05/2016 11:58 am

NEWS

IMMUNISATION KEY TO IMPROVING GLOBAL PUBLIC HEALTH The global upsurge in immunisation over the past couple of decades deserves praise but Australia must continue to spearhead work in the rapidly changing field if positive health outcomes are to be maintained and improved upon.

The message emerged as one of the key points at last month’s 15th National Immunisation Conference in Brisbane.

Public Health Association of Australia (PHAA) CEO and President of the World Federation of Public Health Associations (WFPA), Michael Moore described the conference as an invaluable opportunity for local clinicians to consider diverse perspectives from international speakers on introducing vaccines and encouraging greater take-up. “Immunisation is constantly changing and Australia needs to be a front runner.”

Mr Moore added that the global charter

advocates protection, prevention, and promotion. “Immunisation is integral to achieve the protection and prevention aspects and improve public health on a global level.”

Currently, immunisation prevents an estimated 2 to 3 million deaths per year, with global vaccination coverage plateauing over the past few years. A Global Vaccine Action Plan, developed by the World Health Organization (WHO), aims to foster equitable access to vaccines, with polio eradication marked as the first milestone of the plan.

Locally, Mr Moore said Australia had former Health Minister Dr Michael Wooldridge to thank for the advancement of immunisation, referring back to 1997 and his influence in driving the ‘7 Point Plan’, a comprehensive package of immunisation measures coupled with the establishment of the Australian Childhood Immunisation Register (ACIR). “Since the introduction of the ACIR, immunisation rates have climbed from 75% in 1997 (12 months of age) to 91.4% in 2010.”

The conference included a presentation

by Professor Kim Mulholland, paediatrician and research fellow at the Murdoch Children’s Research Institute, who addressed the introduction of new

PUBLIC HEALTH ASSOCIATION OF AUSTRALIA (PHAA) CEO AND WORLD FEDERATION OF PUBLIC HEALTH ASSOCIATIONS (WFPHA) PRESIDENT MICHAEL MOORE FROM THE 15TH NATIONAL IMMUNISATION CONFERENCE HELD IN BRISBANE 7 - 9 JUNE 2016.

vaccines in developing countries, speaking specifically about the Dengue vaccine and immunisation in the Western Pacific Region.

Mr Moore said it was encouraging to see the impact of immunisation both locally and abroad. “It’s wonderful to see the great work being done by talented and dedicated Australians to help save lives and prevent disease. We are moving forward and will continue to move forward to ensure those who are able to receive vaccinations do so.”

www.facebook.com/ NurseUncutAustralia @nurseuncut

OUR NURSE UNCUT BLOG HAS A DYNAMIC NEW LOOK! Nurse Uncut is a community blog for Australian nurses and midwives to share experiences, advice and opinions on subjects close to our hearts.

The blog is a place where we can vent about the frustrations and challenges – and the rewards – of the job.

After six years, the blog has an energetic new design. But Nurse Uncut will keep delving into the areas our readers want to go – from ‘Shift work is not a lifestyle choice’ to ‘Why I love being in the casual pool’. All posts are written by everyday nurses and midwives and the blog invites your contribution.

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17/06/2016 3:26 PM

NEWS

DIGITAL HEALTH RECORD OBLIGATION IMPACTING GENERAL PRACTICE

AMA president, Dr Michael Gannon, labelled the rule “grossly unfair” and premature in light of the My Health Record system being relatively young and still a work in progress with substantial flaws. “The AMA has strongly backed the introduction of a national E-Health record because of the real benefits it could provide for patient care.

But the My Health Record is plagued with shortcomings that need to be fixed before the government tries to foist it on patients and practices.”

The Australian Medical Association (AMA) is calling for a suspension of rules currently penalising general practices thousands of dollars each year for failing to upload patient health summaries to the government’s My Health Record system.

THE MY HEALTH RECORD IS PLAGUED WITH SHORTCOMINGS THAT NEED TO BE FIXED BEFORE THE GOVERNMENT TRIES TO FOIST IT ON PATIENTS AND PRACTICES

The country’s peak medical body claims less than a quarter of practices have signalled they will be able to comply with the new rules, introduced earlier this year as part of the Practice Incentive Program (PIP), which require practices to upload the digital health data for at least half of their patient cohort each quarter to qualify for the new digital health incentives.

Of practices who indicated they would be unable to meet the new eligibility requirement, about a third estimated it would cost them up to $15,000 a year in lost incentives, 29% reported it would leave them $30,000 a year worse off, and 12% forecast a loss of $60,000.

A recent AMA survey of medical practices revealed just 24% considered themselves able to comply with the requirement, while 39.5% said they were unable to, and 36% remained unsure.

Those that could not comply estimated it would cost them, on average, upwards of $20,000 per year in lost PIP incentive payments.

HOME VISITS BY CARDIAC NURSES SAVES LIVES Hundreds of lives could be saved if specialist cardiac nurses were used to visit patients at home as part of a follow-up program.

Post-discharge patients who received specialist and qualified cardiac nurse-led home-based interventions lived longer than those who received standard care, research has found.

The Mary MacKillop Institute for Health and Research at Australian Catholic University study involved 1,226 patients

anmf.org.au

Dr Gannon warned the shortfall would deal a significant blow to general practices already reeling from the Medicare rebate freeze. “The extension of the rebate freeze has already pushed many practices to the financial brink and the last thing they need is to have thousands more ripped away from them because of a flawed process to introduce a national E-health record system.”

from five Australian states.

Results showed 15% of patients who had specialist cardiac nurse follow up died compared with 20% of patients who received standard care. “Homebased intervention was associated with significantly prolonged survival,” lead researcher Professor Simon Stewart said.

Home based or transitional care approaches were likely to become more relevant with an increasing ageing cardiac patient population, Professor Stewart said. “There is an increasing pressure to develop cost-effective strategies to mitigate persistently high levels of re-hospitalisation and premature mortality associated with chronic heart disease.”

The findings were published in journal Circulation.

Shorts

BAN ON ABORTION LAW VIOLATES HUMAN RIGHTS Ireland’s law prohibiting and criminalising abortion has been determined as a violation on the human rights of pregnant women who have a diagnosis of fatal foetal impairment by the UN Human Rights Committee.

The groundbreaking ruling was made on a case where Ireland’s law prohibited an Irish female citizen to have an abortion despite her receiving a diagnosis of fatal foetal anomaly in 2011. The UN Committee found Ireland’s abortion laws subjected her to cruel, inhuman and degrading treatment, and discrimination. It also called on Ireland to amend its laws on voluntary termination of pregnancy. “The ruling by the UN Human Rights Committee is ground breaking for Ireland, and has far reaching global consequences. The Prohibition, and by extension criminalisation, of abortion in and of itself has been found to violate human rights. Ireland must take heed,” Europe and Central Asia Director of Amenity International, John Dalhuisen said.

LIVED EXPERIENCE MENTAL HEALTH RESOURCE A new mental health online resource was launched in Melbourne last month.

The HealthTalk Australia online resource is aimed to shine the spotlight on the human rights of people experiencing severe mental health problems. It showcases the stories of 60 people with severe mental health problems and their carers from urban and regional Victoria. It took Indigo 10 years after her diagnosis with a mental illness to get on the healing journey after treatment and advice from multiple healthcare workers and providers. “This is a space where people who have made their own decisions on their care can go. If you work in mental health, this is a space to reflect on your practice. “This resource promotes empowerment, choice and recovery.” Lisa, whose brother was diagnosed with schizophrenia, has been his primary carer since she was 10 years old.

“I wish I had this resource available to me.

No one expressed what that label meant.

What the impact would mean – finding a voice for us on our own. It’s giving people a voice – their own voice.”

Visit www.healthtalkaustralia.org

July 2016 Volume 24, No. 1 13

OPTIMISE CARE TO THE ELDERLY WITH THE 2016 AMH AGED CARE COMPANION 2016 Aged Care Companion Book Release.

The AMH Aged Care Companion is a trusted, practical reference for doctors, nurses and pharmacists who work with older people. It contains the latest evidence-based information and is useful when conducting medication reviews and other activities (eg case conferencing) aimed at improving patient outcomes.The AMH Aged Care Companion contains information on the management of more than 70 conditions common in older people, including dementia and its behavioural symptoms, delirium, cardiovascular diseases, fall prevention, osteoporosis, COPD, insomnia, depression and wound management. It also contains general principles on the use of medicines in older people.

The May 2016 release of the AMH Aged Care Companion Book contains new content including a topic on actinic keratosis, information on the process of deprescribing, which is important for optimising the use of medicines in older people, along with a simple diagrammatic guide to inhaler devices with links to instructions for use and considerations for choosing a suitable device in older patients. Other topics reviewed include asthma, COPD, gout, hypertension, dyslipidaemia and dyspepsia.

Online version also available.

For more information go to www.amh.net.au

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NEWS

WHY DEMENTIA TREATMENT IS FAILING PATIENTS The complexity of dementia is poorly understood by the healthcare system and is leading to one-dimensional treatment measures that at their most harmful can prove fatal, a leading dementia researcher has warned.

Addressing the HammondCare International Dementia Conference in Sydney last month, Sube Banerjee (pictured), a Professor of Dementia and Associate Dean at Brighton and Sussex Medical School in the UK, argued that current dementia treatment fails to account for the disorder’s high level of multimorbidity and unique challenges.

team of researchers, found little to no effect for people suffering dementia. “This suggests that drugs that do work in the simple situation of having depression with no dementia don’t work when you have the co-morbidity of dementia.”

shown to be ineffective in patients with dementia due to as yet largely unknown reasons. “The rules that work in complex situations may not be the rules that work in simple situations. Complexity, multimorbidity, is the rule not the exception, for people with dementia, yet much of the evidence we have is based upon people that only have one thing wrong with them.”

Professor Banerjee, who led the development of the UK’s national dementia strategy, said just 17% of people solely suffer from the disorder.

Outlining his own research conducted in the UK, which focused on examining depression in dementia, and the use of anti-psychotic drugs in people with dementia, Professor Banerjee illustrated how well-meaning attempts by health professionals to treat patients often miss the mark.

He explained how treatments that often work in simple situations, such as antidepressants to treat depression, had been

In depression, through trials comparing placebos with two anti-depressant medications, Professor Banerjee and his

ENROLLED NURSES MUST TAKE OWNERSHIP IN FIGHT FOR RELEVANCE

to educate people. You need to get up there and influence workplace policies and healthcare policies.”

Enrolled Nurses need to band together and find a stronger voice in order to safeguard the future of their profession, according to Australian Nursing and Midwifery Federation (ANMF) Assistant Federal Secretary Annie Butler.

She acknowledged that some people within the nursing profession view the second-tier role as a stop gap or cheaper option but added that changing perceptions needed to come from within and through collective action. “You need to get together to stand up for you. Because what’s your relevance?

Whatever you make it.”

Speaking at an Enrolled Nurses’ Forum held last month at the New South Wales Nurses and Midwives’ Association (NSWNMA ANMF NSW Branch), Ms Butler encouraged attendees to seize the reins in shaping their own future. “To go forward you need to articulate your unique contribution. You need to explain it to people. You need to get more active on a range of different committees. You need

anmf.org.au

Exploring further into anti-psychotics, often used to treat dementia patients presenting with symptoms of aggression and mental health issues, Professor Banerjee uncovered similar results, but more alarmingly, that mistreatment triggered 1,800 preventable deaths in the UK. “What this shows is that there is a harm that is attributable to dementia that is not there when you don’t have dementia. These deaths are attributable to the drugs being used in dementia.”

Professor Banerjee reiterated that the multimorbidity associated with dementia changes the ballpark and that practices must change. He said unearthing why dementia is different requires further exploration and research. “The brain is different in dementia because behaviour is different in dementia. It’s perhaps a silly thing for us to have assumed that things would be the same in this complex situation.

“Essentially what we’re doing with our patients with dementia is we’re playing complex medicine with the rules of simple medicine. It’s the people with dementia that lose because of that.”

Ms Butler said around 60,000 Enrolled Nurses make up the workforce across the country yet the National Enrolled Nurse Association of Australia (NENA), the longrunning special interest group established for Enrolled Nurses, disappointingly has less than 100 members.

Passionate union members raised several core issues related to the profession after being prompted by Ms Butler to reveal their first-hand experiences of the job.

Key issues of concern surrounded affordable access to enrolled nursing courses, the potential exploitation of enrolled nurses regarding scope of practice, the non-existence of Enrolled Nurses in education roles teaching the

ANMF ASSISTANT FEDERAL SECRETARY ANNIE BUTLER, CENTRE, WITH ENROLLED NURSES GEORGE AND TABETHA AT THE FORUM.

future workforce, lower rates of pay compared to counterparts across nursing, and an overarching lack of recognition.

Ms Butler, who labelled Enrolled Nurses a critical component of the healthcare profession and arguably the backbone of the system, said building a national voice was now paramount to generating significant change.

“There’s not enough of you. The voice needs to be louder. I really encourage you to think about it and get together more and put stuff forward to get it out there on behalf of enrolled nursing.”

July 2016 Volume 24, No. 1 15

WORLD

AGED CARE FOR THAI STUDENTS

VISION FOR VILLAGERS

Thai nursing students experienced working in aged care for the first time in Western Australia recently.

Nursing students delivered reading and sunglasses to local villagers during a visit to Thailand last month.

Two nursing lecturers and seven students were based at the Mandurah campus of Murdoch University, south of Perth. Two weeks were spent on clinical placement at aged care facility Mercy Place in Mandurah.

Nine students from Charles Sturt University (CSU) travelled to villages in the Wat Jan region in northern Thailand.

The students delivered primary healthcare, health promotion and education activities, and a visit to the McCormack Nursing Faculty at Chiang Mai University.

Murdoch University Nursing Lecturer Caroline Browne said the aged care placement was suggested by the Thai contingent. “They were very interested in how we manage aged care in Australia. Aged care is not something traditionally they have done or not in the same way – the majority of the elderly are looked after at home.”

The population demographics were changing in Thailand, Ms Browne said. “There are a lot more elderly and people are having smaller families. They are starting to have to look at other ways of doing aged care.”

Feedback from the third year students from Payap University was positive, Ms Browne said. “I was a bit worried as we don’t have the same family links as in Thailand but the students really enjoyed the homely environment rather than the clinical setting.

They were intrigued by the resident cat.”

CSU collected more than 100 donated reading and sunglasses. OPSM provided cases, cleaning cloths and education material for the students to take with them.

PAYAP UNIVERSITY ACADEMICS AND STUDENTS VISITING MURDOCH UNIVERSITY MANDURAH CAMPUS, WITH CAROLINE BROWNE AND PETER WALL

International visits offered students an opportunity to see the strengths of different healthcare systems and exchange ideas, Ms Browne said.

Students spent one week at the university in classes, the simulation labs and doing group work, Ms Browne said.

“Students learn about themselves personally even more so than they do professionally.

They are thrown in at the deep end in difficult situations where they need to think outside the box.

A delegation of students from Murdoch University in return visited Thailand last month. The students travelled to rural and remote health clinics in villages to assist primary care nurses.

“They learn how to do a lot with little and of the commonalities in nursing across cultures.

The communication aspect is so important – how to convey meaning with body language and other interactions.”

NURSES SPEAK UP ON WORLD HEALTH STAGE The International Council of Nurses (ICN) spoke to several key items highlighting primary healthcare at the World Health Assembly in Geneva recently.

The ICN urged governments to invest in nursing and midwifery in order to achieve universal health coverage and the Sustainable Development Goals (SDGs).

The World Health Organization and governments need to actively involve nurses in development and implementation of any policies and

16 July 2016 Volume 24, No. 1

strategies for universal healthcare, said the ICN. A primary focus should be on health promotion and prevention of illness. “ICN strongly supports the strategy to reorient health systems towards primary healthcare and peoplecentred health services,” its communique read. “ICN believes that a strong primary healthcare system is key to improving the health and wellbeing of older people.”

CSU School of Nursing, Midwifery and Indigenous Health Lecturer Cathy Maginnis said glasses made a big difference for people living in the poorest area of northern Thailand. “All villagers work in the fields in the harsh glare of the sunlight for long hours every day.

“Many of the women sew intricate detail on clothing and items to sell and often this is done in the poor evening light.”

Students learnt to communicate in different ways and built on their critical thinking and reflective skills while they delivered culturally appropriate care, Ms Maginnis said. “It’s a chance to see the ground-level realities of living in a remote rural village and learn about the health issues and the ways these challenges are met by the local health professionals and community members.

“It also contributes to better health outcomes for the people living in these villages.”

CSU NURSING LECTURER CATHY MAGINNIS AND DUBBO OPSM STORE MANAGER LENORE POLLARD

ICN called on governments to remove regulatory barriers to enable nurses to carry out their role in preventing, identifying and treating age-related illnesses – facilitating the shift to primary healthcare. Other key items addressed included nurses as first point of care in addressing violence, global action on antimicrobial resistance, promoting the health of migrants, and an operational plan to improve women, children and adolescent health.

anmf.org.au

WORLD PROFILE WOMEN’S HEALTH ADVISOR AND MIDWIFE KARA BLACKBURN WITH COLLEAGUES AKILA (AFGHAN NATIONAL STAFF) AND ETSUKO (FROM JAPAN) ON AN ASSESSMENT VISIT TO MSF’S EMERGENCY OBSTETRIC AND NEWBORN CARE PROJECT IN KABUL. PHOTO: RUTH MOLLOY

“WE’RE CERTAINLY SEEING A LOT OF DELIVERIES AND A LOT OF ADMISSIONS INTO OUR HOSPITAL. WE’VE GOT EXTREMELY LOW MATERNAL AND NEONATAL MORTALITY IN OUR HOSPITAL.”

Ms Blackburn believes MSF’s operation is having a significant impact. “We’re certainly seeing a lot of deliveries and a lot of admissions into our hospital. We’ve got extremely low maternal and neonatal mortality in our hospital.

PROTECTING MOTHERS AND BABIES ABROAD

By Robert Fedele A 28-year-old mother who had just given birth to her fourth child when she suffered a postpartum haemorrhage confirms the profound impact of a bustling maternity service established in one of the poorest neighbourhoods in Afghanistan’s capital Kabul.

limited access to healthcare.

The maternity service includes labour and delivery rooms, an operating theatre, a post-natal area, high dependency unit, and a neonatal unit for sick and at risk babies.

Ms Blackburn, both a nurse and midwife, has been involved with MSF since 2006, and has undertaken several field missions in disadvantaged countries, including the north of Sri Lanka during the civil war in 2007, and working as a nurse manager establishing a sexual violence clinic in Papua New Guinea in 2009.

Midwifery has been a constant throughout her travels.

The woman, named Zainab, delivered her fourth son without complication, but was monitored due to a history of heart disease.

A few hours later she began haemorrhaging.

“I think I began my nursing career with the idea of working with mothers and babies.

I was just really drawn to the idea of being with women during this time in their lives.”

