ANMJ March 2016

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CONTENTS

20

Directory 02 Editorial 03 News 04 Special feature

16

Legal 19 Feature – Enrolled nurses 20 Clinical update

26

Working life

30

Wellbeing 31 Professional 32 Focus – Indigenous health 33 Calendar 46

TAKING ENROLLED NURSING INTO A NEW ERA

Mail 47 Annie 48

16 26 33

anmf.org.au

March 2016 Volume 23, No. 8 1

Canberra

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

Front cover: EN Louise Dearman Photograher: Grant Nowell

Editorial

Melbourne & ANMJ

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Federal Secretary Lee Thomas

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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

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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.

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2 March 2016 Volume 23, No. 8

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EDITORIAL

Editorial Lee Thomas, ANMF Federal Secretary There seemed very little to celebrate when the recent Closing the Gap report card on Aboriginal and Torres Strait Islander Inequity indicated limited progress in six of the target areas, including health, this month.

The report showed life expectancy rates were off track with a 10 year discrepancy remaining between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. The report also indicated other health targets were yet to be achieved. But despite this some inroads have been made, which is encouraging.

ALSO TO BE PRAISED ARE THE GREEK ISLANDERS. DESPITE BEING IN ECONOMIC TURMOIL THEMSELVES THEY HAVE SHOWN EMPATHY AND SELF-SACRIFICE TO HELP THE MANY REFUGEES THAT HAVE COME TO THEIR SHORES. OF THE 900,000 REFUGEES AND ASYLUM SEEKERS THAT ENTERED EUROPE LAST YEAR MANY WERE RECEIVED ON THE GREEK ISLANDS.

To help reduce the gap Indigenous leaders believe a consistent approach to policy and funding, as well as a long term commitment despite changing governments, is required to allow for meaningful change to occur.

The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) Chief Executive Officer Janine Mohamed, in her response to the report, said that a united approach by Indigenous and non-Indigenous Australians was needed to address the issues. Speaking to the ANMJ, she said a culturally competent nursing and midwifery workforce was integral to improving health outcomes (see her comments in this month’s news section).

The ANMF continues to be a great supporter of the Closing the Gap campaign.

Additionally, we have worked closely and tirelessly with CATSINaM in supporting their objectives to ensure the best health outcomes are achieved for Indigenous communities as well as Aboriginal and Torres Strait Islander nurses and midwives. While the organisation has grown from strength to strength, there is much more that can be done and we will continue to support CATSINaM to this end.

In this month’s Focus section we have highlighted some of the impressive work nurses and midwives have done to help achieve the gap closing. This includes strategies to improve maternal health for Indigenous women and children, while other work involves improving cultural safety and cultural competence. Also discussed is the

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significant momentum that is happening in improving career pathways to increase Indigenous nursing and midwifery numbers.

Of late there has been significant media around asylum seekers, particularly children, living in detention in unthinkable conditions in Nauru. As I write this editorial nurses, doctors and medical staff at the Lady Cilento Children’s Hospital in Brisbane are steadfastly refusing to allow baby Asha, whom they have been treating, to be returned to the detention centre. The ANMF stands in solidarity with these health professionals who are acting on their moral and legal obligations.

The ANMF fully condemns the Federal government’s treatment of asylum seekers in off-shore detention centres. It’s time that Prime Minister Turnbull shows some compassion and humanely addresses the situation immediately.

Queensland nurse Helen Zahos is an exemplar of such compassion amidst a humanitarian crisis. Working with asylum seekers and refugees on the Greek Islands, Helen’s determination and kind-heartedness significantly made a difference to people in desperate need. Her story, on page16, is testament to us all.

Also to be praised are the people of the Greek Islands. Despite being in economic turmoil themselves they have shown empathy and self-sacrifice to help the many refugees that have come to their shores. Of the 900,000 refugees and asylum seekers that entered Europe last year many were received on the Greek Islands. Numerous Islanders gave up their work to rescue and care for people that arrived by sea. Rightly so, there are calls for the Islanders to be nominated for the Nobel Peace Prize.

As an advanced and civil society Australia needs to take a leaf out of the Greek Islands’ book. Our government must live up to its moral and legal obligation and treat every human with compassion and respect.

www.anmf.org.au

March 2016 Volume 23, No. 8 3

NEWS JOCELYN HOFMAN

ANMF DEFENDING REGISTERED NURSES IN AGED CARE The Australian Nursing and Midwifery Federation (ANMF) has declared its commitment to lobbying the need for registered nurses (RNs) to be on duty at all times within residential aged care facilities in the lead-up to a federal Senate Inquiry examining the structure of the sector’s workforce.

The Inquiry, which is being conducted by the Community Affairs Reference Committee, will investigate several key issues including the current make-up and delivery of the workforce, its future requirements, and ongoing challenges influencing attracting and retaining staff such as low pay.

The Inquiry follows on from a NSW Parliamentary Inquiry last year to determine whether the state’s current laws requiring at least one registered nurse be on duty round the clock across high care nursing homes should be retained. A subsequent report backed the retention of the law and made 17 recommendations in a bid to address the sector’s shortcomings, including bridging the wage disparity between RNs working in aged care and their public health system counterparts.

The ANMF believes the state of aged care has reached a critical juncture and is calling for solidarity to ensure dignity in aged care for residents, staff, and consumers. ANMF 4 March 2016 Volume 23, No. 8

“THAT’S MY BIGGEST FEAR. I BELIEVE IF WE’RE REMOVED, THE CARE STANDARDS IN AGED CARE WILL SHARPLY ERODE.”

Federal Secretary Lee Thomas said the rostering of RNs should be dictated by the high-care needs of residents rather than the discretion of aged care providers. “It’s scandalous that on any given night at a nursing home across the country, a single care worker with minimal training can be looking after 30-50 frail, vulnerable patients with complex, chronic conditions.”

Ms Thomas said RNs are responsible for carrying out many essential duties such as prescribing multiple medications, wound care, and providing palliative care.

She added that if RNs are removed from aged care it is almost certain patients currently able to be treated within nursing homes will need to be transferred to a hospital emergency department.

Registered nurse Jocelyn Hofman, who has worked in aged care for almost three decades, decided to speak out to protect the sector’s future during the New South Wales Nurses and Midwives’ Association’s (NSWNMA) RN 24/7 campaign last year. “We stood up and spoke up. This is not right,” she said of regulations being threatened.

“It’s going to compromise the quality of care that’s going to be delivered to our vulnerable residents.”

Jocelyn works at an aged care facility in the Blue Mountains in NSW. As the RN in

charge, she is responsible for 20 residents, a comfortable ratio in comparison to some other facilities.

Jocelyn welcomed the beginning of the Federal Inquiry, reiterating her stance that RNs are invaluable. “We are crucial in aged care because we are the ones who assess, plan, and implement the care delivered to residents. We provide leadership. We direct.

We support and supervise the care given by assistants in nursing (AINs) and registered care workers.”

Jocelyn said she was deeply concerned removing the requirement for RNs in aged care would open the floodgates to cutting corners. “That’s my biggest fear. I believe if we’re removed, the care standards in aged care will sharply erode.”

The ANMF has encouraged nurses, aged care workers, community groups, and consumers to become active contributors throughout the federal Inquiry.

Jocelyn echoed the calls, adding that the power of unity was “amazing”. “I felt in my heart that I had to speak up because it’s not right. As a registered nurse, it is our role to advocate for our sick and vulnerable because they have no voice. “I urge my colleagues in other states to do the same and I’m sure when we all speak up that we will have the power to make positive changes.” anmf.org.au

NEWS

TEMPORARY WORK VISAS PROBED The number of nurses and midwives holding 457 visas has been questioned in Federal Parliament.

Last month in Parliament it was revealed that 2,433 nurses and midwives currently hold 457 visas, as of 30 September 2015. Further data from the Department of Immigration and Border Protection indicated the top three source countries where 457 visa workers hailed from were the United Kingdom, with 705 visa holders, India with 522 visa holders, and the Philippines with 449 visa holders.

However, the amount of nurses and midwives holding 457 visas had continued to decline significantly in recent years. In 2012, data showed 4,275 nurses and midwives held temporary work visas. A year later the figure increased to 4,630, but by 2014 it was 3,451, and it now sits at just 2,433.

A Parliamentary Inquiry was launched in June last year to examine the impact of skilled migrant work programs on Australia’s workforce, with the Australian Nursing and Midwifery Federation (ANMF) providing extensive submissions and appearing before public hearings. The Inquiry has now been extended.

ANMF Federal Secretary Lee Thomas said the union was committed to safeguarding the employment of local nurses and midwives and continues to monitor and examine the issue.

NOW

2,433

NURSES AND MIDWIVES CURRENTLY HOLD 457 VISAS IN 2013

4,630

LOSING BIG IF PENALTY RATES ARE CUT Nurses and midwives working in Australia’s public hospitals would be more than $1,900 a year worse off if Sunday penalty rates were downgraded to Saturday rates, a report has found.

The report also revealed nurses, midwives, and aged care workers as a collective stand to lose more than $359 million per year if penalty rates are slashed by the government.

Commissioned by the Australian Nursing and Midwifery Federation (ANMF), the McKell Institute report underlines the impact cutting penalty rates will undoubtedly have on nurses and midwives who rely on the extra payments to make ends meet.

ANMF Federal Assistant Secretary Annie Butler said the findings demonstrate the negative impacts that would be faced by nurses and midwives if recommendations by the Productivity Commission (PC) to reduce penalty rates are implemented by the Turnbull government. “As this report finds, health is the ‘ultimate 24/7 industry’ with nurses, midwives and carers required to work inconvenient and unsociable hours, and weekends and nights, often during the busiest times in health and aged care settings.”

Ms Butler said while the Productivity Commission has for now only targeted the hospitality and retail sectors, the McKell report warns that reducing penalty rates in one sector will most likely flow-on to other industries. “With a growing shortage of qualified nurses to care for Australia’s rapidly ageing population, we need to recruit and retain nurses. That won’t happen if the government even considers dramatically reducing their wages by cutting their penalty rates.”

anmf.org.au

SCHOLARSHIP HONOURS RESPECTED NURSE Scholarship applications are now open for the Carol Friday Excellence Scholarship for Maternal and Child Health (MCH) Nurses to undertake a Master’s of Nursing Science in Child, Family and Community at La Trobe University, Victoria.

The annual scholarship is in honour of highly respected Victorian MCH nurse Carol Friday who was killed along with her son aboard Germanwings flight 4U in March 2015.

The state government funded scholarship recognises the important contributions Ms Friday made to her community throughout her career and her work to improve the conditions and practices for all Victorian MCH nurses.

Details about the 2016 Carol Friday Scholarship for MCH Nursing Excellence can be found at www.latrobe.edu.au/ scholarships/carol-friday-scholarship Applications close on 17 March 2016. The scholarship will be awarded on 22 April at the 2016 Victorian MCH Conference.

March 2016 Volume 23, No. 8 5

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NEWS

CURBING VIOLENCE IN NSW PUBLIC HOSPITALS

DILIGENCE IN INFECTION PREVENTION While the federal and Queensland state governments are boosting their response to the Zika virus in an attempt to reduce its spread, healthcare workers are being urged to be diligent with infection control precautions amid a climate of infectious diseases.

The Zika virus, first identified in 1947, was declared an international public health emergency by the World Health Organization (WHO) last month when it reached epidemic proportions in Brazil and was identified in 13 other countries, including in the pacific.

A health roundtable examining growing episodes of violence and aggression across NSW public hospitals has triggered the development of a comprehensive 12-point action plan in a bid to control the crisis.

Held last month, the roundtable evolved in direct response to escalating incidence of violence emerging in the state’s public hospitals.

Concern over the recent wave of attacks included the disturbing shooting by an alleged ice addict of a security guard and a police officer outside the Nepean Hospital in Sydney in January.

Organised by NSW Health, the roundtable engaged several key stakeholders, including the NSW Nurses and Midwives’ Association (NSWNMA).

Wide-ranging discussions at the meeting incorporated improved training for nurses who might be required to intervene in critical situations, the need to clinically assess and better manage substance-fuelled patients, and ways of working together with police and law enforcement agencies.

The resulting 12-point action plan agreed upon was viewed as a major step forward in improving protocols and procedures. It covered extensive strategies, including delivering an intensive training program for ED staff including nurses and security, establishing a working group to help boost the professionalism of NSW Health security staff and improve their response to patient aggression, recruiting and training further security staff, and improving incident management reporting systems.

The plan also pledged to establish a reference group of expert clinicians to develop specific patient management and treatment pathways for patients under the influence of drugs such as ice, and to work collaboratively with NSW Police to handle aggressive individuals presenting at public hospitals.

NSWNMA Acting General Secretary Judith Kiedja described the roundtable as a productive forum tackling a serious problem. “Given the escalating nature of these incidents and the fact they are occurring in both metropolitan and regional settings, as well as beyond emergency departments, we are all of the view that appropriately trained security staff are paramount.”

anmf.org.au

The virus can be transmitted to humans via the bite of an infected mosquito. Symptoms include headache, mild fever, chills, conjunctivitis, joint and muscle aches and rash. The virus is particularly a concern for pregnant women as it can be spread to the unborn child, causing birth defects.

While no cases of locally acquired Zika virus has been reported in Australia, there have been a number of Australians diagnosed with the virus across the country, with 13 cases reported in Queensland since 2014 at the time ANMJ went to print.

In response to the outbreak in the pacific the federal government has pledged $500,000 to the region in an attempt to stop the spread of the virus. The Queensland government is spending $400,000 to increase the capacity of laboratories to rapidly test for Zika virus in humans. It will also spend another $1million to develop a campaign to educate people on the role they can play to reduce the spread of mosquitoes.

“IN THIS CLIMATE, THE NEED FOR HEALTHCARE TO BE ABLE TO SAFELY WORK WITH PATIENTS WITH TRANSMITTABLE DISEASES HAS BECOME MORE IMPORTANT THAN EVER.” But Charles Sturt University’s School of Biomedical Science academic Jennifer Cox said healthcare workers also need to be diligent in their infection control practices to ensure their own safety and that of others.

Ms Cox said healthcare-associated infections had become the most common, preventable complication of healthcare delivery in the modern era but adding to the complexity was the impact of antibiotic-resistance and an unprecedented resurgence of infectious diseases such as Ebola and Zika viruses. “In this climate, the need for healthcare to be able to safely work with patients with transmittable diseases has become more important than ever.”

Yet Ms Cox highlighted that there was a substantial body of evidence to indicate healthcare workers were inconsistent in their application of infection control precautions, particularly hand hygiene.

From her recent studies on the role of microbiology education and the influence of clinical placement experiences on Australian nursing students’ infection control intentions and behaviours; she ascertained the understanding of underlying microbiological concepts influenced correct infection control procedures. “Without being able to apply microbiological knowledge to infection control decision making, that is apply knowledge in context, there is an inherent risk of incorrect application of infection control practices, “Ms Cox said.

She said the findings of her study will help the development of microbiology curriculum including redefining the meaning and assessment of infection control competence.

March 2016 Volume 23, No. 8 7

NEWS

CLOSING THE GAP CAMPAIGN HITS STUMBLING BLOCK Continuing efforts to bridge the health and life expectancy gap between Aboriginal and Torres Strait Islander people and nonIndigenous Australians is failing to make a meaningful impact, the government’s annual report card on Indigenous disadvantage has found.

Handed down in February by Prime Minister Malcolm Turnbull, the Closing the Gap report conceded this year’s results had been “mixed” and demonstrated targets to improve key areas such as health, education, and employment were not working.

The target to close the gap in life expectancy by 2031 was not on track, with a 10 year discrepancy still remaining, according to the report.

Similar attempts to halve the gap in employment by 2018 also fell short.

The government, which stressed some inroads had been made, pointing to progress in reducing the infant mortality rate and boosts in year 12 completion, pledged to intensify its response to the challenge.

Reflecting on the report, the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) Chief Executive Officer Janine Mohamed said major generational change could only be achieved through a united country.

Ms Mohamed said the Reconciliation Australia report, also released in

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February, was a crucial part of the landscape because addressing racism is paramount. “We need to get some of the fundamentals right in this country outside of health, which is a truly reconciled Australia. We need all of these things in alignment and the ground to be fertile for the gap to be truly closed.”

Ms Mohamed said she was pleased to see gains made in some areas of the Closing the Gap campaign, such as infant mortality rates.

She said nurses and midwives had an integral role to play in the push for change, listing workforce supply as one of the most important components.

“We talk a lot about service delivery but there is a workforce that has to deliver that and that workforce has to be a culturally competent workforce or it’s not going to deliver the services, or patients aren’t going to access those services.”

Indigenous leader Mick Gooda, one of the campaign’s Co-Chairs and the Aboriginal and Torres Strait Islander Social Justice Commissioner, said while improvements had been made over the past 10 years, new strategies were now required. “Health inequality has been a stain on our nation for far too long, but this generation has the opportunity to remove the stain and deliver health equality for Australia’s First peoples. There is no quick fix for improving Aboriginal and Torres Strait Islander health and wellbeing. We need

rock solid commitment with structures in place that will survive terms of government.”

Chairperson of the National Aboriginal Community Controlled Health Organisation (NACCHO) Matthew Cooke acknowledged that closing the gap remained a long-term project. He said measures to close the gap should focus on the expansion of Aboriginal controlled primary health services and programs, improvements in the delivery of medicines, and greater patient coordination between hospitals and primary healthcare providers. “It’s absolutely imperative that we continue to see commitments to programs and healthcare models that work – programs created by Aboriginal people, for Aboriginal people which involve them in their own health and support them to have brighter futures.”

KEY STATS LIFE EXPECTANCY

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79.7 years

Non-Indigenous males

73.7 years

Indigenous females

83.1 years

Non-Indigenous females

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NEWS

“IT’S ABOUT INTRODUCING OR INITIATING BETTER SYSTEMS TO MITIGATE THE RISKS ASSOCIATED WITH ISOLATED PRACTICE”

WORKPLACE SAFETY HIGHLIGHTED IN RURAL AND REMOTE The findings of a Coronial Inquest into the tragic death of a remote area nurse following a head-on collision in Western Australia in 2012 have renewed calls for greater support and protection for health professionals working alone.

Remote area nurse (RAN) Gonda Smith, better known as Connie, was killed in the crash while driving along Marble Bar Road, about 20 kilometres north of Nullagine, as a result of multiple injuries.

Ms Smith, the resident nurse at the small town’s clinic, had been in the process of transporting a farmworker who had suffered burns to the Nullagine airstrip so the Royal Flying Doctor Service could fly the patient to hospital.

During the trip, Ms Smith’s car collided head on with a Toyota Land Cruiser Ute travelling along the same road heading towards Marble Bar. The investigation into Ms Smith’s death concluded it was a “tragic accident” most likely caused by driver error.

The coroner commended the remote area anmf.org.au

nurse’s “willingness to go above and beyond to help others” but dismissed fatigue as a contributing factor despite acknowledging evidence of late night callouts on two previous nights making the deceased weary.

CRANAplus, who has lobbied for many years to highlight the inherent safety risks faced by single clinicians working in remote areas in a bid to improve systems, labelled the findings disappointing.

“We just felt it was a missed opportunity for the Coronial Inquiry to not make some recommendation that health services really do seriously look at how some of the risks can be alleviated for those who are working long hours on call,” said Geri Malone, CRANAplus Director of Professional Services and Chair of the National Rural Health Alliance.

Ms Malone acknowledged single clinician posts were a reality in many remote areas with small primary healthcare centres. She said fixing the issue was challenging, but stressed inroads could be made. “It’s about introducing or initiating better systems to mitigate the risks associated with isolated practice and making sure that the isolation factor is firstly identified and really good processes put in place to make sure there is back-up and support for that position, within the community and through management structures.”

Ms Malone also underlined the ongoing need for self-awareness. “What we need to learn is it’s about being really reflective.

Nurses who are in these locations and in these situations, it’s very easy for them to just be completely focused on getting the job done and sometimes their own health and safety is compromised.”

One of the valued management tools facilitated by CRANAplus is a 24-hour counselling program called Bush Support Services, which provides access to psychologists trained in issues surrounding isolated practice. “It really does provide that support from afar for health professions when the impact of the isolated context of their practice and the oft challenging decisions they need to make impacts on the individual,” Ms Malone said.

Similarly, the Australian Nursing and Midwifery Federation (ANMF) has been involved in tackling widespread safety issues affecting remote area professionals.

To respond to the growing concern over workplace violence in rural and remote Australia, the ANMF joined the Rural Doctors Association of Australia (RDAA), the Australian College of Rural and Remote Medicine (ACRRM), the Police Federation of Australia, the Queensland Teachers’ Union, and CRANAplus in establishing the Working Safe in Rural and Remote Australia Project.

