ANMJ May 2016

V O LU M E 2 3 , N O. 1 0 / M AY 2 0 1 6

SHOW YOU CARE THIS FEDERAL ELECTION ANMF’S ELECTION CAMPAIGN

www.anmf.org.au

AMH IS ON THE MOVE As from the 2nd of May our new address will be Level 13, 33 King William St, Adelaide, SA 5000

Australian Medicines Handbook

Aged Care Companion

Our postal address remains the same: PO Box 240, Rundle Mall PO, Adelaide, SA 5000 Our new phone number is 08 7099 8800

Children’s Dosing Companion

EVIDENCE-BASED PEER-REVIEWED INDEPENDENT PREFERRED TRUSTED

Our new fax number is 08 7099 8899

CONTENTS

18

Directory 02 Editorial 03 News 04 World 13

SHOW YOU CARE THIS FEDERAL ELECTION ANMF’S ELECTION CAMPAIGN

International Days

14

Professional

17

Feature 18 Working Life

24

Legal

25

Research 26 Books 27 Clinical Update

28

Viewpoint 33 Reflections 34 Focus – Mental Health (part 1) 35 Calendar 45 Mail 46 Sally 48

04

35 48

anmf.org.au

May 2016 Volume 23, No. 10 1

Canberra

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

Editorial

Melbourne & ANMJ

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

Federal Secretary Lee Thomas

Assistant Federal Secretary Annie Butler

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

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

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

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

Northern Territory

South Australia

Victoria

Branch Secretary Yvonne Falckh

Branch Secretary Elizabeth Dabars

Branch Secretary Lisa Fitzpatrick

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

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

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

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

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

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

Moving state? Transfer your ANMF membership

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

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

New South Wales

Queensland

Tasmania

Western Australia

Branch Secretary Brett Holmes

Branch Secretary Beth Mohle

Branch Secretary Neroli Ellis

Branch Secretary Mark Olson

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

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

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

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

2 May 2016 Volume 23, No. 10

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

144,175

TOTAL READERSHIP

Based on ANMJ 2014 member survey pass on rate Circulation: 98,750 BCA audit, September 2015

anmf.org.au

EDITORIAL

Editorial Lee Thomas, ANMF Federal Secretary At the time of going to print it seems inevitable a Federal election will be called for 2 July.

In preparation the ANMF is launching a public campaign about the core issues that matter the most to nurses, midwives and the greater community.

Without a doubt our health system is under threat and, as deeper cuts are gorged out of healthcare, the ability of nurses and midwives to carry out care to their patients is becoming increasingly difficult. In effect their hands are tied.

ANMF’s campaign If you don’t care, we can’t care is an opportunity to show politicians that we are serious about Australia’s healthcare and as a collective we are a force to be reckoned with.

Specifically, we will be targeting issues that matter most to the professions and these include: • Maintaining nurses’ and midwives’ penalty rates; • Putting an end to healthcare cuts; • Putting an end to Medicare; • Ensuring safe staffing in aged care.

In the coming weeks you will see a flurry of activity on social media, billboards and television ads in some states highlighting and raising awareness about these issues.

In order for our voices to be heard it is essential each and everyone one of you supports the campaign. To do this visit the campaign website www.ICareandIVote. com.au and join the campaign’s facebook page for regular updates and calls to action.

The ANMJ will also keep you abreast of campaign details. Additionally, contact your local MP’s and tell them how important healthcare is to you.

IN ORDER FOR OUR VOICES TO BE HEARD IT IS ESSENTIAL EACH AND EVERYONE ONE OF YOU SUPPORTS THE CAMPAIGN.

It is on these two days that we pay homage to all midwives and nurses around the world for their individual and collective achievements.

It is important that we value and applaud the work that you do every day.

Likewise take the time to acknowledge your role and the difference you make in providing crucial care to so many.

As I sign off I want to remind you that it is time to renew your annual general or nonpractising registration by 31 May. As you are aware, part of the process for registration is to ensure a minimum number of continuing professional development hours. Ways to build up your hours is to read the ANMJ or access ANMF’s online professional training room, which has tutorials on a wide range of topics. To access the tutorials and find out more go to http://anmf.org.au/pages/onlineeducation-programs

This month also marks International Day of the Midwife on 5 May and International Nurses Day on 12 May.

@AustralianNursingandMidwiferyFederation

anmf.org.au

@anmfbetterhands

www.anmf.org.au

May 2016 Volume 23, No. 10 3

NEWS

PUSH TO IMPROVE SAFETY OF REMOTE AREA HEALTH WORKFORCE Australia’s professional body representing remote health professionals has vowed that the tragic death of remote area nurse Gayle Woodford will not be in vain following consultations outlining key priorities for change.

The aftermath of the incident, which occurred in late March, saw CRANAplus attend the meeting convened by Rural Health Minister Fiona Nash at the rural roundtable in Canberra last month in a bid to tackle enduring safety challenges facing the rural and remote health workforce.

CRANAplus Chief Executive Officer Christopher Cliffe said the roundtable presented a crucial opportunity to reinforce long-standing calls for improved safety and canvass fresh strategies. “There was an absolute consensus that this isn’t good practice, that we need to fix this, and that it’s the responsibility of the entire health system to get behind this and make it happen.”

At the meeting, CRANAplus unveiled five key priorities it believes can trigger change, with the plan of attack including appeals for zero tolerance to violence and aggression experienced by the rural and remote health workforce, all after hours callouts in remote communities to be accompanied, 4 May 2016 Volume 23, No. 10

EMERGENCY DEPARTMENT NURSE IAN MILLER FROM THE CANBERRA HOSPITAL, WEARING A BANDAGE ON HIS ARM IN RESPECT OF MURDERED NURSE GAYLE WOODFORD.

avoiding single nurse posts, and establishing a national safety implementation group to oversee the rollout and monitor the effectiveness of minimum standards.

“It’s about having a zero tolerance approach.

It’s about having after hours’ callouts in remote area communities accompanied so you’re not working alone. If you’re being called out at 2 o’clock in the morning then you should have somebody to assist you. It doesn’t have to be another clinician but it should at least be a responsible person from that community,” said Mr Cliffe.

“THERE WAS AN ABSOLUTE CONSENSUS THAT THIS ISN’T GOOD PRACTICE, THAT WE NEED TO FIX THIS, AND THAT IT’S THE RESPONSIBILITY OF THE ENTIRE HEALTH SYSTEM TO GET BEHIND THIS AND MAKE IT HAPPEN.” Mr Cliffe said the intense media interest in the remote health sector sparked by the death of Mrs Woodford placed the organisation in a delicate situation. “Everybody was entitled to an opinion. Everybody was grieving and reacting in their own way and I think as an organisation CRANAplus just needed to be respectful of that and make sure we supported everybody and their views.”

The incident gained national attention and received heartening support from nurses with more than 100,000 people signing a petition titled ‘Gayle’s Law’ backing better protection for health workers. Thousands of nurses also rallied around the issue by

wearing bandages across their arms to pay respect to Mrs Woodford.

Mr Cliffe labelled the incident as “a tragedy” and “terrible act of criminality” but also stressed that attention should now be directed to disconnecting the death from collective safety issues faced by the workforce. “We have to make sure that we’re not generating too much fear within the industry that’s actually not based on reality.

“The priority for CRANAplus is that it doesn’t get forgotten. That we do continue to lobby for this and push for change in remote communities. For us, as an organisation, we need to regroup a little bit. We’re a small organisation and we’ve been struggling through a challenging time with a grieving workforce.”

Mr Cliffe acknowledged that Mrs Woodford’s death had helped to shine the light on longstanding safety issues within the sector. He said CRANAplus’ Bush Support Services, a 24 hour counselling service available to all remote health workers and service providers, had been inundated since the tragedy. “They’ve been really overwhelmed by the number of people that feel quite traumatised. This has brought up an awful lot of previous stresses and issues for people.”

Minister Nash has also committed to a oneto-one meeting with ANMF Federal Secretary Lee Thomas to discuss the union’s strategies on how to improve the safety and security of the rural and remote health workforce. Ms Thomas said the ANMF maintains that no nurse should ever have to attend a callout alone. “Key stakeholders now need to work together to develop viable solutions that prevent violence and protect our dedicated health professionals servicing rural and remote communities across the country.” anmf.org.au

NEWS

SAFETY OUTRAGE

“Government policy on all levels and private policy often supports single nurse posts in many different areas that compromise the safety of the nurse.

Two nurses at all times is the appropriate staffing.”

Leesa Healy, Nurse

More than 130,000 people signed a petition calling for urgent action to support the safety of remote area nurses across Australia following the death of South Australian nurse Gayle Woodford.

Western Australian RAN Joanne Norton started the online petition which called for two nurses to attend after-hours callouts and the abolition of single nurse posts.

“Since Christmas 2015, there have been two sexual assaults of RANs and now the murder of our colleague in Fregon, South Australia.”

An outpouring of emotion resulted in Senator Fiona Nash replying to the public online change.org petition. “I have treated the matter of remote health worker safety with the seriousness it deserves from the outset. I am determined to work with the sector to achieve meaningful outcomes,” the Minister posted.

“My sincere hope is that it won’t be too long before RANs are adequately and satisfactorily protected while engaging with patients, and in pursuance of their vital services. The alternative would be for RANs to pull out from remote community health clinics and withdraw their services because their safety and wellbeing is compromised – let’s hope this is not a reality!”

Gladwin James —

anmf.org.au

— “As an ex-police officer having worked in a remote Aboriginal community, I got to see nearly on a daily basis, the stress, danger and unreasonable workload solitary health workers had to tolerate.”

Ron Lloyd, Narangba — “The police have to have two in a patrol car but a female nurse works alone. This is just so wrong on so many levels. Please do something. Do it now and involve the people that it affects because they are the ones who can tell you exactly how they work and the conditions they have to cope with.”

Mary Moore, Adelaide — “As one who has worked in remote areas professionally I consider the RAN and RFDS to be wholly dedicated to the vast areas of Australia and deserve all the support and respect possible.”

BRIEFS

MENTAL ILLNESS HELP GUIDE LAUNCHED A new guide to help South Australian health professionals deliver better support to people who care for someone with a mental illness has been released.

A Practical Guide For Working With Carers of People with a Mental Illness is aimed at supporting GPs, psychologists, mental health nurses and other allied health professionals and service providers while working with people experiencing mental illness and their carers. Topics covered in a check-list format range from helping carers navigate confidentiality arrangements to ensuring they are aware of the support available to them and having ‘carer champions’ who advocate for carers within workplaces. The guide, which will be rolled out nationally, was developed by numerous mental health organisations including the Private Mental Health Consumer Carer Network Australia and Mind Australia.

The guide can be downloaded from www.mindaustralia.org.au

Andrew Andrejewskis — “Like many who work in remote areas, I am aware of the great challenges that face frontline workers and appreciate the challenges of providing appropriate support. But for their wellbeing and that of their clients, nothing is more urgent.”

Kay Boulden, Cootharaba

SEASONAL INFLUENZA PROGRAM COMMENCED The National Seasonal Influenza Program, which commenced last month, has released two categories of vaccines to protect against virus strains this year.

The 2016 seasonal coverage vaccine was based on the Australian Influenza Vaccine Committee (AIVC) review relating to the strains of influenza that were circulating in Australia and the Southern Hemisphere in the Winter of 2015. Based on the review AIVC recommended to adopt September 2015 World Health Organization’s recommendations. The two categories of influenza are of the virus and trivalent influenza vaccines (TIV) to protect against three strains of the virus (two type As and one type B). The quadrivalent influenza vaccine (QIV) will help protect against four strains (the same A subtypes and the B lineage in TIV, plus a second influenza B virus from the other B lineage). The Australian Technical Advisory Group on Immunisation (ATAGI) recommends the use of QIV in preference to TIV. However, TIVs are an acceptable alternative particularly if QIVs are not available. The 2016 flu shot is available from GP surgeries and other immunisation providers and is available free to certain individuals that are deemed most at risk.

May 2016 Volume 23, No. 10 5

Expanded Pregnancy, Birth and Baby service supporting parents from pregnancy to preschool.

Who can parents talk to about behavioural and development concerns?

Pregnancy, Birth and Baby offers additional support when parents cannot access your services. Pregnancy, Birth and Baby is a free Australian Government service available 7 days a week operated by maternal and child health nurses to provide parents with guidance and reassurance about their child’s behaviour and development.

We can also refer to local services such as early child health and speech therapy. Our social workers and psychologists provide parents with support for perinatal anxiety and depression. Pregnancy, Birth and Baby is not prescriptive and uses a family partnership model to guide practice.

Parents can conveniently access Pregnancy, Birth and Baby via:

NATIONAL HELPLINE

VIDEO CALL

WEBSITE

Refer your patients to Pregnancy, Birth and Baby for guidance and reassurance.

1800 882 436 or www.pregnancybirthbaby.org.au

NEWS REGISTERED NURSE KEITH BELL IS UPSET ABOUT DRASTIC HEALTH CUTS.

As part of its commitment, COAG also called on states and territories to take action to improve the quality of care in hospitals and reduce the number of admissions by implementing strategies centred on better coordinated care for people with complex and chronic disease, reducing hospital-acquired complications that cause unnecessary costs, and reducing the number of avoidable hospital readmissions.

Registered Nurse Keith Bell, an Anaesthetic Nurse at the Flinders Medical Centre in South Australia, described the government’s $2.9 billion hand back as a “drop in the ocean” and extremely insufficient.

GRIM OUTLOOK AS HOSPITAL FUNDING PLUNGES Frontline nurses are bracing themselves for a new era of compromised care as Australia’s shrinking health budget begins to gradually erode the system’s capacity to deliver essential services.

The former Abbott government slashed billions from the health system in its 2015 Budget, including major cuts to hospital funding that would have left states and territories $57 billion worse off over the next decade.

However, at its 42nd meeting, in Canberra in early April, the Council of Australian Governments (COAG) performed a backflip of sorts, pledging an additional $2.9 billion in funding for public hospitals up until 30 June 2020.

“ALREADY HERE [AT FLINDERS MEDICAL CENTRE] I CAN SEE THAT THE HOSPITAL IS TRYING TO SAVE MONEY. THEY’RE BUYING INFERIOR PRODUCTS THAT AREN’T REALLY DOING THE JOB.”

anmf.org.au

Keith has already felt the early impact of health cuts and expects the problem will only increase in coming years. He cites surgery regularly being cancelled at his workplace due to insufficient beds in the Intensive Care Unit (ICU) as an example of how funding can affect care as one such example. “Some of these patients aren’t just locals. We get patients down from the Northern Territory and country areas. It’s hard for them. They’re actually in the hospital thinking they’re going to have surgery that day and then it’s been cancelled on them. If I was a patient, I wouldn’t be too happy, that’s for sure.”

As health cuts begin to penetrate the system, Keith believes nurses will bear the burden as hospitals face greater strain.

“Already here (at Flinders Medical Centre) I can see that the hospital is trying to save money. They’re buying inferior products that aren’t really doing the job.”

Keith is a WorkSafe representative at the public hospital and reveals that health cuts simply mirror many other troubling issues pervading the health system.

Altogether, Keith said the government’s attack on health and vital schemes such as Medicare was upsetting. The government’s removal of bulk billing incentives for pathology services, due to take effect in July, will lead to detrimental health outcomes in the long run, he added. “Medicare is definitely under threat. I don’t think people are aware of what the government is really doing. It’s only when people go and have a scan or something and they’re out of pocket that they will realise what’s actually been going on.

NATIONAL ALCOHOL AND DRUG TREATMENT SNAPSHOT

More than 115,000 people received treatment for drug and alcohol episodes from substance abuse agencies during 2014-15, new data from the Australian Institute of Health and Welfare (AIHW) has revealed.

Alcohol and other drug treatment services help people curb their drug use through a range of treatments, with objectives including reduction or cessation of drug use as well as improvements to social and personal functioning.

AIHW’s Alcohol and Other Drug Treatment Services National Minimum Data Set for 2014-15 showed altogether, 843 publiclyfunded alcohol and other drug treatment agencies helped people seeking treatment during 2014-15, an increase of 27% over the past five years from 2009-10.

Significantly, two in three people treated for alcohol and drug issues were male (67%), just over half were aged 20-39 (54%), and one in seven clients were Aboriginal and Torres Strait Islander people (15%).

The AIHW data determined that the alcohol and drug client group is an ageing cohort, with a median age of 33 years in 2014-15, up from 31 in 2005-06.

Since 2005-06, there has been a decline in the number of 20-29-year-old’s being treated for episodes relating to alcohol and drugs, but this statistic is countered by a rise in the proportion of those over 40 seeking health management.

The number of episodes where clients received treatment for amphetamines (20%) has continued to increase over the past 10 years.

IN 2014-15, THE TOP FOUR DRUGS THAT LED TO CLIENTS SEEKING TREATMENT

38%

24%

20%

6%

“I think a lot of people won’t go and have treatment and things and cut down, just because they can’t afford it. It’s always the low and middle-income people who suffer.”

May 2016 Volume 23, No. 10 7

The not-so-small print about keeping the public safe There’s lots of it... but it’s important.

X Do you know there are things you can and can’t do when advertising health services?

X Have you ever wondered if you should report that practitioner who might be putting the public at risk of harm?

X Are you meeting all your obligations as a registered health practitioner?

These are only three pieces.

Read the not-so-small print to complete the puzzle and keep the public safe.

Go to www.notsosmallprint.com/ANMJ or call 1300 419 495 to find out more.

NEWS

GOVERNMENT URGED TO RECOGNISE GENDER DIFFERENCES IN MENTAL HEALTH POLICY

BRIEFS

KEEP BULK BILL More than 400,000 Australians have signed a petition ‘Don’t Kill Bulk Bill’ calling on the government to reverse its plan to slash $650 million in bulk billing services from the pathology and diagnostic imaging sector.

According to Pathology Australia, Australians are concerned that the cuts may affect their ability to get crucial and potentially life-saving tests. Chief Executive Officer of Pathology Australia Liesel Wett said patient anger at the proposed bulk billing cuts was building. “People realise that they need pathology to aid speedy and accurate diagnosis of many conditions and frankly they are horrified that the health of Australians is being put at risk by the government’s proposal to remove bulk billing incentive on pathology testing.”

MEDICINAL CANNABIS BILL PASSED Victorian patients and their families will be able to legally access medicinal cannabis in exceptional circumstances.

The Access to Medicinal Cannabis Bill 2015, which was passed in the Victorian Parliament last month, ensures a legal framework to enable the manufacture, supply and access to safe and high quality medicinal cannabis products in Victoria. At the time of going to print the Tasmanian government also announced it will establish a Controlled Access Scheme allowing Tasmanians with serious, unresponsive medical conditions, to access medical cannabis products when prescribed by a specialist doctor.

Women experience higher rates of depression, anxiety and eating disorders than men but invariably fall through the gaps in the health system, a new report from Victoria University’s health think tank Australian Health Policy Collaboration has found.

The Australian Health Policy Collaboration (AHPC) is subsequently urging the federal government to improve its poor understanding of women’s mental health needs and make a determined effort to drive prevention, treatment, and management programs.

A policy paper released last month linked poor mental health in women with detrimental social and economic outcomes including disability, reduced life expectancy, unemployment, reduced productivity, and increased healthcare costs.

The paper, Investing in Women’s Mental Health: Strengthening the Foundations for Women, Families and the Australian Economy, reveals women’s mental health needs differ greatly to those of men.

NEW ORGAN DONATION GUIDELINES New national ethical and clinical guidelines for organ donation were released by the government last month.

Ethical and Clinical Guidelines for Organ Transplant supersede the Transplantation Society of Australia and New Zealand’s (TSANZ) Organ Transplantation from Deceased Donors: Consensus Statement on Eligibility Criteria and Allocation Protocols. The guidelines were developed as a collaborative effort between the National Health and Medical Research Council (NHMRC), the Organ and Tissue Authority and TSANZ. It is hoped the document will help improve donation rates and increase access to life saving transplants.

anmf.org.au

WORKFORCE IN DIABETES EDUCATION SURVEY The Australian Diabetes Educators Association is conducting a Workforce in Diabetes Education survey for the first time.

