CPHCNC 2012 program and book of abstracts

PROGRAM AND BOOK OF ABSTRACTS

Community and Primary 17–19 October Health Care Nursing Conference Perth 12AUSTRALIAN COLLEGE OF NURSING

SHAPING & INFLUENCING PRIMARY HEALTH CARE

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Community and Primary Health Care Nursing Conference 17–19 October 2012

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CONTENTS

Welcome from the President, Australian College of Nursing 5

Conference aims and objectives 6

Conference Steering Committee 6

Abstract Review Committee 7

General information 9

Program 11

Key speakers 15

Sponsor profiles 21

Exhibitor floor plan 22

Exhibitor profiles 23

Concurrent abstracts 33

Poster abstracts 54

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WELCOME FROM THE PRESIDENT

Carmen Morgan FACN Transitional Board President, Australian College of Nursing

On behalf of the Australian College of Nursing (ACN) Board and the ACN Community and Primary Health Care Nursing Conference (CPHCNC) Steering Committee it is my pleasure to welcome you to this year’s conference titled Shaping and influencing primary health care.

I, for one, am delighted to be part of this conference for two reasons. On a professional level the CPHCNC is the first event to be delivered under the banner of ACN, and on a personal level the conference is located in my beautiful home state of Western Australia.

We are privileged to present a program that features many prominent community and primary health care leaders; a program full of depth, knowledge and diversity. I’m eager to learn about the many innovative programs that are currently being delivered in primary health care settings around the country.

Whilst community and primary health care has seen some substantial advances over the past few years there is still great opportunity for further acknowledgement, enhancement and expansion of the roles of nurses working in primary health care. It is imperative that policy makers acknowledge the prevalence of nurses across the primary health care system and work to increase the accessibility, flexibility and reach of services. I believe that it is our collective responsibility to ensure the energy and focus for advancement continues in the pursuit of a strong primary health care system in which nurses have a leading role.

The CPHCNC provides the perfect opportunity for this momentum of change to be further explored. The conference program, presentations, workshops and forums will stimulate robust dialogue and debate and provide a platform for ACN to enhance the profile and scope of practice of nurses.

As you would be well aware the nursing community is a close collegiate of professionals and this conference provides an ideal opportunity for delegates to network and contribute to reform discussions. I’m very much looking forward to listening, learning and joining in the conversation with my fellow delegates over the next few days. I hope you enjoy what our program has to offer.

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AUSTRALIAN COLLEGE OF NURSING

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CONFERENCE AIMS AND OBJECTIVES

CONFERENCE STEERING COMMITTEE

Kathleen McLaughlin FACN (Chair) Executive Manager of Member Relations, Australian College of Nursing

Dr Carolyn Briggs FACN Child and Family Health Nurse, Australian Association for Maternal Child and Family Health Nurses

Professor Jeffrey Fuller FACN Professor of Nursing (Primary Health Care) and Associate Dean Research, Flinders University

Melinda Hassall MACN Immunisation Coordinator, Queensland Aboriginal and Islander Health Council

Narelle Janke MACN Director of Nursing, Community & Primary Health Services, Metro South Health Service District

Janet McLeod MACN Parkinson’s Nurse Specialist, Parkinson’s Western Australia

Associate Professor Rhian Parker MACN Associate Professor and Senior Research Fellow, Australian Primary Health Care Research Institute, Australian National University

Dr Kay Price FACN Associate Professor, University of South Australia

Donna Watmuff FACN Coordinator, Health Sector and Family Education, Alzheimer’s Australia VIC

The conference will provide a national forum for nurses and midwives working across all areas of community and primary health care to:

� explore innovations in service delivery

� identify emerging population health needs

� review and present international and national research findings

� translate evidence into practice and

� examine emerging governance structures and roles.


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ABSTRACT REVIEW COMMITTEE

Professor Brett Aimers FACN

Analisa Chhikara MACN

Jeffrey Faccenda MACN

Adjunct Associate Professor Stephanie Fox-Young FACN (DLF)

Professor Karen Francis FACN

Professor Jeffrey Fuller FACN

Professor Desley Hegney FACN

Andrew Horne MACN

Elaine Hosken FACN

Alison Keleher MACN

Gay Lavery FACN

Professor Anne McMurray FACN

Dr Jenny Newton MACN

Lesley Siegloff FACN

Winsome St John FACN

Leeanne Thompson MACN

Jenny Tuffin FACN

Kirstie Walkley MACN

Donna Watmuff FACN

Kathy Wooldridge MACN

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GENERAL INFORMATION

Location information

The Vines Resort & Country Club

The Vines Resort & Country Club is located within the Swan Valley in Perth Western Australia. The Resort is located approximately 35 mins from the Perth CBD and Perth domestic airport and is surrounded by award winning wineries, restaurants and galleries.

The Swan Valley is Western Australia’s oldest wine growing region and is where you will experience a colourful blend of history, people, art, world-class wine, gourmet goodies and fresh produce.

Catering and dietary requirements

Arrival tea/coffee, lunches, morning and afternoon tea will be in the Samuel Copley Room.

Dietary requirements noted during your registration have been passed onto the catering staff and will be available from the dedicated catering station. If attending the conference dinner, please identify yourself to the catering staff. Please ask the catering staff to assist if needed.

Conference dinner

The conference dinner will be held on Thursday 18 October 2012. A conference dinner ticket is included with full conference registrations.

