V O LU M E 2 3 , N O. 1 / J U LY 2 0 1 5
MISSION POSSIBLE Australian nurses and midwives strengthening developing countries www.anmf.org.au
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EDITORIAL
Editorial Lee Thomas, ANMF Federal Secretary In last month’s ANMJ I discussed our concern about the government’s plan to reduce access to paid parental leave (PPL) and it seems many of you are as alarmed as I am. The federal government’s most recent change to reduce access to the PPL, which Treasurer Joe Hockey labelled “double dipping”, could mean new mothers/ primary carers would lose access to the government’s scheme if their employer provides some paid parental leave.
After the devastating earthquakes in Nepal a few months ago, many Australian nurses have been working with local communities in that country, making a dramatic difference to their health outcomes. Many more Australian nurses are still planning to help with the aid effort. The journal’s feature this month tells the stories of nurses that have worked in developing countries, including Dr Helen McCue who established Union Aid Abroad APHEDA - the Australian Council of Trade Union’s overseas humanitarian movement.
THE JOURNAL’S FEATURE THIS MONTH TELLS THE STORIES OF NURSES THAT HAVE WORKED IN DEVELOPING COUNTRIES, INCLUDING HELEN MCCUE WHO ESTABLISHED UNION AID ABROAD APHEDA - THE AUSTRALIAN COUNCIL OF TRADE UNION’S OVERSEAS HUMANITARIAN MOVEMENT.
Over the past weeks we have conducted a national survey of nurses and midwives and this showed almost three quarters of respondents would be prepared to take action to support the PPL. While most respondents clearly indicated they were unhappy with the proposed revised scheme, what I personally found deeply disturbing was that almost half of those planning to have children soon may reconsider if the restrictions go ahead. Plainly, it is an individual’s right to have a family at a time of their choosing rather than be restricted by the constraints forced upon them by our government. Many other nurses and midwives clearly indicated in the survey they would be forced to return to work earlier under the changes to the PPL scheme. As nurses and midwives, we all know the health benefits for both mothers and babies, if new mums can stay home longer and not be stressed about returning to work. This is an issue the ANMF will continue to campaign against. For further updates go to our website: www.anmf.org.au
The focus section in the journal this month explores what is currently happening in the nursing and midwifery education sector. This is the first time the ANMJ has run this topic and we have been inundated with contributions;- somuch-so that we are running the topic over two months. As I sign off, news has just come to hand that Debra Thoms has been appointed as the new Commonwealth Chief Nurse and Midwifery Officer. Debra’s nursing career in health management and nursing leadership spans a period of thirty years. She has been the Chief Executive of the Australian College of Nursing and is both a fellow of the Royal College of Nursing Australia and The College of Nursing. Congratulations Deb, the ANMF looks forward to working with you in your new role.
@AustralianNursingandMidwiferyFederation
anmf.org.au
@anmfbetterhands
www.anmf.org.au
July 2015 Volume 23, No. 1 1
Canberra
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FRONT COVER: RED CROSS AID WORKER AMANDA MCCLELLAND FIGHTING EBOLA IN A RED CROSS FIELD HOSPITAL IN KENEMA, SIERRA LEONE. PHOTO: TOMMY TRENCHARD/ AUSTRALIAN RED CROSS
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The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia. Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement. All rights reserved. Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrangement with the Australian Nursing & Midwifery Federation Federal Office Note: ANMJ is indexed in the cumulative index to nursing and allied health literature and the international nursing index ISSN 2202-7114
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2 July 2015 Volume 23, No. 1
ANMJ IS PRINTED ON A2 GLOSS FINESSE, PEFC ACCREDITED PAPER. THE JOURNAL IS ALSO WRAPPED IN BIOWRAP, A DEGRADABLE WRAP.
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News 4
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Reflections 22 Issues 23 Research 24 Ethics 25 Education 26 Clinical update
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Books 32 Focus – Education part 1 33 Calendar 46 Mail 47 Sally 48
FEATURE
AUSTRALIAN NURSES AND MIDWIVES STTRENGTHENING DEVELOPING COUNTRIES
04
23
NEWS
ISSUES
NURSES – ARE WE DISASTER READY?
25
33 ETHICS anmf.org.au
RATIONING UNIVERSAL HEALTHCARE
FOCUS
EDUCATION PART 1
July 2015 Volume 23, No. 1 3
NEWS Plea to support victims of domestic violence
ANMF on front foot at Senate Inquiry into Temporary Work Visas (457s) Appearing before a Senate Inquiry into the impact of Temporary Work Visas on Australia’s workforce in June, the Australian Nursing and Midwifery Federation (ANMF) called for changes to the 457 scheme that would safeguard the employment of local graduates and provide greater protection to migrant workers facing exploitation. The 457 visa program was devised to engage temporary migrant workers to fill unexpected shortages. But the ANMF believes the scheme is being misused by employers and making it tougher for nursing and midwifery graduates to find a job. The ANMF estimates about 10,000 people holding some form of temporary migrant work visa, including masses of international students, is working within a nursing field. Speaking at the hearing before the Senate Standing Committee on Education and Employment, ANMF Assistant Federal Secretary Annie Butler said the ANMF supported the 457 program, but claimed overseas workers were regularly being employed over capable graduates. “We believe that it’s being taken as a shortcut and that employers see it as a quick fix,” Ms Butler said. The ripple effect means graduates face an ‘early career problem’ where it is increasingly difficult to secure employment. A nursing workforce shortage is predicted in 10 to 15 years and Ms Butler said preparing for the future was critical. “We are producing significant number of graduates. The problem we have is that we’re not getting them into meaningful employment once they finish their degree.” The inquiry examined the exploitation of 457 workers, specifically two nurses from the Philippines who were underpaid and 4 July 2015 Volume 23, No. 1
threatened while working in aged care in Victoria. ANMF Vic Branch member registered nurse Dely Alferaz told the committee she was manipulated by her former employer into paying $3,000 to obtain a 457 visa to work in Australia, then later asked for a similar amount to obtain sponsorship for permanent residency. “I didn’t know she shouldn’t be charging me for the money,” Dely said. Registered nurse Reni Ferreras recounted an identical story when working for the same employer at a different facility. An investigation by the ANMF Victorian Branch uncovered the deception and found both employees were being underpaid significantly. Dely was underpaid since 2009 and is owed $57,000, with Reni reporting similar figures. ANMF Senior Federal Industrial Officer, Nick Blake said the stories exposed what is deemed a widespread problem. To improve the current landscape, the ANMF urged the committee to consider several recommendations, which include: • A one-for-one rule, where employers will be required to hire a nursing and midwifery graduate for every 457 visa worker. • Requested data collection be made public by regulatory bodies in order to measure the migrant impact. • Protection for overseas workers by providing clear information about rights and obligations. Mr Blake said the ease of access to offshore labour had prompted many employers to favour hiring readymade overseas workers instead of young graduates who require training. “The proposal for the one-for-one would have a knock on effect in terms of the obligations for employers to provide support in the workplace in terms of education and training for those new graduates, and would build the workforce.”
The Australian Nursing and Midwifery Federation has joined forces with Australian of the Year, Rosie Batty to help support women and children who have experienced domestic violence. As a foundation partner of Ms Batty’s Luke Batty Foundation for the Never Alone campaign, the ANMF will be calling on members to support the cause through the ANMF website and participate in campaign activities that bring awareness to the need for better support for victims of domestic violence. Ms Batty, who lost her son in a violent domestic attack inflicted by her estranged partner, set up the campaign because women and children who experienced family violence were often alone. “My vision is that Luke’s memory will help give a voice to victims and drive change so they are supported and never alone.” Ms Batty said she was pleased that the ANMF had become a partner of the Luke Batty Foundation for the Never Alone campaign. “Family violence is every Australian’s business, but nurses are on the frontline. It means a great deal to me to have you [the ANMF] as our partners.”
ANMF Assistant Federal Secretary Annie Butler, who launched the campaign with Ms Batty last month, said domestic violence against women and children was a serious problem in Australia that needed to be addressed urgently. “With the backing of ANMF’s strong membership of over 240,000 we have the ability to influence change so that women and children in domestic violent situations are supported”. Ms Butler said she believed many nurses and midwives would feel strongly committed about backing the campaign. “Particularly those working in emergency departments and primary health services who would see first-hand the recipients of domestic violence,” she said. Speaking about the partnership between the two organisations, Ms Batty said the Luke Batty Foundation would stand with nurses and midwives in support of victims of family violence so that they are supported in the community and have a powerful voice in the corridors of power. “I am going to be asking all Australians to stand alongside me and the ANMF so victims of family violence are never alone .Please get involved and share with your networks.” To join the campaign go to: http://anmf.org.au/take-action-landing
anmf.org.au
NEWS A new era for the ANMJ You may have noticed the ANMJ has a new look, but did you know the journal has a new page on the website too?
VO LU M E 2 3 , N O. 1 / J U LY 2 0 1 5
MISSION POSSIBLE Australian nurses and midwives strengthening developing countries www.anmf.org.au
The page highlights ANMJ ’s latest stories as well as an online version of the journal, which is freely available to all members across the country and online subscribers. Members in Victoria, South Australia, Tasmania, ACT and Northern Territory will also have the option of opting out of receiving their ANMJ in the post if they wish to view the digital copy only.
To view ANMJ’s webpage go to:
http://anmf.org.au/anmj-landing To cancel the posted version of the ANMJ contact your state or territory branch. Please refer to the directory page of this edition for your branch contact details.
SYDNEY LOCAL HEALTH DISTRICT
New wristband technology streamlining patient care A Sydney hospital has become the first in the state to roll-out cutting edge wristbands that electronically records a patient’s vital signs and medical data. Under the new system, a patient’s wristband ID is scanned along with the treating clinicians’ ID, with vital signs including blood pressure, pulse, temperature and oxygen saturation all recorded electronically on a computer and instantly transferred to a medical record. The Concord Hospital has pioneered the new technology, which is on trial for three months in its emergency department, and is expected to be adopted by a further 27 hospitals over the next three years. New South Wales Health Minister Jillian Skinner witnessed the new technology in action in late May, including an Electronic Medication Management system (eMM) that streamlines the way anmf.org.au
medicines are prescribed, dispensed, and administered across a hospital. “Technology is changing the way personal clinical data is stored and shared in our hospitals, delivering clear benefits to both patients and staff in terms of safety and efficiency,” Ms Skinner said. The wristband technology will mean staff no longer need to write down vital signs or open a patient’s file on a computer to enter them, saving time and reducing the chance for human error.
Under the eMM, a patient’s medication history is entered into a computer and centrally stored, allowing staff to access it across multiple locations of the hospital at the same time. The eMM aims to reduce the potential for prescription errors due to illegible handwriting and to better co-ordinate a patient’s care. The NSW government has pledged $300 million towards eHealth initiatives as part of its second term. July 2015 Volume 23, No. 1 5
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NEWS NAIDOC Week 2015 celebrates sacred sites All Australians are being encouraged to celebrate local and national sites of Indigenous significance or sacred places for national NAIDOC Week on 5-12 July. The We all Stand on Sacred Ground: Learn, Respect and Celebrate theme celebrates Aboriginal and Torres Strait Islander peoples’ spiritual and cultural connection to land and sea. This year’s NAIDOC theme was also specifically chosen to highlight and celebrate the 30th anniversary of the ‘handback’ of Uluru to its traditional owners on 26 October 1985.
“Lots of places in your local region, your town or your city have traditional names and dreaming stories and we encourage everyone to learn more about their history, their meaning and the extraordinary relationship they have to the traditional custodians,” National NAIDOC Committee Co-Chair Benjamin Mitchell said. www.naidoc.org.au
Carol Friday maternal and child nurse scholarship A Victorian nursing scholarship has been established in the name of Carol Friday, a maternal and child health nurse who was killed along with her son Greig aboard Germanwings flight 4U 9525. Victorian Minister for Families and Children Jenny Mikakos announced the 2016 Carol Friday Scholarship for MCH Nursing Excellence at the recent Victorian Maternal and Child Health Conference. Ms Friday, 68, was a maternal and child health nurse for the City of Casey. The annual scholarship will fund the tuition for one nurse in postgraduate study in maternal and child health at La Trobe University. Minister Mikakos said Ms Friday’s dedication to improving maternal and child health services would not be forgotten. “This scholarship in her name will support other nurses to improve people’s lives, just as she did.” Ms Friday’s husband David and daughter Alexandra, and extended
New standards for midwives to prescribe scheduled meds A new set of national accreditation standards for midwives to be endorsed to prescribe scheduled medicines has been released. The Australian Nursing and Midwifery Accreditation Council (ANMAC) last month released a new single set of standards that replaced two previous sets for midwives to be competent to prescribe medications. The new standards have been approved by the Nursing and Midwifery Board of Australia. anmf.org.au
family were at the conference to hear the announcement. Carol Friday’s brother, Malcolm Coram told the ABC his sister was “a unique and compassionate person who always welcomed and accepted others no matter their background.” Victorian Association of Maternal and Child Health Nurses’ President Kim Howland said the scholarship was fantastic both to remember Carol and for the profession. “Certainly Carol’s death has had a profound impact on the maternal and child health community. It was quite tragic. It has been sad for the profession. Even people that didn’t know her were affected. I knew people would be empathetic and feel for the family but the outreach has been amazing.”
Education providers of a program that leads to endorsement for scheduled medicines for midwives are now only required to meet the one set of standards – ANMAC Accreditation Standards Programs Leading to Endorsement for Scheduled Medicines for Midwives (2015). The newly revised accreditation standards were developed through an extensive review process guided by an expert advisory group, ANMAC Chief Executive Officer Clinical Professor Fiona Stoker said. Key stakeholders included the ANMF, Australian College of Midwives and Council of Deans of Nursing and Midwifery.
Ms Howland said Carol’s students were particularly affected. “Carol was very actively involved in her work and community.” Ms Mikakos announced further measures for the sector, including a new innovation fund and a principal maternal and child health nurse position to provide leadership and expert policy advice. Applications for the 2016 Carol Friday Scholarship open in September.
“It is part of a broader process of assuring the community that, having completed an accredited program, professional practitioners have achieved outcomes agreed to by the profession and can practise safely with the necessary foundation knowledge, professional motivations and essential skills,” Professor Stoker said. ANMF Senior Professional Officer Julianne Bryce said the review had streamlined the process for midwives and education providers. “It means that midwives can provide comprehensive care to pregnant and birthing women in this country, including safe prescribing.” For more information, visit: www.anmac.org.au July 2015 Volume 23, No. 1 7
NEWS Online career pathways for nursing A new online tool is available on the ANMF website for registered training providers to provide educational and career pathways for healthcare workers and nurses.
The Nurse Pathways Project maps current and proposed pathways from workforce entry levels starting at Certificate III (entry levels) to Diploma of Nursing (EN) and Bachelor of Nursing (RN) programs. The project has been developed by the ANMF, Community Services & Health Industry Skills Council, and Australian Government Department of Industry. “We basically worked with the government to provide training providers with a free toolkit that gives them a complete set of tools to be able to put together recognition of prior learning (RPL) for those students who may want to do a diploma or a bachelor of nursing,” ANMF Federal Education Officer Jodie Davis said. “It creates a pathway to encourage Cert III or IV nurses to progress in nursing and makes that relatively seamless for them.” The Recognition of Prior Learning Assessment Toolkit for HLT51612 Diploma of Nursing is free for access and consists of: assessor guide; student guide; unit mapping; forms and templates; and workplace guide. “Recognising students’ attained skills and knowledge is integral to ensuring pathways to careers in nursing and aged care,” Ms Davis said. Pathways for nursing roles were presently fractured between the higher education sector and VET sector and the Health and Community Training Packages, she said. “There is a pressing need to develop effective systems for development of pathways for workers to gain knowledge and skills; and for employers to develop a workforce that meets the needs of consumers of their service.” Ms Davis said assessors working with the nursing profession 8 July 2015 Volume 23, No. 1
and aged care sector should be aware of current industry drivers such as the significant shortage of nurses and aged care workers projected in the future. “There is a need to attract people into the health and community sectors as these sectors will be competing with others for staff in the future.” The Diploma of Nursing units of competency have nine knowledge and skill sets: communication; healthcare systems; transcultural approaches; anatomy and physiology/pathophysiology/ health terminology; infection control principles; planning and delivery of healthcare; legal and ethical frameworks for practice; interventions and management of client care; and management of healthcare needs across the lifespan. Student pathways into the Diploma of Nursing (Enrolled Division 2 nursing) will vary. Although there are nine unit clusters in the RPL toolkit, all clusters may not be required for all students, Ms Davis said. Students may have already gained competency in areas of study in aged care; home and community care; disability; Aboriginal and/ or Torres Strait Islander primary healthcare; and basic healthcare. “RPL recognises that people gain skills and knowledge in paid and unpaid working roles, as well as in activities such as informal training, hobbies or volunteer work,” Ms Davis said. “If that process shows they already hold relevant skills and knowledge, they might not be required to complete some units of competency of a training program. “Assessors should not be limited by the electives in the resource and suggest elective units that relate directly to a student’s work roles,” she said.
Building nursing and midwifery voices in Parliament South Australian nurses and midwives attended historic moments in state Parliament this year in recognition of the professions. South Australian Member for Elder and Registered Nurse and Registered Midwife Annabel Digance moved motions in Parliament for annual recognition of both International Day of the Midwife on 5 May and International Nurses’ Day on 12 May. Nurses and midwives were invited guests to Parliament House on both occasions to sit in the gallery, listen to the motions and MPs’ discussion, followed by lunch and time to chat with SA Minister for Health Jack Snelling. The motion to congratulate SA nurses for their dedication and professionalism and the pivotal role they played in the advancement of all South Australians’ health was unanimously passed. An ANMF South Australian member, Ms Digance said recognition of the events in Parliament was validation of the professions and connected them more closely with government in yet another forum. “Building nursing and midwifery voices is paramount to ensuring the direction of healthcare in this country. We need to regain our territory and not let those who have never worked in our profession to continue to drive our profession.” Ms Digance said she saw advocacy as one of her many roles as an MP. “Nurses and midwives must be heard and this is one way it can be done.” “As nurses we must take charge of our profession to directly influence government and policymakers, management and economists on healthcare and the needs of those who use our healthcare system,” she told the SA Parliament. “Achieving quality care at reduced cost requires leadership by nurses to ensure this change is cost effective, care effective and safe. Knowledge and understanding by nurses of the processes and mechanisms of health financing is fundamental to our leadership and advocacy for health equity and universal health coverage. I urge us all to acquire knowledge in this area.” Recent lobbying against a proposed plan to relocate level six of the neonatal intensive care unit of Flinders Medical Centre to the Women’s and Children’s Hospital was an example Ms Digance cited as leadership.
MIDWIVES ON THE STEPS OF PARLIAMENT HOUSE
anmf.org.au
NEWS Nurses working in detention centres face prison if speak out
No cents in cashing out annual leave
Nurses working in immigration detention facilities could face prosecution and imprisonment of up to two years if they speak out, under new Commonwealth legislation.
In agreeing to a proposal by national employer groups, Australia’s Fair Work Commission has given the green light to employees cashing out their annual leave. The peak national workplace relations tribunal made the decision last month as part of its scheduled four year review of modern awards. Under the changes, cashing out annual leave is now possible should employers and employees come to a mutual agreement. The shift was triggered by the commission’s view that cashing out annual leave was a common feature of many enterprise agreements it approves and that evidence indicates a “significant demand” for a provision which enables accrued leave to be cashed out. The commission maintained any potential for the new rules to have a detrimental effect would be nullified by several safeguards inserted into standard clauses. Primarily, safeguards include capping the amount of annual leave that can be cashed out at two weeks per year, and drawing attention to general protections against undue employer influence. To qualify to cash out, a person must have accrued at least eight weeks’ annual leave. The Australian Council of Trade Unions (ACTU) and several other unions, including the Australian Nursing and Midwifery Federation (ANMF), opposed the changes on the grounds of their ability to undermine the purpose of annual leave. But its views were not considered valid. ANMF Senior Federal Industrial Officer, Nick Blake, labelled the decision disappointing. “It runs completely counter to what the purpose of annual leave is. “It will put pressure on people who struggle to take their annual leave, like nurses and midwives, because they just can’t get away from the workplace or because they’re so short staffed, to cash out their accruals.” Currently, under the nurses and midwives’ award, nurses and midwives working normal hours receive five weeks’ annual leave, while nurses performing shift work are granted six weeks. Mr Blake said it was important for nurses to use annual leave for its intended purpose and take proper respite periods. “It will be attractive to some to trade off leave you can’t take,” he said. “But the fact is, people should be able to take their leave. They should be required to take leave in our view, and have proper rest periods.” Mr Blake also warned the new changes could spark further problems down the track if significant amounts of people cash out their leave. He believes the prospect could potentially arm the employer with a justification to argue the current amount of leave people receive is inflated.
