Nurses for Nurses

National Survey: Access & choice in Maternity Services!

2012-02-26T20:41:00.000+10:00

As nurses we recognise the importance of our clients being able to 'have a say' regarding the services they receive. In 2010 the government commenced reforms to improve access and choice in maternity services for women in Australia. Did you know that the Department of Health and Ageing (DoHA) is seeking feedback from women regarding their experiences with recent maternity service arrangements and whether they are aware of the reforms? An independant organisation has been engaged to conduct and collate the short survey.

It is a short online survey which can be accessed at Maternity Survey. Once you are finished the survey it re directs you to the informatuon on the maternity service reforms. The information on the reforms can be found at Dept of H & Aging Maternity Reform

The survey will close midnight Sunday the 4th of March 2012.

10 Ways to be Happy at Work

2012-02-20T10:37:00.000+10:00

Most Nurses I know love what they do. They may not like every aspect of the role every minute of every day but they do like being a nurse and cannot see themselves in any other job.

The number of nursing roles available within our present day health care system is enormous - we are spoilt for choice and the choice is definitely ours to make.

So if you are a nurse who finds themselves in a role that you no longer enjoy the choice is yours to take - there is no need to continue on a path you no longer want to be on - its time to reflect and maybe make some changes for yourself.

A friend shared this information regarding being happy at work - I have no idea who the author is but I'd like to share the content with you as it provides food for thought.

"1. Choose to Be Happy at Work
Happiness is largely a choice. I can hear many of you arguing with me, but it's true. You can choose to be happy at work. Sound simple? Yes. But, simplicity is often profoundly difficult to put into action. I wish all of you had the best employer in the world, but, face it, you may not. So, think positively about your work. Dwell on the aspects of your work you like. Avoid negative people and gossip. Find coworkers you like and enjoy and spend your time with them. Your choices at work largely define your experience. You can choose to be happy at work.

2. Do Something You Love Every Single Day

You may or may not love your current job and you may or may not believe that you can find something in your current job to love, but you can. Trust me. Take a look at yourself, your skills and interests, and find something that you can enjoy doing every day. If you do something you love every single day, your current job won't seem so bad.

3. Take Charge of Your Own Professional and Personal Development

A young employee complained to me recently that she wanted to change jobs because her boss was not doing enough to help her develop professionally. I asked her whom she thought was the person most interested in her development. The answer, of course, was her. You are the person with the most to gain from continuing to develop professionally. Take charge of your own growth; ask for specific and meaningful help from your boss, but march to the music of your personally developed plan and goals. You have the most to gain from growing - and the most to lose, if you stand still.

4. Take Responsibility for Knowing What Is Happening at Work
People complain to me daily that they don't receive enough communication and information about what is happening with their company, their department's projects, or their coworkers. Passive vessels, they wait for the manager to fill them up with knowledge. And, the knowledge rarely comes. Why? Because the manager/boss is busy doing her job and she doesn't know what you don't know. Seek out the information you need to work effectively. Develop an information network and use it. Assertively request a weekly meeting with your boss and ask questions to learn. You are in charge of the information you receive.

5. Ask for Feedback Frequently

Have you made statements such as, "My manager never gives me any feedback, so I never know how I'm doing." Face it, you really know exactly how you're doing. Especially if you feel positively about your performance, you just want to hear him acknowledge you. If you're not positive about your work, think about improving and making a sincere contribution. Then, ask your boss for feedback. Tell him you'd really like to hear his assessment of your work.

6. Make Only Commitments You Can Keep

One of the most serious causes of work stress and unhappiness is failing to keep commitments. Many employees spend more time making excuses for failing to keep a commitment, and worrying about the consequences of not keeping a commitment, than they do performing the tasks promised. Create a system of organization and planning that enables you to assess your ability to complete a requested commitment. Don't volunteer if you don't have time. If your workload is exceeding your available time and energy, make a comprehensive plan to ask your manager for help and resources. Don't wallow in the swamp of unkept promises.

7. Avoid Negativity

Choosing to be happy at work means avoiding negative conversations, gossip, and unhappy people as much as possible. No matter how positively you feel, negative people have a profound impact on your psyche. Don't let the negative Neds and Nellies bring you down. And, keep on singing in the car on your way to work - or start.

8. Practice Professional Courage

If you are like most people, you don't like conflict. And the reason why is simple. You've never been trained to participate in meaningful conflict, so you likely think of conflict as scary, harmful, and hurtful. Conflict can be all three; done

well, conflict can also help you accomplish your work mission and your personal vision. Conflict can help you serve customers and create successful products. Happy people accomplish their purpose for working. Why let a little professional courage keep you from achieving your goals and dreams? Make conflict your friend..

9. Make Friends

In their landmark book, First, Break All The Rules: What the World’s Greatest Managers Do Differently, Marcus Buckingham and Curt Coffman list twelve important questions. When employees answered these questions positively, their responses were true indicators of whether people were happy and motivated at work. One of these key questions was, "Do you have a best friend at work?" Liking and enjoying your coworkers are

hallmarks of a positive, happy work experience. Take time to get to know them. You might actually like and enjoy them. Your network provides support, resources, sharing, and caring.

10. If All Else Fails, Job Searching Will Make You Smile

If all of these ideas aren't making you happy at work, it's time to reevaluate your employer, your job, or your entire career. You don't want to spend your life doing work you hate in an unfriendly work environment. Most work environments don't change all that much. But unhappy employees tend to grow even more disgruntled."

Health Workforce Australia - how much do you know about it!

2012-02-13T08:47:00.000+10:00

As nurses who work at the coalface of health care, we often don't have time to check out the information surrounding health care decision making at a national level. According to the government website, Health Workforce Australia, a national program of health workforce innovation and reform will be developed and delivered by them. It is intended to "encourage the development of health workforce models to support new models of health care delivery, facilitate inter-professional practice and equip health professionals and employers to successfully manage current and emerging demands on the health care sector". According to the website information,the Framework was approved by the Australian Health Ministers’ Conference (AHMC) on 4 August 2011 and fulfills a commitment detailed within the Council of Australian Government’s (COAG) National Partnership Agreement on Hospital and Health Workforce Reform (2008).
'The National Health Workforce Innovation and Reform Strategic Framework for Action 2011-2015 (Framework) will guide future health workforce policy and planning in Australia. It sets out key priority areas and five essential domains for a " integrated, high performing workforce fit to meet Australia’s health care needs"

　KEY DOMAINS
OBJECTIVES 1. HEALTH WORKFORCE REFORM FOR MORE EFFECTIVE, EFFICIENT AND ACCESSIBLE SERVICE DELIVERY
Reform health workforce roles to improve productivity and support more effective, efficient and accessible service delivery models that better address population health needs.
2. HEALTH WORKFORCE CAPACITY AND SKILLS DEVELOPMENT
Develop an adaptable health workforce equipped with the requisite competencies and support that provides team-based and collaborative models of care.
3. LEADERSHIP FOR THE SUSTAINABILITY OF THE HEALTH SYSTEM
Develop leadership capacity to support and lead health workforce innovation and reform.
4. HEALTH WORKFORCE PLANNING
Enhance workforce planning capacity, both nationally and jurisdictionally, taking account of emerging health workforce configuration, technology and competencies.
5. HEALTH WORKFORCE POLICY, FUNDING AND REGULATION
Develop policy, regulation, funding and employment arrangements that are supportive of health workforce reform.
Check out the website Health Workforce Australia for more information. What do you think?

Australia's 1st National Mental Health Commission

2012-01-29T18:11:00.000+10:00

As nurses we are conscious of the importance of having resources available and support for Clients with Mental Health concerns. On 23rd January the Minister for Mental Health and Ageing, Mark Butler, launched Australia’s first National Mental Health Commission.
The commission is working on the nations first national report card on Mental Health and Suicide Prevention.
The intent is to bring transparency to the current system and to provide insight into current service gaps. According to Mr Butler;
“One of the Commission’s first priorities will be to deliver the first annual National Report Card on Mental Health and Suicide Prevention ......This is important data that will allow us to monitor whether services are working effectively to deliver lasting outcomes for people with mental illness.”
$32 million has been allocated over 5 years for the establishment and running of the commission.
“The new Commission will advocate for the needs of consumers and carers, which should be at the front and centre of policy making. We want to ensure these needs are given the priority they warrant by all levels of government,” according to Professor Fels, the Chair of the commission.

You can find out more at the website of the Mental Health Commission The website also contains useful contact numbers and support services.

2012-01-25T11:13:00.000+10:00

A recent article where 7 babies became ill and 3 died in a Belfast maternity unit from a pseudomonas infection highlights the importance of infection control practices in our health care settings.

Pseudomonas is a common bacterium that lives in our environment and is usually found in moist places. Pseudomonas Aeruginosa is the most common form found in the health care setting. In the Belfast unit it is believed that the water taps supplying the unit had become contaminated with this bacterium.

Pseudomonas Aeruginosa is usually only a problem for immunocompromised patients and it accounts for 10% of hospital acquired infections.

Pseudomonas Aeruginosa is transmitted by:

Direct contact with contaminated water through bathing
Direct contact by ingesting the bacterium - most commonly through uncooked vegetables and fruit - a large amount of the bacterium is found on the skin of these products.
Inhalation
Devices rinsed in contaminated water
The contaminated hands of health care workers

It is interesting to note that Pseudomonas Aeruginosa can last on dry surfaces for up to 16 months.

Pseudomonas Aeruginosa can be difficult to treat as it is resistant to a number of antimicrobial agents.

What can we do as nurses to prevent infection from this bacterium:

Wash your hands
Ensure effective cleaning procedures are undertaken in the units in which you work - all surfaces should be cleaned as part of the routine cleaning program. Do not let cleaners leave mops soaking in buckets of solution
Do not leave medical equipment soaking in solution
Ensure that medical equipment is cleaned effectively and dry
Immunocompromised patients should not be offered uncooked fruit or vegetables

The information in the attached link is quite useful - Click here to read more.

New Hot Line number for women worried about their breast Implants!

2012-01-15T12:37:00.001+10:00

As nurses we have heard about the recent concerns expressed with breast implants. In case you are not aware on 7th January 2012 the government announced a new hot line for women to call if they have concerns. As a recent blog identified whilst there is no evidence of increased rupture rates here in Australia, support is available for women who want more information. Women should ring the Breast Implant Information Line on Ph: 1800 217 257 or contact their surgeon directly for clinical advice.“The Breast Implant Information Line is in operation 24/7. This government service will also register women’s contact details so follow up information can be provided if necessary.”

For women who require further follow up, clinical and radiological investigations will be covered under the usual Medicare arrangements.

“Australian women can be reassured that our experts advise that on the basis of current data available there is no evidence of increased rupture rates for PIP implants in Australia,” Acting Minister for Health and Ageing Nicola Roxon said.

The TGA is contacting all Australian surgeons who have used the PIP implants to ask that they provide a clinical evaluation to their patients.

More information is available atThe Department of Health & Aging

Therapeutic Relationships and Professional Boundaries

2012-01-09T13:15:00.000+10:00

As Nurses we enter into a therapeutic relationship with our patients/clients. The basis of that relationship is that the Nurse brings the required skills to assist the person, the person is of the opinion that the Nurse is a health care professional who has the skill, knowledge, and training to meet their needs.

Part of the therapeutic relationship is the collection of information required to build a picture of the individual in order to work out the best way to assist them. This information is privileged and is provided to the Nurse in confidence.

Within this therapeutic relationship the Nurse has a responsibility to maintain professional boundaries. "Professional boundaries in nursing are defined as limits which protect the space between the professional’s power and the client’s vulnerability; that is they are the borders that mark the edges between a professional,
therapeutic relationship and a non‑professional or personal relationship between a nurse and a person in their care."1.

In the context of a therapeutic relationship the service provided is viewed on a continuum. The aim of the relationship is that the Nurse provides a professional service that is helpful to the patient/ client and remains within professional boundaries. To do less than this is viewed as "underinolvement" and to overstep the boundaries is seen as "overinvolvement".

The behaviour associated with underinvolvement is any behavior that could be detrimental to the patient whilst in the care of the Nurse and most of the issues border on, or are examples of, neglect. These include untimely delivery of care, not delivering the care required, disinterested in the patient and their care requirements, ignoring the patient etc.

There can be a fine line in determining overinvolvement and the individual Nurse should reflect on their behaviour to be confident that the relationship with the client remains therapeutic.

Examples of overinvolvement include:
1. The Nurse discloses personal information to the client. This could include information about their personal problems, personal life, or intimate issues.
2. The Nurse believes they are the only person in the team that can provide the correct care to the patient.
3. The Nurse shares information with the patient and asks them to keep the information secret.
4. The Nurse spends more time with this patient than any other patient
5. The patient may request that only this specific Nurse care for them or will only communicate issues with this Nurse as " they understand them better"
6. The Nurse flirts with the patient - sharing jokes of a sexual nature or sentences that could have a double meaning.
7. The acceptance of gifts outside of organisational policy or industry accepted standards
8. Undertaking a sexual relationship with the patient/client whilst in care

As a health care professional the Nurse is responsible to ensure the relationship they have with their patients/clients is a therapeutic one. If the Nurse finds themselves in a situation where they believe there are issues of under or over involvement they must seek the counsel of a trusted colleague or supervisor to strategise to rectify the situation.

Boundary transgression is unacceptable behaviour and is reportable to AHPRA

1. A nurses guide to professional boundaries, Australian Nursing and Midwifery Council, Feb 2010. As cited on the AHPRA website http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2f1347&dbid=AP&chksum=bes7sYtZAWnmggO%2fzV0uBQ%3d%3d Janurary 2012.

Breast Implants - Information from Department of Health & Aging!

2012-01-06T16:27:00.000+10:00

As nurses we often deal with clients who have varying types of prosthesis. Some interesting information was released by the Department of Health and Aging which may be of relevance to you as an individual or be relevant to your clients.
On 4th January the Department of Health and Aging released a statement regarding breast poly implant prosthesis. According to the information,the TGA has been advised that approximately 9,054 PIP breast implants have been implanted by surgeons between 2002 and 2010.
The TGA advises that, based on current rates of reporting of implant rupture to the TGA, there is no evidence of an increased rupture rate for PIP silicone gel breast implants used in Australia.
The TGA has received 37 reports of rupture of PIP breast implants which is a rate of 0.4% of PIP implants inserted in Australia over the past decade. Apparently this rate is well within the expected rupture rate for silicone breast implants.
Long term follow up studies conducted in the USA show that rupture rates for silicone breast implants are approximately 1.0% per year. That means that for breast implants of all types approximately 10% of implants will have ruptured by 10 years after insertion.
Check out the Department of Health and Aging Poly Implant Prosthesis information which has content for health professionals and clients.

