Ncah issue 22 2013

www.ncah.com.auNursing Careers Allied Health - Issue 22

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Education Feature

Paramedics devastated at helicopter rescue death

ACT nurses reach pay deal

Australian physiotherapists want prescribing rights

Tasmanian graduate nursing positions disappointing: ANMF

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Aged Care Special Feature

Fee cut for students and enrolled nurses

Union action over lack of grade four nurses

Telephone triage to free up paramedics

New Zealand’s �rst specialist stroke nursing course

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Water is a life force in more ways than one - it covers more than 70 per cent of our earth and we drink it to survive. When it comes to using water for childbirth, water birth is still a contentious issue that divides healthcare professionals and organisations alike. The fact that it’s contentious at all surprises some of Australia’s leading midwives, writes Karen Keast.

There are legends of Egyptian pharaohs being born in water and of South Pacific women giving birth in shallow seas.

The first written report of a water birth in the western world occurred in France in 1803, when a mother experiencing a long and difficult labour was helped to give birth in a tub of warm water.

In the 1970s, Igor Tjarkovsky, a boat builder, investigated the therapeutic benefits of water and installed a glass tank in his home for women to use for childbirth.

French obstetrician Michel Odent went on to pave the future of water birth. After a mother, using water to ease the pain of her labour, accidentally gave birth in the water, he went on to install a plastic paddling pool in a hospital so more women could enjoy the benefits of water birth while reducing their need for painkillers.

Only a small proportion of women in Australia choose to give birth in water each year although the exact number of water births is not known.

Griffith University Professor Jenny Gamble, a practising midwife of 30 years, says water births have come a long way in Australia but there is still a long way to go.

Professor Gamble recalls when a new maternity wing opened up at a Brisbane hospital, the then director general who was touring the facility instructed the plugs from the tubs to be removed.

“In his own way, he was saying water births might be a bad thing,” she says.

“Those days are gone. Water has become more accessible to women. There’s quite a lot of evidence to say that water is safe for women.

“More and more hospitals are putting in big tubs and there’s a range of deep tubs. It’s coming but it’s all too slow.”

Advocates of water birth say its benefits include the relaxing effect of warm water and feelings of weightlessness, buoyancy and ease of movement which help to alleviate pain naturally.

University of Western Sydney Professor Hannah Dahlen, a privately practising midwife and spokesperson for the Australian College of Midwives, says evidence shows water immersion may also help improve blood flow in the uterus, lower blood pressure, provide less painful contractions and result in shorter labours and fewer interventions.

Professor Dahlen last year published a study in the Journal of Midwifery examining the outcomes of 6144 Australian women who had normal vaginal births in a birth centre over a 12-year period. Her research compared women giving birth in water with those who gave birth in six other positions out of the water – kneeling or all fours, squatting, side lying, using a birth stool, standing and, the most common birth position in the country – semi-seated.

Professor Dahlen found those who gave birth on a birth stool had almost a one-and-a-half time’s higher rate of major perineal trauma and more than twice the rate of haemorrhage after delivery compared with water birth.

There was no difference in major perineal trauma and haemorrhage after delivery between women who gave birth in water and those who had a semi-seated position.

While those babies born in a semi-seated position had a four-and-a-half time’s higher incidence of five minute APGAR scores less than seven.

APGAR scores, which rate the newborn’s breathing effort, heart rate, muscle tone, reflexes and skin colour, of less than seven at five minutes after birth indicate medical intervention was needed to resuscitate the baby.

“Some studies have shown better outcomes but basically I found no difference to other birth positions,” she says.

“There was no evidence of harm. We want to do more research in Australia.

“We have no evidence to date that it’s harmful but we need more and more evidence to show it’s safe.”

Professor Dahlen says a water birth also provides women with a sense of protected space.

“They talk about how they felt there was a barrier; they felt it was a cocoon where they could feel safe,” she says.

Professor Dahlen says one common concern about water births is that the baby could drown but she says babies are born with a diving reflex, or bradycardic response, that causes them to hold their breath under water.

Professor Dahlen says despite mounting evidence proving the benefits of water birth, they still remain contentious in Australia.

“I have never understood it. I find it fascinating that water is so scary.”

Professor Gamble agrees.

“We’re talking about water, just water - not epidurals, not heavy duty drugs,” she says.

“Thank goodness hospitals are moving towards increasing their remodelling of their maternity suites to include tubs but quite frankly it’s a lot of fuss for something as simple as warm water.”

Professor Gamble says water births are common practice at planned home births, and are used during labour or active birth.

“Some women want to get in and get out for birth, some want to labour in the water and some hop in just for the birth – anything goes.”