Under the Australian Border Force Act, it is a criminal offence, punishable by imprisonment of up to two years, for any person working directly or indirectly for the Department of Immigration and Border Protection to reveal to the media or any other person or organisation anything that happens in detention centres like Nauru and Manus Island. Australian Lawyers Alliance Greg Barns said any departmental workers or contractors would have to subscribe to an oath. “It is possible that the oath will prevent individuals such as doctors and nurses, as well as organisations such as the Salvation Army, United Nations and Amnesty International, from fulfilling their ethical and professional obligations to report physical and mental harm.” Flinders University School of Nursing and Midwifery Associate Professor Linda Starr, a mental health nurse and lawyer, said while there had previously been innuendo and confidentiality clauses preventing health professionals from speaking out about conditions in detention centres, there had been no law behind it. “If nurses are categorised as health professionals under the Act, and I think it is broad enough, then they could face fines and
Reprieve for rehab unit A Tasmanian rehabilitation unit in Launceston has had a reprieve with $10 million of federal funding halting its impending closure. The John L Grove (JLG) Launceston Rehabilitation Centre will stay open for another two years after a late funding pledge by Prime Minister Tony Abbott. It followed action by the ANMF Tasmanian Branch, staff and community to gain government attention, including industrial action, rallies, and an e-petition which had just reached 1,300 signatures before the announcement. “This is a huge win for the northern Tasmanian community and JLG staff,” ANMF Tasmanian Branch Secretary Neroli Ellis said. anmf.org.au
imprisonment within the Act; certainly any disciplinary action would no doubt send them off to the tribunal.” The legislation would silence healthcare professionals who were then not meeting their duty of care and ethical obligations for regulatory requirements, she said. “From a humanitarian point of view, it denies victims the right to getting justice. For the perpetrator, it condones behaviour.” An open letter from former and current medical staff, teachers and social workers at the Nauru detention centre was signed and released to the Australian public in April. In it, the workers condemned the Australian Government and the Department of Immigration and Border Protection as aware of sexual and physical assault of women and children on Nauru for at least 17 months. The workers could be charged and prosecuted under the new legislation, Mr Barns said. The Australian Medical Association (AMA) passed an urgency motion at its recent national conference requesting the government to amend the Act to exempt medical practitioners from prosecution who disclose in the public interest, failures in healthcare delivery in immigration detention centres. The 20 bed rehabilitation unit has treated slow stream rehabilitation patients over the past 18 months through $16.2 million of federal government funding. Funding was only for the refurbishment of the state-owned building and initial staffing setup costs, Ms Ellis said. Ongoing state or federal government funding was always going to be needed when the agreement expired on 30 June. The JLG had helped free up beds for the acute wards of the LGH for surgical cases and reduced pressure on the emergency department, Ms Ellis said. Closure of the rehabilitation unit could have also seen a loss of frontline nurses and hospital assistant positions. The ANMF Tasmanian Branch has sought commitment from the state government for funding for 2018 and beyond.
July 2015 Volume 23, No. 1 9
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POSTGRADUATE DEGREES INFORMATION SESSION Deakin University School of Nursing and Midwifery invites you to an information session to hear about our innovative postgraduate degrees: • Diabetes education • Midwifery • Perioperative care • Intensive care • Cardiac care • Critical care
• Interventional cardiac nursing • Emergency care • Nursing Practice • Nurse Practitioner • Perianaesthesia care • Research degrees
Melbourne Burwood Campus, 221 Burwood Highway Burwood. Building BC, Level 2. Tuesday 8 September, 5.00–6.30 pm. A short presentation will begin at 5.15 pm after light refreshments. There will be an opportunity to move to breakout rooms with course leaders to discuss specific courses and answer your questions. To register your attendance at the information session please email nursinfo@deakin.edu.au. For more information 9244 6102 deakin.edu.au/nursing Deakin University CRICOS Provider Code: 00113B
NEWS Disaster preparedness provided in a postgrad degree A new postgraduate degree in disaster health is being offered for the first time in Australia. The Master of Disaster healthcare, offered by South Australia’s Flinders University in partnership with the National Critical Care and Trauma Response Centre (NCTRC), will be an opportunity for disaster relief professionals to expand their knowledge and preparedness and response capability for local and national disasters.
The Dean of the University’s School of Nursing and Midwifery and Program Head, Professor Paul Arbon said the unique program filled an important gap nationally because Australia and the region were increasingly impacted by disaster events caused by substantial human and economic damage. “As a nation, Australia is very active in disaster
relief both overseas and within our own borders, and the newly introduced Master of Disaster healthcare will give more health professionals adequate qualifications to deliver first class aid in times of crises.” For more information about the course go to: www.flinders.edu.au/ courses/postgrad/dhc/
with a focus on improving midwifery skills. She stayed at Armidale Hospital up until her retirement at age 66 and then moved to Canberra. After a life spent serving others, Beryl continued in the same fashion by taking up a role as a volunteer at the Burrangiri Respite Centre. “Well I thought I’ve got to do something and I was enjoying meeting and helping people. It was the nearest thing I could do to nursing.” Beryl ended up volunteering at the aged care facility for almost two decades and only gave it up last year. However she said she still pops in once a week to say g’day to the staff and residents. Asked to name the highlights of her nursing and midwifery career, Beryl said it had all been a privilege. “Oh, there’s so many things. It’s really intricate. Talking to the mums and the pregnant women and the babies. There were so many different facets of it. It was very demanding and interesting.”
Other Order of Australia Medal recipients across the country for service to nursing and midwifery included: Catherine Birrell, Victoria, for service to nursing, particularly to education and the community. Ms Birrell was the Group Director of Nursing at St John of God Healthcare from 2006-14 and undertook a range of nursing roles at St John of God Hospitals from 1963-1990. Marjorie Yvonne Batchelor, New South Wales, for service to nursing and international outreach programs. Mrs Batchelor was a Senior Theatre Nurse and Theatre Nursing Supervisor at the Sydney Adventist Hospital for 20 years. She was heavily involved in working overseas in outreach programs in Nepal. Mary Therese Williams, Queensland, for service to nursing as an advocate and spokesperson for post-natal depression, and as a mental health administrator and clinician. Ms Williams has been the Clinical Unit Manager at the Brisbane Centre for Postnatal Disorders, at the Belmont Private Hospital.
PHOTO: COLLEEN PERTH
A career in nursing and midwifery fit for a queen Receiving an Order of Australia Medal in the 2015 Queen’s Birthday Honours for service to agedcare and midwifery education in developing countries prompted a characteristic response from the modest Beryl Connah.
“It means a lot because I feel grateful that my life hasn’t be useless,” she said of the honour. On inspection, the life and career of 91-year-old Beryl has been anything but useless, with her education work within midwifery and volunteering in aged care making a profound impact. Beryl began training as a nurse during World War I and then deviated into the stream of midwifery. “I thought it would complete my nursing,” she said. “During my training I did do five weeks’ night duty on the maternity ward. That probably put me onto it.” Beryl became a nursing and midwife educator before being offered a job in Nigeria, West Africa, in 1960, working in various hospitals to teach young women the ins-and-outs of delivering babies. She ended up staying 11 years and describes it as a challenging experience in a bustling environment where 1,000 babies were being delivered per month. “I found it very challenging. The girls I was training, their basic training in education was very poor. We had a lot of basic training to do for them before they could do their midwifery. “The girls that we got came mainly from small villages and towns. People had put money together to pay for their training so that they would go back to the villages or towns and practice, which is what I encouraged them to do.” Beryl moved to Australia in 1971 and began work as a nurse educator at the Armidale Hospital in New South Wales, anmf.org.au
July 2015 Volume 23, No. 1 11
Chat with our Director of Studies on 0448152345 or +613 9455 4458
“I was quite junior when I became an Associate Nurse Unit Manager and essentially the Graduate Diploma was pivital in my obtaining that promotion� Professional Development - www.appdcc.ihm.edu.au Postgraduate - www.ihm.edu.au/course-offerings Online | Domestic | Overseas | Offshore CRICOS Provider Number: 03407G ABN: 19155760437
NEWS Maternal risks remain higher for Indigenous women
Queensland nurse and son win bid to remain in Australia
Indigenous women are dying at twice the rate than nonIndigenous women from complications of pregnancy, an Australian Institute of Health and Welfare (AIHW) report has found. The recently released report, Maternal deaths in Australia 2008-2012, also showed that there were a total 105 deaths from complications of pregnancy and child birth overall in Australia during the five year period. “This number equates to the death of one woman for every 14,085 women giving birth in Australia, giving a maternal mortality ratio of 7.1 deaths per 100,000 women said AIHW spokesperson and lead author of the report, Professor Michael Humphrey. The maternal mortality rate of Aboriginal and Torres Strait Islander women 13.8 deaths per 100,000 women who gave birth compared to 6.6 deaths per 100,000 non-Indigenous women,
said Professor Humphrey. “Deaths due to cardiac conditions and psychosocial causes have been the most prominent in Aboriginal and Torres Strait Islander women over the period 2000 to 2012. The increased risk of death in Indigenous women remains a major concern.” The leading cause of direct maternal deaths for Indigenous and non-Indigenous women included obstetric haemorrhage (11 deaths), thromboembolism (10) and hypersensitivity complications of pregnancy (9). “The leading cause of indirect maternal death was cardiac disease and deaths due to psychosocial morbidity (related to mental health and substance abuse issues),”Professor Humphrey said.
Western Australian nurses could be given police powers The Western Australian government is investigating a proposal that would see mental health nurses join police officers on the beat as part of co-response teams tackling crisis situations. The move could allow nurses the power to stop and search someone, and possibly restrain and move people on. The proposal was developed following discussions between Western Australian Mental Health Commissioner Timothy Marney and Western Australian Police Commissioner Karl O’Callaghan. Both parties have been driven by an objective to ensure people experiencing a mental health crisis are treated from a health perspective, rather than just a justice one. Western Australian Mental Health Minister Helen Morton backed the idea of cooperative police and nursing response teams attending matters which may involve a person in crisis, such as mental illness or druginduced psychosis. anmf.org.au
“The intention is to ensure that an appropriately skilled clinical perspective is brought to the situation to de-escalate and, when appropriate, triage and treat,” Ms Morton said. The government is still yet to legislate the changes but a decision is expected in coming months. Ms Morton said the development would bring change one step further to decriminalising mental illness. “I believe it’s important to investigate ways we can treat people with mental illness who are in crisis situations. “The intention is to also take pressure off the police who currently transport these individuals to hospital emergency departments and have to wait for them to be treated, tying up valuable police resources.”
A Townsville nurse facing the prospect of being deported because her 10-year-old son’s autism was deemed a financial burden on the health system has been given a repreve. Registered nurse Maria Sevilla’s lengthy fight to remain in Australia appeared lost in March when the Migration Review Panel rejected her request for a Skilled Regional Provision visa on the grounds that Tyrone’s condition would result in a significant cost to the Australian government. The rejection backed the original decision handed down by the Immigration Department. With the support of friends, family, and the Queensland Nurses’ Union (QNU, ANMF Queensland Branch), Maria launched a Change.org petition calling on Federal Immigration Minister Peter Dutton to overrule the decision. Following increased public support towards her plight, including more than 125,000 signatures to the petition, Minister Dutton ordered the deportation decision be overturned in late May. The process is expected to be finalised shortly. “Just hearing the news there’s some relief knowing that we can stay here permanently,” Maria said. “The hardest part was the waiting part and being unsure of what was going to happen. Everything was in limbo.” Maria, who moved to Australia from the Philippines in 2007 to pursue a nursing career and works in the rehabilitation ward at the Townsville Hospital, said being forced to leave the country would have meant she and Tyrone would have had to start their lives over again from square one. Maria praised the assistance of the QNU throughout the campaign to stay in Australia. “I didn’t feel that I was alone with these problems,” she said. “Without them I don’t think I would have been able to survive.” “It was really overwhelming,” she added of the wider public support. “Not just the signatures. We have local doctors that have set up a trust fund for Tyrone and things like that. I think we’re really lucky.” Despite the approval of permanent visas, Maria is still nervously waiting to receive the final documentation in her hands. “I guess I feel back to our routine. But still in the back of my mind, I’m still thinking about the official grant letter from the Minister,” she said. “Everyone was congratulating me, but it would be premature of me to celebrate at this stage.” Maria described Australia as a wonderful country with a terrific culture and great lifestyle.
July 2015 Volume 23, No. 1 13
WORLD
Protect nurses on frontline says ICN The International Council of Nurses (ICN) has reissued a call for increased safer working environments for frontline nurses. It followed a World Health Organization (WHO) report showing more than half of the 815 healthcare workers infected by the Ebola virus since onset of the epidemic were nurses and nurse aides. Two thirds of the health workers infected have died. The statistics reinforced the need for vigilance, as well as the need for safe working environments for well-prepared healthcare numbers in sufficient numbers, ICN’s Chief Executive Officer David Benton said. “The devastating numbers of nurses who have lost their lives shows there is clearly an essential need for significant strengthening of safety policies, and the provision of adequate protective
equipment and appropriate training.” Health workers were 21-32 times more likely to be infected with Ebola than adults in the general population, according to the report. While nurses accounted for more than 50% of all health workers infected, doctors and medical students accounted for 12% and laboratory workers and trade and elementary workers 7% each. WHO noted that Ebola “has exacerbated the pre-existing shortage of health workers, high rates of attrition, uneven distribution, poor employment conditions and gaps in occupational health and safety in the three countries – Guinea, Liberia and Sierra Leonne”. WHO also issued advice to healthcare workers caring for people with Middle East Respiratory Syndrome (MERS) following the recent outbreak in the Republic of Korea. Healthcare workers, including nurses, were urged to protect themselves from being exposed to patients’ droplets when providing care to those with MERS symptoms. Over 1,300
people were quarantined and more than 200 schools closed in the initial outbreak, the largest reported outside the Kingdom of Saudi Arabia, where the disease first emerged in April 2012 and where the vast majority of cases have occurred. “It is not always possible to early identify patients with MERS. All healthcare facilities should have infection prevention and control practices in place,” WHO advised. The Republic of Korea’s first case was confirmed on 20 May, a national with a recent history of travel to four countries in the Middle East. He had sought treatment for MERS symptoms at two outpatient clinics and two hospitals, which created multiple opportunities for exposure among healthcare workers and other patients, WHO warned. Most MERS human cases reported had resulted from human to human transmission in healthcare settings. WHO expected more cases to be reported from the Republic of Korea as the ANMJ went to print.
New challenges in a global healthcare environment By Marnie Hitchins An Australian nursing academic has highlighted the importance of leadership education for student nurses as they accept increasing responsibilities and face new challenges in the world healthcare environment. James Cook University (JCU) Deputy Dean of Research and Centre for Nursing and Midwifery Research (CNMR) Director Professor Jane Mills spoke at last months International Council of Nurses (ICN) conference in Seoul on the topic, exploring global trends in nursing and midwifery education. Professor Mills said the ‘big picture’ of global nursing and midwifery education was dominated by three issues – globalisation and cultural diversity in the health workplace; increased scope and variety of nursing practice; and the rise of interdisciplinary team-based healthcare. “Fifty, 40, even 30 years ago, nurses would not have talked about ‘exploring global trends’. Our ‘worlds’ were much smaller then,” explained Professor Mills. “We could walk or drive just about anywhere within them within an hour or two. Here we are now, in 2015, meeting in South Korea, all flying in, tweeting 14 July 2015 Volume 23, No. 1
CENTRE, JANE MILLS
or teleconferencing in from different corners of the globe. “The pace of change in our world is staggering. And in this filled-to-the-brim era, we rarely seem to have the time to stop and think about just how much has changed in such a short time. The question for nursing educators is, ‘How do we to keep up with it all?’.” Professor Mills proposed that the answer to this complex and multifaceted question of keeping up with the rate of change might be simpler than it seemed at first glance. And the answer might lie in focused leadership education for all nurses. Nurses graduating in 2015 need to be self-aware, effective at communication and people management, and capable of thinking critically; essentially they need to be good leaders as well as
competent nurses. As noted by several recent reviews, commissions and inquiries, such as the Future of Nursing project in the United States and the Willis Commission in the United Kingdom, Professor Mills also said it was time to talk in earnest about practical ways of making interdisciplinary education work for all health professions, particularly nursing. Professor Mills said creating opportunities to educate health professionals together (instead of completely discipline-specific degrees) would foster the interdisciplinary collegiality and cooperation needed for success in the healthcare systems of the future. Marnie Hitchins is a Research Officer at James Cook University anmf.org.au
INDUSTRIAL
Parliament to examine the link between migration and employment of local graduates Nick Blake, Senior Federal Industrial Officer Nick Blake
More information Go to anmf.org.au for further information about this story and further industrial information.
anmf.org.au
The Australian Parliament is once again examining the various migrant work programs, on this occasion specifically looking at the impact of the programs on the labour market and whether changes are necessary to improve the employment opportunities for Australian citizens and, if so, how could this be achieved. The Parliament has called for interested organisations to provide their views on these matters. The ANMF provided a submission which is available at: http://anmf. org.au/documents/submissions/ ANMF_Submission_The_impact_ of_Australias_temporary_ work_visa_programs_on_the_ Australian_labour_market.pdf In a country such as Australia, that has historically embraced migration, it remains challenging to ensure the rights of migrants and Australian citizens have a degree of balance, fairness and certainty and that adequate protections existing for all parties. For its part the ANMF has always supported the movement of nurses and midwives. Both professions have a strong tradition of international collaboration, the nurses and midwives moving around the globe to gain further training and different clinical experiences. There is also clear merit in international exchange and diversity, as well as the economic benefit of remittances and transfers in technology. Our union continues to favour permanent migration but recognises there is a place for temporary skilled migration programs to meet short term and unforseen skilled shortages. Our acceptance and the need for temporary skilled migration is based on the firm view that appropriate policy and regulatory settings should discourage employers accessing offshore labour without first investing in training of local workers, undertaking genuine testing of the local labour market and that there are safeguards for protections for both local and overseas workers. In
practice, this means that the ANMF wants employers to be required to genuinely look locally for their nursing and midwifery labour before going offshore. While the ANMF continues to support migration, our union, along with most nursing and midwifery professional and regulatory authorities, are increasingly concerned of the negative impact the high numbers of temporary migrant workers are having on the employment opportunities of domestic graduate nurses and midwives.
by an ANMF survey of graduate nurses and midwives who had successfully completed their studies in 2014. The survey found that over a third of graduates were jobless and those who did find employment worked casually and wanted more hours. Unfortunately the questionnaire responses revealed a number of standard responses by employers who utilise temporary migrant labour to new graduate applications that included: • no offer of employment due to
lack of experience; • without completion of a
OUR UNION CONTINUES TO FAVOUR PERMANENT MIGRATION BUT RECOGNISES THERE IS A PLACE FOR TEMPORARY SKILLED MIGRATION PROGRAMS TO MEET SHORT TERM AND UNFORSEEN SKILLED SHORTAGES.
