Health Times August 2015 by Seabreeze Communications

August 2015

Education and Critical Care Features + New benchmark set for specialist critical care nurses + The challenges of education for critical care nurses + Midwives support calls for breastfeeding friendly workplaces + Critical care nurse fights to save lives with AEDs

HealthTimes - August 2015 | Page 21

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August 2015 We hope you enjoy perusing the range of opportunities included in this Issue. If you are interested in pursuing any of these opportunities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or would like to receive our publication, please email us at contact@healthtimes.com.au DISTRIBUTION 43,219 The HealthTimes magazine is the most widely distributed national nursing and allied health publication in Australia. For all advertising and production enquiries please contact us by telephone on 1300 306 582, email contact@healthtimes.com.au or visit www.healthtimes.com.au Published by Seabreeze Communications Pty Ltd trading as HealthTimes. ABN 29 071 328 053. ÂŠ 2015 Seabreeze Communications Pty Ltd. All right reserved. No part of this publication may be copied or reproduced by any means without the prior written permission of the publisher. Compliance with the Trade Practices Act 1974 of advertisements contained in this publication is the responsibility of those who submit the advertisement for publication.

Advertiser list Austra Health Australian College of Critical Care Nurses Australian College of Nursing Barwon Health Breast Feeding Conference Careers Australia CCM Recruitment International CQ Nurse Critical Care Education Services First State Super Geneva Health Hays Healthcare Jane Lewis Lifescreen Medacs Australia NSW Health Nurse at Call Oceania University of Medicine Opal Aged Care Pulse Staffing Quick and Easy Finance Royal Flying Doctor Service Smart Salary University of Derby

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HealthTimes - August 2015 | Page 05

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HealthTimes - August 2015 | Page 11

The challenges of education for critical care nurses By David Robertshaw

ritical care is a great place to work as a nurse as it provides a variety of challenges and is very diverse – meaning every day is different. It is one of the largest nursing specialties across the World, due to the need for adequate levels of staffing when caring for very sick patients. Clearly managing such patients requires a high level of skill, knowledge and experience and this is often obtained through participating in a post-basic course on critical care. Historically, these courses were often provided by the healthcare institution in which the person was working but there has been a trend towards Universities and other Higher Education institutions providing these. This is due to the increasing professionalisation of nursing between 1990-2010 during which time the level of qualification nurses leaving training with has increased.

So why should a critical care nurse undertake post-qualification study? From the perspective of patient outcomes it has been shown (at least in the neonatal context) that nurses in critical care who have specialist qualifications can have a positive impact on outcomes 1. It’s for this reason that several regulatory bodies and organisations, including the Australian College of Critical Care Nurses (ACCCN, 2006), Faculty of Intensive Care Medicine (2013),

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and the British Association of Critical Care Nurses (2010) recommend minimum levels of critical care nurses with specialist qualifications. Despite these recommendations, it’s difficult to actually determine how many people have specialist qualifications in critical care. In the USA, nurses have a system of ‘credentialing’ whereby critical care nurses spend between 1,750 and 2,000 hours at the bedside followed by an examination after which they may use the post-nominal letters ‘CCRN’. These credentials are granted by the American Association of Critical Care Nurses rather than an educational institution. In other countries, such as the UK, Australia and New Zealand a postgraduate education route is offered with formal University qualifications.

“The biggest issue is that there is no clear definition of the sphere of critical care nursing practice” The biggest issue is that there is no clear definition of the sphere of critical care nursing practice and there is a significant variation in duties between critical care environments making it difficult to determine a curriculum which would suit all entrants.This is despite competency frameworks and position statements issued by the European Federation of Critical Care Nursing Associations, the UK Critical Care National Network Nurse Leads

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“There is a considerable need for consensus across education providers to work to a standardised curriculum” There is a considerable need for consensus across education providers to work to a standardised curriculum which is available in a limited outline form, but not often followed. As a programme leader for an online learning nursing studies programme, I passionately believe in that mode of delivery and its suitability for postgraduate nursing qualifications. There are challenges around developing clinical skills and testing clinical competency, but we are able to overcome these by forging strong links with practice providers. The links with clinical educators who support students in practice are invaluable and it is they who can determine clinical competency.

