ANMJ February 2014

Australian Nursing & Midwifery Journal Volume 21, No. 7.

February 2014

Nurses feel the heat www.anmf.org.au

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

Editorial Lee Thomas, AnMf Federal Secretary Welcome back to the first issue of the ANMJ for the year. I trust you were able to enjoy at least some of the break with family and loved ones.

2014 promises to be yet another big year for the ANMF. While we anticipate many challenges and achievements along the way, one of the greatest contests for the ANMF, and the union movement in general, will be the federal government’s national review on the productivity of Australian workers. The aim of this investigation will be to flag national productivity and competitiveness, including a review of the role and regulation of trade unions and employee entitlements such as penalty rates and workplace laws. The potential ramifications of the review on working conditions and wages for over 300,000 nurses, midwives and carers is of serious concern. And while there is no denying productivity and growth is essential for the prosperity of all Australians, to blatantly target workers, unions and industrial laws, is clearly not the solution.

The ANMF will be strongly advocating and raising awareness for the protection and fair treatment of our members and their families throughout the review. We will keep you informed as more comes to light. I urge you to read Senior Industrial Officer Nick Blake’s column on the issue which highlights the key points.

After living through one of the hottest years on record, and as we head into one of the hottest months, our feature on climate change and the impact it has on health care and our professions is a timely reminder that natural disasters are fast becoming a regular occurrence, especially at this time of the year.

our country. What is clearly evident is the significant role nurses and midwives play in the community dealing and preparing for extreme weather events and natural disasters when they occur. Also apparent is the need for more education for our professions to address these events so as to adequately meet the challenges these changing circumstances create.

Given the opportunity the role nurses and midwives can play in taking action to prevent the environmental threats to public health, the ANMF (Victorian Branch) is running a health and sustainability conference next month which will look at health promotion initiatives and sustainable work practices. If you reside in Victoria I encourage you to attend.

Online registration and information is available at: http:/tiny.cc/14sustconf Also stay tuned for a new climate change education online module available through our CPD website in April. The education resource will give nurses and midwives an understanding of the fundamentals of climate change and examine ways that the health sector can further respond to the changes in our environment.

In our ever changing world our professions can play a leading role in taking action to make a real difference to the health of the community and our environment.

Fires, floods and cyclones along with heat waves and other catastrophic events are too regularly devastating communities and lives in every state of PAGE 1 February 2014 Volume 21, No. 7.

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

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

Melbourne & ANMJ

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

Federal Secretary Lee Thomas

Assistant Federal Secretary Yvonne Chaperon

Editorial

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

Advertising

The Media Company, Jana Gungor Phone (02) 9909 5800 Fax (02) 9909 5810 Email jana.gungor@themediaco.com.au

Australian Capital Territory

Branch Secretary Jenny Miragaya Office address Unit 3, 36 Botany Street, Phillip ACT 2606 Postal address PO Box 1995, Woden ACT 2606 Ph: (02) 6282 9455 Fax: (02) 6282 8447 E: anmfact@anmfact.org.au

Northern Territory

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

South Australia

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

Victoria

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

Design and production

Design: Origin of Image (Ooi) Pty Ltd Printing: AIW Printing Distribution: D&D Mailing Services 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 nuring index ISSN 2202-7114

Moving state? Transfer Your anMf membership New South Wales

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

PAGE 2

Queensland

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

Tasmania

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

Western Australia

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

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 94,687

Source: BCA verified audit, September 2013

Contents Volume 21, No. 7.

News 5 World

15

Industrial 17 Research 18

News

Page 5

Changes to Medicare

Wellbeing

Page 27

Tech Talk

19

Feature

20

Books 25 Working Life

Surviving night duty

26

Wellbeing 27 Clinical Update

28

Ethics 32 Clinical View

33

Focus 34 Calendar 46

Tech Talk “The Clouds are gathering...�

Feature

Nurses feel the heat

Page 19

Focus

Page 34

Mail 47 Yvonne 48

Aged care

Page 20

PAGE 3 February 2014 Volume 21, No. 7.

February

Everyday Medicine – Safety for all Nurses

Bendigo

3-4 Feb

1886

Nurse Practitioners – Medicines and Prescribing

Adelaide

3-4 Feb

1888

Rashes, Fevers and Infectious Diseases

Melbourne

6-7 Feb

1791

Trauma and Emergency Nursing

Adelaide

10-11 Feb

1763

Personality Disorders in the Workplace

Melbourne

10-11 Feb

1896

Nurses as Leaders – Empower Your Team

Melbourne

13-14 Feb

1879

Acting and Associate Nurse Unit Managers – ANUMs

Adelaide

13-14 Feb

1811

Clinical Nursing Assessment

Adelaide

17-18 Feb

1861

Nursing People with Multiple Chronic Diseases 55+

Melbourne

17-18 Feb

1864

Trauma and Emergency Nursing

Melbourne

20-21 Feb

1764

Advanced Palliative Care Nursing

Adelaide

24-25 Feb

1819

Diabetes – Nursing Management

Melbourne

27-28 Feb

1868

March

CPD

Each seminar/conference earns 10 – 12 hrs of CPD

Teenagers and Risky Behaviours

Melbourne

3-4 Mar

1838

Wound Management and Skin Integrity

Adelaide

3-4 Mar

1910

Warrnambool Nurses’ Conference

Warrnambool

6-7 Mar

1914

General Surgical and Orthopaedic Nursing

Melbourne

13-14 Mar

1915

Wound Management and Skin Integrity

Melbourne

17-18 Mar

1911

Aged Care Clinical Nursing Skills

Melbourne

20-21 Mar

1851

Enrolled Nurses’ Conference

Adelaide

24-25 Mar

1900

Enrolled Nurses’ Conference

Melbourne

27-28 Mar

1852

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News Professions rally against changes to Medicare

Nurses at Sydney rally

Nurses and midwives across the country joined rallies in force against the Abbott government’s considered introduction of a $6 fee for every GP visit.

Rallies held in Perth, Sydney and Melbourne saw nurses and midwives marching and waving flags to highlight their disapproval of the proposed scheme.

Australian Nursing & Midwifery Federation (ANMF) Federal Secretary Lee Thomas said the introduction of the fee would be detrimental to the health care needs of many

Australians and therefore it was crucial the government retained bulk billing services.

“Any co-payments of the scheme would force more Australians, particularly low-income earners into lining up at overstretched hospital emergency departments.”

Ms Thomas said she appreciated that the co-payment plan was meant to save

money, but said it should not be at the expense of ordinary Australian families who were unable to afford the out of pocket costs associated with visiting a GP. “We believe it would simply shift the cost burden on to Australia’s public health system, because many people would head to the hospital ED to get a check for routine or relatively minor ailments rather than paying rising upfront fees to see the local doctor.”

Acting General Secretary of the NSW Nurses and Midwives’ Association (NSWNMA) Judith Kiejda said that for decades Medicare had been a sacrosanct above politics. “The idea that all Australians can see a doctor to get medical attention whenever they need to is cherished by almost all of us. Wage and salary earners pay the Medicare levy to make that possible so anyone can get treatment whether they are rich or poor. Money should never be a barrier to medical care in Australia.” Addressing the crowds on the steps of Parliament House at the Melbourne rally, ANMF (Vic Branch) Acting Secretary Paul Gilbert said introducing the $6 fee would pave the way for further upfront costs in the future. “This $6 fee is just a thin edge of the wedge, make no mistake about it.”

More rallies against the changes to Medicare are planned in Sydney and Adelaide this month.

Evolving, expanding and consolidating the enrolled nurse scope of practice

By June Cox and Sean Prendergast The Repatriation General Hospital (RGH) in Adelaide has recently implemented and evaluated an education initiative designed to assist both enrolled and registered nurses as well as nursing leaders to better understand the full scope of practice of the enrolled nurse, and to confidently apply this knowledge to their practice.

This initiative followed on from a recommendation from nursing research conducted at RGH in collaboration with Flinders University School of Nursing and Midwifery, which explored how the hospital’s enrolled nurse scope of practice could be more effectively utilised through cultural and system change.

The program consisted of a series of interactive workshops aimed at all nursing staff on practical problem solving related to scope of practice and included a range of clinical scenarios looking at scope of practice dilemmas and concerns.

An online education program was also developed to support the workshop activities.

Evaluation of the overall education initiative indicated a positive reaction from hospital nursing staff, however there were a few surprises and confirmation that there was still more work to do.

Enrolled nurse scope of practice is easily misunderstood and is commonly reduced to discussion about clinical tasks with many enrolled and registered nurses still requiring the security of check lists and exacting policy to instruct them in scope of practice issues.

Sean Prendergast and June Cox

ahead while less cluttered, still requires skill to navigate. Cultural and systems road blocks still prevent a clear route for contemporary enrolled nurse practice.

The good news is that we are nearly there.

We have travelled a long way on this journey which is not finished, and the path PAGE 5 February 2014 Volume 21, No. 7.

News More than just menopause Nurses need to understand women’s lives, ask questions about what their concerns are and know which services to refer them to, a recent women’s health conference in Melbourne has heard.

Professor Helen Keleher told the AusMed Women’s Health 45+ conference that health issues for women over the age of 45 were not just about menopause.

The health of women as they age is affected by the everyday environments in which they live and the health system to which they have access to, she said.

“We have to stand up and advocate for women to get the care and respect they need when they are most vulnerable, or at any time.”

Professor Keleher said nurses needed to be aware of the social determinants that impacted women’s health. “These are the conditions of daily life that affect health and wellbeing.”

This included financial security, reproductive and sexual health, partner violence, attitudes towards women and girls, caring and the care economy.

Professor Keleher said a disproportionate number of women were in lower paid jobs, had long periods of career interruption while raising children, returned to work in lower paid jobs and were more likely to be pushed into casual, insecure work. As a result, women retired with significantly less superannuation and a number of older women lived in poverty.

Women also made up the majority of carers, saving the economy $19.3 billion dollars are year, but at a very high personal cost. “Eighty three percent of caring is done by women, which has a big impact on their incomes,” said Professor Keleher.

Caring also had an impact on both mental and physical health. Research showed 25% of dementia carers experienced suicidal thoughts, while female carers were 23% more likely than the general population of women to have

Smokers in denial over health effects New figures show that one in ten smokers still do not believe that smoking causes illness, despite 50 years of public health warnings.

The Cancer Council Victoria research also found a quarter of Victorian smokers still believed the effects of smoking had been exaggerated, while only half of all smokers link smoking with lung cancer.

The Perceptions about Health effects of smoking and passive smoking among Victorian adults 2003–2011 report was released in January to mark the 50th anniversary of the first US Surgeon General report on smoking and health, which triggered the beginning of modern tobacco control.

Quit Victoria executive director Fiona Sharkie said it was a seminal moment in public health. “Back in the 1960s, more than half of all Australian men and almost a third of Australian women smoked. You could smoke in your office, in restaurants, in your car and tobacco commercials were all over TV; it was a way of life.

PAGE 6

“Within a few years, this landmark report prompted countries all over the world to take the first step towards reducing the devastating harms caused by tobacco.”

Smoking related illnesses cost Australia’s public health system $32 billion a year. “Smoking rates have halved since 1977 but tobacco is still the number one cause of preventative death and disease in Australia and kills 15,000 people every year,” said Ms Sharkie.

While the report showed many smokers were still in denial about the effects smoking had on their own health, awareness of the effects of second-hand smoke on children has increased. “Recognition that passive smoking causes harm to unborn babies and miscarriage was up from 34% in 2007 to 64% in 2011,” said Ms Sharkie.

Quit and the Cancer Council Victoria are calling for state and federal governments to make restricting the availability of tobacco the next major step in tobacco control.

depressive disorders. Professor Keleher said violence against women and girls was also increasing. “Violence inflicted upon women by their partners is more than the sum of alcohol, tobacco and obesity [for the burden of disease on women].”

Nurses needed to be aware of the issue and know what resources were available, said Professor Keleher. “If women do disclose [intimate partner violence] we should not dismiss it, nurses should know who to refer to.”

Professor Keleher said that women’s health services were an invaluable resource for nurses and for women in general. “Women’s health services should be your go to for information.”

News Eligible midwife accreditation standards under review Midwives are being urged to have their say on a review of eligible midwife accreditation standards.

The Australian Nursing and Midwifery Council (ANMAC) is seeking feedback as part of its review of the existing standards used to assess and accredit the programs of study required for an Eligible Midwife’s endorsement to prescribe scheduled medicines: 1. Nursing and Midwifery Board of Australia - Guidelines for Education Requirements for Recognition as Eligible Midwives and Accreditation Standards for Programs of Study Leading to Endorsement for Scheduled Medicines for Eligible Midwives.

2. ANMAC – Interim Standards for Accreditation of Professional Practice Review Programs.

The first standard is used to assess and accredit curriculum based education programs leading to an award, while the second standard is used to assess the process for midwifery peer review.

ANMAC said some of the key areas being considered include, who should be eligible as providers of professional practice review; is there an ongoing need for Qualified Privilege Legislation to be required by midwifery practice review; what should the provider be required to do regarding referral and support of midwives who are not performing well or have professional conduct issues; and should consumers be involved in the assessment of professional clinical practice.

The Australian Nursing & Midwifery Federation Federal Office (ANMF) is consulting with the state branches to develop a submission to ANMAC. “We hope that out of the review there will be consistency in programs around Australia and that it will open up opportunities for a number of providers to provide these programs,” said ANMF Senior Federal Professional Officer Julianne Bryce.

The consultation paper is on the ANMAC website and there is an online survey for providing feedback at: www.surveymonkey.com/s/V2XFSH6

Push for professional indemnity insurance for midwives The Nursing and Midwifery Board of Australia is pushing for professional indemnity insurance to be made available to privately practising midwives.

A research report looking at different insurance models has been published on the board’s website, along with its recommendations.

National Board Presiding Member Dr Lynette Cusack said the gap in cover for privately practising midwives needed to be addressed. “The National Board would like to see insurance cover accessible to midwives practicing in any setting across the continuum of care. This would boost positive outcomes for the woman, her infant and the midwife.”

Professional insurance products have not been available in Australia for intra-

Better access to medicines required

partum care provided by midwives in private practice who attend home births, since 2001.

The Australian Health Workforce Ministerial Council later introduced an insurance exemption for privately practising midwives if certain conditions were met. However, this exemption expires in June 2015.

The Nursing and Midwifery Board of Australia says it is keen to seek a more lasting and acceptable solution.

The research report it commissioned outlines different strategies for producing a commercially viable professional indemnity insurance that suits both the insurance market and privately practising midwives. “I encourage all midwives, and particularly privately practising midwives, to read the report and the National Board’s commentary on the recommendations,” said Dr Cusack.

People living in remote and rural areas have relatively poor access to medicines and pharmaceutical advice, a discussion paper from the National Rural Health Alliance has found.

According to the Alliance’s Chairperson Dr Tim Kelly the situation indicated an important health care deficit which has received insufficient attention. “The new paper demonstrates the extent to which people in Australia’s rural and remote areas have poorer access to prescribed and non-prescribed medicines, less advice about medicines and poorer access to professional pharmacy services.”

Dr Kelly said the issue could be resolved with simple and low-cost changes to programs and regulation. “As with so many other issues in the rural and remote health sector, there is a gradient of deficit as one moves from major cities through regional areas to remote and very remote places. Our discussion paper explores these issues and begins scoping for a project which could best advise Australian governments on the best way to improve the situations.”

The Alliance is calling for action on this issue and has proposed an investigation into the ways medication prescribing and dispensing legislation can be simplified as well as an evaluation of how pharmacy outposts and telepharmacy can allow more equitable access.

PAGE 7 February 2014 Volume 21, No. 7.

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News Cancer nurse first to benefit from treatment

Women may need different blood pressure treatment Hypertension may need to be treated more aggressively and earlier in women compared to men, according to a new research.

A study published in the Therapeutic Advances in Cardiovascular Disease looked at 100 men and women aged 53 and older with untreated high blood pressure. It found significant differences in the mechanisms that cause high blood pressure in women compared to men, with women suffering 30 to 40% more vascular disease for the same level of elevated blood pressure.

Heart Foundation’s Dr Robert Grenfell said the findings were interesting but more research was needed. “While the differences between high blood pressure in men and women are not yet fully understood, we do know that women are protected in their younger years by higher oestrogen levels.”

A Queensland nurse has become the first public cancer patient to receive radiation therapy on the Gold Coast.

A radiotherapy service has now been established at the new Gold Coast University Hospital (GCUH) through a partnership between Gold Coast Health and Radiation Oncology Queensland.

Gold Coast cancer nurse, Debbie Farrell, is the first patient to benefit from the $6million linear accelerators. Debbie began her career at Gold Coast Hospital as a graduate nurse in 1997. “One of the rotations I did was in the cancer ward and when I arrived there it felt like I had come home,” she said.

As a cancer nurse consultant at GCUH, Debbie has been closely involved in cancer care as a practising nurse, a fundraiser and an educator throughout her career.

She is now experiencing cancer care as a patient having been diagnosed with early stage breast cancer in November last year, following a routine mammogram.

“I consider myself very fortunate. My cancer was detected early and I underwent my surgery at the Robina Hospital soon after diagnosis,” Ms Farrell said.

“With the commencement of public radiation therapy, I can receive my daily treatment at GCUH and continue working.

There is no longer a need for patients like me to travel to Brisbane,” she said.