It is the ANMF’s view that the deregulation of temporary migrant worker programs, which have effectively gifted employers with the ability to employ as many offshore nurses and midwives they wish, is reducing the employment opportunities for local graduates. And while it remains difficult to accurately determine the exact impact of these programs, the number of temporary migrants with work rights is rising at a time when thousands of nurse and midwifery graduates continue to complete their degrees only to face unemployment, underemployment and job insecurity. This was confirmed in early 2015
‘new graduate program’ can’t get work; • lack of jobs available for new graduates; A more comprehensive report on the questionnaire forms Attachment 4 to the ANMF submission referred to above. While migration is not the only reason that graduates find it difficult to secure employment, it remains a fact that the ongoing inability of large numbers of new local graduates to find work is unfair, it represents a structural barrier to effective workforce planning and, may have serious consequences for the provision of care in the years ahead. The ANMF considers the failure of our economy to provide work for new graduates at a time when employers continue to access large numbers of nurses and midwives on temporary work visa arrangements demonstrates a disconnect between the current policy environment that makes possible access to offshore labour when an Australian worker is not available to fill a position and the available supply of new graduates to our health, aged care and community services industries. While maintaining our support for permanent migration we will be urging the Parliament to support appropriate changes to regulation that would strengthen the requirement for employers to utilise local workers, including new graduates, before going offshore. July 2015 Volume 23, No. 1 15
FEATURE
RED CROSS AID WORKER AMANDA MCCLELLAND FIGHTING EBOLA IN A RED CROSS FIELD HOSPITAL IN KENEMA, SIERRA LEONE. PHOTO: TOMMY TRENCHARD/AUSTRALIAN RED CROSS
16 July 2015 Volume 23, No. 1
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FEATURE
MISSION
POSSIBLE AUSTRALIAN NURSES AND MIDWIVES STRENGTHENING DEVELOPING COUNTRIES
Every year, countless nurses and midwives travel to all corners of the globe to provide healthcare relief to countries in need. The effort is empowering both visiting health professionals and local staff to deliver positive health outcomes for the future, writes Robert Fedele.
I
t is the year 2012 in the Maban County of South Sudan. The region sits on the north-east point of the country and holds several refugee camps. Some 40,000 refugees have just fled armed conflict in Sudan’s Blue Nile, crossing the border to the White Nile and out of danger. Australian nurse Monica Burns has arrived on deck as part of a team from medical humanitarian aid organisation Médecins Sans Frontières ( MSF) (Doctors Without Borders). A makeshift hospital is assembled in a tent and the task begins. Facing limited resources, and hazards like the rainy season to grapple with, the unit is a hive of activity. “Very seldom did you get the chance to take a breath,” Monica recalls. “I was there for three months and in those three months I was able to see the mortality come down and help institute some basic public health interventions, like making sure everyone had clean water and trying to improve the sanitation and neonatal care.”
anmf.org.au
At home in Australia, Monica specialises in paediatrics and works in the intensive care unit at the Royal Children’s Hospital in Melbourne. Her pathway to globetrotting humanitarian was first established when at university. In 2010, after completing bits and pieces of charity work with non-government organisations, she joined MSF. Altogether she has completed seven missions across five different countries. The scope of Monica’s contributions working abroad have largely been determined by the crisis at hand. From responding to a measles epidemic in Malawi to floods in Pakistan and civil uprising in Yemen, Monica has tackled most things. “I found MSF’s ideals really appealed to me,” she explains. “I identified with this idea of populations in distress and no one coming to help.” Another reason for her continued involvement, Monica adds, is the unbiased policy the organisation follows. “We’ll help people on both sides of the conflict.
Sometimes you can find yourself in quite difficult circumstances having to separate the fighting forces. But I really like that we’re open to everyone. Anyone who is in need of help, we will help.” Monica is among a band of Australian nurses and midwives making a tangible difference working overseas in countries where healthcare is precious. Aside from building bonds with other like-minded people, Monica suggests one of the biggest incentives is the opportunity to use her trained paediatric skills in a foreign environment with next to nothing. “One of the biggest challenges is realising the limits of what you can in fact do because sometimes you can be in a situation where the need is so great that you have to choose your task and do it wonderfully well because you can’t do everything.” Monica’s most recent mission took place last year in Liberia during the Ebola outbreak. She is already planning to undertake another field assignment July 2015 Volume 23, No. 1 17
FEATURE
NO OF RED CROSS ASSIGNMENTS SOUTH SUDAN
11
SIERRA LEONE
8
LIBERIA
4
AFGHANISTAN
2
SOMALIA
2
JORDAN, LEBANON, MYANMAR, NEPAL, PHILIPPINES, UKRAINE
1
45
A TOTAL OF 45 AUSTRALIAN RED CROSS NURSES HAVE BEEN SENT ON ASSIGNMENTS IN THE PAST 12 MONTHS
THE LARGEST NUMBER OF NURSES HAVE WORKED IN SOUTH SUDAN IN THE PAST YEAR.
104 THERE ARE 104 NURSES ON THE AUSTRALIAN RED CROSS AID WORKERS REGISTER.
in the next month. “Well the world doesn’t seem short of disasters,” she says, when quizzed on why she keeps going back. “Every time I think I’ll stay home and complete my masters or something like that, there seems to be another disaster that crops its head up. Being able to help is a strong motivation for me to go again.”
Working in a war zone Working overseas presents unique challenges, and the inherent dangers of working in conflict zones is something registered nurse Dr Helen McCue identifies with first-hand. In the early 1980s, Dr McCue was a young nurse who quickly developed a desire to do more. In 1981, she was recruited by the World Health Organization as a nurse consultant in The Middle East, working alongside a team of nurses to develop research tools and evaluate practices in Pakistan, Jordan, and Bahrain. A year later Dr McCue was seconded from WHO to work for the United Nations Relief and Works Agency (UNRWA) as part of a group looking after Palestinian refugees in Lebanon. The bulk of the effort focused on providing maternal and child healthcare. In June 1982, Israel invaded Lebanon and they worked with and empowered Lebanese Christian militia who carried out a massacre of over 2,000 men, women, and children, in a Palestinian refugee camp in Beirut. The incident shocked and horrified Dr McCue and triggered her resignation. “I felt the United Nations had failed in its principal mandate to protect those refugees who were directly under their care and administration,” she recounts. Along with a handful of other foreign nurses, Dr McCue returned and worked as a volunteer in the camp where the massacre had played out. “We were nursing patients who’d had really horrific injuries, both physical and psychological,” she says.“The camp itself was very tense because people were very frightened that there would be another massacre.” The gravity of the situation still resonates with Dr McCue today, who remembers young children being killed after unwittingly picking up cluster bombs. “One of my most vivid memories
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is nursing a young girl who’d had her leg blown off. We had little pain relief so wound dressings were exceptionally painful and traumatic. Her young brother had picked up one of these cluster bombs and brought it inside the house and dropped it on the ground. Both her pregnant mum and the little boy were killed and she tragically lost her leg.” Her experience in these refugee camps inspired Dr McCue to establish Union Aid Abroad APHEDA – in 1984, the Australian Council of Trade Union’s overseas humanitarian movement. “During my time in the camp I observed that international teams came and provided support but then once the emergency was over, they would often leave. It was apparent to me that one of the most critical things was the lack of assistance to enable people to get back to their jobs or to develop skills to help them cope with the changed circumstances. In other words, to help people resume normal life.” Union Aid Abroad- APHEDA has multiple projects around the world in countries including Cambodia, Loa, Vietnam, East Timor, Indonesia and South Africa. It concentrates on worker skill training schemes in education and health, and long-standing food production and agricultural projects. Dr McCue last returned to the Middle East in 2010 and is noticeably disappointed that many of the circumstances and conflicts she witnessed decades ago are persisting. “Over four million Palestinians remain refugees with the majority still in camps 66 years later and the ongoing conflict in Gaza means that thousands of these refugees are killed as Israeli bombs or drones or tanks continue to attack the camps and in the process also destroy APHEDA’s vitally important agricultural projects. “It’s a failure of the international community to address a situation that’s been going on for 66 years. International law continues to be violated and the Palestinians still don’t have a state and continue to live in a situation of great uncertainty.” Union Aid Abroad-APHEDA celebrated its 30th anniversary last month and Dr McCue, who still volunteers with the organisation,
“SOMETIMES YOU CAN FIND YOURSELF IN QUITE DIFFICULT CIRCUMSTANCES HAVING TO SEPARATE THE FIGHTING FORCES. BUT I REALLY LIKE THAT WE’RE OPEN TO EVERYONE. ANYONE WHO IS IN NEED OF HELP, WE WILL HELP.” MONICA BURNS
“OUR MAIN FOCUSES AT THE MOMENT ARE AROUND EDUCATION, HEALTHCARE, AND PROVIDING OPPORTUNITIES FOR YOUNG AUSTRALIANS TO EXPERIENCE THE WORLD AND FIND WHAT IT IS THAT THEY’RE PASSIONATE ABOUT IN LIFE AND BRINGING THAT EMPOWERMENT BACK INTO THEIR OWN LIVES.” CINDY ANGEL
anmf.org.au
FEATURE
CLOCKWISE: MONICA BURNS IN SOUTH SUDAN, NOLA HENRY, LAUREN DUNNE AND MONICA BURNS
says she’s proud of the achievement. “I have enormous admiration and respect for the many people who have worked so hard and given so much of themselves to our organisation and who have through our many union supported projects helped hundreds of thousands of workers across the globe to live and work in dignity.”
Progress is possible Another organisation making an impact is leading not-for-profit outfit World Youth International (WYI). The international development organisation was founded in 1988 and helps facilitate volunteer opportunities for Australians in Kenya, Nepal, and Peru. An Overseas Action Program is open to young people aged between 18 and 30 and runs for five weeks, with a team of around a dozen volunteers guided by a Team Leader. The program focuses on sustainable, community-driven development projects that might involve construction, education, or training. From a health perspective, the organisation’s Nurses in Action Program offers skilled health professionals of all ages the chance to challenge themselves with a month-long stint working overseas in under-resourced medical clinics and hospitals. World Youth International’s Education Manager, Cindy Angel, has been anmf.org.au
involved with the organisation since 2007 after undertaking the Overseas Action Program in Cambodia and then visiting the organisation’s primary and secondary school in Nepal. “World Youth is all about empowering people through education and achieving equality,” Ms Angel says. “Our main focuses at the moment are around education, healthcare, and providing opportunities for young Australians to experience the world and find what it is that they’re passionate about in life and bringing that empowerment back into their own lives.” Ms Angel says WYI’s main healthcare efforts currently concentrate on the Odede community of Kenya. The locals have worked closely with WYI for many years and a community centre was built through the Overseas Action Program. Now the focus has shifted to health. “Once the community centre was completed the community actually sat down and said what they really needed desperately was healthcare in the local vicinity. The nearest healthcare centre was kilometres away and just impossible for people to get to. It particularly had an impact on maternal health.” WYI worked tirelessly over the past two years to turn the community centre into a health facility. After opening in March 2013, the community health centre treated 6,333 patients up until November 2014, as
well as delivering 241 babies safely. It also vaccinated 961 children and tested 74 people for HIV. “We’re really proud to say that now the hospital is registered as a level 3 in Kenya through the government. It’s also been registered through the national insurance scheme, which means the services we’re able to provide are broader reaching.” On return from the Nurses in Action Program, all participants have the opportunity to undertake a four-day Personal Empowerment Program (PEP) designed to reflect on the experience and help support re-entry back into normal life.The emphasis is upon triggering inner growth. “We have so many people come back inspired to stay engaged with this kind of work and just wanting to do more with their time, whether that be in a domestic or international capacity. They come back with a lot of energy and a lot of inspiration and what PEP does is help refine that.”
Cultivating leaders Registered nurse and midwife Lauren Dunne signed up for the Nurses in Action Program in Kenya in 2013, the first of its kind in the country, and helped set up the community health centre in Odede. “Basically, we had a blank, empty room, and a shipping container full of donations from Australia. We had to set it up to look and run like a hospital,” Lauren says. July 2015 Volume 23, No. 1 19
FEATURE “It was very different to what I expected. I think people who go overseas to volunteer think it’s going to be really intense and you’re going to see crazy things and it’s going to be really acute and critical, but it was very different to that. “It was a lot of basic health education, hand hygiene and water sanitation, sexual health, and maternal and child health. Plus empowering the community so that they participate and connect with the hospital and use it because many of them haven’t accessed any healthcare because it’s too far away or expensive.” Lauren works as a midwife in the birthing suite at the Royal Darwin Hospital. She became interested in joining WYI after hearing a positive experience from a colleague. Lauren found her experience in Kenya so rewarding she returned last year as a Team Leader to run two of her own assignments. “I fell in love with the people and the village and the staff there and I just wanted to see how the hospital had grown,” she says. “It was amazing in the two months how much it had changed. For the first month I was there for that initial trip we delivered one baby and then when I was there just the past year, the birth rate had gone up and they were delivering between 15 and 30 babies a month, which is fairly huge for the population of the village.” Lauren points out that working overseas is not simply about fixing problems, but rather about creating longterm change. “We don’t just go over there and take over. We try to work with the staff and they have a lot to teach us as well because in Australia we don’t really deal with malaria and things like HIV as much. Both parties definitely learn.” Lauren has undergone two Personal Empowerment Programs as part of WYI and believes the sessions helped her pinpoint both personal and career goals. “I never would have applied to go back as a leader if not for PEP,” she says.“I thought I wasn’t the right type of
person to manage people and have that leadership role.” From her experience Lauren says she discovered she was quite a directive leader. “I know what I want and how things need to be done and how to do it effectively. [But] I identified that I possibly need to listen to other people’s opinions more when making some decisions.” In October, WYI will send its first ever Nurses in Action Program to Nepal. Lauren has already planned to head over as a part of a similar team early next year. She readily admits she has become a more grounded person as a result of volunteering overseas and a much better communicator. “I learnt a lot from the Kenyan people and the people in the village. They have a really positive outlook on life. Professionally, it’s helped me. I’ve come back and I’ve started team leading in the delivery suite up at the Royal Darwin Hospital. It gives me that confidence, that I’ve led people before.”
Fighting Ebola Another Australian making inroads on a global scale is Australian Red Cross aid worker Amanda McClelland. Speaking on the phone from Red Cross headquarters in Geneva, Switzerland, Amanda is still locked in the grip of fighting the Ebola outbreak, with new cases cropping up on the GuineaBissau border. “It’s a bit disappointing this week,” she says. “We were really close (to going down to zero cases) two weeks ago but now we’ve had a big increase in cases in the last week. So we’ve just sent a new team in to try and make sure the cases don’t infect a new country. “The numbers are quite low. We’re talking about 30 cases a week but we had got it down to nine. The fight’s far from over. Ebola’s shown us that if we relax even a little bit it comes back very quickly.” To date, the Ebola epidemic has killed more than 10,000 people in West Africa. Amanda was at the forefront of the Red Cross’ mission to battle the highly infectious disease that starts
with symptoms including a sore throat and fever and escalates to internal and external bleeding. At the peak of the emergency she was responsible for 6,000 volunteers at a treatment centre in Liberia. About 25 Australian nurses joined the effort after the Australian Nursing and Midwifery Federation lobbied the federal government to allow them to serve. “It was kind of like the chaos of the first four weeks of an earthquake,” Amanda says. “We were driving home and you could see dead people on the street. This was everything that you start to see at the beginning of those horror movies. It was quite scary.” Hurdles included reducing stigma associated with the disease, and convincing locals of the enormity of the situation. A prime example was instituting safe burials in communities in the north of Sierra Leone and Guinea, where families traditionally wash and prepare the body following death and spend considerable time with it. In the beginning, several important community members died and the practice is believed to have caused hundreds more cases of Ebola. To force change, aid workers had to win the trust of numerous communities. “We’ve achieved that with communities affected in March and April but it’s almost like we have to start again every time the epidemic moves,” Amanda says. “At the moment we’re literally doing the same thing we were doing last year but in a different community in a new area trying to explain why they need to change. “It has massive implications. Many of the communities feel like their relatives will never transition to the next stage of spiritual ascension. So it’s a big request.” Amanda worked in paediatrics at the Royal Children’s Hospital in Brisbane during her early years. Later, she headed up to Alice Springs to work in emergency and paediatric departments before moving onto the field of rural remote
LAUREN DUNNE PERFORMING CHILD AND MATERNAL HEALTH CHECKS, MONICA BURNS IN MALAWI
20 July 2015 Volume 23, No. 1
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FEATURE
“IT WAS OBVIOUS THAT INTERNATIONAL SUPPORT TEAMS COME IN AND PROVIDE SUPPORT BUT THEN ONCE THE EMERGENCY IS OVER, THEY WOULD LEAVE. IT WAS APPARENT TO ME THAT ONE OF THE MOST CRITICAL THINGS THAT WASN’T HAPPENING WAS HELPING PEOPLE TO GET BACK TO THEIR JOBS AND HELPING PEOPLE DEVELOP SKILLS.” DR HELEN MCCUE
“WE WERE DRIVING HOME AND YOU COULD SEE DEAD PEOPLE ON THE STREET. THIS WAS EVERYTHING THAT YOU START TO SEE AT THE BEGINNING OF THOSE HORROR MOVIES. IT WAS QUITE SCARY.” AMANDA MCCLELLAND
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medicine within Aboriginal communities. “The Aboriginal communities are really very challenging and a lot of people ask me how did you get into international work and it’s very similar in terms of context. Working with communities closely to address health needs and trying to find innovative ways to engage with the community and improve health status.” Amanda’s first mission with the Red Cross took place in the conflict zone of South Sudan in 2004. “It was funny because I was joining the Red Cross and like everyone I wanted to save the world and essentially I spent 12 months teaching people to wash their hands under a tree every day,” she explains. “It really changed the perspective I had in terms of how you could impact health. The simplest actions can have a bigger impact. We were seeing kid’s die of diarrhoea and communicable diseases and simple things like providing clean water and hygiene promotion actually had a massive impact. It’s not always about fixing the bullet wounds or about re-setting broken bones.” Amanda has remained in the field since that first mission and has since taken on various roles responding to all types of disasters and emergencies. Currently, she’s in charge of emergency health and coordinates operations from headquarters, travelling to large-scale missions when required. Ebola is still a major priority, as is dealing with a cholera outbreak that requires moving a population from Burundi to Tanzania. The Red Cross is also highly engaged in Nepal, where it runs four hospitals. Amanda was one of four Australian nurses awarded the prestigious Florence Nightingale Medal last month, an accolade which recognises courage and devotion to victims of armed conflict or natural disaster. The medal was awarded to 36 nurses from 18 countries around the world. Amanda plans to return to Australia in the next few years and expects to use her leadership skills to improve Aboriginal and general public health. “It’s very rewarding and I love it,” she says.“The main thing is the challenge. Every day is different. For me, it’s a combination of being able to use my nursing skills and knowledge with community engagement and public health and coming up with innovative ways to meet those difficult challenges in some of the most inaccessible areas in the world.”
