V O LU M E 2 4 , N O. 4 / O C T O B E R 2 0 1 6
CHRONIC DISEASE CRISIS WHY PREVENTION IS BETTER THAN CURE www.anmf.org.au
Anti-Poverty Week 16-22 October 2016
Poverty and severe hardship affect more than a million Australians. Around the world more than a billion people are desperately poor. In Anti-Poverty Week help fight poverty and hardship. • Why not organise a display, stall or award? • Maybe a workshop, lecture or forum? • How about a fundraiser, fact sheet or petition? For more information and ideas: • visit www.antipovertyweek.org.au • email apw@antipovertyweek.org.au • call 1300 797 290
CONTENTS Directory 02
18
Editorial 03 News 04 Industrial 16 World 17 Feature – Chronic disease crisis 18 Books 24 Ethics 25
CHRONIC DISEASE CRISIS
Clinical update
26
Research 29 Viewpoint 31 Focus – Education Part 2 32 Calendar 45
WHY PREVENTION IS BETTER THAN CURE
Mail 46 Maree 48
04 26 32
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October 2016 Volume 24, No. 4 1
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Editorial
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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.
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Western Australia
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EDITORIAL
Editorial Lee Thomas, ANMF Federal Secretary I could not have been any prouder than when recently the latest Australian Nursing and Midwifery Federation membership figures crossed my desk. As of June ANMF’s membership stood at 258,989, which is a growth of 4.2% over the past 12 months. This cements the ANMF as Australia’s largest union which is no small feat considering other unions’ memberships are on the decline. The ANMF’s growth is attributed to a number of factors, including the union’s ability to stand up for nurses, midwives, assistants in nursing (AINs), and their families when they need it the most whether it’s about wages and conditions or the ongoing attacks on health and aged care. To this end the union has run a number of campaigns, which have fought hard to protect Medicare, reverse the billions the government has axed from health and aged care funding, defend our members’ penalty rates and campaign for better and safer workloads and nurse ratios. The backbone of these campaigns has been the membership. Your ongoing support and vote of confidence in the union drives the success in all that the ANMF does. We still have a way to go but together, united and determined, we will influence positive change in our healthcare and aged care systems, now and into the future. In addition to standing up for improved conditions and quality care, nurses and midwives are also contending with a changing health landscape. Much of this is a result of chronic health issues that have escalated throughout Australia and across the globe in recent years, the outcome of which is severely and universally crippling our healthcare systems and hindering the ability of nurses to maintain care delivery.
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THE ANMF’S GROWTH IS ATTRIBUTED TO A NUMBER OF FACTORS, INCLUDING THE UNION’S ABILITY TO STAND UP FOR NURSES, MIDWIVES, ASSISTANTS IN NURSING (AINS), AND THEIR FAMILIES WHEN THEY NEED IT THE MOST WHETHER IT’S ABOUT WAGES AND CONDITIONS OR THE ONGOING ATTACKS ON HEALTH AND AGED CARE.
This month’s ANMJ feature talks about the need for greater investment in prevention and early intervention in chronic health issues in order to significantly reduce the necessity for expensive and reactive management strategies. It’s no surprise that nurses in a range of primary health roles are well placed to initiate early intervention care to tackle this issue decisively. There is also growing support for Nurse Practitioners to play a key role in reforms to improve the efficiency and effectiveness of services for the care of patients with chronic and complex conditions. This was discussed in detail at the recent Australian College of Nurse Practitioners’ conference, which you can read about in the news section of the journal. Other Nurse Practitioner initiatives also feature in the news section this month. Clearly, the need for Nurse Practitioners in our communities is evident and it’s good to see the sector growing from strength to strength. I look forward to the advances they make in the future to ensure a healthy community for all.
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October 2016 Volume 24, No. 4 3
NEWS
“I WAS ABSOLUTELY WALKING ON AIR. TO ME, IT WAS JUST FANTASTIC THAT THEY APPROACHED ME TO NAME THE CENTRE IN MY NAME. I’M JUST TERRIBLY HONOURED BY IT ALL.” Rosemary Bryant
DR ROSEMARY BRYANT AND ANMF (SA BRANCH) ADJUNCT ASSOCIATE PROFESSOR CEO/SECRETARY ELIZABETH DABARS AM
RESEARCH CENTRE NAMED IN HONOUR OF DR ROSEMARY BRYANT AO Nursing and midwifery workforce planning, along with pinpointing the value nurses and midwives make to patient and health outcomes, will form two key focus areas of a new nurse-led research centre launched by the Australian Nursing and Midwifery Federation (SA Branch) in honour of nursing leader Dr Rosemary Bryant AO. The Rosemary Bryant AO Nursing and Midwifery Research Centre was opened by ANMF (SA Branch) CEO/Secretary, Adj Associate Professor Elizabeth Dabars AM, at the ANMF’s (SA Branch) annual professional conference held in Adelaide earlier this year. The research centre was established to allow the union to drive its agenda as it evolves as an organisation and strives to develop the professions into the future. 4 October 2016 Volume 24, No. 4
Founded in partnership with the University of South Australia, its main base will be positioned at the university’s City East campus. The ANMF (SA Branch) has committed funding for the next five years, matched by the university, which will allow the centre to operate. Adj Associate Professor Dabars said it marked the first of its kind in the state focused solely on nursing and midwifery research. “There are no formal research centres for nursing and midwifery in South Australia and particularly one that is driven by the needs and aspirations of nurses and midwives themselves. “I first raised the concept some years ago and I am very proud of the team who have worked so hard to realise that vision. It is wonderful to now get it off the ground.” Adj Associate Professor Dabars listed the regeneration of the future nursing and midwifery workforce and the impact nursing and midwifery can make to patient and health outcomes as early areas of focus to be examined by the research team. She said gathering such evidence would help illustrate the role nursing plays in safeguarding patient health. “That’s really about providing some evidence about the value of nursing and it’s a really important issue in economically tight times when you’re constantly battling to protect nursing and midwifery services, and where this has been studied elsewhere it’s shown that nurses and midwives have actually saved money when
it’s well resourced, staffed, and run.” Ms Dabars said naming the research centre after Dr Bryant was fitting given her influential background. “She is a former Branch President of the union. She led the first nurses’ stop work meeting and mass rally in 1986/87 around career structure. She was Director of Nursing at Royal Adelaide Hospital and then went on to become the first Commonwealth Chief Nurse and was also the International Council of Nurses (ICN) President. So she has a national, international and local presence in nursing that I think is second to none.” Dr Bryant, who will also take up the position as inaugural Chair of the research centre’s Board, said she felt humbled by the honour. “I was absolutely walking on air. To me, it was just fantastic that they approached me to name the centre in my name. I’m just terribly honoured by it all.” Now retired, she said her role as Chair of the Board was an opportunity to remain invested in nursing and help shape its future. “The research that it [the centre] is set up to undertake is about workforce, quality of care, how many nurses you need, and those sorts of things. We have some overseas studies but we don’t have a lot of evidence in Australia and I think that there’s a gap and that this will fill that gap very well and I hope form their basis for getting proper staffing levels and so on implemented. And not only in South Australia but the rest of the country.” anmf.org.au
NEWS
COMBATING CANCER THROUGH A NATIONAL REGISTER
VICTORIAN GOVERNMENT PERMANENTLY BANS FRACKING Victoria will become the first state in Australia to place a blanket ban on fracking and all onshore unconventional gas mining in a landmark move that campaigners opposing the practice have labelled a win for health and the environment. The ban, to be introduced later this year, was triggered by a Victorian Parliamentary Inquiry into the industry last year that received more than 1,600 submissions, including from the Australian Nursing and Midwifery Federation (ANMF Victorian Branch). The process of coal seam gas mining and fracking involves drilling and pumping large amounts of water, sand, and chemicals, into a gas well in order to fracture the surrounding rock and extract the gas. The negative by-product of the process centres on the generation of naturally occurring chemicals such as methane, benzene, xylenes, and hydrocarbons, which through exposure can lead to poorer health outcomes. The release of chemicals into the environment poses health risks that could potentially cause anything from mild symptoms such as nose bleeds and headaches to more serious conditions including birth defects and cancer. In its submission to last year’s Inquiry, the ANMF (Victorian Branch) emphatically opposed coal seam exploration and
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fracking, citing extensive risks to public health and the environment and the potential to cause long-term harm for future generations. The ANMF (Victorian Branch) made nine recommendations against the practice, including calling for a permanent ban on unconventional gas exploration, greater research into risks to health and the environment, and investing in natural resources and expanding renewable energies rather than the polluting mining industry. “Unconventional gas exploration directly impacts the health and well being of people because it is an industry that generates and relies on the use of chemicals,” the ANMF (Victorian Branch) submission stated. “The naturally occurring radioactive materials from coal seams along with the chemical additives used for fracking pollute the air, the water systems and damage the environment, threatening the safety of people, livestock, and food production.” ANMF (Victorian Branch) Assistant Secretary Pip Carew praised the Victorian government’s decisive action. “The decision to ban fracking is bold and shows progressive leadership. The growing list of harm to the environment and people’s health is too great. The health impacts of fracking will not be reversed by fining a company after things have gone wrong.” Ms Carew said lobbying in regard to the health and environmental issue reflected the passion of nurses when fighting for important issues. “Victorian ANMF Job Reps passed a resolution four years ago calling on the union to actively participate in policy debate on climate change and environmental issues. “Every day, nurses see the impact of ill health on physical and mental health and the flow on to personal and financial stability. It’s vital we stop preventable causes of illness and lives of misery, rather than simply treating the symptoms that will place unnecessary pressure on ever stretched health resources.”
A new national cancer register will boost the detection and timely treatment of bowel and cervical cancers, according to the Consumer Health Forum. Consumer Health Forum CEO Leanne Wells said the ability to collate and collect cases on a national scale would over time empower efforts to combat these cancers. The National Screening Register Bill was introduced in Parliament last month to establish a new register, which will replace eight separate state and territory cervical cancer registers and an outdated and fragmented bowel screening system. Bowel cancer is the second most common cause of cancer deaths in Australia with about 4,000 Australians dying each year. Cervical claims the death of 250 women a year despite being one of the most preventable cancers. “These two cancers cause thousands of deaths in Australia each year, yet both respond well to treatment if the cancer is diagnosed early,” Ms Wells said. “We welcome the national legislation which, by centralising information from all the states and territories, will mean a much bigger data base to more effectively track those two lethal diseases.”
NEW CEO FOR MENTAL HEALTH COMMISSION The National Mental Health Commission has a new CEO, Dr Peggy Brown. Dr Brown, who was appointed last month, has extensive experience in mental health leadership and advocacy roles in both the Commonwealth and state levels. She was most recently Chief Psychiatrist for the NT and Chair of the Queensland Mental Health Commission. The Commission has a key role in supporting the Australian government ensure investment in mental health is both effective and efficient and improves mental health and social and emotional wellbeing for individuals and the community. Dr Brown replaces David Butt as CEO.
October 2016 Volume 24, No. 4 5
NEWS
OPPORTUNITY KNOCKS FOR NURSE PRACTITIONERS
(LEFT TO RIGHT) DEBORAH FOSKETT, ACPN CEO AMANDA DAVIES
Nurse practitioners need to prepare to pounce on new opportunities next year, the Australian College of Nurse Practitioners’ (ACNP) has urged. “We are on the cusp of change,” ACNP CEO Amanda Davies said at the 11th Australian College of Nurse Practitioners’ conference in Alice Springs last month. “There is unparalleled attention to primary healthcare. MBS access for nurse practitioners was designed to increase access to a range of health options in the community, so our profession will play a key role in reforms to improve the efficiency and effectiveness of services for consumers.” The government’s inclusion of NPs to lead in the care of patients with chronic and complex conditions in the Health Care Homes model was one example, Ms Davies said.
“Primary Health Networks will be able to deliver more locally responsive healthcare and address complexity and fragmentation and reduce demand on the acute sector by working with nurse practitioners. “We know that consumers have a high degree of satisfaction with services provided by nurse practitioners. However, there needs to be more support for nursing research, which demonstrates how nurse practitioners are supporting access to quality, cost effective care and producing positive patient outcomes.” Nurse practitioners had a big part to play in shaping the health of Australians now and into the future, Ms Davies said.
The Healthier Medicare Review provided the opportunity to address existing limitations that prevented nurse practitioners and the broader health workforce from meeting future demand in more efficient and effective ways, she said. “Our members must participate in policy development, in particular the Medicare Benefits Schedule Review. Nurse practitioners must be included in clinical committees and working groups.” The Australian College of Nurse Practitioners had come a long way in a very short period of time, Ms Davies said. “We are recognised by health organisations and professional bodies as the representative voice of nurse practitioners.”
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NEWS
NURSE-LED STUDY HELPING WOMEN WITH TYPE 2 DIABETES A new wellness program developed by Gold Coast’s Griffith University is setting out to help women with Type 2 diabetes undertake a healthier lifestyle in order to control the condition. Led by Professor Debra Anderson, from Griffith’s Menzies Health Institute Queensland, and funded by Diabetes Queensland, the nurse-led study aims to reduce the side effects associated with a Type 2 diabetes diagnosis, as well as promoting risk reduction for other chronic health conditions. The study will involve women aged 45-65 with the condition undertaking an evidence-based e-health 12 week lifestyle intervention focusing on diet, exercise, and managing the side effects of diabetes.
EACH PARTICIPANT WILL RECEIVE ACCESS TO A SPECIALLY DESIGNED WEBSITE AND READING MATERIAL PROVIDING THEM WITH A STEP BY STEP APPROACH TO IMPLEMENTING HEALTHY PRACTICES. THROUGHOUT THE 12 WEEKS, PARTICIPANTS WILL BE GUIDED BY AN EXPERIENCED REGISTERED NURSE WHO WILL SUPPORT THEM IN GOAL SETTING AND MAINTAINING MOTIVATION.
Each participant will receive access to a specially designed website and reading material providing them with a step by step approach to implementing healthy practices. Throughout the 12 weeks, participants will be guided by an experienced Registered Nurse who will support them in goal setting and maintaining motivation. Three online consultations with the nurse will also be delivered to relay advice on sleep, diet, exercise, alcohol intake, and stress levels. Professor Anderson said the impetus for the intervention was the increasing number of Queensland women living with Type 2 diabetes coupled with the vast amount of inaccurate health information being pushed. anmf.org.au
TELEHEALTH – A TELEHEALTH NURSE SHOWING A PATIENT HOW TO USE THE HOME MONITORING SYSTEM
TELEHEALTH COULD SAVE HEALTHCARE BILLIONS Home monitoring of chronic disease through telehealth could slash $3 billion a year from the nation’s healthcare costs by reducing avoidable hospital and GP visits, Australia’s first large-scale trial of telehealth has shown. Undertaken by CSIRO, the research involved trialling telehealth systems among 287 patients who self-managed their conditions at home over a 12-month period. Results revealed savings of 24% over the year to the healthcare system, made through reduced GP visits, specialist visits, and procedures carried out, as well as a reduced mortality rate of more than 40%. The trial provided test patients with a telehealth device that allowed video conferencing with clinicians, messaging features, the delivery of clinical and study
DR JAYASENA SAID OVER 500,000 AUSTRALIANS AGED OVER 65 WOULD BE GOOD CANDIDATES FOR AT-HOME TELEMONITORING.
specific questionnaires, as well as the ability to monitor vital signs such as heart rate and blood pressure. CSIRO lead researcher Dr Rajiv Jayasena said aged patients with multiple chronic diseases such as cardiovascular disease or diabetes account for 70% of the health system’s expenditure. “In addition to a 24% saving of Medical Benefits Scheme expenditure over one year, the trial also showed a substantial 36% decrease in hospital admission and most importantly a 42% reduction in length of stay if admitted to hospital during the 12 month trial. “This is a huge saving when you consider the cost of a hospital bed per day is estimated to be about $2051 in Australia.” Dr Jayasena said over 500,000 Australians aged over 65 would be good candidates for at-home telemonitoring. October 2016 Volume 24, No. 4 7
NEWS
NURSE PRACTITONERS TO TACKLE REMOTE DISADVANTAGE The NT is in urgent need of more nurse practitioners (NPs) to address the chronic disease boom currently experienced in central Australia. A three-year strategic plan for NPs in the NT outlined for 25 NPs to be employed across the NT by the end of 2016. NT remote area NP Stuart Mobsby told delegates at the Australian College of Nurse Practitioners conference this figure would not be reached. “There are little or no existing positions within the NT. There is a lack of funds to support new positions.” Restructure of health services in the NT with the Top End and Central Australia health services had not resulted in extra
NURSE PRACTITIONER ADVOCATES FOR CHOICE A nurse practitioner described as a ‘real pioneer’ in her work with children with diabetes presented the prestigious Donna Diers oration at the Australian College of Nurse Practitioners conference held in Alice Springs last month. Gold Coast Nurse Practitioner and Diabetes Educator Deborah Foskett advocated for children with Type 1 Diabetes to receive gold standard treatment in insulin therapy delivery. Ms Foskett described her battle to have children with T1D access to insulin pump therapy instead of pen injection two to eight times daily. “I wanted children and families to have a choice of delivery system. I cannot think of another medical condition that allows us to choose our delivery system.” Ms Foskett said insulin pump therapy was the first line gold standard treatment for management of T1D requiring insulin. “I asked: why are we using medical device injection when it’s not first line treatment? We are not 8 October 2016 Volume 24, No. 4
funding for NP positions, Mr Mobsby said. “We couldn’t ask about new positions when we were not sure about the existing ones.” NT Acting Chief Nurse and Midwifery Officer Heather Keighley said there were currently 19 endorsed NPs and 11 candidates in the NT. She conceded many were not working in NP roles. “We are struggling to create NP roles. It has been a long, arduous journey. There have been barriers.” Ms Keighley said the government had done the costings and it was down to operationalising new NP roles with the new NT government. “The need is urgent and clear. We have high expenditure on agency nurses and we need to reinvest that into remote area nurse practitioners.” The Indigenous population had some of the “worst outcomes in the world”, Ms Keighley said. More than 30% of the NT Aboriginal population aged over 55 already had diabetes - almost 40% if those at risk were included. “The figures are absolutely shocking,”
General Manager Darwin Region and Strategic Primary Healthcare, Top End Health Service Dr Christine Connors said. “It is astonishing that we have rheumatic health disease, tuberculosis and syphilis is coming back as an epidemic.” Smoking rates were as high as 70% in some parts of central Australia, she said. “It took 50 years to see a reduction in smoking rates from 60% to 15%. We do not want to wait 50 years for Aboriginal people to have the benefit of having a smoke free generation. “We do not have enough nurse practitioners in the NT. We could really benefit from having some more. If you attend a primary healthcare clinic you are much less likely to attend hospital.” Recent health gains in closing the gap in mortality rates between Indigenous and non-Indigenous Australians had slowed, Dr Connors said. “We have just started to reach some of the limits of the health system. The health system does very little to improve life expectancy. “Further significant contribution to closing the gap will not be met until improvements in education of young people graduating from high school, employment, reduction in poverty and increased housing affordability.”
keeping up to date with the latest therapy.” The paediatric nurse with experience working with children with long-term illness said she had ‘five years of hell and two studies’ in which she faced inertia and paternalism. “People were not convinced to use the pump. I needed clinicians to believe in the change.” Early results of an initial study showed vast improvements in blood sugar levels of 12 children from the Gold Coast, Ipswich and Toowoomba who started on insulin pump delivery at diagnosis. “Nowhere else in Australia were they putting people on pumps at diagnosis [T1D],” Ms Foskett said. The findings were presented at a medical conference in Spain in 2012. HbA1C results of the children were 7.46% on average. “They were under the guidelines and well and truly below that of the hospital,” Ms Foskett said. Results showed the children’s HbA1C results were sustained after two to three years. “They mostly get a drop after the first year during the honeymoon period but they sustained the results several years later - if they continued to have HbA1c under 7% by the time they are my age they will have no CVD, no CKD or diabetic retinopathy,” Ms Foskett said Results of HbA1C 6.2% seen in the study ‘was unheard of’, she said. Quality of life was an important factor for
DEBRORAH FOSKETT
children diagnosed with T1D and their families Ms Foskett said. “Children with the pump said they didn’t feel any different, their eating habits didn’t change and they had improved glycaemic control. This was sustained over 48 months.” Ms Foskett said it was important for NPs to ‘stick to their guns’ and ‘not waver’.“I was criticised by my medical colleagues and my own colleagues. What has made the difference is the families and their outcomes. Children with diabetes are leading normal lives and normal is what we want in diabetes. You cannot do this alone. You need people on board with different sets of skills. I needed collaboration and support.” Ms Foskett was now involved in the teaching of integration of both pens and pumps in insulin delivery, particularly with children involved in sport. “We have to make sure as nurses and educators we give patients a choice.” anmf.org.au
NEWS conducted on the back of quality care and improvements in patient outcomes. That’s the fundamental premise on which we provided any degree of interest in being involved.” While Adj Associate Professor Dabars acknowledged the principles of Transforming Health as sound she said its implementation thus far had been “appalling” and “disrespectful” to the nurses and midwives providing care to the community.
