CONNECTIONS - Royal College of Nursing, Australia

CONNECTIONS 

Royal College of Nursing, Australia | Volume 14 | Issue 2 | June 2011 

Indigenous 

ceremonies link 

primary health 

care and culture 

the dIsaster frontlIne 

the role of nurses In aId work 

lIvIng wIth ParkInson’s

InspIrIng, 

progressIng and 

promotIng the 

professIon of 

nursIng. 

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From the Chief Executive 

Debra Y Cerasa FRCNA 

1 

The past months have seen natural 

disaster devastate communities on the 

home front and abroad. As often 

happens, with the worst kind of 

situation comes the best kind of 

human behaviour. The special feature 

articles on the Queensland and 

Victorian floods in this issue of 

Connections indicate that recent cases 

are no exception. These articles 

demonstrate the spirit of the nursing 

profession, the team work which 

underlines nursing and the 

fundamental drive so many nurses 

have to care for people in need, often 

with great sacrifice to themselves. In 

light of these recent experiences of 

nurses in disaster response, RCNA are 

developing an exciting new initiative 

with a key focus on disaster health. 

Keep your eye out for progress in the 

September edition of Connections! 

Another upcoming event is the RCNA 

Community and Primary Health Care 

Nursing Conference (CPHCNC) 

which will be held in Hobart from the 

19–21 October 2011. The focus of the 

conference is: Leading the way to local 

care and we are planning a 

comprehensive event that will provide 

CONNECtioNS 

Royal College of Nursing, Australia 

VOL 14 | ISSUE 2 | June 2011 

Connections is distributed quarterly 

Editor Debra Cerasa/Jackie Poyser 

Editorial coordinator Kathryn Hind 

Editorial assistant Casey Hamilton and 

Phoebe Glover 

Design Nina Vesala 

Get published with Connections 

Send your submissions to 

publications@rcna.org.au 

Download submission guidelines and 

view our image specifications at 

www.rcna.org.au/publications/get_published 

Advertise with Connections 

Send your enquiries to: 

advertising@rcna.org.au or visit 

www.rcna.org.au/advertising 

a forum to discuss, plan and innovate 

ways forward for community and 

primary health care. It is such a huge 

topic to cover; community and 

primary health care affects everyone 

as they seek the best care for 

themselves and their families and it 

is also of great importance to a huge 

number of nurses, as they are the 

predominant health professionals in 

the field. The role nurses play in 

community and primary health care is 

invaluable and they are working across 

Australia, including in rural and remote 

settings, to ensure it is everything it 

should be; accessible, reliable and with 

the health and wellbeing of patients at 

the centre of action. The CPHCNC is 

going to be the place to tackle issues, 

challenges and progressions of the 

nursing profession in community and 

primary health care. 

On a final note I am thrilled to report 

that those of us from RCNA who 

attended the 2011 International 

Council of Nurses (ICN) Conference 

in Malta in May have returned 

invigorated after the opportunity 

to unite and engage with the 

international community of nurses. 



Publisher Royal College of Nursing, Australia 

1 Napier Close, Deakin ACT 2600 

Tel 02 6283 3400 

Email canberra@rcna.org.au 

ABN 69 004 271 103 

Printing Paragon Printers 

© Royal College of Nursing, Australia 2011 

The opinions expressed within are the authors’ 

and not necessarily those of Royal College of 

Nursing, Australia or the editors. Information is 

correct at time of print. 

All images marked ‘file photo’ or credited to 

iStockphoto are representative only and do not 

depict the actual subjects and events described in 

the articles. 

While at the conference, RCNA 

hosted a function to promote the 

next ICN 25th Quadrennial 

Conference to be held 18–25 of May 

in Melbourne. This conference will be 

a fantastic opportunity for Australian 

nurses to get involved in the 

development of the nursing profession 

on an international level. More on 

Malta next issue! 

Debra Y Cerasa FRCNA FCN 

Chief Executive 

Contents 

02 Special features 

02 Nurses volunteering on the disaster 

frontline 

04 Reflections on the water 

06 Faculties 

06 Rural Nursing and Midwifery Faculty 

10 movement Disorders and Parkinson’s 

Nurses Faculty 

14 New Generation of Nurses Faculty 

18 Community and Primary Health Care 

Faculty 

20 health and Wellbeing in Ageing Faculty 

22 national networks 

22 Acute Care NN 

24 Breast Care NN 

26 Ethics NN 

28 History NN 

30 Leadership NN 

32 Legal Issues NN 

34 Nurses in Business NN 

38 Nurse Practitioner NN 

40 Oral Health NN 

41 Pastoral Nursing Care NN 

43 Research NN 

46 Transcultural NN 

48 RCNA Chapter committees 

CONNECTIONS | VOL 14 | ISSUE 2 | june 2011

2 

special feature 

Nurses volunteering 

on the diSASter frontline 

By James Bonello MRCNA, Emergency Nurse, Flinders Medical Centre 

In times of natural disasters and tragedy our communities rely upon the hard work and dedication 

of ordinary Australians who support our volunteer emergency services. Registered nurse James 

Bonello, Chair of the RCNA New Generation of Nurses Faculty, shares his experiences of 

deployment as part of the Queensland Flood Relief effort with St John Ambulance Australia. 

Photo courtesy of M. Jenner 

James Bonello (far right) with colleagues from St John Ambulance Australia 

Major flooding devastated extensive 

areas of Queensland from December 

2010 and throughout January 2011. 

Large areas were inundated and 

washed away, with property destroyed 

and lives tragically lost. All of Australia 

watched on in disbelief as 

Queenslanders faced one of the most 

severe natural disasters in living 

memory. 

As a registered nurse and volunteer 

with St John Ambulance in South 

Australia, I was only too keen to put 

my hand up when the call for an 

emergency response clinical 

deployment was made. Fortunately, I 

had the support of my nurse managers 

at Flinders Medical Centre in South 

Australia. 

Feeling excited to be able to help and 

slightly apprehensive about the 

‘unknown’ elements of disaster 

response, I also felt as prepared as I 

could be; my professional experiences 

working as a nurse within a major 

public hospital emergency department 

mean that I’m no stranger to assisting 

people in crisis along with their 

families. I had also been volunteering 

as a uniformed member with St John 

Ambulance for several years and 

worked part-time as an Australian 

Army medic for almost five years. I had 

completed additional training in Mental 

Health First Aid and previously lived as 

a volunteer in rural northern Thailand 

for a year, where I spent time in 

refugee camps on the Thai-Burmese 

border. While all of these qualifications, 

skills and past experiences gave me 

some confidence to fulfil my role, 

I knew that the deployment would 

challenge me physically and mentally. 

The scene in flood affected Brisbane 

was shocking. Thigh-high, stinky, 

contaminated black mud layered over 

previously beautiful suburbs. Entire 

homes, warehouses, major bridges and 

whole suburbs had been submerged, 

showing stark evidence with muddy 

water marks and debris caught in 

CONNECTIONS | VOL 14 | ISSUE 2 | June 2011

special feature 3 

I strongly believe that 

nurses are uniquely placed 

to assist when such large 

scale events occur. 

“ 

” 

structures far above our heads. Local 

residents sat in groups talking softly, or 

wandering slowly down their streets 

as if in a trance, ‘shell-shocked’ by the 

surreal nature of their whole lives 

being changed so suddenly. I very 

quickly discovered that despite my 

previous experiences in emergency 

nursing or as an army medic, by far 

the most important skill needed was 

sincere human compassion and 

emotional maturity, as flood victims 

sought support and comfort in the 

immediate aftermath. 

Elderly people in particular would see 

our uniforms, see the word ‘nurse’ 

written across my high-visibility tabard 

and converge towards us, or invite us 

graciously into what was left of their 

homes. As well as the medical or first 

aid needs, many just wanted some 

human contact and reassurance, to 

tell their story, to debrief and ask 

questions about what was happening 

in other areas. Our role within the 

community recovery process very 

quickly became determined by the 

needs of those in need. 

It was moving to see local residents, 

many of whom had lost their own 

homes and belongings, coming to 

volunteer their time and efforts to 

clean up public facilities. It was hard 

physical work at times, but I did not 

hear one person complaining – in fact 

morale was positive and resilient. In 

addition to this we found many more 

people and community groups willing 

to provide food and water to workers, 

stopping throughout the day to give a 

reassuring word of encouragement. 

On one particularly hot afternoon 

some young men arrived at a 

community work point with bags full 

of cold icy poles for the cleanup teams 

– a welcomed and much needed 

refreshment break. Another older 

gentleman told our team how he 

wanted to contribute so much that 

he’d caught two buses and walked 

blocks from his home to come and 

offer assistance. 

While the vast majority of people 

banded together, there will always be a 

tiny minority who try to exploit others’ 

misfortune. Local residents in one 

flood-affected area told me first-hand 

of looting and violence that had 

occurred during and following the 

floods. Residents had lost property 

to looters, lost money to con-artists 

running scam cleanup or building 

services and in some cases been 

physically attacked by home invaders 

in broad daylight. While the residents 

told me that police had acted 

promptly and appropriately with 

increased patrols, these horrific events 

only served to distress and undermine 

any sense of safety remaining for these 

already traumatised people and their 

families. 

My role in these situations was to 

administer first aid or basic medical 

care if required, but more importantly 

to listen, provide emotional support 

and reassurance, assess the person’s 

risks and needs holistically based on 

their personal situations, then to liaise 

with local Brisbane City Council 

officials and other agencies to refer 

individual cases for appropriate follow 

up. This important link to the 

community meant that St John 

Ambulance volunteers could help to 

ensure victims received ongoing care, 

including access to counselling and 

financial support. 

I strongly believe that nurses are 

uniquely placed to assist when such 

large scale events occur. We remain 

the largest single group of health care 

professionals and with national 

registration in place the capacity 

to work across state borders is 

streamlined without unnecessary ‘red 

tape’. Furthermore, I believe that the 

unique nursing ethos that engages 

Photo courtesy of S. Bolton 

Incident Management Team command 

centre, St John Ambulance Queensland 

Photo courtesy of S. Bolton 

An oval in Queensland which became a 

‘temporary’ dumping zone 

both clinically and personally with all 

areas of human experience and need, 

along with a fundamental 

understanding of holistic health factors, 

means that nurses will remain a vital 

human asset for major disaster 

response and relief efforts. 

Overall I was encouraged to witness 

the incredibly resilient and selfless 

response of Queenslanders and their 

friends from every state and territory. 

I would like to acknowledge the 

incredible volunteers of St John 

Ambulance Queensland, many of 

whom are nurses, who freely gave 

their time and expertise, working long 

hours in extreme heat, all unpaid, to 

serve their communities. I commend 

and thank you. 

If you would like more information 

about volunteering or contributing 

financially to the invaluable community 

work of St John Ambulance nationally, 

please visit the website: 

www.stjohn.org.au 


4 

special feature 

Reflections on the water 

By Wendy Rogasch, Unit Manager, Acute Services, Rochester & Elmore District Health Service 

The old saying “Every dark cloud has a silver lining,” rings true many times during our lifetimes; 

and no truer than in recent events for Rochester & Elmore District Health (REDHS). 

Two years ago, the terrible events that 

unfolded, now known as Black Saturday, 

alerted every Victorian to the awesome 

and terrible power that mother nature 

is capable of unleashing on us mere 

mortals. Organisations and individuals 

across Victoria were suddenly aware 

that planning and systems must be put 

in place to deal with such situations. 

As a result of Black Saturday, REDHS 

had put into place a framework to deal 

with life threatening emergencies and 

the unlikely event of evacuation. This 

framework was tested to its utmost on 

Saturday, January 15 2011, when the 

unusually torrential rainfall in the upper 

catchments of the Campaspe, Loddon, 

Avoca and Murray River systems 

overloaded the river systems far 

beyond any previously documented 

levels, and the township of Rochester 

was caught by surprise, to the horror 

and amazement of all concerned. 

On that Saturday, I was enjoying a 

warm and pleasant day at Lake 

Eppalock, casually incredulous at the 

level of water, which had risen almost 

two metres above its high water mark. 

When I eventually checked my phone 

later in the morning, I found a number 

of messages from work asking me to 

make contact. I felt sick in the stomach. 

I knew there were flood waters on the 

way, but was flabbergasted to find that 

the staff who were on duty were in 

full flight, activating an emergency 

evacuation plan. The role given to me 

that morning was to stand by in 

Bendigo to assist in receiving patients 

and residents who were at that time 

being loaded onto buses, army vehicles, 

ambulances and helicopters to be sent 

to numerous locations in the region. 

After dashing home to stock up on 

clothing and personal items, and to give 

my family the news and inform them 

not to expect to see me for the rest of 

the day, or even for the next few days, I 

arrived at the Mercy Health Bethlehem 

Aged Care facility in Bendigo. Moments 

later, a large bus arrived and off stepped 

all the faces I was so familiar with seeing 

at Rochester, certainly not at Bendigo! 

Seven aged care residents were to call 

Wendy Rogasch 

Bethlehem home for an indefinite 

amount of time. 

As staff struggled to unload each 

one, slowly and carefully and with 

considerable difficulty, the faces of each 

resident were veiled in fear and 

confusion. The faces of the receiving 

staff glowed with such empathy for the 

emotions and pain these elderly frail 

folk were all going through. On the 

faces of the Rochester staff, all smiling as 


special feature 5 

they gently encouraged and consoled 

each person, I also saw the underlying 

worry for the fate of their beloved 

residents, the effort that was required 

to evacuate each individual with as 

much respect and love as humanly 

possible, and the hidden fears that they 

were all trying not to think about – 

their own homes and families who they 

knew were battling rising flood waters 

of a level never before seen 

in the area. 

I spent the rest of that evening assisting 

the wonderful Bethlehem staff in 

settling in their new lodgers. There were 

many questions as they were keen to 

continue the care of each individual 

in a seamless and consistent way. 

Medications to be given, special diets to 

be arranged, worried residents to be 

consoled. Bethlehem staff took it all in 

their stride. The cavalry arrived later 

that evening, in the form of several 

Rochy staff members who pitched in 

and were also able to give detailed care 

requirements of each individual. During 

a quick ‘check-in’ phone call to our 

CEO, Glenis Beaumont, I was given a 

portfolio of three of the destination 

health services to act as Liaison Officer; 

Bethlehem, Castlemaine Health and 

Heathcote Health and so headed home 

to plan for the next day’s priorities. 

The next day and the following six days 

were an endless run of phone calls to 

check for any issues that may have 

arisen, problems that needed to be 

solved, visits to each site to touch base 

with the patients, residents and staff 

who had freely offered to assist in 

direct care of the evacuees. There were 

twice daily phone meetings with the 

team, consisting of the executive, unit 

managers, facilities manager, and 

maintenance and support clerical staff. 

After each meeting, I was able to then 

convey a situation report to all facilities, 

staff and patients/residents. I remember 

the great pleasure that it was to finally 

give the residents the wonderful news 

that we were ready to bring all our 

people home. 

Shortly after we had overcome the 

problems arising from the mass 

evacuation, we were focusing 

on and planning for the return to full 

functional service and bringing ‘our 

people’ home. The logistics of the 

return trip turned out to be almost as 

challenging as our hurried departure. 

To the staff of REDHS, I salute you; to 

the patients and residents who were 

evacuated, your bravery and stoicism 

during that week was truly 

commendable and to all of the staff 

from the facilities who so willingly and 

graciously welcomed our evacuees, I 

cannot thank you enough for your 

patience and generosity. 

Register 

today! 

Conference fast facts 

Dates: Wednesday 19 – Friday 21 October 2011 

Venue: Novotel Sydney Brighton Beach, 

New South Wales, Australia 

Expecting in excess of 300 delegates from 

Australia, New Zealand, Asia Pacific region, 

Europe and USA 

19 July 2011 Early bird registration closes 

19 September 2011 Standard registration closes 

To register now, visit 

www.accypn2011.eventplanners.com.au 

The conference theme is Navigating New Directions in 

Children and Young People’s Health Care. 

Key program themes will include leading and learning: 

in practice in global issues 

through diversity in leadership 

in education in safety and quality. 

Keynote speakers 

Professor 

Philip 

Darbyshire 

Dame 

Elizabeth 

Fradd 

We look forward 

to welcoming you 

to Sydney in 

October 2011! 

Associate 

Professor 

Kari Bugge 

Ms Molly 

Carlile 

ACCYPN 2011 Conference Managers T: +61 7 3858 5529 F: +61 7 3858 5499 

c/- MCI (formerly Event Planners Australia) E: accypn11@eventplanners.com.au 

PO Box 1517 Eagle Farm QLD 4009CONNECTIONS W: www.accypn2011.eventplanners.com.au 

| VOL 14 | ISSUE 2 | june

6 

RURAL NURSING AND MIDWIFERY FACULTY 

A Cultural Rite – The Smoking Ceremony 

Putting culture at the centre of health for Aboriginal 

mothers and babies 

By Margaret Stewart, Lecturer, School of Nursing, Midwifery and Nutrition, James Cook University 

When the songs are not sung, the dances left undone, and the ceremonies no longer remembered, 

then the community begins to disintegrate: the old lose heart and the young lose the direction and 

the certainty that have so long sustained Aboriginal people (Stewart, 2000). 

At the interface between two worlds, 

Aboriginal women’s cultural choices 

concerned with where a woman 

chooses to give birth and the demands 

of Western medicine have become 

problematic, in that the right to exercise 

choice has largely disappeared. Women 

are at their most powerful yet most 

vulnerable when they give birth. This is a 

disarming paradox. Therefore, decisions 

about birthing must be built around 

knowledge, empowerment and social 

justice. The long term practice of 

transferring women from their 

community to birth elsewhere may be 

seen as ‘normal’ practice for some, 

however this practice often has long 

term health and cultural implications. 

Whilst all efforts are made to provide 

the best possible care to Aboriginal 

mothers when they are transferred to 

a regional centre to birth, in many 

instances no one has asked the young 

Aboriginal woman if this is her 

preference, based on her traditional and 

cultural values and her capabilities as a 

mother and a woman. 