Risk and reward It’s a sentiment echoed by Red Cross colleague and fellow Florence Nightingale medal winner Nola Henry. The Victorian registered nurse suggests overseas placements, and even remote opportunities locally, offer a great training ground for Australian nurses. Currently, there are 104 nurses on the Australian Red Cross aid workers register. In the past year, 45 Australian Red Cross
nurses, sourced from backgrounds that include ward nurses to operating theatre nurses, took up assignments overseas. Countries most in need of healthcare include Nepal following the earthquake, the Middle East because of ongoing conflicts, and Africa due to disease outbreaks. “We have a very good opportunity in Australia to prepare well for this kind of work and to work outside the major urban areas in rural or remote parts,” she says. “You’ll be challenged in different ways to if you just remain in the urban setting. In this line of work, if you go overseas to these more disadvantaged places, you obviously don’t have the same health structures around you.” Nola previously worked for the Royal Flying Doctors before being drawn to the Red Cross movement. Her first mission was a nine-month deployment in South Sudan supporting the government run hospital, with a focus on surgical work and establishing a paediatric program. “It’s a small international team that’s usually in these support roles working very closely with local staff. You’re guests in their country and their hospital and you’re trying to enhance their own capacity to deal with things that come along.” Over the years, Nola has travelled to various countries and learned to deal without having medications and supplies on tap. One of her most rewarding experiences was working as part of mobile surgical teams, which consist of a ward nurse, surgeon and anaesthetist, in Sudan. The unit works on request, with people injured in conflicts sending out a distress call for adequate medical care. “It’s not like calling an ambulance and within a short time you’ve got help,” Nola says. “On average it takes about five days from receiving the call to being given the green light to arrive.” Nola says the team treated people at health structures, if there were any, or makeshift areas like tents or even under a tree. The team could be out in the field for three weeks before having to return for supplies. Injuries Nola dealt with included gun-shot wounds, mine injuries, and burns victims. “You go in expecting to find wounded people,” she says. “If you’re working in a hospital in any situation you’re going to have people that don’t survive.” Nola says working in isolation in unpredictable environments gave her the chance to challenge herself every day. She makes a point of highlighting that developing countries often have a shortage of doctors and paramedics, so the responsibility often falls to nurses. Nola says the people in these communities are looking to you to help strengthen their own health service. “It’s enhancing people’s abilities to manage for themselves,” she says. “The greatest reward is if a project can close. That it’s reached a stage where people are able to manage on their own.” July 2015 Volume 23, No. 1 21
REFLECTIONS BALLARAT HEALTH SERVICES, MIDWIFERY TEAM WITH THE QUILT.
Celebrating midwives creatively By Belinda Moore The idea of creating a quilt for display in Ballarat Health Services’ Maternity Unit in Victoria came to surface during a staff lunch break one day in April 2014. About 15 years ago midwives on staff at the time created a quilt, which can still be viewed in the entrance to the birthing suite today. Since then many more just as creative staff have joined the midwifery team at Ballarat Health Services and so it was thought time to create another quilt to display in Ballarat Health Services’ Maternity Outpatients Department. The quilting project idea was launched appropriately on International Day of the Midwife 5 May 2014. A group of 23 interested maternity staff volunteered to work on a beautiful design from a Melbourne quilter, Irene Blanck, who held a quilting workshop for those of us contributing to the quilting project. The blocks that made up the content of the overall quilt came from two midwives’ personal fabric scrap supplies at home. Once the fabric was sorted the blocks were packaged up and delivered to each of the 23 maternity staff members who wanted to work on this quilt. Over the next four to five months we all worked on our own blocks. It was so inspiring to see each completed block when handed back as we came to realise just how talented our colleagues were. Once the blocks came in a few of the quilt contributors got together to piece together the original quilt design. Several staff also worked on putting the borders 22 July 2015 Volume 23, No. 1
together. There were so many beautiful examples of fine team work in the production of this quilt, just like when we work as a team in our maternity unit for the women utilising our services. The idea of incorporating the four seasonal trees into the quilt design came from one midwife who didn’t want to complete a block as she wasn’t a quilter or any other kind of sewer. The idea of these four trees was to include a little about what the maternity unit does on a daily basis, which is care for childbearing women. The four trees represent the cyclical nature of childbirth with each of the four trees representing autumn, winter, spring and summer. The quote that is found intertwined in one of the borders of the quilt came from the theme of the 2014 International Day of the Midwife – “midwives changing the world one family at a time”. A local quilter from Ballarat, Kerryn Brand, was very kind to complete the wording for our quilt, which further connects the quilt to our profession and clinical setting. Then came a day that was one of joy, but also sadness. Literally as one of the more experienced quilt contributors was finishing off the main section of the quilt, Jo Gilbert, who supported the launch of this quilting project, tragically passed away. So it was decided that the quilt would be dedicated to Jo to say thanks for the many clinical projects that she made happen for the maternity services we continue to deliver to the women of Ballarat and the Grampians. The quilt came together more beautifully than imagined. Everyone
was delightfully surprised at everyone’s talents. We then had to decide how we were going to display this amazing masterpiece. The finished product deserved much more protection than on a simple hanger. So we contacted the Ballarat East Community Men’s Shed where we were greeted by an enthusiastic group of men who could see the value in protecting our quilt as much as we did. Nothing was too much for this community group, particularly for Richard Giles who custom built with his own hands the frame to display our quilt that complimented our quilt magnificently. Richard also went the extra mile to arrange a local glazier business to cut and fit glass to complete the frame and further protect our quilt. There was no better time than an International Day of the Midwife to celebrate this quilt and thank all those that helped us with producing it. So from one International Day of the Midwife to another we celebrated the unveiling of this quilt during International Day of the Midwife week, May 2015. During this celebration we recognised all that midwives do for childbearing families around the city of Ballarat and the Grampians region, while also acknowledging the kind expertise from those who guided us with producing this amazing quilt. Although the celebration of this quilt was during just one week of May, as we walk past this amazing quilt in the Maternity Outpatients Department every day we are constantly reminded by why we continue to do what we do as midwives for women and their families.
Belinda Moore is a Registered nurse-midwife and Diabetes Nurse Educator at Ballarat Health Services anmf.org.au
ISSUES
Nurses – are we disaster ready? By Dr Sara K Geale and Professor Christine Duffield Australia is not considered by most to be a disaster prone country. However, in January 2009, 347 people were killed by extreme temperatures; in 2010 175,000 people were affected by floods; in 2013 13,000 people were affected by floods and 98,000 by bush fire. Heat waves and flooding will not only continue in Australia but are likely to increase (UNISDR, 2014). More importantly, there are increasing concerns that Australia has been and will continue to be a probable target for acts of terrorism (Allard, 2014, Owens, 2014, Mullins, 2011). With an increased potential for disasters it is timely to ask whether the Australian hospital system and nurses in particular, are adequately prepared. Auf der Heide (1989) in his seminal work argued that disasters are not simply ‘big’ emergencies (Auf der Heide, 1989). Disasters are unusual occurrences and systems developed to deal with them are infrequently used, not well practised, and often less understood than the systems in place that deal with day-to-day operations. But when a disaster occurs our population has an expectation that healthcare facilities will provide the necessary care to help the injured and infirmed (Furin, 2014). Hospitals must plan for both internal and external disasters and staff must have defined roles and responsibilities for both (The Australian Emergency Handbook on Disaster Health 2011). Without plans and procedures to deal with an unexpected influx of patients and without sufficient training in these systems and processes hospitals and hospital staff will face challenges in providing safe and effective care. A disaster presents unique problems for hospitals. In a disaster the demand for healthcare far outweighs the potential to meet this demand (Hogan & Burstein, 2012). Disasters require a move from normal operating procedures to procedures developed specifically to deal with situations. For example, wards and ICUs need a plan in place to free up beds for new admissions. Operating rooms need to be prepared for an unprecedented number of emergency surgeries. Transportation needs to be arranged for the transfer of patients to other facilities so that disaster victims can utilise the beds. Pharmacies need to support increased demands for medications for pain relief, anaesthesia, resuscitation, and infection. Labs and radiology, supply and sterilisation units, hospital kitchens and engineers, to name a few, are all impacted by an unplanned surge in activity that occurs during a disaster (Hamdan, 2012; Sorensen, et al. 2011). The literature anmf.org.au
References: Allard, T. (2014), Al Qaeda terrorist threat to Australia, The Sydney Morning Herald, 1 February. Arbon, P., Cusack, L., Ranse, J., Shaban, R., Considine, J., Mitchell, B., et al. (2011). Understanding the willingness of Australian emergency nurses to respond to a disaster. Adelaide: Flinders University.
indicates that Australian hospitals are not adequately prepared for a disaster response (Rosenfeld et al. 2005). The nursing workforce in Australia comprises the largest proportion of employees within hospitals (AIHW, 2012; Health Workforce Australia, 2013) and therefore, they are at the forefront of any disaster response. A 2011 study from Flinders University showed that Australian emergency nurses have a willingness to participate in disasters if given the appropriate training (Arbon, et al. 2011). However, studies also show that training programs are lacking and remain ad hoc, and disaster education courses is not well addressed in the Australian undergraduate nursing curriculum. A 2011 study (Hammad et al. 2011; Ranse, et al.; Rokkas et al. 2014) demonstrated that in hospital Australian education courses for nurses on disaster preparedness are inconsistent in their content and lack the practical application of disaster response skills (Ranse et al. 2013). With our increasing risks for disaster it is imperative that Australian hospitals ensure that their workforce is adequately prepared to respond to disaster situations, understand their ‘new’ role in hospital operations should a disaster occur, and constantly review hospital policies and procedures to ensure internal processes and systems are in place and functional. As nurses we need to be proactive in supporting the provision of disaster training to all staff and we need to encourage our hospitals to regularly evaluate their capacity to manage a disaster across the disaster continuum from resilience to recovery.
Auf der Heide, E. (1989), Disaster Response Principles of Preparation and Coordination, C.V. Mosby Company, St. Louis, Missouri. Australian Government Australian Emergency Management Institute (2011), Australian emergency management handbook, available at: https://ema.infoservices. com.au/ collections/ handbook (accessed 4 December 2014). Australian Institute of Health and Welfare [AIHW] (2012), Australian hospital statistics 2011-12: emergency department care, Health services series no. 45. Cat. no. HSE 126, available at: www. aihw.gov.au/WorkArea/ Download Asset. aspx?id =10737423039 (accessed 4 December 2014). Furin, M. (2014), Disaster Planning, Medscape, 28 April. Hamdan, F. (2012), The role of hospitals in disaster management, Human & Health, Vol. 18, pp. 4. Hammad, K.S., Arbon, P., & Gebbie, K.M. (2011), Emergency nurses and disaster response: An exploration of South Australian emergency nurses’ knowledge and perceptions of their roles in disaster response, Australian Emergency
Dr Sara K Geale is in the School of Nursing and Midwifery at Edith Cowan University
Health Workforce Australia (2013), Australia’s health workforce series – Nurses in focus, available at: www.hwa. gov.au/sites/uploads/ Nurses-in-FocusFINAL.pdf (accessed 4 December 2014).
Professor Christine Duffield is the Director, Centre for Health Services Management (UTS) and Professor of Nursing & Health Services Management UTS and Edith Cowan University
Hogan, D. E. and Burstein, J. L. (2007). Basic Perspectives on disaster in Hogan, D. E. and Burstein, J. L. (Ed.) Disaster Medicine. 2nd ed. (pp. 1-12) Philadelphia: Lippencott.
Mullins, S. (2011), Islamist terrorism and Australia: an empirical examination of the home-grown threat, Terrorism and Political Violence, Vol. 23 No. 2, pp. 254-285. doi:10.1080/ 09546553.2010.535717 Owens, J. (2014), 150 Australian jihadis pose terror threat if they return home: Julie Bishop, The Australian, 19 June. Ranse,J.,Hammad,K. & Ranse,K. (n.d.) Future considerations for Australian nurses and their disaster educational preparedness: a discussion Ranse, J., Shaban, R.Z., Considine, J., Hammad, K., Arbon, P., Mitchell, B. & Lenson, S. (2013), Disaster content in Australian tertiary postgraduate emergency nursing courses: a national survey, Australasian Emergency Nursing Journal, Vol. 16 No 2, pp. 58-63. Rokkas P, Cornell V, & Steenkamp M. (2014), Disaster preparedness and response: Challenges for Australian public health nurses - a literature review, Journal of Nursing Health and Science, Vol. 16 No. 1, pp. 60-6. doi: 10.1111/ nhs.12134 Sorensen, B., Zane, R., Wante, B., Rao, M., Bortolin, M. & Rockenschaub (2011), Hospital emergency response checklist, available at: www.euro. who.int/__data/assets/ pdf_file/0020/148214/ e95978.pdf?ua=1 (accessed 4 December 2014). Strydom,E. (2015, May 3). NSW floods: Communities still cut off, 11 rescued, as weather eases after two days of heavy rain. ABC News. Retrieved from www.abc. net.au United Nations Office for Disaster Risk Reduction (UNISDR) (2014). Disaster Statistics retrieved from www. unisdr.org 20 June 2014.
July 2015 Volume 23, No. 1 23
RESEARCH
Tonnes of medicine wastage costs millions Nurses are being asked to educate patients on completing prescribed courses of treatment and not to hoard medication. Research released last month shows more than 600 tonnes of medicines are discarded in Australia each year. The research, published in Australian Prescriber, was based on an audit of medicines returned through the National Return and Disposal of Unwanted Medicines (NatRUM) program which collects drugs to prevent them ending up in landfill and waterways. The annual cost to taxpayers is an
Social media to combat youth drinking Exaggerated ‘boozy’ Facebook profiles exacerbate drinking habits in young people while correcting misperceptions can halve drinking rates, research shows. University of Sydney researcher and psychologist Dr Bradley Ridout said inflated drinking habits and ‘party animal’ status on social media was giving young people a false impression of the amount their friends drank and what was ‘normal’. “The more drinking is depicted as socially desirable on Facebook, the more it perpetuates an online culture that normalises binge drinking,” Dr Ridout said. “The truth is that most young people who drink usually do not do so at risky levels.” The researchers used Facebook to deliver personalised private messages to a group of first-year university students identified as risky drinkers. The messages compared the individual’s drinking habits to those of their classmates and pointed out incorrect assumptions about their friends’ drinking levels. Results found those who received feedback on average, halved their drinking from 40 to 20 drinks per month and sustained this three months later. Co-author Dr Andrew Campbell said alcohol advertisers already used peers to promote their messages. “If we want to shift the culture around binge drinking in Australia we should follow their lead and leverage the share-ability and peerto-peer nature of Facebook for future alcohol strategies.” The study is published in Drug and Alcohol Review. 24 July 2015 Volume 23, No. 1
estimated $2 million for the 31 most frequently discarded medications dispensed under the Pharmaceutical Benefits Scheme (PBS). The three most discarded medicines in Australia are salbutamol, insulin and frusemide. Paracetamol was the eighth most commonly discarded medicine, probably due to large quantities dispensed under the PBS, according to the researchers. Monash University’s Centre for Medicine Use and Safety in Melbourne, Dr Phillip Bergen said the true cost of discarded drugs was likely to be higher as the quantity disposed of in household rubbish bins was unknown. “The audit shows how hoarding and non-adherence are contributing to waste,” he said. “Patients need to be educated about returning unwanted
medicines to pharmacies so the drugs can be disposed of through RUM bins for the wider potential benefits to the environment and society.” The audit found more than 85% of discarded medicines were scheduled drugs. Prescription medicines subsidised by the PBS made up about 70% of medicines discarded. About 44% were still within their expiry date. “A huge concern with the widespread emergence of antimicrobial resistance is the high return rate of antibiotics combined with the dwindling development of new antimicrobial drugs,” Dr Bergen said. Health professionals should consider prescribing the smallest pack size of a medicine at the start of therapy, he said. www.australianprescriber.com
ED increase due to ageing population Three quarters of a hike in Western Australian emergency department admissions is due to the growing, ageing population, research shows. The study, published in Emergency Medicine Australasia, examined seven years of data from all public hospitals across Western Australia. It found ED attendances had grown by 4.6% a year, outstripping an annual population growth rate of 3.3%. “We’re seeing more people who are older, sicker and have more complex disease,” report author Professor Daniel Fatovich said. “This is placing increased demand on emergency departments and hospitals.” While WA’s mining boom and population increase had been expected to have impacted on ED demand, the demographic and behavioural trends that underpinned the increase were the same as that across the rest of Australia, according to the authors. “These results can be generalised to the whole of Australia,” Professor Fatovich said. The findings contradicted that demand transfer from primary care was responsible for an increase in ED admissions. “What we need is an integrated system-wide strategy to ensure access, quality and sustainability of our system. This is especially important because this increase is mainly in patients with complex care needs,” Professor Fatovich said.
Wound ulcer recruits needed Research is underway to determine whether aspirin can improve the healing rates of venous leg ulcers in older adults. More than 260 people from wound clinics around Australia are needed for the study, led by Monash University. Lead researcher, Dr Carolina Weller, said current best practice involved compression bandaging therapy however 30-50% of venous leg ulcers (VLUs) remained unhealed after two years, and recurrence was common. “Two small studies previously suggested that aspirin can improve healing rates and decreases recurrence and we plan to look at that further,” she said. The study will involve 12 weeks of standardised, weekly compression therapy in combination with 12 months of taking either 300mg of aspirin or a placebo. Participants must be over 40 years, not taking routine aspirin, with a leg ulcer for more than six weeks in the presence of chronic venous insufficiency. The study will be completed by December 2017. For more information, visit: www.med.monash.edu.au/sphpm/aspivlu-study.html anmf.org.au
ETHICS
Rationing universal healthcare
Megan-Jane Johnstone
MeganJane 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.
References Asch DA & Ubel PA. 1997. Rationing by any other name. New England Journal of Medicine, 336(23): 1668-1671. Keast K. 2015. Medicare under threat: the Americanisation of Australia’s health system. Australian Nursing and Midwifery Journal, 22(9): 25-29. O’Callaghan G., Meyer H., & Elshaug A. 2015. Choosing wisely: the message, messenger and method. Medical Journal of Australia, 202(4): 175-178. Tilburt JC & Cassel CK. 2013. Why the ethics of parsimonious medicine is not the ethics of rationing. JAMA, 309(8): 773-74.
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Governments with universal healthcare systems are increasingly bemoaning the costs of their systems and the need to contain these costs if affordable healthcare services are to be sustained into the future. In a bid to reduce the costs of healthcare, politicians and bureaucrats have championed the need for reform. Although avoiding the language of rationing, the kinds of ‘reforms’ being championed (eg. greater government regulation of universal health coverage, reducing reimbursement for medical costs, cutting funding to public hospitals) seem however, to be more concerned with restricting universal healthcare coverage, rather than reforming it. The rhetoric of healthcare reforms has also had a political ideological objective shifting the provision of and accountability for public healthcare services to private sector providers. This objective has been pursued despite experts warning that such a shift will ultimately lead (and in some cases has already led) to inequities and unjust disparities in access to healthcare and related health outcomes, especially in vulnerable populations who cannot afford private health insurance. Australia has not been immune from ideologically driven machinations about the sustainability of its universal healthcare scheme, ie. Medicare. Despite health expenditure in Australia reportedly reaching a record low for the period 2012-2013, there has been a political campaign of spreading false and misleading information about Medicare’s sustainability (Keast 2015).This misinformation has included ‘blaming’ vulnerable populations (eg. an ageing demographic, the ‘undeserving poor’) for their allegedly disproportionate overutilisation of public healthcare services and the need to curb this costly ‘wanton’ demand. What has been overlooked in this situation, however, is that a key driver of the spiraling costs of healthcare is not the over-utilisation of services by people in need, but rather ‘the use
of wasteful tests and treatments’ prescribed by doctors (Tilburt & Cassel, 2013) together with the rising costs of drugs (driven by the business behaviours of the pharmaceutical industry) and medical technology, particularly in hospitals. Also overlooked is the problem of language and the tendency to treat the terms ‘healthcare’, ‘hospital care’, and ‘medical care’ as being synonymous, when they are not. Failure to distinguish what each of these terms refers to unnecessarily muddles debate about what healthcare reforms are needed as well as where and how these should occur.
David Benton, ICN Chief Executive Officer, contends that because nurses are the single largest group of health professionals they ‘can have an enormous impact on reducing health costs and increasing quality of care’ (www.icn.ch/). In light of this, the ICN urges all nurses and policy makers to ‘focus on the nursing role as a key priority and determinant for achieving equity, delivering universal health coverage and ultimately improving health outcomes globally.’ To aid in this task, the ICN has prepared a toolkit for examining ‘the current issues around health system financing and the value of nursing’ (available at: www.icn.ch/).