A comprehensive literature review into the risks facing rural and remote professionals, including the prevalence of workplace violence, was undertaken in 2014 and was followed by the establishment of a website offering employers and professionals’ detailed information regarding effective strategies. The report revealed a need to develop reliable mechanisms for recording workplace violence, as well as a gap in the evaluation of violence prevention strategies.

The Working Safe Project continues to monitor the incidence of workplace violence in rural and remote areas and is committed to developing future policies.

March 2016 Volume 23, No. 8 9

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NEWS

NEW RN STANDARDS FOR PRACTICE RELEASED

ANMF NAtioNAl PrActice StANdArdS for NurSeS iN GeNerAl PrActice Australian Nursing and Midwifery Federation Standards funded by the Australian Government Department of Health

The Nursing and Midwifery Board of Australia has unveiled revised registered nurse (RN) standards for practice that will replace the current National Competency Standards for the Registered Nurse.

The NMBA, which regulates Australia’s 370,303 enrolled nurses, Registered Nurses, and midwives, has advised that the new standards will take effect from 1June 2016.

They replace National Competency Standards for the Registered Nurse first published in 2006 by the Australian Nursing and Midwifery Council (ANMC) and adopted by the NMBA at the start of the National Registration and Accreditation Scheme in 2010.

ANMF_Standards for Nurses_2014_v7.indd 1

4/12/14 11:35 PM

The new standards were developed following extensive literature and evidence reviews, gap analysis, a survey of RNs, interviews with RNs, observations of RNs in practice, and consultation with consumers and other stakeholders including education providers.

The seven standards include: 1. Thinks critically and analyses nursing practice 2. Engages in therapeutic and professional relationships 3. Maintains the capability for practice 4. Comprehensively conducts assessments 5. Develops a plan for nursing practice 6. Provides safe, appropriate and responsive quality nursing practice 7. Evaluates outcomes to inform nursing practice The NMBA stresses each criteria is to be interpreted in the context of each RNs practice and that the criteria are not exhaustive and enable rather than limit the development of individual nurse scopes of practice.

ORGAN DONOR REGISTRATION MOVES ONLINE

Australians will soon be able to register to become organ donors in less than ten minutes via a one-step process online.

The streamlined registration system, due to start in May, will be stimulated by awareness campaigns that include engagement on social media.

Eight years ago, the federal government embarked on a drive to increase organ donation and transplantation across the country.

Currently, 7% of Australians are registered organ donors, or 1.8 million people of the country’s 24 million population. Notably, about 4.3 million people have at some stage signalled their desire to become a donor but have not completed the paperwork required under the existing system.

The government is hopeful the simplified method will boost donations and ultimately help save lives.

“If this change results in the 4.3 million people who have previously signalled an intention to become an organ donor complete registration, we could quickly triple the donor pool and save more lives,” said Rural Health Minister, Fiona Nash.

The new online system comes off the back of the government commissioning an independent organ donation review last May to examine why Australia is ranked just 22nd in the world for organ donation.

There are currently 1,600 Australians on the waiting list for some sort of organ at any one time.

Tragically, 50 Australians die each year waiting for an organ.

“We had to develop standards for practice that reflect the contemporary role of the registered nurse in Australia,” Ms Bryce said. “The new standards clearly articulate the standard of practice expected by all RNs.”

The DonateLife audit from last September shows family consent rates to allow donation to go ahead are 91% when the deceased had registered as an organ donor, but only 42% when the deceased had failed to register nor discussed their wishes with family. Progress is being made, however, with Australia continuing to improve its organ donation and transplantation rates.

Ms Bryce encouraged RNs to brush up on the new standards before they come into effect in June. “They’re an essential component of RNs regulated Professional Practice Framework, which also includes the NMBAs registration standards, codes, and guidelines.”

The Australian Donation and Transplantation Activity Report 2015, released in February, showed Australia increased its donation rate by 14% from 2014.

The revised RN standards were released together with similar updates for continuing professional development (CPD), recency of practice, professional indemnity insurance, and endorsement as a nurse practitioner.

New South Wales recorded its highest ever number of deceased organ donors in 2015, with 127 people making a difference.

Key changes in these areas involve the requirement for midwives with an endorsement for scheduled medicines to complete an additional 20 hours of CPD being dropped to 10 hours, and nurse practitioners being required to demonstrate recency of practice at the advance practice nursing level to retain endorsement.

The 127 donors enabled 379 organs to be transplanted and surpassed the previous record of 102 in 2013.

ANMF Senior Professional Officer Julianne Bryce, a member of the project team charged with developing the standards, described the review as “an extensive and essential piece of work.”

anmf.org.au

March 2016 Volume 23, No. 8 11

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NEWS

PASSION FOR NURSING BURNS ETERNAL A registered nurse pivotal in the medical response treatment of dozens of burns victims in the aftermath of the 2002 Bali bombings has retired after almost 50 years in the profession.

Alison Mustapha, a pioneer in establishing a burns unit at the Royal Darwin Hospital in 1997, left her final post in February after spending the past 22 years as a leading burns nurse actively raising awareness, providing clinical education, and delivering crucial treatment.

“I started with nothing and now we have a nationally recognised burns service,” she said proudly. “I’m just grateful that people in the Territory a long way away from the big cities can still get essential treatment for burns.”

NATION’S HEALTHCARE EXAMINED The cost of delivering publicly funded healthcare in Australia has increased by more than $1,000 per person over the past decade, according to a new report.

The Productivity Commission’s annual Report on Government Services (RoGS), released last month, showed combined spending from federal, state, and territory governments on health rose from $4,788 per person in 2004/5 to $6,248 wider health picture, the commission found $44.4 billion was spent on public hospitals in 2013-14, or $1,905 per person nationally, up from

anmf.org.au

DURING THE MEDICAL RESPONSE TO THE BALI BOMBINGS

Alison began her career in Victoria, working as an enrolled nurse (EN) for 16 years, before moving to South Australia and taking up a position with the Royal Adelaide Hospital’s Burns Unit. After climbing the ladder as far as she could go Alison decided to embark on a tree change and relocate to Darwin.

Not long after, Alison approached the hospital’s director of nursing and proposed establishing a specialised burns service. The pitch was received positively and ultimately led to the critical burns unit so valued today.

Asked about the unique qualities a burns nurse must possess, Alison said a broad knowledge was indisputable. “You need to have a bit of experience in a lot of areas of

nursing. The psychological side is hugely important. Being able to deal with people who are totally traumatised, you need to be able to understand what they’re going through.”

Alison’s skills faced their greatest test when news of the Bali bombings emerged back in 2002. Bali’s proximity to Darwin, coupled with the high regard for the Royal Darwin Hospital’s burns service, motivated the transfer of 62 patients to the unit.

Alison recalled everyone from cleaners to gardeners chipping in to help out with the effort. She was awarded an Order of Australia Medal (OAM) for her efforts in coordinating the medical response, and said the defining experience remained rewarding.

$1,692 in 2009-10. In 2013-14, nurses comprised the largest group of full-time staff employed in public hospitals, at 5.6 per 1,000 people. The report lists the objectives for public hospitals as providing safe and high quality acute and specialist services that are affordable, timely, and accessible.

department waiting times across the country, the commission found the ACT delivered the poorest response, with just 59% of patients seen on time. New South Wales and Victoria were the only states to better the national average, with 81% and 75% of patients being seen on time respectively.

One component of the report assesses emergency department waiting times, breaking the area into five triage categories ranging from patients who need to be seen immediately to nonurgent cases where a patient needs to be seen within two hours.

Nationally, emergency department patients waited an average of 18 minutes to be seen. The Commission’s snapshot of other health services showed that 85% of patients were bulkbilled by GPs, while 5% of patients did not visit their GP because of concerns over cost. Similarly, despite $7.1 billion being spent on prescription medicines, the report found 7.6% of Australians delayed or did not buy medicine because of the cost. Nationally, federal spending on mental health services rose from almost $169 per person in 2005/06 to $210 in 2013/14, with 2% of people reporting using state-government run mental health services.

National figures in 2014-15 showed 100% of patients in triage category 1 were seen immediately, and 79% of patients in triage category 2 were seen within the clinically appropriate 10 minute timeframe. For all triage categories combined, 74% of patients were seen within the appropriate waiting times. Comparing emergency

March 2016 Volume 23, No. 8 13

NEWS

NARELLE MARTIN AND PATIENT SHANE GORDON, 16, AT BEAR COTTAGE

AUSTRALIAN NURSES REVERED Nurses were recipients of this year’s Australia Day awards. The ANMJ shares worthy recipients, Narelle Martin and Anne Carey’s, stories.

By her own admission, nurse unit manager Narelle Martin’s lifelong commitment to caring for children is unquestionably innate.

“I was always passionate about caring for children from a very early age,” Narelle said.

Narelle followed in the footsteps of her older sister to pursue nursing, undertaking her training at the Royal Alexandria Hospital for Children in Camperdown, which later relocated to Westmead. “It’s very rewarding and a lot of fun working with kids. Kids are so resilient and they don’t whinge about things like adults do. They take it as it comes.”

For the past 15 years, Narelle worked at Bear Cottage, the only dedicated children’s hospice in New South Wales. The hospice looks after children from birth to age 19 with life-limiting conditions and was one of 14 March 2016 Volume 23, No. 8

“I THINK THERE’S A REAL NEED TO DEVELOP A FACILITY SPECIFIC FOR YOUNG PEOPLE FROM 16-30 THAT ARE STRUGGLING WITH END OF LIFE.

the pioneers of paediatric palliative care in Australia when it first opened its doors.

families and this year also plans to start a grandparents’ support group.

Narelle’s service to nursing, particularly her unwavering efforts at the facility, recently saw her recognised with an OAM (Medal of the Order of Australia) as part of this year’s Australia Day honours.

“The strength that children have in dealing with adverse situations and the strength of the parents and the siblings is incredible to see,” she said. Narelle believes nurses are still largely undervalued and considers her honour as an encouraging boost for the entire profession. But she believes she’ll be able to walk away from her career one day soon knowing she’s made a difference to someone’s life in a positive way.

“It was a huge surprise to me because I just do something that I’m passionate about,” Narelle said. “Working at Bear Cottage isn’t difficult. Obviously it has its hard times, but on the whole it’s not difficult for me because I believe in it so much and the work we do and I’m rewarded everyday by the difference it’s making to children’s families.”

Narelle said working at Bear Cottage was inherently different to nursing in a mainstream hospital setting, with a positive mental attitude essential in the face of inevitable death. The centre provides ongoing bereavement support to

Before then though, she hopes to continue her current work and is keen on driving the development of a young people’s hospice.

“I think there’s a real need to develop a facility specific for young people from 16-30 that are struggling with end of life.

They have their own needs. They’re not old people and they’re not children. They’re stuck in the middle and there’s nothing for them.” anmf.org.au

NEWS

CULTIVATION OF MEDICINAL CANNABIS IN AUSTRALIA LIKELY Landmark legislation that would allow the legal cultivation of cannabis for medicinal or scientific purposes has triggered robust debate across the country.

HUMANITARIAN NURSE NAMED WA’S AUSTRALIAN OF THE YEAR When Australian Red Cross aid worker, registered nurse Anne Carey, signed up for a new mission to tackle the Ebola outbreak in West Africa in 2014 she wasn’t certain of returning home.

“I went in thinking that I wasn’t entirely sure if I was going to get back,” she recalls. “But I felt it was still the right thing to do.”

A nurse for more than three decades, Anne has worked on and off for the Red Cross since 2000, undertaking missions in between nursing across a variety of settings. In fighting Ebola, Anne spent six months in Sierra Leone heading up treatment centres alongside thousands of other volunteers .

Ebola has now been contained but in the grip of the outbreak more than 11,000 people lost their lives.

“When I first got there it was really quite hard because the world response had been low. There was an 80% death rate. It was quite sad,” Anne said. “As I stayed I had a lot of hope that we’d be able to beat the virus and it was great I stayed long enough because at the end of January and February it was in the recovery stage.”

Anne’s bravery in fighting Ebola resulted in the Esperance nurse being named Western Australia’s Australian of the Year in late January. The honour also saw her vie for Australian of the Year, which eventually went to General David Morrison.

“I was surprised that I got nominated and then very surprised that I was the recipient for Western Australia,” she said. “For me, it’s just good to recognise the work of humanitarians around the world, but also for nursing and midwifery. I don’t think it’s an award for myself, I think it’s an award for all nurses and midwives around the world.”

Anne left school at 14 and found nursing in her late teens. She has experienced the diversity of nursing throughout her career, including working with Aboriginal communities in the Northern Territory, and midwifery in Papua New Guinea. “I’m happy to work in everyday stuff but I think it’s nice to step outside the square to realise that it’s quite hard for people in communities and overseas and rural areas in Australia.

Aware of her time in the spotlight as an Australian of the Year finalist, Anne said she hopes to use her newfound prominence as a platform to stamp out workplace bullying. “We spend a lot of time at work and I’ve seen it too often go unnoticed. I’ve witnessed it first-hand as well as to a lot of other people.”

Anne believes people experiencing bullying often don’t have access to support or the appropriate procedures to address the problem. “I think something has to break that open a little bit because there’s so much bullying.

Unless people put in a Unless people put in a grievance they walk away.”

Anne is currently raising funds to help support those who courageously worked in Sierra Leone To support her cause visit: http://makingadifference.gofundraise.com.au/page/ebolafundraiser anmf.org.au

Introduced to Parliament last month, the Bill proposes establishing a national licensing and permit scheme to supply medicinal cannabis to patients with painful and chronic conditions.

With current laws prohibiting the growing of the plant, Australian researchers and patients undergoing clinical trials have long been forced to access international supplies.

The government believes the passing of the Bill will ease the burden on Australians suffering painful and chronic conditions and lead to better health outcomes. Federal Health Minister Sussan Ley described the development as, “the missing piece in a patient’s journey” and one which she hopes will help shift outdated stigma surrounding the use of medicinal cannabis.

The progress of the controversial Bill prompted mixed reactions from various corners. Opposition Health Minister Catherine King said Labor had been lobbying for a national licensing scheme for six months and was pleased the government had finally listened.

However, the Opposition was quick to point out gaps in the proposed Bill, suggesting clearer guidelines regarding decriminalisation for people possessing and using cannabis for medicinal purposes must be first outlined.

Elsewhere, Palliative Care Australia (PCA) welcomed the new Bill, declaring it would afford researchers, and eventually doctors, greater certainty of what is in the medication.

“If we have an Australian product we have the means to ensure all the elements of the drug are known,” PCA Chief Executive Officer Liz Callaghan said.

Sydney Associate Professor Richard Chye, Director of Palliative Care at St Vincent’s Hospital, said the new legislation would also remove current barriers to research.“ “If there was an Australian product, we could know much more about THC/CBD levels, what else is in it and ensure all the elements of the drug are known.”

While acknowledging the cannabis Bill was a step forward, Australian Greens leader Dr Richard Di Natale said it wouldn’t have any impact on changing the fact that cannabis is considered an illegal drug unable to be prescribed by a doctor. “Creating a national framework for cultivation and manufacture is an important step but the final test for any reform is whether it will get this medicine in the hands of everyone who needs it.”

March 2016 Volume 23, No. 8 15

SPECIAL FEATURE

HUMANITARIAN CRISIS A ROLLER COASTER RIDE FOR AN AUSTRALIAN NURSE

The Greek islands neighbouring Turkey are grappling with a major humanitarian crisis as refugees fleeing from Syria, Afghanistan, Iraq and neighbouring countries descend on the small islands.

Australian nurse Helen Zahos spent the past 10 weeks working at the coalface of the crisis, doing what she could to help refugees in desperate need of care and support.

Working off her phone in Greece Helen shares her frank account and personal experiences with the ANMJ. As I sit here in a quiet cafe in Greece sipping on a hot chocolate I have some time to reflect on the last 10 weeks, which I can only describe as a roller coaster ride.

Late August I saw images on social media of the unprecedented humanitarian crisis that was unfolding; masses of refugees fleeing Syria, Afghanistan, Iraq and neighbouring 16 March 2016 Volume 23, No. 8

countries descending on the small Greek islands neighbouring Turkey.

A country already experiencing financial turmoil, Greece was being flooded with overwhelming numbers of refugees. Being of Greek descent, a registered nurse and paramedic, I felt compelled to go and help when I saw the reports of the injured and lack of medical support available on the ground.

In the six weeks leading up to me going I decided to raise funds via an online

crowd funding site. Not expecting much of a response I was overwhelmed by the generosity of the people that donated as within weeks $20,000 was raised for medical supplies and equipment.

The plan was to join the Médecins du Monde Greece team on the Island of Lesvos, and later move onto the border of Greece and FYROM (Macedonia).

My very first day on Lesvos Island I had just been picked up from the airport by a team anmf.org.au

SPECIAL FEATURE

UNACCOMPANIED MINORS WERE TURNING UP THAT HAD LOST THEIR PARENTS ON THE JOURNEY. THERE WERE MANY DISABLED, BLIND AND MAIMED.

member when a call was received. Over 3,500 refugees had arrived on the other side of the island in the last three hours.

There were reports of injuries and help was needed. We headed straight for that side of the island to assist.

The buses were not running as the police were overwhelmed with arrivals of refugees and had forced the buses to stop. This left refugees, in wet clothes and winter cold weather, to hike the 10km up the mountain to the bus stop, to then be informed no buses were running, only to then be faced with a 65km walk to Morya registration camp situated on the other side of the island.

Many of these people were carrying children.

I had asked why we could not drop people off in our car. I was told we would be charged with human trafficking of illegal immigrants if we were caught. After assessing a number of injured people we realised that the greatest need for these refugees were blankets and clothes as the sun had set and they had to sleep on the side of the road. We organised for 500 blankets to be distributed that night. We joined forces with two other organisations and drove around handing women and children, that were asleep on the side of the road, blankets.

We didn’t get back to the hotel until 3am only to start on the morning shift the following day…so began my time on Lesvos Island.

Every day there were tales of tragedy, anmf.org.au

there were frequent drownings after boats capsized; people injured prior to arriving with wounds from bombings and shootings; chemical burns from the rubber boats they sat in due to leaked oil and fuel; pneumonia from spending nights sleeping out in the winter cold; swollen blistered feet from walking kilometres over mountains in wet shoes. Unaccompanied minors were turning up that had lost their parents on the journey.

There were many disabled, blind and maimed. They all had a story of survival from the war they had fled and the treacherous journey they endured. It became clear that no matter what the reason for leaving, this particular way of travelling was absolute hell and no one would choose this way of fleeing unless they absolutely had to do so and their life depended on it. The children were the most difficult to watch suffer. The days when they were out in the cold and rain for up to three days with no change of clothes broke my heart. It was rewarding to be able to change them into dry clothes, organise blankets, food and supplies to get them through to the next part of their trip to the port of Mytillini and then to Athens. Their journey would take weeks to months from the time they fled their country, many days on foot carrying what little to no belongings they had.

One of the worst nights was the big boat accident on 28 October at approximately 5pm where 300 people were involved. The top deck of the wooden boat collapsed due to the rough waves. Five people in wheelchairs drowned instantly, 11 infants

and 27 adults died. We still had 150 people lost at sea at 2am that following morning and with rough seas and freezing conditions we lost hope of any more survivors. We set up a church as a hospital and were treating patients in there overnight. Even the priest and his wife were running around organising clothes and blankets and cups of tea. In between treating patients I was comforting mothers and helping them search for their lost babies, knowing full well that they were probably one of the 11 drowned. I never let them lose hope as I helped them search through the crowds of survivors. In the following days I helped in the morgue assisting the parents identify their children, including a mother who lost her five year old twins. The mother’s words I will never forget, she said: “We left to give you a chance in life from the war and we killed you ourselves instead”. I tried as best as I could to reassure her the accident was not her fault. She told me she did not want to get on the overcrowded boat but the man on the Turkish border had put a gun to her head and said if they did not get on board the boat he would shoot her and her children.

Some of the hardest days were spent on Lesvos Island where I welcomed refugees.

Idoumeni on the border of Greece and FYROM was different, here I said goodbye and bid the refugees farewell and safe travels. Things at the border were calm. We were averaging seeing 260 patients a night as refugees got off buses and crossed the border into FYROM. March 2016 Volume 23, No. 8 17

SPECIAL FEATURE HELEN ZAHOS WITH ONE OF THE INFANTS

SOON REFUGEES FROM COUNTRIES NOT ALLOWED TO PASS IN PROTEST BLOCKED THE PATH FOR ALL PEOPLE WANTING TO PASS INCLUDING SYRIANS. FIGHTING AMONGST THE REFUGEES BEGAN WITH WEAPONS INCLUDING BATONS, KNIVES AND EVEN ROCKS WERE BEING USED.