The ‘smoking ceremony’ for many 

Aboriginal women may be seen as a way 

forward toward compensating for the 

loss of connection to culture and birth 

place as a result of having to birth 

elsewhere. While the smoking ceremony 

after a birth is not common practice for 

some Aboriginal communities, it is a 

powerful cultural rite and one that has 

been practiced for thousands of years in 

a number of remote communities. Many 

Aboriginal women hold the view that the 

secret to better health and 

empowerment lies in this cultural rite 

and practice. My experience as a remote 

area nurse/midwife, in a number of 

remote communities, has lead me to 

believe that it is not only the younger 


7 

women of the community who are 

disempowered as a consequence of an 

inability to exercise a right to choose, 

but their mothers and grandmothers 

are similarly affected by a lack of 

involvement in birthing and child 

rearing practices. 

The women of Milingimbi Community 

in the East Arnhem of the Northern 

Territory demonstrate how the 

strength of Aboriginal culture, through 

the smoking ceremony, rejuvenates the 

community. They demonstrate fidelity 

to this traditional practice when new 

mums and babies present back to the 

community. The smoking ceremony can 

be performed at any stage of a persons’ 

life but is best performed in the first 

instance around the time of the birth. 

This sets the foundation of good health 

and wellbeing. The ceremonies for the 

land, the kinship relationships and a 

sense of self worth are sustained. 

Further, the importance of culture, law 

and tradition in maintaining a strong 

community continues. 

The women speak of the smoke as 

being a healing and cleansing force. 

This force empowers the individual and 

ensures the wellbeing of the child. 

A senior woman of the Milingimbi 

community says “We put this little one 

through the smoke and we know that 

this little one will always be strong and 

know where he/she comes from.” The 

material that is used in the ceremony, 

the paper bark, the swamp grass and 

the place itself – the edge of a paper 

bark swamp – all speak strongly of an 

unbroken and unchanging connection 

to the land which is central to good 

health. 

My experience with the smoking 

ceremonies has reinforced for me the 

centrality of culture and tradition in 

creating an authentic primary health 

care framework which is respectful 

of and responsive to the distinctive 

environment in which health care 

services are delivered. The ceremonies 

in the context of a paper bark forest, 

where women are able to demonstrate 

a sense of connection to culture and 

place, stand in sharp contrast to the 

sterility of a clinical environment which 

may serve to disempower and alienate. 

Even the most detached of health 

professionals would have to reflect 

on the positive health aspects of this 

participation in culture and tradition. 

While the women may not have read 

the texts on primary health care, their 

lived experience is one of 

comprehensive primary health care 

practice and one from which all health 

professionals could learn a great deal. 

I consider it a great privilege to have 

been invited to be a part of such a rich 

and powerful ceremony. It took me 

back to my time in the Kimberley 

17 years ago when as an expectant 

mother I was passed through the 

smoke and upon my return to the 

community, my new born child was 

passed through the smoke and 

welcomed to the land. 

References 

Stewart, M. (2000). Ngalangangpum Jarrakpu 

Purrurn: Mother and Child. The Women of 

Warmun as told to Margaret Stewart. Broome, 

WA: Magabala Books. 

Left page: From left: Ruth Nalmakarra, 

Laurie Milindidj 2, Margaret Stewart, Daisy 

Namanatj 2 and Lena Walunydjunalil 

Right top: The new mothers Elizabeth 

Galangarr and Esther Warrngayu (bottom 

centre) look at their babies Natasha and 

Antonia after the smoking ceremony, while 

their grandmothers Daisy Namanatj 2, 

(bottom far right) and Ruth Nalmakarra 

(bottom far left) take the lead supporting 

role. Extended traditional grandmothers and 

mothers (top from left) Laurie Milindidj 2, 

Lena Walunydjunalil, Nikisha Gulngura, 

Rhonda Gungurinya and Sandra 

Mulanyawuy-Dhumy were all a part of the 

preparation and practice of the smoking 

ceremony for the new mothers and their 

babies 

Right middle: Ruth Nalmakarra passing her 

grandchild over the smoke 

Right bottom: The healing hands of Daisy 

Namantj, over the fire, as she prepares the 

fire and smoke 


8 

RURAL NURSING AND MIDWIFERY FACULTY 

A passion for Indigenous health 

By Kanya Nanayakkara, Remote Area Health Corps 

Alan Wilson 

Alan Wilson, a registered nurse from 

Sydney, has worked with Remote Area 

Health Corps (RAHC) since 2009. 

Alan is one of a growing example of 

dedicated RAHC health professionals 

taking up regular repeat placements 

in the same remote Indigenous 

community. In April 2011 Alan will 

complete his seventh RAHC placement 

for the Anyinginy Regional Remote 

Health Service in communities across 

the Barkly region in Central Australia. 

Alan’s commitment to assisting people 

in the Barkly region has helped him 

forge a special relationship with the 

local Indigenous communities, based 

on mutual trust and friendship. Alan’s 

repeat placements to the Barkly region 

have allowed him to develop a deep 

understanding of the communities 

in the area, their health needs and 

priorities and the value placed on 

being an honest communicator. 

Alan is committed to providing remote 

area nursing services and finds the 

RAHC model suits his professional 

and personal circumstances. These 

placements enable Alan to have 

extended periods in communities 

across Barkly combined with regular 

return trips back home to Sydney 

to see his family and friends. 

For success in remote environments, 

Alan suggests, “The individual should 

be flexible, resilient and have an 

appreciation and respect for cultural 

differences.” Another trait Alan believes 

is vital when working in remote 

Indigenous communities is the ability 

to speak “straight”, be direct and 

compassionate with patients and 

ensure they understand what is 

being relayed to them. 

Be part of the effort to improve 

Indigenous health 

Get involved. 

Call 1300 MYRAHC 

or apply online 

at rahc.com.au 

Funded by the Australian Government

9 

One story Alan shares is his new 

found friendship with not just the local 

people but the local animals. While 

on placement in 2010, Alan’s partner 

Christina came to Tennant Creek to 

visit him and found three small stray 

pups on the train tracks. When she 

tried to remove them, one particular 

puppy was quite stubborn and would 

not leave. However when Christina 

walked away, she turned around to see 

that puppy barking and following her. 

She took it back to Alan and convinced 

him to keep the dog, now named 

Jackie. Every night for six weeks Alan 

washed the dog in borax, peroxide and 

mild shampoo and to his disbelief, black 

hair began to grow. When Alan 

returned home to Sydney he brought 

Jackie with him and before long she 

had the family wrapped around her 

paw. 

Jackie is now a loving dog with black fur 

and a single white blaze on her chest. 

Alan says, “I have gained a wonderful 

friend and mate who keeps me on my 

toes, gives me something to do, makes 

sure I exercise regularly and likes the 

same food as I do. She loves being in 

the bush as much as I do; which is 

every spare minute.” 

Alan believes the work he and other 

RAHC health professionals are doing 

on placements is benefiting 

communities as it provides them with 

additional access to health care. Alan 

Alan’s dog, Jackie 

relishes his time at Tennant Creek 

and in late 2010 his contribution 

was recognised by the Tennant Creek 

community when he received a 

Certificate of Appreciation from the 

Anyinginyi Health Centre. 

Over the back fence 

Pam Brinsmead FRCNA, Professional Development Coordinator, Mental Health/Drug and Alcohol, 

NSW Health 

Pam Brinsmead is a member of the Rural Nursing and Midwifery Faculty and is one of our new 

Faculty Advisory Committee (FAC) members. For many years Pam has been a vocal and passionate 

advocate for nurses living and working in rural communities. RCNA is thrilled to have Pam’s 

expertise on the FAC. 

After 19 years of 

working as a nurse 

educator, I am still 

enthusiastic about 

my role and know 

there is always 

Pam Brinsmead 

much more to 

learn. Variety continues to fuel the 

passion I have for my job. I like the fact 

that there are both big picture projects 

that challenge me and give me a chance 

to have an influence on the culture of a 

workplace, as well as working on some 

really detailed smaller picture issues. 

At the end of the day, my job is focused 

on ensuring that client outcomes, within 

our rural mental health and drug and 

alcohol services, are the best they 

can be. 

My earliest memory… Making mud 

pies in the red volcanic soil under our 

old house in northern New South 

Wales. 

At school I… won a prize for reading 

the entire primary school library by end 

of grade five. I loved reading then and 

still do. 

I wish I’d… found out sooner how 

much fun it was to have longer hair. 

Having a pet… My two long-haired 

Dachshunds (Cammie and Menkee) are 

my family and the three of us just love 

snuggling up together on the lounge 

chair watching TV on cold winter nights. 

The last meal I cooked was… a lovely 

grilled porterhouse steak with mashed 

potatoes and broccolini. 

Kids should be… given every 

opportunity to explore and grow as 

individuals. 

The book that changed my life… 

Cherry Ames: Student Nurse by Helen 

Wells. As a child I used to play being a 

nurse. One day, whilst shaking a glass 

thermometer in the hallway, I 

accidentally broke it. I clearly remember 

chasing the silver mercury balls across 

the floor as I didn’t want to have to tell 

Mum what I had done. However, she did 

find out, as she was highly allergic to 

mercury and came out in a dreadful 

rash when she next went to wash the 

floor on her hands and knees. 

My favourite moment is… having that 

first taste of coffee in the morning. 

Relaxing involves… sitting down in my 

craft room to make cards. I use a 

variety of scrapbooking and other 

innovative craft techniques to design 

and create hand-made cards for friends 

and family. 


10 

Movement Disorders AND Parkinson’s Nurses Faculty 

Peter has Parkinson’s – a partner’s account 

By Gillian Adams 

“Peter has Parkinson’s.” Well those few words say so much and 

yet say so little. Parkinson’s is such a daunting prognosis – 

overwhelming, frightening and even the thought of writing about 

it brings tears to my eyes. My response to Peter’s condition is 

reflective of the way I perceive the world. It will not be the same 

for all who have a person with Parkinson’s (PWP) in their life. 

So first of all a bit about me… I am an 

achiever, in that I perform in ways that 

will garner praise and positive attention. 

My underlying fear is that the world is 

a scary place and that it needs to be 

controlled – and who better to do it 

but me! Get on with it or just get out 

of my way! So you can see that Peter’s 

condition is a personal challenge to me. 

It is something uncertain, something 

that I cannot control or ‘fix’ and 

something that pushes a lot of my 

buttons (and not all the good ones). 

My first reaction was to get some facts 

about Parkinson’s – what it is, what 

causes it, what is the progression and 

what treatments are available. I learnt 

it is a degenerative neural disease, 

no-one knows why, it is highly variable 

in progression and treatments (but 

within a range of expected symptoms 

and drugs). I also joined an email list for 

carers of PWP and watched the email 

traffic go by. I then promptly ignored 

everything I learnt and read as it was 

‘all too scary’. With his diagnosis, the 

rational part of my brain found it easier 

to tolerate some of his foibles – leaving 

the bathroom light on, eating slowly, 

procrastinating and mumbling. The 

emotional side saw everything he did 

and said “it’ll get worse”. My fears 

about it being out of control became 

worse. Our lives, our futures, our plans 

and dreams were all vanishing in front 

of my very tightly closed eyes – or 

rather in my imagination. However, the 

day to day realities were that not much 

changed at all and Peter’s medication 

helped him regain control over his 

movements and activities. 

Nevertheless I was angry, very angry! 

At night in my dreams I endlessly 

fought with Peter – he would make 

changes to our lives without telling me, 

I would punch and hit him and yell and 

nothing would change, it was all out of 

my control. By day I was calm, a bit 

more remote than usual, suffering from 

some increased signs of stress but 

nothing really drastic. It took me six 

months or more to realise just how 

angry I was. At the same time I realised 

that I was actually angry with him. 

I then realised that it was not him that 

I should focus my anger on (if I had to 

focus it on anything or anyone), rather 

it was the disease. 

Well time has gone by, some of Peter’s 

symptoms have become worse, while 

others have changed very little or even 

improved. I worry when he becomes 

stressed because his symptoms get 

worse and take quite a long time to 

recover. I try to let things go and take 

life a bit slower – it doesn’t really 

matter if we are late or if most things 

take a bit longer or even if they don’t 

get done at all! When I offer to help 

Peter do things it is now no longer out 

of a desire to ‘just get it done’ rather it 

is to help him if he wants the help. Of 

course I still get annoyed but I try to 

make the most of our time together 

and when I need a break I take one – 

it reduces my irritation with whatever 

is (or is not) happening and is an 

acknowledgement that I do not have 

all the answers and that going with 

the flow is acceptable. There is time 

enough in the future for whatever 

comes and we, and our relationship, is 

more important than being in control. 

As one of the wise women on the 

email list said “these moments are 

nuggets of gold”. 

“ 

I try to let things go and take life a bit slower – it doesn’t 

really matter if we are late or if most things take a bit longer 

or even if they don’t get done at all! 

” 

A brief post script… The lesson about 

valuing what we have regardless of the 

progression of the disease came home 

to me in a very real manner just the 

other day. On the email list there was 

a posting from a fairly new member of 

the list who asked to be removed from 

the list. Her husband, who had been 

diagnosed just a few years ago and 

who was not yet experiencing the 

problems often discussed on the list, 

had recently been killed in an accident. 

He had been riding his recumbent 

tricycle in a bike lane and was struck by 

a driver who had suddenly swerved 

out of her own lane. She was grateful 

that our support group existed and 

regretted that her husband did not live 

long enough for her to need the kind 

of help it provides. 


11 

I have Parkinson’s – a personal account 

By Peter Swarbrick, Psychologist 

This is my personal account of my Parkinson’s diagnosis. My current situation is that I’m still broadly 

functional, still working reduced hours and trying to maintain and prolong my efficacy. There are some 

things that just don’t work very well any more (my attempts at dancing frighten small children) and 

others which require my full concentration (putting on underwear and doing up shoes). 

Peter and Gillian 

Today, I’m feeling quite well, probably 

because I made myself get enough sleep 

last night, but on some days even 

breathing seems to absorb all my 

attention. I can do most things ‘at my 

own pace’, but my pace is often out 

of step with those around me. The 

challenge for me is to remain positive, 

constructive and creative in how I 

incorporate this condition in the other 

plans I have for the future. None of us 

really know how long we will be around 

for and apart from the occasional days 

when I could scream with frustration 

that my recalcitrant limbs won’t do what 

they’re told, I have a very good life and 

can think of no one I would change 

places with. 

My story 

Four years ago, I was walking to a baker 

for a low-fat apricot scroll (and a 

high-fat sausage roll). I had just bought a 

new belt clip for my mobile phone and 

as I walked my right arm brushed 

against it. I stopped and moved the clip 

further around. For a day or so that was 

sufficient then I noticed my arm 

touching it again when I walked. I moved 

it further to the back but was curious 

about why my arm, which had 

previously swung quite happily, even 

rakishly when I strode about, now 

seemed less enthusiastic. My left arm still 

kept the proper rhythm, so I proceeded 

in a somewhat lopsided fashion. Perhaps 

being a typical male and certainly being 

a procrastinator of long-standing, I did 

nothing about it. 

Three months later, my right forearm 

and shoulder began to ache and my grip 

lessened noticeably. I was training at a 

gym at the time, so reasoned that I had 

simply strained a muscle or jarred a joint 

and continued to work my arm in the 

hope that it would come good with 

exercise. It didn’t. The pain continued 

and despite massage and exercise I 

found that my elbow developed a bend 

– even when I was standing still, my right 

arm would not hang straight unless I 

made it. 


12 

Movement Disorders AND Parkinson’s Nurses Faculty 

You might have thought I would get this 

checked out, but no. I had secretly (it 

probably wasn’t a secret to those who 

knew me) prided myself on being 

physically able and fit – or at least able 

to be so with a minimal amount of 

exercise. Likewise, since childhood I had 

been proud of my intellect, my speech 

and my abilities to connect with people. 

I think this was partly the reason why I 

didn’t want to know what was going on 

with my body. I told myself it was some 

temporary malaise that would right itself 

in time. I didn’t want to confront the 

idea that something wasn’t working 

properly; that I was getting older and 

certainly not that it might be something 

serious. So I ignored it some more. 

A few months later, it was getting more 

difficult to avoid. I was having trouble 

getting dressed. I was experiencing 

cramping and pain in my arm, shoulder 

and across my back. The muscles down 

my spine were as hard as chestnuts and 

I couldn’t find a comfortable position for 

sleeping, sitting or standing. My right arm 

was developing a crook, as if I was 

holding a can of beer at a party, and 

people were beginning to notice. I 

began to wonder if perhaps I had had 

a little stroke. 

I had bought a large and expensive 

motorbike the previous year. Riding it 

was just about the most pleasurable 

thing I could do at the time, but I 

noticed that I was having increasing 

trouble with my neck against the wind 

pressure. If the day was cool, I would 

get shivers and shivers would become 

shakes, making it difficult to ride 

smoothly. I could still ride quite well, 

but the concentration required was 

increasing noticeably and reached a 

point where I could not simply relax and 

enjoy the scenery and the experience. 

At my 48th birthday, someone 

commented that I was shaking. It was 

April (the month, not the person) and 

I had just taken the traditional birthday 

suit dip in the swimming pool. It was 

quite cool (the water, not the 

atmosphere) and again, the shivering 

became shakes and the more I tried to 

control it, the worse it became. I think I 

said to someone “I should see a doctor” 

and I made the appointment for the 

next week. 

I saw my doctor of many years for what 

would be our last appointment. He was 

retiring, ironically, because he had 

developed Parkinson’s disease himself. 

But he must have been in his late 60s or 

early 70s. I was in my late 40s and didn’t 

On one level, I was pleased to have a diagnosis and know 

that there was something actually amiss. On another level, I 

was disappointed that it had not been something less serious. 

“ 

” 

really consider myself to be in the same 

boat. He examined me and referred me 

to a neurologist, saying, “I hope it’s not 

Parkinson’s.” There was a three month 

wait for the next available appointment. 

I could say that I spent those three 

months anxiously, or with bouts of 

depression, but that would be untrue. 

My father has had, for many years, 

benign essential tremor, which I believe 

has some hereditary characteristics, 

so I reasoned that it must be the same 

for me. 

