ANMJ July 2017 by Australian Nursing & Midwifery Journal

V O LU M E 2 5 , N O. 1 J U LY 2 0 1 7

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CONTENTS REGULARS

GREEN HEALTHCARE

02 DIRECTORY 03 EDITORIAL 04 NEWS 15 INDUSTRIAL

OUR ENVIRONMENTAL WARRIORS

CROCODILE TEARS OVER MINIMUM WAGE INCREASES

16 ETHICS SETTING NURSING’S MORAL COMPASS 18 FEATURE GREEN HEALTHCARE:

OUR ENVIRONMENTAL WARRIORS

23 RESEARCH 24 REFLECTIONS

IRAQ

25 WORLD 26 BOOKS 28 CLINICAL UPDATE

CONFRONTING OBESITY, STIGMA AND WEIGHT BIAS IN HEALTHCARE WITH A PERSON CENTRED CARE APPROACH: A CASE STUDY

32 REFLECTIONS

NEPAL: WHERE DO YOU READ YOUR ANMJ?

33 FOCUS

EDUCATION: PART 1

47 CALENDAR 48 ANNIE

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July 2017 Volume 25, No. 1 1

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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 Journal Note: ANMJ is indexed in the cumulative index to nursing and allied health literature and the international nursing index ISSN 2202-7114

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

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2 July 2017 Volume 25, No. 1

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131,889

TOTAL READERSHIP

Based on ANMJ 2014 member survey pass on rate Circulation: 90, 174 BCA audit, March 2017

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EDITORIAL

Editorial Lee Thomas, ANMF Federal Secretary Over a century ago the state of Victoria was one of the first regions in the world to legislate wages and create arbitration boards and councils to resolve labour conflicts before the recourse to strikes. These were the initial steps towards minimum wages. As an eventual consequence of this regulation made here in Australia and similarly in New Zealand, more than 130 countries across the world legislated the minimum wage to safeguard the financial wellbeing of low paid workers today. I was reminded of this fact by Executive Director of Oxfam International Winnie Byanyima, a leader in women’s rights, democratic governance and peace building, who spoke at Progress 2017 in Melbourne last month. As Winnie stated, this essential win for workers’ rights that we all appreciate today did not just occur, rather it was the perseverance of people on the front line making change happen. Just last month the Fair Work Commission raised Australia’s minimum weekly wage by 3.3%. While the increase equates to only $22.20 extra per week for low paid workers, many employers were unhappy about the raise that was only slightly above inflation. However the Fair Work Commission ruled that due to low inflation, low employment, high productivity and strong company profits, the Australian economy could well absorb an increase for low paid workers. While this increase is nominal, and not what unions were seeking, we can at least thank our predecessors whose activism led to the instigation of the basic wage, which is now protected through the Fair Work Act (see the Industrial column this month for more on this topic).

We must stand up against the detrimental changes to Medicare as well as the erosion of safe staffing levels in our aged care facilities. Equally, we must speak out and fight against the recent changes to penalty rates which currently affect retail, fast food, hospitality and pharmacy workers (read about this in the ANMJ news section). The worrying state of our environment and our leaders’ lack of action to save our planet is also cause for concern. Last month American president Donald Trump pulled the US out of the Paris Agreement on climate change, declaring that it was too costly to US industries to participate in. But according to reports from scientists, the ramifications of their withdrawal from its pledge could mean the earth will reach more dangerous levels of warming sooner as America contributes so much to rising temperatures. This month’s feature delves into this issue. It also discusses how nurses, midwives and healthcare facilities are paving the way in making environmentally friendly changes within their amenities which are contributing positively to the preservation of our planet. This is just one of the ways nurses and midwives are standing up for what is right and actively leading by example to make significant change. And just like our predecessors, who fought for legislated wages, it is possible that through our activism to fight for what is right we too can change the world.

Just as the activists of 1896, we too must continue to fight and protect our rights, those of our communities and of our environment. Never has this been more important than today where our healthcare and aged care systems seem constantly under attack. That’s why as individuals and as a collective we cannot sit back as idle bystanders to the injustices of our time or allow the wins made by our predecessors to be diminished.

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July 2017 Volume 25, No. 1 3

NEWS

RISE OF PREMATURE DEATHS IN NURSING HOMES SPARKS CALL FOR ACTION MONASH UNIVERSITY RESEARCH PROFESSOR JOSEPH IBRAHIM.

A 400% spike in the number of premature and potentially preventable deaths of nursing home residents over the past 13 years uncovered in a ground-breaking study last month has prompted appeals for a review into the aged care sector in a bid to fix the systemic problem. Using coronial data, the retrospective study, undertaken by Monash University and led by Professor Joseph Ibrahim, found 3,289 nursing home residents died from potentially preventable causes including falls, choking, and suicide from 2000 to 2013. Falls were exposed as the largest cause of premature deaths with 2,679 cases (81.5%), followed by choking (7.9%) and suicide (4.4%). Almost 60% of fall-related deaths (1,553 cases) involved residents aged 85-94. While the incidents leading to death usually occurred in the nursing home (95.8%), deaths more frequently occurred outside the nursing home (67.1%), reflecting the large number of deaths in hospital from the complications of falls. Overall, the study found the annual number of external cause deaths within nursing homes rose from 1.2 per 1,000 admissions in 2001-02, to 5.3 per 1,000 admissions by 2011-12. Part of this rise was attributed to changes and improvements in the reporting of falls to the coroner. The study concluded that the troubling increase demands a national policy framework to ensure a reduction in the number of premature deaths among Australians living in nursing homes. Further, it urged professionals from governments and the aged care sector to collaborate in developing strategies to prevent such deaths, as well as calling for the establishment of a lead authority to guarantee harm reduction by improving nursing home practices. “Our data challenges the misperception that all deaths of frail, older persons with multiple comorbidities living in residential aged care are natural,” the report’s findings said. “Effective planning for high quality aged care requires accurate data about preventable harm, as well as acknowledging that negatively value-laden judgements about the worth of an older person’s life do not justify inaction.” The Australian Nursing and Midwifery Federation (ANMF) said the research backed findings of the union’s own recent study into aged care staffing that found gaping holes across the system that were compromising essential care and treatment. ANMF’s Acting Federal Secretary Annie Butler said Professor Ibrahim’s research echoed the union’s worst fears regarding Australia’s problematic residential aged care sector and helped vindicate its push for mandated nurse and carer to patient ratios. “There just simply aren’t enough nurses or carers to ensure that every resident receives quality care. “This is a situation that is increasingly distressing for our members as well as for residents and their families and it’s one we are battling to change. The more evidence, such as this research, we have, the more politicians will have to listen.”

WHILE THE INCIDENTS LEADING TO DEATH USUALLY OCCURRED IN THE NURSING HOME (95.8%), DEATHS MORE FREQUENTLY OCCURRED OUTSIDE THE NURSING HOME (67.1%), REFLECTING THE LARGE NUMBER OF DEATHS IN HOSPITAL FROM THE COMPLICATIONS OF FALLS.

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Medicinal cannabis easier to access for terminally ill Terminally ill patients will have easier access to medicinal cannabis after the Senate voted to remove tighter controls imposed last year. While making medicinal cannabis more accessible last year, the federal government also put in place stricter regulations. The regulations required medical practitioners to apply and wait for approval from the Therapeutic Goods Administration (TGA) prior to prescribing medicinal cannabis. Under the Green’s motion passed in the Senate, medical practitioners notify the TGA when they have prescribed medicinal cannabis under the Special Access Scheme Category A process. The decision was supported in the Senate by Labor, One Nation and other key crossbenchers. “If you have a terminal illness, then you should be able to get access to treatment that is going to improve your quality of life,” Greens Leader Richard di Natalie said. The federal government described the decision as reckless. Senator for Tasmania Jacquie Lambie condemned the federal government in its refusal to support a ‘common sense’ decision. “It is a vote to see terminally ill people to be treated with dignity and respect.”

Online aged care training to meet multicultural needs A new aged care training program for staff being rolled out in South Australia is aimed to help address increasing specific needs of multicultural groups nationwide. The Australian online course for crosscultural care for aged care staff is being trialled in four aged care facilities in SA ahead of a national launch later this year. Flinders School of Nursing and Midwifery Associate Professor Lily Xiao said the course was designed for both Australian and overseasborn aged care staff. Overseas-born staff accounted for about 32% of the workforce in residential aged care, many from non-English speaking backgrounds. They cared for about 54,558 residents born overseas, she said. “It is clear we need to keep improving crosscultural communication in our aged-care homes, both between staff and residents, and to develop a multicultural workforce to improve the quality of care for residents,” Professor Xiao said.

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NEWS

REPORT MAPS OUT STRATEGIES TO SLASH GENDER PAY GAP

IMAGE FROM THE MEDIA CAMPAIGN

A federal Parliament Inquiry investigating gender segregation in the workplace and its impact on women’s financial security has triggered calls for a national strategy to close the gender pay gap.

PUSH TO END OCCUPATIONAL VIOLENCE FACED BY NURSES AND MIDWIVES

The Victorian government has launched a determined community awareness campaign in a bid to stamp out widespread occupational violence against healthcare workers including nurses and midwives.

Created by WorkSafe and the Department of Health and Human Services in response to endemic verbal and physical attacks endured by healthcare workers while on the job, the confronting ad campaign features an aged care worker being verbally abused, a nurse being spat on and a paramedic being assaulted on the street. The zero tolerance campaign was unveiled last month together with a pledge from the state government to double its investment in attempting to make hospitals and mental health services safer. An extra $20 million will be injected into the Health Service Violence Prevention Fund, bringing the government’s total investment to $40 million. The scheme’s first two rounds have helped support more than 60 health services improve their workplace environment through a range of projects such as installing alarms, CCTV, lighting and security systems and trialling innovative equipment including body warn cameras for paramedics and stabproof vests for hospital security staff. The government’s latest announcement also included plans which will see a range of public hospital emergency departments establish new behavioural assessment rooms and upgrade existing ones to meet new standards. The purpose-built rooms will be able to better assess and manage aggressive emergency department patients who could potentially harm themselves or staff. The first five rooms will be built at University Hospital Geelong, Austin Hospital, Casey Hospital, Northern Hospital and Warrnambool Base Hospital. Security staff at hospitals with EDs will also be increased, with additional resources set to be deployed to known hotspots to better protect staff and patients. The strong stance against the occupational violence faced by healthcare workers follows a 2015 Victorian Auditor General’s report that shone the spotlight on the level of abuse experienced by staff and the need to improve community awareness about the trauma it causes. Research shows almost 95% of healthcare workers have experienced verbal or physical attacks. ANMF Victorian Branch Secretary Lisa Fitzpatrick said violence was rife and needed to be addressed. “The violence has to stop and people have to learn to manage their frustration in difficult circumstances rather than hurt the people who are trying to care for them or their loves ones.” Ms Fitzpatrick said the government’s action to tackle the problem would make employers more accountable in implementing plans to better protect their staff and end preventable violence. She added that the culture of accepting violence within the health system was changing for the better and said workplace safety was achievable. anmf.org.au

ANMF ACTING FEDERAL SECRETARY ANNIE BUTLER

Measures include better flexible work provisions, payment of superannuation during paid parental leave and setting a pay equity target date.

The Finance and Public Administration References Committee’s final report also recommended amending the Fair Work Act 2009 in order to introduce gender pay equity as an overarching objective within the current regulations. In Australia, the disparity between men and women when it comes to take-home pay remains problematic, with research showing the gender pay gap has hovered between 15% and 20% for the past 20 years. According to the report, in 2015-16, six in 10 Australians worked in an industry dominated by one gender. It states emerging patterns across industries and occupations illustrate how caring responsibilities and the availability of flexible work can restrict the range of roles available to women and how not all workplaces are flexible. For women, the uneven distribution of flexible and part-time employment opportunities funnels them into particular industries and sectors, with the resulting segregation viewed as a key contributor to the gender pay gap. An example used in the report found a woman working in a female-dominated industry earns almost $40,000 less on average than a man working full-time in a male-dominated industry. The committee’s nine recommendations reflect the shifting landscape when it comes to addressing the gender pay gap and increasing calls for the government to take action and deliver fairer workplaces. The Australian Nursing and Midwifery Federation (ANMF) backed the report’s recommendations and said it was time longstanding wage disparity was corrected. “It’s time for the Federal Government to rectify the growing gender pay gap and recognise the invaluable contribution women make to the Australian workforce,” ANMF Acting Federal Secretary Annie Butler said.

July 2017 Volume 25, No. 1 5

NEWS

PENALTY RATE CUTS COME INTO FORCE Controversial cuts to weekend penalty rates that will affect 700,000 Australians working across the retail, fast food, hospitality and pharmacy industries will start being phased in from this month. The development brings to fruition a landmark ruling handed down by the Fair Work Commission (FWC) earlier this year to slash penalty rates across the sectors after it cited factors including insufficient adverse effects to employees working weekends and the potential for the reduction to boost employment. Transitional arrangements regarding the penalty rate cuts were announced last month, with reductions set to be gradually phased in until reaching their full effect in 2019 and 2020. The move will result in thousands of workers facing a pay cut each year over the

next three to four years. Penalty rate cuts will see fast-food employees have their current 150% Sunday rates hacked over the next three years until 2019. Similarly, workers in the retail and pharmacy sectors will have their Sunday penalty rates gradually reduced from 200% to 150% by 2020. For hospitality workers, Sunday pay rates will also fall from 175% to 150% during this period. As the initial penalty rate cuts are due to come into effect, opponents including trade unions remain unwavering in their fight to stop the process unfolding. Last month, the Australian Council of Trade Unions (ACTU) launched a TV and online ad campaign urging key MPs to back a Bill currently before Parliament to halt the cuts. ACTU Secretary Sally McManus said cuts to Sunday penalty rates equalled $70 per week and effectively amounted to more than $1 billion on lost wages across the board. Ms McManus vowed that the fight to protect entitlements would continue. “The workers give up time with family and friends because penalty rates keep them afloat. “We need a government that stands up for working people. Instead we are being told lie after lie about how these cuts are going to boost the economy.” Earlier this year, legal analysis undertaken by Maurice Blackburn on behalf of the ACTU, found the landmark decision could pave the way for a reduction in other sectors such as nursing and midwifery. While nursing and midwifery have been spared in the inaugural rollout of penalty rate

Misconceptions about nursing, triggered by stereotypes which often portray nurses as sexual objects or merely assistants to doctors, must be quashed in order to boost the number of school leavers entering the profession, research claims. According to a University of Queensland study, the nursing sector needs to challenge longstanding misinformed perceptions about the profession in order to accurately reflect the duties of the career.

DEBUNKING NURSING CLICHÉS KEY TO ATTRACTING NEXT GENERATION

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“Unfortunately, there is a misconception among some school leavers that could be attributed to negative media – such as the nurse who set fire to an aged care facility – and historical clichés where nurses were portrayed as sex objects, battle axes or a doctor’s right-hand maiden,” Dr Anthony Tuckett (pictured), of UQ’s School of Nursing, Midwifery and Social Work said. Aiming to combat the negative misconceptions and lack of knowledge, UQ researchers surveyed a group of 109 early-career nursing professionals from Australia and New Zealand, asking them what key words, phrases and images they would use in a recruitment

ACTU SECRETARY SALLY MCMANUS SAID CUTS TO SUNDAY PENALTY RATES EQUALLED $70 PER WEEK AND EFFECTIVELY AMOUNTED TO MORE THAN $1 BILLION ON LOST WAGES ACROSS THE BOARD.

cuts, the legal analysis claimed many of the justifications used for reducing penalty rates likely apply to other industries and open up the door for broader attacks. United Voice, the union for hospitality workers, said it would appeal the FWC’s “unfair” decision in the Federal Court in a bid to “reinstate the principals of our wage setting system. “The system has completely failed the hundreds and thousands of Australians who give up time with their loved ones to work on weekends and public holidays.” National Secretary Jo-anne Schofield said. “We cannot turn away and accept a decision that impacts so dramatically on our members and, potentially, on all workers.”

poster designed to encourage school leavers to study nursing. The results identified the opportunities, rewards and ability to travel that a nursing career can provide, with the top three keywords listed as ‘opportunity’, ‘rewarding’ and ‘travel’, and the three core images survey recipients felt most positively depicted nursing as a lifelong career pointing to ‘care’, ‘opportunity’ and ‘task, technical, technology and role’. The research concluded that in order to encourage more school leavers to pursue nursing the sector must underscore key messages including ‘not two days are ever the same’, ‘make a difference’ and ‘get a job anywhere in the world’. “We hope these findings shape the way nurse educators and leaders recruit for students in the future,” Dr Tuckett said. “It is also necessary to complement this messaging as part of an overall promotional strategy by utilising social media and webbased technology to celebrate and promote exemplary practice, education, research and the achievements of the nursing workforce.”

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NEWS The Coalition of National Nursing and Midwifery Organisations (CoNNMO) has unveiled a list of 12 shared national priorities outlining a range of targets it believes can help promote and support the critical role nurses and midwives play in maintaining the health and wellbeing of the Australian population.

CoNNMO OUTLINES JOINT NATIONAL PRIORITIES CoNNMO CHAIR CHRISTOPHER CLIFFE.

The result of rigorous collaboration and consultation, the priorities include calling on governments to develop a National Aboriginal and Torres Strait Islander Nursing and Midwifery Strategy; the need to overhaul legislative, regulatory and administrative barriers preventing nurses and midwives from practicing to their full scope of practice; and demanding nurses and midwives adopt a zero tolerance approach when dealing with discrimination such as bullying and racism. The national priorities also encourage nurses and midwives to become leaders in their respective professions and improve public awareness about their value within the healthcare system. Established by the ANMF in 1991, CoNNMO comprises 55 diverse nursing and midwifery organisations aiming to improve the country’s health and wellbeing by maintaining an empowered, focused, and qualified nursing and midwifery workforce. CoNNMO Chair Christopher Cliffe, CEO of CRANAplus, said the collective

priorities demonstrated an emerging unified voice that could help trigger significant national change. “The nurses and midwives organisations represent work in every aspect of healthcare, regardless of complexity, from cradle to grave and from the inner city to the most isolated areas of this country. “As nurses and midwives are the largest and clearly essential part of our healthcare workforce, our national priorities commit us to use our considerable, informed voice to advocate for improvements in health outcomes.” CoNNMO Secretariat, ANMF Senior Federal Professional Officer Julianne Bryce, said national priorities reflected a call to arms for nurses and midwives to lead the way in national decision making concerning health and aged care policy practice. “These national priorities provide a framework for future discussion and debate. They form the foundation for future agreed positions on issues of national importance to the nursing and midwifery professions.” CoNNMO will review its national priorities on an annual basis through its regular member meetings.

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NEWS RURAL AND REMOTE RESIDENTS SUFFER POORER HEALTH OUTCOMES Australians living in rural and remote areas have higher levels of disease and injury, poorer access to health services, and die earlier than residents from metropolitan areas, according to a new report released from the Australian Institute of Health and Welfare (AIHW). The report found 54% of people living in rural and remote areas suffer chronic disease, compared to 48% in major cities, and that the cohort faces mortality rates, 1.3 times higher than its urban counterparts. Findings revealed significant health disparities across the board, with rural and remote Australians 5.4 times more likely to die from a land transport accident and 1.7 times more likely to die of suicide, with one in five people smoking daily and more than two in three people considered overweight and obese. The report

suggested poorer health outcomes in rural and remote areas could be attributed to a cluster of factors including disadvantage stemming from reduced education and employment opportunities, income, and access to health services. It also stated higher death rates and poorer health outcomes outside major cities, especially in remote areas, reflects the higher proportion of Aboriginal and Torres Strait Islander population living in those areas, many whom experience greater disadvantage. Despite significantly poorer health outcomes, the report noted that the Household, Income and Labour Dynamics Australia (HILDA) survey found Australians living in small towns (fewer than 1,000 people) and non-urban areas generally experience higher levels of satisfaction compared to those living in major cities.

UNHERALDED CARERS URGED TO SEEK SUPPORT The federal government is attempting to tap into more than 2.5 million Australians who it believes provide care to family, friends, or neighbours but are unaware of support services available that provide practical information and links to resources. The government is encouraging carers to connect with local services via its national online and telephone service – Carer Gateway. The service offers a starting point for connecting with support and services and includes information and advice on types of carers, payments and health and wellbeing. Assistant Minister for Social Services and Disability Services, Jane Prentice, said research showed almost 80% of carers do not consider themselves a carer and therefore aren’t aware of services available to them.“Anyone looking after a person with disability, chronic illness, dementia, mental illness or frailty due to age may be entitled to government assistance and support services. “For example, if you are assisting a severely ill relative, you may be eligible for respite support or you may wish to connect with a support service to help you manage your caring role.” Carer Gateway can be accessed online at www.carergateway.gov.au or by phoning 1800 422 737 between 8am-6pm on weekdays.

HEALTH SYSTEM HOLDS OPPORTUNITY TO PROVIDE BETTER CARE Hospitalisations for many chronic conditions can be significantly reduced with better access to effective secondary prevention programs, a landmark report dissecting the level of variation among common healthcare treatments has found. Released last month, the Australian Commission on Safety and Quality in Health Care’s Second Australian Atlas of Healthcare Variation revealed large variations in typical health treatments across 300 local areas nationally and consequently indicated room to improve patient care and health outcomes. The report found almost half (47%) of potentially preventable hospitalisations in Australia in 2014-15 were associated with five leading chronic conditions – diabetes complications, heart failure, cellulitis, chronic obstructive pulmonary disease (COPD) and kidney and urinary tract infections. The report, which investigated 18 topics including knee replacement and included a specific chapter dedicated to women’s health, states results showing high hospitalisations rates and large variations illustrate the potential for the health system to take action in providing better coordinated care. Examples showing large variations

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included complications from diabetes, with outback North Queensland recording the highest rate of 601 potentially preventable hospitalisations compared to Manly (NSW) and Brisbane registering just 52 and at the lowest end of the scale. The health of Aboriginal and Torres Strait Islander Australians was also explored, with results revealing preventable hospitalisation rates almost five times as high as non-Indigenous Australians for COPD and nearly four times as high for diabetes complications. Despite the fact vision loss from cataract is 12 times as high for Indigenous Australians, the cohort recorded a 17% lower rate for cataract surgery compared to other Australians, pointing to questionable health equity. Atlas Advisory Group chair, Professor Anne Duggan (pictured), said the findings, which contain many positive improvements, also offer valuable information for clinicians on where best to direct efforts to improve patient care. “The goal is appropriate care – the right care for the right person, at the right time. “The Atlas focuses on areas of health care in which the thinking about what treatments work best has changed considerably in recent years, either because treatments have come along or because the evidence about existing treatments has shifted.” Australian Healthcare and Hospitals

Association (AHHA) chief executive Alison Verhoeven said reducing preventable hospitalisations was a longstanding concern, but finding solutions demands increased funding, research and system redesign. “Our health system needs to move towards a value-based system that is patient-centred and rewards efficient, effective and equitable care that produced demonstrable outcomes, rather than a system that rewards number of occasions of service, as happens now.”

