V O LU M E 2 4 , N O. 1 1 J U N E 2 0 1 7
BEATING THE ODDS HOW INDIGENOUS NURSES AND MIDWIVES ARE CLOSING THE HEALTH GAP www.anmf.org.au
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CONTENTS REGULARS
20
02 DIRECTORY 03 EDITORIAL 04 NEWS 16 WORLD 17 SELF CARE TIPS 18 PROFESSIONAL
WHAT’S SO SPECIAL ABOUT ‘SPECIALTY’?
20 FEATURE BEATING THE ODDS: HOW INDIGENOUS NURSES AND MIDWIVES ARE CLOSING THE HEALTH GAP
26 ISSUES
THE EXPERIENCES OF RESIDENTS AND THEIR RELATIVES ACCESSING ORAL HYGIENE CARE IN A RESIDENTIAL AGED CARE FACILITY
BEATING THE ODDS HOW INDIGENOUS NURSES AND MIDWIVES ARE CLOSING THE HEALTH GAP
36
28 RESEARCH 29 LEGAL
WHERE HAS THE PATIENT GONE?
30 CLINICAL UPDATE
NEW PSYCHOACTIVE SUBSTANCES: COMING SOON TO AN ED NEAR YOU
33 ISSUES
CONSUMER DIRECTED CARE
34 REFLECTIONS
LEADERSHIP LESSONS FROM THE UNITED AIRLINES INCIDENT
36 EDUCATION
CRYSTAL METHAMPHETAMINE – ICE
38 FOCUS
MATERNAL HEALTH
46 CALENDAR
04
47 MAIL 48 SALLY
30
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June 2017 Volume 24, No. 11 1
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Photo: Banok Rind Photographer: Carla Gottgens / Oxfam Australia
Editorial 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
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Northern Territory
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The Australian Nursing & Midwifery Journal is delivered free monthly to members of ANMF Branches other than New South Wales, Queensland and Western Australia. Subscription rates are available on (03) 9602 8500. Nurses who wish to join the ANMF should contact their state branch. The statements or opinions expressed in the journal reflect the view of the authors and do not represent the official policy of the Australian Nursing & Midwifery Federation unless this is so stated. Although all accepted advertising material is expected to conform to the ANMF’s ethical standards, such acceptance does not imply endorsement. All rights reserved. Material in the Australian Nursing & Midwifery Journal is copyright and may be reprinted only by arrangement with the Australian Nursing & Midwifery Journal Note: ANMJ is indexed in the cumulative index to nursing and allied health literature and the international nursing index ISSN 2202-7114
Moving state? Transfer your ANMF membership If you are a financial member of the ANMF, QNMU or NSWNMA, you can transfer your membership by phoning your union branch. Don’t take risks with your ANMF membership – transfer to the appropriate branch for total union cover. It is important for members to consider that nurses who do not transfer their membership are probably not covered by professional indemnity insurance.
New South Wales
Queensland
Tasmania
Western Australia
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Branch Secretary Beth Mohle
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Branch Secretary Mark Olson
Office address 50 O’Dea Avenue, Waterloo NSW 2017 Ph: 1300 367 962 Fax: (02) 9662 1414 E: gensec@nswnma.asn.au
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2 June 2017 Volume 24, No. 11
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EDITORIAL
Editorial Lee Thomas, ANMF Federal Secretary Aged care has yet again been dealt a significant blow. As I write this editorial a Bill in NSW to ensure that at least one registered nurse is on duty at all times in high care aged care facilities has been turned down in the state’s Lower House by the National and Liberal Party MPs. This was a highly disappointing outcome given the Bill was passed unopposed in the Upper House only the week before. It goes without saying that the consequences of this decision will be erosion to the level of quality care provided in aged care facilities in NSW. The NSW Nurses and Midwives’ Association (NSWNMA, ANMF NSW Branch) have campaigned tirelessly at the state and national level to ensure that providers meet the needs of aged care residents which, specifically and crucially, includes the expertise of a registered nurse on duty at all times. They have vowed to continue campaigning to this end. Aged care did not fare any better in the federal Budget this month. The crippling $1.2 billion funding cuts made previously have not been reversed and no regulation was made for mandated, safe staffing ratios for nurses and carers in aged care facilities nationwide. The stark reality of aged care in Australia is that the nation is facing a shortage of 20,000 aged care nurses. The nurses and AINs that are currently working in aged care are finding it harder and harder to cope with dangerously high workloads resulting in episodes of missed care. Without adequate targeted funding to address this issue care continues to be detrimentally compromised. Other losers of this Budget are nursing and midwifery students. They will be forced to pay thousands of dollars more to complete their education and start paying their HECS debt much sooner after the Budget cut the income threshold down to $42,000. The phased removal of the Medicare freeze, also announced in the Budget, hardly makes a dent in the healthcare costs Australians have to endure. The gradual wind-back means patients will still be slugged with increasing out of pocket costs for the next two years.
@AUSTRALIANNURSINGANDMIDWIFERYFEDERATION
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On a more positive note, closing of the funding gap for NDIS, funding for mental health initiatives and funding for medical research into childhood cancer are all welcomed Budget measures. For more detail about what the Budget means for nurses and midwives as well as healthcare turn to page 12 of this month’s journal.
THE PHASED REMOVAL OF THE MEDICARE FREEZE, ALSO ANNOUNCED IN THE BUDGET, HARDLY MAKES A DENT IN THE HEALTHCARE COSTS AUSTRALIANS HAVE TO ENDURE. THE GRADUAL WIND-BACK MEANS PATIENTS WILL STILL BE SLUGGED WITH INCREASING OUT OF POCKET COSTS FOR THE NEXT TWO YEARS.
Also in the ANMJ this month, Focus looks at maternal health services. Coinciding with this topic, this month is the 100th year celebration of maternal and child health in Victoria and Tasmania. To celebrate the anniversary in Victoria the ANMF (Vic Branch) in partnership with the Victorian Association of Maternal and Child Health Nurses is hosting a digital exhibition depicting the evolution of the role, from infant baby nurse to today’s highly qualified maternal child health nurse. The exhibition, which is fully funded by the ANMF (Vic Branch), will be online in early June at anmfvic.asn.au/mch100 The exhibition is bound to be an interesting and informative depiction of this speciality over the century.
@ANMFBETTERHANDS
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June 2017 Volume 24, No. 11 3
NEWS
RN 24/7 SUPPORTERS INCLUDING UNION MEMBERS, NSWNMA GENERAL SECRETARY BRETT HOLMES AND MP PHILIP DONATO ON THE STEPS OF PARLIAMENT LAST MONTH
PUSH FOR AROUND THE CLOCK RNs IN AGED CARE DEALT BLOW The spirited campaign to make it a legal requirement for at least one RN to be on duty at all times in high care nursing homes across New South Wales has been dealt a major blow after state ministers rejected a Bill supporting its implementation last month. The NSW Nurses and Midwives’ Association (NSWNMA) launched its RN 24/7 in aged care campaign back in August, 2015, the push emerging from the government’s tinkering with legislation concerning RNs and their use in nursing homes and growing fears RNs could be pushed aside in a bid to cut costs. Subsequent inquiries investigating the need to retain RNs in nursing homes unfolded over the past couple of years and generated strong debate. The contentious topic reached its most significant juncture when a Bill was introduced by the Shooters, Fishers and 4 June 2017 Volume 24, No. 11
Farmers Party last month to enact legislation to keep RNs in NSW nursing homes. In a promising sign, the Bill was unanimously passed by the Upper House, however, just a week later it was quashed after the critical Lower House poll shot it down 45 votes to 35 as a result of Nationals and Liberal Party MPs. NSWNMA General Secretary Brett Holmes labelled the government’s decision shameful and predicted that over time it would gradually erode the level of care provided in aged care to some of the state’s most vulnerable residents. “Rather than ensuring a high standard of care is maintained throughout facilities with high care residents, the government has hidden behind an ill-informed argument that small regional aged care facilities would close if the requirement to employ one registered nurse remained in the Public Health Act 2010,” Mr Holmes explained. “This spurious argument ignores the fact that regional aged care facilities receive Commonwealth funding for complex and high care residents at the same rate as city-based facilities and at least 70% of all residents are deemed to be high care before entering a site. Small rural or isolated facilities also receive additional Commonwealth funding.” Mr Holmes said the union would not lay down after the disappointing decision and would continue to lobby for quality nursing care in aged care at a state and federal level. Orange MP Philip Donato, a member of the Shooters, Fishers, and Farmers Party,
was somewhat dumbfounded his Bill was eventually abandoned. He pointed to timely media reports of an elderly NSW woman found with maggots in her mouth to illustrate the need to protect aged care standards. “Currently, low care nursing homes can receive Commonwealth government funding for high care residents, but not have the appropriate staffing of registered nurses to meet care requirements. They just pocket the extra money,” Mr Donato claimed. “I will not rest and will not abandon the fight when even one nursing home resident is not receiving the quality of care they deserve.” Significantly, while the push to make it mandatory for at least one RN to be on duty in nursing homes has hit a stumbling block, support remains strong from various corners of the state. “Registered nurses play a vital role in managing the complex care medical conditions of many aged care residents,” Australian Medial Association (AMA) NSW Branch President Professor Brad Frankum said. “Providing adequate treatment to aged care residents in their own facilities reduces complications such as falls and medication incidents. It also reduces ambulance callouts and hospital admissions.” Professor Frankum declared the safety of residents as the top priority, suggesting that the government’s loosening of legislation to retain RNs would undoubtedly see a deterioration in care. anmf.org.au
NEWS
NSW BLOCKS BILL TO DECRIMINALISE ABORTION
AGED CARE NURSES INFECTION CONTROL SURVEY
Longstanding laws in New South Wales that deem abortion a criminal act will remain unchanged after a Bill urging reform was strongly voted down in Parliament last month.
The Aged Care National Antimicrobial Prescribing Survey (acNAPS) is aimed to reduce harm to residents by prevention of infection through infection control; promote appropriate antibiotic use; collate data to enable facilities to benchmark results against the Australian average; and support homes to meet accreditation requirements. The survey can be undertaken by a nurse, infection control practitioner or pharmacist between Monday 19 June and Friday 1 September 2017. For more information, visit www.naps.org.au
Put forward by Greens MP Mehreen Faruqi, the Abortion Law Reform Bill sought to remove abortion from the Crimes Act and ensure safe access to clinics. It also called for doctors who object to abortion to refer patients onto a doctor who is willing to undertake the medical procedure. Under the state’s laws, abortion is considered a crime that is punishable by up to 10 years in prison. Despite promising signs of overdue change, the NSW Upper House soundly voted down the Bill, 14 votes to 25, leaving supporters reeling from yet another rejection. NSW and Queensland remain the only two states across Australia that consider abortion a crime at all stages of pregnancy. Emily Howie, Director of Legal Advocacy at the Human Rights Law Centre, said women and doctors shouldn’t have to face jail time. “The law here is hopelessly out of touch with clinical practice and community standards and must urgently be reformed. “It’s well past time for law reform in this state. NSW abortion law was passed in 1990 at a time when women did not enjoy the right to vote. NSW is lagging behind other states by retaining archaic laws that unfairly stigmatise and potentially criminalise women for choosing to terminate a pregnancy.” The state’s current abortion law does include a ruling by NSW courts that stipulates abortion can be lawful under certain circumstances if a doctor deems it the only option. In this scenario, doctors must believe on reasonable grounds that an abortion is required to avoid serious danger to a woman’s life or her physical and mental health and that the danger of continuing the pregnancy outweighs the regulations surrounding abortion. Ms Howie said lobbyists in favour of scrapping abortion would not lay down on the issue. She pointed to recent polls in NSW which found most people think women should be able to decide whether to have an abortion, and similar ones in Queensland showing more than 80% of people think it should be legal for a woman to decide to terminate a pregnancy, as evidence of widespread public support. “It’s simply unacceptable that doctors should make a decision about women’s access to a medical procedure – where else is this the case? Women are perfectly capable of making decisions about their own bodies and the law should not prevent that.”
anmf.org.au
Nurses in aged care facilities are encouraged to participate in a national antimicrobial and infection control survey.
PROSTATE CANCER NURSES PROGRAM EXPANDED The federal budget has committed $5.9 million funding for an extra 14 prostate cancer specialist nurses nationwide. The Budget announcement followed commitment to renew federal funding of the 29 positions under Prostate Cancer Foundation of Australia’s (PCFA) Specialist Nursing Program. “Specialist nurses have the knowledge and skills to help men at all stages in their cancer journey – diagnosis, treatment and aftercare,” PCFA CEO Associate Professor Anthony Lowe said. NSW rural and regional prostate nurse Christine Britton said the additional nurses would help men stop falling through the cracks, particularly in areas currently not serviced by any prostate cancer nurses such as northeast Victoria. “It’s half of what we need but more than we currently have – we are spread fairly thinly on the ground. “Each and every one of us works in slightly different ways – some of us are attached to hospitals, others are in oncology sections and some work in urology practices.” Christine’s fulltime position in the Riverina since January 2016 - 50% federally funded and 50% by the Murrumbidgee Local Health District - is now secured until 2020. The role allows for one on one care by a nurse for men diagnosed with prostate cancer and their families. “I also raise awareness of prostate cancer – if there is a forum at a Men’s Shed I go and talk with them getting
the message out there. It’s about demystifying prostate cancer,” Christine said. There was still a wide variation in ages of men diagnosed with prostate cancer from mid-40s to mid-80s with the mid-range 64-66 years, she said. “For some younger men it’s really devastating who have young children and a mortgage, worrying about taking sick leave to have an op and not having enough money to pay the bills. “It’s quite an intricate picture, if I can somehow help connect all the information it makes the journey easier for everyone. “I do not have a magic wand; as a nurse, I am a problem solver but sometimes there isn’t anything I can do but provide much needed support and compassion. I help them understand what’s going on. I make them aware of what’s available in the community to assist them.” The lack of a definitive screening test for prostate cancer remained one of the biggest obstacles to early diagnosis, Christine said. “The PSA blood test is not reliable. We do not overreact when we have someone with a raised PSA; unless it’s very high it’s a grey area - it could be a UTI or an overlarge prostate. At that point it’s just a high PSA number – not a diagnosis of cancer.” Men are then referred on to an urologist to do a biopsy or rectal probe/digital test to examine whether it’s abnormal lumpy or irregular. “My take home message is talk to your GP, know your prostate cancer risk, have your free PSA test at aged 50 years and then every year or two after that. “If you’re getting your blood tests annually get your GP to tick the box for PSA. It’s free to have it done every year. If you have a family history, start having the PSA at 40 years. Some men shy away from the digital test. But if we catch it early we can cure it early.”
June 2017 Volume 24, No. 11 5
NEWS
HEALTH CARE HOMES DEBATE PANELLISTS, INCLUDING APNA PRESIDENT KAREN BOOTH, THIRD FROM LEFT.
HEALTH CARE HOMES ROLLOUT SPARKS ROBUST DEBATE The imminent beginning of Health Care Homes (HCH), the federal government’s bold plan to reform primary health care, triggered strong debate among key stakeholders during a panel session at the Australian Primary Health Care Nurses Association (APNA) annual conference in Hobart last month. Kicking off in October, the Health Care Homes project will see 200 general practices and Aboriginal Community Controlled Health Services (ACCHS) set up as trial sites in a bid to better manage patients with chronic conditions and provide tailored healthcare. The government says one in four Australians has at least two chronic health conditions and claims the landmark scheme will streamline healthcare delivery and improve outcomes. It estimates 65,000 people will take part in the initial two-year trials, with patients required to enrol at a HCH practice site and undergo the majority of their care at the setting. The problematic My Health Record system is likely to play an important part in the success of the scheme by linking health teams through shared online health 6 June 2017 Volume 24, No. 11
summaries. Facilitated by Dr Norman Swan, the panel discussion generated varying views regarding the demand for the scheme, its implementation, and likelihood of success. Janet Quigley, 1st Assistant Secretary of Health Systems and Policy at the Commonwealth Department of Health, said success would hinge on general practices embracing newer and more efficient models of care.“One of our key objectives is to reduce avoidable hospitalisations where that care can be better met in primary care, as opposed to people landing in hospital because they haven’t had appropriate access or support in the community.”
THE GOVERNMENT SAYS ONE IN FOUR AUSTRALIANS HAS AT LEAST TWO CHRONIC HEALTH CONDITIONS AND CLAIMS THE LANDMARK SCHEME WILL STREAMLINE HEALTHCARE DELIVERY AND IMPROVE OUTCOMES. Consumers Health Forum CEO Leanne Wells said she hoped Health Care Homes would afford practices greater flexibility, autonomy and the time to link patients with wrap-around services. “The experience of the system, the experience of care, is that we’re managing more multi-morbidity, more complexity, these days. We need the system to better connect up.” Tracey Johnson, CEO of Inala Primary Care in Brisbane, spoke of her vision for Health Care Homes embodying practice nurses being better utilised and playing a larger role in healthcare.
Similarly, APNA president Karen Booth backed Health Care Homes, saying practice nurses would be able to showcase more of their skill-set given greater autonomy. She said HCH could also help struggling general practices improve. “You need to have some sort of systematic approach to properly managing care and giving patient access to help to stop those avoidable hospitalisations. Perhaps this formal process that will come through Health Care Homes will help those lesser achieving practices build up systems that they can then use to achieve better outcomes.” Royal Australian College of General Practitioners president Bastian Seidel said he supported the ambition of Health Care Homes but questioned its need in the first place. Mr Seidel suggested funding should be shifted from the hospital sector to primary care, claiming that several billion dollars could be saved by re-directing investment into general practice. Mr Seidel, who works as a GP in a general practice in South Hobart that includes 14 GPs, seven nurses, and a Nurse Practitioner, added that high-performing general practices required a collaborative effort between doctors and nurses. While he acknowledged that greater funding was required to enable better care he doubted whether Health Care Homes could provide the answer. “General practice has been shaken and stirred a fair bit over the last few years and my feeling is we are barking up the wrong tree. General practice with GPs and practice nurses is not the main cost driver of the Australian healthcare system. It is hospitals. It is medication. It’s pathology and diagnostic imaging. We’ve got to be careful not to put the wrong incentive into general practice by coming up with new funding models that haven’t shown to make a major difference internationally.” anmf.org.au
NEWS
SECURED COUNSELLING SERVICE FOR NURSES AND MIDWIVES A critical counselling service that helps Victorian nurses and midwives overcome issues with mental health or substance abuse has had its future guaranteed following a much-needed cash injection from the state government. Established in 2006, the Nursing and Midwifery Health Program Victoria (NHMPV) provides confidential face-toface support for nurses, midwives, and students experiencing health issues such as depression and alcohol abuse. Victorian nurses and midwives had originally funded the program via their annual registration fees payable to the Nurses Board of Victoria but the switch to national registration in 2010 triggered lingering uncertainty over its future.
Victorian Health Minister Jill Hennessy announced the government’s pledge of $627,000 in annual funding required to run the service at the recent ANMF (Vic Branch) Nurses and Midwives Wellness Conference. NMHPV CEO Glenn Taylor described the program as a safe entry point for nurses and midwives to access help. “We help to empower our colleagues to confront their health challenges, learn new ways of thinking and put these into action.” ANMF (Vic Branch) Secretary Lisa Fitzpatrick said nursing and midwifery was a demanding profession that could become incredibly stressful. “Nurses and midwives who’ve used the service for anxiety, psychological distress, depression, alcohol and substance use, all emphasise the importance of its intimate knowledge of the nursing and midwifery professions which cannot be replicated by a generic employee assistance program.” The conference also involved a panel session on coping with stress featuring two nurses who shared their personal experience accessing the NMHPV. One of the nurses, Danielle, a Paediatric Registered Nurse of 13 years, revealed entering a downward spiral after switching from her familiar Emergency Department role to the Intensive Care Unit (ICU) and struggling with the culture shock and bullying. Dealing with other personal issues at
“WE HELP TO EMPOWER OUR COLLEAGUES TO CONFRONT THEIR HEALTH CHALLENGES, LEARN NEW WAYS OF THINKING AND PUT THESE INTO ACTION.”
the time, Danielle began to struggle with anxiety, depression and isolation. “I felt like I’d gone from the height of my nursing, from being ecstatic, from loving my job, to rock bottom and questioning who I was and whether I even wanted to continue as a nurse.” On a friend’s suggestion, Danielle turned to the NMHPV. Through the program, she received regular support in person and via text and email, and quickly realised there was hope. The program offered her resilience tips, coping strategies, and vital support. “It was actually a life-changing experience for me. They really helped me see light at the end of the tunnel. When I felt so broken and didn’t think that I could get back up again they in fact helped me realise that there’s more to me than just being a nurse and that I’m actually a human being and deserve to get help.”
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NEWS
HELP FOR THOSE WITH AN EATING DISORDER
HESTA WINNERS – LEFT TO RIGHT, REBECCA RICH, SARAH BROWN, AND A MATER HOSPITAL TEAM MEMBER.
An online resource for people living with an eating disorder and a second online resource for their friends, family and carers has recently been released. Navigating Your Way to Health and Navigating Their Way to Health both include tips on how to access help throughout the eating disorder treatment process, navigate treatment options, and assist carers and friends with information on how to best support their loved one and understand the recovery journey. Around 4% of Australians are affected by an eating disorder at any one time. Navigating Your Way to Health and Navigating Their Way to Health have been developed by the Hunter Institute of Mental Health in collaboration with the Centre for Eating and Dieting Disorders at the Boden Institute, University of Sydney, the Butterfly Foundation and people with lived experience. The initiative has been funded by the NSW government. Director of the Hunter Institute of Mental Health Jaelea Skehan said having access to up-to-date information and support can be critical to recovering from an eating disorder. “People can and do recover from eating disorders and our hope is that these resources make navigating the experience a little easier. We also need to ensure families, carers and friends look after themselves too, a factor that is often overlooked. The resources are for any gender, age, culture or stage with an eating disorder. They are available at: www. himh.org.au/navigatingedhealth and www.cedd.org.au/begin-recovery
NAVIGATING YOUR G YOUR
NAVIGATIN
WAY TO HHEALTH WAY TO HEALT to approaching the A brief guide the and pathways to approaching treatments challenges, e to ways to A brief guid and path from an eating disorder recovery treatments der challenges, an eating disor recovery from
8 June 2017 Volume 24, No. 11
OUTSTANDING NURSES AND MIDWIVES HIGHLIGHTED A Northern Territory nurse who established remote dialysis services for Aboriginal people captured one of the top accolades at the 2017 HESTA Australian Nursing & Midwifery Awards in Brisbane last month. Sarah Brown was named Nurse or Midwife of the Year for launching the Alice Springs based Western Desert Dialysis, a service which provides social support, allied health and important ‘on-country’ dialysis treatment for Aboriginal people with kidney disease. Ms Brown drew on her past experience as a remote area nurse (RAN) and educator for Aboriginal Health Practitioners to forge a partnership with leaders from the Pintupi Luritja communities to create the culturally appropriate service. Significantly, her unwavering passion led to the expansion of Western Desert Dialysis to the point it now services nine remote communities throughout the Northern Territory and Western Australia. Ms Brown said the services provide a lifeline for people living in remote communities requiring dialysis. “They live longer, have a better quality of life and an opportunity to pass on their heritage and cultural knowledge to their children and grandchildren.” Ms Brown will use the $10,000 in prize money to help build the program even further by establishing the organisation’s first
dialysis service in South Australia’s Pukatja community. The extra funds will also assist in employing nurses to help implement the latest service. Rebecca Rich, from the Perth Clinic in Western Australia, was named Outstanding Graduate for her commitment to achieving patient-centred care in mental health nursing. As a graduate, she proactively pursued education opportunities to improve her skills and knowledge in the mental health field, including online training with children of parents with mental illness.
