ANMJ November 2015 by Australian Nursing & Midwifery Journal

V O LU M E 2 3 , N O. 5 / N O V E M B E R 2 0 1 5

SHINING THE SPOTLIGHT ON AGED CARE

www.anmf.org.au

CALL FOR ABSTRACTS

18th South Pacific Nurses Forum:

Through Nursing Excellence for Universal (Pacific) Health Monday 10 to Friday 14 October 2016, Honiara, Solomon Islands

The forum will bring together evidence, experience and innovations highlighting the critical importance of nursing’s strategic contribution to universal health coverage in the Pacific region and will provide a regional platform for the dissemination of nursing knowledge and leadership across specialities, cultures, countries and territories of the South Pacific.

Our sub-themes are: • Leveraging Nursing Leadership for Health Outcomes • Strategic Management of Nursing Human Resource for Health • Innovative Nursing Education for Improved Health Care • Developing Nursing Workforce for Effective Service Delivery • Improved Health Service Delivery through Nursing Practice • Impact of Nursing Regulation on Health Service Delivery

Key Dates Abstract submission closes: 08 February 2016 Applicants notified of abstract acceptance: 11 April 2016 Registration of abstract presenters closes: 13 June 2016

For more information on the abstract submission process please email: spnfsina@gmail.com or visit www.spnf.org.au SOLOMON ISLANDS NURSES ASSOCIATION

CONTENTS Directory 02

Editorial 03 News 04 Industrial 15 Feature – Aged care 16 World 22 Ethics 23

SHINING THE SPOTLIGHT ON AGED CARE

Research 24 Reflection 25 Clinical update

Working life

Issues 31 Education 32 Focus – Mens Health 34 Calendar 47 Annie 48

04 25 34

anmf.org.au

November 2015 Volume 23, No. 5 1

Canberra

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Front cover: Pamela Blacker Photograher: Michael Amendolia

Editorial

Melbourne & ANMJ

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Federal Secretary Lee Thomas

Assistant Federal Secretary Annie Butler

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Northern Territory

South Australia

Victoria

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

Moving state? Transfer your ANMF membership

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

New South Wales

Queensland

Tasmania

Western Australia

Branch Secretary Brett Holmes

Branch Secretary Beth Mohle

Branch Secretary Neroli Ellis

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

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

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

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2 November 2015 Volume 23, No. 5

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EDITORIAL

Editorial Lee Thomas, ANMF Federal Secretary ANMF’s 12th Biennial conference in Adelaide last month was a success to be proud of.

WHILE THE ANMF HAS AND CONTINUES TO VIGOROUSLY CAMPAIGN FOR BETTER WAGES, CONDITIONS, WORKLOADS, SKILL MIX AND REGULATION, IT IS URGENT THAT THE GOVERNMENT TAKE HEED AND FIX THIS SECTOR IMMEDIATELY.

As always the passion and determination of the delegates to better the professions and healthcare for all Australians was nothing short of inspirational. True to the conference’s theme, we will not be silenced: the power of nurses and midwives, delegates and speakers spoke out on important professional, industrial and social justice issues affecting the professions, such as paid parental leave and penalty rates. With plenty of lively and healthy debate over the two day conference, most delegates left with a fire in their belly to stand up for what is right and important to the professions, and with a knowledge that together we have the power to make positive change. One area of great concern at the conference was workforce issues in aged care. While the ANMF has and continues to vigorously campaign for better wages, conditions, workloads, skill mix and regulation, it is urgent that the government take heed and fix this sector immediately. Without these essential conditions being attended to, nurses and assistants in nursing (AINs) working in aged care are hurtling towards breaking point. The demands placed upon them are growing exponentially, resulting in older Australians failing to get the care that they need and deserve. This month’s feature looks at some of the major issues that plague this sector, including some of the horror stories from nurses about the conditions they are contending with and the impact this is having on quality care. Unfortunately these stories are not unique and are sadly becoming the norm.

@AustralianNursingandMidwiferyFederation

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@anmfbetterhands

To address these issues we need an aged care workforce strategy that is meaningful, and we need it now. To this end we have been lobbying newly appointed Ministers to Aged Care, Federal Minister Sussan Ley and Hon Ken Wyatt, to work with stakeholders including the ANMF in developing a strategy as a matter of priority. Rest assured we will not be silenced until this occurs. The ANMJ’s focus section this month is on men’s health. This coincides with Movember when men sprout moustaches to bring into focus health issues blokes may have. Many of these health issues are significant, but often not recognised or treated. Nurses, however, are making significant inroads in bringing these issues to the fore ensuring men’s health needs are met. I encourage all blokes and those of you with men in your lives to partake in Movember activities this November and bring awareness to this important area of health.

www.anmf.org.au

November 2015 Volume 23, No. 5 3

NEWS

ANMF seizes title of Australia’s largest union

Mandated ratios – Victorian nurses and midwives celebrate ratios win Victoria will now have enshrined in law nurse and midwife to patient ratios in a historic long-fought win. The Safe Patient Care (Nurse to Patient and Midwife to Patient Ratios) Bill 2015 passed unopposed through the state Parliament’s Upper House last month. The new law will outline the minimum number of nurses and midwives needed in most public hospital wards and aged care facilities in Victoria covered by their public sector enterprise bargaining agreement. Nurse/midwife to patient ratios were introduced in Victoria in 2000. California is the only other state in the world to have legislated ratios which were enacted in 2004. The ANMF Victorian Branch has fought every four years to renegotiate ratios in the public sector EBA negotiations since their introduction, ANMF Victorian Branch Secretary Lisa Fitzpatrick said. Before the introduction of ratios in 2000, about 20,000 Victorian nurses and midwives had chosen to leave the profession. Ms Fitzpatrick sat alongside Victorian 4 November 2015 Volume 23, No. 5

nurses and midwives from across the state in the public gallery to witness the longawaited moment. “Victorian patients will no longer need to worry about potential understaffing when they present at one of our public hospitals and nurses and midwives can focus on giving safer care,” she said. “Now that the legislation is in place, we can begin working on improving ratios to ensure Victoria’s patients continue to receive world class care.” Victorian Premier Daniel Andrews committed to introduce legislated nurse and midwife to patient ratios as a preelection promise. “Patient care isn’t something to be bargained with. We’re introducing new laws to take nurse and midwife to patient ratios off the bargaining table once and for all.” The legislation directly affects the current public sector EBA which must be accepted by ANMF members through a postal vote conducted by the Australian Electoral Commission. This is expected to be completed by the end of the year. Ms Fitzpatrick encouraged all nurses and midwives in the public sector to vote in favour for the current 2012-2016 EBA. The Queensland government has committed to introduce similar nurse and midwife to patient ratios legislation in the state next year.

The Australian Nursing and Midwifery Federation (ANMF) can officially lay claim to the title of Australia’s largest union thanks to a 12% boost in membership that has helped propel numbers to a record 249,000 members. News of the membership feat was announced by ANMF Federal Secretary Lee Thomas at the opening of the union’s Biennial National Conference in Adelaide last month. “I’m proud to report that our wonderful nursing and midwifery family has grown to this membership milestone,” Ms Thomas said. Ms Thomas attributed the rise in membership growth to the ANMF’s extensive list of successful campaigns fought passionately and collectively by the ANMF Federal Office and its State and Territory branches. She cited several key victories to illustrate her point, including thwarting the proposed GP copayment, fighting to protect penalty rates for nurses and midwives, and achieving landmark commitments for mandated nurse to patient ratios in both Victoria and Queensland. Ms Thomas said the past two years had posed significant challenges in the form of threats to Medicare, massive job cuts in Queensland’s health workforce, and the federal government’s moves to rip billions of dollars from States and Territories by slashing health and aged care budgets. However, she praised the ANMF for continually banding together to protect the health system and achieve significant triumphs for new and existing members.“It’s put the federal government and government’s across the country on notice that we are a force to be reckoned with across the health, aged care, industrial and political arenas.” anmf.org.au

NEWS

ANMF delivers sonic boom at Fair Work Commission The Australian Nursing and Midwifery Federation (ANMF) has clinched a decisive victory at the Fair Work Commission (FWC) after successfully challenging an application by medical centre operator Sonic HealthPlus that would have resulted in dozens of nurses losing out on valuable workplace entitlements. Sonic HealthPlus, which runs a national network of medical centres, purchased Medibank’s group of Workplace Health and Travel Doctor medical clinics back in June. Soon after the purchase, Sonic HealthPlus made an application to the FWC in a bid to stop the Medibank Health Solutions Enterprise Agreement 2012 transferring across along with any new employees added as part of the business takeover. Sonic Health’s application to the FWC requested its existing Enterprise Agreement apply instead, despite it being acknowledged by both parties that the terms and conditions of the Medibank Agreement were far superior to existing SHP Agreements and that Medibank employees were paid significantly higher.

OUR MEMBERS HAD BEEN PRETTY CONCERNED ABOUT THE DIFFERENCE BETWEEN THE TWO AGREEMENTS Evidence presented by the ANMF listed numerous potential losses in entitlements if the order was approved including: an increase in work hours from 37.5 to 38 hours per week, loss of a shift allowance of 15% for hours worked between 6pm and midnight, a reduction in paid parental leave and superannuation contributions, and overtime no longer being paid for additional hours worked beyond the employee’s rostered hours but rather after 10 hours. Sonic Health claimed the number of Medibank employees who would be made job offers would drop from 159 to 60 if the application was not granted due to significant economic disadvantage. Medibank employed 513 people across both businesses and it was estimated that about 300 to 400 would be made redundant under the changes. ANMF Federal Industrial Research Officer Debbie Richards refuted Sonic’s position. “They were using that as one of anmf.org.au

their key arguments but we didn’t have any guarantee of the numbers they were going to employ,” she said. “We don’t really know whether that was a figure they were just using as a threat to scare people. We don’t really know how definite that figure was.” Sonic Health also argued that hiring new employees under different conditions would create confusion, rostering issues, and potentially upset workplace culture. In turn, the ANMF countered that two agreements already apply to SHP employees and that it is standard practice to have employees grouped on different industrial arrangements. Ms Richards added that Sonic Health is a large and profitable company which would have been fully aware of its operational needs prior to the purchase. Another key point of contention, a claim by Sonic Health that only 27 responses had been received from Medibank employees in opposition to the plans, was similarly dismissed by Ms Richards. “That doesn’t indicate the position of the nurses at all because people sometimes feel a bit nervous about expressing their views to the employer and they may have thought they’d be disadvantaged in their future employment with Sonic.” The Fair Work Commission handed down its verdict in late September, rejecting Sonic’s application. In reaching her decision, Fair Work Commissioner Anna-Lee Cribb said a 2.5% minimum wage increase offered by Sonic Health was unlikely to offset the considerable reduction in entitlements faced by transferring Medibank employees. “It is my view that those factors weighing up against the making of the orders outweigh those in favour,” Commissioner Cribb said. Ms Richards said union members were thrilled with the outcome. “Our members had been pretty concerned about the difference between the two Agreements and losing a lot of their terms and conditions. It’s really good news for them and we’ve had good feedback.” Workplace Health Clinics and Travel Doctor Medical Centres both transferred over to Sonic Health during October. With the Medibank agreement expiring in September, Sonic Health now has the option of continuing with negotiating a new agreement, or pursuing further action by applying to the Fair Work Commission again to have the agreement terminated. Ms Richards said the union was unsure what would transpire and that the ANMF will consider its legal options in due course. “They [the nurses] are really relieved that they’re continuing on their current terms and conditions, so at least that part of it provides some certainty for the time being. But what happens beyond that we don’t know.”

Australian College of Nursing has a new CEO The Australian College of Nursing (ACN) has appointed Adjunct Professor Kylie Ward as their new CEO, taking the reins from Adjunct Professor Debra Thoms who resigned from the position earlier this year to become Chief Nursing and Midwifery Officer of Australia. Adjunct Professor Ward, who will commence as CEO this month, has an extensive background in nursing and healthcare as well as academia, said ACN President Carmen Morgan. “Adjunct Professor Ward has enjoyed a successful and accomplished career in many aspects of nursing and healthcare.” Ms Morgan said, this included a nursing career working across numerous rural, regional and remote eastern sea board health services, in areas such as intensive care, acute care, and aged care. Additionally, Adjunct Professor Ward has held a position as Adjunct Clinical Associate Professor in leadership and management at Monash University, said Ms Morgan. Adjunct Professor Ward said she plans to build upon the strong foundations of the ACN. “I see many opportunities for us to increase our presence, influence and support for nurses everywhere and believe that if we harness the best of our past together with dynamic and contemporary thinking, we will be successful in driving the health and aged care policy agenda.” November 2015 Volume 23, No. 5 5

NEWS

Nursing Fellow a first For the first time a nurse has been honoured Fellow of the Australian Academy of Health and Medical Sciences. Griffith University’s Professor of Nursing, Claire Rickard (pictured) joins 77 new Fellows drawn from across Australia in all aspects of health and medical science within clinical practice and allied healthcare. Professor Rickard, who is Director of Griffith based Alliance for Vascular Access Training and Research (AVATAR), the largest research group in the world investigating intravascular access, has been involved in research that has improved patient comfort while reducing healthcare spend. According to Professor Rickard, the group investigates practices in hospitals that have never been tested before to see which ones work and which ones do not. For about 40 years, peripheral catheters were routinely replaced every

Anxiety as common as depression for new parents More than 50% of callers to the Perinatal Anxiety and Depression Australia (PANDA) National Helpline experience anxiety, according to the not for profit organisation. In the lead up to Perinatal Depression and Anxiety Awareness week, 15-21 November, PANDA is highlighting the issue, stating the challenges faced by parents fall across a wide spectrum that’s not all black and

few days, even if there were no problems. It was thought that doing this would minimise the risk of blood infections or phlebitis. Randomised controlled studies conducted by AVATAR found that leaving the catheter in beyond three days, until it was no longer required made no difference on the onset of infection or other complications. Consequently, the research findings have been changing policy around the world resulting in patient comfort and significant healthcare savings. “Each week we have overseas hospitals contacting us to say they have changed their standard of practice for catheter replacement based on our research findings. In the UK it is now mandatory for all adult NHS hospitals to follow clinically indicated catheter replacement,” Professor Rickard said. “We want patients to have the best experience they can, whether that means less pain or fewer infections, or reduced time in hospital because they have had more effective treatment. That’s what drives us.”

white. “Were finding that anxiety is now just as common as depression and many parents experience both anxiety and depression at the same time so it needs to be front of mind as a health concern during pregnancy and after birth,” said PANDA CEO Terri Smith. “Anxiety is not as well recognised and risks being overlooked because people may wrongly assume that the symptoms are not as debilitating or distressing as those associated with depression.” Ms Smith said over 1,800 Australian parents each week are now diagnosed with antenatal or postnatal depression,

with the illness costing Australia close to half a billion dollars. “We know up to one in seven women and one in 10 men will experience postnatal depression but the issues aren’t as black and white as this, nor are they restricted to the period after birth.” For more information about Perinatal Depression and Anxiety Awareness week or for a range of information for parents go to: www.panda.org.au PANDA’S free National Parental Anxiety and Depression Hotline offers counselling, information and referral services with ongoing telephone support for families throughout Australia. 1300 726 306.

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NEWS

Revamped electronic health records A makeover of the government’s failed first attempt at implementing a national electronic health records system was one of the key issues dissected at a recent event hosted by the Committee for Economic Development of Australia (CEDA). The revamped system will run under the title My Health Record and replace the Personally Controlled Electronic Health Record (PCEHR) that launched in July, 2012. Funding for the overhaul was announced by the government in its 201516 Budget, with $485 million pledged towards simplifying and streamlining the system and establishing an Australian Commission for eHealth that will oversee the operation. Speaking at the CEDA Forum Health: The digital transformation, Paul Madden, the Special Adviser – Strategic Health Systems and Information from the Federal Department of Health, said the overhaul was essential given the original system had failed to be embraced by both consumers and health professionals.

THE SYSTEM EXISTS. IT’S BEEN THERE FOR THREE YEARS. [BUT] IT NEEDS SOME TWEAKING AND USABILITY CHANGES. Mr Madden sang the praises of the system’s capabilities, which make it simple for nurses, doctors, pharmacists, GPs, and other healthcare providers to instantaneously access important medical history and a range of clinical documents. However, he acknowledged that a review of the system had uncovered issues with usability, privacy concerns from consumers, and a lack of awareness. “The system exists. It’s been there for three years. [But] it needs some tweaking and usability changes.” Mr Madden stressed that the review had illustrated a strong level of support for the system. Moving forward, the government will begin the revamp by initiating targeted GP education of the system and revised incentives for GPs who use it. Crucially, the changes will involve plans

to move to an opt-out system, imposing registration. The system currently has 2.4 million people registered. Opt-out trials are soon set to take place in four different locations across Australia to gauge level of support. “We’re looking for a response from the community in terms of acceptance,” Mr Madden said. Former Australian politician Brownyn Pike, who is now an Executive with Telstra Health and Chair of Western Health, and who spoke at the CEDA Forum, is currently working with Telstra Health as part of the senior leadership team developing the new eHealth business for Australia’s largest telecommunications company. Ms Pike said the digital revolution had changed people’s lives but that the potential synergies between health and technology had yet to be fully embraced. Ms Pike said innovation existed and with more acceptance, the landscape would change. “Our ambition is to bring quality healthcare to every Australian in what is a fragmented system.” Ms Pike believes one way in which the digital world can have a positive effect on health is by reducing unnecessary hospital admissions, which she said runs into thousands of dollars. She listed six opportunities for digital health’s future – a more productive system, integrated information, better access, safer pharmacy, reduced admissions, and empowered patients. “Technology can really improve our lives and empower us,” she said. “We’re using technology to build capabilities. Nurses currently spend half their time in engagement paperwork which could all be automated. “The aim is greater productivity and patient outcomes and consumers becoming more engaged in their own healthcare.”

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NEWS

Conference draws hundreds of nurses and midwives

AUNTIES EMILY MARSHALL, GRACELYN SMALLWOOD AND DIANA ROSS

Prominent Aboriginal leaders tie for major award A trio of Townsville nurses who work at the same medical clinic have been named joint winners of the prestigious Lifetime Achievement Award at the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) 2015 Annual Conference in Darwin. Colleagues Aunty Gracelyn Smallwood, Aunty Diana Ross, and Aunty Emily Marshall were bestowed the honour for their years of service to the nursing and midwifery profession and focus on improving indigenous health outcomes. Associate Professor Gracelyn Smallwood, the Indigenous Adviser to the Vice Chancellor at Queensland’s James Cook University, is still a practicing nurse and midwife at the Townsville Aboriginal and Islanders’ Health Service (TAIHS) that she helped establish in the early 70s. Professor Smallwood said she was humbled by the award. “It was very moving and very emotional,” she said. “It’s a blowout because every year’s a bonus for us after 45 because our life expectancy is 45 to 50.” Professor Smallwood counts finishing her PhD in 2011 titled Human Rights and First Australians Well-being as her greatest achievement, and said she now adds the CATSINaM award to the list. A forthright advocate for the rights of Aboriginal and Torres Strait Islander people since the late 60s, Professor Smallwood said progress had become an enduring goal. “Racism is a fact of life and until we combat racism we ain’t gonna win the battle of reconciliation.” Professor Smallwood said TAIHS was established in a bid to break down the barriers of racism within mainstream health. She recalled attending the first CATSINaM conference and said she was pleased to see so many young new faces in attendance this year and that it augured well for the future Indigenous nursing and midwifery workforce. Professor Smallwood, 65, said nursing was a lifelong passion and that she will continue to push to close the health and life expectancy gap. “It’s a privilege to be anmf.org.au

WE’RE ONE OF THE WEALTHIEST COUNTRIES IN THE WORLD YET OUR PEOPLE ARE SUFFERING DISEASES THAT DEVELOPING COUNTRIES HAVE ERADICATED a white Australian in this country. We’re one of the wealthiest countries in the world yet our people are suffering diseases that developing countries have eradicated.” Colleague Aunty Diana Ross described the Townsville clinic where the trio work as a great environment to be part of. Aunty Diana fell into nursing in 1956 and quickly developed a passion for the job. She said she was surprised with the Lifetime Achievement Award. “Accolades don’t mean a great deal to me,” she said. “[But] this is different because it’s what I love doing, taking care of people.” Aunty Diana, 76, said she would continue working at the clinic as long as her health permitted. Attending CATSINaM filled her with great pride and hope for the future, she added. “I look at how it’s developed and what a wonderful job people are doing. “I’d like to see more of our mob in the nursing profession.” Aunty Diana said many Aboriginal people could pursue careers in nursing with a little bit of hard work and persistence. “I think our Murri’s seem to think they can’t do it. But yes you can. It just means that you have to out in 110% effort. “Anybody and everyone can do it if they want to. They just have to put that big effort in.”