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NEWS

FIGHT OF OUR TIMES: STOPPING ADANI The campaign against Australia’s largest coal mine is the fight of our times, delegates at the recent Progress conference in Melbourne heard last month.

MEN’S HEALTH REGISTER FOR BETTER OUTCOMES A new Men’s Health Register to boost men’s representation in health research and lead to better health outcomes was launched last month. The register is a joint collaboration between the University of Adelaide and the Freemasons Foundation Centre for Men’s Health. At best, male representation is 25-30% in health studies compared with women, said University of Adelaide Behavioural Scientist Dr Camille Short. “This really limits our ability to learn what works for men, and how we can better design services and treatments that best meets their needs and preferences.” Dr Short, who established the register, said the stats needed to change to ensure the healthcare system worked for men.

The controversial $16.5 billion Carmichael coal mine and rail project was given the go ahead after the Queensland government approved royalties with Indian company Adani Mining last month. The coal mine proposed for the north of the Galilee Basin would be the first of several coal mines for the area producing 60 million tonnes of coal a year to export to India. It includes development of a 189km railway line. The Queensland Government claims the project would create 10,000 jobs. The ‘Say No to Adani’ campaign has gained public momentum over recent months with high profile Australians and environmental groups leading the charge. Concerns include potential devastating effects to an already threatened Great Barrier Reef, to groundwater and carbon emissions generated. Sunrise Project Executive Director John Hepburn said the mine had been given unprecedented federal and state government support of $1 billion in taxpayer funding to effectively ‘loan’ the project. “Our challenge is to stop that loan from happening. This is a contest of ideas about the future we want to create. People are saying no to a project that is not good for our environment, our future and which is backed to the hilt by the government. “If we lose the Adani campaign we blow our carbon budget, trample Indigenous rights, trash the Great Barrier Reef and drive global warming – we lose the fight for climate change. “If we win, we kick the big polluters out of our system,” Hepburn told delegates at the Progress conference in Melbourne. Former Australian of the Year and Nobel Laureate Professor Peter Doherty urged nurses and midwives to get on board with the campaign at the recent ANMF Victorian Branch Health and Environmental Sustainability conference held in Melbourne.“We can be noisy and we can vote. When people develop coal mines they show contempt for us all. Do not vote for any government that wants to create coal mines.” To show support, visit: www.acf.org.au/sayingnotoadani STOP ADANI MEDIA CONFERENCE INDIA L TO R GEOFF COUSINS AM, IMOGEN ZETHOVEN AO, BRUCE CURRIE AND DR LINDSAY SIMPSON 16 MARCH 2017

After sign up, men will be regularly contacted about studies. They can participate in surveys, studies testing new services and programs, or treatments for common issues affecting men. These include on exercise and nutrition, chronic disease, depression, sexual and reproductive health, parenting, prostate cancer and workplace injury. Men signed up can also opt to receive the latest men’s health information. Freemasons Foundation Centre for Men’s Health Dr Sean Martin said the register would pool together men from all walks of life. “Most of us know that men’s attitudes and behaviours towards their health often differ between sub-groups of men and certainly differ from that of most women. It’s important we capture this difference in our research if we’re to plot the best way forward.” Australian men can register online at: adelaide.edu.au/menshealth/register 10 July 2017 Volume 25, No. 1

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NEWS Victorian general practice nurse Natalie SimpsonStewart said the minimum wage increase was a bitter pill to swallow.

MINIMUM WAGE INCREASE NOT ENOUGH

SUPPORT ABORIGINAL WOMEN’S MARCH AGAINST DOMESTIC VIOLENCE Aboriginal women from Alice Springs Town Camps are calling on all Australians to help lift the cloak on the invisibility of family and domestic violence (FDV). Women from the Tangentyere Women’s Family Safety Group (TWFSG) will lead a Women’s Action March on 11 July in Alice Springs. All Australians are urged to show their support via Facebook and Twitter. TWFSG coordinator Shirleen Campbell said women from the 16 Alice Springs Town Camps were frustrated by the increasing invisibility of Aboriginal women despite the high rates of domestic violence they face. “We are asking Alice Springs and people all around Australia to stand with us women, support our voice and hear our stories. Don’t let Aboriginal women experiencing domestic violence be invisible.” The march will include the planting of symbolic flowers to represent women who are living with, injured or dying because of violence, Ms Campbell said. The TWFSG was set up two years ago after Ms Campbell’s Auntie was murdered by her partner. “Too many women continue to be hurt and killed and we are sick of it,” she said. “We are frustrated by the continued violence and the way Aboriginal women victims are sometimes ignored, especially in the media.” In two years, the TWFSG has worked to help reduce and prevent family and domestic violence, in particular in primary prevention and early intervention. A family violence prevention training on town camps since May last year has trained about 140 women in FDV. TWFSG has developed signs located at the entrance of each of the 16 Town Camps which read: “The Town Camp Women of Alice Springs Say No to Violence”. The group hold monthly meetings with Alice Springs police and engage with government. The TWFSG was awarded a NT Human Rights Award in 2015, and shortlisted for the Indigenous Governance Awards in 2016; and presented at the Global Indigenous Say No to Violence conference also in 2016. Former Australian of the Year and family and domestic violence advocate Rosie Batty is a patron after a visit late last year. The United Nations Special Rapporteur on Violence Against Women met with the group in February.

For more information and to show support: Facebook Page Tangentyere-Women Alice Springs Twitter #standwithuswomen #istandwithyou 12 July 2017 Volume 25, No. 1

The Australian Nursing and Midwifery Federation (ANMF) believes a 3.3% increase to the minimum wage, totalling just a tick over $20 per week more for low-paid Australian workers, will do little to help nurses, midwives and aged care staff struggling to make ends meet. Announced by the Fair Work Commission (FWC) last month, the $22.20 per week increase falls well below the $45 boost unions were seeking on behalf of 2.3 million low-paid workers. Nurses, midwives and assistants in nursing (AINs) working in GP clinics and aged care remain among the most vulnerable workers, receiving up to 20% less than their public sector colleagues covered by Enterprise Bargaining Agreements (EBA). ANMF Acting Federal Secretary Annie Butler labelled the decision “extremely unfair” for thousands of union members working under the current national Nurses Award 2010. “This minimal increase in the weekly minimum wage will do precious little in addressing the wage disparity between awarddependent nurses, midwives and care staff and the rest of the nursing and midwifery workforce on EBAs earning much more,” Ms Butler said. “How can such a measly increase possibly help working families keep pace with rising utility costs, grocery bills, rents and mortgages?”

“For me, it’s not going to change my life dramatically,” she said. “Regardless of where you work, nurses across the board, we’re struggling. We’re certainly not the lowest paid but I wouldn’t say we’re incredibly fairly remunerated for what we do and the liability we carry.” Natalie earns considerably less than she would working in the public sector and also does not receive benefits like shift penalties and access to study leave. “It’s not so much for me, but our assistants in nursing (AINs) and personal care attendants (PCAs) who are getting paid even less than registered and enrolled nurses….I don’t know how they do it. I don’t know how they do shift work and make ends meet and then to be offered $20 a week; it’s discouraging.” As a general practice nurse, Natalie is one of thousands of nurses who work under the Nurses Award 2010. She left the public hospital sector several years ago, sacrificing better wages for more flexibility to work around raising her young children. She believes her knowledge base is broader than when she previously worked in the hospital system and that the autonomy involved in the role is greater. Yet she said her wage doesn’t accurately reflect her output. “I’ve always loved what I do and general practice nursing is my niche and that’s where I’m happiest and feel I’m most useful. But I sort of think and what price?”

anmf.org.au

NEWS

TAX TIPS FOR NURSES AND MIDWIVES Tax time is upon us and all nurses and midwives should be well informed on their entitlements when claiming tax deductions on workrelated expenses to ensure they get the best return. Like any profession, nursing and midwifery is unique. Carrying out the job often involves performing diverse tasks, travel, being oncall and ongoing education. If you are employed as a nurse you could be entitled to claim a tax deduction for work-related expenses including uniforms, self-education, and phone usage. The Australian Tax Office encourages workers to claim everything they’re entitled to but to remember three golden rules make sure you spent the money yourself and were not reimbursed; make sure it’s related to your job and; you must have a record to prove claims. When it comes to car expenses and travel, nurses should claim a deduction for the cost of using their car for workrelated travel if travelling between two separate workplaces, such as hospitals, or

ELDER ABUSE REPORT CALLS FOR ACTION Calls for a national plan to combat elder abuse followed recommendations from a federal inquiry into elder abuse last month.

if travelling from one’s normal workplace to an alternative workplace and back, such as attending a different hospital for a meeting. Make sure to include expenses for using taxis, short-term car hire, parking fees and tolls, and for travel to undertake selfeducation, but only if your employer has not already reimbursed you for the expenses. For clothing, nurses can claim a deduction for the cost of buying, hiring, repairing and cleaning certain work-related uniforms, occupation specific clothing, and protective clothing. A compulsory uniform required by the workplace can allow deductions for shoes, socks, and stockings, if they are an essential part of the uniform. You can also claim a deduction for the cost of laundering and dry-cleaning work clothes, with a claim for laundry expenses of $150 or less not requiring written evidence. Self-education expenses related to a course provided by an educational institution that is undertaken to gain qualifications for use in carrying on the profession, can also be claimed. Tax deductions can include attending seminars, conferences, and education workshops or training courses related to nursing or health. The study must maintain or improve specific skills or knowledge currently used in the person’s job. Further claims for self-education can include costs for textbooks, stationery, and student union fees, as well as home office and travel expenses. Other common expenses claimed by

The Australian Law Reform Commission’s report followed a 15-month inquiry and included 43 recommendations. “This includes a national plan to protect the rights and wellbeing of older Australians with a goal to end elder abuse,” Age Discrimination Commissioner Dr Kay Patterson said. The Elder Abuse – A National Legal Response was the result of 117 stakeholder meetings and more than 450 submissions, including by the ANMF. Report recommendations include for improved responses to elder abuse in residential aged care; better safeguards to protect those at-risk; and banks and financial institutions to protect vulnerable customers. Those working with older people in particular had a responsibility to understand what elder abuse was nd to commit to its elimination, Dr Patterson said. “It has a devastating impact on individuals, families and communities across the country.” The report was released on World Elder Abuse Awareness Day on 15 June. The 2017 WEAD theme is financial

anmf.org.au

NURSES CAN ALSO CLAIM A DEDUCTION FOR UNION AND PROFESSIONAL ASSOCIATION FEES.

nurses include the cost of renewing annual registration, depreciation in equipment used for work including computers, first aid training courses if the designated first aid officer, overtime meal expenses, the purchase of technical publications such as journals related to nursing, work-related telephone calls, and repairing tools and equipment for work. Nurses can also claim a deduction for union and professional association fees. The ATO publishes a range of information on its website to help taxpayers figure out which of their expenses are deductible. It also provides an app that can help make keeping records easier, and at tax time you can send your deductions to your tax agent or upload them directly to myTax. To download the app go to www.ato.gov. au/general/online-services/ato-app/

exploitation. Maurice Blackburn Lawyers Principal Andrew Simpson said financial abuse remained amongst the most highly reported form of elder abuse in Australia. “It is also important that people are aware that elder financial abuse can take many forms, including financial manipulation, a transfer of denial of assets or the withholding of income to live comfortably. Only by recognising these signs and ensuring older people feel safe to seek advice can we hope to stamp out elder abuse.” Labor leader Bill Shorten also acknowledged the report’s focus on financial exploitation. Mr Shorten said he had sought assurance from the Prime Minister the government would respond to the report’s recommendations as a priority. “The mistreatment of older Australians is simply not acceptable and Labor stands ready to work with governments at all levels to stamp out elder abuse.” The report is available at www.alrc.gov. au/publications/elder-abuse-report

July 2017 Volume 25, No. 1 13

NEWS

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A Senate Inquiry into Australia’s aged care workforce has recommended the federal government introduce minimum nurse and staffing requirements in nursing homes. The Senate community affairs committee report found the majority of older people who now entered residential aged care had complex and greater care needs, with the trend predicted to continue. The report noted that the ratio of staff to residents in some facilities “is too low and risked compromising the quality of care delivered.” It recommended providers publish their workforce ratios “in order to facilitate informed decision making by aged care consumers.” The ANMF immediately called on the federal government to take urgent action to introduce minimum nurse and staffing requirements in nursing homes. “All this evidence, on top of report after report into aged care, must now be enough for the Aged Care Minister to accept the committee’s recommendations and fix the crisis in aged care and improve the lives of vulnerable, elder Australians living in nursing homes,” ANMF Federal Secretary Lee

Thomas said. Ms Thomas thanked the Senators for listening to the shocking evidence presented by nurses, carers and families of nursing home residents. The Inquiry received 325 submissions.“Our members working on the ground in aged care recounted shocking stories of how their elderly, vulnerable patients were being neglected due to inadequate staff shortages, with evidence of just one qualified nurse caring for up to 85 patients.” An Australian Law Reform Commission report released last month found a lack of minimum staffing regulations and appropriate skills mix had resulted in the abuse of elderly, vulnerable residents in aged care. The report found the proportion of RNs and ENs had decreased while the proportion of AINs/personal care workers had increased; and accounted for about 70% of direct care workers. The ANMF particularly welcomed the Senate’s recommendation the government consider requiring aged care service providers publish their staff to client ratios. “We think this is an excellent initiative which will make the sector become safer and more transparent and make providers more accountable. Families of nursing home residents have a right to know the level of care they can expect to receive,” Ms Thomas said. Other recommendations included “clear steps” to address the pay difference between the aged care and acute healthcare sectors. In addition, mechanisms to rapidly address staff shortages and other factors that impacted on workloads and health and safety of aged care workers. “It’s time for the government to act now and accept the committee’s recommendations,” Ms Thomas said.

ENERGY BILLS BITE THOSE ON POVERTY LINE NSW residents in hardship are going without food and forgoing medical treatment in order to pay electricity bills, a cost of living report shows. A National Council of Social Services (NCOSS) report found 36% of NSW residents living below the poverty line were forced to go without dental treatment. One quarter had forgone medical treatment. And 9% had gone without a substantial meal on a regular basis. Alarmingly, 6.5% of survey respondents reported children were forced to miss a substantial meal as a result of energy bills. “To see families in our state struggling to put food on the table because of power bills is simply unacceptable,” NCOSS CEO Tracy Howe said. The report followed the release of the Finkel review last month and as energy retailers began expanding hardship programs in preparation for electricity price hikes. The impact of energy prices had serious consequences for many in terms of health

14 July 2017 Volume 25, No. 1

and mental health, Ms Howe said. “The reality is that they [people] are skipping meals, delaying health treatment, not using hot water for bathing and going to bed early to save energy – all to pay their energy bills.” More than 45% of survey respondents said policy efforts for affordable essential services should be the state government’s highest priority. “Energy is an essential service that many of us take for granted. But many in our community are clearly struggling to afford its high and growing cost. More needs to be done to support them,” Ms Howe said. “Retailers need to do better to ensure vulnerable people are on better deals, so that their bills are as low as possible, and that government supports provide the most possible benefit to them.”

anmf.org.au

INDUSTRIAL

Nick Blake, Senior Federal Industrial Officer

CROCODILE TEARS OVER MINIMUM WAGE INCREASES In a recent trip to a favourite café for lunch I noticed that the price of a Mexican focaccia had increased from $9.00 to $9.90 - an increase of a neat 10%. I took particular interest in this change because that morning I had read a number of newspaper and internet reports of employers bemoaning the fact that there had been an increase in Australia’s minimum wage. The national minimum wage is the legal minimum that must be paid to an adult fulltime employee who is not covered by an award or enterprise agreement. While those on the minimum wage tend to be largely invisible workers, they are many in number, with around 66,000 workers identifying as minimum wage employees in 2016. Furthermore, today there are still nearly three million Australian workers reliant on awards which provide for minimum wage rates and basic employment conditions. And despite the media hype most people dependent on minimum wages do not fit the low wage stereotype of a teenager with casual employment in their local supermarket.

WHILE THOSE ON THE MINIMUM WAGE TEND TO BE LARGELY INVISIBLE WORKERS, THEY ARE MANY IN NUMBER, WITH AROUND 66,000 WORKERS IDENTIFYING AS MINIMUM WAGE EMPLOYEES IN 2016. Many are adults with dependent children who work on a full time basis. It is estimated that around 57% of women workers are reliant upon, and receiving, the minimum wage across a number of industries. Under the Fair Work Act our national tribunal must review the minimum wage annually. On 6 June anmf.org.au

2017 the tribunal ordered a 3.3% increase in the minimum wage which is equal to 0.59 cents extra per hour or $22.20 extra per week. In addition the tribunal ordered that all award weekly rates of pay increase by the 3.3%. In making the decision to lift minimum wages the Fair Work Commission observed that with low inflation, low employment, high productivity and strong company profits the Australian economy could well absorb an increase for low paid workers slightly above inflation. The tribunal president, Iain Ross, said the gradual improvement in the Australian economy meant the commission had an opportunity to “improve the relative living standards of the low paid”. He acknowledged the increase would not lift all employees on the minimum wage out of poverty, particularly single parents with children, but stated the increase “means an improvement in the real wages for those employees who are reliant on the minimum wage and an improvement in their relative living standards.” For its part employer groups were pushing for ‘caution and restraint’ advocating for a much smaller increase of between 21 and 26 cents per hour. Their savage response to the announcement of a 3.3% increase was not unexpected, claiming it would restrict jobs growth, particularly for the young and would increase costs for consumers. And the evidence to back up these claims? Well, none. In fact there has been lack of evidence to support the argument that small increases in wages for low paid workers have any

detrimental impact on the economy. The opponents of increases to minimum wages fundamentally pursue shallow and often self-serving arguments designed to benefit the well off in our communities. However anyone who has walked into a supermarket, is renting a house, or has recently paid an electricity or gas bill knows that it would be very difficult to live on around $18 per hour as a single person, never mind for someone who is trying to support a family. The argument that raising minimum wages depresses jobs growth, while basically disproved, simply misses the point. While being unemployed is a difficult economic condition, the whole purpose of a job is for a person to earn enough money to be able to survive in a decent manner. Or, as described by High Court Justice, Henry Higgins in 1904, ‘minimum wages must have as its starting point the cost of living as a civilised being’. Jobs that do not do that are probably better than nothing, but fall well short of meeting the needs of most people. Arguing against raising minimum wages because it may limit the creation of jobs (ie. jobs that do not pay enough for people to survive) is harsh because it essentially advocates for a greater number of jobs at wage levels that are too low. There are also sound economic arguments to increase minimum wages where possible. For instance even if a change in the minimum wage did indeed have a marginal negative effect on employment it is worth noting that low income earners spend most if not all of their income. To get an economic benefit, spending power has to be in the hands of those who actually spend in the real economy; that means regular people, not the wealthy who tend to hoard wealth. Therefore minimum wages along with penalty rates, earned by those on minimum wages and other low paid workers, are effectively returned to the local economy, which in turn increases employer profits and creates employment. And, as a rule, wage earners not only rely less on social security benefits, through their taxes they contribute to the support of others. The bottom line is that if workers’ real earnings fall because they do not keep pace with inflation, then they have less to spend. When people spend less, demand for goods and services falls, and in turn so does the demand for jobs. This is why those that campaign for minimal or no wage increases for low paid workers are pursuing a policy that will not create jobs, rather it will only reduce living standards for those who can least afford it. July 2017 Volume 25, No. 1 15

ETHICS

SETTING NURSING’S MORAL COMPASS Megan-Jane Johnstone Megan-Jane Johnstone

References Calhoun, C (ed). 2004. Setting the moral compass: essays by women philosophers. Oxford University Press, New York. Felblinger, M. 2008. Incivility and bullying in the workplace and nurses’ shame responses. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37(2): 234-242. Malik, K. 2014. The quest for a moral compass: a global history of ethics. Atlantic Books, London. Moore, C., & Gino, F. 2013. Ethically adrift: how others pull our moral compass from true North, and how we can fix it. Research in Organizational Behavior, 33: 53-77.

Megan-Jane Johnstone is a retired Professor of Nursing who now writes as an independent scholar. Internationally renowned for her work, she has published extensively on the subject of nursing ethics and is the author of the widely acclaimed book Bioethics: A Nursing Perspective.

There is much to suggest that nurses individually and collectively have perhaps lost their moral compass. Indications of this can be found in the pages of a growing body of nursing literature on subjects such as incivility and bullying in the workplace, clique behaviours and the alienation of ‘out-group’ colleagues, the rise of academic dishonesty and unethical behaviour in nursing education and clinical practice, the problem of authorship misattribution, breaches of professional conduct standards through the indiscrete use of social media, the unchecked occurrences of racism, ageism, homophobia and other prejudicial behaviours in nursing contexts, the normalisation of deviance, to name some. Nurses’ political alignment with issues that are driven by populist opinion and personal dogma yet are not the raison dètre of the nursing profession.

of the most comprehensive accounts of this quest can be found in a 2015 three volume set on Nursing Ethics published by Sage in the UK (see https://uk.sagepub.com/en-gb/ eur/nursing-ethics/book243340). These three volumes track the development of ethical thought in nursing over the past century, dating from when the first article on the subject was published in 1889. Efforts by successive nurse leaders over the decades have culminated in the development and ratification of companion codes and standards of ethical practice, nationally and internationally. It is appropriate to question, however, whether these codes and standards which the nursing profession has relied on historically are up to the task of guiding nurses in the ‘right direction’.

