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DIABETES a ticking time bomb www.anmf.org.au
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02 DIRECTORY 03 EDITORIAL 04 NEWS 15 WORLD 16 INTERNATIONAL DAY OF THE MIDWIFE & INTERNATIONAL NURSES DAY CELEBRATE THROUGH SELFCARE
21 INDUSTRIAL PENALTY RATES
22 FEATURE DIABETES: A TICKING TIME BOMB 28 REFLECTIONS
BIRTH OF A MIDWIFE
HONESTY AND INTEGRITY IN AUTHORSHIP ATTRIBUTION
32 CLINICAL UPDATE
TEN TIPS FOR DRESSING AND SECUREMENT OF IV DEVICE WOUNDS
PERI / POST OP CARE
46 CALENDAR 47 MAIL 48 LORI-ANNE
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May 2017 Volume 24, No. 10 1
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Editorial Lee Thomas, ANMF Federal Secretary As nurses and midwives it’s our job to look after the healthcare needs of others. Caring is the fundamental core of what nursing and midwifery is all about and is what we do well for our patients, their families, and each other. But at the end of the day how well do we look after our own emotional and physical needs? How much do we give back to ourselves? International Day of the Midwife, 5 May, and International Nurses Day, 12 May, are perfect occasions to thank yourselves for all that you do by giving some self-love. Take the opportunity to ensure your own physical and emotional needs are being met on a regular basis. Simple activities to your routine such as a relaxing bedtime ritual for a better night’s sleep or regularly taking 10 minutes out of your day to switch off in peaceful surrounds can help strengthen coping mechanisms to better deal with everyday stresses that occur. To help inspire you with ways to maintain your own wellbeing, the ANMJ has put together a range of articles and tips on managing stress, diet and physical health. The month of May is also a time to observe the themes for International Day of the Midwife and International Nurses Day, set by the Confederation of Midwives and the International Council of Nurses respectively. The theme for International Day of the Midwife is ‘Midwives, Mothers and Families: Partners for Life!’ This theme emphasises the working relationship midwives have with families to promote safe and fulfilling births. According to the World Health Organization around 800 women and more than 8,000 newborns die every day around the world due to largely preventable complications during pregnancy, childbirth and the immediate postnatal period. In addition nearly 3 million babies are stillborn every year. Many of these lives could have been saved if every birth had been attended by a trained midwife. The Confederation is encouraging midwives and families to band together to advocate for changes to midwifery and maternity services to prevent these deaths from occurring.
This is particularly apparent in response to goal 3: Good health and wellbeing and is highlighted this month in ANMJ’s feature on Diabetes where nurse led interventions are proving pivotal in helping in the prevention and management of the disease. Diabetes, which is fast becoming one of the world’s largest health epidemics, joins a list of other non-communicable diseases which have overtaken infectious diseases as the leading causes of mortality across the world. This has been attributed to economic growth, modernisation and urbanisation. With the changing profile of disease many health systems are not prepared to manage the shifting landscape of healthcare.
INTERNATIONAL DAY OF THE MIDWIFE, 5 MAY, AND INTERNATIONAL NURSES DAY, 12 MAY, ARE PERFECT OCCASIONS TO THANK YOURSELVES FOR ALL THAT YOU DO BY GIVING SOME SELF-LOVE.
Therefore how we improve the quality of health in terms of non-communicable diseases requires a new and considered approach. Already nurses are working towards this and are making significant inroads into disease prevention and care. Clearly the role nurses and midwives play in the sustainability of healthcare is evident. This month acknowledge your value and applaud the work you do every day. Have a very happy International Day of the Midwife and International Nurses Day.
The theme for International Nurses Day is ‘Nurses: A Voice to Lead, Achieving the Sustainable Development Goals’. The purpose of this theme is to raise awareness of contributions nurses are making to achieve those goals.
May 2017 Volume 24, No. 10 3
TASMANIA POISED TO STRENGTHEN AGED CARE WORKFORCE The launch of a one-stop online hub for organisations and workers involved in the aged care sector is expected to boost Tasmania’s ability to cater for a growing demand in aged care services in years to come.
QNMU MEMBERS SHOWCASE THE BRANCH’S BRAND NEW LOGO.
QNMU ASSISTANT SECRETARY SANDRA EALES, TOP LEFT, AND COLLEAGUES AT A MIDWIFERY SYMPOSIUM HELD LAST YEAR IN BRISBANE.
QNU ADOPTS NEW NAME TO EMBRACE MIDWIVES The Queensland Nurses’ Union (QNU) has undergone a name change to incorporate the valuable work of midwives and will be known as the Queensland Nurses and Midwives’ Union (QNMU) moving forward. QNMU Secretary Beth Mohle said the evolution reflected the union’s longstanding representation of both nurses and midwives across the state as well as those in their care. 4 May 2017 Volume 24, No. 10
The QNMU boasts a membership base of 54,000 and the union has been protecting the rights of nurses, midwives, and their patients since formation in 1982. “The name change properly reflects the important roles and work of our members in communities between Cairns, Cloncurry and Coolangatta,” Ms Mohle said. “We’d like to celebrate the midwives who keep women and babies safe during what is one of life’s major events.” QNMU Assistant Secretary Sandra Eales, an experienced midwife, described the job as a privilege and said the name change was a significant step forward. “Childbirth is a profound event in the life of a woman, her child and her whole family. “How she passes through that gateway experience will impact the rest of their lives. The important role of midwives is often unseen as they work in an intimate space with a woman and her family. The name change is significant recognition of the valuable, powerful and unique role of midwives in our society.”
The state government recently unveiled the $150,000 online Aged Services Workforce Development Hub, an initiative it hopes will help recruit more aged care nurses to the sector and provide them with the essential skills needed to deliver specialist care. The hub is geared towards aged care organisations and workers, training organisations, employment services providers, and prospective aged care workers. It provides a range of services, including training and development, online resources, recruitment advice, professional networking, and information on applying for Aged and Community Services Australia’s (ACSA) Graduate Nurse Transition to Practice Training Program. ACSA Manager, Workforce & Innovation, Lee Veitch, said the graduate program had been running for six years and was triggered by registered nurses emerging as the fastest growing demographic entering the aged care workforce. Ms Veitch said the launch of the online hub would prove enormously beneficial in providing practical and useful information to the next generation of aged care staff. “We want to attract right fit people. If we attract right fit people with the appropriate training, they develop the skills that they need to deliver quality services.” Almost 30 graduate nurses recently obtained their official credentials under the training program and will now enter the sector. Reflecting on the program’s development, Ms Veitch said graduates from the first intake back in 2012 had now gone on to fulfil their goals of becoming facility managers and directors of care. Each year, Ms Veitch said graduates typically change their mindset about staying within aged care. “At the start of the year there was only a third of people that wanted to work in the sector. At the end of the year it was the passion that those people now have for working with older people. That’s the most pleasing thing.”
ATTACKS ON NURSES SPARK RENEWED CALLS TO CURB VIOLENCE Two separate incidents involving violent attacks on nurses working in public hospitals have once again highlighted the systemic occupational violence plaguing the health sector. Last month, a nurse at the Royal Melbourne Hospital was allegedly taken hostage by a man armed with a knife before police were called to the scene to control the situation. The disturbing attack followed a similar incident at the Wyong Hospital in New South Wales just days earlier where two nurses were allegedly held hostage by a patient brandishing a meat cleaver who had previously walked into the hospital demanding to see a psychiatrist. The tense standoff between the alleged offender and security staff that unfolded was brought to an end after a male nurse intervened with the aid of security and police. A senior nurse at the Royal Melbourne Hospital, who asked not to be identified,
LAST CALL TO RENEW REGISTRATION
Nurses and midwives have until the end of the month to renew their registration to avoid facing a late payment fee. Online renewal is open for more than 370,000 nurses and midwives across the country who are required to renew their general or non-practising registration with the Nursing and Midwifery Board of Australia (NMBA) by 31 May. Last year, more than 98% of nurses and midwives renewed their registration online. anmf.org.au
said the incident at her workplace was upsetting. “Most people come to work because they have to work and I think anything that happens of that nature is completely uncalled for. It wouldn’t be accepted in any other workplace.” The senior nurse conceded occupational violence was common but suggested inroads had been made in recent years to boost safety strategies to deal with unpredictable patients, many suffering from the effects of drugs and alcohol. “Once upon a time people thought it was part and parcel of the role. I think attitudes are changing. There is an expectation that people come to work like they would in any other job and expect to be safe.” Still, the nurse said reporting of violence remains hit or miss, with many nurses not formally lodging Code Greys due to arduous red tape. “There are a lot of near misses we don’t hear about and that’s probably the unfortunate part of what we do. If everybody thinks that is part and parcel of what we do then there are probably more opportunities for the awareness to be heightened.” In a statement, the Royal Melbourne Hospital said both the patient and staff involved in the alleged knife attack were physically unharmed and that the patient’s care continues. It released figures claiming less than 1% of its patients cause physical and mental harm or use verbal aggression. It also stated that in 2015/16, there were 588 occupational violence incidents, with 32%
NMBA Chair, Associate Professor Lynette Cusack, RN, prompted nurses and midwives to ensure they adequately meet the obligations of revised registration standards which came into effect last year. The NMBA visited workplaces in every state and territory last year to explain the changes and detailed information regarding the updates can be found on the NMBA’s website. This year, renewal for nurses and midwives will include an extra step that asks them to specify the date they were first registered in Australia and also check that their qualifications and registration appear correctly on the national online register of practitioners. Under the Health Practitioner Regulation National Law, the national register should include details of any qualifications required to obtain registration. Nursing and midwifery qualifications that do not lead to registration or endorsement are not regulated by the National Registration and Accreditation Scheme and will therefore not appear on the register. “By checking this information you will be helping us to maintain the integrity of the national register, which helps to protect the public,” Ms Cusack said.
ONCE UPON A TIME PEOPLE THOUGHT IT WAS PART AND PARCEL OF THE ROLE. I THINK ATTITUDES ARE CHANGING. THERE IS AN EXPECTATION THAT PEOPLE COME TO WORK LIKE THEY WOULD IN ANY OTHER JOB AND EXPECT TO BE SAFE. occurring at the RMH. Melbourne Health Chief Executive Adam Horsburgh said the organisation had received $447,367 from the Department of Health and Human Services’ Health Service Violence Prevention Fund, with funding going towards installing CCTV cameras and duress buttons in 12 wards at the RMH’s city site. For many years, the ANMF (Vic Branch) has campaigned tirelessly in a bid to trigger a systemic and cultural transformation in regards to addressing occupational violence. ANMF (Vic Branch) Assistant Secretary Paul Gilbert said the incident at the RMH was distressing for all parties involved and highlighted the ongoing need for all key stakeholders to commit to targeted action plans to reduce, prevent, and respond to violence and aggression in the health sector. “Victoria is in an important transitioning phase moving beyond awareness campaigning amongst nurses and midwives to encouraging reporting of violence to fix this serious issue.”
By now, RNs and ENs, along with midwives and nurse practitioners, should have received an email from the Australian Health Practitioner Regulation Agency (AHPRA) reminding them to renew registration. The emails marked the first in a series of reminders being sent out by AHPRA on behalf of the NMBA. Online renewal is considered the easiest way to renew registration and all nurses and midwives are encouraged to renew via this process. Importantly, nurses and midwives who fail to renew their registration by the end of the month face a late payment fee of $38 in addition to the annual renewal fee of $150. If nurses and midwives do not renew by 31 May, or the following one-month late period, their registration will lapse, their name will be removed from the national register, and they will not be able to practise without undertaking a new application for registration. Nurses and midwives looking to renew their registration can visit http://www. nursingmidwiferyboard.gov.au/Registrationand-Endorsement/Registration-Renewal. aspx to find out more and follow links on where to renew. May 2017 Volume 24, No. 10 5
INTIMATE PARTNER VIOLENCE RESEARCH CENTRE
EDs TO USE DIGITAL HEALTH TO IMPROVE PATIENT OUTCOMES As the epicentre of the healthcare system, emergency departments (ED) are ideally positioned to utilise digital health to streamline care and improve outcomes, delegates were told at the Digital Health Summit in Melbourne last month. Speaking at the Summit, Dr Megan Ranney, Associate Professor of Emergency Medicine and Director of the Emergency Digital Health Innovation program at Brown University in the United States, said EDs touch patients, carers, and family members, and have a great opportunity to improve overall health outcomes. “The reason why we need digital health in the emergency department is because at its most basic level the ED is the centre of healthcare. “That moment in which they enter the doors of our emergency department is a moment in which we can potentially change a healthcare trajectory.” Dr Ranney said EDs in the US handle 130 million visits each year. Like other countries such as Australia, she said discussion around preventable ED visits is a contentious topic, yet ultimately she disagrees with the misplaced focus. “When we look at why people show up in the ED it’s not for the most part because they don’t have a primary care doctor. It’s because they believe they are too sick or too scared to wait longer to get care.” Dr Ranney said while the ED was trained to respond to time-sensitive medical conditions, the majority of visits rarely required urgent attention. Despite this, EDs are also places of “immense chaos”, with ED physicians caring for between 30 and 40 patients on an average shift, she said. Dr Ranney claimed digital health could be incorporated into the emergency department setting in a bid to better coordinate care amongst physicians and more effectively target patients. “Unfortunately, the way the healthcare system exists right now, that simply isn’t possible. Digital health could allow us to unify all of those sources of information and then better engage our patients
6 May 2017 Volume 24, No. 10
DR MEGAN RANNEY, DIRECTOR OF THE EMERGENCY DIGITAL HEALTH INNOVATION PROGRAM AT BROWN UNIVERSITY.
and provide safer and more cost efficient care.” Dr Ranney referred to several digital health strategies already working effectively. A company named Twiage, for example, is delivering real-time prehospital data to help EDs streamline workflow, specifically using an app to allow paramedics to send information to triage nurses such as photos and other vital information.
THAT MOMENT IN WHICH THEY ENTER THE DOORS OF OUR EMERGENCY DEPARTMENT IS A MOMENT IN WHICH WE CAN POTENTIALLY CHANGE A HEALTHCARE TRAJECTORY.
Dr Ranney said advancements during a patient’s visit included the use of wearable monitors that can predict ahead of time if a patient is showing signs of going downhill. Other digital health technologies can improve the care coordination among a range of specialists, with easily accessible health information leading to faster ED care, and a shorter length of stay. Dr Ranney said with good interventions in the ED healthcare trajectories can be changed, yet added that the hustle and bustle of the ED often meant health practitioners failed at implementing interventions that create behavioural change. She said the views of health staff such as nurses were now critical to improving workflow within the ED and ensuring suitable interventions can be implemented. “By using virtual care and by using digital health more effectively we can triage patients better, keep them out of the ED, take care of them during that ED visit, and then help to coordinate that visit afterwards.”
Australia’s first virtual Centre for Research Excellence into the health effects of intimate partner violence and how the health sector can respond was launched last month. The Centre for Research Excellence (CRE) is funded by the National Health and Medical Research Council (NHMRC) over the next five years. The centre is aimed to provide the best evidence on how to early identify and intervene in intimate partner violence for individuals, children and families by the health sector, Royal Women’s Hospital Professor of Family Violence Kelsey Hegarty said. “We think it’s a good area, antenatal appointments, in general practice, in Aboriginal Community Controlled services, this sort of spectrum is where families are going and where health professionals often need some help in identifying and responding to domestic and family violence. “Many health practitioners have had minimal training and limited experience in identifying partner violence or how to respond if a patient discloses their experience.” University of Melbourne Chair of Indigenous Studies Professor Marcia Langton said the CRE would work closely with Indigenous communities. “The findings will inform policy and direction that will directly impact on Indigenous communities, creating stronger families and safer communities.” The centre will have local and international experts undertake research into the prevention, causes, effects and interventions related to family violence. It will include lived experiences from women. The Royal Women’s Hospital in Melbourne CEO Dr Sue Matthews said improved research evidence was needed to help guide healthcare providers in how best to respond to family violence. “Often healthcare workers, particularly those in our hospitals, are in a unique position to identify and support people at risk of or experiencing family violence. “But we require more evidence to show that what we’re doing is improving health outcomes and life chances for people that we are seeing who are experiencing or at risk of family violence.” “We believe this to be the only such centre in the world that has at its core, early intervention as a catalyst for preventing violence against women and children,” Professor Hegarty said.
BROAD CHANGES TO 457 VISA SCHEME TRIGGERS CYNICISM The federal government’s move to abolish the problematic 457 temporary working visa program and replace it with a new framework billed as the answer to safeguarding Australian jobs has been met with widespread criticism due to the questionable extent of the reform. Under the changes announced by Prime Minister Malcolm Turnbull last month, 457 visas will be scrapped to make way for the new Temporary Skill Shortage Visa, boasting stricter conditions involving criminal checks and English requirements and a reduction in the number of professions eligible to obtain a 457 visa. The new program is underpinned by a two-year and four-year visa, dubbed shortterm and medium-term, with medium term visas set to be issued for more critical skills shortages only. More than 600 eligible professions under
the current 457 visa scheme, including chefs and public relations managers, will be slashed to just 435 under the new program. Nursing and midwifery is not listed and will remain unaffected. Significantly, the number of nurses on 457 visas has continued to drop in recent years, with latest figures showing 1,879 RNs working in Australia on 457 visas in 2016, the lowest levels since 2009. Implementation of the new visa scheme will take effect immediately and be fully integrated by March 2018. Mr Turnbull said the new visas were aimed at “putting Australian workers first” and would give local job seekers more opportunity to find employment. “There is no doubt foreign workers have played a significant role in the remarkable economic growth of the nation,” Mr Turnbull said. “This will continue but not at the expense of Australians finding work.” The announcement was met with widespread disapproval, with critics labelling the new program nothing more than a “rebranding” exercise and pointing to the fact that just 9% of foreign workers currently on a 457 visa are working in the jobs set to be turfed. ACTU president Ged Kearney described the name change as “more spin than substance” and said it would do little to address more pressing concerns relating to unemployment and the increasing casualisation of the workforce. “It doesn’t matter what you call the visa scheme itself,
SIGNIFICANTLY, THE NUMBER OF NURSES ON 457 VISAS HAS CONTINUED TO DROP IN RECENT YEARS, WITH LATEST FIGURES SHOWING 1,879 RNS WORKING IN AUSTRALIA ON 457 VISAS IN 2016, THE LOWEST LEVELS SINCE 2009. what matters is that Malcolm Turnbull put an end to the exploitation of workers and of work visas. “When we bring in workers from overseas they need to fill genuine skills gaps. It is unlikely Malcolm Turnbull’s proposal will do anything to remedy the chronic exploitation of our work visa system. Where workers can come to Australia and do entry level jobs like retails shop assistants or kitchenhands, we still have a broken system.” National Rural Health Alliance CEO David Butt argued the changes to 457 visas could have a detrimental impact on the recruitment of health professionals to rural and remote Australia in the future. “I would love to be in a situation where we rely on locally trained health professionals to fill all vacancies in rural and remote communities. But that is still many years away. Without overseas trained health professionals, many rural and remote communities would simply be without access to healthcare.”
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STRATEGIES IN MOTION TO IMPROVE REMOTE AREA NURSE SAFETY
NORTHERN TERRITORY REMOTE AREA NURSE ROBYN HILL. PHOTO: ELISE DERWIN
NATIONAL PLAN TO TACKLE SUICIDE CRISIS The Council of Australian Governments (COAG) Health Council will implement the nation’s first National Suicide Prevention Plan in a bid to tackle the growing public health issue.