Hundreds of nurses, midwives, educators, and policy makers from around the country converged on Darwin last month for the 17th Annual Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) Conference. Running under the theme Unity and Strength through Caring, the three-day conference provided an opportunity for the national health community to showcase the progress being made in Aboriginal and Torres Strait Islander health outcomes. This year’s event featured an eclectic mix of presentations focusing on issues including cultural competency, how ice is impacting on Aboriginal and Torres Strait Islander communities, the state of Northern Territory health, and federal government feedback on tackling workforce numbers. CATSINaM Chief Executive Officer Janine Mohamed described the conference as a crucial opportunity to inspire young Aboriginal nurses and midwives to connect with each other and be resilient and proud of their profession. The broad goals of this year’s conference were to increase the number of participants and to create a program that reflected membership. Ms Mohamed listed a talk by Karen Cook from the Commonwealth Department of Health on investment in a national workforce strategy as an example of topical issues that required ongoing discussion. She said while informative keynote presentations were a vital part of the conference, so too was the chance for members to learn from each other. “The other part of our conference is about people creating friendships and networks for life.” CATSINaM’s membership numbers have increased from just 48 two years ago to 700 and growing. Ms Mohamed said the main aims of the organisation were to become self-sustaining and strong, and look at bringing other like-minded organisations into the fold to support efforts. “For the organisation to continue to grow the membership base. We’re currently at 700 so we know that there’s another 2,300 nurses out there and potentially more that we just haven’t connected with. November 2015 Volume 23, No. 5 9

NEWS

New Pap smear guidelines online New guidelines for cervical screening are now available to nurses online. The changes, to be introduced under the National Cervical Screening Program, (NCSP) will come into effect in 2017. NPS MedicineWise announced the changes last month but urges its “business as usual” for health practitioners until then. “Do not delay testing women under the current screening arrangements – women aged between 18-69 years need to adhere to the two-year screening interval ahead of the change,” Dr Robyn Lindner said. Under the changes, Australia will be the second country in the world after the Netherlands to use primary HPV testing into their national cervical screening program. Dr Lindner said nurses need to encourage women of keeping up to date with Pap smears. The current vaccine only prevents against the two HPV types that cause about 70% of cervical cancers. The new guidelines are aimed to offer women the best chance to detect the primary cause of the majority of cervical cancers with subsequent treatment.

Information on the changes is available at www.nps.org.au/radar

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Help us shape the future of aged care staffing and skills mix By Sally Ward Over the last two decades, there have been several attempts to establish a method of determining safe staffing levels and skills mix in the aged care sector. The Productivity Commission’s June 2011 report Caring for Older Australians identified a lack of research on the number of staff, the type of staff such as nurses and care workers, and the mix of these staff types required to support safe residential care. Using the Productivity Commission’s report as a springboard, over 200 aged care services participated in a national research project in 2011-12 – funded by the Australian government and undertaken by the Australian Nursing and Midwifery Federation (ANMF) – which provided a broad picture of staffing and skills mix in the aged care sector. In partnership with Flinders University and the University of South Australia, the ANMF is now undertaking a research project that builds on this work and aims to develop a robust staffing methodology for the aged care sector nationwide. The research encompasses four separate stages including the establishment of indicative nursing and personal care interventions for aged care residents; creation of focus group to explore these interventions; a national missed care survey; and testing and verification of results.

The research team is currently seeking registrations from aged care stakeholders interested in participating in nationwide focus groups, as well as registrations of interest for the national missed care survey that will commence in the New Year. Focus groups commence in Adelaide on Wednesday, 4 November, before heading to Melbourne on Tuesday, 10 November, Sydney on 11 November and Brisbane on Thursday 12 November. It is not too late to join a focus group or register your interest in taking part in the project. Visit www.safestaffinginagedcare.com for more information.

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Geelong nurse crowned nationâ&#x20AC;&#x2122;s top graduate A graduate nurse working in the oncology ward at Geelongâ&#x20AC;&#x2122;s Barwon Health was named the Outstanding Graduate of the year at the 2015 HESTA Australian Nursing Awards in Brisbane last month. Graduate nurse Narelle Place was recognised for proactively improving procedures for patients requiring sedation while undergoing cancer treatment by driving changes that led to implementing labelling on intravenous medication at the hospital. She was also commended for creating a project during Falls Prevention Week highlighting the risk of patient falls at the health service. Narelle was genuinely humbled by the honour. â&#x20AC;&#x153;Unbelievable. Itâ&#x20AC;&#x2122;s still sinking in. Iâ&#x20AC;&#x2122;m still on cloud nine. In no way did I think I would win.â&#x20AC;? Narelle grew up on a dairy farm in Camperdown in country Victoria and followed in the footsteps of her mother to become a nurse. â&#x20AC;&#x153;I just always had a feeling. I probably like looking after people I think.â&#x20AC;? Narelle studied at Ballarat University prior to starting her graduate position with Barwon Health. She kicked off on the general medical ward before moving to oncology and finding her passion. â&#x20AC;&#x153;I really enjoy it. People are always saying it must be sad but the patients are just there to get on with life most of the time and I enjoy the continuity and getting to know the patients because theyâ&#x20AC;&#x2122;re there for a long time.â&#x20AC;?

L TO R: NARELLE PLACE, CATRIN DITTMAR AND SARAH RAVINE, TEAM LEADER FOR STREET HEALTH

A key part of Narelleâ&#x20AC;&#x2122;s selection as the countryâ&#x20AC;&#x2122;s Outstanding Graduate surrounded her advocacy on behalf of a patient requiring a naso-gastric tube while receiving radiotherapy treatment. â&#x20AC;&#x153;She couldnâ&#x20AC;&#x2122;t eat or swallow tablets. She needed a tube,â&#x20AC;? said Narelle. Narelleâ&#x20AC;&#x2122;s identification of inadequate processes in the hospitalâ&#x20AC;&#x2122;s systems led to changes and improved patient care. Narelle received $5,000 for her win and a further $5,000 to go towards further education. She said she plans to enrol in a post-graduate course next year and undertake her graduate certificate in oncology. Narelleâ&#x20AC;&#x2122;s mother is a nurse in Camperdown but has experience working as a rural remote nurse practitioner in small villages in Cambodia. She said travelling overseas with her mother to improve patient outcomes is definitely on her radar. In other top honours at the 2015

HESTA Australian Nursing Awards, Lake Macquarie nurse Catrin Dittmar was named the Nurse of the Year, while a Perth team of nurses providing healthcare to the homeless took out the Team Innovation category. Catrin a nurse at the RSL Care Bolton Point Retirement Village, was recognised for keeping aged care residents safe when a severe thunder storm with cyclonic winds hit the facility in April this year. â&#x20AC;&#x153;After a dealing with what was a chaotic situation over the hours and days that followed, we were able to slowly get back to an even footing, establishing a level of calm and order back into the facility,â&#x20AC;? she said. The 2015 Team Innovation award was handed to Perthâ&#x20AC;&#x2122;s Street Health Team â&#x20AC;&#x201C; Homeless Healthcare (Mobile GP). The initiative provides vital healthcare to people living on the streets and links in with existing outreach services to deal with the full range of health and social issues facing homeless people.

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NEWS CRANAPLUS CEO CHRIS CLIFFE AND PRESIDENT JANIE SMITH

CRANAplus conference utilises power of sharing stories The engrossing personal accounts of the remote area nursing community were celebrated over three informative and inspirational days at the 33rd annual Council of Remote Area Nurses of Australia (CRANAplus) conference in Alice Springs last month. This year’s theme – Telling Tales, The Power Of The Narrative: How Sharing Stories Shapes And Influences Outcomes –established a setting where the triumphs and challenges experienced by remote area nurses could be creatively explored. Presentations included registered nurse Pepita Hunter recounting the horror of being called out to a major car accident and learning that her two sons were among the wreckage. The alcohol fuelled incident has since spurred on Pepita to become a campaigner highlighting the dangers of drunk driving. Sarah Brown, of the Alice Springs based Western Desert Dialysis, shared the inspiring journey of the affectionately known Purple House and their combined commitment to providing dialysis services in six communities throughout Central Australia. Another uplifting tale centred on the Uti Kulintjaku team in Central Australia and its efforts to facilitate a mental health literacy project designed to break down barriers by finding ways to talk about mental health in Pitjantjatjara and Ngaanyatjarra. CRANAplus president Janie Smith said narrative remained an important tool in achieving progress.“Personal stories are always really powerful because we all have our stories and we don’t often get to tell them.” . “Sometimes it’s just thinking about things in a different way and looking at things from a more humanist perspective, which I think is very valuable.” The issue of racism and disadvantage was an underlying theme throughout the conference. Professor Roianne West, from Griffith University, stated while Indigenous Australians have the worst health outcomes in the world, there was still anmf.org.au

hope. “My vision is that I want to see my people socially and economically included in the nation. I want to see our kids educated, healthy, and with the opportunity to grow up and get jobs and be engaged in meaningful activity.”

I THINK PEOPLE DEMONSTRATE TOLERANCE BUT IT’S SUPERFICIAL AND WHEN YOU DIG A LITTLE DEEPER IT BECOMES A MAJOR ISSUE.

Janie Smith said she believes racism is deeply ingrained in society and still having an eroding impact on the health and wellbeing of Indigenous Australians. “I really believe that it slowly simmers below the surface of all our interactions in Australia. I think people demonstrate tolerance but it’s superficial and when you dig a little deeper it becomes a major issue.” Positively, CRANAplus used the conference to launch its first Reconciliation Action Plan for the next two years. The plan encompasses 21 actions which the organisation hopes will empower the remote health workforce to provide safe, high quality healthcare to remote and isolated areas Australia wide. Chief among the actions is building relationships between Aboriginal and Torres Strait Islander people and CRANAplus employees, improving the understanding of Aboriginal and Torres Strait Islander cultures, and investigating the possibility of creating dedicated

Aboriginal and Torres Strait Islander positions within the workforce. Asked to list the most pertinent issues facing the remote area nursing workforce, Ms Smith listed domestic violence and education as significant. Ms Smith said domestic violence is 45 times more prevalent in remote Indigenous communities and that CRANAplus will investigate introducing dedicated training of its workforce to help them better assist victims of domestic violence. “When people are oppressed they take on each other. When you’re unemployed and you’re living in poverty and you haven’t got much hope for the world and life you sort of take that home with you.” In terms of education, Ms Smith said CRANAplus was looking at broadening its scope given that about 10% of people’s work in remote communities is spent on acute care, while the remaining 90% is taken up by chronic disease management. Ms Smith revealed her intention to push for the development of a Vocational Training program for nurses once they graduate in a bid to create more structured pathways. A presentation by Kylie McCullough, who is finalising her PhD at Edith Cowan University on remote area nurses, revealed many of the workforce feel distressed by the rapid uptake in skills and responsibilities required across the sector, with such issues causing significant workforce attrition. Ms Smith said the findings were typical and part of an enduring problem. “I think remote area nurses’ scope of practice has always been way beyond what people think they actually do out there.” Ms Smith said improving remote area practice was a constant challenge but she believes inroads are being made gradually. November 2015 Volume 23, No. 5 13

NEWS

Ban on over the counter codeine products Australia’s medicines regulator has proposed products containing codeine not be readily available over the counter from pharmacies. The Therapeutic Goods Administration’s (TGA) interim decision last month recommended all over-the-counter medicines that contain codeine, including cough medications, become prescription only. The TGA’s proposals follows recent research that shows the rate of codeinerelated deaths has increased from 3.5 million in 2000 to 8.7 million in 2009. Consumers Health Forum of Australia Acting CEO Jo Root said while clearly there was a problem of misuse and overuse of codeine, the issue was more complex. The majority of users of codeine products took drugs for ongoing or chronic pain. “Consumers want medicines to be affordable and they want to be able to get them when they need them to manage their own lives.” Restricting access to codeine products

Review into tragic infant deaths at Victorian health service Australia’s health regulators have launched investigations into a Victorian health service after revelations as many as seven babies may have died as a result of failings of healthcare. The Australian Health Practitioner Regulation Agency (AHPRA) announced the investigation into obstetric and midwifery care at the Djerriwarrh Health Service in Bacchus Marsh last month. AHPRA commissioned an external review following reports on 14 and 15 October into the care of a number of registered healthcare practitioners at the service. However AHPRA, the Medical Board of Australia and the Nursing and Midwifery Board of Australia first learned of wider concerns about potentially avoidable perinatal deaths at the health service as early as late July. ANMF Victorian Branch Secretary Lisa Fitzpatrick said the union wished the external review had been instigated earlier. “Through our midwife members from the hospital, the ANMF (Vic Branch) 14 November 2015 Volume 23, No. 5

over the counter would increase visits to GPs and the ED, Australian Self Medication Industry (ASMI) CEO Deon Schoombie said. “The vast majority of consumers use over the counter codeine containing products appropriately and there is no evidence of misuse of codeine containing cough and cold products.” A final decision on the proposals will be made later this month. The TGA’s proposed changes would take place from

was aware that some midwives, and possibly doctors, had raised concerns with management and left the service in frustration when their concerns weren’t addressed. “In the past, midwives were ostracised for reporting risk and we know many worked in a culture of fear and intimidation.” “We were not aware of the number of neonatal deaths at the service or that there was a cluster,” she said. One of the long service doctors at the health service had previously been subject to regulatory action over concerns about the care of a mother after the stillbirth of her baby at the hospital. “AHPRA acknowledges that it took longer than it should have to investigate that complaint, which related to a single case and the follow-up care provided to a mother after birth,” the regulator released in a statement. The Victorian Medical Board investigated the doctor and took regulatory action. AHPRA and the Boards reported they were not advised of abnormally high perinatal mortality rates at the health service or of other concerns about the quality of obstetric or midwifery care provided. Ms Fitzpatrick said while not privy to details of the cases involved as part of the review, ANMF members along

June next year. The ASMI has called for a delay on the decision for 12 months to trial a package of targeted measures instead. These would include a mandatory monitoring system in community pharmacy. Such a system would help pharmacists to determine if supply of medication containing codeine is appropriate; identify at-risk consumers; and support referral to a pain specialist when necessary. It could also include front-of-pack warnings on the risk of codeine addiction.

with the union had been briefed by the hospital. “As part of these meetings, hospital management has assured the ANMF and our midwife members that the review found no evidence of professional misconduct amongst the midwifery staff.” Ms Fitzpatrick said the union considered it was a culture of fear of reporting and a systematic breakdown in communication which contributed to a failure in reporting channels at the health service. While some midwives had been relieved, many were traumatised, she said. “Our members and the ANMF Victorian Branch are devastated for the families that are subject to the clinical review, but we also believe that this process will answer many questions that the women involved and their families have not had answered adequately or accurately in the past.” Victorian Health Minister Jill Hennessy announced the entire board of Djerriwarrh Health Service would be replaced with new governance procedures introduced. Federal Shadow Minister for Health Catherine King welcomed the introduction of a new foetal monitoring system at the health service with improved training and support from the Royal Women’s Hospital to ensure the tragedy would not happen again. anmf.org.au

INDUSTRIAL

Changes in aged care Snapshot of the RAC sector

Debbie Richards, Federal Industrial Research Officer

RESIDENTS IN PERMANENT CARE

83% 83% OF RESIDENTS IN PERMANENT CARE ARE CLASSIFIED AS NEEDING ‘HIGH CARE’.

76% 76% IN 2008.

64.4%

64.4% IN 2003.

anmf.org.au

A recently released Australian Institute of Health and Welfare (AIHW) report, Residential Aged Care and Home Care 2013-14, provides some interesting insights into the provision of residential aged care services and the changes taking place across the sector as a whole. For the many hardworking, underpaid and undervalued nurses and carers employed in this sector, much of the information contained in the report is not new but simply reflects the day to day reality of trying to provide high quality care in very difficult circumstances. No nurse or carer will be surprised to hear that 83% of residents in permanent care are classified as needing ‘high care’. This compares with 76% in 2008 and 64.4% in 2003. The report also shows the majority of residents have a diagnosis of dementia. As of 30 June 2014 this was reported to be 52% of all residents and for people entering permanent care for the first time, 42% were diagnosed with dementia. The trends highlighted in this latest report are a reflection of Australia’s ageing population and reflects the evidence that the people who are entering aged care facilities are the ones who have multiple chronic conditions whose care needs are too complex to be managed at home. The number of people aged 85 years and over is expected to increase rapidly in the future, with the ABS projecting that the 420,300 people in this age group (as at June 2012) will more than double within

20 years and double again by 2045. The total number of admissions into residential care has steadily increased over the years with the latest figures indicating 137,948 admissions (permanent and respite) in 2013-14 compared to 103,183 in the year 2006-07.

Who provides residential aged care services? Nationally, there are 1,016 providers who operate 2,688 residential aged care facilities providing a total of 189,283 operational places in residential care. While the number of operational places are increasing overall, the ratio of places per 1,000 persons aged 70 years and over has actually decreased from 86 per 1,000 as at June 2013 to 82.6 per 1,000 persons aged 70 plus at June 2014. Going back a few more years to June 2008, the ratio was higher again providing 87.7 places per 1,000 persons aged 70 plus. The AIHW data also shows that aged care facilities are getting bigger with the average number of places per facility now at 70.4. This compares with 60 places, in 2006. The ownership of residential aged care facilities is also changing. The figures show that in recent years, the number of operational places owned by ‘not-for-profit’ providers (that is, religious, community based and charitable providers), has increased at a slower rate than the number of places owned by ‘private for profit’ providers. As of June 2014, private for-profit providers owned 37.4% of operational places compared with 32% in June 2006. Looking at the ‘not-for-profit’ providers separately: 26% of places were in facilities operated by religious organisations; 13.6% in community based organisations and

17.4% in charitable organisations. Overall, there is a decline in the share of places operated by the ‘not-for-profit’ providers from 60.3% in 2006 to 57.7% in 2014. There is also a reduction in places operated by state, territory and local governments which combined operate just 5.2% of places, down from 7.7% in 2006.

Residential aged care workforce Staffing levels and skill mix in residential aged care is a long standing and unresolved issue that cannot be ignored. The ANMF has campaigned for many years for the development of an aged care workforce strategy. These issues continue to compromise the amount of quality care that can be provided to residents, putting direct care staff under ongoing pressure. While workforce data does not tell us any more than what we already know from ANMF members working in this sector, it does attach numbers to the problem. This data is not part of the AIHW report, but is collected as part of a periodic census and survey conducted by the federal government in conjunction with the National Institute of Labour Studies. The first data collection took place in 2003. A further two reports have been provided for 2007 and 2012. The table below indicates the changes in the number and composition of the direct care workforce since 2003 and that this is not compatible with a 25% increase in residential places and the level and complexity of care that 83% of residents now require. Link to AIHW report Residential Aged Care and Home Care 2013-14: www.aihw.gov.au/ aged-care/residential-and-homecare-2013-14/

Full time equivalent (FTE) direct care employees in the residential aged care workforce OCCUPATION

2003

2007

2012

NURSE PRACTITIONER

N/A

190

REGISTERED NURSE

16,265

13,247

13,939

ENROLLED NURSE

10,945

9,856

10,999

PERSONAL CARE ATTENDANT

42,943

50,542

64,669

ALLIED HEALTH PROFESSIONAL ALLIED HEALTH ASSISTANT

5,776*

5,204*

1,612 3,414

TOTAL NUMBER OF EMPLOYEES (FTE)

76,006

78,849

94,823

SOURCE: KING D, MAVROMARAS K, WEI Z, ET AL. THE AGED CARE WORKFORCE 2012, CANBERRA: AUSTRALIAN GOVERNMENT DEPARTMENT OF HEALTH AND AGEING 2012 TABLE 3.3 *IN 2003 AND 2007 THESE CATEGORIES WERE COMBINED UNDER ‘ALLIED HEALTH’

November 2015 Volume 23, No. 5 15

FEATURE

the

REASON

SHINING THE SPOTLIGHT ON AGED CARE A critical lack of staff and training in many of Australia’s nursing homes is compromising the extent of quality care that can be provided to the elderly. As the aged care sector approaches a defining juncture in its lifespan, Robert Fedele uncovers the hidden toll being felt across the country.

ictoria Hohnen’s story is disturbingly common, and deeply symptomatic of an aged care sector embedded with shortcomings. About a year ago, the experienced registered nurse took up a role as the night-duty supervisor at a shiny new aged care facility that had sprung up on the Gold Coast. The facility boasted four floors, which quickly shuffled in 160 residents. Victoria covered shifts three nights a week, heading the team as the only registered nurse on duty with around seven Assistants in Nursing (AIN) helping her hold down the fort. It was not long into her time at the facility that Victoria became uneasy about what she considered improper practices becoming the norm.

