ANMJ June 2015 by Australian Nursing & Midwifery Journal

A U S T R A L I A N N U R S I N G & M I D W I F E RY J O U R N A L VOLUME 22, NO. 11

JUNE 2015

AUSTRALIA’S

DEMENTIA DIAGNOSIS

Alzheimer’s - the disease of the 21st century

www.anmf.org.au

NEPAL EARTHQUAKE VOLUNTEERS REQUIRED World Youth International (WYI) is a family run, Australian charity that has been deploying volunteers to developing countries since 1988. On April 25, Nepal was struck down by a 7.8 magnitude earthquake. In response to this disaster, WYI are seeking volunteers to join our programs and help us deliver a range of vital health care services to some of the most severely affected areas of Nepal.

NURSES IN ACTION

(For Allied Health Professionals 18+) A team of up to 12 volunteers will be led by a fully trained Australian registered nurse. Accompanying the group will be a Nepalese support team consisting of local medical staff, translators, security staff and a chef. The Nurses in Action Program will run over 30 days and the program fee covers ALL in-country expenses including meals, accommodation, transportation, orientation, placements, medical / school health camps and a range of other activities. Places are limited, but we do have availability on the following dates: October 20 to November 18, 2015 January 5 to February 3, 2016 March 5 to February 3, 2016

(6 places left) (5 places left) (7 places left)

OVERSEAS ACTION PROGRAM

(For people aged 18 – 30 years)

This program is identical to our NIA program in regards to the structure, time frame, cost and location. Volunteers will be based in the mountain community of Jwentar and the team will help to rebuild vital infrastructure projects such as schools, medical centres, orphanages and community centres. Our next program will commence on November 28, 2015. WYI launched the ‘Nepal Earthquake Appeal’ on April 27 and has raised a significant amount of money for the people of Nepal. A large portion of this funding will be kept aside to be used on these programs. All volunteers will receive training in disaster zone deployment and crisis management as part of their preparation. The program fee is $3995 and volunteers can fundraise their fees if they choose! Email admin@worldyouth.org.au for a comprehensive brochure pack. For more information, go to www.worldyouth.org.au or call 08 8340 1266

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

Editorial Lee Thomas, ANMF Federal Secretary The 2015-16 federal Budget is like a bag of liquorice allsorts, some parts are bright and colourful and other parts are dark and unwelcoming. In health there is nothing to cheer about. With a total spend of $69.4 billion in the portfolio, a reported decrease of $2 billion, the woe for patients and health workers will not improve over the coming 12 months. But unlike last year the proposed changes to Medicare have been replaced with announcements to review the Medicare item numbers in the largest review of the system ever undertaken. However, the freeze on doctors’ Medicare rebates and an increase in the price of PBS medicines could result in fewer bulk billing services and more out of pocket expenses for health consumers. Let’s not forget Australians already suffer one of the highest out of pocket costs ($1,075 per annum) for healthcare anywhere in the world. What will this mean in the longterm? Well, only time will tell, but with expected savings in health of $1.7 billion, I think it can only mean doing more with less. Another gloomy announcement was the shedding of $40 million from the aged care portfolio specifically from the aged care Workforce Development Fund. This fund saw innovative projects in the sector that aided recruitment and retention of nurses. With it now axed, the sector is ripe for a decrease in quality care to older Australians. Given this announcement it seems poignant that this month’s feature looks at issues around Alzheimer’s disease, which includes the need to grow our aged care workforce to manage and care for the increasing number of people affected by it. Normally a very optimistic woman, I can only shake my head in disbelief at the inconsistent announcements in this Budget for women particularly those planning to have children. Prior to the Budget the leaks were rife and one of those leaks came in the form of a trial of nannies for shift workers. For many years the ANMF has known the anmf.org.au

difficult, almost impossible situation nurses and midwives have in accessing long hours of day care. Earlier this announcement was welcomed even celebrated, sadly now it seems that while nurses and midwives can access childcare to fit shift working patterns, they won’t be able to afford to take any time off after their baby is born, following drastic changes to the publiclyfunded paid parental leave (PPL) scheme. A poll conducted by the ANMF, showed that 92% of Australia’s nursing and midwifery workforce currently work shifts outside regular Monday-Friday day-shift hours each month, with 78% of them reporting that they work outside of Monday-Friday day shift, on a weekly basis. From our perspective, changes to the PPL results in up to 100,000 of our members who could now lose access to paid parental leave. The Budget’s slashing of the PPL is contrary to expert advice which shows the existing scheme had improved the health and wellbeing of mothers and their babies. In fact, the World Health Organization (WHO) recommends 26 weeks leave of paid leave. As nurses and midwives, we all know the health benefits for both mothers and their babies, if new mums can stay at home longer. They can bond with their babies, breastfeed for longer and not be stressed about returning to work. Finally, I have to touch on the massive reduction in our foreign aid contributions. Millions of dollars has been taken out of this portfolio and the countries most affected are Indonesia and sub Saharan Africa. We should look after our own and balance the aid to other countries and perhaps I could swallow reductions in foreign aid if we were contributing more to Aboriginal and Torres Strait Islander Close the Gap initiatives but sadly those programs funded out of flexible grants have also suffered. It’s a very different budget from last year, and while community polarisation may not be as obvious this year I still believe we are experiencing a budget that does nothing to improve access to health or aged care services.

And just like liquorice allsorts the dark liquorice overtakes the bright colourful parts in a budget that is more measured but only barely. I cannot leave without mentioning the great tragedy following two earthquakes in Nepal. I’m sure like you my thoughts go out to the Nepalese and to all the Australian nurses and other workers that have gone, or who are planning to go to the country to provide emergency relief. Likewise I commend those of you who have donated towards the emergency relief effort. If you would like to help the people of Nepal, Union Aid Abroad - APHEDA is raising funds for medical treatment for the injured, temporary tent and housing, and water and food supply. To donate go to: http://apheda.org.au/ news/1430121386_30245.html or donate to one of the other appeals such as Red Cross Nepal Region Earthquake Appeal redcross.org.au

June 2015 Volume 22, No.11 1

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

@AustralianNursingandMidwiferyFederation

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Editorial

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

Melbourne & ANMJ

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Federal Secretary Lee Thomas

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Northern Territory

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Victoria

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

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

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

The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia. Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement. All rights reserved. Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrangement with the Australian Nursing & Midwifery Federation Federal Office Note: ANMJ is indexed in the CUMULATIVE INDEX to NURSING AND ALLIED HEALTH LITERATURE and the INTERNATIONAL NURSING INDEX ISSN 2202-7114

Moving state? Transfer your ANMF membership

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

New South Wales

Queensland

Tasmania

Western Australia

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

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

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

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

2 June 2015 Volume 22, No 11

144,496

TOTAL READERSHIP

Based on ANMJ 2014 member survey pass on rate Circulation: 98,970 BCA audit, March 2015

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Contents

Volume 22, No 11

News 4

Working life – Immunisation 17 Feature – Dementia diagnosis 18 World 24 Working life – Aged care

Research 34 Professional 35

Australia’s dementia diagnosis

Legal

Viewpoint 38

Alzheimer’s the disease of the 21st century

Issues

Reflection

Clinical update

Focus – Midwifery/Maternal health 44 Calendar 54 Mail

Maree 56

News

Reflections

African immigrant parents’ understanding of their teenager’s newly diagnosed diabetes status

Clinical update

Focus

Amateur theatre and mental health services – a fruitful collaboration to enhance clinical supervision

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Midwifery/Maternal health

June 2015 Volume 22, No.11 3

News

ANMF Vic Branch Secretary Lisa Fitzpatrick (l) and Premier Daniel Andrews

Scathing report on violence calls for action The ANMF Victorian Branch is calling for action against occupational violence to nurses following a scathing report by the state auditor-general released last month. The report examined the effectiveness of systems to protect healthcare workers against occupational violence and aggression (OVA). Shortcomings were found in all agencies audited: the Department of Health & Human Services (DHHS), WorkSafe and health services. Initiatives in place were ‘neither strategic nor coherent’, specifically around training, reporting and management of incidents. Victorian Auditor-General John Doyle questioned cases categorised as ‘mild’ or ‘no harm’, including attempted

Rallies to save rehab unit Tasmanian nurses have held rallies to save a rehabilitation unit of the Launceston General Hospital (LGH) from closure due to lack of state government funding. The John L Grove (JLG) 20 bed rehabilitation unit has treated slow stream rehabilitation patients over the past 18 months through $16.2 million

4 June 2015 Volume 22, No.11

strangulation, the kicking of a pregnant woman in the stomach, sexually inappropriate conduct, and being punched. “Obviously, this sort of categorising understates the risks involved,” he said. The ANMF Victorian Branch has long lobbied, particularly for appropriate risk management and for implementation of its 10-point plan to end workplace violence and aggression. The new Victorian government has supported the 10-point plan. ANMF Victorian Branch Secretary Lisa Fitzpatrick said the auditor-general’s recommendations reaffirmed OVA was an urgent and critical healthcare issue. “The DHHS, WorkSafe and employers have failed to take this issue seriously in the past.” While the ANMF welcomed work being done at WorkSafe to tackle OVA on a strategic level, the union echoed Mr Doyle in calling for better prevention, training, reporting and investigations around OVA incidents.

of federal government funding, under the national partnership agreement. The funding was only for the refurbishment of the state owned building and initial staffing setup costs, ANMF Tasmanian Branch Secretary Neroli Ellis said. Ongoing funding from the state government was always going to be required from the end of this month, she said. The state government had not confirmed funding for the JLG to continue to operate as the ANMJ went to print.

Of serious concern prioritised by the auditor-general and the ANMF was the “normalisation of OVA”. Whether potential or actual, this would eventually drive many nurses and midwives away from the public hospital system unless changes were made, Ms Fitzpatrick said. “Nurses and midwives, and indeed all healthcare workers and patients, deserve to have a safe workplace.” Inconsistencies in reporting of OVA from staff were highlighted in the report. “We acknowledge that nurses and midwives need to report every OVA incident, no matter how insignificant they may think it is, but they need the full support of their workplaces to do so,” Ms Fitzpatrick said. The ANMF welcomed the new state government’s first budget released last month, particularly $20 million in funding allocated to make public hospitals and mental health services safer for staff, patients and visitors.

“WE ACKNOWLEDGE THAT NURSES AND MIDWIVES NEED TO REPORT EVERY OVA INCIDENT, NO MATTER HOW INSIGNIFICANT THEY MAY THINK IT IS A $200 million Hospital Rescue Fund was also announced which would outline exactly how many beds, or points of care, would be opened throughout the year, as well as estimations of the number of patients to be treated annually as a direct result of the funding. “This is not a budget based only on bricks and mortar, it is a budget that bolsters the state’s health system with essential services funding,” Ms Fitzpatrick said.

Ms Ellis said 30% of JLG patients had come from the acute wards of the LGH which had freed up beds for surgical cases. “This in turn has not only had great outcome for patients but has had a significant impact in freeing up acute beds within the LGH.” Ms Ellis said the impact of freeing up these acute beds had reduced the pressure on the emergency department and increased the acute wards’ capacity to take an overflow of short term

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News Nepal recovery will take time Victorian nurse Jessica Moresco is able to understand the extent and context of the current devastation in Nepal more than many Australians. As a co-founder of TrekMedic and volunteer of World Youth International (WYI), Jess has been to Nepal seven times; witnessing first hand the resource poor hospital system and lower standard of nursing practice. She is currently aiding TrekMedic in coordinating the relief work in Nepal for two Australian TrekMedic teams with more to join over the coming months. Jess will return to Nepal in October as part of a WYI Nurses in Action program. “It is difficult at the best of times for Nepalese people to access health care due to financial means and the terrain – add the earthquakes to this and the situation becomes very desperate,” Jess said. More than 8,500 people had been reportedly killed in the Nepal earthquakes and over 19,000 injured as the ANMJ went to print. The first earthquake on 25 April, measured 7.8 on the Richter scale and the second 7.3 on 12 May. Earthquake survivor in Katteldanda, Nischal Kattel, said the community’s most important health needs were safe drinking water, sanitation and hygiene. Almost all of the 90 houses were levelled in the earthquake. “We worry about the toilets. Along with the houses, most of the toilets were destroyed by the earthquake. We want to build some toilets in this area so we do not become sick,” he said. “We have our own water source, but there is no safe drinking water, so we have to purify it.” Jess echoed these comments. She said the biggest health risks faced by those who survived the first earthquake were secondary to initial life-threatening

rehabilitation patients from the acute surgical wards. Closure of JLG would only increase the demand on the often already bed blocked areas of the LGH acute wards, she said. According to Ms Ellis closure of the rehabilitation unit could also see a loss of frontline nurses and hospital assistant positions. The unit has 30 nurses, 11 hospital assistants, eight allied health professionals, four allied health assistants, one administration ward clerk and medical

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injuries, and included: contaminated water and poor sanitation; disease from displaced rubbish and dead livestock; respiratory and GIT conditions; wound related complications; and post-traumatic stress. “These are all compounded by the current monsoon season - landslides and avalanches are common. The terrain is so mountainous. Whole roads can be wiped away. In Kathmandu, a densely populated city on a fault line, infrastructure is not ideal. It only takes after-shocks where buildings are a bit unstable, to collapse,”she said. WHO reported on 3 May that seven communities behind the Himalayas were not easily accessible where there were about 6,000 people who had not been reached with services since the earthquake had struck. Below those villages, there were about 7,000 more people who had not been reached. Government coordination of deploying aid teams appeared haphazard and inconsistent, Jess said. She said international organisations faced delays once in Kathmandu and were not dispersed to areas of need evenly. According to Jess TrekMedic was fortunate to have had two members of a recent team stay on in Nepal; one was due to fly home the day the first earthquake occurred. The other, a team leader was researching future treks and able to organise for TrekMedic to be deployed as a foreign medical team with WHO. TrekMedic was established in 2011 by a small volunteer group of Melbourne based health professionals. Each year the group send one to two teams to Nepal and run mobile village health clinics alongside local health workers and in areas where there is no health care. Primary heathcare and education was the main focus for the teams, Jess said.

professionals. “These are vital frontline services that this government, have preelection and repeatedly since, promised would not be lost,” she said. While redeployment back into the LGH should be an option, there had been no official guarantees, Ms Ellis said. “Such redeployment has the potential to push out current fix term contracted positions already held within the LGH.” Without state government intervention, this would become a reality, she said.

Jess with Nepalese lady in Pokhara

Jess said it would take years after initial emergency relief for Nepal to recover; preventative health and communicable disease being a major concern. World Youth International, an organisation focused on sustainable projects in collaboration with local communities, would play a big part in the future, she said. WYI offer meaningful health and construction based volunteer programs aiming to empower and educate communities. This would include the Nursing in Action program to start in October. “It’s a slow process to recovery,” she said. “Education is keythrough education you empower local communities and create positive change to sustain whatever you leave behind. In a developing country we must work within the resources available in those communities and respect local culture.” To find out more about TrekMedic go to facebook - trekMedic or email: trekmedic@hotmail.com For more information about Nurses in Action program through World Youth International go to: www.worldyouth. org.au/WorldYouth_OurPrograms_ NursesInAction

“Such a reality would be in opposition to the government’s constantly stated position that frontline services would not be cut.” Tasmanian Minister for Health Michael Ferguson said the state government would continue talks with the Commonwealth government. Ms Ellis said ongoing funding of the JLG was “firmly in the hands of the state government”. With community support, further action by staff could include the implementation of work bans, she said.

June 2015 Volume 22, No.11 5

News Older workers feeling the brunt of age discrimination More than a quarter of Australians aged 50 and over have reported experiencing some form of age-based discrimination in the workplace in the past two years, a new study has revealed. Australia’s first survey examining older workers, conducted by the Human Rights Commission, found 27% of mature employees had suffered discrimination on at least one occasion during 2013 and 2014. The National prevalence survey of age discrimination in the workplace found discrimination was most prevalent among people aged between 55 and 64. The most common forms of discrimination included barriers to promotion and training opportunities, a perception of possessing outdated skills, being exposed to jokes by managers or colleagues, and being threatened with a redundancy or asked to retire. Women were found to be more likely to experience age discrimination than men, with the study indicating a bias due to

judgments relating to outdated skills and being slow to learn new things. When it came to income, the study found workers earning $50,000 or less were more likely to experience age discrimination after they turned 50 compared to those on higher incomes. “The high prevalence of age discrimination in the workplace has obvious and lasting impacts on the health and personal security of those trying to get or keep jobs,” Age and Disability Discrimination Commissioner Susan Ryan said. Worryingly, while most people who had been subjected to age discrimination in the past two years were aware of channels to take some form of action, 23% chose not to proceed for fear of not being believed. Of those who reported experiencing age discrimination, an alarming 80% revealed negative health impacts including loss of self-esteem, increased stress, and financial problems. “I am particularly concerned that a third of people who had experienced age discrimination gave up looking for work as a result. Almost half began to think of retirement or accessing their superannuation fund,” Ms Ryan said.

“Winter is Coming” national flu campaign The next stage of a nationwide campaign aimed to fight antibiotic resistance has been launched for the 2015 cold and flu season. Nurses are being urged to take part in the NPS MedicineWise five-year campaign this year by sharing antibiotic resistance facts on social media, including encouraging people not to take antibiotics for ordinary colds and flu that won’t help against viral infections. winteriscoming.nps.org.au

6 June 2015 Volume 22, No.11

Cross-border vigilance on Ebola International medical organisation Mèdicins Sans Frontiéres is urging for continuing vigilance following reports Liberia is free of Ebola. After 42 days of no recorded cases of Ebola, the World Health Organization (WHO) declared Liberia Ebola-free last month. However Mèdicins Sans Frontiéres (Doctors Without Borders) warned the outbreak was not over with new cases of Ebola still recorded in neighbouring countries Guinea and Sierra Leone. “We can’t take our foot off the gas until all three countries record 42 days with no cases,” MSF’s head of the mission in Liberia, Mariateresa Cacciapuoti said. Improved cross-border surveillance to prevent Ebola from re-emerging in Liberia was needed, MSF warned. Nearly 200 Liberian health workers died after they contracted Ebola and the epidemic decimated the country’s already fragile national health system. WHO estimated 10,564 cases of Ebola and 4,716 deaths, with the peak of the outbreak in Liberia between August and October 2014. MSF opened the world’s largest Ebola management centre with 400 beds and treated 1,663 confirmed cases; of which 910 survived.

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When pain is gone, the smile is back.

Nothing is more effective than Children’s Panadol® 1 –4† Suitable from 1 month of age, Children’s Panadol®‡ effectively relieves pain and fever caused by teething, headache, earache, immunisation, and symptoms of cold and flu.1–3

†

Refers to non-prescription medicines at the recommended Australian doses for paediatric paracetamol (15 mg/kg) and ibuprofen (10 mg/kg).‡Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.5

References: 1. Autret-Leca E et al. Curr Med Res Opin 2007;23:2205–11. 2. Walson PD et al. Am J Dis Child 1992;146:626–32. 3. Schachtel BP et al. Clin Pharmacol Ther 1993;53:593–601. 4. Celebi S et al. Indian J Pediatr 2009;76:287–91. 5. NSW Department of Health. Policy Directive: Paracetamol Use. Available at: http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html. Accessed January 2015. Children’s Panadol® contains paracetamol. For the temporary relief of pain and fever. PANADOL® and package design elements are registered trade marks of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington, NSW 2115 Australia. GSK1481/UC 02/15. CHANZ/CHPAN/0021/15b.

News Opt-in trial for national eHealth system Patients will have to opt out of having an electronic health record rather than opt in as part of an attempt to revive the flagging national eHealth system. The federal government announced a trial of an opt-out rather than opt-in option as part of a $485 million package for a revised myHealth Record system. Labor’s Personally Controlled Electronic Health Record (PCEHR) opt-in system was introduced in 2012. A key recommendation of a review of the PCEHR in 2014 was for the system to be opt-out rather than opt-in to increase uptake. Opt out is the way to go as a sufficiently large number of PCEHRs need to be in active comprehensive and reliable use to gain the desired benefits, eHealth Education Chief Executive Officer/Director

Nurses and midwives find time to celebrate the professions Thank you to those of you who entered our photo competition, celebrating International Day of the Midwife and International Nurses Day. Many of you celebrated in creative ways from cake making competitions to afternoon teas. The winner of the $50 voucher is Flight Nurse Janine Hawkes from CareFlight NT. Janine sent in a picture of their team who wore “proud to know a nurse” badges on International Nurses Day. Janine said they celebrated nurses throughout their busy day.

Flight Nurse Gail Hyatt and CareFlight General Manager David Mann and Flight Nurse Janine Hawkes.

8 June 2015 Volume 22, No.11

and nurse eHealth expert Evelyn Hovenga said. However there were still key issues that needed to be addressed for success of the national electronic health record, Ms Hovenga said. “The lack of integration between current systems, a single sign on and ease of navigation between health applications are significant inhibitors to use of the PCEHR.” Development of, and compliance with, standards were critical for adoption of any federated system or process, Professor Hovenga said. “Common terms and language, IT protocols and report structures will improve integration and application however standards should be developed with current workflows in mind and using accepted and tested methods for development.” Nurses would need to be actively involved in the widespread adoption, use and integration of the revised eHealth

system, Australian Primary Healthcare Nurses Association (APNA) President Karen Booth said. “Nurses are well placed to support patients to set up and maintain their own electronic health records and support their active use.” Primary healthcare nurses had extensive experience in the maintenance of patient health records, particularly through their role in care coordination and chronic disease management, Ms Booth said. An open and transparent process and a public education campaign was needed to ensure community and clinician confidence in security and reliability of the scheme, according to the Consumers Health Forum (CHF). “The current opt-in approach has proved very slow to take hold,” CHF Chief Executive Officer Leanne Wells said. “A national electronic health record scheme has been long-awaited.”

Overuse of tests to be scrapped under national initiative A controversial new initiative aimed to reduce the overuse of tests, treatments and medical procedures has been welcomed by the medical community and consumer organisations. Health profession-led and facilitated by NPS MedicineWise, Choosing Wisely Australia, is based on the United States model, launched in 2012. Under the initiative, clinicians and consumers are asked to question and identify which tests, treatments and procedures are of low value or carry unnecessary risk. Evidence-based materials developed for both consumers and health professionals are available on the website www.choosingwisely.org.au Initial recommendations include food allergy testing, prostate cancer screening, vitamin D screening, monitoring of type 2 diabetes, benzodiazepine prescribing, emergency medicine procedures and ankle and spine imaging. An example is the ordering of diagnostic imaging for patients with non-specific acute low back pain which is the third most common presentation for GPs. Under the initiative, imaging is only recommended if a person has indicators of a serious spinal condition, spinal canal stenosis or sciatica. The initiative challenges the notion that 'more is always better' when it comes

to healthcare, NPS MedicineWise Chief Executive Officer Dr Lyn Weekes said. Consumers Health Forum Chief Executive Officer Leanne Wells said the initiative discouraged the use of outmoded or poorly-based treatments so that the “health dollar goes further and reduces the demand for cuts to the health budget.” “Money spent on unnecessary treatments means there is less to spend on the essential healthcare that many rural Australians currently miss out on,” National Rural Health Alliance Chief Executive Officer Gordon Gregory said. Australasian Society of Clinical Immunology and Allergy’s Dr David Gillis said there were tests and treatments in the area of allergy and immunology where there was little or no evidence to support them. “It is the right of every consumer… to be fully informed of the scientific evidence behind the testing or treatments they undergo.” Royal College of General Practitioners President Dr Frank Jones said the recommendations would help GPs in conversations with patients about appropriate care.

