ANMJ May 2015

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

M AY 2 0 1 5

Violence in our health sector

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Australian Nursing & Midwifery Journal - www.anmf.org.au

Editorial Lee Thomas, ANMF Federal Secretary It’s that time of the year again to pay tribute to all nurses and midwives. Around the world we will celebrate International Day of the Midwife on 5 May and International Nurses Day on 12 May.

Yet, more must be done to address this situation. As a matter of urgency the ANMF will continue to work towards ensuring all workplaces are safe through persistent consultation with governments and healthcare facilities. A recommended read is this month’s feature, which delves into all these issues and what is being done, in more detail.

While it’s abundantly clear that the role nurses and midwives play does matter in the sustainability of Australia’s healthcare system, it’s important we acknowledge your value and applaud the work you do every day.

To mark the end of an era the ANMJ pays tribute to two of the professions’ greats - outgoing ANMF Federal President Coral Levett and Australia’s first Commonwealth Chief Nurse and Midwifery Officer Dr Rosemary Bryant, both of whom have recently resigned from their positions.

This said, I strongly encourage you to mark these days with some form of celebration, whether it be cake shared with colleagues, a breakfast event or an acknowledgment given to a work mate for a job well done.

Most of all- be proud of the important and valuable work you and your colleagues do that makes the difference in the lives of so many.

Violent incidents towards nurses are occurring at an ever increasing rate, many of which are happening in our hospital emergency departments and aged care facilities. The rise in the number of assaults seen across the country in these sectors is staggering and a particularly alarming trend. The ANMF has been instrumental in working with key stakeholders to help make our health and aged care facilities and community settings safe for all who work in them. Recently the ANMF joined a newly formed ACTU ant-violence working group, consisting of multiple unions who are also concerned about escalating violence throughout the community and in workplaces.

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Coral, who served six two-year terms as ANMF’s Federal President, has been invaluable to the success of the ANMF and, as mentioned last month, we are grateful for the great support and guidance she provided during this time.

Similarly, Rosemary has been an exemplary nurse leader. With integrity and strength, Rosemary has done much for the professions on a national and international scale. I am also appreciative of her collegial support towards the ANMF and to me personally over the years.

As you are aware, part of the process for registration is to ensure a minimum number of continuing professional development hours. Ways to build up your hours is to read the ANMJ or access ANMF’s online professional training room, which has tutorials on a wide variety of topics. To access the tutorials and find out more go to: http://anmf.org.au/pages/onlineeducation-programs

Before I sign off I just want to remind you that it’s time to renew your annual general or non-practising registration by 31 May.

May 2015 Volume 22, No.10 1

Australian Nursing & Midwifery Federation National Office www.anmf.org.au

Canberra

Editorial

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

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

Melbourne & ANMJ

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

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Northern Territory

South Australia

Victoria

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

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

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

The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia. Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement. All rights reserved.

Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrang­ement with the Australian Nursing & Midwifery Federation Federal Office Note: ANMJ is indexed in the CUMULATIVE INDEX to NURSING AND ALLIED HEALTH LITERATURE and the INTERNATIONAL NURSING INDEX ISSN 2202-7114

Moving state? Transfer your ANMF membership

If you are a financial member of the ANMF, QNU or NSWNMA, you can transfer your membership by phoning your union branch. Don’t take risks with your ANMF membership – transfer to the appropriate branch for total union cover. It is important for members to consider that nurses who do not transfer their membership are probably not covered by professional indemnity insurance.

New South Wales

Queensland

Tasmania

Western Australia

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

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

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

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

2 May 2015 Volume 22, No 10

144,496

TOTAL READERSHIP

Based on ANMJ 2014 member survey pass on rate Circulation: 98,970 BCA audit, March 2015

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Contents

Volume 22, No 10

22

News 4

Violence in our health sector

Leadership 16

In harm’s way

Working life

14

International days

15

Coral tribute

19

Issues

20

World 21 Feature – In harm’s way 22 Clinical update

28

Industrial 32 Ethics 33 Education 34

04

28

Viewpoint 36 Research 37 Wellbeing 38 Working life

39

Issues

40

Focus – Drug and Alcohol 41 Mail News

Clinical Update

Triage nurse’s assessment of a child with a fever

53

Calendar 55 Annie 56

34

41

Education

Focus

Prevention of Occupational Violence and Aggression in Healthcare

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Drug and Alcohol

May 2015 Volume 22, No.10 3

News Chief Nurse and Midwifery Officer Dr Rosemary Bryant to retire

Inactivity increases risk of developing dementia

By Karen Keast

Inactive Australians face a higher likelihood of developing dementia, according to Alzheimer’s Australia.

Australia’s pre-eminent nurse leader Dr Rosemary Bryant AO is bowing out after almost seven years as the first Commonwealth Chief Nurse and Midwifery Officer.

Dr Bryant will retire from her Canberrabased position at the pinnacle of the professions at the end of May. A new Chief Nurse and Midwifery Officer is expected to be appointed within months.

Dr Bryant said while it was a difficult decision to make, she was looking forward to embracing opportunities such as travel.

“I just love the work but, on the other hand, it really is time for me to retire - there are a lot of other things I want to do.”

In her career spanning 52 years, Dr Bryant rose through the nursing ranks to be appointed to the prestigious national position in 2008, was elected to the Board of the International Council of Nurses (ICN) in 2001, served as the Second Vice President from 2005 to 2009 and was the 26th President of the ICN from 2009 to 2013.

Dr Bryant completed her nursing training at Brisbane’s Princess Alexandra Hospital and spent most of her clinical career in Adelaide, where she was the Director of Nursing at the Royal Adelaide Hospital and was also the President of the then Royal Australian Nursing Federation.

Dr Bryant went on to become the Chief Nurse of the Department of Health in Victoria before taking up the position as the Executive Director at the then Royal College of Nursing, Australia, for eight years.

Dr Bryant was then appointed to the Commonwealth role, where she has since provided a significant nursing and midwifery perspective to policy work and advising on developments to the professions.

Last year, Dr Bryant was honoured as an Officer of the Order of Australia for her distinguished service to the nursing profession.

In her retirement, Dr Bryant leaves behind a lasting legacy of advancing nursing and midwifery at both a national and an international level.

Dr Bryant said her time as ICN President, and serving 12 years on the Board of the federation of more than 130 national nurses’ associations, was 4 May 2015 Volume 22, No.10

DR BRYANT SAID WHILE THE RETENTION OF NURSES IN THE WORKFORCE REMAINED A CHALLENGE, THE FUTURE OF THE PROFESSIONS “LOOKS BRIGHT”. incredibly rewarding.

In her role as Chief Nurse and Midwifery Officer, Dr Bryant led the National Review of Maternity Services and was pivotal in enabling nurses and midwives to gain access to the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. Dr Bryant has also been heavily involved in the National Registration and Accreditation Scheme.

Dr Bryant said while the retention of nurses in the workforce remained a challenge, the future of the professions “looks bright”.

“We’ve got very good leaders in nursing and midwifery who have a vision for the future and who are able to implement that,” she said.

“In terms of what nurses do, the scope of practice for nurses is expanding.

Although there’s still the traditional roles for nurses working in acute hospitals, the opportunities are boundless.

“I’ve never regretted becoming a nurse and it’s been a wonderful career,” she said.

It is extremely rewarding and fulfilling and I would recommend it to anyone.”

A recent report from the Australian Institute of Health and Welfare (AIHW), which has indicated more than half of the Australian population are inactive, is of great concern to the organisation who fear the rate of dementia will increase.

Alzheimer’s Australia CEO Carol Bennett said research has found around 13% (or approximately four million) of Alzheimer’s disease cases worldwide are attributed to physical inactivity. “If a quarter of inactive people became more active, this could prevent nearly one million cases of Alzheimer’s disease worldwide.”

Other risk factors for cognitive decline include modifiable diseases such as cardiovascular disease and diabetes.

“A growing body of evidence is finding that there is an association between diabetes, cardiovascular disease, among many other chronic diseases, as well as cognitive decline,” Ms Bennett said. “If left unchecked, these chronic diseases can increase a person’s risk of developing dementia.”

To educate the risk to the Australian public on the modifiable risk factors of dementia Alzheimer’s Australia has launched a dementia risk reduction program Your Brain Matters. The program looks at maximising brain health such as managing blood sugar, blood pressure and cholesterol levels which have been proven to reduce developing chronic diseases including dementia.

To view the program go to: www.yourbrainmatters.org.au

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News QNU fights deportation of nurse and son

By Karen Keast

The Queensland Nurses’ Union (QNU, ANMF Queensland Branch) has called on the federal government to show compassion to a registered nurse and her son who face deportation as a result of the 10-year-old’s autism diagnosis.

The fate of Maria Sevilla and her son Tyrone (pictured) lay in the hands of Federal Immigration Minister Peter Dutton at the time of going to print, with a decision expected to be handed down before the end of April.

In March, the Migration Review Tribunal rejected Maria’s request for a Skilled Regional Provisional visa on the grounds that Tyrone’s condition would “result in a significant cost to the Australian community in the areas of healthcare”.

Maria moved from the Philippines to Australia in 2007 to be closer to her family and studied to fulfill a childhood dream of becoming a nurse. Maria now works in the Rehabilitation Ward at the Townsville Hospital. Tyrone was diagnosed with autism

Private health insurers expand reach to Primary Health Networks

By Karen Keast

The Australian Nursing and Midwifery Federation (ANMF) has warned the federal government’s decision to allow private health insurers to run some of the country’s new Primary Health Networks (PHNs) is a step towards a two-tiered Americanised healthcare system.

ANMF Assistant Federal Secretary Annie Butler said the expansion of private health insurance companies into primary care, with at least four of the 31 PHNs set to feature partnerships with private health insurers, will come at the expense of Australia’s equitable public healthcare system.

Ms Butler said the move raises concerns about prioritised treatment for health insurance members and the potential to influence treatment decisions based on

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at the age of two, six months after they arrived in Australia.

The QNU rallied behind Maria and Tyrone after learning of their plight through Maria’s Change.org petition to the Minister, which has received more than 87,000 signatures.

QNU Secretary Beth Mohle said the union lodged a submission with the Minister’s office on World Autism Day to highlight concerns at the government’s prejudice when it comes to the developmental disability that affects an estimated 230,000 Australians. “It really is time to challenge our preconceptions about people with autism. Who knows, Tyrone could make a significant contribution to the Australian community. Just because he has a disability doesn’t mean that he’s going to be a burden - we need to be fundamentally challenging that.”

The QNU has written to every Federal Member of Parliament in Queensland and the Queensland Health Minister, calling on them to support Maria and Tyrone’s bid to remain in Australia.

“It’s very important for us to get collectively behind a nursing colleague who is a valued member of the profession and making a significant contribution to her community in Townsville,” Ms Mohle said.

“Tyrone can’t speak a language other

cost outcomes. “Private health insurers are profit driven so you just can’t be sure that everybody is going to be given the same treatment,” she said.

“The idea of private health insurance being in control of any health service is that we start to follow in the footsteps of the US system of managed care. This could be a stepping stone to the full privatisation of primary healthcare.”

Ms Butler said the government’s decision to establish the PHNs as GP-centric was an inefficient way to address healthcare demands.“They would be much better to have genuine multidisciplinary teams at the core of the networks and a much wider use of not just nurses but other health professionals. Utilising more nurse practitioners would also dramatically control costs.”

Chris Helms, a primary healthcare nurse practitioner from the ACT, was also concerned that the PHNs had been set up to be medico-centric and GP-led.

“Basic primary healthcare principles which emphasise collaboration and egalitarianism have been somewhat understated in the

than English and Maria is a single mum - all of the family networks are here, so there’s a multitude of reasons why the Minister should be intervening on this matter.

“It’s consistent with our nursing and midwifery and union values that we will act collectively to support someone who is being treated unfairly.”

formulation of these networks.”

Mr Helms said nurses, Aboriginal health workers, community and allied health professionals must help shape the PHNs through clinical councils and advisory groups. “This is an opportunity for nurses to step up and have a voice in the future of primary healthcare in Australia and it’s vitally important that we as nursing professionals apply for advisory and clinical council positions within these PHNs. “Hopefully, these groups are able to function in a manner which leads to true collaboration and innovation in Australian primary healthcare.”

Ms Butler said the federal government had been ignoring nurses and midwives in its health reforms, with Health Minister Sussan Ley yet to meet with the ANMF. “We are just so invisible to the government at the moment, even though we’ve got some solutions for them. You wouldn’t find another health professional who understands unnecessary waste and how to control costs better than nurses.”

The PHNs replace the 61 Medicare Locals and will be rolled out from 1 July.

May 2015 Volume 22, No.10 5

News Senate Inquiry into temporary work visas welcomed A Senate Inquiry into the growing use and reported abuse of temporary work visas including 457 visas has been welcomed by the Australian Nursing and Midwifery Federation (ANMF).

The Inquiry came after the ANMF along with the ACTU and other unions lobbied for Australia’s temporary visa system to be transparent, regulated and put local jobs and training first.

In addition Australian unions had genuine concern that foreign workers on temporary visas were being exploited and that unscrupulous employers were rorting the scheme at the expense of Australian jobs.

The Senate Inquiry will investigate a wide range of issues including: • The extent of exploitation and mistreatment of temporary work hold visa holders; • The impact of temporary visa program on employment opportunities for Australians;

• The impact of the temporary visa

program on skills and training in Australia; • The role and effect of English language requirements in work visa programs.

ANMF Federal Secretary Lee Thomas said it was imperative that graduate nurses and midwives were given every opportunity to gain employment. “There are clearly many graduates unable to find positions, which have been in some instances at the expense of foreign workers on temporary visas gaining work first. The ANMF’s priority is to make certain graduates have jobs as well as safeguarding those on temporary visas from exploitation. We welcome this Inquiry so as to ensure Australia has a fair migration scheme for all involved.”

ACTU President Ged Kearney said the Senate Inquiry was a positive step towards ensuring foreign workers were not being exploited and that employers were genuinely trying to hire Australian workers first. “Across the country we are seeing employers cutting apprentice numbers and graduate nurse positions as well as their investment in training, then complaining they are unable to find skilled workers as a justification for bringing in workers on 457 visas.”

More Tasmanian Diploma of Nursing students to be educated at the ANMF The ANMF (Tasmanian Branch) has been given a financial injection into its Health Education and Research Centre (HERC) to provide the Diploma of Nursing (enrolled nursing) to an extra 20 students.

The state government funding is part of a $198,000 funding boost into Tasmania’s state health system.

ANMF Tasmanian Branch Secretary Neroli Ellis said they welcomed the funding which would provide opportunity for Tasmanians to further their education to meet the needs of the workforce.

6 May 2015 Volume 22, No.10

According to the ANMF Tasmanian Branch there will be a projected shortfall of 384 ENs in Tasmania by 2020 based on current predictions.

“Enrolled nurses are a vital part of the health workforce and our innovative new Diploma will provide industry ready, quality graduates,” Ms Ellis said.

Women’s sector calls for an end to gender violence The Council of Australian Governments (COAG) have agreed to take urgent action to address the unacceptable level of violence against women.

The agreed action follows media reports that suggest 31 women have died in Australia over the last four months as a result of violence. The most recent verified annual data showed that on average one woman a week was killed by her current or former partner.

By the end of 2015 COAG hopes to: • Agree on a national domestic violence order (DVO) scheme, where DVO’s will be automatically recognised and enforceable in any state or territory of Australia; • Progress to be reported on a national information system that will enable courts and police in different states and territories to share information on active DVOsNew South Wales, Queensland and Tasmania will trial the system; • Consider national standards to ensure perpetrators of violence against women are held to account at the same standard across Australia, for implementation in 2016; and • Consider strategies to tackle the increased use of technology to facilitate abuse against women, and to ensure women have adequate legal protections against this form of abuse.

COAG has also agreed to jointly contribute $30 million for a national campaign to reduce violence against women and their children and potentially for associated increased services to support women in seeking assistance.

YWCA CEO Dr Caroline Lambert said violence against women is a national emergency that requires urgent responses from the leaders of our nation. “The Australian community’s awareness of violence against women has grown significantly as a result of previous government initiatives. Now is the time to work on the root causes and raise a generation of children and young people who respect each other, regardless of gender, and for whom violence against women is unthinkable.”

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When pain is gone, the smile is back.

Nothing is more effective than Children’s Panadol® 1 –4† Suitable from 1 month of age, Children’s Panadol®‡ effectively relieves pain and fever caused by teething, headache, earache, immunisation, and symptoms of cold and flu.1–3

†

Refers to non-prescription medicines at the recommended Australian doses for paediatric paracetamol (15 mg/kg) and ibuprofen (10 mg/kg).‡Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.5

References: 1. Autret-Leca E et al. Curr Med Res Opin 2007;23:2205–11. 2. Walson PD et al. Am J Dis Child 1992;146:626–32. 3. Schachtel BP et al. Clin Pharmacol Ther 1993;53:593–601.

4. Celebi S et al. Indian J Pediatr 2009;76:287–91. 5. NSW Department of Health. Policy Directive: Paracetamol Use. Available at: http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html.

Accessed January 2015.

Children’s Panadol® contains paracetamol. For the temporary relief of pain and fever. PANADOL® and package design elements are registered trade marks of the GlaxoSmithKline group of companies.

GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington, NSW 2115 Australia. GSK1481/UC 02/15. CHANZ/CHPAN/0021/15b.

News Rates in golden staph drop The rate of healthcare associated Staphylococcus aureus (S. aureus) (golden staph bloodstream infections) have fallen in Australia’s major public hospitals, according to the latest report from the National Health Performance Authority.

Nurse practitioner gains prestigious fellowship A nurse practitioner and Queensland Nurses’ Union (QNU, ANMF QLD Branch) member is the first Australian to be selected as 2015 Fellow of the American Association of Nurse Practitioners (AANP).

The prestigious fellowship was awarded to Daniel O’Neil, who works at Gympie Hospital as an emergency department nurse practitioner.

Mr O’Neil said the ANNP was in its 15th anniversary of the fellowship program, with the first class of fellows exemplifying outstanding leadership being inducted in 2000.

According to Mr O’Neil AANP has selected outstanding leaders whose

contributions have shaped practice, education, research or health policy. “The selected who have become fellows have made a significant difference to healthcare and to the nurse practitioner role which will continue to expand.

“It’s a huge achievement to be selected for this. It’s an honour to be recognised in this way for my work and acknowledged as an expert in my field,” Mr O’Neil said. “As a Fellow of the AANP my role will be to assist in the advancement of nurse practitioners and the high-quality healthcare they deliver.”

Mr O’Neil set up the nurse practitioner service at Gympie Hospital last September.

“I’m given a lot of exposure to a variety of cases and you can really see the difference that the nurse practitioner role has made in the emergency department.”

Mr O’Neil will be inducted as a Fellow at the AANP’s 30th national conference in New Orleans in June.

School nurses to be reinstated Child health and youth health nurses will be reinstated in Tasmanian government schools as from July this year.

Stage one of the process is recruiting 10 registered nurses and it is expected there will be 20 full time equivalent nurses working across Tasmanian schools by July 2017. Each of the nurses will be allocated a number of schools within their region. The program includes dedicated primary school nurses and secondary school nurses who will provide health services to students in

8 May 2015 Volume 22, No.10

The hospitals recorded a 6% decline in the number of hospital cases with the potentially deadly infection, with the report showing 88 fewer cases in 2013-14 compared to the previous year.

However the report highlighted variations between individual hospitals, with patients still up to three times more likely to catch bloodstream infection depending on the hospital where they recieved care.

National Health Performance Authority CEO Dr Diane Watson said while the reduction of about 100 cases is an improvement, it should be remembered that every healthcare-associated bloodstream infection was both potentially deadly and preventable. “Differences in the rate of infection suggests there is an opportunity for hospitals to continue to learn from each other to lower infection rates.”

targeted schools across Tasmania.

In primary schools, nurses will focus on vision and hearing checks and nutrition, while in high schools risk behaviour and mental health will receive greater attention.

School nurses, which provided health checks to prep children, were phased out of Tasmania in 2013 in favour of a model offering checks for three to five year olds through the Child Health and Parenting Service or the family GP. At the time the Australian Nursing and Midwifery Federation (ANMF Tasmanian Branch) were deeply concerned about the model, amidst concerns at least 10% of families would not engage with the service.

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Can you see yourself behind the wheel of a QASHQAI? Your employer can.

Did you know your employer can help you get into a brand-new Nissan SUV? If you’re working in health, they can. When you salary sacrifice a Nissan with your employer you’ll see that combining the potential for tax minimisation and Nissan’s novated pricing will exceed your expectations.

Talk to your employer about eligibility and your Nissan Dealer for novated pricing.

Excludes GT-R. For more info, visit nissan.com.au/salsac

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News

Pictured (Left – Right): Fiona Wake (RAHC Clinical Manager), Anna Heisar (Award Recipient), Dr Tony Austin (RAHC Chair).

Dedicated remote area nurse honoured

By Karen Keast

A registered nurse and midwife who helped evacuate about 400 people from the remote Aboriginal community of Warruwi in the face of Tropical Cyclone Lam has been recognised for her outstanding contribution to healthcare.

Anna Heisar, a nurse from Apollo Bay in Victoria and a ANMF (Victorian Branch) member, was awarded the Remote Area Health Corps (RAHC) Annette Walker Award for 2014 at an event held in Sydney on 13 March in recognition of her outstanding contribution as a RAHC health professional.

Originally from Italy, Anna trained as a nurse and midwife in the early 1970s

Prominent health organisations demand better health and energy choices A position paper on the implications of energy choices on people’s health in Australia has been released by the Climate and Health Alliance.

