ANMJ December 2014 - January 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. 6

D E C E M B E R 2 014 / J A N U A RY 2 0 1 5

THE ROUND UP

Through our eyes – Looking back at 2014

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

Editorial Lee Thomas, ANMF Federal Secretary It’s hard to believe another year has come and gone. As I reflect on the past 12 months, it’s evident we have worked hard to protect our healthcare rights here at home and for others abroad. Unequivocally I am pleased to say our collective voice is being heard.

Our current government’s proposed austerity measures, introduced at the last federal budget, sent shock waves through many when you learnt about the savage cuts to health and education. No crystal ball was needed to see the detrimental implications this would have for our healthcare system, and on many of you trying to provide quality care for your patients.

Together we have let the government know our dissatisfaction of these reforms through ANMF’s campaign Healthcare Emergency – Lies, Cuts and Broken Promises. Additionally, the ANMF has been persistently lobbying politicians to overturn these measures.

Likewise, we have been lobbying the government to support relief efforts in the fight against Ebola in West Africa, and to allow nurses to volunteer their services in the affected regions. After months of campaigning the government committed $20 million to a 100 bed Ebola treatment clinic in Sierra Leone. It is now important that Australian nurses, who are ready and willing to go to West Africa to join the international relief, are fully supported in their endeavour to do so. This is the only way to fight Ebola, at its source.

Clearly most of you agree as so many of you inundated us with your interest in volunteering and wanting our government to do more. While I’m not surprised by your dedication, passion and selflessness to help fight this devastating virus, I feel incredibly

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proud and humbled by your willingness to give so much of yourselves for this cause.

As I write this editorial our voice is also being heard on an international scale at the L20 Summit, which precedes the G20 World Leader’s Summit in Brisbane this month. Assistant Federal Secretary Annie Butler and I have joined other union leaders, politicians and other interested parties from around the globe to discuss international economies, jobs and wages.

Simultaneously, the NSW Nurses and Midwives’ Association (NSWNMA) and the Queensland Nurses Union (QNU), in conjunction with international and local groups, are campaigning for a Robin Hood tax to help fund services such as public health, aged care and Medicare. The modest levy of between 0.005 and 0.05%, placed on the trading of stocks, bonds, derivatives, futures, options and credit default swaps, can raise billions of dollars in revenue to support our healthcare system and those of other countries.

The tax must be applied across the globe to ensure universal healthcare for all.

This campaign is being noticed by international leaders as well as our own as they gather in Brisbane for the G20.

As we prepare for a new year ahead, I take this opportunity to thank you for your determination, passion and support to ensure we have a sustainable and equitable healthcare system. I am very proud of our professions, as I am of you all.

I extend to you and your families warm wishes for a safe and happy Christmas and New Year.

December 2014 / January 2015 Volume 22, No.6 1

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

Canberra

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Editorial

Editor: Kathryn Anderson Journalist: Mustafa Nuristani 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

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Federal Secretary Lee Thomas

Assistant Federal Secretary Annie Butler

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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

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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 December 2014 / January 2015 Volume 22, No.6

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.

CIRCULATION 98,488

Total Readership: 143,792* *Based on ANMJ 2014 member survey showing readership pass along rate of 1.46 Source: BCA verified audit, September 2014

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Contents

Volume 22, No 6.

News

5

Industrial 17 Feature 18 Education 24 Ethics 27 World 28 Research 29 Clinical update

30

Focus 34

18

Calendar 46

Feature – the round up

5

News

Clinical Update

Review of a home nursing injection service: SHINE

Sally 48

24

Education Crohns Disease

30

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Books 47

Through our eyes – Looking back at 2014

34

Focus

Rural / Remote Nursing Health

December 2014 / January 2015 Volume 22, No.6 3

AUSTRALIAN NURSING AND MIDWIFERY FEDERATION ELECTION NOTICE Fair Work (Registered Organisations) Act 2009

Nominations are called for the following offices: Federal President Federal Vice President Federal Secretary Assistant Federal Secretary Written nominations which comply with the rules of the Federation can be made from Wednesday 14 January 2015. They must reach me not later than 12 Noon (A.E.D.T) on Wednesday 28 January 2015. Nominations cannot be withdrawn after this time.

Statements: In accordance with Rule 47.4 candidates may submit a 200 word (maximum) statement and a photograph of themselves, in support of their candidature. The statement will be reproduced in a form suitable for posting to voters with ballot material.

Statements must reach me not later than 12 Noon (A.E.D.T) on Wednesday 4 February 2015.

Statements and photos are preferred by email to vicelections@aec.gov.au

ADDRESS FOR LODGING NOMINATIONS & STATEMENTS

By Post: Australian Electoral Commission, GPO Box 4382, Melbourne, Vic, 3001

By Hand: Level 8, Casselden Place, 2 Lonsdale Street, Melbourne

By Fax: (03) 9285 7149 BALLOT: The ballot, if required, will open on Friday 27 February 2015 and close at 10:00am on Friday 13 March 2015.

Changed Address? Advise the Federation now.

NOTE: A copy of the AEC’s election report can be obtained from the organisation or from me after the completion of the election.

Jeff Webb / Returning Officer/ Tel: (03) 9285 7141 / 12 January 2015

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News

Nurses should be allowed to do more to fight Ebola The Australian Nursing and Midwifery Federation (ANMF) has commended the government’s commitment of $20 million in funding for a 100 bed Ebola treatment clinic in Sierra Leone, acknowledging the decision as a “terrific first step” in fighting the disease.

The Ebola treatment facility, to be run by private company Aspen Medical, will be staffed mainly by local healthcare workers and supported by a contingent of international staff, including some Australian volunteers, the government announced.

The government’s decision came following two months of lobbying by the ANMF and other health groups for Australia to provide more support in the international relief effort.

ANMF Federal Secretary Lee Thomas said despite the delayed action, she was glad anmf.org.au

to see the government’s response in West Africa and plans to increase preparedness at home. “It’s a terrific first step, but the government must do more to support and allow the many Australian nurses ready and willing to volunteer their services to fight the disease in West Africa.”

An ANMF national nurse and midwifery survey conducted last month was inundated with responses, showing that the majority believed the Abbott government must coordinate health teams from Australia to support the international fight against the Ebola epidemic.

Additionally, 350 Australian nurses indicated they were willing to volunteer if needed.

health practitioners in West Africa to cope with the magnitude of this epidemic.”

The nurses willing to volunteer were highly skilled professionals, passionate about working on the ground in West Africa, Ms Thomas said. “We know the best way to fight the Ebola epidemic is to contain it at its source. The expertise of our nurses willing to volunteer will ensure this happens.

“The government must provide logistical support for a deployment of Australian nurses and other health professionals to Ebola hotspots so that they can join other nurses and healthcare workers from around the world to fight Ebola.”

Useful links:

“We’re not surprised that our nurses want to act out of concern to help others, but we were staggered by the number of nurses and midwives who took part in the survey calling for the government to do more,” Ms Thomas said.

If you are interested in volunteering register at Aspen Medical: www.aspenmedical.com.au/ebola

Ms Thomas said qualified Australian volunteers should be given the opportunity to help. “It’s impossible for locally educated

To donate to the Red Cross appeal to fight Ebola go to: https://donations.redcross.org.au

December 2014 / January 2015 Volume 22, No.6 5

News: G20 update co-payment could threaten Medicare and start an increased schedule of fees for hospital and health services currently funded with taxpayer dollars, adding the Commonwealth needed to consider alternatives to the co-payment. “The Prime Minister called for a measured debate on the federation, including a discussion on tax reform, and we have responded to this by raising awareness of how a Robin Hood tax would stop our public health services from shifting further down the track of a twotier, Americanised health system.”

Universal healthcare solutions under a global spotlight The New South Wales Nurses and Midwives’ Association (NSWNMA) and the Queensland Nurses Union (QNU) have joined forces to campaign for a ‘Robin Hood’ tax to save Australia’s healthcare.

The community awareness campaign travelled across NSW and Queensland on a bus tour leading up to the G20 World Leaders Summit, held in Brisbane last month, where the unions called on the government to participate in discussions with European representatives as well as contribute to dialogue for global consensus.

The road trip was supported by other international nursing officials from around the globe, including the US and Canada.

The Robin Hood tax, more formally known as the Financial Transaction Tax (FTT), is a modest levy applied to banks and other financial institutions each time they make a transaction while trading stocks, bonds, derivatives, futures, options and credit default swaps. The tax would only target large profits made by risky, high volume trading and would not affect everyday transactions made by the public.

According to supporters of the tax each transaction could reap billions of dollars every year, which could be used to ensure health and education are well funded.

A number of G20 countries are already on board with the tax including the European Union, South Africa, Japan, Russia, Italy, Germany and France, the unions said.

NSWNMA General Secretary Brett Holmes said the trip shone a light on growing concerns for the essential Australian public hospital and health services such as Medicare. Mr Holmes said the Abbott government’s proposed $7 GP

QNU Branch Secretary Beth Mohle said nurses were committed to ensuring access to high quality public health and hospital services for people globally. “With the eyes of the world on us, we want to highlight the importance of universal healthcare for people the world over. There are giant disparities around the globe between those who can access appropriate healthcare and those who can’t.”

The bus tour cumulated at the Gold Coast University Hospital where in a show of solidarity representatives from the Australian Nursing and Midwifery Federation, Community and Public Sector Union, the American-based National Nurses United, the Canadian Federation of Nurses Unions, Global Nurses United and Public Services International, joined the tour.

At the end of the tour a G20 International Conference hosted by the QNU, all groups pledged support for tax justice, the importance of keeping universal healthcare in Australia and the need to fight against the impost of privatisation on essential healthcare and other public services.

Pledge to reduce workforce participation gap welcomed A commitment made by G20 Leaders to close the workforce participation gap between men and women by 25% by 2025 has been welcomed by the Australian Nursing and Midwifery Federation (ANMF) and the Australian National Committee for UN women.

The landmark pledge, made at the G20 Summit in Brisbane last month, was the first time a specific commitment had been made by G20 leaders about women’s economic empowerment.

6 December 2014 / January 2015 Volume 22, No.6

ANMF Federal Secretary Lee Thomas said bringing women into the global workforce was essential to increase global growth. “Bringing women into the workforce will also deliver financial independence to millions and help reduce poverty and inequity.”

Executive Director for the Australian National Committee of UN women Julie McKay said despite the progress which had been made towards gender equality globally, women continued to do two thirds of the world’s work, yet earned less than 10% of the world’s income.

“Traditionally gender roles, inflexible employment models and the burden of unpaid care work all impact women’s ability to access decent work.”

Ms McKay said the commitment by the G20 to close the workforce participation gap was an important first step. “Defining the actions which will be taken to ensure women are able to fully participate in the workforce is the next important step and we look forward to supporting the Australian government over the coming months to define its plan.

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News: G20 update Workers’ rights for global economic growth While strategies to create 2.1% economic growth globally were set at the G20 Summit, Labour 20 (L20) have warned meeting these targets will be a struggle if not accompanied by any plan to stimulate demand through higher wages and quality job creation.

The warning came at last month’s L20 Summit, held prior the G20, which was attended by federal government and opposition ministers and union leaders from across the globe, including Australian Nursing and Midwifery Federation (ANMF) Federal Secretary Lee Thomas.

According to communiqué from the Summit 200 million people were unemployed worldwide, as well as massive youth unemployment and stagnate wage growth, accross the globe.

General Secretary of the International Trade Union Confederation Sharan Burrow said projections that the global economy would

Plea for more help to fight Ebola In the lead up to the G20 Liberian nurse Laurene Wisseh along with her colleague ambulance officer Gorden Kamara plead with International G20 leaders for more resources to fight Ebola, describing the conditions they work in as horrific as they attempt to contain the deadly outbreak.

The couple spoke from the Liberian capital of Monrovia live with Australian and international nurses at Queensland Nurses Union’s (QNU) international G20 Nursing Conference held in Brisbane.

Speaking at the conference Ms Wisseh said health workers had been reduced to using plastic bags in an attempt to protect themselves due to the lack of rubber gloves and hazmat suits. “At the moment we are sharing equipment sometimes reusing disposable gloves and in the worst case scenario using plastic bags to protect against Ebola”. anmf.org.au

ANMF Federal Secretary Lee Thomas with Minister for Economy, Industry and Employment of France Christine Lagarde and Canadian Federation of Nurses Unions President Linda Silas

meet 2% growth was based on economic modelling which unrealistically assumed full employment. “We have no confidence that on current economic modelling that 2% growth target can be achieved. With the huge unemployment crisis and no plans to address demand needed to stimulate the global economy, the G20 will be back next year with higher unemployment and more fractured societies.”

ANMF Federal Secretary Lee Thomas, who is a member of the L20 steering group, said in order to reach the targets set by the G20 there needed to be a plan for job creation as well as a reduction in inequality.

Measures recommended at the L20 included workers’ rights such as enabling women and young people to participate in secure jobs and ensuring minimum wage, safe workplaces and social protection floors.

universal healthcare world-wide. The event coincided with many similar being held around the world to highlight the need for Ebola preparedness across the globe.

Gorden Kamara said Liberia had one doctor per 14,000 patients. “To fight the Ebola virus effectively in Liberia, we need more trained doctors, nurses, hygienists, ambulances, drivers, assorted antibiotics, oral hydration salts, vitamins and antimalarial drugs.

“We need a well organised and trained anti-Ebola response hub in each of the 15 political subdivisions of Liberia equipped with Ebola Treatment Unit, warehouses stocked with personal protection equipment and supplies for rapid response to an Ebola outbreak in any part of Liberia.”

Both Ms Wisseh and Mr Kamara called on Australian Prime Minister Tony Abbott, President Barack Obama and other world leaders who were in Brisbane for the G20 to send additional help immediately. “We need the world’s help now to stop the spread of Ebola.”

Healthcare workers and nursing and midwifery unions from Australia, America, Nigeria and around the globe attended QNU’s G20 conference to discuss the Ebola epidemic and other health themes such as

According to a statement from the G20 Summit, leaders have commited to do what is necessary to ensure international efforts would extinguish the outbreak and address its medium-term economic and humanitarian costs.

However humanitarian groups said while the leaders statement built a strong case for action, it lacked urgency and specific commitments in bringing the disease under control and building a robust public health infrastructure to prevent future pandemics.

Oxfam Australia Chief Executive Dr Helen Szoke said there was a real danger that the G20’s goodwill and concern would amount to a talkfest that would do little for those fearing for their lives in Sierra Leone and Guinea.

To donate to the Red Cross appeal to fight Ebola go to: https://donations.redcross.org.au

December 2014 / January 2015 Volume 22, No.6 7

News

Incoming ANMF (ACT Branch) Vice-President awarded ACT Senior Australian of the Year Incoming Vice-President for the Australian Nursing and Midwifery Federation (ANMF ACT Branch) Sandra Malhberg has been awarded ACT Senior Australian of the Year for her volunteer work helping children from developing countries afflicted with serious medical conditions.

Sandra, who also works as a registered nurse and midwife at Canberra’s Calvary Hospital, was recognised for her work as the ACT coordinator for Rotary Oceania Medical Aid for Children (ROMAC).

in Tanzania. She also held a fundraiser to provide paediatric nurses in Timor Leste kits consisting of a stethoscope, calculator, nurse pouch, thermometer, forceps and scissors.

Sandra, who has also been involved with the ANMF (ACT Branch) as a workplace delegate and Branch Councillor, said she was honoured to be recognised for her work, adding she loved being able to help young children. “I do a lot of voluntary work because I enjoy it.”

Sandra, who won the Unions ACT May Day award in recognition for her commitment to unionism, nursing and midwifery in 2011, will soon take on the role as Vice-President for the ANMF ACT Branch.

Sandra’s work at ROMAC has included organising funding, accommodation and transport to and from Australia for a number of children living in developing countries and in need of life saving corrective surgery for treatable conditions such as Tracheoesophageal Fistula and Gastroschisis. She has been instrumental in negotiating free care for the children who come from countries such as China, East Timor, Fiji, Vanuatu and the Solomon Islands, and hosts and supports children requiring medical care along with their parents or guardians in her own home.

Additionally, Sandra is a keen fundraiser.

With her son, she helped raise funds for gender equality at a school in Uganda by joining a group that climbed Mt Kilimanjaro

Lung disease in the spotlight Lung disease contributes to more than 10% of the overall health burden of Australia, according to the latest report from Lung Foundation of Australia.

The report Lung Disease in Australia summarised the information about the overall prevalence, burden and impact of the disease in one place.

Associate Professor Helen Reddel from Woolcock Institute, research institute for respiratory and sleep health, said mortality due to lung disease was significant with 14% or one in seven deaths in 2012.