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Our courses include: • Birthing for the Non-Midwife • BLS/ALS • Care of the Peg & Stoma • Clinical Emergencies in the Aged Care Setting • Deteriorating Patient • Diabetes • IDC Insertion & Care of the IDC/SPC • Midwifery Short Course • Paediatrics • Respiratory • Resuscitation of the Newborn • Wound Management We also offer custom courses and can bring any of our courses to you! Nationally recognised courses offered by NED Victoria include: • Anaphylaxis • Asthma • CPR • First Aid (APL group training partner No. 3586).

20/05/2015 11:33:23 AM

News

Addressing the health needs of a multicultural society By Dr Ruth De Souza

Monash University School of Nursing and Midwifery has teamed up with the Centre for Culture, Ethnicity and Health (CEH) to address the health needs of a multicultural society. The partnership was recently announced publicly by The Hon Robin Scott, Minister for Multicultural Affairs at an event held at

North Richmond Community Health. To strengthen this relationship, Dr Ruth De Souza (pictured), Senior Lecturer Monash University School of Nursing and Midwifery has commenced a joint appointment with the Centre for Culture, Ethnicity and Health to lead its research team. The partnership will work towards building an evidence-base that paves the way to changing how the health sector works with an increasingly diverse community in the years to come. This joint appointment will allow both organisations to advance towards a shared goal of equity and quality in health for our communities, and in particular for people from refugee and migrant backgrounds. Victoria is the most culturally diverse state in Australia, with almost a quarter of Victoria’s population born overseas. Victorians come from more than 230 countries, speak over 200 languages and follow more than 135 different faiths. The partnership represents an acknowledgement of this diversity, and the need for health and social services that are equitable, culturally responsive and evidence-based. Dr De Souza’s joint appointment will help bridge the gap between research

and practice. She has a commitment to developing responsive clinical models of care that consider social determinants of health. Both organisations aim to develop a health and social workforce that can respond effectively to the needs of a diverse community. CEH has expertise in advocacy and community-building roles to contribute to healthier social and physical environments. Monash knows how to educate and inspire practitioners to link their practical knowledge to the centuries of research and scholarship. Through the partnership, Monash and CEH seek a system of care that is just and equitable. CEH has a distinguished track record in supporting health and social practitioners to respond sensitively and effectively to the issues faced by people from refugee and migrant backgrounds. This will be of benefit to students and staff at Monash as we prepare a rapidly changing workforce for a rapidly changing workplace. CEH will be exposed to the university’s dynamic intellectual environment and its knowledge of global currents in cultural research and health research, strengthening its expertise in cultural competence and giving the organisation a platform to lead a much needed transnational research agenda.

Funding for aged care projects The federal government has announced $3.8 million to extend a culturally appropriate care program for older Australians in aged care. The funding is to support training and resources under the Partners in Culturally Appropriate Care (PICAC) programs in each state and territory. Organisations funded under PICAC provide activities including identification of barriers to access services; the provision of training to providers of residential and community based care; and development and distribution of resources that promote best practice. In a separate announcement, the University of Queensland Centre for Research in Geriatric Medicine received $777,296 in federal government funding for a three-year project to develop and test a new assessment system for acute hospital care. University researchers will develop and refine a nurse-administered assessment system with a range of diagnostic and risk assessment tools, Centre Director Professor Len Gray said. While the system would be designed

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for all adult inpatients, it would be most valuable for older patients, Professor Gray said. Older patients admitted to hospital had a greater risk of developing geriatric syndromes such as functional decline, falls, delirium, pressure ulcers, loss of autonomy and morale, which could lead to placement in long term residential care, he said. “Our proposal is to create an early warning and response system for all patients who are admitted to acute care, integrating case findings and good aged

care practice into the program of general care.” This would fill a gap in cognitive, functional and psychosocial screening and assessment, ensuring appropriate treatment and action at the time of admission, Professor Gray said. The funding is for Australian testing across four hospitals in Queensland and Victoria. The project involves Mt Sinai Hospital in Canada and Christchurch Hospital in New Zealand.

June 2015 Volume 22, No.11 11

News – Federal Budget Budget backlash Unions, health and welfare organisations have slammed the federal government’s Budget for 2015 as bare-boned with those on low incomes still reeling from the harsh measures announced in 2014. ANMF Federal Secretary Lee Thomas said the axing of a further $2 billion from health and aged care “added insult to injury” on the $57 billion already ripped from the public health system. “We are angered the government has failed to ensure continued sustainability of our health system through fair and adequate funding allocations, instead relying on misdirected and chronic underfunding.” The federal government had not addressed longstanding issues, such as the growing unemployment of nurse graduates and the appallingly low wages in aged care, she said. The Australian Council of Trade Unions (ACTU) said the tax cut for small businesses that would save the average business no more than $20,000 a year was not enough to hire new staff. “If the government’s plan to create jobs is a $5 billion company tax cut, then it has no plans for jobs,” ACTU President Ged Kearney said. With unemployment at or above 6% for the past 11 months, investment in infrastructure, skills and training, and the public service was needed to create jobs and boost the economy, she said.

Greens’ Leader Richard Di Natale said the failure to raise new revenue would mean in the end schools, hospitals and the environment would lose. “This Budget takes more money from the pockets of nurses and charity workers than it does the big miners or big banks. We need to raise more revenue, not cut one vital service to fund another.” Close to $1 billion would be cut from programs that fund measures such as preventative healthcare, drug and alcohol rehabilitation and mental health. The public Health Association of Australia (PHAA) described the Budget as a “bloodbath” for health organisations. While last year’s Budget foreshadowed $197.1

Budget overview • $69.7 billion in overall spending on health and sport in 2015-16: a $2.3 billion • • • • • • •

• • • • • • •

increase to health budget over four years Hospital funding to increase to $16.4 billion in 2015-16 $10.1 billion on access to medicines this year $1.3 billion over four years for new medicines and vaccines New Primary Health Networks to replace Medicare Locals in 2015-16 $2.4 billion into primary and mental health, with new national mental health plan and national diabetes strategy $1.4 billion to support Aboriginal Community Controlled Health Organisations $26.4 million over four years to improve immunisation rates with $6 incentive per child to doctors who identify and catch-up children more than two months overdue for vaccination $34 million to review of Medicare Benefits Schedule $485 million to create a national e-health electronic records system, including an opt-out, rather than opt-in, system $200 million state and territory governments for dental services in next 12 months $20 million over two years to National Ice Action Strategy $10 million in 2015-16 into Medical Research Future fund; more than $400 million over four years $20 million over two years for the Royal Flying Doctor Service $100 million over four years to respond to health risks of natural disasters and terrorist acts at home or abroad

12 June 2015 Volume 22, No.11

million in cuts over three years, that figure had turned into $500 million. Most affected would be those: who provided essential services in rural, regional and remote Australia; working to Close the Gap in health outcomes for Indigenous Australians; working with communicable diseases; and who provided substance use treatment services. “The government can’t hide the impact of this slash and burn approach,” PHAA Chief Executive Officer Michael Moore said. “Interestingly, the words and phrases not mentioned at all…include ‘continuity of care’, ‘patient-centred care’ and reform,” National Rural Health Alliance Chief Executive Gordon Gregory said. Australian Council of Social Services (ACOSS) Chief Executive Officer Dr Cassandra Goldie said the overall package retained many harsh cuts from the previous Budget which would leave many people on the lowest incomes worse off. “Many children in low income families will lose 12 hours a week of early childhood education.” Welcome measures of investment in childcare were linked to unfair measures like 2014’s family payment cuts, she said. “And the government has yet to find alternatives to cutting health, education, community services and family and youth payments for its savings measures. On the whole people on low incomes are still left to do most of the heavy lifting.” Many patients were likely to face higher medical bills with the freeze on Medicare payments until 2017-2018, said Consumers Health Forum Chief Executive Officer Leanne Wells. This would equate to an extra $8.43 per GP consultation. “We are disappointed that many of the harshest measures in last year’s horror health budget remain, given the rise in chronic illness, the ageing of the population and the gaping holes in health funding over four years left from last year’s cuts.”

Budget health cuts • $252.2 million from PBS listed drugs • $214.1 million from e-health with

no money allocated after 2018 • $144.6 million from the MBS,

including halving the amount paid for child health assessments • $125 million from the Child Dental Benefits Schedule • $72.5 million to health workforce scholarships • $69.6 million to DVA dental and allied health payments

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News – Federal Budget Aged care budget cut A $40.2 million cut to aged care in this year’s budget has been described as short sighted by unions and industry stakeholders.

“More than $40 million has been cut from aged care workforce development, scholarships and training, at a time when Australia urgently needs 20,000 nurses to meet the challenges of a rapidly ageing population,” ANMF Federal Secretary Lee Thomas said. “To wipe $40 million off workforce strategy forward estimates seems like poor policy when 55,770 additional employees are required over the next eight years,” Aged & Community Services Australia (ACSA) Chief Executive Officer John Kelly said. Professor Kelly said measures such as capping of the Fringe Benefit Tax (FBT) at $5,000 as a tax saving would mostly affect lower income care staff. “This was a significant benefit in the not-for-profit aged care sector and setting the cap so low will make it harder to recruit staff at a time when we need to significantly increase the aged care workforce.” Catholic Health Australia Chief Executive Officer Suzanne Greenwood agreed current FBT arrangements were an “important recruitment and retention measure for the not-forprofit sector”. However it welcomed the government’s announcement for allocation of home care packages directly to consumers from February 2017, instead of through the aged care approvals round. “In a difficult budgetary environment the mix of measures is not unexpected,” Ms Greenwood said. COTA Australia Chief Executive Ian Yates said the move to combine home support and home care packages programs would ensure older people had a much simpler and smoother process to access care. “It will result in higher quality service provision as service providers adapt and change to meet the needs of their clients and have less red tape to deal with.”

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Paid parental leave scheme under threat Unions and women’s organisations have lashed out at drastic cuts proposed to the publicly funded paid parental leave scheme in this year’s federal Budget. The Budget announcement would cut $967.7 million from the publicly funded paid parental leave scheme (PPL). It is estimated almost half of new mothers would lose access to the full $11,500 available under the federal government’s existing PPL scheme from July 2016. Up to 100,000 nurses and midwives could lose access to paid parental leave, ANMF Federal Secretary Lee Thomas said. “For many years, the ANMF has campaigned for extensions to PPL and for access for shift workers to ‘long hours’ day care.” The ANMF strongly supported the current PPL as well as the trial of subsidised nannies also announced last month, Ms Thomas said. “As the Minister for Women, Tony Abbott promised a 26 week scheme. Then, in one of his first backflips, it was decreased to 18 weeks and now for more than 100,000 women, it may have been taken off the table completely.” “Forcing mothers back to work too early is indicative of just how out of touch our Prime Minister and Treasurer are with reality,” NSW Nurses and Midwives’ Association General Secretary Brett Holmes said. The PPL introduced under Labor was

aimed for employers who wanted to add to the government’s scheme or in addition for those who already provided PPL for their employees. “To say women are ‘double dipping’ fundamentally misrepresents the paid parental leave scheme which was always intended to complement employer based entitlements,” Australian Council of Trade Unions (ACTU) President Ged Kearney said. Australian unions supported a PPL of 26 weeks paid leave at full pay including superannuation payments, she said. The Women’s Electoral Lobby, Australia (WELA) said the 180 degree turn from the government on PPL was “astounding”. “The Productivity Commission found the current government scheme of at least 18 weeks minimum wage with employers encouraged to top up was working well to maintain women’s connection to the workforce and support families,” WELA spokesperson Emma Davidson said. The new scheme would further increase the staggering gender pay gap which was at a 20 year high, she said. Cuts to paid parental leave would further entrench women’s inequality, Human Rights Law Centre’ senior lawyer Ruth Barson said. “Equality and adequate parental leave are not some sort of luxuries – they are human rights.” Women already lagged far behind men in economic equality, she said. “Women will be more financially dependent on their partners, they will have less economic stability and less independence and flexibility.” June 2015 Volume 22, No.11 13

News Support and mentorship is important for the professions “Provide support and mentorship to each other” was outgoing Commonwealth Chief Nurse and Midwifery Officer Dr Rosemary Bryant’s parting words to nurses during a farewell speech in Melbourne last month. Addressing nurses at the Coalition of National Nursing Organisations (CoNNO), which is made up of more than 50 national nursing organisations, Dr Bryant said her successful career was in part due to the

NMBA update Public consultation on review of the Registered nurse standards for practice The Nursing and Midwifery Board of Australia (NMBA) has funded a review of the Registered Nurse standards for practice (formerly called competency standards). As a part of this review the NMBA is releasing for public consultation papers on the draft revised Registered Nurse standards for practice. We encourage all our stakeholders nurses, midwives and any other interested parties, to review and respond to this consultation. More information including a background paper go to: www. nursingmidwiferyboard.gov.au/News/ Current-Consultations.aspx

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support from staff and people around her. “I had really good mentors and a lot of people have also helped and supported me along the way,” she said. Dr Bryant said providing support and mentorship to each other was important for the professions and was something she also tried to provide to her colleagues. Dr Bryant said she believed nursing was in a good place and that the profession had come far. “There are a lot of things happening. We have had a bit of a dip over the last couple of years, but I think we are about to enter into a development stage.” Speaking about her retirement Dr Bryant said she had mixed emotions ending her career but believed it was absolutely time. “I have done so many things and I have

Re-entry to practice policy revised The NMBA has approved a revised version of the policy for re-entry to practice, which provides information for nurses and midwives who do not meet the recency of practice registration standards and wish to re-enter practice. Under the Health Practitioner Regulation National Law, which is in force in each state and territory, there is a mandatory requirement for applicants for registration and renewal of registration to meet the NMBA’s requirements in relation to the nature, extent, period and recency of any previous practice. The NMBA has also approved provisional registration for nurses and midwives who are no longer registered and are applying to re-enter practice as a nurse or midwife. Provisional registration will be available from 1 July 2015.

been involved in so many things. I enjoyed it all so much that it’s hard to give it up, but on-the-other-hand there are many other things I want to do. In relation to retirement I’m really looking forward to it.”

A transition period for the revised policy will be in place from 1 May to 30 June 2015 during which the internal and external key stakeholders will be informed about the requirements and impact of this policy. Nursing and midwifery codes of conduct and professional boundaries to be reviewed Starting later this year, the NMBA will undertake a phased review of the code of professional conduct and Code of ethics for nurses and midwives respectively. We will keep you up to date about the progress of this project and invite your feedback during the public consultation phase, with the aim of separating the codes of conduct from the professional boundaries documents. For more information go to www. nursingmidwiferyboard.gov.au/

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News Jeff Tinsley

Nurses and midwives honoured for excellence Dozens of nurses and midwives across the country have been paid tribute as part of state and territory nursing and midwifery awards. The awards were handed out to coincide with International Nurses and Midwives Week, which ran from 5-12 May. Clinical Nurse manager Jeff Tinsley of the Coronary Care Unit and Chronic Disease Coordination Unit at Royal Darwin Hospital, was named the 2015 Northern Territory Nurse of the Year. Jeff was among 11 category winners in the Northern Territory Nursing and Midwifery Excellence Awards. “I find it quite embarrassing,” Jeff said. “I work with such wonderful nurses across the board.” Originally from New South Wales, Jeff studied at Sydney University and has travelled extensively during his career, obtaining much of his cardiac experience at the respected Prince Charles Hospital in Brisbane. “It sounds silly but I always find it rewarding, the caring for people, and the passionate side of the job.” About 12 years ago Jeff and his wife drove into Darwin and fell in love with the place. It was around the same time the Darwin hospital opened a new coronary care unit and Mr Tinsley jumped at the chance to get on board. “There’s so much opportunity for nursing staff up here. When I moved up to Darwin, there wasn’t anywhere else in Australia that I would have been offered the position of manager.” Jeff has been a strong advocate for

preserving the cultural safety of Aboriginal people and has worked tirelessly to create change. His contributions include developing outreach programs in remote communities and the production of ‘Cardiac Story’, a DVD that provides information for cardiac patients as well as a six-week rehab program. “Rehab is what prevents people coming back to hospital and further heart attacks. There’s just such a need. Working with indigenous clients up here is such a unique experience. Taking the opportunities to improve health in remote communities….. you can make a difference,” said Jeff Across the border in the Kimberley region, Broom-based paediatric nurse practitioner Scott Stokes was named Western Australia’s Nurse/Midwife of the Year for his work in improving healthcare for babies and children. Scott was part of 13 nurses and midwives recognised across 11 categories from the state’s 37,000 workforce. “It wasn’t what I was expecting because there were so many worthy applicants,” he said. “It’s a great acknowledgment of what we’re doing. It’s overwhelming. All those years of hard work.” Scott grew up in Western Australia and was attracted to a career in nursing on the back of watching iconic television series A Country Practice. He pursued a career in paediatrics and has never looked back. “I like paediatrics because children get better quite quick,” he said. Scott, who works at the Broome hospital, said his job offers a challenging environment where he could be in the paediatric ward one minute, then in emergency the next. Scott has worked across Australia and internationally but has stuck to the Kimberley because of the region’s engaging

community. “I just love the innocence and the relative harmony that the Kimberley lifestyle has. I like the interesting medicine that’s up here that’s very different to the cities. The people are so much more friendly and engaging and have a different outlook on life.” He said the biggest reward of his job was keeping kids close to home. “It’s a long way to Perth and Darwin to receive care, so the biggest reward is to keep them locally.” Elsewhere around the country Meredith Hobbs, of Lyell McEwin Hospital, took out the Midwifery Excellence Award, at the South Australian Nursing and Midwifery Excellence Awards 2015. Kanggawodli Primary Healthcare Services employee Teresa Branson was honoured in the Aboriginal Nurse/Midwife/Enrolled Nurse category at the same event. At the annual ACT Nursing and Midwifery Excellence Awards, Ann Marie Dunk was named Nurse of the Year, while Canberra Hospital’s Alison Clarke was named Midwife of the Year.

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News Concern over pharmacists’ expanded role into wound care Nurses have raised serious concerns a new pharmacy agreement may see pharmacists expansion into primary care include wound care. The federal government signed off on an in-principle $18.9 billion agreement with pharmacists last month. Federal Health Minister Sussan Ley said a key component of the sixth community pharmacy agreement over the next five years would include a doubling of investment of $1.26 billion in new and existing programs for pharmacy in primary care. The agreement covers 5,450 community pharmacies and 28,000 pharmacists. For the first time, all pharmacy programs would be subjected to scrutiny and approval by a Medical Services Advisory Committee. Pharmaceutical Society of Australia (PSA) National President Grant Kardachi indicated in media reports last month that pharmacists already provided wound care and were now seeking a structure around a fee for wound provision. ANMF Assistant Federal Secretary Annie Butler said a better solution would be to direct a portion of funding towards nurse-led clinics, which would work closely and in collaboration with pharmacists to improve care and management of chronic conditions for the community. “While we agree that pharmacists are currently under-utilised, it is ludicrous to expect pharmacists to undertake the education necessary to be competent in wound care while there are thousands of nurses, who are already expert in this area, available.” Accreditation requirements for pharmacists include dose administration, screening and risk assessment, smoking cessation, medication management review, health promotion and disease management. However, there is no specific requirement around wound management. Victorian nurse practitioner in primary care Leanne Boase questioned whether pharmacists had the anatomy, physiology, and pathophysiology knowledge, and clinical reasoning, to provide wound care. “What ongoing CPD around best practice in wound care do they have? This is not a ‘turf war’ but about the properly educated people doing the job they are trained for. “We have kept the two very separate

for a long time with good reason: assessment and diagnosis at one end, and dispensing at the other end - to protect the patient, the consumer.” A PSA discussion paper released late last year mentions the provision of wound care in regional and rural areas where there is a lack of GPs. “Where there are no GPs, pharmacists often play important roles as primary healthcare professionals eg. wound care, minor ailment diagnosis and treatment, chronic disease management.” Ms Boase said there were nurse practitioners in rural and remote areas not employed in the role, who were trained and up-to-date in wound care. “There are enough nurses and nurse practitioners to do this and it wouldn’t take a lot of funding to get them up and running, and who would be safer, more competent and properly trained - why not direct the funding there?” Wound care and management was an integrated component of all nursing degrees, with many nurses, particularly nurse practitioners having undertaken postgraduate education to become highly specialised wound management experts, Ms Butler said. “One group of health professionals should not have to undergo additional training and education to take on roles which currently fall within the expertise of another group of health professionals,” she said. The Australian Medical Association (AMA) expressed alarm at elements of the latest pharmacy agreement it said indicated a shift in government policy that put patient safety at risk by undermining the value of diagnosis. “If this is a taste of the primary health care reform the government has planned, the future of quality health care in this country is under serious threat,” AMA President Dr Andrew Pesce said. Consumers Health Forum Chief Executive Officer Leanne Wells said there was potential for pharmacists to better integrate into primary care, however warned: “These changes should be key to future healthcare reform, not the province of a pharmacy agreement negotiated in isolation from reforms,” she said.

www.lunghealth.org anmf.org.au

Working life Keeping a jab on it By Robert Fedele

Immunisation nurse Vikki Coghlan plays an important part in improving the health of the community by reducing the risk and spread of disease. There was little chance of Vikki Coghlan becoming anything else. “As a child my nanna made me a nurse costume with a little apron with a red cross on it and a little hat and I used to bandage up all our pets,” she recalls of her formative years. “It was just something that I’ve always wanted to do.” Vikki chalks up three decades as a member of the nursing profession this year. It’s a vocation that has seen her undertake a variety of roles in diverse fields including plastic surgery, aged care, and orthopaedics. Vikki’s career started at the now defunct Latrobe Valley Hospital in Moe Victoria, where she embarked on a three year handson training program to become qualified. From there she moved down to Melbourne to take up a position at the Epworth Hospital. “I loved caring for the community and the educational aspect as well,” Vikki says. “I loved being able to be with people at their most frightened and vulnerable and to offer care and assistance with that.” About five years ago Vikki contemplated the area of immunisation when looking for new inspiration and a mini career change. She undertook a 12-week course at La Trobe University in Victoria and quickly became fascinated by the complexity of the field. “Immunisation is so much more than just giving a needle,” she says. “To me, it’s almost like a miracle. Every single time we vaccinate a child we are potentially protecting that child from illnesses and diseases and things that could potentially impact their life.” Vikki currently works as a team leader for Monash City Council in Victoria. The job covers the council’s entire immunisation roll out, which includes more than 20 schools and vaccination clinics and sessions for babies, toddlers and adults. All vaccinations fall under the government funded National Immunisation Program, which contains jabs for diseases such as rotavirus, measles, mumps, and rubella. A typical community immunisation session might yield up to 70 people, Vikki says, while school-based vaccinations usually get through around 350 students. She says immunisation undergoes anmf.org.au

“TO ME, IT’S ALMOST LIKE A MIRACLE. EVERY SINGLE TIME WE VACCINATE A CHILD WE ARE POTENTIALLY PROTECTING THAT CHILD FROM ILLNESSES AND DISEASES AND THINGS THAT COULD POTENTIALLY IMPACT THEIR LIFE.” consistent change due to new vaccines and guidelines being adopted regularly. For example, students from years 7 to 10 are now receiving immunisation against whooping cough whereas previously it was confined to year 10 students. “There’s always changes in immunisation so it’s very exciting to keep up to date with that.” Aside from her day job, Vikki also holds a position as the current president of the Immunisation Nurses Special Interest Group (INSIG), a Victorian-based body that provides a forum for discussion and

encourages professional development. Its ultimate goal is to promote the recognition of immunisation nurses as a speciality and raise public awareness of the profession. Undeniably, vaccination has become a contentious issue in Australian society in recent times, with many parents objecting to having their children immunised. As someone who believes in immunisation and has studied and researched the field, Vikki says it’s difficult to support those sections of the community who adopt that mentality. However, Vikki does concede such people are well-intentioned. “I think perhaps they haven’t really got the facts or what they believe to be the facts have been misconstrued. “But I do understand though that most people when they choose not to vaccinate their child, for whatever reason, they’re doing it out of love. “On the whole most people out in the community are very receptive to immunisation and vaccination.” Vikki intends to continue in the line of work for the foreseeable future and still finds it as exciting as ever. “We’re not just protecting the people we’re vaccinating, we’re also protecting the wider community. “I love continuing to educate myself, other nurses, and the community. I feel that immunisation is one of the greatest inventions. I’m only a very small cog in a very huge wheel but I like to believe that I make a tiny bit of difference.” June 2015 Volume 22, No.11 17

Feature

18 June 2015 Volume 22, No.11

anmf.org.au

Feature

AUSTRALIA’S

DEMENTIA DIAGNOSIS Alzheimer’s - the disease of the 21st century Dementia and its most common form, Alzheimer’s disease, is now the second leading cause of death in Australia. With 342,800 Australians now living with dementia and that figure expected to rise to almost 900,000 by 2050, experts warn the nation must prepare to confront the rising tide of Alzheimer’s, writes Karen Keast.

