A U S T R A L I A N N U R S I N G & M I D W I F E RY J O U R N A L VOLUME 22, NO. 5
N OV E M B E R 2 014
TAKING THE LEAD Nurses, midwives and leadership
Ausmed Education Online Learning | Conferences | Publications
Children's Conference A two-day conference for nurses to learn a broad range of current aspects of paediatric nursing care.
Melbourne 18-19 December 2014 Book Now: www.ausmed.com.au Ph: (03) 9326 8101
11 Hrs of CPD
To book or to learn more, visit www.ausmed.com.au
MONTH TO GO
Australian Nursing & Midwifery Journal - www.anmf.org.au
Editorial Lee Thomas, ANMF Federal Secretary Last month I joined nurse leaders from around the globe for the 20th International Workforce Forum of the International Council of Nurses (ICN) held in Sydney. At this forum we universally acknowledged that current trends of governments are to view nursing as a cost rather than an investment. This conclusion was based on short term financial considerations, poor or inadequate workforce planning and inappropriate role substitution, experienced across the globe. This trend is deeply concerning, as inevitably such short sighted measures impact quality standards of healthcare which ultimately harms the patients we care for. If we want quality healthcare, it can only be delivered if there is sustainable investment in nursing and midwifery professions at all levels. During the forum we affirmed our responsibility as nursing and midwifery leaders to ensure governments value and recognise nursing and midwifery in the delivery of healthcare. What we need is investment in our valuable workforce to sustain our healthcare sector. The forum also recognised that nursing and midwifery leaders assume important leadership roles for the future of our professions. We therefore committed to continue supporting all nurses and midwives who are prepared to advocate for quality healthcare at the highest level of national and international policy making, so that governments understand the importance of universal healthcare.
It is vital we have strong nurse and midwifery leaders at all levels and that they are supported and mentored in order that they are able to continue to advocate on behalf of communities and the health systems. Aptly, ANMJ’s feature addresses nurse and midwifery leadership. Some of our most inspiring nurse leaders from around the country talk about the qualities and attributes they think make good leadership. This month’s Focus section looks at men’s health, which is fast becoming an essential and growing specialty in healthcare. There has been much development surrounding the healthcare needs of men, particularly in relation to encouraging and providing support for men to become more proactive in looking after their own healthcare needs. Many of these programs, along with research into health issues for men, have been developed by those from our professions. Before I sign off I urge you all to donate to the Red Cross appeal to combat the deadly Ebola virus, ravaging countries across West Africa. It’s important we work together to treat victims of the disease, to ensure the protection of healthcare workers, and to stop the disease from spreading further across countries in West Africa. Proceeds from Red Cross’ Ebola appeal will assist with training programs for local health professionals in affected areas and the purchase of personal protective equipment in West Africa.Go to the ANMF website to donate: http://anmf.org.au/
November 2014 Volume 22, No.5 1
Australian Nursing & Midwifery Federation National Office www.anmf.org.au
3/28 Eyre Street, Kingston ACT 2604 Phone (02) 6232 6533 Fax (02) 6232 6610 Email email@example.com
Photographer: Irene Dowdy Pictured: Commonweatlh Chief Nurse and Midwifery Officer, Rosemary Bryant and ANMF Federal Secretary Lee Thomas.
Melbourne & ANMJ
Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email firstname.lastname@example.org
Federal Secretary Lee Thomas
Assistant Federal Secretary Annie Butler
Editor: Kathryn Anderson Journalist: Mustafa Nuristani Production Manager: Cathy Fasciale Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email email@example.com
The Media Company, Jana Gungor Phone (02) 9909 5800 Fax (02) 9909 5810 Email firstname.lastname@example.org
Design and production Design: Daniel Cordner Printing: AIW Printing Distribution: D&D Mailing Services
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: email@example.com
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: firstname.lastname@example.org
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: email@example.com
Branch Secretary Lisa Fitzpatrick Office address ANMF House, 540 Elizabeth Street, Melbourne Vic 3000 Postal address PO Box 12600 A’Beckett Street Melbourne Vic 8006 Ph: (03) 9275 9333 Fax (03) 9275 9344 Information hotline 1800 133 353 (toll free) E: firstname.lastname@example.org
The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia. Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement. All rights reserved. Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrangement with the Australian Nursing & Midwifery Federation Federal Office Note: ANMJ is indexed in the CUMULATIVE INDEX to NURSING AND ALLIED HEALTH LITERATURE and the INTERNATIONAL NURSING INDEX ISSN 2202-7114
Moving state? Transfer your ANMF membership
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: email@example.com
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: firstname.lastname@example.org
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: email@example.com
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: firstname.lastname@example.org
2 November 2014 Volume 22, No. 5
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.
Total Readership: 143,792* *Based on ANMJ 2014 member survey showing readership pass along rate of 1.46 Source: BCA verified audit, September 2014
Volume 22, No 5.
Professional 17 Feature 18
Taking the Lead Nurses, midwives and leadership
Clinical update / Education
Legal 29 World 30 Clinical Review
Wellbeing 32 Focus 33 Mail 44
Personal Development is Professional Development
Clincal update / Education
Alzheimer’s disease study
November 2014 Volume 22, No.5 3
OUMâ€™s innovative teaching style is fantastic and exciting. Truly foreword thinking, OUM allows the student to benefit from both local and international resources. Brandy Wehinger, RN OUM Class of 2015
RN to MD
Make the dream of becoming a doctor a reality, earn your MD at Oceania University of Medicine. n Attractive fee structure for our Graduate Entry Program. n Over 150 students currently enrolled and over 50 graduates in Australia, New Zealand, Samoa and USA. n Home-based Pre-Clinical Study under top international medical school scholars, using world leading Pre-Clinical, 24/7 online delivery techniques. n Clinical Rotations can be performed locally, Interstate or Internationally. n Receive personalised attention from your own Academic Advisor. n OUM Graduates are eligible to sit for the AMC exam or NZREX.
Applications are now open for courses beginning in January and July - No age restrictions
OCEANIA UNIVERSITY OF MEDICINE INTERNATIONALLYâ€ˆACCREDITED For more information visit www.RN2MD.org or 1300 665 343
Send Money Online Anytime, Anywhere Instant Cash Pickup Bank Account Mobile Account Door to Door Delivery
Fees from $3.99
If you are a clinician, manager, policy maker or quality manager in health care, you probably see the need for change every day. Do you think, with the right skills you could make a difference? The Joanna Briggs Institute is offering the Evidence-Based Clinical Fellowship Program to help empower you to improve patient outcomes and give you and your career, the LEAP forward you know you deserve. This course will give you the skills to: Lead your team in an Evidence implementation project of your design, Audit for improvement in health outcomes, and, Publish your findings. To find out more visit: www.joannabriggs.org
...make the LEAP! Fellows Journal advert (#3).indd 1
www.joannabriggs.org 1/08/2014 11:05 am
Aussie nurse volunteer urges health professionals to fight Ebola Registered nurse Sue-Ellen Kovack, who tested negative for Ebola after working in West Africa, does not want the media hype that occurred over her fever during isolation to deter any future health personnel from volunteering. Sue-Ellen, who featured in ANMJ’s September issue for the work she does in remote Queensland communities, recently returned from Sierra Leone where she volunteered for the Red Cross in response to the Ebola crisis. On her return to Australia Sue-Ellen was admitted to Cairns hospital with a fever, sparking concerns she had been infected with the Ebola virus. The news of her potentially contracting the disease created national media frenzy. However it was soon found she was negative for the virus.
support from her family, friends and many from Australia and around the world had been overwhelming and emotional, she wanted to bring the focus back to the tens of thousands of people directly affected by Ebola in West Africa. “Four thousand have lost their lives, and over 8,400 have been infected in total. That means more than 40,000 people have family members that have either died or become infected. “Most importantly for me, I’m sending a message to my fellow medical professionals who are thinking about heading over to treat the sick and work at bringing Ebola under control: Please, please do it.” Australian Nursing and Midwifery Federation (ANMF) Federal Secretary Lee Thomas said she was relieved to hear that Sue-Ellen’s initial tests for Ebola were negative.
Sue-Ellen said it was a huge relief that the tests had cleared her of having the Ebola virus. “It confirms that our protection and safety measures are working well.”
Ms Thomas also reiterated that the risk of contracting Ebola was extremely low. “To quote the Queensland Chief Medical Officer, Dr Jeannette Young: ‘While Ebola is a very serious disease, it is not contagious and cannot be caught through coughing or sneezing’.”
While Sue-Ellen said the outpouring of
According to Ms Thomas personal
protective equipment and other significant resources for front-line health workers to help them as they treat Ebola victims in West Africa were still desperately needed. “The Red Cross Ebola Appeal is raising money to assist with training programs for local health professionals in the affected areas and the purchase of personal protective equipment in West Africa. I strongly urge members and the wider community to donate generously to this appeal to ensure victims of this disease are treated, healthcare workers on the ground are protected and importantly, stop the disease from spreading even further across Africa.” In addition Ms Thomas said it is crucial that the Australian government give more support to the fight against Ebola. “Australian nurses are highly skilled and have a strong history of volunteering in overseas countries. Their efforts should be commended and fully supported by the government. “It’s crucial that the Australian government give more support to the fight against the growing Ebola virus.”
To donate to the Red Cross Appeal go to: http://anmf.org.au/ November 2014 Volume 22, No.5 5
News ANMJ continues as a leading source of information ANMJ continues to be a popular source of information and news for nurses and midwives, according to a recent survey. The survey received a large response from ANMF members across the country, who indicated that the journal was a good source of information about the union (97%) and about nursing and midwifery (96%). More than 89% said the journal was easy to read and professionally prepared. While 96% said the ANMJ was interesting and informative, over 90% said the contents were timely and current.
(Left to right) Tayla Smith and Kayla Bailey
Indigenous youth up for the challenge Two young students say health disparities between Indigenous and non-Indigenous communities have inspired them to take up nursing and midwifery.
it’s terrible that Aboriginal people are treated unfairly. University has opened my mind so much about this and now I really want to help my Indigenous community.”
Attending the annual Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) conference in Perth last month, first year midwifery student at Griffith University, Tayla Smith, said lack of midwives and nurses in remote areas was “crazy”. She said targeting maternity and midwifery care was crucial, which she believed could eventually lead to closing the gap.
While Kayla was encouraged by those close to her to attend university, Tayla said lack of role models in her life encouraged her to break the cycle and study. “I think it wasn’t as much as looking up to somebody it was looking at my surroundings and saying, I don’t want to continue this cycle. I want to break the cycle, I want to get out, and become someone and encourage the rest of my family, the younger generation, to go on.”
Tayla said she wanted to fight for the rights of Indigenous women, especially in isolated areas. “Indigenous mothers had the right to give birth on country because it connected them to the land. When we are born on country we are connected to the land for the rest of our lives.” Student nurse at Griffith University Kayla Bailey said she was passionate to work as a perioperative or ED nurse. However the need for nurses in remote areas had changed her mind. “I think
Most popular sections of the journal included, news (96%), clinical update (93%), feature article (93%) and education (92%). Of nurses and midwives currently studying 83% said they found the ANMJ useful, while 74% were considering further work related study. More than 58% said they kept the journal as a reference. Australian Nursing and Midwifery Federation (ANMF) Federal Secretary Lee Thomas said the results reflected that ANMJ continued to be Australia’s leading nursing and midwifery journal. “This was the greatest response we have ever had to an ANMJ survey and I am pleased to see how valued the journal is to our circulation which has recently increased to over 98,000 nurses, midwives and others across Australia and abroad.”
As the first person on both sides of her family to attend university, Tayla admitted it was challenging to go away for her tertiary education. “I think it’s a big thing, being away from your family, being away from your country, that’s what I struggle with the most. And them [her family] not understanding how difficult it actually is, because they have never been in that position. So yeah that’s what’s hard. But it’s good I think, I’m setting a precedence, I hope.”
NG NURSI ALIAN A U S T R 22, NO. 4 E VOLUM OCTOBE
W & MID
I F E RY
W I F E RY J O U R N A L AUSTRALIAN NURSING & MID AUSTRA VOLUME 22, NO. 3 L VOLUME I A N N U R S I N G & MID 22, NO. W I F E RY 4 SEPTEMBER 2014
LLINaG MOidDwEifeM ry c re m ODELLIN G midmfw.orife g.au ry care an
Nursing beyond the bush
u www.anmf.org.a 4:05 pm 22/09/2014
21/08/2014 4:36 pm z_ANMJ Book_September 2014.indb ver.ind
6 November 2014 Volume 22, No. 5
014 4:05 pm
News Healthcare addresses low carbon transformation An online platform to help better address low carbon transformation in healthcare has been created by a global network of hospital and healthcare settings. The innovative social network platform, GGHH Connect, has been built for the Global Green and Healthy Hospitals (GGHH) network and will link health professionals and sustainability experts around the world to boost innovation and accelerate the uptake of solutions through collaboration. The GGHH is composed of more than 450 hospitals, health systems and health organisations representing the interest of more than 9,450 hospitals and health centres from six continents that are committed to reducing their ecological footprint and promoting environmental health. According to experts at the Climate Adaptation conference, held on the Gold Coast last month, online social networks were key to overcoming global challenges,
such as climate change. Climate and Health Alliance spokeswoman Fiona Armstrong said the social networking platform would offer the potential for the healthcare sector to drive the low carbon transformation worldwide. The platform has been developed based on success from other social networking platforms, to foster interpersonal relationships, information sharing and to accelerate uptakes of initiatives and reduce healthcare’s environmental footprint. Ms Armstrong said the healthcare sector was a significant contributor to GDP in all developed economies and increasingly in developing nations. “As the healthcare sector transitions to low carbon operations, and reduces its environmental footprint, it can have a huge influence on supply chains as demand increases for products and services with low carbon intensity and a light environmental footprint.” Creating an online forum for healthcare
service providers and health organisations to collaborate, provided the opportunity and the means for people working in sustainable healthcare initiatives to learn from others, Ms Armstrong said. “By sharing those lessons about cutting waste, saving energy, reducing water use, implementing energy efficiency, it allows people working on those issues to engage in rapid knowledge exchange and information transfer much more quickly.” According to Ms Armstrong, through utilising the platform, collaborators had a new avenue to share their progress, to ask questions of experts and to leapfrog many of the challenges they would otherwise face alone. “The health professions and the sector have a fundamental mission to do no harm. There is a responsibility to ensure the delivery of healthcare is not compromising health and wellbeing by contributing to climate change, itself a risk to health, or to local environmental pollution.” To view the network go to: http://greenhospitals.net/
Alzheimer’s disease study A study into people’s knowledge of Alzheimer’s disease risk factors is underway to develop strategies and prevent the disease. Alzheimer’s affects one in four Australians over the age of 85, with around 1,700 new cases being recorded each week in Australia. Australian National University (ANU) Centre for Research on Ageing, Health and Wellbeing research fellow Dr Joanna Brooks, said more information about the risk factors for Alzheimer’s disease would help modify and ultimately prevent the disease later in life. The study will explore people’s perception of, and exposure to, factors known to be associated with an increased risk of Alzheimer’s disease, such as smoking,
depression, pesticide exposure and low social engagement. Current interventions for lowering Alzheimer’s disease risk are targeted at people over the age of 60. However according to the ANU evidence suggests risk factors may occur in adults as young as 20. Dr Brooks said the new study would help
identify gaps in people’s information, knowledge or understanding of risk factors and help people modify that risk. “We hope our study will help inform the development of future preventative strategies and interventions.” The study is looking for people over the age of 18 worldwide to complete the new Alzheimer’s disease risk perception tool online.
November 2014 Volume 22, No.5 7
News Health environments seriously affected by climate change The immediate and longer-term impact of climate change has the potential to seriously affect Australian health environments, a new brief from the Australian Healthcare and Hospitals Association (AHHA) has reported. To tackle the issue new public strategies are required, including assessing regional health risks to identify vulnerable populations, collecting enhanced surveillance data and developing monitoring indicators, according to lead author Tony Walter. “Politicians, health bureaucrats and other interested parties must formulate comprehensive, coherent policies to address the direct and indirect impacts of climate change on public health, including allocation of appropriate financial resources as part of a National Plan for Health in Responding to climate change.”
Reflective practice key to eliminating racism Aboriginal and Torres Strait Islander nurses and midwives must implement tools such as reflective practice to combat racism in the health sector, according to Griffith University Professor Roianne West.
foremost an individual’s responsibility, it was also crucial to reflect in group settings, Professor West said. “That’s why the annual CATSINaM conference is critical, because it’s like a group reflective practice.”
Speaking at the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) conference in Perth last month, Professor West (pictured) expressed concerns about the impact of racism across the health sector on Indigenous nurses and midwives.
After speaking at the conference Professor West said the issue of racism in nursing and midwifery conjured up a lot of emotion amongst delegates. “The emotion was raw because it had never been discussed before, a possible solution had never been proposed within the context of the professions, and it was always a barrier. No one wants to feel like that. No one wants to feel disrespected and powerless, that’s not a nice place to be in.”
Professor West said young Indigenous entrants into the sector needed to be more prepared to contest racism. She said from her own experiences reflective practice had proven to combat racism and discrimination, and increase efficiency and patient care. “Nurses who experience racism must use the tools, which allow them to reflect on a particular situation and talk about the emotions that it brought up. You also need to talk about how you would approach it differently.” While reflective practice was first and
8 November 2014 Volume 22, No. 5
AHHA Chief Executive Alison Verhoeven said the health sector must communicate climate change as a human health issue rather than just an environmental problem. “The focus should be on effective, realistic and sustainable solutions rather than problems characterised as bleak and unresolvable.”
However, Professor West said Indigenous nurses and midwives often work in isolation from their Indigenous colleagues. “When you make up 0.8% nationally and even less in remote areas, their level of cultural safety is compromised. And that’s the challenge that we have, we don’t have a lot of or enough of Indigenous nurses and midwives which would make a difference to the issue of racism in the professions.”
