Ncah issue 23 2014 by Seabreeze Communications

Issue 23 24/11/14 fortnightly

Regional & Remote Feature Nursing with the Royal Flying Doctor Service Nurses take Robin Hood tax to G20 summit Jobs forecast in nursing, midwifery and allied health Seize the Day-Laughter in Oncology

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Nursing Careers Allied Health - Issue 23 | Page 3

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www.ncah.com.au www.ncah.com.au )SSUE p !UGUST Issue 23 24January November 2014 1 ––20 2014 )SSUE p !UGUST

We hope you enjoy perusing the range of opportunities We hope you enjoy perusing included in Issue 17, 2013. the range of opportunities 23,2014. 2014. 1, included in Issue 17, 2013. If you are interested in pursuing any of these opportunities, Ifplease you are interested in pursuing any ofvia these contact the advertiser directly the opportunities, contact details please contact the advertiser directly via the details provided. If you have any queries about ourcontact publication or provided. If you any queries about ourplease publication if you would likehave to receive our publication, emailor us ifatyou would like to receive our publication, please email us careers@ncah.com.au at careers@ncah.com.au

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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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Nursing Careers Allied Health - Issue 23 | Page 5

Mental Assessments sign Aussie Health health professionals using Bio-Psycho-Socialup foraEbola response Cultural Model By Karen Keast By Glynis Thorp More than a thousand health professionals have applied to join the Australian Govpatient’s mental health be evaluated ernment’s response to thecan Ebola epidemic in in two dimensions: West Africa. 1) Health The absence mental illness, and Medical, care ofprovider Aspen 2) Theispresence of a well-adjusted individual which coordinating the provision of a 100-bed Treatment Unit (ETU) in Siwho is ableEbola to participate in society. erraA Leone, said there’sofbeen a “significant holistic assessment a patient response” from nurses and docmust consider a Australia’s range of factorsinwith moretheir than 700 of the 1000-plus tors assessing mental applicants invited to the next stage of the health, not just in terms application process. of whether or not the A spokesperson for Aspen Medical said patient is displaying a broad spectrum of health professionsymptoms of a mental als, such as nurses and doctors, alongside illness, but also with health care sector administration/IT and acleaning view to workers assessing will join the response.

He said the first deployment will be sent within weeks after volunteers complete a threelevels can also cause confusion medication day deployment training exerciseand in Australia with toxicity can lead to an impaired mental state.in another two-weeks of training set to take place Diabetes has been linked with depression. Other Sierra Leone. contributing factors to depression sleepis The Canberra-based medicalinclude company taking expressions of interest from disturbances and obesity, which canhealth causeprofessleep sionals wanting apnea. to join the Ebola frontline and, at this stage, there isPsychological no cut-off date for applications. The patient’s develop“This is a rolling project, we will be looking mental history must be for applicants on an ongoing basis,” the spokesconsidered. Have there person said.

been any previous diagnoses? Is there a history of trauma that the perFor the full articlecould visit affect NCAH.com.au son’s mental state either recently or long term? Is the person cognitively impaired?

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other factors that could give rise to concerns about depression and/or anxiety. inno�ative OUM’s Factors teaching that nursesstyle is should consider in performfantastic and exciting. ing a mental health assessTruly foreword thinking, ment include:

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24/7 online delivery techniques. Brandy Wehinger, RN is a good health is of prime importance. Some of the com Clinicalhierarchy Rotations of canneeds be performed locally,starting Interstatepoint or to OUM Class of 2015 determine if someone’s social factors could be monly known conditions that can affect mentalInternationally. Receive personalised from an Academic Advisor. affecting their attention mental health. state include thyroid function abnormalities, vita OUM Graduates are eligible to sit the AMC exam or NZREX. min deficiencies e.g. B12 in the elderly causing Cultural fatigue, lack of appetite and weight loss, apathy Applications are now openespecially for coursesin starting in JanuaryCultural and July background - No age restrictions is a major determinant and depression. Infections, the elof beliefs, morals, customs and consequently our derly, can be responsible for confusion e.g. UTIs. behaviour. It is important to know that different It is thought that low levels of vitamin D may also cultures health differently. INTERNATIONALLY ACCREDITED Fordeinformation visitdefine www.RN2MD.org or 1300Anglo-Celtic 665 343 cause confusion in the elderly and possible culture classifies health and illness into different pression in persons of all ages. Low blood sugar

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406-010 405-013 1PG FULL COLOUR CMYK PDF 404-011 402-036 323-022 1PG FULL COLOUR CMYK PDF 401-003 321-014 1320-006 1PG FULL COLOUR CMYK PDF (RPT) 407-013 324-020 322-035 403-015 423-007 419-006 417-007 409-012 412-005 420-005 415-007 413-010 411-011 414-005 408-007 422-005 418-004 416-004 421-007 specific categories; however it is important to know that some cultures find this very strange. Health can be defined very broadly, in a way that does not distinguish between physical and mental health, but also may not distinguish between an individual’s health and that of the community in which that individual lives, or indeed the relationship to their land and surroundings. All practitioners must practise in a culturally sensitive manner and this involves having an understanding of the issues and beliefs of culturally diverse patients who may come to you for care and help. Appearance What distinctive features does the client have?Describe and assess the patient’s clothing for its appropriateness to the current weather and situation. Assess their level of grooming and hygiene and their cultural appropriateness.Do these considerations give rise to any concerns that may require further investigation? Behaviour Consider the client’sbehavioural style, their eye contact (knowing this may vary culturally), psychomotor behavior including agitation, and any inappropriate or unusual behavior. Conversation Evaluate both the content of the conversation, as well as the form - which includes the rate of the conversation, as well as logic and thought processes. Are there any abnormalities involving speech? What is the rate and volume of their speech? Is it logical? Is it tangential? Is it sparse? Mood Mood descriptors are many and varied. Some key questions or considerations include: can they concentrate and do they get enjoyment from activities? Do they have an appetite? How is their sleep? Do they have trouble getting off to sleep or do they have a problem waking up too early?