8 May 2017 Volume 24, No. 10
The Northern Territory government has begun implementing a widerange of strategies to boost the safety of remote areas nurses (RANs) working across the sector. Fourteen recommendations to improve safety for nurses working in remote areas emerged from the government’s Remote Area Nurse Safety: On-Call After Hours Security Review tabled late last year. The review was directly triggered by the tragic murder of RAN Gayle Woodford in South Australia just over a year ago. The Northern Territory government agreed to implement all recommendations in the review and began the process by honouring its commitment to apply the top five priorities by the end of March. The high priority recommendations include all remote area communities now having a second responder in place, where possible a locally trusted and respected Aboriginal community member, ensuring staff attending call outs are not alone. Other priorities focus on rolling out a standard orientation process across the Northern Territory involving comprehensive training, the re-establishment of an expert internal relief pool to provide support to remote area nurses, and undertaking a detailed infrastructure and equipment audit to address issues such as housing and health centre security.
The National Mental Health and Suicide Prevention Plan, which pledges to bring a co-ordinated approach to addressing the crisis, will look to raise awareness about suicide and acknowledge it as a significant health issue that demands a proportionate public response. Several peak mental health bodies praised the progress, labelling the plan an important step to making inroads and saving lives. “The development of this plan – through genuine co-design with those personally impacted by suicide and those working in suicide prevention – is about providing a strong blueprint for stopping this heartbreaking issue,” Suicide Prevention Australia (SPA) CEO Sue Murray said. “We know that a national suicide prevention plan, with clear outcomes and milestones, has the best potential to save lives. To do so, it needs continued national leadership, a focus on quality through evaluation and accountability, as well as proper investment that stays true to the current focus on regional delivery and person-centred care.”
Plans to employ an Infrastructure Coordinator are also being considered in order to enable feedback on systems and action on streamlined maintenance requests. The review’s five most pressing recommendations have now been implemented across all Northern Territory government run clinics. “We believe every Territorian has the right to feel safe in their workplace,” Northern Territory Health Minister Natasha Fyles said. “Territory nurses play a vital role in caring for the Territory’s most vulnerable and it’s important they are provided with a safe and secure framework to do that in.” The next progress report, to be delivered in September, will further evaluate the implementation of the review’s recommendations. For example, the success of the orientation and training program will be measured through key performance indicators including agency costs, staff retention, and satisfaction and turnover rates. “The Northern Territory government is ensuring the safety and security of all employees, including remote area nurses, second responders and all support staff that work in remote communities,” Ms Fyles said. “Implementing all 14 recommendations remains a high priority and we will continue to work with key stakeholders to make sure they’re implemented in line with the formal review.”
Recent research, commissioned by Lifeline Australia, revealed 80% of Australians supported the development of a National Suicide Prevention Plan. More than 3,000 Australians die as a result of suicide each year – the worst rate in 10 years. Lifeline Australia CEO Peter Shmigel said COAG’s strategy to upgrade the 5th National Mental Health Plan to a National Mental Health and Suicide Prevention Plan illustrated that community calls for greater action had been heard. “Lifeline receives almost a million requests for help each year and, as a result, we know better than most the immense pain and heartache that suicide is causing to individuals, families and whole communities across the country. “We also know that struggles with life’s challenges, such as loneliness, relationship breakdown and unemployment – not only mental health issues – are key reasons behind suicidal behaviour and require their own responses.” For 24/7 crisis support and suicide prevention services, call Lifeline on 13 11 14 or visit www.lifeline.org.au/gethelp
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NURSES FALL SHORT IN PROMOTING PHYSICAL ACTIVITY TO PATIENTS Nurses in public hospitals are half as likely to promote physical activity among their patients, according to a new study unveiled at a global conference on public health in Melbourne last month.
Nurses were less likely to believe that discussing the benefits of physical activity with patients and suggesting ways to boost exercise was a part of the health professional’s role. Similarly, nurses were less likely than other health disciplines to consider incorporating brief physical activity counselling into their practice feasible, largely due to a lack of time and workloads. The findings form part of a newly released study by Monash University titled – A wakeup call for physical activity promotion in Australia: survey of nursing and allied health professionals. Addressing the World Congress on Public Health, Lead Author Dr Danny Hills, Senior Lecturer in Nursing at Monash University (pictured), said low levels of physical activity remains the fourth leading cause of death globally due to non-communicable disease. In Australia, almost half of adults are either sedentary or have low levels of physical activity. In 2016 the troubling trend triggering national calls for the health sector to play a major role in promoting physical activity. The study aimed to investigate the current promotion among nursing and allied health professionals across Australia. A cross-sectional online survey targeting health professionals working across a variety of settings, including nurses and physiotherapists, was conducted early last year. Participants were asked about their knowledge of the levels of physical activity needed to achieve good health benefits and whether they thought it was their role to promote physical activity. They were also asked about the barriers to promotion and to reveal the extent of their own physical activity.
Importantly, participants were quizzed on their awareness of Australia’s Physical Activity and Sedentary Behaviour Guidelines and if they could relay them. “We do have fairly good evidence that physical activity advice by health professionals does increase physical activity levels,” Dr Hills said. “Just like GPs, nursing and allied health professionals are in an ideal position to promote physical activity. “Despite this, there appears to be little evidence on current promotion and knowledge of physical activity amongst these disciplines.” A total of 434 health professionals took part in the study, including 71 nurses. Exercise physiologists and physiotherapists were most likely to deliver physical activity advice to patients. While all disciplines generally felt physical activity promotion was a part of their role, just 16% of clinicians were adequately aware of the current national physical activity guidelines. Health professionals confident or aware of the physical activity guidelines were two to four times more likely to promote exercise. Dr Hills said the study indicated interventions, including training staff within the hospital system, could be useful in increasing physical activity knowledge among nursing and allied health professionals and in turn increasing the population’s physical activity levels and improving Australia’s health. The study found the physical activity of the health professional themselves also plays a role. “It’s hard to be a role model or a teacher if you’re having problems in that area yourself.”
ORTHO EXHIBITION An exhibition showcasing 80 years of orthopaedics in Australia is travelling around the country. The Australian Orthopaedic Association’s exhibition includes sports injury prevention, the evolution of joint replacement, developments in the treatment of fractures, and innovations in robotics, computer navigations and customised implants during surgery. The first exhibition was held in the Epworth Hospital in Melbourne last month. Epworth Chair of Surgery Richard De Steiger said there had been major advances in prostheses, surgical techniques, equipment and imaging. “The exhibition is designed to educate the community about the hundreds of orthopaedic procedures performed in more than 300 Australian hospitals every day.” The free exhibition will be on display in Albury Base Hospital until 17 May. It moves on to Queensland in June-July, Western Australia in August-September and South Australia in October-December.
10 May 2017 Volume 24, No. 10
What’s the chance she’ll complete the course?
Up to 54 of patients studied did not complete their full course of ferrous sulfate as prescribed * %
Maltofer® restores iron levels with significantly less side effects and better treatment compliance.1,2* Ensure they get the iron you intended. For more information, visit maltofer.com.au Maltofer contains iron as iron polymaltose. *In studies comparing iron polymaltose with ferrous sulfate in iron deficient patients. References: 1. Ortiz R et al. J Matern Fetal Neonatal Med 2011;24:1–6. 2. Toblli JE and Brignoli R. Arzneimittelforschung 2007;57:431-438. 3. Jacobs P et al. Hematology 2000; 5: 77-83. Maltofer® is a registered trademark of Vifor Pharma used under licence by Aspen Pharmacare Australia Pty Ltd. For medical and product enquiries, contact Vifor Pharma customer service on 1800 202 674. For sales and distribution enquiries, contact Aspen Pharmacare customer service on 1300 659 646. Date of preparation October 2016.
SUPPORTING KIDS FROM MILITARY AND EMERGENCY SERVICE FAMILIES A children’s book series has been launched that supports children from military and emergency service families living with a parent who has a mental health condition.
OMEGA-3 SUPPLEMENTS BRING NO BENEFIT TO HEALTH OF PREMATURE BABIES South Australian researchers have cast doubt over the reported benefits of giving preterm babies omega-3 supplements, with new findings revealing no discernible difference in the health of premature infants after being given the fatty acids. Undertaken by the South Australian Health and Medical Research Institute (SAHMRI), the project was designed to shed light on whether supplementing premature babies
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The first book, titled Do you still love me? Because I really love you! by author Heather Gibson, is a Military Children’s Mental Health initiative, a project of the Remembrance Foundation. Founder of Modern Soldier and Remembrance Foundation Executive Director Talissa Papamau said the book would help better support military and emergency services families. “It is easier to build strong children than it is to repair broken adults.” The book is one of a number of initiatives to support families as well as veterans. When someone signs up to serve in our armed forces, their entire family also volunteered so we have a duty to support them,” Minister for Veterans ‘Affairs Dan Tehan said. Other indicatives include a program with Kookaburra Kids to run support camps for children of veterans with mental health conditions and access to the Veterans and Veterans Families Counselling Service. The book will be available to purchase online through the Modern Soldier social media. All profits from the sale of the book will go to assisting and supporting the veteran and emergency services communities. The book can be purchased for $22.00 via their facebook page: ‘Modern Soldier’ www.facebook.com/ModernSoldi3r/?hc_ ref=SEARCH
with high-dose omega-3 docosahexaenoic acid (DHA), which has an anti-inflammatory activity, would reduce the risk of developing chronic lung disease. According to the research, most babies born preterm need extra oxygen and help with their breathing, otherwise there is a heightened risk of developing chronic lung disease. In order to determine the tangible benefits of omega-3, researchers gave preterm infants either a supplement providing extra omega-3, or a control supplement without DHA, from birth until the time they were allowed to leave the hospital. Dr Carmel Collins, from SAHMRI, said the surprising results suggested supplementing omega-3 fats for premature babies was widely unnecessary. “Our results suggest that additional supplementation of DHA is unnecessary and reinforces the need to thoroughly test all nutritional interventions designed for babies,” Dr Collins said. It is anticipated that the results could now help paediatricians better inform new parents about how to care for their premature children.
ADULTS SKIPPING FRUIT AND VEGETABLES Australia’s largest ever survey investigating whether adults are eating enough fruit and vegetables has revealed four out of five Australian adults are not meeting the Australian Dietary Guidelines. A Fruit, Vegetables and Diet Score report released by CSIRO found one in two (51%) adults are not eating the recommended intake of fruit, while two out of three adults (66%) are not eating enough vegetables. The report compiled the dietary habits of 145,975 adults across Australia over an 18 month period. “Many Australians believe themselves to be healthy, yet this report shows the majority of those surveyed are not getting all the beneficial nutrients from fruit and vegetables needed for a healthy, balanced, diet,” Research Director and co-author of the CSIRO Total Wellbeing Diet, Professor Manny Noakes said. One of the key findings of the survey indicated a focus on variety could be the solution to boosting consumption. People across Australia, in all occupations and weight ranges, were invited to participate in the online survey between May 2015 and October 2016. Results show women eat more fruits and vegetables than men, with 24% meeting both guidelines, compared to just 15% of men. When comparing the figures by occupation, construction workers and those in the science and programming sector recorded the poorest fruit and vegetable eating habits. Conversely, retirees and health industry workers were more likely to meet the recommended dietary guidelines. —
NEW COIN TO HONOUR ARMY NURSES The devotion and sacrifice displayed by Australian Army nurses in times of war has been recognised by the Royal Australian Mint with the launch of a striking triangular-shaped silver coin that captures the importance of often unheralded service nurses. Released in the lead up to Anzac Day and International Nurses’ Day, the 2017 $5 Coloured Fine Silver Proof Triangular Coin emerged as part of the five-year Official Anzac Centenary Coin Program jointly devised by the Mint, Department of Veteran Affairs, and Australian War Memorial in a bid to commemorate the history, service and sacrifice of Australians who went to war. The eye-catching coin took inspiration from the image of an Australian Army Nurse portrayed by artist Napier Waller that appears on the iconic stained-glass window in the Hall of Memory at the Australian War Memorial in Canberra. The Mint has a long history of conceiving military commemorations but few have paid tribute to the critical role of Army nurses in tending to sick and wounded soldiers, as well as civilians, scarred by war. The Mint’s Product Development Officer, James French, said certain groups within the military, such as nurses, were sometimes less recognised than soldiers
on the front line and that the creation of the coin marked a great opportunity to help bring the untold stories of dedicated nurses working behind the scenes to life. “This year’s coin release recognises the sacrifices made by service nurses and we felt it was a great opportunity to raise awareness of those devoted people who laboured and supported the soldiers on the front lines during Australia’s war efforts,” Mr French said. “Highlighting the service nurses with this new triangular coin not only pays tribute to our brave First World War nurses but highlights the skills and passion they have passed onto the generations of nurses that have followed.” Mr French explained that the Mint’s Design and Development Team undertook extensive research during its developmental process for the coin, including visiting the Hall of Memory within the Australian War Memorial. The evocative space, where service nurses take pride of place among other service personnel, helped cement inspiration for the eventual design. “Many nurses and the general public are unaware that there is also a dedicated memorial to service nurses on Anzac Parade,” Mr French pointed out. “This beautiful site is another touching example of the dedication the generations of nurses have given to the Australian services.” While it is anticipated that the coin will predominantly appeal to collectors, due to its exclusivity and rare beauty it is expected that the wider nursing community will also want to acquire the coin as an emotional keepsake. The Anzac Centenary triangular coin Front Line Angels: The tireless devotion of service nurses – is available to purchase for $90 by calling 1300 652 020 or visit eshop.ramint.gov.au
Fewer pregnant women experience constipation with Maltofer * 1
Ferrous sulfate Maltofer
23% of patients 2% of patients
Ensure they get the iron you intended. For more information, visit maltofer.com.au *Versus ferrous sulfate. Maltofer contains Iron as Iron Polymaltose. Reference: 1. Ortiz R et al. J Matern Fetal Neonatal Med 2011;24:1–6. Study size n = 80. Maltofer® is for the treatment of iron deficiency in adults and adolescents where the use of ferrous iron supplements is not tolerated, or otherwise inappropriate; and for the prevention of iron deficiency in adults and adolescents at high-risk where the use of ferrous iron supplements is not tolerated, or otherwise inappropriate. Maltofer® is a registered trademark of Vifor Pharma used under licence by Aspen Pharmacare Australia Pty Ltd. For medical and product enquiries, contact Vifor Pharma customer service on 1800 202 674. For sales and distribution enquiries, contact Aspen Pharmacare customer service on 1300 659 646. Date of preparation: December 2016.
Body-friendly iron May 2017 Volume 24, No. 10 13
COORDINATION FOR CHILDREN NEEDING COMPLEX CARE A coordinated information system is helping Queensland children with complex medical conditions receive more streamlined healthcare. About 1,070 children with a complex or chronic medical condition who require access to three or more medical specialties are enrolled in Queensland’s Connected Care program. The information program provides case management for children with linkages between healthcare providers in acute, community and primary sectors. “If a child suddenly arrives at a hospital then staff can access the care plan that details the child’s healthcare needs,” Nurse Manager for The Connected Care and Nurse Navigator Program Shirley Thompson said. “We have a lot of children with cerebral palsy on the program. They are often fed through tubes, may be in a wheelchair, need orthopaedics and occupational therapy and three quarters of our children are across the state.” Families often live rural or remote; and the program supports children across Queensland, northern NSW, the NT and Torres Strait.
URGENT ACTION NEEDED TO FIGHT CARDIOVASCULAR DISEASE A new blueprint to tackle one of Australia’s biggest killers, cardiovascular disease, is being touted as a major step forward in the battle to address largely preventable health issues. Launched recently at Parliament House, the Stroke Foundation and Heart Foundation’s joint strategy, Hearts and Minds – Effective measures to tackle heart disease and stroke, includes a range of solutions aimed at meeting the chronic disease challenge head on by tackling the country’s most costly diseases – heart,
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“They live outside of the area and in some incredibly remote locations where there is no hospital anywhere near them,” Ms Thompson said. The system is used from the time a child is first referred to and then enrolled in the program and assigned a specific team. A child living in the Darling Downs region would be assigned by the system to the Connected care coordinator who would case manage the patient needs in Toowoomba and would receive automated workflows associated with that child. “They would see there was a new patient, do an intake and collect data about the child’s admissions, trips to outpatients or emergency presentations in the last 12 months,” said Ms Thompson. Other information about the family and child – how the child is fed, if they are mobile, whether they attend school – can all be collected to better inform a child’s care plan. “The more consolidated information you have, the easier it is to manage a family. Often one of the biggest frustrations they face is having to repeat their story over and over again.” Access to detailed, accurate information had led to better informed decision making, Ms Thompson said. “This has added efficiency and stopped patients falling through the gaps – important things are getting done because of workflows flagging us to take action,” Ms Thompson said. “Anybody can step in the coordinator role and know where the family is up to and that care needs to be completed.” The program could ultimately streamline care across the state, she said.
stroke, and blood vessel disease. Stroke Foundation Chief Executive Officer Sharon McGowan said Hearts and Minds was developed in line with greater awareness about the burden of chronic disease. “With an ageing population and more prevalent risk factors, chronic disease is Australia’s biggest health challenge – internationally chronic disease is being described as a pandemic. “Within Australia, around one-third of the population, or seven million people have a chronic condition, and that number is set to grow, placing ever-increasing demands on our health system and burden on our communities.” Solutions outlined within Hearts and Minds include developing Australia’s first heart and stroke strategy, detecting and managing those at risk of heart disease and stroke, and embedding best practice clinical support and education programs for health professionals. Under the plans, stroke survivors will also be followed up post-discharge. More than 4 million Australians live with cardiovascular disease, with low socio-
DIGITAL PLATFORM TAKES ON JOINT REPLACEMENT RECOVERY An app launched by the CSIRO and medical device manufacturer Johnston and Johnston Medical Devices is being trialled to help patients recover from total knee replacements. The smartphone app will support patients in their pre-surgery preparation and rehabilitation programs. Studies have shown that rehabilitation exercises following surgery can lead to faster recovery times, however many patients fail to implement an effective preparation or rehabilitation plan. The app addresses this issue by providing patients with practical information including physiotherapy demonstration videos, pre surgery checklists, reminders and supportive information in texts, video and audio format. The technology also includes a wearable activity tracker to encourage basic exercise, track sleep and self-monitor progress. This will link to a website where clinicians can configure individual physiotherapy programs and monitor patient progress remotely. The trial, which has been running since November 2016, includes 300 patients across five different hospitals from multiple states. Total knee replacement procedures in Australia have risen by 77% between 2003 and 2014 alone.
economic groups and regional areas the biggest sufferers. Mostly consisting of heart disease and stroke, cardiovascular disease is a major cause of death, disability and avoidable hospital admissions. Heart Foundation CEO Adjunct Professor John Kelly AM said cardiovascular disease was largely preventable and treatable. “The federal government must act now to encourage GPs to detect and manage risk before a life-threatening emergency – like a heart attack or stroke strikes. This action will help address cardiovascular disease and other chronic conditions.” Mr Kelly said. “When a heart attack or stroke does strike, we need to improve treatment and care to help people maximise their recovery. “We also need to provide advice and support to empower survivors to manage their risk of a further event.”
Global health champions in Melbourne tackle Indigenous health Research shows Indigenous people experience poorer health and social outcomes compared to non-Indigenous people in 28 populations around the world. Global Health Alliance Melbourne (GLHAM), a platform that aims to capture Victoria’s health strengths and capabilities, is tackling the disadvantage with a new initiative titled Local to Global. Formed in 2016, GLHAM is based on the highly successful Washington Global Health Alliance and is a testament to Melbourne’s standing as the hub of global health expertise in the Asia-Pacific region. Local to Global, launched by former Victorian Premier John Brumby, will involve an Alliance of member organisations that span nine sectors – client groups, research, education, entrepreneurship, service delivery, advocacy, policy, corporations and philanthropy. The first 10 foundation organisations, including the Australian Red Cross, Save the Children and The Fred Hollows Foundation, share a commitment to creating partnerships across sectors and silos. “Melbourne is a global health leader in clinical care, research and advocacy,” Mr Brumby said. “Together GLHAM partners will discover, maintain and be responsible for a major shift in healthcare, and help close the gap in inequality of healthcare provision in the countries in which our members work, including Indigenous Australia.”
