ANMJ July 2014 by Australian Nursing & Midwifery Journal

Australian Nursing & Midwifery Journal Volume 22, No. 1. July 2014

Social media The pitfalls and the potential www.anmf.org.au

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Editorial Lee Thomas, AnMf Federal Secretary Recently I was fortunate enough to travel to Geneva for the International Council of Nurses Triad and Berlin for the International Trade Union Congress.

here I say! It was such a shame that this was just days after the federal government announced dramatic changes to health funding in this country.

On the way there I spent International Nurses’ Day (IND) in Dubai, where along with Debra Thoms, we presented to a group of international nurses on why investing in nurses makes economic sense. The IND theme was ‘Nurses and Midwives a Force for Change’, and a particularly important point in our presentation was the need for us all (irrespective of the country we practice) to always ensure that when governments look to slash and burn health budgets that we continue to advocate for our patients and campaign against these changes.

After Geneva I was fortunate enough to be one of a small contingent of Australians representing unions at the International Trade Union Congress (ITUC) in Berlin. My delegate status to this congress was through the ACTU and I was honoured to accept.

It was a great way to spend IND and I’m very grateful to our hosts and the Dubai Health Authority for the invitation. The International Council of Nurses Triad then followed in Geneva, the theme this year was ‘Universal Health Coverage’ (UHC). The Triad meeting addressed issues critical to the provision of safe, quality nursing and midwifery care, the development of the nursing and midwifery professions and the effective regulation of these professions. The focus of this fifth Triad was strengthening the nursing and midwifery workforce to support universal health coverage as a means to achieve health goals. Key speakers included Akiko Maeda from The World Bank, Judith Shamian and David Benton from the International Council of Nurses (ICN), Ties Boerma and Mwansa Nkowane from the World Health Organization (WHO) and Frances Day-Stirk and Frances Ganges from the International Confederation of Midwives (ICM).

What an amazing week this was, thousand’s of delegates from unions all over the world. The congress theme was ‘Building Workers’ Power’ and included plenaries and sub plenaries on union growth, corporate organising campaigns, women’s participation in work and unions and sustainable jobs and pensions. There were many highlights amongst them including discussions by Bangladeshi women garment makers who banded together to form a union to stop their exploitation by big business. They expressed that once they joined the union it not only changed their working lives, but empowered them in their personal lives. It was very moving to recognise the power that unionism has. Former British Prime Minister Gordon Brown, now UN Special Envoy for Education, spoke of the necessity to educate children all over the world and in particular young females. At the business end of the congress the current general secretary of the ITUC, Sharan Burrow was re-elected for a further term in the role. Great to have an Aussie woman as head of the peak international union organisation. Good job Sharan!

The speakers highlighted the critical issue that UHC cannot be achieved without a sufficient health workforce, adequately trained, appropriately remunerated and working under decent conditions. Here, PAGE 1 July 2014 Volume 22, No 1.

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

3/28 Eyre Street, Kingston ACT 2604 Phone (02) 6232 6533 Fax (02) 6232 6610 Email anmfcanberra@anmf.org.au

Melbourne & ANMJ

Level 1, 365 Queen Street, Melbourne Vic 3000 Phone (03) 9602 8500 Fax (03) 9602 8567 Email anmfmelbourne@anmf.org.au

Federal Secretary Lee Thomas

Assistant Federal Secretary Annie Butler

Editorial

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

Advertising

The Media Company, Jana Gungor Phone (02) 9909 5800 Fax (02) 9909 5810 Email jana.gungor@themediaco.com.au

Australian Capital Territory

Branch Secretary Jenny Miragaya Office address Unit 3, 36 Botany Street, Phillip ACT 2606 Postal address PO Box 1995, Woden ACT 2606 Ph: (02) 6282 9455 Fax: (02) 6282 8447 E: anmfact@anmfact.org.au

Northern Territory

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

South Australia

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

Victoria

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

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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

New South Wales

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

PAGE 2

Queensland

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

Tasmania

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

Western Australia

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

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.

CIRCULATION 96,450

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Contents Volume 22, No 1. News 5 Issues 15 Professional 17 Profile 18 Legal 21

News

Page 5

Nurses and midwives unite against budget cuts

Profile

Page 18

Australiaâ&#x20AC;&#x2122;s Ambassador for women and girls

Education 22 Feature 24 Tech Talk

Clinical Update

Focus 34 Calendar 45 Mail 46 Annie 48

Legal

Page 21

Bedside handovers and confidentiality

Focus

Page 34

Womenâ&#x20AC;&#x2122;s Health

Feature: Social Media

Page 24

The pitfalls and the potential for nurses and midwives

PAGE 3 July 2014 Volume 22, No 1.

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News Nurses and midwives unite against harsh budget cuts

Nurses and midwives from around the country have rallied to protest against the federal government’s savage budget cuts. Dressed in red and waving flags and placards, the ANMF Victorian branch members marched as part of a 10,000 strong crowd that rallied outside Parliament House in Melbourne for the ‘Bust the Budget’ rally on 12 June. In South Australia, more than 1,000 people marched on state parliament in the ‘Keep SA Healthy’ rally on 4 June. The action follows on from the ‘March in May’ protests held in Adelaide, Brisbane, Hobart, Melbourne, Sydney and Perth after the federal budget was handed down.

Registered nurse Elisabeth Hall attended the recent Melbourne rally and said the crowd was united. “It felt like everyone was really angry and ready to work together to oppose the budget measures and everyone was willing to put time and effort in to make sure the worst bits don’t get through.” Registered nurse Michael Ruyg was also at the rally to voice his opposition to the budget. “It’s a budget that’s unfair to old people, young people, people that get sick, people with disabilities, it’s going to do terrible things to the healthcare system.” The federal government’s plans for Medicare are of great concern, said Michael. “I think the $7 charge for GP visits, plus all the other rearrangements to charges, is going to have a terrible effect on people accessing

healthcare, especially our more vulnerable people and I think that’s going to have a flow on affect for the hospital system.” Unable to be there in person, Victorian registered nurse Belinda Johnson took to social media to answer critics of the rally. “Some people were making unsupportive comments and my response was that unions are exceptionally important and maybe it’s time people stop riding on the coat tails of those that are union members and jumped on board to become a bit more active, whether it’s financially or at least with their time.” “Because at the end of the day, everyone receives the benefits that we fight and argue for with the government when we do our EBAs.” As an emergency department nurse, Belinda fears the savage budget cuts to health will have a devastating effect. “I feel like the system is already in crisis, there are not enough nurses, there are not enough beds, there is not enough of anything and the elective surgery waiting lists are so long.” “I’m not sure how you can continue to provide top quality care with less when you’ve got an ageing population and a growing population.” More action against the federal budget cuts is being planned around the country. PAGE 5 July 2014 Volume 22, No 1.

Changing attitudes to aged care

Nursing leaders honoured

An Australian nursing academic is trying to change student attitudes about aged care. Dr Maree Bernoth from Charles Sturt University in Wagga Wagga has developed an online resource for students and encourages them to engage with older people during their studies. “In keeping with societal attitudes and stigmas, undergraduate nursing students tended to find the study of ageing and caring for older people basic, disinteresting and irrelevant,” said Dr Bernoth. Previously, students doing the aged care subject would only come into contact with frail and dependent older people during a work placement in residential aged care, said Dr Bernoth. “Although obviously a very significant setting, I wanted to broaden their views of aged care nursing and foster their contact with well older people.” During tutorials students now meet and talk with members of the Older Men New Ideas (OMNI) group, whose ages range from 73 to 93. “The students are also engaging with older people outside tutorials by interviewing older people in the main shopping precinct in Wagga Wagga,” said Dr Bernoth. A DVD of an older couple living in the community has also been developed for use in the aged care subject and is part of the assessment. Dr Bernoth said the feedback from nursing students, graduates and people working with the university’s graduates has been positive and encouraging. “During the past four years, I’ve motivated students to learn more about the care of older people and student engagement with this subject has increased.” Dr Bernoth spoke about her work to mark World Elder Abuse Day last month. The United Nations designated 15 June as a day to focus global attention on the problem of physical, emotional and financial abuse of elders. “The quality of the education provided to nursing students and other aged care workers is extremely important in combating abuse of elders,” said Dr Bernoth.

PAGE 6

Left: ANMF (SA Branch) Secretary/CEO Adj Assoc Professor Elizabeth Dabars. Right: Commonwealth Chief Nurse and Midwifery Officer, Dr Rosemary Bryant

Australian Nursing and Midwifery Federation (SA Branch) Secretary/ CEO Adj Assoc Professor Elizabeth Dabars has been awarded a Member of the Order of Australia in this year’s Queen’s Birthday Honours. Ms Dabars, who has experience in nursing, education, governance, leadership and law, has been CEO of the SA Branch since 2008. One of Ms Dabars highlights as CEO has been an unprecedented membership growth of 70%. “We are now more than 18,500 members strong, which means we are better able to influence health policy and system reform. I am extremely proud of this because it demonstrates that people can see the value in being a member and it enables us to not only continue but to build on our important work to protect and improve the healthcare system.” Ms Dabars said she was very surprised and deeply humbled by the honour. “It’s incredibly humbling to be recognised along so many hardworking and inspirational Australians, but if anything it serves as further motivation to keep fighting to protect and empower the nursing and midwifery professions.”

Ms Dabars said the honour was really a reflection of, and an honour she shared, with the ANMF, all its members, supporters and her family. “The recognition, while very unexpected, is a testimonial to the ongoing importance and growth of the nursing and midwifery professions across Australia.” Australia’s Commonwealth Chief Nurse and Midwifery Officer and former President of the International Council of Nurses (ICN), Dr Rosemary Bryant has also been awarded Officer of the Order of Australia. Ms Bryant won her award for distinguished service to the profession of nursing through national and international leadership and as a supporter of access and equity in healthcare. “The ICN nominated Rosemary for this exceptional honour as she is an ideal role model for contemporary careers in nursing,” said Chief Executive Officer of the ICN David Benton. “She is an inspiration to many and someone who will be recognised as playing a significant role in the history of nursing in Australia, the region and the world.”

News New online campaign fights federal budget cuts What you can do

Lies, Cuts and Broken Promises Australia is facing a healthcare emergency. On 13 May this year, the Federal Government announced its plans to slash health funding for the states and territories and introduce a range of extra fees and charges for basic health services such as the $7 GP co-payment and diagnostic and pathology services as well as extra charges for pharmaceuticals. The effects of these cuts will be devastating. State and territory governments will lose $55 billion in funding over the next three to four years, which will compromise their capacity to run their public health systems and provide quality care to their communities into the future. The extra fees and charges for GPs and other services will inevitably deny access to timely care for those who need it most. And you, nurses and midwives, who are effectively responsible for the day to day operation of the healthcare system, will be the ones who have to cope with the increased load of sicker patients who have delayed seeking care simply because they could not afford it. Nurses and midwives as advocates must campaign to stop the proposed changes to protect the health of our communities. The best way to stop these changes is to lobby the Federal Senate, the house of review. The Australian Nursing & Midwifery Federation (ANMF) is calling for nurses and

midwives to fight the savage budget cuts and broken promises through our new online campaign #healthcareemergency. Targeting the Senate The campaign is targeting the new Senate, which was sworn in on 1 July. The Senate has the power to vote against these harsh budget measures and stop them becoming law. We must convince the Senate that the planned changes to Medicare and the introduction of the GP co-payment are bad for health and bad for the community.

• Visit the ANMF website • Nominate which lie, cut or broken promise you are most concerned about • Share your pledge on Facebook and Twitter using the hashtag #healthcareemergency. • Change your Facebook profile picture to the #healthcareemergency logo and share the campaign with friends and family

ANMF Federal Secretary Lee Thomas and Assistant Federal Secretary Annie Butler will be meeting key Senators in Canberra and lobbying against the health cuts and changes. ANMF state branches will also be taking action to show the Senators in their states and territories that the federal government’s lies, cuts and broken promises will not be tolerated. Make your voice heard Nurses and midwives must stand together to support the most vulnerable in our community by fighting these cuts to health to ensure that Australia continues to have one of the best health systems in the world. Help hold the Federal Government to account for the healthcare emergency they are creating.

Go to the ANMF website www.anmf.org.au and make your pledge to help stop the #healthcareemergency. PAGE 7 July 2014 Volume 22, No 1.

Milestone celebrated The Australian Nursing & Midwifery Federation (ANMF) celebrated its 90th birthday with a cake at the Federal Executive meeting last month. The Federation formed in 1924 incorporating the Federation of the Australasian Trained Nurses’ Association, its state branches and the Royal Victorian Trained Nurses’ Association. ANMF Federal Secretary Lee Thomas said she was proud how the union had grown from strength to strength over the years. “Our membership stands at 233,000 making us the second largest union in the country. This is no mean feat and is reflective of the commitment we have as a union to better the professions and serve the community.”

Members of the Federal Executive

Ms Thomas said one of the most historical changes to occur to the union during her time as Federal Secretary has been the name change from Australian Nursing

Federation to Australian Nursing & Midwifery Federation “I am proud and delighted that this change occurred during my time as Federal Secretary.”

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News More Aussie mums needing blood transfusions The number of Australian mums needing a transfusion of blood and blood products when giving birth is on the rise.

The Australian Red Cross Blood Service is working with the University of Sydney’s Kolling Institute to develop a better understanding of how donated blood is being used.

Around 4,800 Australian mothers will need an obstetric blood transfusion each year and according to research published in the journal Obstetrics and Gynaecology that number is increasing.

“By understanding where and how donated blood is being used we can plan and manage our blood supply more effectively,” said Professor David Irving from the Blood Service.

The study found around 80% of transfusions are for excessive bleeding (haemorrhage). “While we can identify some women at increased risk of excessive bleeding, this is often an unpredictable event,” said Associate Professor Jane Ford from the University of Sydney.

The research has focused on analysing blood usage among this group of mothers requiring obstetric blood transfusions.

“Blood transfusion remains a potentially lifesaving intervention for the one in 10 women who experience haemorrhage following birth,” said Associate Professor Ford.

The next phase will examine why usage is increasing, said Professor Irving. “Understanding what is currently happening and why assists us when working with health providers about when these blood transfusions are needed.”

PAGE 9 July 2014 Volume 22, No 1.

XXXHeadingXXX XXXAuthorXXX

When pain is gone, hugs are back on.

Nothing is more suitable

1–3

Children’s Panadol® is a first-line choice for the relief of pain and fever,* and is suitable for babies as young as one month.1,2 FIRST-LINE CHOICE FOR RELIEF OF PAIN AND FEVER*1

*Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.1 References: 1. NSW Department of Health. Policy Directive: Paracetamol Use. Accessed at http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html on September 2012. 2. Children’s Panadol Approved Product Information, last updated November 2009. 3. NSW Department of Health. Infants and children: Acute management of fever. Clinical Practice Guidelines, 2nd edition, 2010. Available at: http://www.ciap.health.nsw.gov.au. Accessed September 2012. Children’s Panadol® contains paracetamol. For the temporary relief of pain and fever. CHILDREN’S PANADOL is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 06/14 GSK1151/UC. PAGE 10

News Nurses stood down for taking protected action

An ethical dilemma

Nurses and midwives are being asked to search their grandmother’s attic and basement for old books and journals on ethics in nursing for a worldfirst publication. Australian nurse academic, Professor Megan-Jane Johnstone, is preparing a three volume series on nursing and healthcare ethics that will bring together the foundational articles in the discipline. Despite the rich and distinctive history of nursing ethics, Professor Johnstone said many early journals and books have been lost to history. “Unfortunately many were simply trashed when nursing education moved from the hospital to the higher education sector and the hospital-based libraries closed.”