Cancer Council Queensland has also welcomed the commencement of services on the Gold Coast. “It will make cancer treatment more affordable for local patients and help to reduce waiting list times for radiotherapy treatment across the state,” said spokeswoman Katie Clift.

More than 3,200 people are diagnosed with cancer each year in the Gold Coast region.

Dr Grenfell said the Heart Foundation was funding Australian research to look at how the sex genes influence the development of high blood pressure.

The latest ABS Australian Health Survey figures show 4.6 million adult Australians have high blood pressure but only 1.46 million of these people have their blood pressure under control.

Dr Grenfell said high blood pressure was often called the silent killer because there are no obvious symptoms.

“The only way to find out if you have high blood pressure is to ask your GP for a regular check-up. Reducing the amount of salt people eat is the single biggest thing they can do to prevent high blood pressure in the first place.”

The Heart Foundation has launched a ‘Halt Hidden Salt’ campaign to pressure government and the food industry to make foods healthier. For more information go to: www.heartfoundation.org.au/ halthiddensalt

PAGE 9 February 2014 Volume 21, No. 7.

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News Ovarian cancer awareness

Each year around 1,300 Australian women are diagnosed with ovarian cancer. With survival rates around 20% it is imperative that woman are aware of the symptoms and have them checked out early by their GP, says research nurse specialist Julene Hallo.

Julene, who has worked at Melbourne’s Royal Women’s Hospital Oncology Unit in the area of ovarian cancer research for around 28 years, said there needed to be more awareness of the signs and symptoms of ovarian cancer so when women are diagnosed they can be treated early. “If people think they have symptoms they should get it checked out by a GP.” While it can be difficult to diagnose ovarian cancer, as many women will only have symptoms from time to time, there are four types of symptoms most frequently reported which include, abdominal or pelvic pain, increased abdominal size or persistent abdominal bloating, the need to urinate often or urgently and feeling full after eating a small amount.

Ovarian cancer is the ninth most common cancer in women and is most common in women over 50.

But despite the cancer being less common than breast or bowel cancer, it can be very deadly with only 20% survival rates, Julene said. “I think that’s the saddest part about it.”

As yet there is no screening test for the cancer, but more gene work is being done to identify the cancer, Julene said. “There are also new trials where we are giving a new drug to stop the cancer coming back too soon [if they are in remission].”

Additionally, women diagnosed with the cancer are having a better quality of life than in previous years, Julene said. “There are a lot more trials and the quality of chemotherapy is much better now than in the early 80’s.

Women are living longer and in some ways

they have a better quality of life. Things are picking up, but 80% are still not surviving.”

Julene said what was needed was more research. “We need to do more research because it’s the only way we are ever going to find a cure for all cancers.”

February is Ovarian Cancer Awareness month to raise awareness of ovarian cancer and to recognise women, their family and friends affected by ovarian cancer. To find out more about it go to: www.ovariancancer.net.au

Midwifery services slashed in Queensland About 80 midwives have signed a letter calling for an urgent meeting with the Queensland Health Minister over the decision to slash community midwifery services in the city of Logan, south of Brisbane.

Eight community midwifery clinics are being abolished in the region. The Queensland Nurses’ Union (QNU) says 11.5 FTE midwifery positions will be axed and women in the Logan area are at risk of not accessing antenatal and postnatal care if it is only available in a hospital setting.

“A large proportion of the users of midwifery services in the Logan area are disadvantaged women from culturally and linguistically diverse backgrounds,” said QNU Acting Secretary Des Elder. “There is a very real potential that many Logan women will disengage from antenatal care due to restricted access of services, the increased cost of travel to Logan Hospital or limitations in accessing public transport, as well as the costs of GP visits and private practice midwives.”

The Health Department has said they are ‘minor service changes necessary to achieve required reform measures at Logan Hospital’ but the QNU rejects this. “There is nothing minor about abolishing an entire community midwifery service and the impact this has on mothers and their babies,” said Mr Elder. “A best practice approach would be to increase community midwifery led models which are relevant and appropriate to this community – not to abolish them.”

The QNU held a rally in protest against the move outside the office of local MP Michael Latter last year and has more action planned. More than 560 people have also signed a petition launched by the QNU calling on the government to reinstate these vital community services.

You can find the petition at: www.change.org/ en-AU/petitions/michael-latter-mp-john-grantmp-michael-pucci-mp-stop-newman-government-cuts-to-community-midwifery-in-logan PAGE 11 February 2014 Volume 21, No. 7.

News Snapshot on Australian deaths Younger Australians are more likely to be killed by external events such as transport accidents or suicide, while chronic disease is the biggest killer of older Australians.

A new report by the Australian Institute of Health and Welfare (AIHW) shows that leading causes of death vary substantially at different ages.

AIHW Deaths snapshot looks at the latest data on deaths in Australia including information on age at death, trends over time, causes of death and life expectancy. “Coronary heart disease was the most common underlying cause of death in Australia for people aged 45 and over,

followed by stroke, cancers, dementia and Alzheimer’s disease and respiratory conditions in 2011,” said AIHW spokeswoman Louise York.

world. Among OECD countries in 2011, Australia was ranked 6th for male life expectancy at birth and 7th for female life expectancy at birth.

Transport accidents were the leading cause of death for people aged 1-24 and suicide was the leading cause among people aged 25-44. Among infants, maternal perinatal and congenital conditions were responsible for the most deaths (76%).

The report showed deaths in children aged 0-4 have also dropped substantially over the past century. In 1907, more than a quarter of all deaths were children of this age compared to just 1% in 2012.

There were 147,098 deaths registered in Australia in 2012, with most occurring among people aged 75 or over, Ms York said. “In general, women outlived men.

The average age at death for men was 78.6%, compared to 84.6% for women.”

“This may be due to improved hygiene, sanitation and neonatal health care, increased community awareness of risk factors for child death, such as accidents, and the reduction of vaccine preventable diseases through universal immunisation programs,” said Ms York.

Australia has one of the highest life expectancies of any country in the

Body mass costs Health conditions linked to excess body mass are increasing hospital costs in Western Australia, a report released by the WA Department of Health has found.

The report, The cost of excess body mass to the acute hospital system in Western Australia, 2011, showed health conditions related to excess body weight

are costing public hospitals in that state more than $240 million a year or 5.4% of total hospital costs.

The study looked at emergency and inpatient expenditure for 18 health conditions which were known to be associated with excess body mass.

According to the report’s author Dr Ben Scalley, the three most costly impatient conditions attributed to body mass were

ischemic heart disease, ischemic stroke and type 2 diabetes mellitus.

The report highlighted some worrying trends, Dr Scalley said. “If current trends continue we can expect the cost of 2011 to have more than doubled by 2021, with projections predicting costs of $488.4 million (in constant price dollars). Our findings highlight the urgent need to develop policies and programs that address body mass in the Western Australian community.”

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PAGE 12

News Mental health consumers locked up Mental health groups say they have grave concerns about the Queensland government’s decision to lock up all people affected by mental illness who are inpatients of hospitals.

The government reportedly said the decision to lock all adult acute inpatients units was to ‘provide a safe environment’.

“It’s a fundamentally flawed decision and profoundly backward step for people with a mental illness in Queensland,” said SANE Australia CEO Jack Heath. “This decision is more likely to provoke frustration by forcing people to stay indoors.

Vulnerable people in need of care will be subjected to further stigmatisation and it’s even less likely they will seek help.”

“Rather than focusing on recovery and the treatment of illness, the Queensland

Government is treating those affected as though they were criminals,” says Mr Heath.

Blow to rural health education

SANE Australia said UK research found that mental health patients who are locked in acute psychiatric wards are significantly more likely to engage in selfharm and violence towards nursing staff than those who are not confined.

The closure of the Rural Health Education Foundation and Rural Health Channel has been described as a blow for people in remote areas.

“SANE Australia has been contacted by many Queenslanders affected by mental illness and their families, as well as health professionals, who all agree that this policy is counter-therapeutic and unjustified,” said Mr Heath.

The foundation began 22 years ago, initially producing a fortnightly health broadcast to over 650 sites and more recently via the free-to-air Rural Health TV Channel. Their live interactive broadcasts dealt with topics like dementia, men’s health, cancer and autism, with over 15,000 DVDs of its programs distributed in Australia each year.

The National Mental Health Commission has also raised concerns about the state government’s action, while the Australian College of Mental Health Nurses and the Royal Australian and New Zealand College of Psychiatrists said in a joint statement that it contradicts the universally accepted principle of ‘least restrictive care’.

The sky is the limit for WA nursing student “I flew with a pilot, flight nurse and often a doctor all over Western Australia, including Port Hedland, Esperance, Albany, Geraldton and Kalgoolie.”

The 20-year-old from Mandurah said she was able to gain valuable hands on experience. “I was able to take a role in assessing patients to see if they were in a condition to fly, participated in scans such as ECGs, looked after pain management and provided support for doctors and nurses.”

Third year nursing student Bianca Tassell’s long-term dream of working for the Royal Flying Doctor Service is one step closer, after completing her final practicum with the organisation.

The Murdoch University student said the experience was invaluable. “Working with the Flying Doctors was incredibly intense but also really awesome,” she said.

The Kulbardi Aboriginal Centre helped Bianca pursue her dream by covering the costs and her Perth accommodation.

“Without Kulbardi, I couldn’t have done it.

I was exhausted from travelling and the time requirements were difficult to manage from Mandurah.”

With her practicum and degree now complete, Bianca plans to spend the next six months working in aged care while applying for entry into a graduate program. All of which supports her longterm ambition. “It’s my dream to work for the Royal Flying Doctor Service, and I’m aware that a lot has to be put into making it happen, including working in a wide range of medical areas, including midwifery. I’ll need about 10 years, but I’m ready to put the hard work in.”

A decline in government contracted work has been blamed for the closure. “We are reluctant and very sad to make this difficult decision but it is the responsible one for the business as the reduction in government work means the Foundation in no longer financially viable,” said board chair Dr David Rosenthal.

“Health care practitioners tell us that accessing education remains difficult and costly for them and that closing the Foundation and the Channel will leave a gap, but we have no choice,” said CEO Helen Craig.

The National Rural Health Alliance said the closure is a major setback for wellbeing in more remote areas. “Despite the fiscal pressure we’re all aware of, Australia is still an affluent nation. We need to ask ourselves why it is that government and business cannot see their way to supporting effective measures for more remote areas to ensure they have fair access to information, including what’s needed for the support and development of professionals working in those areas,” said the Alliance’s chairperson Dr Tim Kelly.

The Foundation has been placed into voluntary liquidation and talks are underway with staff, contractors and suppliers to finalise the closure process.

PAGE 13 February 2014 Volume 21, No. 7.

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World Developing mental health services in Nepal

By Wendy Scott Last year I took three months long service leave and with my family went to Nepal to volunteer establishing a pilot tele-psychiatry service with the Clinical Director of the Nepalese Mental Health Service, Dr Sherchan.

worker, their family and friends from all over Australia joined us on the trip.

Together we examined what already existed, what processes were required and how a model could be developed that was both sustainable and transferable across the country. A proposal was written to present to the Minister for Health for his approval. This was granted and a twelve month trial begun, utilising Skype for mental health assessments in rural areas over the internet.

The group were also shown around the hospital, saw student nurses presenting their assignments to each other, talked with the service’s newly appointed social worker about his role, had a traditional Nepali game demonstrated by the nurse in charge, saw the ECT area and of course met the people who were our common ground - the people admitted for treatment and care.

After twelve months Dr Sherchan was not completely satisfied with its uptake so we decided to bring him to Australia so he could see how our tele-psychiatry services worked and there could be an exchange of mutual learning from each other.

To bring Dr Sherchan to Australia we organised a fundraiser trip to Nepal for mental health nurses and their families/ friends in October 2013. Four mental health nurses, one mental health social

The five clinicians amongst us visited the Lagankhel Mental Hospital. Dr Sherchan welcomed ‘the team’ with smiles and his gentle Nepalese charm. We were presented with the history, the present situation and the vision for mental health services in Nepal.

While symptoms of illnesses are the same the world over, the ability to almost ‘know’ the basics of why people were there without having a common language was comforting. Whether it was being able to offer a quiet smile to someone with downcast eyes who had dared to look up and see them shyly smile back, while their loved one saw it and then beams, or seeing someone bouncing loudly on their bed while family try to do the currently impossible and slow them down as we walked past. It

Nepalese mental health nurses

was both fascinating and an honour to be amongst those that both provided and received mental health care.

Following this trip I made headway into the Nursing Council in Nepal to initially offer one-off interactions with nursing students who are undertaking a mental health placement at the mental health hospital.

Dr Sherchan will be in Australia in May 2014 and we will be delivering his flight tickets on our next tour to Nepal at Easter, April 2014 for a week (which will require only three days annual leave for the Monday to Friday workers). All will have a fabulous holiday and also visit the Lagankhel Mental Hospital.

If anyone is interested in joining us for this fascinating insight into the country, the people and the mental health system you can find out more through: www.watticando.com.au

Competency checks for UK nurses and midwives UK nurses and midwives will face competency checks with the Nursing and Midwifery Council (NMC) every three years which may involve feedback from patients under a new code of conduct.

The process titled as ‘revalidation’ by the NMC aims to ensure nurses and midwives practise safely throughout their careers so as to protect patient safety.

The new measure comes in the wake of a public inquiry into the scandal at Mid–Staffordshire Hospital Foundation Trust, where hundreds died due to failings in care.

According to NMC’s Director of Continued Practice Dr Katerina Kolyva, revalidation was a robust way to ensure that nurses and midwives kept up their knowledge and skills up to date throughout their career.

“The public has an important role to play in shaping revalidation for the nurses and midwives who care for them and their families. We hope that revalidation will help the public feel confident that the people who care for them have demonstrated that their practice meets the professional standards we set on a continuous basis.”

Nurse-midwife leadership global institute program An advanced leadership program for nurses and midwives in senior or executive positions, run by the International Council of Nurses-Burdett trust, will be held 6-12 September 2014.

Nurses and midwives working in these positions from high, medium and low income countries across the world are invited to ap-

ply for the six day ICN-Burdett Nurses’ 2014 Global Nursing Leadership Institute residential program, until 15 February 2014.

Participants will have the opportunity to develop understanding of global health challenges, obtain insight into international leadership styles, and be exposed to and analyse global leadership activity. Partici-

pants will also develop knowledge and competencies that focus on professional and self-regulation and learn how to deal with increasingly complex ethical challenges.

More information about the institute program can be found at: www.icn.ch/

PAGE 15 February 2014 Volume 21, No. 7.

A CHIK Services event

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PAGE 16

Industrial Nick Blake, Senior Federal Industrial Officer

All roads lead to productivity – but at what cost?

The Australian government have made no secret of their desire to make 2014 the year to address Australia’s so called flagging national productivity and competitiveness.

Spurred on by business and parts of the media, the government has announced they will review national productivity by undertaking a range of inquiries mainly about how Australian workers, businesses and government departments can work more efficiently to produce more goods and services from the same level of inputs.

The government announced the parts of the economy to be reviewed in 2014 and so far they include: 1. A root and branch review of the Fair Work Act; 2. Penalty rates; 3. The role and the regulation of trade unions; 4. Industry superannuation funds; and 5. The need to increase labour mobility.

maintained that wages and working conditions were the most pressing problem in the sector and needed to be resolved.

However these calls fell on deaf ears at the Productivity Commission.

Unfortunately this was no surprise to those who deal with the Commission. For some time now there has been a consistency or sameness about the reports and recommendations coming from the Commission.

In fact you can now pretty well guess the content of a Commission report; If it’s an issue about regulation – propose deregulation, If it’s a government service – recommend privatisation, If it’s about government service delivery – give consumers vouchers.

And so on.

In fact you could say that working with the Productivity Commission is a bit like going to buy a pair of shoes and to be told you can have any pair you like as long as they are brown and size 10!

And while the government says this is to be a wide-ranging review, it does appear that the focus of the reviews is to be on workers, workplace laws, employee entitlements and the regulation of trade unions.

Most people in the community accept that productivity growth is important.

It’s one way we get rising living standards and sustainable prosperity and, if the benefits of productivity growth are shared, we can all receive a benefit.

So while you may have been of the view that you and your colleagues have been working hard and efficiently, delivering good services for a fair wage and conditions, you may be at odds with your government. Silly you!

However the targeting of workers, unions and industrial laws is of significant concern.

It suggests that the new federal government remains fixated on these issues and continues to have an industrial relations axe to grind. If so this is disappointing.

The agency to be responsible for these reviews is the Productivity Commission which is a government review and advisory body on microeconomic policy, regulation and a range of social and environmental issues.

For most mainstream observers industrial relations laws and labour costs are not the cause of productivity problems and they are not the solution. The Work Choices laws didn’t fix the problem and the Fair Work Act has not made it worse.

Since its beginning in 1998 the Commission has undertaken reviews of most parts of our economy. You may recall that in 2009 the Commission held an inquiry into the residential aged care sector and recommended new regulations and funding changes for almost everything except employee entitlements. This was surprising given that collectively the industry

However this view hasn’t stopped right wing employers and their think tanks arguing that labour laws and unions in particular have killed the golden goose and if the “free” market could just be allowed to operate, we could finally achieve high productivity, low taxes, cheaper services etc, etc. And while it may be

too early to say, we should all hope that these extreme views do not resonate with the government or the Productivity Commission.

There is also the lingering but diminishing post global financial crisis view that the way forward is to cut public services, reduce social services and stem wages growth.

And while this is also a minority view it is advocated by loud and well resourced organisations like the mining industry.