16 November 2015 Volume 23, No. 5

She was regularly asked to check Schedule 8 drugs with AINs without the authority or qualifications to do so. She witnessed a cohort of 457 visa workers become bullied into accepting back-to-back shifts out of fear of losing their jobs. She also saw graduate nurses worked to the bone and unwittingly trained to carry out unsafe practices by management. Following talks with the Queensland Nurses Union (QNU, ANMF Qld Branch), Victoria decided to confront management with her concerns. “I said I wasn’t prepared to do that [check narcotics with AINs] and it got down to the point where the manager said we all need our jobs. We all have mortgages.” Management retaliated by transferring Victoria onto day duty

so she could supposedly realign herself with the company’s model of care. “They made my life as difficult as they could on day duty. There was very little staff and the care was atrocious.” When the poor practices continued Victoria took what she saw as her only option and quit. “I was just getting to the point where mentally I was going downhill. I couldn’t cope with the lies anymore,” she recalls. “I questioned whether I even wanted to be a nurse anymore.” The QNU is currently pursuing action against the facility in a bid to force it to acknowledge and address its flaws. Victoria says the aged care sector is heading in a dangerous direction and believes facilities are securing more and more residents each year without backing up the

anmf.org.au

FEATURE PAMELA BLACKER HOLDING A PHOTO OF HER MOTHER. PHOTO: MICHAEL AMENDOLIA

anmf.org.au

November 2015 Volume 23, No. 4 17

FEATURE

influx with appropriate staff. “It’s absolutely heartbreaking. A lot of mistakes are being made and the people that are now in aged care are very acutely sick people. “Most nurses will just walk out and leave. They won’t actually report it.”

Aged care in the spotlight A couple of decades ago nursing homes reportedly embraced a system of care where the ratio of registered nurses and carers to residents could correctly be considered ample. In time this level of care has become watered down as aged care operators have grappled with balancing the increasing acuity of patients’ needs with commercial interests. Many aged care advocates believe the sector’s issues stem from a clear lack of resources, driven by aged care providers more concerned with making a profit than delivering care. Aged care reform has been on the table for several years but powerbrokers and the government seemingly continue to curtail efforts by advocates such as the Australian Nursing and Midwifery Federation 18 November 2015 Volume 23, No. 5

(ANMF) to protect and improve the sector. Importantly, the spotlight has perhaps never shone as brightly on aged care as right now in the midst of a critical examination into one of the workforce’s undeniable necessities. Back in June, an Inquiry was launched in New South Wales to determine whether current laws requiring at least one registered nurse be on duty at all times across the state’s high care nursing home should be retained. New South Wales is the only state in the country that has the rule etched in legislation and the outcome of the Inquiry could provide a blueprint for future standards of care across the sector. The New South Wales Nurses and Midwives’ Association (NSWNMA, ANMF NSW Branch) has passionately lobbied against the removal of registered nurses through its RN 24/7 campaign. A petition of more than 24,000 signatures was gathered and tabled to Parliament to illustrate the strong opposition to plans to scrap the requirement. Findings from the Inquiry are expected in early November,

with many fearful the removal of registered nurses could potentially act as a catalyst for inferior care. This line of thinking considers that abolishing the requirement would mean the quality of care would then ultimately fall to the discretion of aged care operators whose financial decisions might override clinical need. Across the nation, there are 1,016 residential aged care providers who operate 2,688 facilities. According to a recent Australian Institute of Health and Welfare (AIHW) report, 83% of residents in permanent care are considered as needing “high care”. Similarly, over the next 40 years, the number of people aged over 65 is expected to double. All figures point to an urgent need for aged care reform in order to safeguard the health of older Australians.

The consumer Semi-retired registered nurse Pamela Blacker was one of 165 individuals or organisations that made a submission to the NSW Upper House Inquiry in the leadup to its debate over retaining the requirement for registered nurses in

NURSE KYLIE BENNETT WITH ONE OF THE RESIDENTS FROM SOUTHERN CROSS AGED CARE, HOBART.

1,016 RESIDENTIAL AGED CARE PROVIDERS

2,688 FACILITIES

ACROSS THE NATION, THERE ARE 1,016 RESIDENTIAL AGED CARE PROVIDERS WHO OPERATE 2,688 FACILITIES.

anmf.org.au

FEATURE nursing homes. Pamela was driven to support the union’s campaign while her late mother was living in a not-for-profit residential aged care facility. Sadly, Pamela’s mother passed away just a month ago. On inspection, her submission highlights alarming examples of significant hiccups at the facility. Chief among them was her mother being given the wrong dosage of medication, and several incidents where Pamela visited her mother and found tablets on the floor because staff had not properly observed her taking the medication. Pamela’s other accounts reveal carers not having enough time to attend to all residents and a shocking incident of neglect. “I arrived at my mother’s facility to find her sitting in heavily soiled underwear that had obviously been there for several hours. Staff themselves have told me that they don’t have time to conduct the necessary personal care. I have also found residents on occasions in states of distress or requiring assistance and been unable to find staff nearby,” Pamela wrote. “They’re just ordinary things that happen all the time. This is just the way it is,” Pamela said later this month when asked about her accounts. Prompted on what should be done to alleviate the sector’s problems, Pamela cited staffing levels and adequate training as fundamental. “I don’t take a position that all care needs to be provided by registered nurses because I think that’s financially impossible,” she explains. “I think carers provide the majority of the workforce in the aged care sector. I don’t see that as a problem if they are properly trained and they are properly supervised.” Pamela has worked in aged care previously during her nursing career and says her concerns about the state of the sector have been long-standing. “I could see this starting to happen at the beginning of 2000 when RNs were kind of being phased out in aged care or reduced. It concerned me then. It was already bad enough but now it’s critical.” Pamela proposes that the government’s funding of the sector needs to be reviewed and that aged care providers should face anmf.org.au

greater scrutiny over the services they provide through regular unannounced inspections. Pamela in no way blames the aged care facility for her mother’s death and says on the whole, the home provided adequate care. She does however warn families contemplating placing a loved one in residential aged care to do their homework. “The general public is very unaware of what to look for and what to ask about. Often they will be taken in by fancy trimmings. It might look like a five star hotel but that doesn’t mean that the service is five star and staffing can in fact be worse and more expensive.”

An age old problem Aged care expert Dr Maree Bernoth, an academic at Charles Sturt University’s School of Nursing, Midwifery and Indigenous Health, contends that the aged care sector’s problems emanate from core issues regarding low wages and sufficient staffing and support that create a ripple effect of neglect and at its most distressing, abuse. “It’s the systems that aren’t in place to support our aged care workers that cause this behaviour to happen. “Those workers are stressed, desperate, uneducated, and trying to work under horrendous conditions and that contributes to the abuse. It doesn’t justify it but you can’t blame the worker. You can’t blame the person who has no power. What’s the infrastructure there? Who don’t we see when this sort of neglect and abuse happens in our general hospitals?” Dr Bernoth has been a nurse since 1971 and worked as a registered nurse in aged care for 15 years before pursuing her studies in a bid to become a strident advocate for quality in aged care. She says the sector is currently facing its most challenging period. One of the key issues, she says, is a heavy reliance on semi-skilled and unregulated care workers who invariably get by without adequate support. Dr Bernoth reflects back to 1994 and a national accreditation of the Certificate III in Aged Care that she remembers being substantial and rigid in its delivery. Today the landscape is glaringly different. “What I find distressing is that this course has been watered down. It’s been deregulated. It’s been opened up to Registered Training Organisations (RTOs) and

the standard of the provision of the course is very inconsistent. So I can do a really good course through TAFE or I can go to an RTO and do it in a weekend or I can do it online.” The consequences? “It doesn’t equip them with the skills they need so they go out into the aged care facilities and they’re not sure enough of their skills so they’re very easily bullied by existing staff who may have entrenched poor practices and they quickly fall into doing what other staff do.”

I COULD SEE THIS STARTING TO HAPPEN AT THE BEGINNING OF 2000 WHEN RNS WERE KIND OF BEING PHASED OUT IN AGED CARE OR REDUCED. IT CONCERNED ME THEN. IT WAS ALREADY BAD ENOUGH BUT NOW IT’S CRITICAL.

Reflecting on recent developments, Dr Bernoth says she was “flummoxed” and “perplexed” that the NSW government would even contemplate removing registered nurses from aged care, pointing to an 80% cohort in residential aged care suffering chronic and complex health conditions. “All of those conditions require very skilled people to oversee them,” she says. “It’s being driven by profit.” More broadly, Dr Bernoth blames many of the aged care’s problems on a clear-cut gap in the workforce. “We’re not doing anything to attract them [nurses]. We’re paying them less. They’re the meat in the sandwich. They’re caught between knowing what should be done but knowing that if they demand the care workers provide the sort of work that’s required, and the care workers don’t like it, they can be reported to management. And management are much keener to keep the care workers. “As a society, we don’t see registered nursing in aged care as an exciting place to be. There are lots of opportunities to use complex skills, complex assessments, and communication skills. They’re not valued.”

83% ACCORDING TO A RECENT AUSTRALIAN INSTITUTE OF HEALTH AND WELFARE (AIHW) REPORT, 83% OF RESIDENTS IN PERMANENT CARE ARE CONSIDERED AS NEEDING “HIGH CARE”.

November 2015 Volume 23, No. 5 19

FEATURE

PHOTO: DAILY LIBERAL

To counter the challenges, Dr Bernoth says registered nurses must be paid better as a starting point, coupled with the establishment of career pathways to ensure working in aged care is pitched as appealing. Universities should forge close links with aged care facilities, and graduate programs for nurses coming out of university should also be provided, she further argues. As part of her work at Charles Sturt University, Dr Bernoth is undertaking a research project investigating ways in which to attract nursing graduates into aged care to curb looming workforce shortages. Dr Bernoth is working with rural aged care facility, Holy Spirt Aged Care in Dubbo, and will attempt to build links between the university and the facility through learning, mentoring, and clinical placements for nurses in the residential aged care setting.

Aged care reform The ANMF has been a longstanding campaigner for major reform in aged care. The battle to challenge the government to take responsibility remains ongoing and with the 20 November 2015 Volume 23, No. 5

aged care sector facing a critical shortage of nurses that will only become compounded by an ageing Australian population, the issue becomes even more precarious. Unacceptably, nurses working in aged care continue to be paid less than their counterparts in public hospitals and the wage gap is growing. Currently, the ANMF is investigating safe staffing levels and skills mix in the aged care sector by conducting a research project in conjunction with Flinders University and the University of South Australia that involves collating valuable feedback from aged care staff, residents, family members, and concerned stakeholders. Simultaneously, ANMF Federal Secretary Lee Thomas has called on the government to develop an aged care workforce strategy urgently that encompasses investment in aged care, mandated staffing levels, and streamlining wages and training. Ms Thomas says the increasing complexities of conditions common in aged care demand a suitably skilled and qualified workforce. “What we desperately need now is an aged care strategy that encompasses workforce, as we

know we are facing a significant shortfall of nurses in the aged care sector over coming years. “In nursing homes across the country, it’s not uncommon to have just one Registered Nurse (RN) with perhaps two personal care assistants, caring for up to 100 residents with increasingly complex needs.” Ms Thomas says it is now incumbent on the federal government to spark positive change for the sake of Australians and their families. She welcomed the recent addition of Minister Sussan Ley to the dedicated position of Minister for Aged Care but says unless real change occurs then the issues plaguing the sector will persist. “In the current landscape, workforce issues continue to compromise the amount of quality care that can be delivered to our elderly, whether in nursing homes or home settings. “Proper investment in aged care and most critically, proper staffing, is the only way forward in reaching a renewed sector focused on quality care.”

Finding solutions Victorian based independent lobby group Aged Care Crisis is indicative

(CLOCKWISE) DR MAREE BERNOTH (L) WITH HOLY SPIRIT AND ST MARY’S RESIDENTIAL MANAGER DI THOMAS, HOLY SPIRIT DEPUTY RESIDENTIAL MANAGER MIRIAM MUTASA AND CHARLES STURT UNIVERSITY LECTURER LYN CROXTON. NSW NURSES FIGHT TO RETAIN REGISTERED NURSES IN AGED CARE. (PHOTO SHARON HICKEY)

24K SIGNATURES

A PETITION OF MORE THAN 24,000 SIGNATURES WAS GATHERED AND TABLED TO PARLIAMENT TO ILLUSTRATE THE STRONG OPPOSITION TO PLANS TO SCRAP THE REQUIREMENT.

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FEATURE of a community that believes unresolved issues in Australia’s aged care system need urgent attention. The organisation was established by Lynda Saltarelli in response to the death of her father while in hospital more than a decade ago. Ms Saltarelli’s father suffered a debilitating stroke before being admitted to hospital. He was no longer classified as requiring acute care and the hospital recommended the family move him to an aged care facility. Fourteen weeks after entering hospital, Ms Saltarelli’s father contracted bedsores and died as a result of septicaemia. The upsetting experience left Ms Saltarelli grief-stricken and later compelled her to launch Aged Care Crisis in a bid to push for greater accountability in the treatment and care of older Australians.

fuelled discussion, engagement, and action, in a concerted effort to break the cycle of the deterioration of aged care.

Moving forward Despite the aged care sector’s obvious challenges, hope persists. Tasmanian aged care worker Kylie Bennett has worked within the sector for over a decade and is currently the Aged Care Funding Instrument (ACFI) coordinator for Southern Cross Aged Care in Hobart. Over the years, Kylie has worked her way up from the laundry to becoming an AIN and then working in management roles. She is currently undertaking a Bachelor of Nursing and a Bachelor of Dementia at the University of Tasmania in order to boost her credentials. Southern Cross Aged Care has 12 facilities spread across Tasmania

UNACCEPTABLY, NURSES WORKING IN AGED CARE CONTINUE TO BE PAID LESS THAN THEIR COUNTERPARTS IN PUBLIC HOSPITALS AND THE WAGE GAP IS GROWING.

This month, Aged Care Crisis launched a new campaign website where it is inviting concerned stakeholders to contribute and debate issues in aged care with a view to finding solutions. “We believe that aged care is broken and accept that politics is paralysed and unable to address the problem,” Ms Saltarelli says. Among Aged Care Crisis’ long-term plans is the creation of community controlled aged care hubs that would collect data and monitor the performance of facilities on behalf of the government. Ms Saltarelli says the most pressing issues currently facing aged care involve a lack of reliable information regarding staffing and standards, the clash between providing care and making a profit, the vulnerability of consumers, and government funding going to profits and not care. “We do not believe that government or industry are capable of meeting the challenge. It will require strong and direct community involvement.” Ms Saltarelli says Aged Care Crisis will be focusing on community anmf.org.au

Social Media Snapshot

and is the largest employer of aged care workers. Kylie undertook her Certificate III in Aged Care back in 1995 and says many carers these days lack the hands on skills needed to deal with patients appropriately. Working in aged care, Kylie understands the stress that arises as part and parcel of the job, but stresses that carers need to find a voice too. “If someone asks you to do something, nine times out of ten people will say yes without stopping to think about whether they should be the person doing it. “We try to chip in and everything but at the end of the day you have to know where your boundaries are. No matter what your role is you have to be responsible. The nurses shouldn’t be asking the carers to do things that they know they can’t do and vice versa.” Kylie believes there is light at the end of the tunnel and that progress can be made. “If we can get mandated staffing levels I think that would ease a lot of the burden across the board for a number of things.”

“The staffing levels in aged care are an absolute disgrace. The focus has shifted from care to profits. I’m becoming very disillusioned.” Libby “Reform can’t arrive quickly enough. It needs to arrive soon or the train will just continue to gather steam, wreaking damage in the aged care sector. I’ve recently left the “high care” aged care sector (private) after six years. As an EN, giving medication to 35 residents, wound care, dealing with families, pharmacy, LMOs, AHPs and supervising staff usually meant a 7.5 shift really being a 10hr shift without overtime pay. Not much was left of me for my family once I got home. Our elders deserve so much more than what they’re getting. They really do need strong advocacy. I was constantly flabbergasted that a nursing home operator would strictly refuse to use agency staff if staff could not be replaced, for fear of cost, and allow the floor to go up to two staff short. This obviously results in other issues directly affecting care or how staff handled themselves. Too many risks. Sad situation.” Jana “We suffer with staff not turning up for shifts every day. Makes everything so much more difficult. Impossible to get 30+ residents to breakfast by 8am. Especially the ones in hoists, etc. I have seen so many residents trying to care for themselves and it’s heart breaking.” Lynn “It’s always about the dollars. Aged care homes are seen as nothing but a business. Whilst I appreciate the owners cannot run at a loss, they seem to not care about the workers or residents, often leaving us short staffed, and employing staff who have little understanding or are poorly trained and left with limited resources. This leaves the elderly in aged care at risk of very poor quality care and staff overworked and stressed. I for one find it very stressful to not be able to give the proper level of care to my residents due to having to cover other staff, whether that be other staff not being replaced or by having staff on the floor who do not know what they’re doing.” Giulia

November 2015 Volume 23, No. 5 21

WORLD 1. AUSTRALIA 2. ASIA PACIFIC 3. UNITED KINGDOM 4. IRELAND 5. NETHERLANDS

Australia signs up to new sustainable global goals

needs and develop resources. www.cepar.edu.au

The federal government has joined a worldwide commitment to end poverty and inequality by signing up to new Global Goals for Sustainable Development. Foreign Affairs Minister Julie Bishop joined leaders from across the world at the UN headquarters in New York recently to commit to 17 goals over the next 15 years.

UK nurses and midwives to revalidate

The goals replace the Millennium Development Goals set in 2000. One of the key targets agreed to by all 193 member states of the UN was to eliminate all forms of violence against women and girls. While the 2030 agenda was comprehensive, Australia welcomed its “strong focus on economic growth, gender equality and women’s economic empowerment and peace and good governance,” Ms Bishop said. Australia was committed to sustainable economic growth and the reduction of poverty, particularly in the Indo-Pacific region, she said. 2

Asia-Pacific research hub

A new research hub on population ageing in the Asia Pacific-wide region has been established in New South Wales.

The Centre of Excellence in Population Ageing Research (CEPAR) was launched at the hub’s inaugural conference in Sydney recently which hosted more than 40 researchers from more than 20 different countries. Asia was the world’s most rapidly ageing region, UniNSW Deputy ViceChancellor Professor Les Field said. “The significant rise in ageing populations throughout Asia will create greater pressure on the capacity of both families and governments to provide support for the ageing demographic.” The hub will research socioeconomic and health and aged care impacts to inform policymakers and providers to identify 22 November 2015 Volume 23, No. 5

Competency checks for UK nurses and midwives, introduced by UK’s Nursing and Midwifery Council (NMC), have been described as a “historic” moment in regulation. Last month’s decision to introduce revalidation will mean that everyone on the register will have to demonstrate that they are able to deliver care in a safe, effective and professional way. Nurses and midwives will have to obtain confirmation that they have met all the requirements before they apply to renew their place on the register every three years. The first registrants to revalidate will be those renewing their registration in April 2016. The revalidation process for nurses and midwives across UK came about in the wake of the Mid Staffordshire scandal that occurred during the 2000’s where poor levels of care and high mortality rates were revealed. The aim of the new process is to boost confidence in the profession and ensure nurses remain fit to practice. “We believe that revalidation will give the public confidence that the people who care for them are continuously striving to improve their practice,” NMC Chief Executive and Registrar Jackie Smith said. Royal College of Nursing (RCN) Chief Executive and Secretary Janet Davies said revalidation was one of the recommendations made to improve patient care. “It is vitally important to help nurses stay up to date with best practice and the RCN has worked with the NMC to develop this work. This is good for patients, and it is also good for nursing staff. This is recognition of the important, highly complex and ever changing nature of the work nurses do, which is long overdue.”

Irish nurses act on ED overload 4

Irish nurses and midwives have ramped up action against emergency department (ED) overcrowding.

The Irish Nurses and Midwives Organisation (INMO) held emergency meetings with its members last month. It followed the latest ED trolley figures which showed 71,486 patients admitted on trolleys – an increase of 28% on the previous year and the highest on record. INMO General Secretary Liam Doran said all measures taken to address overcrowding had failed to address both bed capacity and staffing. “Our focus is on protecting standards for patients and ensuring a safe working environment for our members.” INMO members were yet to take industrial action as the ANMJ went to print.

Aspirin may increase survival of gastrointestinal cancer 5

Double the number of patients with gastrointestinal cancers who took daily aspirin after diagnosis survived compared to those who did not, a study from the Netherlands has shown.

Data from 13,715 patients diagnosed with gastrointestinal cancer; including colon, rectal and oesophageal; were studied in the Netherlands between 1998 and 2011. About 75% of patients who took aspirin following cancer diagnosis survived past five years compared to 42% of nontakers. Martine Frouws of the Department of Surgical Oncology at Leiden University Medical Center said the survival benefit was seen for all gastrointestinal cancers, except pancreatic cancer. “If aspirin can become a regular treatment for cancer, it can have a large impact on cancer survival and global health.” The research was presented at the European Society of Medical Oncology’s European Cancer Congress. anmf.org.au

ETHICS

The loss of common decency

Megan-Jane Johnstone

References Calhoun, C. 2004. Common decency. In C. Calhoun (ed.). Setting the moral compass: essays by women philosophers (pp.128142). Oxford University Press, New York. Darbyshire, P. & McKenna, L. 2013. Nursing’s crisis of care: what part does nursing education own? Nurse Education Today, 33(4): 305-307. Kekes, J. 1984. The great guide of human life. Philosophy and Literature, 8(2): 236-249. McKenzie-Murray, M. 2015. Abbott’s war on Gillian Triggs. The Saturday Paper, 13-19 June: 1&4. Masters, C. 2015. Jonestown’s mass succour. The Saturday Paper, 15-21 August: 1&4. White, P. 1992. Decency and education for citizenship. Journal of Moral Education, 21(3): 207- 216.

