Nursing Review - Apr 2013

Australia independe ’s nt voice of nursing Issue 3 April 2013 www.nursingreview.com.au

Federal health The election issues that affect you

The gap narrows Equality by 2030?

Diversity days Making the most of our differences

We work hard to make things simple.

At Ambient Care we understand manual handling solutions should be simple. Which is why we bring you the world class innovation and European techniques of SystemRomedic. Designed around simplicity and logical thinking, these products allow staff to lift, support, transfer or position residents efficiently and with less risk of injury. Ambient Care also offers training in transfer techniques and equipment so you’ll quickly understand and appreciate the correct use and clear advantages of SystemRomedic. And because SystemRomedic designs the highest quality, task orientated equipment, there’s less duplication, more cost-efficiencies and a better whole of life dividend. For further information, request a catalogue at sales@ambientcareinteriors.com.au

2 | April To find out2013 more about the SystemRomedic range call 1800 429 117 or email sales@ambientcareinteriors.com.au

contents EDITOR Amie Larter (02) 9936 8610 amie.larter@apned.com.au Journalist Aileen Macalintal aileen.macalintal@apned.com.au production manager Cj Malgo cj.malgo@apned.com.au Graphic Design Ryan Salcedo ryan.salcedo@apned.com.au SALES Nicola Mohtram 02 9936 8619 nicola.mohtram@apned.com.au SUBSCRIPTION ENQUIRIES (02) 9936 8666 subs@apned.com.au ACN ADDRESS CHANGE canberra@rcna.org.au 1800 061 660

10 news 04 $1.2bn funding injection

Wage boost for aged care nurses

PUBLISHED BY APN Educational Media (ACN 010 655 446) PO Box 488 Darlinghurst, NSW 1300 ISSN 1326-0472 PP236785/00005

06 Stress levels soar

Midwives risk burnout

08 NSW nurses negotiate

Vote for safer staffing levels

Cover Katana Skinner gets a check-up at Beagle Bay Medical Clinic, WA. Photo by Lorrie Graham, courtesy FaHCSIA PUBLISHER’S NOTE © Copyright. No part of this publication can be used or reproduced in any format without express permission in writing from APN Educational Media. The mention of a product or service, person or company in this publication, does not indicate the publisher’s endorsement.

The views expressed in this publication do not necessarily represent the opinion of the publisher, its agents, company officers or employees.

10 Cancer drug key to HIV VIC research breakthrough

12 Funding for Timor nurses

Congratulations to the winner of Nursing Review’s Reader Survey iPad mini: Margaret Naylor ACT

Program improves outcomes

policy & reform 14 Healthcare campaign

clinical practice 28 Wound care management Why knowledge must be increased

workforce 30 Have your say

Climate-friendly hospitals; An enrolled nurse on career options

32 Q&A with Roianne West

About inspiration, academia and indigenous health

33 Documentation principles Tips on successful recording

Top election priorities

34 Don’t stress

specialty focus 18 Closing the Gap

Juggling workplace demands and pressures

Nursing’s role in health equality

legal corner 36 Dynamic environments

20 Q&A: Sandy Anderson Improving sexual health

Knowing your responsibilities

22 Diversity in health Recognising differences

Audited 15,635 as at Sept 2012

18

12

24 Community care

The call for greater communication

28

technology 38 Healthcare tech forum

Modernising patient participation in care

INSPIRING ONLINE CPD COURSES FROM AUSTRALIA’S LEADING NURSING UNIVERSITY: Spirituality in Healthcare

Healthcare Ethics

• • • •

• • • •

Spiritual distress, assessment & care Care of the whole person Insight into different spiritual traditions The role of organisational values & mission statements

Date: 22 April – 3 June 2013 CPD Hours: 30 (5 per week)

Introduction to healthcare ethics Demystifying the code of ethics Foundations of ethical practice Elective - end of life or beginning of life

Date: 13 May – 24 June 2013 CPD Hours: 30 (5 per week)

Upon successful completion of optional assessment, credit may be granted towards: Grad Cert in Healthcare Ethics, Master in Clinical Education/Health Administration/Clinical Nursing.

Visit www.healthcarehub.com.au to register or call Gillian on (02) 97392837 Earn points for every hour you study with Healthcare Hub and redeem for Ticketek vouchers. www.nursingreview.com.au

April 2013 | 3

news

Government’s

billion-dollar bid

to boost

aged care wages

While Labor’s plan to boost pay draws criticism from the Coalition and LASA, the ANF welcomes the Aged Care Workforce Compact.

By AMIE LARTER

T

he federal government has announced a $1.2 billion injection into the pocket of minimum wage aged care nursing and care staff, in a bid to provide more rewarding careers and conditions for Australia’s 350,000-strong aged care workforce.

The Aged Care Workforce Compact, an agreement between the government, union and employers, will see significant wage increases for aged care nurses, care workers and other professionals in the industry.

Starting in July, workers who are currently paid the award rate and who sign an enterprise agreement with an approved provider could see a wage increase of up to 30 per cent over four years.

“We know that most Australians who pursue a career in aged care do it for much more than the financial reward, but pay rises of that level are a big incentive to work in this growing industry,” said Minister for Ageing Mark Butler, at the launch of the Compact.

“A better-paid, better-skilled and better-trained workforce will underpin a more responsive system that provides older Australians with quality care, when and where they need it.”

The Australian Nursing Federation welcomed the announcement, and called on the Opposition to commit to the Compact if it wins in September.

“We have begun addressing the wages issue through the workforce Compact; we must now address other issues like staffing levels and skills mix,’’ said ANF Federal Secretary Lee Thomas.

“It is imperative that the aged care sector is seen as a viable and exciting place of employment so that as a community we are all assured that the highest quality care is being delivered.”

However, the Coalition remains strongly committed to its fouryear Aged Care Provider Agreement announced in 2010 – what they describe as a “game changer” for the sector.

“With only 40 per cent of providers operating in the black, many providers will be unable to pay the wage increase and meet the associated on-costs,” said Shadow Minister for Ageing and Shadow Minister for Mental Health Senator Concetta Fierravanti-Wells.

“These cost pressures will further erode their viability, especially smaller providers in regional and rural areas.”

4 | April 2013

Top L-R: Mark Butler, Senator Concetta Fierravanti-Wells Bottom L-R: Lee Thomas, Patrick Reid

Fierravanti-Wells described the Compact as nothing more than a union-driven industrial process dressed up as administrative change.

“Minister Butler’s Compact has failed its principal objective to find a sustainable agreement with the aged care sector on workforce issues.”

There were mixed levels of support from aged care bodies and providers, many looking long-terms to matters of staff retention and quality.

Leading Age Services Australia CEO Patrick Reid said that the compact “tinkers at the edges”, and doesn’t address the real issues faced by the industry.

“The compact will not address the huge shortage of age services workers and may in fact worsen recruitment and retention in rural and remote providers,” he said. n

news

More people in health and community services choose HESTA than any other fund

Your super fund can make a lifetime of difference 3 Run only to benefit members 3 No commissions 3 Low fees

hesta.com.au

Product ratings are provided by SuperRatings and Rainmaker Information, and are only one factor to be considered when making a decision. See superratings.com.au and selectingsuper.com.au for more information.

H.E.S.T. Australia Ltd. ABN 66 006 818 695 AFSL No. 235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. Consider a Product Disclosure Statement before making a decision about HESTA products, call 1800 813 327 or visit hesta.com.au for copies. www.nursingreview.com.au

April 2013 | 5

news

Midwives in need

greater support Less negative stress, greater professional recognition and support are just some of the factors that could reduce dangerous stress levels for midwives. By Aileen Macalintal

M

idwives say that increased case loading, lower staff levels and a lack of support are adding to their stress.

Psychology lecturer Dr Lynette Walpole, from Victoria University, studied 32 delivery-suite nurses for her PhD. They were asked to record events in a diary after every shift for six months.

Usually midwives have a sense of control but when circumstances are beyond their control, they perform based on their experience and training, Walpole found.

“If the situation is appraised as manageable, they enjoy the challenge.” This prompts positive stress, she said.

Walpole said that midwives felt that when they didn’t perform well, it was due to poor staff-patient ratios and their lack of skills or experience, thus increasing their stress levels.

For those who care about how their home looks

For many years CareWell Health has been helping people choose better equipment and furniture The people we have typically helped were worried about the look of their care home; irritated by damage done to the walls; sick of maintenance not done or repairs dragging on; and worried about getting value for money.

We can help you make your residents feel more at home Model shown here is the Freya in beech veneer. For further details please contact our toll free number or email.

Toll free 1800 30 32 88 6 | April 2013

email info@carewell.com.au

The frequency of case management, conflict, emergency care and workload were found to have a correlation with a lack of supervisor support; the more cases midwives worked on, the less support they received.

“The average subjective stress for each event was calculated and two bereavement care events of caring for a foetal death in-utero and caring for a mid-trimester termination were found to be the greatest stress. When the categories were considered from the perspective of which had the strongest associations for both frequency and subjective stress, lack of support was identified,” Walpole said.

“The second phase was purely quantitative and because the midwives had to commit to a 24-week period of completing the diary after each shift, it was felt that it needed to be succinct and easily completed. That is why a tick box and rating scale format was decided upon.”

At the start of the quantitative phase of the study, midwives were interviewed to gain their insights and feelings. Walpole advised a number of measures to better manage these situations and limit the burn-out.

“Ensure that managers are aware of the need and are comfortable in providing support,” she said, and “monitor the number of instances each midwife is involved in the care of a bereavement event and monitor their levels of burn-out.”

Liz Wilkes, vice-president of Midwives Australia, said solutions to the stress issues were being worked on. For example, the move to give midwives the opportunity to care for the same woman from early pregnancy until six weeks after birth.

However, Wilkes said the transition to this system was slow. She agreed that management support was also part of the solution, as was the need to recognise that all women need midwifery care, while some may also need obstetric care.

Wilkes also noted that “systemic issues often also add to the feelings of a lack of control. This can be due to midwives still feeling at times that the medical model of care is prevalent.

Depending on where the midwife works, this may significantly add to stress. In models where there are good working relationships and midwifery care is seen as the ‘norm’ for normal, low-risk, pregnant women, these stressors are reduced.”

Wilkes said she had seen some inspirational ways of midwives handling stress recently.

“Many midwives have been gaining notation from AHPRA as Medicare-eligible midwives.” This increased their feelings of control.

“I think that midwives need to be fully recognised as professionals in their own right and to be properly recognised as the primary care provider for the majority of ‘normal’ women. If the models of maternity care in Australia supported this, we would see changes to enable midwives to feel comfortable and supported in their roles,” Wilkes said. n

• Mining giant Rio Tinto has committed $6 million to the Royal Flying Doctor Service (WA) to fund the Rio Tinto Life Flight medical jet service for Western Australia for the next four years. The jet’s capacity allowed RFDS to conduct their first double critical care transfer, where two critically-ill patients were transported at the same time with their own medical teams. RDFS CEO Grahame Marshall said that the jet had made a “tremendous difference” to the team’s ability to respond to rural, regional and remote Western Australians.

Healthy brain program

• Alzheimer’s Australia, as part of the Your Brain Matters program, has launched a new campaign to urge Australians to take some time for themselves in the interests of better brain health. A range of advertisements on commercial television networks will recommend Australians take up brain health activities – highlighting the link between a healthy heart

and a healthy brain. Alzheimer’s Australia CEO Glenn Rees said it wasn’t about running a marathon or climbing mountains, but there were small things people could do daily to make a difference. “It’s all connected. What is good for the heart is good for the brain and vice versa,” he said.

Blue over blueprint

• The Queensland government has announced its Blueprint for Better Healthcare, a state-wide system with patients as the focus. The premier was upbeat at the launch, saying that the government was finding “innovative ways to deliver”. However, QNU secretary Beth Mohle said the Newman government had already cut health services and sacked health workers, and that a blueprint based on outsourcing and cutting back workplace conditions was extremely concerning. Newman suggested that opponents of the new framework “... can either get on the train or get under it”.

