ANMJ October 2014

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. 4

OCTOBER 2014

MODELLING midwifery care www.anmf.org.au

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

Editorial Lee Thomas, ANMF Federal Secretary The ANMF’s Healthcare Emergency – Lies, Cuts and Broken Promises online campaign is building momentum.

While these federal cuts are plenty to be concerned about, state and territory coalition governments are also implementing cuts to wages and erosion of conditions.

As the government’s damaging healthcare and education cuts head to the Senate we are lobbying hard to make sure these detrimental changes are not passed.

Consequently, our position is being heard loud and clear in the upper house of Parliament, giving us the best opportunity to ensure these measures are overturned.

The impact has been felt in Queensland, NSW and Victoria and as I write this editorial, Tasmania is also under attack.

The ANMF (Tasmanian Branch) have been fighting to overturn the government’s plan to freeze wages. To introduce such a measure is clearly a blatant disregard for the industrial relations system aimed at destructing nurses’ and midwives’ career structure, conditions and wages. This month’s industrial column explains in detail the unprecedented attacks on wages and conditions and how the role of industrial tribunals in the affected states have been underminded.

Our opposition to changes in healthcare and education has been amplified because of the support we gain from you who have joined our online campaign. Your backing has been a crucial element to the campaigns success to date. Over 5,000 of you have joined the campaign so far, and I thank you for your support. I urge the rest of you to get on board. The more that join the campaign, the louder our voice will be to ensure our healthcare rights are protected. So if you have not already done so go to our website www.anmftakeaction.org.au and tell your story how the cuts will impact you.

Our campaign continues to focus on a raft of austerity measures, such as the changes to the PBS legislation, incorporating an extra fee for pathology services; the planned $7 GP co-payment to visit a GP and cuts of $50 billion to new healthcare funding over the next decade, which is particularly concerning.

Also in this month’s ANMJ our feature looks at the issues and the benefits of caseload midwifery and our Focus section examines what’s happening in emergency departments.

As I sign off I want to make you aware that Australia’s annual anti-poverty week happens this month between 1218 October. In conjunction with other organisations such as ACOSS and the ICN, the ANMF has been actively involved in helping to reduce poverty and counter growing inequities through working for social policy reform.

In addition we are campaigning strongly against the introduction of higher education deregulation, which will see university fees skyrocket up to $100,000 for nurses and midwives, significantly impacting our new graduates entering into the workforce.

anmf.org.au

October 2014 Volume 22, No.4 1

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

Canberra

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

Editorial

Melbourne & ANMJ

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

Federal Secretary Lee Thomas

Assistant Federal Secretary 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 anmj@anmf.org.au

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

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: anmfact@anmfact.org.au

Northern Territory

South Australia

Victoria

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

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

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

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

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

Moving state? Transfer your ANMF membership

New South Wales

Queensland

Tasmania

Western Australia

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

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

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

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

2 October 2014 Volume 22, No. 4

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

CIRCULATION 96,450 Source: BCA verified audit, March 2014

anmf.org.au

Contents

Volume 22, No 4.

14

Feature

Modelling midwifery care

News

5

Feature 14 Industrial

20

Reflections

22

Ethics 23 Organisational chart

24

Clinical update / Education

26

Working Life

29

Wellbeing 30 Issues 31 Books 32 Research 33

26

Focus 34 Mail 44 Calendar 47 Annie 48

22 Reflections

Clinical update / Education

29

34

Working life

Focus

Training to give hope to fistula patients Nepal

Sandra Moore winds up a nursing career of 50 years

anmf.org.au

Narcolepsy

Emergency Nursing

October 2014 Volume 22, No.4 3

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News Nursing and midwifery education threatened Nursing and midwifery education could be threatened if the federal government’s proposal to deregulate universities and increase HECS fees is passed, according to ANMF Federal Secretary Lee Thomas.

Speaking on Radio Adelaide last month Ms Thomas said if the government’s proposal passed through both the lower and upper house of Parliament, potential

Savage cuts to Indigenous education programs The federal government’s cuts to education programs will impact on Indigenous Australians employment opportunities and health, further widening the gap, Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) has warned.

CATSINaM President Shane Mohor (pictured) has urged the government to reconsider its cuts to university scholarship programs. Of particular concern to the organisation were the changes to the Indigenous Tutorial Assistance Scheme (ITAS); the defunding of scholarships that help cover the costs for final year nursing students; and the uncertainty facing the Puggy Hunter Memorial Scholarship, which provides funding for Indigenous people to study a health-related degree.

Mr Mohor said these programs were anmf.org.au

nursing and midwifery students may think twice before enrolling in courses due to the massive debt they would incur for their study. “Therefore if enrolments are down it may become non profitable for universities to offer courses such as nursing, after all universities are businesses like anything else.”

Ms Thomas said deregulation of universities and increases in HECS debts could mean doubling or tripling of university fees, making nursing and midwifery studies a particularly unattractive option. “Nursing students could incur 15 to 20 years of debt they will be paying off for a three year course.

Clearly this is a significant problem for nursing and midwifery given that starting salaries are reasonably low.”

The proposed changes cut in at a salary of $50,000 and interest would be charged accordingly on the increased amount. “A nursing degree may cost up to $98,000 in the future,” said Ms Thomas. “I think that’s extraordinary given the nursing shortage we are facing in the future.”

Ms Thomas said the proposal was

short-sighted and would have major implications for healthcare. “It does not do the community any good having a workforce that is not robust or well educated now and into the future.”

Through ANMF’s HealthCare Emergency – Lies, Cuts and Broken Promises online campaign nurses and midwives are making federal Senators aware that they are unhappy with these proposed changes and changes to health, Ms Thomas said. “Nurses and midwives want the Senators to vote these changes down.”

Ms Thomas said the professions were passionate in maintaining quality healthcare for the community and will fight against the government’s austerity measures that threaten it. “As nurses and midwives we advocate on behalf of our patients and part of that advocacy role is to ensure that we have good public and private health systems that can support the community at large and we will campaign to that end.”

To take action against the damaging cuts to higher education and health go to www.anmftakeaction.org.au

essential in supporting Indigenous people through their education and ensured they completed their studies, which could lead to employment in health and other industries. “The two hours per week of tutorial assistance, provided through ITAS, really helps some Aboriginal people to overcome the educational disadvantage of leaving their families and communities behind for the first time and travelling long distances to study at university.”

Providing basic travel costs for nursing student placements in Aboriginal Medical Services, under the now defunded AMS Clinical Placement Strategy, made it possible to build cultural respect so both Aboriginal and non-Aboriginal people can provide better care for the First Australians, Mr Mohor said.

The Puggy Hunter Memorial Scholarship, which provides assistance to about 100 Aboriginal and Torres Strait Islander students a year, has confirmed funding only until the end of the year.

Mr Mohor has urged the federal government to include the Indigenous

community when making adverse decisions after no consultation with CATSINaM or the broader Aboriginal health sector about the cuts were made. “We know that Aboriginal people have better health outcomes when they are treated by people from their own communities, or by those who understand their needs and demonstrate cultural respect. So encouraging Indigenous people into study means we address Aboriginal unemployment as well as getting better health outcomes for our people.”

October 2014 Volume 22, No.4 5

News Gender pay gap worse in healthcare Australia’s gender pay gap has reached a record high, according to the Australian Bureau of Statistics (ABS) For the first time since the data was collected in 1994 the pay gap has widened with women working full time earning 18% less than full time working men, the report said.

The Workplace Gender Equality Agency has said the female-dominated healthcare and social assistance sector has the highest gender pay gap at 30.7%.

Sex discrimination Commissioner Elizabeth Broderick said she was disappointed in the discrepancy despite ongoing efforts to try and close the gap. “It’s alarming that the pay gap between men and women has hardly changed in the past 20 years.

Women are earning on average $14,500 less than men each year.”

Gender stereotyping, industry and occupational segregation, caring responsibilities, discrimination and underrepresentation of women in leadership positions, particularly in male-dominated industries, are among the key factors contributing to lower wages among female workers.

While Director of the Workplace Gender Equality Agency (WGEA) Helen Conway said the gap was both concerning and frustrating, she was pleased by evidence that employers were taking steps to ensure that they are paying their staff fairly. In a WGEA survey conducted last year of 2,594 respondents, one third said they had conducted a gender pay gap analysis and a quarter of organisations had undertaken analysis in the previous 12 months. One in two organisations said they had plans to conduct a gender pay gap analysis in the coming 12 months.

“It’s fair to assume employers don’t deliberately set out to discriminate between women and men, but many organisations simply don’t realise they have a gender pay gap,” Ms Conway said. “I say to organisations who think pay equity isn’t an issue for them, ‘how do you know?’.

Unless you’ve analysed your payroll data, any assertion that you don’t have a problem is uninformed.”

6 October 2014 Volume 22, No. 4

Email causes concern Queensland nurses have been told their enterprise bargaining negotiations due to start early next year have been put on hold by the state government.

The government sent out an email detailing the decision to delay the pay negotiations to more than 30,000 Queensland health workers.

Queensland Nurses’ Union (QNU) Secretary Beth Mohle (pictured) said nurses and midwives were shocked to learn their enterprise bargaining negotiations had been delayed. “The Queensland Nurses’ Union has been inundated with messages from distressed nurses and midwives, many who received an email, from Minister Springborg via their personal email address.”

The email stated that nurses’ and midwives’ enterprise bargaining agreements had been extended from March 2015 to March 2016. The email also said that the ‘modernisation’ of the Queensland Health Nurses’ and

Registration fees drop Annual registration fees for nurses and midwives have been reduced for 2014/15, the Nursing and Midwifery Board of Australia has announced.

The new fee, which came into effect from last month, will be $150, a saving of $10, the board said.

The fee will apply to the next registration renewal for nurses and midwives due by 31 May 2015.

Midwives’ Award-State 2012 would be delayed until December 2015.

“Our members are extremely concerned about what this means for their pay and conditions and see it as a cynical, political exercise to avoid a dispute with public sector nurses and midwives in the lead up to the election,” Ms Mohle said.

In addition members were equally alarmed that their personal email contact details had been accessed without their knowledge. Ms Mohle said it was not known how the Health Minister Lawrence Springborg’s office obtained the personal email addresses. “We have written to Mr Springborg seeking urgent clarification on a number of critical issues so that we can communicate this as soon as possible with members.”

National Board Chair Lynette Cusack said she was pleased that the board was able to lower the registration fees while still fulfilling the National Board’s obligation as a regulator. “The fee reduction is consistent with our commitment to nurses and midwives to maintain fees at reasonable level.”

Detailed information about the National Board’s financial operations will be available on the Nursing and Midwifery Board of Australia’s website in the near future.

anmf.org.au

News Diabetes hits Indigenous people the hardest Aboriginal and Torres Strait Islander adults develop diabetes 20 years earlier than non-Indigenous Australians, raising their death rate from diabetes to a staggering seven times higher than nonIndigenous people.

Latest data released by the Australian Bureau of Statistics (ABS) showed Aboriginal and Torres Strait Islander adults were more than three times as likely to have diabetes as nonIndigenous adults.

The figures also suggest Indigenous and Torres Strait Islanders experienced diabetes at a much younger age and more than half of all Indigenous adults also had other chronic conditions.

Dr Paul Jelfs from the ABS said while the study looked at a wide range of chronic diseases and nutrition in Aboriginal and Torres Strait Islander adults, it revealed that diabetes is of major concern. “What

was even more striking was how much earlier in life Aboriginal and Torres Strait Islander adults experienced diabetes.”

Indigenous adults living in the bush were likely to experience diabetes at twice the rate of those living in metropolitan areas, the data indicated.

The study also revealed that many Aboriginal and Torres Strait Islander adults with diabetes had signs of other

Website prepares older Australians to manage their futures Older Australians and aged healthcare providers can now access a new website to prepare them for the move to the new Consumer Directed Care (CDC) system that will come into effect 1 July 2015.

CDC has been progressively introduced into Home Care Packages for older Australians.

The website, ‘Home Care Today’, is a dedicated portal for consumers and providers about Consumer Directed Care, ensuring they are prepared and can take advantage of the opportunities it presents.

Leading organisation for older Australians, COTA Australia CEO Ian Yates said there had been a huge shift in the way aged care is going to be managed in the future which anmf.org.au

chronic conditions.

Dr Jelfs said more than half of all Aboriginal and Torres Strait Islander adults with diabetes also had signs of kidney disease. This compared with a third of non-Indigenous adults with diabetes. “Given these findings, it is not surprising that the death rate from diabetes among Aboriginal and Torres Strait Islander people is seven times higher than for non-Indigenous people.”

would give older people more choice, more flexibility and improved service.

Mr Yates said the new direction would be life changing for tens of thousands of Australian seniors who until now have had little say over the sort of support they receive and the terms on which it is provided. “People might choose to have more respite for their family, or someone to look after their yard. These small things can mean the difference between staying in their home or being forced into residential accommodation.”

As well as the website the project is distributing 50,000 information booklets to older Australians and is rolling out 435 peer education sessions to be delivered to older people and their families to help them understand the benefit of the changes, Mr Yates said. “The program also trains aged care providers and COTA is encouraging them to work closely with the consumers so they get a better understanding for what older people want from their service provision.”

October 2014 Volume 22, No.4 7

News Older Australians staying home longer A majority of older Australians, who received care as part of the Transition Care Program (TCP) following a stay in hospital return to live in the community, according to a new report from the Australian Institute of Health and Welfare (AIHW).

According to the report, Transition Care Program for older people leaving hospital 2005-06 to 2012-13, two thirds of care recipients had not entered residential aged care in the 12 months following their period of care.

Early intervention needed

AIHW spokesperson Dr Pamela Kinnear said about 76% of recipients who completed their planned care left the program with an improved level of functioning and for one in six their

functional status was unchanged.

Ms Kinnear said a hospital stay could be accompanied by a decline in functioning. “TCP provides short term care to older Australians directly after discharge from hospital. The program aims to improve care recipients’ level of independence and functioning and to delay entry to residential aged care.”

Since the program began in 2005 to June 2013, it has delivered over 108,000 transition care episodes that made up more than 94,000 care periods for 87,142 people.

The report showed that at the end of more than half of the care periods, care recipients returned to live in the community – 18% without assistance from aged care services, and 36% with assistance from community-based aged care services.

A lack of WA hospital beds available or people presenting with serious mental issues in emergency departments has raised concern amongst health professionals. But the Western Australian Association for Mental Health (WAAMH) says primary focus should be on early intervention instead.

WAAMH president Alison Xamon said though emergency response departments were stretched and feeling high levels of pressure, simply increasing bed numbers was not the only solution, nor in the long term the highest priority. “Although of course there is a need for more beds for people in deep crisis, it really isn’t the highest level of where investment is needed for mental health reform. The primary focus needs to be on early intervention, prevention and community education. This is the big picture for mental health and where the bulk of financial resources need to be directed.”

Ms Xamon said the greatest urgency was to ensure mental health issues were prevented from escalating to the point where they required emergency department intervention. “Investment in community mental health services, suicide prevention initiatives, and mental education in primary settings, such as schools and workplaces are paramount.”

8 October 2014 Volume 22, No. 4

anmf.org.au

12 YE AR S IN TH E M AK IN G

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The National Critical Care and Trauma Response Centre is looking for dynamic people to join its growing education and training team The National Critical Care and Trauma Response Centre (NCCTRC) is a key element of the Australian Government’s disaster and emergency medical response to incidents of national and international significance.

The Australian Government funded its establishment following 2002 Bali bombings.

The function of the NCCTRC is to provide a rapid medical response in the event of a mass casualty incident in the Asia-Pacific region or within northern Australia; with a primary focus providing clinical and academic leadership towards excellence in disaster and trauma care. Training and education are key priorities for NCCTRC with significant investment in trauma and disaster training for clinicians across Australia.

The Opportunities

Queensland Health Agreement Clinical Facilitator N4 The successful applicant will be responsible for the implementation and coordination of NCCTRC clinical program across Queensland and the Northern Territory in collaboration with key Department of Health stakeholders.

The position will support the Education Consultant in Disaster & Preparedness in the delivery of Major Incident Medical Management Support (MIMMS) and Australian Medical Assistance Team (AUSMAT) Training.