When pain is gone, playing resumes.
Nothing starts to work faster on pain and fever † 1–6
Children’s Panadol® works fast to relieve pain and fever caused by teething, headache, earache, immunisation, and symptoms of cold and flu.7
Refers only to non-prescription medicines and is based on the liquid paracetamol formulation given at a dosage of 15 mg/kg. References: 1. Celebi S et al. Indian Journal of Pediatrics 2009;76:287–91. 2. Autret-Leca E et al. Current Medical Research and Opinion 2007;23:2205–2211. 3. Walson PD et al. American Journal of Diseases of Children 1992;146:626–632. 4. Clark E et al. Pediatrics 2007;119:460–467. 5. Hamalainen ML et al. Neurology 1997;48:103–107. 6. Schachtel BP et al. Clinical Pharmacology and Therapeutics 1993;53:593–601. 7. Children’s Panadol Approved Product Information, last updated November 2009. Children’s Panadol® contains paracetamol. For the temporary relief of pain and fever. CHILDREN’S PANADOL is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 08/14 GSK1260/UC.
News Kids’ mental health risks need monitoring Trained mental health professionals should be made available in schools for children with mental health issues, according to the Australian Psychology Society (APS). The society stated mental health issues were common among school children, estimating 14-20% of children aged 4-17 were affected by mental health issues. Around 50% of lifelong mental problems started before the age of 14, the society said. APS Principal Advisor David Stokes said proper treatment delivered when children first started experiencing difficulty could mean that mental health issues could be resolved before they become entrenched. “Directing funding to interventions in schools for students‘ wellbeing supported by scientific evidence is an effective way
to address mental issues in children.”
who keep participating.
However Mr Stokes said there was not enough school funding for proven programs. “Money that is directed towards programs such as the National School Chaplaincy Program could be more effectively spent on funding more psychologists in schools. It doesn’t make sense to use scarce government funds for school chaplains when the money could be used to provide psychologists in schools who have the capacity to really make a difference to the lives of children and young people affected with mental health problems.”
Study Lead, University of Wollongong’s Dr Stewart Vella, said children who dropped out of organised sport had greater social and emotional problems than those who participated. “While we were expecting our results to confirm the negative psychological consequences of dropping out of organised sport, we were surprised by the magnitude of the differences, with the total relative increase of risk in mental health problems within three years for kids who drop out between 10-20%.”
Mr Stokes said ensuring that there was adequate professional mental health support in schools was possible as there was already funding that could be easily directed into effective proven projects. Meanwhile, research has found children between the ages of 8 and 10 who drop out of organised sport have up to 20% greater risk of developing mental health problems within three years than those
Dr Vella said also concerning was the projected rate of sport dropouts among Australian children. “Based on the dropout rates per year recorded during our study, if this number was to remain consistent throughout childhood and adolescences, it would translate to approximately 250,000 young Australians dropping out of organised sports every year.” According to Dr Vella children who drop out of organised sports should be monitored for psychological difficulties.
Australians hold on to expired medications Many Australians are keeping expired medicines in their home, according to a recent poll conducted by NPS MedicineWise.
The polling of 1,000 adults showed the average Australian surveyed reported more than nine different types of medicines in their home. Of people who had over five different types of medicines in their home around half of those surveyed acknowledged they had out of date medicine. NPS MedicineWise Chief Executive Dr Lynn Weekes said clearly people were holding on to expired medicines and keeping them in the home which increased their risk of misadventure. “Our message is to pay attention to what is in your medicine cabinet and always check the expiry date. Most medicines will slowly deteriorate over time, which can make them less effective and in some cases harmful. “Australians can take their unwanted, unused or expired medicines to their local pharmacy for safe disposal. Disposing of medicines with their local pharmacist will ensure medicines do not end up in waterways or landfill.”
Nothing is more versatile
Children’s Panadol® offers an extensive range to manage pain and fever in children aged one month to 12 years.1
FIRST-LINE CHOICE FOR RELIEF OF PAIN AND FEVER*2
*Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.2 References: 1. Children’s Panadol Approved Product Information, last updated November 2009. 2. NSW Department of Health. Policy Directive: Paracetamol Use. Accessed at http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html on September 2012. Childrens Panadol® contains paracetamol. For the temporary relief of pain and fever. CHILDRENS PANADOL is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 06/14 GSK1154/UC.
GSK1154 Childrens Panadol_ANMJ Half Pg_Versatile_v2a_FA.indd 1
19/06/14 12:13 PM
Nothing is more suitable
Children’s Panadol® is a first-line choice for the relief of pain and fever,* and is suitable for babies as young as one month. 1,2
*Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.1 References: 1. NSW Department of Health. Policy Directive: Paracetamol Use. Accessed at http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html on September 2012. 2. Children’s Panadol Approved Product Information, last updated November 2009. 3. NSW Department of Health. Infants and children: Acute management of fever. Clinical Practice Guidelines, 2nd edition, 2010. Available at: http://www.ciap.health.nsw.gov.au. Accessed September 2012. Childrens Panadol® contains paracetamol. For the temporary relief of pain and fever. CHILDRENS PANADOL is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 07/14 GSK1261/UC.
GSK1261 CP_Suitability_ANMJ_Half_Pg_November_v2c_FA.indd 1
One call does it all.
One call and we’ll find, insure and salary package your ideal car. It’s that easy.
1300 176 168 | www.nurseleasing.com.au DISCLAIMER: For full terms and conditions please visit our website.
31/07/14 12:43 PM
News Kids need to know about cancer
“KIDS ARE INTUITIVE, THEY WILL KNOW SOMETHING IS WRONG AND MAY IMAGINE THINGS TO BE WORSE THAN THEY ARE WHEN NOT INCLUDED.”
Parents suffering from cancer must be honest with their children as xperts warn secrecy might have a far worse side effect for the child’s mental health. University of Sydney’s Chair of Cancer Nursing Professor Kate White said the children of parents who have cancer can feel anxious and isolated when wellmeaning parents withhold information about their health. Professor White said it is best parents keep the conversation going with their children about what is happening and to provide opportunities for children of all ages to explore what this diagnose means to them. “Kids are intuitive, they will know something is wrong and may imagine things to be worse than they are when not included.” Carlee Reed’s mother was diagnosed with breast cancer when she was 11-years-old, which after a brief remission came back and ended her 10-year fight against the disease. Carlee, who is now 30-years-old and mother to a baby girl, said honesty was the best policy. Carlee was 21 when her mother died, but her father had not told her or her brother the extent of their mother’s illness. “He said, ‘mum is sick and she is getting treatment’.” However the intuitive young girl knew
something was really wrong. “I would see my mum crying and didn’t understand what was wrong and that’s because I didn’t understand the seriousness of it.” Professor White said most parents withhold information because they want to protect their child. Others withhold information because they simply don’t know what to say, or they fear that becoming emotional would be distressing for their children. Carlee said children at the age of 11 or 12 understand the meaning of life and death and she would have preferred her parents to be open and tell them everything. “I know that they were trying to protect me, but I didn’t even know till the end. I thought she was still coming home from the hospital but my dad knew that she wasn’t. If I had known that I would have spent more time with my mum.”
Professor White said research data show teenagers who have a parent with cancer have increased levels of emotional concern that can last well after treatments have completed. But for Carlee not knowing that her mother was dying was worse. “I regret that I didn’t spend enough time with my mother. I would go and visit her in the hospital and then go out because I thought she was going to be ok. But had I known that it was her last days I would have stayed with her more. “[To know that my mother had cancer] would have been stressful but I would have dealt with it. Dad and my brother would be going through the same thing, so I wouldn’t be alone. It’s important to be honest and let people be sad and go through that.”
Queensland nurses and midwives offered substandard pay rise The Queensland government’s offer of a 2.2% pay rise made to nurses and midwives without consultation or negotiation is nothing more than substandard and will not be accepted by members, the Queensland Nurses’ Union (QNU) has warned. QNU Secretary Beth Mohle said the state government’s 2.2% pay rise falls well under the Consumer Price Index (CPI) recommended figure of 3%. Ms Mohle said the shock pay decision came just weeks after the Newman
government decided to extend the nurses and midwife enterprise bargaining agreement by 12 months. She said it was not normal practice for industrial relations to be conducted in this way; however it was not unusual for the Newman government to make unilateral decisions about enterprise bargaining agreements or to determine pay increase without negotiation. “We received another unwanted surprise from [Health Minister] Lawrence Springborg in the form of a 2.2% pay rise,” Ms Mohle said.
Ms Mohle said the government was ignoring long established and proven channels and has taken matters firmly into their own hands. “Our members will be shocked to learn this decision has been made without consultation or negotiation and they will certainly not put up with going backwards in terms of pay.” Ms Mohle said an alert flagging the substandard pay increase had been sent to the state’s Queensland Health nurses and midwives. She said the union was seeking member opinions on this development.
November 2014 Volume 22, No.5 13
Nothing starts to work faster on pain and fever† 1–6
Children’s Panadol® works fast to relieve fever and pain caused by teething, headache, earache, immunisation, and symptoms of cold and flu.7 FIRST-LINE CHOICE FOR RELIEF OF PAIN AND FEVER8*
*Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.8 † Refers only to non-prescription medicines and is based on the liquid paracetamol formulation given at a dosage of 15 mg/kg. References: 1. Celebi S et al. Indian Journal of Pediatrics 2009;76:287–91. 2. Autret-Leca E et al. Current Medical Research and Opinion 2007;23:2205–2211. 3. Walson PD et al. American Journal of Diseases of Children 1992;146:626–632. 4. Clark E et al. Pediatrics 2007;119:460–467. 5. Hamalainen ML et al. Neurology 1997;48:103–107. 6. Schachtel BP et al. Clinical Pharmacology and Therapeutics 1993;53:593–601. 7. Children’s Panadol Approved Product Information, last updated November 2009. 8. NSW Department of Health. Policy Directive: Paracetamol Use. Accessed at http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html on September 2012. Children’s Panadol® contains paracetamol. For the temporary relief of pain and fever. CHILDREN’S PANADOL is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 06/14 GSK1153/UC.
GSK1153 Childrens Panadol_ANMJ Half Pg_Faster_v1c_FA.indd 1
19/06/14 3:58 PM
Classic Unisex Scrubs (XS - 4XL)
ON SALE NOW!
First we created the perfect blend for comfort and durability. (55% cotton, 42% polyester & 3% spandex). Then we wove it into a flattering butt-forgiving unisex design so you can look and feel amazing.
Mix & Match 11 colours available (see online or call for details - 1300 886 814) RRP $35
$2995 $2495 each
Available Exclusively at
Predicting mental illness A new model which can predict a person’s likelihood of a good outcome after their first psychotic episode treatment has been viewed as the ‘holy grail of psychiatric medicine‘, but has also raised some ethical questions. University of Adelaide researchers developed the model using published data to predict a patient’s outcome from their first psychotic episode treatment. The researchers said the model was based on a range of factors such as clinical symptoms, cognitive abilities, MRI scans of the brain’s structure and biomarkers in the patient’s blood. University of Adelaide’s head of psychiatry Professor Bernhard Baune said the model was a revolutionary idea for psychiatric care, aimed at improving treatment for people suffering from mental illnesses such as schizophrenia. Professor Baune said the model was applicable to other types of mental illnesses as well. “Being able to predict the trajectory of psychotic illness is a kind of holy grail in psychiatric medicine.” Professor Baune said he believed the model would improve understanding of the course of an illness, and lead to a more personalised approach to the assessment and treatment of people presenting with anmf.org.au
their first psychotic episode. The model builds on a decade of research in this field and a review and reinterpretation of the relevant studies to date, according to Professor Baune. “Individual illness progression is dependent on a wide range of factors, including sociodemographic, clinical, psychological and biological. These are complex issues, and data on all of them is required in order to model the trajectory of the illness.” However Professor Baune said there was no doubt that the model would be challenging for many in the profession, adding the model had raised a number of ethical dilemmas. “Should a patient be offered a rigorous treatment right away at the beginning of the disease that, according to current guidelines, is only offered at later stages afters years of disease progression? Or should certain treatments be denied if evidence suggests that the course of the illness will be mild or that they will do little to the patient’s outcome?” Professor Baune said these were some of the questions that the profession needed to discuss, as the use of this model in practice will require rigorous testing. The model will soon be published in the Australian & New Zealand Journal of Psychiatry.
Mobile forensic mental health unit for prisoners A new mobile forensic mental health unit, the first of its kind for Victoria’s prison system, was launched last month. The forensic mental health unit is based at the Metropolitan Remand Centre (MRC) in Melbourne’s West and staff will travel to other prisons as required. According to the state’s correction Minister Edward O’Donohue the unit will enhance existing mental health services in the prison system, particularly at the Melbourne Assessment Prison where prisoners’ health and mental health issues are first assessed. “The prevalence of prisoners with mental health issues exceeds that found in the general population by three to five times. This new unit will allow us to better manage and treat prisoners, many of whom may have had limited engagement with mental health services prior to coming to prison,” he said.
November 2014 Volume 22, No.5 15
E U E G GU E O L O U T L AA G C A O T L A A T A C C E C AA U T L O G GU O L A T E CACAA T LOGU E 15152015 2020 rch March -rch - Ma 14Nov Ma -2014 v 20 142014 NoNo 20 vNov 15 20 March rch Ma 14 Nov 20Nov 2014 - March 20152015
p op ho es u/ /esh .a.au m.au op sh m /e oom enur .cse.co seenur ururs e.c en en p se.co ho m.au es /esh u/ m.a m.au/eshopop .cose.co enurse enur Shop online anytime, or call us on 1300 886 814. Ships in 24 hrs*
EVERYDAY LOW PRICES
Quality, Colour, & Style
you wont find anywhere else. January!
New styles arriving. Available from January.
SCRUB SALE Amazing fit. 11 Colours | XS - 4XL
16 page mini catalogue Call to request your free copy 1300 886 814 enurse.com.au/eshop
Professional Review of the National Registration and Accreditation Scheme Julianne Bryce and Elizabeth Foley, Federal Professional Officers Many of you will remember registering as a nurse or midwife in your state or territory of residence. Then, if you worked in more than one jurisdiction such as across borders, you had to pay two or more registration fees. With great fanfare the National Registration and Accreditation Scheme (NRAS) swept in on 1 July 2010 bringing a single national register for nurses and midwives, one fee, and common regulatory standards. The ANMF supported a nationally consistent approach to regulation because this meant common professional terminology across the country. The essential areas where commonality has been achieved through national registration and accreditation are: titles and protection of these titles, a national database of registrants, one registration fee, national registration and accreditation standards. Of huge importance to the nursing and midwifery professions was the development of a shared professional practice framework (PPF) to govern the practice of registered and enrolled nurses and midwives. This achievement through NRAS means all nurses and midwives across Australia work under the same framework. From the introduction of NRAS, the ANMF was aware of difficulties encountered by some members in their registration processing interactions with the Australian Health Practitioner Regulation Agency (AHPRA). However, the registration and accreditation components of the Scheme now seem to be working well for our professions. A major review of NRAS is now underway and the ANMF has made a submission anmf.org.au
detailing the achievements of the Scheme as well as highlighting issues we’re concerned about, to the reviewers. See the full submission on the ANMF website: www.anmf.org.au We’ve welcomed the review of NRAS as this demonstrates accountability to the public of regulatory and accreditation mechanisms established for their protection. We see this as an opportunity to highlight significant achievements in both the regulation of nurses and midwives, and, the accreditation of their education programs leading to registration and endorsement. As the AHPRA Annual Report 2011/12 states: “AHPRA undertook the largest ever renewal in Australia when more than 333,000 nurses and midwives renewed their registration in May 2011” (AHPRA 2012). This indicates the enormity of the exercise taken on by AHPRA in implementing the NRAS. There were three specific areas of concern we raised in our submission to the review. The first was the need for regulation of assistants in nursing (AINs). AINs undertake aspects of direct nursing and personal care across acute, community and aged care. But, unlike nurses and midwives, they’re not regulated. Given the purpose of regulation is protection of the public, it’s difficult to understand how a significantly large part of the health and aged care workforce remains unregulated. The ANMF argues AINs should be included in the NRAS as they, like registered nurses, midwives and enrolled nurses provide care, and in doing so, also have the potential to pose significant risk to the public. It’s essential AINs are safe and competent to practice and should be regulated within the current nursing and midwifery regulatory and practice framework. For AINs there is no mandatory minimum educational preparation, no requirement for CPD, no national standards of practice, no codes of conduct or codes of ethical behaviour, no identified scope of practice, no policies on social media usage, no process for mandatory notification of conduct or health impairment issues, and no legal boundaries to the practice of AINs, other than civil law. The second issue concerns midwifery regulation. The ANMF is aware of some discussion about separating the NMBA into two Boards – one for nurses and one for midwives. The union does not support this proposition. The Federation has more than 19,000 midwife members (total registered
midwives 35,062), who are predominantly registered as both nurses and midwives. With the smaller number of registrants in a separate midwifery board this would realistically attract a significantly higher registration fee for midwives to support its operations, than the current NMBA registration fee. Given the vast majority of midwives are dual registered, there would be a requirement for them to pay for both a nursing registration and a midwifery registration. We see no justifiable regulatory gain for a potentially considerable financial impost on our midwife members. Of concern too is that some dual registrants may well discontinue their midwifery or nursing registration if the costs become burdensome, leading to reduced numbers of midwives and nurses available to the Australian community. The third area of concern with NRAS is the notification process. The ANMF recognise notifications as an essential area of NRAS to assist in protection of the public. We therefore want the system to be timely, fair, and consistent with the National Law. Additionally, we want NRAS to provide consistency for regulation and accreditation, around the country. However, the current notification system is variable across jurisdictions. The New South Wales and Queensland notification processes, and the difference in Western Australia with mandatory notifications, have all contributed to this inconsistency. The ANMF is concerned the NRAS review is using notifications as the trigger to potentially unravel a system which is in the most part delivering on its requirements. We don’t want a focus on efficiency gains to come at a cost to the aspects of the National Scheme that currently work well. Reference Australian Health Practitioner Regulation Agency (AHPRA). 2012. AHPRA Annual Report 2011/12. Available from the AHPRA website at: www.ahpra.gov.au/Legislation-and-Publications/AHPRA-Publications.aspx
November 2014 Volume 22, No.5 17
TAKING THE LEAD
NURSES, MIDWIVES AND LEADERSHIP Nurse and midwifery leaders are pivotal in Australia’s changing healthcare landscape. While there are leaders paving the way at the helm of the profession, there’s more to being a nurse leader than a promotion or position, writes Karen Keast.