It is hoped the survey will provide a comprehensive analysis related to the employment status of health professionals who provide services to people with Diabetes in Australia. The survey will help identify employment in diabetes education by geographical location and profession; education level and diabetes education experience; emerging workforce trends, including private practice as well as workforce challenges in diabetes education services. To access the survey go to: www.adea.com.au/ projects/workforce-in-diabeteseducation. The survey will close midnight Sunday 3 July.

Ultimately, it calls for an overhaul of current practices and the implementation of new policies to address the disparity and greater need.

Lead author and policy advisor, Dr Maria Duggan, said existing funding and service models are unquestionably failing women and must change.

“We are letting down some of the most vulnerable people in our community by not paying attention to the physical health of people with mental illness,” Dr Duggan said.

“The life expectancy gap for women with serious mental illness is confronting and unacceptable.

Women are dying up to 16 years earlier than their counterparts without serious mental illness, mostly from avoidable conditions including cardiovascular disease, cancer, and respiratory conditions.”

Dr Duggan said “gender-blind policy” was a result of inadequate analysis and understanding of the causes and consequences of mental health, adding that the shortcoming leads to poor targeting of resources.

“Improving women’s health – and in particular taking specific, evidence-based action to tackle mental illnesses amongst women and girls most at risk – will strengthen the wellbeing of children, families and communities.”

May 2016 Volume 23, No. 10 9

NEWS

LAST OF ASYLUM SEEKER CHILDREN RELEASED FROM MAINLAND DETENTION The federal government has surrendered to mounting public pressure by releasing the remaining group of asylum seeker children living in mainland immigration detention into the community.

Immigration Minister Peter Dutton made the unexpected announcement last month, stating that the dozens of babies and children in onshore detention were now free. Advocacy groups involved in unwavering campaigns to protect the rights of children and asylum seekers have hailed the development a breakthrough and long overdue.

“We’re overjoyed to see children leave the detention centres because we know how distressing it is for kids to live in detention,” Asylum Seeker Resource Centre’s (ASRC) Detention Rights Advocate Pamela Curr said.

“It means living in a house, in a suburb, in a community, and being free, to go to school, to go shopping with their parents, and to live a normal life, with some exceptions.”

Despite the upside of the announcement, doubts surfaced over some of the government’s motives and actions.

Uncertainty remains over whether the government has simply reclassified certain sections of detention centres as community detention in order to make the claims.

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A YOUNG ASYLUM SEEKER CHILD IN DETENTION. PHOTO: ASYLUM SEEKER RESOURCE CENTRE (ASRC) SUPPLIED

Likewise, evidence of a handful of children still currently in detention emerged, including one child in Darwin and a family with four children living in Sydney.

Categorically though, Minister Dutton quashed speculation, vowing that children released into community detention still faced being sent to Nauru once they no longer need medical support in Australia.

Ms Curr believes the government’s ongoing defiance is unnecessary. “The Minister keeps saying that. I don’t know why he has to keep frightening little children with those sorts of remarks.”

While the last of the asylum seeker children have virtually been freed from detention, many more still remain in Australia’s offshore detention facility on Nauru where problematic conditions and treatment persist.

“WE’RE OVERJOYED TO SEE CHILDREN LEAVE THE DETENTION CENTRES BECAUSE WE KNOW HOW DISTRESSING IT IS FOR KIDS TO LIVE IN DETENTION.” ANMF Federal Secretary Lee Thomas said nurses would continue to stand in solidarity against the unjust and inhumane treatment of children in Australia and offshore.

“Australia has a duty to treat every human being compassionately and with respect, courtesy, and consideration, irrespective of the place of treatment. The living conditions in offshore detention are unacceptable and we will continue to fight hard on this issue to ensure fundamental change in the system.”

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NEWS

NEW INITIATIVE NEEDS FUNDING

both the Launceston General Hospital and Royal Hobart Hospital due to the pressures of the current demands. Every day nurses across the state work double shifts.”

The Tasmanian government committed to action in the state’s emergency departments last month after serious concerns of patient safety.

Under the state’s new initiative, ‘Clinical Initiative Nurses’ will be recruited to ‘actively monitor and provide advice’ to patients and their families in the ED waiting room and develop care plans with ED doctors. Ms Ellis said these triage nurses were already in place in the RHH however would be rolled out across the state. “We welcome many of the solutions the government has proposed, particularly around flow,” Ms Ellis said. “It’s about the capacity to move patients through the ED to the beds.”

The new Patients First initiative includes six key areas including ‘red flag’ events for immediate action, such as unacceptable wait times. The Tasmanian government response followed incidents including a 91-year old man who waited two days for surgery and a woman who suffered a miscarriage while waiting in a chair.“ These aren’t incidents that anyone, emergency department doctors and nurses least of all, wants to see,” Immediate past President of the Australian College for Emergency Medicine (ACEM) Dr Anthony Cross said.

Tasmanian hospitals were overburdened and under-resourced, the ANMF Tasmanian Branch and ACEM warned.

ANMF Tasmanian Branch Secretary Neroli Ellis said the Royal Hobart Hospital (RHH) had been completely bed blocked with patients waiting unacceptable times for a bed and elective surgery cancelled.

Oncology patients waiting for beds had been treated for pain relief in the ED. “This is a statewide crisis,” she said. “This is indicative of the lack of capacity to meet our health demands and the impending high demand winter period will soon be here.” Extra beds had been opened up but were staffed with nurses working double shifts, Ms Ellis said. “Currently, there are numerous workload grievances at

A trial to start in July will see senior nursing and allied health staff discharge patients earlier in the day, a move the ANMF Tasmanian Branch has advocated for the past five years. Psychiatric emergency nurses at the Royal Hobart Hospital will also be considered to continue beyond the financial year but were wholly dependent on Commonwealth funding, Ms Ellis said.

“Many of these initiatives will require additional funding when we already have a cash-strapped health system.” The ANMF Tasmanian Branch and AMA Tasmania have called on state Health Minister Michael Ferguson to lobby the federal government to increase Commonwealth funding.

Patients First initiative • Clinical initiative nurses to monitor patients and develop care plans • Earlier discharge in the day by senior nurses and allied health staff • Psychiatric emergency nurses at the Royal Hobart Hospital • Enhanced scope of practice for paramedics • Unacceptable ‘red flag’ events that signal immediate action • Better use of rural hospital beds

CRACKDOWN ON BULLYING IN VICTORIAN HOSPITALS A flying squad of independent antibullying specialists and experts has been assembled in a major push to tackle bullying and harassment within Victoria’s hospitals.

The hard-line strategy, developed by the Andrews state Labor government, marks a landmark shift in holding hospitals and agencies to account in order to stamp out problematic bullying.

The extensive plan entails implementing an anti-bullying flying squad to identify and clamp down on health services with poor workplace culture and higher levels of bullying and harassment, educating and supporting key stakeholders including health service boards and the workforce to help prevent bullying, monitoring the incidence of bullying at health services, and auditing the health workforce via surveys to identify bullying hot spots.

The comprehensive strategy arrives on the back of a request made last year by Victorian Health Minister Jill Hennessy that the Victorian Auditor-General seriously investigate the full-extent of bullying in the public health system and identify opportunities for change. The implementation of the plan will be carried out by an advisory committee consisting of hospitals, unions, colleges, Worksafe, and other stakeholders in a bid to tackle the problem.

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NEWS

Influencing Behaviour Change This 2 day program in creative behaviour coaching will assist health professionals to work with behaviour change coaching principles to help people better manage their conditions and achieve better health outcomes and improved quality of life.

4 – 5 August Asthma Management Update A one day program designed to improve understanding and knowledge in the current management of asthma.

20 June Asthma Educator’s Course A three day program covering the latest advances in asthma care management and delivery, enabling professionals to work effectively to improve health outcomes.

20 – 22 July, 16 – 18 November Respiratory Update This day program will give health professionals the opportunity to improve their skills and knowledge in caring for the person with lung disease.

31 May Respiratory Course A 5 day program for individuals wanting to update and develop their skills and knowledge of respiratory care and the holistic management of respiratory illness.

13 – 15 July (Module A) / 17 – 18 August (Module B) Theory & Practice of Non Invasive Ventilation – Bi-Level & CPAP Management A comprehensive, practical course for individuals wanting an increased understanding of and skills in the management of NIV, Bi-level and CPAP from ICU to the community carer.

3 June Managing COPD A course for professionals to improve their understanding and knowledge of current treatments and management of COPD. 6 – 7 October Smoking Cessation Course This evidence based program aims to give participants the knowledge and skills to treat and manage nicotine dependency to help people addicted to smoking to quit.

28 – 29 July 24 – 25 November Spirometry Principles & Practice This extensive course aims to develop an individual’s knowledge & skills to enable them to perform spirometry to internationally recognised best practice.

23 – 24 June, 18 – 19 August 24 – 25 October Lung Health Promotion Centre at The Alfred P: (03) 9076 2382 E: lunghealth@alfred.org.au W: www.lunghealth.org.

SIMONE O’BRIEN WITH PATIENT

NP CARE UNDER CHRONIC DISEASE PACKAGE Rural and remote Nurse Practitioner Simone O’Brien is hopeful the federal government’s new chronic disease package will throw a lifeline to an outreach trial in central Victoria.

A six-month trial of nurse practitioner and rural and isolated practice RNs (RIPRN) in Heathcote target patients with chronic and complex healthcare conditions who do not access healthcare.

“The aim is to access people who cannot access us,” Ms O’Brien said. “There are a whole lot of people who do not see GPs, who do not access healthcare – whether that’s due to dementia, chronic illness, disparity in socioeconomic status. We link them to healthcare and services.” Statistics show one in five Australians have two or more chronic health conditions. One third of Indigenous Australians have three or more long term illnesses.

The federal government Healthier Medicare package was announced last month. In part response to a Primary Health Care Advisory Group review report released in December.

About 65,000 Australians will participate in two-year trials of ‘Health Care Homes’, responsible for ongoing coordination and management of patient care.

“Turnbull’s announcement in 94 pages put GPs and NPs as the care leaders – for the first time NPs were bumped up with a real direct link to patient care,” Ms O’Brien said.

Ms O’Brien visited a lady with dementia on Good Friday who she assessed with a raging UTI. “She relayed a story where men had broken in and cooked chops. She was doddery on her feet.”

Family were not due to visit until the Sunday.

Ms O’Brien was able to obtain a urine sample and facilitated early antibiotics. “It’s trying to target people who traditionally do not access healthcare and prevent the wheels falling off.”

The trial in Heathcote, funded by the Murray Primary Health Network for six months, had seen a significant reduction in avoidable hospital admissions and after hours’ presentations, Ms O’Brien said. This is a key aim of the government’s new package. Half of all potentially avoidable hospital admissions in 2013-14 were attributed to chronic conditions.

Evaluation of the package should focus on greater system efficiency, including analysis of impact on avoidable hospitalisations, according to the Australian Hospital and Healthcare Associations (AHHA). “This will be particularly important given …$70 million will be withheld from state hospital funding to pay for the chronic disease package,” AHHA Chief Executive Alison Verrhoeven said.

Consumers Health Forum of Australia CEO Leanne Wells welcomed plans to put the patient at the centre of care. “Voluntary patient enrolment will provide a clinical ‘home-base’…. This will open the way for more avenues to advise and care by telephone, email or videoconferencing, including for after-hours advice or care.”

KEY DETAILS • Tailored patient care plans • Establishment of ‘Health Care Homes’ • • • •

to coordinate all medical, allied health and out-of-hospital services Improved use of digital services eg.

MyHealth record and teleheath Bundled regularly quarterly payments Stronger data collection Creation of a national minimum data set of de-identified information to help measure and benchmark primary healthcare performance

Greater coordination between Primary Health Networks and Local Hospital Networks to deliver health services

anmf.org.au

WORLD

UNITED KINGDOM

UK NURSES TAKE STAND ON CLIMATE CHANGE The Royal College of Nursing (RCN) has joined some of United Kingdom’s leading health institutions in lobbying governments to act swiftly on tackling climate change in a bid to prevent adverse future health outcomes.

A major new health alliance launched last month, the UK Health Alliance on Climate Change, has warned that UK health services are currently unprepared by the risks posed by climate change. In a letter to the government, the alliance highlighted 18% of clinical commissioning groups and just one third of National Health Service (NHS) providers have adequate plans in place to adapt to climate change. The alliance claims extreme weather events such as flooding and heatwaves pose direct risks to people’s health and systematic threats to hospitals and health services. RCN Chief Executive Janet Davies said nurses were coming together to call for stronger, smarter measures to tackle climate change.

“By providing their patients with small but important changes in their lives that benefit their health, nursing professionals can also play a significant role in reducing the financial pressures on the NHS and the wider impacts of climate change.”

CANADA

CANADIAN NURSES DEMAND EQUAL WORKPLACE SAFETY Front-line registered nurses (RNs) in Ontario, Canada, are fighting for equal rights to workplace safety after being excluded from new legislation designed to better protect first responders against Post-Traumatic Stress Disorder (PTSD). anmf.org.au

Under Bill 163, Supporting Ontario’s First Responders Act (Post Traumatic Stress Disorder, 2016), PTSD will become a workplace-related illness for paramedics, firefighters, police officers, and prison nurses.

However other nurses didn’t make the cut, with the snub infuriating the union. Ontario Nurses’ Association (ONA) is now calling for the inclusion of all nurses in the legislation, stating that nurses are often put into harm’s way on a regular basis. “In the course of our working lives, our heroic nurses are witness to and experience a wide array of critical and traumatising events,” noted ONA’s First Vice-President Vicki McKenna. “Registered nurses are in every sense first responders.

As a result, we can and many do suffer from PTSD. Nurses have every right to be covered under this progressive Bill.” Research shows frequent exposure to traumatic situations by first responders makes them twice as likely to suffer PTSD. Ms McKenna said workplace safety for nurses was imperative. “In every sector of healthcare, front-line caregivers experience violence, trauma and events that can trigger PTSD. We experience patients who are rushed into the ER after being involved in horrific car accidents, house fires or are gunshot victims, haemorrhaging or burned beyond recognition. Any number of events in our lives can trigger PTSD in nurses.”

GLOBAL

ICN PRESIDENT APPOINTED TO UN HIGH-LEVEL COMMISSION The President of the International Council of Nurses (ICN), Dr Judith Shamian, has been selected to serve on the United Nations SecretaryGeneral’s High-Level Commission on Health Employment and Economic Growth.

The World Health Organization (WHO) is among several groups that will serve as the Secretariat of the Commission. The objective of the Commission is to propose actions in support of the creation of around 40 million

new jobs in the health and social sector by 2030, paying specific attention to addressing the periodic shortage of 18 million health workers by 2030, primarily in low and middle-income countries. The actions must contribute to global inclusive economic growth, the creation of decent jobs, and achieving Universal Health Coverage.

The Commission is a strategic political initiative designed to complement broader initiatives developed by other international agencies and global health partners. “It is an incredible honour for me personally but also for the nursing profession to be chosen as a member of this Commission,” Dr Shamian said. “The work of the Commission will be extremely useful in identifying solutions to the systematic problems which impede the development of a more equitable and sustainable world.”

AUSTRALIA

WORLD’S BEST UNIVERSITIES TO STUDY NURSING REVEALED Australian universities feature prominently within the top 100 ranked nursing and midwifery programs from across the globe.

The standings emerged as part of the annual QS World University Rankings, which highlight the world’s top universities in 42 subjects based on academic and employer reputation and the amount of research citations. This is the first year nursing has been included in the study. The University of Sydney was the highest rated Australian university when it came to nursing, placing at number 13 on the list. Victorian universities Monash (16) and the University of Melbourne (19) also fared well, while the University of Technology Sydney came in at number 20 in the top 100. Other universities to make the cut included Deakin University (22), Griffith University (29), the University of South Australia (50), and Curtin University (53). The United States dominated the rankings with seven universities placing in the top 12 in the world.

May 2016 Volume 23, No. 10 13

IND / IDM

INTERNATIONAL NURSES DAY AND INTERNATIONAL DAY OF THE MIDWIFE: CELEBRATING THE PROFESSIONS International Day of the Midwife kicks off on 5 May and International Nurses Day is celebrated on 12 May. During this time the professions and the community take time to acknowledge the significant, and often extraordinary, contributions nurses and midwives make.

ANMF Federal Secretary Lee Thomas said it was important that nurses and midwives mark the days with some form of celebration.

“Nurses and midwives should be proud of the invaluable work they do that makes the difference they make to the community.”

The 2016 theme for International Day of the Midwife, set by the International Confederation of Midwives, is: ‘Women and Newborns: The Heart of Midwifery’ The International Council of Nurses, has declared 2016 International Nurses Day theme as A Force for Change: Improving health systems’ resilience. This year the ANMJ asks what these themes mean to those working in the professions.

Marni also believes increasing cultural competency in the health system is essential, suggesting that knowledge and awareness of issues surrounding Indigenous people and their health is limited across the board.

Asked to consider the distinct birthing needs of Aboriginal and Torres Strait Islander women, Marni says they vary and part of it is not putting a blanket over the whole Indigenous population. What is right for me is not going to be right for every Indigenous woman. It is about asking the questions and being aware of potential cultural sensitivities or differences. No one should ever assume they know what a woman wants based on her cultural background.”

MIDWIFE MARNI TUALA AT THE TWEED HOSPITAL IN FRONT OF ARTWORK BY LOCAL INDIGENOUS ARTIST CHRISTINE SLABB

WOMEN AND NEWBORNS: THE HEART OF MIDWIFERY Marni Tuala’s bold decision to swap a budding law career in favour of becoming a midwife is paying off.

After being inspired by a friend who is a Clinical Midwifery Specialist Marni decided to pursue midwifery. Completing a Bachelor of Midwifery degree at Southern Cross University, Marni works at Tweed Hospital after securing one of two graduate positions this year. “It’s a huge learning curve being out there as a practising midwife but I’m absolutely loving it and just taking everything on board with the expertise and experience that’s around me.” A mother of five, Marni’s venture into health was not altogether surprising given both her aunty and uncle are nurses.

Marni is a proud Aboriginal woman whose mob hails from Wonnarua country in New South Wales’ Hunter Valley region. Since undertaking her midwifery studies she has demonstrated a strong passion for creating positive change for Indigenous women and their families. While studying at Southern Cross, Marni was employed by the School of Health and Human Sciences to run a project titled ‘Boosting Indigenous Midwifery Students’ Success (BIMSS). She is now working alongside Professor Roianne West, Director of the First Peoples Health Unit at 14 May 2016 Volume 23, No. 10

Griffith University on the Gold Coast.

Her ongoing determination to improve Aboriginal and Torres Strait Islander midwifery students’ retention rates and ensuring they practice in the workforce is fitting during the International Day of the Midwife on 5 May. This year’s theme, ‘‘Women and Newborns: The Heart of Midwifery, supports Marni’s objectives. “We don’t want to focus our efforts on increasing retention rates of Indigenous midwifery students. We want them to finish, to complete their studies and get out there [into the workforce] because that’s where we need them.”

Marni believes this is key to making a difference in a health system that requires significant improvement. “Health disparities between the Indigenous and non-Indigenous populations are well documented. Working within the health system I see the enormity of these disparities first hand. Increasing our Indigenous health workforce by having more Aboriginal midwives is a crucial step towards closing the gap.”

Birthing on country is another issue which has triggered robust debate, with many women in favour of being able to have the choice to give birth on country within their communities. Under current practices, women in rural and remote areas face being relocated from their homes to a regional centre from 36 weeks gestation to await the birth of their child. This practice can take women away from their land, family and other children, and into a hospital setting with little support.

“The right to birth on country is imperative to the empowerment of Aboriginal women and to the survival of traditional knowledge and birth practices,” Marni says. “At the moment it’s not possible in most places due to legislation based on fear but this needs to change. Women should have the choice. If these women could stay in their communities and birth safely on country surrounded by their female relatives, where they have connection to country, it’s only going to improve maternal and neonatal outcomes.”