A question of nursing ethics

Here two questions arise: First, what is a ‘moral compass’? And second, is the nursing profession’s moral compass up to the task of guiding nurses to successfully navigate the moral terrain within which they live and work?

Moral compass defined

The term ‘moral compass’ is used metaphorically to describe a person’s inner sense of right and wrong, which motivates them toward ethically sound judgements and actions (Moore & Gino 2013). The metaphor is informed by the nature and use of navigational compasses which rely on the earth’s magnetic field. Aligned with the magnetic fields at the top and bottom of the earth, the needle of the compass consistently points north, thus allowing successful navigation (Moore & Gino 2013). In the case of a moral compass, ‘pointing north’ indicates a clear and stable moral orientation. Statements about people having ‘lost’ or ‘mislaid’ their moral compass, in turn, metaphorically refers to those who have lost or misinterpreted their moral bearings and, as a result, have ended up in the wrong place (ie. tolerated or engaged in unethical behaviour) (Moore & Gino 2013).

Nursing’s moral compass

The history of the modern nursing profession’s quest for a moral compass is well documented. One

16 July 2017 Volume 25, No. 1

THE TERM ‘MORAL COMPASS’ IS USED METAPHORICALLY TO DESCRIBE A PERSON’S INNER SENSE OF RIGHT AND WRONG, WHICH MOTIVATES THEM TOWARD ETHICALLY SOUND JUDGEMENTS AND ACTIONS (MOORE & GINO 2013)

‘Pointing north’

Contrary to what might be popularly believed people do not have ultimate control over their own moral compasses. Even ‘good’ and well-intentioned people can find themselves crossing ethical boundaries and being ‘ethically adrift’ without even realising it (Moore & Gino 2013, p.55). This is because there are both powerful and subtle influences that can misdirect an individual’s moral compass and which can lead them to believe that they are being ethical when they are not (Moore & Gino 2013, p 55). In a comprehensive exploration

of the subject, Moore and Gino (2013) identify a range of socialpsychological influences and organisational aggravators that can facilitate what they term: moral neglect, (faulty) moral justification (manifest as self-verification), and ultimately moral inaction. In the case of moral neglect, individuals succumb to the social norms of the day and, eager to ‘fit in’ and to behave in socially approved ways, lose sight of the possible moral consequences of their behaviour. Wanting to retain membership (and the approval) of the ‘in-group’, the grounds are set for moral disengagement, moral hypocrisy, moral fading, and ultimately moral inaction. Moral neglect is further facilitated by what Moore and Gino (2013, p.58) term ‘organizational aggravators’. Notable among these are the processes of organisational socialisation and identification, role expectations, goal orientation, and group loyalty – all of which can, in various ways, be morally degrading and corrupting. Taken together, these processes can create a powerful barrier to ‘doing the right thing’. In the case of nurses, they can also work to accustom individuals to ‘tolerating behaviors that are outside the realm of considerate conduct’ often without their even being aware of it (Felblinger 2008, p.238). Agreed codes and standards of practice may well provide ‘the stable point North’ that nurses need. However, if individuals do not know about the profession’s moral compass, misinterpret its directions, lose control of their own moral compasses, or lose their moral compasses altogether, then they risk crossing moral boundaries and tolerating if not actively engaging in unethical conduct. This risk is amplified if the profession’s moral compass is itself faulty or broken. It may be necessary for nurses to recalibrate and reset their moral compasses and, when doing so, to reflect on the point at which they are prepared to stop and take action to prevent an unethical act. They also need to consider instances in which they were the ones who ‘walked away’–who turned a blind eye–and did nothing to rectify what they had observed. Setting and strengthening a moral compass requires effort and progressive moral thinking (Calhoun 2004; Malik 2014). But then so it should since anything less would fail to render that compass a reliable navigational instrument. It also requires an open and honest conversation about the things that matter in nursing, the time for which is ever-present. anmf.org.au

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FEATURE

Extreme weather patterns, global warming and air pollution are increasingly becoming the norm, the consequences of which are being felt across the world. Climate change is being touted responsible, compelling a commitment from world leaders to reduce emissions in an attempt to curtail the impact. Yet to ensure environmental sustainability everyone must play a role including nurses, midwives and healthcare facilities. Natalie Dragon investigates the progress healthcare has made to this end.

arden development and spaces don’t just happen”, says Melbourne Clinical Nurse Specialist and Horticulturalist Steven Wells. “And they have to be sustainable with low water use requirement; they have to survive on rainfall.” Steven is Australia’s first Gardens and Grounds Project Officer at Austin Health, in Melbourne’s north. A “collection of pots and some nursing time” to support patients with acquired brain injury started in 2003. Steven now creates gardens for respite, recovery and restoration. “The use of plants and garden-related activities assist with achieving patient goals and promote physical and emotional wellbeing needs. “While tinkering and chatting we are making a difference to our patients. It’s a moment of normality. Patients are not sitting in a hospital bed but reconnecting with their world, the natural world.” Austin Health’s master plan was to develop gardens to patient areas for their health benefits and also for staff. Since 2011, $754,000 has been spent, largely philanthropic, on garden projects. Some 23 diverse projects include 6,700 plants in garden spaces in acute care, mental health, rehab, child care, and various courtyards over Austin Health’s three campuses. An impressive 19 metre wide Jessie Mary Vasey Labyrinth at the Heidelberg Repatriation Hospital is a tool for personal, psychological and spiritual transformation. The ‘Sensory Gardens’, a green refuge includes areas of privacy. “It’s a place to chat with families who are going through tumultuous times of uncertainty and anxiety in whether a loved one can walk again, talk again - essentially recover.” Steven says there’s a strong link between environmental sustainability and embracing nature to improve health outcomes for patients. “For everyone, it’s how we can make a difference to the core business of patient care and duty of care. Dream big, start small. Keep creeping and creeping,” he says.

Duty of care

Crowds marched in more than 600 cities worldwide for Earth Day in April amid growing concerns of US President Donald Trump’s stance on climate change and cuts to research funding. Think globally, act locally, Australian of the Year and prominent scientist Professor Peter Doherty urged delegates at the ANMF Victorian Branch Health and Environmental Sustainability Conference in Melbourne. “Duty of Care is at the heart of what you do. That must be extended to the natural systems that sustain us and to the other complex life forms. Climate change is the most serious human health problem of today, says Professor Doherty. “Greenhouse gas levels are at the highest they have ever been for 500 million years. We are on an inexorable path to two degree warming. We will have warming by three to five degrees by 2100. It’s really dangerous yet we are doing relatively nothing.” The UN’s Sustainable Development Goals will be extraordinary difficult to meet, he says. “However we need aspirations to work towards and we have got to move forward to have pragmatic solutions. We have to tackle climate change with the best science we have got. “This is an extraordinary time. We need to act – there is no place for despair. We must change our ways of doing things if future generations are to enjoy a green, clean and liveable world. It’s up to us.”

2015 Paris Agreement

At the 21st United Nations Conference of the Parties meeting in December 2015, countries agreed to increase their level of commitment to limit climate change. Australia ratified its commitment last year to reduce its emissions to 26-28% on 2005 levels by 2030. “Paris was great but it’s not enough – it’s not compatible with life,” Climate and Health Alliance (CAHA) President Dr Liz Hanna says.

FEATURE THE 19 METRE WIDE JESSIE MARY VASEY LABYRINTH AT THE HEIDELBERG REPATRIATION HOSPITAL. PHOTOGRAPHER: AARON WALKER PHOTOGRAPHY WWW.AARONWALKERPHOTOGRAPHY.COM

supporting healthy communities; education and capacity building; government collaboration; leadership; emergency and disaster-preparedness; a sustainable and climate-resilient healthcare sector; and research.

Climate reality

Scientists argue climate change is about ‘extremes’, not necessarily always about warming. Such as the recent unprecedented thunderstorm asthma outbreak in Melbourne which resulted in eight deaths and 8,500 hospitalised. Asthma attacks increased by more than 300% during the 2014 heatwave in South Australia. The ‘Ash Fly Crisis’ in SA’s Port Augusta in January led to severe health effects, particularly for those with asthma. The 2015 Lancet Commission on Health and Climate Change was formed to track progress every two years on the effects of climate change until 2030. The direct effects of climate change will include increased heat stress, floods, drought, and increased frequency of storms. Indirect threats to health such as changes in air pollution, spread of disease vectors, food insecurity and undernutrition, displacement and mental ill-health. Two of the Lancet’s proposed indicators measure energy access for health facilities and the greenhouse gas emissions of healthcare systems. “CO2 is right now 410ppm so we know the temperature is going to rise again. Not only are our emissions increasing, they are accelerating. We have been way too much asleep at the wheel.” If all 195 countries signed up to the Paris Agreement adhere to their commitments, there is a 50% chance of staying under two degree warming, Dr Hanna says. “Because the pledges are not strong enough and they’re not binding.” More worrying is that there is only a 50% chance of staying under 3.6 degree warming - a world we cannot imagine, she says. “By 2045, today’s extreme summers will be the norm – every second year half the world’s population will experience the hottest year. “Australia’s 2013 hottest year should occur one in every 12,000 years. We know it’s not going to be another 12,000 years before we have another hottest year on record like 2013.” The impact of climate change will incur injuries and deaths caused by conflict and war, warns Dr Hanna. “There are 7.4 billion people on this planet and conflict is very problematic. Climate change is really going to interrupt the fundamentals that we really need. Existing wars in Sudan and Syria were precipitated by droughts, hunger, and migration exacerbated by existing cultural tensions. There is going to be more of this.” Health professionals need to lobby for urgent and deep mitigation as a health issue, Dr Hanna says. “For us in the health sector we 20 July 2017 Volume 25, No. 1

have to adapt. Mitigate, educate and adapt.”

A national strategy

The gap in climate policy in Australia includes the lack of a national climate change strategy. A national strategy would help the government meet its international obligations under the UN’s Framework Convention on Climate Change (UNFCCC) Paris Agreement and its commitments to the Sustainable Development Goals, argues CAHA’s Founder and Convenor Fiona Armstrong. “Without a national strategy, Australia lacks any mechanism to ensure this occurs.” There is overwhelming public support with 98% of respondents to a national survey indicating Australia needs a National Strategy for Climate, Health and Wellbeing. CAHA released a discussion paper in June last year, followed by a Health Leaders roundtable convened in October. All three major political parties jointly hosted the launch of a proposed framework for a national strategy at Parliament House last month as the ANMJ went to print. Parties indicated they may develop policy positions using the framework, says Ms Armstrong. “It will also deliver ‘win win’ climate change mitigation and adaptation strategies, which both reduce greenhouse gas emissions and the social and economic burden of ill health in the population.” Key areas of policy action include: healthpromoting and emissions-reducing policies;

Green Healthcare

The Global Green and Healthy Hospitals (GGHH) is a worldwide network for the health sector. Globally there are almost 800 members with a reported 25,000 hospital and health services. GGHH connects people doing vital sustainability work, says Project Officer Pacific Region Carol Behne. “It also shows the broader community that the health sector is concerned about its environmental impact.” GGHH focuses on 10 action areas: waste; energy; water; chemicals; transportation; food; pharmaceuticals; buildings; purchasing; and leadership. “There is a lot of opportunity for reducing what ends up in waste landfill, energy use and greenhouse gas emissions,” says Ms Behne. “Installing solar panels and more energy efficient systems are outside the realm of nurses and doctors, they don’t have that level of operational control but they have a role in advocating behaviour change.” “It’s simple things done often, such as closing doors, turning lights off, reducing and disposing of waste correctly,” says Ms Behne. “Our health is so dependent on our environment but it’s not always foremost in people’s minds.” Focus on something within the realm of the workplace which is easy to fix, she says. “Look at something glaringly obvious, something that is getting to you. It’s probably getting to other people to. Polystyrene cups, cardboard recycling, reminder notes to switch off the lights - bring anmf.org.au

FEATURE

GGHH PROJECT OFFICER PACIFIC REGION CAROL BEHNE.

it up with other staff members and see what the reaction is. “Send out an email and see who comes out of the woodwork. Start a conversation in the workplace, have a look at your organisation’s strategic plan, bring it up at meetings. It could be as simple as collecting the organic waste in one small staffroom and taking it away once a week – it heightens awareness.”

Climate challenge

GGHH’s 2020 Healthcare Climate Challenge highlight three key areas: mitigation – reducing healthcare’s carbon footprint; adaptation – preparing for the impacts of extreme weather and disease; and leadership – to promote public health policies. Mater Health was recently recognised as a 2017 GGHH champion for climate resiliency and greenhouse gas reduction (energy). The

organisation achieved a 13% reduction in carbon emissions; a 40% reduction in transport fuel consumption; and reductions in electricity consumption across its major facilities. Strategies include infrastructure and lighting upgrades, policies for air conditioning (temperature set points and scheduling) and staff engagement initiatives. Energy was a big focus with 65% of energy use related to air conditioning, says Mater’s Former Director of Environmental Sustainability Chris Hill. “Of course the cheapest is not to use it. Adjust to winter and summer set points except for specialised areas. Use air con scheduling so that it isn’t 24/7 at the back of the house or in areas not used on weekends.” Mater has 199 sustainability initiatives including in water and waste, procurement, service design, and stakeholder engagement.

“The first initiative was duplex printing – just printing on both sides of the paper saved close to 10 million bits of paper. This was an easy win that reduced paper use by 25%,” says Mr Hill. Nearly 50 campaigns are based on stakeholder engagement. A ‘voluntary pledge of behaviour’ enables staff to sign up to behaviours in energy, water, and waste reductions. To date 4,000 Mater staff are signed up to 40,000 behaviours. Campaigns include a Turn It Off campaign based on behaviour change. A Keep Cup campaign significantly reduced the number of disposable cups. “You need champions to harness momentum once you set up an initiative and leaders to take the initiative,” says Mr Hill. Mater Health also links in with key events, including National Recycling Week and Ride to Work Day. The organisation has reduced its clinical waste by about 30% with a management plan that includes avoiding waste. “In avoiding it, we have to look at where it comes in. We have trialled direct ward unpacking where suppliers (Baxter) bring it in themselves, put it on the shelves and take their waste with them,” says Mr Hill. Mater Health has saved $4.5 million since 2008 with its sustainability plan, says Mr Hill. “We started the journey looking to lessen the impact on the environment - making financial savings was an added bonus. From a patient point of view - $1 million spent less on electricity can go to patient care. That’s the focus and the sell.”

Scourge of plastics

About 100 hospitals across Australia and NZ now participate in the PVC Recycling in Hospitals initiative launched in 2009. Baxter

SAY NO TO ADANI CAMPAIGN A proposal for Australia’s largest coal mine and one of the biggest in the world was back on track last month after the Queensland government struck an agreement with Indian subsidiary Adani Mining over royalties. The $16.5 billion proposed Carmichael coal mine for the north of the Galilee Basin in Central Queensland has drawn widespread condemnation for its potential impact on the Great Barrier Reef and carbon emissions. At peak capacity the mine would produce 60 million tonnes of coal a year. The proposal includes a 189km railway line. The mine would be the first of a number of large mines proposed for the Galilee Basin. Green activists and high profile Australians have led the charge which has gained public outrage and momentum. To show support visit www.stopadani.com/

PHOTO: TOM JEFFERSON

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July 2017 Volume 25, No. 1 21

FEATURE EPWORTH HEALTHCARE IN MELBOURNE WILL BE THE FIRST HOSPITAL IN AUSTRALIA TO RECYCLE ALUMINIUM BOTTLES OF IT’S GAS ANAESTHESIA PRODUCTS. ABOUT 3,000 ALUMINIUM CANISTERS ARE EXPECTED TO BE RECYCLED.

IV fluids, oxygen masks and oxygen tubing are recycled to make garden hoses and outdoor playground matting. “We save 6.7 tonnes of PVC IV bags from potentially going to landfill or untreated or even worse,” says RN Zeta Henderson at Barwon Health in Geelong, Victoria. The project started in three ward areas with five collection bins clearly labelled ‘PVC recycling only’. “People monitor the bins for contamination but it has improved dramatically – 90% of what is in the bins is fine. We positively reinforce the message. “PVC opens up the conversation – to battery recycling, disposable cups, crockery – to get rid of single use products and that’s our goal.” Epworth HealthCare in Melbourne was announced last month as the first hospital in Australia to recycle aluminium bottles of its gas anaesthesia products. About 3,000 aluminium canisters and 80 cubic metres or enough PVC products to fill an operating theatre are to be recycled. St Vincent’s Health in NSW, Group Manager of Energy and Environment Matt Power describes the ‘scourge of plastics’. “Plastic recycling is actually down-cycling. Let’s be clear - no modern plastics are truly recyclable. There is a net reduction but there are still additives such as printing inside the protective bag of IV saline. They cannot be re-used as the original product but go to use as a hose etc.” Ultimately plastics end up in the environment, often as micro-plastics, which can take 1,000 years to biodegrade, says Mr Power. “We need to attack the original problem – we need to find an alternative to plastic.” This includes the creation of truly recyclable or biodegradable plastics (starches), he says. “We need to move back to materials that are truly recyclable – metals and paper-based.” Organisations need to pressure suppliers to use less plastic packaging and ask tenderers to provide life cycle analysis of products, argues Mr Power.

Renewables

“A discussion of climate change is a 22 July 2017 Volume 25, No. 1

discussion of energy,” Mr Power says. “Healthcare is very energy intensive. Healthcare consumes more energy per metre square than almost any other built sector.” This means a massive opportunity for healthcare in reducing its waste, he says. “We changed 9,000 lights in one of our Sydney hospitals.” St Vincent’s National Energy Action Plan (NEAP) approved in 2015 will be completed this year. It involved eight energy efficiencies rolled out simultaneously: sub-metering; LED lighting; reduction in air con use (65% of the electricity load in most hospitals); solar PV on 16 buildings, equipment control; power factor correction; and voltage optimisation. NEAP has seen a total electricity reduction of 35-40% - the equivalent use of a town of 50,000 people and savings of $6.5 million annually in three years. It has projected 10 years savings at $65-72 million and a possible $100 million over 20 years.

The future

Climate change is an intergenerational health equity issue, says Western Australia’s Telethon Kids Institute Dr Brad Farrant. “My concern for those growing up now is that climate change will no longer be reversible and we end up with a generation of kids with a lower standard of living and worse health outcomes than the generation before them.” Dr Farrant is a passionate advocate for those he says do not have a voice yet. “Those who do not have a say in this and who do not have a vote. They will be the most impacted.” Dr Farrant says we all have a responsibility to pressure our decision makers into action. “Let’s have an honest conversation in Parliament. That we are in the highest per capita of greenhouse gas emitters in the world instead of bringing in a piece of coal to Parliament saying ‘this is good for humanity’. “If we were to be a good global citizen then we would have more of a leg to stand on in holding other countries to account. It is disappointing to say the least that Australia reports that it accounts for less than 2% of global emissions. It’s a smokescreen – if all

the countries that accounted for less than 2% are added together - that’s 40% of global emissions and clearly not a viable approach.” Australia should look towards Germany and the UK in the ambitious targets they have set to reduce emissions. “We must play our own part and do what we can to bring about change.”

A green curriculum: the new normal

Monash University has recently introduced two climate change units into the nursing curriculum. A green curriculum is about increasing sustainability literacy, says Monash University Lecturer and RN Trish Schwerdtle. Sustainability literacy includes how climate change affects human health; how the healthcare sector contributes to climate change; and the interconnection between healthcare, adaptation and mitigation. “Sustainability content must be positive, interesting and relevant,” Ms Schwerdtle says. “People are suffering climate change fatigue. Armageddon is disengaging.” The curriculum covers both health sector and climate change preparedness - global citizenship, eco-health, migration, conflict, and carbon mitigation. Generation Y or the Millennials have the characteristics and skills to combat climate change, Ms Schwerdtle says. “Fifty percent of millennials are already in leadership positions which is unprecedented. They are opportunistic and innovative. We need them to know about planetary degradation.” However everyone needs to prepare for a climate changing world, says Ms Schwerdtle “Mitigation is a closing window.” She says nurses and midwives need to speak up. Events such as thunderstorm asthma and water quality in the bay were not linked in the media to the effects of climate change. “We have to make those health connections. Why don’t we as nurses and midwives be the voice on climate change? Take it to the next level nurses and midwives as louder leaders?” Being a green innovator involves persistence and integrating it in everything you do, she says. “Find ways to make it part of your core business, not an add-on.” anmf.org.au

RESEARCH

LIFESPAN PREDICTING A computer that can predict a patient’s lifespan simply by looking at images of their organs is being developed by researchers from Australia. The technology has implications for the early diagnosis of serious illness and medical interventions. Researchers from the University of Adelaide, along with Australian and international collaborators, used artificial intelligence to analyse the medical imaging of 48 patients’ chests. The computer based analysis was able to predict which patients would die within five years, with 69% accuracy comparable to ‘manual’ predictions by clinicians. “Predicting the future of a patient is useful because it may enable doctors to tailor treatments to the individual,” said lead author from the University of Adelaide’s School of Public Health Dr Luke Oakden-Rayner. “The accurate assessment of biological age and the prediction of patient’s longevity have so far been limited by doctors’ inability to look inside the body and measure the health of each organ. Our research has investigated the use of ‘deep learning’, a technique where the computer systems can learn how to understand and analyse images.” While the researchers could not identify exactly what the computer system was seeing in the images to make its predictions, the most confident predictions were made for patients with severe chronic diseases such as emphysema and congestive heart failure. “Instead of focussing on diagnosing diseases, the automated systems can predict medical outcomes in a way that doctors are not trained to do, by incorporating large volumes of data and detecting suitable patterns,” Dr OakdenRayner said. “Our research opens new avenues for the application of artificial intelligence technology in medical image analysis, and could offer new hope for the early detection of serious illness, requiring specific medical interventions.” The researchers hope to apply the same techniques to predict other important medical conditions, such as the onset of heart attacks. The study was published in the Nature journal.

anmf.org.au

POTENTIAL TO IMPROVE EARLY DIAGNOSIS OF MALIGNANT TUMOURS A new algorithm that detects early formation of blood vessels could lead to early diagnosis of malignant tumours and improve success rates of treatment. A new software tool, developed by researchers at CSIRO’s Data61, could significantly improve the detection of angiogenesis- the development of new blood vessels, which is known to proceed the growth of cancers. Earlier detection of blood vessel growth may therefore lead to a faster diagnosis of malignant tumour growth, which is a key factor in successful treatment and patient survival. Anti-angiogenesis treatment aims to prevent cancers from growing blood vessels. The ability to continuously monitor subtle proliferations in blood vessels over time is essential, given that patients may react to anti-angiogenesis treatment differently. The new software allows researchers to measure subtle changes in the proliferation of blood vessels, including the number and length of the blood vessel branches, and produces significantly clearer skeletons of the vasculature than previously possible. While the development of the new technology is a significant step forward, the Shanghai Synchrotron Beamline used to produce the images generates radiation levels unsafe for human imaging. In order to progress clinical trials in humans, the researchers are looking for 3D imaging technologies and partnering with a hardware manufacturer that can produce high-resolution images with safe levels of radiation for humans. “Our robust algorithms for early detection and quantification of angiogenesis could potentially be a great step forward in the detection and treatment of cancer,” lead researcher Dr Dadong Wang said. “However they can also be applied to a wide range of other applications, such as analysis of 3D neurite outgrowth for drug development. “While there is great interest in taking these findings further, there is still a long way to go before the new development can be applied to human patients.”

