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New data shows that pharmaceutical companies are increasingly targeting non-prescribing health professionals, such as nurses, with financial gifts.

Payments to doctors by pharmaceutical companies is commonplace and widely accepted, and there is currently no governmental regulation surrounding these types of payments. But this new data raises some ethical issues.

The University of Sydney has analysed publicly available data of payments to health professionals, submitted by the pharmaceutical companies and submitted to regulator Medicines Australia.

Looking at the period between October 2015 and April 2018, 14,018 healthcare professionals received over $62 million in payments from pharmaceutical companies.

Of that number, 17.8 per cent were found to be nurses.

Lead author Emily Karanges from USYD said: “There is a mistaken idea that non-prescribing healthcare professionals don’t have much influence on medicine use, therefore their pharmaceutical industry ties aren’t that important.

“Yet healthcare professionals like nurses and pharmacists often assist with medication choice and encourage adherence to treatment – and the roles they play in chronic disease management are expanding too.”

Karanges joined Nursing Review to discuss her findings.

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Michelle Roach is a radiation oncology clinical nurse consultant, the first NSW has ever had. And she is passionate about rad-onc.

She is passionate about, it seems, everything. “I’m a pain in the arse”, is how she describes it.

I would say she is a ‘doer’. Like the time she convinced the Australian College of Nursing to start a cancer education day at Liverpool Hospital after, as she puts it, “I got on my soapbox”.

Or like the time she approached eviQ –an online resource of cancer treatment tools – at a conference to bemoan the lack of specialist training for radiation oncology nurses.

Roach wants more recognition for her speciality and education is a big part of that.

“I hove it,” she said of the job. “But people go, ‘who cares about rad-onc, all you do is dressing’. People don’t know what it is.”

Roach’s conversation with eviQ led to the development of RONKAS, or the Radiation Oncology Nursing Knowledge and Skills framework.

RONKAS aims to create an in-depth knowledge of radiation therapy, its side-effects, and its management during and after treatment.

Roach spoke with Nursing Review about RONKAS and why radiation nursing needs more recognition.

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The University of Southern Queensland (USQ) recently welcomed home a group of nine nursing students from a placement in northern Vietnam.

The students had placements in hospitals in Hanoi and Mai Chau as well mobile clinics in rural areas.

The group treated over 870 patients, with cases such as extreme high blood pressure and muscle and joint problems, with some patients still feeling the effects of wars long past.

“I worked with a particular patient who had back pain, and on further questioning he reported having shrapnel still in his chest from the war,” nursing student Thomas Skerlj said.

“The gravity of the situation hit me in the context that now I was able to help provide some care to a person that had been through so much.”

The student nurses found that the experience increased communication skills and problem solving, and the importance of good healthcare was reinforced.

At the end of the placement the locals showed the group their appreciation.

Nursing student Kristen Plazina said: “They treated us with local dances and we treated them to a bit of our culture which included dancing the ‘Nutbush’, singing the national anthem, and a taste of vegemite,” she said.

Nursing review caught up with Associate Professor Coralie Graham – who organised the trip – and student Joanne Stefanaras to hear more.

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“We felt that we deal with anxious upset patients on a daily basis. And we felt that our nurse peers didn’t understand the magnitude of the work that we do. We probably felt a bit undervalued,” says Dr Pamela Ellem.

Ellem has recently developed a valued model of professional peer support, referred to as ‘Connecting the Unconnected’ to help the most isolated specialist breast care nurses and, as a breast care nurse herself, acutely felt the need for support.

“These nurses, who are based across an area of 420,000 square kilometres, are dealing with aggrieved, anxious and upset patients, yet they lacked a way of connecting for professional peer support,” Ellem said.

Together with eight other isolated nurses, Ellem developed the model, which involved face-to-face meetings, teleconferencing, education and, most importantly, listening and support.

This study is a great example of nurses seeing a problem and attempting to fix it themselves, thus improving health outcomes for their patients.

“The study has also created enormous stability in the workforce as we’ve only had one change of personnel across the past four years.

“These nurses are now keen to become researchers to improve their roles. We do need researchers at the bedside so it’s so fantastic that they have realised the worth of this study,” Ellem said.

Nursing Review spoke with Ellem to hear more about the initiative.

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Rural nurse practitioners are facing a number of hurdles when it comes to being able to deliver the best care possible.

This is the opinion of a new study looking into extended scopes of practice in rural settings, carried out by researchers from the University of Newcastle’s Department of Rural Health.

Legal and regulatory barriers occur and slow down the system in these areas, as does ambiguity around the scope of the NP role itself.

Associate professor Tony Smith said his team observed a number of health service gaps, and as Australia seems to have few developed extended scope practice roles, NPs are great case study to use.

“Certainly this has been raised before, not just by myself but by others, such as the Grattan Institute and even the Productivity Commission,” Smith said.