When Karma MacArthur began struggling to perform simple, everyday tasks three years ago, such as making a cup of coffee, the retired Canberra teacher and her husband, Jim, knew something was wrong. “You think you can do it automatically - putting coffee grounds into a coffee maker, then you put the water in and you turn it on,” Karma says. “But I’ll get half way through and if I’m distracted, I’ll end up putting in twice as much coffee and no water or vice versa.” Karma was diagnosed with dementia and suspected Alzheimer’s. “I feel it’s a bit of a road to nowhere,” she says. While her long-term memory remains intact, it’s Karma’s short-term memory that often fails. Jim, a retired geography teacher, does all the driving, cooking and cleaning for the couple. Karma, 78, still regularly walks in the familiar streets surrounding her home, equipped with a location app on her mobile phone, so Jim can keep track of her movements. For the moment, the couple are coping anmf.org.au

together at home but they face the grim reality that Karma will eventually have to move into a residential aged care facility. “There’s so much talk about breast cancer and bowel cancer and prostate cancer but nobody knows anything about stopping Alzheimer’s,” Jim says. “We’ve got to bring it out into the open. There’s no cure - it’s just an inevitability that you’re going to die.”

Dementia prognosis The statistics are frightening. Each week, more than 1,800 people are diagnosed with dementia in Australia. That equates to about one person every six minutes. Unless there is a medical breakthrough, that figure is expected to escalate to 7,400 new cases every week by 2050. Dementia is a collection of symptoms caused by disorders affecting the brain which impact on a person’s functioning, ranging from thinking to behaviour and the ability to perform ordinary tasks. There are many types of dementia and the most common are Alzheimer’s disease, vascular dementia and Parkinson’s disease.

Researchers around the globe, particularly in the United States, Europe, the United Kingdom and also in Australia, are making headway with their research into neurodegenerative dementia but at this stage there is no cure on the horizon and no effective treatment. Professor Tony Broe AM, a researcher at Neuroscience Research Australia (NeuRA), an independent leader in brain and nervous system research based in Sydney, says researchers are working to understand the two common hallmarks of Alzheimer’s disease - the extensive spread of betaamyloid plaques and tau tangles in the brain, which lead to cell death and the brain shrinking. “The way it’s always put is we’re about to have a breakthrough and I’ve been in dementia research for 30 or 40 years and I’m yet to see a breakthrough,” he says. “We steadily eat away at understanding the problem but in terms of finding a cause and a cure, it’s not going to happen in a sudden breakthrough setting because it’s so complex.” June 2015 Volume 22, No.11 19

Feature Karma and Jim MacArthur

“THERE’S SO MUCH TALK ABOUT BREAST CANCER AND BOWEL CANCER AND PROSTATE CANCER BUT NOBODY KNOWS ANYTHING ABOUT STOPPING ALZHEIMER’S,” JIM SAYS. The cost of dementia Carol Bennett, the CEO at Alzheimer’s Australia, the peak body and charity for dementia which advocates for the needs of people living with dementia, their families and carers, is all too familiar with the mounting challenges that lie ahead. “It’s huge and it’s growing,” she says. “It’s gone from being the third leading cause of death to the second - you are now looking at about 11,000 deaths in the last year due to dementia. “It’s very high in terms of prevalence and it’s very high in terms of the cost that it inflicts - both the social costs and the costs to consumers, carers, families and communities.” Ms Bennett says it’s imperative we take a national approach to improving dementia care, from prevention through to care from the moment of diagnosis, as well as supporting people in the health system, better community care and providing quality residential aged care. Alzheimer’s Disease International estimates the total worldwide cost of the dementia epidemic exceeded US$600 billion in 2010 or 1% of global GDP. “So if it were a country it would rank as the world’s 18th largest economy - that gives you a perspective,” Ms Bennett says. Dementia is costing our nation dearly. The total direct health and aged care 20 June 2015 Volume 22, No.11

system expenditure on people with dementia was at least $4.9 billion in 200910 and it’s predicted to become the third greatest source of health and residential aged care spending within just two decades - about 1% of Australia’s GDP. Spending on dementia is tipped to outstrip all other health conditions in the 2060s. In 2012, dementia was recognised as a National Health Priority Area. In its 2014 budget, the federal government dedicated $200 million over five years to boost the nation’s dementia research capacity. Ms Bennett says while the funding was significant and welcome, much more needs to be done. “It’s nowhere near adequate, so we need to see far more investment in research both now and into the future.” Alzheimer’s Australia is calling on the government to increase its investment in dementia research over a three-year period to achieve a level of $80 million per annum by 2025 - which would equate to just half the current NHMRC funding for cancer research. “Compared to heart disease, cancer and other chronic diseases, dementia receives very little research funding,” Ms Bennett says. “We obviously need to fast-track our approach to research if we’re going to tackle what is a coming avalanche of people with dementia in the community.” Australian Nursing and Midwifery

Federation (ANMF) Federal Secretary Lee Thomas says Alzheimer’s is the fastest growing disease in Australia. “We need to acknowledge that dementia and Alzheimer’s is the disease of the 21st century. We shouldn’t shy away from the fact that we are all going to be touched, if not already, by somebody in our family who has dementia.” Ms Thomas says it’s vital the government builds capacity now to address one of the largest healthcare challenges facing Australia. “The government has proven that being proactive about this is not in their game plan and certainly being reactive is not going to work. We need a really extensive overhaul of the way we manage people with dementia and Alzheimer’s, we need the education, and we must have well-funded research into what works and what doesn’t in terms of treatment.” Later this year, the federal government will roll out the first phase of its new Severe Behaviour Response Teams (SBRTs). The ‘flying squads’, a mobile workforce of clinical experts, have been designed to assist residential aged care providers caring for people with severe behavioural and psychological symptoms of dementia. The move comes after the government last year scrapped the Dementia Supplement and instead redirected the $54.5 million, spanning four years, to establish the SBRTs. Ms Thomas says while the funds have remained in the sector, little is known about the new scheme. “At the end of the day there are no plans about how these flying squads are going to work and I have very significant reservations about their ability to actually make a difference to people in residential care who have severe and challenging behaviours that need assistance.”

Workforce crisis Qualified, skilled nurses are a crucial ingredient when it comes to delivering quality care to people with dementia living in residential aged care facilities. Despite escalating demand, Australia faces a shortage of registered nurses working in residential aged care. Department of Health and Ageing figures in 2012 showed while the number of full-time equivalent employees in the residential aged care workforce increased almost 20,000 in the past decade, the percentage of registered nurses fell from 21.4% in 2003 to 14.7% in 2012 and the percentage of enrolled nurses dropped from 14.4% to 11.6%, while the percentage of assistants in nursing (AINs) rose from 56.5% to 68.2%. “We’ve got industrial issues that are impacting upon the sector’s ability to recruit and retain nurses,” Ms Thomas says. “If anmf.org.au

Feature we actually do want a decent workforce, one that is well staffed, well educated and skilled, then we need to put in place financial resources and other resources that is better rates of pay and improving workload management, education, mentoring and support.”

Nurse research Elizabeth Beattie is a nurse leader in Australia’s dementia research. A psychogeriatric nurse and Professor of Aged and Dementia Care at the Queensland University of Technology, Professor Beattie leads the Dementia Collaborative Research Centre (DCRC) - Carers and Consumers, one of three NHMRC-supported centres in Australia. Professor Beattie also leads the Queensland Dementia Training Study Centre, one of five nationally, which works to enhance the knowledge and skills of the graduate dementia care workforce

and promote the translation of research findings into practice. Professor Beattie’s work focuses on the assessment and management of behavioural issues associated with dementia and nurse-led interventions designed to improve the support of people living with dementia and their carers across the dementia journey. With DCRC colleagues, Professor Beattie has been involved in numerous research projects including leading the first nationally representative study of the quality of life of people with dementia living in residential aged care facilities. The study involved 978 staff from 53 facilities across six states and one territory. The study’s results show the ageing of the workforce, with most aged between 40 and 60, the majority (70%) are permanent part-time workers, and the limited registered nurse leadership in the sector - 11% are registered nurses, 26%

“THE WAY IT’S ALWAYS PUT IS WE’RE ABOUT TO HAVE A BREAKTHROUGH AND I’VE BEEN IN DEMENTIA RESEARCH FOR 30 OR 40 YEARS AND I’M YET TO SEE A BREAKTHROUGH.”

“IT’S GONE FROM BEING THE THIRD LEADING CAUSE OF DEATH TO THE SECOND YOU ARE NOW LOOKING AT ABOUT 11,000 DEATHS IN THE LAST YEAR DUE TO DEMENTIA.”

TONY BROE

CAROL BENNETT

anmf.org.au

are AINs, 38% are personal care assistants - that deals with some of our most frail and vulnerable citizens. Professor Beattie says limited registered nurse numbers in residential aged care facilities impact leadership and care quality. “Most care is provided by more than a quarter of the workforce who receive the least training to undertake their roles,” she says. “Our research shows that staff at all levels had strong commitment to the philosophy of person-centred care but those with lower levels of preparation did not hold hope for the quality of life of people living with dementia. This shows the importance of ongoing education and role modelling of attitudes and behaviour by registered nurses to care staff to enhance the daily lives of residents with dementia.” Professor Beattie says there’s a stigma around dementia that’s entrenched not only in society but also within the health

“DEMENTIA KILLS YOU. IF YOU DON’T UNDERSTAND THAT, THAT HAS PROFOUND IMPLICATIONS IN THE WAY IN WHICH YOU MANAGE THAT CONDITION.” ANDREW ROBERTON

June 2015 Volume 22, No.11 21

Feature The key facts: Dementia is not a normal part of ageing. Dementia can happen to anybody but it’s more common after the age of 65 years.

>85

>65

Three in 10 people over the age of 85 and almost one in 10 people over 65 have dementia.

25,100 About 25,100 people in Australia have younger onset dementia, which is a diagnosis under the age of 65, including people as young as 30.

44 million More than 44 million people world-wide are living with dementia and that figure is tipped to reach 135 million by 2050. Types There are many types of dementia and the most common are Alzheimer’s disease, Vascular dementia, Parkinson’s disease, dementia with Lewy Bodies, Fronto Temporal dementia, Huntington’s disease, Korsakoff’s syndrome (alcohol related dementia) and Creutzfeldt-Jacob disease. Early signs Common symptoms may include progressive and frequent memory loss, confusion, personality change, apathy, withdrawal, and the loss of ability to perform everyday tasks. On average, symptoms of dementia are noticed by families three years before a firm diagnosis is made. Treatment Early diagnosis means access to support and information while some medications have been found to reduce symptoms. At this stage, there is no prevention or cure. Care

50%

Only 20-50% of people with dementia in high income countries are recognised and documented in primary care. More than 50% of residents in Australian Government-subsidised aged care facilities had dementia in 2011. It’s estimated 1.2 million people are involved in the care of a person with dementia. Australia faces a shortage of more than 150,000 paid and unpaid carers for people living with dementia by 2029.

Risk reduction - Your Brain Matters, an initiative of Alzheimer’s Australia, was launched in 2012 and is the world’s first publicly-funded dementia prevention program. It’s available online at www.yourbrainmatters.org.au Assistance: National Dementia Helpline - 1800 100 500. Source: Alzheimer’s Australia

22 June 2015 Volume 22, No.11

professions. “In some ways it’s easier to talk about cancer and mental illnesses like depression and bipolar disorder than it is to talk about having a diagnosis of dementia,” she says. “Dementia is still taboo territory and health professionals, nurses and midwives need to be aware of how difficult it is for people to potentially disclose a diagnosis or for families to begin to actually articulate some of the changes they may be seeing in memory and behaviour in a person that they live with every day.” With a significant demand for more research in dementia care, Professor Beattie is passionate about building the small cadre of Australian nurse researchers working in the field. “There is a huge and pressing need for care research and we need to keep care on the dementia research priorities agenda in this country.”

Education and training Andrew Robinson, a Professor of Aged Care Nursing, is co-director of the renowned Wicking Dementia Research and Education Centre at the University of Tasmania. A registered nurse, Professor Robinson says a new approach is essential to attracting the best and brightest nurses into the fastest growing healthcare sector. “These are dynamic, high performance environments - they’re caring for the frailest and sickest and most needy people in our society,” he says. “Recruitment is really about having a programmatic approach to building capacity and capability in this sector, to really making these places where people are wanting to work because it’s interesting, it’s rewarding, it’s challenging, they’re engaged with the universities, they’re engaged with the healthcare system.” The centre is working to improve practice through the Wicking Teaching Aged Care Facilities Program, which creates a partnership between universities and aged care providers while providing placements for nursing, medical, paramedic, and next year, psychology and pharmacy students. Professor Robinson says the teaching aged care facilities are centres of excellence “where you can actually model innovation before you drive it out across the sector”. “This now is part of what these nursing homes do because they understand that this drives quality, this drives high performance, that students are one of the drivers in the achievement of excellence,” he says. “In this program, there’s been a whole body of research around building organisational capacity. It hasn’t all been focused on the nurses who mentor the students, it’s how can the organisation support the mentors to do that.” The university is changing the way anmf.org.au

Feature nurses and other health professionals learn about and understand dementia. Professor Robinson says about 70% of family members and about 50% of people working in aged care believe you die with, not of, dementia. He says dementia, a progressive brain death, must be thought about as a terminal illness. “Dementia kills you. If you don’t understand that, that has profound implications in the way in which you manage that condition. “Evidence out of America shows 40% have an unnecessary burdensome intervention in the last three months of their life in nursing homes. What we are trying to do is to intervene to treat dementia rather than thinking about dementia through the lens of a palliative approach to care, so that’s not end-of-life care, that’s care across the trajectory that is really configured with a primary aim to give

Dr Judy McCrow, a registered nurse and clinical practice development facilitator, says its innovative positive wellbeing model of care is already delivering improved outcomes since it first began trialling it at its Moonah Park Aged Care Service at Mitchelton, Brisbane, a year ago. “Eighteen months ago we were getting verbal and physical aggressive episodes three or four times a week. Now we probably get one or two a month,” she says. “Most models of care, especially in the research fields, look at decreasing negative effect outcomes - looking at decreasing falls, decreasing aggression and decreasing depression whereas we’re actually taking a different spin. We’re saying if you enhance positive wellbeing, if you’ve got everyone happy and engaged, then these other negative effect outcomes will dissipate.” The model of care focuses not only on the quality of care provided to residents

in lifestyle - they might sit down with some people in the dementia units and have an arm wrestle or just have a conversation or read a book with them.”

Brain power Professor Broe says while more funding is key to broadening research in the dementia field, researchers are unlikely to find a magical cure for dementia. “We are not going to cure dementia, we are going to delay it, so that people live on to a ripe old age without dementia in the long run,” he says. “It’s just like delaying lung disease, heart disease, kidney disease, diabetes - all those body diseases. It’s better to think about prevention and health promotion as delaying and enabling people to live longer.” Professor Broe, one of several study investigators in the Koori Growing Old Well Study which found dementia rates in Australia’s Aboriginal communities are

“WHAT WE BELIEVE IS A CONSTRUCTIVE WELLBEING APPROACH, WHICH RELIES ON BUILDING THE POSITIVE EMOTIONS, IS REALLY INTEGRAL TO PROMOTE HEALTHY AGEING AND A FLOURISHING LIFE.” JUDY MCCROW

people the best quality of life.” In 2013, the university launched Australia’s first degree in dementia care, the Bachelor of Dementia Care, and the world’s first and free Massive Open Online Course (MOOC) Understanding Dementia. It’s now developing the Understanding for Dementia Practice Primer, a five-hour course based on the 27-hour MOOC. The bachelor degree is now the university’s third largest course while more than 50,000 people spanning 128 countries have enrolled in the evidence-based MOOC, developed from the centre’s research. Professor Robinson says it’s now time to implement research to develop new models of dementia care. “I think most people would acknowledge that our care provided to people with dementia is very often less than optimal.”

Leading dementia care Not-for-profit organisation Churches of Christ Care in Queensland is transforming how it delivers care to residents living with dementia. anmf.org.au

but also, importantly, on enhancing the residents’ quality of life. “What we believe is a constructive wellbeing approach, which relies on building the positive emotions, is really integral to promote healthy ageing and a flourishing life,” Dr McCrow says. “It means every day you come to work and it’s a good day - it’s a good day for you and for everyone around you. And you know this is happening because you can see smiling faces, you can see people who are happy and content. If people are happy then they tend to have a good quality of life.” The model focuses on residents’ five essential needs - comfort, attachment, inclusion, occupation and identity. It’s a move away from a task-orientated medical model of care to instead injecting more flexibility into the routine, enabling care staff to spontaneously engage with residents. “It’s breaking down those professional barriers so care staff can bring their own personality into the workplace,” Dr McCrow says. “The care staff have a part

three times higher than in non-Indigenous Australians, says the research points to social determinants as a major factor in developing late onset dementia. “Most scientists think it’s a very physical disease but what we’re thinking is that this disease relates to things that happen to you during life - such as poor parenting - so if your brain isn’t well developed you’re more likely to deteriorate earlier, and lack of opportunity to get an education starting off in early childhood. All levels of education will reduce dementia rates.” Professor Broe says while the number of people living with dementia is soaring, the incidence of late onset dementia is actually declining. “The rate in the population is rising rapidly, simply because of the epidemic of good health and long life and there are more people at risk,” he says. “But the actual rate in those people is dropping and we think that is due to education. My personal explanation is that parenting is just as important as education. It’s a ray of hope.” June 2015 Volume 22, No.11 23

World UK: staff shortage impedes training Almost one fifth of nurses in the United Kingdom were unable to complete compulsory job training last year, a recent survey shows.

Of the more than 14,000 nursing staff surveyed by the Royal College of Nursing (RCN), 44.4% said they had not completed training due to few staff to cover their work. Of those who had undertaken training, almost half (48%) reported that no cover was provided while they were absent from their normal duties which potentially put patients at risk. One in 10 had used annual leave or own personal time to complete compulsory training. “It is absolutely critical that all nurses receive essential training each year to maintain standards of care for patients, and it is extremely worrying that almost one in five nurses has not been able to do this,” RCN Chief Executive and General Secretary Dr Peter Carter said. The findings showed some improvement since a similar survey undertaken by the RCN in 2010. Ongoing staff shortages and budget cuts were still significant barriers, the research found. Alarmingly, more than one third of nurses considered they were “not up to date with core training”. Access to continuing professional development (CPD) was also low. More than one quarter of survey respondents reported they had no access to structured CPD. Similarly, more than one quarter considered CPD opportunities had worsened over the past five years. The report found 85% of nurses had completed CPD activities in their own time in the past year; just under a quarter had used annual leave. Almost one third funded CPD themselves.

24 June 2015 Volume 22, No.11

Ireland: rise in workplace bullying The Irish Nurses and Midwives Organisation will launch a SAFE ‘code of advice’ for its members following a significant increase in workplace bullying. A large-scale survey conducted by the INMO with National University of Ireland, Galway (NUI) and the National College of Ireland (NCI) found a 13% increase in reported perceived workplace bullying over a four year period.Almost 6% of respondents reported being bullied on an almost daily basis, the INMO Workplace Bullying Survey Findings: 2010-2014 found. While almost all organisations (9.5%) had a formal anti-bullying policy in place, there was clearly a gap in the implementation of those policies, study lead NUI Galway Professor Maura Sheehan said. “There needs to be a fundamental change in hospitals and aged care facilities – a zero tolerance policy for any bullying must be implemented. This must apply to all employees, no matter how senior, specialised and experienced.” The personal consequences in terms of health, wellbeing and family relationships of people who experienced workplace bullying were extremely serious, Professor Sheehan said. Survey results found negative consequences included: having more time off work than usual through sickness (26.1%); thinking or talking about leaving the job

(21.7%); decreased job satisfaction (23.2%); and increased levels of stress a definite consequence of workplace bullying (26%). Government cutbacks were the probable cause for the increase in bullying, according to the report. “They (members) believe the problem has been accelerated due to the effects the cutbacks in healthcare have had in the workplace, particularly as the activity levels have increased, hospitals are constantly overcrowded and staffing levels have reduced,” INMO Director of Industrial Relations Phil Ni Sheaghdha said. About 3.3 billion has been cut from the Irish health system since 2008. Overcrowding of public hospitals increased again in the past year, while about 2,000 public hospital beds were closed. The INMO will meet with employers on the issues and launch its ‘Code of Advice’. SAFE ‘Code of Advice’ S – Stay calm and walk away A – Act to document incidence F – Follow bullying procedures E – Engage support

Campaign for access to pneumococcal vaccine for developing countries A global campaign has been launched calling on pharmaceutical companies to slash the price of the pneumococcal vaccine in developing countries. Médicins Sans Frontières (Doctors Without Borders) made the recent public call to pressure GlaxoSmithKline (GSK) and Pfizer to cut the price of their pneumococcal vaccines in developing countries to US$5 per child. In the poorest countries, the price to vaccinate a child is 68 times more expensive than in 2001, a 2015 Medicins Sans Frontieres report shows. Many countries are unable to afford the pneumococcal vaccine, with the disease killing about one million children worldwide each year. Part of the reason vaccination has become so costly is that very little information on vaccine pricing is available, leaving many developing countries and humanitarian agencies to negotiate with pharmaceutical companies from a very weak position, with no way to compare

prices, Director of Operations for Medicins Sans Frontieres in Paris, Dr Greg Elder said. Some countries had to sign confidentiality clauses that prevented them from disclosing the price they pay for their vaccines. The launch of the campaign coincided with Pfizer’s shareholder meeting held in New York in which Medicins Sans Frontieres’s staff raised questions from the floor pushing the company’s board members to disclose the price of their pneumonia vaccine in all countries. In about 45 countries, there is no information about the price for the pneumococcal vaccine. “It’s led to the irrational situation where some middle-income countries pay more for the pneumococcal vaccine than wealthy ones. For example the Philippines pays more than Australia,” Dr Elder said. anmf.org.au

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Make a difference to your future Super is one of the biggest investments most of us will make during our lifetime. What you do with your super today can really make a difference to your future. You can achieve the retirement you want when you take some simple steps to look after your super.