Then the inevitable happened. The border closed last week only occasionally opening to Syrian Afghans and Iraqi refugees. All other refugees/migrants were refused entry.

A large fence was soon erected on the FYROM border. Iranian refugees sewed their lips in hunger strikes to protest and after several days rioting and looting. People were hungry and cold after days of waiting at the border, and still buses kept arriving with more and more refugees that were not able to pass.

Soon refugees from countries not allowed to pass in protest blocked the path for all people wanting to pass including Syrians.

Fighting amongst the refugees began with weapons including batons, knives and even rocks were being used. During one of these days more riot police arrived and we were preparing for an onslaught. While we were waiting away from the chaos I received a call from a journalist screaming at me down the phone that a man had been electrocuted on the train tracks and he was burning. By the time the doctor and I got there it was too late. The man, a Moroccan about 20 years of age, had died. I was left to deal with concealing the body from photographers and supporting his grieving and shocked brother. Suddenly the group of 10 men surrounding us turned into 100 as word got out that the man had died. As I finished zipping up the body bag a group of eight men picked him up onto their shoulders, then the crowd started chanting. The police had no control of the situation as they were outnumbered. The group stormed off with the body to the border to show everyone and the worldwide media what this situation of closing the border had done. An accidental death, the man had climbed up on the carriage of a train not realising you don’t have to touch the power lines to get electrocuted.

The man’s death caused an eruption amongst thousands of refugees and 18 March 2016 Volume 23, No. 8

suddenly tear gas and rubber bullets were being sprayed in our direction. Losing the doctor in the crowd, I climbed up a small hill over the train tracks and headed up through a field. As I made my way towards where our medical van was parked, a man was carried out onto the road from the crowd.

He was laid down in front of some police vehicles and as I walked towards him I saw he was frothing at the mouth and nostrils in an altered conscious state. As I leant over to check his airway I saw he was breathing and was affected by the tear gas. I looked up to try and get the team’s attention in the van and saw a man take two steps towards me and swing. I was suddenly hit to the face with a metal pole. There was no reaction. I was stunned. I still had my hands on the patient but I had severe pain in my jaw and could taste blood. As I remained kneeling I thought about lying back but I was alert enough to stay in control and remain kneeling. I started spitting out blood.

The man that hit me circled again but refugees started yelling at him. He kept saying “Police” but another man yelled out “Doctor”.

He came over raising the pole again and then the look on his face when he realised I was not the police, I will never forget it.

He was mortified. He lowered the pole and kept saying “Sorry! Sorry”! Then he came and kissed me on the forehead and held me. A woman took off her scarf and wiped the blood off my face but by then the tears started rolling and I cried. A young man patted me on the forehead and kept saying “Sorry my sister”. He helped me up and walked with me to the medical van. The police nearby ironically did nothing, there were eight of them and four fireman sitting in a vehicle. I cried at that moment more for the overwhelming kindness and the response by the refugees. I now have five stitches in my mouth. The x-rays revealed no fractured jaw and I am sore and tender. I cannot feel any anger for the man that did this. I understand that there was fighting happening at the time. I am here for one more month, I agreed to stay and help cover the Christmas holidays as they do not have staff.

This experience has been life changing as I have been a part of events that were history in the making and I am proud to have been an Australian volunteering over here. I had raised money for medical supplies and medications campaigning prior to leaving and saw firsthand the difference that these supplies made to a country already crippled in a financial crisis and overwhelmed by this humanitarian calamity. anmf.org.au

LEGAL

DOCUMENTATION IS CRUCIAL DEFENDING CLINICAL DECISION MAKING Linda Starr

Documentation is an integral component of patient care.

There are a number of common errors in documentation practices such as illegibility, inconsistencies, ambiguity, lack of dates, times and signatures.

However, a more subtle omission that can threaten the integrity of case notes and the quality of your practice is not only a lack of entries but also insufficient detail to support the statements and clinical decisions you have made.

This can be particularly problematic when your practice is scrutinised years after an event and you are unable to recall the detail surrounding the decisions you made regarding patient care at the time. This was the case when a medical officer’s goals and orders regarding end of life care became the focus in a recent coronial inquiry.

Ms Heims was a 79 year old widowed woman with no children who lived in supported accommodation due to her physical fragility and numerous health problems. From 2006 Ms Heims had consistently expressed a wish not to have life prolonging treatment should she acutely deteriorate in health.

Reference Finding into Death Without Inquest 2015 Victorian Coroners Court.

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

Her general condition had been deteriorating for some time and she was admitted to hospital on 5 October 2008 for assessment of her pain management and mobility needs. She died in hospital 31 December 2008.

During her admission her condition fluctuated from times when she was independent and eating well to days when she had high care needs, requiring assistance and suffering pain and lethargy which left her bed bound. On 27 December 2008 her condition began to deteriorate rapidly.

There were two entries in her notes the next day, the first by the nursing staff recording her MO’s direction that she was not to be transferred to another hospital and that her Not for Resuscitation order should be noted.

The second entry was by the treating MO indicating that he had had a conversation with Ms Heims who told him she wanted to die and ‘this is no way to live’. He wrote in her record: “My impression is that she is starving herself to death - she is a very strong willed lady & I am not happy to let her die such a ghastly death - so my plan - as discussed with Sheila - is to give her morphine to relieve her pain &

midazolam to sedate her, to save her being aware of her dehydration & the mental anguish she is experiencing.

This is a difficult situation but Sheila has chosen her course - I just don’t want her to be distressed & in pain as she dies. Hence the morphine & midazolam orders. *She said she did not want me to ring Pam *(Ms Heims sister).”

He then ordered large, regular doses of Morphine (IM 30mgs 6 hourly) and Midazolam (IM 15mgs 6 hourly), and further doses as required. On the 29th Ms Heims was unarousable and a nursing decision was made to withhold this medication. On 30 December the MO discovered that these drugs had not been given and ‘expressed outrage’ that the nurses had not followed his orders, demanding that they be followed in future. According to the patients notes the nurses complied but were unhappy in doing so. On 31 December 2008 the MO increased the dose of Morphine to 45mgs and Midazolam to 30mgs with hyoscine 400mcg as required.

Ms Heims died later that day having received two doses of the increased amounts of these drugs: the death certificate stated acute renal failure and cardiac failure (1wk) as the primary cause of death. At the time there was no report to the Coroner and so, there was neither toxicology nor autopsy performed.

In 2013 the Coroner received a letter from Nagambie Health Care outlining concerns they had about this MO’s end of life decision making and dosing practices following a peer review of five of his patients including Ms Heims. The result of that review suggested that Ms Heims’ death ought to have been reported to the Coroner due to concerns that she may have been prescribed and administered a potentially lethal dose of both Morphine and Midazolam.

There was also concern expressed about the lack of multidisciplinary team involvement and the fact that the nursing staff followed the medication orders raising questions about their duty of care, although no further comment was made regarding this latter point.

The Coroner sought advice from the Coroners Prevention Unit which agreed that the doses were large for someone with such limited symptoms, however concluded that the management appeared to be within reasonable grounds.

An investigation by the Victorian Homicide Squad concluded that there was insufficient evidence to support any criminal charges being laid against the MO. However, a palliative care specialist reviewing the case raised concerns about the absence of detail in the medical record. There were in fact only four entries made by Ms Heims treating MO during her admission, and no recorded evidence by any staff member that she had complained of or showed any other evidence of pain.

In conclusion this specialist felt that whilst the treatment may have been appropriate the gaps in practice and documentation made it unclear as to what the goals of the treatment regime were and felt unable to comment on the intentions of the MO in this case.

During his non-arrest interview with the Homicide Squad, the treating MO denied any wrongdoing and was unable to recall why he made various decisions including increasing the medication dosage, but claimed he would only have done so for valid reasons. He acknowledged that the lack of entries failed to support his memory but argued that the notes were not an accurate record of her treatment suggesting that they had been tampered with providing evidence through Medicare billing records that he visited the patient on 54 occasions during this admission.

This argument was rejected by the Coroner.

Ultimately the Coroner was unable to establish the precise cause of Ms Heims’ death concluding it was equally possible that the cause of death was due to the administration of the drugs, or acute renal and cardiac failure. Nonetheless the Coroner was concerned about the poor record keeping that impeded the coronial investigation and may have reflected deficiencies in the clinical management of Ms Heims resulting in the notification of the practitioner to AHPRA. This case serves as an important reminder that challenges to our clinical care may be difficult to defend in the absence of clear recorded rationales for clinical decisions made. This is even more important in complex legal and ethical matters such as end of life decisions where the patient is unable to verify their wishes and what they might have said has been poorly documented.

March 2016 Volume 23, No. 8 19

FEATURE LOUISE DEARMAN, PHOTO: GRANT NOWELL

FEATURE

TAKING ENROLLED NURSING INTO A NEW ERA As a new team takes the helm to champion the enrolled nursing workforce, major changes are reshaping the foundations of enrolled nursing education and practice in Australia. Together, these developments are working to strengthen the future of enrolled nurses - our nation’s ‘essential nurses’, writes Karen Keast.

L

ouise Dearman is an enrolled nurse at North Eastern Health Centre in Adelaide, where a nurse-led clinic was established about 10 years ago.

Louise is passionate about enrolled nursing, so much so that she recently put up her hand to become the national face of enrolled nurses as President of the National Enrolled Nurse Association of Australia (NENA).

While enrolled nurses are renowned as our healthcare system’s ‘essential nurses’, who partner with registered nurses to deliver more direct patient care, enrolled nurses often concede there’s an unwarranted stigma attached to the role.

“The minute you announce you’re an enrolled nurse you are stigmatised. People go - ‘you’re just an enrolled nurse’,” Louise says. “I actually still hear myself say - ‘I’m just an enrolled nurse’ because you hear it so much from so many different places that you just start to refer to yourself as that.

“Then you walk away and think - ‘no, I’m not just an enrolled nurse, I am a well educated member of the nursing fraternity’.”

Louise says while many experienced registered nurses appreciate enrolled nurses as a skilled and knowledgable part of the nursing workforce, she finds the stigma emanates from some corners of the nursing profession. It also stems from other health professionals and the wider community.

It’s a stigma Louise wants to stamp out.

Enrolled nurses should be judged on their merit, she says.

“Enrolled nurses are a valuable member of the nursing fraternity, who are well educated and who can go on and

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develop their scope of practice.

“A lot of enrolled nurses are so knowledgeable and their skill sets are amazing, and every nurses’ scope of practice is very different in accordance to the role that they’re doing and the education preparation that they’ve had for that role,” she says.

“You can’t just box all enrolled nurses in the one box and say ‘an enrolled nurse is an enrolled nurse’ - you’ve got to look at their history, their knowledge base, their skill base and their scope of practice.”

Enrolled nursing

Enrolled nurses have transformed the landscape of nursing care provision since the second level practitioner role was first introduced in Australia under the title of ‘nursing aides’ in 1950, and later replaced with ‘enrolled nurses’ in 1981.

Over the years, the enrolled nursing workforce has flourished. The Nursing and Midwifery Board of Australia’s (NMBA) September 2015 quarterly statistics show almost 60,000 enrolled nurses are now registered to practice in Australia, while an extra 5,043 are concurrent enrolled nurse / registered nurse or dual enrolled nurse / registered midwife.

Enrolled nursing practice has also evolved in the past decade. A growing number of enrolled nurses, and all new graduates, are now educated to administer medicines. While enrolled nurses are required to work under the supervision of registered nurses, enrolled nurses can also support and supervise other workers and students in some contexts.

Commonwealth Chief Nurse and Midwifery Officer Adjunct Professor Debra Thoms says

enrolled nurses are a vital part of the health workforce at a time when the sector faces increasing challenges.

“As we go forward into the future, we need to have a workforce that works well together,” she says. “In general, we have seen that registered nurses and enrolled nurses do work well together, they work in a very complementary and collaborative way.

“In acute care but then also working across the continuum, as people move through different parts of the health system, there’s opportunities for enrolled nurses but I think it is challenging at times for everybody to have a full appreciation of what enrolled nurses can contribute.

“We’re meant to be using all the workers within our healthcare system and we are going to need them in the future, so I think it’s important that we look at people like enrolled nurses, who are a good flexible nurse to have in the workforce.”

Louise, who began her career working in country hospitals before spending the last 15 years in general practice, says enrolled nurses provide more hands-on care.

“It’s all about giving that direct care to the patient - facilitating their care, being their advocate, and those are all the things I love about being an enrolled nurse,” she says.

“As an enrolled nurse, you have a closer connection with the patient because you actually get to spend the time with the patient.”

Major changes

Behind the scenes, several pivotal initiatives are redeveloping the backbone of enrolled nurse education and practice in Australia.

March 2016 Volume 23, No. 8 21

FEATURE

LOUISE DEARMAN WITH PATIENT, PHOTO: GRANT NOWELL

Late last year, the Health Training Package was reviewed and updated, new Standards for Practice for enrolled nurses were unveiled, while the accreditation standards to assess and accredit enrolled nurse programs are now being revised.

The Australian Nursing and Midwifery Federation (ANMF) also unveiled its new National Practice Standards for Nurses in General Practice, which builds on the NMBA’s Standards for Practice, and features an accompanying Toolkit to assist both enrolled nurses and registered nurses as well as general practices.Together, the changes aim to strengthen enrolled nursing education and practice while ultimately resulting in the provision of better patient care.

Health Training Package

The recently defunded Community Services and Health Industry Skills Council released a new National Health Training Package for the enrolled nursing qualification, the Diploma of Nursing, in December.

ANMF Federal Education Officer Jodie Davis is Chair of the National Vocational Education and Training (VET) Committee and a member of the Training Package Advisory Committee for the Health Training Package and the Community Services Training Package.

Ms Davis says the review adds medications including intravenous medications into the core of the Diploma of Nursing for enrolled nurses, creating a better course. “It’s a much more comprehensive course, the assessment criteria in it is much more rigorous than was previously available. I would presume that graduates from this course will come out and be more work ready and able to hit the ground running.”

22 March 2016 Volume 23, No. 8

Concerns the transition time to introduce the new package could mean a two year delay in registered training organisations (RTOs) being able to produce qualified enrolled nurses prompted nursing stakeholders, including the ANMF, to take action in a bid to guarantee an uninterrupted supply of enrolled nursing graduates.

“The Australian Skills Quality Authority’s (ASQA) rules said once a qualification is superseded you’ve only got 12 months to finish off your enrolments and completions and then you must be teaching the new course,” Ms Davis says.“We were alerted to the fact that that was going to result in a huge impact on RTOs and the enrolled nurse workforce.

“Some of the major stakeholders got together and approached ASQA and got a transition for the old qualification to the new qualification.

“There were a lot of providers out there that were really concerned about that and they can rest easy that there is now a two year transition time, so they can still take enrolments into the old course while they’re mapping their new course.”

The Australian Nursing and Midwifery Accreditation Council (ANMAC) has developed a transition tool from the old package to the new package, available on its website, that works to assist providers to be compliant with the accreditation standards for education delivery.

Standards for practice

In October last year, the NMBA published its Standards for Practice for Enrolled Nurses.

The update comes more than five years after the move to national registration and is designed to ensure the standards reflect contemporary evidence-based practice for enrolled nurses.

The standards, which came into effect in January, define the core practice standards that provide the framework for assessing enrolled nurse practice. It replaces the National Competency Standards for the Enrolled Nurse, which was first developed in 2002.

The new standards state enrolled nurses engage in “analytical thinking; use information and/or evidence; and skillfully and empathetically communicate with all involved in the provision of care, including the person receiving care and their family and community, and health professional colleagues”.

The standards acknowledge while the scope of practice for each enrolled nurse will vary based on the context and their education, enrolled nurses have the capacity to provide direct and indirect care, engage in reflective and analytical practice, demonstrate professional and collaborative practice, and, where appropriate, can educate and support unregulated healthcare workers when it comes to the provision of care.

Petrina Halloran, a registered nurse and policy manager for the NMBA, says the broad and principle-based standards set the benchmark to assess enrolled nurses’ competence to practise. “The document sets the minimum standard that the NMBA would expect and that the public would expect of enrolled nurses. anmf.org.au

FEATURE “Education providers use them for developing curricula, they are used for assessing students and new graduates, they can also be used to assess enrolled nurses who’ve been educated overseas and want to apply for registration here.

“They’re used to assess enrolled nurses if they’ve been away from the profession for a while and want to return to practice and they’d also be used in the event that we’re required to do a performance assessment if there’s been a notification,” she adds.

“The standards belong to the profession - they belong to enrolled nurses and they are the key document that guides their practice.”

The NMBA embarked on a comprehensive evaluation process, including public consultation and observation of enrolled nurses in practice, to develop the new standards. As part of its communication and recruitment process, it consulted more than 3,000 nurses and midwives across all states and territories and contexts of practice.

“WE HAVE CALLED ON THE FEDERAL GOVERNMENT AND THE WORKFORCE SECTOR TO CONTINUE TO WORK DILIGENTLY WITH STAKEHOLDERS TO ENSURE THAT WE HAVE AN ADEQUATE NUMBER OF WELL-SKILLED NURSES IN THE SYSTEM ACROSS ALL SECTORS TO ENSURE QUALITY CARE.” LEE THOMAS

Ms Halloran says the end result is a more relevant and user-friendly document with just three domains - professional and collaborative practice, provision of care, and reflective and analytical practice.

While the standards have many similarities to the previous document, the new version includes some minor changes designed to reinforce the role of the enrolled nurse, with the update highlighting the importance of the registered nurse’s supervisory role for the enrolled nurse.

“What we say about that is enrolled nurses need to have a named and accessible registered nurse at all times,” Ms Halloran says. “The registered nurse doesn’t have to be physically located in the same place as the enrolled nurse but they do need to be contactable, so we talk about direct and indirect supervision in that space.”

The standards state direct supervision is “when the supervisor is actually present and personally observes, works with, guides and directs the person who is being supervised” while indirect supervision is when the supervisor works in the same facility or organisation as the enrolled nurse but does not constantly monitor their activities.

“The supervisor must be available for reasonable access,” it states. “What is reasonable, will depend on the context, the needs of the person receiving care and the needs of the person who is being supervised.”

The revised standards also clarify the point that enrolled nurses are accountable for the delegated care they provide and that they retain responsibility for their actions in delivering care.

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“THE DOCUMENT SETS THE MINIMUM STANDARD THAT THE NMBA WOULD EXPECT AND THAT THE PUBLIC WOULD EXPECT OF ENROLLED NURSES.” PETRINA HALLORAN

“THE REVISED ENROLLED NURSE ACCREDITATION STANDARDS, TOGETHER WITH NEW NMBA STANDARDS FOR PRACTICE AND NEW NATIONAL HEALTH TRAINING PACKAGE FOR DIPLOMA OF NURSING PROGRAMS, MEAN GRADUATES FROM ENROLLED NURSE PROGRAMS WILL CONTINUE TO BE SUITABLY PREPARED FOR CONTEMPORARY PRACTICE” FIONA STOKER

March 2016 Volume 23, No. 8 23

FEATURE LOUISE DEARMAN WITH PATIENT, PHOTO: GRANT NOWELL

Ms Halloran says it’s important both enrolled nurses and registered nurses read and familiarise themselves with the new standards, available on the NMBA’s website.

Enrolled nurses should apply the new standards to their practice, and can also refer to the standards for self-assessment and use them when determining their ongoing professional development needs, she adds.

Accreditation standards

ANMAC, the independent accrediting authority for nursing and midwifery programs of study that lead to NMBA registration or endorsement, last year began the process of reviewing and updating accreditation standards to assess and accredit enrolled nurse programs.

With the current accreditation standards developed seven years ago, the standards are being revised and updated so they continue to meet the National Law’s objective of protecting the health and safety of the community by ensuring “only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered”.

ANMAC released the first consultation paper with the review of the Enrolled Nurse Accreditation Standards in October last year. Since then, it’s been working with an expert advisory group, with expertise in areas including consumer advocacy, clinical practice, regulation as well as continuing and higher education, while also garnering 24 March 2016 Volume 23, No. 8

widespread stakeholder feedback.

The review is consulting with stakeholders on a range of factors, including specifying a minimum of 400 hours of workplace experience in enrolled nurse programs and proposing education program providers assess whether students meet a minimum level of English language skills prior to undertaking workplace experience.