ANMF (SA Branch) CEO Elizabeth Dabars at Fair Work hearing

South Australian nurses were stood down by their employer after taking protected action in connection to their new Enterprise Agreement negotiations. The RDNS nurses were scheduled to take the action following lengthy negotiations over their new Enterprise Agreement, which had been ongoing since September 2013.

individuals were dismissed and agency staff were on standby to cover their shifts. Later that morning a Fair Work Commission hearing was held over the incident. The sixty nurses who were stood down attended the hearing to show their support for the action. The consequence of the hearing was that the nurses were reinstated and negotiations with the employer were recommenced.

The planned action included a ban on mobile phones and using the electronic ComCaresystem, which meant the nurses would receive their daily schedule at the beginning of the day, and any adjustments required would have been done through the head office manually. The ban would not have applied to emergency situations.

ANMF SA (Branch) CEO/Secretary Adj Assoc Professor Elizabeth Dabars AM said she strongly believed because of the united action that negotiations were kick started again. “RDNS nursing staff want a fair and reasonable agreement that values their ongoing role in the community. Before our members made a brave decision to take a stand, this looked out of reach.

Before the planned action was due to take place, the Australian Nursing & Midwifery Federation (ANMF) (SA Branch) followed the Act accordingly to ensure the nurses were protected to do so.

“As a result of united member action, negotiations have restarted and we are hopeful of reaching an agreement that truly values the contribution these hardworking nurses make to the wider South Australian community.”

But when the RDNS employees arrived to work that day, those stating they were participating in the industrial action were stood down and sent home. Approximately sixty

Collections of many early nursing journals are either incomplete, too fragile to access or simply lost, said Professor Johnstone. “Fortunately many older nurses still have private collections of original works and I’m working with some notable scholars in the USA who are helping to locate missing works and preserving those that are at risk through poor storage or being too fragile.” Professor Johnstone is calling for Australian nurses to help find more missing works. “I’m urging nurses to search their grandmother’s attic and basement for works that might be pertinent for the publication,” she said. The three volumes will focus on: concepts and theories of nursing ethics, practical ethical problems in nursing practice and politics of nursing ethics and future directions. Anyone with old books or journals on ethics in nursing should contact Professor Megan-Jane Johnstone on (03) 9244 6120 or megan.johnstone@deakin.edu.au

Negotiations were still ongoing at the time ANMJ was going to print.

PAGE 11 July 2014 Volume 22, No 1.

Tasmania to bring back school nurses

The state government will spend $4.4 million over four years to introduce child and youth health nurses across all Tasmanian public schools. Registered nurse Julia Taylor from the Tasmanian Health Organisation (THO) - North West has been appointed as the project manager for the program. Ms Taylor’s research on school nursing was published in the ANMJ in February 2013. It involved a pilot program at Wynyard High School in Tasmania’s north-west.

Registerd nurse Julia Taylor (pictured right) will oversee the program to reintroduce school nurses

School health nurses will be reintroduced in Tasmania two years after the program was scrapped.

Under the program every student was allocated a 15 minute appointment with a youth health nurse who was on campus one day a week.

for students, compared to the typical ‘drop in’ model used at most schools. Ms Taylor will work with a range of stakeholders over the next 12 months to prepare for the introduction of child and youth health nurses in Tasmania. In primary schools, nurses will focus on vision and hearing checks and nutrition, while in high schools the focus will be on risk behaviours, mental and sexual health. The Tasmanian Government says there will be 10 FTE child and youth health nurses working across public schools by July next year and 20 FTE nurses by 2017.

The research showed the pilot model provided a more inclusive and accessible service

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News Access to healthcare researched Research to better understand and improve Indigenous people’s health was highlighted at a recent forum at the Adelaide University.

Speaking at the forum Alwin Chong, director of the Yaitya Paurrna Indigenous Health Unit said there had been a lot of work in Aboriginal communities, but very little solid rigorous evidence that could be used to make a difference. Yet research that is making a difference in assisting collaboration with health providers and overcoming barriers to provide good care for Aboriginal patients is being undertaken by Dr Janet Kelly, a community health nurse and Research Fellow from the School of Nursing, University of Adelaide.

Speaking at the forum, Dr Kelly discussed her research which looked at patient pathways in being able to receive care. One of the issues researched was the distances remote and rural Aboriginal people often have to travel which can include a number of visits to different health facilities along the way. “Often Aboriginal people go to local health services which can be far from home. From there they may be sent to the regional hospital, to the city hospital and then they have to get home again.” The barriers and enablers to travel were examined. “We were also looking at the underlying factors that impact access, quality of care and location,” said Dr Kelly. The research revealed some of the major barriers to the patient’s journey which included the lack of coordination between

services. “We found staff were doing fantastic work in pockets, but often it was not connected across the system because the health system is so disconnected,” Dr Kelly said. The different electronic case notes and the different systems across health services also impacted coordination, said Dr Kelly. “So it’s really important that staff communicate.” Dr Kelly said to improve the pathway of health for Aboriginal patients there needed to be communication, coordination and collaboration. “It’s also important that Aboriginal patients feel acknowledged and supported. They need to be home and they need to be well.”

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*Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.8 Refers only to non-prescription medicines and is based on the liquid paracetamol formulation given at a dosage of 15 mg/kg. References: 1. Celebi S et al. Indian Journal of Pediatrics 2009;76:287–91. 2. Autret-Leca E et al. Current Medical Research and Opinion 2007;23:2205–2211. 3. Walson PD et al. American Journal of Diseases of Children 1992;146:626–632. 4. Clark E et al. Pediatrics 2007;119:460–467. 5. Hamalainen ML et al. Neurology 1997;48:103–107. 6. Schachtel BP et al. Clinical Pharmacology and Therapeutics 1993;53:593–601. 7. Children’s Panadol Approved Product Information, last updated November 2009. 8. NSW Department of Health. Policy Directive: Paracetamol Use. Accessed at http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html on September 2012. Children’s Panadol® contains paracetamol. For the temporary relief of pain and fever. CHILDREN’S PANADOL is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 06/14 GSK1153/UC. †

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*Guidelines recommend paracetamol for the first-line treatment of pain and fever in children.2 References: 1. Children’s Panadol Approved Product Information, last updated November 2009. 2. NSW Department of Health. Policy Directive: Paracetamol Use. Accessed at http://www.health.nsw.gov.au/policies/pd/2009/PD2009_009.html on September 2012. Childrens Panadol® contains paracetamol. For the temporary relief of pain and fever. CHILDRENS PANADOL is a registered trade mark of the GlaxoSmithKline group of companies. GlaxoSmithKline Consumer Healthcare, 82 Hughes Avenue, Ermington NSW 2115 Australia. 06/14 GSK1154/UC.

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19/06/14 12:13 PM

Issues Kechi Iheduru-Anderson

Educating senior nursing students to stop lateral violence in nursing Lateral violence (LV) in nursing has been well documented for many years, sometimes referred to as workplace bullying or horizontal violence. LV in nursing is an unacceptable, disruptive and inappropriate behaviour involving nurses either overtly or covertly aiming their dissatisfaction with work to others who are in an equal or lesser position (Coursey et al., 2013). ‘Nurses eating their young’ is the expression used by many to describe the feeling new nurses have when faced by behaviours that signify LV as they enter the nursing workforce. Lateral violence can create a very hostile environment. It has been shown to psychologically, emotionally and physically affect those who experience it. The experience of lateral violence has also been shown to have negative impact on work performance, negative impact on the patient care and outcome, and sometimes lead to nurses’ attrition. Healthy work environment has been recognised as an important factor contributing to the recruitment and retention of nurses. The retention of new nurses is essential for the future supply of nurses to be able to sustain high quality patient care across all healthcare setting. For new nurses who are already facing the challenges of transitioning from students to nurses in a stressful profession and in challenging work environments, “the first months of practice can be chaotic, painful, and traumatic, fostering feelings of isolation, vulnerability, and uncertainty” (Lavoie-Tremblay et al, 2008). Adding the burden of LV can have devastating effect on their wellbeing, career, and their work performance, hence jeopardising patients’ welfare. There is a plethora of nursing literature with examples of prevalence of LV. It has been shown that LV education strengthens coping skills for nurses who deal with disruptive behaviour. There are many examples where student nurses witness LV or bullying and may be bullied by staff nurses during clinical rotations themselves. New nurses have described being afraid to ask questions

of more experienced nurses because of the generalised climate of workplace bullying and hostility. Lateral violence stops newly licensed nurses from asking questions, seeking validation of known knowledge, and leave them feeling like outsiders. It also stops them from learning and gaining the knowledge necessary to develop the competence in clinical practice (Griffin, 2004). This type of situation could lead to these inexperienced nurses making mistakes. Coursey et al, (2013) suggested that nursing education include instruction on how to deal with lateral violence. Providing an educational forum on lateral violence for student nurses at the beginning of the senior year is essential for raising consciousness on this issue. This program utilised cognitive rehearsal as described by Griffin (2004) as an effective educational method to address LV. To address the problem of LV and to mitigate its effect, senior nursing students in an associate degree program at a private community college receive a four hour seminar with scenarios, case studies and role playing on lateral violence. They are asked to read two articles about lateral violence in preparation for the seminar. One of the ways to prevent and stop LV in the nursing profession is to create awareness and break the silence. The goal of this seminar is to illuminate the mechanisms of LV and create awareness to this ongoing problem. It is hoped that with better students’ understanding of the practices and expressions of LV in the workplace, the cycle of LV can be decreased or eliminated as they enter professional nursing practice. This will also allow the students to consider their own practice and reactions to LV activity as they enter the profession. The choice was made to educate student nurses to recognise, speak up and prevent perpetuation of LV in nursing. Senior nursing students were instructed on aspects of lateral violence. They were given laminated cards with some of the most common forms of LV and the responses to lateral violence scenarios suggested by Griffin (2004). During role play and simulations, students observe and respond to be-

haviours indicative of LV. The also practice how to deal with bullying and bullies. They responded to fifteen multiple choice pre and post-tests on LV and wrote a reflective journal detailing their feelings and thoughts during the activities. Most of the students described the experience as empowering. Most of them were especially happy with the opportunity to role play and respond to scenarios. The goal is to continue with this project and invite the students back to participate in focus groups six to 18 months after graduation to explore and ask questions about LV and the effect their educational exercise have on them. Nurses have professional and ethical obligation to stop LV and to put an end to the phrase ‘nurses eat their young.’ We need to support our young, create a positive image for this noble profession. Let us stop participating in these oppressive behaviours that manifest into LV in the nursing practice. Don’t keep quiet or look the other way when you witness these activities that allow LV to flourish. Senior nursing students who are getting ready to join the nursing workforce is an ideal place to start addressing this viral issue. Senior nursing students represent the potential for the future of nursing.

Lavoie-Tremblay, M., Wright, D., Desforges, N., G´elinas, C., Marchionni, C., & Drevniok, U. (2008). Creating a Healthy Workplace for New-Generation Nurses. Journal of Nursing Scholarship, 40(3), 290–297. Coursey, J., Rodriguez, R., Dieckmann, L., & Austin, P. (2013). Successful implementation of policies addressing lateral violence. AORN Journal, 97(1), 101-109. doi:10.1016/j. aorn.2012.09.010 Griffin, M. (2004). Teaching cognitive rehearsal as a shield for lateral violence: an intervention for newly licensed nurses. Journal of Continuing Education in Nursing, 35(6), 257-263.

Kechi Iheduru-Anderson is a professor of nursing at Quincy College, Quincy Massachusetts and Adjunct faculty at Regis College Weston and Laboure College Milton Massachusetts. PAGE 15 July 2014 Volume 22, No 1.

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Professional Julianne Bryce and Elizabeth Foley, Federal Professional Officers

Is it advanced or expanded practice? In our roles as Federal Professional Officers at the Australian Nursing & Midwifery Federation (ANMF) we talk about scope of practice on a daily basis. Every conversation we have about nursing scope raises the question of advanced versus expanded practice. Among the confusion one thing is clear, there is a notable lack of uniformity in the understanding and use of these terms.

The Australian Health Practitioner Regulation Agency (AHPRA) defines the scope of a profession as the full spectrum of roles, functions, responsibilities, activities and decisionmaking capacity that individuals within that profession are educated, competent and authorised to perform. The scope of practice of an individual is then defined as that which they are educated, competent and authorised to perform. Logically, the scope of practice of an individual nurse or midwife is more specifically defined than the scope of practice of their profession.

practice in endoscopy nursing role. This example demonstrates how the terminology can so easily be confused.

The implementation of “expanded” nurse roles in the ED is in response to an increasing demand in presentations to ED’s. These projects have sought to recognise and utilise professional nursing expertise that already exists by introducing models of care which support nurses working to full, or in some cases, an advanced scope of practice. Some of these projects include endorsed nurse practitioners. The eight project sites for the nurses in ED program have a focus on mental health, paediatric nursing, and rural and remote settings. Sites are spread across NSW and Victoria. Overall, the focus of the ED projects is in reality on ‘advanced’ not ‘expanded’ scope of nursing practice. These models hold some promise in improving health outcomes for the community. However, they are not about ‘expanded’ scope but rather allowing individual nurses to work more fully, and at an expert level, within the scope of traditional nursing practice.

In Australia, expanded or extended scope of practice for registered nurses is embedded in the nurse practitioner role using the established regulatory safety and quality framework and the protected title. Registered nurses seeking to expand or extend their individual scope beyond that of the profession must follow the nurse practitioner pathway to endorsement.

The pilot of an ‘advanced’ practice in endoscopy nursing role is in response to the expected increase in demand for endoscopies as a result of the National Bowel Screening Program. The two lead sites for this project are in Queensland and Victoria, with Queensland providing the education and training program for the six project participants. The project has been fraught with difficulty as endoscopy is clearly ‘expanded’ not ‘advanced’ practice for nurses. Performance of endoscopy includes expertise beyond the currently recognised scope of practice for the profession. For this model of ‘expanded’ practice to be acceptable and successful it needs to be embedded in the established nursing safety and quality framework for expanded practice - the nurse practitioner pathway.

Over the last two years, Health Workforce Australia has undertaken a series of what they have termed Expanded Workforce Scope Projects as part of their work plan. Two projects involve nurses, one physiotherapists and one paramedics. The nursing projects are described as focussing on: “expanded” nurse roles in the Emergency Department (ED) and an “advanced”

In order to seek clarity around the many advanced practice roles in Australia, the ANMF has commissioned and funded the ANSWER 4 Nursing and Midwifery Project. This research project is being led by Professor Glenn Gardner from the Queensland University of Technology and Professor Christine Duffield from the University of Technology Sydney. It is a study

Advanced scope of practice is an increase in clinical skills, reasoning, knowledge and experience leading to the nurse being an expert working within the scope of traditional practice. Expanded or extended scope includes expertise beyond the currently recognised scope of practice of the nursing profession.

of the activities and level of nursing and midwifery practice in different positions, titles and grades and advanced practice across the country. This work is essential to understand the meaning of advanced practice for the professions of nursing and midwifery in Australia and for the health industry to understand the capability of nurses and midwives working at different levels of practice. It also has implications for nurses and midwives when they’re considering their postgraduate education options and career planning. It is important for the nursing profession in Australia to critically reflect on the terminology of advanced and expanded practice. We need to use a shared understanding to support registered nurses to work to their full and, in many cases, advanced scope of practice without undermining the expanded nurse practitioner role we’ve fought so hard to establish. Remember, in the words of Gandhi, the future depends on what we do in the present.

PAGE 17 July 2014 Volume 22, No 1.