“She probably lost a litre of blood,” said Kara Blackburn, Women’s Health Advisor with Medecins Sans Frontieres (MSF). “She was there being monitored carefully. When she started to bleed the midwife came and assessed her immediately. That’s what we’re there for. The majority of women will deliver without complication but it’s the women who unexpectedly experience a complication that when you have the appropriate facility, people, drugs, and equipment, you can actually prevent the maternal death that may occur.”

Ms Blackburn has held the position of Women’s Health Advisor with MSF since 2011 and visited the maternity service in Kabul in March to evaluate the fledgling project.

Since starting at the end of November, 2014, deliveries have grown rapidly from the 11,000 recorded in the initial year. “We’re delivering between 40 and 60 babies a day at the moment.”

MSF has been working in Afghanistan for many years and decided to set up a maternity operation in the town of Dasht-e-Barchi in 2014 within the local district public hospital.

Ms Blackburn said the hospital offers free care to a population often forgotten. “It’s predominantly looking after a Hazara population, which is a minority population in Afghanistan and that population has really been displaced during the many years of conflict.

Afghanistan holds the highest mortality rate in the South Asia region and the project was triggered by objectives to provide emergency obstetric care and reduce the risk of maternal mortality in a population with

“Basically, the health infrastructure has been placed under severe strain because of the increase in population and the Ministry of Public Health is really struggling to provide care to the population.”

anmf.org.au

“It’s hard to make generalisations about whether we’re having an impact at population level but certainly our case fatality rates within the hospital have been very good.”

Ms Blackburn credits the success of the hospital to good word of mouth and people realising they can access quality healthcare for free. Still, the increase in numbers presents new challenges, and the service is already investigating ways in which to streamline the flow of patients that require care as well as improve the management of certain conditions to boost efficiency. “We’re going to have to be careful to maintain that standard just because of the volume of activity that’s coming through the hospital on a daily basis. We have to figure out at what point we actually look at stopping admissions. At the moment we’re not, we’re just managing everyone that comes in the door. The questions will have to be asked at some stage, is there other facilities that we can support a bit more so that they can take some of the activity from us so that our level of care doesn’t start to suffer.”

For the time being though, the service is flourishing, and undoubtedly improving health outcomes.

MSF is looking for neonatal and paediatric nurses to help deliver medical assistance to people who need it most across the globe. You must be able to commit to a minimum of six to nine months in the field and be a resident of Australia or New Zealand.

Find out more: www.msf.org.au/ join-our-team/work-overseas/who-weneed/neonatal-nurses

July 2016 Volume 24, No. 1 17

FEATURE

GROUND

ZERO STANDING UP AGAINST VIOLENCE IN OUR HEALTHCARE SECTOR

Occupational violence and aggression is rife within the healthcare sector.

The impact of verbal and physical assault can leave psychological scars that lead many to question their place in the workforce. Growing public awareness, harsher penalties for perpetrators, and improved safety strategies mark a shift towards a culture of zero tolerance and collective attitude that enough is enough. Robert Fedele investigates.

Registered Nurse Lita Olsson was 30 weeks pregnant when an intoxicated and disoriented middle-aged man struck her to the chest as she was carrying out routine nursing care.

The incident, which occurred in the emergency department (ED) at Royal Brisbane and Women’s Hospital, left Lita scarred. “At the time there was a lot of talk about whether or not to press charges and it was quite a contentious issue. This was about five years ago. We didn’t quite have the relationship that we do now with security and police.”

Lita has been a nurse for 11 years and worked in the ED since 2007.

She says workplace violence and aggression in hospitals is widespread.

Incidents like nurses being spat at or bitten, having urine thrown at them, or more worrying scenes involving nurses being cornered or pulled into rooms, is nothing out of the ordinary, she says. “I don’t know of a person who hasn’t been threatened or verbally assaulted or had some sort of near miss with a physical assault. At the moment we’re trying to change that culture around the fact that it’s not acceptable.”

The Royal Brisbane and Women’s Hospital has made significant inroads over the past few years

by empowering nurses to report assaults to police and Lita believes the changing culture has helped build the capacity to capture more accurate data.

Progression towards a zero tolerance approach was initially sparked by several incidents within the department where staff were subjected to ongoing threats over consecutive days and were later unable to complete their shifts due to feeling scared and victimised.

“From that, we really took a stand as a department and banded together to try and change the culture that if it’s not a lifethreatening issue then it’s not acceptable and they won’t be treated,” Lita said.

The Queensland government has jumped on board the push and earlier this year launched a $1.35 million public awareness campaign to stop violence against hospital staff and paramedics.

Figures show that last year, more than 3,300 healthcare workers were physically assaulted across the Queensland workforce.

More than 300 incidents have already been recorded in Royal Brisbane and Women’s Hospital’s ED this year, a statistic Lita labels “just the tip of the iceberg”.

PHOTO: BELINDA HUGHES, ROYAL BRISBANE AND WOMEN’S HOSPITAL.

FEATURE The public campaign features confronting advertisements of healthcare workers being verbally and physically assaulted while on the job.

department and began throwing a water bottle around which nearly hit one nurse and then continued to go around the department and smash a computer and throw other things around.”

“To be fair, it might be a bit sanitised,” Lita suggests. “As scary as it sounds, it’s not far from the mark. I’ve seen those sorts of incidents happen. It’s scary.”

Deanna recalls another incident where a patient affected by Ice became violent and aggressive and smashed up an X-Ray machine before the police were called.

A recent strategy implemented by Royal Brisbane and Women’s Hospital in a bid to capture data that exposes the problematic issue has been a swipe card reader mounted to a wall in the middle of the ED. When an assault occurs the card is swiped in real time and the information is later used to pinpoint peak periods and help shape future strategies.

Lita welcomed the government’s public awareness campaign and says education plays a crucial part in unlocking the puzzle.

“It’s certainly a step in the right direction but I think we’ve got a long way to go. When you talk to the general population they’re actually really unfamiliar with how often it does happen.”

Lita is the Acting Clinical Nurse Consultant within Royal Brisbane and Women’s Hospital ED. She is also the department’s central liaison and sits on Royal Brisbane and Women’s Hospital Aggression Taskforce, a committee formed to address issues, mitigate risks, and altogether keep nurses, doctors, and patients safe within the hospital.

The 32-year-old mother of two was compelled to become an advocate on the issue after returning from maternity leave and uncovering the escalation in alcohol and drug-fuelled violence pervading the ED. She believes change can occur if collective standards are embedded in culture. “The only way we’re going to say we have a zero tolerance approach is if we actually have zero tolerance. It’s following through with the actions about not accepting that behaviour.”

Spotlight on assaults

In Tasmania, Registered Nurse Deanna Butler holds the role of Clinical Coordinator and Navigator within the Royal Hobart Hospital’s ED. In the same vein as Lita, Deanna says life in emergency can be dangerous. “You’re vulnerable. You’re at risk of being hurt. And nobody likes to be abused. As much as words don’t hurt, standing in a full room, there can sometimes be 40 people in the department and it’s like a scene at the pub sometimes. It’s demanding.”

Deanna agrees all hospitals should be enforcing zero tolerance to counter workplace violence and aggression. “I remember when I first started in emergency it was quite frightening when you’re coming through the ropes, there was one lady who was a mental health presentation and she just became very aggressive in the 20 July 2016 Volume 24, No. 1

While the Ice epidemic poses a major issue across Australia, Deanna argues alcohol is the biggest cause of workplace violence in hospitals.

Lita Olsson “I DON’T KNOW OF A PERSON WHO HASN’T BEEN THREATENED OR VERBALLY ASSAULTED OR HAD SOME SORT OF NEAR MISS WITH A PHYSICAL ASSAULT.”

Recent findings from a large-scale study investigating eight emergency departments across Australian, and New Zealand in 2014 conducted by the Australasian College for Emergency Medicine (ACEM) revealed that at peak times, one in eight presentations was caused by alcohol.

The study found verbal aggression from a patient had been experienced in the past year by 97.9% of survey respondents, and physical aggression by 92.2%.

A significant 87% said they felt unsafe in the presence of alcohol-affected patients and 42% had often or frequently experienced physical aggression from alcohol-affected patients.

Women were more likely to experience frequent verbal and physical aggression from alcohol-related patients at 69.1%.

Deanna Butler “WE DO GET A LITTLE BIT MORE UPSET WHEN IT’S THE DRUGS AND ALCOHOL. IT’S WHEN PEOPLE ARE AWARE OF WHAT’S WHAT AND WHAT’S WRONG AND THEY ARE STILL AGGRESSIVE TOWARDS YOU. IT’S THAT SITUATION THAT WE GET SCARED ABOUT BECAUSE WE ARE MORE VULNERABLE AND THEY’RE PEOPLE IN SOCIETY WHO DON’T CARE ABOUT THEIR LIVES SO THEY’RE NOT GOING TO CARE ABOUT WHAT THEY’RE DOING TO US.”

The hidden toll of violence and aggression caused by alcohol-fuelled patients contributes to a negative impact on staff workload, wellbeing, and job satisfaction, the study found.

Deanna concurs, suggesting aggressive incidents within the ED occur daily. But she says incidents emerge from all corners, including delirious patients hitting out, or concerned relatives lashing out at staff while waiting on news about their loved ones.

“They might not believe that they should be waiting or they could become upset with things. A lot of the time that’s anxiety and where our communication probably needs to be a bit better.”

At Royal Hobart the ED is always staffed with security and Code Back teams are on hand to respond to escalating incidents involving threats to staff with weapons.

“If it’s people who’ve been medically unwell I guess we tolerate it a bit more. We’re not there to get abused but we are there to help them get better to manage that,” Deanna explains. “We do get a little bit more upset when it’s the drugs and alcohol. It’s when people are aware of what’s what and what’s wrong and they are still aggressive towards you. It’s that situation that we get scared about because we are more vulnerable and they’re people in society who don’t care about their lives so they’re not going to care anmf.org.au

FEATURE

THE STATS.

3,300 3,300 Queensland healthcare workers were physically assaulted in 2014/15 (SOURCE – QUEENSLAND HEALTH)

12-POINT ACTION PLAN TO IMPROVE SECURITY AT ALL NSW HOSPITALS 1.

Deliver intense training to ED staff including nurses and security on how to manage aggressive behaviour.

2.

Run a program to help boost workplace health and safety culture across NSW health.

1 in 7 patients attending Australian emergency departments (EDs) on Australia Day were there as a result of alcohol harm

92.2% 92.2% of emergency nurses and doctors experienced alcohol related physical aggression from patients in the past year (SOURCE – AUSTRALASIAN COLLEGE FOR EMERGENCY MEDICINE (ACEM))

270,000

Almost 270,000 Australians are regular users of the drug Ice and the highest rates of use are among young people under the age of 34 (SOURCE – NATIONAL DRUG AND ALCOHOL RESEARCH CENTRE (NDARC)

97.9% 97.9% of emergency nurses and doctors experienced alcohol related verbal aggression from patients in the past year

about what they’re doing to us.”

The scourge of Ice and alcohol Professor Gordian Fulde is the Director of Emergency at St Vincent’s Hospital in Sydney, arguably one of Australia’s busiest EDs.

A longstanding advocate against the scourge anmf.org.au

of Ice and alcohol fuelled violence that triggers a flood of people into Australian hospitals each weekend, Professor Fulde was named the Senior Australian of the Year for 2016 largely due to his tiresome work to solve the issue.

“For a while there, in the bad old days, it was considered part of your turf,” Professor

3.

Undertake detailed security audits of dozens of Emergency Departments to determine compliance with mandatory training requirements, security numbers, and adequate response to patients affected by alcohol or drugs including Ice. 4.

Establish a Working Group to recommend strategies to curb patient aggression.

5.

Partner with TAFE to train existing security staff in a course designed for the health environment.

6.

Recruit a new intake of security trainees through the health specific course.

7.

Establish a Reference Group of expert clinicians to develop specific patient management and treatment pathways, especially for patients presenting to EDs under the influence of Ice. 8.

Examine Mental Health and Drug & Alcohol resources including telehealth options for rural and regional areas for patients presenting to EDs under the influence of Ice. 9.

Work with NSW police to ensure incidents involving aggressive individuals are dealt with appropriately.

10.

Examine whether legislative changes are required to protect hospital security staff.

11.

Identify times when security staff are able to exercise power and remove individuals from public hospitals who are not patients but acting in an aggressive manner.

12.

Improve incident management reporting systems.

July 2016 Volume 24, No. 1 21

FEATURE Fulde explains. “In other words, a person out of control who knew what they were doing smashed the walls, broke equipment, punched the staff, and you couldn’t take anybody to court because the government wouldn’t let you do anything. Thank heavens that’s turned around.”

and you heard they were hit you’d go ‘get the hell out of there’ wouldn’t you?”

Professor Fulde does concede societal expectations regarding violence towards healthcare professionals is changing and that a greater willingness to tackle the issue has developed. In his view, the changes must evolve from the grassroots up and local solutions found to confine problems. “The government can help over-archingly but in the first instance these things need to be looked at locally and then escalated as needed.”

Indeed, times have changed, with lengthy jail terms of up to 14 years now in place across several states for people who commit violence against health professionals.

Framing the debate, Professor Fulde says the equation is simple: nobody should have to go to work and feel threatened.

Conducting his own research into the issue, he found the size of a person matters when it comes to violence.“If it was a small person, a nurse or a doctor, at 3 o’clock in the morning, and it’s someone drunk and out of control, they’re more likely to be nasty to a small person than a big person.”

In Professor Fulde’s workplace, the often volatile St Vincent’s, which has been captured in the TV series Kings Cross ER, considerable safety measures have been implemented to curb occupational violence. “There’s still a ways to go. In my department, the security staff are fantastic and they literally put their bodies on the line for us.”

Enforcing zero tolerance Gordian Fulde “THE MOST HORRIBLE THING ABOUT CRYSTAL METH AND THOSE SORTS OF THINGS, COCAINE TOO, IS THAT SOMEBODY COULD BE NEARLY OKAY, EYE CONTACT, TALKING TO YOU, AND WITHIN A NANO SECOND, THEY CAN GO ABSOLUTELY CRAZY.”

Asked to consider the impact of the drug Ice, Professor Fulde says its influence is wideranging and effects unpredictable.

“Our experience says there’s more people taking Ice and it’s going up. The reality is it’s everywhere. Rural, city, the house next to you. Ice is the most profitable drug there is.

Its effects are devastating.”

The culture of violence and aggression against health professionals is crippling, says Professor Fulde. “What it affects is morale. Nurses will not work. If you had a brother, sister, daughter, 22 July 2016 Volume 24, No. 1

The comprehensive strategy came on the back of legislation introducing harsher penalties for those harming healthcare workers, and a Monash University study of 5,000 ANMF members which found 70% experienced violence and aggression in the past year.

A roundtable in February endorsed a 12-point action plan to curb the issue, with strategies involving regular security audits of dozens of EDs, establishing a working group to recommend lines of attack, and delivering an intensive training program for ED staff including nurses so that they learn to manage aggressive behaviour.

Professor Fulde disputes some areas of research, largely survey-based, that indicate a drop in Ice use.

Professor Fulde says the bulk of Ice-affected patients rolling through the doors present with paranoia and agitation rather than being completely wild and berserk as some may believe.

In 2014, the Australian Nursing and Midwifery Federation (ANMF Victorian Branch) adopted a 10-point plan to end violence and aggression, flagging actions to increase security, implementing proactive measures to identify and address risk, and improving reporting culture and support mechanisms.

A similar plan was more recently adopted in New South Wales earlier this year in direct response to increasing aggression and violence across the state’s hospitals, including the double shooting of a security guard and police officer outside Nepean Hospital in Sydney’s west in January.

“The most horrible thing about crystal meth and those sorts of things, cocaine too, is that somebody could be nearly okay, eye contact, talking to you, and within a nano second, they can go absolutely crazy.”

The latest statistics from the National Drug and Alcohol Research Centre (NDARC) support his claims and show almost 270,000 Australians are regular users of Ice, with one in 100 addicted to the harmful drug, and that use has increased in the past five years and remains highest among young people under the age of 34.

Positively, violence and aggression towards health professionals is being tackled in significant ways across the country.

Kate Chapman “RIGHT NOW, THERE’S PROBABLY OVER A HUNDRED REMOTE AREA NURSES (RANS) OUT THERE

BY THEMSELVES ALONE AND VULNERABLE AND A LOT MORE SCARED THAN THEY WERE SINCE GAYLE [WOODFORD’S] DEATH.

The New South Wales Nurses and Midwives’ Association (NSWNMA) has also released an app where nurses can report and log workplace violence as soon as it occurs.

In NSW, a Parlimentary Inquiry is also currently being conducted into Violence Against Emergency Service Personnel, including nurses.

The Committee on Law and Safety will examine the adequacy of current practices tackling violence, the benefit of training and public awareness campaigns, and whether current sentencing options for people who commit assaults remain effective. South Australia is another state taking a stand.

ANMF (SA Branch) CEO/Secretary Adjunct Associate Professor Elizabeth Dabars says occupational violence against nurses is anmf.org.au

FEATURE an “age old problem” that’s continued to escalate. “It’s important to remember that it’s not just confined to emergency departments.

Certainly emergency departments bear a significant brunt but there is violent and aggressive acts in any area in which a nurse or midwife works.”

South Australia’s historic shortcomings in tackling the issue are improving gradually.

Changes to legislation in recent years ensuring successful prosecutions result in more serious penalties have been welcomed, albeit countered by a perceived reluctance to prosecute people engaging in violent acts.

Similarly, while South Australia Health has encouragingly released a Challenging Behaviours Policy aimed at minimising potential harm to healthcare workers, a lack of true implementation lingers.

“We have been both welcoming of that but also somewhat critical because we want to see not just the creation of these policies but implementation of it and real results, not just platitudes of the fact you’ve done this," Ms Dabars says.

According to Ms Dabars real progress has included support in exploring the establishment of designated detox areas for patients who are drunk or under the influence of drugs. A public awareness campaign is in the pipeline to educate the community that violence and aggression towards healthcare workers should not be tolerated. The ANMF (SA Branch) is also working with SA Health to try and pinpoint statistics surrounding aggressive and violent acts in order to properly gauge the success of strategies released a year ago.“I believe at the moment that the success or otherwise of that strategy can only be called patchy.

The statistics so far show there has been some decrease in violent and aggressive acts in some areas but increases elsewhere.

So there is a significant amount of work that needs to occur,” Ms Dabars says.

A key area of ongoing debate within the issue surrounds the potential for a mental health condition contributing to a patient’s actions and blurring the law when offenders are prosecuted, says Ms Dabars.

Ms Dabars stresses that being drunk or drug affected is no grounds for a defence and that it is also inappropriate to use a mental health condition as an excuse on all occasions. “I think we need to move beyond that and say well at the end of the day the person has committed a violent and aggressive act.