Associate Professor Reddel said the data also revealed that lung disease was the cause of 276,505 hospitalisations in

8 December 2014 / January 2015 Volume 22, No.6

2011–2012, representing 5.07% of all patient-days in hospital.

The report looked at information relevant to chronic respiratory disease, respiratory infection and respiratory neoplasms including lung cancer and mesothelioma, and found: • Lower respiratory infections were the leading cause of hospitalisation; • Asthma represented as the leading cause of people living with disability; • Lung cancer represented as the leading cause of death (40% of deaths from lung disease); • Chronic obstructive pulmonary disease contributed to one-third of the burden; • Chronic obstructive pulmonary disease contributed to almost onethird of all deaths.

With a passion for the professions, Sandra believes nurses have an enormous responsibility for patients’ health and must strive for the best care for all their patients.

“If this means nurses need to make a stand either in our own hospitals for more staff or Australia wide as a unit of nurses then we must follow our consciences.”

ANMF (ACT Branch) Secretary Jenny Miragaya congratulated Sandra on her award, stating she had also demonstrated the same level of selflessness and energy through her highly principled leadership within the workplace and as part of the ANMF (ACT Branch), as she did with her humanitarian work. “She is an excellent example of the social justice values of unionism both in terms of her advocacy on behalf of our work colleagues and patients, but also through her Rotary based activities.”

Lung Foundation Australia’s CEO Heather Alan said the report prepared earlier in 2014 highlighted the disconnect between the significant impact of lung disease and the fact that most people don’t think about the health of their lungs.

Ms Alan said more than 50% of Australian adults rarely or never thought about the health of their lungs, which she wanted to change. “We think about our breast health and heart health. It is time we started the conversation about your lung health.”

The report can be accessed at: http://lungfoundation.com.au/ general-information/lung-disease-inaustralia-report/

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Recognising outstanding achievements It’s said that small acts can make a big difference.

Members of the public and those working in health and community services can nominate a Nurse of the Year. Nominations for the Outstanding Graduate Award must come from Graduate Nurse Coordinators, while leading-edge nursing teams can selfnominate for the Team Innovation Award.

This is certainly true when it comes to the HESTA Australian Nursing Awards, with each person nominated receiving a certificate of recognition.

“This gesture is an important part of the HESTA Australian Nursing Awards,” says HESTA CEO, Anne-Marie Corboy.

“Recognition plays a vital role in rewarding professional achievement.

“A certificate lets all those who’ve been nominated know their work is appreciated.”

A $30,000 prize pool — generously provided by ME Bank — will be shared among the winners in three award categories: Nurse of the Year, Outstanding Graduate and Team Innovation.

Nominate now Nominations are now open for the 2015 HESTA Australian Nursing Awards.

“It’s a great opportunity for patients, their families, colleagues or employers to say ‘thank you’, and to tell the community about Australia’s exceptional nurses and midwives,” Ms Corboy says.

Winners will be revealed at the Awards dinner, where all finalists will celebrate with their colleagues, friends and family.

“The achievements of Australia’s remarkable nursing professionals are inspirational, courageous and innovative — and our awards are an avenue to share their stories.”

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HESTA CEO, Anne-Marie Corboy

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News Notifications about health practitioners up An increase of 16% in notifications was made about health practitioners during 2013/14, according to the Australian Health Practitioner Regulation Agency (AHPRA) and the National Registration and Accreditation Scheme, of which nursing and midwifery are a part of.

Changing attitudes for the better Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) is calling for uniformed cultural safety training in healthcare across Australia.

CATSINaM’s CEO Janine Mohamed said the time was right for a uniformed change in legislation to ensure concepts of cultural safety was part of every health workers training.

Ms Mohamed said cultural safety was not about learning Indigenous culture, rather learning about individuals and how to respond in each case. “Cultural safety, or culturally respectful care is really about the individual caregiver examining their belief system, some of the things they have learnt over time and in relation to Aboriginal and Torres Strait Islander people, and really deconstructing that and reflecting on why they [Indigenous people] do the things they do and having an attitudinal shift.”

She said cultural safety training was also about how the individual healthcare provider’s change of attitude and interaction with Indigenous people, with reflective practice, might be more culturally sensitive.

“It’s also about acknowledging that there is this other culture that exists. Individuals are also challenged to not stop with ones’ self but to actually make changes within the system. So it’s a one by one, and then the critical mass and then changing the system approach we want to take.

“Within the nursing and midwifery profession we really need to examine the opportunities that exist.”

Ms Mohamed urged for consistency and

guidance around how cultural safety might be implemented within the course accreditation standards process.

She said the flow on effect would have the potential for continuing professional development, which could then create momentum for all nurses and midwives to respond and undertake cultural safety training. “Health practitioners get a lot of orientation before entering the workforce and cultural safety should be a part of that, but our belief is that it should be integral in our practice, seamless, like infection control is seamless in our profession.”

Ms Mohamed said Australia needed to learn from its neighbours who have implemented cultural safety training to their health system. “We know other countries have done it. In New Zealand they have implemented the Maori culture and I think the time is right within our profession to take that on. There is a lot of willingness for it, we just need to collectively come together to create the tools and identify the opportunities to implement them.”

Ms Mohamed urged the leadership of organisations to attend CATSINaM’s third cultural safety training workshop, which will be held in Canberra on 17-18 February 2015, so that they can implement cultural safety training within their organisation.

Ms Mohamed said if organisations wanted to make a change in this space and wanted to work with Aboriginal people in true partnership then attending cultural safety training and implementing it in their organisation’s training was essential.

10 December 2014 / January 2015 Volume 22, No.6

According to their annual report, more than 10,000 notifications were received about health practitioners, while mandatory reporting rates also increased by 9% nationally over the year.

There were more than 619,500 health practitioners from 14 professions registered in Australia on 30 June, and more practitioners in each profession.

AHPRA Agency Management Committee Chair Michael Gorton said the priority in 2013/14 was improving the agency’s performance on accountability through management and reporting; management of their notifications and the experience of notifiers and practitioners; and on ensuring smooth registration and renewal processes for practitioners.

“Our investment in notifications management is delivering results, and this will remain a critical challenge given the steady increase in recent years in the number of complaints.”

Some of the statistics in the report showed: • 75% of immediate actions taken by the National Boards for the most serious risks posted by registered health professionals led to restrictions on registration; • Of the matters decided by the Tribunals, 88% resulted in disciplinary action; • Of the 139 appeals finalised during the year 81% resulted in no change to the original decision made under the National Law. To view the 2014 annual report, along with the work and the data or each state and territory go to www.ahpra.gov.au/Publications.aspx

anmf.org.au

Breastfeeding: Life and Science

Round One HoBArt February 26 Sydney February 27

Round Two MelBourne March 25 AdelAide March 26 PertH March 28

And online from: March 24, 2015 until May 31, 2015 SPeAkerS include: Helen Ball (UK) Nikk Conneman (The Netherlands) Molly Pessl (USA) Sharon Perrella (Australia) Rachel McDonald (Australia) Diana Casser-Uhl (USA) Julie Stufkens (NZ) (Speakers will vary according to the city)

2015 Seminars for Health Professionals Hobart | Sydney | Melbourne | Adelaide | Perth For more information and registrations go to:

www.breastfeeding.asn.au

Australian Breastfeeding Association in partnership with Breastfeeding Conferences

www.breastfeeding.asn.au

Turning the Tide

for Birth and Breastfeeding Featuring: Helen Ball (UK) Alison Barrett (NZ) Hannah Dahlen (Australia) Andrew Bisits (Australia) Rhea Dempsey (Australia) Jane Scott (Australia) Martien Snellen (Australia)

Dates: 20th, 21st and 22nd of February, 2015 Venue: Lighthouse Theatre, 185 Timor Street, Warrnambool, VIC 3280

Clinton Creagan (Reservoir Dad, Australia) Judi Venten (Australia)

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For more information and to register go to: www.thewarrnamboolbreastfeedingcentre.com.au

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News Vale to Professor Ian Jacobs - Leader in nursing and paramedics Carole Lander On 20 October 2014, as he was bringing a critical trauma patient into the Royal Perth Hospital, Professor Ian Jacobs suffered a brain haemorrhage and never regained consciousness.

He died in the environment in which he spent his working life – one devoted to critical care medicine, which includes resuscitation, emergency medicine, intensive care, trauma, cardiac arrest and pre-hospital medicine. His full title was Professor Ian Jacobs, BAppSc WAIT, DipEd Murd., PhD W.Aust., FRCNA, FACAP, FERC. How often have we heard people say they would like death to come quickly?

Nevertheless, the news of Ian’s sudden passing came as a shock to the many colleagues and friends that he made during his career. They reminisce with fondness on the way he treated everyone as equals regardless of their station; whether you were the cleaner or a consultant, he always treated people the same way. He had a natural warmth, willingness to share and generosity of time and spirit that made him many friends.

Ian’s life was one of constant achievement.

A true polymath, he was as happy in the back of an ambulance as in an Emergency Department, lecture theatre or meeting room. As a teenager in Western Australia, he volunteered for St John Ambulance and became a youth leader with the St John Cadets. When he left school, he wanted to be a paramedic but in those days one had to be 21 years of age to study for that profession. So he completed a hospitalbased Diploma in Nursing at the Western Australian School of Nursing in 1981 and

then a Bachelor of Applied Science (Nursing) at the School of Nursing, Western Australian Institute of Technology in 1983.

Ian always had a keen interest in education and completed a Graduate Diploma in Education at Murdoch University in 1984.

He worked as an emergency nurse at Swan District Hospital and intensive care nurse at Royal Perth Hospital from 1984 to 1996. During this time he also held numerous education and research roles: Senior Tutor in the School of Nursing at the Western Australian Institute of Technology; lecturer positions in the School of Nursing and Centre for Advanced Studies, Curtin University of Technology; and Senior Research Officer, Road Accident Prevention Research Unit, The University of Western Australia. After completing his PhD in 1994 he took on various academic roles in the School of Public Health at Curtin University, and Department of Emergency Medicine at The University of Western Australia. Ian’s roles in clinical care, research and education managed to span health and university sectors and bring together the disciplines of nursing, paramedicine and medicine both nationally and internationally.

For over 25 years Ian served on the Australian Resuscitation Council in various roles, and has been its Chair since 2000.

His contribution to the national and international resuscitation community has been immense. The Council was established in 1974 by medical advisors and lay educators from organisations actively involved in the teaching of Cardiopulmonary Resuscitation. Its aim was, and still is, to standardise teaching and techniques, and to disseminate information about resuscitation

Male life expectancy on the rise Australian men have reached the 80 year mark in life expectancy after playing catch up to women for nearly a quarter of a century, new data says.

Latest figures from the Australian Bureau of Statistics (ABS) revealed male life expectancy has topped 80 years in Australia, joining other countries such as Switzerland, Japan and Iceland with the same statistic.

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ABS Director of Demography Denise Carlton said women had crossed the “elusive 80 year threshold in the 1990s”.

However, she said improvements in expected lifespan for women have since slowed down, increasing by around four years over the period to 84.3 in 2014.

Male life expectancy has been on a steady rise to 80.1 in 2013 from 79.9 in 2012.

equipment and techniques. Its members have expressed their sadness in a public statement: ‘The international resuscitation community has lost an inspirational leader, a prolific academic, and a great friend. He will be sadly missed.’

Although based in Western Australia, Ian’s work and his involvement in the Australian Resuscitation Council took him across the country and across the globe.

As co-chairman of the International Liaison Committee on Resuscitation he facilitated the activities of healthcare professionals and laypeople around the world and in so doing has undoubtedly saved the lives of many victims of cardiac arrest. However, despite his international travel, Ian maintained a strong commitment to family and always loved going home to his wife and stepsons in Perth.

Ian’s colleagues have commented on his passion for research, education and improvement of healthcare for the community. Indeed, the number of papers to which he contributed in recent years is impressive and covers a broad range of topics that reflect Ian’s depth and breadth of knowledge.

Ms Carlton said statistically the older men get the more likely they are to live even longer. “So a man who is now 50 could expect to live to 82, a 65-year-old to 84, and a man who is 85 this year could look forward to a 91st birthday.”

The figures also indicated that the highest life expectancy for both genders in 2013 was in the Australian Capital Territory with the Northern Territory to have the lowest life expectancy.

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News Investment needed into palliative care Greater investment is needed into palliative care, according to a report made on submissions to the Senate inquiry, Medical Services (Dying with Dignity) Exposure Draft Bill.

The report showed many who made submissions to the inquiry or gave evidence shared the view that greater investment was needed in palliative care.

Palliative Care Australia CEO Liz Callaghan welcomed the report’s consideration of palliative care issues, particularly the need for increased investment, better training and investment. “Palliative Care Australia has long called for training and education for all health professionals in palliative care.

The level of expertise and understanding of palliative care in the health sector has an impact on how it’s provided.”

Ms Callaghan said the greatest problems in palliative care lied in the poor provision of palliative care and inequity of access, particularly in rural and remote Australia.

“As an integral part of Australia’s healthcare system, palliative care must be

available when and where people need it regardless of age, income and diagnosis, or cultural background. It is about ensuring people receive high quality, coordinated, reliable care through which they can control, choice and dignity at the end of their life.”

Ms Callaghan said access to palliative care was a basic human right and should be adequately resourced to ensure adequate support for people with a life limiting illness, their family and carers so that they can live as well as possible at the end of life.

App to help men with prostate cancer A new smartphone app has been developed by the Prostate Cancer Foundation of Australia (PCFA) to assist men with the challenges that come with a prostate cancer diagnosis.

ProstateApp is the first innovative app used to deliver resources for men and their families to help them with the emotional, psychological and physical challenges of post diagnosis.

Associate Professor Anthony Lowe, PCFA’s

Chief Executive Officer, said the launch of the prostate cancer app was part of the organisations long term plan to deliver upto-date information that appealed and met the needs of Australian men.

Professor Lowe said the current digitalage climate had meant that apps such as ProstateApp would allow men access to credible and balanced information about prostate cancer. “Our main goal is to ensure all men have easy-to-access and helpful information, especially during the most difficult times such as after a diagnosis. We will continue to find different ways to offer Australian men and their families support so no one is left in the dark.”

The free app is available via the Appstore and contains the following features: Videos of people talking about their own experiences and offering thought on what might help.

Activities designed to help in decision making and helpful strategies to look after yourself - physically and emotionally.

Links to organisations that can help.

Inspirational quotes to keep cancer sufferers in a positive frame of mind.

Daily communication to ensure motivation.

his t u o y o t s Our gift son a e s e v i t s e f BODY SYSTEMS TRAINING ROOM

We are starting our gift giving early, from Wednesday 10 December 2014 the ANMF are giving you free access to your choice of one course on our Body Systems Training Room (BSTR). offer valid from 10/12/14 - 19/12/14 If you still want more, keep an eye on the BSTR website because later in December we will be offering 20% off when you purchase any of our bundles or the complete Library.

Don’t forget when you purchase the BSTR complete Library you have access to any new courses we add to the Library during your 12 month subscription. So if you have already purchased the Library we have just added six new courses to your subscription.

ANMF Federal Office 02 6232 6533 education@anmf.org.au BSTR - ANMJ Dec 2014.indd 1

The ANMF provides all nurses and midwives with access to practical and affordable CPD that can be undertaken at your own pace, at a time that suits you.

anmf.org.au/education 17/11/2014 3:07:57 PM

News Better equipping nurses to deal with stressful situations A new online simulation-based learning program will better equip nursing students to manage stressful situations involving deteriorating patients, experts say.

University of Queensland (UQ) researchers have collaborated with experts across Australia to develop, feedback incorporating review and simulation

Australians are stressed Financial stress is the leading cause of high levels of mental and physical health problems for Australians, according to a new survey.

The Australian Psychology Society conducted the Stress and wellbeing in Australia survey 2014, which showed the levels of general wellbeing had decreased since its first survey in 2011.

While older Australians, 66 and above, reported significantly higher levels of wellbeing, the 18-25 and 46-55 age groups reported the lowest levels of wellbeing.

It was also revealed that young Australians

techniques to act on clinical trends (FIRST2ACT), a website which helps train nurses to respond efficiently in hospital emergency situations.

scenarios that otherwise would not be possible. “In a cohort of final year nursing students approximately half have never encountered a deteriorating patient in clinical practice and only 0.5% have been a first responder.”

“The management of deteriorating patients is a problem throughout the world, and although not complex, in a stressful situation the key essentials can easily be forgotten,” UQ research lead Professor Fiona Bogossian said.

The best way to resolve this issue, Professor Bogossian said, was to engage in the virtual simulation platform. “FIRST2ACT web provides a high degree of reality, enabling students to gain experience in recognising and responding to deteriorating patients, and receiving feedback so they can improve their performance.”