Time For Australia’s Ambassador for Women and Girls on gender equality in Australia and overseas Natasha Stott Despoja famously wore a pair of Doc Marten boots when she delivered her maiden speech to the Parliament in 1995 as the youngest ever Senator in Australia. Fast forward almost 20 years and Doc Martens are back in fashion, while Natasha Stott Despoja and her passion for social justice have never gone away. Now the Australian Ambassador for Women and Girls, Natasha Stott Despoja spoke with ANMJ reporter Kara Douglas about some of the issues facing women internationally and here at home. Q: Your visits to Papua New Guinea and Indonesia earlier this year included tours of local health clinics, what were the conditions like?

We’re not only talking access to services, we’re talking about information and education, and indeed this is a role where Australia can play a part.

A: The provision of services and supplies is at a very basic level, there’s vaccination support, support for women who are pregnant or considering being pregnant, midwifery support, the opportunity to provide skilled birth attendants for women in areas that may be regional or remote.

Q: What sort of response do you get from the women you meet during your visits?

But just meeting with women is really the most engaging and rewarding part of what I do and then being able to promote the good work that Australia does in this area is an added bonus.

“

Does it break my heart that women are not in comparable positions of power, be it politically or in business or industry? You bet it does.

”

Q: How important is it that Australia helps aid the development of child and maternal health services in the region? A: It’s absolutely critical. We know more generally that gender equality and empowering women is the key to any society’s success, whether it’s to do with reducing or eliminating violence and as a consequence giving women choices, opportunities, education, better health, better incomes, better lifestyles and better futures as a result. If you look at the fundamentals in our region, and I think some Australians are sometimes shocked by the fundamentals because they don’t often have to confront some of the realities, but when you’re looking at developing nations that might have women 100 to 300 times more likely to die in child birth or because of pregnancy, that underscores just how critical it is. PAGE 18

A: A combination of responses, people and organisations are excited by the partnership they have with Australia and that’s exciting to see people happy with the work that we do. I guess there is an element too that people want us to do more and I totally understand that. We’re a very fortunate nation and I think we have great obligations to our region, particularly countries on our door step. Having seen some of these issues face-to-face in PNG in the past couple of months, it’s quite confronting when you think how close we are to our near neighbours and yet they have some staggeringly high rates of maternal and infant mortality as a consequence of very basic services. Q: Are you concerned about budget cuts to Australia’s foreign aid? A: I think if Australians saw the work and the impact of our aid and development budgets people would have very different views on foreign aid funding. I think we’re a very comparatively generous nation when it comes to individuals who donate to causes, or to NGOs, or to relief situations but it’s really important to me, regardless of who’s in power, that Australians understand the good work that we can do and how foreign aid and development work is a part of that. Q: Do you think that message cuts through to the Australian public? A: I’m not sure if it does or doesn’t cut through. I’ve watched this with interest over the past couple of months and occasionally there are voices that suggest, understandably, that we need to look after our domestic responsibilities before we look at international obligations.

“

We’ve got a gender pay gap of 17%, the same pay gap that my mother had 40 years ago. These things disturb me greatly. But I think there are some Australians who given the opportunity to see first-hand or even second-hand the work we can do, would change those opinions. When people are informed, when people are aware, when people get to see what’s going on it makes a big difference. There are very few Australians who spend their time, or their holidays, or their leave in places like PNG or the Solomon Island or Nauru or Vanuatu. If they saw firsthand not only the need but the good that we can do, I think that attitude would change. Q: In your role as Ambassador you are focused on promoting gender equality for women in developing nations, how do you feel about Australia’s own progress on the issue? A: I’m passionate about this subject. I’ve spent my life promoting and being an advocate of gender equality. Does it break my heart that women are not in comparable positions of power, be it politically or in business or industry? You bet it does. When I got into Parliament in 1995, 14.9% of the Parliament was female. I thought that almost 20 years later we would see much greater progress but we’ve got a gender pay gap of 17%, the

”

same pay gap that my mother had 40 years ago. These things disturb me greatly, let alone some of the broader debates. In terms of gender equality in our nation, I never underestimate how far we’ve come and I celebrate the success and achievements, and I particularly pay tribute to my foremothers and foresisters in what they’ve achieved, but we have a long way to go and I’m often reminded of that even in my region. I meet with wonderful women in East Timor and they say to me, ‘We’ve only got 38% female representation in our Parliament’ and I say ‘Well we’ve only got 31% in our Federal Parliament’ so we can learn from each other and by no means has Australia got it right. There are some things we can certainly share and others can learn from, but I’m looking forward to the day we don’t have to have these debates over and over. Natasha Stott Despoja’s term as Australia’s Ambassador for Women and Girls runs until June 2016.

PAGE 19 July 2014 Volume 22, No 1.

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Legal Linda Starr

Bedside handovers and confidentiality – can they co-exist? Clinical handover is an important component of patient care. Those caring for patients have a duty of care to ensure that they deliver a clear, comprehensive, complete and accurate account of their patient’s condition and needs to relevant members of the patient’s healthcare team.

This communication may be between members of the team during a shift or in handing over the care of their patient to the responsible staff member on a new shift. The where and how of this handover has from time to time become subject to some scrutiny particularly in relation to maintaining the patient’s confidence in the process. Bedside handovers – a process that is seen as an important aspect of patient centred care is a growing trend that could threaten patients’ confidentiality if not handled carefully. Bedside handovers do not abrogate the need to observe the common law rules around confidentiality and nurses and midwives who merely transfer a ‘full detailed’ handover to the patient’s bedside risk breaching this common law obligation and their obligations under the Code of Ethics and Code of Conduct as stated by the Nursing and Midwifery Board of Australia. Confidentiality is a commonly misunderstood concept. By definition confidentially comes from the Latin term ‘con’ – completeness and ‘fidere’ – to trust (Kerridge et al 2013). Thus an essential feature of confidentiality is the creation of a relationship of trust with patients so they feel able to disclose personal information to their healthcare team knowing this will not be divulged without their consent. This notion of patient consent resonates in part with the concept of bedside handover which has as the core feature patient participation. Hence, a patient should be consulted regarding the practice of bedside handover and their consent obtained for their participation in this activity and to determine the level of disclosure they are prepared to have released at the bedside. To do otherwise would be to adopt a paternalistic approach assuming that the

team knows what is in the patient’s best interest regarding this practice.

Clearly, unauthorised personnel should not be in the vicinity of the handover, including other patients, visitors and staff who are not part of the patients healthcare team. The more public the environment the less secure the patients confidentiality will become and the greater the need to take reasonable steps to minimise the risk of unauthorised disclosures. In any event, private and sensitive material should not be disclosed at the bedside, but in a separate handover privy only to those who have an authorised need for this information. In a healthcare setting confidential information includes all information that the patient discloses where there is an expectation of non-authorised disclosure. This may vary according to patient needs, for example, some patients may not want others to even know of their admission to hospital particularly when being treated for a sensitive matter. Sensitive information would generally include test results, not for resuscitation orders, family issues including domestic violence and elder abuse and communicable diseases. There may also be information that the patient has quarantined and does not want shared at the bedside and if so, their wishes should be respected. In most cases patients will appreciate being consulted about participating in the bedside handover and the opportunity to make comment, and correct any inaccuracies in the information being handed over. However, that said, there is still an obligation to ensure that this handover is conducted near the patient and in a lowered voice to minimise the risk of others overhearing. It would be a rare circumstance that a patient agreeing to a bed side handover would see this as a waiver of their right to privacy and confidentiality.

legitimate access to the information, their right to confidentiality will have been breached. A breach of confidentiality may lead to a patient taking an action in a breach of contract, negligence or defamation, and whilst there have been few law suits in this field, practitioners should also note that a breach of confidentiality can also be viewed as unsatisfactory professional conduct or professional misconduct. Bedside handovers have in part been designed to ensure that patients have an active role in their care, which includes an active role in the right to control the flow of information provided for their care that is disclosed at the bedside. After all, consent to an informed disclosure would not be a breach of their confidence.

References

Kerridge Ian, Lowe Michael & Stewart Cameron. 2013 Ethics and Law for the Health Professions. 4th ed. Federation Press Australia.

An expert in the field of nursing and the law, Associate Professor Linda Starr is in the School of Nursing and Midwifery at Flinders University in South Australia

A breach of confidence occurs when confidential information is provided in circumstances where there is an expectation of confidence, and there has been an unauthorised disclosure of that information. Hence, when a patient provides members of their treating team with personal information in privacy and this is then passed onto another who has no PAGE 21 July 2014 Volume 22, No 1.

Women’s Health Excerpt from the Women’s Health tutorial on the ANMF Continuing Professional Education (CPE) website The following is a summary of the Women’s Health Nurse tutorial written by Linda Oliver, women’s health nurse (WHN) and in partnership between the Australian Women’s Health Association and the ANMF. The tutorial is aligned to the Advanced Practice Standards (APS) and is available in its entirety on the ANMF Continuing Professional Education (CPE) website.

The key principles of women’s health nurse practice encompass a gendered approach to health; apply a social model of health; enable clients to make independent health choices; encompass holistic care practice; emphasise the combination of clinical and advocacy skills; utilise a collaborative approach; provide education to clients; provide accessible affordable and equitable healthcare; and identify key groups of women. Taking the key principles into consideration, this tutorial presents detailed information on breast health and examination, cervical screening, pelvic/

bimanual examination, Human Papilloma Virus (HPV), and Female Genital Mutilation (FGM):

Breast health

There are natural changes to the breast that occur throughout a woman’s lifetime. A sound understanding of the anatomy and physiology of the breast is necessary in order to conduct a thorough breast examination and recognise potential problems and disorders. Taking a detailed history of the woman’s breast development is also very important when undertaking a breast examination. We

The ANMF currently offers three online professional development training rooms, providing best practice information on a wide range of topics applicable to all areas of practice. Each of the training rooms also assist you in maintaining NMBA compliant CPD records. If you are an ANMF, NSWNMA or QNU member you can access the online training at affordable reduced rates. There are even some FREE topics available. Non members can also access the online training. Online Clinical Simulations for Nurses and Midwives

Online CPD Visit our website and get started today!

The Continuing Professional Education (CPE) online training room currently provides 50 self‑directed learning tutorials. Each tutorial is paired with a random 10 question assessment that proves competency in the topic. Our members have free access to a professional development portfolio and 11 free topics. All remaining topics are just $7.70 each for members. Non member prices are also available.

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

Aged Care Training Room The Aged Care Training Room (ACTR) offers all nurses working with older people access to affordable aged care specific CPD. You will find over 60 modules written against the accreditation standards and community care common standards. An annual subscription is $110 for our members and includes access to a learning plan, reflection and evaluation tools and a printable log of course completions.

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PAGE 22

For more information call the ANMF Federal Office on 02 6232 6533

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Education discuss how to conduct a breast examination including both a visual check and a manual check on both breasts. As with natural changes there a various breast problems that can occur over a woman’s lifetime and an understanding of their etiology and management is necessary for the WHN. Knowing when to refer a woman for further investigation is imperative along with an understanding of the investigations and management options. Communication and counselling skills are used with all client interactions and knowledge of the principles for the early detection of breast cancer are discussed including the NHMRC guidelines.

Cervical screening

The Pap test is a screening test not a diagnostic test. It is designed to detect or find early changes in the cervical cells, which can be treated to prevent cancer developing. Research has shown that the majority of women (3 out of 4) who develop cervical cancer have not had a Pap test or have not had one regularly. All women who have had sexual intercourse including heterosexual women and women who have sex with women need to have a Pap test. An understanding of the anatomy and physiology of the reproductive organs underpins the clinical application requirements for the WHN to perform a Pap test. Pap test pathology and management recommendations are also discussed in detail.

Pelvic/bimanual examination

Internal pelvic examinations are performed to check the size and position of the uterus, determine the possibility of fibroids or other irregularities with pelvic floor assessment also being a part of the pelvic examination. This section discusses what can normally be palpated during a bimanual examination along with the organs and structures that normally lie in the abdomen. The effects of oestrogen and progesterone on the body, specifically the vaginal walls and cervix is also addressed.

The floor of the pelvis is made up of layers of muscle and other tissues that stretch from the tailbone to the pubic bone. They support the bladder, uterus and bowel. We discuss what weakens the pelvic floor muscles and how to assess the strength of the muscles. Problems occur for a woman with weak pelvic floor muscles so when these are detected referral for further assessment and management is the role of the WHN.

Female genital mutilation (FGM)

The term ‘Female Genital Mutilation’ was defined at the International Convention in Vienna in 1993. When working with communities affected by FGM this term could be offensive so the term ‘female circumcision’ is preferred.

Research has shown that the majority of women (3 out of 4) who develop cervical cancer have not had a Pap test or have not had one regularly. The problem is identified as having an overall prevalence of over 130 million cases with an annual incidence of 2-3 million women. It has only recently been acknowledged as a widespread practice with health consequences. The communities who practice FGM do not consider it to be mutilation.

The ANMF Women’s Health Nurse tutorial offers you five hours of CPD toward your annual registration requirement. To check or hone your practical skills in Performing a Pap Smear or a Bimanual Examination go to our Online Simulations for Nurses and Midwives website at http://anfsimulation.org/ For further information please contact the ANMF education team at education@anmf.org.au or phone Jodie or Rebecca on 02 6232 6533

There are four classifications of FGM and each is discussed in the tutorial. The complex issues that arise from FGM including fear and women’s sexuality are discussed in detail. Due to increasing numbers of people arriving and settling in Australia from African nations in which FGM is customary, demand for FGM in Australia is present and may be increasing. Australian law clearly prohibits performance of any type of FGM. The above is just a summary of the content from the ANMF tutorial on the CPE website. To complete the tutorial in its entirety, go to http://anmf.org.au/pages/ cpe and log in as an ANMF, NSWNMA or QNU member. Non-members also have access to this best practice learning. PAGE 23 July 2014 Volume 22, No 1.

Most people have heard stories about nurses and midwives being fired for ranting about their employer on Facebook or tweeting an inappropriate photo. But instead of being scared of social media, some nurses and midwives are embracing it as a tool to advance the professions, educate their patients and boost their careers. Kara Douglas reports.

PAGE 24

Feature

uring her 25 years in nursing, blogger and social media fan Tara Nipe has seen some extraordinarily bad decisions made by nurses and midwives on social media. From student nurses posting photos of themselves with dead patients, to a midwife tweeting about the ugly baby she just delivered, or a nurse documenting the tense resuscitation of a child and posting the child’s photo on Facebook - Tara has seen it all. “I’ve also heard about nurses and midwives who have complained about their employers and have had disciplinary action as a result of that, or they’ve used language to describe their patients or employer in ways that are not professional.” But far from warning nurses and midwives against using social media, Tara is passionate about its use as a tool to advance the professions. “We need to have more nurses and midwives involved in social media, particularly in public social media like blogging and twitter because our voices need to be heard, we have useful information to share.” Tara believes Twitter is a great way to network and to educate the public about the issues in nursing and midwifery but it needs to be done with caution. “If you wouldn’t say something to the [main stream] media then you shouldn’t publish it electronically.” Tara very rarely writes anything about work and when she does it is long after the incident has happened and everything is de-identified. “Mostly I talk about nursing and health policy in general terms and the most important thing is to be aware of what the social media policies that govern what we do are and to keep up to date.” A clinical nurse specialist and member of the Victorian ANMF branch council, Tara has one of the largest followings among Australian nursing professionals on Twitter. Since opening her account just over two years ago, she has amassed 2,533 followers and made an astounding 43,100 tweets. “What I find useful about Twitter is that it’s fast, it’s real time, it’s really easy to communicate a thought or a message and it’s very easy to retweet what someone else has said.” Tara prefers Twitter to Facebook and uses them very differently. “I’m generally only friends on Facebook with people that I know personally and I use it to keep in touch with colleagues I’ve worked with and people that I’ve met at conferences that I would otherwise lose touch with.” Whereas on Twitter, Tara says she can engage with new people about nursing, health policy and political debates. “I think I only knew eight of the people I know on Twitter before I joined, whereas I use Twitter to engage with people all over the place, from nurse academics in Australia, the UK and the USA, to union PAGE 25 July 2014 Volume 22, No 1.