Megan-Jane Johnstone is Professor of Nursing in the School of Nursing and Midwifery at Deakin University in Victoria. Professor Johnstone has extensive interest and expertise in the area of professional ethics in nursing. anmf.org.au

In recent years the growing decline of common decency has been amply demonstrated in Australian public domains. Examples include: • Sydney radio shock jock, Alan

Jones, callously suggesting in a 2012 speech given at a Sydney University Liberal Club function, that the then Prime Minister Julia Gillard’s father had ‘died of shame’ because of her apparently ‘telling lies every time she stood in Parliament’ (Masters, 2015). • The disgraceful reputational bombardment of the Australian Human Rights Commissioner, Professor Gillian Triggs, by conservative federal government politicians and their ‘in bad faith’ misrepresentation of the Commission’s The Forgotten Children report (www. humanrights.gov.au/our-work/ asylum-seekers-and-refugees/ publications/forgotten-childrennational-inquiry-children) (McKenzie-Murray, 2015). • The widely reported spiteful behaviour of some members of the public against Adam Goodes, an Indigenous Sydney Swans AFL star, after he performed a traditional Aboriginal war dance in response to dehumanising racist banter directed against him (eg. being called ‘an ape’; told to ‘get back to the zoo’). Questions of common decency and the problem of indecent behaviours have also emerged in relation to the nursing profession. Some warn, for example, that the problem of uncaring disengaged nurses ‘bristling with “bad attitude”’ has not yet become the subject of media attention in Australia but, as has been the case in the UK, it is only a matter of time where it may become so (Darbyshire and McKenna, 2013). Meanwhile, the disrespectful use and abuse of social media by some nurses and students of nursing have prompted nurse regulating authorities and national nursing organisations to develop guidelines reminding nurses of their responsibility to uphold the ethical standards of the profession and to maintain their professional image

when using social media.

A question of nursing ethics During the course of their everyday work nurses encounter people (managers, co-workers, students, educators, and members of the public among them) whose behaviours are mean-spirited, miserly, disappointing, disgusting, disgraceful, petty, paltry, annoying, and even contemptible. The examples given above are just some among many where people (of whom we have a right to expect more) have shown ‘indecently callous attitudes toward others’ (Calhoun, 2004). Here the question arises: Does decency ‘really’ matter? And, if so, what place ought it be given in the nursing profession’s ethical standards? In order to answer this question it is necessary first to clarify what decency is.

AM I A DECENT A PERSON? AM I AS DECENT A PERSON AS I COULD BE? WHAT CONTRIBUTION CAN I PERSONALLY MAKE TOWARD MAKING THE WORLD A MORE DECENT PLACE IN WHICH TO LIVE AND WORK?

What is decency? Decency may be succinctly defined as ‘one’s good will towards others’ and a concern for their welfare over and beyond one’s own (White, 1992). Some philosophers have characterised decency as involving highly normative ‘nonobligatory morally good acts’ (Calhoun, 2004) that often involve ‘not insisting on one’s rights and giving other people more than is due to them’ (White, 1996). Decency also involves ‘good manners’, which function as normative devices exercised by people in an attempt to control their pride, self-conceit, egoism, arrogance, sense of selfimportance, vanity, and the like (White, 1992). Decency may be expressed in a

mixture of ways such as by showing ‘goodwill, politeness, helpfulness and forethought for others needs and wants’ (White, 1992). Some examples of decent behaviours can be found in the authentic ways in which people greet or farewell others, offer an apology, are forgiving, express regret, sympathy, mercy, and gratitude, and honour or congratulate others (Calhoun, 2004; White, 1992).

Why decency matters Decency is ‘unambiguously desirable’ (Calhoun, 2004) and, if it prevails, ‘every one benefits’ (Kekes, 1984). In the case of the nursing and other healthcare professions it frankly ‘comes with the territory’. Without decency, the capacity of nurses and their co-workers to carry out their professional duties would be seriously undermined – whatever their area or level of practice. Many nurses might regard personal integrity, trustworthiness, and justice as being of stronger professional concern than decency. However, as White (1992) points out, ‘the values of decency are not simply an option for people who happen to like them’. Rather, decency fundamentally involves ‘moral attitudes that call upon one to go beyond the rules’ and to show ‘good will toward fellow members of society, a reluctance to injure others in pursuit of our own ends, even if we have the right to pursue our own ends’ (Kekes, 1984). Decency thus has particular resonance as a professional value. Moreover it is not clear – nor does it make sense – why a nurse or anyone else would elect not to be decent and would refuse or neglect to engage in decent behaviours, unless having a flawed moral psychology. Adding to this, being a decent person costs very little: it does not require ‘exceptional motivational resources’ (Calhoun, 2004); nor does it require one to sacrifice their own significant moral interests when interacting with others. The examples given in the opening paragraphs of this article give cause to reflect and to ask ourselves: Am I a decent a person? Am I as decent a person as I could be? What contribution can I personally make toward making the world a more decent place in which to live and work? It is likely that possible answers to these questions will be not only revealing, but also confronting. In either case, neither the questions nor their answers can be credibly ignored. November 2015 Volume 23, No. 5 23

RESEARCH

Women fleeing domestic violence turned away One in six Australian women experience physical or sexual interpartner violence and the majority seeking help are being turned away, alarming statistics show.

Of one third of all people who fled domestic abuse and sought homelessness services, 66% were turned away. The latest data was revealed at the recent biennial Australian Social Policy conference held in Sydney. University of NSW Gendered Violence Research Network Associate Professor Jan Breckenridge (pictured) said the numbers were just the “tip of the iceberg”. “There are a substantial number of women who may want to leave but to all extents and purposes they’ve got nowhere to go in the immediate crisis,” she said. Professor Breckenridge’s research is examining “safe at home” models that enable women who have experienced abuse to remain in their own homes. More than 300 leading national and international researchers, clinicians and policymakers attended the conference. It follows the federal government’s recent announcement of $100 million funding to boost frontline services and education into domestic/family violence. UNSW Social Policy Research Centre Dr Jane Bullen said financial issues were a major factor in women’s decisions to stay or leave in relationships. Access to safe affordable housing was “the single biggest concern for women leaving violence,” she said. About 43% of all women who presented at homelessness services were fleeing some form of abuse, she said. National Drug and Alcohol Research Centre Dr Jenny Chalmers said significant barriers remained with shelters denying access to substance abuse patients and drug and alcohol services seeing domestic violence as a low priority or safety concern. There was a lack of staff and skills to address the issues, she said. 24 November 2015 Volume 23, No. 5

Walk daily to cut risk of death Swapping one hour of sitting with walking each day may cut the risk of an early death by 12-14%. University of Sydney findings shows replacing even one hour of daily sitting with standing linked to a 5% reduction in the risk of premature death. The research, published in International Journal of Behavioural Nutrition and Physical Activity, analysed data from over 200,000 random middle and older people in NSW who took part in the 45 and Up Study. Faculty of Health Sciences and Charles Perkins Centre Associate Professor Emmanuel Stamatakis said the “more you move the better”, even if at a light intensity. “It can be as simple as kicking a ball with your kids in the backyard, going for a walk instead of watching another hour of TV or walking your dog for an extra half hour a day.” The researchers called on governments to address inactivity as a bigger public health challenge. A longer-term vision that made physical activity an easier and more convenient option was required which included better infrastructure including cycleways, parks and public transport, Professor Stamatakis said.

Support for new-time mums Good social support networks for new mothers can lower the risk of postnatal depression, Queensland researchers have found. The research was presented at the recent Australian Psychological Society annual conference held on the Gold Coast. The study of 1,084 women who gave birth over a 10-year period surveyed in the year before they gave birth and between one and 12 months after childbirth. Mothers who lost some of their previously high social support network had a higher risk of mental health decline. The period after a woman gives birth is a time of significant identity change, University of Queensland School of Psychology Magen Seymour-Smith said. “Analysis revealed that mothers with high levels of social support before birth were protected against mental health decline but only if they kept a similar amount of support afterwards.” Postnatal depression is estimated to affect 10-20% of first-time mothers.

Social media can depress night-time teens The use of social media at bedtime can affect teenagers sleep and lead to a depressed mood, according to research presented at the Australian Psychological Society’s 50th annual conference. More than 1,800 teenagers were studied over four years from 2010 to 2014 as part of the Youth Activity Participation Study (YAPS) of Western Australia. Findings found a strong relationship between high social media use, sleep disturbance and increased depressed state. “Investing in social media for some teenagers improves the way they feel,” Murdoch University PhD candidate Lynette Vernon said. “But overuse disturbs their sleep and leads to tired, moody students who then invest further into their online connections to help them feel good.” Social media use included accessing networking sites and posting messages. While many parents encouraged young children to develop good rituals for bedtime, the study reinforced these habits during the teenage years, Ms Vernon said.

Overseas travel may increase UTI risk An increase in international travel and over-use of antibiotics may be increasing the risk of urinary tract infections (UTIs), research indicates. UTIs are amongst the most common infectious disease. Researchers from the University of Queensland (UQ) Centre for Clinical Research are urging patients to disclose recent overseas travel to their GP and nurses before having procedures that involve the urinary tract due to increased risk of infection. UQ Infectious Disease Physician and Microbiologist Dr Patrick Harris said multi-drug resistant bacteria including E.coli and Klebsiella pneumonia could be present following overseas travel to endemic areas. “Resistant bacteria strains can live quietly within our bodies undetected without any symptoms for months.” Patients undergoing prostate biopsy for cancer detection, or those receiving a long-term urinary catheter that required antibiotics were at increased risk, Dr Harris said.

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REFLECTIONS

The value of male faculty from the perspective of newly graduated male registered nurses

References Baldwin, A., Mills, J., Birks, M., & Budden, L. (2014). Role modeling in undergraduate nursing education: an integrative literature review. Nurse Education Today, 34(6), e18-e26. doi: 10.1016/j. nedt.2013.12.007

Dianne Juliff, Kylie Russell, Caroline Bulsara As part of a study that explored the lived experience of newly graduated male nurses one recurrent theme has became evident - the value of male nursing faculty. The study questioned nine male participants on how their journey to qualification had been so far. What became evident was the value and impact of male faculty on male nurses’ retention in their student phase. The men interviewed provided comments such as: “If I am in any doubt of why I’m doing nursing just being in the class with a male nurse lecturer all the doubt disappears.” “Find the male lecturers very positive and their portrayal of nursing really great, enlightens me.” “Good to hear nursing care stuff from a male.” These findings indicated that male faculty was clearly welcomed. What impressed the participants was the presence and the professionalism of the male faculty members, which included their enthusiasm and positive attitudes towards nursing practice. These findings have been supported by another recent study whereby both enthusiasm and positive attitudes is shown to impact greatly on students’ understanding of professional behaviour (Baldwin et al. 2014). Moreover, providing a safe environment devoid of embarrassment, enhances the exchange of differing values respectfully (Morrissette & DotySweetnam, 2010). Participants also commented on their ability to learn and to inquire when appropriate when there was male faculty: “I don’t get embarrassed about things I ask as much”, “I tend to ask more questions”, and “it’s good to hear how they see things as opposed to anmf.org.au

Bevis, E. O., & Watson, J. (1989). Toward a caring curriculum: a new pedagogy for nursing. NLN publications (152278), iii. Etheridge, S. A. (2007). Learning to Think Like a Nurse: Stories From New Nurse Graduates. The Journal of Continuing Education in Nursing [H.W.Wilson - EDUC], 38(1), 24.

the female lecturers”. These comments sit well within Watson’s (1996) theory of transpersonal caring (Wade & Kasper, 2006). From the nursing education aspect, transpersonal caring occurs between the faculty and students (Bevis & Watson, 1989), and replicates the professional-client relationship (Watson, 1988). Furthermore, similar to other studies, the participants’ perceptions of their male faculty role modeling of caring for men may assist with how they learn to care (Grady et al. 2008) and establish the attitudes and behaviours they will utilise in the clinical setting (Horsfall et al. 2012). Due to the presence of male faculty role models, the participants reiterated no issues of uncertainty or isolation during their attainment of registration, as was once previously reported when there was a lack of role models (O’Lynn, 2004) . Similarly to a previous study (Etheridge, 2007), the participants reported they had most interaction with faculty members during their undergraduate years and saw them as role models. What these finding add is the importance of the early stage of male faculty role modeling. The recommendations from

this study focused on the retention of male nursing students within the nursing profession to assist in alleviating the forecasted nursing shortages. Therefore, educational institutions should consider their gender mix within their academic nursing staff, as the presence of male faculty goes a long way in enhancing the stance of a genderless/gender-neutral nursing profession, and with the promotion of nursing to men. The learning to care via role models is well documented in the clinical practice setting, however, in nursing education literature it is limited (Baldwin et al. 2014). Thus this study supports Baldwin’s et al. (2014) recommendations, which is the significance of male faculty members as nurse role models requires further investigation. Dianne Juliff, RN RM MSc(Nursing) is currently undertaking her PhD Dr Kylie Russell is an Associate Dean and Postgraduate Coordinator and Associate Professor Caroline Bulsara is a Research Coordinator, all are from the School of Nursing and Midwifery, University of Notre Dame, Fremantle WA

Grady, C. A., Stewardson, G. A., & Hall, J. L. (2008). Faculty notions regarding caring in male nursing students. The Journal of Nursing Education, 47(7), 314-323. doi: 10.3928/0148483420080701-05 Horsfall, J., Cleary, M., & Hunt, G. E. (2012). Developing a pedagogy for nursing teaching-learning. Nurse Education Today, 32(8), 930. doi: 10.1016/j. nedt.2011.10.022 Morrissette, P. J., & Doty-Sweetnam, K. (2010). Safeguarding student well-being: establishing a respectful learning environment in undergraduate psychiatric/mental health education: Safeguarding. Journal of Psychiatric and Mental Health Nursing, 17(6), 519-527. doi: 10.1111/j.13652850.2010.01551.x O’Lynn, C. E. (2004). Gender-based barriers for male students in nursing education programs: Prevalence and perceived importance. Journal of Nursing Education, 43(5), 229. Wade, G. H., & Kasper, N. (2006). Nursing students’ perceptions of instructor caring: an instrument based on Watson’s Theory of Transpersonal Caring. The Journal of Nursing Education, 45(5), 162. Watson, J. (1988). Human caring as a moral context for nursing education. Nursing & healthcare: official publication of the National League for Nursing, 9(8), 422.

November 2015 Volume 23, No. 5 25

CLINICAL UPDATE

Patient and carer information: Can they read and understand it? An example from palliative care Deb Rawlings and Jennifer Tieman Literacy is considered to be the ability to read and write, with health literacy defined as having the knowledge and skills required to understand and use health information to make informed decisions (Cloonan et al. 2013). Health literacy is vital to effective communication between health professionals and patients, and is associated with adverse patient outcomes (Berkman et al. 2011). With increasing numbers of the population accessing technology, the concept of ehealth literacy has also emerged in the literature, encompassing the ability to use computers, search for and understand online information and be able to put it into context (Norman and Skinner, 2006). This paper looks at the important issue of health literacy, providing an example from an Australian palliative care website. Literacy is a complex concept, incorporating such aspects as information literacy, technology, or visual literacy but simply described as: “to confidently and 26 November 2015 Volume 23, No. 5

appropriately read, write, speak and listen in a range of contexts” (Queensland government, 2014). For nurses, there are common indicators of low literacy to be aware of, which Ennis and colleagues (2012) describe as ‘red flags’, including: • making excuses when filling out forms (“I don’t have my glasses”); • pointing to, or following the text when reading; • missing appointments; • issues with medication adherence or compliance; • avoiding situations where complex learning is needed, or providing incorrect feedback when questioned about what they have read (Cornett, 2009). It is important to recognise that low literacy does not equate to low intelligence, as many of those who

are illiterate are very intelligent and often skilled at hiding their poor reading skills from others.

Health literacy A definition of health literacy from the National Library of Medicine (2013) is: ‘‘the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions’’. Lower health literacy is associated with adverse patient outcomes, including higher hospital readmissions, lower utilisation of preventative services, taking medications inappropriately, greater use of emergency services and higher mortality rates in older people (Berkman et al. 2011). In the 2006 Australian Adult Literacy and Life Skills Survey, 41%

59% HAD DIFFICULTY WITH TASKS SUCH AS LOCATING INFORMATION ABOUT THE MAXIMUM NUMBER OF DAYS A MEDICINE COULD BE TAKEN

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CLINICAL UPDATE of adults were assessed as having adequate or better health literacy skills (Level 3 or above), regarded as the minimum required to allow individuals to meet the complex demands of everyday life (Australian Bureau of Statistics, 2009). Results also showed that 19% of adults had Level 1 health literacy skills, and 40% had Level 2, indicating that 59% had difficulty with tasks such as locating information about the maximum number of days a medicine could be taken (Australian Bureau of Statistics, 2009). Health professionals don’t always recognise the limitations of their readers when creating patient information, or in clinical encounters when using jargon instead of plain language explanations (Coleman, 2011), underestimating its relevance to the general population (Mackert et al. 2011). A person’s health literacy is indicative of their ability to be an equal partner in making health decisions, so if nurses are unaware of low health literacy levels in the population, they cannot address it in practice. Considerations must also be made for those from culturally and linguistically diverse (CALD) backgrounds, and for Aboriginal and Torres Strait Islander (ATSI) people who don’t have English as a first language. Literacy and/or health literacy in these individuals may be further complicated by their having to translate information that they may or may not understand into or from their own language (Ishikawa and Yano, 2008). Interestingly, nurses will often compensate for CALD patients in both information provision and in explanations, but may not always take into account that other patients may have low health literacy as well. However, saying that, in their study of midwives providing antenatal care, Wilmore and colleagues (2014) found that nurses used various strategies “to try to ensure that people understood the health messages and information that they delivered” (Wilmore et al. 2014). In effect, the nurses found it necessary to change the way in which they utilised the written materials for some patients, indicating that they felt them to be too complicated to be understood (Williamson and Martin, 2010). Reading level is an important component of health literacy, and anmf.org.au

readability formulas remind us that patient information should match the reading skills of the intended user. The readability of a document refers to the comprehension level a person must have to understand the information (Schmitt and Prestigiacomo, 2013). The Flesch reading score is a valid and reliable formula for the measurement of readability (comprehension difficulty) in a document (Flesch, 1948). The Flesch-Kincaid Grade Level rates text on a US school grade level, meaning that a 6.0 rating indicates that a sixth grader should be able to understand the documents (Kunz and Osborne, 2010). This is the same as Grade 6 in Australia where students are approximately 11-12 years old. This is likely a lower level than the reading ability of the average American or Australian but a lower readability score in health information terms, helps patients to understand unfamiliar medical terms and concepts (Williamson and Martin, 2010).