Perhaps, most importantly, Professor Dahlen says water births are not about the baby.

“That’s what people get wrong,” she says.

“It’s about the mother and if you have a really happy and relaxed and stress free mother you actually have a baby that’s advantaged – they are born and very placid.

“They don’t often cry - they come up and blink.

“They are breathing fine. They come up all lovely and warm and then go to their mother’s chest.

“I really love water births.”

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

If you are interested in pursuing any of these opportunities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or if you would like to receive our publication, please email us at [email protected]

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Next Publication: Education featurePublication Date: Monday 9th September 2013

Colour Artwork Deadline: Monday 2nd September 2013

Mono Artwork Deadline: Wednesday 4th September 2013

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Issue 22 – 4 November 2013

Advertiser List

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Next Publication: Education featurePublication Date: Monday 18th November 2013

Colour Artwork Deadline: Monday 11th November 2013

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by Karen Keast

Tasmania’s 4000 public sector nurses and midwives have ramped up their industrial action, amid concerns at the state’s declining number of grade four nurses.

Australian Nursing and Midwifery Federation’s Tasmanian Branch secretary Neroli Ellis said nurses and midwives initially began “low key” industrial action after talks on the enterprise bargaining agreement stalled.

“Many nurses don’t claim overtime and missed meal breaks but the goodwill has now been removed and they are claiming those entitlements,” she said.

“In addition…we will put a ban on non-clinical paperwork.

“We don’t have that after hours support so nurses have to pick up those additional roles. There will have to be some extra ward clerks employed.”

Ms Ellis said the union’s members decided to accept the State Government’s offer of a “modest wage increase”, a two per cent pay rise over three years, but would not accept the issues impacting on safe skills mix, particularly the dwindling number of grade four nurses.

Ms Ellis said base grade registered nurses, at grade three and in their first year of nursing after graduation, are increasingly being expected to do the work of more experienced nurses.

“We haven’t got enough grade four nurses employed. Normally we have around 25 per cent,” she said.

“It’s dropped down even to as low as five per cent in some wards. In ICU, at the Royal (Hobart Hospital), it’s down to 10 per cent.

“In ICU, 90 per cent are base grade nurses, which is completely untenable. We want to see at least 25 per cent of grade four.”

Ms Ellis said the lack of more experienced nurses was jeopardising safe patient care.

“Many base grade nurses, who are more junior, are finding that quite stressful, particularly in the rural hospitals,” she said.

“They are asked to be in charge of the whole hospital after hours – they have to manage the whole environment as well as patient care.

“It just makes common sense to have an appropriate skills mix to ensure safe patient care. It’s about patient safety and we will continue to advocate for our patients.”

DHHS workplace relations and safety director Matthew Double said the department was disappointed in the action.

“There is no need for industrial bans and it is our primary aim to make sure there’s no impact on patients,” he said in a statement.

“The union leadership is now asking for significant additional concessions that far exceed what has already been agreed to by other health workers.”

The branch had a meeting scheduled with the government to discuss the EBA at the time of publication.


Many nurses don’t claim overtime and missed meal breaks but the goodwill has now been removed and they are claiming those entitlements “

”– Neroli Ellis

Australian Nursing and Midwifery Federation’s Tasmanian

Branch Secretary


It’s no secret that shift work can be tough on our bodies. Working odd hours and at night will seriously disrupt our circadian rhythm (our normal sleep-wake cycle). Humans are programmed to be awake and active during daytime (light) hours, and rest or sleep during nighttime (dark) hours. Changes in this pattern can often have long-term negative health impacts.

Nearly 20 percent of the Australian work force are employed to work shift rosters. Over 30 percent of shift workers and over 25 percent of people who rotate shifts experience sleep disturbance or sleep disorders. Lead author Robert Sack, M.D. reported in 2007 in “Sleep” that normally this disorder is characterized by insomnia and/or excessive sleepiness affecting people whose work hours overlap with the typical sleep period.

People who work night shifts often have trouble re-acclimatising to a day schedule on their days off. This change can result in significant sleep debt, which has significant implications for how well we function during the day.

Shift work and Light Therapy

The circadian rhythm is largely driven by a central biological clock located in the brain. This regulatory center controls our sleep/wake patterns, core body temperature, blood pressure, heart rate and several hormones. Light is the most important signal for our biological timing system. Therefore, bright light therapy has been developed and clinical studies have shown it improves the alertness and reaction times that shift workers experience.

By avoiding natural light at certain times of the day, and being exposed to artificial light at other times, biological rhythms can be adjusted. Light therapy allows for shift workers to adjust their biological clocks to match their shiftwork schedule, making sleep easier during the daytime and work for efficient during the night hours.