Feature

Tara Nipe

members, including nurses but not only nurses, from across the country and around the world, as well as other nurses and people who are really politically active.”

Brittney firmly believes social media should not be seen as a negative in nursing. “It can do wonderful things for the nurses involved, the patients we serve and the medical community in general.”

Tara didn’t grow up with social media, like many younger nurses have, instead she started using it by chance during the ANMF Victorian branch EBA negotiations in 2011-12. After coming home early from a holiday in the UK, Tara had some free time so she became involved with the union’s Respect Our Work Facebook page, going to rallies and posting photos on the page for nurses who couldn’t attend.

Brittney says there is an unwarranted fear of social media in the healthcare sector. “It’s been around for years but they’re still scared of it and don’t want anything to do with it”.

Tara says she found it very motivating and was inspired by the power of social media to bring people together. “You can feel very isolated if your workplace isn’t very active, so Facebook was a great way of letting nurses across the state, and in fact across the country, know what was happening and that they weren’t alone.” The Victorian ANMF social media campaign was ground breaking. At one point during the campaign, the Victorian government had a Federal Court gag order issued to prevent union officials, including job reps, from saying anything on social media that encouraged illegal industrial action, which is what the Victorian nurses and midwives were taking.

Used wisely, Brittney says social media can provide amazing opportunities for nurses and midwives. “I think I’m a really good example of that because I’m one of the only nurses [in the United States] who really embraces social media and it’s gotten me jobs and wonderful opportunities, I even wrote my book because of it.” While not every nurse or midwife will want to become a social media expert, Brittney says it is a great way to build a profile within a particular field of nursing. “You can establish yourself so much more through that platform and really build your personal brand and set yourself apart from the crowd.” It is also a valuable tool to educate patients and the broader public about issues within nursing and health policy. “I think one of the biggest things we can do is draw attention to issues that are not being acknowledged by administrators in our facilities,” says Brittney.

It backfired on the government, creating outrage among members and spurring on the campaign. “A lot of the job reps, including me, got around it by saying things like - I’m going for a walk if anyone would like to join me - without actually saying anything about the industrial action.”

Safe staffing levels are a perfect example, she says. “I think if nurses want to highlight the research around it or just their personal opinions, the fact that they don’t feel safe with this level of care, I think we can elevate these ideas and get more people talking about it.”

As the campaign progressed, Tara realised she had developed a social media ‘brand version’ of herself and decided to set up her own blog. Conscious of the brand she had created, Tara has set herself a number of rules for social media. She doesn’t swear, insult people or publish anything that would embarrass any association she is affiliated with, including her employer. Tara also made a conscious choice to use her real name. “I use my name for two reasons, one is that I think that it adds veracity to what I’m saying and the other is that it reminds me not to say something that would be uncomfortable if my identity were revealed.”

But Brittney warns that ranting about your employer on Facebook or Twitter is not the right way to go about it. “If you have an unsafe issue you’re immediate response should not be to go to Twitter and blow up Twitter about it, you should be going to your supervisor or your manager and if they don’t want to do anything about it you need to go to your Director of Nursing, you need to go up the flagpole to escalate and fix this issue.”

Brand building Another nurse who has carved out a brand identity through social media is American nurse Brittney Wilson. Known as ‘The Nerdy Nurse’, Brittney is an informatics nurse who blogs about nursing and technology on her website, www.TheNerdyNurse.com, and has recently published her first book under the ‘Nerdy Nurse’ brand. PAGE 26

Going online to talk about your particular facility is a bad idea, says Brittney. Instead social media should be used to talk about issues in general terms to help raise awareness. “You have to generalise because if you go online and talk about how your hospital is terrible because they make you take seven patients, you’re going to get yourself fired. “But I don’t think any facility is going to be upset if you talk about a generalised issue and you raise awareness of it in a professional and an appropriate manner.”

Feature Behaving professionally on social media is vital, says Brittney. “It can be used as a very powerful tool to advance the nursing profession and you can own up to the fact that you’re a nurse on social media, in fact I do everywhere I post, you just have to be very careful of what you do.” Even if you choose not to reveal your job, Brittney firmly believes that nurses and midwives owe it to their professions and themselves to show a certain level of decorum and professionalism when posting online. “I think a lot of people forget that. They think they can clock off and take pictures at the bar, use profanity and do things they would never do in front of their boss, their coworkers or their human resources manager.” Brittney says many nurses and midwives don’t realise that information is stored and can be accessed by almost anyone who wants to. “It could cost you your job and prevent you from getting future jobs if people don’t like the way you present yourself online.” Brittney also warns against becoming friends with patients on Facebook. “The first thing any nurse should do when they have a patient encounter is plan for their discharge and plan for the ending of that relationship. “We are taught from day one in nursing school that the nurse-patient relationship has to have an end, it has to have a resolution and if you’re not providing that, I think you may be giving patients a false sense of what your relationship with them is and it could set you up for a lot of trouble.” While friending patients on social media is a bad idea, Brittney believes posting about patient encounters can be beneficial provided patient privacy is not breached. “I think story telling is a really good tool you can use social media for because it helps us learn and grow as a profession, but you have to be careful that you’re not accidently or purposefully revealing protected health information about a patient online.” Nurses, midwives and other health professionals posting photos of patients online has been a problem. Brittney recalls a nurse she knew being fired for posting a photo of a patient in the emergency department with a metal rod poking through his shoulder after a car crash. “The patient involved actually died so it was really unfortunate. This man was having a terrible tragedy and they kind of made sport of it, they violated his privacy but they also violated his dignity.”

Brittney Wilson

Patient privacy The prevalence of social media and smart phones can lead to breaches in patient privacy. A recent study at a large Australian tertiary hospital found one in five clinicians used their smart phone to take photos of patients. Study author and medical photographer, Kara Burns, says it is fairly common for images to be taken of interesting cases but how the images are shared determines if they are being used ethically or not. “If an image is taken on a phone and shown to another clinician for diagnostic purposes that’s obviously an appropriate use of the image, however if it’s shared just because it’s interesting and it’s shared with another clinician who may not be treating the patient or it has no clinical relevance, that’s when sharing that image may be unethical.” In terms of patient privacy, photos are highly confidential and can only be shared with the clinicians who are treating the patient and must be stored in accordance with all other health data. However from the research, Kara says it appears people were not storing photos as they would other data. “It’s possible because of

The power to connect Angela Garvey knows the power of a tweet. With just 140 characters tapped out on her smart phone, the registered nurse and NSWNMA professional officer was able to have her view on a health policy debate read by 26,000 people, including politicians, health professionals and journalists. “I was ecstatic. I’ve got 800 followers but then a number of people re-tweeted me and people re-tweeted them. You can say one thing and it can reach a huge number of people for free,” she says. Angela joined Twitter in 2009 and says she loves the ability it gives her to be part of public debate. “It’s a real connection to that sort of political communication and discourse.” Angela recalls listening to a live radio interview in which the interviewee criticised ratios. “I quickly tweeted the program, suggested they ask him a particular question and was able to provide the link to the research. They immediately asked him the question and asked him to comment on the research. It was amazing.”

Angela Garvey PAGE 27 July 2014 Volume 22, No 1.

Feature

Kara Burns

the proliferation of images on social media, images that were taken on mobile phones or even images taken on personal digital cameras, weren’t being stored the way that they should have been.” Kara says health professionals know it is wrong to take photos of patients on their smart phones but the practice was still fairly common. “As a medical photographer, I would see people do it and they would try to hide their photos as though they didn’t take a photo. So I think they understood it was inappropriate to be taking photos on their phone but it seems to be quite a prevalent practice anyway.” The phone itself is not a problem provided the images are stored correctly and deleted from the phone, says Kara. “It’s not the actual device as long as the photos are used in accordance with the way the consent has been taken and they’re used ethically.” Kara says the problem comes when consent has not been taken and the image is not stored back in the patient file. “The overwhelming response from my research was the people didn’t realise they had to get written consent for photos, they assumed that verbal consent was sufficient, however given than we live in a world of informed consent, which is the signing of a written document, at this stage photos still need to get written consent to be taken and use of those photos needs to be documented properly.”

Be informed Knowing the rules and policies that govern social media use for nurses and midwives is essential, says ANMF Federal Secretary Lee Thomas. “Social media can be an amazing tool to advance the professions and educate the public but if nurses and midwives don’t use it wisely they could end up facing disciplinary action and hurting their careers.” The Australian Health Practitioner Regulation Agency (AHPRA) released policies on social media and advertising earlier this year. These, along with specific employer policies, apply to all nurses and midwives practising in Australia. The ANMF has developed its own policies and fact sheets on ‘Social Media and Online Networking’ and ‘Advertising for Nurses and Midwives’ to help explain the policies and provide useful tips, says Ms Thomas. “I urge all nurses and midwives to go to the ANMF website and read these fact sheets. Knowing what you can and can’t do on social media is essential to your career.” Understanding the advertising guidelines is particularly important, especially for nurses and midwives in private practice. Under national law, ‘A person must not advertise a regulated health service, or a business that provides a regulated health service, in a PAGE 28

way that – uses testimonials or purported testimonials about the service or business’. “For example, that means a privately practising midwife who leaves a post on her website or Facebook page from a grateful new mum about her wonderful delivery is at risk of breaking the law and could be fined up to $5,000,” says Ms Thomas. To avoid falling foul of the advertising guidelines, nurses and midwives should avoid asking for or publishing testimonials about any health service or health professional, Ms Thomas says. “Also avoid writing or posting comments on social networking sites, blogs or emails that could appear to be testimonials for health services and health practitioners. What may seem like innocent praise for a fellow nurse or midwife could end up costing a lot more.” While there are pitfalls to social media, Ms Thomas says they’re easily avoided by understanding the policies that apply to nurses and midwives. “Arm yourself with the knowledge you need so you can use social media to make a difference to the nursing and midwifery professions and to our patients.”

Tech Talk Gurney Khera

Technology-centric new hospital for Adelaide The ubiquitous expansion of electronic and computer technology in the health sphere continues at unparalleled rates in the latest public hospital in Australia – the new Royal Adelaide Hospital (RAH), currently being built in Adelaide, South Australia. This multi-billion undertaking by the SA government is set to revolutionise the way in which public healthcare is delivered particularly in its use of the latest in medical systems, diagnostics, robotics and computer and information technology, seamlessly integrated into the medical and healthcare delivery model. Some examples of the sophisticated technology being employed include automated guided robotic vehicles, (AGV’s) which will move medical equipment, medications, meals, linen and waste through hidden corridors and will have human interaction capabilities like talking and listening to orders, and communicate wirelessly with the main computer servers. They will be fully programmable and provide key support functions throughout the hospital. There will also be intelligent technology support systems with real time clinical information through smart phones and tablets. This is an exciting new area and one that will directly impact the way nursing and midwifery staff will interact with patients and each other. A key difference is staff will no longer be ‘desk bound’ to a computer terminal and instead will be a lot more mobile by taking the terminal with them in their pocket. Most patient data will be entered at the bedside or at the health service area, and voice recognition technology will be widely used. Key reports and patient charts will be hand held electronically. Communication between clinicians and nursing and midwifery staff will be far better, more detailed and immediate. Google’s highly sophisticated ‘translate’ software may be used, for example on the clinical staff’s smart-phone to translate and converse with a patient whose primary language is not English. Over time, other key new technologies like wearable computer glasses may be incorporated into the technology framework. Patient bedrooms will incorporate sophisticated bedside terminals that will enable individualised food ordering, entertainment

from TV, radio, DVDs, games, telephone and nurse-call functions much like an in-flight system. Identification recognition for both patients and hospital staff will be possible with RFID chips (radio frequency identification) and a smart card reader. Patients will have intranet access, providing them with access to relevant information on their condition and medications as well as helping them keep in touch with family and friends through video-conferencing, Skype and instant messaging. An interesting new technology will be the implementation of a fully programmable and customisable nurse-call system, which is IP (internet protocol) based, enabling data to be transmitted through the hospital’s intranet into the main computer systems for full integration and reporting. This will allow for two way communications between patient and nursing staff as well as various levels and categories of call types and escalations. There will be self-serve electronic kiosks at various locations to give directions and print out maps for visitors and provide information on hospital departments, patient locations and other key promotional or functional information. Another key technology will be the use of electronic tags (E-Tags) which will allow staff to quickly check the whereabouts of equipment, both to prevent theft and reduce time searching for items such as wheelchairs. High-risk patients may also have wearable E-Tags to facilitate patient tracking and alerts automatically sent to medical or security staff if needed. The use of E-Tags is rapidly increasing throughout the medical sphere and not one to be concerned about, as relevant

checks and measures are incorporated to ensure data is not leaked nor misused. Eventually most, if not all patients will have E-Tags upon admission, and this may extend to all hospital staff as well. The RAH will also incorporate a new integrated state-wide electronic health record (EHR) system, designed to improve communications for patients, doctors, nurses, midwives and other public health professionals by connecting a patient’s health record across all metropolitan public hospitals and health services, and some country hospitals. This will eventually be incorporated into the national PCEHR systems. It is a very exciting phase of new technologies being incorporated into a major public hospital and provides the opportunity to showcase them. Nursing and midwifery staff will be at the leading edge in their use. There will no doubt be some teething problems and unforeseen issues but if staff are well trained and embrace their use these technologies will enhance, streamline and provide new efficiencies and ultimately much better healthcare to the patients as well and hopefully increase overall job satisfaction and minimise work stress. To view the plans of the new hospital go to RAH fly through www.newrah.sa.gov.au Do you have a burning question about technology or want us to cover a specific health innovation, then email: techtalk@anmf.org.au Gurney Khera B.E, B.Sc (computer science) is an IT Specialist and Consultant. PAGE 29 July 2014 Volume 22, No 1.

By Elizabeth Gillespie and Emma Canning

Introducing insulin pen needle safety devices in Australia to protect nurses Introduction

Safety devices are important preventative strategies to reduce occupational exposures. We report the outcome of a trial and subsequent introduction of a safety-engineered pen needle device (PNSD) across our health service. The trial demonstrated that using a PNSD whilst in hospital did not require an increase in education and was not viewed as inconvenient or difficult for patients. The advantages were that patient independence was maintained, the risk of a needle stick injury was reduced and cost minimised. The standardised introduction of pen needle safety devices across Australia has the potential to improve and promote a sharps safety culture and significantly reduce the risk of needlestick injury in nurses.

Pen needle use by diabetic patients self-administering insulin has grown significantly with patients expressing a preference for insulin pen devices over insulin vial and syringe (Korytkowski et al 2003; Sucic et al 2002; Davis et al 2008; Hyllested-Winge et al 2010; Asakura et al 2009). Insulin pens were first introduced in 1985 (HyllestedWinge et al 2010) with reports of a slow uptake of their use despite the advantages over a vial and syringe (Fischer et al 2008). We identified an increase in needle stick injuries (NSI) associated with recapping insulin pens in 2008, prompting a review of the management of patients self-administering insulin at Monash Health. (Refer to Table 1 and Figure 1.) As a result, the health service introduced a protocol of administering insulin via a safety engineered needle and syringe. The protocol was initiated only after assessment by staff that the patient was not able to competently administer insulin using their own insulin pen. For six months there was a reduction in occupational exposures but then a return to high numbers of injuries in 2009 and 2010. Heightened awareness may have waned, staff may have returned to previous behaviours, or new staff may not have been aware of the protocol and the system failed. Monash Health is Victoriaâ&#x20AC;&#x2122;s largest metropolitan health service providing 250 programs and services, with a catchment of over one million people, a bed capacity of 2,150 including acute, sub-acute, mental health and aged care beds and 13,700 staff. In late 2009, a pen needle safety device (PNSD) became available in Australia. PNSDâ&#x20AC;&#x2122;s are not funded for use by diabetic patients at home. Therefore, if introduced, patients need to use the PNSD in hospital and revert to the non-safety device when returning home. Nurse educators were concerned this could create confusion in technique for patients. As Monash Health promotes the use of superior engineered safety devices over non safety, a trial was undertaken.