Perceptions Assess any dissociative symptoms e.g. derealization, depersonalization.If any dissociative symptoms are prevalent, is the patient ‘aware’ that the way they perceive their surroundings is abnormal? Note any psychotic symptoms or other perceptual abnormalities including hallucinations and delusions. These perceptual abnormalities can occur in any of the five senses. Cognition Describe orientation, memory and attention, or ability to concentrate. The Mini Mental State Examination MMSE is an excellent and brief cognitive assessment that can be performed by most clinicians in three to five minutes. There are apps available that will assist with this or it can be performed on paper. Insight and Judgment This is important, especially regarding any safety issues. Does the patient acknowledge a possible mental health problem? Does the client understand the possible treatment options? What is their ability to identify potentially pathological events (e.g. suicidal impulses and hallucinations)? Judgment refers to a person’s problem solving abilities. Often the answers to this component of the MMSE will determine what actions as an assessor you need to take or offer. In closing, utilizing collaborative evidence when performing mental health assessments is essential. When conducting any assessment on a patient or client it is important to consider the range of factors that could have a bearing on the patient’s mental health. Treating the whole individual will result in better outcomes for them and their family and community.

For more articles visit NCAH.com.au Nursing Careers Allied Health - Issue 23 | Page 7

Nurses take Robin Hood tax to G20 summit Nurses and midwives have ramped up calls for the introduction of a ‘Robin Hood tax’ in Australia to fund a multi-billion-dollar safeguard for public health care services. The Queensland Nurses’ Union (QNU) joined forces with the New South Wales Nurses and Midwives’ Association (NSWNMA) to propose the new tax measure as world leaders gathered for the G20 summit in Brisbane. The tax, also known as the Financial Transaction Tax (FTT), is a levy of about five cents for every $100 traded, imposed on banks and other financial institutions each time they make a transaction while trading stocks, bonds, derivatives, futures, options and credit default swaps. The unions say the tax reform measure, which is needed in Australia and around the globe, would raise essential funds to preserve Australia’s worldclass universal health care system and would also fund education, assist in the global fight against poverty and AIDS, and help tackle climate change. The NSWNMA launched a road tour to Brisbane with other unions and organisations, hosting local forums and raising support along the way as part of its ‘Bring the Robin Hood tax to Australia’ campaign. The QNU ran a television advertisement campaign throughout the G20 that aimed to target Prime Minister Tony Abbott and other world leaders. QNU secretary Beth Mohle said universal health care should be on the agenda at the economic summit. “What’s important to people is that they have access to health care when they need it, not based on their capacity to pay,” she said. “What we will see around the world, as the current Ebola crisis points out to us, is our global health system is only as strong as the weakest of our health systems.

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“It’s a really potent argument for the importance of universal health care and that it should be the role of all governments around the world to provide universal health care to their citizens. “What are you growing your economy for if it’s not to create a fairer society? “We run economies for people and we need to not lose focus on that.” Ms Mohle said a number of G20 countries have already embraced the Robin Hood tax, including the European Union, South Africa, Japan, Russia, Italy, Germany and France, with the tax raising $38 billion across 40 countries in 2011. “We need to be opening up debate not only about a financial transaction tax but also ensuring that transnational corporations are all paying their fair share of tax too,” she said. “In 2008, we all bailed out, as citizens, the whole of the global financial market when it melted down. “We paid the price for their failings not only through the government bail outs but also in the losses we made in our superannuation returns which are only just recovering now. “We’ve paid for their failings but it seems we need to be having a debate about how everybody should be contributing to things like universal health care that contribute to a fairer society for all.” Ms Mohle urged nurses and midwives to support the campaign. “These sorts of events might seem very high level and not connected to our daily lives but they are,” she said. “What happens at events like this make a big difference - these are world leaders who are talking about the regulation of financial markets and the regulation of the world economy.

For the full article visit NCAH.com.au

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Nursing Careers Allied Health - Issue 23 | Page 9

Seize the Day-Laughter Jobs forecast in nursing,in Oncology midwifery and allied health By Ellen Rosenfeld

A review of New Zealand’s health workforce points to job opportunities for midwives rural was interviewed for a research positionincoorareas, nurses in advanced practice dinating a randomised controlled trialareas (RCT)and in demand for sonographers MRI technicians. the oncology department ofand a leading metropoliThe Health Workforce New Zealand report, tan hospital. During the job interview the Chief InHealth of the Health Workforce, predicts a devestigators, one of whom headed up the departmandwanted for nurses in cancer aged care, my enment, to know how Icare, would manage doscopy and long-term condition management. emotional reactions when working with patients The report states New Zealand will need to who were very unwell. I replied that I train more nurses by 2017 due to the looming redidn’t know the answer to this tirement of the ageing workforce, with 46 per cent question, but like so many of nurses in March this year aged over 50 - up Australian women, I’d had from 40 per cent in 2009. an early breast cancer “The risk of staff shortages becomes greatdiagnosis myself, and er as the proportion of experienced nurses apso some insight into, proaching retirement increases,” it states. and empathy for, “This is a particular issue in specialty areas people facing canwith the highest average ages, such as palliative cer treatment. I gave care (for which the average age of nurses is 53 careful thought as to years, up from 50 in 2009) and mental heath (for whether and in what which the average age is 51 years).” circumstances I would The report also points to opportunities for divulge my own experimidwives in rural areas and good prospects for ence to trial participants. some allied health professions, including sonogOn balance I decided that it raphers, MRI technicians, dental hygienists and would unprofessional to do dental be therapists. so, whilst not categorically out the theraIt states prospects forruling occupational possibility in particular circumstances. Thiswhile bepists and pharmacists will remain stable havioural research focussed patients’ isjob prospects maywas be limited foron dietitians.

sues,The not demand mine. Theforoncology nurses I observed carers and support workwere at times fiercely protective,is and ers innurturing, the non-regulated health workforce also remarkably patient with labile of papredicted to rise in linethe with theemotions ageing populatients. My the decision their tion and trend seemed for care consonant away fromwith hospitals approach: a practical expression of that ubiqand closer to people’s homes. uitous and over-used “patient-centred The report revealsphrase New Zealand’s nursing care.” workforce has grown steadily in the past five I had pre-conceived notions of what practiswould years from 48,527 in 2011 to 51,387 engage the -minds of people palliaing nurses including 48,390confronting registered nurses, tion and death. nurses Patientsand would pre-occupied 2868 enrolled 129 be nurse practitionwith ers. resolving outstanding issues in their intimate