But for the 85% of Australian families, including over 300,000 nurses, midwives and carers who go to work, earn a wage and rely on government services in their daily activities, these productivity reviews will potentially be very important.

The Australian Nursing & Midwifery Federation will be actively involved with written submissions, by raising awareness and campaigning to not only protect our members but also advocate strongly of the need to maintain a balance between the interests, aspirations and fair treatment of workers and increasing productivity and efficiency in our national economy.

PAGE 17 February 2014 Volume 21, No. 7.

Research Teen’s sleep impacted by electronic media use One in ten South Australian teenagers are addicted to electronic media, according to a new study.

Researchers surveyed the electronic media and sleep habits of more than 1,200 students, aged 12-18, from seven high schools.

The results showed overuse of the internet, video games and mobile phones were contributing to a lack of adequate sleep for the majority of South Australian teens.

“Our study has found that more than 70% of adolescents are not receiving optimal sleep during weekdays, with use of electronic media delaying the time they go to bed, interrupting them during the night, and leading to longer times to achieve a deep sleep,” said University of Adelaide study lead Dr Daniel King.

Lack of sleep can have significant health and mental health effects on young people and can lead to problems with learning and concentration, poor eating habits, and a range of other behaviours that are either unhealthy or undesirable, said Dr King.

“One of our concerns, and one of the reasons for conducting this study, was to better understand pathological electronic me-

dia use by adolescents. This is a persistent pattern of media use that is not regulated or limited by the user, which interferes with other daily activities and commitments.”

About 10% of the teenagers surveyed met the criteria for pathological electronic media use, which included internet use and online gaming, said Dr King.

“Our study suggests that adolescent sleep is significantly disrupted when electronic media is used pathologically.”

Dr King said the development of public health guidelines to educate young people, parents and teachers about responsible use of electronic media could help address potential negative impacts of excessive media use.

Tired nurses make poor decisions

Nurses who are fatigued are more likely to make poor decisions that they regret, according to a study published in the American Journal of Critical Care.

Of the 605 nurses surveyed, 29% reported making decisions they regretted.

Those nurses who regretted their decisions reported more fatigue, more daytime sleepiness, less recovery between shifts and worse sleep quality, compared to nurses without decision regret.

The study also found that decision regret was most common among male nurses who work 12-hour shifts and have lower levels of satisfaction with their clinical decisions.

According to the study authors the amount of sleep nurses get affects their PAGE 18

ability to be alert, vigilant and safe. In addition to this, fatigued nurses were unlikely to fully recover during their days off which increased the risk of injury, illness, absenteeism and making poor decisions.

The study suggested nurses and their employers needed to acknowledge the impact of fatigue on clinical performance and patient outcomes.

The authors said nurses should take responsibility at an individual level by practicing good sleep hygiene, while employers should also take measures to manage staff fatigue. This included implementing scheduling models that maximise fatigue management, using relief staff to provide completely relieved work breaks and strategic naps, providing fatigue education and incorporating fatigue countermeasures as routine practices.

Higher risk of birth problems after assisted conception

An Australian study has found the risk of serious complications such as stillbirth, preterm birth, low birth weight and neonatal death is around twice as likely for babies conceived by assisted reproductive therapies.

Researchers from the University of Adelaide compared the outcomes of more than 300,000 births in South Australia over a 17-year period, including more than 4,300 births from assisted reproduction.

They compared adverse birth events related to all forms of available treatment, including IVF, intracytoplasmic sperm injection (ICSI) (the injection of a single sperm into an egg), ovulation induction and cryopreservation of embryos.

“Compared with spontaneous conceptions in couples with no record of infertility, singleton babies from assisted conception were almost twice as likely to be stillborn, more than twice as likely to be preterm, almost three times as likely to have very low birth weight and twice as likely to die within the first 28 days of birth,” said study lead Professor Michael Davies.

These outcomes varied depending on the type of assisted conception used. “Very low and low birth weight, very preterm and preterm, and neonatal death were markedly more common in births from IVF and, to a lesser degree, in births from ICSI,” said Professor Davies. “Using frozen embryos eliminated all significant adverse outcomes associated with ICSI but not with IVF. However, frozen embryos were also associated with increased risk of macrosomia (big baby syndrome) for IVF and ICSI babies.”

Professor Davies said more research was urgently needed into longer term follow-up of those who have experienced comprehensive perinatal disadvantage. “Our studies also need to be expanded to include more recent years of treatment, as the technology has been undergoing continual innovation, which may influence the associated risks.”

Tech Talk Gurney Khera

“The Clouds are gathering…”

Clouds - we know them as the gathering of water condensation in the atmosphere, but you would have also heard the term ‘cloud’ to refer to computers or smart-phones. Apple users, for example, know the word ‘icloud’, to store and retrieve documents, presentations, songs and pictures from that service anywhere, from any Apple device connected to the internet. It is an important development in computing and the way most of us will interact with the internet through streaming into smart phone applications, commonly called ‘apps’, as well as other applications for professional and business use.

Nursing and midwifery practice will most certainly change as a result, realising more efficiencies and greatly improving the access to, and the ubiquity of medical and clinical information.

end’ with the main ‘back end’ sitting on the software provider’s system in ‘the cloud’. This is how the majority of smartphone ‘apps’ work and why they have become so popular and easy to use.

‘Cloud systems’ are so-called because the data and applications are split, with all data stored in a ‘back end’ central system of connected large computers called ‘servers’ with extremely high storage capacity. This ‘back end’ of large computers and data storage systems is called the ‘cloud’.

It is also much easier for the software providers to update information on their central ‘back-end’ database without having to constantly send database updates to each user. Furthermore security and access can be controlled centrally.

The ‘front end’ is on the user’s device, such as a laptop, tablet or smart-phone, and the ‘app’ software required to access the cloud system. The most important aspect is the connection between this ‘front end’ and the ‘back end’ which is through a ‘network’, mainly the internet. The ‘front end’ is what the user sees and the ‘back end’ is the ‘cloud’ section of the system.

The network connects these seamlessly so the user is not aware of the two different parts, as illustrated below:

The key advantages of this technology is that predominantly users can access their applications and data from anywhere at any time, using any computer or device linked to the internet. The data is not stored locally on your hard drive or a USB, or an organisation’s internal computer network. You only download the ‘front-

As the world becomes more connected through the internet, this cloud based model is here to stay and grow.

For instance the personally controlled electronic health record (PCEHR) is an example of a large cloud based system with centralisation of data.

Questions on data ownership and denial of access to one’s data are other major issues. For example a user’s word documents or critical patient records may be inaccessible should there be an internet outage or cloud company shut-down.

Facebook and other social-media ‘apps’ are examples of huge cloud systems where you can access them from any smartphone, laptop or desktop (ie. the ‘front end’). All of your data, pictures, videos, messages and ‘posts’ are kept and owned by these companies, at their ‘cloud’.

In order to minimise risk to these potentially major problems it is important to backup critical data, especially what you access from your sites on the web. Passwords and login codes should be kept private and changed regularly, perhaps every three months. All smart-phones have location service tracking, which can easily be turned off. It is important to be vigilant when downloading various ‘apps’ as they request permissions to access pretty much everything on your phone from messaging, locations, files and automatic updating. It is better to deny these and turn them off unless you are very aware of which data exactly is being transmitted to the ‘cloud’.

However, various concerns and issues arise as a result of cloud technology, mainly around security and privacy of data.

Handing over important data to another organisation can potentially result in the loss, theft or unauthorised duplication of that information. This is particularly pertinent to all medical records and clinical staff data.

If a user (eg. a nurse, midwife or clinician) can run an ‘app’ from any location to access data and applications, it’s possible a patient’s privacy could be compromised.

As technology becomes more mobile, the devices act more like windows into the ‘cloud’, providing seamless access to work information, data and communication. Being aware of these changes will help to facilitate these new technologies in the clinical workplace.

More direct monitoring of user’s activities and tracking of their location and other metrics is also an issue. This is because a smart-phone reports its location to the telco’s cloud each minute, allowing unauthorised tracking or stalking of a user.

Gurney Khera B.E, B.Sc (Computer scientist) is an IT Specialist and Consultant

Do you have a burning question about technology or want us to cover a specific health innovation, then email: techtalk@anmf.org.au

Additionally, a variety of information such as credit card, social security numbers, addresses and private messages have the potential to be stolen. These details are all stored in the ‘cloud’ computers of the companies that provide you the service, and not stored locally on your device.

PAGE 19 February 2014 Volume 21, No. 7.

Feature

Nurses feel the heat When a natural disaster strikes, nurses are among those on the ground providing front line support. They are caring for their patients, providing medical and emotional support, while also dealing with dramatically increased workloads, reduced resources and the fear and uncertainty over what is happening to their own home and family.

Kara Douglas examines the impacts of climate change on nurses, health care and the community.

PAGE 20

Feature

Tasmanian nurse Ken Harriss will never forget the terror he experienced during the bushfires that devastated Tasmania in the summer of 2012-13. Ken was at work when his wife called to warn him that their home was under threat. “There is panic, there is that feeling of, oh hell, it’s real.”

“You never really think that it’s going to happen to you. You never really think that you’re going to have to activate your evacuation plan and then there’s the whole problem of being at work.”

The emergency services had given residents in Ken’s suburb of Primrose Sands, south-east of Hobart, a three hour warning to either evacuate or stay and defend their homes.

Working half an hour from home, Ken says his mind was racing trying to figure out if he could get back in time to help his wife and daughters evacuate. “What if the fire was moving quicker than they had projected, there are a whole heap of what ifs, and you’re also looking around at where you work and you know the staffing levels and you’re thinking of the obligations that you have to your colleagues, not to put them under any extra stress.”

them are in the same position as you are, or they know people who are going through it.”

Fortunately Ken had support from his employer. “You go to your manager and say I’m sorry I’ve got to go, the place is as covered as best we can and thankfully I had a really great manager who said not a problem, you don’t need to be here, you go.”

Ken, his wife and daughters packed up their home and pets and stayed with his father for three, tense and frightening days before being allowed to return home.

Fortunately their home was untouched but others were not so lucky – 200 homes were destroyed in the fires.

Ken says he wonders if any lessons have been learnt. “I could just imagine if a spark was dropped, we’re [still] looking at similar risks that we were in 12 months ago, which is really, really scary.”

Ken says a number of other staff members at the aged care facility where he works were facing the same situation. “How do you continue to manage to staff a facility with care staff and catering staff and maintenance staff when most of them or half of PAGE 21 February 2014 Volume 21, No.7.

Feature

“

There is panic, there is that feeling of oh hell, it’s real

”

weather. To deny the influence of climate change on extreme fire weather, and not take appropriate action to prepare for these changed conditions, places people and property at unnecessarily high risk,” says the Climate Council’s Professor Will Steffen.

President of the Climate and Health Alliance (CAHA) Dr Liz Hanna agrees. “With extreme events like fires, heatwaves and raging storms, all of these will have massive health consequences.”

Nurse Ken Harriss fleeing the Tasmanian bushfires

Climate change impacts The bushfires that devastated Tasmania last summer were not a one-off ‘natural disaster’ event. Most of Australia suffered through an extreme heatwave last month, sparking widespread bushfires across Victoria, South Australia and WA. The Blue Mountains district of New South Wales was hit by deadly large scale bushfires towards the end of last year, while many Victorians still bear the emotional scars of Black Saturday and Queenslanders have endured destructive cyclones and floods.

In recent years, these sort of extreme weather events and record breaking heat waves have devastated local communities around the country and tested the preparedness and ability to cope of our emergency services, health system and government agencies.

Dr Hanna is an advisor to the Australian College of Nursing on climate issues and through her role at CAHA is behind a push to develop a framework for a national climate and health strategy for Australia. She says the response from the federal government has been disappointing so far. “What I find really quite depressing is that the department of climate change, when it existed, had about 400 people and there wasn’t a section that looked at human health, while our health department didn’t actually have much of a section dedicated to preparing Australia for climate change.”

This silo mentality is leaving Australia unprepared for the health impacts of climate change, Dr Hana says. “We’ve got the climate change people pretty much ignoring health and the health people ignoring climate change and the bottom line is that as it keeps warming in these extremes it is a human health issue.”

Health impacts There is no doubting the public health impacts of extreme weather events.

While the political debate around climate change in Australia often revolves around believers versus sceptics, the scientific community’s position is unequivocal: “The natural climate variability that underlies all extreme weather events is now influenced and altered by the effect of human-induced warming of the climate system” (www.csiro.au).

During the NSW bushfires, there was a 20% spike in reported asthma cases. NSW Health data shows during a five day period, when the fires were at their most severe, a total of 228 people attended monitored metropolitan emergency departments with asthma, while 799 people were treated for breathing problems

by NSW Ambulance personnel.

The CSIRO says future climate change impacts will be experienced mostly through extreme weather events, with heatwaves, floods, fires and southern Australian droughts expected to become more intense and more frequent.

Similarly, a paper published recently in the Australian Health Review found an estimated 374 excess deaths occurred in Victoria during the severe heatwave that struck the state in the lead up to the 2009 Black Saturday bushfires, which claimed a further 173 lives.

This raises a number of issues for nurses and other health professionals; such as what are the health impacts of climate change and an increase in extreme weather events, and how prepared is Australia’s health system?

The paper entitled, Preparation of residential aged care services for extreme hot weather in Victoria, Australia, found most of the deaths caused by the heatwave occurred among those aged 75 years or over.

During the NSW bushfires in October last year, the Climate Council linked the disaster directly to climate change and also recognised the impact on health service workers.

It found measures introduced at residential aged care services in response to that event helped reduce the impact of subsequent heatwaves in the 2010-11 summer.

“It is crucial for the public, emergency service workers and health workers to be able to prepare for more of this type of extreme

This included the development of heatwave plans, early preparation activities such as installation and repair of air conditioning

PAGE 22

Feature

QNU branch secretary Beth Mohle on the steps of the QNU Brisbane office at the height of the 2011 floods

What can nurses do?

What role can nurses play in preparing for and dealing with extreme weather events and natural disasters?

CAHA’s Dr Liz Hanna believes nurses working outside the major metropolitan areas, in particular, should be given additional training in emergency response, as they are more likely to be working on the frontline during a disaster. “This sort of nursing care should be led by the people that have done disaster nursing because it’s quite a different model of care to the gentle triage that we might have gone through in our training in hospitals; it’s a bit more intense than public health and community nursing.”

Dr Hanna says the Australian College of Nursing is currently investigating the issue.

“For example, with the NSW fires there are a lot of nurses that live in that area and if we [nurses] had increased skills, we could be pretty certain that throughout Australia there’d be nurses who would be very useful on the ground providing services.”

Queensland Nurses’ Union (QNU) Branch Secretary Beth Mohle agrees. She says a lot of lessons were learnt from Cyclone Yasi and the devastating Queensland floods in 2011. “A critical issue was the fact that nurses have a role to play in disaster recovery but they also get affected themselves.”

Ms Mohle says some nurses had their houses flooded or damaged by Cyclone Yasi.

Emerald Hospital clinical nurse for theatre Tammie Sedgeman wades through flood waters in 2011

units, staff training, checking for adequate supply of drinks and fluid-rich foods, rescheduling or cancelling planned resident outings and preparation of newsletters and pamphlets with heathealth messages for residents and families.

Climate change scientist Professor Lesley Hughes from Macquarie University says heatwaves have been dubbed the silent killer. “More people actually die in heatwaves than some of the more dramatic events and the people who are particularly vulnerable to heatwaves are children, the elderly and people with pre-existing chronic conditions like heart disease, respiratory or kidney disease.”

Professor Hughes says preparation is vital. “It’s always been important but it’s getting more and more important, because for example, in Australia last summer we had the record hottest summer, the hottest January, the hottest day [and] we’ve had one of the warmest ever winters in 2013.”

Indeed, 2013 was the hottest year in Australia since records began in 1910. “So clearly we’re in a changing climate, it’s only going to get hotter, not every year will be hotter than the previous one but the chances of getting a hot year are increasing all the time, so we have to be prepared for those sort of extreme events,” Professor Hughes says.

“Some of them were isolated and couldn’t get back to their homes because of the flooding, so there is a whole range of issues that you need to take into consideration in the context of disaster.”

Nurses played a critical role in providing mental health services after the disaster, while the union was also involved in the post-flood reconstruction taskforce.

One of the points the QNU consistently made to the taskforce was for the union to be utilised in a proactive way. “For example, we’ve got 52,000 members and we’ve got a database. We could work with the emergency services personnel to put out messages to our membership, it’s another method of communication that is underutilised. We’ve offered on many occasions that our members might want to volunteer to help [emergency services] to get a message out to key personnel about what’s happening in particular facilities in certain areas and we had offered help with that in terms of the communication.”

Ms Mohle says that unfortunately that offer has not been taken up. “We think that there is more that could be done. We think that they are under utilising the union movement and civil society generally.”

As well as the underutilisation of unions and nurses in general, another issue that came out of the Queensland experience was the inconsistency in how different categories of staff were treated. Cut off by flood waters or unable to leave because of the cyclone, there were many staff who did not leave their health facilities for days on end.

PAGE 23 February 2014 Volume 21, No. 7.

Feature

Tasmanian nurse Susan Madden and her husband lost their Boomer Bay home in the 2012-2013 fires Ms Mohle says a lot of the people who were coordinating the disaster recovery were senior nurses such as nursing directors and executive directors of nursing who are on salaries. “Medical officers who were doing that sort of work got paid overtime but our members were refused overtime, even though some of them worked 25 hours straight.”