SA HEALTH REFORMS UNDER FIRE OVER LACK OF CONSULTATION The Australian Nursing and Midwifery Federation (SA Branch) has put the state government and its health department on notice following their latest attempts to roll out major reforms designed to streamline the health system. The government’s Transforming Health reforms, which propose cutting bed numbers in a bid to deliver more efficient services, have been in the pipeline for several years and are beginning to take shape. The plans include the closure of the Repatriation General Hospital along with other changes to the Southern Adelaide Health Network, where more than 100 beds and 200 jobs are earmarked to go. The latest developments last month saw SA Health freeze its surprise plans to close 39 beds at the Royal Adelaide Hospital after the ANMF (SA Branch) successfully argued for urgent consultation during crisis talks to resolve the situation. “Obviously we were outraged and opposed to that announcement being made given that there had been an absolute absence of consultation or engagement,” ANMF (SA Branch) CEO/Secretary Adjunct Associate Professor Elizabeth Dabars AM (pictured) said. “One of the most important factors that has meant that we have been tentatively supportive of Transforming Health has been first and foremost that it is supposed to be anmf.org.au
From the outset, the ANMF (SA Branch) has maintained it will fight to protect the closure of beds unless clear evidence shows that losses will boost efficiency and improve outcomes. “I think it’s important to note that at the moment we must realise that we are hearing reports from nurses and midwives across the system that patients are being treated in corridors and that there is systematic overcrowding in emergency departments. That’s not an acceptable scenario and from our perspective you couldn’t argue that beds should close in that environment because it’s clearly the case that people do require those beds.” Similarly, while Adj Associate Professor Dabars conceded that job losses as a result of the Repatriation General Hospital’s impending closure were likely, the government still needed to show cause that those beds needed to genuinely close. If redundancies do occur, it is expected that most nurses would be redeployed to other areas and that natural attrition, such as from retirements and turnover, would cover a large portion of the job losses. “We have been informed that in all probability, in the event that they manage to achieve all this [Transforming Health], that redundancies certainly would not be forced, they would be voluntary. But even more importantly, that largely they would be accounted for by natural attrition,” she said. Adj Associate Professor Dabars said the government’s back down on its plans to close 39 beds at the Royal Adelaide Hospital indicate a long overdue willingness to engage with key stakeholders moving forward. She said the lack of consultation had caused much anxiety for nurses and their patients and that she hoped no more sudden announcements would be made as the process unfolds. Yet in another blow to mounting tensions over a separate issue, the ANMF (SA Branch) again emerged last month to announce public sector nurses and midwives across the state had voted to take industrial action, beginning from 26 September, in direct response to failed EBA negotiations. Plans for the industrial action entailed gradually escalating from ceasing non-nursing duties to refusing overtime and holding stop work rallies on site. If the government has not presented a new EBA by 17 October, nurses and midwives will reportedly proceed to halting Transforming Heath initiatives.
REVIEW OF SUICIDE PREVENTION SERVICES The National Mental Health Commission (NMHC) will undertake a review of suicide and self-harm prevention services available to Australian Defence Force (ADF) personnel members and veterans. The Commission, together with an expert panel of current and former Defence members, will examine the effectiveness of available services in supporting mental wellbeing and preventing self-harm and suicide. In line with the review, the federal government has announced the establishment of the first suicide prevention trial site in North Queensland, an area home to a large veteran community, where the North Queensland Primary Health Network will target the mental health of veterans. It marks the first of twelve trial sites set to be funded by the federal government in a bid to drive a national approach to suicide prevention. Suicide, a leading cause of death in Australia, has continued to increase and is at its highest level in ten years. A Senate Report into the Mental Health of Australian Defence Force members and veterans found that since the year 2000, 108 ADF personnel, of which 47 had previously been deployed, were suspected or confirmed to have taken their own lives. Suicide prevention remains high on the agenda of the Commission and governments, evidenced by the NMHC’s recent establishment of an Australian Advisory Group on Suicide Prevention, which will work with stakeholders to help shape government strategies as it strives to improve outcomes. Issues raised to date included improving data collection, calling for a national suicide prevention strategy, the lack of positive mental health role models for young men transitioning to adulthood, and prioritising high risk and vulnerable groups such as Aboriginal and Torres Strait Islander people and those living in rural and remote communities.
October 2016 Volume 24, No. 4 9
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NEWS 100DAYSCAMPAIGN – CATSINAM DIRECTOR VICKI WADE (LEFT) AND CEO JANINE MOHAMED OUTSIDE THE LAWNS OF PARLIAMENT HOUSE.
CALLS FOR DE-IDENTIFIED MEDICAL DATA TO AID RESEARCH
INDIGENOUS LEADERS CALL FOR URGENT GOVERNMENT ACTION Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) CEO Janine Mohamed stood alongside other peak Aboriginal and Torres Strait Islander leaders united outside the lawns of Parliament House in late August. Together, they challenged the federal government to take urgent action in addressing longstanding disadvantage experienced by the nation’s First Peoples by actively committing to meaningful engagement on the road to reform. The call by the dozens of Indigenous leaders and groups, which coincided with the beginning of the 45th Parliament, specifically asked for the Prime Minister to meet with National Congress of Australia’s First Peoples and peak leadership organisations and commit to a National First Peoples Summit within the first 100 days of the new Parliament as part of the #FirstPeoples1st100Days campaign. Ms Mohamed, who addressed the crowd on the day, and described the coming together of national peak bodies as “empowering”, said the event was the result of a year-long push by leaders to unite to take a collective stand and make their voices heard. Ms Mohamed spoke about Aboriginal and Torres Strait Islander health on a broad level, anmf.org.au
including taking the right steps to building a culturally safe Indigenous health workforce and implementing an Aboriginal and Torres Strait Islander Health Plan. “Some of that was about re-investment in Closing the Gap in terms of life expectancy. It was also about raising the profile of Aboriginal Community Controlled Health Services, as well as asserting that the Aboriginal and Torres Strait Islander workforce is an important cog in health service delivery for our people.”
“THE FACT THAT HE’S ACTUALLY WANTING TO ENGAGE IS A GOOD SIGN. IT’S ABOUT THE NEXT STEP THAT HE TAKES, WHICH IS REALLY LISTENING TO US AND WHAT OUR PRIORITIES ARE, WHICH WILL DETERMINE WHERE WE GO FROM HERE.” Ms Mohamed said more broadly the challenges were about re-setting the relationship. “They’re not necessarily listening to the peak organisations, we feel. They’re making their own decisions on what the priorities are and of course, self-determination and Aboriginal peoples’ health in Aboriginal peoples’ hands is that core of what we’re saying. Come and listen to us. We know what the priorities are and re-set the relationship.” Ms Mohamed said she believed the event in Canberra had resonated with the wider Australian public and that awareness about the important issues was growing. In a sign of progress, Indigenous Affairs Minister Nigel Scullion met with a number of leading Aboriginal and Torres Strait Islander organisations last month to hear their bid for increased engagement and co-designed solutions. “The fact that he’s actually wanting to engage is a good sign. It’s about the next step that he takes, which is really listening to us and what our priorities are, which will determine where we go from here.”
Around 91% of Australians would be willing to share their de-identified medical data if it went towards research purposes, according to findings from a Roy Morgan research poll. “What scientists and researchers need is data to develop treatments and to track changes in the rise and fall of diseases over time,” Research Australia CEO Nadia Levin said. “The Australian health system has not effectively supported the collection and use of health data for research purposes in the past; and what we are saying is that the privacy considerations and other barriers can be overcome with enormous benefits as a result. “If we make better use of our Australian data to understand our own health needs, we can develop solutions that lead to new and better drugs and therapies ourselves.”
CURBING ALCOHOL INTAKE DURING PREGNANCY The West Australian government has launched an initiative to prevent Fetal Alcohol Spectrum Disorders (FASD) last month. The Strong Spirit Strong Future: Promoting Healthy Women and Pregnancies campaign, aimed at Aboriginal women, promotes the message that while pregnant or planning a pregnancy, no alcohol is the safest option. The campaign is being fronted by popular Aboriginal personality Mary G, who has a proven record of influencing Aboriginal women’s attitudes, according to state Mental Health Minister Andrea Mitchell. The mass-reach campaign features television, radio advertisements and support materials for health professionals promoting healthy pregnancies. Studies have found that around half of all people with FASD have attention-deficit hyperactivity disorders (ADHD), 62% have vision impairment and 58% have hearing problems, reports from the federal government reveal. Despite the devastating consequences, one in five women continue to consume alcohol while pregnant, and FASD continues to disproportionately affect Aboriginal and Torres Strait Islander people.
October 2016 Volume 24, No. 4 11
NEWS
UNLOCKING ENDEMIC BULLYING FACING NEW GRADUATES An expert panel of nursing leaders delved into the adage ‘nurses eat their young’ during a wide-ranging discussion attempting to solve problematic issues facing new graduates at the Australian Nursing and Midwifery Federation’s (Vic Branch) annual conference last month. The panel included ANMF (Vic Branch) Professional Officer Belinda Clark, Commonwealth Chief Nursing and Midwifery Officer Adjunct Professor Debra Thoms, Associate Professor Tracey Moroney, Dean of the School of Nursing at Sydney’s University of Notre Dame, and Registered Nurse Narelle Place, winner of the 2015 Outstanding Graduate at the HESTA Awards. The discussion dissected enduring problems faced by new graduate nurses and midwives entering the workforce, triggering potential solutions including building supportive and nurturing workplace cultures, developing leaders of the future, thinking creatively when allocating preceptors, encouraging clinical supervision, and empowering young nurses with the confidence to speak out when problems arise. The session also considered prevailing workforce issues and the reality that many new graduate nurses and midwives cannot secure transition to practice programs in spite of looming nurse shortages.
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ANMF VIC BRANCH CONFERENCE GRADS PANEL – LEFT TO RIGHT, NARELLE PLACE, DEBRA THOMS, AND TRACEY MORONEY.
One of the issues common in nursing is bullying and harassment. Adjunct Professor Debra Thoms said the profession’s bullying culture was complex. “I think some of these issues don’t apply just to our RNs, they apply to nurses new to many workplaces and how we embrace and engage with people new to an environment.” Professional Officer Belinda Clark said emerging strategies to address the issues surrounded Nurse Unit Managers becoming more creative when allocating preceptors, as well as allowing sufficient time for mentors to spend with graduates. “We know inherently that we’ve all got different strengths. The wards need to identify those nurses that have those inherent skills around supporting other nurses. Then we want to make sure we train and support those preceptors to support others and we want to adjust the workloads of those people.” Associate Professor Tracey Moroney stressed all nurses should deliver some form of mentoring. “I believe that RNs should
provide support to early career nurses. I think it’s built into the standards of practice and it needs to be an all-in approach with added mentoring on top of that.” Adjunct Professor Thoms agreed all nurses have a responsibility to create positive work environments. “It’s not just about employing our first year RNs. We also need to retain these nurses beyond years three to five and we know that there are challenges around that longer term retention as well.” Graduate Narelle Place suggested leadership was the key. “I think it starts from the top. To have a good hospital or to have a good ward you’ve got to have a good unit manager and then go from there and that’s how you get good graduates.” The panel conceded workplaces require a balance of graduates and senior nurses to operate effectively, and that often the lack of available placements simply comes down to money.
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NEWS
EMERGENCY NURSES ABUSED OUTSIDE OF WORK Half of emergency department (ED) nurses have experienced some form of work-related verbal or physical abuse outside the workplace, a new survey shows. Preliminary findings of a national study currently underway are to be presented at the 14th International Conference for Emergency Nurses in Alice Springs this month. All ED nurses who participated in the Central Queensland University (CQU) online survey to date had experienced some form of threat, intimidation, harassment, or verbal or physical abuse. “It is clearly grossly unacceptable and unfortunate that it is in keeping with previous overseas and Australian research
AUSTRALIANS TURNING TO DR GOOGLE FOR HEALTH ADVICE Three out of five Australians are turning to the internet for information about health conditions to avoid going to see a GP, a new study has revealed. The ‘Dr Google’ trend was most common among 18-34 year olds, with the proportion of online symptom searches rising to almost four in five people (79%) among the younger demographic. Conducted by NPS MedicineWise, the survey of more than 1000 Australians also revealed that 40% of people search for health information on the internet when they have a question for a doctor but the pharmacy is closed, while 24% of people turn to ‘Dr Google’ every time they are prescribed a medicine or are considering taking a new medicine. The survey also found that one in five Australians said they would use Facebook to try and find answers to questions they have about medicines. anmf.org.au
that emergency nurses are subjected to abuse, intimidation and harassment,” CQU PhD candidate and ED nurse Jacqueline Ingram said. “It is a terrible, terrible thing that continues despite efforts to address it.” The research focused not only on the frequency with which ED nurses experienced direct violence and threats but also the frequency with which the sense of safety was undermined by such encounters with patients on and off duty. Nurses’ experiences of encounters with patients outside of the workplace were surprising, Ms Ingram said. “Seventy five percent of all survey participants had felt unsafe and 50% had been verbally threatened. “When it occurs in the workplace there are code grey or black mechanisms but in the community you are a private citizen and are not protected.” Of the survey respondents, 40% identified as working in metropolitan areas, 40% regional and the remaining 20% rural and remote. “You would think in Melbourne the odds
The increasing use of ‘Dr Google’ is supported by comparisons to the 2012 NPS MedicineWise survey where only one in three people admitted to looking up health information online to avoid face-to-face appointments.
WHILE IT IS ALWAYS GOOD TO EQUIP YOURSELF WITH HEALTHRELATED INFORMATION, IT IS IMPORTANT TO BE AWARE THAT NOT ALL HEALTH INFORMATION YOU ACCESS ON THE INTERNET WILL BE ACCURATE OR RELIABLE.” NPS MEDICINEWISE SPOKESPERSON AINE HEANEY
NPS MedicineWise spokesperson and pharmacist Aine Heaney said searching for health information online was understandable but warned consumers to be wary of accessing reliable information. “While it is always good to equip yourself with health-related information, it is important to be aware that not all health information you access on the internet will be accurate or reliable.” Consumers Health Forum of Australia CEO Leanne Wells said ‘Dr Google’ can provide simple access for consumers seeking
of running into a patient would be small compared with a rural setting of 300 people,” Ms Ingram said. “The important thing is to recognise the work-related abuse of nurses does not begin and end at the door of the emergency department. It happens outside of work.” ED nurses should formally report all incidences at the workplace and outside of work, Ms Ingram said. “Emergency nurses are so frequently subjected to abuse, intimidation and harassment that we have become inured to the problem and rarely report such incidents through formal channels. “If we do not report it, we do not recognise it and we do not know it is happening.” A second phase of the study will examine the impact of abuse and violence on nurses, including fatigue, burnout, and stress and on professional interactions with patients after those experiences. The CQU online study is open until the end of November. Emergency nurses can participate via Facebook: Research:Compassion Fatigue & Burnout
additional health information and could prompt them to seek earlier care, but also acknowleded the dangers of people with low health literacy accepting inaccurate information. “On balance, however, provided consumers check with their doctor before taking any significant health decisions, Dr Google represents a big step forward towards engaging patients and clinicians in shared decision making about their healthcare. “Some doctors may be irritated by patients who raise questions about their medical care prompted by their internet searches. Our view is that doctors should use such occasions to maximise the patient’s understanding of their care which in turn should maximise the chances of a positive care outcome.” Ms Wells said the trend in consumers being active participants in managing their own health was rising rapidly and that emerging digital technology, such as innovative health apps and wearable devices, would play a more prominent role in contemporary healthcare. She said health professionals, such as nurses, should work together with consumers and encourage them to take ownership of their health status. “Patient-centred healthcare which involves health practitioners responding to the individual needs and conditions of each patient does require changes in approach for many clinicians away from a “one size fits all” approach. The result, however, should mean happier and healthier consumers and more satisfied clinicians.” October 2016 Volume 24, No. 4 13
NEWS
LONELINESS COMMON FOR PEOPLE WITH DEMENTIA
AGED CARE FUNDING CUTS SET FOR REVIEW The Australian Nursing and Midwifery Federation has welcomed an impending review into $1.8 billion in funding slashed from the aged care sector as the Labor Party moves to trigger an investigation into the devastating cuts. The Opposition announced last month it would introduce a private member’s Bill into Parliament seeking legislative review of the recent budget cuts made to the aged care sector. ANMF Federal Secretary Lee Thomas said the funding shortfall had already begun impacting the quality of care provided to vulnerable elderly Australians. She praised Labor’s action in tackling the critical issue, revealing widespread concerns from frontline aged care staff across the country. “The sector is currently suffering a shortage of 20,000 nurses and the ANMF’s national aged care survey showed that it is now not uncommon to have one Registered Nurse (RN) caring for up to 100 patients in a nursing home. “Our members are telling us that in nursing homes across the country, even basic standards of care, such as feeding, bathing, bed changes and pain and continence management, are suffering
14 October 2016 Volume 24, No. 4
as a result of poor staffing levels and decreased funding.” The proposed review will include a detailed assessment of the true cost of healthcare for older Australians and a full evaluation of the government’s Aged Care Funding Instrument (ACFI). Ms Thomas said she hoped the review would help provide the impetus to tackle long-standing workforce issues. “The final step is to deliver a workforce strategy for aged care, which must mandate minimum staffing levels for both registered nurses and assistants in nursing/care workers for residential aged care. Improvements in care for our elderly will not be achieved until we get the workforce right.” UnitingCare Australia’s Aged Care Network Chair Steve Teulan said the organisation wanted Parliament to work cooperatively with the aged care sector in order to develop a more sustainable funding model for the future. Mr Teulan said the cuts to aged care targeted some of the most complex areas of healthcare for aged care residents and threatened providers’ ability to deliver care. “The funding cuts would, on average, reduce the amount of funding available to meet each resident’s needs by 11% or $6,655, and as much as $18,000 per resident each year. “We understand the need to manage growth in health and aged care expenditure, but it needs to be done in a way that does not jeopardise the health of the most vulnerable people in our community.”
People with dementia are almost twice as likely to have high rates of loneliness compared to the general public, a survey has shown. The research sparked calls last month during Dementia Awareness Month for greater understanding of dementia by the general public so that people living with the condition feel less isolated and alone. “We believe a large part of that is because of the general lack of awareness and understanding of dementia, people simply don’t know how to interact with their friend of loved one with dementia,” said Alzheimer’s Australia National CEO Maree McCabe. “Treating people with the same respect, kindness, inclusiveness and thoughtfulness you always have is what makes a difference to them. They are still the same person- your parent, sibling, partner, relative, friend- as they were before the diagnosis. They just may need a little bit more time, understanding and support.”
UNIVERSITIES TO SURVEY SEXUAL ASSAULT A nationwide survey to assess the extent of sexual assault and harassment of university students in Australia has been launched by the Australian Human Rights Commission and Universities Australia. The survey to be conducted at Australia’s 39 universities is supported by the National Union of Students and the National Tertiary Education Union. Sex Discrimination Commissioner Kate Jenkins said there had been worrying reports of sexual assault and harassment of university students over the past year. “As universities themselves have observed, one sexual assault on campus is one too many.” The survey will assess the prevalence, nature and reporting of sexual assault and sexual harassment among university students. Universities Australia Chair Professor Barney Glover said universities had a zero tolerance policy on sexual assault and sexual harassment. Students can make a confidential online submission at: www.humanrights.gov.au/ universitysubmissions
anmf.org.au
NEWS
DEVELOPING NURSE UNIT MANAGERS INTO LEADERS A Victorian health service developed an innovative 12-month leadership program in a bid to build the capacity for its Nurse Unit Managers (NUM) to positively influence staff, create better work environments, and drive strategic objectives. The program, spearheaded by Northern Health’s Director of Organisational Learning and Development, Jade Ralston, was outlined at the ANMF (Vic Branch) annual conference in Melbourne last month. “In my experience with consulting I find that leadership is often overly complicated,” Ms Ralston explained. “Leadership itself does not have to be overly complex when we’re trying to think about development. But what it does have to be is specific to the role and specific to the duty that the leader is trying to achieve.”
“meat in the sandwich”, with direct dealings with senior management and staff, as well as patients by the bedside. It led to NUMs being taken off the floor to attend a development day where their first-hand accounts of what leadership skills they considered crucial to their success were taken on board and incorporated into the program. The same process was also carried out with Northern Health’s Directors of Nursing. The information pooled together helped create the eventual Nurse Unit Manager Leadership Program, encompassing competencies, personal enablers, key knowledge areas, and ideal experiences. The 12-month program concluded earlier this year, with about 40 Nurse Unit Managers undertaking education once a month linking back to the competencies they outlined as drivers to success. The program’s seven modules focus on leading and supervising, relationships with people, networking, driving results and working strategically, adapting and responding to change, dealing with conflict management, and building emotional intelligence.
Northern Health developed its leadership program by first attempting to pinpoint what its NUMs required to be successful in the workplace.
Ms Ralston said NUMs require a diverse skill-set in order to carry out their roles, from leading others in a manner that is approachable and fair, to working strategically to break down daily tasks for their team, and at other times making decisive decisions and responding to change promptly.
It initially found NUMs were often the
“They were telling us they really need to
NURSES AND MIDWIVES BLINDSIDED AS PUBLIC HOSPITALS ARE PRIVATISED Hundreds of nurses and midwives have been thrust into limbo after the NSW government announced plans to privatise five major regional public hospitals last month. Five public hospitals – Maitland, Wyong, Goulbourn, Shellharbour and Bowral – are set to change into private hands under the surprise development. anmf.org.au
The move sent shockwaves through affected staff, who will be offered a position for two years on the condition that an equivalent job exists, and won’t be given a say in negotiating their future conditions and entitlements. The NSW Nurses and Midwives’ Association (NSWNMA, ANMF NSW Branch) slammed the development, citing significant concerns that affected staff may not be offered positions at the new hospitals and would be left jobless, as well the potential ripple effect of poorer quality patient care. Late last month, at a NSWNMA delegates’ meeting, branch officials unanimously voted to fight the changes by developing a community awareness campaign, including industrial action and media advertising, against the privatisation agenda. NSWNMA General Secretary Brett Holmes said it was a “sad day” for the state’s public hospital system and that the decision confirmed long-held fears that the NSW government held an agenda to privatise more
“LEADERSHIP ITSELF DOES NOT HAVE TO BE OVERLY COMPLEX WHEN WE’RE TRYING TO THINK ABOUT DEVELOPMENT. BUT WHAT IT DOES HAVE TO BE IS SPECIFIC TO THE ROLE AND SPECIFIC TO THE DUTY THAT THE LEADER IS TRYING TO ACHIEVE.”
be adaptable to change. They don’t really have time to even think about it and they need to make sure that changes coming down from the top are implemented as seamlessly as possible.” Importantly, NUMs were asked to deliver feedback half-way through the program detailing how they had successfully implemented their newfound knowledge within their day-to-day environments. The group was also required to report to the Directors of Nursing once a month and present their development and newfound understanding. NUMs who undertook the program graduated earlier this year and Northern Health is now investigating undertaking a similar program for its Assistant Nurse Unit Managers in the hope of further developing relationships within the health service. public hospitals across the state. “We’re extremely concerned about patient care in the long run, as no large private hospital operator has been prepared to agree to nurse to patient ratios anywhere in NSW. Without these, patient safety is dependent upon budget, and now profit, to determine staffing levels.” Mr Holmes claimed Premier Mike Baird had turned his back on the people of NSW by blatantly ignoring the rights of workers and the community. The NSWNMA has been campaigning hard against the privatisation of the state’s public hospitals yet Mr Holmes said the government had given no warning of its plans, nor attempted to engage in prior consultation with the union. “Not only has the government shut the community out of the decision making process, they’ve forced hundreds of professional nursing and midwifery staff to wait on the sidelines as their future prospects are discussed without consulting them.”