Rationalising healthcare
Question of nursing ethics The ethics of healthcare rationing has been the subject of debate for decades. This debate has primarily rested on the issue of whether it is ever acceptable to ration healthcare and, if so, on what grounds. It has also prompted unresolved controversies about the interests of individuals versus the collective interests of society in accessing limited healthcare resources and how best to balance these competing interests. Meanwhile, those working at the intersection of health policy and ethics have attempted to persuade pundits that the issue should not be about rationing and compromise, but about justification and appropriateness (Asch & Ubel 1997). In other words, it should be about rationalising (justifying) healthcare, not rationing (arbitrarily restricting) it. Here the question arises: What stance should the nursing profession take in response to this vexed issue?
Taking a stance In 2015, the theme Nurses: A force for change - care effective, cost effective has been adopted for International Nurses Day. In a media release announcing this theme,
Achieving equity, delivering universal health coverage and ultimately improving health outcomes is going to require a collective effort on the part of a range of stakeholders, not just nurses. It is also going to require much more than a ‘Choosing Wisely’ campaign (soon to be launched in Australia – see O’Callaghan et al. 2015), the aim of which is to encourage doctors to engage in ‘parsimonious medicine’ and to make better treatment choices, reduce risks and, where able through prudent decision making, reduce costs (Tilburt & Cassel, 2013). As argued previously in this column (ANJ 2010, April & August issues) what is also required is a cultural revolution in thinking about: the values of health and healthcare, ageing and death, the kind of reform that is required to ensure a healthcare system that is responsive and well-coordinated to meet the needs of current and future generations, and whether the solutions being proposed by authorities will be effective and just. The nursing profession needs to think deeply about these issues. Meanwhile, it is incumbent on nurses in Australia to campaign to promote, protect and preserve Australia’s Medicare scheme. This includes taking collective action to: affirm the value of Medicare, expose the misinformation that is being spread about its sustainability, interpret attacks on it as unfair, and to discredit official channels that are distorting the issues at stake in favour of progressing an ideologically driven agenda for dismantling universal health coverage in Australia and dismissing its humanitarian objectives. July 2015 Volume 23, No. 1 25
EDUCATION
I DID THEN WHAT I KNEW HOW TO DO. NOW THAT I KNOW BETTER, I DO BETTER.” - Maya Angelou
Education through Self-directed Learning By Jodie Davis, ANMF Federal Education Officer We start learning from the minute we are born. Formal learning begins at school where we are given the fundamentals for the framework of education, from there we may choose to continue on to another education institution to specialise in a field of interest. However, education is not limited to that obtained through educational institutes, it continues throughout our lives in many forms. This includes self-directed learning, which is said to begin at the point where institutional education ends. There are so many education options available to us now such as those found in universities and vocational institutes, through distance education, offered by workplaces and those we access online. The options continue to increase daily. As healthcare professionals, we are expected to be competent in our practice, this includes skills, knowledge, attitude and values and means that we must continue to learn to ensure we maintain currency in our practice. The healthcare sector is experiencing major changes due to extensive research and development. There are new medical breakthroughs, the threat of emerging diseases, pharmaceutical discoveries and/or healthcare innovations daily. As nurses and midwives play a crucial role 26 July 2015 Volume 23, No. 1
in the delivery of healthcare, we need to embrace new and innovative techniques to provide effective and best possible treatments to our patients. To adapt and respond to these changes it is essential that we engage in continuing professional education. Competence in the profession requires that we keep abreast with the latest advances. Continuing professional development (CPD) or education, has very important implications for the public, as recipients of care. They have a right to access practitioners who possess contemporary knowledge, skills and abilities appropriate to their area of practice. By enhancing the existing skill set of healthcare professionals through access to relevant, accurate and current information, patient care only improves. In the long term, knowledge gained through CPD benefits both the patient and the healthcare professional. It is through education, including self-directed learning (whether through journals, webinars, videos, mentoring or conducting research, to name a few), that we are able to improve outcomes for our patients, which is, of course, the ultimate goal. By attending conferences and/or seminars, or by reading journal articles, we come in contact with members of our professional community who are, in fact, our colleagues and resources. Through their experience and knowledge, we might be able to shape, guide, and improve our own practice. We know that as healthcare professionals the best way for us to stay informed and provide high quality care and of course, to protect ourselves
professionally and legally, is to constantly engage in relevant professional development. It is without question that evidence-based practice and continued learning improve clinical outcomes. When reflecting on the benefits of CPD it is easy to see why the Nurses and Midwives Board of Australia (NMBA) set the standard for Continuing Professional Development for continued registration as part of their Professional Practice Framework. The NMBA requires us to engage in self-directed learning to achieve our CPD requirement. This means that we must take responsibility for our own learning. To quote Knowles (1975), “In its broadest meaning, ‘self-directed learning’ describes a process by which individuals take the initiative, with or without the assistance of others, in diagnosing their learning needs, formulating learning goals, identify human and material resources for learning, choosing and implementing appropriate learning strategies and evaluating outcomes”. It is also said that through selfdirected learning there are positive outcomes for the learner such as being motivated, persistent, independent, self-disciplined, self-confident and goal oriented. Self-directed learning is guided by self-assessment and this must include assessing ourselves against the NMBA’s National Competency Standards and the National Decision Making Framework, evaluating our performance and determining what improvements are required. Self-assessment should also include reflection, critical incident analysis, peer review and client/resident and anmf.org.au
EDUCATION patient outcomes (ANMF Position Statement – Continuing Competence 2013). The NMBA provides details on their website of the CPD Standard including examples of what constitutes professional development through self-directed learning. The list of relevant activities is quite extensive and includes online and/or distance education which is proving to be very popular with healthcare professionals seeking to enhance their knowledge and skills. The Internet has had a positive effect on education with the ability to readily access online training, distance education and online research. People from all over the world and in any age bracket can now access relatively low cost learning materials and resources. It also has the added advantage of providing the learner with access to contemporary content, as websites, and their information, can be updated or modified at any time, and many times, ensuring currency and inclusion of new advances and developments in the relevant subject area. Online courses provide an opportunity for all age groups and level of professional and/or learner to engage in education. People can now gain knowledge according to their need and time available. Geography is only an issue should it affect access to an internet connection
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or service. Sharing of information is also made easier with email access to content providers or colleagues and through web discussions and social media. It is also believed that visual data has a greater impact on learning and
IT IS ALSO SAID THAT THROUGH SELF-DIRECTED LEARNING THERE ARE POSITIVE OUTCOMES FOR THE LEARNER SUCH AS BEING MOTIVATED, PERSISTENT, INDEPENDENT, SELF-DISCIPLINED, SELFCONFIDENT AND GOAL ORIENTED.
memorising than plain text. Images, graphics, animation, pictures, slides and much more have a greater appeal to the learner than a text only hard copy book. Being able to see an actual picture, photo or video of, for example, a clinical procedure or physical condition, aids in a
deeper understanding of the topic. Online education is also a means by which healthcare professionals can contribute to the ongoing education of their colleagues and patients. Nurses and midwives have a responsibility to provide care but we also have an equal responsibility to educate; it is a vital component of the nursing process. It is also through education that we can further provide care to our patients. Patients can be educated about their disease processes and potential treatment options, and through education, we can play a dynamic role in facilitating patients to be independent in managing their disease or condition. We can also positively influence our family and friends and even our community when we share pieces of knowledge gained through recent learnings. Discussing new developments, innovations and treatments can have a powerful impact on the health and wellbeing of those around us. The World Health Organization states “health education is any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitude”. So keep on learning and developing your skills and knowledge, everybody wins when you do.
July 2015 Volume 23, No. 1 27
CLINICAL UPDATE
In-hospital newborn falls
Need for improved recognition of in-hospital newborn falls By Polly Teuten, Sarah Bolger and Siba Prosad Paul
28 July 2015 Volume 23, No. 1
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In-hospital newborn falls Introduction In-hospital newborn falls can be described as an event when a neonate falls to the hospital floor accidentally, either as a result of environmental factors or errors in judgement of the hospital staff or carer (Phalen and Smolenski, 2010; Paul et al. 2011). In-hospital newborn falls occur at a rate of 1.6 to 4.4 per 10,000 live births (Helsley et al. 2010), however this is likely to be an underestimate given that this remains an under-reported entity. The incidence data highlighted is based on studies from the United States but the findings can be reasonably transferred to the United Kingdom (UK) and other developed countries. A local guideline (from two tertiary maternity units in the UK) released in response to in-hospital newborn falls, has revealed an incidence figure of 15 per 10,000 births (Janiszewski and Lee, 2014). Studies have shown that falls are the most common cause of accidental injury in neonates and children in the community (Agran et al. 2003; Matteson et al. 2013), and many parenting websites provide education and information supporting fall prevention. It is essential that this education be reflected in the hospital environment. The number of studies looking at in-hospital newborn falls is limited possibly due to the perception that the hospital setting is considered to be safe for babies and accidents are highly unlikely to happen. This article aims to increase the awareness of these events and to help prevent and manage these events in the future hospital environment.
In-hospital newborn falls are under recognised It is becoming increasingly acknowledged that in-hospital newborn falls are an underrecognised entity and this is likely to be due to a number of reasons (Helsley et al. 2010; Paul et al. 2011; Matteson et al. 2013): • parental reluctance to report the fall as they may feel guilty or fear a negative response from health professionals; • parental apprehension of being judged about their parenting skills and the fear of social service involvement; • lack of education and understanding about the condition and its serious adverse effects (eg. head injury, skull fracture, rarely death) amongst health professionals; • lack of awareness amongst health professionals about environmental and maternal risk factors that increase the risk of in-hospital newborn falls; • health professionals addressing the issue at ground level and not highlighting the event as a risk management issue; • the lack of a transparent noblame culture, which discourages reporting of these events.
CLINICAL UPDATE
• during delivery → in fast vaginal
deliveries (compounded by a large volume of blood and fluid) there is the risk that the baby may slip through the hands of the health professional assisting the delivery of the baby; • during transport → either in the arms of someone who may trip and fall themselves; or during transport in an insecure cot or an unharnessed baby buggy on an unsteady surface (eg. entering a lift, on a ramp); • the post-partum period → when exhausted mothers (especially from high risk groups) are at risk of falling asleep cradling their newborn.
The majority of these falls are preventable and associated serious outcomes can be minimised. This article further highlights the highrisk groups, clinical presentation, and management of injured neonates after in-hospital falls and provides useful strategies that can minimise such events.
The most common situation where an in-hospital newborn fall occurs is from the arms of a parent who falls asleep holding their child (Monson et al. 2008). This evidence is supported by the fact that most falls generally occur in the early hours of the morning. The most likely scenario is an exhausted mother falling asleep whilst feeding their newborn baby in the middle of the night. Various studies (Abike et al. 2010; Helsley et al. 2010; Monson et al. 2008) have identified maternal risk factors, and these include the information presented in table 1 (see below). In order to minimise in-hospital newborn falls, it is necessary that midwifery and nursing staff remain aware of the high-risk mothers and implement strategies for regular monitoring to prevent falls from occurring.
Situations where newborn falls occur
Management of neonates after the in-hospital falls
In-hospital falls can occur throughout the period the neonate stays in the hospital, however, there are certain recognised situations where this risk is increased:
At present there are no clear guidelines available regarding the management of in-hospital newborn falls and the literature displays significant variability in how
PERINATAL PERIOD
epilepsy
limited mobility due to difficult delivery or caesarean section
diabetes
maternal fatigue
severe obesity
patient controlled analgesia, especially opiod pain relief
depression – on medication with sedative side effects
prolonged recovery following difficult delivery or caesarean section
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Abike F, et al. 2010. A new scale for evaluating the risks for in-hospital falls of newborn infants: a failure modes and effects analysis study. International Journal of Pediatrics. 2010, pp.1-9. Agran PF, et al. 2003. Rates of pediatric injuries by 3-month intervals for children ages 0 to 3 years of age. Pediatrics. 111(6), pp.e683-692. Galuska L. 2011. Prevention of in-hospital newborn falls. Nursing for Women’s Health. 15(1), pp.59-61. Helsley L, et al. 2010. Adverse Events: Addressing in-hospital “falls” of newborn infants. The Joint Commission Journal on Quality and Patient Safety. 236(7), pp.327-333. Janiszewski H and Lee L. 2014. Guideline for the prevention and management of baby falls whilst being cared for in Nottingham University Hospitals. Nottingham University Hospitals NHS Trust. Available from www.nuh.nhs.uk/ handlers/downloads. ashx?id=54771 (accessed 01/02/15) Matteson T, et al. 2013. Preventing in-hospital newborn falls: a literature review. The American Journal of Maternal and Child Nursing. 38(6), pp.356-366. Monson SA, et al. 2008. In-hospital falls of newborn infants: data from a multihospital healthcare system. Pediatrics. 122(2), pp.277-280.
Table 1 PRE-EXISTING MATERNAL HEALTH CONDITIONS
References
Paul SP, et al. 2011. Newborn falls inhospital: time to address the issue. The Practising Midwife. 14(4), pp.29-32. Peaglis C. 2005. A report of the findings of the Royal College of Midwives (RCM) United Kingdom (UK) National Bed Sharing Audit. London: RCM. pp.23-29.
July 2015 Volume 23, No. 1 29
CLINICAL UPDATE
In-hospital newborn falls
In-Hospital Newborn Falls Algorithm (figure 1) In the event of an in-hospital newborn fall:
Minimise further injury and ensure the neonate is away from danger [eg. not lying against a radiator or on a cold floor]
If the baby requires resuscitation, take the baby to the resuscitaire and summon the neonatal team
Immediate assessment of potential injuries and severity of fall by midwifery team, including documentation of vital observations (heart rate, respiratory rate and level of consciousness)
Paediatricians should take a detailed history of the event after ensuring that the neonate is clinically stable
Thorough physical examination should be conducted to assess for signs of: • Fractures: deformity and swellings • Spinal injuries • Soft tissue injuries • Cuts and abrasions • Head injury: change in neurological status
If skull fracture or raised or intracranial pressure suspected liaise with radiology for neuro-imaging.
• Scalp swelling: measure occipito-frontal head
circumference Admission to neonatal unit for regular neurological observations If no injuries detected and neonate is stable, ensure safe transfer back to cot
Commence neurological observations and ensure thorough documentation in patient notes. Use a Body Map to record bruises or skin markings.
Baby requires a minimum of 24 hours of observations after the event. Monitor for further swelling of scalp or change in neurological status.
Update parents explain management plan and provide appropriate reassurance
30 July 2015 Volume 23, No. 1
Report this as a clinical incident and implement measures to minimise further accidents. Highlight safeguarding concerns where necessary.
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In-hospital newborn falls to manage these events. However it is essential that every health professional involved in neonatal care is aware of how to manage the situation if it were to arise. Despite a lack of national guidance, there is a general consensus that in the event of a fall, the newborn requires close observation, frequent reviews and sometimes radiological investigation (eg. CT scan of the brain or skull radiograph) (Ruddick et al. 2010; Paul et al. 2011). Midwives can aid in the management of in-hospital falls by alerting paediatricians immediately after the event, and ensuring that the midwife-in-charge is made aware of the accident immediately. The neonate should be fully examined for injuries and the head circumference should be measured at regular intervals. This will allow monitoring for any swelling that may develop. It is essential to reassess the baby every two to four hours to observe for any drowsiness or deterioration in clinical condition. If this does occur then there is the need for escalation, with radiological imaging of the head and admission to a neonatal unit. It is important to reassure parents and update them regularly about their baby’s health. It is important to note that physical examination may not reveal skull fractures or significant intracranial haemorrhages. A study from Newcastle, UK, involving 11 babies who suffered in-hospital falls, found that although almost all (10) of the 11 babies showed no clinical symptoms of an underlying brain injury, five of these neonates had a radiological diagnosis of a skull fracture (Ruddick et al. 2010). The authors therefore concluded that both the height of the fall or a normal physical examination could not be used as a clear indicator for a potential skull fracture; and radiological investigations should be conducted in cases where there is a suspicion of an intracranial injury (Ruddick et al. 2010). The algorithm on page 30 (figure 1) aims to highlight good practice, and has been drawn from our experience of managing such babies following the accident and the available literature. (Ruddick et al. 2010; Paul et al. 2011; Janiszewski and Lee 2014).
Effect on the neonate The majority of neonates who fall anmf.org.au
whilst in hospital do not suffer serious morbidities in most cases. The range of injuries that can occur from in-hospital falls include no obvious injury; minor bruises and abrasions; skull fractures and severe head injuries requiring neurosurgical intervention (Galuska, 2011). Isolated cases of deaths have been reported following in-hospital newborn falls (Warrington et al. 2001; Helsley et al. 2010) and a delay in reporting of the accident has been noted in these situations. The impact of the fall on a neonate depends on several factors including height of fall, nature of the contact surface and the body mass of the infant (Monson et al. 2008). It is important that health professionals take every case seriously and remain vigilant to escalate clinical care if deterioration in clinical condition occurs.
How to minimise these events from occurring Preventing in-hospital newborn falls should be a priority for every health professional caring for this vulnerable population. Such accidents reflect a lack of awareness and it is necessary to improve knowledge about these events to reduce the incidence of inhospital falls. There is a belief that in-hospital falls do not occur, and this view needs to be addressed to improve the recognition of these events. The majority of in-hospital falls that occur tend to follow a common pattern and early anticipation and active safety measures can minimise these events (Matteson et al. 2013). The suggested methods of reducing in-hospital newborn falls available from the literature, local guidelines and our experience (Monson et al. 2008; Galuska, 2011; Janiszewski and Lee, 2014) include: • nursing neonates in cots along the bedside; • closely monitoring all high-risk mothers and their newborn baby; • regularly measuring the blood sugar levels of mothers with diabetes, and treating any episodes of hypoglycaemia; • conducting instigating regular ward rounds of high risk mothers during night shifts; • providing information regarding fall prevention, along with cosleeping and feeding advice.
CLINICAL UPDATE
The way forward From the available literature and our clinical experience, we believe the following practice points will improve recognition of in-hospital newborn falls: • implementing a no blame culture amongst health professionals and remaining non-judgemental about the event; • early review and investigations and review following the accident; • appropriate reporting of every incident; • clear algorithms for managing these events (refer to figure 1); • dissipation of knowledge about in-hospital falls amongst all health professionals caring for babies in post-natal wards. Midwives can play a key role in educating parents about these accidents, which can be initiated during antenatal classes (Peaglis, 2005). There is the need for a uniform policy, both locally and nationally, in order to minimise these accidents and appropriately manage them if they happen. Although the majority of newborn falls are accidental, it is the duty of every health professional to remain alert to cases where there are any safeguarding concerns. Parents should also be given safety advice to follow at home to minimise these falls in the community, as they are the most common cause of accidental injury outside of the hospital setting.
Conclusion In-hospital newborn falls are an under-recognised and underreported entity, and hence considered to be rare. These events are, however, preventable and it is therefore essential that they be avoided. Following in-hospital newborn falls, these neonates generally are best managed through regular examination, monitoring and reassurance, with early paediatric input. A no-blame culture is essential to ensure parents report these accidents and facilitate appropriate management. Promotion of newborn safety is pivotal to all institutions who care for this population and we hope this article will assist developments in practice and improve the outcome of these accidents. Further study in this area is warranted in order to address this issue more widely.
Phalen AG and Smolenski J. 2010. Newborn Falls: Seeking Solutions for a Never Event. Journal of Obstetric, Gynecological & Neonatal Nursing. 39, pp.S46. Ruddick C, et al. 2010. Head trauma outcomes of verifiable falls in newborn babies. Archives of Disease in Childhood: Fetal and Neonatal Edition. 95, pp.f144-145. Slogar A, et al. 2013. Tracking “near misses” to keep newborns safe from falls. Nursing for Women’s Health. 17(3), pp.219-223. Warrington SA, et al. 2001. Accidents and resulting injuries in premobile infants: data from the ALSPAC study. Archives of Diseases in Childhood. 85, pp.104-107.
