Ncah issue 18 2014

Issue 18 15/09/14 fortnightly

Theatre & Critical Care Feature Improving communication in the operating room Superannuation delay short-changes nurses and midwives Physiotherapist debunks concussion myths Wounds and the normal healing process

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Nursing Careers Allied Health - Issue 18 | Page 3

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www.ncah.com.au www.ncah.com.au Issue 18–15 26September August 2013 Issue 2014 117– –20 January 2014 Issue 17 – 26 August 2013

We hope you enjoy perusing the range of opportunities We hope you enjoy perusing included in Issue 17, 2013. the range of opportunities 18,2014.

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The NCAH Magazine is the most widely distributed national The NCAH is the most widely distributed national nursing andMagazine allied health publication in Australia nursing and allied health publication in Australia For all advertising and production enquiries please contact For all advertising and8700, production us on +61 (0) 3 9271 email enquiries please contact us on +61 (0)306 3 9271 email 1300 5828700, careers@ncah.com.au or visit www.ncah.com.au careers@ncah.com.au or visit www.ncah.com.au If you would like to change your mailing address, Iforyou likeon toour change your mailing address, be would included distribution, please email or be included on our distribution, please email careers@ncah.com.au careers@ncah.com.au Published by Seabreeze Communications Pty Ltd Trading as NCAH. Published by 328 Seabreeze ABN 29 071 053. Communications Pty Ltd Trading as NCAH. ABN 29 071 328 053. © 2013 Seabreeze Communications Pty Ltd. 2014 Seabreeze Communications Pty Ltd. © 2013 All rights reserved. No part of this publication may be copied or All rights reserved. part of this publication may bepermission copied or of reproduced by anyNo means without the prior written reproduced byCompliance any means without prior written permission the publisher. with thethe Trade Practices Act 1974 ofof the publisher. Compliance thepublication Trade Practices Act 1974 of of advertisements containedwith in this is the responsibility advertisements contained in this publication is the responsibility of those who submit the advertisement for publication. those who submit the advertisement for publication.

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The Royal Flying Doctor Service, Central Operations (SA/NT), is seeking to

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• Participation in the development of the strategic provided; The role of a Flight Nurse is fun, rewarding and challenging while valuing team work direction for RFDS Flight Nurses; • Extensive training and orientation; and independent practice. If you are registered with AHPRA as a registered • A supportive environment where staff are valued and • Roster development and coverage as required; nurse and midwife, have 3-5 years post • • Undertake Work with a leading Australian brand In addition to appropriate tertiary qualifications in health grad experience in emergency or critical personal development is encouraged.

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Flyingother Doctor of Australia is the world’s Flight Located in Port Augusta, this role is responsible for the fi rst line Opportunities exist for Service suitably qualified Nurses to join the Royal Flying Doctor Service, Central Operations benefi ts, assistance with relocation and makes real difference to all Australians, applyacross now. a •thatAbility toadevelop and maintain relationships subsidised rental and utility costs along first and most comprehensive aero-medical provider of Provide support toof staff hours. in•management Adelaide.

Working inaaafter diverse, fulfilling and rewarding environment, nurses are at the and forefront in diverse of people; with district loadings gratuities are quality nursing service for the range Port RFDS Augusta Base. emergency and primary healthcare services to those who some ofenquiries the incentives offered to the Please direct your confi dential to: delivery of aeromedical health services.

• Excellent interpersonal skills with candidates. the ability to effectively successful live, work and travel throughout Australia. An exciting Qualifi cations and experience: lead and with staff at all the levels; If you are seeking opportunity to Greg McHugh Ph: (08) 8150 1313 wecommunicate offer: Responsibilities include: work in all our locations within WA, Derby, opportunity nowMidwifery exists toNursing join thequalifi RFDS Health Services •In return • General and cations, A proactive attitude high level service skills.

We are seeking registered nurses with General and Midwifery Nursing Certificates, currently registered to: Kate and Guerin, HR Coordinator Jandakot, Meekatharra, Kalgoorlie and •Applications Attractive remuneration and benefi ts (salary packaging); Nurses based in Port and benefi tsclient (salary packaging); • First line management of Flight team.

Port Hedland and would like to know registered with AHPRA; In return, wemotor are offering anand attractive salary, including salary with the Australian Health Practitioner Regulation Agency.

You 381, will also have comprehensive experience more about being aassistance flight nurse contact Box Marleston BC SA 5033 •PO Company vehicle relocation assistance and relocation Augusta; Reporting to the General Manager, Health Services, this Gabrielle West, Director of Nursing on staff packaging benefits in a level supportive environment where • Comprehensive experience in aeromedicine and acare area, and/or post graduate qualifications in strategic a critical together with yingdoctor.net high customer service (08) 9417 6300. The RFDS areskills open to a of the provided; • Participation in the development Email: careers@fl role is responsible for the coordination of health programs are valued and personal development encouraged.

6 month plus flis ight nurse contract for critical care area essential; anddirection a professional approach to service delivery. applicants seeking employment with • Extensive training and orientation; for RFDSthe Flight Nurses; orientation; delivered throughout RFDS Central bases in Enquiries & Applications to: • Post graduate qualifications in criticalOperations care essential; the RFDS. Applications close: 9 April where 2012 • A supportive environment staff are valued and as required; environment where staff are valued • RosterPort development and coverage Adelaide, Augusta, Alice Springs and our Health Facility Nikki Crichton, Project Coordinator Information positions can be and obtained Abilityare to lead andtomanage a group of career staff; If• you keen progress your with an organisation that makes a realondifference to from Rosemary Hunt, by phoning personal development is encouraged. encouraged.