Ms Mohle says it was an insult to those nurses. “We’ve eventually had it addressed, saying this is just an absolute outrage and get it sorted out, but we shouldn’t have had to get it sorted out.”

The QNU has since added a disaster clause to the last EBA so that members who do not normally have access to overtime will get paid overtime in those sorts of circumstances. “Our members were doing all the hard work on the ground but we had to fight for them to get compensated for that,” says Ms Mohle.

A global challenge Australian nurses are not alone in trying to come to terms with the human health implications of climate change and their role in the situation.

The International Council of Nurses first defined the compulsory link between environmental health and nursing practice in 1992: “The healthy lives of people depend ultimately on the health of Planet Earth – its soil, its water, its oceans, its atmosphere, its biological diversity – all of the elements which constitute people’s natural environment. By extension, therefore, nurses need to be concerned with the promotion, maintenance, and restoration of health of the natural environment, particularly with the pollution, degradation, and destruction of that environment being caused by human activities.”

While Australia is certainly far from leading the way on the issue, there is a growing awareness among nurses about the public health impacts of climate change and a desire to act.

This was evident at the Australian Nursing & Midwifery Federation’s (ANMF) Biennial Conference in October last year, where a number of resolutions passed by members related to environmental sustainability.

In comparison, Professor Barbara Sattler from the University of San Francisco says this level of awareness is not as evident in the United States.

A renowned nurse academic and environmental health advocate, Professor Sattler will be the international keynote speaker at the ANMF (Victoria Branch) Health and Sustainability Conference in March.

She says there is a lacklustre attitude towards climate change among health professionals working on the ground in America. “For the most part doctors and nurses are not taught about environmental health, nor for the most part is disaster preparedness part of major curricula. So what that means is that there’s not a place, or a sort of file system, for doctors and nurses to put climate change into and PAGE 24

I don’t think we’ve done a very good job nationally here [in America] of really helping people understand what the human health effects are likely to be, and quantified them and calculated what this means to vulnerable populations and coastal populations and so forth.”

Professor Sattler says there is a growing awareness of the impact of climate change and increased extreme weather events in areas that have been directly affected by events, such as hurricane Katrina in New Orleans and superstorm Sandy in New York, but not elsewhere. “I know Australia has had incredible fires and we have too in this country. We’re seeing hotter fires on larger land masses that are more frequent – these are all predictions of climate change but people are not connecting the dots.

“While we’ve always had tornadoes and we’ve always had fires or hurricanes, what people are not really getting is that these are increasing in their frequency and in their intensity and that is probably because of climate change.”

America’s largest nursing union, the American Nurses Association, recently revised its definition of professional nursing practice to include environmental health as a practice domain for nurses. Professor Sattler was involved in the process. “This means that we [nurses] really need to now understand things like climate change, we really need to understand how energy policy is going to affect human health. It’s part of our responsibility as a nurse to understand these large scale ideologies of our public health impacts.”

Professor Sattler hopes that the inclusion of environmental health as a practice domain for American nurses will lead to curriculum being developed in nursing schools as well as continuing education and professional development. “To expand nurses awareness, understanding and skills, practice implications, not just for climate change but for a wide range of environmental health risks that we have up until now substantially ignored.”

Climate change education In Australia, the ANMF has taken the lead on climate change education for nurses and midwives through the development of a new climate change education resource.

The Continuing Professional Development (CPD) online module will be released in April. It is designed to equip nurses and midwives with a sound understanding of the background and fundamentals of climate change and its effects.

ANMF Federal Secretary Lee Thomas says it will examine ways the health sector is responding to climate change and look at how it might respond further. “This is an issue that isn’t going to go away and it will be nurses on the front line caring for their patients when the next bushfire, flood or heatwave hits.”

Ms Thomas says that knowledge and preparation are vital. “As nurses we need to be informed, be prepared and be advocates for change.”

Feature

Books The Nurse Manager’s Guide to Innovative Staffing

By Jennifer Mensik RRP: US $29.95 Publisher: Sigma Theta Tau International Honor Society of Nursing ISBN: 978-1937554798

Learning how to be a staffing and productivity manager is a tough job for any nurse manager. Keeping staff along with management happy is a difficult balance to achieve. Research suggests inadequate nursing staff directly correlates with adverse patient outcomes. So how do busy nurse managers determine the daunting task of ensuring proper staffing? The Nurse Manager’s Guide to Innovative Staffing can help nurse

managers understand everything from the current state of staffing to innovative solutions. The book includes examples of staffing plans, policies, and delivery models. The author also explains strategies for introducing new processes and technology and provides calculations and worksheets including FTEs, PTO and productivity and nonproductive time.

Breast Cancer Your Treatment Choices

By Terry Priestman RRP: $16.99 Publisher: Exisle www.exislepublishing. com.au ISBN: 978-18470921574

Being diagnosed with breast cancer can be overwhelming making it hard to absorb all the facts. Breast Cancer Your Treatment Choices, written by a leading oncologist, is a clear easy to read book that lays out support and resource information for those needing to make complex choices in regards to their cancer care.

cancer, surgery and therapies including chemotherapy, radiotherapy, hormone, targeted, complementary and alternative therapies. This Book is a useful resource to recommend to patients or family and friends who are newly diagnosed with the cancer.

Information includes all the basic information, such as key facts about breast

Night Shift Nursing

Savvy Solutions for a Healthy Lifestyle

By Katherine PakieserReed RRP: US $29.95 Publisher: Sigma Theta Tau International Honor Society of Nursing ISBN: 9781937554675 www.nursingknowledge. org/STTIbooks.

Most nurses sometime in their career work the nightshift, but nurses who work nightshift on a regular basis are at higher risk of health problems, including sleep disorders, weight gain, depression and cardiovascular disease. Night shift can also cause social and professional isolation.

Night Shift Nursing, provides solutions effective and necessary strategies to ensure night shift works for them. Some of the strategies include energising fitness

routines and nutritious food options to reconstructing sleep patterns and balancing family and personal relationships.

The book is also a useful resource for employers who can learn about creating healthy work environments for night shift workers including rostering patterns to improving job satisfaction and reducing feelings of isolation.

Time to Create a Better Life How to become effective, efficient and focused

By Michele Tocci RRP: $24.95 Publisher: Lifestylerefocus ISBN: 9780646571126 http://lifestylerefocus. com.au/

Does chaos and disorganisation rule your life? Do you always feel you are behind the eight ball? Then it’s time to get your life in order according to Time to Create a Better Life’s author Michele Tocci. In twelve weeks, twelve simple habits will transform your life from chaos to calm, Tocci states. Readers can learn to take control of their time for the life that they want, function at their very best every day and set goals and priorities that work best for them. Also detailed is how to clean out the stress clutter, and procrastination as well as taking time out for you.

There are activities and thinking points throughout the book to help the reader gain the knowledge needed to take back their time.

The author suggests the key to making the positive habits suggested in the book, permanent habits is to identify the new habit you wish to establish and repeat the action every day. In doing so, there will be a better chance to create a happier life to enjoy.

PAGE 25 February 2014 Volume 21, No. 7.

Working Life Different cultures deliver different births A tour of four maternity hospitals at Ho Chi Minh City, Vietnam has given midwife Marie Gentile-Andrit a whole new perspective on hospital births. the only audible sound was the chatter of staff grouped around a common desk.

There was minimal interaction with the women they were caring for. “We were sure they cared, in true gentle Vietnamese style, but there was a cultural difference during labour with the one-to-one midwifery that is common place to us, all but absent.”

Instead women laboured in lithotomy (stirrups), silently and alone. Marie said the whole experience was quite a contrast to her work as a midwife and child birth educator in Australia. “Two of our volunteers were perinatal mental health nurses and part of their presentation involved ante and postnatal depression. It was

“Broadly speaking, my feeling is at times we can over complicate things which can translate to potentiating obstacles.”

The busy level three tertiary hospital that Marie works at in Melbourne delivers 5,500-6,000 babies per year. In contrast one of the hospitals Marie visited in Vietnam has an average of 65,000 births per year.

“The numbers are beyond our imagination,” said Marie.

Given the sheer numbers, Marie said birthing in Vietnam was very process driven and completely different to the experience in Australia. “The labour and birthing department of one major maternity hospital was split into three very separate areas, an early labour area, an established labour area and then a delivery room.”

obvious the audience were not in the least bit interested in the topic. We later discovered it was due to a lack of awareness and understanding about the issue because the incidence of ante and postnatal depression in Vietnam is very rare.”

Marie believes this is largely due to the cultural differences around the expectations of women. “Vietnamese women in labour appear to possess an internal strength, an inner knowing and acceptance that what they are embarking on is their role to own, part of becoming a mother.”

Extensive family and community support were also a major contributing factor to Vietnamese women being able to cope with the challenges of early parenting, according to Marie.

Birthing women would share each of the labour areas together, Marie said. “Primiparous* women were among multiparous** women, spontaneous labouring women were among women who were being induced.”

Marie said she walked away from her experience in Vietnam thinking that having the best resources did not necessarily translate to the best outcomes. “The Vietnamese maternity system has a simplistic framework and I recall that relative to their births, their mortality and morbidity statistics weren’t alarming to us.

Another noticeable difference was the silence in the delivery suite. Marie said

“Broadly speaking, my feeling is at times we can over complicate things which can trans-

PAGE 26

late to potentiating obstacles,” said Marie.

Supporting and empowering women to achieve positive outcomes through birth and early parenthood is what drives Marie and her experience in Vietnam helped to reinforce that. “Observing the look on a woman’s face when she shifts from despair and fear to strength and empowerment is my number one professional motivator. Contributing to change, knowing that a woman has gained confidence in her innate ability to birth in the way that Mother Nature intended is a priceless gift for me as a midwife.”

Marie began her own career following the birth of her fourth child. She trained as a birth attendant before studying midwifery and said it was an invaluable adjunct to her professional career as a midwife.

She is now drawing on her experience and passion for the birth world to create a new holistic practice in Melbourne designed to give women confidence, education and support before, during and after pregnancy. Called MummaBubbas, the practice will initially incorporate midwifery, lactation consultancy, counselling, naturopathy and chiropractics, and is expected to open this year. * Primiparous – first time giving birth ** Multiparous- given birth two or more times

Wellbeing Kim McPherson

Surviving night shift For those who work night shift, lack of sleep is a common occurrence resulting in a multitude of unwanted side effects. But it is possible to beat sleep deprivation, says RN and health and nutrition coach Kim McPherson.

I wrote five tips for surviving nights as a blog post after being asked by our educator to speak to the undergraduate nurses coming through my unit. The students were about to embark on night shift for the first time and I wanted to instil some healthy habits early on in their career. They found this useful but I was also surprised at how many of our regular night shift workers benefited from these simple tips. Feedback was that they were managing to sleep better and feel more ‘switched on’ at work.

When we sleep millions of our cells rest and rejuvenate. We grow new brain cells, repair and rebuild lean muscle and our body produces more chemicals responsible for organising our immune system. Disrupted sleep affects our mood and ability to think clearly, our blood sugar levels, our chances of getting sick, getting depressed and can speed up the ageing process. The odds are against us, but there are ways to deal with the effects of sleep deprivation before we all turn into sick, fat, depressed monsters.

Tips for surviving nights 1. Breathe Sounds effortlessly simple but when we are tired and stressed we tend to shallow breathe and this is ineffective. Try noticing how a child breathes, they naturally breathe through their nose and take effective full breaths. Adequate breaths activate the lower lobes of the lungs where there are an abundance of parasympathetic nervous system (PNS) receptors. Activating the PNS works to calm the mind and rejuvenate the body. Take big SLOW diaphragmatic breaths by sticking your belly out on the inhale and drawing it in on the exhale. This will increase oxygen to your brain and keep you calm and focused. I do this every hour or more if I remember. I definitely do it before heading to the ‘binge table’ and nine times out of ten it works to keep me away.

2. Control your cortisol Cortisol is one of several stress response hormones important in regulating your cir-

cadian rhythm. Chronically elevated levels of cortisol can result from lack of sleep, caffeine/stimulant abuse, chronic exposure to stressful situations, a poor and imbalanced diet, and a lack of exercise.

This results in a suppressed immune system, inflammation, fatigue and weight gain, especially around the midsection.

How do we reduce cortisol? Obviously avoid stressful situations as much as you can, which is near impossible in the line of work we do. Reduce stress by exercising regularly, get adequate sleep and rest, and eat whole nutritious foods. Interestingly, laughter has been proven to reduce cortisol, often not too hard when the five am delirium sets in and all you can do is laugh.

3. Drink more water How much should we have? In times of stress we need more; if you are working in an environment that uses heating/cooling you need more; if you are tired you need more; if you wish to use your brain and body at optimal function you need more; and if you wish to minimise cravings and keep your body looking as fit and healthy as it does then you need more.

I have two big glasses of water as soon as I wake up, if I am on nights or not.

After sleeping most people have gone approximately eight hours without water so their body is going to crave it. This is also a great way to wake up your metabolism in the morning. I add a little apple cider vinegar for detoxification, or you could add lemon in hot water, whatever gets you rehydrated.

Don’t like drinking water? During a night shift I sip on numerous cups of herbal tea.

I also add a combination of a few slices of ginger, lemon, apple cider vinegar and peppermint tea to my big water bottle and try to get through it before midnight (write it on your shift planner if you forget).

4. Spend time outdoors Try and break the ‘work-eat-sleep’ cycle by going for a walk or exercising outside.

On a long stretch of nights it’s common not to see the blessed sun at all. Try getting up a little earlier to take a stroll outside, or if you wake up in the middle of the day and can’t get back to sleep try getting outside for a while before you have another nap. The mental and physical benefits from the great outdoors are huge. Even hanging the washing on the line barefoot will be of benefit.

5. Eat right Knowing our rosters in advance gives us ample time to prepare nourishing food for ourselves. I batch cook several meals in advance when I know my nights are coming up. That way when I wake up from a sleep I don’t turn into cookie monster and ‘spazz out’ in the kitchen.

If you are stuck on healthy recipes, you can download my free e-Book ‘The Well Nurse Lunch Box’ on my website or by using this link http://eepurl.com/GAi2b

Kim References supplied on request

Kim Mcpherson is an RN and a Health and Nutrition Coach. She is also the creator of the website http://thewellnurse.net/, designed for nurses and shift workers looking to improve their health while dealing with stress and shift work.

PAGE 27 February 2014 Volume 21, No. 7.

Clinical Update Stephanie Sprogis

Recommended fasting practices for adult, low risk patients prior to elective procedures requiring general anaesthesia Fasting prior to general anaesthesia is considered critical to patient safety (Brady et al 2010). Tradition has dictated patients should fast from both food and fluids from midnight prior to a procedure, irrespective of their place on the theatre list (Andrew-Romit and van de Mortel 2011).

A plethora of research indicates however, that this practice is overzealous and that shorter fasting times are not only safe but potentially beneficial for healthy, low risk patients (Smith et al 2011; Brady et al 2010). Despite this evidence, prolonged fasting still occurs, reflecting a practice which is purely habitual as opposed to evidence-based (Andrew-Romit and van de Mortel 2011).

Excessive fasting carries serious risks for patients, thus it is imperative that this outdated practice is ceased. Nurses are at the forefront to implement practice change. The following article will explore the literature surrounding key elements of fasting practices for healthy adults undergoing elective procedures under general anaesthesia. Fasting duration, acceptable fluid types and volumes, the influence of chewing gum and the nurse’s role in implementing evidencebased practice will be addressed.

Background Ensuring a patient has fasted is an important aspect of preoperative nursing care. Lung protective reflexes become incapacitated on induction of anaesthesia, thus preoperative fasting is deemed necessary to prevent an increase in gastric volume and a decrease in gastric pH, which may lead to aspiration of the gastric contents into the lungs and serious, potentially fatal pulmonary complications (Brady et al 2010; Seymour 2000). While inadequate fasting has accepted risks, excessive fasting is also undesirable and may result in patient discomfort, anxiety, irritability, nausea, vomiting, fluid volume depletion, hypotension, malnutrition, glycaemic derangements and electrolyte imbalances (Andrew-Romit and van de Mortel 2011; O’Callaghan 2002; Harrow et al 2001).

Excessive fasting may even increase the gastric residual volume, contrary to the common, but now aged belief that the longer a patient is fasted, the more empty the stomach is, therefore the safer the proceeding anaesthetic will be (Brady et al 2010). The stomach PAGE 28

can produce up to 2,500mls of gastric fluid per day, thus the stomach never completely empties and time alone may therefore not ensure safety pre anaesthesia (Marshall et al 2012; O’Callaghan 2002). It is essential that nurses are aware of the evidence for optimal fasting to reduce the risks of either excessive or inadequate fasting periods.

Fasting duration The recommended duration of fasting from solids and fluids has been discussed extensively in the literature. It is important to note that solids and fluids behave quite discretely, with solids, particularly those fatty in nature, per-

“The stomach can produce up to 2,500mls of gastric fluid per day, thus the stomach never completely empties and time alone may therefore not ensure safety pre anaesthesia (Marshall et al 2012; O’Callaghan 2002)” sisting considerably longer than fluids, which pass through the stomach fairly instantaneously in a normal person (Crenshaw 2011; Seymour 2000).

Logically, fasting practices need to be consistent with this physiology.