REBECCA RICH, FROM THE PERTH CLINIC IN WESTERN AUSTRALIA, WAS NAMED OUTSTANDING GRADUATE FOR HER COMMITMENT TO ACHIEVING PATIENT-CENTRED CARE IN MENTAL HEALTH NURSING.
With her career about to begin Ms Rich plans to break down the stigma mental health patients often face and will use her winnings to visit hospitals around Australia to research the diverse ways organisations treat mental health. Lastly, the Team Excellence award went to the North Sydney based Mater Hospital for its Pre-admission Midwife Appointment Program. The program provides holistic multidisciplinary care to women in the third trimester of their pregnancies and focuses on screening for depression, anxiety and domestic violence as well as assisting with other concerns or social stresses. anmf.org.au
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NEWS
EXHIBITION CHARTS 100 YEARS OF VICTORIAN MCH NURSES Victoria’s maternal and child health nursing service turns 100 years old this month. The evolution of the role, from infant baby nurse to today’s highly qualified maternal child health nurse is charted in a new digital exhibition. A maternal and child health nurse in Victoria must be a registered nurse and midwife with postgraduate qualifications in child and family health nursing. The exhibition, which is fully funded by the ANMF (Vic Branch), is a joint project by ANMF (Vic Branch) and the Victorian Association of Maternal and Child Health Nurses (VAMCHN) – a special interest group of the Victorian Branch of the ANMF. Dr Isabel Younger, with her friends Mrs W. Ramsay and Ethel Hemphill,
established the first baby clinic in Melbourne’s inner city suburb of Richmond in 1917 in response to Victoria’s high rate of infant mortality. That year 1,873 babies under 12 months died (Victorian Historical Journal, 1998). Sister Muriel Peck was employed as the nurse in charge. She would become matron of the newly established Victorian Baby Health Centre’s training school in 1919. Today’s Victorian Maternal and Child Health Service is a free, universal service available from birth to school age, offering 10 key ages and stages consultations including a home visit, first-time parent groups, 24-hour/seven days support via the Maternal and Child Health Line and an Enhanced Maternal and Child Health Service for families requiring more intensive support. In a further evolution of the nursing role, the Victorian government announced last month $81.1 million, on top of the $133 million the year before, to expand the service as part of an integrated strategy to stop family violence. The digital exhibition includes interviews with maternal and child health nurses,
A Torres Strait Island nurse with Type 1 diabetes is using her experience living with the condition to tackle its prevalence among her own community as a nurse educator.
INDIGENOUS NURSE PLEDGES TO TACKLE DIABETES
10 June 2017 Volume 24, No. 11
Registered Nurse Shirley Kusu has been working at the Thursday Island Hospital for the past three years. Her pathway to diabetes nurse educator was recently cemented after she completed her Graduate Certificate of Diabetes Education at James Cook University’s campus on the island. Ms Kusu said she was inspired to tackle the condition, particularly Type 2 diabetes, after witnessing its extreme levels in the Torres Strait community first hand. “Studying diabetes education was a personal journey for me to find out how to best manage my own diabetes, which has been a struggle while living in a remote community. I thought I could be helpful for my people here.” Ms Kusu’s role at the Thursday Island Hospital involves looking after patients by providing support and education to better self-manage their diabetes once they are discharged. As part of ongoing prevention, she also conducts home visits in a bid to engage further with people in the community. Ms Kusu is currently being mentored by
including ANMF (Vic Branch) President Maree Burgess and the current VAMCHN Chair Bernice Boland, as well as key contributors to the field such as Professors Emeritus Dorothy Scott and Gay Edgecombe. The digital exhibition will be online in early June at anmfvic.asn.au/ mch100 Reference ‘Baby boon: the infant welfare movement in Victoria’, Margaret Flood, Victorian Historical Journal Vol. 69, No. 1, June 1998 NURSE, BABY AND MOTHER, 1940’S. PHOTO: PUBLIC RECORDS OFFICE VICTORIA
Queensland Health’s Diabetes Educator for the Torres Strait Islands and hopes to one day take over the role. James Cook University Course Coordinator Bronwyn Davis praised Ms Kusu for becoming one of the first Indigenous people to complete the Graduate Certificate. She explained that 30% of Torres Strait Islanders have either been diagnosed with diabetes or are living with the condition but are unaware they have it. “The intergenerational effect of diabetes in Torres Strait Islanders is increasing, with gestational diabetes steadily rising from 13% to 16% of pregnant women,” Ms Davis said. “We are also seeing Type 2 diabetes occurring at a younger age, in children as young as eight. One in four children in the Torres Strait Islands is overweight or obese, consistent with our national stats, and that places them at risk of developing Type 2 diabetes.” Ms Davis said Indigenous people like Ms Kusu could potentially have an immense impact in educating and promoting the management of diabetes within their own communities.
REGISTERED NURSE SHIRLEY KUSU CELEBRATES GRADUATING WITH COURSE COORDINATOR BRONWYN DAVIS.
anmf.org.au
What’s the chance she’ll complete the course?
Up to 54 of patients studied did not complete their full course of ferrous sulfate as prescribed * %
1–3
Maltofer® restores iron levels with significantly less side effects and better treatment compliance.1,2* Ensure they get the iron you intended. For more information, visit maltofer.com.au Maltofer contains iron as iron polymaltose. *In studies comparing iron polymaltose with ferrous sulfate in iron deficient patients. References: 1. Ortiz R et al. J Matern Fetal Neonatal Med 2011;24:1–6. 2. Toblli JE and Brignoli R. Arzneimittelforschung 2007;57:431-438. 3. Jacobs P et al. Hematology 2000; 5: 77-83. Maltofer® is a registered trademark of Vifor Pharma used under licence by Aspen Pharmacare Australia Pty Ltd. For medical and product enquiries, contact Vifor Pharma customer service on 1800 202 674. For sales and distribution enquiries, contact Aspen Pharmacare customer service on 1300 659 646. Date of preparation October 2016.
Body-friendly iron
BUDGET
NURSING STUDENTS AND AGED CARE LOSERS IN HEALTH BUDGET The Federal Budget has failed nursing students, aged care and workforce issues, according to health organisations.
While not a horror Budget of past successive years, it lacks vision and measures to improve healthcare. The ‘phased’ removal of the Medicare freeze has been dubbed as a political fix and meaningless for patients. The gradual wind-back meant patients would still be slugged with increasing out of pocket costs for the next two years, ANMF Federal Secretary Lee Thomas said. “Make no mistake, the freeze on Medicare rebates is still in place, you could say it’s only being defrosted. If this government was serious about alleviating the cost of healthcare, it would have immediately put an end to the freeze on GP rebates, full stop.” “The staged lifting of the freeze in the Budget does mean that many families on average incomes still face the risk of co-payment increases they can ill afford for at least another year,” Consumers Health Forum CEO Leanne Wells said. Rural Doctors Association of Australia President Dr Ewen McPhee said immediate lifting of the freeze in full would “particularly benefit many rural and remote patients who rely strongly on bulk-billed consultations to afford their medical care”. Substantial trust had been placed in consultation with the nation’s GPs, specialists, pharmacists and the medicines sector, Australian Health and Hospitals Association Chief Executive Alison Verhoeven said. “The reform agenda needed across these areas is substantial and won’t be put to bed solely by the formation of compacts with doctors and pharmacy industry groups.” Most disappointing was hospitals, primary care, prevention and Indigenous health were the last in the government’s three wave of priorities, Ms Verhoeven said. “More is needed than just spending on sports and exercise programs – you can’t have a healthy economy or healthy budgets if you don’t have a healthy population.” “Two years is too long” for the third wave of government’s reform for Indigenous health interventions, Public Health Association of Australia CEO Michael Moore agreed. “It makes no sense to wait for another two budget cycles to being on this ‘third wave’ of reform when action taken now will save in the long term.” Australian College of Nursing CEO Kylie Ward expressed disappointment of the continued lack of strategy on nursing workforce development, especially given predicted nurse shortages. This included NPs working to their full potential.
12 June 2017 Volume 24, No. 11
Government Budget’s ‘four pillars’ of health system • Guaranteeing Medicare and the
Pharmaceutical Benefits Scheme
• Supporting hospitals • Prioritising mental health, preventive
health and sport
• Investing in medical research • $94.2 billion in health, aged care
and sport
• $10 billion package in health
system
• Medicare increase from $23.7
billion in 2017-18 to $27.9 billion in 2020-21
• $957 million to retain bulk-billing
incentives for pathology and diagnostic imaging
• $374.2 million in My Health Record
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BUDGET AGED CARE
NO CARE FOR AGED CARE
Aged care has again been hit in the latest Federal Budget with several industry stakeholders resigned to lack of investment in the sector. The ANMF came out firing for the lack of funding for aged care. “Australia faces a shortage of 20,000 aged care nurses, but there’s been no reversal of the crippling $1.2 billion in funding cuts, no regulations for mandated, safe staffing ratios for nurses and carers,” ANMF Federal Secretary Lee Thomas said. “Nurses and AINs are finding it harder and harder to cope with dangerously high workloads and there’s been a notable rise in the number of missed care episodes at aged care facilities across the country. Without adequate targeted funding the care they can provide to their residents continues to be compromised.” Leading Aged Services Australia said a “no surprises” aged care budget with “no further cuts to aged care” was welcomed. “The Turnbull Government’s first federal Budget since its re-election is welcome news after previous federal budgets have seen ongoing cuts to aged care funding and associated programs,” LASA CEO Sean Rooney said. Aged & Community Services Australia CEO Pat Sparrow said while there were “no surprises in this year’s Budget but there are some useful initiatives”. The 2017-18 Budget provided for $1.9 million over two years to establish and support an industry-led aged care workforce taskforce. The taskforce is aimed to improve productivity in the aged care workforce and contribute to development of an aged care workforce strategy, including for regional and remote areas. The government extended funding for the Commonwealth Home Support Program to July 2020. In addition, $3.1 million has been provided for the My Aged Care service. Several government reviews into aged care are pending including the Legislated Review of aged care reforms, the Senate Inquiry into the aged care workforce and review of the aged care funding instrument. “It is critical that these reviews are used in future Budgets to progress the reform destinations envisaged in the Roadmap for Aged Care Reform,” Catholic Australia CEO Suzanne Greenwood said. “However we are concerned at a delay in developing an integrated aged care assessment service, and the lack of a definitive commitment to implement the Aged Care Reform Roadmap on a firm and prompt timetable,” COTA Chief Executive Ian Yates said. Palliative Care Australia welcomed the announcement of $8.3 million for primary health networks to coordinate the care of people at the end of life, including palliative care specialists, GPs, community nurses and nurse practitioners.
• $5.5 billion extend funding for Commonwealth Home
Support Program
• $3.1 million in 2017/18 to improve My Aged Care • $1.9 million over two years for aged care sector workforce
strategy
• $8.3 million over three years for home-based palliative care
through Primary Health Networks
NURSING STUDENTS TO SUFFER
Students dreaming of becoming nurses and midwives have been impacted by the Federal Budget’s hike in the cost of university degrees. ANMF Federal Secretary Lee Thomas said nursing and midwifery students would be forced to pay thousands of dollars more to complete their education. “They’ll have to start repaying their HECS debt much sooner after the Budget cut the income threshold down to $42,000. The ANMF is disappointed the government can deliver up to $50 billion in corporate tax cuts to big businesses, but can target Australia’s next generation of nurses and midwives.”
MENTAL HEALTH STATE DEPENDENT
States and territories are now under pressure to match the Commonwealth’s Budget investment of $173 million to deliver on community based mental health services. The government announced $80 million to assist people with severe mental illness and psychosocial disability who will be ineligible for the NDIS. Mental Health Council of Australia CEO Frank Quinlan said access to services had been uncertain since governments agreed to wind down a range of mental health programs to fund the NDIS. “Our attention will focus on states and territories who are now invited to match the Commonwealth investment. There is much more that needs to be done to guarantee that people living with complex mental illness are not left worse off as a result of the reforms,” SANE Australia CEO Jack Heath said. Lifeline Australia welcomed $11 million over three years to save lives at suicide hotspots. “We know that suicide prevention measures at hotspots save lives,” Lifeline Executive Director Alan Woodward said.
Fewer pregnant women experience constipation with Maltofer * 1
Ferrous sulfate Maltofer
23% of patients 2% of patients
Ensure they get the iron you intended. For more information, visit maltofer.com.au *Versus ferrous sulfate. Maltofer contains Iron as Iron Polymaltose. Reference: 1. Ortiz R et al. J Matern Fetal Neonatal Med 2011;24:1–6. Study size n = 80. Maltofer® is for the treatment of iron deficiency in adults and adolescents where the use of ferrous iron supplements is not tolerated, or otherwise inappropriate; and for the prevention of iron deficiency in adults and adolescents at high-risk where the use of ferrous iron supplements is not tolerated, or otherwise inappropriate. Maltofer® is a registered trademark of Vifor Pharma used under licence by Aspen Pharmacare Australia Pty Ltd. For medical and product enquiries, contact Vifor Pharma customer service on 1800 202 674. For sales and distribution enquiries, contact Aspen Pharmacare customer service on 1300 659 646. Date of preparation: December 2016.
anmf.org.au
Body-friendly iron June 2017 Volume 24, No. 11 13
NEWS DR JENI KLUGMAN AND VICHEALTH CEO JERRILL RECHTER
AGED CARE QUALITY REGULATION REVIEW The federal government’s announcement of a review into how quality care in nursing homes is regulated has been welcomed by the aged care sector.
BEHAVIOUR CHANGE FOR GENDER EQUALITY A series of behaviour change research trials to tackle gender inequality are underway with early insights presented in Victoria last month. Global gender equality expert and economist Dr Jeni Klugman delivered several public talks and forums with health promotion foundation VicHealth as part of a three-year role into how behaviour change can impact gender equality. Australia recently dropped to 46th in the World Economic Forum’s gender equality ranking - 31 places below its 2006 rank. High rates of domestic violence, persistent wages gaps and a lack of women in senior leadership roles held Australia back, Managing Director at the Georgetown Institute for Women, Peace and Security Dr Klugman said. “Despite having access to education, legal protections and supportive government policy, Australian women still aren’t getting the same opportunities as men and it’s costing the economy billions.” Dr Klugman’s work involves the science of behavioural insights to change harmful social norms to drive improvements for women and girls. Underlying causes of inequality included: social practices and norms; unconscious/implicit bias; and 14 June 2017 Volume 24, No. 11
“DESPITE HAVING ACCESS TO EDUCATION, LEGAL PROTECTIONS AND SUPPORTIVE GOVERNMENT POLICY, AUSTRALIAN WOMEN STILL AREN’T GETTING THE SAME OPPORTUNITIES AS MEN AND IT’S COSTING THE ECONOMY BILLIONS.”
gender stereotypes. “Gender equality is multidimensional, it is happening in our homes, our workplaces, our schoolyards, on our television screens and on our sporting fields,” Dr Klugman said. Gender breakdown of sources in Australian newspapers showed 79% were male and 21% female. Portrayal of women and men in sports news also exacerbated stereotypes. In one example a channel 7 news presenter asked Canadian tennis star Eugenie Bouchard to twirl during an on court TV interview at the Australian Open in 2015. “They [women] are often objectified and their achievements often considered ‘luck’ or attributed to coaches,” Dr Klugman said. Harmful perceptions that women don’t deserve the same opportunities as men had negative impacts for women at home and in the workplace, she said. “The good news is we can change attitudes and biases but we need to determine what approaches work best in shifting attitudes, expectations and behaviours.”
Federal Aged Care Minister Ken Wyatt announced the review of the aged care quality regulatory processes following a review of major failures of care found in South Australia’s Oakden Older Persons Mental Health Service. The SA government review uncovered systemic and longstanding failures of care at the Oakden facility. Recent media reports revealed gross misconduct and abuses. Sanctions had already been imposed on the North Adelaide Health Network by the federal government’s aged care quality agency in 2008. “I want this review to assure me and the community that the regulatory system in residential aged care works effectively,” Minister Wyatt said. COTA Chief Executive Ian Yates said despite formal accreditation and complaint processes mandated by successive governments, some poor behaviour continued to ‘fly below the radar’. Many residents and families affected were not confident enough to complain, he said. “This is a frequent observation from residents and families of residents in some nursing homes – that an accreditation review happens and the nursing home passes but the issues they were concerned about continue.” ANMF Federal Secretary Lee Thomas said any investigation into care failures must dig deeper. “It must examine how the lack of qualified nursing staff is regularly resulting in missed care for patients.” ANMF research has shown nursing home residents should receive an average of more than four hours of care a day where currently they only receive 2.84 hours. There should also be a minimum skills mix of 30% RNs, 20% ENs and 50% personal care workers, Ms Thomas said. “Again, that’s not happening, which is why we are seeing increasing numbers of missed care episodes in nursing homes across the country.” Aged & Community Services Australia Acting CEO Darren Mathewson said ACSA understood the community needed to be assured that the Commonwealth’s system of regulation worked as it should. “When the review recommendations are handed down in July, there needs to be capacity for engagement with the industry around how they are implemented.”
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NEWS
NSW SET TO CONSIDER ASSISTED DYING LEGISLATION Legalised voluntary euthanasia has been put back on the agenda in New South Wales with the release of the Draft Voluntary Assisted Dying Bill 2017 which if given the green light will allow terminally ill people to choose to end their life.
The Bill marks the result of a handful of MPs with diverse political allegiances collaborating to create a legal framework to allow compassionate choice for terminally ill people experiencing suffering. Over the past two years, a cross-party working group looked at assisted dying legislation across numerous overseas jurisdictions where laws have existed for up to two decades. The Parliamentary Working Group also gauged the views of key stakeholders to determine the eventual Bill and its strict criteria and safeguards for requesting voluntary euthanasia. For example, under the proposal, the laws would only apply to people aged over 25 who have been given less than a year to live and are experiencing extreme pain or suffering. The draft laws also states doctors would prescribe or prepare an “authorised substance” for the patient, which could be self-administered, or alternatively administered by the doctor. Other safeguards include the patient having to be assessed by an independent psychiatrist or psychologist and a two-day cooling off period. Dying with Dignity NSW spokesperson Shayne Higson said the progressive Bill could help relieve prolonged suffering. “There are certain aspects of this Bill that some of our members may find too
THE BILL MARKS THE RESULT OF A HANDFUL OF MPS WITH DIVERSE POLITICAL ALLEGIANCES COLLABORATING TO CREATE A LEGAL FRAMEWORK TO ALLOW COMPASSIONATE CHOICE FOR TERMINALLY ILL PEOPLE EXPERIENCING SUFFERING. restrictive, including the over 25 years age limit, and eligibility criteria being limited to people with terminal illness. “However, if having the tightest Bill in the world means that it will be passed, we are willing to accept that 70% of something is better than 100% of nothing.” New South Wales’ most recent foray into voluntary euthanasia dates back to its Rights of the Terminally Ill Bill 2013, which saw proposed laws soundly voted down in the Upper House. The state’s latest bid for assisted dying laws follows South Australia’s unsuccessful push late last year, where a voluntary euthanasia Bill was defeated in Parliament by a single vote. Victoria is next cab off the rank and is now poised to deliberate its own legislation later this year.
Nurse Writers Needed Wolters Kluwer a provider of expert solutions in health care is recruiting Nurses to serve as Contributors and Reviewers. Nurses are being invited to contribute to the development of Lippincott Procedures an Evidence Based online product providing step-by-step procedures and skills for nurses in a variety of clinical settings. Your contributions or reviews can be developed in your own home and time to be published and used by nurses at the point-of-care and educational settings. Interested nurses must be Registered Nurses (Division 1) with at least 5 years experience in an acute clinical setting. Experience with policy and procedure creation and maintenance is desirable.
Please submit your expression of interest and Curriculum Vitae to vaughn.curtis@wolterskluwer.com For more information on Lippincott Procedures visit: www.lippincottsolutions.com/solutions/procedures
WORLD
NEW ZEALAND
GLOBAL
Workforce strategy needed to attract and retain Mãori nurses
Hepatitis is fast becoming a growing concern
Without a Māori Nursing workforce strategy, the aim to attract and retain thousands more Māori nurses into nursing would never be realised according to New Zealand Nurses Organisation (NZNO) Kaiwhakahaere Kerri Nuku
New data from the World Health Organization (WHO) has revealed that an estimated 325 million people worldwide are living with chronic hepatitis B virus (HBV) or hepatitis C (HCV) infection.
Ms Nuku made the statement at the United Nations forum of the United Nations Declaration on the Rights of Indigenous People (UNDRIP) in New York recently. “It is unacceptable that nothing has been done to attract more Māori into nursing in Aotearoa New Zealand since I last addressed the UNDRIP forum two years ago,” she said. “It is clear that matching the demographics of the workforce to population, ethnic makeup improves health outcomes. Culturally appropriate health services are economically sensible and the right thing to do for our Indigenous people. “Māori nurses offer a whanau and holistic approach to health and wellbeing and this is proving effective for Māori, particularly in deprived areas. I don’t see a decent commitment to rolling out this approach where needed, or the funding commitment to pay Māori nurses working with Māori health employers on a par with other health providers. “Clearly the government is not fulfilling its obligations under Article 20, Convention 169 of International Labour Organisation agreement to do everything possible to prevent discrimination between workers, and achieve equal remuneration for equal value.” Māori nurses make up 7% of the nursing workforce yet the Māori population is around 15%.