Polly Teuten, 4th Year Medical Student, University of Bristol Sarah Bolger, Practice Development Midwife, Western Sussex Hospitals NHS Foundation Trust Siba Prosad Paul, Specialty Trainee in Paediatrics, Year 8, Bristol Royal Hospital for Children
July 2015 Volume 23, No. 1 31
BOOKS
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NURSES OF THE OUTBACK BY ANNABELLE BRAYLEY
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ANZAC GIRLS The Extraordinary Story of our World War I Nurses BY PETER REES
Publisher: Penguin Books
Publisher: Allen & Unwin
ISBN: 978-1-921901-36-2
ISBN: 978-1-74331-982-6
Author and registered nurse Annabelle Brayley describes herself as someone who was more interested in chronicling patients’ lives than knowing their medical histories. In Nurses of the Outback, she brings the outback to life with the stories of 15 people that prove the “inland runs on nurse power”. From some of the remotest and isolated places on earth, she chronicles nursing tales of outback spirit. From Neen, the ‘outback angel’ in Darwin, to Catherine ‘pushing the boundaries’ in Julia Creek, QLD, and Sue’s ‘west coast nirvana’ in Bidyadanga, WA. Brayley showcases the talents of these remote area nurses from attending life-threatening emergencies to patching up pets. Brayley believes true nurses are called to their profession, even though many of them don’t necessarily recognise the initial summons. Brayley collected and edited the stories that appeared in the bestselling book Bush Nurses.
Using diaries and letters, journalist of 40 years Peter Rees, tells the stories through the eyes of the Australian and New Zealand nurses who served on the front in the Great War. Often they worked in appalling physical conditions such as on the island of Lemnos in the Aegean Sea or at primitive medical facilities on the Western front in France. Like the soldiers, nurses left Australia and New Zealand with little idea of their destination with the war being waged in Egypt, Turkey, Greece, France, England, India, Mesopotamia, Africa, Italy, Serbia and Russia. Aside from the conditions, there was the sheer volume of wounded. In three years at Rouen, more than 90,000 patients passed through No. 1 Australian Hospital. As Rees writes, these women were pioneers in the advancement not just of nursing as a profession, but of women’s place in society. ANZAC Girls inspired the sixpart ABC1 TV Series.
32 July 2015 Volume 23, No. 1
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THE SECRETS OF MIDWIVES
LOOKING FOR WONDERLAND
three generations of women; one captivating tale of life, loss and love
Will Alice ever find what she’s searching for?
BY SALLY HEPWORTH
Publisher: e-format Endeavour Press Available: Amazon (Kindle edition)
Publisher: Pan Macmillan Australia
BY JANE AINSLIE
ISBN: 978-1-74353-432-8
In The Secrets of Midwives, Neva Bradley is a thirdgeneration midwife. Unlike her mother who rejoiced in the magic of new, precious life and her grandmother a strong belief in the power of natural birth, Neva’s decision to become a midwife had nothing to do with babies and everything to do with mothers. She is determined to keep the details surrounding her own pregnancy, including the identity of the baby’s father, hidden from her family and coworkers for as long as possible. But in a family of midwives, some secrets are too big to keep hidden. Mother of Oscar and Eloise, Victorian author Sally Hepworth takes readers on a journey into the world of midwifery, pregnancy and family with its ups and downs, heartbreak and love.
Adelaide registered nurse and author Jane Ainslie’s third novel Looking for Wonderland is a politically incorrect comedy about a registered nurse, highlighting issues faced by many Australian nurses. At 44, Alice is a nurse with burnout, a dysfunctional family and a life she knows needs to change. She calls on her two best friends for advice to help her find her Wonderland. While she tries pilates, yoga and Oprah hoping for the answer could it be Dr Botha, the hospital’s infectious disease consultant? A life-changing event may hold the answer. This fiction novel is a light warm-hearted read. The book has been published in e-format and is available across all Amazon sites.
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Education: Part 1
FOCUS
Praxis to practice: academic integrity equals professional integrity Patricia Bromley
For 20 years, nursing has been nominated ‘the most ethical and honest profession’ (Roy Morgan Research, 2014). Why do nurses stand out from other professions? A businessman explained to me once why he liked to employ nurses; they were knowledgeable, honest and reliable, they had fantastic time management skills, were great problem-solvers and paid attention to detail, and they were wonderful leaders and team players. I just about exploded with pride for my profession when I heard him rattle off this list of qualities. So what has this got to do with academic integrity and writing essays? Over the past few weeks there has been a large amount of media attention regarding students employing external sources to write essays. As a lecturer I have often been asked by nursing students; ‘why they need to know how to write an essay; nursing is about doing not writing’. I have also heard comments such as; ‘how does an essay tell how good someone is in clinical practice, someone can be really good at writing but really poor in practice’. Interestingly, you can tell a lot about future nurses by how they manage their academic work. This paper provides a personal view on how academic credibility (and approach taken to academic work) offers insight into professional integrity.
Knowledgeable, honest and reliable
Reference Roy Morgan Research. (2014). Roy Morgan Image of Professions Survey 2014 - Nurses still most highly regarded. Retrieved 20/04/15, from www. roymorgan.com/ findings/5531-imageof- professions- 2014201404110537
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Healthcare professionals need to have knowledge, and to have the capacity to seek new knowledge. The public come to nurses for answers they cannot find from the internet (including Wikipedia and Google). The public look to nurses for professional knowledge. When students use the resources provided and research quality academic sources, this demonstrates they not only are able to use resources to gain knowledge, they have the capacity to research further when the available resources do not provide all the answers. Honesty in an essay is
demonstrated through presenting one’s own work, it is about acknowledging where you sourced the information, and citing your sources correctly. Honesty in academia is demonstrated through maintaining confidentiality in tutorials and respecting differing points of view. It is demonstrated through taking responsibility of work requirements and not blaming others for poor performance. It is demonstrated through reflecting on own work and realistically evaluating where improvements are required. Reliability is demonstrated through being present. Not just physically present in compulsory tutorials, but present in those tutorials and lectures that are not compulsory. Reliability is demonstrated through being present in online discussions, by frequently reading posts from colleagues and regularly acknowledging others contributions. Reliability is regularly submitting work on time.
assessments and examinations, it is also demonstrated in group work, tutorial participation (both face to face and online) and in the day to day management of student life. Attention to detail is demonstrated in an essay through having pride in one’s work, by presenting work to the best of one’s ability, taking time to read and correct for spelling and grammatical errors. Attention to detail in writing reflects attention to detail in clinical practice; it shows that the student cares about their work.
Wonderful leaders and team players
Great problem solvers and pay attention to detail
Academic work often requires students to work in teams. This might be in tutorials, online discussions, as part of an assessment to produce a combined piece of work. A good team player is one who is aware of their own strengths and of the strengths of others in their team. It is demonstrated through negotiating work accordingly, recognising when others are struggling, identifying and supporting the learning needs of others in the group, rather than doing all the work for them because it is quicker and easier. Group work involves different personalities and abilities, good team players and leaders don’t let personalities threaten group cohesion. In summary, it may seem like just another essay or more group work, however, the way students prepare for and deliver their academic work demonstrates so much more than just their knowledge. I wish students all the best for their future studies, and in their chosen professional careers.
In academia students are preparing for clinical practice to developing their critical thinking skills. This is demonstrated not only through the ability to successfully undertake
Patricia Bromley is a Lecturer in Nursing & Midwifery in the School of Health Sciences at the University of Tasmania
Fantastic time management skills Good time management is demonstrated by good preparation; being on time for tutorials, and undertaking the pre-readings and required work, researching literature related to the topics under discussion. A student who demonstrates good time management in academic work is able to juggle three or four assessment items at once, and not leave work to the last minute.
July 2015 Volume 23, No. 1 33
FOCUS
Education: Part 1 JULIA MORPHET
THIS STUDY FOUND THAT EMERGENCY NURSING TSPPS WERE COMMON IN AUSTRALIAN EDS, AND WERE RECOGNISED AS PREPARATORY FOR SPECIALIST EMERGENCY NURSES.
Transition to specialty practice programs in emergency nursing By Julia Morphet, Julie Considine, Bridie Kent and Virginia Plummer Transition to Specialty Practice Programs (TSPPs) offer supported entry to specialty areas of nursing practice (Boyle et al. 2009). TSPPs were originally designed as a recruitment strategy and to bridge the gap between completion of a Graduate Nurse Program and enrolment in specialty postgraduate study. TSPPs have been introduced in emergency departments (EDs) and other specialty areas nationally and internationally since the late 1990s (Morphet, Considine and McKenna, 2011). TSPPs have developed in an ad hoc manner to meet the needs of individual EDs. This study aimed to examine the design and characteristics of TSPPs in Australian EDs. Data were collected via surveys and interviews of nurse unit managers and nurse educators from 118 EDs across Australia. 34 July 2015 Volume 23, No. 1
TSPPs were offered in most EDs (n = 80, 72.1%). TSPPs aimed to prepare participants for safe, entry level practice as an emergency nurse, and increase emergency nursing recruitment and retention. Most TSPPs were twelve months duration (Mdn IQR 5-12 months). All TSPPs offered participants clinical preparation time, including paid orientation days and supernumerary shifts, however the number of clinical preparation days varied widely (Mdn 5 days, IQR 7-22 days). The number of study days also varied (Mdn 5 days, IQR 2-6 days). One third of TSPPs articulated to postgraduate study (n = 23, 38.3%), providing credit into postgraduate nursing programs for participants who completed the TSPP. This study found that emergency nursing TSPPs were common in Australian EDs, and were recognised as preparatory for specialist emergency nurses. Yet despite having similar aims, there were variations in many TSPP characteristics including duration, resources devoted to educational preparation, and clinical practice outcomes. Variability in TSPP characteristics and participant preparation impedes workforce mobility, articulation to postgraduate study, and raises patient safety issues. To address these issues, a national emergency nursing TSPP framework guiding future development of
TSPPs has been established using the findings of this study and key professional standards. A national emergency nursing TSPP framework is imperative to enable consistent development of knowledge and skills for emergency nurses, and rigorous formal articulation into postgraduate study.
Acknowledgment The authors wish to acknowledge the generous support of the Nurses Memorial Centre and Australian College of Nursing, who provided scholarships to support this study. Dr Julia Morphet is a Lecturer in the School of Nursing & Midwifery at Monash University Professor Julie Considine is Chair in Nursing Eastern Health; Director, Eastern Health - Deakin University Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Faculty of Health Professor Bridie Kent is a Professor in Leadership in Nursing in the School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University Associate Professor Virginia Plummer is Associate Professor Nursing Research at Monash University and Peninsula Health
References Boyle, M., Butcher, R., Conyers, V., Kendrick, T., MacNamara, M., & Lang, S. (2009). Transition to intensive care nursing: Establishing a starting point. Australian Critical Care, 22(1), 48-48. doi: 10.1016/j. aucc.2008.12.009 Morphet, J., Considine, J., & McKenna, L. (2011). Transition to specialty practice programs in emergency nursing - A review of the literature. Australasian Emergency Nursing Journal, 14(1), 45-49. doi: 10.1016/j. aenj.2010.11.001
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Education: Part 1
Exploring the mobile learning paradox to enable redesign of learning and teaching in the workplace By Carey A Mather and Elizabeth A Cummings
While it is becoming increasingly recognised that timely, easy and convenient access to health information using mobile learning (mlearning) technologies can enhance care and improve patient outcomes, there is an inability for nurses to access information at point of care (Mickan et al. 2013). Previous studies indicate that information communication technology literacy and access to mlearning by health professionals and undergraduate students is mixed (Mather, Marlow and Cummings 2013; Hegney et al. 2007). Nursing professional bodies have taken action by ensuring undergraduate nursing programs include students developing knowledge and skills in health technology and the Nursing and Midwifery Board of Australia (NMBA) supports the use of mobile learning (NMBA, 2013). A research project investigating the barriers, challenges, risks and benefits of enabling the use of mlearning at the point of care by clinical supervisors and undergraduate student nurses is being undertaken in New South Wales and Tasmania (Mather, et al. 2014).The next stage of this research will explore how organisational policy impacts on access and utilisation of mobile devices by nurses for learning and teaching and continuing professional development (CPD). The findings will then facilitate discourse on the development of strategies to embed mlearning as legitimate nursing function in the workplace. The use of learning has the potential to globalise the health professions, create unprecedented CPD opportunities and promote connected health. Integrating mlearning into healthcare environments can assist with meeting the aims of the Australian Nursing and Midwifery Accreditation Council, the NMBA and The Australian Health Practitioner Regulation Agency and enable workforce development to occur at point of care, at the workplace (AHPRA, 2012; ANMC, 2006; NMBA, 2013). Carey A Mather is a Lecturer and Elizabeth A Cummings is Senior Lecturer. Both are in the School of Health Sciences at the University of Tasmania
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FOCUS EXPLORING MOBILE LEARNING TO PROMOTE CONNECTED HEALTH. HANNAH BAILEY PHOTOGRAPHY
References AHPRA. 2012. Continuing Professional Development retrieved 26 April 2014. www. ahpra.gov.au/Education/ Continuing-ProfessionalDevelopment.aspx. ANMC. 2006. Australian Nursing and Midwifery Competency Standards for Nurses and Midwives retrieved 26 April 2014. www. nursingmidwiferyboard. gov.au/Codes-andGuidelines.aspx. Hegney, D, E Buikstra, R Eley, T Fallon, V Gilmore, and J Soar. 2007. Nurses and Information Technology Final Report. Canberra Australia: Australian Nursing Federation. Mather, CA, EA Cummings, and P Allen. 2014. “Nurses’ use of mobile devices to access information in healthcare environments in Australia: A survey of undergraduate students.” Journal of Medical Internet Research mHealth and uHealth no. 2 (4):1-10. doi: 10.2196/ mhealth.3467. Mather, CA, A Marlow, and E Cummings. 2013. “Digital communication to support clinical supervision: Considering the human factors.” Studies in Health Technology and Informatics no. 194:160165. Mickan, S, JK Tilson, H Atherton, and NW Roberts. 2013. “Evidence of effectiveness of healthcare professionals using handheld computers: a scoping review of systematic reviews.” no. 15 (10):e212. doi: 10.2196/ jmir.2530. NMBA. 2013. Nursing and Midwifery Continuing Professional Development Registration Standard retrieved 26 April 2014. www. nursingmidwiferyboard. gov.au/RegistrationStandards.aspx.
July 2015 Volume 23, No. 1 35
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Education: Part 1
Innovating point of care education: the clinical coach By Annette Faithfull-Byrne, Lorraine Thompson, Wendy Cross and Cheryle Moss Clinical educators have an important leadership function within the organisation and play a central role in the staff development of qualified staff and undergraduate students (Adelman-Mullally et al. 2013). Recently within the Sunshine Coast Hospital and Health Service, these leadership functions have expanded. While maintaining staff development responsibilities, clinical educators are also primarily engaged in service development.
An alternative was needed to provide this ‘on the ground’ development work. Based in practice development philosophy and ways of working, the clinical coach was an initiative developed in response to the situation. It aims to bring education back to the point of care. Nurses and midwives in the coach role are situated in a defined
practice area and collaborate with unit managers, consultants and educators to facilitate clinical learning. Coaches work at the bedside, supporting and coaching staff, promoting learning and development; leading by example. According to Whitmore (2006) coaching is about ‘unlocking a person’s potential’ to maximise performance through learning rather than teaching. This articulates well with team mantras that have been adopted. “Be the guide on the side, not the sage on the stage” (Morrison, 2014 p1); this mantra reminds the team to adopt an empowering approach in their role activities, and to utilise the principles of adult learning. The mantra “Do with, Not for”, reminds the team that performing for a learner can remove opportunities for deeper learning and result in a superficial learning experience. It’s a cue to work in collaborative partnerships with staff on their learning journeys. A third mantra is
“teach a man to fish” which comes from the proverb attributed to Lao Tzu: “Give a man a fish and he eats for a day, teach him to fish and he can feed his village for life”. This mantra promotes independent learning and empowers individuals in all their activities. The clinical coaches have brought education back to the point of care and preliminary data relating to their key accountabilities suggests they have had a positive impact throughout the service. Mrs Annette Faithfull-Byrne and Lorraine Thompson are in the Practice Development Unit, Sunshine Coast Hospital and Health Service, Nambour General Hospital Professor Wendy Cross and Associate Professor Cheryle Moss are in the School of Nursing and Midwifery at Monash University, Faculty of Medicine, Nursing and Health Sciences
References Adelman-Mullally, Theresa, Cindy K. Mulder, Deborah E. McCarter-Spalding, Debra A. Hagler, Kathleen B. Gaberson, Mary Beth Hanner, Marilyn H. Oermann, Elizabeth T. Speakman, Patricia S. Yoder-Wise, and Patricia K. Young. (2013). The clinical nurse educator as leader. Nurse Education in Practice. 13:2934. doi: 10.1016/j. nepr.2012.07.006. Morrison, Charles D. (2014). From ‘Sage on the Stage’ to ‘Guide on the Side’: A Good Start. International Journal for the Scholarship of Teaching & Learning. 8(1):1-15. Whitmore, John. (2006). Coaching for Performance GROWing People, Performance and Purpose. 3rd ed. London, UK: Nicholas Brealey Publishing.
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Education: Part 1
FOCUS CLINICAL STAFF WORKING WITH THE CLINICAL ASSESSMENT TOOL
Situating clinical assessment tools within workplace learning By David Rainbow, Lorraine Thompson, Lonni Mullamphy, Annette Faithfull-Byrne and Wendy Cross It is our premise that the use of clinical assessment tools to support the workplace learning of experienced nurses and midwives are an essential aspect of the modern health service.
specific clinical contexts; 2. supporting practice standards by the provision of standardised clinical assessment tools; 3. reduces organisation risk by enabling a method by which to measure clinical competence.
Over the past seven years clinical teams at the Sunshine Coast Hospital and Health Service (SCHHS) in Queensland have commissioned the development of more than 100 specialist clinical assessment tools (CATs) to advance their skills and services. To achieve this education specialists working with the teams have had to consider the development of criterion based competencies, current states of clinical evidence for a range of practices. The healthcare organisation has worked to build on the entry to practice skills and knowledge that all new nursing and midwifery graduates possess as readiness for professional practice (McKenna and Newton, 2008). The specific CATs serve three purposes: 1. advancing the individuals clinical skill sets and core knowledge in
In keeping with contemporary educational and coaching frameworks the development and achievement of such competencies through CATs are not reduced to pecuniary and technical interests. Rather they are positioned as facilitative and person-centred measures that aim to support individuals and teams in their clinical achievements and developmental goals. It can be argued that the modern learning organisation requires this form of investment from its clinicians and educators to achieve quality healthcare outcomes (Katsikitis et al. 2013). The Clinical Assessment Tools (CATs) that have been developed as organisational responses to these needs are regularly updated and tested to maintain their accuracy and evidence base. Clinical
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teams over the past seven years have grown to value the learning structures, processes and outcomes attained. Regular staff satisfaction surveys reveal positive adoption and investment in this form of professional development (Duff, 2013). SCHHS currently receives requests from other healthcare organisations for permission to use the CATs that have been developed by the service. Monash University School of Nursing and Midwifery is currently collaborating with SCHHS and evaluating the impact of the CATs on clinical teams. David Rainbow, Lorraine Thompson, Lonni Mullamphy and Annette Faithfull-Byrne are located in the Practice Development Unit, Sunshine Coast Hospital and Health Service, Nambour General Hospital Professor Wendy Cross is in the School of Nursing and Midwifery at Monash University, Faculty of Medicine, Nursing and Health Sciences
References Duff B. (2013). Creating a culture of safety by coaching clinicians to competence. Nurse Education Today. 33(10): 1108-1111. McKenna L, Newton J (2008). After the graduate year: A phenomenological exploration of how new nurses develop their knowledge and skill over the first 18 months following graduation. Australian Journal of Advanced Nursing. 25(4):9-15. Katsikitis M, McAllister M, Sharman R, Raith L, Faithfull-Byrne A, Preiaulx R. (2013). Continuing professional development in nursing in Australia: Current awareness, practice and future directions. Contemporary Nurse. 45(1):33-45.