Marni says making it easier for Indigenous women to access university courses will also lead to better completion rates and have a direct impact on delivering much needed care to communities. “There’s still some barriers to overcome but we will get there,” she says. “The challenge is getting these [students] safely through the courses in our tertiary facilities and through practical placements within health facilities that can be quite affronting to Aboriginal students.” anmf.org.au

IND / IDM International Council of Nurses

NURSES: A force for change

IMPROVING HEALTH SYSTEMS’ RESILIENCE

NURSES: A FORCE FOR CHANGE. IMPROVING HEALTH SYSTEMS’ RESILIENCE Building resilience in preparation for disaster

Nurses and midwives play a critical role in preparing people better and making communities more resilient for times of ‘disruptive challenge’ or disaster, Dean of the School of Nursing and Midwifery of SA’s Flinders University, Professor Paul Arbon says. “The World Health Organization has a focus on more resilient health systems.

Community nurses, practice nurses, school nurses, all nurses, have a significant role in health to educate communities.”

12 MAY 2016 INTERNATIONAL NURSES DAY #IND2016

This year’s IND theme of resilience of health systems raises awareness of risk management, Professor Arbon says.

“Look at infrastructure, potential hazards, resilience of services such as power and water supply, diseases, chronic illness and see whether your hospital or health service would be okay. It comes back to the ability to survive the impact.”

There needs to be an understanding that nursing has a role to play, Professor Arbon says. “Many people most at risk are so

RESILIENCE IN LOCAL COMMUNITIES “We make do with a little to get a lot done,” says Western Australian Nurse Practitioner Deirdre Louw.

Deirdre has a passion for primary healthcare and chronic disease management.

“Working as a NP in rural WA – it’s not a quick turnover, you don’t get quick results, it’s about ongoing perseverance.”

Dierdre works for not for profit Silver Chain in Katanning and outlying areas. Katanning is a town 277km south east of Perth with a population of 3,808 in the 2006 census. “It’s three hours south of Perth in a rural setting, a predominantly farming community. I think they are quite resilient; they just get on with it,” Deirdre says.

As such, people tolerate more and suffer poorer health, she says. “They present later.

I see people farm until their later years there are 70 year olds still farming. So the clients are more chronic. Socioeconomic disparity can also be an issue.”

Deirdre describes her role as “true generalist practice - I do a bit of everything across the spectrum.” This includes aged care, mental health, women’s and maternal health, chronic disease, and primary healthcare.

Deirdre sees the complex cases – there is a high prevalence of diabetes and

anmf.org.au

because of their health status and nurses see them more than anyone. Disasters do not strike everyone in the same way. If you have a platinum credit card, you can spend five days in the Hilton but if you have a mobility problem, chronic disease, mental health illness or are a single parent not so.”

“In our country because we see floods, fire and cyclone there’s a sense that if you live in the city, you’re okay, when in fact it’s completely the reverse,” Professor Arbon said.

A city’s structures depend on interconnectedness which can collapse, he said. “A city loses power supply, communications and emergency services because it’s the same IT system.

“With a wildfire there may be 10 or two or none dead and 10-30 houses destroyed.

Disaster in terms of deaths and injuries are higher in cities due to heatwaves. Adelaide and Melbourne have ten times the death rate due to heatwaves.”

The Disaster Research Centre at Flinders University has an emergency nurse disaster preparedness checklist available online. http://www.flinders.edu.au/fms/disasterresilience/documents/Checklist.pdf

hypertension in the area. Having trained in South Africa, Deirdre started out in primary care and midwifery. She has been a NP since 2007 and in her current role since May 2014.

There are four NPs employed across four sites in the Wheatbelt and Great Southern, Southern Inland Health Initiative, funded through royalties for regions: to improve access and services. “The small country hospitals do not have the capacity for clients to present multiple times; a Risk Screen Project has been set up for people over 65 years. If they present to hospital Deirdre is notified and follows up. “It has decreased hospital admissions we do home visits, see what other services clients can access and try to promote hospital avoidance because of early interventions,” she says. It has also provided better outcomes for management of chronic disease, such as management of diabetes.

Working 24/7 with no or little relief, took its toll. Deirdre applied for her position through WA Country Health Service in 2014. There are four NPs employed across four sites in the Wheatbelt and Great Southern, Southern Inland Health Initiative, funded through Royalties for Regions: to improve access and services.

“The small country hospitals do not have the capacity for clients to present multiple times; A Risk Screen Project has been set up for people over 65 years. If they present to hospital, Deirdre is notified and follows up. “It has decreased hospital

admissions we do home visits, see what other services clients can access and try to promote hospital avoidance.” because of early interventions,” she says.

It has also provided better outcomes for management of chronic disease, such as management of diabetes.

However the future is uncertain. Funding comes to an end in June. “We want to see the four sites continue to get re-funding,” Deirdre says. “We have scored some runs on the board and made a difference. We’ve had an impact on Aboriginal health. It’s really aligned with the government’s new plan. “I feel confident, that said the sad thing is if we don’t get re-funded those clients won’t know until June and it’s not enough time to transfer clients. They will be picked up but it does leave a gap.”

May 2016 Volume 23, No. 10 15

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NURSES IN ACTION KENYA AND NEPAL

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PROFESSIONAL

EROSION OF CARE – IT’S A BATTLE Julianne Bryce

Recently we attended a meeting with a large corporate aged care provider who is considering changing their model of care for a number of their residential facilities.

Aspects of the model of care are consistent with current evidence for quality care.

However, these changes will also see the current 15-minute nurse handover time each shift abolished.

Already it is of great concern that handover for a large number of residents has only been 15 minutes.

To consider removal of even this small amount of communication time between shifts is totally unacceptable.

Elizabeth Foley

Julie Reeves ANMF Federal Professional Officers

Reference Australian Commission on Safety and Quality in Healthcare, Clinical Handover standard 6 factsheet http:// www.safetyandquality. gov.au/wp-content/ uploads/2012/01/ NSQHS-Standards-FactSheet-Standard-6.pdf King, D., Macromaras, K., Wei, Z., et al.

(2012) The Aged Care Workforce 2012, Canberra Australian Government Department of Health and Ageing. Table 3.3 page 10 Stewart Brown 2015, Aged Care financial Performance Survey, Residential Care June 2015, Annual Report

anmf.org.au

There is extensive evidence to support the importance of clinical handover between two nurses providing direct care. The National Safety and Quality Service Standards of the Australian Commission on Safety and Quality in Healthcare, include a specific standard for clinical handover - Standard 6. The Commission identifies breakdown in the transfer of information or in communication “…as one of the most important contributing factors in serious adverse events and …a major preventable cause of patient harm” (Australian Commission on Safety and Quality in Healthcare, Clinical Handover Standard 6 factsheet). Many healthcare facilities are striving to improve clinical handover and are using all available tools such as care assessment and planning documentation, to complement direct handover. It seems incongruous then that a large corporate aged care provider should choose to remove handover time despite the identified safety and quality risk. This is but one example of a health system struggling to provide safe, quality care to our growing and increasingly frail, elderly population.

Recently, the Australian Nursing and Midwifery Federation (ANMF) prepared a comprehensive submission to the Senate Standing Committee on Community Affairs Inquiry into the Future of Australia’s Aged Care Sector Workforce. Addressing 13 terms of reference, the ANMF made six recommendations. Our submission identified the current workforce within aged care - residential and community care, is increasingly expanding in an attempt to meet demand. Although, the care required in residential and community settings continues to significantly increase, the numbers of registered nurses and enrolled nurses working within the sector continues to decrease. In the most recent figures from the Australian Government Department of Health and Ageing, 14.7% of the workforce are registered nurses (down from 16.8% in 2007), 11.6% are enrolled nurses (down from 12.5% in 2007) and 68.2% are

personal care attendants (up from 64.1% in 2007) (King et al. 2012). The personal care attendant category includes personal carers, assistants in nursing and other unlicensed workers (however titled) working in aged care. Of concern, the decrease in the qualified nurse workforce coincides with a large increase in residential aged care places (25.2% increase from 2003-2014) and the number of residents being assessed as high care.

The skill mix change illustrated above (less RNs and more PCAs), will result in less supervision and support for a growing PCA workforce providing high acuity care to an ever-growing elderly population.

A recent study identified the amount of nursing care residents received per day on average (Brown, 2015). Residents were divided into bands depending on their care requirements. Band 1 identified as the highest care category, where a resident receives a total of 3.18 hours nursing care on average for a 24-hour period. The care provided by a Registered Nurse for this type of classified resident is seven minutes and 19 seconds per shift. Is it acceptable for a person to receive, per shift, only seven minutes and 19 seconds of registered nursing care?

That this could be the accepted level of care by aged care providers is surely offensive to all nurses seeking to provide safe, quality nursing care.

Accordingly, the ANMF made the following recommendation in its submission: the Australian government must fund and implement mandated minimum staffing levels and skill mix requirements for registered nurses, enrolled nurses and assistants in nursing in the aged care sector.

The submission also discusses the importance of closing the wages gap for nurses and AINs working in aged care and those in a public hospital. For recruitment and retention of nurses and AINs in the aged care sector, the wages gap and skill mix requirements need to be addressed as a matter of urgency (see full ANMF submission at: www.anmf.org.au/documents/ submissions/ANMF_Aged_Care_ Inquiry_2016_Report.pdf).

Caring for our growing elderly population is the responsibility of all nurses in all contexts of practice.

Whether in the community, a residential facility or a hospital, nurses are caring for the elderly population.

The interconnectedness of each area means that if quality care is not able to be provided in one area then it will directly affect the others. Nurses need to engage in, and be a part of, the ongoing solutions for the future challenges we all face as a community in the provision of safe, quality aged care.

A. THE CURR ENT C THE A OMPO GED C SIT ARE W ORKFO ION OF RCE

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Person 2012 al Car n/a e Atte 16,265 ndant Allied (21.4%) # Health 190 13,247 10,945 Profess (0.2%) (16.8%) ional (14.4%) Allied Health 13,939 Recommendation 3 9,856 42,943 Assista (14.

(12.

(56.

7%) 5%) nt 5%) Total num 10,999 50,542 ber of That dedicated funding is made available by the Australian Government to close the wages gap, and that provision (11.6%) employe (64.1%) *In 2003 5,776* es (FTE of the funding is conditional on the achievement and maintenance of wage parity. and 2007 64,669 #The term (7.6%) ) (%) thes (68.2%) PCs inclu e categori 5,204* es were des pers 1,612 (6.6%) onal care combine 76,006 (1.7%) d unde The Age rs, assi (100%) r ‘Allie stants d Hea 3,414 in nurs total numd Care Wor 78,849 Recommendation 4 kforce ing and lth’ (3.6%) (100%) report other AINs/PC ber of dire unlicens indicate ct care 94,823 Ws and ed outl emp d wor that Allie (100%) All assistants in nursing/personal care workers (however titled) must be licensed and subject to regulation. ine of loyees kers (how in 201 d Hea the cha ever title racteris lth was 147 including RNs 2 the RNs d) wor ,086. Belo tics of : , ENs, Employm king in those aged care • Nat ent cha workers w is a brie iona in resi racteris f . dential compris lly, there wer tics care: e 21,9 ing 14.9 RNs ENs of the direct • 61.3 Recommendation 5 16 emp % In 201 % are care and AIN loyed 2, employeof the direct 19.4% S/PCWs 6 workforce residen 90% of the care wor in 2012 d part tota • One casual tial age All assistants in nursing/personal care workers (however titled) must be required to meet a minimum standard of time; outlined thir 19.3% kforce d care l direct care full time qualification.

(36%) d of RNs wor workfor below des were women. workforce wor and k from crib k betw in ce hea more een 35-4 16 to 34 d count e the total The charact hours • Med than 40 hou pop eris 0 hours as opp ian age rs 5 King osed to ulation, that tics per wee per week; D, Macro • Med is, full-tim k and maras ian age is 51 6 Martin K, Wei 28.6% e equival Z, et al. of rece B and Recommendation 6 King D The Aged ent. nt hire et al 2012 Care Workf s is 47. op.cit Subm orce 2012, ission Canberra: to Sena That there is a mandated/legislated requirement for 24 hour registered nurse cover for all high care residents in te Inqui Austra lian Gove ry – The aged care facilities, inclusive of those low care facilities with residents assessed with high care needs. rnmen future t Depa

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www.anmf.org.au/documents/submissions/ANMF_Aged_Care_Inquiry_2016_Report.pdf

May 2016 Volume 23, No. 10 17

FEATURE

18 May 2016 Volume 23, No. 10

anmf.org.au

FEATURE v

IF YOU DON’T CARE ABOUT $57 BILLION IN HEALTH CUTS, WE CAN’T CARE Nurses and midwives’ hands are tied.

With $57 billion in health cuts it’s becoming harder for them to provide the level of expert care their patients need.

Without appropriate funding its clear nurses and midwives cannot do their job. With a federal election set for 2 July the time has come to stand together as one to put a stop to these cuts once and for all.

In order to do this the Australian Nursing and Midwifery Federation (ANMF) has launched a major campaign to help draw attention to the ominous health cuts and their long-term damage.

Protecting penalty rates, combatting ongoing attacks on Medicare, and improving standards and conditions in aged care with a focus on ensuring a Registered Nurse is on site 24/7, are other issues firmly on the campaign agenda.

The campaign If you don’t care, we can’t care will involve raising awareness about core issues through broadcast and online media. Specifically, a dedicated website and Facebook page have been developed in a bid to trigger discussion and engagement in the lead-up to the election.

In addition, nurses and midwives are also being encouraged to take an active role in helping to safeguard the healthcare system and ensuring quality care can be anmf.org.au

delivered by seeking out their local MPs and candidates to inform them about the issues that really matter.

levels, improved pay, and importantly, legislation that requires a Registered Nurse be on duty at all times at high-care facilities.

As yet no political party has committed to restoring the $57 billion in funding wiped away from healthcare by the former Abbott government.

“The rostering of RNs should be dictated by the high-care needs of residents rather than the discretion of aged care providers,” Ms Thomas said. “It’s shocking that on any given night at a nursing home across the country that a single care worker can be looking after dozens of frail, vulnerable patients, with complex care needs.”

While a recent meeting by the Council of Australian Governments (COAG) in April handed $2.9 billion back to the system, a gaping hole unmistakeably remains.

ANMF Federal Secretary Lee Thomas said it was vitally important nurses and midwives make their voices heard. “It is now imperative that nurses and midwives take the lead and spell out how these dangerous cuts to health are impacting their working lives and ability to provide quality care for their patients and residents.

Our healthcare system is facing a critical juncture and the scale and extent of these cuts is alarming. We cannot stand by idly and let these attacks on health erode our fundamental and inherent duty of care to people in need.”

One of the key issues the ANMF will shine a spotlight on is aged care, a timely goal amid the current examination of the aged care sector workforce through a federal Senate Inquiry. Hundreds of submissions were made to the Inquiry by aged care staff and key stakeholders.

The ANMF is demanding minimum staffing

As the election looms closer, the ANMF will monitor all important promises made by political parties throughout the campaign and immediately share the information via its various social media channels as it comes to hand.

Ms Thomas said significant change can be achieved if nurses and midwives band together and lobby hard. “Healthcare is a right, not a privilege. We need to fight these cuts and begin restoring pride in our healthcare system.”

If you don’t care, we can’t care

As part of the If you don’t care, we can’t care campaign the ANMF plans to highlight to politicians and the general public how these cuts impact nurses, midwives and ultimately the patients they care for. Five nurses from NSW recently featured in an advertising campaign emphasising the issues. The ANMJ spoke to these nurses on how the cuts will affect Australia’s healthcare system.

May 2016 Volume 23, No. 10 19

FEATURE

ICareandIVote

JESSICA HOUSTON

EMILY FOWLER

“If penalty rates were removed I would probably leave the profession,” says RN Jessica Houston.

“You’ve got to think about it from the perspective where you don’t even have a really good base rate anyway. Personally, I’ve got two kids in childcare and just as of Monday I had to resign from my weekday position and I’m only going to be able to work weekends to make ends meet. All my money goes into childcare. I have to sacrifice that family time.”

Clinical Nurse Specialist Emily Fowler is adamant funding cuts to public hospitals will have a detrimental impact on the ability of nurses to do their jobs effectively.

Jessica works for Parramatta Health as a community nurse.

She previously worked in aged care and knows first-hand how important having an RN on duty 24/7 is, giving her full support of the ANMF’s push to protect quality in the aged care sector.

She formerly worked in a facility that had just one RN on duty from 8am until 4.30pm each day. “It really puts a lot of strain on the nurse but you see it on the clients themselves that are in nursing homes. They know there’s only a nurse from 8am until 4.30pm so they want to make sure they get to talk to you and ask questions.”

Jessica is concerned Australia’s healthcare system is heading into trouble. She says health cuts, coupled with the hacking of Medicare and moves towards an American model of privatisation just don’t make sense, adding that nurses now more than ever need to stand in solidarity to stem the bleeding.

“I really do think we should be prioritising health. As a country, we should be supporting healthcare. The problem is privatisation actually increases the cost of everything. They want to make a profit and it’s horrible to think that people want to profit off sick people.”

With health funding continually on the chopping block in recent years Jessica says the country is in the grip of a health crisis. “I think the golden days are slowly going away where cost wasn’t as big of a thing. It seems to be that everything is about the dollar now whereas before it wasn’t as much.”

“I REALLY DO THINK WE SHOULD BE PRIORITISING HEALTH. AS A COUNTRY, WE SHOULD BE SUPPORTING HEALTHCARE. THE PROBLEM IS PRIVATISATION ACTUALLY INCREASES THE COST OF EVERYTHING. THEY WANT TO MAKE A PROFIT AND IT’S HORRIBLE TO THINK THAT PEOPLE WANT TO PROFIT OFF SICK PEOPLE.”

20 May 2016 Volume 23, No. 10

“Working in a private hospital I’m not quite as affected but all of the government cuts that have been made to the health budget definitely hit a chord with most nurses, no matter where they work, public or private.”

Emily works in the Short Stay Unit (SSU) at the North Shore Private Hospital in NSW. She seized the opportunity to become more actively involved in speaking out about important industrial issues facing nurses following attempts by management at her workplace to hack longstanding payments above the EBA. Emily describes some of the government’s strategies to address the health shortfall, such as raising income tax and the GST, as “pretty slack”.

Asked if she believes recent cuts to Medicare foreshadow tactics aimed at moving towards complete privatisation, Emily agrees that the writing is on the wall. “It looks like we’re heading that way. It seems to be following the way of America unfortunately. Only the rich people are going to be able to afford healthcare if it continues going this way.”

Emily suggests increasing cuts to Medicare and plunging health funding will create greater difficulties in the long run. “The cuts to Medicare are just going to put more pressure on hospitals and the public sector with people not being able to afford these important diagnostic tests and leaving it too long and ending up with chronic and complex health issues.”

Emily says it is important all nurses and midwives stand together and fight the cuts to health, attack on penalty rates, and dig their feet in to safeguard the aged care sector.

Emily worked in aged care for a short time during her training as part of an orthopaedic rehab team. She believes RNs are pivotal. “Patients generally need a lot of help and assistance and quite often are even at the end stage of life. Having that RN expertise at hand is vitally important.”

Ultimately, Emily says putting pressure on the government is the only way to trigger recognition and reform. “It doesn’t seem like there are too many parties promising too much regarding healthcare. I’m hoping that the government will realise that more needs to be done with a little bit of pressure from the union.

“Healthcare is vitally important. There’s going to be a lot of people who won’t be able to afford it soon if we keep trying to privatise it and change the way we run things.”

anmf.org.au

FEATURE icareandivote. com.au

icareandivote.com.au

YOU CAN MAKE THE DIFFERENCE The future quality care is in your hands.

Together we can influence politicians to safeguard health for all.

LEADING UP TO THE ELECTION:

Keep informed: • Visit the campaign website www.ICareandIVote.com.au for regular updates and calls to action • Join the campaign’s facebook CareandIVote page and engage in discussions

anmf.org.au

Speak to your community: • Contact your local MP and tell them how important healthcare is for you. Visit www.ICareandIVote.com.au website page for steps on how to • Talk to colleagues and people in the community about how cuts to our healthcare are detrimental to all

May 2016 Volume 23, No. 10 21

FEATURE CUTS TO STAFFING IN AGED CARE

PENALTY RATES

2003

21.4%

BENJAMIN BRADY The government’s mounting attacks on penalty rates strikes a noticeable chord with Registered Nurse Benjamin Brady.