The paper is an agreed position with seven prominent health signatories including the Australian Nursing and Midwifery Federation (ANMF).

The signatories are calling for a swift phase out of fossil fuels arguing its rapid expansion in Australia is posing health risks to Australians and people in other countries whose health is affected by the combustion of fossil fuels exported from Australia.

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before moving to Australia. Anna’s nursing career spans more than 40 years, with the past seven years spent working as a remote area nurse and midwife in both Central Australia and the Top End. Anna, who has undertaken 17 placements in 11 communities with RAHC since 2010, was recognised for her dedication as a Remote Educator, assisting nurses to transition clinically and culturally to remote practice.

Anna’s own negative experience of being ‘thrown in the deep end’ when she first began working remote, before RAHC was established in 2008, prompted her to move into a role where she now provides support and mentoring to new-to-remote health professionals.

RAHC Clinical Manager Fiona Wake said Anna was pivotal in transitioning nurses as part of a program with Melbourne-based Western Health, where she assisted nurses from the hospital’s emergency department to complete regular placements at Warruwi on South Goulburn Island, which is located about 300km east of Darwin, while also working as the acting manager. “Anna opened her arms to each of these young nurses who came up, supported them and worked beside them. She cooked them meals and sat with them when they cried over things and laughed with them.

Ms Wake said every single nurse came away and just raved about Anna - what an incredible nurse she is as well as a person,

Pollutants associated with the exploration and production of energy from fossil fuels contaminate air, water and soil and contribute to cardiovascular, respiratory, neurological, reproductive, endocrine, kidney disorders and cancers, the position paper states.

The signatories are wanting more readily available information about the delirious health effects on current energy policies and practices; make known publicly their own position on climate change, energy and health; and contribute recommendations for action to the public and political debates about these issues.

ANMF Federal Secretary Lee Thomas said the impact climate change had on health significantly added to Australia’s health burden. “It’s imperative Australia commits in a prompt and meaningful way to ensure that catastrophic climate change is avoided for the sake of our environment and the health of all Australians.”

and how much the community admire and respect her. “Anna epitomises what we are trying to do at RAHC and that’s to help build the workforce in a safe and positive way because Anna’s experience when she first started out bush isn’t unique.”

Ms Wake said Anna also went above and beyond the call of duty when she helped the Warruwi community evacuate to the Darwin Showgrounds in February.

“She was diligent in making sure everyone got to safety and then she went around making sure people had warm blankets, clothes, beds to stay in and food.”

This is the second year the Annette Walker Award, named in honour of a much-loved and respected member of the RAHC team who passed away unexpectedly in 2012, has been presented.

Nominations open for Australia’s top nurse or midwife awards Do you know an outstanding nurse or midwife who deserves to be recognised? If so why not nominate them for the 2015 HESTA Australian Nursing awards.

Nominations are being sought from colleagues, patients and employers and are open until 31 July 2015.

The annual awards recognise graduates, individuals and teams for their professionalism, innovation and care, across a range of health settings.

The winners of the Nurse of the Year and Outstanding Graduate Award will each receive a $5,000 ME Bank Everyday transaction account and $5,000 towards further education. The Team Innovation Award winner will receive $10,000 development grant to take their program or initiative to the next level.

The 2015 finalists will be announced in September and interstate finalists will be flown to Brisbane for the Award dinner on 15 October.

To make a nomination or learn more about the awards go to: hestaawards.com.au

May 2015 Volume 22, No.10 11

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Personal Diary

News Saving lives at risk of suicide A guide to help parents and other family members reach out to young people at risk of suicide has been launched by beyondblue.

The Family Guide for Youth Suicide Prevention gives advice on how to have a conversation with a young person who may be at risk, what factors place young people at risk and warning signs to look for.

Suicide is the biggest killer of young Australians, with around 350 people between the ages of 15 and 24 dying by suicide in 2013. This is around one death a day, double the number killed in car accidents.

Beyondblue CEO Georgie Harman said families of young people are often really worried about them, but are too afraid to ask them if they are thinking of

NMBA update • Updated documents for national

policies, guidelines, factsheets and position statements The Nursing and Midwifery Board of Australia (NMBA) has conducted a review and analysis of its suite of documents to ensure consistency across national policies, guidelines, factsheets and position statements.

The review identified a number of documents that required revision or rewrite and a number of recommendations to improve stakeholder engagement with our web page. Based on this review, a new suite of updated and streamlined NMBA documents including national policies, guidelines, factsheets and position statements are now available.

• New registration standards ready

for ministerial approval

Future directions decided at COAG Federal, State and Territory Health Ministers have agreed to the terms of the first National Code of Conduct for healthcare workers at the COAG Health Council held last month.

The Code of Conduct will set the standards of conduct and practice for all unregistered healthcare workers. The ministers agreed the jurisdictions would anmf.org.au

hurting themselves. “That needs to change because we talking about suicide does not cause suicide. In fact, asking questions may prevent suicide by showing the young person that someone cares.”

Ms Harman said the freely available family guide contained potentially lifesaving information, along with other practical tips and evidence-based advice to help family members support at-risk young people and steer them through adolescence and beyond. “If you are concerned about a young person in your life, then you should read this guide. It may be exactly what’s needed to help you save a

The NMBA have developed new versions of two of its key standards: • nurse practitioner endorsement registration standard and associated guidelines; • endorsement for scheduled medicines for midwives registration standard.

These standards will now be sent to the Australian health ministers for approval and will be effective once approved. To keep up with changes visit the NMBA website.

• Online renewal for nurses and

midwives is now open We have recently launched our renewal campaign for 2015. If you are a registered nurse, an enrolled nurse, a midwife or a nurse practitioner, look out for renewal reminders from the Australian Health Practitioner Regulation Agency (AHPRA).

To update your contact details use AHPRA’s secure online services for health practitioners.

examine the implementation of the National Code and the code-regulation regime.

However, Australian Nursing and Midwifery Federation (ANMF) Federal Secretary Lee Thomas said the ANMF still maintained its position that assistants in nursing should be regulated in order to protect the public. “Our concern with the COAG approved approach is that action won’t be taken until harm has occurred.”

The Ministers also agreed at the meeting to extend the current exemption for Professional Indemnity Insurance (PII) for

life or change one for the better.”

For more information go to: www.beyondblue.org.au/resources/ family-and-friends/parents-andguardians/family-guide-to-youthsuicide-prevention

We have reduced your registration fees which is now $150 for general registrants.

We are committed to maintaining fees at a reasonable level for registrants, while still ensuring we can deal with unexpected regulatory matters as they arise.

Registrants who hold both nursing and midwifery registration will continue to only pay one registration fee.

In order to meet registration requirements we remind you to carefully read the NMBA’s requirements for registration renewal. Make sure you understand the declarations you must make regarding mandatory registration standards.

If you do not renew your registration by 31 May, or within the following onemonth late period, your registration will lapse. Your name will be removed from the national register of nurses and midwives and you will not be able to practise without making a new application for registration. For more information go to: www.nursingmidwiferyboard.org.au

privately practising midwives providing intrapartum care at home until December 2016, while further work on an indemnity product is being undertaken.

Ms Thomas said the ANMF welcomed the extended exemption which would allow these midwives to continue to practice thereby giving women choice. “We urge the government to continue working towards ensuring there is professional indemnity insurance for these midwives for the protection of birthing mothers and for the midwives themselves.”

May 2015 Volume 22, No.10 13

Working life

Nurses in Action - a step out of my comfort zone but so rewarding

By Danielle Hanlon

In January this year I participated in World Youth International’s Nurses in Action program based in Kenya, Western Africa.

Along with seven other Australian nurses I stayed one month in the rural community of Odede near Lake Victoria. Here we spent time at the local hospital, other hospitals and clinics nearby, as well as community outreach, where we took our nursing equipment and medical supplies in our backpacks and headed out on motorbikes to villages further afield, visiting people in their own homes.

We provided nursing care to newborn babies right through to the elderly. We held school medical camps, where we provided intestinal worming and ringworm treatments to the students, and health education to the students and teachers.

As a group we provided education and assessment on basic life support and wound care to the nursing staff of Odede hospital.

Although we provided a lot of education while in Odede, we also learnt new 14 May 2015 Volume 22, No.10

information and skills from the Kenyan people.

One of our most rewarding experiences was our medical camp. All eight Australian volunteers, as well as nurses, clinical officers, laboratory staff and assistants from Odede set up a temporary camp in an outlying village. Here we provided assessment, consultation, pathology and pharmacy services, as well as cervical cancer screening to locals, some who had travelled a great distance. In just one day we treated 321 men, women and children.

It truly was one of the most uplifting and inspiring events of the trip.

While in Odede, we lived in very basic conditions with no running water, we ate traditional Kenyan food and spent time with local women and children. We spent our Saturday’s at the Vulnerable Children’s group, where we provided education and fun activities for the children who are either orphans, HIV positive or from extremely impoverished backgrounds.

My time spent in Kenya definitely was an eye opening experience and a huge learning curve as we helped treat people with conditions such as HIV/AIDS, tuberculosis, ringworm and malaria (most of which are uncommon in Australia).

The healthcare standards and practices are very different to Australian standards, which often made our work more

challenging and we did definitely see some practices that were at times heartbreaking.

The Kenyan people were very happy and extremely appreciative for the care they received.

Life changing This experience has been life changing… I have met some wonderful Australian nurses with whom I will stay in contact with in the future. It opened my eyes and reminded me how lucky we are in Australia and it has inspired me to continue to volunteer in the future.

It was a big step out of my comfort zone, to join a group of nurses I had never met before, live and work with them for a month in an environment very different to what I was accustomed to, but I am so glad that I did and I encourage other nurses to look into this program. This program is open to nurses (including 3rd year students) and other healthcare professionals.

For more information please go to www.worldyouth.org.au My time in Kenya had both heartbreaking and heart-warming times and because of this Kenya will remain in my heart forever.

Danielle Hanlon is a Registered Nurse (Paediatrics) from Albury Wodonga Health, Albury, NSW anmf.org.au

International days Midwives and nurses acknowledge and celebrate International Day of the Midwife kicks off on 5 May and International Nurses Day is celebrated on 12 May. During this time the professions and the community take time to acknowledge the significant, and often extraordinary, contribution nurses and midwives make to so many.

International Nurses Day was first declared on 12 May 1974 by the International Council of Nurses (ICN) to celebrate the birthday anniversary of Florence Nightingale.

Each year the ICN picks a theme to highlight an important issue to the profession. This year’s theme is: A Force for Change: Care, Effective, Cost Effective. The statement acknowledges ICN’s commitment to strengthen and improve health systems around the world.

Australian Nursing and Midwifery Federation (ANMF) Federal Secretary Lee Thomas said the theme reflected the impact the nursing community could make in driving efficiency while also providing quality health outcomes.

“It’s clearly evident the cost of healthcare is significantly rising worldwide resulting in financially burden on healthcare.

Solutions must be found in order to financial support quality healthcare delivery in a way that does not compromise on the standard of care that nurses provide.

Midwife (IDM) is: Midwives: for a better tomorrow.

Ms Thomas said that nurses must take leadership roles at the policy level in order to direct universal health coverage that achieves equity, and ultimately improves patient outcomes.

The theme, which is set by the International Confederation of Midwives (ICM), holds special significance in this target year of the Millennium Development Goals (MDG). Written in the International Day of the Midwife resource pack, ICM Chief Executive Frances Ganges said important progress had been made towards the reduction of all preventable maternal and newborn deaths, however there was still much to be done as the transition is made from MDGs to the new Sustainable Development Goals (SDGs). “This is why we have chosen the 2015 theme ‘Midwives for a better tomorrow.’

It reminds us of the critical role of midwives in creating a brighter future for mothers, babies and families. Continued progress and sustainable development will not be a reality unless mothers and babies survive and thrive. Investment in midwives is fundamental in accelerating progress towards these goals.”

For more information on International Nurses Day from the ICN go to: www.icn. ch/publications/2015-nurses-a-force-forchange-care-effective-cost-effective/ The theme for International Day of the

For more information on the International Day of the Midwife from the ICM, go to: www.internationalmidwives.org/ events/idotm/international-day-ofthe-midwife-2014/

“As the single largest profession in the health workforce worldwide, nurses are in a position to drive healthcare in a way that is efficient, effective while also maintaining positive quality care outcomes for their patients.”

Time to celebrate your achievements

WIN!

Activities will be held worldwide to celebrate the achievements of the professions commencing 5 May. From breakfasts to barbeques, morning or afternoon teas, make sure you take the time to celebrate in recognition of the great job that you do.

The ANMJ team have come up with the idea of cupcakes to celebrate the days. While these cakes won’t last long in the office, we are sure the nurses and midwives at the ANMF will appreciate them!

Whatever your celebration, email us a photo of the event to be published in next month’s ANMJ and social media, and you could win a Coles/Myer $50 voucher.

Send your photo to: celebrate@anmf.org.au

anmf.org.au

May 2015 Volume 22, No.10 15

Leadership Five minutes with ANMF’s new leadership team Now that Australia Nursing and Midwifery Federation’s (ANMF) new federal leadership team has been established, it’s time to learn more about them and their vision for the union over the next four years. Meet Federal Secretary Lee Thomas, Assistant Federal Secretary Annie Butler, Federal President Sally-Anne Jones and Federal Vice President Maree Burgess.

Karen Keast reports

Sally-Anne Jones – President Passionate nursing and midwifery proponent Sally-Anne Jones is the ANMF’s new President.

With her mother a registered nurse, SallyAnne began her career as an assistant in nursing working in aged care. “The first shower of that little old lady - I just loved it, and I haven’t looked back,” she says.

Sally-Anne went on to graduate from the Queensland University of Technology as a registered nurse, before finding her niche in oncology nursing at a large metropolitan hospital, where she spent

Lee Thomas – Federal Secretary

Annie Butler – Assistant Federal Secretary

Lee Thomas has been advocating for nurses and midwives long before she was first elected to the helm of the ANMF as Federal Secretary in 2010.

With a diverse career in nursing spanning more than 30 years, Annie Butler brings a wealth of experience to the position of Assistant Federal Secretary of the ANMF.

A registered nurse and registered midwife, Lee became a union member in 1981 and went on to become a job rep, before joining the ANMF South Australian Branch as an Organiser in 1997.

Lee rose through the Federation ranks to become the SA Branch’s Assistant Secretary and then Secretary, before taking on the ANMF’s Assistant Federal Secretary position and, more recently, the role as Federal Secretary.

Lee is passionate about standing up for the nation’s nursing and midwifery professions and defending Australia’s equitable healthcare system. “My motivation is to ensure we have a healthcare system that works for the people who need care and works for the people who give the care,” she says. “It is imperative that we make a difference to our members’ lives and that we campaign together with our members about issues that are important to them.”

Lee began her nursing career as an assistant in nursing in aged care, completing her general nurse education at Adelaide’s Queen Elizabeth Hospital and her midwifery training at the Queen Victoria Hospital. Lee also completed a Bachelor of Nursing and a certificate in

16 May 2015 Volume 22, No.10

neonatology.

Lee holds positions on the ACTU Executive, is a Board member of the Pacific Region of the Commonwealth Federation of Nurses, a member of the Professions Reference Group at AHPRA, a member of the ANMAC Board, and a member of the Aged Care Sector Committee and aged care financing authority.

Under Lee’s steadfast leadership, the ANMF has become one of the fastest growing and largest unions in Australia, with more than 240,000 members.

Lee says the ANMF’s Federal leadership team is committed to saving Australia’s universal healthcare system, improving wages and conditions for nurses working in aged care, and providing safe patient care through nurse to patient ratios.

The ANMF will also fight any government attack on nurses and midwives’ penalty rates, with a recent ANMF survey of more than 13,000 nurses and midwives showing 87% of respondents will stop working shift work if penalty rates are removed or reduced.

“It is only fair and just that nurses and midwives are fairly compensated for working these unsociable hours - on weekends, public holidays and special days, like Christmas, when they leave their own families and friends to care for others,” Lee says.

Annie began as a registered nurse in the public acute hospital setting, working mostly in surgical nursing, before venturing into community nursing and then into health education and promotion, with a focus on immunisation.

After 10 years in the field, Annie went on to work in research and education before joining the New South Wales Nurses and Midwives’ Association (NSWNMA, ANMF NSW Branch) as a Professional Officer in 2000, where she gained a grounding in the registration and legal aspects of nursing and midwifery.

Annie then seized an opportunity to move into the industrial side of the union as an Organiser, assisting nurses and midwives with workplace issues, before becoming a Lead Organiser for the southern New South Wales area.

Annie advanced into

anmf.org.au

Leadership 15 years caring for cancer patients.

“There is so much that fills up your own bucket as a humanbeing when you are caring for people who are undergoing treatment for cancer,” she says.

Sally-Anne, who is married and has two teenage daughters, has since taken up a leadership position as the Assistant Nursing Director in the Emergency Department at the same hospital.

On her very first day as a graduate

her current position with the ANMF Federal Office in March 2014, where she works as part of the Federal leadership team to improve nurses and midwives’ working conditions and to progress the professions in the national sphere. “I feel like my career has gone along such a great path to now be in this position,” she says.

“I’ve spent time doing what nurses do - trying to do the best for others and caring for others. I’ve spent a bit of time working out what lies underneath - with how you make that care happen.

“Now through the union, I’m working to care for the nurses and midwives who are doing the caring for others. I feel very privileged and it’s an extremely fulfilling position.”

While nurses, midwives and assistants in nursing across Australia may be separated by state and territory boundaries, they mostly face the same challenges.

“The things that matter to nurses and midwives, matter to them across the country,” Annie says. “Our role is to get everyone together and to speak for the members on national issues.”

Annie says the Federal leadership team will continue to fight for Medicare, will work to bolster staffing, skills mix and workloads in aged care, and will campaign to safeguard penalty rates and protect other hard fought for conditions.

“We also need to ensure that we keep educating enough nurses and midwives and making sure we get them into meaningful employment once they’ve graduated,” she says. “We must defend the future of our professions.”

anmf.org.au

nurse, Sally-Anne signed up as a member of the Queensland Nurses’ Union (QNU Branch ANMF Queensland).

Now, 20 years later, she not only holds the position of QNU President but after serving two years as ANMF Federal Vice President, she is thrilled to step up to the ANMF Federal President’s role.

Sally-Anne thanked outgoing ANMF Federal President Coral Levett for guiding her through the transition from a state to a national level, after she joined the

Maree Burgess – Federal Vice President Victorian maternal and child health nurse Maree Burgess is excited to be joining the ANMF’s Federal leadership team.

A registered nurse of more than 30 years, Maree has spent the past four years as the ANMF Victorian Branch President before being elected to the ANMF Federal Vice President’s role.

Maree completed her general nurse training at St Vincent’s Hospital in Melbourne and her graduate year working in a haematology and oncology unit. She went on to complete her midwifery training at the Mercy Hospital, where she worked predominantly as a domiciliary midwife.

Maree has since found her calling in maternal and child health. With a Diploma of Applied Science (Community Health) at RMIT and a Bachelor of Education at Latrobe University under her belt, Maree now works for local government in a high-need area in Melbourne’s northern suburbs.

In this role, she regularly provides care for migrant, refugee and vulnerable families.

“It’s a really dynamic and challenging place to work,” she says. “With qualifications in midwifery as well as our

Federal leadership team. “Coral has been an incredible mentor at a professional level but also in the role as President,” she says. “I’ve still got a lot to learn but I accept this challenge and I understand the responsibility that the position holds. I am really looking forward to representing nurses and midwives over the next term.”

Sally-Anne says the ANMF will continue to focus on advancing the professions while ensuring nurses and midwives have a voice in the constantly changing federal health arena.

“It’s about getting involved in things that really matter to the public and to health in general - you can’t just be a bystander when you’re a nurse because you are with the community every step of the way.”

community health, you’re able to provide support emotionally and physically, encouraging the mothers to talk about their birth experiences, assessing their recovery from birth and providing lactation support and advice. We work in a family partnership model and the initial home visit is the starting point of a long-term engagement with the family.”

Through the ANMF Victorian Branch, Maree began as a job rep in 2004 and joined the Council in 2008 before becoming President in 2010. As the ANMF Federal Vice President, Maree is looking forward to broadening her gaze to tackle issues that affect nurses and midwives at a national level.

Ensuring a safe working environment for nurses amid the escalating rates of violence and aggression is vital, as is securing more jobs for nursing and midwifery graduates. “When there is so much talk from the government about perceived shortages, it’s appalling we can’t find positions for a large number of graduates.”

Improving aged care is also an issue close to Maree’s heart. “My own mother is in a residential facility and even though it’s an excellent facility I’m really aware of the concerns around staffing levels and skills mix.”

May 2015 Volume 22, No.10 17

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Coral tribute ANMF pays tribute to Coral Levett

By Karen Keast

A staunch champion of the nursing and midwifery professions, Coral Levett has stepped down after 12 years as the Federal President of the Australian Nursing and Midwifery Federation (ANMF).

After serving six two-year terms, and with a strong Federal leadership team in place, Coral decided not to run for the position but will remain an important part of the Federation, as a member of the ANMF Council in her roles as President of the New South Wales Nurses and Midwives’ Association (NSWNMA) and President of the ANMF (NSW Branch).

Coral first became involved in the Federation as a student nurse in Canberra more than 30 years ago, and soon found herself campaigning to save her first Sydney workplace, St George Hospital, from privatisation.