July 2015 Volume 23, No. 1 37
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Education: Part 1
FOCUS
References Australian Commission on Safety and Quality in Healthcare (ACSQHC) (2011, September), National Safety and Quality Health Service Standards, ACSQHC, Sydney.
Teaching of safe practices to our undergraduates By Sara Geale and Gina Mata Since the release of the US Institute of Medicine, To Err is Human report in 2000, healthcare providers, accreditation bodies, quality advisors and educators have toiled to incorporate safety for the patient and the healthcare provider as part of the healthcare arena. Regardless of their work, patient safety remains an ongoing issue in healthcare. While media focus is mainly on the medication errors and sentinel events (Johnstone, 2014),we know that falls, pressure injuries, identification errors and errors related to poor communication continue to negatively affect healthcare outcomes (ACSQH, 2011). These negative outcomes are despite a number of systems and processes that have been put in place to support ongoing safety in healthcare. In September 2012, the Australian Commission on Safety and Quality in Healthcare (ACSQHC) published the National Safety and Quality Health Service Standards detailing fundamental areas that healthcare facilities and providers need to address to minimise risk to the healthcare recipient and improve the quality of healthcare provision. Care tools are available to provide quality care and provide a mechanism for quality assurance systems for follow up on use of the tools anmf.org.au
and their effect on patient safety. These tools include, but of course are not limited to, the National Observation Track and Trigger or Early Warning Signs chart, Falls Risk tools, Pressure Injury Risk Scores, National Medication charts, Rights of Medication Administration, surgical safety check lists, clinical pathways and the ISOBAR (ISBAR, SBAR) handover. The systems are in place and the audit mechanisms to check the systems. So why are we still experiencing problems with falls, pressure injuries, medication errors, and communication (ACSQHC, 2012)? Of course healthcare is complex, and indeed in this increasingly complex world, it has become more so, and with this an increasing number of ways for things to go wrong (Leape, 2011). With these complexities in mind we understand that systems and processes are needed, and we also understand that there is a need for patient safety. Extensive research has demonstrated links between positive patient experiences, patient safety and clinical effectiveness (Shekelle et al. 2013). We also have research and statistics to demonstrate that while there has been improvement we still have room to improve. In a 2015 PowerPoint presentation Vollman, quoted W. Edwards Denning: “It is not enough to do your best; you must know what to do, and then do your best”.
This is where academics step up and ask themselves if education is doing enough to champion safety and the use of our safety tools. Education is critical to how nurses think about, communicate about and then practice patient care (Steven, et al, 2013; Twigg and Attreeb, 2013). As undergraduate educators do we do enough to integrate the safety tools into the learning experience or are we still too focused on teaching skills and task? Other members of the healthcare team do biophysical assessments for the purpose of making diagnosis. Do we as educators allow students to experience the use of ISOBAR handovers in the demonstration labs? Do we incorporate falls and pressure injury risk tools into patient assessment education and using the early warning site charts to document vital signs in the educational setting? With the ongoing financial and social costs of healthcare errors in Australia it is time that the teaching of safe practices and use of healthcare tools become integral to undergraduate nursing education. Our nursing graduates should go out into the clinical area with the knowledge, skills and attitude that this is just the way we do things around here. Dr Sara Geale and Gina Mata are Lecturers in the School of Nursing and Midwifery at Edith Cowan University in WA
Johnstone, M. (2014, March 10). Reducing medical errors, one patient at a time. The Conversation. Retrieved from http:// theconversation.com Kohn LT, Corrigan JM, Donaldson MS.(2000) To Err Is Human: Building a Safer Healthcare System. Washington, DC: National Academy Press Leape, L. Foreword (2011) In Spath, P.L. (Ed.) Error Reduction in Healthcare: A Systems Approach to Improving Patient Safety (pp. ix). San francisco: J. Wiley and Sons. Retrieved from http://books. google.com.au Shekelle P.G., Pronovost P.J., Wachter R.M., McDonald K.M., Schoelles K, Dy S.M., et al. (2013) The Top Patient Safety Strategies That Can Be Encouraged for Adoption Now. Annals of Internal Medicine.;158:365-368. doi:10.7326/0003-4819158-5-201303051-00001 Steven, A, Magnusson, C., Smith, P. Pearson, P.H. ( 2013) Patient safety in nursing education: Contexts, tensions and feeling safe to learn doi:10.1016/j. nedt.2013.04.025 Twigg, D., Attreeb, M. (2013). Patient safety: Committing to learn and acting to improve. doi:10.1016/j. nedt.2013.11.002 Vollman, K.M. (2015, March 24) The Future is Now: Innovations in Nursing Quality and Patient Safety (PPT) retrieved from www. vollman.com/pdf/ FutureisNowInnovations 03%2019%20 2015revised.pdf
July 2015 Volume 23, No. 1 39
Acute Cardiac Module
Acute Renal Module
Introduction
FOCUS
Results
Acute Neurological
Education: Part 1
Flinders Medical Centre (FMC) is a 580 bed public teaching, tertiary referral hospital in Adelaide with over 2000 nurses. OneModule of the biggest challenges has been creating education opportunities for a large cohort of nurses to meet the changing needs of the clinical environment, the learner and the organisation. One of the key successes in nursing education at FMC has been creating and developing a post graduate level hospital based acute program which incorporates flexible delivery and innovative teaching and learning methods.
Identified key contributing factors that increased attendance included generic design of module content, applicable to any nurse in any clinical area and provision of a broad range of essential knowledge. Participant interest and support from managers was increased due to the flexibility of attending modules as an alternative to completing the whole program and the clinical relevance.
Method The Acute Clinical Assessment Program (ACAP) was developed in response to changing clinical needs and increasing demands on nurses. The program aims to provide knowledge and skills in the assessment and management of the deteriorating patient in the acute setting. A high standard of quality education was recognised by Flinders University of South Australia receiving transferable credit points for post graduate studies in lieu of program completion. Some of the key work in developing the program included incorporating aspects of the new National Safety and Quality Health Service Standards (NSQHS) (Picture 1). In particular Standard 6 Clinical Handover (Picture 2) and Standard 9 Recognising and Responding to Clinical Deterioration in Acute Health Care (Picture 3).
To date there have been over 500 nurses attend the program or modules in a two and a half year period (Table 1). Attendance was predominately from FMC nursing staff however there is now increasing interest from across the Southern Adelaide Local Health Network (SALHN) and beyond, including Country Health SA and private industry.
Didactic
The Acute Clinical Assessment Program was developed in response toModule changing clinical Attendance needs and increasing demands on nurses. The program aims to provide knowledge and skills in the assessment and management of the deteriorating patient in the acute setting. A modular approach was adopted to allow the program to be accessible, applicable, equitable The use of online learning has ultimately assisted with an increased knowledge in the assessment and management of the acutely unwell patient. It has also greatly and flexible and allow nurses to improved nurse’s general computer skills in searching electronic databases to support evidence based practice and supported the incorporation of information tailor learning needs to their clinical technology in health care. The quality of participant assessments was extremely high with excellent outcomes environment. for most program participants. There was a clear correlation with knowledge from the program incorporated into assessments with theof key component being able to The development an online identify and manage the unwell or deteriorating patient regardless of the primary cause of concern. Participant feedback hasfor been extremely positive as represented learning platform each module/ by the common themes from evaluations in Picture 7. program components utilised the FMC Learning Management System, Moodle or www. saheducation.com This online learning platform was used for communication; pre-readings and reference material, assessments and certificate issuing. The increased use of online learning has ultimately assisted with increased computer skills; improved nurse’s skills in Conclusions andelectronic Future Directions searching databases to The ongoing success of the program can be attributed to the unique modular support evidence nursing; design creating flexible options for nursingbased staff to attend and achieve quality and applicable ongoing professional development opportunities. Furthermore the and and incorporating successful supporting integration of online learning to compliment and supplement ongoing learning is essential to the program. information technology in An ongoing commitment to improve the program continues with a focus on incorporating more simulation based practical sessions and determining key healthcare. performance indicators or long term program outcomes and the clinical impact. Ultimately the goal of this program is to increase the knowledge and skill of To date over 400 nurses have nurses, support safety and quality in care and achieve optimal patient outcomes. attended the six modules since October 2011 which impacts on Contact Details Caroline Henderson Centre for Nursing, Midwifery Education and Research clinical knowledge and skill of Education Facilitator Flinders Medical Centre nurses and caroline.henderson@health.sa.gov.au ultimately optimal patient outcomes. 140 120
Problem based Learning
Engaged Learner
100
Simulation
80 60 40 20
0
Caroline Henderson
Clinical Scenarios
Table 1 – Participant attendance to program modules over past two and a half years.
Picture 5 – Teaching methods
Fundamental to the success of this program is the increase use of online learning to support face to face teaching. To complement the modular approach, the development of an online learning platform for each module/program components utilised the FMC Learning Management System, Moodle or www.saheducation.com (Picture 6). This online learning platform is used for communication; pre readings and reference material; assessments and certificate issuing. Ultimately the online components compliment study day material and provide a great opportunity to expand on essential knowledge required to meet the program/module outcomes and reduce face to face teaching time.
Picture 1 – National Safety and Quality Health Service Standards
Picture 2 – NSQHS Clinical Handover
Picture 3 – NSQHS Recognising and Responding to Clinical Deterioration in Acute Health Care
The program framework includes a modular approach which allows flexibility and the option to individualise the program design over a varying length of time. Beyond the program, the modules are available to nurses as individual components allowing education to be more accessible, achievable and relevant to the nurses from many differing clinical contexts.
Acute Assessment Module Acute Gastrointestinal Module
Picture 7 – Participant feedack common themes
Acute Respiratopry Module Acute Clinical Assessment Program
Acute Cardiac Module
Acute Renal Module
Flexible education opportunities Acute Neurological Module
POSTER HIGHLIGHTS A HOSPITAL BASED NURSING EDUCATION PROGRAM AT FLINDERS MEDICAL CENTRE, SA. POSTER WAS THE WINNER OF THE ‘PEOPLE’S CHOICE’ AWARD AT THE NATIONAL NURSE EDUCATION CONFERENCE IN 2014
Flinders Medical Centre (FMC) is a 580 bed public teaching, tertiary referral hospital in Adelaide with over 2,000 nurses. Didactic One of the key successes in nursing education at FMC has been recreating and developing a Picture 4 – ACAP framework
There are six fundamental or core one day modules including the Acute Assessment, Respiratory, Cardiac, Neurological, Renal and Gastrointestinal modules. Each module provides comprehensive knowledge relevant to assessment and management of the acutely unwell client and is applicable to any clinical context (Picture 4). Each module embraces didactic teaching methods with a strong focus on problem based learning, clinical scenarios and simulation which created highly engaged learners (Picture 5).
Problem based Learning
www.ausgoal.gov.au/creative-commons
Engaged Learner
postgraduate level hospital based acute program that suits the changing learner and organisational needs and incorporates flexible and innovating teaching and learning methods. Fundamental to the success of this program was the increasing use of online learning to support face to face clinical teaching. Picture 6 – Online ACAP program page
Flexibility is also provided with assessment components. The option of attendance only or module completion is provided for each module with varying Continuing Professional Development (CPD) hours to assist in meeting professional nursing registration requirements. The program participants are required to complete all of the module assessments and other summative assessments to meet the program and FUSA requirements.
Acknowledgements
Caroline Henderson is Nurse Education Facilitator the Nurse Clinicians/Clinical Experts: Thank you to the manyin Clinical Practice Consultants, Clinical Service Coordinator, Associate Clinical Service Coordinators Centre for Nursing & Midwifery and Registered Nurses that have presented or contributed to clinical based workshop sessions. Education and Research at Flinders Medical Centre in SA
Education Facilitators (EFs) CNMER: Thank you to the large classroom contribution by many EFs that have delivered lectures and facilitated clinical based scenarios and/ or skills workshops and those EFs that provided IT support for online components.
Simulation
THE NATIONAL NURSING FORUM Clinical Scenarios
Advancing nurse leadership
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Education: Part 1
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Virtual simulation developing nontechnical skills in student nurses and midwives By Monica Peddle Literature highlights that education programs are producing unprepared graduates from stagnant, fragmented and out dated curricula that are not keeping pace with healthcare demands and workforce changes (Frenk et al. 2010). Some of the essential skills that have been identified as lacking in new health professional graduates are teamwork, team communication, and making and managing decisions in the clinical setting (Frenk et al. 2010). These skills, categorised as non-technical skills (NTS), are defined as “the cognitive, social and personal resource skills that complement technical skills and contribute to safe and efficient task performance” (Flin and Patey, 2009). Traditionally, undergraduate health professional education focuses on discipline and technical expertise, clinical reasoning and communication skills. NTS that are required for competent practice are left to be attained through ‘on the job’ learning experiences during
clinical placement. It is argued that early health professional education in NTS can provide learners with, a basic understanding of factors influencing human performance, improved teamwork and team communication, and promote patient safety (Flin and Patey, 2009). The Virtual Simulated Patient Resource (www.vspr.net.au) is a freely available web based resource that provides student nurses and midwives the opportunity to engage in interactive simulation based learning activities to develop and apply knowledge, skill and attitudes of NTS. The resource provides a sustainable, flexible and reproducible learning experience that is easily accessed online by large student cohorts. Knowledge, skills and attitudes related to NTS are developed through interactive online content modules. Following the modules are innovative virtual patient
simulations that enable application of NTS and knowledge to realistic clinical situations. The simulations follow a branching design, supported by video vignettes that require students to make decisions regarding patient care from the driver’s seat; the decisions made by the student focusing on NTS, determines a positive or negative patient outcome. This approach enables the learner to explore and experience the crucial role NTS play in safe and competent patient care. This project is funded by Health Workforce Australia. Further details contact Monica Peddle. Email m.peddle@latrobe.edu.au Monica Peddle is a Research Fellow in the School of Nursing and Midwifery, College of Science, Health and Engineering at La Trobe University
References Flin, R., and Patey, R. (2009). Improving patient safety through training in non-technical skills. BMJ, 339. Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., Fineberg, H., Garcia, P., Ke, Y., and Kelley, P. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The Lancet 376 (9756):1923-1958.
HIMAA Education Services - Enrolment Calendar Intakes open on the 1st and close on the 22nd of each month Phone: +61 2 9887 5898 Email: education@himaa.org.au Comprehensive Medical Terminology Introductory Clinical Coding Intermediate Clinical Coding Advanced Clinical Coding Refresher Clinical Coding Accelerated Program Please check website for entry requirements www.himaa2.org.au/education
RTO ID: 91660
FOCUS
Education: Part 1 A STUDENT NURSE DEMONSTRATING THE COMMENCEMENT OF INTRAVENOUS THERAPY IN THE VIDEO ASSESSMENT
Using video assessments as an alternative to the Objective Structured Clinical Examination (OSCE) By A Framp, T Downer and J Layh Traditional OSCE assessments have been utilised to assess nursing student competence at clinical skills in undergraduate nursing programs across Australia, and this method has found to be a reliable assessment to determine knowledge, clinical skill and problem solving (Henderson et al. 2013; Smith et al. 2012). However these assessments can be both resource intensive for staff and stressful for both students and staff.
Students identified it was difficult to perform while being observed, and there is often the need for debriefing after the assessment which requires more time to be allocated. It was decided to trial video assessments as an alternative for both the second and third 42 July 2015 Volume 23, No. 1
year undergraduate nurses, and undergraduate midwifery students. Students worked in pairs and groups of three to demonstrate clinical skills which were videoed and submitted as an assessment. The second year students demonstrated skills in patient education and included a reflection in their submission and the third year students were assessed on teaching a clinical skill to another nurse. The undergraduate midwives were assessed using woman centred care on their assessment of the newborn. The outcomes of these assessments showed benefits for both the students and the educators. Students reported enjoying the assessment and were able to reflect and self-correct their behaviours as they were doing the assessments. Students could add a verbal reflection to the video at
the end if they recognised they had omitted a part of the skill at the time. Educators reported resource savings that included time to assess, time to mark assessments and time to train assessors. Moderation was achieved through review of videos and the ability for each assessor to replay videos. The outcomes of these assessments highlight the benefits of this method for nursing and midwifery students. This assessment will now be trialled across other nursing programs at this university. Affiliations: University of The Sunshine Coast, Sippy Down, Queensland. A Framp and T Downer are Program Leaders and J Layh is a Nursing Lecturer. All are at the University of the Sunshine Coast, Queensland
References Henderson, A., Nulty, D., Jeffrey, M., 2013. An implementation framework for using OSCE’s in nursing curricula. Nurse Education Today. 33(12)1459-1469. Smith, V., Muldoon, K., Biesty, L., 2012. The objective structured clinical examination (OSCE) as a strategy for assessing clinical competence in a midwifery education in Ireland: A critical review. Nurse Education in Practice. 12(5):242-247.
anmf.org.au
Education: Part 1
FOCUS USC DRAMA STUDENTS VANESSA EWIN (LEFT) AND HOLLY HEDGMAN
Advances in midwifery simulation at USC By Patrea Anderson, Terri Downer, Joanne Loth and Jennifer Penton A $24 million state of the art teaching and learning hub at USC, including advanced simulation technology, has enabled the school of Nursing and Midwifery to realise curriculum development in undergraduate midwifery education. These facilities combined with drama students playing simulated patients provide students with exceptional learning experiences.
Second year students studying the dual degree in Nursing and Midwifery undertake immersive simulation in a variety of courses. Scenarios prepared students for placement and included key threshold concepts in antenatal care, early labour, postnatal care, discharge planning and follow up home visits. Lasting approximately 10 minutes, the scenarios are videoed followed by debrief using the +Delta method to explore the student experience and reinforce learning outcomes. Authentic clinical and home environments were created to enhance fidelity and engage the students in deep learning. Drama anmf.org.au
students from the Acting 4 Health research program played the role of pregnant women, while midwifery students modelled the role of midwife and student midwife. A low cost pregnancy suit using a beach ball, a neonatal manikin and digital recording of a fetal heart allowed students to undertake abdominal assessment including palpation and listening to the fetal heart using a pinard.
STUDENTS REPORT THAT THEY FEEL MORE CONFIDENT IN INITIATING THERAPEUTIC RELATIONSHIPS THAT ARE WOMEN CENTRED.
This experience has assisted students to consolidate and translate theory in practice and has been helpful in developing confidence when recruiting women for continuity
of care experiences. Students report that they feel more confident in initiating therapeutic relationships that are women centred. The Satisfaction with Simulation Experience Scale (SSES) Cronbach’s alpha coefficient (α) 0.78 (LevettJones et al. 2011) was used to collect data regarding student perceptions (n=81) of the simulation experience including the impact on learning of debriefing and reflection, critical thinking and clinical reasoning, clinical learning and application to practice. Using a 5 point Likert scale 1=strongly disagree, 5=strongly agree, most participants responded either “agree” or “strongly agree” indicating high levels of satisfaction with the simulation. Mean scores were high (>4.87) with a standard deviation of 0.44. Students reported that the simulation experience felt “a lot like being on prac”. They enjoyed the authentic immersive approach using real people to practice communication skills with rather than manikins or using part task training models. As this learning experience has been so successful, immersive simulation is being extended throughout the dual degree.
Reference: Levett-Jones, T., McCoy, M., Lapkin, S., et al., (2011). The development and psychometric testing of the satisfaction with simulation experience scale. Nurse Education Today. 31(7):705-710.
Patrea Andersen is an Associate Professor, Terri Downer is a Lecturer in Nursing and Midwifery, Joanne Loth is a Discipline Leader, Drama and Jennifer Penton is a Research Assistant. All are at the University of the Sunshine Coast.