18 November 2014 Volume 22, No. 5
Commonwealth Chief Nurse and Midwifery Officer Dr Rosemary Bryant and ANMF Federal Secretary Lee Thomas
November 2014 Volume 22, No.5 19
Registered nurse Laurie Bickhoff never considered herself to be a nurse leader. That is, until she was encouraged to apply for the Emerging Nurse Leader (ENL) program at the Australian College of Nursing (ACN). Now, in her third and final year of the program and also completing a transition to cardiology nursing program at New South Wales’ John Hunter Hospital, Laurie has a different view of what defines a nurse leader. “Initially, I always thought a nurse leader was someone with 30 years’ experience, all the way up the top of the food chain in nursing and so I never really saw myself in that role,” she says. “I’ve come to realise that there are leaders the whole way through, especially on the clinical floor but also in academia and nursing policy as well. “Leaders can be anyone from the student on their first placement doing their very first prac all the way through to our Chief Nurse of New South Wales type of position.”
Forging the future
Recent figures from the Nursing and Midwifery Board of Australia show the nation is now home to more than 355,000 practising nurses and midwives. As the largest group of healthcare practitioners and the frontline of the nation’s healthcare, nurses and midwives are being encouraged to take the lead and find their voice, whether it’s advocating for the patient, for the profession or for the future of the health system. As the nation’s pre-eminent nurse leader, Dr Rosemary Bryant, Commonwealth Chief Nurse and Midwifery Officer, says leaders are needed at every level of nursing and midwifery. Dr Bryant, who was honoured in the Queen’s Birthday honours list this year as an Officer of the Order of Australia for distinguished service to the profession of nursing, says nurses and midwives have to be ready for the healthcare challenges that lie ahead. “We haven’t seen the full potential of nursing and midwifery, particularly nursing, being unleashed yet and I think we have got to be ready for that opportunity and grab it when we can,” she says. “There are 20 November 2014 Volume 22, No. 5
a number of areas where we will come into our own in the future…particularly in the area of primary healthcare. “We haven’t seen yet the contribution that nurses particularly can make to the care of those with chronic disease and the number of ageing in the community. At the moment, we have got a model which is focused on that care being delivered almost exclusively by GPs, although there is some movement. That, to me, is the next big area of opportunity for nursing particularly.” Australian Nursing & Midwifery Federation (ANMF) Federal Secretary Lee Thomas has been advocating for nurses and midwives industrially, professionally and politically since she first made the transition to the union movement 17 years ago. Ms Thomas says it’s vital more nurses and midwives become champions on the healthcare front. “I think many nurses and midwives are leaders, it might be at the ward level or it might be in positions like mine. When the opportunities arise to be able to advocate on behalf of the patient or of the health system we should and we must take those opportunities. “We need to show leadership to ensure that governments understand the importance, particularly in our country of universal healthcare, of how the privatisation of our health system and its Americanisation puts at risk the fantastic and very well supported health system that we have in this country.”
Advocating for Aboriginal health
Poor family health spurred registered nurse Faye Clarke into pursuing a nursing degree as a mature age student. After losing both of her parents to illness and her sister and brother to suicide, Faye began working as a nurse at the age of 40. In the 10 years since, she has become a leading light in the fight to improve Aboriginal health. “I don’t feel like a leader - I have been here for all of five minutes in nurse years,” she says. “Having said that, because of my Aboriginality and because of the opportunities I have had, I have ended up in leadership roles.”
AS A ROLE MODEL, FAYE ALSO ENCOURAGES ABORIGINAL STUDENTS TO PURSUE A NURSING CAREER IN A BID TO BUILD A STRONGER ABORIGINAL NURSING WORKFORCE, WHICH IN TURN WILL DELIVER BETTER HEALTH OUTCOMES FOR ABORIGINAL PEOPLE.
Based in Victoria, Faye works at the Ballarat and District Aboriginal Co-operative as the care coordinator for Closing the Gap and as anmf.org.au
Feature a diabetes educator. Faye, whose family originates from the Gunditjmara, Wotjaboluk and Ngarrindjeri people of Victoria and South Australia, also represents the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) on the board of the Australian Nursing and Midwifery Accreditation Council (ANMAC). Through her roles, Faye advocates for Aboriginal health and cultural safety in the health system. “At an Aboriginal medical service, people are more likely to come in and come to their appointments - they just feel more comfortable,” she says. “We have got a lot of Aboriginal staff here so we can get people to come in and do health checks and management plans, follow up all their appointments and go to the specialist. “If they are out in mainstream and someone has treated them rudely or hasn’t taken the time to explain things properly to them, you can see where they miss out on care - that’s what drives me.” As a role model, Faye also encourages Aboriginal students to pursue a nursing career in a bid to build a stronger Aboriginal nursing workforce, which in turn will deliver better health outcomes for Aboriginal people. Faye says she didn’t set out to become a nurse leader, instead she seized opportunities. “There’s been different opportunities to go and do presentations to different groups because of the unique role that an Aboriginal nurse has. “There’s not many of us and if you have got someone that’s willing to go and do a talk, I’m okay about doing that because you see the benefit of it.” Faye concedes her first attempt at public speaking was “atrocious”. “It was supposed to last an hour and I think I was done and dusted in 20 minutes because I read it really fast,” she says. “If you let that get the better of you, you would never do it again but that was 10 years ago, and now when I give a talk they have to shut me up - there’s so much to talk about. “A leader has to not be afraid to try things, you have to be willing to give it a go, even anmf.org.au
if it does make you feel nervous or you make a mistake. You have to be kind to yourself and just go - never mind, I’ll learn from that and just move on.”
Finding your voice
Registered nurse and ENL participant Laurie Bickhoff believes nurse leadership is having the moral courage to be able to stand up and speak out where others remain quiet. It’s a stance she’s already put into action. “I’ve had to say - I don’t think this is appropriate. Can we get this reviewed? “My guiding philosophy has always been - I’d rather look like an idiot than have the patient suffer in any way. The focus really has to be on the patient - is this going to improve their outcomes, is this going to be detrimental, am I going to be preventing harm? That focus always has to remain on the patient rather than on their ego.” Participating in the ENL program has enabled Laurie to evaluate and improve on both her strengths and weaknesses. It’s forced her to step outside her comfort zone, encouraging her to network, write articles and abstracts, and present at conferences, while bolstering her confidence and skills. Those experiences also prompted Laurie to launch her own blog, www.definingnursing.com where she writes about nursing topics and shares her experiences and ideas. Launched earlier this year, the blog already has more than 600 Facebook ‘likes’ and Laurie hopes it will grow into a platform for nurses. Laurie advises nurses aspiring to become leaders in their field to consider their core values, ethics and interests. “Definitely ask for feedback, go in and sit down with your nurse unit manager or a close mentor, ask them for feedback on how they think you’re going and in what areas they think you can improve.”
“MY GUIDING PHILOSOPHY HAS ALWAYS BEEN - I’D RATHER LOOK LIKE AN IDIOT THAN HAVE THE PATIENT SUFFER IN ANY WAY.
Laurie says nurses should also put their hands up for positions on various associations, boards and committees. “Find something that you’re passionate about - whether that’s on a clinical floor, in academia or on a specific subject. If you’re passionate about a subject, I really do believe that passion shines through in what you do and naturally draws people to you.” November 2014 Volume 22, No.5 21
Cultivating leaders For the past three years, the ACN has been equipping future leaders, such as Laurie, with leadership skills through its three-year ENL program of personal and professional development. Now, the College is developing a new initiative to nurture nursing leaders, from novice nurses right through to experienced nurses. Debra Thoms, Chief Executive Officer of the Australian College of Nursing (ACN), says the leadership program will span the entire career journey. “While there are people in positions that are viewed as being nurse leaders and in leadership roles, leadership is something that everybody can express every day in the way that they engage with others, in the way they work they can display leadership capabilities.” The program will also cater to executive nurses, enabling them to network and discuss how they exercise leadership in their roles.
NURSES AT SENIOR LEVELS OFTEN HAVE TO BALANCE THEIR NURSING BELIEFS AND WHAT THEY WANT TO ACHIEVE FOR THE NURSING PROFESSION WITH THE DEMANDS OF THEIR ROLE.
An Adjunct Professor at Sydney’s University of Technology and also at the University of Sydney, Professor Thoms says nurses at senior levels often have to balance their nursing beliefs and what they want to achieve for the nursing profession with the demands of their role. “We will be looking at workshops and other ways of working with nurses to help them explore how they can do that for themselves. That will hopefully prove to be of positive benefit for them and for those that they work with.”
Nurse and midwifery leaders are renowned for having personal qualities of integrity, initiative and courage. Effective nurse and midwifery leaders also inspire and empower others to work to achieve a common goal, such as enhanced patient care, while envisaging the future. With a career in nursing, health management and nursing leadership spanning more than 30 years, Professor Thoms says good leaders listen actively to people and engage with them while having a plan for progression. “You need to be able to translate that and, to be honest, sometimes that’s hard but the people you are working with, they need to come with you on the journey,” she says. Professor Thoms, who progressed her
22 November 2014 Volume 22, No. 5
career through taking on challenging positions, says good leaders also take pleasure in seeing others achieve. “It’s not about you, yourself being the only achiever - a lot of what you do is achieved through others. It is about enabling and supporting others to achieve and through that you achieve your own goals.” Dr Rosemary Bryant, who is also the immediate past president of the International Council of Nurses, says she planned her early career to gain the appropriate experience for the positions she aspired to achieve and then embraced opportunities. She says good leaders must be pragmatic, be able to advocate and look to the future. Dr Bryant advises nurses and midwives to complete the right qualifications when it comes to their education, whether it’s university degrees, CPD or short courses, and to have an open mind, take advice and be self-aware. “It’s building on your strengths and understanding what your weaknesses are and trying to address them to a degree.” As a registered nurse and midwife who was elected Federal Secretary of the ANMF in 2010, Ms Thomas credits her career advancement to a combination of drive, professional development, mentoring and support. “There’s absolutely no doubt that my journey has been about opportunities but it’s almost, in some respects, other people recognising the leadership in me rather than my own recognition of it.” Ms Thomas says a good nurse leader listens, acknowledges and understands issues, and communicates well while speaking with a voice of credibility. Mentors have a pivotal role to play in the future of the profession, she adds. “We need to ensure that we do mentor our young men and women in the profession that we provide them with opportunities to expand their knowledge and abilities. They are the successors to us for the future.”
While nurses and midwives are leading the way in workplaces, unions and organisations, Australia only has a few nurses and midwives braving the political arena. Ms Thomas says nurses and midwives are essential to driving change at local, state and federal levels of politics. “That’s the anmf.org.au
Feature one thing that we don’t have in this country and I think that is one of the areas that we really need for the future to work on.” “Nurses and midwives play such vital roles in our communities, not just from a caring aspect but from advocacy advocacy for our health system, advocacy for our patients, but it’s vital that it’s supplemented by nurses in Parliament.” Nurses have been voted Australia’s most ethical and trusted professionals for 20 consecutive years in the Roy Morgan Image of Professions Survey. With patients and the community holding nurses and midwives in such high regard, Ms Thomas says that respect and appreciation needs to translate into policy. “I think if we want there to be good policy decisions made that benefit the community then politics is one of the places that nurses need to become more involved. “After all, that is the only way that we are going to ensure a decent health system into the future.” Ms Thomas advises nurses and midwives aspiring to move into roles at the forefront of health policy and decision-making to get involved in the union, advocacy and activism, embrace opportunities and to demonstrate leadership. “It’s having the willingness and the drive and motivation to put themselves forward for local government, for state Parliaments or federal Parliaments.”
Moving from the United States to Australia was almost a “soul-destroying experience” for registered nurse and endorsed nurse practitioner Chris Helms. A nurse practitioner in the States, with two masters degrees under his belt, Chris’ qualifications were not recognised when he moved to Sydney in 2007, forcing him to completely rebuild his career as a nurse practitioner on Australian soil. At one stage, Chris considered leaving the nursing profession but an inspiring patient experience and the encouragement of nurse leaders helped reaffirm his passion for nursing. Chris now credits those difficult few years with transforming his career - making him a better, more holistic and confident nurse practitioner. The experience set him on a path to anmf.org.au
working with the Australian College of Nurse Practitioners (ACNP), where he was able to learn from nurse leaders who encouraged him to grow as a professional while offering him opportunities to become an advocate for the profession. It’s a role Chris has embraced. Now he balances his part-time work at a GP practice in Canberra with completing his PhD research, which focuses on validating Australian nurse practitioner metaspecialties and aims to develop clinical practice standards for each metaspecialty. Chris manages the ACNP website and also speaks at conferences, represents the College and nurse practitioner profession on several national committees, writes government submissions and serves on the editorial committee of the Journal for Nurse Practitioners. Chris describes nurse leadership as “having the courage of your convictions”. “A mentor of mine once told me that and it has consistently guided me throughout my career,” he says. “Don’t get me wrong having the courage of your convictions may just as likely bring about grief, hardship and discouragement but even those things will eventually lead you to a path which rings true. “I recognise now that passion is the battery which gets you through the times when having the courage of your convictions isn’t enough.” Chris says more nurses are needed to get involved - to add their voice, ideas and perspective to boost the profession and drive it into the future. “One of the things I hear is - ‘I’m too busy, I just have too much on my plate, I don’t know how to do that’. “I think it’s extremely important for us to continue our journey as a profession and elevate nursing to an equal place at the table,” he says.
HAVING THE COURAGE OF YOUR CONVICTIONS MAY JUST AS LIKELY BRING ABOUT GRIEF, HARDSHIP AND DISCOURAGEMENT BUT EVEN THOSE THINGS WILL EVENTUALLY LEAD YOU TO A PATH WHICH RINGS TRUE.
“It’s important that we learn how to better engage and mentor those people that are afraid to expand their horizons.” It’s surprising what considered and deliberate action at the grassroots level can achieve in a much broader context, Chris says. “Believe in nursing and believe in your own ability to make ripples of change in the individual, your community and the nation’s health.” November 2014 Volume 22, No.5 23
Research Aussie women fitter but highly stressed
Disabled homeless need more care
Young Australian women are fitter yet fatter and highly stressed today compared to 20 years ago, a new study has revealed.
People living with a disability have been linked to extreme risk of homelessness and should get the greatest level of accommodation assistance, researchers say.
The study, Health and wellbeing of women aged 18 to 23 in 2013 and 1996, was undertaken at the University of Queensland and the University of Newcastle. The 17-year-old study showed that 70% of women aged 18 to 23 met Australian guidelines for physical activity in 2010, compared with 59% in 1996. One of the study leads Professor Gita Mishra from the University of Queensland said that the improvement in women’s physical activity was encouraging, but the percentage of overweight and obese young women was increasing. “In 2013, 33% of the young women surveyed were overweight or obese, compared with 20% in 1996.” Study lead at University of Newcastle Professor Julie Byles said the research also found the prevalence of stress in this group to be higher than in those surveyed in 1996. “Worryingly, we also found that 59% of these young women had experienced suicidal thoughts in the past
Sport related concussion in the spotlight Complacency in sports related concussions is putting players at risk of further brain injury, according to a recent study which is urging for more comprehensive testing. A Deakin University study measured the motor control, mental functioning and brain activity of 40 amateur players over one season. Eight players who had sustained concussions were tested 48 hours,
24 November 2014 Volume 22, No. 5
year, while 45% had engaged in selfharming behaviour.” The survey of 17,500 young women across Australia also found that one in five women had experienced physical or sexual violence in the past 12 months, while 56% had experienced either form of violence at some point in their lives. Intimate partner violence had increased to 13% in 2013, from 11% in 1996. Researchers said women with less than a year 12 education fared worse in almost all categories surveyed – reporting poorer mental health; higher incidence of being bullied; more likely to have experienced intimate partner violence; more likely to have not used contraception and been pregnant at some stage; less likely to have received the Human Papillomavirus (HPV) vaccination.
96 hours and 10 days after the injury. The other players were tested three times over two weeks at the end of the season. The study revealed that compared to uninjured players, those who had suffered a concussion showed abnormal motor control, with some still present 10 days after the concussion. Study lead Dr Alan Pearce said this meant the underlying brain injury took some time to mend and may still be present after the visible symptoms had passed. “Current testing measures will not pick up the actual impact to the brain so there is a need to review the testing regime to ensure that concussed players do not return to the field before the brain has had time to fully recover.”
University of Adelaide researcher Dr Emma Baker said up to 25% of people with an intellectual disability and 34% of people living with a mental illness are at risk of homelessness, compared to approximately 16% of people without a disability. Dr Baker said people with a disability and those with care responsibilities are at risk of homelessness because of low incomes, limited employment opportunities and restricted capacity within the private rental sector. She said policies and programs were needed to address the higher risk of homelessness amongst the disable. “People with disabilities are often undiagnosed upon entry into homelessness-specific housing and support services and this means that assistance is either not provided or only offered after a considerable delay.” Dr Baker said as more than 100,000 Australians sleep rough on any given night, it was time to look at how to better help the needy.