3rd Biennial National Falls Prevention Summit

16–17 May 2013 | Stamford Plaza Brisbane | www.healthcareconferences.com.au/falls Strategies for preventing the incidence and reducing the severity of falls in hospital and community settings

13th Annual Hospital in the Home Conference

23–24 May 2013 | Novotel Melbourne on Collins | www.healthcareconferences.com.au/hith Now in its 13th successful year IIR’s Hospital in the Home Conference is the premiere event on the Australian HITH calendar 2nd Annual PCEHR: The Journey Towards National eHealth Adoption

27 May 2013 | Sydney Harbour Marriott at Circular Quay | www.healthcareconferences.com.au/pcehr Personally Controlled eHealth Records: Moving beyond compliance to adding value 2nd Annual Transition Care: Improving Outcomes for Older People

30–31 May 2013 | Pullman Sydney, Hyde Park | www.healthcareconferences.com.au/transition A national conference focused solely on the implementation and delivery of the Australian government’s transition care program 6th Annual Pharmaceutical Law Conference

31 May 2013 | Radisson Blu Plaza Hotel Sydney | www.healthcareconferences.com.au/pharmalaw Don’t miss your opportunity to receive top-quality guidance on the latest legal and regulatory hurdles facing the pharmaceutical industry.

2nd Annual Younger People with very High & Complex Care Needs Conference

17–18 June 2013 | Novotel Melbourne on Collins | www.healthcareconferences.com.au A conference for organisations looking to provide alternative options to residential aged care

N om i N tE NoWa !

Nomin

2012 winners, left to right: Chris McGowan representing Silver Chain, Rhonda Sawtell, Abby Dunnicliff and Shirley Nelson.

2010 winners, left to right: Jan Wright and Raeline George

Know someone in the aged care sector who deserves an award?

Recognise aged care professionals for their outstanding care by nominating them in one of three categories: Individual

Organisation

calendar

Rio Tinto’s $6m gift

inbrief

news

atio 31 May ns close 2013

s tickEatlE s oN

NoW

Generously provided by:

Proudly presented by:

Team

hestaawards.com.au

@HESTAACawards

Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL No. 235249 Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321.

www.nursingreview.com.au 1091.ACA2013_185x133.indd 1

April 2013 | 7

19/03/13 2:34 PM

news

Record number support

safer staffing levels

Nurses and midwives are committed to better staff-patient ratios. By Aileen Macalintal

A

record number of NSW nurses and midwives are backing pay and staff ratio demands, according to the NSW Nurses and Midwives’ Association.

The NSWNMA wants guaranteed safer nursing levels in emergency departments, high dependency units, for seriously ill children, in rural hospitals and multipurpose services, and safer nursing and midwifery staffing arrangements in community health services.

The NSWNMA contends that the state government needs to work on the safer hospital staffing levels promised in 2011 under an agreement between the NSWNMA and the previous government.

The claim also includes two 2.5 per cent annual pay rises, which will provide the majority of experienced, full-time nurses and midwives with a pay rise of more than $70 weekly, or more than $3800 annually,

by July 2014.

The NSWNMA presented the claim to the state government on March 11, through the Health Ministry, to have it incorporated into the new Public Health System Nurses & Midwives (State) Award, which replaces the current award in June.

Of the 215 NSWNMA branches that voted, a record 214 branches endorsed the claim. Voters represented more than 30,000 nurses and midwives in NSW’s public hospitals and community health centres.

NSWNMA general secretary Brett Holmes said the strong vote showed the commitment of NSW nurses and midwives to safer patient care.

“Nurses and midwives working under the first round of compulsory, minimum ratios are clear they have provided a safer clinical and less stressful working environment. This record vote indicates just how committed they are to extending the benefits to all patients around the state,” Holmes said.

8 | April 2013

“The strong vote also sends a clear message to the state government about the nurses’ and midwives’ determination to maintain and extend safer staffing levels,” he said.

“The O’Farrell government is very willing to take credit every time a new batch of nurses or midwives is employed to fill the new positions created by the ratios, which were actually agreed between the NSWNMA and the previous Labor government.”

Holmes said that it “will be interesting to see how (the state government) reacts now that it has a chance to act in its own right and extend this reform into other important areas such as children’s wards, emergency departments, high dependency units, rural facilities and community health services”.

“Hopefully, it will heed the message from nurses and midwives and do the right thing, without the need for an extended campaign.”

A spokesperson for the NSW Ministry of Health said it would begin negotiations with the NSWNMA in coming weeks.

“Since March 2011, the NSW government has recruited more than 3000 nurses, by headcount, in NSW hospitals – surpassing its commitment of 2475 more nurses,” the spokesperson said.

“Of these, more than 1300 have been recruited to hospitals in rural and regional local health districts.

“In addition, the NSW government is currently welcoming more than 2000 nurse graduates to hospitals throughout the state, 500 of these in rural and regional local health districts.”

The spokesperson added that a staffing formula called ‘nursing hours per patient day’ guided the number of nurses in regional and metro hospitals, as agreed between the ministry and the NSWNMA in February 2011. n

Visit our website

news

www.qef.com.au

Need money QUICKLY? Funds on demand, the ‘Quick & Easy’ way™

Quick and Easy Finance specialises in nonconforming, short term personal loans for repayment over 3–24 months.* A short-term loan means your debt is paid off sooner, and with loans that range from $500–$10,000,* you can afford to pay for the things you’ve always wanted.

PLUS, by repaying your loan with Payroll Deduction and by using your unencumbered1 vehicle as security, you can enjoy a discounted installment on your loan.

wrightcreative.com.au 0913NR

HOW SOON CAN I RECEIVE THE FUNDS?

Within 2– 4 days from the moment we receive your completed application form and supporting documents.* How’s that for service! Our turnaround time is second to none and we pride ourselves on our quick and easy approval process, with funds deposited directly into your bank account.

WHAT CAN I USE THE LOAN FOR?

Anything you want! Guilt-free shopping; gift purchases; a holiday of a lifetime; home renovations; car repairs or new tyres; new furniture; upgrade to a new plasma TV or home cinema… in fact, it’s your loan – so use the funds however you choose!

FEES & EARLY SETTLEMENT?

Unlike other companies, Quick and Easy Finance DOES NOT CHARGE ANY FEES OR PENALTIES if you choose to settle your loan early. So you are free to pay out your loan whenever you want.

There is simply no better way to solve all your cash flow needs than a short-term personal loan from Quick and Easy Finance – it’s your cash on demand, the Quick & Easy way.™

Call now and be pre-approved in minutes 1300 654 230 *Terms and Conditions Apply. ABN 76 104 030 793. A National Credit Act compliant company. A member of the National Financial Services Federation Inc. A member of Credit Ombudsman Service Limited (www.cosl.com.au). 1: A motor vehicle which is paid off, registered in your name and not encumbered (i.e. not currently used as security on any loan with another financial institution). Australian Credit Licence April 388145 2013 | 9

www.nursingreview.com.au

news

Cancer drug

may beat

Victorian researchers have made a significant step in understanding how the virus works.

By Amie Larter

HIV

A

team of researchers from Melbourne’s Alfred Hospital, Monash University and the Burnett Institute have made a key discovery in the fight against HIV, unlocking one of the disease’s major mysteries.

According to Sharon Lewin, director of the Infectious Disease Unit at Alfred Hospital, when people are on anti-HIV drugs, the virus will effectively “go to sleep” inside resting cells.

This has meant that one of the major barriers in HIV research is finding out how the resting cells are infected and why the cells remain hidden – despite long-term treatment.

The team found that common anticancer chemotherapy drug vorinostat, part of the family of drugs known as histone deacetylase inhibitors (HDIs), effectively ‘woke up’ the virus.

“All HIV patients need is to take antiHIV drugs and that keeps the virus under control, and what we were trying to do with the cancer drug is to dig out those last bits of the virus that hang around in people on the anti-HIV drugs.

“It [vorinostat] actually turned the virus back on – but it only wakes the virus from a particular kind of cell where the virus is hiding,” Lewin said.

Twenty healthy people who all had HIV and were taking anti-HIV drugs received fourteen days of vorinostat as part of the research.

Lewin told Nursing Review that the hope of the research is that once the virus is awakened and starts producing copies of itself, that the infected cell would become visible to the immune system or might even die.

“We haven’t demonstrated that that happens – the first step is just showing that we can wake the virus up. We are still a long way off getting rid of the sleeping cells but it has given us a clue that we can actually wake them up.”

Vorinostat was the first of the HDI family to be licensed, and Lewin said that future studies may involve a combination of other

10 | April 2013

drugs in the group.

“There are other HDIs that are probably more potent than vorinostat so [the research] has given us a much better understanding of how to dose and give these drugs to inform future studies of the newer inhibitors.

“The next studies may need combination treatment – activating the virus in multiple ways and finally the other approach is to activate and try and kill the cell.”

The team plans to continue monitoring the twenty patients who have already received the drug to better understand the changes the drug made to the virus and each patient’s genes.

“We think there are a lot more questions to answer, and we are doing that in a few different ways.

“We are looking at the sequence – the genetic code of the virus that comes out of these cells – because that might tell us more about where it is coming from.

“We are also looking at the host response to the drugs – following these patients up now for a lot longer to see what happens to the virus once it’s been woken up,” Lewin said.

Australia had 31,645 cases of HIV diagnosed by the end of 2011, according to the 2012 Annual Surveillance Report of HIV, viral hepatitis and STIs. n

news

www.nursingreview.com.au

April 2013 | 11

news

Silver

lining

Our nurses are passing on their knowledge to their East Timorese counterparts. By Aileen Macalintal

A

trip to East Timor made clinical educator Barry Flynn realise just how lucky we are.

Flynn, who has worked with Aboriginal communities and refugee populations in the Ballarat area, went to the fledgling country for a nursing development program.

“The first impressions of poverty and general lack of hygiene within the hospital and the community opened my eyes, and made me appreciate how fortunate we are,” he said.

Flynn has been part of the Nursing Development Program of Perth-based St John of God Health Care to help improve health outcomes in East Timor.

Recently SJGHC received about $250,000 from an oil and gas exploration and production company for a development program to boost training opportunities for Timorese nurses.

The donation, from ConocoPhillips and venture partners, means ongoing support for nurse trainers like Flynn and for hospitalwide training in Dili – the first since the country’s independence in 2002.

The investment will also fund training places for Timorese nurses at some of Australia’s best hospitals.

Anne Russell-Brown, group director of St John’s Social Outreach and Advocacy, said the aim of the NDP was for all hospital patients in East Timor to get long-term

People often ask us, what does a foster carer look like?

This could be you ...

12 | April 2013

benefits of reduced mortality and morbidity and decreased hospital stays.

She said the upskilling of nurses through the investment from ConocoPhillips and its partners in the Bayu-Undan project, would focus on areas with the highest morbidity and mortality, to maximise the impact of health development and improve patient outcomes.

“It is important to note that the impact of the NDP will accrue as a result of sustained effort over many years,” she said.

“Combined with the successful implementation of SJGHC’s Pathology Development Program in East Timor, our programs have the potential to improve health outcomes across the whole

news

Top left: Timorese nurses engaged in basic life support training. Top right: NDP manager Liz Elsworthy presents certificates for the basic life course

take part, and often we take for granted the population of more than one million amount of opportunities we get for training people.” and improving ourselves in Australian SJGHC’s commitment to health care hospitals.” in East Timor started in 2004 through the Amid the abject conditions he witnessed, PDP, a national initiative.

Flynn found that every cloud has a silver The need to improve lives can be felt in lining. the experiences of the nurses who have “To see that these people were happy in participated in the NDP. their environment was a big thing for me.

Flynn said he had more than just culture They were striving for something better, shock at first. “Coming from Ballarat (where) it was less than 10 degrees Celsius, but were quite content, and they weren’t standing in the streets holding their hands and there (East Timor) it was at least out for money.”

30 degrees and very humid, it was like Another participant, Margit Nack, found jumping into a can of soup, which took the NDP as “a very uplifting experience for a few days to get used to.” everybody”.

But the differences between his home Nack, associate nurse unit manager and host extended beyond the climate.

“The resources at the hospital were very, at SJG Geelong Hospital said, “We had a fantastic team of nurses. We’d never met very low. The local nurses work from basic each other before, but we bonded and I can standards and there is not much incentive only say positive things about the expatriate for them to better themselves.” From there, nurses and the Timorese nurses in Dili.” he saw what Australians would sometimes She said that some local nurses were take for granted. initially reluctant to come to the training “When we brought new ideas during the Nursing Review 67Hx 185Winvolved BB 20130325and OL.pdf 1 26/03/2013 12:40:01 PM were not used to it. But they because they training, they wanted to get

all eventually became good friends.