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It shows Maori and Pacific nurses are underrepresented putting compared the Maori and Pacific relationships, theirto“spiritual houses” in orpatient population all of the district health der and settling theiracross financial affairs. The general boardof(DHB) tenor their regions. days would be inward looking and Overseas-trained nurses engaged make upin26 contemplative.Though patients all per of cent of the nation’s workforce, with just over half these activities at times, I had a great deal to learn. coming from and thewas United One of the Australia great revelations that Kingdom patients while some come from Asia. wanted to really LIVE until they died; to relish the The report also highlights a trend for nurses myriad small joys life has to offer, literto leave the New Zealand workforce when ecoally until their last breath. In parnomic conditions improve. ticular, they savoured humour “Some leave the profession, others seek emand laughter, enjoying my ployment in countries such as Australia, where a life-long habit of satirical shortage of nurses is forecast,” it states. quips and my terrible “This is expected to place further pressure on “Christmas bon-bon” New Zealand’s future supply of nurses.” jokes. We collaborated While the nation’s nursing workforce is ageseriously on the work ing, it’s midwifery workforce is slowly decreasing of the trial, but if I disin age due to an increase in student midwifery covered along the way numbers. that participants were Figures show New Zealand had 3072 pracreceptive, that work tising midwives in March 2013, up from 2823 in was leavened with a solid 2009. dash of humour. Geoffrey,* a New Zealand had 23,966 practising allied lovely man with stomach canhealth professionals spanning 20 professions in cer dietitians, with whom169 I’d MRI worked for over 2013, with 555 technicians, 18 months, had been delivered devastat2296 occupational therapists, 661 optometrists, ing prognostic news the dayphysiotherapists, before I visited him 3351 pharmacists, 4265 538 on the ward. Though mosttherapists. of life’s unpsychotherapists andI feel 348 that radiation expected crashdown on our (NZNO) heads New catastrophes Zealand Nurses Organisation without warning like a giant Monty Python Trim boot,laI professional services manager Susanne was cross with in theplanning universe.for Tothe dieimpending relatively young belled delays nursfrom stomach as cancer, the prevalence of which has ing shortage “worrying”. been“We steadily declining the last century seemed identified the in urgent need to address the so unfair. “Geoff,” I said, “What can I do forsaid. you pending crisis a number of years ago,” she now?“The I’ll do anything” fromtwo theyears’ pashortage will (wicked occur ingrin a mere tient) time.“within reason.” There was a slight pause as Geoff feigned a serious response, followed by a smile that illuminated his face. “OK then, give me one of your reallyfull stupid jokes.” For the article visit NCAH.com.au

423-013 1/2PG FULL COLOUR CMYK PDF They give a brief overview of the mass of reElizabeth, a brilliant, articulate, opinionated search about the importance of humour in health woman in her early 40s had the great misforcare relationships, observing that â&#x20AC;&#x153;despite varitune to be diagnosed with two discrete cancers, ability in settings and approaches, findings condiscovered on investigation after trauma sheâ&#x20AC;&#x2122;d sistently identify the importance of humour as a sustained in an accident. She was gifted and means of enabling communication, fostering refeisty, without a smidgeon of â&#x20AC;&#x153;Why me?â&#x20AC;? Elizalationships, easing tension, and managing emobeth promised to puke violently on anyone who tionsâ&#x20AC;?healthcare (Kinsman professionals Dean and Gregory, the experts recruiting specialist within 2004,p.140). usedWe theare phrase â&#x20AC;&#x153;cancerinjourney;â&#x20AC;? orsenior calledand her a hospital and medical settings. FromShe specialist to Clinical Managers, The authors identify threeNursing primary functions of â&#x20AC;&#x153;cancer suffererâ&#x20AC;? or â&#x20AC;&#x153;cancer survivor.â&#x20AC;? con- Nurses Directors, Social Workers, allied health and executive management, weâ&#x20AC;&#x2122;ll use our expertise humour in their palliative care study: to build residered the former invoked pity, an emotion she to help you ďŹ nd your next career opportunity or an exceptional employee for your team. lationships, to contend with circumstances, and loathed, and the latter battles and heroics, neither As experts in healthcare recruitment, we have the and sensibility. Their notion of humour tolocal express of which she aspired to. She worked part-time national networks, international presence, track record and as â&#x20AC;&#x153;energisingâ&#x20AC;? or life-affirming resonates with and technical pursued understanding her intellectual to passions becomeuntil yourmerecruitment partner my oncology experience: sharing crazy satirical and create valuable relationships. tastases precluded both.long-term Elizabeth had cherished stories and falling about laughing was a joyous, a formidable of the language. To speak command conďŹ dentially to English a dedicated Healthcare Recruiting â&#x20AC;&#x153;normalâ&#x20AC;? part of life: a way for patients in my trial Nevertheless fishing Expert in she yourlampooned local area, her contact usexpediat ausHH@hays.com.au 1800 805 nouns, 051. her nominal aphasia the to express the currency of their lives. It was as if tionsorfor elusive they were saying: â&#x20AC;&#x153;Donâ&#x20AC;&#x2122;t treat me like Iâ&#x20AC;&#x2122;m leaving subject of endless satire. Through treatment and the world! Iâ&#x20AC;&#x2122;m here now, enjoying life NOW.â&#x20AC;? Our disease progression her engaging and acerbic hays.com.au banter affirmed the uniqueness of each patient spirit remained intact. who laughed with me. Elizabeth enjoyed pithy, I was impressed by the skill and humanity of slightly acid phrases. Eddie, a 70 year old from the departmentâ&#x20AC;&#x2122;s palliative care team. Like some the bush, was a fine raconteur and a master of other patients at the end of their lives , howevthe deadpan resolution. Sharing humour was, as er,UNIQUE Elizabeth viewed palliation and hospices asFOR OPPORTUNITY REGISTERED NURSES Kinsman Dean and Gregory (2004) describe, an anathema, and was determined to stay at home Are you a self-motivated registered nurse acknowledgement of personhood. for as long as possible. I was on the ward when searching for work/life balance? she was admitted, having had seizures at home. Are you an ICU, ED, recovery, HITH, or even remote *Pseudonyms are used for patients. She wassearching febrile and to death. shefit in nurse forclearly a wayclose to earn income,Asand was beingyour transferred to a bed, she opened her around existing lifestyle? eyes. With provides an archHealth of theServices eyebrow she gave me Lifescreen to the Insurance Industry, andlast Clinical Services for several pharmaceutical companies. one sardonic look. â&#x20AC;&#x153;Oh, itâ&#x20AC;&#x2122;s you againâ&#x20AC;Ś.â&#x20AC;?she We are looking for nurses to join our expanding operations to said, her community-based habitual greeting of thefor prior years. provide services our two clients. There is a substantial body of research in Lifescreen can offer you: To be considered for a role a s wide range of clinical areas, including oncolas a nurse contractor for %XTRA Lifescreen you must have the ogy, which demonstrates the physiological, psys 7ORK LIFE BALANCE Leave a comment on this and other following: chological and sociological benefits of laughter. s #ONTINUITY OF PATIENT CARE articles by visiting the â&#x20AC;&#x2DC;newsâ&#x20AC;&#x2122; s 2EGISTERED NURSE WITH Laughter can result in an increase in experience heart rate, years s *OB SATISFACTION section of our website respiratory rate, and oxygen consumption, then Forhttp://www.ncah.com.au enquiries or to apply, please call s !USTRALIAN #ITIZEN s #ERTIl ED #02 ANAPHYLAXIS training provided and at no decreases cost s !". muscle relaxation, in heart rate, 1800 673 123 or send your resume to you respiratory rate and blood pressure. evaluations@lifescreen.com.au Totogo to this article directly, visit s #ANNULATION COMPETENT Researchers Kinsman Dean and Gregory http://tinyurl.com/lblzlbj s 3TRONG WRITTEN AND VERBAL communicationreskills (2004) conducted clinical ethnographic s /WN CAR AND MOBILE PHONE search in a 30-bed palliative care inpatient unit about the functions of humour and laughter.