Fluids:

Studies by Scarr et al (1989), Phillips et al (1993) and Maltby et al (1991) have shown that the consumption of clear fluids up to two to three hours preoperatively, when compared to a standard fast from midnight, produces no significant alteration to gastric volume or pH (used as surrogate markers for aspiration risk) therefore, this practice is not thought to increase the risk of aspiration (Stuart 2006). The recent Cochrane Collaboration review (Preoperative fasting for adults to prevent perioperative complications) and major anaesthetic bodies including the Australian and New Zealand College of Anaesthetists (ANZCA)

Clinical Update and the European Society of Anaesthesiology (ESA) all recommend the consumption of clear fluids up to two hours preoperatively (Smith et al 2011; ANZCA 2010).

Additionally, the consumption of fluids in this period may be associated with a reduced experience of hunger, thirst, anxiety, headache, malaise, nausea and vomiting, thus significantly improving patient comfort and hydration state and should therefore be encouraged (Power et al 2012; Smith et al 2011; Phillips et al 1993).

Solids:

There is limited data available regarding the ideal fasting time for solids. Miller et al (1983) conducted a small study comparing the gastric residual volume of patients who had consumed a light breakfast two to four hours pre gynaecological surgery compared to patients who had fasted overnight and found that there were no differences in the gastric residual volume between groups. Limitations of this study however, were the small sample size (n=45) and practical difficulties encountered when measuring the residual presence of solids within the stomach (Smith et al 2011; Stuart 2006). Despite the limited research, cessation of solid intake for six hours preoperatively is widely practiced and is also recommended by the Cochrane Collaboration review and the major anaesthetic bodies (Andrew-Romit and van de Mortel 2011; Smith et al 2011; Stuart 2006).

Types of fluids and volumes While it is safe and advantageous to consume fluids up to two hours preoperatively, it is vital to specify the types of fluids and their respective volumes which are permissible. There is considerable difference between the gastric transit times of clear versus full fluids, as clear fluids are thought to progress past the stomach rapidly, while full fluids, such as milk, tend to persist and increase the gastric volume (Crenshaw 2011). Clear fluids alone are therefore widely deemed permissible. Moreover, some literature states that the consumption of water specifically may actually reduce the aspiration risk, by decreasing the gastric volume (Agarwal et al 1989; McGrady and MacDonald 1988; Maltby et al 1986).

that there were no differences in gastric volume or pH in the majority of studies of patients who received these fluids two hours preoperatively compared to those who fasted from midnight (Brady et al 2010; Stuart 2006). Therefore, no single clear fluid has been found to alter the risk of aspiration, deeming all to be equally safe (Brady et al 2010; Stuart 2006). However, whether milk should be allowed to be added to tea or coffee or indeed the volume of which would be considered safe remains unclear in the research (Smith et al 2011). It is therefore likely best omitted until further research is conducted.

“Despite the limited research, cessation of solid intake for six hours preoperatively is widely practiced and is also recommended by the Cochrane Collaboration review and the major anaesthetic bodies (Andrew-Romit and van de Mortel 2011; Smith et al 2011; Stuart 2006).�

Furthermore, the role of specifically carbohydrate rich drinks has been investigated. Fasting reduces the absorption of nutrients and quickly depletes stored glycogen, unfortunate consequences given that energy expenditure is heightened intraoperatively (O’Callaghan 2002; Nygren et al 1995). Indeed, surgery is known to inflict a state of hypermetabolism on the body, which may produce hyperglycaemia and insulin resistance (de Aguilar-Nascimento and Dock-Nascimento 2010; Nygren et al 1995). Several studies have therefore proposed that the consumption of a carbohydrate rich drink two hours preoperatively may not only improve preoperative comfort but may also reduce postoperative insulin resistance and muscle wastage, without increasing the gastric volume, having a significant positive impact on postoperative recovery (de Aguilar-Nascimento and Dock-Nascimento 2010; Hausel et al 2001; Nygren et al 1998). Further research is needed however, to identify the specific patient groups who may be most advantaged by such drinks and indeed which particular formulations should be recommended (Awad et al 2013).

The Cochrane Collaboration review compares the influence of a range of clear fluids including water, apple juice and black tea or coffee, summarising PAGE 29 February 2014 Volume 21, No. 7.

Clinical Update “The development of comprehensive, evidence-based fasting policies is crucial to encourage the adoption of the recommended fasting practices (Crenshaw 2011; Brady et al 2010).”

Fluid Volume It seems that the fluid volume itself, whether high or low, does not alter the gastric environment and the type of fluid may be more imperative that the amount taken (Stuart 2006). Guidelines from the Australian and New Zealand College of Anaesthetists (ANZCA) do stipulate, however, that no more than 200ml should be consumed per hour, although it seems there is minimal evidence to support the consumption of this volume specifically (ANZCA 2010).

Chewing gum Typically, gum chewing is not allowed in the preoperative period. However, there is little evidence to validate this practice, with only two studies investigating the influence of preoperative gum chewing on gastric content in adults. One single centre, randomised study, by Dubin et al (1994), found that sugar-free gum chewing during the preoperative period resulted in no difference to gastric volume or pH, when compared to patients who had fasted overnight alone, thus the authors conclude that gum chewing could be continued if desired and should not warrant cancellation of surgery. Conversely, another larger study by Søreide et al (1995) found that the gastric volume of non smoking gum chewers was significantly higher than non smokers who had merely fasted overnight, while the gastric volume of smokers who chewed nicotine gum preoperatively was unchanged when compared to smokers who did not chew gum. The authors therefore recommend that nicotine gum use may be permitted for smokers preoperatively, given that it may aid stress management without compromising aspiration risk, while non smokers should not chew sugar-free gum as this may heighten the aspiration risk (Søreide et al 1995). Both the Royal College of Nursing and the ESA guidelines advocate against the use of chewing gum preoperatively, yet more research is required to definitively establish the influence of gum on the gastric environment (Smith et al 2011; RCN 2005).

PAGE 30

arduous process and many patients continue to be fasted for unnecessarily long periods (Andrew-Romit and van de Mortel 2011; Brady et al 2010).

It has been suggested that the well ingrained ‘fast from midnight’ culture often persists because it is considered convenient to apply a ‘blanket rule’ to all patients. There may also be a lack of trust in patients’ abilities to follow more ‘complex’ instructions and a lack of knowledge by nursing and medical staff regarding more liberal fasting practices (Andrew-Romit and van de Mortel 2011; Harrow et al 2001; Seymour 2000). The development of comprehensive, evidence-based fasting policies is crucial to encourage the adoption of the recommended fasting practices (Crenshaw 2011; Brady et al 2010). However, the mere existence of such policies does not guarantee real life practice change.

Health care organisations have a responsibility to educate the multidisciplinary team and patients about the optimal fasting practices detailed within hospital policies (Harrow et al 2001).

Nurses play a central role in the care of the preoperative patient and as such need to collaborate with medical staff to develop fasting policies, participate in their review and facilitate policy and practice adoption in the workplace.

All nurses should at the very least be aware of their existence, how to access them and most importantly understand the evidence (Harrow et al 2001). Nurses need to be aware of the negative outcomes associated with excessive fasting and need to ensure that they are equipped to inform their patients of the preoperative requirements. The common concern that if patients are permitted to drink clear fluids two hours preoperatively, they will somehow mistakenly eat solids as well also seems inordinate (Harrow et al 2001). While clearly the individual circumstance requires assessment, most healthy elective patients, armed with sound preoperative education, in verbal and written form, could be trusted to consume the right type of fluid at the right time (Crenshaw 2011).

Barriers to implementation and the role of the nurse

Conclusion

The translation of evidence-based fasting principles into current clinical practice has been an undoubtedly

Although fasting pre anaesthesia is required to reduce the likelihood of pulmonary aspiration, patients are

Clinical Update frequently fasted for unreasonably long periods, contrary to the wealth of research recommending otherwise, placing them at risk of significant complications. Current recommendations state that patients should fast from solids for six hours, while clear fluids are permissible up to two hours preoperatively. The chewing of gum preoperatively is discouraged by key guidelines. Hospital policies need to be consistent with evidence-based recommendations. Nurses have a responsibility to be well informed and actively support the application of the evidence, to ensure optimal patient outcomes in the perioperative period.

Summary of best practice recommendations l

l

l

l

I n adult, low risk patients prior to elective procedures requiring general anaesthesia, prolonged fasting from midnight is not required.

Shorter fasting times are not only safe, but potentially beneficial.

T he consumption of clear fluids up to two hours preoperatively is recommended and does not increase the risk of pulmonary aspiration. The volume taken has not been found to alter the risk of aspiration.

P atients should fast from solids for six hours preoperatively.

P atients should be provided with verbal and written instructions about the required fasting practices, including examples of what constitutes a ‘clear fluid’.

References Agarwal, A., Chari, P. and Singh, H. 1989. Fluid deprivation before operation: the effect of a small drink.

Anaesthesia. 44(8): 632-634.

Andrew-Romit, J.J. and van de Mortel, T.F. 2011.

Ritualistic preoperative fasting: is it still occurring and what can we do about it? The Journal of Perioperative Nursing in Australia. 24(1): 14-19.

ANZCA. 2010. Recommendations for the perioperative care of patients selected for day care surgery. www.anzca.edu.au. Sourced 25/8/2013 Awad, S., Varadhan, K., Ljungqvist, O. and Lobo, D.N. 2013. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clinical Nutrition. 32: 34-44.

Brady, M.C., Kinn, S., Stuart, P. and Ness, V. 2010.

Preoperative fasting for adults to prevent perioperative complications (review). The Cochrane Collaboration. 5:1-125.

Crenshaw, J. (2011). Preoperative fasting: will the evidence ever be put into practice? Australian Journal of Nursing. 111(10): 38-43.

De-Aguilar-Nascimento, J.E. and Dock-Nascimento, D.B. 2010. Reducing preoperative fasting time: a trend based on evidence. World Journal of Gastrointestinal Surgery. 2(3): 57-60.

Dubin, S.A, Jense, H.G., McCraine, J.M. and Zubar, V. 1994. Sugarless gum chewing does not increase gastric fluid volume or acidity. Canadian Journal of Anaesthesia. 41(7): 603-606.

Harrow, D., Foster, J. and Greenwood, J. 2001.

Evidence and leadership: the tools for change. Contemporary Nurse. 11: 9-17.

Hausel, J., Nygren, J., Lagerkranser, M., Hellström, P., Hammerqvist, F., Almström, C., Lindh, A., Thorell, A. and Ljungqvist, O. 2001. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesthesia & Analgesia. 93:13441350.

Maltby, J. R., Lewis, P., Martin, A. and Sutherland, L. R. 1991.Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery. Canadian Journal of Anaesthesia. 38(4): 425-429.

Maltby, J. R., Sutherland, A. D., Sale, J. P. and Shaffer, E. A. 1986. Preoperative oral fluids: is a five-hour fast justified before elective surgery? Anesthesia & Analgesia. 65: 1112-1116.

Marshall, A., Williams, T. and Gordon, C. 2012. Gastrointestinal, liver and nutritional alterations, in Elliott, D., Aitken, L. and Chaboyer, W. (ed). ACCCN’s critical care nursing. 2nd edn. Chatswood: Elsevier.

Nygren, J., Soop, A., Thorell, A., Efendic, S., Nair, K.S. and Ljungqvist, O. 1998. Preoperative oral carbohydrate administration reduces postoperative insulin resistance. Clinical Nutrition. 17: 65-71.

O’Callaghan, N. 2002. Preoperative fasting. Nursing Standard. 16(36): 33-37.

Phillips, S., Hutchinson, S. and Davidson, T. 1993.

Preoperative drinking does not affect gastric contents. British Journal of Anaesthesia. 70: 6-9.

Power, S., Kavanagh, O., McConnell, G., Cronin, K., Corish, C., Leonard, M., Crean, A., Feehan, S., Eguare, E., Neary, P. and Connolly, J. 2012. Reducing preoperative fasting in elective adult surgical patients: a case-control study. Irish Journal of Medical Sciences. 181:99-104.

Royal College of Nursing. 2005. Perioperative fasting in adults and children. In rcn.org.uk. Sourced 25/8/2013 Scarr, M., Maltby, J.R, Jani, K. and Sutherland, L.R. 1989. Volume and acidity of residual gastric fluid after oral fluid ingestion before elective ambulatory surgery. Canadian Medical Association Journal.

141:1151-1154.

Seymour, S. 2000. Preoperative fluid restrictions: hospital policy and clinical practice. British Journal of Nursing. 9(14): 925-930.

Smith, I., Kranke, P., Murat, I., Smith, A., O’Sullivan, G., Søreide, E., Spies, C. and Veld, B. 2011. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. European Journal of Anaesthesiology. 28: 556-569.

Søreide, E., Holst-Larsen, H., Veel, T. and Steen, P.A. 1995. The effects of chewing gum on gastric content prior to induction of general anaesthesia.

Anesthesia & Analgesia. 80(5): 985-989.

Stuart, P. 2006. The evidence base behind modern fasting guidelines. Best Practice & Research Clinical Anaesthesiology. 20(3): 457-469.

Stephanie Sprogis is an RN and postgraduate student at Deakin University undertaking the Master of Nursing Practice, specialising in Intensive Care Nursing. She completed graduate certificate subjects in 2013 and was awarded the ACCCN (Deakin) Prize for academic and clinical performance in this program.

McGrady, E.M. and MacDonald, A.G. 1988. Effect of the preoperative administration of water on gastric volume and pH. British Journal of Anaesthesia.

60:803-805.

Miller, M., Wishart, H. Y. and Nimmo, W. S. 1983.

Gastric contents at induction of anaesthesia. British Journal of Anaesthesia. 55: 1185-1188.

Nygren, J., Thorell, A., Jacobsson, H., Larsson, S., Schnell, P., Hylén, L. and Ljungqvist, O. 1995.

Preoperative gastric emptying: effects of anxiety and carbohydrate administration. Annals of Surgery.

222(6): 728-734.

PAGE 31 February 2014 Volume 21, No. 7.

Ethics Megan-Jane Johnstone

Media manipulation and the euthanasia debate marks of being driven more by personal opinion than ethics, and by conjecture rather than empirical fact. Thus an important question arises: What are nurses to make of the quest to have them acquiesce to highly politicised catalysts to support the legalisation of euthanasia?

Minority issue

In October 2013, ABC News Radio conducted a web poll on the question: ‘Should there be a national referendum on voluntary euthanasia?’ Those responding to the poll had the option of answering a simple yes/no question, without qualifying their response. Just why the public broadcaster conducted the poll is a matter for speculation.

Even so, its media priming effects and capacity to both influence as well as create public opinion on the subject should not be underestimated. Nurses, like the general public, are not immune to media priming and, in the interests of public accountability, need to become ‘skeptical readers of the media’ and to mitigate its effects (Louw 2010, p.24). This includes nurses being better apprised of the various ways in which the euthanasia debate and possibly their own opinions are being manipulated by the media.

Question of nursing ethics The nursing profession in Australia has been under immense pressure by proeuthanasia supporters to take a definitive stance advocating the legalisation of euthanasia. The basis for urging this support is questionable and has the hallPAGE 32

In answering this question it is important to clarify that despite media-generated public opinion polls suggesting majority support for euthanasia, in reality it is a minority issue. The actual practice of euthanasia affects only a small percentage of people – even in jurisdictions in which it has been legalised, eg. the Netherlands (Johnstone 2013). Moreover, only around 12% of the world’s recognised countries have affiliated euthanasia societies championing legislative change. International commentators have also observed that the development and implementation of what has been termed ‘death policy’ is neither a universal phenomenon nor a public policy imperative. Despite this reality, euthanasia is falsely promoted ‘as if’ it is of universal importance and priority.

Referendums in Australia In Australia, referendums are polls which are held to approve parliament-proposed changes to the Australian Constitution or state or territory. For other matters relating to statutory law and an advisory question of policy, a plebiscite may be conducted by the government. In contradistinction to referendums, plebiscites can offer a variety of options (not just simple yes/no questions) and voting is optional.

The call by ABC News Radio for a referendum on what is largely an individual preference issue is significant. We would be hard pressed to find an equivalent example of where the ‘wants’ of people have provided sufficient justification for a major change in public policy. While media-generated public opinion polls may create the impression that the failure to legalise euthanasia is a ‘major problem’ which governments ought to address, research shows it is not (Johnstone 2013). In light of this, the ABC web poll needs to be seen for what it is: a ‘drip feed’ political act aimed at fuelling the illusion that it is imperative for governments to legalise euthanasia.

Public opinion As argued previously in this column (Johnstone 2011), the moral rightness or wrongness of an act can be decided only by sound reasoning, not by public opinion.

Research has shown, however, that when it comes to deciding complex issues, decision makers rarely change their minds – even when presented with ‘the facts’. Instead, decision makers tend to search for and only accept information that reaffirms their initial viewpoints – including public opinion polls.

When it comes to complex moral issues, nurses have a professional responsibility to be more discerning than the average person on the street and to ensure they take a well-informed approach to the issue in question. Putting pressure on the nursing profession to take a definitive stance either way on euthanasia should be seen for what it is: a political stunt aimed at dragging a non-partisan party into an unwanted dispute in order to give material advantage to a partisan party (Johnstone 2012).

Nurses have an obvious stake in the outcome of the euthanasia debate. Accordingly they need to be more discerning and advocate a level of intellectual honesty, transparency and public accountability in the debate that up until now has largely been missing. This includes being able to recognise and resist media manipulation that has the capacity to entice non-partisan bystanders into taking a partisan stance.

References

Johnstone, M. 2011. Public opinion and ethics.