Nurse Practitioners in Residential and Community Care!

2011-12-19T10:14:00.000+10:00

On 15th December 2011 it was announced that the Australian Government is investing $18.7 million to expand the role of nurse practitioners in residential and community based care. Mark Butler, the minister for Mental Health and Aging identified that this will allow nurse practitioners to increase their role in the aged care workforce. According to the press release there are more than 30 projects funded under the Nurse Practitioner - Aged Care Models of Practice Programs. The aim is to improve access to primary health care for our aged persons. If you work in community or aged care - Do you think this initiative will really make a difference to the residents or clients receiving service?

As we know Nurse Practitioners can assess and manage clients, directly refer clients to other health care professionals, prescribe medication and order diagnostic investigations. It is also anticipated that it will reduce the number of hospital admissions.
The government believes that the program will provide new and extended career paths for aged care nurses.
According to Mr Butler “Delivering flexible training initiatives focused on improved clinical care will assist industry recruitment and retention and create attractive career paths in aged care,”
Successful applicants are being funded in all states and territories, including services in rural, regional and remote areas, and organisations that provide Aboriginal and Torres Strait Islander and culturally specific care.

Are you a nurse practitioner- or do you have a friend that is? What are you thoughts about this initiative?

For more info check out Dept of Health & Aging

Delegation

2011-12-13T14:37:00.000+10:00

Delegation is giving someone you work with the job of completing a task that you are ultimately responsible for. In nursing a Registered Nurse may delegate a nursing task to an Enrolled Nurse or an Unregulated Health Care Worker if they believe the individual has the knowledge and competence to complete the task.

Delegation happens in every workplace and there are a number of things that you can do to make sure that the delegation is successful:

1. You need to be clear about the result you want to achieve. In the nursing context this is based on a nursing assessment and the intervention to meet that assessed need would be documented in the nursing care plan.

2. Never delegate a task to a person that has never done the task before - you have a responsibility to ensure that the person you are delegating to can complete the task correctly and competently.

3. You need to be able to explain to the person exactly what you want done (Care Plan - Recipe), the result that you expect (Goal) , the time that it should be completed, and the framework for how the task is to be completed. This is the time to teach and explain to others how you want it done. In a nursing context it is the nursing care plan that will direct staff on the what, when, and how of care delivery.

4. With delegation you need to set up a reporting schedule on the progress with the task/s. Don't leave it to chance - it is critical that those you have delegated to report back to you on their progress. In a nursing context staff should report back to the Registered Nurse regarding the tasks that have been delegated to them for the shift so that the Registered Nurse is confident that all care has been delivered as per the care plan.

5. "Inspect what you expect" in a nursing context the Registered Nurse remains responsible for the care activities delegated to others - the Registered Nurse remains accountable for the nursing care delivered - so if you are held responsible then it is critical that you check that the care has been delivered.

"Delegation is not abdication" and that is a very important concept for Registered Nurses to understand when they are working in a team with non registered staff.

Tips to Reduce Skin Tears!

2011-12-06T14:48:00.001+10:00

As nurses we are aware of the impact of skin tears on our clients and we aim to reduce the potential of skin tears occurring. QUT( Queensland University of Technology) & IHBI (Institute of Health and Biomedical Innovation) 2011 Champions for Healthy Skin has produced a summary of guidelines, with the recommendations classified using the National Health and Medical Research Council levels of evidence.

Here is a snapshot of key points to remember:

All Clients’ to have risk assessment for skin tears on admission

Risk factors include;

o Reduced mobility and use of wheelchairs and mobility aids
o Cognitive impairment
o Poor nutrition
o Polypharmacy
o Sensory loss

Use a recognised skin tear assessment and classification system
Remember to assess the size of the skin tear and document your assessment!

Management:

Gently cleanse the wound
Approximate any skin tear flap if possible
Air or gently pat the skin dry
Use non-adherent dressings
Use tubular non adhesive wraps, stockinettes or flexible netting to secure dressings, rather than tape
Place an arrow to indicate the direction of the skin tear on the dressing

Tips to prevent Skin Tears:

A prevention protocol should be in place for clients at risk
Use an emollient soap substitute for dry or vulnerable skin instead of a non –emollient soap
Moisturise skin at least twice daily
Dry skin well after washing. Dry skin by patting, not rubbing
Gently smooth on the moisturiser or barrier cream in the direction of the body hair – don’t rub
Pad wheelchair arms, footrests, bedrails, walking frames
Ensure enough light so clients don’t bump into furniture
Long sleeves and pants can be worn to protect extremities
Use correct lifting devices and manual handling techniques
Maintain optimal nutrition and hydration of clients

Summary of Wound Care Guidelines - Key Tips to Remember!

2011-11-21T09:20:00.001+10:00

As nurses we appreciate the discomfort, costs, lifestyle restrictions and the time it takes to care for clients who have wounds.

QUT( Queensland University of Technology) & IHBI ( Institute of Health and Biomedical Innovation) 2011 Champions for Healthy Skin has produced a summary of guidelines, with the recommendations classified using the National Health and Medical Research Council levels of evidence.
Here is a snapshot of some of the guidelines;

Assessment and wound management should be conducted by staff with training, skills and experience in wound Care
Assess , classify and document wound size, shape, depth, tissue type, colour, exudates, wound margin surrounding skin and tissue condition – reassess regularly
Assess for signs of infection: cellulitis, erythema, malodour, increased pain, delayed healing deterioration of the wound, purulent exudates
Referral for specialist treatment may be necessary if there is failure to heal, unexpected change in level or type of exudate, pain, uncertainty in diagnosis, signs of infection , an ulcer appears ischemic
Chronic wounds may be cleansed using potable tap water if normal saline is unavailable
Ulcers should be irrigated with a neutral, non irritating, non toxic solution and cleansing undertaken with minimal chemical or mechanical trauma
Removal of necrotic and devitalised tissue should be undertaken through mechanical, sharp, autolytic or biological debridement
If dry gangrene or eschar is present, however, debridement should not be undertaken until arterial flow has been re-established
A moist wound environment should be maintained for optimal healing. It promotes healing by enabling migration of tissue-repairing cells and spread of immune and growth factors. Extreme wetness or dryness may delay healing.
Dressings should:
Maintain a moist wound-healing environment
Manage wound exudates and protect peri-ulcer skin
Remain in place and minimise shear, friction, skin irritation and pressure
Be non-adherent to reduce trauma on removal
However- dry gangrene or eschar is best left dry until revascularisation
Dressings should be cost effective, acceptable to the patient and be changed once pr day or less often when possible
Hydrocolloid dressings can improve wound healing in comparison to paraffin gauze or wet/dry gauze dressing
Alginate dressing are more effective than other modern dressings for debriding necrotic tissue
Topical antimicrobial dressing may be beneficial when wounds are chronically or heavily colonised
Effective pain management strategies should be implemented to minimise pain during wound dressing procedures
Maintain optimal levels of nutrition
Provide client education on all aspects of wound management
Promote psychosocial support

The use of Webinar Technology in Continuing Professional Development in Nursing

2011-11-15T11:00:00.000+10:00

There has been much debate in nursing circles about the various ways continuing education can be developed and delivered. With the introduction of the Australian Health Practitioner Regulation Agency and the Continuing Professional Development Registration Standard from 1st July 2010 there has been a flurry of activity relating to the delivery and recording of ongoing nursing education.

The aim of continuing education should be to provide information that is:
• Relevant
• Easily accessible
• Provided at a time suitable to the individual
• Provided by individuals with a specialist knowledge in the field

Continuing professional development “...is the means by which members of the profession maintain, improve and broaden their knowledge, expertise and competence, and develop the personal and professional qualities required throughout their professional lives.”1

The concept of continuing professional development is not about training and testing for new skills but the recognition that the professional should keep up to date with the best practice guidelines that underpin their area of practice.

The problem with education that is delivered at the workplace is getting from the workplace to the education session. Money is tight and staffing levels reflect this – staff may want to attend the session but are unable to leave their work area to do so.

Traditional delivery methods need to keep pace with the requirements of the profession. There is not a one size fits all solution, however a very clever method that is proving successful is the use of webinars.

A webinar is “...used to conduct live meetings, training, or presentations via the Internet. In a web conference, each participant sits at his or her own computer and is connected to other participants via the internet.” 2.

The Nurses for Nurses Network was one of the first organisations to utilise webinar technology to provide education sessions for its members. The sessions are offered live so that nurses can register to attend the session in real time or the sessions are recorded and can be watched a time that suits the individual.

The feedback from nurses has been very positive 3:

• Great set up, excellent value and easy and comfortable learning from home. I really look forward to what’s on next. This has taken the stress out of completing CPD points every year. Thank you so much – Kirstine

• Technology worked very well. This is a great idea and invaluable resource for busy professional nurses – Michael

• It is an excellent way to get current updates, especially with regard to medication. It is impossible to keep up with all new medications esp. if you are specializing in a specific field of nursing, you aren't coming into contact with some meds, so this type of presentation means that you can touch base without having to take time out from work or as in my case you can replay the webinar at your leisure and still gain good information. - Barbara.

• Thank goodness the presenter didn't talk in a monotone. It was very easy to listen to and also to relate to – Deirdre

Nurses recognise the need to maintain their knowledge base in their area of practice to ensure that care delivery meets the needs and expectation of the community. In order to achieve ongoing registration as a nurse, individuals are required to have evidence that identifies that they have met the continuing professional development standard set by AHPRA. The use of webinar technology provides an easy and accessible method for nurses to access education sessions at a time and venue that suits them.

References:

1. Nursing and Midwifery Board of Australia Continuing Professional Development Standard, 1st July 2010. http://www.nursingmidwiferyboard.gov.au/Registration-Standards.aspx

2. Wikipedia http://en.wikipedia.org/wiki/Webinar

3. Nurses for Nurses Network http://www.nursesfornurses.com.au/

Tips for Skin Care!

2011-11-07T11:40:00.000+10:00

As nurses, we all appreciate the cost in terms of time, resources, discomfort and loss of lifestyle for clients who have loss of skin integrity. It is far better to promote skin integirty.

According to QUT/ IHBI ( Institute of Health and Biomedical Innovation) 2011 Champions for Healthy Skin there are some key tips to remember!

• Have a documented protocol for clients who have incontinence

• Avoid dryness or maceration of the skin – moisturise dry skin, avoid sustained contact of skin with fluids, encourage continence

• An emollient soap substitute should be used for dry or vulnerable skin and is more effective than a non-emollient soap in preventing skin tears

• Skin cleansers ( no rinse cleanser or foam cleansers) are better than soap ad water for prevention of incontinence related skin problems

• Dry skin thoroughly after washing! Dry skin by patting, not rubbing

• Moisturise dry skin at least twice each day

• Gently smooth on the moisturiser or barrier cream in the direction of the body hair- don’t rub!

• A no –sting barrier film or hydrogel barrier cream may have better skin integrity outcomes in comparison to petroleum based ointments or creams in clients with incontinence

• Protect skin from friction

• Do not vigorously massage over bony prominences

• Avoid overheating skin ( avoid plastic support surfaces, ensure regular turning – do not exceed 2 hrly intervals for clients on basic mattresses)

• Use correct lifting devices and manual handling techniques

• Disposable incontinence products may be better at preventing skin problems than using non disposable products

• Maintain optimal nutritional status with adequate calories, proteins, carbohydrates fats and vitamins and minerals

They are Listening and Watching You

2011-10-31T15:01:00.000+10:00

As nurses we all endeavour to do the best we can for our patients in the situation that we find ourselves in. We can become very busy doing the things we need to do and can sometimes forget that we are on constant display and our profession is being judged by our actions.

I recently had the experience of being in a hospital as a concerned relative rather than as a nurse and I have to tell you that it was a very interesting experience.

The first thing that struck me was the amount of information that nursing staff relay to each other within earshot of their patients. Topics covered included the diagnosis of the poor man in bed 3 that was obviously not going to recover and that his lovely wife would be grief stricken when she heard the news. I then found out about the difficulties that one nurse was having in her ECG interpretation course - she believed the course content was too difficult and she was having all sorts of trouble identifying the different rhythms - this caused me some concern as she was working in a Coronary Care unit at the time. I then discovered that staff believed the person doing the rosters was incompetent based on the recent problems they had all experienced, and various other bits of information from what colour lolly snakes were the best through to the various plans for days off and upcoming holidays.

Patients and their relatives have nothing better to do that watch the staff in their ward - how they interact with each other and the other patients in the unit. By the end of my relatives stay at the hospital I could tell you which staff members got on well, who was lazy and who loved what they were doing, who ironed their uniforms and who didn't, who had kids, who was having relationship issues, what the staff thought of the visiting medical officers, who turned up for work on time, that not everyone followed the same policy guidelines, and the medical status of patients in rooms near to my relatives as their cases would be discussed with the medical offer in the corridor.

Whilst a hospital environment is natural for nurses it is foreign and scary to others. As nurses we need to remember that there are two faces to the environment that we work in. The private face is the interaction that we have with colleagues about our personal information and beliefs, - this should occur in private spaces like the staff room or treatment room. The public face is the interaction that we have in front of the public and the information exchange in this environment should always be professional and concise. The public need to believe that nursing staff are focused on caring for the patient and have the knowledge and skill to do so. It is very interesting when the shoe is on the other foot so please remember "they are listening and watching you"

AHPRA Notification Process - continues to be interesting!

2011-10-31T14:26:00.002+10:00

Recently we wrote about mandatory reporting and our obligations as nurses. Since the introduction of the Health Practitioner Regulation National Law Act 2009 ( National Law) we have an obligation to report notifiable conduct of other health practitioners. As nurses it can be confusing when determining what constitutes mandatory and voluntary reporting. Those in the profession who have already been faced with obligations of reporting have not always found it to be a clear process when seeking clarification regarding the term ' substantial harm ' or reference to 'practice that significantly departs from accepted professional standards'. It also appears that depending on the geographical location there may be delays in the resultant investigative process. The Nursing and Midwifery Board of Australia have Guidelines for Mandatory Reporting which is worth a read. It can be found at Mandatory Reporting. Please also refer to our previous blog on this subject.

On the other side of nursing care- do perceptions change?

2011-10-11T18:28:00.000+10:00

As nurses we try very hard to do the right thing, every time, all the time in the workplace and most importantly to always do the right thing for our clients. When nurses have the opportunity to experience the delivery of health care services from a different perspective - that of being a patient, or relative of persons recieving health care, do our perceptions of the quality of service received alter?

Perhaps they do- we would love to hear your feedback.

