Download MAY 2002 - Nurses and Midwives Board

ISSN 1444-0350
MAY 2002
The Board wishes to thank Mid Western Area Health Service for their assistance in
obtaining many of the photographs in this issue. Thanks are also extended to the
nurses and their clients who appear in photographs in Board Works.
Contents
MAY 2002
Know Your Board
Board Members 2002 .................................................................... 2
From the President ......................................................................... 3
Definitely not Bored on the Board ............................................... 4
Responsibilities of Board Members – Disclosure of Information 5
Professional Conduct Studies
A review of disciplinary matters .................................................... 6
Board Projects
Margaret White, RN, shares a cup of tea with
resident, Mrs Rewa Geach in the gardens of
Wontama Nursing Home, Orange
Disciplinary Decisions – a Case Book ........................................... 9
Nursing Research Workshops ........................................................ 10
Scholarship Reports
4th International Congress on Ambulatory Surgery – Celia Leary 11
26th Congress of World Federation for Mental Health – Kevin
McLaughlin .......................................................................................... 13
6th Australian Palliative Care Conference – Matthew Bullen ........ 15
Jenny Hick, RN, helps Heather Black entertain
6-month-old Heath on the paediatric ward at
Orange Base Hospital
Cover photograph: David Turcato, registered nurse authorised to practise as a nurse practitioner. David is
employed as a registered nurse at Hill End, in the mid-west of New South Wales. He was photographed with
Robert Watt, aka "Wobbly Bob", resident of nearby town Sofala.
Board Works is published by the Nurses Registration Board of New South Wales
Postal Address: PO Box K599, Haymarket NSW 1238, Australia
Office Address: Level Two, 28-36 Foveaux Street, Surry Hills NSW
Telephone: (02) 9219 0222 or rural access number 1800 241 220
Facsimile: (02) 9281 2030
E-mail: [email protected]
Internet: www.nursesreg.nsw.gov.au
1
Know Your Board
Adjunct Professor
Joan Englert
President
Ms Kate Dyer
Deputy President
Registered nurse, authorised to
practise midwifery. Elected by
registered nurses eligible to vote
for this purpose.
Registered nurse. Nominated by the
New South Wales College of
Nursing.
Mr David Cathie
Ms Dale Sutton
Dr Tara Walker
Ms Lynette Taylor
Mr Charles Linsell
Enrolled nurse. Elected by
enrolled nurses and
enrolled nurses
(mothercraft).
Registered nurse. Elected
by registered nurses.
Registered nurse. Elected
by registered nurses.
Registered nurse. Elected
by registered nurses.
Nominated by the Minister.
Registered nurse who
practises in the area of
mental health.
Mr Brett Holmes
Miss Judith
Meppem
Ms Yvonne Grant
Dr Chris Guest
A barrister or solicitor
nominated by
the Minister.
Nominated by the
Minister as a
representative of
consumers.
Professor Jill
White
Registered nurse.
Nominated by the
New South Wales
Nurses Association.
2
Nominated by the
Minister. Registered nurse
who is an Officer of the
Department of Health, an
Area Health Service, the
Ambulance Service of
New South Wales or
the Corporation.
Photograph not available
Ms Amanda Cornwall
Nominated by the Minister as a
representative of consumers.
Registered nurse who is
an educator of nurses.
Jointly nominated by the
Minister for School
Education and Youth Affairs
and the Minister for
Further Education, Training
and Employment.
From the President
Dear Colleagues
Welcome to the first edition of Board Works for 2002.
In this edition you will find information regarding the completion of two major projects
commissioned by the Board. The first project, the development of a Case Book of Disciplinary
Decisions Relating to Professional Conduct, was commissioned by the Board to provide a resource
for registered and enrolled nurses in regard to professional and ethical conduct. Following a
competitive tendering process Professor Diana Keatinge and Professsor Mary Chiarella were
selected as the co-investigators. The case book will provide nurses with the most comprehensive
resource about professional conduct issues. The second project, recently completed, was a series of
workshops and associated activities designed to assist nurses in preparing applications for
research scholarships. The successful tenderer was the Centre of Family Health and Midwifery at
the University of Technology, Sydney. Feedback from participants in the workshops has been
appreciative and favourable. The Board was pleased to provide nurses with the opportunity to
further their research skills through the workshops and is currently reviewing the outcomes.
Each edition of Board Works includes edited reports from nurses who have each received a
scholarship from the Board to attend a conference or undertake research. The reports in this issue
relate to varying areas of nursing, namely nursing in palliative care, mental health and
ambulatory surgery settings. Publication of these reports is one way of sharing with you the
information gained by the scholarship recipients, as it is important that the benefits of
scholarships are shared with professional colleagues.
I trust that you find these reports and the rest of this issue of Board Works informative and
interesting. In particular I think nurses in all areas of the profession will be interested in learning
about the excellent new Case Book of Disciplinary Decisions relating to Professional Conduct
Matters
Joan Englert
President
3
BOARD MEMBERS
Have you ever wondered what it’s like to be elected as a member of the Nurses Registration Board?
Here one new member reveals how she felt . . .
DEFINITELY NOT BORED ON THE BOARD
By Kate Dyer
Nominate for the Board they said, you can have a say,
In how we nurses and midwives do it day by day.
Help maintain the standards of what we do so well,
To safeguard the general public from those not taught so well
With L-plates firmly fastened, the day has finally come,
The meetings on, I’m doing well, pre reading’s all been done.
The list is long and heavy of things we have to do,
I ask myself the question: how do they see it through?
What a responsibility, so far away it seemed,
Such an important role – well, you know what I mean
Soon the thoughts of responsibility and work this will
involve,
Disappear so quickly as things begin to evolve.
With awe and sheer amazement, I watch them on the run,
The meeting moves so speedily, the agenda nearly done.
I forget to be so nervous as the motions pass on by,
And feeling very welcome, I find I’m on a high.
The forms are complete, the numbers are in,
I’m so surprised, my mind’s in a spin.
Shock, dismay, excitement too,
I’ve been voted in, it really is true.
The orientation package, I can’t believe my eyes
I start to read and realise there is so much to memorise.
PSC, AOB and INP are terms I’ve never used
If I sprout this language, will I be abused?
There’s committees for this and committees for that and
meetings galore, oh hell!
There’s conduct and curriculums and health reviews as well.
There are registers and rolls and competencies too.
I cannot believe there is so much work for so few to do.
I take in all the knowledge of my colleagues at my side,
They all know where they’re going and I’m revelling in the ride.
So soon the meetings ended and it’s time to say goodbye
It was really quite uplifting, I cannot tell a lie.
Still with L-plates firmly fastened I reflect on what we’ve done,
And wonder if I’ll ever think this isn’t really fun.
The Nurses Registration Board is just the place to be,
Good heavens, did I say that? was it really me?
There is so much to learn, and so much to read,
Sometimes I really wonder, will I reach their speed?
One year already down, and only three to go,
Who was it that said this would sure be slow!
To Joan and Jan and Ron and all, I’ve one last thing to say
You’ve made feel so welcome, I guess I’ll have to stay.