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RFDS Central Operations (08) 9417 6300 during office hours or • Ability to work both independently and as part of a all Australians, apply now. send your e-mail request to clinical competency testing; The Royal Flying Doctor Service is an Equal Opportunity Employer Tel: (08) 8238 3333 Other responsibilities include: nursing@rfdswestops.com.au. multi-disciplinary team; Post: PO Box 381 Marleston SA 5033 • Facilitating Participationthe in recruitment activities; Closing date for applications is Monday •Please planning, delivery and evaluation ofGreg the McHugh If you are keen to move your career into an your career into an organisation organisation • Confident in decision making abilities; direct your confidential enquiries to Ph: (08)8150 1313 6th February 2012.

Email: careers@ • various Liaison with other Health Services; with the relevant that makes a real difference programs incations collaboration difference to to all all Australians, Australians, apply apply now. now.

• Post graduate qualifi in aeromedicine desirable; flyingdoctor.net Applications to: Kate Guerin, HR Coordinator RFDS Central Operations program • individual Provide support to coordinators; staff after hours.

Applications close: 20 • General computer literacy.DC SA 5033 Box 381 Marleston •PO Seeking new opportunities for health program delivery ; Please direct your confidential enquiries to: dential enquiries to: September 2013 •Email: Preparing reports for each program; Qualifi cations andrequired experience: Greg McHugh Ph: 8150 careers@flyingdoctor.net 8150 1313 1313 The RFDS is an(08) Equal • General and Midwifery Nursing qualifi cations, • Day to day management of health program staff.

Applications Kate Guerin, Guerin, HR HR Coordinator Coordinator Opportunityto:Employer The Royal Flying Doctor Service Is An Equal Opportunity Employer registered with AHPRA; PO Box 381, Marleston BC SA SA 5033 5033 • Comprehensive experience in aeromedicine and a Email: careers@flyingdoctor.net yingdoctor.net critical care area essential;

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For further information and to apply online, visit our website swinburne.edu.au/jobs Swinburne values diversity in its work environment and has been recognised as an Employer of Choice for Women since 2007. Swinburne encourages applications from Indigenous Australians; women; mature age workers; people with disabilities; people who identify as LGBTI; and those from culturally and linguistically diverse backgrounds.

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Senior Flight Nurse Nursing Careers Allied Health - Issue 18 | Page 9

Superannuation delay shortchanges nurses and midwives

A

ustralia’s ageing nursing and midwifery workforce will retire much poorer as a result of the Federal Government’s decision to postpone compulsory superannuation increases, according to the Australian Nursing and Midwifery Federation (ANMF).

ANMF assistant federal secretary Annie Butler said nurses and midwives, where a major portion are aged in their 40s and 50s and set to retire in the next decade, will be among those hardest hit under the changes.

“Our workforce is 90 per cent female, they’re disadvantaged in every possible way and our very expert clinical nurses and those at higher registered nurse levels have reasonable earning capacity but a vast bulk of our workforce is part of the lower paid workforce, so this is going to hit them very hard,” she said.

“They tend to be in the sectors where bargaining over things like superannuation can be particularly difficult, like in aged care.

“They have been planning under the certain assumption that this is how it’s going to work for them and now that’s been removed, so that means that what they’ve planned for the next 10 to 15 years could be affected.”

Ms Butler said some nurses and midwives are still reeling from the impact of the Global Financial Crisis.

“We’ve already had examples of people who even now can’t retire or aren’t going part-time when they’ve reached maybe over 50 or 55 be-

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cause of the impact on their super,” she said.

“We’re very concerned that nurses are going to be forced to continue working to well over 70 because they just can’t afford to retire.”

Ms Butler said the superannuation freeze combined with the proposed changes in pension indexation will result in a 25 per cent reduction in overall retirement incomes for nurses and midwives, on average earnings, now aged 45.

“If we look at our lower paid workers in the aged care industry, maybe more an assistant-in-nursing (AIN) or care worker level, the affects to them could be that they’re just forced onto welfare,” she said.

“We don’t know what’s going to happen with pensions exactly, we know they are going to be made more difficult to access, so we’re concerned about driving people into circumstances of disadvantage and poverty.

“That is a real concern for some elements of our members.”

The government has announced the compulsory superannuation contribution that employers make for their workers will now remain at 9.5 per cent until 2021, when it will gradually begin to rise towards 12 per cent, instead of rising to 12 per cent by 2019-20.

The superannuation freeze comes amid ANMF concerns the government’s proposal to deregulate university fees will drive the cost of a nursing degree to $100,000.

“Our concern is not just about the fact that we are going to see perhaps impossible fees

403-013 1/2PGFULL FULLCOL COL 407-008 404-007 405-011 402-013 414-002 416-002 418-002 401-039 409-008 408-00 1/2PG 410-003 412-002 411-006 413-005 415-004 417-004 for nurses, we won’t see any people from lower socio-economic backgrounds be able to access nursing or midwifery,” Ms Butler said.

“They will never be able to pay off that debt because they just don’t have the incomes potentially to support it.”

Ms Butler said deregulation could also result in some universities moving to withdraw their cost-intensive nursing courses.

“Some years ago it was determined by the government that nursing and education were dedicated priority areas - we had public universities who were required to make sure that they service the public good, so things like nursing and midwifery is one of those areas,” she said.

“The government has systematically withdrawn funding from the tertiary sector over the last decade…so for universities to be able to function and make their money, even just to survive, they are going to be chasing income rather than making sure that they serve their obligation to the community.

“Universities seeking income could just withdraw entirely from wanting to even offer nursing courses - that is a real concern.”

Ms Butler said the federation is calling on all Senators to oppose the Higher Education and Research Reform Amendment Bill 2014, as it moves into the Senate, where it is expected to be considered in October.

She said the ANMF’s Lies, Cuts and Broken Promises campaign has now reached 5000 supporters and will continue to take a stand against the government’s health care cuts.

“We want to keep track and keep not just the government but all of the parties and the crossbenchers accountable,” she said.

“We are going to keep a mechanism of what these people have said before they got into their position and now what they are doing.