July 2015 Volume 23, No. 1 43
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www.anmf.org.au/education The ANMF Federal Office offers all nurses and midwives four separate online CPD training rooms offering best practice information on a wide range of topics applicable to all areas of practice. All members of the ANMF including NSWNMA and QNU members receive access to our CPD training at discounted rates and receive access to some free topics. If you are not a member you can also access the online training at affordable rates. ANMF Federal Education Team E education@anmf.org.au | P 02 6232 6533 ANMF - July 2015.indd 1
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Education: Part 1
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Attracting generation Z into nursing as a career By Annette Faithfull-Byrne, Lorraine Thompson, Shane Convey, Wendy Cross and Cheryle Moss In Australia, a shortage of over 109,000 nurses by the year 2025 is anticipated (Health Workforce Australia, 2012). Other health professions are similarly experiencing shortages. According to the World Health Organization there is a global shortage of all types of health workers (World Health Organization, 2015). Nursing and Midwifery are challenged in recruiting young people into the profession and strategies to ensure a sufficient health workforce supply in the future are essential to meet projected workforce demands (Health Workforce Australia, 2012).
The oldest individuals in generation Z have just turned 18 and are now entering universities and their chosen careers (McCrindle Research). Targeting this generation while in school, as they make decisions about subject choices and course options, is an essential strategy in promoting nursing as a career. A wide variety of programs exist that promote careers in nursing to high school students, with some offering work placements, however, time spent organising and conducting these programs can be costly to organisations. High quality programs that are guided by research are not only best practice, but essential in ensuring these initiatives are appropriately tailored to be attractive for those in generation Z considering a career in health. One program that utilises research to guide its activities is the High School Healthcare Engagement Program (HSHCEP) on the Sunshine Coast in Queensland. The health-career promotion initiative is aimed at high school students and was established by the Sunshine Coast Hospital and Health Service (SCHHS) in collaboration with 15 local schools, the Queensland Department of Education Training and Employment (DETE) and a partnership broker (Sustainable Partnerships Australia). The program is aimed specifically at year 10 students anmf.org.au
and is scheduled to take place just prior to the students choosing their curriculum subjects for their final years of schooling. The program consists of two days of experiential learning and runs twice a year for 40 students at a time. During the program, students interact with a variety of healthcare professionals including nursing, midwifery, physiotherapy, occupational therapy, psychology, speech therapy, dietetics, radiology and social work. Each professional facilitates an interactive education session, where the students actively participate in related skills based learning. Nurses coordinate the program. Research has shown a variety of factors can be influential in young people choosing or rejecting nursing as a career, including parents, guidance teachers and career advisors (Neilson and McNally, 2013). All of these key stakeholders work in partnership and were consulted as the program developed. Stereotypical images can be a powerful influencing factor (Pool, 2012) when young people are considering choosing nursing or midwifery as a career, particularly where young men are concerned (O’Brien et al. 2008). The program actively addresses the media and society’s perceptions of nursing as a career choice, particularly for young men and there are several positive male role models who facilitate the discussions. Role models from the profession can be an influential factor in high school students choosing to enrol in a nursing course (Hickey et al. 2013). Students in the program engage in activities with enthusiastic nurses from different roles, in a range of specialties. Research has highlighted that high achieving students who are attaining good grades and considering a career in nursing, can be actively dissuaded against it by family, career advisors or career guidance teachers (Neilson and McNally, 2013). Outdated views can persist, where nursing as a career option is seen as not challenging and ‘on a par with hairdressing and office work’ (Neilson and McNally, 2013). The HSHCEP actively
engages with this issue, dispelling such myths. A simulation suite is utilised to engage students in a variety of scenarios demonstrating the team work, assessment skills, critical thinking, and high levels of communication, theoretical and technical knowledge required by contemporary professionals. The key aspects of being a professional are also emphasised including reflection on practice, evidence based practice and the need for continual personal and professional development. Generation Z are known as digital integrators and are “the most materially endowed, technological saturated, formally educated generation…[we have] ever seen” (McCrindle Research, 2012). The program caters to this characteristic of generation Z by demonstrating some of the technological aspects of contemporary practice, including telehealth, eHealth records, teleconferencing and simulation. Knowledge of the differences between generations regarding expectations and attitudes towards the workplace, also inform discussions regarding a career in nursing or midwifery. Early data from this tailored program suggests that the HSHCEP is likely to be helpful in recruiting school leavers into the nursing and midwifery professions. Annette Faithfull-Byrne is Nursing Director: Education, Staff Development and Research (SCHHS), Lorraine Thompson is Nurse Educator Research, Mr Shane Convey is Nurse Educator Aged Care all work at Nambour General Hospital Professor Wendy Cross is Head, School of Nursing and Midwifery, Associate Professor Cheryle Moss is in the School of Nursing and Midwifery both at Monash University, Faculty of Medicine, Nursing and Health Sciences
STUDENT PERFORMING A BGL
References Health Workforce Australia. 2012. Health Workforce 2025 – Doctors, Nurses and Midwives – Volume 1. Adelaide, SA. Hickey, Noelene, Jennifer Sumsion, and Linda Harrison. 2013. “Why nursing? Applying a socio-ecological framework to study career choices of double degree nursing students and graduates.” Journal of Advanced Nursing no. 69 (8):1714-1724. doi: 10.1111/jan.12029. McCrindle Research (2012). Generation Z Defined: Global, Visual and Digital. PDF Available from http:// blog.mccrindle.com. au/the-mccrindle-blog/ generation_z_defined_ global_visual_digital. Accessed April 2015. Neilson, Gavin R, and Jim McNally. 2013. “The negative influence of significant others on high academic achieving school pupils’ choice of nursing as a career.” Nurse education today no. 33 (3):205-209. O’Brien, F., M. Mooney, and M. Glacken. 2008. “Impressions of nursing before exposure to the field.” Journal of Clinical Nursing no. 17 (14):1843-1850. doi: 10.1111/j.13652702.2007.02214.x. Pool, Leanne. 2012. “How culture influences choosing nursing as a career.” Whitireia Nursing Journal (19): 27-42. World Health Organization. Health Workforce. The crisis 2015. Available from www.who.int/hrh/ strategy/information/en/. Accessed April 2015.
July 2015 Volume 23, No. 1 45
CALENDAR
AUGUST DonateLife week 2-9 August. www.donatelife.gov.au/ donatelife-week-2015
JULY NAIDOC Week 5-12 July. Theme: We all Stand on Sacred Ground: Learn, Respect and Celebrate www.naidoc.org.au/ Anniversary of the Australian Aboriginal flag 12 July. http://matsiti.edu.au/ events/indigenous/ Lung Health Promotion Centre at The Alfred 14 July - Educating & Presenting With Confidence 15-17 July - Asthma Educator’s Course 23-4 July - Smoking Cessation Course 30-31 July - Creative Behaviour Change Coaching For Chronic Illness P: (03) 9076 2382 E: lunghealth@alfred.org.au Summer Global Nursing Symposium Nursing Practice, Nursing Education, Nursing Management, and Disaster Management 17-18 July. Los Angeles, California, United States of America www.uofriverside.com/conferences/ global-nursing-symposium/2015summer-global-nursing-symposium/ International Confederation of Midwives (ICM) Asia Pacific Regional Conference Midwifery care for every mother and their newborn 20-22 July, Pacifico Yokohama, Japan. www.icmaprc2015.org/en/ general_information.html 5th Asia-Pacific Summit on Cancer Therapy Forum for a world without cancer 20-22 July, Brisbane, Australia. http://cancer.global-summit.com/ asia-pacific/ Perth Practice Nurse Clinical Education 25-26 July. Western Australia’s leading event for Nurses working in General Practice. Earn 12 CPD hours. www.pnce.com.au VPNG (Victorian Perioperative Nurses’ Group) State Conference Strategies for Success: Safety and Quality in Perioperative Care 30-31 July, Pullman in Albert Park, Melbourne. www.vpng.org.au Garma Cultural Festival 31 July- 3 August. www.garmafestival.com.au/
46 July 2015 Volume 23, No. 1
Health Informatics Conference Driving reform: Digital health is everyone’s business 3-5 August, Brisbane Convention and Exhibition Centre, Qld. www.hisa.org.au/hic2015/ National Aboriginal and Torres Strait Islander Children’s Day 4 August. Theme: Little Kids, Big Futures. http:// aboriginalchildrensday.com.au/ Lung Health Promotion Centre at The Alfred 7 August -Theory & Practice of Non Invasive Ventilation – Bi-Level & CPAP Management 20-21 August - Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au International Day of the World’s Indigenous Peoples 9 August. http://matsiti.edu.au/ events/indigenous/ Drug and Alcohol Nurses of Australasia’s (DANA) Annual Conference Many Faces of Addiction 13-14 August, Novotel Sydney Central, NSW. www.danaconference. com.au Gurindji Land Rights Anniversary 16 August. http://matsiti.edu.au/events/ indigenous/ 12th International Family Nursing Conference Improving Family Health Globally through Research, Education, and Practice 18-21 August, The Radisson Blue Hotel, Odense, Denmark. http://internationalfamilynursing. org/2013/07/11/2015-conference/ 2015 Scientific Meeting of Flight Nurses Australia and Aeromedical Society of Australasia 19-21 August, Darwin Convention Centre. www.flightnursesaustralia. com.au/conference 25th Meeting of the International Society for Neurochemistry 23-27 August, Cairns Qld. www.neurochemistry.org/biennialmeeting.html Endocrine Nurses Society of Australasia Symposium 24 August, The Adelaide Convention Centre, SA. www.ensa. org.au/ensa-2015/
6th Annual Correctional Services Healthcare Summit 24-25 August, Rendezvous Grand Hotel, Melbourne. Addressing the gaps, promoting multidisciplinary care and improving the continuum of care into the community. www.informa.com.au/conferences/ TheMHS Conference Translating Best Practice into Reality 25-28 August, Canberra. www.themhs.org 3rd Annual National Forensic Nursing Forum Addressing the issues surrounding clinical forensic nursing and forensic mental health 26 August, Rendezvous Grand Hotel Melbourne. www.informa.com.au/conferences/ health-care-conference/nationalforensic-nursing-conference
SEPTEMBER Australian Disease Management Association 11th Annual Conference Count me in: Partnerships in chronic care? 9–11 September, Brisbane Convention Centre. www.adma.org. au/ E: b.shen@alfred.org.au P: (03) 9076 4125 Lung Health Promotion Centre at The Alfred 16-18 September/14-15 October - Respiratory Course (Mod A & B) 16-18 September - Respiratory Course (Module A) P: (03) 9076 2382 E: lunghealth@alfred.org.au CATSINaM - National Professional Development Forum The only way is up 22-24 September, Darwin. www.catsinam.org.au
OCTOBER Lung Health Promotion Centre at The Alfred 5-6 October - Spirometry Principles & Practice 14-15 October - Respiratory Course (Module B) 22-23 October - Managing COPD P: (03) 9076 2382 E: lunghealth@alfred.org.au 12th Biennial National Enrolled Nurse Association of Australia (ANMF SIG) Conference 21 October, InterContinental, Adelaide SA. P: 1300 972 315 E: info@nena.org.au www.nena.org. au/2015NENAConference.html
NETWORK Box Hill Hospital, Group 99, 30-year reunion For further information contact Clare D’Arcy-Evans E: clarebears21@icloud.com or M: 0416 399 881. Prince Henry’s Hospital, 2/85 Reunion 25 July. Venue and time not yet decided. Contact Vivienne Jose E: vivvy38@hotmail.com or search Prince Henry’s Hospital Melbourne Memorial Page for further details. Queen Victoria Hospital, Melbourne, Midwifery Group Aug 1970–1971, 45-year reunion 29 August at Glen Iris. Contact Lyn Kirby E: lynmkirby@gmail.com M: 0407320824 Royal Hobart Hospital, 4/75 PTS, 40-year reunion 30 October, 6.30pm, Janne Gordon’s, 94 Nelson Road, Mount Nelson, Tasmania 7007. BYO drinks and $20 towards pizzas, nibbles and cake. Contact: Janne E: gordies@ southernphone.com.au, Alex E: therandalls3@netspace. net.au, Heather E: hknichols@gmail.com or Sue E: susan.cunningham57@ hotmail.com by 30 September (let us know of any special dietary needs) LaTrobe University, LaTrobe/Bendigo Campus nursing group (19881991), 25-year reunion 20 February 2016, Bendigo. Contact Steven Graham E: sgraham@bendigohealth. org.au or Sarah Shipp (nee Prudham) E: sshipp@ bendigohealth.org.au or search Facebook page LaTrobe 1991 reunion
Email cathy@anmf.org.au if you would like to place a reunion notice
anmf.org.au
At their mercy (letter of the month) I felt saddened watching the ABC 4 Corners program that aired on 24/05/15 titled, At Their Mercy. The documentary made public the belittling, bullying and bastardisation within the medical profession and highlighting the experiences of some of our medical students ‘teaching by intimidation’.
Letter of the month The winner of the ANMJ best letter competition receives a $50 Coles Myer voucher. If you would like to submit a letter to the ANMJ email anmj@anmf. org.au Letters may be edited for clarity and space. anmf.org.au
I have never known of nurses or midwives bullying doctors but that is not to say that it has or does not occur. I have known of doctors bullying and intimidating nurse’s and midwives’ as mentioned in The 4 Corners program. What is wrong with us? Why do we do these things to each other? We all have the right to go to work, to feel safe, respected and considered. We should treat others as we would wish to be treated ourselves, that’s basically it in a nutshell. It is a sad realisation to come to that for many of us, the profession we have chosen to make a career of, and are passionate about, by providing healthcare to the community is beset by these behaviours. As a result in the process of doing our job, our own health and wellbeing is adversely affected. It is not the work that we do but what we do to each other and to our aspiring younger workers that feeds this disease. We are constantly reading about the bullying, harassment and intimidation issues identified at the middle management level in the numerous health employee survey findings across the country and in our professional journals. What are we doing with the results of these surveys? There are no state or federal surveys to track and monitor bullying and aggression incidences in the workplace. Professor Farrell, ANMJ Vol 21 March 2014, we don’t know how effective we are at addressing this problem. It is one thing to endorse a zero tolerance to aggression and bullying policy on paper, with notices posted in our workplaces; however, it is another thing altogether to enforce it and know how to effectively act on it. So how do we change this culture? Maybe I am naïve but has any health organisation or department thought about embedding into all our healthcare position descriptions key selection criteria that address our acknowledgement of and adherence to enforcing appropriate workplace behaviours? With specific criteria for our unit manager position
descriptions to meet? In my opinion this needs to be included in the mandatory selection criteria and not mentioned as a “desirable” attribute. In researching workplace culture, I read that in some large private organisations, employees are encouraged to participate in online surveys which actively seek their anonymous feedback about their experience of their manager’s performance and professional behaviours. The goal is to ensure a positive workplace culture flourishes. Why, because their employees and their opinions are valued by the company. It costs less financially, in time, absenteeism, staff turnover and in recruitment costs. The 4 Corners program made me think back to my own hospital based midwifery training days in the early 1990’s. I remember a newly graduated midwife in her 20’s who was enthusiastic, passionate and supportive to us, who were the next intake of midwifery students. One day I came to work to be informed that she had taken her own life, we were all shocked, distressed and in disbelief. This experience has left its mark on me. It is a legacy that never on my watch will anyone who comes to work and I am aware of, or I have heard of, or just feel that something is just not right will I never not go and ask RUOK? If I do hear that terrible news again, I want to know that there was not something I was aware of and could have said, done or behaved in some way that may have made a difference to that person. Maybe to help prevent that outcome but definitely not contribute to it in anyway. It is a sad day when we as a profession of many good people with good intentions stand by collectively or individually in silence and witness something inappropriate happening to one of our colleagues. We must find a way to speak up professionally and persistently. Because if we don’t, this disease will never be managed and treated more efficiently and effectively. “Enough is enough”... Anonymous RN, RM
Commending the ANMJ I would like to commend the June 2015 ANMJ publication. The news reporting was very relevant and the feature story on dementia was excellent. Very valuable all remaining sections: in particular the midwifery/maternal health articles. Keep publishing. This journal is an excellent professional medium which is relevant to me even after reading my first publication in the 80’s. Angie Parker, Education Facilitator, SA
Euthanasia could undermine the perception of the profession Bianca Salter applauds Canada’s embrace of euthanasia (ANMJ Mail June 2015). However, it is well documented that in countries where assisted suicide and euthanasia have been legalised there are higher rates of elder abuse, deaths by ‘regular’ suicide and cases of euthanasia without consent. The Daily Mail Online 10 June, 2010 reported a study that found “A high proportion of deaths classed as euthanasia in Belgium involved patients who did not ask for their lives to be ended.” More than “100 nurses admitted to researchers that they had taken part in ‘terminations without request or consent’.” Elderly and frail patients are the most vulnerable of all. Euthanasia only increases their vulnerability. In the public perception nurses remain the most ethical and honest profession, but the embrace of euthanasia would severely undermine this perception. Maree Triffett, RN Tasmania July 2015 Volume 23, No. 1 47
SALLY
Sally-Anne Jones, ANMF Federal President
49% 49% OF AUSTRALIANS ARE AWARE OF THEIR FAMILY MEMBER’S DECISION TO DONATE.
378 DONORS
1,117 LIVES TRANSFORMED 2014, THE GENEROUS GIFT OF ORGAN DONATION FROM 378 DONORS AND THEIR FAMILIES TRANSFORMED THE LIVES OF 1,117 AUSTRALIANS.
There are a small number of highly specialised nurses with extraordinary emotional intelligence, well developed communication skills and clinical experience who work in Organ and Tissue Donation Coordination services across Australia. I am fortunate enough to work in a facility where there is a dedicated Organ and Tissue Donation team, and in a recent stint of higher duties, I developed an appreciation for what the nurses who work in this service do, and how special they are. It is Donate Life Week from 2 to 9 August 2015, so it is timely to share with all nurses and midwives how donation in Australia works, how it is important, and how you can help promote this program in your everyday work. The Australian Government funds dedicated nursing staff and doctors as part of the Donate Life Network, in 72 hospitals. In 2014, the generous gift of organ donation from 378 donors and their families transformed the lives of 1,117 Australians. Australia is a world leader for successful transplant outcomes. As you can see, one organ and tissue donor can save the lives of up to 10 people! Despite the willingness of the public to become donors, the willingness of families to uphold the decision of a loved one to donate (94%) and Australia’s success once transplant has occurred, only 49% of Australians are aware of their family member’s
48 July 2015 Volume 23, No. 1
decision to donate. In your everyday roles as health professionals, no matter what setting, you may have the opportunity to have a conversation with your patients, their families or members of the community about becoming an organ or tissue donor. The decision to become a donor is personal and important but also complex emotionally, ethically,
health professionals. There is also a comparison with international countries and their donation reforms on the site. The point of time when a decision to donate is followed through is possibly one of the most confronting, frightening, sad and challenging moments for any family member. Dealing with the feelings of grief, accepting the inevitable
IN YOUR EVERYDAY ROLES AS HEALTH PROFESSIONALS, NO MATTER WHAT SETTING, YOU MAY HAVE THE OPPORTUNITY TO HAVE A CONVERSATION WITH YOUR PATIENTS, THEIR FAMILIES OR MEMBERS OF THE COMMUNITY ABOUT BECOMING AN ORGAN OR TISSUE DONOR.
culturally for many people, and there are many questions about how it all works. The first place to start is a visit to the Donate Life website – www.donatelife.gov.au which has a plethora of information about the Australian Organ Donor Register with links to informative material, pamphlets and registration forms. Frequently asked questions and myths relating to donation are addressed such as: If I agree to donate, will doctors still work hard to save my life? Thousands of other people donate so I don’t need to… There are guides for how to start a conversation with family members about registering, and an online education tool for
end of the life of someone you love, and then having to think about whether or not you wish to follow through with the wishes of that person to donate their organs is almost impossible to comprehend or understand. Donor coordinator nurses are extraordinary people who have the clinical experience, communication skills, diplomacy and patience to approach families and loved ones in such difficult circumstances in order to facilitate fulfilment of the wishes of the donor, and to enable the receipt of healthstatus changing organs and tissues for others. This year, think about how you and your workplace can promote Donate Life week from 2 to 9 August. anmf.org.au
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