James Daley, Palliative Care/Oncology RN, administers chemotherapy to Mr Noel Hotham at Daffodil Cottage, Bathurst Community Health Service. Built with
funds raised by the local community, this day only unit provides support and symptom control for patients in their local area so they no longer have to make the
long trip to Sydney.
4
BOARD MEMBERS
Responsibilities and
Duties of Board
Members – Disclosure
of Information
The Nurses Registration Board consists
of 13 members of whom five are elected
and eight are nominated by various
organisations and bodies.
Even though the Board consists of
members who are elected by registered
nurses or enrolled nurses or who are
nominated by, amongst others, professional
associations representing nurses, it is
important to remember that the primary
duty and obligation of members of the
Board is to the Board itself rather than to
those who elected them or the relevant
professional association that nominated
them.
There are two reasons for this:
First, there is the provision of the
Health Administration Act 1982, which
restricts the circumstances in which a
person can disclose any information
obtained by them in the administration or
execution of the Nurses Act 1991.
Second, there is the general rule about
the duties and obligations of a member of a
statutory board or committee with respect
to confidential proceedings of that board or
committee.
The provision of the Health
Administration Act 1982 restricting
disclosure of information provides that it is
an offence for a person who obtains
information in connection with the
administration or execution of the Nurses
Act 1991 to disclose that information
except:
approval of the Director-General of the
Department of Health.
Unless such information is disclosed in
one of those circumstances set out in points
(a) – (e) above, the person disclosing the
information will be guilty of an offence.
The second reason why Board members
may not be able to disclose information is
because of the rule that members of
statutory boards or committees owe a
primary duty to that statutory board or
committee and must not disclose
information about confidential proceedings
of that board or committee.
It is clear that the situation of an elected
Board member cannot be equated to that of
an elected politician. The duty owed by an
elected Board member (or a nominated
Board member) is to the Board itself rather
than to those who have elected them or
nominated them. This rule was set out in a
decision of Street J (as the former Chief
Justice then was) in the supreme Court of
New South Wales in Bennetts v Board of
Fire Commissioners of New South Wales &
others (1967) 87 WN (NSW) Pt 1 307.
The decision has been followed and
applied in a number of jurisdictions and
States in Australia, including by Young J in
the Supreme Court of New South Wales in
Harkness v Commonwealth Bank of
Australia (1993) 32 NSWLR 554.
In summary form it can be said that the
rule from those cases is that:
(i)
A person who is appointed or elected
to a statutory board or committee
must promote the interests of that
body;
(ii) The interests of that body are the
advancement of a particular public
purpose;
(iii) Members of the body must not
compromise themselves by allowing
the interests of the group, section or
person responsible for their
appointment to decisively influence
their decisions in circumstances where
those interests are in conflict with the
interests of the body;
(iv) If a member is in genuine doubt in the
matter then he or she should act in
what he or she conceives to be the
interests of the body;
(v) If there is any question of the interests
of the body being compromised by a
member disclosing its decisions or
proceedings, or even publicly debating
such decisions before or after they
become public, then the interests of
the body must take precedence;
(vi) If there is any doubt as to whether a
matter should be treated as
confidential, the body should itself
make a ruling on the matter.
Of course, the above rule needs to be
read in the context of the statutory
provision restricting the circumstances in
which any information can be disclosed by
any person.
(Note: The above article was provided on
request by the Crown Solicitor.)
(a) with the consent of the person from
whom the information was obtained,
or
(b) in connection with the administration
or execution of the Health
Administration Act 1982 or the Nurses
Act 1991, or
(c) for the purpose of any legal
proceedings arising under those Acts
or a report of those proceedings, or
(d) with other lawful excuse, or
(e) in other prescribed circumstances.
In brief, the Health Administration
Regulation will allow disclosure of some
information in accordance with the
Jenny Hick, RN, helps Heather Black entertain 6-month-old Heath on the paediatric ward
at Orange Base Hospital.
5
Professional Conduct
Matters
A Review of Disciplinary Matters during the 2000–2001 year
A REVIEW OF
DISCIPLINARY
MATTERS DURING
THE 2000–2001 YEAR
Disciplinary matters form an important
part of the work of the Nurses Registration
Board. Sometimes people find it disturbing
to read about the conduct of nurses which
has resulted in disciplinary action. It is
important to remember that in the year
2000, over 76,000 nurses were on the
Register and over 16,000 nurses were on
the Roll. That is a total of over 92,000
persons, very few of whom will ever be the
Professional Standards Committees
The Nurses Tribunal
Professional Standards Committees
These Committees are independent of
the Nurses Registration Board.
When the Board refers a complaint to a
Professional Standards Committee, three
persons are appointed by the Board to sit as
the Committee for the purpose of
conducting an inquiry into a complaint.
The Committee consists of two registered
nurses with appropriate qualifications,
depending on the case to be heard, and one
lay person who does not have nursing
qualifications.
Professional Standards Committees may
only conduct inquiries which do not
provide grounds for the suspension or
cancellation of the nurses accreditation to
practise. However these Committees are
empowered to place conditions on a nurses
registration, if a complaint is proved.
subject of disciplinary proceedings. Those
nurses who are subject to disciplinary
action are dealt with by the Board, initially
through the Conduct Committee. The
Conduct Committee reports to the Board.
Conduct Committee
The Conduct Committee has been
established by the Board to consider
complaints received concerning registered
nurses and enrolled nurses. The Conduct
Committee consults with the Health Care
Complaints Commission and determines
Status of matters before
Professional Standards Committees
During the 2000–2001 year, five matters
were referred to Professional Standards
Committees for Inquiry.
Matter 1. Complaint: A surgical
instrument nurse failed to check with the
surgeon the medical order for a substance
to be used in the procedure, failed to check
with the surgeon the vial marked “caustic
substance” and failed to act upon the
warning on the label before injecting the
patient.
Committee Orders: The nurse was
reprimanded.
whether matters are to proceed and, if so,
what action is to be taken. The Conduct
Committee also screens applications for
registration in instances where the
applicant has been convicted of an offence
or has previously been de-registered in
another jurisdiction.
6
Matter 2. Complaint: The nurse, while
involved in a therapeutic relationship with
a psychiatric patient, inappropriately
purchased items of furniture from that
patient and failed to seek professional
assistance for that patient when his
behaviour warranted it.
Committee Orders: The nurse was
reprimanded and the following conditions
were placed on the nurse’s registration – to
complete a university course in ethics, legal
issues and documentation; to provide any
current nursing employer with a copy of
the Reasons for Decision document in this
matter prior to the completion of the
university course.
Matter 3. Complaint: The nurse, without
administering medication, (a) signed prior
to 10am that she administered medications
due at 12 mid-day; (b) made entry prior to
10am that she omitted one patient’s 12
mid-day medication that day; (c) made
entry prior to 10am that one patient
refused medication ordered for 12 mid-day.
Committee Orders: The nurse was
reprimanded and the following conditions
were placed on her registration – prior to
commencement of nursing employment the
nurse is to complete a nursing refresher
course with a clinical component and a
component dealing with the legal
administration of medications. Further, the
nurse is to provide a report to the Board
from a psychologist that she is fit to
practise as a registered nurse. When those
conditions have been satisfied she is to
provide a report to the Board every 3
months for a 12 month period on her
nursing practice detailing in particular her
administration of medications.
