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February 2016
Midwifery Feature + Midwives caring for bereaved parents + Midwives confused about asthma management + Nurses ‘missing’ in New Zealand + Advance care planning
HealthTimes - February 2016 | Page 31
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HealthTimes - February 2016 | Page 07
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HealthTimes - February 2016 | Page 09
Midwives confused about asthma management A new study shows midwives are confused about their role and lack confidence when it comes to managing asthma in pregnant women. The qualitative descriptive study, published in Midwifery, of Australian midwives’ perceived role in antenatal asthma management involved interviews with 13 midwives working in a regional tertiary hospital. Lead author Karen McLaughlin, a midwife with 20 years’ experience and University of Newcastle PhD candidate, said she investigated the role of midwives in asthma management after noticing a gap in midwifery care. “I was part of a large asthma in pregnancy study, Managing Asthma in Pregnancy (MAP), which examined the best way to manage women’s asthma in pregnancy,” she said. “Until I was part of that study, even myself as a midwife, if I saw a woman with asthma and I was doing her booking-in visit…I would simply say - ‘do you have asthma?’ and she would say - ‘yes’. I’d tick a box and move on. “There are international guidelines stating how women should be managed in pregnancy if they have asthma but often from a midwife’s point of view it’s almost like ‘we don’t need to know about that’.” Asthma is one of the most common chronic disorders that affects pregnant women. An Australian Institute of Health and Welfare (AIHW) report shows about 12 per cent of pregnant women have asthma which is associated with an increased risk of adverse maternal outcomes, such as worsening asthma and preeclampsia as well as a greater risk of adverse fetal and infant outcomes. Evidence-based clinical practice guidelines recommend careful management of asthma during pregnancy to control the disorder and
Page 10| www.HealthTimes.com.au
prevent symptoms from occurring and worsening. Ms McLaughlin, a clinical midwife at John Hunter Hospital and clinical nurse midwife educator at Hunter New England Local Health Service, said her small study found midwives are uncertain about their role in asthma management. “There’s some that definitely feel their role is to educate women about the importance of looking after themselves in pregnancy in regards to their asthma - so making sure that they keep check of their symptoms and continue to take their medications,” she said. “But even those who said their role was to educate, then said they didn’t have enough knowledge to do that. “Then there was the other group who said their role was to simply refer women on to other health professionals - they didn’t think this was their area to deal with.” Ms McLaughlin said while the role of midwives is to be with women and to care for them holistically throughout their pregnancy, midwifery models of care and maternal comorbidities influences the way in which a midwife provides care for women during pregnancy. “If a midwife is working in a low-risk continuity model of care then certainly the job is to care for all aspects of that woman and so she hopefully would be able to provide basic information about asthma management during pregnancy, and then to identify that if that asthma progressed to worsen during her pregnancy then she should know where to refer her on to,” she said.
For the full article visit HealthTimes.com.au
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HealthTimes - February 2016 | Page 15
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ATTEND AND GAIN SKILLS TO:
Midwives caring for bereaved parents By Karen Keast
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annah Dahlen understands the heartache of losing a baby at birth. The renowned privately practising midwife and mum lost two of her own babies, shortly after giving birth. “I lost my two little boys a year apart - full term babies who were born and came out in very poor condition, and later on we had to switch their ventilators off,” she says. “It was only with the second one that we discovered there was a rare genetic abnormality that wasn’t picked up with the first.” Those devastating experiences prompted the now Professor of Midwifery at the University of Western Sydney (UTS) and spokesperson for the Australian College of Midwives (ACM) to travel Australia and New Zealand conducting workshops on grief and loss. She also released a short training film, Hannah’s Story, to shine the spotlight on perinatal loss. The birth of a baby is supposed to be one of the happiest times in people’s lives but Australia’s Mothers and Babies report shows in 2013 there were a total of 2998 perinatal deaths - 10 perinatal deaths for every 1000 births, with 2191 fetal deaths and 807 neonatal deaths. Professor Dahlen says midwives are often at the forefront of providing vital care for mothers and fathers through the traumatic experiences of miscarriage, stillbirth and perinatal death.