The conference dinner will be held at Sandalford Winery. Transfers to and from the venue have been organised for attending delegates. Coaches will depart the Vines Resort at 6.30pm then return to the Vines from Sandalford at 10.00pm and 10.30pm.

Conference satchel

Each registered attendee will receive a conference satchel at the time of registration.

Continuing Nurse Education (CNE) points

ACN CNE points are awarded to professional development activities that are organised by ACN or have been endorsed or accredited by ACN. One point equates to 60 minutes of education. ACN recommends that nurses should aim to achieve 30 CNE points per year (that is, 30 hours of professional development per year) when enrolled in the ACN Life Long Learning Program (3LP).

Attendees of the CPHCNC will receive:

Conference day one – Thursday 18 October 5 CNE points

Conference day two – Friday 19 October 5 CNE points

Delegate list

A delegate list with name, organisation and state will be supplied to delegates and exhibitors at the conference. Those delegates who indicated on their registration form that they did not wish for their information to appear on the list have not been included.

Disclaimer

The conference committee reserves the right to change the conference program at any time without notice. Please note: this program is correct at the time of printing.

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Dress

The conference dress is smart casual for all sessions.

Duplication/recording

Unauthorised photography, audio taping, video recording, digital taping or any other form of duplication is strictly prohibited in conference sessions.

Evaluation survey

A hardcopy evaluation form will be provided to delegates for completion prior to the conference close. Delegates will also be emailed an online evaluation following the conference.

Exhibition

The conference exhibition will be located in the Samuel Copley Room. The exhibition will officially open at the welcome reception on Wednesday 17 October at 5.30pm. The exhibition will close on Friday 19 October at 1.30pm.

Lost and found

Please report any lost or found property to the registration desk.

Mobile phones

Attendees are asked to switch off their mobile phones when in sessions.

Name tags

Name tags are provided to each delegate upon their registration. Delegates are encouraged to wear their name tags at all times during the conference. Entrance to sessions and the exhibition is restricted to registered attendees only. If you misplace your name tag please go to the registration desk to arrange a replacement.

Privacy

Information provided on the registration form will be used to administer the conference. Data obtained will remain the property of the event organisers.

Registration desk

The registration and information desk will be open for the duration of the conference and will serve as your main point of contact for conference related queries.

The registration desk will be located at the entrance to the Barrett Lennard Room and will be open as follows:

Wednesday 17 October 3.00pm – 7.30pm

Thursday 18 October 7.30am – 5.00pm

Friday 19 October 8.00am – 3.30pm

Smoking

Smoking is not permitted in, or outside of, the session rooms or in the exhibition.

Special requirements

Every effort has been made to ensure people with special requirements are catered for. Should you require any assistance, please contact the registration desk to enable us to make your attendance at the conference a pleasant and comfortable experience.


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Wednesday 17 October3.00pm – 6.00pm Registration desk opens

6.00pm – 7.30pm Welcome reception and exhibition trade opening

Thursday 18 October7.30am Registration desk opens

8.45am Official opening – Adjunct Professor Debra Thoms FACN (DLF), CEO, Australian College of

Nursing

Welcome to Country

8.55am – 9.15am Welcoming address – Carmen Morgan FACN, President, Australian College of Nursing

9.15am – 10.00am Keynote address Great care is our business

Adjunct Associate Professor Catherine Stoddart MACN, Chief Nurse and Midwifery Officer

Western Australia

10.00am – 10.45am Plenary session Future proofing the nursing workforce

Karen Cook FACN, Health Workforce Australia

10.45am – 11.15am Morning tea

11.15am – 12.30pm Concurrent session 1

Applying Population Health NeedsBarrett Lennard room 1

Influencing Policy and PracticeBarrett Lennard room 2

Safety and Quality in Clinical GovernanceBarrett Lennard room 3

Exploring innovative advanced practice and nurse led models which effectively and efficiently meet the health needs of refugees in a primary health care setting

Jan Williams MACN

A national framework and toolkit to support advanced nursing development and sustainability in general practice (SANDS in GP)

Dr Kelly McGorm

A tool to evaluate patients’ experience of nursing care in Australian general practice: Development of the Patient Enablement and Satisfaction Survey (PESS)

Jane Desborough MACN

Research and collaborative partnerships in promoting fertility awareness

Dr Wendy Abigail

Nurse clinics in Australian general practice: Planning, implementation and evaluation

Lynne Walker MACN

The perceptions of key stakeholders of a model of nurse-led chronic disease management in Australian general practice

Professor Desley Hegney FACN

The race for excellence has no finish time

Karen Drury

Primary health care policy and practice: Sustaining older people living at home

Dr Deborah Hatcher MACN

How do we know?

Dr Heather Moore FACN

12.30pm – 1.30pm Lunch

1.30pm – 2.15pm Panel workshop presentation

Positioning the primary health care nursing workforce

ACN CPHC Faculty Advisory Committee

2.15pm – 3.00pm Plenary presentation Delivering primary health services in the custodial setting

Jenny Law, Justice Health NSW

3.00pm – 3.30pm Afternoon tea and poster viewing with authors

PROGRAM

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3.30pm – 4.45pm Concurrent session 2



The Role of the Consumer Barrett Lennard room 3

The development of a primary health care framework for a neurological support service

Julie Crack FACN

Primary health care as a philosophical framework for nursing education: Rhetoric or reality?