Matter 4. Matter 4 involved two separate
Inquiries involving three nurses.
(This complaint involved three nurses of
which two nurses attended a joint hearing
and the remaining nurse was heard
separately). Complaint: The nurses failed to
take adequate observations and adequately
assess the patient’s health status.
Additionally the nurses failed to maintain
adequate patient records.
Committee Outcome: No complaints were
proved against any of the three nurses.
PROFESSIONAL CONDUCT MATTERS
Matter 5. Complaint: That the nurse
supplied alcohol to a psychiatric patient
and engaged in inappropriate sexual
conduct with that patient.
Committee Outcome: The Committee
terminated the Inquiry as the members
believed that if the complaints were
proved, it may provide grounds for the
suspension or de-registration of the nurse
and therefore referred the matter to the
Nurses Tribunal. The Tribunal is yet to
finalise this matter.
The Nurses Tribunal
The Nurses Tribunal was established by
the Nurses Act 1991.
The Nurses Tribunal is a statutory
authority independent of the Nurses
Registration Board.
Complaints which may provide grounds
for the suspension or cancellation of a
nurse’s accreditation must be referred to
the Nurses Tribunal.
The Governor appoints the Chairperson
and Deputy Chairperson who have the
appropriate legal qualifications as specified
by the Act.
For the purpose of conducting an Inquiry
or hearing an appeal, the Tribunal consists
of a Chairperson, two accredited nurses
drawn from a panel of nurses, having such
qualifications as may be prescribed, and
who are appointed by the Board and one
lay person, appointed by the Board, and
drawn from a panel of persons nominated
by the Minister. Lay persons do not have
nursing qualifications.
Matters considered by the Nurses
Tribunal
Note: Readers should note than in addition to
the penalties ordered by the Tribunal, nurses
who are before the Tribunal may have been
sentenced in the Courts if the matter was also
the subject of separate criminal charges.
The Nurses Tribunal commenced
eighteen (18) matters.
Matter 1. Complaint: Cultivate and
supply prohibited drug (cannabis), stealing
money and possession of illegal firearm.
Sentenced to three years imprisonment
following Court hearing.
Tribunal orders: Nurse’s name removed
from the Roll of Nurses. Cannot reapply
to the Tribunal for accreditation as a nurse
for a period of two years.
Matter 2. Complaint: An enrolled nurse
held herself out and commenced
employment as a registered nurse when she
did not have the qualifications to practise as
a registered nurse.
Tribunal orders: Nurse’s name removed
from the Roll of Nurses. Cannot reapply
to the Tribunal for accreditation as a nurse
for a period of three years.
Section 45 (5) of the Nurses Act 1991 and
refused to attend an Impaired Nurses Panel
as advised by the Board.
Tribunal orders: Nurse’s name removed
from the Register of Nurses. Cannot
reapply to the Tribunal for accreditation as
a nurse for a period of two years.
Matter 6. Complaint: The nurse failed to
administer medications to patients and
falsified entries in the medical/nursing
notes. The nurse made an incorrect entry
in the medication charts and signed that
document.
Tribunal orders: The complaints were not
proved at the Inquiry.
Matter 3. Complaint: Nurse convicted in
Court of 15 counts of defrauding the
Commonwealth Government by making
untrue/false statements/claims on
numerous occasions for her own financial
gain.
Tribunal orders: Suspended from practising
as an accredited nurse for nine months.
Conditions on registration as a nurse: for
three years following reaccreditation she
can only practise as an employee and
cannot produce documentation other than
supervised by her employer.
Matter 4. Complaint: Nurse
misappropriated 31 ampoules of Morphine
from her employing hospital, forged
prescriptions for Morphine from a number
of medical practitioners (approximately
3,500 ampoules). Court convictions for
forge, utter and alter prescriptions and
receiving stolen property.
Tribunal orders: Nurse’s name removed
from the Roll of Nurses. Cannot reapply
to the Tribunal for accreditation as a nurse
for a period of three years.
Matter 5. Complaint: The nurse suffers
from an impairment that detrimentally
affects his mental capacity to practise
nursing. The nurse was admitted as an
involuntary patient with a serious paranoid
disorder to a psychiatric unit of a hospital.
Subsequently the nurse failed to attend a
medical practitioner for assessments under
Matter 7. Complaint: The nurse was
convicted in the District Court of an act of
gross indecency with a male person under
the age of 16 years. The complaint related
to serious sexual abuse over a number of
years of a minor and was perpetrated
without consent and was accompanied by
threats of violence.
Tribunal orders: Nurse’s name was removed
from the Roll of Nurses. Cannot reapply
to the Tribunal for accreditation as a nurse
for a period of five years.
Matter 8. Complaint: The nurse stole
blank prescription forms and forged a
doctor’s signature to obtain Valium and
Rohypnol on a number of occasions.
Tribunal Orders: The nurse was
reprimanded. The following conditions
were placed on the nurse’s registration – to
undertake counselling and not to practise as
the most senior registered nurse in any
employment situation.
Matter 9. Complaint: The nurse was
convicted of 15 charges of making false
instrument, 9 charges of fraudulent
misappropriation of money from
intellectually disabled clients under her
care. Additional complaints included
forging signatures, withdrawing
unaccounted monies from bank accounts
without authorisation.
7
PROFESSIONAL CONDUCT MATTERS
Tribunal orders: Nurse’s name was
removed from Register of Nurses. Cannot
reapply to the Tribunal for accreditation as
a nurse for a period of three years.
Tribunal orders: Nurse’s name was
removed from the Register of Nurses.
Cannot reapply to the Tribunal for
accreditation as a nurse for a period of 12
months.
Matter 17. Complaint: The nurse
attempted to use two medical prescriptions
to obtain Rohypnol knowing the
prescriptions were forged.
Tribunal orders: The nurse was
Matter 10. Complaint: The nurse was
convicted of obtaining financial benefit by
deception over a number of years. The
nurse dishonestly obtained funds by
making false claims upon a health fund for
amounts totalling over $18,000.00.
Tribunal orders: The nurse was
reprimanded and the following conditions
were placed on her registration as a nurse –
to undertake psychiatric counselling
including financial counselling.
reprimanded.
Matter 14. Complaint: The nurse
inappropriately washed and inserted his
fingers into a patient’s vagina and
subsequently kissed the patient on her neck
while assisting her to dress.
Tribunal orders: The nurse was
reprimanded and the following conditions
were placed on his registration – to
undertake a course in ethics, to work in an
obstetrics unit for 6 months in a nonsupervisory position.
Section 68 Applications: applying to
the Tribunal for restoration
following removal from the Register
Matter 18. An accredited nurse was
removed from the Register in 1988
following an Inquiry dealing with the selfadministration of Pethidine while on duty
in public and private hospitals and the
falsification of entries in the drug registers.
Matter 11. (Appeal to the Nurses Tribunal of
a decision made by a Professional Standards
Committee). The complaint before that
Committee dealt with inadequate
documentation of patient records, failure to
keep appropriate records for numerous
patients, failure to advise outpatients of
their abnormal test results within an
appropriate period, failure to follow up
those results, removed documents without
permission and failed to maintain the
confidentiality of those records.