PAGE 30

Methods

An historic comparison study of before and after effects without a control group was employed for the trial in a busy medical ward, specialising in diabetes, at Dandenong Hospital, Monash Health. This ward was chosen because three of the nurses had recently had a NSI, associated with the use of non-safety pen needles. The aim was to assess if there was an increase in the need for education instruction when using a PNSD. It was expected that the device would enable patients, who were temporarily unable to administer their own insulin, to maintain some level of independence and at the same time protect our staff from the risk of NSI. In 2011, a nursing assessment tool was implemented to determine the time required for education of patients using a non safety pen needle. This measured administration technique, instruction time and competence of the patient self administering insulin. The assessment took place when the patients were within 48 hours of expected discharge. A train-the-trainer program was then initiated for nursing staff that included the correct technique for insulin administration using the PNSD. The PNSD was introduced once staff training was completed. The nursing assessment tool was then used to determine the education requirements when new patients used the PNSD to self-administer their insulin. Ten patients were assessed prior to the introduction of the safety device and only eight patients were assessed after the introduction of the safety device as staff time restraints prevented further data collection. This project was undertaken without any additional resource or funding. A cost analysis was also undertaken of PNSD compared with safety insulin needle and syringe with insulin supplied. This included direct cost of supplies, cost of occupational exposures associated with pen needle use in 2008 compared with 2009/2010, and the costs of injuries included in the review (Table 1).

Clinical Update A cost of $500 for each occupational exposures was used, which allowed for one follow-up session, counselling pre and post occupational exposure testing for the patient and staff member and serology collection with processing. This figure has been reported in the literature by the Medical Technology Association of Australia 2013. A review of the insulin pen associated occupational exposures that had occurred from April 2009 to December 2010 was undertaken. How the NSI may have been prevented and the circumstances of the injury were considered, to determine if a PNSD may have reduced the risk of the occupational exposure.

Results

Nursing assessment of education requirements Ten patients using the non-safety pen needle, required 50 cumulative minutes education by the ward nurses and three sessions with a diabetes educator. One patient required 20 minutes and six patients required five minutes education by the ward nurses. Of these 10 patients only one patient required instruction in self administration for the first time with the remaining nine patients having had at least three months or more experience in self-administering insulin. Three patients did not require any instruction by ward nurses. Eight patients using the pen needle safety device required 60 cumulative minutes of education by the ward nurses and one session with a diabetes educator. This was 10 minutes of education for six patients by ward nurses. All eight patients had been self-administering insulin for three months or more, using a non-safety insulin pen needle. Two patients did not require any instruction by ward nurses.

Review of insulin pen needle injuries A review of recent injuries resulting from the use of the patients’ own non safety insulin pen needles demonstrated that all may have been prevented if a passive

(automated) safety device had been used. (Refer to Table 1.)

dramatically reduce safety risks to healthcare workers (Guillaudin et al 2011).

Of the 28 incidents reviewed there were six occasions when the nurse recapped the needle (21.4%) and nine incidents (42.8%) where the patient had recapped the needle and an injury resulted in the nurse assisting.

PNSD’s are superior and are safety engineered, designed to protect staff from injury. The PNSD eliminates the risk of needle stick injury because it is a passive device that retracts the needle automatically, on withdrawal of the needle from the epidermis. A safety needle and syringe requires activation after use but also removes the patient’s capacity to maintain independence. PNSD’s allow patients, who are temporarily incompetent, to continue self-administering insulin with assistance but without compromising HCW safety.

Prior to the introduction of PNSD across the entire health service, there was a reduction in injuries (Quarter 1 08/09 to Quarter 3 08/09), but then a return to previous levels (Quarter 4 08/09 to Quarter 4 09/10). PNSD implementation was completed by Quarter 4 10/11 and a reduction of injuries has been observed since.

Cost benefit analysis In 2008, there were 21 NSIs associated with using non safety pen needles. This cost the health service $10,500. From April 2009 to December 2010 occupational exposures from the use of non-safety insulin pen needles cost the health service $14,000. The cost of purchasing the PNSD is two and half times more expensive than a safety needle and syringe but an additional $5 (minimum) is required for insulin, if using the needle and syringe. Single insulin administration using a PNSD costs five times less than using a safety insulin needle and syringe. However, with each successive administration of insulin using the PNSD, the cost benefit reduces and is cost neutral after five insulin injections or after two and a half days, if insulin is administered twice per day. In 2011/2012, Monash Health spent $11,692 on safety pen needles. This was $9,028 more than would have been spent on non-safety pen needles for the same time period. However, the reduction in expected NSI associated with pen needle use for that period saved $10,500. The cost benefit of using the PNSD was $1,472, a saving of 14%.

Discussion

Safety engineered sharps devices have been shown to be cost effective and to

Our study showed there was no additional education required for patients when a PNSD was used compared with a non-safety pen-needle. Similarly other authors have identified the average instruction time for patient education is 10 minutes and insulin pens are highly acceptable to patients (Bohler et al 2010). The concern by educators that patients might become confused was excluded when patients commented that the PNSD was easy to use. We concur with others, that the use of the patients own insulin pen is more cost effective than an insulin needle and syringe (Davis et al 2008). We also found the use of a pen needle safety device made the process of insulin administration much safer (refer to Figure 1). When we reviewed previous injuries (Table 1), we noted there were numerous instances where the non-safety pen needle had been capped by either the attending nurse or the patient. This occurred despite more than 30 years of education in Australia, excluding the recapping of needles, in any circumstances. We note some observations. 1. Nurses appear to disregard their risk and safety as they prioritise helping others. 2. Patients who are semi-independent and require the assistance of a nurse to administer their insulin, will instruct the assisting nurse to re-cap the needle before returning it to their belongings. PAGE 31 July 2014 Volume 22, No 1.

Figure 1

Monash Health: occupational exposures related to insulin pens

No. Per OBDs 0.07

0.06

0.05 8

Increasing use of insulin pens

0.04 Pen needle safety device implementation at Monash Health

0.03

4 0.02 2

0.01

3. Patients frequently recap their own non-safety needles and we noted anecdotal reports of re-use of their own needles. 4. Non-safety pen needles are difficult to remove from the insulin pen, which encourages recapping for removal. 5. Some authors have noted healthcare workers do not attend training in safety device use, nor demand implementation of safety devices for their protection and sometimes do not even report NSIs (Lee et al 2005). Nurses appear to disregard their own safety when undertaking the care of others. There is no centralised system in Australia, to report and monitor the number of occupational exposures. This includes public and private hospitals, GP clinics, pathology services and community health services. To demonstrate the elimination of health and safety risks through the implementation of safety engineered devices is impractical without a centralised system (Medical Technology Association of Australia 2013). PAGE 32

In Australia, non- safety pen needles are provided free to diabetic patients who are self administering their insulin. However, the safety device, commercially available since 2009, is not provided. The safety device is four times the cost of the non-safety device. The non-safety device is provided free through the National Diabetes Subsidy Scheme, funded by the Federal Government and managed by Diabetes Australia. It is understandable that most patients will continue to use the non-safety device because it is provided free. The introduction of a free safety needle could cost an additional 60% per device. When patients are admitted to hospital with a non-safety device on their pen needle, a risk to staff from NSI remains until it is replaced with a PNSD. Ensuring application of the PNSD on admission is a challenge in a large health service. The introduction of pen needle safety devices uniformly across Australia has the potential to improve and promote a sharps safety culture and reduce the risk of NSI.

There are no conflicts of interest to declare. The authors wish to acknowledge Ms Julie Campbell, Ms Jacqui Sladden and Ms Alicia Barrientos who implemented the patient assessment component of this study. The authors confirm that this was not an industry sponsored study. There was no financial support or association with any manufacturer or distributing company provided to undertake this study.

Clinical Update Table 1 Review of the injuries April 2009 – December 2010 Monash Health insulin pen needle associated occupational exposures Date of Designation of staff Comment incident member injured 18/04/2009 RN DIV 2 Patient giving own insulin. Handed back to RN and NSI occurred. 2/05/2009 Nursing Student Nurse recapping an insulin pen after dispensing and sustained NSI. 5/05/2009 RN DIV 1 RN gave patient insulin using insulin pen and was recapping NSI occurred. 19/06/2009 RN DIV 1 NSI after giving subcutaneous insulin and changing used needle. 25/06/2009 RN DIV 2 Recapping with the assistance of the patient and NSI occurred. 10/07/2009 RN DIV 1 When patient finished with own insulin pen, handed it back to RN, resulting in NSI. 24/07/2009 RN DIV 2 After patient gave own insulin, RN recapped and sustained NSI. 2/08/2009 Cleaning staff Cleaner saw an object on floor, picked it up, NSI occurred. 4/08/2009 RN DIV 2 Working with another staff member who had just given an insulin injection. Both went to grab a falling peg feed and NSI occurred. 17/10/09 RN DIV 1 Patient showing nurse there wasn’t enough insulin in pen. The loose cap fell off and NSI occurred. 04/11/09 RN DIV 1 RN gave insulin to patient, NSI occurred after withdrawing needle from patient skin. 22/01/10 RN DIV 1 Removing cap from patient’s used insulin pen and NSI occurred. 01/02/10 RN DIV 1 RN assisting patient to put insulin pen away, NSI occurred. 06/02/10 RN DIV 1 Removing patient medication bag from patient’s cupboard, NSI occurred from needle sticking through bag. 01/03/10 RN DIV 1 After giving insulin, staff member attempted to place end of insulin pen in sharps container and sustained NSI. 03/03/10 RN DIV 1 Stabbed finger on old insulin pen left in the fridge, needle protruding through cap. 30/04/10 RN DIV 1 Stabbed finger when recapping. 16/05/10 Cleaning staff Cleaner removing rubbish sustained NSI from needle of insulin pen left lying in patient bed area. 24/06/10 RN DIV 2 RN recapping insulin pen and sustained NSI. 26/06/10 RN DIV 1 Tip of needle of insulin pen sticking through cap had been used the day before and NSI occurred. 14/07/10 RN Div 1 Stabbed finger while removing needle from end of insulin pen device. 02/08/10 RN DIV 1 NSI after RN gave injection of insulin to patient. 10/09/10 RN DIV 2 Patient self-administered insulin, cap not replaced correctly. RN sustained NSI. 16/09/10 RN DIV 1 NSI into palm of hand from insulin pen after injection. 22/10/10 RN DIV 1 NSI to finger after insulin injection with patient insulin pen. 23/10/10 RN DIV 1 Picked up capped needle from insulin pen. Attaching end of needle caused NSI before disposal. 30/11/10 RN DIV 2 Patient self-administering insulin and re-capped. The needle pierced side of cap. Nurse stuck her finger when unscrewing cap from pen as patient requested assistance. 17/12/10 RN DIV 1 Nurse stripping bed and punctured finger on pen needle left in bed sheets.

References

Asakura T, Seino H, Nakano R et al., 2009. A comparison of the handling and accuracy of syringe and vial versus prefilled insulin pen (FlexPen).. Diabetes Technol Ther. 11(10):657-61 Bohler S, Landgraf W, Schreiber A., 2010 Evaluation of a new disposable insulin pen and injection habits of diabetes patients in everyday clinical practice. MMW Fortschr med 14;151 Suppl 4:179-87 Davis E, Christensen C, Nystrom K et al., 2008. Patient satisfaction and costs associated with insulin administered by pen device or syringe during hospitalization.. Am J Health Syst Pharm. 65(14):1347-57 Lee J, Botteman M, Nicklasson L, Cobden D, Pashos C., 2005 Needlestick injury in acute care nurses caring for patients with diabetes mellitus: a retrospective study. Current medical research and opinion. 21(5):741-747 Fischer J, Edelman S, Schwartz S., 2008. United States patient preference and usability for the new disposable insulin device Solostar versus other disposable pens. J Diabetes Sci Technol. 2:1157-60

Guillaudin M, Tortolano L, Bouche V, Jumel C, Borget I, Tilleul P., 2011.Dublin Fortieth., Symposium on Clinical Pharmacy of the European Society of Clinical Pharmacy. Cost-effectiveness of safe needles for insulin pen versus standard needles in the prevention of occupational blood exposure., Ireland Hyllested-Winge J, Jensen K, Rex J.,2010. A review of 25 years’ experience with the NovoPen family of insulin pens in the management of diabetes mellitus. Clin Drug Investig. 30(10):643-74 Korytkowski M, Bell D, Jacobson C et al. A multicenter, 2003. Randomized, open-label, comparative, two-period crossover trial of preference, efficacy, and safety profiles of a prefilled, disposable pen and conventional vial/syringe for insulin injection in patients with type 1 and 2 diabetes mellitus. Clin Ther. 25(11):2836-48 Medical Technology Association of Australia. Value of Technology: Needlestick and sharps injuries and safety-engineering medical devices., April 2013 www.mtaa.org.au/docs/vot/vot-

needlestick-and-sharpscopytosend.pdf?sfvrsn=0 Last accessed May 20 2013 Medical Technology Association of Australia., May 2013. Appendix section: economic evaluation to estimate the cost savings for the implementation of SEMDs in Australian hospitals, www.mtaa.org.au/docs/vot/vot-needlestick-andsharps-appendix-cost-savings.pdf?sfvrsn=0 Last accessed May 20 2013 Sucic M, Galic E, Cabrijan T, Ivandic A, Petrusic A, Wyatt J, Mincheva N, Milicevic Z, Malone J., 2002. Patient acceptance and reliability of new Humulin/ Humalog 3.0 ml prefilled insulin pen in ten Croatian diabetes centres. Med Sci Monit. 8:P121-6

Elizabeth Gillespie BN, MPubHlth is a sterilisation and infection control co-director at Monash Health Emma Canning BN is an associate unit manager at Dandenong Hospital Monash Health PAGE 33 July 2014 Volume 22, No 1.