“There was very strong community support for the action led by the nurses at the hospital at the time and the community just did not want to lose their public hospital to a private entity,” she recalls. “They stood up with us, and for us, and the outcome is what it is - it’s still a public hospital to this day.”

In 2000, Coral was elected to the Council of the NSWNMA (ANMF NSW Branch) and was President within two years. Around the same time, she was also elected ANMF Federal President.

While holding the dual roles, Coral has actively campaigned at a federal level on large campaigns, such as the successful Australian Council of Trade Union’s (ACTU) Your Rights at Work campaign and the ANMF’s Because We Care campaign.

Coral has represented Australian nurses, midwives and assistants in nursing at numerous South Pacific Nurses Forums, enabling her to learn from and share experiences with some of Australia’s closest neighbouring countries. In her leadership role, Coral has chaired South Pacific Nurses Forums and sessions, and had the opportunity to travel to locations ranging from the Cook Islands to Samoa, New anmf.org.au

“...THERE IS NO LIMIT TO WHAT CAN BE ACHIEVED IF YOU WORK TOGETHER AS A GROUP.”

Zealand and Fiji. Coral chaired the Forum when it was held in Melbourne in 2012.

Coral also represented Australia at the prestigious International Council of Nurses (ICN) triennial forums in Taipei and Melbourne.

As Federal President, Coral enjoyed regularly writing for the Australian Nursing and Midwifery Journal. She has also assisted the Branches with conferences and the orientation of their new Councils, while working as a role model to support state and territory Branch Presidents in their development.

Likewise, being a part of the Federal Executive has given Coral an opportunity to learn from leaders in the industrial relations arena and more broadly in the union movement. I have had great opportunity to watch and learn from great women leaders particularly within the ANMF, having served with three Federal Secretaries in my time starting with Jill Iliffe and then Ged Kearney and more recently with Lee Thomas.

“I’ve also had enormous support from my own state, from NSWNMA (ANMF NSW Branch) General Secretary Brett Holmes and Assistant General Secretary Judith Kiejda in my federal role.

“They are great leaders and great role models. I have learnt a lot from them in navigating my way through my federal role, and also in understanding the responsibilities that the role brings in governance and in leadership itself.”

Coral has balanced her leadership positions with completing a number of university degrees, all while working for the South Eastern Sydney Local Health District in New South Wales. She thanked her employer and her colleagues for their ongoing support. I’ve always been fortunate enough to have supportive managers and chief executives who have afforded me the time to get involved in our union movement for the betterment of the professions and I’m very appreciative of that.”

Whether it’s standing up for nurses and midwives on the industrial relations front, tackling social justice issues or working to elevate the professions in the political domain, Coral says it’s been a privilege to represent nurses and midwives at a national level.

Coral has watched the Federation become one of the largest unions in Australia with a membership of more than 240,000. She hopes it will continue to grow - providing a strong, united voice for the professions at a national and international level.

It is also up to nurses, midwives and assistants in nursing to help the ANMF continue to make an indelible impact on the future of the professions, Coral says. “Nurses have changed - they know now that they’ve got to lobby their local politicians, they know they need to get out and door knock and talk to people.

“Fifteen years ago we didn’t do that, we pretty much left the union to drive those campaigns and to do the work. Our membership sees that it has to be them that lead the way in change and that’s where we will see real results in the next five to 10 years.”

Coral says more ANMF members are now taking up the gauntlet. “They are taking responsibility for getting things changed to improve their own lives and their family’s lives and the health of their own community.

“The outcome that you can achieve through working in such collectives is just phenomenal - there is no limit to what can be achieved if you work together as a group.”

May 2015 Volume 22, No.10 19

Issues hospital (Draper et al. 2011); • require new residential care placement

following their stay (Fong et al. 2012); • older patients with cognitive

impairment are two to three times more likely to die while they are in hospital (Marengoni et al. 2013).

A better way to care for patients with cognitive impairment in hospital

By Erica Hall Cognitive impairment in older people is common when they are in hospital (Travers et al. 2013).

Dementia and delirium are the most common forms of cognitive impairment in these patients.

Around 20% of people aged over 70 who are admitted to hospital have dementia, and this rate increases with age. Another 10% of older patients are admitted with delirium and a further 8% will develop delirium during their hospital stay (Travers et al. 2013).

Older patients with cognitive impairment are at higher risk of adverse outcomes and preventable complications (Fick et al. 2013; Inouye, Westendorp, and Saczynski 2014).

Patients with cognitive impairment are more likely to: • experience a fall resulting in harm (Deandrea et al. 2013); • experience significant functional decline (Watkin et al. 2012); • develop complications such as pressure injuries, pneumonia and urinary tract infections (Bail et al. 2013); • have increased length of stay in 20 May 2015 Volume 22, No.10

Patients with cognitive impairment may be unable to relay important information about their symptoms or pain, follow instructions, adapt to hospital routines or find their way. The noisy, busy, unfamiliar environment can be frightening and the myriad of new encounters can also exacerbate disorientation, cause distress and agitation, and lead to aggression.

Despite these risks, cognitive impairment is often not recognised, dismissed as a normal part of ageing, not viewed as clinically relevant or can be incorrectly diagnosed.

Nurses play a key role in making sure patients with cognitive impairment receives safe, high-quality care in hospital. This includes ensuring that the patient has adequate food and fluids; that normal sleep patterns are promoted; that the patient mobilises, and that they can use their glasses and hearing aids. Nurses can also involve family members to assist with a patient’s orientation and to provide reassurance.

New resources for health service managers, clinicians and consumers To support health service managers, clinicians and consumers to improve care of older patients with cognitive impairment, the Australian Commission on Safety and Quality in Health Care (the Commission) recently released a set of new resources.

Actions for health service managers – is a resource for health service managers, executives and owners of health services.

It describes a pathway to improve the early recognition of, and response to, patients with cognitive impairment to reduce harm and ensure they receive safe and highquality care in hospital. The steps in the pathway are consistent with the framework of the National Safety and Quality Health Service Standards.

Actions for clinicians – is a resource designed for those who are responsible for the care and treatment of patients with cognitive impairment in hospital.

The resource guides clinicians through the safety and quality pathway and provides consolidated evidence-based actions from research, existing guidelines and current good practice.

Actions for consumers – is designed for patients with cognitive impairment, their carers and families. It outlines what they can do to help in the provision of safe and high-quality care.

For more information and access to the resources, visit: www.safetyandquality. gov.au/abetterwaytocare Actions for Clinicians is also available as an App. Search for A better way to care in your app store.

References: Bail, K., H. Berry, L. Grealish, B. Draper, R. Karmel, D. Gibson, and A. Peut. (2013). Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study. BMJ Open no. 3 (6). doi: 10.1136/bmjopen-2013-002770 e002770 [pii] bmjopen-2013-002770 [pii].

Deandrea, S., F. Bravi, F. Turati, E. Lucenteforte, C. La Vecchia, and E. Negri. (2013). Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Arch Gerontol Geriatr no. 56 (3):407-15.

Draper, B, R Karmel, D Gibson, A Peut, and P Anderson.

(2011). The hospital dementia services project: Age differences in hospital stays for older people with and without dementia. International Psychogeriatrics no. 23 (10):1649-1658. doi: 10.1017/S1041610211001694 S1041610211001694 [pii].

Fick, D, M Steis, J Waller, and S Inouye. (2013). Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. Journal of Hospital Medicine no. 8 (9):500-505. doi: 10.1002/jhm.2077.

Fong, T, R Jones, E Marcantonio, D Tommet, A Gross, D Habtemariam, E Schmitt, L Yap, and S Inouye. (2012).

Adverse outcomes after hospitalization and delirium in persons with Alzheimer disease. Annals of Internal Medicine no. 156 (12):848-56, W296. doi: 10.7326/00034819-156-12-201206190-00005 1183010 [pii].

Inouye, S. K., R. G. Westendorp, and J. S. Saczynski.

(2014). Delirium in elderly people. Lancet. doi: 10.1016/ S0140-6736(13)60688-1.

Marengoni, A, A Nobili, V Romano, M Tettamanti, L Pasina, and S Djade. (2013). Adverse clinical events and mortality during hopsitalization and 3 months after discharge in cognitively impaired elderly patients. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences no. 68 (4):419-425.

Travers, C., G. Byrne, N. Pachana, K. Klein, and L. Gray.

(2013). Prospective observational study of dementia and delirium in the acute hospital setting. Intern Med J no.

43 (3):262-9. doi: 10.1111/j.1445-5994.2012.02962.x.

Watkin, L, M Blanchard, A Tookman, and E Sampson.

(2012). Prospective cohort study of adverse events in older people admitted to the acute general hospital: Risk factors and the impact of dementia. International Journal of Geriatric Psychiatry no. 27 (1):76-82. doi: 10.1002/gps.2693.

Erika Hall is a Communications Coordinator for the Australian Commission on Safety and Quality in Health Care

anmf.org.au

World Elderly resilience in Thailand: an Ethnographic study

By Wilaiwan Pathike, Anthony Paul O’Brien and Sharyn Hunter The resilience of older people living in rural Thailand in a community nursing setting has been the focus of an ethnographic study.

Wilaiwan Pathike, a University of Newcastle PhD student, conducted the study when visiting the Roi-et province in Thailand last year. The study was carried out in the primary care units (PCU) of four provincial subdistricts.

Ms Pathike interviewed 35 older women and men, and some of their families, and observed older people’s daily interactions in the local community. The preliminary findings from the interviews indicate that there were cultural issues unique to Thailand about resilience.

In particular, the following cultural artefacts contributed to resilience: Buddhist religion; donating their money to help maintain the temple in their community; ‘making merit’ (a variety of cultural activities that help the older person to feel happy); meditation practice; Buddhist teaching; ‘enjoying their family and feeling proud with nothing to be worried about’; ‘feeling proud if their children looked after them’; and ‘gaining pleasure talking to everyone else about how good their

Staffing issues linked to ward suicides Shortages of experienced staff are linked to ward suicides in the UK, a report has found.

Researchers from Manchester University indicated 18 in-patients a year died by suicide when under observation.

Observation usually meant checks every 10-15 minutes, but in 9% the patient was meant to be constantly observed.

Details of all suicides under observation over seven years in the UK were examined.

Researchers also conducted an online

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who provide healthcare to older people living in rural Thailand.

In the context of global ageing, studies such as this one are important because as the global population ages, resources will diminish (Department of International Economic and Social Affairs.

2013). Harnessing opportunities, which support resilience in older people living in Thailand and in other countries, is especially important as older people are becoming short of traditional care givers. To do so is a must for the healthy future of our often marginalised and isolated older people.

children are’; together with ‘having the opportunity to talk and laugh with each other’. Many of the elderly interviewed talked about how much they enjoyed local music and dance as it enriched their everyday experience.

Conversely, the things older people described as not contributing to resilience were discussing their personal business with others; having a disability and worrying that it might be caused by a superstitious belief; having to go to the fortune teller; and not having their wishes fulfilled, or making enough merit to be happy and secure.

As resilience is related to healthy ageing (Wagnild 2003, Windle 2012) these cultural differences identified in Thai older people could also enhance the Australian older persons ageing experience and at the same time build resilience. For example: ‘making merit’, sharing opportunities to ‘laugh and enjoy each other’s company’, and ‘listening to music’.

What this study is beginning to reveal is the subtle but previously unidentified nuances of the older person’s everyday life in rural Thailand, and to identify what community nurses can do to tap into them.

Further data analysis, which is yet to occur, is about the community nurses in the PCU

Wilaiwan Pathike PhD candidate, Professor Anthony Paul O’Brien and Lecturer Dr Sharyn Hunter are all at the School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, NSW

survey for patients and staff to report on their experience of observation.

The study found half the deaths examined occurred when less experienced staff or agency staff that were unfamiliar with the patient were carried out. Deaths occurred when staff were distracted by ward disruptions during busy periods or when the ward was poorly designed.

“The current observation approach is not working safely enough. This is an important part of keeping patients safe but we found that where deaths occurred, responsibility had often been given to less experienced members of staff,” said the director of the inquiry Professor Louis Appleby. “Deaths

also occurred when protocols were not followed. Observation is a skilled task, not an add-on that can be delegated to anyone available.”

According to one nurse who participated in the focus group, very few nurses really understand what an observation meant.

“They thought it meant go away, see someone, come back and sign the sheet.”

Co-author Professor Jenny Shaw said that observation should not just be about watching the patient, but an opportunity to engage with them as part of a comprehensive care plan. “New models of observation need to be developed and tested to cut the number of deaths.”

References Department of International Economic and Social Affairs 2013. World Population Ageing. New York: United Nations.

Wagnild G 2003. Resilience and successful aging: Comparison among low and high income older adults.

Journal of Gerontological Nursing. 29 (12):42-9.

Windle G 2012. The contribution of resilience to healthy ageing. Perspectives in Public Health. 132 (4):159-60. doi: 10.1186/1477-7525-9-8.

May 2015 Volume 22, No.10 21

Feature

22 May 2015 Volume 22, No.10

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Feature

Violence in our health sector While nursing is the most trusted profession in Australia, it is also one of the most dangerous. Violence towards nurses is occurring at an alarming and increasing rate. So what is being done about it?

Jessica Gadd investigates.

Compensation claims for the health sector reveal a disturbing truth - nursing is one of the most dangerous professions in Australia. Safe Work Australia records that during the years 2000-2013 hospitals (10%) and residential care services (12%) together account for 22% of violent incidences in the workplace that resulted in an accepted compensation claim for physical or mental injury.

This figure is second only to the Public Administration and Safety sector, which includes correctional services at 24%.

But that is just the successful compensation claims. The Australian Nursing and Midwifery Federation (ANMF) believes that

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only a fraction of aggressive and violent incidents are actually reported. A more accurate indication of violence levels might be reflected in a recent Monash University study involving 5,000 nurses, which found that an average of 38 nurses are assaulted every day.

This equates to more than one nurse being assaulted per hour, every day, every night, 365 days a year.

High-risk hot spots “A lot of our high risk concern is around amphetamine user presentations at emergency departments,” says New South Wales Nurses and Midwives’ Association (NSWNMA, ANMF NSW

Branch) Secretary Brett Holmes.

Mr Holmes says this is of particular concern in rural emergency departments (ED) where lower numbers of nursing and security staff are present and police response times are increased. “Some mental health patients are even delivered to EDs by police in handcuffs, and then left for staff to deal with.

Staff not only need to be trained to deal with this, they actually need to be present. For example, a restraint requires six people, when many facilities might only have three staff present. It’s potentially a very dangerous situation in terms of managing risk – to the patient, and to others present.”

May 2015 Volume 22, No.10 23

Feature Mr Holmes says that while there is an agreement in NSW between the police, health and ambulance services, the police have been very clear in saying they do not have time to take cases to the nearest mental health unit, so they often drop them at the local ED to await transfer. “In such cases we have major concerns about the physical ability of the units and the staff that have to deal with it. Hospital services are not well prepared for psych disorders in general, including methamphetamine (ICE) users – use of which makes a patient a disordered person. For example, recently a patient believed to be affected by methamphetamines couldn’t be contained within the hospital. She went out into the hospital carpark and tried to hijack a mother with a child in her care, while staff

Branch), also reports an increase in violence and aggression towards nurses. “We have seen an increase in nurses coming to us reporting assaults in recent years. I recently attended a police station with a member who wanted to report an assault. He’d been spat in the face by a mental health patient who was unhappy about being discharged.

“In 2013 we had an extreme situation where there was almost a riot in a mental health institution, where a number of patients conspired to attack the nurses.

And the other problem, of course, is issues around patience. Often workloads mean long waiting times, and perhaps it’s a reflection of our culture, but many people don’t like to wait – the reactions can be a bit like road rage.”

IT CAN BE A VERY BIG STEP FOR A STAFF MEMBER TO CALL POLICE AND LOOK TO FORMALLY CHARGE A PERSON.

were physically trying to drag her off.”

The other area that is increasingly becoming high risk for nurses is aged care.

Mr Holmes reports that the NSWNMA is trying to respond to frequent calls from members for violence and aggression towards nurses in the aged care sector to be addressed, but has found that most aged care operators are resistant or feel constrained in their ability to respond to the issue. “Low staffing levels, or the employment of staff with low education levels, can be dangerous in a situation where you have one or two staff members to eight or ten dementia patients. The patients might be mobile, and not require a lot of nursing, but if there is an incident of unpredictable and violent behaviour that results in a high level of risk for the individual, the staff, and the other residents.

“So we are trying to engage with WorkCover and the aged care providers on this issue, but frustrated by the lack of progress in recognising the level of risk in aged care. Ironically aged care workers are risk rated higher than police by WorkCover themselves when it comes to premiums for Workers Compensation Insurance.”

The risk rating is also higher for aged care workers than it is for police in Queensland, where James Gilbert, Health and Safety Officer at the Queensland Nurses’ Union (QNU, ANMF Queensland 24 May 2015 Volume 22, No.10

Spotlight on assaults Safe Work Australia’s data reveals that violence and aggression towards nurses has risen steadily over the past 12 years, going from about 400 healthcare and Social Assistance sector compensation claims in 2000-2001, to more than 1,200 in 2012-2013. In Victoria, Melbourne daily, The Herald Sun, surveyed 11 regional and metropolitan hospitals to reveal that there were almost 20,000 ‘Code Grey’ – clinically-led response to a potentially violent situation – or ‘Code Black’ – intent to harm with a weapon – incidents in two years (2012/2013-2013/2014), an increase of 13.58% year on year.

“Violence in the community is increasing,” says Kathy Chrisfield, OH&S Unit Coordinator for the ANMF Victorian Branch. “So it’s not surprising that we are seeing an increase in hospitals, given they are a microcosm of the community as a whole.”

The types of assaults being committed vary but many are extremely serious – some of the violent incidents recently reported to the ANMF Vic Branch include a nurse being left unconscious following an assault by a patient who then dragged the nurse away from the area, a nurse strangled and dragged down a hospital corridor, a nurse concussed after receiving a blow to the head from a patient. anmf.org.au

Feature “It’s horrifying, and we’re very aware and scared that before we get some real action from these hospitals there will be a death,” says Ms Chrisfield. “I would say that on a regular basis it is only luck that has prevented a death from occurring.”

Sue Cowling, ED Nurse Unit Manager at Melbourne’s St Vincent’s Hospital says that while a rise in assaults is a worrying trend, a rise in Code Greys is not necessarily a negative. “If a hospital shows an increased number of Codes that is not necessarily a reflection of an increase in violence – it could be a decrease in staff tolerance to aggression and an increase of staff awareness and confidence to call a Code.

“It can be a very big step for a staff member to call police and look to formally charge a person. It could become quite personal for the staff member when they were just doing their job. At times the stress felt by the whole process was far outweighed by any satisfactory outcome.

Now there is a lot more work being done to make it a situation where the health service itself is responding to the incident, as opposed to just the individual responding to it.”

Ms Cowling is a member of the Victorian State government’s Improving Hospital Safety and Security Ministerial Advisory Committee, established in 2013 to provide advice and overview of government initiatives to address aggression and violence in the healthcare system. She says that some of the committee’s key priorities include introducing a standardised Code Grey response, which is occurring in Victoria across 2014-2015, improving the Victorian Health Incident Management System (VHIMS) reporting system, which is currently in progress, and making the monitoring, reporting and review of incidences an integral part of good governance.

“The Committee is truly trying to support organisations and individuals, looking at what both need, and also at what is occurring in the community, as their pressures are funneled into health services.

It is focused on standardising policies and making sure there is good governance in place, and while we recognise that we can never completely eradicate erratic behaviour because it could be clinical, we do need to make working environments as safe as possible and provide the right resources to allow this to be managed.”

Law and order In Victoria during 2014 two pieces of legislation were introduced that reinforce the message that violence towards health workers acting in accordance with their professional duties is unacceptable. One introduced a minimum sentence for anmf.org.au

May 2015 Volume 22, No.10 25

Feature ANMF Victoria’s 10-point plan to end violence towards nurses

1. Improve security

2. Identify risk to staff and others

3. Include family in the development of patient care plans

4. Ensure violent incidents are reported, investigated and acted upon

5. Prevent violence through workplace design

6. Provide education and training to healthcare staff

7. Integrate legislation, policies and procedures in a state-wide approach

8. Provide post-incident support

9. Apply anti-violence approach across all healthcare disciplines

10. Empower staff to expect a safe workplace For a full copy of the 10-point plan visit: www.anmfvic.asn.au/news-andpublications/news/2014/11/26/ violence-increasing-in-victorianhospitals

26 May 2015 Volume 22, No.10

assaults on medical workers, the other made it an offence to assault a registered health practitioner engaged to provide care.

The Queensland state government also introduced tougher penalties for harming health workers in 2014, as part of its Safe Night Out Strategy. But QNU’s James Gilbert says that past experience has shown this is not necessarily an effective deterrent.

“Our concern with that is that the horse has already bolted. As far back as 2008 the Queensland Nurses’ Union got the previous government to change the law so that offenders could be charged with serious rather than common assault – but we didn’t see it used. People on drugs and alcohol just don’t think like that.”

The ANMF Vic Branch is calling for improved security as part of an overall 10-point plan to decrease violence and aggression towards nurses (see breakout box). Some of the improved security measures recommended by the plan include specifically trained security personnel, the installation of security cameras, access to secure areas and safe zones, and improved workplace design, including retrofitting workplaces to help prevent and minimise violence.

“One of the biggest changes we have seen in ED design in recent years is the inclusion of a specific area to contain outof-control behaviour – thus preventing this from occurring, for example, alongside another patient with chest pain,” explains Nurse Unit Manager Sue Cowling. “It’s about safety for staff, for other patients, and for the patient, who has a right to the dignity of a safe place when their behaviour might be beyond their control.”