Methods of Light Therapy

There are various methods to supply light therapy. The majority of the light therapy uses blue light, (which is approximately 470 nano metres). Professor Leon Lack and Dr Helen Wright from Flinders University in Adelaide have researched various intensities to find the precise dose with the maximum effect on timing of the biological clock. Through this extensive research, they have developed the Re-Timer glasses. The Re-Timer glasses use a light intensity of 497 nano meters, which visibly is a green colour, but has blue light in it. It was found that this particular light intensity was found to be the most effective in phase advancing or delaying.

Light therapy can help improve sleep and nighttime alertness within a few days, although full effects of light therapy may take several weeks. Wearing dark goggles or special sunglasses to block daylight when trying to sleep increases the effectiveness of light therapy for shift workers.

Check out www.homemed.com.au for your pair of Re-Timers to keep you alert on your nightshifts.

Use the coupon code NURSE to get 15% off your purchase. Visit www.homemed.com.au

Managing Shiftwork with Light Therapy





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ENQUIRE TODAY

BENEFITS ON OFFER:




Free utilities









by Karen Keast




















Many nurses don’t claim overtime and missed meal breaks but the goodwill has now been removed and they are claiming those entitlements

“”– Neroli Ellis


Branch Secretary


















Geneva Healthcare

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For the full article visit NCAH.com.au

by Karen Keast

Registered nurses will be able to participate in New Zealand’s first specialist stroke nursing course next year.

The course comes amid increasing demand and interest in the stroke nursing specialty as statistics show the country’s ageing population is rising rapidly and forecast to grow from 600,000 to 1.1 million people aged more than 65 by 2031.

The University of Auckland’s School of Nursing will hold the six-day course in February, enabling registered nurses to up-skill in the area of nursing stroke patients.

Dr Julia Slark, who will lead the course, said the national clinical guidelines for stroke nursing highlight the need for nurses caring for stroke survivors to acquire specialist training to ensure patients receive best quality of care.

“The need for specialist knowledge in this area is really growing,” she said.

“This is partly because of New Zealand’s ageing population, and partly because stroke as a nursing specialty is new to New Zealand.”

Dr Slark, who has 15 years’ experience of clinical neurosciences and stroke specialty nursing, joined the School of Nursing as a senior lecturer and member of the Palliative and End of Life Care Research Group this year after steering London’s largest hyper-acute stroke unit, at the Imperial College Healthcare NHS Trust, through the implementation of the London Stroke Model.

The model ensures any London patient with a suspected stroke is transported to a Hyper Acute Stroke Unit (HASU) within 30 minutes, where they receive advanced intervention and treatment from specialist stroke staff.

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LOCUM SUPPORT FOR MIDWIVES

“Having a NAHRLS midwife here is great.”

“Having a NAHRLS midwife

here is great. Every NAHRLS

locum has enjoyed their time

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Find out more by visiting

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Carol Barnes Director of Nursing and Midwifery Wallaroo Hospital & Health Service, SA

Australian Government FundedNo Fees or Charges Apply

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We look forward






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For enquiries or to apply, please call 1800 673 123 or send your resume to [email protected]

UNIQUE OPPORTUNITY FOR REGISTERED NURSESAre you a self-motivated registered nurse searching for work/life balance?

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Midwives, Midwives, MidwivesLooking for a rewarding rural experience in the horse capital of Australia?IF YES, THEN DON’T MISS THIS OPPORTUNITY!Are you looking to escape the daily grind, need a new outlook on life, thinking about a tree change or just a few weeks away from the family to breathe? Well have we got an opportunity for you!

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by Karen Keast


Australia’s nursing and midwifery students applying for registration as a nurse or midwife will save $140, with the fee slashed to just $20.

The Nursing and Midwifery Board of Australia has cut the fees for final year students of board-approved study programs that will lead to their registration as a nurse or midwife.

The national board has also reduced the application fee for enrolled nurses applying for registration as a nurse or midwife from $140 to $20.

The fee cut takes effect from October 16 but any students or enrolled nurses who applied from July 1 will receive a refund.

The fee reduction does not apply to internationally qualified nurses and midwives participating in a bridging program.

Fee cut for students and enrolled nursesNational board presiding member Dr Lynette Cusack said the fee cut was designed to support new entrants into the nursing and midwifery professions while addressing their five-month period of initial registration, up until May 31 next year.

“This is an important initiative to support graduating students. We want to encourage them into the nursing and the midwifery professions,” she said in a statement.

Dr Cusack said new nurses and midwives will then need to reapply to renew their registration along with their 360,000 colleagues across Australia by May 31, 2014.