Jacqui Soccio is a womenâ&#x20AC;&#x2122;s health CNC working for South West Sydney LHD PAGE 34

Focus

Women’s Health

Women with problematic drug and alcohol use have higher rates of trauma and abnormal Pap smears By Jacqui Soccio, Margaret Brown, Elizabeth Comino and Emma Friesen

Cervical cancer is largely preventable as we now have a greater understanding of its natural history and its primary causative factor, persistent infection with human papilloma virus (HPV)(Reece 2007). Screening rates for cervical cancer remain low (56.5%) with approximately 4.4% of Pap tests performed in 2010 having a screen detected abnormality (NSW Cancer Institute). It is recognised women from marginalised and disadvantaged groups are under screened for cervical cancer. However, women with problematic drug and alcohol use who are screened have higher rates of trauma and abnormal Pap smears (Greenfield et al 2003). To date there has been limited Australian data on the gynaecological needs of women in addiction recovery and even less specifically about rates of Pap testing, abnormalities and follow up. Previous studies have either been retrospective file reviews (Tilley et al 2012 and Kricker et al 2013), or cross-sectional interviews (Bingswanger et al). While large in sample size, these studies showed little qualitative information about sexual activity, rates of sexual assault, domestic violence and mental health history. Various studies have found that women with problematic drug and alcohol use are more susceptible than men to trauma and the medical consequences of such. This in turn heightens their vulnerability to victimisation and violence. (Greenfield et al 2003). Women’s health nurses work with the most vulnerable women in our community. One of the most vulnerable groups is women with problematic drug and alcohol use, who are often overlooked in terms of their primary and general healthcare needs. A residential drug and rehabilitation facility in the South West Sydney Local Health

District (SWSLHD) that caters for women with drug and alcohol problems provided a chance to offer opportunistic screening. Consequently, a nurse-led women’s health clinic was created within this facility. At this clinic, we undertook a prospective study to describe cervical screening rates and treatment history, examine the prevalence of abnormal Pap test results and document the specific vulnerabilities of these women. We compared two groups of women; those attending the clinic in the rehabilitation facility (n=36) and those in a generic well women’s clinic in South West Sydney (n=63). Data was analysed from the history that was taken during the consultation and information on previous smears and treatment history was verified from the NSW Pap Test Register. The following findings were that women in the residential Drug and Alcohol rehabilitation facility were more likely to have a history of: • domestic violence (65% vs 11%), • sexual assault (44% vs 17%), and • a history of mental illness (69% vs 33%). In addition women in the residential facility reported a younger age of first sexual intercourse of 15.3 years compared to 18.3 years for women attending the community clinic. These findings highlighted that this population of women were amongst the most vulnerable of all the populations that we see and consideration of the history of trauma provides better understanding of the circumstances that sometimes lead women into problematic drug and alcohol use. Women’s health nurses are well placed to provide emotional support and sensitivity when undertaking intimate physical examinations such as a Pap test.

cancer in criminal justice settings, Journal of Women’s Health. 20(12):1839-1845. Greenfield S.F., Manwani S.G. and Nargiso J.E. 2003. Epidemiology of substance use disorders in women, Obstetrics and Gynaecology Clinics 30(3):413-46. Kricker A., Burns L., Goumas C. and Armstrong B 2013. Cervical screening, high grade squamous lesions and cervical cancer in illicit drug users, Cancer Causes Control. 24: 1449-1457. Reece A 2007. Lifetime prevalence of cervical neoplasia in addicted and medical patients, Australian and New Zealand Journal of Obstetrics and Gynaecology. 47.419-423. Tilley, D., Hristov, S., Templeton D., Sharp N and O’Connor C. 2012. Cervical cancer screening and abnormalities among women in a residential drug rehabilitation program, Australian Journal of Primary Health. 18(4):266-267.

Jacqui Soccio is Clinical Nurse Consultant Women’s Health at the Rosemeadow Community Health Centre in Rosemeadow, NSW Dr Margaret Brown works in public health research and education at the community paediatrics department of Liverpool Hospital in South West Sydney and as a General Practitioner at Karitane. Elizabeth Comino is a Senior Research Fellow at the Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales. Emma Friesen is a Research Officer working in research capacity development in South Western Sydney.

References

NSW Government. Cancer Institute NSW 2013 Cervical Cancer Screening in NSW Annual Statistical Report 2009-2010. Sydney: Cancer Institute NSW. Binswanger I.A., Mueller S., Clark C B. and Cropsey, K L. 2011. Risk factors for cervical PAGE 35 July 2014 Volume 22, No 1.

Focus The perinatal emotional health program – hope for isolated rural women By Lisa Sambrooks, Sinead Barry and Louise Ward It is well recognised internationally and within Australia that perinatal anxiety and depression is experienced at rates as high as 16% (beyondblue 2011). This is a major public health concern as women experiencing stress or anxiety while pregnant (Glover and O’Connor 2006) or in the postnatal period (Henrichs, et al. 2009), have infants that are at twice the risk of developing emotional, behavioural and cognitive problems in childhood. Additionally, increased maternal stress and anxiety are thought to contribute to impaired emotional attachment between a mother and her infant due to impaired neurological development. The literature supports poor attachment at infancy leading to emotional dysregulation that negatively impacts on functioning at school and increases risk for mental illness into adulthood (Schore and Schore 2008). The Perinatal Emotional Health Program (PEHP) was implemented throughout rural and regional Victoria (Victorian State Government, Department of Health 2010) in 2010 to provide early intervention for women in the perinatal period. The PEHP clinician provides consultation regarding screening for symptoms of mental illness at antenatal clinics and maternal child health centres. The clinician also provides mental health assessment in maternity services or the woman’s home that results in onward

referral or brief intervention therapy for women. This service provision is particularly important in rural regions where access to mental health treatment is limited. A secondary function of the PEHP clinician is outreach to rural populations to provide education and capacity building regarding mental health to otherwise isolated maternal child and health nurse (MCHN) and midwives working with these women (Victorian State Government, Department of Health 2010). Clinical governance is provided by the Area Mental Health Services (AMHS) with regular access to a consultant psychiatrist. Australia is now a world leader in providing universal screening utilising the Edinburgh Postnatal Depression Scale (Highet and Purell 2013). As more women are identified with symptoms of mental illness the PEHP clinician’s role has become pivotal in providing an early intervention treatment service in regions of limited access to psychological treatment. Early indicators of an evaluation of this program have identified it as highly valued by new mothers, midwives and MCHNs. The improved emotional wellbeing of new mothers will positively impact on their infants formation of neurological pathways. Current clinical studies indicate this will improve behaviour and cognitions for these children into their future.

References

beyondblue. 2011. Clinical practice guidelines for depression and related disorders - anxiety, bipolar disorder and puerperal psychosis - in the perinatal period. A guideline for primary care health professionals. Melbourne: beyondblue:the national depression initiative

Glover, V. and T. O’Connor. 2006. Maternal anxiety: it’s effect on the fetus and the child. British Journal of Midwifery 14(11): 663-667. Henrichs, J., Schenk, J., Schmidt, H., Velders, F., Hofman, A., Jaddoe, V., and Tiemeier, H. 2009. Maternal pre and postnatal anxiety and infant temperament. The generation R study. Infant & Child Development 18(6): 556-572. The Australasian Marce Society. 2013. Conference. Perinatal mental health: from conception to kindergarten. Connecting research to clinical practice. 2013. What worked and what didn’t in the implementation of the National Perinatal Depression Initiative - where to from here. Highet, N. and Purell, C. Melbourne: The Australasian Marce Society. Schore, J. and A Schore. 2008. Modern attachment theory: The central role of affect regulation in development and treatment. Clinical Social Work Journal.36:9-20. Victorian State Government, Department of Health. 2010. Victoria’s response to the National Perinatal Depression Initiative. www.health.vic.gov. au/npdi/login/aim/htm (accessed 13 April, 2014)

Lisa Sambrooks is Acting Clinical Manager Infant & Child Mental Health at the Grampians Area Mental Health in Ballarat, Victoria. Dr Louise Ward is Senior Mental Health Lecturer and Sinead Barry is Lecturer in Nursing in the School of Nursing and Midwifery at La Trobe University, Melbourne.

Women’s health research in rural and remote South Australia By Wendy Abigail Women living in rural, regional and remote areas in Australia generally have poorer access to sexual and reproductive healthcare. In my role as a researcher at Flinders University School of Nursing and Midwifery, I am researching the extent of the issue in an ethically approved university funded project. PAGE 36

I will be examining health professionals’ views of sexual and reproductive health service provision using an online survey. The study, which is aimed at nurses and medical personnel, was previously conducted in Victoria in 2012 (Women’s Health Association, 2012). In that study 225 health professionals in country areas completed an online survey on their views of women’s access to family planning services. My current project has built on that research by adapting the survey to a South Australian context. I contend that research in the area of women’s health is an under-researched area of healthcare, particu-

Women’s Health Is anyone listening? By Rose Cole

Respecting Aboriginal women who have experienced domestic violence (DV) is widely recognised as a problem by government departments and policy. Policies such as the National Women’s Health Policy (Australian Government Department of Health & Ageing, 2010), the NSW Health Framework for Women’s Health 2013 (Ministry of Health, 2013) and the Aboriginal Family Health Strategy 2011-2016 (NSW Department of Health, 2011), have acknowledged this issue. Yet a report, Aboriginal women speaking out about violence: Is anyone listening? Reflections of Wirringa Baiya Aboriginal Women’s Legal Centre (2011), emphasises the lack of understanding for the genuine needs of Aboriginal women to have a dedicated and culturally appropriate cultural service. Aboriginal and Torres Strait Islander women experience 45 times higher levels of violence than non-indigenous women, with the normalisation of violence against women within communities and low socio-economic status being reported as major contributing factors (Australian Human Rights Commission, 2012). Research demonstrates that domestic violence is related to not only physical injury and physical health complaints but also mental disorders such as attempted suicide, anxiety, depression and post-traumatic stress disorder (Rees et al., 2011). Additionally, a birthing mother from a DV situation who may be suffering from depression and or anxiety, is at greater risk for postnatal depression (Herron et al. 2004).

larly in rural and regional areas and as such this research has implications for clinicians, practice nurses, GP’s and policy makers. With over 20 years experience working in the area of sexual and reproductive health, I have been conducting research in this area of healthcare for the past eight years. Previous research includes investigating trends in termination of pregnancy (TOP) clinics in Adelaide and fertility experiences of women aged over 30 years prior to a TOP (Abigail, Power and Belan, 2010) (Abigail and de Lacey, 2014). The results of the research were translated into practice by developing four advertise-

Fortunately, midwives screen antenatally for these disorders. Postnatally, child and family health nurses initially screen on universal home visits, then again six months later. Yet, while all community health staff screen for DV using the domestic violence screening tool, a Cochrane review suggests the tool is not justified for universal screening (Taft et al. 2013). Despite this, the identification of DV is happening. But there is a lack of cultural awareness and cultural sensitivity in mainstream services, posing a huge barrier for Aboriginal women experiencing DV to access help (Australian Human Rights Commission, 2012). The question remains how do we help Aboriginal women in a community in a culturally appropriate and culturally sensitive way to prevent domestic violence? Women’s health nurses (WHNs) are well placed to contribute to the primary healthcare response to domestic/family violence. In their community development role, WHN’s are involved in court support for women taking out apprehended violence orders. In health education and health promotion activities they educate the women as individuals (clinic) or in groups (diverse) in a variety of different contexts on healthy relationships and gender based violence. Collaborative and cooperative efforts are needed between WHNs, midwives, child and family health nurses, the Aboriginal and Maternal Infant Health Service, Building Strong Foundations, the Aboriginal community (particularly women and men elders), and Aboriginal service providers to show our respect for Aboriginal women in order for them to gain self-respect and improve the wellbeing of themselves, their family and community. Research is needed from a health perspective along with expertise in violence prevention and culture in order to

ment length videos titled ‘Contraception: Is it working for you?’ suitable for viewing in GP clinics and other similar venues. Additionally, the short videos can be used as teaching tools for clinicians and student nurses. These videos, which were a collaborative project with industry partners from Flinders Medical Centre, Noarlunga Health Services and SHineSA, was funded by a grant from Flinders University. These videos can be accessed on YouTube. Further details can be directed to Dr Wendy Abigail: wendy.abigail@flinders.edu.au

References

Abigail, W, Power, C, & Belan, I (2010). Termination of pregnancy and the over 30s: what are

develop appropriate evidence based programs to prevent DV and respect Aboriginal women experiencing domestic violence.

References

Australian Government Department of Health and Ageing, 2010. National Women’s Health Policy 2010. Canberra: Commonwealth of Australia. Australian Human Rights Commission, 2012. Australian Study tour report. Author. Heron, J., O’Connor, T., Evans, J., Golding, J., Glover, V., ALSPAC Study Team. The course of anxiety and depression through pregnancy and the postpartum in a community sample. Affective Disord, 80, 65-73. Ministry of Health, 2013. NSW Health Framework for Women’s Health 2013. North Sydney: Author. NSW Department of Health, 2011. Aboriginal Family Health Strategy 2011-2016, Centre for Aboriginal Health. Sydney. Rees, S., Silove, D., Chey, T., Ivancic, L., Steel, Z., Creamer, M., Teeson, M., Bryant, R., McFarlane, A., Mills, K., Slede, T., Carragher, N., O’Donnell, M., Forbes, D, 2011. Lifetime prevalence of gender based violence in women and their relationship with mental disorders and psychosocial function. JAMA, 306 (5), 513-21. Taft, A., O’Doherty, L., Hegarty, K., Ramsay, J., Davidson, L., & Feder, G. Screening women for intimate partner violence in healthcare settings, 2013. Cochrane Database of Systematic Reviews (4). Art No.:CD007007.DOI:10.1002/14651858. CD007007.PUB2. Wirringa Baiya Aboriginal Women’s Legal Centre, 2011. Aboriginal women speaking out about violence: Is anyone listening. Indigenous Law Bulletin, 7, (23), 26-30.

Rose Cole is the women’s health nurse at Mudang Mudjin (Building Strong Foundations) at the Cranebrook Community Health Centre in Cranebrook in NSW

trends in contraception 1996-2006? Australian Journal of Primary Health, 16(2), 141-146. Abigail, W, & de Lacey. S (2014). Australian women’s fertility experiences prior to a termination of pregnancy. The Scientific World Journal, (article ID794380, http://dx.doi. org/10.1155/2014/794380) 1-8. Women’s Health Association of Victoria. (2012). Victorian rural women’s access to family planning services: survey report August 2012: Women’s Health Association of Victoria.

Dr Wendy Abigail is from Flinders University School of Nursing and Midwifery in South Australia PAGE 37 July 2014 Volume 22, No 1.

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Focus

Women’s Health

Does mindfulness training reduce the stress of pregnancy? By Jill Beattie, Helen Hall, Mary Anne Biro, Rosalind Lau and Christine East Some pregnant women welcome the challenges of birthing and the transition to parenthood, while others feel significant stress. Prenatal stress appears to be associated with perinatal anxiety and depression and other adverse maternal and neonatal outcomes (Chojenta et al 2012). Approximately 10% of women living in Australia are diagnosed with antenatal depression and 16% with postnatal depression (PANDA 2013). Pregnancy presents a window of opportunity for promoting emotional resilience that may benefit both the mother and child throughout life. Research on the effects of mindfulness during pregnancy suggests that it may be effective and acceptable for increasing emotional resilience and managing pregnancy related stress (Dunn et al 2012). Mindfulness training is a non-invasive, non-pharmacological, evidence-based intervention for preventing and/or managing mood disturbance in the general population. The evidence for benefits in pregnancy remains limited. There is a need for research to evaluate the effectiveness of mindfulness as a preventative strategy for perinatal anxiety and depression within the Australian context. Mindfulness involves moment-to-moment, non-judgemental awareness of one’s

present situation. Instead of ruminating on the past and worrying about the future, which contribute to depression and anxiety, mindfulness begins with awareness of one’s body and thoughts. Mindfulness practice develops the capacity to observe the changing mental and physiological states and sensations without necessarily trying to change them. The individual is more likely to accept what is happening and make clearer decisions about their response. Monash University researchers are conducting a pilot randomised study to measure the effects of a mindfulness program of two hours weekly, for eight weeks, on stress and depressed mood, compared to a pregnancy support group. Benefits may include improvement in health outcomes for women and their families. This study aligns with the National Perinatal Depression Initiative (DoHA 2013) of improving nurses and midwives’ knowledge of perinatal mental health and may lead to mindfulness as an expansion of midwifery scope of practice as is emerging in the United Kingdom.

vention on women’s psychological distress and well-being in the perinatal period. Archives of Women’s Mental Health. 15(2): p. 139-143

References

Dr Jill Beattie is the Senior Reseach Fellow; Dr Helen Hall is a Lecturer; Dr Mary Anne Biro is a Senior Lecturer and Dr Rosalind Lau is a Research Fellow all located in the School of Nursing and Midwifery at Monash University in Victoria

Chojenta, C., D. Loxton, and J. Lucke, 2012. How Do Previous Mental Health, Social Support, and Stressful Life Events Contribute to Postnatal Depression in a Representative Sample of Australian Women? Journal of Midwifery & Women’s Health. 57(2): p. 145-150 Department of Health and Ageing. National Perinatal Depression Initiative. 2013 22/05/13]; Available from: www.health.gov.au/internet/ main/publishing.nsf/Content/mental-perinat Dunn, C., et al., 2012. Mindful pregnancy and childbirth: Effects of a mindfulness-based inter-

PANDA. New mothers to miss out on postnatal depression support services due to soaring demand and funding shortfall 2013 17/05/13; Available from: http://www.panda.org.au/

Christine East is the Professor of Midwifery at Monash University and Co-Director of Maternity Services at Monash Health in Victoria

Psychological issues for women diagnosed with gestational diabetes mellitus By Grazyna Stankiewicz, Kay McCauley and Lin Zhao

In pregnancy women experience enormous physiological and psychosocial changes including behavioural changes, craving for specific foods, rapid alteration in mood, and inability to sleep (Carolan, Gill and Steele, 2012; Lawson and Rajaram, 1994).