Ultimately, whatever mode of delivery is employed, postgraduate qualifications in critical care are needed. There are shortages of qualified and experienced nursing staff, and healthcare providers can provide financial or career incentives to promote postgraduate courses to critical care nurses. By doing so, providers will retain staff and develop an engaged and skilled workforce. These nurses can then provide a higher standard of care based on evidence and rigour, improving outcomes for patients. They also become the leaders of the future and can in turn work with new staff and students to encourage them to become highly qualified, skilled and engaged colleagues in critical care which I believe is the best environment to work in as a nurse. For more information about UDOL, go to: www.derby.ac.uk/online/

HealthTimes - August 2015 | Page 13

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HealthTimes - August 2015 | Page 15

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New benchmark set for specialist critical care nurses By Karen Keast

he Australian College of Critical Care Nurses (ACCCN) has released new practice standards for specialist critical care nurses. The latest edition, available online, is the third since the first standards for critical care nurses was unveiled in 1985. ACCCN president Dr Diane Chamberlain says the revised practice standards reflect the shift towards a more modern and professional practice for the nation’s 10,000 critical care nurses. “It’s a far more contemporary and accurate picture of what the critical care nurse specialist is - what they do and what their practice looks like,” she says. “Practice has become more professional and there’s more advocacy for nursing and for patient-centred care. “The way that nurses deliver care involves a lot more clinical reasoning, critical thinking, and professional and safety-based practice.” Based on the Nursing Midwifery Board of Australia’s National Competency Standards for Registered Nurses, the practice standards outline the benchmarks of nursing practice and the behaviours that define the nursing specialty. Dr Chamberlain says the standards are important for the education of nursing students and also for nurses working in the field. “A lot of the university courses use them as a guide for standards of practice for their critical care nurse graduates,” she says.

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“Often, performance reviews will be done around that as a student and even some clinical areas use it as a performance review for their registered nurses who are critical care nurse specialists.” A project group, led by Dr Fenella Gill, Tina Kendrick and Melanie Greenwood, conducted a two phased study to review the existing practice standards and draft new standards using an eDelphi technique. After two and a half years of work, ACCCN launched the revised standards at its Institute of Continuing Education Conference (ICE), held in Adelaide in June. Dr Chamberlain says feedback to the standards has been overwhelmingly positive. “At the conference, we sold them like hotcakes,” she says. “People were buying the hard copy even though they could have downloaded the PDF - we just didn’t have enough copies. It was lovely to see that positive approach to it.” Dr Chamberlain, a senior lecturer in critical care nursing at Flinders University, says the revised practice standards include a focus on the professional and legal parameters of critical care nursing practice, safety and quality aspects of care, and the provision of patient and family-centred critical care. The practice standards also highlight important changes to areas such as the critical thinking and analysis domain. “This domain is a lot stronger for a start,” she says.

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“The things that talk about advanced practice are standing out a lot more so specialist nurses are becoming far more professional in the way they approach their practice and are becoming more autonomous. “In the critical care area, there aren’t a lot of nurse practitioners. There are some but there’s that tier of nurses which are just under that that have an advanced practice manner so the part on the critical thinking and analysis domain is actually really important for them.” Dr Chamberlain says the practice standards will be used to develop standards for educating critical care nursing students at universities. “The variability of courses in universities for critical care nurses is actually quite huge,” she says. “Some are totally theory or online - it’s interesting that to be able to achieve these outcomes you need to have a certain type of education that goes with it. “We are going to explore that - what is the best model to achieve these standards.

Nursing and Allied Health Scholarship Support Scheme is funded by the Australian government and administered by ACN

“We will publish those and in a way what that will do is set a benchmark for the education of critical care nurses in a postgraduate field.” Dr Chamberlain says the release of the practice standards are a distinguishing moment for the college, which is experiencing a new phase of growth. She says the college, which has a membership base of about 3000 critical care nurses, has made its membership opportunities more flexible and it also plans to review and further develop its education processes online. “It’s a very exciting time,” she says. “We’ve just released, for example, our position statement on family care and it relates not just to critical care areas but to a lot of areas. “It’s really great to be able to place in the professional picture all of these documents and policies and processes that can make a difference to patient outcomes.

For the full article visit HealthTimes.com.au HealthTimes - August 2015 | Page 19

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HealthTimes - August 2015 | Page 23

Midwives support calls for breastfeeding friendly workplaces By Karen Keast

he Australian College of Midwives (ACM) is one of about 120 organisations and companies across Australia accredited as a ‘breastfeeding friendly workplace’. “With midwifery being a female-dominated profession, having a breastfeeding friendly work culture just makes sense,” ACM president, Professor Caroline Homer, said. “Not only is it important to protect breastfeeding for the known health benefits for mothers and babies but employers benefit too by retaining a valuable, skilled workforce.” The Australian Breastfeeding Association runs an accreditation program for businesses wanting to support breastfeeding mothers in the workforce. With statistics showing returning to work is the fourth highest reason for mothers of seven to 12-month-olds not continuing to breastfeed, more employers are providing mothers with a private, comfortable space to breastfeed or express breastmilk, approved lactation breaks, part-time or flexible work arrangements, and general workplace support. As part of World Breastfeeding Week earlier this month, breastfeeding stakeholder bodies across Australia and New Zealand called for employers to take up the gauntlet with breastfeeding policies and practices to enable mothers to continue to breastfeed when they return from maternity leave.