Australian Nursing Journal, 19(1): 25 Johnstone, M. 2012. Organization position statements and the stance of ‘studied neutrality’ on euthanasia in palliative care. Journal of Pain and Symptom Management, 44(6): 896-907.

Johnstone, M. 2013. Alzheimer’s disease, media representations and the politics of euthanasia: constructing risk and selling death in an ageing society.

Ashgate, Farnham, Surrey.

Louw, E. 2010. The media and political process, 2nd edn. Sage Publications, London.

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.

Clinical View Natasha Franklin

Malnutrition and the role of nurses: A nursing issue Nutrition and malnutrition The importance of nutrition has long been recognised as quintessential by nurses for the health and wellbeing of patients, but despite this, nutritional assessment and management remains a problematic issue in nursing (Estes et al. 2013). Malnutrition is a significant clinical issue for patients in hospital as it is estimated as high as 34 to 43% in Australian hospitals and this figure is reported as high as 72% in ‘at-risk’ patients, such as residents in aged care facilities (National Health and Medical Research Council [NHMRC] 2013; Dietitians Association of Australia [DAA] 2008). Malnutrition increases hospital stays; is associated with increased readmission rates; increased risk of falls and infection; delayed wound healing; post-operative and treatment complications; decreased quality of life; and a significant contributor towards mortality (DAA 2008). Malnutrition is a significant risk-factor for chronic diseases, such as cardiovascular disease and type 2 diabetes mellitus (NHMRC 2013). The financial burden of malnutrition has been estimated at $1,745 per admission per patient in Australia but the costs are thought to be higher than this amount due to insufficient and inadequate malnutrition screening and reporting (Rowell & Jackson 2011).

Nursing and malnutrition screening Nurses are in the prime position to perform malnutrition screening as part of their holistic patient admission assessment (Dudeck 2010). Several studies however, acknowledge nutrition assessment and malnutrition screening is infrequently and inconsistently performed by nurses and some of the reoccurring reasons for this are due to lack of compliance with malnutrition screening; confusion regarding the screening role of nurses, uncertainty of malnutrition screening protocols, competing task priorities, value of clinical judgement, recognition of evidence-based practice, discrepancy amongst nurses regarding attitudes and practices, degree of competence, lack of education and training, and organisational culture (Green & James 2013; Porter et al. 2009; Tannen & Lohrmann 2012; Pradignac et al. 2011; Raja et al. 2008). In Australian hospitals, the Malnutrition Screening Tool (MST)

and the Malnutrition Universal Screening Tool (MUST) are the two most commonly used screening tools. However, malnutrition screening is more often than not based on ‘clinical judgement’ rather than using an evidence-based tool (Raja et al.

2008). Utilisation of malnutrition screening tools can be viewed as; tedious, time consuming, not an admission priority, not necessary, and not necessarily the role of nurses, but of the dietitians (Green & James 2013; Porter et al. 2009). Hospitals that have clearer policies, processes and referral systems regarding the nutritional management of patients, and that have nurse unit managers leading malnutrition screening have higher screening compliance rates (Green & James 2013; Tannen & Lohrmann 2012). A lack of education and training are central reasons why malnutrition screening does not occur, including correct screening assessment practices (Pradignac et al. 2011). Communication and physical mobility have been common cited reasons for not weighing and therefore screening patients, when arguably, these groups of patients are at higher-risk of malnutrition (Tannen & Lohrmann 2012; Porter et al. 2009).

Hospitals that have dedicated nurses that are in essence ‘nutrition champions’ have higher rates of malnutrition screening, but further education and training is required for correct screening of patients (Tannen & Lohrmann 2012). At an individual level, one of the biggest barriers for malnutrition screening is the lack of understanding and recognition for a necessary admission assessment, and a lack of engagement or interest by nurses to screen malnourished patients (Raja et al. 2008).

Nurses have a pivotal and essential role in the nutritional care of patients and have a duty of care to screen patients for malnutrition. Florence Nightingale (1820-1910, p. 54) summarises the important role nurses have in regards to the nutritional assessment and management of their patients by stating, “I would have this to say to the nurse, have a rule of thought about your patient’s diet; consider, remember how much he has had, and how much they ought to have today.”

References

Green, SM., James, E.P. 2013. “Barriers and facilitators to undertaking nutritional screening of patients: a systematic review”. Journal of Human Nutrition and Diet. 26(3). 211-221.

Dietitians Association Australia. 2008. Malnutrition. http://daa.asn.au/for-the-media/hot-topics-innutrition/past-hot-topics/malnutrition-2/, viewed 29/11/2013.

Dudeck, S.G. 2010. Nutrition Essentials for Nursing Practice. 6th edn. Lippincott & Williams. China.

National Health and Medical Research Council. 2013.

Eat for Health. Australian Dietary Guidelines. Providing the scientific evidence for healthier Australian diets. Australian Government. Department of Health and Ageing. www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n55_australian_dietary_guidelines_0.pdf, viewed 29/11/2013.

Nightingale, F. 1820-1910. Notes on nursing: what it is, and what it is not. Churchill Livingstone, 1980.

Edinburgh, New York.

Pradignac, A., Petitdemange, A.M., Sery, V., Hubsch, A., Ayed, C.B., and Schlienger, J-L. 2011. Nutritional education program for the nursing staff may improve hospitalized patients’ nutritional assessment and management. Clinical Nutrition. 31. 862-867.

Porter, J. Raja, R. Cant, R. Aroni, R. 2009. Exploring issues influencing the use of the Malnutrtion Universal Screening Tool by nurses in two Australian hospitals. Journal of Human Nutrition and Dietetics.

22(3). pp. 203-209.

Raja, R. Gibson, S. Turner, A. Winderlich, J. Porter, J. Cant, R. Aroni, R. 2008. Nurses’ views and practices regarding use of validated nutrition screening tools.

Australian Journal of Advanced Nursing. (1). 26-33.

Rowell, DS. Jackson, TJ. 2011. Additional costs of inpatient malnutrition, Victoria, Australia, 2003-2004. European Journal of Health Economics. 12(4). 353-361.

Tannen, A & Lohrmann, C. 2013. Malnutrition in Austrian hospital patients. Prevalence, risk-factors, nursing interventons, and quality indicators: a descriptive multicentre study. Journal of Advanced Nursing. 69(8), pp. 1840-1849.

Natasha Franklin MNUR, CCRN BN, AFACHM PhD student Baker IDI Central Australia Bellberry Indigenous Health Research Recipient

PAGE 33 February 2014 Volume 21, No. 7.

PAGE 34

Aged Care Using tablet technology to improve interactions in residential facilities

By Margaret McAllister Residents of a Churches of Christ Nursing Home, visitors, volunteers, nurses, carers, managers and researchers are all engaged in research that’s turning out to be lots of fun. Family groups are invited to work with health researchers and digital design experts to develop a Tablet App called the Memory Keeper.

At this stage we are in prototype development. We have conducted one information evening and a workshop to produce material such as songs, films, letters and photographs, to be uploaded. We hope to run a few more of these events, until we have the material needed to make fantastic models.

When this is done, we will move to the next phase of the study which is to test how well the tool works in encouraging residents/visitor/staff interaction. In a

larger study, involving training of carers, we intend to examine whether, and to what extent, the tablet can become a digital therapeutic tool assisting in the reduction of agitation, fear, disorientation, loneliness and depression.

ries, achievements and personality and so the benefits flow in several ways, family members gain enjoyment from the visits, researchers are engaged in projects that have social benefit, and older people are enabled to be generative and contribute to enhancement of care for the future.

“In a larger study, involving training of carers, we intend to examine whether, and to what extent, the tablet can become a digital therapeutic tool assisting in the reduction of agitation, fear, disorientation, loneliness and depression.”

The project is funded by the Jo Wicking Trust and is a collaboration between CQUniversity, University of the Sunshine Coast and Churches of Christ Care.

Margaret McAllister is the Professor of Nursing and Deputy Dean Research at CQ University in Queensland, Australia Opposite: Sheila and Arthur Renton working on their memory keeper

Already we have noticed that in the process of research involvement, families are learning something new about each other, and bonds may be strengthened.

Projects such as these provide an opportunity for older people to share their sto-

Impact of aggression

By Jean Booth In 2008 I completed a PhD which looked at the experiences of aged care nurses who cared for residents with dementia that displayed aggression. One of the themes I identified was nurses who cared for aggressive residents tended to be as quick as possible in delivering care for fear of being injured.

we look at the impact of this aggression on the resident?

not only in the best interest of the staff, but also is in the best interest of the resident.

If, as the study reported, nurses deliver care as quickly as possible, then what does this mean for the resident? It would be reasonable to suggest that the care the resident is receiving is not optimal. We could ascertain that this haste does not allow the nurse to thoroughly wash and dry the resident, nor does it allow for the nurse to observe the resident or to maintain therapeutic communication with the resident.

There are two measures that can be taken to address the issues of aggression in nursing homes. One is to ensure that staff receive adequate education in the management of aggression and the other is to ensure that there are sufficient staff employed to care for these residents. Whilst minimum staff numbers are maintained, our efforts to protect both residents and staff will be in vain.

In the words of one nurse, “we get in and out as quickly as possible”. This applied to every contact they had with the resident whether it be feeding, toileting or showering and grooming. In doing so, only the most basic care was delivered to the resident.

It is also important to recognise that this haste in delivering care can further exacerbate the aggression.

Reference

We express concern about the impact of aggression on our nursing staff, but do

While these issues are difficult to resolve, it is important that nurses be aware of the effect aggression and their management of is having on their residents. We need to find a way to manage aggression that is

Booth,J. (2008) It’s just part of the job, isn’t it? Violence and aggression in the nursing home. (Unpublished PhD Thesis) University of Newcastle. Australia

Jean Booth is a Lecturer in Nursing at Latrobe University, Bendigo in Victoria

PAGE 35 February 2014 Volume 21, No. 7.

Focus The importance of culture and A journey – spiritual life for older people: A but where is Practice Development Initiative the start line?

By Ann Harrington

grounds is expected to increase by over 40% between 2011 and 2026.

The Aged Care Accreditation Standards acknowledge the need for cultural diversity, linking culture with spirituality under expected outcome 3.8 ‘Culture and Spiritual Life’.

Spirituality has been found to be an important predictor of quality of life and presents challenges in understanding to an older and increasing diverse population. Clinical auditing by nursing staff in the aged care sector report that there is ambiguity with the documentation around this standard, creating questions as to whether this aspect of care has been delivered to residents.

Ann Harrington

Australian projections in ageing are similar to those worldwide, where it is expected the number of people in Australia aged 85 and over will increase to 1.8 million by 2050. This figure will represent 5.1% of the population. The Productivity Commission emphasised an associated increase in cultural diversity of older Australians particularly their preferences for ‘culturally relevant care’.

According to the Australian Institute of Health and Welfare, around 169,000 older people live in a residential aged care facility (RACF). Although this figure represents only 11% of older people over 65 years of age, for those individuals the RACF becomes their permanent place of residence. Further, 15% of residents in RACFs were born in countries where language other than English is spoken. Australia’s population of older people from non-English speaking backPAGE 36

The role of practice development in nursing, particularly in aged care, provided an opportunity to ensure a continuous process of improvement around patient centred care (Manley et al 2008). Practice development is an opportunity to link academia with the real world of clinical practice. Following the successful award of a grant from Flinders University, a project to identify culture and spiritual needs of residents became a collaborative study between members of Flinders University School of Nursing & Midwifery and a Residential Aged Care Facility (RACF) in South Australia. Thirteen older people across three sites of a RACF in South Australia were interviewed describing what they considered were important in regard to their culture and spirituality.

Using a phenomenological approach to analysis, three major themes were identified that led to the production of a conceptual model to assist health care providers. In addition, information was generated to guide the aged care workforce in the implementation of Standard 3.8, to avoid ambiguity and an appreciation of older people’s diverse cultural practice and spiritual expression.

Reference

Manley, K, McCormack, B, Wilson, V & Thoms, D 2008, The future contribution of practice development in a changing healthcare context. In K. Manley, B. McCormack, & V. Wilson (eds.), International Practice Development in Nursing and Healthcare (pp. 379-395). Oxford: Blackwell.

Ann Harrington is Associate Professor, Health Care for the Older Person in the School of Nursing & Midwifery at Flinders University in South Australia

By Fleur Duane and Di Goeman

Fleur Duane (centre) and a family

Dementia is a journey. It has a beginning, but all too often few people recognise it. Like a motorist with no map or GPS on an unfamiliar country road, best possible outcomes depend on the earliest possible assistance – not just for the driver but for all the passengers who are part of the journey.

Delay in diagnosis and difficulties in accessing appropriate health care services plague dementia care delivery in the community setting, potentiating the risk for misdiagnosis, inappropriate management, poor psychological adjustment and reduced coping capacity and ability to forward plan.

Therefore in 2011, RDNS implemented the specialist role of the Clinical Nurse Consultant – Cognition (CNC) to support generalist nurses in providing holistic and person-centred service for older people and their families who are experiencing memory loss and/or dementia.

This CNC role functioned also to provide support for those people without formal diagnosis through timely arrangement of diagnostic procedures and easing of access to – and coordination of appropriate support services and strategies.

Using processes and tools from the RDNS Dementia Model of Care, the CNC undertook comprehensive assessment

Aged Care of older people referred to the service.

This information was shared with the client’s local doctor and geriatrician to assist in making a diagnosis.

Support of the older person and their family members is also achieved by way of promoting coping capacity, facilitation of advanced care planning and navigation of available in-home services and support programs.

An action research approach was used to refine the CNC role to accord with client and carer/families’ needs and a step-instep-out approach while accompanying the client through their journey. Evaluation of the CNC role demonstrated that not only was the CNC highly regarded by clients but that the role enhanced collaboration between services and created a partnership with Alzheimer’s Australia Victoria.

Clients reported that the relationship with the CNC was integral to their journey of adjusting to changes in their cognition. They cited many benefits including face-to-face contact, and an opportunity

“This CNC role functioned also to provide support for those people without formal diagnosis through timely arrangement of diagnostic procedures and easing of access to – and coordination of appropriate support services and strategies.” to explain their needs and concerns to someone who really listened and did not talk at them.

As part of RDNS’ involvement in the recent National Health and Medical Research Centre Partnership Centre for cognitive and associated functional decline in the elderly, the RDNS Research Institute will undertake a systematic review of dementia related key worker/support roles in Australia and overseas. This will be followed by an evaluation of key worker/support roles currently operating in Australia.

Fleur Duane is an RDNS Clinical Nurse Consultant - aged care/continence and a Nurse Practitioner Candidate (Aged Care) Dr Di Goeman is a Senior Research Fellow at RDNS Institute

Innovation in aged care leadership: Overcoming workforce and care quality issues?

By Associate Professor Yun-Hee Jeon Researchers at the University of Sydney, in partnership with the Baptist Community Services NSW & ACT and University of Technology Sydney are in the final stage of evaluating the Clinical Leadership in Aged Care (CLiAC) Program within community and residential aged care services. The program was developed in response to emerging evidence that effective leadership in aged care is critical to improving the care quality and outcomes for older people, as well as job satisfaction and retention of staff (Wong 2007; Anderson et al 2003 and Castle et al 2007).

The CLiAC is based on the Aged-Care Specific Clinical Leadership Qualities Framework, developed from key findings of a literature review on aged care leadership and management (Jeon et al 2008). The CLiAC consists of four modules delivered by a facilitator in workshops, followed by a practice improvement project of the program participant’s choice, implemented in their workplace.

In addition, mentoring was provided by the facilitator over a 12 month period.

The CLiAC aims to achieve improved work environment and high-quality care by developing the capacity of middle managers to develop effective teams and person-centred and evidence-based approaches to care. The evaluation is the first cluster randomised control trial

to examine the effectiveness of CLiAC compared to usual care, in terms of the work environment, care quality and safety and staff turnover rates. Other outcomes of interest include: cost-benefits, managers’ leadership capacity, staff absenteeism, intention to stay and leave, stress levels and job satisfaction. The findings of the three-year evaluation are expected to be published early in 2014 and will make a significant contribution to addressing issues facing aged care services and policy makers concerned with the provision of safe and quality aged care services. A video describing the views of the program participants, researchers and aged care key stakeholders about the CLiAC and the research can be found at: YouTube www.youtube.com/ watch?v=0HrPBHgBaAQ).

References

Anderson RA, Issel LM, McDaniel RR: Nursing homes as complex adaptive systems: relationship between management practice and resident outcomes. Nursing Research 2003, 52(1):12-21.

Castle NG, Engberg J, Anderson R, Men A: Job Satisfaction of Nurse Aides in Nursing Homes: Intent to Leave and Turnover. The Gerontologist 2007, 47(2):193-204.

Jeon Y, Merlyn T, Sansoni E, Glasgow N: Final report: Optimising the residential aged care workforce: Leadership & management study. 2008.

Wong CA, Cummings GG: The relationship between nursing leadership and patient outcomes: a systematic review.

J Nurs Manag 2007, 15(17576249):508-521.

Associate Professor Yun-Hee Jeon, RN, PhD is located in the Sydney Nursing School at the University of Sydney

“The CLiAC consists of four modules delivered by a facilitator in workshops, followed by a practice improvement project of the program participant’s choice, implemented in their workplace. ” PAGE 37 February 2014 Volume 21, No. 7.