“Both professionally and personally, I’ve gained a lot from meeting all the people involved in the program, who I value so much and learned so much from. I think the experience and knowledge will follow me throughout my career,’’ she said.

A team of eight expatriate nurses is currently working at the Hospital Nacional Guido Valadares in East Timor, and an additional five nurses from St John of God hospitals in Australia are sent for up to six weeks to deliver basic life support training and hand hygiene training.

Dr Michael Stanford, group CEO of SJGHC, said that St John was “delighted that ConocoPhillips has invested in the NDP that we operate in partnership with the Timorese Ministry of Health.

“This is the first major investment in one of our international health development programs from a corporate entity and a resounding endorsement of our commitment to nursing in East Timor,” he said. n

C

M

Y

CM

MY

CY

CMY

K

www.nursingreview.com.au

April 2013 | 13

policy & reform

Setting

the agenda As a federal election looms, it’s time to bring major nursing issues to attention. By Louis White

Nursing shortages have been identified nationally, and internationally, for the past 30 years ... and therefore what is in place is not working ‌ it is even worse in the rural areas.

14 | April 2013

policy & reform

o

n the eve of the recent Western Australian state election, premier Colin Barnett caved in to nurses’ demands for a 14 per cent pay rise over the next three years.

Barnett had been steadfast in his denial, but backed down after a sustained campaign of newspaper advertisements and protests by nurses throughout the state. The Australian Nursing Federation ran a well-orchestrated campaign.

The 14 per cent increase will cost the WA taxpayers an estimated $71 million, with the re-elected premier none too happy about having to give in.

“When you are faced, as premier, with clear professional advice that lives could be lost – and they probably would be – I think I had a responsibility to act on that,” Barnett said at the time.

The truth of the matter is that Barnett inherited a problem that has been passed from state government to state government around Australia. Nurses have been underpaid for a long time, and the ramifications around the country are being felt.

The issue with the state of nursing in Australia is important and one that won’t go away no matter whether there is a federal election looming or not. It just so happens that there is a federal election in September.

ANF federal secretary Lee Thomas aims to ensure the issue is on the election agenda.

“As Australia’s largest health union, the ANF continues to call on all sides of politics to ensure that health and particularly safe patient care is a priority at the upcoming federal election,” she said.

“That’s why we will be seeking urgent representations with all major parties, as well as key independents over the coming

months, to put our health platform to them and asking that they commit to the ongoing delivery of safe patient health care for the Australian community.”

Thomas said the ANF has a health platform of significant issues that must be addressed as part of the federal campaign, including the predicted shortage of 109,000 nurses and midwives by 2025.

The ANF claims that in aged care there is a shortage of 20,000 nurses and that there is the continued underemployment of nursing graduates.

The ANF is also campaigning for the reimbursement of HECS fees as an incentive for nursing graduates who relocate to areas of need such as rural and remote communities; on behalf of experienced nurses and midwives losing their jobs due to ‘slash and burn’ budget cuts across the states and territories; and for the right staffing levels for nurses and midwives to ensure the delivery of safe care.

“These are serious issues which impact the ANF’s growing 225,000 membership, as well as the whole of the Australian community,” Thomas said.

“As a major stakeholder in the health, aged care and the industrial and professional arenas, the ANF will be working hard throughout this election campaign to ensure all parties listen to our concerns and commit to safe patient care this election.”

The nursing shortage in Australia is only growing. It is an area which needs to be addressed on a federal and state level, and one that the ANF is campaigning to highlight, especially in the area of nursing graduates not being employed.

“Even though we have a welldocumented prediction of a shortage of

nurses, as high as 109,000 nurses by 2025, the non-employment of graduate nurses by state governments across the country is staggering,” Thomas said.

“Almost every state is affected, with Queensland employing only 10 per cent of graduates, while in Victoria more than 800 graduate nurses will be without employment.

“At the same time, we have seen highly trained nurses and midwives sacked and the recruitment of graduates stopped, as part of so-called savings to state health budgets.

“Billions of dollars have been slashed from public health systems across Australia and it is nurses and midwives and the people they care for, each and every day, who are suffering as a result of it.

“The ANF believes these cost-cutting exercises are nothing but a direct attack on nursing, midwifery and care staff and their daily working conditions across the public health system, and we’re concerned these cuts will dramatically impact the amount of safe, quality patient care nurses and midwives can deliver.

“The federal government, along with state and territory governments, must finally accept that the growing shortage of nurses and midwives is everyone’s responsibility if we are to ensure a sustainable heath workforce in the future,” Thomas said.

Dr Mary Casey, from the Casey Centre in New South Wales, which combines nursing, education, training and counselling services, believes that an overhaul of the system is essential in order for everyone to work in harmony and more systematically.

“Simplifying the whole system is critical,” she said. “At this point in time it is not just confusing but impossible to understand.

Dementia Beyond Drugs...

Unleashing the power of Person Centred Care

14th & 16th May 2013 Melbourne

Through the Eden Alternative we aim to evolve the next generation of care partners to support older people living with dementia.

In May 2013, we are offering for the first time, a choice of two 2-day experiential workshops facilitated by Dr G. Allen Power MD based on his award-winning book “Dementia Beyond Drugs.”

Where: Pullman Melbourne (formerly Sebel Citigate) 65 Queens Road, Melbourne, Victoria.

Who should attend? Representatives of and individuals who support people living with dementia in residential, community care and assisted living communities.

Workshop 1 - Monday 13th & Tuesday 14th May 2013 Other Eden AlternativeTM education offerings include: • Implementing the Eden Alternative in Aged Care (3 day) open sessions in July, September, October, November 2013 • Community Visitor workshops – (1 day) • Introduction to the Eden Alternative – (1 day) • Open Hearts, Open Minds – (1 day) • Eden Associate Refresher – (1 day) • Eden Registry Master Class – ( 1 day) • Reframing Dementia – (2 day)

www.nursingreview.com.au

Workshop 2 – Thursday 16th & Friday 17th May 2013

TO FIND OUT MORE OR TO MAKE A BOOKING Go to our website: www.edeninoznz.com.au or contact our office +61 3 8819 4732 or email admin@edeninoznz.com.au

Find us on Facebook/EdenOzNZ

April 2013 | 15

policy & reform There are too many departments, conflicting guidelines and rules. Those involved need to go back to the drawing board and include people at all levels – beginning at the grassroots – and from every area of nursing.

“There is currently a lack of insight into the funding and where it is actually wasted. Wages need to be examined and streamlined for registered nurses, enrolled nurses, assistants in nursing carers, attendant care workers; again, consultation needs to be with all those involved,” Casey said.

She believes assistant nurses can play a bigger role if it is accepted that “a proportion of the work that registered nurses have done in the past can in fact be done by assistant nurses”.

“Train more assistant nurses to carry out those duties and utilise registered nurses to suit their expertise. Wage changes need to be in conjunction with funding as they are not in line with each other and in many cases the funding does not match the industrial relation requirements.”

Professor Julie Considine, director, Eastern Health, at Deakin University’s Nursing and Midwifery Research Centre, believes that although there is a lot of talk about a nursing shortage, she is not quite

sure it exists. She concedes, however, that interns can struggle to get work.

“There are nursing graduates who are unable to get employment in graduate year programs and there are health services in Victoria who have very few nursing vacancies and are winding right back on employing casual nurses on their nurse banks.”

But there are nursing problems within every state of Australia that have been present for many years. It is not just pay – safety, funding, workloads and genuine commitment from governments are also issues.

Mike Smith, a clinical nurse consultant in the HIV Outreach team in the NSW Health Service, believes that pay needs to increase in accordance with responsibilities.

“Workloads and responsibilities continue to increase and yet wage [increases] in NSW are fixed at 2.5 per cent with yearly increases,” says Smith.

“Funding for wages and improved conditions is vital to recruitment and retention of nursing staff.

“We need a genuine commitment from governments to improve wages and conditions. If these improve, nurses are less likely to leave the profession for other professions and overseas work.

“Also, improved wages and conditions should improve both sick leave and workrelated stress.

“Further research about nursing practice will support arguments about the productivity and positive health outcomes that nurses can provide.”

Smith is adamant that reduced funding helps no-one and leads to more errors within the profession due to staff shortages.

“Nursing is also given a lot of lip-service by politicians about how vital we are, what a good job that we do, but this is never represented in work and conditions,” he said. “Our entitlements are often less than other public servants and other health professions.

“This is despite the fact that we can be criminally accountable for our work and we are heavily regulated by our registration body. The media always identify nurses if ever patient care is poor and it is never reported that the health area may be under high workload and stress. No-one ever publicly reports on why errors occur,” Smith said.

Another important area of nursing is the role that academia can play. Nursing is a popular option for students and there are now more options for graduates

e b i r c s Sub Now • Latest news and resources for all health care professionals • Comprehensive coverage of a diversity of topics • Analysis of the major issues facing the health sector as a whole • Delivered free of charge

Nursing Review provides unrivalled coverage of specialist topics in a range of regular monthly features, as well as topical opinion pieces, international news, profiles, a round-up of national news and the latest in education and training.

02 9936 8666 | subs@apned.com.au | www.nursingreview.com.au 16 | April 2013

policy & reform in terms of post-graduate courses and career opportunities.

The role of the specialist nurse is set to grow, but academia must work in partnership with other government and private enterprise health bodies.

Professor Carol Grech, the head of the Nursing and Midwifery School at the University of South Australia, says that the higher education sector “must work in partnership with government health departments to determine workforce numbers and the skill set nurses and midwives need for future practice models in a sustainable health system”.

“We know that many programs still prepare graduates for work in traditional hospital settings, but the growth area for the future health workforce is in primary practice.

“With an ageing population, nurses can play a lead role in coordinating and delivering primary health care services in the community, services that improve health outcomes in cost-effective ways.

“Nursing programs nationally meet the accreditation standards identified by the Australian Nursing and Midwifery Accreditation Council so we need to continue to work collaboratively to ensure that programs are producing work-ready

These cost-cutting exercises are ... a direct attack on nursing, midwifery and care staff and their daily working conditions. We’re concerned these cuts will dramatically impact the quality patient care nurses and midwives can deliver.

graduates with the knowledge, skills and attitudes to deliver high-quality health services.

“Government needs to ensure that the jobs are there for graduates and working conditions are such that they want to remain in the profession,” Grech says.

She believes that addressing the nursing shortage in rural areas should be a main priority for governments in every state and territory.

“To some extent, it depends on the region,” she says. “However, rural Australia, in particular, has a significant shortage of experienced nurses.

“Nurses working in rural Australia, often in areas with no local medical officer support on site, need to be highly skilled to manage the vast array of conditions that people can present with in these settings.

“Often there will be only one registered

nurse working in a rural or remote community and this places considerable demands on these nurses who may be on call 24/7, which can often lead to burnout,” Grech says.

Casey agrees: “Nursing shortages have been identified nationally and internationally for the past 30 years and therefore what is in place is not working … it is worse in the rural areas.”

As the build-up to September’s federal election intensifies, other issues will be thrown into the spotlight. But the problems facing nursing won’t disappear. The ANF will only grow stronger, and its campaigns longer, to improve the conditions for nurses around the country.

It is time for all parties to gather around the operating table before it is too late. n

How does your fund compare?

When comparing funds, make sure you have all the facts before you decide. Not all super funds are the same – know your apples from your oranges.

Our fund offers:

❯ ❯ ❯ ❯ ❯

Low fees Commission-free financial advice 12 investment options – including two SRI options Income stream options for income in retirement You’ll join one of Australia’s largest funds with over 770,000 members Call 1300 650 873 Visit www.firststatesuper.com.au Email enquiries@firststatesuper.com.au

This advertisement contains general information only and is issued by FSS Trustee Corporation (ABN 11 118 202 672, AFSL 293340) as Trustee of the First State Superannuation Scheme (ABN 53 226 460 365). Any advice it contains does not take into account your specific objectives, financial situation or needs. Consider the Product Disclosure Statement available at www.firststatesuper.com.au or by calling 1300 650 873 before making a decision in relation to your membership. Financial planning services are provided by Health Super Financial Services Pty Ltd (HSFS) (ABN 37 096 452 318, AFSL 240019) trading as FSS Financial Planning (FSSFP) and Health Super Financial Planning (HSFP), which is wholly owned by the FSS Trustee Corporation. HSFS is responsible for the advice they provide. November 2012.

www.nursingreview.com.au

April 2013 | 17

specialty focus

Gap narrows, but more

work

needed

There are still many obstacles facing the 2030 aim of health equality for indigenous Australians. By Amie Larter

A

lthough it appears Australia is starting to minimise the disparity between quality of life for indigenous and non-indigenous Australians, there is still more to be done.