Education Consultant Trauma and Critical Care N5 The successful applicant will develop and deliver trauma and disaster response training and education, managing the integration of NCCTRC courses into the tertiary education

Further information Ms Bronte Martin Nursing Director Trauma & Disaster National Critical Care and Trauma Response Centre Royal Darwin Hospital Phone: (08) 8944 8011 Email: Bronte.Martin@nt.gov.au

sector with primary focus on trauma and critical care portfolios. Participate in education projects associated with the NCCTRC education strategy, including ongoing development of the program and evaluation of the courses.

Education Consultant Disaster and Preparedness P3/A07 An exciting and challenging opportunity to manage and coordinate the AUSMAT training program. Australian Medical Assistance Teams (AUSMAT) are multi-disciplinary health teams incorporating doctors, nurses, paramedics, firefighters (logisticians) and allied health staff such as environmental health staff, radiographers and pharmacists. The successful applicant will coordinate all educational aspects of AUSMAT course delivery in the NT, and liaise closely with internal and external stakeholders to ensure the successful delivery of the NCCTRC program nationally.

How to apply Applicants should address the selection criteria and provide a current CV and contact details for two referees (preferably an email address). A full job description can be obtained by visiting www.nt.gov.au/jobs Further information about these positions can be obtained by TOLLFREE 1300 659 247 or email recruitmentjobvacancies@nt.gov.au

Closing date: Sunday, 26 October 2014 Note: The preferred or recommended applicant will be required to hold a current Working with Children Clearance notice / Ochre Card (application forms available from SAFE NT www.workingwithchildren.nt.gov.au) and undergo a criminal history check. A criminal history will not exclude an applicant from this position unless it is a relevant criminal history.

News Elder abuse goes unreported Healthcare workers who want to report elder abuse find themselves in breach of patient confidentiality, as there is no mandatory reporting of elder abuse without the victims consent in Australia, according to Victoria’s Westmead and Sunshine Hospital care coordinator John Clarkson.

the assailant of elder abuse is a family member living with the victim, who feels ashamed or scared to report, leading to underrepresented statistics. “Abuse does not have to cause serious injury, it can be and often is ongoing [abuse] such as slapping, pinching and choking, which can only be revealed from physical examination.”

Speaking at the Australian Nursing & Midwifery (ANMF) Victorian Branch Professional conference last month, Mr Clarkson said elderly victims may deny being abused due to fear of repercussions.

Additionally, elderly victims may not report their abuse because they are living with dementia and other co-morbidities, which could impair their capacity to make decisions.

Mr Clarkson said Australia needed better policy and regulation in responding to elder abuse. “Countries such as Canada have mandatory reporting to the police.

Other countries such as Argentina and New Zealand have implemented, or are in the process of implementing protective reporting and setting out clear guidelines for nurses to deal with elder abuse and effectively advocate for their aged care clients.”

However Mr Clarkson said as reporting was not mandatory, nurses and other healthcare workers were unable to report abuse without the victim’s permission.

New IV T-shirts Patients who are undergoing intravenous therapies can now wear an IV T-shirt, that allows them to dress/ undress easily when connected to treatment lines, drains, and tubes.

The ‘IV Tee’s designer Gary Walker, who was treated for Burkitt lymphoma in 2009, said he noticed a gap in the market for those who wanted to look dignified while undergoing treatment. “I was sick, but psychologically did not want to feel sick and wanted to look dignified and presentable.”

Mr Walker said the IV Tee allowed the wearer to easily dress without being disconnected.

The garment, trialled in aged care and on surgical wards, has received positive feedback from nurses and family members, according to Mr Walker. The Heart Foundation has ‘acknowledged the garment as a beneficial’ development for patient care, according to the IV Tee website.

Mr Walker said the garment, lessened the feeling of hospitalisation, allowed direct access to surgical or wound sites, without compromising treatment and avoided the ‘gown gap’.

For more information go to: www.ivtcarewear.com anmf.org.au

Mr Clarkson said around 90% of the time

While Australia lags behind with its elder abuse regulations, Western Australia has launched a new telephone helpline (1300 724 679) that offers an impartial ear for older people to share their situation.

Aboriginals face discriminatory funding rules Indigenous health organisations face discriminatory regulations under the federal government’s introduction of new funding rules, according to Aboriginal Health Council of Western Australia (AHCWA).

is far easier for them to intervene in the affairs of Aboriginal organisations.

“Non-Aboriginal organisations will effectively be able to do as they please under ASIC; while ORIC will have incredible powers to direct the affairs of Aboriginal organisations.”

Aboriginal organisations receiving over $500,000 per year from the Indigenous Advancement Strategy (IAS) will now be required to incorporate under the Office of the Registrar for Indigenous Corporations (ORIC), which is the federal body administering the corporations.

Ms Tucker said these new rules ran completely against the spirit of the community controlled health model, which is to empower local communities to make decisions about the health service needs of their own communities.

According to AHCWA, the peak body representing 20 Aboriginal Community Controlled Health Services said the new rules are discriminatory and disadvantage Indigenous organisations compared with non-Indigenous organisations.

AHCWA’s Chairperson Marelda Tucker said without outlining any need for change, the federal government is creating a two-class system, where it

Bega Garnbirringu Health Service Aboriginal Corporation CEO Wayne Johnson said the new requirements would create additional red tape and would result in less money being spent on front line services. “This government was elected on a platform that included cutting red tape. Unfortunately, this commitment to cut red tape appears as if it will only apply to non-Aboriginal people.”

October 2014 Volume 22, No.4 11

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Anti-Poverty Week

Poverty and severe hardship affect more than a million Australians.

Around the world more than a billion people are desperately poor.

In Anti-Poverty Week help fight poverty and hardship.

• Why not organise a display, stall or award?

• Maybe a workshop, lecture or forum?

• How about a fundraiser, fact sheet or petition?

For more information and ideas: • visit www.antipovertyweek.org.au • email apw@antipovertyweek.org.au • call 1300 797 290

Principal National Sponsors

Poverty and severe hardship affect more than a million Australians.

Around the world more than a billion people are desperately poor.

In Anti-Poverty Week help fight poverty and hardship.

• Why not organise a display, stall or award?

• Maybe a workshop, lecture or forum?

• How about a fundraiser, fact sheet or petition?

For more information and ideas: • visit www.antipovertyweek.org.au • email apw@antipovertyweek.org.au • call 1300 797 290

Principal National Sponsors

Health Sciences Postgraduate Information Evening Wednesday 15 October

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News It’s a matter of trust ANMF’s Healthcare Emergency

- Lies, Cuts and Broken Promises campaign

By ANMF Federal political director Sue Bellino When people are frail and at their most vulnerable they put their trust in a nurse.

It’s therefore not surprising nurses have been voted the most trusted profession for 20 years in a row. Trust is not only important to nurses, but also our community at large.

When Australia voted the Liberal/Coalition parties to power, they trusted Tony Abbott when he said there would be no cuts to education and health, nor would there be changes to pensions or changes to the GST. Come the 2014 Federal Budget, that trust was abused as a very different picture was painted. Promises were broken as the government slashed $80 billion to health and education spending over the next decade, and proposed the introduction of a mandatory $7 co-payment for visiting the GP effectively ending universal healthcare, a plan to increase charges for pathology tests and an increased mandatory payment for prescription medicines. In addition the government wants to deregulate universities which would see university fees dramatically increase, means test the family tax benefit and freeze the pension indexation rates.

Alarmed at the range of budget cuts, the ANMF started the Healthcare Emergency – Lies, Cuts and Broken Promises campaign, asking members and supporters to stand up and be counted, to defend universal

healthcare and Medicare, and to fight for what is important to us.

The campaign has gained fantastic online support from you with over 5,000 taking a stand and joining at ANMFtakeaction.com. au By taking action against these budget cuts, together we are helping to save Medicare, the family tax benefit, cuts to the indexation of pensioner payments and university fees.

We need the support of the minor parties, cross bench Senators and Palmer United Party to stop these cuts happening when they go through the Senate for approval.

The ANMF is monitoring the Senate closely and how the Senators are voting and lobbying these politicians on these important campaign issues.

Superannuation changes already though

the next seven years was yet another broken election promise by the Abbott Government – robbing tens of billions of dollars from the retirement savings of average Australian workers.

Who can we trust?

As we’ve just demonstrated, many politicians promise us one thing but then do another. So we think it’s time to hold them to account.

Nurses and midwives are continuously held to account by the requirements of registration and professional standards. The mechanisms for holding our politicians are not so clear.

So the ANMF is going to keep track of what politicians promised they would do and what they are actually doing.

The current Senate and where they stand The current Senate is made up of thirty-three Lib/Nat, twenty-five Labor, ten Greens, three Palmer United Party (PUP), one Motoring Enthusiasts party (voting with PUP), one Liberal Democrat from NSW, one Family First from SA, one Independent from Victoria and one from South Australia. It’s a complex mix, where the Abbott government will be required to negotiate Bills and their budget proposals through the Senate and will require support from at least the Palmer United Party to ensure their agenda becomes law. It is likely that deals will be done, bills watered down, and some legislation rejected completely.

The Abbott government promised no cuts to pensions prior to the last election, but last month, they announced a deal done with Clive Palmer and the Palmer United Party Senators (PUP) to abolish Labor’s scheduled increases to the superannuation savings of hundreds of thousands of workers across the country.

ANMF Assistant Federal Secretary Annie Butler said the decision to freeze superannuation contributions at 9.5% for

Where the members of the Senate sit on each of the major issues Impose $7 GP Fee

$5 raise in PBS Copayment

Cut family tax benefit

Freeze pension payments

$7 co-payment for pathology tests

Superannuation

Deregulation of Universities

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Ricky Muir (Vic Senator)

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John Madigan – Vic Senator – Independent

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Nick Xenophon – SA Senator – Independent

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anmf.org.au

October 2014 Volume 22, No.4 13

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14 October 2014 Volume 22, No. 4

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MODELLING midwifery care

Each year in Australia, around 310,000 babies are born – that’s around 800 births a day – with midwives across the nation busy providing care and support to help the mothers and their babies have the best possible outcomes and return home safe and healthy. In recent years a popular model of midwifery for women has been caseload care with studies finding it linked to less intervention and less neonatal intensive care and there are also potential benefits for perinatal mental health care... Cate Carrigan reports.

August saw the release of Australian Institute of Health and Welfare statistics showing mental health and substance abuse as the second leading cause of maternal death in the five years from 2006-10, claiming 13 lives and underlying the ongoing importance of perinatal mental health care.

According to beyondblue, one in ten women experience either depression or anxiety during pregnancy and one in six in the year following birth.

Less commonly, severe mental health disorders, such as psychosis and bipolar disorder arise or recur. To address the problem, beyondblue has developed a resource for midwives and other health professionals to help assist women at risk or those experiencing mental health problems.

The Australian Nursing & Midwifery Federation’s (ANMF) Victorian Branch maternity services officer Julianne Barclay says perinatal mental health is an area where continuity models of midwifery care have positive effects. She says in Victoria the state government has supported the rollout of specialist midwifery perinatal mental health training, and some midwives have also accessed online opportunities

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such as the beyondblue program.

The ability to address perinatal mental health issues early is seen as one of the advantages of the caseload or continuity of care (CoC) midwifery model where midwives are assigned a certain number of women a month and follow them through the pregnancy, childbirth and post natal period.

Midwives using the model see it as an ideal way of picking up mental health issues early, enabling them to refer women on to community services or mental health professionals.

Queensland-based private practice midwife Sonia Sloane says working in a CoC model allows the women and the midwives to really get to know each other. “Getting to know the women well we are able to pick up on post natal depression early – which is of benefit to women and their families as well.”

Ms Sloane, who works out of Toowoomba providing outreach services to women in the towns of Chinchilla, Inglewood and Millmerran, says the partners and families of the women also get to know the midwives, so are much more likely to approach them if they are worried about what is going on at home. “This allows us

October 2014 Volume 22, No.4 15

Feature to get help early and refer the women to the appropriate local services.”

100% continuity in public sector continuity models of care”

Liz Wilkes from Midwives Australia (which represents private practice midwives) agrees, saying a caseload model for low risk women and having constant checks and balances around maternal wellbeing is the best way to deal with the mounting problem of perinatal mental health. “We have perinatal mental health training as part of our CoC model at our group practice in (the south east Queensland city of) Toowoomba. We have groups that run here constantly with psychologists as part of our model and we have a direct referral process through our Medicare Local here to a mental health team.”

Queensland midwife Liz Wilkes is one who accesses the public hospital in Toowoomba for birthing women. She says since the 2012 changes to collaborative arrangements (which are necessary if midwives want to access Medicare and PBS rebates) allowing hospitals or health services and not just individual doctors to enter arrangements with private practice midwives (PPM), the system has worked much better and has been expanding particularly well in Queensland.

“Our practice delivers around 10% of the babies in Toowoomba (16-24 women a month); we have fantastic collaborating obstetricians and a very tight and robust relationship with Toowoomba Hospital where we provide our birth care. It works beautifully for women, midwives and doctors.”

310,000

Number of babies born each year

Ms Wilkes says women with a previous history of mental illness during pregnancy are referred to the practice by doctors because these women feel supported by a caseload model and there are less inpatient admissions as a result. “Just having that same person repeat the mental health screen allows for a very robust and accurate measure.”

More broadly, caseload midwifery caters for around 10-20% of Australian births (the rates vary across states and individual hospitals with caseload covering a large number of births in some) is well supported by the midwives involved and backed by statistics showing improvements for mothers and babies.

The Royal Women’s Hospital (Melbourne) COSMOS study (2012), which recruited over 2,300 women, found low risk women given caseload care were less likely to have caesareans, less likely to be admitted to the special care nursery or neonatal intensive care, and that women were also more satisfied with their care during pregnancy, birth and after the birth in hospital and at home.

The ANMF Victorian Branch’s Julianne Barclay says CoC is a fantastic model of care for women and families. There are currently about twenty caseload models in place in Victoria. But she says, while midwives absolutely love the work, there are significant issues with burnout in this model and the retention rate of midwives for this model in Victoria is low.

Under the model, midwives are assigned a caseload of women and provide all their pregnancy care, are involved in the labour and birth, and provide the postnatal care.

In the public sector caseload models, they usually work in pairs comprising a primary and a backup midwife.

16 October 2014 Volume 22, No. 4

According to beyondblue, one in ten women experience either depression or anxiety during pregnancy

“What we find over time is that because some midwives are reluctant to take sick leave, and because there is a commitment to absolute continuity, and a lot of the models don’t have built-in sick leave relief or annual leave relief, the midwives end up becoming really exhausted,” says Ms Barclay.

Fine-tuning public sector caseload models is an ongoing project. Ms Barclay says the ANMF Victorian Branch is working with employers and ANMF members to address issues around remuneration (including the expense of using private vehicles), adequate backup from core hospital midwives and possibly bigger teams. “I don’t know if bigger teams are necessarily the answer but I think a solid mainstream maternity service to provide the backup is important and a willingness and acceptance by both consumers and midwives that there will be occasions when the caseload midwife isn’t available.

“Women need to go into the model understanding that they get massively enhanced continuity of care but there will be times when their primary midwife isn’t available. You are never ever going to get

At busy Canterbury Hospital in south west Sydney, the maternity unit caters to low and moderate risk women with 1,800 births a year. Clinical midwifery consultant Kate Griew says there are a number of models of care including GP shared care (20-35%), doctors’ clinics for women at higher risk, through the midwifery clinics (30-45%) or through the midwifery group practice, the continuity of care model (around 10%).

Ms Griew says the CoC model has been operating about three and half years at Canterbury with four midwives working in pairs looking after around 40 women a year.

They work as a primary and backup midwife, taking it in turns to have weekends off. “It’s really successful and so popular we can’t meet demand. We would like to see this grow and we have quite a few of the newer midwives who have come through their course in recent times who are very keen to work in these models.”

Ms Griew explains that it is a matter of reconstructing the unit to ensure there’s a core staffing level in all levels of the hospital, which enables CoC midwives to have the flexibility to come in when their women are in labour and look after them.

Burnout hasn’t been a big issue at Canterbury yet, but Ms Griew says caseload certainly doesn’t suit all midwives. “Some people can’t get their head around not being in the hospital when they’re not busy and tend to hang around and then get tired when it comes time to be with their caseload women.”

Ms Griew says expanding the teams is also something she’d like to see as working one anmf.org.au

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Midwife Theresy Oleary and pregnant woman Canterbury Hospital Midwifery unit

Mother Tracey Large and baby Zac with midwives from SA’s midnorth.