The Australian Health Practitioner Regulation Agency (AHPRA) is urging all graduating nursing and midwifery students to apply online before completing their program.


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As part of the National Health Reform, Inner West Sydney Medicare Local (IWSML) has been funded by the Department of Health to improve access to after hours care in local aged care facilities through a pilot program. Through this program, a nurse practitioner will be employed and supervised through the Sydney Local Health District to provide face-to-face after hours services at some aged care facilities in the Inner West Sydney region.

This model has the potential to improve access to primary health care for older people residing in RACFs. Care will be provided by a Nurse led After Hours Team who will have a mobile and rapid response capacity outside of normal business hours. The service will cover the entirety or part of the sociable after hours period.

Note: As de�ned by DOHA, the sociable after hours period is inclusive of:

The NP will be employed to provide mobile, face-to-face after hours services to aged care facilities in the Inner West Sydney region. Referrals to the After Hours Team will be via the Aged Chronic Care Triage (ACCT) and Residential Aged Care Facilities directly. The NP will coordinate a comprehensive hospital admission and avoidance strategy in collaboration with external and internal stakeholders to provide optimal care for residents of Aged Care Facilities in the SLHD catchment

Debra Donnelly at 0434567941

Or visit: http://nswhealth.erecruit.com.au/ViewPosition.aspx?id=159400

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The largest study of depression in nursing homes conducted in Australia to date has found that more than half of aged care residents suffer from depression.

The report, by the Australian Institute of Health and Welfare, shows 52 per cent of permanent aged care residents had symptoms of depression.

The finding, based on assessments of residents using the Cornell Scale for Depression (CSD) suggests depression among aged care residents is more common than previously suggested. The CSD is a modified version of the Cornell Scale for Depression in Dementia (CSDD), originally developed as a tool to screen for symptoms of depression in people with cognitive impairment. People with higher scores are more likely to have depression, which can only be diagnosed from a full medical assessment.

The study found that at 30 June 2012, just over half (52 per cent) of all permanent aged care residents had a CSD score that indicated symptoms of depression. There was a slightly higher rate in women (53 per cent) than men (51 per cent).

In terms of those entering residential aged care for the first time, about 45 per cent of those first time entrants from 2008 to 2012 had a CSD score that indicated symptoms of depression. In that period, the proportion of newly-admitted residents with symptoms increased by 21 per cent.

The research also found that residents with symptoms of depression had higher care needs; newly-admitted residents with a CSD score indicating symptoms of depression had higher care needs, with 73 per cent classified as high care, compared with 53 per cent of those without symptoms.

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Occupational therapists will shine the spotlight on the occupational disruption facing refugees and asylum seekers in Australia.

Occupational Therapy Australia has created a Refugee Settlement Special Interest Group for occupational therapists who are interested or have expertise in transcultural work with new arrivals.

OTA CEO Rachel Norris said the group comes on the back of the World Federation of Occupational Therapists’ (WFOT) position paper outlining the occupational disruption that occurs in the wake of human displacement.

“The primary goal of occupational therapy is to enable people to participate in the activities or occupations of everyday life, and our therapists work with people and communities to make sure they can engage in all of the activities they want to, need to, or are expected to,” she said.

“As such, the lack of fair occupational participation for refugees and asylum seekers, particularly those in detention, is a huge concern for our profession.

“We are positioned to play a significant role in enabling displaced people to bridge context gaps in their lives so that the human and health needs of these people are met and they can participate in meaningful life activities in this country.”

Occupational therapists and occupational therapy students also encouraged to register their protest at the occupational deprivation of refugees and asylum seekers online.

The launch of the new group comes as Australia’s 16,000 registered occupational therapists celebrated their valuable and innovative contributions to both the profession and their local communities as part of Occupational Therapy Week, held recently.

Ms Norris, an occupational therapist who has more than 25 years’ experience in the health care and non-for-profit sectors, said the profession was embracing a state of growth with many OTs becoming specialised and embarking on innovation in treatments and programs - ranging from YouTube channels for breast cancer patients to programs helping children develop their fine motor skills.

“We’re really trying to communicate to the wider community the great work occupational therapists are doing as for many it is a little known field until they are one day handed a referral from their GP,” she said.

“OTs are doing much more in the community than people realise.”

As part of OT Week, OTA held a range of events from award ceremonies recognising outstanding OTs to participating in a panel discussion at the University of Western Sydney on the National Disability Insurance Scheme.

Occupational therapists move to support refugees and asylum seekers


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www.ncah.com.au Nursing Careers Allied Health - Issue 22



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