“There’s certainly people who do have mental health conditions who still have control over their actions. We need to break down those myths and those barriers and make sure that as much as possible we prevent and deter these kinds of behaviours but in the event that they do occur, that appropriate penalties apply.” anmf.org.au

Ms Dabars says violence and aggression must end and that all health professionals “have an absolute right to a safe working environment”.

Elizabeth Dabars “THERE’S CERTAINLY PEOPLE WHO DO HAVE MENTAL HEALTH CONDITIONS WHO STILL HAVE CONTROL OVER THEIR ACTIONS. WE NEED TO BREAK DOWN THOSE MYTHS AND THOSE BARRIERS AND MAKE SURE THAT AS MUCH AS POSSIBLE WE PREVENT AND DETER THESE KINDS OF BEHAVIOURS BUT IN THE EVENT THAT THEY DO OCCUR, THAT APPROPRIATE PENALTIES APPLY.”

Leading change

“Right now, tonight, there’s probably over a hundred remote area nurses (RANs) out there by themselves alone and vulnerable and a lot more scared than they were since Gayle [Woodford’s] death,” Remote Area Nurse (RAN) Kate Chapman says.

Ms Woodford, a remote area nurse from South Australia, was tragically murdered in late March, with her death sparking national interest and renewed calls to tackle enduring safety challenges facing the rural and remote health workforce.

In May, Kate accompanied ANMF’s Assistant Federal Secretary Annie Butler and Senior Federal Professional Officer Julianne Bryce in visiting Rural Health Minister Fiona Nash to outline challenges and canvass strategies moving forward.

“I felt that she was engaged and supportive. She was interested. She was asking questions and she had a few things clarified,” Kate says. “She was surprised we weren’t calling the police if someone was verbally abusing us whereas we think that’s amusing because we at times have difficulty getting the police when we are having a physical altercation.”

Undoubtedly, aggression and violence can occur in any health setting, with the rural and remote sector perhaps the most vulnerable due to isolation. Kate says she believes the voices of RANs are being heard, and with the backing of the ANMF, the workforce feels reassured that progress is slowly unfolding.

At a recent meeting of ANMF Federal

Executive in May, the ANMF acknowledged the alarming issue of occupational violence and aggression and demanded it be allocated national importance.

The ANMF believes the issue should be placed on the agenda of the Council of Australia Governments (COAG), so that health ministers, in consultation with key stakeholders, can develop and implement a national strategy in response to the growing problem.

Kate, who has been a RAN for the past six years and loves the autonomy and diversity of the role, says occupational violence is part and parcel of the job. “With verbal abuse it’s at least daily. Physical abuse is pretty prominent and sexual violence is increasing.”

Kate lists the rise in Ice use and longstanding alcohol issues as the major causes behind occupational violence in rural and remote.

“I think we’re more at risk. We’re more isolated. We’re sort of stuck between a rock and a hard place. If someone’s yelling at us and demanding something, if you’re on your own, if you ignore them or don’t respond, they very well might rock your house or try and get in. You’re going to make them angrier.”

Kate says working on call as a RAN means you often attend scenes despite safety concerns. “You can’t refuse. You’ve got to think what could happen? If something happens and you hadn’t responded you’re in big trouble. Not only could you risk your registration but, if you get blamed, you could suffer paybacks by family or community members. But also you’ve got to live with yourself. With a lot of RANs it’s their conscience. They’re not going to be able to sleep at night worrying about it so they go out.”

Kate says RANs were galvanised by the death of Gayle Woodford and are now taking a stand and knocking back single nurse posts. More and more nurses are sharing their horrific stories and accessing CRANAplus’ Bush Support Service.

“Everyone’s quite traumatised because they know it could have been them,” she says.“There’s a real stand and we are uniting.

We’re not taking posts when they’re offering it. We’re demanding security. We’re not asking for another nurse, we’re asking purely for another set of eyes to keep us safer.”

Ultimately, it is clear that aggression and violence should not be tolerated in our health system. To combat the problem, health services must ensure safe working environments for staff and governments must inject funding to educate the public through comprehensive awareness campaigns.

The prevailing culture of violence and aggression in health settings is no longer acceptable and change is critical.

July 2016 Volume 24, No. 1 23

CLINICAL UPDATE

ASSISTING WOMEN TO CONCEIVE: A CLINICAL UPDATE ON FERTILITYAWARENESS Kerry Hampton and Jennifer Newton This update on fertility-awareness has two principle aims. First, to highlight the gaps in women’s understanding of when in the menstrual cycle it is possible to conceive and second, to outline the accurate use of fertility-awareness methods to ensure correctly timed intercourse for a pregnancy.

Nurses and midwives who provide sexual and reproductive healthcare services will find this clinical practice update particularly helpful.

References Australian government Department of Health and Ageing. 2010.

Building a 21st century primary care system, Australia’s first national primary health care system. Commonwealth of Australia.

Colombo, B., and G. Masarotto. 2000. Daily Fecundability: First results from a new data base. Demographic Research 3. doi:10.4054/ DemRes.2000.3.5.

ESHRE Capri Workshop Group. 2004. Diagnosis and management of the infertile couple: missing information. Human Reproduction Update 10 (4):295-307.

ESHRE Task Force on Ethics Law. 2009.

Providing infertility treatment in resourcepoor countries. Human Reproduction 24 (5):1008-1011. doi: 10.1093/humrep/ den503.

Fehring, R. J. 2004. The future of professional education in natural family planning.

Journal of Obstetrics and Gynecological Neonatal Nursing 33 (1):34-43. doi: 10.1177/0884217503 258549.

Fehring, R. J., M. Schneider, and K. Raviele. 2006. Variability in the phases of the menstrual cycle.

Journal of Obstetric, Gynecologic, and Neonatal Nursing 35 (3):376-384. doi: 10.1111/j.15526909.2006.00051.x.

Gnoth, C., D. Godehardt, E. Godehardt, P. FrankHerrmann, and G. Freundl. 2003. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Human Reproduction 18 (9):1959-1966.

24 July 2016 Volume 24, No. 1

anmf.org.au

CLINICAL UPDATE The article begins by defining ‘fertility-awareness’, then outlines the main findings of a recently completed fertility-awareness study (Hampton, 2014), and concludes with recommendations for practice on use of fertility-awareness methods in assisting women to conceive.

Defining fertility-awareness

Fertility-awareness is generally defined as a woman’s ability to identify the fertile period of the menstrual cycle. There are three methods of fertility-awareness (rhythm, temperature, and mucus); however, all vary in their capacity to identify the ‘fertile period’. For example, rhythm is accurate for less than one-third of women who have a regular monthly menstrual cycle (Fehring et al. 2006), whereas both temperature and mucus are highly accurate (Pallone and Bergus, 2009).

Temperature and mucus are now known as ‘modern fertility-awareness methods’, to help distinguish them from the outdated and much less accurate rhythm method.

Fertility-awareness study

We conducted a four-year fertilityawareness study with the aim of informing a future primary care model (Hampton, 2014). Primary care interventions that included fertilityawareness have reduced referrals for assisted reproductive technology (ART) treatment by assisting spontaneous conception (Stanford et al. 2008; Tham et al. 2012). However, no such intervention currently exists in Australian general practices, despite the healthcare system’s transition to a preventive model of healthcare to reduce reliance on costly specialist treatment (Department of Health and Ageing, 2010).

The study used a mixed methods design and involved both women and their primary healthcare (PHC) practitioners – general practitioners (GPs) and primary healthcare nurses (PHCNs). Concordant with published international research, we found that women’s understanding of the fertile period of the menstrual cycle is generally poor across the reproductive life course (Hammarberg et al. 2013; Lundsberg et al. 2014).

Similarly, we found that women’s PHC practitioners are generally aware of women’s low levels of knowledge on this aspect of their reproductive health.

Although women’s interest in fertilityawareness rises sharply when they experience trouble conceiving – increasing from 37% among women who attend general practice to 87% among women who attend ART anmf.org.au

clinics – their knowledge of the ‘fertile period’ only increased slightly, up from 2% to 13% respectively. The main sources of women’s information were the internet, books, and general practitioners. We found that unanimity exists among women (95% and 92%) and their PHC practitioners’ (89%) that women’s fertility-awareness should be enhanced when first reporting trouble conceiving.

Similarly, both GPs and PHCNs (93%) nominate nurses and midwives as the most preferred practitioners to deliver such education for women in general practice (Hampton 2014; Hampton et al. 2016).

Consistent with these findings, both temperature and mucus, the most accurate fertility-awareness methods, were poorly understood by women and their PHC practitioners alike.

Correspondingly, rhythm, the least accurate fertility-awareness method, was the most frequently taught method in general practice (57%) and most frequently used method by infertile women (51.9%) before resorting to assisted fertility treatment at ART clinics.

Our study highlights a critical gap in the primary care of infertile women and also an opportunity for expanded scope of practice for PHCNs to redress this gap in the initial assessment and care of infertile women in general practice.

Current trends in the care of infertile couples

Infertility (the failure to conceive after 12 months of trying) occurs in one in six Australian couples (Loxton and Lucke, 2009). Couples who report trouble conceiving in general practice are increasingly being referred to ART clinics. ART treatment is, however, costly, highly invasive and associated with increases in morbidity and mortality for both mothers and their babies. In addition, concern is mounting about the possible overuse of ART treatment (Kamphuis et al. 2014).

Benefits of fertility-awareness

Intercourse within the fertile period of the menstrual cycle is essential for a pregancy (Wilcox et al. 2000) and may help some couples to overcome infertility whether the cause is a male or female factor problem (Stanford et al. 2008; Tham et al. 2012). A lesser known benefit of correctly timed intercourse is that it may halve the usual time to pregnancy, with 85% of couples being pregnant at six months rather than at 12 months (Colombo and Masarotto, 2000; Gnoth et al.

2003). Proponents have long argued that the knowledge is low cost,

without side-effects, and compatible with the religious or philosophical values of those who cannot use ART treatment or choose not to use ART treatment (ESHRE Capri Workshop Group, 2004; ESHRE Task Force on Ethics Law, 2009).

Below, an overview of fertilityawareness methods is presented together with the advantages and limitations of each method when used for guiding timed intercourse.

Fertility-awareness methods Mucus method

The mucus method is the most accurate and most useful fertilityawareness method to guide timed intercourse, as this method prospectively indicates the entire fertile period of the menstrual cycle by the presence of fertile-type mucus at the vulva. Fertile-type mucus is released from the cervix and is present for an average six days leading up to the day of ovulation in the menstrual cycle. Over these days, a sensation at the vulva changes from moist to wet to wet/slippery, then back to dryness or an unchanging sensation of slight moistness. When fertile-type mucus is observed, it is clear, shiny, and stringy in appearance.

The last day fertile-type mucus is sensed or observed at the vulva is called the peak day of fertility, as this is the most likely day of ovulation in the menstrual cycle. Outside the fertile period, sensation at the vulva is one of dryness or a slight unchanging moistness. When mucus is observed at this time, it is a dense white/creamy colour (Odeblad, 1994).

Advantages and limitations The mucus method enables the entire ‘fertile period’ to be observed, irrespective of whether the menstrual cycle is monthly and regular or irregular (Odeblad, 1994).

Intercourse timed within the threeday period just prior to ovulation optimises the chance of a pregnancy.

With the mucus method, women can know for certain that intercourse was correctly timed for pregnancy.

Women who may find this method challenging include those who suffer from dysmorphic body disorder or have a history of sexual abuse.

Infections of the vulva or vagina will impair accurate observation/sensation of mucus changes.

Temperature method

The temperature method is the next most accurate fertility-awareness method. This method retrospectively indicates the timing of ovulation in the menstrual cycle by a basal body temperature (BBT) rise of 0.2 to 0.5

Hammarberg, K., T. Setter, R. J. Norman, C. A. Holden, J. Michelmore, and L. Johnson.

2013. Knowledge about factors that influence fertility among Australians of reproductive age: a population-based survey. Fertility and Sterility 99 (2):502507. doi: 10.1016/j. fertnstert.2012.10.031.

Hampton, Kerry D. 2014. Informing the development of a new model of care to improve the fertilityawareness of sub-fertile women in primary health care. PhD Department of General Practice Monash University (ethesis-20141120-133 130).

Hampton, Kerry D., Jennifer M. Newton, Rhian Parker, and Danielle Mazza. 2016. A qualitative study of the barriers and enablers to fertility-awareness education in general practice. Journal of Advanced Nursing Mar 9. doi: 10.1111/ jan.12931. [Epub ahead of print].

Kamphuis, Esme I, S Bhattacharya, F. van der Veen, B W J Mol, and A Templeton.

2014. Are we overusing IVF? British Medical Journal 348 (g252). doi: 10.1136/bmj.g252.

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Reproductive health: Findings from the Australian longitudinal study on women’s health. Australian government Department of Health and Ageing.

Lundsberg, Lisbet S., Lubna Pal, Aileen M. Gariepy, Xiao Xu, Micheline C. Chu, and Jessica L. Illuzzi. 2014.

Knowledge, attitudes, and practices regarding conception and fertility: a populationbased survey among reproductive-age United States women. Fertility and Sterility 101 (3):767774. doi: 10.1016/j. fertnstert.2013.12.006.

Maheshwari, Abha, Mark Hamilton, and Siladitya Bhattacharya.

2008. Effect of female age on the diagnostic categories of infertility.

Human Reproduction 23 (3):538-542.

July 2016 Volume 24, No. 1 25

CLINICAL UPDATE

Murayamas, s, T Hashimoto, T Saito, K Shimizu, K Saito, T Norzawa, and Y Suda.

1987. The present state of utilization of NFP techniques fertilityawareness methods.

Japanese Journal of Fertility and Sterility 31 (1):65-71.

Odeblad, E. 1994. The discovery of the different types of cervical mucus.

Bulletin of the Natural Family Planning Council of Victoria 21 (3):1-34.

degrees Celsius that remains elevated until next menstruation. The BBT is the resting temperature of the body after a minimum of four to six hours of sleep. The temperature must be taken with an ovulation thermometer on waking each morning from the same site, either orally or vaginally.

Ovulation usually occurs at the bottom of the sustained BBT rise.

Three consecutive elevated BBTs over a lower previous six confirm the occurrence of ovulation (Colombo and Masarotto, 2000).

Advantages and limitations With the temperature method, consecutive fertility charts are needed to guide timed intercourse in anticipation of ovulation. Intercourse within the three-day period just prior to the BBT rise optimises the chance of pregnancy (Pallone and Bergus, 2009).

Only in retrospect can women know for certain that intercourse was correctly timed with this method (Colombo and Masarotto, 2000).

The retrospective nature of the temperature method is an obvious limitation (Pallone and Bergus, 2009). Ideally, it is combined with mucus, and when this occurs the method becomes known as the symptom-thermal method (Colombo and Masarotto, 2000). This double check method is especially helpful for women who have an irregular menstrual cycle (Colombo and Masarotto, 2000). Factors that can render BBT measurements inaccurate 26 July 2016 Volume 24, No. 1

include alcohol consumption, late nights, oversleeping, disrupted sleep, travel, time zone differences, stress, illness, and medication (Pallone and Bergus, 2009).

Rhythm method

As previously mentioned, the rhythm method is the least accurate fertilityawareness method. This method estimates the timing of the fertile period of the menstrual cycle by applying two calculations: one to estimate the ‘early safe days’ and the other to estimate the ‘late safe days’.

The ‘fertile period’ comprises the days that fall between the calculated ‘safe days’(Fehring, 2004).

These calculations are based on the earliest and the latest possible time that ovulation might occur in the menstrual cycle as well as the maximum lifespan of sperm and ovum. Based on these calculations, the fertile period is days six to 24 inclusive. The ‘early safe days’ are estimated by subtracting , ‘21’ from the shortest menstrual cycle recorded in the previous six to 12 months: (ie.

27 - 21= 6: days 1-5 are considered the ‘early safe days’). The ‘late safe days’are calculated by subtracting ‘10’ from the longest menstrual cycle recorded in the previous six to 12 months (ie. 34 - 10 = 24: days 25 onwards are considered the ‘late safe days’). These calculations can seem confusing, and few women who report using rhythm actually apply them (Murayamas et al. 1987).

Advantages and limitations Rhythm calculations significantly overestimate the duration of the ‘fertile period’, necessitating intercourse to occur daily or second daily over many more days than pregnancy is a possibility (Pallone and Bergus, 2009).

This approach may be difficult for some couples to maintain (Scarpa et al. 2007) and unsatisfactory for others who wish to be certain of correctly timed intercourse (Stanford et al. 2002).

Rhythm is accurate for less than onethird of women who have a regular monthly menstrual cycle (Wilcox et al.

2000) and cannot be used by women (around 27%) whose menstrual cycle is irregular (ie., more the 36 days long) (Maheshwari et al. 2008).

Summary and conclusion

This paper has provided an introduction and overview to fertilityawareness, and highlighted the importance of basing this critical education for women on mucus and temperature, not rhythm, to assist spontaneous conception.

With appropriate education and resourcing, nurses and midwives could play a greater role in fertilityawareness education for women in general practice.

Dr Kerry Hampton is in the Department of General Practice at Monash University Associate Professor Jennifer Newton is in the School of Nursing & Midwifery at Monash University

Pallone, Stephen R, and George R Bergus. 2009.

Fertility awarenessbased methods: Another option for family planning. Journal of the American Board of Family Medicine 22 (2):147-157.

Scarpa, B., D B. Dunson, and E. Giacchi. 2007.

Bayesian selection of optimal rules for timing intercourse to conceive by using calandar and mucus. Fertility and Sterility 88 (4):915-924.

Stanford, J B., Tracey A. Parnell, and Phil C. Boyle. 2008. Outcomes from treatment of infertility with natural procreative technology in an Irish general practice. Journal of the American Board of Family Medicine 21 (5):375-384.

Stanford, J B., G L. White, and H. Hatasaka. 2002. Timing intercourse to achieve pregnancy: current evidence. Obstetrics & Gynecology 100 (6):1333-1341.

Tham, Elizabeth , Karen Schliep, and Joseph B Stanford. 2012.

Natural procreative technology for infertility and recurrent miscarriage: Outcomes in a Canadian family practice. Canadian Family Physician 58 (May):e267-e274.

Wilcox, A. J., D. Dunson, and D. D. Baird. 2000. The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study. British Medical Journal 321 (7271):12591262. doi: 10.1136/ bmj.321.7271.1259.

anmf.org.au

ISSUES

I FEEL I AM CONSTRAINED IN DISCUSSING THE TOPIC TO ANY GREAT EXTENT BECAUSE IT REMAINS AN ILLEGAL ACT, YET AS A NURSE I AM BOUND BY A CODE OF ETHICS AND PROFESSIONAL PRACTICE WHICH SUPPORTS THE VERY TENETS UNDERPINNING THE CHOICE OF VE.