When we are 'on the job' we are often focused on getting onto the next task? Consider the following;
. After each meal - do we make sure that our clients teeth are cleaned ?
. If our clients need to use a commode - do we offer them a wet washer and towel to wipe and dry their hands?
.Do we remember to ensure there is toilet paper within easy reach?
.Do we hide the toilet rollout of public view and remove urinals when full - or do we leave them on the overbed table?
. Do we ( for clients who can't for themselves ) always ensure that hair is combed at the beginning of each day?
. Do we always explain to our clients what we are going to do - before we commence the task?
. Do we assume that the clients are happy to hear what we have to say about their condition in front of their visitors ( because we know they are family?)
. Do we speak about other clients using their name or other identifiers eg. room number in the hearing of other clients?
. Do we assume that our clients want to hear about how our day is going or how busy we are?
.Do we still take the time to always remove used linen, check there is a chair available for visitors and ensure the buzzer is within reach?

If you or others close to you have been on the receiving end of nursing care - did these experiences reinforce that nursing is a unique profession and nurses remain truely wonderful people?

Nursing Titles and Enrolled Nurses

2011-09-26T10:37:00.001+10:00

Its interesting to note, that despite information being provided by the Nursing and Midwifery Board of Australia and also the Australian Health Practitioner Regulation Agency ( AHPRA) nurses still hear of instances where non regulated staff comment to members of the public that they are nurses. It's also interesting to observe that many health care organisations continue to provide identification for their Enrolled Nurses which identifies that they are Endorsed Enrolled Nurses ( EEN's). No wonder health care staff remain a little confused with the legislative changes in titles .

With the implementation of the national registration and accreditation scheme on the 1 July 2010 all nurses and midwives are registered under the Health Practitioner Regulation National Law Act 2009 (National Law). The key objective of the National Law is to provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practice in a competent and ethical manner are registered. The National Law has clear restrictions on the use of protected titles. This issue is addressed in s113, s.116, s.117, s.119 and s.120 of the National Law.
Only people who have met the requirements of the National Law can use a protected title.
For nurses and midwives the protected titles are:
 Nurse
 Registered nurse
 Enrolled nurse
 Nurse Practitioner
 Midwife
 Midwife practitioner

Under this legislation it is an offence for anyone either knowingly or recklessly to use any of the protected titles to make another person believe that you are registered under the Act unless you are registered in the profession. Check out more info at Nursing and Midwifery Board

There is no title Endorsed Enrolled Nurse - the single title relating to Enrolled Nurses is just that Enrolled Nurse. For Enrolled Nurses who do not have what was previously referred to as medication endorsement - they will have a notation on the register against their name which states ‘Does not hold Board-approved qualifications in administration of medicines’. This transitional notation will remain in place for five years or until the EN provides evidence of having completed a Board-approved administration of medicines unit. A review of the policy will occur at the end of the five-year period.
For more info please check out Nursing and Midwifery Board frequently asked questions.

Nursing Notifications to AHPRA:

2011-09-11T18:46:00.000+10:00

Registered Nurses understand that we are bound by the Health Practitioner Regulation National Law and the Nursing and Midwifery Board. Recent experience by some nurses has highlighted the need for clarity regarding our responsibilities in notifying AHPRA; in particular mandatory and voluntary notification requirements.
Mandatory Notifications:

Section 140 of the National Law requires that a registered health practitioner must notify the Board if, in the course of practising their profession, they form areasonable belief that another registered health practitioner has behaved in a way that constitutes ‘notifiable conduct’.

Notifiable conduct is defined as when a practitioner has:

1. practised the profession while intoxicated by alcohol or drugs, or

2. engaged in sexual misconduct in connection with their profession, or

3. placed the public at risk of substantial harm in their practice because they

have an impairment, or

4. placed the public at risk of harm during their practice because of a significant

departure from professional standards.

Nurses should take note of the sections on voluntary notification, unprofessional conduct and professional misconduct. Experiences by some nurses recently, has identified that although for example medication incidents ( which may include non signing for medication administration ) had been reported at the facility, and the nurses who made the errors were being counselled, and placed on performance management plans, it may still be necessary to report these circumstances to AHPRA.

Take the time to check out the AHPRA website, and it may well be worth your time to ring AHPRA to discuss what does and does not constitute in particular voluntary notifications . It will be an interesting time for nurses as there appear to be some blurred areas in relation to the wording which guides us on when we should make a notification.

Unprofessional conduct includes:

breach of the national law
breach of a registration condition or undertaking
conviction for an offence that may affect suitability to continue practice
providing health services that are excessive, unnecessary or not reasonably required
influencing, or attempting to influence, the conduct of another registered health practitioner that may compromise patient care
accepting a benefit as inducement, consideration or reward, for referrals or recommendations to use a health service provider
offering or giving a person a benefit, consideration or reward, in return for providing referrals or recommendations to use a health service provider
referring a person to, or recommending another health service provider, health service or health product, if there is a financial interest, unless the interest is disclosed

Professional misconduct includes:

conduct that is substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience
more than one instance of unprofessional conduct
conduct that is not consistent with being a fit and proper person to hold registration in the profession

Snapshot of Wound Debriding Methods:

2011-08-26T12:43:00.000+10:00

Debriding wounds is alwys a topic of interest to nurses.

Autolysis uses the body's own enzymes and moisture to re-hydrate, soften and liquefy hard eschar and slough. Autolytic debridement is selective; only necrotic tissue is liquefied. There is minimal discomfort for the client. Autolytic debridement can done using occlusive or semi-occlusive dressings which maintain wound fluid in contact with the necrotic tissue e.g. hydrocolloids, hydrogels and transparent films.
Chemical enzymes are fast acting products that produce slough of necrotic tissue. Some enzymatic debriders are selective.
Mechanical debridement has been used for decades in wound care. It allows a dressing to go from moist to wet, then the physcial removal of the dressing causes a form of non-selective debridement.
Hydrotherapy is also a type of mechanical debridement.
Sharp surgical debridement and laser debridement under anesthesia are the fastest methods of debridement. They are very selective, meaning that the person performing the debridement has complete control over which tissue is removed and which is left behind
Surgical debridement can be performed in the operating room or at the bedside, depending on the extent of the necrotic tissue.
Maggot Debridement Therapy (MDT) is the medical use of specific live maggots (fly larvae) for treating non-healing wounds.It is conducted by placing the immature stage of a blowfly into a wound to clean the area of necrotic tissue and stimulate healing.Maggot secretions have antibacterial properties and they disinfect the woud while debriding necrotic tissue. They alter the wound environment so that cell growth and fibroblast formation is encouraged.Maggots work well on non healing necrotic soft tissue for example ulcers and traumatic or post surgical wounds.

More interesting info on maggot therapy is available at University of Sydney

A Nursing History

2011-08-24T14:39:00.000+10:00

At our conference in January 2011 we met a wonderful Registered Nurse who was still working as a Nurse at the age of 82 and passionate about her work and keeping her knowledge up to date.

That Nurse now writes for the Network about her experiences and as I read one of her stories about her first day on the job I realised how tenacious and focused she must have been - how much she wanted to succeed in the profession.

When Bonnie commenced her training in 1946 there were no theoretical classes to prepare her - she simply turned up for work and did what she was told to do. The only support she had came from the junior nurses that she reported to. Her day commenced at 6am and she worked until 10am doing a mixture of care and catering/ housekeeping duties. She then went to lectures for 6 hours and returned to work in a clean uniform at 4pm to work until 10pm. After this to use her words "you collapsed" into bed to get up and do it all the next day.

On night duty the shift was ten hours and Bonnie and her colleagues worked for 4 weeks straight without any days off. After this time they were given 2 weeks holiday. The Matron, who was also the Tutor Sister expected the nurses to send her a postcard whilst they were on holidays and there was hell to pay if they didn't.

Bonnie went on to train as a Midwife and had a varied and interesting nursing career.

Bonnie has enjoyed every day that she has worked as a nurse and remains passionate about where nursing is heading and the contribution the profession makes to our society. How wonderful to have that level of commitment and energy.

If you would like to read Bonnie's stories they are published on the Recollections Page in the Members Section of the website.

Confusion Continues over Continuing Professional Development (CPD)

2011-08-08T11:28:00.000+10:00

If you are confused about what constitutes CPD as defined in the Continuing Professional Development registration standard then I can't blame you. There is a lot of misinformation out there and nurses are spending a lot of money to achieve what should be a simple requirement.

This is my understanding:

1. All nurses and midwives registered with AHPRA must comply with the standard.
2. You do not have to collect points - there are no points identified in the AHPRA standard. One hour of active learning equates to one CPD hour. So if people are talking to you about points ignore them.
3. If you are registered with AHPRA you are required to have evidence of completing 20 hours of CPD each year.
4. If you are registered with AHPRA as a midwife you are required to have evidence of completing an additional 20 hours of CPD each year. Please note if the education is relevant to both general and midwifery practice then it can be counted under the general and midwifery allocation. An example would be wound care, infection control, therapeutic communication to name a few.

5. If you hold scheduled medicines endorsement then you are required to have evidence of attending an additional 10 hours of CPD each year.

6. CPD must be relevant to the context of practice of the nurse. BUT it does not have to be specific - there are a number of general topics that cross all nursing specialties like infection control, wound care, counselling skills, team effectiveness and building etc that are relevant and that we need to keep up to date with.

7. You are required to keep an evidence portfolio of what you have completed

8. You are required to review your practice and identify your learning needs - ask yourself the question "what area am I working in?" and "what information or activities do I need to focus on to keep myself current?" now write that down - you've just completed your review and documented your learning needs. The plan now is to undertake the activities to meet those needs.

9. A little hint if you keep your learning needs and activities broad then you have a better chance of achieving them.

10. Its not all about attending lectures - perceptoring students, reading journals, involvement in committees can all be counted as CPD.

I've attached links to the AHPRA website and the ANMC 2009 document that AHPRA quote for your
info.
Photo by Ambro

Standards for Wound Management!

2011-07-15T15:48:00.000+10:00

Regardless of where you work, over time as nurses you may run into differences in opinion regarding wound management. These varying opinions may be based on experience, tradition, organisational policy and education. Check out Australian Standards for Wound Management- they are great reference when clarifying varying opinion in the workplace.
Marked discussion is still apparent in organisations when determining what ' wound cleansing solution' to use on a wound. At a quick glance the wounds are best cleansed with water or
Normal Saline: isotonic, economical, no bad effect on living tissue,has no antiseptic effect and can be used to irrigate cavities
Chlorhexidine: is an antiseptic, cytotoxic effect increases when combined with cetrimide, is inactivated by soaps and anionic material, antiseptic activity is reduced by blood or organic contaminants, can be contaminated by pseudomonas; it doesn’t work when used with povidine iodine. Remember to discard unused portion of sachets or steritubes.
Savlon: Not recommended for routine cleansing of wounds due to toxic effects.
Hydrogen Peroxide: Limit use for removal of debris from wounds – has potential for oxygen embolus if used under pressure or in closed or narrow cavities
Acetic Acid: Lowers the PH of a wound environment – effective against pseudomomas, but there is no concentration of acetic acid that can be safely used on wounds.
Povidine Iodine: Effective against gram positive and gram negative bacteria, spores, fungi, viruses and protozoa. It is inactivated by body fluids and a 5% concentration may cause cessation of blood flow
Sodium Hypochlorite:Eusol, Milton and Dakins solution ( chlorinated soda solution) No safe use on wounds!!

For more info check out the Silver chain Wound Care Manual by Carville.

Accreditation: Residential Facilities - Main Changes!

2011-07-09T19:37:00.000+10:00

For all the nurses who work in residential aged care facilities, you may have heard management talking about recent changes to the accreditation process. This is because the new Accreditation Grant Principles came into effect on 20th May 2011, thus the old Accreditation Grant Principles of 1999 no longer apply.
At a glance;

Still do a self assessment before accreditation - but you don't have to use the agency supplied template and you don't have to submit the self assessment at the time of submitting your application for re-accreditation
No changes to the Standards or the outcomes at this time
Accreditation fees and structure have not altered
If you don't meet the accreditation standards, you need to submit a revised plan for continuous improvement (PCI) to the agency. You still need to maintain a plan for improvement for your service
The agency no longer recommends sanctions to the Dept of Health and Aging. The Department makes their own decision
10% residents must be interviewed at review audits and re-accreditation audits
The facility must tell residents at least 21 days before a visit and display a special poster provided by the agency in a prominent place
You can not nominate assessors
there are no desk audits now undertaken
Support contacts are now called assessment contacts
You can ask the agency to reconsider a decision - if still unhappy you can go to the Administrative Appeals Tribunal to review the decision

For more info check out the Accreditation Agency site

To clean or not to clean wounds at dressing changes

2011-07-05T08:17:00.000+10:00

Nurses continue to juggle multiple demands each day at work. On occasion nurses also express concern with the time it takes doing wound dressings. Whilst its vital that nurses don't cut corners and that nurses should adhere to the Australian Wound Management Association Standards for Wound Management 2nd edition AWMA , it is no longer recommended that nurses have to cleanse a wound each time a dressing is changed. A summary of the circumstances of when a wound needs to be cleansed are listed below;

Wound infection
Excessive exudate
Foreign bodies, debris, eschar or slough
Where there’s a need to reduce contamination or remove devitalised tissue

Remember: Solutions must NOT be detrimental to the healing process and solutions should be warmed to body temperature

The standards identify you need to avoid aggressive wound cleansing unless you are debriding.
Many of the modern dressings negate the need for frequent wound cleaning- the hydrophilic action in absorbing exudate, cleans the wound.

Accreditation: Do nurses think it makes a real difference to the standard of care delivered at the bedside?

2011-06-24T15:07:00.000+10:00

Nurses across the acute, aged care and community based services are familiar with the term 'Accreditation'. For many nurses working at the bedside or providing direct client care, questions continue to be raised in relation to the perceived costs associated with 'preparing' for accreditation, the pre accreditation purchases of new equipment and the close scrutiny given to ensuring staffing levels are maximised (at least) for the accreditation period. Regardless of the sector, Accreditation is aimed at setting a minimum standard for care and related services and provides health funds, the government and most importantly the Australian public with data and information that should provide a sense of confidence regarding the quality of care and service at specific organisations. Nurses at the coal face,however are not always as confident that Accreditation as a process ensures good client care and service. In practical terms, service delivery is as good at the skill and competence of the person delivering the care and their access in a timely manner to appropriate resources. The Aged Care Standards are currently under review with the proposed draft standards available at Draft Aged Care Standards. Its interesting to compare these with for example hospital ACHS Accreditation . Some nurses are of the opinion that the accreditation process, regardless of the sector remains subjective, in terms of interpretation of information, the depth of analysis & the on site review along with the knowledge base of the assessors when compared to the skill of persons being interviewed at the site. It will be interesting to see if the future refined accreditation standards are effectual in raising the base line standard for care and service delivery in Residential Aged Care Services.