16 June 2017 Volume 24, No. 11
According to WHO the large majority of these people lack access to life-saving testing and treatment. As a result millions of people are at risk of a slow progression to chronic liver disease, cancer and death. Viral hepatitis caused 1.34 million deaths in 2015, a number comparable to deaths caused by tuberculosis and HIV. But while mortality from tuberculosis and HIV have been declining, deaths from hepatitis are on the increase. While Hepatitis B levels vary across the world, the African Region and Western Pacific Region share the biggest burden. “Viral hepatitis is now recognised as a major public health challenge that requires an urgent response,” said Dr Margaret Chan, WHO Director General. There is currently no vaccine against HCV, and access to treatment for HBV and HCV is still low. WHO’s Global Health Sector Strategy on viral hepatitis aims to test 90% and treat 80% of people with HBV and HCV by 2030. “We are still at the early stage of the viral hepatitis response, but the way forward looks promising,“ said Dr Gottfried Hirnschall, Director of WHO’s Department of HIV and the Global Hepatitis Programme. “More countries are making hepatitis services available for people in need. But the data clearly highlights the urgency with which we must address the remaining gaps in testing and treatment.”
IRELAND
Irish nursing and midwifery graduates plan to leave the country Over 78% of nursing and midwifery students studying in Ireland plan to emigrate upon qualification according to a survey conducted by the Irish Nurses and Midwives Organisation (INMO). However, nearly the same number of respondents said they would consider staying in the Irish public health service for at least a year upon qualifying if offered guaranteed permanent contracts. The survey results suggested that 70.2% of respondents had been approached by overseas recruitment agencies, while only 29.8% had been offered permanent or part time positions in the Irish public health service. “The results of this survey have clearly put into perspective the ongoing crisis in the recruitment and retention of nurses and midwives in the country. It highlights the significant need to improve the current incentives being offered in the public health service and the need to offer full-time permanent posts to current interns much earlier in their 4th year. This trend must be halted given the current crisis in the public health service, Ireland’s ageing population and increasing demands on the public health system.” “The number of nurses and midwives working in the Irish public health service has reduced from 39,006 in 2007 to 35,835 in 2016. The actual number is less given that 2% are on maternity leave at any given time and there is very little replacement,” said Phil Ni Sheaghdha INMO Director of Industrial relations. “Our new graduates continue to be lured abroad and into private hospitals in Ireland by high cost area supplements access to ongoing education, signing on bonus, accommodation allowances etc.”
anmf.org.au
SELF CARE
On night duty I make sure my bed has fresh sheets, sleepy spray for my pillow and the bath is clean so I can soak after a long BREAKLESS SHIFT!
Leonie
My top tips for self-care are; debriefing after a stressful day with colleagues, scheduling social events to maintain a work-life balance, relaxation exercises, and drinking lots of water and getting enough sleep. Without these things, I wouldn’t be able to be the best nurse I can be.
For my own wellbeing I like spending time gardening especially growing vegetables. I find gardening very relaxing and it takes my mind off of the stress of work.
Nicole
Carmen
Every day, I document three things that I have achieved that day. A simple, powerful practise that encompasses gratefulness leading to wellbeing. Try It :)
To remind myself that even though I am a nurse and love my job, that it is a job, not my whole life and I am allowed to turn it off when I am not there and focus on myself and my family.
Jennifer
Kylie
WHILE LOOKING AFTER YOURSELF SHOULD BE ON TOP OF THE PRIORITY LIST, THE REALITY CAN SOMETIMES BE QUITE DIFFERENT. LAST MONTH WE ASKED MEMBERS FROM ACROSS THE COUNTRY TO SHARE THEIR TIPS ON WELLBEING. ONE LUCKY CONTRIBUTOR HAS WON A $1,000 GIFT VOUCHER FROM FLIGHT CENTRE FOR THEIR EFFORTS AND WILL BE NOTIFIED SOON. WE HOPE YOU FIND THESE TIPS USEFUL IN HELPING TO LOOK AFTER YOU.
To enjoy a personal hobby or passion and NOT FEEL GUILTY about it. Allowing myself to enjoy some yoga is one of my favourite ‘time out’ moments. Switching off, forgetting about work-life stresses and relaxing with a clean conscience is SO satisfying!
I listen to music in the car on the way home from work and match the songs to different work situations, helps me to unwind
Brittany
Kate
Cut caffeine, cut social media, add vitamin B, with a laugh and stretch with colleagues pre shift, breathe deeply, hydrate.
Stefanie
I have stopped consuming sugar, allowing a healthy weight loss; improved sleep; eliminated sweet cravings; clear skin; improved gym workout and an overall feeling of enhanced wellbeing.
Have a “Jim Jam” day, I shower using fragrant body wash, fresh PJ’s, scented candles, music, a book/magazine. This is my daya treat.
Lynne
Diana
anmf.org.au
June 2017 Volume 24, No. 11 17
PROFESSIONAL
WHAT’S SO SPECIAL ABOUT ‘SPECIALTY’? Julianne Bryce
Elizabeth Foley
Julie Reeves ANMF Federal Professional Officers
CONGRESS OF ABORIGINAL AND TORRES STRAIT ISLANDER NURSES AND MIDWIVES (CATSINaM) CEO, JANINE MOHAMED, KIRKLAND PHOTOGRAPHY
Reference Chang, A., Gardner, G., Duffield, C., Ramis, M-A. 2012. Advanced practice nursing role development: factor analysis of a modified role delineation tool. Journal of Advanced Nursing, 68(6), 13691379. Gardner, G., Duffield, C., Doubrovsky, A., Adams, M. 2016. Identifying advanced practice: A national survey of a nursing workforce. International Journal of Nursing Studies, 55, 60-70.
We’ve recently been to two national forums which, on the face of it, appeared to have very different agendas. However, on reflection we can see that there was a commonality of themes. The first, a two day symposium convened by the Commonwealth Chief Nurse and Midwifery Officer, Deb Thoms, was held in Canberra in March. The aim of the symposium was: to debate the concept of advanced practice based on the research commissioned by the ANMF and conducted by Professor Glenn Gardner and Professor Christine
remote Australia. This conference was immediately followed by the 14th WONCA World Rural Health Conference, an international event with over 900 delegates from 37 countries around the world exchanging information on the latest developments and challenges in rural family practice and rural and remote health generally. Although
panel for the workshop which was well attended with 64 participants. Following the panel, the group work discussion at the workshop generated five recommendations which were added to the overall conference recommendations. A list of the priority recommendations from the conference can be viewed at: www.ruralhealth.org.au/14nrhc/ recommendations There was much discussion at the rural conference about the importance of generalist practice. It was suggested a number of times that there is a need for a rural generalist nurse pathway. This was spoken about as if it’s a new concept. Nurses
IT IS THE GENERALIST ATTRIBUTES OF NURSING THAT DEFINE YOU AS A NURSE NOT THE CONTEXT OF YOUR PRACTICE, WHICH MAY OR MAY NOT BE A SPECIALTY.
Duffield (2012, 2016) ; and to engage stakeholders in discussion exploring the relevant prescribing models and associated regulatory requirements that would support implementation of nurse and midwife prescribing. Approximately 200 participants discussed advanced practice role development using the domains identified in the research, those being: clinical care; education; research; systems management; and leadership. These generalist attributes were found to be identifying features for advanced practice registered nurses. Group work discussion at the advanced practice forum kept coming back to the concept of specialty versus generalist practice. Many seemed to think that specialising is the only pathway to advanced practice. The research tells us that this isn’t the case. The domains of advanced practice are generalist. The second forum, the 14th National Rural Health Conference, A World of Rural Health, convened by the National Rural Health Alliance, was held in Cairns in April. There were more than 1,200 delegates in attendance to discuss issues impacting the health and wellbeing of the 6.7 million people in rural and
18 June 2017 Volume 24, No. 11
I’m declaring my bias up front, the very best of the plenary speakers for the NRH Conference were both nurses. Central Queensland University Professor of Nursing and Midwifery, Gracelyn Smallwood and Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) CEO, Janine Mohamed, who received a standing ovation. These impressive nursing and midwifery leaders took us on a journey, one looking at the integration of world views on health and wellbeing and the other painting a picture on what it would look like in the future if we truly closed the gap in health inequality. Nursing and midwifery is represented on the National Rural Health Alliance by the ANMF, CATSINaM, CRANAplus, the Australian College of Nursing Rural Nursing and Midwifery Community of Interest and the Australian College of Midwives Rural and Remote Advisory Committee. These organisations jointly conducted a pre-conference workshop for nurses and midwives, titled ‘Rural and Remote Workforce Sustainability – is it possible?’ which was sponsored by James Cook University. Queensland Branch Secretary, Beth Mohle represented the Federation on the
working in a rural context of practice have always been rural generalists. What is the purpose of a so-called pathway? Is it a means to require nurses to jump through more hoops to work in rural areas? Is it so we can say that being a rural generalist nurse is a specialty? The undergraduate nursing curriculum produces a generalist. Then we move into a context of practice and start to define ourselves by ‘specialty’. Are mental health, aged care, rural health, general practice, paediatrics, acute care, remote health, community health all nursing specialty’s or are they a context of practice? What is to be gained by defining ourselves by specialities rather than as a registered nurse working at a particular time in our nursing career, in a particular context of practice? Labelling ourselves only by our current context of practice, restricts our role and scope of practice. It is the generalist attributes of nursing that define you as a nurse not the context of your practice, which may or may not be a specialty. Be proud of your context of practice but remember we are all, first and foremost, a generalist nurse. anmf.org.au
FEATURE
BEATING THE ODDS HOW INDIGENOUS NURSES AND MIDWIVES ARE CLOSING THE HEALTH GAP
“It’s incredibly challenging because every day as Aboriginal and Torres Strait Islander people we are forced to constantly educate ignorant people on what to say and what not to say.” BANOK RIND
— PHOTO: BANOK RIND. PHOTOGRAPHY: CARLA GUTTGENS / OXFAM AUSTRALIA
FEATURE The vast health disparities between Aboriginal and Torres Strait Islander people and the rest of the Australian population has been a longstanding issue. While urgency to improve health outcomes for Indigenous Australians is evident, the gap continues to widen, gripping everything from life expectancy to the burden of chronic disease and suicide. It’s now been acknowledged that building a robust Indigenous nursing and midwifery workforce is a key solution to achieving health equity. Robert Fedele speaks to the next generation of nurses and midwives determined to make change.
B
anok Rind was the sole Aboriginal student at her high school. Many of her peers had never been exposed to an Aboriginal person before and she invariably spent time educating them on how best to interact. It didn’t spare her from facing racism on more than one occasion. Like the time a teacher told her she wouldn’t finish school or amount to anything of worth. “It motivated me to believe that those stereotypes aren’t true,” Banok recalls. “Just wanting to show that our people, Aboriginal and Torres Strait Islander people, aren’t drunks, aren’t unemployed. There are so many of us that are well educated in the health system.” Banok grew up in Western Australia and moved to Victoria when she was 15. Her roots chart back to the lands of her father’s family in Mount Magnet, Badimia country, about 600 kilometres north-east of Perth. When she returns to visit, Banok relishes connecting with her country and reflecting on the resilience of her people. Banok was drawn to a career in nursing after witnessing the cluster of chronic diseases, particularly diabetes, which struck down her extended family while she was growing up. “I’ve always known that I wanted to go back into the community and change the face of our health because the disparities between Indigenous people and non-Indigenous people are quite large.” Banok studies nursing at RMIT University and is about to graduate after recently completing her final placement at St Vincent’s public hospital. The 22-year-old is set to enter a health system stained by ongoing racism, evidenced by the most recent Closing the Gap report that painted a picture of widespread discrimination and called for urgent action. Banok isn’t surprised. During one of her hospital placements as a student she could not handle the environment any longer and eventually left after it was deemed culturally unsafe for her to stay. Another occasion she witnessed a group of health professionals questioning a patient’s Aboriginality because of the colour of their skin. “It made me question whether or not he would be given the appropriate care. “It’s incredibly challenging because every day as Aboriginal and Torres Strait Islander people we are forced to constantly educate ignorant people on what to say and what not to say.” Despite obvious hurdles, Banok isn’t giving up. Significantly, her entry into the workforce typifies an emerging breed of Indigenous health professional committed to making a difference. “I want to create a safe environment where people, whether it’s my community or other people’s community, come into a health service and feel like they’re going to be taken care of because it’s their own people taking care of them,” she says.
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This year’s face of Oxfam’s Closing the Gap campaign, Banok believes the health gap can be closed. “I want to see government actually listening to us and considering community based solutions that are community controlled as opposed to the governments’ usual one size fits all approach because every Aboriginal community is different and the needs of every community are different.”
BUILDING WORKFORCE
The Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) is leading the push to boost Indigenous nursing and midwifery numbers. According to the Australian Institute of Health and Welfare (AIHW), in 2015 there was 3,187 nurses and midwives who identified as Aboriginal and Torres Strait Islander, with the Northern Territory and Tasmania employing the most workers. Figures, however, show growth has been stagnant over the past decade despite increasing need. CATSINaM CEO Janine Mohamed says Indigenous nurses and midwives can help close the health gap by triggering a more culturally safe health system which Aboriginal people are more likely to access. “Aboriginal people don’t just work their shifts. They provide health literacy in the homes to their families. They’re an economic contributor. They are also role models for other people in their community wanting to take on nursing or midwifery as a career.” CATSINaM continues to work tirelessly in its mission to embed cultural safety into the health system. Various strategies include conducting cultural safety workshops, building cultural safety codes of conduct, tapping into university curriculums, and lobbying governments to enact legislation. Ms Mohamed stresses cultural safety is a two way street and that the remaining 97% of the non-Indigenous population, particularly nurses and midwives, also needs to improve its knowledge. “What we’re ultimately after is leaders in this space and a seamless transition for someone from university to the health service to that cultural safety being part of the norm.” Ms Mohamed says many barriers stop Aboriginal and Torres Strait Islander people from pursuing nursing and midwifery, including a lack of education pathways and support systems. Significantly, she lists racism as an overarching issue. “If you look at Aboriginal health as a whole, just having them [nurses and midwives] within the system reduces racism. “In terms of key health concerns, primary healthcare and giving people health literacy and prevention rather than a cure is what we’re aiming for because when you look at the
“Aboriginal people don’t just work their shifts. They provide health literacy in the homes to their families. They’re an economic contributor. They are also role models for other people in their community wanting to take on nursing or midwifery as a career." JANINE MOHAMED, CATSINaM CEO
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“A lot of people have a misconception of what it actually means. They believe it means that all Aboriginal women want to have their babies in the dirt. That’s not what it’s about. It’s about bringing birthing closer to the home and understanding and appreciating the cultural competency required to facilitate those services for Aboriginal women.” MARNI TUALA, INDIGENOUS MIDWIFE/NSW DIRECTOR OF CATSINaM
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June 2017 Volume 24, No. 11 21
FEATURE “I could see all the chronic health diseases like asthma, kidney failure, heart disease and obesity and all these things that were just evident in nearly every single patient that came through our door, which is very different to a non-Indigenous person with a similar age bracket and background.” JOSHUA PAULSON, INDIGENOUS RN
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FEATURE statistics we have higher rates of everything across the board but some of the areas of concern like diabetes and cardiovascular disease are completely and utterly preventable.”
GROWING DISPARITY
The ninth Closing the Gap report card, unveiled by Prime Minister Malcolm Turnbull in February, delivered a dire snapshot of the widening disparity between Indigenous and non-Indigenous Australians. Troublingly, just one of the seven Closing the Gap targets is on track a decade after the federal government committed to addressing Indigenous disadvantage. The target to close the gap in life expectancy by 2031 is not on track, with at least a 10-year discrepancy remaining. Cancer rates continue to rise, the push to halve infant mortality rates by 2018 is falling short, and employment has also stalled. The cluster of preventable chronic diseases too remain problematic. The Close the Gap campaign, run by Oxfam and the Human Rights Commission, released its 2017 progress and priorities report in March, using it to blame the government’s inaction and table 15 recommendations to ignite change. Recommendations included calls for a National Summit with Aboriginal and Torres Strait Islander leaders in 2017 to forge a collective path forward, restoring funding, holding a national Inquiry into racism and institutional racism within healthcare settings, particularly hospitals, and a re-invigorated national approach to health inequality. One of the key focus’ of this year’s report also included boosting the number of Aboriginal and Torres Strait Islander health professionals and investigating the social and cultural determinants of health.
INDIGENOUS HEALTH WORKERS CRUCIAL
Recent Newcastle University nursing graduate Joshua Paulson is an emerging Indigenous nurse determined to close
the health gap. Joshua is a proud Worimi and Baudjalung man who grew up on Biripi country in Taree. The 28-year-old began working as an Enrolled Nurse after finishing high school in 2008. “I just liked the involvement with people and the difference you could make in somebody’s life, whether it be directly or indirectly,” he says. As a young Indigenous nurse working across public hospitals, Joshua claims he didn’t experience racism directly yet did witness what the community faced. “If an Aboriginal person was in the healthcare setting I noticed the way they were treated and spoken to was very different to how other people were spoken to.” After working as an EN for eight years, Joshua decided to enrol in nursing in a bid to expand his skills and scope of practice as an RN. For the past two years, Joshua has worked casually at the Biripi Aboriginal Medical Service at Taree where he saw the health disparity first hand. “I could see all the chronic health diseases like asthma, kidney failure, heart disease and obesity and all these things that were just evident in nearly every single patient that came through our door, which is very different to a non-Indigenous person with a similar age bracket and background.” Joshua prefers to view the grim health statistics as an opportunity to inspire change. He believes his skills could be best utilised working across Indigenous communities in primary healthcare roles where he can influence early prevention of the most problematic diseases. “I think Indigenous people take health information a lot better from other Indigenous people.” For now, Joshua is uncertain where his health career will take him but he maintains his core goal revolves around mentoring other Indigenous people to pursue careers in health or education.
EMPOWERING COMMUNITIES
Indigenous RN Sean Taylor was among the first crop of nurses to graduate from James Cook University’s (JCU) Thursday Island
campus in the Torres Strait in 2005. He began his career earlier on Mer Island as an Indigenous health worker where he was struck by the prevalence of diabetes. “I saw the diabetes epidemic swish through the Torres Strait and I saw some poorly controlled diabetes and a lot of the complications that were faced with diabetes and it made me go on and study nursing.” After graduating as an RN, Sean worked in various places across Australia, both clinically and in research, investigating diabetes. He is currently undertaking a doctorate of Public Health investigating the association between health and glycaemic control among Torres Strait Islanders. Reflecting on his journey from Aboriginal Health Worker to diabetes educator and nurse leader, Sean suggests motivation has come easy. “Every time people die it inspires me to do more and more. Losing family members and unnecessary complications associated with chronic disease. “Torres Strait Islanders have the highest prevalence of Type 2 diabetes in Australia and the prevalence or the complications associated with diabetes is evident in most of these communities and I saw with the naked eye how it can destroy a population.” Working in Indigenous communities while completing his doctorate, Sean says he noticed an increase in attendance rates and compliance regarding accessing health and diabetes treatment. “I don’t think it’s just because you’re an Indigenous nurse. You’ve got to build your trust like anybody else and that’s what I found.” Since graduating in 2005, Sean believes there’s been a noticeable increase in Indigenous people becoming health workers, then transitioning into nursing. He believes more Indigenous people should move into public health, research, and primary healthcare to promote better prevention and self-management. “The nurses are too focused on acute care in these primary healthcare centres and not focused on public health and primary healthcare. “It’s about empowering the people. The
CLOSING THE GAP CAMPAIGN Run by Oxfam, Close the Gap is Australia’s largest campaign to improve Aboriginal and Torres Strait Islander health equality. Launched in 2006 by Cathy Freeman and Ian Thorpe, the campaign continues to play a leading role in shaping government policy by working with Aboriginal and Torres Strait Islander organisations to hold government to account. The campaign is calling on all governments to take real action to achieve Indigenous health equality by 2030. Its key objectives include the implementation and monitoring of a comprehensive National Action Plan developed in partnership with Indigenous communities and health organisations; improving Indigenous participation, control and delivery of health services; and a commitment to investing in strengthening of the Indigenous health workforce. Australians can support the enduring Close the Gap campaign by taking part in annual National Close the Gap Day events in March and signing the pledge. Find out more at www.oxfam.org.au
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June 2017 Volume 24, No. 11 23
FEATURE communities need to take control. We can only provide 50% of healthcare and the community has to take the other 50%.”
3,187
nurses and midwives employed in Australia identified as Aboriginal or Torres Strait Islander in 2015
LOCAL SOLUTIONS DELIVERING OUTCOMES
73.7 / 83.1 years
University of New England Indigenous nursing student Katie Brett is another hoping to close the health gap in her own community of Tamworth. Katie followed in the footsteps of her mother, an Enrolled Nurse, to become an Assistant in Nursing in the aged care sector after finishing high school. Motivated to improve Aboriginal health outcomes, Katie embarked on becoming an RN two years ago and is on the cusp of graduating. As part of her education she has undertaken several placements in the health system, including with the renowned Purple House in Alice Springs, an organisation which carries out dialysis treatment. She’s also given back to her own community, working at Tamworth’s Coledale Health and Education Centre. The centre is largely accessed by Aboriginal people and Katie says several community development and health programs are facilitated from the hub. Katie believes Aboriginal and Torres Strait Islander nurses are vital to closing the gap. “People feel more comfortable coming to a centre if they know there’s other Aboriginal people that work there. A lot of the time it’s just that they don’t feel comfortable going to a mainstream clinic. They don’t like going to the hospital.” Earlier this year, Katie was among 10 university students with a passion for rural and remote health awarded a scholarship by HESTA to enable attending the National Rural Health Conference held in Cairns in April. Scholarship recipients were selected for demonstrating a commitment to improving health outcomes for rural communities and earmarked as future leaders. After completing her studies, she plans to put her energy into improving Aboriginal health as a nurse actively engaging the community. “A lot needs to be done. It’s going to be a long process. Not reaching the targets that were initially set for Closing the Gap, we haven’t met those as yet, so I think a lot more education needs to go into it and a lot more health promotion and awareness, especially in smaller communities. Getting the community involved is the key.”