With several months of further consultation and fine tuning ahead, the new standards are expected to be submitted to the NMBA for approval and then launched later this year.

ANMAC CEO Fiona Stoker, a Clinical Professor with 40 years’ experience in the nursing sector, says while ANMAC works to protect the public, the new accreditation standards will provide guidance to education providers in the design and delivery of enrolled nurse programs so that graduates meet the NMBA’s enrolled nurse Standards for Practice.

“The revised Enrolled Nurse Accreditation Standards, together with new NMBA Standards for Practice and new National Health Training Package for Diploma of Nursing programs, mean graduates from enrolled nurse programs will continue to be suitably prepared for contemporary practice in the Australian healthcare context,” she says.“This high quality education and training, assures the public and the community will receive care from suitably trained and qualified enrolled nurses.”

Clinical Professor Stoker says initial consultation in the review has been aimed at improving the links between enrolled nurse education and the nation’s health priorities, alongside the particular needs of communities. “The other area we are strengthening is program content with links to safety and quality principles as outlined in the Australian Safety and Quality Framework for Health Care.”

Clinical Professor Stoker says while ANMAC works to protect the public, it also supports nurses and midwives - ensuring that they’re highly educated, highly qualified health practitioners who can practise competently and ethically. “Having a robust accreditation framework ensures Australia can be held up as having high quality nursing and midwifery education, resulting in enrolled nurses, registered nurses, nurse practitioners and midwives that meet the NMBA Standards for Practice.”

Standards for general practice

The ANMF released its new National Practice Standards for Nurses in General Practice last year. The standards, a project led by the ANMF with the University of Wollongong as its research partner, details best practice standards for both enrolled and registered nurses working in general practice, a growing area of employment for nurses.

Unique to the general practice setting, the 22 standards of practice are featured under the four domains of nursing practice - professional anmf.org.au

FEATURE practice, nursing care, general practice environment and collaborative practice.

“THE STANDARDS GIVE THAT CLARITY AND THEY ALSO ALLOW OTHER STAKEHOLDERS TO SEE THE MUCH BROADER SCOPE THAT NURSES CAN WORK TO” JULIANNE BRYCE

ANMF Senior Federal Professional Officer Julianne Bryce says the standards clarify the role and scope of practice of enrolled and registered nurses working in general practice.

“Primary healthcare is an expanding area, there are more nurses moving into work in the area, and it’s really important for there to be clarity about how the nursing team works in general practice - how registered nurses and enrolled nurses work together in that environment. The standards give that clarity and they also allow other stakeholders to see the much broader scope that nurses can work to, so that they’re not limited to a small amount of activities that can be billed under the Medicare Benefits Scheme.

Instead, they can deliver the care that the community needs.”

The ANMF also recently launched a revised Standards Toolkit to accompany the standards. Both resources are now available on the ANMF website.

“The toolkit has an assessment tool within it that the enrolled nurse can use to assess themselves against the standards to see whether they’re meeting the standards and to determine what they might want to do from a CPD perspective to enhance their practice,” Ms Bryce says.“The toolkit enables them to meet standards that they’re not currently meeting.”

The toolkit also includes support documents for general practices looking to employ enrolled nurses, from sample advertisements to job descriptions and interview questions.

Workforce concerns

In 2014, Health Workforce Australia (HWA) released the ‘Australia’s Future Health Workforce - Nurses’ report to project the nation’s future nursing workforce requirements from 2012 to 2030.

“I THINK WE NEED TO WORK ON HIGHLIGHTING WHAT WE DO RATHER THAN WHAT WE DON’T DO.” SIOBHAN BIDGOOD

The report not only projected a shortfall of about 109,000 nurses in 2025, it also featured data that showed only 55% of enrolled nurse graduates were immediately entering employment as a nurse compared to 85% of registered nurses. HWA analysis of the early exit of nurses from the workforce found while the exodus for registered nurses was high in the early working years, enrolled nurse exit rates were high across all ages.

With HWA axed under the 2014 federal budget and its work transferred to the Department of Health, the ANMF says new data is needed to gain a better understanding of whether enrolled nurses are getting jobs, taking on further study or leaving the profession.

ANMF Federal Secretary Lee Thomas says it is vital Australia has a well consulted, live and futuristic health workforce plan. “Health workforce planning is not something where you can take your hands off the wheel.

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You’ve got to keep your eye on the ball you need to be constantly assessing and reassessing what’s actually happening in the workforce and predicting what you’re going to need, where the shortfalls are, and that’s across all sectors.

“We have called on the federal government and the workforce sector to continue to work diligently with stakeholders to ensure that we have an adequate number of well-skilled nurses in the system across all sectors to ensure quality care.”

The National Institute of Labour Studies is now examining the labour force in aged care. Its research project aims to provide new evidence and recommendations for policy makers and aged care providers on how to attract, retain and up-skill workers, with its report expected to be released later this year.

Ms Thomas says the review will shed some much-needed light on the assistant in nursing (AIN), enrolled and registered nursing workforce in aged care.

“It will be the third study that they’ve specifically had into aged care. It’s going to be very telling,” she says.

Championing ENs

A new executive committee was recently unveiled for NENA, the peak body representing enrolled nurses. The committee plans to breathe new life into the national organisation that works to advance and promote the value of enrolled nurses.

Siobhan Bidgood, an enrolled nurse who has spent most of her 30-plus career working in mental health, is the newly elected secretary of NENA. Siobhan, who works at Melbourne’s St John of God Pinelodge Clinic, says NENA gives enrolled nurses, whether they’re students, clinicians, managers or educators, an amplified voice. “NENA is there to reach out to enrolled nurses.

“We’re there for ENs. Let us know what you want and we’ll try to meet that challenge.”

Siobhan has joined Louise on the expert advisory group for the review of the enrolled nurse accreditation standards, providing representation for enrolled nurses in the fundamental changes.

Siobhan says it’s time enrolled nursing is seen as a career path in its own right.

“People shouldn’t feel that to be a real nurse they need to be a registered nurse,” she says.“I think that people need to start thinking about what it means to be an enrolled nurse and to talk about the value of that role rather than seeing it as a diminished form of nurse.

“I think we need to work on highlighting what we do rather than what we don’t do.”

March 2016 Volume 23, No. 8 25

CLINICAL UPDATE

References ANZDATA 2013.

Appendix B: Prevalent Data 2012. Table: B2, 20 December 2013 Available from www. anzdata.org.au/v1/ report_2013.html 9cited 2 January 2014 Brown, L. and Harvie, B. 2010. Nephrology nurse practitioners: making a difference. Renal Society of Australasia Journal no. 6 (3):101 Brown, M. A., Crail S. M., Masterson R., Foote C., Robins J., Katz I., Josland E., Brennan F., Stallworthy E. J, Siva B., Miller C., A. Urban K., Sajiv C., R. Glavish N., May S., Langham R., Walker R., Fassett R. G., Morton R. L., Stewart C., Phipps L., Healy H., and Berquier I. 2013. ANZSN Renal Supportive Care Guidelines 2013.

Nephrology no. 18 (6):401-454. Campbell, S., and M. Duddle.

2010. Health literacy in chronic kidney disease education. The Renal Society of Australasia Journal no. 6:26-31.

Chanouzas, D., Ng K. P., Fallouh, B. and Baharani J. 2012. What influences patient choice of treatment modality at the pre-dialysis stage?

Nephrol Dial Transplant no. 27:1542-1547.

Cho, Eun Jin, Hayne Cho Park, Hyun Bae Yoon, Kyung Don Ju, Hwajung Kim, Yun Kyu Oh, Jaeseok Yang, Young-Hwan Hwang, Curie Ahn, and KookHwan Oh. 2012. Effect of multidisciplinary pre-dialysis education in advanced chronic kidney disease: propensity score matched cohort analysis. Nephrology no.

17:472-479.

Cowan, D., Smith, L., and Chow, J. 2015.

Care of a patient’s vascular access for haemodialysis: A narrative literature review. Journal of Renal Care. de Leur, K., Çigdem Öztürk, Michiel L. P. Van Zeeland, Hans G. W. de Groot, Jan M. M. Heyligers, Patrick W. H. E. Vriens, Gwan H. Ho, and Lijckle van der Laan. 2013. Vascular access outcome in the elderly dialysis patient in combination with the quality of life. Vascular and Endovascular Surgery no. 47:444-448.

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CLINICAL UPDATE

UNDERSTANDING THE JOURNEY TRAVELLED BY PATIENTS AND CARERS LIVING WITH END STAGE KIDNEY DISEASE AND HAEMODIALYSIS

By Debi Cowan Patients living with chronic kidney disease (CKD) have complex clinical needs requiring evidence based nursing care. Often the focus of evidence based care is towards interventions that are readily demonstrated to be effective through interventional trials.

People experiencing CKD however, require nursing and healthcare that goes beyond the available quantitatively biased evidence base.

Care required needs to incorporate a deep recognition of the ecology and relationships that influence decision making and outcomes of care.

The prevalence of chronic diseases including CKD, in our societies are strongly anticipated to increase due to an ageing population and extended life expectancy, which has already resulted in frailer elderly populations (Abdelhafiz et al.

2013). Although through timely and appropriate management of their CKD and multiple co-morbidities, not all patients living with CKD will experience a decline of their kidney function, to end stage kidney disease (ESKD). Many patients with advanced CKD carry a heavy burden of co-morbidities and as a result, around 50% of this population die from cardiovascular disease before reaching ESKD (Cho et al. 2012).

Importantly then, CKD-ESKD has become a global socio-economic epidemic (Paraskevas et al. 2010).

By the end of 2011, with a worldwide population of seven billion people, it was estimated that around 2,786,000 patients were living with ESKD and undertaking renal replacement therapies (Fresenius Global Services, 2011). In Australia of the 9,219 patients living with ESKD and receiving haemodialysis therapy in 2012, a 3% increase from 2011, there were 51% of patients aged 65 years and older including 27% of patients aged 75 and older (ANZDATA, 2013). Patients’ lives become burdened with the chronicity and complexity of kidney disease and multiple co-morbidities such as diabetes, peripheral cardiovascular disease, reduced cognitive function – dementia (MacPhail et al. 2012); as well as complex time consuming treatment regimens and travel to and from treatment (Moist et al. 2008).

When combined this frequently results in complete life changing experiences, which often has anmf.org.au

devastating effects on the patient and their family and friends as well as their carer(s) lives (Kastrouni et al. 2010).

Management

Patients living with CKD travel through five stages of their disease as they progress towards ESKD. These stages are related to their estimated glomerular filtration rate (eGFR) as a measure of kidney/renal function (Sood et al. 2015), aligned with patient’s age (Hallan et al. 2012) and symptom burden (Jansen et al. 2013).

IT IS IMPORTANT THAT THE PATIENT HAS A VOICE IN DECISIONS MADE ABOUT THEIR CARE, EVEN WHEN THE INDIVIDUAL DISPLAYS REDUCED COGNITIVE FUNCTION Ideally, during the early stages of CKD, usually considered as stages one to three of kidney disease/ dysfunction, patients experience management of their CKD by primary care professionals - their local general practice doctors and practice nurses. It is the aim of primary healthcare management of CKD to provide interventions to slow down the decline and preserve the patient’s residual kidney function (Campbell and Duddle, 2010; White et al. 2010), and manage and treat symptoms of CKD and co-morbidities such as diabetes, hypertension and cardiovascular disease. As CKD progresses, the patient’s symptom burden increases and they are generally referred to a nephrologist’s care (Johansen et al. 2013). The patient along with their family and friends, whose roles as carers include supporting patients in their daily lives (Godbold, 2013) are involved in healthcare education supporting

their decision making processes.

Importantly the patient and their family/carer(s) require individualised healthcare planning, education and information disseminated to meet their own needs (Moustakas et al.

2015). Notably, a patient’s cognitive function may decline in conjunction with their deteriorating kidney function and increasing symptom burden (Campbell and Duddle, 2010).

When CKD progresses through stage three and early stage four patients and family/carer(s) are faced with decisions that influence the course of the rest of their lives choosing between conservative or interventional ESKD care.

At all times, none more so when considering life altering decisions, it is important that the patient has a voice in decisions made about their care, even when the individual displays reduced cognitive function (MacPhail et al. 2015).

Patients and family/carer(s) may choose conservative care based on medical management without initiating renal replacement therapies (RRT). The patient’s CKD is managed through renal supportive care processes, coordinated through the role of a renal specialist supportive care clinical nurse (Josland et al. 2012). Renal supportive care processes include a holistic approach by a team including multidisciplinary healthcare professionals, the patient and their family and friends as carers for the management and care of the patient’s physical and psychological healthcare needs. Importantly addressing patient and family/ carer(s) wishes, are key objectives to improve the patient’s and family/carers’ quality of life (QOL).

Management of a patient’s CKD in order to slow the progression of the patient’s declining kidney function, manage multiple co-morbidities and symptom burden aligned with supporting patient and family/carer(s) psychological healthcare needs and their management of personal affairs is central.

Feddersen, M. A., and Roger S. D. 2012. Arteriovenous fistula surveillance: everyones responsibility.

Portuguese Journal of Nephrology & Hypertension no.

26:255-265.

Fluck, R., and Kumwenda, M. 2011.

Renal association clinical practice guideline on vascular access for haemodialysis. Nephron no. 118 (S1):c225-c240.

Godbold, N. 2013.

Tensions in compliance for renal patients – how renal discussion groups conceive knowledge and safe care. Health Sociology Review: The Journal of the Health Section of the Australian Sociological Association no. 22 (1):52-64.

Hallan, S. I., Matsushita, K., Sang, Y., and et al. 2012. Age and association of kidney measures with mortality and end-stage renal disease. JAMA no. 308 (22):2349-2360.

Jansen, D. L., Heijmans, M. J. W. M., Rijken, M., Spreeuwenberg, P., Grootendorst, D. C., Dekker, F. W., Boeschoten, E. W., Kaptein, A. A., and Groenewegen, P. P. 2013. Illness perceptions and treatment perceptions of patients with chronic kidney disease: Different phases, different perceptions? British Journal of Health Psychology no. 18 (2):244-262.

Johansen, K.L., Delgado, C., Bao, Y., and Tamura, M. K. 2013.

Frailty and dialysis initiation. Seminars in Dialysis no. 26 (6):690696.

Josland, E, Brennan, F., Anastasiou, A., and Brown, M. 2012.

Developing and sustaining a renal supportive care service for people with endstage kidney disease.

Renal Society of Australasia Journal no.

8:12-18.

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Kastrouni, M., Sarantopoulou, E., Aperis, G., and Alivanis, P. 2010. Quality of life of Greek patients with end stage renal disease undergoing haemodialysis. Journal of Renal Care no.

36:126-132.

MacPhail, A., Ibrahim, J. E., Fetherstonhaugh, D., and Levidiotis, V. 2015.

The Overuse, Underuse, and Misuse of Dialysis in ESKD Patients with Dementia. Seminars In Dialysis no. 28 (4):1-7.

Moist, L. 2014. What are the causes of the Ill effects of chronic hemodialysis? Seminars in Dialysis no. 27:23-25.

Brown and Crail (2013) relate, because the element of dying is rapid for patients when reaching ESKD. This involves a holistic multidisciplinary/ multi-professional team responsive to the patient’s preferred place of care and care needs for the patient and family/carer(s), towards the end of the patient’s life journey.

It is important that healthcare professionals maintain good communication with the patient and family and or friends, as the patient’s symptom burden is similar to that of patients living with cancer or end stage heart failure (Brown et al. 2013).

Alternatively the patient may choose a pathway that includes preparation to receive a living donor kidney or inclusion on a waiting list in the anticipation of receiving a cadaver donor kidney transplantation. Due to the lack of availability of cadaver donor kidneys for transplantation, it may take a lengthy period of time and patients generally experience living with ESKD for many years before a cadaver donor becomes available, that is suitable for the patient to receive for kidney transplantation, if at all. Additionally, the patient may not be suitable to receive a kidney transplant, such as advanced age and or co-morbidities and frailty (Feddersen and Rodger, 2012). Some patients may choose not to undergo kidney transplantation as there are alternative options of dialysis RRTs. Dialysis options include peritoneal dialysis, or alternatively modes of haemodialysis which require a mature/viable vascular access in readiness for the patient’s first 28 March 2016 Volume 23, No. 8

haemodialysis therapy (Feddersen and Roger, 2012; Polkinghorne et al. 2009). Chanouzas et al. (2012) propose that there are important factors that can influence patient selection in treatment options of RRTs, such as the information related to option outcomes, which is presented to patients and their family/carer(s). Studies comparing peritoneal dialysis to haemodialysis have shown overall patient survival rates to be similar (Moist, 2014). For people who travel towards RRT, the nephrologist will embark the patient on a pre-dialysis pathway including referring patients to a vascular surgeon and close monitoring through a schedule of pre-dialysis clinic visits. This is to manage the progression of the patient’s CKD and empower patients and family/carer(s), through individualised and timely education supporting their health, treatment management and self-care (Cho et al. 2012).

In order to receive haemodialysis therapy, patients require the surgical formation of a vascular access.

Studies comparing vascular accesses of native arterio-venous fistula (AVF), synthetic arterio-venous graft (AVG) and haemodialysis central venous catheters (DCVC) have displayed all options may result in the patient experiencing complications (Moist 2014). However, patients are placed at an increased risk of complications associated with AVGs and DCVCs along with reduced survival rates of their vascular access (Feddersen and Roger, 2012). For example DCVCs have resulted in higher patient risk

of fatal infections and cardiovascular events compared to AVFs (Moist, 2014). Unfortunately, patients can experience their RRT and vascular access being associated with a reduced QOL, co-morbidities and mortality. This can be attributed in the majority of reported incidences to thrombosis and infection of their vascular access and or septicaemia.

As such, maintaining a viable vascular access and managing the risk of complications is beyond the capacity of the patient’s healthcare team alone.

Support

The patient and their family and or friends who have an interest in the patient’s care have a contributing role in maintaining the viability of the RRT the patient is receiving and in reducing complications such as infection. Adopting a family centred approach to nursing care that is empowering and inclusive of the family and or carer(s) has been demonstrated to enhance patient care outcomes (Cowan et al. 2015).

Decisions regarding the most suitable vascular access option for a patient remain individual. Factors to consider include patient age and gender (de Leur et al. 2013), cardiovascular status (Swinnen, 2011), patient and family/ carer(s) wishes and lifestyle (MacPhail et al. 2015). Other factors include the timing of surgery and surgeon’s experience/skills, maturation time, interventions, monitoring and surveillance (Polkinghorne et al. 2013).

Vascular access nurse coordinators retain vital and various roles in

Moist, L. M., Lee, T. C., Lok, C. E., Al-Jaishi, A., Wang Xi, Campbell, V., Graham, J., Wilson, B., and Vachharajani, T. J. 2013. Education in Vascular Access.

Seminars in Dialysis no.

26:148-153.

Moist, L., BraggGresham, J., Pisoni, R., Saran, R., Akiba, T., Jacobson, S., Fukuhara, S., Mapes, D., Rayner, H., Saito, A., and Port, F. 2008. Travel time to dialysis as a predictor of health-related quality of life, adherence, and mortality: The dialysis outcomes and practice patterns study (DOPPS).

American Journal of Kidney Diseases no.

51:641-650.

Moustakas, J., Bennett, P. N., and Tranter, S. 2015. The information needs of older people who choose supportive care over dialysis: a case study approach. Renal Society of Australasia Journal no. 11 (1):6-11.

Paraskevas, K., Bessias, N., Koupidis, S., Tziviskou, E., Mikhailidis, D., and Oreopoulos, D. 2010.

Incidence of end-stage renal disease in the elderly: a steadily rising global socioeconomic epidemic. International urology and nephrology no. 42:523-525.

Polkinghorne, K., Seneviratne, M., and Kerr, P. G. 2009. Effect of a Vascular Access Nurse Coordinator to Reduce Central Venous Catheter Use in Incident Hemodialysis Patients: A Quality Improvement Report. American Journal of Kidney Diseases no. 53:99-106.

anmf.org.au

CLINICAL UPDATE

Polkinghorne, K. R., Chin, G. K., MacGinley, R. J., Owen, A. R., Russell, C., Talaulikar, G. S., Vale, E., and LopezVargas, P. A. 2013.

KHA-CARI Guideline: Vascular access – central venous catheters, arteriovenous fistulae and arteriovenous grafts. Nephrology no.

18:701-705.

Schmidt, R., Goldman, R., and Germain, M. 2012. Pursuing permanent hemodialysis vascular access in patients with a poor prognosis: Juxtaposing potential benefit and harm. American Journal of Kidney Diseases no.