Free time, family and no deadlines — what are you looking forward to when you retire? Despite media claims you need over $1 million to retire, the majority of Australians live well in retirement by supplementing the Age Pension. If you live well on your current wage — living well in retirement is achievable. When combined with the Age Pension, even a modest super balance can help you enjoy the things you look forward to the most.

Did you know, around 80% of Australians who’ve reached the age to qualify, receive a full or part Age Pension?* *Source: http://ncoa.gov.au/report/phase-one/part-b/7-1-age-pension.html

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June 2015 Volume 22, No.11 25

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How you can get there

It’s never too late to start making a difference!

Growing your super comes

How an extra $20 per week could leave you over

down to what you put in and

$52,000 better off!

earning interest over time. Finding $20 a week to add to your super can make a big difference to living well in retirement. The earlier you start adding a little extra, the more time – and money – there is for interest to accumulate. Just like a savings account at a bank.

$20 extra can really add up by the time you retire.

Sam and Pip are both 36 years old and earn a before-tax salary of $50,000 p.a. Sam makes no extra contributions to super. The only super going into his account is the compulsory super his employer pays on his behalf. Pip tops up her account with $20 extra each week from her take-home pay. She ends up with more than $52,000 extra in her account for her future than Sam. $400k

$375,428 $350k

Pip

$323,095 $300k

Sam

$250k

*Assumptions: The above case study assumes a starting super balance of $30,000, full-time earnings of $50,000 p.a. with a constant Super Guarantee (SG) rate of 9.5%. An inflation rate of 2.5% has been applied and all figures calculated in today’s dollars. An annual investment return of 6.5% has been included, but fees (including insurance fees) have not been taken into account. An allowance of 15% earnings tax has been deducted on all earnings within super before retirement. Retirement at age 67. This example is an illustration only. It is not a guarantee in any way. Actual outcomes may vary. Source: https://www.moneysmart.gov.au/tools-and-resources/ calculators-and-apps/superannuation-calculator

26 June 2015 Volume 22, No.11

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Putting away more for your future Fact: Putting an extra $20 a week into your super can improve your retirement outcome. The question is: how should you contribute? There are two options.

1. Contributions from your before-tax pay If you earn more than $48,488 p.a. this is usually the best way to build your super. The main benefit is tax – these contributions are generally taxed at 15% when they go into your super – so before-tax contributions make a lot of sense if you pay more than 15% income tax. It’s also called ‘salary sacrifice’ – talk to your employer about setting up a regular contribution from your pay into your super account.

How much can I contribute? Age

Maximum before-tax earnings you can contribute to super

Under 49

$30,000*

49 and over

$35,000*

*Concessional contributions cap includes employer Super Guarantee compulsory contributions

2. Contributions from your after-tax pay After-tax super contributions are paid from your take-home pay. If you earn under $48,488 p.a. this is usually the best way to build your super, because you could also receive a bonus super top up from the government. You may have heard of the government co-contribution? This is where, for every dollar you put in to your super (from your after-tax pay), the government will kick in another 50 cents. It can be as much as $500 worth of bonus super from the government! It all depends on what you earn and how much you put in. Another way to build your savings is to deposit a tax refund or any inheritance you receive into your super.

How much can I contribute? Each year, you can contribute up to $180,000 of after-tax earnings to your super. If you’re under 65, you can bring forward three years’ contributions into one year, to allow a maximum of $540,000. Keep in mind: •

Your super fund needs your tax file number (TFN) or you can’t make after-tax super contributions.

It pays to supply your TFN. If you haven’t already, give your super fund a call. Don’t forget to claim your government co-contribution! If you earn under $48,488 p.a. in the 2014/15 financial year and make after-tax super contributions, you may be eligible to receive a super co-contribution of up to $500.

Keep in mind: •

Before-tax contributions may be subject to extra tax if you withdraw them from super before you turn 60.

•

They’re included in the income test for co-contributions and other government benefits.

•

Keep track of your super contributions, if you exceed your concessional contributions cap, excess contributions may be taxed at your marginal tax rate, plus incur an interest charge. Excess concessional contributions can be withdrawn.

•

If you haven’t provided your TFN, contributions will be taxed at the highest marginal tax rate.

•

If your taxable income exceeds $300,000 you will be taxed at 30% for before-tax contributions.

Extra super at age 67 $119,820 more

Age 30

$70,416 more

Age 40

$36,515 more

Age 50

Assumptions: Income $30,000 p.a. Account balance $0. Inflation 2.5% p.a. Growth rate after fees 6.5% p.a. (CPI+4%). Salary index 3.5% p.a. $1,000 non-concessional contribution made at end of each financial year from stated age to age 67 with $500 co-contribution received at the end of the following financial year, except the year member turns 67. Contributions received monthly, at end of each period, contributions tax applied at the time of contribution. Net growth rate on monthly contributions at 2.53%. Interest on concessional contribution based on interest calculated in 2014/15 financial year and applied as a constant rate of return each year thereafter. This is a conservative rate of return, actual interest applied will increase in line with salary indexation. Retirement at age 67. This example is an illustration only. It is not a guarantee in any way. Actual outcomes may vary.

For more information on the government co-contribution scheme visit ato.gov.au/super anmf.org.au

June 2015 Volume 22, No.11 27

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Why pay more than you need to? Fees and costs can vary significantly between super funds. While it can be hard to imagine, even an extra 1% in fees can add up to a fairly big dent in your savings by the time you retire. Worse still, if you’ve ever changed employer, you could actually be paying fees for your old super fund as well as your existing one!

Make sure your hard earned cash is working towards securing your future Every cent counts — comparing fees and costs and making sure you consolidate your super into one account are two easy ways to make sure more of your super is working for you. Bear in mind, before consolidating super from one account to another, it’s also important to compare both funds before you exit. Look at fees and other charges that may apply when you leave a fund, including exit fees. You’ll also want to consider differences in insurance cover and investments — including long-term investment performance when making your decision.

Desperately seeking super To find out how your super fund compares on fees, check out the MoneySmart Superannuation calculator at moneysmart.gov.au

Are you one of the millions of Australians with lost super? If you’ve ever changed jobs you could have lost some of your super. You’ll be glad to know you can find your lost and unclaimed super by running a quick SuperSeeker search. SuperSeeker lets you: •

check super accounts paid into for you in the last two financial years

•

find lost super held at the Australian Tax Office (ATO)

•

transfer your super to the super account you want to keep.

To access SuperSeeker, you need to register online with the ATO and create a myGov account. This is an important security measure to protect the personal information displayed. It also helps to ensure any transactions are made by you. Reclaim your lost super Visit ato.gov.au/superseeker to register today.

28 June 2015 Volume 22, No.11

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Super is your investment If you put your money into a savings account, do you take notice of the interest, fees or risks that apply? It may not feel like your money yet, but super is one of the biggest investments you’ll ever make. Super funds often provide a MySuper, or default investment option for members who don’t make a choice when they join. While this may be the right option for some, it isn’t a one-size-fits-all approach, so it’s important to check with your fund and make sure you’re happy. Just like shopping around for the best rate on your savings account, you can take an active role in where your super savings are invested if you want. Most funds offer members a choice of investment options — with varying aims, strategies and levels of expected risk and return. You can look at the options available to make sure your savings are working the way you want them too.

Get involved with your investments: Visit your fund’s website and download their investments guide.

anmf.org.au

June 2015 Volume 22, No.11 29

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Where to get more information if you need it If you need some information about super, it helps to know where you can get the right information if you need it. Thankfully there are plenty of places to find information about super, including:

Your fund’s website A good place to start when looking for information about your super.

moneysmart.gov.au Offers free, independent guidance and tips so you can make the best choices for your savings. You can use MoneySmart’s range of interactive calculators, not only to work out your super options, but also to calculate income tax, create a budget, investigate mortgage options and more.

Your fund’s education and advice services Check if your fund runs workplace super education sessions or advice for members. Sometimes these services are offered as a member benefit at no-extra cost or for a low fee. They can be a great way to access information — on topics such as insurance, making investment choices, your super contribution options, managing money and retirement planning. To help keep your super strategy on track, consider speaking to a qualified adviser who can tailor their advice to your personal situation. You may be able to access personalised super advice through your fund.

30 June 2015 Volume 22, No.11

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Transition to retirement — boost super or wind back on work — the choice is yours. If you’re at the age where you’re starting to think about retirement, you might be interested to know there’s a way you can ease into retirement, without leaving the workforce completely. Most super funds offer a transition to retirement option for those who have reached their preservation age and want to start accessing their super — without stopping work.

Transition to retirement (TTR) lets you: •

continue working and boost your super for when you retire, taking advantage of potential tax breaks, or

•

reduce your hours without reducing your income — by supplementing your employment income with your super.

And it doesn’t affect your eligibility to continue building your super!

Protecting your biggest asset Super is one of your biggest investments — but your biggest asset of all is you! Many Australians don’t have enough — or in some cases any disability or death insurance — exposing them and their loved ones to potential financial hardship if they suddenly lose their ability to earn an income.

Your health and ability to earn an income are vital assets that need protection.

Of course, there are some limitations to how you can use a transition to retirement income stream, like you can’t take lump-sum payments until you retire fully and you need to withdraw a minimum amount each year.

Regardless of what path you choose to retirement, seeking the advice of a certified Financial Planner can help with any important decisions. Find out your preservation age at ato.gov.au

Insuring through your super fund can be a cost-effective way to protect yourself and your income should the unexpected happen. And with insurance fees generally deducted from your super account you don’t need to fund them from your weekly budget.

Disclaimer Information issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. This information has been carefully compiled from sources we consider to be reliable. However, it is only current at the time of writing (15/5/14) and may not be accurate in all instances. It is of a general nature. It does not take into account your objectives, financial situation or specific needs. You should look at your own financial position and requirements before making a decision. You may wish to consult an adviser when doing this. Third-party services are provided by parties other than H.E.S.T. Australia Ltd and terms and conditions apply. H.E.S.T. Australia Ltd does not recommend, endorse or accept any responsibility for the products and services offered by third parties or any liability for any loss or damage incurred as a result of services provided by third parties. You should exercise your own judgment about the products and services being offered. Investments can go up or down. Past performance is not a reliable indicator of future performance. Consider a Product Disclosure Statement before making a decision about HESTA products. Call 1800 813 327 or visit hesta.com.au for copies.

anmf.org.au

June 2015 Volume 22, No.11 31

Recognising outstanding achievements It’s said that small acts can make a big difference.

A $30,000 prize pool — generously provided by ME — will be shared among the winners in three award categories: Nurse of the Year, Outstanding Graduate and Team Innovation.

This is certainly true when it comes to the HESTA Australian Nursing Awards, with each person nominated receiving a certificate of recognition.

“It’s a great opportunity for patients, their families, colleagues or employers to say ‘thank you’, and to tell the community about Australia’s exceptional nurses and midwives,” Ms Blakey says.

“This gesture is an important part of the HESTA Australian Nursing Awards,” says HESTA CEO, Debby Blakey.

“The achievements of Australia’s remarkable nursing professionals are inspirational, courageous and innovative — and our awards are an avenue to share their stories.”

“Recognition plays a vital role in rewarding professional achievement. “A certificate lets all those who’ve been nominated know their work is appreciated.”

HESTA CEO, Debby Blakey

Nominate now Nominations close on 31 July for the 2015 HESTA Australian Nursing Awards. Winners will be revealed at the Awards dinner, where all finalists will celebrate with their colleagues, friends and family. HESTA is the super fund for health and community services, with more than 800,000 members and $32 billion in assets. More people in health and community services choose HESTA for their super.

tion nomina a e k a To m out or find bout more a it ards, vis the aw s.com.au ward hestaa

Left to right, 2014 winners: Zoe Sabri (Outstanding Graduate), Steve Brown (Nurse of the Year) ® ¯ and Prof. Jeanine Young representing the Apunipima Pepi-pod Program (Team Innovation). Read their stories at hestaawards.com.au

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H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No.235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. Terms and conditions apply, see hestanursingawards.com.au for details.

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Working life

Jess Shute

Nursing in aged care: a surprise package Twelve years ago I was enrolled in a Veterinary Science Degree when I withdrew from university to work. I was 18, living with my grandmother, and I was broke. I returned home after work one night to find a scribbled note; “Gone to hospital in ambulance.” At the time, I was unaware this event would set the path for my career in aged care nursing. My grandmother had left home via ambulance six hours prior. She told me it wasn’t until I phoned the hospital that she was attended to. Seemingly, she got ‘lost’ in the system. How could my grandmother, an eccentric, gambling, smoking, free-spirited artist, have been ‘lost’ in a hospital? What if I hadn’t called? What if I hadn’t gone straight home after work? Most importantly, when the hospital staff shrugged off the ‘fuss’ I was making, did this indicate that this happens all the time? My fury propelled my enrolment in a division two nursing traineeship the following week; a specialisation in aged care in mind. Over the next two years I worked through

my traineeship in a large private aged care facility. I learned clinical, social and emotional requirements of carers, in a facility where culture and variable care requirements challenged me daily. I laughed, I cried, I learnt time management and communication skills, and I worked with a team who were supportive, driven and inspiring. After graduating, I was immediately appointed care coordinator of one floor. A different role to current clinical care coordinators, I was charged with staffing, allocations, client care documentation and preparation, care planning and management of the unit. Inspired, I took every opportunity available to enhance my skills. I completed my medication endorsement, and utilised aged care industry networks to move roles, consolidating Endorsed Enrolled Nurse (EEN) skills in medication administration, communication, time management, documentation, and team leadership. The anger over my grandmother’s hospital visit was just a memory, however the flames were reignited by the demise of the facility I worked at, and subsequent displacement of 90 vulnerable residents. As I helped these residents and families navigate the confusion, I again felt disappointed by a system, and I was now also unemployed! Not one for quitting, I enrolled in a Bachelor of Nursing Degree. I wanted to contribute more effectively to the industry, and have greater impact on the decisions and lives of my clients. When applying for my graduate year, a professional development lecturer said applying for the Aged Care Graduate Nurse Program “was a waste of time. If you wanted to do that, why didn’t you just stay an EEN?” Driven again by that flame, I successfully applied

for an Aged Care Graduate Nurse Program, and was placed in a not-for-profit aged care facility, released for seven weeks a year to attend university for training dedicated to aged care and the elderly. This was a place where networking was fabulous, lecturers inspirational and students could feel proud of their choice to focus on aged care, and were respected instead of ridiculed. After successful completion I successfully applied for an Australian College of Nursing scholarship valued at $30,000 to complete my Master of Nursing, focusing on Aged Care. The first unit was granted as recognised prior learning for completing the Aged Care Graduate Nursing Program. This brings me to today. I remain employed in aged care, and have undertaken a six month secondment to the Research and Advocacy team within my organisation. This role provides insight into the organisation, industry and opportunities for aged care nurses. It is an immensely different experience from working at an operational level; driven by strategies and vision, not tasks. There is a need for greater availability of these placements, as it is a valuable environment and experience, enhancing sector, industry and organisational perspectives of operational staff. I was disappointed to hear the Aged Care Graduate Nursing Program I participated in, which was run through (Leading Aged Services Australia) LASA and Monash University, has been discontinued. I am unaware of any other programs in Victoria that involves a significant university component and aged care placement and support provided by a peak body, such as LASA. Programs bridging industry, organisation and education institutes are key to attraction and retention of knowledgeable and passionate industry leaders. These programs will flourish if the industry improves its public profile and demonstrates the value of aged care nursing. There is opportunity for the aged care industry to re-negotiate partnerships with universities to facilitate such programs, and foster placements to drive program demand. Aged care has much to offer. In my own early career I have experienced frustration and disappointment, but also opportunities and rewards this industry offers its committed workforce. It is exciting to be just commencing my journey, and looking forward to everything aged care offers. Jessica Shute is an RN and Research Innovation and Advocacy Team member, Residential care at Benetas in Victoria

anmf.org.au

June 2015 Volume 22, No.11 33

Research Australians support industry to tackle alcohol abuse

One less sugary drink a day cuts risk of diabetes Replacing one sugary drink a day with water or unsweetened tea or coffee can reduce a person’s risk of developing diabetes by up to a quarter, research shows. However, for each 5% increase of total energy intake provided by sweet drinks, including soft drinks, sweetened tea or coffee, milk drinks, and fruit juice, the risk of developing type 2 diabetes may increase by 18%. The research published in Diabetologia, the journal of the European Association for the Study of Diabetes, studied more than 25,000 men and women aged 40 to 79 years living in Norfolk, United Kingdom. Study participants recorded everything they consumed for one week. After an 11-year follow-up, 847 participants were diagnosed with newonset type 2 diabetes. The researchers found replacement of one serving of soft drink with water or unsweetened tea or coffee could cut the risk of developing diabetes by 14%; and replacement of sweetened milk drinks could lower the risk by 20-25%. A reduction in diet of sweet beverages to below 10, 5 or 2% of total daily energy intake could reduce the risk of new-onset diabetes by 3, 7 and 15% respectively. “The good news is that our study provides evidence that replacing a daily serving of a sugary soft drink or sugary milk drink with water or unsweetened tea or coffee can help to cut the risk of diabetes, offering practical suggestions for health alternative drinks for the prevention of diabetes,” Lead scientist of the UK Medical Research Council Epidemiology Unit, University of Cambridge Dr Nita Forouhi said.

34 June 2015 Volume 22, No.11

Three quarters of Australians consider the country has a problem with excess drinking or alcohol abuse, the nation’s largest alcohol poll reveals. However latest government statistics show Australians are drinking less alcohol overall than any time in the previous 50 years. Australian Institute of Health and Welfare (ABS) data of 2013-14 released last month showed the lowest level of alcohol consumption per person aged 15 years and over since the early 1960s. The pattern of alcohol use had also changed. While beer made up three quarters of all alcohol consumed 50 years ago, it now made up under half (41%). Wine consumption increased over the same period from 12 to 38%. Alcohol is responsible for 15 deaths and 430 hospitalisations each day, according to the Foundation for Alcohol Research & Education (FARE). Its annual alcohol poll 2015: Attitudes and Behaviours analysed data and community perspectives on alcohol. Figures showed 71% of participants polled considered Australia’s alcohol problems were unlikely “to get better” in the near future. The majority (73%) agreed more needed to be done to reduce the harms from alcohol. More than half of poll participants (55%) considered government action addressing the

Women to be vigilant on eye health Women, especially those 40 years and older, are urged to be vigilant on their eye health as research suggests they are at greater risk than men for eye disease. The Royal Australian and New Zealand College (RANZCO) issued the warning to women indicating they are at greater risk for macular degeneration, cataracts, glaucoma and diabetic retinopathy. An estimated 143,000 Australian women suffer from glaucoma, compared to 77,000 men, with higher prevalence in women aged over 40. “Glaucoma is one disease which is often discovered too late, because there are no obvious symptoms,” Sydney ophthalmologist Dr Diana Semmonds said.

problem was not enough. Australians were supportive of alcohol policies implemented in NSW and more recently, those proposed in Queensland: 81% polled supported a 3am or earlier closure for pubs, clubs and bars. Most respondents agreed clubs and pubs (60%) and alcohol companies (66%) needed to be doing more to prevent harms; 70% agreed the alcohol industry should pay for reducing alcohol harms. Industry-led initiatives such as asking young people for identification at the pointof-sale were rarely being implemented. The poll found 42% of Gen Y had never been asked for ID in the past year at a bottle shop and 38% had never been asked at a pub, club or bar. “Alcohol has long been seen as an issue that’s too hard to touch – but the poll shows this couldn’t be further from the truth,” FARE Chief Executive Michael Thorn said. “A majority of Australians think alcohol is a problem, the majority support a range of policy solutions, and we’ve seen from the response to efforts to date that communities will reward strong leadership and embrace meaningful alcohol reform.” The poll showed support for policies, including: an increase in the number of police on the streets (85%); an increase in penalties for alcohol-related violence (86%); a ban on alcohol advertising from public transport (65%) and on television before 8.30pm (63%); the introduction of health information labels on alcohol products (60%); and development of a national alcohol plan for Australia which would outline strategies to be implemented by all levels of government (68%).