Indigenous females
EDUCATION PATHWAYS
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1%
of people working in the health workforce are Indigenous
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$4.6 billion
of Australia’s health expenditure in 2010-11 was spent on Aboriginal and Torres Strait Islander people Source: Australian Institute of Health and Welfare (AIHW)
“IT IS IMPORTANT TO HAVE A STRONG INDIGENOUS HEALTH AND AGED CARE WORKFORCE TO PROVIDE CULTURALLY APPROPRIATE SERVICES TO THE ABORIGINAL AND TORRES STRAIT ISLANDER COMMUNITY, AND FOR THE MAINSTREAM HEALTHCARE SYSTEM TO EMPLOY INDIGENOUS HEALTH PROFESSIONALS.” SOURCE: PRIME MINISTER’S 2017 CLOSING THE GAP REPORT
The target to Close the Gap in life expectancy between Indigenous and non-Indigenous Australians by 2031 is not on track
69.1 / 79.7 years Indigenous males
Non-Indigenous males
Non-Indigenous females
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Chronic diseases including circulatory disease, cancer, diabetes, and respiratory disease account for 70% of Indigenous deaths
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Between 1998 and 2015 there was a 21% increase in the cancer mortality rate for Indigenous Australians compared to a 13% decline for nonIndigenous Australians
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Risk factors such as smoking, obesity, alcohol and diet account for 19% of the health gap
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Social determinants including education, employment status, overcrowding and household income account for 34% of the gap
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Indigenous suicide rates are double that of non-Indigenous Australians
24 June 2017 Volume 24, No. 11
Despite greater awareness around the need to bolster the Aboriginal and Torres Strait Islander nursing and midwifery workforce, growth remains slow. Linda Deravin, a Lecturer in Nursing in the School of Nursing, Midwifery and Indigenous Health at Charles Sturt University, recalls working for a local health district in 2010 and attempting to encourage Indigenous people to consider nursing cadetships. “The uptake was quite poor and I wondered why that was and there were a range of reasons for why Indigenous people weren’t coming into nursing at that particular time, even though scholarships were being offered. Some of those were because of a lack of support services to help them study and to help them move through into working as a nurse.” anmf.org.au
FEATURE
“People working in isolation can only do so much but if we work together we can do so much more. I’d like to see more representation of Indigenous people in nursing because I believe if we have more Indigenous nurses they will have a stronger voice and will be able to make change, particularly in nursing, because we are such a large workforce in health.” LINDA DERAVIN, LECTURER IN NURSING IN THE SCHOOL OF NURSING, MIDWIFERY AND INDIGENOUS HEALTH AT CHARLES STURT UNIVERSITY
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Ms Deravin says better promoting scholarships could unlock one piece of the puzzle. “We need to encourage Indigenous communities that there are these options available. It’s getting the word out that these things are out there and available.” She suggests other areas of potential development surround thinking laterally about expanding distance education into Indigenous communities along with recognising prior learning of people such as Aboriginal Health Workers who often struggle to transition into nursing. Ms Deravin says Aboriginal and Torres Strait Islander people employed in health often fill positions within auxiliary and support services rather than clinical type roles such as nursing and midwifery. Boosting the workforce, she says, requires a multi-pronged approach involving governments, the tertiary sector, the health industry, and communities banding together. “People working in isolation can only do so much but if we work together we can do so much more,” she says. “I’d like to see more representation of Indigenous people in nursing because I believe if we have more Indigenous nurses they will have a stronger voice and will be able to make change, particularly in nursing, because we are such a large workforce in health.” Ms Deravin is currently undertaking a PhD looking into how government policy supports Indigenous people to enter, remain and advance in nursing. At CSU, she says the progressive university is leading the way in instilling cultural competency. “What I see happening is some people identifying as Indigenous that perhaps didn’t previously because now there’s a certain amount of pride coming through which is a small cultural change. “I also see non-Indigenous students really gaining an awareness of what some of their pre-conceived ideas have been and it’s been challenging them in their way of thinking.”
BIRTHING ON COUNTRY
“Torres Strait Islanders have the highest prevalence of Type 2 diabetes in Australia and the prevalence or the complications associated with diabetes is evident in most of these communities and I saw with the naked eye how it can destroy a population.” SEAN TAYLOR
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Indigenous midwife Marni Tuala is helping close the health gap by providing culturally safe continuity of care for Aboriginal women giving birth at Tweed Hospital in New South Wales. Part of her passion also lies in mentoring the next generation of Aboriginal and Torres Strait Islander midwives entering the health system. Marni was appointed the hospital’s first Aboriginal liaison midwife earlier this year, a role created to reflect Tweed’s 7% Indigenous birth rate.“It’s a huge responsibility but also a huge privilege. I wanted to be able to further provide for my community. That’s what it’s about and I know I’m leading the way for Aboriginal midwives coming through underneath.” Marni says the impact of having an Aboriginal midwife on staff at Tweed has been immense, pointing to strengthened relationships within the hospital and a greater emphasis on culturally safe care. There’s a flow on effect to women giving birth and improved outcomes, she adds. A landmark Birthing on Country maternity services program launched in November last year has given Aboriginal women newfound opportunity to give birth closer to home. Typically, indigenous maternity services
in rural and remote Australia have removed and transferred pregnant women from their community to a hospital between 36 and 37 weeks gestation to give birth. The new program involves increasing the cultural competency of health services, establishing primary maternity units, and boosting the Indigenous maternity workforce. Marni, also the newly appointed NSW Director of CATSINaM, described the program as “empowering” and “potentially life changing” for Aboriginal women. “A lot of people have a misconception of what it actually means. They believe it means that all Aboriginal women want to have their babies in the dirt. That’s not what it’s about. It’s about bringing birthing closer to the home and understanding and appreciating the cultural competency required to facilitate those services for Aboriginal women.” Tweed Hospital isn’t one of the pilot sites involved in the program but Marni and the team are nevertheless making their own inroads. “It’s multi-faceted. There’s the element of having another Aboriginal face. The evidence shows Aboriginal people feel more comfortable accessing services when there are other Aboriginal people working in those services. “The other side of it in terms of Closing the Gap is if we are getting these kids into health education and out into health professionals, not only are they improving their circumstance on a socio-economic level – they’re improving health literacy in the home. So it’s a flow on effect for future generations. They’re encouraging their parents, elders, kids, sisters, and brothers to access health services and potentially continue education.”
THE ROAD AHEAD
CATSINaM’s CEO Janine Mohamed is optimistic the next wave of Indigenous nurses and midwives can close the health gap by making it less confronting for Aboriginal people to access healthcare. Ms Mohamed says while racism continues to have a negative impact on the health system the silver lining lies in the fact a conversation around change is happening, courtesy of initiatives like the Close the Gap campaign and recent historic Redfern Statement, where Aboriginal peak bodies came together to get their voices heard. “I think these days when we think of racism as an accelerant of poor health then at least we know that we all have to contribute to eradicating racism.” As change at political level slowly takes shape, Ms Mohamed emphasises health outcomes can only be improved by investing in a strong Aboriginal and Torres Strait Islander nursing and midwifery workforce to deliver care. “The driving force behind what they do is not wearing the nursing uniform. It’s actually some really grounded, deep-seated values around improving Aboriginal and Torres Strait Islander health outcomes. “That usually comes from what they’ve experienced in their young lives, being surrounded by young people who are ill and family members that die at a young age, which is what all those stats really are when you put them into life terms.” June 2017 Volume 24, No. 11 25
ISSUES
THE EXPERIENCES OF RESIDENTS AND THEIR RELATIVES ACCESSING ORAL HYGIENE CARE IN A RESIDENTIAL AGED CARE FACILITY By Sarah Jane Cresp and Maree Bernoth Older people in residential care are at risk of developing complex oral health diseases and conditions (Philip et al. 2012). This is endorsed by Hopcraft et al. (2012), who recognise edentulism rates have decreased from 90% to 50% over the past 50 years, consequently attributing to higher risk of periodontal disease among dentate residents in residential aged care facilities (RACFs). Dental services are not considered to have a role in the RACF. Dentistry is not funded under the Aged Care Funding Instrument (ACFI) hence, there is no incentive for the provision of routine oral care, specific treatment room or equipment. With the approval of an ethics committee, a small study was conducted to gain insight into the perceptions of residents of a RACF and their relatives about the provision of oral care. Three residents and three relatives were interviewed and, although this is a small sample, it raised some of the major issues related to the provision of oral care in RACFs. Their concerns were related to previous oral health practices, accessing dental services, the provision of skilled dental care, and costs. Despite participants having annual dentist visits, most participants required fillings and teeth extractions during childhood due to the severe dental problem associated with the absence of fluoridation in water (Lo et al. 2012; Petersen & Phantumvanit 2012). As described by most participants, having a tooth extracted at school was an agonising experience due to no anaesthetic available, namely: Oh...they were butchers...And then, oh it was murder...and I’ll never forget chloroform. It’s absolutely shocking...it used to make you very, very sick, like vomit and everyone would go through that, like adults and children. So, even though you didn’t feel any pain after...the operation...you were very sick after it, especially everyone would vomit after they’d come round (Luke). The participants described how visits by a dentist to the RACF would be very advantageous. Non-weight bearing residents were precluded 26 June 2017 Volume 24, No. 11
from receiving professional dental care due to no lifting apparatus at the clinic. Weight-bearing older persons transported to a dentist were described as a traumatic and difficult experience. One resident described her own dilemma regarding access to the dentist: ...about two and half years ago...I broke my knee cap one year and the next year, I fell out of the wheelchair and broke my leg...I haven’t been able to walk....I could get a wheelchair taxi, but it depends on the dentist surgery, whether they have wheelchair access and not many of them have proper wheelchair access. When I get into the house, it’s in an old home; with narrow passages and things...I can’t get my [electric] wheelchair around...the other problem [is] I’ve got to have a lifter to get from this chair on to the other [dental] chair....So, I’m afraid it’s one of those things that I keep putting off and wondering what I’m going to do (Joy). Physical access barriers could be eliminated by RACFs providing a treatment room with a dental chair and relevant dental equipment to facilitate regular dentist or dental nurse visits, oral assessments and teeth cleaning which in turn would aid in minimising oral diseases and dental emergencies. This was endorsed by a residents’ relative: Especially, when you take a home the size [120 beds] that you have now...your facility having a dentist chair... would be a fantastic idea!... Dentist calls, like the doctor calls!...I can see a very big use for it...I know it would be a very costly item...We pay for his [resident] haircut, we pay for his [resident] feet to be done...it would be just another one added to the list...And the lifting facilities are in the home there and you could get them
into the chair, where they can do a proper inspection of their mouth and gums (Luke). Financial issues were identified by all participants. The dental services were viewed by most residents as expensive, which in turn led to them deciding against dental treatment. Residents felt they were unable to afford payment even though some relatives were willing to pay for treatment. Costs incurred were more than the cost of treatment. Also, costs involved transport and the cost of a relative or friend being available and able to transport the resident to the dentist surgery. As portrayed by a resident: I haven’t been to the dentist for a couple years now. I know I have to go again, but I’m dodging it...it’s so expensive and I know I’ll have to do something about that plate...I don’t know whether my mouth has got a bit smaller or whether the plate has got a bit worn, but I’ll have to go to the dentist to do something about it...I’m on a pension...[and] for what I was going to probably have done, was going to cost me over six hundred dollars plus the cost of a new plate ...it’s a bit pricey!...I’m on my own, so I have to pay for that...(Joy). All participants acknowledged that poor oral healthcare, physical access restrictions, lack of oral health professionals within the RACF, and financial issues were problematic in receiving optimal oral care. These barriers warrant urgent attention to minimise oral diseases, dental emergencies, and systemic complications among the institutionalised elderly. The findings from this research underline the need for the Australian government to institute policy changes at the local and national level with the aim of providing universal oral health to all Australians. The outcomes of these interviews delineate the perspectives of the residents and their relatives, and the rationale for an increase in the likelihood of residents in RACFs having dental problems. Dental caries and their concomitant infections result in pain, malnutrition, pathophysiology, and reduced quality of life for older people which necessitate the provision of timely, accessible, competent and affordable oral care in RACF.
Sarah Jane Cresp is a Teaching Associate and PhD Candidate in the School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences at Monash University in Victoria Maree Bernoth PhD IS Associate Professor, School of Nursing, Midwifery & Indigenous Health, Charles Sturt University in NSW
References Hopcraft, M. S., Morgan, M. V., Satur, J. G., Wright, F. A., & Darby, I. B. 2012. Oral hygiene and periodontal disease in Victorian nursing homes. Gerodontology, 29(2), 220-228. doi: 10.1111/j.17412358.2010.00448.x Lo, E. C., Tenuta, L. M., & Fox, C. H. 2012. Use of professionally administered topical fluorides in Asia. Advances in Dental Research, 24(1), 11-15. doi: 10.1177/002203451142 9350 Petersen, P. E., & Phantumvanit, P. 2012. Toward effective use of fluoride in Asia. Advances in Dental Research 24(1), 2-4. doi: 10.1177/00220345114 29348 Philip, P., Rogers, C., Kruger, E., & Tennant, M. 2012. Oral hygiene care status of elderly with dementia and in residential aged care facilities. Gerodontology 29(2), 306-311. doi: 10.1111/j.17412358.2011.00472.x
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front line angels The tireless devotion of service nurses Nurses have played a critical role in Australian military history, tending to the needs of sick and wounded soldiers as well as civilians whose lives have been affected by war and natural disaster. This Anzac Centenary triangular coin is inspired by Napier Waller’s iconic stained glass window in the Hall of Memory at the Australian War Memorial.
$
90
each
1300 652 020 eshop.ramint.gov.au
RESEARCH
RESISTANCE TRAINING TO COMBAT INFECTION Nurses may be advising patients to undertake resistance exercise to ward off an infection or help heal an injury in the near future. Queensland researchers found resistance exercise performed at different doses resulted in increased white blood cells central to immune defence. The Griffith University study showed both high and low dosages of resistance exercise increased the immune system’s response. “Importantly, we found that at higher dosages of exercise such as circuit protocol, there appeared to be a more rapid and greater number of these cells in the blood,” Griffith’s Menzies Health Institute Queensland Dr Adam Sziezak said. “We can see that exercise immunology has the ability to make people totally rethink their reasons for exercise. It may not just be for fitness and losing weight; it could also overhaul our whole approach to health.” Regular moderate intensity workouts of 20-45 minutes in the gym could provide protection against URTI, Dr Sziezak said. It may eventually be possible to prescribe resistance exercise in a healthy limb to improve the transport of white blood cells to an injured limb, effectively changing the way injuries are managed, according to the researchers. GPs and nurse practitioners requesting full blood counts should recommend patients abstain from all forms of exercise in the hours prior to blood collection, Dr Sziezak said. “As we now know that exercise can markedly affect the number of white blood cells in the circulation for a short period of time.” The Griffith University study was published in Immunology Letters.
28 June 2017 Volume 24, No. 11
VIRTUAL REALITY DEBILITATING GAMES MOTIVATE PERIOD PAIN TO EXERCISE RESEARCHED Some virtual reality (VR) games can provide enough exertion to be considered exercise according to University of Sydney researchers.
A new research study into why one in five teenage girls experience debilitating period pain is being conducted.
‘Exergames’ – the combination of physical exercise and video games – performed in people’s own homes had the potential to improve people’s physical and cognitive health, the research found. The most common on the Nintendo Wii and Microsoft Kinect platforms delivered the health benefits despite not being explicitly designed as ‘exergames’.
The University of Adelaide study funded by the Australian and New Zealand College of Anaesthetists (ANZCA) Research Foundation suggests the missing link in better understanding the causes of severe period pain may be the activation of the immune system by the female hormone oestrogen.
Results showed Fruit Ninja VR where players hold a virtual sword in each hand to slice fruit in the air resulted in a maximum heart score equal to light exercise or walking. Hot Squats where players squat to duck under oncoming barriers resulted in a heart score considered heavy or comparable to running. Other VR games showed similar results in exertion to dancing and very light activity. Study participants reported they felt they had worked muscles such as their gluteals and legs the next day. The study found the more engaging the game was, the less the participant felt like they were exercising, even when they worked up a sweat. University of Sydney PhD student and study co-author Soojeong Yoo said the motivation and convenience of VR games offered a way for people to achieve the national recommended guidelines for exercise of at least 2.5-5 hours a week. “The participants’ main response was enjoyment of playing the games, rather than feeling it was exercise – this shows that virtual reality games have the potential to make exercise feel fun, engaging and relatively easy.” VR games could also be made more challenging if people wore weights, she said.
Research Partner Dr Susan Evans said chronic period pain was a serious condition that not only affected teenage girls but also one in 10 women of reproductive age. “It is so important that we examine the impact severe period pain has on so many young women. The suffering not only affects them, but their families and society in general. “We are looking at what is different about these young women who suffer so badly. So often their pain is underrecognised. Others find it difficult to understand a pain that can’t be seen, and they can’t imagine having themselves.” Dr Evans said finding new reasons why some women have more pain, may lead to new and more effective medications for both severe period pain and other pain conditions where inflammation is present. “Further development of the blood test used in the study may provide us with a way to measure severe pain, quickly and easily. Improved ways to measure an oversensitive immune reaction to pain is a cutting edge focus of pain research.”
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LEGAL
WHERE HAS THE PATIENT GONE? Linda Starr
Linda Starr 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
From time to time health practitioners are faced with a situation where a patient leaves the facility against medical advice or without advising staff of their intention to leave. This raises ethical and legal concerns for the practitioner who must reconcile their duty to treat with the patient’s right to make autonomous decisions about their healthcare. Not only is it important to reduce the negative impact of ill-advised premature discharge on a patient’s health and the risk of litigation, such untimely discharges also have a significant cost to the healthcare system. Australian research findings have revealed that the financial costs of patients who discharge against medical advice exceed $40 million annually (Laur 2016). Competent adult patients have the right to consent and refuse treatment and have some responsibility for the decisions they make regarding their healthcare choices. Furthermore, a competent adult is free to leave a facility if they choose: compelling them to stay could leave practitioners open to civil actions of battery (intentionally touching a patient against their will) and false imprisonment. A medical practitioner has a legal duty to provide appropriate information to patients when they express an intention to leave against medical advice, however that said, there is no absolute legal protection for practitioners when a patient chooses to leave in these circumstances (Wang v Central Sydney Area Health Service [2000]). And so, what is the risk of liability for the health practitioner in these cases, and what information should the patient be provided with?
Reference Berger Jeffery 2008. Discharge Against Medical Advice: Ethical Considerations and Professional Obligations. Journal of Hospital Medicine Vol 3 p 403. Laur Audrey, 2016. Discharge against medical advice. Journal of Law and Medicine Vol 23 p 921. Wang v Central Sydney Area Health Service [2000] NSWSC 515
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To some extent this will depend on how the patient leaves the service. Did the patient abscond - that is, leave the health facility without advising staff of their intention to do so? Did the patient leave against medical advice (AMA) that is, when the patient leaves the facility before there is a medical recommendation to do so, and where the appropriate discharge documentation/forms have not been completed? Or, was the patient discharged against medical advice (DAMA), where the patient has completed and signed a declaration (often referred to as a risk form) that they are refusing treatment and are leaving the facility against medical advice? (Laur 2016)
A beginning point when faced with AMA/DAMA is the patient’s capacity to make such a decision. Health practitioners routinely make implicit assessments on their patient’s capacity to make decisions about their healthcare. In most cases the patient’s decision is in alignment with recommended care and as such are not questioned and are rarely documented. However, when the patient’s decision appears to be contrary to their welfare and/or the practitioner has a concern about the patient’s health literacy and cognitive ability to make decisions it is critical that more effort is made in assessing their capacity to make the decision and that this effort is reflected in the practitioner’s documentation for example, when patients may be intoxicated from drugs or alcohol or have symptoms of a mental illness.
TREATING PRACTITIONERS CAN MAKE A POSITIVE IMPACT ON PATIENT COMPLIANCE WITH TREATMENT AND CHOICES BY MAKING THE EFFORT TO IDENTIFY THE REASON FOR LEAVING AMA AND TRYING TO FIND A WAY FORWARD USING A MULTIDISCIPLINARY TEAM APPROACH TO LOOK AT THE PATIENTS EMOTIONAL, SOCIAL AND WELFARE CIRCUMSTANCES.
The next important step is to determine why the patient wants to leave and to respond to their decision in a non-judgemental way. For example, some patients may feel the need to leave for personal reasons such as family obligations or social and welfare issues including a lack of personal leave from work, lack of health insurance or funds to pay for treatment. On the other hand, the patient may not trust the system, have had a poor experience in the past or may feel the need to leave to source illicit substances.
Regardless of the reason, the circumstances are likely to have some influence on the voluntariness of the patient’s decision to leave. Hence, the need for health practitioners to make a reasonable effort to ascertain the reason for the patient’s decision to leave, attempt to provide a solution where possible and ensure the patient fully understands the risks involved in their decision (Berger 2008). A risk form alone (standard forms for DAMA) will not necessarily waiver legal responsibility on the part of the health practitioner – particularly when the risk to the patient is high. Any signed and completed DAMA form should be accompanied by detailed documentation in the patient’s case notes as to the identified reasons the patient has refused to stay and accept treatment, the health literacy of the patient, options provided to the patient, others involved in the discussion (eg. patient relatives, medical power of attorney, social worker, spiritual adviser) the risks of refusal of treatment, alternatives, after discharge follow-up options and where relevant, referral to available services. Treating practitioners can make a positive impact on patient compliance with treatment and choices by making the effort to identify the reason for leaving AMA and trying to find a way forward using a multidisciplinary team approach to look at the patient’s emotional, social and welfare circumstances. Ultimately the healthcare provider has an obligation to respect their patient’s autonomy, a legal duty to provide the appropriate standard of care through promoting informed decision making regarding the risks and benefits of treatment/ refusal of treatment and be mindful of the way they communicate these decisions and record them in the patient’s file.
June 2017 Volume 24, No. 11 29
CLINICAL UPDATE
NEW PSYCHOACTIVE SUBSTANCES: COMING SOON TO AN ED NEAR YOU By Melise Ammit The prevalence of substance use means nurses working in an emergency department (ED) are likely to be exposed to people experiencing problems from a range of alcohol and other drugs.
Use of new psychoactive substances (NPS) has been an emerging drug trend in recent years. These drugs, manufactured to mimic the effects of illicit drug groups such as cannabis, amphetamines, opioids and hallucinogens, are potentially dangerous to mental and physical health. Sold in specialty shops, and online, these substances, sometimes marketed as ‘legal highs’, can be perceived as less harmful than illicit drugs. However NPS are often more potent than the drug types they mimic and, unlike traditional substances of abuse, little is known of the effects as there are no long term studies of the effects on humans (Munro & Wilkins 2016). NPS do not appear on routine blood and urine drug screening which creates clinical challenges in detection and appropriate treatment provision. Described as the ‘Hydra Monster of recreational drugs’ by Helander and Backberg (2016), global incidence of morbidity and mortality from NPS has been rising over the past five years. Reports of hospitalisations and death from these so-called ‘designer drugs’ have hit the headlines recently in Australia with the death of a man who thought he was taking MDMA, but actually ingested the synthetic hallucinogen ‘NBOMe’.