60:1023-1031.

A PATIENT’S PRE DIALYSIS PATHWAY ALSO REQUIRES HEALTHCARE PROFESSIONALS WHOSE ROLES INCLUDE SUPPORTING THE EMPOWERMENT OF THE PATIENT AND FAMILY/CARER(S) ROLES WITHIN THE PATIENT’S HEALTHCARE TEAM. supporting nurses, patients and family/carer(s), primarily optimising the viability of the patient’s vascular access (Polkinghorne et al. 2009).

Collaboration with the patient, their family and/or carer(s) to empower the patient through educating and skill developing to self-care by monitoring, protecting and caring for their vascular access both prior and after commencing haemodialysis therapy is essential. Importantly nurse practitioners support the patient’s, family/carers’ and nephrologist’s role in the patient’s and their family/carers’ transition from CKD to ESKD in care management (Brown and Harvie, 2010).

Patient and family/carer(s) QOL as an outcome of care can be influenced by the timing of the patient’s pre-dialysis care. This will include the timely surgical creation and optimal time for maturation and any necessary interventions that promote the viability of the patient’s vascular access prior to commencing haemodialysis therapy (Fluck and Kumwenda, 2011). A patient’s pre-dialysis pathway also requires healthcare professionals whose roles include supporting the empowerment of the patient and family/carer(s) roles within the patient’s healthcare team. Ultimately, these are all key factors that contribute greatly to the anmf.org.au

viability and longevity of the patient’s vascular access and effectiveness of their haemodialysis therapy and therefore QOL as an outcome of care, of the patient and that of their family/ carer(s).

Once the patient commences haemodialysis therapy, their journey continues as a routine of treatments and in particular haemodialysis therapy. The majority of Australian patients living with end stage kidney disease (ESKD) receiving haemodialysis therapy as their RRT attend satellite haemodialysis units (SHDU) for management and care, as an example in 2012, 61% of the population attended SHDUs (ANZDATA, 2013). For patients such a routine of attending a SHDU community for management and care does not cease until the patient receives a kidney transplant or becomes too unwell and transfers to hospital and or continues to receive their haemodialysis therapy in one of the acute care haemodialysis units.

The patient and or their family/ carer(s), may reach a point in the timeline of the patient’s journey, where they make the decision that the patient withdraws from dialysis therapies and receives renal supportive care including medical management, which may last a short time of a few days or weeks until

the patient passes away (Josland et al. 2012). Discontinuation of RRTs is seen most frequently (although not exclusively), in the older populations of patients living with ESKD. Around 20% of patient deaths are preceded by withdrawal from dialysis (Tong et al. 2014). Although such decisions are challenging, the chronicity and complexity of living with ESKD, co-morbidities and treatment burden can outweigh the medical and psychological benefits for an individual patient.

The patient may experience a number of vascular access related problems requiring revision, revival or replacement of their vascular access.

Utilising fewer and less viable options over time frequently attributed to the patient’s peripheral-cardiovascular disease. The patient may have become devoid of any permanent vascular access options to continue receiving haemodialysis therapy. This is why the patient’s vascular access is generally referred to as their life-line (Moist et al. 2013; Schmidt et al. 2012; Wang et al. 2008).This overview of the journey travelled by patients, their family and friends as carers while living with CKD, ESKD and haemodialysis serve to confirm the importance of a holistic team approach to the care of a patient’s vascular access. Such an approach includes surveillance, monitoring and involvement in decision making by all those involved and or with an interest in the patient’s care, including the patient and their family and friends (Feddersen and Roger, 2012).

Debi Cowan is a Clinical Registered Nurse (RN) Renal Services, at Central Coast Local Health District (CCLHD) NSW

Sood, M. M., Ayub Akbari, Hiebert B, Hiremath S., Komenda, P., Rigatto, C., Zimmerman, D., and Tangri, N. 2015. Trends in arteriovenous fistula use at dialysis initiation after automated eGFR reporting. Seminars in Dialysis no. 28 (4):439445.

Swinnen, J. 2011.

Duplex ultrasound scanning of the autogenous arterio venous hemodialysis fistula: a vascular surgeon’s perspective.

Australian Journal of Ultrasound in Medicine no. 14:17-23.

Tong, A., Cheung, K. L., Sumi Sukumaran Nair S., Manjula Kurella Tamura, Craig J. C. and Winkelmayer W. C. 2014. Thematic Synthesis of Qualitative Studies on Patient and Caregiver Perspectives on End-of-Life Care in CKD. American Journal of Kidney Diseases no.

63 (6):913-927.

Wang, Ningning, Junwei Yang, Xiangbao Yu, Jianming Hu, Changying Xing, Xiaobing Ju, X. I. A. Shen, J. U. N. Qian, Xiufen Zhao, and Xiaoyun Wang.

2008. Radial artery calcification in endstage renal disease patients is associated with deposition of osteopontin and diminished expression of α-smooth muscle actin. Nephrology no.

13:367-375.

White, A., Wong, W. Sureshkumur, P. and Singh G. 2010. The burden of kidney disease in Indigenous children of Australia and New Zealand, epidemiology, antecedent factors and progression to chronic kidney disease. Journal of Paediatrics and Child Health no. 46 (9):504509.

March 2016 Volume 23, No. 8 29

WORKING LIFE

NURSING STUDENTS GAIN LIFE CHANGING EXPERIENCE IN THE KINGDOM OF TONGA

By Lucinda Ashton Undergraduate nursing students from the University of Canberra (UC) recently undertook a short term international practicum in the Indo-Pacific region as part of their nursing studies. I was fortunate enough to act as Clinical Liaison Nurse for the group.

The benefit of the program is to provide students with a unique opportunity to develop their nursing skills in an international arena while also allowing them to make valuable contacts and be immersed in a very different healthcare setting.The opportunity for the students to take up the placements was made possible thanks to a successful grant application made by the university’s Discipline of Nursing and Midwifery to the Commonwealth government for the New Colombo Plan Mobility Program (NCP).

The grants provide financial support for the NCP Program which aims to improve student knowledge about our Indo-Pacific neighbours and to strengthen long term relationships between Australia and the region. This experience provided students with a unique opportunity to develop their nursing skills in an international setting, to make valuable contacts and be immersed in very different healthcare settings.

From 6 July to 6 August 2015, I led 10 undergraduate nursing students to the Kingdom of Tonga to undertake a 20 day clinical placement at Vaiola Hospital, Tongatapu. The international program of clinical learning, in its second year, was approved by the Australian Nursing & Midwifery Accreditation Council for inclusion in the students’ required clinical hours for their Bachelor of Nursing Degree.

As the Clinical Liaison Nurse for the group my roles were many and varied and I was prepared as this was my second visit to Tonga with a nursing student group. I liaised with the Tongan Ministry of Health, Queen Salote 30 March 2016 Volume 23, No. 8

School of Nursing (QSSN) and Tupou Tertiary Institute in Tonga who all supported our experience, and was the in-country clinical supervisor for the students during their placement. As this was a Commonwealth funded program for students, I strengthened the university’s relationship with the Australian High Commission in Tonga.

Additionally, I was the accommodation organiser, tour guide, social planner, personal confidant and at times, mum.

The students rotated through many acute and community areas working with nursing and medical staff during this placement gaining invaluable experience which they demonstrated through critique and reflection on healthcare practice in Australia and Tonga.

Further to developing their professional skills in communication, listening and negotiation, I observed students develop an appreciation of Tongan culture, including introducing some Tongan language into their conversations.

The students developed affection for the Tongan people. They were impressed with the resourcefulness of the Tongan nurses who worked within their means. The students were genuinely surprised by the limited resources that Tongan nursing staff work with leading to a new appreciation of the abundant, taken for granted resources available within the Australian healthcare system. This learning could translate to their nursing practice at home as they were now better equipped to use available resources efficiently.

The effect of limited resources on clinical care provided to patients caused frustration

UNIVERSITY OF CANBERRA NURSING STUDENTS (L TO R) LAURA O’MALLEY, CASSIE LUKE, JAMES BURRY, JAMIE NAIRN, KERRIE MANSON, ANNIE LEVIDO, KYLE ABEY, SAM STUART, CARLY BALLARD AND SARAH RYRIE.

and sadness in some students. Of course, there were many confronting clinical scenarios, which if managed in Australia, would have had a different outcome. When these challenging situations occurred, my role was to debrief sensitively with students, to reorient them away from a sympathetic dialogue and help them to recognise the ‘real world’ limitations, to understand the economics and many other challenges that exist in the Pacific and to encourage them to provide the best nursing care within their scope of practice during their placement.

During their 31 day adventure, I was impressed with how the students adapted to their new environment. We all lived harmoniously together in one house, sharing ‘home duties’ such as cooking and shopping, and debriefing each day discussing the funny, sad and unusual day’s events. The students adapted to working within the Tongan healthcare system and time schedule well, and we all relished in the positivity and feeling of joyfulness that the Pacific brings through singing, laughing and spirituality.

Throughout the placement, I observed the exchange of clinical knowledge and skills between nursing staff, medical staff and students from both UC and QSSN. In my view, this sharing is beneficial for all of the students as well as the Tongan nurses.

Working together, with different strengths and an inquisitive and non-judgemental approach, the UC students were able to create a positive learning environment for themselves, which enabled improved practice through discussion, demonstration, observation and reflection. My time was a wonderful, fulfilling and humbling experience and the engagement between the students, staff and the Tongan people will be strengthened by future clinical placements supported by the NCP scheduled for 2016.

Overall a life changing experience for all and one we will never forget.

Lucinda Ashton is a Registered Nurse and a Clinical Liaison Nurse with The University of Canberra. anmf.org.au

WELLBEING

Bron Watson

IS IT POSSIBLE TO HAVE A WORK-LIFE BALANCE? As nurses we have all at some time experienced shift work where you were at work and everyone else wasn’t!

To sign up for nursing, means signing up for working strange hours and shifts. Our profession is a 24/7 day job, something you all know too well, especially if you have been working for a while. However, it does not mean you have to love it. In fact there are times when many of you wish you could just give it all away!

Is there such a thing as work-life balance (WLB)? Great question!

The truth of it is, balance alone will not solve this issue, it does not mean an equal life, it is more about having a fulfilling life and enjoying what you do. There are times when you need to work, there are times when you need to rest, and these vary from day to day, person-to-person; different priorities, different lives. In the ever-changing environment of nursing today, Simmons (2012), states that although this is a challenging task, it is necessary for your health and ongoing wellbeing.

In fact, your future depends on it.

BEFORE YOU CAN ACTUALLY SET YOUR GOALS, IT IS AS IMPORTANT TO WORK OUT WHAT YOUR INTENTION IS.

References Simmons, Susan, 2012, ‘Striving for work-life balance’, American Journal of Nursing, vol, 112, no.1, pp. 25-26. doi:10.1097/ 01.NAJ.0000410173.98 529.f6

Bron Watson is a registered nurse, educator, mentor and founder of Nurse Power.

Email: bron@ nursepower. com.au anmf.org.au

I have been asked…‘How do I achieve a work-life balance, how to make it work and enjoy both working as a nurse and having a ‘balanced’ life?’. Research is numerous, blogs and experts a plenty, however, a common theme emerges, and is based on two core concepts; achievement and enjoyment.

Achievement is something I am sure you are familiar with, let’s take a look at enjoyment and why it is important to have BOTH these in living the life you want. As part of a relevant WLB definition, enjoyment does not just mean ‘laugh until you drop’ style happiness. It can mean anything from love, a sense of empowerment, pride, joy, and a satisfaction of a job well done…both at work and in your down time.

Not only are the core concepts

relevant, you need to be aware of the mind traps…the ‘as soon as I’, or ‘I will wait until….type traps that happen throughout your week. For example; ‘As soon as I have finished that course’; ‘As soon as I have enough money’ or ‘As soon as I go part-time’…waiting until the right time, means you may be waiting for a very long time.

Where to start

The best way to start your WLB program is…today! Imagine I have come to work on a morning shift, before my caffeine fix and one bright patient asks me a question way out of the norm. ‘Bron…what is your life purpose?’ Oh my, it is a bit early for a loaded question like that!

The way I could answer this question is something like this. ‘I choose to enjoy one thing and achieve one thing today. If that happens I am in for a good day. If I do this every day for the next year, I am sure the year is going to be amazing’.

Take a moment to think about this, one small achievement and one small enjoyment and the day can work out your way. We all work, sometimes the choice is not there, why not make it a good day, give it your best and really focus on WHY you became a nurse in the first place. Connecting back to you, and why you are here is so important to maintaining a WLB. Ask yourself the following questions: 1. When was the last time you enjoyed and achieved something at work?

2. When was the last time you enjoyed and achieved something at home, or in your down time?

3. What about something just for YOU? 4. Look at what you can control each day, there are times when the stress and fatigue make this a challenging experience, which means taking a ‘stock take’ on the controllables is essential. Your

energy must be on what is in your control and not on what is not Write your answers down and let’s look at what you can do next to get your WLB program going for you.

Next…

The reality of what you do NOW does not have to dictate how you would like your reality to be in your future.

This means aligning your WLB with your goals and intentions in the next 12 months and beyond.

Before you can actually set your goals, it is as important to work out what your intention is. Intention is your WHY, the big reason why something is important to you, being clear on how this will be each day is more important than the goal. It carries energy and is empowering for YOU. Once you have this clear intention, create goals that will help you make it a reality. Make them real, make them manageable and include the small steps to celebrate along the way.

Visualise the goal, add a date and reverse engineer, and start with the end in mind.Take action!

Let’s recap

WLB is about enjoyment and achievement every day, it is NOT about equal balance, it is a choice on what you want to achieve each and every day. To make this real, set a goal on what you would like to achieve and enjoy every day, every week, every month and year….as you know, when you have something to work for, and a commitment to making it a reality… your reality…your WLB program is up and away!

Wishing you a fantastic week, and as Dolly Parton says, ‘don’t get so busy making a living, that you forget to make a life. Cheers,

March 2016 Volume 23, No. 8 31

PROFESSIONAL

CALLING CODE BLUE ON CLIMATE CHANGE Julianne Bryce

Elizabeth Foley

Julie Reeves ANMF Federal Professional Officers

References Australian Nursing & Midwifery Federation.

ANMF Policy: Climate change. Reviewed and re-endorsed May 2015.

Available at www.anmf. org.au Climate and Health Alliance. http://caha. org.au Domrose, C. The climate connection: Nurses examine effects of climate change on public health. Posted on Nurse.com on 12 October 2015. Retrieved from https://news.nurse. com/2015/10/12/44479 on 18/11/2015 International Council of Nurses. Position Statement: Nurses, climate change and health. 2008. Available at: http://www.icn.ch The Lancet Commissions. Health and climate change: policy responses to protect public health.

Published online 23 June 2015. www. thelancet.com

“We don’t get into the technical stuff…We’re talking about the health impact of what we’re seeing with our patients. It’s about real people,” (Domrose, 2015). This is how a nurse and midwife in the United States described her approach to ensuring her message on the effects of how climate change would be heard and understood by politicians.

There is a huge amount of technical literature written about factors which are adversely affecting our environment. You’ve no doubt seen terms splashed across print and televised media such as: ‘carbon emissions intensity percentages’, ‘fracking-related air and water pollution levels’, ‘greenhouse gas inventories’, ‘total anthropogenic carbon dioxide emissions tonnage’, ‘degrees of global warming’. Data on this ‘technical stuff’ is important in mounting arguments to governments that action must be taken to reverse the adverse effects of climate change. This data has added to the abundant evidence which now clearly demonstrates the fact that climate change is a major threat to public health, on a global scale.

While nurses and midwives don’t necessarily need to be conversant with the technical details alluded to above, we do have, as highlighted by the International Council of Nurses (ICN), a “shared responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction,” (International Council of Nurses, 2008). This is primarily because of the health consequences of changes in our natural environment.

As frontline health professionals, nurses and midwives see the impact of climate, and climate change, on the health of individuals and communities for whom they provide care. They see the direct effects from storms, drought, flood and heatwaves. We experience the indirect effects from altered water quality, air pollution, land use change and ecological change; and, we anguish over the senseless effects such as mental illness, cardiovascular and respiratory diseases, infectious disease epidemics, injuries and poisoning (The Lancet Commissions, 2015).

Adverse health effects on individuals and communities will obviously impact health systems and healthcare delivery, with the treatment of climate change-related health conditions adding to the burden of an already stretched healthcare workforce (Australian Nursing & Midwifery Federation, 2015).

32 March 2016 Volume 23, No. 8

WE SEE THE DIRECT EFFECTS FROM STORMS, DROUGHT, FLOOD AND HEATWAVES. WE EXPERIENCE THE INDIRECT EFFECTS FROM ALTERED WATER QUALITY, AIR POLLUTION, LAND USE CHANGE AND ECOLOGICAL CHANGE; AND, WE ANGUISH OVER THE SENSELESS EFFECTS SUCH AS MENTAL ILLNESS, CARDIOVASCULAR AND RESPIRATORY DISEASES, INFECTIOUS DISEASE EPIDEMICS, INJURIES AND POISONING (THE LANCET COMMISSIONS, 2015).

According to the ICN, of particular concern is the impact of climatic change on people living in poverty.

They are “more dependent on natural resources, more vulnerable to infectious diseases and more prone to suffer the impact of disasters such as flood, drought, fires, and storms.”

In Australia, these more vulnerable groups are particularly in rural and remote areas, such as isolated Aboriginal and Torres Strait Islander communities.

In its position statement, the ICN calls on national nursing organisations to be active in taking measures to develop plans and policies to mitigate the impacts of climate change on health, including lobbying

governments to act at the national level and also globally. The ANMF does this in a number of ways through our state and territory Branches – for example, disseminating information to members in professional education forums where members share how they use their workplace sphere of influence to promote environmentally sustainable strategies; and, at the national level through membership of the Climate and Health Alliance (CAHA).

As a member of CAHA, the ANMF is able to join in an alliance of stakeholders in the health sector who “wish to see the threat of climate change addressed through prompt policy action,”(Climate and Health Alliance). A benefit of Alliance membership is the ANMF can rely on CAHA to research and interpret the “technical stuff” of climate change, and we can collectively bring the important health voice to climate change debates and policy development.

CAHA representatives were present at the Paris climate conference (COP21) in December 2015, where 195 countries adopted the first-ever universal, legally binding global climate agreement. This historic agreement sets out a global action plan to put the world on track to avoid dangerous climate change by limiting global warming. The Paris agreement is due to enter into force in 2020.

The health sector should play a key role in promoting public environmental health. A global campaign launched in 2015 in the lead up to the Paris conference - the 2020 Health Care Climate Challenge, aims to mobilise hospitals and health centres around the world to commit to 2020 emissions reduction targets.

Visit: https://noharm-global.org/ issues/global/2020-health-careclimate-challenge to see how you can participate.

‘Technical stuff’ is important, but we need nurses and midwives to highlight the human health impacts of climate change. That’s where we’re the experts. anmf.org.au

Indigenous health FOCUS

FROM 1 MARCH 2016, HCV TREATMENTS OFFERING CURE WILL BECOME AVAILABLE ON THE PBS.

Resources ASHM resources: www.ashm.org.au/resources ASHM training: www.ashm.org.au/training or education@ashm.org.au

VIRAL HEPATITIS IN ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITIES References

By Alison Kerr The time for action to reduce viral hepatitis within Aboriginal and Torres Strait Islander communities is now. It is important that Indigenous people have access to culturally competent viral hepatitis care (screening, testing, treatment and monitoring), to ensure improved individual and community health outcomes.

Aboriginal and Torres Strait Islander communities experience a disproportionate burden of viral hepatitis. When left untreated, Hepatitis B (HBV) and Hepatitis C (HCV) can lead to cirrhosis, liver cancer and sometimes death (MacLachlan & Cowie, 2012). Mortality due to liver cancer is substantially higher within Indigenous people (Parker et al. 2014), with 13% of the life expectancy gap attributable to chronic disease relating to liver disease, largely caused by viral hepatitis (AIHW, 2011).

The Fourth National Aboriginal and Torres Strait Islander BBV and STIs Strategy 2014-2017 sets the target to increase the number of Aboriginal and Torres Strait Islander people receiving antiviral treatment for viral hepatitis.

The strategy outlines key areas for action: increased rates of testing, health workforce development, and community education (Department of Health, 2014).

From 1 March 2016, HCV treatments offering cure will become available on the PBS. Safe and effective HBV anmf.org.au

treatment options are able to be prescribed and dispensed in the community, and Australia has a universal infant vaccination program.

Ensuring Aboriginal and Torres Strait Islander people have access to viral hepatitis prevention and treatment strategies is crucial, and workforce development activities that support this are timely.