“We want to keep track of every broken promise that we see.”

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Nursing Careers Allied Health - Issue 18 | Page 11

Wounds and the normal healing Physiotherapist debunks process concussion myths

By Bonnie Fraser RN, BSc, BNURS Players and professional athletes should be removed from play is after ound healing thereceiving process aofhead-injury the body on thereplacing sporting devitalised field amid and/or estimates only tissue 10 per missing of to concussions in unconsciousness, incent order fill a cavity result and repair damaged skin. according to occurs an Australian physiotherapy reThis typically in a coordinated fashion searcher. along a healing continuum, a process taking up Professor Tony Schneiders, a physiotherapy to two years. During this time wounds are vuland sports physiotherapy researcher and lecturer nerable to repeated trauma and breakdown and at Central Queensland University, said undetectshould be protected where possible.

Across the ed injuriesofand concussions could increase the spectrum health care settings health profeschance of players returning to the field, placing sionals face the challenge of difficult, hard to them at risk of another more serious injury. heal wounds in addition to the uncomplicated Professor Schneiders said it’s important wound that heals as expected. In order to faciliphysiotherapists on the sidelines quickly identify tate healing it is important for nurses to not only the symptoms of concussion. recognise the stage of healing but to recognise “Obviously diagnosing a brain injury is not when a wound is failing to heal. In this article we something that we necessarily have within our will look at the types of healing intention, some scope of practice but looking out for the signs of the factors that influence wound healing and and symptoms associated with that in a general revisit the stages of wound healing. situation or in a sporting situation is really important for a physiotherapist to be aware of,” he said.

Types of healing “It’s also important to be able to identify if Nurses will come across three types of healing someone does have a subdural hematoma or a intention during their clinical practice - healing bleed in the brain which could be catastrophic, by primary or secondary closure and delayed as opposed to saying it’s just a head knock, treat primary closure (or tertiary closure).1 ,4 Some it as a concussion. might“They be familiar with terms first, second need to bethe able to identify where and perthird healing respectively.

In the acute hapsintention that minor concussion can transgress and care setting, the majority of result wounds heal by priactually get worse and can in more serious

W

mary intention where wound edges are easily apconsequences for the athlete. proximated held in place with various “That’sand a difficult area because theclosure trouble materials such as sutures, staples, glue or steriis the signs and symptoms that are associated strips.

These wounds generally unconwith concussion are are if not exact clean, but very simitaminated or non-infected wounds with minimal lar to the signs and symptoms with a subdural tissue defects. Surgical wounds, clean hematoma…until the symptoms get socuts badand and lacerations examples of such wounds.

These the athleteare loses consciousness and obviously wounds havethat minimal scarring as with theresomething is no tisyou realise you are dealing sue defect and new dermal tissue is only required more serious.” to fillProfessor the gap across the closely aligned Schneiders, who will speakwound about concussion in sport at the September 19-21 edges.

Page 12 | www.ncah.com.au

Physiotherapy New Zealand (PNZ) conference, saidWounds initial signs are by both cognitive intention and physical, healing secondary are from poorchronic memorywounds, to slurredwounds speech, with loss of baltypically large ance and coordination. tissue defects or wounds that cannot be easily Hedue saidto it’sthe vitaldegree physiotherapists take a conclosed of skin loss.

Healing servative approach to head injuries, particularly occurs more slowly by granulation (growth of when it comes and adolescent sport. new tissue to filltoachildren’s cavity), wound contraction (to “Their brains are much more susceptible close the wound) and re-epithelialisation (growthto and to problems than an adult ofdamage new skin) of ongoing the wound surface.1,4 These brain, so even if we’ve had the inkling or thought wounds usually result in lager scar tissue formathat they might have sustained a concussion they tion as new skin must grow across a larger area. should be removed from play and not returned Pressure injuries, diabetic ulcers, leg ulcers and to play until they have been checked over by a dehisced wounds are examples of wounds healdoctor,” he said. ing by secondary intention.

“With the adult athlete, perhaps not as conSome wounds may require delayed closure servative, but certainly the consensus document due to infection, the need for debridement or on concussion guidelines at the moment do sugformation of new granulation tissue to cover exgest that the player is removed from play despite posed fascia, bone or tendon prior to definitive what level of concussion they have, because or primary closure. This type of healing is comthe symptoms they have after concussion will monly referred to a delayed primary closure or change from person to person.” tertiary closure. 1 The need for a skin graft is an Professor Schneiders said there has also example where delayed primary closure may be been much hype and misconception around secrequired. Primary closure may occur up to 7 days ond-impact syndrome, where it’s believed that after cleansing or debridement of the wound bed two concussions in quick succession can result and where infection is adequately treated. in serious and sometimes fatal consequences.

“Probably, all it is is a slower swelling of the Factors affecting healing brain which takeswound a while to manifest, so with Athe myriad factors can slow or impair first of knock they’ve had down damage to the healbrain, ing notwithstanding complex which has caused age, it to illness, swell or bleed, disease and deprocesses, psychological pending onmedications, what damage occurs it canorbesocial quite factors, or a combination of any of these. Any catastrophic,” he said. condition thatof reduces perfusion to the wound “In a lot cases with head injuries that bleed bed will impair healing for example vascular dis-to or that swelling actually takes a period of time ease (arterial disease or chronic venous insuffistart giving you symptoms because it needs to ciency) and chronicinairways disease emphybuild up pressure the brain, and (e.g. that can take sema, asthma lung cancer) rheumatoid anything from or minutes to hourswhile in some cases. arthritis, diabetes and age impact wound healing

through altered cellular mechanisms involved in the healing process.