October 2016 Volume 24, No. 4 15
INDUSTRIAL
YET ANOTHER ATTACK ON WAGES AND CONDITIONS Andrew McCarthy Federal Industrial Officer
An unobjectionable-sounding title obscures the real intent of the latest in a series of Bills which the federal Coalition government is attempting to legislate in its ongoing attempts to undermine employee wages and conditions and attack unions. The government recently introduced the Fair Work Amendment (Respect for Emergency Services Volunteers) Bill into Parliament as a response to a long-running dispute in Victoria involving the Country Fire Authority (CFA), the Victorian government and the United Firefighters Union for a new enterprise agreement. The most controversial aspect of bargaining has centred around clauses that relate to the CFA’s use of volunteers. In an attempt to capitalise on prominent anti-ALP media coverage in Victoria arising from the dispute, the Turnbull government promised in the lead-up to the July federal election to legislate around the issue. The Bill introduced recently by the reelected government is the result. The Bill would make unlawful clauses in an enterprise agreement that relate to volunteers. While the precise wording is more confined than this, the practical effect of the legislation would make it very difficult for a clause that related to volunteers to have any legal effect. The Bill would prevent the Fair Work Commission approving an agreement that contained such clauses, and any existing agreement that contained such a clause would be of no effect. What this means is that even when an employer and its employees and their union have agreed to a clause as part of a package of wages and conditions, such clauses would be of no effect. An agreed clause that for example provided for employees to be consulted by management before changes to the way volunteers were used in a particular organisation would now be deemed unacceptable, even if those changes might have significant effects on the employees of the organisation (such as the occupational health and safety of employees). While there is no doubt that volunteers play a valuable role in many organisations, it is hard to see the logic why employees in those same organisations should not be able to have a say in matters that might significantly affect their working conditions. And yet the federal government says such terms are ‘objectionable’. While it is bad enough that the government is legislating because
16 October 2016 Volume 24, No. 4
of one particular dispute on what is in any event a state matter, the Bill goes even further by allowing the government to make regulations to intervene in any disputes involving volunteers at ‘emergency management bodies’. This phrase is defined, among other things, as a public organisation which ‘responds to an emergency or natural disasters’. It is not hard to see how public hospitals or other organisations that employ nurses and midwives could fall within this expression, enabling the federal government to step in to effectively override any clauses that might bear on volunteers that are agreed between employees, their unions including the ANMF, and management of those organisations. The ANMF has recommended in a submission to a Senate Inquiry that the Bill be rejected. While clauses relating to the use of volunteers are relatively uncommon, the Bill is unfortunately part of a wider trend towards banning other terms in agreements that governments do not agree with. Employer organisations have recently been pressing hard to outlaw terms that relate to contractors, labour hire employees and even casual employees and last year’s Productivity Commission (PC) Inquiry into Australia’s workplace
relations framework made the same recommendation. The government has stated that it will seek to implement this recommendation. Another proposal made by the same PC Inquiry was to introduce a statutory form of individual contract called an “enterprise contract”. The PC proposed that the contract be offered to prospective employees on a take it or leave it basis (ie. sign or no job), and no negotiations over the terms of the contract with new or existing employees (or their union) would be required. The contract would not be required to be approved by the Fair Work Commission. One might conclude from all this that certain groups and governments are not actually interested in genuinely collective bargaining or are willing to put up with it until it produces outcomes they do not like. We await with interest the government’s response (if any) to the PC report, which it has not yet officially responded to, despite promising to release its response prior to this year’s federal election. What we can be certain of is a trickle of similar legislation to the Volunteers Bill chipping away at wages and conditions. anmf.org.au
WORLD
UNITED KINGDOM
RCN tackles emergency care crisis A joint report undertaken by UK union the Royal College of Nursing (RCN) and Royal College of Emergency Medicine (RCEM) has put forward numerous solutions in a bid to address increasing pressures on emergency care services. In The Medicine Needed for the Emergency Care Service report the RCN and RCEM claim rising pressures could be eased with the implementation of three key changes – better education and training for staff along with a workforce planning strategy, emergency departments aligning with Accident and Emergency (A&E) hubs where patients have access to a range of healthcare professionals including speciality trained nurses and GPs, and developing a new culture of collaboration where healthcare professionals across the wider hospital system work more effectively together to support patients. The recommendations come on the back of a summit bringing together experts from across both organisations that examined solutions to coping with an increase in patients that is outpacing growth in the workforce and resulting in insufficient nurses and emergency doctors. RCN Chief Executive Janet Davies said the pressure on emergency departments was extensive and unrelenting.“Despite the best efforts and dedication of staff, these pressures are affecting all patients accessing emergency care. “These problems cannot be solved overnight, and will require a systemwide approach to reduce the blockages which so often add to the pressures on A&E. There can be no excuse to ignore the situation any longer. Patients deserve better.”
anmf.org.au
MIDDLE EAST
Conflicts usurp health gains The Arab uprising in 2010 and subsequent wars in the eastern Mediterranean have had serious effects on health and life expectancy of people in many of the 22 countries in the region, a study has found. The study, funded by The Bill & Melinda Gates Foundation, was published in international journal The Lancet Global Health. The conflicts threatened to jeopardise health gains over the past two decades and will impact on the region and world for many years to come, warn the authors. “This region has historically seen improvements in life expectancy and other health indicators, even under times of stress. But the Arab uprising has evolved into complex wars that have killed hundreds of thousands of people and displaced millions,” said lead researcher Professor Ali Mokdad of Global Health at the Institute for Health Metrics and Evaluation, University of Washington, US. Between 2010 and 2013, Yemen, Tunisia and Egypt lost about three months of life expectancy while the war in Syria wiped six years off average life expectancy. Evidence showed infant mortality rates were on the rise in some countries: Syria had gone from a 6% drop in infant mortality rates in the decade before 2010 to a 9% increase between 2010 and 2013. Further, worsening health conditions in countries where conflicts had escalated since 2013 have developed. Wars in Syria and Libya intensified and conflicts and unrest continued or broke out in Yemen, Lebanon, Afghanistan, Iraq and Somalia. “Along with population growth and ageing, these ongoing conflicts have dramatically increased the burden of chronic diseases and injuries and many health workers have fled for safer shores,” Professor Mokdad said. “These issues will result in deteriorating health conditions in many countries for many years and will put a strain on already scarce resources.”
UNITED KINGDOM
Nurses warned to dodge pension opt-out offer UK union, The Royal College of Nursing (RCN), has urged its members to reject a bold recruitment scheme created by the East and North Hertfordshire NHS Trust that promises nursing staff better pay in return for giving up their pension contributions. The recruitment drive, engineered to fill 200 nurse vacancies, allows Band 5 and 6 nurses and midwives the opportunity to opt-out or not join the NHS pension scheme in return for a higher salary. But the RCN has slammed the scheme, claiming it places the retirement nest eggs of nurses in jeopardy and could lead to financial instability. “This ill thought-out move asks people to neglect their future and will stop them from making retirement plans,” RCN Chief Executive and General Secretary Janet Davies said. “It could put nurses into poverty when they retire and lead to an even greater reliance on state support.” Ms Davies said nurses should not bear the brunt of the government’s failure to properly fund the NHS and that the latest developments threatened the long-term viability of the NHS Pension Scheme. The RCN is urging all of its members to seek financial advice before considering taking up the offer. Senior RCN workplace representative Anne Wells opted out of the NHS Pension Scheme back in 1985 after being lured by more money and still counts the decision as her biggest regret. “Always seek independent financial advice or speak to RCN Direct if you’re not sure what to do.”
October 2016 Volume 24, No. 4 17
FEATURE
PHOTO: PAUL BAMFORD PICTURED: LAURIE WEST
FEATURE
CHRONIC DISEASE CRISIS WHY PREVENTION IS BETTER THAN CURE A health check-up shows the burden of chronic disease is crippling our nation. About half of all Australians now have a chronic disease while 20% have multiple chronic diseases. It’s time we changed course to prioritise prevention, health promotion and early detection, while recognising the valuable contribution of nurses and midwives, to combat the skyrocketing incidence of chronic illnesses, writes Karen Keast.
W
hen Laurie West’s weight peaked at 198kg in his early 20s, he knew it was time to overhaul his lifestyle to change the course of his health. An Aboriginal descendant of the Kalkadoon tribe of Mount Isa, Queensland, Laurie says the high number on the scales rang alarm bells. “I looked in the mirror one day and remembered the medical history of my family and the genetics going on - my father had had a stroke, he’d also had a heart attack, my mother had a history of hypertension in the family, and we also had diabetes in the family,” he says. As one of just a handful of Aboriginal and Torres Strait Islander male registered nurses in Australia, Laurie knew he had to start practising what he preached to his Indigenous chronic disease patients. Laurie has since lost an astounding 102kg and now describes his health as “great”. He watches his diet and exercises daily from attending his morning workout at the gym to playing basketball and division one netball. For the past four years, Laurie practised as a regional nurse tackling chronic disease with the Institute for Urban Indigenous Health, where he worked across 18 sites in southeast Queensland along with sites in anmf.org.au
THE STATISTICS:
Gladstone and Hervey Bay. In this primary healthcare role, he was able to share his own story and discuss the importance of taking preventative measures for chronic disease with his patients. “They like a yarn when they come in. When you start sharing stories about - this is what’s gone on in my family, this is how I prevented it, they say - ‘oh, it can be done’. “I’ve had other patients in there who are doing really well with their health and progressed, and I’ve said to some of the other patients - ‘this is so and so and they’ve done really well’. “It’s not about getting out there and tooting my own horn, it’s about making sure the elders in each community that I worked in could see that it can be done, it’s about getting in that mental zone and having that thought process of ‘yeah I can do this’.” Laurie, who recently began working for the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM), says it’s crucial nurses and other health professionals take a holistic approach, looking beyond treating the diagnosis, in a bid to tackle high rates of chronic disease in Indigenous health. Laurie saw a need to utilise telehealth conferencing to enable his patients
and their family members to better connect with their team of health practitioners. He completed education on telehealth and introduced case conferencing. Case conferencing has improved the experience of patients using healthcare in more ways than one. It’s boosted communication between the patient, their family and practitioners and, most importantly, enhanced patient understanding. “Usually the patients want to get out of a consult as quick as they can just because they don’t really care anymore, they’ve heard all of the medical jargon and it confuses them,” Laurie says. “You get them into a case conference and you’re able to encourage them. You can say - ‘Aunty/Uncle, do you have any questions? Ask now.’ It’s those simple things that make them just want to look after themselves better.”
The burden of chronic disease
Chronic disease has been labelled the nation’s biggest health challenge. Australians may be living longer but major, and mostly preventable, lifestyle-related risk factors such as high rates of obesity, poor nutrition, alcohol consumption, smoking, and physical inactivity are contributing to greater levels of disease and
1 IN 2 AUSTRALIANS HAVE A CHRONIC DISEASE. _ CHRONIC DISEASES SUCH AS CARDIOVASCULAR DISEASE, CANCER AND DIABETES ARE THE LEADING CAUSE OF ILLNESS, DISABILITY AND DEATH IN AUSTRALIA. _ ALMOST ONE THIRD COULD BE PREVENTED THROUGH REMOVING EXPOSURE TO RISK FACTORS SUCH AS SMOKING, HIGH BODY MASS, ALCOHOL USE, PHYSICAL INACTIVITY AND HIGH BLOOD PRESSURE. _ ONLY 1.5% OF SPENDING, AS A PROPORTION OF TOTAL HEALTH EXPENDITURE, IS DEDICATED TO PREVENTION.
October 2016 Volume 24, No. 4 19
FEATURE
“SOME COUNTRIES ARE STARTING TO RECOGNISE THAT HEALTH POLICIES AND HEALTHCARE ACTUALLY NEEDS TO BE ABOUT KEEPING YOU HEALTHY, NOT DEALING WITH YOUR ILLNESS WHEN YOU’RE THROUGH THE DOOR, ALREADY UNWELL.” Rosemary Calder
disability, particularly for Aboriginal and Torres Strait Islanders, people in the lowest socio-economic groups, and those living in very remote areas. Australian Institute of Health and Welfare (AIHW) statistics show chronic diseases are the leading cause of illness, disability and death in Australia - responsible for 90% of all deaths in 2011. Chronic diseases are defined as longlasting with persistent effects, such as arthritis, asthma, musculoskeletal conditions, cancer, chronic obstructive pulmonary disease, cardiovascular disease, diabetes and mental health conditions. While Australia’s rates of chronic disease are surging, our nation is not alone. Chronic diseases kill 38 million people around the world each year, with three quarters of those deaths occurring in low and middle income countries. In 2011, Australia was one of 190 countries which agreed to the World Health Organization’s Global Action Plan for the Prevention and Control of Non-Communicable Diseases 2013-2020. The blueprint aims to achieve a 25% reduction in the number of noncommunicable disease deaths by 2025, outlining nine targets that focus on the main risk factors. In 2018, the UN General Assembly will hold a meeting to review the progress of countries around the globe.
Weak progress
The Australian Health Policy Collaboration (AHPC), a health policy think tank at Victoria University, has supported a national collaboration of 80 public health and chronic disease 20 October 2016 Volume 24, No. 4
organisations and experts to produce a report card on Australia’s progress towards achieving the WHO targets and a healthier Australia, titled Australia’s Health Tracker. AHPC says Australia is falling well behind comparable countries in tackling the risk factors for chronic disease. The tracker is a snapshot of how Australians measure up against targets for better health and reduced levels of preventable chronic disease in the population by 2025. It calls for a national prevention agenda, through political will, leadership and investment, for population-level policies and interventions that target common risk factors and determinants of chronic disease. The snapshot shows Australia has made poor progress in the percentage of children, young people and adults who are overweight or obese, and the percentage of adults with high blood pressure and diabetes. On the upside, Australia has made positive progress in tackling excessive alcohol consumption, smoking rates, and in improving levels of bowel and breast cancer screening. Rosemary Calder, AHPC Director, says Australia needs to shift its health and public policy to focus on prevention, early intervention and improving health. Ms Calder applauded New Zealand’s new strategic health plan that features a core message of ‘be well, stay well, get well’, for articulating that government has a responsibility to not only treat people who are already unwell but to ensure its people are
well. “Other countries are ahead of us in this. They are building, through funding models and through service models, much better focus on how to integrate acute and primary care, or acute and out of hospital care, for people with established risk and established disease. “Some countries are starting to recognise that health policies and healthcare actually needs to be about keeping you healthy, not dealing with your illness when you’re through the door, already unwell.” Ms Calder says the tracker points to the priority targets that governments must address to wind back escalating rates of chronic disease. “The options include better targeting of funding as well as new funding to increase prevention while still managing the consequences of today’s chronic disease burden but, most importantly, governments should provide leadership for the health sector to focus better on health improvement and chronic disease prevention. “We don’t always need new money to do different things. In fact, much of the issue won’t be new money, it will be doing what we’re doing a whole lot smarter with a much clearer expectation of the numbers that we must reach.”
Time for action
The Public Health Association of Australia (PHAA), one of the organisations involved in the collaboration behind Australia’s Health Tracker, has called on the Federal government to up the ante in the fight against chronic disease. It wants the government to introduce a sugar tax on soft drinks, a ban on alcohol advertising, and to continue its investment in the health star rating.
OUR HEALTH DIAGNOSIS THE RISK FACTORS OBESITY 63.4% OF NONINDIGENOUS ADULTS ARE OVERWEIGHT OR OBESE AND 71.4% OF ABORIGINAL AND TORRES STRAIT ISLANDER ADULTS ARE OVERWEIGHT OR OBESE _ 25.6% OF CHILDREN AGED 5-11 AND 29.5% OF YOUNG PEOPLE AGED 12-17 YEARS ARE OVERWEIGHT OR OBESE anmf.org.au
FEATURE Michael Moore, CEO of the PHAA and president of the World Federation of Public Health Associations, says the government only invests 1.5% into prevention for chronic diseases. While individuals ultimately have to take responsibility for their own health, Mr Moore says good government oversight is also imperative. He says governments should create an environment that’s conducive to enabling people to make healthier choices, much like government leadership in tobacco control or the successful implementation of seat belt regulations, which have dramatically improved road safety. “At the time, there was plenty of people who were saying - seat belts should be a personal choice, how you drive and the amount of speed you do should be a responsible choice, and we should only pick on people who are not driving safely,” he says. “There were all of those sorts of arguments around but good government stewardship combined with sensible personal responsibility is how we get the best outcomes.” Mr Moore says it’s time the government established an environment where eating the healthy choice is actually the easier choice. “When you are making a choice, and when you’ve been swamped with the sort of marketing we see at football games for example, then the healthy choice doesn’t come into your mind because you’re constantly having reinforced the junk food message for children and the alcohol message for adults.” Mr Moore says government regulation and price, such as taxation on soft drinks, creates a level playing field for individuals who are often bombarded with marketing from major food and alcohol companies. “We saw it with tobacco - price assists us with making a healthier choice and that’s why we are an advocate for a sugar tax. Information is helpful but price is a big lever, regulation is a big lever. “We believe that these are the levers that government have that they can use - and for a healthier society we want them to use them.”
National agenda
In May, the House of Representatives Health Committee released the report for its Inquiry into Chronic Disease Prevention and Management in Primary Health Care.
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The committee examined the prevention and management of chronic disease, funding models of care, the emerging role of Primary Health Networks, and the government’s plan to roll out the Health Care Homes model from July 2017. Some of the report’s key recommendations include growing the Practice Incentive Program to include breast, bowel and skin cancer screening and Integrated Health Checks, and expanding the My Health Record to support chronic disease prevention and management. In its submission to the committee, the Australian Nursing and Midwifery Federation (ANMF) outlined a raft of recommendations including strategies to increase the Aboriginal and Torres Strait Islander health workforce. It also called for improved funding, uncoupled from the GP, for both the Practice Nurse Incentive Program (PNIP) and for the Aboriginal Community Controlled Health sector. ANMF Federal Secretary Lee Thomas says while the government has introduced some programs to tackle chronic disease, much more needs to be done to target chronic disease prevention and management, particularly for Aboriginal and Torres Strait Islanders. “We really need to be doing way more in Closing that Gap,” she says. “It’s a very sad indictment that in 2016 we are still talking about this and we should be doing more in a culturally sensitive way to address the health inequalities that we have amongst Australia’s first peoples.” A National Strategic Framework for Chronic Conditions is now being developed to provide a national
“WHEN YOU ARE MAKING A CHOICE, AND WHEN YOU’VE BEEN SWAMPED WITH THE SORT OF MARKETING WE SEE AT FOOTBALL GAMES FOR EXAMPLE, THEN THE HEALTHY CHOICE DOESN’T COME INTO YOUR MIND BECAUSE YOU’RE CONSTANTLY HAVING REINFORCED THE JUNK FOOD MESSAGE FOR CHILDREN AND THE ALCOHOL MESSAGE FOR ADULTS.” Michael Moore
approach to guide the planning, design and delivery of policies, strategies, actions and services to tackle chronic disease in Australia. The framework, which will supersede the National Chronic Disease Strategy 2005, is expected to be released later this year.
Nurses at the frontline
The rising incidence of chronic disease is placing greater demand on the nation’s healthcare system, from increasing the number of ‘frequent flyer’ presentations at emergency departments to longer length of stays in hospitals. With most people in residential aged care living with chronic disease, Ms Thomas says chronic illnesses are also taking a toll on nurse workloads. “We always say there’s a way that we can work out the right number of nurses to the number of patients in our public hospitals, depending on how acute the patient’s illness is, but of course we don’t have that in aged care. The increasing burden of chronic disease is impacting the ability of our nurses to be able to provide good care because of workload management issues.” Changing how we manage chronic disease is crucial. Ms Thomas says there’s a need for greater investment in ‘front-end’ prevention, health promotion and early intervention which will significantly reduce the need for expensive and reactive ‘back-end’ management strategies. Nurses and midwives are combatting chronic disease in a range of primary healthcare roles, such as school nurses, nurses in general practice, community health nurses, maternal and child health nurses, eligible midwives, and nurses working in rural and remote communities.
OUR HEALTH DIAGNOSIS THE RISK FACTORS PHYSICAL INACTIVITY 44.5% OF ADULTS FAIL TO MEET PHYSICAL ACTIVITY RECOMMENDATIONS _ 70.8% OF NON-INDIGENOUS AND 40.5% OF INDIGENOUS CHILDREN AGED 5-11 YEARS FAIL TO MEET PHYSICAL ACTIVITY RECOMMENDATIONS 91.5% OF NON-INDIGENOUS AND 65.2% OF INDIGENOUS YOUNG PEOPLE AGED 12-17 YEARS FAIL TO MEET PHYSICAL ACTIVITY RECOMMENDATIONS
October 2016 Volume 24, No. 4 21
FEATURE Ms Thomas says Nurse Practitioners (NPs) also provide a service that with more government support, such as designated public sector NP positions, particularly in rural and remote communities, and ‘request and refer’ access to the Medicare Benefits Schedule (MBS), could redefine how we deliver chronic disease management. “Nurse practitioners have the ability to diagnose and treat and that is an extraordinarily important feather in the bow of primary healthcare and its ability to be able to treat chronic illnesses.” A range of prevention and management models are driving best practice in the chronic disease field, from nurse clinics to the Mental Health Nurse Incentive Program (MHNIP) and community-based specialist nurses, including the Parkinson’s nurse model. Other models, including a unique NP model and a multidisciplinary team model, are also working to tackle chronic disease head-on.
Novel NP model
An Integrated Chronic Disease Nurse Practitioner (ICDNP) service is changing the way people receive care for multiple chronic diseases in southeast Queensland. The NP model, believed to be a world-first, bucks the normal management journey of chronic disease, which traditionally involves patients attending several outpatient clinics, each focused on managing individual diseases. With heart failure, chronic kidney disease and diabetes interrelated and often co-occurring, this NP community-based model of care for patients with at least two of those chronic diseases aims to reduce the fragmentation of healthcare and prevent the cycle of hospital readmissions. Under the initiative, Logan Hospital NPs Cassandra Stone (nephrology), Maureen Barnes (heart failure) and Jennifer Abel (diabetes) collaboratively deliver integrated care to patients through regular, close follow-ups and home visits. The three NPs also partner with medical specialists and GPs.
INTERGRATED CHRONIC DISEASE NURSE PRACTIONER SERVICE
the NPs provide specialised care, self-management strategies and education to patients in the 45-60 minute-long appointments.
amid plans to grow it into a fulltime service. The model can be replicated anywhere in Australia and globally, she says.