Professor Bogossian said the online based training was useful for final year nursing students, as it exposed them to

in the 18-25 and 25-35 years were in the highest level of stress and distress age group compared to reports in 2012 and 2011.

The major cause of stress for almost half of participants was financial issues who said it had impacted their wellbeing. Family issues counted for 45% of respondents’ cause of stress and 42% said personal health had caused them to feel stressed.

Other issues such as maintaining a healthy lifestyle caused 39% of participant’s to feel stressed. While 36% reported issues with the health of close ones to have caused them to feel stressed.

For those over the age of 46 years, personal health issues were the catalyst for high levels of stress.

Australia’s first graduate primary healthcare transition program There is a major change in healthcare delivery happening in Australia. As hospital resources are stretched, care is increasingly shifting to communitybased settings.

As a consequence, the number of people with complex chronic diseases being cared for in the community is rapidly increasing, and there are not enough specialist nurses to meet the demand.

The nursing profession needs to find ways to quickly increase the number of nurses working in primary healthcare settings.

In response, Sydney Nursing School at the University of Sydney in collaboration with Northern Sydney Medicare Local has

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developed the first primary healthcare transition program in Australia, designed to help new nursing graduates move directly into the specialty.

Co-ordinator of Sydney Nursing School’s Master of Primary Healthcare Nursing Dr Christina Aggar said the program was already in demand.

The program provides robust training and support to new nursing graduates in the first 12 months of their careers – a crucial period in the development and retention of skilled graduates.

Dr Aggar said transition programs had already been around in the acute care setting for some time and that they help attract and retain highly skilled, specialist staff, according to research. “This program has been designed to specifically address the shortage of skilled primary healthcare nurses.

The interest from both GPs to partner with us and students to get involved has been phenomenal. We believe there is an opportunity to grow the existing scheme and roll out similar programs nationally.”

It involves a full orientation program, study days, two placements at GP practices, and structured learning blocks provided by Sydney Nursing School, with support from key national primary healthcare experts.

Project Investigator and Course

December 2014 / January 2015 Volume 22, No.6 15

News Myths of alcohol consumption during pregnancy

ANMF mourns the passing of dedicated unionist Bob Burrows

A resource designed to assist midwives and health professionals to warn women about the dangers of alcohol consumption during pregnancy and breastfeeding, has recently been developed.

The Australian Nursing and Midwifery Federation mourned the sad passing of Bob Burrows, who died on 29 September 2014.

The new initiative, Women Want to Know, developed by Foundation for Alcohol Research and Education (FARE), provides resources and education to health professionals about the myths of alcohol consumption during pregnancy. Alcohol consumption during pregnancy can cause significant harm to the unborn child and can result in fetal alcohol spectrum disorder (FASD), which is a devastating lifetime condition, said Senior Policy Officer for FARE Sarah Ward.

Ms Ward said research showed 97% of pregnant women wanted their health professionals to ask about their alcohol consumption, but only 45% of health professionals did so. FARE’s recent research indicated 83% of health professionals asked first time pregnant women about their alcohol consumption. But that dropped to 47% when talking to women who had been previously pregnant.

Ms Ward said most health practitioner’s generally advised pregnant women abstain from alcohol during pregnancy as the best course of action. “But there are still some health professionals who say that one drink should be fine.

Bob played an important role on the AMNF Industrial Advisory Committee for more than 10 years. He was cherished by his colleagues and was the ‘go-to guy’ for advice about the trade union during his 33-year commitment to the movement. things such as smoking, nutrition, physical activities and lots of other stuff, so talking about alcohol consumption should be another topic that should be covered and easily talked about.”

To help health professionals undertake a conversation about alcohol with pregnant women FARE has developed the five A’s approach.

• Ask all women about their alcohol consumption, not just those you think might be drinking.

• Assess how much the woman is drinking.

• Advise that no alcohol consumption is the safest but depending how much she is drinking give advice that increasing the consumption and increasing the frequency of alcohol consumption will impact her and the baby’s health.

• Assist the women with strategies that could reduce or stop her alcohol consumption.

• Arrange for further support or for another conversation.

“Another myth is that there are different types of alcohol that could cause more harm and we know that that is not the case as all alcohol causes harm.”

The resources are available free including an online training course with the Australian College of Midwives which is CPD accredited.

Additionally, the Australian Institute of Health and Welfare has developed a new tool called the National FASD Action Plan to address information gaps regarding FASD due to be released in 2015.

Ms Ward said that conversations about alcohol were welcomed by women. In addition she said it was valuable for health professionals to have that conversation because it could prevent a child being born with a disability. “Health professionals talk to women about a whole range of

The government has provided $9.2 million towards the plan for a range of projects aimed at tackling the harmful impacts of FASD on Australian children and families. For more information about the project go to: www.alcohol. gov.au

16 December 2014 / January 2015 Volume 22, No.6

As the senior industrial officer at the ANMF (Vic Branch) for more than 13 years (1992-2005), Bob was instrumental in the success of many campaigns and the growth of the union.

His selfless commitment to the working people, positive outlook on life and integrity earned him respect by a wide circle of people, especially from those who worked with him.

Bob’s extensive knowledge of the union’s history and excellent memory in retaining any number of industrial relation issues made him a valued contributor to ANMF across Australia.

Held in high esteem Bob is remembered with great affection for his humour, wise counsel, camaraderie and love of the occasional lunch.

ANMF will miss Bob and send its sincere condolences to his wife Faye, his daughters Melissa, Megan and their families.

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Industrial Nick Blake, Senior Federal Industrial Officer Over a few days in early November, Australia stopped to reflect on the legacy of Gough Whitlam and his Labor government (1972-75). We watched a long line of political, community and business leaders talk, in mostly positive terms, about the lasting reforms of his government.

The Whitlam government’s reforms to higher education were rightly remembered as being instrumental to permanently changing, for the better, the Australian community.

Prior to Whitlam, students in Australia were charged substantial up-front tuition fees.

Those students who were not wealthy could only afford to access higher education through a small number of scholarships (that generally went to private schools), by bonded scholarships (typically where the students on graduation were required to work for a particular employer for up to seven years eg. teaching) or by taking out a large personal loan.

In 1974 the Whitlam government abolished up-front tuition fees and his government took over the running and funding of higher education. As a consequence the higher education sectors grew substantially with students from a range of socio-economic backgrounds, a large percentage of them being female students, accessing universities for the first time.

Attempts by the conservative Fraser government to reintroduce full fee paying tuition fees in 1977 and 1982 backed by student loans were unsuccessful, partly because the banks were unwilling to underwrite loans for students. The banks’ reluctance was basically due to the experiences in the United States of America where graduates default of loans at the time were running at over 20%. That is to say over 20% of American students were unable to meet their loan repayments and consequently forced into a form of bankruptcy. Shocking statistics that continue to this day.

In 1996, the Howard government introduced changes that all students would have to meet part of the costs of their education and also introduced the concept that university fees for courses of study be based on the cost to the university of providing the education. Howard also partially deregulated HECS fees, however, continued to ensure that students could access a loan from the Commonwealth and not be obliged to repay those monies until their salary reached a particular threshold.

And while successive conservative anmf.org.au

governments attempted to unpick the Whitlam reforms it is fair to say until 2014, this was done with a relatively light touch.

In assuming office in 2013 the Abbott government moved quickly to introduce major reforms to the funding and operations of the Australian universities sector, including changes to the repayment regime for the HECS scheme that involve a lowering of the repayment threshold and the introduction of a real rate of interest on outstanding debt.

Christopher Pyne, the Education Minister and the chief proponent for university deregulation is openly hostile towards the current system and a passionate advocate of user pays. When announcing the proposed changes the Minister was adamant it was a “good deal for students”, and that “deregulation is the only way to respond to what students and employers want. It is the only way to set our universities free to ensure they can deliver what they need. It is the only way to ensure Australia is not left behind”.

And while acknowledging that students will have to pay more the Minister claimed those with a university degree “earn up to 75% more than someone without a degree “or “can earn an extra $1,000,000 over their working life”. Thankfully most commentators and political groups outside of government are not buying this vacuous ideological dogma and see these proposed changes as unfair and a backward step for both universities and students.

They understand that, increasing fees and the interest rate on student debt, will increase repayments and repayment periods for all graduates and also the impact will be biggest for those who earn less. Furthermore women, who are more likely to fall into lower income groups and more likely to take time off to raise a family, are the ones who will be hardest hit by the proposals.

For those contemplating a career in nursing and midwifery the changes are potentially devastating and may have long term deleterious effects on the provision of healthcare in Australia.

Nursing and midwifery education are

relatively high cost courses, largely because of the clinical component. Faced with the opportunities arising from the deregulation of courses of study, ANMF is fearful that universities will be drawn to offering courses of study where the cost of providing the course is lower.

It is also likely that the deregulation of course fees (thereby providing an opportunity for universities to increase revenue) will encourage many universities to offer more places to international students.

The ANMF, while recognising the importance of international ties and reputation, does not support the provision of places to overseas students, if it impacts negatively on access to places for domestic students, supply for the domestic workforce, and the overall quality of education provided.

Then there is the impact of the increase in course fees. Despite the government’s conviction that higher student fees will not act as a significant disincentive to participation from lower income groups, ANMF believes that, faced with escalating fees and longer periods of debt, many students will be reluctant to undertake courses that do not have clear pathways to high remuneration ( eg. medicine). Any move away from nursing and midwifery study will have long term impact on the provision of healthcare The ANMF supports a university sector that is based on the principles of equity, fairness and quality. We do not believe cuts to tertiary funding, deregulated course fees and increased student fees and debt meet these principles.

ANMF will continue to call on the government to scrap these changes and draw on the Whitlam legacy as evidence of the long term benefits to all Australians of a university sector that remains accessible to all and not just the privileged few.

December 2014 / January 2015 Volume 22, No.6 17

Feature

18 December 2014 Volume 22, No.6

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THE ROUND UP

Through our eyes – Looking back at 2014

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MARCH

APRIL

1 A $6 fee for every GP visit was taken under consideration by the federal government resulting in nurses and midwives joining rallies to highlight their disapproval of the scheme across the country. ANMF Federal Secretary Lee Thomas said the extra expense should not be put on ordinary Australian families who were unable to afford the out of pocket costs associated with visiting a GP.

1 After a ten year career with the Australian Nursing and Midwifery Federation (ANMF) Yvonne Chaperon resigned from her role as Assistant Federal Secretary to take on a position in the Mental Health Tribunal in Tasmania. Ms Thomas said for the past decade Yvonne had worked tirelessly to represent the interests of nurses, midwives and assistants in nursing at both a state level with the ANMF Victorian Branch and on the national level at the ANMF Federal Office.

1 The Australian Nursing and Midwifery Federation grew to 233,000 members in April, cementing its place as one of the largest and most influential unions in the country.

2 ANMJ’s February feature looked at natural disasters and the impact it has had on nurses, midwives and their families at home and in their workplaces.

2 The ANMJ featured a story on lateral violence sparking a huge response from nurses and midwives across the country about their personal experiences of workplace bullying. The response clearly indicated that lateral violence remained rife within the professions.

20 December 2014 / January 2015 Volume 22, No.6

2 Annie Butler was appointed Assistant Federal Secretary. Ms Butler previously worked at the New South Wales Nurses and Midwives’ Association (NSWNMA) for 11 years as a Professional Officer and then as an Organiser and Lead Organiser.

3 The ANMJ reports on the complex and multiple health needs of Australia’s asylum seekers in and out of detention centres and the role of the nurse providing care.

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1 Nurses and midwives hold celebrations across the country in honour of International Day of the Midwife and International Nurses’ Day.

1 The Federal Budget is announced sending shock waves across the country. Brutal cuts to healthcare included a $7 co-payment for GP visits and a $5 increase in PBS co-payment, winding back of funding agreements with the states and territories, cutting $50 billion over eight years, income thresholds for Medicare levy surcharge and the private health insurance rebate frozen for three years.

In addition significant increases in university fee’s potentially adversely impacting graduate nurses and midwives. The ANMF swore it would fight and defend the Australian health system against the savage cuts.

1 Nurses and midwives joined thousands of other Australians across the country to rally in protest against the federal government’s Budget cuts in Bust the Budget rallies.

2 ANMF (Victorian Branch) job rep Carole Ellis helped organise a breakfast at her workplace for the Knox Maternal and Child Health team in Melbourne. Carole said it was a lot of fun and a great way to get the team together.

3 Little known nursing speciality, Forensic Nursing, was under the spotlight in May’s ANMJ. The crucial role these nurses take in supporting vulnerable patients and gathering evidence is examined.

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2 ANMJ finds out what it’s like for ANMF Federal Secretary Lee Thomas and ACTU President Ged Kearney to be two of Australia’s most powerful women in the union movement. On union leadership Ms Thomas said if you’ve got a passion for advocacy then union work and this sort of advocacy work is amongst the best you can get. “Be determined, have a vision for your future and if that’s part of the union movement, then go for it.” Speaking about the roles of women in the union movement Ms Kearney said a lot of things had to change starting with women themselves.

“I think women have to tell themselves they can do it. It’s hard, I’ll be honest. I know what it’s like to walk into a room full of men and for a sole woman that can be quite intimidating.”

2 Meanwhile the ANMF launched its online campaign, Healthcare Emergency – Lies, Cuts and Broken Promises, against the savage austerity measures set out in the Budget. Members were asked to visit the ANMF website and nominate a lie, cut or broken promise. ANMF Federal Secretary Lee Thomas said nurses and midwives needed to band together and fight the proposed cuts to healthcare so as to support the most vulnerable in our community.

3 The ANMF celebrated its 90th birthday this month. Members of the Federal Executive acknowledge the ANMF had grown from strength to strength, with a membership currently standing at 233,000 making it the second largest union in the country.

December 2014 / January 2015 Volume 22, No.6 21

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1 Thousands of nurses, midwives and the community joined the ANMF’s campaign Healthcare Emergency – Lies, Cuts and Broken Promises, meanwhile ANMF Federal Secretary Lee Thomas addresses the crowd at a Bust the Budget rally in Canberra, where she affirmed ANMF’s commitment to fight the government’s cut backs to health and education.

1 ANMF Federal Secretary Lee Thomas spoke out about the importance of aged care and the care of those with dementia.

She condemned the government’s action on cutting the Dementia and Severe Behaviours Supplement. Ms Thomas affirmed the ANMF would continue to campaign for the aged care sector.

1 As ANMF’s campaign Healthcare Emergency – Lies, Cuts and Broken Promises built momentum ANMF Federal Secretary Lee Thomas and Assistant Federal Secretary Annie Butler spoke out about the government’s proposal to deregulate universities and increase HECS fees and the impact it would have on future nursing students. Ms Thomas said the deregulation of universities and increasing HECS debts could mean the doubling or tripling of university fees, making nursing and midwifery studies a particularly unattractive option. “Nursing students could incur 15 to 20 years of debt they will be paying off a three year course. Clearly this is a significant problem for nursing and midwifery given that the starting salaries are reasonably low.”

Ms Thomas and ANMF Assistant Federal Secretary Annie Butler also met with Cross Bench Senators and the Federal Health Minister Peter Dutton to state the union’s case about its opposition to the budget.

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2 This month’s feature looked at remote and rural nursing delving into the challenges and rewards of working in these areas.

3 ANMF workplace/job reps, are highlighted in this month’s ANMJ. Their important role was explored and the support they give to nurses and midwives and the union.

22 December 2014 / January 2015 Volume 22, No.6

2 October’s feature looks at midwifery and the pros and cons of caseload care.

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1 The 20th International Workforce Forum of the International Council of Nurses was held in Sydney. Attended by ANMF Federal Secretary Lee Thomas, the nursing leaders agreed there was an international trend to view nursing and midwifery as a cost rather than an investment. The leaders affirmed their responsibility to ensure governments value and recognise nursing and midwifery in the delivery of healthcare. “What we need is investment in our valuable workforce to sustain our healthcare sector,” Ms Thomas said.

1 After delayed action the government announced additional support to fight the Ebola crisis raging in West African countries. While the move was welcomed by the ANMF, who had been lobbying the government to step up its support, the union believed more should be done to allow Australian nurses to volunteer to fight the disease. Prior to the government’s commitment the ANMF had undertaken a survey which indicated hundreds of Australian nurses were ready and willing to support Ebola if the government coordinated efforts.

The feature this month investigated nursing and midwifery leadership, looking at what has made some of our finest in the professions into great leaders.

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Ms Thomas said she was overwhelmed by the response from members who continued to be deeply concerned by the government’s reluctance to join the international effort to fight what is rapidly becoming a devastating humanitarian crisis. “Our members feel a strong obligation as healthcare professionals, to care for people with all types of illnesses regardless of their circumstances or where they are located.”