But on some level, I knew different. Bits 

of me just didn’t work properly. I have 

been a musician since I can remember, 

playing clarinet primarily and was still 

performing with a jazz band. However, 

when we did a big performance, I would 

get nervous and my right arm would 

lock, my fingers became claws and I 

would tremble uncontrollably. Every 

morning I would have to stretch to free 

up my back and I often had pain in my 

legs. Normally, I could consume a 

creditable amount of alcohol and still 

function effectively on most levels. Now, 

I was finding that after two or three 

drinks, my speech became unintelligible 

and my body would slow to a crawl. I 

was experiencing occasional impotence, 

although again I could put that down to 

ageing. Another thing I put down to 

getting older was a gradually reducing 

sense of smell, which I could actually 

remember being affected at least 10 

years ago, but hadn’t really connected 

it with what was happening to me now. 

While waiting for the appointment 

with the neurologist, my new doctor 

suggested I try acupuncture. It would be 

nice to report that it was a rewarding 

experience, but it wasn’t. It was 

interesting, somewhat uncomfortable 

and when I was sitting still with the 

needles inserted I didn’t shake so much, 

although perhaps that was fear of 

puncturing something vital. The effect 

lasted for an hour or two, and after 

several sessions, I gave up that line of 

treatment. 

By the time the appointment with the 

neurologist came around, I had already 

decided that I probably had Parkinson’s 

disease. As it turned out, I was right and 

the appointment was a formality. 

On one level, I was pleased to have 

a diagnosis and know that there was 

something actually amiss. On another 

level, I was disappointed that it had not 

been something less serious. I don’t 

think the reality of the confirmation 

really came to light until sometime later. 

The neurologist prescribed a dopamine 

agonist and told me it would make me 

nauseous for three days, which it did, 

but then my body started to work and 

feel a lot better, which was a relief but 

also a strong indication that the 

diagnosis was correct. The next part 

of the saga began. 

Editor: We thank Peter and Gillian for 

their personal and thoughtful accounts 

and look forward to Peter’s follow-up 

article in the September edition of 

Connections where he will discuss his life 

after the prognosis. 


13 

So how did I get here 

By Victor McConvey MRCNA, Parkinson’s Nurse Consultant, 

Parkinson’s Victoria 

Victor McConvey 

As the dust cloud obscures the road 

ahead and I slow to 20km per hour, I 

reflect back upon the conversation I 

had with a farmer an hour ago. It took 

10 minutes of talking about the 

drought before we were able to start 

discussing the difficulties he was having 

with his Parkinson’s disease. 

As the nurse who is responsible 

for supporting people living with 

Parkinson’s disease in Victoria, the 

driving conditions and the 

conversations that occur in a 

roundabout way are common place. 

I work for Parkinson’s Victoria, the peak 

body for People Living with Parkinson’s 

(PLWP), and am the only nurse on the 

team. Much of my role involves 

providing advice and signposting 

people living with Parkinson’s to the 

most appropriate and local service to 

them, explaining symptoms and how 

they are managed. Encouraging PLWP 

to participate in their disease 

management and coaching on how to 

get the most out of interactions with 

neurologists and the health care system 

is a pivotal aspect of the role. 

Secondary consultation with other 

health care professionals on best 

practice ways of delivering care and 

providing education, increasing 

awareness and knowledge of 

treatments, is another essential 

element. 

Parkinson’s is a complex illness 

involving the Motor, Non Motor and 

Autonomic symptoms and while 

incurable there are some very effective 

treatments. The biggest challenge is that 

the symptom control is supported by 

some very complex pharmacology, 

with medications being administered 

frequently (two hourly is common) and 

the margin between being on time or 

not is about 10 minutes. If it’s not on 

time the symptoms will worsen and it 

will be harder to catch up on the next 

dose. Not getting medication on time 

is the biggest difficulty experienced by 

PLWP when they are in hospital and 

can have some adverse effects. The 

issue is complex and multi factorial; 

staffing levels are often insufficient 

to support complex drug regimes, 

compounded by a limited 

understanding of the condition and the 

need for medication. Nursing staff are 

further compromised by policies and 

procedures that do not adequately 

support patients being able to self 

administer their own medications. 

A way of addressing this issue and 

enhancing patient support is the 

development of a dedicated 

Parkinson’s support nurse. I can 

appreciate the value of this, having 

worked in Leeds in the United 

Kingdom as a Parkinson’s Disease 

Specialist Nurse (PDNS), a role I 

consider to be the most satisfying of 

my career. The National Health Service 

in Britain is never seen as a great 

innovator and is frequently criticised, 

however in the case of Parkinson’s 

disease it has worked collaboratively 

with Parkinson’s UK to support the 

growth of the PDNS and there are 

now over 300 PDNS’s across the 

United Kingdom. 

In my role in Leeds I was able to 

develop nurse lead clinics involving 

other members of the multi-disciplined 

team, work within the neurology clinics 

and carry out home visits, enabling me 

to assess home situations and make 

referrals for aids and assistance where 

required. The effectiveness of this role 

was supported by some additional 

training allowing me to become a 

non-medical prescriber. 

The current situation in Australia is that 

there are very few Parkinson’s nurses 

and those that are in posts are often 

employed to support research, specific 

therapies or work within a set health 

care network. In Australia there are less 

than 20 Parkinson’s nurses for an 

estimated 80 000 people living with 

Parkinson’s. It is an objective of 

Parkinson’s Australia to grow this 

number, so that all people with 

Parkinson’s have access to a nurse. 

Some achievements are being made 

with four Parkinson’s nurses’ positions 

opening in Tasmania and some success 

in developing pilots for nurse positions 

in many states. 

This specialist nursing role offers 

tremendous satisfaction, enabling 

you to work independently and in 

partnership with neurologists and 

allied health care professionals to 

address your patient’s needs and 

more efficiently use the health care 

resources available. However, the most 

satisfying part of the role is that your 

patients value you, your skills and 

interventions, which for me is the 

essence of nursing. 

Victor navigating his way through a dust storm 


14 

new generation of nurses FACULTY 

A third year nursing student 

with a world of experience 

By Kathryn Hind 

Peter Kieseker is a third year nursing student, but his life has been a series of lessons in helping 

people. He is the kind of man who has a vault of wild and adventurous stories which have informed 

a spectrum of theories and ideas. Whether he’s undertaking famine aid work in Somalia, working 

with refugees in Kosovo, or completing his nursing placement at the emergency department (ED) 

of a QLD hospital, Peter is always testing boundaries. 

He engages deeply with the situations 

he throws himself into, collecting 

observations and experiences to 

brimming point and then offering his 

own innovations. If these are the kind of 

traits we can look forward to seeing in 

our new generation of nurses, the 

nursing profession is in for quite a ride. 

Peter left school at the age of 15 and 

joined the Australian Army; he wanted 

to be a nurse, but he says, ‘things were 

different back then’. Men working in 

nursing roles were rare and carried a 

certain stigma. So Peter shifted his aim 

to becoming a mine warfare specialist. 

He was selected for officer training 

when he was 19 and following 

graduation to commissioned rank, Peter 

joined the Medical Corps. He served in 

Papua New Guinea, specialising in 

malaria field work. This exposure to the 

medical world of a third-world country 

prompted a thirst for knowledge and a 

will to contribute that formed the basis 

for his future path. Remembering his 

time in Papua New Guinea, Peter says 

“We would track from one village to 

another collecting blood supplies and 

samples, doing screen tests and some 

eradication education and it got me 

interested in the whole primary health 

care area.” 

Peter put this new desire for knowledge 

into action; he left the army and 

enrolled in the four year Bachelor of 

Human Movement Studies at the 


15 

University of Queensland. He specialised 

in physical activity for the atypical, 

something close to his heart due to the 

experiences of his disabled sister. He 

landed the job of QLD Health Regional 

Superintendent for disability services in 

Central Queensland but after 5 years in 

this position, things began to feel a little 

stale. Bored of the public service life, 

Peter took a leap of faith and launched 

himself into a new career in the world 

of international aid. When asked what 

prompted this decision he says, “I went 

to find adventure. I joined the army for 

a bit of adventure, but it was a 

peacetime army so there wasn’t any 

adventure to be had.” It was a huge 

change, and one that took Peter to 

rarely explored corners of the world. 

Peter led primary health and emergency 

aid teams in Somalia for three years, a 

veterinary health and development 

team in South Sudan (until the project 

was bombed out of existence), refugee 

work in Serbia and Kosovo, and was the 

Australian representative for Freedom 

from Hunger in Cambodia, responsible 

for refugee repatriation and irrigation 

rehabilitation. Peter claims Somalia is the 

most extreme place he’s been. He says 

“The government had fallen apart and 

it was just the wild west out there. 

Everywhere we went we had to go 

armed, had to take escorts with us. It 

was very hard to do primary health care 

in that setting, but of course if you don’t, 

a lot of people die unnecessarily.” 

In between assignments, Peter found 

time to work for a year as the 

establishing CEO for Unicare, the then 

Uniting Church of Queensland’s state 

wide disability service. Peter’s next 

assignment was of a different nature; the 

birth of his daughter, Telissa. He gave up 

full-time aid work in order to be close 

to her, though he still went to the aid 

field for short missions. It was during this 

time at home that Peter decided to 

return to university and undertake a 

Bachelor of Nursing Science (Graduate 

Entry) at University of the Sunshine 

Coast. His studies are by no means a 

different direction to aid work; Peter 

sees nursing as a tool to greatly enhance 

the aid he delivers. He says “Whenever 

you’re in the aid world, people come up 

to you with their health problems and 

nursing fills in the square; I have more 

knowledge, more ability and more skills 

which means I can actually help in the 

short-term as well as the long-term. 

If someone comes up with an injury, 

I can do something. Well, I will be able 

to, if I pass!” 

Peter believes there is enormous scope 

for nurses to play an integral role in 

international aid. Opportunities include 

front line nursing intervention, nurse 

education and primary health care. 

Peter states, “This role is for someone 

who’s got a bit of adventure in them. 

You can go for short periods of time 

so you don’t have to lose your career 

structure. It’s just a broadening 

experience.” Peter goes on to talk about 

a period in Somalia when he was 

working with a small team of nurses 

and midwives; “I was helping with 

miscarriages and things like ventouse 

extractions, not knowing what I was 

doing but just following the midwife’s 

instructions. You’re the only person 

there, you’ve got to try and do 

something. And now I’ll know more 

about what to do.” Equipped with 

formal training, Peter will be able to 

educate these communities in need of 

aid. “Education is always a fundamental 

aim of any primary health care 

intervention and the measure of its 

success is if when you leave the project, 

a local person can take over your job.” 

Before taking on these missions, 

Peter must first finish his own nursing 

education and in this he is not alone. His 

daughter, Telissa, is currently in her third 

year of a degree in midwifery at the 

Queensland University of Technology 

and his partner, Bhavana, is in her third 

year of nursing, currently undertaking 

placement in mental health on the 

Sunshine Coast. Peter plans to do a 

graduate year in the Northern Territory 

and when he and his family have 

finished their studies, they plan to take 

on aid work. “We will be heading to 

Africa; it’s the place I know best. Because 

my daughter is coming, I’ll probably go 

to tamer places than where I’ve been 

before”, he says. With Peter’s track 

record, it is bound to be a wild 

adventure. Wherever they end up, 

there’s no doubt this family team of new 

generation nurses will be a force to be 

reckoned with. 

Left page: Delivering food to a remote village 

in west Somalia – there was no food as an 

opposing war lord’s gang had destroyed all 

food and seed stock 

Top: A refugee camp where diarrhoeal 

diseases were killing about 70 children a day 

– the woman was asking Peter for help with 

her infected eye, a turning point that inspired 

him to extend his medical knowledge into 

nursing 

Middle: An extremely remote village in Papua 

New Guinea – Peter and his team took blood 

samples looking for malaria epidemiology 

profiles and blood infection and followed up 

with vector control programs 

Bottom: Bhavana, Telissa and Peter 


16 

new generation of nurses FACULTY 

Making the connection: Reflections of 

first semester tutorial for third year nursing students 

By Susan Austin MRCNA, Senior Project Officer, Dementia Workforce Development Officer 

Health care is 

constantly evolving 

with advances in 

person-centred 

care becoming 

more complex 

Susan Austin 

in addition to 

technological progression; this results in 

a greater need for higher order thinking 

skills. Nursing students have a vast 

quantity of information to consume in 

the undergraduate nursing curricula in 

preparation for their first qualified 

nursing position. Due to the nature 

of the profession, it is necessary to 

develop undergraduate nurses as 

lifelong learners (Hoffman, 2008). 

Sessional academics like myself are an 

essential part to the process of learning. 

This is partly due to the promising 

number of nursing students, the delivery 

of course offerings or the opportunity 

to act as a temporary replacement for 

faculty staff (The University of 

Queensland, 2003). Sessional academics 

can at times feel isolated and excluded 

from faculty communication due to the 

time spent on campus and the nature 

of the business (Gottschalk, & 

McEachern, 2007). 

In preparation for the first tutorial of 

the semester, I found myself doing 

hours of preparation, even though I had 

been given the outline of what to cover 

and activities to conduct in class. Having 

done a Graduate Certificate in Higher 

Education last year, I call myself a late 

bloomer even though I have conducted 

workshops in hospitals, given 

conference presentations and 

guest lectures at universities. 

One of the primary concerns for 

the first tutorial, dealing with health 

promotion, was how well would I 

connect with third year students to 

assist them in actively embracing the 

subject, so that they will return to 

further tutorials in preparation for 

assessment and clinical competency. 

Like any first class, nerves play a part 

for educator and student. For me this 

meant more preparation than usual, 

developing ice breakers to assist in 

learning names and gaining information 

One of my aims was to facilitate an experience 

that students would not get anywhere else and 

to make sense of the unit content. 

“ 

” 

on backgrounds, establishing the ground 

rules and conducting small group 

activities. One of my aims was to 

facilitate an experience that students 

would not get anywhere else and 

to make sense of the unit content. 

Knowing that my cohort was of the 

generations X and Y, I needed to be 

flexible in my delivery but still cover 

what was necessary. I took into 

consideration the various types of 

learners (visual, audio, kinesthetic) and 

different cultural identities by finding 

examples of each to demonstrate key 

points. The whiteboard became my 

friend – posing questions related to 

everyday issues created discussion and 

links to students’ experiences. I also 

incorporated different perspectives, 

involved students to think outside the 

box and allowed time for students to 

focus on psychosocial and interpersonal 

issues that confront consumers of 

health care. This was beneficial as it 

presented awareness and depth of 

knowledge of the topic being discussed. 

At the end of the tutorial, I asked 

students for comments and feedback, 

which was minimal as they headed for 

the door. However, a few students 

came up and asked the normal 

questions concerning assessment. Later 

that afternoon, I received an email from 

the Unit Coordinator on feedback from 

some of the students indicating they 

had really enjoyed the session. To me 

that was the icing on the cake, because 

I had enjoyed the experience just as 

much and it helped me to develop 

more confidence. I wrote down my 

reflections to help my recognition of 

what had worked well, and what had 

been learnt, what could be improved 

and what would be different next time. 

I believe that dedication to providing a 

holistic undergraduate experience can 

be very gratifying for both the student 

and educator. Reflective practice is after 

all an integral part of lifelong learning, 

which our nursing profession strives 

to represent. 

References 

Gottschalk, L., & McEachern, S. (2007). Casual 

and Sessional Employment: Motivation and Work/ 

life Balance. Retrieved March 24, 2011, from 

http://www.ballarat.edu.au/ard/business/ 

resources/casual_sessional_employ.pdf 

Hoffman, J. (2008). Teaching strategies to 

facilitate nursing students’ critical thinking. 

Annual Review of Nursing Education, 6, 225-236. 

The University of Queensland, (2003). 

Literature review: Training Support and 

Management of Sessional Teaching Staff. 

Retrieved March 24, 2011, from http://www. 

tedi.uq.edu.au/sessionalteaching/pdfs/Lit_ 

review/Lit_review2.pdf 


17 

The ‘Matures’ 

By Natalie Ellis RCNA Student Member 

have travelled to Walgett, Deniliquin 

and Terrigal for my practicals and found 

welcoming and supportive people 

throughout. I am learning skills that 

I will use for a lifetime and making 

friends I am sure I will keep forever. 

Juggling four children, working parttime 

and studying full-time for the past 

18 months has been hectic, to say the 

least, for my family and I. The first four 

weeks of full-time study were the most 

challenging, as I had submitted my first 

essay and was exhausted – I was just 

about ready to give it all up. I said to 

one of my friends that if I failed the 

essay it would be a sign that I am mad 

for trying to go back to university! 

Fortunately this was not to be as I 

received a distinction and proceeded 

to ‘walk on air’ for the next two weeks. 

I think this was the point I realised I 

could do it. 

Natalie (right) and Heidi Mackay, (left) a fellow ‘mature’ 

For all those people who have dreamt 

of becoming a nurse, but worried it 

may not eventuate please read on as 

my story will show that it is possible! 

I have known since I was five years old 

that I wanted to be a nurse. I started 

my training when I was 19 but deferred 

to look after my ill mother. I then went 

on to marry and have four children. 

During this period I did work in 

medical related fields thinking that 

would satisfy me however it only made 

me want to be a nurse even more. 

One day I finally had the courage to 

talk with staff at Charles Sturt 

University and they suggested I do a 

single subject to see how I coped with 

juggling studying, working and 

parenthood. Seeing as 18 years had 

now lapsed between my initial training, 

I was terrified at the thought of writing 

an essay. I quickly discovered that there 

is so much help and support that you 

can access through the university 

setting – especially if the staff can see 

that you are enthusiastic and eager to 

work hard. There are also learning 

advisors who can assist you with essay 

writing skills and review your grammar 

and formatting. Away from the campus 

setting, you can also access numerous 

websites for information. I found this to 

be especially true for subjects such as 

anatomy and physiology. 

After passing one subject I realised that 

studying was a feasible option for me 

and my family, so in 2010 I commenced 

as a full-time student, studying a 

Bachelor of Nursing. As a mature aged 

student I thought I would be on my 

own but was amazed to find several 

more people in a similar life situation 

to me – in their late thirties, with 

families, who had returned to university. 