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References Australia. NSW Department of Health. 2008. Clinical guidelines for nursing and midwifery practice in NSW:Identifying and responding to drug and alcohol issue. North Sydney Armenian, P. and Gerona, R.R., 2014. The electric Kool-Aid NBOMe test: LCTOF/MS confirmed 2C-C-NBOMe (25C) intoxication at Burning Man. The American Journal of Emergency Medicine, 32(11), pp.1444-e3. Baumann, M.H., Solis, E., Watterson, L.R., Marusich, J.A., Fantegrossi, W.E. and Wiley, J.L., 2014. Baths salts, spice, and related designer drugs: the science behind the headlines. The Journal of Neuroscience, 34(46), pp.15150-15158. Bleeker, A., 2013. New drugs: New problems? Of Substance: The National Magazine on Alcohol, Tobacco and Other Drugs, 11(3), p.16. Bright, S., 2013. Arresting the tide of synthetics. Anex Bulletin, (12)2 Penington Institute. Dillon,P & Copeland,J. 2012, Synthetic Cannabinoids: The Australian Experience. https://ncpic.org. au/media/1926/ bulletin-13-syntheticcannabinoids-theaustralian-experience. pdf <Accessed 2 January 2017> Evans-Brown, M. and Sedefov, R., 2016. New psychoactive substances: driving greater complexity into the drug problem. Addiction, 112(1), pp.36-38. Helander, A. and Bäckberg, M., 2016. New Psychoactive Substances (NPS)–the Hydra monster of recreational drugs. Clinical Toxicology, pp.1-3.
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CLINICAL UPDATE The hospitalisation in the same week, of sixteen teenagers in Queensland after consuming a ‘mystery drug’ during schoolies week, and sensational Youtube videos of a socalled ‘zombie’ drug ‘flakka’ heralds a changing local drug landscape. Many chemicals sold as NPS were developed as drugs that never eventuated into a medical product; others are made by clandestine chemists. Use of guesswork and uneven distribution techniques in the manufacturing process can lead to ‘flaws that are a recipe for disaster’ (Evans-Brown & Sederov 2016 pp 36). They are cheap and easily available as alternatives to traditional illicit drugs (Bleeker 2014). Nurses are in a unique position to minimise harms from substance use; increasing awareness of these drugs can enhance confidence in providing appropriate interventions.
Prevalence
It is difficult to adequately estimate NPS use due to the constant changing market for these drugs; the World Drug Report lists 75 new substances reported in the past year (UNDOC 2016). The most common NPS used in Australia and New Zealand are synthetic cannabinoids; users tend to be males in their teens and twenties. Australian research shows people using other psycho-stimulants are more likely to use NPS that have similar effects to the illicit drugs they already consume (Sutherland et al. 2016).
cause severe psychiatric symptoms. Synthetic hallucinogens: • The 251-NBOMe and 2C-B series are from the phenethylamine group of drugs. • Sometimes passed off as LSD and sold on blotter paper, these chemicals have sub milligram activation which increases the risk of overdose (Erowid). Synthetic opioids: • With names such as ‘AH7921’ and ‘U4770’, these mu opioid agonists were originally developed as potential analgesics or are fentanyl derivatives (Schneir et al. 2016).
Clinical Implications for Nurses
While NPS can deliver pleasurable experiences to some, chronic use and high doses can result in dangerous medical and psychiatric consequences.
THE MOST COMMON NPS USED IN AUSTRALIA AND NEW ZEALAND ARE SYNTHETIC CANNABINOIDS; USERS TEND TO BE MALES IN THEIR TEENS AND TWENTIES. AUSTRALIAN RESEARCH SHOWS PEOPLE USING OTHER PSYCHOSTIMULANTS ARE MORE LIKELY TO USE NPS THAT HAVE SIMILAR EFFECTS TO THE ILLICIT DRUGS THEY ALREADY CONSUME
Categories
Categories of NPS are defined by the drug class they mimic and are marketed with novel names sometimes derived from their chemical make-up. Synthetic Cannabinoids: • There are multiple varieties with names such as ‘Kronic’,’Spice’ and ‘K2’. • Manufactured by spraying a psychoactive substance onto an innocuous plant such as mango leaf. • Erroneously marketed as a ‘legal’ or ‘herbal high’ or potpourri and incense. Synthetic stimulants: • Cathinones derived from the Khat plant mimic the effects of amphetamine type stimulants such as cocaine, amphetamine and MDMA (Karila et al. 2015). • Sold as ‘bathsalts’ ‘meow meow’ and ‘flakka’, these drugs can be snorted and injected and can anmf.org.au
or medical symptoms. Having a high suspicion of NPS use when drug screening is negative, despite a clinical indication of substance ingestion, can improve patient outcomes by timely treatment provision. Often supportive treatment and a period of observation are sufficient until the effects of the drug wears off or the medical intervention needs to be escalated.
Case Studies
The range of harms and symptoms from NPS are evident from recent ED presentations at a metropolitan Sydney hospital. For example, three men in their forties presented with reduced level of consciousness after smoking ‘Kronic’ and an 18 year old who accidentally overdosed on a synthetic opioid ‘U4770’ required intravenous naloxone to reverse respiratory depression and reduced level of consciousness. Moreover, there is increasing anecdotal evidence that NPS are appearing in traditional illicit drug groups. An example of this occurred when a 19 year old was brought to the same ED with a decreased conscious level after snorting cocaine thought to be laced with synthetic opioid These patients were discharged on the same day. However intensive medical intervention may be required as the following case describes. A 17 year old was brought to the ED by ambulance after experiencing a seizure that was witnessed by his friends. They reported that he had taken ‘25I NBOMe’, a synthetic hallucinogen, earlier that night. Assessment in ED showed:
Delirium and tachycardia, consistent with symptoms of sympathomimetic syndrome have been reported with use of synthetic hallucinogens (Armenian & Gerona 2014); synthetic cathinones can lead to psychosis, violence, hyperthermia, seizure and death (Baumann et al. 2014) and non-cannabinoid ingredients such as benzodiazepines and psychedelic derivatives have been found in synthetic cannabinoids (Dillon & Copeland 2012). Synthetic opioids been reportedly gaining popularity and come with the same risks as traditional opiates - respiratory depression, coma and death (Mohr et al. 2016).
• a Glasgow Coma Scale of 3; • extreme fluctuations in vital signs; • no airway maintenance and
Awareness of NPS can increase the nurses’ ability to screen for these substances and consult with other clinicians when people present to ED with unexplained psychiatric
This young man appeared to make a full recovery other than being amnesic to events from 20 minutes after ingestion of the substance until extubation three days later. He had
decreased respirations;
• pupils were fixed at 5mm; • brain CT scan showed no
abnormalities; and
• urine drug screen was negative.
A decision was made to intubate and transfer him to the Intensive care unit. Over the next 48 hours he experienced ongoing seizures, rigors, mydriasis and autonomic instability. He remained intubated for three days and treated with midazolam, propofol and phenytoin infusions, intravenous clonidine and antibiotics.
Karila, L., Megarbane, B., Cottencin, O. and Lejoyeux, M., 2015. Synthetic cathinones: a new public health problem. Current Neuropharmacology, 13(1),pp.12-20 Mohr, A.L., Friscia, M., Papsun, D., Kacinko, S.L., Buzby, D. and Logan, B.K., 2016. Analysis of Novel Synthetic Opioids U-47700, U-50488 and Furanyl Fentanyl by LC– MS/MS in Postmortem Casework. Journal of Analytical Toxicology, 40(9), pp.709-717. Munro, G. and Wilkins, C., 2014. New Psychoactive Drugs: No Easy Answer. Melbourne, Australia Drug Foundation. www. adf.org.au/policy-aadvocacy/policytalkissues/blog <Accessed 2 January 2017> NBOMe Series.(Internet) www. erowid.rog/chimicals/ nbome/ <Accessed 20 October 2015> Schneir,A., Metushi, I., Sloane, C., Benaron, D. & Fitzgerald, R., 2016 Near death from a novel synthetic opioid labeled U-4770: emergence of a new opiod class Clinical Toxicology 1-4 Sutherland, R. and Burns, L., 2015. The use of new psychoactive substances amongst a sample of regular psychostimulant users, 2010–2014. Drug & Alcohol Dependence, 156, p.e217. United Nations Office on Drugs and Crime, World Drug Report 2016 www.unodc.org/doc/ wdr2016/WDR_2016_ Chapter_1_ATS_NPS. pdf <Accessed Dec 2015>
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CLINICAL UPDATE young and computer savvy. There is widespread availability of information and peer to peer discussion sites available via the internet and electronic media and access to these should be encouraged (Bauman et al. 2014). NPS harm reduction tips such as: • researching the substance; • letting others know what is being taken; • starting with a lower dose and waiting for effect before topping up; and • avoid mixing with alcohol and other drugs (Bright 2013), can be provided as part of a general substance use intervention that includes evidence based treatment options.
Conclusion
used cannabis previously and said he was curious about trying ‘NBOMe’ after reading about it on drug user’s forums and blogs. In summary, in all but one of these cases the person self-reported their use or had friends who were able to do so. What happens when the substance ingested is unknown?
Harm reduction
Harm minimisation is the central tenet of health policy for substance use in
Australia. It is a pragmatic approach based on the acceptance that alcohol and other drug issues exist and are likely to continue. Harm reduction means that abstinence may be one of a range of strategies, not the only goal (NSW Health 2008). As the number of NPS is constantly expanding and changing most risk comes from the fact that many users don’t actually know what they are taking (Evans-Brown & Sederov 2016). The cohort of NPS users tend to be
The harms arising from use of NPS have been emerging globally over the past few years. The long term effects of these new drugs are unknown; they are easily available and competitively priced. Reports of increasing prevalence, variability of effects and the fact these substances are undetectable by routine drug screening can cause challenges for emergency nurses. Having an awareness of the current substances available, and the possible negative sequelae resulting from their use, will allow nurses to provide timely, appropriate interventions that result in improved patient health outcomes.
Melise Ammit is a Clinical Nurse Specialist at Drug & Alcohol Service, Northern Sydney Local Health District
ANMJ IS LOOKING FOR CONTRIBUTORS FOR ITS CLINICAL UPDATE SECTION. CLINICAL UPDATE
CLINICAL UPDATE
cl
DO AGED CARE NURSES PERCEIVE MORE PROFIT EQUALS LESS AUTONOMY?
CLINICAL UPDATE
Australian Bureau of Statistics. 2008. 4102.0 Australian social trends: How many children have women in Australia had? Commonwealth of Australia, Last Modified 01/01/2008 Accessed 11/09/2009. www.abs. gov.au/
Shirley Papavasiliou The number of Australians aged 85 years and over is projected to double by 2032 with an additional 82,000 residential care places required by 2025 (Sudholz 2016).
Australian Government Department of Health and Ageing. 2010. Building a 21st century primary care system, Australia’s First National Primary Health Care System. Commonwealth of Australia.
This update on fertility-awareness has two principle aims. First, to highlight the gaps in women’s understanding of when in the menstrual cycle it is possible to conceive and second, to outline the accurate use of fertility-awareness methods to ensure correctly timed intercourse for a pregnancy. Nurses and midwives who provide sexual and reproductive healthcare services will find this clinical practice update particularly helpful.
Eijkemans, M.J.C., Lintsen, A.M.E., Hunault, C.C., Bauwmans, C.A.M., Hakkaart, L., Braat, D.D.M. and Habbema, J.D.F. 2008. Pregnancy chances on an IVF/ICSI waiting list: A national prospective cohort study. Human Reproduction 23 (7):1627-1632. doi: 10.1093/humrep/ den132.
Kerry Hampton, Jennifer Newton and Danielle Mazza Defining informed consent
Informed consent is a well-accepted cornerstone of ethical practice in all fields of healthcare. The WHO defines informed consent as follows: Patients have a right to be fully informed about their health status, including the medical facts about their condition; about the proposed medical procedures, together with the potential risks and benefits of each procedure; about alternatives to the procedures, including the effect of non-treatment; and about the diagnosis, prognosis and progress of treatment (The World Health Organization, 1994). This definition shows that there are several components to gaining informed consent from patients (WHO, 1994). In this article on ethical issues in nursing and midwifery practice, we focus on just one of these components in the health context of infertility; women’s knowledge of alternative treatment options to assisted reproductive technology (ART). 28
March 2017 Volume 24, No. 8
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February 2017 Volume 24, No. 7
Health literacy and informed decision making
We recently completed a four-year fertility-awareness study, which sought to inform a future primary care model as one way of reducing infertility in general practice (Hampton, 2014). We found that only 13% of infertile women who attend ART clinics understand the fertile window of the menstrual cycle for correctly timed intercourse. This is despite, 87% actively tried to improve their understanding of this ‘window’ to optimise natural conception in the hope of avoiding costly and invasive ART procedures (Hampton et al. 2013).
Evidence and practice
The most reliable test of a couples’ ability to conceive naturally, is correctly timed intercourse within the fertile window of the menstrual cycle over six or more cycles (Stanford et al. 2002). For the one in six Australian couples who experience trouble conceiving (Loxton and Lucke, 2009) this test remains true whether the fertility problem is of male, female or
combined (male and female) origin (Eijkemans et al. 2008). In developed countries like Australia, delayed childbearing is the single biggest cause of infertility (Australian Bureau of Statistics, 2008). Seminal studies in Ireland and Canada have shown that educating women regarding fertility awareness in order to correctly time intercourse as part of comprehensive care in general practice can substantially mitigate the impact of reduced fecundity that naturally occurs with increasing age (Stanford et al. 2008; Tham et al. 2012). Despite the fundamental importance of correctly timed intercourse to women’s agency for family planning, Australian studies have consistently shown that women’s understanding of ‘fertile window’ is generally poor across the entire reproductive life course (Hampton et al. 2013; Hampton et al. 2015; Hammarberg et al. 2013).
Bias towards specialist care In Australia, access to ART treatment is mediated first by
Defining fertility-awareness
Kerry Hampton and Jennifer Newton
Commonwealth of Australia. 2010. National Women’s Health Policy. Canberra: Australian government Department of Health and Ageing.
ASSISTED FERTILITY TREATMENT AND THE QUALITY OF INFORMED CONSENT
CLINICAL UPDATE The article begins by defining ‘fertility-awareness’, then outlines the main findings of a recently completed fertility-awareness study (Hampton, 2014), and concludes with recommendations for practice on use of fertility-awareness methods in assisting women to conceive.
ASSISTING WOMEN TO CONCEIVE: A CLINICAL UPDATE ON FERTILITYAWARENESS
References
References Australian government Department of Health and Ageing. 2010. Building a 21st century primary care system, Australia’s first national primary health care system. Commonwealth of Australia. Colombo, B., and G. Masarotto. 2000. Daily Fecundability: First results from a new data base. Demographic Research 3. doi:10.4054/ DemRes.2000.3.5. ESHRE Capri Workshop Group. 2004. Diagnosis and management of the infertile couple: missing information. Human Reproduction Update 10 (4):295-307.
Hammarberg, K., Setter, T., Norman, R. J., Holden, C. A., Michelmore, J. and Johnson, L. 2013. Knowledge about factors that influence fertility among Australians of reproductive age: A population-based survey. Fertility and Sterility 99 (2):502507. doi: 10.1016/j. fertnstert.2012.10.031.
ESHRE Task Force on Ethics Law. 2009. Providing infertility treatment in resourcepoor countries. Human Reproduction 24 (5):1008-1011. doi: 10.1093/humrep/ den503.
Hampton, K. D. 2014. Informing the development of a new model of care to improve the fertilityawareness of sub-fertile women in primary health care. Monash University Accessed ethesis-20141120-13313 0. http://arrow. monash.edu.au/ hdl/1959.1/1060341
Fehring, R. J. 2004. The future of professional education in natural family planning. Journal of Obstetrics and Gynecological Neonatal Nursing 33 (1):34-43. doi: 10.1177/0884217503 258549.
Hampton, K. D. , Mazza, D., and Newton, J.M. 2013. Fertility-awareness knowledge, attitudes and practices of women seeking fertility assistance Journal of Advanced Nursing 69 (5):1076-1084. doi: 10.1111/j.13652648.2012.06095.x.
Fehring, R. J., M. Schneider, and K. Raviele. 2006. Variability in the phases of the menstrual cycle. Journal of Obstetric, Gynecologic, and Neonatal Nursing 35 (3):376-384. doi: 10.1111/j.15526909.2006.00051.x.
Hampton, K. D., Newton, J. M., Parker, R., and Mazza, D. 2016. A qualitative study of the barriers and enablers to fertility-awareness education in general practice Journal of Advanced Nursing Mar 9. doi: 10.1111/ jan.12931. [Epub ahead of print].
Gnoth, C., D. Godehardt, E. Godehardt, P. FrankHerrmann, and G. Freundl. 2003. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Human Reproduction 18 (9):1959-1966.
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Fertility-awareness is generally defined as a woman’s ability to identify the fertile period of the menstrual cycle. There are three methods of fertility-awareness (rhythm, temperature, and mucus); however, all vary in their capacity to identify the ‘fertile period’. For example, rhythm is accurate for less than one-third of women who have a regular monthly menstrual cycle (Fehring et al. 2006), whereas both temperature and mucus are highly accurate (Pallone and Bergus, 2009). Temperature and mucus are now known as ‘modern fertility-awareness methods’, to help distinguish them from the outdated and much less accurate rhythm method.
Fertility-awareness study
We conducted a four-year fertilityawareness study with the aim of informing a future primary care model (Hampton, 2014). Primary care interventions that included fertilityawareness have reduced referrals for assisted reproductive technology (ART) treatment by assisting spontaneous conception (Stanford et al. 2008; Tham et al. 2012). However, no such intervention currently exists in Australian general practices, despite the healthcare system’s transition to a preventive model of healthcare to reduce reliance on costly specialist treatment (Department of Health and Ageing, 2010). The study used a mixed methods design and involved both women and their primary healthcare (PHC) practitioners – general practitioners (GPs) and primary healthcare nurses (PHCNs). Concordant with published international research, we found that women’s understanding of the fertile period of the menstrual cycle is generally poor across the reproductive life course (Hammarberg et al. 2013; Lundsberg et al. 2014). Similarly, we found that women’s PHC practitioners are generally aware of women’s low levels of knowledge on this aspect of their reproductive health. Although women’s interest in fertilityawareness rises sharply when they experience trouble conceiving – increasing from 37% among women who attend general practice to 87% among women who attend ART
clinics – their knowledge of the ‘fertile period’ only increased slightly, up from 2% to 13% respectively. The main sources of women’s information were the internet, books, and general practitioners. We found that unanimity exists among women (95% and 92%) and their PHC practitioners’ (89%) that women’s fertility-awareness should be enhanced when first reporting trouble conceiving. Similarly, both GPs and PHCNs (93%) nominate nurses and midwives as the most preferred practitioners to deliver such education for women in general practice (Hampton 2014; Hampton et al. 2016). Consistent with these findings, both temperature and mucus, the most accurate fertility-awareness methods, were poorly understood by women and their PHC practitioners alike. Correspondingly, rhythm, the least accurate fertility-awareness method, was the most frequently taught method in general practice (57%) and most frequently used method by infertile women (51.9%) before resorting to assisted fertility treatment at ART clinics. Our study highlights a critical gap in the primary care of infertile women and also an opportunity for expanded scope of practice for PHCNs to redress this gap in the initial assessment and care of infertile women in general practice.
Current trends in the care of infertile couples
Infertility (the failure to conceive after 12 months of trying) occurs in one in six Australian couples (Loxton and Lucke, 2009). Couples who report trouble conceiving in general practice are increasingly being referred to ART clinics. ART treatment is, however, costly, highly invasive and associated with increases in morbidity and mortality for both mothers and their babies. In addition, concern is mounting about the possible overuse of ART treatment (Kamphuis et al. 2014).
Benefits of fertility-awareness
Intercourse within the fertile period of the menstrual cycle is essential for a pregancy (Wilcox et al. 2000) and may help some couples to overcome infertility whether the cause is a male or female factor problem (Stanford et al. 2008; Tham et al. 2012). A lesser known benefit of correctly timed intercourse is that it may halve the usual time to pregnancy, with 85% of couples being pregnant at six months rather than at 12 months (Colombo and Masarotto, 2000; Gnoth et al. 2003). Proponents have long argued that the knowledge is low cost,
without side-effects, and compatible with the religious or philosophical values of those who cannot use ART treatment or choose not to use ART treatment (ESHRE Capri Workshop Group, 2004; ESHRE Task Force on Ethics Law, 2009). Below, an overview of fertilityawareness methods is presented together with the advantages and limitations of each method when used for guiding timed intercourse.
Fertility-awareness methods Mucus method
The mucus method is the most accurate and most useful fertilityawareness method to guide timed intercourse, as this method prospectively indicates the entire fertile period of the menstrual cycle by the presence of fertile-type mucus at the vulva. Fertile-type mucus is released from the cervix and is present for an average six days leading up to the day of ovulation in the menstrual cycle. Over these days, a sensation at the vulva changes from moist to wet to wet/slippery, then back to dryness or an unchanging sensation of slight moistness. When fertile-type mucus is observed, it is clear, shiny, and stringy in appearance. The last day fertile-type mucus is sensed or observed at the vulva is called the peak day of fertility, as this is the most likely day of ovulation in the menstrual cycle. Outside the fertile period, sensation at the vulva is one of dryness or a slight unchanging moistness. When mucus is observed at this time, it is a dense white/creamy colour (Odeblad, 1994). Advantages and limitations The mucus method enables the entire ‘fertile period’ to be observed, irrespective of whether the menstrual cycle is monthly and regular or irregular (Odeblad, 1994). Intercourse timed within the threeday period just prior to ovulation optimises the chance of a pregnancy. With the mucus method, women can know for certain that intercourse was correctly timed for pregnancy. Women who may find this method challenging include those who suffer from dysmorphic body disorder or have a history of sexual abuse. Infections of the vulva or vagina will impair accurate observation/sensation of mucus changes.