Benjamin, who works in the Intensive Care Unit (ICU) at North Shore Private Hospital in NSW, recounts a stand-off between nurses and the hospital last year after management tried to cut penalty rates during the afternoon section of a 12-hour shift.

“For a good 15 plus years they’ve been giving us these same sorts of concessions and entitlements so to just suddenly take them away was pretty much a slap in the face.”

Fortunately, employees were able to fight off the cuts, which would have left most nurses at least $50 poorer each fortnight, with the help of the New South Wales Nurses and Midwives’ Association (NSWNMA).

Nevertheless, Mr Brady is under no illusions regarding the lingering threats to penalty rates faced by the wider profession.

“It disheartens me. It makes me wonder about where we are going in the industry. Aren’t we doing this job to help these sick, frail, elderly people?

2007

16.8%

2012

14.7% Decline in fulltime equivalent RNs working in aged care As per 2012 census data

Addressing the health cuts currently infiltrating the system, Mr Brady says nurses and midwives cannot sit idly. He says a lack of funding and moves to eat away at Medicare spell a recipe for disaster. “I think it will put a lot more pressure on private hospitals. If they’re going to cut funding for public areas then private hospitals will have to take on a lot more of the strain.

“In my area, they are constantly trying to cut staff here and there.

“I feel like everyone needs to try and get more involved and if I can do just a little bit extra to make it known and spread the word then it might get a little bit more momentum. More often than not, healthcare gets lost in all the political talks and the backstabbing and bribing. We’ve just got to talk as much about the issue and drive it home to families.”

22 May 2016 Volume 23, No. 10

$1921 LESS PER YEAR

First year registered nurses in public hospitals would lose $1921 a year in wages if their Sunday penalty rates are cut to Saturday level.

“The hospital has a support base so we can provide effective therapies and treatments to these patients but we can’t do our job properly and efficiently if we’re worrying about how much we’re earning at the end of the day and whether we can afford to pay bills, put petrol in the car, and food on the table.”

Benjamin says many nurses will consider leaving the profession if penalty rates vanish. “Whenever I talk to anyone they always say that we don’t get enough recognition in terms of how much money we’re getting paid. People who aren’t in my profession also agree. “With that in mind, and these looming budget cuts on the horizon, it’s going to make a lot more people think twice about getting into the role of nursing and midwifery and we’re going to lose a lot of energetic, passionate young people, who are going to look elsewhere.”

Nurses, midwives and carers would lose 20% of their income if cuts to penalty rates were implemented

HOSPITAL CUTS $57 Billion slashed out of public health country wide

$650 MILLION CUT CUTS TO MEDICARE $650 million cut from Medicare benefits

-$359 MILLION

Collectively nurses, midwives and aged care workers would lose $359 million a year if Sunday penalty rates are reduced to Saturday levels and a further $3 billion would be under threat if changes go further.

anmf.org.au

FEATURE

ICareandIVote

VANESSA POSTLE

MARTIN GRAY

Midwife at the RPA, Vanessa Postle says she’s passionate about public healthcare. “It is a core value of what is Australian. I am worried about the healthcare cuts, everybody is. I feel that we are going backwards and it’s quite scary.”

Health and education policies are key to his vote this election, says NSW Clinical Nurse Educator (CNE) Martin Gray.

Vanessa says she has concerns about Australia’s public healthcare system turning into an Americanised system. “It affects everyone. The fact that lower socioeconomic people cannot have access to healthcare is a huge problem - they cannot afford Pap smears or simply access their GP. They will fill up the ED, putting more pressure on ED nurses and ED departments. When they present they will be sicker and the impact will be greater. It’s feeding the cycle of poverty.”

Vanessa’s mother, who is a nurse, worked in disability for most of her career and has been in private aged care for the past 10 years. “It’s hard work. My mother deserves more money than I do. When my parents moved to Ballina it was the first job she could get, then she fell in love with it when she could have taken other opportunities. Now she won’t leave.

“It’s hard for me to see her so undervalued when she’s been highly regarded all her working life. She’s highly regarded where she works but she’s not treated like that.”

Having worked in a nursing home when doing her EN training, Vanessa is aware of conditions nurses and care staff work under in aged care. “I cried every day. The conditions were hard. I hurt myself, split my disc. I couldn’t do it which is why I have such high regard for nurses, like my mother, who work in aged care.

It’s such an important area.

“As a midwife, we have good ratios, the women I care for are looked after well; I am looked after well. I feel incredibly fortunate but I have a holistic view. My husband and I are very socialist. It’s very scary that Australia could lose public healthcare. As a mother of two, a two- and five-year old, Vanessa says penalty rates are important to their family. “I work every single weekend. We should be appropriately paid for missing out on birthday parties and activities as a family unit. It’s a whole lifestyle issue.”

“I could work a job where I don’t work night shifts, I am keen on education and management but I would always want to work on the floor. I work in delivery and am passionate about that.”

I WORK EVERY SINGLE WEEKEND. WE SHOULD BE APPROPRIATELY PAID FOR MISSING OUT ON BIRTHDAY PARTIES AND ACTIVITIES AS A FAMILY UNIT. IT’S A WHOLE LIFESTYLE ISSUE.

anmf.org.au

“The government is pilfering from them, particularly health. The area is under attack – attack by stealth. I believe access to [tax payer funded health] and education is a basic human right.”

CNE at the Prince of Wales Hospital, Martin says he liked the premise of the ANMF’s ad campaign. “If the public don’t care, we cannot care. When you see relatives of patients, they say “You do a fantastic job” but then people do not think of the consequences of policies when they vote for a party. People often do not think of the impact of the legislation and what that does to health.”

Martin, originally from England, says he’s seen cuts to healthcare in Australia over the past 15 years. With two young children, he is considering relocating from Sydney to Coffs Harbour. “I am 43, I feel like I’m 19, living pay packet to pay packet. I rely on that extra little bit from penalty rates otherwise I cannot afford when the washing machine breaks down or routine maintenance on my car. It’s vital – people rely on it.

“On weekends you miss out on all the fun times – kids’ sport, weekend birthday parties. You make lots of sacrifices, you deserve to be reimbursed.” Martin says Australia should be wary of taking the UK’s path. “In the UK they got rid of penalty rates for another scheme where it gave people a little pay rise.

People who did nights all the time stopped doing them.

“I was in my early 20s working every weekend. I seriously thought about leaving the profession. It wasn’t life - it was a real hard slog. I thought I might as well get a job stacking trolleys. “If you want to retain staff you need to pay appropriate wages. It starts with the casual workers but it needs to be nipped in the bud. If you work weekends you need to be paid penalty rates.”

The government has targeted Medicare, Martin says, with consequences yet to come. “In the UK there was dismantling piece by piece of the health system until they could say ‘it doesn’t work, it’s not efficient’ when it’s run into the ground and they feel there’s no alternative but privatisation.”

Martin says cuts to healthcare, particularly staffing are detrimental to direct patient care. “Ratios came in and that was good. But they will always be under attack and we still have a long way to go.” Martin says he has concerns about colleagues in nursing homes under the pump with the numbers of patients they look after. “And we are always under the threat of losing registered nurses full stop. There is a risk that we have unqualified people looking after our senior people. That people without skills are looking after these people is inconceivable.”

May 2016 Volume 23, No. 10 23

WORKING LIFE the community and medical sign off; they are not drinking, they are stable.

They turn up. They do not have huge amounts of fluid like 5-6 litres, but 2 litres.”

Kirsty has been to Kintore twice, her last trip she spent two weeks each in Warburton and Yuendumu. She says it’s a different type of work and the challenges include going to a community where English is not the first language and oriented to culture.

“At North Shore and St Vincent’s we do not have a large group of Indigenous patients.

WORKING LIFE

By Natalie Dragon Renal Nurse Kirsty Musgrave trades the bustle of Sydney for the Northern Territory’s Western Desert each year to help tackle the demand for dialysis services.

“I’ve settled back in although I’ve nearly gone under a couple of cars – you get used to being the only vehicle on the road,” Kirsty laughs, back at work in St Vincent’s Hospital in Sydney. “I have a strong belief people should be allowed access to health when they need it,” she says of her latest trip to the NT. “In the city patients may have to drive 30 minutes but they still go home. This group of patients often can never go home.”

On her last stint, one woman undergoing haemodialysis had been waiting to go home for 12 months.

“She was being treated in Kalgoorlie.

Even then she won’t be able to be home permanently – only for three or four months,” says Kirsty.

Clinical Nurse Consultant of the Renal Ambulatory Unit, Dialysis, at St Vincent’s in Sydney, Kirsty has taken one month off each year for the past five years to work in the NT outback.

She was inspired to help after hearing of the need at a conference of the Renal Society of which she is a member. “I was hearing about this dislocation and a breakdown in culture.”

24 May 2016 Volume 23, No. 10

The Pintupi Luritja people from the Western Desert communities in the NT recognised they were losing people to Alice Springs in the 1990s.

“Patients going there for dialysis were not coming back,” says Kirsty.

Others would choose palliative care rather than be moved from country.

Concerned their family members were being forced to move away from their homes and families to access dialysis treatment, the community held an Art Exhibition of its paintings.

An auction raised $1 million and the funds culminated in the first clinic in Kintore in 2004, which had one dialysis machine. Health Minister Nicola Roxon under Federal Labor, injected $1 million a year to boost renal services in remote areas in central Australia and to help fund the Purple House renal facility in Alice Springs in 2010.

Kirsty says there is still unmet demand for renal services in central Australia.

“There is a huge demand, when you look at the community with 10-15 patients needing dialysing.

“Many Aboriginal people have diabetes; they have the highest rate of end stage renal failure.”

There are a lot of unfounded myths and stereotypes about Aboriginal patients on dialysis coming in with large amounts of fluids and being non-compliant, says Kirsty. “Those out in the community cannot be sick otherwise they are transported back to town. They have to have an assessment before they go out to

“When you go somewhere in Australia as a first nation and see the poverty it can be quite confronting.

The first time, it’s ‘Oh my God’ I cannot believe this. You go out and recognise that you are not going to change the world. This is how these communities run. You bring in your standards and your practice and patient care and have to accept that things are done differently.

“Dialysis is similar wherever you go; the standard is very high, it’s the other things you do – driving patients, cooking breakfast and lunch, doing patients’ washing.

“I’ve been taken hunting, eaten goanna. I have done a 4WD course; I can change tyres on a hi-lux and troop carrier. Friends have been taken hunting for honey ants and witchetty grubs. You become involved in the community as much as you want to be involved. It’s very much up to you.

I really enjoy living in the community and experiencing a different way of life. It was a privilege to be asked hunting, they don’t ask everyone.”

Dialysis is the end point, says Kirsty, and governments should be focussed on prevention and chronic disease management. “It comes down to the social determinants of health – poverty, low birth weight, highly processed food - they all contribute to make for the perfect storm.”

Kirsty highly recommends the experience. “It does challenge you clinically and it is a lot of fun.”

The Western Desert Nganampa Walytja Palyantjaku Tjutaku Aboriginal Corporation (WDNWPT) was incorporated in 2003. The name means ‘Making all our families well’. It recognises that people must be able to stay on country, to look after and be looked after by their families. WDNWPT has an all Indigenous governing committee, elected by its members.

anmf.org.au

LEGAL

GUILTY “At 63, you are professionally disgraced, de-registered, socially isolated and facing imprisonment for a large proportion of the rest of your life – perhaps all of it” (Forrest J p 1).

Linda Starr

This was the opening remark in R v Peters [2013] when Dr Peters who had been charged with 55 counts of negligently causing serious injury having knowingly infected a number of patients with Hepatitis C was found guilty and sentenced to 14 years imprisonment with a non-parole period of 10 years. He was 63 years of age.

Doctor Peters was an anaesthetist who had been addicted to narcotics for more than 18 years. His health impairment became evident when it was discovered that he had issued a number of false prescriptions between 1994 and 1995 which he first claimed was to feed his wife’s narcotic addiction. However, late in 1995 Dr Peters advised the Victorian Medical Board that he had an addiction to IV Pethidine and Fentanyl which led to criminal charges being heard in the Magistrates Court where he received a six month suspended sentence. He also had his registration suspended by the Medical Board for 12 months and on returning to work stayed under strict supervision until 2010 when he was ultimately de-registered.

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

Dr Peters became aware of his Hepatitis C condition in 1997 and whilst the Health Department was notified of this neither he nor the Department notified the Medical Board. This was also the year he returned to work as an anaesthetist even though he was still addicted to and using narcotics on a regular basis. His ongoing use of narcotics was known to other staff members working with Dr Peters. For example in the year 2000 a nurse complained about his appropriation and use of Fentanyl, and in 2010 another giving evidence to police in the investigation to this current matter, stated that “All the nursing staff were aware Jim had a drug problem…I remember he was doing daily urine tests…they were coming back clean…late last year I noticed a change in Jim…We all knew that Jim was using again…” (p2). Indeed, the practitioner was having regular urine screens however, they were not tested for Fentanyl or its metabolites despite this being his narcotic of choice.

Despite this Dr Peters continued to practice and administered more than 3,500 anaesthetics at the Croydon Day Surgery (CDS) between 2006 and 2009. In 2010 a cluster of Hepatitis C cases, the same strain as Dr Peters was traced back to CDS and, 47 patients had contracted the infection and eight more tested positive for Hepatitis C antibodies. Dr Peters

pled guilty to 55 counts of being culpably negligent. These patients became infected when Dr Peters used the same needle and syringe to inject both himself and his patients with Fentanyl. Apart from knowingly infecting these patients he was also stealing these drugs from his employer.

THE ADVANTAGE OF HAIR TESTING IS THAT THIS WILL SHOW DRUG USE FOR WEEKS TO MONTHS PRIOR TO THE SAMPLE BEING COLLECTED WHEREAS URINE AND BLOOD SAMPLES PROVIDE EVIDENCE OF HOURS OR AT MOST DAYS (DRUMMER, 2014).

This conduct was considered to be significantly below the standard that could be expected from a reasonable anaesthetist and as such warranted punishment under criminal law. Judge Forrest considered this practitioner’s conduct to be “truly reprehensible and [his] moral culpability in relation to each offence as very high” (p4). His Honour noted that the practitioner’s addiction provided an explanation for this criminal negligence but made it clear that this did not excuse it. Furthermore, he noted that the practitioner had shown no sign of remorse.

In sentencing, Judge Forrest considered the importance of a sentence that serves as a deterrent to others. On this point he stated that: “Other health professionals, whether addicted or not, must understand that their patients are entitled to

conscientious and professional care, and that criminally culpable negligent conduct will be met with stern punishment” (p6).

This case highlights the importance of ensuring that where there is a reasonable belief or knowledge that a registered health practitioner has a health impairment a report is made to the Australian Health Practitioner Regulation Authority (AHPRA) so that adequate steps can be taken to assist the practitioner in addressing their health concerns and steps are put in place to protect the public from the potential risk of harm that could occur as a result of their impairment.

Recently AHPRA has updated the drug and screening protocol with increased risk management for health practitioners who are being monitored for substance misuse. This new evidence based protocol now requires all practitioners who have any restrictions on their registration due to substance abuse in the past to undergo not only routine urine testing but also hair testing. The advantage of hair testing is that this will show drug use for weeks to months prior to the sample being collected whereas urine and blood samples provide evidence of hours or at most days (Drummer, 2014).

This protocol can be found on the Nursing and Midwifery Board of Australia’s website at www.ahpra. gov.au/About-AHPRA/Monitoringand-compliance/Drug-and-alcoholscreening.aspx A very interesting report, Testing for impairing substances in health professionals, written by Professor Olaf Drummer from the Victorian Institute of Forensic Medicine is also available on the same link. The report provides information on the type of substances that should be tested across all the health disciplines regulated and guestimates of the prevalence of these substances in the professions.

References Drummer Olaf 2014. Testing for Impairing Substances in Health Professionals. A Report for the Australian Health Practitioner Regulation Authority. Victorian Institute of Forensic Medicine. Victoria.

R v Peters [2013] VSC 93

May 2016 Volume 23, No. 10 25

RESEARCH

RESEARCH ETHICS PROTECT PUBLIC Crimes committed by scientists, doctors and nurses in the name of ‘medical science’ during World War II could reoccur without vigilance, a leading Australian nursing academic warns.

“We all need to know what has occurred in the past so it can’t happen again,” Charles Sturt University Professor of Nursing Linda Shields (pictured) said. Co-author of Nurses and Midwives in Nazi Germany: The ‘Euthanasia Programs’ Professor Shields delivered a recent lecture on the need for human research ethics committees (HRECs).

The Nuremberg Code for Research Ethics arose from the Nuremberg trials of Nazi war criminals, which remain the basis for HRECs. “The atrocities committed by the Nazis and health professionals in concentration camps of Auschwitz and Ravensbruck are an eternal and constant reminder of why ethics approval for research is so important to protect the wellbeing of people who take part in research,” Professor Shields said.

While Australia had good guidelines and HRECs, there was no real auditing role of the National Health and Medical Research Council, she said. “Checking on the ethics committees themselves is left to selfregulation.”

There had been many instances of highly unethical research since World War II, Professor Shields said. One of the most recent and notorious was in Auckland in the 1970s. “Women with cervical cancer were left untreated so doctors could study the natural course of the disease.

“One of the worst things we can do is think it could never happen again,” she said. There was a ‘public responsibility’ for ensuring research was ethically acceptable to the Australian community, Professor Shields said.

Australia’s National Statement on Ethical Conduct in Human Research updated in May 2015 is available at www.nhmrc.gov.au

26 May 2016 Volume 23, No. 10

DIABETES EPIDEMIC ENORMOUS, RESEARCH SHOWS

R PE SU Y A ST

if in doubt, check!

Research revealing the enormous scale of the global diabetes epidemic coincided with World Health Day 2016: Beat Diabetes theme last month.

The World Health Organization (WHO) released its inaugural Global Report on Diabetes. The number of people with diabetes worldwide quadrupled since 1980 with an estimated 422 million adults with the disease in 2014. Its prevalence has grown in all regions of the world.

WHO called for greater action from governments to prevent and control the disease. Only one in three low and middle income countries are able to provide basic technologies for diagnosis and management of diabetes.

Leading expert in diabetes screening and prevention at the University of Sydney and the only Australian contributor to the global report, Professor Stephen Colagiuri said particular groups in Australia had needs similar to those in developing countries.

“While we tend to think of countries as fairly uniform in health provision, it’s important to note that certain communities in Australia are faring just as badly as those in less developed countries.”

This included Aboriginal and Torres Strait Islander communities and people from CALD backgrounds, he said. “Their rates of diabetes and complications such as kidney disease, especially for

#diabetes | www.who.int /whd /diabetes

Aboriginal and Torres Strait Islander communities, still remain among the highest in the world.”

Access to quality care, essential medicines and technologies in remote communities was problematic, Professor Colagiuri said.

The WHO report attributed the dramatic rise in diabetes to factors such as obesity. A University of Queensland (UQ) study last month showed a 20% tax on sugar-sweetened drinks would result in widespread, long term health benefits and cost savings. “We found there would be 800 fewer new Type 2 diabetes cases each year once the tax was introduced,” UQ School of Public Health researcher Dr Lennert Veerman said. After 25 years, about 1,600 fewer deaths would occur in Australia each year; with 4,400 fewer people with heart disease and 1,100 fewer people suffering from stroke. A tax would raise an estimated $400 million a year and reduce annual health expenditure by up to $29 million, the UQ study with the WHO Collaborating Centre for Obesity Prevention found.

NATIONAL SURVEY TO SHOW HEALTHCARE GAPS Nurses are encouraged to complete a national survey on healthcare services in their area if selected to participate.

The National Health Performance Authority has commissioned the survey of nearly 125,000 Australians aged 45 and over, to assess coordination and continuity of healthcare in local areas. The survey is aimed to provide the most accurate picture of local areas and identify gaps in health services. Results will inform all 31 Primary Health Networks (PHN). Survey participants will be randomly selected. “For the first time, a survey of this scale will…enable analysis of individuals’ use of Medicare, prescription medicines and hospitals,” Consumers Health Forum of Australia spokesman Mark Metherell said.