BREASTFEEDING COULD REDUCE THE RISK OF UTERINE CANCER Women who have breastfed at least one child have a lower risk of cancer in the uterus, according to an international study involving Australia, the United States, Europe and China. Cancer of the uterus is the fifth most common cancer in Australian women. While rates have been increasing over recent decades, Cancer Australia estimates nearly 2,900 new cases will be diagnosed in 2017. The study, led by Australia’s QIMR Berghofer Medical Research Institute, examined data from more than 26,000 women with at least one child, including nearly 9,000 women with uterine cancer. “We looked at the total amount of times these women had spent breastfeeding over the course of their lives.” The head of QIMR Berghofer’s Cancer Causes and Care Group Susan Jordan said. “We found that women who had ever breastfed had a 11% lower risk of developing uterine cancer than women who had never breastfed.” Dr Jordan said the longer women breastfed each child, the more their risk of uterine cancer reduced, up until nine months when the reduction risk plateaued. “When women breastfed for between three to six months, their risk dropped by about 7% per child compared to women with children who didn’t breastfeed. And when women breastfed for between six and nine months, their risk dropped by 11% for each child they nursed.” According to Dr Jordan it was not certain if this was a causal relationship but said it was plausible that breastfeeding could directly reduce the risk by suppressing ovulation and reducing estrogen levels, and in turn reducing cell division in the lining of the uterus. “It is important to point out that breastfeeding won’t guarantee that women won’t develop cancer in the uterus, and, conversely, not breastfeeding doesn’t mean a women will get uterine cancer.” Yet the study strongly suggests breastfeeding reduces a woman’s risk and is one more benefit to breastfeeding, Dr Jordan said. “For a whole range of reasons, some women are unable to breastfeed, or struggle with breastfeeding.

July 2017 Volume 25, No. 1 23

REFLECTIONS

IRAQ MARCH 2017By Helen Zahos

Have you ever had a moment where you have thought to yourself ‘I can’t believe I’m doing this?’ I had that moment today as I was standing in a recovery room of a theatre in a public hospital in Iraq. I arrived here 10 days ago to volunteer in the internally displaced people (IDP) camp 20km outside of Mosul. My intention was to help ADRA set up their Emergency Field Hospital which would be eventually servicing 100,000 people with the nearest hospital over an hour away. On the days that I was not needed on our project I attended other camps assisting and treating primary care patients. Presentations in the children were nothing unexpected for this type of setting with vomitting and diarrhoea, mumps, anaemia and failure to thrive being the most common. There have been many stories circulating through the camps of being captured, of torture, witnessing family members being murdered in front of them. It is difficult to even comprehend what they endured and have come from to now. One of our nurses was visibly upset when a child came up to where the construction of the building was and took a piece of styrofoam that was about to be thrown out. Thinking the child wanted it to play with it she soon realised it was for a pillow for him to use in the tent. A four month old baby that I treated was constipated as the mother had no breast 24 July 2017 Volume 25, No. 1

milk and there was only cake to feed the baby. Formula had stopped being handed out one month ago at the IDP camp and the mother had nothing else to feed her baby. Children have been sitting around the camp playing with stones with nothing else to occupy their time, their gaunt faces and dullness in their eyes is saddening, they have witnessed and gone through what no child should ever have to. Several days ago we had a report that there was a child that had been transferred from Sulaymaniyah with severe burns . Reem, a 10-year-old girl, had been in her home in Ramadi outside of Mosul when Daesh (Isis) struck her home with a Rocket-Propelled Grenade. Sustaining life threatening injuries and significant percentage of burns she was sent to a hospital in Sulaymaniyah. After several weeks of keeping Reem alive the hospital was unable to continue to treat her as her injuries were too extensive so they transferred her to a hospital in Erbil. That hospital soon wanted to discharge Reem from there and send her home, which had been blown up. Newroz hospital took on her case where local doctors volunteered their services to treat Reem from plastic surgeons to paediatricians. We went in to help change Reem’s dressings, and were met by the Director of

Newroz hospital, the plastic surgeon and the paediatrician who had been involved in her care. We were ushered up to the 4th floor where the theatres were and after being placed into gowns, we entered the recovery room. There she was, lying on a trolley on a blue paper sheet, looking sleepy and curled up into a ball under a blanket. I lifted the blanket slightly and she yelled out. I asked what she was saying and the doctor laughed, she was calling out for her grandmother. I gently patted her shaven head and whispered in her ear canal where her ear used to be. ‘It’s ok Reem we are going to get you out of here’. She tried to wriggle under the blanket to hide using her two stumps. Her left hand had all of her fingers amputated and her right hand was contracted and melted into a ball, both hands were bandaged and there was serous fluid coming from the bandage. The doctor said ‘she does this when it is time to change her dressings’, as she fought with him when he tried to gently remove her dressings. Despite best intentions the Newroz hospital was not equipped to deal with her injuries and it became clear that if she continued to deteriorate she would soon die. The humanitarian medical circle is a small one, soon we reached out to contacts internationally to see what could be done. A fellow volunteer Doctor Kristin Welch and I went to conduct an assessment and compile a referal to see if any overseas hospital would accept Reem. Our Medical Director MichaelJohn from ADRA contacted International SOS for input on how to transport this child and before we knew it there was a plan to medivac this injured girl to a specialist paediatric burns hospital in Boston. The forms were filled out and we know a hospital had accepted her but processes were frustratingly slow. Additionally, we were concerned she may not make the journey. Tomorrow we need to try and organise a passport for this girl who now does not have a face that resembles her identification, in a country with different processes than what I am used to. For now I am relieved that there is a group of us involved to help this girl, but next week I leave and I wonder if the paperwork will be sorted in time. Since this article was written Reem made it to Italy as it was a closer destination. She got stronger prior to the flight and was able to sit up long enough for transfer to the flight and for take-off. She even managed to smile and was excited about the trip. Helen Zahos, is a humanitarian, emergency nurse and paramedic. She has joined numerous international responses in the Philippines and Nepal and has worked on Christmas Island at the Asylum Seeker Detention Centre. Her recent volunteer positions this year have included a Syrian refugee camp located in Northern Greece, and Iraq in the IDP camps in May of this year. When in Australia she works at the Gold Coast University Hospital. anmf.org.au

WORLD

GLOBAL

Global plan of action on dementia

Global efforts to fight infectious diseases

The World Health Organization (WHO) has adopted a new Global Plan of Action on Dementia.

Australia will be supporting international efforts in developing vaccines to fight emerging infectious diseases.

“Alzheimer’s Disease International (ADI), which is the international federation of Alzheimer’s associations around the world, and of which Alzheimer’s Australia is a part, has been actively seeking ratification of a global plan for more than a decade, so its adoption is a significant step in tackling worldwide action to elevate the priority of dementia,” said Alzheimer’s Australia CEO Maree McCabe. The Global Plan on Dementia aims to improve the lives of people living with dementia, their families and carers, while decreasing the impact of dementia by setting out seven goal action areas, with measurable targets. These include: dementia as a public health priority; dementia awareness and friendliness; dementia risk reduction; dementia diagnosis; treatment, care and support; support for dementia carers; information systems for dementia; dementia research and innovation. Ms McCabe said there was an estimated 413,000 people living with dementia and it was the second leading cause of death in Australia. “Without a significant medical breakthrough, that number will soar to be more than 1.1 million by 2056. “A fully-funded National Dementia Strategy would build and enhance the National Framework for Action on Dementia 2015-2019, which Australia has already adopted and see the development of measurable outcomes to improve treatment and care options for people who are living with dementia as well as reducing the number of Australians likely to develop it in the future.”

The announcement was made at a G20 meeting in Germany by Federal Minister for Aged Care and Minister for Indigenous Health Ken Wyatt, last month. Minister Wyatt said Australia would provide $2 million to the Coalition for Epidemic Preparedness Innovations (CEPI). “This new international initiative will address critical research and development gaps for pandemic preparedness and global health security. Australia’s contribution to CEPI will help stimulate the development of vaccines to fight against emerging infectious diseases with epidemic potential.” Minister Wyatt said one of the main themes of the G20 Health Ministers’ meeting was the emergence, early identification and containment of novel infectious diseases that could lead to a pandemic. “Australia is a strong advocate of the International Health Regulations (IHR) and we will undergo an external assessment of our compliance with the IHR in November 2017.”

anmf.org.au

AUSTRALIA

Chronic kidney disease prevention An agreement to fight against chronic kidney disease of unknown aetiology (CKDu) between Sri Lanka and Australia was made in Canberra last month. An MOU was signed by Australia’s nuclear agency, the Australian Nuclear Science and Technology Organisation (ANSTO) with the Presidential Taskforce for Prevention of Chronic Kidney disease in the hope new

insights into the disease will be provided. Under the agreement ANSTO, which operates the Synchrotron and other national research facilities, agreed to help with “Inkind support to investigate the epidemiology of CKDu.” Around 100,000 people are affected by CKDu causing 5,000 deaths every year. It also has serious public health problems in other countries, particularly in Central America, and despite more than 20 years of study in Sri Lanka and globally, it is not well understood. The World Health Organization has identified several potential contributing factors, including heavy metals in the groundwater, agrochemicals, heat stress, malnutrition, low birth weight and leptospirosis. Australia and Sri Lanka have developed a cooperative relationship over the past 70 years, and this new agreement will positively impact the people’s lives, further strengthen Australia’s ties with Sri Lanka, and broaden Australia’s relationship in the region, said the Australian Minister for Industry, Innovation and Science, Senator Arthur Sinodinos. The signing of the MOU was attended by Sri Lankan President Maithripala Sirisena and Australian Prime Minister Malcolm Turnbull. July 2017 Volume 25, No. 1 25

BOOKS

RRP:

$19.95

RRP:

$65 RRP:

RRP:

$39.95

NURSES AT WORK:

A history of industrial and occupational health nurses in New South Wales BY NANCY BUNDLE AND JIM KITAY PUBLISHER: NSW NURSES & MIDWIVES’ ASSOCIATION ISBN: 978-1-9211326-12-7

The New South Wales Nurses & Midwives’ Association has published a fascinating history of the role of the occupational health nurse, charting its origins and the early days up until its eventual demise.The book covers three distinct eras of occupational health nursing in NSW – the early years (1911-39), wartime and after (1940-59), and the rise and fall (1960 onwards).Three decades in the making, Nurses At Work was inspired and shaped by lead author Nancy Bundle, a former occupational health nurse and one-time President of the NSW Nurses’ Association. Ms Bundle’s intimate knowledge of occupational health nursing shines through in the detailed account, which covers the development of places where nurses worked (public, private, manufacturing, government and other service industries). Notably, the book illustrates the ever-changing nature of occupational health nursing, with focus switching from a primary healthcare role, where the emphasis was on health both at work and home, to a primary carer role, targeting the treatment of illness and injuries, and back to primary healthcare in providing a healthy workplace and the promotion and management of collective and individual health. A driving focus within the book, addressed in latter chapters, reveals why occupational health nurses faded away following a loss of professional identity. 26 July 2017 Volume 25, No. 1

$39.95

MEDICAL BUSINESS MANAGEMENT:

Developing a successful healthcare practice and business BY LEANNE BOASE AND DR GRACE LAI PUBLISHER: WILEY PUBLISHING AUSTRALIA PTY LTD ISBN: 978-0-730-34372-1

Starting and developing a medical business is a balancing act that requires knowledge across a wide range of areas in order to adhere to the highest professional standards and deliver quality care to patients. Medical Business Management provides owners, operators and managers of health-related businesses with the tools and advice needed to embark on running their own businesses successfully, while also being productive as clinicians. The book addresses common problems encountered by health professionals running their own businesses, including dealing with unexpected cash flow issues, managing issues of leadership, creating suitable business plans, marketing the business across different channels and the ongoing challenges associated with juggling clinical time with business responsibilities and personal commitments. Cowritten by Victorian based Leanne Boase, who has over 20 years’ experience working in health, including as a Practice Nurse, Practice Manager, consultant and Medical Centre owner, Medical Business Management is an ideal tool for prospective medical business owners who want to excel in their venture while providing the highest quality care.

MAGGIE’S RECIPE FOR LIFE BY MAGGIE BEER AND RALPH MARTINS PUBLISHER: SIMON & SCHUSTER AUSTRALIA ISBN: 978-1-925596953

For those wondering whether Maggie’s new cookbook would involve the subject closest to her heart, the answer is a resounding yes! Australia’s much loved Maggie Beer has teamed up with Professor of Neurobiology and Foundation Chair in Ageing and Alzheimer’s Disease at Edith Cowan University Ralph Martins. Based on the latest scientific research ‘Maggie’s Recipe for Life’ includes 200 delicious recipes to reduce your chances of Alzheimer’s and other lifestyle diseases. “These are my recipes for every day, for everybody, full of deep flavours and beautiful ingredients that will nourish you and your family. Nobody wants to eat worthy food that tastes like cardboard. For me, food without flavour is unthinkable!” says Maggie. The former Senior Australian of the Year and passionate advocate for older Australians, Maggie says her recipe for life is to have a healthy attitude to eating. “It’s all about balance, variety and choosing foods that give you the best chance to being in good health now and into your future. This is not a diet book – it’s a way of life.” The book will be published this October by Simon & Schuster Australia. Proceeds will be shared between the Maggie Beer Foundation and the Lions Alzheimer’s Foundation.

INTRODUCING MENTAL HEALTH NURSING:

A service user-oriented approach 2ND EDITION BY BRENDA HAPPELL, LEANNE COWIN, CATH ROPER, RICHARD LAKEMAN AND LEONIE COX PUBLISHER: ALLEN & UNWIN PTY LTD ISBN: 978-1-74331-268-1

Introducing Mental Health Nursing is an all Australianauthored systematic overview of both the science and the art of caring for people experiencing mental health issues. This comprehensive but easy to read and navigate textbook provides nurses with the skills and knowledge required to provide care for service users across all healthcare settings, from specialist mental health services to general hospitals and community care. An emphasis is placed on the role of the nurse as an intrinsic member of the mental health team. The quizzes, case studies and critical thinking breakout boxes encourage nurses to think critically about the perspectives that they bring to their practice. The second edition has been fully revised and updated, with increased focus on Indigenous social and emotional wellbeing. There are two new chapters on Recovery and Cultural Safety. This is a must-have book for undergraduate nursing students, new graduates and professionals changing specialties or those wanting to update their knowledge of best practice in the mental health arena.

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ADJUNCT PROFESSOR DEBORA PICONE AM FACN (DLF)

Vice President Health Informatics, Elsevier Clinical Solutions

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* Eligibility criteria and conditions apply. See website for full terms and conditions. Nurses & Midwives Health Pty Ltd ABN 70 611 479 237. A Registered Private Health Insurer. NMH-ANMJ-03/17

CLINICAL UPDATE

CONFRONTING OBESITY, STIGMA AND WEIGHT BIAS IN HEALTHCARE WITH A PERSON CENTRED CARE APPROACH A CASE STUDY Kerry Wakefield and Rebecca Feo Introduction The increasing rates of obesity within Australia present a challenge for healthcare professionals from all disciplines working in the health system. Current statistics indicate that 63% of adults are outside of the normal weight range, with 35% overweight and 28% obese (Australian Bureau of Statistics 2012).

References Armstrong, M., Mottershead, T., Ronksley, P., Sigal, R., Campbell, T. and Hemmelgarn, B. 2011. Motivational interviewing to improve weight loss in overweight and/ or obese patients: a systematic review and meta-analysis of randomized controlled trials, Obesity reviews, Vol. 12, pp: 709-723. Australian Bureau of Statistics. 2012. Australian Health Survey: First Results, 2011-12 Catalogue no. 4364.0.55.001, ABS: Canberra. Australian Commission on Safety and Quality in Health Care. 2011. Patient-centred care: Improving quality and safety through partnerships with patients & consumers, ACSQHC, Sydney, Australia. Australian National Preventative Health Agency. 2014. Obesity: Prevalence trends in Australia, Commonwealth of Australia, Canberra, Australia. Bessenoff, G. and Sherman J. 2000. Automatic and controlled components of prejudice toward fat people: Evaluation versus serotype activation, Social Cognition, vol 18, no. 4 pp: 329-350. Bombak, A. 2014. Obesity, Health at Every Size, And Public Health Policy, American Journal of Public Health, Vol. 104, No. 2, pp: 60-67.

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CLINICAL UPDATE Obesity is a highly complex issue influenced not only by the physiological interplay of diet and exercise but also by genetics, environmental, social, psychological, metabolic, pharmacological, economic and political factors (Budd et al. 2009; Wright and Aronne 2012; Phelan et al. 2015; Ward-Smith and Peterson 2016). Obesogenic drivers include readily available energydense foods that are aggressively marketed, sedentary lifestyles due to increases in technology, less access to open green spaces, busy lives, family and peer influences, stress, insomnia, anxiety, depression, past traumatic events, some prescription medication and endocrine disorders (Australian National Preventative Health Agency 2014; Leung and Fudner 2014; Wright and Aronne 2012). People with obesity are at risk of facing daily discrimination from a weight-bias society. This bias is present amongst healthcare professionals of all disciplines. Many people who are overweight or obese report experiencing judgemental attitudes and discrimination from health professionals and subsequent feelings of fear and shame (Poon & Tarrant 2009; Bombak 2014). Nurses represent the most prevalent workforce within the healthcare system and the challenge of obesity requires nurses to reflect on their beliefs and preconceived attitudes in order to provide optimum care. A person-centred care approach assists nurses and other healthcare professionals to better understand, treat and support patients to gain improved control over their lives (RNAO 2015). This paper will explore through the use of a case study, the stigma and discrimination related to obesity in healthcare settings and highlight how a person-centred care approach can improve patient outcomes.

Obesity, stigma and discrimination in healthcare settings Research by Puhl and Brownell (2006) on 2,671 overweight or obese adults found that weight-bias and discrimination occurred in 69% of interactions with doctors, 46% with nurses and 37% with dieticians/ nutritionists. Given the amount of time nurses typically spend engaged in patient care, the high statistic for nurses is concerning. The bias displayed by health professionals is connected to stereotypical assumptions that people with obesity are lazy, inactive, incompetent, selfindulgent, undisciplined, lacking in willpower and have poor hygiene anmf.org.au

(Puhl and Brownell 2006; Puhl and Latner 2007; Phelan et al. 2015; Ward-Smith and Peterson 2016). For instance, a study of 398 British nurses working in primary care settings found that 69% believed personal choices related to food and exercise were the reason for patients’ obesity, and one-third believed that a lack of willpower over food choices was the main influencing factor (Brown et al. 2007). These prevalent stereotypes are often reinforced by media that ignore the broader complexity of the obesogenic environment (Pheln et al. 2015; Fruh et al. 2016).

PEOPLE WITH OBESITY ARE AT RISK OF FACING DAILY DISCRIMINATION FROM A WEIGHT-BIAS SOCIETY. THIS BIAS IS PRESENT AMONGST HEALTHCARE PROFESSIONALS OF ALL DISCIPLINES Healthcare professionals who view people with obesity as personally responsible for their weight often perceive the patient as hindering the delivery of optimum treatment and care (Phelan et al. 2015). Studies have found that when nurses and general practitioners (GP) perceive obesity to be purely a preventable condition, this perception results in a belief that the patients’ unsuccessful weight loss is related to poor motivation and compliance with recommendations. Such a belief does not consider the profound impact that the healthcare professionals approach or attitude can have on the patients change process (Hoppe and Odgen 1997; Campbell et al. 2000). Weight-bias is so pervasive that nurses who work specifically with patients who have obesity and who wish to be unbiased can still struggle against the dominant societal message that individuals are solely responsible for their weight (Teachman and Brownell 2001; Bessenoff and Sherman 2000; Reto 2003). In a study of implicit and explicit weight-bias amongst 4,732 medical students, Phelan et al. (2014) found that overt negative attitudes directed towards people with obesity were more socially acceptable than overtly racist attitudes.

Impact of stigma and discrimination on the patient Several studies have shown that individuals with obesity learn to become vigilant for signs of stigma in order to protect themselves

psychologically (Phelan et al. 2015; Drury and Louis 2002; Puhl and Heuer 2009; Fruh et al 2016). Experiences of weight bias can result in the fight and flight response, thereby increasing levels of anxiety and impairing cognitive functioning, resulting in ineffective communication causing the person to retreat or display defensive reactions (Phelan et al. 2015). As is clearly demonstrated in the case study below, these psychological effects of discrimination can have an immediate and enduring impact on self-esteem, depression and an increase in body image dissatisfaction. Behaviours resulting from these psychological impacts include binge eating, social isolation and the delay or avoidance of seeking much-needed future healthcare (Drury and Louis 2002; Puhl and Heuer 2009; Phelan et al. 2015; Fruh et al. 2016).