Over the last 18 months we have 

managed to form a small network 

where we support and encourage one 

another. Our little group has been 

nicknamed the ‘Matures’ by some of 

the younger students (who I have also 

become firm friends with) and I think 

that name will stick! During this time I 

I have now embarked on my second 

year of study. While I realise there 

will be many more late nights and 

challenges to come, I know with great 

certainty that come what may, I am 

going to graduate as a registered 

nurse. 

Natalie and her family 


18 

COMMUNITY AND PRIMARY HEALth C ARE FACULTY 

Community nursing: 

A career to be proud of 

By Patricia Shepherd FRCNA, Regal Health Services, Executive Director of Nursing 

Looking back over 50 years in the nursing profession, and 45 

years of service to the community after founding Regal Health 

Services, one of the most rewarding aspects has been the lifestyle 

that Regal has provided for my family. This is something that many 

of us think of as secondary, but as a young mother raising two 

small children, finding my feet in a profession I love was an 

astounding piece of luck. 

In 1954 I had not yet recognised the 

career of nursing as one for me and 

was busily working for a stock broker 

in Sydney. Luckily, said stock broker did 

recognise nursing as a good fit for me 

and encouraged me to apply. It took 

me a further year of indecision until I 

realised nursing was the career for me 

and I commenced my general training 

at Repatriation General Hospital 

(RGH) Concord. I feel incredibly 

fortunate to have trained at Concord 

as the training school was excellent, 

frequently topping the state in the final 

examinations despite its then status 

as an emerging ‘new’ hospital. On 

completion of my general training I 

was encouraged to go to the Mater 

Maternity Hospital to obtain my 

midwifery certificate, where Sister 

Margaret Mary was the Matron, an 

inspiration to all nurses who had the 

good fortune to train there. On 

returning to Concord I was sent to the 

training school part-time, spending the 

remainder of my time in a wonderful 

ward to learn about becoming a 

registered nurse and the responsibilities 

that went with holding this position. 

I had the utmost respect for the 

Charge Sister (Sister Clare Gill) and 

shall be eternally grateful to her, as 

she was a great mentor to me. 

In 1961 I moved to London with my 

husband, returning in 1962 with a one 

year old daughter, Anna, and six months 

pregnant with my second child, John. 

By then nursing was very much in my 

blood and with the help of my mother 

I worked two nights a week in 

hospitals. I soon realised I needed 

more. My mother, as well as the owner 

Anna and Patricia Shepherd 


19 

Community nursing was not as big as it is today 

and I quickly discovered that there was a need for a 

good private community nursing service. 

“ 

” 

of the nursing club I was working for, 

encouraged me to consider going it 

alone and in 1966 Regal Aid Service 

(now Regal Health Services) was born. 

Community nursing was not as big as 

it is today and I quickly discovered that 

there was a need for a good private 

community nursing service. At first 

there was just me, but I gradually 

added friends and other nursing 

colleagues. Right from the start my love 

of education was the ‘driver’ behind 

Regal. I quickly introduced evening 

educational lectures, which were well 

attended by our nurses hungry for 

more knowledge. We started these 

VENUE & ACCOMODATION 

lectures in a private home then moved 

to the College of Nursing. Strangely 

enough the shift into the area of 

community nursing, where I saw a need 

for additional training and services, was 

the real breakthrough for Regal. 

Thankfully this need has lessened 

over the years and perhaps the most 

significant change in the nursing 

industry has been the recognition of 

community nursing by the health funds. 

The Fourth Tasmanian Infection Control Association 

Biennial conference will be held at the 

Wrest Point Casino, Hobart, Tasmania. 

Wrest Point is a Tasmanian icon – a world 

class hotel, convention and entertainment 

centre located in the yachting precinct of 

Sandy Bay. With breathtaking views of the 

Derwent River and Mount Wellington, and a 

range of facilities that are unequalled in the 

State, Wrest Point is the ultimate convention 

venue. 

The TICA conference will be held in the Wellington 

rooms at Wrest Point Casino. The Wellington 

rooms enjoys beautiful views of the 

marina and Derwent River, and features natural 

lighting. 

Wrest Point Casino - 410 Sandy Bay Rd 

Hobart, TAS 7000 

Throughout my career I have also had 

a commitment to the war veteran’s 

community, being the daughter of an 

army officer who fought in both WWI 

and WWII and having three brothers 

TICA Conference 2011 Registration Costs 

nce can be undertaken who fought in WWII. I had Early Bird also trained Full 

erence website – 

prior 10/07/2010 Registration 

website you can register at the veterans’ hospital, so it was a 

TICA Member $175 $220 

and request an invoice. 

Non TICA Member $220 $270 

cated on the conference 

natural fit for Regal to move into this 

Student $200 $200 

health area. We have now treated 

more than 20 000 veterans and 

engaged over 1000 community nurses. 

become the first private community 

nursing service in Australia to be ACHS 

accredited. 

Through all these years of business 

establishment and growth I was also 

busy caring for my two children and in 

1983 these two ‘worlds’ were to join. 

Anna joined Regal when she was just 

21 to help out for a short time – Anna 

is still here today! We are very proud 

of the high standard Regal continues 

to provide to the community, for the 

benefit of our patients and our nurses. 

After 50 years working in the 

community nursing sector I remain 

optimistic about the future. I believe 

we need to focus on further health 

care services being delivered in the 

community, coupled with a recognition 

that our community deserves and 

needs highly skilled and experienced 

community nurses. It concerns me 

to see that some services in the 

community are being delivered by 

organisations that do not necessarily 

match the skill set with the service 

requirement. 

I am very proud to be a nurse, and of 

my career in community nursing. I was 

honoured to be recognised by RCNA 

when they invited me to become an 

RCNA Fellow in 2009. 

Register today 

Keeping It Clean 

4th Biennial TICA Conference 

Another important milestone in my 

career was when my daughter and I 

worked with the Australian Council 

on Healthcare Standards (ACHS) to 

establish community nursing standards 

for Regal. In 1994 Regal was to 

www.thetica.net.au 


20 

HEALth AND WELLBEING IN AGEING FACULTY 

Duty of care to vulnerable adults 

By Associate Professor Linda Starr FRCNA 

June 15 is World Elder Abuse Awareness Day and an opportunity 

for all health practitioners (and indeed members of the community) 

to consider how we can contribute to the prevention, identification 

and prosecution of elder abuse and help to protect older people. 

The World Health Organization has 

defined elder abuse as: 

“A single or repeated act or lack of 

appropriate action, occurring within 

any relationship where there is an 

expectation of trust, which causes 

harm or distress to an older person.” 

(WHO, 2008) 

Abuse of the older person is not only 

a breach of their civil rights but a crime. 

Elder abuse presents in many different 

forms: 

Physical abuse – hitting, kicking, 

punching whether or not these actions 

cause serious or permanent injury. 

Psychological abuse – belittling, 

intimidation, humiliation and verbal 

abuse with the intent of causing 

emotional pain (Gray-Vickrey, 2004). 

Financial abuse – where the older 

person’s assets are misappropriated 

through theft, fraud, forceful changing 

of documents such as land title deeds 

and wills and unlawfully accessing the 

older person’s income entitlements 

(Lewis, 2004). 

Sexual abuse – this includes any kind 

of non-consensual sexual activity. 

Neglect – intentional or unintentional 

acts where the care provider fails to 

meet the elder’s needs such as 

withholding food, medicine, access 

to health care, hygiene, and the like. 

Self neglect – where the older 

person places their own health and 

safety at risk due to their own 

behaviour when they are unable to 

provide adequate food and clothing for 

themselves, medical care, access aids 

such as glasses, hearing aids, dentures 

and mobility aids (Pearsall, 2005). 

Institutional abuse – less 

acknowledged as a ‘type or form’ of 

abuse, institutional abuse is evident 

when any of the previous behaviours 

are exhibited against an elderly resident 

by staff. 

Even though the Commonwealth 

Government introduced compulsory 

reporting of elder abuse through 

amending the Aged Care Act 1997 

(Cth) in 2007, many older people 

remain unprotected. There are several 

reasons for this. In the first place the 

only type of abuse that must be 

reported is excessive use of force and 

sexual assault; hence there is no legal 

compulsion to report any of the other 

forms of abuse listed above. Secondly, 

the scope of the law is limited as it only 

compels employees of Commonwealth 

approved residential care facilities and 

subsidised in-home care services to 

report a suspicion of or witnessed 

abuse of residents. As the majority 

of older people (approx 92%) 

(Productivity Commission, 2011) do 

not live in these environments they 

remain outside of the protection of the 

Aged Care Act and dependent on 

‘good Samaritans’ to report any abuse 

to organisations such as Aged Rights 

Advocacy Services and the Health 

Care Complaints Commission. 

Nonetheless, all those involved in the 

care of the older person have both a 

legal and an ethical obligation that is 

inextricably entwined within our role 

File photo 

to act according to the demands set 

down by our profession. Ethically there 

is an obligation to ‘do no harm’ and in 

law this is translated into a ‘duty of care 

to avoid causing harm and to act 

reasonably’ (Donoghue v. Stevenson). 

Furthermore there is a non–delegable 

duty of care, which is a duty of care 

owed for example, by a hospital to its 

patients and by a nursing home to its 

residents and also to their staff (Ellis v. 

Wallsend District Hospital). 

Hence, it is arguable that a health 

practitioner who has an older person 

as a client, would not only have a moral 

and ethical duty but also a legal duty of 

care to ensure the safety of their client 

and to act if they witness or suspect 

that the person is being abused or 

neglected and at risk of suffering 

foreseeable harm. The appropriate 

action to take would be what could 

reasonably be expected of the health 

practitioner, according to their level of 

skill and expertise in the circumstances 

of the matter. It is here that health 

professionals need to be familiar with 

expected standards of care and policy 


21 

guidelines of their organisation and to 

follow these closely when the need 

arises. 

Notwithstanding the legal obligations 

to report abuse and the paucity of 

these cases going to court, there is also 

an alarming deficit in the number of 

actions initiated by the older person 

(or someone acting on their behalf) 

in claims of civil negligence, breach of 

contract or fiduciary duty or trespass 

when they have suffered some form 

of abuse. Why this is so is open to 

speculation. Nonetheless, there is a 

developing body of case law in the 

United States of America, where courts 

have found the institution liable for 

abuse residents have suffered ‘on their 

watch’ regardless of any actual 

knowledge of it. This was the case in 

Caretenders, Inc v. Commonwealth where 

the corporate defendant was found 

liable for the abuse of an elderly 

resident who suffered from multiple 

extensive pressure sores whilst in their 

care, and also in State v. Boone 

Retirement Ctr., where a court found 

that the defendant corporation 

knowingly tolerated the offending 

conduct of elder abuse and held that it 

could be held criminally responsible for 

this (Morgan & Scott, 2003). 

Therefore, it would seem prudent for 

employers under their non-delegable 

duty of care to recognise their legal 

obligation and ensure that their staff 

are aware of the expected standard of 

care in elder abuse cases, and provide 

the appropriate policy and support for 

staff to report any suspicion or 

knowledge of abuse or neglect of their 

clients whether or not they are 

mandated to do so. This would be a 

step forward in the mission to protect 

all older people from abuse regardless 

of where they reside. 

References 

Aged Care Act 1997 (Cth) (Austl.). 

Donoghue v. Stevenson 1932 AC 562 

Ellis v. Wallsend District Hospital 1989 17 

NSWLR 553 

Gray-Vickrey, P., (2004). Combating Elder 

Abuse. Nursing, 34(10), 47. 

Lewis, R., (2004). Elder Law in Australia. 

Australia: Lexis Nexis Butterworths. 

Morgan, S., & Scott, J., (2003). Prosecution of 

Elder Abuse, Neglect & Exploitation: Criminal 

Liability, Due Process, and Hearsay. American 

Prosecutors Research Institute Special Topics 

Series, Protecting America’s senior citizens,1-57. 

Pearsall, C., (2005). Forensic Biomarkers of 

Elder Abuse: What Clinicians Need to Know. 

Journal of Forensic Nursing, 1(4),182-186. 

Productivity Commission, (2011). Caring for 

Older Australians: Draft Inquiry Report. Canberra. 

World Health Organisation [WHO], (2008). A 

Global Response to Elder Abuse and Neglect: 

Building Primary Health Care Capacity to deal 

with the Problem World Wide: Main Report. 

Geneva, Switzerland. 

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Australia’s peak professional nursing organisation 

CONNECTIONS | VOL 14 | ISSUE 2 | june 2011 


member of ICN

22 

ACUTE CARE NAtioNAL NETWORK 

Editor: Position vacant 

Sub-editor: Position vacant 

Nurse educators in acute care: 

Envisioning renewal 

By Jan Sayers MRCNA, Lecturer, UWS and PhD Candidate, Curtin University and Michelle 

DiGiacomo , Post doctoral fellow, University of Technology Sydney and Curtin University and 

Patricia M. Davidson FRCNA, Professor of Cardiovascular and Chronic Care, University of 

Technology Sydney and Curtin University 

Jan Sayers 

Introduction 

Australia’s health workforce is 

responsible for patient safety and 

quality. Nursing practice is underpinned 

by nurses’ clinical, professional and 

organisational learning throughout their 

career. As societal demands have 

changed, nurse education has moved 

from the hospital setting to colleges 

and universities. In tandem with these 

changes, the nurse educator role in the 

hospital environment has also changed. 

Nursing literature frequently refers to 

nursing faculty, their role and workforce 

issues. However the literature is 

relatively devoid of discussion regarding 

the pivotal role of the nurse educator 

in hospitals in Australia. 

Study and findings 

This article reports on the Nurse 

Educators in Acute Care Hospitals 

(NEACH) study that identified the 

characteristics and role of the nurse 

educator workforce in Australia (Sayers 

& Davidson, 2009). A recent national 

survey of nurse educators across 

Australia was undertaken to describe 

the demographics and dimensions of 

the role. Factors examined included 

role criteria and enactment, 

performance standards, appraisal and 

career intentions, workplace issues and 

the practice environment. A diverse 

group of 425 nurse educators 

completed the survey with 

representation from all states and 

territories. The majority were female 

(88%). All respondents reported role 

blurring and overlap of activities 

performed by nurse educators and 

other nursing roles. Although 81% held 

a specialty clinical qualification few held 

a Masters degree (22%). 65% had a 

performance review in the preceding 

12 months and 62% had their learning 

needs identified. 

Discussion 

This study has demonstrated role 

blurring and overlap between the 

nurse educator role and other nursing 

roles with responsibility for education. 

Where there is role ambiguity, role 

conflict may also arise, adversely 

influencing professional identity, job 

satisfaction and performance (Dubois 

& Singh, 2009). This is an important 

issue as the role may be ‘at risk’ when 

it is not clearly defined, performance 

outcomes are not measured and 

importantly where nursing roles not 

directly providing clinical care are 

increasingly scrutinized (Conway & 

Elwin, 2007; Sayers & DiGiacomo, 

2010). Engagement in research and 

policy debate is essential for nurse 

educators to influence decision-making 

regarding their role in education in 

practice settings (Sayers & DiGiacomo, 

2010). 

Nurse educators need to provide role 

clarification by redefining and 

redesigning their role to address role 

blurring and ambiguity. An important 

part of this process is the development 

and application of frameworks for 

career role design, embracing group 

engagement by service users, nurses, 

service managers, education providers 

and researchers to achieve clientfocused 

services (Lockhart, 2004). Role 

clarity and validation of performance is 

crucial to role enactment, effectiveness 

and workforce engagement (Dubois & 

Singh, 2009). 

Consideration of the qualifications and 

professional development essentials 

supporting the role is another 

imperative as is the development of 

curricula reflecting role requirements. 

A grounding in teaching and learning 

theories, frameworks and processes in 

clinical practice are necessary 

foundations for nurse educators 

(Billings & Halstead, 2005). Learning 

about management and partnership 

concepts that underpin clinical learning 

environments are required 

(Henderson, Briggs, Schoonbeek, & 

Paterson, 2011). Leadership capabilities 

to support reconfiguration of practices 

and processes inspiring practice 

development and acquisition of new 

knowledge are also vital (Cook & 


23 

Leathard, 2004). Nurse educators who 

model and foster expert behaviors will 

be transformational clinical leaders 

(Benner, Stutphen, Leonard, & Day, 

2010). The impact of these 

characteristics on learning is influential 

on student and graduate nurses’ 

attitudes, behaviors and practices and 

their importance cannot be 

underestimated (Brammer 2006; 

Dickson, Walker, & Bourgouis, 2006; 

Eaton, Henderson, & Winch 2007). 

Leadership is an essential nurse 

educator attribute for creating and 

sustaining vibrant learning 

environments that build nursing 

excellence, workforce capacity and 

positively influence patient outcomes 

(Henderson, et al., 2011). 

Conclusion 

Engagement in policy and practice 

debate to define and redesign the 

nurse educator role and address 

blurring and ambiguity is a strategic 

imperative. Role development, 

underpinned by professional education 

and development may enhance 

specialty recruitment and career 

opportunities. Performance review and 

articulation of performance outcomes 

acknowledges the contribution of 

nurse educators to clinical practice and 

may enhance their performance as 

clinical leaders in education and drivers 

of policy and practice initiatives. The 

development of career pathways and 

qualifications to enhance continued 

recruitment to the specialty is a 

requirement for professional credibility 

and career advancement. 

References 

Benner, P., Sutphen, M., Leonard, V., & Day, L. 

(2010). Educating nurses: A Call for Radical 

Transformation. San Francisco: Jossey-Bass. 

Billings, D. M. & Halstead, J. A. (2005). Teaching 

in Nursing. St. Louis: Elsevier Saunders. 

Brammer, J. (2006). A phenomenographic study 

of registered nurses’ understanding of their 

role in student learning - An Australian 

perspective. International Journal of Nursing 

Studies, 43, 963-973. 

Conway, J. & Elwin, C. (2007). Mistaken, 

misshapen and mythical images of nurse 

education: Creating a shared identity for clinical 

nurse educator practice. Nurse Education in 

Practice, 7, 187-194. 

Cook, M. J. & Leathard, H. L. (2004). Learning 

for clinical leadership. Journal of Nursing 

Management, 12, 436-444. 

Dickson, C., Walker, J., & Bourgouis, S. (2006). 

Facilitating undergraduate nurses clinical 

practicum: the lived experience of clinical 

facilitators. Nurse Education Today, 26(5), 

416-422. 