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LIVELIHOODS AND LIBERATION STRUGGLES: 30 Years of Australian Worker Solidarity

BY DANI COOPER PUBLISHER: UNION AID ABROAD-APHEDA ISBN: 978-0-9943261-0-2

Written by union journalist Dani Cooper, Livelihoods and Liberation Struggles: 30 years of Australian worker solidarity traces the story of Union Aid Abroad-Apheda and its commitment to fighting against poverty and injustice around the globe. Based on 25 blowby-blow interviews, including many familiar union names, the book canvasses the crucial role unions have played in supporting union and freedom struggles and tackling inequality.

The book celebrates 30 years of achievement by Union Aid Abroad-Apheda by delving into its unwavering passion and drive as a humanitarian organisation focused on supporting the development of health, education, and human rights programs. Union Aid AbroadApheda has always stood for social justice across the world, and this gripping account of Australian worker solidarity over the past 30 years reinforces how positive change can be achieved through care and support. Union Aid Abroad-Apheda continues today with the commitment of thousands of Australian unionists who give financially as well as commit to educating others about the struggles for workers internationally.

anmf.org.au

HAPPY MAMA:

The guide to finding yourself again

BY AMY TAYLOR-KABBAZ PUBLISHER: AFFIRM PRESS ISBN: 978-1-925344-52-3

Happy Mama delivers a practical guide to motherhood based on the simple yet radical premise: looking after yourself means looking after your family. Author Amy Taylor-Kabbaz sharers her personal journey from strungout parent to happy, self-loving mum, and explores the benefits of what she has dubbed ‘oxygen mask parenting’ – allowing yourself time to breathe before you help your children. Drawing on her 14 years’ experience as a journalist, Taylor-Kabbaz investigates the pressure on a generation of women who were brought up to believe they could have it all. Whether it’s natural births or caesareans, breast feeding or formula, sleep training, discipline, or returning to the workforce, there’s an assumption in parenting discussions that every decision needs to be right for the baby.

But as Taylor-Kabbaz poses, what if getting it right for the baby means getting it wrong for the mother? With post natal depression and anxiety affecting one in seven mothers and one in ten fathers, Taylor-Kabbaz argues that it’s time society looked at parenting and expectations differently. Taylor-Kabbaz speaks to numerous working mums, including Antonia Kidman, as well as counsellors, and spiritual leaders to deliver a book full of empowering insights for all mothers.

UNDERSTANDING TYPE 2 DIABETES: Fewer highs, fewer lows, Better health

BY PROFESSOR MERLIN THOMAS, BAKER IDI HEART AND DIABETES INSTITUTE PUBLISHER: EXISLE PUBLISHING ISBN: 978-1-921966-20-0

Diabetes is the world’s modern pandemic, but it needn’t mean a world of frustration, restrictions and complications for its millions of sufferers. Positively, most people with diabetes are able to live full, free, and healthy lives with the right attitude and application. All it takes is a clear understanding of the condition and good health management.

In Understanding Type 2 Diabetes, Professor Merlin Thomas, of the renowned Baker IDI Heart and Diabetes Institute, astutely covers what diabetes is and how it develops in people, the right diet someone with diabetes should follow and how to maintain it, and how exercise can improve and maintain health. Professor Thomas also specifically examines the medical aspects of diabetes, including the best ways to control one’s waistline, blood glucose levels, blood pressure, and cholesterol.

Preventing and treating the major complications caused by diabetes is also thoroughly investigated. While managing diabetes is not simple, it can nevertheless be achieved with discipline and dedication. With Understanding Type 2 Diabetes people have access to a comprehensive guide which can lead to successfully managing diabetes.

AUSTRALIAN MIDWIVES: Moving real-life stories of that everyday miracle – birth

BY PAULA HEELAN PUBLISHER: HARLEQUIN ENTERPRISES ISBN: 9781760371982

This uplifting book involves Australian midwives sharing their sweet, funny, and sometimes sad stories of life’s most precious moment – childbirth. The majority of the 13 midwives involved in this collection of stories work in remote areas where resources are limited.

Armed only with courage, skill, and commitment to the profession, they recount tales of regularly saving lives and regularly delivering babies into the world in difficult circumstances. For these dedicated women, midwifery is not just a job, it’s a committed and passionate way of life where they thrive. Whether in planes or cattle stations, in a dinghy with one eye out for ominous crocodiles, or in the face of a cyclone, these stories celebrate the skill of Australian midwives in unison with the courage of Australian mothers. These moving accounts make for great reading and will bring you closer to the drama and wonder of birth than ever before.

May 2016 Volume 23, No. 10 27

CLINICAL UPDATE

OVER-THE-COUNTER CODEINE DEPENDENCY: A CASE ANALYSIS OF AN INPATIENT NURSING INTERVENTION Melise Ammit The following clinical update describes a nursing intervention for a patient with over-the-counter codeine dependency.

28 May 2016 Volume 23, No. 10

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CLINICAL UPDATE As the largest group of healthcare providers nurses are uniquely qualified to minimise complications arising from substance use. However many lack confidence or feel unsure how to do this (Hamilton, 2009).

This case analysis outlines best practice guidelines for assessment and management of substance use disorders. It demonstrates integration of theory into practice by discussing addiction, clinical presentation, management of withdrawal and the importance of developing a therapeutic relationship in patientcentred treatment planning. *All data which could identify the patient has been removed or modified where appropriate to retain relevant aspects of the case.

Overview

Over-the-counter (OTC) codeine has come into focus as a public health issue involving people who intentionally or unintentionally overuse or abuse it.

Codeine is an addictive opioid which is found in compound form with either ibuprofen or paracetamol. It is cheap, legal and easily available from pharmacies.

Harms caused by these medications can occur from non-steroidal antiinflammatory (NSAID) toxicity, which includes gastrointestinal irritation such as bleeding, perforation and ulceration; constipation, liver and renal toxicity, and from dependency to codeine (Frei et al. 2011).

Studies generally show two types of user: nonmedical/recreational users with a current or previous drug and alcohol history, and those whose only use is OTC codeine (Neilson et al. 2010).

The first group of users are more likely to have previously sought drug and alcohol treatment. Initiation to codeine usually occurs via use of prescription opioids such as oxycodone or panadeine forte which are obtained though legal prescriptions and/or doctor shopping.

Once these sources are exhausted the user will often resort to obtaining OTC codeine (Neilson et al. 2010).

Characteristic of the second group of users is that approximately half report no other substance use apart from OTC codeine. They see themselves as different, whether dependent or not, from illicit users. Their use stems from what they deem to be genuine medical reasons, such as headache or back pain, but they are also likely to anmf.org.au

use them for the pleasurable narcotic sensation (Cooper, 2013a). These users are usually employed, have completed high school education and are well presented: ‘I put on my suit and tie, the pharmacist gives them to me, no questions’ (OTC codeine user) (Neilson et al. 2010).

Seen by some as a middle class or hidden addiction (Cooper, 2013), this trend of misuse has been likened to the misuse of Bex powders, which were widely used decades ago until they were eventually taken off the market once the harms became clear (Scott, 2013).

SEEN BY SOME AS A MIDDLE CLASS OR HIDDEN ADDICTION (COOPER, 2013), THIS TREND OF MISUSE HAS BEEN LIKENED TO THE MISUSE OF BEX POWDERS, WHICH WERE WIDELY USED DECADES AGO UNTIL THEY WERE EVENTUALLY TAKEN OFF THE MARKET ONCE THE HARMS BECAME CLEAR (SCOTT, 2013).

In the case discussed below, use was made of the Hospital Drug and Alcohol Hospital Consultation Liaison (C/L) service.

Drug and Alcohol C/L nurses have a key role in the assessment and management of drug and alcohol related presentations. Their main aim is to enhance the safety, clinical outcomes, quality and efficiency of services for patients with substance use disorders in hospital settings (NSW Health, 2015).

C/L services provide comprehensive drug and alcohol assessments, withdrawal management and staff education, and contribute to the discharge planning for those patients that require ongoing drug and alcohol treatment (Latt et al. 2009).

Case study

Kate*, a 39-year-old woman, presented to the emergency department of a public hospital with

sudden onset of abdominal pain. She also reported a three-day history of constipation.

A clinical picture of small bowel obstruction was thought to be in the context of OTC abuse, for which she had previously sought treatment.

Codeine decreases gut motility (Australian Medicines Handbook, 2015) and an abdominal CAT scan showed a segment of thickened stenotic mid small bowel causing the obstruction.

The medical treating team suspected this woman of having a substance use disorder - she was referred for assessment and management to the Hospital Drug and Alcohol C/L team.

Assessment

Substance use needs to be viewed and responded to as a health issue and not a moral one. An empathetic, non-judgemental approach to people who use drugs can engender trust and enhance treatment outcomes (NSW Health, 2008).

A comprehensive assessment is needed prior to development of a treatment plan. This includes assessment of the presenting issue, the person’s personal history and background, their past and present substance use, and their readiness for change (NSW Health, 2008).

Previous history

Kate had been admitted due to complications from OTC codeine overuse two months prior. At that time she was ingesting 25 tablets a day of Nurofen Plus, an OTC analgesic containing ibuprofen and codeine phosphate (200mg/12.8mg), initially taken at suggested levels for back pain.

This misuse resulted in gastric erosion and renal tubular acidosis, a potentially fatal side effect of ibuprofen ingestion that can occur with excessive doses (Ng et al. 2011).

She required an inpatient admission for correction of electrolyte imbalance and observation and management of a mild opioid withdrawal from codeine. On discharge she appeared motivated, with a desire for abstinence and a preference for outpatient drug and alcohol counselling treatment.

Unfortunately she relapsed to use of OTC codeine soon after discharge.

Current presentation:

• a slim, anxious, 39-year-old

woman, employed part time, lives with her partner and child; • Scoring five, out of a possible 36,

References American Psychiatric Association. 2000.

Diagnostic and statistical manual of mental disorders. Fourth edition. American Psychiatric Association.

Washington, DC. Australian Medicines Handbook. 2015.

Adelaide, SA. Australia. NSW Department of Health.

2008. Clinical guidelines for nursing and midwifery practice in NSW: Identifying and responding to drug and alcohol issues. North Sydney.

Australia. NSW Department of Health. 2006. Opioid treatment program: Clinical guidelines for methadone and buprenorphine treatment. Sydney: Mental Health and Drug & Alcohol Office.

Australia. NSW Ministry of Health 2015 The hospital drug and alcohol consultation liaison model of care.

North Sydney. www. health.sw.gov.au/ mhdao/programs/da/ publications/HospDA-consult-moc.pdf Accessed 9 October 2015 Babor, T.F. & HigginsBiddle, J.C. 2001.

Brief intervention: for hazardous and harmful drinking. A manual for use in primary care.

Geneva: World Health Organization (WHO) Department of Mental Health and Substance Dependence.

May 2016 Volume 23, No. 10 29

CLINICAL UPDATE on the Clinical Opioid Withdrawal Scale (COWS); • Some aches and pains, insomnia, restlessness and chills; • No pupil dilatation, no gooseflesh, no yawning; • Blood results – Serum Potassium 2.3 – Liver function tests normal – Hepatitis C antibodies, PCR negative

change she had been attempting for a while. The Stages of Change Model describes readiness to change as a five-part process (DiClemente et al. 2004). It moves from a precontemplation (denying there is a problem), through contemplation, preparation and action stages to a successful maintenance period where the person maintains and sustains long term change.

Substance use:

Kate expressed feeling shame about her relapse so soon after her last inpatient admission. Most people think that there is something wrong if they have urges or cravings, but they are a normal part of attempting to abstain from drug use. Relapse is considered an important part of the change process and can be used to help develop maintenance strategies in the future (Marlatt, 2011). This intervention included supporting her to view this relapse as something other than weakness.

• using up to 40 tabs of Nurofen

Plus (520mg codeine) daily for the past year; • Alcohol approximately three standard drinks a day; • Last use of both substances was 40 hours ago.

Previous interventions:

Kate had a significant substance use history, which began with alcohol as a teenager and intravenous heroin use beginning in her mid 20s. She had long periods of abstinence from drugs, after two inpatient rehabilitation admissions and participation in a 12-Step program (Lile, 2003). She had relapsed to heroin use twice over the past 15 years.

Signs of dependency:

The Diagnostic and Statistical Manual of Mental Disorders (fourth ed. 2000) outlines criteria for dependence as being three or more of the following occurring within a 12-month period: • tolerance; • withdrawal; • taking the substance for longer, and in larger amounts than intended; • craving, and unsuccessful attempts to control use; • great time spent in substance related activities; such as obtaining the drug or recovering from its effects; • exclusion of important events in the person’s life due to substance use; • continued use despite adverse effects.

Kate described a pattern of using Nurofen Plus that indicated dependence on codeine. What began as use for relief from back pain increased to a level that caused significant physical and psychological distress. Despite having some insight into her behaviour, she was using larger amounts of medication to obtain the desired narcotic effect; she had previously experienced a withdrawal syndrome upon ceasing the OTC codeine, and was unsuccessful in repeated attempts to stop using it.

Stage of change:

Kate was contemplative of a behaviour 30 May 2016 Volume 23, No. 10

KATE EXPRESSED FEELING SHAME ABOUT HER RELAPSE SO SOON AFTER HER LAST INPATIENT ADMISSION. MOST PEOPLE THINK THAT THERE IS SOMETHING WRONG IF THEY HAVE URGES OR CRAVINGS, BUT THEY ARE A NORMAL PART OF ATTEMPTING TO ABSTAIN FROM DRUG USE.

Impression:

The clinical impression was of a relapse to opioid dependency in this patient. The codeine component in OTC medication triggered a brain response and craving for opioids that may have occurred outside of consciousness (Sellman, 2010). Once aware of her problematic use Kate described an inability to control it, therefore a treatment plan that addressed the neurobiology as well as the psychology of addiction offered the best outcomes.

Management plan:

Physical treatment and withdrawal management:

While not life-threatening, opioid withdrawal can cause extreme discomfort and may lead to the resumption of opioid use (NSW Health, 2008:37).

Codeine withdrawal tends to have later onset than other short acting opioids, such as heroin, despite having a short half-life objective symptoms of opioid withdrawal; pupil dilatation, gooseflesh and yawning, may not be experienced until 48-72 hours after last use.

Other symptoms of withdrawal include gastrointestinal disturbances such as vomiting and diarrhoea; muscle aches and pains, cramps, insomnia, and craving for opioids.

These symptoms usually resolve after five to seven days, though some people describe the psychological withdrawal as lasting much longer and causing more distress (Neilson et al. 2010:48).

A Clinical Opioid Withdrawal Scale was commenced four hourly with lowlevel subjective signs of restlessness, aches and pains and insomnia observed. Symptomatic treatment was provided by p.r.n paracetamol, diazepam and baclofen (NSW Health, 2008).

The small bowel obstruction was relieved by a single balloon enteroscopy and dilation. An endoscopic investigation showed healing ulcers and gastric erosion and an MRI enterography was normal.

Pantoprazole was commenced and her pain relief provided by intravenous morphine 2.5-5mg as needed. Regular observations were stable once her pain was controlled.

She was managed nil by mouth, with intravenous fluids and a naso-gastric tube with minimal drainage.

Brief intervention:

Education was provided on harms from OTC codeine misuse, and Kate was also alerted to the risk of relapse to use of other opioids or resumption of injecting behaviour. Interestingly she stated ‘I knew paracetamol could damage the liver but I thought ibuprofen was safe’.

Harm reduction strategies such as reducing use and cold-water codeine extraction; a process of separating codeine from the compounded NSAID medication, were discussed.

These tools are usually appropriate for harmful and hazardous substance use. However, Kate acknowledged an inability to control her use, which indicated dependency requiring a more specialised intervention (Babor and Higgins-Biddle, 2001).

Cooper, R.J. 2013 ‘I can’t be an addict. I am.’ Over the counter medicine abuse: a qualitative study. BMJ Open 3 (6). http:// bmjopen.bmj.com/ content/3/6/e002913. full Accessed 10 September 2015 Cooper, R. 2013a. Over the counter medicine abuse-a review of the literature. Journal of Substance Use. 18(2):82107.

DiClemente, C.C., Schlundt, D. and Gemmell, L. 2004.

Readiness and stages of change in addiction treatment. American Journal of Addiction 13:103–119.

Frei, M.Y, Nielsen, S., Dobbin, M.D.H, Tobin, C.L., 2010. Serious morbidity associated with misuse of over the counter codeineibuprofen analgesics: a series of 27 cases.

Medical Journal of Australia. 193 (5):294296.

Hamilton, I. 2009.

Substance use 2: nursing assessment, management and types of intervention. Nursing Times. 105: 27, early online publication. www. nursingtimes.net/clinicalsubjects/substancemisuse/substance-use2-nursing-assessmentmanagement-and-typesof-intervention/5003828 Accessed 15 November 2015 Latt, N., Conigrave, K., Saunders, J.B. Marshall, E.J., Nutt, D. 2009.

Addiction Medicine.

Oxford University Press.

Oxford.

Lile, B. 2003 Twelve Step Programs: an update. Addictive Disorders and Their Treatment 2(1):19-24 Lingford-Hughes, A. & Nutt, D. 2003 Neurobiology of addiction and implications for treatment.

British Journal of Psychiatry.182:97-100 Marlatt Prof.G. Alan.

2011. Prof Alan Marlatt’s lecture on MBRP: Part 1. www.youtube.com/ watch?v=3ri2YboApIg Accessed 2 December 2015

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CLINICAL UPDATE

Drug and alcohol treatment plan:

Opioid replacement pharmacotherapy with a buprenorphine/naloxone combination (Suboxone) was recommended in conjunction with Cognitive Behaviour Therapy and relapse prevention therapy.

NSW Health guidelines (2006) state that patients suitable for opioid treatment should be provided with sufficient information to make an informed choice. The evidence and rationale of prescribing buprenorphine/naloxone was described to her as being three fold: a. to relieve symptoms of withdrawal and craving; b. to induce tolerance so the effects of other opioids on the brain is blunted; c. to allow the case management of the client by daily attendance at a clinic.

Buprenorphine/naloxone treatment helps to stabilise the lives of users due to the pharmacological properties of the drug. Buprenorphine is a partial mu opioid receptor agonist/ antagonist (Lingford-Hughes & Nutt, 2003). It is the active ingredient in Suboxone with naloxone added to decrease the risk of diversion.

Suboxone is given sublingually, and naloxone is not absorbed via this route. However, if Suboxone is injected the naloxone becomes bioavailable, and counteracts the effect of the buprenorphine.

Suboxone has a long duration of action and is slowly absorbed. There is a risk of precipitated withdrawal during induction to Suboxone and care was taken to ensure the last opioid use was over 24 hours ago and a steeped approach to the medication commencement with close observation of adverse effects was observed (NSW Health, 2006). anmf.org.au

Kate was initially reluctant to consider opioid treatment as she had a strong abstinence focus. A motivational style of interviewing (MI) was used to help her move through the ambivalence that is often found in conflicting situations, such as with substance use and its treatment (Rollnick & Miller, 1995). This person-centred approach was used to reduce her resistance to evidence based opioid replacement intervention (NSW Health, 2006).

Conclusion

Therapeutic relationship:

Continued misuse of these medicines places a burden on primary and public healthcare providers, from pharmacists involved in the codeine acquisition to GPs and hospital staff dealing with negative physical consequences of use. Currently the treatment and range of interventions can vary within the health setting and with individual clinician confidence. Development of screening tools for OTC codeine use and implementation of guidelines for targeted brief interventions could maximise opportunities to provide harm prevention messages and minimise the incidence of signs of dependency going undetected.

The therapeutic relationship is comprised of several components, the most important being the bond that forms between the health professional and the individual seeking treatment This bond, or rapport, can predict engagement, retention in treatment and medication compliance (Todd, 2010). The person’s previous experience of treatment can also affect this alliance (Meier et al. 2005).

With this in mind, the C/L intervention was viewed as part of a pretreatment phase. A rapport had been established during Kate’s previous admission with a drug and alcohol C/L nurse who had experience in providing treatment options while respecting her abstinence based preference.

Discharge treatment consisted of • opioid replacement therapy; • outpatient counselling; • resumption of her 12-Step program.