Studies have reported that the psychological distress of ‘normal’ pregnancy involves emotional loss of stability and balance, anxiety, depression and personality reorganisation (Devsam, Bogossian and Peacock, 2013; Lawson and Rajaram, 1994). Pregnant woman also face the perspective of new responsibilities and distinctive physiological changes as their bodies prepare for birth. Gestational diabetes mellitus (GDM) compounds the psychological disturbances of “normal’ pregnancy. GDM usually develops towards the end of the second trimester of

pregnancy and occurs in approximately 5% of pregnancies in Australia (Carolan, Gill and Steele, 2012). Adjustment to the new diagnosis, negative thoughts and fear about wellbeing of self and her baby, management of GDM with diet, blood sugar monitoring, insulin administration, exercise and related feelings of guilt, loss of control and confronting the possibility of diabetes in the future. Women with GDM must learn the diabetes regimen when their coping ability is already strained. Reports identify women’s reactions being shock, distress, scared, numbness, PAGE 39 July 2014 Volume 22, No 1.

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Focus

Women’s Health associated with increased rates of maternal and neonatal complications and significant morbidity (Carolan, Gill and Steele, 2012; Devsam, Bogossian and Peacock, 2013).

fearful, terrified, disappointed, surprised, anxious and worried (Carolan, Gill and Steele, 2012). This leads to apprehension as they consider future pregnancies as GDM can be more severe in subsequent pregnancies (Lawson and Rajaram, 1994). Experiencing GDM has a long term effect on women’s perception on their general health and of the health of their child. GDM is

The psychological aspect is related to a complexity of issues which the woman diagnosed with GDM may experience and which require support has been identified by the woman as pivotal in helping and encouraging them to enhance in diabetes self-management and make the woman feel less isolated and in better control of GDM (Carolan, Gill and Steele, 2012; Devsam, Bogossian and Peacock, 2013). Adjustment to an imposed lifestyle change and the need for information and support requires clinicians and the women and their families to have an understanding of the impact of GDM diagnosis on the woman’s psychological wellbeing and ongoing mental health (Carolan, Gill and Steele, 2012).

References Carolan, M., Gill, G.K., Steele, C. 2012. Women’s experiences of factors that facilitate or inhibit gestational diabetes self-management. BMC Pregnancy and Childbirth, 12:99 Devsam, B. U., Bogossian, F.E. and Peacock, A. S. 2013. An interpretative review of women’s of gestational diabetes mellitus: Proposing a framework to enhance midwifery assessment. Women and Birth, Article in Press (2013). Retrieved on 30/01/2014, from http://dx.doi. org/10.1016/j.wombi.2012.12.003 Lawson, E. J. and Rajaram, S. 1994. A transformed pregnancy: the psychosocial consequences of gestational diabetes. Sociology of Health & Illness, Vol. 16, No. 4; 536-562

Dr Grazyna Stankiewicz is a Lecturer; Dr Kay McCauley is Senior Lecturer and Dr Lin Zhao is a Lecturer all located in the School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences at Monash University in Victoria

Correct interpretation of Hepatitis B serological tests important By Anne Glass

In the antenatal setting the incorrect interpretation of hepatitis B serology can have serious consequences for both mother and baby. Vertical transmission of Hepatitis B from mother to baby at birth results in 90% likelihood of the progression to chronic hepatitis B (Bayo etal. 2010). The major complications of this are hepatocellular carcinoma and decompensated cirrhosis, occurring in 15-25% of people with chronic hepatitis B infection (Davison etal. 2014). For antenatal screening in the first trimester of pregnancy, guidelines recommend testing only for HBsAg (Davison etal. 2014). In Australia all babies receive Hepatitis B vaccination at birth, followed by further Hepatitis B, containing combination vaccine at two, four and six months of age. A baby born to a mother who has been identified as being Hepatitis B positive (HBsAg +ve) should also receive Hepatitis B immunoglobulin (HBIG) within 12 hours of birth (The Australian Immunisation Handbook, 2013). The administration of the Hepatitis B vaccine and HBIG to newborns within 24 hours of birth is 85% to 95% effective in preventing HBV transmission. Hep B administration alone within the same timeframe is only 70%-95% effective (Bayo etal. 2010).

It is therefore essential that all pregnant women are screened for Hepatitis B and that these results are interpreted correctly. HBIG (concentrated Hepatitis B antibodies) is derived from human plasma from donated blood. It therefore carries with it the potential for transmission of other viruses such as Cruzfeld Jacob Disease and any, as yet, undiscovered viruses (Hepatitis B Immunoglobulin – VF , Product information). The baby of a mother, incorrectly interpreted as having Hepatitis B (eg. pathology stating HBsAb +ve and indicating immunity) would be the recipient of a medication error, having been given HBIG which could lead to the risks stated above as well as the possibility of anaphylactic reaction.

to reduce the HBV DNA at birth and hence the likelihood of transmission of HBV. She will not have the opportunity to have an assessment of her liver disease and education regarding essential lifelong surveillance to prevent progression of her liver disease. Also, any sexual contacts and household members will miss an opportunity to be screened for Hepatitis B. It is acknowledged that Hepatitis B serological tests are difficult to interpret therefore antenatal services need to implement protocols to prevent the misinterpretation of these tests. Is it time for nursing and medical staff to be accredited in the interpretation of Hepatitis B serological tests?

Similarly, the baby of a HBsAg positive mother who is incorrectly interpreted as not having Hepatitis B (eg. HBeAg –ve, indicating Hepatitis B positivity) will not receive HBIG at birth and therefore has an increased risk of vertical transmission of Hepatitis B. Additionally, the undiagnosed HBsAg positive mother will not receive a referral to a liver clinic and her HBV DNA viral load will not be assessed.

References

There is a direct relationship between a maternal HBV DNA viral load > 7IU/mL and a transmission rate of 8%-10% despite passive and active immunisation at birth (Wiseman E et al).

The Australian Immunisation Handbook 10th edition 2013.Dept of Health and Ageing.

In many centres the mother is offered antiviral medication, at week 30-32 gestation

Bayo C.Willis.MPH,Pascale Wortley, MD, MPH, Susan A Wang, MD, MPH,Lisa Jacques- Carroll, MSW, Fan Zhang, PhD, MD, MPH.2010. Gaps in Hospital Policies and Practices to Prevent Perinatal Transmission of Hepatitis B Virus. Official Journal of the American Academy of Pediatrics Vol no 125 no.4 Davison S., Strasser S., 2014. Ordering and Interpreting Hepatitis B Serology. British Medical Journal 2014;348:g2522 doi:10.1136/bmj.g2522.

Hepatitis B Immunoglobulin – VF , Product information. www.csl.com.au/docs/411/186/7.00,4.pdf Wiseman E et al 2009. Perinatal Transmission of hepatitis B virus. An Australian Experience Medical Journal of Australia 209. 190(9)489-92 PAGE 41 July 2014 Volume 22, No 1.

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Oestrogen can help treat schizophrenia in previously treatment-resistant women, according to research from Monash University. The world first study, which was conducted over several years as a large scale randomised-controlled trial, found women who were given estradiol (the oestrogen supplement) made better recoveries than those who were given the placebo. Research lead Professor Jayashri Kulkarni said persistent schizophrenia was common despite advances over the years in antipsychotic drug development. She said a specific focus for women with schizophrenia was still somewhat lacking and there was a need to consider the special issues facing women with schizophrenia. “What we found was that adjunctive estradiol treatment has practical use for women who have not responded well to antipsychotic drug treatment previously. “We also found that due to the fluctuations of oestrogen in women and its impact on mental state, the premenstrual period, post natal and menopause phase of a women’s life are critical times for mental changes. A team approach to her treatment is vital to the best healthcare outcomes.” Professor Kulkarni said she was excited about the positive results of the study, with trials of selective oestrogen receptor modulators representing a hopeful future direction for schizophrenia research. “There are many promising newer forms of hormone treatment that offer great hope in the much-needed area of new, effective treatments for people with persistent schizophrenia and should be expanded to include men and postmenopausal women.”

Focus

Women’s Health

Red alert: women still unaware of their number one killer By Camilla Jury

Heart disease is the single biggest killer for women in Australia, claiming 25 lives every day, but most women remain unaware of their most important risk factors – high blood pressure and cholesterol. Heart Foundation statistics reveal only one in 20 women aged 45-65 considers high blood pressure and cholesterol to be important risk factors for heart disease while four in five women believe a lack of physical activity and poor diet put their hearts at greater risk. The heart health charity ‘Go Red for Women’ campaign ran through June to raise awareness and urges all Australians to get on board throughout the year. Julie Anne Mitchell, women’s health spokesperson at the Heart Foundation said many people are still surprised to learn that heart disease is the single biggest killer of Australian women and that it claims more than three times as many female lives as breast cancer. “We’re very concerned that women are failing to prioritise their health,

by not getting their blood pressure and cholesterol checked by a doctor.” One in three adult women have high cholesterol, but 90% of those women don’t know it. One in four women over the age of 35 have high blood pressure but two thirds who do, don’t know it. Ms Mitchell said there were often no signs or symptoms associated with high blood pressure and high cholesterol which is why women can overlook it. However it is vital that women know their blood pressure and cholesterol levels so that they are armed to take steps to reduce them if they are too high. “Go Red for Women has been an important campaign to address the knowledge gap around women and heart disease. When we launched nationally in 2009, only 20% of women aged 45-65 were aware that heart disease was their single biggest killer. But by the end of last year, this had risen to 36%. A pleasing result but with only one in three women aware this is still not good enough. “Heart disease kills more than 9,000 women in Australia a year, which is why we’re urging all Australians to Go Red for Women.”

raise women’s awareness of heart disease. We thank our national campaign supporters Aurizon and Bupa - and national cause supporter Napoleon Perdis for their support of our Go Red for Women activities last month. For more information visit: www. goredforwomen.org.au Camilla Jury, is the media and communications manager for the Heart Foundation

Now in its sixth year, the Heart Foundation’s Go Red for Women campaign helps

Cervical Screening – presentations to Well Women’s Clinic By Sara Hristov

A project looking at cervical screening rates of women who attended a public funded Well Women’s Clinic in the South West Sydney Local Health District was recently conducted. In particular the study looked at comparing differences in abnormal Pap results that were unscreened or under screened of women with or without a mental illness. The study is a retrospective study, reviewing the medical files of women who attended the clinic during a 12 month period. To date the data collected includes: • 143 women attendees • Of the women who attended, 90 needed an interpreter

• 17 reported having an abnormal Pap test in the past • six reported that they had needed treatment for the abnormal Pap • 57 were under screened (last Pap test four plus years ago) • 33 were unscreened (first Pap test) • 23 women reported having a mental illness Literature indicates that women with a mental illness have lower participation rates in preventative screening programs, than the general population (Webster, 2007). Cervical screening is one of the services that a Well Women’s Clinic provides. The aim of the cervical screening program is to detect and treat any cervical lesions before they progress to cervical cancer. Current recommendations for cervical screening are for all women aged 20-69, who have been sexually active, to have a Pap test every two years (Hristov, 2013).

The findings to date indicate that women, with or without mental illness, are not attending to cervical screening as recommended. This study is only looking at women who attended a publicly funded Well Women’s Clinic, and is not representative of the general population. This study has the approval of the South Eastern Sydney Local Health District Research and Ethics Committee.

References

Webster, S. Access to cancer screening for women with long term mental health problems Australian Nursing Journal: ANJ, Vol. 15, No. 5, 2007 Nov: 26 Hristov, Sara. Cervical screening for women with severe mental illness Australian Nursing & Midwifery Journal, Vol. 21, No. 3, Sep 2013: 46.

Sara Hristov is a Clinical Nurse Consultant, Women’s Health, Community Health, South West Sydney Local Health District (SWSLHD). PAGE 43 July 2014 Volume 22, No 1.

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Calendar JULY

Nurse Practitioner Masterclass Deakin University Melbourne Campus 9 and 10 July 2014. http://www.deakin.edu.au/ health/nursing/ or further details Ph: (03) 9251 7393 Lung Health Promotion Centre at The Alfred 15 July, Educating & Presenting With Confidence 16-18 July, Asthma Educator’s Course 24-25 July, Smoking Cessation Facilitator’s Course 30–31 July, Creative Behaviour Change Coaching For Chronic Illness Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au AIDS2014 Conference - Nursing Welcome Reception 19 July, 5-7:30pm, Crown Casino, Southbank Melbourne. Cost: FREE. All nurses and their colleagues are invited to the reception, being held at the commencement of the AIDS2014 Conference. Please join ASHM, ASHHNA, ANZANAC and the American Association for Nurses in AIDS Care (ANAC) to welcome our international nursing colleagues and celebrate the important work of nurses in HIV globally. The theme of the evening will be Nurses Stepping Up, Stepping Forward and Stepping Beyond, and there will be keynote presentations from Australian and international nursing leaders in HIV. You do not have to be a conference delegate to attend and it is a free event. Contact Emily Wheeler (Manager - ASHM Nursing Program) Email: emily.wheeler@ashm.org.au or call (03) 9341 5244 or visit http://www.nursesinaidscare. org/i4a/forms/index.cfm?id=150 Cancer Nurses Society of Australia 17th Annual Winter Congress Cancer Nursing: Leading in a time of change 24-26 July, Pullman Albert Park, Melbourne. http://cnsa.org.au/professional-development/ national-conferences.html APNA Continuing Education Workshops for Nurses in General Practice. 25-26 July, Mercure Hotel Brisbane, QLD. For more information and to register go to www.apna.asn.au/nigp

AUGUST

Update’ study day with Kathy Mills, RN, MEd, Credentialled Diabetes Educator. This study day for enrolled and registered nurses covers contemporary and evidence based research on dietary, exercise, psychological and pharmacological management of diabetes mellitus. Date: Friday 8 August from 9am-4pm at Inner East Melbourne Medicare Local, 6 Lakeside

Network

Royal Melbourne Hospital PTS School of 16 June 1964, 50-year reunion Contact Jenny Cunningham Email: jennifermonaghan@ bigpond.com.au Austin Hospital 1984 C2 graduation group, 30-year reunion

2 August. Contact Liz Stickland Mobile: 0403 010 324 or via Facebook for details. Royal Melbourne Hospital, Group 289 25-year reunion 9 August 2014, Met Hotel 36-42 Courtney St, Nth Melbourne from