Dubois, C. A. & Singh, D. (2009). From staff-mix 

to skill-mix and beyond: towards a systemic 

approach to health workforce management. 

Human Resources for Health, 7(87), 1-55. 

Eaton, E., Henderson, A., & Winch, S. (2007). 

Enhancing nurses’ capacity to facilitate learning 

in nursing students; effective dissemination and 

uptake of bets practice guidelines. International 

Journal of Nursing Practice, 15(3), 316-320. 

Henderson, A., Briggs, J., Schoonbeek, S., & 

Paterson, K. (2011). A framework to develop a 

clinical learning culture in heath facilities: ideas 

from the literature. International Nursing Review 

(early view). doi: 

10.1111/j.1466-7657.2010.00858.x 

Lockhart, K. (2004). Presenting a framework 

for developing nursing roles in Scotland. Journal 

of Research in Nursing, 10(1), 7-25. 

Sayers, J. M. & Davidson, P. M. (2009). Under 

the spotlight: nurse educators in acute care. 

Connections, 12(1), 35. 

Sayers, J. M. & DiGiacomo, M. (2010). The nurse 

educator role in Australian Hospitals: 

implications for health policy. Collegian, 17, 

77-84. 

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24 

BREAST CARE NAtioNAL NETWORK 

Editor: Elisabeth Coyne MRCNA 


Mastitis: How to diagnose and treat 

By Danielle Gleeson, Midwifery Lecturer, Griffith University 

©iStockphoto 

Mastitis is a condition estimated to affect between 3% and 33% 

of breastfeeding women (World Health Organization [WHO], 

2000), while a recent Australian study found an incidence of 17% 

(Amir, Forster, Lumley & McLachlan, 2007). 

It is a condition 

which can have a 

significant negative 

impact on 

women’s 

experiences of 

Danielle Gleeson 

breastfeeding 

(Amir & Lumley, 2006) and is often 

associated with early breastfeeding 

cessation (Crepinsek, Crow, Michener 

& Smart, 2010; Lewallen et al., 2006; 

Scott, Robertson, Fitzpatrick, Knight & 

Mullholland, 2008). 

To minimise the pain and distress 

encountered by women with mastitis, 

it is important for health professionals 

working with breastfeeding women to 

have a thorough understanding of this 

condition and the associated treatment 

options. 

Definition and predisposing factors 

The literal meaning of mastitis is 

inflammation of the breast which may 

or may not be associated with infection 

of the breast tissue (Jahanfar, Ng & 

Teng, 2009). If not treated early, mastitis 

seems to follow a continuum from 

engorgement to inflammation to 

infection and finally to abscess 

(Crepinsek, et al., 2010; Academy of 

Breastfeeding Medicine [ABM], 2008). 

Staphylococcus aureus, is the most 

common cause of infective mastitis 

(Kvist, Larsson, Hall-Lord, Steen & 

Shalén, 2008). The majority of 

predisposing factors for mastitis such as 

infrequent feedings, incorrect 

attachment, rapid weaning and a 

blocked duct, relate to milk stasis. 

Other factors include damaged nipples, 

maternal illness and Candida infection 

(ABM, 2008). 

Symptoms and diagnosis 

The clinical symptoms of mastitis can 

mimic other conditions such as flu-like 

illnesses. Confirmation of mastitis can 

normally be made through associated 

breast symptoms which often occur in 

a wedge shape (ABM, 2008). The most 

common symptoms are: 

• breast erythema 

• breast tension 

• fever (>38.5°C) 

• breast pain 

• breast lumps 

• muscular aches (ABM, 2008) 

Due to the ease of identifying the 

above symptoms, it is uncommon for 

laboratory investigations, such as 

breastmilk culture, to be carried out. 

Kvist et al. (2008) found that bacterial 

counts in breastmilk cultures were of 

little value in determining appropriate 

treatments. Diagnosis should specify 

whether an infection or abscess is 

thought to be present as this will 

effect treatment requirements. 

Treatment 

Treatment for mastitis can be divided 

into three categories: supportive, breast 

care and pharmacological. Supportive 

measures include general measures to 

improve the mother’s wellbeing such 

as adequate rest, fluids and nutrition 

(Jahanfar et al., 2009). 

Regular breast emptying through 

continued breastfeeding or expressing 


RCNA’s Life Long Learning Program 

fr eca l 18 0 2 3 705 

3lp@rcna.org.au 

w.rcna.org.au 

Australia’s peak profe sional nursing organisation 

For more information: 

Visi the 3LP website 

www.3lp.rcna.org.au 

or call 18 0 2 3 705. 

If you are not an RCNA 

member, pleas email 

us at 3LP@rcna.org.au 

to set up a fr e triaL. 

Royal Co lege of Nursing, Australia | Volume 13 | I sue 2 | June 2010 

Nursing and 

Health Expos 

Canbe ra, ACT 

Sunday 6 March 20 1 

National Convention Centre 

Sydney, NSW 

Sunday 27 March 20 1 

Sydney Convention & Exhibition Centre 

Brisbane, QLD 

Sunday 10 April 20 1 

Brisbane Convention & Exhibition Centre 

Melbourne, VIC 

Sunday 15 May 20 1 

Royal Exhibition Building 

Adelaide, SA 

Sunday 5 June 20 1 

Adelaide Convention Centre 

For more information contact RCNA Events: 

NuRsiNg iN the outbACk – page 14 

fr eca l 18 061 60 

events@rcna.org.au 

w.rcna.org.au 

An event of RCNA, Australia’s peak profe sional nursing organisation 

Perth, WA 

Sunday 26 June 20 1 

Perth Convention & Exhibition Centre 

Hobart, TAS 

Sunday 10 July 20 1 

Hotel Grand Chance lor 

As the only expo in Australia to profile a l 

nursing options under the one r of, RCNA’s 

Nursing and Health Expo provides direct 

a ce s to leading universities, hospitals 

and specialty nursing groups. 

The RCNA Nursing and Health Expo is a 

must for anyone interested in the nursing 

profe sion. 

RCN Australian 


Royal Co lege of Nursing, Australia | Volume 14 | I sue 1 | March 20 1 

ageing in the northern territory 

25 

aims to reduce milk stasis and 

according to WHO (2000) is the 

mainstay of mastitis treatment. Sudden 

weaning during an acute bout of 

mastitis is likely to exacerbate 

symptoms and increase the risk of 

abscess formation (ABM, 2008). It is 

important for health professionals to 

inform the woman that continued 

breastfeeding is not only safe but will 

assist in her recovery from mastitis. 

Heat packs to the breast are 

recommended prior to feeds to 

assist in milk flow and cold packs are 

recommended after feeds for the 

reduction of pain and oedema (ABM, 

2008; Crepinsek et al., 2010). Support 

should be provided to women who 

have nipple damage, nipple pain or are 

having difficulties latching their baby to 

the breast (Jahanfar, et al., 2010). 

Compromised nipple integrity can 

allow an easy entry point for infection, 

thus correct attachment will minimise 

the risk for further episodes of mastitis. 

Pharmacological treatment includes 

pain relief and antibiotic therapy. The 

Academy of Breastfeeding Medicine 

(ABM, 2008) recommends an antiinflammatory 

drug such as ibuprofen 

as it is more likely to target the many 

symptoms related to inflammation than 

other simple analgesics such as 

paracetamol. Ibuprofen, given at 

recommended dosages, is not 

detectable in breastmilk and is thus 

compatible with breastfeeding (ABM, 

2008). 

Antibiotics are regularly prescribed for 

women presenting with infective 

mastitis or mastitis associated with a 

fever. Kvist et al. (2008) suggests that 

studies show between 77% and 97% 

of women are treated for mastitis with 

antibiotics. The preferred antibiotics are 

those that are effective against 

Staphylococcus aureus. Such antibiotics 

are penicillinase-resistant penicillins and 

Cephalexin or Clindamycin may be 

used for women with penicillin allergy 

(ABM, 2008). It is important to note 

that a 2009 Cochrane review (Jahanfar 

As a nurse, 

et al., 2009) suggested that the 

effectiveness of antibiotic therapy 

for the treatment of mastitis in 

breastfeeding women was still in 

question with further research 

recommended. 

Mastitis will effect up to a third of all 

breastfeeding women so it is important 

for health care professionals to be 

familiar with the symptoms and 

evidence-based treatments for this 

condition. Providing supportive and 

pharmacological care and encouraging 

and assisting women with breast care 

will hopefully ensure women continue 

to breastfeed successfully beyond their 

recovery. 

References 

Academy of Breastfeeding Medicine. (2008). 

ABM Clinical Protocol: Mastitis (Revision). 

Breastfeeding Medicine, 3(3), 177-180. 

Amir, L. & Lumley, J. (2006). Women’s 

experience of lactational mastitis – ‘I have 

never felt worse’. Australian Family Physician, 

35(9), 745-747. 

Amir, L., Forster, D., Lumley, J., & McLachlan, H. 

(2007). A descriptive study of mastitis in 

Australian breastfeeding women: incidence and 

determinants. BMC Public Health, 7, 62. 

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Breaking the silence on sti lBirth 

Crepinsek, M.A., Crowe, L., Michener, K., & 

Smart, N.A. (2010). Interventions for 

preventing mastitis after childbirth (Cochrane 

Review). The Cochrane Library. In Cochrane 

Database of Systematic Reviews, 2010 (1). 

Retrieved February 24, 2010, from http:// 

onlinelibrary.wiley.com/o/cochrane/clsysrev/ 

articles/CD007239/frame.html 

Jahanfar, S., Ng, C., & Teng, C. (2009). Antibiotics 

for mastitis in breastfeeding women (Cochrane 

Review). In Cochrane Database of Systematic 

Reviews 2009 (1), Retrieved February 24, 2010, 

from http://onlinelibrary.wiley.com/o/cochrane/ 

clsysrev/articles/CD005458/frame.html 

Kvist, L., Larsson, B., Hall-Lord, M., Steen, A. & 

Shalén, C. (2008). The role of bacteria in 

lactational mastitis and some considerations of 

the use of antibiotic treatment. International 

Breastfeeding Journal, 3, 6. 

Lewallen, L., Dick, M., Flowers, J., Powell, W., 

Zickefoose, K., Wall, Y., et al. (2006). 

Breastfeeding Support and Early Cessation. 

Journal of Obstetric, Gynecologic, & Neonatal 

Nursing, 35(2), 166-172. 

Scott, J., Robertson, M., Fitzpatrick, J., Knight, C. 

& Mulholland, S. (2008). Occurrence of 

lactational mastitis and medical management: A 

prospective cohort study in Glasgow. 

International Breastfeeding Journal, 3, 21. 

World Health Organization [WHO] (2000). 

Mastitis: Causes and Management. Available 

from http://whqlibdoc.who.int/hq/2000/ 

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26 

ETHICS NAtioNAL NETWORK 

Editor: Dr Evdokia Kalaitzidis MRCNA 


Nursing, employers and the 

distribution of ethical responsibilities 

By Dr Evdokia Kalaitzidis MRCNA, Lecturer, Flinders University 

Dr Evdokia Kalaitzidis 

Most nurses, not surprisingly, are 

employed by hospitals (Australian 

Bureau of Statistics, 2006). Individual 

nurses are responsible for looking after 

their patients. Hospital managers and 

administrators are responsible for 

keeping the hospitals running. The 

Australian Nursing and Midwifery 

Council has the responsibility of 

co-ordinating the development and 

maintenance of professional standards 

and the code of ethics. 

When it comes to ethical decision 

making, it is useful for both parties to 

be clear about who is responsible for 

what. In this article I want to explore 

the proper distribution and allocation 

of ethical responsibilities between 

nurses and their employing institutions. 

The shift from hospital-based nurse 

education and training to the higher 

education sector represents a major 

evolutionary development of the 

nursing profession. Nursing has become 

increasingly complex work. It requires 

nurses to apply sophisticated problem 

solving skills and other competencies to 

deal with complex problems associated 

with moment to moment client care. 

The nursing profession as a whole 

does not control the management 

of hospitals, nor do individual nurses 

on the wards. An individual nurse’s 

responsibilities to their employer are 

also related to the professional 

standards. Hospitals rely on the work of 

professional associations and affiliations 

to keep nurses accountable to the 

wider community. So to an employer, 

pre-existing professional standards are 

important. 

Setting standards for nursing practice is 

a responsibility of the nursing profession 

as a whole. As with any profession, 

there are generic bodies of knowledge 

and application techniques universal for 

all members of the same profession. 

These bodies of knowledge and 

application techniques are standards 

of professional practice, and hence 

transferable from one workplace 

to another. In a nurse-employer 

relationship, the nurse has an overriding 

ethical obligation to practise according 

to the standards of the nursing 

profession. These ‘institutionalised’ 

standards of practice distinguish the 

type of work performed by nurses from 

other forms of work. Professional 

standards are not open for negotiation 

between the nurse and the client, nor 

between the nurse and employer. 

Employment relations pose difficulties 

for nurses when employers expect 

them to provide a service that is 

beyond the boundaries of their 

professional expertise. 

Hospitals supply the human and 

material resources necessary to provide 

medical and nursing care for sick and 

injured people in the community and 

are responsible for environmental 

impacts. They are largely responsible 

for the effective management and 

facilitation of services according to 

institutional interests. More importantly, 

each hospital establishes its own set of 

routines and policies, and these vary 

considerably from one hospital to 

another. 

As such perhaps the hospitals should 

consider developing a code of 

management practice to address 

concerns of privacy, information, policy 

development and relations with the 

community. 

Employment relations pose difficulties for nurses when 

employers expect them to provide a service that is 

beyond the boundaries of their professional expertise. 

“ 

” 

I call upon your insights and to invite 

member contributions to the Ethics 

National Network. If you wish to remain 

anonymous your name and identity will 

be withheld. Please contact me at 

evdokia.kalaitzidis@flinders.edu.au 

Reference 

Australian Bureau of Statistics. (2006). 4102.0 

- Australian Social Trends, 2005. Retrieved 

February 10, 2011 from www.abs.gov.au/ 

Ausstats/abs@.nsf/0/8A87EF112B5BCF8BCA2 

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See you in Hobart! 



28 

HISTORY NAtioNAL NETWORK 

Editor: Sue DeVries FRCNA 



29 

Nurses in WAR 

The Australian War Memorial’s Nurses: from Zululand to Afghanistan 

exhibition opens in Canberra in December. This beautifully 

evocative display tells the story of nursing in overseas conflicts, 

an important but often neglected aspect of Australia’s wartime 

experience. 

It draws on the Memorial’s rich collection to highlight the work of Australian nurses 

in war and focuses on the men and women who served as military nurses in 

overseas conflicts. With a strong focus on photographs and private records it traces 

the involvement of nurses from the first known Australian contribution in the Zulu 

War of 1879 to today’s operations in Afghanistan. 

Most Australians are familiar with the stories of Australian nurses in recent conflicts 

but the experiences of nurses in previous wars stand in danger of being forgotten. 

Nurses: from Zululand to Afghanistan will remind Australians how difficult it was for 

many women to serve in extremely primitive and dangerous conditions. Like other 

Australian service personnel, many paid the ultimate price. 

Left page: London, England. c. 1917. 4TH London General Hospital. A nurse helps a soldier 

use a passive ankle exerciser, an item of medical equipment 

Top: Kent, England. Queen Mary (centre) escorted by an unidentified officer, Sister Edith 

Horton (far right) and another unidentified nurse visiting a patient with a heavily bandaged 

face at Sidcup Hospital in Kent. An Australian facio-maxillary section was based at this 

hospital which was designed especially to treat soldiers with severe facial injuries (Donor H. 

Crompton) 

Top right: A nurse at Antwerp Hospital tending to a heavily bandaged Belgian patient whose 

face and arms have been severely wounded by shell splinters. Two other patients lie in beds 

beside him (Donor M. Wolfer) 

Bottom right:Victoria Barracks, Sydney, c. 1921. Lord Frederick William Forster (right), the 

Governor-General of Australia, presenting the Military Medal to Staff Nurse Pearl Corkhill at a 

medal investiture ceremony. Nurse Corkhill received the award for her courage and presence 

of mind when the British Army’s No. 38 Casualty Clearing Station, to which she was 

temporarily attached, was twice bombed by enemy aircraft in 1918–07. (Original print housed 

in P run in AWM Archive Store) (Donor G. Smith) 

Images courtesy of the Australian War Memorial 


30 

LEADERSHIP NAtioNAL NETWORK 

Editor: Julie Shepherd FRCNA 

Sub-editor: Lynne Slater MRCNA 

Utilising practice development concepts 

to establish an effective team 

By Elizabeth Newham MRCNA and Leigh Darcy, Members of the Hunter New England Essentials 

of Care Team 

In 2009 a team was established to develop and implement a cultural change program, the Essentials 

of Care (EOC) program, based on emancipatory practice development (ePD) principles. EOC is a 

framework for the evaluation of the essential care provided at the clinical ward and unit level. 

Clinical staff are engaged in the evaluation and development of the clinical care provided. The aims of 

the project are to improve patient safety and outcomes and to enhance the experiences of patients, 

families and carers as well as staff involved in the delivery of care. (NSW Health, 2009) 

The first construct of this framework 

is having prerequisites that will enable 

person-centred outcomes to occur. 

Attributes such as professional 

competence, well developed 

interpersonal skills, commitment to the 

job, clarity of beliefs and values and 

knowing self are integral to PCN 

(McCormack, et al., 2008, p. 195). 

Back Row L–R Maria Relf, Catherine Turner, Penny Cummings, Mary Downey, Di Targett and 

Elizabeth Newham; Front Row Kim Glashoff & Leigh Darcy 

The team itself had members situated 

in diverse geographical areas. The 

program was being implemented in 

what was the Hunter New England 

Area Health Service (now Local Health 

Network) which still covers a large 

geographical area of 130 000 square 

kilometres, with 45 inpatient health 

facilities providing care to 

approximately 840 000 people. Over 

the last 18 months the team has been 

able to utilise the practice development 

principles of the program to effectively 

establish and maintain the team in 

introducing and maintaining the 

Essentials of Care program. 