Depression leads cause of ill health Depression is now the leading cause of ill health and disability worldwide, according to the World Health Organization (WHO). Latest figures estimate more than 300 million people currently live with depression, indicating a rise of more than 18% between 2005 and 2015. Despite depression’s growing prevalence, WHO says a lack of support for people with mental disorders, coupled with fear and stigma surrounding the condition, prevents many sufferers from accessing
treatment. WHO Director-General, Dr Margaret Chan, said a year-long campaign to lift the silence on speaking about depression, titled ‘Depression: let’s talk’, would hopefully turn the tide. “These new figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency it deserves.” Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO, said one of the first steps to tackling depression is addressing issues around prejudice and discrimination.“For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery.”
Nurses slam decision to continue with 1% pay cap For the sixth year running, National Health Service (NHS) staff in England, including nurses, have failed to secure adequate remuneration as the government rolls on with its divisive 1% pay cap. The Royal College of Nursing (RCN) condemned the decision, labelling it a further cut to pay in real terms, and a move which will worsen already severe staffing shortages. “This deal is a bitter blow for nursing staff across England,” RCN Chief Executive Janet Davies said.“The nursing profession is rightly held in high regard but kind words don’t pay the bills.” RCN campaigned tirelessly for an aboveinflation pay increase but the continuation of the cap now means pay once again fails to match the rising cost of living. “The government has already cut nursing pay by 14% in real terms – leaving too many struggling and turning to foodbanks and hardship grants,” Ms Davies said. UNISON, the public service union, was equally outraged. “The government insists it values them, but after endless pay freezes and wage caps, they feel taken for granted,” UNISON general secretary Dave Prentis said. “Day after day NHS staff are giving 100% but getting just 1% in return. “Low pay makes it tough for the NHS to hold onto experienced employees and recruit the next generation. Without enough staff, patient care will suffer.”
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H E S TA
International Day of the Midwife and International Nurses Day, celebrated on 5 May and 12 May respectively, are when nurses and midwives are acknowledged for the job that they do and also thanked for the vital care they give to their patients, their patients’ families and each other. Yet while nurses and midwives are good at taking care of others, sometimes they can fall short of taking care of
themselves. When celebrating nurses and midwives during May it is important to take time to acknowledge your own achievements as a nurse and/or a midwife, but also review what you are doing to care for yourself. Applying a few strategies could help you live more fulfilling, productive and happier lives, professionally and personally.
NEED SOME INSPIRATION? WE’VE COME UP WITH SOME TIPS AND STORIES TO MOTIVATE YOU.
Whether you work a run of late/early shifts or nights, shift work can play havoc with your sleeping patterns. While the demands of shift work can make it impossible to get eight hours of sleep a night, experts suggest the quality of sleep rather than the time spent in bed is what is important. According to the Mayo clinic doing the following will give you a better night’s rest. • Don’t go to bed either hungry or completely full as your discomfort might keep you up. Be mindful of nicotine, caffeine and alcohol at night. The stimulating effects of nicotine and
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caffeine take hours to wear off and can wreak havoc on quality sleep. Alcohol can make you feel sleepy at first but can disrupt sleep later in the night. Create a bedtime ritual that you practise every night to tell your body it’s time to wind down. This may include taking a warm bath or shower, reading a book or listening to music. These activities can promote better sleep by easing the transition between wakefulness and drowsiness. Ensure your room is ideal for sleeping such as making sure it is dark, quiet and cool. Room-darkening shades, earplugs, a fan or other devices to create an environment that suits your needs. Make sure your bed, pillow and coverings are most comfortable to you.
International Day of the Midwife and International Nurses Day special A P P S
It’s a well-known fact that yoga can have a positive impact on the body including emotional and physical health as well as disease prevention. “Yoga and meditation are great ways to deal with workplace stress,” says Registered Nurse Jana Hnatova. Jana, who works in the area of anaesthetics in Melbourne, discovered Ashtanga Yoga well over a year ago after she sustained an ankle injury from running. “I came across it quite accidently,” she says. Since then Jana, who now attends yoga classes four times a week, has noticed significant benefits of her practice that have helped her physically and emotionally, at work and in her personal life. This has included relief from ongoing lower back pain, she says. “Standing all day doing anaesthetics I would go home so sore and was getting massages to try and help relive that. “I can honestly say in the past 12 months since practising yoga I haven’t had any troubles [with my lower back].” Besides relieving back pain regular yoga practice is known to lessen musculoskeletal stiffness as well as improve flexibility and posture which can aid in the prevention of work injuries. Prevention of heart disease, reducing blood pressure, controlling weight and strengthening bones to help prevent osteoporosis are also other known benefits. Yoga can also help focus the mind, ease tension, help with concentration, improve energy levels and promote a feeling of calm. “It brings you to the space that you feel more relaxed,” Jana says. According to Jana this can be attributed to connecting with the breath while doing postures, which brings peace. Being more conscious of the breath Jana now applies breathing awareness to stressful situations in her daily life. “When facing a stressful situation I now just stop and think about what I am doing and start breathing then I think ‘oh yeah this is really helping’. I’m much calmer because of it.” Moving from South Australia to Victoria almost 12 months ago on her own, Jana has found yoga invaluable in helping deal with the stress of moving interstate and starting a new job. “I think the reason I stayed in Melbourne was because of yoga. If I hadn’t found this studio I don’t think I would still be here [in Melbourne]. I was considering going home but going to the studio every night helped me to adjust. It has been something to look forward to.” “I think all nurses should try yoga,” says Jana. “It really does take all your worries away.”
Bending, pushing, and lifting are regular movements nurses and midwives perform during a typical shift on the job. Unfortunately, the inherent demands of the profession can also lead to serious back and neck pain and other niggling injuries that impede the ability to work.
KEEP ON TRACK WITH APPS Apps can help you keep on track of your health and wellbeing goals. Here are a few to help you on your way.
HTTP://WWW. THEHABITHUB.COM/ PLATFORM: ANDROID AND COMING IN IOS SOON
Want to create positive new habits to help you accomplish your goals? Do you have trouble keeping track of activities and goals, or reaching them? If so HabitHub could be the app for you. According the description HabitHub is based on Seinfeld’s productivity secret, which involves building habits over long streaks of days. These streaks that you build will motivate you to keep moving forward. The app works by creating a habit, marking the days on the calendar that you perform the habit and then building a chain. The task is to build a long streak of days for the habit you are working on. To help you reach these goals HabitHub lets you set daily reminders and even provides graphs that help you stay motivated along your journey. The manufacturers state that it will take a couple of months to build a solid habit and by being consistent it will work.
National Chair of the Australian Physiotherapy Association’s Occupational Health Group David Hall says injuries to nurses were so common back in the day that the concept of ‘nurses’ back’ emerged as a phenomenon. These days, workplaces are more progressive in implementing training programs and adhering to safe patient handling No Lift policies. Mr Hall, who is also the Director of the Melbourne-based Productive Healthy Workplaces (PHW) Group, which specialises in keeping people fit, healthy, and injury free at work, said one of the biggest challenges nurses face in protecting their health on the job is time. “There can be a difference between what the policies say and how things are actually done on the ground and one of the greatest interactions with those policies is time.”
your stories, our inspiration HESTA_Your stories our inspiration_188x21mm.indd 1 anmf.org.au
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International Day of the Midwife and International Nurses Day special A P P S
Stretching is paramount to avoiding injury and maintaining health in the workplace. A few key simple exercises can help nurses and midwives to keep on top of their health.
Calf Stretches Start with one foot in front of the other (as though walking) with the toes pointing forwards. Lean forward onto a support until a stretch is felt on the calf of the back leg. Hold position with the back knee straight for 20 seconds and then bend the knee of the back leg and hold for a further 20 seconds. Repeat this twice each way.
Standing Back Twist Start by standing with a wide base of support. Cross your arms in front of you. Gently twist your upper body around to the left side as far as comfortable, hold the position momentarily, then twist your upper body around towards the right. Repeat the exercise 10 times in each direction, increasing movement as you go, and ensuring the movement is slow and feels natural.
Shoulder Blade Retractions This exercise helps improve posture by helping switching on the upper back muscles between your shoulder blades. Using a Theraband, stand upright as though standing to attention. Slowly stretch your arms back, rolling your shoulder blades together as you do so. Hold this end position to a count of three. Slowly return to the starting position and repeat 10 times.
Stop, Breath and Think http://www. stopbreathethink.org/ PLATFORM: ANDROID, IOS AND WEB FREE OR PREMIUM $15.49/MONTH
Let’s face it; we all become exhausted, frustrated and overwhelmed from time to time but feeling calm in minutes is possible using the Stop, breath and think app. The app, which is very simple to use, urges you to stop what you are doing and check in with what you are thinking and how you are feeling before encouraging you to practice mindful breathing to create space between your thoughts emotions and reactions. The app then offers specific meditations on your results to broaden perspective and strengthen your force field of peace and calm.
Mr Hall lists lower back pain, neck and shoulder pain, and knee problems as the most common injuries suffered by nurses. He said good manual handling techniques and the willingness to say no and choose a safer way when the task is too difficult are the keys to preventing injury. Being physically flexible and strong are also beneficial. Mr Hall suggests leading an active life and regular exercise such as walking, swimming, Pilates and yoga could prove beneficial to workplace health.
Watch out for fatigue
Nurses are on their feet for most of their shifts and thus endurance and standing tolerance become crucial. Mr Hall implored nurses to take their breaks when available and sit down to rest and give legs a chance to recover. “If they’re working while they’re tired what we’re finding is that all the manual handling techniques that they know and do reasonably well can suffer. In particular they [nurses] can start to keep their legs locked when they’re reaching and doing tasks. “Physiotherapists see a lot of nurses not so much for the big heavy lifts and transfers, because those are the ones they really think about, but for the little things like reaching down to the ground to get a pen or tucking in a sheet in a bed.”
your stories, our inspiration HESTA_Your stories our inspiration_188x21mm.indd 1 18 May 2017 Volume 24, No. 10
12/04/2017 11:52 AM anmf.org.au
INTERNATIONAL DAY OF THE MIDWIFE AND INTERNATIONAL NURSES DAY COMPETITION SHARING YOUR WELLBEING TIPS COULD EARN YOU A BREAK
HESTA is a specialist industry super fund and for almost 30 years we’ve been dedicated to some of the hardest working Australians – people working in health and community services. And, while we’re focused on helping you achieve the best possible retirement in the future, we also want to help you look after yourself now. What better way to do this than to take some time out for yourself to rest and rejuvenate. To celebrate International Day of the Midwife and International Nurses Day the ANMF and HESTA are giving one lucky member the chance to take a well-deserved break with a $1,000 gift voucher from Flight Centre. Your tips may also be published to help others. For your chance to win share with us in 25 words or less what you do for your own wellbeing. Please provide your full name, contact number, the state you live in and your membership number.
— TO ENTER EMAIL US AT: SELFCARE@ANMF.ORG.AU — For Terms and Conditions contact ANMJ on 03 96028511 Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249, Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321.
$1,000 gift voucher from Flight Centre
International Day of the Midwife and International Nurses Day special A P P S
www.myfitnesspal.com/ PLATFORM: IOS AND ANDROID FREE OR PREMIUM PLAN $9.99/MONTH
A great way to keep on track of diet and exercise goals is to use apps. Studies have shown people who use apps are more likely to keep on top of their health and fitness goals than non-users. There are thousands of diet and fitness apps available, but one that has been spruiked as the best in the industry is MyFitnessPal.
It’s well known that the demands of shift work make it hard to maintain a healthy diet. Shift work can significantly impact on nutritional intake of balanced protein, fats and carbohydrates. According to the Australian Journal of Advanced Nursing, shift work causes poor dietary intake, smoking and weight gain, thereby leading to numerous gastrointestinal issues. The Human Gastrointestinal Tract or (GIT) has an enormous impact on our health. The ‘Gut Flora’, officially known as Microbiota, encompasses over 70% of our immune system. It performs a multitude of tasks including regulating the toxic by-products of digestion, pathogenic bacteria, carcinogenic toxins and the cleaning and absorption of nutrients. Many diseases and conditions have been implicated in poor gut health, ranging from allergic manifestations, inflammatory bowel disease (IBD), irritable bowel disease (IBS), colon cancer and obesity. A number of other causes, implicated in an imbalance of gut health, include antibiotics and particular medications. An unhealthy diet of trans fats, sugar, preservatives, artificial sweeteners, wheat and gluten not only lead to slow digestion and constipation, but can also be implicated in insulin resistance and weight gain. The state of your microbiome can affect what
kind of foods you crave, when you feel hungry, and how your food is metabolised. Stabilising your microbiome for better health is achievable (even for shift workers) through small changes in your diet. Rather than coffee and biscuits, or take away food on the way home, a small handful of blueberries and yoghurt may help sustain long shifts, while a bowl of homemade soup, with gut healing bone broth, can be easily made on a day off and frozen in order to package up and take to work. Eating whole foods, including natural sources of probiotics and prebiotics, will help feed the good bacteria and stave of cravings and hunger pangs (generally the cause of poor snacking). Great sources of probiotics are fermented foods such as sauerkraut; kimchi and kefir, while good sources of prebiotics include asparagus, leeks, garlic, onion, tomatoes and radishes. Our gut microbiota are delicate and need time to heal, especially if they have been abused through continuous poor diet and/or medication. The best way to assist this process is to stick to a healthy diet with some of the above foods included, and reduce the amount of processed food and alcohol that potentially destroy good bacteria. Finally, while difficult for shift workers, sleep is an amazing way to recuperate those damaged microbiome, so making sure that a regular pattern of sleep is maintained where possible can’t be underestimated.
The easy to navigate app, helps to determine your fitness and dietary goals and then helps you to keep on track by counting the number of calories consumed and expended through exercise. The app can track all major nutrients including calories, fat, protein, carbs, sugar, cholesterol as well as gives insights into where they are coming from and how to make healthier choices.
your stories, our inspiration HESTA_Your stories our inspiration_188x21mm.indd 1 20 May 2017 Volume 24, No. 10
12/04/2017 11:52 AM anmf.org.au
Andrew McCarthy Federal Industrial Officer
In February 2017, the Fair Work Commission (FWC) handed down a decision which cut penalty rates for employees in the retail, hospitality and fast food industries. In particular, it cut the level of penalty rates for working on Sundays and public holidays by 25% to 50%. While recognising that the cuts would cause hardship to some employees, the FWC justified the cuts on the basis that: • there are likely to be some positive employment effects from cuts to penalty rates, although it is difficult to quantify the precise effect. In other words, the reduced labour costs to employers will supposedly lead to employers hiring more staff and opening during hours they would not otherwise open; • deterring employers from employing workers on Sundays and public holidays is no longer a relevant consideration when setting penalty rates; • consumer expectations have changed over time. The decision arose out of applications by employer groups to reduce penalty rates in the award safety net in particular industries. These applications were just the latest in a long line of attempts by employers to reduce penalty rates. On several previous occasions, the employer arguments were rejected due to a lack of evidence however this time were partially accepted despite ample evidence demonstrating little link between wages and employment levels. At the time of writing, the FWC was determining when the cuts would commence including whether they should be phased in gradually. The Prime Minister and federal government, after initially trying to avoid the issue, later announced it supported the cuts. The decision has the potential to affect up to 680,000 employees in the affected industries, with cuts to income for individual employees of up to $3,500 per year. The ANMF is concerned that the decision could flow on to other industries. The FWC stated that its decision was confined to the industries in question, and largely based on particular circumstances of those industries which distinguish
them from other industries. Legal advice by law firm Maurice Blackburn released to the media following the decision however has noted that several of the reasons given for the decision could equally apply to other industries, including the health and aged care industries. For example, if it is accepted that employment benefits may flow from cuts to wages, then there is little difficulty in applying the same argument to penalty rates in other industries, and even to wages generally.
FOR EXAMPLE, IF IT IS ACCEPTED THAT EMPLOYMENT BENEFITS MAY FLOW FROM CUTS TO WAGES, THEN THERE IS LITTLE DIFFICULTY IN APPLYING THE SAME ARGUMENT TO PENALTY RATES IN OTHER INDUSTRIES, AND EVEN TO WAGES GENERALLY. More broadly, the decision shows that penalty rates can be reduced even where the FWC accepts that there will be significant negative effects on the income of many employees. For nurses, any future reduction in penalty rates could reduce take home pay significantly because penalty rates contribute a significant proportion of income for many nurses. Soon after the decision Sonic Health, a primary healthcare employer, proposed the reduction of Sunday penalty rates by 25% during negotiations with its nurses for a new enterprise agreement before backtracking after media publicity.
The cuts, and the federal government support of them, comes during the same period as the federal government has been attempting to pass a Bill significantly cutting company tax, again based on the dubious argument that the extra cash accruing to businesses will somehow lead to more employment. Decreased government revenue from tax cuts will in turn undoubtedly lead to calls at a later date for cuts to spending, usually in areas of health and education and social security, on the basis of a claimed ‘budget crisis’. Similarly, recent employer group and government submissions to the FWC’s annual review of minimum wages urge no or minimal increases, on the basis that an increase would impact employment. This argument that ‘now is not the right time for an increase’ is predictably trotted out every year and the ‘right time’ for an increase is strangely never specified. What all this leads to is heightened inequality, corporate greed and a sense that enough is never enough. What unions and workers fought for and obtained decades ago, like penalty rates, is constantly under attack and entitlements cannot be taken for granted and have to be fought for all over again. The federal Opposition and Greens at the time of writing had introduced a Bill into federal Parliament in an attempt to stop the decision taking effect. Several of the crossbench senators who had initially supported the decision (Nick Xenophon Team, One Nation, Derryn Hinch) quickly changed their tune when they realised the widespread opposition to the decision in the community. The Bill is however unlikely to pass due to government control of the House of Representatives.
May 2017 Volume 24, No. 10 21
DIABETES: A TICKING TIME BOMB Diabetes is fast becoming one of the biggest epidemics in the world. Nowhere is this more apparent than in Australia where approximately 1 million Australians have been diagnosed with the disease. Natalie Dragon investigates why Diabetes has become so prevalent and what is being done about it.
iabetes Nurse Practitioner (NP) Giuliana Murfet remembers doing bladder catheterisation for preventing UTI in diabetes patients with autonomic neuropathy. “We were accustomed to those things we don’t see anymore. When I first started every third person had an amputation, many children had severe hypos and fitting with coma.” The growth in diabetes, along with progress in care has been phenomenal, says Giuliana who works in rural Tasmania.
surgery. The NP role in diabetes is about improving patient flow and has enabled increased access to vulnerable populations. “In Tasmania, the diabetes NPs target those with mental health issues, pregnancy complicated by diabetes, those with cancer and those in high risk foot clinics. We definitely have seen a reduction in the number of amputations.”
“A lot of that growth is in primary care in general practice looking at early diagnosis and management – certainly we are doing a lot better there.”
Giuliana has been Director of the Board of the Australian Diabetes Educators Association (ADEA) and a member of the government’s Tasmanian Lead Clinicians Group. “Whether it’s paediatrics, pregnancy, high risk foot, obesity, I keep trying to find ways of improving care in the region for people with diabetes.
One of the first four NPs in Tasmania, Giuliana was endorsed in 2010. With almost 10 years’ experience she runs multiple clinics – Type 1, pregnancy, insulin pumps, and a new obesity clinic, which includes referral for bariatric
“How can I develop a model of care that is evidence based, multidisciplinary, based on national guidelines and incorporate those people so they are getting the same care as that in the finest urban, metropolitan diabetes centre?”