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Nursing Careers Allied Health - Issue 23 | Page 11

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Home Based Nursing Services Manager We are seeking an enthusiastic and experienced Nurse to manage and lead our home based nursing services. Services include Residential In Reach, Hospital In The Home, District Nursing Service and Community Palliative Care. For more information contact: Bernadette Hammond, Director of Nursing, Midwifery and Aged Care on 03 5150 3423

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Nursing Careers Allied Health - Issue 23 | Page 13

Nursing with the Royal Flying Doctor Service

mergency and flight nursing are the loves of Judy Whitehead’s professional life. “I can’t imagine doing anything else,” she says. “I like the autonomous role as well as the challenges of dealing with patients as an isolated practitioner. “We are also caring for patients in a mobile and sometimes hostile environment because we are at the mercy of the weather - whether it is due to winter cold, rain and storms or heat turbulence in summer.” Judy has worked for the RFDS for 23 of the 30-plus years she has spent in nursing, and she is also the president of Flight Nurses Australia. As a flight nurse, Judy has worked at Port Augusta, Alice Springs and Adelaide and is now the nurse manager at the RFDS south eastern section, an area that covers 640,000 square kilometres across rural and remote New South Wales, including Dubbo, the Cooper Basin oil and gas fields in north eastern South Australia, and south west Queensland. Based at Broken Hill, Judy’s role includes coordinating health quality for the section and she maintains roster capability across all bases. Judy says aero-medical nursing covers the entire life span from birthing babies to end of life care. “We see a broad range of patients and conditions such as medical and palliative care patients to critical care and trauma patients and obviously there’s the occasional baby as well, which is lovely,” she says.

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“Our emergency work is about giving short interventions of high quality care.” The work involves both inter-hospital transfers as well as primary response. “In our situation, probably the maximum time we have someone on board is maybe two hours however if patients need to be stabilised we can be with them for much longer periods, we could be working at a roadside, a station kitchen or bedroom, to a small community clinic or hospital.” First established in 1928 as the Australian Inland Mission Aerial Medical Service in Cloncurry, Queensland, the RFDS is now renowned as one of the largest and most comprehensive aero-medical organisations in the world. The not-for-profit organisation employs about 1100 staff at 22 RFDS bases, five RFDS health facilities and 10 other facilities across Australia. The majority of nurses working at the RFDS are flight nurses with the retrieval services. Flight nurses are highly qualified in areas of critical care, such as emergency and intensive care, and are also certified midwives. The organisation also employs nurses, ranging from mental health nurses to practice nurses and nurse practitioners, for its primary health care services . Linda Cutler, health services general manager with the RFDS south eastern section, says the organisation offers midwifery scholarships for nurses with a critical care background wanting to move into flight nursing.

Ms Cutler says the RFDS has attractive remuneration packages, with not-for-profit sector tax benefits, and covers a part of nurses’ relocation expenses while the service also offers some study leave. She says alongside the employment benefits, most nurses thrive on the diversity of practice. “I think it is attractive to people who have the confidence to be a sole practitioner because it is that type of practice - you are the flight nurse on the aircraft and a large number of our retrievals we do flight nurse only retrievals,” she says. “The medical officers go at certain levels of acuity but the flight nurses often go on their own. “The thing that I get back from my flight nurses is that they feel they really make a difference, they offer a service to people who in times of need just couldn’t access it any other way. “They really do get a lot of satisfaction out of making that difference.” Judy, who was this year awarded the CRANAplus Aurora Award for outstanding contribution to remote health, says flight nursing enables nurses to take in some incredible sights of Australia. “In an aircraft, we can cover huge distances in a single shift, so we have got ever-changing views out of our office window, which can be very spectacular,” she says. Aside from caring for patients, Judy says flight nurses also have to deal with issues that affect the planes, from weather to wildlife. “Everything is about safety,” she says. “We always have issues with weather. I’ve been in an aircraft in the Territory where we had fork lighting and fortunately it was some distance from the plane. “It was very spectacular but not good weather to be flying in because obviously we don’t want a lighting strike into the engines. “It would hit the ground and you could see a fire start. It was nerve-racking for the pilot but it was very safe.”