The ANMF Victoria’s 10-point plan also recommends that workplaces integrate their violence prevention policies with post incident support policies, training and education policies, and security policies as well as many of the clinical escalation policies that can deal with an increased risk of violence from a patient or family early in the episode.

NSWNMA General Secretary Brett Holmes points to an extensive number of state government policies in place, many of which the NSWNMA has had input into, including Protecting People and Property, Zero Tolerance, and Safe Use of Sensory Rooms in Mental Health, but warns that policies are only as good as the enforcement and resources devoted to them.

“For example, we often have to go into workplaces where the equipment fails to meet the workplace’s own policy, such as out-of-date duress alarms. Yes it’s a cost to update these things but the biggest cost of all is injury to nurses. The loss of a single nurse is far more costly than implementing any of these safety precautions.”

Combating a culture of under-reporting “There is a system for reporting – but the official level of reports has stayed the same for a long time, even though we have seen an increase in the number of nurses speaking to us about the issue,” says QNU’s James Gilbert.

“For example, I recently visited a workplace that we’d been told had a number of incidents but when asked the employer could only give me five incident reports. So we don’t think it’s accurate.”

Mr Gilbert believes there is a culture of not reporting violent incidents; in part due to the extra time required to report, but in Queensland exacerbated by confusion about which reporting system to use. He says that many nurses report incidents using the patient-focused, clinical Prime Incident System – which is right and proper, but often the incident should also be reported via the Incident Management System (IMS), which is specifically for the reporting of occupational violence.

Given they need to make two reports, little wonder nurses don’t bother, Mr Gilbert says. Not only that, the Incident Management System does not give the nurse a copy of the report made, which makes it difficult for them, their workplace, and the QNU to keep track of the amount of reports being made.

“Nurses say they get on the computer and have to fill out four or five screens only to find once submitted they do not get a copy – and there have been incidents of the reports going missing too.”

The Incident Management System of reporting is a difficulty for health service staff in Victoria and NSW as well.

“Getting access to incident reports is very frustrating,” Mr Holmes says. “The only real statistics we get access to are those incidents that are reported to police – and they’re only a minor fraction. It seems to be a great difficulty for WorkCover to collate reports – and there seems to be a great reticence for the health system to share information about incidents of workplace violence.”

ANMF Vic Branch’s Kathy Chrisfield says that the Victorian Health Incident Management System (VHIMS) was declared not fit for purpose by the Victorian AuditorGeneral’s Office (VAGO) performance audit into Occupational Health and Safety Risk in Public Hospitals in 2013. Unlike the other states, VHIMS does permit a printed copy, but Ms Chrisfield has heard of many nurses being threatened with disciplinary action for removing reports from their workplace, for patient privacy reasons. She’s also heard of many cases where nurses have followed up on reports only to discover that the anmf.org.au

Feature severity level or category of the report had been changed.

“The under-reporting of violent incidents is significant,” Ms Chrisfield says. “It doesn’t help that the reporting system is so atrocious – it’s a convoluted, complex process. For a nurse who’s been the victim of an assault to then have to spend 30-40 minutes filling out a difficult report that requires you to categorise your incident in certain ways, which makes it difficult to know whether it’s a clinical rather than violent incident, is unrealistic. If the incident is both clinical and violent you would then have to do the report twice, which is unlikely to occur.”

Ms Chrisfield explains that the Victorian ANMF is trying to change a previouslyaccepted cultural belief that healthcare facilities are all about patients: therefore reporting to police could be seen as impinging on the nurses’ duties or the patient’s rights. “I still sometimes hear nurses say: ‘It’s a dementia /mental health ward, that’s what I expect when I come to

training is not sufficient, and points out that although there is some good training available in Victoria, nurses do not necessarily have access to it. She says it would help if security staff received the same training too. “Some facilities do involve security staff, but as far as we are aware the majority of security may have no experience in health, which is very different to a nightclub.

“This is an issue when it comes to knowing the procedures for responding to incidents. For example in a Code Grey security staff need to stand back and be directed by clinical staff. It’s not their fault necessarily, but they often think they are helping by jumping in. Security employed by the hospital are more likely to have access to training, and an awareness of the correct responses in their workplace.”

Sue Cowling explains that the response to the incident is influenced by the cause of the behaviour, which can vary. “You’ve got to determine whether it’s behaviour associated with a condition – low blood

ON TOP OF THAT THERE HAVEN’T BEEN A LOT OF CASES WE’RE AWARE OF WHERE ACTIONS THAT HAVE BEEN REPORTED HAVE BEEN FOLLOWED UP, SO STAFF THINK THERE’S NO REASON TO REPORT.

work’. That’s just not acceptable! These nurses might come to work expecting a Code Grey, and to be injured in the response – at no time is this okay.

“On top of that there haven’t been a lot of cases we’re aware of where actions that have been reported have been followed up, so staff think there’s no reason to report.

No follow up, no feedback, and no change … at some point you decide you could better spend those 40 minutes.”

Training NSWNMA General Secretary Brett Holmes believes that nurses are being asked to deal with situations for which they are not always equipped or trained. “When it comes to responding to or managing violent incidences, the minimum training we would recommend is two full days, face-to-face.

But that’s a minimum – in reality nurses need more training than that to deal with these sorts of violent situations. So it’s a significant level of training that’s required and it’s the health system that somehow needs to pay for that.”

Ms Chrisfield agrees that online anmf.org.au

glucose, dementia, mental health – that requires care and support; or whether it’s anti-social behaviour which requires police presence and accountability,” Sue Cowling explains. “It can be tricky for staff to ascertain that initially. This is where the right place, appropriate resources, education and support is vital.”

Where to from here?

Kathy Chrisfield says she feels positive about the Victorian government and the future handling of the issue of violent behaviour in the health sector.

“I believe our current government understands the issues and cares about the situation and am positive that we will see action rather than lip service,” she says.

“We need to see some guidelines and to see facilities held to account, and we need this from WorkSafe Victoria as well. I am hopeful that there will be a different approach.”

James Gilbert is less positive, but still hopeful about the prospects for the new QLD state government to address this issue.

“We had been trying to get the previous

state government to work with us on this issue using an overarching, corporate approach but they wanted us to work directly with the individual institutions. We are hoping the new government will work with us strategically to address occupational violence in the healthcare sector.

“We want improved public awareness, barriers within the physical environment and government commitment to transparency about when assaults occur.”

Nurses the most at-risk healthcare workers Safe Work Australia reports that during the years 2000-2013 nursing and associated caring professions accounted for nearly 60% of workplace-violence related compensation claims in the healthcare sector, as follows:

22%

Registered Nurses

19%

Nursing Support and Personal Care Workers

12%

Aged and Disabled Carers and

5%

Enrolled and Mothercraft Nurses

These are all proportionately higher than compensation claims for other professions within the healthcare sector such as

2% 2%

Security Officers and Guards

Social Workers and Ambulance and

2%

Paramedics

May 2015 Volume 22, No.10 27

Clinical update Triage nurse’s assessment of a child with a fever Angela Knight

This best practice guideline aims to provide detailed information for the triage nurse assessing the child (0 to 5 years) presenting with fever, and the appropriate administration of paracetamol. It aims to promote evidence-based practice to encourage consistent care and management strategies for best patient outcomes. The information is based on recently published papers and guidelines including feverish illness in children (NICE 2007), the most current and in-depth published guidelines identified. It contains information on current knowledge to promote best practice in children with fever.

28 May 2015 Volume 22, No.10

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Clinical update

Triage

Assessing a child with fever

As stated in the emergency triage education kit: “The triage nurse makes urgency decisions using clinical and historical information to avoid systematic under or over triage. Secondary triage decisions are concerned with expediting emergency care and disposition. The triage nurse employs locally based policies and procedures to expedite care for all patients,” (Triage Education Kit 2009).

Immediate assessment of a child with fever should always include assessment of lifethreatening issues such as impeding airway, breathing and circulation, and any altered level of consciousness including disability, history of presenting complaint and past history (Emergency Triage Education Kit 2009). When taking a temperature, the following recommended methods are suggested: • electronically under the axilla for children under 4 weeks of age; • electronic/chemical dot/infra-red for children over 4 weeks to 5 years; • under the tongue for older children as appropriate; • tympanic for children of all ages though has increased risk of inaccuracy; • disposable thermometers should only be used; • forehead thermometers are unreliable and should not be used (NICE 2007, RCH Fact Sheet 2007).

Infants and small children differ from adults both psychologically and physiologically implicating challenging levels of assessment and disposition for the triage nurse. Children can deteriorate rapidly, however, consistency and efficiency in triage of the child is optimised when age, historical data and clinical presentation are included in the triage assessment (Emergency Triage Education Kit 2009).

Nurses triaging the unwell child are therefore responsible for identifying those at risk of more serious illness and should include evidence-based decisions in applying a triage category. Guidelines to direct appropriate categorisation and consistent care should therefore improve the systematic approach to achieving best patient outcomes.

Fever Fever in children is a normal protective mechanism, usually due to a viral infection that is self-limiting (Cameron, Jelinek, Browne & Raftos 2006), and has certain benefits that can actually benefit the host playing an important role in immunologic defence (Paul, Mayhew & Mee 2011). In certain circumstances, a fever may indicate a more serious condition that the triage nurse should consider expediting care.

It is important as the triage nurse to understand the normal variables for children aged 0 to 5 years of age. Medical observation charts within the hospital flag normal observations for the child within these age groups. Vital signs outside these parameters should indicate a fever in a child and be considered by the triage nurse to further investigate the cause of fever.

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The Launceston General Hospital utilises the Paediatric Early Warning Tool to document vital signs and flag abnormalities that the triage nurse should consider at the time of assessment and provide guidance in the level of care the child may require. A childhood early warning tool (CEWT) score can be applied and identifies those children at risk of more serious illness. Furthermore, it categorises age groups of children (0 to 1 years, 1 to 4 years, and 5 to 9 years) allowing for variances in normal parameters in children of different ages.

In coordination with this, the National Institute for Health and Care Excellence (NICE) (2007) describes a ‘traffic light’ system that identifies the ‘at risk’ child and can guide other methods of assessment to flag the unwell child. Parameters are consistent with those offered in the paediatric early warning tool adopted by the Launceston General Hospital.

See Table 1: (on the next page) Taking a thorough history and listening seriously to the concerned parent is important to determine risk factors for a more serious condition other than a simple fever. Fever can be harmful in people with neurological insults (Thompson & Kagan 2010), suppressed immunity, congenital heart disease, head injury or sickle cell anaemia (Broom 2007) and should expedite care. The duration of the fever, other signs and symptoms and care already attempted

by parents such as the administration of antipyretics including time and dosages should be considered.

Febrile convulsions are a fear for both nurses and parents and should be taken seriously when taking a history from parents. While research states febrile convulsions are probably related to rapidly ascending temperatures (Warwick 2008), children who have experienced febrile convulsions previously are more at risk of further febrile convulsions (Glatstein & Scolnik 2008). The triage nurse should therefore be well educated about the myths surrounding febrile convulsions and be able to provide accurate assessment and education.

Care and Management Fever is an uncomplicated immunological and protective mechanism that should be let run its course (Warwick 2010) if considered harmless at the time of assessment. Supportive therapy such as education of parents and adequate hydration of the child is ample to treat a simple fever.

Tepid sponging and cooling of the febrile child is no longer recommended and may in fact increase core body temperature and be unbeneficial to the child (Cameron et al 2006).

Initial and continuous assessment of the child is imperative to achieve best patient outcomes and reduce the risk of inaccurate triage assessments. Regular observations and documentation is important to substantiate decisions and alterations in care and condition of the child.

Antipyretics Paracetamol and other antipyretics are often used to treat the febrile child, research identifying however, that the protective mechanism of fever outweighs treatment. Paracetamol can in fact block the protective mechanism that a simple fever provides (Warwick 2010).

NICE (2007) does however suggest that paracetamol is indicated if the child is uncomfortable. A child may feel generalised malaise, look pale, be anorexic, have altered perfusion, abnormal vital signs and have rigors (Broom 2007). In these instances, appropriate administration of paracetamol is applicable.

May 2015 Volume 22, No.10 29

Clinical update Table 1: NICE traffic light systems for identifying risk of serious illness. (NICE 2007)

Green – low risk

Amber – intermediate risk

Red – high risk

Colour

• Normal colour of skin, lips and

• Pallor reported by parent/carer

• Pale/mottled/ashen/blue

Activity

• Responds normally to social

• Not responding normally to

cues • Content/smiles • Stays awake or awakens quickly • Strong normal cry/not crying

social cues • Wakes only with prolonged social stimulation • Decreased activity • No smile

• No response to social cues • Appears ill to a healthcare

tongue

professional • Unable to rouse, or if roused

does not stay awake • Weak, high pitched or

continuous cry

Respiratory

• Nasal flaring • Tachypnoea • Respiratory rate > 50 age

• Grunting • Tacchypnoea • Respiratory rate > 60 breaths

6 – 12 months

minute moderate or severe chest indrawing

• Respiratory rate > 40 minute

> 12 months • Oxygen saturation < 95% in air • Crackles

Hydration

• Normal skin and eyes • Moist mucous membranes

• • • •

Other

• None of the Amber or Red

• Fever for > 5 days • Swelling to a limb or joint • Non-weight bearing or not

signs or symptoms

Dry mucous membranes Poor feeding in infants Cap refill time > 3 seconds Reduced urine output

• Reduced skin turgor

• Age 0 – 3 months

with a fever > 38 • Age 3 – 6 months with

using an extremity • A new lump > 2cm

It is important as the triage nurse to consider if paracetamol has already been administered to the child by the parent upon presentation to the emergency department. Dosage as well as time or times of administration during a 24-hour period are important to reduce the risk of toxicity in children. The safety margin between a therapeutic and toxic dose of paracetamol varies widely amongst individuals and according to routes of administration (Paul et al 2011).

Explicit variable doses of paracetamol are reported throughout literature without being able to make specific recommendations. Paracetamol guidelines (NPS 2012) in Australia recommend a 30 May 2015 Volume 22, No.10

weight-based dose that is reiterated by Glatstein and Scolnick (2008) as 15mg/ kg four hourly but not exceeding 80mg/ kg a day. Currently the dosages prescribed are those specified by the medical officer, as cannot be nurse initiated in the current hospital environment. Therefore, recommendations and dosages may change depending on the doctors perception. It is however, important for the triage nurse to be aware of dosages, including maximum dosages.

Risks of toxicity are variable throughout literature. Most importantly, if the triage nurse is concerned, paracetamol should be withheld. Knowledge surrounding the risk of toxicity including an increased risk in

• • • • • • •

a fever > 39 Non-blanching rash Bulging fontanelle Neck stiffness Status epilepticus Focal neurological signs Focal seizures Bile stained vomit

the dehydrated child, and those with preexisting conditions should be considered (Dixon, Deehan, Dickson, Miller & PegnamMason 2006).

Documentation Inaccurate documentation is cited as one of the main reasons contributing to inconsistent fever management practices and in most cases, nurses to not document the rationale for administering paracetamol or abnormalities in conditions (Thompson & Kagan 2010). At times of triage when it is busy and time constraints limit the ability to anmf.org.au

Clinical update

reassess the child, particularly in the waiting room, it is important to prioritise, reassess and document all clinical findings until the child is seen by a medical officer.

Education Education of the parents is a role of the triage nurse that promotes comfort and security in the level of care being provided.

It is well documented that informed patients are more satisfied with care when confident health education is promoted.

NICE (2007) recommends ideas such as information charts, education on things parents should be aware of in their unwell child such as rash and dehydration, and encourages a reduction in the perceptions surrounding febrile convulsions.

The Launceston General Hospital provides information sheets on febrile convulsions and fever to parents of children with fever supplied by the Royal Children’s Hospital in Melbourne as part of discharge planning to reduce discomfort in parents and encourage appropriate management of their unwell child. anmf.org.au

literature review. Journal of Research in Nursing, 11.

Summary Fever in children is a common presentation to the emergency department and in most instances has no adverse consequences. The role of the triage nurse is to have thorough knowledge of up to date practices in caring for the child with fever, and to accurately assess and manage the child.

Using evidence based practice to apply appropriate triage categories, effective care including accurate and informed education of parents. Every nurse working on triage should maintain current knowledge and have continuous education concerning the child with fever and the unwell child to promote best patient outcomes and maintain best practice standards.

References Broom M, 2007. Physiology of Fever, Paediatric Nursing, 19 (6), 40–45.

Cameron P, Jelinek G, Browne G & Raftos J 2006.

Textbook of Paediatric Emergency Medicine. Churchill Livingston, UK. Dixon G, Deehan D, Dickson R, Miller H & PegnamMason H, 2006. Clinical and consumer guidelines related to the management of childhood fever: A

Emergency Triage Education Kit 2009. Commonwealth of Australia. www.health.gov.au/publicat.html. Accessed 28 August 2012.

Glatstein M, Scolnik D 2008. Fever: to treat or not to treat? World Journal of Paediatrics 4(4).

NICE CG47 2007. Feverish illness in children: Assessing initial management in children younger than 5 years. www.nice.org.uk. Accessed 8 August 2012.

NPS 2012. Paracetamol for pain and fever, www.nps. org.au, accessed 8 August 2012.

Paul S, Mayhew J & Mee A, 2011. Safe Management and prescribing for fever in children. Nurse Prescribing, 9(11).

RCH: Royal Childrens Hospital kids health information: What is Fever, 15/11/2007. Accessed from Launceston General Hospital Intranet, 12 Sept 2012.

Thompson H, Kagan S, 2010. Clinical management of fever by nurses: doing what works, Journal of Advanced Nursing 67 (2) 359–370.

Warwick C, 2008. Paracetamol and fever management, The Journal of the Royal Society for the Promotion of health, 128 (6), 320–323.

Angela Knight is a Registered Nurse who until recently worked in the, Emergency Department, John Hunter Hospital - Hunter New England Health, NSW and in the Emergency Department at Launceston General Hospital Tasmania May 2015 Volume 22, No.10 31

Industrial

32 May 2015 Volume 22, No.10

As the table below shows Australia compares favourably to other OECD countries in minimum wage levels. It is part of our fabric and helps ensure all workers receive a reasonable minima.The importance of the minimum wage for nurses and midwives cannot be underestimated. The maintenance and steady increase in the minimum wage has been the driver of increases in nursing and midwifery wages.

The minimum wage is the principal mechanism by which the wages and conditions of nurses and midwives are determined. As the minimum wage moves consequent wage adjustments for nursing and midwifery skills, qualifications and experience, either through the award or agreements, also occur. This is an important issue which is often overlooked when debating the future of minimum wages.

It is ironic that whenever there is a debate about employee’s entitlements to wages, working hours or penalties, those calling loudest for change are often those furthest away from minimum wages and shift work.

They are typically well heeled, highly paid male executives who are not required to work unsociable hours, at weekends or at night. Quite frankly they would have little understanding of the impact of working rotating shifts and struggling to make ends meet. For the ANMF the maintenance of penalties and a fair minimum wage are articles of faith. We will be knocking on politicians doors and running campaigns at a national, state and territory level all the way to the 2016 federal election to ensure these vital protections are retained. We invite all nurses and midwives to join us.

©2013 ‘Ranking America’ (http://rankingamerica.wordpress.com $18.00 Data from OECD http://stats.oecd.org/Index?Queryid=7219 $16.00 $14.00 $12.00

United States

$2.00

Japan

$4.00

Canada

$6.00

New Zealand

$8.00

United Kingdom

$10.00

Netherlands

While the campaign backfired, as plenty of businesses stayed open and did a roaring trade, it is interesting to look at the employers’ rationale which, when you strip it back, is basically a flagrant push to remove all obstacles to an employer requiring an

which has not moved for over 10 years and where many employees are forced to work two jobs just to make ends meet.

Top Eleven OECD Countries by Mimimum Wage

Belgium

In an attempt to highlight this issue, over the Easter period the peak national employer body (ACCI) called on restaurants and shops who closed over the holidays to put signs in their windows saying “it’s because penalty rates are too high”. In support of their campaign ACCI pointed to the fact that times had changed as now most people did not attend church during the Easter period as they did 50 years ago. So in the view of the ACCI, and their members supporting the campaign, if you’re not at church you should be at work without penalties or loadings.

Many employers hate the legislated minimum wage and are now campaigning for its complete removal. They crave for the minimum wage system of the United States

Ireland

Also as expected the employers and their representatives are using the review to again call for further deregulation of penalty rates and deregulation of the minimum wage.

And in this context deregulation definitely means a reduction! In regard to penalty rates the broad thrust of the employer’s argument is, in the global economy of the 21st century, weekends, public holidays and shift work are no different to nine to five Monday to Friday and employers shouldn’t be required to pay penalties or loadings.

Minimum wages also play an important role in Australian society. The minimum wage, which is enshrined in law in Australia, is specifically intended to address the inherent imbalance in power between employers and low wage workers that can push wages down to poverty levels. A minimum wage helps ensure that the weakest in our workforce (typically unskilled, part time, female workers often referred to as the working poor) are not forced into poverty.

France

As part of this process the Commission has called for written submissions. The submissions, including by the ANMF, are available to read at www.pc.gov.au/ inquiries/current/workplace-relations/ submissions

Luxembourg

As expected the federal government has now directed the Productivity Commission to undertake a review of Australian workplace relations laws and to make recommendations for change to government by November 2015.