E-health is changing healthcare: Nurses meeting the challenges

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2014 ANMF (Vic Branch) Health and Sustainability Conference: Nurses, midwives and sustainability - we’re all in this together ANMF (Vic Branch) is excited to announce an inspiring program for the 2014 ANMF (Vic Branch) Health and Environmental Sustainability Conference including: • Professor Barbara Sattler, international keynote speaker, from the University of San Francisco • ANMF (Vic Branch) members and health networks providing presentations on practical and achievable ways to improve environmental sustainability at work • Ged Kearney, ACTU President • Fiona Armstrong from the Climate and Health Alliance • Jefferson Hopewell, Sustainable Procurement Officer, Health Purchasing Victoria

Wednesday 5 March 2014 8.45am to 4.30pm Carson Conference Centre ANMF House, 540 Elizabeth St. Melbourne 3000 ANMF member - $120 | Non-member - $200 | ANMF HSR/Job rep - $100 | CPD: 7 hrs

Online registration is now open: http://tiny.cc/14sustconf PAGE 38

Aged Care Management of aged care residents in the emergency department Dr Debra Griffiths, Julia Morphet, Tamsin Jones, Associate Professor Allison Williams, Kelli Innes, Dr Kimberley Crawford and Jo Morey Older people have a greater need for emergency medical care than others in the community, and the number presenting to emergency departments (ED) from residential aged care is increasing (Roberts, McKay and Shaffer 2008). In the case of elderly patients transferred from residential aged care facilities (RACF), many arrive via ambulance and are unable to give a coherent medical history or describe their treatment wishes.

which in turn will improve ED efficiency.

Findings to date highlight that information gaps were prevalent in all cases reviewed (n=408). With respect to the information that was considered to be essential (reason for transfer, past medical history, medication chart, baseline cognitive function, advance directive, vital signs at time of complaint and GP contact details), only 23 (5.6%) arrived with each of the seven essential criteria.

In addition, more than half of the sample were returned to the RACF (n=224, 54.9%), and 110 of these (49.1%) were considered to be potentially avoidable transfers, which could have been managed in the RACF.

In the ED, health professionals are reliant on information regarding a patient’s clinical, functional and social circumstances being communicated to them to provide appropriate, timely care. Insufficient communication between RACF and the ED impede treatment and care, contributing to ED delays (Givens et al 2012). Moreover, any delay in providing care makes the recently introduced ‘National Emergency Access Target’, where patients are to be discharged, transferred out of, or admitted to the treating hospital within four hours (Department of Health and Ageing 2012), difficult to achieve.

Department of Health and Ageing. 2012. National Emergency Access Target 2012 [cited 23/05/12 2012]. www.health.gov.au/internet/yourhealth/ publishing.nsf/Content/npa-improvingpublichospitalsagreement-toc~schedule-c

A group of Monash University researchers are examining the information shared between the RACF and the ED and the

“Insufficient communication between RACF and the ED impede treatment and care, contributing to ED delays (Givens et al 2012).” subsequent care provided within the ED. This study is important because the findings may assist in the reduction of avoidable resident transfers to the ED, and enhance ED patient care decisions,

Nursing people with dementia in hospital

By Robin Digby, Associate Professor Allison Williams and Dr Susan Lee

References

Givens, J. L., K. Selby, K. S. Goldfeld, and S. L. Mitchell. 2012. “Hospital transfers of nursing home residents with advanced dementia.” Journal of the American Geriatrics Society no. 60 (5):905-909.

Roberts, D. C., M. P. McKay, and A. Shaffer. 2008.

“Increasing Rates of Emergency Department Visits for Elderly Patients in the United States, 1993 to 2003.” Annals of Emergency Medicine no. 51 (6):769-774.

Associate Professor Debra Griffiths, PhD, LLM, LLB, BA, RM, RN, Legal Practitioner; Julia Morphet, RN, MN (Education); Tamsin Jones, RN; Associate Professor Allison Williams, PhD MN, RN; Kelli Innes, MN RN; Dr Kimberley Crawford PhD are all at the School of Nursing and Midwifery, Monash University.

Jo Morey, MN, RN is located at Dandenong Emergency Department, Monash Health

Nursing people with dementia can be challenging. Dementia affects memory, thinking, orientation, comprehension, learning capacity, language and judgement, which all impact on the ability of a person to adapt to new surroundings and circumstances (WHO 2012). Being admitted to hospital can escalate anxiety and trigger behavioural symptoms such as agitation, aggression and wandering.

The way the person is treated can mean the difference between acclimatisation, appropriate treatment and a successful outcome, on the one hand, and a problem admission possibly with hospital acquired injuries and a longer length of stay on the other.

It is important to recognise that all patients including those with dementia have their own life story and range of individual needs, PAGE 39 February 2014 Volume 21, No. 7.

NURSING & MIDWIFERY SCHOLARSHIPS

An Australian Government initiative supporting nurses and midwives.

ACN, Australia’s professional organisation for all nurses is proud to work with the Department of Health and Ageing as the fund administrator of this program.

Open 3 March 2014 – Close 18 April 2014 Scholarships for all nurses & midwives are available for: > Continuing Professional Development > Nurse re-entry > Midwifery Prescribing.

Additional scholarships for: > Tasmania

Apply online www.acn.edu.au freecall 1800 117 262 (charges may apply)

> Emergency Departments > Aboriginal Medical Services > Non clinical staff in an emergency department.

An Australian Government initiative supporting nurses and midwives.

Australian College of Nursing, Australia’s professional organisation for all nurses is proud to work with the Department of Health as the fund administrator of this program.

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FedUni offers practical nursing courses at undergraduate, postgraduate and TAFE levels. Combined with a strong working relationship with the local health industry that provides clinical work placements, we’ve got more ways to help future nurses learn to succeed. So when it comes to making your name in nursing, choose FedUni.

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PAGE 40

Aged Care as this significantly impacts on the patient’s perception of hospitalisation. Positive attention and focus from the staff can improve the patient’s experience. It has been shown that there is a direct correlation between nurse stress and patient disruptive behaviours (Lippa 2010). Patients cared for by less stressed nurses have fewer incidents of disruptive behaviour; however nurses who have been the victims of violent behaviour from patients can show a high incidence of stress (Edvardsson et al 2012).

Emotional withdrawal and ‘depersonalisation’ of the patients are common coping strategies in this situation.

Eriksson C, Saveman B-I. Nurses’ experiences of abusive/non-abusive caring for demented patients in acute care settings. Scandinavian Journal of Caring Sciences. 2002;16(1):79-85.

People with dementia can have attributes which make a connection with other people difficult as they may have trouble communicating and understanding the needs of others, and may be uneasy in the presence of unfamiliar people (Eriksson, Saveman 2002). It is sometimes evident that nurses don’t believe that patients with dementia

Robin Digby, Associate Professor Allison Williams and Dr Susan Lee are all in the School of Nursing and Midwifery at Monash University, Peninsula Campus in Melbourne

“It is important to recognise that all patients including those with dementia have their own life story and range of individual needs, as this significantly impacts on the patient’s perception of hospitalisation.” have the capacity to engage in personal interactions and therefore focus on physical tasks. Protests from the patients are then seen as ‘behaviours of concern’ (Marshall 2001). This type of dehumanising behaviour has been termed ‘malignant social psychology’ (Kitwood 1997) and is often displayed by nurses who believe that the behavioural symptoms of dementia are deliberate and in control of the individual rather than a symptom of the condition or a demonstration of unmet need.

Education to increase understanding of dementia and opportunities for reflective practice enable nurses to see behaviour objectively and maintain an empathetic approach in the face of challenging behaviour (Cunico et al 2012).

References

Cunico L, Sartori R, Marognolli O, Meneghini A. Developing empathy in nursing students: A cohort longitudinal study. Journal of Clinical Nursing.

2012;21:2016-25.

Edvardsson D, Sandman P-O, Rasmussen B. Forecasting the ward climate: a study from a dementia care unit.

Journal of Clinical Nursing. 2012;21(7-8):1136-114.

Kitwood T. Dementia reconsidered: The person comes first. Buckingham: Open University Press; 1997.

Lippa CF. Review of issue: The impact of time of day, mood, and caregiver stress on function in patients with dementia. American Journal of Alzheimer’s Disease and Other Dementias. 2010;25(6):475-6.

Marshall M. The challenge of looking after people with dementia. British Medical Journal.

2001;323(7310):410-1.

WHO. Dementia A Public Health Priority. In: International AsD, editor. Geneva, Switzerland: World Health Organization; 2012. p.1-102.

Online tool gives access to residential aged care research

By Roma Dicker and Sarah Hayman There is increasing pressure on nurses in all areas to find and use evidence to support the best nursing practice and this is true in residential aged care as in all other fields. However reliable evidence for aged care can be very difficult to access quickly.

To assist all those working in residential aged care, CareSearch has provided free online tools to ensure that all those caring for older Australians in residential aged care can have reliable and easy access to the latest research information, about both residential aged care and dementia in residential aged care. The tools can be found on the CareSearch website as part of the RACHub service at: www.caresearch.com.au/caresearch/ tabid/2256/Default.aspx.

One challenge for searching is the huge amount of information that is available online and steadily increasing. Articles on residential aged care are added to PubMed at a rapidly growing rate (results obtained using the Residential Aged Care Search Filter show that over 1,800 items were added in 2012. Already since October 2013, over 2,000 have been added). A second challenge is the difficulty of knowing where to look and which search terms will retrieve useful information. Busy clinicians do not have time to spend creating complex search strategies, and may not have much experience in constructing effective searches.

CareSearch has created the tools using a search filter to target residential aged care information in the PubMed database.

The service is free to use and gives easy one-click access to current information PAGE 41 February 2014 Volume 21, No. 7.

Asthma Educator’s Course This 3 day course covers the latest advances in asthma care & provides participants with the knowledge & skills to work effectively with people with asthma to improve their health outcomes. (NB: Optional 4th day on education & presentation skills.)

5 – 7 March 16 - 18 July 12 - 14 November Respiratory Course This two part, 5 day course is for participants wanting to update & increase their skills & theoretical knowledge in the area of respiratory care & holistic management of the person with respiratory illness.

7 – 9 May / 11 – 12 June 3 – 5 September / 15 – 16 October Theory & Practice of Non Invasive Ventilation – Bi-level & CPAP Management This comprehensive & practical day course is for participants wanting an increased understanding of & skills in the management of NIV, Bi-level & CPAP from the ICU to the community carer.

13 June Managing COPD This 2 day program is for participants wanting to improve their understanding of & update their knowledge in the current treatment & management of COPD. 20 – 21 March 23 – 24 October Smoking Cessation Course This 2 day, evidence-based course aims to give participants the knowledge & skills to treat & manage nicotine dependency to help people addicted to smoking to quit.

27 - 28 March 24 - 25 July 20 - 21 November For further information about these & other courses contact the: Lung Health Promotion Centre at The Alfred Phone: (03) 9076 2382 E-mail: lunghealth@alfred.org.au

www.lunghealth.org

PAGE 42

relevant to residential aged care. The RAC Search Filter is a tested effective search strategy, developed using an empirically tested method (Tieman and Hayman 2013). It embeds technical searching expertise to save busy clinicians time and effort in creating their own searches.

Importantly, the search filter development was guided by an expert advisory team with a significant level of clinical expertise and experience. They provided valuable advice about the terminology used in the sector and the information that is clinically useful in a residential aged care setting.

The Expert Advisory Group also provided advice on the particular topics of interest to nurses and others working in this field.

For these topics, the team has created targeted expert searches, to give simple one click access directly to the topics of interest. Members of the Expert Advisory Group were researchers, managers and nurse educators from Australian residential aged care organisations.

The outcome of this project has been a service which was launched in October 2012 as part of the RAC Hub on the CareSearch website (CareSearch 2012).

Nurses and other residential aged care staff can go to the pages within the Literature and Resources section of the RAC Hub on the CareSearch website and search for information on aspects specific to residents (such as Advanced Care Planning or Nutrition and Hydration); aspects relating to the residential aged care workforce (such as Multidisciplinary teams or Self Care) or aspects relating to providers and facilities (such as Policy or Quality of Care).

Once there, users can choose to see only those references that are immediately available as whole articles and free to view.

CareSearch recognises that many people who work in the RAC setting do not have access to large libraries with commercial subscriptions to journals. Hence this is a free service that does not require a logon and is straightforward to use.

Searching for literature in residential aged care can be difficult because of the many variations of terms used worldwide and even between Australian states. In developing the search filter, the project team undertook extensive testing of the many terms used in the sector (such as “homes for the aged” “nursing homes, “care homes” and “residential aged care”). They then determined

which terms performed most effectively in retrieving the articles deemed to be relevant by the expert clinical advisors.

Thus this is a robust search, effective in returning relevant items to those working in residential aged care in Australia. For those interested in the technical detail; the RAC search filter has a sensitivity rating of 73% in the gold standard set from which it was developed and a rating of 83.47% for precision in the post hoc relevance test (Tieman and Hayman 2013).

The Dementia Search Filter is also available in the RAC Hub, with a different set of special topic searches relevant to dementia care in residential aged care (CareSearch 2013). This works in the same way as the Residential Aged Care Search filter and its associated topic searches.

The Dementia Search Filter was created with funding from HammondCare and was also guided by an Expert Advisory Group who provided expert clinical advice. Terms relevant to the field of dementia were identified and systematically tested to enable the creation of an effective and trustworthy search strategy for literature about dementia in a palliative care context.

CareSearch encourages readers to make use of this free service and to contact the service with any questions, comments or suggestions.

References CareSearch Palliative Care Knowledge Network. 2012.

RAC PubMed Topic Searches. Bedford Park, SA : Flinders University. Available from http://www.caresearch. com.au/caresearch/tabid/2437/Default.aspx CareSearch Palliative Care Knowledge Network. 2013.

Dementia in RAC Topic Searches. Bedford Park, SA: Flinders University. Available from http://www.caresearch.com.au/caresearch/tabid/2793/Default.aspx Tieman, J. and Hayman, S. 2013. Residential Aged care Search Filter Project. Bedford Park, SA : Flinders University. Available from http://www.flinders.edu.au/clinicalchange/research/flinders-filters/projects/caresearch-residential-aged-care.cfm [accessed October 24, 2013]

Roma Dicker is a nurse with experience in aged care, currently an academic staff member of Flinders University, School of Nursing and Midwifery.

Sarah Hayman is a librarian, currently Research Fellow at CareSearch Palliative Care Knowledge Network, Flinders University

Aged Care Therapeutic seals come to Townsville

By Marie Bodak, June Harwood, Mary Pether and Melanie Birks

shopping centres and the facility’s café and hairdresser donated gift vouchers for raffles that formed a major part of the fundraising activities. Family members and contractors at the facility also made donations of cash. A cookie drive, sales from homemade preserves and a ‘walk around for Paro day’ ensured sufficient funds were raised to purchase a robot seal. The outgoing CEO of the facility made a commitment to match the funds raised dollar-for-dollar from Freemason’s donations. This additional money enabled the purchase of a second seal.

The seals were unveiled on 19 September 2013, but were at that stage unnamed. A competition was held with two $100 gift vouchers on offer to ‘name the Paro’. All staff, residents, family and friends were invited to enter. In October 2013, two residents drew the names out of a box and the seals were subsequently officially named ‘George’ and ‘Sally’.

People working with our aged citizens are usually the unsung heroes of the health care system. Working in residential care facilities can be physically and emotionally demanding, yet usually attracts lower salary and less status than other areas of health care. What it also attracts, are individuals with a commitment to improving the quality of life of elderly members of our society. This commitment has certainly been demonstrated by staff at the Masonic Care facility in Townsville, Queensland who joined forces to ensure that those under their care had the opportunity to benefit from advances in therapeutic technology.

Companion animals in aged care facilities are relatively commonplace these days.

Increasingly, however, we are starting to see the introduction of socially responsive robots with numerous positive effects for those who are given the opportunity to interact with them. At the Townsville Masonic Aged Care facility, the potential advantages of using therapeutic robots has seen staff rally to fundraise for the purchase of two Paro robotic seals. June Harwood, the facility manager, had used Paro seals in a nursing home in Western Australia. Having seen how effective that program had been, she was keen that the seals be introduced at the facility.

The decision to introduce the seals was made by the centre’s lifestyle team. Research by the activity department identified the costings and potential application to the dementia program. The identified benefits of introducing the seals supports the growth of the facility as a centre of excellence in dementia care and the program reflects the ethos of Masonic Care.

As the robotic seals are not currently recognised as therapeutic tools, it was not possible to purchase them from the facility’s funding. Staff of the centre therefore rose to the challenge and commenced a period of fundraising from May to August, 2013. Traders from local

Some research into the use of seals as a therapeutic tool has been undertaken both in Australia and overseas, with the focus of those studies largely being on people living with dementia. In order to explore the value of the robotic seals more broadly, June Harwood and care manager Mary Pether, in conjunction with Marie Bodak and Melanie Birks from James Cook University, will be implementing a research study in 2014 that will examine the impact of the program on the wellbeing of residents. Positive findings from this work will be an important validation of the level of commitment shown by the staff, friends and family of the residents of Masonic Care Townsville.

Marie Bodak, RN, BN, PGCertNSc (Clinical teaching), Lecturer, School of Nursing, Midwifery and Nutrition, James Cook University, Townsville Qld June Harwood, RN, RMS, BNS, Facility Manager, Masonic Care Queensland, Townsville Mary Pether, RN, Care Manager , Masonic Care Queensland, Townsville Melanie Birks, RN, BN, MEd, PhD, Professor of Nursing, Teaching and Learning, School of Nursing, Midwifery and Nutrition, James Cook University, Townsville Qld

PAGE 43 February 2014 Volume 21, No. 7.