Nursing Documentation

2011-06-13T14:12:00.000+10:00

There continues to be a lot of discussion amongst nurses about nursing documentation and what is required.

In its simplest form nursing documentation is a process of communicating to other nurses and health care team members what has happened to the patients under your watch. The nursing team will be judged by the consistency of the nursing documentation and its ability to tell the full story of what has occurred for the patient during their time under the care of the organisation.

Whether it be acute care, aged care, or community care we need to be able to display what occurred for the patient and what the nursing team did to address the issues as they presented.

A simple example is notation that the patient had complained of a burning sensation on voiding, a ward urine test indicated blood and protein in the urine and an MSU had been sent to pathology. Then there is no further documentation in the notes. What did happen was the MSU came back indicating a urinary tract infection that was treated with antibiotics as well as the direction from the primary Registered Nurse to push fluids and provide pain relief as ordered. But none of these interventions were documented in the notes so a third party reviewing and judging the service provided is led to believe that no further follow up occurred.

The nursing process hasn't changed in a very long time and remains the basis on which documentation standards are tested. We need to assess the care required, document the plan for others to follow, initiate the interventions and document the patient response to same in the progress notes. We then need to evaluate if the care interventions remain current based on the ongoing assessed needs and expressed wishes of the patient.

In a nutshell nursing documentation needs to be:

1. Comprehensive and concise - don't waffle tell it as it is and make sure that the information is based on fact not presumption. Do not judge - it is not your place

2. Legible - others need to read it - print if you have to

3. Timely - write as it happens

4. Documents must have labels to identify the patient

5. Entries must display the date and time

6. You must sign the entry and print your name in brackets after each entry.

7. Only use excepted abbreviations.

Gaining Consensus in Wound Care

2011-06-06T09:44:00.000+10:00

Regardless of where nurses work, nurses often find that there is varied opinion at a clinical level amongst peers regarding wound management. The differences in opinion are often based on personal experience, traditional practice and the exposure to education. Did you know that the Australian Wound Management Association has established Standards for Wound Management ( 2nd edition ) March 2010. They are a great reference and cover the following;
STANDARD 1 Collaborative Practice & Interpersonal Care
The optimal healing of the individual with a wound or potential wound is promoted by a collaborative and interprofessional approach to wound management.

STANDARD 2 Professional Practice
The safety and wound healing potential of the individual is ensured by clinical practice that respects and complies with legislation, regulations, codes of practice, evidence and health provider policies.

STANDARD 3 Clinical Decision Making: Assessment & Planning
The optimal outcome for the individual with a wound is facilitated by a continuous process of general, wound and environmental assessment that determines their risk of wounding, would aetiology, would healing potential and informs the plan of care.

STANDARD 4 Clinical Decision Making: Practice
Wound management is practiced according to the best available evidence for optimising outcomes for the individual, their wound and their healing environment.

STANDARD 5 Documentation
Documentation will provide a legal, comprehensive, chronological record of the individuals would assessment, management and prevention plan

STANDARD 6 Education
The clinician maximises opportunities for advancing self knowledge and skills in wound prevent and management

STANDARD 7 Research
Evidence based wound prevention and management advances optimal outcomes for individuals and the interprofessional team.

STANDARD 8:Corporate Governance
The service provider framework within which the clinician practices, supports evidence based wound management.

Check out the website Australian Wound Management Association for more information.

Enrolled Nurse and Medication Administration

2011-05-30T11:53:00.000+10:00

For Enrolled Nurses who have not completed additional study in regards to medication administration prior to 2008 AHPRA has decided that:

"There needs to be a transitional process in place to accommodate ENs across the jurisdictions who are not yet qualified to administer medicines. ENs who have not yet completed the required units will have a notation on the register against their name and will read: ‘Does not hold Board-approved qualifications in administration of medicines’. This transitional notation will remain in place for five years or until the EN provides evidence of having completed a Board-approved administration of medicines unit. A review of the policy will occur at the end of the five-year period."

Nurses who have completed an approved Enrolled Nurses Course since 2008 will have completed the required units of study for medication administration. Enrolled Nurses who trained before this date will be required to undertake additional units of study to qualify to administer medication.

For further information regarding Enrolled Nurses and registration with AHPRA see the attached link:

http://www.nursingmidwiferyboard.gov.au/FAQ-and-Fact-Sheets.aspx

Tips for taking a Wound Swab!

2011-05-23T10:26:00.000+10:00

Nurses are often requested to take a wound swab - here are some tips that may be of interest to you!Please note that a single and universally agreed ‘best way’ to take a wound swab has not be established.

Wound swabs should be taken from an area of viable tissue where the clinical signs of infection are present .e. Do not swab eschar( dead tissue) or yellow, fibrous slough( layer of dead tissue separated from the surrounding or underlying tissue).Infection causing organisms are most likely to be found in viable tissue.

Do not culture pooled exudate or wound dressings. Risk of non-wound contaminants is high.

Antiseptic solutions should not have been used prior to taking wound swab .Organisms will be killed, and false negative result may occur .

Swabs should be taken prior to the client commencing systemic antibiotic therapy. Antibiotic therapy can adversely affect swab results.

Local anaesthetic should not be used prior to taking a swab. Local anaesthetics can demonstrate antibacterial effects .

Avoid surrounding skin .Will avoid introducing superficial skin organisms into the culture.

If fresh pus or wound fluid is present collect this . This will allow the most accurate estimation of organism type/s and load.

Remove excessive debris and all dressing residue without unduly disturbing the wound surface using a gentle stream of normal saline Surface organisms are often different to those causing the wound infection and skin cells and other harmless contaminants may be present on the wound surface

Use a zig-zag motion to swab wound surface and rotate swab during swabbing (30 seconds minimum)

Wait for 1-2 minutes before taking swab .Allows organisms to rise to the surface of the wound.

Swabs must be transferred to the laboratory as quickly as possible and ideally processed within four hours of collection.

The Power to Influence

2011-05-16T10:33:00.000+10:00

As nurses our patients rely on us to provide the care they require in the sitaution in which they find themselves in. So wether that be in a surgical ward, midwifery unit, or doctors surgery we need to understand the level of influence we have in this nurse patient relationship.

When we first meet a patient/client it is up to us to form a therapeutic relationship with them. We will set the ground rules for interaction and whether the patient/client is satisfied with the interaction will depend on our ability to communicate with them.

It is the issue of communication that is so important in our patient/client relationships. Our patients watch us closely to try and make sense of the situation they find themselves in. Every word that we utter, ever expression on our faces becomes part of their story of this episode of care. If a nurse is undertaking a dressing and grimaces then the patient will think oh my goodness what is wrong with my wound - they don't know that you are grimacing from the sore back you now have from a weekend of gardening.

With verbal communication we should ensure that we do not use acronyms that only medical people understand. We should also only discuss issues of relevance to the patient - the patient doesn't need to know about your car breaking down, you're illness, or what you have planned for the weekend - they simply need to know what is happening to or for them.

Discussions with your colleagues should not be in front of the patient - the fact that there are 8 going to theatre at the same time and the bookings clerk is an idiot for organising this does not make for a professional interaction. We need to instill confidence in the patient that we know what we are doing and that they are in the best hands possible.

The patient also needs to believe that they are important and you are focused on them - when asked by a colleague if you are available to assist - don't yell back "when I have finished with this one - I'll give you a hand and then we can go to tea together" - this does not give the impression that you are focused on the needs of the individual you find yourself with.

The ability to communicate in a therapeutic environment is a skill that we all need to continue to work on - the power of that ability to communicate has a massive influence on how our patients/clients experience the health care system.

Venous Ulcers: Tips for choosing an appropriate dressing:

2011-05-12T11:49:00.000+10:00

Promoting a healthy wound bed is an objective in wound management so select a dressing that supports this purpose, taking into account the potential need for;

Ø Debridement ( debridement method needs to be carefully considered )

Ø Managing exudate ( dressing needs to maintain a moist wound environment, be absorbent, and minimise the risk of wound edge maceration)

Ø Managing Infection (consider a dressing/ and or topical treatment and / or systemic treatment to resolve the infection)

Compression bandaging remains a significant factor in the healing of venous leg ulcers.

It is noted that the following modern dressings have resulted in complete healing of venous ulcers over study trial periods

Ø Zinc oxide paste bandage

Ø Hydrocolloid dressings

Ø Perilesional injection of granulocyte-macrophage colony – stimulating factor

Ø Porcine collagen derived from small intestine submucosa

Ø Human skin equivalent ( 63%) was superior in outcome to a hydrocolloid dressing ( 48%)

Best Practice Recommendations:

According to the Joanna Briggs institute ( 19/05/2010 ), there is a lack of evidence to suggest that modern dressings ( more complex products including, hydrocolloids, foams, alginates and hydrogels) are more effective than conventional dressings ( e.g. saline/gauze and non adherent knitted viscose dressings) in healing venous leg ulcers– thus its important to consider cost and client comfort.

When considering cost – remember; Gauze dressings and normal saline are more expensive ( not unit cost ) as they are more labour intensive and require multiple dressing changes each day.

All dressings need to be accompanied by best practice wound care

The management of venous leg ulcers involves the use of compression therapy

The dressing should be in contact with all surfaces of the wound bed; if packing is required, a ribbon gauze should be used and only gently applied – prevent damage from pressure

Avoid maceration to surrounding skin – keep the moist dressing within the wound margins

Choose a dressing that does not shed fibres into the wound

Recency of Practice Requirement

2011-05-02T13:04:00.000+10:00

There has been a lot of discussion regarding the Recency of Practice requirement to maintain registration. At the Network we continue to get a number of queries from members who are on maternity leave worried that they will not be able to meet the Recency of Practice requirements to register again this year.

Recency of Practice means "... that a practitioner has maintained an adequate connection with, and recent practice in, the profession since qualifying or obtaining registration."

The term practice does not need to be related to the provision of direct clinical care the nurse may have worked in nursing administration, education, research, or an advisory role.

You need to have evidence that you have practiced as a nurse in the last 5 years for a period that equals 3 months full time work. The work does not have to be continuous so you can work a number of days here and there as long as it adds up to 3 months full time work.

If you wish to maintain your midwifery registration as well as general registration you will need to have evidence that you have worked in the area of midwifery for the equivalent of 3 months full time in the last 5 years also.

You are advised to keep your records of practice so you have evidence should you be audited. Evidence of practice can include statement of service from an employer, pay slips, tax returns etc.

For more information go to the AHPRA website http://www.nursingmidwiferyboard.gov.au/FAQ-and-Fact-Sheets.aspx

Tips for Smelly Wounds!

2011-04-25T16:07:00.000+10:00

We‘ve all had to deal with wounds that smell. Whilst it may make us feel ill – we need to remember – its the patient and often their visitors who are really suffering!
Malodour may be caused by a range of conditions which include and are not exclusive to wound infections, necrotic tissue and fistula formation leading to the bowel. The Wound Care Manual (5th edition), written by Silver Chain Clinical Nurse Consultant Keryln Carville is a great resource and provides some useful tips.
Smelly wounds need odour control and can be managed in 3 different ways; topically, systemically or via the environment.
Suggestions to control odour include;
Tea Bags: Can be a cheap and effective alternative. Fresh dry tea bags are placed between the primary & secondary / retention dressings. The number of tea bags depends on the size and dimensions of the wound - 3- 4 bags may be required. ( Ng & Lee, 2002)
Topical Agents: Carbon backed or impregnated dressings, Cadexomer iodine ( broad spectrum antimicrobial) dressings and Topical Flagyl( metronidazole) Gel.
Bag it: Wound drainage & ostomy bags can isolate the odour and contain exudate. Consider the use of products e.g. Neutropol , that contain enzymes that deactivate odour-causing pathogens for use in the bags- note these substances should never be in direct contact with the wound.
Systemic Control: Oral Flagyl can be effective ( but it may cause nausea and headaches and it is contraindicated with alcohol consumption).
Environment: Ensure the room is well ventilated and soiled dressings are removed. Keep the room clean and be mindful of the choice of room deodorants as some products may make the patient feel nauseous and exacerbate the bad odour in the room.

Did you know: There is anecdotal evidence supporting the use of yoghurt & buttermilk containing lactobacillus acidophilus for wound irrigation to control odour. The wound is initially cleaned with water or normal saline before the yoghurt or buttermilk is installed at body temperature. Irrigations are conducted 3 - 4 times a day for approximately 3 days. (Welch, 1982).

MORE INFORMATION:

http://www.silverchain.org.au/order-wound-care-manual

Notifiable Conduct

2011-04-19T12:51:00.000+10:00

As nurses we need to understand that we are obliged by law to report to AHPRA any conduct or behaviour of a health practitioner colleague or student that we believe constitutes "notifiable conduct" - not to do so could lead to disciplinary action by the Board against us.

So what is notifiable conduct?

"Notifiable Conduct - in relation to a registered health practitioner, means the practitioner has

(a) practised the practitioner’s profession while intoxicated by alcohol or drugs; or
(b) engaged in sexual misconduct in connection with the practice of the practitioner’s profession; or
(c) placed the public at risk of substantial harm in the practitioner’s practice of the profession because the practitioner has an impairment; or
(d) placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards."

If you are concerned in regards to a colleagues behaviour or ability then seek confidential consultation with your supervisor or you can go directly to AHPRA for guidance as to whether your concern constitutes notifiable conduct. Your discussion with AHPRA will remain confidential in the first instance.

http://www.ahpra.gov.au/Notifications-and-Outcomes/Conduct-Health-and-Performance/Conduct.aspx

Stay Safe This Easter!

2011-04-10T12:55:00.024+10:00

With the extended Easter/ Anzac Day break coming up its useful to consider some travel safety tips if you or your loved ones are going to be on the move. As nurses we are very aware of the trauma and tragedy that is linked to accidents on the road or people on Holiday. Check out.RACQ travel tips .
Driver fatigue adversely affects road safety and is a proven killer.
If you are travelling long distances over extended periods of time, take a 15-minute break after every two hours of driving to rest and revive. Make the most of the extensive Driver Reviver network that operates throughout Queensland and interstate. Driver Reviver stops provide free tea or coffee to drivers as an incentive to take a break.
On long trips, setting off in the early hours of the morning may seem like a good idea, however this may be counter-productive to effective road safety if your body still expects to be sleeping.
Part of good driving is recognising that driver fatigue can affect your performance behind the wheel well before you actually feel tired. Signs of fatigue include:

Yawning, heavy eyes or sweaty hands
Droning or humming in the ears

Daydreaming or loss of concentration
The vehicle wandering on the road
Unintentional changes in vehicle speed
Pressure in the head or temples
Stiffness or cramps

If you recognise the symptoms of driver fatigue and there is not another licensed driver in the vehicle, pull over where it is safe to do so, lock the doors and sleep until you are refreshed.
Make use of permanent roadside rest areas provided by state and local road authorities.
Remember to remind every one don't drink and drive.