One of the underlying concepts of 

ePD is the Person-Centred Nursing 

(PCN) framework (McCormack et al, 

2008). This concept provides links 

between caring and personcenteredness 

with expected outcomes 

from an effective PCN including 

satisfaction and involvement of care, 

feelings of wellbeing and the creation 

of a therapeutic culture (McCormack 

et al., 2008, p. 194). 

During the planning of the roll-out of 

the Essentials of Care program, it was 

established that the principles of ePD 

needed to be used not only with the 

nursing units engaging in the program, 

but also within the team that was being 

established to accomplish the work. 

The first challenge was to identify the 

necessary essential skills and attributes 

that would enable the new team 

members to be able to work effectively 

in a person-centred way within the 

team and with others, while working in 

geographical isolation. By applying the 

ePD framework to the establishment 

of the team, a group of prerequisites 

for interview were developed prior to 

the recruitment process. These 

prerequisites included problem-solving, 

knowledge of the Area Health Service, 

flexibility and self motivation. 

The second challenge was to create 

ways of working to ensure new staff 

inter-connected as a team and 

maintained a person-centred 


31 

environment while often working in 

isolation; most members of the team 

were based in different regions of the 

vast geographical area. 

In the PCN framework, care 

environments that support effective 

person-centeredness include: 

appropriate skill mix, shared decision 

making, effective staff relationships, 

supportive organisational systems, 

power sharing and potential for 

innovation and risk taking (McCormack 

et al, p. 196). This framework was 

introduced to the establishment of the 

team and was adopted as an 

underpinning vision. 

It was essential to ensure that all team 

members were able to develop the 

skills needed to conduct the EOC 

program. This included developing a 

structured orientation program for 

participants involving course 

attendance, familiarisation of the 

program and workplaces and the time 

to deconstruct the various 

components of the work involved in 

the program. To facilitate the inclusion 

of all the team and group participation 

in decision-making, various ePD tools 

The first construct of 

this framework is having 

prerequisites that will 

enable person-centred 

outcomes to occur. 

“ 

” 

and strategies were used such as 

facilitated group discussions and 

teleconferences. 

The next step was for the EOC team 

to undertake a values clarification 

exercise. This exercise enabled team 

members to acknowledge each 

individual’s beliefs and values and to 

begin to develop a statement that 

outlined shared values. Some of the 

core bases in the team include 

role-modelling, sharing of skills and 

ideas, mentoring, co-facilitation and 

communication plans. The team has 

established a collaborative way of 

working so that the power is shared by 

the group and an environment of high 

challenge and high support has been 

established which enables innovation 

and risk taking to occur. During this 

venture the ethos of utilising ePD 

principles and person-centredness as a 

way of working has been reinforced. 

As a result of utilising the concepts of 

the PCN framework, the EOC team 

was able to rapidly establish effective 

ways of working. Team members 

continue to work both independently 

and collaboratively by supporting each 

other’s portfolios. This has facilitated 

learning from each other and the 

engagement with other nursing teams. 

One more part of maintaining an 

effective team and an essential principle 

of ePD is reflecting on our practice. 

Throughout the process, reflection has 

been vital and at present the team is 

conducting a formal evaluation to 

review if the functioning of the team 

reflects person-centredness. 

References 

McCormack, B., McCance, T., Slater, P., 

McCormick, J., McArdle, C., & Dewing, J. (2008). 

Person-Centred Outcomes and Cultural 

Change. In K. Manley, B. McCormack & V. 

Wilson (Eds)., International Practice 

Development in Nursing and Healthcare 

(pp. 189-214). Oxford: Blackwell. 

NSW Department of Health (2009). Working 

with Essentials of Care: A resource guide for 

Facilitators. NSW Department of Health. 

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32 

LEGAL ISSUES NAtioNAL NETWORK 

Editor: Associate Professor Linda Starr FRCNA 


Do we take the principle of 

double effect for granted 

By Anne Milln MRCNA, Registered Nurse, Masters in Health and Medical Law Student 

Registered nurses (RNs) all over Australia will be familiar with 

giving a dose of morphine to a terminally ill patient, with the 

intent of alleviating the patient’s pain and distress. The morphine 

has been ordered by a doctor and a range of dosage has been 

given – let’s say 2.5-5mg, to be given subcutaneously, and the 

frequency is as necessary (prn). How often does the RN consider 

the possible other effect, that it might kill the patient 

Anne Milln 

That other effect is part of what is 

known as the principle of double effect. 

This is an ethical principle which 

suggests that for an action there are 

two possible outcomes – one desired 

and the other not desired, the good 

effect or the bad effect. The ethics of 

giving that dose of morphine is a 

debate in itself. 

In some jurisdictions in Australia, 

health professionals are protected 

by legislation. For instance in South 

Australia the legislation states that 

where the treatment or care of a 

patient is given with the intent of 

relieving pain or distress, according to 

proper professional standards, but 

hastens the death of the patient, the 

health professional is protected from 

civil or criminal liability (Consent to 

Medical Treatment and Palliative Care Act 

1995 (SA)(Austl.)) This makes it very 

clear that the intent must be to relieve 

pain or distress. How do we prove that 

intent to make ourselves invulnerable 

to criminality 

A case in the UK occurred at the 

Airedale NHS Trust in Yorkshire 

England. Anne Grigg Booth was 

charged in 2004 with “3 offences of 

murder, one offence of attempted 

murder and 13 offences of 

administering noxious substances with 

intent to cause grievous bodily harm 

or harm” (Thirlwall, Kinsella & Mullan, 

2010, pp. 3). Unfortunately Anne Grigg 

Booth committed suicide before her 

case came to court. 

The case has been vigorously 

examined in The Airedale Inquiry: 

Report to the Yorkshire and The 

Humber Strategic Health Authority 

(Thirlwall, Kinsella & Mullan, 2010), 

which was presented in June 2010, and 

it is this document which gives us the 

facts of the case. 

To look at all the charges would take 

more time and space than is available 

here, but one charge is particularly 

interesting in the context of the principle 

of double effect. The offence is alleged 

to have occurred in November 2001. 

CX, a 75 year old woman with a long 

history of smoking, presented to the 

hospital with a possible diagnosis of 

pneumonia; an X-ray suggested lung 

cancer. On admission to the ward she 

was found to have a cyanosed and 

discoloured arm and was taken 

immediately to theatre for a right 

brachial embolectomy under local 

anaesthetic. Post operatively she 

developed renal problems and was very 

hypotensive, despite fluid resuscitation. 

She was conscious and agitated so the 

medical staff ordered diamorphine 

1.25–2.5mg to be given IV prn (Thirlwall, 

Kinsella & Mullan, 2010, pp. 63). An initial 

dose was given and it was recorded in 

the notes that CX was ‘very settled after 

administering diamorphine’ (Thirlwall, 

Kinsella & Mullan, 2010, pp. 63). Further 

attempts were made at fluid 

resuscitation without effect. After 

discussion with the family it was decided 

not to attempt further active treatment 

and in effect that CX was to be kept 

comfortable. One and a half hours later, 

a further dose of diamorphine was 

given, and signed for appropriately by 

Booth and another RN, however there 

was no explanatory documentation to 

support why the diamorphine was given. 

Hence there is no way to determine 

whether CX was in distress at the time. 

The patient died about 30 minutes after 

the diamorphine was given. 


33 

In order for murder to be proved there must either be an intent to kill or 

extreme irresponsibility which leads to someone’s death. 

“ 

” 

Witness statements are contradictory 

about whether the patient was 

distressed or not and the expert 

witnesses consulted by the police for 

the inquiry also contradict one another. 

Booth said that “she would not have 

given the diamorphine unless the 

patient was in pain or distress” 

(Thirlwall, Kinsella & Mullan, 2010, pp. 

65). Booth was charged with the 

murder of CX. 

What is at issue here is the intent of 

Booth when she gave the second dose 

of diamorphine. In order for murder to 

be proved there must either be an 

intent to kill or extreme irresponsibility 

which leads to someone’s death. In the 

eyes of a court, the absence of proper 

documentation means that the intent is 

open to interpretation. If it hasn’t been 

documented it hasn’t been done 

(Staunton & Chiarella, 2008). 

Timely and objective documentation is 

the RNs’ greatest protection from such 

a charge of murder. It leaves no doubt 

about the intent to relieve pain or 

distress, rather than intent to hasten 

death or indeed to kill the patient. This 

is conjecture, but if Booth completed 

adequate documentation of her 

nursing care, she almost certainly 

would not have been charged with 

murder. 

References 

Consent to Medical Treatment and Palliative Care 

Act 1995 (SA) (Austl.). 

Staunton, P., & Chiarella, M. (2008). Nursing and 

the law (6th ed.). Marrickville, NSW: Elsevier. 

Thirlwall, K., Kinsella, E., & Mullan, A. (2010). The 

Airedale Inquiry: Report to the Yorkshire and The 

Humber Strategic Health Authority. Available from 

http://www.airedale-trust.nhs.uk/docs/ 

Inquiry%20-%20full%20report.pdf. 

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34 

NURSES IN BUSINESS NAtioNAL NETWORK 

Editor: Dr Jane Truscott MRCNA 


Essentials 

for successful 

business 

planning 

By Dr Jane Truscott MRCNA, 

Senior Consultant, TEPL Consulting 

One of the most critical aspects of starting a business is effective 

planning. You may be thinking of providing services within the 

public or private sectors or for people living in the community. 

You may have found that product development and delivery to 

market is your niche. Whether you aim to provide a service or 

product, business success is highly contingent upon thoughtful 

and realistic planning (Johnson, 1990). 

A business plan, sometimes confused 

with a business case, is a plan for a 

start-up business. It is a formal 

statement that outlines all aspects of 

the economic viability of your business. 

A business case is the justification for 

an initiative within an existing business, 

such as a new service, piece of 

equipment or software. While the 

development of a business case may be 

familiar to many nurses within Australia, 

Dr Jane Truscott 

few may have experience with the 

actual development of a business plan. 

Business plans vary depending on the 

type of service or product. The 

following elements are usually 

considered: executive summary, 

company description, market analysis, 

service or product description, 

marketing and competition, financials, 

key personnel and an appendices. 

Executive summary 

The executive summary is a critical 

aspect of your plan and probably the 

first thing the reader will access. 

However, it should be written last, after 

you have researched and developed 

other components of the plan. There’s 

a good chance the reader of your plan, 

possibly a potential investor (e.g banker, 

venture capitalist, or business angel), 

will not have much time to study your 

plan in detail. The executive summary 

should peak their interest and 

encourage them to read more (Mason 

& Stark, 2004). Typically one to two 

pages, it should include a mission 

statement, a description of the business, 

a description of your service or 

product, marketing, financial 

considerations and key personnel. 

Company description 

The company description should be 

fairly straight-forward, providing a vital 

description of what you do, why you 

do it, who you do it for and why you’ll 

be successful doing it. It should provide 

the vision and direction of the 

company. At a minimum, it should 

include: company name, mission 

statement, company objective and 

goals, service or product, target 

customer, ownership structure, current 

status and business history. You may 

also wish to include such topics as the 


35 

strengths and skills of the business, legal 

form of ownership and business 

philosophy. 

Market analysis 

Consider who you want to reach and 

why. This is one area where many 

companies do not devote sufficient 

research, often contributing to 

avoidable failure. Identify and define 

your market; know what population 

and/or group of people would be 

interested in your service or product 

and develop a well-defined statement 

that is supported by evidence. 

Consider such questions as: 

• What is the size of your target 

market 

• How old are they 

• What gender are they 

• Where do they live 

• What is their family structure 

• What is their income 

• Are there cultural or ethnic 

considerations 

• How do they spend their spare 

time 

• What motivates them 

Service or product description 

Now that you have described your 

market, you want to provide a 

convincing argument; why is there a 

substantial need for your service or 

product A detailed service or product 

description should identify the specific 

benefits, your ability to meet the 

consumer’s needs and competitive 

advantages. Provide supporting 

evidence as to why your service or 

product is needed with numerical data 

and information supported by 

testimonials. 

Marketing plan 

The marketing plan will describe how 

you plan to get your service or product 

to your customer. Essentially, you will 

want to describe your sales strategy, 

pricing plan, proposed advertising and 

promotion activities and the benefits of 

your service or product. Traditionally, a 

market plan would address the four ‘Ps’ 

of marketing, that is: product, price, 

promotion and place. While this 

framework often forms the core of 

many marketing plans, it has also been 

criticised as obsolete, and somewhat 

simplistic for the modern market place 

(Constantinides, 2006). Other areas, 

referred to as the additional four Ps, 

should also be considered: process, 

people (frontline staff), physical 

environment (appearance of your 

location) and productivity and quality 

(ways to improve productivity and 

quality as defined by your customer), 

depending on your type of service or 

product (Lovelock &Wirtz, 2007). 

Financials 

Provide an overview of your financial 

plan, including your start-up budget, 

start-up expenses and operating 

expenses. You will also want to include 

details regarding your financial goals, 

how you plan to receive payment from 

your customers and what accounting 

system you plan to use. Commonly 

included here is a balance sheet, break 

even analysis, profit and loss statement, 

equipment list and any needed 

investment or loan requests. This is 

another opportunity for you to 

convince a potential investor to invest 

in your business. 

Key personnel 

One of the most important aspects of 

a business, particularly in the health 

care service sector, is its people. 

Success is often contingent upon 

having experienced and qualified staff 

who are competent to meet consumer 

needs. Identify the company 

organisational structure and include a 

brief biography with details of their 

professional and educational history. 

Also identify appropriate professional 

licensure, endorsements and 

credentials. 

“ 

While the development of a business case may be familiar 

to many nurses within Australia, few may have experience 

with the actual development of a business plan. 

” 

Appendix 

Include supplemental information that 

provides supporting evidence to your 

plan. This may be things like tables, 

charts, graphs and spread sheets that 

you’d like to include but don’t 

necessarily fit within the other sections. 

With thoughtful and detailed 

development of these basic elements, 

you will be well equipped to address 

the challenges of starting a business 

and growing it to success. Adequate 

detail will help inform potential 

investors as well as put your business 

idea in a realistic position, without 

overlooking potential pitfalls. Being 

realistic and objective with your vision, 

goals and expectations will help you 

address any unforeseen problems 

down the road, and position you well 

as a nurse-lead business. 

References 

Constantinides, E. (2006). The marketing mix 

revisited: Towards the 21st century marketing. 

Journal of Marketing Management, 22, 407-438. 

Johnson, J.E. (1990). Developing an effective 

business plan. Nursing Economics, 8(3),152-154. 

Lovelock, C. &Wirtz J. (2007). Services 

marketing: People, technology, strategy (6th ed.). 

New Jersey, USA: Pearson International – 

Pearson/Prentice Hall. 

Mason, C. & Stark M. (2005). What do 

investors look for in a business plan A 

comparison of the investment criteria of 

bankers, venture capitalists and business angels. 

International Small Business Journal, 22(3), 

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36 

NURSES IN BUSINESS NAtioNAL NETWORK 

Editor: Dr Jane Truscott MRCNA 


A successful nursing business model 

By Casey Hamilton 

Suzie Hoitink completed her Bachelor of 

Nursing degree at the University of Canberra 

in 1996 and has since nursed in a variety of 

clinical settings. After struggling with acne-prone 

skin since her teenage years and finding very 

little help available, she turned her attention 

to skin care. 

In 2005 Suzie founded the first Clear Complexions Clinic in 

Canberra after seeing a need to provide a medical approach 

for people with skin care problems. 

In just five short years her business has come a long way. Her 

original staff of two nurses has grown to 15 and Suzie now has 

two beautiful clinics, one of which has training facilities. Over 

the five years the clinics’ nurses have treated over 10 000 of 

Canberra’s men, women and teenagers. With plans to expand 

this year, it is clear to Suzie that her clinics have indeed found 

a niche market. 

Clear Complexion Clinics are unique; they exclusively employ 

highly skilled nurses to perform all treatments. This has allowed 

the clinics to source the latest medical grade technology and 

products that aren’t available to those without a medical 

background. Suzie knows that when you combine the best 

possible technology with the highest qualified people, the 

client benefits. That’s what she has done at Clear Complexions. 

This investment in her staff and equipment has meant clients 

are better analysed, more informed and ensures they receive 

the most effective outcome. 

The clinic employs enrolled nurses and registered nurses as 

well as a nurse practitioner from a variety of backgrounds such 

as accident and emergency, remote and rural nursing and 

midwifery. Along with an extensive training program, all nurses 

undertake independently accredited IPL/Laser Safety 

certification conducted by the Australasian Academy of 

Cosmetic Dermal Science. 

Suzie strongly believes that nurses have the right mix of skills 

to thrive in this industry. They think critically, work 

independently as well as part of a team and they empathise 

with clients. While there are a lot of cosmetic skin care clinics 

out there, Suzie’s clinics are about good skin medicine, not just 

cosmetic medicine. The staff at the clinics are specialists 

because they stick to a narrow field; they only treat skin and 

this is why Suzie believes her business is such a success. 

Conditions she treats include acne, scarring, rosaceous skin, 

sun damage, pigmentation and unwanted hair. 

This year Clear Complexions have forged a partnership with 

a local charity, Lifeline Canberra. Apart from being able to give 

back to the local community, which has supported the clinics, 

the nurses at the Clear Complexions clinic will also undertake 

the Lifeline Accidental Counsellor course. This will ensure that 

the clinic remains focused on building the client’s confidence. 

In many circumstances a client’s skin issues have affected their 

self-esteem. Clear Complexions give clients direction and it is 

a thrill to see them grow in confidence with good skin. 

Although her business has expanded considerably, Suzie still 

works in the clinics every day and thrives on the regular 

contact with her clients. She believes this attitude, her own 

personal journey and immense professional pride are the 

foundations behind this successful nursing model of business. 

Suzie Hoitink, registered nurse, founder, Clear Complexions 

For more information contact the Clear Complexions Clinics at 

www.clearcomplexions.com.au 


37 

RCNA’s Life Long Learning Program 

As a nurse, 

are you ready for the continuing professional 

development (CPD) requirements under 

national registration 

For more information: 

Visit the 3LP website 

www.3lp.rcna.org.au 

or call 1800 233 705. 

If you are not an RCNA 

member, please email 

us at 3LP@rcna.org.au 

to set up a free triaL. 