Kangaroos, stock and other wildlife can also pose a risk to the planes, particularly during take off at dusk and dawn. “We often have someone there who does a ‘roo run’ to make sure there are no wildlife or stock or anything on or near the runways,” she says. “I’ve been on board when we’ve hit kangaroos and fortunately we had no patient on board. “We normally don’t do things unless they are very safe because not only are our lives very important but we have also got $8 million worth of aircraft there.” Judy says pilots often work with flight nurses as a second set of hands. “I laughingly say that in an emergency when there’s only myself on the aircraft - the last person I want to see at the back with me, when the propellors are running, is the pilot,” she says. “On the ground, I’m more than happy to see them because realistically flight nurses don’t work with our fellow nursing colleagues but you do work with your pilot. “They act as a hunter and gatherer in bringing equipment to you or opening a pack so you can get something that you need. “We can normally get the pilot to document things for us - so we’ve got a time and a drug dose and a drug which you can write up properly later after you’ve stabilised the patient. “They also become very good at crowd control if people are getting a bit close to the aircraft or angry, and they can help lift.” While she relishes the unpredictable nature of the work, Judy says it’s far from glamorous thanks to the extreme temperatures, when the mercury can reach 45 degrees. “The sunblock can be melting off your face and we also have a whole lot of routine checking and cleaning and chores to do because the nurse is actually responsible for the back end of the aircraft.”

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 23 | Page 15

423-009 1PG FULL COLOUR CMYK PDF NAHRLS LOCUM SERVICE

Rural health programme reaches significant milestone

Above pictured from left to right is Glenn Keys - Managing Director of Aspen Medical, Senator The Hon Fiona Nash - Assistant Minister for Health, Ruth Osadebay - NAHRLS 3000th Locum, and Mark Ellis - General Manager Australian Subsidiaries at NAHRLS’ parent company Aspen Medical.

The Government funded Nursing and Allied Health Rural Locum Scheme (NAHRLS) celebrated its 3000th placement at an event at Parliament House last night. The Government funded Nursing and Allied Health Rural Locum Scheme (NAHRLS) celebrated its 3000th placement at an event in Parliament House on Wednesday, 29 October 2014. Since 2011, NAHRLS has been placing nurses, midwives and allied health professionals in remote rural areas across Australia. Over the past year alone, in excess of 200 rural clinics have benefitted from the NAHRLS scheme. Marking this milestone event recognised those who have helped their peers across the country to take time away from their roles for professional development and other reasons.

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Senator The Hon. Fiona Nash, Assistant Minster for Health, presented the NAHRLS 3000th Locum Award to Ruth Osadebay, a registered nurse and midwife, who recently took up a 14 day placement in rural New South Wales. Senator Nash said, “One thing that is absolutely vital is making sure that we get services out to regional areas where they’re needed most and NAHRLS has done a great job in putting health professionals out into those areas to provide health services where they are so important.” Read full article by scanning the QR code or visit nahrls.com.au/news_ and_events

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Be the heart of Barwon Health.

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Nursing Careers Allied Health - Issue 23 | Page 17

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Nursing with the Royal Flying KATHERINE WEST HEALTH BOARD Doctor Service REMOTE AREA NURSES

$91,131 - $97,907 | Positions are available from January 2015.

â&#x20AC;&#x153;Our emergency work is about giving short inmergency and flight nursing are the loves of Katherine West Health Board (Northern Territory) is seeking permanent full time Remote terventions ofhealth highcentres, qualityproviding care.â&#x20AC;?quality health care to Judy Whiteheadâ&#x20AC;&#x2122;s professional Area life. Nurses to work in our remote community individuals, families and communities. Our registered nursing staff work in multi-disciplinary The registered work involves inter-hospital â&#x20AC;&#x153;I canâ&#x20AC;&#x2122;t imagine doing anything else,â&#x20AC;? she remote health teams comprised of GPs, Aboriginalboth Health Practitioners andtransfers administrative support staff. as well as primary response. says. KWHB RANs enjoy a high level professional and practical support visiting time â&#x20AC;&#x153;Inofour situation, probably thefrom maximum â&#x20AC;&#x153;I like the autonomous role asAtwell asour the chalcolleagues such as health program coordinators, a range of corporate services from we have someone on board is maybe two hours lenges of dealing with patients asKatherine an isolated pracstaff, and cultural support from our Aboriginal staff. Furnished accommodation, including phone and electricity subsidies, are provided for RANs based in remote however if patients need to be stabilised we can titioner. communities. be with them for much longer periods, we could â&#x20AC;&#x153;We are also caring for patients in a mobile and KWHB offers an attractive salary package including six weeks annual leave including leave loading, upwe to two weeks development leave, FOILSathree timeskitchen per year (travel be working at a roadside, station or bedsometimes hostile environment because are at professional RXW RI LVRODWHG ODQGV HQWLWOHPHQW D UHORFDWLRQ DOORZDQFH DQG JHQHURXV VDODU\ VDFULÂżFH room, to a small community clinic or the mercy of the weather - whether it is Training opportunities also available. provisions. hospital.â&#x20AC;? due to winter cold, rain and storms For a copy of the position description and selection criteria, please visit our web site Liz Yatesin at 1928 First Manager established or heat turbulence in summer.â&#x20AC;? www.kwhb.com.au - For further information please contact General hr@kwhb.com.au or on 08 8963 6400. as the Australian Inland Judy has worked for To apply for a position, please forward a cover letter and current CV including a minimum of the RFDS for 23 of the two referees to hr@kwhb.com.au - Applications will be actionedMission on receipt. Aerial Medical Service in Cloncurry, 30-plus years she has All employees commencing with KWHB will be required to complete a Criminal Record Clearance and Working With Children clearance (NT Ochre Card).Queensland, Aboriginal peoplethe are RFDS spent in nursing, and encouraged to apply. is now renowned as she is also the presione of the largest and dent of Flight Nurses most comprehensive Australia. aero-medical organisaAs a flight nurse, tions in the world. Judy has worked at The not-for-profit orPort Augusta, Alice ganisation employs about Springs and Adelaide and 1100 staff at 22 RFDS bases, is now the nurse manager at five RFDS health facilities and 10 the RFDS south eastern secother facilities across Australia. tion, an area that covers 640,000 Silver Chain across is one rural of the in Western The majority of nurses Australia working at the square kilometres andlargest remotecommunity health providers Country Services of Silver Chain provides range support RFDS are flight nursesa with the of retrieval services. New(WA). SouthThe Wales, including Dubbo,Division the Cooper services including Nursing, Allied Health, and much more. Flight Assistance nurses are highly qualified in areas of Basin oil and gas fields in north eastern South Aus- Domestic Listed below are the current vacancies within Country Services: critical care, such as emergency and intensive care, tralia, and south west Queensland. areTherapy also certified midwives. Based at -Broken Hill, Judyâ&#x20AC;&#x2122;s roleRegistered includes coorAlbany Physiotherapist, Nurseand and Assistant The organisation also employs nurses, ranging dinating health-quality for the section and she mainBeacon Remote Area Nurse â&#x20AC;&#x201C; Physiotherapist from mental health nurses to practice nurses and tainsBusselton roster capability across all bases. Hyden â&#x20AC;&#x201C; Remote Area Nurse Practitioner (Full Time, with on-call requirements) nurse practitioners, for its primary care serJudy says aero-medical nursing covers the enKalgoorlie/Esperance - Registered and Enrolled Nurses (expressions ofhealth interest) vices . tire life span from birthing Practitioner babies to end of life care. Northam - Nurse Pilbara Case range Co-ordinator Linda Cutler, health services general manager â&#x20AC;&#x153;We see a- broad of patients and condiShark Bay - Remote Area Nurse Practitioner (Part Time, with on-call requirements) with the RFDS south eastern section, says the ortions such as medical and palliative care patients Western Australia - Chronic Disease Co-ordinator, Remote Area Nurse ganisation offers midwifery scholarships for nurses to critical care and trauma patients and obviously If you to make a difference to Australian with a critical care background wanting to move thereâ&#x20AC;&#x2122;s thewant occasional baby as well, which is communities then visit silverchaincareers.org.au today. into flight nursing. lovely,â&#x20AC;? she says.