*Sara’s story: A case study

Sara’s case study, as detailed below through extracts from an interview, highlights both the devastating impact that weight bias from healthcare professionals can have on patients, as well as the positive impacts of a person-centred care approach, including improved motivation and self-efficacy. After many years of struggling with her weight and now in her early fifties, Sara’s GP suggested she consider bariatric surgery. She attended an initial appointment with a bariatric surgeon in the hope of discussing her options. During this appointment, Sara was told she was ‘too fat’ and could not be helped. Sara described how the surgeon did not give her eye contact during the consultation and concluded the appointment by saying ‘meeting’s over’. A month later, Sara presented to the same hospital’s emergency department (ED) with abdominal pain. She was told by several ED nursing staff that she would not be in pain if she lost weight. However, Sara had a large incisional hernia that was exaggerating her size and causing pain, and which would go undiagnosed for a further two years. Sara described her encounter with the surgeon and ED nursing staff as having a devastating effect on her psychological health, which in turn impacted her physical, social and spiritual wellbeing. She recalled her thoughts and feelings at the time: “…oh my God I’m nothing to anybody. No-one can help me, I’m beyond help. I’m a waste of oxygen.” “I think I went into a complete depression. I didn’t talk to people,

Brown, I., Stide, C., Psarou, A., Brewins, L. and Thompson, J. 2007. Management of obesity in primary care: nurses’ practices, beliefs and attitudes, Original Research, vol 59, no.4 pp: 329-341. Budd, G., Mariotti, M., Graff, G. and Falkenstein, K. 2009. Health care professionals’ attitudes about obesity: An integrative review Applied Nursing Research, vol 24, pp: 127-137. Campbell. K, Engel, H., Timperio, A, Cooper, C. and Crawford, D. 2000. Obesity Management: Australian General Practitioners’ Attitudes and Practices, Obesity Research, vol.8, no.6 pp: 459 – 466. Drury, C., and Louis, M. 2002. Exploring the Association between Body Weight, Stigma of Obesity and Health Care Avoidance, Research, Vol. 14, No. 12, pp: 554-561. Epstein, R., Franks, P., K., Shields, C., Meldrun, S., Miller, K., Campbell, T. and Fiscella, K. 2005. Patient-centered communication and diagnostic testing, Annals of Family Medicine, Vol. 3, No. 5, pp: 415-421. Fruh, S., Nadglowski, J., Hall, H., Davis, S., Crook, E and Zlomke, K. 2016. Obesity Stigma and Bias The Journal of Nurse Practitioners, vol. 12, issue 7, pp: 425- 432. Gujral, H., Tea, C. and Sheridan, M. 2011. Evaluation of nurse’s attitudes towards adult patients of size Surgery for Obesity and Related Diseases, vol. 7 pp: 536-540. Hoppe, R and Ogden, J. 1997. Practice nurses’ beliefs about obesity and weight related interventions in primary care International Journal of Obesity, vol. 21, pp: 141-146. Leung, J. & Fudner J. 2014. Obesity: A National Epidemic and its Impact on Australia, Obesity Australia, Australia.

July 2017 Volume 25, No. 1 29

CLINICAL UPDATE I just shut right off. I just didn’t care about myself, about my house, about my relationship, about anything. I just, I just went into withdrawal. I just closed in and just had to deal, had to deal with that in my own way, in which my way is just shutting my doors and windows and just sitting in my lounge room and just saying well that’s it I’m just going to die like this.” Sara speaks here of losing self-respect and self-worth. She also reflected that the impact of her interactions with the medical and nursing staff might have led her to ‘punish’ herself on some level, feeling that others did not care about her. As such, she learnt to internalise her low self esteem. Puhl, Moss-Racusin and Schwartz (2007) suggest that people with obesity have a greater tendency than other stigmatised groups to internalise the stereotypes made against them because such stereotypes constitute pervasive and socially accepted ideas. Shaming individuals with obesity in the belief that it will motivate them to lose weight has been found to have the opposite effect (Phelan et al. 2015). This was the case with Sara in the two years following her initial bariatric surgical consultation: “I gained weight, I gained a lot more weight, I probably gained about 30 kilos because I just didn’t care…I felt like I didn’t matter.”

A person-centred care approach

A person-centred care approach is described as a deflection from the biomedical model to an emphasis on creating partnership with patients to understand the whole person and their experiences of health (The Nursing and Midwifery Office 2014; RNAO 2015). The aim is to improve both the psychological and physiological wellbeing of a person through seeking to understand their personal circumstances, competing life priorities and how these impact health outcomes. A best practice approach is the 5A’s framework of behaviour change which uses a brief intervention model to explore motivation and promote self management (RNAO 2015; NHMRC 2013; ACSQHC 2011). The underlying principles of a person-centred care approach include treating people with dignity, respect, active participation in informed decision making and collaboration in the delivery of care that is acceptable to the patient. A person-centred care approach can have a significant impact for 30 July 2017 Volume 25, No. 1

patients who are overweight or obese. Motivational interviewing, a key tenet of a person-centred care approach aims to explore and resolve ambivalence to change and can aid in the significant reduction of weight (Armstrong et al. 2011). Sara’s story clearly highlights the absence of a person-centred care approach and its consequences. Non-verbal cues, such as the lack of eye contact Sara experienced, communicates an absence of empathy and respect, which can affect a patient’s commitment to treatment (Perskey and Eccleston 2010). As in the case of Sara she isolated herself for two years and gained additional weight before being diagnosed with a hernia. At this time she sought a second opinion from a different surgeon on her options for bariatric surgery so that she could have the hernia repaired. Sara described the consultation with this surgeon differently, highlighting that he took an interest in attempting to understand her journey, while being attentive and giving her a sense of hope: “It was like chalk and cheese. Completely different attitudes. The doctor met me in the waiting room, shook my hand as he met me, walked me in, had a nice conversation on the way to the room, asked me my life story’ (and said following the consultation) ‘I can and I will help you’.” This narrative indicates the key components to a person-centred care approach, including showing respect and the building of a rapport through effective communication, such as making eye contact, active listening and attempting to understand the person’s health journey from their perspective. Sara made it clear how such an approach provided a human connection that promoted emotional and spiritual wellbeing and gave her a sense of hope. Sara was asked how she felt following this interaction: “…I just walked out of there on like a pillow of air, I just felt 10 foot tall and proud and everything else in between, I just can’t explain it, the feeling that I walked out of there with. And I think that made a big change. I just felt at last somebody can see that I’m not a waste of space. That I am a human being who has an issue that needs serious help. And I just felt like ‘Thank God’. I think I went home and for the first time in a long time I was happy. I hadn’t been happy in a very, very long time. About myself, about my

situation, about how my life was.” As Sara journeyed towards bariatric surgery she worked with a multidisciplinary team, including several nursing staff, to optimise her fitness for surgery. She spoke of how the team of healthcare professionals involved her in the planning of her care and the positive impact this had: “A very planned approach and the approach is personal. Every time I seen them it was a personal ‘Hello how are you going’ and I felt like I’m the only one that mattered. And that to me made a big difference. Because I felt then very important and that’s a big step, big step.” Sara also highlighted how her ability to self manage improved: ”Well whatever they require of me, I’m going to do 110%, because they’re putting themselves out, I need to prove to them that I am now worthy of them doing that. And that turned everything around, it just made me feel more positive about the whole situation.” “…something clicked in my head that said you have to do this. If you want people to help you, then you have to help yourself. So every day I got up with that in my head…you have to keep going, you have to keep working at it. It’s not going to be an overnight process. You’re not going to wake up tomorrow and have no weight problems. Tomorrow you’re going to get up and it’s still going to be there so you better just deal with it. And that was the difference, I just had that in my head that… and I think that it was because everyone around me was so positive that I could do it, then I became positive as well.” The outcome from this personcentred care approach was an increase in Sara’s self-efficacy resulting in a reduced BMI from 87kg/ m2 to 61kg/m2 or a 30% reduction in body weight over a seven month period prior to surgery.

Lessons for improving clinical practice

Reflective practice is at the foundation of good clinical nursing care (Nursing and Midwifery Board of Australia 2006). Having an awareness of one’s own belief systems to identify and overcome bias is an important step to ensuring these beliefs do not adversely impact patient care (Fruh et al 2016; Ward-Smith and Peterson

National Health and Medical Research Council. 2013. Clinical practice guidelines for the management of overweigh and obesity in adults and children in Australia, National Health and Medical Research Council, Melbourne, Australia. Nursing and Midwifery Board of Australia. 2006. National Competency Standards for the Registered Nurse, Nursing and Midwifery Board of Australia, Melbourne, Victoria, Australia. Nursing and Midwifery Office. 2014. The Nursing and Midwifery Professional Practice Framework: Caring with Kindness Government of South Australia, Department of Health and Ageing. Persky, S and Eccleston, C. 2010. Medical student bias and care recommendations for an obese versus nonobese virtual patient, International Journal of Obesity, vol. 35, pp: 728-735. Phelan, S., Burgess, D, Yeazel, M., Hellerstedt, W., Griffin, J. and Ryn, M. 2015. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity, Obesity reviews, Vol. 16, pp: 319-326. Phelan, S., Dovidio, J., Pulh, R., Burgess, D., Nelson, D., Yeazel, M., Hardeman, R., Perry, S. and van Ryn, M. 2014. Implicit and Explicit Weight Bias in a National Sample of 4,732 Medical Students: The Medical Student CHANGES Study, Obesity, vol. 22, no. 4 pp: 1201-1208. Poon, M., and Tarrant, M. 2009. Obesity: attitudes of undergraduate student nurses and registered nurses, Journal of Clinical Nursing, Vol. 18, No. 16, pp: 2355-2365. Puhl, R. and Brownell, K. 2006. Confronting and Coping with Weight Stigma: An Investigation of Overweight and Obese Adults, Obesity, Vol.14, No. 10 pp: 1802-1815

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CLINICAL UPDATE TABLE RESOURCES Name

Source

Overview

‘Patient-centred care: Improving quality and safety through partnerships with patients & consumers’

Australian Commission on Safety and Quality in Health Care (ACSQHC) 2011

National and international examples and resources of person-centred care initiatives and recommendations for practice in Australian context

‘Clinical practice guidelines for the management of overweight and obesity in adults, adolescence and children in Australia’

National Health and Medical Research Council (NHMRC) 2013, Australian Government, Department of Health

Evidence based recommendations for managing overweight and obesity across the lifespan. Use of 5A’s behaviour change model to aid in establishing a therapeutic relationship through a person-centred approach.

‘The Nursing and Midwifery Professional Practice Framework: Caring with Kindness’

Nursing and Midwifery Office, 2014, Government of South Australia, Department of Health & Ageing

A person-centred care approach provides the framework for one of the five core components that form the foundation of the Caring with Kindness strategic priority document.

‘Nursing Best Practice Guidelines: Person- and Family-Centred Care’

Registered Nurses Association of Ontario (RNAO) 2015, Canada

Comprehensive clinical best practice guideline providing recommendations to increase knowledge and skills in patient-centred care

www.uconnruddcenter. org/weight-bias-stigmavideos-exposing-weightbias accessed 21/12/16

The UConn Rudd Centre for Food Policy and Obesity, New Haven, Connecticut, USA

Rudd Centre aims to stop stigma through education, research & advocacy. Free access to 17 minute video on weight bias in healthcare and publications.

http://biastoolkit. uconnruddcenter.org/ accessed 21/12/16

The UConn Rudd Centre for Food Policy and Obesity, New Haven, Connecticut, USA

Free 8-module tool kit designed for healthcare professionals to assist them to combat weight bias

http://whyweightguide. org/ accessed 21/12/16

Strategies to Overcome & Prevent (STOP) Obesity Alliance

An open collaborative forum designed to provide resources to prevent obesity. Produced ‘Why Weight guide’ for healthcare professionals on how to discuss weight and health with overweight patients

2016). Gujral, Tea and Sheridan (2011) in their evaluation of nurses’ attitudes towards adult patients with obesity, found that while bariatric sensitivity training did improve care it did not change the nurses’ belief systems. This suggests that nurses need to find a way to challenge or accept their fears of weight while providing care with compassion and attempting to understand the individual patient’s unique experiences (Reto 2003). Since nurses are trained to provide holistic care and are the most prevalent discipline in our healthcare system, it is important for nurses to be a positive influence as leaders for themselves, their peers, students and the public, through raising awareness of the complexity of obesity and rolemodelling unbiased attitudes (Fruh et al. 2016). There are several best practice evidence based guidelines and public view online resources that provide recommendations to improve a person-centred care approach as well as helping healthcare providers to explore and combat their own weight bias (see table). anmf.org.au

KEY ORGANISATIONS HAVE TOOLS AND BEST PRACTICE GUIDELINES TO ASSIST HEALTHCARE PROVIDERS TO INCREASE THEIR SELFAWARENESS AND EXAMINE THEIR THINKING.

Conclusion

Obesity is complex in its aetiology and there is conclusive evidence of the pervasive and damaging effects of weight bias in Western society. In the case of Sara, the discrimination she experienced through weight bias resulted in lowering her selfesteem, social isolation, a sense of worthlessness and substantial weight gain. Conversely, a patientcentred care approach gave her hope, increased her self-efficacy and improved her motivation for positive behaviour change resulting in clinically significant weight loss.

This demonstrates the importance of nurses and other healthcare professionals monitoring and challenging their own preconceptions so that they can better understand, treat and assist their patients to gain improved control over their lives. Key organisations have tools and best practice guidelines to assist healthcare providers to increase their self-awareness and examine their thinking. It is nurses who are well-placed to provide leadership in this area and in doing so can help to dismantle some of the barriers to the provision of expert care and the injustice that accompanies prejudice. *Sara is a pseudonym in the interest of confidentiality. Kerry Wakefield, BNg, Grad Dip MHN, is the Pre-hab/Bariatric Clinical Practice Consultant, Central Adelaide Local Health Network, Adelaide. Kerry.wakefield@sa.gov.au Rebecca Feo, BPsych(Hons), PhD, is a Postdoctoral Research Fellow in the Adelaide Nursing School at The University of Adelaide

Puhl, R. and Heuer, C. 2009. The Stigma of Obesity: A Review and Update, Obesity, vol. 17, no. 5, pp: 941-964. Puhl, R., Moss-Racusin, M. and Schwartz, M. 2007. Internalization of Weight Bias: Implications for Binge Eating and Emotional Well-being, Obesity, vol. 15, no. 1, pp: 19-23. Registered Nurses Association of Ontario. 2015. Nursing Best Practice Guidelines: Person and Family Centred Care, RNAO, Ontario, Canada. Reto, C. 2003. Psychological Aspects of Delivering Nursing Care to the Bariatric Patient Ward-Smith, P., and Perterson, J. 2016. Development of an instrument to assess nurse practitioner attitudes and beliefs about obesity Journal of the American Association of Nurse Practitioners, vol 28, pp: 125-129. Teachman, B. and Brownell, K. 2001. Implicit anti-fat bias among health professionals: is anyone immune? International Journal of Obesity, vol. 5, pp: 1525-1531. Ward-Smith, P. 2016. Development of an instrument to assess nurse practitioner attitudes and beliefs about obesity, Journal of the American Association of Nurse Practitioners, vol. 28, pp: 125-129. Wright, S. and Aronne, L. 2012. Causes of obesity, Abdominal Imaging, No. 37, pp: 730-732.

July 2017 Volume 25, No. 1 31

REFLECTIONS

WHERE DO YOU READ YOUR ANMJ ? By Jackie Wright Recently I took the opportunity to take a 10 day trip to explore Nepal, which began in Kathmandu, followed by Bandipur, Pokhara, Chitwan National Park and then back to Kathmandu. Travelling around the country by road where contending with chaotic traffic jams in city streets is the norm. Roads are also made narrower by endless lines of trucks and heavy machinery, which makes even small distances travelled between villages take hours. Consequently, I had time to drink in the scenery while inhaling the fumes and ever present rising dust. We were advised to wear masks. Some of the masks people wore reminded me of the personal protective equipment (PPE) worn in hospitals. It is only two years since the devastating earthquakes hit Nepal, but already, from what I observed, a lot of restoration work is occurring. The population of Nepal, of around 31 million people, are mainly Hindus, Buddhists and Muslims and are amongst the friendliest people on earth. In Kathmandu on the banks of Bagmati river is the Hindu temple of Pashupatinath. Here I witnessed the holy Hindu pilgrimage where deceased bodies are cremated along the river. 32 July 2017 Volume 25, No. 1

I was unaware that others in my tour group felt uncomfortable of what they were observing, where I, on the other hand, was rather curious about the process details. After all I am a nurse....always! Leaving Kathmandu Valley I headed towards Bandipur, which was once an important stop on the India-Tibet trade route until the1960’s. The elevation of Bandipur is 1,030 metres. Our large bus was driven on narrow winding roads to our destination which was a harrowing experience every time a vehicle passed by. Should there have been a miscalculation, the only route was a steep decline off the edge of the road. I was so grateful to the skilled driver who managed the journey and rewarded him with a handsome tip for his expertise. During my travels I made it to the hill top Sarangkot at sunrise for a close-up view of Annapurna and Fishtail mountains, before embarking on a three hour walk. The experience was good for the body and soul. My next destination was Pokhara which

is known as the gateway to the Annapurna ranges. It was here where I took the opportunity to take a flight over Mount Everest and a helicopter flight landing at Annapurna Base Camp. Both equally AMAZING! The stunning views will remain with me forever. When at Annapurna Base Camp I remembered I had the latest edition of the ANMJ in my luggage, I was not going to miss a great photo opportunity with the journal. It was due to an emergency evacuation from Base Camp that I and four others from my tour group were able to extend our time to two hours at the site. It gave me time to wander a little, chat with trekkers from Belgium, France and Germany, and a few Sherpas who are incredible men, so important, so invaluable and so responsible for the safety of many lives. The sun shone bright and I felt surprisingly warm. I took off my jacket. I will admit to feeling somewhat affected by the high altitude at 4,130 metres. On landing, a feeling of light headedness progressed to an annoying headache, which only subsided when we returned to Pokhara and two Paracetamol were washed down with a large quantity of water. I thought for a moment about the rescue mission; what were the possible outcomes, and was quietly satisfied I had taken the less strenuous option. Jackie Wright is an enrolled nurse who has nursed for more than 43 years at Lyell McEwin Hospital, South Australia. She says nursing has enabled her to do the job she loves and travel, both of which have given her opportunities to meet wonderful people. anmf.org.au

FOCUS EDUCATION PART 1 SUPPORTING ENROLLED NURSES TRANSITING TO UNIVERSITY By Jacqueline Johnston and Sonia Reisenhofer As the scope and practice for nurses develops, many Australian Enrolled Nurses (ENs) are choosing to upgrade their professional qualifications to that of a Registered Nurse with a Bachelor’s degree. Some Australian universities have responded to this demand providing an accelerated study pathway that allows ENs to complete their degree over 18–24 months rather than the usual three year timeframe required for students without previous nursing or academic qualifications. While accelerated pathways may have the benefit of lower costs, financial and time, they may also provide unique challenges for the individual. Undoubtedly the transition for an EN to the Bachelor of Nursing (BN) degree in an accelerated pathway can be stressful and one for which they may be unprepared (Ralph et al. 2013; Hutchinson 2011). Although often skilled in the provision of fundamental nursing care, EN’s may experience difficulty with the academic study requirements and information communication technology used at a tertiary level (Newton et al. 2017). They have generally had minimal prior experience with written assessment tasks at the standard that is expected anmf.org.au

at a Bachelor degree level, and may be lacking the literature searching, evidence based and analytical inquiry skills necessary for academic success at university. Ralph et al. (2013) suggests that for the transition of EN’s into a BN program to be successful, supports that include academic writing courses and the opportunity for on-campus orientation are essential. In response to findings from a research project undertaken at La Trobe University in 2016 (Newton et al. 2017), a new support program was built into the accelerated pathway for EN students commencing in 2017. This program focused on enhancing ENs academic study skills and was implemented across both the metropolitan and four regional campuses. Developed with nursing academics and a nursing-focused librarian, an Academic Skills program was provided to EN accelerated pathway students during the first two weeks of their studies. This program included information on how to

search databases for literature; evidence based practice, and writing at university with emphasis on how to write as a nurse and with academic integrity. The workshop also included an online and physical tour of the library resources in order to accommodate students differing learning styles. Assessment tasks within the students’ first subject ‘Transition to Bachelor of Nursing’ were also amended to allow implementation of these skills in a scaffolded manner. Initial anecdotal feedback was very positive, with students highlighting the value they placed on developing academic skills in order to achieve success at University. Students’ academic results will be analysed at the end of the year in comparison with those of previous programs to assess the value of the program towards achieving positive academic results. As universities explore new avenues for students to enter accelerated nursing degree programs it is vital to ensure that students are supported in a manner that best meets their individual needs, promotes student success and supports the development of informed professional nurses for the future. Jacqueline Johnston is a Nursing Academic and Sonia Reisenhofer, PhD is International Courses Coordinator. Both are in the School of Nursing and Midwifery, College of Science, Health and Engineering at La Trobe University

JACQUELINE JOHNSTON, LUCY LE RICHE AND STAV HILLEL

References Newton, M., Lewis, V., Mosley, I., Jokwiro, Y., Reisenhofer, S., Herd, A., Carter, M. January 2017. Improving students’ experience of and retention in accelerated pathways of the La Trobe University Bachelor of Nursing degree. A report for the College of Science, Health and Engineering, La Trobe University Teaching & Learning Internal Grants Scheme Ralph, N., Birks, M., Chapman, Y., Muldoon, N. & McPherson, C. 2013. From EN to BN to RN: An exploration and analysis of the literature [online]. Contemporary Nurse: A Journal for the Australian Nursing Profession. 43(2): 225-236. Hutchinson, L. 2011. The transition experience of Enrolled Nurses to a Bachelor of Nursing at an Australian university. Contemporary Nurse: A Journal for the Australian Nursing Profession. 38(1-2): 191

July 2017 Volume 25, No. 1 33

FOCUS: Education stress amongst nursing staff as staffing numbers increased, and the Diploma of Nursing would be a stepping stone for students who want to progress to a Bachelor of Nursing. Additionally, it is very difficult for rural people to leave their towns and families for large cities to study courses. By offering a course locally, people can live at home and most likely will stay there after graduation (Bush 2015). Training nurses in the western region of Victoria has occurred in the past however this was a new concept for ACUcom.

L-R DONNA BRADSHAW (TRAINER), CHRIS LE-GASSICK (STUDENT), MEG BROWN (STUDENT), PHOTOGRAPHER: JODIE HOLWELL, COMMUNITY LIAISON OFFICER, EAST GRAMPIANS HEALTH SERVICE

BY OFFERING A COURSE LOCALLY, PEOPLE CAN LIVE AT HOME AND MOST LIKELY WILL STAY THERE AFTER GRADUATION (BUSH 2015).