Dr Sandra Mackey MACN

An exploration of the barriers and facilitators of community access and social inclusion for disabled and socially-marginalised population groups

Nick Arnott MACN

Roaming education and community health

Julie Fereday MACN

Barriers and enablers in general practice to nurses working in advanced roles: A multiple case study

Professor Karen Francis FACN

Getting to know you: Understanding the work of nurses in Australian general practice

Lynne Walker MACN

Effectiveness and acceptability of nurse managed long term condition planning in primary care


Wound prevalence amongst the metropolitan EACH Client populations, Silver Chain

Susannah Mulligan

Vicky Brewer

Engaging consumers in the aged care nurse practitioner journey

Associate Professor Rosemary Saunders

Sheila Craik

Hayley Haines

Anne McKenzie

7.00pm Conference dinner


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Friday 19 October8.00am – 3.30pm Registration desk opens

9.00am – 9.45am Keynote address

Primary care nursing & midwifery: What do consumers say about our services & how do

we respond to them? Using consumer complaints for quality improvement

Beth Wilson, Health Services Commissioner, Victoria

9.45am – 10.30am Plenary presentation

Nurse capacity building for policy impact

Professor Tracey McDonald AM FACN, National Lead Clinicians Group

10.30am – 11.00am Morning tea

11.00am – 12.15pm Concurrent session 3



Safety and Quality in Clinical GovernanceBarrett Lennard room 3

Improving access to coronary artery bypass grafts for aboriginals living in remote areas in the top end of the Northern Territory

Deborah Geary

Closer to home – Moree Oncology and Chemotherapy

Bronwyn Cosh

An electronic solution for safe client outcomes

Sandy Ryan

Breathe – Community Based Respiratory Program

Frank Nelson

Wendy Siddall

Linking cultural safety and clinical governance during an international clinical placement

Hazel Rands

Sustaining quality in secondary school nursing practice

Diana Guzys

Applying population health needs in acute emergency setting

Doris Graham

Coralie Spark

Supporting integrated service provision: How does care coordination by registered nurses ‘fit’ within the general practice context?

Associate Professor Winsome St John FACN

Preparing new to remote health professionals – lessons learned from the RAHC experience

Fiona Wake MACN

12.15pm – 1.15pm Lunch and close of exhibition

1.15pm – 2.00pm Plenary presentation Establishing the role of a primary health nurse practitioner in country WA

Laura Black, Southern Inland Health Initiative

2.00pm – 2.45pm Plenary presentation Medicare Local 12 months on

Kate Clarke, Chief Executive Officer, South West WA Medicare Local

2.45pm – 3.00pm Conference close – CEO, Australian College of Nursing

3.00pm – 3.30pm Afternoon tea

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KEY SPEAKERS

Conference chair

Adjunct Professor Debra Thoms FACN (DLF) Chief Executive Officer, Australian College of Nursing

Professor Debra Thoms began studying nursing in 1974, undertaking the combined degree program at the University of New South Wales and the Prince Henry/Prince of Wales hospitals.

Debra continued her early nursing career as a registered nurse at the Cardio-Thoracic Unit, Prince Henry Hospital, New South Wales during 1979 and 1980, before embarking on a career as a rural and remote area nurse in the Northern Territory in the 1980s. It was during this time Debra gained her midwifery certificate.

In March 1987 Debra returned to New South Wales and commenced her Master of Nursing Administration at UNSW. In 1991 she became the Director of Nursing, Camden District Hospital. Debra went on to become the DON and then Executive Director of the Royal Hospital for Women until July 2000.

Debra then became the Chief Executive Officer of Macquarie Area Health Service – her first senior management role in New South Wales. Debra went on to become the Area Director of Nursing & Community Development, South Eastern Sydney AHS, a position she held until December 2003. Debra then took up the position of Chief Nursing Officer, Department of Health, South Australia until May 2006. At this time she returned to New South Wales to become the Chief Nursing and Midwifery Officer at the now Ministry of Health, New South Wales.

That brings us to 2012 when Debra commenced her role as the inaugural Chief Executive Officer of the Australian College of Nursing.

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Keynote speakers

Adjunct Associate Professor Catherine Stoddart MACN

Associate Professor Catherine Stoddart is the Chief Nurse and Midwifery Officer of Western Australia. Catherine has held positions in both state and Commonwealth governments. She has held executive management roles and senior clinical nursing positions at Sir Charles Gairdner Hospital and was the Executive Director of Nursing across WA Country Health Service and the Regional Director for the Kimberley.

In September, Catherine was awarded the 2011 Telstra Western Australia Business Woman of the Year and the White Pages Community and Government Award in recognition of her contribution to removing the barriers that prevent people entering careers in nursing and the development of innovative community contribution initiatives.

Catherine has a Bachelor of Health Science (Nursing), Master of Science (Project Management), Master of Business Administration and is currently undertaking a PhD in International Corporate Volunteerism.

She is a Nuffield Fellow (2000) and Churchill Fellow (2006) which allowed her to review models for isolated nursing practice in Alaska and Canada, focusing on Indigenous communities.

Catherine has a passion for developing corporate volunteer options in international and Indigenous health in rural and remote areas which has culminated in the establishment of health wide community service leave and the Global Health Alliance, Western Australia in 2009 as a mechanism for health professionals to contribute to global health.

Catherine is passionate about making Western Australia the place where nurses and midwives can have the most amazing career while delivering excellent care to our community


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Beth Wilson

On 1 May 1997 Beth Wilson became Victoria’s Health Services Commissioner. She is a lawyer by training and has worked mainly in administrative law. Beth has had a long-standing interest in medico/legal and ethical issues.