Labour pains: is homebirth going to remain an option?

The countdown is on to the end of an insurance exemption allowing private practice midwives (PPM) to deliver babies at home. From June 2015, unless the federal and state governments reach an agreement to allow these midwives to continue offering homebirths, the option will be illegal in Australia.

With midwives required to have insurance cover and no such cover available for PPMs involved in home births, the federal government extended an exemption on such cover until next year, but with the deadline less than a year away there are concerns a compromise won’t be reached.

While the numbers of women accessing homebirths, 0.9% of pregnant women in 2010, are small, demand has grown with 1,267 home births in 2011, up from 863 in 2009. For the women who choose the option it’s an important decision.

Australian Nursing & Midwifery (ANMF Victorian Branch) maternity services officer Julianne Barclay says an expert group is looking at a supervisory model for private practice midwives as regulatory bodies work to try and assist regulation of homebirth. Ms Barclay says such frameworks may encourage an insurer to offer a PII product for private practice homebirth midwifery services. She says that some concerning incidents involving a very small number of midwives being connected with the deaths or injury of babies during

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or following home births has created significant interest in this area of practice.

without the fear of not having the insurance.”

According to ANMF federal senior professional officer Julianne Bryce the federation has written to the Federal Health Minister Peter Dutton to seek answers as women who will be giving birth after June 2015 will be looking to book a private midwife later this year. “Without a solution the only lawful option would be through a public hospital program,” she said.

As a midwife she finds home births very enjoyable with the women comfortable and relaxed in their own environments and not having to worry about when is the right time to transfer to hospital.

Ms Barclay said in Victoria there are currently two public hospitals that are offering home births within their caseload model. “We would support that option because the midwives are covered by all the hospitals policies and work within the hospital’s quality framework and the outcomes have been generally pretty good.”

But with only five or six such hospital programs operating across the country, and none in Queensland or Tasmania, the option is limited, according to private practising midwife (PPM) Liz Wilkes of Midwives Australia. “It’s really not a solution as the whole of Queensland would be off limits for home births and there would be very limited availability elsewhere.”

Another Queensland-based PPM, Sonia Sloane is concerned about the insurance issue, saying she believes the uncertainty is turning some women who would opt for home births away. “We would like to be able to provide them with this choice

“Obviously, women who have home births are very low risk. Although anything can happen, it’s more than likely that everything will go absolutely smoothly and it is a pleasure to be there.”

Julianne Barclay says as the debate and discussions continue there are those who believe home births should all be done in the public sector and regulated. Then there is another group who believe the best way to provide true choice for women is through midwives operating independently and privately.

She says whatever happens in the private space will affect the mainstream, with hospitals making decisions on whether to continue caseload and home birth models in part based on whether women have these choices open to them in the private sector.

Liz Wilkes is confident there will be a solution to the issue, arguing there is a Commonwealth of Australian Governments’ (COAG) advisory committee looking at the issue and putting a lot of effort into resolving it and “where there is political will there is a way.”

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person down when a midwife is taking leave can be ‘quite stressful’. “You certainly need a supportive structure to manage being on call. There are certainly women with kids who manage caseload midwifery very well but they usually have a strong support base or work with people who work in very well with them.”

JUST HAVING THAT SAME PERSON REPEAT THE MENTAL HEALTH SCREEN ALLOWS FOR A VERY ROBUST AND ACCURATE MEASURE

At Canterbury the midwives are encouraged to book their caseload of women around their time off, leaving two months without bookings to ensure they can take leave. The system is structured around two groups of two midwives, who negotiate with each other to provide the best care to the women in the caseload model while ensuring they share weekend on call. “If they have someone who they think will have a long labour to organise to get their backup to care for the woman early in labour and they’ll see the end of the labour through,” Ms Griew says.

The midwives ensure their clients know all the team, says Ms Griew. “It’s very unusual you’ll ever have four involved but someone might pop in and do a home visit after the baby is born when the other midwife is on time off or make a phone call and check how a woman is.”

As to women’s satisfaction, the surveys are “pretty universally glowing”; although one problem is that women with more complicated pregnancies also want to access the model, but Canterbury does not yet cater for these women as part of caseload care.

In the mid north of South Australia, the Crystal Brook (pop 2,500)/Port Pirie (pop 15,000) midwifery group practice provides caseload care to around 150 women a year with the babies born at Port Pirie and Crystal Brook hospitals.

The executive officer director of nursing and midwifery at Port Broughton and Crystal Brook, Liz Traeger, says the six midwives involved at the group practice are each allocated a caseload of low risk women. “In our model the women get to meet all the midwives so if their midwife isn’t available for the birth then the midwife on call will be another midwife that they have met.

“It doesn’t really provide challenges because in our model about 80 to 90% of women have their own midwife at the birth, with 18 October 2014 Volume 22, No. 4

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Feature Kelmscott: Perinatal Mental Health Service midwives so keen to attend the birth of their caseload of women they sometimes plan their holidays around them.”

At the Kelmscott Memorial Hospital in Armadale in WA mental health intervention has been part of maternity care since 2010, with around 20 women a month referred for treatment.

Kim Adey, the Clinical Nurse Specialist, Mental Health Consultation with the Armadale Health Service, says all women attending for their 20 and 32 week antenatal assessments (or at other times if concerns are raised) undergo the EPDS screening tool for depression and anxiety, with referrals when concerns are identified.

Ms Adey says upon receiving a referral, the mental health intervention service offers a voluntary assessment and devises a management plan. “The women are referred on to relevant support agencies according to the presenting issue and severity of the symptoms with feedback provided to the referring midwife, doctor or social worker and the women’s GP.” If women present with a high risk to themselves or others and/or have symptoms of a major mental illness, they are referred directly to mental health services and receive ongoing consultation liaison between the maternity service and mental health services throughout their pregnancy through to post birth discharge planning.

For women who decline the service, Ms Adey says information is provided about avenues of assistance. “It is important to note that people with mental health problems and illnesses often feel shame and fear of discrimination about their condition and this can create a barrier to seeking help and one key component of this service is to demystify mental illness by educating patients and staff providing the care.”

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The midwifery manager at Kelmscott, Sarah Weightman, says before the hospital had the service, (which has received overwhelmingly positive feedback from women and GPs) there would be incidents of women turning up at the maternity unit in distress and midwives having to scramble around to find out how and who they could refer them to.

“So now we plan for the care of these women and have everything in place before they go home with their babies. For the women, they feel more supported and the midwives know they have backup and a plan of action.”

Ms Weightman gives one example of a second time mum who had had serious mental health issues following the birth of her first child and was concerned she was going to have another breakdown.

“We were able to follow her closely all the way through and though she did have significant mental health issues afterwards it was much more controlled and it meant less stress for her and the midwives because support was at hand.”

Kim Adey says picking up mental health issues in pregnant women and, where necessary, establishing ongoing links with available support in the community, reduces early parenting stress and attachment issues between mother and child. This potentially has a lifelong impact on the development and health of the child and reduces family stress.

The Kelmscott Memorial Hospital service was recognised as a finalist in the WA Mental Health Commission’s Good Outcomes Award in 2011 and was nominated for the WA Premier’s Award in the same year.

Ms Traeger says both the women and midwives show high levels of satisfaction with the service. “The midwives find it very rewarding and love the flexibility of being able to book appointments with women when it suits them – it could be after hours.

They enjoy being able to follow women through and maybe look after them a second or a third time and watch the whole family grow up – that’s very rewarding.”

With one of the major challenges for rural midwifery the sustainability of services, Ms Traeger says caseload care could prove a key factor to attracting and keeping midwives in regional and rural areas. “One of the reasons midwives don’t stay in rural areas is that they are often required to work in a conventional ward structure where they need a nursing qualification to work across mixed wards, eg. both surgical and maternity.

“We have midwives graduating now who aren’t necessarily registered nurses so that should make our rural caseload models attractive as midwives are able to come to the country and work in these models. And midwives will do that – they will relocate and come to country areas if it means they can work in a caseload model.”

It also addresses the other key barrier in rural centres, that of isolation, as in the caseload model the midwives are working in a group practice that provides support, mentoring, professional development, and multidisciplinary education, she says.

Midwives Australia President Liz Wilkes says the caseload model for low risk women is expanding quite rapidly and has gained momentum since the maternity services review of 2007/8. While the rates vary widely across the country, she says some hospitals have goals of 10 to 20 or 50% and even 100%. “My goldstar for maternal healthcare would be for every woman to have access to their own midwife for all of their pregnancy care with an integration with the medical and allied health system running alongside it. That is achieved by having CoC models in the public sector, and by private practice midwives having access to hospitals.”

October 2014 Volume 22, No.4 19

Industrial Industrial Nick Blake and Debbie Richards, Federal Industrial Officers Early September 2014, the federal government with the support of the Palmer United Party passed legislation through the Parliament to freeze employer superannuation payments until 2021. The legislation reverses the previous Labor government’s commitment to progressively increase superannuation from 9.5 to 12% by 2025.

For most workers these new arrangements mean superannuation balances will grow more slowly and there will be less money in retirement. Female workers will feel the changes more deeply as they are more likely to have part time or precarious employment and often have their working

FEDERAL GOVERNMENT Individual contracts While attempting to distance itself from the much hated ‘Australian Workplace Agreements’ the federal government is keen to make changes that will allow individual employers and employees to agree on arrangements that may differ from an award or collective agreement.

While this has been available for some time these provisions presently can only be made where the employee is better off overall and where the arrangements can be terminated by either party. The government is backing employer calls for these protections to be removed.

Provide support to employers to reduce leave entitlements While not addressing this issue directly the government has on a number of occasions supported employer applications (in retail and hospitality) to reduce the loadings and penalties entitlements of workers.

Changes to right of entry arrangements The government has introduced new regulations making it much harder for union representatives to meet with members and potential members in workplaces.

Productivity Commission review of Fair Work Act The Productivity Commission is to review national employment laws to ascertain 20 October 2014 Volume 22, No. 4

lives disrupted by periods of unpaid parental leave.

restrict wage increases and undermine the role of independent industrial tribunals.

While the federal government’s decision puts in stark display their values and priorities when it comes to working people, it also continues a subtle but sustained attack against employees, both at a national level and in most states and territories, where the conservative governments now hold power.

Furthermore it is arguable that in the last two to three years, even with the absence of the dreaded Work Choices laws, the attacks against working people, particularly those in the public sectors, has been ferocious and relentless.

In fact thousands of nurses, midwives and carers working in the public sector are presently facing unprecedented attacks on their wages and working conditions as several state Liberal/Coalition governments around the country legislate to remove or

whether the laws are a barrier to productivity and efficiency at workplaces.

While the terms of reference for the review have yet to be announced it is widely expected to be detrimental to the interests of employees.

Royal Commission into trade unions The government has established a royal commission to investigate and make recommendations on the activities and practices of trade unions. While the royal commission is only focussing on a small number of unions it is expected that changes to laws arising from the recommendations of the royal commission will apply to all unions.

TASMANIA Wages policys Tasmania’s Liberal government has just tabled legislation in state Parliament to impose a 12 month wage freeze affecting all public sector nurses, midwives and care staff. The legislation also places a freeze on increases due to incremental progression within a classification structure and any increase in wage related allowances.

The 12 month freeze applies to all employees whether they are covered by an industrial agreement, an Award, contract of employment or any other instrument, and operates retrospectively on and from 28 August 2014.

In real terms, the wage freeze for nurses

While not attempting to list all the issues this article highlights the major changes nationally and in the states of Tasmania, Queensland, Victoria and NSW affecting nurses and carers, as well as, changes to public health and aged care services which are having a damaging impact.

and midwives is a pay cut. With the consumer price index (CPI) currently running at about 3% per annum and trending up it will leave public sector nurses and midwives significantly worse off.

The government’s legislation also imposes restrictions on wage increases after the 12 month freeze. This is currently limited to 2% however the legislation further states that this can be “prescribed by regulation” meaning that even the 2% is not guaranteed, it could be less or even a further wage freeze.

The legislation also removes the right of Tasmanian nurses to commence negotiations for a new enterprise bargaining agreement to replace the current public sector agreement due to expire at the end of this year. The government may also bring in future regulations that further restrict the functions and powers of the Industrial Relations Commission and potentially lead to other restrictions on the right to bargain and bargaining outcomes.

Democratic rights It is no coincidence that separate legislation already before the Parliament, (the Workplace Protection Bill), introduces new anti-protest laws which potentially make it illegal to protest at a workplace in relation to an opinion or belief, in respect of a political, environmental, social, cultural or economic issue. It also makes it illegal anmf.org.au

Industrial to incite a protest, so organising events becomes illegal, as does waving a placard and the like. Not only is the government cutting real wages and over-riding rights to bargain, it is attacking democratic rights by outlawing any protest action.

QUEENSLAND Wages and conditions In Queensland, Campbell Newman’s Liberal/ National Party (LNP) government has, in effect, imposed a 12 month wages freeze on nurses and midwives announcing a 12 month delay in negotiations for the new entitlements.

This latest attack by the LNP is by no means atypical of the modus operandi of this government. Following their election in 2012, they wasted no time introducing changes to Queensland’s industrial relations laws. The fall-out from the changes continues with a second round of legislative changes rushed through late last year.

Described by unions as Work Choices for Queensland, the changes potentially remove long established conditions and working arrangements negotiated over several years of enterprise bargaining and established in Queensland Health Nurses and Midwives Award- State 2012 as a result of cases argued before the State Commission. The content of enterprise agreements will be dictated by matters the legislation deems “allowable” and “non-allowable”. As a result, current nursing and midwifery award and agreement provisions providing a “Workload Management Tool” are not “allowed”. This type of provision is now a critical feature of public sector agreements across the country and is used to determine appropriate staffing levels for nurses and midwives. It ensures that safe nursing practice can be maintained and therefore ensures the safety of the patient. This poses a serious threat to nursing workloads particularly in the context of almost 5,000 cuts to hospital and health service jobs over the last two years including 1,800 nurse and midwife positions so far.

Attack on Award conditions Included in the latest legislative changes is a requirement for State awards to be “modernised”. So far the government has refused to rule out cuts to current award entitlements and have delayed the modernisation process creating more uncertainty about the outcome of this process.

Democratic rights Unions in Queensland, including the anmf.org.au

Queensland Nurses’ Union (QNU), successfully challenged draconian laws requiring unions to ballot members before spending more than $10,000 on “political matters”. This law, now repealed, was designed to make it impossible for unions to campaign around workplace and community issues by mandating a time consuming and expensive ballot process.

Nurses and midwives enterprise agreement expiration has been extended to March 2016. The government’s decision to do this provides no detail of the impact on current and future wages and entitlements leaving nurses and midwives extremely anxious about their rights.

VICTORIA During 2011/2012 Victorian public sector nurses faced off against an aggressive state liberal government seeking to make major changes and reductions to nursing entitlements, including changes to staffing ratios, the introduction of split shifts and short shifts, separate agreements for each health facility and a miserable wage offer.

At the conclusion of a bitter and protracted campaign which resulted in many nurses and midwives having their pay docked for participating in stop work meetings and other forms of industrial action. The ANMF Victorian branch were successful in not only defeating the attempts by government to reduce nursing conditions but also secured a single collective agreement covering public health facilities which was overwhelmingly supported by the membership.

NEW SOUTH WALES Wages policy The New South Wales state government has capped public sector wage increases at 2.5%. In June, the government legislated to require that the NSW Industrial Relations Commission give effect to the capping policy in decisions to approve enterprise agreements.

This places the government in a unique position of power in the bargaining relationship. As a bargaining party they have, among other advantages, the superior advantage of significant resources and of being able to legislate their bargaining position.

Superannuation The NSW government is putting a further squeeze on public sector employees’ pay by revealing it will make them pay for the federal government’s compulsory

rise in superannuation out of their own pockets arguing the rise in compulsory superannuation – 0.25% from July 2014 is an employee expense which falls under the government’s 2.5% cap.

This decision along with below inflation wage increases means that NSW nurses, midwives and carers in the public sector are suffering real reductions in their remuneration.

Workers compensation In early 2012 the NSW government legislated major changes to the states workers compensation scheme. The changes including caps on medical and related expenses and new return to work arrangements will mean many nurses, midwives and carers injured at the workplace will face more severe financial hardships.