Julia Gillard has tabled the annual Closing the Gap: Prime Minister’s Report 2013, which covers the main areas of life expectancy, child mortality, education and employment.

This year, health was once again high on the agenda.

The report identified that while the health of Aboriginal and Torres Strait Islander people is improving, there are still hurdles to cross to meet the target of equality in health for indigenous and non-indigenous Australians by 2030.

It also confirmed that the government is working with indigenous people and providing funding to indigenous community-controlled health organisations to reaffirm this is a high priority and strengthen its capacity to deliver services.

According to the shadow report released by the Closing the Gap campaign steering committee, 2013 is a critical year for Aboriginal and Torres Strait Islander health.

The report outlines three critical events that will likely determine whether future equality is achieved: the scheduled completion and implementation of a National Aboriginal and Torres Strait Islander health plan; the renewal and adequate funding of the National Partnership Agreement on Closing the GAP in Indigenous Health outcomes (set to expire on June 30); and the September 18 | April 2013

14 federal election – an opportunity to strengthen support and commitment.

According to Mick Gooda, the Aboriginal and Torres Strait Islander social justice commissioner, the 2005 Social Justice Report framed the issue of health inequality between indigenous and non-indigenous people as a human rights issue and not one solely confined to the health system.

When the Labor Party was elected in 2007, minimising the gap was made a major plank in its election platform, and the Closing the Gap strategy was initiated the next year.

“In the five years since this process started we have seen some good building blocks put in place, such as funding arrangements agreed between the Commonwealth and state government, a source of endless frustration for those of us who try to work our way through a web of programs, policies and administrative arrangements,” Gooda said.

“But importantly, we are now seeing other building blocks such as the increase in the birth-weight of our babies, and I reckon we are on track to meet the target of halving the infant mortality rate by 2018.

These two indicators are so important in predicting what each person’s health status will be from children into adulthood.”

The Australian government committed $805.5 million from 2009-2013, working with different organisations and state and territory governments to improve health outcomes.

Gooda believes that we are just beginning to see the dividends from

that investment, and that vigilance is still required in all areas.

“The rate of tobacco use, social and emotional health and wellbeing, obesity and maternal and child health would be the areas that require special attention,” he said. “Again, these are addressing the underlying causes and not just the symptoms of ill-health.”

Closing the Gap campaigners have argued extensively for the implementation of a national plan to be developed in coordination with the indigenous health sector. It’s one of the ways Gooda sees of formalising agreed milestones, targets and resources that are needed to meet the equality target.

“This, with well-founded monitoring measures, will ensure accountability to those targets and milestones and will inform the community, and I mean the general community, on the rate of progress.

Or the lack thereof,” Gooda said.

How can nurses help?

Australia has a high-quality health workforce and making sure Aboriginal and Torres Strait Islander people have access to the appropriate professionals should be high on the agenda when aiming for equality.

Gooda suggests that this means building a workforce that is not only professionally equipped “but also one that is culturally competent”.

“So take time to get to know your community, wherever it may be, get to know the people and this will build the trust

specialty focus

and understanding of each other that is necessary to close this gap,” he said.

Sandy Smyth, a Remote Area Health Corps clinical educator and remote area nurse, agrees. She suggests that nurses are the key link between an indigenous patient and their health outcomes on a daily basis.

“Nurses who are committed to delivering high quality, equitable health care in a respectful and culturally safe manner are an essential component to any strategy which seeks to continue closing the gap,” she said.

“They are involved everyday in pursuing the PHC principles of education, health promotion, illness prevention, treatment and management with the goal of developing effective, principled partnerships with individuals, families and

www.nursingreview.com.au

communities to see improved outcomes.”

Organisations like RAHC, which offer short-term paid placements to urbanbased health professionals, can help nurses keep up-to-date with what’s going on in the sector.

RAHC offers a range of free e-learning modules that provide insight into the major clinical areas of focus in the Northern Territory.

Currently, the NT is experiencing nursing shortages in child and maternal health and preventable chronic disease, both which are target areas for the Closing the Gap strategy.

“RANs are particularly good at developing the skills required to accomplish tasks facing them, which includes managing PCD and early childhood programs,” Smyth said.

“There are opportunities available for education and upskilling in both areas and there appears to be a greater emphasis on recruiting specifically to these positions in the past few years.”

For those nurses wishing to play a role in helping indigenous communities reach equality, Smyth suggests that taking a proactive approach to keeping informed is imperative.

She said that nurses should assess their own skills, background and experience, and ask themselves, ‘Could I be part of this strategy?’ The answer is invariably, yes.

“Invest in your career, address gaps and up-skill,” said Smyth.

“Take a risk, expose yourself to the compelling exhausting, exhilarating, frustrating, satisfying world of health care delivery in remote indigenous Australia.” n

April 2013 | 19

specialty focus

Sandy’s story

Sandy Anderson is a women’s health nurse and practice nurse at the Baarlinjan Medical Clinic at Ballarat and District Aboriginal Cooperative. Last year, Sandy was awarded the ASHM/NSW STIPU/GPV Best Practice Nurse Award for Sexual Health for her work in developing Koori regional women’s cervical screening, and improving the quality of sexual health among women in the region.

What are the most rewarding parts of your job?

The most rewarding part of my job is seeing an increasing number of women access our nurse-led clinics, and for me seeing the peace of mind women have after knowing that their pap smear or BreastScreen is up-to-date and women’s health questions answered.

What are the most challenging aspects?

What I find most challenging is engaging women and building trust. While I have worked at the clinic for two years and previously worked jointly with clinic staff on women’s health, regularly visiting the clinic for over five years, I continue to have to work hard on building trust with the community.

I am fortunate in the clinic to have access to the patients through the medical director and can then get in contact to get their permission to identify their screening history, then working with the women to get their screening updated.

It is totally different from working with the non-indigenous population as many indigenous Australians are, sadly, struggling with basic issues such as safety, shelter and the impact of low income.

Despite wonderful local work to continue building relationships between large mainstream services and the clinic, many women still need support when accessing further treatment in a mainstream service.

20 | April 2013

My role enables me to provide that one-onone support.

One of the challenges faced is that there is quite a large proportion of the community who move frequently and this can mean important follow-up is lost, but due to close work with both the Victorian Cervical Cytology Registry and BreastScreen I have, with the woman’s permission, been able to build their complete screening history and ensure they get appropriate follow-through.

When I worked in a mainstream organisation, my biggest challenge was to find a way to work with my community.

For many years I built a relationship with BADAC staff and would offer to help work on any of the health promotion priorities ... and stayed in there doing this for the long-term. I was prepared to do any task to be involved. One year, I staffed the animal nursery at a NAIDOC week celebration.

How is this helping to close the health gap between indigenous and non-indigenous Australians?

Every Australian indigenous woman who is undertaking routine screening is more likely to have a better health outcome. Research indicates that Australian indigenous women are four times more likely to die of cervical cancer and with breast cancer are more likely to have a poorer outcome after diagnosis and treatment at five years due to later detection.

The clinic has increased cervical screening for Aboriginal women by over 20

per cent and has a BreastScreen twoyearly rate of 42 per cent of the community.

The official aim is achievement of Aboriginal and Torres Strait Islander health equality by 2030.

What role do you think nurses can play in getting there?

Nurses have a very important role to play, whatever the setting in which they work, ensuring that there are good processes to make indigenous Australians comfortable to identify their status and regularly reviewing your service data to identify how many indigenous people you see.

Aim to seek partnerships with Aboriginal Community Controlled Organisations or other mainstream organisations which are successfully engaged with the community to build capacity. Nurses have an important role as they have a trusted role in the community and therefore can play an important part in breaking down the stigma that some of the community have experienced in accessing mainstream services.

What advice would you give to a nurse looking to make a move into working in this field?

Increase your understanding about Australian indigenous issues and look for an opportunity to work collaboratively with your local service. Then you will be in a better position when job opportunities come up. n

e b i r c s b u S today

specialty focus

 Comprehensive and diverse range of topics  Independent and insightful articles making our publications essential reading  All our websites feature interactive areas where users can comment directly on the conversation and debate the topics that face your industry, today and in the future  Delivered free of charge, and you will also receive weekly online updates and special content.

APN Educational Media is a division of APN News and Media, serving the education and health sectors. It has a stable of publications, which combine to cover all aspects of secondary, tertiary and further education, together with a range of related professions and careers.

Using the latest technology to address this range of niche publishing markets, the company has access through its books, magazines, newspapers and the internet to virtually every teacher, university student, academic and health professional in the country.

APN Educational Media has identified the importance and dynamism of the education and health sectors and is growing and adapting with these industries, working in successful partnership with a large range of educational and health institutions and industry bodies.

APN Educational Media is not just covering the education and health industries - it is a part of them.

SUBSCRIPTIONS Aged Care INsite

agedcareinsite.com.au agedcareinsite

www.nursingreview.com.au

T: (02) 9936 8666 Campus Review

campusreview.com.au campusreview

subs@apned.com.au Education Review

educationreview.com.au edreviewau

Nursing Review

nursingreview.com.au nursingreviewau April 2013 | 21

specialty focus

Role model St Vincent’s in Sydney believes its diversity model could help other health facilities.

By Jeremy Gowing and Tami Ebner

D

iversity health is a vital part of holistic patient care and is based on recognising the individual needs and expectations of our patients which may be driven by cultural or other diversity factors.

Working collaboratively, the diversity health team at St Vincent’s Private Hospital and St Vincent’s Hospital in Sydney has developed an innovative model to facilitate cultural competence among clinicians for the diverse communities we serve. Diversity Health Day plays a big part in this model.

“The purpose of Diversity Health Day is to encourage and support staff in the provision of culturally appropriate care to all. It aims to raise awareness amongst our staff of the need to be more finely attuned to the differences in and between our patients and how we might better work with them to enable safe, effective and culturally sensitive care,” said professor Kim Walker from the research office at St Vincent’s Private.

Running annually since 2010, Diversity Health Day engages community experts and local universities to create significant learning opportunities for our multidisciplinary staff.

The event also serves to celebrate

22 | April 2013

diversity with a multicultural afternoon tea provided to those who attend.

The team at St Vincent’s has an inclusive view of diversity, including ethnicity, culture, language, religion, gender, age, political background, sexuality, geographical location, disability, responsibility as a carer and literacy levels.

Simone Engel, medical records manager at St Vincent’s Hospital, highlighted some of the diversity on campus. “Last year we cared for patients from 160 countries of birth, 40 different religions and speaking over 75 languages at home,” she said.

The Diversity Health Day model

Community speakers were organised to give presentations to staff in 2010, 2011 and 2012. Speakers addressed the care needs of patients, including refugees, Jewish and Buddhist patients, traditional Chinese medicine, health literacy and multicultural mental health.

Each year speakers donate their time, representing communities and contributing to staff learning. We select the topic areas based on an analysis of our patient admission demographics, community trends and from clinician survey results identifying learning needs.

Also requiring early planning is the diversity health poster display.

Each year local universities and students are encouraged to submit posters, and hospitals encourage campus staff to submit work highlighting their diversity health projects.

“The poster display engages staff to focus on diversity issues in their own ward areas and increases awareness of diversity in the community,” said Julie Brooks, nursing unit manager, St Vincent’s Private. The French project which won the poster prize in the inaugural year came from collaboration between nurses and the hospital’s French interpreter, developing educational resources for French-speaking patients.

To engage all staff disciplines in the events, we obtained the support of our CEOs to open each event. Nursing, medical and allied health clinicians were informed of the events at key councils and committees. Key nursing, medical and allied health executives were asked to judge the poster display, further securing “buy-in” from leaders in these professions.