“What mostly happens with chronic disease is not only is the disease process there, but you have lifestyle risks that need modification,” she says.
“I think we should be looking at more NPs being utilised in chronic disease - it’s a valued area that NPs can be leaders in really and that’s what our integrated service is showing.”
“To get a patient to come on board with that it does require that longer appointment time, input and support for the patient, and what we’re trying to teach patients is self-management. Because each of the disease processes and medication management can be affected by the other conditions, working together we very closely monitor their medications and adjust them, so that each medical condition is looked at, at the same time.” Queensland University of Technology (QUT) evaluated the first year of the service, labelling it a resounding success. Its review showed 55 patients attended 258 appointments, while the program received extremely positive patient and stakeholder feedback. “Most of the patients did not present to the ED or require admission as an inpatient,” the report states. “Those patients that did present to the ED had heart failure, and due to the NP referral documentation, ED were advised to admit straight into the hospital in the home service; thus further avoiding an inpatient admission.”
The innovative service began one day a week in June 2014, with outreach clinics held at Meadowbrook Primary Care Practice and at Beaudesert.
In one of seven recommendations, the evaluation team called for Logan Hospital to continue the service and consider expanding it to patients with other chronic diseases, such as respiratory or mental illness.
Ms Stone, who began working in chronic disease 10 years ago, says
Ms Stone says while funding has stalled, the service has continued
22 October 2016 Volume 24, No. 4
The clinic has its fair share of patient success stories. Since attending the service, a 65-year-old female heart failure patient with type 2 diabetes and stage four chronic kidney disease, who had received a poor prognosis from her cardiologist, has lost 30kg and now has a new lease on life. “Her quality of life has improved so much that she is out dancing, gardening and enjoying life fully so she’s a fabulous example of what we’ve been able to achieve as a group of NPs,” Ms Stone says.
A team approach
In Victoria, specialist nurses are working as part of multidisciplinary teams to prevent and manage chronic disease in the community. The Health Independence Program (HIP) provides a suite of holistic services to support patients’ transition from hospital to home while it also supports people with complex issues living in the community, at home or in an ambulatory setting. The Werribee Mercy Hospital introduced HIP several years ago, merging five teams comprising 30 health professionals, including a diabetes nurse educator, respiratory nurse, chronic heart disease nurse, emergency nurse, mental health nurse and a continence nurse coupled with physiotherapists, dietitians, occupational therapists and allied health assistants.
OUR HEALTH DIAGNOSIS THE RISK FACTORS DIET AUSTRALIAN ADULTS ON AVERAGE CONSUME 62% OVER THE RECOMMENDED SALT INTAKE WITH 8.1G THE AVERAGE DAILY CONSUMPTION OF SALT _ 47.8% OF ADULTS, 70.3% OF CHILDREN AGED 9-11 YEARS, AND 73.1% OF YOUNG PEOPLE AGED 14-18 YEARS CONSUME TOO MUCH SUGAR _ THE PROPORTION OF TOTAL ENERGY INTAKE FROM JUNK FOODS IS 34.6% FOR ADULTS, 39.4% FOR CHILDREN AGED 9-13 YEARS, AND 40.7% FOR YOUNG PEOPLE AGED 1418 YEARS _ 18.2% OF ADULTS DRINK AT RISKY LEVELS, AND 6.4% OF YOUNG PEOPLE AGED 1217 BINGE DRINK anmf.org.au
FEATURE as important as the doctor or as the physiotherapist. You play an important role.” While multidisciplinary care is essential to target escalating rates of chronic disease, Professor Halcomb says nurses can work with patients and community groups to provide a more tailored service. “It’s about engaging with those particular people and working out what suits them, what do they need rather than trying to have a one-size-fits-all approach.”
“REFLECT ON YOUR ROLE IN WHATEVER CHRONIC DISEASE MANAGEMENT SETTING YOU’RE WORKING IN AND IDENTIFY WHAT YOUR CONTRIBUTION TO HEALTHCARE CURRENTLY IS.” Elizabeth Halcomb
HIP manager and registered nurse Brigitte Grant says the program is effective in reducing health service utilisation, such as avoidable admissions, while increasing healthy behaviours. Ms Grant says the program manages the physical, emotional and social impact of conditions, and works to improve the overall health status of patients. The program often has a major impact on patients’ lives. “Clients are referred to the program for a certain problem out of the acute system, and it is like opening Pandora’s Box. Because we have more time to see people, between three to nine months depending on their needs, it often enables them to open up and let you know what is actually really going on. It’s often not the reason that they are referred for - that’s where the complexity comes through.”
Nurse research
Dr Elizabeth Halcomb, Professor of Primary Health Care Nursing at the University of Wollongong, has worked in research around chronic disease for more than a decade on a range of projects, from evaluating nurse-led interventions for smoking cessation and hypertension management in general practice, to exploring chronic disease self-management in Australian grey nomads and the health and support needs of people living in mobile home villages. While nurses are taking a lead role on the chronic disease frontline, Professor Halcomb’s research shows there is still room for improvement. She says gains can be made in building the multidisciplinary team in primary healthcare. “While there’s many more general practice anmf.org.au
nurses than there were 10 years ago, GPs and nurses are still not at a stage where they are working as collaboratively as they could. “It’s just about having those open, transparent conversations around what you perceive your role to be, what your scope of practice is, and how you can work together. It sounds pretty simple but it’s quite complex, particularly in general practice, because the GP you’re working with as a colleague is also your employer.” Professor Halcomb, a registered nurse, says many nurses fail to have a strong identity of their major contribution to healthcare. “All too often, nurses adopt the attitude of ‘I’m just a nurse’. You’re not just a nurse - you’re a health professional who is just
As Australia strives to more effectively combat the biggest health challenge of the 21st century, nurses will increasingly play a crucial role in not only how chronic disease is managed but in championing a stronger spotlight on prevention, health promotion and early detection. It’s important nurses optimise their role, ensuring they work to the full extent of their scope of practice to tackle chronic disease, Professor Halcomb says. “Reflect on your role in whatever chronic disease management setting you’re working in and identify what your contribution to healthcare currently is,” she advises. “Reflect on how you could contribute within your scope of practice, and think about how you can then develop your role within your scope to be as fulfilling as you want it to be. Most importantly, be proud of that role and articulate what you do to others.”
OUR HEALTH DIAGNOSIS THE RISK FACTORS SMOKING 12.8% OF AUSTRALIANS AGED 14 AND OVER ARE DAILY SMOKERS _ 4% OF NON-INDIGENOUS YOUNG PEOPLE AGED 1517 YEARS SMOKE DAILY AND 18% OF INDIGENOUS YOUNG PEOPLE AGED 15-17 SMOKE DAILY _ 23.5% OF ADULTS WITH MENTAL ILLNESS SMOKE DAILY HEALTH 23% OF ADULTS HAVE HIGH BLOOD PRESSURE 32.8% OF ADULTS HAVE HIGH CHOLESTEROL _ 4.7% OF ADULTS AGED 25-65 HAVE DIABETES _ SOURCE: AUSTRALIA’S HEALTH TRACKER 2016, AUSTRALIAN HEALTH POLICY COLLABORATION (AHPC). _ HTTPS:// WWW.VU.EDU. AU/AUSTRALIAN-HEALTH-POLICY-COLLABORATION/ PUBLICATIONS#GOTO-AUSTRALIAS-HEALTHTRACKER=1
SPECIALIST NURSES AT THE HEALTH INDEPENDENCE PROGRAM October 2016 Volume 24, No. 4 23
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DANCING IN MY DREAMS:
Confronting the spectre of polio BY KERRY HIGHLEY ISBN: 978-1-22235-84-8
An entire generation has lived free from the spectre of polio, but for 50 years during the 20th century that fear was overwhelming, with polio triggering panic and survivors of the disease often finding they faced a world unkind to their disability. In pre-Second World War Australia, polio treatment methods were fiercely debated and caused rifts among some sections of the medical community and those advocating alternative therapies. Kerry Highley’s Dancing in my Dreams identifies the polio disease and its treatment, charting the scientific endeavour that led to the discovery of the poliovirus, and studies in virology and immunology that culminated in the production of a polio vaccine. The book highlights the experiences of patients and the voices of survivors, revealing how ethnicity, class, age and gender affected an individual’s reaction to the disease. Despite vaccination programs initiated by the World Health Organization, polio has not been eliminated globally, and remains present in three countries – Nigeria, Pakistan and Afghanistan.
24 October 2016 Volume 24, No. 4
LISTENING, LEARNING, CARING & COUNSELLING:
The Essential Manual for Psychologists, Psychiatrists, Counsellors & Other Healthcare Professionals on Caring for Their Clients
DIET PROOF YOUR KIDS:
What Every Parent Should Know About Raising Happy and Healthy Children BY: LISA RENN PUBLISHER: NOBLE WORDS
FEED YOUR BRAIN: 7 Steps to a Lighter, Brighter You!
BY DELIA MCCABE PUBLISHER: EXISLE PUBLISHING PTY LTD ISBN: 978-1-925335-11-8
ISBN: 978-0-9944106-0-3
BY DR CATE HOWELL OAM, CSM, PHD (MED.) PUBLISHER: EXISLE PUBLISHING PTY LTD ISBN: 978-1-925335-04-0
A highly accessible reference work full of ideas and techniques, Listening, Learning, Caring & Counselling emphasises ways in which health professionals can help clients as they navigate through common issues such as depression, relationship issues, trauma, anxiety, anger, and grief. At the centre of any professional caring role lies the capacity to listen attentively and empathetically to the concerns and needs of others. The book describes numerous therapies within its core approach, while case studies, and skills and tips for everyday practice, are also included as a practical and userfriendly resource. It provides a toolbox of evidence-based therapies and demonstrates how an integrative approach can work and information about selfcare for professionals dealing daily with mental health issues, and provides trigger questions to help improve ‘Bedside manner’ and a more holistic view of the carer/client relationship.
With more than one in four kids between five and 14 years overweight or obese, childhood obesity is a growing problem in Australia. The author, Lisa Renn, says dieting doesn’t work. “Dieting is the single most important risk factor for eating disorders and a huge predictor of future weight gain.” Diet Proof Your Kids: What Every Parent Should Know About Raising Happy and Healthy Children is a guide to setting up kids with good healthy eating habits. Renn’s top three messages are to ditch the diets; for parents to examine their own relationship with food; and to de-stress the food environment. Parents are the ultimate role models and need to model the eating behaviour and relationship they want to see in their children. “Kids copy parents, simple,” she says. The book includes the inspirational stories of six top Australian athletes who have struggled with body image including former swimming Paralympian Jessica Smith. The book includes steps to turning around body image.
With a worldwide ageing population, the need to look after one’s brain optimally has never been more important. Just like an athlete training for a marathon, people’s brains need very specific nutritional requirements, in order to function optimally. Feed Your Brain offers the ultimate guide to getting your brain in shape and keeping it healthy via the foods you eat. It asserts that by simply enjoying a diet rich in the right nutrients it can be possible to improve focus and memory, reduce stress and anxiety, and think more clearly. Delia McCabe offers a self-help guide to modifying eating habits and addresses key areas including sleep, food intolerances, why your brain needs protein to communicate effectively, and how best to fuel your brain. The book also features recipes that form the basis of the new diet.
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ETHICS
THE HARMS OF HATE SPEECH Megan-Jane Johnstone
In 2009, Andrew Bolt, an Australian journalist and right wing columnist, published two articles in the Herald-Sun in which he impugned the identity and authenticity of ‘fair skinned’ Aboriginal people. His articles conveyed the offensive messages that fair-skinned Aboriginal people ‘were not genuinely Aboriginal and were pretending to be Aboriginal so they could access benefits that are available to Aboriginal people’ (http:// www.austlii.edu.au/cgibin/sinodisp/au/cases/cth/ FCA/2011/1103.html). Bolt’s views were later successfully challenged in the Federal Court of Australia, which found that his public comments contained ‘erroneous facts, distortions of the truth and provocative language’ and, under the Commonwealth Racial Discrimination Act (RDA) 1975, were unlawful. The Bolt case did not end with this finding, however, and was to have an ‘ironic aftermath’ (see http:// www.austlii.edu.au/au/journals/ MelbULawRw/2015/5.html): rather than silencing his hate speech, the case galvanised public debate on the right to freedom of speech and whether hate speech should ever be restricted. Of particular note was the (ultimately unsuccessful) campaign to amend section 18C of the RDA, specifically to remove the words ‘offend’, ‘insult’, and ‘humiliate’ from the Act (Johnstone, 2014).
A question of nursing ethics References Gelber, K & McNamara, L. 2015. The effects of civil hate speech laws: lessons from Australia. Law & Society Review, 49(3): 631-664. Gelber, K & McNamara, L. 2016. Evidencing the harms of hate speech. Social Identities, 22(3): 324-341. Johnstone, M-J. 2014. Bigotry and racial discrimination. Australian Nursing and Midwifery Journal, 22(2): 27. Williams, P. 1991. The alchemy of race and rights. Harvard University Press, Boston.
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In light of the current political climate which is seeing the legal regulation of hate speech being increasingly challenged by right wing conservatives, it is important that nurses understand what hate speech is and why it warrants particular attention as an ethical issue of relevance to the nursing profession.
Defining hate speech
There is currently no single legal definition of hate speech in Australian jurisdictions. Nonetheless, there is general agreement that the term ‘hate speech’ involves an expression (via words, symbols, pictures, gestures, conduct, moving images, etc.) that vilifies and incites prejudice
towards and the marginalisation of individuals or groups on the basis of their personal characteristics such as race, ethnicity, religion, and sexual orientation. Hate speech has also been characterised as a form of ‘spirit murder’ on account of it expressing a profound ‘disregard for others whose lives qualitatively depend on our regard’ (Williams, 1991, p73). Hate speech commits spirit murder by producing ‘a system of formalised distortions of thought’ and ‘social structures centred on fear and hate’ (Williams, 1991, p73).
Harmful effects of hate speech
Hate speech expresses much more than mere ‘ordinary’ dislike or disagreement. It encompasses the expression of ‘extreme’ detestation, abhorrence and hatred that fosters a hostile environment manifest as harassment, intimidation, fear, discrimination and violence towards those targeted. The harmful effects of hate speech are well documented and supported by empirical evidence and thus stand as being much more than a philosophical issue (Gelber & McNamara, 2016). Research has shown, for example, that hate speech can directly harm the physical and mental health of those targeted, assault their dignity and worth as human beings and, in environments that are hostile to their legitimate vital interests, subordinate and silence them as inferior and threaten their security and capacity to carry out their daily lives without harassment. Hate speech is harmful in other more general ways as well: it persuades onlookers to believe the stereotypes being promulgated and to engage in other harmful conduct with impunity; and it creates a culture and climate in which hate speech acts are normalised, defended, and even justified (Gelber & McNamara, 2016).
Regulating hate speech
In Australia the enactment of hate speech laws have primarily been driven by: concerns about the circulation of hate speech by extreme right wing organisations; the documented accounts of ‘disturbing levels of racism directed at ethnic minority and Indigenous communities’; and an increase in the prevalence of public acts of homophobic violence against members of the LGBTI community (Gelber & McNamara, 2015, pp 6345). These concerns have not stopped those opposed to the regulation of hate speech from promoting their fears and fallacious arguments,
notably, that such regulation will devastate liberty and the democratic right to free speech (which, incidentally, has never been absolute), stifle public debate on controversial issues, suppress the discovery of knowledge and truth, and silence necessary dissent. However recent Australian research suggests these fears are unfounded and that hate speech laws can have the following positive effects: • provide a remedy for the individuals and groups who have been personally assaulted or placed at significant risk of prejudice and discrimination by hate speech acts; • proscribe incivility which, rather than silencing discussion on controversial subjects, encourages a more respectful, decent and constructive discussion of them; • educate the public and influence public behaviour by publicly expressing a commitment to upholding people’s dignity; • help to deter people from engaging in harmful behaviours (Gelber & McNamara, 2015, pp 638-640). It is acknowledged that hate speech laws might have the unintended consequences of ‘creating martyrs’ (hate speakers who use the regulatory system to claim they are being unfairly silenced by the state). Even so, the creation of such individuals in Australia is rare. The Bolt case (referred to above) is an example. Ironically, despite claiming to have been silenced by hate speech laws, Bolt was nonetheless able ‘to disseminate his views widely through prominent media attention’ (Gelber & McNamara, 2015, p656). Previously in this column (Johnstone, 2014) nurses were reminded of their professional obligation to take appropriate action in cases where the health, safety and care of people are placed at risk by the prejudicial, discriminatory and hateful behaviours of others. This applies to hate speech. The profession cannot stand idly by as hate speakers, who seek to sadistically express their unfettered hatred toward those they dislike, disrupt the civility, health and peaceable bonds of our society.
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. October 2016 Volume 24, No. 4 25
CLINICAL UPDATE
USING ADENOSINETRIPHOSPHATE BIOLUMINESCENCE TO VALIDATE DECONTAMINATION FOR DUODENOSCOPES Elizabeth Gillespie, William Sievert, Michael Swan, Carryn Kaye, Isla Edridge and Rhonda L Stuart
Abstract: Reports of outbreaks involving Carbapenemase resistant Enterobacteriaceae have been associated with gastrointestinal endoscopy. We used Adenosinetriphosphate (ATP) bioluminescence to demonstrate cleanliness prior to Endoscopic Retrograde Cholangiopancreatography (ERCP). We compared ATP testing with microbiological monitoring for 40 duodenoscopes. ATP testing of duodenoscopes prior to ERCP procedures provided a timely marker of safety and quality.
26 October 2016 Volume 24, No. 4
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CLINICAL UPDATE Introduction
Following the recent reports of outbreaks involving Carbapenem resistant Enterobacteriaceae associated with gastrointestinal endoscopy, (Epstein et al. 2014; Kola et al. 2015; Muscarella, 2014) we commenced a study using Adenosine Tri-Phosphate (ATP) to demonstrate validation of decontamination. The outbreaks were associated with deficiencies such as inadequate cleaning, inappropriate disinfection and damaged duodensocopes, flaws in the design of the endoscopes or automated flexible endoscope reprocessors (AFER). In 2007, Monash Health conducted a review of five years of microbiological testing when using the GESA guidelines. (GESA, 2010; Gillespie et al. 2008) This review demonstrated that the testing cost AUD$100,000 and that quality assurance for endoscopy would be better achieved through process controls. This involved strict adherence to cleaning procedures and ensuring all reprocessing staff met credentialing requirements. Some studies have investigated using ATP as a quality assurance measure for endoscope cleaning. (Batailler et al. 2015; Alfa et al. 2013; Fernando et al. 2014) The capacity of ATP as a marker for cleanliness is feasible since ATP is present in organic residue. The aim of this study was to develop a reliable and user friendly method for monitoring the cleaning of duodenoscopes prior to ERCP.
Materials and methods
Our study was conducted at Monash Health, Melbourne Australia in the Endoscopy Suites at Monash Medical Centre, Clayton (MMC) and Dandenong Hospital. Monash Health is Victoria’s largest health service with a catchment population of 1.34 million residents in south-east Melbourne. Almost 10,000 endoscopic procedures are undertaken across both suites. Of these, 500 Endoscopic Retrograde Cholangiopancreatography (ERCP) procedures are performed at MMC and 100 ERCP procedures at Dandenong Hospital. Both endoscopy suites at Monash Health are fitted with Medivator Advantage Plus™ automated flexible endoscope reprocessors, which use peracetic acid as the high level disinfectant, and have been in use for 18 months. There are two AFER units at Clayton and one AFER unit at anmf.org.au
Dandenong. All nursing and technical staff working in the Endoscopy Suites undertake annual credentialing for cleaning of endoscopes and reprocessing competency. They are supported with additional professional development to ensure that their skills and expertise are maintained. Twenty ERCP procedures at MMC followed by 20 ERCP procedures at Dandenong were included. Each duodenoscope was tested using ATP just prior to the commencement of the ERCP procedure. The sample collected was then sent to the laboratory for microbiological testing. During the set up for the ERCP, 20 ml of sterile 0.9% saline was flushed through all duodenoscope channels, using an aseptic technique. The flushing fluid was collected in a small sterile specimen container. The tip of the duodenoscope was immersed into the flushing fluid so that the recess with the cannula elevator was fully immersed. The cannula elevator was activated to open and close a minimum of five times before the end of the duodenoscope was removed from the container with the flushing fluid. An ATP surface test swab was taken of the flushing fluid, following the manufacturer’s instructions for activation and use (3M clean trace, 2016). The ATP surface test is activated and the swab is brought into contact with the test enzyme solution (luciferin-luciferase). The enzyme reacts with any ATP residue present on the swab bud. A product of this reaction is the generation of light by the enzyme solution. The ATP swab is placed in the luminometer which produces a result expressed in Relative Light Units (RLU). The greater the level of ATP present on the swab, the higher the RLU level produced. Immediately following ATP testing, the specimen container of flushing fluid was sent to the microbiology laboratory for routine endoscope microbiological testing. To provide context to ATP readings, the first two ERCP procedures also included ATP testing, before and after cleaning. The company providing the sample swabs and luminometer were requested to issue swabs with the longest expiry date possible (at least 12 months). This was aimed at reducing the risk of false positive ATP results as identified previously (Fernando et al 2014).
Results
ATP values were low in two previously cleaned and stored duodenoscopes and significantly elevated (levels above 1,000 RLU) in both endoscopes
following an ERCP procedure but prior to cleaning (Table 1). Of the 40 microbiological cultures, the RLU range at MMC was 1-27 RLU and at Dandenong the range was 3-17 RLU. There was no growth of pathogenic bacteria (Table 2). We estimated that each test using ATP and the collection of the microbiological sample added an additional 5 – 15 minutes to the preparation procedure for ERCP.