The peri-operative period, For the full article visit NCAH.com.au

411-017 414-009 409-036 407-034 1PG FULL COLOUR CMYK PDF 412-010 408-012 418-007 417-011 415-011 416-007 413-013 surgical procedure and post-operative pain in particular can create stress and anxiety which induce physiological responses that interfere with healing processes. Similarly, psychosocial factors such as the lack of social and family support networks, loss of independence, depression and poverty initiate the same stress responses that delay healing. Locally wound characteristics also influence reparative processes. Tissue type, infection and inflammation, moisture balance, wound edges, wound temperature and the capacity of the microcirculation to deliver oxygen to the wound bed and surrounding tissues all impact on healing.

The wound healing process Regardless of the type of wound the same basic physiological principles apply to how wounds heal. Generally there are three stages in the wound healing process although some authors tend to separate haemostasis and inflammation. The wound healing occurs though a continuum and comprises haemostasis, inflammation, proliferation and maturation (or remodelling). 2,3 Immediately post injury blood vessels at the The UK Government has announced site ofnew the restrictions injury will firstly to reduce fromconstrict next April on (NHS, Police etc.)fibres being blood civil flow servants to the area.2,3 Collagen are able their pensions totissue exposed at to thetransfer site of damaged vascular Australia. This may also be expanded which trap platelets, which in turn release chemito the private sector. cals that make nearby platelets sticky and clump together formstill a platelet plug It istonow possible to resulting transferin forclot more detail UKPTA formation.2,3 The contact inflammatory phase occurs simultaneously where vasoconstriction is folCALL US TODAY ON (08) 9309 4001 lowed info@ukpensionsaustralia.com.au by vasodilation increasing blood flow to the damaged site with an influx of macrophages and neutrophils which begin to clean the wound

removing debris, bacteria, damaged cells and devitalised tissue readying the site for the next stage of healing. 2 The inflammatory phase is characterised by the cardinal signs heat, pain, redness and swelling and usually will lasts from line adnature ethe zero to three days depending on of d 5 201 characteristics ced but n the wound and other patient u o ann will continue until the wound bed has been adequately prepared for the next stage of the healing, the proliferative phase.

The proliferative phase usually occurs from between three days to approximately three weeks (again depending on the nature of the wound and patient factors that may limit healing). 2,3 It is during this phase that new blood vessels are created (angiogenesis) and new tissue in the form of extra cellular matrix, primarily composed of collagen and elastin, is produced to fill the wound cavity over which new skin will grow (epithelialisation).2,3 Collagen and elastin together provide tensile strength and elasticity to newly formed skin.2,3 Once the wound is repaired the final phase of wound healing, the maturation phase begins.2,3 This phase, lasting up to two years involves wound contraction and remodelling of newly formed collagen to produce scar tissue. 2.3 Remember it is during this phase the wound remain vulnerable to breakdown though repeated insult especially wounds healing by secondary intention such as dehisced wounds, pressure ulcers, diabetic foot ulcers and leg ulcers and subsequently should be protected at all times.

w!

o Act n

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 18 | Page 13

Lyell McEwin nurses take industrial action Nurses have launched industrial action at a South Australian hospital in protest at plans to use existing staff for a dedicated resuscitation team.

Emergency nurses at Adelaide’s Lyell McEwin Hospital are implementing low level industrial action designed not to impact on patient care as the staffing dispute continues.

Australian Nursing and Midwifery Federation (ANMF) South Australian branch secretary Adj Assoc Professor Elizabeth Dabars AM said three additional nurses are needed in the emergency department to staff the dedicated resuscitation team.

“It became apparent that they were seeking to implement that resuscitation team out of the existing staff cohort,” she said.

“That’s completely ridiculous because those existing staff members already have important work that they are undertaking, and therefore in order to take them and utilise them in relation to the dedicated resuscitation team would be simply a matter of robbing Peter to pay Paul.

“That’s something that the nurses at the Lyell McEwin Health Service emergency department did not accept because they are interested in providing an appropriate service to the community at Lyell McEwin and the surrounds.

“It seems absolutely bizarre and it is unacceptable to us that the northern suburbs would receive a lower standard of care than their counterparts at the Flinders Medical Centre and the Royal Adelaide Hospital, both of whom are described as tertiary hospitals and do have dedicated resuscitation teams.”

Adj Assoc Professor Dabars said emergency nurses have replaced their uniforms with ANMF-

Page 14 | www.ncah.com.au

branded scrubs and are distributing leaflets to the community to raise awareness of the issue.

“At the moment it’s all designed not to impact negatively on patient care because of course the entire point is that we want to improve patient care at the facility and so the action really involves bringing community attention to the issue,” she said.

Adj Assoc Professor Dabars said nurses are also planning to participate in a lunchtime rally.

“We are ever hopeful that we could get the matter resolved prior to then but in the event it’s not resolved…then the lunchtime rally will go ahead,” she said.

“The members will also consider what other strategies or potential escalation of their industrial action that they might be able to consider at that time.”

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Nursing Careers Allied Health - Issue 18 | Page 15

Improving communication in the operating room An Australian researcher aims to improve team-work and communication between nurses, anaesthetists and surgeons in the operating room.

Associate Professor Brigid Gillespie, a Senior Research Fellow at Griffith University’s NHMRC Centre for Excellence in Nursing (NCREN), is researching the use of non-technical skills during surgery in the OR. A former theatre nurse, Assoc Professor Gillespie said there are several issues contributing to miscommunication in the OR. “You have got so many disciplines working together and all of them have a different focus,” she said.

“The team should function in an inter-dependent way but that doesn’t always happen.

“While we have this overarching goal of providing safe patient care, sometimes our priorities are competing, and what I think I should be doing may not be understood by someone else.”

Assoc Professor Gillespie has conducted several observational studies that measure communication, teamwork and interruptions in the OR at Queensland hospitals since 2007.

She’s also leading a large Australian Research Council-funded observational study at the Gold Coast University Hospital and the Princess Alexandra Hospital to evaluate team training intervention designed to improve surgical team members’ situational awareness.