The Health Services Commissioner receives and resolves complaints about health service providers with a view to improving the quality of health services for everybody.

Prior to becoming Health Services Commissioner, Beth was the President of the Mental Health Review Board, a Senior Legal Member of the Social Security Appeals Board and WorkCare Appeals Board and a past president of the Victorian Branch of ANZAPPL (Australian and New Zealand Association of Psychiatry, Psychology and Law). In 2007 Beth was appointed a member of the Disability Services Board.

Beth has received several important awards in recognition of her achievements. These include:

2002 – Monash University’s Distinguished Alumni Award for outstanding professional achievements and inspirational leadership

2003 – Centenary Medal for services to health

2004 – An Honorary Doctorate from RMIT for contributions to health education

2008 – Induction onto the Victorian Honour Roll of Women for services to women’s health in Victoria

Beth regularly conducts seminars, lectures and classes for consumers, carers, health service providers and others. Beth advocates for work-life balance and the importance of humour, storytelling and music in providing inspiration and education and in health promotion.

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Plenary speakers

Karen Cook FACN

Karen Cook has over 30 years’ experience as a nurse in a variety of practice areas in Australia and overseas. Karen worked for a number of years in nursing and midwifery regulation at the state, national and international level. More recently Karen has been involved in workforce planning with Health Workforce Australia.

In addition to her nursing qualifications she has qualifications in health administration and business administration and is a graduate of the Australian Institute of Company Directors. Karen also does volunteer work as the Vice President of the Board of Carers Australia; the national peak body representing carers in Australia.

Jenny Law

Jenny Law is presently employed as the Service Director of Primary and Women’s Health with the Justice and Forensic Health Network in NSW. Her responsibilities include the provision of primary health service across NSW for people in gaol. Primary and women’s health is a challenging area which provides a wide range of high level nursing services including chronic care, midwifery, primary health and women’s health. Jenny’s role also has oversight of general practitioners, oral health, medical imaging, physiotherapy, optometry, pharmacy, podiatry and a range of support staff for these areas.

Jenny began her nursing career at Balmain Hospital in Sydney in 1977 and later gained further qualifications at the University of New England. She has obtained experience in a variety of areas including surgical nursing, burns and ambulatory care. Jenny worked for 11 years as a senior manager and three and a half years as a health service planner at The Children’s Hospital in Westmead, Sydney.


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Professor Tracey McDonald AM FACN

In 2012 Professor Tracey McDonald was invested as a Member of the Order of Australia for her work in nursing, aged care, United Nations expert groups and the development of national and international public health and social welfare policy. As Professor and RSL LifeCare Chair of Ageing she brings qualifications and many years of experience in the health, education, nursing and aged care industries. Her deep understanding of health services, management, nursing, ageing and social issues supports her work on clinical outcomes, management, national and international policy related to health concerns and late age. Her wisdom and skill in these areas was further endorsed through her 2011 ministerial appointment to the National Lead Clinicians Group.

Laura Black

Laura Black is a nurse practitioner who started her journey in nursing in Scotland, and now has over 30 years nursing experience, having worked across the UK, Africa and Australia throughout her career. Laura has worked for Silver Chain in positions enabling her to take a lead role in the development of both, Silver Chain’s Hospital in the Home program, and the Priority Ambulatory Response Unit in the Perth Metro area. Laura has played an integral role in the development of the Nurse Practitioner Service Delivery Plan for Silver Chain’s Country Services, and was appointed as the first Primary Health Nurse Practitioner in country WA under the Southern Inland Health Initiative.

Kate Clarke

Kate has been involved in regional, rural and remote organisations for over 25 years. Kate is a graduate of the Australian Institute of Company Directors, a fellow of the Australian Leaders Foundation and has qualifications in business administration, applied science and nursing.

Kate has worked as a nurse and midwife in hospital and community settings primarily in South Australia. She undertook an undergraduate degree in nursing, completed a Bachelor of Nursing and qualified as a midwife after completing midwifery training in Scotland.

Kate was the General Manager for the Eyre Peninsula Natural Resources Management Board from 2004 to 2011 and after spending a year travelling, volunteering and consulting she was appointed to the role of CEO, South West WA Medicare Local in July 2012.

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Panel workshop presentation

Members of the Community and Primary Health Care Faculty Advisory Committee will participate in a panel workshop presentation.

The Community and Primary Health Care Faculty was established with a view to facilitate the exchange of information and advice on community and primary health care issues. The launch of the faculty was very timely as it coincided with major contemporary health care reforms which support and encourage advanced community and primary health care nursing practice.

The Faculty aims to actively engage with its members and promote its core functions which are collaboration, integration and reform.

CPHC Faculty Advisory Committee

Chairperson:

Mark Smith FACN

Committee members:

Cheryl Bush MACN

Gaylene Coulton MACN

Professor Anne McMurray AM FACN

Nicole Steers MACN

Associate Professor Winsome St John FACN

Donna Gallagher MACN

Carol Nolan MACN

Catherine Wilkin FACN


Narelle Janke MACN


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Key NAHRLS facts:

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� Locum travel, accommodation and incentives covered

� Locum support up to 14 days

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Health Workforce Australia (HWA) is a Commonwealth statutory authority that delivers a national, coordinated approach to health workforce reform. It was set up by the Council of Australian Governments (COAG) to address workforce shortages and growing demands for health care arising from an ageing population, growth in chronic disease and increased community expectations.