Your voice:

To voice your nursing perspective on this issue, visit the SA Nurses Supporting Choices in Dying Facebook page, write to Susie Byrne at sanursessupportingchoicesindying@ hotmail.com, or write to the ANMF Federal Office at anmfcanberra@anmf. org.au. Nurse-led practice is the future and we need to be prepared for it in all aspects of our care.

The voluntary euthanasia (VE) debate has again come into the spotlight after a VE Bill was tabled in the South Australian Parliament (South Australian government 2016) a few months ago.

Since 2013, there have been VE Bills or reports tabled in New South Wales, Victoria, Tasmania and Commonwealth governments (Willmot et al. 2016). In addition to this, Andrew Denton and The Wheeler Centre have produced a number of podcasts on all aspects of the VE debate – both pro and con – to understand whether VE is truly an option for the Australian public and if so, how it may occur (The Wheeler Centre, 2016).

The ANMF Federal Office has a position statement on VE which supports a nurse to respect a person’s right to selfdetermination, identification of quality of life, and compassion for those who suffer (Australian Nursing and Midwifery Federation, 2015). The statement acknowledges that assisted dying is currently an illegal act and that nurses are obliged by law and professional codes to operate within those boundaries of the law. However, the ANMF position statement also states that its role is to “participate in the broader public debate as an appropriate organisation to ensure that the nursing and midwifery voice is heard” (ANMF, 2015).

I participate as a nurse in this debate through my research on advance care directives (Bradley, 2015), by holding community forums and seminars on the new South Australian Advance Care Directive Form (SA ACD form). anmf.org.au

The average age of people attending the community forums is 65+ years who are not vulnerable because they are older. They are knowledgeable, articulate and have been contemplating completion of this document for their own satisfaction as well as to support family members who may be called upon in a time of need. Participants in these forums have been generous in sharing their concerns and experiences and inevitably someone will raise the issue of voluntary euthanasia.

I tell them that in the new SA ACD form, the Act (South Australia government, 2013) specifically says that healthcare professionals cannot respond to a request for VE as VE is currently an illegal act.

Not being able to discuss voluntary euthanasia to address individual concerns about this issue frustrates me as a nurse. I feel I am constrained in discussing the topic to any great extent because it remains an illegal act, yet as a nurse I am bound by a code of ethics and professional practice which supports the very tenets underpinning the choice of VE. So what to do?

I am a member of the SA Nurses Supporting Choices in Dying group. The group’s convenor Susie Byrne and I have written articles about the group and VE in general for the ANMJ (Bradley, 2008, 2010, 2011; Byrne, 2013). The ANMF leadership has also written on this subject (Levett, 2013) as well as Australia’s recognised nursing ethicist, Professor Megan-Jane Johnstone (2014).

Nevertheless, Australian nurses, in general, remain quiet on this issue.

Whichever way you feel about VE, it is

important to make your voice heard from a nursing perspective – not a personal perspective.

Do you believe, as a nurse, that a person should have the right to determine the manner and time of their death if they are at the end of their life? If not why not? If so why?

More importantly, and I think this is where nurses get stuck, how do you think this might play out in your professional practice?

Would you be prepared to discuss VE with a person who has put this in their Advance Care Directive? Would you be prepared to assist in the act of administering VE should it be made legal? From a nursing point of view, what are the pros and cons of this for your practice?

Your voice on this issue is critical. Families and carers who feel the need to discuss concerns around voluntary euthanasia should be able to do so with us. The ANMF’s position statement gives us the support to do so “Where a person expresses a wish for assistance with dying, nurses should be educationally prepared to discuss the legal and medical parameters of this request as well as other options available to the person or seek the assistance of knowledgeable healthcare professionals” (ANMF, 2015).

References on request

Sandra L Bradley is an RN, MSc Research, PhD and Advance Care Directive Consultant This article is based on the views and research of the author(s) and has not been peer reviewed.

July 2016 Volume 24, No. 1 27

RESEARCH

OPIOIDS LENGTHEN TIME IN PAIN

MEDICATION IGNORANCE PUTS KIDS AT RISK

Morphine may more than double the duration of pain and amplify its severity.

New parents and pregnant women access inaccurate medicine information online with many unaware of the maximum dose of paracetamol for children.

The controversial findings were published in journal Proceedings of the National Academy of Sciences (PNAS).

University of Colorado Boulder research found rats with chronic nerve pain treated with morphine for five days experienced prolonged pain sensitivity.

This lasted for up to two to three months - double that of the control group.

“WHAT WE FOUND IS THAT THE OPIOID PAINKILLERS ACTIVATE SPINAL IMMUNE CELLS, CAUSING A FURTHER INFLAMMATORY RESPONSE.”

“What we found is that the opioid painkillers activate spinal immune cells, causing a further inflammatory response.

The pain is effectively transitioned to a chronic state, making the pain itself both more severe and longer lasting,” said study author Dr Peter Grace of the University of Colorado Boulder, US, and Research Associate in Pharmacology at the University of Adelaide.

The results added growing scientific weight that opioids such as morphine may contribute to people’s chronic pain, Dr Grace said. “The results are of concern because of the huge number of opioid prescriptions being written for patients each year.”

New drugs to be tested in clinical trials were in the pipeline, he said.

Two separate studies were presented at the recent National Medicines Symposium in Canberra recently.

Pharmacists at Calvary Public Hospital in Canberra analysed 55 Facebook posts of pregnancy or children and medicines, with 825 responses.

“We found that 19% of responses to people’s posts about medicines or health conditions in pregnancy or in their children were actually classified as inaccurate,” study author Sarah Smith said.

Incorrect information included advice that could make a condition worse; too frequent administration of paracetamol; and immunisation guidance outside the recommended schedule. Inappropriate medication advice was also shared for pregnancy and breastfeeding.

Online groups were an excellent source of support for new parents, Ms Smith said, however 2% of the responses were considered potentially harmful.

“We now have a much stronger focus on making people aware of the importance of finding reliable medicines information in our maternity department.”

In a separate study presented at the Symposium, a quarter of respondents were unaware of the recommended maximum daily dose of children’s paracetamol.

University of Wollongong researchers found almost half were unaware how many consecutive days the recommended dose could be safely given.

Strategies to address the knowledge gap included improved healthcare, professional and patient communication and better product labelling.

FRONTLINE RESEARCHER IS WA NURSE OF THE YEAR Susan Slatyer says she never expected to be in research. The Curtin University Research Fellow has been awarded Western Australia’s 2016 Nurse/Midwife of the Year.

Susan has a joint appointment with Curtin University and Sir Charles Gairdner Hospital working five days at the hospital. “I think I am in a unique position – very close to the clinical frontline for nursing research. This is very important – the research questions are meaningful to nurses and to the needs and outcomes of patients.”

A key project included the impact of a ‘Lotus Room’ for end of life patients set up in the hospital. “People in the last week of life are transferred to the room. Staff step back and families become involved,” Dr Slatyer said.

Published research had shown increased staff satisfaction. “We think it has a positive effect on bereavement. Families are able to continue to practice their death and dying practices and are able to have that space rather than two people at the bedside in an ICU,” Dr Slatyer said.

Other research projects underway include development of a communication model of care for people with dementia admitted medically unwell; and resilience work with graduates. However it is the core business of reviewing evidence for nursing practice guidelines with senior clinical nurses that had enhanced relationships and opportunities for collaboration on research. “I think it has taken away the mystique of research. The way we are engaging is trying to bring research and the clinical areas closer,” Dr Slatyer said.

“We need more nursing research to have a nursing voice,” she said. “I never expected to be in research. It started with one little project around pain for my PhD. I audited pain assessments and nursing practice and management of pain.

“Stick to an area you want to research, that interests you – that means something to you.

It has to sustain you – research takes time.

“Look in your hospital or workplace for opportunities – there might be a research assistant position that becomes available.”

28 July 2016 Volume 24, No. 1

anmf.org.au

PROFESSIONAL

WE MAKE A DIFFERENCE Julianne Bryce

Elizabeth Foley

Julie Reeves ANMF Federal Professional Officers

Reference Buresh, B., and Gordon, S., 2006. From Silence to Voice: What nurses know and must communicate to the public. Canadian Nurses Association. Ottawa Parker, J., and Gardner, G. E., 1992. The silence and the silencing of the nurse’s voice: a reading of patient notes.

Australian Journal of Advanced Nursing. Vol 9 (2): pp.3-9.

Taylor, B. J., 1994. Being human: ordinariness in nursing. Melbourne, Churchill Livingstone. pg.24.

anmf.org.au

Back in 2009 Julianne used this column to raise the issue of the importance of language ‘in the way we describe ourselves as nurses and midwives, what it is that we do and what that means to both ourselves and others’. Her assertion was that when attempting to define nursing or midwifery, or the role of a nurse or a midwife, the definition never seems to adequately address all that a nurse or midwife is, or does.

We are not ‘just a nurse’ or ‘just a midwife’.

At a recent meeting of the Coalition of National Nursing and Midwifery Organisations (CoNNMO), guest speaker Professor Sanchia Aranda told a beautiful story of a nurse caring for a man in a debilitated state, to illustrate her point that nurses and midwives so often tone down the impact they have on people’s lives.

She said, “We downplay what we do for people and what it means to them”. The nurse in this story restored the man’s humanity through a simple act - an act so simple and second nature to her that the nurse later struggled to recall the incident when he thanked her profusely for what she’d done for him and what it had meant to him.

We were reminded by Sanchia of past writings by Australian and international authors on the subject of nurses and midwives not being clear and articulate about their contribution to healthcare. These included Australian authors such as Professor Bev Taylor (1994) who highlighted the seeming ‘ordinariness’ of nursing displayed “when nursing knowledge and skills are shared in human ways…”; and, Professors Judy Parker and Glenn Gardner (1994) who used an analysis of patient notes to demonstrate that nurses tend to take for granted many of the practices of their everyday working lives. Judy and Glenn argued that “taken-for-granted practices are by definition invisible”.

This theme of invisibility is highlighted by the international authors Sanchia referred to - North American journalists Suzanne Gordon and Bernice Buresh (2006). These writers had first-hand experience of the stunning positive difference nursing practice made to the lives

of those for whom they cared. They were, therefore, appalled by the indifference shown by media to nursing, and more especially, to the seeming lack of awareness of nurses about the significance of their day to day actions.

RAISING THE VISIBILITY OF OUR PROFESSIONS IS LARGELY IN OUR HANDS. REGARDLESS OF THE SETTING OF OUR PRACTICE WE, AS NURSES AND MIDWIVES, MUST USE OUR INDIVIDUAL OR COLLECTIVE VOICE TO EMPHASISE THE IMPORTANCE OF OUR ROLE TO THE COMMUNITY, OTHER HEALTH PROFESSIONALS AND OURSELVES.

The essential take-home messages Sanchia gave the nurses and midwives present at the CoNNMO meeting which we wish to share with members, were to: • avoid using the word ‘just’ when talking about their roles; • be clear and articulate about what they do, and; • be bold in speaking out about what they do.

As Sanchia quite rightly pointed out, much of our unique contribution to health and aged care goes unrecognised as such, by nurses and midwives themselves. We promote health, care for women during pregnancy and birth, and interact with

people at critical/crisis points in their lives using knowledge and skills to: prevent illness/injury, restore people to optimal health, provide palliative care for those with life-limiting illnesses or those who are dying. Our evidence-based interventions and therapeutic actions make a difference to people’s health and wellbeing, often to the point of preventing misadventure or even saving their lives. This is happening every day, all around the country! And, it’s because of this that nurses and midwives so often take their actions for granted and downplay what these actions – the simple and/or the complex - have meant to the people they’ve given care to.

Each year the Roy Morgan Image of Professions Survey consistently rates nurses and midwives as the most ethical and honest of all professions.

While the community clearly has high regard for the nursing and midwifery professions, our invisibility in the media and often scant regard shown by governments in funding decisions, would suggest there is little understanding of what our professions actually do.

Raising the visibility of our professions is largely in our hands. Regardless of the setting of our practice we, as nurses and midwives, must use our individual or collective voice to emphasise the importance of our role to the community, other health professionals and ourselves.

For more information about the work of the Federal Office Professional Team go to the ‘Professional’ and ‘Media and Publications’ sections of the ANMF website: www.anmf.org.au July 2016 Volume 24, No. 1 29

VIEWPOINT

BREAKING THE SILENCE – THE TERMINALLY ILL MENTAL HEALTH CLIENT

By Mick Hawkins Both mental illness and terminal disease require an adjustment of expectations from both therapist and client if management of either condition is to be achieved.

When mental illness is present in the terminal patient, these adjustments are both radical and very difficult. Which beckons the question, does this provide a basis for integrated mental health services within palliative care?

The psychiatrist

Fairman and Irwin (2003) acknowledges mental health therapy for the dying requires “emotional, spiritual, social, and experiential dimensions of their suffering”, but at the same time dwell at much greater length on adjustments to psychotropic medication.

Schuyler (2010) describes the psychiatrist’s role as “typically cognitive therapy”. He suggests the support to palliative care should broaden to include “carefully chosen mental health professional(s)”.

Moffic (2015) discusses the psychiatrist’s role in the euthanasia debate and emphasises the psychiatrist’s diagnostic skills in “better screening of treatable mental disorders in those requesting euthanasia”. He also makes the point that all of us suffer “death anxiety” and that this is likely to rise once we have a terminal diagnosis.

It is hard to argue against a significant role a psychiatrist could play in supporting both patients and therapists in the provision of palliative care.

Both diagnostic and pharmacological expertise can easily be integrated into the total palliative care approach.

The mental health nurse

Physicians and palliative care nurses readily accept social workers and psychologists as part of the palliative care team (Claxton-Oldfield et al. 2004).

30 July 2016 Volume 24, No. 1

THE CROSS TRAINING OF PALLIATIVE CARE AND MENTAL HEALTH NURSES HAS BEEN IDENTIFIED AS A ‘KEY OBJECTIVE IN IMPROVING PALLIATIVE CARE SERVICE DELIVERY’ BOTH FOR PATIENTS WITH PERSISTENT MENTAL ILLNESS AND THOSE WHO DEVELOP A MENTAL ILLNESS POST THE DIAGNOSIS OF THEIR LIFE THREATENING ILLNESS

However nurses experienced in mental health can also provide positive outcomes in palliative care.

The cross training of palliative care and mental health nurses has been identified as a ‘key objective in improving palliative care service delivery’ both for patients with persistent mental illness and those who develop a mental illness post the diagnosis of their life threatening illness (Taylor et al. 2012). This acknowledges the mutual challenges faced by both types of practitioner.

But, more than this, Taylor’s research and conclusions suggest that mutual support could well be a vital complement to cross-training.

Picot (2014) acknowledges palliative care has a different focus to mental health, but recognises “similarities in philosophy” concluding from her case studies that palliative care and mental health nurses “working together” maximise the chance of “optimal end of life care”.

Her arguments and those of Taylor would give grounds for collaboration at the individual/allocated nursing level and would enhance further the patient’s palliative care experience.

Coaching a patient without a mental illness to manage their end of life experiences of physical and emotional pain as well as what is often a spiritual crisis requires very special skills. These are distinct from helping the patient acknowledge a mental illness and agreeing to try measures both medical and cognitive to manage this.

Conclusion

Mental health nurses and palliative care nurses are not interchangeable, but the complexity of the comorbidity present in the terminally ill patient with a mental illness justifies consideration to including mental health nurses to the palliative care treating team.

Mick Hawkins is a mental health nurse from South Australia This article is based on the views and research of the author(s) and has not been peer reviewed.

References Claxton-Oldfield S, Jefferies J, Fawcett C, Wasylkiw L., 2004 Palliative Care Volunteers – Why do they do it?, Journal of Palliative Care 20.2. 78 – 84 Fairman, Nathan and Irwin, Scott, 2013, Palliative Care Psychiatry: Update on an Emerging Dimension of Psychiatric Practice, Curr Psychiatry Rep.15 (7): 374 Moffic, Steven, 2015, Death and the Psychiatrist, Psychiatric Times, April 21 Picot, Sharon, 2014, Coordinating Life Care for Individuals with a Mental Illness – A nurse practitioner collaboration, 1322.7696, Australian College of Nursing Ltd, pp 143-149, pub Elesvier Ltd Schuyler, Dean, 2010, Roles and Goals of a Palliative Care Psychiatrist, Primary Care Companion to Journal of Clinical Psychiatry, 12 (5): PCC. 10f0.1054 Taylor, Janet; Swetenham, Kate; Myhill, Karin; Picot, Sharon; Glaetzer, Karen; and van Loon, Antonia, 2012, IMhPaCT: an education strategy for cross-training palliative care and mental health clinicians, International Journal of Palliative Nursing, Vol 18, No 6, pp 290-294

anmf.org.au

LEGAL

FAILING TO IDENTIFY AND RESPOND TO THE DETERIORATING PATIENT: A CASE FOR THE CORONER Linda Starr

The Coroners Court is a unique court that fulfils an important function in our legal system – determining the manner and cause of death of those who have died in unexpected or unexplained circumstances. With broad powers of investigation the Coroner through the coronial process will make findings and recommendations regarding the death or suspected deaths of individuals in their particular circumstances.

For relatives and friends of the deceased this brings some closure to their grieving whilst for organisations and health professionals it is an opportunity to identify human error or system failures that contributed to the death of a patient and consider how these could be avoided in the future.

Reviewing the findings of an Inquest where there has been a failure to recognise and manage a deteriorating patient gives us the opportunity to not only identify what mistakes were made but also what can be done to prevent them from recurring. The investigation into the death of SM was such an occasion.

In this case SM a 32 year old man died in a large regional hospital following an emergency appendectomy.

His medical history noted a recent ankle injury and a history of intellectual disability. On arrival to the hospital he was commenced on IV fluids, antibiotics and fasted. That evening under general anaesthetic he underwent a laparoscopic appendectomy which revealed four quadrant peritonitis – the perforated appendix was removed, the abdominal cavity washed out and a drain inserted.

Reference Non-inquest findings into the death of SM Queensland Coroners Court 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

SM was an outlier on the orthopaedic ward following his discharge from recovery and remained on low flow oxygen. During the early hours of the morning he had continuing tachycardia and hypotension, his calves were observed to be soft.

During the next two days SM complained of abdominal pain, a mild abdominal distension was noted.

Two days postoperatively his oxygen saturation level was between 84-85% and required oxygen via a mask to maintain saturation levels at 97%.

The following days after complaining of generalised abdominal pain and distension he was diagnosed and successfully treated for post-surgical ileus. During this time both the physiotherapists and nursing staff made notes in his medical record of periods of moderate hypoxia whenever he removed his oxygen mask.

The next day SM was again reviewed by a surgeon who noted that SM’s continued low oxygen saturations could possibly have been due to aspiration during the operation period. Throughout the rest of that day and early into the next day SM continued to have tachycardia, abdominal pain and mild hypoxia.