Assoc Professor Gillespie said the study has found anaesthetists display higher levels of situational awareness, leadership and communication than surgeons.

“For those of us that work in the operating room or have worked in the operating room, we’ve always kind of known that intuitively because people’s roles are so well defined and circumscribed,” she said.

Page 16 | www.ncah.com.au

“The surgeons are focused on the surgery even before they get in there, so they are perhaps not as aware of what’s going on around them.”

Assoc Professor Gillespie said nurses are often the conduit of information and communication in the OR. “Nurses are, in many instances, what holds everyone together in terms of communicating changes,” she said.

“We all think we have the skills in terms of communication, we all think we’re innately good communicators but the research, and not just my research, other people’s research demonstrates that we’re not as good as we think we are and there is room for improvement.”

Assoc Professor Gillespie is also conducting a National Health and Medical Research Council study to investigate the implementation of the mandated surgical safety checklist, which her research shows significantly reduces postoperative complications.

“All of the hospitals to some degree do use it but it does boil down to culture and it’s very context specific,” she said.

“The component that’s done the best is this time out component where it’s like a team huddle and they check - have we got the right patient, what’s the operation that’s being done, what side are we operating on, are there any concerns?

“The checklist gives everybody in the team the opportunity to voice their concerns in a nonthreatening way so that everybody is aware - it heightens everybody’s situational awareness in terms of the bigger picture.”

Assoc Professor Gillespie said she hopes her research will eventually be implemented in new clinical guidelines for the operating room.

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Nursing Careers Allied Health - Issue 18 | Page 17

Legislation won’t safeguard nurses and allied health professionals New legislation that aims to protect nurses and allied health professionals against assaults and threats will not work to deter violent offenders, according to the Australian Nursing and Midwifery Federation’s (ANMF) Victorian branch.

ANMF Victorian branch secretary Lisa Fitzpatrick said a raft of measures are needed to improve workplace safety for health professionals.

“The bills are only going to be effective as people are charged and prosecuted which of course we don’t see,” she said.

“So in effect, having this sort of legislation, it’s not going to act as a deterrent.

“There’s research upon research around mandatory sentencing; increased penalties isn’t a deterrent so on its own it’s of little value.”

Under Victorian legislation introduced into parliament in August, offenders who assault health practitioners, including nurses, midwives, GPs, pharmacists, physiotherapists and psychologists, face a six month jail term, double the penalty for a common assault.

The legislation is designed to build on legislation introduced into parliament earlier this year that covers emergency workers in hospitals and emergency services staff, providing increased penalties for violent offenders.

Ms Fitzpatrick said measures such as better security, increased risk planning, pre-admission assessments, education, increased reporting and a change of culture in hospitals are also needed.

“Boards and hospital managers…(need to take) the issue seriously and report about changes being implemented as a result of violent events taking place, feedback being given to staff about what action is being taken - they are the sorts of things that are really going to have a significant impact on decreasing violence in our workplaces.”

Page 18 | www.ncah.com.au

Ms Fitzpatrick said Freedom of Information statistics show a 33 per cent increase in reports of violence against Victorian health care professionals.

“There’s no question that the violence is not only increasing in the number of incidences but it’s also increasing in the severity,” she said.

“People are becoming not just violent more often but more violent in so far as nurses are being punched now, they are being knocked unconscious, they are having their hair pulled out, they are being dragged along the floor.”

Ms Fitzpatrick said while the branch’s ‘Say No to Violence’ campaign has raised awareness about the level of violence perpetrated against health professionals, little has been done to curb the problem.

“We’re disappointed that this is the fix that’s been provided by the state government after four years,” she said.

“There’s been it’s own inquiry that it completed in 2011, where it said that it would support the recommendations but the recommendations haven’t been implemented, hospitals haven’t been funded to implement recommendations.

“We’d like to see it be a real priority of government, not just given lip service and that there actually be measures implemented that prevent violence rather than the attitude of everything in Victoria can be fixed by locking somebody up and throwing away the key.

“The problem is far more comprehensive and needs a more intelligent and detailed implementation of a suite of measures to actually address the issue so that nurses and other health workers actually feel safe going to work and are safe.”

For the full article visit NCAH.com.au

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Nursing Careers Allied Health - Issue 18 | Page 19

Wounds and the normal healing process

By Bonnie Fraser RN, BSc, BNURS

W

ound healing is the process of the body replacing devitalised and/or missing tissue in order to fill a cavity and repair damaged skin.

This typically occurs in a coordinated fashion along a healing continuum, a process taking up to two years. During this time wounds are vulnerable to repeated trauma and breakdown and should be protected where possible. Across the spectrum of health care settings health professionals face the challenge of difficult, hard to heal wounds in addition to the uncomplicated wound that heals as expected. In order to facilitate healing it is important for nurses to not only recognise the stage of healing but to recognise when a wound is failing to heal. In this article we will look at the types of healing intention, some of the factors that influence wound healing and revisit the stages of wound healing.

Types of healing Nurses will come across three types of healing intention during their clinical practice - healing by primary or secondary closure and delayed primary closure (or tertiary closure).1 ,4 Some might be familiar with the terms first, second and third intention healing respectively. In the acute care setting, the majority of wounds heal by primary intention where wound edges are easily approximated and held in place with various closure materials such as sutures, staples, glue or steristrips. These wounds are generally clean, uncontaminated or non-infected wounds with minimal tissue defects. Surgical wounds, clean cuts and lacerations are examples of such wounds. These wounds have minimal scarring as there is no tissue defect and new dermal tissue is only required to fill the gap across the closely aligned wound edges.

Page 20 | www.ncah.com.au

Wounds healing by secondary intention are typically chronic wounds, wounds with large tissue defects or wounds that cannot be easily closed due to the degree of skin loss. Healing occurs more slowly by granulation (growth of new tissue to fill a cavity), wound contraction (to close the wound) and re-epithelialisation (growth of new skin) of the wound surface.1,4 These wounds usually result in lager scar tissue formation as new skin must grow across a larger area.