HWA works in collaboration with governments and non-government organisations across health and education sectors to address critical priorities in the planning, training and reform of Australia’s health workforce.

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EXHIBITOR PROFILES

The Australian College of Nursing is a result of the unification of The College of Nursing and Royal College of Nursing, Australia. ACN combines the strengths of the two former colleges as it leads the way towards a bright future for the profession.

ACN, Australia’s professional organisation for all nurses, will build on the strength of its predecessors in its contribution to policy and health care debate, and provide relevant and responsive education to meet the needs of the profession.

Importantly, the organisation will further boost the public profile of the nursing profession and make available a wide range of nursing information and professional resources. ACN looks forward to working with its members and key stakeholders to achieve its intent – Leading nursing expertise and care through access, learning and advocacy.

To learn more visit www.acn.edu.au

Leading nursing expertise and care through access, learning and advocacyRCNA TCoN&


The Australian Indigenous HealthInfoNet is an extensive free web resource helping to ‘close the gap’ in health between Indigenous and other Australians by making the evidence base accessible www.healthinfonet.ecu.edu.au.

Their translational research aims at providing the knowledge and information needed for health practitioners and policy-makers to make informed decisions.

www.healthinfonet.ecu.edu.au


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Drug and Alcohol Nurses of Australasia (DANA) is the peak nursing organisation in Australasia providing leadership to nurses and midwives with a professional interest in alcohol, tobacco and other drug (ATOD) issues.

DANA actively promotes a legitimate role for nurses, midwives and their professional non-nursing peers to respond to ATOD related issues. In doing so, DANA promotes practice based on the best available evidence, and promotes active involvement in research in ATOD related interventions, and other issues relevant to the ATOD field.

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Visit our exhibition booth.

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You are invited to the 1st Australasian Mental Health and Addiction Nursing Conference to be held in Auckland, New Zealand.Jointly organised by Drug and Alcohol Nurses of Australasia Inc (DANA) and Te Ao Maramatanga, the conference is themed “Close to Home”. People with drug and alcohol problems present in all areas of medicine, and their situations can often be complicated to manage. This conference will to provide a mechanism for practice development and an opportunity to promote critical thinking, analysis and ongoing discussion on best practice for people with drug and alcohol problems.

Abstracts can now be submitted!Consider submitting an abstract for an oral or poster presentation. Further information regarding the call for papers is available from www.conference.co.nz/mhn13

Registrations open January 2013Visit the conference website to keep updated about the conference program, to register your interest and for information about sponsoring and exhibition. The conference website is being updated regularly. Join us for what is planned to be a fantastic professional development opportunity in 2013.

Invitation from DANA to the 1st Australasian Mental Health and Addiction Nursing Conference Auckland, New Zealand, 19th – 21st June 2013

Te Ao MaramatangaNew Zealand College of Mental Health Nurses Inc

www.conference.co.nz/mhn13

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EBSCO Publishing is the leading provider of online nursing resources for hospitals, universities, nursing colleges and other medical institutions. CINAHL® and Nursing Reference Center™ (NRC) are EBSCO’s two core nursing resources, and together they provide nurses with their literature needs for nursing research, evidence based practice and continued professional development.

www.ebscohost.com/academic/cinahl-plus-with-full-text/ (for CINAHL)

www.ebscohost.com/pointOfCare/nrc-about (Nursing Reference Center)

Epilepsy Action Australia is Australia’s only national service provider offering vital support services. EAA provides a wide range of services for people with epilepsy, their carers, families & the broader community including, information and education, individual case management, seizure management planning, emergency medication training, seizure first aid, memory workshops, residential camps for families.

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Australian College of Nursing (ACN) will host the International Council of Nurses (ICN) 25th Quadrennial Congress in Melbourne, Australia.

Titled Equity and Access to Health Care the conference will be held from 18–23 May 2013. It is anticipated the ICN Congress will bring together approximately 3000 to 5000 nursing delegates from across the globe and will present a great opportunity for all nurses to expand their knowledge and expertise within an international nursing context.

The ICN Congress will feature many dynamic speakers including Her Royal Highness Princess Muna Al-Hussein, who will deliver the keynote address, and Anne Marie Rafferty, who will present the Virginia Henderson lecture. It will also feature a Student Nurses Assembly and the Florence Nightingale International Foundation Luncheon in support of the Girl Child Education Fund.

Come and visit us in the exhibition area or please visit www.acn.edu.au or www.icn.ch

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The Nursing and Midwifery Telehealth Consortia combines the support and expertise of the Australian Practice Nurses Association, Australian Nursing Federation, the Australian College of Midwives, the Australian College of Nurse Practitioners and Cranaplus. We aim to provide more equitable access to specialist services for patients in regional, rural, remote and outer metropolitan areas by enabling nurses and midwives to facilitate and contribute effectively to safe, high quality Telehealth consultations.

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Nursing Jobs is a niche Internet job board for nursing professionals seeking their next career appointment.

For employers nursingjobs.com.au offers an easy to use and cost effective method to reach out to the nursing profession.

Talk to us about your recruitment needs and lets us tailor a plan to assist you in meeting them.Come and have a chat during the conference!