Approximately 8:30am when mobilising to the bathroom SM complained of dizziness, sat down and was suddenly unresponsive – despite resuscitation efforts SM could not be revived. An autopsy confirmed that SM died from a pulmonary embolism that originated from a deep vein thrombosis in his right calf following the surgery.

Prior to the coronial investigation the local hospital and health service had commissioned a root cause analysis (RCA) of the care SM received concluding that there was a failure to identify SM’s deteriorating condition due to a number of system issues which they were in the process of addressing - as such the Coroner did not make any additional recommendations. The system issues identified included the failure to use a warning observation tool correctly, fractured handover processes and a lack of oxygen prescribing procedures.

In the first instance, it was noted that had the warning observation tool been used correctly the persistent low saturation levels, hypoxia and oxygen use would have flagged the need for SM to be medically reviewed more frequently. The weakness here was that observations were not always recorded, some were not trended, some scores were not recorded and others were added up incorrectly.

Furthermore, there was a failure to record any action taken to escalate SM’s condition on the many occasions the scores on the Q-ADDS chart flagged a higher level that warranted medical review.

Who should order oxygen? Ordinarily oxygen is a therapeutic substance and so should be ordered and reviewed by a medical officer. The RCA team considered that whilst it may be

appropriate for the nursing staff to begin oxygen therapy to increase oxygen saturation levels in cases such as this, it was also important to ensure that this action was accompanied by a medical review and investigation to determine the underlying cause of the patient’s hypoxia. This did not occur although there was evidence that the nursing staff reported significant episodes of hypoxia or continual low saturations in their notes there is no evidence in SM’s medical record that this raised the alarm or need for further action by the medical staff. The fact that SM was on oxygen for the entire six days post operatively without adequate review demonstrates a failure to adequately manage his oxygen therapy by all those involved.

The final issue was the ‘fractured unstructured handover’ process practiced by the treating team. It was noted that there was no formal process for the handover of patients between shifts and that members of the medical and surgical rounds would arrive and leave at different times during the handover to attend to other duties. This meant that the medical officer who actually completes the ward round and reviews patients may not have been present to hear the handover from their colleagues on the previous shift and thus may have missed important details of the patient’s health status.

It is clear that the standard of care delivered to SM fell short of what could reasonably be expected by registered health professionals on several occasions during SM’s brief admission to hospital.

This case highlights the importance of contemporaneous, complete, consistent and accurate communication in both written and oral form for optimal patient outcomes along with competent patient care delivery. It is crucial that all health staff are able to identify and adequately respond to a patient’s deteriorating health status and that organisations have clear and effective processes in place to assist staff in the management of these cases.

July 2016 Volume 24, No. 1 31

EDUCATION

FALLS PREVENTION The following excerpt on Falls Prevention is from the newest addition to the topics list on the Continuing Professional Education (CPE) website. The tutorial covers falls risk, contributing factors, screening and assessment tools, strategies to reduce falls and the nurses and midwives role in prevention and treatment. The ANMF falls prevention tutorial is relevant to all levels of nurses and midwives.

CPD

HOURS

Falls can impact on an individual in many ways. These impacts can cause physical injuries, have negative social consequences and induce psychological distress. Therefore falls prevention programs are essential in order to decrease the risk of an individual falling and experiencing these negative effects. All healthcare workers have a role in assisting in falls prevention programs with organisational policies and procedures in place to guide their care in this area.

The World Health Organization (WHO) defines a fall as ’an event which results in a person coming to rest inadvertently on the ground or floor or other lower level’. Any falls related injuries are classified as fatal or non-fatal, with most falls being within the non-fatal category. Although most falls are non-fatal, worldwide 37.3 million people require medical attention every year due to falls.

• Worldwide, falls are the second leading 32 July 2016 Volume 24, No. 1

• • •

•

• •

cause of death resulting from accidents of unintentional injuries; people over 65 years of age have a higher risk of falling; 30% of Australians over the age of 65 experience at least one fall per year; Australians over the age of 65, falls account for 40% of all injury related deaths; with the population ageing, the number of people experiencing falls is also expected to rise; in 2010, 240,000 bed days were related to falls; over 80% of injury related hospital admissions for people over the age of 65 are due to falls and their injuries.

In sub-acute and rehabilitation settings, more than 40% of patients with specific clinical problems (such as stroke) will fall at least once during their admission with injuries resulting in 30% of these falls. There

MOST HIP FRACTURES (91%) ARE CAUSED BY FALLS AND THEY ARE ONE OF THE MOST COMMON REASONS FOR HOSPITAL ADMISSION.

are many different injuries associated with falling, including: cuts and abrasions; soft tissue damage and bruises; fractures, and head injuries. The hip and thigh are the most commonly injured areas following a fall which can require hospitalisation.

Most hip fractures (91%) are caused by falls and they are one of the most common reasons for hospital admission. Hip fractures anmf.org.au

EDUCATION Worldwide people requiring medical attention every year due to falls.*

37.3 MILLION

*ALTHOUGH MOST FALLS ARE NON-FATAL

cause increased morbidity and increase the risk of death for the individual. They can also result in increasing the likelihood that the individual will need to be admitted into a residential aged care facility following their fall and injury. Wrist fractures are also a common injury following a fall due to the instinct to use your hands to break your fall.

These injuries can be severely debilitating for the individual and result in a decrease in their level of independence. People who have fallen can also develop a fear of falling and lose their confidence in their ability to walk.

This can then reduce their independence and consequently their quality of life. An increased burden can then be placed on their family and care-givers to undertake more care responsibilities for the individual.

The National Safety and Quality Health Service (NSQHS) Standards were developed to improve the quality of care provided by health services and to protect the community from harm. They consist of 10 standards which allow health service organisations to ensure their quality improvement programs are aligned with the framework provided by the NSQHS standards

Standard 10: Preventing falls and harm from falls

The aim of standard 10 is to ‘reduce the incidence of patient falls and minimise harm from falls’. This standard aims to identify a patient’s falls risk promptly and ensure that the appropriate prevention strategies are undertaken. It guarantees health services have falls prevention systems in place which include screening and assessing the falls risk of patients. It also covers the use of prevention strategies to decrease the incidence of falls and includes the management of a patient following a fall.

The standards are nationwide, but may be applied differently depending on the different types of health services eg. the falls risk assessment and interventions needed would be different for a day procedure unit anmf.org.au

injury related hospital admissions for people over the age of 65 years

80

PERCENT DUE TO FALLS AND THEIR INJURIES

(such as a fertility clinic) than a large tertiary hospital or rehabilitation facility.

Falls can occur in all age groups and in all environments. Adults over the age of 65 are more at risk of falling due to both environmental risk factors and personal risk factors (intrinsic). The more risk factors an individual has, the more likely it is they will fall. Both genders are at risk of falls equally, however some studies have shown that males are more likely to suffer from fatal falls than females. Increased length of stay in a hospital setting increases falls risk and falls occur more commonly in the immediate time following a transition between settings. Individuals with underlying medical conditions including neurological and cardiac conditions are more likely to fall and individuals with limited access to health and social services are more likely to fall than those with adequate access. Socioeconomic factors including poverty can impact on an individual’s risk of falling.

Falls risk screening and assessment tools identify patients at an increased risk of falling. They then prompt us to implement strategies to help decrease this risk of falling.

These tools have been evaluated across different hospital settings and are good predictors of the risk of falls.

So what is the difference between a falls screening tool and a risk assessment?

A falls screening tool

Screens patients for their falls risk; is a brief process; classifies people as either being low risk or an increased risk; usually contains five brief items.

It isn’t designed as a comprehensive assessment, however it can still assist in determining any interventions needed to decrease the patients falls risk.

A falls risk screen should occur on admission

CPD

READING THIS ARTICLE WILL GIVE YOU 15 MINUTES OF CPD, WHILE THE COMPLETE COURSE IS ALLOCATED TWO HOURS OF CPD TOWARDS ONGOING REGISTRATION REQUIREMENTS.

to hospital, when a person’s health or functional status changes and when their environment changes. If the falls screen shows the patient is at an increased risk of falling, a falls risk assessment should then be completed. If any item on the falls risk screen shows the patient is at risk of falling, interventions should be implemented for that item regardless if the patient has a low overall risk score. Falls risk screening tools are more relevant in acute care settings than residential care as most residents will most likely exceed the falls risk, therefore a falls risk assessment should be completed on all residents.

The information presented here is just the tip of the iceberg in relation to the content in the tutorial. To learn more about, or just refresh your knowledge on falls prevention, go to http://anmf.org.au/pages/cpe This tutorial was written by RN Sally Moyle, Masters in Nursing (Clinical Nursing and Teaching), Rehabilitation Clinical Nurse Specialist and Nurse Educator. Sally has experience in many nursing sectors and aspires to share her expertise with nurses and midwives to improve their skills and knowledge and to engage them in lifelong learning practices.

For further information, contact the education team on 02 6232 6533 or education@anmf.org.au

NEWS:

The Basic Life Support (BLS) tutorial has been updated to reflect recent changes in BLS practice. The Advanced Life Support (ALS) tutorial is currently being updated and will be available in the coming weeks. A tutorial on Methamphetamine – Ice is in the peer review process as is Bullying in the Workplace. So keep an eye on the website for the new course additions

July 2016 Volume 24, No. 1 33

ISSUES

A REGISTERED NURSE IN 20 WEEKS?

FOR A BACHELOR LEVEL DEGREE (USUALLY THREE YEARS) PRESCRIBED CLINICAL PRACTICE HOURS

By Elizabeth Miller and Simon Cooper This paper raises concerns and issues related to the adequacy of nursing students’ clinical placement hours.

There are significant workforce demands as the nursing workforce ages, and graduate retention reduces, coupled with the fact that there is a predicted shortage of 109,000 nurses in Australia by 2025 (Health Workforce Australia 2012).

Retention rates are influenced by poor preparation for healthcare roles, false graduate nurse expectations and unrealistic demands by employers leading to attrition rates as high as 20% in the first two years of practice (Dept of Health, 2014; Healy and Howe, 2012). Concerns over quality care have also been reported (Darbyshire and McKenna, 2013), and there are significant international concerns relating to patient safety (Buykx et al. 2012).

Hours across the world

These issues are set against a backdrop of reduced clinical training hours, which vary across the developed world. For a bachelor level degree (usually three years) prescribed clinical practice hours in Australia are 800, New Zealand 1,100 to 1,500 hours, UK 2,300 (of which 300 can be simulated practice), and in South Africa 2,800.

Original decisions on the adequacy of clinical training hours is a mystery but appear to have come from the UK requirements of 1,000 hours for trade apprenticeships, eg. plumbers, mechanics, electricians (Coyle, 2007).

Placement hours in Australia, one of the lowest in the developed world, tend to be concentrated in the latter few years of study with only short blocks of two to three weeks in the first year. This is compared to the UK where students are placed for up to 700 hours in their first year (Karstadt, 2009). However, Australian universities constantly battle to find placements and the costs are high – clinical venues normally charge $60 a day per student regardless of the supervision model.

Objectives and adequacy of clinical placements

Objectives of clinical education include the need to embed knowledge (overcoming the theory practice 34 July 2016 Volume 24, No. 1

South Africa: 2,800 UK: 2,300 (of which 300 can be simulated practice)

Australia: 800 New Zealand 1,100 to 1,500 hours

divide), and to develop skills and a deep understanding of empathetic, cultural and inter-professional practice. The Australian Nursing and Midwifery Accreditation Council (ANMAC) reiterate clinical practice should be “considered essential for promoting cultural acclimatisation to the workplace and preventing ‘culture shock’ that leads to high attrition rates”. Also that placements should be early to sustain student interest and that final year blocks should be uninterrupted and facilitate transition to work (ANMAC, 2009).

However, as Coyle (2007) suggests there are numerous unanswered questions about placements including the length, type and variety of experience required to reach competency and become ‘safe’. All of which is made more complex by individual student’s needs and learning styles. However we know that the length and quality of placement does influence students’ degree of belongingness with evidence that short placements are filled with the requirements of orientation and ‘fitting in’ (Levett-Jones et al. 2009).

Further, graduate nurses do not feel work ready and experienced nurses report that limited placements and generalised education do not enable achievement of graduate competencies (Missen et al. 2016).

Learning through simulation

Learning through simulation may improve preparation for practice and reduce the time it takes to reach competency, but can simulation replace the full remit of skills that are essential for clinical work (Cooper et al. 2012)?

Simulated wards could be one approach with students learning to prioritise, make decisions and work in teams (Liaw et al. 2014). Simulated practice may also reduce medical errors (Sears, 2010) and the use of patient actors (as opposed to manikins) does increase the reality of the experience (Buykx et al. 2012).

Conclusion

Australia needs more highly skilled competent nurses yet students are only placed in practice for 20 weeks.

Simulation may reduce the time it takes to reach competency but should it be used to replace clinical practice?

Where should nurses competencies lie? As in China should the focus be on skills, personal attributes and ability to care (Karstadt, 2011), or in India a curriculum rich in the sciences but with care directed by medical staff (Karstadt, 2012b).

Currently we have a mixture of these approaches but is this too much of a compromise? Perhaps an academic apprenticeship model would be better (The National Nursing and Nursing Education Taskforce, 2006).

We have clearly raised many more questions than we have answered but it is time for a serious debate on the adequacy of clinical placements.

As authors, we need to acknowledge our biases. Elizabeth Miller is a second year student who gained two weeks clinical experience in aged care in her first year. Simon Cooper is a UK hospital trained nurse from the 1980s where, in addition to theory blocks, he completed 4,347 hours (109 weeks) in eight specialities.

References supplied on request

Elizabeth Miller is a second year student nurse and Simon Cooper is a Professor of Emergency Care. Both are at the School of Nursing, Midwifery and Healthcare, Federation University Australia, Victoria.

This article is based on the views and research of the author(s) and has not been peer reviewed. anmf.org.au

REFLECTION Zealand in 1970, I had the Guthrie/Newborn Screening Test. The results of this test were positive for PKU. As a result my carers were informed that I would be mentally retarded and would require full time care. The medical profession at the time, with limited knowledge and understanding, asked my carers, “What have you done to your baby?”

Not their finest hour.

However, I am very happy to report this predicted outcome did not eventuate. I am now an experienced Registered Nurse working in a diverse range of healthcare settings and currently teaching in the educational sector.

So what is PKU

PKU is an inborn error of Amino Acid (protein) metabolism.

Once known as ‘Follings Disease’, it was founded by Norwegian biochemist Ivor Asborn Follings, who found that a strong odour in the urine of PKU positive children contained phenylpyruvic acid. He concluded the excess amount of this acid was the cause of the odour and the result of the inability to breakdown the amino acid Phenylalanine into Tyrosine due to a heredity deficiency of the enzyme Phenylalanine Hydroxylase (PAH) found in the liver.

HOPE FOR PKU FUTURE

BY RN Justine Inglis I have been living with Phenylketonuria (PKU) for 45 years.

My journey has been challenging for many reasons but mostly related to how the disease is viewed and the lack of awareness.

The healthcare system’s knowledge around treatment of PKU has been developing over the past 50 years and is mostly driven by specialist clinics such as the Australian Society for the Inborn Error of Metabolism (ASIEM). However the information within these clinics has not been accessible or shared with broader general healthcare services and health professionals.

By writing this article I hope to bridge that gap and raise more awareness and care in the difficulties surrounding PKU treatments, advancements and the lack of general awareness, both publicly and in the nursing/ medical professions, which adds to the frustration of living well with this rare disease.

On 1 May each year and throughout the month is PKU awareness day/month.

Something I bet most reading this were unaware of.

My story

When I was born, in New Plymouth, New anmf.org.au

Without treatment of low protein/ phenylalanine diet, which was not accessible until well after 1952, the deficiency resulted in severe irreversible mental impairment.

It was during 1952 that Dr Horst Bickel at Birmingham Hospital undertook a study of a three year old PKU positive patient and studied the effects of a controlled Protein/ Phenylalanine intake by the child, resulting in obvious and profound changes in neurological assessment, mood, behaviour and activity. The video of this interaction can be viewed at the following link: www. youtube.com/watch?v=CEiOYSYhnhY The current mainstay of treatment is a low protein diet for life, with supplemental synthetic protein formulas daily based on age and weight of the individual. This is difficult to adhere to due to amount required, taste and tolerance of the formula, and of course cost.

The formula and some of the pharmaceutically made foods are PBS funded and there is a IEM Payment monthly from Department of Health & Ageing to support those on the diet. There are some new advancements in PKU treatments, one of which is called Kuvan. This requires a BH4 positive PKU genome to respond to this medication which has a hugely positive effect on the body’s ability to metabolise “Phe” or Phenylalanine. It allows a more relaxed diet and the ability to eat a balanced and healthy diet without the use of pharmaceutically made foods, which therefore decreases the cost. At this stage Kuvan is only given to babies and children who are BH4 positive.

Adults such as me are not given this option.

I have asked my clinic to have both Genome testing and Kuvan BH4 responsiveness testing and both have been denied, for what reasons I am unsure, but have been told it is cost related.

The blood testing regime has not changed in 50 years. To do a blood test in Victoria, a spot Guthrie card is tested at a lab in Melbourne, though this varies in each state.

As I live in rural Myrtleford, Victoria the response to this test can take up to a week.

As a PKU adult my diet advice is to control PHE intake daily, which means I am restricted to 15g Protein. PKU is also affected by lifestyle choices. Related PHE levels are raised when, exercising, fasting, during a minor illness such as colds/flu, weight loss or weight gain, loss of sleep and shift work.

I am envisioning a future that brings about more general awareness, education programs for health professionals, patient driven care planning, ownership of choices and appointments that are in line with person centred care and need will become the status quo.

I need to have hope for the PKU advancements of the future.

This article is based on the views and research of the author(s) and has not been peer reviewed.

THE RESULTS OF THIS TEST WERE POSITIVE FOR PKU. AS A RESULT MY CARERS WERE INFORMED THAT I WOULD BE MENTALLY RETARDED AND WOULD REQUIRE FULL TIME CARE

For further information please contact me: juzinglis@gmail.com or see my website www.pku-happy.com

Other sites: www.mdda.gov.au (metabolic dietary disorders association) www.pkunsw.org.au

July 2016 Volume 24, No. 1 35

FOCUS – Women’s Health

Tracey Ahern

AN EXPLORATION OF THE AUSTRALIAN BREAST CARE NURSE ROLE IN SUPPORTING WOMEN WITH BREAST CANCER The lack of literature surrounding the role of the Australian Breast Care Nurse (BCN) and the well documented disparity between cancer survival in urban versus rural and remote areas has inspired an RN working in rural Australia to undertake doctoral research to further explore these issues.

The research, which has recently been completed, was conducted

by Tracey Ahern at Australian Catholic University, Canberra. The research, conducted from 2011–2015, comprised three studies representing a significant and original contribution to understanding the supportive care needs of women with breast cancer (BC), as well as the role the BCNs have for women in cancer care.