“You know, we're going back to 2005, when the Productivity Commission did an extensive analysis of the Australian health workforce. They drew similar conclusions that we needed to actually have a close look at some of these barriers. Now we're almost 15 years on and I think we're still struggling with some of the same issues that we were struggling with then.”

Smith and his team conducted semi-structured, in-depth interviews with primary nurse practitioner informants, who were also invited to nominate up to two colleagues as secondary informants.

Nursing Review spoke with Smith to hear more about the barriers and enablers affecting practice.

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Patricia Davidson is a "proud Aussie nurse". She has been an RN since 1980 and has clinical, teaching and practice expertise in cardiovascular science and the care of vulnerable populations.

Starting her career at Wollongong hospital, Davidson is now flying the flag overseas as the dean of America’s number one nursing school at Johns Hopkins University in Baltimore, Maryland.

Taking on the role in 2013, Davidson has a unique insight into two vastly different healthcare systems and Nursing Review called the US to hear about life there, the importance of NPs and the similarities between US and Australian nursing.

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You've been at Johns Hopkins now, which it's a world-renowned facility and university, since 2013. That must have been a stark change after spending most of your career here in Australia.

It wasn't such a stark change. One thing that you'd find is that schools of nursing and education and hospitals are pretty much the same all around the world. Even though it was a big shock to have to go back and do my licencing exam. It's probably more about similarities than differences.

What interesting research or innovations are coming out of the US at present?

I think there's certainly more innovative research in the nurse-led model of care in chronic illness. It’s so exciting to see a lot of the innovation in terms of telling how the use of apps and other digital technologies enhance healthcare. And there's a big emphasis in the US on the care of the vulnerable population, so in the School of Nursing we have some exciting projects that are looking at addressing issues such as food insecurity and housing. And even though we've had those issues within Australia, they're not really as amplified as they are here in the US, where the mechanisms for health and social services aren't as accessible and equitable.

Are there things you've learned from the American health system that make you think, ‘Wow, that would be great if we could bring these ideas back to Australia'?

I think in Australia we lead some tables, and it's actually very efficient and effective in healthcare delivery. One of the things that is particularly important, I think especially at Johns Hopkins, is the importance of nursing within the hospital and university leadership. And I think certainly here in the United States at Johns Hopkins, the importance of nursing and a nurse's role in terms of influencing healthcare is more recognised.

In what ways? Policy decisions?

I think in terms of policy decisions, most importantly, having nursing at the head of or on board tables. Also we're very excited that the head of the whole Johns Hopkins health system, which is over six hospitals and many operations internationally, is a nurse. So, I think there is a strong emphasis on the knowledge, skills and capabilities that nurses bring to healthcare, and their effectiveness at leading and managing healthcare systems.

You worked in academia in Australia for a long time. Are there things that the American university system does well, or could they learn some things from Australia in terms of teaching?

I think that across the world there are a lot of similarities. I would say [my former university] the University of Technology in Sydney, which is a leading school of nursing internationally, and Johns Hopkins would be very similar in terms of the educational preparation. I think one of the things that is different in the US was addressing the importance of the role of advanced practice nurses in healthcare delivery. The nurse practitioner will have been established in the US for over 50 years and so the role of the advanced practice nurse, and nurse practitioner specifically, is much more entrenched and recognised and valued in the healthcare system than it is in Australia at the current time.

You mentioned earlier some of the problems that the US faces with food insecurity, and I think that kind of leads into some of the great wealth disparity in that country. How have you found the health system? They don't have Medicare, they have more of a private insurance-based health system.

I came to the US at the time of the introduction of the Affordable Care Act, so as a consequence of that act, 23 million people, almost the population of Australia, had increased access to healthcare. So certainly, as you think in the media there's a lot of focus and attention on healthcare reform but, certainly, there is a lot of advantages to be seen from the healthcare system in Australia and the UK and other European countries where healthcare is recognised as an essential human right and part of living in a just and civil society. And so we really hope in the US that the healthcare reform continues and that increasing numbers of people there have access to healthcare.

Are your American colleagues jealous of the Australian and UK systems, or do you think they are quite happy with the way things are currently?

I think many people in the healthcare system, many of my colleagues, anyway, are envious of the system, where there's much more equitable access to healthcare and where healthcare is not tied to your employer, and that everybody has access to healthcare. So, I think that many people in the US would envy that system of healthcare.

As well as your role at Johns Hopkins, you are the secretary general of the Secretariat of the World Health Organization’s collaborating centres for nursing and midwifery. What does this role entail?

We are very excited to take this role, which was actually held previously in Australia at University of Technology Sydney. The role of the secretariat is to convene and communicate among the 42 collaborating centres of nursing and midwifery throughout the world, and we hope that at the World Health Assembly next month that it will be ratified by 2020, which will be the year of the nurse and the midwife. We’re also involved in working with the World Health Organization to facilitate an important report called State of the World's Nursing. We hope that this report takes data sets from all over the world and really tries to get a handle on a whole range of issues in nursing. Not just numbers of healthcare professionals and distribution, but also their role and functions in individual countries and how they contribute to healthcare outcome.