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YOU CAN MAKE A DIFFERENCE Current Vacancies

Page 18 | www.ncah.com.au

423-020 1PG FULL COLOUR CMYK PDF Ms Cutler says the RFDS has attractive remuneration packages, with not-for-profit sector tax benefits, and covers a part of nurses’ relocation expenses while the service also offers some study leave. She says alongside the employment benefits, most nurses thrive on the diversity of practice. “I think it is attractive to people who have the confidence to be a sole practitioner because it is that type of practice - you are the flight nurse on the aircraft and a large number of our retrievals we do flight nurse only retrievals,” she says. “The medical officers go at certain levels of acuity but the flight nurses often go on their own. “The thing that I get back from my flight nurses is that they feel they really make a difference, they offer a service to people who in times of need just couldn’t access it any other way. “They really do get a lot of satisfaction out of making that difference.” Judy, who was this year awarded the CRANAplus Aurora Award for outstanding contribution to remote health, says flight nursing enables nurses to take in some incredible sights of Australia. “In an aircraft, we can cover huge distances in a single shift, so we have got ever-changing views out of our office window, which can be very spectacular,” she says. Aside from caring for patients, Judy says flight nurses also have to deal with issues that affect the planes, from weather to wildlife. “Everything is about safety,” she says. “We always have issues with weather. I’ve been in an aircraft in the Territory where we had fork lighting and fortunately it was some distance from the plane. “It was very spectacular but not good weather to be flying in because obviously we don’t want a lighting strike into the engines. “It would hit the ground and you could see a fire start. It was nerve-racking for the pilot but it was very safe.”

Geneva

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 23 | Page 19

Leading dietitians recognised By Karen Keast

Queensland dietitian working to help women eat their way to a healthy pregnancy is one of six of the nation’s leading dietitians recently awarded the Advanced Accredited Practising Dietitian (AdvAPD) credential. Dr Susie de Jersey, a senior dietitian nutritionist at the Royal Brisbane and Women’s Hospital and a Visiting Research Fellow at the Queensland University of Technology, has received the Dietitians Association of Australia (DAA) credential. Dr de Jersey joins five newly appointed AdvAPDs including Kim Crawley, a senior nutritionist at Food Standards Australia New Zealand, Phillip Juffs, a dietitian team leader in food service at the Royal Brisbane and Women’s Hospital, Marie-Claire O’Shea, a private practitioner and lecturer at Griffith University, Tania Passingham, a professional services manager at the DAA, and Wendy Swan, a manager in nutrition and dietetics at Goulburn Valley Health and consultant dietitian to Shepparton Private Hospital. The dietitians join almost 100 other dietitians who have previously been awarded the AdvAPD credential which recognises proactive leaders who integrate high-level nutrition and dietetic skills to influence the health of the community. Dr de Jersey, a dietitian of 13 years, specialises in the area of maternal nutrition and chronic disease prevention during the reproductive years, through teaching, mentoring, research and strategic activities.

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She was involved in the New Beginnings Healthy Mothers and Babies study, an observational study examining the nutrition and physical activity behaviours of about 700 pregnant women through the RBWH. In another prospective study of pregnancy weight gain in Australian women, Dr de Jersey and her colleagues found 36 per cent of women gained weight according to guidelines while 26 per cent gained inadequate weight. Thirty-eight per cent gained excess weight while 47 per cent of women at 16 weeks were unsure of their weight gain recommendations. “We found that only a third of women gained weight within the recommendations and those women that started pregnancy already above a healthy weight were much more likely to gain too much weight, which places them and their baby at a greater risk of complications in pregnancy but also being overweight into the future,” she said. “We also found that over 80 per cent of the women wanted education and nutrition advice in their pregnancy but less than 50 per cent were provided with it, and women mostly wanted this information as early as possible in their pregnancy and they wanted it individualised and face to face.

For the full article visit NCAH.com.au

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Nursing Careers Allied Health - Issue 23 | Page 21

Seize the Day-Laughter in Oncology By Ellen Rosenfeld

was interviewed for a research position coordinating a randomised controlled trial (RCT) in the oncology department of a leading metropolitan hospital. During the job interview the Chief Investigators, one of whom headed up the department, wanted to know how I would manage my emotional reactions when working with patients who were very unwell. I replied that I didn’t know the answer to this question, but like so many Australian women, I’d had an early breast cancer diagnosis myself, and so some insight into, and empathy for, people facing cancer treatment. I gave careful thought as to whether and in what circumstances I would divulge my own experience to trial participants. On balance I decided that it would be unprofessional to do so, whilst not categorically ruling out the possibility in particular circumstances. This behavioural research was focussed on patients’ issues, not mine. The oncology nurses I observed were nurturing, at times fiercely protective, and remarkably patient with the labile emotions of patients. My decision seemed consonant with their approach: a practical expression of that ubiquitous and over-used phrase “patient-centred care.” I had pre-conceived notions of what would engage the minds of people confronting palliation and death. Patients would be pre-occupied with resolving outstanding issues in their intimate