Dr Pearce said the brain stimulation tests used transcranial magnetic stimulation (TMS), a safe and painless way of delivering electromagnetic pulses into select areas of the brain, to get a true measure of the changes in brain activity occurring. TMS tests enabled researchers to quantify the level of changes to brain activity more accurately than the desktop computer tests used by official football club scientists, said Dr Pearce. The study, Acute motor, neurocognitive and neuropsychological change following concussion injury in Australian amateur football, is due to be published in the Journal of Science and Medicine in Sport.
Reflections An alternative approach for dealing with workplace grievances Chris Hicks, Director, CWH Mediation & Workplace Relations Background
Situated in regional Victoria, this health service and its staff have a long and proud history of caring for the people that live in the region it serves. It is also a teaching facility that has helped to train hundreds of medical, nursing, allied health and support staff. The hospital and its staff are part of the community fabric. Yet, despite appearances staff within a large unit of the hospital were struggling - not with caring for their patients, but with their interactions with a number of senior nurses. Steps had been taken in an attempt to address the issues that staff had raised eg. the manner in which feedback was provided to them, (often bluntly in front of coworkers) and while these actions had some impact, relations continued to deteriorate to the point where staff lodged a collective grievance citing numerous examples of repetitive and unreasonable behaviour and in some instances workplace bullying. Given the number of parties to the grievance and the issues raised, the traditional approaches of mediation or investigation to help resolve the grievance appeared limited, in large part due to practical considerations such as the length of time that an investigation would take and the fact that many of the staff were not comfortable with mediation out of a genuine fear of reprisal for raising concerns. Fortunately, the staff made an important decision that led to involvement of the Australian Nursing and Midwifery Federation (ANMF) Victorian Branch. From this there were some pivotal discussions between the health service chief executive and a senior officer from the ANMF (Vic Branch) that opened the way for alternative approach for dealing with the grievance.
What Happened Next An agreement was reached between the anmf.org.au
hospital and ANMF (Vic Branch) that an independent external party would be engaged to review the issues identified in the grievance, along with the unit’s culture, management, staff relations and professional development. The reviewer engaged by the hospital was an economist, whose career had involved senior HR roles in large public hospitals as well as formal mediation training at Harvard Law School. The goals of the review were simple - meet with staff and management to gather information, review written materials and provide recommendations. The key step was the process of meeting with staff and management. The meetings the reviewer had with staff were not ‘inquisitorial’, they were about each person ‘telling their story’ with a focus on ‘what could we do to improve’? The impact of this approach allowed people the opportunity to be heard, but also focused on their professional expertise about what could be done to improve the unit and the outcomes for its patients. The review also took into account feedback from medical and ward support staff. The recommendations that emerged were straightforward and critically involved the chief executive going back to his direct reports and asking some questions about processes and actions that had been reported to him as having occurred. The reviewer then met with the chief executive and senior officers from the ANMF (Vic Branch) and provided feedback on his observations and suggested recommendations. This was the start of the process, which has led to an improvement in unit morale, along with making the unit more efficient by reducing operating costs through lower levels of unplanned staff absences. The hospital and ANMF (Vic Branch) agreed to establish a consultative forum at which senior management representatives, unit staff (staff nominated representatives) and the ANMF (Vic Branch) would meet on a regular basis to work through a plan of what actions needed to be taken, by whom and when. The meetings were initially chaired by the reviewer, but after several meetings this was no longer necessary.
The forum was the beginning of a ‘reconciliation’ between management and staff and one of the most powerful actions was an apology from the CEO to unit staff about what had happened. Subsequent actions involved the confirmation of several ongoing appointments and a workshop where all staff were part of deciding what the core values and behaviours of the unit would be. There will also be ongoing monitoring of the unit through objective HR measures such as levels of unplanned absence, lost time due to injury and an annual survey that will allow for internal and external benchmarking. By allowing people to talk about what they had experienced at work, but with a focus on improvement, measurement and consultation, senior management, along with staff, supported by the ANMF (Vic Branch) have shifted the workplace culture away from a place of conflict and fear to one of accountability and collaboration that has its key focus on quality outcomes for patients. Staff like coming to work and managers are being supported to perform their roles. All are accountable. Some significant professional expertise that had been overlooked is now helping patients before they come to hospital - saving time and patient angst. The learning from this experience is that whilst grievances and conflict can be difficult to manage and corrosive, taking an approach that looked at the interests of the organisation, staff, patients and the community has helped to identify solutions that have had a positive and durable impact. November 2014 Volume 22, No.5 25
Clinical update / Education
Prostate Cancer The following excerpt is from the Understanding Prostate Cancer course available on the ANMF’s Body Systems Training Room. The complete course is 1.5 hours in duration and will introduce you to the fundamentals of prostate cancer. The course begins with the epidemiology of prostate cancer and continues with the risk factors and the pathogenesis of the disease. The course also discusses screening tests, symptoms and the diagnostic procedure for patients with suspected prostate cancer.
Upon completion of the complete learning program you will be able to: Discuss the incidence, prevalence and mortality of prostate cancer. Describe the risk factors and the neoplastic and genetic origins of the disease. Recall the screening methods used for detecting prostate cancer and the symptoms associated with the disease. Aside from skin cancer, prostate cancer is the most commonly diagnosed cancer in men worldwide, with 899,000 diagnoses and 258,000 deaths reported globally in 2008. Prostate cancer represents a major health challenge. Most prostate cancer patients – 81%- are diagnosed with localised prostate cancer, with 12%, 4% and 3% of patients having regional, metastatic and unknown disease stage at time of diagnosis. Asymptomatic prostate cancer, unlike other common malignancies, is often observed 26 November 2014 Volume 22, No. 5
among ageing men. Autopsy studies found an increase in microscopic prostate cancer lesions with increasing age, with 30% of men in their fourth decade, 50% of men in their sixth decade and more than 75% of men older than 85 years.
contrast, those initially diagnosed with distant metastatic disease have a five year survival rate of 28.7%. In a study of patients with metastasis diagnosed after radical prostatectomy, 63% involved bone, 36% the lymph nodes and 6% the viscera.
Prostate cancer is the second most common cause of cancer death in men, after lung cancer. Mortality rates have shown distinct phases since 1975. During the last decade, mortality rates have trended downward; however, reasons for the decline are debated. Some studies suggest that prostate-specific antigen (PSA) screening and the resultant increase in rate of detection of early stage disease may be casual, while other studies suggest that improvements in treatment, surgery and the use of hormonal therapy have contributed to the decline.
Although the specific causes of prostate cancer are still unknown, epidemiological studies suggest both genetic and environmental contributors to the disease. The progression of prostate cancer from a normal epithelium through premalignant lesions to metastatic cancer is a multistep process involving a variety of cellular and genetic changes.
The five year survival rate for patients initially diagnosed with local disease or locally advanced disease is 100%. In
Family history affects the relative risk of developing prostate cancer as the number of affected family members increases, so does the relative risk of prostate cancer. The degree of relatedness to the affected family member also affects the relative risk of prostate cancer. In addition, relative risk for prostate cancer is inversely related anmf.org.au
Clinical update / Education from somatic genome changes. Most prostate cancers start in the epithelium of the glandular tissue, due to uncontrolled cellular proliferation and differentiation. This kind of cancer arising in glandular tissue is known as adenocarcinoma and mostly originates in the peripheral zone of the prostate. Chronic or recurrent inflammation of the prostate or prostatitis, is thought to play a role in the development of prostate cancer. The mechanism underlying inflammationinitiated prostatic carcinogenesis is now believed to result from the production of antimicrobial oxidants by inflammatory cells. These antimicrobial oxidants may cause cellular or genomic damage in the prostate. Areas of chronic inflammation can consequently result in atrophic lesions called proliferative inflammatory atrophy (PIA) which contain proliferating and incompletely differentiated epithelial cells. PIA is often found next to prostatic intraepithelial neoplasia (PIN) lesions, prostate cancers or both, and is therefore believed to be a precursor to PIN and prostate cancer.
to the age at which family members were affected. Men with a first degree relative – father or brother diagnosed with prostate cancer at age 50 have approximately a two fold increased risk of developing the disease themselves, compared to the general population. There appears to be no correlation between a positive family history and the patient’s survival rate or tumour aggressiveness. It should be noted that 85% of all prostate cancers are considered sporadic, while 43% of early onset prostate cancers can be explained by heritable factors. Age is the most important risk factor for prostate cancer. Black men have a higher incidence of prostate cancer than any other racial group, and are more likely to die from the disease than white men in every age group. American Indians and Alaska Natives have the lowest rate. Certain diets, such as those high in calcium, fat, or red meat, have been implicated as risk factors for prostate cancer. Also, anmf.org.au
increased body mass index (BMI) has been correlated to an increased risk of prostate cancer, possibly due to the interaction between insulin resistance and inflammation. However there is insufficient evidence to fully support these claims, as results between studies have been inconsistent. A growing body of evidence from observational studies suggests a protective role of sufficient consumption of vegetables, antioxidants, lycopene, selenium and Vitamin E against the development of prostate cancer. Androgens play a central role in the normal development of the prostate gland. Signalling through the androgen receptor is used by prostate cancer cells not only for differentiation but also for proliferation, which explains their initial dependence on androgens for maintenance and survival. However, prostate cancer ultimately becomes androgen independent. This may be a result of a selection of pre-existing cellular variants with androgen independence generated
PIN is a non-invasive proliferation of epithelial cells within ducts. PIN lesions, which are often multifocal, are highly unstable and potentially become malignant. PIN lesions are categorised into low and high grade, and only high grade PIN is thought to be a precursor to prostate cancer. Continuous growth of a prostate tumour eventually causes it to extend through the prostate capsule and to invade nearby organs such as the seminal vesicles, the bladder or the rectum. Further invasion of blood or lymph vessels allows the cancer cells to spread and metastasise to distant organs, mainly the bones, viscera and lymph nodes. Bone is the most common site of metastatic disease in prostate cancer, and to better understand the pathogenesis of bone metastasis, knowledge of bone remodelling is necessary. Even though bone turnover is highest in children and adolescents, bone is a dynamic tissue that continues to remodel itself throughout life. In a healthy individual, the cycle of bone resorption and bone formation is well balanced. Prostate cancer screening aims to detect November 2014 Volume 22, No.5 27
Clinical update cancer at an early stage, when a cure is still possible. The two procedures commonly used to screen for prostate cancer are digital rectal examination (DRE) and PSA testing. Since the widespread use of PSA testing, prostate cancer is often diagnosed before the appearance of any symptoms. Local symptoms usually do not manifest until the invasion of the periprostatic tissue has occurred. At this point, curative therapy is difficult to achieve. The types of symptoms a patient will complain about depend on whether the prostate cancer is early stage, locally advanced, or metastatic. The most common symptoms of prostatic disease in men aged 50 years and older are bladder outlet obstruction, nocturia, incomplete voiding, and a diminished urinary stream. If the cancer is metastatic, the symptoms will vary according to the site of the metastasis. Lymph node metastases can lead to lower extremity lymphoedema. However, the most common site of prostate cancer metastases is in the bones. These patients may complain of back pain or bone pain, or may present with vertebral fractures. Metastatic disease to the vertebral column may be associated with symptoms of spinal cord compression. These include paraesthesia, weakness of the lower extremities and urinary or faecal incontinence. Currently, with the advent of increased screening and patients being diagnosed with early stage disease, men rarely present with symptoms of metastatic disease. If results of screening tests are indicative of prostate cancer, additional tests are required to make a definitive diagnosis of the disease. Different tests are available that may be used to diagnose either the primary tumour in the prostate or spreading to other organs. The main imaging test used to assess the primary tumour is transrectal ultrasound (TRUS). Computed tomography (CT) and magnetic resonance imaging (MRI) are used to assess disease extension to the lymph nodes, while a bone scan is used to detect bone metastases. TRUS is not reliable for diagnosing prostate cancer with certainty, and is not used for routine prostate cancer screening. It is mainly used to target sites for needle biopsy in the prostate and to determine prostate volume. CT is an x-ray based imaging technique routinely used for prostate cancer treatment planning and for detecting metastases to regional lymph nodes and the intra28 November 2014 Volume 22, No. 5
abdominal region. However, data from CT are insufficient to accurately identify or stage prostate cancers. Cross-sectional MRI is a standard imaging technique to detect prostate cancer and local disease spreading. It uses a powerful magnetic field and radio frequency pulses to visualise the prostate lesion itself, as well as regional lymph nodes, and may involve a contrast dye. Additional types of MRI for prostate cancer include endorectal MRI and magnetic resonance (MR) spectroscopy, which both involve an endorectal coil placed inside the rectum. Endorectal MRI provides better pictures and is superior to CT. It assesses the prostate anatomy and allows better delineation of tumour location, volume and stage. MR spectroscopy provides metabolic information that detects differences in cellular metabolite concentrations associated with prostate cancer, such as lower levels of citrate and higher levels of choline and creatine. A bone scan involves a radioactive tracer that targets diseased bone throughout the skeleton. It can reveal hot spots, which are suggestive of metastatic disease. However, despite the sensitivity of this test, it lacks specifity because hot spots are also indicative of many other bone diseases including arthritis and infection. A bone scan is only recommended in patients with more advanced local lesions, symptoms of metastases, such as bone pain, high grade disease or strongly elevated PSA levels. Elevation in serum PSA can be a main determinant in prostate cancer diagnosis. Additional blood tests after diagnosis help determine if the prostate cancer has spread and if other organs are still functioning normally after treatment. Common blood tests include a complete blood count and blood chemistry. Abnormal blood chemistry values, such as a rise of lactate dehydrogenase, alkaline phosphatase, and calcium levels are indicative of prostate cancer spreading, in particular to the bones. Tissue biopsies are the only way to determine if the prostate has become cancerous, and if cancer cells have spread to other organs, such as the lymph nodes. Initial diagnosis of prostate cancer should be established by TRUS guided needle biopsy. The needle biopsy procedure is performed transrectally, using a thin needle mounted on a spring-loaded gun under TRUS guidance. Abnormal areas visible on TRUS should be sampled, together with
at least 10 systematic biopsies taken from different areas of the prostate. The prostate biopsy samples are sent to the pathologist for histologic preparation and microscopic examination. Each biopsy, or core sample is identified separately by location and orientation to determine the extent of the grade of cancer. Lymph nodes in the pelvis are usually the first place affected by spreading prostate cancer. Once in the lymph nodes, the cancer continues to grow, causing them to enlarge. This increase in size of the lymph nodes can be detected with a CT or MRI scan. However a complete analysis of the lymph nodes requires a histologic examination. Suspicious looking lymph nodes should be sampled using a CT guided fine needle aspiration biopsy to confirm whether the cancer has indeed spread to regional lymph nodes. To access the complete course on Understanding Prostate Cancer go to www.anmf.adamondemand.com.au/ For further information contact Jodie or Rebecca at email@example.com or ph: 02 6232 6533
Earn hours of CPD By reading this article you have gained half an hour of learning that can be added to your CPD portfolio. By accessing this tutorial in its entirety you will learn more about prostate cancer and earn 1.5 hours of CPD. Go to the CPE website www.anmf. adamondemand.com. au/ to complete this online activity. The online article this month costs $30.99 for ANMF, NSWNMA and QNU members and $43.99 for non-members. (prices are GST exclusive). For further enquiries please contact Jodie or Rebecca on Ph: (02) 6232 6533 or firstname.lastname@example.org
Legal Uncovering a cover up Linda Starr In this final article for 2014 we look at an astonishing attempt to cover up the circumstances of an elderly woman’s death in a nursing home and how the working culture of an environment can serve to support poor practices regardless of policy and procedures being in place to deal with such events. Mrs Montalto (the deceased) was 76 years of age when she died in an Aged Care Facility (ACF) in 2011. She had a lengthy medical history including dementia and was resident in a dementia unit that had doors opening onto an internal courtyard housing a water filled fountain. Although a reportable death, the coroner was not notified – until a young carer courageously blew the whistle on what really happened. Consequently, the incident was investigated by police, who were advised that the deceased was found near the water fountain and possibly had some part of her body submerged in that fountain. Fortunately the police officer attending noticed a closed circuit camera pointing in the direction of the courtyard and subsequently retrieved the CCTV footage of the event leading to the deceased’s death. Not only did this film show how the deceased fell into and became submerged in the fountain, it also revealed important evidentiary proof of the actions of the staff who found her. The coroner concluded that not only were there significant breaches of policy and procedures at the ACF there was clear evidence of the staff taking steps to cover up what actually happened to the deceased. A review of the footage showed the deceased walking unattended in the garden, tripping on a garden light and falling head first into the fountain where she lay motionless - her head and torso immerged in the water. She lay there for more than 50 minutes before two RN’s arrived, alerted to the deceased’s anmf.org.au
whereabouts by a carer (the whistle-blower) who saw her in the pond from an upstairs window. It appears from this footage that an ambulance was on site at the time she was discovered, but no attempt was made to engage their services. The staff made no attempt to resuscitate presuming that, as she had cyanotic lips and no pulse or respirations, she was deceased. As the body had been embalmed determining the cause of death proved to be problematic. Whilst no definitive cause was determined, the pathologist, having viewed the footage, determined that the deceased could have died from immersion either after being rendered unconscious following a blow to the head (hitting the fountain floor) or cardiac arrest following immersion in cold water. However, of interest is the staff’s response to this event, given that this was a notifiable death. The deceased was taken back to her room where she was dried and put in clean clothes and placed back in bed. Records in both the progress notes and medication charts were falsified. The deceased’s GP was told she was found dead next to the pond, and on that basis made no further inquiry when she attended the ACF some hours later to certify the death, describing the deceased as `she was very tidy, peace-very peaceful’ (p10). The staff notified the family telling them that their mother had died from a heart attack, which in good faith they accepted as the truth. Evidence was given that the RN in charge at the time was told by the facilities manager to tell staff ‘they would be sacked if they mentioned [the incident]’ (p12). This did not deter the carer who informed police as to what she saw. Her account of the event can be heard at: https:// soundcloud.com/abc_rn/excerpt-deathin-a-five-star-nursing-home When this courageous whistle-blower returned to work the next day she was told that her probationary period of employment was not successful and her position terminated, presumably for her breach of confidentiality for speaking publicly on this incident. Overall the coroner found the evidence given by many of the staff at the ACF to be inconsistent, competing and on the ‘verge of the absurd at times’, given the conflicting accounts presented by those
involved. Some witnesses also had vague recollections of the circumstances of the death until the evidence of the footage emerged. At the very least this conduct is evidence of a breach of duty in the failure to monitor the deceased adequately, a breach of the trust and a failure to adhere to the Australian and Midwifery Board code of ethics by the registered staff. The coroner raised a number of concerns regarding the workplace culture that was `…reactive rather than proactive regarding the safety of residents‘ and one that easily enlisted staff to participate in the cover up and omission of detail surrounding this death. This later point is particularly important given the current trend in the aged care workforce to employ a number of staff from culturally and linguistically diverse backgrounds, many new arrivals to this country. On this point the coroner saw employers as having the responsibility of acknowledging how vulnerable such staff members may be to manipulation and exploitation and thus must ensure there is a `culture and structure in place to ensure that strong organisational moral values are upheld particularly in an aged care environment providing care for those who are amongst the most vulnerable in our community’ (p19). Reference Inquest into the Death of Caterina Montalto. 2013 Victorian Coroners Court.