Discussion
With the recent reports of outbreaks of carbapenem resistant Enterobacteriaeceae (Epstein et al. 2014; Kola et al. 2015; Muscarella, 2014) we used ATP testing to assess duodenoscope cleaning prior to ERCP. We did not find elevated ATP values in cleaned endoscopes nor any bacterial growth. We had planned to use a cut-off value of 100 RLU based on the study by Fernando et al. (2014). The results of our study suggest, for our setting, a cut off at 50 RLU would reflect the cleaning conditions achievable. A recently published study from France examined samples from 165 endoscopes. However, ATP levels did not exceed 40 RLU, despite levels of microbiological contamination of >1,000 CFU (Batailler et al. 2015). ATP swabs must be stored at temperatures between 2 to 8 deg C as swabs become unstable after 28 days, if stored at room temperature. The manufacturer also recommends that storage temperatures should not exceed 21 deg C to avoid inconsistent or unreliable results. Inconsistent results were reported by Fernando et al. (2014) and Batailler et al (2015). In our own previous experience during surveillance of environmental surfaces, we also found that swabs were most reliable if they had a long expiry date and were stored at 4 deg C (Gillespie et al 2012). Testing using ATP, just prior to use, has the disadvantage of adding 5 – 15 minutes to the preparation for the procedure. This time would need to be considered when coordinating the workflow in a busy Endoscopy Suite. Microbiological testing of endoscopes has a number of disadvantages, including cost (AUD$30 per sample at Monash Health), detection of skin contaminants, delay in finalising results (routinely 7 – 10 days at Monash Health) and the need to quarantine endoscopes until microbiological results are available; these factors can adversely impact delivery of patient care.
References Alfa, M. Fatima, I. Olson, N. 2013. The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels American Journal of Infection Control. 41:249-53 Batailler, P. Saviuc, P. Picot-Gueraud, R. Bosson, J-L. Mallaret, M-R. 2015. Usefulness of adenosinetriphosphate bioluminescence assay (ATPmetry) for monitoring the reprocessing of endoscopes Infect Control Hosp Epidemiol. 36:1437-1443 Epstein, L. Hunter, J. Arwady, A. Tsai, V. Stein, L. Gribogiannis, M. Frias, M. Guh, A. Laufer, A. Black, S. Pacilli, M. Moulton-Meissner, H. Rasheed, K. Avillon, J. Kitchel, B. Limbago, B. MacCannell, D. Lonsway, D. Noble-Wang, J. Conway, J. Conover, C. Vernon, M. Kallen, A. 2014. New Delhi Metallo--lactamaseproducing CarbapenemResistant Escherichia coli associated with exposure to duodenoscopes. Journal of American Medical Association. 312:1447-55 Fernando, G. Collignon, P. Beckingham, W. 2014. ATP bioluminescence to validate the decontamination process of gastrointestinal endoscopes. Healthcare Infection. 19:59-64 Gastroenterological Society of Australia. Infection control in endoscopy Third Edition Mulgrave, Victoria, Australia 2010
October 2016 Volume 24, No. 4 27
CLINICAL UPDATE
ATP results are available within 10 seconds and the cost of AUD$5 per swab makes ATP a practical consideration for cleaning assessment of duodenoscopes.
wish to acknowledge the assistance provided by 3M with the supply of the luminometer and ATP swabs to conduct this trial. These were supplied at no cost.
Michael Swan is a Gastroenterologist at the Gastroenterology and Hepatology unit.
Conclusion
Conflict of interest: All authors report no conflict of interest relevant to this article.
Carryn Kaye is Associate Nurse Unit Manager at the Dandenong Hospital Endoscopy suite.
In light of recent reports of infection transmitted via duodenoscopes, further study of ATP prior to commencing an ERCP is warranted. Obtaining a reliable reading just prior to the ERCP procedure has the potential to provide assurance that the equipment is safe to use if quality and safety parameters have been met. ATP testing may have application for monitoring all endoscopes, potentially replacing microbiological testing regimens. Acknowledgements: The authors
Financial support: Nil Elizabeth Gillespie is Sterilization and Infection Control Co-Director Infection Control and Epidemiology unit. William Sievert is Professor at Faculty of Medicine, Nursing and Health Sciences, Monash University and Director, Gastroenterology and Hepatology unit.
Isla Edridge is Nurse Unit Manager at Clayton Endoscopy suite Rhonda L Stuart is Associate Professor, Faculty of Medicine, Nursing and Health Sciences, Monash University, Infection Control Co-Director – Medical Infection Control and Epidemiology unit. All are at Monash Health
Table 1: Results of before and after testing from the first 2 ERCP procedures Before procedure (after cleaning and storage) After procedure (before cleaning) Scope 1
5 RLU
3,572 RLU
Scope 2
1 RLU
1,182 RLU
Table 2: The results of the microbiological testing and ATP mean and range results Site
Microbiological results
ATP range
ATP mean results
Clayton
No growth or <10 cfu skin flora
1-27 RLU Median = 14
6.5 RLU
Dandenong
No growth or <10 cfu skin flora
3-17 RLU Median = 10
5.8 RLU
28 October 2016 Volume 24, No. 4
Median
Gillespie, E. Kotsanas, D. Stuart, R. 2008. Microbiological monitoring of endoscopes: 5-year review. Journal of Gastroenterology and Hepatology. 23:1069-74 Gillespie, E. Scott, C. Wilson, J. Stuart, R. 2012. Pilot study to measure cleaning effectiveness in health care. American Journal of Infection Control. 40:477-8 3M clean trace user manual http:// multimedia.3m. com/mws/ media/919873O/3mcle an-trace-ngiluminometer-anddocking-stationuser-manual.pdf (last accessed May 2016) Kola, A. Piening, B. Pape, U. VeltzkeSchliefer, W. Kaase, M. Geffers, C. Weidenmann, B. Gastmeier, P. 2015. An outbreak of OXA-48producing Klebsiella pneumonia associated to duodenoscopy. Antimicrobial Resistance and Infection Control. 4:8-12 Muscarella, L. 2014. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related ‘superbugs” during gastrointestinal endoscopy. World Journal of Gastroenterology. 16:457-474
anmf.org.au
RESEARCH
RISK OF HOUSING SLUMS RETURN More than one million Australians are living in sub-standard housing, with many at risk or in poor health, research shows. People with an existing illness or disability were almost twice as likely to live in very poor housing as those without disability or illness. Findings of South Australian research of national data were published in the Journal of Prevention & Intervention in the Community. University of Adelaide Associate Professor Emma Baker said the scale of the findings was surprising. “We assume there is good quality housing in Australia but there is a sizable hidden fraction living in poor housing. We found that one million Australians are living in poor or very poor quality housing.” Public housing only accounted for about 3.5% of housing in Australia, Professor Baker said. “Public housing was not too bad as there is an obligation for housing to meet minimum standards. It was mostly private renters.” More than 100,000 Australians lived in housing regarded as very poor or derelict. “It was mostly those with poor health, disabilities, private renters and elderly people – those who probably need good housing more so,” Professor Baker said.
POOR PSYCH SERVICES FOR AGED CARE RESIDENTS Access to psychologists and psychological services remains poor within Australian residential aged care facilities, a new study has found. Undertaken by the Swinburne University of Technology in conjunction with a team of Australian research institutes, the study found aged care residents were rarely referred to psychologists for treatments. Swinburne psychology Associate Professor Sunil Bhar said chronically ill people were more prone to depression and anxiety but that a low availability in psychologists specialising in treating older adults, coupled with a lack of government funding and insufficient staff training to detect depression and anxiety, had created barriers to accessing appropriate treatment. The study involved 90 senior staff from a random sample of residential aged care facilities across Australia answering questions regarding their perspective on the availability of psychological services to form the results.
The key issue with poor quality housing was its impact on people’s health and wellbeing, Professor Baker said.
The first of its kind to investigate the accessibility of psychological services for older residents living in residential aged care facilities, the study proposed access to services could be improved by developing a workforce of clinical psychologists specialising in older clients, boosting funding, and improving staff knowledge about depression and anxiety.
“Poor housing makes the already disadvantaged even worse off. We know that damp, cold or mould in homes can cause or exacerbate respiratory illnesses like asthma and overcrowding can promote communicable disease.”
“Our aspiration is for residential aged care settings to employ mental health professionals such as psychologists and social workers to work with residents and provide training and support to staff,” Professor Bhar said.
Living in poor quality housing had been linked to anxiety, depression and other mental health conditions, she said.
DISTINGUISHING INFECTIONS IN CHILDREN Researchers from the University of Queensland and the Imperial College London have developed a method to distinguish viral and bacterial infections in children that could save lives and reduce unnecessary antibiotic use. Associate Professor Lachlan Coin, from the Centre for Superbug Solutions at UQ’s Institute for Molecular Bioscience, said bacterial and viral infections were often difficult to tell apart. “Most children with a fever have a self-resolving viral infection like a flu, but a small number have lifethreatening bacterial infections such as meningococcal disease.” The study analysed gene patterns in the blood of children presenting with a fever at various hospitals in the United Kingdom, Spain, the Netherlands, and the United States between 2009 and 2013 and discovered two genes that could distinguish bacterial infections from other causes of fever. The method will help prevent the unnecessary prescription of antibiotics to children with viral infections while ensuring dangerous bacterial infections don’t go undetected. Professor Coin warned that multidrugresistant bacteria, or superbugs, were of serious concern. “Unless we tackle this problem, by 2050 superbugs could be claiming the lives of 10 million people each year. “Over-prescription of antibiotics is significantly contributing to the rise of superbugs, so this discovery is a major breakthrough in this serious global challenge.” The biomarker discovered also has the potential to diagnose other childhood diseases such as lupus and juvenile arthritis. The research team will now seek to translate its discovery into clinical tests suitable for use in hospitals.
“We believe governments need to take steps to ensure the supply of affordable and reasonable quality housing, otherwise we are destined to become a nation scarred once again by slums, reduced life chances and shortened lives.”
anmf.org.au
October 2016 Volume 24, No. 4 29
HEALTH TIMES UPDATE
HealthTimes UPDATE
HOW MIDWIVES ARE REDUCING FEAR OF CHILDBIRTH By Karen Keast, provided by Whether it’s dramatic childbirth scenes on the screen, the effects of sex abuse, or women sharing their birth horror stories, fear is having a major impact on the way some women give birth. Researchers are now working to conquer women’s fears through midwifery-led counselling. Midwives are delivering counselling to reduce the fear of childbirth in pregnant women as part of a pioneering initiative designed to improve birth outcomes. In what’s believed to be an Australian first, more than 20 midwives at the Gold Coast University Hospital have completed counselling training, and are now screening women for fear of childbirth and delivering counselling to reduce women’s fears. The Griffith University-led research initiative comes after an earlier trial showed an antenatal midwife-led psycho-education intervention reduced women’s fears, resulting in lower rates of caesarean section. Professor Jenny Gamble, a leading researcher with Griffith’s Menzies Health Institute Queensland and a midwife of more than 30 years, says high levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbeing for about one in five women.
Under the Queensland Health-funded implementation study, the intervention was rolled out this year coupled with the introduction of new parenting education classes to target reducing fear in childbirth. Midwives participated in three days of workshops followed by competencybased assessments. Midwives now use a simple screening tool, the Fear of Birth Scale, developed by Australian academic Dr Helen Haines, as part of routine practice. Professor Gamble says the counselling intervention is woman-led, with midwives responding to the woman’s identified needs while providing evidence-based information. “It’s quite important for the midwife counsellor to make sure that we hear what
“Sometimes they just really need to have a clear understanding of what they are choosing, and why and how it connects with what they’re feeling. “Sometimes, that’s when you hear - ‘mum had three kids and she said it was the worst thing that ever happened to her’, and you can really work out where these feelings might be coming from.” While the midwifery-led interventions are in their early days, data shows the initiative is already working to decrease fear rates in pregnant women. Researchers will continue to track the results and hope to conduct further research examining the impact of the interventions on rates of postnatal depression, caesarean sections and pre-term births. Professor Gamble says the interventions
“The reality is that if you’re very fearful of birth, you are much more likely to have both antenatal and postnatal depression. You are also more likely to have a caesarean section,” she says. Professor Gamble says childbirth fear is well recognised and has been investigated in Scandinavian countries for more than 30 years, with researchers in the United Kingdom and Canada putting fear of childbirth under the microscope for more than a decade. “Studies internationally, from the UK, Finland and Sweden, show between seven and 22 per cent of caesareans are linked to fear of birth which is very significant,” she says. “Our work has found 10 per cent of fearful first time mothers preferred a caesarean section, 22 per cent of fearful multiparous women preferred a caesarean section while 80 per cent of those had a previous caesarean section, which in fact might have been a traumatic experience. “We want to intervene earlier with support for women and see if we can mitigate or prevent these levels of traumatic childbirth.” 30 October 2016 Volume 24, No. 4
the woman’s current expectations and feelings are, so we usually just start by asking the woman to tell her story. “That seems to be really powerful. She will tell you what happened in her previous birth, what’s been happening in the pregnancy, why she’s feeling frightened or why that’s escalating.” Professor Gamble says the intervention connects the emotions and beliefs to the behaviours and also works to fill information gaps or clarify misunderstandings. “Women might say - ‘I’ll have an epidural because I’m scared of having forceps or a vacuum’. Then you might say - ‘choosing an epidural doubles your chance of the very thing that you’re fearful of’.
unlock the potential of midwifery practice. “Midwifery practice has been, in a way, restricted. I call it ‘the outpatient’s approach to having a baby’. They have conceptualised the provision of maternity care like they would any other acute care service - with outpatient appointments, in for a procedure, as soon as possible you’re out the door, and some sort of follow up. “But having a baby doesn’t fit with that. This outpatient approach doesn’t privilege any sense of authentic relationship and isn’t able to respond to the woman’s actual needs.”
More articles at HealthTimes.com.au anmf.org.au
VIEWPOINT
NURSE PRACTITIONER LEADERSHIP IN PATIENT-CENTRED COLLABORATIVE CARE By Amanda Davies Important changes are underway for the Australian health system. National health reform and the Healthier Medicare Review are creating new opportunities to lead innovation in primary healthcare, in particular, chronic disease management. This comes with a renewed focus on the role and scope of practice of nurses in the context of increasing pressures on the health system, and the potential of the profession to respond to rising costs and increasingly complex care needs across the lifespan (Delamaire & Lafortune, 2010). Nurse practitioner services in particular, has significant potential for the government to achieve a truly reformed health system and to improve the reach and access to healthcare. The efficiency of Australia’s healthcare system is an important area of government policy. Greater efficiency means securing better health outcomes, higher quality care and less waste. There is also opportunity for regulatory reform to support better use of health workforce skills and competencies (Productivity Commission: Efficiency in Health, 2015). The nursing profession is well placed to lead health reforms. Nurses have close interaction with patients and their families in all healthcare settings across the health continuum. Reflected in literature, both in Australia and internationally, nurse-led models of care are well-established health service options for the community. Evidence supports the valuable contribution these types of services provide for the wider health system, through cost efficient and accessible services across wide geographical areas (Middleton et al. 2010). Historically, nurses have been left out of decision making processes due to the dominant biomedical model and have been left with implementing initiatives or policy that have been proposed by other professions. Non-medical groups have remained peripheral to health policy debate due to the cultural dominance of medicine. Nursing has also been seen to be a female profession and as such subordinate to medicine which is constructed as a male profession, anmf.org.au
NURSE PRACTITIONER SERVICES IN PARTICULAR, HAS SIGNIFICANT POTENTIAL FOR THE GOVERNMENT TO ACHIEVE A TRULY REFORMED HEALTH SYSTEM AND TO IMPROVE THE REACH AND ACCESS TO HEALTHCARE. despite increasing numbers of women doctors (Lewis, 2005). Consequently, the health system has not been geared to incorporate nurses as service providers, nonetheless they are poised and readied to lead essential reforms. In order for government funded initiatives, such as the continued advances in digital health to realise anticipated benefits, the design, delivery and implementation of any initiative must take into account a wider range of business models, services and systems that are needed now and for the future. Health system leadership is critical for shaping the future of healthcare in Australia. In the report from the Primary Health Care Advisory Group (2015), it was recognised that nurse practitioners have the clinical expertise and accountability to lead the ongoing care of patients, oversee the delivery of continuous and comprehensive care and to provide the link between the patient, their family and carers and the health system more broadly. This is important recognition and establishes the need to lead further discussions about new models of care. The establishment of Health Care Homes was a core recommendation
of the report. The Primary Health Care Advisory Group acknowledges that a nurse practitioner has the necessary skills to be a preferred clinician within the Health Care Home. The Health Care Home model is being introduced to improve care for patients with chronic and complex conditions. Under this model, eligible patients will voluntarily enrol with a participating medical practice. This practice will provide a patient with a ‘home base’ for the ongoing coordination, management and support of their conditions. In some instances, where primary healthcare services are provided by Aboriginal Medical Services or nurse-led clinics in remote areas, these services may also become Health Care Homes (Department of Health website, 2016). Nurse practitioner roles supporting chronic disease management are in place across Australia in a range of settings. In primary healthcare, nurse practitioners are providing clinics, outreach and home-based services that are demanded by the community, but better care coordination, improved health outcomes and system efficiency gains could be achieved through regulatory changes and appropriate funding models that truly reflect the service capabilities of the nurse practitioner role. A new bundled payment model will be based on conversion of existing fee for service arrangements (Department of Health, 2016). This will need to consider nurse practitioner access to existing MBS items including referral to allied health, to ensure consumers are not disadvantaged and nurse practitioners can work to their full scope of practice as the consumer’s preferred clinician. This will undoubtedly reduce variations in care and duplication of services. There are significant opportunities for nurse practitioner models to deliver comprehensive chronic disease prevention and management programs. However, advocacy is required to leverage this highly skilled workforce to create sustainable career pathways for advance practice nurses who can provide quality, cost effective chronic disease management to individuals, and the wider community. Nurse practitioners work very successfully in collaboration with medical and allied health colleagues and achieve high levels of patient satisfaction and care effectiveness. However, high quality research is essential to establish a solid evidence base for nurse practitioner service outcomes.
References on request Amanda Davies RN MNursing (NP) is Chief Executive Officer for the Australian College of Nurse Practitioners This article is based on the views and research of the author(s) and has not been peer reviewed.
October 2016 Volume 24, No. 4 31
FOCUS Education part 2
THIS MODEL PROVIDES STUDENTS WITH A CLINICAL LIAISON NURSE (CLN) EMPLOYED WITHIN THE FACULTY, WHO IS INVOLVED IN THE TEACHING AND DEVELOPMENT OF STUDENTS’ CLINICAL SKILLS IN WORKSHOPS, UNDERSTANDS THE CURRICULUM AND PROVIDES A POINT OF CONTACT FOR INDUSTRY PARTNERS REGARDING STUDENTS AND UNIVERSITY BASED EXPECTATIONS.
CLINICAL ENGAGEMENT MODEL: PROVIDING THE SUPPORT BETWEEN STUDENTS AND THE CLINICAL ENVIRONMENT By Lori Delaney and Kath Sainsbury Clinical placement is an essential component to undergraduate nursing students’ development and provides an invaluable opportunity to develop skills, tacit knowledge, demonstrate conceptual understanding, and professional competency. The cornerstone of effective clinical placement is the supervision and support provided to students that facilitates their professional development. The University of Canberra has developed and implemented a ‘clinical engagement model’ whereby, there is an entrenched connection between the university and the clinical environment. This model provides students with a Clinical Liaison Nurse (CLN) employed within the faculty, who is involved in the teaching and development of students’ clinical skills in workshops, understands the curriculum and provides a point of contact for industry partners regarding students and university based expectations. The clinical engagement model endeavours to foster critical thinking through reflective practice which is undertaken in ‘learning circles’ conducted twice weekly by the CLN and are further contributed to by Registered Nurses from the clinical setting. This approach to clinical 32 October 2016 Volume 24, No. 4
learning creates a positive clinical education environment, which provides students with an important opportunity to critically examine and reflect on clinical practice and promotes self-development (Murray et al. 2011; Moscato et al. 2007; Walker et al. 2013). The implementation of the clinical engagement model has resulted in the appointment of nine clinical liaison nurses within the Discipline of Nursing who contribute to the clinical education of the students, and provide a supervisory role in the clinical environment at a ratio of 1:12. Key to the success of the Clinical Engagement Model are the strong relationships formed between the university, the student, clinicians, educators and ward managers. CLNs assist students to construct learning objectives relevant to the clinical context and seek feedback on student development from RN supervisors. They develop and implement strategies to engage and
assist the development of individual students with RN involvement. This approach provides a structured consistency to student placement support and cohesion in student assessment in the clinical setting. The developed clinical partnership provides a dynamic process within the clinical environment to garner clinician based feedback on student performance and the ability to implement supportive strategies for students who can be extended or requires further developmental support. The model acknowledges the clinician as the expert in their clinical area who works in partnership with the undergraduate students, and collaboratively with the CLN. The development of professional alliances in the clinical area enables the clinical liaison nurse to access resources to support student development and broaden learning opportunities, and supports the student’s transition into the clinical area. The collaboration supports the reciprocity of the learning experience and provides the foundations for a positive clinical learning environment. This model has been the cornerstone of the University of Canberra’s clinical support of students in order to bridge the gap between theory and clinical practice, and prepare students transitioning into professional practice. Lori J Delaney is Assistant Professor in Clinical Nursing at the University of Canberra and PhD Scholar at College of Medicine, Biology and Environment at Australian National University Kath Sainsbury is PhD Scholar in the School of Medicine at Australian National University
References Moscato, S.R., Miller, J., Logsdon, K., Weinberg, S. & Chorpenning, L. 2007. Dedicated education unit: An innovative clinical partner model. Nurse Outlook, 55(7). Murray, T.A., MacIntyre, R.C. & Teel, C.S. 2011. An analysis of the partnership performance: The St Johns Mercy Medical Centre-Saint Louis University School of Nursing dedicated education unit project. Journal of Professional Nursing, 27(6), e58-e63. Walker, R., Cooke, M., Henderson, A., & Creedy, D. K. 2013. Using a critical reflection process to create an effective learning community in the workplace. Nurse Education Today, 33(5), 504-511.
anmf.org.au
Education part 2 FOCUS
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PALLIATIVE CARE WORKFORCE DEVELOPMENT By Kylie Ash and Patsy Yates Palliative care is delivered in almost all settings where healthcare is provided, including neonatal units, paediatric services, acute hospitals, general practices, community settings and aged care services. People who are dying have needs which require that nurses are able to deliver high quality evidence based and compassionate care no matter what their setting of practice. All nurses thus require some level of knowledge and skills in how to apply the principles of palliative care. A National Palliative Care Workforce Development Framework has been developed to provide guidance for individual healthcare providers, education providers, health service managers and policy makers to ensure all healthcare providers are equipped with capabilities relevant to their context of practice. The ultimate aim of this Framework is to enhance the quality of palliative care service delivery and increase support for people affected by life limiting illnesses in all care contexts. The Palliative Care Education & Training Collaborative (the Collaborative) based at Queensland University of Technology (QUT) developed the Framework following extensive consultation with the sector. The Framework includes a palliative care workforce development model (draft) (Figure 1) which underpins anmf.org.au
the practical learning and teaching strategies that can be used to support workforce development in this field. Key elements of the Framework include: • core values underpinning palliative care in Australia; • defining characteristics of the palliative care workforce in Australia; • palliative care capabilities for specialist and non-specialist healthcare providers; • principles to support the development of palliative care capabilities; • teaching and learning strategies to develop palliative care capabilities. The QUT Collaborative has worked with the Caresearch team from Flinders University to incorporate the principles and approaches within the Framework on the Education section of the Caresearch website. Caresearch is an online palliative care knowledge network bringing relevant evidence
and quality information on palliative care to the community and to health professionals. The re-development of the Caresearch Education section has been a collaborative project between the QUT and Caresearch teams. Users are able to access practical information on how to support learning by using one of the three pathways:
PALLIATIVE CARE WORKFORCE DEVELOPMENT MODEL (DRAFT) FIGURE 1
• I am part of the health workforce
and want to explore my learning options (this includes conferences, workshops, formal qualifications, web based learning) • I am an educator or manager and I want to support learning in palliative care (this includes how to apply the workforce development Framework, develop teaching and learning skills) • I am a volunteer/unpaid carer and I want to access community education (this includes community education and eLearning for volunteers and eLearning for carers). The Palliative Care Education and Training Collaborative is funded by the Australian government Department of Health. For further information on this work contact pcc4u@qut.edu.au
Kylie Ash is National Project Manager, Palliative Care Curriculum for Undergraduates and Professor Patsy Yates is Head of School, Faculty of Health, School of Nursing. Both are at Queensland University of Technology
October 2016 Volume 24, No. 4 33
FOCUS Education part 2
RE-DO STATIONS AFTER HIGHFIDELITY SIMULATION DEBRIEF IN NURSING EDUCATION By Nina Sivertsen and Liz McNeill DR NINA SIVERTSEN
MS LIZ MCNEILL
References Carson P. 2013. The educational benefits of simulated practice, Nursing Standard, 28(4), p71. Clapper, T.C., & Kardong-Edgren, S. 2012. Using deliberate practice and simulation to improve nursing skills, Clinical Simulation in Nursing, 8(3), e109-e113. Lin X. 2001. Designing metacognitive activities, Educational Technology Research and Development, 49(2), pp23-40. Scoresby J., & Shelton B. 2014. Reflective redo from the point of error: Implications for after action review, Simulation & Gaming, 45(4), pp666–696. Vincent A.W., Aleven V.A., & Koedinger K.R. 2002. An effective metacognitive strategy: Learning by doing and explaining with a computer-based cognitive tutor, Cognitive Science, 26(2), pp147-179. Wang S.K., & Reeves T.C. 2007. The effects of a web-based learning environment on student motivation in a high school earth science course, Educational Technology Research and Development, 55(2), pp169-192.