All women over the age of 40 should have an eye examination, Dr Semmonds said. Increased risks of eye disease for women included: • living longer than men; • hormonal and lifestyle factors, such as menopause which can cause dry eye syndrome, and drugs or supplements that counteract its effects which may cause eye inflammation; • high blood pressure during pregnancy which can result in blurry vision and retinal detachment; and . • increased risk for autoimmune diseases such as lupus, multiple sclerosis, rheumatoid arthritis, and Sjogren’s syndrome, which destroys glands in the eye and mouth that produce moisture. Women were also five to six times more likely than men to get Grave’s eye disease due to overactive thyroid. anmf.org.au

Professional

Julianne Bryce, Elizabeth Foley and Julie Reeves, Federal Professional Officers

Caring for the caring professionals On 5 May 2015 the Medical Board of Australia (MBA) announced a joint initiative with the Australian Medical Association (AMA) to deliver a national health program for doctors and medical students. In noting the importance of improving services for doctors with health concerns Dr Joanna Flynn, MBA Chair said, “The Board is committed to supporting the wellbeing of all doctors and medical students in Australia. Creating health services that are accessible and fair to everyone – and are targeted to meet doctors’ needs – is a really important contribution we are proud to make.” President of the AMA, Associate Professor Brian Owler, highlighted that: “Critically, the services will remain at arm’s length from the Medical Board to ensure that doctors and medical students trust these services and use them at an early stage in their illness”. This is all good news - for our medical colleagues, but what about nurses and midwives? Nurses and midwives care for the health needs of other people in their daily practice. They manage health crisis situations for other people. They support other people through vulnerable times in their lives. Sometimes, however, the strength and resilience needed to care for others, in the course of their work, impacts on their personal life. Either, pressure is added to underlying health issues, or, the ‘coping’ mechanisms they turn to actually damage their health and thus their ability to safely practice nursing or midwifery. The ANMF’s position is that as caring professionals, and in the interests of retaining these nurses and midwives in the workforce, it’s essential we (the professions) assist our colleagues to address their health challenges. We have, therefore, been strong advocates for some years, for the anmf.org.au

establishment of a national nursing and midwifery health program, run by nurses and midwives. In our submissions on this issue we’ve argued that this national program should work closely with the Australian Health Practitioner Regulation Agency (AHPRA) and the Nursing and Midwifery Board of Australia (NMBA), to support impaired nurses, midwives and students seeking to restore their health, and assist their return to safe and competent practice. We agree with sentiments expressed by the MBA’s Dr Flynn that the regulator’s focus is, and should be, on public safety. While this means the regulator cannot directly provide these services, the ANMF maintains the NMBA can, and should, fund them and work with stakeholders to make them happen. The overarching components in designing

students in all areas of the country. An excellent example of good practice of referral, assessment, treatment and rehabilitation of impaired health professionals is the Nursing and Midwifery Health Program in Victoria. This program is an evidencebased model, providing an initial contact point for referral and case management support for nurses and midwives with alcohol and other drug problems and/or mental health concerns, in order to promote individual health and wellbeing. Overseen by nurses and midwives this program works well with the regulator – NMBA, and when required, the employer. This service model demonstrates a valuable resource to all industry stakeholders, including employers, professional organisations, the NMBA, education

AN EXCELLENT EXAMPLE OF GOOD PRACTICE OF REFERRAL, ASSESSMENT, TREATMENT AND REHABILITATION OF IMPAIRED HEALTH PROFESSIONALS IS THE NURSING AND MIDWIFERY HEALTH PROGRAM IN VICTORIA. a support/management model for health professionals with a health impairment are that the model be based on principles of confidentiality, trust, respect and professional accountability. Key features of the model are for it to: • be confidential and independent of the NMBA; • be promoted, accessible and free of charge; • enable and encourage self-referral; • provide assessment and case management by nurses and midwives to enable profession specific understanding; • refer as required to other health professionals and support services; • include development of an individualised management plan; • provide monitoring and ongoing support; • focus on rehabilitation; • support re-entry to employment; • offer support and advice on the management of the notification processes; • be an accessible resource for nurses and midwives, employers and the profession, and • use advanced IT infrastructure to enable engagement with nurses, midwives and

providers and the general community, for advice on how to approach nurses, midwives and students who may have a health impairment. A service of this nature may effectively intervene before the health issue impinges on a nurse’s or midwife’s practice. Early contact and appropriate action can provide the individual with the assistance required to enable them to continue practising safely and feel supported in their work environment. This early intervention and treatment may then circumvent the need for a notification to the Board. The ANMF participated in a project commissioned by the NMBA and AHPRA in 2014, to explore the role of the regulator in the referral, treatment and rehabilitation of nurses and midwives with a health impairment. The project report is now with the NMBA for consideration. Surely there is an obligation for the Board to support these nurses and midwives so they are retained within the professions, as safe, competent health professionals. We support the NMBA providing ongoing sustainable funding for an independent service overseen and conducted by nurses and midwives. The result will be a significantly positive outcome for the professions and the public. June 2015 Volume 22, No.11 35

Research extra

Rebecca (Becky) Ingham-Broomfield

The issue of nurses understanding research Nurses are responsible for a significant amount of judgments made in healthcare on a daily basis. Those judgements are made using clinical reasoning (Levett-Jones 2013) and through the understanding of evidencebased practice (Hoffman, Bennet & Del Mar 2013). This paper briefly explores the underlying difficulty of using research and the terminology associated with it. Discussion The Nursing and Midwifery Board of Australia (2013) clearly states in the Codes of Professional Conduct for both nurses and midwives that they must participate in research and practice within the Boardapproved Competency Standards. Nursing and midwifery must be evidence-based professions. Evidence-based practice acknowledges the integration of the best research evidence with clinical expertise and the unique values and circumstances of the patient (Hoffman, et al. 2013). The purpose of evidence-based practice is to assist the health professional in clinical decision making (Hoffman, et al. 2013). While health professionals may be conversant with the importance of research for supporting their clinical knowledge (Hoffman, et al. 2013 ) the actual task of reading and understanding research papers is not necessarily so familiar particularly for novice nurses (Ingham-Broomfield 2014a). Research words are unique and sometimes, intimidating, and indeed, the vocabulary is not unlike a foreign language. A foreign language is defined by the Merriam Webster Dictionary (2015) as coming from, or belonging to, a different place and for many nurses the terminology of research is akin to learning a new language. Nurses may find reading and critiquing their first research paper to be a particularly daunting experience (Ingham36 June 2015 Volume 22, No.11

Broomfield 2008) and it is not uncommon to find students wondering about the relevance of research (Wright-St Clair, Reid, Shaw, & Ramsbotham 2014). This is partly due to the complex language of research. There are many research terms to grasp. Knowing what questions the nurse should be asking is perhaps the most difficult task. It is, however, a necessary part of gaining a degree in the health sector which means the nurse must be familiar with research in a way that informs practice (Wright-St Clair, et al. 2014). Nurses also need to understand the subsequent value of a research paper (Moxham, 2015). “It is our business to ensure that our clients have the most up-todate and appropriate knowledge with which to make informed decisions about their care and management” (Jirojwong, Johnson, & Welch 2013). Therefore, nurses and midwives do need to understand the terminology, as well as understand the importance, and value, of evidence and integrate research into their practice. However, over many years, it has become apparent that while nurses have access to many resources on research, there is frequently so much information that sorting through, and deciding what is needed, becomes difficult. There is a myriad of jargon that is unfamiliar and as an example, separating words like ‘qualitative’ from ‘quantitative’ is not always clear or easy. In an attempt to disentangle the terms and organise the main components the following articles are available to the novice researcher through the following series, which will be gradually added to. There are presently three articles to help nurses gain a more streamlined understanding of terms and meanings. They are: A nurses’ guide to the critical reading of research (Ingham-Broomfield, 2014b), A nurses’ guide to Quantitative Research (Ingham-Broomfield, 2014a) and A nurses’ guide to Qualitative Research

(Ingham-Broomfield, 2015) published by the AJAN. Reference List: Hoffman, T., Bennett, S., & del Mar, C. (2013). Introduction to evidence-based practice. In T. Hoffmann, S. Bennett & C. Del Mar (Eds.), Evidence-Based Practice across the Health Professions. (2nd ed.). Sydney: Churchill Livingstone, Elsevier. Ingham-Broomfield, R. M. (2008). A nurses’ guide to the critical reading of research. Australian Journal of Advanced Nursing, 26(1), 102-109. Ingham-Broomfield, R. M. (2014a). A nurses’ guide to Quantitative Research. Australian Journal of Advanced Nursing, 32(2), 32-38. Ingham-Broomfield, R. M. (2014b). A nurses’ guide to the critical reading of research. Australian Journal of Advanced Nursing, 32(1), 37-44. Ingham-Broomfield, R. M. (2015). A nurses’ guide to Qualitative Research. Australian Journal of Advanced Nursing, 32 (34-40). Jirojwong, S., Johnson, M., & Welch, A. (2013). Research Methods in Nursing and Midwifery. Sydney: Oxford University Press. Levett-Jones, T. (2013). Clinical Reasoning - Learning to think like a nurse. French’s Forest, NSW: Pearson. Merriam Webster Dictionary. (2015). Retrieved from www.merriam-webster.com/dictionary/foreign, Accessed 28/04/15 Moxham, L. (2015). Nurse Education, Research and Evidence-Based Practice. In A. Berman, S. J. Snyder, T. Levett-Jones, M. Hales, N. Harvey, Y. Luxford, L. Moxham, T. Park, B. Parker, K. Reid-Searl & D. Stanley (Eds.), Kozier & Erb’s Fundamentals of Nursing (3rd ed., Vol. 1). Frenchs Forest, Sydney: Pearson Australia. Nursing and Midwifery Board of Australia. (2013). Codes, Guidelines and Statements. Retrieved from www.nursingmidwiferyboard.gov.au/ Accessed 28/04/15 Wright-St Clair, V., Reid, D., Shaw, S., & Ramsbotham, J. (2014). Evidence-based Health Practice. South Melbourne: Oxford University Press.

Rebecca (Becky) Ingham-Broomfield is a Lecturer in Nursing, University of New England, Armidale, NSW, Australia

anmf.org.au

Legal resulted in deregistration or limited registration being imposed on Mr Dean” (para 270).

Linda Starr

What can we learn from Quakers Hill? In the early hours of 18 November 2011 registered nurse Roger Dean used a cigarette lighter to ignite two mattresses in the Quakers Hill Nursing Home where 89 high care residents were living at the time. On 27 May 2013 he pleaded guilty to 11 counts of murder by way of reckless indifference to human life, and eight counts of recklessly causing grievous bodily harm. Eight more suffered serious injuries from burns and/or smoke inhalation (R v Dean). He was also charged with a number of counts of larceny as a clerk following the theft of a substantial amount of S8 medication on the night of 16 November. Initially when asked why he lit the fires he responded: “I’m just corrupted with evil thoughts that had made me do that “…Satan saying to me that it’s the right thing to do…”. (para 223) Later he admitted to lighting the fires as a distraction in the hope that the facilities managers would not pursue their inquiries into the theft of the medication. In sentencing, the judge described the murders as ‘heinous’, ‘atrocious’ and ‘greatly reprehensible’ (para 108). He was sentenced to life on each count of murder as well as prison terms for each count of his other crimes. During the inquiry it became evident that Dean suffered an impairment due to polysubstance abuse. This matter was also the subject of a coronial inquiry where the Coroner noted that: “With hindsight we can see that there may have been an opportunity to diagnose and address Mr Dean’s polysubstance abuse issues before he caused the harm he ultimately inflicted on his victims. Moreover, a mandatory notification to AHPRA may have anmf.org.au

Missed opportunities: Dean first registered as a nurse in 1996. From 20022007 he worked in mental health and drug & alcohol rehabilitation at St George’s Hospital & Community Health Services. In April 2007 Dean became upset following a dispute with his supervisor, who later found white paint splashed over her car and screws pushed into the tyres. Dean learnt that management intended investigating this incident and resigned. He confessed to this crime following the fires. From 2005 Dean also had a part time position with St John of God Hospital converting to full time following his resignation at St George’s. It was at St John’s that evidence of his health impairment emerged with records of at least one incident of Dean attending work under the influence of drugs. Dean claimed to have bipolar disorder and his poor coordination, dishevelled appearance, slurred speech, and white froth at the corners of his mouth was due to a medication change. He was suspended but returned to his position after gaining medical clearance from his GP confirming he had bipolar disorder with a strong depressive tendency. It should be noted that there was never any formal diagnosis of bipolar nor any mention of this in his case notes. Regardless, early in September 2011, management had sufficient concerns regarding Dean’s conduct that, in the interest of public safety they shifted him from night to day duty so that he would be better supervised. Dean resigned three days later. A further missed opportunity occurred when Dean applied for the position of RN on night duty at Quakers Hill. In evidence it was noted that the organisation was keen to fill this vacancy, and whilst conducting a police check and ensuring he had current registration no one checked with his previous employer or his referees. In fact, Dean’s CV was flawed and misleading with seriously out of date references, and concealment of his appointment at St John’s. A required pre-employment medical screen was not done either. The Coroner believed that had some inquiry been made of past employers it would have been difficult to be confident in Dean’s suitability for the position given the evidence of a number of concerns about his past practice and conduct. Soon after commencing employment at Quakers Hill, staff were concerned about his erratic behaviour, his dishevelled appearance and bizarre practice which

included waking residents to give them pain relief that was not requested or indicated. He was also noticed to spend long periods of time alone in the locked treatment room where S8 drugs were kept. Whilst it appears that management were aware of this conduct no action was taken. The Coroner was also concerned with the lack of action taken on the night of the fire when the missing S8 drugs was discovered. CCTV footage showed Dean entering the treatment room on 36 occasions spending two hours in the room during that shift. Although managers of the facility suspected Dean to be the culprit no mention of this was made to police when they reported the theft. Nor was Dean suspended. Despite the staff voicing their fear over being left alone with Dean on the shift, he was left in charge with sole possession of the key to the S8 drug cupboard that night. Unfortunately Dean was alerted to the impending police investigation into the thefts – soon after the fires were lit. Whilst the Coroner believed that Dean’s ‘extreme response’ could not have been anticipated, he felt that the failure to suspend him until the outcome of any internal and police investigations was a ‘lame and risky response’ (para 282). There are many good lessons to be learnt from this case that apply across the healthcare industry. Space allows me to dot point just a few: • always conduct reasonably thorough background checks on potential employees; • a police check alone is unlikely to reveal any drug addiction issues; • provide training for staff to recognise signs of drug impairment and the procedures to take when this is suspected; • ensure adequate policies and guidelines are in place to support staff who witness, investigate and manage incidences of notifiable conduct under the Health Practitioner Regulation National Law; • registered practitioners need to be aware of their mandatory reporting responsibilities under the National Scheme. References R v Dean [2013] NSWSC 1027 Inquest into the fire and deaths at Quakers Hill Nursing Home. NSW Coroners Report 2015.

An expert in the field of nursing and the law Associate Professor Linda Starr is in the School of Nursing and Midwifery at Flinders University in South Australia June 2015 Volume 22, No.11 37

Viewpoint A new frontier for nursing: the servicepractice gap Carolyn Astley, Kate Pennington, Rosanna Tavella, Marion Eckert , Michelle Munro and Robyn Clark Pressures to avoid hospital admissions, improve service delivery, facilitate cost effectiveness and enhance access to healthcare services have led to the development of expert nursing roles (Avery & SchnellHoehn, 2010; The Centre for International Economics, 2013). In Australia, cardiac specialist roles exist in heart failure, cardiac rehabilitation, chest pain, cardiac arrhythmia and implantable device management, and operate within both public and private hospital systems, in clinics and the community as well as at the hospital bedside (Fry, 2009). Nurses in these roles provide skills and expertise necessary to support not only their patient cohort but also their medical and allied health colleagues (Fox-Wilson & Cruickshank, 2012; Sawatzky et al., 2013). Gains to healthcare provision and its cost effectiveness, as a result of cardiovascular nurse specialist roles, have been reported in acute (Fry, 2011), primary health (Allen et al 2013; Betihavas et al., 2011) and aged care settings (Adrian and Chiarella, 2008), however funding and infrastructure to support these positions in Australia remains an ongoing challenge. In January 2013 the Workforce and Training Workgroup of the Cardiac Clinical Network initiated a project to understand the diversity and characteristics of cardiac nurse specialist roles in SA. An online survey was distributed to source the required information: location, personnel, funding, operating hours, and details of actual services provided. The aim of the survey was to use the data obtained to inform future recommendations on design, delivery, location and resources for nurse-led cardiac services.

Design The online survey comprised both multiple choice and open ended questions. It was distributed via email link to cardiac 38 June 2015 Volume 22, No.11

specialty nurses in both public and private healthcare, community and hospital-based environments across South Australia. Forty-six responses were received from 81 requests with 94% of respondents female and 28% located at country services.

implemented are incorporated in to the private as well as public sectors, that delivery plans are dynamic and adjust to patient demographics, and that governance on roles and communication between stakeholders is addressed.

Results

Conclusion

Outcome themes included service and participant characteristics, patient profile of services, measuring and reporting service effectiveness and deficits in service delivery. Specialist cardiac area demographics included rehabilitation-14 (38%), heart failure - nine (24%), chest pain- five (14%), implantable device-one (3%), with another one eight (22%) clinicians in primary healthcare, indigenous health, paediatrics, surgery or heart transplantation. The majority of services operated during normal business hours, with 3% providing a service on each of Saturday, Sunday or over 24 hours. Most services measured hospital avoidance strategies (18%) and length of stay (15%). Data was generally reported to either local nursing or medical directors, or hospital or regional executives. Forty-eight percent of roles were full time, with 13% employed at less than 0.5 FTE (full time equivalent). Sixty-nine percent of positions received no backfill (an employee is assigned to a position temporarily while the substantive employee is on leave) thereby limiting service availability. Positions were commonly provided by local state government health networks (n=14, 42%), whilst others (n=11, 33%) were funded by general practice ‘super clinics’. Federal Medicare Local (primary healthcare) organisations funded three (9%) positions, with the remaining five (15%) funded by private or community sources. Twenty-five percent of positions underwent annual review for ongoing funding. Clinicians reported numerous challenges when trying to sustain or expand their services. The dominant issue identified was that of insufficient staffing/FTE positions allocated to the role or service. Funding constraints were the second most commonly reported challenge to service provision. The third most frequently reported service deficit was the inability to provide clinical services over a seven day week. These top three themes in relation to service delivery gaps constituted 33% of responses. The inability to service all patients was the fourth most common deficit. Absence of suitable support, direction and role definition was also identified. Additional issues include the need to ensure that improvements

Although this survey has identified current nurse specialist services and locations in South Australia, it is only a beginning in determining service deficits and opportunities for improvement. A national survey in collaboration with the Australian Nursing & Midwifery Federation (ANMF) is now in development. Cardiac nurse specialists can provide comprehensive, diverse and cost effective services. This survey has identified a service-practice gap of unrealised potential for cardiac nurse-led health services. The challenge now will be to define cardiac nurse specialist roles that continue to provide patient-centred care, can participate in improved access and equity of health services, and consistently demonstrate efficient and effective healthcare delivery. References on request

Dr Carolyn Astley is the Network Development Manager - Statewide Cardiology Clinical Network, SA Health Flinders Medical Centre and Senior lecturer - Flinders University, South Australia Ms Kate Pennington is a Nurse Education Facilitator - Statewide Cardiology Clinical Network, SA Health Flinders Medical Centre, South Australia Dr Rosanna Tavella is Data Manager - Central Adelaide Local Health Network, SA Health The Queen Elizabeth Hospital and Senior Lecturer - Discipline of Medicine, The University of Adelaide, South Australia Dr Marion Eckert is the General Manager, Support, Research and Policy of Cancer Council, South Australia Ms Michelle Munro is the Clinical Service Consultant, Cardiac Unit, Lyell McEwin Hospital, South Australia Prof Robyn Clark is Professor of Nursing (Acute Care & Cardiovascular Research) School of Nursing & Midwifery, Flinders University, South Australia anmf.org.au

Reflection African immigrant parents’ understanding of their teenager’s newly diagnosed diabetes status

By Sadie Geraghty, Sara Bayes and Annette Hart

In recent years, Western Australia (WA) has seen a sharp increase in the size of its African population due to both economic and refugee migration. Concurrently, there has been a rise in the numbers of African teenagers presenting to health services with uncontrolled symptoms of diabetes. The aim of this investigation was to discover what migrant African parents now residing in WA knew about the dietary needs of their diabetic child.

Australia has a rapidly growing population; it is currently recorded as 23 million people with 2,536 million of those resident in WA (ABS, 2013). Presently, of the one million people registered as having diabetes in Australia (National Diabetes Sevices Scheme, 2013), 78,000 (8%) reside in WA (The Australian Institute of Health and Welfare, 2013). The International Diabetes Federation (2014) report the incidence of type 1 diabetes in teenagers across all cultural groups in WA is currently 23:10,000. The rates of diabetes amongst Black and Minority Ethnic (BME) populations in WA have not been reported however in 2013 at the WA state tertiary children’s hospital, The Princess Margaret Hospital for Children (PMH), migrant African teenagers were presenting with symptoms of unmanaged diabetes in increasing numbers. It is well recognised that a chronic disease such as diabetes places an additional burden on to teenagers already dealing with major hormonal, neuro-maturational, emotional and psychosocial challenges (Cameron, 2006). In addition, the demands of a chronic condition like diabetes undoubtedly adds to the burden of assimilating into a new country (Rintala, 2013). For this reason, PMH provides specialist nurses for this group who are both sensitive to their needs and adept at supporting and enabling them. The service also works closely with the parents of young people diagnosed with diabetes in acknowledgement of the known need in this situation for “recognising the emerging maturity of the adolescent, encouraging

anmf.org.au

self-reliance and self-efficacy…but also retaining the trust and support of parents” (Anderson,1997). Despite whole family engagement with a dedicated diabetes-focused healthcare service and receiving education about the condition, this group is seemingly not effectively managing the disease, and increasingly they are presenting to emergency departments (EDs) with elevated blood sugar levels, weight loss and feeling unwell. There is no research reported to date focusing on African migrant teenagers’ and their parents’ capacity to manage diabetes. An exploratory investigation undertaken at PMH to explore possible factors underlying this situation revealed information that is useful for clinicians working with this group of service users. Ten mothers and two fathers of eight teenagers aged 13-16 years participated in this investigation, all of whom were from a range of African ancestral backgrounds and had lived in WA with their teenager since immigration. Almost half the participants stated their family’s drinks now included fizzy beverages (for example ‘Coca Cola, Sprite, lemonade’), and the same number reported now including fruit juice in their families’ diet. Prior to arriving in WA, participants reported their family’s every day drinks to have included camel milk, which they were now unable to obtain. Four participants had also traditionally cooked with relatively low GI camel meat and maize flour prior to migration, however described being unable to obtain it readily in Australia. Further, many of the participants said they ate only one main meal a day which is contrary to the recommended eating guidelines provided by the PMH diabetes team, wherein this group is advised to eat regular meals of low fat, low glycaemic index foods with meals consisting of a variety of the five food groups (Australian Dietary Guidelines, 2014). Research suggests that uptake of different dietary habits is an important factor in

the health of immigrants to their adopted country (Sanou, et al.,2014); the risk of children developing diabetes is significantly increased (Hjern, 2012). Finding effective ways to get food-related health messages to migrant parents and their diabetic children is essential if they are to achieve health stability.

Conclusion Although small, the study reported in this article provides some insight into why diabetic African migrant teenagers are at risk of poor symptom control. The findings have led to the PMH diabetes team implementing new measures to assist this group’s care. Further research is required to develop and test approaches to health education for these families. References: Anderson,et al.,(1997) Parental involvement in diabetes management tasks: relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus. The Journal of Pediatrics,. 130(2): p. 257-265. Australian Bureau of Statistics.(ABS) (2013); Available from: www.abs.gov.au/ausstats/abs@. nsf/ mediareleasesbycatalogue/8668A9A0D4B0156 CCA25792F0016186A?OpenDocument. Australian Dietary Guidelines. Eat for Health. (2014); Available from: www.eatforhealth.gov.au/sites/default/ files/files/the_guidelines/n55f_children_brochure.pdf Australian Institute of Health and Welfare. (2013); Available from: www.aihw.gov.au/. Cameron, F.,(2006).Teenagers with diabetes: management challenges. Australian Family Physician, 35(6): p. 386. Hjern, A., U. Söderström, and J. Åman, (2012), East Africans in Sweden have a high risk for type 1 diabetes. Diabetes Care,. 35(3): p. 597-598. National Diabetes Sevices Scheme. (2013); Available from: www.diabetesaustralia.com.au/NDSS-Content/AboutNDSS/Key-facts--figures/. Rintala, T.-M., E. Paavilainen, and P. Åstedt-Kurki, (2013) Everyday Living with Diabetes Described by Family Members of Adult People with Type 1 Diabetes. International Journal of Family Medicine Sanou, D., et al., (2014), Acculturation and nutritional health of immigrants in Canada: a scoping review. Journal of Immigrant and Minority Health. 16(1): p. 24-34.