Workforce development

The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) aims to support and educate nurses working in Indigenous health. ASHM has resources and training programs to support health professionals to provide viral hepatitis care.

In collaboration with the Aboriginal Health Council of South Australia (AHCSA), ASHM developed the Communicare User Manual for Viral Hepatitis and the Communicare Administrator Manual for Viral Hepatitis. These manuals aim to standardise best practice management within Aboriginal Community Controlled Health

Services (ACCHSs) (using the patient information management system, Communicare), and provide a comprehensive step-by-step guide.

ASHM is also working with nurses within Aboriginal Medical Services (AMS), to support them to provide best practice viral hepatitis care.

Through ASHM’s Viral Hepatitis Capacity Strengthening Program, nurses working within AMS can access: inservice education, clinical advice and mentoring, assistance developing and implementing protocols, and scholarships to attend advanced training.

ASHM hepatitis B and hepatitis C advanced nursing courses provide practical skills and knowledge with learning objectives based on the Australasian Hepatology Association’s Competency Standards and Guidelines. ASHM has also developed training and resources to support Primary Healthcare Nurses (PHCNs) working in viral hepatitis which provide information about how PHCNs can incorporate viral hepatitis care into their existing role.

Australian Institute of Health and Welfare 2011. Contribution of chronic disease to the gap in adult mortality between Aboriginal and Torres Strait Islander and other Australians (www. aihw.gov.au/WorkArea/ DownloadAsset. aspx?id=10737418922) Department of Health 2014. Fourth National Aboriginal and Torres Strait Islander Strategy 2014-2017. Canberra: Australia MacLachlan, J. H. & Cowie, B. C. 2012.

Liver cancer is the fastest increasing cause of cancer death in Australians. Medical Journal Australia [Letter]. 197(9):492–3 Parker C., Tong, S.Y., Dempsey K., Condon J., Sharma S., Chen J., Sievert W., Davis, J. S. 2014. Hepatocellular carcinoma in Australia’s Northern Territory: high incidence and poor outcome. Medical Journal Australia.

8(201):470-474

Alison Kerr is Project Officer (National Policy and Education Division, ASHM) and a Registered Nurse

March 2016 Volume 23, No. 8 33

FOCUS Indigenous health

WORKING WITH OLDER INDIGENOUS GENERATIONS – AGED CARE PERSPECTIVES

By Nina Sivertsen and Ann Harrington While nurses and care workers, who work in Aboriginal aged care facilities, are faced with complex work environments and tasks to fulfil, there is limited research about how they work with older Indigenous Australians.

Numerous standards and guidelines exist, but how this data is translated into practice is challenging. According to government standards, South Australian aged care facilities aim to provide responsive and flexible services to Aboriginal and Torres Strait Islander peoples in a way that respects culture, promotes independence, choices, dignity and services (Australian Aged Care Quality Agency, 2014; Aboriginal Elders and Community Care Services, 2012). However, it is unknown whether or not these standards are successfully implemented.

Nor is it known how the facilities support their staff in achieving this outcome.

A review of statistics and literature provides a clear indication of the disparate health outcomes that Indigenous Australians experience (Francis, 2012; Jorm et al. 2012; Shepherd et al. 2012; Marmot, 2011; ABS, 2005). Culture and spirituality are important components of Aboriginal health (Dudgeon et al. 2010), and nurses and care workers play a pivotal role in providing culturally safe care to Aboriginal and Torres Strait Islander peoples in aged care (West et al. 2011). Nurses constitute 50% of the health workforce (AIHW, 2015), and good practice is needed in providing care that leads to improved health.

This Flinders University School of Nursing and Midwifery project, alongside an advisory circle, explores nurses’ and carers’ perspectives

97% of Australian women want to be asked about alcohol use during pregnancy.

of accommodating the older Indigenous Australian’s care at Aboriginal aged care facilities in South Australia. The project contributes to illuminating what support is needed to improve the work environment including staff, with sufficient resources and education to best provide for clients’ cultural and spiritual needs.

Cultural safety is the pinnacle of nursing care involving Indigenous Australian patients.

Cultural safety is multifaceted and consists of both an individual change including awareness of others and self (reflexivity) and own actions, but also institutional change (Mackean et al.

2007). It is the recipient that decides whether the care they receive is culturally safe (Papps & Ramsden, 1996), and nursing staff development is imperative in achieving this goal as well as support from aged care facilities.

The extent to which South Australian aged care is successful in supporting staff to accommodate culture and spirituality for its Aboriginal residents is unknown, but important for the profession to research if we wish to improve patient care for our older generations.

Dr Nina Sivertsen and Associate Professor Ann Harrington are both at Flinders University School of Nursing and Midwifery in South Australia

Aboriginal Elders and Community Care Services 2012.

Aboriginal Elders and Community Care Services Inc. Australia.

Viewed 10 May 2015, www.aboriginalelders. com.au/ Australian Aged Care Quality Agency 2014.

Quality of care principles 2014. The Aged Care Act of 1997. Australian Government. Viewed 15 May 2015, www. aacqa.gov.au/copy_of_ BROCAH0011Accredit ationS tandardsfactsheetEng lishv14.1.pdf Australian Bureau of Statistics (ABS) 2005.

The Health and Welfare of Australia’s Aboriginal and Torres Strait Islander Peoples 2005. Australian Bureau of Statistics.

Cat.No. 4704.0, ABS, Canberra.

Australian Institute for Health and Welfare (AIHW) 2015. The Health Workforce, by Australian Institute for Health and Welfare. Viewed 15 May 2015, www.aihw.gov.au/ workforce/ Dudgeon, P., Wright, M., Paradies, Y., Garvey, D. & Walker, I. 2010. ‘The Social, Cultural and Historical Context of Aboriginal and Torres Strait Islander Australians’.

In Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice.

Purdie, Dudgeon & Walker (Eds).

Australian Government Department of Health and Ageing.

Women Want to Know encourages midwives to discuss alcohol and pregnancy with women.

Free accredited training is available from the Australian College of Midwives (ACM) for members and non-members. There are also resources for health professionals and health services about alcohol and pregnancy and pamphlets for women.

The campaign is supported by the Australian College of Midwives and funded by the Australian Government.

For more information on the free accredited training or to access the resources visit www.alcohol.gov.au

Francis, K. 2012; Health and health practice in rural Australia: where are we, where to from here? Journal of Rural Nursing and Healthcare; 5(1):28-36.

Jorm, A., Bourchier, S., Cvetkovski, S. & Stewart, G. 2012. Mental health of Indigenous Australians: a review of findings from community surveys. Medical Journal of Australia. 196( 2):118121.

Mackean, T., Mokak, R., Carmichael, A., Phillips, G., Prideaux, D. & Walters, T. 2007.

Reform in Australian medical schools: a collaborative approach to realising Indigenous health potential. Medical Journal of Australia.

186(10):544.

Marmot, M. 2011.

Social determinants and the health of Indigenous Australians.

Aboriginal and Islander Health Worker Journal.

35(3):21.

Papps, E. & Ramsden, I. 1996. Cultural safety in nursing: The New Zealand experience.

International Journal for Quality in Healthcare.

8(5):491-497.

Shepherd, C., Li, J., & Zubrick, S. 2012.

Social gradients in the health of indigenous Australians. American Journal of Public Health.

102(1):107-117.

West, R., West, L., West, K., & Usher, K. 2011.

Tjirtamai –‘To care for’: A nursing education model designed to increase the number of Aboriginal nurses in a rural and remote Queensland community.

Contemporary Nurse.

37(1):39-48.

Indigenous health FOCUS

IN 1863, THREE DECADES AFTER THE FIRST WESTERN-TRAINED NURSES ARRIVED IN AUSTRALIA, FLORENCE NIGHTINGALE REPORTED ON THE NEGATIVE IMPACT COLONISATION HAD ON THE HEALTH OF INDIGENOUS PEOPLE (BEST, 2014).

INDIGENOUS HISTORY, HEALTH, WELLNESS AND CULTURE WITHIN NURSING CURRICULUM

By Ali Drummond and Leonie Cox The nursing profession has had a long history participating in the health and wellbeing of Aboriginal and Torres Islander people.

Throughout various government policy eras imposed on Indigenous people, nurses were at the coalface of implementing these policies (Cox, 2007; Forsyth, 2007). Forsyth (2007) found that while nurses were aware of the impact of early discriminatory policies that controlled the lives of Indigenous people, there was little done to minimise the harm of them.

Nurses worked in hospitals that enforced segregation, and some nurses were even instruments in the removal of Indigenous children (Forsyth, 2007).

However nurses today, as the largest health workforce, have a central role in closing the ‘gap’ in life expectancy for Indigenous people as well as other parameters of health and wellbeing that is proving somewhat resistant to change as reported in 2015 (Department of Prime Minister and Cabinet [DPMC], 2015). While the gap in children’s mortality rates and year 12 attainment at school are on track to improve, life expectancy overall, educational access and attendance, reading, writing and numeracy, and employment outcomes are not (DPMC, 2015).

Each of these gaps and targets have implications for person centred nursing practice and therefore nurses’ education for preparation to practice. anmf.org.au

To enable a more positive nursing contribution to Indigenous health, a national health priority, the Australian Nursing and Midwifery Accreditation Council (ANMAC), ensures nursing students learn about Indigenous history, health, wellness and culture in their Bachelor of Nursing programs (ANMAC, 2012). However, a number of inconsistencies in the curriculum delivered and delivery methods impacts the success of this initiative. Health Workforce Australia (2014), found inconsistencies in the development and implementation of associated curriculum across all health disciplines in Australia. While nursing fared best of all in the health disciplines, only 75% of Australian Schools of Nursing reported having a stand-alone subject. Confusion also existed in the understanding of the philosophical underpinning associated with the teaching of such content (Downing & Kowal, 2011).

This paper introduces a masters/ doctoral project that will employ an Indigenist methodology in exploring the development, implementation, evaluation and accreditation of Indigenous history, health, wellness and cultural content in three of Queensland’s Bachelor of Nursing programs.

The Indigenist methodology values

the voices of Indigenous peoples, challenges colonial imaginations of them, and promotes resistance as an emancipatory imperative (Saunders, West & Usher, 2010).

Indigenous perspectives on teaching about Indigenous people have grown in importance, a reflection of the growing value of Indigenous people (Nakata, 2002). Previous education programs objectified Indigenous people, as opposed to valuing the voice and experience of the Indigenous. McLaughlin and Whatman (2007) argue that course curricula require significant reform to deconstruct or decolonise western imaginations of Indigenous peoples and their experiences. The proposed project seeks to optimise nursing’s contribution to closing the gap, in the delivery of Indigenous history, health, wellness and culture such as by addressing inconsistencies in curricula and delivery methods and in the understanding of founding philosophies of Indigenous perspectives.

Mr Ali Drummond is Lecturer and Dr Leonie Cox is Senior Lecturer in the School of Nursing, Faculty of Health at the Queensland University of Technology

References Australian Nursing and Midwifery Accreditation Council 2012. Registered nurse accreditation standards 2012 (ISBN: 978-09808210-3-1). Retrieved from www.anmac.org. au/sites/default/files/ documents/ANMAC_ RN_Accreditation_ Standards_2012.pdf Best, O. 2014. The cultural safety journey. In O. Best & B. Fredericks (Eds.), Yatdjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care (pp.

51-73). Port Melbourne, VIC: Cambridge University Press.

Cox, L. 2007. Fear, trust and Aborigines: The historical experience of state institutions and current encounters in the health system.

Health & History, 9(2), 1-23.

Department of Prime Minister and Cabinet 2015. Closing the Gap: Prime Minister’s Report 2015. Retrieved 6 March 2015, from www.dpmc. gov.au/pmc-indigenousaffairs/publication/ closing-gap-primeministers-report-2015 Downing, R., & Kowal, E. 2011. A postcolonial analysis of Indigenous cultural awareness training for health workers. Health Sociology Review, 20(1), 5-15.

Forsyth, S. 2007.

Telling stories: Nurses, politics and Aboriginal Australians circa 19001980s. Contemporary Nurse, 24(1), 33-44.

Health Workforce Australia 2014.

Aboriginal and Torres Strait Islander Curriculum Framework Environmental Scan.

Canberra, Australia: Department of Health.

McLaughlin, J. M., & Whatman, S.L. 2007. ‘Embedding indigenous perspectives in university teaching and learning: lessons learnt and possibilities of reforming/ decolonising curriculum’ In Proceedings 4th International Conference on Indigenous Education: Asia/Pacific, Vancouver, Canada.

Nakata, M. 2002.

Indigenous knowledge and the cultural interface: underlying issues at the intersection of knowledge and information systems.

IFLA Journal, 28, 281–291.

March 2016 Volume 23, No. 8 35

FOCUS Indigenous health

UNDERSTANDING SUICIDE AMONG ABORIGINAL COMMUNITIES

By Monika Ferguson, Amy Baker, Shirley Young and Nicholas Procter Globally, suicide is recognised as a public health concern for Indigenous communities, and Australia is not an exemption. As noted by Tatz (2001) ‘To understand Aboriginal suicide, one has to understand Aboriginal history’. Suicide among Australian Aboriginal communities was reported to be a rare occurrence in pre-colonial times (Tatz, 2001). Historical events, social policies and other circumstances have ongoing consequences for the health and wellbeing of Aboriginal peoples.

Recent statistics indicate that suicide was the fifth leading cause of death for Aboriginal and Torres Strait Islander people in 2013, with rates more than twice as high compared to those for non-Indigenous Australians (ABS, 2013). This discrepancy is even more alarming for young people, and those living in remote areas.

Despite the resilience, strength and ongoing connection to culture among Aboriginal communities, the impacts of suicide are profound. The grieving process is often haltered, as the frequency of deaths among Aboriginal communities (suicide or otherwise) leaves little time for losses to be processed, creating complex trauma experiences. In addition, suicide ‘clusters’ are not uncommon, with one death having the potential to spark many more.

When examining this complex topic, a wide range of dimensions affecting Aboriginal health and wellbeing need to be considered. Anecdotal evidence points towards a number of interconnected factors contributing to suicide, including: high levels of psychological distress, loss and grief associated with intergenerational trauma, cultural dislocation, racism, intergenerational disadvantage, substance misuse and dependency, loss of loved ones, scarcity of role models, unemployment and loss of connection to culture and land.

The authors are currently conducting a systematic review to collate the

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DESPITE THE RESILIENCE, STRENGTH AND ONGOING CONNECTION TO CULTURE AMONG ABORIGINAL COMMUNITIES, THE IMPACTS OF SUICIDE ARE PROFOUND. existing evidence. Preliminary findings suggest that, despite powerful anecdotal information (eg. see The Elders’ Report, 2014), the literature is falling behind in terms of academic investigations, particularly those which incorporate a lived experience perspective. There is currently limited evidence for the effectiveness of suicide prevention programs to assist Aboriginal communities, but it is thought that initiatives which are culturally tailored and collaboratively run by Aboriginal communities are more successful and sustainable (Ridani et al. 2015).

It is hoped that this review will provide new insights and a deeper understanding of this important issue and help to identify future research priorities, including holistic, community-led suicide prevention programs which aim to promote social and emotional wellbeing. In

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collaboration with communities and other practitioners, nurses have a key role to play in prevention and healing, both for those who have contemplated or attempted suicide, and those who have experienced the loss of a loved one.

Acknowledgements

We wish to acknowledge TrevorTirritpa Ritchie for his contributions, and our Indigenous colleagues for the conversations we’ve had and the knowledge they’ve shared.

Dr Monika Ferguson is Research Associate and Professor Nicholas Procter is Chair: Mental Health Nursing in the School of Nursing and Midwifery at the University of South Australia Dr Amy Baker is Lecturer at the School of Health Sciences at the University of South Australia Shirley Young is Aboriginal Consultant working specifically with children and families to access mental health services at Child and Adolescent Mental Health Services (CAMHS) in South Australia

Resources Lifeline 13 11 14 beyondblue 1300 224 636

References Australian Bureau of Statistics (ABS).

2013. Causes of death, Australia, 2013. Canberra: Commonwealth of Australia. Cat.no.3303.0.

Retrieved from: www. abs.gov.au/ausstats/ abs@.nsf/Lookup/by%20 Subject/3303.0~2013 ~Main%20 Features~External%20 Causes%20 (V01-Y98)~10021.

Ridani, R., Shand, F.L., Christensen, H., McKay, K., Tighe, J., Burns, J., and Hunter, E. (2015).

Suicide prevention in Australian Aboriginal communities: A review of past and present programs. Suicide and Life-Threatening Behavior. 45:111-140.

Tatz, C. 2001. Aboriginal suicide is different: A portrait of life and selfdestruction. Canberra, Australia: Aboriginal Studies Press.

The Elders’ Report.

2014. The Elders’ report into preventing Indigenous self-harm and youth suicide.

Melbourne, Australia.

Retrieved from: www. cultureislife.org/theelders-report/

Indigenous health FOCUS

CREATING PATHWAYS IN NURSING EDUCATION TO INCREASE INDIGENOUS NURSING NUMBERS

By Linda Deravin-Malone The Closing the Gap policy is well recognised as the initiative aimed at reducing the health inequity of Indigenous people in Australia. A variety of funding, grants and specific programs have evolved under the Closing the Gap policy. Yet the evidence demonstrates that increasing Indigenous nursing numbers has had very little impact.

Government reports which are publicly available show that numbers of Indigenous people employed in health have increased yet it is not until you examine the distribution of the numbers that you understand the increases have been seen in auxiliary and support services and not in clinical type roles such as nursing and midwifery. In 2008, 0.6% of the nursing and midwifery workforce identified as Indigenous and in 2014 this percentage is reported as 1% (Australian Institute of Health and anmf.org.au

Welfare, 2015). Over a six year period this growth is incredibly poor.

The issue of increasing Indigenous representation in nursing is not new (West, et al. 2010). Areas that have been targeted involve both the recruitment and retention of Indigenous people into these programs. A variety of supportive programs and additional grants and scholarships are available to assist people in entering the nursing profession.

As suggested by West et al. (2010) incorporating Indigenous cultural awareness programs into nursing is a strategy to encourage students to stay within nursing education programs and simultaneously educates non Indigenous people about Indigenous health and social issues that impact on the delivery of healthcare. The development of the Aboriginal Health Worker role has created an opportunity for Indigenous people to enter health yet it could be argued that people who choose this career path are being diverted from entering other health professions such as nursing, in essence ‘robbing Peter to pay Paul’.

The critical area is to encourage Indigenous people to enter nursing in the first instance (Indigenous Nursing Education Working Group, 2002). It would seem timely to review education pathways into nursing courses and establish recognition of other qualifications that would assist Indigenous people to enter nursing, such as those who have completed Aboriginal Health Worker qualifications. This is one potential solution that could have a greater impact on increasing Indigenous

THE DEVELOPMENT OF THE ABORIGINAL HEALTH WORKER ROLE HAS CREATED AN OPPORTUNITY FOR INDIGENOUS PEOPLE TO ENTER HEALTH YET IT COULD BE ARGUED THAT PEOPLE WHO CHOOSE THIS CAREER PATH ARE BEING DIVERTED FROM ENTERING OTHER HEALTH PROFESSIONS SUCH AS NURSING, IN ESSENCE ‘ROBBING PETER TO PAY PAUL’. nursing workforce numbers. To increase Indigenous nursing numbers there needs to be a multifaceted approach between governments, tertiary education providers and Indigenous community groups so that significant change can occur and an Indigenous nursing workforce continues to grow.

The author declares no conflict of interest Linda Deravin-Malone is Lecturer in Nursing in the School of Nursing, Midwifery and Indigenous Health at Charles Sturt University

References Australian Institute of Health and Welfare 2015. Nursing and midwifery workforce 2014: Nurses and midwives, overview tables 1-25. Canberra, AIHW. Indigenous Nursing Education Working Group 2002. Gettin em and keepin em: Report of the Indigenous Nursing Education Working Group.

Canberra.

West, R., Usher, K. and Foster, K. 2010.

“Increased numbers of Australian Indigenous nurses would make a significant contribution to ‘closing the gap’ in Indigenous health: What is getting in the way?”

Contemporary Nurse 36 (1-2): 121-130.