You're a dean and you have had various other management roles, do you miss the day to day practice and teaching of nursing?

Well, fortunately, I'm still pretty actively involved at Johns Hopkins. I teach. I don't directly practice any more, but I'm actively involved in a number of initiatives within the healthcare system. For example, I'm an executive sponsor for a quality and safety initiative at the unit-based level. And also, it's very exciting that I'm involved in a range of clinical research projects, and particularly, some projects looking at developing nursing models of care. So, they're very exciting and so I still feel that I'm actively engaged with the healthcare system.

While I was researching for our chat I was looking at your CV. It's like 90 pages long. I think everyone in the world knows of Johns Hopkins, so you're reaching the pinnacle of your career. Is there anything you want to tick off in your career next?

You know what? I think I'm just very honoured and humbled to have this amazing opportunity to be dean at the number one school of nursing in the US, at Johns Hopkins University, which is an amazing research university. So, what I'm really committed to for the rest of my nursing career is to continue to advocate for the importance of nursing and the role of nurses, and influencing the healthcare trajectories of the individual's families and communities. And I think that there's never been a better time to be a nurse and I feel that I'm very honoured to be at such an esteemed institution where I have the ability to advocate for the role that nurses play in improving healthcare outcomes.

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Healthcare is one of the few industries dominated by female employees, yet in these industries CEO roles are only held by women 37.6 per cent of the time and key management positions are held by women 48.2 per cent of the time (Workplace Gender Equality Agency, 2019).

What's more, in these industries men are still paid more, approximately $15,000 pa, while female managers working in male-dominated organisations are more likely to earn salaries closer to their male colleagues.

The likelihood of a female gaining a management position also falls as they age, compared with their male counterparts who show an upward trajectory.

Co-author of Core Confidence Fiona Pearman believes that there are a number of structural and systemic issues that preclude women from management positions in healthcare. She also believes there are things women can do to remedy this.

Peraman joined Nursing Review to discuss this issue.

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In the wake of the Royal Commission and a perceived skills shortage in the sector, the University of Wollongong, in partnership with Illawarra Health and Medical Research Institute, have released the Gerontological Nursing Competencies (GNCs) framework.

The framework provides an evidence-based pathway where nurses can develop specialist skills, and a study of the framework has found that the program produced nurses who were more confident and skilled.

The research was led by Professor Victoria Traynor of the UOW School of Nursing, who saw a problem with the makeup of the current workforce. While the number of support staff has risen, registered nurse numbers have stayed the same, leading to a skills shortage.

“A competency framework says if you’re working in aged care as a registered nurse you should be competent in these areas. It would give the public reassurance that the aged care industry is going to deliver services of a similar high standard,” Traynor said.

“Using this framework will contribute to the delivery of high-quality person-centred care by enabling staff to know what aspects of aged care are the most valuable and the standards they are expected to reach in their individual practice.”

Nursing Review spoke with Traynor to unpack the new competencies.

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The inaugural Health Minister’s award for nursing trailblazers has been awarded to a Canberra nurse for her work in improving the delivery of palliative care to Australians living in residential aged care.

Nikki Johnston, a palliative care nurse practitioner based in Canberra at Calvary Health Care’s Clare Holland House, took out the award on April 9 for her ‘INSPIRED’ project which aims to integrate specialist palliative care into residential aged care, providing better pain management and helping people die in the place of their choosing.

The award is the first of its kind in Australia and acknowledges the vital role nurses play in transforming our country’s health and aged care system.

“This award is about recognising nurses who are leading the way, who are able to influence policy and models of care that can be implemented nationally. Nurses are patient advocates who are instrumental to the promotion, prevention and treatment of health care to patients and communities,” Australian College of Nursing chief executive Kylie Ward said.

“Congratulations to Nikki on being selected as this year’s Nursing Trailblazer for her work in improving the delivery of palliative care to Australians living in residential aged care."

In a conversation with Nursing Review, Johnston – who also recently picked up a Medal of the Order of Australia – praised her colleagues at every opportunity, saying that nurses in the sector are “so hard working and undervalued".

“It is such a pleasure working here with a lot people without whom the work wouldn’t be possible.”

Nursing Review spoke with Johnston about her work and her award-winning streak.

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This issue of psychotropics has been front and centre during the Royal Commission, but not much time has been devoted to the reason behind its use, mental illness.

Approximately half of all aged care residents exhibit symptoms consistent with depression, and typically those who currently reside in aged care facilities have low mental health literacy, so identifying issues can be problematic.

Unfortunately, this issue is often neglected as it is assumed that depression comes with old age.

Sunil Bhar disagrees. As professor of psychology at Swinburne University, Bhar believes that more should be done to tackle mental health issues, and a good starting point would be mandated access to psychological help.

Bhar does see room for optimism, however, with last year’s federal budget allocating significant funds to mental health in aged care.

Bhar joined Nursing Review to talk about this problem and his work in the mental health space.

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