Drive, Burwood East. There is free onsite parking. Morning tea, lunch and notes are provided. Eligible for 6 hours professional education. Cost: Early bird special (pay by Friday 25 July) is $220. Full registration fee: $250 All queries to Kathy via email only at diabetes. ed@optusnet.com.au Nurses-Healing Workshops 8-16 August, Glenelg SA. Boutique Training in Luxury Surrounding and the ANMF Ed Centre. These quality one day (6 hours CPD) workshops on massage, health and wellbeing will give you the skills, knowledge and confidence to help clients with your hands, and health inspired presence. Calendar and information go to http://nurses-healing.com or Contact Angeline von Doussa – 0431 994 618 Email angeline@nurses-healing.com Nursing Informatics Australia Conference E-health is changing healthcare: Nurses meeting the challenge. Smart phones, smart tablets, smart nurses. 11 August 2014, Melbourne Convention & Exhibition Centre. http://www.hisa.org.au/page/hic2014nia APNA Continuing Education for Nurses in General Practice 15–16 August, Novotel Canberra, ACT. For more information and to register go to www.apna.asn.au/nigp Lung Health Promotion Centre at The Alfred 18-19 August, Spirometry Principles & Practice Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au 8th International Council of Nurses, International Nurse Practitioner/Advanced Practice Nursing Network Conference Advanced nursing practice: Expanding access and improving healthcare outcomes 18-20 August, Helsinki, Finland. http://www. nurses.fi/8th-icn-international-nurse-prac/ National Forum on Long Term Unemployment Building Capability 18-19 August, QT Hotel, Gold Coast Qld. This conference will address the causes of long term unemployment and what can be done for these at risk groups of disability, mature age, youth, indigenous and the regional unemployed. It will focus on Building Capability to successfully tackle long term unemployment and how to create employment for the future. http://longtermunemployment.org.au Community Health Nurses Western Australian Conference No man is an Island 22-24 August 2014, Rottnest Island, WA. http://chnwa2014.iceaustralia.com/

4pm. Contact Freya Leeming (nee Chamberlain) Email: dallasfreya@gmail.com or Scott Robinson Email: islandofittledetroit@ bigpond.com Northern District School of Nursing School 103 1984 – 198, 30-year reunion

23 August, Bendigo. At a venue to be announced. Contact julesbarbetti@live. com.au or facebook John Fawkner Private Hospital/Sacred Heart Hospital celebrates its 75th anniversary October. We are

SEPTEMBER

9th National Conference of the Australian College of Nurse Practitioners New Frontiers – Building future generation 2-4 September 2014, The Masonic Conference Centre, Sydney. http://acnp.org.au/events/15 Lung Health Promotion Centre at The Alfred 3–5 September/ 15 – 16 October, Respiratory Course 3–5 September, Respiratory Course (Module A) Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au CATSINaM 16th National Conference Embrace the difference within our people 23-25 September, Perth WA. http://catsin.org.au/ 18th International Conference on Cancer Nursing 7-11 September, Hilton Panama, Panama City. http://www.isncc.org/?page=18th_ICCN 3rd World Congress of Clinical Safety (3WCCS) Clinical Risk Management 10-12 September, Ayre Gran Hotel Colon, Madrid, Spain. http://www.iarmm.org/3WCCS/ New Zealand Nurses Organisation (NZNO) Conference Nurses – champions for change 18 September 2014, Michel Fowler Centre, Wellington, New Zealand. www.nzno.org. nz/2014conference CATSINaM 16th National Conference Embrace the difference within our people 23-25 September, Perth WA. http://catsin.org.au/

OCTOBER

Australasian Association of Bioethics and Health Law Conference How should we decide 2-4 October, University of Western Australia, Perth WA. http://www.conferencedesign.com. au/aabhl2014/ Lung Health Promotion Centre at The Alfred 15–16 October, Respiratory Course (Module B) 23–24 October, Managing COPD 27-28 October, Spirometry Principles & Practice Lung Health Promotion Centre at The Alfred Ph: (03) 9076 2382 Email: lunghealth@alfred.org.au Nurses-Healing Workshops 20-26 October. Glenelg S.A Boutique Training in Luxury Surroundings. These quality one day (6 hours CPD) workshops on massage, health and wellbeing give you the skills, knowledge and confidence to help clients with your hands, and health inspired presence. Calendar and information go to http://nurses-healing.com or contact Angeline von Doussa 0431 994 618 Email angeline@nurses-healing.com

seeking memorabilia, old photographs, uniforms, books, instruments, stories etc. from past staff, doctors and students. An open day and other activities are planned for this milestone event. Contact Chris Papas, Executive Secretary at chris.

papas@healthscope. com.au or Ph: (03) 9385 2501 Royal Adelaide Hospital Nurses Training, Group 895, 25-year reunion 29 November, Adelaide. Contact Julia Curley Email: juliacurley@hotmail.com

PAGE 45 July 2014 Volume 22, No 1.

Basic care priorities - Letter of the month

Australian Nursing & Midwifery Journal

I noticed that the feature article in the June ANMJ was missing my voice, that of hospital trained and university educated, always at the coal face nurse, and I feel that it needs to be heard.

Volume 21, No. 11. June 2014

I have been part of the huge changes in the nursing profession. I am forever grateful to Sister Stone for the grounding she gave me in ‘basic nursing care’, which she did not know was evidence based care as we know it today. I continue to work closely with student and new graduate nurses and I am dismayed and disheartened by the majority of new nurses who I feel place ‘basic care’ very low on their priority list. When it does occur, it is often poor quality and definitely would not pass the tests I had to pass. It has taken me a long time to form this view as I believe that education is fundamental to our work and future. As these nurses gain experience I have seen them move into areas where ‘basic care’ is not required as much. Could this be a contributor to the “nursing shortage”? Jenny, RN, Victoria Women leading the way

The winner of the ANMJ best letter receives a $50 Coles Myer voucher. If you would like to submit a letter to the ANMJ email anmj@anmf.org.au

www.anmf.org.au

201406 AnmjJune.18.indd 1

22/05/14 2:18 PM

Letters may be edited for clarity and space

Standards set influences care ANMJ’s June feature, ‘the responsibility of care’ was a very interesting and thought provoking article. My daughter was a patient in a children’s ward in a large public hospital. She had a closed head injury, was in a lot of pain, vomiting at times and very drowsy. What I would call ‘basic nursing care’ was non-existent in the emergency department and the ward. Although there was a fluid balance chart for her, all that was recorded was her IV fluids. When I pointed out to a nurse that my daughter had not passed urine for more than 24 hours, I was told she had a palpable bladder and would have to be catheterised if she did not pass urine. However her output (including vomit) was not followed up. When my daughter was able, I got her up to the shower as this basic hygiene need was not offered by nursing staff. In the shower she vomited which caused her to pass urine. Although meals were delivered and taken away, nobody bothered to find out if she had eaten anything (she hadn’t). Her bed linen was soiled by blood from her abrasions and vomit. I remade her bed with clean linen which was given to me when I asked for it. A boy in the bed across from my daughter was loudly told by a nurse that he was a good patient, not like the girl in the bed PAGE 46

across from him. (Her headache caused her to be short with the staff when they did her head injury observations, which apart from monitoring her IV fluids and giving panadol as necessary, was all they did for her). When my husband came to visit for the first time, he noticed the staff grouped around the computer looking at holidays. He wandered around the ward peering into the rooms until he found us. Nobody stopped him. I wrote to the hospital after her discharge regarding, what I considered to be an extreme lack of nursing care. The other three children in the room were not offered any better care. I received an extremely patronising letter in return. Previously my daughter has been a patient in the major children’s public hospital. She received excellent care there and staff were at all times considerate of parents as well as the children under their care. As most of the staff in both these hospital were relatively young, I would assume them to be university trained. Therefore, it is my opinion, that it is not whether a nurse is hospital or university trained that influences the care they give, but rather the standards set by senior staff and management in their place of work. Carrie Roberts, RN RM, Victoria

Mail Gender equality in nursing? “Women Leading the Way? Piss off... given that the vast majority of nurses ARE women there would be something wrong if they didn’t”, was my honest first response to the cover article in June’s ANMJ. This thought was followed closely by, “I wonder how much flak the magazine would cop if it’s cover article had been Men Leading the Way?” which got me thinking about the perceived double standards around gender I find as a male RN. As a male RN with a non-gender specific name (Alex) I find it’s often presumed I’m female. And don’t get me started how many times I’ve been referred to as ‘Alice’. I know gender bias is alive and well in many ways shapes and forms. I remember being made a laughing stock at university by the lecturer only because I was male. I remember being told by my student colleagues that I had no ‘right’ to have a view on motherhood because I was male. I remember being told that as a man, I was going to have an easy ride up the ladder of progression in my career and would most likely end up in a critical care area because men were just more technically minded. I remember a wards person being roundly berated for bringing in a “Zoo” magazine but I was laughed at when I told the nursing staff in another area that it was inappropriate to have a Fireman calendar hanging up. I sometimes think gender politics in nursing is a dead rubber. Surely we’ve all got it by now. We get it. We’ve all got HR departments there to tell us what to do and how to do it, we all know what is and isn’t acceptable whether we try to push those boundaries or not. Usually, I consider myself more “in-line” and compliant to these behavioural standards than most. But my gut reaction to this cover story, without having read a single word, reminded me that perhaps we’re not there. We’re certainly not there as a country, so no surprise we’re not there as a profession. Or at least I’m not. Not yet. Alex Miller, CNC/Nurse Manager, ACT

Editor’s note: The story was about women in unions, not nursing, but your letter raises some valid points about gender equality in general.

Hard to find permanent work

Left wondering

I agree with the letter of the month ‘No jobs’, May 2014. However it’s not just Adelaide facing this problem, contracts are becoming rare as casual jobs are all that seem to be available. If you are willing to slog it out and deal with uncertainty in income, last minute shift cancellations and in some cases unfair workloads because you are ‘the casual who gets paid more than us’ then maybe a job with at least a few permanent hours will become available.

I am wondering why there are still so many 457 visa nurses still coming to Australia when so many of our own nurses who have paid to train here cannot get jobs. If 457 visa nurses are paid the same as Australian nurses where is the benefit of using the 457 visa nurses? Is it because the employing facilities get a large kick-back from the government for employing the 457 nurses? If this is not the case I cannot understand the beneficial draw-card.

I currently work with some very experienced nurses who have held quite high positions who are unable to get permanent work. I myself have a post graduate degree and five plus years acute experience including remote work but struggle to find permanent hours. All the positions I apply for and am qualified for I don’t get. How can we get our feet in the door when 50 other people in the same position want the same jobs? At a hospital I worked for, 30 graduate nurses finished their grad year and only six got permanent jobs. I would also like to point out this is in regional areas, and many of my friends in a different town are experiencing the same thing. We always discuss how we should do something different (for our careers). Casual may be ideal for some people but not everyone. Long gone is the idea nurses are needed everywhere and we can always get work. And yes I have also noticed the influx of overseas trained nurses with permanent positions over the past few years.

As an agency nurse I move around quite a bit and often it is difficult to find an Australian nurse to relate to because the foreign nurses are difficult to understand and often speak amongst themselves in their own language. I’m just left wondering why? Anonymous, Victoria

Anonymous, RN, Victoria.

Thanks ANMJ I am really enjoying the ‘new look’ ANMJ. Not only do I like the format, but also the array of interesting, diverse and informative information you are covering in your articles. Of particular interest to me is the ‘Wellbeing’ section for nurses and midwives. We all work in busy, chaotic and emotional environments, and while it is important for all of us to step back, take stock and look after ourselves, too

often we don’t. Your articles in this section remind each and every one of us to spend a little time giving ourselves a bit of ‘self-care’. I also commend you on the ‘Techtalk’ page. Technology is becoming an ever important aspect of our care and I am sure more so in the future. I appreciate you covering this subject to help inform us on new technologies that will impact us all.

It’s so important to keep abreast of what is happening in our industry and have the ability to share that information with each other – this is made possible thanks to the ANMJ. Keep up the good work ANMJ team. Nicky, RN, South Australia

PAGE 47 July 2014 Volume 22, No 1.

Annie Annie Butler, ANMF Assistant Federal Secretary age the increased load of sicker patients both in hospitals and the community simply because they have not been able to afford to access care when they needed it. So perhaps it is time that we as nurses and midwives, who will have to cope with the consequences of this budget’s health cuts, stop to consider whether this is the directions we want our health system to take; or whether we need to act to prevent this from happening. To make this decision we need to consider several questions. Firstly is whether we need to change our health system because it is unaffordable. In the lead up to the federal budget, the government made many claims about the ‘unsustainability’ of Australia’s health system, and Medicare in particular. They claimed that the country was heading into financial crisis and facing a ‘budget emergency’.

Since 13 May, when the Federal Government announced its first budget, I have been reflecting with some dismay as to the sort of Australia we could be heading towards and, with perhaps even greater dismay, what sort of health system our nurses and midwives will be expected to work in. As we are all by now very much aware, the budget announced by the Federal Government will have great consequences for our health system and for the care that nurses and midwives will be able to deliver.

Even the briefest of explorations reveals that these claims are largely untrue. Health experts and health groups have been united in demonstrating that the health system, including Medicare, is sustainable and the ’unsustainability’ panic that has been whipped up by the government is simply irresponsible. No one is suggesting that we should be frivolous or irresponsible in spending our country’s resources, whether it’s spent on health or any other public service. But in a country as prosperous as ours we have options; we can actually have whatever health system we choose to have. It is up to us to decide what sort of health system we want, what kind of care we want to provide and to whom.

This is the pivotal question. Do governments have an obligation to provide quality public services to all citizens using the funds that are collected from those citizens’ taxes? Or, should governments be able to choose not to provide full services, to use taxpayers’ contributions in other ways and allow private markets to determine how those services will be provided and to whom? I’m fairly confident that with respect to health services the majority of Australians believe that the former option is the appropriate role for government. This is because thirty years ago Australians committed to Medicare, the universal health insurance scheme which underpins our public health system and which, with some additional funding from other tax revenue, allows access to all services by all Australians. Whenever tested during those thirty years, Australians have not been prepared to let Medicare go. This pooling of funds to share resources and distribute services on the basis of need has been highly successful as measured by the health outcomes we have achieved and has been consistent with the Australian ethic of a ‘fair go’ for all. However, I believe we are now being asked more seriously than ever before to let go of our egalitarian principles. To lose the approach to healthcare where we share our resources to provide the best outcomes for the majority and where all are entitled to access to services based not on the size of their individual contribution but on the need they have for the service.

Second is the question of whether we need to change the health system because it’s not delivering the best outcomes for the community.

This is the source of my dismay. Nurses and midwives provide care wherever and whenever it is needed. We are not accustomed and have not been prepared, either professionally or culturally, to provide care on any other basis than clinical need.

The series of co-payments proposed for GP visits, pharmaceuticals and diagnostic and other services will inevitably deny access to timely care for those who most need it and will very likely lead to worse health outcomes overall.

While we need to improve aspects of the health system, particularly prevention and primary heathcare, by every current measure Australia’s public health system delivers some of the very best health outcomes in the world and provides quality healthcare to all Australians on the basis of clinical need.

We need to decide whether we are prepared to participate in the dismantling of the health system as we know it and let the principles that underpin our professions’ practice be undermined. Or whether we need to take a stand to save our health system and maintain the standards we take pride in.

It is also very likely that nurses and midwives, who are effectively responsible for the day to day operation of the healthcare system, will be the ones who have to man-

Finally, it is reasonable for the government of the day to fund the health system or whether it should be, as the government suggests, a ‘user pays’ system?

If the measures that were announced proceed, we will see state and territory governments lose significant amounts of funding compromising their capacity to run their public health systems and provide quality care to their communities into the future.

PAGE 48

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