Call 1300 588 277 Email [email protected] www.nursingjobs.com.au

NT Health Workforce offers a personalised support service to nurses that are interested in moving to the Northern Territory. Opportunities are available in a variety of primary health care settings. Grants and assistance for orientation, professional development, relocation and travel may be available.

www.gpnnt.org.au

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Nursing and Midwifery Telehealth Consortia – supporting APNA, CRANAplus, ANF, ACNP & ACM members

Visit us in the trade display area

at hub 13


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The Remote Area Health Corps (RAHC) recruits Australian registered, urban-based registered nurses, RN/midwives and other health professionals to undertake short-term paid placements in remote Indigenous communities in the Northern Territory as part of the effort to close the gap in Indigenous health outcomes.

www.rahc.com.au

SITA-MediCollect is the specialised Medical Waste management division of SITA AUSTRALIA, Australia’s leading Advanced Resource Recovery, Recycling and Waste Management company. We offer hospitals and health care facilities an integrated waste management collection, treatment, disposal, recycling and resource recovery service for all waste streams generated.

www.sitamedicollect.com.au

Terumo® is a research and development company that is recognised worldwide for product innovations and the outstanding qualities of its systems. Our products comply with the high standards of the medical world.

For more information on our range of products, visit our stand or simply call Toll Free: 1800 TERUMO (1800 837 866)

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The Public Health Association of Australia in partnership with Sexual Health and Family Planning Australia invite you to participate in the first Australian conference to bring together practitioners, policy makers, scholars, educators and others enthusiastic about improving the sexual and reproductive health of all Australians.

The conference will be an excellent opportunity to hear the most recent national and international research evidence and practitioner wisdom and to make your own contribution to implementation ideas foreshadowed in the new National Women’s and Men’s Health policies.

The Conference is relevant to:• sexual and reproductive health, community health, women’s and men’s health practitioners and scholars• other public health practitioners• nurses, allied health professionals and welfare workers• educators and teachers• women’s and men’s health consumer advocates

For more information visit: www.phaa.net.au

Registration Now Open

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Collaboration, integration and reform

Voice, views and values

Preparedness, response and recovery

Disaster Health Faculty

monthly topics and issues related to disaster health.

eDisasterhealth

Health and Wellbeing in Ageing Faculty

Rural Nursing and Midwifery Faculty

Community and Primary Health Care Faculty

New Generation of Nurses Faculty

Movement Disorders and Parkinson’s Nurses Faculty

Disaster Health Faculty

JOIN ONE OF ACN’S FACULTIES…

www.acn.edu.aufreecall 1800 061 660


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CONCURRENT SESSION 1 Thursday 18 October 11.15am – 12.30pm

STREAM 1 Applying Population Health Needs

Exploring innovative advanced practice and nurse led models which effectively and efficiently meet the health needs of refugees in a primary health care setting

Jan Williams MACN, Migrant Health Service

This presentation outlines the findings from a SA Premiers Scholarship study tour conducted by the Clinical Services Coordinator of a primary health care service for refugees and asylum seekers in Adelaide. The aim of the study tour was to examine models of advanced practise refugee health nursing in the UK, Canada and USA.

South Australia currently receives more than 2000 humanitarian refugees and asylum seekers a year, many of whom face significant health care challenges after arrival, including access to appropriate and timely health care. State funded refugee health services in Adelaide deliver a range of multidisciplinary programs to approximately 40% of SA’s annual intake. In order for SA Health primary health care services to respond to growing demand, the complexity of refugee health issues and pressures on the health system, different expanded models of health care are required.

Internationally, refugee health models include utilisation of advanced practice nurses through nurse led clinical programs focussing on health screening, capacity building, health literacy and health sector development. The role of refugee health nurses and primary health care Nurse Practitioners (NPs) as

primary care providers is well defined and pivotal to successful models of care. Several international primary health care programs for refugees and asylum seekers were visited as part of the study tour which was undertaken in April 2012.

The findings discussed include examples of successful RN and NP led primary care programs which have informed refugee health service development in SA to better meet the needs of a vulnerable and expanding population group. The presentation will discuss innovations such as ‘patient centred care planning’ coordinated by RNs, primary health care initiatives to build sector capacity and increase client access to mainstream services and developing a diverse and integrated workforce encompassing a range of nursing roles and scopes of practice.

Research and collaborative partnerships in promoting fertility awareness

Dr Wendy Abigail, Flinders University

Background This presentation will focus on current research findings on women’s fertility awareness where the findings have been transferred into the primary health care setting using an innovative approach.

Pertinent research A recent mixed methods project examined women aged over 30 year’s experiences of their fertility management prior to a termination of pregnancy in South Australia. This research identified three categories of women, those with a high (35.0%), low (22.2%), and nil (19.1%) levels of fertility management awareness. A successful grant application allowed collaborative primary health care partnerships with women’s health

CONCURRENT ABSTRACTS (Abstracts of conference presentations are printed here as submitted to ACN)

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organizations to develop electronic media vignettes based on these research findings. Focus group/s of nurses, allied health professionals and community women were conducted to develop appropriate scripts for the vignettes. Filming by professional film crew occurred at various locations. Four 30 second media clips have been produced as well as accompanying print materials.

Summary The process of promoting the project ‘Contraception – Is it working for you?’ involved many different strategies and timely opportunities. The research and project have been featured on ABC TV, radio, newspapers, women’s group newsletters, websites and journals. These new resources are being made available to General Practitioner centres, primary health care nurses/clinicians, and women’s health groups (including webpage links) for educational and training purposes throughout Australia and internationally. Additional avenues for promotion are continually being sorted.