DIABETES NURSE PRACTITIONER GIULIANA MURFET, PHOTOGRAPHER: DALE CUMMING PHOTOGRAPHY
“We have a long way to go to have any effect nationally on what is arguably the biggest health epidemic to affect the world.” — DIABETES AUSTRALIA CEO ADJUNCT PROFESSOR GREG JOHNSON
DIABETES NURSE PRACTITIONER GIULIANA MURFET, PHOTOGRAPHER: DALE CUMMING PHOTOGRAPHY
Diabetes Australia CEO Adjunct Professor Greg Johnson says the global impact of diabetes is staggering. “We have a long way to go to have any effect nationally on what is arguably the biggest health epidemic to affect the world.” There are nearly 1.3 million Australians who have voluntarily registered as having diabetes and there is an unknown undiagnosed and silent Type 2 diabetes population estimated at 250,000-400,000. “When we put these together the current number of Australians with diabetes is around 1.7 million people right now,” says Professor Johnson. “In just over 12 months, there were over 105,000 new cases of diabetes – that’s 280 people every day diagnosed with diabetes – and it’s continuing to grow.”
One size doesn’t fit all
“What we are seeing in Australia is being seen in other countries which is a massive change in lifestyle and the risk profile,” says Professor Johnson. However there is not ‘one thing’ for all diabetes, he says. “It’s often over-simplified. Type 2 diabetes is due to obesity which is a disservice to the complexity of this serious epidemic – that people with Type 2 diabetes are people who eat too much and are largely overweight, this simplifies a complex epidemic that affects all groups of Australians. There are many more people in their 20s getting Type 2 diabetes, says Professor Johnson. “Many in adolescence and childhood getting Type 2 24 May 2017 Volume 24, No. 10
diabetes that was unheard of 15 years ago. It is much more complex. “Yes, vast numbers of Australians buy takeaway as the norm because it’s cheap and available but this notion of choice – some people do not have choice on the true economies of scale. “For the poor and more socially disadvantaged they are more likely to have Type 2 diabetes. The price of a 2 litre bottle of sugary drink is cheaper and gets to rural areas before an apple or banana. There are a lot of social drivers where people do not have a choice in terms of supply and genetics – there is a huge population with high risk Type 2 diabetes independent of other factors.”
National Diabetes Strategy
The federal government released a National Diabetes Strategy in November 2015, which sets out key goals and potential areas for action to address the outcomes for people with diabetes. Yet response has been slow and frustrating, says Professor Johnson. “In some areas there have been some specific decisions but we haven’t seen serious implementation of the national strategy. “If we step back and assess the size and scale of the issue, the response at a federal, state and territory and community response is not big enough and almost certainly diabetes will get bigger and worse and more suffering and cost as a community will ensue.”
“Physical inactivity is by far the most dominant risk factor for obesity, with an estimated prevalence of 85% in the Australian adult population. It’s hard to imagine any other health risk factor reaching a prevalence of 85%, yet our healthcare system and political priorities have not mobilised to find an effective solution, or at least try to test some solutions.” — ASSOCIATE PROFESSOR EMMANUEL STAMATAKIS, CHARLES PERKINS CENTRE & SCHOOL OF PUBLIC HEALTH
A comprehensive response by government – anmf.org.au
FEATURE federal and state and territory – to all sign up to invest more to prevent diabetes is urgently needed, Professor Johnson says. “We need more states and territories to partner with the Commonwealth to deliver comprehensive diabetes-prevention initiatives that link with a national framework and stronger national public health policies.
“They often then book in for a one to one for more individual care planning on their BSL monitoring, more detail about their medications and general management of their health.”
“We need to prevent more people with Type 2 diabetes with a range of things more public health initiatives such as the unhealthy food supply, a levy on sugary drinks, and targeted diabetes programs across the country to make a difference.”
Nurse led intervention
As the numbers of people with diabetes increases, so do the healthcare costs. Research published in BMJ Journals estimates the indirect economic cost of rising numbers measured in ‘lost productive life years’ is set to hit $2.9 billion a year by 2030, up from $2.1 billion in 2015. The research was based on population growth and disease trend data of those aged 45-64 years by 2030. It projected costs of lost income, tax revenue, GDP, ‘productive life years’ and rising welfare costs. “People can glaze over the costs but to put it more meaningfully one of the things that staggers people is to break it down. In Australia diabetes impacts in serious ways – there are 4,000 amputations a year due to diabetes and the vast majority are preventable – 85% are preventable,” says Professor Johnson.
Worldwide there is good evidence to prevent up to 60% of Type 2 diabetes. Nurse and diabetes educator at Diabetes SA Daniela Nash says prevention is key. “We work with people with pre-diabetes to prevent them getting a diagnosis. We get people to ‘check out the numbers’ – of what their cholesterol is, what their blood pressure is. Ask the doctor what the numbers actually are. Are they better, stable or worse?” Daniela sees the role of those who work in diabetes as empowering each person to knowledge and self-management. Dieticians and nutritionists at Diabetes SA take small groups of up to eight clients with diabetes on supermarket tours. “It’s looking at the content on the labels empowering people to make healthier choices for themselves,” Daniela says. “Looking for low salt and fat content – a fibre content of 5g or sodium less than 200g or 200-400g.” Daniela presents in a three-week Living Well with Diabetes series for people with Type 2 diabetes. “I see people in week three of the series come from knowing very little to feeling like they know much more about their condition and are better equipped with that knowledge. anmf.org.au
“My mantra is to equip them to control their diabetes rather than the diabetes taking control of them.” A nurse-led education program in Queensland is helping women with Type 2 diabetes manage their condition. Women aged 45-65 with Type 2 diabetes undertake an evidence based e-health 12 week lifestyle intervention. Nurses provide advice on sleep, diet, exercise, alcohol intake and stress levels.
1 MILLION AUSTRALIANS AN ESTIMATED 1 MILLION PEOPLE AGED TWO OR OVER WITH DIAGNOSED DIABETES IN AUSTRALIA
“The fact that it is nurse led makes a difference; it gives the program a lot of credibility and we have seen the results – women have found it empowering and it’s given them control,” Griffith University’s Janine Porter-Steele says. The prime focus is on nutrition, Janine says. “With Type 2 diabetes we want to decrease the risk of chronic disease and look at waist circumference of less than 88cm which puts these women at increased risk of other disease such as heart disease, cancer of the bowel and breast.” However the program is much broader than addressing a physical ailment, says Janine. “We get them to goal set. What we are trying to do is to promote self-efficacy to make changes. If we can increase their self-efficacy to exercise and keep exercising it helps improve their resources and motivation.” The women in the program have a Facebook group in which they stay connected, says Janine. “They are still getting targeted peer support.”
A comprehensive report: Globesity: tackling the world’s obesity pandemic shows obesity rates have more than doubled since 1980, with 13% of adults worldwide classified as obese and nearly 40% as overweight. Current figures show around two thirds of Australian adults have a body mass index (BMI) greater than 25. Obesity is predicted to reach 35% by 2025 – up from the current 28%. Of even more concern is the prevalence of severe obesity. By 2025, 13% or one in eight adults will have a BMI of over 35 – up from 5% in 1995 and 9% in 2014/15. It is estimated more than 27% of Australian children are overweight or obese. In 1995, around one in 10 young adults were obese, but in 2014 it was closer to one in five. The World Health Organization’s (WHO) targets to maintain 2010 levels of overweight and obese people will not be met in Australia, according to joint modelling.
SUGAR TAX A Grattan Institute report calls for an excise tax to help recoup some of the costs of obesity to the Australian community. An excise tax of 40 cents per 100 grams of sugar on all non-alcoholic, water-based drinks that contain added sugar. It would increase the price of a two-litre bottle of soft drink by about 80 cents and raise about $500 million a year. This would generate a fall of about 15% in the consumption of sugar-sweetened drinks as consumers switched to water and other drinks not subjected to the new tax. Grattan Institute Health Program Director Stephen Duckett says the tax offers twin benefits: it will reduce the number of people who become obese and it will ensure fewer taxpayer dollars have to be spent on the damage done by obesity. Countries that already have or are planning to introduce a tax on soft drinks include France, Belgium, Hungary, Finland, Chile, the United Kingdom, Ireland, South Africa and parts of the United States. —
May 2017 Volume 24, No. 10 25
Diabetes and emotional health handbook Health professionals are urged to consider screening for the emotional impacts of diabetes in every health consultation. Diabetes and emotional health: a handbook for health professionals supporting adults with type 1 or type 2 diabetes is free to download. www.ndss. com.au/online-resources-forhealth-professionals
Statistics show Type 2 diabetes has a greater impact on the disadvantaged. Those in lower socioeconomic areas, people in rural and remote areas and Aboriginal and Torres Strait Islanders are all more likely to develop Type 2 diabetes and more likely to develop serious complications.
The incidence of diabetes in Indigenous Australians is high with rates as high as 26% - six times higher than the general Australian population. cohealth Community Health Nurse in the Aboriginal and Torres Strait Islander Health team in Melbourne’s west, Sally Berger, says her clients have complex needs with multiple chronic diseases. cohealth runs a bulk-billed endocrinology service in Braybrook which was set up in 2011. “Research showed there was very little in endocrinology services in the west yet the stats showed a really high prevalence of diabetes,” Sally says. The cohealth Aboriginal and Torres Strait Islander
Platypus venom to treat diabetes
Health team have a Foodshare program which supplies free nutritious food every Thursday to the community. “Mapping in the west showed access to nutritious food was poor. There were a lot of takeaway shops and so there is an emphasis on fresh food and growing vegetables.” Educational events and expert talkers tap into Foodshare and other event days to promote key healthy lifestyle and prevention messages. Sally and an endocrinologist run a monthly Diabetes clinic for Aboriginal and Torres Strait Islander clients and much of Sally’s work is care coordination including linking community members to dietetic, podiatry, optometry and specialist services. “It’s very specific to Aboriginal and Torres Strait Islander clients’ needs. Those with complex needs such as with housing, Centrelink, disability support often need assistance, support and follow up.” Indepth education and support of clients with preexisting diabetes to self-manage complications is important and targeting prevention of diabetes through community engagement is a major part of the role.
“In some respects with childhood diabetes it’s easier as we have good data and we know how many children in WA have diabetes. That’s not the case with adult diabetes and it’s something services are working on.”
The platypus and the echidna could pave the way for new treatments for type 2 diabetes in humans. SA researchers found the same hormone produced in the guts of animals and humans to regulate blood glucose is produced in the venom of the platypus and echidna. Stable molecules in the venom may be potential type 2 diabetes treatments.
— MARK SHAH
“Ensuring that clients have access to a culturally responsive service system is essential to improve health outcomes.” —
Breath-testing for ketones A simple hand-held breath testing device could mean an end to finger-prick blood tests for diabetes patients. The technology similar to an alcohol breathalyser measures elevated ketone levels. The sensing technique is two times more sensitive than the existing finger prick approach, according to University of Sydney scientists.
SALLY BERGER PICTURED WITH TANYA DRUCE ABORIGINAL PRACTICE LEAD AT COHEALTH
“…Even the most sound person has to manage this disease which can require three to six injections a day and it’s a challenge and we are conscious of that.” — MARGIE VITANZA
26 May 2017 Volume 24, No. 10
FEATURE Advocacy is key says Sally. “Ensuring that clients have access to a culturally responsive service system is essential to improve health outcomes.”
Researchers have found that rates of gestational diabetes in some regional and remote areas in Western Australia are two to three times higher than other areas of the state.
“The big concerns with this age group is that they are lost to follow up – they are comfortable with paediatric services and there is the uncertainty with adult care and it can be quite daunting,” Margie says The nurse transition clinic shows young adults what adult care looks like and helps with the adjustment.
Clinical co-lead of WA’s Diabetes and Endocrine Health Network Mark Shah says the huge increase in gestational diabetes seen across the country is of concern on several levels.
“We cannot underestimate the impact it has on a person - even the most sound person has to manage this disease which can require three to six injections a day and it’s a challenge and we are conscious of that,” Margie says.
“Children are being exposed to high levels of glucose in the womb, leading to increased risk of congenital malformation, risks to the mother in pregnancy and later on risks to mother developing Type 2 diabetes and child developing diabetes themselves.”
There is a focus on young adult selfmanagement. “Literature suggests establishing rapport with young children and then handing over the reins gently to them for self-managed own care as they transition into adulthood,” says Margie.
The gestational diabetes rate across Australia was up by 16% in 2016, says Mark. “Obstetric services and diabetes services are struggling to cope with the number of women with gestational diabetes.”
“I see when the penny drops for them. Some are flippant, others are driven and know exactly what they want. You have to be really flexible and non-judgemental; it is a transient point in their life. They go from immaturity to maturity and you are helping guide them.”
Mark is a diabetes nurse practitioner at the Princess Margaret Hospital which is WA’s only paediatric tertiary centre. This provides WA with data on almost 100% of children with Type 1 diabetes and about 92% of children with Type 2 diabetes. “We do have a state-wide model of care with established health networks on policy and guidelines for children with diabetes. “In some respects with childhood diabetes it’s easier as we have good data and we know how many children in WA have diabetes. That’s not the case with adult diabetes and it’s something services are working on with health networks to develop better data and it is something for all states and the Commonwealth to ensure we have data to improve care.”
ADEA CEO Joanne Ramadge says there will need to be better use of the resources used in a much more strategic way.
AROUND 85% HAVE TYPE 2 DIABETES AND 12% HAVE TYPE 1 DIABETES
1 IN 20 PREGNANCIES GESTATIONAL DIABETES AFFECTS ABOUT ONE IN 20 PREGNANCIES EACH YEAR
280 ONE PERSON EVERY FIVE MINUTES DEVELOPS DIABETES - 280 AUSTRALIANS A DAY
Better use of existing and new infrastructure, increased use of technology, and working with people with diabetes to focus on selfmanagement. “Having good systems in place is really key for management of all chronic disease, not just diabetes. Diabetes is a really important chronic disease and overlaps with other chronic diseases, not in isolation – it’s really important health professionals working in their areas have collaboration.” Dr Ramadge wants to see increased standard knowledge base of diabetes for all health professionals. “All health professionals have a role in providing and working with people with diabetes, who may be at risk of diabetes and who may have pre-diabetes. All health professionals need to have an understanding about diabetes.”
“There are still many people with undiagnosed diabetes in Australia. Testing not only detects the disease; it also identifies people without diabetes who are at high risk of developing it. Even modest changes like eating healthier, increasing physical activity and losing a small amount of weight can help reduce the chance of developing diabetes by half.”
“In 2016, paediatricians see children still in primary school who have Type 2 diabetes, who have abnormal liver function, who require knee or hip surgery or who are on CPAP for their sleep apnoea – just because they have obesity. Why can’t we regulate marketing of junk foods to children, have easy-to-read food labelling, have a soft drink tax, provide affordable public transport for all and ensure access to green space and pedestrian-friendly spaces?”
PROFESSOR STEPHEN COLAGIURI, CO-DIRECTOR, WORLD HEALTH ORGANIZATION COLLABORATING CENTRE ON PHYSICAL ACTIVITY, NUTRITION AND OBESITY
PROFESSOR OF CHILD & ADOLESCENT HEALTH LOUISE BAUER, UNIVERSITY OF SYDNEY
Nurse and CDE Margie Vitanza specialises in care for young adults aged 16-25 years who are transitioning from paediatric to adult services. The dedicated nurse transition clinic was established only 12 months ago at the Mater Young Adult Health Centre in Brisbane.
85% TYPE 2
May 2017 Volume 24, No. 10 27
BIRTH OF A MIDWIFE By Jo Jones Like many experienced midwives and nurses I have a plethora of experience spanning over 13 years. I completed my nursing degree in my home town of Derry City, Northern Ireland before completing my Post Graduate Degree in Midwifery at Queens University, Belfast.
Ever since I can remember I have always wanted to be a nurse. My mum still has a photograph of me aged three years of age in a nursing uniform, which was all I ever wished for from Santa. I made it my life ambition to become a nurse and even though it was difficult at times I persevered as all I wanted to do was help others. My grandfather played a key role in this as he always encouraged me and helped me to believe in myself. On completion of my Nursing Degree I wanted to work in the Emergency Department (ED). The emergency setting seemed so exciting and I believed this was where I could really make a difference. After about two years working in an ED in Northern Ireland, dealing with all kinds of trauma victims from gunshot wounds to resuscitation of patients, my confidence grew, as did my skills and knowledge. Nothing ever seemed to faze me. Then one of the most memorable experiences of my life occurred. I remember it like it was yesterday. It happened on a very cold winter’s night in December. It was the early hours of a Sunday morning and there was snow on the ground outside, there was not just a chill in the air but a slight eeriness in the department. Then the ‘red phone’ rang. Dubbed the ‘red phone’ due to its colour was the Ambulance phone and on this night I received a call that “there was two ambulances en route, one with a newborn baby requiring resuscitation”. 28 May 2017 Volume 24, No. 10
I had dealt with all sorts of emergencies at this time, and had experience in dealing with fitting children, but never a newborn. All kinds of thoughts went through my head mostly relating to the condition of this newborn infant, and why there was a second ambulance required.
AFTER ABOUT TWO YEARS WORKING IN AN ED IN NORTHERN IRELAND, DEALING WITH ALL KINDS OF TRAUMA VICTIMS FROM GUNSHOT WOUNDS TO RESUSCITATION OF PATIENTS, MY CONFIDENCE GREW, AS DID MY SKILLS AND KNOWLEDGE. NOTHING EVER SEEMED TO FAZE ME. I did not have any specific training on infants and deliberated on how to set up for such a resuscitation. I turned on the oxygen at the wall with a small neonatal mask attached and then I searched for the ‘huggy bear’ warming blanket which was nowhere to be found so had the adult size one on standby. I waited anxiously at the door, and as I wasn’t sure of what emergency was coming through, I alerted other nursing staff members, the paediatric team and the medical team and hoped that someone would come along that would take charge of the emergency. Then the ambulance pulled up outside, sirens and lights on high alert. The ambulance doors swung open and in came one of
the ambulance officers who was carrying a newborn infant that appeared to be whitish blue in colour and was not moving. At this point none of the teams I had paged had arrived. The ambulance officer put this baby on the resuscitation bed and then looked at me as to say do something. I thought if this was an adult what I would do. I immediately administered oxygen, and turned on the ‘huggy bear’ warmer and wrapped this newborn inside it, I heard the baby cry and it was the most amazing feeling I have ever experienced. With that the baby’s mother, a 16 year old girl, came through the door on another stretcher with her mum by her side. She was crying and in absolute shock. Of course the paediatric team then arrived including a midwife with an incubator at that moment. The midwife gently lifted the baby and placed him in the incubator next to his mum. Prior to their arrival in ED, the girl had given birth to her baby boy on the bathroom floor at home. Delivered by her mother, the teenage girl had concealed the entire pregnancy from her. I remembered thinking that the midwife was so calm through the event and although my experience to date was fantastic in the adult resuscitation situation, this was definitely new territory and something I wished to pursue. It was there and then that I decided to become a Midwife. anmf.org.au
Critical Second has just released V3 Complete Nurse App • Easy CPD section e-mail to yourself or anyone anytime • IVT, Pt Assessment, Math conversions, ECG translations • Interactive Drip Rate calculator • Poo, Pain, Blood Gas ... everything you need • So much more ... With thanks to HESTA for helping us make this possible. If updating, e-mail your CPD to yourself. The update will clear the file.
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HONESTY AND INTEGRITY IN AUTHORSHIP ATTRIBUTION Megan-Jane Johnstone Megan-Jane Johnstone
References References Kennedy, M.S., Barnsteiner J., & Daly, J. 2014. Honorary and ghost authorship in nursing publications. Journal of Nursing Scholarship, 46(6): 416-422. Kornhaber, R.A., McLean, L.M., & Baber, R.J. 2015. Ongoing ethical issues concerning authorship in biomedical journals: an integrative review. International Journal of Nanomedicine, 10: 4837-4846. Marušić, A., Bošnjak, L., & Jerončić, A. 2011. A systematic review of research on the meaning, ethics and practices of authorship across scholarly disciplines. PLoS ONE, 6 (9): e23477. doi:10.1371/journal. pone.0023477. Street, J.M., Rogers, W.A., Israel, M. & Braunack-Mayer, A.UJ. 2010. Credit where credit is due? Regulation, research integrity and the attribution of authorship in the health sciences. Social Science & Medicine, 70: 14581465.