Sadie Geraghty is coordinator of Master of Midwifery Practice at the Edith Cowan University, Perth, WA Sara Bayes is senior lecturer and Associate Head of School at the Edith Cowan University Perth, WA Annette Hart is a consultant diabetes clinical nurse and nurse practitioner candidate at the Princess Margaret Hospital, Perth, WA

June 2015 Volume 22, No.11 39

Clinical update

Amateur theatre and mental health services – a fruitful collaboration to enhance clinical supervision By Dr Derith M. Harris As a means of enhancing clinical practice, collaboration between an amateur theatre company and four large mental health services was undertaken to develop a course for mental health clinicians in clinical supervision. The aim of course was to teach the skills required to become a competent clinical supervisor as well as maximise the use of clinical supervision within the workforce. A number of educational modalities were utilised to promote the development of knowledge and problem solving skills including small group work, large group discussion, and the strategic use of filmed vignettes. Strategies were used that engaged participants in dealing with the issues that are encountered in clinical 40 June 2015 Volume 22, No.11

supervision such as the ethical issues confronted by both the supervisee and supervisor. By far the most innovative and effective strategy employed was the use of the actors from the local theatre company who were able to highlight the complex nature of human relationships as they may be found in the clinical supervision relationship. The course would not have been able to provide such a high level of reality and confrontation as was achieved without this innovation. This paper will describe the process and stages that were discovered in the development of the course including the journey of writing, coaching the actors and making the vignettes that challenged participants beyond what was expected. anmf.org.au

Clinical update The use of filmed vignettes in an academic course is not new (Chau et al. 2001, Freshwater 2001, Fall 2004, and Cutcliffe et al. 2011). Most healthcare professionals will have participated in courses, and grimace at the experience of yet another outdated badly dressed protagonist with a broad accent from the US or UK. However the idea of using vignettes to demonstrate and develop skills is valuable as it adds interest and variety to teaching modalities. Therefore when the idea for incorporating filmed vignettes into a new course on clinical supervision for mental health clinicians was suggested, discussion centred on how the process could be improved to ensure clinical relevance and interest.

Background The author of this paper worked in a large metropolitan health service in Melbourne with over 13,000 staff who worked at more than 40 sites within the health service. It was the largest metropolitan health service in Victoria providing specialist services to greater Melbourne, regional Victoria and interstate in such specialties as adolescent mental health, eating disorders, early psychosis and autism, and has extensive links with universities. The main mental health programs were child and adolescent, adult acute, community based services, and aged mental health services. The mental health service operated within a cluster of other mental health services to maximise the use of its educators and senior clinicians to capitalise on each other’s particular area of skill. The ‘cluster’ met regularly to discuss, plan and provide professional development to all clinicians.

Beginning the project The project brief was to develop a course for mental health clinicians that would encourage and equip all disciplines to be providers of clinical supervision. Clinical supervision refers to a formal, structured process of professional support, learning and reflective practice that aims to provide a form of professional development for clinical staff and improve patient care (Cutcliffe et al. 2011). The course used a number of educational modalities including small group work, large group discussions, and the strategic use of filmed vignettes to promote the development of knowledge and problem solving skills. This last modality proved to have many unexpected benefits stemming from the collaboration between Beaumaris Theatre and the mental health services. To make it more relevant and challenging for participants it was decided anmf.org.au

THE PROJECT BRIEF WAS TO DEVELOP A COURSE FOR MENTAL HEALTH CLINICIANS THAT WOULD ENCOURAGE AND EQUIP ALL DISCIPLINES TO BE PROVIDERS OF CLINICAL SUPERVISION.

to include some ‘real life drama’. Clinical educators met and identified some of the problematic and frequently encountered issues that arose in clinical supervision. A request was sent out to the ‘cluster’ to write scripts for vignettes about clinical supervision issues. Many of the subjects identified by the group were the subtle challenges and ethical issues that are often experienced in providing supervision. The topics dealt with were: • The disengaged supervisor; • the conflict in the role of supervisor – clinician in supervision; • demonstrating good clinical supervision and what it might look like; • a breach of confidentially re Facebook; • a role conflict between manager and supervisor; • engaging the supervisee; • reporting the supervisor’s unprofessional behaviour. The scripts received were reviewed by senior clinicians of all disciplines. It was obvious that the scripts needed to be far more prescriptive and precise than had originally been anticipated. The writers (educators) had to develop their script writing skills and the finished work needed

to read like a literary play. However, the easiest and most effective way of undertaking this task they found was to role-play the scenario in private between the two authors and make an audiotape of the dialogue. They then transcribed the scenario verbatim and added some nonverbal language cues or stage directions. They also expanded the characters and gave them more depth. Until this point, they had not been described as ‘people’ but emerged as such when role-playing. So educators and senior clinicians examined each scenario accentuated some aspects of the characters to make them individuals with different traits and personalities. At times it was felt that the characters were exaggerated and needed to be less dramatic. However, from an educational point of view, some theorists of problembased learning point out those students need to trip over the clues in order to get the meaning of the scenario or problem (Koh et al. 2008, Wood 2003). Therefore, these were left in as a hurdle. Later feedback was that it was not as exaggerated as first thought.

Bringing the scripts to life A group of actors were recruited through the theatre database. Approximately 10 June 2015 Volume 22, No.11 41

Clinical update

THE ACTORS CONTRIBUTED BY BRINGING EACH ROLE TO LIFE. THEY TOOK DESCRIPTIONS OF CHARACTERS AND GAVE THEM BELIEVABLE HUMAN FEATURES. THESE ARE THINGS THAT HEALTH EDUCATORS ARE NOT SKILLED AT DOING.

replies were received and selected by a cluster member with experience in amateur theatre. When scripts were finalised a meeting with the actors was held to go over the process of what was to be expected of them, eg. number of rehearsals required, necessity of learning the scripts and not adlibbing. The background to the project was discussed; what is clinical supervision, why a course is necessary, where the vignettes fit. Thought had been given to matching each actor with a particular part. After the first read through of the scripts it was clear that there was no need to change roles.

The rehearsals Three rehearsals were held in which all vignettes were played out. The actors were also encouraged to rehearse in their groups in between formal rehearsals. As each scenario was written for two people, three to four groups could rehearse at the same time. The authors of the course went from group to group, clarifying clinical questions, providing more background information so that the actors had a better understanding of the material they were presenting, and giving direction. The rehearsals quickly became workshops – the scripts had been written by people with clinical knowledge but no expertise in scriptwriting and no idea of how to act. The experienced actors had a good idea of what would work and what would not, so they were able to work with the material presented and change it 42 June 2015 Volume 22, No.11

to convey issues effectively. One example of this process was a very short script in which the message was clear to the writers but not to the actors. The meaning emerged as the actors tried to bring it life, but they were confused about what they needed to accentuate because the script was unclear. Despite further rewrites the script was still unclear and as a result it was merged with other topics to make one coherent piece. It became apparent that it was valuable to have several messages within each scenario. The scenarios brought out many different points so participants could choose that which was most relevant to them. The scenarios were designed for the classroom but initially came out of clinicians’ personal experiences. As might be expected it tapped into the writers’ (clinicians) memories of some serious and sensitive issues and incidents involving clinical work and clinical supervision. It was also identified that for better engagement of the students it was necessary to include some level of humour and entertainment in the scenarios rather than sole clinical material. What they all realised was the clinicians/ supervisors were very sensitive to the work because it had personal meaning for them, but by adding humour and drama it is made more watchable and more conducive to learning. This was an essential part of the learning process for the writers and it was where the collaboration between the knowledge of the mental health clinicians

and the craft of the actors was most important to the success of the project. One of the benefits of the authors being from different disciplines (one an occupational therapist and the other a credentialed mental health nurse) was that it ensured a multidisciplinary approach. A study by Nango and Tanaka (2010) showed that problem based learning within multidisciplinary groups enhances a number of important clinical issues including decision-making. These findings were supported by other studies such as Parpara et al. (2010) who found that different disciplines have different learning styles as a result of their different views of the world. There is mutual benefit in sharing these views with other disciplines. It was felt that the course must appeal to all disciplines and be clinically relevant. The authors of the course and this paper are active mental health clinicians. While the course was always planned to be multidisciplinary, often the dominant discipline’s approach (nursing) tends to come through more strongly. Unfortunately courses then often lose their appeal to other disciplines.

The benefits of actors Another benefit of using actors rather than role-play by clinicians was the demonstration of reality. One of the most effective strategies was the actor’s ability to express human feelings nonverbally. The actors’ skills enabled the vignettes’ anmf.org.au

Clinical update to highlight the complex nature of human relationships as they may be found in the clinical supervision relationship. This was one of the most important aspects to bring into the classroom for meaningful discussion on issues such as intimidation, bullying and confidentiality. The filmed vignettes would not have been able to provide such a high level of reality and challenge as was achieved without this innovation. The themes brought out for discussion included: • confidentiality; • the power play between workers; • differences in expectations and ideas of the purpose of clinical supervision; • awkward office politics; • the interplay of being a clinician, a clinical supervisor and being a colleague; • conflict between the manager’s and supervisor ideas of professional clinical supervision. The actors contributed by bringing each role to life. They took descriptions of characters and gave them believable human features. These are things that health educators are not skilled at doing. Therefore, in one example of a nurse who is in conflict with himself over his choice of career, the audience actually meet a human being who was anxious, angry and disappointed in his profession and at a crossroad ethically over reporting his colleague over a serious misdemeanour. What we see in his face is his personal torment, and the clinical supervisor responding to his emotional state more than his spoken word. During the final rehearsal, by which time no scripts were permitted, each group played out their scenario and were given immediate feedback from a clinical and a theatrical perspective. An unexpected benefit was in educating the actors about mental illness and stigma. None of them had experience in this area prior to the workshops and they found it very useful and educational.

The filming The filming was done in a community mental health clinic, with the rooms arranged to depict offices - minimal resources were available. An audio-visual technician with one video camera on a tripod filmed all seven scenarios in one day. For each new scenario, the same room was rearranged by one of the actors with expertise in set design to look as if it was somewhere different. The actors had one anmf.org.au

last rehearsal, and then each scene was filmed. The actors then viewed the result, discussed what could be improved with the director, and the scene was filmed again.

Developing the training A train the trainer model was utilised. It was designed to be run over two days by a group of educators. The course aimed to have independent sections so that any section of the course could be run by any educator and in that way overcoming obstacles if an educator became ill in the future. Each trainer was allocated one section and initially practiced without an audience. Each trainer then took a section at a time and became very familiar with it. It was felt necessary that trainers needed to have ownership of their topics and be able to embellish or highlight the parts that they felt should be brought out. A teaching guide was developed that identified areas that must be covered and other areas that may be covered. It also gave them licence when running a course multiple times to change the emphasis according to the audience and their needs. They were encouraged to make changes to the first draft of the curriculum that might put their stamp to it so they felt ownership of the course.

Pilot The draft course was run to a selected group of senior clinicians. The audience was selected from the heads of departments in the mental health program, senior educators, and those with significant experience in clinical supervision. The idea was that they be an expert panel rather than typical course participants. Four newly qualified clinicians who had an interest in clinical supervision but little experience were also included to ensure that the material could be understood by people with limited knowledge or expertise. Many methods of providing feedback were encouraged, such as anonymous evaluation forms at the end of the workshop, invitations to contact the trainers with further ideas, and focus group sessions on the final day that was run by an independent person. This was to establish that the course was worthy of the time and financial investment of health services.

Feedback The feedback was extremely positive. Both authors were part of the pilot and delighted watching the audience become engrossed in the scenarios. The trainers were thrilled in seeing the level of discussion that the scenarios provided. The audience reflected

that the situations depicted were very real and very challenging. They felt that it brought the topics to life. They felt that the scenarios provided great stimulation to topics that they had not discussed before and probably would not have brought up otherwise, eg. corridor talk, reporting colleagues within a classroom setting. We felt that one of the strengths to arise from the course was the increased communication between the cast, the AV technician and the authors. The course has now run three times in the last 12 months to about 60 clinicians and each time has received excellent feedback. In general this project is considered to be a great success. It is expected that there will be ongoing collaborations of this nature as the authors move on in their careers. This article was written with the assistance of Janine Chugg, a senior occupational therapist and past president of Beaumaris Theatre Company. Her enthusiasm for the project and indeed life has not been forgotten with her passing. In loving memory of a true and wonderful friend. References: Chau, J. , Chang, A. , Lee, I. , Ip, W. , Lee, D. and Wootton, Y. (2001), Effects of using videotaped vignettes on enhancing students’ critical thinking ability in a baccalaureate nursing programme. Journal of Advanced Nursing, 36: 112–119. Doi: 10.1046/j.13652648.2001.01948.x Cutcliffe, J.R., Hyrkas, K., & Fowler, J (2011) Routledge Handbook of Clinical Supervision: Fundamental International Themes. New York: Routlegde books Fall, M. (2004) In Sutton Jr., J. (2004) Clinical supervision: A handbook for practitioners. Auckland, New Zealand: Pearson Education Freshwater, D. (2001) Clinical supervision as an emancipator process: avoiding inappropriate intent. Journal of Advanced Nursing, 32, 5, p 1298–1306, DOI: 10.1046/j.1365-2648.2000.01600.x Koh, G. , Khoo, M ., Wong, H. and Koh, D. ( 2008 ) The effects of problem-based learning during medical school on physician competency: a systematic review CMAJ January, 2008 178:34-41; doi:10.1503/cmaj.070565 Nango, E. and Tanaka, Y. (2010) Problem-based learning in a multidisciplinary group enhances clinical decision making by medical students: a randomized controlled trial. Journal of Medical and Dental Sciences, Mar; 57(1):109-18. Parpala, A., Lindblom-Yl, A., Komulainen, E., Litmanen, T. and Hirsto, L. (2010), Students’ approaches to learning and their experiences of the teaching–learning environment in different disciplines. British Journal of Educational Psychology, 80: 269–282. Wood, D (2003) Problem based learning. BMJ 2003; 326 – 328. Doi: 10.1136/bmj.326.- 328

Dr Derith M Harris RN, PhD, CMHN, MEd, BEd, FACMHN, MRCNA is a senior Lecturer at the University of Tasmania June 2015 Volume 22, No.11 43

Focus – Midwifery/Maternal health Midwives were sent Pre-ETOS and SES questionnaires electronically four to six weeks prior to the program. On the last day of the program, midwives completed the scales again along with a questionnaire related to the program modules. Seventyeight midwives completed the pre and post ETOS and SES. The results showed that after the program, the mean post score for ETOS had increased by 4.39 and the mean post score for SES by 2.83. Despite the minimum increment in the post-test scores, they were in a positive direction. In addition, midwives who completed the program have significantly increased their perceived level of knowledge in PMH conditions. The program has the potential to increase midwives’ perceived optimism, self-efficacy and knowledge demonstrating the positive impact of the education package. References Jones, I. 2008. Perinatal psychiatry. Medicine. 36:459-462.

Evaluation of an advanced perinatal mental health program for midwives

By Rosalind Lau, Kay McCauley, Cheryl Moss, Maureen Miles and Wendy Cross Perinatal mental health refers to the emotional wellbeing of women during antenatal and postnatal periods. Women in the perinatal periods are vulnerable to a range of mental health conditions including depression, anxiety disorders, eating disorders, substance abuse (Jones 2008), and the most common being depression. Perinatal mental health (PMH) conditions have negative consequences for women, their children and their families. It is important for midwives to have the skills and abilities to screen women for PMH conditions, especially for depression. In 2012 the Department of Health Victoria tendered a project to prepare and deliver an Advanced Perinatal Mental Health Education program to assist maternity services across Victoria in implementing a consistent approach to routine depression 44 June 2015 Volume 22, No.11

THE ETOS IS A SELF-REPORT QUESTIONNAIRE DESIGNED TO MEASURE THE CLINICIANS’ LEVEL OF OPTIMISM RELATED TO THE PERCEIVED EFFECT OF THEIR INTERACTIONS WITH THEIR CLIENTS screening of perinatal women. The study evaluates the impact of an advanced PMH program (six modules, three days) on increasing midwives’ self-efficacy, optimism and their knowledge to work with women with PMH conditions in Victoria. Midwives who attended the program completed the Elsom Therapeutic Optimism Scale (ETOS) and Self-Efficacy Scale (SES) ‘mental health nursing’. The ETOS is a selfreport questionnaire designed to measure the clinicians’ level of optimism related to the perceived effect of their interactions with their clients (Elsom & McCauley-Elsom 2008). The SES adapted from the General Self-Efficacy Scale (Sherer et al, 1982) is designed to assess self-beliefs in coping with a variety of hassles in life (Sherer et al. 1982).

Elsom, S. & McCauley-Elsom, K. 2008. Measuring therapeutic optimism. Paper presented at the Australasian Society for Psychiatric Research, Newcastle, Australia. Sherer, M., Maddux, J., Mercandante B., et al. 1982. The self-efficacy scale: Construction and validation. Psychological Reports. 51:663-671. Acknowledgments The authors would like to acknowledge the contribution of Professor Louise Newman and Associate Professor Jakqui Barnfield in the development of the education program. The study was funded by Department of Health Victoria, Australia.

Dr Rosalind Lau is a Research Fellow in the School of Nursing & Midwifery at Monash University, Clayton Campus in Victoria Dr Kay McCauley is a Senior Lecturer in the School of Nursing and Midwifery at Monash University, Peninsula Campus in Victoria Associate Professor Cheryle Moss is Director of Practice Development, Deputy Director JBI Centre for Chronic Disease Management (Monash University), Monash Nursing Academy, School of Nursing & Midwifery, Monash University, Clayton Campus in Victoria Dr Maureen Miles is a Lecturer in the School of Nursing and Midwifery at Deakin University, Melbourne Campus in Victoria Professor Wendy Cross is Head, School of Nursing and Midwifery at Monash University, Clayton Campus in Victoria anmf.org.au

Focus – Midwifery/Maternal health

International midwifery focus on Bali, Indonesia By Virginia Skinner

A recent innovative project between Charles Darwin University (CDU) and Polytechnik and Kardini University, Denpasar has enhanced collaboration and collegiality between both academics and midwifery students in both countries. International collaborations have been duly noted by universities as a way of connecting both staff and students from different backgrounds (Spencer-Oatey, 2012). This relationship commenced with an invitation to present at an International Conference in Denpasar in July 2014 on the development of midwifery services in Australia. Memorandum of Understandings (MOU’s) were initiated to promote and encourage joint research projects of mutual interest, sharing of experiences between student midwives and organisation of midwifery focused seminars to promote evidence-based practice. Recently, Australian Nursing and Midwifery Accreditation Council (ANMAC, 2013) published new standards that anmf.org.au

include clinical hours internationally being counted towards the Australian Bachelor of Midwifery curriculum for midwifery students. This international connectivity is a perfect opportunity to commence this journey. Late last year in 2014, as an academic, I returned to Bali to reconnect with my colleagues there. This visit involved a remote community antenatal clinic mainly conducted by midwifery students from Poytechnik, Denpasar. I communicated the benefit of this experience to my Indonesian colleagues for midwifery students in Australia. Achieving mutual understanding is at times difficult (Spencer-Oatey, 2012) as I cannot speak Indonesian, albeit, my Indonesian colleagues speak good English. In February, 2015, I coordinated an Indonesian trip that included five CDU midwifery students and two of my own colleagues as we were invited to present at an International seminar at the Kardini Akademie, Denpasar. The first day after arriving, Bali celebrated a public holiday for Chinese New Year and our colleagues from Polytechnik accompanied us to the Uluwatu temple that was a culturally rich enhancing experience and provided an opportunity for our CDU midwifery students to meet the Indonesian students. The following day we visited a remote community village approximately two hours from Denpasar for a maternal child and family health clinic named Antiga Village at Karangasem. Women and children were provided education by both the student midwives, lecturers and midwives and this experience enabled our CDU midwifery students to mingle and speak English with the Balinese

RIGHT: Ready for a cultural experience L to R – Cherie Thomas, Virginia Skinner, Karen Stark, Cynthia Riris (Polytechnik), Heidi Jones, Sumiasi (Polytechnik), Angela Bull, Rhylee Mathias, Bee Nagle and Freya Martin LEFT: Conference presentation Virginia Skinner, Angela Bull and Karen Stark

students. The most startling discovery by CDU midwifery students included knowledge that Indonesian midwifery students had never witnessed a caesarean section and that Indonesian women do not require much analgesia. We toured Sanglah hospital maternity unit (720 beds in comparison to Royal Darwin Hospital of 360 beds) that included the birthing suite, postnatal ward and the special care nursery where triplets had recently been born. The following day the three of us presented at a midwifery seminar for 300 student midwives, lecturers and midwives. A truly amazing experience! References Australian Nursing and Midwifery Accreditation Council, Standards and Criteria for the Accreditation of Nursing and Midwifery Courses Leading to Registration, Enrolment, Endorsement and Authorisation in Australia, accessed at www.anmac.org.au/accreditation-standards on 23 January 2013. Spencer-Oatey, H., (2012). Maximizing the Benefits of International Education Collaborations: Managing Interaction Processes, Journal of Studies in International Education, 17(3), 244-261.