TAKING OWNERSHIP OF NURSING SHORTAGES IN A RURAL COMMUNITY By Pam Shackleton An initiative for improving the nursing workforce in rural Victoria, came about from the comment, “Identify the need and do something about it”, which was made by a CEO who was desperate to address the nursing shortage within his health service. In 2012 Health Workforce Australia (HWA) identified there were a quarter of a million registered nurses and approximately 60,000 Enrolled Nurses in Australia (HWA 2012). HWA concluded that due to the ageing workforce and low retention rates of nurses there would be a serious shortfall of nurses in the immediate future and more would be required to meet health workforce needs than are currently being supplied (HWA 2012). Congruent with the above findings, the East Grampians Health Service (EGHS) statistics indicate they are at least 10 nurses short of staffing their organisation with no foreseeable improvement in the numbers of staff in the future (Bush 2015). EGHS has a skill mix of RNs and EENs with EENs now filling more positions than previously in operating theatres, acute wards and hospital in the home. EGHS is in the rural community of Ararat which has a population of approximately 8,000 people and is located about 200 km west of Melbourne. 34 July 2017 Volume 25, No. 1

To help address the issue of the current and expected continued shortage of nurses, the EGHS Chief Executive Officer Nick Bush with his management team, met with ACUcom’s Director Debbie Wilson and the Ballarat Diploma of Nursing Course/Clinical Coordinator Pam Shackleton to discuss ACUcom conducting the Diploma of Nursing course at the EGHS site at Ararat Hospital. ACUcom (Australian Catholic University community) is the Vet sector “arm” of the Australian Catholic University. ACUcom is a highly respected RTO that is accredited to conduct many courses Australia wide including Early Childhood, Certificate 3 in Aged Care and First Aid to name a few. Nick was convinced there were many reasons for EGHS to partner with ACUcom and prepare nurses for practice and these included: ‘growing their own’ which would cease the decline in workforce capacity; reduce risks to services and possible closures due to the staff shortages; decrease

Director Debbie Wilson was keen to extend ACUcom’s training capacity to include EGHS. Debbie and staff regularly negotiated the newly built highway to Ararat during the following 12 months to develop the training package that the Australian Nursing and Midwifery Accreditation Council (ANMAC) require for endorsed enrolled nurses to be eligible for the award of Diploma of Nursing and register with AHPRA on successful completion of their course. The process for setting up the course to be ready for its inception in January 2017 was exciting and arduous. Complexities that were worked through included the ANMAC accreditation process; course funding arrangements; sourcing support services for students including counsellors, information technology, library and preparing trainers and the course advisor via workshops. EGHS is in an enviable position of having experienced and motivated registered nurses who hold the training and assessment qualification as required by the Vet sector. Recruiting the minimum desired 25 prospective students was not difficult. After traversing ACUcom’s recruitment process, 28 eager students commenced their EEN training at EGHS in February 2017. It is envisaged that some of the nursing workforce issues will be addressed with this excellent initiative.

References Bush, N. 2015. CEO, East Grampians Health Service. Girdlestone Street, Ararat, Victoria. 3377. Health Workforce Australia, 2014. Australia’s future workforce-nurses. Department of Health, Canberra ACT. August. pp 3-6.

Pam Shackleton is Course and Clinical Coordinator, ACUcom Diploma of Nursing at ACU, Aquinas Campus anmf.org.au

FOCUS: Education so that they could be autonomous. All of our national nursing staff were refugees themselves who fled Sudan for their lives, and some only had a primary school education, so I had expected the training to be limited to the absolute basics. But I was amazed at how quickly they absorbed all the information – delivered in a language that wasn’t their own – and the speed with which they put it into action. In fact, the greatest challenge I found was in keeping up with their demands for information.

EDUCATING NURSES IN RESOURCE-POOR AREAS By Jai Defranciscis Jai Defranciscis is an Australian nurse with a passion for paediatrics and education in resource-poor settings. Last year she joined the international medical aid organisation Médecins Sans Frontières (MSF) – also known as Doctors Without Borders – heading to South Sudan for a year, working with refugees fleeing fighting between armed groups. This is her account. When I accepted the position of ‘Training Nurse’ with Médecins Sans Frontières in South Sudan I braced myself for the worst, and hoped for the best. It was my first time working for a humanitarian organisation and my first time in South Sudan, so everything was very new. But from the moment I arrived I was overwhelmed both by the national staff’s hunger for education, and how much of an education I would receive myself. The MSF project was in a remote area of South Sudan close to the Sudan border. Refugees had been streaming across this border since 2011 when conflict erupted between the Khartoum government (Sudan) and rebels in the south (South Sudan).

organisations. Our team of 220 national staff and 10 international staff (MSF 2015) ran inpatient therapeutic feeding, a paediatric ward, a neonatal ward, a TB-HIV ward and an adult general ward. Medical aid was also extended to even more remote locations affected by conflict in the surrounding areas. I had never worked in a place like this. Children were being admitted with preventable diseases such as measles, tetanus and polio. There were diseases that were new to me such as kala azar. And there were conditions that were difficult to fathom: people coming in with war wounds that hadn’t been treated for years simply because there was no one to treat them.

The area had a rugged beauty which I quickly fell in love with, but conditions were harsh. I had the luxury of my own tent and a dugout latrine, but for the 70,000 or so refugees in the overcrowded camp of Yida, simply getting enough food and water to survive each day was a struggle.

Given the circumstances, it would be easy to assume that the work might be demoralising or disheartening but my experience was the exact opposite, thanks to the endless optimism and strength of our national team and their fierce determination to learn.

There was no infrastructure and the only healthcare available was provided by a handful of aid

From the outset my personal goal was to empower the nursing staff and develop their knowledge and skills

anmf.org.au

JAI DEFRANCISCIS (L) IN SOUTH SUDAN

My approach was to be as handson as possible, holding theoretical teaching sessions to complement and build on the practical, on-thejob training I provided. MSF works with ‘medical tool kits’ – a collection of protocols, guidelines and policies that address every disease and every condition and which ensure we maintain the highest medical standards even in such resource poor settings. These became my bible. My background experience in paediatrics also proved to be invaluable. I loved the hands-on approach to teaching and would revise with the nurses a specific technique, skill or procedure and then give them the opportunity to practise it themselves with my supervision. On any given day you could find me either in the hospital working directly with the staff or in my “classroom” teaching the corresponding theoretical lessons. There was never a dull moment. And as crazy as it seems, it was fun. Our national team’s zest for life was infectious and they taught me so much – both professionally and personally. I can’t really put it into words; all I can do is say that I feel humbled and honoured to have been a part of this. And I look forward to going back. My appreciation for nursing education is now on a whole new level. Organisations such as MSF won’t be there forever, but – hopefully – the legacy of their investment in national staff training will. Médecins Sans Frontières Australia (MSF) is looking for neonatal and paediatric nurses to help deliver medical assistance to the people who need it most. You must be able to commit to a minimum of six to nine months and be a resident of Australia or New Zealand. Find out more on the MSF Australia website. www.msf.org.au

Reference Médecins Sans Frontières (MSF). 2015. MSF employed more than 2,937 South Sudanese staff and 329 international staff to respond to a wide range of medical emergencies and provide free and high quality healthcare to people in need through 18 projects. Final 2016 figures not available

Jai Defranciscis is a Nursing Activity Manager at Médecins Sans Frontiers Australia

July 2017 Volume 25, No. 1 35

FOCUS: Education

RESEARCH: PATIENT DETERIORATION – PATIENT SAFETY By Simon Cooper, Catherine Chung, Leigh Kinsman and the First2Act Impact team Hospitalised patients with complex health issues are vulnerable to rapid physiological deterioration (Buykx et al. 2012; Liaw et al. 2016). Early identification, appropriate management and applicable help seeking behaviour continues to be of international concern (Waldie et al. 2016).

The Victorian government supported a patient safety project that tested the education, clinical and financial impact of the patient deterioration program FIRST2ACT™ (Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends). Nursing staff were trained for up to two hours in primary responses to emergencies in a medical ward in two public regional hospital wards and two private hospitals using either face-to-face (F2F) or a web based (WB) version of FIRST2ACT™. The F2F program was completed with teams of three nurses, and the WB individually. The results indicated that both the F2F and WB programs significantly improved nurses’ knowledge, competence and confidence and were positively evaluated by participants. Skill performance for WB increased significantly, while F2F training is likely to improve skills with repetitive practice. Both programs had a significant clinical impact, increasing clinical reviews and improving nursing interventions. Over time the web based version will be considerably cheaper to implement. Focus group interviews with key stakeholders indicated positive educational and clinical impact but room for improved debriefing, limits to the fidelity of simulation, and a need to consider clinical communication, vital sign chart forms and practice. Details of the First2Act programs are available at http://first2actweb.com/

The face-to-face program runs for two hours for a team of three participants and includes simulations with patient actors (Buykx et al. 2012). The 1.5 hour web based program is available free on the website and includes interactive video based scenarios which to date have been completed by 10,000+ participants from across the world. The study has been completed with the protocol, review paper and final report now available. For further information, please contact Professor Simon Cooper s.cooper@federation. edu.au Acknowledgement - Federation University acknowledges the support of the Victorian government. Professor Simon Cooper, PhD is Professor of Emergency Care and Research Development in the School of Nursing, Midwifery and Healthcare, Faculty of Health at Federation University Australia Catherine Chung is Lecturer and Project Manager – Impact of face-to-face and webbased simulation on patient safety, Faculty of Health at Federation University Australia Professor Leigh Kinsman, PhD is Professor of Healthcare Improvement in the School of Health Sciences, Faculty of Health at University of Tasmania

References Australian Commission on Safety and Quality in Health Care. 2012. Quick-Start Guide to Implementing National Safety and Quality Health Service Standard 9: Recognising and responding to clinical deterioration in acute health care. Sydney ACSQHC. Buykx, P. Cooper, S., Kinsman, L., Endacott, R., Scholes, J., McConnell-Henry, T., Cant, R. 2012. Patient deterioration simulation experiences: impact on teaching and learning. Collegian 19(3):125-129. Jha, A.K, Larizgoitia, I., Audera-Lopez, C., Prasopa-Plaizier, N., Waters, H., Bates, D.W. 2013. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Quality & Safety 22(10): 809-815 Liaw, S.Y., Chan, S.W., Scherpbier, A., Rethans, J.J., Pua, G.G. 2012. Recognizing, responding to and reporting patient deterioration: Transferring simulation learning to patient care settings. Resuscitation 83(3): 395-398.

Odell, M., Victor, C., Oliver, D. 2009. Nurses’ role in detecting deterioration in ward patients: systematic literature review. Journal of Advanced Nursing. 65(10):1992-2006. Stevenson, J.E., Israelsson, J., Nilsson, G.C., Petersson, G.I., Bath, P.A. 2016. Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered inhospital cardiac arrest. Health Informatics 22(1): 21-33. Waldie, J., Day, T. et al. 2016. Patient safety in acute care: are we going around in circles? British Journal of Nursing (Mark Allen Publishing) 25(13): 747.

CRICOS provider: Monash University 00008C

The ‘failure to rescue’ evidence suggests that nurses are not always clear about when to call for assistance, do not seek advice and fail to appreciate clinical urgency (Odell et al. 2009).

FOCUS: Education

LITTLE THINGS DO MATTER By Joy Penman A few nursing students asked me does it really matter that nurses write drug dosages in a particular way and follow a certain set of rules that have been devised. Must we belabour ‘little things’ as abbreviations and symbols? What is wrong with .5grms and not 0.5 g? “Of course it matters”, was my quick reply. I gathered my thoughts and enumerated the reasons for observing the conventions of units of measure, abbreviations and rules for writing drug dosages. First, it is important for nurses to speak and write as other health professionals. Nurses are part of the scientific community and we need to be in agreement with others when it comes to internationally agreed upon units and language. Second, observing convention will reduce the chance for medication errors, misinterpretations and confusion. Third, an average patient should be able to read and understand numerical nomenclature and uniformity in expression will facilitate his/her understanding considerably. Accuracy and consistency are paramount for medication charts and records, prescriptions, pharmacy computer orders, labels, and internal and external communications. The rules have been summarised by Cree and Rischmiller (2001) and Thompson and Taylor (2008). NIST has also produced a complete 80+ page document covering all aspects of this topic which can be downloaded at: http://physics.nist.gov/cuu/Units/ rules.html

Another resource is the Institute of Safe Medication Practices that has listed error-prone abbreviations, symbols, and dose designations with this link: http://www.ismp.org/tools/ errorproneabbreviations.pdf Here are some rules to follow: • Any quantitative measurement has to have a unit. The number four by itself can represent four elephants. • The units and symbols of quantities pertinent to nurses are to be written as follows: length, metre, m; mass, kilogram, kg; time, second, s; mass, gram, g; capacity, litre, L; time, minute, min; time, hour, h. • μg representing microgram has been mistaken as “mg”, hence, use “mcg”. • When any calculation is performed involving two or more numbers, the answer can be no more accurate than the accuracy of those numbers. A case in point is the quantity 1.2345 mL which is meaningless. Use only two significant figures - 1.2 mL is meaningful and accurate (could be stretched to 1.23 mL but nothing more). • Do not pluarise units, 7 h is correct but not 7 hrs. • Full stops are not used at the end of abbreviations, 15 kg is correct but not 15 kg.

ACCURACY AND CONSISTENCY ARE PARAMOUNT FOR MEDICATION CHARTS AND RECORDS, PRESCRIPTIONS, PHARMACY COMPUTER ORDERS, LABELS, AND INTERNAL AND EXTERNAL COMMUNICATIONS.

• A space in between the number

and the symbol for the unit is observed. Thus 98 min and not 98min. • A zero is always used before the decimal for any numbers less than one, hence, 0.60 mL is correct but the naked .60 mL is not. • Use the word ‘zero’ instead of ‘nought’ or ‘oh’. • Use up to date abbreviations and symbols. Many older practices have been changed. Dr Joy Penman is Senior Lecturer in Nursing and Midwifery at Monash University

References Cree, L and Rischmiller, S. 2001. Science in Nursing, 4th edn, Elsevier. Thompson, A and Taylor, B.N. 2008. Guide for the use of the International System of Units (SI). http://physics.nist.gov/ cuu/Units/rules.html

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FOCUS: Education

CAN CHINA LURE ITS FOREIGN-TRAINEDNURSES HOME OR WILL AUSTRALIA WIN THE NURSING TALENT WAR? By Carol Chunfeng Wang Many countries are experiencing a shortage of nurses and this demand is set to increase and potentially reach a crisis point in the next decade (Twigg et al. 2013; Health Workforce Australia 2012; World Health Organization 2013). Further, 40% of nurses are predicted to retire in the next 10 years in developed countries (World Health Organization 2013).

References Australian Education International. 2015. International Student Enrolments Department of Education and Training Deloitte Touche Tohmatsu Limited. 2014. Global health care outlook: shared challenges, shared opportunities (Report).

It is estimated that, in Australia, there will be a shortage of approximately 109,000 nurses by 2025 (Health Workforce Australia 2012; Twigg et al. 2013). China is also experiencing nursing shortages (Deloitte Touche Tohmatsu Limited 2014) and has suffered a loss of economic investment due to its continuing loss of nurses (Zweig and Wang 2013). Despite the need for nurses at home, Chinese citizens comprise the single largest group of international nursing students in Australia (Australian Education International 2015). Australia seeks to attract international nursing students from China to maintain its economic advantage and alleviate its projected nursing shortage. In contrast, China desperately needs its best and brightest citizens who have trained abroad as nurses to return to China in order to cope with its current challenges in the healthcare system and nursing education (Wang et al. 2016). Little is known about the underlying factors that motivate Chinese nursing students to study in Australia, these students’ learning experiences at Australian universities, and whether or not these students will return to China after graduation (Wang et al. 2015). Through a narrative inquiry of Chinese nursing students at Australian universities, the authentic voices of six participants’ stories were collected to capture the entire emotional, social, intellectual and reflective processes of each student’s motivations, learning experiences and future career plans (Wang et al. 2017; Wang 2017; Wang and Geale 2015). The research findings from this study are presented as both 38 July 2017 Volume 25, No. 1

narrative and thematic representations and the meaning was unpacked to provide insights to the ‘reality’ as seen by the study participants. The participants’ experience of studying in Australia was characterised by the need to learn a new language, feeling lost in a new education system vastly different to the one at home, the challenge of making new friends and socialising, and eventually successfully completing their study and attaining their goals. The experience of being an international student was not described as easy. It requires taking risks, courage, determination, motivation and persistence to succeed. Through their lived experiences and reflections of their learning journey in Australia, the participants reconstructed their personal identity and worldviews, which ultimately helped them locate their place in Australia (Wang 2017; Wang et al. 2017). Given the global competition for skilled nurses (Welch and Hao 2015; Wang 2016), the policy implication of the research is important for key decision makers in Australia, China and beyond, which could include university administrators, educational ministries, healthcare administrators, and even private enterprises in the field of international education, healthcare development, future connections and investment in education globally. The insight gained from the study can support the development of successful human capital investment for all parties involved. Carol Chunfeng Wang, PhD, is a Lecturer in the School of Nursing and Midwifery at Edith Cowan University in WA

Health Workforce Australia. 2012. Health Workforce 2025 Doctors, Nurses and Midwives. Volume 2. Adelaide, Australia. Twigg, D., E, Duffield, C. & Evans, G. 2013. The critical role of nurses to the successful implementation of the National Safety and Quality Health Service Standards. Australian Health Review, 37, 1. Wang, C. C. 2017. Conversation with presence: a narrative inquiry into the learning experience of Chinese students studying nursing at Australian universities. Chinese Nursing Research. Wang, C. C. 2016. Closing the gap in nursing education: comparing nursing registration systems in Australia and China. Chinese Nursing Research, 3, 1-6. Wang, C. C. 2017. Chinese nursing students at Australian universities: A narrative inquiry into their motivation, learning experience, and future career planning. PhD, Edith Cowan University Wang, C. C., Andre, K. & Greenwood, K. M. 2015. Chinese students studying at Australian universities with specific reference to nursing students: A narrative literature review. Nurse Education Today, 35, 609-619.

Wang, C. C. & Geale, S. K. 2015. The power of story: narrative inquiry as a methodology in nursing research. International Journal of Nursing Sciences, 2, 195-198. Wang, C. C., Whitehead, L. & Bayes, S. 2016. The real ‘cost’ of study in Australia and the ramifications for China, Australia, and the Chinese nursing students: what do these three players want? A narrative review. Globalisation, Societies and Education. Wang, C. C., Whitehead, L. & Bayes, S. 2017. They are friendly but they don’t want to be friends with you: A narrative inquiry into Chinese nursing students’ learning experience in Australia. Journal of Nursing Education and Practice, 7, 27. Welch, A. & Hao, J. 2015. Global argonauts: returnees and diaspora as sources of innovation in China and Israel. Globalisation, Societies and Education, 1-26. World Health Organization. 2013. Global health workforce shortage to reach 12.9 million in coming decades. Zweig, D. & Wang, H. 2013. Can China bring back the best? The Communist Party organizes China’s search for talent. The China Quarterly, 215, 590-615.

anmf.org.au

FOCUS: Education

ADVANCED LIVER DISEASE NURSE EDUCATION By Janice Pritchard-Jones Liver disease and liver cancer is increasingly prevalent in Australia. The Economic Cost and Health Burden of Liver Diseases in Australia report commissioned by GESA and the Australian Liver Association (ALA) in 2013 estimated more than six million Australians, or over a quarter of the population, were affected by liver disease (Deloitte Access Economics 2012). In 2015, we piloted a new nine month education program at Royal Prince Alfred Hospital and St George Hospital for nurses caring for people with advanced liver disease. The program includes mentoring by a hepatologist, face to face lectures, clinical placements, skills workshop, online learning, written and oral assessments. The program is accredited by Sydney University and credit points can be used towards a post-graduate course. We are trying to build a highly skilled hepatology workforce. At completion of the program the nurses are expected to have the knowledge and skills to present a long case to a hepatologist and a hepatology nurse consultant The program is now in it is third year. We have had nurses enrol from across Australia. Nurses can be mentored by their local hepatologist or a tertiary hospital hepatologist. This year we have had 14 nurses enrolled and over the last three years we have had over 20 hepatologists agree to be mentors. If you would like more information about the program please contact Janice Pritchard-Jones, Hepatitis Coordinator, Sydney Local Health District on 0434 360 357. Reference Deloitte Access Economics for The Gastroenterological Society of Australia/Australian Liver Association. 2012. The economic cost and health burden of liver diseases in Australia. Sydney: Deloitte Access Economics

Janice Pritchard-Jones is Hepatitis Coordinator at Sydney Local Health District in NSW anmf.org.au

THE IMPORTANCE OF PALLIATIVE CARE EDUCATION FOR NURSING STUDENTS

By Judith Anderson and Linda Deravin In Australia, most people die within healthcare facilities (Australian Institute of Health and Welfare 2014). This makes it important that nursing students are well prepared to care for people at their end of life. Palliative care is included in undergraduate nursing curricula (Adesina et al. 2014; Anderson & Malone, 2015; Deravin-Malone et al. 2016; Dobbins 2011) however, in a recent study conducted at Charles Sturt University, newly graduated nurses felt that this was an area of practice that they were not adequately prepared for (Anderson et al. 2017). This is echoed within the literature (Adesina et al. 2014) and is a global concern (Barrere & Durkin 2014; Dobbins 2011), particularly in rural areas, limited staffing numbers at small sites and ‘after hours’ (evenings, nights and weekends) result in a lack of support for newly graduated RNs. This limited support makes new graduates working in these small sites more reliant on the undergraduate education they have received (Anderson et al. 2011; Anderson & Malone 2014). Typically education includes the physiological process of dying, however areas where new graduate nurses felt they were unprepared to work with people at the end of their lives was the responsibility of dealing with families and carers who had specific questions around the dying process and communicating with families in general (Deravin-Malone et. 2016; Mutto et al. 2012). Education should include simulation activities (Ellman et al. 2012; Fluharty et al. 2012) and role modelling difficult conversations that support effective communication with patients and families (Deravin-Malone, Anderson et al. 2016; Mutto et al. 2012). Literature identifies that this has been an effective means of alleviating student and new graduate anxiety when providing care for the dying person (Ellman et al. 2012; Fluharty et al. 2012). Valuable resources exist to assist the education of new graduate nurses, for example, Palliative Care Australia, the Palliative Care Curriculum for Undergraduates (PCC4U) website and Program of Experience in the Palliative Approach (PEPA). Other suggestions to enhance education of student nurses include the provision of guest speaker sessions from palliative care nurses experienced in the field and from relatives who are able to share the lived experience of the person who is palliated. This is a teaching practice highly valued in mental health (Happell et al. 2015). Another strategy to support student learning is the use of reflective practice where clinical educators or experienced staff take the lead in facilitating these discussions (Deravin-Malone, Anderson et al. 2016; Gillett et al. 2016). Palliative care education is important to newly graduated nurses as it has been identified in the literature as being poorly addressed. Several strategies have been identified to assist this process including, simulation, role modelling and reflective practice. If palliative care education is not well addressed in undergraduate curricula then there is a significant need to address this gap for new graduate nurses. Acknowledgements: The author declares no conflict of interest

Dr Judith Anderson is a Senior Lecturer and Linda Deravin is a Lecturer in Nursing. Both are at Charles Sturt University in the School of Nursing, Midwifery and Indigenous Health

References Adesina, O., DeBellis, A., & Zannettino, L. 2014. Third-year Australian nursing students’ attitudes, experiences, knowledge, and education concerning end-of-life care. International Journal of Palliative Nursing, 20(8), 395-401. doi: 10.12968/ ijpn.2014.20.8.395 Anderson, J., Croxon, L., & Deravin, L. 2017, Apr. Newly graduated nurses working in isolation with palliative patients. Paper presented at the 14th National Rural Health Conference, Cairns, QLD. Anderson, J., & Malone, L. 2015. Chronic care undergraduate nursing education in Australia. Nurse Education Today, 35(12), 1135-1138. doi: 10.1016/j. nedt.2015.08.008 Anderson, J. K., Bonner, A., & Grootjans, J. 2011. Collaboration: developing integration in multipurpose services in rural New South Wales, Australia. Rural and Remote Health, 11(1827). Anderson, J. K., & Malone, L. 2014. Suitability of the multi-purpose service model for rural and remote communities of Australia. Asia Pacific Journal of Health Management, 9(3), 14. Australian Institute of Health and Welfare. 2014. Palliative care services in Australia 2014, Cat no. HWI 128. Canberra: AIHW. Barrere, C., & Durkin, A. 2014. Finding the right words: the experience of new nurses after ELNEC education integration into a BSN curriculum. Medsurg Nursing, 23(1), 35. Deravin-Malone, L., Anderson, J., & Croxon, L. 2016. Are newly graduated nurses ready to deal with death and dying? - a literature review. Journal of Nursing and Palliative Care, 1(4), 89-93. doi: 10.15761/ NPC.1000123 Deravin-Malone, L., Croxon, L., McLeay, M., & Anderson, J. 2016. End of Life Care. In L.