Pressure injuries, diabetic ulcers, leg ulcers and dehisced wounds are examples of wounds healing by secondary intention.

Some wounds may require delayed closure due to infection, the need for debridement or formation of new granulation tissue to cover exposed fascia, bone or tendon prior to definitive or primary closure. This type of healing is commonly referred to a delayed primary closure or tertiary closure. 1 The need for a skin graft is an example where delayed primary closure may be required. Primary closure may occur up to 7 days after cleansing or debridement of the wound bed and where infection is adequately treated.

Factors affecting wound healing A myriad of factors can slow down or impair healing notwithstanding age, illness, complex disease processes, medications, psychological or social factors, or a combination of any of these. Any condition that reduces perfusion to the wound bed will impair healing for example vascular disease (arterial disease or chronic venous insufficiency) and chronic airways disease (e.g. emphysema, asthma or lung cancer) while rheumatoid arthritis, diabetes and age impact wound healing through altered cellular mechanisms involved in the healing process. The peri-operative period,

surgical procedure and post-operative pain in particular can create stress and anxiety which induce physiological responses that interfere with healing processes. Similarly, psychosocial factors such as the lack of social and family support networks, loss of independence, depression and poverty initiate the same stress responses that delay healing. Locally wound characteristics also influence reparative processes. Tissue type, infection and inflammation, moisture balance, wound edges, wound temperature and the capacity of the microcirculation to deliver oxygen to the wound bed and surrounding tissues all impact on healing.

The wound healing process Regardless of the type of wound the same basic physiological principles apply to how wounds heal. Generally there are three stages in the wound healing process although some authors tend to separate haemostasis and inflammation. The wound healing occurs though a continuum and comprises haemostasis, inflammation, proliferation and maturation (or remodelling). 2,3 Immediately post injury blood vessels at the site of the injury will firstly constrict to reduce blood flow to the area.2,3 Collagen fibres are exposed at the site of damaged vascular tissue which trap platelets, which in turn release chemicals that make nearby platelets sticky and clump together to form a platelet plug resulting in clot formation.2,3 The inflammatory phase occurs simultaneously where vasoconstriction is followed by vasodilation increasing blood flow to the damaged site with an influx of macrophages and neutrophils which begin to clean the wound

removing debris, bacteria, damaged cells and devitalised tissue readying the site for the next stage of healing. 2 The inflammatory phase is characterised by the cardinal signs heat, pain, redness and swelling and usually will lasts from zero to three days depending on the nature of the wound and other patient characteristics but will continue until the wound bed has been adequately prepared for the next stage of the healing, the proliferative phase.

The proliferative phase usually occurs from between three days to approximately three weeks (again depending on the nature of the wound and patient factors that may limit healing). 2,3 It is during this phase that new blood vessels are created (angiogenesis) and new tissue in the form of extra cellular matrix, primarily composed of collagen and elastin, is produced to fill the wound cavity over which new skin will grow (epithelialisation).2,3 Collagen and elastin together provide tensile strength and elasticity to newly formed skin.2,3 Once the wound is repaired the final phase of wound healing, the maturation phase begins.2,3 This phase, lasting up to two years involves wound contraction and remodelling of newly formed collagen to produce scar tissue. 2.3 Remember it is during this phase the wound remain vulnerable to breakdown though repeated insult especially wounds healing by secondary intention such as dehisced wounds, pressure ulcers, diabetic foot ulcers and leg ulcers and subsequently should be protected at all times.

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 18 | Page 21

Superannuation delay Number of nurses andshortmidwives changes nurses and midwives job hunting escalates

A

ustralia’s ageing nursing and midwifery

New figures reveal the number of nurses workforcesearching will retire much poorer as a result and midwives for work in Australia has of the Federal Government’s decision to postjumped 86 per cent in just a year. poneThe compulsory superannuation latest Australian Institute increases, of Health acand cording the Australian Nursing and Welfare to (AIHW) report, Nursing and Midwifery Midwifery Federation (ANMF).

Workforce 2013, shows of the 317,988 registered nurses andassistant midwives, more secretary than 8100Annie were lookANMF federal Butingsaid for anurses job in and 2013, up from 4365 ler midwives, whereina 2012. major porTheaged report shows there a to total of tion are in their 40s and 50swere and set retire 344,190 registered nurses and midwives, with in the next decade, will be among those hardest 317,988 workforce. hit under in thethe changes.

Of those, 8151is were “Our workforce 90 perlooking cent for work, 266,509 were working as clinicians and 29,520 female, they’re disadvantaged were working in non-clinician roles, while 13,808 in every possible way and were on extended leave. our very expert clinical Queensland Nurses’ Union secretary Beth nurses and those at Mohle said the increasing number of nurses and higher registered nurse midwives searching for employment came as no levels have reasonsurprise. able Ms earning capacity Mohle said almost 1800 full-time equivabut a vast bulk of ourpositions have been cut in lent (FTE) nursing workforce part of Queenslandis alone while the state is also grapthe work- number of unemployed plinglower withpaid a growing graduate force, so nurses. this is going the first ever, our members are fearto hit“For them verytime hard,” ing for their job security - it’s the biggest issue for she said. them right now,” she said.

“They tend to be in the “Is itwhere any wonder there are sectors bargaining overpeople looking for jobs when there have been jobs massively cut things like superannuation can be from the public sector?” particularly difficult, like in aged care.