Staffing cuts Since its election the NSW Liberal government has waged a relentless attack on public sector jobs. In 2011/12 the government axed 5,000 jobs and announced an intention to cut a further 10,000 EFT. In addition the government has been open about its desire to remove from awards any requirement for minimum staffing.

Privatisation The NSW government is slavishly pursuing a program of privatisation of public health services. This includes the privatisation of the Northern Beaches Hospital, ADHC, mental health services and community services like physical health, drugs and alcohol support. All Greenfield sites, like Byron Central Hospital, will be public private partnership models.

The government is also proposing that public sector employees who are affected by the privatisation of public health facilities will only have their wages and employment conditions protected for up to two years The examples of changes in regulation does illustrate that nurses and health services are, in the eyes of many conservative governments and their bureaucracies, an expense or cost that needs to be reduced.

The ensuing campaigns by the ANMF, its branches and members also serve to illustrate the determination the professions have to ensure health and aged services are maintained, that public sector workers are respected and valued and employment conditions are fair and reasonable.

October 2014 Volume 22, No.4 21

Reflections Training to give hope to fistula patients in Mugu District, Nepal Pauline van Ooijen The journey was difficult especially after rain. Quickly sand becomes mud so driving is hard. We wanted to reach the forgotten women. My two companions on the journey were doing just that. They leave their families for a whole week to travel a long distance risking their own lives in order to reach their neighbours. My respect for them grew with every kilometre.

Our journey ended in the little mountain town of Gamghadi, surrounded by beauty and majesty. Around 7,000 people live there, mostly in poverty; struggling to have enough fresh water and electricity each day.

There are not many opportunities to earn money in Mugu. Very strong men work hard cracking rocks into gravel for road building.

Not many vegetables grow at this time of the year: potatoes and beans are the staple vegetables along with rice and dhal.

In Gamghadi there is a district hospital with 15 beds, an ultrasound machine, an X-ray, some lab examinations, a doctor and a nurse. To reach the hospital there is one path, a car cannot travel the road and an ambulance is not an option. When the residents become mildly sick, they can walk to the hospital. When they become very sick, they have to stay at home or maybe will be carried down to the hospital.

The women that give birth at the hospital are mostly healthy and are often hard working until term. But delivering a baby is a hard job so they need support from a loving husband, a good nurse and if needed, a doctor. The doctor and nurse in the hospital are doing a fine job but when the women need a caesarean section there is no one with the skills to do this in Mugu.

In the midst of all this beauty and suffering there was a spark of hope. Twenty-two auxiliary nurse midwives (ANMs), came together for our International Nepal Fellowship (INF) training about safer 22 October 2014 Volume 22, No. 4

motherhood and fistula patients. The training is run by nurse Dil Kumari Giri who visits three or four districts in Nepal every year to conduct the sessions.

Dil Kumari gives training about safe motherhood, how to monitor a delivery and to recognise prolonged/obstructed labour. In these far western districts our fistula patients are women suffering from leaking urine. Poor patients are most often affected due to lack of funds for a hospital delivery. Consequently, women suffer alone at home for many days. If the family-in-law finally decides to travel and bring the woman to the hospital, particularly if they live remote, it would take from a couple of hours to several days to get there. It is hard for nurses to find these isolated women, suffering alone, sometimes rejected by family and neighbours.

That is exactly the reason for the training.

Dil Kumari teaches the ANMs how they can deliver babies safely and how to prevent long labour, and in this way, to prevent fistula.

The ANMs are wonderful. They are the ones who perform pregnancy checks, such as blood pressure monitoring, ensuring iron tablets are taken and assist during labour.

The government pay for the women is not generous and sometimes waiting for the budget to come through means waiting months to be paid.

and (more importantly) what not. Medical treatment is provided free of charge for the patients who do not have money for travelling or surgery. She gives all the trainees the phone number of INF or, if needed, her own number. She is willing to be called both day and night and on her days off.

We also spoke about a normal delivery. How can we monitor a safe delivery? How do we know that the labour is too long and when the situation becomes dangerous for mum and baby? Although all of the ANMs have had training for safe motherhood in the regional hospital in Surkhet, most of them are struggling with this monitoring. It makes me sad that these motivated and loving women are struggling with their daily practice.

I feel sad, I feel frustrated and sometimes I feel angry. Life in Nepal is so hard. Delivering a baby is so normal in my country and at the same time, unique. Everybody expects to have the support of a midwife and/or doctor.

These women are giving their neighbours what they can. But who helps them to keep their knowledge updated? Who helps them to practice and grow in their job?

These are women whom I deeply respect for the work they are doing to help pregnant women, for the love they are giving to their neighbours — a spark of hope in the darkness.

I was blessed to join this training, to see Dil Kumari’s passion and to witness her efforts.

She leaves her family behind when she goes to train the health workers. These workers in turn can pass the knowledge they have gained onto their colleagues in the villages.

From there the word is spread to the remote houses, reaching our fistula patients and giving them a spark of hope.

During the training Dil Kumari teaches what a fistula is, its symptoms and what can be done to help the women.

Additionally Dil Kumari speaks about the annual fistula camps INF organises where there is the chance for healing and possible operations. She tells them how long the patients have to stay in Surkhet, what they are allowed to do after the operation,

Dr Pauline van Ooijen is part of International Nepal Fellowship (INF).

INF is a mission serving Nepali people through health and development work.

INF helps people affected by TB, leprosy, disability, HIV/AIDS and drug abuse as well as facilitating development among poor communities, running medical camps and providing medical training. anmf.org.au

Ethics Poverty ethics and the nursing profession Megan-Jane Johnstone In March 2014, National Nurses United (NNU), the largest union and professional association of registered nurses in the US, took a public stand against the decision by a Michigan municipality to cut off the water supply to homes whose householders had failed to pay their bills.

The decision stood to affect up to 80,000 homes and, according to New Scientist (2014), galvanised the NNU into calling for the immediate reconnection of all shut-off water supplies. Labelling the decision as a ‘major public health disaster in the making’, the NNU also announced plans to lead a march against the cuts and joined the United Nations in condemning the move as a violation of human rights.

In Australia six months later, the September 2014 issue of the Victorian edition of The Australian newspaper The Senior carried a front page report alleging that many of the state’s aged pensioners were ‘living in “energy poverty.”’ According to the report, ‘pensioner poverty’ and the inability of pensioners to pay their energy bills was severely limiting older people’s access to the energy resources required for such essentials as washing, cooking, heating and cooling. Although retailers were reportedly taking steps to reduce the burden of energy poverty being carried by aged pensioners, many consumers claimed that they had nonetheless been denied access to hardship programs and faced ongoing threats of their power supplies being disconnected.

A question of nursing ethics The Australian Council of Social Services (ACOSS) estimates that around 2,265,000 (12.8%) of people in Australia live below the OECD poverty line of 50% of the median wage (www.acoss.org.au/policy/ poverty). Of these, 575,000 (17.3%) are children. Globally, it has been estimated that over 1.3 billion people live in poverty.

While the Australian figures constitute only a small fraction of the world’s poor, as ACOSS Director of the Social Justice Fund points out, anmf.org.au

‘in a country as wealthy and as lucky as ours, it is a travesty that there are still so many people living in poverty. We can do better’.

The incidence and impact of poverty nationally and internationally raise fundamental questions about the ethics of poverty and what should be done to mitigate its deleterious effects. Poverty ethics also raises important questions for the nursing profession in regard to what its moral obligations might be, given that poverty can be both the cause and the consequence of ill health.

Politics of poverty Defining that nature and incidence of poverty has historically been an intensely political act. ‘Poverty’ is generally defined in terms of a lack of purchasing power, specifically the deprivation of the economic resources necessary to meet ‘the food, shelter and clothing needs necessary for physical wellbeing’ (Akindola 2009 p 123).

Many contend, however, that this definition is inadequate since it fails to recognise the multidimensionality of poverty, including what Amartya Sen has influentially described as ‘capability deprivation’ and the “coupling” of disadvantages between different sources of deprivation’(2009).

Moreover, as Akindola (2009) observes, once ‘wellbeing and quality of life are to be considered, then vulnerability, physical and social isolation, insecurity, lack of self-respect, lack of access to information, distrust of state institutions and powerlessness can be as important to the poor as low income’.

Poverty ethics Poverty encompasses people’s needs of the necessities of life. Since deprivation of the necessities of life threatens the life and fundamental wellbeing of people, poverty ethics is fundamentally an ‘ethics of survival’. An ethics of survival, in turn, may be seen as encompassing the moral imperatives of actions aimed at reducing poverty, which by its very nature threatens prejudicially the significant moral interests and wellbeing of those affected by it.

Call to action In its 2007 Nursing Matters Fact Sheet ‘ICN on Poverty and health: breaking the link’, the ICN (www.icn.ch) asserts that nurses

have a vital role in reducing poverty and its impact on health and wellbeing. It reminds nurses that whereas poverty ‘is a disease that saps people’s energy, dehumanises them and creates a sense of helplessness and loss of control over one’s life’, health is a ‘vital asset’ for the poor. Without health, the ICN explains, ‘a person’s potential to escape from poverty is weakened due to lost time, labour, income, and the burden of healthcare costs’.

Poverty ethics challenges nurses to expand the concerns of everyday nursing ethics from its conventional narrow focus on individual patient rights in healthcare to what Cohen and Reuter (2007) advocate as a ‘broader focus on the socio-political context that affects the health of individuals, groups and communities’ and to actively engage in a critical ‘emancipatory nursing’ aligned with a proactive social justice agenda.

Each year, throughout the world, the UN’s International Day for the Eradication of Poverty is held annually on 17 October.

An expansion of this day is found in Australia’s annual ‘anti-poverty’ week (www.antipovertyweek.org.au/), also held in October. Australian nursing organisations have been active participants in the annual poverty eradication days. The ANMF, for example, works with a range of other groups (eg. ACOSS, the ICN) for social policy reform to counter growing inequities and reduce poverty (http://anmf.org.au/pages/professionaloctober-2013). However, as ANMF federal professional officer Elizabeth Foley states, there is still a great deal of advocacy work for nurses to do in order to redress the harmful burdens that poverty imposes.

References Akindola RB. 2009. Towards a definition of poverty: poor people’s perspectives and implications for poverty reduction. Journal of Developing Societies, 25(2): 121-150.

Cohen BE & Reutter L. 2007. Development of the role of public health nurses in addressing child and family poverty: a framework for action. Journal of Advanced Nursing, 60(1):96-107.

New Scientist. 2014. Detroit water shut off. New Scientist, 223(2978, 19 July): 6.

Sen A . 2009. The idea of justice. Allen Lane/Penguin Books, London.

Megan-Jane Johnstone is professor of nursing in the school of nursing and midwifery at Deakin University in Victoria. Professor Johnstone has extensive interest and expertise in the area of professional ethics in nursing.

October 2014 Volume 22, No.4 23

Organisational Chart

Did you know that as a member of a state or territory nursing and midwifery union means you are also a member of the ANMF, the national nursing and midwifery union?

Just as members elect state officials they also elect the federal office bearers.

The ANMF is a federation established under the Fair Work Act with branches in every state and territory. Each branch comprises members who elect workplace representatives, branch council, including branch president, and full time elected officials, secretary and assistant secretary. Branches also employ specialist staff to provide legal, industrial, professional and education services.

Workplace representatives meet nationally at the Biennial National Conference every two years to debate and develop ANMF policies.

BNC BIENNIAL NATIONAL CONFERENCE

Western Australia Branch

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NT Members

KEY: BS: Branch Secretary, BP: Branch President 24 October 2014 Volume 22, No. 4

anmf.org.au

Organisational Chart

Fair Work Australia 2009 (FWA)

Registered Organisation Act (ROA)

FAIR WORK COMMISSION (FWC)

Registration

ANMF

FEDERAL COUNCIL

ELECTED FEDERAL OFFICE BEARERS President Vice President Federal Secretary Assistant Federal Secretary

ANMF Rules

FEDERAL OFFICE STAFF

FEDERAL EXECUTIVE

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QLD Members

NSW Members

ACT Members

VIC Members

anmf.org.au

October 2014 Volume 22, No.4 25

Clinical update / Education

NARCOLEPSY

The Body Systems Training Room (BSTR) is the fourth of ANMF’s CPD training room for nurses and midwives.

The BSTR offers the highest quality information and graphics for contemporary best practice CPD in the areas of anatomy and physiology, pathophysiology and disease management. Each course is complimented by an audio narration, animations, progress checks, pop quizzes, full text available, a final assessment and a certificate of completion for your CPD evidence. You will also have access to “side-notes” where further information is made available. The Glossary provides definitions and pronunciations of terms used throughout the learning program.

The following excerpt is from the Understanding Narcolepsy course. The complete course is one hour in duration and covers the epidemiology, clinical presentation and pathophysiology of Narcolepsy.

Understanding Narcolepsy

All of us have had a lifetime of personal 26 October 2014 Volume 22, No. 4

experience with the phenomenon of sleep, either hitting the snooze button as teenagers, burning the midnight oil as busy professionals, or rocking a fussy baby to sleep as parents. It does not require any special expertise to appreciate the importance of sleep quantity and quality for our health and wellbeing, and it is easy to understand how sleep disorders can have a significant impact on functioning.

Although many sleep disorders relate to problems with falling asleep or staying asleep, conditions that cause excessive sleepiness can be equally problematic.

This learning program is designed to introduce you to narcolepsy, one of the most severe conditions associated with excessive daytime sleepiness (EDS).

Upon completion of this program you will be able to:

Define narcolepsy, discuss the incidence, prevalence and demographics of narcolepsy; identify and describe the signs and symptoms of narcolepsy; describe the functioning of the sleep-wake switch and how it is altered with narcolepsy; and explain the autoimmune hypothesis underlying narcolepsy pathophysiology.

The term narcolepsy was first coined in 1880 by the physician Gelinau from the

Greek work nark, meaning “seized by somnolence”. Aptly named, this condition is associated with intermittent, irresistible urges to sleep arising throughout the day, often in unusual circumstances, such as while standing, eating, or conversing, which distinguish these urges from everyday drowsiness. Narcolepsy is the second leading cause of EDS after sleep apnoea. Owing to the generality of symptoms at onset and the difficulty in distinguishing EDS associated with narcolepsy and EDS associated with the use of medications, lifestyle, other sleep disorders, and unrelated medical conditions, narcolepsy can be difficult to diagnose and patients may go years without treatment.

Narcolepsy often co-occurs with other sleep disorders, including sleep-disordered breathing, and narcoleptics experience a higher incidence of sleep apnoea.

Although it can be successfully managed, narcolepsy represents a debilitating lifelong condition if left untreated. Given its impact on functioning, narcolepsy can also affect mental health. Up to one half of patients that have been diagnosed with narcolepsy suffer from depression, and may participate in narcolepsy support groups.

Narcolepsy is a sleep disorder characterised anmf.org.au

Clinical update / Education

The Sleep-Wake Switch and Narcolepsy Thalamus Cortex

Basell forebrain

Brainstem Hypothalamus

by four classic symptoms: EDS accompanied by sleep attacks, hypnagogic hallucinations, sleep paralysis and, in most patients, an intermittent and abrupt loss of muscle tone, known as cataplexy. Because it may resemble regular weakness and may present in many atypical ways, especially closer to the onset of narcolepsy, cataplexy is difficult to diagnose.

EDS is the primary symptom shared by all narcoleptics and is typically the first symptom to appear at onset. This is also the symptom that most frequently draws patients to a healthcare professional.

Narcoleptic patients become particularly sleepy after meals, during meetings, or in other sedentary situations, and they frequently succumb to short, irresistible naps known as sleep attacks. Sleep attacks often occur at inappropriate times while patients are engaged in normal activities, such as standing, eating, having a conversation, or even driving. These episodes can occur several times daily and rarely last longer than 15 minutes. Naps typically leave the patient feeling refreshed for several hours, which is in contrast with what is observed among patients suffering from other sleep disorders with EDS as a symptom. Sleep attacks can cause significant disability, particularly when they result in accidents. EDS may also anmf.org.au

Awake

Asleep

Hypocretin-1 and -2 (orexin-A and -B

be accompanied by symptoms common in extreme drowsiness, such as blurred or double vision, gaps in memory, and automatic behaviour episodes, similar to those observed in sleepwalking.