Page 24| www.HealthTimes.com.au

The Australian Breastfeeding Association (ABA) and the New Zealand Breastfeeding Authority (NZBA) want employers to protect, promote and support breastfeeding in the workplace through simple initiatives, such as providing a clean, private space where women can breastfeed or express their milk. The ABA points to research that reveals in workplaces equipped with a breastfeeding policy, 61 per cent of mothers were exclusively breastfeeding their baby at the age of six months. In comparison, only 34 per cent were exclusively breastfeeding at six months in workplaces where there was no breastfeeding policy or the mothers were unsure whether a policy existed. “Studies have found that women who are supported in breastfeeding their babies by their employers are more likely to return to work after maternity leave,” ABA CEO Rebecca Naylor said. The World Health Organisation recommends exclusive breastfeeding for babies to the age of six months, and then for breastfeeding to continue alongside solid foods up until the age of two years and beyond.

For the full article visit HealthTimes.com.au

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HealthTimes - August 2015 | Page 25

Critical care nurse fights to save lives with AEDs By Karen Keast

ritical care nurse Anne Holland has always worked to save lives. But when her husband, Paul, died after a cardiac arrest she was unable to save him. Now the Melbourne mother of five is working to raise awareness and is also campaigning for the introduction of life-saving automated external defibrillators (AEDs) in the community. The former Epworth HealthCare nurse, who worked as a level one operating suite critical care nurse for 20 years, is a registered first aid trainer and has launched a business, Defib First, providing information and training demonstrations to groups on how to use AEDs in a medical emergency. Anne has launched a not-forprofit venture, Urban Lifesavers, in a bid to build a national awareness campaign designed to get the message out to the community, organisations and government about the importance of training people to use AEDs. The registered nurse is also campaigning for AEDs to be quickly and easily accessible at community hubs, such as supermarkets and businesses across Australia, similar to community access to AEDs in the United Kingdom. With statistics showing cardiac arrests are the number one killer in the nation, Anne says it’s time the government legislated for AEDs to be compulsory - and as common as fire extinguishers.

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“Fifty-six people died in fires or from smokerelated causes in Australia in 2013,” she says. “Obviously fire equipment has made an enormous impact on the reduction in the number of deaths, injury and property damage and all businesses have to have fire extinguishers and homes have to have smoke detectors and smoke alarms. “There are 33,000 cardiac arrests each year and getting that message through to government, the workplace and the general population that you are 590 times more likely to have to deal with a cardiac arrest than someone who is going to die in a fire - and yet we don’t have compulsory installation of AEDs or readily-accessible AEDs throughout the community. “That’s one of the points that does resonate with people, they don’t realise it’s as significant as that - it’s the number one killer. “It outstrips all cancers combined - it’s the one cause of death that you need the person standing next to you to do something about, and it’s the one cause of death that a person can reverse. “The one thing that matters is you get a defibrillator onto that person and the person next to you does it.”

For the full article visit HealthTimes.com.au

A health check on our health system – surviving change By David Wilson – Davidson Executive

he Australian health and human services sector is a complex and rapidly growing industry of tremendous scale. Nearly three times larger than the global banking industry, it faces increasing pressure from a growing aging population and the ramifications of a workforce unprepared to deal with the demand. According to the Government’s Productivity Commission, Australia’s population is set to rise to around 38 million by 2060, and in the same timeframe, more than 14 people out of every 100 will be aged over 75. Furthermore, by 2020, 70 per cent of Australia will have health issues associated with chronic disease. In their report, ‘Australian Jobs’, Deloitte stated the health care and social assistance is Australia’s largest employing industry. The industry’s 1.4 million workers account for 12 per cent of the national employment figure and the largest employing industry in regional Australia, with around 442,600 jobs. Further to that, SEEK’s recent reports say there will be more than 258,000 new healthcare and medical jobs created by 2019. It’s an ongoing discussion and debate in many corners of the political and commercial arenas. The healthcare challenge will not be going away any time soon. So how do we prepare for the significant change facing this enormous industry that influences everyone in society?

A devoted workforce unprepared As with any industry, the core fabric is the workforce behind it and the team that leads it. A scalable workforce of appropriately qualified and skilled professionals is crucial to meet the demands of the industry’s changing landscape. Dr Frances Peart, a nurse of more than 20 years, said the last time all stakeholders discussed large-scale health workforce redesign was during former Prime Minister Paul Keating’s days when healthcare leaders across Australia were consulted and national reforms were implemented. “It is widely recognised that there are a number of inequities in relation to the workforce and that these issues must be addressed for our health system to be able to respond to the burgeoning aging population,” Dr Peart said. “The health workforce is not a homogenous entity and solutions need to be crafted that address the particular concerns of disciplines and groups. “For example, nurses are reluctant to step up to management roles due to the lack of incentives, there is disproportionate access to skilled health practitioners in regional and remote areas and there is a gap in services in relation to generalist patient-centric roles.