Tribunal outcome: The nurse withdrew her
appeal against the Professional Standards
Committee decision.
The Tribunal held an Inquiry to ascertain
Matter 15. Complaint: The nurse placed a
psychiatric patient in a head-lock, used
excessive force while restraining the patient
and struck the patient’s face with his fist
while the patient was being held on the
floor.
Tribunal orders: The nurse was
reprimanded and the following conditions
were placed on his registration as a nurse –
to complete a university graduate certificate
in mental health, a component of which
must include the management of difficult
patients.
whether the public could be assured the
nurse was fit to practice following the
period of deregistration.
Tribunal orders: That the nurse’s name be
restored to the Register and that the
following conditions be placed on his
registration as a nurse – to complete a
general refresher course for registered
nurses; to undertake urine analysis from
the time of commencement of clinical
placement during the refresher course to
continue for 12 months after
recommencement of employment as a
registered nurse; to continue attending two
Matter 12. Complaint: The nurse engaged
in inappropriate sex with a patient.
Tribunal orders: Nurse’s name was
removed from the Register of Nurses.
Cannot reapply to the Tribunal for
accreditation as a nurse for a period of
three years.
Matter 13. Complaint: The nurse forged
or caused to be forged signatures in his
Clinical Experience Records while training
for a Graduate Diploma in Midwifery. The
nurse falsely claimed the award of the
Diploma in an application to the Nurses
Registration Board for an authority to
practise midwifery.
8
Matter 16. Complaint: The nurse, while
employed as the scrub nurse in a surgical
theatre undertaking multiple ophthalmic
procedures, failed to ascertain the
suitability of “Eyestream” for intraocular
use, failed to examine the printed warning
on the product to be used, failed to advise
the surgeon of the written warning on the
product and did not show the bottle
containing “Eyestream” to the surgeon.
The nurse in his capacity as theatre
manager did not inform hospital
management following his notification of
the unsuitability of the product and did not
remove stocks from the operating theatre
environs.
doctors at a medical centre as directed and
Tribunal outcome: The complaints were
not proved.
may be obtained upon written request to the
to advise the Board of his place of
employment and the employer’s name and
title.
Note: The above matters are brief summaries
of cases and do not describe the full
circumstances of each case. Professional
Standards Committee matters are
confidential and further detail is not generally
available. Nurses Tribunal matters, unless
otherwise directed, are open to the public.
Subject to any orders made by the Nurses
Tribunal, Reasons for Decision documents
Registrar, Nurses Registration Board.
Board Projects
Disciplinary Decisions Concerning Nurses: What can we learn?
Disciplinary Decisions
Concerning Nurses:
What can we learn?
Professor Mary Chiarella,
Professor of Nursing in Corrections Health,
Faculty of Nursing Midwifery and Health,
University of Technology, Sydney.
Co-investigator of the Case Book
Dr Diana Keatinge,
Professor of Paediatric,
Youth and Family Health Nursing,
Faculty of Nursing,
The University of Newcastle.
Co-investigator of the Case Book
Complaints against nurses are common
yet most nurses are unaware of the nature
or extent of such complaints, the pathways
involved in investigating them and the
disciplinary proceedings instigated to
remedy them.
Now, we have a valuable resource about
the complaint handling process and
disciplinary proceedings in regard to
nurses. In Professional Conduct: A Casebook
of Disciplinary Decisions Relating to
Professional Conduct Matters, all the cases
Nursing Research Workshops Rated Highly
heard by either Professional Standards
Committees or the Nurses Tribunal (bodies
set up to conduct inquiries involving
nurses) from 1991 to 1999 have been
reviewed.
Commissioned by the Nurses
Registration Board in August 1999, the
book explains the protective jurisdiction of
the Nurses Act 1991 (NSW), which is called
into play if a complaint is made against a
registered nurse, enrolled nurse or midwife.
Nurses enjoy a highly respected public
profile but, as part of a regulated
profession, are accountable for their
practice at all times. Protective jurisdiction
is a body of law that exists not to punish
but to protect those who need protection –
in this case, members of the public.
Conditions may be imposed on a nurse's
practice in order to protect public safety or
the nurse may have her/his name removed
from the Register or Roll and must cease
working as a nurse.
The Nurses Registration Board, as the
authority responsible for maintaining
professional standards of nursing practice in
NSW, wanted to provide nurses with a
resource that would give them a greater
understanding of professional and ethical
conduct. The Board considers that through
the provision of case summaries together
with an analysis of unsatisfactory
professional conduct and professional
misconduct, the co-investigators, Professor
Diana Keatinge of the Faculty of Nursing
at the University of Newcastle and
Professor Mary Chiarella of the Faculty of
Nursing, Midwifery and Health at the
University of Technology Sydney, have
developed a valuable reference for the
nursing profession.
The book begins with a thorough
explanation of how complaints are made,
by whom and what happens when the
complaint is received. Each chapter then
addresses a particular category of complaint
which may be made about an accredited
nurse, as listed under s.44 (1) of the Nurses
Act 1991. Complaints against nurses can be
loosely grouped into the following
categories: "unfit in the public interest to
practise nursing"; "has been guilty of
unsatisfactory professional conduct"; "has
been guilty of professional misconduct";
"suffers from an impairment" or "does not
have sufficient physical or mental capacity
to practice nursing" and "is not of good
character". Case summaries are located at
the back of the book for easy reference as
well as a chapter on recurrent themes
emerging from the case law.
Applicable case studies illustrate the
types of behaviour that fall into each
category. Importantly, the casebook
includes the reasons for the decisions made
by Professional Standards Committees or
Nurses Tribunals and the possible
implications for the wider profession.
Nurses will learn much from reading of
the experiences of their colleagues. Not
only in seeing how the disciplinary
processes that govern the practice of
nursing operate but in reflecting on what
constitutes unacceptable behaviour and
how they might avoid such situations
themselves. Professional Conduct: A
Casebook of Disciplinary Decisions Relating
to Professional Conduct Matters is essential
reading for nurses as well as being of
interest to other health care professionals
and consumers.
ORDER YOUR COPY NOW!
Professional Conduct: A Casebook of Disciplinary Decisions Relating to Professional
Conduct Matters is now available for purchase for only $15.00 (including GST and
postage, if required). For 5 or more copies the price is $12.00 each). This 268-page
publication will become a valuable addition to your reference library. An Order Form
is printed on the inside back cover. As well, order forms are available on the Nurses
Registration Board's website http://www.nursesreg.nsw.gov.au or from the Board's
Sydney office (see page 1 for address details).
9
BOARD PROJECTS
Nursing Research
Workshops Rated
Highly
One of the six categories of scholarship
offered to nurses in NSW is that which
provides funding for nursing research.
However, many nurses who have an
interest in research or have a particular
research question in mind can find it
difficult to put together the proposal
necessary to acquire the funding.