Megan-Jane Johnstone is a retired Professor of Nursing who now writes as an independent scholar. Internationally renowned for her work, she has published extensively on the subject of nursing ethics and is the author of the widely acclaimed book Bioethics: A Nursing Perspective.
The publication of peer reviewed journal articles, book chapters, and books have become an important hallmark of the professional, academic, social and scientific credibility of the nursing profession. Since the first nursing journals were published in the late 1880s, nursing scholarship has grown exponentially and, in an era involving the continual assessment of research excellence in the university sector, has seen the discipline of nursing ranked at or above world class standard. The credibility that nursing publications has earned the profession is, however, under threat due to inappropriate, dubious and frankly dishonest authorship attribution practices (Kennedy et al. 2014). Notable among the practices concerned are: inappropriately bestowing ‘honorary’ authorship (also called gift, guest, courtesy, or prestige authorship) on a person who has not made a significant and substantive contribution to a work, and failing to attribute authorship to a person (a ‘ghost author’) who has made a significant and substantive contribution to a work. In one study involving a survey of 10 leading peer-reviewed nursing journals the prevalence of inappropriate authorship attributions was estimated to be 42% for honorary authors and 27.6% for ghost authors (Kennedy et al. 2014).
A question of nursing ethics
Journal editors have long been concerned that the names appearing in the by-line of an article ‘do not reflect its true authorship’ (Street et al. 2010). Here two key questions rise: What constitutes ‘appropriate’ authorship attribution? And why, if at all, is this an important ethical issue for the nursing profession?
Undeserving authorship attribution
Today most leading biomedical and health science journals require compliance with the International Committee of Medical Journal Editors (ICMJE) guideline Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals www.icmje.org.
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The ICMJE guideline recommends that authorship be based on the following four criteria- all of which must be met by a person claiming or being attributed authorship of a work: • Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; • Drafting the work or revising it critically for important intellectual content; • Final approval of the version to be published; and, • Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved www.icmje.org
WHAT CONSTITUTES ‘APPROPRIATE’ AUTHORSHIP ATTRIBUTION? AND WHY, IF AT ALL, IS THIS AN IMPORTANT ETHICAL ISSUE FOR THE NURSING PROFESSION? In addition, the ICMJE guide makes clear that an author “should be able to identify which co-authors are responsible for specific other parts of the work”. It also clarifies that those who do not meet all four criteria, but who have nonetheless made a contribution in some way should be acknowledged, ie. attributed with ‘contributorship’. Most university authorship procedures and codes for the responsible conduct of research and the dissemination of research findings require compliance with the ICMJE or similar criteria. Even so, studies suggest that despite not meeting all or even any of the ICMJE criteria, undeserving individuals are still being named as authors in the bylines of journal articles. In one systematic review it was suggested that up to 63% of authors failed to satisfy the ICMJE criteria and that authorship misconduct was around 10-times greater than the 2% prevalence in research misconduct (Marušić et al. 2011).
Drivers of dishonesty
Various reasons have been advanced for why undeserving authorships are bestowed on individuals and why a person might misattribute, misrepresent, misappropriate, distort, falsify, and over state their own contribution to a work. One reason is that even a gross violation of the ICMJE guideline rarely attracts attention unless it is part of a larger review of research misconduct despite involving fabrication, falsification and plagiarism, misattribution tends to be treated as a ‘mere misdemeanor’ rather than serious academic misconduct (Street et al. 2010). A second reason relates to the culture and internal politics of academic units where senior or supervising faculty place more value on the number of publications listed in their curriculum vitae, rather than on their actual substantive contribution to a work. This stance can be so entrenched in a unit’s culture that it is near impossible for junior researchers, faculty subordinates, students and honest peers to challenge it (Kornhaber et al 2015). A third reason relates to the lack of infrastructure and compliance training in organisations to ensure that author credit is not inappropriately assigned. Thus faculty and students are either unaware of the guidelines for authorship attribution, are aware but choose to ignore them, or are aware and accept the criteria but interpret them so loosely as to justify attribution even for the smallest activity eg. merely reading and approving a manuscript for submission (Kornhaber et al. 2015; Street et al. 2010).
Why an ethical issue
A publication list can be taken as a measure of a nurse’s professional achievement and used to support job applications, promotion, tenure and one’s standing in the profession. The inappropriate attribution of authorship is thus a serious issue. Not only is it unfair to those who have done the work, but it breaches professional integrity and enables false credentialing to occur. This, in turn, risks bringing into question the credibility of the profession and its hard-won reputation as a morally accountable and responsible entity. This issue cannot be overlooked and must be given the critical attention it needs before irrevocable damage is done.
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TEN TIPS FOR DRESSING AND SECUREMENT OF IV DEVICE WOUNDS Claire Rickard, Amanda Ullman, Tricia Kleidon, Nicole Marsh Nurses insert and care for more than two billion intravascular (IV) devices globally each year. A wound is created for each IV insertion, and the wound cannot heal while the IV remains.
Usually, millions of microorganisms live on our skin and cause no harm. However insertion of an IV allows these microorganisms to be directly pushed into the blood, or to ‘crawl’ up the device body while the IV is in place. Devastating infections, organ failure and death can occur. Evidence based nursing is vital to prevent complications associated with IV device wounds. Here are ten ways to ensure your patient stays safe and comfortable, regardless of whether their IV is a peripheral or central venous catheter, peripherally inserted central catheters, totally implanted venous port, arterial, umbilical, or dialysis catheters. We’re not going to mention hand hygiene though as we know that you know hand hygiene is vital before every IV procedure. Clip (don’t shave) visible hair before device insertion Hair and dressings don’t mix. A hairy arm or chest prevents good contact 32 May 2017 Volume 24, No. 10
of dressing adhesive with the skin. That’s bad news as the dressing will become loose quicker, water or body fluids may enter the wound, and an extra dressing replacement will be needed. It also means increased pain or even a skin tear when the dressing is removed. Ouch! Of course, use a single-use disposable clipper head, or sterile scissors (not a razor), and trim the entire rectangular/other area that will be covered by the dressing. Do this before skin decontamination. Jugular catheters in men can be an ongoing problem from rapid beard growth ‘pushing’ the dressing away from the skin - even taking the line with it. Inserters can ‘tunnel’ (yes just like in Hickman lines) jugular catheters to exit the skin lower on the neck, rather than directly over the vein puncture, to avoid the beard area. Ensure the skin is clean and decontaminated properly before inserting the device First, clean off any moisturisers with soap and water, and adhesive residue
with medical adhesive remover (eg. Remove). Then apply antiseptic solution to reduce the number of microorganisms on the skin. Use single-use products, as bottles can become contaminated. Chlorhexidine (>0.5% concentration) in 70% alcohol is recommended (Moureau, 2013), as alcohol has an immediate effect and dries quickly, but chlorhexidine has ongoing antimicrobial action for 7-10 days – used together they also kill a wider variety of microorganisms. For patients sensitive to chlorhexidine, consider tincture of iodine, povidoneiodine, or 70% alcohol (Gorski et al. 2016). For really delicate skin, consider 70% alcohol to clean, remove this with sterile saline, then 0.5% chlorhexidine in aqueous solution. Your pharmacist can import octenidine through the TGA’s Special Access Scheme. Whichever kind of decontamination product you use, be patient - wait for the antiseptic to air dry, before applying the dressing. Dressings placed on moist skin are the true cause of many wrongly
References Bugden, S., K. Shean, M. Scott, G. Mihala, S. Clark, C. Johnstone, J. F. Fraser and C. M. Rickard. 2016. Skin glue reduces the failure rate of emergency department-inserted peripheral intravenous catheters: a randomized controlled trial. Annals of Emergency Medicine early on-line(68): 2. Gorski, L., L. Hadaway, M. E. Hagle, M. McGoldrick, M. Orr and D. Doellman. 2016. Infusion Therapy Standards of Practice. Journal of Infusion Nursing 39(Supp1): S1-S159. Marsh, N., J. Webster, G. Mihala and C. M. Rickard. 2015. Devices and dressings to secure peripheral venous catheters to prevent complications (Review). Cochrane Database Syst Rev(6): CD011070.
CLINICAL UPDATE called ‘dressing allergies’ where skin becomes red, painful and/or itchy. Apply a sterile dressing Dressings can be transparent plastic type, or sterile gauze used with good quality, preferably sterile, tape; but they must be sterile (Marsh et al. 2015; Ullman et al. 2015). Choose a dressing that fits the anatomical location you are applying it. If the patient is sweating or oozing, plastic dressings will not stick well, and sterile gauze with sterile tape is a better choice. While non-sterile paper tape seems to be everywhere in hospitals, it’s not ideal as it adheres poorly, is rough on skin, and non-sterile. Better quality tapes provide stronger, gentler adherance to skin and stay in place longer. Sterile tape should be sought, espcially if placed close to the wound (ask your IV-starter kit provider to include sterilised tape). Try silicone dressings and tapes for patients whose skin may tear or is
irritated. Don’t compromise your sterile dressing by placing nonsterile foam under the hub to reduce pressure, or use non sterile tape under the dressing - other sterile foam and tape are available. Patients with poor skin benefit from skin protectant barrier solution applied before the dressing – of course let this dry before applying the dressing!
into place, so there are no gaps or wrinkles, and to activate the adhesive across the entire dressing. Further, don’t wrap tape tightly all around the limb. IV devices can fail due to torniquet-like effect of too much tape. Sure, it’s good to keep the line in, but it’s not much use if it’s blocked off, and pretty uncomfortable for the patient too.
No tension. Don’t ‘stretch’ plastic dressings as you apply them, or place dressings/tape so that skin is ‘pulled’ away from it’s natural resting shape. It can be tricky to stop some dressings sticking to themselves once you’ve removed the backing, but don’t hold them in a ‘stretched’ manner as you place them on the skin. Dressings need to be placed gently in a direct ‘downwards’ motion onto the skin. There should be no tension on the skin, in any direction, as this causes skin injury, and encourages the dressing to become loose. Gently ‘pat’ rather than ‘smooth’ the dressing
Apply both a dressing and a securement Way back when, we all thought dressings were enough to keep the wound clean as well as to hold the IV in place. It’s clear now that most dressings need additional securement to hold the IV and any attached tubing to the skin. This extra securement of the catheter prevents not just the line falling out of the vein, but also ‘micro-movement’ of the device within the vein.
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The cells inside the vein are delicate - even the smallest IV movement causes irritation, pain, thrombosis, and swelling of the vein. The less micromotion the less chance the IV will be ‘occluded’ or ‘tissued’ when you want to use it. There are many ways to get additional securement for different IV types. These include ‘two-part’ dressings which hold the device both from above and below, additional ‘securement devices’ which may stick to the skin or penetrate it with ‘staple’ like components, various tapes, sutures, and stretchy bandage tubes (which patients often like). These all reduce the chance of IVs getting caught on tables, bed rails, handles and so on. One to two drops of medical grade superglue (cyanoacrylate) applied directly to the wound, and under the hub on insertion, are an effective way to reduce micro-movement, achieve haemostasis in oozy patients, and provide further infection prevention (Bugden et al. 2016; Rickard et al. 2016). If a dressing needs replacing, replace it Admit it, we’ve all added layer upon layer of non-sterile paper tape to avoid doing a dressing replacement sometimes the patient resembles an Egyptian mummy. But if the dressing has loose edges, has blood under it or is otherwise dirty, it needs replacing so infections are kept out, and the IV kept in. That means cleaning off blood using sterile sodium chloride, re-applying skin decontamination (waiting until it dries), and replacing with a new sterile dressing, and new securement.
Moureau, N. 2013. Safe patient care when using vascular access devices. British Journal of Nursing 22(2): S14,S16,S18passim. New, K. A., J. Webster, N. M. Marsh and B. Hewer. 2014. Intravascular device utilisation, management, documentation and complications: a point prevalence survey. Aust Health Rev 38(3): 345-349. Rickard, C. M., M. Edwards, A. J. Spooner, G. Mihala, N. Marsh, J. Best, T. Wendt, I. Rapchuk, S. Gabriel, B. Thomson, A. Corley and J. F. Fraser. 2016. A 4-arm randomized controlled pilot trial of innovative solutions for jugular central venous access device securement in 221 cardiac surgical patients. J Crit Care 36: 35-42. Russell, E., R. J. Chan, N. Marsh and K. New. 2013. A point prevalence study of cancer nursing practices for managing intravascular devices in an Australian tertiary cancer center. Eur J Oncol Nurs.
May 2017 Volume 24, No. 10 33
Remove dressings/tape carefully When removing, don’t rapidly pull these at a vertical angle – this pulls the epidermis, risking skin injury. Instead, loosen the edge of the dressing/tape, and remove ‘low and slow’ in the direction of hair growth, keeping it close to the skin surface while pulling it back over itself, and supporting the newly exposed skin with your other (gloved) hand. For patients at high risk of skin injury, consider a medical adhesive removal product, but remember these are not sterile, and will need washing off. Each dressing change also requires cleaning the IV wound with sterile saline, and reapplication of the antiseptic solution. Residue from previous dressings can be removed with medical adhesive remover. Quarterly audit your IV dressing and securements and discuss results with your team If you walked around your unit today, how many IVs would have dressings that are dry, clean and intact? 100%? How many patients would have skin irritation or injury from dressing/tape use (or misuse)? How many would have pressure tugging on the device from unsecured tubing? How many patients would feel confident that their IV is well secured? This topic can be a simple, regular quality improvement project, leading 34 May 2017 Volume 24, No. 10
to local improvements for patients and pride in nursing care standards. Why not run a competition with other wards in your institution as to who has the ‘best IV dressings’. Such data could justify more expensive dressing and securement options that actually save money and nursing time through reduced complications. You could present your findings at a nursing conference or write about them in ANMJ or another journal (Russell et al. 2013; New et al. 2014; Ullman et al. 2016). If you’re having trouble, ask a wound and/or vascular access nurse specialist If a patient has pain, itching, or skin injury from a dressing, or you just can’t get the dressings to stay stuck, seek help from the experts (Ullman et al. 2015). Wound specialists in particular have a deep knowledge of, and access to, the range of specialty dressing products that may be needed in some patients. Even though the wound is from an IV device, it is still a wound and their advice will be invaluable for you and the patient. The Alliance for Vascular Access Teaching and Research has a strong interest in providing and sharing evidence about effective dressing and securement of IV devices across a range of patient and device types.
For more information, check our website avatargroup.org.au, follow us on Twitter AVATAR_grp, or on Facebook @avatargroup4111 Claire Rickard RN is Professor of Nursing, Alliance for Vascular Access Teaching and Research (AVATAR) Group. Griffith University Amanda Ullman is Senior Lecturer, Alliance for Vascular Access Teaching and Research (AVATAR) Group. Griffith University. Tricia Kleidon is a Nurse Practitioner – Vascular Access, Research Fellow, Alliance for Vascular Access Teaching and Research (AVATAR) Group. Griffith University and Lady Cilento Children’s Hospital Nicole Marsh , Nurse Researcher, Intravascular Access, Alliance for Vascular Access Teaching and Research (AVATAR) Group. Griffith University and Royal Brisbane and Women’s Hospital
Ullman, A. J., M. Cooke, T. Kleidon and C. M. Rickard. 2016. Road map for improvement: point prevalence audit and survey of central venous access devices in paediatric acute care. J Paediatr Child Health on-line early. Ullman, A. J., T. Kleidon and C. M. Rickard. 2015. The role of the Vascular Access Nurse Practitioner in developing evidence, promoting evidencebased vascular access practice and improving health services. Vascular Access 1(1): 10-20. Ullman, A. J., M. Mitchell, F. Lin, K. New, D. Long, M. Cooke and C. M. Rickard. 2015. Dressings and securement devices for central venous catheters (Review). Cochrane Database of Systematic Reviews in press.
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LISA YANG (PERIOPERATIVE NP SPECIALISING IN ORTHOPAEDIC SURGERY) INJECTING LOCAL ANAESTHETIC FOR PAIN RELIEF POST PROCEDURE.
FOCUS PERI / POST OP CARE
References Australian Federal Government. 2013. Health Workforce Australia Work Plan 2013-2014. www. hwa.gov.au/sites/ uploads/HWA-Workplan-2013-14_vF_LR.pdf Australian Institute of Health and Welfare. Nursing and midwifery workforce. 2012. A snapshot of nurse practitioners in Australia. Fact Sheet 6. Retrieved from http://anf.org.au/ documents/reports/ Fact_Sheet_Snap_Shot_ Nurse_Practitioners.pdf Brennan, B. 2001. The registered nurse as a first surgical assistant: the “downunder” experience. Seminars in Perioperative Nursing, 10(2), 108-114. Christensen, C. 2016. Disruptive Innovation. Retrieved from http:// www.claytonchristensen. com/key-concepts/
THE PLIGHT OF THE PERIOPERATIVE NURSE PRACTITIONER IN AUSTRALIA
Foster, J. 2010. A History of the early developement of the Nurse Practitioner role in New Soth Wales, Australia. (Doctor of Philosophy), University of Technology Sydney, http://epress.lib.uts.edu. au/research/bitstream/ handle/10453/20243/02 Whole.pdf?sequence=2.
By Lisa Yang and Toni Hains “A nurse practitioner is a registered nurse educated to a post graduate Masters level and authorised to function autonomously and collaboratively in an advanced and extended clinical role” (Queensland Government 2011).
The nurse practitioner (NP) role was established in the United States (US) during the 1960s in response to a shortage of primary care doctors. Physicians began to pool resources and collaborate with nurses they identified as having a strong clinical focus, and the concept of advanced nursing practice was born. The concept was to expand the number of accessible healthcare providers at a reasonable cost, together with a robust emphasis on advanced nursing practice in collaboration with a physician. The foresight to implement this role as a post graduate degree gave 36 May 2017 Volume 24, No. 10
professional and formal recognition to the role of advanced nursing practice (Schober & Affara 2009). The NP evolution then spread across the US and on to the United Kingdom in the 1980’s. Thirty-six years later, the first NP roles were introduced to New South Wales with endorsement of the initial NPs in 2000. The role of the NP is now established in Australia with 1,380 NPs endorsed with the Australian Health Practitioner Regulation Agency (AHPRA) as of March 2016. (Nursing Midwifery Board of Australia 2016) The NP role in Australia is highly regulated with title protection and
Foster, J. P. 2010. A history of the early development of the nurse practitioner role in New South Wales, Australia.
rigid competency standards. According to a Nursing and Midwifery Workforce Report, the current clinical practice setting of the NP in Australia includes a plethora of specialties but what is not mentioned in the list is the NP working in the perioperative clinical setting (Australian Institute of Health and Welfare, Nursing and Midwifery Workforce, 2012). The role of the Perioperative NP is comprehensive and can include preoperative patient assessment and “work-up”, intraoperative surgical assisting and postoperative care including discharge education and planning; and wound care.
Hains, T., Turner, C., Gao, Y., & Strand, H. 2017. Valuing the role of the Non-Medical Surgical Assistant. ANZ Journal of Surgery, In Press. Hains, T., Turner, C., & Strand, H. 2016. Practice Audit of the Role of the Non-Medical Surgical Assistant in Australia, an Online Survey International Journal of Nursing Practice. doi:10.1111/ijn.12462 Horrocks, S., Anderson, E., & Salisbury, C. 2002. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ, 324(7341), 819-823.