While use of simulation in nursing education is both complex and well established, learning by re-doing is a scaffolded learning strategy neglected in simulation and minimal research has been conducted with it. Re-do stations provide enhanced learning opportunities following simulation debrief and further enable targeted and specific student focused learning. This Flinders University project aims to understand the students’ reception of a new re-do station and review its effect on factors like confidence, knowledge, and whether it helped relieve any negative affect, such as anxiety and stress, that is reported by students in simulated environments. The project had 230 participants of a total cohort of 431 undergraduate final year undergraduate nursing students. Data collection occurred over three intakes where the participants worked in teams of two to five members depending on class numbers, to complete clinical activities. After the completion of the topic, students were invited to complete a voluntary and anonymous student evaluation form consisting of Likert Scale and open ended questions evaluating their experience of the simulation. As learning by re-do is a new concept in nursing simulation, our re-do station was based on a simulation reflection method called After Action Review, also used in flight simulation (Scoresby & Shelton, 2014). Carson (2013) stated that “the more a student engages in and reflects on the simulated learning experience, the greater the learning potential”. The re-do station encourages learning through reflection, a technique observed in other studies on simulation learning (Lin, 2001; Vincent et al. 2002; Wang and Reeves, 2007). Scoresby and Shelton (2014) argue that when students have to identify where they failed, this forces them to implement reflective skills. The role of the re-do station for learning may have profound benefit for student learning in simulation. The results show that many students appreciated the opportunity to use the re-do station at their own pace as a learning and debriefing experience; whereas the students
34 October 2016 Volume 24, No. 4
who disliked it felt it was not realistic enough. Data about the reflective re-do station also showed that students used this opportunity to revisit the scenario as a group. They documented discussing knowledge deficit areas, accessing web resources for learning to clarify understanding such as pathophysiology, reviewing procedures and equipment – thus creating a ‘deliberate learning’ opportunity (Clapper & KardongEdgren, 2012). However, those who had time with a staff member felt they gained more knowledge and were able to apply this knowledge better. Perhaps this indicates that although the re-do station might be useful in students’ learning experience, so how we set it up and explain the purpose of the re-do station might be changed to reflect the aim of the station better.
THE RESULTS SHOW THAT MANY STUDENTS APPRECIATED THE OPPORTUNITY TO USE THE RE-DO STATION AT THEIR OWN PACE AS A LEARNING AND DEBRIEFING EXPERIENCE; WHEREAS THE STUDENTS WHO DISLIKED IT FELT IT WAS NOT REALISTIC ENOUGH.
The extent to which re-do stations in simulation is successful in supporting students in their learning and confidence with clinical decision making is important for the profession to research, if we wish to improve student learning by simulation in nursing education. Dr Nina Sivertsen is Lecturer in Nursing and Ms Liz McNeill is Lecturer and Simulation Coordinator. Both are in the School of Nursing and Midwifery at Flinders University
SUPPORTING CLINICAL FACILITATORS THROUGH PEER REVIEW OF TEACHING By Alan Barnard, Theresa Harvey, Karen Theobald, Vivienne Tippett and Timothy Rider The QUT School of Nursing is currently trialling peer review of teaching (PRoT) as one strategy to support clinical facilitators working with undergraduate students. Work integrated learning (WIL) relies on collaborative partnerships and clinical facilitators need specific skills and knowledge. Facilitators however, highlight problems of variable knowledge, training, support and feedback on their contribution(s) to WIL (Campbell & Wozniak, 2014; Finn et al. 2011; Embo et al. 2015). Facilitators can be isolated in practice, have limited knowledge of courses and student learning needs, and rely on students for feedback on their teaching skills and knowledge (Gusic et al. 2013; Mookherjee et al. 2014). Well-designed PRoT encourages personal reflection and skill development. During the QUT trial examples of facilitator comments have included: …this opportunity as a new clinical facilitator was invaluable Another facilitator highlighted direct change as a result of reflection on practice, stating that: …the experience has prompted me to change my method of working with students PRoT involves peers meeting together to discuss their roles; participation in agreed observation of student facilitation; providing feedback, and engaging in personal reflection. The objective is to provide a framework in which to have a constructive conversation about facilitating student learning needs and undertaking an education role. The program is confidential, voluntary and developmental. It is designed anmf.org.au
Education part 2 FOCUS in response to a need to support facilitators in their teaching role and promote excellence in student learning and assessment in the workplace (HWA, 2014). PRoT has enhanced facilitator growth by introducing alternative teaching strategies, building assessment and language skills, and inspiring student and facilitator learning (Bolam et al. 2005; Vescio et al. 2008).
References Barnard, A., Croft, W., Irons, R., Cuffe, N., Bandara, W. and Rowntree, P. 2011. Peer partnership to enhance scholarship of teaching: A case study. Higher Education Research & Development. 30(4) 435–448. Bolam, R., McMahon, A., Stoll, L., Thomas, S. and Wallace, M. 2005. Creating and sustaining professional learning communities. Research Report Number 637. General Teaching Council for England, Department for Education and Skills. London: England.
THE OUTCOMES OF THE PROT TRIAL ARE DEMONSTRATING POSITIVE IMPACT FOR STUDENTS, FACILITATORS, AND COURSE QUALITY IN SUPPORT OF WIL
The outcomes of the PRoT trial are demonstrating positive impact for students, facilitators, and course quality in support of WIL. PRoT has been demonstrated to improve teaching strategy awareness and professional reflection on practice, strengthen networks, clarify role expectations, and develop a culture of peer support (Barnard et al. 2011; Gusic et al. 2013). The current PRoT work parallels a longstanding QUT commitment to real world clinical workplace learning. It will provide further insight into facilitator perceived teaching efficacy and experiences of PRoT, as well as refinement of guidelines, resources and tools for successful PRoT when facilitating students during work integrated learning. Alan Barnard and Karen Theobald are Senior Lecturers; Theresa Harvey is Lecturer. All are in the School of Nursing at Queensland University of Technology Vivienne Tippett is Professor in the School of Clinical Sciences at Queensland University of Technology Timothy Rider is Inspector at Queensland Ambulance Service anmf.org.au
Campbell, N., and Wozniak, H. 2014. Work-based peer review of clinical supervision practice: A guide to creating a culture of quality supervision. Greater Northern Australia Regional Training Network (GNARTN). Darwin: Australia. Embo, M., Driessen, E., Valcke, M. and van der Vleuten, C.P.M. 2015. Integrating learning assessment and supervision in a competency framework for clinical workplace education. Nurse Education Today. 35 341-346. Finn, K., Chiappa, V., Puig, A., and Hunt, D.P. 2011. How to become a better clinical teacher: A collaborative peer observation process. Medical Teacher. 33(2) 151-155. Gusic, M., Hageman, H., and Zenni, E. 2013. Peer review: A tool to enhance clinical teaching. The Clinical Teacher. 10(5) 287-290. Health Workforce Australia (HW A). 2014. National Clinical Supervision Competency Resource. Canberra. Australia. http://www.hwa. gov.au/sites/default/files/ HWA_National-ClinicalSupervision-Competency Resource_FINAL_LR_0_0. pdf (Accessed 30 June 2016). Mookherjee, S., Monash, B., Wentworth, K.L., and Sharpe, B.A. 2014. Faculty development for hospitalists: Structured peer observation of teaching. Journal of Hospital Medicine (Online). 9(4) 244-250. Vescio,V., Ross, D. and Adams, A. 2008. A review of research on the impact of professional learning communities on teaching practice and student learning. Teaching and Teacher Education. 24 80–91
NURSES REPORT FORMAL EDUCATION IMPROVES PRACTICE By Amanda Fox, Karen Theobald and Patsy Yates Increased demand for colonoscopy procedures has led to the introduction of nurse endoscopist in Australia. Evidence suggests that nurse endoscopy is safe and effective (Williams et al. 2009). An educational pathway was developed in order to support this exciting new role providing advanced skills in gastroenterology, and a pathway for nurses wishing to continue study as nurse endoscopist. In 2014, Queensland Health sponsored a group of students to complete a Graduate Certificate course containing gastroenterology units developed in consultation with industry experts. This collaborative approach ensured a course highly specific and applicable to the discipline area that also met university standards. The course was evaluated for relevance and the application of knowledge to the clinical setting.
Method
Following ethics approval, a survey was conducted with students using a 22 item questionnaire distributed electronically to maintain respondent anonymity. Demographic data and Likert Scale responses were analysed through descriptive statistics using SPSS v21.
Results
Questionnaires were sent to 45 students with a response rate of 47% (n=21). The majority (76%, n=16) of respondents were 31 years or older and 90% (n=19) were female. Years of experience in gastroenterology was evenly distributed with 33% (n=7) of respondents each having less than two years’ experience, between two and five years and five years or more. Most (91%, n=19) agreed the content was intellectually stimulating and course activities assisted with learning (86%, n=18). Perception was that course content was relevant and applicable to the workplace. ‘The course content was very thorough and stimulating with topics that were both interesting and relevant…’ (Participant 5) All respondents (100%, n=21) reported having applied knowledge gained in this course to their workplace setting and over 81% (n=17) would consider continuing tertiary studies. Perceptions were that nursing is changing, with responses such as:
‘This course showed me how much the gastroenterology field is growing…; it really excited me about my future’ (Participant 6) ‘Formalised … education is a real asset to our specialty and the units were useful for improving my practice’ (Participant 17)
EVALUATION OF THE GRADUATE CERTIFICATE COURSE SHOWS THAT KNOWLEDGE GAINED BY STUDENTS WAS APPLIED IN THE WORKPLACE.
Conclusion
Evaluation of the Graduate Certificate course shows that knowledge gained by students was applied in the workplace. Of equal importance is recognition of formal education as an asset to improving practice. Expanded nursing roles are continuing to help meet growing expectations and costs of healthcare. It is imperative educational pathways are developed collaboratively to deliver highly applicable education for improved learning and ultimately better patient outcomes. Reference Williams, J., Russell, I., Burai, D., Cheung, W., Farrin, A., Bloor, K., Coulton, S. and Richardson, G. 2009. Effectiveness of nurse delivered endoscopy: Findings from randomised mulit-institution nurse endoscopy trial (MINuET). BMJ online
Dr Amanda Fox is the Postgraduate Course Coordinator and Lecturer; Dr Karen Theobald is the Director of Academic Programs and Senior Lecturer and Professor Patsy Yates is the Head of School. All are in the School of Nursing, Faculty of Health at the Queensland University of Technology October 2016 Volume 24, No. 4 35
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Education part 2 FOCUS
EDUCATION IN PRE AND POSTOPERATIVE SURGICAL NURSING: CAN GUIDED PERIOPERATIVE EXPERIENCE ASSIST? By Paula Foran It is reported that surgical adverse events occurred in 3.6% of patient admissions representing 64.5% of reported events (Zegers et al. 2011). These were severe and 41% were considered to be preventable (Zegers et al. 2011). The Australian Commission on Safety and Quality in Health Care (2010) stated that education must be provided to ensure healthcare professionals are skilled in knowledge of appropriate patient observations, identification of clinical deterioration and appropriate corresponding treatment regimens. While the mortality in surgical patients has fallen in the last decade, failures in this process are still occurring (Helling et al. 2014). A surgical patient’s journey involves a three-part process, including preoperative, operative and postoperative phases (Foran, 2016). Australian research considered the potential educational impact on undergraduate and graduate nurses’
EDUCATION INITIATIVES IN GRADUATE TRANSITION By Canice Brown, Julie Shaw and Lyn Armit While transitioning from a student nurse to a graduate registered nurse is exciting and scary, the literature shows that graduate nurses experience a lack of professional confidence (Oritz, 2016), marginalisation (Boychuck Duchscher & Cowin, 2004) and various forms of incivility (Read & Laschinger, 2015). New graduates need support (Gardiner & Sheen, 2016) and guidance during this time as they develop confidence in using their knowledge and skills in providing quality care for others and in working effectively with colleagues. In meeting these needs of the graduate registered nurse, Gold Coast Health initiated individualised graduate nursing education. Each year since 2009 cohorts of over anmf.org.au
knowledge of pre and postoperative care when the middle piece of the three-part surgical process was omitted (Foran, 2016). This national research project knowledge-tested nurses on areas surrounding pre and postoperative surgical ward nursing. Participants’ results were compared to the model of operating room (OR) education students had participated in to determine if there was a correlation between their OR education and surgical ward nursing knowledge. Findings revealed that undergraduate nurses receiving guided OR experience had a 76% pass rate compared to 56% with non-guided 100 graduates have successfully transitioned at Gold Coast Health. In meeting graduates’ educational needs, consideration was given to organisational needs, results of national benchmarking with similar organisations as well as feedback from stakeholders including the Nurse Unit Managers, Nurse Educators, Clinical Facilitators and of course past graduates. A four pronged approach provides the support for graduates in transition, these include a focus on: • orientation to the health service and the role of nursing; • safety and support in the clinical workplace unit from practice partners within the unit and an entry to practice team external to the unit; • a themed workshop schedule including: introduction to graduate transition; extending clinical health assessment; promoting patient safety; and consolidating professional practice and, • learning using a variety of teaching strategies to move away from ‘death by PowerPoint’ that includes group work, scenario based simulation and the stimulation of critical thinking and debate. In 2015, 146 out of 147 graduate nurses
or no experience (p<0.001) (Foran, 2016). At a graduate nurse level, nurses with guided OR experience as an undergraduate or graduate nurse achieved a 100% pass rate compared to 53% for non-guided or no experience (p<0.001) (Foran, 2016). Participants reported transferable skills learned via guided OR experience included, pre and postoperative care, pain management, anatomy and physiology, what the patient goes through, surgical procedures, patient education, asepsis, monitoring, and patient assessment skills. Opposing principles have been revealed as OR clinical experience has been gradually phased out of most nursing schools’ curricula, even when this experience has been shown to provide greater surgical ward knowledge than is gained from surgical ward nursing experience alone (Foran, 2016). The operating suite may not be everyone’s desired workplace, however guided OR experience should be viewed as an area of rich learning for all surgical ward nursing preparation. Dr Paula Foran is Education Officer at the Australian College of Operating Room Nurses (ACORN) successfully transitioned. On evaluation students commented positively on how the program was a good way to begin the new role of a registered nurse and provided support for them to apply knowledge in the workplace and communicate with the health team in difficult situations. In particular, the interactive learning activities developed confidence in addressing work skills and communication. Transitioning from a graduate to an independent registered nurse can be stressful. Supporting a graduate’s transition is essential for both the newly registered nurse and the organisation in which they work. Gold Coast Health initiated a themed, effective, education pathway for graduate nurses, focussing on orientation, safety and support, using innovative learning activities, which has led to the successful transition of graduate nurses. Canice Brown & Lyn Armit are in the Nursing and Midwifery Education and Research Unit at Gold Coast Hospital & Health Services. Julie Shaw is a Lecturer in the School of Nursing, Griffith University and a member of the Menzies Health Institute Queensland
References Australian Commission on Safety and Quality in Health Care. 2010. National consensus statement: Essential elements for recognising and responding to clinical deterioration, pp1-20. Foran, P. 2016. Undergraduate surgical nursing preparation and guided operating room experience: A quantitative analysis’, Nurse Education in Practice, 16(1), pp21724. Helling, T., Martin, L., Martin, M. & Mitchell, M. 2014. Failure events in transition of care for surgical patients. Journal of the American College of Surgeons, 218(4), pp731-3. Zegers, M., de Bruijne, M., de Zeizer, B., Merten, H., Groenewegen, P., van der Wal, G. & Wagner, C. 2011. The incidence, root-cause, and outcomes of adverse events in surgical units: Implication for potential preventable strategies, Patient Safety in Surgery, 5 (13), pp3-11.
References Boychuk Duchscher, J. E., & Cowin, L. S. 2004. The experience of marginalization in new nursing graduates. Nursing Outlook, 52(6), 289-296. Gardiner, I., & Sheen, J. 2016. Graduate nurse experiences of support: A review. Nurse Education Today, 40, 7-12. Ortiz, J. 2016. New graduate nurses’ experiences about lack of professional confidence. Nurse Education in Practice, 19, 19-24. Read, E., & Laschinger, H. K. 2015. Correlates of new graduate nurses’ experiences of workplace mistreatment. Journal of Nursing Administration, 45(10 Suppl), S28-S35.
October 2016 Volume 24, No. 4 37
FOCUS Education part 2
GOLD COAST SIMULATION SERVICE By Catherine Driver There is plenty of evidence about how effective simulation education is in healthcare despite all the challenges it brings. The literature reflects improvement of not only technical and nontechnical skills in clinicians, but ultimately patient outcomes. Although simulation education in healthcare has been around for quite a while, recent rapid capital investment of simulation centres and equipment, in some cases, has lurched ahead of training for clinicians and educators. This may have resulted in a gap between maximising simulation potential, practical implementation and ultimately its benefits in healthcare services. It is clear that local clinical experts and educators need to be upskilled in simulation education so that they can provide responsive, relevant, and high quality simulation education for their staff. If clinicians gained a basic working knowledge of simulation education, they could begin to incorporate simulation education into their standard way of providing training programs. A high level of support from the central simulation team would be provided and then weaned according to confidence and competence of these local simulation champions. A simulation upskilling program was developed and peer reviewed in collaboration with experts in simulation education, management, and the clinical environment. Underpinning principles were that those clinicians interested in
embracing simulation education would do so once provided the skills, knowledge, and equipment to do so. Providing responsive levels of ongoing support and assistance troubleshooting technical issues was considered quite important especially in the initial stages. The aim was to imbed simulation education into the fabric of the way we provide education for our healthcare providers.
A SIMULATION UPSKILLING PROGRAM WAS DEVELOPED AND PEER REVIEWED IN COLLABORATION WITH EXPERTS IN SIMULATION EDUCATION, MANAGEMENT, AND THE CLINICAL ENVIRONMENT.
Target participants for the course were clinical educators and clinicians with an interest in simulation. All
disciplines were invited to ensure an interdisciplinary approach was expected and promoted. Those who had been previously involved in simulation education were identified. It was recognised that clinicians with an interest in education and simulation had many existing skillsets that would lend themselves well to providing simulation education programs. Building upon these skills seemed an effective and efficient way to promote and build capacity for simulation education across and between the healthcare services. Recruitment for the course was voluntary and required support from local managers. Local credentialing formalised the training and acknowledged continuing professional development hours. A review of what preparation and training was necessary to develop and deliver a simulation education session was done. A basic simulation education program was then developed incorporating these components. These included knowledge, skills and behaviours. The three course sessions were: designing and delivering scenarios, simulation technical skills, and debriefing. Evaluations sought to find out whether the training achieved its aims and if the program needed further development. So far, feedback is positive and overall, those who participated in the course feel able to design and deliver a simulation session with support from the simulation team. We are already planning another series of simulation upskilling sessions due to demand and look forward to increasing and enhancing simulation education delivery across the health service.
Cathy Driver is Simulation Educator, Nursing and Midwifery Education and Research Unit at Gold Coast Health/Gold Coast University Hospital
Education part 2 FOCUS
THE NATIONAL CANCER NURSING EDUCATION PROJECT – TEN YEARS ON By Kylie Ash and Patsy Yates KYLIE ASH
The National Cancer Nursing Education Project (EdCaN) suite of resources support integration of a nationally consistent approach to cancer care education and professional development of nurses at all levels of practice in a range of settings.
nurses has continued since the initial phase of the project to embed the EdCaN Framework into education, policy and practice. The EdCaN resources have been integrated into key professional development programs, including: • antineoplastic Drug Administration Course (Cancer Institute NSW); • practice Framework and Competency Standards for the Prostate Cancer Specialist Nurse (Prostate Cancer Foundation Australia); • Queensland Cancer Education Program (Queensland Health). There is extensive integration of the EdCaN learning resources into entryto-practice and postgraduate nursing courses across Australia.