Cataplexy describes an abrupt neurological attack characterised by sudden muscle weakness. The attack, which occurs without a loss of consciousness, is brought on by emotional triggers. It is typically triggered by strong positive feelings such as laughter or excitement, and less often in reaction to negative feelings such as stress, fear or anger. In rare cases, it may be unprovoked. Most episodes are partial, affecting the facial muscles, eye muscles and knees, typically causing the jaw to drop, the head to fall forward and the knees to wobble or buckle. In other cases, patients may collapse completely and remain unable to move until the episode passes. Episodes usually last from seconds to minutes, and the frequency varies widely between patients, ranging from once per year to several times a day.

Cataplexy is unique to narcolepsy and is considered the best diagnostic indicator for this disease. However, cataplexy may be overlooked by patients, their families, or healthcare professionals when symptoms appear outside the typical range for onset

of narcolepsy, when cataplexy is difficult to distinguish from normal fatigue, when patients have no prior experience with it, or when the symptoms of cataplexy are atypical.

Approximately two thirds of narcoleptic patients experience dreamlike auditory, visual, tactile, or multisensory hallucinations associated with sleep. These are known as hypnagogic hallucinations when they occur at sleep onset, and as hypnopompic hallucinations when they occur upon waking. These experiences may range from vague impressions to complex visualisations involving multiple senses and detailed story lines. Hypnagogic hallucinations are often emotionally disturbing in nature, such as the sensation of limbs transforming or disappearing, or the awareness of an intruder in the home. Hallucinations can be so realistic that patients may attempt to act on them upon waking. Such incidents may lead to a misdiagnosis of psychosis and are a common reason for the inappropriate prescription of antipsychotics in patients with narcolepsy. Hypnagogic hallucinations are more common in younger patients and tend to decline with time.

Sleep paralysis describes a temporary inability to move or speak either while falling asleep or upon wakening, especially during periods of REM sleep.

Patients remain conscious throughout these episodes. Episodes can last from a few seconds to several minutes and resolve spontaneously. Sleep paralysis can be a frighteneing experience, especially when occurring for the first time or in combination with hypnagogic hallucinations. Many patients report difficulty breathing, a sensation of being encased in concrete, and a frustrating psychological struggle to move the body.

Although sleep paralysis is not specific to narcolepsy, it affects approximately half of all narcoleptic patients, and occurs with greater frequency and severity in this group than in the general population.

Contrary to popular belief, narcoleptic patients do not sleep more than the average person within a 24 hour period, but rather have trouble staying either awake or asleep for extended periods of time. This is because narcolepsy is not simply a disorder of EDS or abnormal REM sleep. Instead narcolepsy is a generalised disorganisation of the sleep-wake cycle.

In order to understand the pathological October 2014 Volume 22, No.4 27

Clinical update / Education

processes underlying narcolepsy, the normal biological pathways regulating wakefulness and sleep, as well as the transition between these two states must first be understood.

Current dioagnostic criteria for narcolepsy identify three categories: narcolepsy with cataplexy, narcolepsy without cataplexy and secondary narcolepsy caused by an underlying medical condition. Diagnosis is often delayed, as presentation varies over time in terms of symptoms and intensity.

All four symptoms appear in 30 to 50% of patients, and in only 10% of patients all at once. In addition to the classic tetrad of symptoms, many narcoleptics also experience disturbed nocturnal sleep, impaired focus, memory loss, blurred vision, automatic behaviour and a greater incidence of other sleep disorders.

It is now recognised that narcolepsy appears to have both a genetic and an environmental component. The risk of narcolepsy in first degree relatives of patients is 10 to 40 fold greater than in the general population. Yet this risk is less than what might be expected if the condition were completely determined by genetic inheritance. Studies demonstrating that 25 to 30% of identical twins will both develop narcolepsy strongly suggest that a genetic predisposition to disease is modulated by environmental risk factors.

However, the nature of environmenal triggers that could possibly be involved remain unknown.

Key points: • Narcolepsy affects between 1 in 2,000 and 1 in 4,000 people.

Earn hours of CPD

28 October 2014 Volume 22, No. 4

• The incidence of narcolepsy is estimated at 1.37 new cases/100,000 people/year.

• There are two primary peaks of onset: around age 15 and around age 35.

• Approximately 70% of narcoleptics first present with cataplexy, and another 15% will develop cataplexy later on.

• Narcolepsy in general affects men and women equally.

As previously stated, patients with narcolepsy also experience a higher incidence of other sleep-related problems, including disrupted night time sleep (DNS), nightmares, night terrors, dream enactment, nocturnal eating disorders and sleep walking. Clinical evaluation of narcolepsy typically begins with detailed history taking to establish symptoms and to rule out other causes of EDS. Generally, physicians order a polysomnography, multiple sleep latency test (MSLT), maintenance of wakefulness test (MWT), and measurement of hypocretin in the cerebrospinal fluid (CSF) in order to confirm the diagnosis.

The aforementioned tests are covered in great detail in the course content, including diagnostic results. For purposes of this clincal update we will move on to the sleep-wake switch.

The normal oscillation between waking and sleeping states is governed by neurotransmitters. A variety of interconnected neurochemical systems produces excitatory monoaminergic neurotransmitters – norepinephrine, serotonin, dopamine, histamine and acetylcholine – within the basal forebrain, hypothalamus and brainstem. These

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 narcolepsy and earn three hours of CPD.

substances travel to higher regions of the brain, including the cortex and thalamus, where they promote arousal and wakefulness and inhibit pathways associated with sleep. The transition from wakefulness to sleep is brought about by the ventrolateral peoptic area (VLPO) and the median peoptic area (MNPO). The regions promote sleep primarily through the production of the inhibitory neurotransmittery-aminobutyric acid (GABA), which inhibits the arousal pathways. The dynamic interaction between these two pathways is known as the sleep-wake switch, where moderate mutual inhibition ensures stable state of wakefulness and sleep, facilitates transition between these states and minimises intermediary states of drowsiness.

The sleep-wake switch is regulated by input from neurons that produce excitatory neuropeptides, hypocretin 1 and 2. The hypocretin expressing neurons play an important role in sustaining wakefulness and preventing abrupt transistions between sleep-wake states. Hypocretin signalling is absent in narcolepsy, leading to a pathological destabilisation of the sleep-wake switch. (Further detailed pathophysiology is provided in the course content).

A low hypocretin level can help distinguish narcolepsy from other sleep disorders.

The autoimmune model proposes that in genetically predisposed individuals, environmental triggers may drive the immune system to attack hypocretin cells.

To access the course in its entirety visit: www.anmf.adamondemand.com.au/

Go to the CPE website www.anmf.adamondemand. com.au/ to complete this online activity. The online article this month costs $26.99 for ANMF, NSWNMA and QNU members and $38.99 for non-members. (prices are GST exclusive).

For further enquiries please contact Jodie or Rebecca on Ph: (02) 6232 6533 or education@anmf.org.au

anmf.org.au

Working life SANDRA MOORE winds up a nursing career of 50 years Carole Lander When Sandra Moore left school aged 14 in 1960 there were limited work choices for girls in Queensland. While labouring in factories and shops she set her heart on becoming a nurse but had to wait until she was 17 to begin training. A schoolteacher neighbour wrote on her reference: ‘Sandra comes from an honest hardworking family’.

She was one of eight children and could not wait to leave home.

Now, 50 years later, Sandra is retiring from her chosen profession and moving back to Queensland. The intervening years hold many stories and memories that she cherishes.

At the Royal Brisbane Hospital in the early 1960s the training was minimal compared to today. The young nurses had lectures (more like hands-on classes) that were squeezed in between shifts. Topics included anatomy, physiology, general bedside nursing duties, cleanliness and how to cook invalid foods.

“Most of what we learned happened by observing the more experienced nurses,” Sandra recalls.

Leaving her crowded Brisbane home, Sandra enjoyed having her own room in the hospital although the regime was strict and discipline harsh. Of the 30 trainees in each new group, only four or five would go on to qualify. She recalls the hierarchy as being oppressive but also has delicious memories of finding ways around the rules. “One evening six of us signed out for a home leave and then headed to Brisbane Airport to welcome the Beatles. We rented a cheap room in town for the night.”

Looking back, the punitive system is outweighed by the camaraderie and fun she shared with fellow nurses. “You made good friends, you worked hard and you put up with what seemed like unnecessary jobs such as counting the cutlery after meals.”

Initially Sandra was paid £2 a fortnight with which to buy stockings (which should never be laddered) and luxuries like coffee and biscuits.

After four years of training and one more of midwifery, Sandra went to the Northern anmf.org.au

Left to right: 1964 - first year nurse at RBH, 1967 - fourth year nurse RBH.

Territory to be the only nurse on a cattle station. She remembers delivering babies on her own, treating both Indigenous and nonIndigenous patients and setting out flares to guide the flying doctor’s plane. It was her first post and she had no other nurse to turn to for help. “It was nous and common sense that got me through - as well as my intuition,” she says.

with kindness and kept abreast of clinical advancements.

Sandra then returned to Brisbane to spend two years in midwifery. She also did a stint in the outback of Western Australia before moving to Melbourne in 1973 to continue midwifery and gynaecology at the Royal Women’s Hospital.

“I’m encouraged by what I see in the young ones coming through now. The training of new nurses – both male and female – has changed a lot and they can run rings around me in the science of it all,” she admits. Sandra says in her day, it was all rote learning and now it’s evidence-based.

But there’s still that intangible quality that cannot be learned. A nurse (like Sandra) is lucky to have it instinctively – that special quality that ensures patients will give you their trust.

From 1984 Sandra nursed at the Maribyrnong migrant hostel in Victoria where many refugees from war-torn Vietnam and Cambodia were placed on arrival in Australia before it closed in 1992.

Meeting these people aroused her interest in politics so she studied part-time for a politics degree at Swinburne University. That led her to leave nursing for a few years in order to process migrant applications at the Department of Immigration.

“I hated having to refuse people entry to Australia,” she says and after ten years in the office, Sandra found herself back on the wards.

The government was offering retraining and she took it at St Vincent’s Hospital, where she worked until very recently. Now, nearly 68 years old, Sandra finds the physical demands of the profession are taking their toll. But for the past fifty years she has had the stamina and personality to be a very good nurse. In other words, she has had a good sense of humour, treated her patients

“In these last 14 years at St Vincent’s I’ve been much more conscious of nursing the ‘whole person’, Sandra says. As a result, she considers that she is a much better nurse than in the past but she also attributes this improvement to her age and experience.

Sandra has always been a member of the union and participated in campaigns to improve nurses’ working conditions. In her opinion the 4:1 ratio in Victoria is the best thing that has happened. ‘It’s allowed a much higher standard of care,’ she says. She is also delighted with the structured peer support that exists for nurses in a range of situations.

When Sandra announced to her family that she was taking up nursing all those years ago, her mother’s response was: ‘Well, you’ll always have a job.’ And she has. “It’s the laughter I will remember and I’ve made great friends,” Sandra says.

Sandra’s message to anyone contemplating entering the profession now is: “You have great options in what you can do as a nurse, so go for it!”

October 2014 Volume 22, No.4 29

Wellbeing How to create a calm and confident mindset Jane Robotham Are you feeling overwhelmed, fatigued or stressed after a busy shift? Do you notice yourself over-giving, becoming frustrated and feeling disempowered?

A 2013 survey of nearly 5,500 nurses researched the health and wellbeing of nurses across Australia. It revealed that more than half believed they experienced stress that affects their health (Holland et al 2012). Earlier studies indicate that although nurses get satisfaction from their role, burnout and emotional exhaustion cause many nurses to leave the profession (Holland et al).

I have worked on and off as a nurse for almost 30 years in many facets of acute and aged care. I am very familiar with the pressure and emotional and physical exhaustion that so many of us accept as just being ‘part of the job’.

But does it always have to be this way? I now don’t believe it does.

All of the various techniques to maintain wellness I’ve tried over the years paled into insignificance when I tried using a groundbreaking technique called the Siramarti Personal Growth Process.

Siramarti, which is endorsed by the Nursing and Midwifery Health Program Victoria, is a brain-changing approach to personal transformation. By using it you learn how to consciously change those negative responses to life such as stress, frustration, worry, anxiety, lack of confidence or burn-out.

It replaces these uncomfortable responses with the ability to stay calm, centred and self-caring in everyday life. The process has been developed over the past decade with the help of hundreds of individuals who have benefited from it.

The Siramarti process teaches skills based on the power of brain change visualisation to alter a person’s default neural pathways (Doidge 2007). In other words by using simple, practical techniques Siramarti changes the way your brain responds to everyday problems.

Say goodbye to stress When I was nursing in the late 80’s I joined an agency to do extra shifts at different Melbourne hospitals. It was an awful experience. I felt stressed, overwhelmed and 30 October 2014 Volume 22, No. 4

out of control and hated every moment. I did more shifts only to find I felt the same wherever I went. I stopped doing agency shifts because of the stress. Over the years I watched from afar as many agency colleagues experienced the same sort of discomfort thinking, “Why do it to yourself?”

As a mother with a new business on the go I decided to give agency work another go – less work hours for more pay was attractive, and the flexibility was a necessity! Immediately I made the decision, the same feelings of fear, stress and worry overwhelmed me, becoming more intense the closer the first shift became.

However, now I had my brain change tools.

I set about using them religiously to target and dissolve the mounting emotions.

Along came my first shift, overseeing the care of a large aged care facility in regional Victoria – very scary when you are the only “go to” person on duty! In the days leading up, I used the basic fear dissolving visualisation whenever I had a thought that felt uncomfortable. I also used a daily five minute process called Seven Steps for Highly Effective People to create an enjoyable day where I could be calm, relaxed and in charge. The night before my first job, I felt surprisingly okay.

The day came and went. I was stunned to find it was incredibly easy! Everything was a replication of my Seven Steps. I tried another shift at a different facility and it was the same. Clearing the self-sabotaging story that it was just a fluke, I accepted more shifts in both private and public hospitals, in different wards that required different skills, with different staff, patients and nursing demands.

The amazing thing was that none of the new situations made me feel at all uncomfortable. I felt confident, calm and open to whatever was to come. I felt in charge of my tasks and able to adapt to new surrounding as if I had been there before. I was able to respond logically and give my attention to each task without anxiety. I felt effective, efficient and calm.

Jane Robotham

I could not help but accept that the neuroplasticity work that I had done over the past few years had profoundly changed the way I functioned. I now have a new mindset that gives me more confidence, focus and productivity. And I thank the previous difficult experience because without it I would never have witnessed the comparison!

Using these powerful techniques on a regular basis will enable you to become calmer and more resilient to the challenges of daily life. Given a commitment you can expect a marked improvement in your previous susceptibility to stress, anxiety and burnout.

The result is greater mental clarity, physical vitality and whole-of-life balance in personal and professional circumstances.

I look forward to sharing these exclusive techniques to create a new way of working that allows you to care for yourself while time caring for your patients with ease!

References Doidge, N., (2007), The Brain That Changes Itself, Scribe Publications, Victoria Australia Holland, P., Allen, B., Cooper, B., (2012) What Nurses Want: Analysis of the first national survey on nurses’ attitudes to work and work conditions in Australia, Monash University, www.buseco.monash.edu.au/mgt/ new/documents/nurses-survey.pdf

Jane Robotham is a motivational speaker and coach who is passionate about facilitation of the Siramarti Process in conjunction with practical self-care and wellness tips for nurses and carers. She presents the WellNurse program via presentations to hospitals and organisations, and runs short workshops and wellness retreats.

For details of upcoming workshops or to contact Jane go to: Website: soulclarity.com.au Email: jane@soulclarity.com.au anmf.org.au

Issues Smart nurses thoughtless posts on social media Laurie Bickhoff For decades, as nurses we have been fighting to prove we are competent, trusted health professionals. Nurses have worked tirelessly to advance our cause by leaps and bounds, with nursing now recognised as a true profession.

However, our reputation now faces a new threat, and it comes from within our own ranks. Repeatedly, we see nurses uploading inappropriate posts on social media. These posts depict nurses as untrustworthy and unprofessional, disparaging our reputation and, as such, we need to take action to prevent further damage.

Numerous studies have shown the colossal discrepancy between the public image of nursing and the reality. Despite the efforts of nurses over the past decades, the general public still do not recognise the breadth of knowledge, education and skills nurses possess or the high level of responsibility we now carry (Walker 2014; Patino 2013; Kalisch et al 2007). The outdated stereotypes still persist, that of a female subordinate, whose main interest is finding a husband, who jumps when a doctor says jump, and spends most of her day carrying out mindless tasks (Patino 2013; Wood 2008).