Temperature method
The temperature method is the next most accurate fertility-awareness method. This method retrospectively indicates the timing of ovulation in the menstrual cycle by a basal body temperature (BBT) rise of 0.2 to 0.5
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Hampton, Kerry D. 2014. Informing the development of a new model of care to improve the fertilityawareness of sub-fertile women in primary health care. PhD Department of General Practice Monash University (ethesis-20141120-133 130). Hampton, Kerry D., Jennifer M. Newton, Rhian Parker, and Danielle Mazza. 2016. A qualitative study of the barriers and enablers to fertility-awareness education in general practice. Journal of Advanced Nursing Mar 9. doi: 10.1111/ jan.12931. [Epub ahead of print]. Kamphuis, Esme I, S Bhattacharya, F. van der Veen, B W J Mol, and A Templeton. 2014. Are we overusing IVF? British Medical Journal 348 (g252). doi: 10.1136/bmj.g252. Loxton, Deborah, and Jayne Lucke. 2009. Reproductive health: Findings from the Australian longitudinal study on women’s health. Australian government Department of Health and Ageing. Lundsberg, Lisbet S., Lubna Pal, Aileen M. Gariepy, Xiao Xu, Micheline C. Chu, and Jessica L. Illuzzi. 2014. Knowledge, attitudes, and practices regarding conception and fertility: a populationbased survey among reproductive-age United States women. Fertility and Sterility 101 (3):767774. doi: 10.1016/j. fertnstert.2013.12.006. Maheshwari, Abha, Mark Hamilton, and Siladitya Bhattacharya. 2008. Effect of female age on the diagnostic categories of infertility. Human Reproduction 23 (3):538-542.
July 2016 Volume 24, No. 1
A clinical update is written as a best practice ‘how to guide’ for nurses and midwives in an area of nursing or midwifery practice relevant to a wide cross section of nurses or midwives. It can include a case study/ies, guidelines, graphs, tables, or illustrations. If you would like to contribute go to http://anmf.org.au/pages/anmj-contribute to view our writers’ guidelines for more information or contact anmj@anmf.org.au
Hammarberg, K., T. Setter, R. J. Norman, C. A. Holden, J. Michelmore, and L. Johnson. 2013. Knowledge about factors that influence fertility among Australians of reproductive age: a population-based survey. Fertility and Sterility 99 (2):502507. doi: 10.1016/j. fertnstert.2012.10.031.
25
ISSUES UNDER A CDC PROGRAM, THE INDIVIDUAL CONSUMER WILL NEED TO MANAGE THE CHOICE OF PROVIDER, CHOICE OF SUPPORT WORKER, THE CARE ACTIVITIES REQUIRED, CONTACT WITH THE SERVICE COORDINATOR, MANAGING THE BUDGET AND MANAGING UNSPENT FUNDS
Sandra Bradley
CONSUMER DIRECTED CARE Sandra Bradley, RN, PhD Currently, there is a convergence of two important policies which are in the early stages of implementation. The first is consumer directed care (CDC) - a service where a person who through illness or frailty is provided a Home Care Package or similar funding arrangement for home services (Australian Government 2017).
References Australia. Department of Health. 2017. Ageing and Aged Care: Commonwealth Home Support Program. https://agedcare.health. gov.au/programs/ commonwealth-homesupport-programme Accessed 23 April 2017. Sammut, J. 2017. Real Choice for Ageing Australians: Achieving the Benefits of the Consumer-Directed Aged Care Reforms in the New Economy. The Centre for Independent Studies. Research Report 24. Sydney. Gill, L., McCaffrey, N., Cameron, I., Ratcliffe, J., Kaambwa, B., Corlis, M., Fiebig J., Gresham, M. 2017. Consumer Directed Care in Australia: Early perceptions and experiences of staff, clients and carers. Health and Social Care in the Community. 25 (2): 478-491. McCaffrey, N., Gill, L., Kaambwa, B., Cameron, I., Patterson, J., Crotty, M., Ratcliff, J. 2015. Important features of home-based support services for older Australians and their informal carers. Health and Social Care in the Community. 23 (6): pp. 654-664.
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The individual has control of the funding to determine which provider will manage their services (Australian Government 2017). In the past, these services were largely provided by residential and community aged care providers however, in the future, these services may be provided by others who are not necessarily as tightly regulated. For example, a report recently released by Sammut (2017) argues that to make the most of CDC, deregulation of care workers may need to occur. Specifically, the article states “requiring mandatory qualifications for care workers is an example of over-regulation…Just because care workers have attended and completed a training course does not guarantee they will practise what they have learned, nor ensure that consumers will be guaranteed a quality experience. Quality of care… is largely dependent on what the consumer perceives about the attitude and motivation of the care worker.” This argument is a smoke-screen for opening up the market to anyone who wishes to engage as a personal care worker without any accountability. This could set a dangerous precedent for both the nursing profession and the ideology behind CDC because unlicensed, unregulated workers hired by people who, by definition,
are of ill health and need home care packages, could lead to ill-informed and exploitative practices completely at odds with what is trying to be achieved with government-funded home care packages; that is to keep ill and ageing people safe, cared for, and at home for as long as possible. Keeping people at home is the second policy being promoted to reduce the amount of time that a person spends in residential aged care or hospital (Australian Government 2017). Under a CDC program, the individual consumer will need to manage the choice of provider, choice of support worker, the care activities required, contact with the service coordinator, managing the budget and managing unspent funds (McCaffrey et al. 2015). Gill et al. (2016) found that uncertainty in management of these elements can cause stress and anxiety for the individual who is already at a disadvantage through ill health and frailty. Therefore, the convergence of these two policies introduces a number of considerations for the nursing profession: Who will oversee the standards of service provision? Who will be allowed to provide services? Who will protect consumers who may not have the cognitive capacity to make decisions and manage funding in a way that is beneficial to their circumstances?
If the nursing profession is to maintain its good standing with the community, it will need to monitor closely anyone who professes to provide ‘nursing care’ within the CDC space to prevent misuse and abuse of what nurses have struggled to achieve over many hard-fought years of action – that is, evidence based, licensed, regulated, professional and skilled care of those in our community who are ill or frail. As a researcher working across dementia, aged care, advance care planning, CDC and end of life care, I understand the importance of individuals being given the ability to drive the decision making processes providing the best choices for their own individual circumstances. However, if the argument of Sammut (2017) finds traction, the CDC environment may leave people who, through ill health, are not able to understand the nuances of the decisions that will need to be made in these situations, leaving them more vulnerable and possibly in a worse situation than they were before. It is hoped that the ANMF will act to provide oversight in this emerging space of care which may also offer the opportunity for more nurses to provide care in the community in a way that can ensure nursing’s professional integrity is kept intact and the public maintains its trust in the regulated and accountable skills of the real nursing profession. Sandra Bradley is a registered nurse with a PhD on advance directive decision-making. As a postdoctoral researcher she has worked on projects associated with dementia, aged care, consumerdirected-care, palliative care, end of life care and voluntary euthanasia. This article is based on the views and research of the author(s) and has not been peer reviewed. June 2017 Volume 24, No. 11 33
REFLECTIONS
LEADERSHIP LESSONS FROM THE UNITED AIRLINES INCIDENT By Di Kenyon I have been watching the United Airline debacle unfold with very mixed emotions. How could this happen? It has made me think more about leadership and workplace culture, and how important it is in any industry – including the healthcare industry. A couple of months ago a man was violently removed from a United Airlines flight by aviation police officials at Chicago’s O’Hare international airport. The man was dragged along the floor of the plane, with blood visible on his face from where his head had been knocked in the process. It was an incident captured on video by several other passengers that went viral globally. The airline said in a statement that the flight was overbooked, and that no passengers agreed to voluntarily give up their seats. Just to put this in perspective, United Airlines are not acting illegally by asking the passenger to leave the plane. They conduct business by overbooking the planes and hope that not all passengers show up. When all passengers show up, as was the case on this day, they are legally allowed to ask them to leave. The passengers were asked to leave voluntarily and were offered compensation of $400 but no takers. They were then offered $800. The passenger that was injured in the event allegedly offered to leave the plane with his wife and then found he could not get another flight that would get him to his destination in time, so then refused to leave (Gunter 2017). Subsequently the man was forcibly and violently removed from the plane. The response from the CEO after the incident was one of blame. There was no acknowledgement of the brutality displayed by security and police. He came across as insensitive and not trying to make the best of a terrible situation. The CEO has now moved into damage control saying the company will do whatever it takes so that this will never happen again.
34 June 2017 Volume 24, No. 11
United Airlines conduct in question includes: • how they reacted; • how they handled the situation; • why a better apology was not offered; • what makes the team mindlessly follow rules without caring for the person; • what happened during and after the incident; • if they were in their rights to take the passenger of the plane; and • how they allowed the situation to escalate.
So what healthcare leadership lessons can be taken from the incident?
In a health environment, mistakes happen. We have all made or been involved with some. If this type of situation happened in your health environment, what do you think would happen? Leadership covers many things, but comes back to one major point: you are there to support your team.
Under the right leadership, teams will: • seek to challenge their own
• • • •
•
•
beliefs and attitudes about what’s possible; own their role; boost their personal performance; find more job satisfaction; be encouraged to contribute to the improvements and innovations in the organisation; learn to solve problems in a way that demonstrates good judgement and thought for consequences; and be allowed to think of others and the impact their decisions have on them.
This form of high-impact leadership encourages innovative thinking and empowers the team to ‘own’ not just their performance, but also the outcomes for the entire team. Think about the type of leadership United Airlines displayed. Compare it to the type of leadership in your organisation or the kind of leader you are and how you influence your team. Think about the standards that you expect as a leader, and what you want to see in your organisation.
Great people want to improve themselves and want to contribute. Great team members want to be useful, contribute to the team (or the organisation). They will find themselves feeling deflated if the culture they find themselves in is not matched to that. Success in an organisation starts with the leader. Leaders set the standards and everything flows from there.
Di Kenyon
Be a great leader and you’ll have a great culture and be able to recruit great people. Be ordinary and ask little of yourself, and the opposite will occur. It all starts with you. What standards do you expect? Be clear on the standards and what is non-negotiable. A positive culture can also have a significant impact on an organisation’s long-term performance. Collins (2001) explains that discipline and positive culture is what makes the difference between the world’s top businesses. I know some people will say that health is not a business, though I will challenge that assumption and say that health organisations still have huge budgets to manage and teams to support. A disciplined focus on culture and the upholding of particular standards will lead to a happier and more engaged workforce. A happy and engaged workforce = increased productivity = increased profit. Can you see where United Airlines went wrong? What needs to change in your organisation? What needs to change in you as a leader and in setting the standards? Try it and see what happens. Think about what other lessons we can learn from this terrible incident and ensure it does not happen in your environment. Di Kenyon is Director of Di Kenyon Transformations and is passionate about leadership, culture and what makes people tick. She has over 30 years experience in the nursing industry in many roles including clinical, stomal therapy and wound care, education and leadership. This article is based on the views and research of the author(s) and has not been peer reviewed.
References Chi, L. 2017. Not so friendly skies: United Airlines’ public relations disaster, BBC Business, 11 April, viewed 21 April 2017, www.bbc.com/news/ business-39562182 Collins, J. 2001. Good to Great, Jim Collins, viewed 21 April 2017, www.jimcollins.com/ article_topics/articles/ good-to-great.html Gunter, J. 2017. United Airlines incident: What went wrong? BBC News Washington, 10 April, viewed 21 April 2017, www.bbc. com/news/world-uscanada-39556910 Seppala, E & Cameron, K. 2015. Proof That Positive Work Cultures Are More Productive’, Harvard Business Review, 1 December, viewed 21 April 2017, https://hbr.org/2015/12/ proof-that-positivework-cultures-are-moreproductive
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EDUCATION
Crystal Methamphetamine – ICE One of our newest topic additions to the CPE website is Crystal Methamphetamine – ICE, a tutorial for nurses and frontline workers. This topic was written in collaboration with Marie Coughlan, CNC Co-morbidity, Hospital Consultation Liaison SESLHD D&A Services; Jodie Davis, ANMF Federal Education Officer and Peer reviewed by the NSWNMA Drug and Alcohol Reference Group.
CPD
HOURS
Statistics show that it is highly likely, as nurses and frontline workers, that in the course of your work, you will, in some form or another, encounter the issue of methamphetamine use – also commonly called ICE or meth for short. According to the 2013 National Drug Strategy Household Survey (NDSHS), (Latest national data available); 7% of the Australian population aged 14 years or older reported using amphetamine or methamphetamine at least once in their lifetime. In the same survey, 2.1% reported recent amphetamine or methamphetamine use. Of these people, 50.4% report Crystal or ICE as the main form of the drug used. The last United Nations World Drug Report
36 June 2017 Volume 24, No. 11
(2014) confirmed that Australia leads the world in ecstasy and cannabis use, was third for methamphetamines and fourth for cocaine. Methamphetamine is not a new drug, although it has become more powerful in recent years as techniques for its manufacture have evolved. It is the chemical 2-methylamino-1phenylpropane hydrochloride, also known as methylamphetamine or desoxyephedrine. When it is in its crystalline form, the drug is called Crystal Meth or ICE. Methamphetamine is a highly addictive stimulant. Estimates suggest that there have been substantial increases over the past
five years in the numbers of regular and dependent methamphetamine users in Australia. While the crystalline appearance of ICE makes it look pure, its side-effects are worse than for other forms of methamphetamine. The short-term effects include euphoria, alertness and increased confidence, and may also be accompanied by a decrease in appetite. Methamphetamine is a strong psychomotor stimulant that mimics the actions of certain neurotransmitters that affect mood and movement. It causes a release of dopamine and serotonin, producing an intense rush. After the initial rush subsides, the brain remains
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in an alert state. After the effects have worn off, the brain is depleted of its dopamine, sometimes resulting in depressed mood and fatigue. It imitates the brain’s reward chemical, dopamine, and its alertness chemical, noradrenaline, which causes the brain’s neurons to release more of those, while also causing neuro adaptation creating a demand for the drug in the brain. Long term use can result in chronic depletion of brain serotonin levels and endorphin production. ICE also stimulates locomotor activity (ie. reflexes, basic physical movements) and can produce ‘stereotypic behaviours’ random, repetitive, compulsive movements and actions such as twitching or picking at the skin - as a side effect. ICE users experience bursts of energy, talkativeness, and excitement. People who use ICE may go without sleep or food as a result of this intense energy. High doses or chronic use have been associated with increased nervousness, irritability, paranoia, and occasionally violent behaviour, while withdrawal from high doses can lead to low mood, anxiety, agitation, irritability and feeling down. Use of ICE, as with other drugs can exacerbate existing mental health problems such as anxiety and depression. After using ICE a person may experience a comedown which can cause fatigue or sometimes a crash, which may leave them dehydrated and exhausted physically, mentally and emotionally. This stage can last from two to five days depending on how much the person has used. Withdrawal from ICE will usually start within the first few days of ceasing use. For some people they can experience a low mood, loss of energy and the inability to experience normal pleasures that they previously experienced. As with other drugs people are likely to experience cravings and again, as with other drugs, cravings can continue for weeks, months or years and may be a significant contributor to relapse of use. One of the side effects of regular crystal meth addiction is formication (latin for ‘creep like an ant). Heavy stimulant use causes a rise in body temperature and increased blood flow to the skin to counteract it. The produced sweat contains an enzyme that increases blood flow to the skin even more. When the sweat evaporates, it removes the protective sebaceous oil which coats the skin. The combined effects of dehydration, sweating and removal of the sebaceous oil on the skin create a sensation on the nerve endings of the skin and cause the addict feelings of something irritating or ‘crawling’ on or under the skin (Delusional Parasitosis). Meth also reduces the amount of protective saliva. Saliva is needed to neutralise harsh acids and reduce bacteria in the mouth. Meth dries up the salivary glands, letting the acids and bacteria build up and rot teeth anmf.org.au
and gums. Meth causes blood vessels to shrink reducing the supply of blood to the teeth and gums. This can lead to infections and gum disease. Users often clench and grind their teeth causing cracked teeth and sores in the mouth. Oral hygiene may also be neglected.
Short-term effects include:
• brief rush, euphoria, surge of energy; • increased physical activity; • increased blood pressure and breathing • • • • • • • • • • • • •
rate; dangerously elevated body temperature; loss of appetite; sleeplessness; paranoia, irritability; unpredictable behaviour; performing repetitive, meaningless tasks; dilated pupils, heavy sweating; nausea, vomiting, diarrhoea; tremors; dry mouth, bad breath; headache; uncontrollable jaw clenching; seizures, sudden death.
Soon after taking ICE, the receptors in the brain start to turn off the natural production of dopamine. Unlike other stimulants that allow brain cells to re-capture and package dopamine, ICE does not. When taken repeatedly over time, methamphetamine can produce lasting damage in the nerve cells located in the brain’s pleasure centre, as well as nerve cells in other locations. For a detailed list of long term effects of ICE use, please refer to the tutorial. A collaborative approach between police, ambulance and emergency departments is essential to ensure prompt and timely management of individuals who are experiencing, or suspected of experiencing, psychostimulant toxicity. A thorough assessment should be undertaken which includes drug use history and presence of psychostimulant toxicity. Calming communication to deescalate potentially dangerous situations is recommended. Security or the police should always be called to any high-risk situation. The aim of initial management is to firstly identify patients who present with suspected psychostimulant toxicity; rapidly and safely manage suspected or confirmed psychostimulant toxicity utilising a standardised sedation protocol; and recognise and safely manage medical complications. Medical complications are often serious and include hyperthermia, cerebrovascular accidents, seizures, myocardial ischaemia and infarction, serotonin toxicity, rhabdomyolysis, hypoglycaemia, hyponatremia, hyperkalemia and others. Some peculiarities of medical management are specific to psychostimulant use being identified.
EARN UP TO TWO HOURS OF CPD By accessing the complete topic, reading about management guidelines and treatment this article in its entirety and doing the associated learning activity online you can receive two hours of continuing professional development (CPD). For more information go to http://anmf. cliniciansmatrix.com If you have any questions please contact us via education@anmf.org.au
Individuals suffering from psychostimulant toxicity can become extremely agitated, irrational, impulsive, paranoid and psychotic, which may lead the person to behave in an uncontrolled, aggressive and/or violent manner. The number of ambulance attendances to patients presenting with putative psychostimulant intoxication or toxicity has risen in some Australian locations, and paramedics and emergency department staff are increasingly required to manage the acute behavioural disturbances associated with psychostimulant misuse. The primary aim of management of behavioural disturbance is to reduce the risk of harm to the patient, emergency department staff and other people. It is necessary to utilise the established hospital protocols for the management of behavioural disturbances in the event of such an incident. Hospital security or police presence is mandatory until behaviour is controlled. In emergency situations it is often difficult to differentiate between a severe behavioural disturbance secondary to acute drug intoxication, drug-induced psychosis, or an exacerbation of a pre-existing psychotic disorder. Suspected drug-induced psychosis (or exacerbation of existing psychotic disorder) should not be considered a contraindication to urgent sedation. Rather, a period of sedation and behavioural control will allow clinicians to re-assess the patient after the acute effects of the drug have worn off, allowing for a more accurate differential diagnosis. In general, treatment of patients with psychostimulant-induced psychosis is similar to treatment of acute mania or schizophrenia and establishing a ‘safe’ environment should be the first priority.
June 2017 Volume 24, No. 11 37
FOCUS: Maternal health
EXPLORING DIET AND EATING HABITS DURING PREGNANCY IN THE EMIRATES: EAT WELL ASSIST STUDY
EXPECTANT MOTHERS WERE MORE LIKELY TO DISCUSS THAT THEY NEEDED AND BELIEVED IN TAKING VITAMINS, MINERALS AND PROBIOTIC SUPPLEMENTS WHILST EXPECTANT FATHERS WERE MORE LIKELY TO DISCUSS HOW THE HUMAN BODY DID NOT NEED SUPPLEMENTS AND A HEALTHY DIET AND EATING HABITS WAS ALL THAT WAS REQUIRED.
By Mary Steen expectant mothers did not drink enough. Quotes from expectant mothers • ‘I am concerned about putting weight on, I do not want to get too big and have trouble getting back to my previous weight’ • ‘I believe you need supplements, especially when you are pregnant and I think also afterwards’ • ‘I need to drink more water as I get water infections, but when I do I feel too full and bloated’
Intergenerational effects of poor diet on an infant’s health are influenced by obesity and diabetes in pregnant women and then by parental diets and eating behaviours that collectively contribute to the development of unhealthy diets in infants and children (Hillier et al. 2016; Savage et al. 2007). This short article briefly summaries the undertaking and findings of Phase 1 of a recent feasibility study that explored current diets, feeding practices and family influences of expectant mothers and fathers recruited from three study sites, representing urban and rural settings in Ras Al Khaimah, United Arab Emirates.
Data collection and analysis
A purposive sample of n=20 expectant mothers and n=10 fathers were recruited by local coordinators and to participate in a one-to-one interview. A thematic analysis was undertaken to transcribe verbatim using the Braun and Clarke (2006) 6-stage framework.
Findings
Expectant mothers current diet and eating habits identified seven main themes: ‘Fast foods’, ‘Influences’, ‘Body Image’, ‘Knowledge and Understanding’, ‘Using Supplements’, ‘Eating patterns’, ‘Likes and dislikes’. Interestingly, expectant 38 June 2017 Volume 24, No. 11
fathers identified five similar main themes: ‘Fast foods, ‘Influences’, ‘Knowledge and Understanding’, ‘Eating patterns’, ‘Likes and dislikes’ but in contrast to expectant mothers, ‘No Supplements’ was a theme and ‘Body Image’ did not emerge. Expectant mothers were more likely to discuss that they needed and believed in taking vitamins, minerals and probiotic supplements whilst expectant fathers were more likely to discuss how the human body did not need supplements and a healthy diet and eating habits was all that was required. Expectant mothers were more concerned about their body image and weight but a few fathers recognised and requested help to lose some weight. Overall expectant fathers were more likely to express how they enjoyed food and eating together as a family. The importance of drinking sufficient amounts of water daily was highlighted by several participants but expectant fathers were more likely to adhere to this essential requirement and it was concerning that many of the
Quotes from expectant fathers: • ‘I see food as fuel for my body and you need all of the ingredients for it to be super fuel’ • ‘You do not need supplements, my wife takes them and also those probiotics but your body knows what it needs’ • You must drink plenty of water to be healthy, this is not always recognised, I encourage my wife to do so…’ In addition, breastfeeding was discussed. Several participants mentioned how in Islam, breastfeeding is highly recommended and if the mother is able to do so, to breastfeed for two years. Being a good role model and home cooking for their infant was also discussed.