RCNA’s Life Long Learning Program, 3LP, has a new 

look and easy navigation to assist you with developing 

your learning plan, accessing online learning activities, 

recording your CPD hours and much more. 

RCNA 

freecall 1800 233 705 

3lp@rcna.org.au 





38 

NURSE PRACtitioNER NAtioNAL NETWORK 

Editor: Debbie Deasey MRCNA 

Sub-editor: Tim Crowley MRCNA 

Complex Care and Trauma Mental Health 

Nurse Practitioner 

By Tim Crowley MRCNA, Nurse Practitioner, Complex Care and Trauma Mental Health, Child and 

Adolescent Mental Health Services, Child, Youth and Women’s Health Service, South Australia 

I have worked 

with the Child, 

Youth and 

Women’s Health 

Service for the 

past 14 years. I 

Tim Crowley 

have always found 

it a privilege to work with young people 

with mental health concerns. Seeing 

them respond to treatment and more 

importantly the natural process of 

maturation is something to admire. 

More often than not, they are a 

marginalised group of young people 

whom require high level care, therapy 

and expertise. These requirements are 

what formed the catalyst to my 

undertaking further training to become 

a Nurse Practitioner (NP). 

My key responsibilities as a Complex 

Care and Trauma Mental Health NP 

include the assessment, management 

and treatment/therapy of young people 

who have experienced trauma and or 

complex developmental trauma. The 

impact of this trauma effects their 

functioning in many domains including 

affectively, cognitively and with 

interpersonal relationships – just to 

name a few. My role also includes 

managing systemic issues and concerns 

related to this cohort of young people 

as well as working with key stakeholders 

in the coordination of care. 

An additional key responsibility of my 

role is to provide education to 

stakeholders on the assessment and 

management of young people with 

mental health concerns with a particular 

focus on trauma, disaster and complex 

developmental disturbances. I also 

provide clinical supervision and 

leadership to multi-disciplinary staff. My 

role as an educator extends to the 

writing and development of resources 

related to complex care and trauma 

“ 

I have always found it a privilege to work with young 

people with mental health concerns. Seeing them respond 

to treatment and more importantly the natural process of 

maturation is something to admire. 

” 

mental health. Through my writing and 

research I have found that the body of 

science surrounding young people and 

mental health is constantly evolving and 

to maintain contemporary practice, I 

have found that my knowledge needs to 

be a melding of the old and the new 

evidence. I also have national and state 

involvement in the psychological 

responses to disaster and trauma events 

and act as an adviser for systems of care. 

My career evolvement to that of an NP 

has presented me with vast 

opportunities. I am able to work and 

observe other clinicians; their 

conceptualisations of cases and care and 

their motivation to act in the best 

interest of young people. The 

collaborative nature of the NP role and 

the sharing of knowledge and skills with 

other health professionals often bring 

another layer of skill and understanding. 

This additional layer adds value to the 

care process of young people and 

therefore ultimately improves outcomes 

for young people. 

Like any career progression, there have 

been challenges along the way. The initial 

process of application to become an NP 

was one of these challenges. Once I 

accepted that it was to be more of a 

marathon rather than a sprint to an NP, 

it made the process a little easier to 

fathom. There are also everyday clinical 

challenges but the biggest by far is 

ensuring there is enough time in the day 

and week to complete all tasks – from 

direct clinical care, to teaching, to 

researching, it often feels like an 

endless list. 

However, these challenges are 

insignificant to the huge rewards my 

role as an NP affords me. My role allows 

me to think outside the square, always 

with the best interest of young people 

foremost. I am able to see young people 

develop and replace previous unhelpful 

thinking and coping strategies with new 

and appropriate self-management skills. 

I also feel immense professional 

satisfaction through my teaching and 

input into the development of other 

non-mental health service staff. 

I am currently involved in teaching and 

training school counsellors across the 

state. This allows me to reflect on my 

own clinical practice whilst teaching and 

sharing skills with others. 

As you can see, my role as an NP allows 

me the scope of practice to be a leader, 

a clinician, an educator, a collaborator, a 

learner and an observer – sometimes all 

of these roles simultaneously. 


The Australian Government has established the Nursing & Allied Health Rural 

Locum Scheme (NAHRLS) to support nurses, midwives and allied health 

professionals in rural and regional Australia to get away to do the professional 

development training they need to continue their vital work. 

NAHRLS will find you and your workplace a suitable locum for the period you 

are away. The scheme supports all locum recruitment, travel and accommodation 

costs. Applications for this Scheme will be accepted four times a year. 

First round applications are now open and you can apply online. 

For more information visit: 

www.nahrls.com.au 

Funded by the Australian Government 

Can’t get away to do your 

Continuing Professional 

Development training 

Apply to the Nursing 

& Allied Health Rural 

Locum Scheme for 

someone to fill in for 

you while you are 

away... 

Apply Online!

40 

oral health NAtioNAL NETWORK 

Editor: Marlene Carlin 

Sub-editor: Nina Christofi 

Temporomandibular Disorder 

By Marlene Carlin, Dental Assistant, Oral Medicine Department, The Royal Dental Hospital of Melbourne 

©iStockphoto 

“I have been told I have TMJ 

problems – can you help me” 

This is a common cry that clinicians 

working in the area of 

temporomandibular joints (TMJ) 

or more accurately TMD 

(temporomandibular disorder) 

encounter on a daily basis. Below is 

some information that might help 

answer some of the fundamental 

questions about this disorder. 

What are the temporomandibular 

joints (TMJ) 

TMJs are the two joints that connect 

the jaw to the skull. They are the joints 

that slide and rotate in front of each 

ear. When properly aligned, a smooth 

muscle action such as chewing can 

eventuate. When these components 

are not aligned nor synchronized in 

movement, several difficulties can 

occur. Some of these problems are 

headaches, neck and shoulder aches, 

and back pain. 

What is the cause of TMD 

Any problem that prevents the 

complex system of muscles, bones, and 

joints working in harmony may result 

in TMD. Several theories have been 

proposed with multiple factors 

responsible, including an incorrect bite, 

direct or indirect physical injury, stress 

or emotional factors and tooth 

grinding. Common or more obvious 

causes of TMD can include motor 

vehicle and sporting accidents, falls or 

a blow to the face. Less obvious causes 

can include a wide uncontrolled yawn, 

prolonged playing of a musical 

instrument (such as a wind or a string 

instrument) or opening too wide to 

bite into a hamburger or hard food. 

Teeth grinding or clenching occurs 

frequently in patients with TMD. 

There is no evidence for a genetic 

predisposition. 

“ 

A good analogy for TMD 

is that of an individual with 

a sprained ankle who 

continues to walk or run. 

” 

A good analogy for TMD is that of an 

individual with a sprained ankle who 

continues to walk or run. The ankle 

becomes sore and the surrounding 

muscles protecting the ankle become 

tight. A similar situation is seen in TMD. 

If an individual does not seek treatment 

and continues daily function by eating, 

speaking, yawning, not allowing the jaw 

to rest or is a night time teeth grinder 

(as if they are running a marathon in 

their mouth), this can result in TMD 

and if left untreated can result in 

chronic pain. 

What are the symptoms of TMD 

Symptoms of TMD include: 

• jaw discomfort or soreness (early 

morning /late afternoon) 

• headaches 

• pain radiating behind eyes, shoulder, 

neck and back 

• ear aches, ringing in the ears 

• clicking/popping of the jaw 

• locking of the jaw 

• clenching of the teeth 

• dizziness. 

Treatment of TMD includes: 

• resting the TMJ 

• medication and/or pain relievers 

• relaxation and stress management 

techniques 

• behavior modification (to reduce 

or eliminate the clenching of the 

teeth) 

• physical therapy such as massage 

and physiotherapy 

• an orthopaedic appliance or mouth 

guard worn at night to reduce 

teeth grinding 

• posture training 

• diet modification (to rest the jaw 

muscles) 

• heat packs 

• surgery. 

Intra-oral appliances such as occlusal 

splints may be required to alter the jaw 

position, to reduce muscle activity as 

well as for protection of the teeth from 

grinding habits. These are usually only 

required to be worn at night and over 

time will relieve the pain of TMD. 

If simple conservative measures fail and 

the pain becomes severe and chronic, 

then referral to an oral medicine 

specialist for further management is 

required. Surgery is rarely needed and 

should only be contemplated after 

extensive conservative management 

has failed and where there is definitive 

evidence of joint disorder. 

Surgery should only be undertaken by 

an experienced oral and maxillofacial 

surgeon. 


PASTORAL NURSING CARE NAtioNAL NETWORK 

Editor: Leonie Rastas FRCNA 

Sub-editor: Carmel McLeod MRCNA 

41 

BOOK REVIEW 

Five Wishes: Honouring ones personal, 

spiritual and medical wishes 

Reviewer Rose Hoey MRCNA 

File photo 

“Getting the care 

you want when it 

matters most.” 

Dr Charlie Corke 

spoke of his father’s 

attitude toward death 

in the documentary entitled In the End, 

filmed in Geelong in 2009. His dad 

made something very clear; he only 

wanted to die once. When his time 

came he didn’t want to have several 

goes, he wanted to die without all the 

medical intervention that is available 

today. According to Dr Corke, older 

Australians are increasingly being 

nursed in intensive care, often 

prolonging their lives without any 

hope of recovery. 

There is a recognised gap in the 

medical system in relation to Advanced 

Care Planning (ACP); dying is becoming 

a medical moment complete with tubes 

and alarms rather than a peaceful time 

with family and loved ones. 

Leonie Rastas, in conjunction with 

health promotion charity, Pastoral 

Healthcare Network Australia (PHNA), 

has recently introduced an innovative 

program called Five Wishes. Developed 

in Florida in 1997 by Aging with 

Dignity’s Jim Towey, Five Wishes is 

helping address some of the issues 

surrounding ACP. 

Unlike most hospital-based ACP 

programs, Five Wishes is communitybased 

and presented by specialist 

pastoral nurses. Five Wishes is taken to 

community groups, health care facilities 

and faith communities to provide a 

simple and sensitive means of 

empowering people about their future 

health care choices, before they 

become ill. This ACP program 

specifically incorporates personal, 

spiritual and emotional care in its plan. 

Individuals can rest assured that their 

cultural and personal faith practices 

will be honoured if they can no longer 

speak for themselves. The Five Wishes 

ACP is designed for people over 18. 

There is also a My Wishes booklet 

especially designed for children under 

18 suffering life-limiting illnesses. 

Fives Wishes presents an opportunity 

for patients to express their wishes in 

regard to their end of life treatment 

and support, an important opportunity 

in the instance that they’re unable 

to express their own needs when 

it comes time. 

The Five Wishes ask the following 

questions: 

1. Who do you want to make health 

care decisions for you when you 

cannot make them yourself 

2. What kind of medical treatment 

do you want or not want 

3. How comfortable do you want 

to be 

4. How do you want people to 

treat you 

5. What do you want your loved 

ones to know 

Five Wishes also covers issues like 

pain management, life support, organ 

donation options and funeral wishes. 

The thought of having to make 

decisions about another person’s health 

care is daunting for most people. The 

Five Wishes booklet helps take the guess 

work out of difficult situations such as 

continuing life support after a 

devastating accident or stroke. Most 

ACPs are left until too late when 

emotions often distort decision making. 

The common fears around end of life 

care are fully addressed in the Five 

Wishes booklet and it is highly 

recommended for all health care 

providers to complete the process for 

themselves too. Five Wishes truly is a 

gift to oneself and one’s family. 

For more information, please go to 

www.pastoralhealthcarenetwork.org 

References 

Roseby, C. (Director). (2010). In the End. 

[Motion picture]. Geelong, VIC: Screen 

Australia. Available from www.in-the-end.com 

Aging with Dignity. Aging with Dignity Five 

Wishes. (2010). Retrieved from www. 

agingwithdignity.org 


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RESEARCH NAtioNAL NETWORK 

Editor: Raymond Chan FRCNA 

Sub-editor: Judith Anderson MRCNA 

43 

Enhancing self-management 

program to improve 

outcomes in cardiac 

patients with diabetes 

By Dr Jo Wu MRCNA, Research Fellow, School of Nursing and 

Midwifery, Institute of Health and Biomedical Innovation, 

Queensland University of Technology 

Dr Jo Wu 

I am a Research Fellow at the School 

of Nursing and Midwifery, Queensland 

University of Technology (QUT) – one 

of only 3 Australian nursing schools 

receiving an ERA Ranking 5/5, indicating 

outstanding performance well above 

world standard. I am also an Early 

Career Researcher, an affiliate member 

of the Institute of Health and 

Biomedical Innovation (IHBI) at QUT 

being mentored by Professor Anne 

Chang (local) and Professor Mary 

Courtney (international). I have held 

positions as a clinical nurse in critical 

care units for over 16 years in Australia 

and overseas. My research interests 

evolved from this clinical experience 

and have made a significant 

contribution to promoting selfmanagement 

for patients with 

coronary heart disease and diabetes. 

Current literature supports the success 

of self-management programs based 

on improving self-efficacy levels in 

modifying lifestyles for different patient 

groups with chronic diseases such as 

type 2 diabetes and cardiac disease. 

However, existing models of discharge 

planning and follow-up care for people 

with these two major co-morbidities 

do not address the need to provide 

self-management programs tailored for 

these patients, who are confronted 

with highly complex self-management 

needs when transitioning from the 

Coronary Care Unit (CCU) to home. 

My studies have addressed these gaps. 

The aim of my doctoral research was 

to gain in-depth understanding of the 

characteristics, needs and experiences 

of patients with type 2 diabetes who 

were hospitalised for a critical cardiac 

event (Wu & Chang, 2008; Wu, Chang, 

& McDowell, 2008). A further aim was 

to develop and pilot test a selfmanagement 

program (Wu, Chang, & 

McDowell, 2009). The research results 

from these studies have provided 

clinically relevant knowledge of the 

potential for a self-management 

program to promote continuity of care 

from the critical care environment to 

home, thereby contributing to clinical 

practice. The implications include 

enhancing transition from hospital to 

home, potentially reducing hospital 

re-admissions, and incorporating more 

effective self-management behaviour in 

patients’ daily life. 

My post-doctoral studies have 

continued to advance knowledge in 

the promotion of self-management for 

patients with coronary heart disease 

and diabetes. Projects planned for the 

future include refinement of the 

cardiac-diabetes self-management 

program, incorporating telephone and 

text-messaging (Wu, Chang, Courtney, 

Shortridge-Baggett, & Kostner, in press) 

and peer supporters (Wu et al., in 

press) in the delivery of the program, 

evaluating these delivery modes for 

transitional care, and undertaking the 

intervention in different cultural 

contexts. 

References: 

Wu, C.-J., & Chang, A.M. (2008). Audit of 

patients with type 2 diabetes following a 

critical cardiac event. International Nursing 

Review, 55, 327-332. 

Wu, C.-J., Chang, A., & McDowell J. (2008). 

Perspectives of patients with type 2 diabetes 

following a critical cardiac event - an 

interpretive approach. Journal of Nursing and 

Healthcare of Chronic Illness in association with 

Journal of Clinical Nursing, 17(5a), 16-24. 

Wu, C.-J., Chang, A., & McDowell J. (2009). 

Innovative self-management program for 

diabetics following CCU admission. 

International Nursing Review, 56, 396-399. 

Wu, C.-J., Chang, A.M., Courtney, M., 

Shortridge-Baggett, L.M., & Kostner, K. (in 

press). Development and pilot test of a 

Peer-support based Cardiac-Diabetes 

Self-Management Program using randomised 

controlled trial: A study protocol, BMC Health 

Services Research. 

Wu, C.-J., Chang, A.M., Courtney, M., & Ramis, 

M. (in press). Using user-friendly 

telecommunications to improve cardiac and 

diabetes self-management program: A pilot 

study. Journal of Evaluation in Clinical Practice. 

For further information on this research 

program, please contact me at 

c3.wu@qut.edu.au. 


44 

RESEARCH NAtioNAL NETWORK 

Editor: Raymond Chan FRCNA 

Sub-editor: Judith Anderson MRCNA 

Celebrating an emerging 

research and development culture 

By Dr Katrina Cubit MRCNA, Innovation Coordinator, Calvary Health Care ACT 

The National Health and Hospitals Reform Commission 

(2009:202) identified continuous improvement, innovation and 

research as the fifth level of reform needed to create an agile and 

self improving health system. 

Based on this report, the focus of 

Australian health reform will include 

building a “vibrant culture of innovation 

and research” that permeates health 

services. This undertaking is to be 

underpinned by collaborative and 

cohesive partnerships between 

universities, research institutes, hospitals 

and health services. 

As a Catholic health care provider, the 

vision of Calvary Health Care ACT 

(CHCACT) is to excel and be 

recognised as a continuing source of 

healing, hope and nurturing to the 

Canberra community. To reach these 

goals, embracing a cultural shift toward 

recognising the importance of research 

and development is paramount. 

CHCACT is proud to promote two 

new research projects whose aims are 

to improving the care of people with 

delirium. 

What is delirium 

Delirium is a disturbance of 

consciousness where inattention is 

accompanied by a change in cognition 

or perceptual disturbance that 

develops over a short period of time 

(DSM IV, 2000). It is characterised by 

an acute confusion defined by 

fluctuating mental status, inattention 

and either disorganised thinking or an 

altered level of consciousness 

(Maldonado, 2008; Girard et al., 2008). 

Delirium is reported to occur in up to 

62% of hospitalised older orthopaedic 

patients (Olofsson, Lundström, Borssén, 

Nyberg & Gustafson, 2005). The 

incidence of delirium increases up to 

80% in critically ill ICU patients 

receiving mechanical ventilation (Pun & 

Ely, 2007; Girard et al., 2008) and to 

89% of patients who have dementia 

(Fick, Agostini & Inouye, 2002). 

Most of the mechanisms involved in 

developing delirium are reported to be 

related to imbalances in 

neurotransmitters that modulate 

cognition, behaviour and mood, thus 

generating different subcategories of 

delirium according to psychomotor 

symptoms experienced, such as 

‘hyperactive’, ‘hypoactive’ and ‘mixed’ 

delirium (Maldonado, 2008; Girard et 

al., 2008). 