To promote ongoing sustainability past the project, the ‘Southern Partnerships in Sexual and Reproductive Health’ network group has formed. This new group of interdisciplinary members from various organisations will continue to provide leadership on women’s sexual and reproductive health initiatives in the southern area of Adelaide.

Conclusion This presentation will provide an overview of the research findings, the processes of working in collaborative interagency partnerships, and lessons learnt about dissemination of the research findings and the project.

The race for excellence has no finish time

Karen Drury, Royal Flying Doctor Service

How do we assess how effective we are as health care providers in a primary health care setting? Are we responsive to the population health needs of our communities?

Reflecting on the success or failure of health care provision is paramount in the primary health care setting in order to make effective, positive change. Data collection alone is meaningless unless strategies are created and outcomes assessed to see if goals are achieved. To learn from mistakes and adapt practical strategies for change is at the basis of my work in primary health care in an indigenous community in remote Cape York.

The results of school screening over a three year period identified specific health needs and were used to guide health promotion and education in the community. Reflecting on the outcomes of screening meant assessing whether strategies were realistic and successful and adapting health promotion accordingly. In order to maximize health outcomes, interdisciplinary collaboration and service provision utilising external partners has increased dramatically.

2010 results identified undiagnosed heart murmurs, anaemia, skin sores, poor hearing health and poor dental health as key health issues in this age population.

Comparative data two years after the initial screening demonstrates that while some strategies were effective, we have not been totally successful in addressing all health concerns.

Positive change is linked directly with increasing health literacy and empowering the


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individual to make positive change in their life. Therefore the aim of addressing these health needs rests on the importance of community collaboration with increased communication pivotal to success. It must be remembered that health promotion and prevention alone is not enough to make effective change as we work within the context of the social determinants of health that are within indigenous communities.

STREAM 2 Influencing Policy and Practice

A national framework and toolkit to support advanced nursing development and sustainability in general practice (SANDS in GP)

Dr Kelly McGorm, Australian Primary Health Care Research Institute, Australian National University

Co-authors SANDS in GP Group

Introduction National Health Reform aims to shift the focus of services from secondary to primary care. The growing needs and expectations of the community, increased chronic disease, and workforce shortages require nurses working in the general practice setting to work in more advanced and expanded roles. Providing support to nurses in order to achieve this will be a challenge for Medicare Locals and education providers until it is clearly outlined what that support needs to be.

Methods Five teams were individually funded by the Australian Government and the Australian Medicare Local Alliance (AMLA) to contribute evidence-based resources towards a national framework and toolkit to support advanced nursing in general practice. Teams were based

in Divisions of General Practice/Medicare Locals and partnered with one or more academic institution(s). The five system level projects funded were: 1) individual nurse, 2) general practice, 3) governance, 4) leadership and management, and 5) primary health care organisations. The Australian Primary Health Care Research Institute (APHCRI, ANU) provided overall project management and developed the final framework and toolkit.

Results Organisational factors and activities impact on the development of the role of the advanced general practice nurse in terms of career framework, clinical skills, competency standards, definitions, education, evaluation, leadership and management, mentoring and research. A framework to support general practice nurses to work in advanced and extended roles has been developed to articulate this.

Conclusion A user-friendly, web-based resource has been developed for those working in Medicare Locals to provide practical information and support to all general practice nurses, especially those working towards or in advanced roles.

Nurse clinics in Australian general practice: Planning, implementation and evaluation

Lynne Walker MACN, Australian Medicare Local Alliance

Co-authors Julianne Crowe, Active Business Solutions

Jane Desborough MACN, Australian Primary Health Care Research Institute, Australian National University

Introduction This presentation will outline the structure of a newly created evidence based resource

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which is designed to assist nurses and general practices in setting up any model of nursing care, including nurse clinics. The Australian Medicare Local Alliance was funded by the Australian Government to undertake this project and was supported by the Australian Primary Health Care Research Institute and Active Business Solutions.

Methods An international literature review was conducted on the definition of a nurse led clinic suitable for the Australian general practice context and subsequently a set of characteristics for a nurse clinic developed for the purpose of the resource. Using the evidence based quality framework developed by the Royal Australian College of General Practitioners, the resource has been structured around the six domains identified as necessary for safe and effective health care in a general practice setting. They are patient focus, professionalism, capacity, competence, finance, information management and technology.

Case studies are used to highlight how implementation of nurse clinics can be successful and identify the benefits and challenges of this model of nursing care. To provide strategies for evaluation of nurse clinics, the resource contains an evaluation toolkit containing options for a patient survey, focus groups and clinical audits all of which can be undertaken by the practice.

Conclusion This resource aims to provide a structure to assist general practice nurses and their practices to plan, implement and evaluate nursing care provided. Ultimately, this will build on the evidence to support employment of nurses to provide safe, efficient and sustainable nursing care to their communities

Primary health care policy and practice: Sustaining older people living at home

Dr Deborah Hatcher MACN, University of Western Sydney

This presentation discusses the findings of a study supporting primary health care (PHC) as a guiding philosophy for policy and practice to sustain older people living at home.

Australia has an ageing population and it is expected that the number of people over the age of 65 years will continue to increase. As there are social and financial consequences associated with the ageing population, government policies are directed at sustaining older people to live in their homes. These policies have implications for individuals, families and communities.

The findings from this study examining the experiences of 21 older people aged 66 to 97 years who reside in their homes in Western Sydney, New South Wales, Australia, highlight how policies and practices based on a PHC approach can support older people to stay living at home.