Unfortunately, nurses are perpetuating these stereotypes on social media. These social media posts show nurses breaching patient privacy, bullying each other, as well as other health professionals, and demonstrating a range of unprofessional behaviours (Allen 2013; Springer 2012; Greyson 2010). The media is quick to highlight these negative examples, with headlines such as “Naughty nurses told to behave after posting saucy selfies on social media” (Silmalis 2013).

It is important to realise there are consequences for nurses who post inappropriately on social media. At the start of the year, AHPRA released their social media policy applicable to all registered health professionals in Australia (Australian Health Practitioner Regulation Agency 2014). For nursing, the basic premise of this policy is to refer to our Code of Professional Conduct, which states nurses are expected anmf.org.au

to uphold the code “both within and outside of professional domains in order to ensure the ‘good standing’ of the nursing profession” (Nursing & Midwifery Board of Australia 2013, p 1). Failure to do so can lead to a verbal or written warning or, in more grievous cases, even suspension or disqualification of your registration.

The Australian Nursing & Midwifery Federation has also developed its own policies on social media, online networking and advertising for nurses and midwives to help explain polices and provide useful tips.

We need to be mindful that anything posted on social media is a direct reflection of the professionalism of all nurses and has the ability to influence the public’s perception of nursing (Patino 2013; Englund et al 2012).

We need to be aware of what stereotypes we are perpetuating and the impact these have. The public can view social media posts as an indication of the common sense, discretion and professionalism of someone trusted with the responsibility of caring for vulnerable people (Spector & Kappel 2012; Springer 2012).

Furthermore, if we continue to portray ourselves as nothing more than something pretty to look at, as workers who act inappropriately and have no compassion for the people they care for; then what right do we have to argue when the media does the same thing? We lose our credibility on all fronts.

How do we address this issue? First and foremost, I think it is important we don’t blame social media for these posts. Used correctly, social media can be great. It can enhance your career, provide a wealth of evidence-based information, give networking opportunities and spread the positive impact of nursing (DeJong 2012).

There is a person behind every keyboard, every phone, every post; a person who should be accountable for their actions.

Nurses need to take responsibility for how they portray our profession.

What we do need is more education and awareness. We need to teach nurses the impact they are having, whether they intended to or not (Walker 2014; Anderson 2012). We need to be aware that negative stories, provocative images and scandalous headlines will always spread further and faster than positive ones. Social media posts can spread with unprecedented speed and range, even if the original

post is deleted (Anderson & Puckrin 2011).

We need to learn to be advocates for our profession. Advocacy is a core nursing competency and we excel at advocating for our patients. It is time to extend this to the reputation of nursing online. Nurses need to speak up when they see these posts. A quiet word to a friend or a quick message to a coworker may be all that is needed (Anderson & Puckrin 2011). We need to defend our profession from misrepresentations by those within our ranks, as fiercely as we do from those outside.

References Allen, C. (2013). Careless tweets cost profession public trust and credibility. Nursing Standard, 27(26): 31.

Anderson, J., & Puckrin, K. (2011). Social Network Use: A Test of Self-Regulation. Journal of Nursing Regulation, 2(1): 36-41.

Anderson, T. (2012). ANA’s new principles for social networking. Nebraska Nurse, 6(2): 5.

Australian Health Practitioner Regulation Agency. (2014).

Social media policy for registered health practitioners www.ahpra.gov.au/documents/default.aspx?record=WD14%2f13125&dbid=AP&chksum=jsP%2fas5XSKNCIWHN5%2fECsQ%3d%3d Retrieved 1 May, 2014.

DeJong, S. M. (December 2012). Networking, Professionalism, and the Internet. Psychiatric Times.

Englund, H., Chappy, S., Jambunathan, J., & Gohdes, E. (2012). Ethical reasoning and online social media. Nurse Educator, 37(6): 242-247.

Greysen, S. R., Kind, T., & Chretein, K. C. (2010). Online professionalism and the mirror of social media. Journal of General Internal Medicine, 11: 1227-1229.

Kalisch, B. J., Begeny, S., & Neumann, S. (2007). The image of the nurse on the internet. Nursing Outlook, 55(4): 182-188.

Nursing & Midwifery Board of Australia. (2013). Code of Professional Conduct for Nurses in Australia www. nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2f1353&dbid=AP&chksum=Ac7KxRPDt289C5Bx%2ff4q3Q%3d%3d Retrieved 1 April 2014.

Patino, E. (2013). Lights, Camera, Accuracy: Nurses in the Media www.minoritynurse.com/article/lights-camera-accuracy-nurses-media Retrieved 20 June, 2014.

Silmalis, L. (2013). Naughty nurses told to behave after posting saucy selfies on social media www. dailytelegraph.com.au/news/naughty-nurses-told-tobehave-after-posting-saucy-selfies-on-social-media/story-fni0cx4q-1226729242709 Retrieved 1 June 2014.

Spector, N., & Kappel, D. (2012). Guidelines for using electronic and social media: the regulatory perspective.

Online Journal of Issues in Nursing, 17(3).

Springer, R. (2012). Social media - risk management.

Plastic Surgical Nursing, 32(1): 22-24.

Walker, L. (2014). Promoting Nursing’s Professionalism.

Kai Tiaki: Nursing New Zealand, 20(3): 2.

Wood, D. (2008). How the media influences public perceptions of nursing. www.nursezone.com/nursing-newsevents/more-news/How-the-Media-Influences-Perceptions-of-Nursing_25788.aspx Retrieved 20 June, 2014.

Laurie Bickhoff RN works at John Hunter Hospital and is currently completing Honours in Nursing October 2014 Volume 22, No.4 31

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Life can be a struggle for many families requiring support and guidance. Nurses and midwives often encounter families needing help where they can make a real difference. However knowing how to work with families is a skill. Collaborative Family Work offers practical strategies working with families, always emphasising the importance of collaboration in assisting them in developing strategies to learn new skills and improve their lives.

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This book is a unique reference manual that presents the essential elements of conducting clinical trials in the healthcare setting. In addition it offers templates and practical strategies to serve as a springboard for solving the logistical challenges faced by research professionals, such as study feasibility, budgeting and maintaining risk.

The US based authors share their wealth of knowledge from working collaboratively with research professionals nationally and internationally based trials for more than two decades. This manual offers clinical research professionals the foundation they need to successfully organise their research operations, avoid the pitfalls and ensure successes.

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Research Health workers lack safety awareness

Stillbirth rules for care providers Guidelines in providing care for families impacted by stillbirth have been developed as a result of research from the Joanna Briggs Institute.

Healthcare providers, including community services and aged care staff, lack safety awareness, despite having the highest number of workplace injury claims in 2012, a study reveals.

The project, funded by Stillbirth Foundation Australia, looked at worldwide research on how healthcare professionals provided care to families impacted by stillbirth.

The study, Dangerous Personalities Making Work Unsafe, surveyed more than 1,400 employees in a range of sectors and organisations.

The respondents were asked about their views on OH&S guidelines in the workplace, which indicated a lack of workplace safety awareness within the health sector employees.

The study, commissioned by consulting firm SACS, showed workers in the health sector had moderate safety consciousness, despite having the highest number of workplace injuries.

SACS Managing Director and principal researcher of the study Andrew Marty said the findings were concerning.

Mr Marty said the latest data from Safe Work Australia showed employees in health and community services had by far the highest number of serious workers compensation claims in 2011-12, at 19,060 claims. “The evidence is clear – the health and community services sector needs to improve the overall safety behaviours of its employees.”

Holistic approach helps fight cancer A holistic approach in treating patients post-cancer designed to make recovery more comfortable is said to have a wide range of benefits, according to a new study.

The report, Evaluating Blue Mountains Cancer Help Model of Care, looked at holistic approaches to cancer care, which combined mainstream medicine with complementary therapies such as message, yoga, acupuncture, art therapy, counselling and a 12-week Living Well with Cancer program.

The study involved project partners from Blue Mountains Cancer Help (BMCH), Nepean-Blue Mountains Medicare Local, the University of Western Sydney, The University of NSW and Nepean Cancer Care Centre, Nepean Hospital.

The researchers interviewed cancer sufferers and post-treatment patients who had received the holistic approach with their treatment to find out about the quality of their lives.

According to the report a wide range of benefits were gained from the approach. BMCH’s CEO Robyn Yates said Australians needed to have an open mind when looking for cancer treatment options. “There’s a distinct lack of understanding about complementary therapies and the integrated care that is needed to support people through the posttreatment phase of cancer.

“Many people experience clear benefits including improved energy levels from complementary therapies in offsetting side effects from treatment.”

anmf.org.au

The findings showed families were most comforted by healthcare professionals who were prepared to involve them collaboratively in decision-making, and who provided empathetic, sensitive and respectful care at all times.

The work has resulted in a new set of guidelines aimed at assisting nurses, midwives, doctors, and others in providing the best possible care to families.

Stillbirth Foundation Australia’s CEO Jan Samuels said the systematic review provided meaningful and useful information that could immediately be translated into practice. “With six babies being stillborn every day in Australia, it is critical that parents, and the health professionals who care for them, are well supported.”

Associate Professor Zoe Jordan with the Joanna Briggs Institute said despite the prevalence of stillbirth the research showed healthcare professionals were often not well trained or prepared to provide the level of care needed for families.

She said parents were at heightened risk of detrimental psychological effects, including grief, depression and self-blame following stillbirth. “Our research confirmed that the actions, behaviours and communications of healthcare professionals during their interaction with parents, and the stillborn baby, can have a considerable impact on parents’ psychological wellbeing.”

Professor Jordan said the risk for care providers, without sufficient training and support, was also heightened in these horrific circumstances. “Healthcare professionals may themselves be emotionally affected by stillbirth, and this can influence their interaction with parents.”

The guidelines are planned to be made available on the Stillbirth Foundation Australia website this month. www.stillbirthfoundation.org.au October 2014 Volume 22, No.4 33

Focus – Emergency Nursing The fast lane: Nursing in WA’s busiest emergency department

By Matthew Avery Royal Perth Hospital (RPH) is home to Western Australia’s largest and busiest emergency department (ED), treating more than 82,000 patients every year.

The demanding nature of emergency requires nurses who are able to think on their feet and to provide a high standard of care across various disciplines for a range of patients.

ED clinical nurse specialist Sarah-Louise Moyes (pictured) thrives in the fast-paced environment of emergency and the uncertainty about what each day may bring always keeps her on her toes.

“When a multi-trauma patient arrives, we often have less than a few minutes to prepare, so I have learnt to be prepared for anything,” said Ms Moyes.

“Every day in emergency is different,” Ms Moyes said. “We are confronted with challenging situations on a daily basis and we really do make a difference in people’s lives.”

Although nursing wasn’t always her first career choice, Ms Moyes says she was inspired by her aunty who worked as a nurse for many years.

“Growing up, my aunty would often share interesting and exciting stories and I became fascinated by the prospect of a career in such a diverse environment.

Busy NSW EDs show improved performance

“I have been an emergency nurse for almost 10 years now. I have treated thousands of patients but I feel I make the most difference when I provide support and comfort for bereaved relatives in trying circumstances.

“I am very proud to be an emergency nurse at RPH. It is very rewarding knowing I have made a difference; there is nowhere else I’d rather work.”

“I have always had a passion for people, something that is very important when working in emergency. Strong will and passion is vital to success in the ED,” said Ms Moyes.

Ms Moyes is also a committee member of the College of Emergency Nurses Australasia, working to promote emergency nursing in Western Australia.

RPH is also home to the State Adult Major Trauma Centre with the ED receiving 75% of all trauma cases in WA.

Matthew Avery is the Public Relations Assistant at Royal Perth Hospital in WA

NSW’s public hospital emergency departments (ED) have shown an improvement in performance despite the highest number of visits in two years.

Bureau of Health Information Chief Executive Dr Jean-Frederic Levesque said the positive result had occurred despite a 3% increase in presentations to EDs.

The latest report from the Bureau of Health Information, Hospital Quarterly (April to June), showed the time taken for the majority of patients leave EDs within four hours had decreased, indicating an improvement of six percentage points compared to the same quarter last year. Overall the results indicated the best performance for the quarter over the past five years.

34 October 2014 Volume 22, No. 4

Ms Moyes said the most rewarding aspect of her role is making the patient journey through the ED as smooth as possible and providing comfort to family and friends.

The report showed more than 600,000 patients visited an ED across NSW – the highest number of visits for this quarter in two years. For patients who arrived by ambulance, 85% had their care transferred from ambulance to hospital staff within 30 minutes. The time patients waited to start treatment across all urgency categories was the same or shorter compared to the same quarter last year.

anmf.org.au

Focus – Emergency Nursing

Cultural competence in emergency department

By Kannikar Wechkunanukul, Hugh Grantham and Robyn Clark

Australia is one of the most multicultural societies in the world, and continues to grow in diversity of culture, language and religion. Almost one-third of the Australian population have been born overseas (Australian Bureau of Statistics 2013) and therefore one third of emergency department (ED) presentations will have been born in another country.

New migrants to Australia often have difficulties with settlement including trying to understand our education, employment and taxation and healthcare systems.

There is evidence to indicate that Australia’s culturally and linguistically diverse (CALD) population has different perceptions of health and illness which contribute to their health behaviours, including emergency care. CALD groups are also less likely to access primary and preventive care such as follow up visits and often experience difficulties communicating with health professionals, which create issues for emergency nurses when gaining informed consent and providing education regarding medication at discharge (Kirkman-Liff and Mondragón 1991).

Over the past decade, several studies have concluded that routinely using interupters can enhance delivery of healthcare, decrease ED visit time and reduce diagnosis-related costs. However, there is evidence interpreters are largely underutilised in ED settings (Ramirez et al 2008).

Effective communication is not only the anmf.org.au

indicator of quality of emergency care according to CALD patients but should also include empathy and interpersonal interaction with family (Beattie et al 2012).

There are standards of practice and competencies for nurses and clinical nurse specialists in emergency care. Nonetheless, these documents are focused on providing timely care in an appropriate manner to a general population who are Englishspeaking. How well these standards apply to culturally and linguistically diverse population, working in a different language and culture is unknown. How emergency department staff including nurses meet these standards when faced with challenges in culture and communication with patients is the subject of a research project we currently have in progress.

Cultural competence is a set of congruent behaviours, attitudes and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations. It is more than awareness of culture difference but includes the notion where reciprocity, action and accountability are emphasised to improve practice on the basis of cultural differences (National Health and Medical Research Council 2006).

Acknowledging Australia’s diversity, cultural competence should be normalised into ED nursing practice in order to improve provision of care for our minority and often highly disadvantaged population.

Ensuring optimum care for all those in

need is one of the main reasons for our existence, ensuring cultural competence in our emergency department is a key stone of our care, achieving cultural competence can easily be within our grasp.

References Australian Bureau of Statistics. (2013). Migration, Australia, 2011-12 and 2012-2013.

Australian Bureau of Statistics: 2013 Canberra. Cat. No. 3412.0.

Beattie, M., Atherton, I., McLennan, B. and Lauder, W. (2012). Compassion or speed? Which is a more accurate indicator of healthcare quality in the emergency department from the patients’ perspective?

The International Journal of Person Centered Medicine, 2(4):647-655.

Kirkman-Liff, B.,and Mondragón D. (1991). Language of interview: relevance for research of southwest Hispanics.

American Journal of Public Health, 81(11):1399-1404.

National Health and Medical Research Council. (2006).

Cultural Competency in health: a guide for policy, partnership and participation. National Health and Medical Research Council: Canberra.

Ramirez, D., Engel, K. G., and Tang,T. S. (2008).

Language interpreter utilization in the emergency department setting: a clinical review. Journal of healthcare for the poor and underserved, 19(2):352-362.

Kannikar Wechkunanukul is a PhD candidate at the School of Nursing and Midwifery, Flinders University in South Australia Hugh Grantham is Professor of Paramedics in the Paramedic Unit, Flinders University in South Australia Robyn Clark is Professor of Nursing in the School of Nursing and Midwifery, Flinders University in South Australia October 2014 Volume 22, No.4 35

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Focus – Emergency Nursing

New ED busiest in NSW

Midwifery excellence delivering a new generation

By Tracey Hutton Delivering Nina Dean’s son Joe in a home birth last month was a special moment for Flinders Medical Centre midwife Julie Pratt, who also delivered Nina 30 years ago.