An expert in the field of nursing and the law Associate Professor Linda Starr is in the School of Nursing and Midwifery at Flinders University in South Australia November 2014 Volume 22, No.5 29
World Strike action a first in 32 years
Irish public hospital crisis
Thousands of UK National Health Service (NHS) employees, including nurses and midwives, took strike action last month to protest the government’s decision to deny the majority of them a pay rise.
The Irish Nurses and Midwives Organisation (INMO) is demanding the government immediately lift a nursing/midwifery recruitment ban, and inject extra funding into health services, in the face of increasing overcrowding in Irish public EDs and wards.
The four hour action occurred as a result of workers anger at the government’s decision to reject the NHS Pay Review Body’s recommendation for a 1% pay rise for all staff. UNISON, UK’s largest nurses and midwifery union, General Secretary Dave Prentis said it was the first time in 32 years NHS members had taken strike action over pay. “They [the members] have sent a clear message to the government that they deserve fair pay and the government cannot take advantage of their good will any longer.” According to UNISON, pay in the NHS has not kept in line with inflation and staff had not received an above-inflation rise since 2009. This year, 60% of NHS staff will not get a pay rise and only those at the top of their bands will receive a 1% unconsolidated pay rise. UK Health Secretary Jeremy Hunt was quoted defending the government’s
Addressing child blindness in Asia An Australian survey on blindness in Laos is the latest attempt to prevent and repair child blindness, which affects one million children in South East Asia. University of Adelaide eye surgeons together with South Australian charity group Sight For All will launch the survey next month to better understand the size and scope of blindness in the Asian nation. The team, involving more than 100 eye care professionals from around Australia and New Zealand, had been working in nine countries including Bangladesh, Cambodia, Laos, Myanmar, Sri Lanka, and Vietnam to conduct research. 30 November 2014 Volume 22, No. 5
Photo: Mark Thomas
actions, saying that a 1% pay rise would lead to as many as 4,000 nurses being laid off this year and 10,000 next year. Adding to their financial burden, UK nurses and midwives have recently had their registration fees hiked from £100 to £120, which is an increase of 52% in the last three years. UNISON’s Head of Nursing Gail Adams said nurses and midwives have had their pays frozen since 2010, yet they are expected to fork out for more fees. “The truth is financial hardship has hit them [nurses and midwives] hard and they simply can’t afford it so they will be understandably angry.”
University of Adelaide ophthalmology lecturer and chairman of Sight For All Dr James Muecke said an estimated 45 million people worldwide are blind, and half of those are in Asia and the Western Pacific. “There are one million blind children living in developing countries in Asia. Unless something is done to address their blindness, they will live with that disability for the rest of their lives, receiving little to no education and greatly reducing their quality of life.” He said research has consistently found that half of all blindness in Asian countries is avoidable. “In three of the five countries where we’ve conducted childhood blindness studies, the leading cause was found to be measles. It costs less than $1 per child to vaccinate against measles, so this is a sign of a very poor nation when it can’t afford to vaccinate its children.”
INMO General Secretary Liam Doran said figures released in September 2014 revealed a 32% increase in overcrowding in ED’s and wards compared to 2013. The figures also confirmed that compared to September 2012 there had been a 49% increase in the level of overcrowding recorded this year. Mr Doran said urgent action was needed from the government to address this crisis facing Ireland’s public hospitals, which was having a negative impact on patient care and staff workload. “The organisation has no doubt that patient care is being severely compromised as a direct result of this overcrowding.” According to Mr Doran the figures served as evidence for the government to lift the recruitment ban and allow employment of more healthcare professionals, which would ensure patient safety and avoid unnecessary costs of engaging agency staff. He said it was imperative, as the government finalises its budget for 2015, the health service is provided with immediate assistance. This included an immediate injection of supplementary funding to allow Health Service Executive (HSE) deal with this crisis and, most importantly, open closed beds to deal with this overcrowding emergency. The INMO also wants a multi-year funding commitment, which would allow it to plan for the development of services, including additional bed capacity.
Clinical Review Drop Precautions Staff to use a fluid repellent surgical mask e.g. influenza, meningococcal, pertussis
Airborne Precautions Staff to use a high particular (P2/N95) mask e.g. pulmonary tuberculosis, chicken pox, measles
Patients in droplet or airborn precautions that are required to leave their room are to wear a fluid repellent surgical mask
What mask to use? Rachel Paton, Nicole Tolhurst, Marija Perisa, Kathy Dempsey and Jo Tallon The type of face mask used in the clinical setting needs to be determined dependent on the reasons for wearing it, whether it be for droplet or airborne precautions. Westmead Hospital had combined droplet and airborne precautions under one isolation modality - respiratory precautions. This isolation method did not require staff to distinguish between droplet and airborne transmission but treated patients the same under respiratory precautions. Therefore staff needed to use a P2/N95 mask for all patients in respiratory isolation, regardless of mode of transmission. Infection Control separated respiratory precautions into airborne and droplet precautions to comply with state and national policies in late 2011. Healthcare workers (HCWs) were informed of this change face to face and also using visual signage. Using the incorrect mask can facilitate the transmission of infection within the healthcare setting (Australian Commission on Safety and Quality in Healthcare 2010). With this in mind, and due to the heightened alert regarding the possibility of VHF (Ebola) reaching Australian shores, it was essential that staff had a sound understanding of correct mask usage. Current Infection Control policy (Clinical Safety, Quality and Governance 2007) anmf.org.au
Loren Cleaves, CSO Infection Control Westmead Hospital
directs HCWs to wear the P2/N95 mask for airborne precautions and fluid repellent surgical masks for droplet precautions. Airborne dissemination may occur via particles containing infectious agents that remain suspended in the air inhaled by susceptible individuals. To prevent airborne transmission a P2/N95 mask are used (Balazy et al 2006). Respiratory droplets transmit infection when they travel directly from the respiratory tract through coughing, sneezing, fomites and hands to the mucosal membranes (Clinical Safety, Quality and Governance 2007). A fluid repellent surgical mask prevents the transmission of droplet pathogens. Patients with suspected or confirmed pathogens transmitted by the airborne/droplet route are required to wear a fluid repellent surgical mask when exiting their room (Australian Commission on Safety and Quality in Healthcare 2010). One hundred randomly selected nursing staff answered a closed ended questionnaire determining current understanding of airborne and droplet precautions in 2012. The results indicated that nurses had an average of 62% understanding on correct mask usage. This promoted infection control to improve mask usage knowledge by educating as many HCWs as possible. This included face to face inservicing, a media broadcast poster was sent to all senior nurses, and a display board located outside infection control promoted correct mask usage. After the education initiatives the questionnaire was again completed by 100 randomly selected nursing staff, indicating an average of 84% understanding on correct
mask usage. This improved knowledge has the potential to prevent the transmission of respiratory diseases, especially with the current emerging respiratory infectious diseases and the heightened alert around VHF. It is essential that staff members have a sound understanding of correct mask usage. References Australian Commission on Safety and Quality in Healthcare, (2010) Australian guidelines for the prevention and control of infection in healthcare. Balazy A, Toivola M, Adhikari A, Sivasubramani SK, Reponen, T and Grinshpun, SA, (2006) Do N95 Respirators Provide 95% Protection Level Against Airborne Viruses and How Adequate are Surgical Masks? American Journal of Infection Control; 34(2):51-57 Clinical Safety, Quality and Governance, (2007) Infection Control Policy PD _036.
Rachel Paton, RN, Bachelor of Nursing, GDip. is the Infection Control at CNS Infection Prevention and Control Westmead Hospital Nicole Tolhurst Dip AppSc, BASc (Nursing), Gcert. is the Operating Suite/ Recovery CNS Infection Prevention and Control Westmead Hospital Marija Perisa RN, Bachelor of Nursing is the CNC Infection Prevention and Control Westmead Hospital Kathy Dempsey RN, Dip AppSc, BASc (Nursing), MNSc-Infection Control & Hospital Epidemiology, SHEA/CDC Cert Infection Control, is the CICP CNC/ Co manager Infection Prevention and Control Westmead Hospital Jo Tallon RN, GCert Nephrology, Transplant & Haemodialysis, GCert Public Health, Infection Control & Hospital Epidemiology (SHEA&ECCMID) Cert is the CNC/Co Manager Infection Prevention and Control Westmead Hospital November 2014 Volume 22, No.5 31
Wellbeing potential when we are engaged in activities that absorb and inspire us.
Relationships Our wellbeing relies heavily on the quality of our relationships. Build your wellbeing by building strong networks of relationships. Humans are social animals. We need connection with others, love and physical contact. Healthy relationships help us to thrive. The key to all relationships is balance. Building relationships at work where you support and champion others means those same people will be more prepared to support and champion you. Become a leader by developing the skill of building, acknowledging and supporting others to achieve.
Personal Development is Professional Development Taking care of the wellbeing of our nurses Janette Cooper Nurses are a vital part of the health care team. Maintaining our own health and wellbeing is important for the organisations we work in, our patients, for ourselves and our families. Director of the Penn Positive Psychology Center in the US Professor Martin Seligman, is a leading authority in the field of Positive Psychology. He suggests that happiness is obtainable for all of us. Dr Seligman has spent years developing a theory of happiness. What he has uncovered is the building blocks of wellbeing. When we build our wellbeing and satisfaction with life our lives become happier.
Wellbeing Theory. They are positive emotion, engagement, relationships, meaning and accomplishment (PERMA). Each of these elements is essential to our wellbeing and satisfaction with life. Together they create the foundation upon which we can build a happy and flourishing life. Our aim has to be to create a life where we flourish in order to be happy.
PERMA Positive emotion Positive emotions do more than make us smile. Feeling good helps us to perform better in all areas of our life. It improves our physical health, it strengthens our relationships, inspires us to be creative, take chances and look to the future with optimism and hope.
The nursing profession can be demanding and stressful at times. We have to have a plan to create happiness and fulfilment in life to counter balance these demands and stresses. We all want to be happy and Dr Seligman claims that being happy or experiencing positive emotions are only one of the building blocks of wellbeing and it is our wellbeing where we must focus our efforts.
Highs and lows are a part of life and it is vitally important to focus on doing things that make us feel good so that we experience more positive emotion. What makes you feel good? It might be spending time with friends and family or exercise, getting out into nature or doing something creative. We have a natural tendency to focus on the negative. Seeing through a more positive lens is a skill that can be learned.
There are five elements of Seligman’s
Engagement Engagement happens when we are doing anything that completely absorbs our attention. When we live a life that lacks an element of engagement we become bored. When we identify and cultivate our personal and professional strengths, virtues and talents we can seek out opportunities to engage in work and opportunities to engage in work that allow us to feel more productive, competent and confident. We are more likely to fulfil our own unique
32 November 2014 Volume 22, No.5
Meaning We are at our best when we dedicate our time to something greater than ourselves. Studies have shown that people who belong to a community and pursue shared goals are happier than people who don’t. Do things that are consistent with your personal values and beliefs. What do you value? It could be family, learning, or a faith. Find what matters most to you and then find like-minded people so you can work together on the things that you care about. You can find meaning in your professional life. If you see a deeper mission in the work you do, you are better placed to apply your talents and strengths in the service of this mission.
Accomplishment We have all been taught that ‘winning isn’t everything.’ We shouldn’t focus on winning but more on being part of the game. This might be true and it is also true that we need to be able to set goals and to win some times. To achieve wellbeing we have to be able to look back on our life with a sense of accomplishment. Creating and working towards goals helps us to anticipate and build hope for the future. Past successes help us to feel more confident and optimistic about the future. Feeling good about your achievements makes you a confident and competent teacher for those that will learn from you. We have to set ourselves tangible goals and keep them in sight. The performance development plan is our vehicle to identify our ambitions and our strengths in order to reach our goals. Janette Cooper, BN, Grad Cert Health Services Mgmnet, Leadership Coach Contact: email@example.com anmf.org.au
Focus – Men’s health
Beating to the sound of an HIV men’s health drum By Dr Liz Crock Dr Liz Crock (3rd from left) and Dr Jason Farley from Johns Hopkins University (5th from left) with HIV nursing teams
The recent international AIDS 2014 conference, which attracted a record 14,000 delegates to Melbourne, put a bright spotlight not only on the challenges facing the medical profession, but also on the passion, commitment and dedication of nurses and carers to help those living with and affected by HIV. In many ways it was an ideal opportunity to consider an area of men’s health that is not particularly well understood. The RDNS Nurses’ Welcome Reception was a remarkable forum for international nurses to network and exchange views and news.
monitoring, care coordination, medication management, health promotion and education for carers, other nurses and external agencies. VAC provides volunteers who assist with transport to medical appointments and practical and social support. VAC runs groups and services that RDNS clients have immediate access to through the partnership. Long-term survivors of the HIV epidemic comprise over half of RDNS HIV clients.
When thinking of men’s health, it is probably unlikely that nurses in Australia would immediately think of older homosexual men living with Human Immunodeficiency Virus (HIV) infection.
Health problems now faced by this group of older men living with HIV include anal and other cancers, osteoporosis, arthritis, heart disease, depression and HIV-associated neurocognitive impairment (HAND). Some comorbidities are related to HIV itself (through chronic inflammation and immune activation), some related to antiretroviral medications, and some can be attributed to high rates of smoking or other factors.
But thanks to the great advances in treatments made over the past 25 years, many homosexual men with HIV are living longer and are now entering older age. Some have a range of health problems requiring specialist nursing assessment, nursing care and support at home by nurses who are educated, skilled and sensitive to their specific needs and experiences.
If recognised early, some conditions can improve (such as HAND). Others can be managed well in the community with strong collaboration with HIV specialist GPs, hospital-based HIV nurses and social workers and infectious diseases physicians. A minority of people with HIV may eventually require residential care in nursing homes or hostels.
The RDNS (Royal District Nursing Service) HIV Program has provided home-based nursing to people living with HIV since 1985, in partnership with the Victorian AIDS Council (VAC). This team of HIV specialist nurses, with the support of local RDNS staff, cares for over 150 clients with HIV at any one time. Key areas of support include health
In a recent evaluation of HIV clients’ changing needs conducted within RDNS, older homosexual men expressed most concern about HIV specialist nursing service provision being available to them, friends dying and dying of AIDS, being forced to leave my home, HIV and non HIV–related illnesses, pain, having to go to a nursing home and finances. Many were concerned
about being able to get the healthcare they need in the future. Anxiety, grief and sadness were concerns for many, as these two responses illustrate:
“SADNESS HAS ALWAYS BEEN THERE,” 49 year old homosexual man, long term survivor
“MY YOUTH IS GONE. I WORRY ABOUT COMPANIONSHIP AND BEING WITH SERVICES AND PEOPLE WHO ARE NON– JUDGMENTAL AS I AGE,” 76 year old homosexual man Many homosexual men in Australia had their social networks decimated, and their lives were shaped by the epidemic in the 1980s. As this group of older men living with HIV ages, many are fearful of possible discrimination within aged care services and most want to stay in their own homes. It is important for nurses in all sectors to receive up-to-date education about, and be sensitive to, the needs of older homosexual men living with HIV. Reference Crock, E. (2013) The Royal District Nursing Service HIV Program in a changing epidemic: an action evaluation. Unpublished evaluation report. Melbourne, RDNS.
Dr Liz Crock is RDNS Clinical Nurse Consultant (HIV). Last year she was awarded the International Centre for Nursing Ethics Human Rights Award November 2014 Volume 22, No.5 33
Focus – Men’s health Expanding our understanding of suicidal men’s help-seeking practices By Jo River There is a striking gender difference in suicide rates in Australia and worldwide with men accounting for approximately 80% of all deaths (World Health Organization (WHO), 2011; Australian Bureau of Statistics (ABS), 2012). Yet research data suggests suicidal men are less likely than women to access professional help (Booth & Owens, 2000).
theory, which has emerged from the sociology, is able to capture the complex nature of gender within a life story.
While the link between men’s suicide and help-seeking continues to gather public and political attention, recent research suggests that men are not a homogenous group with uniformly poor help-seeking behaviour (Wenger, 2013). In order to move beyond homogenising accounts and adequately address the health service needs of suicidal men, this study aimed to provide a more substantive theory of suicidal men’s help-seeking practices.