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What stuffed your gut? By Maureen Minchin, BA (Hons), MA (Melb), TSTC.

and the baby’s body, need to grow and develop normally. Infant formula produces a gut microbiome radically different from that of the solely-breastfed baby: that has been known for a hundred years, and it remains true. Without breastmilk, an abnormal gut microbiome is created, more pathogens are present – bugs that can cause serious disease - and they entrench themselves, shaping the baby’s gut to make it hard to dislodge them. Astonishingly, very little care is taken to assist the development of the normal infant gut microbiome. Some parents think that from birth infant formula is just as good as breastmilk, deceived by misleading marketing puffing the inclusion in formula of both probiotics (bugs) and prebiotics (food for bugs). These have not been shown to match breastmilk’s effects, and can only be considered experimental, with the results not independently monitored or evaluated. Changing this begins with spreading awareness of the importance of the microbiome and of exclusive breastfeeding – or at worst, of exclusive human milk feeding. This means enabling and rewarding breastfeeding for women, not promoting it, and then leaving breastfeeding women to struggle in cultures where formula is seen as an equivalent choice - and where it is defended by trolls who insult healthworkers for doing their job of informing women of a few of the many many risks of not breastfeeding. (No one educates either mothers or healthworkers about the problems of infant formula itself!) I believe that vocal bottle bullies are now silencing public health messages. Is this just ignorance? Or might it be astro-turfing? (See http:// tedxtalks.ted.com/video/Astroturf-and-manipulation-of-m)

HealthTimes - August 2015 | Page 29

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veryone is talking about the new discoveries that the billions of bugs in our gut (our gut microbiome) have a profound effect on our mental and physical health – and we are becoming aware that physical and mental health cannot be separated. People taking anti-depressants to keep up their levels of serotonin, for instance, need to realise that most of that happy hormone is made by bacteria in their gut, and that a disturbed gut microbiome can therefore mean depression and misery as well as obvious local symptoms. A healthy gut microbiome begins before and during birth, with the seeding of the gut by bacteria from the mother’s body. It continues after birth as those bugs, and others from food and the environment, have to multiply and establish secure niches for themselves, in the process sculpting the developing infant gut in ways that increase their chance of survival. The process goes on over the first year or longer, but the beginning is critical. The balance and types of bugs present in the infant gut affects our lifelong chances of allergy, immune disorders, ill health and gut problems. Great concern is being expressed about antibiotics and surgical births in this regard, as research is showing they have negative consequences. (Read Missing Microbes, by Martin Blaser). However, as you might expect, the single most powerful influence postnatally is what goes into the gut every day: food. Breastmilk, preferably from the child’s mother, is the necessary first food for all infants. This is because breastmilk provides not only a complex array of hundreds of different types of bugs, but also thousands of supportive immune factors, including stem cells, in a perfect mix of nutrients that are exactly what both those friendly bugs,

Nurses and midwives vow to safeguard penalty rates

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“A Sunday is a Sunday, no matter whether you are a hospitality worker or a nurse. Touch one of us, you touch us all.” The draft report, Australia’s Workplace Relations Framework, recommends the change to the Sunday rate would be “a floor to the penalty rate, and employers may decide to pay more if they find it hard to attract employees on Sundays”. It states penalty rates, except for Sunday rates, should remain - “penalty rates have a legitimate role in compensating employees for working long hours or at unsociable times. They should be maintained”.

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For the full article visit HealthTimes.com.au

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Public sector surgical nurse Ellen McRae works most Sundays. In fact, Ms McRae works 10 shifts a fortnight and all fall outside the traditional 9am5.30pm working day, with starts at either 7am, 1pm or 9pm. “Three weekends ago it was my first full weekend off in nine weeks - it’s exhausting having to take away your time from your loved ones and only having weekdays, which are often split days, off.” Ms McRae added her voice to Australian Nursing and Midwifery Federation (ANMF) concerns at recommendations of the Productivity Commission’s draft report into workplace relations. The commission proposes retaining Sunday penalty rates for essential services, such as nurses, midwives and paramedics, while reducing Sunday rates to Saturday rates for workers in hospitality, entertainment and retail. ANMF federal secretary Lee Thomas said the proposal would create a two-tiered workplace relations system. “What we say to that is, you can mark my words, this is the beginning of the end - it’s hospitality and retail workers today and tomorrow it will be nurses and midwives. It’s a slippery slope,” she said. “We’ve already seen in one state, an industry peak in aged care delay bargaining awaiting the outcome of this report, because clearly in aged care they are considering what they do with penalty rates into the future. “We will continue to campaign alongside hospitality and retail workers because we can’t have a two-tiered penalty rates system in this country.

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