To assist nurses in preparing
applications for research scholarships, the
Nurses Registration Board commissioned
the Centre for Family Health and
Midwifery at the University of
Technology, Sydney to conduct a series of
workshops. After extensive advertising as
well as leaflet distribution to scholarship
applicants and previously unsuccessful
applicants, 11 workshops were held in
Sydney and country areas of NSW from
August 2000 to August 2001. Of the 111
nurses who participated, most were
registered nurses. Of these, approximately
50% were clinical nurse specialists or
clinical nurse consultants. Most were
novice researchers and wanted to learn the
skills needed for designing and
implementing a research plan and reporting
the findings.
plan. Other suggested strategies were to
increase the duration of the workshop and
have smaller groups.
One of the aims of the workshop was to
improve the availability of research
expertise and mentors to nurses. Initially,
61% reported that they had a mentor
available to them and at follow-up, 30%
had developed a working relationship with
their mentor. It was found that identifying
and developing a relationship with a
mentor was positively associated with
proposal submission. Workshop facilitators
also provided a total of 50 hours of
mentoring and feedback to participants
who completed their proposal. Participants
perceived this mentoring to be useful.
At follow-up, most responders reported
that they had either not worked on their
proposal or that the proposal was
developing slowly since attending the
workshop. Barriers identified to research
development were inadequate time at
work, lack of support, and a lack of
research experience and knowledge to
confidently continue with the project.
Other barriers were personal and social
factors, ineligibility to apply for an NRB
scholarship and difficulties associated with
gaining ethics approval. Facilitators said
that many of the participants wanted to
develop plans which would require more
time and funds than that currently
provided by the NRB.
When asked how the NRB could
support nursing research in the future,
suggestions included continuing the
workshops and improving workplace
support as well as providing internet
resources, mentors, larger more accessible
grants and feedback to unsuccessful
research applications.
The Board was pleased to provide nurses
with the opportunity to further their
research skills through the workshops and
is currently reviewing the outcomes.
A report on the outcome of these
“Writing a research proposal” workshops has
now been submitted to the Board outlining
the views of participants and offering
recommendations for the Board’s
consideration. Views were sought from
participants on application to the
workshop, on completion of the workshop
and at follow-up (one to 12 months after
completion of the workshop). Here are
some of the report’s findings.
The workshops were rated positively by
participants, with the provision of
information and handouts as well as the
interaction with other participants as the
most useful aspects. At the follow-up
evaluation, nearly all perceived they had
more skills for writing a research report as
a result of attending the workshop.
Preparation prior to attending was the
most commonly identified strategy for
improving the workshop. Although most
had developed a general research question,
few had examined the research literature
relevant to their topic, which is an essential
step for developing a workable research
10
Dianne Wykes, RN on the paediatric ward at Bathurst Base Hospital helps to make 4-year-old Kyle
Cavanough’s stay in hospital a little more pleasant with a game on the slide.
Scholarship Reports
4th International Congress on Ambulatory Surgery
26th Congress of the World Federation for Mental Health
4th International
Congress on
Ambulatory Surgery
6th Australian Palliative Care Conference, Hobart
in 1909. In reviewing the history of day
surgery, Professor Jarrett asked the
question “Where are we today – 100 years
later?”
Of significance is the fact that there are
still many countries that practice little or
no day surgery especially those in Africa,
Asia, Central and South America. These
are the very countries which would derive
the most benefit from a cost effective and
efficient service. In these countries and
elsewhere, there is a lack of understanding
regarding the benefits of day surgery. If
those benefits are to be recognised, political
and media promotion as well as education
at all levels is needed.
The Congress ran over 3 days and as is
usual when there are concurrent sessions it
was difficult to decide which ones to
attend. I was particularly interested in the
opening address and Nicholl Lecture that
traditionally starts the Congress.
Professor Jarrett suggested that between
countries and among hospitals within
countries, acceptability continued to be
varied because of political apathy, the
reluctance of the medical profession to
change and the apathy of hospital
management. To overcome these attitudes
he recommended formal and informal
education for undergraduate and
postgraduate nurses and medical
practitioners and for all other key players.
He also recommended that all available
mediums be used to inform the general
public of the benefits of day surgery. Public
demand would make it difficult for
managers and politicians to dismiss day
surgery.
The most significant features/papers
of the conference
Professor Jarrett then outlined the
potential for day surgery in the future:
Celia Leary, Manager Day Surgery Unit
Wait List Manager, Campbelltown Hospital
The “4th International Congress on
Ambulatory Surgery”, held in the beautiful
city of Geneva, was attended by
approximately 700 delegates from around
the world. The Australian delegation
numbered about 50.
The Nicholl Lecture. Professor Paul
Jarrett, United Kingdom
Because of his long time involvement
and promotion of day surgery, Professor
Paul Jarrett, Editor-in-Chief of the
Ambulatory Surgery Journal, from the
United Kingdom was given the honour of
opening the Congress and presenting the
Nicholl Lecture.
After welcoming delegates from around
the world Professor Jarrett paid homage to
Dr Nicholl, the early pioneer, for his
vision of day surgery which he presented in
a publication in the British Medical Journal
• new techniques in minimally invasive
surgery will allow more complex
procedures to be performed on a day
basis;
• new technology such as improved laser
devices, robotic cameras, virtual reality
surgery and 3D ultrasound-controlled
surgery will increase the use of day
surgery;
• new anaesthetic drugs will allow greater
use of local anaesthetic and improved
anaesthesia for patients with comorbidities;
• development of additional free standing,
fully self contained units (still considered
the ideal environment for day surgery)
will include a wider range of medical as
well as surgical services;
He added that for day surgery to
prosper there must be continual auditing of
all that we do and that particular attention
must be given to documenting our
outcomes.
On a final note Professor Jarrett said
that the growth of day surgery has been the
most significant surgical event of the last 20
years. He believed that given less fear of
change, reduced apathy, more effective
education and increased promotion of day
surgery, day surgery could include 80% of
all elective surgery internationally in the
foreseeable future.
‘Organisational and management
issues: a multidisciplinary approach’.
Peter Callinan, Australia
In this session a number of countries
presented their approach to overcoming the
barriers to day surgery in their countries.
Australia was well represented by Peter
Callanan, who outlined the current reform
strategies being undertaken by the Federal
Government in health insurance provisions
in the private sector.
He stated that the Commonwealth
Government is keen to broaden the scope
of private health insurance to cover out of
hospital care, including hospital-in-thehome services for patients. He also stated
that the Government was looking at the
feasibility of using limited care
accommodation and extended recovery
services for step-down recovery for patients
undergoing more advanced day only
surgery. Mr Callanan said that the
Commonwealth Government was
developing the option of categorising
facilities to encourage step-down
procedures in more cost effective settings
and to further support the use of day
facilities. Mr Callanan’s remarks were
encouraging, as potentially these policies
will promote the expansion of day surgery
services in Australia, a country already seen
as one of the leaders in the promotion of
day surgery.
11
SCHOLARSHIP REPORTS
‘The intraoperative experience of
patients undergoing cataract surgery
under local anaesthetic’. Mandy
Cripps, United Kingdom
This study explored the needs of
patients during the intraoperative phase,
i.e., comfort, pain relief and the coping
methods adopted by patients. Qualitative
interviews revealed three main themes of
importance to patients:
• preparation of the patient for surgery
• the intraoperative environment
• the professionalism of staff
A further survey revealed that 50% of
patients were unaware of nursing staff
presence in the operating room.