March 2016 Volume 23, No. 8 37

FOCUS Indigenous health

NURSE PRACTITIONERS COULD SIGNIFICANTLY IMPROVE INDIGENOUS HEALTH OUTCOMES 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 not 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 For more information, please go to www.health.act.gov.au and click on: Employment – Current vacancies Contact Officer: Maret Rebane PH: (02) 6207 6279 E: maret.rebane@act.gov.au www.health.act.gov.au For more information visit http://www.canberrayourfuture.com.au

38 March 2016 Volume 23, No. 8

By Rosemary Harbridge A nurse practitioner role could significantly improve outcomes in the prevention and management of acute rheumatic fever (ARF) and rheumatic heart disease (RHD), according to RHDAustralia’s Framework for a nurse practitioner role in acute rheumatic fever and rheumatic heart disease (2015).

The framework recommends a scope of practice for a nurse practitioner (NP) within the current model of service, and presents a case for a NP in building the capacity of the health service to provide a more systematic, timely and coordinated approach to addressing service gaps (www.rhdaustralia.org.au/professional-development/nursepractitioner-framework).

RHD is a significant health issue in Australia, affecting predominantly Aboriginal and Torres Strait Islander people living in remote and rural areas.

For Indigenous people living in these areas, remoteness, transient population, poor living and education standards, high health practitioner turnover, and limited knowledge of the disease all contribute to delays and deficiencies in health service delivery and, ultimately, to the burden of disease.

ARF is a generalised inflammatory illness caused by a group A streptococcus (GAS) bacterial infection of the throat or possibly the skin. It affects specific parts of the body including the heart, joints, brain and skin.

If the heart is involved, there can be persisting heart valve damage, leading to RHD. Recurrent ARF may cause further valve damage, and worsening of RHD. Primary and secondary prevention of ARF episodes is therefore a priority. Recurrences can be prevented by providing regular and timely antibiotics usually in the form of benzathine penicillin G (BPG) injections every 28 days. Adherence rates, however, are commonly poor, leaving many patients vulnerable to repeat episodes of ARF, and potential development of RHD. RHD typically requires complex long-term care including regular medical specialist review, echocardiograms and blood tests, and heart failure medication. The highest rate of ARF is found in children aged 5-14 years, and the highest rate of RHD is found in adults aged 35-39.

The areas where the service system falls down along the RHD care pathway are well known. Delays and gaps in service are commonly experienced in initial identification, assessment and initiation of treatment, diagnostic investigations and review of results, initiation, review, titration and cessation of medication, and follow up of patients.

Many practitioners are not experienced in working in Aboriginal and Torres Strait Islander communities and may never have seen a case of ARF. It is not taught in some medical and nursing courses - perhaps because it is commonly (and wrongly) thought to have disappeared in the Australian healthcare setting. This can lead to misdiagnosis and/or missed diagnosis.

A NP would play a role in education and support for the RHD team, as well as providing an autonomous, advanced and extended clinical nursing role. A NP could identify and respond to healthcare needs more flexibly than the existing nursing workforce, thus addressing the issues and gaps in services outlined above, streamlining the patient journey between acute and primary healthcare services, and enhancing health outcomes.

A NP could also contribute to cost savings in terms of reduction in medical practitioner workload, the need for hospitalisation, and specialist and surgical input. To learn more about ARF and RHD, and to access a copy of the NP Framework and The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease.

(RHDAustralia, 2012) visit the RHDAustralia website: www.rhdaustralia. org.au/ For further information contact: Rosemary Harbridge (Project Officer) RHDAustralia rosemary.harbridge@menzies.edu.au

Rosemary Harbridge is Project Officer at RHDAustralia anmf.org.au

Indigenous health FOCUS

WORKING TOWARDS ‘CLOSING THE GAP’ AT CENTRAL AUSTRALIA HEALTH SERVICE

By Carol McPherson “It is not credible to suggest that one of the wealthiest nations of the world cannot solve a health crisis affecting less than 3% of its citizens”.

(Calma, Aboriginal and Torres Strait Islander Social Justice Commissioner, HREOC 2005).

The Northern Territory is one of Australia’s most colourful and culturally diverse regions, where 42% of people speak a language other than English at home (ABS Census, 2014). At Alice Springs Hospital, over 85% of admissions are Australian Aboriginal people and over 30% of hospital staff have culturally and linguistically diverse backgrounds (CAHS, 2015).

For people working in central Australia health is challenging, complex and continually changing.

It requires commitment, tenacity and patience. Many nurses come to the Territory drawn by the notion of making a difference for Aboriginal people. Typically, many non-Aboriginal nurses and midwives have had few interactions with Aboriginal Australians; therefore have limited knowledge about the cultural, economic and historical contexts. Cultural safety and cultural competence form the basis of effective patient centred care (Nguyen, 2008).

Health outcomes for Aboriginal and Torres Strait Islander people are poor and in many circumstances continue to deteriorate. For example, Aboriginal and Torres Strait Islander people who commence dialysis in the Northern Territory (NT) are at least 20 years younger than in other Australian jurisdictions. Since 2009, there has been a 42% increase in dialysis treatments in Central Australia (Department of Health and Ageing, 2011). The rates of kidney disease anmf.org.au

alone in the NT are highest among Aboriginal and Torres Strait Islander people living in remote communities where access to dialysis treatments is limited (Department of Health and Ageing, 2011). Chronic conditions are estimated to contribute to 77% of the life expectancy gap between Aboriginal and non-Aboriginal populations in the NT (AIHW, 2014).

With poorer health and escalating economic and social issues, there is growing evidence that interactions in caring for Aboriginal people can significantly influence health outcomes. It is vital to ensure that a health system can appropriately provide culturally safe services that both meet the needs of Aboriginal and Torres Strait Islander people and improve health outcomes (Australian Government, 2013).

The NT Department of Health is highly focused on developing workforce strategies that provide an accessible and culturally competent health workforce. Of equal importance is that service delivery reflects the mandate of the Australian Charter of Healthcare Rights. The charter recognises that genuine health partnerships are necessary to achieving better care outcomes.

The Central Australia TeleHealth program is a clear example of how developing partnerships assist towards keeping Aboriginal and Torres Strait Islander people ‘in country’ with access to healthcare.

The TeleHealth NT Network is available in 62 communities across the NT. Recently, the Alice Springs Hospital opened up renal dialysis training opportunities for enrolled nurses. The first cohort commenced in February 2016.

Furthermore, there are opportunities for employment for enrolled nurses across the health service and a range of ‘grow our own programs’ for all healthcare staff. These programs have been developed as both a workforce development strategy and for the provision of safer and better care for our community.

There are clear differences between the experiences of Aboriginal and non-Aboriginal people across all the indicators of quality of life. Improving health outcomes and quality of life requires a flexible, highly skilled and committed nursing and midwifery workforce. The experience of living and caring for Aboriginal and Torres Strait Islander people in the NT is unique and enhanced by diversity of the culture and the distinct differences between clan groups, languages, dialects, and geographical landscapes.

Closing the gap for Aboriginal and Torres Strait Islander people and achieving equality of health expectancy between Aboriginal and Torres Strait Islander people and non-Aboriginal Australians in the NT is clearly a challenging and ongoing target, but one that offers great rewards to nurses and midwives working across all health sectors.

Note: For employment opportunities in the Northern Territory click on this link www.health.nt.gov.au/Nursing_ and_Midwifery/Employment_and_ Vacancies/index.aspx

Carol McPherson is a PhD Candidate and Nursing Director at the Alice Springs Hospital, Central Australia Health Service

Reference Australian Bureau of Statistics (ABS) 2014.

4727.0.55.001. Retrieved from www.abs.gov. au/ausstats/abs@. nsf/mf/4727.0.55.001 Australian Government (2013) National Aboriginal and Torres Strait Islander Health Plan 2013 -2023. Retrieved from www.health.gov. au/internet/main/ publishing.nsf/content/ B92E980680486C3BCA 257BF0001BAF01/$File/ health-plan.pdf Australian Institute of Health and Welfare 2011. The health and welfare of Australia’s Aboriginal and Torres Strait people an overview Retrieved from www. aihw.gov.au/WorkArea/ DownloadAsset. aspx?id=10737418955 Central Australia Health Service (CAHS) 2014.

Nursing recruitment data.

Department of Health and Ageing 2011.

Central Australia Renal Study. The George Institute for Global Health Retrieved from www.health.gov. au/internet/main/ publishing.nsf/Content/ B442C16562A8AC37C A257BF0001C9649/$ File/Final%20Report%20 Central%20Australia%20 Renal%20Study.pdf Department of Health and Community Services (DHCS) 2012 Aboriginal. Retrieved from www.health.nt.gov. au/Aboriginal_Health/ Aboriginal_Policy/index. aspx Nguyen, H. T. 2008.

Patient centred care: cultural safety in indigenous health.

Australian Family Physician, 37(12), 990.

March 2016 Volume 23, No. 8 39

ANMJ Magazine (188 mm x 130 mm)

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Indigenous health FOCUS

WHAT IS ACUTE RHEUMATIC FEVER (ARF) AND RHEUMATIC HEART DISEASE (RHD)?

By Christian James and Claire Boardman Despite Indigenous Australians having some of the highest recorded rates of RHD in the world, the majority of Australian trained nurses and doctors have had insufficient training and have never seen a case.

The major burden of ARF and RHD in Australia is seen across the top end in remote Indigenous communities.

However, in Australia a majority of the tertiary institutions teaching nursing and medicine are situated below the Tropic of Capricorn and in major urban centres. This limits the chance of our newly trained nurses and doctors to consolidate their tertiary training with active case finding and clinical presentations.

RHDAustralia (RHDA) is funded by the Australian government under the Rheumatic Fever Strategy. Known as the National Coordinating Unit we work collaboratively with state and territory RHD control programs to provide technical assistance, promote best practice, data collection and reporting, development and dissemination of evidence based clinical guidelines and the provision of both patient and clinician education resources.

In an endeavour to improve clinical understanding of ARF and RHD, RHDA in collaboration with experienced clinicians researched and developed a free online healthcare professional package to provide a basic to moderate insight into ARF and RHD diagnosis and management which is endorsed by the Australian College of Nursing (ACN) and the Australian College of Rural and Remote Medicine (ACRRM). More recently RHDAustralia launched another 15 endorsed specialist modules that were researched and prepared by clinicians for clinicians. RHDAustralia has sought to improve the learning experience for all old and new users of the modules by developing an online learning management system (LMS) to house all clinicians’ education. The new LMS is a free one stop ARF/RHD education shop that tracks the student’s education achievements and enables a record of time and certification.

These statements can be printed and used for verification of professional development activities. These are found at: www.rhdaustralia.org.au/ professional-development The online modules have been referred to internationally as the gold standard of ARF/RHD education and anmf.org.au

THIS MODULE IS AIMED AT PROVIDING HEALTH PROFESSIONALS WITH BEST PRACTICE TIPS AND TECHNIQUES ON MINIMISING PAIN AND DISCOMFORT WHEN GIVING INTRAMUSCULAR INJECTIONS.

uptake of the modules has increased by nearly 600% over the last 12 months with over 1,000 modules completed.

Each of the modules were researched and designed by leading Australian health professionals, this guarantees the student the most relevant and evidence based education.

RHDAustralia is pleased to announce the launch of their latest module titled ‘Improving the delivery of Benzathine Penicillin’. This module is aimed at providing health professionals with best practice tips and techniques on minimising pain and discomfort when giving intramuscular injections.

Also in 2016 RHDAustralia plans to launch an interactive discussion forum moderated by senior experts who will answer and guide clinical enquires and practice.

Rheumatic Heart Disease is 100% preventable, but we must first acknowledge the presence of this disease within our community before a commitment can be made to prioritise the development of sufficient knowledge to screen, diagnose and manage ARF and RHD in a sustainable manner.

Christian James is Education and Training Program Manager and Claire Boardman is Deputy Director at RHDAustralia March 2016 Volume 23, No. 8 41

FOCUS Indigenous health

CALCULATOR MAKES ACCURATE AND SIMPLE DIAGNOSIS

By Christian James Indigenous Australians have some of the highest recorded rates of rheumatic heart disease (RHD) in the world, yet the disease is 100% preventable. Early diagnosis of acute rheumatic fever (ARF) is pivotal in the prevention and management of RHD; however diagnosis of ARF is very challenging because of the absence of a single diagnostic test, inexperienced and transient clinical staff in the areas of higher incidence, lack of sensitivity and specificity of clinical features.

RHDAustralia has sought to minimise ARF diagnostic complexities by developing an innovative, technology based ARF diagnosis calculator which is simple, accurate and guides clinicians with varying levels of education and experience through the complex diagnostic process (Figure 1 and 2).

To develop this new app, RHDAustralia first undertook a review of existing literature and resources on ARF diagnosis and concurrently designed an anonymous online survey to ascertain current practices and perceived utility of an electronic tool for ARF diagnosis and distributed this to clinical members of the online ‘Murmur’ newsletter and to delegates attending a rural nursing conference (doctors, nurses

and Aboriginal health workers). We then reviewed and updated the existing ARF diagnostic algorithm to form the basis of a smartphone app coding. Based on the above processes, and using the 2012 Australian modified Jones Criteria for high-risk populations refinements of the existing ARF diagnostic algorithm were accomplished (Figure 2).

This includes provision for ‘definite’, ‘probable’ and ‘possible’ ARF diagnostic categories. Before final approval and release a further three targeted functionality and case-study testing phases were undertaken, including testing by and input from experienced ARF/RHD clinicians and researchers.

The diagnosis calculator now has around 4,000 users worldwide.

Recently RHDAustralia caught up with one of the users from Royal Darwin Hospital. Dr Jessica Sommer describes her experience using the diagnosis calculator: “One of my first cases of acute rheumatic fever was a 14 year old girl – she was transferred from her community with chorea. The diagnosis was not initially clear to my team, as we had limited experience in diagnosing the illness. Someone suggested ARF and had the RHDA diagnosis calculator app on their phone, so we had a look, and it showed definite acute rheumatic fever.

“Another case was a 27 year old man from a very remote community presented with a strange constellation of symptoms. We suspected ARF but had other differential diagnoses.

We were not confident to exclude all our differentials. With the assistance of the app, we were able to confirm quickly, that it was ARF”.The new app not only provided vital diagnostic assistance, but it also helped guide the management and disease notification process which is just as important as the initial diagnosis. The Diagnosis Calculator is available free of charge at www.rhdaustralia.org. au/apps or via Google play or the Apple store.

It provides a simple tool to aid ARF diagnosis and links to evidence based reference material. While diagnosis ultimately remains a clinical decision, the calculator provides accurate, instant information to minimise error.

Christian James is Education and Training Program Manager at RHDAustralia

FIGURE 1: ORIGINAL ARF DIAGNOSIS FLOWCHART DESIGNED BY MARC REMOND AND RHONA DAWSON BASED ON THE 2012 AUSTRALIAN RHD GUIDELINES FIGURE 2: UPDATED DIAGNOSIS ALGORITHM FORMS THE BASIS OF THE ONLINE DIAGNOSIS CALCULATOR

42 March 2016 Volume 23, No. 8

anmf.org.au

Indigenous health FOCUS BIRTHING AWAY FROM HOME (COURTESY LAUREN SAYER)

References Australian Bureau of Statistics 2015. Prisoners in Australia, 2014.

Retrieved from www. abs.gov.au/ausstats/ abs@.nsf/Lookup/by%20 Subject/4517.0~2014 ~Main%20 Features~Aboriginal%20 &%20Torres%20 Strait%20Islander%20 prisoner%20 characteristics~10007

STRATEGIES TO IMPROVE MATERNAL HEALTH FOR INDIGENOUS WOMEN AND CHILDREN By Sally de-Vitry Smith The Close the Gap Progress and Priorities Report 2015 begins with the picture of a young, healthy Indigenous man with a big smile. Unfortunately the report provides little to smile about as it illustrates the persistent chasm between health outcomes for Indigenous and non-Indigenous Australians.

It is important to be familiar with the evidence and consider how health professionals can contribute to closing the gap.

The contrast in health outcomes for Indigenous and non-Indigenous women and children is stark. For example, Indigenous women have double the maternal mortality and a five times higher risk of maternal death from psychosocial conditions (Holland, 2015). The infants of Indigenous mothers die at double the rate, and are twice as likely to be born with a low birth weight which is a factor known to increase mortality.

Indigenous women are more likely to have chronic conditions which are undiagnosed or poorly treated (Holland, 2015).

The distressing statistics on domestic violence are even worse when comparing Indigenous and nonIndigenous Australians. Indigenous women are five times more likely to be a victim of homicide, and 34 times more likely to be hospitalised due to family violence, while domestic assault reports to police are six times higher but are probably underreported due to Indigenous women’s mistrust of police officers (Phillips & Vandenbroek, 2014).

Indigenous women fear reporting anmf.org.au

family violence as their children are over-represented in out-of-home care (AIHW, 2015; AIFS, 2015).

Factors such as institutionalised racism, socioeconomic deprivation, the stolen generation’s forced removal of children, in addition to intergenerational problems are linked to chronic diseases and psychological distress. Indigenous women’s rates of incarceration have increased dramatically over the last five years.

intentional self-harm have increased and the rate of suicide is double that of non-Indigenous Australians (Holland, 2015).

Health professionals caring for Indigenous women and children can help close the gap by taking the following measures: • learn how to provide culturally responsive care; • place women and their families at the centre of their care by listening and responding respectfully; • being alert to insidious racism; • avoid judgemental behaviour which leads to women feeling embarrassment and shame; • re-open maternity services in rural and remote communities rather than force Indigenous women to travel to a strange city away from their family; • support Indigenous women’s desire to birth on country and the importance of the deep spiritual connection with land, kin and tradition related to birthing on country;

AGE STANDARDISED IMPRISONMENT RATES SHOW THE LEVEL OF INCARCERATION IS 13 TIMES HIGHER FOR INDIGENOUS AUSTRALIANS WHEN COMPARED TO NON-INDIGENOUS AUSTRALIANS (ABS, 2014).

Age standardised imprisonment rates show the level of incarceration is 13 times higher for Indigenous Australians when compared to non-Indigenous Australians (ABS, 2014). A Queensland study found 86% of Indigenous women who are imprisoned have a mental health condition (Heffernan et al. 2012).

In Indigenous Australians, rates of psychological distress are almost three times higher, while reports of

• commit to supporting training

for Indigenous midwives. Only 0.9% (223) of Australia’s 28,756 registered midwives identified as Indigenous (AIHW, 2014); • being more aware of institutionalised racism; • take the ‘Invisible Discriminator’ test to become aware of passive or subtle discrimination. This test is part of the beyondblue campaign which targets racial discrimination.

Australian Institute of Family Studies 2015.

Child protection and Aboriginal and Torres Strait Islander children.

Retrieved 18/1/16 from https://aifs.gov.au/ cfca/publications/ child-protection-andaboriginal-and-torresstrait-islander-children Australian Institute of Health and Welfare 2015. Child protection Australia 2013–14.

Child welfare series no.

61. Cat. no. CWS 52.

Canberra: AIHW. Australian Institute of Health and Welfare 2014. Nursing and midwifery. Canberra: Australian Government.

Retrieved from www. aihw.gov.au/workforce/ nursing-and-midwifery/ midwives/ Heffernan, E. B., Andersen, K. C., Dev, A., & Kinner, S. 2012.

Prevalence of mental illness among Aboriginal and Torres Strait Islander people in Queensland prisons. Medical Journal of Australia, 197(1); 37-41.

Holland, C. (2015).

Close the Gap Progress and Priorities Report 2015. The Close the Gap Campaign Steering Committee.

Phillips, J., & Vandenbroek, P. 2014.

Domestic, family and sexual violence in Australia: an overview of the issues. Retrieved from www.aph.gov. au/About_Parliament/ Parliamentary_ Departments/ Parliamentary_Library/ pubs/rp/rp1415/ ViolenceAust

Dr Sally de-Vitry Smith is Midwifery Discipline Lead in Nursing, Midwifery & Indigenous Health at Charles Sturt University

March 2016 Volume 23, No. 8 43

espect – Professionalism Caring – Committed – Collaboration Respect - –Professionalism - Caring -

Committed - Collaboration Acting NUM Emergency Department Temporary position to February 2017

For enquiries please contact Kath Curran, Acting NUM Emergency Department (03)50339367, email kcurran@shdh.org.au

Registered Nurses rotating between Acute Medical/Surgical Unit and Emergency Department Full/Part-time Minimum of 2-3 years nursing experience in Australia and current AHPRA registration.

For enquiries please contact Rose Hanns, NUM Acute Unit (03)50339253, email rhanns@shdh.org.au Work/life balance is what you get working at Swan Hill District Health. As well as lifestyle comes: ✔ A professional, committed workforce and highly supportive community ✔ Variety in work and a sense of achievement ✔ Salary packaging options available Applications 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.

COB 18 March 2016.