This plan was developed with the patient through a non-judgmental, coordinated and consistent nursing approach to patient care. Kate’s experience of previous successful treatment episodes and the use of best practice guidelines developing a referral pathway helped her feel optimistic and empowered about her future.

Over-the-counter codeine misuse has been an emerging problem over the past decade. Characteristics of this group can diverge from and overlap with those of traditional illicit opioid users. This cohort can be difficult to identify and treat due to a self-perception that they differ from other drug users. They may also have a tendency not to see their use as problematic.

Nurses play an important role in health education and can elicit positive behaviour change in substance users. However, many feel ill-equipped to do so. Increasing the ability of nurses to assess and manage these clients through ongoing inservices and training, would enhance confidence in delivering interventions and care to this cohort.

Melise Ammit is a Clinical Nurse Specialist – grade 2 at Northern Sydney Local Health District Drug & Alcohol Service and D&A Hospital Consultation/Liaison at Manly/Mona Vale Hospitals This article is based on the views and research of the author(s) and has not been peer reviewed.

Meier, P.S., Barrowclough, C., Donmall, M.C. 2005.

The role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature. Addiction 100(3):304-16 Nielson, S., Cameron, J.M., Pahoki, S. 2010.

Over the counter codeine dependence.

Turning Point Drug and Alcohol Centre.

Melbourne.

Ng, J.L., Morgan, D.J., Loh, N.K., Gan, S.K., Coleman P,L., Ong, G,S., Prentice, D, 2011. Life threatening hypokalaemia associated with ibuprofen-induced renal tubular acidosis. Medical Journal of Australia 194(6):313-315.

Rollnick S., & Miller, W.R. 1995. What is motivational interviewing?

Behavioural and Cognitive Psychotherapy 23: 325-334. www. motivationalinterview. net/clinical/whatismi. html Accessed 2 December 2015 Scott L. 2013. Codeine addiction a growing problem as Aussies abuse over-the-counter pain medication. The Courier Mail. www. couriermail.com.au/ news/queensland/ codeine-addictiona-growing-problemas-aussies-abuseoverthecounter-painmedication/story-fnihsrf2 Accessed 10 December 2015 Sellman, D. 2010. The 10 most important things known about addiction. Addiction 105 (1):6-13.

Todd, F.C. 2010. Te Ariari o te Oranga: The assessment and management of people with co-existing mental health and substance use problems. Ministry of Health Wellington www.health.govt.nz/ publications Accessed 1 June 2015

May 2016 Volume 23, No. 10 31

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VIEWPOINT

LACK OF HEALTH CONCERN ABOUT SA’S NUCLEAR FUEL CYCLE

References Australian Radiation Protection and Nuclear Safety Agency: www. arpansa.gov.au/ pubs/factsheets/ RadioactiveWaste.pdf: (Accessed 8 March 2016).

Australian Research Reactors and Synchrotron: www.worldnuclear.org/info/CountryProfiles/Countries-A-F/ Appendices/AustralianResearch-Reactors/ (Accessed 13 January, 2016)

By Amanda Ruler The tentative findings of the SA Nuclear Fuel Cycle Royal Commission proposed importation and management of international high, intermediate and low level nuclear waste represented opportunities to generate revenue for South Australia.

Yet associated major technical, toxic, safety, financial, social, regulatory and ethical risks were not acknowledged, according to the Medical Association for Prevention of War and Public Health Association of Australia.

Nurses, midwives and health workers have always expressed associated health concerns with dumping of nuclear waste. Some of the main issues for consideration follow.

The world creates 12,000 tons of high level waste and 130,000 cubic metres of low and intermediate level waste yearly from electricity generation of 438 nuclear reactors. By 2000, 201,000 tons of highly radioactive irradiated waste was created worldwide.

The plutonium in this will remain radioactive for 240,000 years or more (Plutonium Free Future Project 2016).

Operational high level waste repositories do not exist anywhere in the world. Many technical failures have been associated with them in the past. Radioactive waste must be isolated from exposure to all living things, water, land and air to avoid contaminating chains of life.

The Commission’s reference to “the successfully developed long term domestic solutions” of Finland and Sweden’s high and intermediate level nuclear waste omitted to say that these will not be operational until next decade and previous endeavours have failed (Medical Association for Prevention of War and Public Health Association of Australia, 2016).

The Commission acknowledged it is impossible to predict future anmf.org.au

geological and climatic conditions.

The proposed ‘engineered barriers’ designed to delay exposure of the waste to groundwater supplies are only experimental. High level waste needs storage well beyond the period for which movement of any geological formations can be predicted (Medical Association for Prevention of War and Public Health Association of Australia, 2016).

Any additional radiation can increase the risk of cancers, cardiovascular and other diseases. Creating a nuclear waste dump does not address these negative health and environmental effects that will affect many generations in the foreseeable future (National Research Council, 2006; Cardis, 2005; Little et al. 2012).

Transport of nuclear waste to the site is also risky. The spent fuel could be potentially targeted by criminals when being moved, stored or eventually placed. (Only 8kg of plutonium is needed to make a nuclear weapon). Significant security risks for criminal attack and tensions with our neighbours could occur if Australia is perceived to be acquiring nuclear weapons material (Medical Association for Prevention of War and Public Health Association of Australia, 2016; Women’s International League for Peace and Freedom, 2016).

Claims the dump is urgently needed for ongoing nuclear medicine manufacture is highly misleading. Less than 1% of the waste will be medical in the repository and is low level (Medical Association for Prevention of War and Public Health Association of Australia, 2016).

Canada has been the world leader in isotope manufacture and export for many years, which has left them with a disproportionate amount of the nuclear waste burden associated with reactor-based isotope production.

(Medical Association for Prevention

of War and Public Health Association of Australia, 2016). The reactor production of these isotopes has been shown to be unreliable, resulting in worldwide shortages of supply due to unplanned outages (Medical Association for Prevention of War and Public Health Association of Australia, 2016).

Recently cyclotron technology was developed, which has been proven to be cheaper, less prone to supply shortages, and does not produce any long term nuclear waste. Full production of cyclotron isotopes is planned for Canada in the next three to five years while reactor production is being closed down (Australian Research Reactors and Synchrotron, 2016; Report of the Expert Review Panel on Medical Isotope Production, 2009).

By following Canada’s example Australia could use cyclotrons rather than reactor products to produce medical isotopes, helping to prevent nuclear waste.

For more information go to: www.mapw.org.au/files/ downloads/10 questions about nuclear waste January 2016.pdf Fact sheet 6 (2016) Radioactive Waste in Australia: www.mapw. org.au/files/downloads/Radioactive waste in Australia colour FINAL.pdf Thanks to Dr Margaret Beavis and Dr Peter Karasmoskos of Medical Association for Prevention of War for their review of this article.

Dr Amanda Ruler is a Health Science Researcher, Adjunct Research Fellow, School of Nursing and Midwifery, UniSA and the National Vice President , Medical Association for Prevention of War (Australia).

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

Cardis E. (2005) Risk of cancer after low doses of ionising radiation: Retrospective cohort study in 15 countries.

British Medical Journal http:www// dx.doi.org/10.1136/ bmj.38499.599861.

E0 (Accessed 4 March, 2016) Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, (2006) National Research Council, http://www.nap.edu/ catalog/11340.html; (Accessed 1March, 2016) Draft Joint MAPW and PHAA response to the South Australian Nuclear Fuel Cycle Royal Commission tentative findings.(March 2016) Medical Association for Prevention of War and Public Health Association of Australia, Melbourne, Personal Communication.

Little M.P., Azizova T.V., Bazyka D., (2012) Systematic Review and Meta-Analysis of Circulatory Disease from Exposure to Low-level Ion- izing Radiation and Estimates of Potential Population Mortality Risks, Environmental Health Perspectives,120, (11): 1503–151.

Plutonium Free Future Project: http://inochi.us/ plutonium-free-future/ (Accessed March 5, 2016) Report of the Expert Review Panel on Medical Isotope Production.

(2009). Presented to the Minister of Natural Resources Canada: www. google.com.au/search? q=Canadian+review+n uclear+isoptope+produ ction&ie=utf-8&oe=utf8&gws_rd=cr&ei=SEXVvHLFMbA0gSL4YrA Aw (Accessed 14 January 2016) Women’s International League for Peace and Freedom (WILPF): www. reachingcriticalwill.org/ resouces/fact-sheets (Accessed 4 March, 2016)

May 2016 Volume 23, No. 10 33

REFLECTIONS

YOU ARE THE SUCCESSFUL APPLICANT – WHAT NEXT? Di Kenyon So you have landed the job of your dreams as a nurse manager – what should you do next?

The pressure will start and it may come from the places you least expect. People will want to see what you have got and what you will bring to the role. Some will test you, some will support you but have no doubt, all will be watching you.

The people above you will want to see progress, results and plans.

They may also want to see change, depending on the starting position.

They will expect to see problems addressed. They will expect you to see the problems that they see.

Those beneath you will be watching for different reasons. They will be thinking, how is this going to affect me? This expectation may make you tempted to start ‘doing stuff.’ This may mean making changes and doing it fast.

Slow down

There will be time to deal with the issues. When it feels like you don’t have time, think again.

Back yourself and form your own opinions. You have been hired for a reason and unless you fudged your own CV you have all the necessary skills and resources to do this job. So before you take any action assess the current situation and really look at what you have inherited.

But first…

Get to know your people and your team. Spend time ‘wandering around.’ Have ‘one-on-one’ conversations with people who are on your team. Find out what they think and what makes them tick. Ask them about the organisation. It is amazing 34 May 2016 Volume 23, No. 10

how engaged people can be when you ask and then truly listen and care about what they think and value their opinions. This is 101 rapport building and if you want the best from your team you need to start here.

Keep talking - Go beyond your direct reports

The people who report to the people who report to you will have valuable information and can tell you a lot about the organisation and what makes it tick. A casual chat is all that is needed. Introduce yourself and find out what is important to them. Ask them what the clients and patients think of the organisation and where they think problems might be.

DO NOT BE AFRAID TO DO IT YOUR WAY AND NOT BE PRESSURED TO ‘GET STUFF DONE’ Don’t sit in front of the computer get out of the office Repeat this exercise with clients and patients if appropriate. Get out and talk to as many as you can. It is an opportunity to get valuable feedback and really find out what is important to them and what you are doing well and what they don’t like.

Who else will talk to me?

Quite simply, anyone who will listen. Many different vantage points and opinions will give you

valuable feedback on what is going well and what is not going so well.

Having recently learned the term Management by Wandering Around (MBWA) I cannot tell you how valuable this is and how much real information you will hear. Not only are you connecting with the people that are the lifeblood of the organisation and finding out what makes them tick you are building rapport and trust.

You will by now have discarded all of the information that you were told at the interview. You have gathered your own information.

Where to now?

Your questions are enabling you to build up your own SWOT analysis.

What are we good at? Where are we weak? Where are the opportunities?

What are the threats? Who are our good people? Who’s struggling?

What follows is a well thought out list of what your priorities will be during the remainder of your first 90 days.

Then communicate your findings to the key stakeholders and give them the opportunity to challenge your assumptions. They need to understand what you are trying to achieve so they can support your aspirations and decisions.

Do not be afraid to do it your way and not be pressured to ‘get stuff done’ Get the first 30 days right and you will achieve more in your first 90 days and be ready for your first review.

All because you took the time to ask and listen to the people that can make it work.

So get out there and make a difference.

Di Kenyon is Director at Di Kenyon Transformations which focuses on leadership, mindset, team building and continuous improvement through innovation. She is also a Clinical Coordinator at Bentleys Aged Care This article is based on the views and research of the author(s) and has not been peer reviewed. anmf.org.au

Mental Health (part 1) FOCUS

ALCOHOL USE DISORDERS: A MENTAL HEALTH NOT A MORAL ISSUE

By Rebecca Bosworth, Lorna Moxham and Renee Brighton The prevalence of alcohol use disorders (AUD) and associated alcohol related harm amongst women in the community can compromise their mental and physical health (Foster et al. 2014).

An alcohol use disorder, combining abuse and dependence, is defined by the DSM-5 as a psychiatric disorder characterised by a cluster of psychiatric and behavioural symptoms.

Consuming alcohol at increased levels leads to alcohol related harm, which is defined by the National Health and Medical Research Council (2015), as adverse effects of injury and disease secondary to drinking.

Given Australia’s drinking culture, AUDs are not an uncommon problem and are a mental health issue of significance. In comparison to men, women are underrepresented in research despite the fact they are more vulnerable to the effects of alcohol related harm.

Gender differences of how alcohol is metabolised is one contributing factor to increased harm. Women who drink are exposed to toxins for greater periods due to their higher percentage of body fat. This results in higher blood concentrations of alcohol, thus increasing the risk of organ damage (Foster et al. 2014).

Females are also more likely to exhibit severe symptoms sooner and even despite lower consumption of alcohol, a greater biopsychosocial impact anmf.org.au

IN COMPARISON TO MEN, WOMEN ARE UNDERREPRESENTED IN RESEARCH DESPITE THE FACT THEY ARE MORE VULNERABLE TO THE EFFECTS OF ALCOHOL RELATED HARM. occurs for women (NSW Health, 2015).

All people with AUDs deserve care, but due to the barriers women experience in engaging with essential quality healthcare they seek treatment less. Raistrict et al. (2015) identified barriers like stigma, discrimination and fear of exposing their substance use disorder. The prevalence of stigma is of concern, with literature suggesting that because of this, healthcare professionals are less likely to intervene in alcohol related issues (Barr & Lovi, 2009).

However research suggests when interventions do occur they are often negative. These negative experiences place women’s mental health at risk. Vandermause and Woos (2009) explain the anxiety felt, triggered by hurtful interactions and the fear evoked by the need to expose their AUD act as deterrents to seeking help. Everyone is entitled to equal

access to healthcare. AUDs are considered a health issue not a moral issue (NSW Health, 2007). It is not the place of healthcare professionals to pass moral judgement.

The reluctance then of women with AUDs to seek help may be due to the way nurses treat them. Little is known about the perceptions nurses have of caring for a woman with an AUD. To understand the perceptions nurses may have, the first author, RN Rebecca Bosworth, embarked on an Honours research project ‘Exploring what it meant to care for a woman with an AUD’. The focus was specifically on new nurses. The desire was to explore what Bachelor of Nursing (BN) students thought providing nursing care for a woman with an AUD would be like. The purposive sample of BN students had not been on a clinical placement and the inclusion criteria was that they had not been exposed to a woman with an AUD. The researcher wanted to gain an understanding from these future RNs before they became enculturated into the profession. Findings from the indepth semi-structured interviews conducted. Using an interpretive phenomenological approach, provide insight into how personal perceptions and stereotyping have the potential to impact upon professional behaviours and how healthcare is delivered. Nurses need to understand how important the therapeutic use of self is when providing care and to do this effectively nurses need to constantly engage in self-awareness.

References Barr, J. & Lovi, R. 2009 Stigma reported by nurses related to those experiencing drug and alcohol dependency: a phenomenological Giorgi study, Contemporary Nurse, 33(2), 166-178 Foster, K., Hicks, B., Iacono, W., McGue, M. 2014 Alcohol-use disorder in women: risks and consequences of adolescent onset and persistent course, Psychology of Addictive Behaviors, 28(2), 332-335 National Health & Medical Research Council 2015 Alcohol and health in Australia, www.nhmrc.gov.au/ health-topics/alcoholguidelines/alcohol-andhealth-australia

Rebecca Bosworth is a BN honours student and RN Dr Renee Brighton is a Lecturer and Professor Lorna Moxham is Professor of Mental Health Nursing. All are in the School of Nursing at the University of Wollongong in NSW

May 2016 Volume 23, No. 10 35

FOCUS Mental Health (part 1) NEIL RIGBY AND VOLUNTEER IN MENTAL HEALTH UNIT

NEW MENTAL HEALTH UNIT IS IMPROVING SERVICES

By Neil Rigby A new purpose built Mental Health Unit that provides a safe and supportive environment is playing a major part in integrating mental health into main-stream hospital care and reducing the stigma often associated with mental health.

Opened last year, the unit is located within the building of the new St John of God Midland Public Hospital in Western Australia.

The unit comprises 56 beds, incorporating 40 adult beds, 15 of which are secure, and 16 older adult beds.

Integrating the unit physically into the hospital building has allowed for a quick response when there are medical concerns about a patient. It also enables mental health patients to utilise mainstream hospital services, 36 May 2016 Volume 23, No. 10

such as the hydrotherapy pool and the hospital discharge lounge.

Additionally, the unit provides a liaison service in the Emergency Department, whereby all mental health referrals are reviewed and assessed by either a Senior Registered Nurse or a Psychiatric Registrar. A consultation liaison service also is provided to the main hospital.

The unit provides both inpatient and outpatient services, such as electroconvulsive therapy. There are newly developed post discharge services for patients who are admitted to the older adult ward. This service outreaches from the mental health service post discharge for up to two weeks, seeing patients in their own homes and ensuring there is a smooth transition to community services.

This post follow up service ensures patients discharged from the mental health older adult service have the appropriate follow up and care, which reduces the likelihood of readmission.

All of these mental health services are helping the hospital to establish good working relationships with the local community mental health service. As part of this, regular interface meetings are held at the hospital as well as weekly videoconferencing.

Hospital design

Great focus has been placed on the design of the unit, which is located on the top floor of the hospital. There are four large internal courtyards with access to fresh air and sky views.

All patient rooms are single and include ensuite facilities and views to natural light.

There are several lounge areas, female lounge areas, TV/music rooms, art/therapy rooms, treatment rooms and a gymnasium.

The Nurse Unit Manager’s office is close to the wards and is located next to a meeting room and staff dining room. A separate reception area for the mental health unit leads into two corridors that accommodates two large meeting rooms, including videoconferencing facilities and large multidisciplinary shared offices.

In addition to medical and nursing staff, allied health professionals in the hospital, including social workers, occupational therapists, clinical psychologists, dieticians and physiotherapists, work on the unit on a six-month rotation.

The Mental Health Unit’s contemporary facilities combined with our distinctive compassionate care is greatly contributing to a healthy future for the people of Midland and surrounding communities.

Neil Rigby is the Mental Health Unit Nurse Manager at St John of God Health Care anmf.org.au

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FOCUS Mental Health (part 1) UNDERTAKING THIS PROGRESSION OF WORKING WITH HIGH AND COMPLEX NEEDS HAS REQUIRED A CHANGE IN CLINICAL PRACTICE THAT HAS BEEN MET WITH ENTHUSIASM BY THE STAFF GROUP AND TEAM LEADERSHIP.

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

The SICC has used a redesigning care process to work within the Consumer flow across the mental health stepped system of care review that occurred in 2015 by KPMG. This redesigning care work has led the SICC to set aside up to nine beds for mental health consumers with high and complex needs who would have normally stayed in an acute mental health setting.

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 Jodie Bowden Manager - Service Development Mental Health, Justice Health and Alcohol & Drug Services Phone: 02 6207 6279 Mobile: 0407207800 Email: jodie.bowden@act.gov.au www.health.act.gov.au For more information visit http://www.canberrayourfuture.com.au

38 May 2016 Volume 23, No. 10

SUE CROUCH

SOUTHERN INTERMEDIATE CARE CENTRE REDUCING RELIANCE ON THE ACUTE SECTOR

By Sue Crouch The Southern Intermediate Care Centre (SICC) part of the Southern Adelaide Local Health Network’s Mental Health Services provides holistic care that is planned, managed and evaluated on the basis of increasing responsiveness and choice for people, reducing South Australia’s reliance on acute and emergency or unplanned admissions.

The SICC staff work in collaboration with the consumer, community mental health services and non-government agencies, effectively managing the pathways between hospital and home.

The SICC operates from a recovery orientation that is focused on helping people with a mental illness to live a satisfying, hopeful and contributing life.

This change is part of a suite of service changes that have led to mental health consumers transitioning to sub-acute service settings such as the SICC much earlier in the consumer journey. The SICC team’s commitment to quality improvement and their strong professionalism has led to this practice change being implemented seamlessly.

The SICC provides a high standard of sub-acute care to consumers requiring intensive facility based community care.

Over the past five years, the SICC has built on its person focussed care environment to provide pathways from inpatient and emergency department settings that provide collaborative and individually focussed care with consumers and their families.