HEALTH PROFESSIONALS DON’T ALWAYS RECOGNISE THE LIMITATIONS OF THEIR READERS WHEN CREATING PATIENT INFORMATION, OR IN CLINICAL ENCOUNTERS WHEN USING JARGON INSTEAD OF PLAIN LANGUAGE EXPLANATIONS By employing these formulae (found in Microsoft Word) an author can for example, modify the length of sentences and substitute shorter words which in turn help to make a piece simpler to read. However, it should be noted that these formulae are not perfect (Stossel et al. 2012), and for example, in reducing sentence length too much, the subsequent information can be interpreted as patronising to the reader (DR personal conversation with a palliative care social worker, 2013). While not the complete solution, readability is an important precursor to health literacy and

readability scores can provide a first indicator of the need to revisit a document or webpage. It must also be acknowledged that applying readability scores will not account for poor grammar, typographical errors, and vague language (Taylor and Bramley, 2012). Various authors have retrospectively screened patient information with a view to assessing readability, such as Terblanche and Burgess (2010) who looked at consent forms that had been used in research for nine years finding that all 84 forms were too complex to be understood by the average study participant, which could easily lead to problems such as therapeutic misconceptions. Similarly, Taylor-Clarke and colleagues (2012) looked to the readability scores of 18 patient education materials from local heart failure clinics and from the internet, finding only two that had ideal suitability and readability. Williamson and Martin (2010) also screened 171 patient information leaflets available in a hospital, with the majority exceeding patient comprehension. One Australian study looked at health literacy from the patients’ perspective, identifying several areas of concern: knowing when and where to seek health information, explaining the health problem to health professionals and understanding their responses to it, clarifying information received, following up on information after the conversation, the capacity to process and retain information (emotional and physical) and the ability to follow instructions (Jordan et al. 2010). There were also a range of factors at the healthcare level (such as a health professionals’ approach or their trust in them) and broader community level (culture, education and socio-economic) that affect these abilities. A suite of strategies to increase understanding and readability is required. Cloonan and colleagues (2013) describe successful strategies to address low health literacy that include: teach back methods, jargon-free communication, tailored messages and early assessment of post-discharge needs. Teach back methodologies are one well evaluated way in which nurses can confirm that a patient has understood what they have been told. For example, many

References Australian Bureau of Statistics (ABS), Australian Social Trends, June 2009: Health Literacy www.abs.gov. au/AUSSTATS/abs@. nsf/Lookup/4102.0Main +Features20June+2009 (accessed 11/08/2014) Australian Commission on Safety and Quality in Healthcare. 2013. Consumers, the health system and health literacy: Taking action to improve safety and quality. Consultation Paper. Sydney: ACSQHC, 2013. Australian Human Rights Commission. 2010. World Wide Web Access: Disability Discrimination Act Advisory Notes ver 4.0. www.humanrights.gov. au/our-work/disabilityrights/standards/ world-wide-web-accessdisability-discriminationact-advisory (accessed 14/08/14) Berkman, N. Sheridan, S. Donahue, K. Halpern, D and Crotty K. 2011. Low Health Literacy and Health Outcomes: An Updated Systematic Review. Ann Intern Med.; 155 (2):97-107. Cloonan, P. Wood, J and Riley, J. 2013. Reducing 30-Day Readmissions: Health Literacy Strategies. Journal of Nursing Administration. 43 (7/8): 382-387 Cornett, S. 2009. Assessing and Addressing Health Literacy. The Online Journal of Nursing. 14(3) www.nursingworld.org/ MainMenuCategories/ ANAMarketplace/ ANAPeriodicals/OJIN/ TableofContents/ Vol142009/No3Sept09/ Assessing-HealthLiteracy-.aspx (accessed 20/08/14) Ennis, K. Hawthorne, K and Frownfelter, D. 2012. How physical therapists can strategically effect health outcomes for older adults with limited health literacy. Journal of Geriatric Physical Therapy; Jul-Sep. 35, 3: 148-154 Flesch, R. 1948. A New Readability Yardstick. Journal of Applied Psychology. 32(3): 221-233 Fox, S and Duggan, M. Health Online 2013: Pew Research Center’s Internet & American Life Project http://pewinternet.org/ Reports/2013/Healthonline.aspx (accessed 14/08/14)

November 2015 Volume 23, No. 5 27

CLINICAL UPDATE

Greene, J. Peters, E. Mertz, C.K; Hibbard, J.H. 2008. Comprehension and Choice of a Consumer-Directed Health Plan: An Experimental Study. American Journal of Managed Care. 14(6):369-376 Hunter, E. Dignan, M and Shalash, S. 2012. Evaluating Allied Health Inpatient Rehabilitation Educational Materials in Terms of Health Literacy. J Allied Health. 41(2): e33–e37. Ishikawa, H and Yano, E. 2008. Patient health literacy and participation in the healthcare process. Health Expectations. 11(2): 113-122 Jordan, J. Buchbinder, R and Osborne, R. 2010. Conceptualising health literacy from the patient perspective. Patient Education and Counseling. 79: 36–42

patients will automatically say “yes” when asked if they have understood something. Others may immediately forget what they have been told or even misinterpret it in the first place. Asking them to repeat back in their own words the instructions they have received can confirm their understanding. It is not only important to develop interventions aimed at nurses but to recognise that healthcare organisations also share a responsibility to become more health literate (Parker and Hernandez, 2012). The Australian Commission on Safety and Quality in Health Care (2013) recommend strategies to address health literacy in a coordinated way in Australia, which can be facilitated by including signage around buildings, easy to complete registration forms, engaging consumers, and educating all staff (including frontline and administration).

Ehealth literacy With more and more of the population accessing technology, the concept of ehealth literacy has also emerged, which encompasses 28 November 2015 Volume 23, No. 5

the ability to use computers, search for and understand online information and be able to use it effectively in decision making. A survey conducted in America in 2012, found that 81% of adults used the internet and, of those, 72% said that they had looked online for health information in the past year, so legitimate concerns about readability of patient information also apply to online arenas (Fox and Duggan, 2013). In terms of sourcing and understanding health information on the internet, there is likely a link between ehealth literacy and technology use (Norman and Skinner, 2009). Many consumers are using the internet for health information, but cannot always do this well, coming away with false or misleading information which in turn can have adverse health outcomes. The ehealth literacy scale (eHeals) is a self-report tool designed to assess consumers’ ehealth skills which can support clinical care (Norman and Skinner, 2009). Walsh and Volsko (2008) randomly sourced consumer targeted web pages from five American chronic disease websites

(eg. American Heart Association), finding that more than three quarters of the articles had a reading level requiring higher education to understand them. A PhD study of online palliative care documents included in HealthInsite, an Australian consumer resource, found that around 60% of documents would require some university level education to read. Reading levels for 40% of the retrieved items were seen to be as complex as reading tax legislation (Tieman, 2011).

An example from practice Palliative care will affect most people whether as a patient, carer, family member, neighbour or friend. Each of these people may need different information, given in different ways at different times in the disease trajectory. This may depend on: who they are; their outlook on life and on serious illness, and their culture or upbringing. While it is important to provide good quality information, it is also important that the information provided can be easily read and understood (Walsh and Volsko, 2008).

Kunz, M. and Osborne, P. 2010. A Preliminary Examination of the Readability of Consumer Pharmaceutical Web Pages. Journal of Marketing Development and Competitiveness. 5(1): 33-41 Mackert, M. Ball, J and Lopez, N. 2011.Health literacy awareness training for healthcare workers: Improving knowledge and intentions to use clear communication techniques. Patient Education and Counseling. 85 (3): e225–e228 National Network of Libraries of Medicine. 2013. Health Literacy http://nnlm.gov/ outreach/consumer/ hlthlit.html (accessed 30/06/15) Nielsen-Bohlman, L. Panzer, A.M. Kindig, D.A. 2004 Health Literacy: A Prescription to End Confusion. Washington, DC: The National Academies Press. Norman, C and Skinner, H. 2006. eHeals: The eHealth Literacy Scale. J Med Internet Res. 2006 Oct-Dec; 8(4): e27. Parker, R and Hernandez, L. 2012. What Makes an Organization Health Literate? Journal of Health Communication: International Perspectives, 17:5, 624-627,

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CLINICAL UPDATE CareSearch (www.caresearch. com.au) is an Australian website that provides information and resources for anyone providing palliative care and anyone affected by the need for palliative care. The website is funded by the Department of Health and has been in existence since 2008. The quality processes built into the website ensure that the information is evidence based and that it is easy to read and to understand. The following case study provides information on some of the processes used to ensure a quality product.

MANY CONSUMERS ARE USING THE INTERNET FOR HEALTH INFORMATION, BUT CANNOT ALWAYS DO THIS WELL, COMING AWAY WITH FALSE OR MISLEADING INFORMATION WHICH IN TURN CAN HAVE ADVERSE HEALTH OUTCOMES Case study CareSearch has a suite of pages written especially for patients, carers and families, with quality processes in place to guide the development of the content. This included training page authors in writing for the web and employing readability scores when writing. An advisory group supported the page author, in this case drawn from those who represent or work alongside patients and their families: Carers Australia, Consumer Health Forum, Palliative Care Nurses Australia and the Federation of Ethnic Communities Councils of Australia. The group provided feedback which led to the inclusion of more visual images and videos, increased font sizes (accessibility - tested for the visually impaired), changes to page layouts, changes to the content architecture, and new content. The use of dot points, well-spaced information, sub-headings, colour on pages and text size options also help to make pages easier for the intended anmf.org.au

audience to read. Usability testing was employed, with a group of intended users (in this instance consumers) testing how easy the pages were to navigate, to read and to understand. The readability scores of each page was aimed at a Flesch grade of 6-7. The CareSearch project team considered web design, even when readability scores are at a suitable level, the way in which information is displayed on a website can affect how easy it is to read. Staff ensured compliance with the standardisation of web technologies (W3C and WCAG 2.0 standards) which ensures that the content is accessible for people with disabilities. These quality processes have helped to improve the presentation and usability of the For Patients, Carers, Families pages. www. caresearch.com.au/caresearch/ tabid/64/Default.aspx

Recommendations for practice Nurses are often in a position where they are required to provide written information for patients. This may be instructions regarding medication compliance or a certain task to be performed at home. Acknowledging that there are large numbers of patients who do not read well, or who struggle to understand health information, is vital. There are skills and strategies that nurses can use to make sure that what they are providing, or communicating to, patients will increase the likelihood that it can be more easily read and understood. Some of these are: • use a larger text/font size; • include images, diagrams or videos (Walsh and Vosko, 2008); • present numerical information in tables (Sheridan et al. 2011); • slow down when talking (Williams, 2002); • provide information about medications (Cloonan et al. 2013); • revise sentence structure, use plain language and remove jargon (Hunter et al. 2012); • usability testing (ask non-health professionals to read a leaflet, brochure or web page and get them to tell you what it means can also confirm how well the message has been delivered); • limit the information provided at each interaction, and focus on

the most important (Peters et al. 2007). When creating content for websites there are also specific considerations (see Table 1) which health professionals are also not always aware of. Table 1 Checklist for consideration in the web environment 1. Are staff familiar with writing for the web? 2. What readability levels have been set and how are they decided? 3. Are intended users involved in content development and processes? 4. Are templates used to help ensure consistency? 5. Are images appropriate to reinforce the message? 6. Could the message be delivered in another format eg. video 7. Are font sizes and styles appropriate? 8. Are pages W3C compliant? (ie. accessible) 9. Would user testing be useful? 10. Would page editing help?

Conclusion Health literacy and ehealth literacy are emerging concepts in the literature, highlighting that large numbers of patients and carers cannot read or understand either written or online information to help them to make decisions about their health. Nurses provide information for patients, often in the form of a written brochure or leaflet, not always considering that many are unable to read it. Using defined quality processes increases the likelihood of producing materials that can be understood by patients and carers. Deb Rawlings is Lecturer and Research Officer (CareSearch) Palliative and Supportive Services, School of Health Sciences, Flinders University, SA Jennifer Tieman is Associate Professor, CareSearch Director, Associate Dean (Research), School of Health Sciences, Palliative and Supportive Services, School of Health Sciences Flinders University, SA

Peters, E., Dieckmann, N., Dixon, A., Hibbard, J. H., & Mertz, C. K. 2007. Less is more in presenting quality information to consumers. Medical Care Research and Review, 64(2), 169–190. Queensland Government, 2014 http://education.qld.gov. au/literacyandnumeracy/ (accessed 30.06.2015) Sheridan, S.L. Halpern, D.J. Viera, A.J. Berkman, N.D. Donahue, K.E and Crotty, K. 2011. Interventions for Individuals with Low Health Literacy: A Systematic Review. Journal of Health Communication: International Perspectives, 16:sup3, 30-54. Stossel, L.A. Segar, N. Gliatto, P. Fallar, R and Karani, R. 2012. Readability of Patient Education Materials Available at the Point of Care. J Gen Intern Med 27(9):1165–70 Taylor-Clarke, K. HenryOkafor, Q. Murphy, C. Keyes, M. Rothman, R. Churchwell, A. Mensah, G. Sawyer, D. and Sampson, U. 2012. Assessment of Commonly Available Educational Materials in Heart Failure Clinics J Cardiovasc Nurs.; 27(6): 485–494. Terblanche, M. and Burgess, L. 2010. Examining the readability of patientinformed consent forms Open Access Journal of Clinical Trials. 2: 157–162 Tieman, J. 2011 Investigating barriers to accessing online palliative care information, PhD Thesis, Flinders University Walsh, T. and Volsko, T. 2008. Readability Assessment of InternetBased Consumer Health Information. Respiratory Care 53 (10):1310 -1315 Williamson, J.M.L and Martin. A.G. 2010. Analysis of patient information leaflets provided by a district general hospital by the Flesch and Flesch–Kincaid method. Int J Clin Pract. 64 (13):1824–1831 Wilmore, M. Rodger, D. Humphreys, S. Clifton, V.L. Dalton, J. Flabouris, M. and Skuse, A. 2014. How midwives tailor health information used in antenatal care. Midwifery. In Press http: //dx.doi.org/10.1016/j. midw.2014.06.004i

November 2015 Volume 23, No. 5 29

WORKING LIFE

Taking it from excellence and making it exceptional By Natalie Dragon Keeping a nurse and midwife with you at all times is the advice Chief Executive Officer of The Royal Women’s Hospital in Melbourne and Women’s Health Nurse Sue Matthews recommends for people entering into some form of leadership, whether it be education, research or management . “Those who take the nurse and midwife with them, always make the best decisions.” Dr Sue Matthews, from Ontario, Canada, took the role of CEO at The Women’s Hospital in February 2014. She came from Interim President and CEO of the Niagara Health System in Canada and has held numerous leadership positions, including Provincial Chief Nursing Officer of Ontario in 2003. “Nursing is who I am, not what I do. In everything I do, there’s a nurse somewhere in the decision making process, thinking about patients and staff is automatic.” Sue says it’s very empowering as a leader to work in an environment like The Women’s, which she says is doing great work. “My goal is to take it from excellent and make it exceptional, especially in the patient experience. People go into healthcare to make a difference, sometimes the system prevents that. It is my job to support staff to provide the best care they can.” Sue and her mother both survived breast cancer; Sue two and a half years now. The ground-breaking research the Women’s Hospital is involved in, not only in cancer but also in midwifery and neonatal is special to her. “It has a very warm place in my heart. Being a part of that is important to me - someone in this organisation may be involved in curing cancer. Every day I come to work thankful for what we do.” Starting out on a general ward, Sue found herself drawn to the ‘gynae’ patients, where she first thought she might be drawn to women’s health. It was experience doing extra casual work in a new 30 November 2015 Volume 23, No. 5

sexual assault crisis centre that was the biggest turning point for her, Sue says. She cared for a young woman who came in at 3am, having been sexually assaulted. “I was always the nurse that looked at the newest greatest piece of equipment and how it worked, it was exciting. I could IV resite and was called on often because I was proficient at it. But with this woman, I didn’t do anything technical other than gather the forensic evidence kit. This is where I really understood what nursing is. Nursing is not about being technically proficient - it’s great when you are - but it’s only a piece of it.”

THIS WAS WHEN I REALISED THAT THERE WERE RULES IN PLACE IN A SYSTEM THAT DID NOT PROVIDE FOR PATIENTS. I THOUGHT ‘I HAVE TO CHANGE THIS’ Sue gravitated more and more towards women’s health. A passion for delivering patient centred care propelled her after another ‘turning point’. Looking after a woman who had a dilation and curettage, visiting hours had ended and Sue asked a woman’s partner to leave. “This man turned to me and said: ‘We have waited seven years and spent $35,000 on this dream that has gone. You are telling me to go; I want to stay and grieve with my wife.’ “This was when I realised that there were rules in place in a system that did not provide for patients. I thought ‘I have to change this’.” Soon after, Sue transitioned into

an educator role between hospital and university which started the ball rolling into leadership. “I never ever had a vision to become a CEO. My goal has always been to gain experience, expand my learning and provide that patient centred-ness of care.” Education equals opportunity, is her message to nurses and midwives starting out. “The further you go and broaden your education, the more opportunities are in front of you.” Her own career has been serendipitous, she says. “I’ve been in the right place and at the right time.” She has taken positions that have been out of her ‘comfort zone’, including her move to Australia to take on the CEO role at The Women’s. “If you are considering another role, do not be afraid to go from being an expert to novice again.” The “stars were aligned” Sue says of her move to Australia. “We have been so warmly welcomed. In Canada we lived about 25 minutes from the US border – it was a completely different place. Yet we could fly 25 hours and feel right at home.” Husband Rick transferred to a similar position in the Asia-Pacific region and 23 year old daughter Kirsten is studying law at Monash University. Their other daughter Hayley is in Canada studying Media and Communications. Another piece of advice Sue says is not to turn down a position without knowing enough about it. “People talk themselves out of applying for a position. If it’s not too much of a stretch, and even if it’s not necessarily the direction you think you want to move in, do not let it prevent you from applying. If you look at a sailboat, it does not always go straight to its destination – it’s about trusting yourself.”

DR SUE MATTHEWS

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ISSUES

Are there warning signs for suicide? References Australian Human Rights Commission. 2014. Children’s Rights Report 2014. Sydney: Australian Human Rights Commission. beyondblue. 2015. “Responding to warning signs.” https://www. beyondblue.org.au/ the-facts/suicide/ worried-about-suicide/ what-are-the-warningsigns/responding-towarning-signs. (accessed 10 September 2015).

Nicholas Procter and Monika Ferguson Suicidal behaviour can have profound and lasting impacts on the individual, as well as their family, friends, and the wider community. The aim of this article is to deepen nurses and midwives understandings of how the work they do intersects with the lives of people who are suicidal.

European College of Neuropsychop harmacology (ECNP). 2015. www.ecnp.eu/~/ media/Files/ecnp About%20ECNP/Press/ AMS2015/Popovic%20 PR%20FINAL.pdf (accessed 10 September 2015). International Association for Suicide Prevention (IASP). 2015. https:// www.iasp.info/ (accessed 10 September 2015). Nicolai, K. A., Wielgus, M. D. and Mezulis, A. 2015. Identifying Risk for SelfHarm: Rumination and Negative Affectivity in the Prospective Prediction of Nonsuicidal Self-Injury. Suicide and LifeThreatening Behaviour. doi: 10.1111/sltb.12186 Procter, N.G., Baker, A., Grocke, K. and Ferguson, M. 2014. Introduction to Mental Health and Mental Illness: Human Connectedness and the Collaborative Consumer Narrative, in Procter, N.G., Hamer, H., McGarry, D., Wilson, R., Froggatt, T. 2014. Mental Health: A person centred approach. Melbourne: Cambridge University Press. Suicide Prevention Australia. 2015a. http:// suicidepreventionaust. org. (accessed 10 September 2015). Suicide Prevention Australia. 2015b. Transforming Suicide Prevention Research: A National Action Plan. Sydney: Suicide Prevention Australia. University of South Australia (UniSA). 2015. https://www.youtube. com/watch?v=WdC3 nhxA66U. (accessed 10 September 2015). World Health Organization (WHO). 2015. Suicide. www. who.int/mediacentre/ factsheets/fs398/en/ (accessed 10 September 2015). Youth Suicide Warning Signs. 2013. www.youth suicide warning signs. org/ (accessed 10 September 2015).