“The whole experience was wonderful and it was a really lovely birth,” said Julie, who heads up the hospital’s Southern Midwifery Group Practice.

Julie delivered Nina’s son after four hours of labour at her Glenelg South home on 20 May and Nina was relieved to have Julie’s midwifery experience to guide her through.

“Julie is amazing – she might just give you a look or a few supportive words but she really gets you to refocus time and time again,” Nina said.

“It was such a special moment to have Julie be there to deliver my son Joe when she delivered me 30 years ago.”

Julie’s impressive midwifery career, which includes more than 1,000 births spanning 30 years, was recognised at the 2014 South Australian Nursing and Midwifery Excellence Awards, with Julie winning the award for Midwifery Excellence. anmf.org.au

“I was excited and flattered to win – to me it’s just the job I love and to receive this award is humbling,” she said.

Julie spent 18 years as an independent midwife before taking up a role at FMC in 1996 with a goal to work towards introducing homebirth as a public option.

FMC has offered homebirths for women across the south since November 2012 and Julie says there have been some memorable moments.

“Recently there was a mother who was due to deliver her fifth baby and she was at home with her family supporting her, Julie said. “The six-year-old son, who had just witnessed the birth of his baby brother, shouted excitedly ‘this is the best day of my life’. That was a special day that I will never forget.’’

In the Southern Midwifery Group Practice, Julie and her team try to promote a natural and drug free birthing option for mums.

“For a lot of women it’s the support before and after the birth that is truly important,” she said. “Our role is to get them through the process and try and make their experience a powerful one.”

Tracey Hutton is the Media & Communications Officer at Southern Adelaide Local Health Network, Flinders Medical Centre in South Australia

A southern Sydney hospital will be opening its doors to a new $41million emergency department this month.

The new department at St George Hospital services Southern Sydney and the northern Illawarra.

St George and Southerland Hospitals Director of Operations Cath Whitehurst said the emergency department will be one of the busiest in NSW. “St George Hospital is a tertiary referral centre and is the Level 1 Trauma Centre for the South Eastern Sydney Local Health District meaning the benefits of this new emergency department will be far reaching.

“The new emergency department will be a significant boost for St George Hospital, which has one of the busiest emergency departments in NSW, seeing more than 67,000 patients (including 14,000 paediatric presentations) and admitting around 25,000 patients each year.”

Ms Whitehurst said the new emergency department will be of great benefit to families for many years to come and will boost the capabilities of St George Hospital in treating more patients at a time when there has been unprecedented growth.

October 2014 Volume 22, No.4 37

Focus – Emergency Nursing Patient stories about being cared for in the emergency department

By Cheryle Moss and Katherine Nelson Researchers Cheryle Moss from Monash University in Australia and Kathy Nelson from Victoria University of Wellington in New Zealand, recently found themselves listening to consumers’ stories about their need for emergency department (ED) care.

Interviews with 34 consumers who frequently visit the ED for emergency management of their chronic respiratory or mental health conditions revealed that the consumers had experienced significant variation in ethic and duty of care responses by the health professionals who had interacted with them. Of interest to the researchers was that the consumers mainly reported inconsistencies in the attitudes of health professionals (HPs) and the care that

they received from them. The researchers used Joan Tronto’s (1998) insights into the ethnic of care (as having the inter-related elements ‘caring about and attentiveness’, ‘caring for and responsibility’, ‘care giving and competence’, ‘care receiving and responsiveness’) to understand these variations and inconsistencies in care.

The researchers were able to describe examples of consumers experiencing sustained and enmeshed duty of care from ED HPs, when this happened the consumers felt dignified, supported and helped. At other times when the consumers experienced ‘consistent duty of care’ from HPs they noted ‘technical smoothness’ and the competence of their carers. While these examples showcased good care, most of the consumers also had experienced and shared examples of HP care they had received which was ‘inconsistent’ or mixed in the provision of either the ethic of care or duty of care; and some had examples of HP care they experienced which was in ‘breach of both duty and ethic of care’.

The results highlight the importance of

listening to and learning from consumers’ experiences of the care they receive. The issue says the researchers, is not so much in determining whether what the consumers perceive is right or wrong, but rather seeking insight into how our actions and attitudes as HPs are perceived by them. From consumers’ stories of their experiences we can become more aware of our moral comportment and the impact of this on the people for who we care. The research findings may assist ED HPs to proactively seek ways to build the moral climate of care as integral to their services.

References Moss C, Nelson K, Connor M, Wensley C, McKinlay E, & Boulton A, (2014). Patient experience in the emergency department: inconsistencies in the ethic and duty of care.

Journal of Clinical Nursing. doi: 10.1111/jocn.12612 Tronto JC, (1998). An ethnic of care. Generations 22 15-20.

Cheryle Moss PhD RN, School of Nursing and Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Australia Katherine Nelson PhD RN, Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, New Zealand

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Focus – Emergency Nursing Cheryl’s love of nursing wins high praise

By Tracey Hutton From tending to the broken arm of a young child to providing support for a trauma patient involved in a major car accident, Flinders Medical Centre (FMC) nurse Cheryl Kimber never quite knows where her day will take her.

Cheryl, an Orthopaedic Nurse Practitioner (ONP) at FMC, became Australia’s first authorised ONP in 2005.

Her position sees her working across orthopaedics, emergency and paediatrics and following a patient’s journey from the initial GP referral through to the Emergency Department, wards and outpatient clinics.

Cheryl’s dedication to nursing was recently recognised when she won the award for Nursing Excellence at the 2014 South Australian Nursing and Midwifery Excellence Awards.

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“What a great honour – I think the best part is to be acknowledged by colleagues, it really is the highest accolade you can receive,” Cheryl said.

One of the highlights of Cheryl’s longstanding career has been spearheading the development of a virtual orthopaedic clinic which provides ongoing orthopaedic healthcare and reviews for rural and remote patients – saving them the long drive to Adelaide.

“I saw there was a need for this service so I made it happen and some days I am speaking to up to 16 country callers a day, providing advice as well as speaking with GPs and physios to achieve the best possible outcome for the patient,” she said.

Cheryl still loves her job after working as a nurse for almost 30 years.

“I am lucky to work with amazing teams across FMC and after all this time I still enjoy what I do - I want to make a difference to patients and families and I believe I have a lot to offer them and my colleagues in regards to knowledge and support.”

Tracey Hutton is the Media & Communications Officer at Southern Adelaide Local Health Network, Flinders Medical Centre in South Australia

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Focus – Emergency Nursing

of an emergency department.

Study lead for the research Belinda Kennedy, who is also a 15 year critical care veteran, said emergency nurses were a special breed. “Despite numerous studies about personalities of nurses in general, there has been little research done on the personalities of nurses in clinical speciality areas.”

Emergency nurses a breed of their own Emergency department (ED) nurses are more extraverted than other nurses a NSW study has found.

The study from the University of Sydney also revealed that ED nurses are more agreeable and possess open attributes, making them successful in the demanding, fast-paced and often stressful environment

Ms Kennedy said working as a critical care nurse made her more aware of the difficulty in retaining emergency nurses and that she observed apparent differences in personality among these speciality groups.

“This prompted me to undertake this research which is the first on this topic in more than 20 years.”

According to Ms Kennedy the research found emergency nurses demonstrated significantly higher levels of openness to experience, agreeableness and extraversion personality domains compared to the normal population. “EDs are a highly stressful environment - busy, noisy, and with high patient turnover. It is the

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entry point for approximately 40% of all hospital admissions, and the frequency and type of presentations is unpredictable.

Emergency nurses must have the capacity to care for the full spectrum of physical, psychological and social health problems within their community. They must also be able to develop a rapport with individuals from all age groups and socioeconomic backgrounds, in time critical situations and often at a time when these individuals are most vulnerable.”

For these reasons, ED staff experience high levels of stress and emotional exhaustion, Ms Kennedy said. “It’s understandable that it takes a certain personality type to function in this working environment.”

Ms Kennedy said the research findings had potential implications for workforce recruitment and retention in emergency nursing. “The retention of emergency nurses not only has potential economic advantages, but also likely positive impact on patient outcomes, as well as improved morale among the nursing workforce.”

Focus – Emergency Nursing

Unscheduled returns to the emergency department

By Nathane Carolina Vieira De Sales, Cheryle Moss, Ingrid Brooks, Kerry Hood and Katherine Nelson An unscheduled revisit (USR) is different from frequent clients of the emergency department (ED) and from those who are asked to return for follow-up. A USR is defined as a re-presentation of the patient for the same chief complaint to the ED within a specified period time of their initial evaluation (Wu et al 2010).

The aim of this study was to describe the problem of unscheduled patient returns to adult EDs, which happens with a relatively frequent occurrence, as quality indicator. Moreover, looking into the reasons behind these return visits to identify any weaknesses in the system of care and to identify possible strategies for improvement.

A diverse team of nurses is undertaking this research. Nathane Carolina Vieira De Sales is a nursing student from Brazil who is doing overseas placement and study at Monash University. Cheryle Moss from Monash University in Melbourne frequently researches with Katherine Nelson from Victoria University of Wellington in New Zealand into vulnerable people’s needs for anmf.org.au

ED care. Ingrid Brooks and Kerry Hood are nursing academics at Monash University who also have relevant histories working and teaching in EDs. During researcher discussions about what current research is reporting, it was clear that return visits by patients to ED are part and parcel of any busy emergency service.

However, returns may also represent unnecessary visits that could have been avoided through different actions by providers on the initial visit (Easter & Bachur 2013). Furthermore, a persistent problem for emergency physicians are the patients who return unscheduled to the ED with an illness that either has not improved or has worsened. It is commonly understood that an initial evaluation or treatment was inadequate when patients return shortly after discharge of ED (Nunez, Hexdall and Aguirre-Jaime 2006).

These were likely to be due to avoidable causes and factors in a setting for a period of time such as wrong diagnosis, wrong treatment, wrong follow-up, wrong information, wrong care provided at home and so on (mix between illness, patient, doctor and healthcare systems factors).

Therefore, unscheduled repeat visits to the ED may be an important quality indicator of performance of individual clinicians as well as organisations and systems responsible for the delivery of emergency care (Trivedy and Cooke 2013).

The scoping review of the literature determined how recording and analysis of unscheduled returns to the ED is currently being used as a quality indicator. After systematic searching of SCOPUS,

MEDLINE and CINAHL plus databases, the researchers identified approximately 100 relevant research studies. The findings from analysis of these papers has led to identification of five key types of uses for monitoring USRs in the ED. To understand more how to use USR as a measure for general screening of clinical quality issues in the ED is necessary. This includes an investigation of patient factors and hospital staff related to USR; prevalence of USRs admitted or discharged with underline diseases; medical errors and client choice factors; and a pattern of USR post hospital discharge, overall risk of USR. References Easter, J. S., & Bachur, R., (2013). Physicians’ assessment of pediatric returns to the Emergency Department.

J Emerg Med, 44(3), 682-688. doi: 10.1016/j. jemermed.2012.05.011 Nunez, S., Hexdall, A., & Aguirre-Jaime, A., (2006).

Unscheduled returns to the emergency department: an outcome of medical errors? Qual Saf Healthcare, 15(2), 102-108. doi: 10.1136/qshc.2005.016618 Trivedy, C. R., & Cooke, M. W. (2013)., Unscheduled return visits (URV) in adults to the emergency department (ED): A rapid evidence assessment policy review. Emergency Medicine Journal. EMJ Online First, published on 28 October 2013 as 10.1136/ emermed-2013-202719 Wu, C. L., Wang, F. T., Chiang, Y. C., Chiu, Y. F., Lin, T. G., Fu, L. F., & Tsai, T. L. (2010). Unplanned emergency department revisits within 72 hours to a secondary teaching referral hospital in Taiwan. J Emerg Med, 38(4), 512-517. doi: 10.1016/j.jemermed.2008.03.039

Nathane Carolina Vieira De Sales, Cheryle Moss, Ingrid Brooks, Kerry Hood are all in the School of Nursing and Midwifery at Monash University in Victoria and Katherine Nelson is at Victoria University of Wellington in New Zealand October 2014 Volume 22, No.4 41

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Focus – Emergency Nursing The lifespan of peripheral IVs inserted in the paediatric ED: do they go the distance?

By Amanda J Ullman, Lorelle Malyon and Claire M Rickard

Peripheral cannulation in the paediatric emergency department (ED) is a necessary, time-consuming, resource intensive and highly skilled procedure (Reigart et al 2012). The insertion of peripheral intravenous (IV) devices in this population can be a source of stress for all concerned - the patient, the parents and the clinicians. But they are essential for the administration of fluids and medicines.

Unfortunately, emergently inserted IV devices are thought to be at higher risk for developing infections, especially when adherence to aseptic technique cannot be guaranteed (O’Grady et al 2011, Stuart et al 2013). Other sources of peripheral IV failure prior to the completion of treatment include accidental dislodgement, phlebitis, occlusion and infiltration (Wallis et al 2014).

All of these cause premature failure of the peripheral IV, which results in discomfort to the patient, interruption to necessary treatment and insertion of a new IV device.

A new study based out of the ED at the Royal Children’s Hospital (RCH), Brisbane has explored the duration and failure rates of peripheral IVs inserted in the ED and admitted to the wards, in order to develop strategies to promote their survival. Recently accepted for publication in Emergency Medicine Australasia, this prospective cohort study of 458 participants reported anmf.org.au

a failure rate of 25% for these essential devices. This failure was most commonly associated with peripheral IV insertion in the antecubital fossa, in comparison to the hand which had better outcomes.

Lorelle Malyon, nurse educator in the RCH ED led the research, in collaboration with the Alliance for Vascular Access Teaching and Research (AVATAR) group. Ms Malyon explains that of the peripheral IVs that failed, infiltration and dislodgement were the leading causes of failure – despite having a bordered polyurethane dressing, splint and several additional securement devices in place. “Our group were unsurprised by the frequency of accidental dislodgement, due to the developmental attributes of the paediatric population being studied. The adequate securement of these devices - whilst ensuring easy visibility of the insertion site - is a challenge for all paediatric nurses,” said Ms Malyon.

In better news, there were no infections observed in the study.

The group are now exploring alternative securement and dressing products, flushing regimens and other IV maintenance strategies to reduce the premature failure of peripheral IVs. References O’Grady, N.P., et al., (2011) Guidelines for the prevention of intravascular catheter-related infections.

Clinical Infection Diseases,. 52(9): p. e162–93.

Reigart, J.R., et al., Peripheral intravenous access in pediatric inpatients. Clinical Pediatrics (Phila), (2012).

51(1): p. 468-72.

Stuart, R.L., et al.,(2013) Peripheral intravenous catheter-associated Staphylococcus aureus bacteraemia: more than five years of prospective data from two tertiary health services, Medical Journal Australia.

198(10): p. 551-3.

Wallis, M.C., et al.,(2014), Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial. Infection Control Hospital Epidemiogy,. 35(1): p. 63-8.

Amanda Ullman is PhD candidate and senior Research Assistant at NHMRC Centre for Research Excellence in Nursing, Centre of Health Practice Innovation and School of Nursing and Midwifery, Griffith University and Honorary Research Fellow at the Royal Brisbane and Women’s Hospital Professor Claire Rickard is director of the Alliance for Vascular Access Teaching and Research (AVATAR) Group, and Professor of Nursing at the NHMRC Centre for Research Excellence in Nursing, Centre of Health Practice Innovation and School of Nursing and Midwifery, Griffith University Lorelle Malyon is Nurse Educator at the Department of Emergency Medicine at the Royal Children’s Hospital, Brisbane October 2014 Volume 22, No.4 43

Mail A lot to offer Adhere to stethoscope hygiene In response to Shaw and Cooper’s article on ‘Stethoscope hygiene’ (March 2014), let me paint you a picture of a health professional (that’s you), roles reversed - hospitalised in a four bed ward (the horror) as a patient.