The outcome of this multidisciplinary team practice improvement has led to improved consumer flow across the acute and subacute continuum including meeting the National Emergency Access Target (NEAT) for all mental health consumers to be transferred out of emergency within 24 hours. This change has been beneficial for the consumer with better quality of care and links to services before they are discharged.

Undertaking this progression of working with high and complex needs has required a change in clinical practice that has been met with enthusiasm by the staff group and team leadership. Throughout the redesigning care process, the team has retained their commitment to consumer engagement characterised by offering choice, providing accountable practice and is evidenced in individual care and discharge plans and very low readmission rate to inpatient care.

Sue Crouch is Clinical Services Coordinator at Southern Intermediate Care Centre in South Australia anmf.org.au

Mental Health (part 1) FOCUS orienteering and a high wire course (Moxham et al. 2015).

Participants of the qualitative study were people living with mental illness who attended the camp.

The participants were asked during semi-structured interviews to reflect on their camp experience with regard to personal recovery. From the participants descriptions five sub-themes and one overall theme were identified. The sub-themes were self-determination; participation, extending self; relationships and positive change. These sub-themes interrelate with each other and with the overall theme of empowerment.

A PARTICIPANT STATED "THE SAFE THERAPEUTIC ENVIRONMENT WAS FORMED THROUGH TEAM EFFORT; TRUSTING PEOPLE; LEARNING TO BE ADVENTUROUS; ACCEPTING YOU WERE SCARED BUT TRYING ANWAY." PHOTO CREDIT: THE RECOVERY CAMP UOW

For example, the interrelationship of the sub-themes self-determination; participation and extending self were described in the following quote from Participant five who was determined to increase her level of activity when she said: “It was about deliberately deciding to increase my participation, my activity, to stir myself up to get into new things.”

THERAPEUTIC RECREATION FOR PEOPLE WITH A MENTAL ILLNESS IS BENEFICIAL

By Caroline Picton, Lorna Moxham and Christopher Patterson The positive benefit of therapeutic recreation for people living with mental illness has been identified in a recent BN Honours research study. The study findings concluded the supportive and encouraging milieu provided a therapeutic environment conducive to the principles of a strength based mental health recovery.

The study’s participants described the therapeutic intervention as positive which increased their physical activity and social engagement while enhancing personal empowerment.

These positive benefits can contribute to mental health recovery as well as reducing some of the significant health disparities experienced by people living with mental illness.

It is widely acknowledged people living with mental illness experience anmf.org.au

significant health disparities with a reduced life expectancy (Lawrence et al. 2013). A lack of physical activity and medication side-effects increase the risk of metabolic syndrome and its associated health risks (Lawrence et al. 2013). Often people living with mental illness experience an excessive amount of free time and social isolation which can cause them to partake in behaviours posing a risk to their health (Iwasaki et al. 2014; Lawrence et al. 2013). Innovative projects involving therapeutic recreation can be a means of reducing some of these disparities.

The study focused on a University of Wollongong innovation, the Recovery Camp, which brings together people living with mental illness and nursing and allied health undergraduate students to participate in therapeutic recreation. The five day outdoor adventure camp is run by the YMCA at Yarramundi, west of Sydney. The camp includes activities such as a giant swing; flying fox; archery;

The sub-theme of relationships was described by all participants as having the biggest impact. For example, Participant one said ‘The biggest thing for me, the friendships; the camaraderie’. The study’s participants all talked about how the supportive and encouraging relationships at the camp created a safe therapeutic environment which moved them ‘out of my comfort zone’ and challenged them into trying new activities. Each participant described positive changes such as increased confidence and trust.

Importantly, participants expressed the camp experience contributed to their resolve towards their mental health recovery following the camp.

The study concluded the participants experienced empowerment, selfdetermination and increased physical and social involvement. These findings indicated the Recovery Camp is an effective intervention which can enhance wellness by encompassing the principles of mental health recovery.

References Iwasaki, Y., Coyle, C. & Shank, J., et al.

2014 Role of leisure in recovery from mental illness. American Journal of Psychiatric Rehabilitation, 17(2):147-165.

Caroline Picton is a Registered Nurse and Honours student at the University of Wollongong; Shoalhaven Sub-Acute Mental Health Service, ISLHD in NSW

Lawrence, D., Hancock, K. & Kisley, S. 2013 The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: Retrospective analysis of population based registers. British Medical Journal (Clinical Research Ed), 346: f2539.

Dr Lorna Moxham is Professor of Mental Health Nursing and Christopher Patterson is PhD Candidate and Subject Coordinator (undergraduate and postgraduate) Mental Health Nursing. Both are in the School of Nursing at the University of Wollongong

Moxham, L., LierschSumskis, S., Taylor, E., Patterson, C. & Brighton, R. 2015 Preliminary outcomes of a pilot therapeutic recreation camp for people with a mental illness: Links to recovery.

Therapeutic Recreation Journal, 49(1):61-75.

May 2016 Volume 23, No. 10 39

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MUSIC NIGHT FOR NOKOR TEP WOMEN’S HOSPITAL CAMBODIA 28th May 2016 at 7.30pm - MEENIYAN HALL Join us for a night of musical celebration to support the building of the Nokor Tep Women’s Hospital Local performers will be donating their time & talent….

Music from - Beggs to Differ, Acoustic Kitchen, Danny & the Detonators, Travel Light, John Budileani, Comedy from – Steve Horton & Yvette Stubbs Cost $20.00 at the door, Table Seating provided, BYOdrinks & nibbles BOOKINGS Camille Shaw / 0422 275 310 / shawcamille@hotmail.com Tarnya Wilson / 0427 647 473 / tarnyawilson@bigpond.com

Nokor Tep Foundation Australia is a volunteer non-profit organization. 100% of the proceeds from this event will support the Nokor Tep Women’s Hospital in Cambodia .

Website: www.nokortepaustralia.org.au Facebook: www.facebook.com/nokortepaustralia If your unable to attend but want to support our event and make a donation, go to the Nokor Tep Australia website. When processing your donation please add the comment “Music Night“.

Spare a thought for the women of Cambodia who do not have the privilege of Health Care.

Mental Health (part 1) FOCUS

References Australia. Bureau of Statistics (ABS) 2007 National survey of mental health and wellbeing: Summary of results. Canberra, ACT: Australian Bureau of Statistics. Cat.no.4326.0.

Australia. Department of Health 2013 A national framework for recovery-oriented mental health services: Guide for practitioners and providers. Canberra, ACT: Australian Department of Health.

Carpenter, J. 2002 Mental health recovery paradigm: Implications for social work. Health and Social Work. 27(2): 86-94.

SELF-DETERMINATION IN THE CONTEXT OF MENTAL HEALTH RECOVERY

Chang, L. 2011 An interaction effect of leisure self-determination and leisure competence of older adults’ self-rated health. Journal of Health Psychology. 17(3): 324-332.

By Ellie Taylor, Lorna Moxham, Dana Perlman, Christopher Patterson, Renee Brighton and Susan Sumskis Approximately one in every five Australians will experience a mental illness each year (ABS, 2007). Mental illnesses are not homogenous. There are no clearly established clinical pathways and, as such, care and treatment is necessarily highly individualised.

It is within this nebulous treatment approach that personal recovery is the goal for many who live with debilitating mental health issues.

Personal recovery is not synonymous with cure, but can be defined as “gaining a social identity through engagement in an active life” (Moxham et al. 2015).

In recent years, self-determination has arisen as an area of importance within mental healthcare (Craike and Coleman, 2005). Carpenter (2002) asserts that there are strong links between increased self-determination and personal recovery. Selfdetermination can be considered as vthe propensity of an individual to act in a “self-directed, self-regulated, autonomous” way (Field et al. 1998).

Such an approach is respectful of values and appreciates lived experience – a fundamental tenant of personal recovery. People with a lived experience of mental illness, however, report significantly low levels of self-determination (Okon and Webb, 2014). According to Hagger and Chatzisarantis (2009), self-determined motivation is strongly associated with engagement in positive health anmf.org.au

behaviours such as increased medication and service adherence, and other activities that promote wellbeing (Chang, 2011).

The Australian Department of Health (2013), in their National framework for recovery-oriented mental health services: Guide for practitioners and providers, posits that mental healthcare should maximise opportunities for personal autonomy and self-determination. This involves maximising choice on the part of the consumer, with less reliance on restrictive methods of treatment, such as restraint and seclusion. However, very little empirical research has been conducted regarding the relationship between practices and outcomes (including self-determination) associated with personal recovery from mental illness (Le Boutillier et al. 2011).

This research project explores the influence of a recovery-oriented, strengths-based therapeutic recreation initiative and how it influences selfdetermination among people with a mental illness. In doing so, a detailed examination will occur to investigate the mechanisms (eg. shared decision making, addressing social context) by which self-determination influences personal recovery from mental illness.

Informed by the lived experience of people with a mental illness, a mixed methods approach has been employed. Surveys will be administered at three time points: before and after the intervention, and again at three-month follow-up. At follow-up, a qualitative approach will be used to collect data through individual

semi-structured interviews and focus groups. These interviews will further explore the quantitative findings by incorporating a comprehensive person-centred approach. To date, quantitative findings from this project have supported the efficacy of therapeutic recreation in increasing self-determination among people with a mental illness. The mechanisms by which this contributes to personal recovery are, however, not visible in research literature. It is this concept that will be explored in this project.

Healthcare providers have a responsibility to respect and emphasise the autonomy and selfdetermination of all people for whom they provide care. This is no less an expectation for people who live with a mental illness. Their journey towards personal recovery is one that should be heavily reliant on their own expertise and based on their own choices. Results from this research are expected to inform future mental health services and programs.

Ellie Taylor is a PhD Candidate (Health Science) at the University of Wollongong Dr Lorna Moxham is Professor of Mental Health Nursing; Christopher Patterson, Renee Brighton and Susan Sumskis are Lecturers. All are in the School of Nursing at the University of Wollongong Dr Dana Perlman is Senior Lecturer in the School of Education at the University of Wollongong

Craike, M. and Coleman, D. 2005 Buffering effect of leisure selfdetermination on the mental health of older adults. Leisure/Loisir.

29(2): 310-328.

Field, S., Martin, J., Miller, R., Ward, M. and Wehmeyer, M. 1998 A practical guide for teaching self-determination.

Reston, VA: Council for Exceptional Children.

Hagger, M. and Chatzisarantis, N. 2009 Integrating the theory of planned behavior and self-determination theory in health behavior: A meta-analysis. British Journal of Health Psychology. 14: 275-302.

Le Boutillier, C., Leamy, M., Bird, V. J., Davidson, L., Williams, J. and Slade, M. 2011 What does recovery mean in practice? A qualitative analysis of international recovery-oriented practice guidance.

Psychiatric Services.

62(12): 1470-1476.

Moxham, L., LierschSumskis, S., Taylor, E., Patterson, C. and Brighton, R. 2015 Preliminary outcomes of a pilot therapeutic recreation camp for people with a mental illness: Links to recovery.

Therapeutic Recreation Journal. 49(1): 61-75.

Okon, S. and Webb, D. 2014. Self-determination: A curriculum of empowerment for health and wellness in a psychosocial rehabilitation clubhouse.

Occupational Therapy in Mental Health. 30(2): 196-212.

May 2016 Volume 23, No. 10 41

FOCUS Mental Health (part 1)

WHERE ARE THE MENTAL HEALTH NURSES?

By Anita Cregan, Dana Perlman and Lorna Moxham In the 2007 national census, 7.1 million Australians answered yes to having a mental illness in their lifetime (ABS, 2013). This is a significant number of people, all of whom deserve specialist care from appropriately trained and qualified nurses.

Just as a woman who is having a baby deserves care and treatment from a trained midwife, or a child has the right to be cared for by a nurse trained in paediatrics, so too, a person with a mental illness also deserves a nurse who is qualified and trained in mental health. But where are these nurses?

Despite 1:5 people having a mental health condition, of the 296,028 employed nurses in 2013, only 19,226 worked primarily in mental health.

This equates to only 7% (AIHW, 2015).

The term mental illness can create fear and misunderstanding in individuals who are not familiar with mental illness or who have not been educated on the many types of mental illnesses (CMHA, 2015). This confusion, concern or fear can lead to avoidance and when this comes from healthcare staff, consumers can be left feeling isolated, challenged and unsupported; often leading to a negative therapeutic interaction (CMHA, 2015).

These aforementioned challenges could be a reason why there is a shortage in the number of nurses working in the area of mental health.

Given then, that Bachelor of Nursing (BN) students are the future workforce it is important that we understand where they want to work and perhaps of even more interest is gaining an understanding of why they make the choices that they do.

In Australia it is compulsory that all nursing students participate in clinical placements as part of their educational requirements. The National Health and Hospitals Reform Commission (NHHRC) identified

VO LU M

IN PARTICULAR, SELF-DETERMINATION THEORY HAS BEEN APPLIED IN SETTINGS THAT ASSIST IN GAINING INSIGHT INTO HOW EXPERIENCES SUCH AS CLINICAL PLACEMENT CAN INFLUENCE THE DESIRE AND MOTIVATION TOWARD FUTURE CAREER INTENTIONS.

that clinical placements can be inconsistent from one placement to the next and acknowledges that without the proper supervision and support the student can be left to feel overwhelmed, undervalued and disinterested in that area of health (NHHRC, 2008). It is now well known that clinical placements shape the way that students progress into their selected discipline areas as registered nurses (Boyd-Turner et al. 2016).

This Honours project is investigating the effects of clinical placement on BN students choice of discipline area

as a registered nurse. The conceptual framework for this study is grounded in self-determination theory. Selfdetermination theory is a theoretical framework that has been applied within a variety of professional development settings to gain insight into human behaviour. In particular, self-determination theory has been applied in settings that assist in gaining insight into how experiences such as clinical placement can influence the desire and motivation toward future career intentions.

A quantitative, quasi-experimental design is being used to frame this Honours project. Data is being collected using a pre-test and post-test design with two surveys administered to BN students. The four pillars of SDT are examined. These are autonomy, competency, relatedness and motivation. Survey analysis will identify each participants support for key psychological needs and individual motivation towards working with people living with a mental illness. This will enable the research team to have an understanding of who wants to work in mental health and why. With such an understanding we might be able to increase the future mental health nursing workforce – let’s hope so.

Anita Cregan is a Registered Nurse, NSW Health - Community Health Batemans Bay in NSW Dr Dana Perlman is Senior Lecturer in the School of Education at the University of Wollongong Dr Lorna Moxham is Professor of Mental Health Nursing in the School of Nursing at the University of Wollongong

References ABS 2013 Mental Health, Australian Bureau of Statistics.

AIHW 2015 Mental health nursing workforce. Retrieved from https://mhsa. aihw.gov.au/resources/ workforce/mentalhealth-nursingworkforce/ Boyd-Turner, D., Bell, E. & Russell, A. 2016 The influence student placement experience can have on the employment choices of graduates: A paediatric nursing context. Nurse Education in Practice, 16(1) 263-268.

CMHA 2015.

Understanding Mental Illness. Retrieved from www.cmha.ca/mentalhealth/understandingmental-illness/ NHHRC 2008 A healthier future for all Australians Interim report December 2008: 326.

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Mental Health (part 1) FOCUS

References Baer, R. A., Lykins, E. L. B. and Peters, J. R. 2012 Mindfulness and self compassion as predictors of psychological wellbeing in long-term mediators and matched nonmediators. The Journal of Positive Psychology. 7: 230-238.

Da Silva, T., Ravindran, L. N. and Ravindran, A. V. 2009 Yoga in the treatment of mood and anxiety disorders: a review. Asian Journal of Psychiatry. 2: 6-16.

Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J. and Pilkington, K. 2005 Yoga for anxiety: a systematic review of the research evidence. British Journal of Sports Medicine. 39: 884-891.

Penman, S., Cohen, M., Stevens, P. and Jackson, S. 2012 Yoga in Australia: results of a national survey.

International Journal of Yoga. 5: 92-101.

YOGA AND MENTAL HEALTH

By Nicole Butterfield Research into yoga and mental health is a new area of study with implications for mental health services and nursing practice. Anxiety and depression are growing mental health problems globally (WHO, 2012; Smith et al. 2007; Pilkington et al. 2005), with the World Health Organization (WHO) estimating that depression will be the world’s leading health problem by 2020 (WHO, 2012).

Structured mindfulness programs are well established interventions for anxiety and depression (Baer et al. 2012) and mindfulness is often considered the ‘active ingredient’ in yoga (Salmon et al. 2009).

Preliminary research supports the use of yoga for depression (da Silva et al. 2009; Pilkington et al. 2005), anxiety (Kirkwood et al. 1995) and stress management (Penman, 2012; Varambally and Gangadhar, 2012).

However further high quality research is needed to establish yoga as a clinical intervention. anmf.org.au

In 2012 I embarked on a PhD on yoga and mental health at the University of Adelaide to explore this further.

The aim was to examine the role of yoga in development of skills in mindfulness and self-compassion and relationship to measures of stress, anxiety, depression and wellbeing and implications for mental health services and nursing practice.

In 2014 I started yoga classes with consumers and staff of Southern Mental Health. The feedback from participants was overwhelmingly positive and provided further evidence to pursue yoga and mental health research. Many participants continue to access yoga through donation classes I run at GP Plus Noarlunga and the community.

The Yoga and Mental Health research project includes: Phase 1: Surveys to yoga teachers and students, undertaken in 2014, with the aim to explore the demographics, yoga practices and mental health outcomes of current yoga participants.

Phase 2: Consultation and focus

groups with mental health consumers, staff and yoga teachers, currently being undertaken.

Phase 3: Pilot yoga course with Southern Mental Health Consumers, to be undertaken in 2017. The aim is to compare pre and post measures of mindfulness, self-compassion, depression, anxiety and wellbeing and qualitative information from yoga journaling, interviews and focus groups with an experimental and control group.

Promising results from phase 1 indicate a relationship between yoga practice characteristics, mindfulness and mental health outcomes. Findings of phase 1 and 2 along with existing yoga research protocols will be used to develop phase 3. Recommendations for future healthcare delivery and specific strategies for the role of nursing practice will be developed with the project expected to finish by 2019.

Nicole Butterfield is Associate Clinical Service Coordinator – Trevor Parry Centre; PhD Candidate – University of Adelaide

Pilkington, K., Kirkwood, G., Rampes, H. and Richardson, J. 2005 Yoga for depression: the research evidence.

Journal of Affective Disorders. 89: 13-24.

Salmon, P, Lush, E, Jablonski, M, & Sephton, S.E. 2009 Yoga and mindfulness: clinical aspects of an ancient mind/body practice. Cognitive and Behavioural Practice, 16, 59-72.

Smith, C., Hancock, H., Blake-mortimer, J. and Eckert, K. 2007 A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complementary Therapies in Medicine.

15: 77-83.

Varambally, S. and Gangadhar, B. N. 2012 Yoga: a spiritual practice with therapeutic value in psychiatry. Asian Journal of Psychiatry. 5: 186-189.

World Health Organization. 2012 Depression: a global public health concern www.who.int/mental_ health/management/ depression/wfmh_ paper_depression_ wmhd_2012.pdf Accessed 04/02/2016.

May 2016 Volume 23, No. 10 43

FOCUS Mental Health (part 1) NP SEXUAL HEALTH MODEL

Education and capacity building clients & health professionals.

Suzanne Wallis

Clients – anyone: self-referral, GP, Physician, Allied health, HCWs Drop in / out Re-referral prn

SEXUAL HEALTH @ HEADSPACE SHEPPARTON Australian National Youth Mental Health Foundation, headspace, provides early intervention mental health services to 12-25 year olds.

The service is designed to make it easy as possible for a young person and their family to get the help they need for problems affecting their wellbeing. This covers four core areas: mental health, physical health, work and study support and alcohol and other drug services (http:// headspace.org.au).

http://headspace. org.au/ (accessed 10/03/2016) www.who.int/topics/ sexual_health/en/ (accessed 10/03/2016)

Suzanne Wallis is a Rural Sexual Health Nurse Practitioner, Honorary Fellow, Rural Health Academic Centre, University of Melbourne

A partnership between headspace, Shepparton and Goulburn Valley Health, Sexual Health Service, has enabled the establishment of a Nurse Practitioner led clinical and health promotion service at headspace, Shepparton. This has meant clients of headspace are able to access sexual health services in an environment they are familiar with, where they are already engaged and feel safe.