Dr Virginia Skinner is a Senior Lecturer and Course Coordinator in Midwifery in the Engineering Health Science & Environment, School of Health at CDU in the Northern Territory June 2015 Volume 22, No.11 45

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Focus – Midwifery/Maternal health

Angela Marie Kucia

Takotsubo (stress) Cardiomyopathy: a possible cause of acute heart failure in birthing Peripartum cardiomyopathy is a rare and clinically variable condition that may in some cases actually be Takotsubo Cardiomyopathy (TCM), also known as ‘stress cardiomyopathy’. The pathophysiology of TCM is not well understood, but around two thirds of cases are associated with an acute emotional or physical stressor that triggers the condition (Neil et al., 2012). TCM is associated with characteristic changes in the shape of the left ventricle that temporarily impairs the heart’s ability to pump properly. While TCM is most commonly seen in postmenopausal females, several recently published reports have described TCM in pregnancy, particularly during and soon after birthing, which seems to be a particularly vulnerable time for the development of TCM-related heart failure, probably due to the expanded maternal blood volume, physical and emotional stressors during birthing, and interventions that can cause haemodynamic changes such as spinal anaesthesia, caesarean delivery, and administration of vasoactive medications, including uterotonics (Kucia, Arstall & Dekker, 2015). Currently there are very few reported cases of peripartum TCM – perhaps in part because it is a relatively rare condition, but most certainly it is under-recognised. In cases reported to date, TCM most commonly occurs in women with caesarean delivery. High risk features that appear to be more prevalent in the TCM population anmf.org.au

compared with a general population of pregnant women are older age; multiple gestations; and preterm labour. Peripartum haemorrhage appears to be a common feature seen in around 25% of reported cases. Other less frequent complications included preeclampsia and HELLP Syndrome (Kucia, Arstall & Dekker, 2015). Recognising TCM in the early stages can be difficult: the presenting symptoms are the same as those for acute coronary syndrome, including chest pain and dyspnoea. The 12-lead electrocardiogram (ECG) may not be initially diagnostic but serial ECGs should be collected at least daily in the first 48 hours (Kucia et al, 2010). Serum cardiac troponins (biomarkers indicating myonecrosis) are usually elevated 3-6 hours after symptom onset, and should be collected at symptom onset and repeated 6-8 hours later. Serum NT-proBNP, a marker of heart failure, is elevated in TCM (Nguyen et al, 2011). NT-proBNP should be collected at symptom onset and repeated 12-24 hours later. Coronary angiography is rarely performed during pregnancy as the likelihood of obstructive coronary artery disease requiring intervention is low. The key to diagnosis of peripartum TCM most likely lies with cardiology involvement and prompt echocardiography if TCM is a possibility. Once TCM is identified, appropriate supportive care with cardiology input can be initiated, including avoidance of vasopressors and inotropes where possible, which may be counterproductive and possibly harmful. From published cases

to date, it would seem that women with pregnancy-related TCM generally make a full recovery; however, they are often critically ill for a period of time. As TCM is currently rarely recognised in pregnancy, we need to consider the possibility that there may be a link between TCM and unexplained cases of heart failure and death. Systematic and collaborative collection of data is required to get a better sense of the prevalence of this condition – it may not be as rare as we think. References Kucia AM, Neil C, Nguyen T, Beltrame J, Arstall M, (2010), Horowitz J. Evolution of ECG changes in tako tsubo cardiomyopathy: Arrhythmias first, QT prolongation later? Heart, Lung and Circulation; 19:S104. Kucia, A.M., Dekker, G., & Arstall, M. (2015). Peripartum Takotsubo Cardiomyopathy. Journal of the American College of Cardiology, 65 (10_S). Neil, C.J., Nguyen, T.H., Sverdlov, A.L., Chirkov, Y.Y., Chong, C., Stansborough, J., et al. (2012). Can we make sense of takotsubo cardiomyopathy? An update on pathogenesis, diagnosis and natural history. Expert Review of Cardiovascular Therapy, 10(2), 215-221. Nguyen, T.H., Neil, C.J., Sverdlov, A.L., Mahadavan, G., Chirkov, .Y.Y., Kucia, A.M., et al. (2011). N-terminal pro-brain natriuretic protein levels in takotsubo cardiomyopathy. The American Journal of Cardiology, 108(9), 1316-1321.

Dr Angela Marie Kucia is a Senior Lecturer in the School of Nursing and Midwifery at the University of South Australia, and clinical practice consultant in the Department of Cardiology at Lyell McEwin Hospital, Adelaide, South Australia June 2015 Volume 22, No.11 47

Focus – Midwifery/Maternal health Contemporary midwifery education focussing on maternal emergency skills in remote and isolated areas By Glenda Gleeson

Midwives working in isolation in remote and rural health services in Australia see it critical to maintain contemporary practice as midwives. The Midwifery Upskilling (MIDUS) Program fulfils this requirement, as it is designed to improve the knowledge and skills of remote and isolated midwives.

Learning to manage a “Shoulder Dystocia” Midwives Leanne Walters (kneeling) and Helen Priest (red shirt) teaching for CRANAplus

Pregnant women in remote and rural Australia need to travel long distances to regional health services for birth and for specialist care during their pregnancy. Midwives working in these remote environments are required to attend unplanned and emergency maternal situations, such as preparation for stabilising the unwell mother and their newborn to prepare for evacuation to a referral hospital. The MIDUS program offered by CRANAplus is unique in its delivery, specifically tailored to the needs of remote and isolated midwives across Australia. With the aim to provide culturally safe

PREGNANT WOMEN IN REMOTE AND RURAL AUSTRALIA NEED TO TRAVEL LONG DISTANCES TO REGIONAL HEALTH SERVICES FOR BIRTH AND FOR SPECIALIST CARE DURING THEIR PREGNANCY.

and evidence based maternity care, which informs and guides reflective practice and ‘hands on’ clinical skill station activities. At the completion of the MIDUS program midwives have expressed that they have an increased ability to deal with emergency situations and have clearer steps to manage complications during the pregnancy and peri partum period. The MIDUS program focuses on the integration of latest evidence into antenatal care complications, managing emergencies, the importance of cultural safety as well as providing the opportunity for professional collegiality. Glenda Gleeson, CRANAplus Coordinator MIDUS/MEC courses

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Focus – Midwifery/Maternal health Exploring perinatal needs of incarcerated women and their children: role of midwives By Kay McCauley, Lin Zhao and Virginia Dods

The impact of the prison environment on incarcerated mothers and their prison born, and/or raised children has become an increasingly prominent criminal justice and healthcare concern in Australia. The Mother-Child program, an alternative program established three decades ago, has functioned as an alternative to allow young children to stay with their imprisoned mother and is currently available as an option for women in two women’s prisons in Victoria, Dame Phyllis Frost and Tarrengower. Maternal Child Health Nurses (MCHNs) have served as focal points in providing the necessary level of parental guidance and maternal care to incarcerated women. Despite the Mother Child Program’s offering significant cost savings to the individuals, families and communities, there is very limited research available in support of such programs on motherhood, family bond and

psychosocial development of mothers and children; and no public data available in Victoria in regard to children raised in prison. A project was aimed filling the knowledge gap. This was done by interviewing maternal and child health nurses in regard to the historical perspectives and their experiences of working with women who have children with them across two correctional facilities. It is aimed to also perform a retrospective review of existing MCH health records of those who participated in the Mother and Child Program in Victoria. Of interest is the physical and developmental wellbeing of the children, and the provision of the background to the mother child in prison programs in Victoria, which will contribute to the development of further research in this area. Findings from such studies will enable the development of policies and

programs by government departments, such as the Justice and Correctional System, the Commission for Children and Young People, as well as enhanced maternal child health services and ultimately to positive outcomes for the mothers and their children. Dr Kay McCauley works at the School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria Lin Zhao, works in the School of Nursing and Midwifery, Peninsula Campus, Faculty of Medicine, Nursing and Health, Monash University, Victoria Virginia Dods, PhD, Senior Policy Advisor, Commission for Children and Young People

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Focus – Midwifery/Maternal health

2014 graduate midwives and midwifery educators at Western Health

Graduate midwives making a difference By Cate Nagle and Elizabeth Collis

This article presents select results from the 2014 graduate year midwifery program projects at Western Health and the significance of these findings in improving the quality and safety of pregnancy care. The projects were developed to align with Western Health’s strategic focus and ‘best care’ framework and the National Safety and Quality Health Service Standards (ACSQHC, 2011). Descriptive approaches were undertaken to assess women’s experience of care with a particular focus on the coordination and continuity of pregnancy care using 2013/14 data. Midwives were self-selected to work in groups on these projects, which were identified by managers. Project 1: A review of birthing women that were at low risk of complications records 50 June 2015 Volume 22, No.11

revealed 61% women received midwife-led care and 55% women saw ≥four different midwives. Project 2: A review of records of women booking for pregnancy care with a body mass index (BMI) >35 revealed that 24% women saw the same midwife for ≥four consultations and 7% saw the same doctor; 46% women saw ≥four different midwives and 20% saw ≥four different doctors; 13% women saw ≥10 different clinicians. In this high risk group, 23% did not see a doctor in pregnancy. Project 3: Women who experienced complications in pregnancy were surveyed. Overall women’s experience of care was positive; 61% described that midwives and doctors were ‘always’ sensitive and understanding and 60% responded that their worries, anxieties or concerns were ‘always’ taken seriously. However, 31% never saw the same midwife and 21% never saw the same doctor. Waiting >30 minutes in clinic was a common experience; women experienced midwifery and medical appointments as rushed (36% and 52% respectively). These projects have provided valuable insights and findings have informed the implementation of clinical pathways.

Project 4: An electronic survey of midwives’ care of women with decreased fetal movements (DFM) obtained a 53% response rate (n=78). There was considerable variation regarding the definition of DFM and the advice provided to women. Midwives described establishing what is the normal pattern of fetal movements for the woman as part of their assessment (n=13), numerous timeframes were used to measure movements. Advice reported was inconsistent with best practice including to drink cold liquid (n= 23), and the use of a kick-chart (n=32). This project will inform educational activities and has increased awareness of best practice for DFM. Reference Australian Commission on Safety and Quality in healthcare, National Safety and Quality Health Service Standards www.safetyandquality.gov.au/ accessed 7 April 2015

Cate Nagle is an Associate Professor at Deakin University, Geelong Waterfront Campus and Sunshine Hospital, Women’s and Children’s Division, Western Health, Victoria Elizabeth Collis is a Coordinator Women’s and Children’s Education, Sunshine Hospital, Western Health, Victoria anmf.org.au

Focus – Midwifery/Maternal health

By Vanessa Watkins

Collaboration in maternity care: are we missing the point? In recent years demand has increased for multi-professional collaboration in maternity care in Australia (AHMAC 2008; Improving Maternity Services in Australia: The Report of the Maternity Services Review, 2009). Internationally, failures in collaboration, communication and teamwork regularly feature in reports into adverse outcomes and confidential enquiries into maternal and neonatal deaths (Lewis 2007; Knight et al. 2014; Lennox and Marr 2014; Simpson and Lyndon 2009; Hastie and Fahy 2011; CMACE 2011; Kirkup, 2015). So, what is going wrong? Why are the same recommendations made repeatedly with seemingly little impact or real change? The answer is not clear, but a deeper understanding of the key elements of collaboration may assist in the quest to achieve effective multi-professional collaboration in maternity care. The concept of ‘collaboration’ is complex and poorly understood in maternity care in Australia (McIntyre, Francis, and Chapman, 2012; Schmied et al. 2010; Psaila and Schmied, 2011). A review of the literature shows: • Maternity care is largely medically

dominated (Reiger and Lane 2009; Lane, 2005) • Collaborative maternity models predominantly reflect initiatives to move services from ‘coexistence’ to models of ‘cooperation and coordination’ (Schmied et al., 2010) • In practice the term ‘collaboration’ is used synonymously with related terms like ‘cooperation’ or teamwork’, or to assume authority over midwifery (Downe, Finlayson, and Fleming, 2010) • Scope of practice boundaries and philosophical differences between anmf.org.au

maternity care professionals cause conflict and tension (Lane, 2012; Newnham, 2010; Downe, Finlayson and Fleming, 2010) • Maternity care is sometimes experienced as ‘fragmented’ or ‘disjointed’, with women receiving conflicting advice (Improving Maternity Services in Australia: The Report of the Maternity Services Review, 2009). • Poor collaboration, communication and delays in escalation of care can decrease the quality, safety and experience of maternity care (Downe, Finlayson and Fleming, 2010; NHMRC, 2010; Cantwell et al., 2011) Wood and Grey (1991) propose the following definition: ‘Collaboration occurs when a group of autonomous stakeholders of a problem domain engage in an interactive process, using shared rules, norms, and structures, to act or decide on issues related to that domain’ (Wood and Gray, 1991), and suggest that collaboration can be promoted by exploring the following domains: • Why the collaboration was convened

and what is it aiming to achieve? • the implications of collaboration

for either control or mitigation of complexity and risk; • identification of the stakeholders in the proposed alliance; • the relationship between self-interests and the collective interests of the stakeholders. So with this in mind, we can ask: Who are the stakeholders for collaboration in maternity care? Do all stakeholders achieve equal autonomy? Which rules, norms, and structures should stakeholders refer to? Are consumers included as a stakeholder in the collaborative alliance, or are they the passive recipients of care determined by the actions and decisions made by healthcare professionals? Does a shared decision making approach hold the key? I propose that attempts to promote effective collaboration in maternity care are futile until further research into the key elements of collaboration is undertaken, and a shared understanding of collaboration is achieved across all stakeholder groups. References AHMAC., (2008). Primary Maternity Services in Australia- A Framework for Implementation. Sydney: NSW Department of Health. Centre for Maternal and Child Enquiries (CMACE)., (2011). Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer: 2006–2008. BJOG: An International Journal of Obstetrics & Gynaecology 118:1-203.

Downe, S., Finlayson, K., and Fleming, A., (2010). Creating a Collaborative Culture in Maternity Care. Journal of Midwifery & Women’s Health 55 (3):250-254. Hastie, C. and Fahy, K., (2011). Inter-professional collaboration in delivery suite: a qualitative study. Women And Birth: Journal Of The Australian College Of Midwives 24 (2):72-79. Improving Maternity Services in Australia: The Report of the Maternity Services Review., (2009). edited by R. Bryant. Canberra: Department of Health and Ageing. Kirkup, B., (2015). The Report of the Morecambe Bay Investigation. https://www.gov.uk/government/ publications/morecambe-bay-investigation-report, accessed 1 April 2015 Knight, M., Kenyon, S., Brocklehurst, P., Neilson, J., Shakepeare, J., and Kurinczuk, J., (2014). Saving Lives, Improving Mothers’ Care- Lessons learned to inform future maternity care from the UK and Ireland Confidential Enquires into Maternal Deaths and Morbidity 2009-2012, ed MBRRACE-UK. Oxford: National Perinatal Epidemiology Unit, University of Oxford (accessed 15 December 2014). Lane, K., (2012). When is collaboration not collaboration? When it’s militarized. Women and Birth 25 (1):29-38. Lane, K., (2005). Still suffering from the ‘silo effect’: lingering cultural barriers to collaborative care Canadian Journal of Midwifery Research and Practice 4 (1):8-16. Lennox, C., and Marr, L., (2014). Scottish Confidential Audit of Severe Maternal Morbidity. edited by R. H. Program: Healthcare Improvement Scotland. Lewis, G., (2007). The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers’ Lives: reviewing maternal deaths to make motherhood safer2003-2005. The Seventh Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. edited by CEMACH. London. McIntyre, M., Francis, K., and Chapman, Y., (2012). The struggle for contested boundaries in the move to collaborative care teams in Australian maternity care. Midwifery 28 (3):298-305. Newnham, E., (2010). General section: midwifery directions: the Australian maternity services review. Health Sociology Review 19 (2):245-259. NHMRC., (2010). National Guidance on Collaborative Maternity Care. Canberra: NHMRC (National Health and Medical Research Council). Psaila, K., and Schmied, V., (2011). Continuity, collaboration and change: Defining roles and boundaries for future practice. Women & Birth 24:S18-9. Reiger, K., and Lane, K., (2009). Working together: collaboration between midwives and doctors in public hospitals. Australian Health Review 33 (2):315-324. Schmied, V., Mills, A,. Kruske, S., Kemp, L., Fowler, C., and Homer, C., (2010). The nature and impact of collaboration and integrated service delivery for pregnant women, children and families. Journal of Clinical Nursing 19 (2324):3516-3526. Simpson, K., and Lyndon, A., (2009). Clinical disagreements during labor and birth: how does real life compare to best practice? MCN: The American Journal of Maternal Child Nursing 34 (1):31-39. Wood, D., and Gray, B., (1991). Toward a Comprehensive Theory of Collaboration. The Journal of Applied Behavioral Science 27 (2):139-162.

Vanessa Watkins is a Clinical Midwife Consultant, Women and Children Program, Maternity Services, Eastern Health/Box Hill Hospital, Victoria June 2015 Volume 22, No.11 51

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Focus – Midwifery/Maternal health

Donna Hartz

Caseload midwifery care: promoting a healthy future for Australia By Donna Hartz and Sally Tracy

Australia has one of the highest caesarean rates in the world at 32% (Hilder et al., 2014). However this high rate has not delivered health improvements for mothers and babies. Caesareans are contributing to increased morbidity rates in Australia (Dahlen et al., 2014). The long-term effects for babies born by caesarean are increased risk of chronic diseases such as asthma and diabetes (Cho and Norman, 2013). There is also growing research into the impact of caesareans on the gene expression in neonatal stem cells (Almgren et al 2014). In short the stress of being born vaginally prepares the baby positively for a healthy life compared to a caesarean, which may not. The drivers of caesarean section are diverse and complex. In Australia two highly preventable causes of high caesarean section rates are the unintended effects associated with private health insurance (Roberts et al 2000, Tracy et al., 2014) and unexplained hospital variation (Lee et al., 2013). A beacon on the horizon to help reduce the caesarean section rate in Australia is the introduction of caseload midwifery care. Australian caseload midwifery care is a model where named midwives in a small midwifery group practice provide continuity of care throughout pregnancy, labour, birth and beyond in collaboration with obstetricians. Recent Australian research found that caseload midwifery is safe, promotes normal birth (Tracy et al., 2013, Monk et al., 2014, Tracy et al., 2014, McLachlan et al., 2012) and is cost effective (Tracy et al., 2013) for women of all risk. Aboriginal and/or Torres Strait Islander women are also benefiting from this holistic anmf.org.au

midwifery care (Homer et al 2012, Josif et al 2013). Caseload midwifery is also associated with reducing preterm birth rates (Sandall et al 2013). The successful, sustainable introduction of caseload midwifery care on a large scale can be found at The Royal (Hospital for Women) Sydney (Hartz et a.,l 2012), The Mater Mother’s Brisbane (Tracy et al., 2013) and The Women’s and Children’s Hospital Adelaide (Turnbull et al., 2009). While caseload midwifery models are being slowly introduced, these are still a token gesture by our governments and health services to most childbearing women. Wait lists for caseload care remain enormous while caesarean section is becoming the ‘norm’ for one third of all women giving birth. The solution looks obvious for a healthy tomorrow…let midwives work to their full scope of practice in continuity of care models … at least one would think so! References Almgren, M., T. Schlinzig, D. Gomez-Cabrero, A. Gunnar, M. Sundin, S. Johansson, M. Norman, and T. J. Ekstrom.,(2014). Cesarean delivery and hematopoietic stem cell epigenetics in the newborn infant: implications for future health? Am J Obstet Gynecol no. 211 (5):502. e1-8. doi: 10.1016/j.ajog.2014.05.014. Cho, C., and Norman, M.,(2013). Cesarean section and development of the immune system in the offspring. American Journal of Obstetrics and Gynecology no. 208 (4):249-254. doi: http://dx.doi.org/10.1016/j. ajog.2012.08.009. Dahlen, H. G., Tracy S., Tracy M., Bisits A.,. Brown C, and Thornton C., (2014). Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000-2008): a linked data population-based cohort study. BMJ Open no. 4 (5):e004551. doi: 10.1136/bmjopen-2013-004551. Hartz, D. L., White J., Lainchbury K. A., Gunn H., H. Jarman, A. W. Welsh, D. Challis, and S. K. Tracy. 2012. “Australian maternity reform through clinical redesign.” Aust Health Rev no. 36 (2):169-75. doi: 10.1071/ ah11012. Hilder L, Zhichao Z, Jahan S, and Chambers GM. 2014. Australia’s mothers and babies, 2012. Perinatal statistics series no. 30. Cat. no. PER 69. Canberra: AIHW. Homer,C.S.,. Foureur M.J, Allende, T., Pekin, F., Caplice, S., and Catling-Paull,C., (2012). It’s more than just having a baby’ women’s experiences of a maternity service for Australian Aboriginal and Torres Strait Islander families. Midwifery no. 28 (4):E449-55. doi: 10.1016/j.midw.2011.06.004. Josif, C. M., Barclay, L., Kruske, S., and Kildea, S., (2013).’No more strangers’: Investigating the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling aboriginal women in northern Australia. Midwifery. doi: 10.1016/j.midw.2013.03.012. Lewe,Y.Y., Roberts C. L., Patterson, J.A.,Simpson,J.M., Nicholl,M.C.,Morris, J.M.,and Ford, J.B., (2013). Unexplained variation in hospital caesarean section rates. Med J Aust no. 199 (5):348-53. McLachlan, H, Forster, D., Davey, M., Farrell,T.,

THE LONG-TERM EFFECTS FOR BABIES BORN BY CAESAREAN ARE INCREASED RISK OF CHRONIC DISEASES SUCH AS ASTHMA AND DIABETES (CHO AND NORMAN, 2013). THERE IS ALSO GROWING RESEARCH INTO THE IMPACT OF CAESAREANS ON THE GENE EXPRESSION IN NEONATAL STEM CELLS (ALMGREN ET AL 2014). Gold, L., Biro, M., Albers, L., Flood, M., Oats, J., and Waldenstrom, U., (2012). Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG no. 119:1483 - 1492. Monk, A.,Tracy, M., Foureur, M., Grigg, C., and Tracy, S., (2014). Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia. BMJ Open no. 4 (10):e006252. doi: 10.1136/bmjopen-2014-006252. Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev(8). Tracy, SK., Hartz DL.,Tracy,M., Allen,J.,Forti, A., Hall, B., White, J., Lainchbury, A., Stapleton, H., Beckmann, M., Bisits, A., Homer,C., Foureur, M., Welsh,A., and Kildea, S., (2013). Caseload midwifery care versus standard maternity care for women of any risk: M@ NGO, a randomised controlled trial. The Lancet no. 382 (9906):1723-32. doi: http://dx.doi.org/10.1016/S01406736(13)61406-3. Tracy,S., Welsh, A.,Hall, B.,Hartz,D., Lainchbury, A., Bisits, A.,White, J. and Tracy, M., (2014). Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes. BMC Pregnancy and Childbirth no. 14 (1):46. Turnbull, D.,Baghurst, P.,Collins,C.,Cornwell,C.,Nixon, A.,Donnelan-Fernandez,R. and Antoniou,G.,(2009). An evaluation of Midwifery Group Practice. Part I: clinical effectiveness. Women & Birth no. 22 (1):3-9.