Study one was a replication of a study completed in 2002 by Raupach and Hiller (2002), examining the information and support needs of breast cancer patients compared to 10 years ago. Additional comparisons between urban, regional and rural women were also conducted. The study, published in Health Expectations, highlights the importance of BCNs to women living geographically isolated areas and 36 July 2016 Volume 24, No. 1

indicates the role of the BCN is an area needing more research (Ahern et al. 2014).

THE RESULTS OF THIS QUANTITATIVE RESEARCH HAVE FILLED A CRITICAL GAP AND HAVE THE POTENTIAL TO INFORM POLICY REGARDING FUTURE ENACTMENT OF THE BCN ROLE. The second study completed was a study of BCNs Australia-wide and was the first such study to investigate the BCN role nationally. This study of 50 breast care nurses spanning all parts of Australia has provided data useful for describing the differences experienced based on geographical location of work context. The study, published in Nursing Open, identified gaps, potential education needs, and professional development needs of BCNs (Ahern et al. 2015).

The third study made comparisons between the unmet needs and self-efficacy of women who were

supported by a BCN, to women who were not supported by a BCN. This study adds considerably to the literature, clearly demonstrating the value of the BCN in decreasing unmet needs and increasing self-efficacy of women with BC. One of the particular strengths of the work is that it is underpinned by the previously published Canadian-based, Professional Navigation Framework (Fillion et al. 2012). Through the use of this previously published theoretical framework, and in combination with study findings, a new conceptual model applicable to BCN practice in the Australian context has been proposed.

The needs of women with breast cancer have been well documented and the gaps in their supportive care have been identified. In many cases, the role of the BCN was designed to respond to these needs. However, there has been little quantitative research to evaluate the role and impact of the BCN. The results of this quantitative research have filled a critical gap and have the potential to inform policy regarding future enactment of the BCN role.

Dr Tracey Ahern is a Sessional Teacher in the School of Nursing, Midwifery and Nutrition at James Cook University, Townsville Qld

References Ahern, T., Gardner, A. & Courtney, M. 2014. Geographical comparisons of information and support needs of Australian women following the primary treatment of breast cancer: a 10 year replication study. Health Expectations, 18(6), 2678-2692 Ahern, T., Gardner, A. & Courtney, M. 2015.

A survey of the breast care nurse role in the provision of information and supportive care to Australian women diagnosed with breast cancer. Nursing Open, 1-10. Retrieved from http://onlinelibrary. wiley.com/doi/10.1002/ nop2.18/epdf Fillion, L., Cook, S., Veillett, A., Aubin, M., de Serres, M., Rainville, F., et al. 2012.

Professional navigation framework: Elaboration and validation in a Canadian context.

Oncology Nursing Forum, 39(1), E58-E69 Raupach, J.C.A. & Hiller, J.E. 2002. Information and support for women following the primary treatment of breast cancer. Health Expectations: An International Journal of Public Participation in healthcare and Health Policy, 5(4), 289-301

anmf.org.au

Women’s Health – FOCUS

References Bortolini, M., Drutz, H., Lovatsis, D. & Alarab, M. 2010 Vaginal delivery and pelvic floor dysfunction: current evidence and implications for future research, Int Urogynecol J, vol. 21 pp. 1025-1030.

Dudding, T., Vaizey, C. & Kamm, M. 2008 Obstetric anal sphincter injury; incidence, risk factors, and management, Ann Surg, vol. 247 pp. 224-237.

Fornell, E., Matthiesen, L., Sjo¨dahl, R. & Berg, G. 2005 Obstetric anal sphincter injury ten years after subjective and objective long term effects, British Journal of Obstetrics and Gyneacology, vol. 112 pp. 312-316.

Milsom, I., Altman, D., Laritan, M., Nelson, R., Sillen, U. & Thom, D. 2009 Epidemiology of urinary (UI) and faecal (FI) incontinence and pelvic organ prolapsed (POP).

Norton, C. 2004 Nurses, bowel continence, stigma, and taboos, J Wound Ostomy Continence Nurs, vol. 31 no. 2 Mar-Apr pp. 85-94.

Rasmussen, J. & Ringsberg, K. 2009 Being involved in the everlasting fight – a life with postnatal faecal incontinence; a qualitative study, Scand J Caring Sci, vol. 24, pp.

108-115.

Tucker, J., Wilson, A. & Clifton, V. 2013 Women’s experience of anal incontinence following a history of obstetric anal sphincter injury: a literature review, Int J Evid Based Health, vol.

11 pp. 181–186.

Tucker, J., Wilson, A. & Clifton, V. 2014 Teetering near the edge; women’s experiences of anal incontinence following obstetric anal sphincter injury: an interpretive research study, Aust N Z J Obstet Gynaecol, vol.

54 no. 4 pp. 377-381.

Williams, A., Lavender, T., Richmond, D. & Tincello, D. 2005 Women’s experiences after a third-degree obstetric anal sphincter tear: a qualitative study, Birth, vol. 32, no. 2 June pp. 129-136.

anmf.org.au

IMPROVING COMMUNICATION AROUND ANAL INCONTINENCE FOR WOMEN OF REPRODUCTIVE AGE

By Julie Tucker, Anne Wilson and V L Clifton Anal incontinence (AI) is the accidental loss of liquid or solid stool and flatus (Milsom et al. 2009). The concept of uncontrolled faecal loss can evoke social disgust and marginalise those afflicted from the community in which they live (Williams et al. 2005).

Disclosure is complex for those afflicted and often compounded by the negative stigma attached to AI and may influence how health professionals approach this complex issue (Norton, 2004; Rasmussen & Ringsberg, 2009). Nondisclosure prevents access to appropriate clinical care and management of this condition.

The aetiology of AI is multifactorial, however trauma to the anal sphincter muscles (OASIS) following vaginal delivery is a predominant cause of AI in women of reproductive age (Bortolini et al. 2010; Dudding et al.

2008). Subsequent trauma following vaginal delivery and ageing compound injury increases the risk of worsening incontinence (Fornell et al. 2005). The risk factors for pelvic floor trauma and prevalence of OASIS are noted within current literature, however there is little in-depth research information which addresses the impact of AI on a woman’s quality of life, following a history of OASIS (Tucker et al. 2013).

An interpretive phenomenological research study was undertaken in South Australia to explore and interpret 10 women’s experiences of AI following OASIS.

Three essential themes; Grieving for loss, silence and striving for normality revealed the debilitating physical and psychological impact of AI on a woman’s quality of life.

Young women’s stories detailed the anger and sadness that consumed their lives and they were mortified by lack of bowel control. Women described how the social stigma which surrounds AI marginalised them from their community and prevented them from speaking out. Isolation was compounded by professional silence which not only impacted on isolation but fuelled the anger and despair of these women (Tucker et al. 2014).

OVERALL THE RESEARCH IDENTIFIED THAT THESE WOMEN WANTED TO BE HEARD, TO REAFFIRM THEIR SELF-ESTEEM, AND REGAIN SOME CONTROL OF THEIR LIFE TO REDUCE THEIR SOCIAL ISOLATION

Overall the research identified that these women wanted to be heard, to reaffirm their self-esteem, and regain some control of their life to reduce their social isolation. The role

of health professionals was identified as pivotal for the identification of AI and to promote clinical opportunities to improve access and equity for appropriate healthcare for women across the lifespan. Women confirmed that health professionals needed to initiate sensitive dialogue, and to listen and hear women’s stories to raise awareness around a taboo topic, which is poorly understood.

Health professionals are in a privileged position to ask women about their continence status.

Given the risk of AI in women of reproductive age and worsening symptoms across the lifespan, it is important that health professionals enquire about AI especially in reproductive aged women. Early identification of this condition will expedite access to appropriate healthcare and potentially improve quality of life for women.

Julie Tucker is a PhD Candidate; Robinson Research Institute, School of Medicine, University of Adelaide Professor Anne Wilson is Chief Investigator NHMRC, School of Medicine, Flinders University, South Australia and Prince of Wales Clinical School, University of New South Wales Professor V L Clifton is in the Robinson Research Institute, School of Medicine, University of Adelaide and Professional Research Fellow, Mater Medical Research Institute, University of Queensland July 2016 Volume 24, No. 1 37

FOCUS – Women’s Health

EXPANDING PRACTICE INTO AREAS ALIGNED PHILOSOPHICALLY WITH MIDWIFERY

By Ruth King The number of midwives practising in Australia in 1999, were 11,985 and in 2014, 23,862 (Australian Institute of Health & Welfare, 2014 workforce report). Just over 3,000 are registered as a midwife only.

This figure is likely due to the introduction of the undergraduate Bachelor of Midwifery pathway and new registration and recency of practice requirements resulting in individuals with both RN/RM registration opting to maintain one qualification; the consequence of which has led to an increase in midwives in the system, who are non-nurses or who are no longer registered to practice nursing.

For these midwives, entry into many post registration fields of employment are restricted because registration as a nurse is a minimum entry requirement. Some desire the completion of a general nursing qualification however the majority do not wish to undertake further education that requires them to work in areas which have no alignment with midwifery.

Regardless of current barriers, a growing number of these midwives are indicating their interest to expand their practice into areas that align philosophically with midwifery.

Examples of such areas include: • Diabetes educators • Maternal, child and family health nursing • Neonatal nursing • Sexual health and family planning • Continence care The Australian College of Midwives (ACM) acknowledges that nursing may currently be the primary entry pathway to these occupational roles, however proposes that this need not be the only pathway.

The Diabetes Association of Australia (ADEA) has a number of other health professions including physiotherapy and nutrition whose members are recognised as suitable to work as diabetes educators providing the required training is undertaken. The ADEA has accepted an approach from the ACM and approved midwifery as a profession whose members can seek accreditation as diabetes educators following the completion of an approved course.

The Australian College of Midwives believes that Bachelor of Midwifery course curricula, which include a strong focus on holistic, preventative and primary community based healthcare, adequately prepare midwives for undertaking further education in these areas of practice. Further, with the changing landscape of healthcare moving to increase community-based services to accommodate Australia’s population distribution, the inclusion of midwives not holding an additional qualification as a nurse in such occupational roles may address some workforce shortages. Rural and remote areas would ideally be able to employ midwives who could work in multiple communitybased health promotion areas such as those outlined above.

The ACM further understands that current workforce models for rural and remote healthcare prioritise family-centred care in the community setting which impacts staffing requirements for small country hospitals and health services. The employment of midwives is often limited to part time positions or restricted to individuals holding

dual registration as a nurse and midwife so they can work in a general nursing capacity when not employed as a midwife. This is not an appealing option for many midwives.

Enabling midwives to gain qualifications in the primary healthcare roles identified above, would complement their midwifery education and practice, enable care to be centralised and delivered in the community (where appropriate), and optimise staffing allocations in health facilities.

The ACM continues to work with the lead professional associations for all but one field identified (continence) to understand their position on and the potential for the role of non-nurse midwives. Positive dialogues have also commenced with the Chief Nurse & Midwifery Officers around Australia about the following key objectives: • To recognise midwifery as a profession with suitable pre-requisite preparation for areas such as child and family health, sexual and reproductive health, continence care, and neonatal nursing care as this has the potential to expand workforce opportunities especially in rural and remote areas of Australia • To consider changing the title of nonnurse specific qualifications (where there is not a registerable requirement) to ‘health worker’ or suitable alternative for more inclusive entry criteria.

Ruth King is Midwifery Advisor, Education Unit at the Australian College of Midwives

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Women’s Health – FOCUS with stakeholders (including midwives) were also undertaken during project visits. Four individual interviews with pregnant women and three focus group interviews with 20 mothers were undertaken as well as 14 interviews with stakeholders. Thematic analysis was guided by Ritchie and Spencer, 1994 analytical framework.

‘BIRTH TRAUMA CAN TRIGGER A MENTAL HEALTH PROBLEM’ CREDIT: F SWEETING 2015, USED WITH PERMISSION

IT IS ESTIMATED THAT ONE IN SEVEN WOMEN EXPERIENCE A MENTAL HEALTH ILLNESS DURING THE CHILDBIRTH CONTINUUM Findings

In summary, women’s interviews identified the themes: befriending, sharing with others, knowing I’m not the only one, unrealistic expectations, good enough mum.

Quote example: “I learnt that the perfect mum doesn’t exist and I’m a good enough mum and other mums feel the same too”.

THE PERFECT MUM DOESN’T EXIST BUT A GOOD ENOUGH MUM DOES: BUILDING RESILIENCE FOR BETTER MATERNAL MENTAL HEALTH

By Mary Steen The issue of women experiencing mental health problems during pregnancy which can progress and exacerbate into the transition of motherhood is one that midwives need to be alerted to.

It is estimated that one in seven women experience a mental health illness during the childbirth continuum (NICE, 2007). Therefore, developing skills and coping strategies to be resilient are essential for maintaining maternal mental health (Steen et al.

2015). Recently, a resilience model to promote mental health focusing upon wellbeing, coping strategies and social connections was developed anmf.org.au

(Robinson et al. 2014). This article reports qualitative findings collected as part of a mixed methods study to evaluate this model.

Aim

The aim of the study was to explore women’s and stakeholder’s views and experiences of the resilience model.

Methods

Qualitative data was collected near completion of the resilience program.

The study was undertaken during a six month period and participants were recruited from four pilot sites in urban and rural regions in the UK. Pregnant women and new mothers were asked to participate in individual or focus group interviews. Individual interviews

In summary, stakeholder interview findings related to: referrals, expectations, needs of women, views on benefits to women, factors contributing to success, challenges and enablers, sustainability.

Quote example: “This program is filling a gap that the health service cannot do, it plays a vital role to stop women slipping through the net and becoming socially isolated, we need to make the commissioners listen to how beneficial this program is to our new mothers…”

Conclusions

The resilience model for better maternal health promotes and maintains wellbeing. Engagement in positive activities and building social connections to reduce social and rural isolation played an essential role. Learning coping strategies to maintain wellbeing helped women to build resilience and stay well. This study supports the need for midwives and other health professionals to work much closer with non-government organisations.

Professor Mary Steen is Professor of Midwifery in the School of Nursing and Midwifery at the University of South Australia

References NICE, 2007. Mental Health Problems during Pregnancy and after Giving Birth. NICE Clinical Guideline 45. London, National Institute for Health and Clinical Excellence.

Ritchie, J. and Spencer, L. 1994. Qualitative data analysis for applied policy research. In: A. Bryman and R.G. Burgess (eds) Analyzing Qualitative Data, pp.173-194.

Robinson, M., Steen, M., Robertson, S., Raine. G. 2014 Evaluation of the local Mind Resilience Programme, Final Report. London, Mind Charity.

Steen, M., Robinson, M., Robertson, S., Raine, G. 2015 Pre and post survey findings from the Mind ‘Building resilience programme for better mental health: pregnant women and new mothers’ Evidence Based Midwifery 13(3): 92-99

July 2016 Volume 24, No. 1 39

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Women’s Health – FOCUS

WOMEN’S HEALTH NURSES: WHY WE NEED THEM

By Dr Wendy Abigail With governments reducing funding in health services, the eroding of nursing positions in the community have been severely impacted on, including women’s health nurses.

Women’s health nurses work in community settings and specialises in women’s health areas such as sexual health, reproductive health, menopause, breast care, Pap smears, non-communicable diseases and domestic violence, just to name a few.

The nurses provide individualised care, group education sessions, health promotion activities, and telephone consults for women of all ages and races in need of qualified skilled professional care. Often the women they see are some of the most vulnerable group in our society. Vital healthcare services are/have been provided to women by caring and sensitive nurses across Australia in both metropolitan and rural settings.

Peak women’s health organisations are continuing to advocate for better services for women throughout Australia. These include (but not limited to) Equality Rights Alliance (Equality Rights Alliance, 2016), National Rural Women’s Coalition (National Rural Women’s Coalition, 2016), and the Australian Women’s Health Network (Australian Women’s Health Network, 2016).

Evidence based studies, such as the Australian Longitudinal Study on Women’s Health (Australian Longitudinal Study on Women’s Health, 2016) provide research supporting the need for specialised services. So why is it that governments continue to reduce funding for women’s health? Women in rural settings are particularly affected where women’s health services have been significantly reduced. This is despite evidence where research continually identifies that people in rural areas have poorer health outcomes than those residing in city areas (Thomas et al. 2014). anmf.org.au

Adequately funding women’s health makes sense. In 2015 it was reported that domestic violence alone cost the economy $21.7 billion a year (news. com.au, 2015). If adequate funding was provided for women’s health nurses such costs could be reduced and in turn contribute to adequately funding women’s health nurse positions. By adequately funding these positions preventative healthcare measures for women of all ages could be implemented at an appropriate level which in turn would impact in reducing healthcare spending.

PEAK WOMEN’S HEALTH ORGANISATIONS ARE CONTINUING TO ADVOCATE FOR BETTER SERVICES FOR WOMEN THROUGHOUT AUSTRALIA Therefore instead of the government reducing services for women, services need to be increased. It is time for the government to provide adequate funding for services that offers care to all women’s specific healthcare needs.

Dr. Wendy Abigail is Lecturer at SONM at Flinders University, South Australia

References Australian Longitudinal Study on Women’s Health. 2016 www.alswh. org.au/ Accessed April 2016 Australian Women’s Health Network. 2016 http://awhn.org.au/ Accessed April 2016 Equality Rights Alliance. 2016 www. equalityrightsalliance. org.au/ Accessed April 2016 National Rural Women’s Coalition. 2016 www. nrwc.com.au/ Accessed April 2016

news.com.au 2015 The cost of domestic violence: Australian economy ‘robbed’ of billions. www.news.com. au Accessed April 2016 Thomas, S. L., Wakerman, J. & Humphreys, J. 2014 What core primary healthcare services should be available to Australians living in rural and remote communities? BMC Family Practice, 15, 143-157.

REDUCING THE POTENTIAL NEGATIVE IMPACT OF CHRONIC LIFE STRESS ON WOMEN’S HEALTH AND WELLBEING

By Charrlotte Seib Exposure to chronic stressors can negatively impact women’s health. Data amassed over several decades has linked chronic stress with a number of health problems including mental health issues (Turner and Lloyd, 2004), somatic complaints, increased chronic disease risk (for example, diabetes and cardiovascular disease) and premature mortality (Cohen et al. 2009; Juster et al. 2010).

Compared to men, women frequently report a higher prevalence of traumatic experiences particularly in relation to violent victimisation, negative events in childhood and family obligations (Hegarty et al. 2004; Willette-Murphy et al. 2009). Whether stressors are perceived as temporarily distressing or are a cause of concern depends on the event’s severity, as well as resilience, personality and support mechanisms (Cohen et al. 2009). It is also likely that health outcomes are associated with the number and severity of reported events. According to Kendler et al. (2010), the likelihood of major depression increased 10-fold among those reporting four severe stressful events (ie. death of a close relative, assault, serious marital problems or breakup) in one month.