The Nurse Practitioner has an outreach model of care with a primary care focus which supports the provision of satellite clinics to our disadvantaged young people and at times facilitates re-engagement with mainstream health services.

44 May 2016 Volume 23, No. 10

Long term, follow up and management of clients exposed to persistent infections.

NP led clinic for the management of asymptomatic clients.

Collaborative Patient-Centred Care of the Sexual Health Patient at Goulburn Valley Health NP led clinic for the management of symptomatic clients.

References

NP works collaboratively with Physicians, and MSHC to accommodate the management of clients not clearly defined by the NPs scope of practice.

Referal to specialist physician's CASA, Allied Health Professionals

Capacity build service provision across the Hume Region.

In rural and regional settings there are restrictions and limitations on access to specialist services, particularly those that are free, confidential, appropriate and founded on best practice principles, and this is what is provided.

The Sexual Health Nurse Practitioner Clinic provides information, support, clinical service and appropriate specialist referral for issues surrounding: • sexually transmitted infections, including screening; • sexually transmitted infection treatment; • contraception (including Implanon insertion); • counselling; • emergency contraception; • pregnancy testing; • unplanned pregnancy counselling and referral; • Pap smears; • genital pain and discomfort; • blood borne virus screening, counselling and referral; • contact tracing; • referral to specialist services.

Apart from these obvious clinical services, young people have accessed the service for conversations on the following topics: • what is normal; • what does consent look like; • respectful relationships; • sex and the law; • previous sexual assault follow up; • good vein care; • menstruation; • genital skin care.

Community based NP led satellite clinics.

When we consider the World Health Organization’s (WHO) working definition of sexual health “…a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.

Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.

For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.” (www.who.int/topics/ sexual_health/en/) the importance of the availability of sexual health services within this mental health and wellbeing space becomes apparent.

The challenges of adolescence with regard to mental health intersect with sexual health in the following domains: • experimentation and risk taking; • health literacy and knowledge; • body image, self-esteem and autonomy.

For teens who are trying to understand sex and sexuality not talking about sex could have huge implications. Although adolescents have access to information on sex from a variety of sources, healthcare providers can support and guide our young people’s healthy sexual development, behaviour and expression, and through this partnership, this is the opportunity that headspace, Shepparton affords to its clients. anmf.org.au

CALENDAR

MAY International Day of the Midwife Women and Newborns: The Heart of Midwifery 5 May. www.internationalmidwives.org/ events/idotm/ 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/2016nurses-a-force-for-change-improvinghealth-systems-resilience/ Cancer Nurses Society of Australia 19th Annual Congress Bridging the gap: distance, culture, workforce and knowledge 12-14 May, Cairns Convention Centre, Qld. www.cnsa.org.au/ 12th World Congress of Nurse Anesthetists Building bridges between nurses and anesthetists 13-16 May, Glasgow, UK. www.wcna2016.com/ Australian Dermatology Nurses’ Association National Conference 14-15 May, Convention Centre, Perth WA. www.adna.org.au/events/ Gastroenterological Nurses College of Australia National Conference Gastroenterology into the 21st century 14-15 May, Rydges Hotel Melbourne. www.genca.org/

ATSA Independent Living Expo Australasia’s largest display of rehabilitation and assistive technology equipment 18–19 May, Melbourne 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

ANMF Vic Branch Annual Delegates Conference & Health and Safety Rep Conference 23-24 June, Melbourne Convention and Exhibition Centre. This two day conference focuses on exploring occupational health and safety issues for nurses and midwives as well as giving Job Reps the opportunity to vote on resolutions and help shape the direction of the branch for the next 12 months. www.anmfvic.asn.au/eventsand-conferences

World Humanitarian Summit 23-24 May, Istabul, Turkey. www.worldhumanitariansummit.org

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

ANMF Vic Branch - Prevention of Workplace Bullying Conference 26 May, Carson Conference Centre, Melbourne. Workplace bullying is a significant psychological hazard and a risk to the health and safety of many nurses, midwives and carers and it should not be tolerated in any workplace. www.anmfvic.asn.au/eventsand-conferences National Sorry Day 26 May. www.nsdc.org.au/ Go ORANGE for Prader-Willi Syndrome (PWS) Day 27 May. Wear or do something ‘Orange’. http://go-orange.org.au/ Anniversary of the 1967 Referendum 27 May National Reconciliation Week 27 May-3 June. www.reconciliation.org. au/nrw/

JUNE

Women Deliver Conference 16-19 May, Copenhagen, Denmark. www.womendeliver.org/ conferences/2016-conference/

National Native Title Conference 1–3 June, Darwin Convention Centre, NT. http://aiatsis.gov.au/news-andevents

Australian & New Zealand Addiction Conference Alcohol – other drugs – behavioural addictions, prevention, treatment and recovery 18-20 May, Mantra on View Hotel, Gold Coast. www.addictionaustralia.org.au

Mabo Day 3 June

NETWORK 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 Alfred Hospital, Group 281, 35-year reunion 4 June. Contact E: carolineandrew1011@ gmail.com or search Facebook for Alfred Hospital Group 281 Reunion

Lung Health Promotion Centre at The Alfred 3 June – Theory and Practice of NonInvasive 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

JULY Lung Health Promotion Centre at The Alfred 13-15 July/17-18 August – Respiratory Course (Modules A & B) 13-15 July – Respiratory Course (Module A) 20-22 July - Asthma Educator’s Course 28-29 July – Smoking Cessation Course P: (03) 9076 2382 E: lunghealth@alfred.org.au ANMF Vic Branch - Mental Health Forum: Advocacy 29 July, Carson Conference Centre, Melbourne. www.anmfvic.asn.au/eventsand-conferences DonateLife Week 31 July-7 August. www.donatelife. gov.au/

AUGUST Lung Health Promotion Centre at The Alfred 4-5 August – Influencing Behaviour Change – a formula 17-18 August – Respiratory Course (Module B) 18-19 August – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au

ANMF Vic Branch - Working Hours, Shifts and Fatigue Conference 18 August, Carson Conference Centre, Melbourne. Find out how working hours, shifts and fatigue affect the health and safety of nurses, midwives and patients in this exciting one-day conference. Get practical strategies for reducing the impact of shiftwork and fatigue. Aimed at all levels of nursing and midwifery, this conference will be particularly useful if you roster or manage staff. www.anmfvic.asn.au/ events-and-conferences

SEPTEMBER ANMF Vic Branch - Australian Nurses and Midwives Conference 8-9 September, Melbourne Convention and Exhibition Centre. This Conference brings together nursing and midwifery professionals from across Australia and overseas. The two-day program features a range of international, interstate and Victorian speakers exploring professional and clinical issues and innovations in nursing, midwifery, mental health and aged care. www. anmfvic.asn.au/events-and-conferences Australasia-Pacific Post-Polio Conference Polio: Life stage matters 20–22 September. Four Seasons Hotel, Sydney. This conference will facilitate better care and build international connections by bringing together health care providers, researchers, polio survivors, their caregivers and patient organisation representatives. www.postpolioconference.org.au

OCTOBER Australian Disease Management Association 12th Annual National Conference Person centred healthcare: Achievements & challenges 20-21 October, Melbourne Convention Centre (MCEC). www.adma.org.au/ E: info@adma.org.au T: (03) 9076 4125 18th South Pacific Nurses Forum Through nursing excellence for universal health 31 October-4 November, Honiara, Solomon Islands. Contact Edward Iuhanisuna E: spnfsina@gmail.com or www.spnf.org.au

Royal Adelaide Hospital, Group 764, 40-year reunion 18 June. Private room at pub with small charge to cover cost of food platters.

Contact Patrice O’Loughlin M: 0405 399 171 E: patrice_oloughlin@mail.com

St Vincent’s Hospital, Melbourne, August 1986, 30-year reunion 5 August. Contact Celia Kenny (nee Murphy) E: paulandcelia@hotmail.com or search Facebook page AUGUST 86 30YR REUNION 2016

Princess Alexandra Hospital, Group 59C 30-year reunion 7-8 October. Contact Jenny Whittle (nee Dredge) E: jennydredge@hotmail. com or search Facebook page 59C Princess Alexandra Hospital Group

Royal Adelaide Hospital, Group 765 reunion Suggest combining with 764 at The Gov (Hindmarsh) 18 June. Contact Christine Freeman (nee Williams) E: christine_freeman25@ hotmail.com

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”

Royal Melbourne Hospital, October 1976, 40-year reunion 8 October, Naughtons Parkville Hotel.

Contact mezzarankin@gmail.com or Kris Alderson (nee McGuigan) E: pjka@ ozemail.com.au or Jane Beetham (nee Collyer) E: beethams@mmnet.com.au

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

anmf.org.au

May 2016 Volume 23, No. 10 45

MAIL

STUDENTS AND WORK LIFE BALANCE I refer to the article ‘Is it possible to have a work-life balance?’ written by Bron Watson in the March issue of ANMJ. I have to say, it was read with a great deal of scepticism.

Having been through the experience of placements while completing my Bachelor of Nursing, and now being obliged to participate in placements once again to complete a Graduate Diploma; I believe students should not be forced to attend placements where those employed in the facility are not assessed as appropriate mentors for nursing students.

I have experienced several instances of bullying at various units, and for fear of failing the placement, I have had to endure the unprofessional conduct of those who should know better. This behaviour was reported but no action was taken. Universities deny bullying of students is a problem yet I have been told by numerous students that their experience has been less than satisfactory due to the unprofessional behaviour of the nurses who are supposed to be their mentors.

How are nursing students supposed to get the most out of their placement and concentrate on learning as much as possible while stressed and anxious about how they are being treated?

How does this optimise safety for patients when a student taking a ‘full patient load’ is exhausted? Students are expected to attend full-time placements for weeks at a time, but how can they continue paying ongoing expenses with no income?

It is not possible to have an appropriate ‘work/ life’ balance in this situation. I was unable to graduate due to a bullying incident and have been without my Graduate Diploma ever since even though I have put two years into participating in placements in various locations and being assessed as competent in all contexts. The university in question accepted a performance review and development as evidence of competence yet maintained I had to participate in another placement.

The arbitrary nature of placements is causing harm to students on multiple levels instead of dealing with the imbalances of power for students, addressing the bullying, acknowledging the financial burden and impact on mental health. At such a fundamental level, where we are supposed to be learning and building a solid foundation on which to build our practice, there is no work/life balance.

Until students are treated with respect and offered genuine and commensurate reward for participating in placements, there will be no safe, work/life balance for them.

RN, Victoria 46 May 2016 Volume 23, No. 10

TAKING ACTION AGAINST AUSTRALIA’S ASYLUM SEEKER POLICY Thank you for the article on children in detention (ANMJ April 2016). I would like to add that there are many actions readers can take, and I urge them to google the following.

There are two petitions opposing the secrecy and intimidatory provisions of the Border Force Act, set up by Christine Cummins and Alison Hughes respectively. They also accord with amendments to the Migration Maritime Powers Bill moved by Senator Hanson-Young and passed by the Senate last November. This included the right to disclose without fear of retribution, and for media access to immigration detention facilities. It would be good to have a massive show of public support when the amendment is tabled in the House of Representatives, hopefully accompanied by presentation of the petitions.

There is also another petition asking the ICC to make a public statement to the Australian government that sending people to offshore detention while an investigation is taking place is unwise. The petition at http://tinyurl.com/ICCreNauru references both complaints and it would be good if people signed.

A massive action taking place regularly around Australia is the #LetThemStay campaign.

This has taken place every week in Newcastle since 25 February, outside the Federal ALP member’s office. Search the hashtag, and you are likely to find one near you or otherwise start one yourself.

The No Business in Abuse campaign is currently targeting local councils, urging them to sign a pledge that they will not deal with corporations, institutions and organisations that profit from abusive practices towards people seeking asylum. Search for it and if there is not one targeting your local council it is easy to start one yourself.

There are an increasing number of screenings of the film ‘Chasing Asylum’, which the Australian government does not want you to see. It’s easy to organsie a screening from the film’s website. The main thing you can do though is to join a group. Facebook is the easiest way, although there are traditional blog sites as well. Join so you can take part in organising or participating in actions that will one day lead to massive rejection of Australia’s cruel, illegal, and fundamentally Kafkaesque asylum seeker policy.

Dr Niko Leka, EN, Convenor, Hunter Asylum Seeker Awareness NSW

NURSES CREATING A BETTER WORLD FOR WOMEN AND GIRLS Being denied education, particularly for women in developing countries, is a well-documented issue. However, sometimes a practical solution can be the difference between girls attending school and women working or not.

The Days for Girls International NGO is a worldwide organisation that aims to create a more dignified, free and educated world through access to lasting feminine hygiene solutions. Without sanitary supplies it can mean girls have days without school and isolation. Additionally, in some poor communities, they use leaves, mattress stuffing, newspaper, corn husks or rocks are used as substitutes for sanitary products.

Sanitary kits made by Days for Girls East Gippsland in Victoria, will give a girl back 180 days of school and a woman 36 months without interruption to work. Women and girls will also regain their dignity.

Recently, in the Western Province of the Solomon Islands, two retired nurses from Australia spoke about the Days for Girls International NGO to a group of volunteer nurses from Munda. Hearing about the program this remote community, they embraced the idea with enthusiasm.

All the nurses were given starter kits to try or give away with information on how to care for the kits and reproductive and hygiene information. Reusable washable kits last up to two to four years if washed correctly. Order forms are available for more online or by phone contact. For more information www.daysforgirls.com or contact Wendy Flahive: wendyflahive@gmail.com Wendy Flahive, Maternal and Child Health Nurse, East Gippsland Days for Girls, Vic anmf.org.au

MAIL

/ APRIL 2016 V O LU M E 2 3 , N O. 9

FEATUR E

ELDER ABUSE I would like to comment about the article on elder abuse in the April issue of the ANMJ. I am a nurse manager in a Victorian bush nursing centre and have recently witnessed elder abuse of a 91 year old gentleman with dementia.

He had been living at home with his wife and adult son (who has an acquired brain injury), but sadly his wife, who was his carer, passed away with cancer four years ago. Immediately after the death of the mother, one of the sons took his brother off the Will as power of attorney (POA) and placed himself as the enduring POA instead. This son and one of his sisters then took control of the finances of the demented father and disabled brother and used the funds as they saw fit.

The son, with the help of the cousin’s lawyer husband, bought the family home (the father with dementia was not aware of what he was signing) and then commenced to charge the father and disabled brother $560.00 per fortnight, to live in their own home. The father’s money continued to pay for all running costs of the home.

The care for the father was lacking and community members were approaching me with their concerns. The local businesses were also concerned about the daughter’s use of the father’s credit cards.

The two other siblings became aware of what was occurring and stepped in to take over the care of the father and disabled brother. They then had unfounded Intervention Orders placed on them by the abusers. They contacted Seniors Rights Victoria, Latrobe Community Health and local police, with no assistance.

They had to engage a lawyer and take the matter to VCAT. The financial POA was removed and placed in the hands of the State Trustees. The elderly gentleman was placed in a nursing home for permanent care and the son then tried to evict the disabled brother from the family home, where he had resided with his caring parents for the past 30 years.

If a child is being abused, the DHHS steps in to help. But if it is an elderly man with dementia, or a disabled man, there is nowhere to turn to for help.

As I became involved in this situation, I was abused by a few of the community members and the daughter did her best to try to have me deregistered.

LETTER OF THE MONTH

HOW AU

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www.anmf.org.au

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INFORMATIVE ANMJ

April 2016

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While I always enjoy reading the ANMJ and generally find something of interest in each edition, I was particularly pleased to read the current April 2016 edition for its several very informative articles.

I found the feature article on ‘Asylum Seekers’ to be excellent in its content, analysis and suggestions for action.

It is immensely gratifying to see nurses taking a stand on this very fraught issue and I feel proud to be associated with the views expressed.

As an educator, albeit lacking in current expertise/knowledge of diabetes, the comprehensive coverage of this subject has added significantly to my awareness of the aetiology, symptoms, treatment, management and complications of this increasingly urgent health issue. The recommendations for diabetes health promotion programs are very well expressed; serving as a prompt for all nurses.

Please accept my sincere thanks and hearty congratulations to all contributors of this excellent edition of the ANMJ. Rosalie Hudson Associate Professor, 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.

I can only hope in the future there will be much better support available to these vulnerable people, as well as the nursing staff in these small communities.

Thank you for taking the time to read my story and understand what we face when caring for a small rural community.

RN, Victoria EDITOR’S NOTE: The ANMF condemns violence within healthcare and in the community. The union will continue to lobby against all forms of violence including acts that affect vulnerable older Australians.

anmf.org.au

May 2016 Volume 23, No. 10 47

SALLY

GLOBAL CITIZENSHIP Sally-Anne Jones, ANMF Federal President

My eldest daughter is completing Year 12 this year.

Like all mothers, I am intensely proud of my children and their achievements but more recently it has occurred to me that they are both becoming extraordinary young people whose aspirations, motivations and understanding of the world far exceeds my own at their age.

The school they attend is like all public schools, and much like the one I attended years ago, with robust academic, sporting, language and arts programs that create opportunities to grow the next generation into all they can be. But the new element is the development of global citizenship behaviours. It’s not a subject. It’s not a discipline. It’s an ethos, and it’s inspiring to behold.

A CITIZEN IS A MEMBER OF A COMMUNITY WITH RIGHTS AND RESPONSIBILITIES. BEING A GLOBAL CITIZEN MEANS BEING INFORMED ABOUT ISSUES OF GLOBAL IMPORTANCE AND TAKING ACTION TO BETTER ONE OR MORE OF THESE COMMUNITIES. In the context of globalisation, with the extraordinary movement of people and their ideas, it has been increasingly recognised that people 48 May 2016 Volume 23, No. 10

need to be interculturally capable, that is, be able to negotiate meanings across languages and cultures. The US Fund for UNICEF defines a global citizen as someone who understands interconnectedness, respects and values diversity, has the ability to challenge injustice, and takes action in personally meaningful ways.

Through my readings, I understand that defined curricula are being developed for all levels of schooling as this topic is of such value and interest. The enduring understandings of global citizenship, whilst not being specifically taught to my daughters, are engendered in the way they participate in the school community, through their teachers creating opportunities and through development of enquiry, engagement and curiosity about the world.

The enduring understandings are as follows: 1. A citizen is a member of a community with rights and responsibilities. Being a global citizen means being informed about issues of global importance and taking action to better one or more of these communities.

2. Human rights are universal and should be guaranteed to all people, everywhere. They include the right to food and clean water, healthcare, education, and more.

3. Being a good citizen entails taking personal responsibility for one’s decisions and actions, including respecting others, obeying rules and laws, and setting a good example to others. Global citizens feel a sense of responsibility to help when the rights of others are violated, no matter where in the world they live.

4. Positive change often begins with one person who is passionate and dedicated to making a difference.

When individuals join with others,

local action can create global change.

My daughter recently participated in a Model United Nations Conference as an Intern. This is an educational simulation in which high school interns and university students can learn about diplomacy, international relations, and the work of the United Nations. Delegates employ researching, public speaking, debating, and writing skills, in addition to critical thinking, teamwork, and leadership abilities as they represent nominated countries on the more commonly simulated six main committees of the United Nations General Assembly, the UN Security Council, as well as the Press Corps.

We had the most amazing conversations during and after that experience. She, and her fellow delegates, demonstrated a depth and maturity of comprehension of the big ticket global issues that many who are older do not. We spoke a lot about the role of unions in facilitating the achievement of the UN Sustainable Development Goals. She has a new, and shared, understanding of the power and benefit of unionism. The Australian Nursing and Midwifery Federation is committed to social justice and represents Australia in the interconnectedness of healthcare and health workers around the globe.

I have such hope for the future when I see that skills and abilities in global citizenship are emerging in the generations to come like this.

Whilst they may frustrate us with their obsession with social media and addiction to technology that sometimes prevents communication, there is a drive in this group to change the world. Really, truly change it. 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.

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