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“While I lost two babies and it was tragic and there has been no experience in my entire life that has been worse, I can honestly say I was given wonderful care and I have talked to plenty of mothers who haven’t had that,” she says. “I think the psychological damage that can be done at this time is immense and we are very good at perhaps doing the paperwork and doing all of the pathology and those things but where we do fall down a lot is in that ability to simply be with women and their families during this terrible time. “I think nothing can make the loss less but the care you receive can help you come through it the other side a much more intact person, a person who is wise as opposed to a person who is shattered and damaged for life.” Professor Dahlen, a midwife with more than 25 years’ experience, says while it’s common for undergraduate programs to include bereavement training, it’s important student midwives are not shielded from bereavement experiences while on placement. “Often student midwives are excluded when a baby dies, people want to protect them and they say - ‘they can deal with that later, let’s not get them involved now’,” she says. “Well, you know what happens when later comes and they’re expected to know what they’re doing and they haven’t got that experience.
“The theoretical part at university we do teach but also equally critical - nobody can teach you how to be with women in a more profound way than actually being with women. “It’s really critical that students are exposed to perinatal loss and are well supported by experienced midwives, so that they come out of the experience not traumatised but able to provide sensitive care in the future.” Professor Dahlen says midwives can tap into feelings from their own experiences of loss and grief to empathise with, care and provide support for grieving families, regardless of whether the parents are experiencing a miscarriage, stillbirth or perinatal death - which are all vastly different experiences of loss. “We can’t really walk in another person’s shoes but we have to walk that journey with them and we have to be able to understand that it is whatever that person says it is,” she says. “We can’t go back into their past experiences, we can’t understand all of the characteristics they bring to that experience that defines that so uniquely for them.” It’s crucial midwives keep communicating with parents and providing reassurance, information and support instead of resorting to silence amid fears of not knowing what to say to families. “There’s this terrible feeling when a baby dies that we feel responsible, we feel guilty, there’s all these fears about litigation and so sometimes what people do is they all hunker down and don’t talk to the mother, which is the worst possible thing you can do,” Professor Dahlen says. “We need to understand that the best way to be with a woman is to be able to just be there, have the ability to touch and cry with a woman, and that this isn’t being unprofessional, this is something women highly value. “When a midwife sheds a tear with a mother she honours that child with her tears and the ability to say ‘I’m just so sorry’, the holding of a hand, the rubbing of a back - all of those things are absolutely critical.”
There are many small but vital ways midwives can provide care, compassion and support for grieving parents, from respecting their cultural, religious and individual beliefs around death to creating memories of their baby. Amid the sorrow and suffering, Professor Dahlen says midwives can make a fundamental impact on the experience of families grieving through stillbirth and perinatal loss. “I will never forget a woman who came in with her daughter, and her daughter had a baby, and the woman rang me the next day and she’d had a baby in this hospital about 25 years ago,” she recalls. “She said - ‘I never ever found out what she was or anything about her. Is there any way that there’d be a record now?’ “For 25 years, she hadn’t even talked about this experience - the baby was just whisked away. In those days that’s what we did - we thought if they didn’t see the baby, then they wouldn’t grieve but of course that’s ridiculous. “I went back through the records for 25 years and I found her baby’s records and it was a little girl. I found the names of the people who were there and the weight and everything, and I made her out a memory book and posted it to her. “She rang me back and said - ‘that’s just healed a quarter of a century’s grief to know those details’. “So while a woman may not want it now, it’s really critical that we have something later on that we can give them.” How midwives can assist bereaved parents: 1. Say - I’m so very sorry. These are the most important words a midwife can say, Professor Dahlen concedes. “Just saying - ‘I’m so very sorry, I can’t begin to imagine what you’re going through but I want you to know I’m here’ and giving them time.”
Continued overleaf HealthTimes - February 2016 | Page 19
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2. Don’t try to make it better. You can’t make it better but you can be there for the journey. “Make sure they have good supports, there are fantastic support networks out there and lots of perinatal loss groups that are brilliant, where women who have gone through similar experiences can support each other with professional help,” Professor Dahlen says. “It’s really important for midwives to make sure all those structures and supports are put in place.” Sands is an Australian miscarriage, stillbirth and neonatal death charity that helps bereaved parents. 3. Don’t forget the dads. We often focus on mums and forget the dads, Professor Dahlen says. “Fathers go through their own way of grieving. When a baby is first lost, they’re very much trying to support the mother and often their needs are not as well identified and addressed. If the dad later on crumbles because he’s not had that support, then the whole family crumbles.” Not-for-profit organisation Pillars of Strength can help.