Ms Mohle said workforce planning is need“They have been planning under the certain ed to offset the predicted looming shortage assumption that this is how it’s going to work of nurses.“We need to be taking on more new for them and now that’s been removed, so that graduates because we need to be planning for means that what they’ve planned for the next 10 the tsunami of retirement that’s going to be hitting to yearswith could affected.” us15 soon, thebe ageing nursing and midwifery Ms Butler some nurses and midwives workforce,” shesaid said. are still reelingisfrom the at impact of theas Global Fi“Nobody looking workforce an issue nancial Crisis. that should be invested in, they are only looking at already had examples of people who it as“We’ve a bottom line cost.

even now can’t retire or aren’t going part-time Page 22 | www.ncah.com.au when they’ve reached maybe over 50 or 55 be-

cause of the impact on their super,” she said.

“Until we change the thinking about that we “We’re very concerned that nurses are going are going to continue to see really troubling data to be forced to continue working to well like this, so this is really quite significant.”over 70 because can’tshows affordthe to retire.”

The they AIHWjust report number of nursMs Butler saidincreased the superannuation es and midwives in five of thefreeze eight combined the proposed changes in pension states andwith territories from 2009 to 2013, with the largest increase in Western Australia, at 8.5 per indexation will result in a 25 per cent reduction in cent, and the greatest dropfor in the Northern Terrioverall retirement incomes nurses and midtory, aton 8.3 per cent. wives, average earnings, now aged 45.

It also reveals very remote have the “If we look at our lower paid areas workers in the greatest number of nurses and midwives, with aged care industry, maybe more an assis1264 FTE nurses and midwives peotant-in-nursing (AIN)per or 100,000 care worker ple in very remote areas. level, the affects to them could In comparison, major cities have the largest be that they’re just forced number of doctors with 426 FTE medical practionto welfare,” she said. tioners per 100,000 people, while there are 1111 “We don’t know FTE nurses and midwives per 100,000 people in what’s going to hapouter regional areas. pen with The figures show the total number pensions of nurses weincreased know and midwives registered exactly, in Australia they are going to be from 320,982 in 2009 to 344,190 last year, alongmade more difficult side a 35 per cent fall in the number of midwives. to access, we’re “This is likely to be related to manysodual registered nurse/midwives concerned not activelyabout working driv-in midwifery and, therefore, being into ablecircumto meet ingnot people a recency of practice standard,” it states. stances of disadvantage The number of and registered nurses rose 9.8 per poverty. cent in 2013 while the number enrolled nurses “That is a of real concern for dropped 3.9 per cent. some elements of our members.”

The workforce snapshot shows almost 90 The government has announced the compulper cent of nurses and midwives are female, and sory superannuation contribution that employers the average age of the workforce was 44. make for their workers will now remain at 9.5 per The 60-64 age group of nurses and midwives cent until 2021, when it will gradually begin to rise has more than doubled from 9592 in 2003 to towards per cent, of rising per 22,658 in122013, whileinstead the 65 and over to age12group cent by 2019-20. has almost tripled in size from 3288 to 9151.

The freeze comes amid Moresuperannuation than 2600 nurses and midwives idenANMF concerns the government’s proposal to tified as an Aboriginal or Torres Strait Islander, deregulate university the cost of a representing 0.9 per fees centwill of drive the workforce who nursing degree to $100,000. provided their Indigenous status.

“Our concern is not just about the fact that we are going to see perhaps impossible fees

414-029 418-024 417-030 415-032 1PG FULL COLOUR CMYK PDF 416-018 for nurses, we won’t see any people from lower socio-economic backgrounds be able to access nursing or midwifery,” Ms Butler said.

“They will never be able to pay off that debt because they just don’t have the incomes potentially to support it.”

Ms Butler said deregulation could also result in some universities moving to withdraw their cost-intensive nursing courses.

“Some years ago it was determined by the government that nursing and education were dedicated priority areas - we had public universities who were required to make sure that they service the public good, so things like nursing and midwifery is one of those areas,” she said.

“The government has systematically withdrawn funding from the tertiary sector over the last decade…so for universities to be able to function and make their money, even just to survive, they are going to be chasing income rather than making sure that they serve their obligation to theNCAH community. is looking to hire expert nurses and midwives to “Universities seeking income could just withwrite nurse practice related articles on a freelance basis. draw entirely from wanting to even offer nursing courses - that is a real concern.”

If you are an experienced Australian nurse educator or nurse specialist, Ms Butler said the federation is calling on all and you are interested in writing to complement your income on a very Senators to oppose the Higher Education and flexible basis we would love to hear from you.

Research Reform Amendment Bill 2014, as it moves into the Senate, where it is expected to be Nursing and Midwifery experts are sought to write articles covering one considered in October. or more clinical areas including but not limited to: She said the ANMF’s Lies, Cuts and Broken Promises campaign & has now reached 5000 sup• Accident Emergency • Critical Care porters• and will continue to take a stand against Aged Care • Cardiac Care the government’s health care cuts.

• Paediatric Nursing • Continence “We want to keep track keep not just the • Healthcare IT & and Information • Neurology government but all of&the parties and the cross• Midwifery Neonatal nursing • Practice nursing benchers accountable,” she said.

• Nurse Leadership and Management “We are going to keep a mechanism of what these Please people have before they got into their to careers@ncah.com.au sendsaid expressions of interest position and now what they are doing.a CV and covering letter detailing your Applications must include “We want to keep track of every broken professional experience. promise that we see.”

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Nursing Careers Allied Health - Issue 18 | Page 27

Better health training needed to prevent suicide Improved training for health professionals will work to make an impact on Australia’s suicide rates, according to SANE Australia.

The national mental health charity states most health professionals, including psychologists and GPs, do not receive specific training about suicide with on-the-job training usually focusing on risk assessment tools or crisis intervention.

“Most health professionals rely on suicide risk assessment tools that ask people about whether they are having suicidal thoughts and if they have made a plan to act,” it said in a statement.

“These tools are extremely poor at predicting suicide with the majority of people who go on to take their life being assessed as at low risk.

“There is a serious lack of education about how to prevent a suicidal crisis, or how to talk to people about their suicidal feelings.”