Better Health Victoria also has some great reminders for holidays.

Australian Nurse Making a Difference in Bali

2011-03-31T17:33:00.004+10:00

Members of the Nurses for Nurses Network recently travelled to Bali to provide a wound care education workshop to Balinese colleagues. This eventuated after a meeting an inspirational Australian nurse who is doing exceptional work in exceptional circumstances at the Sanglah Public Hospital in Denpasar. Sanglah hospital is the largest hospital in Bali and was the main treatment centre for many of the victims of the Bali bombing.

Di Brown is a registered nurse and her role at Sanglah Hospital is Practice Improvement Coordinator. Di undertakes this role as a volunteer through Australia Volunteers International (AVI) and has been at the hospital since August 2009.

Regardless of location and demographics Di confirms that Nurses everywhere are faced with common challenges; changing the mindset and practices of staff including senior staff and leaders through education, exposure to opportunities with strong mentorship and dealing with ‘internal politics’.

Everyday there are operational challenges to be faced in relation to patient care, as there are only skeleton levels of staff available after 1300hrs. The care of patients remains heavily reliant on the patients family; including the provision of sufficient food and oral fluids.

Nurse training is very different in Indonesia. There is no national registration process, there are a number of agencies that regulate education facilities but none that have been created to monitor professional practice and protect the public.

Radiation Fears!Advice on exposure to radiation arising from nuclear incidents in Japan

2011-03-28T16:30:00.000+10:00

Australians were shocked by the visual images of the earthquake and tsunami that struck on 11 March 2011 and damaged a number of nuclear reactors on the east coast of Japan resulting in the release of radioactive contaminants to the atmosphere.

Nurses are often seen as 'experts' in many fields and you may be finding that you are being asked questions by your family, friends or clients about radiation.The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) provides interesting information via their Radiation Protection Fact Sheets
Addtionally, today, the ARPANSA website has information regarding
.Advice on exposure to radiation
.Advice for Australians remaining in Japan on food and water precautions, the availability and use of potassium iodide tablets and on appropriate sheltering from radiation if required
According to the website;
.ARPANSA and the Department of Health and Ageing are recommending , as a precautionary measure, that Australians within an 80 km zone from the Fukushima nuclear power plant move out of the area.
.Australians returning home from Japan are highly unlikely to be contaminated or exposed to significant radiation and will not require checks for radioactivity. However, if people wish to seek medical advice they should contact their local GP.
.ARPANSA and the Chief Medical Officer advise that iodine tablets are only required when exposed to substantial radiation doses from radioactive iodine. There is no current need for those returning from Japan or those in Japan outside the Exclusion Zone to consider the use of potassium iodide tablets at this time.
People are also being encouraged to visit http://www.smarttraveller.gov.au/ and read the travel advice and the travel bulletin for Australians in or returning from Japan.

Interesting Times

2011-03-09T10:33:00.000+10:00

As I read the article where 5 boys that were unable to urinate due to pelvic injury have remained cured for 6 years because they were given artificial urethras grown in a lab I was in awe of how far science has come.

What fabulous things we can do in medicine. The time and resources required to fund medical research is enormous and with each new discovery that is made the greater the expectation of the general public that this technology be widely available for their use.

Then I began to think about the difficulties of supplying the technology - is there a fair distribution of access to these new innovations. If I live in a major city am I better off than if I live in a regional or rural community? Certainly the statistics, in Australia, show that access to medical services are not the same based on geography. One example being - to take advantage of the new treatment for stroke you need to live within 3 hours of a hospital who can deliver the new treatment protocol to you. The new protocol has been proven to limit the more devastating symptoms of stroke such as paralysis and speech problems. If you live outside of this 3 hour time frame you do not get the new treatment. How fair is that?

Whilst advances in medical care are wonderful we are still unable to adequately feed a large proportion of the world population. We can grow urethras in a lab but are unable to grow food crops. We are able to treat and cure complex conditions but are unable to use diplomacy to stop a war.

This is a wonderful but complex time in which we live. As a civilised society we should continue to fund research that enables people to live long and happy lives, however, what is good for one is good for all - unless you can provide the advance for all then should it be provided?

If we are unable to feed people then should research dollars be funnelled into food production. If we are unable to maintain a peaceful relationship with other countries dollars are spent in maintaining armed forces that could have been used in health and humanitarian aid.

As nurses we have an ethical obligation to our clients and the broader community - we need to start asking the questions about health care access, utilisation of resources, and become aware of how the health care dollar is being used.

http://www.webmd.com/urinary-incontinence-oab/news/20110308/boys-given-lab-grown-urethras-okay-6-years-later?src=RSS_PUBLIC

Gambling: Do you know anyone who may need help!

2011-03-01T16:53:00.000+10:00

Nurses are a trusted group of people and often people confide in nurses. As a nurse do you know clients or perhaps family or friends that appear to have an unhealthy focus on gambling? Better Health Victoria has provided some interesting info which includes reasons why people may gamble, signs to look out for and links to an on line test about gambling that individuals can complete.
Support contact details are also listed and include;
.Gambler’s Help Tel. 1800 858 858, TTY 1800 777 706 – 24-hour telephone counselling service
.Gambling Help Online - for problem gambling counselling and support (Australia-wide), 24 hours, seven days
.Gamblers Anonymous Tel. (03) 9696 6108 – support group for people with a gambling problem
.Gam-Anon Tel. (03) 9898 7526 (volunteers only) – support group for family and friends
.Crown Responsible Gaming Support Centre Tel. 1800 801 098
.Australian Hotels Association – (AHA) Self Exclusion Program Tel. (03) 9654 3491 Mon to Fri (business hours) Answer Machine Out of Hours
.Lifeline Tel. 131 114
.Financial and Consumer Rights Council Tel. 1800 134 139 or (03) 9663 2000
.Doctors or other health professionals
It is suggested that some people may gamble because;

Feel a sense of security when they gamble – they may feel they don’t belong in social settings other than the gaming venue
Hope to win lots of money
Want to escape from reality and forget their worries
Need something to do because they don’t have interests or hobbies
Cannot give up the dream of great wealth, even in the face of repeated financial losses
Feel excited when they gamble and find their feelings of nervousness, irritability, indecision and frustration disappear.

Support After Recent Natural Disasters!

2011-02-13T12:12:00.000+10:00

As nurses we deal everyday with circumstances and issues that members of the general community would find difficult. The recent multiple natural disasters across many areas of Australia; in particular the floods, Tropical Cyclone Yasi and the fires have created long term devastating effects for our communites, many families and friends.

For many nurses, we are currently having to maintain our professionalism and our level of service to others, whilst dealing with the effects of these recent events on a deeply personal level.

Many resources have been made available in the locations impacted upon by these terrible events,however as nurses you may find it useful to download the Dept Health & Aging Trauma & Grief Resource List for your personal and perhaps professional reference.

You are part of a wonderful group of people who are committed to serving others - remember in these difficult times to be kind to yourself and to seek assistance if you need it.

Remember to care for yourself as much as you care for those around you!

CPD Continuing Professional Development - what do you need to do?

2011-01-31T17:13:00.000+10:00

One standard that all nurses must meet to obtain their registration each year is the Continuing Professional Development Registration Standard. To achieve this all nurses registered with AHPRA (Australian Health Practitioner Regulation Agency) must meet the minimum requirements of the standard and the CPD must be relevant to the nurses context of practice.

What are the requirements?

1. All nurses registered with AHPRA will participate in at least 20 hours of continuing professional development (CPD) each year

2. If you are also a registered midwife you need to have 20 hours of CPD for your midwifery registration as well - note though that some of the topics in general CPD education are also relevant to your midwifery practice - so they count in both areas.

3. If you hold scheduled medicine endorsement you will need evidence of 10 hours of CPD relevant to this area.

4. One hour of active learning equals one hour of CPD

5. The CPD must be relevant to your area of work - remember it is you who decides what is relevant to your work, it is your opinion, your own self assessment of what you need.

6. You must keep documentation to validate your CPD attendance

7. If you choose self directed CPD activities there are a few extra steps that you need to include as evidence of CPD.

Here is the link to the AHPRA document: http://www.nursingmidwiferyboard.gov.au/Registration-Standards.aspx

If you are a member of the Nurses for Nurses Network then there is an example of an evidence portfolio that you can use on the website. Members also have access to over 150 education activities that would meet your CPD requirements - you receive a certificate of attendance after each session that you attend.

CPD should not cost you a fortune and should not be difficult - as a profession we need to continue to learn and make sure we offer a service that meets industry and best practice guidelines - AHPRA has commenced the process of continual learning by ensuring you attend at least 20 hours of education per year to maintain your registration.

Have a look at www.nursesfornurses.com.au to see what CPD sessions are available to you as a Network member.

A New Year: Time to Focus on being Happy!

2011-01-26T16:12:00.002+10:00

As nurses we work in environments that present a range of situations that personally impact on us. With the new year there has been lots in the media focusing on happiness. It is proposed that up to 40% of the variation in happiness from one person to another is due to the activities and behaviours we engage in according to Dr Tony Grant Director of Coaching Psychology at the University of Sydney.There are lots of web sites on happiness - perhaps take the time to check out the site Making Australia Happy or Beyond Blue if you need information on dealing with anxiety and depression.

Nurses work hard and we need to put effort into looking after ourselves and part of that is being happy. Here are some behaviours that are linked to increased satisfaction and well being.
. Focus on the 'here and now' - rather than working about what might be
. Identify goals that mean something to YOU and actively pursue them
. Work out what matters in your life and make sure you take care of those things
. Performing acts of kindness towards others - including outside your normal social circle
. Making the time to enjoy your relationships with family and friends
. Consciously express thanks for the good things in your life
.Consciously be optimistic when thinking about your future
. Focus on what you do well - rather than on mistakes - learn to fail forward
. Forgive
.Be kind to yourself- if you don't look after yourself - who can you look after?

National Teenager Drug Use Report Released:

2011-01-19T11:02:00.000+10:00

This month the statistical report on Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2008, was released.
The information identifies that tobacco and alcohol trends are altering with 40% of drinkers aged 16 to 17 years old still drinking at risky levels, which supports the implementation of the national binge drinking strategy implemented by the government.

The information also identifies an increase in the 16 to 17 year olds who had reported using ecstasy in the month prior to the survey (an increase from 2.3% in 2005 to 3.4% in 2008).

Festival-goers around the country are being targeted this summer by the Government’s National Drugs Campaign to combat illicit drug use. The latest phase of the National Drugs Campaign will be promoted through the popular In the Mix website - the go-to site for the summer music festival program.

The Australian Secondary Students Alcohol and Drug Survey, partly funded by the Australian Government, is coordinated by the Cancer Council of Victoria and takes place every three years. This survey took place during the academic school year of 2008, with around 24,000 secondary students aged between 12 and 17 years participating. They were asked about their lifetime and current use of tobacco, alcohol, analgesics, tranquilisers, illicit substances and related behaviour.

The report can be downloaded at the National Drug Strategy Web site

Alcohol Reminders: What is a Standard Drink?

2011-01-03T09:48:00.006+10:00

This is the time of year when it hits home that many Australians drink alcohol, generally for enjoyment, relaxation and sociability, and do so at levels that cause few adverse effects. However, a substantial proportion of people, including teenagers drink at levels that increase their risk of alcohol-related harm. As nurses we are aware that alcohol is a cause of significant ill health and hardship. As the government web site on alcohol highlights,in many countries, including Australia, alcohol is responsible for a considerable burden of death, disease and injury. Alcohol-related harm to health is not limited to drinkers but also affects families, bystanders and the broader community. There is a great website established by the government on Alcohol . It has good resources and is really easy to use. If you are caring for patients / clients or know of others around you who are suffering due to the impact of alcohol - this web site is worth checking out!

Standard drinks:

A standard drink contains 10 grams of pure alcohol, but the drinks you buy often contain more than one standard drink. There are no common glass sizes used in Australia.

The label on an alcoholic drink container tells you the number of standard drinks in the container.

Here is a quick summary relating to standard drinks. The info is available on the website.

Beer Glass 1.1 285mls full strength 4.8% alc.vol

Glass 1.6 425ml full strength 4.8% alc.vol

Bottle 1.4 375ml full strength 4.8% alc.vol

Can 1.4 375ml full strength 4.8% alc.vol

Wine Glass 1.4 150mls Average restaurant serving:sparkling
12% alc.vol

Glass            1.6         150mls Average restaurant serving:red wine
                                  13.5% alc.vol
Glass            1.4         150mls Average restaurant serving:white wine
                                   11.5% alc .vol
Bottle             8           750mls Bottle of red wine 13.5% alc.vol

Spirits Bottle 1.2 330mls full strength ready to drink
5% alc.vol

Glass              1           30mls high strength spirit nip 40% alc.vol
Can                 1.5       375mls full strength pre -mix spirits 5 % alc.vol
Can                 1.6       300mls high strength pre-mix spirits
                                    7% alc.vol

Christmas: Not always Festive!

2010-12-21T17:19:00.001+10:00

Whilst many of us are happily planning for a fantastic Christmas and holiday season, its timely to remember that within our communities, families and work places, we know people who are struggling with depression.Over a million people in Australia live with depression and over two million have an anxiety disorder. With the right treatment, most people recover. Beyond blue, the national initiative to address depression has a fantastic website with lots of great information to download. This site provides easy to understand information, checklists and resources - that may just make the difference. Check out the website Beyond blue and save it to your internet favourites - you never know when you may need to access it for someone you care for.

Have an exceptional Christmas, recognise that whilst nurses work hard and deal daily with difficult circumstances, nurses make a positive difference in the lives of many - remember to care for yourselves and those you love!

Is the safe sex message getting through?

2010-12-17T11:14:00.000+10:00

There has been some debate in the media regarding safe sex practices or lack of and the rise of HIV infections - particularly in the younger female age group. When HIV was first recognised as a public health issue in the late 1980's the "Grim Reaper" adds where very effective in getting the message across to the general public - indeed the Australian public health initiative won world wide praise for innovation in health education.

Some Sexual Health professionals believe that we need another Grim Reaper type initiative to refocus the community to the fact that HIV remains a public health risk, and whilst new antivirals are allowing people to live longer they do not cure the disease.

What is safe sex?

" Safe sex, as defined by the Royal Adelaide Hospital Sexually Transmitted Disease Service, means not allowing your partner's body fluids (blood, semen, vaginal fluids) into your body and vice versa. It can also mean covering up or avoiding contact with parts of the body that might be infectious e.g. herpes sores or warts."