Many patients said they had experienced
discomfort due to the positions they had to
assume during surgery but they did not
report it at the time. The most common
coping method of dealing with pain and
discomfort was to ‘switch off’.
Recommendations from the study were:
• that nurses raise their profile in the
intraoperative experience of the patient;
• that pain/comfort assessment and
management strategies for this group of
patients be developed;
• that further research include replication
of the study across a broader
geographical area;
• that further research be directed towards
developing a more detailed
understanding of patients’ coping
strategies during local anaesthetic
procedures.
Cataract surgery under local anaesthetic
is an area of intraoperative nursing which, I
believe, demands much more attention.
Commonly these patients are elderly and
may have difficulty in lying still for
extended periods of time. In the future,
more surgery will be done under local
anaesthetic or regional block, so we need to
look at the nursing care we provide to our
patients during this time.
‘Nurse-directed preoperative
assessment clinics’. Sarah Lloyd,
United Kingdom
Ms Lloyd described their model which
is the same as used by my own unit. One
aspect of their organisation is that they
conduct weekly multidisciplinary meetings,
the purpose of which is to present
problems which have been identified with
individual patients and which could not be
resolved with their current guidelines. All
notes and investigation results are taken to
the meeting and presented to the
anaesthetist for discussion and further
management. This is an effective model for
managing high-risk patients and also offers
opportunities for teaching and professional
development. I will be strongly advocating
that, in our own unit, the anaesthetists
consider becoming involved in regular
weekly meetings, along the lines described
in this presentation.
The session on anaesthesia addressed
‘Optimal anaesthesia, preparation and
prevention of postoperative morbidity’.
The main points emerging were that:
• The control of postoperative nausea and
vomiting has been improved through
new anaesthetic drugs and techniques.
Identification of those patients most
likely to be affected leads to good
management of this problem.
• Methods of controlling pain are
continually improving but safe effective
pain relief remains a challenge for the
future. Drug companies need to consider
longer acting or slow release analgesia for
patients.
The speakers generally agreed that the
approach to the control of pain and
postoperative nausea and vomiting should
be:
• Pre-emptive
• Multi-modal
• Peripheral – use of local infiltration
‘Quality control’. A Forster, Geneva
The speaker highlighted the need to
encourage the reporting of incidents in
anaesthesia. He defined incidents as “an
event presenting a risk to the health of the
patient”. These would include, but not be
limited to, near misses, drug errors,
equipment failures and staffing problems.
He stated that reporting should be
voluntary, anonymous and in a narrative
format.
In my view, anaesthesia incidents are
not well documented. They need to be
included as part of each hospital’s quality
improvement program and should be
viewed as constructive and instrumental in
ensuring patient safety.
Teaching and training in ambulatory
surgery
The various presentations during this
session highlighted that formal educational
programs in day surgery for nurses and
medical practitioners have been poorly
addressed. The session included accounts of
the ways in which various countries were
attempting to address the problem of
educating nurses and medical practitioners.
In general, only very limited opportunities
are available.
Day Surgery – Macarthur Health Service
12
Australian nurses now have the
opportunity of undertaking a graduate
diploma course through the University of
Technology in Sydney and Deakin
University in Melbourne. These courses
can lead on to a Masters degree. There are
SCHOLARSHIP REPORTS
also courses through the nursing colleges
and regular educational days for nurses
throughout Australia.
Relevance of the conference to
nursing in New South Wales
The congress highlighted the need for us
to encourage nurses to undertake further
study in the specialty of day surgery
nursing, to conduct more research into the
many aspects of our daily work which
affect our patients and to publish and
present our findings so that we can share
this knowledge with our colleagues on a
national and international level. In general
we can be proud of the day surgery service
that we provide but we need to let others
know about it. Benchmarking on a national
and international level can only improve
the care we give our patients and we should
take up opportunities to do this.
Ideas, strategies or procedures
which could be introduced in New
South Wales
There were a number of presentations
on procedures that can be performed on a
day basis such as hernia repair, varicose
vein surgery, anal surgery, a large variety of
breast and plastic surgery, tonsillectomy
and nasal procedures, complicated
gynaecological laparoscopy and
laparoscopic cholecystectomy. Although
not all these procedures are routine in
Australia at this time, there is sufficient
evidence to promote expansion of day
surgery to include these more complex
procedures.
achieved as day surgery. This set target is
encouraging hospitals and therefore the
nursing divisions to evaluate work
practices, look for areas of improvement
and implement change. I believe that this
will generate ideas, strategies and
procedures that Australians can introduce
to other states and countries while we still
keep a close eye on what is happening
internationally.
Details as to how information
gained through attendance at the
conference has been disseminated
and further plans which have been
made in this regard
Over the past few years, I have regularly
presented papers at state, national and
international conferences. Information
gained from attendance at this congress will
be included in future presentations,
university lectures and may be included in
any publications.
I will have the opportunity to
disseminate some of this information at my
next presentation at the Day Surgery
Nurses Association state conference in
Launceston, Tasmania.
Information and ideas resulting from the
congress have already been discussed with
my own staff with the view of identifying
areas of possible research and of using some
of the information to improve our own
work practices.
A new procedure presented by S. N.
Lloyd of the United Kingdom was
endoscopic prostatectomy, normally an
inpatient procedure. As part of a clinical
trial, the procedure was carried out in the
morning and if the urine was clear the
catheter was removed and the patient
discharged at 6pm. A nurse followed up
patients at home using a bladder ultrasound
scanner to record voided volumes. There
was direct communication between the
nurse and the specialist. The trial was
successful and all patients listed for elective
prostatectomy are now considered for day
surgery.
The New South Wales Department of
Health recognises the advantages to be
gained from increased day surgery. Current
health reform strategies state that a target
of 60% of all elective surgery is to be
26th Congress of the
World Federation for
Mental Health
Kevin McLaughlin, Nursing Unit Manager
South Eastern Sydney Area Health Service.
The World Federation for Mental
Health Congress was held in Vancouver,
British Columbia, Canada. The theme of
the Congress was ‘Respecting diversity in
mental health in a changing world’. I
presented a paper at the Congress and
chaired one of the Congress sessions.
The most significant features/papers
of the conference
For me one of the most significant
features of this conference occurred on the
day prior to the start of the conference
proper. On that day I attended the
conference venue to complete my
registration. A public meeting was in
progress outside the venue. The meeting
was being held to ‘protest psychiatric
stigmatisation and child drug pushing.’
The group particularly targeted use of
the ‘medical model’ of psychiatry to
explain human behaviour as they felt it
deprived people of choice and
responsibility. One of the ‘psychiatric
abuses’ the group had highlighted was
involuntary hospitalisation.
Dolores McGann, Nursing Unit Manager,
Paediatrics, at Bathurst Base Hospital with
7-week-old Jacob Prideaux and mum Sandra.
Other issues being addressed by the
group were the multi-million dollar
psychiatric drug industry and the
prescribing of psychiatric drugs to children.
Local statistics were quoted. In 2000, more
than 32 million prescriptions were written
for a psychiatric drug in British Columbia.
Of 21,000 people in British Columbia
taking psychiatric stimulants in 1999, two
thirds were high school students.
According to a government estimate, the
percentage of boys diagnosed with a mental
13
SCHOLARSHIP REPORTS
illness and receiving medication may have
been as high as 1 in 10.