2 ANMF Federal Secretary Lee Thomas and Assistant Federal Secretary Annie Butler attended the L20 Summit in Brisbane, to discuss international economies, jobs and wages.

The Summit, held ahead of the G20 and chaired by ACTU President and former ANMF Federal Secretary Ged Kearney, was attended by federal government and opposition ministers and union leaders from across the globe. Ms Thomas, who is a member of the L20 steering group which developed a process of engagement between organised labour and G20 leaders this year, said the Summit was an important opportunity to inform government on the relevant views of labour and workforce.

December 2014 / January 2015 Volume 22, No.6 23

Education Understanding Crohn’s Disease The following excerpt is from the Understanding Crohn’s Disease course available on the ANMF’s Body Systems Training Room. The complete course is approximately 70 minutes in duration and will introduce you to the disease state and clinical management of Crohn’s disease. This excerpt gives you 30 minutes of CPD toward your annual requirements.

Irritable Bowel Disease (IBD) is a chronic, immune-mediated intestinal condition that manifests in two major forms, Ulcerative Colitis (UC) and Crohn’s Disease (CD). It involves inappropriate immune responses in the gut, resulting in chronic inflammation in affected individuals.

There are a number of diseases, chemicals and drugs that can cause similar symptoms, mimicking IBD. These include a number of infections of the intestines and colon, as well as other diseases that produce inflammation in the gastrointestinal (GI) region.

Conditions that mimic IBD (see table) CD is a form of IBD that is characterised by discrete nodes of inflammation called granulomatous lesions, and by normal passages from one body cavity to another, called fistulas. These can occur anywhere in the GI tract, from mouth to anus, but they usually manifest in three areas: the small intestine, the colon (especially the ileocecal region), and the perianal region. Some of the effects of CD can be seen outside the GI tract eg. in the skin, eyes and joints.

In 1998, a classification for CD was released at the World Congress of Gastroenterology in Vienna, which classified the disease by age of onset, disease location and disease behaviour. The Vienna classification is used primarily in research, not in clinical practice, this system was later revised in 2005 and released at the World Congress of Gastroenterology in Montreal, which

kept the same three categories, but made modifications within each.

The CD Activity Index (CDAI) is another classification used to differentiate between mild, moderate or severe CD. (For detailed information on classification statistics, please refer to the course online).

CD affects individuals across the globe.

Precise numbers for the incidence and prevalence of CD are difficult to obtain.

Even in regions or countries where attempts have been made, the lack of gold standard for diagnosis of CD makes the identification of cases difficult. While there are wider ranges of estimates, a survey of the existing evidence shows that the highest numbers are in westernised nations, especially in urban areas, suggesting an environmental influence in the development of the disease.

Also, there have long been reports of rates going from higher in the North to lower in the South, but this gradient has been diminishing since the 1980’s. IBD, including CD, is a growing problem. In every region of the globe where the disease has been studied, the incidence rates of IBD are either holding steady or increasing. Currently, Australia is ranked highest in the world for annual incidence of CD. (For further statistics on incidence and prevalence, please refer to the course online).

Risk factors associated with CD include ethnicity, age, family history, environmental factors and smoking. Studies have found Jewish or Caucasian ancestry to be a risk

factor. However, studies also show that people moving from low-prevalence regions to high-prevalence regions demonstrate increased risk.

• There are two peaks of onset when the development of CD seems most likely to occur: between the ages of 15 and 30 years, or between the ages of 60 and 80 years of age.

• IBD runs in families. The first-degree relative of a patient with IBD has approximately a 10% lifetime chance of developing the disease.

• CD is less common in developing countries and in rural areas.

Industrialisation and a westernised lifestyle and diet seem linked to the prevalence of CD eg. certain saturated fats present in the Western diet are thought to contribute to the development of IBD in genetically susceptible individuals. These dietary fats may cause changes in bile composition, disturbing the balance between the microbiota and the host defensive response.

• Smoking may double the risk of developing CD. CD is considered an autoimmune disease, during which the immune system attacks its own cells. While the exact etiology, or cause, is unknown, there are many pieces to this puzzle that have already been described.

CD symptoms may vary, depending on which region of the GI tract is inflamed. A commonly affected region is the terminal ileum. If this or other regions of the lower part of the GI tract are affected, typical symptoms are lower abdominal pain and diarrhoea. If the upper GI tract is affected, typical symptoms include nausea, vomiting and upper abdominal pain.

The clinical presentation of symptoms often consists of intermittent periods of remission and flares, affecting the quality of life of the patient. Other symptoms

Infections Bacterial

Viral

Fungal

Other

Salmonella

Cytomegalovirus

Histoplasmosis

Amebiasis

Clostridium difficile

Clostridium difficile

Candida aspergillus

Tuberculosis

Gonorrhoea

Human Immunodeficiency Virus (HIV) Non-infections

Inflammatory

Neoplastic

Drugs and chemicals

Appendicitis

Lymphoma

Non-steroidal anti-inflammatory drugs (NSAIDs)

Diverticulitis

Carcinoid

Gold salts

Ischaemic Colitis

Cancer of the Ileum

Oral contraceptives

24 December 2014 / January 2015 Volume 22, No.6

anmf.org.au

Education

include weight loss, low-grade fever and malaise. Because they are not specific to CD, differential diagnosis is necessary to confirm the cause of these symptoms.

Lesions in CD can be found anywhere in the GI tract, but are usually found in the small intestine, the colon and the perianal region. About 33% of cases involve the small intestine alone, about 20% involve only the colon (part of the large intestine) and about 47% involve both the small and large intestine. Taken together, this means that approximately 75% of patients have some involvement of the small intestine and, of these, the terminal ileum is affected 90% of the time.

In Crohn’s disease, the inflamed nodes, called granulomas, are usually discrete and surrounded by normal tissue, leading to a cobblestone appearance.

Some of the consequences of this inflammation include a thickening of the bowel wall, the abnormal formation of fibrous tissue, and chronic obstruction of the passage.

CD lesions are transmural and can affect all layers of the bowel, although the submucosal region is most affected. Severe inflammation can locally thin the walls of the GI tract, which can cause microperforations, and, ultimately, fistulas, or abnormal passages between adjacent structures.

There are a number of complications outside the intestinal tract inflammation associated with CD, such as malnutrition, musculoskeletal and joint pain, arthritis, skin lesions, liver problems, eye problems, anmf.org.au

and heart and lung disease.

Also CD carries with it an increased risk of colon cancer. Even after a negative result from a colonoscopy, dysplasia or cancer are discovered by the fourth endoscopic surveillance exam in about 22% of CD patients who have extensive inflammation of the colon, or colitis. A CD patient is 2.4 times more likely to develop colon cancer than a member of the general population.

CD and IBD in general is a polygenic disorder, meaning that a number of genes have been associated with a predisposition to developing the disease. One of the strongest genetic links is to a genomic region on chromosome 16, in an area called IBD1. It is linked specifically to CD and is the region where a gene called CARD 15 is found. CARD stands for caspase-associated recruitment domain and its genetic variation has been identified as a predisposing factor for CD. Normally, the CARD15 protein detects intracellular bacterial molecules and is involved in the pro-inflammatory nuclear factor –kB signalling pathway. For other genes associated with CD, please view the course online.

Initial tests seek to identify physical symptoms. Signs suggestive of CD usually prompt laboratory tests. If the laboratory tests indicate CD, then imaging techniques and biopsies are used to evaluate the extent and location of the disease.

Throughout, differential diagnosis is performed to eliminiate the possibility of other, closely related diseases that may mimic the symptoms of CD. CD patients often visit a physician due to

chronic abdominal pain and diarrhoea.

They may also complain of perianal lesions and haematochexia (the passage of fresh blood per anus, usually in or with stools), although this is less common. Clinical evaluation of patients begins with physical findings, such as weight loss, fever, general malaise, anal fissures, perianal ulcers, skin tags and bowel obstruction. Although often observed, it is important to know that these symptoms and signs are not specific to CD. If CD is suspected following the physical examination, blood samples are collected and are analysed to detect signs of inflammation, malnutrition and anaemia. While these laboratory results can provide clinical indicators of Crohn’s Disease, none of them can individually quantitate disease activity.

However, they may help determine the need for imaging data to confirm diagnosis.

Diagnositic imaging, namely radiography and endoscopy, is used to locate the region of inflammation and to evaluate the extent of that inflammation. Importantly, these techniques can identify fistulas and narrowing of the GI tract, or stenosis.

In combination with radiography and endoscopy, a tissue biopsy can be analysed to support a CD diagnosis. More specifically, the histological evaluation of the biopsy specimen is examined for the presence of granulomas in the lining of the GI tract.

Contrast radiography is essential for evaluation of CD lesions. This information helps establish a treatment strategy.

Many features of CD are similar to Ulcerative Colitis. In 15% of all cases of IBD, CD cannot be distinguished from

December 2014 / January 2015 Volume 22, No.6 25

Education UC; these cases are termed indeterminate colitis. The features that are used to help differentiate between these two IBD’s can be found in the complete course online.

There is no gold standard to define the disease severity of CD, and so severity is described by working definitions of disease activity. Patients are said to be in remission if they are asymptomatic. This includes patients responding to medical intervention.

If they have active disease, then the severity can be categorised according to the following three degrees: mild to moderate, moderate to severe, or severe to fulminant. Treatment guidelines use these degrees of severity to recommend different therapeutic approaches.

Mild to moderate: • The patient is able to walk and eat • There is absence of dehydration, high

glucocorticoids, immunomodulators, antimetabolites and anti-tumour necrosis factors (TNFs). Patients are moved to alternative treatments if they fail to respond to initial ones.

Anti-inflammatory drugs: Salicylates, also known as 5-aminosalicylic acid (5-ASA) agents, are anti-inflammatory drugs on the first line of therapeutic treatment of CD. They are used in mild to moderate disease and often to maintain remission as well.

Sulfasalazine and Mesalazine are examples of 5-ASA agents that reduce inflammation in the GI tract.

Antibiotics: are the second line of therapy for the attenuation of CD symptoms. In the cases of perianal and fistulous CD, it is the first line of treatment. Commonly used antibiotics are Metronidazole and Ciprofloxacin.

fever and abdominal tenderness • There is no more than 10% weight loss • There is absence of detectable painful

mass or obstruction in the abdomen.

Moderate to severe: • The patient has pronounced symptoms,

including fever, abdominal pain or tenderness, nausea and vomiting • There is more than 10% weight loss • There is absence of bowel obstruction or significant anaemia • Patients who have failed treatment for mild to moderate disease are also placed in this classification.

Severe to fulminant:

Glucocorticoids: are a class of steroids that possess anti-inflammatory effects. These steroids are effective in inducing remission but ineffective in maintaining remission.

Examples of glucocorticoids are Prednisone, Budesonide and Hydrocortisone. Long term administration of these steroids may cause a number of serious side-effects such as adrenal suppression, fluid retention, myopathy and emotional disturbances.

Therefore, dosage should be tapered after remission until discontinued, which may take several months. Glucocorticoids should be the first line of treatment for both moderate to severe disease activity and for mild activity that is refractory to anti-inflammatory drugs.

• The patient has high fever, persistent

vomiting, rebound tenderness, cachexia, or evidence of an abscess • There is presence of intestinal obstruction • Patients who have persistent symptoms, despite outpatient steroid or biological therapy are also placed in this category.

Management of CD depends on disease severity, location and the presence of complications. The general strategy is to attempt to induce remission with medication and then to maintain the remission state as long as possible.

Surgery is recommended for patients resistant to medication or in the presence of intestinal obstruction, abscess, fistula, perforation, haemorrhage, neoplastic lesions and perianal disease.

The six types of drugs used in medical management of CD are: anti-inflammatory drugs, antibiotics,

Immunomodulators: Drugs that belong to the immunomodulator class inhibit the immune response that causes inflammation.

Azathioprine and 6-mercaptopurine, potent immunomodulators, effectively induce remission. They are also used as substitutes for glucocorticoids, once they have been tapered off. Cyclosporine is another modulator of the immune response. Its rapid onset of action makes it more potent but also carries more side effects such as hypertension, gingival hyperplasia, tremors and headaches.

Antimetabolites/Antifolates: Methotrexate is an antifolate that interferes with the synthesis of DNA. It may also reduce inflammation by reducing interleukin 1 (IL-1) production. It is effective at both inducing and maintaining remission.

Anti-TNF: TNF is a naturally occurring inflammatory cytokine that has increased

26 December 2014 / January 2015 Volume 22, No.6

expression in CD patients. Anti-TNF’s such as Infliximab and Adalimumab, are antibodies that block TNF in the serum and at the cell surface, and are effective in inducing disease remission. Anti-TNF agents are also effective for remission maintenance, and Infliximab has demonstrated fistula-closing abilities as well.

The development of modern therapeutic drugs has lowered the incidence of surgeries for treatment of CD. Today, the surgical treatment option is often considered as a last resort. Despite this, anywhere from 50 to 80% of patients with CD will eventually require surgery.

Indications for surgery include perforation, persistent or recurring obstruction, abscesses that cannot be drained, cancer or dysplasia and fulminant disease.

Surgical options include: intestinal resection, endoscopic balloon dilation and stricturoplasty.

Intestinal resection involves the removal of the diseased tissue from the intestine. This method is usually considered when all the therapeutic options have failed to significantly reduce inflammation in the GI tract. In cases of patients with fistula complications, stenosis, massive haemorrhage, development of cancer and frequent relapse, intestinal resection is also strongly considered.

One of the most common non-resectional surgical treatments is a procedure known as endoscopic balloon dilation. This procedure is recommended for benign stenosis, or obstructions that do not show evidence of deep ulcers or fistulas. It is mostly recommended for stenosis of short length, such as 4cm or less. This operation is often performed for its low incidence of complications, which is about 2%.

An alternative to resection in CD is stricturoplasty, which involves surgically reopening a narrowing of the intestines.

This procedure is advised for stricture lengths of less than 10cm in the small intestine. Stricturoplasty in the colon is not recommended due to an increased chance of cancer.

To complete the course online, go to http://www.anmf.adamondemand.com. au/ You may select this as your free course on the BSTR between 10-19 December.

For further information please contact Jodie or Rebecca at education@anmf.org.au or ph 02 6232 6533 anmf.org.au

Ethics Navigating a bill of rights for Australia Megan-Jane Johnstone In 1948 the United Nations adopted the Universal Declaration of Human Rights (UDHR). The UDHR gives unequivocal recognition to the inherent dignity, worth and inalienable rights of all human beings.

Available in over 439 languages, the UDHR is now widely recognised as the cornerstone of modern human rights across the globe (www.ohchr.org/en/udhr/ pages/introduction.aspx).

In the six decades since the UDHR was first adopted there has been significant growth in various human rights conventions, treaties and other mechanisms, including national charters or bills of rights, aimed at identifying and clarifying the rights and freedoms of human beings that must be protected. Some examples include the freedoms and rights of life, speech, religion, security of person, and non-discrimination.

In keeping with these trends most western democratic countries have adopted a national bill of rights, eg., the USA (1791), Canada (1982), New Zealand (1990), South Africa (1996), Britain (1998), and 25 members of the European Union.

To date Australia has rejected the path of its sister nations and currently stands as the only western democratic country that does not have a national bill of rights. Although an Australian bill of human rights has been proposed, its adoption has been successfully opposed by political conservatives worried that such a bill would see ‘minorities and the disadvantaged being given too much attention’, the unacceptable transfer of power from Parliament to an ‘unelected judiciary’, a drain on public resources, and the undermining of the very freedoms the bill had ostensibly being proposed to protect (Leeser & Haddrick 2009).

Tabloid journalists in turn have fuelled misperceptions of the intents and benefits of an Australian bill of human rights by spuriously aligning its passage with enabling protection of the ‘rights’ of bullies, criminals and terrorists to perpetrate their malevolent acts against individuals and communities, the self-interested promotion of a human rights ‘industry’ of benefit only to lawyers and ‘lefties’, and the diminution of Australian society.

A question of nursing ethics An important right underpinned by the UDHR is the ‘right to health’. Enshrined in anmf.org.au

the World Health Organization’s (WHO) Constitution and in ‘international and regional human rights treaties as well as national constitutions all over the world’ (www.who.int/mediacentre/factsheets/ fs323/en/) the right to health holds that attaining the highest standard of health is a fundamental right of every human being.

This right is taken to mean that all people are entitled to have ‘access to timely, acceptable, and affordable healthcare of appropriate quality’ and that the State has a correlative obligation to respect, protect and fulfil this right. Here the question arises of what impact, if any, will the sidelining of an Australian bill of rights have on the right to health as enshrined in the various mechanisms to which Australia is a signatory?

The right to health The right to health has not escaped criticism by opponents of an Australian bill of rights.