We provide students with a programme that leads to real opportunities and excellent understanding of Aesthetic procedures. This is a three day post graduate certificate workshop. Our trainers and staff provide students with knowledge and ongoing support vital to success in this field.

On completion each delegate will be competent in the delivery of basic techniques of Botulinum Toxin and Dermal Fillers.

Expand your clinical skills as a health care professional. Enjoy additional income by offering rewarding treatments that can improve clients self esteem.

Upcoming Melbourne workshops 4th, 5th & 6th of April, 27, 28 & 29 June 2016 Visit: www.skinscience.co for more information.

Call: 1300 817 524 Finance available through Maccredit.

REGISTERED NURSES • PT & FT positions available • 1 Senior RN Role with ownership of Wound Management • Perm Days/Afternoon shifts or Perm Nights available

Join a placement in Nepal and Kenya with Nurses in Action through World Youth International.

Very Special Kids is a NFP organisation who aims to improve the quality of life for more than 900 Victorian families caring for children with life-threatening conditions, from diagnosis through to bereavement and beyond.

For more information see the poster in this month’s journal and share it in tearooms and on the wards or go to

Our 8 bed children’s hospice offers planned respite and emergency respite as well as end-of-life care for children with complex medical and care needs. Our staff/patient ratio of 1:2, allows the unique opportunity for high quality care and a rewarding experience.

www.worldyouth.org.au

To be successful in this role you are a RN & preferably have some exposure to paediatrics or palliative care nursing. Passion for and commitment to providing holistic, family centred care is a must and experience working with children, families and volunteers within a health setting is desirable. For the RN position with ownership of Wound Management you will oversee; reporting, wound management, assessing and wound care education in the team.

Experience in wound management is desirable.

For a detailed job description, visit www.vsk.org.au. Please apply in writing addressing the key selection criteria to Katrina Hall, HR & OHS Manager, Very Special Kids, via jobs@vsk.org.au

NET NEP

2016

6

R TE IS G W RE NO

Aesthetic Training Australia

BE THE DIFFERENCE YOU WANT TO SEE IN THE WORLD

TH INTERNATIONAL NURSE EDUCATION CONFERENCE

3-6 April 2016

Brisbane, Australia

Transforming education practice through scholarship, development of academic leadership and evaluation research: committed to improving the lives of communities worldwide.

Join delegates from around the world to share the latest research, knowledge, ideas, innovations and current developments within nursing and healthcare education from local, national and international regions.

Topics will include: • Continuing Professional Development /Education

Keynote speakers

• Education for Patient Safety

Tracy Levett-Jones The University of Newcastle, Australia Anne-Marie Rafferty King’s College, London, UK

• Teaching, Assessment and Learning in University and Clinical Practice • Technology, Simulation & Education • Curriculum Innovation, Academic Leadership and Evaluation Research for Nursing Education (CIANP) • Midwifery Education in Practice (MEiP)

Register now at www.NETNEP-conference.elsevier.com Organised by:

NETNE2016_90x135.indd 1

Organised and sponsored by Elsevier, Nurse Education Today and Nurse Education in Practice in collaboration with Curtin University, University of Newcastle, University of South Queensland, University of Wollongong, Griffith University and the Australian Nurse Teachers Society.

11/02/2016 13:14

Indigenous health FOCUS

CULTURALLY SAFE MENTAL HEALTHCARE

By Shirley McGough Cultural safety holds a great opportunity in transforming culturally appropriate healthcare for Aboriginal Australians (Taylor & Guerin, 2010). However the experiences of nonAboriginal health professionals in providing culturally safe mental healthcare is not well documented. Therefore it is critical that culturally safe care in this setting is explored.

Objectives

The objective of the research was to: • explore and describe mental health professionals’ experiences of providing culturally safe mental healthcare to Aboriginal people in the Western Australian community; • identify the factors that facilitate or inhibit that experience and generate a substantive theory that explains the interactional and structural aspect of care provision for Aboriginal people; • evaluate the developed theory within the context of existing international literature. anmf.org.au

THIS STUDY REVEALED THAT MANY MENTAL HEALTH PROFESSIONALS FELT UNPREPARED TO PROVIDE CULTURALLY SAFE CARE AND THIS WAS ATTRIBUTED TO A LACK OF KNOWLEDGE AND UNDERSTANDING OF ABORIGINAL CULTURE, BEING UNPREPARED

BY THE SYSTEM AND FEELING OVERWHELMED.

Method

Twenty-eight semi-structured interviews were conducted with mental health professionals (25 registered nurses and three psychologists) working in mainstream mental health services in Western Australia. Constant comparative methods of data analysis continued until core codes emerged and analysis persisted until data saturation was reached. Permission for this study was obtained from the University’s Human Ethics Committee and the South Metropolitan Area Health Service Hospital Ethics Committee.

Findings

This study revealed that many mental health professionals felt unprepared to provide culturally safe care and this was attributed to a lack of knowledge and understanding of Aboriginal culture, being unprepared by the system and feeling overwhelmed. A range of emotions accompanied the feeling of being unprepared including fear and anxiety, sadness, shame and guilt and feeling futile.

To manage the experience of being unprepared participants engaged in

a process entitled seeking solutions by navigating the labyrinth. Phases identified as part of this process included: neutralising the differences, moving forward, seeking new solutions, and becoming a culturally safe practitioner.

Several conditions influenced this process namely: participants’ experience of racism and discrimination, participants’ level of social support and feeling part of the solution.

Implications and recommendations

The experience of being unprepared to provide culturally safe care to Aboriginal patients occurred despite national agendas to reduce the gap in poor health outcomes for Aboriginal people and the national frameworks outlining cultural care requirements for health services and professionals.

The findings suggest there is a need to continue to push towards improving health professionals’ understanding of Aboriginal history and culture and recognising the relationship to mental health and wellbeing for Aboriginal people.

Reference Taylor, K. & Guerin, P. 2010. Healthcare and Indigenous Australians: Cultural safety in practice. 2nd ed.

South Yarra: Palgrave Macmillian

Shirley McGough is a PhD Candidate and Lecturer at Curtin University

March 2016 Volume 23, No. 8 45

CALENDAR

MARCH Lung Health Promotion Centre at The Alfred 3-4 March – Respiratory Course (Module B) 10-11 March – Smoking Cessation Course 15 March – Allergy Day 16-18 March – Asthma Educator’s Course P: (03) 9076 2382 E: lunghealth@alfred.org.au International Women’s Day Theme: Pledge for parity 8 March. www.internationalwomensday.com/ ADMA Evidence-based Primary & Secondary Prevention of Chronic Disease Seminar 11 March, AMREP Lecture Theatre, The Alfred Hospital, Melbourne. www.adma.org.au/ E: info@adma.org.au T: 0390764125 3rd Commonwealth Nurses and Midwives Conference Toward 2020: Celebrating nursing and midwifery leadership 12-13 March, London UK. www.commonwealthnurses.org/ conference2016/ National Close the Gap Day 17 March RHDAustralia 2 day Workshop Think ARF Stop RHD 22-23 March, Brisbane Convention Centre. This workshop aims to improve early detection, diagnosis and reporting of acute rheumatic fever and rheumatic heart disease in Australia. www.rhdaustralia.org. au or E:info@rhdaustralia.org.au

APRIL NETNEP 2016: 6th International Nurse Education Conference 3-6 April, Brisbane, Australia.

Transforming education practice through scholarship, development of

NETWORK Geelong Hospital Nurses League (Barwon Health) annual reunion 19 March. All members, past trainees and current staff are invited to attend. Contact Secretary Bev Lodge E: terrylodge@bigpond.com P: (03) 5243 7794 M: 0419 107 995 St Vincent’s Hospital, February 1976, 40-year reunion 19 March. Contact Mary Hibble (nee Ross) E: maryhibble@yahoo. com.au or Ra Cunningham (nee Savaris) E: vtcunningham@hotmail. com or Seach Facebook page: St Vincents Hospital Nurses Class of 1976

46 March 2016 Volume 23, No. 8

academic leadership and evaluation research: committed to improving the lives of communities worldwide. www.netnep-conference.elsevier.com World Indigenous Cancer Conference 12-14 April, Brisbane Convention and Exhibition Centre, Qld. www.menzies.edu.au/ Lung Health Promotion Centre at The Alfred 14-15 April – Managing COPD 18-19 April – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au

MAY International Day of the Midwife 5 May. www.internationalmidwives. org/events/idotm/ Australian Primary Health Care Nurses Association (APNA) National Conference Nurses the heart of primary healthcare 5-7 May, Pullman Melbourne, Albert Park. The conference for nurses working in primary healthcare. www.apnaconference.asn.au Lung Health Promotion Centre at The Alfred 9 May – Paediatric Respiratory Update 31 May – Respiratory Update P: (03) 9076 2382 E: lunghealth@alfred.org.au International Nurses Day Nurses: A force for change: Improving health systems’ resilience 12 May. www.icn.ch/ publications/2016-nurses-a-forcefor-change-improving-healthsystems-resilience/ ATSA Independent Living Expo Australasia’s largest display of rehabilitation and assistive technology equipment 18–19 May, Melbourne 50 years of Nursing Reunion Tour, Group 80 21 March at 10am, RGH Concord.

Contact Victoria Stevenson 0414 670 226 Prince Henry’s Hospital, Melbourne, 1/76, 40-year reunion 2 April at 2pm. Contact Debbie Webber (nee Cox) at E: webberde@ ramsayhealth.com.au or log on to Facebook event ‘1/76 PHH 40th Nursing Reunion’ for further details.

Flinders Medical Centre Paediatric Unit, 40-year reunion 10 April. Contact Shirley Coxs M: 0407 799 886; Michelle Petch M: 0408 059 631 or Rae Vertue M: 0419 831 511. Face book page: FMC Paediatric ward 40 year reunion

Showground. The ATSA Independent Living Expo will have over 100 exhibitors displaying a wide range of products and services in assistive technology, mobility solutions, pressure care, employment support, modified motor vehicles and a lot more. www. atsaindependentlivingexpo.com.au

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

National Sorry Day 26 May. www.nsdc.org.au/

OCTOBER Childbirth and Parenting

Anniversary of the 1967 Referendum 27 May National Reconciliation Week 27 May-3 June. www. reconciliation.org.au/nrw/

JUNE Lung Health Promotion Centre at The Alfred 3 June – Theory and Practice of Non-Invasive Ventilation (Bi-Level and CPAP Management) 20 June – Asthma Management Update 23-24 June – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au Active Ageing Conference Wellness, reablement and restorative care in aged care 30 June, Swissotel Sydney.

The Active Ageing Conference is a one-day conference and series of workshops to share the latest evidence on wellness, reablement and restorative care, and to equip community care providers with strategies to meet their new requirements. www. activeageingconference.com.au

SEPTEMBER

Educators of Australia Bi-Annual National Conference (hosted by SA Branch) Nurture the primal instinct 12-14 October, ‘the Sanctuary’, Adelaide Zoo. www.ivvy.com/ event/cape 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

NOVEMBER Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) Annual Conference 8-10 November, Melbourne Convention Centre. http:// catsinam.org.au/conference/ conference-catsinam ICIN2016 24-25 November 2016, Parmelia Hilton Perth. Showcasing innovation and leadership in clinical practice, research and education. Abstracts open 1 February 2016. www.icinperth.com

Australasia-Pacific Post-Polio Conference Polio: Life stage matters 20–22 September. Four Seasons RAH Nurses, Group 762, 40-year reunion 16 April from 6.30pm onwards.

Venue: Private (city fringe) address will be forwarded RSVP 9 April to Alison James M: 0414 722 463 E: alison.james@tafesa.edu.au or Heather Crosby M: 0417 806 674 E: heather@sambrook.com.au Adelaide Children’s Hospital, Group 276, 40-year reunion 27 May. Contact Anne Bartholomew (nee Lennox) E: wald06@tpg.com. au or M 0417 854 015 Royal Adelaide Hospital, Group 764, 40-year reunion 18 June 2016, Private room at pub with small charge to cover cost of food platters. Contact Patrice O’Loughlin M: 040 539 9171 E: patrice_oloughlin@mail.com

St Vincent’s Hospital, Melbourne, August 1986, 30-year reunion 5 August, Melbourne, Venue TBA. Contact Celia Kenny (nee Murphy) E: paulandcelia@hotmail.com or search Facebook page AUGUST 86 30YR REUNION 2016 Woden Valley Hospital “L Group”, 35-year reunion 1-3 October. Contact Murray Harper M: 0448 211 059 E: dodgerlily21@bigpond.com Facebook: Search for page “Woden Valley Hospital L Group”

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

MAIL

QUESTIONS ABOUT DETENTION I read with interest the article, ‘Detention is damaging children’, ANMJ Dec 2015/Jan 2016.

Detention centres are designed to screen persons attempting to enter Australia illegally. Among the purposes of such facilities is health screening and proof of identity.

Whilst I agree detention can harm children, the article fails to address several relevant points.

Releasing children from these facilities creates the following issues: • Who will be responsible for these children, both financially and socially.

• What guidelines will determine a child by (age) definition.

Consider these facts: Children are highly susceptible to propaganda, manipulation and coercion by radicals. A nine year old child can be a suicide bomber; separation from the family unit (adults and siblings) can also be damaging.

We are creating another “stolen” generation by this course of action.

A policy of releasing detainees with children is susceptible to abuse as unaccompanied children (in country) can be grabbed by fleeing adults to ensure an early release (in Australia).

There is NO quick solution in reducing timeframes in detention. Release from detention requires proof of identity, among other criteria. Unfortunately, many detainees have fled from situations that preclude the safe custody of such documentation.

The safety of this nation, and border security, is paramount. I trust this assists others to reflect on a different viewpoint.

Rowena PCA, VIC

WORKPLACE VIOLENCE I unfortunately witnessed the dreadful behaviour of new parents of twins in a major hospital.

The mother was in a two bed ward with one twin while the other twin was in the nursery. The parents were visiting the nursery and did not return till well after midnight. The husband was asked to leave as it was past visiting hours. He became aggressive and verbally abused a staff member calling her a scumbag in front of her colleagues and the hapless other lady whose baby was unsettled due to the commotion going on.

I was asked to take a set of observations on the patient as her midwife was otherwise engaged. The public patient asked me why she didn’t have a private room so her husband could stay the night. I replied that I didn’t know as I was only helping out.

Eventually the hospital supervisor was called and she spent a great deal of time appeasing the couple. In the end they were moved into a single room and not a peep was heard afterwards. This incident was documented in the patient’s history and a VIMS was lodged only to become another statistic.

I feel that moving the patient into a single room rewarded the demeaning behaviour shown by these devious people. Indeed it would have been better to move the other petrified lady into the single room to escape such dreadful and unacceptable behaviour that she and the staff are faced with on an increasing occurrence.

LETTER OF THE MONTH

IT’S IMPORTANT TO SAY THANKS Recently I attended our 30 year nursing reunion and had a fantastic night with a group who were initial strangers but, who are now part of a very special and unique part of my personal history and nursing history.

School 385 trained on the wards of Geelong Hospital. Looking back we were a group of naive, innocent young women and men (only one of the original two males made it to finals and graduated). Nine weeks of preliminary training school (PTS), included intense study and practise of skills such as making beds with hospital corners, perfecting bed baths, doing and recording observations and urinalysis, and the skills of administering enemas with metres of thick plastic tubing to the ever accommodating life size mannequins. Following this intense time, we were then released into the wards.

From unskilled, nervous anxious individuals our teachers, charge nurses, doctors, registered nurses and peers assisted us to hone our skills. Thirty years later with only one to two exceptions we are all still in the nursing profession, working as skilled health professionals in a range of positions and settings.

My thanks to group 385 - a wonderful assortment of characters and individuals for sharing the journey, and to all the people from teachers to senior charge nurses who helped us and many nurses before and after us to transform from “rookie to registered nurse”. I/we are indebted to you.

Jo Read RN Victoria

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.

It seems patients’ rights take precedence over workers’ rights and responsibilities. We have reached an age that no one should be exposed to such vulgarities. The cliché: “That sticks and stones can break my bones but words cannot hurt me “ does not apply today as words can and do ruin reputations.

RN Victoria

anmf.org.au

March 2016 Volume 23, No. 8 47

ANNIE At the time of writing this column, a furore was erupting across the country over the treatment of ‘baby Asha’. The furore was not because of the treatment the little girl was receiving from nurses and Annie Butler, doctors in a major Queensland Assistant Federal hospital but because of her Secretary treatment by the government, which in the view of those nurses and doctors, threatened the little girl’s safety.

One year old baby Asha, was brought from Nauru to Australia for treatment for burns, which could not have been adequately treated on the island.

She received the emergency care she needed in Brisbane’s Lady Cilento Children’s Hospital and was said to be recovering well when the government announced that baby Asha, along with 267 other people including more than 50 children, were to be ‘fasttrack’ deported to Nauru.

This is what sparked the furore. The nurses and doctors caring for baby Asha refused to discharge her to be returned to Nauru because of concerns that the detention centre where she would be headed is unsafe.

They would only release her from care if a suitable home environment could be found.

ADULTS HELD IN THESE DETENTION CENTRES ARE SUFFERING, BUT CHILDREN AND BABIES ARE SUFFERING EVEN MORE This led to a stand-off between the hospital staff and the Federal government and provoked a series of protests, primarily from nurses, midwives, doctors and other health professionals, across the country asking the government to let her stay. A vigil was held outside the Lady Cilento Children’s Hospital and solidarity protests were held by nurses, midwives and doctors at major Sydney and Melbourne hospitals.

The Federation itself entered the fray, issuing a statement of support for the staff at Lady Cilento and calling on the Prime Minister and his government to show some compassion and let baby Asha, her family and other asylum seeker families stay in Australia.

The Federation engaged in this debate for a number of reasons, the first of which is because at last year’s national biennial conference ANMF members directed us to lobby the 48 March 2016 Volume 23, No. 8

government and other political parties to stop mandatory detention and to ensure safe and fair treatment for refugees and asylum seekers.

The second is because the view of the Federation and many of our members is that the government’s policy of indefinite detention, especially of children, is morally unacceptable.

Successive governments continue to sanction appalling treatment of refugees and asylum seekers forcing them into physical and mental illness.

They continue to imprison children in detention centres denying them a right to safety and security, denying them a right to education, denying them the right to play, learn and develop and denying them the most basic right – just to be healthy.

Adults held in these detention centres are suffering, but children and babies are suffering even more - mentally, emotionally and physically.

In 2014 the Human Rights Commission launched an Inquiry into children in closed immigration detention.

The purpose of the Inquiry was to investigate the ways in which life in immigration detention affects the health, wellbeing and development of children. The final report of the Inquiry, The Forgotten Children: National Inquiry into Children in Immigration Detention 2014, was provided to the Attorney-General in November 2014 and tabled in Federal Parliament in February 2015.

The report clearly outlines the abuses being suffered by children in detention. Crowded conditions are causing unusual physical illnesses and the deprivation of liberty is causing serious mental illness – a child in detention is 17 times more likely to have a serious mental illness than a child living free in Australia.

The report revealed that not only are children being denied these rights, they are being exposed to terrible dangers – in just over one year in

Australian detention centres there were 233 assaults involving children.

The dangerous behaviours that children are being forced to witness and experience in detention centres is causing them to harm themselves, to starve themselves and even to try and kill themselves.

Many Australians are disturbed by this situation but nurses, midwives and other health professionals are particularly alarmed. Nurses’ and midwives’ normal practice would be to find remedies for these sorts of problems, and to try and prevent them occurring – if this was happening to Australian children, nurses and midwives would be reporting it to governments. But in this situation it is actually our governments that are causing the problems.

And, as reported in the ANMJ previously, the government has attempted to tie the hands of health professionals and prevent them from speaking up about substandard and harmful care in detention centres via the Border Force Act. This is why the case of baby Asha and the actions of the health professionals caring for her are so significant. They demonstrate that the Border Force Act’s disgraceful assault on the ethics of the nursing, midwifery and other registered health profession, which seeks to prevent us from fulfilling our core responsibility, to protect the safety of our patients, will not prevail.

Nurses, midwives, doctors and others are showing us right now that they will not compromise their professional practice standards or their codes of ethics; that they will not ignore their legal, professional and moral obligations to their patients, whoever they are.

Nurses and midwives told us that they will not be silenced, they will always stand up to protect the safety of their patients. And we will stand right by them. 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.

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Sarah believes everybody deserves respect, including the homeless.

She fights for their rights to quality health care.

She becomes a familiar face for those that need help.

Tickets now on sale Join us to celebrate 10 years of excellence in nursing at the 2016 HESTA Australian Nursing Awards, Thursday 12 May

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