The team worked with internal communications to promote the event on our intranet and via colourful posters.

“An additional strength of the annual event is the venue; our mezzanine lounge is an open area rather than a closed lecture theatre, so it accommodates large numbers of clinicians from both St Vincent’s Hospital and St Vincent’s Private and community members and patients are

specialty focus

also able to attend,” said Dr Brett Gardiner, the director of clinical governance at St Vincent’s Hospital.

A resource table created each year provides written diversity health resources on a wide range of topics for clinicians.

Outcomes

After each event, we held online surveys to evaluate staff understanding of diversity health generally and for the specific patient groups addressed.

Survey responses indicated that the information presented raised the awareness and intention of clinicians to provide enhanced care. For example: • About 80 per cent of survey responses (in all years) agreed/strongly agreed that the information presented would enhance their cultural competence when caring for all patients from diverse backgrounds.

• More than 68 per cent agreed/strongly agreed that information presented would improve care to patients who are refugees.

• More than 70 per cent agreed/strongly agreed that information presented would improve care to patients who are Jewish.

• More than 75 per cent agreed/strongly agreed that information presented would improve care to patients who are Buddhist.

• More than 72 per cent agreed/strongly agreed that information presented would improve care to patients who do/could use traditional Chinese medicine.

• More than 74 per cent of clinicians reported that they would improve their practice in relation to health literacy.

• More than 72 per cent would improve their practice in relation to caring for multicultural or diverse mental health patients or their carers.

Other survey questions relating to the structure of the day, poster display, resource table and multicultural afternoon tea were all highly regarded.

Our surveys also indicated that a significant number of staff return each year to attend Diversity Health Day. Following Diversity Health Day, articles have been included in our campus magazines. This continues the focus “on diversity and cultural competence after the events”.

“Diversity Health Day is a major campus educational event that in addition to contributing to improved patient care, also assists our hospitals to meet public and private hospital accreditation requirements and Magnet recognition for St Vincent’s Private,” said adjunct professor Jose Aguilera, the director of nursing and clinical services at St Vincent’s Private.

While many hospitals hold events celebrating staff or patient diversity using art, music or food, our event expands on this in order to create an event that both stimulates and improves diversity practice at our hospitals.

Future directions

The team have already started planning for Diversity Health Day 2013. To sustain and develop the initiative, we will continue to ask innovative guest speakers to give presentations on relevant topics related to the real needs of our patients, community and clinicians.

Continuing to analyse demographics, issues in diversity health and staff surveys, we will focus on additional areas of diversity, such as gender, age, disability and sexuality.

While our surveys currently measure clinician intention and knowledge, measurement of actual improvements in care practices and patient outcomes is our goal.

Last year, diversity health representatives from neighbouring health networks attended our event. Based on our experience, we would encourage other facilities to introduce similar events to help enhance diversity and cultural competence of their clinicians.

Diversity Health Day has enabled us to put our hospital values into practise, improving culturally competent care for our community. n Jeremy Gowing is the nursing unit manager and project manager for emergency planning, St Vincent’s Private Hospital. Tami Ebner is the diversity health coordinator at St Vincent’s Hospital.

Excellence is the result of continuous learning and development Further your professional development with VEA’s programs that attract RCNA CNE points

Visit www.VEA.com.au/healthcare for more information www.nursingreview.com.au

April 2013 | 23

specialty focus

Hitting

the mark

Mary Casey provides an insight into the evolution of community care.

I

t is twenty years since I established the Nursing Group and I am astonished at how much things have changed when it comes to community care.

I founded the nursing service in 1993, at a time when I observed there was a stigma attached to community care and it was believed that the occupation was easier than hospital work. It was also believed that those who provided the care weren’t as experienced or professional as hospital staff. This of course was not true; however, training and further education was not an ongoing requirement for community workers back then. There were no requirements or standards.

Care provision in the community was once only done by registered nurses.

When it became apparent that smaller tasks could be carried out by unregistered professionals, carers and assistants in nursing were introduced. At that point there were no industry guidelines as to what training was required.

My decision to start a nursing service was to set a benchmark for high standards of care and to also eliminate any negative stigma around community care, especially when it came to training and service provision.

Education is a major development in community care. I remember the day I opened the Casey College – I was able to create something that gave my business 24 | April 2013

an edge on setting standards that would become a necessity in order to have skilled professionals caring for our most vulnerable citizens in the community. I hit the mark.

Education has completely changed and students are now required to experience hands-on situations like never before.

I truly believe that nurses must learn about what it is like to be elderly or disabled by facing situations that these vulnerable people face day-in and dayout – situations such as spending a day in a wheelchair or being lifted in and out of bed, or being spoon fed. This gives our students a very thorough insight into how it is on the other side, so to speak, or to spend time in someone else’s shoes. At the end of our courses we provide two weeks in a facility under supervision so that our students have a great understanding about what they will face when starting their new career. It is not so daunting and gives them a much better chance to succeed.

Another major shift was when the government expanded programs and packages in the community to allow people to stay in their homes longer and also to decrease the number of trips and admissions to hospital. Such schemes are very cost-effective and work well. Hospital stays are much shorter than ever before.

Once upon a time a cholecystectomy was a 7-10 day stay; patients are now out the

day after surgery. This is the case for a lot of surgery these days.

This move in the system has also changed the face of nursing in that care is more acute and nurses need to be more autonomous and responsible than ever before. This means they need to be highly skilled with a sound knowledge base. The care has become much more complex and where registered nurses once provided that care, the costs were astronomical, not to mention there was a shortage of RNs across the country.

In my view, one of the problems is that while sections of community care became complex, there were still the more menial tasks such as personal care – putting a person’s stockings on or cleaning their room or cooking them a meal. It became difficult to find registered nurses who were highly trained, had spent three years at university and had to balance complex care with domestic duties. It was obvious that this was not possible. So this is when carers and AIN’s became necessary. It was easier to up-skill by providing additional training for them as opposed to finding registered nurses to do AIN’s work. As a result of this, the whole community care provision changed.

Today, with the National Disability Insurance Scheme, things are going to change again, with clients making their own

specialty focus choices and decisions as to who will provide their care and how and when it will be done.

Time will tell if this scheme is successful or if more changes need to occur or be implemented.

Another major influencing factor in high standards of community care is pay rates. There have been some changes to these in particular areas which, in my view, are going backwards. Creating lower rates and taking penalties from nurses and carers will also lower the standards. It’s common sense! Don’t forget the old adage, ‘Pay peanuts and you get monkeys’. In other industries, and in hospitals and for some community work, nurses receive penalties if they work Saturdays, Sundays and public holidays.

Are they going to work those days for the same rate as weekdays?

I don’t think so! Why would they miss out on spending time with their families for no extra pay?

The problem, I believe, lies in decisions being made without proper consultation with those involved at a grassroots level.

Government, non-government, the private sector and, most of all, the clientele who receive care need to work together. Policymakers need to ask those people their opinions in order to develop systems that are efficient for the people receiving the care and also if they are financially viable for the economy in general. The whole system needs to be observed from a broader perspective. Otherwise, people – those who most need the care – are given a false sense of security in terms of making their own choices and decisions.

My thought is that ongoing change is essential. Systems need to be cost-effective together with the best care possible. If they aren’t, it affects all of society in one way or another. n Dr Mary Casey has over 30 years’ experience in health and education. She is founder and CEO of the Casey Centre. See www.caseycentre.com.au

Nursing and Midwifery Professional Development Growing leadership through knowledge, skills and confidence.

Our professional development program is: n Developed to meet your organisations needs n Flexible teaching for different learning styles n Built on the knowledge, research and clinical expertise of the school’s academics n Delivered on a date and location of your choice To find out more: Email SoNM-Professional.Development@monash.edu Phone 9905 3467 med.monash.edu.au/nursing/professional-development

www.nursingreview.com.au

CRS-13P-253 - MNHS - Nursing Prof Dev.indd 1

April 2013 | 25

18/03/13 11:05 AM

Mid Staffordshire: heeding the lessons

An inquiry into a UK health service scandal has released its findings.

Could such a tragedy happen here?

By Debra Thoms

26 | April 2013

T

he Report of the Mid-Staffordshire NHS Foundation Trust Public Inquiry, recently released in the UK, examines how hundreds of people died due to substandard care at two UK hospitals between 2005 and 2009. It contains a number of lessons that nursing as a profession and the broader health community would do well to note.

The report highlights a number of failings that led to patient care standards that many would say were not possible. But looking at our own health systems, are we sure that we do not already have some of the early warning signs?

Robert Francis, who chaired the inquiry, talks in the Executive Summary about the number of incidents and issues that were occurring, but that the system failed to consider in full or see as representative of a larger problem. The answer, he argues, does not lie in “top-down” pronouncements or reorganisation of the system but in “engagement of every single person serving patients in contributing to a safer, committed and compassionate and caring service” (p18).

He further says that patient safety and requirements are obligations that “need to transcend particular policies and permeate all consideration within the system of fundamental standards” (p38).

Francis did not find that there were one or two poor managers or clinicians, but rather a combination of factors and deficiencies within a complex health system (p36).

In several places in the report, Francis refers to the focus on financial outcomes and targets. While he does not argue that having such requirements is inappropriate, it is the concentration on them to the detriment of care that is questioned.

Measurement is critical for the feedback it

provides on how our system is operating, and in identifying opportunities to make the delivery of care more efficient and effective. There is, though, a need for balance and for a number of the measures to be seen to connect directly to care and patient outcomes. The measures that we use need to have meaning for clinicians and managers and provide feedback that supports and enables them to truly improve care. Margaret Wheatley, in a 1999 article with Myron KellnerRogers on measurement, noted: “But in too many organisations, just the reverse happens.

The measures define what is meaningful rather than letting the greater meaning of the work define the measures. As the focus narrows, people disconnect from any larger purpose, and only do what is required of them. They become focused on meeting the petty requirements of measurement, and eventually, they die on the job. They have been cut off from the deep wellsprings of purpose which are the source of the motivation to do good work.”

A number of the comments in the report seem to reflect this potential disconnection. Specifically for nursing, Francis notes the issues of poor leadership and staffing policies and the delay in addressing the shortage of skilled nursing staff (p45). A number of other recommendations are specific to nursing and are encapsulated in the need to have a culture that is one of “compassion and caring” – and that goes through the recruitment, training and education of nurses. He highlights the need for the ward nurse managers to not be office-bound but to be out on the floor and aware of the plans and care of patients (p76).

Francis argues that there is no need to “radically reorganise”, but to emphasise what is truly important: that the patient should be the centre of

Can we really be confident that some of the problems of Mid Staffordshire could not be found in our health system? care and that there should be no tolerance for poor or substandard care. He lists eight items that he sees as being important (p66): • Emphasis on and commitment to common values throughout the system by all within it • Readily accessible fundamental standards and means of compliance • No tolerance of non-compliance and the rigorous policing of fundamental standards • Openness, transparency and candour in all the system’s business • Strong leadership in nursing and other professional values • Strong support for leadership roles • A level playing field of accountability • Information accessible and useable by allowing effective comparison of performance by individuals, services and organisations.

Some people reading the report may think the situation would never happen in Australia, that we do not have these issues – but is that really the case? Can we really be confident that some of the problems of Mid Staffordshire could not be found in our health system? Ours, too, is increasingly focused on meeting targets and financial outcomes, and it is not unusual to hear clinicians commenting that the interest in the patient seems to be at times overridden by the need to meet a target.

Nurses talk about the frustrations they feel at the emphasis on the targets to the exclusion of other important care issues.

In thinking about this further, I would argue that they are, in Wheatley’s words, in danger of becoming “cut off from the deep wellsprings of purpose” that not only motivates but sustains people in what are increasingly challenging and complex systems.

We also hear of the workload of ward nurse managers; that they find it difficult to get out of their offices and spend time on the ward, not only knowing what is happening with patients and their care but www.nursingreview.com.au

also providing the support and mentoring needed to nurses and contribute to longerterm staff retention.

All is not lost, though! Several health services in Australia have either undertaken or are undertaking work to both build the skills and capabilities of those in the critical role of ward nurse manager and also to ensure that they are not bound in offices.