The doctor comes in to undertake his daily rounds and after auscultating the other three patient’s lungs and heart without any sanitisation in between, proceeds to undertake his assessment on you. You can almost visualise the millions of tiny superbugs, long-jumping from his stethoscope to his crisp, white shirt. In the opposite bed, a patient furiously scratches away at what you have already diagnosed as some rare form of leprosy. He asked you to lean forward so he can listen to your lungs. You freeze and struggle to find words as you intently eyeball the enormous queen super-bug that’s hanging off the bell of his stethoscope.

Hopefully, this scenario makes you squeamish enough to invoke some form of reflection on your adherence to stethoscope hygiene.

As a recent nursing graduate, I struggle to remember any formal training or a teacher

enforcing the importance of stethoscope hygiene whilst educating students on auscultation skills (Saunders, Hryhorskyj & Skinner 2013).

It is an unfortunate but true reality of the human’s innate predisposition for laziness and surely by providing readily accessible disinfection supplies and visual reminders in the hospital setting, this will increase stethoscope hygiene amongst healthcare practitioners (Zaghi et al 2013).

Here’s to good stethoscope hygiene, hospital-acquired infection rate minimisation and a world free from rare forms of leprosy.

Reference Saunders, C, Hryhorskyj, L & Skinner, J 2013. Factors influencing stethoscope cleanliness among clinical medical students. Journal of Hospital Infection, 84(3):242-244.

Shaw, F & Cooper, S 2014. Stethoscope hygiene: a best practice review of the literature: the aim of the study was to determine rates of health professional’s stethoscopes and their attitude toward routine disinfection.

Australian Nursing & Midwifery Journal. 21(8):28.

Zaghi, J, Zhou, J, Graham, D.A. Potter-Bynoe, G & Sandora, T.J. 2013. Improving Stethoscope Disinfection at a Children’s Hospital. Infection Control and Hospital Epidemiology. 34(11):1189-1193

At 60 I am nearing retirement. I could work a few more years nursing but as my ward, previously sub-acute is becoming more acute, I am thinking of leaving now. I don’t want to, I love nursing, but I don’t need more stress.

Yes, we are offered more education but I also work part-time and unless you are doing a particular thing all the time you do forget or you just don’t feel competent enough to be doing it. Yet as a ‘senior’ staff member you may be in charge or put in a situation where you need to have that experience.

Older staff, like myself, are aware of our deficiencies and we are perhaps more aware of the dangers. I am a good ‘basic nurse’, I love teaching students good ‘basic care’, patients smile when they see me and ask when I am on next, as I spend time and talk to them, even if it’s only a few minutes.

Why not utilise nurses who are close to retirement and wouldn’t mind working less hours. Use them as an extra pair of hands, their experience would be utilised particularly during busy periods – mornings, evenings when settling, admission days etc. – similar to what used to be called a ‘floater’. If that were to happen I would continue to work for quite some time to come.

Amy Quirk RN, Victoria Anonymous, RN, Victoria

Nursing passion (Letter of the month)

Nurses and basic care – When do we stop learning?

As a nurse educator, it never ceases to surprise me when students inevitably ask me prior to clinical placement: “Do we need help out with ADL’s/basic care, we did a lot of that on the last placement?” I always need to take a breath before I answer…

Basic care is the essence of nursing. It is integral to the role of the nurse and we can never have too much exposure to basic care as a student, there are always learning opportunities. Delivery of basic care gives us the opportunity to improve our communication skills, it allows us to develop stronger therapeutic relationships with our patients, so when the patient requires the IDC/dressing/injection/they say, “Yes. I’m happy for the student

44 October 2014 Volume 22, No. 4

to do the procedure, they are a capable nurse”. It shows initiative, improves our time management skills and indicates to the staff that this nurse is conscientious and capable and can work well as part of a team. As a consequence, the staff are more inclined to offer this nurse increasingly complex skill development opportunities such as, “come and do the drug round with me”. Delivery of basic care gives us an unparalleled chance to engage in patient assessment both physical and psychological - from a skin, pain, mobility or cognitive assessment to a chance for the patient to talk about concerns or issues that may affect their recovery. It gives us the opportunity to develop our critical thinking skills as we come across unexpected circumstances and difficulties even with these basic interventions. Finally, it gives us a great chance to undertake patient education and clarify further queries the patient may have.

the opportunity to engage in provision of basic care whenever possible on clinical placement it will reward you with skills and knowledge far beyond your expectations.

Johanna Drake RN, Victoria The winner of the ANMJ best letter competition receives a $50 Coles Myer voucher. If you would like to submit a letter to the ANMJ email anmj@anmf.org.au Letters may be edited for clarity and space.

So, yes students, you should embrace

anmf.org.au

Mail Bullying vs Disrespect Nursing and midwifery in the twenty-first century is full of paradoxes. There is not an ANMJ that does not mention ‘bullying’ and ‘nurses eat their young’, and yet in my workplace older RN and RM’s are experiencing age discrimination and lack of respect.

Workforce statistics and conference papers present a picture of a shortage of RN and RMs, and yet in my workplace RN/RM’s are being actively encouraged to drop one of their dual registrations.

My experience as a clinical RN/RM (as per the SA public sector EB) is that my depth and breadth of knowledge is no longer appreciated or utilised because the dual role has become an ‘inconvenience’. Registered nurse managers do not give me responsibility because I might be called away to attend to a woman in labour; and midwifery managers think I’m not a real midwife because I am not totally focussed on women only.

WORKFORCE STATISTICS AND CONFERENCE PAPERS PRESENT A PICTURE OF A SHORTAGE OF RN AND RMS Unfortunately I am a product of my time. In the twentieth century we were encouraged to progress from RN to RM. Over the years I have intuitively used both sets of knowledge to care for anyone, male or female. I have held positions which I would not have qualified for without dual registration.

Recently I attended a midwifery update, with other nurses/midwives from around Australia. They also had stories about professional disrespect, and a sense of being disenfranchised from both the nursing profession and midwifery.

Am I a bitter old woman jealous of university educated registered nurses and direct-entry midwives, or do people like myself have a complex mix of skills that contribute flexibility and adaptability to the workforce??

My thoughts on aged care What is missing from contemporary aged care is the notion of ‘love’. For some reason, this word is shied away from when discussing how we care for our elderly. Societal norms frown on such emotive language because it wrongly either romanticises or sexualises the concept of love. We talk about ‘valuing’, ‘respecting’, being ‘dignified’ and a whole lot of other terminology, but we never say that we need to show love to those we care for.

In fact, as nurses, we are encouraged ‘not to get too close’ to those we care for as we might get hurt or our caring may be construed as inappropriate by families or other care givers.

Maybe they think we would be ‘after their money’, I don’t know, but that negativity is there.

Apparently, it’s ok to buy a puppy and shower it with love, but in caring for an older person in a very intimate way at a time in their lives when they are their most vulnerable, we discourage acknowledging that a ‘kind of love’ comes into play.

It’s that very capacity that most nurses and care givers inherently have, that makes them able to do the job most of society cannot or will not do. So when can we actually be truthful and overtly acknowledge that it is love that we give?

We need to be proud of our capacity to feel this way rather than suffer the constant barbs and criticisms that are traditionally dished out by the media and even by other professionals who tend to view our work as menial or unimportant.

When we get that our work is incredibly important and that we as carers are incredible people, the culture of aged care will improve.

In applying this concept of promoting loving environments where our elderly can be cared for, there is a need to be brave and bold in smashing some of the bureaucratic bungling that is so choking our current system of aged care.

Unquestionably, there must always be a system of checks and balances to ensure that all aged care providers are doing the right thing and providing what is required.

Historically, there have been, and I dare say there are still a few, unscrupulous providers who have abused the trust put in their hands by residents and their families, and we must never allow this to happen again.

Anonymous RN/RM, SA

Questioning the use of the dementia supplement While reading the latest issue of the ANMJ I read with interest your article about the Dementia and Severe Behaviours Supplement being cut.

Until recently I was very involved with the Aged Care Funding Instrument (ACFI) process but left before the cuts to the Dementia Supplement were implemented.

During this time I was encouraged to get a certain percentage of residents into the supplement program. I was encouraged to ask doctors to review residents and to get as many of them to say that the residents had a dementia diagnosis. Even if there was no real evidence. I imagine the private aged care facility I worked in was not the only one to encourage this.

At the time I was under the impression that the money received from the supplement would go to the residents care needs, however I saw no evidence of that.

Staffing levels did not change and there was no new equipment received or any improvements I could see.

And don’t even get me started on the way that ACFI is done. Or should I say manipulated. I was encouraged to give up my ACFI role as I was not being ‘creative’ on a regular basis.

I think the government SHOULD be investigating how nursing homes are using the grants before they invest in any more programs that facilities can exploit.

Anonymous EN, Victoria

NOTICE TO MEMBERS ANMF Federal Office Financial Report The ANMF Federal Office Financial Report for the year ended 30 June 2014 is now available at www.anmf.org.au Members without internet access may obtain a hard copy of the report by applying in writing to: Federal Finance Officer Australian Nursing & Midwifery Federation Level 1, 365 Queen Street, Melbourne Victoria 3000

Susan McVeigh RN, Victoria anmf.org.au

October 2014 Volume 22, No.4 45

Director of Nursing North West Private Hospital Burnie

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This 48 bed acute medical, surgical, psychiatric and obstetric hospital is located in the scenic city of Burnie on Tasmania’s North West Coast.

This position aims to ensure continuous quality improvement and the realistic utilisation of nursing resources while providing support to approx. 90 nursing staff and the CEO. Retaining accountability to clients and stakeholders, the DON will manage services and programs relevant to the achievement of the organisation’s vision and goals, including maintaining accreditation for the NSQHS standards.

To be effective and successful in this challenging role, candidates must demonstrate prior experience implementing bed management and patient flow strategies. Excellent clinical quality and risk management skills are required, as is a demonstrated ability to develop new business opportunities and service models. A proven ability to make clear decisions, initiate action and manage subsequent change must also be displayed.

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Calendar OCTOBER National Indigenous Mens Conference 13-15 October Pullman Cairns International Hotel, Cairns, Qld www.indigenousconferences.com Greening the Healthcare Sector 2014 Hosted by Australian Healthcare and Hospitals Association (AHHA) and Climate and Health Alliance (CAHA) The Health Sector as a Leader in Low Carbon Transformation 14 October Mater Hospital, South Brisbane To register your interest in attending, please email convenor@caha.org.au or sign up to the mailing list for updates at www.caha.org.au Navigating the e-mental health web 15 October 2014; 6:30pm AEDT Please join us for this free introductory webinar on using e-mental health resources presented by the ANU. Read more or register at http://www2. redbackconferencing.com.au/ NIMHR Lung Health Promotion Centre at The Alfred 15–16 October Respiratory Course (Module B) 23–24 October Managing COPD 27-28 October Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au 25th PANDDA Conference and AGM Through the looking glass… wisdom, reflection, experience 15-16 October Novotel Hotel, Paramatta, NSW. www.pandda.net/PANDDA/ Conference_2014.html

NOVEMBER Australian College of Nursing National Nursing Forum 2-4 November Adelaide www.acn.edu.au/forum The National Primary Health Care (NPHC) Conference 5-7 November National Convention Centre Canberra http://amlalliance.com.au/events/ national-primary-health-careconference-2014

anmf.org.au

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: lunghealth@alfred.org.au

MARCH

6th Australian Rural and Remote Mental Health Symposium The Practitioner’s Voice 12-14 November Commercial Club, Albury, NSW. http://anzmh.asn.au/rrmh/

Australasian Cardiovascular Nursing College 9th Annual Conference 13-14 March 2015 Crowne Plaza, Coogee, Sydney. www.acnc.net.au

2nd International Conference on Nursing & Healthcare Exploring the Possibilities towards Better Healthcare 17-19 November Chicago, USA. http://nursing2014. conferenceseries.net/

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

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/ 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, Northern Territory 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/

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

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/

APRIL World Health Day (WHO) 7 April 2015 www.who.int/world-health-day/en/ 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/

International Nurses Day 12 May 2015 www.icn.ch/ 13th National Rural Health Conference People, Places, Possibilities...for rural and remote Australia 24-27 May 2015 Convention Centre in Darwin NT www.ruralhealth.org.au/13nrhc/

NETWORK Royal Adelaide Hospital Nurses Training Group 895, 25-year reunion 29 November Adelaide. Contact Julia Curley E: juliacurley@hotmail.com

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: wwnorris56@gmail.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: hookings@ozemail.com.au M: 0427 833 725 or Jan Huckel E: janh55@bigpond.com M: 0458 253 427 or E: memorial_reunion74@ ozemail.com.au

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

October 2014 Volume 22, No.4 47

Annie

measures on its people, mainly income tax, which it is then supposed to use for the good of its people.

Annie Butler, Assistant Federal Secretary As we now struggle with protecting our health system from the impending Federal Budget proposals and all that this will bring, I find that I am genuinely perplexed by persistent propositions from some quarters that healthcare in Australia is ‘free’.

And therefore, that the budget measures of mandatory co-payments being introduced or increased are warranted and fair because ‘you can’t get something for nothing’, ‘it’s about time we all paid a fair share’ and ‘the age of entitlement is over’ and other such platitudes.

Listening to all of this I have to ask myself, in all seriousness, what planet are these people on? Are they in some parallel universe version of Australia where the government collects its revenue from some other source than taxation of its people?

From the way these sectors are acting one would think that politicians were being personally asked to fund public services from their own pockets.

This is what makes this Government’s Budget, apart from being cruel, harsh and unusually unfair, utterly ridiculous.

We pay for the systems and services we have. The Australian Government receives its revenue through a range of taxation 48 October 2014 Volume 22, No. 4

regardless of how much money they have.

This Federal Government’s claims that our healthcare system is free are simply untrue.

Using the revenue collected from taxation, our health system is funded and administered by several layers of government, national, state/territory and local and is underpinned by Medicare, the universal insurance scheme which covers medical services, prescription pharmaceuticals and hospital treatment.

They are trying to hoodwink us into believing their preposterous claims that our health system is in crisis and that we’re running out of money because it’s ‘free’ so the good times have to come to an end. As I’ve just explained, this is nonsense.

Medicare’s objectives are to make healthcare accessible and affordable to all Australians, and to provide high quality care. It is indisputable that Medicare has done this very well since its introduction in 1984 by pooling and then distributing the resources the government collects from us.

This is not to say that we don’t need to make improvements to our health system and to Medicare or that we don’t need to prepare for the future. Of course we do, but there is no ‘crisis’, budget or otherwise, and with good policy decisions, better use of our resources and much fairer means of how the Government collects these resources, this can be readily achieved.

The individual contribution to these funding arrangements is via our tax, and the Medicare levy, and private health insurance, if you choose to have it or even if you don’t, your tax is taken to contribute to the 30% rebate for those who do have private health insurance. And then on top of all this, we each pay a further $1,053 on average per year!

That’s not free – that’s paid for.

But the Federal Government is trying to persuade us that because some services, eg. public hospitals and bulkbilling GPs are free at the point of service, Australians have made no contribution to the health system.

While the assertion that we don’t contribute to our health system is simply ludicrous, it’s important to make the distinction between ‘free’ and ‘free at the point of service’.

Thirty years ago Australians agreed to the Medicare levy as a supplement to our other taxes to enable governments to meet the additional costs of the universal national healthcare system. Proportionally we all pay the same, ie. 1.5% on our taxable income, so there can be equal access to all services by all Australians.

This means that anyone, rich or poor, can go to the doctor or to a hospital when they need without having to pay for the service when they receive it. This is the important, and wonderfully egalitarian point that allows everyone to receive the same level of care based on the clinical need they have

(In fact, the ANMF has just submitted to the Federal Senate Budget Committee, the health and budget proposals, which we believe could address these issues - visit anmf.org.au under submissions for further information.)

The truth in this debate is that the Government is supposed to deliver quality, cost-effective services to its citizens, including healthcare, so it should design its budget to achieve this. But the Abbott Government’s Federal Budget 2014-15 has not been designed this way.

The Abbott Government’s Budget seeks to impose more costs and risks on to individuals through a very unfair distribution of resources rather than meet people’s basic needs through equitable collective programs and processes and cost-effective government management.

The Abbott Government’s budget is abrogating its responsibility to deliver important services to its citizens and the Government is trying to blame us for the problem.

So I think it’s time nurses and midwives told the Federal Government, “you can’t get something for nothing – you got given the power, now we expect the delivery of decent services and a responsible government.”

Join us in taking a stand against the Government’s Budget.

Visit anmftakeaction.org.au 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.

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