The use of condoms remains the barrier of choice in preventing exchange of body fluids, however, it should be noted that condoms will not protect against genital warts or genital herpes as the condom may not cover the infected area.

The other barrier that is available for use in oral sex is a dental dam which is a thin square of latex that can be placed over the area "that is being worked on"!

As nurses we need to continue to educate those we come into contact with on safe sex practices - as nurses we have a responsibility to keep up to date with current safe sex information.

The following sites may be of interest:

http://www.stdservices.on.net/std/prevention/

http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=240&np=299&id=2062#3

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Safe_sex?open

National Drugs Campaign - Party Safe this Summer

2010-12-08T20:47:00.000+10:00

As nurses it's useful to be aware that the latest phase of the National Drugs Campaign is being promoted through the popular In the Mix website, the go-to site for the summer music festival program.

Minister for Health and Ageing Nicola Roxon has confirmed

"Generally, illicit drug use is declining in Australia. However, ecstasy use has risen over the past decade."

In 2007, 3.5 per cent of Australians aged over 14 years reported using ecstasy in the preceding 12 months. This means it is the second-most commonly used illicit drug after cannabis.

"The latest phase of the campaign increases the focus on information and education about the risks and harms of ecstasy use."The campaign continues to cover other amphetamine-type stimulants including ice and cannabis. As we all work and live in different settings, take the time to check out the user friendly website National Drugs Campaign . It has great info and interesting facts which can be downloaded. Have a read before the Silly Season really gets underway - you may learn something new that may assist your clients, or even someone in your personal life!

Stress Busters: Time to Chill Out!

2010-11-20T19:56:00.000+10:00

As the end of the year draws closer it seems to many that the stressors in our lives increase.
Whilst we spend our days at work reassuring our clients and patients that 'everything is o.k , we work in jobs that to many are viewed as stressful. Stress, as we all know can be a fantastic motivator, but we can all take a few minutes to consider how we can manage stress when it no longer remains at a level that is positive and motivating.
Here are some quick suggestions!

• Pop some bubble wrap.
• Standing, bend and place palms on your thighs. With chin parallel to the floor, breathe in and arch your chest forward; breathe out and arch it up like a cat.

• Soak a hand towel and microwave for two minutes until steamy. Place on back of neck, on face or computer-achy hands.

Mini-massage: Lie on your back and position a tennis ball under the tense points—your lower back, between your shoulder blades, etc. Roll gently up and down and side to side.

• Switch off your computer so the screen goes blank and that ever-present buzz stops. Think of a fantasy place—the beach, the mountains, playing at home with your kids—for five minutes before restarting.

• Dab lavender body oil on your wrist and sniff a few times.

• Drink green tea—packed with theanine, which increases the brain’s output of relaxation-inducing alpha waves and reduces the output of tension-making beta waves.

• DIY reflexology: Tap the tips of your fingers together to clear your head. Or, hold one finger at a time between your other thumb and finger and roll the finger like a pencil. It is thought to relax neck muscles and improve circulation.

• Touch a talisman or object that has meaning to you—your grandmother’s necklace, a cross, a shell you found on the beach as a child, a cherished stuffed animal—and let pleasant memories in.

• Sitting down, as you inhale, touch your tongue to the roof of your mouth. Exhale, relaxing your tongue. Repeat.

• Drink a glass of cold water, then go for a walk outside. The water gets your blood moving and the air invigorates by stimulating the endorphins that distress you.

• While reading e-mail, breathe slowly and focus your attention on your breath. Make the out-breath two times longer than the in-breath.

• When seated or standing, pull your shoulders back and down—good posture and alignment brings oxygen directly to your brain to help you think more clearly.

• Rub the palms of your hands together vigorously to create heat. Quickly place hands over each closed eye and relax for a full minute.

• Cross your bare foot over your opposite leg, and place one thumb at the base of the pinkie where the soft sole meets the ball. Bend toes forward and back with the other hand as your thumb massages up toward the big toe, in this diaphragm-relaxing move.

• Crawl between soothing sheets, freshly washed with scented detergent e.g. lavender and vanilla.

• Forgive someone.

Habits of Highly Effective Nurses

2010-11-01T11:28:00.000+10:00

Whilst this list is not exhaustive it does identify the habits of effective nurses as defined by those that work with them.

Effective Nurses:

1. Are Pragmatic - they understand what needs to be done and they put actions into place to get the job done.

2. Are realists - they do not strive for perfection but understand that the service they provide needs to be good. This nurse has the ability to prioritise the tasks that need to be done and the knowledge that senior administration needs to be made aware that required tasks are being juggled and that less important tasks have been put on the back burner.

3. Understand that they are responsible for their own knowledge and skill base. These nurses seek out information to ensure that they are providing care based on best practice guidelines.

4. Do not shy away from organisational politics - they do not seek to play the game but understand that resources are tight and they can influence who receives the resources.

5. Cultivate relationships to ensure the best possible service is delivered. These nurses cultivate relationships within their team but also with other health care workers such as pharmacists, physiotherapists, and medical officers so that these individuals want to assist them in service delivery - no it is not using people - being pleasant, helpful, and inclusive costs you nothing but others appreciate you and will want to assist you.

6. Have a great attitude - they like what they do - they don't drag themselves into work stating I wish I could win lotto - and blame everyone else as to why they are not happy. Effective nurses take responsibility for where they are in their career path and if they don't like something they work to change it.

7. Are observant and have cultivated the skill of active listening - they are confident that they have all the information they need to create the plan that will provide the best outcome for their patient/client.

Effective nurses are a valuable asset - we should applaud them and seek to be more like them.

cheers

Taking Care of Yourself Whilst on Holidays Overseas!

2010-10-22T15:30:00.000+10:00

Nurses spend all day taking care of others - remember to take care of yourself if you are planning to travel on holidays overseas.There are lots of great sites to check out to save you time and angst for example Smart Traveller and Better Health Victoria

Suggestions for consideration include:

• Allow an easy day or two to recover from jet lag. Remember the effects of jet lag may be reduced if you fly west instead of east.

• If you are unsure of the water supply, drink bottled water.

• To reduce the risk of food poisoning, avoid food buffets, seafood, undercooked meats, peeled and raw fruits and vegetables, and unpasteurised dairy products. Don't buy food from street vendors.

• Don't draw up a jam-packed itinerary – arrange for plenty of rest breaks, particularly in hot weather.

• Wear thongs in communal showers to reduce the risk of infectious diseases (like warts and tinea).

• Pack condoms and practise safe sex.

• Some women prefer to take their own supply of tampons and pads when they travel. These items can be difficult to find or very expensive in developing nations.

• Avoid activities that could infect you with a blood-borne disease - for example, dental work, tattooing or ear piercing.

• Travellers' diarrhoea may reduce the effectiveness of your medications. Consult a doctor if you have diarrhoea for more than one day. Your Australian embassy can provide you with a list of doctors

.• Some medications that are legal in Australia may be prohibited overseas. Contact the Australian embassies in the countries you intend visiting to check.

• Take enough regular medication with you to last the entire trip. Some drugs may not be available overseas.

Safety Tips:

• Don't travel around at night. - try to travel during daylight hours.

• Never hitchhike.

• Don't wear expensive jewellery on obvious display.

• Wear valuables (such as traveller's cheques and credit cards) on a belt worn under the clothes and next to the skin. Remember that handbags, clutch purses and bum bags can be easily stolen

• Consider carrying a 'dummy' wallet holding a small amount of cash. If you are directly confronted by a mugger, you can hand over the dummy wallet and avoid further distress.

• Choose train compartments that have a few people in them. Being alone in an empty carriage could make you vulnerable.

• If you are feeling particularly nervous in an unfamiliar city, notify your hotel manager of where you are going for the day, including details on when they should expect you back. If you don't return to the hotel on time, the manager can call the police.

• Be culturally sensitive to dress codes.Many countries have different ideas about how women should dress and behave. People will make assumptions about you based on what you are wearing. Dress conservatively. Men in certain cultures will judge your sexual availability by your style of clothing.

• Certain countries require women to cover their hair, arms and legs- don't get arrested.

• Many Buddhist temples in South East Asia require visitors to wear long pants and long-sleeved shirts as a sign of respect.

• Visitors to Buddhist temples and Muslim mosques must be barefoot.

• Some tourists at beachside cities feel that wearing bathers around the streets is appropriate, even when the locals are wearing business suits. Take notice of the dress codes.

In some countries, men may consider a woman travelling alone as an easy sexual target. You may experience unwelcome catcalls, obscenities and pinches. Suggestions include:

• Ignore the attention as best you can.

• Leave the situation if possible.

• Go to the nearest police station if you are concerned.

• Err on the side of caution.

Be conscious that you are not at home- always take note of your surroundings. Plan well, read widely and you will have an exceptional oversea's holiday - you deserve it - you're a Nurse!!

What Makes a Good Nurse?

2010-10-18T16:32:00.000+10:00

What makes a good nurse? this question came up in discussion the other day. From a patients perspective a good nurse is the nice nurse, the kind nurse - the one that checks that they are OK and fluffs their pillows for them. The nurse that has time to sit and talk with them, the nurse that is happy and bubbly.

That same nurse may have not given the patients medication in a timely manner or not attended their dressing with the best product for the job. That same nurse may have managed to provide care to three clients whilst her two colleagues had to manage the other 25 patients on the floor.

In the discussion nursing colleagues identified a "Good Nurse" as a knowledgeable professional, good at time management, with great people skills that enables them to coordinate and provide care delivery to ensure the best possible outcome for each patient they come into contact with. This nurse is a good team player, who is quick and competent with a pleasant disposition.

All those present identified that they could tell by the roster whether they would have a good or a bad shift before the shift started simply by the colleagues they were rostered to work with. As nurses we have a responsibility to our clients to ensure the service provided to them meets their needs and the expectation of the employing organisation, our professional regulatory body, and our own ethical stance. That responsibility includes assisting our colleagues to be the best that they can be - which may mean highlighting your concerns to them about their work or reporting to senior management if those nurses are not responsive to your initial discussion.

Nothing changes unless someone initiates the process - to ignore poor performance is as bad as providing poor care.

Thinking about your next Holiday - Reduce Jet Lag!

2010-10-08T20:33:00.000+10:00

Nurses work really hard and often for long periods of time without having a decent holiday or break. For those nurses who are thinking or planning an exceptional holiday that includes oversea's travel, it worth considering how to reduce jet lag to allow you to make the most of your time off !
The Victorian Government Better Health Site is worth checking out for info on travel and jet lag.
Jet lag is a combination of being tired and other symptoms caused by travelling quickly across different time zones. Another name for jet lag is ‘time zone change syndrome’.
The body is synchronised to night and day by the action of sunlight through brain neurotransmitters, especially melatonin. Many bodily processes are timed on this 24-hour physiological ‘clock’ e.g. temperature, digestion, heart rate, and your blood pressure This changing rate of activity over each 24-hour period is called the circadian rhythm (‘circadian’ means approximately one day). Travelling disrupts the circadian rhythm.

Symptoms of Jet Lag:
Fatigue, sleepiness, digestive upsets, impaired judgement and decision making ,memory lapses, irritability & Apathy.

Flying east or west makes a difference:
Your circadian rhythm (body clock) is less confused if you travel westward. Travelling west ‘prolongs’ the body clock’s experience of its normal day–night cycle. Consider a westerly travel route if you are prone to jet lag.

Tips to Help:
Limit or avoid alcohol and caffeinated drinks.

Get enough sleep before you leave.

Drink plenty of water.

Try to nap whenever you feel sleepy.

Eat small meals frequently, choosing lighter foods like fruit and vegetables.

Wear loose, comfortable clothing.

Whenever possible, walk around the cabin.

When you sleep on the plane, try to plan sleep as if the time is that of the destination.

Wear earplugs.

Wear an eye mask. Maximise comfort with a pillow supporting your neck and head.

Tips to Sleep in the new time zone:

Expose yourself to daylight or, if this is not possible, bright light to help ‘reset’ your body clock.

Drink caffeinated drinks in moderation during the day.

Avoid alcohol or caffeinated drinks for a few hours prior to sleep at night.

Try to copy your usual bedtime routine.

Use relaxation techniques.

Enjoy your holiday - you deserve the very best!

Continuing Professional Development (CPD) What you need to know

2010-10-04T15:01:00.000+10:00

There is a lot of confusion in the workplace about the Continuing Professional Development (CPD) Standard that came into being on the 1st of July this year.

Some people are getting the CPD (Continuing Professional Development) requirement for registration confused with CNE (Continuing Nursing Education) points allocated by the Royal College of Nurses to programmes that it endorses.

The difference between CPD hours and CNE points is that you need evidence of CPD hours to meet the standard requirement for your annual registration - you do not need to collect CNE points to do so.

Some organisations are advertising that their courses attract a number of CNE points, which is great and you can convert this information to CPD hours, but (and I cannot stress this enough) you do not need to collect CNE points.

What you need to do (this is directly from the standard on the AHPRA website):
"1. Nurses on the nurses’ register will participate in at least 20 hours of continuing nursing professional development per year.

2. Midwives on the midwives’ register will participate in at least 20 hours of continuing midwifery professional development per year.

3. Registered nurses and midwives who hold scheduled medicines endorsements or endorsements as nurse
or midwife practitioners under the National Law must complete at least 10 hours per year in education
related to their endorsement.

4. One hour of active learning will equal one hour of CPD. It is the nurse or midwife’s responsibility to calculate how many hours of active learning have taken place. If CPD activities are relevant to both nursing and midwifery professions, those activities may be counted in each portfolio of professional development.

5. The CPD must be relevant to the nurse or midwife’s context of practice.

6. Nurses and midwives must keep written documentation of CPD that demonstrates evidence of completion of a minimum of 20 hours of CPD per year.

7. Documentation of self-directed CPD must include dates, a brief description of the outcomes, and the number of hours spent in each activity. All evidence should be verified. It must demonstrate that the nurse or midwife has:

a) identified and prioritised their learning needs, based on an evaluation of their practice against the relevant competency or professional practice standards

b) developed a learning plan based on identified learning needs

c) participated in effective learning activities relevant to their learning needs

d) reflected on the value of the learning activities or the effect that participation will have on their practice.

8. Participation in mandatory skills acquisition may be counted as CPD.

9. The Board’s role includes monitoring the competence of nurses and midwives; the Board will therefore
conduct an annual audit of a number of nurses and midwives registered in Australia."

We believe that AHPRA have made the process quite simple, that simplicity has been lost in the translation to practice. We have provided a couple of links to the current documents (as of this date), housed on the AHPRA and ANMC websites, that will be helpful to you in understanding this requirement.