Dr Donna Hartz is a Research Fellow, Poche Centre for Indigenous Health, University of Sydney in NSW Professor Sally Tracy is a Professor of Midwifery, Faculty of Nursing and Midwifery, University of Sydney, NSW June 2015 Volume 22, No.11 53

Calendar JUNE World Environment Day 5 June. www.unep.org/wed/ Lung Health Promotion Centre at The Alfred 11-12 June – Spirometry Principles & Practice 18 June – Paediatric Respiratory Update 24 June – Asthma Management Update P: (03) 9076 2382 E: lunghealth@alfred.org.au National Blood Symposium 11-12 June, Brisbane Convention and Exhibition Centre, Qld. www.safetyandquality.gov.au 18th Cancer Nurses Society of Australia Annual Winter Congress Cancer nursing: expanding the possibilities 14-16 June Perth Convention and Exhibition Centre, Western Australia. www.cnsawintercongress.com.au/ Renal Society of Australasia Conference Digging deeper: Golden opportunities to advance renal care 15-17 June Crown Convention Centre, Perth WA. http://rsaannualconference.org.au/ 16th Institute of Continuing Education (ICE) meeting (Australian College of Critical Care Nurses) Let’s Get Clinical 19-20 June, Stamford Grand Adelaide, SA. www.acccn.com.au/ events/event/ice2015-adelaide Medical Imaging Nurses Association National Conference 19-21 June, Luna Park Sydney, NSW. www.minanational.com/ International Council of Nurses (ICN) International Conference and Council of National Representatives (CNR) Global Citizen, Global Nursing 19-23 June, Seoul, Republic of Korea. www.icn2015.com/

NETWORK Alfred Hospital Melbourne, Group 2/75 40-year reunion 13 June, Royal Yacht Club of Victoria, Williamstown. Contact Fiona Williams E: fiona.williams777@gmail.com or Denise Peterson (nee Letcher), snail mail: 3 Sienna Close, Strathfieldsaye, Vic. 3551

54 June 2015 Volume 22, No.11

World Refugee Day 20 June. www.un.org/en/events/refugeeday/

www.uofriverside.com/conferences/ global-nursing-symposium/2015summer-global-nursing-symposium/

3rd International Conference on Ageing in a Foreign Land 24-26 June, Flinders University, Bedford Park, South Australia. www.flinders.edu.au/ehl/conferences/ ageing/

International Confederation of Midwives (ICM) Asia Pacific Regional Conference Midwifery care for every mother and their newborn 20-22 July, Pacifico Yokohama, Japan. www.icmaprc2015.org/en/ general_information.html

Suicide & Self-harm Prevention Conference Across the lifespan: different ages and stages 24-26 June, Cairns Convention Centre Qld. Bringing together researchers, practitioners, health workers, the “key players” within the suicide prevention sector, those within the community and anyone affected by suicide. www.kochfoundation.org.au/ 3rd Annual Worldwide Nursing Conference 29-30 June, Singapore. www.nursing-conf.org/ No 2 Bullying Conference 29-30 June, Outrigger Surfers Paradise, Gold Coast. The Conference will address Bullying Policy, Prevention and Management Strategies and will examine bullying in schools, workplaces and cyberspace. www.no2bullying.org.au

JULY Lung Health Promotion Centre at The Alfred 14 July – Educating & Presenting With Confidence 15-17 July – Asthma Educator’s Course 23-4 July – Smoking Cessation Course 30-31 July – Creative Behaviour Change Coaching For Chronic Illness P: (03) 9076 2382 E: lunghealth@alfred.org.au Summer Global Nursing Symposium Nursing Practice, Nursing Education, Nursing Management, and Disaster Management 17-18 July. Los Angeles, California, United States of America Royal Adelaide Hospital, Group 754, 40-year reunion 19 June. Contact Liz Strachan E: lizstrachan1@hotmail.com M: 0405 535 762 Prince Henry’s Hospital, 2/85 Reunion 25 July. Venue and time not yet decided. Contact Vivienne Jose E: vivvy38@hotmail.com or search Prince Henry’s Hospital Melbourne Memorial Page for further details.

5th Asia-Pacific Summit on Cancer Therapy Forum for a world without cancer 20-22 July, Brisbane, Australia. http://cancer.global-summit.com/ asia-pacific/ Perth Practice Nurse Clinical Education 25-26 July. Western Australia’s leading event for Nurses working in General Practice. Earn 12 CPD hours. www.pnce.com.au VPNG (Victorian Perioperative Nurses’ Group) State Conference Strategies for Success: Safety and Quality in Perioperative Care 30-31 July, Pullman in Albert Park, Melbourne. www.vpng.org.au

AUGUST DonateLife week 2-9 August. www.donatelife.gov.au/ donatelife-week-2015 Health Informatics Conference Driving reform: Digital health is everyone’s business 3-5 August, Brisbane Convention and Exhibition Centre, Qld. www.hisa.org.au/hic2015/ Lung Health Promotion Centre at The Alfred 7 August – Theory & Practice of Non Invasive Ventilation – Bi-Level & CPAP Management 20-21 August – Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au

Queen Victoria Hospital, Melbourne, Midwifery Group Aug 1970–1971, 45-year reunion 29 August at Glen Iris. Contact Lyn Kirby E: lynmkirby@gmail.com M: 0407320824 LaTrobe University, LaTrobe/ Bendigo Campus nursing group (1988-1991), 25-year reunion 20 February 2016, Bendigo. Contact Steven Graham E: sgraham@bendigohealth.org.au

Drug and Alcohol Nurses of Australasia’s (DANA) Annual Conference Many Faces of Addiction 13-14 August, Novotel Sydney Central, NSW. www.danaconference.com.au 12th International Family Nursing Conference Improving Family Health Globally through Research, Education, and Practice 18-21 August, The Radisson Blue Hotel, Odense, Denmark. http://internationalfamilynursing. org/2013/07/11/2015-conference/ 2015 Scientific Meeting of Flight Nurses Australia and Aeromedical Society of Australasia 19-21 August, Darwin Convention Centre. www.flightnursesaustralia. com.au/conference 25th Meeting of the International Society for Neurochemistry 23-27 August, Cairns Qld. www.neurochemistry.org/biennialmeeting.html

SEPTEMBER Australian Disease Management Association 11th Annual Conference Count me in: who cares about chronic care? 9-11 September, Brisbane Convention Centre. www.adma.org.au/ E: b.shen@alfred. org.au P: (03) 9076 4125 Lung Health Promotion Centre at The Alfred 16-18 September/14-15 October – Respiratory Course (Mod A & B) 16-18 September – Respiratory Course (Module A) P: (03) 9076 2382 E: lunghealth@alfred.org.au CATSINaM - National Professional Development Forum 22-24 September, Darwin. www.catsinam.org.au

or Sarah Shipp (nee Prudham) E: sshipp@bendigohealth.org.au or search Facebook page LaTrobe 1991 reunion

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

anmf.org.au

Mail

News News QNU fightsr they deportation afte months and of sixnurse son two,

QNU of nu fights de rse an porta d so tion n

at the age of two, six months after they arrived in Australia. The QNU rallied behind ia and ugh age of tralia. Bylearning and Karen ind Mar at the in AusBy Tyrone after Keast t thro Kare of theirMaria , pligh d beh n Ke plight through their the Minister arrived QNU rallie at the Maria’s Change.org petition ing of to the Minister, as The learn petition to Thereceived arrived age of t which has 87,000 afterThe Queensland Queen more than 87,000 in Aus two, six thanNurses’ Union (QN nge.org Tyrone Cha signatures. (QNU, more Queensland The month ANMF U, AN sland tral ived Branch) has Nurse call Tyrone QNU ralli ia. Maria’s called s afte QNU Secretary ed on MF said the has rece on the federal Beth QuMohle s’ Un r the the een said Maria’s after lear ed beh Mohle government to which es. the y ion unionsho the slan lodged show compassion w a Beth ind Ma submission fed y com with atur with d Bra to a registered and which Change ning of nurse sign Day to ast passio eral govthe ission Minister’s Secretarsubm nch office on her their ria and face Autism QNUandedher a son who deportation n toAutismern Day to ) has son World as a sign has rece .org pet ren Ke ent’s highlight World a reg ment atures. as a result concernswh res itio plight lodg ived government’s 10-year-old’s e onof the By Ka governm Union autism ult of at othe to has fac iste union autism more n to the through the offic ses’ ch) QN prejudice ’s at red when the toethe Nur diagnosis. than Min Bran dia it comes to the cts an to 10-yeadeportatio nurse union U Secreta Minister concerns 87,000 ister, developmentalgno ensland ensland ernment comes affe sis. that disability y is r-ol n affects The Ministelodged ry Beth nurse highlight when it bility that F Que The Que “It reall ut fate 230,000 Australians. d’s an estimated a Mo The ANM federal gov stered fate ofl disa dice ans. Maria r’s abo of U, Sevilla Tyro highlig “It really is office submission hle said regi trali andptio hernsson preju (QN on the ne (pic Maria tion time to to a Tyroneenta ,000 Aus the our once d Sevpreconceptions with layprec Imm challenge sion in the prejud ht concernon Wo hands developm (pictured) deportas about illa and 230 ofne calle Federal igrationture rld the d) layWho people ws, Tyro Immigration ated compaswho face autism. e our Peter to the old’ knoDutton time with developice when s at the Autism her Tyrone in theknows, estim challengMinister eartion Min show at the Who son of son could ribu Day 10-y time iste to going sm. goinga significant han expectemake estima menta it comes govern conta decision print,ntwith contribution he has autito time ofwith to the and her lt of the to prin r Peter Dut ds of Fed ment’s to l Australian ifica expected toabe d to community. becausegoing to end is. resu time ted 230 disabilit to the Just because handedJust people down era ton he has e sign before the ly a disability as a of Apr be han t, wit y ,00 to diagnos at the l ral end dofmak her son ntal munity. April. a dec that he’s mean hthat people challen 0 Aus that affe coul he’s In Ma il. doesn’tded autism to lla and ds of Fede isiogoing an com sn’t mean be fundame ge our tralians cts an a burden wit n mum - all cou rch, - we needdow Intrali March, rejebe n bef ia Sevi han the Migration the to be to Aus fundamentally doe cted the Mig precon . “It real ld ma h autism ore le of Mar lay in the Dutton at e’s sing bility - we need Review Tribunal challenging Maria’sthat.” rejected the cep r ly ratiMar request for a Skilled a disa Maria’s ia is a so ther Austral ke a sign . Who Federal Regional The fate(pictured) sion on Rev reques here, knows, tions abo is burden that.” The every QNU Regional Pro ister Pete a deci and ifica tha and ister a disa ian com has are to every iew Federal be a Provisional visio visaten lish written nt re the t fororks on to Tyrone tion Min with Tyro the grounds ut Eng enslandnginont Member Trib the Min nal lenging print, down befo thatchal netwina Queensland of be a bility doe munity. contributioTyrone Parliament Tyrone’s Skilwhy visa thancon has writwould a sign ne’s ily condition in Que Immigra going to calli Just led una lter. ons “result burden sn’t and mat fam dition of on n to reasthe ament Min ister, bec nal in a significant Queensland comto theifica of cha The QNUcost me and handed ofntthe on this Parlito eHealth wouldMinister, time thelth calling Australian ne’s bid mu inggro costitud to be on will llengin - we nee an tha ause he the ew Tribu und nity to nursing ber of and Hea t to Maria community t he’s support g tha “reTyrone’s a mul has n Revi ed interven Ma them in and Tyro Mem inensl d to we Theis the areas of healthcare”. expectedApril. the sultour s that be the bid to going t with ld Ausand QNEnglisht.” be than Maria area mo shou Australria remain Que Migratiofor a Skill who in Australia. ortthe Maria a single the moved s ofisten tralnianvalues eoneMe mber U has and Maria is fun to - all from end of ch, the dam mum cons est grounds ia in“It’sved from totoget a.Philippines wri hea to supp of unio the som “It’s who and ent of family the the us requ e networks trali tten Australia very lthc In Mar 200 ort and for us Par are here, so there’s the ally in 2007 them for agustud Que to be closer ry Phil to get are” 7 to important to eve in Aus Maria’s al visa on ld “result colle ensland liam ied to supp ortant to her of becn and them a multitude collectively . lyipp be clos ofent ing family and studied reasons midwife ry the remain a nursing to fulfill inesirly.” wou tralian in Quewhy rejected l Provision ctive Minister nursdream Federa a childhood colleague essio omising to fulfillbehind very imp who er tounfa ition to suppor the should remainto prof ind a the be Hea “It’s a valued intervening acolle lth Min onens l member tedthe chiltrea Reh a nur act beh to her this herprofession of a nurse. Regiona ne’s cond to the Aus thcare”. of becoming matter. land ly of Maria t dho . abil now and in Ma tion g fam works ister, Hos ber inpita le making “It’s consistent and Aus said od dre itation a se. ria and bein ily Maria contribution significant “It’s with collectiveed mem ourcall that Tyro ificant costareas of healppines tothe Rehabilitation nursing contribu Moh Ward at the l. Tyro nt Townsville very tralia. am to hercoll ing onand Wa r now ily ifica community imp and unionTyro Hospital. fam ecti midwifery ne was rd is a valu ne’sthat we in Townsville,” values lle,” Ms uage othe Tyrone woMs in a sign ity in the at the the Phili was a sign diagnosed Mohle orks nsviwith rks in bid to will said. th ortant is a.”valuvely ing autism from closer to her m actbeh Tow collectively mun diag lang Tow “Tyrone heal ed in to a mak support can’t for al com ia mov speak a nsv someone who is ind a ity nos drea in language us to other speak ille e netw ma rigin edth ed wit of than thes being 7 to be childhood me treated nurunfairly.” Mar get communone can’t on h aut nurses, Aboking English works heal a sign s mber of sing coll a in 200 ll a of the now “Tyr lle allied formulati s saidism andcom and muthe Australi ied to fulfi e. Maria nityPHNificant conthe professeague wh Townsvi sm a mu family net Maria are Mr Helm munity in Tow “Tye and studming a nursWard at the d with auti is a sing tributio ion and o com ltitu insurers help shap rone sory kers, should de of works esnsv can must cils and advi health costthat nose nurs outcomes.wor of beco abilitation ’t speof ille,” Ms n to her “Private be inte reasons are her le mum healthal insurers essionals coun ortu “Private can’t be sure are nity for e was diag e, so formulation “It’s profit a lang samdriven why future aklyof these Mo rven the Reh l. Tyrone hle said omes. networks.” clinic an so prof just you just opp the all can’t n the the ing in the Mrit’sHelms midwif consist vital said uage is sure that through “Thisbe cost outc n so you to be give everybody is going . ent wit on this Ministe re’s Hospita nurses,oth a voice Aboriginal and to be given have drive g health act coll ery and cos er same nals r ma raliaworkers, h our groups. up andthe profit treatment,” rance Aust y is goinsaid. int out com professio community and allied healthbein ectively union valu nursingtter. re fit th insu is thatshe said. professionals to step healthcapro everybod t,” sheBy cil ce idea of private nursinges. “The to must help shape the PHNs g trea te heal servi “Privat asdriv coun Ka health insurance en so eve ted unf suppor es that we and althrough werybo of priva e hea councils renthstep primary t that treatmen ideaThe clinical being you s ofinthe control any heal dyclinic airly.” t someon will lth insu and advisory rtan service health trea By Karen Keast just can is goin “The s.groups. isand Austra footKe d be of any sory that to is rol of impo tme as PHN “This we coul advi e wh rers start the cont e able an Mid to opportunity g follow nt,” ’t t in in for in the to This lian thes sheps are be true be sure are for nurses y of w o is of in the “Th applfootsteps being The Australian Nursing care.US rsin followif steps up togive ery with andnnhave a voice towa said system e idea tisation e grou to of tha and agedFed Nu form of bein rne care. tions . priva This h lead could g and managed man be whic ralia the sam t in the future of primary ulation posi lly,g thes we start dec era Midwifery Federation d the full in con healthcare a stepping m ofisio pefu in Australia stone (ANMF) nertrol privnate in Aust e we star and it’s has sionto the full syste e to thefederation (AN “Ho of the privatisation Mrvitally man of hea deci warned the federalUSgovernment’s a n ston vatio important Hel insure of any to primary thatinsu t to inno MF) lth we as nursing professionals healthcare.” ent’s l gov workers ms said se net ping USinsyst and follo apply has function hea rs tore.”allo works.” a stepnew w rnm ern decision to allow private rnmentran w in tionem of ic was for lth advisory healthca Ms ce me Butler profess , commu nurses, and the govepriv run a step said entr ast insurers aryhealth serv the government’s the ate Prim ral gove rent’s manfede thcare.” decision ivesice is clinical council collabora r said foo Abo ping (PH positions hea as GP-c thca to run someprim ary s som within and establish tsteps these midw ofMs rigin ren Ke prim heal theButle Ns) the tha PHNs. throughionals mu nity and country’s stonthe age ofheal has Hea toeess and ister er PHNs as GP-centric al hea care. 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Short-sighted reaction

22/04/2015 3:21 pm

2015

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22, No.1

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I have just finished reading your article in the May ANMJ about Maria Sevilla, (Pg 5). I am writing to express my disgust at the QLD federal government and the political system as a whole and their shortsightedness. We have many people in this country who are a significant burden on the budget and yet are fit, healthy and capable of contribution, but believe that the country owes them something and they have a right to accept payment for no contribution to the community at all. What has happened to us as a nation? After all the recent celebrations of ANZAC Day and the acknowledgement of us as a people, what we stand for and who we are and then I read this article. It is truly disgusting! Has Maria not already proven her value to the community, firstly by training at one of our universities and now to contribute and ‘pay her way’ by giving back to the community? Perhaps the people in these positions have never been touched by family crisis or have never had the need to reach out for assistance or maybe it is because they are so busy in their ivory tower creating policy and making up rules that they have forgotten to look out the

It is considered cruelty to keep an animal living when it has an irrevocably poor quality of life due to a terminal illness, pain to just old age. Why should we put people through the same experience where euthanasia can bring them the peace of mind being put out of their pain and misery. Many patients I have encountered would opt for euthanasia if it was an option. As nurses we are trained to provide comfort for our patients and to do no harm. No matter how much analgesia, other medication and nursing interventions are provided patients still experience extreme pain right until their death. Although we are not causing the pain we cannot fully provide the comfort that is needed in these times. Canada’s criteria for the appropriateness of euthanasia is sufficient and patients have the right to refuse euthanasia if they so wish. Australia should get on board and give patients the right to elect euthanasia.

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

Bianca Salter, RN Victoria A be with tter wa dem y to c enti a in are for p hosp a ital tients Dem

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Handling bullying I have been a victim of bullying but there are a number of things that you can still do. Unfortunately bullying often results in one’s resignation as it takes its toll on one’s health and wellbeing, as attested by the number of letters recently published.

anmf.org.au

Good on ya Canada! I applaud you for giving people the option of euthanasia from ANMJ (April 2015, Vol. 22, No. 9).

Editor’s note: To date Federal Minister for Immigration Peter Dutton has granted Maria Sevilla and her son a three-month bridging visa allowing them to stay in Australia until a final decision is made. At the time the ANMJ went to print no further decisions had been made. The journal will publish developments as they occur.

of the risk and entia ocare ium dem to delir erwayt nts with Be alert /abett to patie harm gov.au

Report bullying in writing, not to the managers (who often are the bullies) but to the Board of Directors sending copies to no less than three members. This way the matter cannot be swept under the carpet. Ask them to acknowledge the letter, to investigate the matter and to report back the findings. Ask the Ombudsman office to

Canada’s embrace of euthanasia applauded

window and acknowledge the people who are paying for them to be in those positions. I honestly hope that they will never need any type of healthcare or experience having their rights stripped from them and to then experience the powerlessness of others making decisions on their behalf. I sincerely hope that good common sense and human decency has prevailed and she has been granted residency. I hope you publish in the next ANMJ the outcome of the submission as I am sure I would not be the only one sickened by this situation. Anonymous, South Australia

investigate. These services are free. They can make recommendations and send the matter to the Victorian Civil Administration Tribunal which is also free. Although these measures did not help me personally, they do help by officially documenting incidents occurring in these institutions. So when the next incident

4:08

happens, these institutions are held accountable and the next person may get some reparation. You can also employ the services of a private solicitor to act on your behalf. Some firms have a no win, no fee policy, however the amount I paid I consider it peace of mind. In my case I found out much later that the bullies were dealt with through ‘re-structuring’ resulting in them being: passed over for promotion, demotion, and termination. I got my pound of flesh. Maria LIew RN, RM, Victoria June 2015 Volume 22, No.11 55

Maree

ANMF Vice President Maree Burgess

Community health nurses I am excited to be part of the ANMF Federal leadership team and looking forward to sharing some of my thoughts on the ‘back page’. I am a Victorian maternal and child health nurse, part of the broader community of ‘out there’ (in a geographical sense!) nurses and midwives. I work in the community space, along with a myriad of other nurses and midwives who deliver aged care, palliative care, mental healthcare, immunisation, district, regional, drug and alcohol services to name but a few. Community health nurses work within communities to promote and optimise health and wellbeing and to provide care, assessment and interventions in response to increasingly complex healthcare needs within Australian communities. In maternal and child health nursing, I work with families following the birth of a baby to assess the health and wellbeing of the baby, mother and family. The ongoing relationship with this family involving visits either in the home, or at a maternal and child health centre will continue until their final child reaches preschool age. I recently attended the 6th Biennial Conference of Maternal, Child and Family Health Nurses Association (MCaFHNA) held in Perth. It provided a great opportunity to network with a range of family health nurses and midwives from across the nation. We are a diverse group of community nurses and midwives, providing a range of services to children and their families. Indeed, on a state by state and territory basis, the more we networked, the commonalities in practice became very clear and the differences better understood. The goals in achieving optimal family health and wellbeing were enthusiastically embraced by all in attendance. While sitting in the conference auditorium and enjoying and being challenged to think about my own community health practice, I reflected on the impact of my midwifery experience and its relevance to maternal and child 56 June 2015 Volume 22, No.11

health nursing. Early discharge following birth requires essential skills relating to breastfeeding, sleep and settling, care of a newborn and in addition, monitoring the health and wellbeing of women as they recover from the birth. The birth experience for women is profound, even when it is classified as a ‘normal’ delivery. The physical and psycho-social changes experienced by women following birth extend well beyond the six week post-natal period. My mother is 88 years old and can recount her birth experiences in minute detail, including the pain and grief of a miscarriage, the sadness remains even today.

THE PHYSICAL AND PSYCHOSOCIAL CHANGES EXPERIENCED BY WOMEN FOLLOWING BIRTH EXTEND WELL BEYOND THE SIX WEEK POST-NATAL PERIOD.

A few years ago I was invited to speak to a group of masters students about the role of maternal and child health nurses. I proceeded to enlighten a group of approximately 30, mixed aged, potential early years educators about the impact of birth, the early post-natal care and the ongoing support provided for babies, their mothers and families. As I spoke a little more about the memories and impact of birth for women, I noticed one of the older students

sitting in the front row, with tears falling silently down her cheeks. At the end of the presentation, we found time to connect. Her first birthing experience had been very traumatic and even though her son was now 12 years old, her grief was unresolved. While back at the conference, Emeritus Professor Dame Sarah Cowley, a UK health visitor and academic, spoke of the need to invest in universal health services and provide targeted services for vulnerable families. She spoke of her recent research in support of the UK government‘s decision to reinvest in the health visitor program. There was broad agreement by those attending the conference, that investing in primary and preventative health services was critical, as was specific and well funded targeting for vulnerable families. On day two, Professor John Lynch, an epidemiologist and professor of public health at the University of Adelaide spoke about inter-generational disadvantage. He mentioned a range of programs which focused on providing intensive home visiting targeting vulnerable families. One of these programs, ‘right@home’ which is administered by the Australian Research Alliance for Child and Youth (ARACY) has commenced in both Victoria and Tasmania and will look at how the universal maternal and child health service might be improved to meet the needs of more vulnerable families by increasing the number of home visits. The delegates at the conference were inspired by his thoughtful presentation. Concurrent sessions covered topics from a broad range of perspectives, including working with diversity, closing the gap in Aboriginal health, breastfeeding, social media, vulnerability and violence and service challenges and initiatives - more food for thought and more time for reflection. The final panel discussion focused on building the MCaFHNA profile and a vision for its future. An open forum for discussion was not a feature and as a process, failed to capture the excitement and collegiality that had been engendered throughout an otherwise wonderful conference. I believe that across Australia, maternal, child and family health nurses have a common vision for the provision of health services for families however we acknowledge the very real differences between the states and territories in relation to educational preparation and service provision. It is paramount that in our final deliberations, we respect difference, continue to build connections and look to develop standards of professional practice which incorporate the breadth of practice in Australia. anmf.org.au

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