Deravin-Malone & J. Anderson (Eds.), Chronic care nursing: A framework for practice. London: Cambridge University Press. Dobbins, E. H. 2011. The impact of end-of-life curriculum content on the attitudes of associate degree nursing students toward death and care of the dying. Teaching and Learning in Nursing, 6(4), 159166. doi: 10.1016/j. teln.2011.04.002 Ellman, M. S., Schulman-Green, D., Blatt, L., Asher, S., Viveiros, D., Clark, J., & Bia, M. 2012. Using online learning and interactive simulation to teach spiritual and cultural aspects of palliative care to interprofessional students. Journal of Palliative Medicine, 15(11), 1240-1247. doi: 10.1089/ jpm.2012.0038 Fluharty, E., Hayes, A. S., Milgrom, L., K., M., Smith, D., Reklau, M. A., McNelis, A. M. 2012. A multisite, multiacademic track evaluation of end-of-life simulation for nursing education. Clinical Simulation in Nursing, 8, e135-e145. doi: 10.1016/j. ecns.2010.08.003 Gillett, K., O’Neill, B., & Bloomfield, J. G. 2016. Factors influencing the development of endof-life communication skills: A focus group study of nursing and medical students. Nurse Education Today, 36, 395-400. doi: 10.1016/j. nedt.2015.10.015 Happell, B., Bennetts, W., Harris, S., Platania‐Phung, C., Tohotoa, J., Byrne, L., & Wynaden, D. 2015. Lived experience in teaching mental health nursing: Issues of fear and power. International Journal of Mental Health Nursing, 24(1), 19-27. doi: 10.1111/ inm.12091 Mutto, E. M., Cantoni, M. N., Rabhansl, M. M., & Villar, M. J. 2012. A perspective of endof-life care education in undergraduate medical and nursing students in Buenos Aires, Argentina. Journal of Palliative Medicine, 15(1), 93-98. doi: 10.1089/ jpm.2011.0238

July 2017 Volume 25, No. 1 39

FOCUS: Education

THE EXPERIENCE OF LEARNING ABOUT AND THROUGH PRACTICE DEVELOPMENT IN AN UNDERGRADUATE SETTING By Moira Stephens, Josie Christine Aitken and Kimberley Borg Practice Development (PD), person centredness and the nexus that binds them are essential yet complex elements in effective and compassionate nursing care. It is essential to work with students studying nursing to effectively facilitate their understanding of these concepts to enable future generations of nurses to be compassionate, person centred and critical delivers of care. Undergraduate students in the Bachelor of Nursing (Advanced), a four year degree leading to registration as a nurse in Australia, enrol in the core subject ‘Practice Development and Person Centredness’ in the final year of their degree. The subject introduces the student to PD as a tool for culture change and locates it within an integrated theoretical and practice context. Students learn about person centredness through pedagogy of Practice Development itself thus learn about PD through PD. ‘Practice Development is a continuous process of developing person-centred cultures…The learning that occurs brings about transformation of individual and team practices’ (Manly et al. 2008 p9) Students are introduced to five key themes: improving patient care; transforming the context and cultures where nursing takes place; employing systematic approaches to effect change in practice; the continuous

nature of practice development activity and facilitation which enables change. This subject aims to facilitate the student’s understanding and skills focusing on the nexus between practice-development strategies, leadership and effective healthcare delivery. This is a BN (Advanced) subject and as such, students are invited to use the site, readings and resources only as a starting point for their learning journey at this time in their degree. Students are invited to think critically and also to have fun in exploring ideas and ways of thinking. The whole of the assessment is a Patchwork Text comprising four ‘patches’. Students created an ePortfolio keeping reflective journals throughout the semester. They created pages using text, images, music and video to submit as assessment items for patches one, two and four. Each of the patches had a specific focus. For patch one students were asked - How did the prerequisites (of person centred nursing) impact on your ability to provide person centred care in your workplace experience? For patch two, by analysing the care environment and processes, students were asked to consider the care environment for person-centred nursing. For patch three, students created a digital media presentation wherein they

OUM’s innovative teaching style is fantastic and exciting. Truly foreword thinking, OUM allows the student to benefit from both local and international resources. Brandy Wehinger, RN OUM Class of 2015

considered the notion of person-hood and person centred nursing. Having examined workplace cultures that they experienced in practice, students were invited to provide an illustration of how they could facilitate one change in the workplace to enable a more person centred workplace culture. Students presented this in the online meeting space using Adobe Connect and then engaged in a rich, synchronous discussion in the space. Patch four provided opportunity for synthesis and reflection. This patch, where students ‘stitched it all together’, invited reflection on what students believed were their key learnings from each of the patches: How has what you have learned enabled you, as a nurse, to work effectively and compassionately with people with healthcare needs? The subject has been evaluated well and students are invited to feed forward for future iterations of the subject. Acknowledgements to Rebecca Jepson, Tapasya Shrestha and Taylor Yousiph

References Manley, K., McCormack, B. & Wilson, V. 2008. International Practice Development in Nursing and Healthcare. Blackwell: UK

Moira Stephens is Senior Lecturer in the School of Nursing at the University of Wollongong Josie Christine Aitken is a Registered Nurse at Illawarra Aboriginal Medical Services Kimberley Borg BN(A)

RN to MD

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FOCUS: Education

PRECEPTOR MASTERCLASS IN THE EMERGENCY DEPARTMENT: IMPROVING THE EXPERIENCE FOR UNDERGRADUATE NURSING SUPERVISION By Kaitlin Hingston and Rachel Cross The aim of this study was to deliver an educational preceptor masterclass for Registered Nurses (RN) who were preceptors for nursing students in one emergency department (ED) to assess whether education increased their experience as a preceptor. Ethics approval was gained. The masterclass content included allocated pre-readings, relationship development and effective teaching strategies in the clinical environment. To evaluate effectiveness participants completed a Clinical Preceptor Experience Evaluation Tool (CPEET) before and after attending the masterclass (O’Brien et al. 2014). The CPEET consisted of 39 statements divided into four domains (Roles, Challenges, Experience and Education and Satisfaction) (O’Brien et al. 2014). Participants self-rated their response to each statement using a 7-point Likert scale (strongly disagree to strongly agree). Eleven RNs participated in the study ranging from 20 to 50 years of age. Six were Clinical Nurse Specialists and five were Grade 2 RNs. Seven of the participants were female, four participants were male. Following the masterclass participants reported greater role clarity, a decrease in challenges as a preceptor, an increase in personal professional development and an increased satisfaction with the preceptorship experience. Post CPEET results showed participant’s reported greater understanding of their role when

a preceptor and in doing so enhanced their understanding of the requirement to educate and promote critical thinking in nursing students.

FOLLOWING THE MASTERCLASS PARTICIPANTS REPORTED GREATER ROLE CLARITY, A DECREASE IN CHALLENGES AS A PRECEPTOR, AN INCREASE IN PERSONAL PROFESSIONAL DEVELOPMENT AND AN INCREASED SATISFACTION WITH THE PRECEPTORSHIP EXPERIENCE.

Participants highlighted preceptoring nursing students did pose challenges. Main challenges faced included personality clashes, increased workload and motivation of students. Despite these challenges, post the educational intervention participants reported a decrease in perceived challenges faced when being a preceptor and reported increased

willingness to undertake ongoing preceptor roles. Post masterclass CPEET results identified participants were more likely to engage in professional development activities including self-reflection and reading updated resources. Overall participants felt the preceptorship experience enhanced their nursing knowledge. Post the masterclass participants reported they were overall more satisfied with the role. Feeling underprepared for a preceptorship role has been found to deter RNs from undertaking preceptorship and is also associated with a decrease in satisfaction and experience (McClure & Black 2013). This study sought to examine whether an educational intervention increased the experience of the preceptor role for RNs in one ED when preceptoring nursing students. Following the masterclass participants self-reported greater role clarity, a decrease in the perceived challenges faced when a preceptor, an increase in personal professional development and an increased satisfaction with the experience. The provision of professional development to preceptors can be of benefit.

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References McClure, E., and Black, L. 2013. The role of the clinical preceptor: an integrative literature review. Journal of Nursing Education, 52, 335-341. O’Brien, A., Giles, M., Dempsey, S., Lynne, S., McGregor, M. E., Kable, A., Parmenter, G., and Parker, V. 2014. Evaluating the preceptor role for pre-registration nursing and midwifery student clinical education. Nurse Education Today, 34(1), 19-24.

Kaitlin Hingston is a Clinical Support Nurse at Eastern Health, Maroondah Hospital, Emergency Department in Melbourne Victoria Rachel Cross is a Lecturer at La Trobe University, Alfred Clinical School in Victoria

FOCUS: Education

WE ARE ONE, BUT WE ARE MANY: HOW A REBOOT TO THE BACHELOR OF NURSING PROGRAM COULD BENEFIT US ALL By Margaret McAllister and Sue Dean In Australia, the process for becoming a qualified registered nurse has, more or less, stayed the same for 30 years. Our view is that it is time for a reboot and we give six good reasons why. Clinical services are now extremely diverse, depending on nurses to understand and respond to their unique client needs and treatments. They are fast paced, highly technical and attract keen clinicians who may not intend to work there for a lifetime (Krahn and Galambos 2012). To stay efficient and effective, they require graduates who come fit for practice, and who do not need re-training and extra resources. New graduates should be ready for their chosen field upon leaving university, yet many specialty areas have identified that graduate nurses are ill equipped to work in specialty areas (Albutt et al. 2013, Cable et al. 2015, Happell and Gaskin 2013). The highly-regulated bachelor of nursing program in Australia teaches a broad and basic set of skills to produce what is mythically known as ‘the comprehensive nurse’ able to practice in any area, from intensive care to mental health. Such an expectation is, we believe, excessive and unrealistic. No other health professional would have this burden placed upon them. This kind of generic training is more in tune with what monolithic hospitals from the 1970s and 80s may have needed, or provided, but it is anachronistic today (Keleher et al. 2010). Furthermore, most universities today increasingly are accepting that they have a responsibility to the communities in which they are placed. The university as ‘ivory tower’ has been replaced by the concept of the university as a partner and collaborator in improvements for their local community. An important way for universities to collaborate with health services is to produce healthcare graduates, such as nurses, who are fit for specific community needs. Customised programs would satisfy local health service and community expectations, and lead to programs that are rich in diversity across the country. Perhaps the graduate could no longer lay claim to comprehensive training, but they could begin to proudly assert that their alma mater prepared them for a modern nursing specialty. They 42 July 2017 Volume 25, No. 1

are an aged care nurse from UTAS, for example, or a Mental Health Nurse from UQ. Thus, linked to this second reason, is this third argument: university students ought to be proud of their specialised learning and know that they are entering the workforce with a specific set of skills that are welcome and respected. Yet most nursing students leave without clear career goals, and frightened at the prospect of where they might be placed and in need of lengthy induction training and remedial education. This is a disempowered position for the new graduate and wasteful education dollars for the health service.

AN IMPORTANT WAY FOR UNIVERSITIES TO COLLABORATE WITH HEALTH SERVICES IS TO PRODUCE HEALTHCARE GRADUATES, SUCH AS NURSES, WHO ARE FIT FOR SPECIFIC COMMUNITY NEEDS. Despite the heavy investment that the student, the university and the health service has made in preparing graduates for work, nursing has the highest turnover rate of all the health professions (Duffield et al. 2014). Reasons cited are: unprepared for the work, role overload, unhappiness and a failure to care according to personal values (Fida et al. 2016; Boamah and Laschinger 2015; Leineweber et al. 2016). Any economist, or even job placement officer knows this makes no financial or social sense. The few graduates who do stay long enough to be able to clarify which specialty they may want to focus on, are then hit with another hefty fee. To work in the area they have developed a passion for, where they are likely to make a positive difference in the care quality and the advancement of the knowledge

in that field, they must return to university and pay to complete a graduate diploma or Masters program (Happell and Gaskin 2013). To the 90% of women who constitute nursing this is economically unfair, and burdensome if not impossible for their families (Snyder and Green 2008). Most of these graduate diplomas are actually entry to specialist practice. An example is Midwifery. It is now possible, in many parts of the country for students to identify midwifery as their career goal and to study it at undergraduate level. The same should be true for most other specialty contexts, such as mental health, aged care, disability and so on. This is not an argument for deskilling or diluting programs, but focusing learning so that it is relevant to context. Our final argument, is that there is growing evidence healthcare consumers are dissatisfied with the care that they or their family members receive. Often these complaints are directed at nurses. Consumers believe that they are not receiving personalised care, and that nurses are not communicating clearly, compassionately or respectfully (Rahmati et al. 2015; Zamanzadeh et al. 2014; Drury et al. 2014; Dean et al. 2016). Given most students who enter nursing state they like talking to people and really want to make a positive difference (Sharp, McAllister and Broadbent 2015) then their failings with patients may be more to do with their own unmanaged anxiety and lack of role confidence. Anxiety and lack of confidence could both be assuaged with training that was focused, and where skills to be enacted were practised repeatedly with close guidance. Margaret McAllister is Professor of Nursing in the School of Nursing, Midwifery and Social Science at CQ University in Qld Sue Dean is Lecturer in the Faculty of Health at the University of Technology Sydney in NSW

References Albutt, G., Ali, P. & Watson, R. 2013. Preparing nurses to work in primary care: educators’ perspectives. Nursing Standard, 27, 41-46. Boamah, S. A. & Laschinger, H. 2015. The influence of areas of worklife fit and work‐ life interference on burnout and turnover intentions among new graduate nurses. Journal of Nursing Management. Cable, C., Dickson, C. & Morris, G. 2015. Inspiring undergraduates towards a career in community nursing: Clare Cable and colleagues look at what must be done to create evidence-based models for placements that go beyond traditional clinical areas. Nursing Management, 22, 18-25. Dean, S., Zaslawski, C., Roche, M. & Adams, J. 2016. “Talk to them”: Teaching communication skills to students of Traditional Chinese Medicine. Journal of Nursing Education and Practice, 6, p49. Drury, V., Criagie, M., Francis, K., Aoun, S. & Hegney, D. G. 2014. Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: Phase 2 results. Journal of Nursing Management, 22, 519-531. Happell, B. & Gaskin, C. J. 2013. The attitudes of undergraduate nursing students towards mental health nursing: a systematic review. Journal of Clinical Nursing, 22, 148-158. Keleher, H., Parker, R. & Francis, K. 2010. Preparing nurses for primary health care futures: how well do Australian nursing courses perform? Australian Journal of Primary Health, 16, 211-216. Leineweber, C., Chungkham, H. S., Lindqvist, R., Westerlund, H., Runesdotter, S., Alenius, L. S. & Tishelman, C. 2016. Nurses’ practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction: a multi-country, multilevel study. International Journal of Nursing Studies, 58, 47-58. Rahmati, F., Gholamalipoor, H., Hashemi, B., Forouzanfar, M. M. & Hossein, F. 2015. The reasons of emergency department patients’ dissatisfaction. Iranian Journal of Emergency Medicine, 2, 59-63. Zamanzadeh, V., Rassouli, M., Abbaszadeh, A., Nikanfar, A., Alavi-Majd, H. & Ghahramanian, A. 2014. Factors influencing communication between the patients with cancer and their nurses in oncology wards. Indian Journal of Palliative Care, 20, 12.

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FOCUS: Education JULIA BOCKING AND BRENDA HAPPELL IN REYKJAVIK WITH EXPERTS BY EXPERIENCE (MENTAL HEALTH) AND THEIR NURSING ALLIES WORKING ON OUR INTERNATIONAL PROJECT

WHEN THE CLIENT BECOMES THE TEACHER By Julia Bocking and Brenda Happell We all know how much we learn from the people we work with. We learn so much that can’t be taught through textbooks or classroom teaching. Most often that kind of learning happens in clinical practice. So what happens when we bring the client into the classroom? Julia Bocking and Brenda Happell from SYNERGY: Nursing and Midwifery Research Centre (University of Canberra and ACT Health) are involved in an international collaboration with universities from Iceland, Ireland, Norway, Finland, and the Netherlands to answer that very question. It is not the first time work of this kind has been done, however one distinguishing feature of this project is the partnership between nurse academics and clients (known as consumer or service users). Each university is represented by a nurse academic and a service user to produce a recovery-orientated, consumer focused learning module for undergraduate nursing students to prepare students for the complex task of supporting mental health recovery. Once the module is developed it will be delivered by service-user educators. Service-users are getting increasingly involved in the delivery of mental health nursing curricula. The aim is to increase the relevance of the content based on their lived experiences. Our project COMMUNE (co-production of mental health nursing education) takes this involvement further with anmf.org.au

a co-production approach. Serviceusers and academics have equal standing in co-produced work; working together as partners with a common goal. COMMUNE refers to service users as Experts by Experience to acknowledge the valuable and unique expertise they bring to the research. All partners have a strong commitment to creating a module which extends beyond the traditional medical approach to working with people diagnosed with mental illness. The first phase of COMMUNE required each partner university to facilitate service-user focus groups to gather more information about what service-users value in nurses and how they may become involved in nursing education. Interestingly, the findings (from 50 service-users across six countries) were similar in each country; service-users wanted an emphasis on communication skills, respect and empathy, nonjudgemental attitudes and an ability to engender hope. Ideas for achieving this included hearing personal stories of recovery and self-reflection exercises. These two aspects will help nursing students better understand the process of recovery from mental illness and promote selfdevelopment.

The second phase of COMMUNE took take place at Iceland University in May 2017. The entire research team will come together to produce the module which will later be piloted to determine the impact on nursing students. All partners are optimistic that the use of co-production will result in a unique offering which will assist nurses to provide recoveryorientated care; to meet policy imperatives and provide better care for people affected by mental illness. COMMUNE is the first project in the world to use the expertise of serviceusers in this way to improve mental health nursing curricula.