1. Nursing and Midwifery Continuing Professional Development Registration Standard>>
2. Continuing Competence Framework>>
3. Fact Sheet on the changes with National Registration>>
4. Frequently Asked Questions>>

If you are a member of the Nurses for Nurses Network log on and select the "What Nurses Need to Know" Tab and then choose CPD as this information and a suggested portfolio outline are available to you.

Traveling Overseas: Don't forget your Vaccinations!!

2010-09-29T08:12:00.000+10:00

Nurses are known for being organised and no doubt some of us are already planning for our next holiday! For some nurses this includes traveling overseas.
Don't forget to check with your Doctor and government web sites e.g. Smart Traveller for the latest info- don't leave it until the last minute! Even if you think your travel destination is safe, keep in mind that disease outbreaks can and do happen.
Vaccination for all travellers:The National Health and Medical Research Council recommends certain vaccinations as routine for all travellers. These include: Tetanus,Diphtheria,Pertussis,Varicella,Measles,Mumps,Rubella and Polio.
The common diseases of childhood occur more frequently in developing countries, but they can also occur in adults in Western countries.

Vaccination for travellers with special needs:Some additional vaccinations are recommended for travellers who are at risk of infection or other health problems. This includes people with asthma, respiratory and cardiac conditions, metabolic conditions (such as diabetes) and anyone over 65 years of age. Vaccinations include: Influenza and Pneumonia.

Vaccination for young travellers:Young people may also be offered vaccination againstMeningococcal C,Hepatitis B and Cervical cancer.

Vaccinations for travellers to high risk areas:Developing countries often have a higher risk of particular diseases. Vaccinations recommended for travellers to high risk areas may include: Hepatitis A and B Typhoid, Meningococcal meningitis, Tuberculosis, Rabies, Japanese encephalitis and Yellow fever.

Cholera vaccination is no longer recommended by the World Health Organization for any country.

Vaccination for specific diseases
Hepatitis A

This is the most common vaccine-preventable disease in travelers.
It is spread by contaminated food or water.
The cause is a virus.
Symptoms include fever, lack of energy (malaise) and jaundice (yellow skin colour).
Hepatitis A is rarely fatal.
Symptomatic treatment is the only treatment available.

Hepatitis B

This is spread by body fluid – commonly through sexual intercourse or shared syringes, but also by accident.
The cause is a virus.
Symptoms include fever, lack of energy (malaise) and jaundice (yellow skin colour).
Around half of all cases worldwide result in death.

Typhoid

This is common in developing countries.
The cause is a bacterium.
Symptoms include fever, weakness, headache and sometimes a rash.
Typhoid can be treated successfully with antibiotics.
Vaccinations must be completed at least one week before travelling.

Rabies

This is common to North, Central and South America, Europe, Africa and Asia.
The cause is a virus passed on by a bite or scratch from an infected dog or any mammal that carries the virus.
Symptoms include headache and fever, then convulsions and death.
A three-dose vaccination is given over 3–4 weeks prior to travel.
All animal bites and scratches should be immediately and thoroughly washed with soap and water for at least 10 minutes.
Treatment after a bite from a possibly rabid animal involves a course of five vaccines and, if previously unvaccinated, an injection of immunoglobulin.

Meningococcal meningitis

This is common in sub-Saharan Africa.
The cause is a virus spread by aerosol droplets.
Symptoms include headache, fever, confusion and neurological damage.
Treatment can only ease the symptoms.
Vaccination is a legal requirement for some countries.

Tuberculosis

This is common in developing countries.
The cause is a bacterium spread by aerosol droplets.
Symptoms include persistent cough and fever.
Treatment involves a prolonged course of antibiotics.
Vaccination is recommended only for some travellers to high risk areas for prolonged periods and must be preceded by a special skin (Mantoux) test.

Japanese encephalitis

This is present throughout greater Asia.
The cause is a virus spread by infected mosquitoes.
Symptoms include headache, fever, confusion and neurological damage.
Treatment can only ease the symptoms.
Three doses of vaccine are required well before you travel.

Yellow fever

This is present in tropical South America and sub-Saharan Africa.
The cause is a virus spread by infected mosquitoes.
Symptoms include fever, headache, bloody vomiting, jaundice and death.
The vaccination gives immunity for around 10 years.
Vaccination is a legal requirement for some countries and certification can only be given by an authorised travel health clinic.

Infectious diseases for which there are no vaccines
Infectious diseases are generally transmitted by food, water or a lack of personal hygiene (for example, ‘gastro’, traveller’s diarrhoea, giardiasis and amoebic dysentery) or by insects (for example, malaria and dengue fever). They can be life threatening. Your doctor will advise you on measures and medications that should be taken to help prevent these diseases.

Where to get help

Your doctor
Travel Clinics Australia Tel. 1300 369 359 – for before and after travel advice from a travel clinic doctor
Travel Clinics Infoline Tel. 1900 969 359 – calls cost 99c per min and are not available from all mobile and public phones www.travelclinic.com.au
Department of Foreign Affairs and Trade Travel Advice Tel. 1300 139 281
Travel vaccinations
National Immunisation Infoline Tel. 1800 671 811

Resource:Better Health Victoria

Aching Feet: Suggestions for You!

2010-09-12T17:03:00.000+10:00

As Nurses we spend most of our time on our feet and sometimes our feet feel a little worse for wear. Here are some suggestions that may assist with pampering your feet to have them ready for another busy day at work!

Soak Feet: Place 2 tablespoons of Epsom salts into a large basin of warm water and soak them for 15 minutes. Pat dry gently and apply your favourite moisturizer.

Hot & Cold Water: Place your feet in the bath and run alternatively comfortably hot and cold water over your feet for 1 minute at a time - finish with cold water.

Feet Massage:Apply massage oil, moisturizer or baby oil and start with medium light strokes using your thumbs and fingers.Start at the ball of the foot and go across and down the foot using your thumbs to make small circular motions. Use your thumbs to make long strokes along the arches of your feet, moving the direction toward your toes.Squeeze,rotate and pull each toe. Complete the massage by placing both hands around each foot and gently squeezing up and down each foot.

Ice your feet: If your feet are swollen after a hard day at work, try placing some ice in a washer and rub the washer over your feet.

Exercise your feet: Place a golf ball or similar size ball under your bare foot - don't stand! Roll the ball around under your foot using only the weight of your foot. Whilst sitting, raise your foot and rotate the entire foot in a circle . Point and flex your toes. Repeat at least 6 times for each foot.

Know your feet: Ensure you are wearing shoes that suit your shape foot-e.g. if you have high arches you may need shoes with lots of cushioning as your feet may tend to be rigid.Wear shoes that suit the purpose and remember to invest in new shoes when your old work shoes are becoming worn- investing in your feet is worth it!

Check out Australasian Podiatry Council and complete a quick foot health quiz and download some of the Australasian Podiatry Council brochures on looking after your feet.

HEALTH CHECKS FOR US:

2010-08-27T17:30:00.000+10:00

As nurses we spend our time looking after others and often, at the end of the day we put ourselves last. How can we properly look after others if we don't look after our own health.Whilst we can all access lots of info on what checks we should have and when, please take a few minutes to check out the info below and follow through - look after you!

Men & Women, ask yourself:

How long has it been since you had a skin check?
Is your blood pressure within normal range?
Do you know your cholesterol and blood triglycerides levels?
What is your personal Body Mass Index ( BMI) and waist measurement?
Are you over 50 and have you been checked for Bowel Cancer?
Are you at risk of type 2 diabetes?
When did you last have your eyesight tested - do you have a family history of glaucoma?
Do you need to be checked for osteoporosis?

Men Only:

It may still not be regularly talked about - BUT when was the last time you checked your testicles for thickening or lumps?
Are you over 50 - have you been to the Doctor for a prostate check?

Women Only:

When was the last time you had a pap smear?
Do you check your breasts monthly?- visit your Doctor to determine the frequency of additional checks/mammograms

Remember YOU are important - take good care of yourself. For more detailed information check out Better Health Victoria

Self Directed Learning

2010-08-23T16:25:00.000+10:00

When discussing Continuing Professional Development with nurses the topic of self directed learning is usually raised. What is self directed learning, how do I "do" self directed learning, how can I prove that I have undertaken self directed learning, and why would I want to do self directed learning are some of the questions that are routinely asked.

Self directed learning is a simple task - it simply means that you have taken the initiative to look up a nursing topic to gain a greater understanding of that topic and you've done this on your own. No one made you do it and you won't be paid for doing it. The reason that you have undertaken self directed learning is that you understand that due to scientific and technical advances the way in which we provide care will change - it is no longer reasonable (not that it ever really was!) to assume that just because we have always done it like that means we should continue to do it like that.

As professionals we have an obligation to ensure that the service we provide to our client is current. Just as you would have an expectation that your surgeon would be using the latest surgical techniques, and your mechanic would have updated his knowledge so he can service your new car; the general public believe that the nurse caring for them knows exactly what they are doing and is applying the latest information to their care delivery.

So how do you "do" self directed learning - this depends on how you process information. Some people may choose to subscribe to a journal, others may google health sites, others may subscribe to newsletters, and some may seek out more learned colleagues via membership of nursing committees and forums. Which ever method you choose the focus should be on embracing new information and reflecting on how that information impacts on your practice and the policy direction of the organisation you work for.

The way in which you provide evidence of self directed learning for your Continuing Professional Development (CPD) evidence portfolio is relatively easy. You would have undertaken a self assessment of your education requirements and identified the education topic. On a piece of paper write down the date, the topic of education, where the information came from e.g journal article, website etc. Write down the name of the journal or web site address, the amount of time you spent on the topic including reflecting how the information could be used in your work area. Then write down how you will use the information - will it change your practice or has it reinforced what you presently do - sign the bit of paper and place it in your portfolio.

Nursing is a great career but it comes with multiple responsibilities - one of which is to ensure the care you provide is based on science and is current - self directed learning activities are one way you can ensure that you meet your patients and professions expectations.

Sleep Hygiene: Tips for Sleeping!

2010-08-16T15:09:00.000+10:00

Nurses often work in settings that provide 24/7 care and services.Shiftworkers are recognised as being at risk from fatigue. Workplace, Health and Safety Queensland Fatigue has some interesting information.

We spend lots of time ensuring our clients are comfortable and assisting them with strategies to rest and sleep - but how often do we forget to apply simple techniques to assist ourselves?

The Victorian Better Health Channel provides the following suggestions.
‘Sleep hygiene’ means habits that help you to have a good night’s sleep. Common sleeping problems (such as insomnia) are often caused by bad habits reinforced over years or even decades. You can dramatically improve your sleep quality by making a few minor adjustments to lifestyle and attitude.

Obey your body clock

The body’s alternating sleep–wake cycle is controlled by an internal ‘clock’ within the brain. Most bodily processes (such as temperature and brain states) are synchronised to this 24-hour physiological clock. Getting a good sleep means working with your body clock, not against it. Suggestions include:

• Get up at the same time every day.
• Don’t ignore tiredness. Go to bed when your body tells you it’s ready.
• Don’t go to bed if you don’t feel tired. You will only reinforce bad habits such as lying awake.
• Get enough sunshine. Exposure to light during waking hours helps to set your body clock.

Improve your sleeping environment
Good sleep is more likely if your bedroom feels restful and comfortable. Suggestions include:

• Invest in a mattress that is neither too hard nor too soft.
• Make sure the room is at the right temperature .
• Ensure the room is dark enough.
• If you can’t control noise (such as barking dogs or loud neighbours), buy a pair of earplugs.
• Only use your bedroom for sleeping and sex. If you treat your bed like a second lounge room – for watching television or talking to friends on the phone, for example – your mind will associate your bedroom with activity.

Avoid drugs

Some people resort to medications or ‘social drugs’ in the mistaken belief that sleep will be more likely. Common pitfalls include:

• Cigarettes – many smokers claim that cigarettes help them relax, yet nicotine is a stimulant. The side effects, including accelerated heart rate and increased blood pressure, are likely to keep you awake for longer.
• Alcohol – alcohol is a depressant drug, which means it slows the workings of the nervous system. Drinking before bed may help you doze off but, since alcohol disturbs the rhythm of sleep patterns, you won’t feel refreshed in the morning. Other drawbacks include waking frequently to go to the toilet and hangovers.
• Sleeping pills – drawbacks include daytime sleepiness, failure to address the causes of sleeping problems, and the ‘rebound’ effect – after a stint of using sleeping pills, falling asleep without them tends to be even harder. These drugs should only be used as a temporary last resort and under medical advice.

Relax your mind
Insomnia is often caused by worrying. Suggestions include:

• If you are a chronic bedtime worrier, try scheduling a half hour of ‘worry time’ well before bed. Once you retire, remind yourself that you’ve already done your worrying for the day.
• Try relaxation exercises. You could consciously relax every part of your body, starting with your toes and working up to your scalp. Or you could think of a restful scene, concentrate on the rhythmic rise and fall of your breathing, or focus on a mantra (repeating a word or phrase constantly).

General suggestions
• Exercise every day, but not close to bedtime and try not to overheat yourself – your body needs time to wind down.
• Try not to engage in mentally stimulating activities close to bedtime. Use the last hour or so before sleep to relax your mind.
• Don’t take afternoon naps.
• Avoid caffeinated drinks (tea, coffee, cola, chocolate) close to bedtime. Instead, have a warm, milky drink, since milk contains a sleep-enhancing amino acid.
• Take a warm bath.
• Turn your alarm clock to the wall. Watching the minutes tick by is a sure way to keep yourself awake.
• If you can’t fall asleep within a reasonable amount of time, get out of bed and do something else for half an hour or so, such as read a book.
• If you have tried and failed to improve your sleep, you may like to consider professional help. See your doctor for information and referral.

Continuing Professional Development (CPD) Requirements

2010-08-09T11:55:00.000+10:00

We produced a blog post in May this year discussing the CPD requirements under the new national registration scheme for nurses. Now that the scheme is up and running we thought that it would be worthwhile to review the requirements as identified in the AHPRA fact sheets.

All registered nurses and midwives in Australia from the 1st of July 2010 will be required to be able to provide evidence that they undertook at least 20 hours of Continuing Professional Development (CPD) each year in order to maintain their registration. One hour of active learning equals one hour of CPD evidence.

If you are a midwife then you will be required to complete 20 hours of nursing CPD and 20 hours of midwifery CPD, however, there are a number of activities that would be counted for both nursing and midwifery evidence.

If you are a nurse practitioner you will be required to complete 20 hours of CPD as a nurse and an additional 10 hours of CPD in your area of endorsement.

The Australian Health Practitioner Regulation Agency (AHPRA) recommends that you keep at least three years of CPD evidence available in your portfolio.