Conclusion
In general, expectant mothers and fathers had a good understanding of what is a healthy diet but lacked knowledge about portion sizes. Expectant mothers were more likely to not drink sufficient amounts of water and were more likely to believe in the need for taking dietary supplements and concerned about their body image when compared to expectant fathers. All participants recognised the importance of breastfeeding and being a good role model for their infant. Mary Steen is a Professor of Midwifery at the School of Nursing and Midwifery, Division of Health Sciences at UniSA. She is the Chair of the Mothers, Babies and Families Research Group and facilitates the promotion of research and scholarly activities both nationally and internationally. anmf.org.au
FOCUS: Maternal health
NURSING THE FAMILY OF TEENAGE MOTHERS IN THAILAND: UNDER PRESSURE AND THE LACK OF SUPPORT By Nuttaya Sritakaew, Anthony Paul O’Brien and Kerry Hoffman Exploring family and teenage experiences when confronted by teenage pregnancy was recently researched in a grounded theory nursing study. The study was conducted with 10 participant families in the northern part of Thailand which included 10 teenage mothers, 20 parents and eight healthcare professionals. The data analysis revealed participant families of teenage mothers were faced with problems related to cultural and religious beliefs, coupled with inadequate health services and social support. Traditionally, Thai families support their children until they graduate from school, or they are settled into adult life (Chompikul et al. 2009). Abortion is also illegal in Buddhist Thailand and only performed in a medical crisis. Subsequently, there are many illegal abortions performed (Office of the Council of State 2008). Parents reported feeling overwhelmed, embarrassed and ashamed because of their daughter’s unexpected pregnancy. Some parents tried to isolate themselves by avoiding talking or meeting with people in their local community. Other parents were blamed by local people for not being good role models as parents. This study developed an exploratory theoretical model for community nurses to engage with families and their daughters in a teenage pregnancy situation. Affected families reported many issues once their daughter became pregnant, including an increase in family conflict and financial pressure, made especially difficult due to their lower socioeconomic status.
References Braun, V., & Clarke, V. 2006. Using thematic analysis in psychology, Qualitative Research in Psychology, 3:2, 77-101 Hillier, T.A., Pedula, K.L., Vesco, K.K. et al.. 2016. Matern Child Health J, 20: 1559. doi:10.1007/ s10995-016-1955-7 Savage, J.S., Fisher, J.O., Birch, L.L. 2007. Parental Influence on Eating behaviour: conception to Adolescence. J Law Med Ethics. 35(1): 22– 34. doi:10.1111/j.1748720X.2007.00111.x.
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To build up the theoretical model in the study, data analysis was performed by constant comparison of data, theoretical sampling and progressive theory development. All main categories and subcategories were integrated to refine the core theoretical context. The theoretical model highlighted teenage pregnancy complicated by the family’s socioeconomic status, parental educational background, teenage maturity and other influential external factors, such as Thai culture and Buddhist spirituality. Most of the care for the teenage mother was provided by the hospital. The healthcare professionals that participated in the study, who were nurses, social workers and public health educators described being limited in the amount of support they could provide in a community context. They were disappointed
NUTTAYA SRITAKAEW
about not being able to provide better outreach and follow-up, including prenatal care. The study also found teenage pregnancy influenced families and teenage girls developmentally, emotionally and in terms of their cultural experience in the Buddhist sense of living peacefully and calmly. Most of the main themes emerging from the research reveal teenage pregnancy as being negative rather than a positive impact on teenagers and their families. Young mothers, families and healthcare professionals tried to manage, however many things were not within their control. It does appear from the data analysis that teenage pregnancy is not only a teenager’s problem, or a family responsibility, but also a national problem needing to be addressed within Thai society.
AFFECTED FAMILIES REPORTED MANY ISSUES ONCE THEIR DAUGHTER BECAME PREGNANT, INCLUDING AN INCREASE IN FAMILY CONFLICT AND FINANCIAL PRESSURE, MADE ESPECIALLY DIFFICULT DUE TO THEIR LOWER SOCIOECONOMIC STATUS. Healthcare professionals and other stakeholders could help families to decrease the severity of the problem by providing appropriate support for all family members; however findings from this study indicate support was not provided. Support during the antenatal period should focus on the physical, mental and, social as well as in the perinatal period for both family and teenage mothers. Preventative care such as health promotion and education to prevent teenage pregnancy should also be implemented. Nursing, healthcare and social support for families of teenage mothers is extremely important to reduce social and cultural stigma but to also ensure a stable family life for the child to be born into remains intact. Including better care for families would help to improve the quality of life for the teenager and her newborn child.
References Chompikul, J., Suthisukon, P., Sueluerm, K., and Dammee, D. 2009. Relationship in Thai families. Mahidol University, Thailand. Office of the Council of State. 2008. Code of laws: Criminal code. www.krisdika.go.th Accessed March 2014
Nuttaya Sritakaew is an RN (Thailand) and PhD candidate; Anthony Paul O’Brien is an RN, PhD and Kerry Hoffman is an RN, PhD. All are in the School of Nursing and Midwifery at the University of Newcastle in NSW.
June 2017 Volume 24, No. 11 39
FOCUS: Maternal health
IS THE CURRENT GROUP B STREPTOCOCCUS SCREENING BEST PRACTICE? By Emma Vander Veeken and Wendy Abigail Group B Streptococcus (GBS) is a bacterium identified primarily in the vagina, gastrointestinal tract and urethra (Sheehy et al. 2012). GBS colonisation in the mother is a significant cause of neonatal sepsis, amassing the newborn morbidity and mortality rate in developed countries (Valkenburg-van den Berg et al. 2010).
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FOCUS: Maternal health Newborns can obtain GBS via vertical transmission after membranes rupture or through the birth canal during delivery. Intrapartum antibiotic prophylaxis (IAP) when timely administered to women prior to delivery considerably reduces the risk of transferring GBS to neonates (Kaambwa et al. 2010). Since this finding, the main challenge in maternity care has been identifying which women should receive IAP. GBS is a transient bacterium, thus there is a question as to whether a positive result at 3537 weeks gestation is an accurate indicator of intrapartum colonisation. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (2016) currently recommend that all women at 36 weeks’ gestation have a combined low vaginal swab and rectal swab taken for GBS culture. Several studies have produced discordant results between antepartum screening and the intrapartum screening. In these studies, such as Kunze et al. 2015; Szymusik et al. 2014; Florindo et al. 2013 and Abdelazim 2013 there were a number of pregnant women whose GBS status changed during the interval between the antepartum screening and intrapartum screening. These studies revealed the transitory nature of GBS colonisation and exposed that not all GBS positive women who require IAP will have it administered based on results at 35-37 weeks of gestation. Suggestive discrepancy has been found in the recommended method of microbiological screening to determine which women receive IAP during labour. Various studies have produced evidence that the polymerase chain reaction assay test was the most accurate, with the highest sensitivity and specificity (Kunze et al. 2015; Szymusik et al. 2014; Florindo et al. 2013; Abdelazim 2013 and Van Dyke et al. 2009). However, it has been unanimously agreed that screening with PCR
assay was not cost effective, in comparison to the enriched culture screening. It has also been recognised that PCR has a significant limitation in time required to determine GBS status and provide full IAP coverage.
GBS IS A TRANSIENT BACTERIUM, THUS THERE IS A QUESTION AS TO WHETHER A POSITIVE RESULT AT 35-37 WEEKS GESTATION IS AN ACCURATE INDICATOR OF INTRAPARTUM COLONISATION.
There is significant disagreement on which microbiological screening method is best for standard practice. PCR is the most accurate form of testing available, but enriched culture is currently recommended for midwifery practice, as it is the most cost effective, and easiest to use method available. There is a substantial question on whether enriched culture can reliably predict which women will require IAP at delivery. The relevance of these findings highlights the need for further research and development of PCR technology to create a more time efficient and cost effective assay to provide accurate results in determining IAP administration.
Emma Vander Veeken is a Midwifery student and Dr Wendy Abigail is a Lecturer. Both are in the School of Nursing and Midwifery at Flinders University in Adelaide, SA.
References Abdelazim, I. 2013. Intrapartum polymerase chain reaction for detection of group B streptococcus colonisation, Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 53, no. 3, pp. 236-242. Florindo, C, Damia, V, Lima J, Nogueira, I, Rocha, I, Caetano, P, Ribeiro, L, Viegas, S, Gomes, J, and Borrego1, M. 2014. Accuracy of prenatal culture in predicting intrapartum group B streptococcus colonization status, The Journal of Maternal-Fetal & Neonatal Medicine, vol. 27, no. 6, pp. 640-642. Kaambwa, B, Bryan, S, Gray, J, Milner, P, Daniels, J, Khan, KS, Roberts, TE. 2010. Cost-effectiveness of rapid tests and other existing strategies for screening and management of early-onset group B streptococcus during labour, An International Journal of Obstetrics & Gynaecology, vol. 117, no. 13, pp. 1616-1627. Kunze, M, Zumstein, K, Markfeld-erol, F, Elling R, Lander, F, Prömpeler, H, Berner, R, Hufnagel, M. 2015. Comparison of preand intrapartum screening of group B streptococci and adherence to screening guidelines: a cohort study, European Journal of Pediatrics, vol. 174, no. 6, pp. 827-835. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. 2016. Maternal Group B Streptococcus (GBS) in Pregnancy, viewed on 10 October 2016, accessed at www.ranzcog.edu.au/ document-library/maternalgbs-in-pregnancy.html
Sheehy A, Davis D & Homer, C. 2012. Assisting women to make informed choices about screening for Group B Streptococcus in pregnancy: A critical review of the evidence, Women and Birth, vol. 26, no. 2, pp. 152-157. Szymusik, I, KosinskaKaczynska, K, Krolik, A, Skurnowicz, M, Pietrzak, B, Wielgos, M. 2014. The usefulness of the universal culture-based screening and the efficacy of intrapartum prophylaxis of group B Streptococcus infection, 2014, The Journal of Maternal-Fetal & Neonatal Medicine, vol 27, no. 9, pp. 968-970. Valkenburg-van den Berg, AW, Houtman-Roelofsen, RL, Oostvoge,l PM, Dekker, FW, Dörr, PJ, Sprij, AJ. 2010. Timing of group B streptococcus screening in pregnancy: a systematic review, Gynaecologic and Obstetric Investigation, vol. 69, no. 3, pp. 174-183. Van Dyke, M, Phares, C, Lynfield, R, Thomas, A, Arnold, K, Craig, A, MohleBoetani J, Gershman, K, Schaffner, W, Petit, S Zansky, S, Morin, C, Spina, N, Wymore, K, Harrison, L, Shutt, K, Bareta, J, Bulens, S, Zell, E, Schuchat, A, Schrag, S. 2009. Evaluation of Universal Antenatal Screening for Group B Streptococcus, The New England Journal of Medicine, vol. 360, pp. 2626-2636.
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FOCUS: Maternal health GANM SCREEN SHOT
IMPROVING NURSING AND MIDWIFERY PRACTICE THROUGH THE USE OF INFORMATION, COMMUNICATION TECHNOLOGY (ICT) By Ashley Gresh, Fernando Mena-Carrasco, Darlene Nnanyelugoh and Teresa Pfaff The Global Alliance for Nursing and Midwifery (GANM) is a virtual online community of practice moderated through the Johns Hopkins School of Nursing Pan American Health Organization (PAHO)/World Health Organization (WHO) Collaborating Center. The GANM has a broad membership with over 4,000 members from 161 countries including nurses, midwives, researchers, academics and policymakers. The GANM leverages the use of information, communication technology (ICT), striving to be a platform for knowledge dissemination through the Knowledge Gateway (https://knowledge-gateway.org/ ganm/) by hosting a discussion board, online virtual library, blog site and podcast series (http://ganm.nursing. jhu.edu/). The content disseminated focuses on achieving the Sustainable Development Goals. Using low bandwidth technology, the GANM seeks to increase access to knowledge through collaborative strategies to share research on evidence based practice with healthcare providers throughout the world. Over the past year through the Knowledge Gateway, three topics emerged that illustrate the effect of GANM’s knowledge dissemination activities on respectful maternity care globally: self-care for midwives; use of fundal pressure in the second stage; and incorporating traditional birth attendants into healthcare systems. The first discussion around midwifery 42 June 2017 Volume 24, No. 11
and self-care was stimulated by audiovisual blogs and a webinar hosted through the GANM that engaged more than 1,500 participants. The dialogue focused around the available research and shared experiences that highlight the importance of sustainability and resilience in midwifery, and how selfcare activities are critical to ensuring nurses and midwives are delivering the best possible care to patients. The consensus among members was that this topic is not discussed enough, and approaching it from a systems level to incorporate self-care in to practice would be beneficial for practitioners as well as patients. The second discussion around fundal pressure in the second stage of labour began with a request for information from a student in Iran about its benefits and risks, which opened up an important discussion about varying practices in different countries. There were strong sentiments among members against the use of fundal pressure, with members sharing research on the risks for adverse outcomes. The discussion also elucidated that many countries use it routinely in practice, highlighting a divide between research and
practice. This informative discussion is ongoing, as the literature states that, when practiced routinely, fundal pressure in the second stage can be a harmful practice to women. The third discussion on incorporating traditional birth attendants (TBAs) in to healthcare systems generated discussion with members from 15 countries sharing their experiences and research around the topic. The majority of contributing members agreed that TBAs are informally practicing in many countries, which emphasises the importance of finding ways for formally incorporating them into healthcare systems. The GANM moderators enhanced the discussion by synthesising the available literature and broadening perspectives. These three examples are among many other pertinent topics that are discussed daily through the GANM’s various modes of knowledge dissemination. The GANM serves as an exemplary model utilising online platforms to share knowledge and improve practices around the world by increasing access to information and promoting dialogue and peer support.
Teresa Pfaff is the Manager of the Center for Global Initiatives at the Johns Hopkins School of Nursing (JHSON). Ashley Gresh is an Intern at the Center for Global Initiatives, WHO/PAHO Collaborating Center at JHSON. Fernando MenaCarrasco is as a Nurse Case Manager at the Comprehensive Care Practice (CCP) at Johns Hopkins Bayview Medical Center, and is an Intern at the Center for Global Initiatives, WHO/PAHO Collaborating Center at JHSON. Darlene Nnanyelugoh is an Intern at the Center for Global Initiatives, WHO/PAHO Collaborating Center at JHSON. anmf.org.au
FOCUS: Maternal health
BOOST TO VICTORIAN MATERNAL CHILD AND HEALTH SERVICES Victorian Maternal Child Health (MCH) nurses will get training in the latest techniques and practices to support families including those struggling with trauma thanks to a $81.1 million funding boost into the child and maternal health sector as part of the Victorian Budget 2017/18. As part of the package parents are eligible for child and maternal health support until their child turns three. Previously the service cut out just after one year. Additionally those at risk of family violence will receive additional outreach services of Maternal Child Health Nurses. The Maternal and Child Health Line will get additional funding to respond to
parents’ concerns over the phone. According to the ANMF Victorian Branch the much needed $81.1 million to boost Victoria’s highly qualified maternal and child health nursing service as part of the plan to identify, refer and support vulnerable families demonstrates the government understands MCH nurses’ skills and experience and the increased demand on them. Combined with last year’s budget this brings investment into
Victoria’s maternal and child health nursing service to $214.1 million. “We’re really pleased with the investment into ending unacceptable family violence and we believe including the additional maternal and child health nurses and the service they provide in this plan will be a game changer,” ANMF Victorian Branch Secretary Lisa Fitzpatrick said.
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FOCUS: Maternal health
UNIVERSAL FUNDED FLU VACCINE FOR CHILDREN Less than one third of Australian parents plan to vaccinate their child against flu this winter. A universal funded flu vaccine for children could substantially increase flu vaccine uptake rates in children, according to The Royal Children’s Hospital (RCH) in Melbourne. The latest RCH Australian Child Health Poll found more than one quarter of parents believed that healthy kids don’t get seriously unwell from the flu. One in six consider the flu is not a serious disease. This is despite influenza being the leading cause of hospitalisation due to a vaccine-preventable disease in children under five years. Australian Child Health Poll Director and Paediatrician Dr Anthea Rhodes said more than 1,500 children were hospitalised with flu-related complications each year. “Children, including healthy children (20-30% of children) are more likely to catch the flu than adults (10-30% of adults) and healthy children under five are the group most likely to be hospitalised for neurological or respiratory complications related to flu.
“Around half of all children who become seriously unwell and die from the flu are previously healthy children, with no underlying medical conditions.” The poll found cost a potential barrier for parents having their child vaccinated against the flu. One in five parents reported they could not afford the flu vaccine for their children. “Half of all parents said they would vaccinate their child if the flu vaccine was free,” Dr Rhodes said. “Universal funded flu vaccine for children has been on the agenda for some time and this poll reinforces the potential for such a program to substantially increase flu vaccine uptake rates.”
The poll found confusion still existed in the community about safety of the flu vaccine. Almost one in 10 parents believed children could ‘catch the flu’ from the flu vaccine; while a further 27% unsure. Dr Rhodes said this was an important reminder for health professionals to keep educating people that there was no live virus in the flu vaccine. The flu vaccine is recommended for everyone from six months of age and is free for those at higher risk under the National Immunisation Program. For more information, visit www.childhealthpoll.org.au
100 YEARS AND STILL GOING STRONG! By Bernice Boland
References
The State of Victoria in June 2017, will celebrate 100 years of the Maternal & Child Health Service. The need for healthcare for women and infants was evident as early as 1910 where wealthy mothers could contract with a home visiting service for the cost of two pounds for a private nurse/midwife attendant at the home. Services included the provision of advice in regard to the mother and infant for up to ten days post-delivery. This also included advice on the prevention of the deadly Summer Diarrhoea (Visiting Trained Nurses Association 1910). At this point in time, the mortality rate for small infants and children was soaring. Internationally, France had initiated hygiene measures which were assisting in decreasing the mortality rate of infants. The nation in 1914-1918 had been gripped by war with extensive loss of young men and women. The continued loss of children was becoming an 44 June 2017 Volume 24, No. 11
increasing emotional and social loss to communities. Other major contributing factors were poverty, infectious diseases, lack of sanitation and overcrowding (Sheard 2007, p10). The milk being fed to children was determined to be a cause of disease. Crockett (2000, p1) writes that in 1916, “Breast feeding was neither encouraged nor popular.” The Health Officer in 1918 for City of South Melbourne said, “It is more gratifying to note that the principle fall (Mortality Rate) is in the preventable diseases, like gastroenteritis, and the other wasting diseases dependent on errors in diet. It does more in that it shows that the diseases and deaths are preventable. The ways in which a mother can assist a child to its death are almost as numerous as the ways in which she is called upon to assist it at all” (City Surveyor’s Report 1918-1919).
Lady Talbot, wife of the Victorian State Governor established the Lady Talbot Milk Institute in 1908. The Institute provided a regulated fresh milk supply over the summer to needy mothers in Melbourne to counter problems experienced when babies were fed cow’s milk. It supplied small ice chests and ice to homes where Talbot milk was delivered for families. Lady Talbot nurses then visited mothers to impart up to date mothercraft advice. The scheme was successful but only reached a handful of mothers (Sheard 2000, p12). Sister Eva Perrett in 1918 wrote in her report to Dr Cuscaden Health Officer, “The Attendance is very regular… the big question is the milk supply for the infants for when the Talbot Institute closes, so many babies are put onto patent foods, and it seems to undo all the good work the milk
Campbell, K. & Wilmot E.A. 1976. Guide to the Care of the Young Child, Department of Health Victoria, p1. City Surveyors Report (Dr Cuscaden Health Officer). 1918-19. City of South Melbourne, p2, 5). Crockett, C.D. 2000. Save the Babies, The Victorian Baby Health Centres’ Association and the Queen Elizabeth Centre, Arcadia, Melbourne. p1, 5, 19, 21. Report to the Minister of Public Health: Welfare of Women and Children. 1926. Green Government Printer, Melbourne p53. Sheard, H. 2007. All the Little Children, The Story of Victoria’s Baby Health Centres, Municipal Association of Victoria, p10, 12. Visiting Trained Nurses’ Association, Pamphlet. 1910. Punt Road. Sth Yarra, p3.
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FOCUS: Maternal health supply had done during the summer months. The majority of mothers are anxious to breastfeed their infants but so many think that unless the babies gain 1LB per week, they are not thriving, and when the centre is visited and the mothers find that beautiful infants only gain 4 oz, they are surprised”(City Surveyor’s Report 1918-1919, p5). In 1917, an attempt was made to reduce the infant death rate by setting up centres in the community where mothers could bring their babies for health supervision and receive teaching on nutrition, hygiene and mothercraft. The Victorian Baby Health Centres Association headed up by Dr Isabella Younger Ross was formed. The first centre in Richmond was a baby health clinic in the Boroondara Free Kindergarten and together, Dr Isabella Younger Ross and Sister Muriel Peck worked together to change the outcomes for infants and young children (Campbell 1976 p1). In 1918, the State government Minister for Health granted a “Pound for Pound” subsidy up to 125 Pounds to encourage any municipal council which would support a local centre (Crockett 2000, p5). In 1920, Muriel Peck is appointed as Matron of the Training School and Dr Vera Scantlebury offers her services as an Honorary Lecturer to the Training School and Model Baby Health Centre situated in South Melbourne. Preference is given to trained nurses with a midwifery certificate (Crockett 2000, p19). Compulsory lectures were held on Tuesday morning with a follow up Saturday morning conference at the Children’s Hospital with the opportunity to consult medical staff (Crockett 2000, p21). In 1926, Doctors Main and Scantlebury report to the Minister of Public Health on the “Welfare of Women”. Within this report were the beginnings of the Maternal & Child
boroughs compulsory within three days of delivery. Registrars should furnish the welfare centre with lists of birth preferably daily or at the earliest possible opportunity. • One standard of statistics with monthly reports sent to the Health Department.