Spruiking concerns about the resource implications of an enshrined right to health, opponents contend that the judiciary might usurp the authority of an elected government to decide health resource questions and unacceptability to reprioritise public health expenditure on items and illnesses that society can ill afford. They conclude that as there are already sufficient laws and mechanism in place to assure the respect, protection and fulfilment of the right to health in Australia, a bill of rights is not needed (Leeser & Haddrick 2009).

Damaging cuts to healthcare budgets and services have long demonstrated that elected governments on both sides of politics are not necessarily the best guardians of the right to health. For example, in Victoria, the recent loss of over 800 aged care beds (including those in mental health facilities designated for the care of older persons with complex disorders and long-term mental illnesses) has shown that government department processes, current laws and other ‘protective’ mechanisms are not always up to the task of safeguarding the fundamental health rights of the people affected. The heartrending stories of consumers desperately trying to find appropriate placements for their dispossessed elder relatives add further testimony to the failure of ‘the State’ to ensure even the most basic protection of the human rights of its vulnerable citizens.

Obligations of the nursing profession In its 2011 position statement on Nurses and Human Rights (www.icn.ch), the ICN recognises that all individuals have a right to healthcare and that nurses have an obligation to safeguard and respect this right at all times. Fulfilling this obligation, however, is becoming increasingly difficult.

Hunt (2007) notes that ‘human rights are easier to endorse than enforce’. It is of concern an Australian bill of rights may not have the legal force necessary to ensure that the fundamental health rights of all people living in Australia are respected, protected and fulfilled. However, its symbolic power should not be underestimated. As Williams (2008) points out, like human rights conventions generally, bills of rights can often serve as an important ‘rallying point for those who have been denied their basic freedoms’. And when we feel disgusted and outraged when human rights are violated, bills of rights can also serve as a touchstone for galvanising public opinion and calling governments to account.

Meanwhile the question remains why opponents of an Australian bill of rights are so eager to trample on the inherent dignity, worth and inalienable rights of people living in Australia and, in effect, demean and trade away their humanity? This is a question that has yet to receive a satisfactory response.

References Hunt L. 2007. Inventing human rights: a history.

WW Norton & Co, New York.

Leeser J & Haddrick R (eds). 2009. Don’t leave us with the bill: The case against an Australian bill of rights.

The Menzies Research Centre, Barton, NSW. Williams G. 2008. A charter of rights for Australia.

Dissent, 27(Spring): 10-12.

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.

December 2014 / January 2015 Volume 22, No.6 27

World Safe workplaces needed for the care of Ebola patients Nurses have called on world governments to create safe workplaces for the care of Ebola patients at a high-level nursing summit organised by the International Council of Nurses (ICN) and the Spanish Nursing Council (CGE).

The meeting, held last month, brought together representatives from ICN, CGE, the European Federation of Nurses, Public Services International, Médecins San Frontières, members of Spanish nurses unions, delegates from the European and African countries where patients with Ebola have been treated, and expert nurses in the direct care of Ebola patients.

ICN CEO David Benton said nurses were central to dealing with the Ebola crisis and simultaneously at great risk. “Training of nurses and the establishment of protocols for care of patients with Ebola have thus far been fragmented.” At the time of print World Health Organization (WHO) said more than 443 healthcare workers have been infected and 244 have died from Ebola.

The two day summit resulted in nurse leaders agreeing to: • develop a centralised platform to obtain all information on nursing and the Ebola Virus Disease; • develop training programs that guaranteed competence and that will be internationally accredited by the ICN; • demanding an active participation by nurses at the decision-making level regarding prevention and care of patients with Ebola.

While Europe’s summit addressed concerns of the deadly virus, the US state of California announced landmark mandatory Ebola guidelines following thousands of US nurses across 14 states striking over inadequate safety protocols, training or equipment to properly care for patients

The Services Industrial Professional and Technical Union (SIPTU) instigated the call, after renewal fees jumped to €150.

SIPTU Sector Organiser Kevin Figgis said no state organisation was entitled to increase its income from 50% from a single source “NMBI (Nurses and Midwifery Board of Ireland) is seeking to do just that at the expense of hard working nurses and midwives who have endured staffing and pay cuts.

Their campaign of opposition can and will work.”

Mr Figgis said the union would advise nurses and midwives when payment of a €100 only could be made. “We need to send a message to the NMBI loud and clear. We have taken all the cuts and increases we can take. Enough is enough.”

US nursing union National Nurses United (NNU) said the guidelines should be a model for federal and state action in all US hospitals.

“These rules are a testament to the outspoken efforts of nurses who have repeatedly pressed for the highest level of mandatory safety precautions to protect nurses, patients and the public. Nurses have raised their voices, and California has now listened, acted and once again set a landmark for the nation,” said NNU Executive Director Rose Ann DeMoro.

The need for US nurses to strike for better safety precautions was heightened after a nurse treating a patient in a US hospital contracted Ebola.

with improved resistance.

Irish nurses urged to hold off on registration fees Irish nurses and midwives are being advised to ignore renewing their annual nursing and midwifery registration in protest against a 50% hike in renewal fees.

with Ebola in their hospitals.

Older citizens rebuild the Philippines Older people have been key in rebuilding disaster stricken Philippines after Typhoon Haiyan destroyed millions of homes, a new report says.

The report, Typhoon Haiyan one year on: older people key to recovery, was conducted

by HelpAge International, a global network of organisations fighting for older people, and Coalition of Services of the Elderly (COSE), which ensures full implementation of laws related to older people.

HelpAge and COSE with their local partners set to ensure older Filipinos had regular homes, shelter, healthcare and access to their rights and entitlements. Older carpenters were trained in new building techniques, resulting in stronger shelters

28 December 2014 / January 2015 Volume 22, No.6

The agencies, through cash transfers, conducted shelter repairs, training in carpentry and geriatric care, piloting a mobile community health service and ensured community pharmacies had access to appropriate and affordable medicines.

“We received 10,000 pesos from HelpAgeCOSE and restarted our mini store and food outlet. Now we make sure we have some savings from these businesses,” said Erlinda Yabao, 71, from Tacloban, Leyte.

According to the report older people have been key in helping 150,000 people recover from Typhoon Haiyan by helping to build homes and also diversified farms using global aid.

HelpAge International and COSE Programme Director in the Philippines said in any emergency, helping communities to meet their most immediate needs as well as aiding longer term recovery was a challenge. “But we have overcome these challenges with the active involvement of older people themselves as well as with the support of their organisations.”

Approximately 1.27 million people over the age of 60 were affected by the typhoon, according to the Philippine Statistics Authority, many losing their homes, livelihoods and loved ones. anmf.org.au

Research Self-treatment of wounds

By Suzanne Kapp registered nurse and PhD candidate Chronic wounds are breaks in the skin that take greater than four weeks to heal. Two percent of Australians have a chronic wound and the condition is even more common among older people.

Chronic wounds cause pain and suffering and cost the Australian healthcare system $2.85 billion each year. Chronic wound treatment involves wound cleansing, wound dressings and adjunct therapies such as compression therapy and pressure redistribution. Some people self-treat their wounds, either with or without professional assistance.

Self-treatment of wounds study A study investigating self-treatment of chronic wounds among people living in metropolitan, regional, rural and remote areas in Australia is about to be conducted.

The study will involve most people completing a survey (online, paper or over the phone).

The research, which has been approved by the University of Melbourne Human Research Ethics Committee, will be conducted by registered nurse and PhD candidate Suzanne Kapp and the University of Melbourne Department of Nursing’s Professor Nick Santamaria.

How you can help Nurses often come into contact with people who have chronic wounds and are

ideally positioned to direct people, who meet the study eligibility criteria, to make contact with the researchers.

Eligible participants must be aged 18 years or older, have a wound that is more than four weeks old, and self-treats the wound (ie. cleanses it, or applies/removes a wound dressing, or applies/removes compression therapy).

People can participate even if: • The wound is small; • They have only self-treated for a short while; • They only conduct some self-treatment activities; • Someone assists them with self-treatment; • Sometimes a healthcare professional does their wound treatment.

Registered nurse and PhD candidate Suzanne Kapp

Significance of this study: Care of the skin and wound management are fundamental nursing activities. A better understanding of the characteristics, experiences and practices of people who self-treat chronic wounds has the potential to improve patient outcomes, and the support that nurses provided to people who self-treat.

The researchers appreciate you supporting this important study. Please share information about the study within your networks. If you have any questions or would like more information about the study, or to participate, please contact

Suzanne Kapp via: • The study web site: www.selftreatmentofwounds.net • By email: skapp@student.unimelb.edu.au • Phone or text Suzanne Kapp on 0412 972 106

Shift work causes impaired brain power Shift work has been linked to impaired brain power and a range of health problems such as ulcers, cardiovascular disease, metabolic syndrome and some cancers, according to recent research.

Researchers tracked the cognitive abilities of more than three thousand people from France who were either working in a wide range of sectors or who had retired, at three points of time: 1996; 2001; and 2006. anmf.org.au

had only worked normal office hours.

Participants were aged 32, 42, 52 and 62 at the time of the first set of tests, which aimed at assessing long and short term memory; processing speed; and overall cognitive abilities.

The research also looked at the impact of shift work and whether stopping shift work was linked to a recovery in cognitive abilities.

While the observational study could not produce definitive conclusions about the cause and effect, researchers said the disruption of the body clock as a result of shift work could generate physiological stressors, which may in turn affect brain functioning.

The data showed that those who currently, or who had previously worked shifts, had lower scores on memory, processing speed, and overall brain power than those who

The researchers also indicated that recovery in cognitive abilities was possible however it took at least five years, depending on the person.

December 2014 / January 2015 Volume 22, No.6 29

Clinical update

Review of a home nursing injection service: SHINE Venecia Willenberg, Marion Bamblett, Meredith Cummins, Deborah Hoberg.

The SHINE home injection service is part of a patient support program run by Novartis. SHINE is for people prescribed octreotide long–acting release (Sandostatin LAR) for neuroendocrine tumours (NETs) and acromegaly. SHINE has been running in Australia since 2009. The service is run by a third-party and administered by homecare (SHINE) nurses. Five hundred people with NETs or acromegaly have been involved since the service started. We review our collective experience of the benefits of SHINE, and make recommendations for future development. We hope this review provides guidance for developing future home injection service.

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Clinical update

Neuroendocrine tumours (NETs) and acromegaly are chronic conditions often requiring long-term treatment with a somatostatin receptor ligand (SRL).

Standard practice requires patients to attend clinic for their injection every 28 days.

People with NETs need support to manage their symptoms throughout treatment, including, regulating the secretion of gastrointestinal hormones. Typical symptoms of NETs may include food sensitivity, diarrhoea, flushing, breathing difficulties, blood sugar disturbances and carcinoid heart disease (Modlin et al. 2010). People with acromegaly have disproportionate skeletal tissue, and organ growth (Melmed 2009). These patients commonly have arthritis, facial changes, a protruding lower jaw, and glucose intolerance (Melmed 2009). People with acromegaly have raised levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1). Acromegaly symptoms can lead to low self-esteem (22%), tiredness and pain (31%) (Modlin et al. 2010).

Many medical consultations and delays in diagnosis can result in financial difficulties, an inability to work (31%) and job losses (Australian Pituitary Foundation 2014).

Management of people with NETs or acromegaly requires awareness of the impact of treatment on quality of life (Adelman et al. 2013, Modlin et al. 2010).

Studies of services treating patients with cancer, acromegaly, dystonia and multiple sclerosis in the home have found that home injections or chemotherapy could replace some clinic visits. Home visits improve compliance, are flexible, convenient and cost-effective (Salvatori et al. 2013, Bevan et al. 2008, Syed et al. 2014, Whitaker et al. 2001, Bordonaro et al. 2014).

SHINE (Sandostatin Home Injection Nurse Education Service) is available to patients receiving injections of octreotide longacting release (Sandostatin LAR) for NETs or acromegaly. anmf.org.au

In discussions with patients we found many have difficulty attending appointments and collecting medication. While convenience was the main reason, emotional support and reassurance with managing day-to-day life were highly valued and many patients reported enjoying their visit from the SHINE nurse. Patients in SHINE felt less stress associated with travel, parking, moving around the hospital, picking up medication, waiting times, and the unexpected onset of symptoms such as diarrhoea often associated with NETs. In the last five years more than 500 patients have enrolled in SHINE. Currently, 110 SHINE nurses treat 300 patients across Australia. In this clinical update, we share our experience of SHINE in Australia. We hope to provide guidance that seeks to ensure the effective delivery of home care injection services into the future.

Overview

People prescribed octreotide LAR for NETs or acromegaly attend the clinic for monthly injections, given by an oncology or endocrinology nurse. These nurses work closely with the doctor responsible for each patient. The nurse undertakes a thorough assessment of the patient’s needs following diagnosis, and provides education and support. However, when the patient’s condition is stable and dosing is unchanged, monthly visits to hospital may be inconvenient and stressful for patients.

Enrolment into SHINE may be considered for this patient group.

Patients are not suitable for SHINE if they are not stable, need dose adjustment or response reassessment. Some patients prefer receiving injections in the clinic.

Patient Lifestyle

People with a chronic condition, such as NETs or acromegaly, have more to think about than their monthly injections. For example, in both conditions, diet is part of the treatment, requiring some patients to modify their lifestyle. A dietitian helps

patients with gastric disturbances to identify triggers and provides dietary advice. People with acromegaly have a predisposition to type 2 diabetes mellitus.

We promote a healthy lifestyle, and monitor patients for possible onset of diabetes.

Both conditions have some embarrassing psychosocial and physical symptoms.

People with NETs require immediate access to a toilet for urgent and unexpected diarrhoea, making time away from home stressful at times. They may also experience flushing without warning.

Changes in appearance for people with acromegaly can lead to relationship problems, loss of confidence and low selfesteem. These patients may be concerned about increased reliance on family and friends, physically and emotionally. People with acromegaly often experience pain, including headaches or joint pain, limiting their ability to drive. If unable to travel alone, patients may need family or friends to take time off work to accompany them to the clinic. Having their independence threatened increases pressure on the patient and may lead to withdrawal from their family and the community.

The time, cost and lack of parking associated with travelling to and from hospital concern many patients. Patients who work, may need to take time off to attend the hospital each month.

Most people with a chronic illness lead active lives while quietly managing their symptoms. Any support to improve their daily living is welcomed.

SHINE: Focus on the Patient

The needs of patients vary and are individual. Some patients prefer a quick injection in their otherwise busy day. Other patients enjoy time to chat. SHINE aims to meet the needs of all people living with these chronic conditions. SHINE nurses travel to the patient’s place of work or home, at a mutually convenient time.

December 2014 / January 2015 Volume 22, No.6 31

Clinical update

Importantly, the healthcare professional and patient should discuss how they will manage the individual’s needs and priorities.

The main aim of SHINE visits is to administer the injections. However home visits provide the opportunity to discuss adverse events and clinical concerns. SHINE nurses identify whether the patient needs to see their doctor for an earlier than planned review.

Diagnostic tests for tumour markers in most cancer types are reimbursed, however in NETs, this cost is passed onto the patient. A positive aspect of SHINE is reimbursement of the costly Chromogranin A (CgA) test. CgA monitors the effectiveness of treatment and detects recurrence in patients with NETs (Modlin et al. 2010).

Patient Care In our experience, continuity of care is the main concern for the hospital team (hospital nurses, oncologists and endocrinologists) managing people in SHINE. Once patients are on a stable dose of octreotide LAR, the oncologist or endocrinologist refers the patient to SHINE. The consultant completes the application form and the hospital nurse sends the form with a summary of the patient’s treatment plan to the third party, Ascott. Following each visit, the SHINE nurse sends a report to the hospital team and the SHINE project manager within 24 hours. The hospital team review clinical issues and adverse events in the report. The report is also sent to the pharmaceutical company responsible for pharmacovigilance within 24 hours, for

32 December 2014 / January 2015 Volume 22, No.6

regulatory purposes.

Since SHINE started, referrals have increased dramatically, demonstrating improved confidence in SHINE and the positive impact of the professional relationship and communication between team members. Patients continue to attend clinic visits for review and tests every 3-6 months, depending on their health status.

Patients in SHINE report they do not feel their ongoing care is compromised.

Training and Education

A novice SHINE nurse partners with an experienced SHINE nurse for training.

Nurses should be confident as well as competent at giving the injection every time. A good rapport and confidence in anmf.org.au

Clinical update

the nurse reassures the patient and relieves anxiety associated with the injection. When not administered well, the injection can be uncomfortable, with mild pain in the area for a couple of days. Each home visit lasts about 30 minutes, enough time for the nurse to discuss issues with the patient and develop their relationship.

Consistency

Where possible, the same SHINE nurse visits the patient each time, developing a supportive and trusting relationship. The nurse becomes increasingly experienced at administering the injection to the individual.