A number of programs around Australia are seeking to shift the balance back to a focus on care; a number of these have transformational practice development as a foundation and they are having some success. Critically important in these programs is the examination of values that underpin the care that staff seek to provide, to enable them to implement strategies to deliver that care. I understand a system developed in the USA, known there as Transforming Care at the Bedside, is also being trialled in Australia. These more humanistic approaches to care contrast with the more mechanistic systems prevalent in recent years. They do not bring about fast changes or improvements, because they seek to bring about true cultural change, and that takes time.

However, as Francis says, it is critical that the culture and values that underpin our health systems are focused on compassionate care for patients.

I would suggest that all nurses take the time to read the Executive Summary (see www.midstaffspublicinquiry.com/ report), reflect on their own work and practice, and identify what can be learnt both from an individual and system point of view. Ask ourselves: Are we satisfied that compassionate care is the overriding driver of our work each and every day, or are we only doing something because it is to meet a target?

Adjunct Professor Debra Thoms is chief executive of the Australian College of Nursing.

For a fully referenced version of this article see www.nursingreview.com.au April 2013 | 27

clinical practice

Healing

wound care crisis

the

Better management of wound care could generate significant savings as budgets come under increasing pressure.

By Aileen Macalintal

No one profession working in isolation has the expertise to respond adequately to the increasing complexity of patients’ needs.

28 | April 2013

W

ho would think caring for wounds could cost billions?

An estimated 433,000 Australians deal with acute and chronic wounds annually, costing the health system $2.6 billion, according to a new organisation for wound-care tools, systems and technologies.

The Wound Management Innovation Cooperative Research Centre, established at the University of Queensland, contends that wound management is one of the 21st century’s major clinical challenges as the area receives little attention despite the need to improve approaches in diagnosis, treatment, management and prevention of wounds.

Research in this field, such as studies in wound and tissue repair, is yet to adopt modern biotechnology and evidence-based clinical practice, according to the centre.

In Australia, there are 4000 amputations due to a non-healing diabetic wound per year; more than 50 per cent of community nursing care involves wound care; a quarter of aged-care home residents have a wound; the second most frequently billed item in general practice is wound care; 400,000 Australians suffer from wounds at any given time; and wounds affect up to 10 per cent of those over 80 in Australia.

clinical practice Nurse practitioner Michelle Gibb, who heads QUT’s wound healing community outreach service, is alarmed by these statistics.

She said that with an ageing population, the problem of wounds is likely to rise, so it is essential that nurses identify those individuals at risk, know what interventions could be implemented to prevent skin breakdown and identify strategies on wound management.

Wounded health system

Gibb said research at QUT found that up to 70 per cent of patients with a venous leg ulcer have never been assessed to determine the aetiology (cause). Those patients have never had best-practice wound treatment – compression therapy – due to the simple reason that many are unaware of the availability of treatment, while others do not know where to seek help.

“Unfortunately, current Medicare subsidy arrangements do not encourage best-practice care. Australia does not fully subsidise the essential costs of care outside of the acute hospital system,” Gibb said.

This leaves major costs – including the cost of compression bandaging and stockings – with patients, who have to shoulder major costs. Many pensioners cannot afford the treatment.

“The result is a false economy where wounds do not heal, patients suffer and the health system is burdened with substantial avoidable costs such as repeat visits by community nurses and general practitioners and repeat admissions to hospital for recurring complications,” Gibb said.

All these add to the pressure on public hospitals, she said.

Leading the world

Every day, new dressings, diagnostic tools and therapies are designed to help improve outcomes for wound sufferers. Gibb admits it can be overwhelming keeping up with the developments in the area, yet there is an urgent need for more research.

“Fortunately in Australia, we have become world leaders in wound-healing research and are now working collaboratively across the nation to raise awareness and change practices and outcomes for patients,” she said.

WMICRC involves 21 partner organisations from around Australia. It has a $110 million research project focusing on the development of cost-effective and practical wound therapies, as well as diagnostics and clinical interventions.

In the coming years, a number of developments are expected to emerge from this project, helping to change the lives of those suffering from wounds and the most exciting thing, according to Gibb, “is that nurses will be one of the key people to implement the outcomes of this research”.

When caring for people with chronic wounds, nurses and other health professionals are being called on to develop partnerships and collaborative working relationships.

“No one profession working in isolation has the expertise to respond adequately to the increasing complexity of patients’ needs,” Gibb said.

while Upton is the leader of the Tissue Repair and Regeneration Program at QUT’s Institute of Health and Biomedical Innovation.

Learning more

Registered and enrolled nurses who want to specialise in wound management need to have an in-depth look at the latest evidencebased, cost-effective practices.

“It is essential that all health professionals increase their knowledge of wound care to provide the best management for their patients and work in a collaborative team together for the best outcomes,” said professor Geoff Sussman, from the faculty of medical and health science at the University of Auckland and faculty of medicine at Monash University.

Sussman, who has been involved in this area for almost 40 years as a clinician, researcher and educator, has been teaching in Ausmed Education Pty Ltd’s program, Wound Care Management – The Next Step, a two-day course designed for nurses who have knowledge of wound care.

The course includes a bandaging workshop and lectures on the impact of prescribed drugs on wound healing, caring for the feet of people with diabetes, and non-clinical complex wound issues.

Ausmed CEO, Cynthea Wellings, said feedback about the program had been great. “We have been running this program for a considerable period of time now and it is consistently highly evaluated by those who attend.

“The presenters are proficient in the area of wound care and continually update their knowledge to keep abreast of new evidence as it emerges and its implications for practice. They are also great lecturers who can really get their message across.

“This program has been run by the same educators for several years and we find that many participants seem to return to keep themselves up-to-date,” Wellings said. n

The dressing protector that keeps wounds dry while showering

Keep-Dri Dressings An effective solution to wound management and infection control in the hospital and home.

Rectangle protectors available in four sizes – Perfect for small to large wounds, catheters, hip replacements and drainage sites.

Bag protectors available in two sizes – Perfect for leg and arm casts, knee replacements and varicose veins.

Seminars and research

Through seminars and research, strategies and treatments are continuously developed to address the pain and suffering from different kinds of wounds.

The social and economic impacts of diabetic foot ulcers, for instance, have been studied. This research was presented when the Australian embassy in Jakarta hosted a seminar on wound management innovations last February.

Professors Zee Upton and Helen Edwards, who established the new centre, tackled treatment and management of wounds and their significant cost to patients, the economy and the wider community.

Edwards is from QUT’s School of Nursing and Midwifery, www.nursingreview.com.au

• • • •

Waterproof and hypoallergenic Ready made Simple to use Benefits nurses, patients and hospitals • Time and money saving

ABN 92 347 834 602 002

Australian owned and manufactured T +61 8 9271 4844 F +61 8 9271 4846 E nursinnov@iprimus.com.au www.nursinginnovations.com.au April 2013 | 29

workforce

What is a

climate-friendly hospital?

Hospitals are responding to climate change, but many nurses still don’t understand the issue. By Teresa Lewis

i

n response to Dr Liz Hanna’s article Dealing with climate change (Nursing Review, page 16, February), I wholeheartedly agree with the need to respond to our change in climatic activities. As Dr Hanna points out, since 2009, there have been global experiences of weather extremes.

“With the flexible hours it’s perfect for me.”

Nicole, Enrolled Nurse

You can make a difference

To search current vacancies or to register for alerts visit www.silverchaincareers.org.au

SC0740

Join over 3,000 staff and 400 volunteers who have dedicated their careers to making a difference to the lives of others. And, while you are helping people living in your community, we’ll help you build a rewarding career and reach your full potential.

Unfortunately, the call for mitigation measures has fallen upon deaf ears as target audiences fail to struggle with the whole concept behind global warming. Many scenarios have represented the causation of climate change and global warming which only adds to the confusion. Despite individual understanding, unequivocally our climate is changing.

The World Health Organisation and Healthcare without Harm in 2009 drafted a paper in response to a changing climate and the effects on health. This paper was called Healthy Hospitals, Healthy Planet, Healthy People and its basis was to define a framework for global health organisations to mitigate their greenhouse gases.

Since the 2009 draft, and the Australian government’s unconditional pledge to mitigate our carbon footprint, Australian healthcare organisations have begun shifting their ‘business as usual’ approach to one that is more climate-friendly.

Recently, some hospitals have published anecdotal information about their initiatives to become more climate-friendly. However, nurses working within these hospitals often struggle to understand the reasons and significance of such initiatives.

My research focuses on this very issue. Under the guidance of professors Lorna Moxham and Richard Fleming at the University of Wollongong and Dr Marc Broadbent at CQ University, I am undertaking a PhD examining the role of nurses who work within a climate-friendly hospital.

Using in-depth individual interviews as the method of data collection embedded within a phenomenological methodology, preliminary analysis has revealed a number of concepts but one area of note appears to be that nurses are ‘intrinsically’ committed to environmental issues, particularly at home.

However, when it comes to the workplace, there appears to be a lack of knowledge about initiatives and why they have been introduced.

There are also nursing implications for working in a climate-friendly hospital that are yet to be fully explored and understood. n Teresa Lewis is a PhD candidate at the University of Wollongong’s Faculty of Science, Medicine and Health.

30 | April 2013

workforce

Acute

frustration

Is the role of EN falling off the radar?

By Disheartened EN/PCA

I

am tired of constantly hearing about the plight of graduate RNs. I read many nursing magazines and feel the professional role of EN is disappearing from view.

In 2010, I was accepted into TAFE in the Fleurieu SA for the Diploma of Enrolled Nursing Div/2. Being a mature-aged student, I juggled classes, placements, study and some casual work in aged care as a personal carer. This was it; I was living the dream.

I had been led to believe there was a shortage of nurses and we would be able to work anywhere once we were qualified.

My life’s ambition was finally in my grasp.

The TAFE lecturers didn’t mention it was RNs the hospitals needed, not ENs. Disappointingly, the TAFE lecturers were so negative about the prospect of any of their students ending up working in the aged care sector that it became the class joke.

It wasn’t long before I realised we country ENs have been left with barely a place in the system other than in aged care.

My placement hospital had me believe I would have a casual position once my registration with the board was through.

That was over 12 months ago. I have had a few shifts at our local hospital as a PCA for difficult dementia patients or when PCAs are busy helping out on the ward.

I was sure this would lead to a position in the casual pool as an EN but once again, I missed out.

It seems city hospital ENs or ENs with more experience are the preferred option

for employment. I know young and old ENs trying to get an acute job and having to settle for aged care as they are overlooked locally.

My workplace just lost a young aged care EN to a Melbourne Hospital as that was the only acute job she could get.

I understand employers want experience but I feel my confidence wane as the year has passed, as I have not used the skills I learned on placement. I have completed my EN Diploma, medications and an IMVS placement, and have enrolled in the Advanced Diploma of Enrolled Nursing to increase my knowledge, but worry I am wasting my time.

I have been told the position of EN is being phased out. Is this true? Only one woman in our TAFE class is working as an EN. So I’m left with no confidence, and it seems there are no options for working in the field.

I have decided to take on more of a role as a PCA in the nursing home where I work and will not pursue my EN career in the acute sector locally any more. Who knows, I might move to Hobart and find a job there, but that’s another story. n To share your story, email the editor: amie.larter@apned.com.au

Directors of Nursing, Hamad Medical Corporation – Doha, Qatar Join one of the most ambitious healthcare organisations in the world Not only is Hamad Medical Corporation the premier healthcare provider in Qatar, it’s the driving force behind Qatar’s Academic Health System, one of the most ambitious in the world.

One of the largest employers in Qatar, HMC employs 20,000 staff and manages eight hospitals along with further specialist clinical, educational and research facilities. We are growing in capacity each year to meet the diverse needs of the expanding population and are currently building new Women’s, Ambulatory and Minimally Invasive Surgery, and Rehabilitation Hospitals.

HMC’s ambition, together with partners in education and research, is to become an academic health system; an internationally recognized centre of excellence in patient care, clinical education and research that transforms into significant clinical advancements.

receive world-class nursing care. With a post graduate nursing qualification and a strong track record of management, you will be able to demonstrate your experience in creating strategy and embedding transformational change to the profile and delivery of nursing services. We offer a competitive package and a good quality of life, as well as a once in a lifetime opportunity to make a real difference to the care of our patients.

If the challenges and opportunities offered by these exciting posts appeal to you, you can find further information at www.hamad.qa/ier and for a candidate brief containing application details please see www.odgers.com/42529 or email 42529@odgersberndtson.co.uk.