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Suicide and suicidal behaviour are major public health concerns (IASP, 2015). Globally each year more than 800,000 people die by suicide (WHO, 2015). This corresponds to approximately one death by suicide every 40 seconds. Significantly suicide attempts and suicidal ideation are far more common than suicide deaths. The number of suicide attempters is believed to be up to 20 times the number of deaths by suicide. In Australia some 2,500 people die by suicide each year (Suicide Prevention Australia, 2015a). Suicide deaths are not limited to adults. Data from the Australian Human Rights Commission (2014) reveals that between 2007 and 2012, 333 children aged 4-17 years died due to intentional self-harm (64% male; 20% Aboriginal). Of these deaths, 81% were by hanging and 76% occurred at the young person’s home. Much-needed attention is being given to preventing suicide across the lifespan (Suicide Prevention Australia, 2015b). Below is a consensus list of warning signs to indicate a young person might be at risk of suicide (Youth Suicide Warning Signs, 2013): 1. Talking about or making plans for suicide. 2. Expressing hopelessness about the future. 3. Displaying severe/overwhelming emotional pain or distress. 4. Showing worrisome behavioural

cues or marked changes in behaviour, particularly in the presence of the warning signs above. Specifically, this includes significant: • withdrawal from or changing in social connections/situations; • changes in sleep (increased or decreased); • anger or hostility that seems out of character or out of context; • recent increased agitation or irritability. Warning signs have also been identified for adults. Recent findings from the BRIDGE-II-MIX study (ECNP, 2015) reveal that ‘depressive mixed states’ – when a person is depressed, but also has excitation – often precede suicide attempts. The risk of attempting suicide is at least 50% higher for a person diagnosed with depression and experiencing any of the accompanying signs: 1. Risky behaviour (eg. reckless driving, promiscuous behaviour). 2. Psychomotor agitation (pacing around a room, wringing hands, pulling off clothing and putting it back on or other similar actions). 3. Impulsivity (acting on a whim, displaying behaviour characterised by little or no forethought, reflection or consideration of the consequences). Understanding warning signs

and implementing prevention strategies is clearly a much broader task than understanding and responding to mental illness. Suicidal behaviour is a complex interaction of social, economic, personal and situational variables (Suicide Prevention Australia, 2015a). A gentle probing inquiry to support the person in distress is considered best practice; see www.youtube. com/watch?v=WdC3nhxA66U (UniSA 2015). Also important are cultural explanatory models specifically relating to how people from cultural and linguistically diverse backgrounds understand the concepts of mental distress; how they perceive themselves and those around them; how they communicate distress; when, how and why they seek help; and what they perceive as a good outcome. Person-centred care at the time of responding to people demonstrating suicidal warning signs is critical. A person-centred approach is concerned with human connectedness: the capacity for feelings to be received and understood, and lives to be revealed (Procter et al. 2014). Being in despair, in deep distress and frightened may mean some people ruminate without openly discussing what is on their mind (Nicolai et al. 2015). Rumination, a cognitive emotion regulation strategy, may increase the likelihood of self-harming behaviour. Others struggle for words and may express themselves in ways that family, work colleagues, health professionals and even those who have previously been suicidal, are not familiar. Simple steps such as speaking up when worried about someone, and learning how to start conversations around suicide are essential to responding to suicide warning signs (beyondblue, 2015). Professor Nicholas Procter, RN MBA PhD is Professor and Chair: Mental Health Nursing at the University of South Australia Dr Monika Ferguson, PhD is Research Associate, School of Nursing and Midwifery, University of South Australia

Lifeline 13 11 14 beyondblue 1300 224 636 MensLine 1300 789 978 November 2015 Volume 23, No. 5 31

EDUCATION

Post-Traumatic Stress Disorder The Australian Nursing and Midwifery Federation (ANMF) has a long history of working with the Department of Veterans’ Affairs (DVA) in the capacity of professional and industrial consultancy. Many of our members around the country are employed by DVA approved providers to administer nursing care to Australian veterans, and as would be expected, many of our returned soldiers suffer from some level of Post-Traumatic Stress Disorder (PTSD). However PTSD is not limited to war veterans, as by definition, it is a psychological response to the experience of intense traumatic events, particularly those that threaten life. It can affect people of any age, culture or gender. Migrants, refugees and asylum seekers also suffer a high level of PTSD as do older people with dementia. The ANMF’s Aged Care Training Room website has an excellent learning module on PTSD and this article is an excerpt from that module. PTSD in war veterans was formally recognised in the 1980s following the Vietnam War. It is categorised as a mental illness under the DMS V (Diagnostic and Statistical Manual of Mental Disorders) categories for psychiatric illness. But its existence dates back over many centuries. In World War I it was referred to as ‘Shell shock’, in World War II it was called ‘Combat fatigue’. Studies have shown consistent prevalence rates of between 24 and 33% of post combat war veterans experiencing PTSD at some time in their lives. The incidence of associated mental health and physical health illness is also much higher than in their noncombat counterparts. An Australian study of Korean War veterans that was conducted 50 years after the war showed that: • The veterans are experiencing significantly higher levels of mental health illness than similarly aged men who were not involved in the combat. • There was an association between PTSD and combat exposure, length of deployment, time of deployment, being of lower rank and having been injured in action. • Army forces fared worse than the Navy followed by Air Force veterans. Older people are at risk for PTSD from recent events and from those that happened long ago. Depression, anxiety, alcohol or drug dependency are the common co-morbidities of PTSD. The older person’s current level of social support as well as feelings of fear and anxiety (actual or perceived) can increase his vulnerability for PTSD. 32 November 2015 Volume 23, No. 5

Your client/resident who is a war veteran may have chronic or late onset PTSD and so may those who were sexually abused as children or your Culturally and Linguistically Diverse (CALD) client/resident who has lived through extreme trauma or atrocities in his country of origin.

PTSD can be defined as an anxiety disorder that results from: • Witnessing or having

experienced a life threatening event or situation; • witnessing a death or having caused the death of another person; or • violent personal assault. The result is feelings of intense fear, helplessness or horror. Other responses include guilt, shame, intense anger or feeling emotionally numb. PTSD most commonly occurs in the weeks or months following the trauma. There is some evidence that it may occur years or even decades after the trauma. A link has also been suggested between dementia and the re-emergence of PTSD. Diagnosing and treating PTSD can be complicated by the existence of co-morbidities. Health professionals and aged care workers should include PTSD as a possible cause for an older person’s poor mental health, deteriorating mental health or cognitive and behavioural changes. High risk groups include: War veterans, victims of war, refugees and asylum seekers, Aboriginal and

Torres Strait Islander peoples, CALD older people, victims of sexual assault, adult victims of childhood abuse or sexual assault, older people with cognitive impairment who have experienced trauma in the past, those who have been involved in disasters including flood, fire, earthquakes, older people who have high levels of fear and perception of threat, older people who have been seriously injured either accidentally or intentionally. There are a range of symptoms that may be displayed by the person who has PTSD, including behaviours or reactions that seem unrelated. These symptoms may consist of increased prescription medication or alcohol use and other behaviours including aggression, defending, escaping, hoarding, over compliance, passivity and hiding. Any changes in the person’s usual way of relating to others and his behaviour should always be investigated.

PTSD symptoms can be grouped into three categories:

1. Repetitive or re-experiencing symptoms: Disturbing memories, reoccurring nightmares, flashbacks these may take the form of hallucinations. These symptoms are involuntary and intrusive. The result is intense distress and physiological reactions including sweating, racing heartbeat, hyperventilation, stomach cramps, diarrhoea. Images, sights, sounds, smells, even the

WAR VETERANS

24 & 33% STUDIES HAVE SHOWN CONSISTENT PREVALENCE RATES OF BETWEEN 24 AND 33% OF POST COMBAT WAR VETERANS EXPERIENCING PTSD AT SOME TIME IN THEIR LIVES. ASYLUM SEEKERS, REFUGEES AND IMMIGRANTS BETWEEN

250,000 AND

800,000 REFUGEES AND ASYLUM SEEKERS WORLDWIDE ARE AGED 60 YEARS AND OVER.

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EDUCATION time of day can trigger the reliving of the event. 2. Avoidance symptoms: Making extreme changes to the person’s everyday life to avoid being exposed to reminders or triggers of the trauma. This may result in avoiding social contact with particular people, avoiding any type of media exposure, alcohol or other drug use, selfimposed social isolation. They may try to prevent themselves from thinking about or feeling the trauma and will avoid talking about it. This may result in the loss of meaningful relationships, ability to relate to people and the loss of social interactions and activities. 3. Hyperarousal symptoms: Exaggerated startle response, insomnia, mood variances including irritability or anger, hypervigilance, problems with memory and concentration. The sufferer is in a state of anticipation, alert or heightened preparedness. This may result in locking doors, windows and checking that they are locked, inability to settle and get involved in an activity, increased anxiety and restlessness in the evenings or when they are in a situation that is not familiar. The person may also experience a range of typical anxiety or stress related symptoms including: sweating, palpitations, hyperventilation, diarrhoea, stomach cramps, feeling panic or fear, feeling like they have no power or control, feeling trapped or restrained. The existence of other mental health co-morbidities has been estimated at up to 80% for people with PTSD. The most common comorbidities are: • Depression and suicide. • Anxiety disorders including panic disorder. • Alcohol dependence or abuse. • Other substance abuse/ dependence (including prescription drugs). The presentation or exacerbation of these mental health illnesses in older people may be warning signs for chronic or delayed onset PTSD. Escalation of alcohol or other substance use are common coping mechanisms for PTSD. Increased alcohol or prescription medication use should be investigated. If PTSD is the underlying problem then increased alcohol consumption or use of anmf.org.au

sedatives will only add to the burden. There is a strong correlation between alcohol misuse or dependence and PTSD for war veterans. Disability caused by alcohol dependence is more often than not accompanied by PTSD or other mental health illness. The support that returned service personnel experienced was often centred on mateship and the consumption of alcohol. If alcohol had been used as a strategy to manage anxiety and intrusive symptoms of PTSD, he may be strongly opposed to reducing or stopping the consumption of alcohol even in the face of serious co-morbid health problems including liver disease and alcohol related dementia.

THERE IS GROWING EVIDENCE TO SUPPORT THE THEORIES THAT PTSD MAY BE A PRECURSOR FOR DEMENTIA OR A CONSEQUENCE OF DEMENTIA. The implications for providing care to clients/residents who are war veterans is that they may have chronic PTSD or delayed onset PTSD that has not been diagnosed or ever treated. They may be living in a constant state of anxiety or have depression and not be aware of the cause or know that PTSD and its co-morbidities can be treated and managed. The CALD war veteran client/ resident will have his own personal and cultural beliefs that will impact on his vulnerability for PTSD. Feelings of guilt and shame are common for refugees who fled or migrants who left others behind. Another group of people who are debilitated by PTSD are asylum seekers, refugees and immigrants. Statistics in 2008 for the United Nations Refugee Agency are that between 250,000 and 800,000 refugees and asylum seekers worldwide are aged 60 years and over. Australia offered refuge to 11,000 refugees in 2008 via the United Nations resettlement program. The CALD client/resident with PTSD may be displaying a range of depression or anxiety symptoms. He may self-isolate or fear may

manifest as aggressive behaviour. Chronic or delayed onset PTSD must be considered as a possible cause for the CALD client/resident’s behaviour, actions and reactions. There is growing evidence to support the theories that PTSD may be a precursor for dementia or a consequence of dementia. For CALD older people this may be compounded by the loss of English language skill. Like any mental illness, PTSD treatment or management needs to target the individual’s needs. His ability or willingness to engage in treatment needs to be part of a specialist mental health assessment. Assessment of mental health stability including suicide risk should be established before cognitive behavioural therapy is considered. Management principles include: • Facing or being exposed to the traumatic memories. This can help to empower the person to develop coping skills to reduce the impact of the memories as opposed to relying on avoidance strategies like alcohol or other drug abuse. • Altering the beliefs of the sufferer. He may have overwhelming feelings of guilt or beliefs that he was in some way responsible for what happened. In the case of war conflict he may have been the victim or perpetrator of trauma. • Pharmacotherapy may be useful in the diminution of symptoms, as a co-treatment for associated depression or as an alternative if other forms of treatment are not appropriate. Anti-depressants and in particular the selective serotonin reuptake inhibitors (SSRIs) have been found to be most effective. . • Taking the time to develop a trusting relationship with the sufferer. Refugees and asylum seekers may be reluctant to disclose the trauma. For example a female PTSD sufferer is not likely to disclose rape to a male worker. • Family and significant others will benefit from support and education and explanation about the probable impact of PTSD therapies. • Modifying the environment in an aged care facility may help as a way to reduce triggers that may be based on memories of imprisonment, torture or interrogation.

Reading this excerpt will give you 0.5 CPD hours. THE PTSD MODULE ON THE ACTR WEBSITE GOES INTO GREATER DETAIL INCLUDING TREATMENT PRINCIPLES AND WILL TAKE APPROXIMATELY 2.5 HOURS TO COMPLETE (2.5 CPD HOURS). THE MODULE CAN BE PURCHASED VIA AN ANNUAL SUBSCRIPTION TO THE ACTR FOR $110 FOR ANMF, NSWNMA AND QNU MEMBERS AND $132 FOR NON-MEMBERS. THE SUBSCRIPTION WILL GIVE YOU ACCESS TO OVER 60 OTHER QUALITY MODULES. TO PURCHASE YOUR SUBSCRIPTION GO TO HTTP://ANMF. ORG.AU/PAGES/CPEACTROOM FOR ANY ENQUIRIES RELATED TO CPD OR EDUCATION CONTACT JODIE DAVIS AT: JODIE@ANMF.ORG. AU OR PHONE 02) 6232 6533

November 2015 Volume 23, No. 5 33

FOCUS

Men’s Health

References

Sexual diversity and social stigma on HIV prevention for Thai gay men By Praditporn Pongtriang, Anthony Paul O’Brien and Jane Maguire It is widely accepted that HIV infection is a serious global health issue for gay men. HIV prevention continues to be a challenge and appears to have been ineffective in some developing countries, including Thailand, with the number of new infections increasing (UNAIDS, 2012; Bureau of Epidemiology Thailand, 2014). Gay entertainment areas in Bangkok have been associated with an increased incidence of HIV infection for the Thai gay community (Kittitornkul et al. 2011). An ethnographic study was conducted with 30 gay men in Bangkok, Thailand between May and August 2014. The aim of the study was to more deeply appreciate their everyday lives, particularly in relation to their perspectives on the prevention of HIV. Face-to-face semi structured interviews were held, along with non-participant observation in gay entertainment venues; field notes were also recorded. Preliminary qualitative data from the study broadly suggests that participants’ desire more specifically targeted HIV interventions, ones that better reflect an understanding of their everyday lives. Some of the more specific findings include the negative influence of social stigma on participants’ lives and their family experiences and the diversity of sexual roles involved in being Thai, gay, and living in Bangkok. 34 November 2015 Volume 23, No. 5

Social influences on life experiences Participants reported that gay men want to be treated equally and that they felt they were sometimes seen as less than human. Men reported being discriminated against which isolated and marginalised them within their own subcultural world. Mainstream Thai discrimination is reported by participants to negatively affect their self-esteem. It is also apparent from participants, that Thai families can reject their sons who come out as gay. Disclosing their sexuality to family can sometimes mean they will move away from their family. Discrimination from local community members is also described by participants as pushing men toward the urban areas in search of work and greater social acceptance. In contrast, gay men who were accepted by their family and community reported having a more comfortable life and felt more socially equal.

Sexual diversity The findings of this ethnography describe a variation in the sexual identity of Thai gay men. For example, some men reported hiding their effeminate behaviour in order to appear to be more masculine, thus avoiding social conflict; and

others would display different sexual identities. The receptive-gay male (Gay Queen) for instance, might change his sexual role to being either insertive or receptive. This way he could then identify as being versatile (Gay Both). The participants in this study described promiscuous behaviours and regularly changed their sexual partners. Participants said that some Thai gay male relationships have less permanence and are only short term compared with heterosexual ones. They described gay men as being forced to meet via the internet, or in gay entertainment venues, because being gay is not completely socially accepted in Thailand. Accordingly, the subcultural reasons for male gay multiple partnering need to be understood to develop a better more meaningful strategy for HIV prevention. This brief report describes a rich tapestry of qualitative findings from an ethnographic study conducted in Bangkok, Thailand with gay men. The participants describe the Thai Bangkok gay community as emerging from underneath traditional Buddhist heterosexual cultural values and beliefs. Although many HIV prevention projects have been established in Thailand, this study indicates that there is still a large variation in the safe practice of sex in the gay community of Bangkok. Participants indicate there are many factors contributing to decisions to use, or not use a condom, or even to declare, or not declare their HIV status. These preliminary outcomes highlight the diversity and complexity of the Bangkok gay male subculture.

UNAIDS., UNAIDS report on the global AIDS epidemic 2012, UNAIDS, Editor. 2012. p. 1-110 Bureau of Epidemiology Thailand. (2014). Thailand HIV/AIDS annual report 2014. Retrieved 23 March 2015, from www. boe.moph.go.th/ files/report/2014112 8_61345755.pdf Kittitornkul, E., Ratanadilok Na Phuket, S., & Tongtan, K. (2011). Trends and sexual behaviors affecting HIV infection among men who have sex with men in Phuket, 2005-2010 (in Thai). Disease Control Journal, 37(1), 9-17

Praditporn Pongtriang is a Research Higher Degree Candidate in the School of Nursing and Midwifery at The University of Newcastle and also a Lecturer in the Faculty of Nursing at Suratthani Rajabhat University in Thailand Anthony Paul O’ Brien is a Professor and Jane Maguire is Associate Professor, both are in the School of Nursing and Midwifery at The University of Newcastle anmf.org.au

Men’s Health

FOCUS

Del Lovett References Australian Bureau of Statistics. 2010. Men’s Health. Australian Bureau of Statistics Accessed 24 July 2012. www.abs.gov.au/ socialtrends Australian Institute of Health and Welfare. 2014. Australia’s health 2014. AIHW Accessed 28 September 2014. www.aihw. gov.au/publicationdetail/?id=60129547205 Britt, H., G.C. Miller, J. Henderson, J. Charles, L. Valenti, C. Harrison, C. Bayram, C. Zhang, A. Pollack, J. O’Halloran, and Y. Pan. 2012. General practice activity in Australia 2011–12 General practice series no.31. Sydney University Press Accessed 28 November 2012. http:// ses.library.usyd.edu.au/ handle/2123/8675 Department of Health & Human Services. 2015a. Engaging men in healthcare: Information resource paper. Victorian Government Accessed 22 July 2015. (European Commission 2011) http://docs2.health. vic.gov.au/docs/doc/ ABF1ED71403DE136C A257E66001393 BF/$FILE/Engaging%20 men%20in%20 healthcare%2-%20 information%2resource %20paper%20JUNE%20 2015%20Final-v02.pdf Department of Health & Human Services. 2015c. Improving men’s health and wellbeing: Resource: data and evidence. Victorian Government Accessed 13 August 2015 www2.health.vic.gov. au/.../%7B53064243EA2A-40F4-BE74-2E European Commission. 2011. The State of Men’s Health in Europe - Extended Report. Geneva, Switzerland: European Commission. http://ec.europa.eu/ health/population_ groups/docs/men_ health_extended_en.pdf Malcher, G. 2006. What is it with men’s health? Men, their health and the system: a personal perspective. Medical Journal of Australia 185 (8):459-460. www.mja.com.au/ journal/2006/185/8/ what-it-mens-healthmen-their-healthand-system-personalperspective

anmf.org.au

Has the Practice Nurse Incentive Program improved health promotion and illness prevention education access for men? By Del Lovett, Marc Broadbent, Patrea Anderson and Alan White A study that looks at what impact the Practice Nurse Incentive Program (PNIP) has on improved access for men to health promotion and illness prevention education is being conducted. The study’s primary aim is to discover the ways in which the general practice nurse (GPN) may utilise the Practice Nurse Incentive Program (PNIP) funding in Australia, and in particular in relation to, what constitutes the level of health promotion and illness prevention education provided for men. A second aim will be to identify the facilitators or barriers to providing this nursing service. The need for a specific focus on men’s health is a strong one and has been well documented in Australia and internationally in recent years. There are strong economic and social arguments for improving men’s health. Ill health has considerable psychosocial impacts on men as well as affecting their partners and families (Department of Health & Human Services, 2015c). In Australia health areas of concern for men include: • average shorter life expectancy; • higher levels of avoidable mortality; and • higher mortality from almost all common causes of death including heart disease, cancer, respiratory disease and suicide (AIWH, 2014; Department of Health, & Human Services, 2015a).

Men between 15–24 years of age have the highest incidence of death from suicide, followed closely by road traffic accidents (ABS, 2010). There has been a tendency for men to present with health problems later than women, and when they do present to have shorter consultations (Malcher, 2006). This also accounts for less opportunity for men to seek help and utilise health services (Britt el al. 2012). While ‘male socialisation tends not to lead men to be as aware of health and wellbeing issues as women, men are seldom the focus of specific or targeted health education or health promotion initiatives’ (European Commission, 2011). GPNs are in an optimal position to deliver health promotion and illness prevention education for men in primary care. The PNIP nurse-related Medicare incentive was introduced in 2012 for increased employment of GPNs and to support, expand and enhance role for nurses working in general practice. However, there is limited research that explores if this funding has improved access for men to men’s health services. This current study will discover how

GPNs currently utilise the PNIP to expand and enhance their role to engage men in targeted health promotion and illness prevention education and identify facilitators or barriers to this funding mechanism. The research study is important as it has the potential to inform alternative approaches to improving health service planning and delivery for men’s health services in general practice. Further information on this research project is available from Dr Marc Broadbent (Principal Supervisor), School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Locked Bag 4, Maroochydore DC, Qld, 4558. Phone (07) 5459 4549 or Fax (07) 5456 5940 or Email: mbroadbent@usc.edu.au Del Lovett is a PhD student; Dr Marc Broadbent and Associate Professor Patrea Anderson are all at the University of the Sunshine Coast in Qld Professor Alan White is at Leeds Beckett University in the UK November 2015 Volume 23, No. 5 35

FOCUS

Men’s Health

Men at work: study probing fathers’ work-life balance The work-life balance of Adelaide fathers, and the culture of companies in which they work, is at the centre of new University of Adelaide research.