SHINE nurses follow a consistent process.

After receiving the patient’s treatment plan from the hospital, the SHINE nurse agrees a mutually convenient time for the first visit with the patient. The visit includes time to discuss the patient’s needs and administer the injection. The day before each visit, the nurse calls the patient to confirm the appointment time and check they have collected their medication from the pharmacy. Forty minutes before the appointment, the SHINE nurse calls the patient to remind them to remove the medication from the fridge.

During the visit, the nurse reconstitutes the medication and reviews any issues since the last visit. At the end of the visit and before leaving, the nurse agrees the date, time and place for the next injection. Patients are responsible for collecting and storing medication and following up with their doctor for new repeats, allowing them to maintain independence.

Convenience

Once each person’s condition is well controlled, they continue with their usual lifestyle. People who are working or busy are keen to spend less time travelling for injections. For some, clinic visits can take up to half a day including travel time. SHINE nurses are local to the patient, and can conduct visits at any time to suit the patient, including evenings, weekends or during the working day. They can meet the patient at a preferred location to administer the injection, such as at work. One patient in SHINE spent six months travelling around Australia, meeting a SHINE nurse in each location.

Recommendations

As SHINE develops, opportunities to grow anmf.org.au

References Adelman, D. T., K. J. Liebert, L. B. Nachtigall, M. Lamerson, and B. Bakker., (2013). Acromegaly: the disease, its impact on patients, and managing the burden of long-term treatment. Int J Gen Med 6:31-8. doi: 10.2147/IJGM.S38594.

the service become apparent. SHINE could support treatment of the common symptoms associated with NETs or acromegaly. SHINE nurses may be able to facilitate bloods tests for assessment of GH and IGF-1 in patients with acromegaly.

Australian Pituitary Foundation.,(2014). Acromegaly awareness campaign. Accessed 1 July. http://pituitary. asn.au/News/AcromegalyAwarenessCampaign.aspx.

We recommend that hospital nurses assist with training and support of SHINE nurses.

Through one to one mentoring, hospital nurses could help SHINE nurses to identify early warning signs of disease progression in patients.

SHINE nurses, and hospital nurses could attend professional development conferences. Examples include the Endocrine Nurses’ Society of Australasia Inc (ENSA) and the Clinical Oncology Society of Australia (COSA). Combined nurse meetings for all nurses involved in SHINE would allow best practice to be shared across the service.

Patients with NETs require a form of PET (Positron Emission Tomography) scan called GaDotate to monitor the neuroendocrine tumour. These are currently not funded by Medicare. However there may be an opportunity for SHINE to reimburse this cost, bringing the cost of diagnostic testing for patients into line with other cancers.

Conclusion

The perceived benefits of SHINE vary between patients. For many patients, SHINE helps them maintain independence. Other patients appreciate the flexibility to have the injections anywhere and at any time.

Collaboration and communication between the hospital nurse, hospital doctor and SHINE nurse ensure SHINE meets patients’ needs.

Bevan, J. S., J. Newell-Price, J. A. Wass, S. L. Atkin, P. M. Bouloux, J. Chapman, J. R. Davis, T. A. Howlett, H. S. Randeva, P. M. Stewart, and A. Viswanath., (2008).

Home administration of lanreotide Autogel by patients with acromegaly, or their partners, is safe and effective.

Clin Endocrinol (Oxf) 68 (3):343-9. doi: 10.1111/j.13652265.2007.03044.x.

Bordonaro, S., F. Romano, E. Lanteri, F. Cappuccio, R. Indorato, A. Butera, A. D’Angelo, F. Ferrau, and P. Tralongo., (2014). Effect of a structured, active, homebased cancer-treatment program for the management of patients on oral chemotherapy. Patient Prefer Adherence 8:917-23. doi: 10.2147/PPA.S62666.

Melmed, S., (2009). Acromegaly pathogenesis and treatment. J Clin Invest 119 (11):3189-202. doi: 10.1172/JCI39375.

Modlin, I. M., S. F. Moss, K. Oberg, R. Padbury, R. J. Hicks, B. I. Gustafsson, N. A. Wright, and M. Kidd.

(2010). Gastrointestinal neuroendocrine (carcinoid) tumours: current diagnosis and management. Med J Aust 193 (1):46-52.

Salvatori, Roberto, Whitney W. Woodmansee, Mark Molitch, Murray B. Gordon, and Kathleen G. Lomax.

(2013). Lanreotide extended-release aqueous-gel formulation, injected by patient, partner or healthcare provider in patients with acromegaly in the United States: 1-year data from the SODA registry. Pituitary 17 (1):13-21. doi: 10.1007/s11102-012-0460-2.

Syed, M., D. Rog, L. Parkes, and G. L. Shepherd., (2014). Patient expectations and experiences of multiple sclerosis interferon beta-1a treatment: a longitudinal, observational study in routine UK clinical practice. Patient Prefer Adherence 8:247-55. doi: 10.2147/PPA.S46421.

Whitaker, J., A. Butler, J. K. Semlyen, and M. P. Barnes.,(2001). Botulinum toxin for people with dystonia treated by an outreach nurse practitioner: a comparative study between a home and a clinic treatment service. Arch Phys Med Rehabil 82 (4):480-4. doi: 10.1053/apmr.2001.21843.

Marion Bamblett RN is the Clinical Nurse Manager at Fremantle Hospital, WA

The SHINE model could be extended to other chronic diseases that require frequent clinic visits for injections. Examples include cancer, multiple sclerosis, chronic pain, immunotherapies, and palliative care.

Meredith Cummins RN, is the Director of Nursing at the Northern Cancer Institute, NSW

Acknowledgments

Deborah Hoberg, RN, is a Nurse Practitioner at the ICON Cancer Care, South Australia.

Katie Burslem from WriteSource Medical Pty Ltd provided medical writing services funded by Novartis Pharmaceuticals Australia Pty Ltd.

Financial Declaration

SHINE is funded by Novartis Pharmaceuticals Australia Pty Ltd

Venecia Willenberg, RN, CN, RM is the Endocrine and Research Coordinator at Southern Adelaide Diabetes and Endocrine Services Repatriation General Hospital, South Australia.

December 2014 / January 2015 Volume 22, No.6 33

Focus – Rural / Remote Health

Midwifery scholarships help students fly

For XuJun Wu, or Viv Wu as she is known to her colleagues, flying to remote outback communities and helping people who are sick or injured has been a long-held dream.

A visit to the Royal Flying Doctor Service Port Augusta Base 10 years ago fired her interest in aeromedical nursing and in one day joining the RFDS. Mark Brittle, a Critical Care Nurse at Canberra Hospital, also harboured a similar ambition. Their interest was rewarded in 2012 when both received the RFDS Midwifery Scholarship to support their postgraduate study while nursing part-time.

Viv topped her class at Flinders University and in May 2014, received the Margaret Grace McNair AM Award for Midwifery as Flinders’ best post-registration midwifery student.

rural and remote Australian communities,” Viv says. “It makes me feel proud that I am able to join this excellent organisation to contribute my knowledge and skills to such a unique health service.”

Mark says he’s thrived since he started at RFDS Central Operations, which covers South Australia and the lower two thirds of the Northern Territory. With its challenging physical environment and clinical settings, working for RFDS has allowed Mark to draw on his experience while also requiring him to be flexible and resourceful.

“Working with First Australians has also provided me with new clinical challenges and a greater insight into issues of Indigenous health,” Mark says. “The supportive team within Central Operations, and specifically Alice Springs, has ensured a smooth transition into my new role … the view from the office isn’t too bad either.”

Mark completed his midwifery at the University of Canberra after working in a variety of critical care roles at Canberra Hospital. Both began working as flight nurses at RFDS Alice Springs Base during 2014 and haven’t looked back, finding the close-knit aeromedical crews at the base welcoming.

“I have already met so many friendly and supportive people here and felt their passion about making a difference for the 34 December 2014 / January 2015 Volume 22, No.6

Both Mark and Viv are now part of the world’s largest aeromedical organisation with 21 bases, 63 aircraft and five remote primary health facilities delivering emergency assistance and essential primary healthcare services to more than 290,000 people living, working and travelling in Australia each year.

The RFDS offers a limited number of annual Midwifery Scholarships available across Australia each year for suitably qualified Registered Nurses.

For more information visit: www.flyingdoctor.org.au/Careers/ Scholarships/Scholarships---CentralOperations/ Kate Hannon is Media & Communications Manager at the Royal Flying Doctor Service, Central Operations in South Australia

IT MAKES ME FEEL PROUD THAT I AM ABLE TO JOIN THIS EXCELLENT ORGANISATION TO CONTRIBUTE MY KNOWLEDGE AND SKILLS TO SUCH A UNIQUE HEALTH SERVICE. anmf.org.au

Focus – Rural / Remote Health Collaborative action to improve rural mental health

By Nicholas Procter and Monika Ferguson The University of South Australia’s Mental Health and Substance Use Research Group has, for the past five years, been engaged in collaborative research, policy and practice development to address challenges for Australians living in rural and remote regions.

There is now considerable evidence that certain factors (eg. isolation and natural disasters) exacerbate the experience of mental illness for these individuals and may contribute to higher suicide prevalence among men (ABS 2011). Moreover, rural Australians face difficulties accessing sustainable mental healthcare. With almost one third of the Australian population residing outside of major cities (ABS 2013), UniSA’s Mental Health and Substance Use Research Group has responded to such challenges by recognising the importance of working to improve the provision of mental healthcare by nurses in these regions.

One key example of this work is a collaborative action research project, conducted by UniSA researchers and SA Health clinicians. Based on the shift towards localised mental healthcare, the clinicians identified consumer engagement as an important practice issue. They were particularly interested in identifying the skills and attributes employed by mental health clinicians to improve consumer engagement in the rural community setting. Qualitative research was undertaken with mental health clinicians working in a regional South Australian centre to understand the nature, scope and effectiveness of engagement in day-to-day practice. A preliminary thematic analysis of data indicates that, although many strategies parallel those employed by clinicians in metropolitan settings (Procter et al in press 2014), the unique nature of the rural environment also requires unique engagement approaches, such as drawing on informal community networks and partnerships to provide care. anmf.org.au

Mental Health and Substance Use Research Group member and SA Health clinician, Bernie Stefan-Rasmus, at one of the Shared Learning and Clinical Practice symposia

THE PROJECT RAISED NUMEROUS IMPORTANT QUESTIONS, SUCH AS HOW TO ENCOURAGE CLINICIAN-COMMUNITY COLLABORATION, AND HOW TO SUPPORT REFLECTION ON PRACTICE TO IMPROVE CONSUMER OUTCOMES. Practice development symposiums are also an effective vehicle for ensuring that clinicians working in new or existing services have the opportunity to reflect on what works well in light of contemporary clinical practice evidence.

The project raised numerous important questions, such as how to encourage clinician-community collaboration, and how to support reflection on practice to improve consumer outcomes.

Another initiative arising from the joint working partnership is a series of practice development symposia under the banner of Shared Learning in Clinical Practice.

Each symposium provides an opportunity for information exchange and capacity building. In recent times, more than 500 clinicians, researchers, policy makers, consumers and carers have taken part in this state-wide initiative. The focus on rural symposia and what this means for nurses providing mental healthcare has become an exemplar of UniSA’s and SA Health’s commitment to working in partnership with professionals in regional South Australia.

It is testimony to a focus on building and supporting a proficient and sustainable mental health workforce in rural areas.

References Australian Bureau of Statistics (ABS). Australian social trends, (March 2011). Health outside major cities.

Canberra: ABS. Cat. No. 4102.0.

ABS. Regional population growth, Australia, 2012-13., (2013). Canberra: ABS. Cat. No. 3218.0.

Procter, N.G., Backhouse, J., Cother, I., Ferguson, M., Fielder, A., Jackson, A., Murison, J. & Reilly, J-A., (2014).

Engaging consumers in the Australian emergency mental health context: A qualitative perspective from clinicians working in the community, In press, Health and Social Care in the Community.

Professor Nicholas Procter is the Mental Health Nursing Chair and Monika Ferguson is a Research Assistant, both in the School of Nursing and Midwifery at the University of South Australia

December 2014 / January 2015 Volume 22, No.6 35

Focus – Rural / Remote Health

Respecting the courage and making a difference

By John Allin

it out and got it healing, he has made it comfortable so I can at least be mobile. Not just that ... my needs are being looked after in my own surroundings, not in a hospital.”

Garth is one of RDNS HomeCare’s hundreds of clients in Tasmania. Some, like Garth, have nursing needs; others need personal and domestic care.

Noel’s area in the north west of the state is big and challenging. Two hours to the east is Launceston, an hour north is Devonport.

It is hilly country, sometimes bordering on mountainous. The roads are windy and many are unmade. Noel and his team have about 230 clients within a 75 kilometre arc of their base in Devonport.

RDNS HomeCare nurse Noel Kenzie chats with patient Garth on the edge of Tasmania’s beautiful Lake Barrington.

The wind skipping across the valley is chilly. It is midday and the clouds are rolling in. The one settling over Mt Roland is flat as a pancake. It descends rapidly, levelling the peaks and crags.

It settles at 1,100 metres and within minutes the mountain has become a table top.

cat, Snowball, and Jessie the cockatiel. The setting is idyllic. It is dense country. Black cockatoos, plovers and green bush parrots play chasey in the tree tops while the golden brown and white plovers seek out worms in the shallows and geckos basking on the dry rocks.

Garth shifts his gaze to the south west where Cradle Mountain lies in the far distance. He rolls his right shoulder slightly and flinches. His bones and joints tell him what’s in the air. “It’s going to snow tonight,” he says eventually. “Nothing surer. I can always feel the weather.”

Garth knows this part of Tasmania like the back of his hand. He grew up here and, except for the stint in the army and a tour of duty to Vietnam 45 years ago, these hills have been his home.

He would like his health to be better than it is. Over the years he has had two abdominal operations, heart surgery and three spinal operations but the thing that has been niggling him in recent times has been the ulcer-like wound on his right foot.

Twice a week for the past eight weeks, RDNS HomeCare nurse Noel Kenzie has been visiting Garth treating his foot, cleaning the infected area of the sole, changing the dressings and making sure Garth is comfortable. Garth has one word for Noel – amazing.

Garth is one of Australia’s revered veterans.

In 1969 and 1970, initially based in Nui Dat, he was putting his life on the line, fighting the Viet Cong. It was a long time ago but the scars are very real and remain in the form of sad memories and nightmares.

Today Garth has his foot resting on the stool. Noel has set up a sterile field and he is washing out the wound with saline and looking closely for any deterioration.

He finds none. “You’re doing really well, Garth,” says Noel, reassuringly.

Garth’s house is nestled in the bush off a track just a short stroll through the white gums, wattles and iron barks from the cool waters of Lake Barrington. He lives with his

Garth is well pleased. “You know,” he says, “This foot was going nowhere. Then Noel came on the scene and he has turned my life around. Not only has he cleaned

For Garth, yesterday was the threat of bullets and booby traps. Today it is the beauty of nature at its best.

36 December 2014 / January 2015 Volume 22, No.6

Noel himself drives between 1,200 to 1,700 kilometres a fortnight on his nursing rounds. A devoted family man, father and grandfather, Noel is a latecomer to nursing.

Deciding on a career change after a life as a dairy farmer, security guard and bouncer, he enrolled at university and five years ago graduated as a registered nurse.

“It’s the only position I have had in 30 years of working where I love jumping out of bed every morning knowing I am going to look after my clients and work with the RDNS HomeCare team – and enjoy every minute.

“Garth is a great person who has fought for our country and I believe he deserves a lot of respect for that,” says Noel. “In a way I am lucky because I find I am able to communicate freely due to my interest in history and Garth’s experiences in life.

“I look forward to my visits with him because I have been able to assist him not only with his wound care but actually be someone that he can talk with about his problems. “For me that’s a great privilege.”

John Allin is a Melbourne journalist and media and communication specialist for RDNS

RDNS HomeCare provides home nursing and home support services (such as domestic assistance and personal care) in every state. It is also one of the largest providers of services to veterans across Australia. RDNS HomeCare is a subsidiary of RDNS which celebrates its 130th anniversary next year.

anmf.org.au

Focus – Rural / Remote Health

Advancing nursing and midwifery practice through strategic collaboration: The establishment of a rural clinical school

By Karen Francis, Margaret McLeod, Judith Anderson, Mary FitzGerald, Andrew Crowther, Angela Brown, Sharon Bourgeois, Maria Mackay and Antje Badger Cooma Hospital and Health Service, Charles Sturt University and the University of Wollongong have joined forces to establish a regional clinical school to advance nursing and midwifery clinical research and education. Wellarticulated governance structures and processes, reflecting the expectations of the three partnering organisations, have been key strategies in the formation of the new clinical entity.