The Nursing and Midwifery Board of Australia has identified a number of examples that would equate to Continuing Professional Development. These include:

“Without wishing to limit the examples, active learning may include:

•Reflecting on feedback, keeping a practice journal
•Acting as a preceptor/mentor/tutor
•Participating on accreditation, audit or quality improvement committees
•Undertaking supervised practice for skills development
•Participating in clinical audits, critical incident monitoring, case reviews and clinical meetings
•Participating in a professional reading and discussion group
•Developing skills in IT, numeracy, communications, improving own performance, problem solving and working with others
•Writing or reviewing educational materials, journal articles, books
•Active membership of professional groups and committees
•Reading professional journals or books
•Writing for publication
•Developing policy, protocols or guidelines
•Working with a mentor to improve practice
•Presenting at or attending workplace education, in- service sessions or skills workshops
•Undertaking undergraduate or postgraduate studies which are of relevance to the context of practice
•Presenting at or attending conferences, lectures, seminars or professional meetings
•Conducting or contributing to research
•Undertaking relevant online or distance education (ANMC, 2009)

The cycle below identifies how individual nurses will identify their CPD requirements and monitor their progress.

If you are a member of the Nurses for Nurses Network you will have access to a portfolio template so you can identify what educational activities you may require, document the activities as you attend them and reflect on the information provided in the session.

For further information regarding CPD follow the link to the AHPRA website:
http://www.nursingmidwiferyboard.gov.au/en/Registration-Standards.aspx

How Do You Measure Up!

2010-08-02T16:44:00.000+10:00

As nurses we spend all day every day looking after others! Whilst we may have heard about this campaign have we each taken the time to measure up! The Measure Up Campaign is part of the Australian Better Health Initiative (ABHI), a national program, supported by the Australian and state and territory governments, which aims to reduce the risk factors for chronic disease such as some cancers, heart disease, and type 2 diabetes.

A simple check to determine if you may be at risk of chronic disease is to measure your waist,.
When measuring your waist;

Measure directly against your skin.
Breathe out normally.
Make sure the tape is snug, without compressing the skin.
Measure halfway between your lowest rib and the top of your hipbone, roughly in line with your belly button.

As the how do you measure up site identifies; most people are at increased risk of chronic disease if your waist is;

Men: more than 94 centimetres
Women: more than 80 centimetres

The site offers free downloadable information including tape measures.
Check out the Quiz to rate your physical activity Physical Activity Quiz
The Dietary Guidelines for Australian Adults, amongst other recommendations, encourage people to enjoy a wide variety of nutritious foods: Information on dietary guidelines for all Australians can be found on the National Health and Medical Research Council website Australian Dietary Guidelines.htm

If you are really focused on ensuring you look after yourself as well as you look after others,you may like to check out the 12 week planner which is downloadable form the site.

Remember - how can you successfully look after others - if you don't take good care of yourself.

The Science of Hand Washing

2010-07-06T12:31:00.000+10:00

The recent recommendation that has resulted in most aged care facilities requesting visitors and staff to use an alcohol based hand rub on entry to there facilities has provided an opportunity to reflect on the most basic cross infection preventative action - that of hand washing.

" In 1847 Hungarian-born physician Ignaz Semmelweis made striking observations which lead to the practice of hand washing in medical clinics. While working at an obstetrics clinic in Vienna, Dr. Semmelweis was disturbed by the fact that fatal childbed (or “puerperal”) fever occurred significantly more frequently in women who were assisted by medical students, compared with those who were assisted by midwives. Through meticulous examination of clinical practices, he discovered that medical students who assisted in childbirth often did so after performing autopsies on patients who had died from sepsis (of bacterial origin). After instituting a strict policy of hand-washing with a chlorinated antiseptic solution, mortality rates dropped by 10- to 20-fold within 3 months, demonstrating that transfer of disease could be significantly reduced by this simple hygienic practice."1.

Since 1847 hand washing has continued to be the focus for health educators and achieving compliance amongst nursing and medical students has been a challenge that has resulted in a number of strategies applied to the cause. Most students have an understanding of the theory of cross infection and are able to expouse the virtues of hand washing. Educators and Infection Control practitioners continue to report that there is a huge difference between what students and qualified staff appear to know and what they do in practice.

A website has been established to focus on hand hygiene http://www.hha.org.au/home.aspx and it even provides a web based education session on hand hygiene.

The website identifies the following reasons as to why health care workers do not wash there hands:

"Heavy workloads - the busier you are the less likely you are to wash your hands
Time consuming - there just isn't enough time to wash your hands as often as you need to if using the traditional Hand Hygiene techniques
Hands don't appear dirty - Bugs are there even if you can't see them
Problems with skin irritation - frequent washing with soap and water removes skin lipids, and in some health are workers causes dryness, skin irritation and damaged skin
Sinks poorly located - if it's hard to get to a sink you are less likely to use it."

The concern is that health care workers, even though they know the reason for washing their hands' choose not to do so - yet we trust our loved ones to their care.

Hence the recommendation to use an alcohol based hand rub and only wash hands with soap and water if they are visibly soiled. The belief of this strategy is that health care workers will be compliant due to the ease of application of the hand rub and the less likely hood of skin irritation that occurs with soap and water.

The bean counters believe that the introduction of the alcohol based rub would be cost neutral as there will be less use of soap based applicators and paper towel for drying of hands.

Hopefully the success of the initiative will be monitored from a client outcome as well as a financial implication perspective.

1. http://infectiousdiseases.about.com/od/prevention/a/history_hygiene.htm
2. http://www.hha.org.au/

Women and Heart Disease

2010-06-22T23:40:00.000+10:00

Cardiovascular disease (CVD), in the main, is a preventable illness - the risk factors of which have become very common amongst Australian women. Coronary heart disease and stroke are the leading causes of death for women in this country. As health care workers we have a responsibility to be informed so as to educate our clients - as nurses we have a responsibility to care for ourselves so that we are able to live a full and healthy life.

"Key points
• We know which risk factors are responsible for most of the burden of CVD.
• We know that most Australian women have one or more of the modifiable risk factors; in fact, half of all women have two or three modifiable risk factors.
• We know that most of these risk factors can be reduced, both in terms of the severity of individual risk factors and in the number of risk factors per person.
• So the good news is that there is enormous potential to improve the risk profile of women and therefore reduce the number of women and families affected by CVD.
• Specifically, among Australian women:
- 27% have high blood pressure
- 48% have high blood cholesterol
- 54% are overweight or obese
- 2–7% have Type 2 diabetes
- 93% do not eat the recommended serves of fruit or vegetables
- 76% are physically inactive
- 15% smoke daily
- 10% drink alcohol at risky or high risk levels
- 15% have had at least one episode of depression in their lifetime."

What do we need to do:
1. Get a grip on lifestyle issues that we can alter like managing our weight (I know this is easier said than done and there is a huge market out there flogging weight loss potions) When all is said and done the only way to lose weight is to eat less energy than you expend.
2. Losing weight will also assist with blood pressure levels and cholesterol, however, medical intervention in the form of medication may be required for both these issues until we have our weight under control.
3. The research indicates that Type 2 diabetes is also related to obesity - so losing weight will also assist in managing this illness.
4. Eat the recommended amounts of fruit and vegetables - that's 2 serves of fruit and 5 serves of vegetables each day - how stupid are we that we are willing to risk heart disease because we can't fit in a couple of apples and a few vegetables in a diet each day.
5. We need to get moving, however, this doesn't need to be a marathon - my understanding is that any physical activity is better than no activity - so get out there and do something that you enjoy - if you can't enjoy it then just get up and do something.
6. Stop smoking - it stinks and you get wrinkles around your mouth - so not only will you get heart disease but you're going to look bad too!
7. Don't drink to excess
8. Everyone needs a support network- in order to get support you need to also be supportive to others - take the time to work on your friendships.

Look after yourself, be nice to yourself, recognise that you are as important as anyone else in your life and if you don't care for you then no one else will.

I think I may take some of this advice!!

Source: Women and Heart Disease: Cardiovascular profile of women in Australia, Australian Institute of Health and Welfare, June 2010

2010-06-09T13:05:00.000+10:00

We have been discussing how we manage stress in both our personal and professional lives.

Certainly stress is experienced differently by all of us. What is stressful for one person may be viewed as exhilarating by another. It is our response to a situation that will lead us to perceive whether it is stressful or not - so the way in which we manage our response will allow us to better manage our stress.

Reflect on the issues that are causing you stress and discuss these issues with a trusted friend or workmate. You may be stressed because you believe that you are not managing the situation you find yourself in well enough - this may be due to a lack of knowledge and skill or it may be due to uncoordinated work practices.

Whatever the reason there are strategies that you can employ to manage the situation:

1. Learn to relax - try a bit of meditation - find a quite spot, sit in a relaxed position, close your eyes and take a long deep breath - exhale - as you do so let all the pent up stress of the day leave your body with that wonderful full breath. Now keep your eyes closed and breath normally - concentrate on your breathing and push any other thoughts out of your mind. Two or 3 minutes is long enough to re energize you.

2. Discuss your concerns with people who can actually make a difference in your work environment. It is no use discussing the issue with work mates when it is only the supervisor who can change work routines.
3. Plan and organise your work tasks - if you work as part of a team discuss the tasks that need to be achieved with all team members and agree on how the team will achieve them.

4. Try having a positive attitude - others respond to people that are positive and happy not to the person that is always negative. "try looking at the glass being half full rather than half empty - you will surprise yourself with how much better this can make you feel.

5. Don't worry about the little things - "don't sweat the small stuff". Recognise that others think differently to you and actually have a right to do so - the aim of dealing with people is compromise in order to achieve the goal.

6. Know that it is OK to look after yourself - take the time to do the things that make you happy whether that be gardening or belly dancing.

Don't say "I'm stressed" do something to manage the situation. If you don't look after yourself no one else will.

Continuing Professional Development

2010-05-26T15:17:00.000+10:00

There has been a lot of discussion regarding the Continual Professional Development (CPD) requirements for Registered, Enrolled Nurses and Midwives from the 1st of July 2010. The CPD requirements are one component of the Continuing Competence Framework that the Australian Nursing & Midwifery Council (ANMC) has developed to protect the public by ensuring base line competence requirements are met.

The CPD requirements are actually straight forward:

The nurse needs to reflect on their education requirements based on their role and develop a learning plan to meet those requirements.
The nurse is then required to undertake education that meets the education requirements identified in their plan.
"Nurses and midwives will participate in at least 20 hours (points) of CPD per year, with a minimum of 60 hours (points) every three years. Documentation of participation in CPD must be completed at least once each year." One hour of learning equals one CPD point.
The nurse is responsible to provide evidence of CPD activities, this "Documentation must provide details of any CPD activities, including dates, a brief description and hours (points) spent in each activity."
CPD activities may be self directed which includes education provided via the in service program of the nurses employer or may be individual nurses seeking information from journals etc.
CPD activities may be formal which includes programs provided by a number of professional organisations these programs do not have to be endorsed to provide education by an accrediting body.
"Participation in mandatory continuing education, such as Basic Life Support training or manual handling, should not be counted as CPD unless active learning of new knowledge or skills has taken place."
"Examples of Effective CPD Activities
• Reflecting on feedback, keeping a practice journal
• Acting as a preceptor/mentor/tutor
• Participating on accreditation, audit or quality improvement committees
• Undertaking supervised practice for skills development
• Participating in clinical audits, critical incident monitoring, case reviews and clinical meetings
• Participating in a professional reading and discussion group
• Developing skills in IT, numeracy, communications, improving own performance, problem solving and working with others
• Writing or reviewing educational materials, journal articles, books
• Active membership of professional groups and committees
• Reading professional journals or books
• Writing for publication
• Developing policy, protocols or guidelines
• Working with a mentor to improve practice
• Presenting at or attending workplace education, in service sessions or skills workshops
• Undertaking undergraduate or postgraduate studies which are of relevance to the context of practice
• Presenting at or attending conferences, lectures, seminars or professional meetings
• Conducting or contributing to research
• Undertaking relevant online or distance education"

It is not a complicated process - reflect on your requirements, seek education to address same, document attendance so that you have evidence of same.

Don't get confused by the large number of organisations who are identifying that they have courses specifically designed to provide CPD points - as you can see from the list of examples of CPD activities this is not required.

Also be aware that the Royal College of Nursing allocates CNE points (Continuing Nurse Education) to conferences and education courses but these points are not required to be collected to achieve the ANMC requirements.

To read the full document provided by the ANMC click here>>

International Nurses Day

2010-05-11T10:41:00.000+10:00

Wednesday the 12th of May is celebrated as International Nurses Day. This date was chosen as it is the Birthday of Florence Nightingale, the woman attributed as founding modern nursing. I wonder what Florence would think of the way the profession has evolved since she became the Superintendent of a hospital for gentlewomen in Harley Street in 1853.

Nursing remains the backbone of health service delivery, even though over the years various professions have evolved that specialise in one aspect of health care, nursing continues to provide a holistic approach to client assessment with specialist knowledge that enables the delivery and coordination of services to the community.

The number of speciality areas of nursing practise continues to grow and the advent of the Nurse Practitioner will see the profession alter both in the way in which it prepares students and how it is perceived by other health care practitioners and the wider community.

As nurses we have a responsibility to ensure that the reputation of our profession is continually enhance with every interaction that we have with our clients. Whilst society has changed since Florence took up that first position as hospital Superintendent the need to retain a professional demeanour remains. In our modern egalitarian society the nurse/patient relationship has altered so that the client is a key participant in decision making and the driver of their health care delivery - as it should be. However, the changing dynamic of this relationship can create a situation where the nurse interacts with the client as a friend or peer rather than as a paying customer. The relationship is more casual with information sometimes exchanged that is outside of the therapeutic relationship that should exist between a client and a health care professional.

We would be interested on your comments and experiences regarding professional relationships and any problems that you have experienced with same.

Norfolk Island Conference

2010-05-05T14:06:00.000+10:00

The registration for this conference is open to members of the Network and we are really excited to bring this event to you. One of the reasons that we created the Network was to provide nurses the opportunity to visit interesting places to see how health care is delivered in that setting. Norfolk Island is classified as a remote health care service and the health care team on the island manage both acute and chronic health care conditions with great skill.

Another reason that we chose Norfolk Island was the wonderful location - beautiful scenery, steeped in history, good food, and fabulous shopping.

Two great dinners are included in the cost of the conference. The first night we will dine amongst the convict ruins at Kingston Harbour, have a sumptuous meal including wine, whilst we adjust to Norfolk Island "time". The Gala Conference Dinner, held on the last night of the conference, will be an 80's themed party - so those of you who remember the advent of disco bring your dancing shoes with you.

Download the full program from the website which lists all of the conference sessions and activities.

http://www.nursesfornurses.com.au/