SANE Australia CEO Jack Heath said improved training, a better understanding of suicide attempts and a national effort to reduce the stigma surrounding suicide could make a real impact on the nation’s suicide rates.

“While it is an extremely complex issue, we must always remember that suicide is preventable,” he said.

“In particular, we need to understand better the experiences of people who have attempted suicide.

Page 28 | www.ncah.com.au

“We know that many people’s main motivation for attempting to take their own life is to put an end to what they feel is an unbearable pain and sense of hopelessness.”

The statement, to mark World Suicide Prevention Day on September 10, comes as the latest Australian Bureau of Statistics figures show Australia experienced the highest suicide rate in 10 years in 2012, with 2535 lives lost to suicide.

The recently released World Health Organisation (WHO) report, Preventing Suicide: A Global Imperative, shows more than 800,000 people commit suicide every year - which equates to around one person every 40 seconds.

The report, WHO’s first global report on suicide prevention, shows 75 per cent of suicides occur in low to middle-income countries.

“This report is a call for action to address a large public health problem which has been shrouded in taboo for far too long,” WHO director-general Dr Margaret Chan said in a statement.

SANE, a founding member of the National Suicide Prevention Coalition, said it’s vital to train GPs to detect suicidal thoughts and behaviours with statistics showing 80 per cent of people who commit suicide visit their doctor in the weeks leading up to their death.

The organisation recently released research that shows well-presenting people who have survived a suicide attempt have encountered dismissive and negative attitudes in the health sector.

The research, conducted with the University of England, found judgemental attitudes still exist among some allied health professionals, nurses and doctors when it comes to treating people who have attempted suicide.

For help with suicide prevention call Lifeline on 13 11 14, Suicide Call Back Service on 1300 659 467 and SANE Australia Helpline on 1800 18 7263

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Opportunity.Experience.Lifestyle.

Executive Director of Nursing and Midwifery Location: Office of the Chief Executive, Townsville, Townsville Hospital and Health Service (THHS).

Looking for a change? Do you want to enjoy the benefits of stable employment combined with occasional travel? Do you want an attractive salary yet still enjoy work/lifestyle balance… Make the move to North Queensland today.

Why make the move? Townsville is the largest urban centre north of the Sunshine Coast, yet offers a relaxed tropical/coastal lifestyle as the gateway to the Great Barrier Reef. Enjoy local attractions such as beaches, rivers, wetlands and national parks whilst benefiting from all the conveniences of city living — culture, fine dining, and bustling nightlife.

Salary details: Remuneration value up to $214 694 p.a., comprising salary rate: $188 169 p.a., employer contribution to superannuation (up to 12.75%) and annual leave loading (17.5%), plus motor vehicle allowance (Nurse Grade 12 [1]).

Duties / Abilities: Advocate for modern, safe, high quality, patient centred care, provide professional nursing and midwifery leadership and develop the THHS as the employer of choice for excellent nurses and midwives.

Enquiries: Mrs Julia Squire (07) 4433 0072.

Job Ad Reference: TV142126.

Application Kit: www.smartjobs.qld.gov.au or (07) 4750 6771 Closing Date: Monday, 29 September 2014 (applications will remain current for 12 months).

health • care • people Nursing Careers Allied Health - Issue 18 | Page 29

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program

out now!

ACMHN’s 40th International Mental Health Nursing Conference For more information visit

www.acmhn2014.com ACMHN’s 40th International Mental Health Nursing Conference 7-9 October 2014 | Melbourne VIC Honouring the Past, Shaping the Future

Page 30 | www.ncah.com.au

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Nursing in Dubai

intervie ws Mid-oct ober - book t oday!

Benefits on offer:

The Chief Nursing Officer from the American Hospital, Dubai is visiting Australia mid October to interview Nurses in the following positions: rn’s, senior rn’s and nurse Unit Managers. Book your interview today.

✔ Salary paid tax free ✔ Flight paid at beginning and end of contract

This is a great opportunity to earn a tax free salary and work in a cosmopolitan city with almost 365 days sunshine! The American Hospital Dubai is a high technology, state of the art, 186 bed, acute care, general medical/surgical hospital.

✔ Annual vacation ticket ✔ 40 days leave (annual leave plus public holidays)

Vacancies in the following areas: Critical Care, Medical/ surgical, oncology, operating room, niCU and rehab

✔ Free accommodation ✔ Free utilities ✔ Uniform provided

To apply please contact AUS Free Phone: 1800 818 844 NZ Free Phone: 0800 700 839 Email: dawn@ccmrecruitment.com.au raquel@ccmrecruitment.com.au Find us on facebook CcmAustralasia

Nursing Careers Allied Health - Issue 18

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POSTAGE PAID AUSTRALIA

Seabreeze Communications Pty Ltd (ABN 29 071 328 053) PO Box 6744, Melbourne, VIC 3004

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CHANGE OF ADDRESS: If the information on this mail label is incorrect, please email careers@ncah.com.au with the address that is currently shown and your correct address.

OUM’s innovative teaching style is fantastic and exciting.

Truly foreword thinking, OUM allows the student to benefit from both local and international resources.

Brandy Wehinger, RN OUM Class of 2015

RN to MD

Make the dream of becoming a doctor a reality, earn your MD at Oceania University of Medicine. n Attractive fee structure for our Graduate Entry Program. n Over 150 students currently enrolled and over 50 graduates in Australia, New Zealand, Samoa and USA. n Home-based Pre-Clinical Study under top international medical school scholars, using world leading Pre-Clinical, 24/7 online delivery techniques. n Clinical Rotations can be performed locally, Interstate or Internationally. n Receive personalised attention from an Academic Advisor. n OUM Graduates are eligible to sit the AMC exam or NZREX.

Applications are now open for courses starting in January and July - No age restrictions

OCEANIA UNIVERSITY OF MEDICINE INTERNATIONALLY ACCREDITED For information visit www.RN2MD.org or 1300 665 343

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