FIGURE 1: EDCAN PROFESSIONAL DEVELOPMENT MODEL FOR NURSING IN CANCER CONTROL
Kylie Ash is National Project Manager, Palliative Care Curriculum for Undergraduates Professor Patsy Yates is Head of School, Faculty of Health, School of Nursing. Both are at Queensland University of Technology anmf.org.au
EdCaN was originally funded by the Australian government in 2005. The initial phase (2005–2009) of the project involved development of a range of learning resources that were underpinned by two key publications: A National Professional Development Framework for Cancer Nursing (the Framework), and Competency Assessment in Nursing: A summary of literature published since 2000. The EdCaN Framework defined the level of competence required for nurses working at differing levels of practice to meet the needs of people affected by cancer (Figure 1).
The EdCaN suite of online resources include 11 case studies following a person’s cancer journey. The resources include an aim, objectives, evidence based information, links to other key reference sources, video and learning activities. Supporting modules focusing on key aspects of cancer care and competency assessment tools and resources are also available. The EdCaN model is an innovative professional development framework for nursing. Ongoing collaboration with government and professional bodies, clinical and academic education providers and individual
To appraise the reach and impact of the EdCaN project, a search of grey and published literature from 2006 to 2015 was undertaken to identify citations of EdCaN and the two key EdCaN publications. The Publish or Perish software program, Google scholar, Web of Science and Scopus databases were reviewed. EdCaN and the EdCaN Framework have been cited in 51 publications. The competency assessment paper has been cited in 30 publications. These citations occurred in workforce development frameworks, position statements, research and discussion papers and government policy statements and reports within Australia and in 12 other countries. The EdCaN Framework has been adapted for use in cancer nursing frameworks developed in Ireland and New Zealand and in the development of standards for other specialist nursing and allied health groups. Several publications also described use of the EdCaN project materials in guiding local professional development and research initiatives. Ten years on, the EdCaN project has provided a useful framework for workforce development that has informed system wide and local approaches to cancer nursing development within Australia and in many other countries. Cancer Australia supports EdCaN on its Cancer Learning website and continues to be managed by QUT. Ongoing resource maintenance and promotion ensures that EdCaN remains a relevant and responsive resource for Australian nurses nationally.
edcanpsgc@qut.edu.au www.edcan.org.au October 2016 Volume 24, No. 4 39
FOCUS Education part 2 support graduation and employment opportunities (Figure 1). The use of an Action Learning approach to design and implement the PPL allowed us to learn and improve/modify our approach as we progressed through each phase of the project. Following the pilot with first year students in 2014, review of the administrative, learning technology, business systems, clinical learning and academic coordination elements of the PPL were modified in support of wider implementation across the curriculum.
FIGURE 1: THE COMPONENTS OF THE PPL
Benefits from the PPL include: • Providing all students with a
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A PROFESSIONAL PORTFOLIO OF LEARNING FOR UNDERGRADUATE NURSING STUDENTS By M Peddle, Y Jokwiro, M Carter and T Young Traditionally, the assessment of clinical competence has been completed using ‘paper based’ systems which is still the predominant approach in Undergraduate Nursing Programs. We have found that a paper based system has pedagogical limitations as they are unable to capture the depth and breadth of clinical learning experiences, the achievement of competence and wider professional development. The ‘sign off’ approach can cause disconnection between the clinical facilitator, hospital, university academic and student. Moreover, there is limited opportunity for student reflection on prior clinical experiences across the curriculum and it is difficult for students and educators to evaluate progress in clinical performance. Paper based approaches do not support comprehensive learning needs analysis by educators. Contemporary curricula and workforce expectations require that professional education is a developmental process where students use feedback 40 October 2016 Volume 24, No. 4
provided from enrolment through to graduation to identify learning needs and develop personal goals for professional growth. Developments in e-portfolio pedagogy, such as PebblePad, provide greater capacity for students to reflect on learning experiences, identify strengths and weaknesses and develop personalised learning plans to guide their professional development (Peacock et al. 2010; Acosta & Liu, 2006; Green et al. 2014). In 2013, the Professional Portfolio of Learning (PPL) was introduced in the Bachelor of Nursing at La Trobe University to support the assessment and development of nursing student’s clinical competence. The aim of the PPL is to blend clinical, online and class based activities into one space for formative, summative and personal assessment activities to
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PPL to support professional development, life-long learning and career transition from enrolment to graduation and beyond. Ability for students to review performance, identify strengths and plan to address areas of weakness. Development of a far more comprehensive professional profile of the graduating student with supporting evidence. Improved rigour and administration of clinical appraisal systems and enhanced relationships with external partners Real-time performance monitoring and timely opportunities to effectively manage student activity in clinical placement and identify students in need of support. Improved integration of theory and practice for teaching, learning and assessment activities.
Currently there are more than 2,600 nursing students and over 1,000 external clinical assessors using a PPL to support the three/four year clinical development whilst meeting the requirements of the curriculum. Students are spread across five campuses and more than 60 clinical venues in metropolitan and rural Victoria. The ultimate benefit for students from the PPL is the ability to record evidence of their development of competence as a registered nurse. M Peddle is Lecturer in Nursing Program Coordinator; Y Jokwiro is Lecturer in Nursing; M Carter is Associate Professor, Associate Head of School, Director of Teaching and Learning and T Young is Educational Designer, Personal Learning Systems, Education Development. All are in the School of Nursing and Midwifery, College of Science, Health and Engineering at La Trobe University
References Acosta, T & Liu, Y. 2006. ePortfolios: Beyond assessment. In A. Jafari & C. Kaufman (Eds.), Handbook of research on ePortfolios (pp15-23). Hershey, PA: Idea Group Reference. Green, J., Wyllie, A., & Jackson, D. 2014. Electronic portfolios in nursing education: A review of the literature. Nurse Education in Practice, 14(1), 4-8. Peacock, S., Gordon, L., Murray, S., Morss, K., & Dunlop, G. 2010. Tutor response to implementing an ePortfolio to support learning and personal development in further and higher education institutions in Scotland. British Journal of Educational Technology, 41(5), 827-851.
anmf.org.au
Education part 2 FOCUS
STRATEGIES FOR FUTURE NURSING AND MIDWIFERY EDUCATION By David Gillham Major challenges can be expected for nurse education in the near future in response to changes in healthcare practice, technology, regulation and funding. The advancement of nursing and midwifery professions is largely dependent upon what occurs at the teaching-research-practice nexus. Teaching, research and practice need to be mutually supportive so that research informs practice and both research and education are relevant to practice needs. Technological strategies have the potential to contribute enormously in this area but for this to occur, universities and healthcare providers need to improve cooperation and collaboration. Specifically, high quality openly accessible multimedia education resources, informed by research
and clinical expertise should be developed and shared nationally. These resources should be developed by clinician specialists whose expertise is recognised professionally and financially as they integrate their clinical knowledge with current research evidence. Such resources should be multidisciplinary and include consumer input. There is also a greater role for national professional bodies in promoting such activities, as occurs in many European countries
ENGAGING STUDENTS IN ACUTE MENTAL HEALTHCARE By E L Kunst, M L Mitchell and A N B Johnston Mental health is an increasing component of the burden of disease worldwide, providing challenges in healthcare and health systems (World Health Organization, 2013); it is widespread, and not limited to dedicated mental health facilities. Nurses are integral in the provision of quality mental healthcare, and should be competent in mental healthcare, exemplifying positive attitudes, behaviours, capability, experience, knowledge and skills in patient care, irrespective of their clinical speciality. Despite this need for multi-skilled nurses, many undergraduate nursing programs have proportionally little mental healthcare content, and it is primarily focused in dedicated mental health courses with little or no dissemination into other areas of nursing care (Moxham et al. 2011). This may limit student engagement with mental healthcare during placement, particularly in acute care placements. Simulation activities in acute clinical courses can help address such curriculum limitations. Simulation is widely used in nurse education, however there is little evaluation of transference of capability from a simulated setting into nurses’ clinical practice. As part of a broader project, we explored the impact of mental health simulation anmf.org.au
scenarios, and factors that influence nursing students’ engagement and capacity in clinical practice. This included examining whether simulation training translated into meaningful therapeutic care benefits in acute care settings. Students with and without exposure to the simulation activity participated in focus group interviews after a clinical placement in an emergency department (ED). There was a real and noticed benefit of the simulation activities. Students reported ‘that it allowed us to make decisions about what we would do; on practical, in mental health settings, we were never allowed that opportunity’, and that the experience encouraged engagement in mental healthcare in the clinical space. The level of support available to students to engage in mental healthcare in the ED was varied. Students who felt supported were more likely to engage in lower acuity mental healthcare. However, across all groups, students felt that they were protected from the
and other disciplines. Currently universities compete and duplicate online resources with dedicated staff attempting to maintain expertise and currency across multiple specialties. There is an immediate need to use simple online technology and sharing of resources to pool expertise, increase efficiency and actively shape the teachingresearch-practice nexus. Postgraduate nursing students have a collective body of clinical expertise that should be recognised and valued much more in academic areas. This collective expertise can be captured through collaborative content development.
DAVID GILLHAM
While many of the strategies advocated here are implemented in individual projects, now is not the time for complacency. Universities need to consider new education models that promote professional advancement through collaboration and cooperation between universities and those providing healthcare.
David Gillham is Associate Professor in the School of Nursing & Midwifery at Flinders University in South Australia
more challenging clinical situations, with one stating ‘I feel like you get pushed to the back and you observe more. With the other [patients] you can engage, but when its mental health patients [the clinicians] are more in there and you are kind of on the side, just watching. They are kind of like, you don’t need to worry about this….’.
E L Kunst is a Lecturer at Southern Cross University, Gold Coast, Qld
Others acknowledged that sometimes they were excluded to protect the patient, saying ‘…if someone’s escalating and agitated, and there’s a nurse and security and then there’s a student gawking at them… that’s not helpful to the situation’. The support from other nurses seemed to play a key part in the extent to which students’ were able to engage in mental healthcare in the acute care setting, with students reporting that feeling supported by their preceptor encouraged their engagement in mental healthcare. This was to some extent applicable to even the students who felt most supported. The reasons for this were unclear, but would warrant further investigation in future research.
References Moxham, L., McCann, T., Usher, K., Farrell, G., & Crookes, P. 2011. Mental health nursing education in preregistration nursing curricula: A national report. International Journal of Mental Health Nursing, 20(4), 232-236 World Health Organization. 2013. Mental Health Action Plan 2013-2020. World Health Organization Geneva.
ML Mitchell, PhD, is Associate Professor Critical Care and holds a joint appointment with School of Nursing and Midwifery, Griffith University and Princess Alexandra Hospital, Brisbane, Qld ANB Johnston is a joint appointment research fellow in the School of Nursing and Midwifery, Griffith University and Gold Coast Hospital & Health Service, Qld
October 2016 Volume 24, No. 4 41
FOCUS Education part 2
REIMAGINING A FUTURE FOCUSED BACHELOR OF NURSING CURRICULA By Karen Theobald and Christina Campbell Higher education providers of nursing education programs are charged with the responsibility to produce ‘work ready’ graduates to meet the changing demands of healthcare including a shift from acute care to home and community based chronic care (Primary health Care Advisory Group, 2015). Designing an innovative and futuristic curriculum that serves student and industry needs for the 2020 context is both exciting and challenging. Juggling competing national (ANMAC, 2012), sector (Australian Qualifications Framework Council, 2013) and professional accreditation (NMBA, 2016) demands while also embedding best practice learning design was successfully enabled through a reimagined partnership process. To achieve this, the School of Nursing (SON) at the Queensland University of Technology embarked on a process of reimagining a future focused Bachelor of Nursing curricula to equip graduates for beyond 2020 healthcare provision. A core curriculum team
formed a ‘think-tank’ group which led the review, direction and maintenance of course integrity. Partnerships with students, staff and external advisory groups provided rich advice, feedback and insights as the course developed. The university learning and teaching unit also participated as an invaluable partner to the process. Essential milestones included: course performance analytic workshops; conceptualising course themes and threads; an offsite three day planning retreat; embedding different technologies which scaffold learning (Johnson et al. 2014) and course costings meetings. The lessons learned provide powerful insight for those embarking on such a
large and challenging redevelopment task. Establishing a project management approach is vital; having an appointed curriculum project manager is a must. Spending time to develop a considerate, trusting and engaging working group who are representatives of the wider staff was pivotal in the success of this process. Overall this is a rewarding journey that will not be fully understood until the first cohort of graduates begin to practice as registered nurses in 2021.
DR CHRISTINA CAMPBELL
References Australian Nursing and Midwifery Accreditation Council. 2012. Registered Nurse Accreditation Standards 2012, viewed 22 June 2016, www.anmac. org.au/accreditation-standards Australian Qualifications Framework Council. 2013. Australian Qualifications Framework Second Edition January 2013, viewed 23 June 2016, www.aqf.edu. au/wp-content/uploads/2013/05/AQF-2nd-EditionJanuary-2013.pdf Johnson, L., Adams Becker, S., Cummins, M., & Estrada, V. 2014. NMC Technology Outlook for Australian Tertiary Education: A Horizon Project Regional Report, Austin, Texas: The New Media Consortium. Nursing and Midwifery Board of Australia. 2016. Registered nurse standards for practice, viewed 22 June 2016, www.nursingmidwiferyboard.gov.au/ Codes-Guidelines-Statements/Professional-standards. aspx Primary Health Care Advisory Group. 2015. Better outcomes for people with chronic and complete health conditions through primary healthcare: discussion paper, viewed 23 June 2016, www.health. gov.au/internet/main/publishing.nsf/Content/primaryphcag-discussion
DR KAREN THEOBALD
Dr Karen Theobald, Director of Academic Programs and Dr Christina Campbell, Undergraduate Course Coordinator are Senior Lecturers in the School of Nursing, Faculty of Health at the Queensland University of Technology.
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Education part 2 FOCUS
READY TO TRY SOME NEW CPD? THINKING OUTSIDE THE BOX FOR ONGOING MIDWIFERY EDUCATION By Olivia Tierney As registered midwives in Australia, there is a need to maintain an ongoing involvement in education, to complete Continuing Professional Development (CPD) activities. This responsibility is not only to be able to tick the box on your registration renewal, but also a professional responsibility to maintain and grow our knowledge, skills and practice.
This will in turn be to the benefit of both the women and families we care for and the inter-professional workforce we work with. The purpose of this discussion is to identify avenues for accessing CPD activities and to encourage midwives to explore and reach out to an educational opportunity they may not have undertaken in the past.
becoming more freely available and diverse. Beyond activities such as inservice, workshops and conferences, there lies a large variety of educational opportunities for midwives to achieve their CPD. The opportunity to get creative with your CPD and try a new approach is easily obtainable.
As a midwife, you also have a responsibility to maintain your competence in accordance with national professional standards, including: • National Competency Standards for the Midwife • Code of Ethics for Midwives • Code of Professional Conduct for Midwives
Midwives have an opportunity to participate in some exciting ventures whilst obtaining CPD. This may prove to not only be educationally beneficial to them but may also have the potential to influence policy, practice or the profession. This diagram above is a visual representation of some CPD that is readily available to all midwives that may take them outside of the box and into some creative ways of seeking out their next CPD activity.
Midwives need to actively participate in CPD and record education in a reflective portfolio, as evidence of maintaining professional competence. The CPD cycle involves reviewing your own practice, identifying personal learning needs, planning and participating in relevant learning activities, and reflecting on the value of those activities (Tierney & Sweet, 2015). Access to CPD activities is fast anmf.org.au
So what lies outside the box?
Planning and recording CPD
It is an essential part of CPD to record and reflect on your professional development activities. Your CPD record should be guided by the requirements as set out by the Nursing and Midwifery Board of Australia. This record can be developed in hard copy or on an
online environment such as MidPLUS hosted by the ACM (Australian College of Midwives). To assist this process of planning and recording CPD, the ACM have developed and published pieces on reflective practice, portfolio development and how to access CPD activities. The following are some links to ACM hosted pages that can support your CPD access to activities and reflective records. • ACM Events: www.midwives.org. au/our-events • ACM CPD Recognised Events: www.midwives.org.au/cpdrecognised-events • ACM Webinar Recordings: www. midwives.org.au/shop/253 • ACM eLearning Courses: www. midwives.org.au/shop/248 • ACM Reflective Activity templates: www.midwives.org.au/ resources/reflective-activitywritten-article Midwives, you are encouraged this year to think outside the box! Make the 2016-2017 registration year one where you try a new and exciting approach to planning and conducting your educational options and reflecting on your CPD.
CPD CHART
Olivia Tierney RM/ RN is ACM Professional Development Committee (PDC) member, Midwifery Educator at the University of Newcastle/Mid North Coast Area Health (NSW) and PhD Candidate at Flinders University
October 2016 Volume 24, No. 4 43
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OCTOBER Australasian Implementation Conference Driving effective implementation 5–6 October, Melbourne Convention Exhibition Centre. www. ausimplementationconference.net.au/ Lung Health Promotion Centre at The Alfred 6-7 October – Managing COPD 24-25 October – Spirometry rinciples & Practice P: (03) 9076 2382 E: lunghealth@alfred.org.au World Mental Health Day 10 October. Australasian Rehabilitation Nurses’ Association 26th Annual Conference Hands, hearts and minds: Capturing the essence of rehabilitation 10-11 October, Betty Cuthbert Room, MCG, Melbourne. www.arna.com.au/ Short term memory loss & considering behavioural expression Sydney Workshop 11 October, Y-Hotel - Hyde Park, Sydney. http://internationalfaculty.cmhe. org/events/shorttermmemorylosscon sideringbehaviouralexpression/ CRANAplus 34th Annual Conference Going to extremes 12-14 October, Grand Chancellor, Hobart. https://crana.org.au/ conference/2016-conference Childbirth and Parenting Educators of Australia National Conference Nurture the primal instinct 12-14 October 2016, ‘the Sanctuary’ Adelaide Zoo. Registration Open. www.ivvy.com/event/capea Anti-Poverty Week 16-22 October. http://www.antipovertyweek.org.au/ about/about-anti-poverty-week World Federation for Mental Health International Conference 17-19 October, Cairns Convention Centre, Qld. www.wfmh2016.com Innovations in Hospital Management Forum Driving organisational efficiency and reducing operating costs 18–20 October, Sydney. https://akolade.com.au/events/ innovations-hospital-management-forum/ 21st International Congress on Palliative Care 18-21 October, Montreal, Canada. www.mcgill.ca/palliativecare/congress
NETWORK Princess Alexandra Hospital, Group 59C 30-year reunion 7-8 October. Contact Jenny Whittle (nee Dredge) E: jennydredge@hotmail. com or search Facebook page 59C Princess Alexandra Hospital Group Royal Melbourne Hospital, October 1976, 40-year reunion 8 October, Naughtons Parkville Hotel. Contact mezzarankin@gmail.com or Kris Alderson (nee McGuigan) E: pjka@ ozemail.com.au or Jane Beetham (nee Collyer) E: beethams@mmnet.com.au
anmf.org.au
Transplant Nurses Association Conference 19-21 October, Adelaide Convention Centre. www.tnaconference.com.au
18th South Pacific Nurses Forum Through nursing excellence for universal health 31 October-4 November, Honiara, Solomon Islands. Contact Edward Iuhanisuna E: spnfsina@gmail.com or www.facebook.com/spnf.org.au or www.spnf.org.au
Lung Health Promotion Centre at The Alfred 16-18 November – Asthma Educator’s Course 24-25 November Smoking Cessation Facilitator’s Course P: (03) 9076 2382 E: lunghealth@alfred.org.au
Australian Disease Management Association 12th Annual National Conference Person centred healthcare: Achievements & challenges 20-21 October, Melbourne Convention Centre (MCEC). www.adma.org.au/ E: info@adma.org.au T: (03) 9076 4125
5th International Conference on Forensic Research & Technology Cutting edge forensic technology 31 October-2 November, San Francisco, California, USA. http:// forensicresearch.conferenceseries.com/
National Primary Health Care Conference 23-25 November, Pullman Albert Park Melbourne. www.phaa.net.au/events/ event/NPHCC-2016
Assessment: Neurological Nursing 24-25 October, Comfort Inn Haven Marina, Glenelg North. www.ausmed.com.au
Hospital in the Home 9th Annual Scientific Meeting Bridging the GAP – Governance, Accountability, Partnerships 2-4 November, Stamford Grand, Glenelg SA. https://hithsociety. wildapricot.org/Conference
Birth and Beyond Conference 19-22 October, Ontario Canada. www.birthandbeyondconference.ca/
42nd International Mental Health Nursing Conference Nurses striving to tackle disparity in healthcare 25-27 October, Adelaide Convention Centre, South Australia. www.acmhn2016.com/ 27th PANDDA Conference (Professional Association of Nurses in Developmental Disability) A New World: Inspiring Abilities 26-27 October, Novotel Hotel Parramatta. http://www.pandda.net/conference/ The National Nursing Forum The power of now 26-28 October, Melbourne Park Function Centre, VIC. https://www.acn.edu.au/nnf2016 Australian College of Children & Young People’s Nurses Conference Honouring the past, treasuring the present, shaping the future 26-28 October, Stamford Grand, Glenelg, SA. www.accypn.org.au/ conference-2016 34th Audiometry Nurses Association of Australia Annual Conference & AGM 26-28 October, Noahs on the Beach, Newcastle NSW. http://anaa.asn.au/ conference-2015/ 21st Nursing Network Violence against Women International Conference Strengthening healthcare systems to promote safety and health of women and families 26-28 October, Melbourne. www.latrobe.edu.au/jlc/news-events/ NNVAWI-Conference-2016
Prince Henry’s Hospital 25-year reunion 22 October, 3-9pm, Bells Hotel, 157 Moray Street, South Melbourne. Cost $38 per head (includes finger food and a complimentary drink, security and venue hire). Drinks at bar prices. Bookings essential. Dress is smart casual. To book go to http:// www.trybooking.com/JVEX Prince Henry’s Memorial Page reunion. This reunion is in honour of the hospital’s closure and demolition in 1991 (25 years ago). Go to Prince Henry’s memorial page: https://www.facebook. com/Princehenryshospital/ to share memories and old photos.