Findings suggest that there is no set pattern of help-seeking among suicidal men. While some men avoided health services, others actively sought help. In some cases, helpseeking was triggered through unsolicited contact with health services. However, this study found the responsibility for helpseeking behaviour did not rest solely with suicidal men. Men’s help-seeking practice could either be facilitated or blocked by the kind of professional support that was offered. Men overwhelmingly rejected services that framed emotional distress or suicidal behaviour as mental illness. In contrast, a ‘person-centred’ approach to care, which focused on the concerns of men and avoided a psychiatric framework, tended to maintain or activate help-seeking behaviour.
Life history method, underpinned by a theoretical framework of gender-relations, was used to explore the lives and helpseeking behaviour of 18 Australian men who had engaged in nonfatal suicide. This methodology has demonstrated value in research on men and masculinity. Life history method makes visible wider socio-cultural factors, and gender-relations
There is an increasing drive for personcentred care within current health services, particularly with the discipline of nursing (eg. McCormack, 2001; Mead, & Bower, 2000). McCormack and McCance (2010) identify the power of the medical discourse and organisational culture as major barriers to person-centred practice. The findings from this study suggest that a person-
centred model of practice is clearly not outside the current scope of professional practice in Australia. However, the power of psychiatry to structure health service response means that the needs of many suicidal men continue to be overlooked. References Australian Bureau of Statistics [ABS]. (2012). 3303.0 Causes of Death, Australia, 2010. Canberra: Commonwealth of Australia. Booth, N., & Owens, C. (2000). Silent suicide: Suicide among people not in contact with mental health services. International Review of Psychiatry, 12, 27-30. McCormack, B., & McCance, T. (2010). Person-Centred Nursing: Theory and Practice. Oxford: Wiley-Blackwell. Mead, N., & Bower, P. (2000). Patient-centeredness: a conceptual framework and review of the empirical literature. Social Science and Medicine, 51(7), 1087-1110. Wegner, L. (2013). Moving through Illness with Strong Backs and Soft Fronts: A Substantive Theory of Men’s Help-seeking during Cancer. Men and Masculinities, 1-23. World Health Organization [WHO], (2011). Suicide rates per 100,000 by country, year and sex. World Health Organization. Retrieved 11 December 2013 from www. who.int/mental_health/prevention/suicide_rates/en/
Jo River is Lecturer in Health Politics, Social Determinants of Health and Illness Experience in the Sydney Nursing School at The University of Sydney
$99 ALL INCLUSIVE , TO PURCHASE GO TO WWW.TRYBOOKING.COM/GCXU & WWW.TRYBOOKING.COM/107426 CONTACT: PETER GIBBINS 0409000225 or LEIGH JOHNSON 0416060021 Launch party o Official f 'Th eW orl ds Big ge st
Hu g Co mm u n it y'
Your ticket purchase assists World’s Biggest Hug Community, World Youth International & Access Rugby help change the lives of those in need. Learn more at www.facebook.com/worldsbiggesthugcommunity
Focus – Men’s health Black men and utilisation of healthcare services By Kechinyere (Kechi) Iheduru-Anderson Health disparities is described as inequalities signified by differences in environment, access, utilisation, quality of care, health status, or particular health outcomes. On a variety of health measures, healthcare access and other social determinants of health, minority men fare worse than white men. Nurses have the responsibility to eliminate health disparities among people from diverse racial, ethnic, and cultural backgrounds. To do this, nurses must become more knowledgeable about the health disparities among the racial and ethnic groups they serve.
It is documented that men have fewer interactions with the healthcare system and are less likely to have an ongoing relationship with a primary care provider. The incidence of certain conditions such as unintentional injuries, alcohol and substance are higher in men than women. Race, socioeconomic factors, and cultural factors interact to influence health seeking behaviours. Black men, in contrast with white males, are more likely to hold fundamentalist religious beliefs that include prayer and reliance on God would heal. Studies suggest fear and embarrassment have prevented many black men from seeking screening for certain diseases such as prostate cancer. There is also a lack of awareness of screening, denial of self-risk and a fatalistic perspective toward diseases in general.
that incorporate specific cultural beliefs about diseases and screening, such as stoicism, as well as strategies to overcome barriers to screening. Several studies also support the need for outreach to racial and ethnic minority populations. Minority men suffer disproportionately from a wide variety of diseases and medical conditions which can be prevented and controlled with screening and early detection. The healthcare providers’ aggressive, positive engagement in shared decision-making is highly predictive of black men making informed decisions to seek help and follow through. When the providers’ engagement is surrounded by social influences promoting a clear prevention message targeting black men, there is a strong possibility that they will participate in health screenings and make better choices.
Most black men feel that if they do not have any symptoms, there is no need to seek health services. Yet most diseases which disproportionately affect minority men have no symptoms until they are well advanced. Interactions with the healthcare system, such as an ongoing relationship with a physician, influence how men obtain and use services. The importance of screening services, such as colorectal cancer screenings, has been well documented. Yet minority men shy away from such procedures even when they have insurance coverage.
To help bridge the gap in health disparity, there is great need to build trust in healthcare. Seeking medical help is hard for most black men stemming from generations of old distrust of the medical profession held by many in black communities. Black men are taught from young to present strength in an underprivileged environment and show no weakness in the face of adversity. This often transcends to their attitude to seeking healthcare services. Some black men stemming from their socioeconomic background have been exposed to very unhealthy coping strategies to certain life conditions such as stress and depression which contribute to health problems.
Studies have shown that there are significant relationships between knowledge of early warning signs of diseases such as cancer, attitudes related to screening procedures, perceptions of seriousness of the disease, and disease risk reduction and early detection health promotion behaviours. It is important to understand how culture and health literacy affect individual health behaviour. As nurses it is crucial to design interventions for clients anmf.org.au
Nurses should seek to provide culturally sensitive care at all times. Considering the limited access and contact that black men have with healthcare professionals, it is important to ensure that when minority men do seek medical help, they receive comprehensive medical evaluations to promote health and wellness and undergo
health screenings for the early detection, prevention and/or treatment of the immense number of medical conditions which disproportionately afflict minority male populations. Cleveland Clinic in Ohio United States hosts a Minority Men’s Health Fair annually, creating awareness by providing various screening and health information. The event’s overarching message is the importance of preventive health screenings, especially in men who have no symptoms. As nurses, let us develop male community advocates and champions for preventive healthcare screening and health education. Join forces with faith and communitybased groups who understand the culture of the minority men in our midst to raise awareness about the importance of health screening. Events like health fairs for minority men or men in general provide opportunity to have important conversations about health and wellbeing. While some of the contributors to health disparities cannot be completely eliminated or prevented, more efforts can be made by healthcare professionals to reach the minority communities to address modifiable behaviours, and provide better access to healthcare. References on request
Dr Kechinyere Iheduru-Anderson DNP, RN, CWCN is a professor of nursing at Quincy College, Quincy Massachusetts and Adjunct faculty at Regis College Weston and Laboure College Milton Massachusetts. Kechi created and maintains the website www.westafricaneducatednurses.com a resource for newly migrated West African internationally educated nurses and other internationally educated nurses as they transition into clinical practice in the United States. November 2014 Volume 22, No.5 35
Focus – Men’s health Remaking masculinities after spinal cord injury: Mapping psychosocial needs By Murray J Fisher and Julie Pryor This life history project aims to examine how men reconstruct their masculinity following a spinal cord injury (SCI). SCI is a catastrophic life event, where individuals often become functionally dependent, prone to depression and have a reduced quality of life. This study will identify the psychosocial needs of men as they transition to a post injury life, where their functional performance in areas of mobilisation, bladder, bowels, and sexuality have been significantly affected. Understanding this aspect of the SCI experience for men will help reduce physical and mental health complications. This project fits with a Commonwealth Department of Health and Aged Care national report outlining a research agenda for men’s health (Connell et al 1999). It identified key research problem areas and recommended high priority be given to: • Studies of the development of
masculinities in boys and youth, looking at physical growth, histories of health and illness and injury, consciousness of body and health, gender identities, and the social and family contexts of growth;
SCI can challenge a person’s identity, in particular how males see themselves as men and their role in society (Ostrander 2008). Functional independence, depression and social interaction are major predictors of quality of life in SCI (Sweet et al 2013). The prevalence of depression amongst individuals with SCI is in the range of 20-30%, two to three times more than the general population and it is suggested that there is a relationship between depression and secondary physical complications (Krueger et al 2013). According to Bombardier (2012) having few rewarding activities and less confidence in one’s ability to manage the effects of SCI are independent predictors of greater depression severity. Furthermore, men’s adherence to masculine norms has been found to be a major predictor of employment status among men with SCI (Burns et al 2010). What is lacking in the literature is an understanding of how SCI disrupts gender identity and men’s embodiment of masculinities. Masculinities are relational, competitive and hierarchical (Connell 1995). Using gender relations as a theoretical framework for understanding masculinities makes the impact of SCI on the construction of masculinities evident.
• Studies of the practices of men and
boys, in motor vehicle use, workplaces, and sport, which generate high levels of accidental injury and other health effects, and which are often presumed to be connected to male socialisation and risk taking. (Connell et al 1999) An incidence rate of traumatic SCI that is 5.3 times higher for men than women (AIHW 2010) suggests that men act in ways that predispose them to traumatic injury (Mitchell et al 2012). The mechanisms of SCI are often related to activities mostly conducted by men, including: driving practices leading to transport accidents; work (employed and at home) and leisure activities leading to water-related accidents; falls or collisions; alcohol and illicit drug consumption and violence (recipients and perpetrators) (AIHW 2010). To this end, the mechanism of SCI can be understood as an outcome of masculinity. 36 November 2014 Volume 22, No. 5
This project will use life history, a qualitative research method, to document the lives of men with SCI or significant parts thereof as narrative, through the telling and recording of one’s life (Plummer 2001). Fifteen to 20 men with recent SCI will be invited to participate in the study and will be recruited from an inpatient SCI rehabilitation unit. Data collection consists of two interviews, one after four weeks of rehabilitation care and the other at least six months after discharge from inpatient rehabilitation, and biographical information from participants’ clinical notes. Data analysis will consist of a structural analysis using a fourdimensional structural model of gender relations (Connell 2000, 2002). This study is supported by the Transport Accident Commission Victoria through the Institute of Safety, Compensation and Recovery Research.
Gaining an understanding of how men with SCI reconfigure their masculinity is important for identifying and addressing psychosocial needs throughout rehabilitation to enable men with SCI to possess a positive sense of self and lead meaningful lives. References Australia. AIHW. Norton, L. (2010). Spinal cord injury, Australia 2007–08. Injury research and statistics series no. 52. Cat. no. INJCAT 128. Canberra: AIHW. Bombardier, C.H., Fann, J.R., Tate, D.G., Richards, S., Wilson, C.S., Warren, A.M., Temkin, N.R. and Heinemann, A.W. (2012). An exploration of modifiable risk factors for depression after spinal cord injury: which factors should we target? Archives of Physical Medicine and Rehabilitation. 93: 775-781. Burns, S.M., Boyd, B.L,, Hill, J. and Hough, S. (2010). Psychosocial Predictors of Employment Status Among Men Living With Spinal Cord Injury. Rehabilitation Psychology. 55(1): 81-90. Connell, R.W. (1995). Masculinities. Sydney: Allen and Unwin. Connell, R.W., Schofield, T., Walker, L,, Wood, J, and Butland, D. (1999). Men’s Health: A Research Agenda and Background Report. Canberra: Commonwealth Department of Health and Aged Care. Connell, R.W. (2000). Men and the Boys. Sydney: Allen and Unwin. Connell, R.W. (2002). Gender: Short Introductions. Cambridge: Polity Press. Krueger, H., Noonan, V.K., Williams, D., Trenaman, L.M. and Rivers, C.S. (2013). The influence of depression on physical complications in spinal cord injury: Behavioral mechanisms and health-care implications. Spinal Cord. 51:260-266. Mitchell, R., Curtis, K. and Fisher, M.J. (2012) Understanding trauma as a men’s health issue: gender differences in traumatic injury presentations at a level 1 trauma centre in Australia. Journal of Trauma Nursing. 19(2): 80-88. Ostrander, N.R. (2008). When identities collide: masculinity, disability and race. Disability & Society. 23(6), 585-597. Plummer, K. (2001). Documents of Life: an Invitation to a Critical Humanism. London: Sage Publications. Sweet, S.N., Martin Ginis, K.A. and Tomasone, J.R. (2013). Investigating intermediary variables in the physical activity and quality of life in persons with spinal cord injury. Health Psychology. 32(8): 877-885.
Murray J Fisher is Associate Professor and Acting Associate Dean (Research) in the Sydney Nursing School at the University of Sydney and Nursing Scholar in Residence at Royal Rehab Julie Pryor is Clinical Associate Professor in the Sydney Nursing School at the University of Sydney and Nursing Research and Development Leader at Royal Rehab anmf.org.au
Focus – Men’s health Research project supports the emotional wellbeing of young fathers during the perinatal journey in parenthood By Donovan Jones, Rachel Rossiter and Lyn Ebert In Australia, mental health problems carry the highest burden of disease in 18-25 year olds, with males representing 23% of those affected (Australian Institute of health and Welfare [AIHW] 2011). Research studies indicate that young men entering fatherhood encounter multiple emotional risk factors (Wilkes, et al. 2012). Young fathers have been demonstrated to be as vulnerable to depression and emotional issues as young mothers, with a significant correlation between younger age and level of risk (Bergstrom, 2013). However, the Australian Government Department of Health has mandated routine screening for depression and referral to mental health services for women only during the perinatal period (Rowe, Holton, & Fisher, 2013). Furthermore, childbirth education in Australia does not include mental health interventions such as stress reduction or emotional management skills targeted specifically to expectant fathers. Pregnancy presents a unique opportunity for health professionals to engage not only with the mother-to-be but also the fatherto-be, in programs that can have a positive impact on the family unit throughout the child-rearing years. Recent studies postulate significant links between the involvement and support of fathers and reductions in maternal anxiety and depressive symptoms in the postnatal period and beyond (Sapkota, Kobayashi, & Takase, 2013). Research has demonstrated the effectiveness of targeted mindfulness programs in both the treatment and prevention of psychological dysfunction in a diverse range of people (Byrne, et al. 2014; Majumdar, et al. 2002). The high anmf.org.au
prevalence of stress and anxiety commonly experienced in pregnancy, birth and parenting, has led maternity researchers to investigate Mindfulness Based Stress Reduction (MBSR) as a potentially effective intervention throughout the perinatal period (Allison, et al. 2010; Rallis, et al. 2014; Willinger, Diendorfer-Radner, et al. 2005). A recent pilot study utilising MBSR has demonstrated a reduction in fear prior to childbirth and decreased anxiety in the postnatal period (Byrne et al., 2014). To date, no mindfulness based programs for young fathers have been evaluated. A research project scheduled to commence early in 2015 will target emotional wellbeing of young fathers during their partner’s pregnancy through participation in mindfulness classes. The project will evaluate the effectiveness of the mindfulness intervention utilising a mixed method research design collecting quantitative data pre and post intervention and focus group data post intervention. Data will provide the basis of further translational research and applications for funding for interventions to support young men about to become parents. References AIHW. (2011). Young Australians: their health and wellbeing 2011 (full report; 10 June 2011) (AIHW). 1-262. Allison, J., Stafford, J., & Anumba, D. (2010). The effect of stress and anxiety associated with maternal prenatal diagnosis on feto-maternal attachment. Women & Health, 11 (1), 33-33. doi: 10.1186/1472-6874-11-33 Bergstrom, M. (2013). Depressive Symptoms in New First-Time Fathers: Associations with Age, Sociodemographic Characteristics, and Antenatal Psychological Well-Being. Birth-Issues in Perinatal Care, 40(1), 32-38. doi: 10.1111/birt.12026 Byrne, J., Hauck, Y., Fisher, C., Bayes, S., & Schutze, R. (2014). Effectiveness of a Mindfulness-Based Childbirth Education pilot study on maternal self-efficacy and fear of childbirth. Journal of midwifery and womens health, 59(2), 192-197. doi: 10.1111/jmwh.12075 Majumdar, M., Grossman, P., Dietz-Waschkowski, B., Kersig, S., & Walach, H. (2002). Does mindfulness meditation contribute to health? Outcome evaluation of a German sample. Journal of alternative and complementary medicine (New York, N.Y.), 8(6), 719-730- discussion 731-715. doi: 10.1089/10755530260511720 Rallis, S., Skouteris, H., McCabe, M., & Milgrom, J. (2014). The transition to motherhood: towards a broader understanding of perinatal distress. Women and birth: journal of the Australian College of Midwives, 27(1), 68-71. doi: 10.1016/j.wombi.2013.12.004 Rowe, H. J., Holton, S., & Fisher, J. R. W. (2013). Postpartum emotional support: a qualitative study of women's and men's anticipated needs and preferred sources. Australian Journal of Primary Health, 19(1), 46-52. doi: 10.1071/PY11117
Donovan Jones at work
YOUNG FATHERS HAVE BEEN DEMONSTRATED TO BE AS VULNERABLE TO DEPRESSION AND EMOTIONAL ISSUES AS YOUNG MOTHERS Sapkota, S., Kobayashi, T., & Takase, M. (2013). Impact on perceived postnatal support, maternal anxiety and symptoms of depression in new mothers in Nepal when their husbands provide continuous support during labour. Midwifery, 29(11), 1264-1271. doi: 10.1016/j. midw.2012.11.010 Wilkes, L., Mannix, J., & Jackson, D. (2012). 'I am going to be a dad': experiences and expectations of adolescent and young adult expectant fathers. Journal of Clinical Nursing, 21(1-2), 180-188. doi: 10.1111/j.1365-2702.2011.03715.x Willinger, U., Diendorfer-Radner, G., Willnauer, R., Jörgl, G., & Hager, V. (2005). Parenting stress and parental bonding. Behavioral Medicine (Washington, D.C.), 31(2), 63-69. doi: 10.3200/BMED.31.2.63-72
Donovan Jones is Lecturer, Deputy Program Convenor Bachelor of Midwifery; Dr Rachel Rossiter is Senior Lecturer and Dr Lyn Ebert is Senior Lecturer, Program Convenor Midwifery Studies all in the School of Nursing and Midwifery at The University of Newcastle in NSW
November 2014 Volume 22, No.5 37
Do you need locum support but can’t afford the agency fees? Only 20 funded nursing and midwifery placements remain open for application this year. Over 80% of Australian Government funded placements have already been awarded.