It has been argued that because of the correlations between stress, coping and morbidity, a better understanding of the potential sequelae of life stressors are necessary in the context of women’s health (Cohen et al. 2009).

Nurses, through their roles as patient advocates and health educators, are ideally positioned to provide leadership to promote gender-sensitive healthcare programs that address inequities that lead to adverse health outcomes in women (Lathrop, 2013).

Charrlotte Seib RN MN PhD is in the Institute of Health and Biomedical Innovation at the Queensland University of Technology

References Cohen B., Marmar C., Neylan T., Schiller N., Ali S., and Whooley M. 2009.

Post-traumatic stress disorder and healthrelated quality of life in patients with coronary heart disease. Archives of General Psychiatry.

66(11):1214-1220.

Hegarty K., Gunn J., Chondros P. and Small R. 2004. Association between depression and abuse by partners of women attending general practice: descriptive, cross-sectional survey.

British Medical Journal.

328(7440):621-624.

Juster R.P., McEwen B.S., Lupien S.J. 2010.

Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience and Biobehavioral Reviews. 35(1):2-16.

Kendler K.S., Kessler R.C., Walters E.E., MacLean, C., Neale, M.C., Heath, A.C. and Eaves, L.J. 2010. Stressful life events, genetic liability, and onset of an episode of major depression in women.

The Journal of Lifelong Learning in Psychiatry.

8(3):459-470.

Lathrop, B. 2013. Nursing leadership in addressing the social determinants of health. Policy, Politics and Nursing Practice.

14(1):41-47.

Turner R. and Lloyd D. 2004. Stress burden and the lifetime incidence of psychiatric disorder in young adults: racial and ethnic contrasts. Archives of General Psychiatry.

61(5):481-488.

Willette-Murphy K., Lee K.A., Dodd M., West, C., Aouizerat, B.E., Paul, S., Swift, P., Wara, W. and Miaskowski, C. 2009.

Relationship between sleep and physical activity in female family caregivers at the initiation of patients’ radiation therapy. Journal of Obstetric, Gynecologic, & Neonatal Nursing.

38(3):367-374.

July 2016 Volume 24, No. 1 41

FOCUS – Women’s Health

FERTILITYAWARENESS KNOWLEDGE, ATTITUDES, AND PRACTICES OF WOMEN ATTENDING GENERAL PRACTICE

By Kerry Hampton and Danielle Mazza Infertility (the failure to conceive after 12 months of trying) affects one in six Australian couples. Infertile couples are increasingly being referred from general practice for assisted reproductive technology (ART) treatment.

However, ART treatment is costly, highly invasive and associated with increases in morbidity and mortality for mothers and babies (Kamphuis et al. 2014).

As part of a comprehensive fouryear study that sought to inform a future primary care model in fertilityawareness (women’s knowledge of the fertile period of the menstrual cycle) as one way of reducing infertility, we measured fertility-awareness knowledge, attitudes and practices of women who attend general practice.

We found that a third (37.1%) of women who attend general practice actively try to improve their understanding of fertility-awareness, but only 2.1% correctly identify the ‘fertile period’. This was despite the fact that 4.3% were using fertilityawareness as contraception and 9.8% were actively planning a pregnancy.

This is the first Australian study to measure fertility-awareness in women who are using this method as contraception, showing that none in our study had correct knowledge putting them at risk for unplanned pregnancy. Similarly, 9.8% were actively planning a pregnancy but few understood the fertile period for optimal timing of intercourse.

When comparing the results of this study with our previously published one on infertile women, we found that fertility-awareness only slightly increased up to 12.7%. In both studies, the internet and books were the most frequently accessed sources of fertility-awareness information.

However, only trained teachers in fertility-awareness are consistently associated with higher levels of knowledge (Hampton, et al. 2013).

WE FOUND THAT A THIRD (37.1%) OF WOMEN WHO ATTEND GENERAL PRACTICE ACTIVELY TRY TO IMPROVE THEIR UNDERSTANDING OF FERTILITY-AWARENESS, BUT ONLY 2.1% CORRECTLY IDENTIFY THE ‘FERTILE PERIOD’

The findings of our study suggest that better training of general practitioners and practice nurses in fertilityawareness could play an important role in enhancing women’s fertility knowledge to assist them to achieve their reproductive life plan.

The article was published in Australian Family Physician. To read it in full, go to www.ncbi.nlm.nih.gov/ pubmed/26590626 Dr Kerry Hampton is a Sessional Teaching Associate at Monash University and Professor Danielle Mazza is Head of the Department of General Practice at Monash University

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Kamphuis, E.I., Bhattacharya, S., van der Veen, F., Mol, B.W.J and Templeton, A. 2014. Are we overusing IVF? British Medical Journal 348 (g252). doi: 10.1136/bmj.g252.

Respect - Professionalism - Caring Committed - Collaboration

SUBSCRIBE TO ANMJ

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BY ME

www.anmf.org.au n nurses

Hampton, K.D., Mazza, D. and Newton, J.M. 2013. Fertility-awareness knowledge, attitudes and practices of women seeking fertility assistance Journal of Advanced Nursing 69 (5):1076-1084. doi: 10.1111/j.13652648.2012.06095.x.

Respect – Professionalism – Caring – Committed – Collaboration Associate Nurse Unit Manager Dialysis/Chemotherapy

15 U LY 2 0 V O LU M E 2 3 , N O. 2 / A U G U S T 2 0 1 5 O. 1 / J E 23, N

Nurses and midwives putting a stop to domestic violence

Australia

References

22/07/2015 4:24 pm

ANMF.ORG.AU/MEMBERS/REGISTER

Part time (0.8FTE)

Summary Applicants are invited from suitably qualified and experienced RNs interested in an ANUM position within the Dialysis/Chemotherapy unit.

Swan Hill District Health, ‘My Hospital’ Work/life balance is what you get working at Swan Hill District Health.

As well as lifestyle comes: • Advanced training opportunities • A professional and committed workforce • Variety in work and a sense of achievement for the community

We are located on the mighty Murray River, around 3.5 hours from Melbourne.

Swan Hill is a safe place where you will be greeted with a warm smile from our friendly local community.

• Our main street boasts a vibrant shopping district with high quality restaurants and no traffic congestion.

• You’ll find affordable housing, safe spaces for kids, swimming pools, quality education options and a healthy lifestyle.

• Imagine breakfast by the riverside, 18 holes at Murray Downs Golf Club, water skiing at Lake Charm and fishing for the mighty Murray Cod Want More Info?

For more information go to our website www.shdh.org.au or Ms. Gillian Mays, NUM on 5033 9342 or email gmays@shdh.org.au Closing Date: COB 20 July, 2016.

Applications should include names of three referees. A copy of the Position Description and HOW TO APPLY information is on our web site www.shdh.org.au Completed ‘Application for Employment’ form should be forwarded to the Human Resources department, Swan Hill District Health, PO Box 483, Swan Hill 3585, Victoria or email: hrmanager@shdh.org.au

Women’s Health – FOCUS LIZ BRUHN RN

Pregnancy Birth and Baby: 1800 882 436 www.pregnancybirthbaby.org.au

EXPERT ADVICE AND PEACE OF MIND IS JUST A CALL AWAY

By Liz Bruhn A team of specialised RDNS nurses are providing tailored advice and peace of mind for thousands of people around Australia who have recently become or about to become mums and dads.

The service is in the form of a new national telephone helpline staffed

by Maternal and Child Health Nurses (MCHNs) who say much of their reward comes from hearing and seeing very relieved callers expressing gratitude for advice and support from an experienced RN who may be many thousands of kilometres away.

Quite often it is a matter of simply normalising what they are experiencing and giving simple strategies that help their situation.

When necessary the nurse can see and hear the caller via a video call.

The enhanced Pregnancy, Birth and Baby helpline went live at RDNS on 1 December last year. The new service is an enhancement to the existing service which commenced six years ago.

Pregnancy, Birth and Baby helpline and its website are operated by Healthdirect Australia on behalf of the Australian Government Department of Health. The service operates from 0700-2400 hours (Eastern Standard Time) seven days a week with a callanmf.org.au

back service available.

The Pregnancy, Birth and Baby service commenced in 2010 following the Commonwealth Government Maternity Services Review (2008). The review identified the need to increase resources and support to women and families around pregnancy, birth and early parenting, particularly in rural and remote areas.

Last year the existing Pregnancy, Birth and Baby service was further enhanced with the addition of MCHNs, who are registered nurses and midwives, and also hold postgraduate qualifications in child and family health, with expertise in children up to school age.

These nurses provide a wellness model of care and advice for callers ranging from pre pregnancy through to parenting children up to five years of age. The professional counselling component of the service remains. To date approximately half of the number of calls to the Pregnancy, Birth and Baby helpline are pregnancy related; this is where the nurse’s midwifery expertise is utilised for these callers – and also those in the early postpartum period who need to talk to a midwife.

The RDNS maternal and child health nurses can also provide expert support to breastfeeding mothers

who call, especially those who have just been discharged from hospital with lactation not yet established.

These are the mothers that are most vulnerable to breastfeeding problems and are at risk of giving up breastfeeding when simple interventions from a professional can prevent this from occurring.

The enhanced service provides the option of accessing the service via a video call capability. This allows for the use of a variety of visual aids by the nurses for care of infants and early parenting.

QUITE OFTEN IT IS A MATTER OF SIMPLY NORMALISING WHAT THEY ARE EXPERIENCING AND GIVING SIMPLE STRATEGIES THAT HELP THEIR SITUATION With the enhanced Pregnancy Birth and Baby helpline now in its sixth month of operation, anecdotal evidence shows that callers are very happy with the service. This correlates with the last quarterly caller survey results that showed a large majority (96.8%) of callers to the helpline were satisfied overall with the service delivered, including over threequarters (79%) being ‘very satisfied’.

These results represent the highest level of satisfaction measured so far.

The large majority (96%) of the callers also reported that they were likely to use the helpline again, including over two-thirds (70%) being ‘very likely’.

Liz Bruhn is RDNS Team Leader, Pregnancy Birth and Baby Helpline

July 2016 Volume 24, No. 1 43

FOCUS – Women’s Health

PELVIC FLOOR EXERCISES FOR WOMEN TIPS AND TRICKS

By Janette O’Toole Discover your Personal and Professional Potential in Canberra with Mental Health, Justice Health, and Alcohol & Drug Services (MHJHADS) Are you a Registered Nurse, Social Worker, Occupational Therapist, Psychologist or Medical Officer? Do you have a specialist range of skills in the areas of Mental Health, Justice Health or Alcohol or Drug Services?

If you have answered yes to the questions above then we want to hear from you as we are recruiting now.

Do you know that Canberra is rated as the Number 1 City in the world to live?

The Canberra community has diverse culture and a population of 379,000 people with all the amenities of a city but without the stress.

Now for a little about us; the ACT Health Division of Mental Health, Justice Health and Alcohol & Drug Services (MHJHADS) delivers a broad range of acute and community services delivered through partnerships with community and other government organisations. There is a major focus on Consumer & Carer participation in all aspects of service planning and delivery. Our innovative Models of Care have been developed utilising a population health framework and are informed through extensive consultation, and designed to embrace best evidence practice to meet National Standards and the principles of Person Centred Care.

The range of specialises services includes programs in the following areas; • Child & Adolescent Mental Health Services (CAMHS) • ACT Wide Services • Adult Mental Health Services • Justice Health Services • Alcohol & Drug Services • Secure Mental Health Services For more information, please go to www.health.act.gov.au and click on: Employment – Current vacancies Jodie Bowden Manager - Service Development Mental Health, Justice Health and Alcohol & Drug Services Phone: 02 6207 6279 Mobile: 0407207800 Email: jodie.bowden@act.gov.au www.health.act.gov.au For more information visit http://www.canberrayourfuture.com.au www.actmentalhealthjobs.com

44 July 2016 Volume 24, No. 1

Over 4.7 million Australians experience bladder or bowel control problems (Australia Continence Foundation of Australia, 2011). Pregnancy and childbirth are both risk factors with one third of women experiencing urinary incontinence after childbirth (Boyle et al. 2012).

Pelvic floor muscle exercises (PFME) are beneficial in the prevention and management of incontinence (Hay-Smith et al. 2012). However, up to 40% of women are unable to perform an effective pelvic floor (PF) contraction following brief verbal instruction (Bump et al.1991). This highlights the need for high quality instruction when teaching PFME’s.

Tips to teaching PFME 1. Use a diagram or model of the pelvis 2. Provide verbal instruction on: • The role of the PF, where they are and how they work and how to do PF exercises. An example could be: ‘Imagine you are trying to stop yourself from passing urine and wind from your back passage. Squeeze around the openings and lift inwards’ • Encourage the woman to practice a few contractions Ask her to do this as strong as possible each time, but emphasise relaxed breathing throughout.

3. Use visual Imagery For example ask the woman to imagine…

• you are shutting the doors (urethra, vagina and anus) to a lift and going up to the top floor; • a string hanging from the vagina and you are trying to draw it up; • holding something inside the vagina that is slipping down’.

Each healthcare professional will use different imagery depending on what suits them and what is acceptable and understood by the woman.

4. Use physical feedback In sitting, ask the woman to be aware of her perineum resting against the chair and to draw up away from chair. This can be done in other positions using her own

hand or a folded towel against the perineum.

5. Perform a vaginal examination Whenever possible a visual observation by the healthcare professional should be performed.

When attempting a PFME, the perineum should draw inwards and the vagina and anus should close. Provide positive feedback if they are performing the exercise correctly.

6. Use visual feedback The woman can use a mirror to observe her perineum (as above) to provide reassurance that she is doing the exercise correctly.

7. Teach ‘the knack’ Encourage the woman to performing a PFME before and during any physical activity that increases intra-abdominal pressure, eg. coughing, sneezing or lifting.

This can reduce urethra and bladder descent (Peschers, 2001) and reduce leaking.

8. Provide a written leaflet

Common errors in performing PFME’s:

• straining and bearing down; • breath holding; • contracting other muscles, eg.

abdominals, inner/outer thighs and buttocks.

A basic program

The woman should carry out one set, three times per day. With one set consisting of: • 8-12 short contractions; • 8-10 holds of 3-10 seconds.

This is a generalised program.

PFME should be performed in different positions such as lying, standing or whilst walking. If this program is too easy or difficult the number of repetitions or holds should be modified accordingly.

Preventative advice and early intervention for women experiencing symptoms is important. It is important that healthcare professionals are able to teach women how to perform these exercises correctly. If the woman is persistently unable to perform a PFME further referral to a pelvic floor physiotherapist or continence advisor may be helpful.

Janette O’Toole is a Women’s Health/Pelvic Floor Physiotherapist at Better Health in Stanmore, NSW.

References The economic impact of incontinence in Australia Continence Foundation of Australia 2011 Hay-Smith J, Mørkved S, Fairbrother KA and Herbison GP (2008). Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane database of systematic reviews, (8):1-115.

Boyle R, HaySmith EJ, Cody JD and Mørkved S. (2012).

Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women.

Cochrane database of systematic reviews, (10):1-112.

Bump R, Hurt WG, Fantl JA et al 1991.

Assessment of Kegel exercise performance after brief verbal instruction. American Journal of Obstetrics and Gynaecology, (165):322-329.

Peschers, U, Vodusek, D, Fanger, G, Schaer, G, Delancey J and Schussler, B. (2001). Pelvic floor muscle activity in nulliparious volunteers.

Neurourology and Urodynamics (20): 269-275.

anmf.org.au

CALENDAR

JULY NAIDOC week 3 to 10 July. www.naidoc.org.au/ Lung Health Promotion Centre at The Alfred 13-15 July / 17-18 August – Respiratory Course (Modules A & B) 13-15 July – Respiratory Course (Module A) 20-22 July – Asthma Educator’s Course 28-29 July – Smoking Cessation Course P: (03) 9076 2382 E: lunghealth@alfred.org.au 21st International AIDS Conference 17-22 July, Durban, South Africa. www.aids2016.org/ 4th Asia-Pacific Global Summit & Expo on Healthcare 18-20 July, Brisbane, Qld. http://healthcare.global-summit.com/ asia-pacific/ International Conference on Neuro Oncology and Brain Tumor 21-22 July 2016, Brisbane, Qld. http:// neurooncology.conferenceseries.com/ Health Informatics Society of Australia 24th HIC Conference Digital health innovation for consumers, clinicians, connectivity, community 25-27 July, Melbourne Convention and Exhibition Centre. www.hisa.org.au/hic/ ANMF Vic Branch - Mental Health Forum: Advocacy 29 July, Carson Conference Centre, Melbourne. www.anmfvic.asn.au/eventsand-conferences DonateLife Week 31 July-7 August. www.donatelife.gov.au/

AUGUST International Academy of Nursing Editors Conference 1-3 August, London UK. http:// inane2016.com/ Active Ageing Conference 4 August, Swissotel Sydney.

The conference consists of presentations, panel discussions and hands-on workshops, to share the latest evidence on enabling approaches and strategies to implement them. http:// www.activeageingconference.com.au/

NETWORK Royal Women’s Hospital, ‘theatre staff’, 1980-1990 reunion Interested? Contact Leesa Samarin.

E: samarinl@optusnet.com.au Mercy Maternity Midwifery Group August 1976, 40-year reunion 20 August. Contact Carole Ellis E: ellisfam2003@yahoo.com.au or Marie Smith (nee Allen) E: mmars_20@ hotmail.com

Lung Health Promotion Centre at The Alfred 4-5 August – Influencing Behaviour Change – a formula 17-18 August – Respiratory Course (Module B) 18-19 August – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au International Day of the World’s Indigenous People 9 August Cystic Fibrosis Australia and New Zealand (CFANZ) Nurses Conference 10-12 August, Grand Chancellor Hotel, Launceston, Tasmania. Contact gaylene. bassett@ths.tas.gov.au Hyperbaric Technicians and Nurses Association 24th Annual Scientific Meeting 10-14 August, Hamilton Island, Queensland. http://htna.com.au/ moodle/ ANMF Vic Branch - Working Hours, Shifts and Fatigue Conference 18 August, Carson Conference Centre, Melbourne. www.anmfvic.asn.au/eventsand-conferences Endocrine Nurses Society of Australasia Annual Symposium Endocrinology: Transition through the ages 22 August, Gold Coast Convention Centre, Qld. www.ensa.org.au Healthcare Leaders Forum 23-24 August, Menzies Hotel, Sydney. http://healthcareleaders.com.au/ 28th Aeromed Australasia & College of Air & Surface Transplant Nurses Aiming higher reaching further 24-26 August, Queenstown New Zealand. www.aeromedconference. com/ or www.flightnursesaustralia.com. au/our-events-1 11th Conference of the Australian College of Nurse Practitioners (incorporating NursePrac ED) The centre of care 30 August-2 September, Alice Springs Convention Centre, Alice Springs. www.dcconferences.com.au/acnp2016/ home

OCTOBER

Midwives on Board! Education at Sea Riding the waves of contemporary practice and innovation 3-16 September, NCL Jade: Greek Island cruise departing Venice. www. educationatsea.com.au/conferences/ midwives-on-board-2016

Lung Health Promotion Centre at The Alfred 6-7 October – Managing COPD 24-25 October – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au

Deakin University School of Nursing and Midwifery invites you to hear about our innovative postgraduate degrees 6 September, 5.00-6.30pm, Melbourne Burwood Campus. www.deakin.edu.au/nursing-midwifery/ upcoming-events or Ph: (03) 9244 3059 Enrolled Nurse Professional Association Conference I can and I will. Watch me!