NOVEMBER
Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) International Indigenous Health Workforce Meeting 7 November, Melbourne Convention Centre. http://catsinam.org.au/ conference/conference-catsinam The Lowitja Institute Indigenous Health and Wellbeing Conference 8-10 November, Melbourne Convention Centre. www.lowitja.org.au/ conference 9th European Public Health Conference All for health -health for all 9-12 November, ACV, Vienna, Austria. www.ephconference.org/futureconferences-128 11th National Australian Wound Management Association Conference State of play 9-12 November, Melbourne Convention and Exhibition Centre. www.awma2016.com.au 25th National Conference on Incontinence 9–12 November, Adelaide Convention Centre. South Australia. www.continence.org.au/nationalconference.php 7th Biennial Ngā Pae o te Māramatanga International Indigenous Research Conference 15–18 November, Auckland, New Zealand. www.indigenousresearch2016.ac.nz/
Australian Women’s Health Nurse Association 30-year anniversary inservice and reunion dinner 17-18 November, Carrington Hotel Katoomba (17 and 18 November inservice/18 November reunion dinner). E: Jenny.Bath@hnehealth.nsw. gov.au Royal Children’s Hospital, October 1974, 42-year reunion 18-19 November. Venue TBA. For further information contact Elizabeth Zambotti E: elizabeth.zambotti@gmail. com
International Congress on Innovations in Nursing (ICIN) Conference 24-25 November, Parmelia Hilton Perth. Showcasing innovation and leadership in clinical practice, research and education. http://icinperth.com/ Modern Clinical Nursing – In Search of Excellence 28-29 November, Comfort Inn Haven Marina, Glenelg North. www.ausmed.com.au/ Considering Behavioural Expression Melbourne Workshop 30 November, Essentia Health & Wellbeing Centre, Highett Victoria. http:// internationalfaculty.cmhe.org/events/ consideringbehaviouralexpression/
DECEMBER World AIDS Day 1 December. http://worldaidsdayworldwide.org/ Adelaide Nurses’Conference 1-2 December, The Lakes Resort Hotel, Adelaide. www.ausmed.com.au/ International Indigenous Health Conference 1-3 December, Pullman Cairns International Hotel, Cairns Qld. www.indigenousconferences.com/ Law and Nursing 8-9 December, The Lakes Resort Hotel, Adelaide. www.ausmed.com.au/ 8th International Conference on Healthcare, Nursing and Disease Management 21-22 December, Flora Grand Hotel, Deira, Dubai, United Arab Emirates. http://iaphlsr.org/index.php
RAH, group 772, 40-year reunion February 2017. Interested? Contact Bronwyn Glitheroe (nee Deed), AnneMarie McBride (nee Rogers), Helen Kirby (nee Osborn) or Rhona Edwards (nee McGarrigle) E: rah772reunion@ gmail.com or search Facebook page Rah772
Email cathy@anmf.org.au if you would like to place a reunion notice October 2016 Volume 24, No. 4 45
MORAL DUTY As I was reading the September issue of ANMJ, the title on the last page, ‘Moral duty to stand up for what matters’, caught my eye.
ANNIE
The following is my response to this. I cannot think of anything that matters more. Take a can of black paint and throw it at a wall. What will happen?
Nauru. ined on ers deta m seek of asylu rightly ives have But as ort for ity supp ts. and midw ps’ and Nurses ed these even g commun other grou nurses by as The stron F’s and many condemn ally licensed again to stand the ANMcampaigns onceent of the professionis it sufficient ts and express ives election the commitm icare and even midw moral these a to have confirmed people to Med y to give witnesses ge or do we on Nauru. abilit of asylum seekers detained Australian dence in its adequate, for our outra strong community support The act? e of their confi s access to otherJ,groups’ duty to ANMF’s and many have rightly irrespectiv ralian the of the ANM Nurses and midwives all Aust e healthcare, nces. ists, again issues once But as lumn twocampaigns election last co-co condemned these events. affordabl onal circumsta the ofess, page In the Burg commitment nurses and confirmed w back theand Maree dentand , professionally licensed their pers s my fello e Jone ion now to Medicare to stand by as people Australian ral Elect Senators Vice-Presi to give midwives is it sufficient -Ann and Fede Sally ability ra in its and express the dent confidence Sand their MPs and Presi ing witnesses to these events But with ber Dr to adequate, ed, all ANMF tive the open done have a moral F mem accessDirec Australians all our outrage or do we ANM finally decid red, and Care irrespective of ment and first half sing and nce decla and healthcare, the Parlia s ally Adva affordable For Nur duty to act? returns th Australian d nurse Bradley, personal broadly (ANMF) form ANMF tralian their t, urge circumstances. e more of the 45 ed, and as the defend, the Aus eration’s ily, Consultan to participat tes and act the ANMJ, to ry Fed of ssar Butler, In the last two issues of and dust yday’ work of this estsyear, al debaElection midwives the Midwife was, neceAnnie ring now half Federal ‘ever the first the inter ty’s ethic For But with s lf er an suffe my fellow back page co-columnists, and ourFederalto its of in socie and tionAssistant and nesSenators and furth ives, key focu all MPs the hum I find myse Maree Burgess, Nursing If decided, confi prote thectAustralian Sally-Anne Jones and address eral Elec cam paign, nd the tofinally , of our (ANMF) Secretary and the opening s and midw declared, the Fed formally extent rring beyo Federation’s nurse ANMF President and Vice-President decent Midwifery occu t care, l election on the . th Parliament done Sandra ion to a Australian walls of the nationa care, we can’ ributnecessarily, ital45 reflecting . 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DUTY ANNIE MORAL D UP TO STANHAT FOR W RS MATTE of this year,
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Today on the early news there was a report of a six year old girl being raped in her school toilet by two 12 year old boys. My heart broke again and I cannot stop thinking about it. This is Australia, this is supposed to be a civilised country. I have been and continue to be sickened by the attempts to sexualise our children as young, and, maybe younger than kinder. If a society thinks it can prevent bullying by a program of sexualising and destroying a generation of kids, the society itself is so sick it is on the verge of death, it is extremism in a different guise. Does anyone else remember the value and protection of ideals such as purity, protection, honour, value of a human being, the right to a childhood untainted by political agendas, self-control? This generation are not political chess pieces, they are our children. What are the politicians thinking? Is anyone awake out there? It is not only the younger ones. Most recently there was a push to have older kids sitting in a classroom ‘imagining’ sexual acts, HELLO, who will be the first rape victim of this? Will it be your child? Please, hands off our kids! Libby Cruden RN, Tasmania
CONDITIONS ON NAURU The conclusion by Sue Barker in her article ‘Refugees in Nauru’ that “neo-colonialism is alive and well” on Nauru and those who “have learnt well from their colonial masters”, “continue to do so”, should have been her opening premise. I briefly examined what she wrote from using that perspective. She claims the health of Nauruan people are on par with Australia’s Aboriginal and Torres Strait Islander people, with the exception of lower life expectancy. A report of a visit to Nauru by podiatrists
46 October 2016 Volume 24, No. 4
Having just got home from an overseas holiday, I recently read the July addition of the ANMJ about Voluntary Euthanasia (VE) debate. you are here
ISSUES
TIME TO YOUR VO MAKE
I FEEL I AM CON IN DISC STRAINED USSI TO ANY NG THE TOPIC BECAUS GREAT EXTENT E IT ILLEGAL REMAINS AN ACT, YET NURSE AS A I A COD AM BOUND BY E PROFESS OF ETHICS AND WHICH IONAL PRACTIC SUPPORT E TENETS S UNDERPI THE VERY CHOICE NNING THE OF VE.
THE VOICE HEARD IN LU EUTHAN NTARY A DEBATESIA
Your voic e:
To voice on this your nursing perspect issue Supportin , visit the ive SA Facebook g Choices in Nurses Dying sanursess page, write to hotmail.coupportingchoi Susie Byrne cesindyin at m, or Federal Office write to the ANM g@ at org.au. F Nurse-ledanmfcanberr and we a@anmf. need to practice is the aspects be prep futur e of our ared for care. it in all important to make a nursi your ng Since 2013 for their lating completio and have beenare perspect perspective voice heard from , there own – not a ive. reports have been family mem satisfactio n of this docu personal tabled ment VE Bills bers who n as well as in New Tasmania a time Do you or to supp South Wale may of and need be belie Com ort (Willmot called upon . Participan have been ve, s, Victo monweal should ria, have the as a nurse, that th gove Andrew et al. 2016). In and expe generous in ts in these forumin manner rnme right to a perso addition Denton shari and time n dete have prod and The to this, nts will raise riences and inevi ng their conc s rmin the end Wheeler of their of their death e the aspects uced a num I tell themthe issue of volun tably someone erns Cent life? If ber of not why if they are at that in – to unde the VE deba of podcasts re the Act the new tary euthanas More impo not? If on all te (South so why? for the rstand whether – both pro rtantly, Australia SA ACD form ia. specifical nurses and con Aust and I governme , get occur (The ralian publ VE is truly an cannot ly says that healt might play stuck, how think this is wher nt, 2013 option respond Wheeler ic and if so, hcare profe ) e out in your do you think currently to how it Centre, Would ssion may an illega a request for you 2016). profession this The ANM VE as VE als l act. a person be prepared al is statemen F Federal Offic to discu practice? Not bein Care Direcwho has put this in theirss VE with nurse to t on VE whic e has a posit euthanas g able to discu assist in tive? Would h supp ion Advance ss volun ia to addr orts a you be the act determin respect a pers abou tary be prep of adm ess indiv on’s t this made ared to inistering of life, ation, identifica right to selffeel I am issue frustrates idual conc what are legal? From and VE shou erns constrain a nursi me as a the pros suffer (Aus compassion tion of quality ld it to any ng poin for ed nurse and for your in grea tralia discussing t of view thos . I cons of practice? t extent Federatio n Nurs illegal , this ing and e who beca the act, yet acknowle n, 2015). The Midwifery as a nurse use it remains topic code of Your voice statemen dges ethic an I am that assis an illega t bound which supp s and profe and carer on this issue l by law and act and that ted dying is curre the choic orts the very ssional practice a concerns s who feel the is critical. Fam nurse profe ntly e of VE. tenets ilies those boun ssional code s are oblig underpinn should around volun need to discu ed by s to oper darie be ss tary euth ing ANMF So what ate position able to do so anasia position s of the law. to do? However, within statemen with us. role is statemen do so “Wh to The ANM t gives t also state the debate “participate F’s I am a for assis ere a person us the supp s that in the as an appr member ort to tance with expresse ensure Choices opriate broader publ its of the SA education that the s dying a orga ic in wish Nurses is heard” nisat nursing convenor Dying grou and med ally prepared , nurses shou Supportin and midw ion to (ANMF, p. The ld g grou 2015). articles Susie Byrne ifery voice well as ical paramete to discuss the be and I have p’s about the other optio rs of lega I participat for the or seek written group ns avail this request as l ANMJ and VE the my resea e as a nurse able to (Brad Byrne, in gene healthcare assistance in the 2013). The ley, 2008, (Bradley, rch on advance this debate profession of knowledg person 2010, 2011 ral written ANMF through on this eable als” (ANM forums 2015), by hold care directives subject leadership has ; as Aust Reference F, 2015 and ing com ralia’ (Levett, ). Australian seminars on s on reque munity Professor s recognise 2013) as also st d (SA ACD Advance Care the new Sout Neverthel Megan-Jane nursing ethic well h form). Sand Directive ist, Johnston ess, Aust remain Form Researchra L Bradley quiet on ralian nurse e (2014). is s, in gene this issue Directive , PhD and Adv an RN, MSc anmf.org.a ral, . ance Care Consultan Whicheve u t r way you This artic feel abou t VE, it research le is based on is been peerof the author(s)the views and reviewed and has 24-27_ ANMJ not . July16
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I have been nursing for 34 years (and many more to come) in areas from general/acute nursing, midwifery, peri-operative and ICU. I have seen and nursed the very young, young and old, I have seen them suffer and die before my eyes. 22/06/2016
4:26 pm
I believe we all have a right to die with dignity and assisted voluntary euthanasia is a humane act. There have been many patients and family members who have pleaded with myself and the medical staff to display kindness to end their life. The list is endless of reasons, but they are important to the patient and family. The prolonging of an ill patient’s life is detrimental for the patient and the living relatives who have to view the suffering. I am proud to say when working in ICU, how kind we nurses were with the patient and family members when we turned off the ventilators. The family members are of course distraught, but they are so relieved their relative is not suffering and it is the suffering that most relatives can’t cope with. I wish you all the best with this mammoth task to voice VE, I fully agree with VE and I hope it will be around when it is my time to leave this planet, as I would hate my loved ones to be prosecuted for assisting in my death. Sandra Hollis RN, Vic
in 2012 www.footscape.com.au/files/ November2012.pdf reveals a struggling health service. It contradicts the Hon Peter Dutton’s assertion that healthcare on Nauru is equivalent to Australia’s healthcare. So where did the massive funding for refugee health services go? It is a fact, and not a judgment, that there are numerous reports from refugee children about being beaten up at school. There does seem to be serious problems with children’s behaviour on Nauru- see for instance: www.facebook.com/ EquatorialOpportunities/ Many adult refugees have been seriously assaulted and are living in fear in the Nauruan community. It should be recalled that the Nauruan government did take active steps to cripple the judiciary. It hardly sets a good role model.
The claim that Australian people and the media “damn the Nauruans at every turn” would not pass peer review. But it’s a well-known outcome that, sadly, those who experience colonisation attack those who they should really regard as allies. For instance, neither Alanna Maycock RN nor Professor David Isaacs who visited Nauru, damned the Nauruan people in their subsequent public appearances. Ms Baker’s advocacy for the Nauruan people would be better served by encouraging the Nauruan community to recognise they and refugee advocate have a common enemy in those who promulage and profit from a policy of abusing innocent people forced to flee from their homes. Niko Leka, EN, NSW
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ANMF (SA BRANCH) EBA NEGOTIATIONS While the current EBA is in progress I believe clarification of casual employees as written in the EBA agreement is needed: 3.8.1 A casual employee is engaged for a minimum of 3 hours. 3.8.2 Following assessment, casuals who have been engaged to work on a pattern of hours that are regular are to be converted to permanent employment status. Regular hours for casuals means employees who work some of their hours in a predictable fashion and those hours are rostered on an ongoing basis. In addition such employees may work extra hours that meet the unplanned or irregular needs of the health unit from time to time. There is no CLEAR understanding of what clause 3.8.2 actually means or how to implement the clause. As a ‘casual’, I am getting plenty of hours but they are not secure. My hours have been at risk for various reasons. I am particularly concerned when my hours are cut in favour of new staff members “who need to have the hours”?! I would like to have some permanent hours and have asked for permanency based on this clause but I was turned down. The ANMF offered me instructions which I followed as best I could. However, my attempt was thwarted by a lack of sound documentation regarding this clause. I left my meeting feeling humiliated and foolish for not having enough documented support in order to achieve my goal. I have attempted to implement this clause without success despite being employed on a casual basis, attending between 30 - 40 hours per week on a regular basis for a year and a half. SA Health is intent on using and failing to support nursing staff who are relegated to the ‘casual pool’. Casuals are not eligible for supported education or professional development, nor do they have the luxury of carer’s leave or sick leave. There are precious little opportunities to apply for permanent positions as all the vacancies are advertised as ‘Casual’. Now SA Health is advertising ‘Casual Contracts’ which means not only is our employment not secure, casual staff will be expected to re-apply for their current position every year. If the ANMF (SA Branch) is serious about the EBA, it would be pertinent to ensure that this clause is underpinned by clear and concise instructions. This will enable and empower casual staff to actually implement it! Judith Hurrell RN, SA
NEVER OFF DUTY INDEED
LETTER OF THE MONTH
Reading about Karen Thompson’s experience in September’s edition of the ANMJ ‘Nurses - are we ever off duty?’ I was reminded of a boat trip I made 25 years ago from a remote island in the south of Thailand. A ‘comatose’ young man was on the boat being taken to the mainland two hours away. I told his desperate co-workers attending that I was a nurse and would have a look at him. As a newly registered psychiatric nurse, I felt I had no idea what I was doing, but I eventually found out (in mangled Thai and imaginative gestures) that he’d had an overdose of three antihistamine tablets. His pulse was normal and his eyelids struggled desperately to stay closed as I tried to open them. I realised he wanted a day off work (and I wanted him to save face), so I very seriously declared that he needed to rest for the day and would be all right in the morning. The locals entitled me, “Doctor suay maak maak “ (very very beautiful doctor) and offered me a job on their island. I sadly declined this life in paradise due to job commitments in Melbourne and awareness of my total inadequacy as an emergency/remote nurse (kudos to all of you who are). Since then I have been the first present at a very nasty motorcycle accident while on holiday, and I’m sure there will be more challenges to come. I feel a sense of pride and quiet reassurance that there are so many nurses around who will do their best, whatever and whenever it happens, to help a stranger in need. I agree with Karen - we are never off duty. Michaela Pratt RN, Vic
The winner of the ANMJ best letter competition receives a $50 Coles Myer voucher. If you would like to submit a letter to the ANMJ email anmj@anmf.org.au Letters may be edited for clarity and space.
NOTICE TO MEMBERS ANMF FEDERAL OFFICE FINANCIAL REPORT The ANMF Federal Office Financial Report for the year ended 30 June 2016 is now available at www.anmf.org.au Members without internet access may obtain a hard copy of the report by applying in writing to: Federal Finance Officer ANMF Level 1, 365 Queen Street Melbourne Vic 3000
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October 2016 Volume 24, No. 4 47
MAREE
OPENING THE DISCUSSION Maree Burgess, ANMF Vice President
Like many pet owners, I have a story to tell about a great companion. A dog called Lucy who was a faithful, reliable and much loved member of our family. She was a yellow Labrador and shared our family life, including camping trips, family celebrations and daily walks to the local park. She did have a dark side which saw her eat my mother’s boiled fruit cake with disastrous gastroenterological consequences and on one occasion, abscond with an expensive block of parmesan cheese, but on the whole, was a great friend to all in the family.
THE RECENT VICTORIAN GOVERNMENT REPORT ON THE ‘INQUIRY INTO END OF LIFE CHOICES’ (AUGUST, 2016) PROVIDES A COMPREHENSIVE REVIEW OF CURRENT PRACTICES INTO END OF LIFE CARE. IT HIGHLIGHTS THAT AS A SOCIETY WE ARE HESITANT TO TALK ABOUT DEATH.
References Parliament of Victoria Legislative Council Legal and Social Issues Committee, Inquiry into End of Life Choices, Final Report 2016 viewed at: www. parliament.vic.gov.au/ lsic/inquiry/402 Stand up for assisted dying, August 2016, On the Record p7.
She maintained excellent health until a few months ago, when at the age of eleven years she developed urinary symptoms, initially thought to be a simple infection, but on further investigation revealed an extensive pelvic tumour. We discussed the interventions available with our local veterinarian and then consulted with a specialist surgeon. The expert opinion of both vets was that surgery was not indicated and that it would be kinder to euthanase Lucy. We discussed the advice of the experts with the family and in the best interests of Lucy, decided to follow their advice. With final hugs and farewells, Lucy died quickly and peacefully in our arms and under the supervision of the surgeon.
48 October 2016 Volume 24, No. 4
So why am I sharing this story? It is about life and dying and the decisions we are able to make about the members of our families with four legs, as opposed to those with two. Of course, a human life cannot be compared to that of a pet, but the decisions we make about our own lives when it comes to dying seem to be so complicated. Andrew Denton spoke at the recent ANMF (Vic Branch) Delegates Conference as he has done in several states about the introduction of voluntary euthanasia laws in Australia. His recent documentary ‘Better off Dead’ presented the views of health professionals, academics and palliative care specialists from both sides of the debate. It is the discussion and debate we need to have as a community. It is an evolving debate in which we all have an interest. The great certainty in life is that we will all die. Andrew spoke of the impact of his father’s death nineteen years ago and the inadequacy of the attempts at palliating his pain in the final days. He spoke of the effect on all family members. His father’s death remains for Andrew the “most profoundly shocking experience of his life” (On the Record, August 2016). The recent Victorian government report on the ‘Inquiry into end of life choices’ (August, 2016) provides a comprehensive review of current practices into end of life care. It highlights that as a society we are hesitant to talk about death. It acknowledges that we have a very good palliative care system, but that prohibition of assisted dying results in some individuals experiencing great pain and suffering in their final days of weeks of life. The Legal and Social Issues Committee responsible for the Inquiry established a set of shared core values which provided an underpinning for their work. These included statements reflecting the value of human life: that people should be able to make informed choices about the end of their lives, that pain and suffering should be alleviated for those who are unwell and supported by laws which are coherent and transparent (Inquiry into End of Life Choices Final Report, 2016). The report made 49 comprehensive recommendations which included strengthening a community based approach to Palliative Care, recognising the increasing need for services in both city and rural
areas and promoting palliative care services into Aboriginal and culturally and linguistically diverse (CALD) communities. In addition, recommendations were made around improving Advanced Care Planning through raising awareness within the community around end of life choices, improving the education of health professionals and improved data systems to ensure that documentation is linked to a data system such as My Health Record. Recommendation 49 calls for the government to introduce legislation to allow adults with decision making capacity, suffering from a serious and incurable condition, at the end of life to be provided assistance to die in certain circumstances. The recommendation includes amending the Crimes Act 1958 to provide the exemptions needed to protect health practitioners who act within the provisions of voluntary euthanasia legislation. It also includes details around conscientious objection so that no Doctor, Health Practitioner or health service can be forced to participate in voluntary euthanasia. There are additional inclusions which cover the establishment of a task force to lay the foundations prior to the framework being implemented, an Assisted Dying Review Board and the creation of End of Life Care Victoria (Inquiry into End of Life Choices Final Report, 2016). The Chair of the Parliamentary Committee, the Hon Edward O’Donohue MLC in his foreword to the report noted that in recommending a voluntary euthanasia framework for Victoria, the Committee acknowledged that only a small percentage of Victorians would use the new legislation but many more Victorians would feel comforted knowing that another option existed (p17 Inquiry into End of Life Choices Final Report, 2016). Andrew Denton is hoping that his Podcast series, ‘Better off Dead’ ís his way of informing and inflaming the debate. As Nurses and Midwives, we are there for life’s journey and have great insights to share in this debate. Please read the Victorian Parliamentary Report into Assisted Dying. Please watch Andrew Denton’s Podcast ‘Better off Dead’. I would encourage you to have that discussion with colleagues, friends and family.
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