We are now looking for senior nursing leadership to develop our service as we move forward into this new era and ensure that the people of Qatar

www.nursingreview.com.au

April 2013 | 31

workforce

Inspiring change

Associate professor Roianne West, of James Cook University, is the first fulltime Aboriginal academic in the School of Nursing, Midwifery and Nutrition.

She spoke to Aileen Macalintal

We understand how gruelling doing a PhD is. How did you brave the storms of a PhD student? What kept you going?

There is this terrific song by Joyce Johnson Rouse called Standing on the Shoulders.

It came to mind when I finally celebrated the academic attainment and success of being awarded a Doctor of Philosophy and reflected on exactly that question.

What kept me going? I am ever mindful of those who have gone before me, in whose footsteps I have followed and now veer from to create my own path. The song goes: I am standing on the shoulders of the ones who came before me I am stronger for their courage, I am wiser for their words I am lifted by their longing for a fair and brighter future I am grateful for their vision, for their tolling on this Earth.

Sometimes that support lifted my academic game; sometimes it has been a personal inspiration, especially on those days when I felt I could not get out of bed and face another moment of the journey’s challenges. Sometimes, that support has been a reminder of the exquisite gift of family, friends, colleagues and loved ones who have been prepared to support me even when it meant putting their needs ahead of my wants.

32 | April 2013

How do you manage your time between your children and your career?

I laugh because I don’t know if I have done this bit that well, but hey, I survived. I knew that the sacrifices I made were short-term only and the benefits outweighed those.

At times I felt torn, but thinking of the longer-term benefits, although hard at that point in time, made this task easier.

Who influenced you in taking up a career in nursing and a place in academia?

I come from a family of nurses on both my mother’s and father’s side. They were hospital-trained.

It’s inevitable that I would work in indigenous health. I started out as a health worker, but I wanted to do more and make a difference to a greater number of my people and, for me, nursing was the best vehicle in which to do that. My three children also strongly inspire me to do what I do; to show them that anything was possible in spite of the challenges we sometimes face.

I went to the academe as I developed a passion for teaching which I felt comes naturally. In order to succeed here, completing a PhD is of paramount importance, and I’ve never looked back.

What makes you passionate about improving the lives of Aboriginal people?

For generations, my family has worked tirelessly towards improving the lives of Aboriginal people. My mother, who was

in indigenous health for over forty years, inspires me every day to do what I do. This is my purpose in life and my destiny.

What do you think can be done to finally close the gap? What can nurses contribute to this movement?

Indigenous nurses and midwives are critical to closing the gap! I can’t emphasise that enough. Evidence demonstrates that an increase in the indigenous health workforce is necessary to ensuring the Close the Gap campaign success.

Given that nurses and midwives make up the greatest percentage of that workforce, it makes sense that there is a concentrated effort in increasing indigenous nurses and midwives along with their capacity to take on leadership positions in industry, research and academia towards leading Australia’s nursing and midwifery workforce towards improving indigenous health outcomes.

Any memorable experience in caring for others?

Every day! To see the response from my mob when they hear and see what I do every day; they don’t necessarily know me, but they feel proud, and this gives them faith that things are improving for our people.

What is your perfect weekend like?

Work-free! A walk up Castle Hill, and then laze in the ocean! Coffee and breakfast with family and friends. n

workforce

Five wise men and a hardworking nurse

Amanda S. Gossman provides tips on keeping documentation up-to-date.

N

urses are talented and intelligent professionals, and our clinical skills, education and personal attributes are admired by many. These attributes need to be demonstrated at all times by our documentation principles.

This documentation conveys the care we have provided. Without it, our expertise is frequently judged in medico-legal matters.

Here are some of my hints for extraordinary documentation. These tips help me to reflect on the quality of care I provide as a nurse clinically, or in my case, work as a legal nurse consultant. I call it the Five Wise Men and the One Hardworking Nurse.

Who?

This refers to the patient. Whether I’m assessing them holistically at the start of a shift and throughout the shift, administering their medication or reporting changes in their clinical status, I always ensure that I verify that it is recorded into the notes of the correct patient. On occasion, I have found patients who share identical names, making for interesting discussions. Always remember to verify for yourself who it is that you are caring for and reporting about!

When?

I often chuckle about the frequency of recording in patient notes. My rule is that whenever I have any contact with a patient, regardless of how brief and trivial the contact may seem to others, I record it.

I once made a note about a phone call a patient received, and noted the patient had a subtle, but obvious, change in mood shortly thereafter. Further investigation revealed the patient had been informed of a distressing social issue, and it explained the lack of determination from the patient to participate in their recovery program from that moment.

This prompted a social work referral, and what a difference it made! The skill of knowing when to document something that is different from the usual care regime is developed by a nurse over time, and with experience.

With sufficient mentoring and continued education, nurses are able to rationally make appropriate and timely notes in patient records.

This sort of appropriate documentation indicates thought processes that are innate to nurses as patient advocates.

www.nursingreview.com.au

What?

I fear that this is the tricky one of the wise men.

Nurses are taught the conventional aspects of care to be recorded, such as medication rounds, doctor’s visits and fluid balances, to name a few. Every nurse does this beautifully. It is appropriateness and English language skills that need further exploration in discussions on documentation.

Why?

Documentation is a form of communication and therefore implies that there is a reason why something is being documented. If you are writing a progress note, then you want to convey a message to someone, usually any staff member who is nursing the patient in your absence.

Where?

Everywhere that your institution specifies you are to document – with no exceptions!

How?

Make time to document immediately after caring for the patient. It may be hard at first, but keep at it.

Write clearly and don’t convey your personal opinions about anything in your documentation. Give your clinical impression followed by the action you have taken. Always read the notes written prior and don’t rely completely on verbal handover to provide all the information needed about a patient.

Create your own style and quality that defines you.

Have fun documenting. n Amanda S. Gossman, B Cur RN, B Cur (Hons) Critical Care, CNE.

April 2013 | 33

workforce

Killing stress

“What causes me stress is the inadequate staff and/or skill mix … at the end of the day, you feel you’ve done a poor job.”

With work-related mental health issues on the rise, it seems a fitting time to address workplace stress prevention. By Amie Larter

I

n a perfect world, we would all have a job that is without stress of any kind – we would have the right skills, time and management support to complete our roles effectively.

In reality, there is an extremely high prevalence of stress throughout most professions, including nursing.

As defined by the World Health Organisation, stress is “the reaction that people have when presented with demands and pressures that are not matched to their knowledge and capacity and which challenge their ability to cope”.

Nurses and midwives have caring down pat – the profession is recognised for it.

However, when it comes to looking after their own health, nurses are often less active.

Michael Licenblat, resilience expert and CEO of www.bouncebackfast.com, knows all too well the implications of stress in the workplace.

“Workplace stress is a condition that occurs when the pressure of work (deadlines, working hours, client needs, etc) impairs your effectiveness, working stamina or wellbeing,” he said.

“Workplace stress is not something that happens ‘to’ you, but rather it happens ‘because’ of the way you handle pressure.”

Last year, Monash University released a report – What Nurses Want: Analysis of the First National Survey on Nurses’ Attitudes to Work and Work Conditions in Australia – that investigated the intrinsic and extrinsic aspects of working as a nurse in Australia, and the perceived shortfalls in nurses’ working conditions.

This was the first study of its kind, and it revealed that nurses felt they were under increased stress and pressure at work,

34 | April 2013

with a large proportion of respondents suggesting an increased workload as the primary cause of their work-related stress.

Heavy workloads, long hours, lack of management initiative, inadequate staffing and high patient loads were also listed as main stressors.

The report confirmed that burn-out, “a condition where an individual feels overextended and depleted of their emotional and physical resources as a result of the work they do”, is rife throughout the nursing profession.

Dr Virginia Skinner, from the University of Newcastle, agrees that the work environment can be quite stressful. “(Nurses) have high expectations and want to provide quality care to the woman or the patient and sometimes it is not always possible in that working environment.”

Skinner believes that another key stress factor is the requirement to work within an institution’s agenda – following specific policies and guidelines.

“If a nurse or midwife doesn’t work within those policies or deadlines and they do step out beyond those, then their registration could possibly be on the line ...

“They almost work in a risk-orientated culture and I think that makes them stressed even more.”

So how can we minimise the stress faced at work?

Licenblat believes nurses need to be proactive in handling pressure and take responsibility for responses, rather than waiting for managers to act after they notice signs of stress. He suggests three practical ways to build resilience to workrelated stress.

Punctuate your pace

Discipline yourself to take short breaks that get your body moving every two hours.

Physical and mental pressure builds when you are focused on a series of tasks for a sustained period.

Vary the intensity periods of your work so that you are not working at breakneck speed your entire day.

Keep moving forward

Give yourself space to fail and learn. Use your challenges and problems to improve on your next call, project, task, interview, etc. Leave the sulking to the children. Save your tears and self-pity for your therapist.

Not succeeding doesn’t mean that you are a ‘failure.’ It just means that you didn’t get what you expected. That’s it. Pressure will impair your personal drive when you dwell on what went wrong. Forgive yourself for being imperfect and keep moving forward.

Unwind your mind

Your work will never be done. When people don’t know when/how to stop working, they become burnt out and are less productive at work. Therefore, for career sustainability and self-preservation, it is vital that you practise leaving work ‘at work’ by switching off your mind and relaxing your body each night. To work at your best and maintain your energy and wellbeing, you need to have a life outside of work. n Quotes taken from What Nurses Want: Analysis of the First National Survey on Nurses’ Attitudes to Work and Work Conditions in Australia report, February 2012.

workforce “I am burnt out due to the huge workload that I am expected to achieve which is far beyond normal working hours. I currently do at least 15 hours unpaid work per week ...”

“There is insufficient staff to care for patients safely and this is extremely stressful ...”

“Fee unable ling the hig to provide quality hest level of c acuity p are due to hig h atient l oads an inadequ d a makes te staffing me feel stressed very ...”

“The main stressor is working in a system that is so broken ... where individuals or groups who have desire or ability to fix the problems are criticised, beaten down or just blocked by senior management.”

“We are consistently, daily, understaffed on each shift, and it is becoming part of the norm … it’s expected staff will pick up the extra patient loads.

It can be quite stressful in these circumstances just doing all the work that one needs to do in a day ...”

www.nursingreview.com.au

April 2013 | 35

legal corner

Lessons

from the of

sad case

Joshua

Who’s my patient?

Who am I responsible for? When should I request help? Sound familiar?

By Scott Trueman

36 | April 2013

N

Plumb

urses often work in very stressful, dynamically changing environments.

They have to be flexible, committed and able to work under pressure. Often they work with less than optimal levels of staffing and adjust working arrangements to cope. As the findings of the Joshua Plumb inquest highlight, this can be fraught with danger for patients and staff. In an attempt to cope, nurses need to ensure they are not making assumptions which expose them to liability and/or criticism.

Background

Joshua Plumb was born in 2003 with aspirated meconium and diagnosed with epilepsy and spastic quadriplegia. He was hospitalised 122 times in his seven years of life. He was unable to walk, talk or crawl and unable to control his head or sit up, although in bed he was mobile.

In December 2010, he presented at the hospital with blood in his bowel motions and a generalised deterioration in his condition; his mother proffered a flare-up of colitis. Blood tests confirmed a diagnosis of gastroenteritis with mild dehydration. The admitting doctor informed the ward staff that Joshua’s urine output should be checked every two hours, but did not comment on the frequency of ‘general’ observation; this was to be at the discretion of nursing staff.

The ward Joshua was admitted to was particularly busy and arguably became somewhat chaotic. The sequence of events was that RN A went to Joshua’s room about 7.40pm to administer his medication. He was crying and upset. Padded bed ‘bumpers’ were attached to the bed rails by RN B. While firmly in place, they could be pushed, and hence there was a possibility for Joshua to protrude though the vertical bed rails.

On the last occasion that Joshua was seen alive, at 9.35pm, his PEG tube was entangled; RN B attended to correct the situation. That was the last time observations were made on Joshua before he was found dead. At the time, the nurses were trying to cope in a highly fluid, increasingly stressful and ever-demanding

environment. There were 10 patients in the ward, including two children with cystic fibrosis, two in isolation and three post-operative patients for two nurses. In response to the ‘heavy’ workload and falling behind in their scheduled tasks, the two nurses decided to work as a team and share all the duties rather than have assigned patients.