Subscribe to the new look ANMJ call (03) 9602 8500 or email cathy@anmf.org.au

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PAGE 44

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Aged Care Osteoarthritis: More than a stiff joint

By Dr Lea Budden with activities of daily living and these people are usually older family members.

Research is continuing to focus on preventative and management of arthritis and its pain and disability. Unfortunately, there does not seem to be any major advances for this disease in the immediate future.

The preventative advice is to reduce the risk and disability of osteoarthritis and maintain a healthy weight, reduce the occurrence of joint injuries where possible and avoid repetitive joint activities such as kneeling etc. (AIHW 2010). Arthritis Australia provides some invaluable information and support about managing this painful and disabling disease for sufferers and their carers.

References

Access Economics Pty Limited. (2007). Painful realities: The economic impact of arthritis in Australia in 2007. Sydney: Arthritis Australia.

AIHW. (2010). Medication use for arthritis and osteoporosis. Canberra: AIHW Retrieved from www.aihw.gov.au/ publication-detail/?id=6442468332

Osteoarthritis is one of over 100 types of arthritis and a major chronic health problem for many older Australians aged 45 years and over.

Over two million adults in Australia suffer with this condition and it is one of the most common reasons for visiting GP clinics (AIHW 2011; Arthritis Australia 2012). The disease can be caused by trauma and ageing breakdowns in the articular cartilage. These changes lead to inflammation of body joints, pain, stiffness and often disability. The most frequently affected joints are those which are weight bearing such as hips, knees and spine (AIHW 2010). This condition is more common in females and Aboriginal and Torres Strait Islander people (AIHW 2011).

Some individual factors are associated with osteoarthritis such as being overweight or obese. People who suffer with this disease often have other comorbidities such as ischemic heart disease, osteoporosis, hypertension, mental disorders, back pain and disc disorders (AIHW 2010). Osteoarthritis is a major reason for people to undergo knee and hip replacements and a cause of huge health expenditure (in excess of $1 billion per year) in Australia (Access Economics Pty Limited 2007).

The most common medication management of osteoarthritis is to treat the symptoms with the use of analgesia and anti-inflammatory medication.

AIHW. (2011). Population differences in healthcare use for arthritis and osteoporosis in Australia.

Canberra: AIHW Retrieved from www.aihw.gov.au/ publication-detail/?id=10737419754.

AIHW. (2010). A snapshot of arthritis in Australia 2010. Canberra: AIHW. Arthritis Australia. (2012). Whose problem is it anyway? The voices of GPs on Arthritis. Retrieved from www.arthritisaustralia.com.au/index.php/reports/thevoice-of-gps-on-arthritis-2012.html

Dr Lea Budden is the Student Experience Coordinator Senior Lecturer in the School of Nursing, Midwifery & Nutrition at James Cook University in Townsville Queensland

Sufferers of this condition, mostly women, commonly use complementary medicine and treatment to help ease their pain and discomfort. Women in the higher economic group are more likely to use complementary modalities even though osteoarthritis is more common in the lower socioeconomic population (AIHW 2010). People with severe osteoarthritis often need personal carers to help them

“The most common medication management of osteoarthritis is to treat the symptoms with the use of analgesia and antiinflammatory medication�

PAGE 45 February 2014 Volume 21, No. 7.

Calendar FEBRUARY

5 March, Carson Conference Centre, ANMF House, 540 Elizabeth Street, Melbourne

1st International Conference on Clinical Teaching / Learning in Nursing and Health Sciences Conference Clinical Teaching / Learning in Nursing and Health Sciences 10-12 February, Jeddah, Kingdom of Saudia Arabia, Western Region, Saudi Arabia. http://nhsc.ksau-hs.edu.sa/ We Can Walk it Out Turning the Tan teal in aid of Ovarian cancer research awareness 16 February Every year the Women’s Cancer Foundation holds the We Can Walk it Out Fun Run/Walk.

Located around the famous Tan (Victoria), participants can choose to run either 4km or 8km or walk 4km. Open to people of all ages, and even your special pet pooch. We Can Walk it Out is a fun day for the entire family. http://www.womenscancerfoundation.org.au/ index.htm 2nd Annual National Forensic Nursing Conference 20-21 February, 2014, Sydney http://www.healthcareconferences.com.au/ healthcare-conferences/healthcare/nationalforensic-nursing-conference

MARCH

Lung Health Promotion Centre at The Alfred 4 March, Educating & Presenting With Confidence 5-7 March, Asthma Educator’s Course 20–21 March, Managing COPD 27–28 March, Smoking Cessation Course Lung Health Promotion Centre at The Alfred

APRIL

Online registration now open: http://tiny.cc/14sustconf

Australian Pain Society’s 34th Annual Scientific Meeting

‘Diabetes Update’ study day with Kathy Mills, RN, MEd, Credentialed Diabetes Educator

Personalised Pain Management – Quest for the Holy Grail

For enrolled and registered nurses covering contemporary and evidence based research on dietary, exercise, psychological and pharmacological management of diabetes mellitus. Date: Friday 7 March from 9am-4pm at IEMML, 6 Lakeside Drive, Burwood East. There is free onsite parking. Morning tea, lunch and notes are provided. Eligible for six hours CPE. Cost: Early bird special (pay by Friday 21 February) is $220. Full registration fee: $250 All initial queries to Kathy via email only at diabetes.ed@optusnet.com.au

13-16 April, Hotel Grand Chancellor, Hobart.

Health–e–Nation Leadership Summit Powerful health connections 25-27 March, Shangri-La Hotel, Sydney NSW. Leaders from health care, government and IT take the opportunities the one day Summit and associated meetings provide to shape next steps and connect across the health industry.

Health is powered by information and relationships – with people, concepts & organisations.

All are in plentiful supply at Health-e-Nation. In a time of unprecedented change Health-e-Nation stays true to its focus – taking care of business, the business of health in all its guises – while looking after the individual – you. http://www.health-e-nation.com.au/ ehomeindexhp?eventid=66856& 3rd Annual Electronic Medication Management Conference 25-26 March, Sydney Harbour Marriott, NSW.

http://www.dcconferences.com.au/aps2014/ Lung Health Promotion Centre at The Alfred 28–29 April Spirometry Prinicples & Practice Lung Health-Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

MAY

Australian & New Zealand Disaster and Emergency Management Conference Earth, Fire and Rain 5-7 May, QT, Gold Coast http://anzdmc.com.au Lung Health Promotion Centre at The Alfred 7-9 May / 11-12 June, Respiratory Course 7–9 May, Respiratory Course (Module A) 29 May, Respiratory Update Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

JUNE

Lung Health Promotion Centre at The Alfred

ANMF (Vic Branch) Health and Sustainability Conference

This event will act as an interactive meeting place for clinicians, pharmacists, vendors, LHDs and policy makers to allow for open discussion and knowledge sharing on how eMM can be best implemented, managed, maintained and further integrated into the health care setting.

11–12 June, Respiratory Course (Module B) 13 June, Theory & Practice of Non Invasive Ventilation – Bi-Level & CPAP Management 18 June, Asthma Management Update 19-20 June, Spirometry Principles & Practice 25 June, Paediatric Respiratory Update Lung Health Promotion Centre at The Alfred

Nurses, midwives and sustainability – we’re all in this together

www.healthcareconferences.com.au/emedicationmgmt14

Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

Ph: (03) 5571 1174 or Glenys Zerbst Email: bgzerbst@bigpond.net.au Mobile: 0414 784 503

17 May 2014 at RACV Club, Melbourne. Contact Chris Fautley Email: chrisfau@netspace. net.au Ph: (03) 9347 3546 or Sue Scott Email: sue. scott@rch.org.au

Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au

Network

Lister house – what are your memories?

From 1950 to 1989, Lister House at 37 Rowan St, Bendigo was home to the Northern District School of Nursing (NDSN). The NDSN Graduates Association is compiling a history of the NDSN in order to publish a book. This is an opportunity for you to contribute anecdotes, photographs and experiences of your time at Lister House. Please contact Jenny on 03) PAGE 46

54427857 or kayjay@netcon.net.au or Fay on 03) 5443 8280 or flyawayfay@ gmail.com or Joan on (03) 5443 6850 or joan.o@bigpond. com or mail to PO Box 509, Bendigo 3552 Alfred Hospital 174 40th reunion 1 March 2014.

Archives tour at hospital 1030. Lunch 1200. RSVP either Kerry Seymour Email: k.seymour@cgmc. org.au Mobile: 0432 892 133; Judy Esson

The Queen Elizabeth Hospital, Woodville, SA, March 1974 PTS, 40–year reunion 9 March 2014.

Contact Margaret Chalk (nee Kerr) Email: chalk77@ bigpond.com Mobile: 0418 434 280 or Pamela McPherson (nee Hancock) Email: p.mcpher@ activ8.net.au Mobile: 0404 849 567

Geelong Hospital Nurses League 80th annual reunion and AGM 15 March 2014. If you have a connection to the Geelong Hospital (Barwon Health), are a past trainee or current employee and are interested in attending this reunion please contact Bev Lodge Ph: (03) 5243 7794 or email: terrylodge@ bigpond.com Royal Children’s Hospital past trainees and RCH Grads reunion

John Fawkner Private Hospital / Sacred Heart Hospital celebrates its 75th anniversary October 2014. We are seeking memorabilia, old photographs, uniforms, books, instruments, stories etc. from past staff, doctors and students.

An open day and other activities are planned for this milestone event. Contact Chris Papas, Executive Secretary at chris.papas@ healthscope.com.au or Ph: (03) 9385 2501 Royal Adelaide Hospital Nurses Training, Group 895, 25-year reunion 29 November 2014 in Adelaide, at a venue to be announced. Please contact Julia Curley for further details Email: juliacurley@ hotmail.com

Mail designing a “Caring for your Soul” brochure and including “psychosocial and spiritual care” in my GP management plan template.

Spiritual health care is not about simplifying spiritual life, providing formulas, denying difficulties or minimising them or offering shortcuts.

It is about being a companion, giving significance to difficulty, conversation and LISTENING, helping to lighten loneliness and maintain hope (Petersen, 1992).

There are a number of spiritual health assessment tools already in use around the globe and varying degrees of spiritual care.

Spiritual health care The decline of Christendom, the secularisation of Australia, the rise of New Age practices and other world religions has, I believe, resulted in many Australians experiencing a soul disconnection; an impoverished spiritual health.

I am in the early stages of developing a model of spiritual health care – assessment, care planning, facilitating, advocating (things nurses do well anyway) - that could be used by nurses in all fields regardless of personal beliefs and convictions and those of their patients. Spiritual health assessment could be as confidently undertaken as vital signs or health history. My efforts so far are limited to

Adequately addressing Borderline Personality Disorder Dear Registered Nurse, Victoria, Thank you very much for your response to the article “New BPD Management Guidelines” which was published in the October 2013 ANMJ. You are right to point out that not only people suffering with BPD, but also their families, carers and support people require care and deserve compassion, kindness and appropriate information and guidance from nurses and other health professionals.

You may be heartened to learn that a suite of organisations, including Spectrum and the Borderline Personality Disorder Foundation of Australia (which was officially launched in October 2013) have been working hard to improve outcomes for both suf-

To my knowledge spiritual care in the acute and residential settings is limited to perhaps a question in the history regarding religious affiliation, and a small section in a care plan, with any care being left to visiting clergy. In the primary care or community setting addressing spiritual needs is mostly non-existent unless a nurse or GP has an interest in the area.

I would like to hear from any nurses who have encountered any measure of spiritual health care in the course of their work or • used a spiritual assessment tool or • identified spiritual stress or • written spiritual care into a care plan or • anything else you think may be relevant to my quest.

Please contact Christine: cadgschreiber@gmail.com

Reference:

Petersen, E. (1992). Five Smooth Stones for Pastoral Work (Kindle version). Grand Rapids, MI: William B. Eerdmans Publishing Co

Letter of the month: Pressure area care has always been essential It is with concern that I read the article in the Dec/Jan ANMJ regarding the lack of pressure area care (PAC) in the acute sector as if it is a new part of our care. I did my training at the Alfred Hospital in 1964 and it was a very important part of our learning. My colleagues today have often heard me say if you do not do the basics you end up with a technical problem, ie a decubitus ulcer. We were also taught to tauten the bottom sheet as crinkles in bottom sheets mark the patients/ residents skin and can cause a wound especially on fragile skin. Also the top sheet needs to be anchored properly over the top of the mattress to prevent slippage. The most vulnerable areas are the sacrum, hips and heels I have been working in aged care for a long time now and have always attended to pressure area care.

Pam Miller RN, Victoria

The winner of the ANMJ best letter competition receives a $50 Coles Myer voucher.

If you would like to submit a letter to the ANMJ email anmj@anmf.org.au

Christine Schreiber RN, Practice Nurse ferers of BPD and their carers and families.

Both of these organisations offer information and support and can also direct you to other organisations that are working to assist the carers and families of people with BPD. Information, support strategies, counselling and peer support are all available through a range of networks and services. Where suffers have died from their illness, their loved ones can receive compassionate support from others who have also lost someone to this disorder through peer support initiatives. To access these services please contact Spectrum on (03) 8833 3050 or via the website at www.spectrumbpd.com. au Alternatively, please contact the BPD Foundation via the BPD Foundation website at www.bpdfoundation.org.au For doctors in general practice, 2013 has seen Spectrum launch the BPD Clinic. This

service can be accessed by GPs who may be looking for diagnostic clarification. The service offers a one off, bulk billed second opinion by a psychiatrist with specialised BPD experience. Where a possible diagnosis of BPD is confirmed, the service provides GPs with a range of recommendations which aim to set the direction of treatment and support the GP in their ongoing care of the individual. Further information on this service may be gained by telephoning Spectrum on (03) 8833 3050.

I hope you find this information useful and that these resources assist nurses and others to support families and those who care for or about (or have cared for or about) an individual with BPD. Narelle Everard, RN, BN, PG Dip Health Promotion, Bachelor of Law, Senior Nurse, Spectrum PAGE 47 February 2014 Volume 21, No. 7.

Yvonne Yvonne Chaperon, Assistant Federal Secretary

A big year ahead Welcome back to the ANMJ for 2014! I hope you enjoyed a wonderful break over the summer and were able to kick back and enjoy life.

I also hope you are all energised as 2014 is going to be a big year for us.

As you may know the previous Labor government announced a $1.2 billion funding boost for aged care nurses and carers in March 2013.

You will no doubt recall our Because We Care Campaign where we lobbied formally for over four years to secure this money to close the wages gap in aged care in order to attract and retain nurses and carers in the aged care sector. This money became known as the Workforce Supplement.

Last December the federal government axed this $1.1 billion wage improvement (originally set at $1.2 billion) for low-paid aged care nurses and assistants in nursing. This Workforce Supplement was to go directly to the workers pockets to increase their wages and improve their working conditions. While some workers have already gained a pay increase, the cessation of the wage supplement will prevent all workers receiving the cash. Unfortunately, the coalition government used its numbers in Parliament to vote against Labor’s earlier move to restore the $1.1 billion Workforce Supplement. This was done without any real consultation or consideration from the government and certainly no consultation with the ANMF. It is clear that the government has chosen to place the profits of some aged care providers ahead of the interests of thousands of frontline nurses and care workers across the country by scrapping this supplement. The government owes an explanation not only to the nurses and aged care workers robbed of their wage rise, but to the elderly Australians they care for each and every day.

Interestingly during the Howard government years over $877 million was allocated to wage increases for aged care nurses and care workers. This money NEVER reached the pockets of those workers. The money was not tied to an enterprise bargaining agreement, so did not fund pay rises as it should have. In this latest funding round, the ANMF were careful to make sure that the $1.2 billion would reach nurses and care workers via an enterprise bargaining PAGE 48

agreement. This was agreed to, but at the eleventh hour it became apparent that this agreed position had shifted.

The current government intends to reallocate the agreed workforce funding into general aged-care funding instead and we are concerned that if funding didn’t reach nurses and care workers in previous funding allocations, it certainly won’t reach them now.

The ANMF had been invited to be a member on a newly created Workforce Supplement Committee and we will keep you informed of developments as they come to hand.

Now on a lighter note, I would like to welcome all the new nursing and midwifery graduates to the nursing and midwifery profession.

The health care sector in Australia is challenging and as new graduates in our health system you will play an important role in contributing to the wellbeing of all Australians. You may not realise, but as you rely on the skills and knowledge learnt in your undergraduate program and gain professional confidence, you are becoming our future generation of health practitioners and leaders in our profession.

I recall my first weeks on the ward as a new graduate. It was at the Royal Melbourne Hospital and I was on the burns and colorectal unit. It was a very busy surgical unit. I had spent the previous three years day dreaming about that WHITE FROCK with Staff Nurse embroidered on it that I hoped to wear one day. Getting ready for my first shift as a “staff nurse” was thrilling, but also daunting. So when I pushed open the ward door and walked through, down the long corridor to the nurses’ station I felt so proud. Then a patient called out “sister” and I thought that patient was calling for someone more senior! No….they were calling me. This is when the realisation hit me - this is what I had worked so hard for and I was finally a ‘real’ nurse.

So please enjoy your graduate year. It will be daunting and you will learn so much.

As new grads we feel pressure that we are expected to know everything – well you are not. Make sure you feel supported and ask lots of questions. This is your year to consolidate your undergraduate learning. It was one of the best years of my life and I hope it is for you too.

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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.

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