This clinical school will provide opportunities for nurses and midwives to engage with their university partners to promote and advance knowledge through education. It will support the existing nursing and midwifery workforce through inquiry, leading to the generation of new knowledge and the translation of evidence for practice. The planned activities to be anmf.org.au

undertaken in a range of clinical areas will benefit the township of Cooma and neighbouring communities by improving health outcomes and securing a nursing and midwifery workforce that will be both responsive and futuristic.

Healthcare in rural contexts is reliant on a workforce that is generalist in orientation.

It must have the capacity to provide specialist care in a range of targeted areas, including but not limited to, primary care, emergency care, maternal and child health, mental health and chronic care. Rural health services, such as Cooma Hospital and Health Service, understand the diversity of the population they service. A history of agility has enabled rural healthcare providers to modify practices using creative options to meet current and projected needs. Adjunct appointments, visiting academic fellowships and collaborative professional development programs will be key activities to sustain this exciting collaborative venture.

Professor Karen Francis, RN, PhD, MHlth Sc, Nsg, MEd, Grad Cert Uni Teach/ Learn/BHlth Sc, Nsg, Dip Hlth Sc, Nsg

Associate Professor Margaret McLeod, PhD, MA (HSM), GradDip (MH), BA (SocWel), RM, RN Dr Judith Anderson, RN, PhD, MHSM, MHSci (NursEd), BN Professor Mary FitzGerald RN PhD Associate Professor Andrew Crowther, RN, RMN, CertEd, MA, PhD, RNT Associate Professor Angela Brown, RN, RM, MA Healthcare Ethics, PGDip Health Services Research and Technology Assessment, BSc Nursing, Cert Ed Professional Education, Dip Nursing, PhD Candidate Associate Professor Sharon Bourgeois, RN, PhD MEd, MA, BA, OT Cert Maria Mackay, RN, RM, MSc (Health Policy & Management), Grad Cert (Public Health), Paediatric Certificate, MN Research Candidate Antje Badger, RN/RM

December 2014 / January 2015 Volume 22, No.6 37

Focus – Rural / Remote Health

EXAMPLES OF COMMENTS RECEIVED FROM NURSES WORKSHOPS:

“EXCELLENT TOOL” (Mental Health Nurse, 5 years experience)

“BRIEF INTERVENTIONS CAN BE USEFUL ” (Midwife, 13 years experience)

“YOU CAN CHANGE” (Community Health Nurse, 28 years experience)

“HEART WARMING STORIES. LIKED THE FACT THAT ANY OPPORTUNITY TO INTERVENE IS GREAT.”

A practice nurse conducting a Brief Intervention with client ‘Ben’.

(Community Health Nurse, 15 years experience)

The alcohol, smoking and substance involvement screening test

By Jennifer Harland

and innovative way, nurses can conduct the ASSIST in their own practice and reduce the overall harms and effects of drugs and alcohol in the Australian community.

The misuse use of alcohol and other drugs can have devastating effects on an individual, their family and the wider community (UNODC, 2012). Screening for drug and alcohol use, combined with a targeted brief intervention has been shown to reduce drug and alcohol use and subsequent harm (Ali et al 2013).

Although there are screening tools available, nurses are reluctant to use them.

Research evidence shows that the main barriers to conducting screening and brief intervention is the time taken to administer the questionnaire and their confidence to ask a patient about drug and alcohol use (Humeniuk et al 2010).

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) with Substance was made by nurses, for nurses. The resource was developed by the DASSA-WHO Collaborative Centre, University of Adelaide and is a collaboration between health professionals from a range of academic and clinical backgrounds.

The resource is evidenced-based and is designed for use in undergraduate nursing programs (on line and face-to-face) and has been shown to be easily adapted to postgraduate programs and clinical settings. It aims to educate nurses, on how to implement the ASSIST and provide a targeted brief intervention for problematic substance use.

ASSIST with Substance highlights the anmf.org.au

benefits of screening and brief intervention in an innovative way and encourages nurses to include the ASSIST screening tool in their routine clinical practice. The DVD portrays three real life scenarios and additional information is provided in the accompanying manual. The application of the principles outlined in the package help nurses identify drug and alcohol issues early and help reduce the negative impact of drugs and alcohol on the individual, their family and the Australian community.

This resource aims to address the barriers raised by the nursing profession: time and confidence (Humeniuk et al 2010). Using ‘real life’ scenarios the DVD shows that in just 10-15 minutes a nurse can make a difference in a person’s life. For example, the characters portrayed in the DVD are ‘typical’ Australians who are unaware that their alcohol and/or drug use are causing themselves, their relationships and worklife harm. Conducting a drug and alcohol screen and providing a brief intervention on how to modify their behaviour at this early stage, decreases the risk of future harms.

By learning these key principles in a fun

ASSIST with Substance is currently being rolled-out across clinical settings, Australian tertiary institutions and internationally (Vietnamese version is available). It has been designed to be used for face-toface, flipped class room model and on line student forums. It has been included in postgraduate programs and clinical settings (ie. in-service sessions).

Since development, the product has been tested with a range of nurses and received positive feedback.

For details on obtaining a copy of the ASSIST with Substance Resource, contact greg.macpherson@ adelaide.edu.au References: Ali, R., Meena, S., Eastwood B., & Marsden, J. (2013) Ultra-rapid screening for substance-use disorders: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-Lite). Drug and Alcohol Dependence, 132, 352-361.

Humeniuk RE, Henry-Edwards S, Ali RL, Poznyak V and Monteiro M (2010). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): manual for use in primary care. Geneva, World Health Organization.

United Nations Office on Drug and Crime (2014). World Drug Report 2014. United Nations Office on Drugs and Crime. Available from www.unodc.org

Jennifer Harland is Clinical Practice Development Coordinator Mental Health, Justice Health, Alcohol and Drug Services ACT Health, Canberra

December 2014 / January 2015 Volume 22, No.6 39

Focus – Rural / Remote Health An innovative approach to nursing education: bridging the theory practice gap using simulated learning.

By Renee McGill, Judith Anderson and Karen Francis Nursing students on graduation must be competent and confident novice clinicians and experienced users of information and communication technologies. Further, it is expected that they are able to access, interpret and translate best available evidence when making practice decisions.

Ensuring graduates meet these expectations and are work ready is a challenge for nursing educationalists.

The use of simulation for effective learning experiences particularly for practicebased disciplines such as nursing is well documented and has been a feature of nursing programs for many decades. Charles Sturt University, a regional provider of

OUM’s innovative teaching style is fantastic and exciting.

Truly foreword thinking, OUM allows the student to benefit from both local and international resources.

Brandy Wehinger, RN OUM Class of 2015

nursing education has recently incorporated cutting edge simulation software, vSim© into the Bachelor of Nursing to complement traditional teaching methods and workplace learning experiences. This software was designed to augment student’s appreciation of the connection between theory and practice through the use of simulated authentic learning episodes. vSim© exposes students to learning materials in an applied interactive medium.

The software enables student engagement with virtual patients and facilitates reflection on performance utilising a detailed log of events and actions undertaken, or missed. Missed actions are highlighted and the system offers the user (student) immediate access to additional information to assist learning. The online computer animated avatar provides interactive responses to student initiated assessments or interventions with subsequent clinical alteration as a manifestation of user input.

The use of common clinical scenarios used in vSim© and also in mannequin based simulation sessions allows students to draw on and augment the knowledge gained from each learning episode. This process promotes awareness of the range of clinical cues that are indicative of alteration to health status, the relevance of this knowledge to assessment of patients and determining appropriate interventions. Moreover, the program supports the development of prioritisation and delegation skills, bolsters clinical confidence and competence and strengthens communication and teamwork

capability. The mannequin based simulation session integrates technology through the use of SimPad driven automated scenarios complemented by the new Australian version of the simulation software Docucare© as a supportive electronic health records system. Alterations to the mannequin monitor input that reflect changes to health status enable students to practice and refine assessment skills and clinical decision-making. Students are able to access patient data from the bedside electronic health records (EHR) including electronic diagnostic results such as biochemistry and chest x-rays to inform decision-making and are also able to contribute to the health record (eg. nursing notes, observations, assessments). vSim© mimics contemporary healthcare information systems while providing capacity for students to practice nursing in a safe and non-threatening learning environment that can be teacher led and/or student initiated. Initial feedback suggests that students value the program and believe it aids their learning.

Ms Renee McGill RN, Grad Cert CC, MN Dr Judith Anderson RN, PhD, MHSM, MHSci (NursEd), BN Professor Karen Francis RN. PhD, MHlth Sc, Nsg, MEd, Grad Cert Uni Teach/Learn/BHlth Sc, Nsg, Dip Hlth Sc, Nsg

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Focus – Rural / Remote Health Caring for those with Islamic beliefs

Internet changes young lives

Caring for a Muslim patient for some nurses and midwives can be a new and daunting experience because of the unfamiliar cultural and religious beliefs.

Mr Gulam explained that the consumption of pork and alcohol was strictly prohibited in Islamic faith, but again if it saved a life it could be consumed. “We as nurses know that some of our products have alcohol content and obviously some of the grafts that we use come from porcine, for example pancreas organ donation and the like, so if there is no other alternative those things are permissible.”

According to Mr Gulam another important element of the faith is cleanliness. Muslims, who pray five times a day, must cleanse fully before they commence prayer. This is to ensure they are in a complete state of ablation. “This is not exclusive to Islam but it helps nurses to understand that Muslim patients need to be in a state of cleanliness for most parts of the day,” Mr Gulam said.

To help demystify some of these barriers Muslim Australian nurse Hyder Gulam (pictured), spoke at the recent CRANAplus conference, themed diversity, about some key elements within the faith concerning healthcare providers.

Mr Gulam, a transcultural registered nurse and a qualified lawyer, said the best way for nurses or midwives to overcome any cultural challenges when treating Muslim patients was communication.

Mr Gulam also spoke of some of the cultural beliefs and how nurses and midwives should best address them.

For example the veil or head/face coverings called the hijab or niqab that Muslim women usually wear at all times was allowed to be removed in a healthcare setting when following Islam’s most important principle, which is the preservation of life.

The hijab or niqab can be taken off by female health professionals. However if a female carer is not available, and this is explained, then the patient will most likely comply and remove the scarf, Mr Gulam said. anmf.org.au

Mr Gulam also spoke about reversible contraception, which he said was not prohibited in Islam but discouraged. He said abortion was not permitted unless there was a threat to the mother, though adding there were no ‘absolutes’ as each circumstance warranted family discussion where a decision would be made on the course of action.

Muslim men were commonly circumcised based on Islamic ‘cultural beliefs’, Mr Gulam said. However, he warned female genital mutilation was not permitted. “It’s against the Australian Law and against Islamic Law, according to Muslim scholars.”

Mr Gulam said the month of fasting, known as Ramadan, would mean no eating or drinking from sunrise to sunset or sex, smoking, etc. for the observant. He said it was considered an important element of the faith where Muslim people would want to fast. “But if they [the patient] needed to take medicines then you would need to explain to them that there is no alternative and they will accept it. Injections and IVdrips are permissible.”

President of CRANAplus Janie Smith said knowing how to care for a Muslim patient was certainly part of the diversity of being remote. “The population out there is becoming very diverse and certainly we need to learn about how to care for a Muslim patient.”

Technology is making life easier for young children who have a hearing loss and live in remote and rural areas of Queensland, thanks to new online auditory tool.

The technology, known as e-auditoryverbal therapy and e-audiology and produced by Hear and Say, a paediatric auditory-verbal and implantable technology organisation, is an early intervention program that focuses on listening and spoken language for children aged from birth to six years of age.

Spokesperson for the organisation Michelle Ryan, who presented at the recent CRANAplus conference in Melbourne, said children with hearing loss who used the program can reach an average child’s hearing capability.

While the organisation has six centres across the state of Queensland where families are provided with face-to-face sessions, more than 60% of children who require the program live outside the Brisbane metropolitan area, making the internet technology ideal for people unable to reach a centre, Ms Ryan said.

According to Ms Ryan the program involves webcam sessions where the parent uses an online program such as Skype to plan a session with a practitioner.

The child then receives the program from his or her parent, who is guided by the therapist via the online teleconference. There is also regular contact with the parents via phone or email to ensure the development of the child’s hearing and spoken language. The duration of a session can be anywhere from 45 to 60 minutes in a quite space, said Ms Ryan. “In addition to the tele-practice sessions each term we provide a face-to-face session on home visits to regional areas where the families live or to centres where families can visit twice a year.”

December 2014 / January 2015 Volume 22, No.6 41

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Focus – Rural / Remote Health

Ante-natal services return to the Cape York Peninsula Ante-natal services are returning to Weipa on Cape York Peninsula after a 20 year absence.

According to Queensland’s Minister for Health Lawrence Springborg birthing will recommence by 2016. “As part of the process, Torres and Cape Hospital and Health Service (HHS) will consult with communities in the region.”

The service will be developed as a midwifery group practice for ‘low-risk’ local mothers. Currently, each year 180 women travel from these regions to have their babies elsewhere.

“The Torres and Cape HHS estimates about 60 of these women will meet the low-risk criteria to be able to deliver their babies safely through the new Weipa birthing service. This means they will not need to travel outside the region to have their babies,” Mr Springborg said.

According to Mr Springborg additional midwives, doctors, nurses, and healthcare workers will be recruited to deliver the proposed new Weipa birthing service.

Birthing services at Weipa Integrated Health Service ended in the mid-1990’s due to problems obtaining access to doctors to deliver babies via emergency caesarean section. anmf.org.au

Tackling oral health issues in remote and rural areas Nurses and midwives are being urged to undertake oral health training in rural and remote areas of Australia to help tackle oral health disease in children.

Recently speaking at the CRANAplus conference in Melbourne Nurse Manager Margaret Dawson from the Royal Flying Doctor Service (RFDS) in Queensland said dental caries [tooth decay] is a widespread disease among Aboriginal communities and the single most common chronic disease of childhood.

According to Ms Dawson, the Australian Institute of Health and Welfare conducted a child dental health survey in 2005, which revealed Aboriginal children have twice the dental decay compared to non-Indigenous children.

Several studies showed that fluoride varnish proved to be highly effective in strengthening tooth enamel as well as areas of enamel beginning to show signs of decay in both primary and secondary teeth, Ms Dawson said. “Research by the Menzies School of Health Research, 2006-2008, has shown that the six monthly application of fluoride varnish to the teeth of children aged from 18 months translated to a 25-45% reduction in the decay rate.”

She said the training of healthcare providers, including nurses and midwives, would develop their skills and knowledge to apply fluoride varnish to

children in rural and remote areas and will see a reduction in loss of teeth and dental caries.

The shortage of oral health trained healthcare workers prompted RFDS to partner with the NT Oral Health services to access their training and education packages to educate Queensland primary healthcare nurses and non-dental health professionals, Ms Dawson said.

However exemptions needed to be made to legislative and regulatory requirements for non-dental health professionals to undertake the procedure.

“It’s a major loss [if the legislation doesn’t go through] because we don’t have the facilities out there now; it’s a two or three year waiting list for kids to get oral treatment,” Ms Dawson said.

Ms Dawson said that the challenges were not ‘insurmountable’. “But it’s a big if, because they can quite easily turn around and say this is a dentist only, an oral health practitioner only practice.”

Ms Dawson has urged interested healthcare workers to watch this space for further developments, which she anticipated would be in early 2015.

December 2014 / January 2015 Volume 22, No.6 43

We know you are a caring and nurturing person and great with people, so have you ever considered a career as a Marriage Celebrant?

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URSING LIAN N 3 AUSTRA 22, NO. VOLUME 2014 SEPTEMBER

AL JOURN W I F E RY & MID 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. 5 AUSTRALI AN VOLUME 22, N U R S I N G & M I D W I F E RY J O NO. 4 URNAL N OV E M B E R 2 014

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Focus – Rural / Remote Health Making a difference is satisfying To be a remote midwife you need to be jack of all trades says Dinah Northcott.

Dinah, who works in the Ngaanyatjarra Lands Western Australia, has been a midwife for 18 years. She has worked in several countries such as Canada, Bermuda and the Middle East as well as New Zealand, where she was born.

Dinah said she loved her job but faced some difficult challenges on a daily basis.

“The biggest challenge is the travel. It’s very tiring because it is all dirt roads, it’s very hot and it can be 43 degrees. Flat tyres are very common so you have to carry two spare tyres at all times. The danger is the roads and that’s the concern because I could drive for five to six hours a day.”

Dinah’s other greatest challenge is to locate

the pregnant women. “Indigenous women are very transient, one day they will be in one community and the next day they will be somewhere else. So for example I could drive for four hours to a town to find out that my client is in a different town in the opposite direction.“But that’s fine, it’s part of my job.”