The aetiology of delirium is considered 

to be multifactorial, a result of 

predisposing factors (age, dementia) 

and precipitating factors (polypharmacy, 

bladder catheterisation, sleep 

deprivation) (Siddiqi, House & Holmes, 

2006; Inouye & Charpentier, 1996). 

Although delirium may result from 

patients’ specific underlying illness, it is 

often an outcome of different 

iatrogenic factors and thus preventable 

sources (Pandharipande et al., 2006). 

Observational prospective and 

retrospective studies have documented 

increased evidence linking delirium and 

a higher risk of long-term cognitive 

impairment, including dementia 

(MacLullich, Beaglehole, Hall & Meagher, 

2009), as well as decreased survival, 

functional outcomes, and quality of life 

(Girard et al., 2010; Meyer & Hall, 

2006). Published work refers to these 

patients exhibiting deficits in executive 

functions (planning, organisation, 

behavioural inhibition, and decision 

making); attention deficits, problem 

solving and onset or worsening of 

dementia. This increases the risk of 

discharge to a residential aged care 

facility and patient mortality in hospital 

as well as 12 months post discharge 

(Pun & Ely, 2007). 

Delirium prevention, early detection 

and management program 

The first of the two delirium research 

projects at CHCACT is an 

interdisciplinary nurse-led delirium 

prevention, early detection and 

CHCACT is proud to promote two new research 

projects whose aims are to improving the care of 

people with delirium. 

“ 

” 

management program which 

commenced in March 2011. The aim of 

this pilot project is to provide delirium 

specific education to nursing and 

medical staff at CHCACT. The 

education will focus on prevention, 

early detection, diagnosis, 

documentation and the environmental 

and pharmacological management of 

delirium. 

While there is some evidence to 

suggest that antipsychotics are effective 

in treating the behavioural problems 

associated with delirium, additional 

resources and education focussing on 


45 

Dr Katrina Cubit, Gary Mercer and Daniella Bulic 

the non-pharmacological management 

of delirium will be provided as part of 

the pilot project. This component of 

the project will be supported by Ms 

Stefanie Pearce (Occupational 

Therapist). The project team comprises 

of Dr Katrina Cubit (Innovation 

Coordinator); Mr Gary Mercer (Older 

Persons Mental Health Unit); Dr Anna 

Burger (Senior Staff Specialist and 

Liaison Psychiatrist); and Dr Pravin 

Kumar (Consultant Psychiatrist). The 

team was awarded an ACT Health 

Practice Development Scholarship for 

2011. 

Cognitive and psychosocial impact of 

delirium on mechanically ventilated 

patients in ICU 

The second project is a prospective, 

observational pilot study in the 

CHCACT Intensive Care Unit (ICU) 

which aims to explore cognitive and 

psychosocial outcomes of mechanically 

ventilated ICU patients with and 

without delirium. The study seeks to 

investigate the effects of delirium on 

patients’ cognitive functioning and 

psychosocial outcomes, in particular 

their potential for developing 

depression and anxiety, and/or Post 

Traumatic Stress Disorder (PTSD). 

These psychological outcomes seem to 

be significant markers of a decline in 

cognitive function, daily functioning, 

quality of life and (in)ability to return to 

work, which can result in discharge to 

aged care facilities (Oeyen, Vandijck, 

Benoit, Annemans & Decruyenaere, 

2010). This project is coordinated by 

Daniella Bulic (Social Worker, PhD 

Candidate) with Associate Professor 

Michael Bennett (supervisor UNSW), 

Yahya Shehabi (Consultant Intensivist, 

UNSW supervisor), Associate Professor 

Jeffrey Looi (Psychiatrist, ANU 

supervisor) and Dr Paul Lambeth 

(Director of ICU CHCACT). 

Both projects will contribute to 

improving the patient experience 

and reducing length of stay through 

enhancing staff skill and competence. 

References 

American Psychiatric Association, (2000). 

Diagnostic and Statistical Manual of Mental 

Disorders. (4th ed.). Washington, DC: American 

Psychiatric Association. 

Bulic, D., (2009). ‘We Thought We’d Never Sleep 

Again’, exploration of couples’ relationships one 

year after their participation in standard and 

“Bringing Baby Home”, (BBH modified antenatal 

classes in Calvary Health Care antenatal 

education), paper presented at ANZAME, 

Launceston, Tasmania 30th June - 4th July. 

Fick, D.M., Agostini, J.V., & Inouye, S.K. (2002). 

Delirium superimposed on dementia: a 

systematic review. Journal of the American 

Geriatrics Society, 50(10), 1723-1732. 

Girard, T.D., Jackson, J.C., Pandharipande, P.P., 

Pun, B.T., Thompson, J.L., Shintani, A.K., ... Ely, 

E.W. (2010) Delirium as a predictor of 

long-term cognitive impairment in survivors of 

critical illness. Critical Care Medicine, 38(7), 

1513-1520. 

Girard, C.I., Pandharpipande, P.P., & Ely, E.W. 

(2008). Delirium in the intensive care unit. 

Critical Care, (Supplement 3), S3. 

Inouye, S.K., & Charpentier P.A. (1996). 

Precipitating factors for delirium in hospitalized 

elderly patients: predictive model and 

interrelationship with baseline vulnerability. 

JAMA, 275, 852-857. 

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Commission (2009). A healthier future for all 

Australians. Retrieved from http://www.health. 

gov.au/internet/nhhrc/publishing.nsf/Content/ 

nhhrc-report 

MacLulluich, A.M.J., Beaglehole, A., Hall, R.J., & 

Meagher, D.J. (2009). Delirium and long-term 

cognitive impairment. International Review of 

Psychiatry, 21(12), 30-42. 

Maldonado, J.R. (2008). Pathoetiological Model 

of Delirium: A comprehensive understanding 

of the neurobiology of delirium and an 

evidence-based approach to prevention and 

treatment. Critical Care Clinics, 24, 789-856. 

Meyer, N.J., & Hall, J.B. (2006). Bench-tobedside 

review: Brain dysfunction in critically ill 

patients - the intensive care unit and beyond. 

Critical Care, 10, 223. 

Olofsson, B., Lundström, M., Borssén, B., 

Nyberg, L. & Gustafson, Y. (2005). Delirium is 

associated with poor rehabilitation outcome in 

elderly patients treated for femoral neck 

fractures. Scandinavian Journal of Caring 

Sciences, 19(2), 119-127. 

Oeyen, S.G., Vandijck, D.M., Benoit, D., 

Annemans, L. & Decruyenaere, J.M. (2010). 

Quality of life after intensive care: a systematic 

review of the literature. Critical Care Medicine, 

38(12), 1-15. 

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B.T., Wilkinson, G.R., Dittus, R.S., ... Ely, E.W 

(2006). Lorazepam is an independent risk 

factor for transitioning to delirium in intensive 

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46 

TRANSCULtuRAL NAtioNAL NETWORK 

Editor: Professor Violeta Lopez FRCNA 

Sub-editor: Dr Sue Webster MRCNA 

Glenn Yepes 

From the Philippines to Australia: 

A career spanning great ethnic diversity 

Glenn Yepes 

By Professor Violeta Lopez FRCNA, School of Nursing (NSW and ACT), Australian Catholic University 

Glenn Yepes completed his nursing degree with honours in the 

Philippines and received a silver medal for clinical expertise. He was 

employed as a company nurse in a construction company and was 

responsible for the care of 100 construction workers. 

Glenn went on to complete a course in 

paediatric cardiology, which prepared 

him to work in the Philippines 

Children’s Medical Centre, Neonatal 

Intensive Care Unit. He worked there 

for seven years, until accepting a job in 

Saudi Arabia, working as a neonatal 

intensive care nurse in a 700 bed 

military hospital. Glenn stayed in Saudi 

Arabia for two years before taking 

another position at Our Lady’s Children 

Hospital in Ireland, also as a neonatal 

intensive care nurse. He continued to 

attend several courses in newborn care 

including skills in intravenous 

cannulation and cardiac resuscitation. 

It was the long, cold climate in Ireland 

that drove Glenn to move to Australia. 

It was a warmer place to live and was 

also the home of some of his friends 


47 

from Saudi Arabia and Ireland. Glenn 

says that working in Saudi Arabia and 

Ireland had broadened his perspective 

on cultural issues that contributed to 

his understanding when caring for his 

patients and families, especially those 

parents who had premature infants. 

He also said that he learned to speak 

a little bit of Arabic but found it difficult 

to imitate the Irish way of speaking. 

Glenn now works at Canberra Hospital 

Centre for Newborn Care. With his 

knowledge and experience working in 

neonatal intensive care units for the last 

12 years, he found it easy to adjust 

working in another environment, 

especially one which provided him 

with a mentor during his first months 

at work. Glenn is an ambitious person 

and decided to enrol in the Graduate 

Certificate in Clinical Nursing, Neonatal 

Care, at the Australian Catholic 

University. He completed this course 

with distinction and now plans to enrol 

in a master’s program. 

Hospital colleagues are helpful and easy to work 

with and there are always opportunities to upgrade 

skills and knowledge in my chosen specialty. 

“ 

” 

When asked about his experience 

working in Australia, Glenn says “People 

here are friendly and hospitable. 

Hospital colleagues are helpful and easy 

to work with and there are always 

opportunities to upgrade skills and 

knowledge in my chosen specialty. 

Glenn goes on to say, “Coming to 

Australia has been the best career 

decision I have ever made.” 

Glenn is also a member of the 

Australian College of Neonatal Nurses 

and takes every opportunity to be 

involved in its activities. Glenn plans to 

spend his annual leave in the Philippines 

and visit his alma mater and the 

hospitals he used to work in. He hopes 

to share his experiences working in 

different parts of the world as well as 

share his knowledge and skills with 

other neonatal nurses back home. 

Glenn believes in giving back what has 

been given to him, in passing on the 

experiences and lessons that have 

prepared him for his work and success 

in life. 

EffEctivE advocacy 

CAN iNflueNCe the heAlth RefORm AGeNdA 

RCNA provides a singular voice and united policy 

focus for the nursing profession. RCNA actively 

participates on many national and state/territory 

forums of significance to the nursing profession. 

We take your ideas forward to Government and 

other health stakeholders. 

RCNA’s strength comes from the participation 

of and support from its members. 

Our members are able to provide a diverse 

nursing perspective to our policy development. 

WE WaNt yoUR iNvoLvEMENt! 

As an RCNA member you can: 

contribute to an RCNA submission – provide 

your ideas, feedback, experiences or comments 

to inform RCNA submission development 

raise professional issues that concern you – 

send us your thoughts on issues affecting the 

nursing profession 

apply to become an RCNA representative – 

RCNA regularly seeks experienced and enthusiastic 

members and fellows to represent us on a wide 

variety of working groups, advisory bodies and 

at professional functions. 

visit rcna.org.au/getinvolved 

RCNA 

freecall 1800 061 660 

canberra@rcna.org.au 






48 

rcna chapter committees 

ACT/SOUTHERN NSW 

Chairperson 

Eric Daniels FRCNA 

Vice Chair 

Shane Lenson FRCNA 

Secretary 

Narelle Caligari MRCNA 

Committee members 

Associate Professor Laurie Grealish FRCNA 

Kaye Hogan AM FRCNA 

Lacey Smale MRCNA 

Daniel Gordon MRCNA 

Link member 

Pamela Brinsmead FRCNA 

Student member 

Leeanne Thompson 

Board member 

Paula Elliott FRCNA 

HUNTER VALLEY/ 

NORtheRN NSW 

Chairperson 

Beverley Bailey MRCNA 

Vice Chairperson 

Maria Gorton MRCNA 

Secretary 

Elizabeth Newham MRCNA 


Lynne Slater MRCNA 

Lynette Bowen FRCNA 

Whenua Oner MRCNA 

Link members 

Jennifer Carney MRCNA 

Susan Creech MRCNA 

Kerry Harman MRCNA 

Raelene Kenny MRCNA 

Tiana Trappel MRCNA 

Student representatives 

Donovan Friel 

Elizabeth Kepreotes MRCNA 

Board member 

Julie Shepherd FRCNA 

NORTHERN TERRitoRY 

Chairperson 

Beryl McEwan MRCNA 


Associate Professor Peter Brown FRCNA 

Secretary 

Dr Beverly Turnbull FRCNA 


Catherine Brown MRCNA 

Gylo Hercelinskyj MRCNA 

Elizabeth Webb FRCNA 

Christine Quirke MRCNA 

Board member 

Gay Lavery FRCNA 

QUEENSLAND 

Chairperson 

John Brown FRCNA 


Susan DeVries FRCNA 

Secretary 

Mark Kearin MRCNA 


Belynda Abbott MRCNA 

Lieutenant Colonel Kerry Clifford MRCNA 

Robyn Dickie MRCNA 

Dr Judith Gonda MRCNA 

Lorraine McMurtrie MRCNA 

Carolyn Robinson FRCNA 

Kathryn Wooldridge MRCNA 

Debra Culter MRCNA 

Anne-Marie Goes MRCNA 

Kate Kunzelmann MRCNA 

Board member 

Associate Professor Stephanie Fox-Young 

FRCNA FCN 

SOUTH AUSTRALIA 

Chairperson 

Lesley Siegloff FRCNA 


Ian Thackray FRCNA 

Secretary 

Anne Davies MRCNA 


James Bonello MRCNA 

Tiffany Conroy FRCNA 

Heather Schubert OAM FRCNA 

Collette Lancaster-Lockwood MRCNA 

Esther Michelsen MRCNA 

Board member 

Ian Thackray FRCNA 

TASMANIA 

Chairperson 

Associate Professor John Field FRCNA 

Past Chairperson 

Jenny Tuffin FRCNA 


Elaine Hosken FRCNA 


Helen Bryan FRCNA 

Karen Linegar FRCNA 

Dianne Miller MRCNA 

Karen O’Shea MRCNA 

Wayne Smith MRCNA 

Deanne West MRCNA 

Simone Baxter MRCNA 

Link members 

Francine Douce MRCNA 

Alison Keleher MRCNA 

Professor Mary Fitzgerald FRCNA 

Board member 

Gayle Heckenberg FRCNA 

VICTORIA 

Chairperson 

Donna Watmuff FRCNA 


Sussan Pleunik FRCNA 

Secretary 

Kay Plymat FRCNA 


Maryanne Craker MRCNA 

Michelle Gardner MRCNA 

Hyder Gulam FRCNA 

Pamela Ingram MRCNA 

Jill Linklater FRCNA 

Suzanne Metcalf MRCNA 

Adjunct Professor Penny Newsome FRCNA 

Yvette Gomez FRNCA 

Link member 

Julieanne Crow MRCNA 

Student Representative 

Melissa Bloomer MRCNA 

Board member 

Christine Smith FRCNA 

WESTERN AUSTRALIA 

Chairperson 

Cheryle Poultney MRCNA 

Past Chairperson 

Vicki Cope FRCNA 


Tony Patton FRCNA 

Secretary 

Janet Anderson MRCNA 


Jane Cranley MRCNA 

Sarah Hession MRCNA 

Professor Linda Shields FRCNA 

Colleen Van Lochem MRCNA 

Marie Tyrell-Clark FRCNA 

Patricia Canning FRCNA 

Board member 

Carmen Morgan FRCNA 

Correction 

The credit for the photo of 

Kathleen Kehoe FRCNA, Cr Judith 

Klepner and Cr Frank O’Connor, 

featured on page 2 of the March 

edition of Connections was omitted. 

The Mayor’s office of the City of 

Port Phillip kindly gave us 

permission to publish this photo. 


Exciting RCNA 

Member Offer 

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Standard membership fees * 

• Initial Once Off Start Up Fee * 

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Please take a copy of this flyer and 

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*Subject to Fitness First terms and conditions of membership (available in club). Not valid with any other offer. Start Up fee payable on joining or transferring to this offer. If a Lifestyle 

membership is taken up under this offer (whether by a new or existing member), the minimum term of that membership is 12 months from the date of taking up this offer. Discount off 

Standard Memberships are based on the current standard membership pricing available in club and do not include Concessionary or Off Peak Memberships. The Corporate Offer is only 

valid when there is a current agreement signed between Fitness First and your employer corporation. Offer valid from 1st February 2011 until 28th February 2012. 

† ‘Passport’ memberships exclude ‘Platinum’ clubs.

GPYR MDFT3059 

NOT ALL HOSPITALS HAVE WARDS. 

As a Nursing Officer in the Navy, Army or Air Force, you’ll have opportunities that you won’t get in the 

private sector. For instance, your patients will be your co-workers, as well as civilians on deployment. 

You will get the chance to lead a team of health professionals and provide humanitarian aid. You’ll 

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and would like further information call 13 19 01 or visit www.defencejobs.gov.au/graduate 

NURSING OFFICER 

IT’S NOT YOUR GENERAL PRACTICE 

NOW RECRUITING: NURSES. 

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InspIrIng, 

progressIng and 

promotIng the 

professIon of 

nursIng. 

Become an RCNA member, and 

contribute to influencing health policy in Australia 

access resources for nurses 

receive advice and support 

apply for RCNA grants and awards 

receive RCNA publications. 

Your RCNA membership entitles you to receive discounts on 

Guild Professional liabilities Insurance. 

To find out more visit guildinsurance.com.au/nurses or freecall 1800 810 213 

Employment Status 

Limit of 

Indemnity 

NSW 

VIC/WA/ 

ACT/NT 

QLD SA TAS 

Employed/Part time $10M $232.76 $242.00 $232.10 $244.20 $235.84 

Employed/Full time $10M $384.06 $399.30 $382.96 $402.92 $389.13 

Self Employed/Part time $10M $465.52 $484.00 $464.20 $488.40 $471.68 

Self Employed/Full time $10M $698.28 $726.00 $696.30 $732.60 $707.52 

*Price variations are in accordance with Government and Stamp Duty Fees as applicable in each State. 

Part time – Less than 20 hours per week 

Full time – 20 hours or more per week 

Join today! 




RCNA does not provide advice on whether insurance selected is appropriate or suitable for an RCNA member. RCNA 

members should rely on their own enquiries as to whether the insurances are appropriate or suitable for their needs.

CONNECTIONS - Royal College of Nursing, Australia

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