8-9 September, Novatel North Beach Hotel, Wollongong NSW. www.enpansw.org/ ANMF Vic Branch – Australian Nurses and Midwives Conference 8-9 September, Melbourne Convention and Exhibition Centre. www.anmfvic. asn.au/events-and-conferences Australasian Neuroscience Nurses Association Conference The jewel in the crown: keeping it safe in our hands 9-11 September, The Novotel, Brisbane. www.anna.asn.au Palliative Care Nurses Australia 6th Biennial Conference 11-12 September, Canberra ACT. www.pcna.org.au/conference XIX International Congress for Tropical Medicine and Malaria 18–22 September, Brisbane Convention & Exhibition Centre. http://tropicalmedicine2016.com/

Australian Disease Management Association 12th Annual National Conference Person centred healthcare: Achievements & challenges 20-21 October, Melbourne Convention Centre (MCEC). www.adma.org.au/ E: info@adma.org.au T: (03) 9076 4125 18th South Pacific Nurses Forum Through nursing excellence for universal health 31 October-4 November, Honiara, Solomon Islands. Contact Edward Iuhanisuna E: spnfsina@gmail.com or www.spnf.org.au

NOVEMBER Lung Health Promotion Centre at The Alfred 16-18 November – Asthma Educator’s Course 24-25 November - Smoking Cessation Facilitator’s Course P: (03) 9076 2382 E: lunghealth@alfred.org.au International Congress on Innovations in Nursing (ICIN) Conference 24-25 November, Parmelia Hilton Perth. Showcasing innovation and leadership in clinical practice, research and education. http://icinperth.com/

Australasia-Pacific Post-Polio Conference Polio: Life stage matters 20–22 September. Four Seasons Hotel, Sydney. This conference will facilitate better care and build international connections by bringing together health care providers, researchers, polio survivors, their caregivers and patient organisation representatives. www.postpolioconference.org.au

Ballarat University, Diploma of Applied Science 1986-1988, 30-year reunion 18 September, George Hotel, 27 Lydiard Street, North Ballarat from 2pm onwards.

Contact Paul Smith M: 0410 561 421 E: pcsmithrn@hotmail.com

Royal Melbourne Hospital, October 1976, 40-year reunion 8 October, Naughtons Parkville Hotel.

Contact mezzarankin@gmail.com or Kris Alderson (nee McGuigan) E: pjka@ozemail.com.au or Jane Beetham (nee Collyer) E: beethams@mmnet.com.au

Woden Valley Hospital, L Group, 35-year reunion 1-3 October. Contact Murray Harper M: 0448 211 059 E: dodgerlily21@ bigpond.com or search Facebook page Woden Valley Hospital L Group

Prince Henry’s Hospital 25-year reunion 22 October, 3-9pm, Bells Hotel, 157 Moray Street, South Melbourne.

Cost $38 per head (includes finger food and a complimentary drink, security and venue hire). Drinks at bar prices. Bookings essential. Dress is smart casual. To book go to http:// www.trybooking.com/JVEX Prince Henry’s Memorial Page reunion. This reunion is in honour of the hospital’s closure and demolition in 1991 (25 years ago). Go to Prince Henry’s

Princess Alexandra Hospital, Group 59C 30-year reunion 7-8 October. Contact Jenny Whittle (nee Dredge) E: jennydredge@hotmail. com or search Facebook page 59C Princess Alexandra Hospital Group

anmf.org.au

SEPTEMBER

memorial page: https://www.facebook. com/Princehenryshospital/ to share memories and old photos.

RAH, group 772, 40-year reunion February 2017. Interested? Contact Bronwyn Glitheroe (nee Deed), Anne-Marie McBride (nee Rogers), Helen Kirby (née Osborn) or Rhona Edwards (nee McGarrigle) E: rah772reunion@gmail.com or search Facebook page Rah772

Email cathy@anmf.org.au if you would like to place a reunion notice July 2016 Volume 24, No. 1 45

MAIL

LACK OF GRAD JOBS REMAINS AN ISSUE

I am in my final placement for the Graduate Diploma of Mental Health Nursing. I am also casually employed in a local mental health facility. I have been applying for permanent work since graduating from my Bachelor of Nursing (2011), approximately five years ago.

To date I have little hope I will ever get permanent work, despite continuing to improve my skills and participate in ongoing professional development. I was assured when I completed my Bachelor of Nursing, I would never be out of work. I gave up a permanent full-time position for unreliable, casual employment in a profession that fails to protect its members.

Individuals from overseas are continuing to be encouraged to come here to take up jobs that Australian nurses should be offered. I have witnessed advertisements on Facebook pages (Mental Health Nurse group) to come to work in Australia because we are “very short of nurses.” I have also observed and worked with nurses who have been sponsored to come to Australia. I keep asking myself, ‘why do they get the permanent work and I am abandoned?’

I GAVE UP A PERMANENT FULL-TIME POSITION FOR UNRELIABLE, CASUAL EMPLOYMENT IN A PROFESSION THAT FAILS TO PROTECT ITS MEMBERS. What is the rationale for allowing excessive numbers of enrolments in university nursing courses and bridging nurses courses, when we know there are a vast number of Australian nurses who are unemployed or like myself, struggling to survive on casual employment.

Why is our government allowing the immigration and subsidisation of wages of nurses securing employment to work here in Australia? And what is our union doing to stop this ‘carte blanche’ attitude to bringing in extra nurses and allowing our universities to continue enrolling excessive numbers into nursing courses? This problem is so out of hand that less than a third of nurses graduating in my year were offered TPPP’s, thus graduates were thrown to the wayside because they had no clinical experience. I went straight into post-graduate education thinking this would reduce the risk of unemployment. Not only have I been unemployed but I was forced to sell my home due to the lack of funds to pay the mortgage.

What I want to know is, when will anybody stand up and say “enough is enough” and do what is necessary to protect and support Australian nurses living in Australia?

RN, Vic Editor’s note: The ANMF has been working with key stakeholders including the government, healthcare providers and educational bodies to address the issue. While some progress has been made, the ANMF acknowledges more needs to be done and will continue to work on this issue to this end.

46 July 2016 Volume 24, No. 1

Part 2 MENTAL HEALTH

LAND THE SAFEWARDS PROGRAM IN QUEENS PUBLIC HOSPITAL ACUTE MENTAL HEALTH SETTINGS Meehan,

By Niall Higgins, Nathan Dart, Thomas Anderson and Lisa Fawcett Paul Fulbrook, Michael Kilshaw, Debra

NIALL HIGGINS

challenge is frequent, problematic, and a major factor that can Aggression during psychiatric hospitalisation more generally. An important protective for nurses and mental health services between nursing staff THof aggression is the strength of the therapeutic alliance limit the likelihood

Part

AL AL HE NTconsumers. and 2 ME

BRENDA

The continuing need to focus on good communication and teamwork are also integral to contemporary management of aggressive behaviour (Emmerson et al. 2007). The Safewards program, designed by Professor Len Bowers, Kings College London, offers the opportunity to reduce the frequency of these risks and harmful events resulting with keeping consumers and staff safer (Bowers et al. 2015). This is obtained by reducing the conflict originating to factors and finding alternative ways manage them to prevent flashpoints from arising.

evaluation focussed on how the implementation has impacted on conflict and containment indicators.

The overall evaluation has been carried out by the Royal Brisbane and Women’s Hospital mental health nursing academic office in collaboration with Service Evaluation Unit at The Park – Centre for Mental Health, Treatment, Research and Education and Queensland University of Technology, School of Nursing.

The aim of the research at Metro North Mental Health in Queensland was to introduce the structured Safewards program of 10 mental health nursing interventions in order to understand their impact compared with the traditional and approach of nursing assessment management of aggression. Ethics the approval was granted to conduct VER inpatient WE current study on general TPCH and INGofHO RBWH, wards psychiatric EA OFhas not H NURS Safewards Ipswich Hospitals.

LTY AR L HEALT CIA ATE specialised in NTA studied been SPE ME A RADU THE INS previously are currently extending weRG andDE units REMA THA ESS T toUN PR Health Mental EX Secure this NTS Units. N AND CARE Rehabilitation STUDE SIO

Niall Higgins is at the Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Brisbane and the University of Technology, Brisbane

and Lisa Fawcett TH Part 2 Nathan DartRoyal Brisbane MENTAL HEAL are both at the

ENTAL ING M NG SI MA STER cant Barry rs signifilth H NUR hea HEALT Ward and Sineaardd ing careerlicthaandt offe private ting, set

and Women’s Hospital, Metro North Hospital and Health Service, Brisbane and the Australian Catholic University, Brisbane Thomas Meehan is at The Park – Centre for Mental Health, Treatment, Research and Education, West Moreton Hospital and Health Service, Brisbane and the University of Queensland

HAPPELL

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PLAN their physical period. knowledge of HEALTHCARE groups break the Nurse Practitiocommittee was tion in fitness and participa Nicole staff, A physical health Today the clinic multidisciplinary s also improved. to link .au Butterfield developed with thrive with plans anmf.org ken, clinic processe te continues to student Associa gy is audits underta er physiolo and consum ns ners. This with exercise Clinical Service trialled and staff chronic conditio with general practitioalso provides held. The Physical – placements and projects.

Coordinator education sessionsheld in February t nursing led initiativepractice in Day self-managemen Trevor Parry Health Open the clinic 45 a model for clinical promotes the .indd the opening of and Centre; PhD Project has 16_Focus 2014 marked other settings nurses J June become an The Physical Health barriers to _ANM mental health Candidate – and has now 40-51 down nting importance of helped break and impleme University of annual event. consumers about in leading change focus engaging with ged ments with a Adelaide Project health, encoura and practice improve er centred care.

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References

implemented over Bowers, L., James, K., period between October 2015 and Quirk, A., Simpson, A., Stewart, D. and March 2016. The evaluation has Hodsoll, J. 2015 three recognised components, Reducing conflict and containment rates on process, impact and outcome. acute psychiatric wards: the project, data has Throughout The Safewards cluster as a collected on the number of staff been nursing randomised controlled lth trial. Internationaltal hea receiving education support; hours men Journal of Nursing choice. d, at unit level provided er e Studies, 52 care of supervision (9), 1412-22. reporte nsiv d inte program; number studentthe tosssupport on Available online at week delivere Cla nsive kno the program ofw period tent building tal www.sciencedirect.

Master an components of inte hing One com/science/article/pii/ in con men l and staff teac get toimplemented; ng lth successfully in S0020748915001601 us to dationa tal hea “Learni h other

Paul Fulbrook and Michael Kilshaw are both at The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane and the Australian Catholic University, Brisbane

LTH PROJECT: E PHYSICAL HEA LTH NURSING LED INITIATIV A MENTAL HEA

40

40-51_ANMJ

June 2016 Volume

23, No. 11 20/05/2016

June16_Focus.indd

5:25 pm

40

COVERING MENTAL HEALTH ISSUES I am writing to congratulate you on the fantastic coverage of mental health issues in the June 2016 issue.

I have found over the last few years there has been a smattering of articles that cover issues of mental health in a way that I felt relevant to my nursing work. However this changed with this issue! Well done!

This year, after five years as an RN, I transitioned from general nursing to postgraduate studies in mental health and it has been a rocky road.

During my undergraduate training I don’t recall any real work being done on mental health and found myself often at a loss when trying to assist people with mental health issues that arose when they presented with other issues to the ward environment.

We are moving forward with education and providing better grounding now, and the article on mastering mental health nursing filled me with hope. Master class intensive focus groups have such potential to support students and nurses in general when starting in mental health.

My personal experience has been that finding a holistic method of treatment is challenging at the best of times, but also very rewarding. Therefore it was interesting to read the ‘physical health project: a mental health nursing led initiative’, which is a great initiative that needs to be rolled out across the country as a necessary step forward.

We are facing budget cuts that will potentially hinder our ability to provide the care we feel we could provide, so if projects like this are rolled out we can address the physical health issues in a much more inclusive manner with our mental health nursing staff.

Paul Cooper, RN – Postgraduate

anmf.org.au

MAIL

LETTER OF THE MONTH

PROPOSED CHANGES TO SUPER WILL IMPACT Recent changes proposing amendments to rules around superannuation will affect many nurses in my situation. I am a single 62 year old nurse working almost full-time and I am one of thousands of women in the nursing profession who will be highly disadvantaged by the proposed changes.

I, like most, have a very modest super balance for all the reasons highlighted: • spending many years at home in a childrearing capacity; • working in sporadic part-time jobs in nursing and midwifery, recently maternal and child health; • very little capacity, prior to now to make extra superannuation contributions.

Now, in my 60s, I realistically have very few years to ‘top up’ my meagre balance. Last year I instigated changes in order to do just that by: • arranging to salary sacrifice to the current capacity, $35,000; • setting up a small Transition To Retirement fund (TTR), at a cost I might add; • taking a small pension from the TTR to compensate for the salary sacrificed income; • taking advantage of the tax free environment of the TTR and its earnings.

This has the potential to significantly enhance my financial position heading towards retirement , almost certainly meaning that I could be financially independent come the time, depending on me being able to work until I’m 70.

However the proposed changes mean I will only be able to salary sacrifice $25,000 per year. Taxing the TTR eliminates all the current advantages, rendering it pointless financially, to what I thought would be a proactive plan.

While I understand the principle of the proposals which is to prevent very high earners (greater than $250,000/year) and those with a capacity to use superannuation as wealth creation, and as a tax free environment, I feel very strongly that this does not apply to me and possibly thousands of others in a similar situation.

I earn about $100,000/year and have a very modest amount in superannuation, way, way less than $1.6 million and have very few years to make further contributions.

ALL NURSES HOWEVER TITLED SHOULD BE EQUALLY PROUD I write in response to the letter by ‘Rachel, EN’ in June’s ANMJ. When I graduated as a Registered Nurse Division 2 in 2007, I too was so proud to be able to finally write ‘RN2’ after signing my notes.

While studying for my degree in nursing, the title changed to EN, and although I was aware of the history of the enrolled nurse title, I too felt I was somehow being shamed as a lesser nurse.

When I graduated in 2010 as a Registered Nurse (or ‘Div 1’), I was proud again of my new title.

Having been an EN beforehand, I was aware of the difference university study made to my professional practice. I knew I was a good nurse when I was an EN, but I was restricted by what I didn’t know. As an RN with the past experience of being an EN, I am so much more aware of the significance of critical thinking skills, the ability to act on and teach from evidence-based research, and the importance of being aware of the breadth of knowledge and skills of the enrolled nurses and AINs for whom I am ultimately responsible when acting as the ‘nurse in charge’.

Yes, RNs and ENs are different. But when I was studying to be a Div 2, I remember being told to think of titles not as ranks, but as side-by-side: equally important but different.

To feel so ashamed at the title of ‘EN’ that you would wear your ID badge back-to-front is both misleading to your colleagues and patients, and a slur on your fellow ENs. You can be the nurse who shows us how skilled, competent and respected ENs should and could be. Wear your EN badge with the equal amount of pride that RNs wear theirs, and show the world what you’ve got to offer.

Elisabeth Hall RN, Vic

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.

While I acknowledge that change is needed, Mr Morrison has taken a sledge hammer approach to the issue. If changes are to proceed, consideration should be given to those in my position; a grandfather clause to assist my demographic to make a genuine effort to be financially independent.

I urge fellow colleagues to strongly lobby the federal government to amend the proposed changes for our cohort of workers.

Piri Davidson RN, VIC

anmf.org.au

July 2016 Volume 24, No. 1 47

MAREE

THE PLIGHT OF REFUGEES: HOW COMPASSIONATE ARE WE? Maree Burgess, ANMF Vice President

Well, it’s finally over after eight long weeks. The campaign trail has come to an end. The media scrutiny, claim and counter claim, street walks, policy debates, all over. We can all go back to our normal lives and learn to live with the new government; but who won?

I am not sure given this article was submitted well before the 2 July federal election poll. But what is certain is that as you read this article, the plight of refugees on Nauru and Manus islands will remain unchanged.

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

48 July 2016 Volume 24, No. 1

We are signatories to the United Nations Refugee Convention. We have obligations under the convention to offer a safe haven for people seeking refuge, but rather than comply with our obligations, we have politicised the future of these people and have turned our collective backs on them.

Many have likened the conditions for refugees on Manus and Nauru to those of concentration camps. During the ANMF Victorian Branch Delegates Conference in 2015, Marianne Evers moved the delegates to tears when she spoke of her experiences working on Nauru. She spoke about a man who came to her sobbing in the middle of

the night. As he lay in his stretcher, in a hot, vermin infested tent, a rat had bitten his big toe, its tooth piercing the nail and the bone. He wept with pain and grief, not just from the injury, but from despair at his life. Marianne found it difficult to comfort him and balance her role as a nurse, providing healthcare in an environment in which there was no care.

As I write, Immigration Minister Peter Dutton has been vitriolic in demonising refugees as illiterate, innumerate, likely to take Australian jobs and/or likely to extend the dole queues.

He has found the refugee debate an easy card to play.

It appeals to our collective fear as a nation, that we have limited resources and that we will be overrun by refugees.

This is nonsense, but plays out in the media and press as though it were a real threat. We have the resources not

just in dollar terms, but in our humanity.

We are a generous people.

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

The fiscal argument is simple. Why is it that the compassionate, humanistic argument is so much harder to understand?

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

In the years to come, Australia will be held to account for our inhumane response to the refugee problem. It is not a defence to proudly proclaim that we have ‘stopped the boats’ in the hope of reducing the drowning at sea. It is not a defence to ‘turn the boats back’ towards the persecution and fear from which they fled. It is not a defence to deny refugees a safe haven from well-founded fear of political, religious and racial persecution. It is not a defence that in a country with rich resources that we shift our responsibilities to our regional neighbours. It is not a defence that in their time of need, we turned our backs.

I implore this new government to restore the humane treatment of refugees in our region. To increase the intake of refugees languishing in refugee camps in Indonesia and Malaysia and restore the hope and dignity of people in our care. anmf.org.au

We do everything as if you are here You work hard caring for others; we work hard to care for you.

Your needs, your goals, your future.

You wouldn’t have it any other way. Neither would we.

Winner.

Best Growth Super Fund.

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