This protest meeting was
confrontational to me in that it questioned
the legitimacy of the branch of nursing in
which I have been involved for many years
and related directly to the content of the
paper I intended to present. Although
being provoked into reflecting on one’s
practice is a good outcome from attending
a conference, I found it ironic that I had
encountered this provocation prior to the
start of the conference, and from a source
that was directly opposed to psychiatry and
by extension, to mental health nursing.
So far as the conference proper was
concerned, the papers which interested me
most included one on coercion in
community mental health care and a
number stressing the need for a greater
emphasis on health promotion in mental
health and on ways to include this in
clinical settings. Papers on the issue of
men’s mental health were conspicuous by
their absence.
The paper on coercion in community
mental health highlighted the dichotomy
between the assertive approaches to
treatment, including involuntary
hospitalisation, which suggests a type of
‘state paternalism,’ and support for the
consumer movement that emphasises
empowerment. The paper suggested the
development of practice guidelines for
workers carrying out coercive
interventions.
Relevance of the Conference to
Nursing in New South Wales
A number of the papers presented by
nurses at the Conference involved the
subject of mental health promotion.
Participants stated many times that health
promotion should not be the domain of a
‘health promotion unit’ but rather
promotion should be included in clinical
settings. Speakers emphasised that nurses,
with their broad skill base and their close
involvement with clients and their families,
are well placed to provide health
promotion. I agree with this assertion and
as a nursing unit manager I am in a
position to encourage nurses to have a
greater focus on mental health promotion.
It is worth noting that many of the
papers presented by nurses detailed primary
research in which they were involved.
From my local experience, I know that
mental health nurses in New South Wales
are part of this worldwide nursing research
movement.
14
Ideas, strategies, procedures that
could be introduced in New South
Wales:
am confident that this initiative will go
ahead and see it as a positive outcome of
my attendance at the conference.
The Ulysses Agreement:
Evaluation of the conference
experience:
The Ulysses Agreement builds on the
concept of the living will. The Agreement
is a care, treatment and personal
management plan developed by the client,
family members and workers involved in
the case. The purpose of the Agreement is
to provide a clear set of guidelines for
action by the client’s support team should
the client exhibit any signs of illness. The
specific signs of illness are outlined in the
Agreement. In cases where the client has
dependent children, the Agreement
documents who should take responsibility
for them.
I feel this initiative is a very positive step
in client involvement in care planning and
have been discussing with clinicians the
possibility of introducing the Ulysses
Agreement, or a similar system, for clients
in our service.
The Community Best Practice SelfAssessment Checklist:
This Checklist is a tool to evaluate the
extent to which service provided is
comprehensive and holistic. It is
particularly useful as it can be used by the
individual clinician or by the service as a
whole. Although it includes some aspects
of care provision, such as availability of
adequate affordable housing, over which
the individual clinician, and in many cases
the health services, have little or no
control, nonetheless it serves to keep all
aspects of care planning on the agenda. I
have tabled a copy of the Checklist with
my local service and am currently working
on a modified version which I hope can be
used by our support groups.
Support groups for adult children of
parents affected by mental illness:
A number of papers delivered at the
conference related to support groups and
self-help groups. Following the
presentation of my paper on children of
parents affected by mental illness, I was
approached by an Australian woman who
was interested in starting a support group
for the adult children of parents affected by
mental illness. I felt this was a novel
concept as until then my focus had been on
adolescent offspring. We are now discussing
how such a group could be formed in
Sydney. We anticipate that mental health
professionals would support the group but
not necessarily attend the meetings since
this could be restricting to the members. I
Attending this conference gave me the
opportunity of interacting with colleagues
from many countries. I was impressed with
the extent to which some countries have
progressed with the notion of consumer
involvement in service delivery. Informal
discussions gave me the opportunity to get
more detailed information on ideas that
could be implemented in my own service
area. It was clear that some countries had a
more structured approach to consumer
involvement. A significant aspect of this
was a training programme for consumers,
covering committee membership and
procedure for running meetings. There
were many examples of consumer
involvement in self help groups and a
number of these groups received funding
from drug companies. This support from
drug companies generated much discussion
both formally and informally.
An innovative example of consumer
involvement in service delivery came from
Germany. In Berlin, a crisis centre for the
homeless is controlled and managed by the
residents. The Centre encourages
withdrawal from psychiatric drugs and
rejects the notion of mental illness. It
fosters the returning of responsibility to
the individual. Such a concept is a far cry
from the predominately medical model that
operates in Australia.
In my paper I discussed the topic of
ethical issues involved in early intervention
with children of parents affected by mental
illness. I had hoped this would generate
some discussion but interestingly, the
comments made on this issue came from
consumers. I was unable to draw any firm
opinions from professionals in the
audience. The ethics of early intervention is
not a new idea but few workers seem to
have seriously considered the matter. As I
consider it is a topic worthy of debate, I
will continue to introduce it when I can.
Dissemination of Information:
I have discussed many aspects of the
conference with my teams and with my
managers. I will present an overview at a
Professional Development Forum and I am
presenting a paper at a Senior Mental
Health Nurses Network. I am preparing a
paper on the development of a support
group for adult children of parents affected
by mental illness.
SCHOLARSHIP REPORTS
6th Australian
Palliative Care
Conference, Hobart
Significant papers
‘Truth may hurt but deceit hurts
more: communication in palliative
care’. Professor L J Fallowfield.
This paper dealt with and challenged the
way health professionals communicate with
their patients, especially in the context of
cancer care, and with the prospect of giving
patients bad news. Professor Fallowfield
highlighted the misguided desire to protect
patients from knowing the truth if it was
to be hurtful to them. He encouraged a
more sensitive and skillful but open and
honest approach to dealing with such
information. His said that ‘a conspiracy of
silence usually results in a heightened state
of fear, anxiety and confusion, not one of
calm and equanimity.’
Matthew Bullen, Registered Nurse
Armidale Palliative Care Service
The sixth Australian Palliative Care
Conference, held in Hobart, had as its
theme ‘Learning to Live.’ It focused
particularly on communication, paediatric
and motor neurone disease issues in a
palliative care context. The conference
theme touched participants in more ways
than was expected as the international
events of September 11th unfolded in the
United States and the collapse of Ansett
towards the end of the week caused
disruption to the travel arrangements of
many participants. These events reminded
us all to live fully now as there is nothing
certain in this life.
Significant features and papers
The conference was well planned and
presented with an excellent poster
presentation of research projects in
palliative care from throughout Australia
and New Zealand. The posters presented
excellent ideas for future collaboration. It
was inspiring to see such a variety of issues
being researched, ranging from symptom
control and art therapy through to issues
relating to palliative care workers.
A special feature of the conference was
the volunteer’s day with which it began.
This day acknowledged the incredible
contribution made by volunteers to the
quality and viability of effective palliative
care services. Volunteers welcomed the
opportunity to meet and share their
experiences with each other and with the
conference participants.
‘Health promoting palliative care
through popular writing’. Professor
A Kellehear
Professor Kellehear highlighted the
potential importance of death education to
build up personal life skills and through
those increased skills, better communities.