Dinah, works for an Aboriginal NGO and looks after Indigenous pregnant women in 11 communities with a population of a thousand people. She travels to eight communities in a four wheel drive with her dog, portable ultrasound machine, water, lunch and medical supplies.

In addition to midwifery care Dinah provides education to women about contraception, and assists them with other health related issues, which she said is not common for a city midwife to do. “I work under the umbrella of a doctor who is not always there, so I have a manual and from that I can give advice and treat different things. But if I’m worried I call the doctor.”

Dinah’s previous experiences has made

Gender dysphoria and sexual orientation issues need addressing in remote Australia Australia’s rural and remote health practitioners must be armed with information to help reduce risk of mental health problems in individuals with issues of gender dysphoria and sexual orientation, according to Australia’s Human Rights Commissioner Tim Wilson.

Speaking at the CRANAplus conference in Melbourne recently, Mr Wilson said lack of specialist services for individuals who identify as lesbian, gay, bi, trans or intersex (LGBTI) in remote and rural areas were often the catalyst for them to move to the cities.

Mr Wilson said it was important health practitioners who were approached by families with a teenager who identified as LGBTI for advice had the right information to help them. “If an individual speaks to their health practitioner about gender dysphoria or would like to go through a gender affirmation surgery, too often we are told that the simple answer is that people don’t know what to say or where to refer people, and this is in the cities let alone in rural and remote areas.”

Mr Wilson said it was important to address this issue as each year many children were listed to undergo some form of gender affirmation surgery. “This is a huge systemic challenge in our society. I think it anmf.org.au

is a direct consequence of when you slowly and progressively remove social stigma from society.”

working in the Indigenous community a lot easier in terms of cultural sensitivities.

“I take my cues from people I treat for example pregnancy is called secret women’s business, so it’s not something that you would talk about. Even though they are pregnant they call it waiting.”

Dinah said even if she did not know how to deal with a situation the Indigenous women were very helpful and would inform her about what is appropriate and what was not. “They would tell me not to go somewhere that day as there is men’s business there. Or don’t do that, so the women are quite good to work with. And so far I don’t think I have offended anybody.”

Regardless, Dinah enjoys being autonomous and feels satisfied when she has developed relationships with the Aboriginal women. “I have been here for a few years now, which makes a huge difference. They all know who I am and the older women come to me and anything to do with women’s business I’m your girl.”

CRANAplus’ President Janie Smith echoed Mr Wilson’s words saying gender diversity was not spoken about in rural and remote areas of Australia despite more than 10% of the community being gay or lesbian.

Ms Smith added that there were very little resources going into that area and that employees were insufficiently educated about the issue. “People in the LGBTI community are 14 times more likely to suicide because they are not accepted in these rural and remote communities.”

Consequently Mr Wilson has been travelling to remote areas of Australia raising awareness on this issue and asking communities to engage in a survey that would address the challenges for people who identify as LGBTI. “We need to have a good understanding of where those issues exist and what support teams are available to tackle these issues,” he said.

Meanwhile Western Australia’s Mental Health Minister Helen Morton announced $600,000 of One Life Suicide Prevention small grants for community groups to run suicide prevention initiatives, including specific training for the LGBTI community.

The ‘Opening Closets’ training helps organisations to help LGBTI community members who may be at risk of suicide.

“We know that people with mental illness and a previous suicide attempt are more likely to die by suicide. People who are socially isolated or experiencing disadvantage, including Aboriginal people, young people, people who are alcohol and other drug dependent, LGBTI communities and older people are vulnerable,“ Ms Morton said.

In addition Mr Wilson said visibility of a diverse sexual orientation culture would also help reduce stigma and improve individual’s mental health.

For more information on the issues confronting people in rural and remote areas of Australia, go to: Humanrights.gov.au/rights2014

Mr Wilson, the first human rights commissioner to focus on sexual orientation and gender identity, said the stigma attached to LGBTI issues was a lived community experience which needed to be tackled through education and awareness.

December 2014 / January 2015 Volume 22, No.6 45

Calendar FEBRUARY 2nd Flinders Centre for Innovation in Cancer Survivorship Conference Life after Cancer – from Recovery to Resilience 6-7 February 2015 Adelaide Convention Centre, South Australia. www.survivorship2015.org/ Inaugural International Conference on Migration, Social Disadvantage and Health Toward developing national and international priorities for migration, health and social wellbeing 11–13 February 2015 Rydges on Swanston, Melbourne. http://www.international-migrationconference2015.net.au/ Lung Health Promotion Centre at The Alfred 12-13 February 2015 Spirometry Principles & Practice Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au 4th Biennial Nephrology Educators Network Symposium Leading the charge for change 16-17 February 2015 Rydges - World Square, Sydney, New South Wales. www.nen.org.au/symposium-2015/ TheMHS Summer Forum Men’s Mental Health: Building a Healthier Future 19-20 February 2015 Northside Conference Centre, Crows Nest, NSW. www.themhs.org

MARCH Lung Health Promotion Centre at The Alfred 4-6 March 2015 Asthma Educator’s Course 19-20 March 2015 Smoking Cessation Course Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au Diabetes study day with Kathy Mills, RN, MEd, Dip Business, Credentialled Diabetes Educator.

This study day for enrolled and registered nurses covers contemporary and evidence based research on dietary, exercise, psychological and pharmacological management of diabetes mellitus.

6 March 2015 from 9am-4pm Inner East Melbourne Medicare Local, 6 Lakeside Drive, Burwood East. Free parking. Morning tea, lunch and notes are provided. This study day is eligible for 6 hours professional education. Early bird special (pay by 20 February, 2015) is $220. Full registration fee: $250.

All queries to Kathy via email only at diabetes.ed@optusnet.com.au 19th National Otorhinolaryngology Head & Neck Nurses meeting and ASHONS 65th scientific meeting Excellence and innovation 7-9 March 2015 Australian Technology Park, Sydney NSW. www.ohnng.com.au/ national_conference.html International Women’s Day 8 March 2015 www.unwomen.org/ Florence Nightingale Foundation Annual Conference 12-13 March 2015 Queen Elizabeth II Conference Centre, London www.fnfalumni.org/event-1717850 Australasian Cardiovascular Nursing College 9th Annual Conference 13-14 March 2015 Crowne Plaza, Coogee, Sydney. www.acnc.net.au ATSA Independent Living Expo 7 May 2015 – Brisbane 13-14 May 2015 – Sydney Free to attend clinical program and expo offering assistive technology, mobility solutions, pressure care, employment support, accessible recreation/holiday ideas, modified motor vehicles and lifestyle choices. www.atsaIindependentlivingexpo. com.au ACMHN 8th Primary Mental Health Care Conference Primary mental health care in the digital age 13-14 March 2015 Canberra ACT. www.acmhn.org/ news-events/conference-news/ pmhc-conf-2015 Australian Pain Society 35th Annual Scientific Meeting Managing Pain: from Mechanism to Policy 15-18 March 2015 Brisbane Convention Centre, Qld. www.dcconferences.com.au/ aps2015 Sustainable Healthcare Transformation International Conference on Health System Innovation 18-20 March 2015 Hotel Grand Chancellor, Hobart. www.healthcaretransformation. com.au/ World Down Syndrome Day 21 March 2015 www.worlddownsyndromeday.org

46 December 2014 / January 2015 Volume 22, No.6

12th Annual World Healthçare Congress Connecting and preparing leaders for healthcare transformation 22-25 March 2015 Marriott Wardman Part Hotel, Washington DC, USA. www.worldcongress.com/events/ HR15000/ 6th World Congress on Women’s Mental Health Trauma, depression, resilience 22-25 March 2015 Keio Plaza Hotel Tokyo, Japan. www.congre.co.jp/iawmh2015/ contents/congress.html World Tuberculosis Day (WHO) 24 March 2015 www.stoptb.org/events/world_tb_day 4th Annual eMedication Management Conference 26-27 March 2015 Swisshotel Sydney. www.informa.com.au/conferences/ health-care-conference/electronicmedication-management

APRIL World Health Day (WHO) 7 April 2015 www.who.int/world-health-day/en/ 6th Biennial Conference of the Maternal, Child & Family Health Nurses Australia Our voice our future 9-11 April 2015 The Crown, Perth Western Australia http://www.aamcfhn.org.au/ Lung Health Promotion Centre at The Alfred 16–17 April 2015 Managing COPD 20-21 April 2015 Spirometry Principles & Practice 29 April– May/27–28 May 2015 Respiratory Course (Mod A &B) 29 April–1 May 2015 Respiratory Course (Module A) Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

MAY Lung Health Promotion Centre at The Alfred 27–28 May 2015 Respiratory Course (Module B) 7 May 2015 Respiratory Update Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

NETWORK Past Ashford Community Hospital employees from Betty Lockwood DON era staff from 1978 to 1988 18 January 2015, 2 to 6pm Highway Inn Anzac Highway.

Contact Ellen Sabey E: sabey123@adam.com.au M: 0430 738 035 Adelaide Children’s Hospital, Group 175, 40-year reunion 8 February 2015 at 12md Venue to be advised.

Contact Wendy Norris (nee Hornabrook) if you were part of our group or know the whereabouts of some of the 44 nurses who began training in Feb 1975.

E: wwnorris56@gmail.com or search for ACH 175 on facebook and message St John’s Hospital Hobart, All Trainees Reunion 8 February 2015 Site 9 Waterworks Reserve, 11am-4pm. Contact Alison Salisbury (PTS 1985) M: 0401 589 299 E: Salisbury.ac@gmail.com Memorial Hospital North Adelaide reunion for those who worked there between 1974 to 1978 14 February 2015 Venue TBA. Contact Helen Hookings (nee Murchland) E: hookings@ozemail.com.au M: 0427 833 725 or Jan Huckel E: janh55@bigpond. com M: 0458 253 427 or E: memorial_reunion74@ ozemail.com.au Alfred Hospital Melbourne, Group 2/75 40-year reunion 13 June 2015 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

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

anmf.org.au

Books The Dark Side of Nursing

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Her book gives practical and strategic techniques to help young families get ‘more in sync’ with their baby’s needs. An easy-to-read book, it tells real-life stories with advice on how to deal with feelings of anxiety and depression. And it answers questions about reflux and allergies, allowing the parent to enjoy life with their new-born.

The book sights expert literature to explore the behaviours and motivations of the bully and suggests approaches for dealing with the problem. She also discusses changes to legislation that would counter the crime of bullying and present options for education and reform.

Transforming Education and Improving Outcomes

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Reflective Practice

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An Outback Nurse is a true story of a young woman who did exactly that and moved to the outback in 1957.

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The first 16-weeks of a baby’s life can be a challenging time for the parents. Nightly waking, feeding, changing the nappy - and the baby still crying - can push any person into an anxiety attack. A quick fix attempt, like medications or sleep training, might even make the situation worse.

Bullying has generally been associated with teens and school-grounds. However, this could not be further from the truth. Complaints of workplace bullying have been around for decades, especially in the health sector. In The Dark Side of Nursing, author Ingrid Teresa Pryde shares her experiences of being bullied and defines the ‘crime of bullying in all its forms’.

By Thea Hayes

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By Gwen D. Sherwood and Sara Horton-Deutsch Publisher: Sigma Theta Tau International Honor Society of Nursing ISBN: 978-1-9354-7679-5 Nursing is a challenging and demanding occupation, where a nurse is expected to deal with highly stressful situations on a daily basis. Reflective Practice: Transforming Education and Improving Outcomes is a strategic book that helps a nurse develop key skills to deal with complex patients and the human impact of dealing with life, death and loss.

It provides a systematic tool that can help make sense of issues and events and change future actions and responses. It shows that reflective practice also improves patient outcomes by reducing errors.

The authors provide a dynamic resource for nurse educators in academic and clinical settings and nurses, who want to develop leadership skills and advance in their careers.

December 2014 / January 2015 Volume 22, No.6 47

Sally THERE HAS BEEN AN 11% DECREASE IN FAMILY OWNED FARMS IN THE PAST FIVE YEARS AgForce is an industrial organisation currently running a campaign Every Family Needs a Farmer aimed at developing urban consumers’ awareness about the role of farming and farmers. There is a plethora of information on their website including: From our Paddock to Yours webinars, practical links such as drought assistance and public education programs.

Sally-Anne Jones Federal Vice President I recently attended the Brisbane Exhibition – affectionately known by locals as the EKKA, with my family. It is one time each year where city slickers like me get to connect with the people and produce that we take for granted in our well-stocked supermarkets every day. The pride of the farmer whose cattle are stalled for show can be felt, and the quiet dignity with which he cares for and prepares his animals is humbling.

After the hectic jostling through the many displays of produce, flowers, cooking, animals (domestic and farm), clothing, food and artwork, we took our seats to get ready for the fireworks. A short community announcement came on that conveyed the plight of our Aussie primary producers – ravaged by extremes in climate sustained over years, the story of the uncertainty of their futures accompanied by images of livestock starving in the field and dying of thirst beside dry dams as well as crops burned to dirt and washed away by flood.

It was a brutal wakeup call for me to their reality that ended with an appeal for the Buy a Bale campaign that is underway across Australia. Aussie farmers everywhere are doing it tough. I wanted to know more, and do something to help so I am sharing with you some of the facts I found, and websites I visited where you can volunteer or donate to Australians who work the land.

Of interest to nurses and midwives The Healthy Farmer Program is designed to raise awareness of preventative health and wellness in farmers across Australia, who face a combination of physical and mental health challenges including an ageing workforce, access to care in rural and remote areas, and increasing mental health issues and suicide.

The Paddock is Aussie Farmers Direct’s official blog that has some farm facts listed.

Did you know that Australian Farmers export earnings are expected to decrease by $1.2 billion during 2014-15; that there has been an 11% decrease in family owned farms in the past five years and there was a 25% decrease in the average farm cash income during 2010-13?

The Australian Bureau of Statistics states in 2009, Australian farms produced 93% of the total volume of food consumed in Australia. After catering for the needs of the Australian population, 60% of Australia’s farm produce was exported, helping feed approximately 40 million people outside Australia each day. In 2011, there were 157,000 farmers in Australia. Evidence suggests events such as major droughts have a big impact on the farming workforce - not only a decline in the number of families living and working on farms, but there is an impact on their physical and mental health and wellbeing. With no significant rainfall for the past two years in more than 70% of Queensland and 62% of New South Wales, farm incomes have been considerably impacted and farming families are struggling. Furthermore, the suicide rate among farmers in drought-stricken Australia has risen to an all-time high.

Some of you who are living and working in farming communities may be all too aware

48 December 2014 / January 2015 Volume 22, No.6

of these issues, but for those of us who don’t…what can we do?

One of the first things is to contribute to the Buy a Bale campaign. The Buy a Bale Fundraising campaign has been developed and is run by The Give Back Campaign on behalf of Frontier Services who are a fully registered charity and have DGR (Deductible Gift Recipient) status.

As drought continues to ravage 80% of Queensland and almost 50% of New South Wales, Buy a Bale continues to deliver hay to much needed farmers with over 50,000 bales being delivered in just the last five months to over 420 farmers.

You can also check out Aussie Helpers website. Brian and Nerida Egan established Aussie Helpers on 21 May 2002 to help fight poverty and lift the spirits of those severely affected by drought in the outback. Brian and Nerida lost their own farm through hard times and saw a need to support similarly affected people. Aussie Helpers work around three words “care, share and respect” and is not aligned with any other charity or religious association, relying on volunteers to make a real difference to lives of real people. Brian was nominated for Australian of the Year in 2014. Aussie Helpers launched a Buy a Bale campaign in mid-2013 and links to this are available on their website.

By taking a moment to think about those who grow and raise the food we eat, their vulnerabilities and the impact of the environment on their work, lives and health we pay tribute to their contribution to the Australian way of life. We can be proactive in supporting the farmers, families and communities in agricultural Australia by buying Australian, linking to the sites below to donate or volunteer and helping out where we can.

References: http://blog.aussiefarmers.com.au/2014/06/03/aussie-farming-statistics-infographic/ www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.

0Main+Features10Dec+2012

Useful links: www.agforceqld.org.au/index. php?page_id=153 www.buyabale.com.au/aboutfrontier-services http://aussiehelpers.org.au/ about/

anmf.org.au

First State Super

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Call 1300 650 873 or visit firststatesuper.com.au Consider our product disclosure statement before making a decision about First State Super. Call us or visit our website for a copy.

FSS Trustee Corporation ABN 11 118 202 672 ASFL 293340 is the trustee of the First State Superannuation Scheme ABN 53 226 460 365.

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Caring for the people who care

2014 winners, left to right: Outstanding Graduate: Zoe Sabri, Nurse of the Year: Stephen Brown, and Team Innovation: Prof Jeanine Young representing the Pepi-pod® Program.

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