IN 2017, VAMCHN WORKS TOWARDS STRENGTHENING THE MATERNAL & CHILD HEALTH SERVICE, ADVOCATING AT A STATE AND NATIONAL LEVEL NOT ONLY ON BEHALF OF MATERNAL & CHILD HEALTH NURSES BUT ALSO ON BEHALF OF VICTORIAN FAMILIES. Health Service as we know it today. A number of recommendations were made including the following: • That the government should continue to extend the movement by giving subsidies, building and maintenance grants and by paying the salaries of a medical director and special nurses, including relieving nurses. Payment of railway passes. • That municipalities should continue to assume responsibility for part payment of their own nurses and in providing accommodation for the centres. Industrial areas were encouraged to continue or commence the “giving of milk” at reduced rates to necessitous cases attending the centres.” • Voluntary committees representing all classes of the community should be established to stimulate local interest, purposes of propaganda, formation of subcentres, and collection of funds. • Appointment of a full time Medical Director of Child Welfare. • Appointment of nurses with special qualifications to provide education. • State based curriculum, examinations, certificates, selection committee for proposed nurse applicants. • Notification of births in cities and
Maternal & Child Health Nurses will recognise a number of the elements of the existing Maternal & Child Health Service of today. In 1942, the Special Interest Group is formed which today, is recognised as the Victorian Association of Maternal & Child Health Nurses (VAMCHN). The nurses following on from Muriel Peck and others through the last 70 years have continued to advocate for the health and wellbeing of families. The advocacy for families has continued and at times has been fraught with difficulties where Maternal & Child Health Nurses have needed to stand up and be heard in regard to the preservation of the service and also for the welfare of the nurses. In 2017, VAMCHN works towards strengthening the Maternal & Child Health Service, advocating at a State and National level not only on behalf of Maternal & Child Health Nurses but also on behalf of Victorian Families. We continue to influence the health and wellbeing of families across Victoria. As Chair of VAMCHN, I invite you to join the Victorian Association of Maternal & Child Health Nurses and continue the proud history. In Victoria over this celebratory year of 2017, there are a number of events to be run by VAMCHN, come and join us. You are very welcome. Happy 100th birthday to the Maternal & Child Health Service of Victoria and to all those nurses who are currently working within the Service and to all those who have gone before us and led the way with incredible commitment and vision.
Bernice Boland is Chair of the Victorian Association Maternal & Child Health Nurses
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JUNE Bowel Cancer Awareness Month www.bowelcancerawarenessmonth.org/ Deakin University – Nurse Practitioner Masterclass This Masterclass supports registrants in their continuing professional development related to the role and function of the Nurse Practitioner in Australia and aims to provide the latest information on scopes of practice for Nurse Practitioners, clinical decision making and current issues. 1-2 June, Deakin Downtown, Level 12, Tower 2, 727 Collins St, Melbourne Vic. www.deakin.edu.au/about-deakin/ events/nurse-practitioner-masterclass Maternal Child and Family Health Nurses of Australia Conference The journey 1-3 June, The Peninsula, Docklands Melbourne. www.mcafhna.org.au/ Lung Health Promotion Centre at The Alfred A Practical Management Approach of Non Invasive Ventilation & Sleep Disorders 1-2 June Sleep: the how, why & the what – skills for your toolkit 1 June The Pressure to Breathe – the skills for success with NIV Spirometry Principles & Practice 5-6 June Paediatric Respiratory Update 26 June P: (03) 9076 2382 E: lunghealth@alfred.org.au Mabo Day 3 June. Commemorate the anniversary of the 1992 High Court decision in the case brought by Eddie Mabo and others which recognised the existence in Australia of native title rights. The historic court decision buried the legal description of early Australia as ‘terra nullius’, or ‘no man’s land’ www.aboriginalheritage.org/news/2013/ mabo-day/ World Environment Day 5 June. www.un.org/en/events/ environmentday/
10th International Conference on Childhood Obesity and Nutrition To enhance the prevention and treatment efforts for childhood obesity 12-13 June, Rome, Italy. http:// childhoodobesity.conferenceseries. com/
World Blood Donor Day 14 June. www.who.int/campaigns/ world-blood-donor-day/2016/en/
ANMF Vic Annual Delegates Conference 22-23 June, Melbourne Convention and Exhibition Centre, Vic. This two day conference will focus both on exploring occupational health and safety issues for nurses and midwives as well as giving delegates the opportunity to vote on resolutions and help shape the direction of their union for the next 12 months. http://bit.ly/ANMFevents
World Elder Abuse Awareness Day 15 June. https:// elderabuseawarenessday.org.au/
JULY
International Men’s Health Week 12-18 June. Theme: Healthy body – healthy mind: Keeping the balance. www.menshealthweek.org.au/En/ Default.aspx
20th Cancer Nurses Society of Australia Annual Congress Evolving cancer care: Enhancing quality Embracing innovation 15-17 June, Adelaide Convention Centre, South Australia. www.cnsacongress.com.au 13th Conference of the European Council of Enterostomal Therapists Building bridges – from west to east, from south to north Ostomy – Continence – Wound 18-21 June, Berlin, Germany. www.ecet2017.org 31st International Confederation of Midwives Triennial Congress Midwives - Making a difference in the world 18-22 June, Toronto, Canada. www.midwives2017.org/ National Refugee Week 18-24 June. www.refugeeweek.org.au/ Dying Well Conference 19-20 June, Nunyara Conference Centre, Adelaide Hills, SA. Learn how to journey alongside a person at the end-of-life to help them to die well. http://afcna.org.au/event/dying-wellconference/ Renal Society of Australasia Annual Conference Renal care in a changing environment: Innovation and transformation 19-21 June, International Convention Centre, Darling Harbour NSW. www.renalsociety.org/ International World Refugee Day 20 June. www.un.org/en/events/ refugeeday/
NETWORK The Queen Elizabeth Hospital, South Australia, Group 3/86 reunion Date and venue to be advised. Contact Justine Grant (nee Reddaway) E: justine.grant@sa.gov.au Royal Darwin Hospital, Group 7/77 (also including other groups from this year), 40-year reunion 15 July. Contact Di Robertson E: drobertson1959@hotmail.com The Southern Grampians Maternal and Child Nurses Regional Network will be celebrating 100 years of Maternal and Child Health Nursing in Victoria and closure of the group 18 August, 6.30pm, Ballarat Golf Club. All past and present M&CH nurses
46 June 2017 Volume 24, No. 11
Happiness & It’s Causes Conference Tools and techniques for a happier life 22-23 June, International Convention Centre, Sydney. www.happinessanditscauses.com.au
working in the local government areas of Golden Plains, Pyrenees, Moorabool, Hepburn and Ballarat are warmly invited to attend a dinner. Contact: belindajoyce@ballarat.vic.gov.au Victorian School Nurse Conference 9 September, Lauriston Girls School Armadale. Contact: Lindsey Booth E: lbooth@whitefriars.vic.edu.au M: 0407 509 622 Sturt College Nurses, 40-year reunion 4 November. Hoping you can join us for a casual and fun reunion of the first year of Sturt College nurses. It will be for drinks and dinner with time and venue to be advised. See event on Facebook. Contact Elizabeth Jarman M: 0422 702 917 or E: elizabethjanejarman@gmail.com
National Aborigines & Islanders Day Observance Committee (NAIDOC) Week 2-9 July. http://www.naidoc.org.au/ Australia and New Zealand Society of the History of Medicine 15th Biennial Conference Health, Medicine, and Society: Challenge and Change 11-15 July, Australian Catholic University, Fitzroy Campus, Melbourne, VIC. www.dcconferences.com.au/ hom2017 ANMF (Vic Branch) Enrolled Nurse Student Study Day 14 July, ANMF House, 540 Elizabeth Street Melbourne. http://bit.ly/ANMFevents Lung Health Promotion Centre at The Alfred Asthma Educator’s Course 19-21 July Respiratory Update 28 July P: (03) 9076 2382 E: lunghealth@alfred.org.au 5th Annual World Wide Nursing Conference The Role of Nursing in Leading and Advancing Global Health 24-25 July, Singapore. http://nursing-conf.org/
AUGUST Lung Health Promotion Centre at The Alfred Smoking Cessation Course 3-4 August Influencing Behaviour Change – a formula 10-11 August Influencing Behaviour Change – Theory & Practice 10 August Influencing Behaviour Change – Intensive Workshop/Case Studies 11 August Spirometry Principles & Practice 14–15 August P: (03) 9076 2382 E: lunghealth@alfred.org.au 18th Asia-Pacific Prostate Cancer Conference 2017 30 August–2 September, Melbourne Convention & Exhibition Centre. http://prostatecancerconference.org. au/ or apcc2017@icms.com.au APCR are proud to host the 18th AsiaPacific Prostate Cancer Conference and will present a world-class Faculty of both International and National presenters, across a full 3-day program. Streams in Clinical Urology, Translational Science, Nursing and Allied Health will ensure the most contemporary information and research-validated findings are presented.
SEPTEMBER International Wound Practice and Research Conference 6-7 September, Brisbane Convention & Exhibition Centre. http://iwprc2017.com.au Lung Health Promotion Centre at The Alfred Respiratory Course (Modules A & B) 18–21 September Respiratory Course (Module A) 18–19 September Respiratory Course (Module B) 20–21 September P: (03) 9076 2382 E: lunghealth@alfred.org.au
World Indigenous Peoples Conference on Education A Celebration of Resilience 24-29 July, Toronto Canada. www.wipce2017.com/ World Hepatitis Day 28 July. http://worldhepatitisday.org/
Prince Henry’s Hospital, 1/73, 45-year reunion 27 January 2018. Planning well underway. Trying to locate Carol Ball, Sue Ball, M de Graaf, Barb Gilmore, Sue Gladigau, Hilary Hammond, Barb Dunne, Narelle Harley, Chris Horton, Sue Ramage and Pam Walsh. Contact Jeanne O’Neill (nee Pinder) E: ej_oneill@yahoo.com PHH, POW and Eastern Suburbs Hospitals, NSW reunion for PTS intake of Feb 1973 17 February 2018. Contact Roslyn Kerr E: gert2@optusnet.com.au or Patricia Marshall (nee Purdy) E: tapric135@ bigpond.com
NDSN Bendigo School 71, 50-year reunion 2018. Seeking students from Bendigo, Castlemaine, Echuca, Swan Hill, Mildura. Contact E: margie_coad@ hotmail.com or M: 0427 567 511
Email cathy@anmf.org.au if you would like to place a reunion notice
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IT’S ABOUT CHOICE I read with interest the Letters to the Editor in the February issue of the ANMJ (V 24, #7) by Therese McLinden and Mary Sexton.
THE BENEFITS OF YOGA
LETTER OF THE MONTH
How refreshing it was to read how to improve the body, mind and spirit with yoga and Jana Hnatova’s experiences on how yoga has helped her. Being one of the older generations of nurses I can relate to her when she experienced physical relief from lower back pain. By attending yoga three to four times per week, I have been able to continue with my nursing. Unfortunately we were taught unhealthy ways to lift patients. I suffered with back pain especially when lying in bed and rising in the morning. Now, I am free of pain at night and can get up freely in the morning. Fortunately there is a ‘no lift’ policy in the hospital now so the younger nurses are protected to a certain degree from back injuries.
In response to Ms McLinden, the need for consideration of palliative care when discussing Voluntary Euthanasia (VE) has been done consistently over 15 years in the fight for VE legislation in South Australia (South Australian Voluntary Euthanasia Society 2017). Nevertheless, the Australian Institute of Health and Welfare (2014) has shown that only 40% of people who die in hospital (where most people die) received palliative care. Palliative care services across Australia were recently reviewed by the Department of Health (2016) and many people in this industry are awaiting the outcome of this review in relation to continued funding. As much as we would like to say that everyone will receive palliative care at the end of their life, the fact is that many people
References South Australian Voluntary Euthanasia Society. 2017. Palliative care and voluntary euthanasia complementary, not incompatible - concepts of care for ALL people. Viewed 25 April 2017 at www.saves. asn.au/issues/pall_care.pdf Australian Institute of Health and Welfare. 2014. Palliative Care Services in Australia. Australian Institute of Health and Welfare. Canberra. Cat No. HWI 128 Department of Health. 2016. Australian Government Response to the Senate Community Affairs References Committee Report: Palliative Care in Australia. Canberra
Sandra Bradley, RN, PhD, South Australia
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It’s a well-known fact that yoga can have a positive impact on the body including emotional and physical health as well as disease prevention. “Yoga and meditation are great ways to deal with workplace stress,” says Registered Nurse Jana Hnatova. Jana, who works in the area of anaesthetics in Melbourne, discovered Ashtanga Yoga well over a year ago after she sustained an ankle injury from running. “I came across it quite accidently,” she says. Since then Jana, who now attends yoga classes four times a week, has noticed significant benefits of her practice that have helped her physically and emotionally, at work and in her personal life. This has included relief from ongoing lower back pain, she says. “Standing all day doing anaesthetics I would go home so sore and was getting massages to try and help relive that. “I can honestly say in the past 12 months since practising yoga I haven’t had any troubles [with my lower back].” Besides relieving back pain regular yoga practice is known to lessen musculoskeletal stiffness as well as improve flexibility and posture which can aid in the prevention of work injuries. Prevention of heart disease, reducing blood pressure, controlling weight and strengthening bones to help prevent osteoporosis are also other known benefits. Yoga can also help focus the mind, ease tension, help with concentration, improve energy levels and promote a feeling of calm. “It brings you to the space that you feel more relaxed,” Jana says. According to Jana this can be attributed to connecting with the breath while doing postures, which brings peace. Being more conscious of the breath Jana now applies breathing awareness to stressful situations in her daily life. “When facing a stressful situation I now just stop and think about what I am doing and start breathing then I think ‘oh yeah this is really helping’. I’m much calmer because of it.” Moving from South Australia to Victoria almost 12 months ago on her own, Jana has found yoga invaluable in helping deal with the stress of moving interstate and starting a new job. “I think the reason I stayed in Melbourne was because of yoga. If I hadn’t found this studio I don’t think I would still be here [in Melbourne]. I was considering going home but going to the studio every night helped me to adjust. It has been something to look forward to.” “I think all nurses should try yoga,” says Jana. “It really does take all your worries away.”
Wendy Stephens RN, Tasmania
International Day of the Midwife and International Nurses Day, celebrated on 5 May and 12 May respectively, are when nurses and midwives are acknowledged for the job that they do and also thanked for the vital care they give to their patients, their patients’ families and each other. Yet while nurses and midwives are good at taking care of others, sometimes they can fall short of taking care of
themselves. When celebrating nurses and midwives during May it is important to take time to acknowledge your own achievements as a nurse and/or a midwife, but also review what you are doing to care for yourself. Applying a few strategies could help you live more fulfilling, productive and happier lives, professionally and personally.
NEED SOME INSPIRATION? WE’VE COME UP WITH SOME TIPS AND STORIES TO MOTIVATE YOU.
THE WINNER OF THE ANMJ BEST LETTER COMPETITION RECEIVES A $50 COLES MYER VOUCHER.
Whether you work a run of late/early shifts or nights, shift work can play havoc with your sleeping patterns. While the demands of shift work can make it impossible to get eight hours of sleep a night, experts suggest the quality of sleep rather than the time spent in bed is what is important. According to the Mayo clinic doing the following will give you a better night’s rest. • Don’t go to bed either hungry or completely full as your discomfort might keep you up. Be mindful of nicotine, caffeine and alcohol at night. The stimulating effects of nicotine and
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caffeine take hours to wear off and can wreak havoc on quality sleep. Alcohol can make you feel sleepy at first but can disrupt sleep later in the night. Create a bedtime ritual that you practise every night to tell your body it’s time to wind down. This may include taking a warm bath or shower, reading a book or listening to music. These activities can promote better sleep by easing the transition between wakefulness and drowsiness. Ensure your room is ideal for sleeping such as making sure it is dark, quiet and cool. Room-darkening shades, earplugs, a fan or other devices to create an environment that suits your needs. Make sure your bed, pillow and coverings are most comfortable to you.
May 2017 Volume 24, No. 10
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Bending, pushing, and lifting are regular movements nurses and midwives perform during a typical shift on the job. Unfortunately, the inherent demands of the profession can also lead to serious back and neck pain and other niggling injuries that impede the ability to work.
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National Chair of the Australian Physiotherapy Association’s Occupational Health Group David Hall says injuries to nurses were so common back in the day that the concept of ‘nurses’ back’ emerged as a phenomenon. These days, workplaces are more progressive in implementing training programs and adhering to safe patient handling No Lift policies. Mr Hall, who is also the Director of the Melbourne-based Productive Healthy Workplaces (PHW) Group, which specialises in keeping people fit, healthy, and injury free at work, said one of the biggest challenges nurses face in protecting their health on the job is time. “There can be a difference between what the policies say and how things are actually done on the ground and one of the greatest interactions with those policies is time.”
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your stories, our inspiration HESTA_Your stories our inspiration_188x21mm.indd 1 anmf.org.au
12/04/2017 11:52 AM May 2017 Volume 24, No. 10 17
WELLBEING FOR WELLNESS I’d like to thank you for your International Day of the Midwife and International Nurses Day Wellbeing special in the May 2017 issue of the ANMJ. As nurses and midwives our focus is always about the patient. While most of us wouldn’t have it any other way, this feature is a good reminder that we must care for ourselves as well as each other; not only for our own sakes, but the sakes of our patients. The wellbeing tips were a useful prompt of what we should do.
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Ms Sexton mentioned ‘Soylent Green’ the movie. In the movie there is a special facility for people to enter when they wish to die – there they are provided the food and drink that they like, see photos/movies/visual images that calm them, hear the music that has made them sing in life and at the end of the day are given a painless lethal injection - today, we call that hospice and palliative sedation.
International Day of the Midwife and International Nurses Day special
BROUGHT
I had no idea how yoga would change my life. As one ages, one realises how important it is to keep going with exercise to maintain mobility. For those nurses who suffer with pain or injuries, there is hope out there. How about giving yoga a go!
IF YOU WOULD LIKE TO SUBMIT A LETTER TO THE ANMJ EMAIL ANMJ@ANMF.ORG.AU LETTERS MAY BE EDITED FOR CLARITY AND SPACE.
won’t. Therefore, other choices, such as assisted dying, should be made available to alleviate suffering that may occur at the end of life if that is the person’s choice.
While I guess most of your ideas were common sense, it’s nice to be reminded that it is the simple things that we can do for ourselves that make the biggest difference. Rest assured I will be taking up yoga again and implementing a new night time routine. Jodie Smith RN, South Australia
June 2017 Volume 24, No. 11 47
SALLY
IMPACT OF CLIMATE CHANGE ON HEALTH After a stunning, provocative presentation by the Climate and Health Alliance www.caha.org.au (CAHA) to the Federal Executive of the ANMF, I feel compelled to share with you some of the scary things I heard that make me even more concerned about the impact of climate change on the future health and wellbeing of humankind living on Earth. Sally- Anne Jones, ANMF Federal President
Nurses and midwives all over the world are already working with people and communities suffering from the effects of climate change such as drought, floods, heat waves, and severe storms as examples.
experienced the hottest Christmas ever at 41.3 degrees; and Canberra had its hottest summer with temperatures of at least 35 degrees on 18 days – far higher than the 12 days projected for 2030!
These events lead to communities being harmed through lack of food and water, inability to shelter from extreme weather events, increased spread and resilience of disease, respiratory effects of pollution, exacerbation of chronic disease, heatstroke leading to collapse, dehydration and heart failure.
Apart from the health risks, the effects of climate change impact on productivity at work; risk to the environment with fire, floods and damage to the reef; it places pressure on critical infrastructure such as electricity grids and roads, and impacts the economy.
The effects may vary from country to country depending on location and development, but no nation is exempt. Not one. Our emergency departments are inundated over prolonged heat events with children and adults, young and old who are suffering the effects of heat exposure from kids who forget to drink enough water, to workers with heat-exposed jobs like farmers and construction workers to the elderly who close up their house for safety and don’t want to use the air-conditioner (if they have it) because it is too expensive. While not many reported deaths can be directly attributable to climate, an overheated and dehydrated human body starts a cascade of physiological sequelae that may ultimately lead to the death of an individual. The World Health Organization estimates that by 2009, climate change was responsible for the deaths of 300,000 people each year.
AS NURSES AND MIDWIVES, WE ARE CONSTANTLY LINKING THE RELATIONSHIPS BETWEEN SOCIAL DETERMINANTS OF HEALTH (FOOD, CLEAN WATER, SHELTER, INCOME) URBAN DESIGN, ENERGY AND WATER SECURITY, TRANSPORT AND ENVIRONMENT ON THE HEALTH OF THE COMMUNITIES WE WORK IN. The Climate Council www. climatecouncil.org.au published a document called The Angry Summer 2016/17 during which 205 Australian extreme weather records were broken in just 90 days – the wettest December in the Kimberley, 100 bushfires in NSW in February, Moree had 54 consecutive days of 35 degrees or above; 30 consecutive days above 30 for Brisbane; Adelaide 48 June 2017 Volume 24, No. 11
NASAs prediction is that that as the world consumes more fossil fuel, greenhouse gas concentrations will continue to rise, and Earth’s average surface temperature will rise with them. According to climate scientists, the difference that half a degree could make is stark. At 2 degrees of warming, southwest Asia, and the Middle East would become uninhabitable without permanent air-conditioning, there would be an ice-free Arctic and viability of food crops would decline significantly. And of course, the potential for rising political and military tension between countries over water resources cannot be ignored either. Hot days and heatwaves, like those experienced in the 2016/17 Angry Summer, are becoming the new normal. Even if the global temperature rise was only 2°C from pre-industrial levels, what was once a one in 50 year extreme weather event would instead occur every five years. So unless the cause of the rise in global temperature is addressed, the heat, the severe storms, the blasting gusty winds, cyclones and flooding rains are not predicted to abate anytime soon. Australia joined the rest of the world in Paris at the 21st United Nations Conference of the Parties (COP21) meeting in December 2015 to increase the level of commitment to limit climate change. Despite signing the Paris agreement, Australia’s carbon emissions has increased, while China’s has remained steady and the USA’s has reduced. It is clear the Australian government’s current climate change policy is not good enough. For me today, I had a lightbulb moment and connected this seemingly separate issue with my
nursing work. CAHA outlines a range of strategies for investment in sustainable healthcare and preparing the health sector to deal with existing and future health effects of climate change ranging from partnerships across the globe to share strategy and models of care; development of a climate resilience national health performance standard; mandating the inclusion of health and climate change science in all health professional curricula; and investing in continuing professional education programs for health professionals to ensure there is an adequately staffed and skilled workforce cognisant of climate risks and able to respond to the increased burden on the population and health services from climate change. Even with scientific, ecologic, social science and meteorological evidence available there are some who still believe that the changes we feel and see in our climate in Australia and across the world are natural peaks and troughs of cool and warm periods (El Nino) , and that perhaps the ‘hippies and greenies’ drive unnecessary public hysteria. I’ve never had those doubts, but what I heard today is a call to action for health professionals everywhere to get involved in the climate change movement. Apart from lobbying political parties to commit to carbon emissions reductions, considering renewable energy sources, reducing pollution and increasing recycling, nurses and midwives in all sectors and in all environments, can prepare our communities by assisting them in anticipating and adapting to climate risks essential to protecting health and wellbeing. As nurses and midwives, we are constantly linking the relationships between social determinants of health (food, clean water, shelter, income) urban design, energy and water security, transport and environment on the health of the communities we work in. Let us harness our commitment to better health outcomes for Australians by strengthening our commitment to the climate change movement – the health of our patients and future generations depends on it. anmf.org.au
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