Page 20| www.HealthTimes.com.au
4. Don’t rush parents. It’s important parents have the ability to see their baby afterwards, and can see the baby for several days. “We have now increasingly got things like cold cots available which means that women can take their babies home as well, if they want to do that, and the cot will keep their baby cool. It’s really important that we don’t put any deadlines on women. I would hope there’s nobody that pressures any mother or father to give up their baby before they’re ready to say to goodbye.” 5. Respect cultural, religious and individual beliefs. “It’s really important that we find out what’s important for the parents,” Professor Dahlen says. “For example, for many Muslim parents burying the child before sundown is really critical and for some New Zealand parents the placenta is a very important thing that is kept and buried.” 6. Create memories. Creating memories or mementoes, such as taking footprints and locks of hair, can improve maternal mental health outcomes.
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Dementia: Accessible education for healthcare professionals Vicky Cockerill, Lecturer in Nursing at the University of Derby Online Learning (UDOL) comments.
I
mprovements within today’s Health and Social Care sector are enabling us to live longer, but the opportunity for a longer life has its drawbacks. Dementia is a global issue that affects an estimated 46.8 million* people across the world and continues to gain worldwide attention. Dementia is more than just memory loss, it affects the functioning of the brain, resulting in the irreversible loss of cognitive memory and capacity, subsequently impacting on a person’s behaviour and ability to function socially, physically and emotionally over time. As a nurse who has worked with patients living with dementia, I have had the privilege to offer high quality care and firmly believe that healthcare should never be static. I viewed my role as a continuous journey and now, as a lecturer in Nursing, I have the ability to support Health and Social Care professionals around the world to develop their skills and knowledge through online learning. I am passionate about providing accessible education to healthcare professionals that is evidence based and responsive to the changing needs of their patients. I believe that there is an exciting opportunity to be part of a health care delivery system that offers high standards of care and support to meet the specific needs of individuals living with dementia.
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In 2015 UDOL developed a free Massive Open Online Course (MOOC) on dementia to help raise awareness and provide high quality education to health care professionals. As experts in online learning we hope to inspire learners to engage further in their educational opportunities and knowledge acquisition. Our ‘Bridging the Dementia Divide: Supporting People Living with Dementia’ MOOC will be starting again in March 2016 and is open to all, regardless of location, profession or education level, giving Health Care professionals the opportunity to develop their knowledge of dementia through part-time, online learning. This course will help to address the global challenge of dementia and has a strong focus on integrative collaborations and partnerships as a way to reduce barriers between services. We also offer a range of courses for professionals working within the Health and Social Care sector that include, Dementia Care University Advanced Diploma; BSc (Hons) in Nursing Studies Top-Up; BSc (Hons) in Integrative Health and Social Care Top-Up and MSc in Integrative Health and Social Care. The courses can be studied parttime, 100% online and are designed to meet the demand of today’s rapidly changing health care sector.
For the full article visit HealthTimes.com.au
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HealthTimes - February 2016 | Page 25
Advance care planning Advance care planning is when people outline their future treatment and personal care requirements in the event they become unable to express their wishes. It’s not about dying - in fact, the conversation about advance care planning should begin well before patients reach end-of-life care By Karen Keast
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t’s the conversation many health professionals don’t know how to begin. As a former critical care nurse and now project officer at Austin Health’s Advance Care Planning Department, Sharon Neyland says it’s a crucial conversation nurses and allied health professionals often need to have with their patients. Ms Neyland says one simple way of broaching the subject is to liken advance care planning to car insurance. “Most of us will have car insurance and we don’t plan on having a car accident but we have the insurance there just in case,” she says. “You don’t plan on becoming so unwell that you can’t communicate but you’ve got this there just in case. It makes people think about if anything happened and that they couldn’t speak for themselves, who would speak on their behalf? “It’s important for them to know that the benefit of having the Medical Enduring Power of Attorney (MEPOA) is that they can refuse treatment on their behalf when no-one else can.” Victoria’s Austin Health is leading the way in advance care planning. The organisation runs the Advance Care Planning Australia website with the support of the Commonwealth
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Department of Health to provide a national platform for resources for health professionals and consumers on advance care planning. The Advance Care Planning Department provides training, including a free online course plus a practical workshop, and hosts an annual Advance Care Planning and End of Life Care national conference each November. The health provider is also striving to improve its own advance care planning processes with a major change management project across its three sites. Advance care planning was first implemented at Austin Health in 2002. From 2009 until recently, its model supported specific advance care planning clinicians to facilitate discussions and complete advance care planning documents with patients. While the model itself was a success, it only enabled a small number of patients to have access to advance care planning services and complete advance care plans. A more sustainable model is now being rolled out, which supports all health care staff to have advance care planning conversations and to complete advance care plans. Under the move, the role of the advance care planning clinician is being expanded to offer expert support, staff education, clinical