Scan QR code to apply today or visit www.nahrls.com.au
THE KIDS ARE GETTING THEIR BREAK
Shouldn’t you make time for yours?
BOOK A 2 NIGHT STAY THIS SUMMER AND WE’LL INCLUDE A 5 COURSE DINNER WORTH $190 Spicers Retreats invigorates more than mind, body and spirit. Luxurious accommodation, natural serenity, award-winning cuisine and attentive service create the perfect environments in which to reconnect and relax. After all, once the kids have had their holiday, surely you deserve a little time for you. To take advantage of this exclusive summer offer call 13 SPICERS or visit spicersretreats.com/summer
Focus – Men’s health
New project targets men’s mental health The Movember foundation in conjunction with beyondblue are launching two new initiatives to help reduce Australia’s suicide rate among men. The National Ambulance Mental Health Project, plans to collect data from incidents attended by paramedics and track patients’ journeys through the health system so as to pinpoint areas of high male self-harm and suicide. The CEO for beyondblue Georgie Harman said the project is aimed at reducing Australia’s suicide rate, which currently sees about five males take their lives every day. “Incidents such as suicide attempt overdoses, panic attacks or callouts relating to mental illness such as anxiety or depression will be mapped to identify when, where and how men present in crisis.” Ms Harman said this would give unprecedented information about the mental health of men and identify opportunities to help them in a way that was previously impossible. The project expands on a pilot program funded by the Commonwealth government and is set to run in every Australian state and territory, with negotiations ongoing with Western Australia. The recorded data relating to mental health anmf.org.au
will be stored for three years from 2015 – while excluding personal details such as names – and may be extended to women, according to beyondblue. Movember Foundation’s Asia Pacific Director Jeremy Macvean said the project focussed on men because they seek support less often than women, but are three times more likely to die by suicide. Director of Turning Point and Monash University and project lead Professor Dan Luhman said training of paramedics was crucial to better prepare them in dealing with presentations of mental health, selfharm and suicidal behaviour. A new smartphone app designed for men working in rural and remote industries to help reduce rates of males at risk of committing suicide is the second initiative funded by beyondblue with the Movember Foundation. Targeting more than 60,000 male workers in industries, such as farming, construction and emergency services such as firefighters, the app Men@work will ensure managers receive training to help them develop the confidence to approach an
employee about whom they are concerned. beyondblue’s CEO Georgie Harman said the workplace was a vital place to help men tackle depression and anxiety. She said men struggled to reach out for help because they fear what other people might think and are scared about what might happen to their careers. “This app will help men get around this, offering personalised and confidential guidance as well as additional information on where to seek appropriate support.” Movember Foundation’s Asia Pacific Director Jeremy Macvean said maledominated industries now have somewhere to turn as Men@work app will allow them to develop personalised mental health plans. “They can update to assess their mental health and see how they can improve their wellbeing.” The project will be delivered by a consortium led by the Black Dog Institute and the Brain and Mind Research Institute at the University of Sydney. Black Dog Institute senior lecturer Dr Samuel Harvey said it would be rolled out through a number of urban and rural workplaces to address issues directly. “Not only will this new program be firmly located in a variety of different workplaces, but it will be subject to a very robust evaluation, so we can be sure which elements are effective and which are not.” November 2014 Volume 22, No.5 39
Focus – Men’s health depression and anxiety: An existing CBT program for mothers will be adapted and trialled in a pilot study targeting distressed new fathers. • Involving Fathers in Maternity Care –
Guidelines for Midwives: A proposal has been requested by the Australian College of Midwives based on the model of Reaching out: Involving Fathers in Maternity Care adopted by the Royal College of Midwives (2011) in the UK. References Australia. Department of Health. (2009). Framework for the National Perinatal Depression Initiative 2008-09 to 2012-13 (online). www.health.gov.au/internet/ publications/publishing.nsf/Content/mental-pubs-fperinat-toc Accessed: 17 September 2014
The paternal perinatal depression initiative By Richard Fletcher, Eileen Dowse, Elaine Bennett, Sally Chan, Anthony (Tony) O’Brien and Donovan Jones For many men, the birth of a child enhances their emotional and psychological wellbeing. For some however, the inevitable stressors and necessary adjustment(s) to parenthood can be overwhelming and as a result their mental health can suffer. The early detection of mood disorders among fathers and the provision of support during the perinatal period are important for the wellbeing of fathers, their families and the wider community. Conditions such as depression and anxiety during the perinatal period however can be common and there are effective treatments available. What has been lacking in the research about fathers during the perinatal period is a way to identify fathers in need and to provide them with appropriate gender orientated levels of support. The National Perinatal Depression Initiative (NPDI) (Department of Health, 2009) is a program of screening and treatment already available for mothers in Australia. However, simply mimicking the NPDI in an attempt to address fathers’ mental health would be 40 November 2014 Volume 22, No. 5
Rowe, H.J., Holton, S., Fisher, J.R. (2013). Postpartum emotional support: A qualitative study of women’s and men’s anticipated needs and preferred sources. Australian Journal of Primary Health. 19(1): 46–52.
misdirected. A father’s role, particularly in terms of his readiness to engage with health services due to time, familiarity and social context, necessitates a very different style of support (Rowe et al 2013). The Paternal Perinatal Depression Initiative (PPDI) is a multi-disciplinary, multi-state project team bringing together a unique combination of clinical, research, project development and policy skills that includes nursing and midwifery researchers, policy makers and clinicians. PPDI will take advantage of new communication technologies screening and supporting fathers without requiring across-the-board changes in their occupational or time use patterns. By developing and testing key elements in association with key parenting services, policy-makers and professional groups, the PPDI will set the stage for the development of mental health supports for fathers that complement the support already available for mothers. The following provides a snapshot of PPDI nursing or midwifery led related projects currently in progress: • Mental Health Screening and Referral
for Fathers in Early Parenting Centres: A telephone survey of Early Parenting Centres will identify, describe and quantify the instruments and procedures for screening fathers as well as referral processes and pathways for fathers attending residential and day stay services. • Cognitive Behavioural Therapy (CBT)
intervention addressing new fathers’
Royal College of Midwives. (2011). Reaching out: Involving Fathers in Maternity Care. www.rcm.org.uk/ sites/default/files/Father%27s%20Guides%20A4_3.pdf Accessed: 17 September 2014
Dr Richard Fletcher is Senior Lecturer, Family Action Centre, Faculty of Health and Medicine, Fathers and Families Research Program Convenor, Australian Fatherhood Research Network, The University of Newcastle Eileen Dowse is PhD Candidate and Lecturer in the School of Nursing and Midwifery, Faculty of Health and Medicine at The University of Newcastle Dr Elaine Bennett is Director Services & Research, NGALA in Western Australia Professor Sally Chan is Head of School in the School of Nursing and Midwifery, Faculty of Health and Medicine at The University of Newcastle Anthony (Tony) O’Brien is Associate Professor Nursing, Clinical Lead HNE Nursing and Midwifery Research Centre, Hunter New England (HNE)/ Newcastle University, School of Nursing and Midwifery, Faculty of Health and Medicine Donovan Jones is PhD Candidate, Lecturer, Deputy Program Convenor Bachelor of Midwifery in the School of Nursing and Midwifery, Faculty of Health and Medicine at The University of Newcastle anmf.org.au
Focus – Men’s health
Movember awareness Men around the globe will be sprouting moustaches this month for the annual Movember campaign to highlight a number of key health issues affecting men. The campaign aims to raise awareness and funds for prostate and testicular cancer as well as mental health issues, including anxiety and depression. Since 2003 the Movember community has raised $580 million and has funded more than 800 programs to date, in 21 countries. The campaign works by men and women signing up to movember.com to grow or support the moustache. Men start 1 November clean-shaven and grow their moustache for 30 days, getting friends, family and colleagues to donate to their moustachegrowing efforts. Men (also known as Mo Bros), with their new moustaches, become walking, talking billboards. They use their hairy ribbon to spark conversations around the often ignored issue of men’s health and seek to raise funds to support the work of
the Movember Foundation. Women who support men’s health (known as Mo Sistas) are also an important part of Movember’s success. They get involved in the same way as men, except they don’t need to grow a moustache. They sign up at movember.com, start a team, recruit the men in their lives to participate, donate, fundraise, plan and participate in events. Asia Pacific Director for Movember Jeremy Macvean said the Movember moustache is leading the charge in raising crucial awareness and funds for men’s health. “We encourage Movember participants to fully embrace the movement and have meaningful conversations with friends, family and colleagues in support of the cause. “We look forward to seeing our community growing and supporting the moustache again this year and making it the biggest and hairiest one yet!” For more information go to: http://au.movember.com
M EN’S HEAL THKITRESO T URCEKIKITRESOUR 1: PracCE MEN’S RESOHEALTH titioners’ GuURCE KIT ALTH Guide ide Acce Guide toners’ 1: ’Practitio M EN’S HE titKIT rs ss ne ibl io en e M Health Care r fo KIT 1: PracibletoHeAccessib for Men alth Carele Health Care for Men to Access
.indd 1 18/06/14 12:36 PM
Health Care_2.indd 1 MHI4399 Mens Health_Accessible 1 .indd Care_2 Health _Accessible Health
4 12:36 PM
Resources to provide best practice for men Resource kits to help healthcare providers engage better with their male clients have been developed by the University of Sydney. The four kits provide best practice guides for health and community services working with men and boys and include: • Practitioners’ Guide to Accessible Health Care for Men; • Practitioners’ Guide to Effective Men’s Health Messaging; • Practitioners’ Guide to Men and Their Role as Fathers; • Practitioners’ Guide to Men and Mental Health. The Resource Kits provide in–depth reviews, best practice and essential background information to enable proactive health and community services to structure their services in a more accessible and male friendly style. The guides also consider the essential factors that becoming and being a father play on men’s and boys’ health and the health of the whole family. These factors are only starting to be recognised by services as an important part of the entry point into working with men and their health and wellbeing. University of Western Sydney Men’s and Health Information and Resource Centre’s Director Professor John Macdonald said the resources had been compiled by Australia’s foremost experts on each male health topic. “The authors bring extensive experience of the challenges and opportunities they have faced in designing and implementing programs to attract and engage men and boys across a variety of health initiatives.” For more information go to: www.mengage.org.au/
November 2014 Volume 22, No.5 41
Focus – Men’s health Study to reduce adolescent depression Jonathon Greening Memorial Scholarship Fund 2014 Applications are invited from District Nurses who are planning to undertake further education, training or to conduct research related to district nursing clinical practice. There is one award in the JONATHON GREENING MEMORIAL SCHOLARSHIP FUND this year of an amount up to $5,000 however this award may be divided into several smaller awards if considered appropriate by the selection panel. The closing date for applications is: 5 December 2014 Application forms may be obtained from: Beth Pyke – RDNS 31 Alma Road, St. Kilda VIC 3182 Telephone:(03) 9536 5225 Facsimile:(03) 9537 0287 Email:firstname.lastname@example.org
Young Australian men will take part in a new study which uses sport to reduce the risk of depression and suicide in male adolescents. More than 5,000 young men from across the sporting codes are expected to take part in this multi-million dollar project.
Better bone health awareness needed Aussie males believe bone disease is unusual in men, according to a recent study conducted by Osteoporosis Australia. The study showed there were significant gaps in young men’s knowledge about their risk of getting chronic bone disease. Osteoporosis Australia CEO Gail Morgan said about 40% of the 18-24 year age gap believed Osteoporosis was rare in men or only occurred in women. “As men age their understanding about the condition increases – 55-64 year olds (83%) are most aware of the risks. Significantly, more than a quarter of all men think it is unusual to have osteoporosis.” Ms Morgan said the fact young men in particular know so little about the disease was concerning because in their 20’s and 30’s men needed to build up their bone strength. “Men can buff their bones by getting safe sun exposure, exercising and making sure calcium is part of their diet.”
Are you ready for your new mid morning snack? Locally made in Melbourne. 12 all-natural ingredients. Full of protein! Gluten, dairy & preservative free. Loaded with flavour, each bar contains two 40g serves. Individually hand wrapped in unbleached paper from FSC certified forests. dansnutbars
According to Ms Morgan the survey found that as men aged their knowledge of osteoporosis and its potential impact on them also increased, but by then preventative efforts would have less effect. “Osteoporosis is a natural health priority and we need to keep the focus on bone disease, which has a huge effect on communities. Brittle bones not only result in poor quality of life for those who break a bone, but have a significant financial impact on the health system, and will cost taxpayers up to $33.6 billion within the next decade.”
42 November 2014 Volume 22, No. 5
22/10/2014 4:12 pm
The University of Wollongong (UOW) together with the Movember Foundation, and mental health provider, the Black Dog Institute and the Australian Drug Foundation’s Good Sports Program, have teamed up to address mental health issues among adolescent male athletes. Leading the project, Sports Psychologist Dr Stewart Vella from UOW’s Early Start Research Institute said the aim was to reduce the rate of suicide among adolescent males, provide strong social and community networks, and reduce the stigma associated with mental health problems. Dr Vella said Australia’s strong sporting culture provided an avenue to reach a large proportion of adolescent males, who experience disproportionately higher rates of suicide and mental health concerns. “Sport provides an opportunity to build social and emotional skills which underpin our general wellbeing in a consistent and safe environment.” Australia’s leading government sports body the Australian Sports Commission, and top sporting organisations such as AFL, Cricket Australia, Tennis Australia, Swimming Australia, Basketball Australia and Football Federation Australia will also partner with UOW to ensure impact. More than 2.5 million children and adolescents participate in organised sports throughout Australia each year. However research shows adolescents who drop out of organised sport are 10 to 20% more likely to be diagnosed with a mental health problem during the next three years than their peers who stay in organised sport.
Focus – Men’s health studies show men underestimate the impact of age on female and male fertility and overestimate the ability of Assisted Reproductive Technology to overcome this. Education campaigns have proven unsuccessful and research into the attitudes and perspectives of both women and men has been overwhelmingly survey based.
Sheryl de Lacey
Recruiting men to research about reproduction: A fruitless goal or a challenge? By Sheryl de Lacey Many countries are growing concerned about negative population growth. Delayed childbearing culminating in age-related infertility are current issues in many western countries where population growth has ceased. Women have been the target of discussion and campaigns about delayed child bearing, age-related infertility and preconception health. Women are considered especially vulnerable to delayed reproduction because of accumulated education debt and professional careers that are inflexible to the demands of motherhood. However researchers have found that women speak of their decision to delay as influenced by the stability (or instability) of their partnership with a man and their ability to find a partner who will participate in reproduction and parenting. Clearly men are socially if not physically implicated in delayed childbearing. Australian men in a survey study expressed a preference for having children later in life and planned to delay parenthood until their career was established. Several anmf.org.au
There is a need for qualitative studies to develop a deeper understanding of the feelings, experiences, beliefs and knowledge that underpin lifestyle issues in fertility and reproductive decisions. We noticed a distinct shortage of research about men’s perspectives of fertility and reproduction although we understood they would have an investment in this. In 2013 we sought to recruit both men and women from the community to focus groups to explore issues of reproductive choice and joint decision making. Despite considerable effort in advertising the study in South Australia via multiple newspaper advertisements, advertisements on key organisational websites, through the university newsletter and email distribution and some snowball sampling we were unable to recruit any male participants. Researchers rarely discuss the difficulties of recruitment. Given the paucity of available reports of surveys of male participants in reproductive research we may assume researchers are disinterested in the views of men. But it’s more likely that men prove extremely difficult to recruit, especially to qualitative studies involving conversation about a sensitive topic like fertility and reproduction. Men are acknowledged to be especially difficult to contact because of their lack of presence in the clinical interface. Reflecting on their problems of recruiting men to a study about a prenatal blood test Preloran (2001) concluded men were disengaged from issues of reproduction and healthcare systems. We feel we may be experiencing the same phenomenon and now are turning our energies to collaboration with key contacts such as the men’s health network and brokering study participants. Reference Preloran H, Browner C, Lieber E. Strategies for motivating Latino couples’ participation in qualitative health research and their effects on sample construction. 2001. American Journal of Public Health. 91(11): 1832-41.
Associate Professor Sheryl de Lacey for the Fertility Literacy project team, Flinders University School of Nursing and Midwifery in South Australia
Healthy behaviours reduce heart attacks in men Four out of five men could avoid a heart attack with just five simple lifestyle changes, according to an international study, published in the Journal of the American College of Cardiology. The study followed 20,721 healthy Swedish men aged 45 to 79 over 11 years and found almost 80% of heart attacks could be prevented by maintaining a healthy weight, eating a healthy diet, being physically active, not smoking and limiting alcohol consumption. The Heart Foundation encourages everyone 45 and over (or 35 and over if you are an Aboriginal or Torres Strait Islander) to have their heart health checked every year by their doctor. For more information go to: www.heartfoundation.org.au/ news-media/Media-Releases-2014/ Pages/healthy-behaviours-reduceheart-attacks-men.aspx
Editor’s note: The July issue of ANMJ, Beattie et al reported on the study: Does mindfulness training reduce the stress of pregnancy? The funding body for the study was omitted by the ANMJ. The authors wish to gratefully acknowledge the Nurses Board of Victoria Legacy Limited (NBVLL) for providing a Mona Menzies Grant toward conduct of this study.