Professor pointed out that through the
telling of personal stories, communities can
reflect and make sense of their own
experiences of death and loss. The
facilitation of this process is health
promoting in itself.
‘Spiritual intervention from an
Aboriginal perspective’. J B Baban
This was a beautifully crafted and
presented talk that illuminated both
contemporary and traditional beliefs
surrounding death and Aboriginal
spirituality, as seen through the speaker’s
experience. During the talk we learned how
the didgeridoo is used as a healing tool for
mental and spiritual health.
‘When words fail, music begins: a
phenomenological research project
investigating how terminally ill
patients experience music therapy’.
B E Hoagy
Ms Hoagy gave this paper as the
inaugural Ian Maddocks Lecture and I
found it truly inspiring. The speaker
showed how, within the context of dying,
music therapy is a complex, diverse and
intricate process. She sought to unveil the
essence and constituents of the music
experience for her patients. Her research
results revealed that patients experienced
music therapy emotionally, physically and
spiritually; that it acted as a catalyst on all
levels and had a lasting effect on them. Ms
Hoagy demonstrated that music is a very
beneficial therapy for dying people.
‘Persistent pain: a disease entity’.
M J Cousins AM
This paper included an excellent
overview of the expansion of recent
scientific knowledge in the understanding
of pain and its aetiology. The speaker
suggested that, since all pain is part of the
pain continuum, the term ‘chronic pain’
should be changed to ‘persistent pain.’
Potentially, with early intervention and
appropriate assessment of the individual
patient’s biological, social and
psychological needs, an improved outcome
can be achieved.
Relevance of the conference to
nursing in New South Wales
The Palliative Care Conference, held
every two years, is the main gathering of a
wide range of palliative care professionals
from all over Australia and New Zealand.
The conference offers a unique opportunity
to learn and update with other nursing
colleagues working in varied contexts and
situations. The chance to listen to
colleagues from around New South Wales
and from other States inspired me to
incorporate what I have learned into our
local service. I believe that this result in
itself explains the relevance of the
conference to nursing in New South Wales.
Ideas, strategies and procedures
that could be introduced in New
South Wales
The following ideas and strategies could
be introduced/enhanced in NSW:
• Formalise self care models for palliative
care workers including peer
supervisor/mentor model especially for
new workers, ongoing professional
support and education.
• Establish formal relationships with
developing world palliative care services
to promote two way learning and
support
• Promote and develop music therapy and
art therapy to palliative care services,
especially in the rural context.
• Develop formal collaborative
relationships with tertiary education
15
SCHOLARSHIP REPORTS
institutions for the purpose of ongoing
evidence based research that will feed
directly into patient outcomes.
• Promote and develop palliative care
nurse practitioners, especially in rural
areas, with the prime aim of improving
access to and quality and
comprehensiveness of care for people
with terminal illness.
Evaluation of the conference
Networking with rural and
metropolitan based palliative care nurses
was invaluable. I learned of research similar
to that occurring in our service, namely the
effect of massage in the prevention of
nausea and vomiting of patients receiving
chemotherapy. I found that meeting peers
and leaders in palliative care was helpful
and inspiring. I learned new ideas and
strategies to incorporate into my workplace
in Armidale. The feedback and interest
expressed by other colleagues led me to feel
reassured about the value of the work and
service we are offering in our rural context.
Objectives
In applying for the scholarship I had the
following objectives:
exploration of the possible spiritual needs
and concerns of the dying child. Once
again the emphasis on open and honest
communication was stressed.
3. To gain a deeper understanding of
communication issues, to develop
attributes and learn further skills and
knowledge to enhance current practices in
communication at a personal and
organisational service levels.
I met this objective through my
attendance at a presentation on
communicating with dying people through
impromptu drawings, attendance at the
workshop ‘Living life through quality
communication’, where we were
encouraged to ‘speak the unspeakable,’
look for unfinished business and encourage
a sense of hope that is based on reality and
not wishful thinking. Through exploring
the concept of “vicarious victimization”, I
became more aware of the cumulative
nature of loss and grief for the palliative
care worker and the importance of
developing supportive teams,
communication styles and acknowledging
both overtly and formally the stressful
nature of palliative care work.
My final two objectives relating to
network formation and to representing a
rural perspective to fellow conference
attendees were met through the formal and
informal interaction with my colleagues
throughout the conference. I was pleased to
be able to actively promote awareness of
the issues that face rural practitioners.
Disseminating the information
I have had the opportunity of discussing
my experience with several colleagues,
highlighting new and informative
developments in palliative care as learnt at
the conference. I have also organised
sharing of conference abstracts and
informationwith colleagues at our local
health service. The information has been
shared with palliative care workers in other
areas who were unable to attend the
conference. I will be incorporating
information gained from the conference in
the material to be presented at an ongoing
inservice program for community nurses in
this area.
1. To network with volunteers and volunteer
co-ordinators so as to gain knowledge,
insight and practical advice to assist with
the ongoing establishment and
development of a volunteer service for
Armidale and surrounding districts.
I felt that this objective was met through
my attendance at volunteers day. This was
a great opportunity to meet with
volunteers and volunteer co-ordinators.
Some of the workshops included ‘Tackling
the tough stuff’ (looking at difficult
management issues in dealing with
volunteers); ‘Forget the myths – these are Real
Families’ (Joining with families anticipating
loss.)
2. To gain further knowledge and skill in the
palliative care of children and their carers.
I attended a workshop presented by the
Westmead Children’s Hospital Palliative
Care Service on Palliative care for children
in Australia – medical, nursing, spiritual
perspectives. The Workshop included an
overview of the epidemiology of childhood
death in Australia, an outline of models of
palliative care of children, and discussion of
symptom management and psychosocial
issues. I was particularly interested in an
16
Margaret White, RN, shares a cup of tea with resident, Mrs Rewa Geach in the gardens of Wontama
Nursing Home, Orange.
NURSES REGISTRATION BOARD
NEW SOUTH WALES
PROFESSIONAL CONDUCT: A Case Book of Disciplinary Decisions Relating
to Professional Conduct Matters
Please send me ___ copy/copies of the book "Professional Conduct: A Case Book of
Disciplinary Decisions Relating to Professional Conduct Matters".
The price is $15 per copy, including GST and postage.
For orders of 5 or more copies, the price is $12 per copy, including GST and postage.
Please do not include other payments (eg annual renewal fees) when paying for the
purchase of publications: other payments should be made separately.
Enclosed is a cheque/money order for $_______
OR
Please charge the amount of $_______ to my credit card:
! Bankcard (Australia or New Zealand only)
! Mastercard
! Visa
Tick applicable box
Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiry date: __ __ / __ __
Name as shown on card: _________________________________________________________
Signature of card holder: _________________________________________________________
Daytime telephone number: ______________________________________________________
Name and postal address for delivery:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Mail your order to:
NURSES REGISTRATION BOARD
PO BOX K599
HAYMARKET NSW 1238
NOW AVAILABLE....
A useful reference
book for nurses and
others.
Includes cases heard
by Nurses Tribunal
and Professional
Standards Committees
Cost $15 per copy
OR
buy 5 or more only $12 per copy
See page 9 for ordering details
NURSES REGISTRATION BOARD