Due to a series of interruptions and escalating workload from 9.35pm to 11.15pm, Joshua’s scheduled observation at 10pm was missed.

At 11pm, RN B left the ward, passing on that Joshua’s scheduled nappy check and observations had not been done. Between 11.10pm and 11.15pm, RN C entered Joshua’s room and saw he was lying cross-wise on the bed wedged between the padded vertical bed rail and the mattress, and obviously compromised. He was cyanotic and not breathing.

The coroner made findings in relation to a number of issues.

Issue 1: Nursing care plan

There was no written nursing care plan – a written and carefully considered nursing care plan was neither realistic nor feasible in light of the level of staff and demands of delivering nursing care. Consequently, the nurses created a verbal plan (an ‘understanding’).

It was agreed as part of the plan that twohourly observations were sufficient. Clearly, the admitting nurse should have completed a written nursing care plan.

Issue 2: Nursing care agreement/arrangement

The coroner found that the nurses’ agreement – to cope with the workload – to share all the nursing tasks of the ward, failed to deliver sufficient observational regularity for Joshua. It was found that the agreement was not patient-specific and failed to stipulate which nurse was responsible for which task.

The vagueness of responsibility pursuant to the agreement contributed to the failure of checking Joshua.

legal corner

Survival was worth the effort

i

Issue 3: Team leader responsibilities/ A request for staff – a challenge to training institutions

The team leader assessed that the ward was understaffed but was reticent to ‘argue’ for or ask the nurse manager for more staff.

The coroner recommended that nurse training be reviewed to highlight and educate nurses concerning their responsibility as a team leader, to continually consider the need for additional staff, the responsibility of the team leader to actively enquire and respond to a ward’s capacity to deliver adequate care and the need to continually assess risk and prioritise competing demands on staff. This potentially has consequences for nursing education.

Nurses are the front-line workforce which tends to simply cope. While coping with the pressures of the clinical situation, careful consideration should be made to match resources to demands. This inquest highlighted the need for nurses not to be afraid or timid in requesting assistance/more staff when they feel they are understaffed.

This is the primary responsibility of the team leader.

This inquest highlighted the tension between nurse’s assuming a ‘cope at all costs’ mentality (knowingly or not) and thereby exposing themselves to questioning of their professional conduct (in the eventuality of an adverse event) and their ethical duty of beneficence to do good and provide care.

It is arguable that the invidious position thrust upon nurses on occasions due to unrealistic demands dictates that they must pause, caution themselves and consider their potential liability and own exposure to censure. n Scott Trueman is a lecturer in the School of Nursing, Midwifery and Nutrition at James Cook University. www.nursingreview.com.au

am writing to respond to the article Anorexics force legal decision (Nursing Review, page 36, February). My reaction is heartfelt compassion and empathy for the issue of autonomy that the author Scott Trueman so rightly identifies as a legal and medical conundrum.

As someone who lived with severe anorexia nervosa for more than 15 years, including multiple hospitalisations (some involuntary admissions), tube feedings, ECT and a multitude of behavioural modification programs that focused on punishment and rewards linked to weight changes, I was one of those sufferers who felt intense depression and futility about life. I believed that it was my right to refuse treatment because of the torturous mental aversion/fear of any food or fluid touching my lips and entering my body. Following suicide attempts and severe illness over 15 years, the doctors in Australia gave up hope for recovery.

At that time, I believed that I was competent to make life decisions, including those regarding acceptance or refusal of medical treatment. After all, I knew the consequences of each choice. I was a registered nurse with experience in caring for those with eating disorders. From my perspective, my thoughts were rational and clear.

I had the self-perception of competence and would challenge anyone who doubted it.

My last admission in Australia was as an involuntary in-patient in an adult psychiatric ward of a major public hospital in Melbourne. I fought that involuntary status tenaciously and subsequently was awarded my ‘freedom’. I was dying. I knew I was dying and I really didn’t care. I believed that it was my right to choose treatment refusal.

To me it was the only way to escape the mental distress associated with eating.

My world changed when I left Australia a month later for a last-ditch chance at recovery. I had received a glimmer of hope from someone a world away in Canada – someone who understood my mental anguish without need for explanation. This private treatment facility in British Columbia promised hope for full recovery. I didn’t believe that I deserved treatment or that I was worthy of their investment in my future.

But there was a tiny part of my mind that grasped onto their words of compassion and hope.

The mental mindset at the core of eating disorders is one that convinces the sufferer that they are unworthy of support, that they need to reduce their size to take up less space in the world, and it twists thoughts to make the individual believe that food and fluid will somehow inflate their body size and increase their degree of distress. It is this mindset that the sufferer seeks relief from. Death can seem like a viable outcome. But the truth is that every single sufferer, no matter how severe or chronic with their eating disorder, has a tiny place inside that yearns for help, safety and wellness. They just can’t voice it because it seems indulgent or self-centred to ask.

The physical effects of malnutrition experienced by people with anorexia and bulimia do have a significant impact upon neuro-cognitive functioning. The negative voice that dominates their mind filters every conversation and thought into a deleterious message in their head that paralyses them and makes rational decision-making about treatment elusive. Biochemical changes adversely change the pattern of activity in the brain. Although often capable of logical thought in other areas of life, the emotional disengagement and irrational beliefs about nutrition and the illness process impair judgement specific to treatment refusal.

For the legal system to decide that a sufferer has the right to refuse treatment even when critically ill is simply evidence of a lack of understanding and knowledge about the true nature of eating disorders.

Sufferers have their minds controlled by an illness that disrupts brain function and destroys the physical body. How can someone with such impairment make an informed and rational choice about treatment refusal?

I would suggest that there is real hope for recovery for every person afflicted with an eating disorder. I plead with lawmakers and treatment professionals to search for that tiny voice within each sufferer that is seeking release and can cling to hope. One can reverse the deadly eating-disorder mindset completely.

I thank the author of the article for bringing this challenging scenario to the forefront and prompting dialogue and reflection. I hope that my personal story and assertions of hope can prevent even one legal or medical decision that allows treatment refusal when there really is true hope for a full recovery. No-one, absolutely no-one, is beyond help.

By the way, 14 years along and I am happily living an active and fulfilling life. The old patterns of illness, food aversion and weight loss are simply a long-ago memory. Life is indeed worth the effort of recovery. Life is bright, rewarding and full of opportunity.

By Jenelle Cooper RN April 2013 | 37

technology

CIOs brainstorm to help health professionals A group of Australians look at using technology to improve the provision of care. By Aileen Macalintal

i

nteractive video games and smart phones could be used to help improve the health of rural Australians, according to CIOs. A series of forums, the CIO Solution Roundtable, is underway among chief information officers nationwide, with the first forum brainstorming ways to modernise healthcare among mostly ageing rural Australians and change the way patients participate in their own care.

The first forum tackled how complex industries can address the many problems of rural healthcare and work on solutions together. Games and smart phones are some ideas that came up.

“If we improve the communications between companies that develop, market and integrate healthcare technology, then Brendan Lovelock this will drive innovation in the industry and deliver better solutions,” said roundtable convenor Dr Brendan Lovelock, the health industry practice lead at Cisco Australia.

Since a number of elements interplay to improve the connectivity between those involved in healthcare delivery, Lovelock said the forum did not just focus on one area of technology.

“It is hoped that by bringing these industry players together with the more traditional members of the healthcare ICT industry, we will develop more innovative ways of addressing the challenges faced by rural healthcare providers and their patients,” he said.

The potential of interactive media and game development industries will be tapped to deliver “a more engaging and purposeful experience for the user”, Lovelock said.

This meant exploring opportunities to better engage healthcare professionals and patients through smart phones and tablets, as well as personal measurement technologies to make information easily accessible.

38 | April 2013

Lovelock said he didn’t see a problem with people adapting to technology. “The essence of good technology is to create a user-appropriate experience so that the technology element disappears.

“Creating devices which are sympathetic to the physical challenges confronting many elderly patients is one aspect but creating software applications which have features appropriate to their healthcare needs is another important requirement.

“If you make technology relevant to elderly patients and support them appropriately, then they will use it.

“Also, the user of this technology is often not the elderly person, but the carers and healthcare providers who support those patients,” he said.

Lovelock said the important issues for those who will provide efficient care are: Does this technology really assist in managing my health, or the health of those I care for? Does the technology fit in with my lifestyle or the workflow I use when caring for others? Is this technology engaging? Is it not only simple to use but also enjoyable?

Lovelock outlined what he believed to be the most interesting ideas at the forum.

“The group decided that to make a difference in the Grampians (a remote area in western Victoria) in the shortto medium-term, we should focus on improving the connectivity between acute care, primary care (GPs), allied healthcare providers and the patient.

“We would look to reconvene a broad group including those members of the games and interactive media industries, plus the device development industries, to look at gaps in connectivity.”

Another goal was to build an evidencebased approach that could address problems in hospital overcrowding. If more patients were well-connected to relevant information and with their care providers, overcrowding in emergency rooms might be avoided. “A number of diseases that drive emergency department overcrowding

were discussed and it was decided that we needed to gather together a clinical subgroup of the roundtable,” Lovelock said.

Some of the diseases that cause overcrowding are coronary heart disease and chronic obstructive pulmonary disease.

“Information technology provides the capability for clinicians and patients to access and share information independent of where they are located, so that specialist care can be delivered in even the most remote, rural environment and patients can access information.”

Lovelock said rural health care faced multiple challenges, including an increase in chronic disease due to an ageing population, a shortage of skilled workers, and a healthcare process challenged by long distance.

“Addressing these issues requires the innovative and efficient use of our precious rural health care resources and the better coordination of care delivery in the country.”

With healthcare information technology, new models will be developed to overcome many barriers, he said.

Lovelock said IT would put workers and patients in better control of chronic conditions. “In addition, it allows better connectedness between care providers allowing improved coordination of the care process and enabling the right care resources to be delivered when and where required.”

The CIO Solution Roundtable grew from the Partnering for Healthcare Innovation conference last year in conjunction with the Medical Software Industry Association.

Lovelock said “the opportunity is to drive innovation by bringing together the smartest people from both large and small companies in the industry to share their knowledge and catalyse innovation in healthcare solution design.” n

save way with salary packaging

Take home as much as $2,960 more in pay each year.

As a health services employee, you could receive up to $2,960 more in disposable income each year by salary packaging with Maxxia. With the Maxxia Visa Card, you can pay for everyday expenses such as clothes, shoes, groceries and bills using pre-tax dollars. So whatever your lifestyle, Maxxia could help you save.

Maxxia offers: • Peace of mind - Talk to a real person when you call • Convenience - Manage your account online 24 hours a day • Inclusiveness - Even part-time and casual workers could claim

Find out how you could get more out of your salary with the Maxxia Visa Card.

CALL

1300 123 123 saveyourway.com.au/health

Talk to your HR adviser and find out whether you’re eligible to salary package with Maxxia.

Things you need to know: Salary packaging is subject to eligibility criteria and terms and conditions (available from maxxia.com.au or by calling us on 1300 123 123), and your employer’s Salary Packaging Policy. PAYG tax rates effective 1 July 2012 have been used, fees and charges apply. Your savings may vary depending on your particular financial, taxation and welfare benefit circumstances. You should seek independent professional advice before salary packaging. Maxxia does not provide financial, taxation or financial product advice on the relative merits of salary packaging or on any other basis. Maxxia may receive commissions or rebates in connection with some services it provides or arranges to be provided by third parties. Maxxia Pty Ltd ABN: 39 082 449 036 Auth Rep (No. 278693) of McMillan Shakespeare Ltd (AFSL No.2013 299054).

April | 39 www.nursingreview.com.au

The next generation in AmbulATory CAre And ACuTe PAin mAngemenT With an intuitive touchscreen, innovative design and unique patented technology, Sapphire helps you deliver.

more SimPliCiTy. more PerFormAnCe.

More Care.

Hospira Pty Ltd, Level 3 / 500 Collins Street, Melbourne Vic 3000 Š Hospira Pty Ltd 2013 ABN 13 107 058 328 130320SAPP 03/2013

international distributor of: