N u r s e C l i c kJUNE 2016

Climate change: Time for nurses to step up

Ending the aged care ‘lottery’

Using social media to lead, lobby and inform

When reassurance goes a long way

In focus @ACN

When reassurance goes a long way

NMBA update

Renew your registration by 31 May

In this edition

Events @ACN

Answering the call for ‘stories from the field’

Events @ACN

Over 200 breakfasts and 9,000 nurses!

Professional development @ACN

CPD short courses @ACN July–August

Snapshot

The latest health care news

Welcome

Adjunct Professor Kylie Ward FACN, CEO of ACN

Representation @ACN

ACN voices – meet our representatives

Policy @ACN

Ending the aged care 'lottery'

In focus @ACN

Vital Signs: Using social media to lobby, lead and inform

In focus @ACN

Climate change: Time for nurses to step up

3

10 13

4

19

7 9

20 22

11

Events @ACN

It’s time to secure your early bird registration before June 30

THE NATIONAL NURSING FORUM

26–28 October

2016

16

15

3

Publishing details

Publisher

Australian College of Nursing

Editors

Karina Piddington

Wendy Hooke

Designers

Nina Vesala

Emma Butz

Enquiries

t 02 6283 3400

publications@acn.edu.au

© Australian College of Nursing 2016

The opinions expressed within are the

authors’ and not necessarily those of ACN

or the editor. No part of this publication can

be reproduced without permission from

ACN. Information is correct at time of print.

All files marked ‘file photo’ or credited

to iStock are representative only and do

not depict the actual subjects and events

described in the articles.

Cover image: iStock photo

ACN publishes The Hive, NurseClick

and the ACN Weekly eNewsletter.

Welcome

WelcomeAdjunct Professor Kylie Ward FACN, CEO of ACN

It is my pleasure to welcome you to the June edition

of NurseClick.

The National Aged Care Alliance, of which the

Australian College of Nursing (ACN) is a member,

recently relaunched the Australians Deserve to Age

Well campaign, which advocates for important aged

care reforms. In the article, ‘Ending the aged care

lottery’, our policy team outlines the current shortfalls

in the system and why ongoing reform is so vital for

the future of older Australians.

Following on from her inaugural piece in last month’s

NurseClick, our wonderful nurse educator and

member Trish Lowe MACN continues to highlight the

innovation and leadership in nursing and midwifery in

her column, Vital Signs. This month, Trish explores

the value of, and potential in, social media as a tool for

nurses to communicate, lead and inform.

I am excited to welcome another regular commentary,

which comes from ACN’s Climate and Health

Community of Interest Key Contact, Dr Liz Hanna

FACN. As the President of the Climate and Health

Alliance, of which ACN is a member, Liz will be

keeping us up to date with developments in the

climate space and what we, as nurses and health

professionals, can do to protect and promote health

through climate action.

Experience and personal reflection are powerful

learning tools. In her article, ‘When reassurance

goes a long way’, Jenny Cavanagh MACN writes

of her challenging experience going from registered

nurse to patient and the immense difference it

made to have support and respect from the health

professionals caring for her. As well as understanding

serotonin syndrome, we can all take Jenny's

experiences into our own hearts, reflections and

practice. Thank you for your honesty, Jenny, and for

sharing your story.

This invaluable conversation via our publications is

just one of the many reasons our members are so

amazing. Whether it is through ACN’s representation,

policy, networking or learning activities, our members

are constantly proving their passion and commitment

to their profession. One such member is Tracey

McDonald FACN, who has been an outstanding

representative for ACN for many decades. Tracey has

kindly summarised her incredible work in this month’s

representation profile.

I am extremely proud to be able to give back to our

valued members with the unveiling of our first wave of

new member benefits this month. ACN Members

and Fellows can now access three new initiatives

– a new online portal, three free CPD courses and

discounts off all ACN courses. This offer value is

greater than the annual cost of ACN membership.

I am committed to ensuring our members enjoy

substantial benefits as a way to say thank you for the

knowledge and experience you bring to ACN.

More people in health and community services choose HESTA for their super

Find out more

4Snapshot

In the news

Nat ional

Brain scans could be used to diagnose depression and tailor treatments for it

Brain scans can reveal whether someone suffers

from depression and show what kind of depression

they have, according to a breakthrough new study.

The findings, published in Psychological Medicine,

showed that medical imaging techniques show

distinct differences in the brains of people suffering

different types of depression.

Read more

New device offers blood-free glucose testing for diabetes patients

A new device is promising to revolutionise the way

diabetes sufferers manage their condition on a

daily basis, by offering a pain-free alternative to the

standard blood sampling technique. Insulin users can

now scan their arm to read glucose levels using a

specially devised sensor the size of a 20 cent coin.

Read more

Ketamine could treat chronic pain

Ketamine, a drug mainly used as an anaesthetic,

could double up as an effective treatment for long-

term pain following surgery – with the potential

of saving billions in healthcare costs. A review of

studies found that ketamine was the safest and most

effective option available.

Read more

Key to long-term malaria vaccine unlocked

Queensland researchers believe they might have

found the key to developing a long-term malaria

vaccine. Scientists at the QIMR Berghofer Medical

Research Institute announced the results of a study

that looked into utilising immune cells known as CD8+

to help increase the life of malaria vaccines.

Read more

Gum an unlikely ally in stopping blindness

Researchers from the University of Sydney's Save

Sight Institute say they've discovered a simple

chewing gum test, which could hold the key to

identifying and treating Giant Cell Arteritis (GCA). The

condition is caused by the inflammation of the lining

of arteries in the head, restricting blood flow.

Read more

NSW emergency department presentations soar in summer months

Demand on NSW hospitals continues to rise

significantly, with more emergency department

presentations than ever before over the 2016 summer

months. Hospital admissions increased to nearly

459,000 this quarter – 14,100 (or three per cent) more

than the same time last year.

Read more

The link between chronic pain and depression: which comes first?

It’s easy to imagine that people with persistent pain

have cause to become depressed. After all, it’s a

problem that affects every part of life, not just the

bit that got injured. But like so much to do with

persistent pain, it becomes harder to unravel exactly

what the relationship is when one digs a little further.

Read more

Simple approach to buckle fractures eases strain on EDs

A streamlined pathway for a common childhood

fracture that utilises removable splints rather than

traditional plaster casts is leading to faster and

simpler outcomes for families and hospitals. The

pathway is designed to provide a more efficient

treatment to patients, speed up treatment times in

the ED and reduce demand on outpatient services.

Read more

Postgraduate Certificate courses

JULY ENROLMENTS NOW OPEN10% discount for members and alumni

The Australian College of Nursing’s postgraduate courses are designed specifically for nurses and midwives by nurse educators. We offer a range of accredited graduate certificate courses that deliver advanced knowledge and clinical expertise. Our graduate certificate courses are available online, studied over four terms of ten weeks each. They have a strong clinical focus and include leadership subjects that help you prepare for a leadership position in your chosen specialty.

5Snapshot

World

US to establish 'superbug' response lab network after detecting antibiotic-resistant strain

US authorities have announced plans to establish a

network of laboratories that can quickly respond to

antibiotic-resistant "superbugs", following the nation's

first human case of a dangerous strain of E. coli.

Read more

Scientists discover an inherited gene for MS

Scientists say they have found a gene that causes

a rare but inherited form of multiple sclerosis. It

affects about one in every thousand MS patients and,

according to the Canadian researchers, is proof that

the disease is passed down generations.

Read more

India hospital transfusions infect thousands with HIV

At least 2,234 Indians have contracted HIV while

receiving blood transfusions in hospitals in the past

17 months alone, say officials. The information was

revealed by the country's National Aids Control

Organisation in response to a petition filed by

information activist Chetan Kothari.

Read more

Cancer vaccine moves a step closer

Scientists may be closer to developing a cancer

vaccine after discovering a way to trigger the immune

system to fight the disease just like it would a virus.

They've developed a vaccine that is based on a

type of genetic material – RNA – that helps cells

create proteins.

Read more

Heart disease linked to women's migraines

Women who experience migraines are also more

likely to suffer from major heart problems, a new

study has found. Experts examined data on more

than 110,000 nurses taking part in the American

Nurses' Health Study. Of these almost 18,000

were reported to suffer migraines when they were

initially examined.

Read more

Alzheimer’s disease may stem from infections

Alzheimer’s disease may be the result of byproduct

that builds up in the brain when it fights infections,

according to a new study. The new study, if proven,

could change the way the medical community thinks

about the disease, and the development of drugs to

treat it.

Read more

Statins could stop breast cancer returning

Breast cancer survivors could benefit from taking

statins, scientists believe, after discovering that

lowering cholesterol halves the chance of the disease

returning in 10 years. A new study from the Institute

of Cancer Research has shown that breast cancers

use cholesterol to produce a molecule which has the

same impact as oestrogen.

Read more

Study links child obesity to bowel cancer

Children who struggle to stay at a healthy weight run

an increased risk of developing bowel cancer in later

life, research suggests. A Danish study of more than

250,000 individuals found young people with higher

body mass index (BMI) had an increased likelihood of

suffering from the illness in adulthood.

Read more

Apply now to start in June1800 818 865une.edu.au/pg-nursing

Progress your career with a Postgraduate Nursing Degree from UNE.

*Please note some units may have Intensive School requirements.

We have a range of flexible online* postgraduate degrees for you, including:▪ Graduate Certificate in Acute

Care Nursing▪ Graduate Certificate in Clinical

Education and Teaching▪ Master of Nursing

(Specialisations in Mental Health, Nursing Management and Rural Health)

▪ Master of Philosophy (Nursing)▪ PhD

6

Exci t ing new benef i t s now avai lable for ACN’s Members and Fel lowsThe first wave of new benefits for Australian

College of Nursing (ACN) members has arrived!

ACN values its Members and Fellows. Not only do

they inform our response to policy and contribute

knowledge and experience to help us shape health

care debate, they are the lifeblood of our preeminent

nursing organisation.

There are three new initiatives that will streamline

the member experience and provide significant

value that is greater than the annual cost of our

membership fees:

My ACN

My ACN is a new online portal where members can

access all of their details, benefits and services.

Members can update their profile and preferences,

and specify the publications they wish to receive.

My ACN is a practical information hub that will

ultimately put everything members need in one

place, with the convenience of a single login. We're

delighted to start to deliver these changes and will

continue to improve the services available in the

My ACN hub.

If you are a current member and have forgotten

your username or password, simply enter the

email address that you currently receive your ACN

correspondence to, to reset your login.

If you have any questions or issues with this process

please contact ACN Membership on 1800 061 660

or membership@acn.edu.au.

1, 2, 3 CPD courses for free

Members can now access three free CPD

courses each registration year (1 June to 31 May).

The courses that will be available are:

Abdominal Assessment

Cardiac Assessment

Deteriorating Patients

Musculoskeletal and Neurovascular

Assessment of the Lower Limbs

Musculoskeletal and Neurovascular

Assessment of the Upper Limbs

Neurological Assessment

Physical Assessment

Respiratory Assessment

To access simply follow these steps:

1. Log in to My ACN

2. Click on the Resources tab

3. Select the CPD course you wish to enrol in

4. Click Claim

You will be taken directly to CNnect where you can

start your free CPD course straight away.

If you have any questions or issues with this process

please contact ACN Membership on 1800 061 660

or membership@acn.edu.au.

Discounts off all ACN courses

Members and Fellows, you now receive a 10%

discount off full fees for all ACN Courses.

As an example: if you enrol in a graduate certificate

course, your discount represents a saving of between

$790 and $1120. If you don’t have the time or

resources to study a graduate certificate course,

you can enrol in a postgraduate unit of study, which

will provide you with a Statement of Attainment.

The discount will save you up to $327 on the cost of

a single unit of study, depending on the subject fee.

For a full list of courses offered by ACN please

visit our education page or contact our

Customer Services team on 1800 265 534

or customerservices@acn.edu.au.

How to claim your discount:

When you fill out the application form for your unit or

course, please quote your member number as your

special offer discount code.

1. The discount is valid for all full-price ACN courses,

excluding CPD workshops and short courses,

which are already priced at a reduced member rate.

2. It is not valid with any other discount offer.

3. You need to quote your member number on

course enrolment documentation in order to claim

the discount.

4. Offer subject to change without notice.

If you are not already a member of ACN, you can 

sign up now to take advantage of these benefits

and services.

Snapshot @ACN

ACN NURSING & HEALTH EXPO 2016

Attend the Expo to expand your nursing or health career!

Free entry!

Sunday 19 June 2016 8.30am – 1.30pm Perth Convention & Exhibition Centre

With thanks to the support of

PERTH

7In focus @ACN

Ending the aged care ‘ lot ter y’: The Nat ional Aged Care A l l iance work ing towards the fu ture of Aust ra l ia’s aged care sys tem By Anita Pak, Stefan Wythes and Stacie Murphy MACN

Australian College of Nursing (ACN) encourages

anyone concerned about access to quality aged

care to back the relaunched National Aged Care

Alliance (the Alliance) Australians Deserve to Age

Well Campaign. The campaign outlines the need for

ongoing aged care reform, including the need to end

the capping of aged care places, otherwise known

as the “aged care lottery”.

ACN is a member of the Alliance, a collaborative

of peak national aged care organisations which

includes consumer groups, providers, unions and

health professionals working together to determine

a more positive future for aged care in Australia.

The Alliance supports a vision for aged care in

Australia that enables access to quality aged care

services that are planned, resourced and integrated.

The Alliance also upholds that services are flexible

and equitable, and also recognise diversity and

promote choice and respect for users and workers

(National Aged Care Alliance (NACA), 2007).

At the inaugural meeting of the Alliance in 2000,

representatives identified a number of issues at the

forefront of aged care health policy, which included

consumer rights, quality of care, workforce

planning and the short and long term financing of

aged care. These issues became the cornerstones

of the Alliance’s united policy agenda aiming to

improve outcomes in the care of older Australians

(NACA n.d.).

Australians Deserve to Age Well campaign

The impact of Australia’s ageing population is

evident with an estimated 3.5 million Australians

predicted to utilise aged care services by 2020

(NACA 2016a), with the changing nature of

Australia’s ageing population highly published.

On 23 May 2016, the Alliance relaunched its

Australians Deserve to Age Well campaign, which

targets all political parties, seeking reform to ensure

that older people do not have to wait months on

waiting lists to receive aged care services as there

are not enough aged care packages available

(NACA & COTA 2016a).

With the election campaign in full swing, the Alliance

is sending a clear message to all parties to end

what they call the “aged care lottery”. The “aged

care lottery” is essentially a process of rationing

aged care places. For example, at the moment, the

government only funds 112 services for every 1000

Australians over 70 years (NACA & COTA 2016a).

Policy @ACN

8Policy @ACN

“Representatives identified a number of issues at the forefront of aged care health policy, which included consumer rights, quality of care,

workforce planning and the short and long term financing of aged care.”

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with postgraduate study

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specialist

The current system means that if you are number 113,

you may miss out (NACA & COTA 2016b).

Under the current system, an older person may be

assessed as requiring a certain level of care, however,

due to the imposed caps, the necessary care may

not be immediately available and they may need to

wait for services. Some people may only get a portion

of the care they really need or they may never get

the care even though they have been assessed as

requiring it (NACA & COTA 2016a).

A weakness of the current system is that the funding

structures prevent providers from tailoring care to

individual requirements. It is therefore important that

there is a move towards individualised funding for

consumers to allow for greater flexibility, supporting

clients to choose from services offered within the

private and public sector and the general community

(NACA & COTA 2016b).

The Alliance has also developed its Position

Statement for the 2016 Federal Election (the Position

Statement). In addition to ending the “aged care

lottery”, this key statement highlights reforms the

Australian Parliament should adopt to further improve

aged services to better cater for the diverse needs of

older Australians (NACA 2016b).

The Position Statement builds on the proposals

outlined in the Alliance’s 2015 Blueprint II, forming a

series of documents stemming from the Alliance’s first

Blueprint for Aged Care Reform published in 2012.

The Position Statement also revisits reforms

already undertaken or committed to by Australian

governments following the release of the Productivity

Commission’s seminal report, Caring for Older

Australians (NACA 2016b).

Reform principles

The key principles underlying the reforms that the

Alliance highlights are consumer choice and control.

The Alliance states reform must “move beyond the

specific meaning of individualised funding that the

implementation of Consumer Directed Care (CDC)

Home Care Packages has attached to the term CDC.

The focus is on ensuring that care is available which

is responsive to people’s level of ability, life goals and

strengths, by providing tailored service options across

the service systems” (NACA 2016b).

Importantly, the Alliance suggests that governments

and service providers must, in consultation with the

consumer, ensure support to “individuals who may

struggle to receive equal access to the services they

require under an individualised, market-based model”

(NACA 2016b).

Key proposals of the campaign

The Alliance has put forward a number of proposals in

the Australians Deserve to Age Well campaign which

aim to improve the services that older Australians are

receiving. These include:

• Giving the consumer the right to choose where

their residential care funding will be allocated

and the choice to move services if they are

not satisfied.

• Uncapping aged care supply to better allow care

to be provided where and when it is needed.

• That the government and the aged care sector

work together to identify the risks (financial and

other risks) associated with proposed reforms

to move to consumer led and demand driven

aged care.

• A commitment to an independent “cost of care”

study so informed decisions can be made on how

aged care will be funded in the future.

• The campaign encourages political parties

to adopt the Alliance’s Election Positions to

progress aged care reform (NACA & COTA 2016b).

The Alliance encourages everyone to sign the

Australians Deserve to Age Well petition, addressed to

the Prime Minister, the Opposition Leader and Leader

of the Greens, to end the “aged care lottery”.

The Alliance believes by removing the current

restrictions on the level, quantity and distribution

of services that providers can deliver, Australia can

develop an aged care system that is more responsive

to each older person’s individual needs. ACN

members and non-members are encouraged to sign

the petition here and to visit the Alliance’s website

for further information.

References:

National Aged Care Alliance 2007, National Aged Care Alliance, NACA, Canberra, viewed 24 May 2016, <http://www.naca.asn.au/index.html>.

National Aged Care Alliance n.d., About NACA, NACA, Canberra, viewed 24 May 2016, <http://www.naca.asn.au/about.html>.

National Aged Care Alliance 2016a, Australians Deserve to Age Well, viewed 25 May 2016

National Aged Care Alliance 2016b, Position Statement for the 2016 Federal Election, viewed 27 May 2016 < http://agewellcampaign.com.au/wp-content/uploads/2016/05/NACA_Blueprint_Election_Campaign_2016.pdf>

National Aged Care Alliance & Council on the Ageing 2016a, What is the problem in aged care today?, viewed 26 May 2016 < http://agewellcampaign.com.au/reforms/problem-aged-care-today/>

National Aged Care Alliance & Council on the Ageing 2016b, How can we improve aged care, viewed 26 May 2016 < http://agewellcampaign.com.au/reforms/can-improve-aged-care/>

9Events @ACN

Community & Primary Health Care Nursing Week

Nurses where you need them19–25 SEPTEMBER 2016

How to get involved:

The ACN Community and Primary Health Care Nursing Week: Nurses where you need them national campaign will take place from  19–25 September 2016. Here’s how you can get involved this year:

• If you have an interest in sharing a story that describes a time ‘when’ your nursing care has impacted on the health and wellbeing of individuals and/or communities, then we encourage you to submit your story.

SUBMIT YOUR STORY

• Wear an orange scarf or t-shirt during the week of 19–25 September 2016 to show your support of Community and Primary Health Care Nurses.

• Hold an event during the week to get your town or city on the virtual map of supporters across the country and to share readings from the eBook to promote and discuss the important roles in Community and Primary Health Care Nursing. Events you can host may include a social gathering, morning or afternoon teas, public lecture or informal networking function.

REGISTER AN EVENT

• Nursing organisations can join ACN as a supporter of the week to raise awareness and the profile of Community and Primary Health Care Nurses. Supporters will be acknowledged on the ACN website and in the eBook.

REGISTER AS A SUPPORTER

• Spread the word to your networks! #nurseswhereyouneedthem

With thanks to the support of our official sponsor

Ruth’s inspiring story features in the

2015 Community and Primary Health

Care Nursing Week: Nurses where

you need them eBook. This year,

we’re asking nurses to share a story

that describes a time ‘when’ their

nursing care has impacted on the

health and wellbeing of individuals

and/or communities. Click here to

find out more and submit your story

for the 2016 eBook!

Ruth Sheahan (right) with one of her patients

Answering the call for ‘stories from the field’By Ruth Sheahan

My primary health story is a tale of passion and compassion.

I feel very lucky to have been selected to work within the NSW Refugee Health Service as a member of the NSW Refugee Health Nurse Program (RHNP), which commenced service in October 2012. This recent and innovative NSW Health initiative aims to address the health needs of this marginalised population group whom arrive in our country often in poor health, with meagre health literacy and, more often than not, no English language skills to speak of.

The RHNP focuses upon newly arrived refugees holding a valid Australian Humanitarian Entry Visa. It aims to settle them into our complex health system by linking them with a local general practitioner

and other area health services such as dietetics, oral health, early childhood and women’s health clinics as required. We do our best to link those that need psychological healing into trauma counselling (STARTTS) as soon as possible. The RHNP also offers in-house services such as immunisation, treatment of vitamin D deficiency and QUIT smoking programs. Those whom arrive with more urgent and complex health issues are managed as a priority.

My position requires that I operate in an often autonomous role, drawing on a broad spectrum of nursing knowledge and experience. The ability to advocate on behalf of my clients is especially pertinent as a great deal of my time is spent assisting them gain access to services such as disability and aged support, access to specialist outpatient clinics and sourcing professionals and services that will provide pro-bono or bulk billing services.

I am based at the Refugee Health Service Head Office in Liverpool. The Liverpool district hosts a large proportion of Arabic speaking refugees whom have arrived fleeing conflict and persecution in Iraq and more recently Syria. I find it very important to be culturally informed in regard to my client’s respective customs and beliefs, and sensitive toward the situations they have fled. Iraq was once a very cultural and diverse country with peoples from many faiths and ethnicities living in relative harmony. During the recent civil upheaval this ethnically cohesive society has been torn to shreds, Muslim sects turned

against each other, ethnic minorities such as the Mandean peoples have been particularly victimised, prominent Christian communities such as the Assyrian and Chaldean peoples have also suffered persecution. People of secular and liberal Muslim views came under threat of attack as did anyone who ran a profitable businesses. Many have suffered torture, kidnap and witnessed unspeakable atrocities.

Nonetheless, the strength and resilience of our refugee individuals and families never ceases to amaze me and it is such a great privilege to welcome and care for these folk on behalf of NSW Health and the greater Australian public. Our service aims to strengthen the community as a whole by providing the most optimal health pathways possible to assist these new members of our society make Australia home.

10In focus @ACN

Using social media to communicate, lobby, lead and informBy Trish Lowe MACN

Sitting on a crowded train, surrounded by fellow commuters, it is hard to imagine a time when portable access to the internet and social media, did not exist. Yet, it is estimated that since the first generation of smartphones were released in 2007, ownership has

expanded to over 80% of the Australian population. Ownership confers the capacity to complete a range of tasks, including monitoring social media and listening to podcasts, music or newsfeeds at any time. Nurses and midwives have embraced social media as a means of communicating and engaging with each other, lobbying, informing and leading the way.

In 2014, The Australian Institute of Health and Welfare, estimated that 40% of nurses and midwives, were 50 years of age, or older. These health professionals have consequently witnessed significant social, economic and political change throughout their lives whilst simultaneously enjoying the personal and professional benefits, associated

with technological advancement. Notwithstanding the geographic, cultural and age related diversity of Australia’s nursing and midwifery workforce, requirements for rapid distribution and assimilation of knowledge remain, with social media providing a means of achieving this. Some useful examples of nursing and midwifery related social media sites include the Australian College of Nursing Facebook, Twitter and Instagram pages.

Whilst personal communication is undoubtedly considered the least authoritative source of information within the ‘hierarchy of evidence’, opinions expressed via social media offer insights into the realities of life for nurses and midwives, have a useful role in expanding professional networks and may initiate critical enquiry.

“Nurses and midwives have embraced social media as a means of communicating

and engaging with each other, lobbying, informing

and leading the way.”Trish Lowe MACN

Vital Signs

TO RESEARCH REVIEW

MAKING EDUCATION EASY FOR NURSESwww.researchreview.com.au

Subscribe

free

subscribe now

Visit www.collegianjournal.com

Read the latest in nursing research and practice in ACN’s digital journal, Collegian.

Access to the peer-reviewed publication is free for all ACN Members via the My ACN member portal, members.acn.edu.au

11

Hedland Health Campus

Events @ACN

Over 200 breakfasts and 9,000 nurses!

Proudly supported by

We would like to sincerely thank all our members who got involved in the 2016 ACN National Nurses Breakfast. We hope you enjoyed spending International Nurses Day with your colleagues and friends and celebrating the invaluable contribution nurses make to the health of our society.

240 breakfasts were held across the country with over 9,000 individuals taking part. It was wonderful to see so many groups involved and sharing their celebrations on social media.

Click here to see all the #ACNBreakfast posts from breakfast hosts and supporters across Australia.

North TasTAFE Griffith University

Esperance Hospital Darling Downs Hospital and Health Service Neurological Council of Western Australia

12Advertorial @ACN

Best care at fingertips with palliAGEDnurse app

Nurses caring for older people near the end of life

are now able to access current clinical advice at

the point of care, thanks to the development of a

new smartphone app.

Available free through Google Play and the

Apple Store, the app – palliAGEDnurse –

has been developed as part of the Decision Assist

program for aged care staff in residential and

community settings.

It provides clinical advice based around three key

areas – advance care planning, case conferencing

and terminal care.

The app was developed by the CareSearch

Project Team at Flinders University, following

the production last year of the palliAGED app for

General Practitioners (GPs).

Suite of two palliAGED apps

The positive response from GPs to the palliAGED

app has led Decision Assist to produce this

second app for nurses, with the two apps being

marketed through app stores as a suite of two

apps – one for GPs and one for nurses.

CareSearch Director and Associate Professor

Jennifer Tieman identifies several reasons for the

palliAGEDnurse app development.

“With the rapidly expanding knowledge base for

clinical practice, it can be challenging for health

professionals – including nurses – to keep their

knowledge and skills up to date,’’ she says.

“While continuing professional development is an

important professional responsibility to invest in

new skills and knowledge, nurses also need to

be able to access knowledge at the point of care,

that is, where they practice.

“Web based resources that are constantly updated

are helpful for this and the growing use of apps

prompted Decision Assist to explore different ways

to share clinical knowledge and encourage its use

in practice.”

The locations in which nurses are providing care to

older people are increasingly varied, which raises

the need for portable resources for nurses to

consult at the point of care.

For example, increasingly older people are enabled

to live at home through the provision of Australian

Government Home Care Packages and many are

spending some or all of the last year of their life

at home. Nurses will therefore need to be able to

recognise and address their palliative care needs.

Whatever the location for care, nurses usually need

similar information, as well as some setting-specific

ideas which are provided through the app.

A palliative approach

Being able to recognise that an older patient may

die within the next 12 months is an opportunity for

nurses to plan for changing care needs.

Using a palliative care approach, the palliAGEDnurse

app provides four key sections:

• Understanding a palliative approach

(and identifying older people needing a

palliative approach)

• Advance care planning

• Palliative care case conference

• Terminal care planning

App keeps up to date and works anywhere

CareSearch has designed the app to constantly

update the advice that it gives nurse users.

Being web based, the app goes to the website –

where new evidence is published – to read its

content.

Nurses working out of internet range can use the

app as it holds a version locally in the phone.

13In focus @ACN

Climate change: Time for nurses to step upBy Dr Liz Hanna FACN, Key Contact ACN Climate and Health Community of Interest

Climate deniers are a

dying breed. Their voices

are increasingly fading

under the overwhelming

evidence that climate

change is scientifically

valid (IPCC 2013) and

evidence of climate

mayhem unfolding all

over the world (WHO &

UNFCCC 2015 ).

Similarly, the evidence is overwhelming that fossil

fuel industries were funding the leading groups

working to disseminate the seeds of doubt

(Oreskes & Conway 2010; Klein 2014). They have

failed. Nations are moving towards renewable

energy sources and away from fossil fuels. In

2015, global investment in renewables was double

that of fossil fuels (McCrone et al. 2016). Coal

prices have plummeted, such that the world’s

largest coal company declared bankruptcy in April

(Kary et al. 2016).

Those of us who are concerned about climate

change and studying these trends have been

warning banks, universities and superannuation

funds that the end is nigh for the fossil fuel

industries, urging them to ‘divest’, that is, to

protect their investment portfolio and sell all

shares in fossil fuel companies. It was inevitable

that shares in those companies would become

‘stranded assets’, meaning they will lose their

value as alert nations shift their economies

towards clean energies. International coal prices

have collapsed, hence the bankruptcy.

You may ask why has the health sector been

involved in these campaigns? It seems a long

way from our “core business”.

To the contrary, collectively, the health sector

works to optimise human health and well-

being. Some of us work in curative health,

restoring health, many others are involved in

preventing ill health, working to ensure that

health determinants are optimised to enable

opportunities for people to enjoy good health

and remove the barriers to good health (such as

redressing situations where high-fat, high-sugar

foods are cheaper than healthy options). Others

are involved in research, policy, training the next

generation of health workers and administration.

We are all working towards the same goal –

keeping Australia healthy.

How climate change fits into all this is through our

global energy usage. Our past habit of burning of

fossil fuels has released gigatonnes of greenhouse

gases into the atmosphere, to such an extent that

we have now altered atmospheric chemistry and

warmed the planet. 2014 was the world’s hottest

year, then 2015 quickly passed that by a very long

margin, and January to April 2016 have continued

breaking global heat records, by increasingly large

margins (WMO 2016a; WMO 2016b).

Liz Hanna FACN

Climate & Health

14

The average annual global temperature is now more

than one degree higher than pre-industrial times

(WMO 2016b). So, using long term data, we are

halfway towards the arbitrary 2oC limit, and more

importantly, two-thirds of the way towards the more

sensible limit of 1.5oC of total warming.

The short term data is even more concerning. Global

average land temperatures between December

2015 to February 2016 were 1.95oC warmer than

pre-industrial times, and was more than 2oC warmer

for the entire month of April (NOAA 2016). The most

intense El Niño on record is now receding, so these

hyper extreme temperatures are expected to settle

as a flip to La Niña is likely over the coming year

(BOM 2016).

Already, with a global averaged one degree of

warming, 300,000 people die every year due to

climate change alone. The numbers will increase

exponentially as temperatures continue to rise and

storms, droughts, floods, sea-level rise, heat and

fires really ramp up. Global heat deaths have risen by

a massive 2,300% (WMO 2013), and there is more

to come.

The Climate and Health Alliance (CAHA) was set up

to provide a cohesive voice from the health sector

to educate the public and policy makers that climate

change was bad for health (see www.caha.org.au).

I am President of CAHA, and the Australian College

of Nursing (ACN) is a member.

A recent study, commissioned by CAHA, calculated

the health costs attributable to coal mining in the

Hunter Valley from exposure to the very small

particles of air pollution (PM2.5) amount to $65.3

million and the full annual social costs to $66 billion.

So not only is coal causing global warming, it is also

directly harming the health of Australians, especially

those living nearby. This amount of illness and waste

of money need not occur. Australia can already fully

power itself through renewable energy sources,

which do not kill, and can offer long term jobs

(Jotzo & Kemp 2015).

So we, as nurses have an important role to play.

Firstly, we all need to know the climate change risks

for our part of the world and how that will impact our

professional activities. The health sector needs to be

prepared and this includes education and training of

our future workforce, plus professional development

for the existing workforce. In the next issue I will

expand further on preparedness, vulnerability

assessments and adaptation which are all key to

this planning.

If any of you are still feeling trepidacious about

whether nurses should be engaging in this space,

you may ask who else is now on board. In 2009 The

Lancet called climate change “the greatest health

threat facing humanity”. The International Council of

Nurses, the Royal Australian College of Physicians,

the Australian Medical Association, the Australian

Psychology Society, the Pope, the World Health

Organization, World Bank, and even the Australian

Government Department of Defence are all on

board.

I am a member of an International group of nurses

who are engaging with climate change. It is time for

Australian nurses to come out and lend their support

and energies into:

• Cutting greenhouse gas emissions from their

private lives and professional arena

• Educating themselves on climate change and

what needs to be done

• Becoming a trusted source of education for

the Australian community who seek expertise

from nurses

• Be part of the global movement to urge for a

cleaner, safer world to save lives and prevent

ill health.

• The ACN Climate and Health Community of

Interest is now reforming. We are facing a brave

new world; one that carries serious threats, and

needs nurses to help protect current and future

generations. I invite you to join.

Nurses CAN make a difference! Let’s do it together!

References

BOM 2016, ENSO Wrap-Up: Current state of the Pacific and Indian Ocean, Bureau of Meteorology, Melbourne, viewed 5 May 2016 <www.bom.gov.au/climate/enso/wrap-up/archive/20160426.archive.shtml>

IPCC 2013, Working Group I Contribution to the IPCC 5th Assessment Report "Climate Change 2013: The Physical Science Basis". Geneva, Switzerland: Intergovernmental Panel on Climate Change (IPCC), 2013. viewed 3 Dec 2014. <www.ipcc.ch/report/ar5/wg1/#.UudGWhB9Lcs>

Jotzo F. & Kemp L. 2015, Australia can cut emissions deeply and the cost is low: Submission to the review of Australia’s post-2020 emissions reductions target, Centre for Climate Economics & Policy, Crawford School of Economics and Government, The Australian National University, Canberra, viewed 23 November 2015 <https://ccep.crawford.anu.edu.au/files/uploads/ccep_crawford_anu_edu_au/2015-05/australia_can_cut_emissions_and_the_cost_is_low-_jotzo_and_kemp_april_2015_-_submission_to_dpmc.pdf>

Kary, T., Loh, T. & Polson, J. 2016, "Coal Slump Sends Mining Giant Peabody Energy Into Bankruptcy", Bloomberg, 13 April 2016 <www.bloomberg.com/news/articles/2016-04-13/peabody-majority-of-its-u-s-entities-file-for-chapter-11>

Klein N. 2014, This Changes Everything: Capitalism vs. the Climate, Simon & Schuster, New York.

McCrone, A., Moslener, U., d’Estais, F., Usher, E. & Grüning, C. 2016, Global Trends in Renewable Energy Investment 2016, Frankfurt School UNEP Collaborating Centre for Climate & Sustainable Energy Finance, Frankfurt, viewed 20 May 2016 <http://fs-unep-centre.org/sites/default/files/publications/globaltrendsinrenewableenergyinvestment2016lowres_0.pdf>

NOAA NCEI 2016, Global Analysis – April 2016, National Oceanic and Atmospheric Administration National Centers for Environmental Information, viewed 20 May 2016 <www.ncdc.noaa.gov/sotc/global/201604>

Oreskes, N. & Conway, E. 2010, Merchants of Doubt, Bloomsbury Press, New York.

WHO & UNFCCC 2015, Climate and Health Country Profiles - 2015: A Global Overview. Geneva: World Health Organization (WHO) and UN Framework Convention on Climate Change (UNFCCC), viewed 4 December 2015 <www.who.int/entity/globalchange/resources/country-profiles/climatechange_global_overview.pdf?ua=1>

WMO 2013, The Global Climate 2001-2010: A decade of climate extremes, World Meteorological Organization, Geneva, viewed 1 March 2015 <http://library.wmo.int/pmb_ged/wmo_1119_en.pdf>

WMO 2016a, Monthly and seasonal temperature records smashed, World Meteorological Organization, Geneva, viewed 21 March 2016 <http://public.wmo.int/en/media/news/monthly-and-seasonal-temperature-records-smashed>.

WMO 2016b, WMO Statement on the Status of the Global Climate in 2015, World Meteorological Organization, Geneva, viewed 21 March 2016 <http://library.wmo.int/pmb_ged/wmo_1167_en.pdf>

In focus @ACN

Author details: Dr Liz Hanna is an environment, climate & health researcher at The Australian National University, President of the Climate and Health Alliance and Key Contact for ACN’s Climate and Health Community of Interest.

Editor’s note: ACN is currently developing a position statement on the impact of climate upon nursing and health.

“We, as nurses have an important role to play… we all need to know the climate change

risks for our part of the world and how that will impact our professional activities.”

15Events @ACN

The ACN team are busy working to develop an exciting and stimulating program for this year’s National Nursing Forum, The Power of Now. The program will include a host of influential thought leaders and inspiring nurses, high quality concurrent sessions, stimulating discussions and masterclasses, along with the opportunity to network and share ideas with colleagues and peers from across Australia. Several speakers have already been announced and are pictured. We are honoured to have each one contributing to our program this year. Keep an eye out for more speaker announcements coming soon!

Click here to secure your early bird registration before the end of the financial year so that you can be a part of the nursing event of the year.

26–28 October

2016

Melbourne Park Function Centre

THE POWER OF NOW

THE NATIONAL NURSING FORUM

IT’S TIME TO SECURE YOUR EARLY BIRD REGISTRATION BEFORE JUNE 30

Adjunct Professor Debra Thoms FACN (DLF) Commonwealth Chief Nursing and Midwifery Officer, Australian Department of Health

Professor Wendy Cross FACN Associate Dean, Nursing and Allied Health, Monash University

Professor John Daly FACN Dean, Faculty of Health and Head of the UTS/World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, University of Technology Sydney

Dale Fisher Chief Executive, Peter MacCallum Cancer Centre

Brian Dolan MACN (Associate) Director, Health Service 360

Dr Louise Schaper Chief Executive Officer, Health Informatics Society of Australia (HISA)

Adjunct Professor David Plunkett MACN Executive Director – Acute Health and Chief Nursing and Midwifery Officer, Eastern Health

Adjunct Associate Professor Lydia Dennett MACN Chief Nurse and Midwifery Officer, SA Health and Chair, Australian and New Zealand Council of Chief Nursing and Midwifery Officers

16Representation @ACN

ACN voices – meet our representativesAustralian College of Nursing (ACN)

representatives ensure the views of the

nursing profession are at the forefront of

health care decision making. We harness

the expert knowledge, experience and

insights of our members and through ACN

representation activities we facilitate the

vital conversations about health and aged

care and the leading role that nurses play in

designing health care models and giving care.

Each month, we feature our valued member

representatives who are making a difference

through their active participation in ACN

representation activities.

Professor Tracey McDonald AM FACN

Which working groups have you represented ACN on?

Aged Care Funding Instrument (ACFI) Monitoring

Group (from September 2012 to 2014):

Since the aged care reforms commenced in 2002,

we as a professional college have highlighted

issues that we feel are of particular importance

to older persons as well as difficulties facing the

aged care system with financing, staffing and

ensuring equitable access to services. Australian

Government funding for provision of residential

aged care services is paid as a basic subsidy

determined by assessing residents and classifying

them against the ACFI. I represented ACN on the

ACFI Industry Reference Group (IRG), which was

in place from 2009 following the identification of

issues by the government, related to feedback on

the processes and outcomes of ACFI appraisals.

Reviews of ACFI funding began February 2009 and

I was appointed to the ACFI IRG from 2010 to 2014.

However, it was disbanded and replaced by the

ACFI Monitoring Group in 2012.

Changes to the ACFI scoring and funding

arrangements introduced in March 2008 and

further refined in April 2012 generated concern

among aged care providers and other stakeholders

that funding would be reduced, compromising

sustainability. The ACFI Monitoring Group was set

up to monitor the effects of these changes over time

and to advise the government on the impact

of changes.

ACFI Technical Reference Group

(From March 2009 and then September 2012):

The purpose of the ACFI Technical Reference

Group is to provide advice to the ACFI Monitoring

Group on possible changes to the ACFI from a

technical perspective, including improving the

evidence requirements such as assessment of

residents, to support funding claims under the ACFI.

The group is set up for a defined set of meetings

and then called as necessary to consider further

issues as they arise.

National Aged Care Alliance (NACA):

NACA was set up in 2002, bringing together

national peak organisations representing key

categories of professions, service providers, trade

unions and consumers. NACA comprises 48

peak body organisations representing consumers

and their families, informal carers, special needs

groups, nursing, allied health and personal carers

involved in the aged care sector, and private and

not-for-profit aged care providers. Members meet

Recommend the flu and whooping cough vaccines to your pregnant patients.

health.wa.gov.au

WA Department of Health

If you are interested in future

representation opportunities with ACN,

please email engagement@acn.edu.au

“The opportunity to be involved with the

development of a private practice NP (nurse

practitioner) service built naturally onto the past three decades of effort I have put into shaping policy and regulation."

17Representation @ACN

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quarterly to identify issues and collaborate on

strategies that meet a consensus view of member

organisations. I have been involved with NACA since

its inception and have represented several of the

key member categories. Currently I represent ACN

in the ‘professional organisations’ category.

As the ACN representative I have been actively

involved with the following NACA working groups:

• Specified Care and Services Advisory Group

(Scheduled implementation 1 July 2015)

• Gateway Advisory Group

(Staged implementation commencing July 2013

• Home support Advisory Group

(Scheduled to commence on 1 July 2015)

• Complaints Management Scheme

(Ongoing since 2011)

As a member of NACA I have been able to ensure

that ACN’s positions on a variety of issues have

been heard and, where required, adopted by NACA

in position statements and responses to various

reviews and inquiries. The aged care reforms are

progressing since the passing of five Bills in 2013 to

address finding, quality and service scope.

These are:

• Aged Care (Living Longer Living Better) 2013

• Aged Care (Bond Security) Amendment 2013

• Aged Care (Bond Security) Levy Amendment 2013

• The Aged Care Quality Agency 2013

• The Aged Care Quality Agency

(Transitional Provisions) 2013

International Council of Nurses (ICN)

expert panels:

I was nominated in 2010 by ACN to be the ICN

representative on the expert panels for Ageing,

Human Rights and Patient Safety.

I have since responded to reviews of position

statements and ICN policy in all of these areas.

Aged Care Nurse Practitioner in Private

Practice Project:

In 2010 I was approached by ACN to participate in

an application for funding from the Department of

Health and Ageing under the Nurse Practitioner in

Aged Care Models of Practice program. We were

successful in our application for funding to set up

and evaluate a nurse practitioner in private practice

model which continued until late 2014.

I chair the steering committee for this project and

this involves ensuring that the nurse practitioner

(NP), Lyn Day, has access to guidance and that

the funding under the program grant is managed

appropriately, and that ACN and stakeholders in the

project are provided with timely and accurate reports

on the management of the grant.

In the early 1980s, I heard about nurse practitioners

in USA and decided Australia needed to be thinking

about NPs here. I was teaching in universities at

that time and began to seed ideas into the final year

students about independent nursing and advanced

practice, including assessments such as envisioning

being a nurse practitioner and questions such as

‘would you employ yourself’ in private practice.

As part of my work in introducing NPs to Australia,

I have been involved with the NSW NP projects;

regulation of NP practice and eligibility pathways;

clinical guidelines for NP processes towards

endorsement; negotiations and advice related to

industrial frameworks to set up relativities between

NPs and medical practitioners; negotiations related

to access to the Pharmaceutical Benefits Scheme;

review of NP competencies, and discussions with

employers in aged care on roles for NPs in aged care.

The opportunity to be involved with the development

of a private practice NP service built naturally

onto the past three decades of effort I have put

into shaping policy and regulation and building

widespread acceptance of NPs in Australia.

Faculty of Health and Wellbeing in Ageing:

From August 2009 to mid 2013 I acted as the

elected chair for this group of expert nurses with

an interest in aged care issues and practice. The

purpose of the faculty was to facilitate the exchange

of information and advice on health and wellbeing

in ageing issues as required between the Royal

College of Nursing Australia (RCNA) and key nursing

experts. With the amalgamation of RCNA with the

College of Nursing to become ACN the faculty

structure was disbanded. (Editor's note: ACN's

Healthy Ageing Community of Interest now

serves this function.)

I am also involved with ACN as an assessor for the

Nursing and Allied Health Scholarship and Support

Scheme and aged care nursing scholarships.

What led to your interest in these areas?

My background in nursing, management, health

economics, nurse practitioner development in policy

and practice and commitment to the success of

ACN and the nursing profession.

Can you highlight any issues and/or benefits arising for the profession as a result of these working groups?

Having a nurse involved with these high-level

committees who is aware of policy, economics and

demographics associated with developments in

these aspects of government and social change,

delivers for ACN a high profile and credibility within

these forums that would otherwise not be possible.

18Advertorial @ACN

Nursing that takes you places

Nursing in the Army has given Captain Katrina

Kelly opportunities not available in a civilian

career. Katrina has trained as an aviation nurse

and practiced her skill from helicopters and

ships; she’s deployed on operations; undertaken

graduate study; and even undertaken training roles.

She said her deployment to Afghanistan in

2014–15, in a United Kingdom led mentoring

mission, was her most satisfying role so far.

Deployments test individuals’ professional, mental

and physical capabilities. Nurses in a deployed

environment play a role in primary health care,

pre-hospital emergency care, evacuation of

casualties, and surgical support.

Katrina demonstrated that she has what it takes,

receiving a commendation for ‘distinguished

performance of duties in warlike operations’ for her

work in Afghanistan. “I was there for seven months

and my work focused on health and well-being

management, primary health care, emergency and

working with soldiers,” Katrina said.

During that deployment there was a mass

casualty from an insider attack at a Defence

University. Katrina’s citation states that her

level-headed actions following this attack had

a “force multiplying effect that aided the critical

treatment and extraction of 14 casualties”.

Back in Australia, Katrina is currently the officer

in charge at the Soldier Recovery Centre in

Darwin. The centre works collaboratively with

health professionals to assist wounded, injured or

ill soldiers with a wide range of complex needs.

Katrina said the work changes on a daily basis

and it’s very rewarding. “What I like most is the

ability to influence the stigma of injury and mental

health; and assisting soldiers to get from point A

to point B in a really positive environment.”

Katrina said her Army career has also enabled her

to expand her qualifications. She has completed

a Graduate Certificate in Emergency Nursing;

will complete a Masters (Nurse Practitioner) this

year; and is currently studying for an additional

Graduate Certificate in Rural and Remote Nursing.

The Army has also provided her with the

opportunity to develop her leadership skills.

Army Nursing Officers take on management,

administrative and command positions.

These roles develop their skills and professional

opportunities beyond the purely clinical.

It is a career that offers variety, challenges, travel

and the means to gain experience and skills

that are in high demand. The Army recruits

Nursing Officers from most specialisations, and is

especially seeking nurses with postgraduate,

general, emergency, perioperative and intensive

care qualifications.

To find out more visit defencejobs.gov.au/army

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As a Nursing Officer in the Navy, Army or Air Force, you’ll have opportunities that you won’t getin the private sector. For instance,your patients will be your co-workers, as well as civilians on deployment. You’ll also have the chance to lead a team of health professionals and provide humanitarian aid, all while receivinga favourable salary and benefits.

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19Professional development @ACN

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18–19 AUGUST Orthopaedic update RN/EN | 2 days | 14 CPD hours | Newcastle

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20In focus @ACN

When reassurance goes a long wayBy Jenny Cavanagh MACN

A recent routine hospitalisation for me went, as they

say, “pear shaped”. As a registered nurse for more

than 25 years who has worked in a wide variety of

settings, I was in the situation of having a frightening

episode that brought challenges not only to the

professionals caring for me – but, most of all to me.

When I heard the surgeon say, as we both looked

at the MRI of my right knee, “There is no other

option but replacement”, I just sat there. I filled in

my paperwork for the admission and headed back

to my workplace to let them know. It was here that

I broke down in tears, frightened of what would

come and daunted by the recovery I knew I would

have to undergo.

But what was to come almost two weeks after the

surgery was one of the most taxing and wearing

experiences of my life to date. Serotonin syndrome

or serotonin toxicity as it is known, is something

that I had never heard of but is “characterised

by the presence of a triad of clinical features:

neuromuscular excitation, autonomic stimulation and

changes in mental state”(Isbister et al. 2007).

I write this brief note to let others know and to

plead with my colleagues to understand just how

frightening this really is. Also to ask them just

“to be there” and understand. I was diagnosed

with depression many years ago and have been

successfully managed with Paroxetine and cognitive

behaviour therapy.

At the pre-admission clinic, I confirmed all of

my medications with the medical personnel in

attendance. Post-op, I awoke to find myself quite

groggy as expected (I had been through many

surgeries before). My chronic arthritis pain was

gone and I was only experiencing mild discomfort.

Through the post-op night, however, the block and

epidural anaesthesia wore off. I was commenced

on a routine course of medications which included

Endone, Paracetamol and Palexia.

Several days later, I moved along to the gym in

the facility (I had been receiving physiotherapy

in my room post-op until then) and commenced

my rehabilitation. I was feeling what I can best

describe as fuzzy, “not present” and fragile. The

physiotherapists were fantastic. Most nurses too

were terrific.

I hit a hiccup six days after leaving hospital when

I was back for outpatient therapy. All was fine

except for when I hit the hydrotherapy pool. After

15 minutes I apparently went white as a sheet and

was pulled out quickly. Vasovagal? Who knows?

But the rehabilitation specialist then started talking

about a syndrome that I had never heard of. I was

experiencing periods of hypertension, pallor and

a general feeling of “blankness”. Nonetheless, I

was discharged the next day to return for further

rehabilitation.

Another day passed at home. Mid-afternoon I began

to feel quite, what I can best describe as, skittish;

no longer in control of things that were happening.

I felt a little nauseous, I was getting diarrhoea and

generally really unwell. I spoke to family who were

21

staying with me and came back to hospital via the

emergency department. In emergency I began to

shake, experienced neuromuscular twitching and

the diarrhoea persisted. I was extremely scared.

Thank goodness the registrar believed me when I

mention my specialist had said probable serotonin

syndrome the day before.

I was readmitted to the local private hospital next

door. I have nothing but praise for the two registered

nurses who came to collect me from emergency. It

was, however, the after-hours nurse manager who

I could not believe was saying, “Settle down and

you will have to behave”. It took me quite a while

to absorb this as I didn’t trust myself with what

I was hearing because of the toxicity. To add to

my distress, I had been placed on an alternating

mattress replacement which was rock hard beneath

me and the staff did not seem to know how to

operate it!

Through that night and the following five days, I was

subjected to a barrage of tests; cardiac monitoring,

faecal testing, urine testing, an urgent CT scan of my

brain and Doppler ultrasound of my lower legs. The

reasoning for the Doppler was that a prior patient

had exhibited similar symptoms and was found to

have a DVT (deep vein thrombosis). My scans all

came back clear. My orthopaedic rehab continued.

Only three nurses took the time to really ask how I

was doing! One, a new graduate closing my door

for privacy, and the others just reassuring me quietly

that all was going to be okay. The physiotherapists

and occupational therapists were nothing short of

fabulous and kept an eye on me consistently. These

people I am eternally grateful for as they continued

to treat me with respect.

I had hyperreflexia upon testing, tremor, persistent

diarrhoea (faecal testing was clear) and extreme

distress with diaphoresis for a few days yet. I was

struggling with my temperature regulation. The

specialist saw me regularly and decreased my

Paroxetine slowly and then commenced me on

another antidepressant. It was to be six days before

I came home for good.

I guess you could say I had experienced moderate

seratonin toxicity.

Now, at almost nine weeks post-op I am almost

back to my old self. The thermoregulation

problem is proving to be a little persistent but my

rehabilitation as an outpatient is complete and I am

back seeing my regular physiotherapist. My general

practitioner is monitoring me and I will go and see a

toxicity specialist.

So, what have I learnt?

• Trust my feelings about my body and ensure I do

my best to remember the little things in nursing

such as gentle reassurance and giving someone

privacy and respect.

• Encourage others to be aware of this syndrome

as antidepressants are quite commonplace now

in our medical environments.

• That “awareness of the possibility and supportive

care are the most important treatments of

serotonin syndrome” (TGA 2015).

ReferencesIsbister, G.K., Buckley, N.A. & Whyte, I.M. 2007, “Serotonin Toxicity: A practical approach to diagnosis and management”, Medical Journal of Australia, vol. 187, no. 6, pp. 361-365.

TGA 2015, Medicines Safety Update Volume 6 Number 4, Therapeutic Goods Administration, Canberra, viewed 21 April 2016 <www.tga.gov.au/publication-issue/medicines-safety-update-no6-2010#serotonin>

In focus @ACN

Drugs that may contribute to serotonin syndrome

Antidepressants

• SSRIs

• MAOIs (reversible and irreversible)

• tricylic antidepressants

• SNRIs

Opioids

• tramadol

• pethidine

• dextromethorphan

• fentanyl

CNS stimulants

• cocaine

• amphetamines and derivatives such as MDMA (ecstasy)

Other

• lithium

• St. John's Wort

• Tryptophan

Source:TGA

Clinical features of serotonin syndrome

Altered mental

status

Confusion, agitation,

restlessness, excitement

Autonomic

dysfunction

Tachycardia, hypertension,

hyperthermia, sweating,

mydriasis, flushing,

shivering

Neuromuscular

Excitation

Hyperreflexia, hypertonia,

ataxia, tremor, clonus

(spontaneous, inducible or

ocular

Source: TGA

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“I have learnt to trust my feelings about my body and ensure I do my best to remember the little things in nursing such as

gentle reassurance and giving someone privacy and respect.”

22NMBA update

Revised NMBA regis t rat ion s tandards, s tandards for pract ice and guidel ines now in ef fectA number of revised registration standards, standards

for practice and guidelines from the Nursing and

Midwifery Board of Australia (NMBA), for nurses

and midwives across Australia, took effect from

1 June 2016.

The NMBA regulates Australia’s over 370,300 enrolled

nurses, registered nurses and midwives.

NMBA Chair Dr Lynette Cusack, RN said, “The newly

effective standards and guidelines are further important

steps to improve how we protect the public. We

have made changes to standards and guidelines to

make the obligations for nurses and midwives clearer

allowing them to be more effective in how they provide

care to the public. This benefits the professions, their

employers and is good for public protection. It is a

testament to the work of the individuals and all the key

stakeholder organisations involved, who contributed to

our consultations.”

The revised common registration standards1, guidelines

and supporting documents now in effect for both

nurses and midwives are:

• Registration Standard: Continuing professional

development (CPD), guideline, factsheet and

Policy: Exemptions from continuing professional

development for nurses and midwives

• Registration Standard: Recency of practice and

factsheet, and

• Registration Standard: Professional indemnity

insurance (PII) arrangements and factsheet.

These revised registration standards, guideline and

supporting documents came into effect on 1 June 2016

and replace any existing versions that were in place.

In addition, the revised Registration standard:

Endorsement as a nurse practitioner, the new

Registered nurse standards for practice and revised

guidelines also came into effect on 1 June 2016,

including:

• Registration standard: Endorsement as a nurse

practitioner and factsheet

• Safety and quality guidelines for nurse practitioners

• Guidelines: For nurses applying for endorsement

as a nurse practitioner, and

• Registered nurse standards for practice and

factsheet.

All nurses and midwives will need to meet the

obligations of the revised registration standards by the

next registration renewal period in May 2017.

You can find the revised standards, guidelines and

supporting documents on the Registration Standards

and Professional Codes & Guidelines sections of

www.nursingmidwiferyboard.gov.au.

The NMBA would also like to remind midwives that

the effective date for the Registration standard:

Endorsement for scheduled medicines for midwives

and the Safety and quality guidelines for privately

practising midwives and supporting factsheets is

1 January 2017.

For more information see the Board’s news

item’s which explain what these changes mean

for nurses and midwives on the News section of

www.nursingmidwiferyboard.gov.au.

The standards and guidelines were revised after a

scheduled review, which included public consultation.

The NMBA has published consultation reports

providing a summary of the consultation processes,

rationale for any changes and proposed way forward,

including areas where further work is planned.

1Registration standards define the requirements that applicants and registrants in the regulated professions need to meet to be registered.

For more information

Visit the NMBA website:

www.nursingmidwiferyboard.gov.au

For registration enquiries:

1300 419 495 (within Australia)

+61 3 9275 9009 (overseas callers) 

For media enquiries: (03) 8708 9200