Men’s mental health By Ian Munro The area of men’s mental health, while slightly improving, remains an area of concern particularly with regard to rates of depression and suicide. While city based men can more easily access, if they choose, treatment options, regional and rural men’s health options are only slowly improving and there clearly remains a stigma associated with seeking help for mental health problems. As well as this stigma regional and rural men additionally have to find time to seek mental healthcare within an area or smaller community where they could be well known. Sadly the lack of take up of mental healthcare by these men, leads directly to an increase in the suicide rate within regional and rural areas. This is compounded by their easy access to weapons used on farms or recreationally. AIHW (2007) identified that regional and remote men were up to 2.6 times more likely to kill themselves than urban men. Reducing availability of work within regional and rural areas, as workplaces close or farms struggle to cope with extreme weather events leads to financial hardships that in some cases only compounds this problem. ABS data shows the total number of suicides in 2010 was 2,361, higher than any road toll. Yet while there are strong 36 November 2015 Volume 23, No. 5

programs to reduce the carnage on the roads, mental health programs struggle to gain funding to reduce this saddening loss of life. Though the ABS data for 2010 does show a reduction of the overall suicide rate from 17 to 12.7 per 100,000, it still is unacceptably high. Furthermore, the toll on loved ones is not counted. Families are often left to cope with minimal resources, additionally combatting the stigma of coping with the loss of their loved one to a manageable mental illness. We as a country need to say this has to stop. The loss of life is unacceptable. The untold grief and disability that is left in the wake of suicide must be addressed. Clearly programs that can educate healthcare professionals and the wider community about how best to manage depression and those that are suicidal is essential, and most importantly health education programs targeted at rural areas that reduce the stigma of seeking help for mental illness must be funded and implanted. Dr Ian Munro is a Senior Lecturer in the School of Nursing and Midwifery at Monash University in Victoria

Ian Munro References ABS (2010) in www.abs.gov.au/ ausstats/abs@.nsf/ Products/3309.0~2010 ~Chapter~Geography? Open Document accessed 12/8/2015 AIHW (2007) in http:// ruralhealth.org.au/ sites/default/files/ fact-sheets/fact-sheet14-suicide%20in%20 rural%20australia_0.pdf accessed 12/8/2015

Ashlee Borgkvist, PhD student from the University of Adelaide’s School of Public Health, wants to know about fathers’ experiences using flexible work arrangements. “The Australian work culture often depicts the ideal worker as someone who has no outside commitments but the reality is that everyone, particularly parents, has a life outside of work,” said Ms Borgkvist. “In my research I want to hear from fathers from a broad range of organisations, varying levels of responsibility, and even business owners, about how they balance work and family-life. “I want to know more about the various flexible work arrangements currently offered and what fathers’ experiences are with those arrangements,” she said. Ms Borgkvist said she wants to understand the potential barriers to a good work-life balance and explore ways for employers to better support fathers. “Studies suggest that when men take advantage of flexible work arrangements they are healthier and happier. “It has also been shown that when a father takes time off work after a child is born; they are more engaged in the child’s development, which has a positive impact on both the father and the child.” Additionally, when fathers have a constructive work-life balance, their partners can also feel more supported to return to work, Ms Borgkvist said. Following the completion of her study, Ms Borgkvist will aim to make recommendations about initiatives that organisations can implement to improve work-life balance for fathers. Working men over the age of 18, who have at least one child between the ages of one and 12, are invited to participate in the study. For more information, email ashlee.borgkvist@adelaide.edu. au or call 0401 844 702. anmf.org.au

Men’s Health

Nindee Men’s Shed a place to reconnect

New funding to raise men’s health awareness

The former Nindeebai Hostel in Kalgoorlie-Boulder, Western Australia, will be converted into a men’s shed, thanks to funding from the Aboriginal Lands Trust.

Men’s health in Victoria has been given a $1.1 million funding boost by the state government.

Aboriginal Affairs Minister Peter Collier said the revitalised building would offer a place for local Aboriginal men to socialise and reconnect with their community. “The shed will give those experiencing physical, emotional, social, economic or spiritual stress a place to go, to talk, to learn and to share,” Mr Collier said. The state government, through the Aboriginal Lands Trust, is supporting the development of the men’s shed, providing funding towards its construction and fit out. The Minister acknowledged the role of Nindee Men Inc. led by Aboriginal elders, which developed the concept and sought the required funding. “Nindee Men Inc. recognised the need for a local service dedicated to the needs of Aboriginal men in the area,” he said. “Being productive and feeling of value to your community is key to being healthy and happy. “This men’s shed will provide that much-needed opportunity for the Aboriginal community in Kalgoorlie-Boulder.” The shed is expected to open in early 2016.

THE STATE GOVERNMENT, THROUGH THE ABORIGINAL LANDS TRUST, IS SUPPORTING THE DEVELOPMENT OF THE MEN’S SHED, PROVIDING FUNDING TOWARDS ITS CONSTRUCTION AND FIT OUT.

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PROSTATE CANCER IS THE MOST COMMON CANCER DIAGNOSED AMONG VICTORIAN MEN. IN 2013, THERE WERE 4,257 NEW CASES OF PROSTATE CANCER IN VICTORIA, MAKING UP 27% OF ALL NEW MALE CANCERS DIAGNOSED.

The funding over the next four years will provide awareness about men’s health and prostate cancer, and to support research into the disease. Prostate cancer is the most common cancer diagnosed among Victorian men. In 2013, there were 4,257 new cases of prostate cancer in Victoria, making up 27% of all new male cancers diagnosed. Sadly, 729 men died from the disease last year. Despite this, prostate cancer has the third highest survival rate of all cancers, with 93% of Victorian men surviving five years after a diagnosis of prostate cancer. The EJ Whitten Foundation, which raises awareness of prostate cancer and promotes regular testing and early detection, will be provided with $500,000 of the funding to develop and roll out a new men’s health initiative called “Inspiring men, saving lives”. The initiative will include community education sessions and encourage men to take ownership of their individual health and wellbeing and have regular health checks. A research fellowship for a leading prostate cancer researcher in Victoria will also be established through the Victorian Cancer Agency with the funding.

FOCUS MEN LOOKING AFTER THEIR HEALTH AT ANY AGE

Men’s health – the man with breast cancer By Rebekkah Middleton, Lorna Moxham and Dominique Parrish Too often we forget that men can be diagnosed with breast cancer. And too often men forget they can be subject to it, hence postponing seeking medical care and potentially presenting with advanced cancer. Although it is rare, with 0.1% of all male cancer deaths in Australia being attributed to breast cancer (AIHW, 2015), it is as significant for men as it is for women who are diagnosed with this cancer. It is not clear the cause, but possible risk factors are associated with age (getting older), family history of male or female breast cancer or ovarian cancer, hormonal reasons (eg. high oestrogen), medical history (eg. orchitis, undescended testis), or environmental causes (Cancer Australia, 2015; Ruddy & Winer, 2013). Treatment for the man with breast cancer is similar to women with breast cancer. Surgery is often required (modified radical mastectomy) along with node dissection and staging so that ongoing treatment is informed by the disease progress and stage. Commonly, chemotherapy, radiation and hormonal therapy are given in association with surgery (Cancer Australia, 2015; Ruddy & Winer, 2013). To provide effective nursing care for the man with breast cancer, a person-centred approach is required where each individual is supported and included in their own care. The psychosocial aspects associated with the man with breast cancer need to be considered and addressed compassionately and transparently. Engaging both the man and his family in the process is essential so that treatment and ongoing therapeutic care is optimised.

References Australian Government. Cancer Australia. 2015. http:// breastcancerinmen. canceraustralia.gov.au/ welcome-breast-cancermen-website Accessed 27/8/15 Australia. Australian Institute of Health and Welfare (AIHW). 2015. Australian cancer incidence and mortality (ACIM) book. Breast Cancer. Sydney. www. aihw.gov.au/acim-books/ Accessed 27/8/15 Ruddy, K.J and Winer, E.P. 2013. Male breast cancer: risk factors, biology, diagnosis, treatment, and survivorship. Annals of Oncology. 24 (Supp.3):1-

Rebekkah Middleton is a PhD Candidate and Lecturer, Lorna Moxham PhD is a Professor of Mental Health Nursing and Dr Dominique Parrish is Director of Learning, Teaching and the Student Experience. All are at the University of Wollongong in NSW

November 2015 Volume 23, No. 5 37

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Men’s Health

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Getting men to talk about suicide By Lorna Moxham and Christopher Patterson It may be hard to get men talking about their mental health, but that is just what we need to do.

Lorna Moxham

Christopher Patterson

How can nurses actively help? Let men know you’re there to listen. Listen with empathy and hope. Help them gather information about and link with the many treatment and support options. Encourage them to seek the support of family, friends and community. Encourage them to get enough sleep, exercise and eat well. Open discussion about how turning to alcohol or other drugs can actually make them feel worse. And most importantly – if you think a man is suicidal, ask him.

What we know is that compared to women, men consistently demonstrate a greater reluctance to seek help about their mental health (Cramer et al. 2014). Men’s innate sense of masculinity, the idea that society expects them to be tough, self-reliant and able to take charge of situations, can be factors that inhibit them talking about how they feel (Lindinger-Sternart, 2015). Male suicide is a prominent public health concern. In 2013, 75% of Australians who died by suicide were men; with 1,885 (16.4 per 100) dying by this means (ABS, 2015). Depression can lead to suicide; and frontline care providers, such as nurses, are in a prime position to be alerted to the signs of depression in men. Nurses will encounter men who have many of the known risk factors for depression and suicide. Risk factors include, men living with chronic physical health problems, those who self-harm, misuse drugs and alcohol, and/or live with mental health problems. Nurses who are vigilant will also notice indicators such as frequent consultations, often purportedly to speak about physical health issues.

Lorna Moxham is Professor of Mental Health Nursing and Christopher Patterson is Lecturer in Mental Health Nursing. Both are at the University of Wollongong in NSW

PHYSICAL SIGNS OF DEPRESSION

EMOTIONAL SIGNS OF DEPRESSION

Persistent pain Loss of energy Loss of sex drive Changes in appetite Lethargy or exhaustion Change in sleep patterns & restlessness Alcohol and/or drug abuse

Thinking about death or suicide Feeling guilty Feeling angry or violent Losing interest in hobbies Feeling indifferent or lacking interest Feeling sad or nervous Feeling alone Taking unnecessary risks

anmf.org.au

ENCOURAGE THEM TO SEEK THE SUPPORT OF FAMILY, FRIENDS AND COMMUNITY. ENCOURAGE THEM TO GET ENOUGH SLEEP, EXERCISE AND EAT WELL. References ABS (2015). Cat No. 3303.0 Causes of Death, Australia 2013. Cramer, H., Horwood, J., Payne, S., Araya, R. & Salisbury, C. 2014, ‘Do depressed and anxious men do groups? What works and what are the barriers to help seeking?’ Primary Healthcare Research & Development, vol. 15, pp. 287-301. Lindinger-Sternart, S. 2015, ‘Help-Seeking Behaviours of Mental for Mental Health and the Impact of Diverse Cultural Backgrounds’, International Journal of Social Science Studies, vol. 3, pp. 1-6

Movember has a new MOVE For the purpose of raising awareness and funds for men’s health Movember has traditionally been about growing moustaches in November. However this year the Movember Foundation has introduced a new way to support the cause - MOVE, a 30 day fitness challenge. While the moustache will always remain king, MOVE is a way ‘Mo Sistas’ can help change the face of men’s health by inspiring the men in their lives to get active and take control of their physical and mental wellbeing. Movember Foundation’s Executive Director Paul Villanti said MOVE not only offers an opportunity for ‘Mo Sistas’ to do something for their own health, but also have a positive impact on the health of the men in their lives by encouraging them to get active too. “Moving on a regular basis can lower your risk of heart disease, diabetes and cancer up to 50% and is one of the best ways to stay mentally healthy, as well as the best treatment for mild to moderate depression.” Mr Villanti said too many men do not take action and die too young. “With men growing moustaches for Movember, we’re generating conversations that we hope will lead to blokes talking about the big stuff in their lives and taking action when they notice something is different in their health.” The need for better lifestyle choices was recently highlighted after an AIHW report, Premature Mortality in Australia 1997–2012, showed that of all deaths in Australia in 2012, almost 50,000 (34%) were considered premature, and half of cases could have been prevented. The report detailed the leading cause of premature death in 2010–12 as coronary heart disease, accounting for 10% of all deaths in people aged under 75. Coronary heart disease was also the leading cause of death in Australia overall, accounting for 14% of deaths across all ages in 2010–2012, with one in four (25%) of these deaths being premature. “Many of the leading causes of premature death in Australia, including heart disease, can be impacted by implementing simple lifestyle changes at home such as quitting smoking, increasing physical activity, reducing alcohol intake, and maintaining a healthy weight,” said National Heart Foundation CEO Mary Barry. Movember has raised funds and awareness for the past 11 years, helping fund over 1,000 men’s health projects in 21 countries. For more information go to https://au.movember.com November 2015 Volume 23, No. 5 39

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Men’s Health

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Perinatal mental health and men By Donovan Jones, Michael Hazelton and Lyn Ebert

References

The emotional wellbeing of men with pregnant partners is central to supporting both the woman and the child (Bergstrom, 2013; Wynter, Rowe, & Fisher, 2013). There is substantive evidence to support that high levels of stress are as prevalent for men as women in the perinatal period, with men being as likely to suffer stressors associated with pregnancy as their pregnant partners (Wynter et al. 2013). Depressive or anxious episodes experienced by men as a result of stressors in pregnancy increase the possibility of anger being expressed physically (Bergstrom, 2013). Negative results of anger experienced during pregnancy can then lead or contribute to a decrease in physical and emotional wellbeing of the woman that has a cascade effect on the child, family and community. The use of mindfulness interventions for men with pregnant partners provides the possibility to change emotions and behaviours that unchallenged might otherwise have the potential to manifest anmf.org.au

ESCALATION OF UNMANAGED ANGER DURING THE PERINATAL PERIOD CAN ALSO POTENTIALLY LEAD TO DOMESTIC VIOLENCE

into stress, anger and violence. An improved ability to cope with stressors is postulated to improve wellbeing and decrease the chance of stress and anger becoming uncontrollable. Escalation of unmanaged anger during the perinatal period can also potentially lead to domestic violence; mindfulness interventions postulate a potential pathway for primary intervention in reducing intimate partner violence toward women during the perinatal period. Current literature on mindfulness interventions establishes positive outcomes across a variety of clinical and non-clinical populations. Reduction

in the emotions of anger, anxiety and depression has been reported in literature on mindfulness interventions (Bergen, Possemato, & Pigeon, 2014; Kearney et al. 2011; Mastrianno, 2012). However, there is currently a gap in the literature regarding whether mindfulness interventions can be used to support the emotional regulation and wellbeing of men with pregnant partners. Accordingly a pilot research project is currently underway at the University of Newcastle in conjunction with Smiling Minds to trial the benefits of mindfulness for men with pregnant partners in an online environment. For further information on this pilot project please contact any of the authors. Donovan Jones is a PhD Candidate, Lecturer, Deputy Program Convenor Bachelor of Midwifery, Professor Michael Hazelton is Professor of Mental Health and Dr Lyn Ebert is a Senior Lecturer, Program Convener Midwifery Studies. All are in the School of Nursing and Midwifery at The University of Newcastle in NSW

Bergen, C., Possemato, K., & Pigeon, W. 2014. Reductions in Cortisol Associated With Primary Care Brief Mindfulness Program for Veterans With PTSD. Medical Care, 52 (5), 25-31. doi:10.1097/ MLR.0000000000000 224 Bergstrom, M. 2013. Depressive symptoms in new first-time fathers: associations with age, sociodemographic characteristics, and antenatal psychological well-being. Birth-Issues in Perinatal Care, 40 (1), 32-38. doi:10.1111/ birt.12026 Kearney, D., McDermott, K., Malte, C., Martinez, M., & Simpson, T. 2011. Association of participation in a mindfulness program with measures of PTSD, depression and quality of life in a veteran sample. Journal of Clinical Psychology, 68 (1), 101-116. doi:10.1002/jclp.20853 Mastrianno, H. 2012. The impact of Zen meditation on security and satisfaction in monogamous relationships. Mental Health, Religion & Culture, 15 (5), 495-510. doi:10.1080/13674676.2 011.587402 Wynter, K., Rowe, H., & Fisher, J. 2013. Common mental disorders in women and men in the first six months after the birth of their first infant: a community study in Victoria, Australia. Journal of Affective Disorders, 151 (3), 980-985. doi:10.1016/j. jad.2013.08.021

November 2015 Volume 23, No. 5 41

FOCUS

Menâ&#x20AC;&#x2122;s Health

An attitude of adventure By Allan Rudner Inherent in men of all ages is the imperative to provide, perform and protect. How this is demonstrated is through the driving urge to compete in sport, accumulation of wealth, building and showcasing a family and friends. The prevailing attitude is usually one of being in control and operating from a headspace of the warrior - an attitude of predictability. This is all very well in early adulthood in a competitive and challenging world. However, the risk is that our hearts harden, we neglect our inner world while focussing on pushing the strength and endurance of our bodies. We abuse our bodies with alcohol and drugs, little rest and needing to achieve more. Evidence of a poor attitude to a manâ&#x20AC;&#x2122;s health and wellbeing is apparent from the high suicide rate of males, the extent of coronary disease, and earlier deaths than women.

So what needs to change? Attitude! This includes an internal shift from expectation to non-attachment. A shift from being goal oriented to intention focussed. A shift from living in the past or the future to being in the present. A shift from doing to being. Using our breath to keep letting go, to soften our hearts, to take on new values of compassion, gratitude, acceptance, and kindness.

These values need to first be directed to self and then to others. In essence, having an attitude of adventure means loosening up the normal constraints of male drivenness and taking pleasure in finding the simplicity of every day. This becomes increasingly important as we age beyond our 50th birthday. The impact is better health from within to without. Attitude is the first step in self-care.

Allan Rudner is a Lecturer, Clinical Supervisor, Clinic Director in the School of Health Professions at Murdoch University

Men’s Health

FOCUS

Men’s health in Australia By Ambreen Zubair The health of Australian males has been neglected for decades, given the research data indicates the shorter life expectancy of Australian males dying at 78.7 years compared to 83.7 years for Australian females (DH&A, 2010).

Evidently, less attention has been paid to the health needs of Australian males which has contributed to the unequal health outcomes between males and females. The major contributor to the higher male morbidity and mortality is that the healthcare system has been less responsive and unfriendly to men compared to women (Karoski, 2011). Rigid masculinity, inadequate health literacy, social isolation and negative health seeking behaviours contributed further to male’s poor health (McDonald, 2011). The higher male mortality rate has brought the health inequalities into the national spotlight and the first Australian Male’s Health Policy has been finalised in 2010. For the first time, Australian males were being nationally acknowledged as having poorer health outcomes, lower life expectancy and enormous burden of diseases, injuries and higher health risk factors compared to women (DH&A, 2010). Despite the high mortality rate of males compared to women, the National Male’s Health Policy was ignored until it was introduced by the Rudd government in 2010 (DH&A, 2010). Interestingly, the National Health Policy for Women came into existence in 1989 and their health has been tracked by the Australian Longitudinal Study on Women since 1996 (McDonald, 2011). While developing women’s health policies, a significant pressure was enforced by women on health systems to address their needs through attitudinal and structural changes. Whereas, considering men’s health policies anmf.org.au

and services, the insistence has mainly been on males to alter their attitudes towards health. In general practice, the majority of health activities are often presented in settings such as family planning and baby health clinics where the health promotion is geared toward women.

MANY HEALTHCARE PROFESSIONALS, INCLUDING MEN ARE NOT TRAINED TO FACILITATE COMMUNICATION WITH MALE PATIENTS ABOUT SENSITIVE HEALTH ISSUES Many healthcare professionals, including men are not trained to facilitate communication with male patients about sensitive health issues. Moreover, the longer waiting time and restricted surgery hours also result in underutilisation of men’s health services (McDonald, 2011). To overcome these issues, the healthcare system needs to be proactive, male friendly and initiate programs to assist males in a more proficient manner. Masculine behaviours and traits have been closely associated with men’s health and are determined by their risk-taking practices, lifestyle and negligence of their own health needs. Adherence to the rigid masculinity often results in men keeping “stubborn attitude” toward illness which leads

to underutilisation of healthcare services, delayed implementation of medical intervention and escalation of primary symptoms into advanced stages of disease. It is however promising that the policy has recognised the lifestyle and work related risk factors related to men’s health and has adopted preventive activities to minimise the occurrence of diseases which may lead to death or disability. Various studies highlight that in comparison to women, men exhibit low health literacy and are less capable of accessing, interpreting and applying information to improve and maintain health (DH&A, 2010). Improving men’s health literacy is crucial for their wellbeing. Australian males, particularly older rural males are identified to benefit from informal and hands on learning which was undertaken outdoors and in groups. The men’s shed program is a successful, popular and male friendly approach which provides a supportive environment at community places to alleviate social isolation, promote men’s health and provide significant benefits not only to the males but to the whole society (Karoski, 2011). Based on this discussion, it is evident Australian males have experienced significant health problems and timely measures should be taken to address their needs and ensure wellbeing. The prevalence and responsiveness to health issues differ with gender and therefore it is essential to implement interventions which effectively address both male and female population to minimise unequal health outcomes.

References Department of Health and Ageing (DH&A). 2010. The National Male Health Policy. www.health.gov.au/ malehealthpolicy Karoski, S. 2011. Has the health system failed men? The perceptions of the men’s movement on men’s health in Australia. International Journal of Men’s Health, 10 (1), 45-64. McDonald, J. 2011. Building on the strengths of Australian males. International Journal of Men’s Health, 10 (1), 82-96.