Peri / Post Op Care : FOCUS TONI HAINS (PERIOPERATIVE NP, MAINLY WORKING IN CARDIO-THORACIC SPECIALTIES) IN THE NETHERLANDS LEARNING ENDOSCOPIC RADIAL ARTERY HARVEST IN PREPARATION FOR THE PATIENT UNDERGOING CORONARY ARTERY BYPASS GRAFTS.
SUPPORTING NATIONAL IMPLEMENTATION OF NEW WORKFORCE ROLES”, SUGGESTS THAT THE ROLE OF THE PERIOPERATIVE NP WOULD PROVIDE COST BENEFITS WITHIN THE PERIOPERATIVE SETTING
Brennan, a pioneer in Australian advanced perioperative practice, proposed in 2001 that the advanced practice of the perioperative nurse in Australia could provide a costeffective and versatile service in the healthcare sector. This assertion, coupled with a mandate of the Australian Government in the Health Workforce Australia Work Plan 2013-14 to boost productivity (within healthcare) with an emphasis on “Supporting national implementation of new workforce roles”, suggests that the role of the perioperative NP would provide cost benefits within the perioperative setting (Australian Federal Government 2013). A recent paper investigating nurses as surgical assistants in Australia concluded that nurses in this role increase productivity by decreasing in-theatre preparation time and promote a decrease in operating time (Hains et al. 2016). In Australia no nationally regulated criteria exists for the broader role of the intraoperative surgical assistant; be that for medical or nursing personnel. The Royal Australasian College of Surgeons (RACS) has a position statement for the surgical assistant which does not outline specific qualifications required to perform this role (Royal Australasian College of Surgeons 2015). The peak perioperative nursing body, the Australian College of Operating Room Nurses (ACORN), standard for this role states the Perioperative Nurse Surgeon’s Assistant (a category in which the perioperative NP can reside) must be a registered nurse with a minimum of three years perioperative experience (ACORN 2015). This standard is not imposed by the Australian Health Professional Regulation Agency (AHPRA) or healthcare facilities that are responsible for credentialing surgical assistants. anmf.org.au
Medical Observer. 2016. MBS reviewers push for GP fee parity. Medical Observer. Retrieved from www. medicalobserver.com. au/professional-news/ mbs-reviewers-push-forgp-fee-parity?mkttok= eyJpIjoiWXpFM09EVT BNbVUwT0RsaiIsInQi OiJuMThOc3Z1TTNXc lNqRkJGYWU1Y0N2O ENNcDArd2NsNmQ0 NW81dTFDVHIrZ0R1SVwvd3VtdjVXc2ZYU0Jc L2pUeXZOTmRQZFB5W mRXeG1pRGRHSTNjMX c5QWcyT0xVNEt3aHVI NmYwV3RhRld3PSJ9
Investigating practice in the private sector of the Australian Healthcare System, the perioperative NP is able to seek remuneration in the form of a consultation fee for pre and post-operative care as long as these are not in addition to the surgeon billing the Medical Benefits Schedule (MBS). What is not provided for under the MBS is any care given by the perioperative NP in the intraoperative phase as surgical assistant. This provision is for medical personnel only (Victorian Government 2014). So while NPs in Australia possess a Provider Number and a Prescriber Number they cannot access “Assisting at Operation” Item Numbers on the MBS. This means that the perioperative NP is a disruptive innovator who provides a service and fills gaps that exist in the healthcare system without the required support from the system (Christensen 2016). Remuneration through the MBS would take the role of the perioperative NP from a disruptive innovator to a sustainable innovator providing a valuable service for appropriate remuneration. In September 2016, the Medical Observer published an online article calling for parity of remuneration between General Practitioners (GP) and specialists. The article states that, “GP fees should be boosted to match specialists’ for identical services, according to a committee tasked with
reviewing the design and structure of Medicare Benefits Schedule regardless of the medical practitioner’s background qualification” (Medical Observer 2016). This statement sets precedence that if GPs should be paid the same as specialists for the same clinical services, then perioperative NPs should be paid the same as GPs for the same intraoperative assisting clinical services. The perioperative NP has to date shown a trend toward cost saving in the Australian Healthcare System. (Hains et al. 2017; Hains et al. 2016.) If a small change to the MBS allowed the perioperative NP to access the ‘Assisting at Operation’ Item Numbers this cost saving has the potential to increase as more NPs would be encouraged to practice in this setting. Both authors are in agreement with the content of this paper. No funding was received for this paper. Toni Hains is a PhD Scholar at the University of Queensland and a Perioperative Nurse Practitioner Self Employed Lisa Yang is a Perioperative Nurse Practitioner - Self Employed Both work at multiple private hospitals in Queensland
Nursing Midwifery Board of Australia. 2016. Registrant Data – Nursing and Midwifery Board of Australia. Retrieved from www. nursingmidwiferyboard. gov.au/About/Statistics. aspx Queensland Government. 2011. Clinical Governance for Nurse Practitioners in Queensland: A guide. Brisbane: Queensland Government Retrieved from www.health.qld. gov.au/__data/assets/ pdf_file/0021/158223/ np-impguide.pdf Royal Australasian College of Surgeons. 2015. Position Statement - Surgical Assistants. Retrieved from www.surgeons.org/ media/304233/2015-05 -20_pos_fes-pst-028_ surgical_assistants.pdf Schober, M., & Affara, F. 2009. International council of nurses: Advanced nursing practice: John Wiley & Sons. The Australian College of Operating Room Nurses. 2015. ACORN Standards for Perioperative Nursing Nursing Role: Perioperative Nurse Surgeon’s Assistant (PNSA). Adelaide, South Australia: The Australian College of Operating Room Nurses Ltd. Victorian Government. 2014. 10.5.22.6 The MBS rules. Retrieved from www1. worksafe.vic.gov.au/ vwa/claimsmanual/ Content/10Entitlements _MedicalAndLikeServic es/1%205%2022%20 6%20The%20MBS%20 rules.htm
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FOCUS: Peri / Post Op Care
SITUATION AWARENESS AND PATIENT SAFETY IN THE PERIOPERATIVE ENVIRONMENT By Melanie Murray In 2014-15 there were 10.2 million hospitalisations in Australia, and approximately 2.5 million of those admissions required surgery. As such, perioperative safety is crucial to patient outcomes (AIHW 2016). It was the mid 1990’s that saw an international focus on patient safety throughout the developed world with adverse events in healthcare reaching the tens of thousands per year in the United States of America (USA), the United Kingdom (UK), and Australia (Gluyas & Morrison 2013). Due to this intense focus reports on human factors impacting adverse events, the role of Situational Awareness came to the fore (Francis 2013; Kohn et al. 2000). Situation awareness (SA) was a little known phenomenon in healthcare until the mid-2000’s with the concept introduced to anaesthesia practice by Gaba, Howard and Small in 1995 (Schulz et al. 2013). SA is a non-technical human factors skill that has been recognised in high reliability organisations, such as aviation, since as early as World War I (Endsley 1995). SA is required for the successful management of situations where decisions made are critical to the outcome (Wright 2015). Endsley (1995) describes a three level hierarchical construct model of SA with the levels termed perception, comprehension and projection. In basic terms, SA is knowing what is going on (perception), making sense of what is going on (comprehension), and predicting future events based on the interpretation of the initial observation (projection). A lack of SA was famously described in the perioperative realm through the story of Elaine Bromiley who died of hypoxic brain injury as a result of a mismanaged ‘can’t intubate, can’t ventilate’ scenario due to a loss of SA by operating room staff. This occurred even though the operating theatre was well equipped for difficult airways and on the day had highly qualified, competent senior staff (Reid & Bromiley 2012).
38 May 2017 Volume 24, No. 10
TODAY’S NEW GRADUATES HAVE THE ADVANTAGE OF SIMULATED TRAINING TO BUILD THE MENTAL MODELS OF NON-ROUTINE EVENTS WITHIN THE PERIOPERATIVE ENVIRONMENT
Loss of SA can occur at any level in medicine and nursing. In the safety critical area of the operating theatre, individual SA is pertinent, but team SA is essential for appropriate communication amongst theatre team members, as communication errors account for twice as many hospital deaths than inadequate clinical skill (Parush et al. 2011). Today’s new graduates have the advantage of simulated training to build the mental models of non-routine events within the perioperative environment (Wright & Fallacaro 2011). This has the advantage of increasing individual SA to augment team SA of the operating room. Continued simulated education will ensure the success of new graduates entering the perioperative realm and the perioperative team. This commentary forms part of a PhD project being undertaken concerning new graduate registered nurses and patient safety. Melanie Murray is a Lecturer in Nursing in the School of Health Professions at Murdoch University in WA.
References AIHW. 2016. Australia’s hospitals 2014-15 at a glance. Accessed at URL www.aihw.gov. au/hospitals/#haag on 06/03/2017 Endsley,M.R. 1995. Toward a Theory of Situation Awareness in Dynamic Systems. Human Factors: The Journal of the Human Factors and Ergonomics Society, 37(1), 32-64. doi:10.1518/001872095 779049543 Francis, R. 2013. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Retrieved from www. midstaffpublicinquiry. com Gluyas, H., & Morrison, P. 2013. Patient Safety An Essential Guide. Hampshire, UK: Palgrave Macmillin. Kohn, L.T., Corrigan, J., & Donaldson, M.S. 2000. To err is human: Building a safer health system. Washington, DC: National Academy Press. Parush, A., Kramer, C., Foster-Hunt, T., Momtahan, K., Hunter, A., & Sohmer, B. 2011. Communication and team situation awareness in the OR: Implications for augmentative information display. Journal of Biomedical Informatics, 44, 477485. Doi:10.1016/j. jbi.2010.04.002 Reid, J., & Bromiley, M. 2012. Clinical human factors: the need to speak up to improve patient safety. Nursing Standard, 26(35), 35-40. doi:10.7748/ ns2012.05.26.35.35. c9084 Schulz, C.M., Endsley, M.R., Kochs, E.F., Gelb, A. W., & Wagner, K.J. 2013. Situation Awareness in Anesthesia. Anesthesiology, 118(3), 729-742. doi:10.1097/ aln.0b013e318280a40f Wright, S.M. 2015. Patient safety in anesthesia: learning from the culture of highreliability organizations. Critical Care Nursing Clinics North America, 1-16. doi:10.1016/j. cnc.2014.10.010 Wright, S.M., & Fallacaro, M.D. 2011. Predictors of situation awareness in student registered nurse anesthetists. AANA Journal, 79(6), 484-490. Retrieved from www.aana.com/ aanajournalonline.aspx
PERIOPERATIVE SCOPE BROAD FOR NURSES By Josephine M Perry and Yvette Salamon Perioperative Nursing as a recognised specialty has traditionally focussed on the scrub/scout role or the anaesthetics/recovery role. In 2016, However, we performed an exploration into perioperative nursing roles on a wider scale, and discovered that there were many nurses who worked within elements of the perioperative environment, but who did not fit the traditional ‘mould’ of a scrub/ scout or an anaesthetic/recovery nurse. Such nurses may work in gastroenterology, mental health, day surgery, burns units and rural settings (among others). There were few available options for professionally and clinically relevant postgraduate education for this cohort of nurses. The Adelaide Nursing School at the University of Adelaide has developed a Graduate Diploma option where nurses can ‘pick and mix’ from a wide range of courses offered to explore essential tenets relevant to their particular context. This way, nurses from diverse workplaces can study the theoretical concepts and courses relevant to them and their daily practice. The University of Adelaide also continues to offer clinically specialised Graduate Diplomas of Nursing in Perioperative and Anaesthetic/ Recovery Nursing along with many other specialties. Our courses have innovative, engaging and relevant coursework, readings and assignments. Student intakes are restricted which allows for personal attention and support for every student. For more detail on our courses go to The Graduate Diploma of Nursing Science at the University of Adelaide www.adelaide.edu.au/degreefinder/gdnsc_gdnsaccare.html For more information, contact Jo Perry or Yvette Salamon at the University of Adelaide. Josephine M Perry and Yvette Salamon are Specialty Course Coordinators, Perioperative Nursing in the Adelaide Nursing School, Faculty of Health & Medical Sciences at the University of Adelaide anmf.org.au
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SURGICAL COUNTING: A PERIOPERATIVE NURSE’S PERSPECTIVE By Principle Researcher:Vicky Warwick and Supervisor: Brigid Gillespie The Australian College of Perioperative Nurses (ACORN) have developed a set of standards to guide clinical practice within the perioperative setting. The ACORN standard ‘Management of accountable items used during surgery and procedures’ (ACORN 2016) details a process for perioperative nurses to follow when undertaking a surgical count. This standard has been utilised by Healthcare Facilities (HCF) to develop local policies and procedures in relation to the surgical count which assists perioperative nurses in mitigating the risk of a retained foreign object during surgery. A surgical count is the process perioperative nurses follow to ensure that all surgical instrumentation and accountable items are accounted for throughout a surgical procedure. If they are not accounted for during this process, then there is the potential for them to be left within a body cavity following a surgical incision. Human and environmental factors contribute to retained foreign objects that may potentially lead to severe harm and occasional death for surgical patients (Rowlands 2012). This research study provides insights into the perioperative nurses’ perceived nuances in relation to undertaking a surgical count. It considers ingrained rituals of the operating room that may or may not lead perioperative nurses to deviate from undertaking the count process as recommended by ACORN, and in doing so compromising patient safety.
A two phased sequential mixed methods study using qualitative and anmf.org.au
quantitative methods was undertaken. Phase one included structured observations of perioperative nurses while undertaking surgical counts while phase two involved interviews and focus groups with perioperative nurses and past/present members of the ACORN Board. Analysis of the structured observations and interviews provides important insights about the potential barriers and enablers in relation to perioperative nurses performing a surgical count.
Implications for practice, education and policy
Perioperative nurses have an obligation to follow ACORN standards that local policy and procedure are based upon and question any deviations from the normal count process. Understanding the life changing and devastating effects on both the patient and staff involved in a surgical procedure with a retained foreign object is important for ongoing compliance (Rowlands 2012; Butler et al. 2010). Junior perioperative nurses must be taught to follow recommended practices and have sound knowledge around the potential harm that a deviation from practice may have on the surgical patient (Rowlands and Steeves 2010). The outcomes of this study will identify important recommendations that will inform subsequent review of the
current ACORN standards and provide opportunity to improve practice of the surgical count process. Ultimately, this has the potential to reduce the risk of harm to surgical patients
The process of surgical counting is integral to safe perioperative nursing practice. The ACORN standard ‘management of accountable items’ standard provides overarching best practice principles for HCF to develop policy and procedure. This is not to increase the workload of the perioperative nurse but to provide a recognised system that accounts for all surgical adjuncts utilised during surgical procedures. Principle Researcher: Vicky Warwick is a Nurse Educator in the Nursing and Midwifery Education Service at Fiona Stanley Fremantle Hospital Group Supervisor: Professor Brigid Gillespie is Professor of Patient Safety in the National Centre of Research Excellence in Nursing at the Menzies Health Institute Queensland; School of Nursing and Midwifery at Griffith University and Gold Coast University Hospital, Gold Coast Health, Nursing and Midwifery Education and Research Unit
References Australian College of Operating Room Nurses Ltd. 2014. ACORN standards for perioperative nursing 2014-2015. Adelaide, S.A: The Australian College of Operating Room Nurses Ltd. Butler, M., Ford, R., Boxer, E. and Sutherland-Fraser, S. 2010. Lessons from the field: An examination of count errors in the operating theatre. ACORN: The Journal of Perioperative Nursing in Australia. 23(3): 6, 8, 10, 12, 14-16. Rowlands, A. 2012. Risk factors associated with incorrect surgical counts. AORN Journal. 96(3): 272. Rowlands, A. and Steeves, R. 2010. Incorrect surgical counts: A qualitative analysis. AORN Journal. 92(4): 410-419.
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PARENTAL PRESENCE DURING INDUCTION OF ANAESTHESIA – AN EVIDENCE BASED PRACTICE REVIEW By Judith Smith Parental presence during the induction of anaesthesia remains a controversial issue related to family centred care which is highlighted through discrepancies in observational studies, beliefs and current practices. A national survey published in the USA in 2006 (Kain et al. 2006) indicated large variabilities in practice which also exist within Australian practice currently. The study in Kain et al. (2006) reported 32% of the hospitals surveyed allowed parental presence, 26% did not and 23% had no formal policy. There were also irregularities amongst anaesthetists with only 10% reported having parents present during induction of anaesthesia. ‘The Children’s Hospital Network’ is regarded as the benchmark in provision of care for paediatric patients in NSW. However they do not provide clear guidelines stating ‘The decision for a parent to be present at induction of anaesthesia is a joint decision between the anaesthetist and the parent, with the anaesthetist retaining the final decision’ (CHW 2014 p2). While this supports individual decision it does not support family centred care.
Common objections cited for parental presence include distraction of the anaesthetic and nursing staff, adverse parental reactions and delays in operating room schedule (Caldwell-Andrews et al. 2006; Himes et al. 2008; Kain et al. 2006). Pruitt et al. (2008) suggest the anaesthetists’ reluctance may stem from being ‘watched’ by the parents and the fear of something going wrong. A review of observational studies by Gupta et al. (2010) indicated conflicting views. One study proposed that the presence of a parent during induction of anaesthesia was not advantageous, whilst another study suggested that parental presence decreased child anxiety and increased cooperation. In the authors experience, the practice of having parental presence during anaesthesia reflects the results reported in Kain et al. (2006) with the practice being very much dependant on anaethetist preference. Anectdotally the beliefs of anaethetists, when questioned, regarding their preference of parental presence reflected those cited above. Research findings in (Chundamala et al. 2009; Manyande et al. 2015; Wright et al. 2010) 40 May 2017 Volume 24, No. 10
indicates that parental presence provides compelling benefit to both parent and child and proffers a definitive and strong rationale supporting evidence-based practice.
Evidence-based practice (EBP) considers both the clinician’s experience and patient preferences. Successful promotion of EBP requires a governance framework which is committed to the ongoing redesign of clinical care processes in response to new evidence about patient need and the effectiveness of interventions (Scott et al. 2013 p399). A barrier to implementing EBP is that of attitudes and beliefs, which differs between anaesthetists and impacts on practice. This creates confusion amongst nursing staff in both the perioperative unit and the paediatric unit, as there is no clear guidance on what to inform parents before they arrive in the perioperative unit. Often what the paediatric nurse tells the family is contradicted on arrival in the perioperative unit, which can cause undue anxiety and distress. Andersson et al. (2015 p73) have identified that a lack of cooperation between different departments impedes the alignment of shared goals and directions. This highlights a key obstacle to implementing EBP within the perioperative unit, specifically a lack of a common policy for communication and cooperation between the different departments. Successful implementation of evidence into practice involves cooperation between individuals and departments (McClusky 2013 p371). There needs to be a definitive policy developed to address the issue of parental presence during induction of anaesthesia. A policy statement indicates an organisations position, which embraces EBP (Scott et al. 2013 p401). In order to develop a policy, specific targeted strategies need to be planned which take into account potential identified barriers to change (McClusky 2013 p379). Such strategies include identifying specific clinical conditions in which parental presence is not appropriate, such as emergency procedures, when complications are more likely to arise (CHW 2014 p2). It would also be beneficial to include specific age groups where parental presence is advised, such as children in two to six age group, who are significantly more likely to exhibit anxiety at induction (Wright et al. 2010 p756). Infants, under six to eight months of age rarely benefit from parental presence during induction this coupled with the increased risk of anaesthesia complications in this age group would suggest parental presence might not be appropriate (CHW 2014 p3). Departments such as the perioperative unit and wards such as the Paediatric ward are regarded as the first order of practice in which health professionals directly confront challenges in integrating evidence into routine care of individual patients. (Scott et al. 2013 p392) It is within these units that change needs to occur to provide consistency and excellence in caring for the most vulnerable of our patient populations. Judith Smith is Associate Lecturer, Scholarly Academic Fellow in the Faculty of Health at the University of Technology, Sydney
References Andersson, A, Gifford, W & Nilsson, K. 2015. Improving care in surgery – a qualitative study of managers’ experiences of implementing evidence-based practice in the operating room, Journal of Hospital Administration, vol. 4, no. 4, pp. 73-83. Caldwell-Andrews, A, Maranets, I, Nelson, W, Mayes, L & Kain, Z. 2008. Predicting which child-parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach, Anesthesia Analg, vol.102 no. 1, pp. 81-84. Children’s Hospital Westmead (CHW). 2014. Anaethesia: Parents attending the induction of, Policy and Procedure, Policy No: 0/C/06:8179-01:03, viewed 19 May 2016 www.schn.health. nsw.gov.au/_policies/ pdf/2006-8179.pdf Chundamala, J, Wright, J, Sheelagh, M & Kemp, M. 2009. An evidencebased review of parental presence during anaesthesia induction and parent/child anxiety, Canadian Journal of Anaethesia, vol. 56, pp. 57-70. Gupta, A, Ommid, M, Mehta, A, Mahajan, C, Arora, R & Dhulkhed, V. 2010. Does parental presence help during induction of anaesthesia on children?, Anestesia Pediatrica e Neonatale, vol. 8, no. 1, pp. 1-8. Kain, Z, CaldwellAndrews, A, Krivutza, D, Weinberg, E, Wang, S & Gaal, D. 2006. Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States, 1995-2002: results of a follow-up national survey, Anesthesia Analg, vol. 98, no. 5, pp. 1252-1259. Manyande, A, Cyna, A, Yip, P, Chooi, C & Middleton, P. 2015. Non-Pharmacological interventions for assisting the induction of anaesthesia in children (Review) Cochrane Database of Systematic Reviews, issue 7, viewed 18 May 2016, The Cochrane Library, http:// onlinelibrary.wiley.com/ store/10.1002/1465185 8.CD006447.pub3/ asset/CD006447.pdfz
Melnyk, B & FineoutOverholt, E. 2011. Evidence-based practice in nursing and healthcare, 3rd edn, Lippincott, Williams and Wilkins, Philadelphia. McClusky, A. 2013. Implementing evidence into practice, in T Hoffman, S Bennett & C Del Mar (eds), Evidencebased practice across the health professions, Elsevier Australia, Sydney, pp. 392-403. Pruitt, J, Johnson, A, Elliot, J & Polley, K. 2008. Parental presence during paediatric invasive procedures, Journal of Paediatric Healthcare, vol. 22, no. 2, pp. 120-127. Scott, I, Del Mar, C, Hoffmann, T & Bennett, S. 2013. Embedding evidence based practice into routine clinical care, in T Hoffman, S Bennett & Del mar (eds.), Evidence-based practice across the health professions, Elsevier Australia, Sydney, pp. 392-403. Wilczynski, N & Mc Kibbon, A. 2013. Finding the evidence in T Hoffman, S Bennett & C Del Mar (eds.), Evidence-based practice across the health professions, Elsevier Australia, Sydney, pp. 43-59. Wright, K, Sherry, H, Finley, A. 2010. When are parents helpful?: A randomised clinical trial of the efficacy of parental presence for pediatric anaesthesia, Canadian Journal of Anaesthesia, vol. 57, pp. 751-758. Zhou, H, Shields, L, Watts, R, Taylor, M, Munns, A & Ngune, I. 2012. Family Centered care for hospitalised Children aged 0-12 yrs: A systematic review of qualitative studies. Joanna Briggs Institute – Library of Systematic Reviews, vol. 10, no 57, pp. 3917-3935.
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GUIDANCE FOR PERIOPERATIVE NURSES TO PREVENT PERIOPERATIVE HYPOTHERMIA IN OBSTETRICS By Judy Munday The prevention of perioperative hypothermia is a responsibility of all members of the perioperative team. Nurses are well placed to have a central role in implementing strategies to reduce perioperative heat loss, which is associated with a host of adverse outcomes (National Collaborating Centre for Nursing and Supportive Care 2008) International guidelines intended to prevent and manage inadvertent perioperative hypothermia target general adult populations and specifically exclude pregnant patients (National Collaborating Centre for Nursing and Supportive Care 2008). A systematic review was undertaken to review the body of primary research which has tested interventions to reduce perioperative hypothermia in women undergoing caesarean section (Munday et al. 2013, 2014). This was conducted as the first phase of a program of research which aimed to improve thermal care for this population. The recommendations from this review were integrated into a Joanna Briggs Institute Best Practice Information Sheet (Giles et al. 2013), providing busy clinicians with recommendations in an accessible format based upon the best available evidence. Implications for practice, based upon the review, centre around utilising warmed intravenous fluids, and ensuring that preoperative, and active, warming strategies are utilised where possible. The importance of maintaining ambient temperature, and ensuring thermal comfort, are also highlighted (Munday et al. 2013, 2014). A proactive approach to preventing perioperative heat loss is vital, and one of the first vital steps during the patient’s perioperative journey, is preoperative temperature measurement. Unfortunately, evidence suggests that both preoperative and intraoperative temperature measurement is a simple procedure which is anmf.org.au
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often overlooked (Arkiliç et al. 2000).
References Arkiliç, C. F., Akça, O., Taguchi, A., Sessler, D. I., & Kurz, A. 2000. Temperature monitoring and management during neuraxial anesthesia: an observational study. Anesthesia & Analgesia, 91(3), 662-666. Giles, K., Munday, J., Hines, S., Wallace, K., Chang, A. M., Gibbons, K., & Yates, P. 2013. Interventions to assist perioperative temperature management for women undergoing cesarean section. JBI Best Practice Information Sheet. Munday, J., Hines, S., Wallace, K., Chang, A. M., Gibbons, K., & Yates, P. 2013. The clinical effectiveness of interventions to assist perioperative temperature management for women undergoing cesarean section: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 11(6), 45-111. Munday, J., Hines, S., Wallace, K., Chang, A. M., Gibbons, K., & Yates, P. 2014. A systematic review of the effectiveness of warming interventions for women undergoing cesarean section. Worldviews on Evidence-Based Nursing, 11(6), 383-393. National Collaborating Centre for Nursing and Supportive Care. 2008. Clinical Practice Guideline. The management of inadvertent perioperative hypothermia in adults National Institute for Clinical Health and Excellence.
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May 2017 Volume 24, No. 10 41
FOCUS: Peri / Post Op Care for a purpose designed bedside folder in which to ‘house’ the chart soon became apparent. Multiple pre-existing designs were considered, all of which were deemed unsuitable, mainly due to the size of the charts which would open outside the width of a standard A4 folder. To solve this, a prototype was mocked up by the Nursing Project Coordinator, initially by engineering two binders together, which was sent for trial on a ward at RCH. After seeking verbal feedback from multiple nurses across four shifts and liaison with infection control nurses from three separate hospitals who advocated to remove the plastic cover (traditionally found on the front of a standard A4 folder), some minor adjustments were made which led to the engagement of a local Melbourne manufacturer.
MULTIPLE PRE-EXISTING DESIGNS WERE CONSIDERED, ALL OF WHICH WERE DEEMED UNSUITABLE, MAINLY DUE TO THE SIZE OF THE CHARTS WHICH WOULD OPEN OUTSIDE THE WIDTH OF A STANDARD A4 FOLDER
VICTOR FOLDER IN ACTION
COLOURED PATIENT FOLDERS: THE LITTLE THINGS MAKING A DIFFERENCE FOR THE BEDSIDE NURSE By Jennifer Sloane Jointly initiated by Monash Children’s and The Royal Children’s Hospital (RCH), The Victorian Children’s Tool for Observation and Response 42 May 2017 Volume 24, No. 10
project, known as ViCTOR (www. victor.org.au) is a sector-led project funded by the Victorian Paediatric Clinical Network. The ViCTOR charts are available for paediatric patients in the ‘inpatient’ and ‘urgent care’ setting. The project has currently supported 55 Victorian hospitals to develop or review paediatric escalation responses and implement a standardised track and trigger paediatric observation chart. Unlike other observation charts, the ViCTOR charts are presented in an A3 vertical format. This format was selected by key stakeholders in order to enable viewing of the vital signs on one page, to enhance the identification of trends and to highlight any vital sign modifications next to the relevant vital sign. With the introduction of ViCTOR, the need
The final product met infection control principles, sealed via a magnet system, came with five reusable dividers and is available in multiple colours. The folders were made available via the ViCTOR website. Despite the first orders reporting spine tears, the second reinforced and refined version has since received positive reviews. To date a total of 4,950 folders have been ordered, with some hospitals transitioning entire wards and units. Although originally designed to house the ViCTOR charts, the folders have reportedly been used in multiple other ways. Some of the reported benefits of the colour coded folders are; identification of patient subgroups on the same ward (eg. renal and cardiac), ‘medication only’ folders and distinction of paediatric patients in emergency departments. The ability of the folders to lock closed has reduced paperwork falling out and improved the ease of cleaning after patients. Additionally through the benefit of bulk (statewide) ordering the folders are available at less than half the individual unit purchase price. Developed by and for nurses, colour coded bedside folders originally designed for the ViCTOR project have proven to be a cheap, versatile and effective solution to help improve bedside document management in various ward and unit settings. Jennifer Sloane is Statewide Project Coordinator (RN) – Victorian Children’s Tool for Observation and Response (ViCTOR) at The Royal Children’s Hospital in Melbourne anmf.org.au
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A2K: A COMPREHENSIVE AND SYSTEMATIC APPROACH TO THE PHYSICAL ASSESSMENT OF POSTOPERATIVE PATIENT By Evan Plowman The physical assessment of postoperative patients is a crucial and potentially lifesaving skill that may be improved with the use of a mnemonic to guide assessment structure. The definition and elements of a primary survey (ABCDE) are generally accepted as including assessment of airway, breathing, circulation, disability and exposure/environment (Parker & Magnusson 2016). There is far less agreement about what should happen next. Studies show knowledge retention is improved with the use of mnemonics (McCabe et al. 2013; Gravel et al. 2010) so we introduced a secondary survey for patient assessment to our undergraduate nursing students, which we called A2K, to establish a systematic and consistent approach to post-operative assessment. In addition to performing a rapid, primary assessment as described above, the A2K assessment goes on to include F for fluids and full set of vital observations, G for glucose, H for
head-to-toe assessment and history, I for investigations and interventions, Jot for jot it down and K for Kin or Kindred. This approach provides a systematic and comprehensive physical assessment for the postsurgical patient that can be used in the acute surgical ward setting and is easily remembered by the student with the help of a mnemonic. Fluid management is vital in the postoperative patient, particularly after undergoing major surgery (Kayilioglu et al. 2015) and collecting a full set of vital signs is equally important to detect early warning signs of deterioration. Assessing glucose in the diabetic patient postoperatively is important in avoiding complications associated with deranged metabolic processes disrupted by surgical intervention (Sudhakaran and Surani
2015). Head-to-toe assessments include a comprehensive physical examination of the patient’s body using inspection, auscultation, percussion and palpation. A patient SAMPLE history includes the assessment of signs/symptoms (particularly pain or nausea), allergies, medications, previous illness, last food or drink consumed and events leading up to the assessment. Investigations and interventions include anything attached to, or testing of, the patient, which would include intravenous access, wound assessment, drain output and any other medication or treatment ordered by the surgical team. Jot it down refers to ensuring complete and accurate documentation has been attended. Finally, Kin or Kindred refers to the need to ensure the patient’s family or person for contact has been updated about the patient’s condition. The A2K assessment provides a structured and comprehensive approach that the nurse can use to guide their assessment in the post-operative setting. This approach requires further research to establish validity and reliability as an assessment method. Evan Plowman is a Lecturer in Nursing at Charles Sturt University in NSW
References Gravel, J., Roy, M., & Carriere, B. 2010. 4455-66-PM, a mnemonic that improves retention of the Ottawa Ankle and Foot Rules: a randomized controlled trial. Academic Emergency Medicine. 17(8): 859-864. Kayilioglu, S. I., Dinc, T., Sozen, I., Bostanoglu, A., Cete, M., & Coskun, F. 2015. Postoperative fluid management. World Journal of Critical Care Medicine. 4(3): 192-201. McCabe, J. A., Osha, K. L., Roche, J. A., & Susser, J. A. 2013. Psychology students’ knowledge and use of mnemonics. Teaching of Psychology. 40(3): 183-192. Parker, M., & Magnusson, C. 2016. Assessment of trauma patients. International Journal of Orthopaedic and Trauma Nursing. 21: 21-30. Sudhakaran, S., & Surani, S. R. 2015. Guidelines for perioperative management of the diabetic patient. Surgery Research and Practice. Article ID 284063.
Nurse Writers Needed Wolters Kluwer a provider of expert solutions in health care is recruiting Nurses to serve as Contributors and Reviewers. Nurses are being invited to contribute to the development of Lippincott Procedures an Evidence Based online product providing step-by-step procedures and skills for nurses in a variety of clinical settings. Your contributions or reviews can be developed in your own home and time to be published and used by nurses at the point-of-care and educational settings. Interested nurses must be Registered Nurses (Division 1) with at least 5 years experience in an acute clinical setting. Experience with policy and procedure creation and maintenance is desirable.
Please submit your expression of interest and Curriculum Vitae to firstname.lastname@example.org For more information on Lippincott Procedures visit: www.lippincottsolutions.com/solutions/procedures
FOCUS: Peri / Post Op Care
THE BENEFITS OF DEVELOPING A MENTORING RELATIONSHIP IN NURSING INCLUDE IMPROVED JOB SATISFACTION AND TEAM MORALE, INCREASED RECRUITMENT AND RETENTION, AND THE OPPORTUNITY TO DEVELOP NEW SKILLS AND KNOWLEDGE References
IMPLEMENTING A MENTORING PROGRAM IN THE OPERATING SUITE By Patricia Nicholson Due to the rapidly increasing demand for healthcare, driven by an ageing population and the rising cost of technology, Australia is facing the challenge of sustaining a health workforce to meet this demand. In the most recent Health Workforce Australia (HWA) Report (2014) a predicted shortfall in the supply and demand of critical care and emergency nurses was reported. A major contributing factor associated with the shortfall included the number of nurses exiting the specialty area exceeding those entering, although the impact of older nurses retiring from the workforce was also widely acknowledged (HWA 2014). Although perioperative nursing is not detailed in the report, parallels can be drawn due to its similarities to other specialties in acute care settings. Registered nurses are leaving the profession due to feelings of inadequacy, stress and disempowerment, often as a result of abuse between healthcare workers in their workplace (Amrein 2012). Job dissatisfaction, including low morale, is also reported due to limited resources and high patient acuity. Both these factors not only impact on the workforce but may also influence positive patient health outcomes (Baltimore 2006; Bally 2007; Frederick 2014; Johnson 2009; Laschinger et al. 2010). While initiatives such as recruitment and retention may resolve staffing issues in the short term in the perioperative environment, long 44 May 2017 Volume 24, No. 10
term strategies aimed at promoting quality within the workplace should also be considered. Although mentoring has been identified as a strategy for establishing a healthy work environment and promoting leadership, it has also been highlighted as an effective strategy to address bullying in the workplace (Bally 2007; Frederick 2014). Mentorship is defined as ‘acting as a guide’, with the concept mentorship viewed as a relationship in which a mentor acts as both a teacher and guide for the learner (Lundin 2013). It is considered “an integral relationship to be fostered between members of a discipline for the purpose of developing future nurse leaders” (Milton 2004, p116). Mentoring is not a new phenomenon, in fact mentorship has existed for many years in a number of disciplines (Grossman 2013). The benefits of developing a mentoring relationship in nursing include improved job satisfaction and team morale, increased recruitment and retention, and the opportunity to develop new skills and knowledge. It is also reported to enhance the mentees
autonomy in professional practice (Frederick 2014; Hubbard et al. 2010; Mirbagher et al. 2016). In fact, this is further supported by Sheila Grossman (2013) who states that, ‘due to our chaotic healthcare system and volatile economy, there has never been a greater need for nurses to gain new skills and knowledge to empower themselves” (p163). Graduates, or nurses entering the operating suite for the first time, are expected to function at an advanced level while continuing to address their learning needs. An important aspect of mentoring includes being a role model for the less experienced nurse, helping them develop clinical skills and critical thinking while providing safe competent care in an unfamiliar environment. A recent publication highlighted the benefit of a mentorship program linking undergraduate nurses, assigned to work in operating suite during the final semester of their degree, with improved clinical competence. While limitations are listed in the study the introduction of a mentoring program could be beneficial providing support to new nurses as they enter the profession (Mirbagher et al. 2016). There is limited evidence supporting mentorship programs in the perioperative environment, and the challenge of understanding how mentoring can be implemented to retain and look after staff in the operating suite is one that deserves further investigation. Dr Patricia Nicholson is Associate Professor, Perioperative Course Director in the School of Nursing and Midwifery, Faculty of Health, Deakin University, Researcher for the Quality and Patient Safety Research at Deakin University and President of the Victorian Perioperative Nurses Group
Amrein, K. 2012. Horizontal violence: Can anything be done? Nursing. 42(9): 1 -2. Bally, J. 2007. The role of nursing leadership in creating a mentoring culture in acute care environments. Nursing Economics, 25(3): 143-149. Baltimore, J.J. 2006. Nurse collegiality. Fact of fiction? Nursing Management, 37(5): 28 – 36. Frederick, D. 2014. Bullying, Mentoring, and Patient Care. AORN Journal, 99(5): 587-593. Grossman, S. 2013. Mentoring in Nursing: A dynamic and collaborative process (2nd ed.). New York: Springer Publishing Company. Health Workforce Australia 2014: Australia’s Future Health Workforce – Nurses Detailed. Hubbard, C., Halcomb, K., Foley, B., & Roberts, B. 2010. Mentoring: a nurse educator survey. Teaching & Learning in Nursing, 5(4): 139-142. Johnson, S. 2009. International perspectives on workplace bullying among nurses: a review. International Nursing Review. 56(1):34-40. Laschinger, H.K.S., Grau, A.L., Finegan, J., & Wilk, P. 201). New graduate nurses’ experiences of bullying and burnout in hospital settings. Journal of Advanced Nursing. 66(12): 2732–2742. Lundin, L. L. (2013). Mentorship. Salem Press Encyclopedia. Milton, C.L. 2004. The ethics of personal integrity in leadership and mentoring: A nursing theoretical perspective. Nursing Science Quarterly. 17(2): 116 – 120.
Peri / Post Op Care : FOCUS
PHYSICAL RESTRAINTS IN INTENSIVE CARE: EXPERIENCES OF PATIENTS, FAMILIES AND NURSES By Dawn Perez, Kath Peters, Lesley Wilkes and Gillian Murphy Critically ill patients admitted to an intensive care unit (ICU) often require many invasive procedures and medical devices (Martin and Mathisen 2005). While these interventions are a necessity, they can potentially cause patients a great amount of pain and discomfort, often leading to restlessness and agitation (Langley et al. 2011). Physical restraints (PR) are often applied to prevent ‘treatment interference’, a term commonly used when patients either accidentally or purposefully remove potentially life-saving medical devices (Hofsø and Coyer 2007). Treatment interference can be detrimental for the health, safety and medical progress of these patients and may even result in death (Kielb et al. 2005). Despite this, the application of PR ultimately impinges on a patient’s autonomy and interferes with the nurses’ ability to maintain patient dignity (Jiang et al. 2015). Nurses, who have been identified as the primary decision makers in the application and removal of physical restraints in ICU (De Jonghe et al. 2013), have reported that this can lead to many moral and ethical dilemmas (Choe et al. 2015). In addition, PR can also cause injuries, delirium and further agitation (Warlan and Howland 2015). Mechanically ventilated patients are particularly vulnerable as they already experience a great degree of pain, distress and discomfort and are unable to verbally communicate (Wang et al. 2009). This experience can also affect patient’s families, potentially generating familial distress as they are often present during patients’ ICU admissions and witness PR during mechanical ventilation (Fink et al. 2015).
There is an extensive amount of literature available regarding the presence and practical uses of physical restraints in intensive care worldwide, as well as evidence of the inconsistencies in policy availability and adherence among these ICUs regarding PR. However, there is a paucity of literature that explores the lived experiences of patients who have been physically restrained during mechanical ventilation, their families and the nurses who care for them. Further research therefore is needed in this area.
This study has gained ethical approval from the Western Sydney University Human Research Ethics Committee (HREC No. H12028). This qualitative study will explore the experiences of physical restraints during mechanical ventilation from the perspectives of the patients, families and nurses. Participants will be recruited using purposive sampling and semi-structured interviews will be used to collect data. Those who may be interested in participating in this study are welcomed to contact the first named author for further information.
This research has the potential to provide new insights into the experiences of physical restraints during mechanical ventilation in intensive care from the perspectives of patients, families and nurses. These insights have the potential to inform strategies for practice change and policy development related to PR. Dawn Perez is a PhD Candidate in the School of Nursing and Midwifery at Western Sydney University and Registered Nurse at Blacktown Hospital Associate Professor Kath Peters is Director of Academic Programs (International) School of Nursing and Midwifery at Western Sydney University Professor Lesley Wilkes is Professor of Nursing in the School of Nursing and Midwifery at Western Sydney University. Centre for Nursing Research and Practice Development at the Nepean Blue Mountains Local Health District. Dr Gillian Murphy is a Lecturer in the School of Nursing and Midwifery at Western Sydney University.
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References Choe, K., Kang, Y. & Park, Y. 2015. Moral distress in critical care nurses: A phenomenological study. Journal of Advanced Nursing, 71(7), 1684-1693. De Jonghe, B., Constantin, J. M., Chanques, G., Capdevila, X., Lefrant, J. Y., Outin, H. & Mantz, J. 2013. Physical restraint in mechanically ventilated ICU patients: A survey of French practice. Intensive Care Medicine, 39(1), 31-37.
Kielb, C., HurlockChorostecki, C. & Sipprell, D. 2005. Can minimal patient restraint be safely implemented in the intensive care unit? Dynamics, 16(1), 16-19 Langley, G., Schmollgruber, S. & Egan, A. 2011. Restraints in intensive care units. A mixed method study. Intensive and Critical Care Nursing, 27(2), 67-75.
Fink, R. M., Makic, M. B. F., Poteet, A. W. & Oman, K. S. 2015. The ventilated patient’s experience. Dimensions of Critical Care Nursing, 34(5), 301-308.
Martin, B. & Mathisen, L. 2005. Use of physical restraints in adult critical care: A bicultural study. American Journal of Critical Care, 14(2), 133-142.
Hofsø, K. & Coyer, F. M. 2007. Part 1. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: Contributing factors. Intensive and Critical Care Nursing, 23(5), 249-255.
Wang, K., Zhang, B., Li, C. & Wang, C. 2009. Qualitative analysis of patients’ intensive care experience during mechanical ventilation. Journal of Clinical Nursing, 18(2), 183-190.
Jiang, H., Li, C., Gu, Y. & He, Y. 2015. Nurses’ perceptions and practice of physical restraint in China. Nursing Ethics, 22(6), 652-660.
ADVERTISE IN THE AUSTRALIAN NURSING AND MIDWIFERY JOURNAL AND GET IN FRONT ADVERTISE IN ANMJ OF 134,000 NURSES AND MIDWIVES AROUND AUSTRALIA. Contact Heidi Adriaanse for the 2017 rates, deadlines and readership information. 0415 032 151 or email@example.com
Warlan, H. & Howland, L. 2015. Posttraumatic stress syndrome associated with stays in the intensive care unit: Importance of nurses’ involvement. Critical Care Nurse, 35(3), 44-54.
ER 2016 O. 5 / N O V E M B V O LU M E 2 4 , N
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MAY Prader-Willi Syndrome awareness month http://praderwilli.org.au/ Kiss Goodbye to MS Day 1 May. Wear red lipstick and help kiss goodbye to MS. www.kissgoodbyetoms.org Lung Health Promotion Centre at The Alfred Respiratory Course (Modules A & B) 1–4 May Respiratory Course (Module A) 1–2 May Respiratory Course (Module B) 3–4 May Asthma Update 26 May P: (03) 9076 2382 E: firstname.lastname@example.org Star Wars Day 4 May. www.starwars.com/may-the-4th Australian Primary Health Care Nurses Association (APNA) National Conference State of the Art 4-6 May, Hobart. http://apnaconference.asn.au/ International Day of the Midwife 5 May. www.internationalmidwives.org/ HealthTimes in partnership with the Australian College of Midwives present: Optimising Fetal Wellbeing Conference A day long examination of fetal wellbeing topics with an outstanding list of expert speakers. The day will commence with the International Day of the Midwife Annual Walk (details on website), participation in the walk is optional. 6 May, Novotel, Melbourne Vic. www.bit.do/fetal Australian College of Dermatology (ACD) Annual Scientific Meeting 6-9 May, International Convention Centre, Darling Harbour NSW. www.adna.org.au/ World Ovarian Cancer Day 8 May. http://ovariancancerday.org/ Holistic Nurses/Midwives Retreat Bali 8-12 May Relax, Recuperate, Renew, Replenish 25 CPD hours (tax deductible) Contact Angeline von Doussa E: email@example.com http://nurses-healing.com/holisticnurses-retreat-bali-may-2017/
NETWORK The Queen Elizabeth Hospital, South Australia, Group 3/86 reunion Date and venue to be advised. Contact Justine Grant (nee Reddaway) E: firstname.lastname@example.org Royal Prince Alfred Hospital, PTS March 1976 reunion 7 June. Contact: Trish Walcott M: 0402 159 352 E: email@example.com Royal Darwin Hospital ,Group 7/77 (also including other groups from this year), 40-year reunion 15 July. Contact Di Robertson E: firstname.lastname@example.org
46 May 2017 Volume 24, No. 10
CHHHS Nursing and Midwifery in the Tropics - Expanding your Horizons Exploring the challenges in clinical practice when caring for clients in tropical regions of Australia and beyond 11-12 May, Pacific Hotel, Cairns Qld. www.bit.ly/ NurseSymposiumViewConference Flyer International Nurses Day Nurses: A Voice to Lead, Achieving the Sustainable Development Goals 12 May. www.icn.ch/ World Hypertension Day 17 May. http://ish-world.com/public/ world-hypertension-day.htm Australian College of Critical Care Nurses Paediatric Conference Basics to bizarre 19 May, Mantra Bell City, Preston, VIC. www.acccn.com.au/ ANMF Vic Branch Undergraduate Student Nurse and Midwife Study Day 19 May, Melbourne Town Hall, Vic. http://bit.ly/ANMFevents Helping Older People to Avoid Hospital Admissions 25-26 May, Sydney NSW. www.changechampions.com.au National Sorry Day 26 May. www.reconciliation.org.au/ news/national-sorry-day-an-importantpart-of-healing/ Gastroenterological Nurses College of Australia National Conference 27-28 May, SeaWorld Conference Centre, Gold Coast, Qld. www.genca.org/ International Council of Nurses (ICN) Student Assembly 27 May, Barcelona, Spain. https:// inscripcion.icnbarcelona2017.com International Council of Nurses (ICN) Congress Nurses at the forefront transforming care 27 May-1 June, Barcelona, Spain. http://www.icnbarcelona2017.com/en/
Bowel Cancer Awareness Month www.bowelcancerawarenessmonth.org/
National Aborigines & Islanders Day Observance Committee (NAIDOC) Week 2-9 July. http://www.naidoc.org.au/
Deakin University – Nurse Practitioner Masterclass This Masterclass supports registrants in their continuing professional development related to the role and function of the Nurse Practitioner in Australia and aims to provide the latest information on scopes of practice for Nurse Practitioners, clinical decision making and current issues. 1-2 June, Deakin Downtown, Level 12, Tower 2, 727 Collins St, Melbourne Vic. www.deakin.edu.au/about-deakin/ events/nurse-practitioner-masterclass Maternal Child and Family Health Nurses of Australia Conference The journey 1-3 June, The Peninsula, Docklands Melbourne. www.mcafhna.org.au/ Lung Health Promotion Centre at The Alfred A Practical Management Approach of Non Invasive Ventilation & Sleep Disorders 1-2 June Sleep: the how, why & the what – skills for your toolkit 1 June The Pressure to Breathe – the skills for success with NIV Spirometry Principles & Practice 5-6 June Paediatric Respiratory Update 26 June P: (03) 9076 2382 E: email@example.com ANMF Vic Annual Delegates Conference 22-23 June, Melbourne Convention and Exhibition Centre, Vic. This two day conference will focus both on exploring occupational health and safety issues for nurses and midwives as well as giving delegates the opportunity to vote on resolutions and help shape the direction of their union for the next 12 months. http://bit.ly/ANMFevents
National Reconciliation Week 27 May-3 June. http://www.reconciliation.org.au/nrw/
Victorian School Nurse Conference 9 September, Lauriston Girls School Armadale. Contact: Lindsey Booth E: firstname.lastname@example.org M: 0407 509 622 Sturt College Nurses, 40-year reunion Hoping you can join us for a casual and fun reunion of the first year of nurses at Sturt College on 4 November. See event on Facebook. Contact Elizabeth Jarman M: 042 270 2917 E: email@example.com
Prince Henry’s Hospital, 1/73, 45-year reunion 27 January 2018. Planning well underway. Trying to locate Carol Ball, Sue Ball, M de Graaf, Barb Gilmore, Sue Gladigau, Hilary Hammond, Barb Dunne, Narelle Harley, Chris Horton, Sue Ramage and Pam Walsh. Contact Jeanne O’Neill (nee Pinder) E: firstname.lastname@example.org PHH, POW and Eastern Suburbs Hospitals, NSW reunion for PTS intake of Feb, 1973 17 February 2018. Contact Roslyn Kerr E: email@example.com or Patricia Marshall (nee Purdy) E: firstname.lastname@example.org
Australia and New Zealand Society of the History of Medicine 15th Biennial Conference Health, Medicine, and Society: Challenge and Change 11-15 July, Australian Catholic University, Fitzroy Campus, Melbourne, VIC. www.dcconferences. com.au/hom2017 ANMF (Vic Branch) Enrolled Nurse Student Study Day 14 July, ANMF House, 540 Elizabeth Street Melbourne. http://bit.ly/ANMFevents Lung Health Promotion Centre at The Alfred Asthma Educator’s Course 19-21 July Respiratory Update 28 July P: (03) 9076 2382 E: email@example.com 5th Annual World Wide Nursing Conference The Role of Nursing in Leading and Advancing Global Health 24-25 July, Singapore. http://nursing-conf.org/ World Indigenous Peoples Conference on Education A Celebration of Resilience 24-29 July, Toronto Canada. www.wipce2017.com/ World Hepatitis Day 28 July. http://worldhepatitisday.org/
AUGUST Lung Health Promotion Centre at The Alfred Smoking Cessation Course 3-4 August Influencing Behaviour Change – a formula 10-11 August Influencing Behaviour Change – Theory & Practice 10 August Influencing Behaviour Change – Intensive Workshop/Case Studies 11 August Spirometry Principles & Practice 14–15 August P: (03) 9076 2382 E: firstname.lastname@example.org NDSN Bendigo School 71, 50-year reunion 2018. Seeking students from Bendigo, Castlemaine, Echuca, Swan Hill, Mildura. Contact E: margie_coad@ hotmail.com or M: 0427 567 511
Email email@example.com if you would like to place a reunion notice
BENEFITS OF HOLISTIC WORKPLACES
LETTER OF THE MONTH
I appreciated the discussion on ways to cope with stress in the ANMJ (February 2017). It is helpful to talk about stress release as Amy Benn writes in Dealing with Death as an ICU nurse. Along the lines of what Maree Burgess described in her column (in the same issue), about the fish tank at her workplace being a remedial experience, health worksites need to be therapeutic places for staff and patients and visitors. Strategies such as going off site for yoga and mindfulness sessions are of benefit, but the workplace as a whole needs to reflect a holistic attitude. Staff office designs as a rule do not incorporate central lounge areas with fish tanks. There are no ‘tea rooms’ anymore. There are ‘stations’ to get a drink or heat food, which results in most people eating at their desk. The culture is of non-stop work. My strategy is to go for a walk and create a break time at different places and times, which does interrupt the everyday stress levels. The topic of holistic workplaces and therapeutic designs in health is worth an edition of its own. Jenny Esots, RN South Australia
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.
EVIDENCE BASED PRACTICE Nurses are taught to seek the most current scientific evidence in order to provide excellent patient care. Evidence-based practice (EBP) in nursing is crucial to successful patient care, and it is also a good tool for shaping policies, procedures and safety regulations. Thus, EBP continues to improve our healthcare systems both for patients and healthcare professionals. The PICOT model is a technique healthcare professionals can use to frame a clinical question and find an answer:
HOSPITALS: THE CAREGIVER’S DILEMMA Breathe in. Breathe out. (insert: a cataclysmic series of unfortunate events) Breathe in. Breathe out. The shift’s over. It’s 0700. Oh wait... What happens when the end of the supply chain is not simply a physical commodity but an intangible product that allows customers to have another shot at life? What happens when a customer’s willingness-to-pay is influenced by whether or not they’d like to come home to their families, whether or not they’d like to get on that horse again, and whether or not they’d like to make it out alive. The value of a life is a proposition one does not simply decide on. Between 2010-2011 and 2014-2015, the number of hospital patient admissions within Australia has increased by 3.5% on average each year (Australian Institute of Health and Welfare, 2016). The demands of the healthcare industry on its major workforce, the caregivers or nurses, are alarming. Excessive workload and unsafe staffing, further complicated by a stressful environment and a shift work lifestyle, contribute to the norms of ‘compassion fatigue’ and burnout among nurses. Researchers have found that nurses experience depressive symptoms at a rate twice as high (18%) - as the general public (http://www.inqri.org/spotlight/ nurses-experience-depressiontwice-rate-general-public). Sick
P – Patient or problem I – Intervention or issue C – Comparison O – Outcome T – Time The evidence, by itself, does not make the decision, but it can help support the patient care process. The full integration of these components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, and/or the etiology of disorders. Sijimole Johnson, RN, Master of Science in Medical Surgical Nursing, Northern Territory
leave is rampantly claimed, often referred to as a “mental health” day or “I just needed a break” day. What happens now when the caregivers themselves need care? The call to be a caregiver is no easy undertaking. It redefines what it means to be selfless in that caregivers give beyond the position description mailed to them by HR, as a response to an emotional responsibility to their customers, also known as patients. Professionalism can only go so far when faced with situations that tamper with the inner recesses of one’s sense of humanity - what it means to be human, what it feels like to suffer from loss, and what it feels like to rejoice in awakening. However, it is this act of selflessness, performed day in and out, that breeds counter-productivity, a lack of motivation and disengagement. The challenge that the healthcare industry faces is one of cultural sustainability. How does this industry keep its workforce productive, motivated and engaged? How will teams of doctors, nurses and allied health professionals work both collaboratively and effectively despite highly stressful environments? The increasing demands of healthcare, due to advancements in science and technology and a growing ageing population, pose an imminent threat to the current model of healthcare provision. For now, reliance on a high staff turnover rate seems to temporarily fix the problem. Unless artificial intelligence emerges sooner rather than later, this industry has a crisis to resolve. Mariella Salita, Critical Care, RN Victoria May 2017 Volume 24, No. 10 47
LORI-ANNE patient ratios. Several campaigns stand out for Lori-anne, including the 2007 EBA where she felt the flood of emotion watching Victorian Secretary Lisa Fitzpatrick walk into Dallas Brooks Hall to announce victory. “There’s been many monumental moments along the way. It’s a fantastic experience to be part of the leadership team and have inspirational role models to learn from.” Lori-anne officially began her new post last month, taking over from predecessor Maree Burgess.
NEW ANMF FEDERAL VICE PRESIDENT VOWS TO GIVE PEOPLE A VOICE Newly appointed ANMF Federal Vice President Lori-anne Sharp believes nurses and midwives have the ability to become influential leaders. “Nurses and midwives are often the pillars in our society that many people refer to when they need help,” she explains. “Nurses and midwives’ ability to empathise and show compassion is a great strength. I’d like to encourage nurses and midwives to be leaders within their workplace and get involved with their union because they have much to offer and it can open the way to many different opportunities.”
LORI-ANNE DESCRIBES HERSELF AS A NATURAL LEADER, APPROACHABLE AND ABLE TO CONNECT PEOPLE TOGETHER.
justice and equity in health lent itself to joining the HPP,” Lori-anne recalls. Lori-anne says she’s never met anyone who chose to be homeless. Her passion for the sector stems from a desire to offer hope, understanding, and ensuring those experiencing homelessness receive the same level of healthcare as the rest of the population. “Circumstances that lead people to homelessness are often complex. We see a lot of generational poverty, a history of childhood trauma and mental illness. Homelessness is not just having a safe place to live but also having the family and community supports that many people often take for granted.
A Registered Nurse with more than two decades of experience, Lori-anne has spent the majority of her career in district nursing working for the Royal District Nursing Service (RDNS) across a variety of roles and sites. A decade ago she took up a role with the RDNS Homeless Persons Program (HPP), a specialised team of Community Health nurses who provide healthcare to people experiencing homelessness.
“In terms of nursing, it’s an honour to be a nurse. You experience intimate relationships with people and that is a privilege. It’s also fantastic working amongst nurses, who understand the frailties of life and what is important.”
She is currently a Team Coordinator managing a team of nurses who deliver healthcare to some of the most vulnerable.
She rose from a Job Representative to joining the Victorian Branch Council in 2004 and became a pivotal cog in the union effort negotiating EBAs on behalf of members and securing landmark policies such as nurse-to-
“My values and ideals around social 48 May 2017 Volume 24, No. 10
Looking back, given Lori-anne’s drive to advocate for others and improve conditions in the workplace, becoming a more active member within the ANMF seemed a logical step.
Undoubtedly, the role presents new challenges and a chance to trigger change. Lori-anne says she is looking forward to tackling numerous key areas of focus within the ANMF, including protecting penalty rates, ensuring qualified staff in aged care, safeguarding universal healthcare, and supporting assisted dying legislation. On a personal note, she plans to use her newfound voice to raise awareness about social justice issues like affordable housing and how a well-considered national housing strategy could positively impact the health of those disadvantaged. Lori-anne describes herself as a natural leader, approachable and able to connect people together. She is committed to the nursing profession and mobilising the nursing workforce. She says her promotion to Federal Vice President heralds a great opportunity to further her dedication to the union movement. “I’ll be on a learning curve but I’m certainly ready for it. I’ll really enjoy the national perspective and challenge. I will be mindful of looking at issues from a national standpoint.” As part of her new appointment to Federal Vice President, Lori-anne will write regular columns in the ANMJ throughout the year. She says topics of interest she’d like to delve into include increasing activism within communities, mobilising the nursing workforce, and the benefits of reflective practice. Now an integral part of the ANMF’s Federal Executive, Lori-anne says she hopes to bring people together and build on the union’s reach. “I’d like to empower all nurses to get active within their union, organise and support each other to speak out about injustices. Nurses should be encouraged to hold leadership roles within their workplaces and communities.” anmf.org.au
front line angels The tireless devotion of service nurses Nurses have played a critical role in Australian military history, tending to the needs of sick and wounded soldiers as well as civilians whose lives have been affected by war and natural disaster. This Anzac Centenary triangular coin is inspired by Napier Wallerâ€™s iconic stained glass window in the Hall of Memory at the Australian War Memorial.
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