November 2014 Volume 22, No.5 43
Mail Letter of the month
Giving basic care isn’t really basic
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 email@example.com
I read with enthusiasm Johanna Drake’s letter which quite rightly won her the ‘Letter of the month’ award (October ANMJ).
physical, psychological, social, spiritual and cultural needs. I’m sure Florence Nightingale and her peers did the same all those years ago.
I wholeheartedly agreed with her point of view and was saddened and mortified to hear that nursing students are asking “Do we need to help out with ADL/basic care, as we did a lot of that on our last placement?” My answer to them is this... yes you do need to help out with ADL/ basic care because this is the integral part of nursing. We (and I use this term collectively) became nurses because we wanted to help people, make them feel more comfortable and independent in their time of need.
The biggest changes have been technological advancements, implementing new career structures/roles like allied health professionals to assist us. The move from hospital to university education and realising our potential and stance ie. that nurses are professionals in their own right and that we were no longer hand maidens to doctors but worked collaboratively. Ultimately nurses aims and goals have remained the same...to provide holistic care. Giving ‘basic care’ isn’t really that basic. When assisting with hygiene for example you are putting all your senses to use. For example looking at the patient’s colour, observing their mood/interaction with you, their family/ environment. Developing a rapport so that they feel comfortable opening up to you with some concerns/fears they may have. Assessing mobility and how they are managing overall, and general observation.
Letters may be edited for clarity and space.
Unclear waste management practice I found the article ‘Clinical waste in home healthcare: Navigating the swamp’ (October ANMJ) interesting. Even though I do not work in a home care setting, it reminded me of my profession as a theatre nurse and how people handle the waste. It is rather unclear for me (I am quite new in this field) what is supposed to be done. While my educator during my postgraduate program told me that anything that was opened for an operation had to go into contaminated waste bin (this included unused packs or drapes, etc.), I have met many seniors who have practised throwing things that only have small amount of blood into the normal rubbish bin. I find the surgeons even more careless, they just throw any rubbish to any bin nearby (clinical waste or not). There is a lot of rubbish daily produced in theatre. I wish there was more training for everyone about handling the waste to make our environment more environmentally friendly. Anonymous RN, Victoria 44 November 2014 Volume 22, No. 5
I’m sure nursing students today (and I quite often work with some of them during their double degree midwifery placements) will be excellent nurses/ midwives as I think the education and communication skills learnt are of a very high standard. Maybe they just need clarification that basic skills learnt (as Johanna mentioned) will carry through with them as they progress with the more technological skills. One of the most important skills a nurse has is not how well he/she can master a procedure or efficiently know the ‘ins and outs’ of a machine but it is the many skills used in the interaction with their patients/clients. Talking to a patient while assisting with basic care can open up so much more. When I commenced nursing in the mid 80’s we were taught ‘holistic care’ although this term wasn’t used then but the meaning was the same. My career began as an enrolled nurse in the UK. It was a hospital based training and our focus was on the ‘Physiological, Psychological, Spiritual and Sociological’ needs of the patient. When I moved to Australia and undertook my RN education at university in the early 90’s we were taught to call our patients clients. We had to follow and explore various frameworks and models of nursing care, when I noticed a common theme. Most nursing models of care all highlighted the concept of providing ‘holistic care’ looking at the person as a whole. This meant addressing their
THE BIGGEST CHANGES HAVE BEEN TECHNOLOGICAL ADVANCEMENTS, IMPLEMENTING NEW CAREER STRUCTURES/ ROLES LIKE ALLIED HEALTH PROFESSIONALS TO ASSIST US. We use the word ‘complex care’ to describe more advanced cases and requirements, more advanced procedures and technology, staff with higher skills and training which indeed is a necessity. However, basic nursing care may appear to be just that, but as the nursing students advance into their careers they will discover that it’s really so much more and not basic at all. Ann Craig RN/RM, Victoria
Loving the Yolngu ways (Letter of the month) It was around one am, I was bleary-eyed and struggling to get through the double shift, but during the shift something happened that kept me going. So I wrote it down-bleary-eyed and all! “Tonight an elderly Yolngu man is dying. He comes from Galiwinku East Arnham Land in the Northern Territory. A proud traditional man, hooked up to various plastic and metal machines that tell me what I already know just by looking at him. I am in my dark green bland hospital uniform blending into the pale green hospital walls. He is partially covered with a bleached hospital sheet. It’s all very sterile and clinical. Then the family arrive - a huge family. The men all dressed in bright shirts - bright like Hawaiian shirts. The women come in with long flowing skirts in bright flower patterns and swirls. They have such dark glossy skin it makes the colours stand out. Their kids start running around opening draws and sticking their hands in the dirty linen bags. It’s all colour and noise! Then the didgeridoo comes out. The elder place the end of the didgeridoo about 10cm from the patient’s heart and plays. The sound is loud and sharp, then long and deep. It bounces off the walls. It vibrates in my lungs. The patient relaxes into it and the kids laugh, I think they are laughing at the feeling of their lungs vibrating, it kind of tickles. Then they all leave. Just like that! And the patient is relaxed. And I am loving the Yolngu ways more and more.” Jaala Stott RN, East Arnham Land, NT
November 2014 Volume 22, No.5 45
We know you are a caring and nurturing person and great with people, so have you ever considered a career as a Marriage Celebrant? The Gordon offers a fantastic program to become a registered Commonwealth Celebrant.
POSTGRADUATE DIPLOMA IN NURSING (MENTAL HEALTH) IN CANBERRA Full Scholarship First Semester 2015: February Intake A scholarship for the Postgraduate Diploma in Nursing (Mental Health) program is offered by the Division (MHJHADS). This is an excellent opportunity for Registered Nurses to build their knowledge and skill base in caring for people experiencing a range of mental health conditions. Successful applicants are employed on temporary contract with paid employment, studying either parttime or full-time. During the program RNs rotate through a range of clinical areas. Eligibility/Other Requirements: Registered or eligible for registration with the Nursing and Midwifery Board of Australia. Hold a current driverâ€™s licence. Have Australian citizenship or permanent residency. For full details of how to apply please contact Jo McDougal, Clinical Support Officer (02) 6205 3661 Closing date: 14 November 2014
The course is delivered through a combination of workbooks with continual teacher support and three compulsory weekend workshops in Geelong.
For further information phone 5225 0500 or email firstname.lastname@example.org
Discount given to ANMF members
Specialising in Nursesâ€™ Tax Returns
Salary packaging advice
Out-of-hours appointments available
Accountant Glenn Pannam
Level 2, 499 St Kilda Road Melbourne 3004
Phone 03 9258 1611
PD C d e r i u q e our r y g n i en n i d r a u G b a e ot b n d l u o h s hours The ANMF provides all nurses and midwives with access to practical and affordable CPD that can be undertaken at your own pace, at a time that suits you. Our four online CPD training rooms (Aged Care Training Room, Body Systems Training Room, Continuing Professional Education Online and Online Clinical Simulations for Nurses and Midwives) provide best practice information on a wide range of topics applicable to all areas of practice. New topics are added regularly and existing topics are reviewed frequently to ensure we continue to provide up-to-date information. If you are a member of the ANMF (including NSWNMA and QNU) you can access our discounted member prices. Non members can also access the online training at affordable rates.
anmf.org.au/education CPD - November 2014 - ANMJ.indd 1
ANMF Federal Office 02 6232 6533 | email@example.com 8/10/2014 11:12:11 AM
Calendar NOVEMBER Lung Health Promotion Centre at The Alfred 11 November Educating & Presenting With Confidence 12-14 November Asthma Educator’s Course 20-21 November Smoking Cessation Facilitator’s Course P: (03) 9076 2382 E: firstname.lastname@example.org 6th Australian Rural and Remote Mental Health Symposium The Practitioner’s Voice 12-14 November Commercial Club, Albury, NSW. http://anzmh.asn.au/rrmh/ 2nd International Conference on Nursing & Healthcare Exploring the Possibilities towards Better Healthcare 17-19 November Chicago, USA. http://nursing2014.conference series.net/ 17th South Pacific Nurses Forum Nurses collaboratively rowing (leading) the way Showcasing innovative ways for promoting Pasifika healthy lifestyles 18-21 November Tonga www.spnf.org.au/ National Conference on Advance Care Planning & End of Life Care 19-20 November Austin Hospital, Burgundy St, Heidelberg, Victoria E: Leeemail@example.com or www.advancecareplanning.org.au Australasian College for Infection Prevention and Control Conference 23-26 November Adelaide Convention Centre, Adelaide, SA. www.acipcconference.com.au/ The Emerging Face of Midwifery - Education & Research Conference 28 November Charles Darwin University, NT. This one day midwifery conference provides an opportunity to explore current research and perinatal trends in the Northern Territory. www.midwiferynt.com.au
2015 JANUARY Winter Global Nursing Symposium Nursing Practice, Nursing Education, Nursing Management, and Disaster
Management 9-10 January 2015 Los Angeles, CA. United States of America. www.uofriverside.com/conferences/ global-nursing-symposium/2015winter-global-nursing-symposium/
FEBRUARY 2nd Flinders Centre for Innovation in Cancer Survivorship Conference Life after Cancer – from Recovery to Resilience 6-7 February 2015 Adelaide Convention Centre, South Australia. www.survivorship2015.org/ 4th Biennial Nephrology Educators Network Symposium Leading the charge for change 16-17 February 2015 Rydges - World Square, Sydney, New South Wales. www.nen.org. au/symposium-2015/ TheMHS Summer Forum Men’s Mental Health: Building a Healthier Future 19-20 February 2015 Northside Conference Centre, Crows Nest, NSW. www.themhs.org
MARCH Diabetes study day with Kathy Mills, RN, MEd, Dip Business, Credentialled Diabetes Educator. This study day for enrolled and registered nurses covers contemporary and evidence based research on dietary, exercise, psychological and pharmacological management of diabetes mellitus. 6 March 2015 from 9am-4pm at Inner East Melbourne Medicare Local, 6 Lakeside Drive, Burwood East. Free parking. Morning tea, lunch and notes are provided. This study day is eligible for 6 hours professional education. Early bird special (pay by 20 February, 2015) is $220. Full registration fee: $250. All queries to Kathy via email only at firstname.lastname@example.org 19th National Otorhinolaryngology Head & Neck Nurses meeting and ASHONS 65th scientific meeting Excellence and innovation 7-9 March 2015 Australian Technology Park Sydney NSW www.ohnng.com.au/national_ conference.html International Women’s Day 8 March 2015 www.unwomen.org/
Florence Nightingale Foundation Annual Conference 12-13 March 2015 Queen Elizabeth II Conference Centre, London. www.fnfalumni.org/event-1717850 Australasian Cardiovascular Nursing College 9th Annual Conference 13-14 March 2015 Crowne Plaza, Coogee, Sydney. www.acnc.net.au
Australian Pain Society 35th Annual Scientific Meeting Managing Pain: from Mechanism to Policy 15-18 March 2015 Brisbane Convention Centre, Qld. www.dcconferences.com.au/ aps2015
Royal Adelaide Hospital Nurses Training, Group 895, 25-year reunion 29 November Adelaide. Contact Julia Curley E: email@example.com
12th Annual World Healthçare Congress Connecting and preparing leaders for healthcare transformation 22-25 March 2015 Marriott Wardman Part Hotel, Washington DC, USA. www.worldcongress.com/events/ HR15000/
Past Ashford Community Hospital employees From Betty Lockwood DON era Staff from 1978 to 1988 18 January 2015 2 to 6pm, Highway Inn Anzac Highway. Contact Ellen Sabey E: firstname.lastname@example.org M: 0430 738 035
APRIL World Health Day (WHO) 7 April 2015 www.who.int/world-health-day/en/ 6th Biennial Conference of the Maternal, Child & Family Health Nurses Australia Our voice our future 9-11 April 2015, The Crown, Perth Western Australia. http://www. aamcfhn.org.au/ World Day for Safety and Health at Work (ILO) 29 April 2015 www.un.org/en/events/ safeworkday/
MAY International Conference on Nursing 4-7 May 2015 Athens, Greece. www.atiner.gr/nursing.htm International Day of the Midwife 5 May 2015 www.internationalmidwives.org/ World Red Cross Day 8 May 2015. www.icrc.org/eng/ resources/documents/misc/57jqz6. htm Asia Pacific Cardiorenal Forum 8-9 May 2015, Amora Hotel Jamison Sydney. http://cardiorenal. com.au/
Adelaide Children’s Hospital, Group 175, 40-year reunion February 2015 Contact Wendy Norris (nee Hornabrook) if you were part of our group or know the whereabouts of some of the 44 nurses who began training in Feb. 1975. Details will appear here soon. E: email@example.com or search for ACH 175 on facebook and message.
Memorial Hospital North Adelaide reunion for those who worked there between 1974 & 1978 14 February 2015 venue TBA. Contact Helen Hookings (nee Murchland) E: firstname.lastname@example.org M: 0427 833 725 or Jan Huckel E: email@example.com M: 0458 253 427 or E: memorial_reunion74@ ozemail.com.au
Email firstname.lastname@example.org if you would like to place a reunion notice
November 2014 Volume 22, No.5 47
Coral OUR COUNTRY CAN AFFORD A UNIVERSAL HEALTHCARE SYSTEM THAT PROVIDES ACCESS TO QUALITY HEALTHCARE FOR EVERYONE – WE MUST KEEP FIGHTING FOR IT. back of Medicare - one of the world’s finest and most effective universal health insurance systems.
Say No Way to Medicare Co-Pay Coral Levett, ANMF Federal President Many of you will have been involved in the public rallies held over recent months to show opposition to the Abbott government’s plan to introduce a range of co-payments for medical services including GP visits. The ANMF has feared for some considerable time (well before the May Budget was handed down), the attacks on our universal health system. This is because we have been watching the slow erosion of our public hospitals and other traditionally managed public health services throughout a number of Australian states. Signals were being sent to the private health industry as early as April last year, when the now federal Health Minister, Peter Dutton, declared in an interview that, if given the chance, he would throw everything on the table when it came to slashing public healthcare costs, including his preference for health to be managed entirely in the private domain. Knowing how important equitable access to quality healthcare is to our members and the broader community, our union, through its branches, wanted to make people aware of what was at stake before the federal election. The NSW branch ran a fairly dramatic TV commercial to try and initiate debate about the issue of privatisation of our public health system and the attack on 48 November 2014 Volume 22, No.5
universal healthcare system. Those towing the conservative media line labelled the union ‘scaremongers’ and ‘liars’. Here we are today, witnessing the steady stream of public hospital privatisations by conservative Liberal state governments throughout the country – and make no mistake, it is all part of a bigger strategy to dismantle our universal health insurance system, Medicare, and down grade our free public hospital and community health services to a safety net for the poor. The Abbott government’s announcement of the $7 co-payments for GP visits, medications, diagnostic and pathology services in May this year was nothing more than opportunistic. If introduced, these co-payments will result in decreased access to healthcare and people delaying treatments. We know when this happens, people are much sicker when they finally seek treatment. They are less likely to get their scripts filled or have diagnostic blood tests; immunisations go by the way side. All of this leads to higher health costs overall and a sicker society - especially in the disadvantaged and marginalised groups in society. Documents obtained by the NSW Legislative Council on the impact of the GP co-payment revealed an expected flood of emergency department attendances by an estimated 500,000 presentations a year in NSW alone at a cost of around $80 million annually. The co-payment has nothing to do with fixing the supposed budget emergency. It has everything to do with breaking the
The blue print for these attacks on Medicare is set out in the National Commission of Audit, heavily directed by the business council. It is the ANMF’s belief that the $7 co-payment is just the first of many attacks on the principles of Medicare. In NSW, the Premier Mike Baird is handing over the new Northern Beaches Hospital at French’s Forrest to be built, owned and operated by a private hospital corporation, either Ramsay or Healthscope - both big donors to the Liberal Party. But that’s not all. NSW has also seen palliative care services privatised; sub-acute mental health services are in the process of being privatised; and the wholesale privatisation of our public disability services, which are earmarked to be gone by 2018. Try and imagine how the most vulnerable in our society will be cared for, if profit is the driver? Our country can afford a universal healthcare system that provides access to quality healthcare for everyone – we must keep fighting for it. We have to tell the current government to get its hands off our universal healthcare insurance system. Medicare is not in crisis and it is not theirs to destroy. It works well alongside a complementary private health system. We are a country that prides itself on its democratic culture. We have to keep fighting to stop these unjust, regressive budget measures that will impact our way of life. We must call on all members of Parliament and particularly our Senators right now to reject this abhorrent attack on Medicare and the public health system, because as Australians, we value these things above almost any other creation of government. anmf.org.au
First State Super
At First State Super we believe Australians who choose careers looking after others deserve to be confident that their super is in safe hands. Join the super fund that puts members first.
Call 1300 650 873 or visit firststatesuper.com.au Consider our product disclosure statement before making a decision about First State Super. Call us or visit our website for a copy. FSS Trustee Corporation ABN 11 118 202 672 ASFL 293340 is the trustee of the First State Superannuation Scheme ABN 53 226 460 365.
Caring for the people who care
2014 winners, left to right: Outstanding Graduate: Zoe Sabri, Nurse of the Year: Stephen Brown, and Team Innovation: Prof Jeanine Young representing the Pepi-pod® Program.
Know someone in nursing who deserves an award? Nominate them for a 2015 HESTA Australian Nursing Award in one of three categories: Nurse of the Year Team Innovation Outstanding Graduate
NomiN atioN s opeN Novem ber 2014
*Generously supported by:
in prizes to be won!* Follow us:
Facebook “f ” Logo
CMYK / .eps
Facebook “f ” Logo
Proudly presented by:
CMYK / .eps
hestaawards.com.au Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. Terms and conditions apply. See hestanursingawards.com for details.
November 2014 issue of the ANMJ