championing and mentorship while assisting patients with more complex advance care planning conversations. An advance care plan includes an advance care directive - a written document that records the person’s medical treatment wishes in the event they are unable to communicate for themselves due to injury or illness. Another document, known as the MEPOA, appoints a substitute decision maker. While there are differences between the state and territories, the MEPOA can consent to medical treatment or legally refuse treatments on the patient’s behalf. Ms Neyland says advance care directives are living documents that can be reviewed and updated either annually, as the patient’s medical condition or social circumstances change or as they wish. “Advance care planning has been shown to significantly improve many outcomes for patients and their families,” she says. “It improves the quality of care, including their end-of-life care, and increases the likelihood that the patient will die in their preferred place. “It’s associated with increased utilisation of hospice services and a reduction in hospitalisation and also the use of intensive treatments at the end-of-life. “It also results in lower risk of stress, anxiety and depression in surviving relatives and it reduces moral distress amongst health care providers as well.” Austin Health completes almost 500 advance care plans each year, seeing about 1200 inpatients a year. Ms Neyland says about 10 per cent of patients have an advance care plan when admitted to hospital but up to 80 per cent of patients are likely to meet the criteria for the development of an advance care plan. “There’s lots of different illnesses where people would benefit from an advance care plan
- anyone who is elderly and frail, anyone who has any chronic conditions or people who have early cognitive impairment with dementia,” she says. Ms Neyland says allied health professionals and nurses, especially those working in hospital admission risk programs, transitional care, hospital in the home, outpatients, pre-admission clinics, community health care centres, general practice and residential aged care facilities, have numerous opportunities to have advance care planning conversations with patients. Those conversations should begin when people who have ongoing health problems are still well and living either in the community, a more sub-acute setting or in outpatients - not at end-of-life. “It depends on the person but we always say the sooner we do an advance care plan, the better. “It’s something that can be done nice and early while they are well and not stressed and sick, and then it gets reviewed as time goes by,” she says. “Then, it’s less stressful and they’ve had time to think about it if it’s due for review, or they’ve been into hospital and their medical condition has changed. “They might have a better understanding of what their hospital experiences have been like in that 12 months and had more time to think about what they want or don’t want.” On all admissions, nurses should ask patients whether they have an advance care plan. It’s also important nurses know how to have the conversation and fill out the advance care plan documents, be able to find the document and read it, know when to review it and share it, and understand when it needs activating. “At the end of the day, it’s about the patient’s wishes,” Ms Neyland says.
For the full article visit HealthTimes.com.au HealthTimes - February 2016 | Page 27
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HealthTimes - February 2016 | Page 29
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Nurses ‘missing’ in New Zealand The New Zealand Nurses Organisation (NZNO) has warned nurses are going ‘missing’ in the country’s health workforce despite a Government report showing an extra 6700 nurses are now on the ground. NZNO associate professional services manager Hilary Graham-Smith said the government’s report, Health of the Health Workforce 2015, featured misleading statistics. “Where most would follow the axiom that prevention is better than cure, it is clear that the government is not concerned with either the prevention of looming health workforce issues, or with fixing the current problems,” she said. “A policy of denial seems to be the order of the day. “The report contains an inadequate and simplistic analysis of some of the issues facing the nursing workforce.”
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The report shows the nation’s health workforce grew to a record 97,786 practising health practitioners last year, with an extra 6764 nurses since 2009. The total number of practising nurses in 2015 was 52,729, including 145 nurse practitioners, 49,769 registered nurses and 2815 enrolled nurses. It also shows 3068 midwives were practising in 2014, up from 2823 in 2009 - equating to 33.6 midwives for every 10,000 women of childbearing age. The report found new midwifery graduates are benefiting from a revised and compulsory Midwifery First Year of Practice program that includes one-on-one mentoring with a New Zealand College of Midwives’ approved mentor.
for the full article visit HealthTimes.com.au
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Exciting things are happening at Medacs Healthcare! With unprecedented growth and new opportunities for our Nurses why not give Medacs a go? We are currently looking for: RN/EEN’s - agency shifts across Sydney metro area Theatre RN’s - All states , all specialities - temp/perm Emergency RN’s - WA, NT, QLD, VIC - temp/perm Midwives - All states plus Sydney CBD ICU/HDU RN’s - QLD, VIC and Sydney metro - perm Med/Surg EEN’s - Sydney - perm Contact us for more temp or perm opportunities.
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