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relationships, putting their “spiritual houses” in order and settling their financial affairs. The general tenor of their days would be inward looking and contemplative.Though patients engaged in all of these activities at times, I had a great deal to learn. One of the great revelations was that patients wanted to really LIVE until they died; to relish the myriad small joys life has to offer, literally until their last breath. In particular, they savoured humour and laughter, enjoying my life-long habit of satirical quips and my terrible “Christmas bon-bon” jokes. We collaborated seriously on the work of the trial, but if I discovered along the way that participants were receptive, that work was leavened with a solid dash of humour. Geoffrey,* a lovely man with stomach cancer with whom I’d worked for over 18 months, had been delivered devastating prognostic news the day before I visited him on the ward. Though I feel that most of life’s unexpected catastrophes crashdown on our heads without warning like a giant Monty Python boot, I was cross with the universe. To die relatively young from stomach cancer, the prevalence of which has been steadily declining in the last century seemed so unfair. “Geoff,” I said, “What can I do for you now? I’ll do anything” (wicked grin from the patient) “within reason.” There was a slight pause as Geoff feigned a serious response, followed by a smile that illuminated his face. “OK then, give me one of your really stupid jokes.”

Elizabeth, a brilliant, articulate, opinionated woman in her early 40s had the great misfortune to be diagnosed with two discrete cancers, discovered on investigation after trauma she’d sustained in an accident. She was gifted and feisty, without a smidgeon of “Why me?” Elizabeth promised to puke violently on anyone who used the phrase “cancer journey;” or called her a “cancer sufferer” or “cancer survivor.” She considered the former invoked pity, an emotion she loathed, and the latter battles and heroics, neither of which she aspired to. She worked part-time and pursued her intellectual passions until metastases precluded both. Elizabeth had cherished a formidable command of the English language. Nevertheless she lampooned her fishing expeditions for elusive nouns, her nominal aphasia the subject of endless satire. Through treatment and disease progression her engaging and acerbic spirit remained intact. I was impressed by the skill and humanity of the department’s palliative care team. Like some other patients at the end of their lives , however, Elizabeth viewed palliation and hospices as anathema, and was determined to stay at home for as long as possible. I was on the ward when she was admitted, having had seizures at home. She was febrile and clearly close to death. As she was being transferred to a bed, she opened her eyes. With an arch of the eyebrow she gave me one last sardonic look. “Oh, it’s you again….”she said, her habitual greeting of the prior two years. There is a substantial body of research in a wide range of clinical areas, including oncology, which demonstrates the physiological, psychological and sociological benefits of laughter. Laughter can result in an increase in heart rate, respiratory rate, and oxygen consumption, then muscle relaxation, and decreases in heart rate, respiratory rate and blood pressure. Researchers Kinsman Dean and Gregory (2004) conducted clinical ethnographic research in a 30-bed palliative care inpatient unit about the functions of humour and laughter.

They give a brief overview of the mass of research about the importance of humour in health care relationships, observing that “despite variability in settings and approaches, findings consistently identify the importance of humour as a means of enabling communication, fostering relationships, easing tension, and managing emotions” (Kinsman Dean and Gregory, 2004,p.140). The authors identify three primary functions of humour in their palliative care study: to build relationships, to contend with circumstances, and to express sensibility. Their notion of humour as “energising” or life-affirming resonates with my oncology experience: sharing crazy satirical stories and falling about laughing was a joyous, “normal” part of life: a way for patients in my trial to express the currency of their lives. It was as if they were saying: “Don’t treat me like I’m leaving the world! I’m here now, enjoying life NOW.” Our banter affirmed the uniqueness of each patient who laughed with me. Elizabeth enjoyed pithy, slightly acid phrases. Eddie, a 70 year old from the bush, was a fine raconteur and a master of the deadpan resolution. Sharing humour was, as Kinsman Dean and Gregory (2004) describe, an acknowledgement of personhood. *Pseudonyms are used for patients.

HAVE YOUR SAY Leave a comment on this and other articles by visiting the ‘news’ section of our website http://www.ncah.com.au To go to this article directly, visit http://tinyurl.com/lblzlbj

Nursing Careers Allied Health - Issue 23 | Page 23

Health practitioner notifications on the rise The number of notifications made about nurses and midwives, optometrists, physiotherapists, psychologists, osteopaths and medical radiation practitioners has increased in 2013-14, according to new data from the Australian Health Practitioner Regulation Agency (AHPRA). AHPRA’s 2014 annual report reveals a 16 per cent increase in notifications made against 1.4 per cent of the nation’s 619,509 health practitioners, with 10,047 notifications received in 2013-14 compared with 8648 in 2012-13. The report shows a 26 per cent increase in notifications made about nurses and midwives, with 1900 notifications made about nurses in 2013-14 and 110 lodged about midwives while medical practitioners received the highest number of notifications with 5,585. Pharmacists received 514 notifications, there were 487 about psychologists, 134 were lodged about physiotherapists, 66 about optometrists, 28 about medical radiation practitioners and 11 about osteopaths. More than 950 notifications were made about dental practitioners, 111 about chiropractors, 54 about podiatrists, 43 about occupational therapists, 26 about Chinese medicine practitioners and six notifications made about Aboriginal and Torres Strait Islander health practitioners. Health care entities made almost 30 per cent of the notifications, 34 per cent were received from the community, 10 per cent came from another practitioner and 10 per cent resulted from an employer or hospital. More than 6800 notifications were assessed with no further action required in 2550 cases while disciplinary action was taken in 485 cases. The National Boards took immediate action regarding 474 notifications, with 76 per cent of cases resulting in the practitioner’s registration being restricted as a result.