Ambreen Zubair is a Bachelor of Nursing student at Victoria University in Victoria

November 2015 Volume 23, No. 5 43

FOCUS

Men’s Health

Get paid while you study and work

POSTGRADUATE DIPLOMA IN NURSING (MENTAL HEALTH) IN CANBERRA Full scholarships First Semester 2016 February Intake Annual Salary RN 1 $60,772-$81,180 Closing date 20th November 2015 A nursing scholarship to study at the University of Canberra is offered by the Division of Mental Health, Justice Health, Alcohol & Drug Services (MHJHADS) and is an excellent opportunity for Registered Nurses to build their knowledge and skills base in caring for people experiencing a range of mental health conditions. Successful applicants are employed via temporary contract, studying either parttime or full-time. During the program, RNs rotate through the diverse services, both inpatient and community based, provided by MHJHADS. Eligibility /other requirements: • Registered with the Nursing and Midwifery Board of Australia. • Hold a current driver’s licence. • Have Australian citizenship or permanent residency. For full details of how to apply contact Jo McDougal, Clinical Support Officer on (02) 6205 3661

44 November 2015 Volume 23, No. 5

Men’s health – it should be a feminist issue By Sara Geale When we think about women’s health a number of issues come to mind – menopause, child and maternal health, ovarian cancer, breast cancer, dysmenorrhea, postnatal depression. When we think about men’s health we get stuck after prostate cancer and TURPS. In fact when we go to the Australian Bureau of Statistics there is a statistical group devoted to women’s health but there is no such heading for men’s health. That, in itself, is significant in terms of how society views men and health and perhaps how men view the importance of their own health in society. The reality is that we need to take a close look at the health of the male in Australian Society. According to the Australian Health Survey: First Results, 2011-12 men do marginally better for arthritis, kidney disease, and asthma but in most other reported conditions men’s health are significantly worse than that of their female counterparts. Men also score lower than women for mental and behavioural conditions and psychological distress but it begs the question about how comfortable men are in reporting lack of mental wellness. The facts do, however, speak for themself regarding physical wellness: • In 2011-12, more Australian men were overweig ht or obese than women (70.3% compared with 56.2%). • Australian men were more likely to smoke daily than women in 2011-12 (18.2% compared with 14.4%). • Australian men were almost three times more likely to exceed the safe guidelines of no more than two standard drinks per day for alcohol consumption than women (29.1% compared with 10.1%, respectively). • Australian men were less likely to meet the guidelines for recommended intake of fruit and vegetables daily (4.5% and 6.6% respectively). • Cancer was more common amongst Australian men (1.8%) than women (1.2%). • More Australian men reported having diabetes than women (4.3% of all men compared with 3.6% of all women) • Heart disease, which includes heart, stroke and vascular disease, is more common amongst Australian men (5.1%) than women (4.3%). References

MEN ALSO SCORE LOWER THAN WOMEN FOR MENTAL AND BEHAVIOURAL CONDITIONS AND PSYCHOLOGICAL DISTRESS BUT IT BEGS THE QUESTION ABOUT HOW COMFORTABLE MEN ARE IN REPORTING LACK OF MENTAL WELLNESS.

As healthcare providers we should take careful note of these figures and consider how we can help to improve men’s health in our society. Research shows that gender plays a role in health issues. Men score higher in many risk factors than do their female counterparts and men die earlier. Yet, in Australia, men still seem to go under the radar as a major health group. As healthcare providers we should take careful note of these figures and consider how we can help to improve men’s health in our own practice and encourage engagement with men’s health issues in society. As women we need to recognise that men’s health or men’s poor health can have a negative effect on family and home life and on our greater society. Perhaps it is time we made men’s health a feminist issue.

Australian Bureau of Statistics. 2012. Australian Health Survey: First Results, 2011-12 Retrieved from www.abs.gov. au/ausstats/abs@.nsf/ Lookup/034947E844F2 5207CA257AA30014BD C7?opendocument Australian Bureau of Statistics, 2015. Authoritative information and statistics to promote better health and wellbeing Retrieved from www.aihw.gov.au/ deaths/life-expectancy/

Dr Sara Geale is a Lecturer in the School of Nursing and Midwifery at Edith Cowan University in Western Australia anmf.org.au

Men’s Health

FOCUS

Chlamydia in men – are you thinking about it? By Nikitah Habraken and Emily Wheeler Chlamydia is the most commonly reported communicable disease in Australia (The Kirby Institute, 2014), frequently affecting sexually active young men and men who have sex with men (MSM.) Chlamydia is a sexually transmitted bacterial infection caused by the bacteria Chlamydia trachomatis. It is a sexually transmitted infection that is spread through unprotected vaginal, anal or oral sex with an infected partner, although transmission by oral sex is rare (ASHM, 2010). Chlamydia is frequently asymptomatic and only around 50% of men will have symptoms (ASHA, 2015). Symptoms among men can include: • Dysuria (burning or discomfort when urinating) • Urethral discharge • Testicular pain • Anal discharge and/or pain. A urine sample is required to test for chlamydia in men, in addition to a rectal swab if the patient is MSM. Chlamydia is easily treated with a single dose of antibiotics. Chlamydia can lead to infertility in both men and women if left untreated. Untreated anmf.org.au

chlamydia can also increase the risk of contracting other infections such as HIV. While notifications of chlamydia in Australia are higher among young women compared to young men (The Kirby Institute, 2014), this may be influenced by differential testing rates. For example, research suggests around 86% of young women (16-29 years) in Australia visit a GP at least once per year, whereas in comparison, only 64% of young men visit a GP over the same period (Kong et al. 2011). Also, chlamydia testing may be more easily introduced into discussions with female patients (Wallace et al. 2012).This provides more opportunities for women to be tested for chlamydia. It can be more challenging to initiate a discussion about chlamydia testing during consults with male patients, especially if their presenting problem is not related to their sexual health. Normalising chlamydia testing is an easy way

to raise it eg. “We are offering chlamydia testing to all sexually active people under the age of 30. Would you like to have a test while you’re here today?” For more tips on how to take a quick sexual history, see the Australian STI Management Guidelines for Use in Primary Care www.sti.guidelines.org.au Testing male patients for chlamydia is central to reducing transmission rates. Chlamydia is simple to test and treat, and nurses should look for opportunities to introduce chlamydia testing during consults with male patients, particularly sexually active young men (15-29 years old) and MSM.

Nikitah Habraken is a Nursing Project Officer and Emily Wheeler is a Manager. Both are located in the Nursing Program, National Policy and Education Division at ASHM

References ASHA. 2015. Australian STI Management Guidelines for Use in Primary Care. www. sti.guidelines.org.au/ sexually-transmissibleinfections/chlamydia accessed 3 September 2015. ASHM. 2010. Australasian Contact Tracing Manual. 4th ed. Sydney: ASHM. Kong, F., Guy, R., Hocking, J., Merritt, T., Pirotta, M., Heal, C., Bergeri, I., Donovan, B. and Hellard, M. E. 2011. Australian general practitioner chlamydia testing rates among young people. Medical Journal of Australia. 194(5):249-252. The Kirby Institute. 2014. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2014. Sydney: UNSW. Wallace L., McNulty C., Hogan A., Bayley J. 2012. Exploring attitudes and practices of general practice staff towards offers of opportunistic screening for chlamydia: a UK survey. Primary Healthcare Research and Development. 13(3):255–268.

November 2015 Volume 23, No. 5 45

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The John and Ina Davey Trust Fund Scholarship 2016 for Victorian District Nurses Applications are invited from District Nurses working in Victoria who are planning to undertake a Post Graduate or Post Basic Course related to district nursing clinical practice.

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There are two awards in the John & Ina Davey Scholarship this year. One is valued at $5,000 and the other at $3,000. The latter award may be divided into smaller awards of equal value, if considered appropriate by the selection panel.

The closing date for applications is: 8 January 2016 Application forms may be obtained from:

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Alison Killin RDNS 31 Alma Road, St Kilda VIC 3182

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@AustralianNursingandMidwiferyFederation

The ANMF offers four online Professional Development training rooms, providing best practice information on a wide range of topics applicable to all areas of nursing practice. Each of the training rooms also assist you in maintaining compliant CPD records. If you are an ANMF, NSWNMA or QNU member you can access the online training at reduced members rates. There are even some FREE topics available. Non members can also access the online training.

OnlineCPD

Visit our website and get started today! NE

Online Clinical Simulations for Nurses and Midwives The Online Clinical Simulations for Nurses and Midwives training room oﬀers 3D simulated learning for clinical procedures and currently consists of 32 modules. Our members can access the modules for only $10 each. Every module teaches a diﬀerent procedure through an interactive simulation, accompanied by step-by-step text with hyperlinks, a video demonstration, a 3D model of the anatomy encountered during the procedure and a quiz.

The Continuing Professional Education (CPE) online training room currently provides over 50 self-directed learning tutorials including those topics deemed mandatory annual competencies by large health organisations and nursing agencies. Each tutorial is paired with a random 10 question assessment that proves competency in the topic. Our members have free access to a professional development portfolio and 11 free topics. All remaining topics are just $7.70 each for members.

The Body Systems Training Room (BSTR) offers the most comprehensive collection of health education. The BSTR currently offers 49 courses and we add more courses all the time. Courses can be purchased individually, as part of tailored packs, or as a complete library. Courses are available for 12 months from the date of purchase and all courses offer a minimum of 1 hour of CPD. All individual courses on the BSTR are only $19.99 for ANMF, NSWNMA and QNU members, non-members pay $24.99 per course. Please note all BSTR prices are exclusive of GST.

Aged Care Training Room The Aged Care Training Room (ACTR) is a one-stop-shop for aged care and community care nurses. Here you will ﬁnd over 60 modules written against the aged care accreditation standards and community care common standards. An annual subscription for this training is $110 for our members and includes access to a learning plan, reﬂection and evaluation tools and a printable log of course completions.

ANMF Federal Ofﬁce T | 02 6232 6533 E | education@anmf.org.au

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NOVEMBER Australian Association of Gerontology 48th National Conference 4-6 November, Alice Springs Convention Centre. www.aag.asn.au/ national-conference/2015-conference Annual Scientific Alcohol and Drug Conference 8-11 November, Perth, WA. www.apsadconference.com.au Lung Health Promotion Centre at The Alfred 11–13 November - Asthma Educator’s Course 19-20 November - Smoking Cessation Facilitator’s Course P: (03) 9076 2382 E: lunghealth@alfred.org.au Australian & New Zealand Orthopaedic Nurses Association (ANZONA) Conference Climbing to the summit: Bridging research and practice in orthopaedic nursing 11–13 November, Hilton Hotel, Sydney. www.anzonaconference.net/ Hospital In The Home Society, 8th Scientific Meeting HITH at 21: Maturity, Responsibility and Quality 11–13 November, Rydges World Square, Sydney. http://conference.hithsociety.org.au/ Australian and New Zealand Society for Vascular Nursing Conference Working Together for an Integrated Vascular Approach 13-14 November, Adelaide Convention Centre, SA. www.anzsvn.org/ Melbourne Practice Nurse Clinical Education Australia’s leading event for nurses working in General Practice. Earn 18 CPD hours. 13 –15 November. www.pnce.com.au

2nd Annual Mental Health Conference Intergrating the NDIS, policy and clinical practice to support individualised care 25-26 November, SMC Conference & Function Centre, Sydney. www. informa.com.au/conferences/healthcare-conference/ Aged Care – Getting Ready for Increased Consumer Control 25-26 November, Sydney NSW. www.criterionconferences.com/ event/ccc/ 24th National Conference on Incontinence 25-28 November, Crown Conference Centre. www.continence.org.au/ Nursing & Midwifery Leadership Conference Nursing and midwives: Leading change, celebrating success 26-27 November, Pan Pacific Hotel, Perth WA. http://nmlc2015. iceaustralia.com/ International Diabetes Federation, World Diabetes Congress 30 November-4 December, Vancouver, Canada. www.idf.org/ worlddiabetescongress

DECEMBER World AIDS Day 1 December. http:// worldaidsdayworldwide.org/ International Day of People with Disability 3 December. www.idpwd.com.au/ Australian and New Zealand Mental Health Association “Stop Domestic Violence” Conference 7-9 December, Canberra, ACT. www.stopdomesticviolence.com.au Human Rights Day 10 December. www.un.org

2016 FEBRUARY

A Day in the Garden at Tieve Tara, Mt Macedon Victoria 22 November, 10am-4pm. The day will feature ABC’s Gardening Guru Michael McCoy along with a host of children’s activities, delicious local food and drink, High Tea in the exclusive private marquee, produce stalls, live entertainment, garden tours and more. www. womenscancerfoundation.org.au/

Ovarian Cancer Awareness Month February 2016. www.womenscancerfoundation.org.au/

Australasian College for Infection Prevention and Control Conference 22-25 November, Hotel Grand Chancellor, Hobart Tasmania. www.acipcconference.com.au/

Anniversary of the Apology (2008) 13 February 2016

anmf.org.au

World Cancer Day We Can. I Can. 4 February 2016. www.worldcancerday.org/ Chinese New Year 8 February 2016

Lung Health Promotion Centre at The Alfred 12-13 February 2016 - Spirometry Principles & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au National Disability Services Conference 18-19 February 2016, Hilton Hotel, Sydney. www.nds.org.au/events/1413497081 4th National Elder Abuse Conference Ageism, rights and innovation 23-25 February 2016, Pullman Melbourne on the Park. http:// elderabuseconference.org.au/ Women’s Cancer Foundation – Ovarian Cancer Institute We Can Walk it Out 28 February 2016, In aid of ovarian cancer research and awareness. this is a day for the entire family - even the pet pooch! As well as the 4km walk, and the 4km and 8km runs, there will be family entertainment, a free BBQ, fruit and water for all to enjoy. www. womenscancerfoundation.org.au/

MARCH Australian Cardiovascular Nursing College Conference Celebrating 10 years 4-5 March 2016, Melbourne Convention & Exhibition Centre, Southbank, Melbourne. www.acnc.net.au/ Lung Health Promotion Centre at The Alfred 4-6 March 2016 - Asthma Educator’s Course 19-20 March 2016 - Smoking Cessation Course P: (03) 9076 2382 E: lunghealth@alfred.org.au 3rd Commonwealth Nurses and Midwives Conference Toward 2020: Celebrating nursing and midwifery leadership 12-13 March 2016, London UK. www.commonwealthnurses.org/ conference2016/ National Close the Gap Day 17 March 2016

APRIL Lung Health Promotion Centre at The Alfred 16–17 April 2016 - Managing COPD 20-21 April 2016 - Spirometry Principles & Practice 29 April–1 May/27–28 May 2016 - Respiratory Course (Mod A &B) 29 April–1 May 2016 - Respiratory Course (Module A) P: (03) 9076 2382 E: lunghealth@alfred.org.au

NETWORK Royal Adelaide Hospital, Class of 756, 40-year reunion Contact Karen Braithwaite or Frances Woodcock on M: 0422 812 187 or E: woodcock7@gmail.com Box Hill Hospital, Group 99, 30-year reunion Contact Clare D’Arcy-Evans E: clarebears21@icloud.com or M: 0416 399 881 Box Hill and Eastern Health, Group 101, 30-year reunion 30 January 2016, The Upton Room, Box Hill RSL. Gourmet food and entertainment: $28 per head. Contact Ken Gaffney M: 0409 901 889 Royal Melbourne Hospital, Group 186, 30-year reunion 6 February 2016, venue TBC. Contact: Deb E: clare. debra@gmail.com or AnneMarie E: acairns29@yahoo. com.au or search Facebook page Royal Melbourne Hospital Group 186 LaTrobe University, LaTrobe/Bendigo Campus nursing group (19881991), 25-year reunion 20 February 2016, Bendigo. Contact Steven Graham E: sgraham@bendigohealth. org.au or Sarah Shipp (nee Prudham) E: sshipp@ bendigohealth.org.au or search Facebook page LaTrobe 1991 reunion St Vincent’s Hospital, February 1976, 40-year reunion. 19 March 2016. Contact Mary Hibble (nee Ross) E: maryhibble@ yahoo.com.au or Ra Cunningham (nee Savaris) E: vtcunningham@hotmail. com or Seach Facebook page: St Vincents Hospital Nurses Class of 1976 St Vincent’s Hospital, Melbourne, August 1986, 30-year reunion 5 August 2016, Melbourne, Venue TBA. Contact Celia Kenny (nee Murphy) E: paulandcelia@Hotmail.com or search Facebook page AUGUST 86 30YR REUNION 2016

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

November 2015 Volume 23, No. 5 47

ANNIE

Annie Butler, Assistant Federal Secretary

83% 83% OF PEOPLE IN PERMANENT CARE NEEDING HIGH-LEVEL CARE

52% 52% OF ALL PEOPLE IN PERMANENT CARE DIAGNOSED WITH DEMENTIA

A couple of months ago I flew to Canberra to meet with Senators and other Federal MPs, who would agree to meet with us, to discuss aged care. In particular to talk about staffing in aged care or rather, the lack of it. On the plane I sat next to a very tall man who was having an uncomfortable time trying to contain his long limbs while reading his paper in the small space provided by 10E. Boundaries were crossed; but rather than continue the struggle to gain more territory, the man put down his paper and asked me why I was going to Canberra. And, we started to chat.

how many other families might be sharing his pain. In preparation for our meetings with politicians I had researched recent incidents and adverse outcomes in aged care across the country, which had made for very uncomfortable reading. The circumstances in which these incidents occurred and the number of occasions that inadequate staffing was noted as a primary cause were, quite frankly, horrifying. Unfortunately, this is not news to ANMF members. We know aged care needs increasing, our members tell us that residents are older, frailer and with more complex health issues, requiring sophisticated

When the man found out where I worked and why I was going to Canberra, his story just poured out. He was working extra hours and taking on additional projects, hence the trip to Canberra, because he and his wife were trying to fund care for his elderly mother. She was living with them, he explained, but she needed professional care, so they were working hard to pay for 24 hour individual nursing care. This was clearly a strain for them and something that he and his wife had not expected they would have to do, but they were determined to keep her out of a nursing home. The man was not going to let his mother experience the same fate as his father. The man’s grief then became obvious; his father had just died in a nursing home… from dehydration. As we continued to talk I saw how crushed this poor man was by the unnecessarily premature death of his father, and I thought of

management than ever before. Yet, the stories we hear from nurses and assistants in nursing working in aged care about poor staffing, inadequate resources and lack of respect for residents and staff continue to grow. The Residential aged care and home care 2013-14 report, released by the Australian Institute of Health and Welfare on 4 September 2015, supports our members’ stories. The report confirms that the needs of aged care residents are increasing with 83% of people in permanent care needing high-level care, compared to 76% in 2008, and with 52% of all people in permanent care diagnosed with dementia. We know that these increasing needs demand a suitably skilled and qualified workforce. And we know from members’ stories that workforce issues continue to compromise the amount of quality care that can be provided to the elderly, whether they’re in nursing

homes or their own homes. The level of distress our members describe because they feel they can’t provide the care they know is needed by their residents also continues to grow. As does, it seems, their level of cynicism and even anger towards politicians, governments and employers. They have told us that all too often profits come before care for aged care residents and they, the nurses and carers, despite their best efforts are forced to watch the elderly suffer. Surely it’s time to change this situation - we think so. The ANMF is calling on yet another new Prime Minister to take action and develop a genuine and sustainable aged care workforce strategy that will actually meet the needs of our ageing population. We were encouraged to see that Prime Minister Turnbull’s new Ministry includes a Minister for Aged Care with the portfolio now added to Minister Ley’s responsibilities for Health and Sport, and an Assistant Health Minister with a focus on aged care. However, it remains to be seen whether the Turnbull Government is serious about respectful treatment of the elderly. We were not encouraged by Minister Ley’s statement to the media, less than a week after her appointment to the portfolio, that current fiscal constraints are not adversely affecting aged care as “limited dollars” can provide “the best possible system” for aged care. We beg to differ. Our members’ view is that aged care is chronically underfunded. If the government is serious, it needs to recognise that we need better care for our elderly right now and to do this we need to provide proper staffing, this means more investment in the sector. Aged care is specialised care, it deserves safe and skilled staffing. But to make the government serious, we need to be serious. I think it’s time to up the ante and take the campaign for safe staffing in aged care to another level. Because if I ever meet the long legged man from 10E on a plane again I’d like to think that debating whose paper is taking up whose space will be our only topic of conversation.

Join the ANMF’s project for safe staffing in aged care by registering your interest here: www.surveygizmo.com/s3/2317158/Register-your-interest

48 November 2015 Volume 23, No. 5

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Caring for the people who care

More people in health and community services choose HESTA for their super Supports your industry | Low fees

| A history of strong returns

â&#x20AC;&#x2DC;MySuper of the Yearâ&#x20AC;&#x2122;

H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. Product ratings are only one factor to be considered when making a decision. See hesta.com.au/ratings for more information. Investments may go up or down. Past performance is not a reliable indicator of future performance. For more information, call 1800 813 327 or visit hesta.com.au for a copy of a Product Disclosure Statement which should be considered when making a decision about HESTA products.