Julia Bocking is a Consumer Academic and Brenda Happell is Professor of Nursing and Executive Director at SYNERGY: Nursing and Midwifery Research Centre at The Canberra Hospital, ACT July 2017 Volume 25, No. 1 43

FOCUS: Education GRADUATES

References Adeniran, R. K., Rich, V. L., Gonzalez, E., Peterson, C., Jost, S., and Gabriel, M. 2008. Transitioning internationally educated nurses for success: A model program. The Online Journal of Issues in Nursing, 13(2). Department of Employment. 2012. Job Outlook: An Australian Government Initiative. Australian Government. Canberra, Australia. Retrieved from http://joboutlook. gov.au/occupation. aspx?code=2544and search=keywordandTab =prospects

THE GRADUATE CERTIFICATE IN AUSTRALIAN NURSING, SOUTHERN CROSS UNIVERSITY By Lucy Shinners, Christina Aggar and Associate Professor Lynnette Stockhausen The nursing workforce in Australia is ageing (Department of Health and Ageing 2010). In 2011, almost two in five of all employed nurses were over the age of 50 years (Australian Institute of Health and Welfare 2012). Medium to long term projections show that Australia’s demand for nurses will significantly exceed supply (Health Workforce Australia 2014; Department of Employment 2012) There is now a strong focus on the International Educational and Training Industry to promote growth in the economy, enrich our communities, facilitate international diplomacy and enhance our research standings (Department of Trade and Investment Queensland 2016). Approved by the Nursing and Midwifery Board of Australia (NMBA) and accredited by the Australian Nursing and Midwifery Accreditation Council (ANMAC), Southern Cross University developed the first Graduate Certificate in Australian Nursing program for internationally qualified registered nurses (IQNs). The Graduate Certificate in Australian Nursing draws on and articulates with the Australian Nursing and Midwifery Accreditation Council (ANMAC), National Competency Standards for registered nurses (2016) to provide a comprehensive framework for the curriculum. It is designed to build on prior knowledge, skills and nursing experience to develop a deeper understanding of nursing in the Australian healthcare context. Entry requirements are strict and students are assessed by 44 July 2017 Volume 25, No. 1

the Australian Health Practitioner Regulation Agency (AHPRA), prior to entry to the course as being deemed to hold the equivalent of an undergraduate degree. A number of prerequisite requirements need to be met prior to applying, including an English language test, national criminal record check, record of immunisation and visa certificates. The program consists of a four week intensive theoretical component, comprising of on-campus lectures, tutorials and high and low fidelity simulated learning, followed by a facilitated eight week professional experience placement within the surrounding health district. This February 2017, the first cohort of Graduate Certificate in Australian Nursing students graduated from Southern Cross University. It is well known IQN’s and preceptors require a high level of support during the transition to professional practice in Australia (Adeniran et al. 2008; Ohr et al. 2014). Previous research suggests it is a complex social and psychological experience in regards to learning environment, clinical placement, relocation and acculturation and, little is known about the retention of IQNs within the Australian nursing workforce (Stankiewicz 2014; Yunxian 2010.) Therefore, a program that addresses these issues will improve the

implications for practice settings. With this in mind Southern Cross University are evaluating the experience of the IQN’s enrolled in the program, the clinical facilitators and nurse preceptors supervising the professional experience placement and the IQNs intention to remain within the Australian healthcare system. Preliminary program evaluation results suggest an improvement in the IQNs’ professional development and confidence, through the provision of a course that promoted a high standard of clinical performance, a sound knowledge of legal responsibilities and a contribution to organisational engagement. The Graduate Certificate in Australian Nursing program is offered three times a year at Southern Cross University. For further information please contact Christina.Aggar@scu.edu.au Christina Aggar, PhD is Discipline Lead Nursing, Bachelor of Nursing Coordinator in the School of Health and Human Science at Southern Cross University Lucy Shinners is a Nursing Lecturer in the School of Health and Human Science at Southern Cross University

Department of Health and Ageing. 2010. Submission to the Productivity Commission Inquiry Caring for Older Australians from the Department of Health and Ageing. Australian Government Department of Health and Ageing Retrieved from www.pc.gov.au.ezproxy. uow.edu.au/__data/assets/ pdf_file/0016/104092/sub482. pdf Department of Trade and Investment Queensland. 2016. International education and training strategy to advance Queensland 2016-2026. Queensland, Australia. Health Workforce Australia. 2014. Australia’s future health workforce-Nurses: Detailed Report Canberra, Australia: Retrieved from www.health.gov.au/ internet/main/publishing. nsf/content/34AA7E6FDB 8C16AACA257D95001 12F25/$File/AFHW%20-%20 Nurses%20detailed%20 report.pdf Health Workforce Australia. 2012. Health workforce 2025: doctors, nurses and midwives, volume 1. Nursing and Midwifery Board of Australia. 2015. Nurse and midwife registration data. Australian Health Practitioner Regulation Agency. Retrieved from www. nursingmidwiferyboard.gov.au/ About/Statistics.aspx Ohr, S. O., Jeong, S., Parker, V., and McMillan, M. 2014. Organizational support in the recruitment and transition of overseas‐qualified nurses: lessons learnt from a study tour. Nursing and Health Sciences, 16(2), 255-261. Stankiewicz, G., and O’Connor, M. 2014. Overseas qualified nurses in Australia: reflecting on the issue. Australian Journal of Advanced Nursing. 31(3), 32-38. Yunxian, Z. 2010. The experience of China educated nurses working in Australia: A symbolic interactionist perspective. School of Nursing and Midwifery, Faculty of Health and Biomedical Innovation, Queensland University of Technology, Doctor of Philosophy Thesis, Brisbane, Australia

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FOCUS: Education

‘BIG IDEAS’ FOR IMPROVING PATIENT CARE: STUDENTS AND STAFF LEADING THE WAY By Louise Ward and Sinead Barry The ‘Big Ideas’ conference focused on improving patient care through a collaborative transdisciplinary partnership between the Royal Melbourne Hospital (RMH) and La Trobe University (LTU).

The Big Ideas conference was an innovative educational initiative designed to provide a learning opportunity for LTU/RMH students, healthcare professionals and members of the community. The Big Ideas conference created a platform for participants to engage in real life experiential learning and teaching practice (Kolb & Kolb 2005). The Big Ideas conference was held on 22 June in line with the RMH Research week. An experiential learning framework was used to motivate students/staff to take part in the Big Ideas conference and create innovative responses to improving patient care. The experiential framework is a learning centred educational innovation supporting knowledge creation through experience (Kolb & Kolb 2005). Participation in the Big Ideas conference required students and staff to develop an abstract, and an evidence based presentation that was delivered either face to face or via a recorded zoom session. All participants engaged in peer learning in numerous ways. Firstly, through the interaction with the academics organising the conference; secondly, via peer engagement and thirdly through presentation discussion and feedback.

This transdisciplinary conference provided students and staff with an opportunity to present their practical, imaginative and innovative ideas on improving patient care to audience members consisting of RMH/LTU staff, students, and local community members. The Big Ideas conference fostered a collegial relationship between students and staff. Student feedback confirmed that this partnership was considered beneficial for future employability and professional development. Staff reported positive impact to transdisciplinary collaboration and leadership capacity. Dr Louise Ward is an Associate Professor in Clinical Nursing Practice and Ms Sinead Barry is a PhD candidate and Lecturer in Nursing. Both are in the School of Nursing and Midwifery at La Trobe University, Melbourne. Reference Kolb, A.Y. & Kolb, D.A. 2005. Learning Styles and Learning Spaces: Enhancing Experiential Learning in Higher Education. Acad Manag Learn Edu, vol. 4 no. 2 193-212

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FOCUS: Education

THE ART OF FACILITATION: INSIGHTS FROM RESEARCH By Margaret McAllister and Cathie Withyman Like everyone, nurses and midwives need to multi-task. Not only must they be competent clinicians, but often they need to take on the role of facilitator. Often this takes the form of facilitating student learning while on work placement. At other times clinicians are expected to facilitate learning amongst clients and community members. Rarely are clinicians given formal training to help them develop good facilitation skills (Tengland 2010). Understandably, without training, clinicians may resort to their knowledge based on personal past experiences (Adriansen and Madsen 2013; Fitzpatrick and Tinning 2014). A simple definition of facilitation is the act of making something easier for another person to enact (Manley and Titchen 2017). Facilitation differs from teaching in that expert knowledge does not emanate from the facilitator to the learner. Rather, facilitation involves relationship building to understand the learner/ client/community’s personal interests and needs; sharing information in ways that are engaging, manageable and practical; and motivation so that participants stay engaged and practise new skills. In a recently completed study designed to assist clinicians become mental health promotion facilitators (McAllister et al. 2017), several discrete skills and attributes were found to be important in the process of facilitation. The training experience involved a combination of awareness raising, explanation and skills-practice, after which the clinicians and guidance officers demonstrated applied knowledge of mental health promotion and could effectively use

a range of strategies to be solutionfocused and engaging facilitators. The participants also shared their perspectives on what made for good facilitation. The first idea was that facilitation required the skilful ability to facilitate and encourage discussion. In particular, solution-focused skills were important which focuses on the strengths and abilities of learners, not their weaknesses or vulnerabilities, (McAllister 2013). When problems or challenges with the process arise, the aim is to acknowledge difficulties but not to indulge them and become trapped in trouble-talk. Practising strengths-based language to communicate is therefore vital. For example, upon first meeting a learner, the facilitator could adopt a warm, unknowing, yet curious stance that affirms, acknowledges and listens, by saying ‘Good to meet such a bright person. What are your hopes and aims for this upcoming placement?’ The next idea was that good facilitators need to be creative with use of learning materials and resources so that learners are intrigued, engaged and have fun. For example, it is useful to have a range of ice-breaker activities that simultaneously require the people to speak, talk about themselves, but also listen to those around them so that a supportive group can emerge. Good facilitators hold belief in and support for learners, and encourage them to identify as a group. Transforming isolated individuals into a group deepens identity, and enables peer learning to occur, which in turn supports learning. Group

activities such as ice-breakers, group analysis of trigger material and fun shared activities are strategies all facilitators can use. Flexibility and tailoring of information delivery to suit individual and group needs is important. Facilitators also need to be approachable, humble and choosing appropriate self-disclosure. Being careful not to dominate the conversation, or constantly take centre-stage, a good facilitator, could use subtle, indirect ways to model coping or problem-solving when the conversation lulls. For example, ‘I remember my first day at work. Someone told me I should fake it till I make it! Boy, were they right’. Then the facilitator could take the conversation back to participants and ask them what they thought that might mean in their lives. To know whether you have been effective as a facilitator, one needs to observe the impact on learners. If learners are displaying new actions and using new skills, which in our case were resilience strategies to support their own self-care and mental health, then this shows empowerment, and the achievement of facilitation by making complex information and skills easier for other people to apply. Finally, to promote ongoing improvement in one’s own facilitation skills, the facilitator needs to develop the ability to honestly reflect on practice. This happens by being aware of one’s own limitations, and capacity to relate with a diverse range of people, and to be open to new learning and self-discovery. Margaret McAllister is a Professor of Nursing and Cathie Withyman is a Research Fellow. Both are in the School of Nursing Midwifery and Social Sciences at CQUniversity in Qld

References Adriansen, H. and Madsen, L. 2013. Facilitation: A novel way to improve students’ well-being. Innovative Higher Education. 38(4), 295–308. Fitzpatrick, K. and Tinning, R. (Eds.) 2014. Health education: Critical perspectives. London: Routledge. Handley, C. and McAllister, M. (in press). Elements to promote a successful relationship between stakeholders interested in mental health promotion in schools. Australian Journal of Advanced Nursing. McAllister, M., Hasking, P., Knight, B. A., and Alexander, D. 2017. iCARE-R Building resilience in regional schools: Final Report. Noosa: CQUniversity Australia. McAllister, M. 2013b. Solution focused nursing. In T. Stickley and N. Wright (Eds.), Theories for Mental Health Nursing (pp. 269–287). London: Sage. Manley, K. and Titchen, A. 2017. Facilitation skills: The catalyst for increased effectiveness in consultant practice and clinical systems leadership. Educational Action Research. 25(2), 256–279. Tengland, P. 2010. Health promotion or disease prevention: A real difference for public health practice? Health Care Analysis. 18(3), 203–221

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JULY National Aborigines & Islanders Day Observance Committee (NAIDOC) Week 2-9 July. http://www.naidoc.org.au/ Australia and New Zealand Society of the History of Medicine 15th Biennial Conference Health, Medicine, and Society: Challenge and Change 11-15 July, Australian Catholic University, Fitzroy Campus, Melbourne, VIC. www.dcconferences.com.au/ hom2017 ANMF (Vic Branch) Enrolled Nurse Student Study Day 14 July, ANMF House, 540 Elizabeth Street Melbourne. http://bit.ly/ ANMFevents Lung Health Promotion Centre at The Alfred Asthma Educator’s Course 19-21 July Asthma & COPD Intensive – Mildura 24 July Respiratory Update 28 July P: (03) 9076 2382 E: lunghealth@alfred.org.au 5th Annual World Wide Nursing Conference The Role of Nursing in Leading and Advancing Global Health 24-25 July, Singapore. http://nursing-conf.org/ World Indigenous Peoples Conference on Education A Celebration of Resilience 24-29 July, Toronto Canada. www.wipce2017.com/ World Hepatitis Day 28 July. http://worldhepatitisday.org/ Key Concepts of Public Health and Tropical Medicine - Papua New Guinea What are the issues now for Australia and our near neighbours? What does the future look like? 28 July-7 August. The Conference is being held aboard the P&O Pacific Aria. Delegates will have the opportunity to explore the public health issues facing our near neighbour as we visit colleagues at a number of health services during the optional shore tours

NETWORK Royal Darwin Hospital, Group 7/77 (also including other groups from this year), 40-year reunion 15 July. Contact Di Robertson E: drobertson1959@hotmail.com St Vincent’s Hospital, July 67 PTS, 50-year reunion 22-23 July. Contact Barb Ford (nee Meich) E: barbara.ford1@bigpond.com or M: 0424 503 244 The Southern Grampians Maternal and Child Nurses Regional Network will be celebrating 100 years of Maternal and Child Health Nursing in Victoria and closure of the group 18 August, 6.30pm, Ballarat Golf Club. All past and present M&CH nurses working in the local government areas of Golden Plains, Pyrenees, Moorabool, Hepburn and Ballarat are warmly invited to attend a dinner. Contact: belindajoyce@ballarat.vic.gov.au

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at Alotau, Kitava, Rabaul, Kiriwana Island, and Conflict Islands. https:// www.nursesfornurses.com.au/events

AUGUST Tradies National Health Month www.tradieshealth.com.au Inaugural International Conference on Non Communicable Diseases Global Responses to a Global Epidemic 1-2 August, Kuala Lumpur, Malaysia. http://ncdcongress.co/ National Homelessness Prevention Week 1-7 August. www. homelessnessaustralia.org.au Lung Health Promotion Centre at The Alfred Smoking Cessation Course 3-4 August Influencing Behaviour Change – a formula 10-11 August Influencing Behaviour Change – Theory & Practice 10 August Influencing Behaviour Change – Intensive Workshop/Case Studies 11 August Spirometry Principles & Practice 14–15 August P: (03) 9076 2382 E: lunghealth@alfred.org.au 18th Victorian Collaborative Mental Health Nursing Conference 3-4 August, Moonee Valley Race Course, Moonee Ponds, Victoria. This annual, two-day conference showcases the specialist practice of mental health nursing across the full range of service settings and therapeutic approaches. It’s a relaxed, ‘grassroots’ event that’s open to students and nurses at any stage of their career. http://cpn. unimelb.edu.au/conferences/vcpnc National Aboriginal and Torres Strait Islander Children’s Day (NATICD) 4 August. www.snaicc.org.au/children 25th Health Informatics Conference 6-9 August, Brisbane Convention and Exhibition Centre, South Brisbane, Qld. Australia’s premier digital health, health informatics and ehealth conference and expo. www.hisa.org.au/hic/

Royal Hobart Hospital, PTS 8/84, 30-year reunion 19 August, 4pm, New Sydney Hotel, Hobart. Contact Chrissie Webster E: christine.webster@hotmail.com M: 0413 774 049 or facebook page PTS 8/84 Victorian School Nurse Conference 9 September, Lauriston Girls School Armadale. Conference trybooking link: https://www.trybooking.com/OPRX and Conference Dinner at Quaff trybooking link: https://www.trybooking.com/ PNDG Contact: Lindsey Booth E: lbooth@whitefriars.vic.edu.au M: 0407 509 622 Royal Canberra Hospital (Acton) reunion Luncheon 16 September, 12-3.30pm. For more information E: rchreunion2017@gmail.com

Australian New Zealand Intensive Care Society - Safety and Quality Conference: The Deteriorating Patient 7-8 August, Sofitel Sydney Wentworth. www.sqao-anzics.com International Day of the World’s Indigenous People 9 August. www.un.org/en/events/ indigenousday/ Australian Viral Hepatitis Elimination Conference 10-11 August, Cairns. www.avhec.com.au Drug and Alcohol Nurses of Australia ‘Endurance’ Forum 11 August, Park Royal Darling Harbour NSW. www.danaonline.org/danaconference/ International Elvis Week 11-19 August. Celebrate the 40th anniversary of Elvis’ passing with music, movies, and legacy of Elvis Presley. www.graceland.com/elvisweek/ National Left-Handers Day 13 August. www.lefthandersday.com 12th New Zealand Dermatology Nurses Conference 17-18 August, Queenstown New Zealand. www.nzdermatologynurses.nz/ 25th Annual Scientific Conference on Diving and Hyperbaric Medicine Back to the beginning 17-19 August, Adelaide Convention Centre, SA. www.htna.com.au Vietnam Veterans Day (Long Tan Day) 18 August www.vietnamvetsmuseum. org/node/vietnam-veterans-day-longtan-day Australian College of Nursing National Nursing Forum Make Change Happen 21–23 August, The Star, Sydney, NSW. www.acn.edu.au/nnf2017 National Daffodil Day (Cancer Council Australia) 25 August. www.daffodilday.com.au

Sturt College Nurses, 40-year reunion 4 November. Hoping you can join us for a casual and fun reunion of the first year of Sturt College nurses. It will be for drinks and dinner with time and venue to be advised. See event on Facebook. Contact Elizabeth Jarman M: 0422 702 917 or E: elizabethjanejarman@gmail. com Prince Henry’s Hospital, 1/73, 45year reunion 27 January 2018. Planning well underway. Trying to locate Carol Ball, Sue Ball, M de Graaf, Barb Gilmore, Sue Gladigau, Hilary Hammond, Barb Dunne, Narelle Harley, Chris Horton, Sue Ramage and Pam Walsh. Contact Jeanne O’Neill (nee Pinder) E: ej_oneill@yahoo.com

18th Asia-Pacific Prostate Cancer Conference 2017 30 August–2 September, Melbourne Convention & Exhibition Centre. APCR are proud to host the 18th Asia-Pacific Prostate Cancer Conference and will present a world-class Faculty of both International and National presenters, across a full 3-day program. Streams in Clinical Urology, Translational Science, Nursing and Allied Health will ensure the most contemporary information and research-validated findings are presented. http:// prostatecancerconference.org.au/ or apcc2017@icms.com.au

SEPTEMBER Lung Health Promotion Centre at The Alfred Asthma & Allergy Seminar 4 September Respiratory Course (Modules A & B) 18–21 September Respiratory Course (Module A) 18–19 September Respiratory Course (Module B) 20–21 September P: (03) 9076 2382 E: lunghealth@alfred.org.au International Wound Practice and Research Conference 6–7 September, Brisbane Convention & Exhibition Centre. http://iwprc2017.com.au

OCTOBER Congress of Aboriginal & Torres Strait Islander Nurses & Midwives (CATSINaM) Professional Development Conference Claiming our Future 10-12 October, Sofitel Broadbeach, Gold Coast Qld. http://catsinam.org.au/ Lung Health Promotion Centre at The Alfred Managing COPD 12-13 October Spirometry Principles & Practice 23-24 October P: (03) 9076 2382 E: lunghealth@alfred.org.au

PHH, POW and Eastern Suburbs Hospitals, NSW reunion for PTS intake of Feb1973 17 February 2018. Contact Roslyn Kerr E: gert2@optusnet.com.au or Patricia Marshall (nee Purdy) E: tapric135@bigpond.com NDSN Bendigo School 71, 50-year reunion 2018. Seeking students from Bendigo, Castlemaine, Echuca, Swan Hill, Mildura. Contact E: margie_coad@ hotmail.com or M: 0427 567 511

Email cathy@anmf.org.au if you would like to place a reunion notice July 2017 Volume 25, No. 1 47

ANNIE

DO YOU READ THE BACK PAGE? Assistant Federal Secretary, Annie Butler As you may be aware, the ANMJ has been available free online to all those interested in nursing and midwifery since February this year. The decision to make the journal freely available to all is part of the ANMF’s overall review of our communications with our members and with those in the community interested in our professions. We’re currently reviewing the ANMF’s communications from a national perspective both via the journal and online to ensure the ANMJ remains relevant, valuable and easily accessible to all nurses and midwives.

SOMETHING I’M PARTICULARLY INTERESTED IN IS WHAT NURSES AND MIDWIVES WOULD LIKE TO SEE AS THE ‘BACK PAGE’ OF THE JOURNAL. OVER THE PAST THREE YEARS, SALLY-ANNE JONES, ANMF FEDERAL PRESIDENT, LORI-ANNE SHARP, ANMF FEDERAL VICE-PRESIDENT (AND MAREE BURGESS, IMMEDIATE PAST FEDERAL VICEPRESIDENT) AND I HAVE TENDED TO USE OUR BACK PAGE COLUMNS TO DISCUSS SIGNIFICANT AND SERIOUS ISSUES.

We also want to ensure that we’re communicating effectively with a broader audience to let them know what’s happening in nursing and midwifery, as well as healthcare and aged care, and to let them know how nurses and midwives are continuously working for the wider benefit of the community. You will have noticed that this month’s ANMJ includes a member communication survey, which examines how and when nurses and midwives read the ANMJ, why you read the ANMJ and what you’d like to read in the ANMJ – both in the journal and on a specialised ANMJ website. Something I’m particularly interested in is what nurses and midwives would like to see as the ‘back page’ of the journal. Over the past three years, Sally-Anne Jones, ANMF Federal President, Lori-anne Sharp, ANMF Federal Vice-President (and Maree Burgess, immediate past Federal Vice-President) and I have tended to use our back page columns to discuss significant and serious issues. We’ve covered topics such as the health effects of climate change, the deplorable state of aged care, our society’s treatment of refugees and asylum seekers, the plight of the homeless and poverty stricken, the impact on our communities, and nurses and midwives, of major political

decisions and federal budget cuts, and the ethical obligation of nurses and midwives to act to improve our society overall, to name just a few. We are convinced that these are important topics and areas that should be discussed by nurses and midwives but we’re not at all sure that the back page column is the right place for these discussions. We’re also not at all sure that many, if any, nurses and midwives actually read the back page columns. We suspect that your responses to our current survey will confirm this. If we are right in thinking that the back page column is not the right place to try and encourage these sorts of serious discussions, we’d like to know two things. Do you agree that these are important discussions that we should have in a more appropriate place? And, what would you like to see as the back page of the journal? In considering the second question, I did a little research into how other magazines and publications use their back pages. I looked at a wide range, including newspapers, health journals, member based organisations’ journals, cooking magazines and special interest journals. As most of us know, the back page of newspapers is about sport, many magazines have crosswords and puzzles, some have ‘recipe of the month’, others have financial tips and advice or health tips and advice, and many more have cartoons and humorous pieces. My personal favourite though was the back page zodiac. We’re pretty sure that a back page ‘zodiac’ isn’t what nurses and midwives really want from their national nursing and midwifery journal but we’re very keen to know what you do want.

So let us know, either by adding your thoughts on the back page to our member communication survey www.surveymonkey.com/r/anmjsurvey

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