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Almost 2000 investigations were finalised in 2013-14 with 1469 cases closed after investigation and 468 cases resulting in disciplinary action. There were 473 notifications that continued beyond investigation with 242 moving to a panel hearing and 190 to a tribunal hearing. Of the panel hearings finalised, disciplinary action was taken against more than three quarters of practitioners with restrictions placed on practice in 82 cases, 57 practitioners were cautioned, 26 were reprimanded, two surrendered their registration, and four practitioners had their registration suspended. Tribunal hearings resulted in the practitioner’s registration being cancelled in 12 matters, suspended in 12, surrendered in two, imposed conditions on practice in 25, practitioners accepted undertakings in six cases, and one practitioner was permanently prohibited from undertaking midwifery services. In another 43 cases, one practitioner was cautioned, 35 were reprimanded and seven were fined, while no further action was taken in 14 cases. In 2013-14, AHPRA also conducted 61,000 criminal record checks, with National Boards taking action in 79 cases, resulting in limiting practitioners’ registration. The report also reveals there were 547 advertising-related complaints received and of the 296 cases closed, 98 per cent were resolved when the practitioner or organisation complied with AHPRA’s demand to amend or remove the advertising.

For the full article visit NCAH.com.au

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1800 818 865 une.edu.au/nursing-en Nursing Careers Allied Health - Issue 23 | Page 25

Mental Health Assessments using a Bio-Psycho-SocialCultural Model By Glynis Thorp

patient’s mental health can be evaluated in two dimensions: 1) The absence of mental illness, and 2) The presence of a well-adjusted individual who is able to participate in society. A holistic assessment of a patient must consider a range of factors in assessing their mental health, not just in terms of whether or not the patient is displaying symptoms of a mental illness, but also with a view to assessing other factors that could give rise to concerns about depression and/or anxiety. Factors that nurses should consider in performing a mental health assessment include: Biological The physical health of the patient and the effect this could be having on the client’s mental health is of prime importance. Some of the commonly known conditions that can affect mental state include thyroid function abnormalities, vitamin deficiencies e.g. B12 in the elderly causing fatigue, lack of appetite and weight loss, apathy and depression. Infections, especially in the elderly, can be responsible for confusion e.g. UTIs. It is thought that low levels of vitamin D may also cause confusion in the elderly and possible depression in persons of all ages. Low blood sugar

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levels can also cause confusion and medication toxicity can lead to an impaired mental state. Diabetes has been linked with depression. Other contributing factors to depression include sleep disturbances and obesity, which can cause sleep apnea. Psychological The patient’s developmental history must be considered. Have there been any previous diagnoses? Is there a history of trauma that could affect the person’s mental state either recently or long term? Is the person cognitively impaired? Social factors Social factors alone cannot be responsible for making someone happy or unhappy as the level of satisfaction of individuals can be highly variable. However, it is important to gather information about someone’s circumstances. Maslow’s hierarchy of needs is a good starting point to determine if someone’s social factors could be affecting their mental health. Cultural Cultural background is a major determinant of beliefs, morals, customs and consequently our behaviour. It is important to know that different cultures define health differently. Anglo-Celtic culture classifies health and illness into different

specific categories; however it is important to know that some cultures find this very strange. Health can be defined very broadly, in a way that does not distinguish between physical and mental health, but also may not distinguish between an individual’s health and that of the community in which that individual lives, or indeed the relationship to their land and surroundings. All practitioners must practise in a culturally sensitive manner and this involves having an understanding of the issues and beliefs of culturally diverse patients who may come to you for care and help. Appearance What distinctive features does the client have?Describe and assess the patient’s clothing for its appropriateness to the current weather and situation. Assess their level of grooming and hygiene and their cultural appropriateness.Do these considerations give rise to any concerns that may require further investigation? Behaviour Consider the client’sbehavioural style, their eye contact (knowing this may vary culturally), psychomotor behavior including agitation, and any inappropriate or unusual behavior. Conversation Evaluate both the content of the conversation, as well as the form - which includes the rate of the conversation, as well as logic and thought processes. Are there any abnormalities involving speech? What is the rate and volume of their speech? Is it logical? Is it tangential? Is it sparse? Mood Mood descriptors are many and varied. Some key questions or considerations include: can they concentrate and do they get enjoyment from activities? Do they have an appetite? How is their sleep? Do they have trouble getting off to sleep or do they have a problem waking up too early?

For more articles visit NCAH.com.au Nursing Careers Allied Health - Issue 23 | Page 27

Nurses crucial in transition to palliative care Patients often turn to nurses for emotional support when transitioning from life-prolonging care to palliative care, according to the results of a new Australian study. University of Queensland researchers found nurses are pivotal in decisions about when treatments should end and in supporting patients and their families through the dying process. Researchers interviewed 20 nurses, with most of the nurses working in oncology at several Brisbane hospitals, about their experiences of managing the patient transition to palliative care. The interviews covered the purpose of nursing in the transition to palliative care, talking to patients about palliative care and dying, communicating with families of patients, the emotional toll, doctor-patient communication and interprofessional dynamics. In the study, which was recently published in Qualitative Health Research, nurses discussed caring for the dying as “an opportunity for people to have a good death”. Researchers found while formal conversations were often initiated and conducted by medical staff, nurses took on much of the responsibility of conversing with patients about dying, mortality, questions of hope, and the fear of suffering during the dying process. “The nurses held that it was their skill and responsibility to access what was ‘really going on’ with patients, working through what participants talked about as ‘denial’, ‘pretend positivity’, ‘acting strong for the doctor’, family resistance, and misunderstandings about the meaning of palliative care,” the study states. “Reframing palliative care as something not to be feared was viewed as a key role of the nurses and involved careful consideration and reassuring language.”

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School of Social Science Associate Professor Alex Broom said nurses often bear the brunt of patient and family grief as end of life nears. “The study found that patients would often put on a brave face when their doctor was present and then ask the nurse to tell the doctor they’d had enough,” he said. “This can put the nurse in a difficult position professionally, placing them as mediator between doctor, patient and often panicked family members.” Nurses are also expected to “mop things up” after short and sometimes abrupt interactions between specialists and their patients. In the study, nurses reveal communicating with patients and families was easier when doctors had already spoken openly and honestly with patients about stopping active treatment. “A major problem for nurses is that some doctors avoid difficult conversations; even continuing patients on active treatment, while others were rushed or blunt, leaving the nurse to explain the situation and provide emotional support to patients and their families,” Dr Broom said. Nurses said families were often the most time-intensive and challenging aspect of nursing during the transition. The study found nurses work to help families face the inevitability of medical futility and the need for palliative care, while nurses also view themselves as responsible for dealing with family members’ emotions on the ward. “We have relatives saying - how long is it going to be? She’s been struggling on,” one nurse said in the study. “And then you’d ask the question, like - have you told her it’s okay to let go?”

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