Nursing Review April 2013

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Information about Nursing Review April 2013
Health & Medicine

Published on March 10, 2014

Author: papaRACSi


Australia independe ’s nt voice of nursing Issue 3 April 2013 Federal health The election issues that affect you The gap narrows Equality by 2030? Diversity days Making the most of our differences

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contents EDITOR Amie Larter (02) 9936 8610 Journalist Aileen Macalintal production manager Cj Malgo Graphic Design Ryan Salcedo SALES Nicola Mohtram 02 9936 8619 SUBSCRIPTION ENQUIRIES (02) 9936 8666 ACN ADDRESS CHANGE 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 to register or call Gillian on (02) 97392837 Earn points for every hour you study with Healthcare Hub and redeem for Ticketek vouchers. 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

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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 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 | 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 | 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 | 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 | 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 | 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 | A conference for organisations looking to provide alternative options to residential aged care N om i N NoWatE ! 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 ti ck E t E sa l oN NoW Generously provided by: Proudly presented by: Team @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. 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

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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

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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 to 185W BB 20130325 OL.pdf because they training, they wanted67Hx get involved and 1 26/03/2013 12:40:01 PM were not used to it. But they 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 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) Workshop 2 – Thursday 16th & Friday 17th May 2013 TO FIND OUT MORE OR TO MAKE A BOOKING Go to our website: or contact our office +61 3 8819 4732 or email 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 scribe 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 | | 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: U U U U U 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 Email 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 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. 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 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

ribe ubsc 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 T: (02) 9936 8666 Campus Review campusreview Education Review edreviewau Nursing Review 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

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