Australia

Penalty rates and minimum wages again under attack

While they may be a relatively blunt instrument, penalties and shift loadings do play an important role in deterring employers from requiring employees to work long and unsociable hours. They help ensure reasonable working hour’s standards are maintained.Penalty and shift payments are also a critical component of an employees’ wages and often the difference between a fair wage and a low wage. Analysis undertaken by the ANMF shows that a small reduction of current penalties and loadings for nurses and midwives working in the acute sector would mean a loss of hundreds of dollars each week. Similarly an Assistant in Nursing in the aged care sector could lose up to $250 each week if current penalties and loadings were removed. A detailed analysis of the financial impact of these changes is available in the ANMF submission. http://anmf.org.au/pages/ anmf-submissions

Minimum wage in $USD exchange rates (2011)

Nick Blake, Senior Federal Industrial Officer

employee to work at any time. And in pursuing this outcome employers appear to place no credence whatsoever on the importance to employees of spending leisure time with families and communities.

$0.00

anmf.org.au

Ethics

Megan-Jane Johnstone

Moral competence in nursing During the early 1990s, the Australian Nursing and Midwifery Council (ANMC), now the Nursing and Midwifery Board of Australia (NMBA), adopted the first set of core National competency standards for registered nurses (NMBA 2008).

The purpose of these standards, which have since undergone periodic review and revision, is to provide a benchmark against which the competence of nurses to practice in a range of settings can be assessed in order for them to obtain and retain registration as a nurse in Australia. The standards are also used to: communicate to the public the standards it can expect of nurses; guide the development of nursing curricula; and assess the performance of students and new graduates (NMBA 2008).

Question of nursing ethics ‘Competence’ is defined in the standards as the ‘combination of skills, knowledge, attitudes, values and abilities that underpin effective and/or superior performance in a profession/occupational area’ (NMBA 2008). The essential competencies (ie. skills, knowledge, attitudes, values and abilities) expected of registered nurses are organised into four domains: professional practice, critical thinking and analysis, provision and coordination of care, and collaborative and therapeutic practice.

The first of these domains, professional practice – pertains specifically to the moral competencies nurses are expected to be able to demonstrate. These are outlined to include a satisfactory knowledge base, accountability for practice, and the protection of individual and group rights (NMBA 2008).

Few would doubt the importance of moral competence as an essential component of responsible, responsive, safe and high quality (‘excellent’) nursing care. Moreover, it is appropriate to distinguish moral competence from the general professional competence anmf.org.au

expected of a registered nurse since ‘it cannot be assumed that ethical competence will inevitably emerge during the development of general professional competence’ (Gallagher 2006). Even so questions remain about what moral competence really is and how it might be recognised (how will we ‘know’ moral competence when we see it?). One reason for this is that the concept of moral competence has not been well defined in the nursing literature. Nor is there a consensus on a taxonomy of moral competencies (such as those developed by the American Society for Bioethics and Humanities (ASBH) (Tarzian 2013) or the underlying principles that might be used to classify the moral knowledge, skills, attitudes, values and abilities that nurses must demonstrate.

settings and their possible influence on the way in which ethical issues are perceived and addressed. Nurses also need to develop a set of the moral skills, including assessment skills (eg. being able to identify moral problems, correctly ‘diagnose’ the nature of the moral problems at hand, and access relevant resources to assist in addressing the problems identified); implementation skills (eg. be able to apply their moral knowledge in a sound and valid way to address the problems at hand and evaluate the success or otherwise of the outcomes of their interventions); and interpersonal skills (eg. ‘good’ communication skills, ability to listen to others, and the capacity to guide effective problem-solving with patients and other members of the healthcare team).

Moral competence

Pedagogical challenges

With rare exception (eg. Gallagher 2006), what little has been written on the notion of moral competence in nursing has tended to over-emphasise its values and attitudinal or characterological components – eg. kindness, compassion, equanimity, honesty, respectfulness, sensitivity, etc. This has been at the expense of the knowledge, skills and abilities components of moral competency and, equally important, how these things might be reliably recognised and assessed – either by nurses themselves or their regulating bodies.

There is a risk that nurses may not be able to achieve the conventional moral competency standards expected of registered nurses.

While nursing curricula contain a professional ethics component, it is questionable whether the content taught and teaching methods used are sufficient to enable graduates to develop anything more than a superficial understanding of professional ethics or indeed the skills, knowledge, attitudes, values and abilities necessary to demonstrate the moral competencies expected. As noted earlier, it cannot be assumed that nurses will acquire the necessary moral competencies by virtue of developing the general competencies expected of a registered nurse.

Left unresolved this issue has significant implications for nursing practice and policy.

Accordingly it stands in need of immediate critical inquiry.

Moral competence involves much more than and goes beyond mere ‘moral sensitivity’, moral awareness and being of ‘good character’. While these components are important, moral competence also fundamentally includes the possession of moral knowledge (knowing that and knowing how), the capacity to respect different moral perspectives (including those different to one’s own) and, importantly, having the necessary skills and ability to use these skills effectively to deal with morally problematic situations.

In terms of the moral knowledge nurses need to have, this minimally includes their having knowledge and understanding of: the different ethical concepts and theories that are pertinent to healthcare settings and how these relate to nursing and healthcare practice; processes for enabling sound moral reasoning and decision-making; common ethical issues arising in and affecting nursing and healthcare practice; codes of ethics, guidelines and standards of practice relevant to nursing practice and to the settings in which nurses work; and the power dynamics of the social, cultural, political, legal and institutional environment in which ethical issues arise in nursing and healthcare

References Gallagher A 2006. The teaching of nursing ethics: content and method. Promoting ethical competence. In AJ Davis, V Tschudin & L de Raeve (eds). Essentials of teaching and learning in nursing ethics: perspectives and methods.

Churchill Livingstone/Elsevier, Edinburgh, pp.223-239 Nursing and Midwifery Board of Australia (NMBA) 2008. National Competency standards for the registered nurses. NMBA, Canberra.

Tarzian A 2013. Health care ethics consultation: an update on core competencies and emerging standards from the American Society of Bioethics and Humanities’ Core Competencies Update Task Force. American Journal of Bioethics, 13(2): 3-13.

Megan-Jane Johnstone is Professor of Nursing in the School of Nursing and Midwifery at Deakin University in Victoria. Professor Johnstone has extensive interest and expertise in the area of professional ethics in nursing. *Editorial note: The RN competency standards are currently being revised as Standards for Practice. The Code of Ethics are being revised later this year.

May 2015 Volume 22, No.10 33

Education

Prevention of Occupational Violence and Aggression in Healthcare The following excerpt is from the Prevention of Occupational Violence and Aggression in Healthcare tutorial available on the Australian Nursing and Midwifery Federation (ANMF’s) Continuing Professional Education (CPE) website.

The tutorial has been designed for health service staff who are increasingly being confronted with incidents of occupational violence and aggression. Upon completion of the complete learning program in its entirety (available on the ANMF website) you will be able to: Discuss the types of occupational violence and aggression (OV&A), legislation relevant to OV&A, Australian Standards, strategies for preventing and managing OV&A, identifying that an incident is occurring, evaluating an incident and taking action and post incident de-briefing and review.

Occupational violence and aggression OV&A not only affects the health and wellbeing of health service staff but has significant workforce and financial implications for the healthcare industry. For all of these reasons, staff need to know how to prevent, reduce and manage incidents of violence and aggression in the workplace.

constitutes a violent or aggressive incident.

The key issue here is that the aggressive behaviour creates a risk to the health and safety of an employee.

There are three general types of OV&A. It is important to understand the different types of OV&A as they are used as a basis for planning and preventing OV&A incidents.

• The first type of OV&A is clientinitiated violence which occurs when a client or a client’s family member, friend or guardian is the source of the OV&A. • The second type is internal violence which occurs when someone who works under the direction of an organisation is the source of the behaviour. Examples of this include employee-to-employee, contractor-to-employee and supervisorto-employee OV&A. • The third type is external violence which occurs when violence is perpetrated by persons with no legitimate relationship to the organisation, eg. robbery.

Occupational violence and aggression is defined as ‘any incident where an employee is abused, threatened or assaulted in circumstances arising out of, or in the course of, their employment’.

Managing incidents of OV&A is not just best practice, it is also a legislative duty of care. This means that your organisation has a legal responsibility to protect your health and safety.

There really are no limitations on what

Australian Standards recommend that

34 May 2015 Volume 22, No.10

healthcare facilities develop a Code Black response to specific OV&A incidents. Code Black incidents occur when there are: ‘armed or unarmed persons threatening injury to others or to themselves’.

All healthcare organisations should have a Code Black response plan that outlines the actions that should be taken in the event of an aggressive or violent incident. You should be aware that Code Black procedures vary from organisation to organisation. Some healthcare organisations have a different definition of Code Black than that provided

by Standards Australia. In many larger hospitals, for example, Code Black is only called for armed offenders.

It is your responsibility to understand and implement your organisation’s guidelines on preventing and managing incidents of OV&A. You need to do this not only to protect patients, visitors and other staff from harm but also to protect yourself from temporary or permanent physical and/or psychological injury.

The steps involved in managing a violent or aggressive incident include the following: • Being prepared for incidents; • Identifying that an incident is occurring; • Evaluating an incident and taking action; • Post-incident review and debriefing. anmf.org.au

Education One of the most important issues for managing aggressive incidents is performing tasks well under the stress of an actual incident. Good knowledge of your workplace environment and the equipment in it is crucial.

Your actions and decisions should be confident and efficient. To achieve confidence and efficiency, you need to undergo simple, regular training scenarios in your workplace, where the aggressive incidents are likely to occur, using your security equipment that you may use in an actual incident, and gauging your performance in the workplace environment.

Regular training will assist you in performing your tasks safely and efficiently when an incident occurs. When you are confident, you will know what to do and your fear and anxiety will be reduced.

Training scenarios should be based on the actual incidents that have occurred in your workplace within the last 12 months.

Look at the information contained in safety incident reports – this will show staff what sort of incidents you and your staff should be training for. For example, triage departments need to train for triage incidents, and aged care facilities need to train for incidents involving residents and/or their relatives.

Training scenarios should also be based on incidents that haven’t occurred in your health service but have taken place at similar organisations. All issues that are identified in real life incidents should be addressed in the training drills. For example, if staff responded too slowly to an incident, this needs to be discussed and measures taken to prevent such a response in future. On the other hand, incidents that are well handled also need to be highlighted and discussed.

Another way of preparing yourself for OV&A incidents is to fully appreciate the OV&A hazards that exist in your workplace.

To begin with you need to understand the factors that may increase the risk of violent and aggressive incidents occurring in your facility. There are a range of conditions that predispose people to being violent and aggressive such as: conditions such as infection, dehydration, pain, stress, fear, grief, anger, or frustration, including mental illness or disorders may cause some people to become violent and aggressive.

Substance abuse/Misuse: When faced with a client who is affected by alcohol anmf.org.au

or other drugs please consider the following information: • Amphetamines and methamphetamines (in their various forms known as ice, speed, base, meth etc.) are central nervous system stimulants. They increase the body’s responses, making people feel alert, energetic, excited and euphoric.

• Withdrawal or ‘coming down’ from these drugs cause the user to feel irritable, anxious, paranoid, scared, exhausted and depressed.

• They are more likely to be prone to violence and aggression at this stage.

• Alcohol on its own, or mixed with other drugs can make some people aggressive and prone to violence.

When faced with a person clearly intoxicated by alcohol and/or other drugs you will need to use your judgment in terms of negotiation. If the situation is dangerous, call an emergency code immediately. Do not put yourself at risk. Be aware of your body language and tone of voice when dealing with people under the influence of drugs and/or alcohol. Remain calm and speak calmly and reassuringly.

workplace is very important in preventing OV&A incidents from occurring. What are the factors in your work setting that predispose patients, clients, residents or visitors to violence? What factors are known to trigger violent and aggressive behaviours in the people you come into contact with as part of your day-to-day work? Your ward/unit/service should have a process for screening and assessing clients who may be at high risk of violence or aggression.

The next stage of managing a violent or aggressive incident is to recognise that an incident is about to happen. To identify that a violent or aggressive incident is occurring, you need to pay attention to your instincts. Often your senses will pick up signals before your brain registers them.

As the incident is developing you will get the feeling that ‘something doesn’t feel right here’.

The next section of the tutorial discusses the measures you can take to manage incidents of OV&A. Additionally, four real life scenario videos are embedded within this tutorial to demonstrate the right and wrong ways of managing an aggressive person

The factors that trigger incidents of OV&A will vary according to the types of clients you come into contact with and the settings in which you work. For example, in emergency departments factors that may increase the risk of OV&A incidents occurring include: dissatisfaction with care (eg. long waiting times or staff shortages), and the presence of other noisy or agitated clients.

Health service staff need to be aware of the factors that predispose people to acts of violence and aggression as well as those factors that may trigger this type of incident.

For example, a client who is a smoker and is predisposed to violent behaviours may become aggressive if a nurse or staff member ignores a request for a cigarette.

Some other triggers may include: • Lack of sleep; • Excessive noise; • Overcrowding; • Perceived lack of communication with staff; • Poor information – including staff as well as clients; • Boredom; • Change of routine; • Inexperienced, new or easily intimidated staff members; • Cultural issues; and • Misinterpreted body language.

Continuing Professional Development (CPD) By reading this excerpt you have gained one hour of continuing professional development (CPD) towards your ongoing registration requirement. By accessing this tutorial in its entirety you will learn how to manage OV&A incidents in your workplace and earn five hours of CPD. Go to the CPE website: www. anmf.org.au/cpe to complete this online activity. ANMF, NSWNMA and QNU members pay only $7.70 For further information contact Jodie or Rebecca at education@anmf. org.au or ph: 02 6232 6533

Undertaking a risk assessment in your May 2015 Volume 22, No.10 35

Viewpoint Dehydration and climate change

By Amanda J Ruler Extreme weather patterns caused by climate change are being experienced across Australia and will continue – contributing to future disasters on an unprecedented scale.

In Australia, health facilities need to be prepared for climate change related emergencies such as heat stress and associated bushfires. Developing and planning policies to accommodate changing weather conditions and their impact is essential. Prolonged extremes in temperatures in city and regional areas may also cause other less dramatic health issues.

Dehydration is not an uncommon feature at emergency departments and the risk of being affected is greatly exacerbated by being exposed to higher temperatures. Vulnerable people in our community such as young children, the elderly, Indigenous communities and the impaired are most at risk.

The body responds to dehydration by creating a thirst sensation to increase fluid intake, and decreased urine output to conserve water loss. As dehydration progresses, the urine becomes more concentrated and yellow in colour. Further dehydration may cause dry mouth, reduced tear and sweat production, muscle cramps, nausea and vomiting, heart palpitations, light headedness (especially when standing), weakness and decreased urine output. The body initially vasodilates (to rid excess heat) yet also tries to maintain cardiac output.

With decreasing amounts of extra and intravascular fluid in the system, the heart rate increases and blood vessels constrict to try to maintain blood pressure and blood flow to the vital organs of the body- such as the brain, heart, lungs, kidneys, and intestines. The skin feels cool and clammy.

This coping mechanism however gradually fails as dehydration progresses and places an increasing amount of stress on the cardiac system. Confusion and weakness 36 May 2015 Volume 22, No.10

will occur as the brain and other body organs receive less blood flow as the body further dehydrates. If untreated, coma, organ failure and finally death will occur.

The initial treatment for simple dehydration is fluid replacement and gentle cooling in case of heat stress. Small, frequent amounts of cool clear fluid may be attempted orally- however if this fails intravenous fluids (room temperature) may be required. Clear fluids include: • water (not recommended for infants; use balanced electrolyte solutions instead); • clear soups; • ice blocks; • clear jelly; • other electrolyte replacement fluids such as Gastrolyte or Gatorade, Powerade etc., diluted.

The ability of the client to tolerate oral fluids and the extent of their dehydration will determine whether intravenous therapy is required. If the client becomes confused or lethargic, fever persists or vomiting or diarrhoea occurs, then further interventions will be required to avoid a relapse.

Dehydration is preventable on hot days with regular fluid intake and keeping cool.

Do not schedule activities in the heat of the day. Ensure vulnerable people have access to air coolers indoors. Always ensure adequate fluids are readily available and allow people access to cooler, shaded areas when outside. Given the average adult needs between two and three litres of fluid per day, encourage and assist people with fluids wherever possible, especially when they have impaired judgment and /or are unable to drink independently (Werdo et al.).

Checking skin turgor can help assess dehydration. This is done by pinching up a skin portion (ie. on the back of the hand) between two fingers to raise it for a few seconds. Then release the skin – if no dehydration is present the skin returns quickly to its normal position. With moderate to severe dehydration, decreased skin turgor causes the pinched–up skin to remain elevated and only slowly returns to its flat position. Use fluid balance charts as needed to monitor fluid input and output, especially where dehydration is suspected.

Know the signs of heat cramps (painful, brief muscle cramps occurring during exercise or work in a hot environment), heat rash (a pink/red skin condition caused by blocked sweat ducts and trapped sweat beneath the skin), heat exhaustion (heavy sweating and a rapid pulse, a result of the body overheating), and heat stroke (defined as hyperthermia with a body temperature greater than 40.6 °C). Preventing dehydration allows these conditions to be avoided (MedicineNet.com 2012).

This is the critical decade: Australia must strive to cut emissions rapidly and deeply to join global efforts to stabilise the world’s climate and reduce the risk of extreme events - including bushfires, droughts, food and water shortages and resultant mass migrations, wars and conflict (Doctors for the Environment 2015).

We can also: 1. Be more active by driving/flying less and walking/cycling more will not only save the environment but is good for your health.

2. Divest, by taking your superfund out of fossil fuel shares (the average superfund has up to 50% of your money exposed to fossil fuel hence greenhouse gas causing activities) 3. Join a health organisation to lend your voice for strong climate action and opposition to warfare. Contact Amanda Ruler RN at: Amanda.ruler@mapw. org.au for more information or go to the website mapw.org.au References Doctors for the Environment Australia Website http:// dea.org.au/ MedicineNet.com (2012) Definition of Turgor www. medicinenet.com/script/main/art.asp?articlekey=90720 viewed 16/3/15 Wedro B and Stoppler MC. Dehydration www. medicinenet.com/dehydration viewed 16/3/15

Dr Amanda J Ruler RN, BA (Hons) Grad Dip Gerontological Nursing, PhD Practising RN and Adjunct Research Fellow, School of Nursing and Midwifery, University of SA anmf.org.au

Research Improving midwifery outcomes More in-depth education relating to clinical reasoning and decision-making could improve the safety and effectiveness of midwifery practice in Australia, a study has found.

The study from the Southern Cross University investigated how midwives made decisions and what conditions affected their decision-making.

One of the study leads Dr Elaine Jefford used clinical narratives from 26 practising midwives from various services across Australia. Two narratives were collected from each midwife – one the midwife deemed an example of good clinical reasoning and the other of poor clinical reasoning. These were assessed against a decision making framework devised by Dr Jefford.

The study found significant variations in midwives’ decision- making processes at the time of birth. Yet according to Dr Jefford the key to high standards in care is effective decision-making. “In Australia universities and around the world there are no standards on how or where in the curriculum to teach clinical reasoning or decision making skills to students of midwifery or how to refine these skills.

These inconsistences undermine the effectiveness and application of midwifery education in to practice, as well as hindering a midwife’s professional autonomy and the discipline generally. Ultimately, the health and safety of women and babies is compromised.”

According to the research findings midwifery regulatory authorities should revise professional decision-making frameworks to explicitly reflect analytical clinical reasoning and that bodies overseeing midwifery education introduce clinical reasoning into midwifery curricula for teaching and assessment.

In collaboration with other researchers, Dr Jefford is in the process of developing an online learning package focussing on clinical reasoning and decision-making for students of midwifery. Dr Jefford said the online package will provide structured, comprehensive and transparent theoretical and philosophical approach to decisionmaking processes and their application to midwifery.

anmf.org.au

Nurse expedited discharge from hospital Allowing nurses to discharge patients has multiple benefits, Australian research shows.

Teresa Kemp from the Respiratory Chronic Care, Camden and Campbelltown hospitals presented the research findings at the annual scientific meeting at the Thoracic Society of Australia and New Zealand on the Gold Coast last month.

“This was a careful study with robust reporting. It demonstrated significant benefits on numerous levels in allowing nurses, in collaboration with the treating Physician to discharge patients,” Ms Kemp said.

Ms Kemp said previous evidence suggested discharges earlier in the day improved patient flow. However traditionally, patients required medical review prior to discharge which often led to delays in discharge.

In an endeavour to increase the proportion of patients discharged prior to midday (DPMD) a program of Nurse Expedited Discharge (NED) was developed.

Only patients on the respiratory ward

were eligible for NED and were selected as suitable by medical staff the day prior discharge. Nursing staff were then able to discharge the patients if they met the conditions on the NED checklist.

As part of the study a rigorous reporting strategy reviewed adverse events and satisfaction of both patients and stakeholders was undertaken.Over the period of the study the rate of DPMD from the respiratory ward was higher than both comparison wards. Additionally 100% of patients reported that NED was either good or very good and often preferred NED to traditional discharge. Nursing staff also reported a high level of satisfaction with the process. No reported adverse events related to NED were reported.

Ms Kemp said it was fair to say that the NED pilot study was an overwhelming success. “Further research is now needed to extend the approach to other health services and subspecialties.”

Nurses’ experience of being a healthcare consumer By Associate Professor Jennifer Newton Research that aims to explore the experiences of nurses as healthcare consumers is being conducted at Monash University, Victoria.

The study, From carer to recipient: nurses’ experience of being a health care consumer, is being led by Associate Professor Jennifer Newton who has been passionate about supporting the education of nurses and student nurses, particularly in the nexus between academia and the clinical workplace.

Her focus is on enhancing nurses’ practice, through exploration of how personal experiences can impact on nurses’ professional practice.

The research comes in light of recent criticism that the compassion of caring in nursing is being eroded. Nurses need to ensure that they are meeting the expectations of the profession. A workplace culture that embraces personcentred care, and is supportive of new graduates and students ‘doing the little things’ needs to be considered as an essential component of nursing care.

Therefore it is critical that the voice of nurses’ experiences as care recipients

is heard to enable translation into education, practice and management.

Registered nurses from Victoria, currently practising in a clinical, managerial or educational role, who have been a hospitalised patient or have identified themselves as the primary carer for a hospitalised patient, are now being sought for the study.

Participation involves at least two audio recorded interviews, conducted throughout a period of six months during 2015, to talk about experiences as a healthcare consumer. No payments or incentives will be offered.

The study is funded by a 2015 Nurses Board Victoria Legacy League (NBVLL) major grant.

If you are interested in participating or would like further information about the study please contact Associate Professor Jennifer Newton via email: jenny.newton@monash.edu or by telephone: 03 9902 4570.

May 2015 Volume 22, No.10 37

Wellbeing

Janette Cooper

Nurses as leaders – creating nurses with drive and passion Nurses are increasingly being encouraged to step up as leaders in the healthcare setting. The field of nursing demands nurses use leadership skills regularly so knowing what the core skills of leadership are and how they can be used to get the outcomes you desire is an area of education that is increasingly important to your career, your job satisfaction, your interpersonal relationships and consequently your health.

We want nurses to be capable and confident in their abilities to lead. We want nurses to have the confidence in their ability to manage their own emotions and the emotions of others. This is best achieved through knowing yourself. What are your values and how do those values affect your attitudes, beliefs and decisions.

We all come to the workplace with our own set of values and beliefs. It is understandable that within work teams there is sometimes conflict. How you manage conflict and influence the outcome of the conflict will depend on your leadership skills.

Developing your leadership skills will go a long way in managing an ever changing work environment. How well people will follow you depends on your skills as a leader. Nursing education has historically focussed on acquiring knowledge and skills. While these areas of expertise are important for performing adequately as a nurse they are of less importance when you are required to lead. Leadership requires you assess your attitude – how you think and feel and your habits – the way you do things.

If you want to succeed as a leader you have to have people who are willing to follow you. Some people seem to achieve this effortlessly. They have an innate skill 38 May 2015 Volume 22, No.10

of getting people to like them and trust them and this allows them to influence and achieve their objectives more easily.

Understanding emotional intelligence, what it is and what the core competencies are can help build your leadership capabilities. These are all skills that can be learned and enhanced.

Leadership is the ability to influence others to achieve goals set by individuals or organisations. Great leaders inspire their team to do their best. Great leaders are liked and trusted by their team.

Emotional intelligence is the ability to recognise your own emotions and how they impact on your behaviour and how that behaviour affects the people around you as well as understanding the emotions of others and how that is motivating or creating their behaviour. With a greater understanding of emotional intelligence you will be able to more easily manage your own emotions and manage and defuse the emotions of others (Goleman 1996).

Every decision we make is affected at some level by our emotions.

The core competencies of emotional intelligence include:

•

•

•

•

others’ feelings and perspectives and taking an active interest in their concerns.

Developing others: sensing others’ development needs and bolstering their abilities.

Service Orientation: anticipating, recognising and meeting customers’ needs.

Leveraging diversity: cultivating opportunities through different people.

Political awareness: reading a group’s emotional current and power relationships.

Social Skills • Influence: wielding effective tactics

for persuasion.

• Communication: listening openly and

sending convincing messages.

• Conflict Management: negotiating

and resolving disagreements.

• Leadership: inspiring and guiding

individuals and groups.

• Change catalyst: initiating or

managing change • Building bonds: nurturing

instrumental relationships.

Self-awareness

• Collaboration and cooperation:

• Emotional awareness: recognising

working with others towards shared goals.

• Team capabilities: creating group synergy in pursuing collective goals.

your emotions and the effects they have on you and others.

• Accurate self-assessment: knowing your strengths and your limitations • Self-confidence: a strong sense of your self-worth and capabilities.

Self-Regulation • Self-control: keeping disruptive

emotions and impulses in check.

• Trustworthiness: maintaining

standards of honesty and integrity.

• Conscientiousness: taking

responsibility for personal performance.

• Adaptability: flexibility in

handling change • Innovation: being comfortable

with novel ideas, approaches, and new information.

Motivation • Achievement drive: striving to improve

or meet a standard of excellence.

• Commitment: aligning with the goals

of the group or the organisation.

• Alignment: readiness to act on

opportunities.

• Optimism: persistence in pursuing goals despite obstacles and set-backs.

Empathy • Understanding others: sensing

Developing our emotional intelligence takes time. If we want to be a great leader that inspires our team to be the best they can be we have to spend the time to understand how we can make that happen.

What attitudes and habits do I take to work and how do they impact on me and on the people I work with. If I wanted to have a better day at work how could I do that? We have to look at our attitudes and habits and assess whether we can modify how we do things so that our lives at work are happier and healthier.

Nurses must develop their emotional intelligence if they want to thrive in their careers. Our emotions can sometimes be surprising. Knowing how to manage our emotions so that we can reduce the stress and tension in our day is important to our health and our ability to thrive in our chosen profession.

Reference Goleman D 1996. Emotional Intelligence, Bloomsbury Publishing PLC, London

Janette Cooper BN, Grad Cert Health Service Management is a Life Coach and Presenter anmf.org.au

Working life

Cate Nagle

A year in Provence Well not quite Provence, but just as restorative! In the second half of 2014 I was fortunate to be granted leave from Deakin University and spent nine weeks ‘returning to the fold’, embedded in three midwifery settings in regional Victoria, metropolitan Melbourne and south-west UK. This was a wonderful opportunity and the generosity (and curiosity!) of midwives I worked alongside was greatly appreciated.

I reflect on three observations I found most striking.

Same, same… but different Firstly, it was remarkable how some experiences were so familiar to me- the vunerability of a woman in pregnancy, the intense focus of a labouring woman, the complexities of the lives of some women and the privilege of providing midwifery care, all evoked powerful memories.

Some things however had changed, measuring a temperature temporal rather than typmpanic methods are now used; incident reports are now ‘Riskmans’; and an overwiew of the woman’s plan of care has moved from the whiteboard to the journey board. While these are really minor applications of technology, I am not covinced that the provision of safe, quality care has advanced.

The risk environment Secondly, it was striking to note that the safety paradigm seems to have highjacked commonsense. The universal application of the Australian Commission on Safety and Quality in healthcare’s (ACSQHS), National Safety and Quality Health Service Standards to the maternity environment provides a case in point. In clinical environments that are already busy, a requirement to assess a young fit childbearing woman for a falls risk and pressure care injury and then apply the appropriate sticker to specific sheets so compliance can be assessed needs to anmf.org.au

be questioned. I ponder the motivation of the universal application of these safety standards. Is a default to guard against a poor assessment and care and if so, is this an appropriate response?

The early warning chart to assist clinicians detect a woman’s clinical deterioration by providing graphical representation of variances in vital signs and other measurements appears a useful innovation. However there needs to be modifications to parameters to accommodate the physiological changes that occur in pregnancy and with little evidence to guide practice there is widespread disagreement on measures.

Standardised processes are recognised to decrease risk and this area warrants development so that all services in the same jurisdiction are using and documenting the same reference points, with adjustments for individual women made by the collaborative team. In Victorian and UK maternity services, significant variations also exists in the systems response to detection of clinical deterioration.

Documentation Thirdly, I recall the frequent complaints from past colleagues of too much paper-worknow I think it is worse!

There is an overwhelming amount of paper-based and electronic data entry and much of it continues to be documented distant from the data source. In these times of lean thinking, a critical lens applied to identifying the minimum data set required to inform care would seem a significant advance. With each data point entered there exists a potential for error so the nature of the information we record and how we document is critical.

Technology abounds. There have been new generations of cadiotocography machines and in some services these can be viewed from the tea-room or desk, clocking on or off shifts can now be performed with a digital reading and all clinical environments are more secure, yet we are still grappling with blended use of paper-based and electronic data sources.

Every time we transcribe a blood group or Group B streptococcus result, are we relying on the original pathology or referencing a secondary source? I reflect on the significant risks of poorly integrated software, multiple entries of the same data and the significant need for digital data entry at point of care. Because of the significant cost of this investment, the UK service I visited has returned to paper-based documentation-the resultant reduction of risk is not known.

Regardless of the method of data capture, the quality of what is recorded remains variable in quality and an area for continued professional development.

The most enduring legacy of my professional practice is a conviction of how meaningful midwifery is as a career. In environments where we can be distracted by the untapped potential of midwifery led care, increased rate interventions, increased acuity of the woman in our care and other challenges, there remains the truism that each of us can make a difference. How we make advances in safety and quality in midwifery care requires us all to be engaged, curious and questioning.

Cate Nagle is an Associate Professor at Deakin University, Geelong Waterfront Campus and Sunshine Hospital, Women’s and Children’s Division, Western Health, Victoria May 2015 Volume 22, No.10 39

Issues Cardiovascular screening by Women’s Health Nurses

By Lorena Schot Cardiovascular disease (CVD) is a major cause of morbidity and mortality in Australian women and is primarily the cause of premature death. Women are four times more likely to die of heart disease than breast cancer and it is estimated that one in five Australian women has CVD but most do not know they are at high risk (AIHW 2010).

Women are also misdiagnosed as they present to emergency department with less specific symptoms of heart attack and are therefore less likely to receive important diagnostic tests and treatments than men (Milner et al. 1999).

Despite over 90% of Australian women having at least one modifiable risk factor for CVD there is poor knowledge around its prevention, with few women able to correctly identify risk factors for CVD (AIHW 2010).

As CVD is a multi-factorial disease, it is important to consider the combination of multiple risk factors when assessing an individual’s risk rather than a single risk factor in isolation. Risk factors for CVD can be divided into non modifiable and modifiable. Non modifiable risk factors

are age, gender, ethnicity, genetics.

Modifiable risk factors include poor diet, high cholesterol, physical inactivity, diabetes, high blood pressure, smoking and depression (AIHW 2010).

I became involved in The Heart Smart for Women project, an integrated care model in a disadvantaged area which aims to reduce risk factors for CVD for women over the age of 40 years, through early identification and screening. The CVD screening tool is to screen women with no personal history of CVD, to calculate their five year absolute risk using the Australian cardio vascular chart and the Heart smart for women additional risk factor sheet.

The woman’s CVD risk is then measured using the tool to determine if they are at low risk (<10%), moderate risk (10-15%) or high risk (>15%).

Depending on the woman’s risk will determine their recommended follow up or referral pathway, resources based on their level of risk can then be provided to women with information, such as Quit smoking information, life style changes and recommendation for follow up.

Women can be referred to walking group, physical activities group and educational sessions to address a number of risk factors for heart disease.

Referral letters to GPs are provided for the woman if screening has identified high blood pressure or a high risk for CVD in the next five years. Information on CVD, life style changes and self-monitoring resources are provided to women to improve and take control of their own health.

There is enormous potential to improve the health outcome of Australian women and reduce the number of women and their families that are affected by CVD (AIHW 2010).

Women’s Health Nurses are in a prime position to offer CVD screening and early identification and to provide community education to raise awareness of CVD and risk factors in women.

References Australian Institute of Health and Welfare 2010.

Women and heart disease: summary. Canberra Milner KA, Funk M, Richards S, Wilmes RM, Vaccarino V, Krumholz HM. 1999. Gender differences in symptom presentation associated with coronary heart disease.

The American Journal of Cardiology 84(4):396-9.

Lorena Schot is a Clinical Nurse Consultant Women’s Health at Rosemeadow Community Health Centre, NSW

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Focus – drug & alcohol

Drugs, alcohol, older adults and mental health

By Adam Searby, Phil Maude and Ian McGrath “Invisible addicts” is a term that has been applied to the older adult population for a number of reasons: a lack of research interest, relatively poor screening of alcohol and other drug (AOD) use and the absence of specific treatment options in Australia (Searby et al. 2015).

Research also indicates a high prevalence of mental health problems in older adults who use AOD (Coulson et al. 2014).

Bearing this in mind, the authors set out to determine the prevalence and experiences of co-occurring mental health problems and substance use disorders in an inner Melbourne community mental health service for older adults. An audit of admissions conducted by the service over a two-year period (June 2012–June 2014) revealed that approximately 16% anmf.org.au

of individuals disclosed a co-occurring substance use problem during assessment.

Predominately, these individuals were male, and alcohol was the main substance being used. However, a number of females presented to the service with polysubstance use, with benzodiazepines being the common substance in these cases.

A qualitative interview process followed, revealing a number of key themes. These themes included medical complexity, social isolation, the stigma of mental health and AOD use being barriers to help-seeking and the notion of ‘adaptive’ substance use, where participants changed their patterns and substances used to suit their ageing bodies. Challenging the notion that older adults are ‘set in their ways,’ most of the participants expressed a desire to change or cease their current substance use. This research project paves the way for further research into intuitive screening tools and brief interventions for older adults in a variety of settings. With the baby boomer cohort predicted to challenge health service

resources, in addition to older adults being more likely to drink alcohol daily, it is essential that nurses are able to assess and identify AOD use in older adults.

References Coulson C, Williams L, Berk M, Lubman D, Quirk S and Pasco J. 2014. Association between alcohol consumption and self-reported depression among elderly Australian men. Geriatric Mental Healthcare 2 (1-2):3-8.

Searby A, Maude P and McGrath I 2015. Dual diagnosis in older adults: a review. Issues in Mental Health Nursing 36 (2):104-11.

Adam Searby is a Case Manager/ PhD Candidate at the Caulfield Hospital Mobile Aged Psychiatry Service/RMIT University Phil Maude is an Associate Professor at RMIT University/Alfred Health/ University of Tasmania Ian McGrath is a Senior Lecturer at RMIT University May 2015 Volume 22, No.10 41

Focus – drug & alcohol

Alison Hutton

Alcohol use at outdoor music festivals

By Alison Hutton and Jennie Jaensch

With outdoor music festivals becoming increasingly popular, the combination of sun, large crowds and alcohol can have disastrous effects. Researchers at Flinders University School of Nursing & Midwifery have found that young adults between 18–25 years old are the group most often transferred to hospital with drug and alcohol related illnesses.

In a study of 26 outdoor music festivals, with a total of 4,950 patient presentations, 42 May 2015 Volume 22, No.10

15% of these were for drug and alcoholrelated admissions.

The research also looked at how young adults prepared for attending outdoor music festivals, to understand how this preparation affected their health. For many young people, attending pre-parties is as much a part of the day as the festival itself.

Participants explained that pre-events are a time to catch up with friends in order to travel to the event together, and to engage in pre-loading - meaning drinking alcohol prior to attending the event.

Pre-loading is perceived a social norm among young Australians, and many of them see consuming alcohol as conducive to having fun.

The majority of participants also reported financial motivations behind pre-loading.

Rather than buying expensive alcohol at the festival, they plan to save money by consuming alcohol at home first to reach their ‘buzz’ level, and then just maintain it at the event.

There are several influential factors associated with the use of alcohol at outdoor music festivals, one of them being that young people at these events consider alcohol use to be the social norm.

This observation is supported in the literature with alcohol consumption occurring at a higher frequency and higher levels in social contexts. There is also

a social status that comes with drinking excessive amounts of alcohol. For example, a ‘hero- like status’ for those consuming large amounts of alcohol, with a lesser status for those eating while drinking.

Young adults do not actively seek out health messages to keep themselves safe and healthy. Alcohol is widely used at music festivals to celebrate and facilitate a good time. This lack of focus on health is not surprising considering that young people are generally quite healthy and therefore not accustomed to worrying about maintaining their health.

Effective approaches to harm reduction strategies need to fit the context and intent of what the young person wants out of an event. Targeted messages to ‘take care of your mate’ or ‘look after your friends’ would have far more relevance to young adults at this time of celebration, rather than being told not to drink.

Associate Professor Alison Hutton is a Midwifery Course Coordinator at Flinders University School of Nursing & Midwifery Mrs Jennie Jaensch is a Honours Student at Flinders University School of Nursing & Midwifery anmf.org.au

Focus – drug & alcohol Accessibility of Opioid Replacement Therapy and how it’s managed

By Warren Harlow, Brenda Happell and Graeme Browne

For over 40 years Opioid Replacement Therapy (ORT) programs have assisted people with heroin and more recently, with problematic pharmaceutical opioid use such as oxycontin. In 2013, 46,697 Australians were treated with ORT. The uptake of this intervention suggests the benefits of ORT have been recognised.

Although controversial, benefits include reductions in the severity of physical and mental illness; decreased criminal behaviour and subsequent incarceration; and less use of illicit substances. Clinicians play an important role in facilitating access to programs, however how clinicians manage requests for treatment has not been explored. In his clinical role, Warren Harlow, a registered nurse at the Gold

Alcohol and other drug treatment services remains prevelant Alcohol continues to be the most common principle drug of concern for treatment agencies, according to a report from the Australian Institute of Health and Welfare (AIHW).

The report, Alcohol and Other Drug Treatment Services in Australia: 2012-13 also showed treatment for amphetamines was on the rise.

AIHW spokesperson Geoff Neideck said alcohol, cannabis, amphetamines and heroin had remained the most common anmf.org.au

Coast Hospital and Health Service, saw this as a problem needing to be addressed. As part of his practice Warren was frequently confronted by multiple people requesting ORT and he had to make decisions to prioritise these people for treatment. He wanted to identify a system to manage these treatment requests and to also understand how clinicians make decisions in supporting these people into ORT. These questions led Warren to undertake an investigation into this process and ultimately to becoming a PhD student at the University of Canberra.

From 2010, Warren has been completing a research project examining the use of a triage system in an ORT program and exploring the experiences of clinicians (n = 35) in managing access to ORT. The results included awareness that people wait for treatment; the ORT triage system supports consumer access to treatment reflecting their priority category allocation, and enhanced understanding of how clinicians make decisions in managing access to ORT. These are important findings as they can support clinicians in their management of access to ORT and be used as a foundation for future investigations into this practice. Publications arising from this study include: • Harlow W, Happell B and Browne G 2014a. Guided by priority: how clinicians manage access to opioid replacement therapy. Issues in Mental Health Nursing no. 35 (6):455-463. doi: 10.3109/01612840.2013.873102.

principle drugs of concern since 2003-04.

According to the report around 108,000 clients had almost 162,400 treatment episodes from 714 publicly funded alcohol and other treatment agencies across Australia between 2012 and 2013.

Counselling was the most common type of treatment for clients for 46% of all episodes.

Mr Neideck said the age profile of people using the services suggested there was an ageing cohort of people in alcohol and other drug treatment. “This is particularly evident for those in treatment for illicit drug use, especially heroin use.”

Over the five years to 2012-13, the proportion of people treated who were aged 20 to 29 fell from 31 to 27% while the proportion who were aged 40 and over rose from 29 to 32%. The proportions who were aged 10 to 19 and 30 to 39 remained steady.

• Harlow W, Happell B and Browne

G 2014b. How clinicians manage access to opioid replacement therapy.

International Journal of Mental Health Nursing no. 23 (5):451-419.

• Harlow W, Happell B, Browne G and Browne M 2014. Can monitoring consumer requests for opioid replacement therapy improve access to treatment? Australian Health Review no. 38 (3):312-317.

• Harlow W, Happell B, Browne G, Choudhury J and Pinchin D 2013.

Triage in opioid replacement therapy: what’s the wait? Journal of Substance Use and Misuse no. 48 (1-2):137-146.

Warren Harlow is an RN and PhD student at the University of Canberra and Gold Coast Hospital and Health Service Brenda Happell is a Professor of Nursing and Executive Director, RCNMP at the University of Canberra Graeme Browne is a Senior Lecturer at the University of Newcastle

Funding extended for alcohol and drug treatments Government funding for alcohol and drug treatment organisations will have their funding extended until the end of June 2016. This includes approximately 160 organisations.

Meanwhile, a review of the drug and alcohol treatment services sector to address issues of duplication and overlap between services is under consideration by the Commonwealth and state and territory governments.

“The review outcomes are complex and require further analysis to determine the most appropriate approach to delivering quality and sustainable alcohol and other drug treatment funding,” Assistant Minister for Health Senator Fiona Nash said.

Shadow Minister for Health Catherine King said the extended funding arrangements would do nothing to provide certainty for these services leaving them in limbo for another 12 months.

May 2015 Volume 22, No.10 43

Focus – drug & alcohol Development of a dual diagnosis undergraduate elective

By Phil Maude

Studies have consistently shown that comorbid substance use and mental health comorbidities are the norm rather than the exception (Croton 2010). This association is found highest in treatment settings (Wang et al 2007). Considering the level of distress at a time of crisis and admission, it is common to find people increasing their substance use around first admission or relapse of mental illness.

Despite this health professionals are not adequately trained to treat patients with co-occurring mental health disorders and substance use disorders. This problem is directly tied to the separate treatment systems for mental health disorders and substance use (World Health Organization 2008). This inconsistency reflects our

44 May 2015 Volume 22, No.10

national ambivalence about the treatment of addicted consumers and the lack of substance use curriculum content within healthcare programs.

Because of this a new university wide elective was established at RMIT University to examine dual diagnosis in the Australian community and provide students with a greater understanding of how healthcare workers need to consider the impact of substance use on assessment and treatment planning with consumers.

In 2014 the course was piloted with 72 students enrolled from nursing, social work, psychology, criminology and radiotherapy.

The course ran over 48 hours of workshops and utilised real life scenarios and a strong consumer focussed recovery framework.

Students examined definitions of dual diagnosis and the co-occurrence of mental illness with problematic patterns of behaviour. The social and political role that drugs, homelessness, poverty and illness have impacted on mental health in the past and present were considered with contemporary literature and music used to engage and illustrate the extent of substance use within our society. The course introduces students to the history of mental illness, drug use in various cultures and the impact of colonisation and globalisation on human wellbeing internationally. Models of change and motivational assessment interviewing along with health promotion strategies with a

variety of target populations were explored and integral to the assessment for the course.

The course evaluation suggested opportunities were provided for students to explore and acquire knowledge of this complex area involving co-morbidity and substance abuse and the impact on the current social and health issues in Australia. Students appreciated the level of attention given to problems of addiction and the issues such as rise of violence/illegal and criminal activities and the real life application of case studies utilised. Student evaluation indicated that education in substance use could be useful in future clinical work and engaged several students to consider working in addictions healthcare environments in the future.

References Croton G 2010. Dual Diagnosis – Australasia. In P Phillips, O MCKeown and T Sandford (Eds). Dual Diagnosis: Practice in Context. (pp 212-229) Chichester UK: Wiley-Blackwell.

Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC and Borges G 2007. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. The Lancet 370: 841–850. doi: 10.1016/s0140-6736(07)61414-7 World Health Organization 2008. The global burden of disease: 2004 update. Geneva: World Health Organization.

Phil Maude is an Associate Professor at RMIT University/Alfred Health/ University of Tasmania

anmf.org.au

Focus – drug & alcohol A comprehensive care model for pregnant and parenting women with substance use issues

By Andrea Louise Fielder, Elisabeth Johnson and Hendree Jones

Approximately 5.4% of pregnant women in the United States (US) report using an illicit substance (SAMSHA 2013). Maternal substance use during pregnancy creates challenges in the health management of both the mother and fetus.

Between 2000 and 2009, Neonatal Abstinence Syndrome (NAS) incidence increased from 1.2 to 3.4 per 1,000 hospital live births in the US and cost an estimated $53,400 per infant (compared to less than $10,000 for a non NAS infant) (Pattrick et al 2012).

A 10-month Fulbright Scholarship provided one co-author the opportunity to attend the University of North Carolina (UNC) Horizons program in the US. UNC Horizons provides comprehensive addiction treatment services to pregnant and parenting women with an emphasis placed upon caring for the mother-child dyad.

UNC Horizons has demonstrated that treating pregnancy and substance abuse in the same setting allows the full clinical picture to emerge. Both outpatient and residential treatment services are offered where nurse practitioners (NP), obstetricians, counsellors, case managers, child and family therapists and peer support specialists enable women to achieve healthy birth outcomes, take back their lives and re-establish relationships with their children. The program emphasises trauma-informed education and support, which promotes self-sufficiency and economic independence through parenting classes, job readiness, safe and healthy anmf.org.au

relationships and dealing with trauma, anger and violence.

The NP’s role within UNC Horizons is pivotal. The NP provides antenatal care including standard maternal and fetal monitoring, collaborative buprenorphine management for opioid dependent women in conjunction with a prescribing Obstetrician and counselling regarding multiple health behaviours (eg. nutrition, smoking cessation). The NP also coordinates the healthcare of the women and their children living in the two residential facilities as well as facilitates medication management at these sites.

The UNC Horizons model is effective.

Of the women who complete the one year residential component of the program, 100% of those who had an open child protective services case at the time of program entry, had their cases closed. Not only does the program provide for improved clinical outcome and unseen cost savings in the future, direct healthcare cost savings of over $5,000 per mother infant dyad have been proven with similar programs (Svikis et al 1997). This program model is absent in Australia, resulting in significant gaps, shortfalls in service delivery and standards of practice of care of pregnant substance using women and their exposed infants.

For more information visit www.med.unc.edu/tcrb/Patient_Care/ unc-horizons-program References Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM 2012. Neonatal abstinence syndrome and associated healthcare expenditures: United States, 2000-2009. Journal of the American Medical Association. 307(18):1934-40.

Svikis DS, Golden AS, Huggins GR, Pickens RW, McCaul ME, Velez ML et al 1997. Cost-effectiveness of treatment for drug-abusing pregnant women. Drug and Alcohol Dependence. 45(1-2):105-13.

Substance Abuse and Mental Health Services Administration (SAMSA). Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-48, HHS Publication No. (SMA) 14-4863. Rockville, MD: SAMSA Administration, 2014.

Dr Andrea Louise Fielder is a Research Fellow at the School of Nursing and Midwifery, University of South Australia Dr Elisabeth Johnson is a Nurse Practitioner at the Department of Obstetrics and Gynecology, Horizons Program, University of North Carolina Professor Hendree Jones is Director of Horizons, Department of Obstetrics and Gynecology, University of North Carolina May 2015 Volume 22, No.10 45

Focus – drug & alcohol Assessing midlife women for alcohol misuse: a nursing role

By Janice Withnall, Sharon Bourgeois and Stuart Hill High-risk drinking by midlife women (35 to 59 years) in Australia has continued to increase (from 8% in 1995 to 16% in 2014) without there being a corresponding increase in healthcare treatment (Withnall et al 2014). Healthcare practitioners, particularly registered nurses, can enable early identification of an ‘alcohol problem’ and help to reduce misdiagnosis by applying the three age-focused, womenoriented recommendations developed from the Australian study, Researching with Women in Recovery from Alcohol Use Disorders (RWR 2006-2014, Withnall et al 2014).

These recommendations include strategies to ‘Protect, Prepare and Prevent’ women in midlife from becoming alcohol dependent and suffering from any of the known 200 alcohol-related physical and psychological illnesses (Shield et al 2014).

Protect: when assessing a client, nurses

DIABETES UPDATE SESSIONS

asking “when was the last time you drank three drinks of alcohol?” can help ‘Protect’ women from alcohol dependence. If the woman replies that she drank more than three drinks on one or more occasions in the last month, the nurse can assess the women by using the Alcohol Use Disorders Identification Test (AUDIT; Jenner & Lee 2013), a 10-item questionnaire that identifies alcohol misuse and related harms. Such midlife women in an early stage of high alcohol use need to be confidentially cared for in a safe environment, be encouraged to talk about their life at regular scheduled appointments with the nurse or with another healthcare practitioner who is willing to offer non-judgmental, educative and ongoing care. This person-centred care engages women to find out how they can lower their alcohol consumption and therefore limit or stop alcohol-related cognitive impairment, anxiety, central nervous system and organ damage and alcohol-related depression.

Prepare: if the woman is reactive, resistant and inconsistent, or cannot remember the amount of alcohol she has consumed when asked ‘the three drinks of alcohol on one occasion’ question. It is likely that she is already suffering from an Alcohol Use Disorder (AUD), and will require a ‘Prepare’ approach.

The RWR study found that it is best to help midlife women by firstly lowering their distress and fatigue. Any focus on an ‘alcohol problem’ at this stage of their AUD recovery journey is threatening to women and they can withdraw from healthcare.

Nurses have the unique opportunity to enable women to feel calm and worthy of assistance (less vulnerable) and encourage

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agreement to attend their next scheduled appointment to improve health. In the following appointments, encouraging the women to talk about their thoughts (likely to be circular and chaotic) as they express feelings of being lost, in despair and overwhelmed. Through this type of support, women’s emotional experiences (fear, anger and shame) and interpersonal conflict (blame and guilt) can emerge and be discussed. The Prepare strategy leads to care partnerships that enable midlife women to be proactive in their diagnosis and treatment, eg. agreeing to tests, then discussion of options for AUD intervention and achievement of good health.

Prevent: nurses can engage with women in lowering their alcohol consumption following a response (to the three drinks question) that suggests they drink ‘two and sometimes more’ regularly. Nurses are pivotal in providing care that can guide midlife women away from using alcohol as selfmedication to relax, and as a false-reward for completing ‘too much to do’ (overwork).

The healthcare goal is to enable women to address midlife difficulties with less alcohol consumption so that alcohol-related actions will not make personal, work-life, family and community relationships more difficult. The Prevent strategy will support women toward lowering or stopping their ongoing drinking with information on how their consumption contributes to increased risk for high blood pressure, stroke, cardiovascular disorders, mood disorders, AUD, cancers and diabetes.

Learning self-care (eg. mindfulness), and new living skills (eg. acceptance and commitment therapy)* improves women’s quality of life and enables them to address feeling ‘unseen’, over-burdened and negative.

• Type 1 diabetes • Type 2 diabetes • Aged care • Disability care • Carbohydrate counting Find out more and register at:

diabetesvic.org.au/health-professionals/workshops

Focus – drug & alcohol Nurses have and can develop healthcare expertise to recommend and complete screening of midlife women for AUD and then advocate an intervention that is informed by the women’s personal circumstances, family history, living environment and health conditions.

Nurses taking such ‘Protect, Prepare and Prevent’ action will contribute to stopping a complex chronic illness for women and its broad harmful impact.

References Withnall J, Hill SB & Bourgeois S 2014. How midlife women establish and sustain recovery with alcohol use disorder in Australia: a participatory action research study. Alcoholism: Clinical and Experimental Research.

38 (Suppl. 1): 292A-292A Shield KD, Parry C & Rehm J 2014. Chronic Diseases and Conditions Related to Alcohol Use, Alcohol Research: Current Reviews: 155-173 Jenner L & Lee N 2013. Screening for substance use and related issues by specialist alcohol, tobacco and other drug treatment and support services in the ACT: discussion paper, ACT, Canberra: Alcohol Tobacco and Other Drug Association. *For detail of women-oriented treatments see Janice Withnall, 2013, PhD: Researching with women in recovery (RWR): how midlife women with alcohol use disorder maintain quality abstinent recovery and wellbeing http://handle.uws.edu. au:8081/1959.7/537175 - UWS Research Repository

Dr Janice Withnall is an independent scholar in Sydney NSW Associate Professor Sharon Bourgeois is at the University of Wollongong NSW Emeritus Professor Stuart Hill is at the University of Western Sydney NSW and Foundation Chair of Social Ecology

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*Based on the following assumptions: living in NSW 2123, salary: $70,000 gross p.a., travelling 15,000 kms p.a., lease term: 48 months. All figures quoted include budgets for fuel, servicing, tyres, maintenance and re-registration over the period of the lease. Also includes QBE comprehensive motor insurance, 2 year extended warranty (except for all Hyundai and Kia models) and platinum aftermarket pack, which includes window tint as part of the offer. Vehicle pricing is correct at the time of print and may be subject to change and availability.

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Focus – drug & alcohol Electronic Screen 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Screened for AOD use

Screen not complete Screen complete Rationale • Total of 4758 presentations were recorded during the time frame (Dec14) where all persons over the age of 18 are screened for AOD use.

• The sample size was calculated based on a small data audit determining 70% of electronic files were screened. A sample size of 144 of files to audit is required to detect a differece in proportion of screens pre and post electronic introduction (Power=0.95) • A Wilcoxon signed rank test was used to determine there was a significant difference between the proportion of files that were screen pre and post electronic screening introduction (p<0.001)

120

Screen complete Screen not complete

58%

100 Number of AOD presentations

Total presentations

Paper vs Electronic

80

21%

60

17%

Enhancing alcohol and other drug (AOD) screening by emergency nurses

By David Kelly, Raymond Chan and Virginia Plummer Within Australia it is culturally acceptable to consume alcohol and it is an integral part of the Australian way of life (Australian Government 2013).

The National Drug Household Survey stated that about fourfifths of Australians aged 14 or older reported they had consumed alcohol in the past year and 6.5% drank on a daily basis (2013).

The culture of heavy drinking has resulted in poor outcomes, including deaths four times the Australian road toll (Thorn 2014).

Desy and Perhats found that screening and brief intervention for alcohol related presentations to emergency departments anmf.org.au

18%

Sep

Oct

40

20

0

July

Figure 1

David Kelly

17%

Aug

Nov

Figure 2

(ED) is warranted and can effectively minimise future alcohol consumption, reduce injury recurrence, and decrease the number of repeat ED presentations (2008:11).

In contrast, data on illicit drug use and outcomes may be incomplete because it is stigmatised and often more than one drug is used (Degenhardt & Hal 2012).

The sequelae are acute illness, such as overdose, chronic illness, mental illness and blood borne diseases (Degenhard & Hal 2012). Patients may present to ED with alcohol and other drug (AOD) use as a primary diagnosis or as a secondary diagnosis after screening by emergency nurses.

In May 2013 Peninsula Health commenced paper based screening for alcohol and other drugs (AOD) for all persons over the age of 18 who presented to ED for treatment. Staff education sessions were conducted. However after the first 18 months there was a poor screening rate - only 17–21% of AOD presentations were actually being screened (Fig 1).

In November 2014 the paper based system was replaced with an electronic clinical information system, including AOD screening. Nurses were prompted to complete the screen as they entered patient data in the cubicle. This resulted in increased detection of AOD related presentations and subsequent increase of AOD screening to 58%. By December 2014, the detection rate had increased further to 70% of all ED patients screened for drugs and alcohol use (Fig 2). The increase was attributed to an enhanced

digital user-friendly screening system, supported by a nurse education series and clinical liaison nurses from Peninsula Health Alcohol and Other Drug Services. Patients that are detected by screening have an opportunity to be fully assessed for risk and treatment, and the improved systems have increased this opportunity from 17-70% of patients in just two months.

References Bendtsen P, Holmqvist M, Johansson K 2007.

Implementation of computerised alcohol screening and advice in an emergency department: a nursing staff perspective. Accident and Emergency Nursing 15, 3-9 Degenhardt L & Hall W 2012. Extent of illicit drug use and dependence, and their contribution to the global burden of disease, The Lancet, Volume 379, Issue 9810, 7–13 January 2012, Pages 55–70, doi:10.1016/S01406736(11)61138-0 Desy P & Perhats C. Alcohol Screening, Brief Intervention and Referral in the Emergency Department, An Implementation Study. J Emerg Nurs. 2008 Feb;34(1):11-9. doi: 10.1016/j.jen.2007.03.019. Epub 2007 Dec 3 National Drug Strategy Household Survey 2013, Australian Government Thorn M 2014. Foundation for Alcohol Research ABC AM Program 31 July 2014

David Kelly is the Clinical Liaison Consultant at Peninsula Health Alcohol and Other Drug Services Dr Raymond Chan is an Addiction Medicine Specialist at Addiction Medicine Unit, Peninsula Health Virginia Plummer is an Associate Professor Nursing Research, Monash University and Peninsula Health May 2015 Volume 22, No.10 49

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

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Our innovative Models of Care have been developed utilising a population health framework and are informed through extensive consultation, and designed to embrace best evidence practice to meet National Standards and the principles of Person Centred Care.

The range of specialised services includes programs in the following areas; • Child & Adolescent Mental Health Services (CAMHS) • ACT Wide Services • Adult Mental Health Services • Justice Health Services • Alcohol & Drug Services.

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Billy Bentley, Senior AOD Clinician, Peninsula Health

Integrated recovery model for Victoria’s Mornington Peninsula

By Sue Montague

On Melbourne’s Mornington Peninsula, an innovative recoverybased model for the delivery of Alcohol and Other Drug (AOD) services is providing integrated initial screenings, assessments, treatment plans and community health support to clients.

The model was launched in September 2014 following the Victorian Government’s alcohol and drug treatment reforms by the Frankston and Mornington Drug & Alcohol Service (FaMDAS). FaMDAS is a partnership between Peninsula Health, FrankstonMornington Peninsula Medicare Local and the Youth Support & Advocacy Service.

The FaMDAS team at Peninsula Health includes a program manager, trained ACCESS - Community Health Subacute and Specialist Services workers who do the initial screening and assessment by phone using Department of Health endorsed tools, and senior AOD clinicians who are responsible for comprehensive assessments, development of initial treatment plans, active holding of clients waiting for an AOD treatment service, providing brief interventions, and day-to day management of the multi-disciplinary AOD teams.

Clinical supervision is provided by relevant discipline-specific senior staff. Senior AOD Clinicians are co-located with ACCESS workers at three of Peninsula Health’s key sites in Frankston, Hastings and Rosebud.

An experienced AOD and mental health nurse, Billy Bentley works in Peninsula Health’s FaMDAS team as a Senior AOD

Assessment Clinician.

“The government’s roadmap for alcohol and drug services recognised the need to address the range of interconnected issues that impact on a person’s ability to address their alcohol and drug issues,” says Billy.

“As an AOD nurse, it is great to be part of this holistic approach to addressing client needs and client participation.

“FaMDAS is the hub for AOD assessment and treatment across this region. It is a multidisciplinary, locationbased service where clients can be screened, assessed and referred within their own locality. This is particularly important in a large region such as the Mornington Peninsula, where a mix of urban and rural communities is spread across 850 square kilometres, and where accessibility to health services can in parts be very limited.

“Thanks to our integrated referral and treatment processes and multidisciplinary team approach, clients no longer have to negotiate a minefield of service providers in various locations when seeking withdrawal treatment, counselling or residential services. It’s a faster and less frustrating process for clients as it reduces the need for them to repeat the same information to different service providers at different times in different places.

“The nursing position within FaMDAS is recognised as a key one because our clients generally present with multiple comorbidities, and in many cases, with medically compromising conditions. With 18 years of client management experience in both community and hospital settings here and overseas, I have been able to bring practical nursing skills and knowledge to complement the strengths of my nonnursing colleagues, such as social workers and psychologists.

“This new model of care may be more intensive than previous ones.

For example, the holistic and very comprehensive assessment alone takes 90 minutes on average. But it has only increased my enthusiasm and commitment to promote nursing within AOD services, and to deliver person-centred care, support and improved health outcomes to our clients and their families.”

ACCESS - Community Health Subacute and Specialist Services is the first point of contact for information and referrals to a wide range of community health, aged care, rehabilitation and specialist services provided by Peninsula Health.

Sue Montague is the Editor and Major Projects Coordinator at Peninsula Health, Victoria anmf.org.au

Focus – drug & alcohol

Nyanda McBride

Paternal involvement in alcohol exposure during pre-conception and pregnancy Alcohol exposure during pregnancy, which results in Fetal Alcohol Syndrome (FAS), is the leading cause of environmental birth defects and intellectual disability in the western world. FAS is characterised by irreversible, primary structural brain damage, leading to secondary deficits in growth and neurological development resulting in a range of life long intellectual and behavioural disabilities.

In Australia, the estimated prevalence rate of FAS is 0.06 per 1,000 live births (under 15 years) and an Indigenous rate of 8.11 per 1,000 (Elliott et al. 2008). These rates are relatively low due to the underdeveloped diagnosis of FAS in Australia.

However, Australia has a high level of alcohol exposed pregnancies with approximately 50% of Australian women consuming alcohol during pregnancy (AIHW 2010) and around 21% of pregnant women drinking to high risk levels (McBride et al 2012).

Australian per capita alcohol consumption is high by world standards (WHO 2011) and therefore alcohol use during pregnancy is often supported by complex social and cultural circumstances. Social determinants research spotlights reasons for alcohol use during pregnancy: recent maternal drug use (Accornero et al. 2002), high life stress (Lewis et al. 2011), custodial changes, current drug use in the home, and exposure to violence (Delaney-Black et al 2000), all increase use. Several of these factors have a level of partner involvement suggesting that decisions about alcohol use during pregnancy are not solely made by women, anmf.org.au

but occur within the context of the home and the broader social environment.

Research from human studies also indicates that paternal alcohol consumption in the preconception period plays a role in fertility, and in fetal and child health.

Alcohol use during sperm development can impact on the viability and health of sperm (Muthusami & Chinnaswamy 2005); male consumption during preconception is associated with early pregnancy loss (Tine Brink et al. 2004); and not achieving a live birth (Klonoff-Cohen et al. 2003). Paternal alcohol consumption can result in offspring with low birth weight (Little & Sing 1987), and reduced cognitive ability (Hegedus et al 1984). Several studies report that heavy alcohol consumption by the father during pre-conception results in an increased level of internalising and externalising behaviours in young children (McBride & Johnson 2015).

Research also reports that male partners can have an important impact on maternal alcohol consumption during pregnancy through social facilitation (Abel 2004).

Australian data indicate that women are most likely to drink in their own home or at the home of a friend; that over 75% of women who drink during pregnancy usually drink with their partner, with nearly 40% of these women reporting that their partner usually initiates a drinking occasion (McBride, Carruthers & Hutchinson 2012).

Recent studies report that most men (75-80%) want male-oriented pre-conception information (Frey et al.

2012); and that male involvement in preconception health increases female partners compliance on behaviours that could impact on fetal health (Czeizel et al.

2013). Involving and informing prospective fathers about male preconception health is likely to be an important prevention strategy for FAS. References Abel E. 2004. Paternal contribution to fetal alcohol syndrome. Addiction Biology. 9:127-33.

Accornero V, Morrow C, Bandstra E, Johnson A, Anthony J. 2002. Behavioral outcome of preschoolers exposed prenatally to cocaine: role of maternal behavioural health. Journal of Pediatric Psychology. 27(3):259-69.

Australian Institute of Health and Welfare 2010.

National Drug Strategy Household Survey report. Drug statistics series no. 25 (cat. no. PHE 145). Canberra: AIHW; 2011.

Czeizel A et al. 2013. The participation of prospective fathers in preconception care. Clinical medicine insights.

Reproductive Health. 7:1.

Delaney-Black V, Covington CY, Templin T, Ager J, Nordstrom-Klee B, Martier S, et al. 2000. Teacherassessed behaviour of children prenatally exposed to cocaine. Pediatrics. 106(4):782-91.

Elliott E, Payne J, Morris A, Haan E, Bower C 2008. Fetal alcohol syndrome: a prospective national surveillance study. Archives of Disease in Childhood 93:732-7.

Frey K et al 2012. Preconception healthcare: what do men know and believe? Journal of Men’s Health.

9(1):25-35.

Hegedus A, Alterman A, Tarter R 1984. Learning achievements in sons of alcoholics. Alcoholism: Clinical and Experimental Research. 8:330-3.

Klonoff-Cohen H, Lam-Kruglick P, Gonzalez C 2003.

Effects of maternal and paternal alcohol consumption on the success rates of in vitro fertilization and gamete intrafallopian transfer. Fertility & Sterility. 79(2):330-9.

Lewis PT, Shipman VC, May PA 2011. Socioeconomic status, psychological distress, and other maternal risk factors for fetal alcohol spectrum disorders among American Indians of the northern plains. American Indian and Alaska Native Mental Health Research.

17(2):1-21.

Little R, Sing C 1987. Father’s drinking and infant birth weight: reporting of an association. Teratology. 36:59-65.

McBride N, Johnson S. Paternal role in alcohol exposed pregnancies and FASD. Finding from a systematic literature review. 6th International Conference on FASD, Vancouver, Canada 3-7 March 2015.

McBride N, Carruthers S, Hutchinson D 2012. Reducing Alcohol Use During Pregnancy: Listening to women who drink as a prevention starting point. A formative intervention research study. Global Health Promotion.

19(2):102-14.

Muthusami K, Chinnaswamy P 2005. Effects of chronic alcoholism on male fertility hormones and seman quality. Fertility and Sterility. 84(4):919-24.

Tine Brink H et al. 2004. Consumption at the time of conception and spontaneous abortion. American Journal of Epidekiology. 160(7):661-7.

World Health Organization (WHO) 2011. Global health report on alcohol. Geneva, Switzerland: WHO Press

Nyanda McBride is a Senior Research Fellow and Program Leader at the National Drug Research Institute, Curtin University, WA May 2015 Volume 22, No.10 51

Focus – drug & alcohol Women and alcoholrelated harms

By Renee Brighton, Lorna Moxham and Victoria Traynor

Alcohol is a determinant of health that contributes to significant health problems. The excessive use of alcohol ranks among the top five risk factors for disease, disability and death throughout the world (WHO 2014; Lim et al. 2012). Alcohol is the leading contributor to premature death and disability worldwide in people aged between 15 and 59 years (WHO 2014).

The topic of women and alcohol, when compared to the plethora of studies

examining male drinking, has been an extremely under-researched area (Bravo et al 2013). The findings of research with male participants involving alcohol consumption have been typically applied to female drinkers. This is despite the fact when compared to men, women are considered more vulnerable to the toxic effects of alcohol and physiological and psychological alcohol-related harms (Alfonso-Loeches et al 2013).

Women consistently drink less than men but experience more alcohol-related harms than men. There is a body of research that discussed a phenomenon called the ‘telescope effect’, where women progress more rapidly when compared to men from drinking onset to unhealthy drinking and the development of alcohol-related physiological and psychological harms (eg.

Kay et al 2010).

The patterns of alcohol consumption by women have changed over the last few decades. Contemporary patterns of women’s drinking have become similar to that of their male counterparts (WHO 2014). This, along with the telescoping effects, signifies that the time has been

reached when increasing nursing attention must be given to gender influences in the identification and prevention of alcoholrelated conditions. The nature and value of the early detection of harmful alcohol use by women can no longer be ignored.

References Alfonso-Loeches S, Pascual M & Guerri C 2013. Gender differences in alcohol-induced neurotoxicity and brain damage. Toxicology. 311, 27-34.

Kay A, Taylor TE, Barthwell AG, Wichelecki J & Leopold V 2010. Substance Use and Women’s Health, Journal of Addictive Diseases 29(2), 139-163.

Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H. 2012. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990– 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2224−2260.

World Health Organization (WHO) 2014. Global status report on alcohol and health 2014. ISBN 978 92 4 069276 3. Geneva.

Renee Brighton is a Lecturer, Lorna Moxham is a Professor and Victoria Traynor is an Associate Professor. All are in the School of Nursing at the University of Wollongong

Alcohol and drug use raise health concerns in older Australians While the focus on drug and alcohol consumption is usually discussed in relation to youth, new concerns are being raised about the alcohol-related issues suffered by older Australians.

According to University of Adelaide, School of Nursing’s Dr Lynette Cusack the elderly may not consume alcohol in the same quantities as young people, but they can experience from a unique set of health issues related to alcohol.

“Older people don’t usually drink as much as younger people in a single sitting but they can drink more regularly and more likely to drink alone. They can underestimate the quantities they consume.”

Dr Cusack said as people get older, chronic conditions and medication use

52 May 2015 Volume 22, No.10

increases which can react badly with alcohol. “Older people are also at an increased risk of fractures from falls because their muscles and bones are frailer.”

Dr Cusack said alcohol screening in community settings would be helpful to help health professionals accurately identify alcohol consumption in older people and the potential harmful effects.

While there is no universal tool for screening, Dr Cusack said it was vital to create awareness to the over 65s of the risks of alcohol and to assist with health professionals and caregivers.

Dr Cusack is currently leading a study to evaluate a screening tool, Alcohol, Smoking, Substance Involvement Screening Test (ASSIST), which has been developed by the World Health Organization for risky alcohol and drug use.

She is evaluating the tool with people over 65 in South Australia and in NSW. “Our aim is to ultimately develop a tool, based on ASSIST, that can accurately screen for substance use including alcohol drinking habits in older Australians in a community setting, which will support healthy ageing.”

anmf.org.au

Mail Stamp out the bully!

I’m saddened and sickened on reading the April ANMJ entry by anonymous EN Victoria.

It is particularly saddening to see yet another victim crying out for help and help not given once again! Nor support encouraged for this poor victim of inappropriate behaviour from nursing management, those managers being nurses who accept their oath and cross their heart so to speak to give heartfelt care, these nurses have excelled in their careers to the very top.

I myself have been the subject of bullying from peers throughout my nursing career, spanning 36 years. I have encountered numerous occasions and lengthy periods of abuse and bullying from nursing peers, some in very recent times by operating room doctors.

I am a current registered nurse and previous registered midwife. I have attained a high level of success through years of experience as an operating room nurse and several years as a practice nurse including nurse manager and still I have not been able to avoid this sad situation involving bullying, harassment and unsupportive management systems that let those that bully to continue to bully

Is this how we treat nurses?

How many nurses out there dreamt when they were little girls of being nurses, wearing white uniforms, flowing caps (thank heavens they have gone) and being with people and making them feel better at a bad time in their lives?

How many of those little girls became nurses and are now stressed, disheartened, out of the industry. In response to a letter in April’s ANMJ, ‘Culture of bullying must stop’ I would like to share my experiences.

I have been bullied over the last twelve months by my unit manager, human resources manager and my DON. I have been threatened verbally and in written form threatened with the sack, consequently I was forced to resign - yet I had done nothing wrong. I have been a nurse for over 32 years, first a Div 2 then eight years ago became a Div 1.

I worked in aged care and I loved my job, I loved the residents, my interaction with anmf.org.au

without losing their positions and those that are bullied left helpless and let go; usually resigning from their hard earned position where they were employed to fulfil their nursing commitment and obligations and hopefully to advance in their nursing careers.

I have experienced the highs of nursing, allowing me to attain a wealth of knowledge and experience to the opposite end of the scale - the extreme lows of nursing. I wonder how I have managed to hang on sometimes but I have a very supportive husband who has enabled me to take time off from work when there has been no other option.

It’s a very sad situation it seems that the health system can’t get its head around supporting their own employees and effectively stamp out bullying once and for all!

I am now expressing this openly as I feel deeply about the behaviour the anonymous writer/reader has expressed to ANMJ. I wish the EN and other nurses subjected to inappropriate behaviour by colleagues my total support and to let it

families and enjoyed working with some wonderful people. My interest was palliative care, as I like to think that I could help families over a very stressful time and to ease the pain and suffering of the palliative resident and in return I would feel valuable to everyone including myself.

As I live in a rural community you seem to be social with your work mates and as a result made wonderful friends.

However, a new unit manager commenced at our workplace who was out to make lives miserable. Many staff were sacked over stupid incidental things, but lies were told and of course the staff member was not believed. The hospital must have worn a track to WorkCover, which must have been flooded with claims from our unit.

Three of us were stood down, one was because of a conversation she had with staff, one was because of a false incident report and the other was because of a missing signature on a drug chart. Out of the three staff stood down, one works casually and only night shift, one is still on WorkCover for stress and has been for over

be known they are not alone.

I am now 53 and because I have been the subject to another bout of unprofessional behaviour and bullying from colleagues, I am seriously thinking of not renewing my 33 years of registered nurse registration due 31 May this year.

Yes, it is honestly having a detrimental effect on my ability to have faith in the systems that are put in place to protect us as nurses.

Terrie Carr RN, South Australia

Letter of the month The winner of the ANMJ best letter competition receives a $50 Coles Myer voucher.

If you would like to submit a letter to the ANMJ email anmj@anmf.org.au Letters may be edited for clarity and space.

twelve months, the other one was forced to resign and had now been reported to AHPRA. I am one of these people. I received no support from anyone at my workplace. I wrote to the DON and CEO and complained over the treatment of staff, and the claims that they had against me. I was told to make a formal complaint, which I did, but it was never looked into.

Is this how nurses treat nurses? Aren’t nurses supposed to be caring nurturing people?

I am a good nurse, I loved my job, I cared about the elderly citizens in my town and I got great rewards back, but the hell I have been through and continue to go through is not worth it. I suffer badly with depression and I don’t enjoy anything much anymore, which upsets my family. The hurt and pain of what myself and my work colleagues have been through and are still to go through will never go away. The job I loved and always wanted to do has ruined my life.

Anonymous May 2015 Volume 22, No.10 53

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Calendar MAY APNA Continuing Education Workshops for Nurses in Primary Care 1-2 May 2015 – Perth 29-30 May 2015 – Adelaide www.apna.asn.au/ educationworkshops World Press Freedom Day 3 May. www.un.org/en/events/ pressfreedomday/ International Conference on Nursing 4-7 May, Athens, Greece. www.atiner.gr/nursing.htm International Day of the Midwife 5 May. www.internationalmidwives.org/ Lung Health Promotion Centre at The Alfred 7 May – Respiratory Update 27–28 May – Respiratory Course (Module B) P: (03) 9076 2382 E: lunghealth@alfred.org.au Nurses & Midwives Wellness Conference Create your healthy footprint 8 May, Melbourne Convention & Exhibition Centre. Learn how to manage stress and anxiety, conflict and negative relationships. Be opened up to new ways to build resilience, improve motivation and increase your energy levels. Earn up to eight hours CPD. www.anmfvic.asn.au/eventsand-conferences World Red Cross Day 8 May. www.icrc.org/eng/resources/ documents/misc/57jqz6.htm Asia Pacific Cardiorenal Forum 8-9 May, Amora Hotel Jamison Sydney. http://cardiorenal.com.au/ 14th World Congress of the European Association for Palliative Care Building bridges 8-10 May, Copenhagen Denmark. www.eapc-2015.org/

7th Australian Primary Health Care Nurses Association National Conference Brave to Bold 14-16 May, Gold Coast Convention & Exhibition Centre, Queensland. www.apna.asn.au/ Australian Dermatology Nurses Association 14th National Conference 16-17 May, Adelaide, SA. www.adna.org.au/events/ 2nd Australian & New Zealand Eating Disorders & Obesity Conference 18-19 May, Outrigger, Surfers Paradise, Qld. http:// eatingdisordersaustralia.org.au/ The person centred approach to healthy weight management. If not dieting, then what?® 22-23 May 2015 – Hobart 5-6 June 2015 – Perth 19-20 June 2015 – Adelaide www.apna.asn.au/ifnotdieting Sydney Practice Nurse Clinical Education 23-24 May 2015 Sydney Showgrounds, Sydney Olympic Park NSW. Australia’s leading event for nurses in general practice.

Earn 12 CPD hours. www.pnce.com.au 13th National Rural Health Conference People, Places, Possibilities...for rural and remote Australia 24-27 May, Convention Centre, Darwin NT. www.ruralhealth.org. au/13nrhc/ Biennial National Homelessness Summit Developing the intervention and integration strategies to break the cycle of homelessness 26-27 May, Wesley Conference Centre Sydney, NSW. www.informa.com.au/conferences/ health-care-conference/biennialnational-homelessness-summit

JUNE

Creating Futures Practice, Evidence and Creativity in Tropical and Remote Settings 11-14 May, Shangri-La Hotel, The Marina, Cairns. http://cf15. conorg.com.au/

Deakin University School of Nursing and Midwifery Nurse Practitioner Masterclass 4 and 5 June in Melbourne. www.deakin.edu.au/nursing-midwifery/ news/nurse-practitioner-masterclass

International Nurses Day 12 May. www.icn.ch/

World Environment Day 5 June. www.unep.org/wed/

12th Behavioural Research in Cancer Control Conference Bridging the gap 12-15 May Dockside, Cockle Bay Wharf, Sydney. www.cancercouncil.com.au

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Lung Health Promotion Centre at The Alfred 11-12 June Spirometry Principles & Practice 18 June Paediatric Respiratory Update 24 June Asthma Management Update P: (03) 9076 2382 E: lunghealth@alfred.org.au National Blood Symposium 11-12 June, Brisbane Convention and Exhibition Centre, Qld. www.safetyandquality.gov.au 18th Cancer Nurses Society of Australia Annual Winter Congress Cancer nursing: expanding the possibilities 14-16 June, Perth Convention and Exhibition Centre, Western Australia. www.cnsawintercongress.com.au/ World Refugee Day 20 June. www.un.org/en/events/ refugeeday/

JULY Lung Health Promotion Centre at The Alfred 14 July – Educating & Presenting With Confidence 15-17 July Asthma Educator’s Course 23-4 July – Smoking Cessation Course 30-31 July – Creative Behaviour Change Coaching For Chronic Illness P: (03) 9076 2382 E: lunghealth@alfred.org.au VPNG (Victorian Perioperative Nurses’ Group) State Conference Strategies for Success: Safety and Quality in Perioperative Care 30-31 July, Pullman in Albert Park, Melbourne. www.vpng.org.au

AUGUST Lung Health Promotion Centre at The Alfred 7 August – Theory & Practice of Non Invasive Ventilation – Bi-Level & CPAP Management 20-21 August – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au

SEPTEMBER Australian Disease Management Association 11th Annual Conference Count me in: who cares about chronic care?

9-11 September Brisbane Convention Centre. www.adma.org.au/ E: b.shen@alfred. org.au p: (03) 9076 4125

NETWORK Royal Children’s Hospital, Parkville, League of Former Trainees & Associates (including RCH Graduate Nurses) reunion Luncheon, with AGM & Guest Speaker 16 May, RACV Club, Melbourne.

Contact Sue Scott E: sue.scott@ rch.org.au M: 0402 092 601 www.rch.org.au/loft/ Prince Henry’s Hospital Melbourne, Group 1/85 30-year reunion 30 May, further details TBA. Contact Kristen Jones E: moretonview@bigpond.com or Wendy Larkin E: wendylarkin@ bigpond.com or search Prince Henry’s Hospital 1/85 on Facebook Geelong Hospital School 275 40 year reunion 8 June, luncheon at Jack Rabbit Winery, Bellarine Peninsula Victoria. Contact Sue Baker (nee McKenzie) E: suebaker@y7mail. com M: 0409 811 990 or Jo Hall (nee Scott) E: johall4@optusnet. com.au M: 0401 405 362 Alfred Hospital Melbourne, Group 2/75 40-year reunion 13 June, Royal Yacht Club of Victoria, Williamstown.

Contact Fiona Williams E: fiona. williams777@gmail.com or Denise Peterson (nee Letcher), snail mail: 3 Sienna Close, Strathfieldsaye, Vic. 3551 Royal Adelaide Hospital, Group 754, 40-year reunion 19 June. Contact Liz Strachan E: lizstrachan1@hotmail.com M: 0405 535 762 Prince Henry’s Hospital, 2/85 Reunion 25 July. Venue and time not yet decided. Contact Vivienne Jose E: vivvy38@hotmail.com or search Prince Henry’s Hospital Melbourne Memorial Page for further details.

LaTrobe University, LaTrobe/ Bendigo Campus nursing group (1988-1991), 25-year reunion 20 February 2016, Bendigo.

Contact Steven Graham E: sgraham@bendigohealth.org. au or Sarah Shipp (nee Prudham) E: sshipp@bendigohealth.org.au or search Facebook page LaTrobe 1991 reunion

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

May 2015 Volume 22, No.10 55

Annie

Annie Butler, Assistant Federal Secretary

Fighting for our rights As many of you would be aware, there is currently considerable debate in Australia over the future of penalty rates. Industry and business groups are pushing for reductions in penalty rates and, as we have reported in previous issues of the ANMJ, the Productivity Commission is now investigating penalty rates and related payments as part of its Inquiry into the workplace relations framework.

Nurses, midwives and assistants in nursing have reacted strongly to this debate and possible threats to penalty rates with more than 13,000 of you giving us your views on the importance of penalty rates in our recent survey and thousands taking action across the country in March to defend penalty rates and other important conditions.

The strength of this reaction is not surprising, threats to penalty rates are extremely concerning for nursing and midwifery. As we all know, most nurses, midwives and assistants in nursing work according to a roster designed to meet the service requirements of the care setting.

This means that they must work all hours of the day, all days of the year, across all health and aged care settings – they have no choice, this is how the health and aged care systems survive.

The ANMF is strongly committed to the payment of fair and reasonable penalty rates for nurses, midwives and assistants in nursing to compensate for the unsociable hours they work and to acknowledge the contribution of their skilled and dedicated work to our society.

But this critical point is ignored by the current debate on penalty rates. Rather than focus on the need for the shift work that is undertaken and the significant contribution that is made to our society because of this work the debate focuses 56 May 2015 Volume 22, No.10

on the cost of the additional payments required by penalty rates to employers.

When we raise this with governments, business and employers, we are met with incredulity and responses of “we don’t mean penalty rates for nurses” (they rarely acknowledge midwives or AINs) and “of course 24 hour health workers should get penalty rates”.

But history tells us to be wary of these glib offerings of support for nursing and midwifery. As many of you pointed out in our survey, as with most aspects of our professions, penalty rates were hard fought for – they did not come easily.

From nursing’s and midwifery’s beginnings in Australia, every improvement sought by nurses and midwives whether in working conditions, health funding or standards of education has involved struggles and disputes, often bitter, with governments, employers and, frequently, the medical profession.

In 1868, Henry Parkes, best known as the “father of federation” and the then Premier of NSW, recognised the deplorable state of his state’s hospitals and the desperate need for qualified, trained nurses. He appealed to Florence Nightingale for assistance, and was sent six Nightingale trained nurses, led by Lucy Osburn.

Despite the government’s explicit support for qualified nurses and their importance to improving healthcare in NSW, Osburn and her nurses encountered enormous prejudice, ignorance, suspicion and jealousy in their efforts to reform the system. They were hindered and obstructed by doctors and managers and even subjected to public legal inquiries into their plans for system reform.

Nonetheless, the determined Osburn achieved considerable reforms and laid the foundation for properly trained, disciplined nursing in Australia. But a century of difficult disputes followed.

For decades, dominated by the medical profession and exploited by employers, nurses and midwives met resistance when seeking improvements to their appalling working conditions, inconsistent standards in practice and education and inferior facilities leading to failures in patient care.

With seemingly little respect for nursing and midwifery or regard for the standard of patient care, politicians and bureaucrats relied on nurses’ and midwives’ dedication

FOR DECADES, DOMINATED

BY THE MEDICAL PROFESSION AND EXPLOITED BY EMPLOYERS, NURSES AND MIDWIVES MET RESISTANCE WHEN SEEKING IMPROVEMENTS TO THEIR APPALLING WORKING CONDITIONS, INCONSISTENT STANDARDS IN PRACTICE AND EDUCATION AND INFERIOR FACILITIES LEADING TO FAILURES IN PATIENT CARE. to continue to provide service under persistently poor conditions. The long standing opposition within the professions to industrial action by nurses and midwives because of presumed risks to patient care did little to help the cause.

Although concerns for patient care had always been central to nurses’ and midwives’ demands, it wasn’t until the 1970s and ‘80s when no-strike clauses were dropped from union rules that real gains were made both for the professions and for patients. Nurses and midwives took a level of action for improvements in staffing and pay that had not been seen before.

Governments had to pay attention; nurses and midwives had realised that the quality of their working lives was inextricably linked to the quality of patient outcomes. The way to achieve improvements in both was through strong collective action.

The struggle between governments and employers and nurses and midwives continued over the following decades.

Governments claimed they supported the professions but didn’t deliver. Nurses and midwives had to fight for improvements in education, staffing and conditions. They won of course, but only through hard fought and determined battles.

Today is no different. Unfortunately, regardless of what governments say, we will need to fight to secure improvements in patient care and advance our professions.

Fortunately, in the recent activity around penalty rates, you have made it perfectly clear that you will. anmf.org.au

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