Data revealed the strategies used by older people to enable them to remain living in their homes were Depending on inner resources, Maintaining wellbeing and Negotiating relationships and services. The success of these strategies is influenced by equity, participation and intersectoral collaboration, three principles of PHC.

These findings suggest policy and practice based on a PHC philosophy is required to support participation in decision making and the creation of services that build on the strengths of older people themselves. They identify a need for affordable and flexible service provision, and improved access to community venues and simple technology.


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Better intersectoral collaboration ensuring appropriate transport and facilities at large shopping complexes is also required.

STREAM 3 Safety and Quality in Clinical Governance

A tool to evaluate patients’ experience of nursing care in Australian general practice: Development of the Patient Enablement and Satisfaction Survey (PESS)

Jane Desborough MACN, Australian National University

Co-authors Dr Michelle Banfield, Australian Primary Health Care Research Institute

Associate Professor Rhian Parker, Australian Primary Health Care Research Institute

Background In Australia, primary health care is largely provided in the general practice setting, where in response to policy initiatives the presence of nurses has increased significantly. In order to evaluate the impact on patients of nursing care provided in general practice, The Australian Primary Health Care Research Institute (APHCRI) in collaboration with the Australian Medicare Local Alliance (AMLA) developed the Patient Enablement and Satisfaction Survey (PESS). The processes utilised to develop, refine and validate this tool are presented in this paper.

Methods The Patient Enablement and Satisfaction Survey (PESS) was adapted from two instruments: the Client Satisfaction Tool (Bear & Bowers 1998) developed using Cox’s (1982) interaction model of client health behaviour, a nursing framework; and the Patient Enablement Tool (Howie 1998), validated in the United Kingdom general practice setting. Refinement and validation of the survey for the Australian context was

achieved through conducting focus groups and pre-survey evaluation interviews with patients who access nursing services in a variety of general practice settings, and feedback from general practice nurses. The reliability of the survey was established through the use of test-retest and alternate form methods.

Results Feedback from patients and nurses resulted in fourteen changes being made to the draft survey, including the removal of questions, insertion of additional questions, changes to wording and the sequence of questions.

Conclusion The PESS incorporates elements of nurse-patient interaction; ‘affective support’, ‘health information’, ‘decisional control’, and ‘professional/ technical competencies’. It also measures patients’ experiences of accessing nursing care and time spent with nurses. Combined with other measures of patient satisfaction and enablement, the PESS provides a comprehensive and robust tool through which patient outcomes of nursing care in Australian general practice can be evaluated.

The perceptions of key stakeholders of a model of nurse-led chronic disease management in Australian general practice.

Professor Desley Hegney FACN, Curtin University

Co-authors Professor Chris del Mar, Bond University

Associate Professor Diann Eley, The University of Queensland

Professor Elizabeth Patterson FACN, University of Melbourne

Aims and objectives To explore perceptions of key stakeholders of a model of nurse-led chronic disease management in Australian general practice.

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Background The high prevalence of chronic disease in Australia presents a significant challenge for its health system, particularly in general practice. The Australian Government provides financial incentives for the employment of nurses to assist doctors in preventive screening and care planning. However, the feasibility, acceptability and sustainability of an Australian nurse-led model in chronic disease management in general practice had not been investigated.

Design and methods A concurrent mixed methods design with a 12 month intervention of nurse-led collaborative care in three general practices. Adult patients with Type 2 diabetes, hypertension and/or stable ischemic heart disease were randomised into nurse-led or standard care. Patients in the nurse-led arm of the study, participating doctors, nurses and practice managers were interviewed pre and post-trial. The data were thematically analysed.

Results Factors influencing perceptions were: importance of time; collaborative relationships; nurse job satisfaction, confidence and competence; patient self-management; and choice.

Conclusion Nurses provided chronic disease management that was acceptable to themselves, patients and GPs. However, patients wish to retain the right to choose their practitioner. When planning nurse-led care, the amount and quality of patient time with the nurse must be accommodated, as the personalised advice, support and motivation helped patients to self-manage their conditions. The collaborative involvement of doctors is intrinsic to patient acceptability of nurse-led care. The role facilitated job satisfaction, and therefore

workforce retention and growth of this nursing speciality.

Relevance to clinical practice Critical factors to this model of nurse-led chronic disease management are: sufficient nurse time and private consultation space; collaborative relationships between staff; patient choice of practitioner; and ongoing continual professional education.

How do we know?

Dr Heather Moore FACN, Cape York Hospital and Health Service

Orientation programmes provided to nurses, their content, delivery and focus on health outcomes provide the direction for this paper. Orientation is central to the practice of a new employee and may be viewed as both an intervention and an evolving body of knowledge. It is also responsive to the current health care climate with its emphasis on patient safety and health outcomes.

This paper explores the orientation experiences of nurses working in remote communities and the systems and resources available to them in their delivery of safe care.

Induction and orientation have been adopted as acceptable ways of introducing new employees into an organisation. Employees have in fact come to accept orientation as a right and most look forward to learning about the organisation and how things are done.

Orientation provides an opportunity for mandatory training needs to be ‘ticked off’ and the clinical procedures for more specialised topics such as the deteriorating patient to be discussed. There is also a social aspect to orientation as each new employee starts to make sense of the requirements of a new work environment.


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However what happens when you are an agency nurse sent to a remote indigenous community who is expected to ‘hit the ground running’ from day one having never been in the community before? Alternatively you might be the new nurse who, after completing mandatory requirements on day one, is left on your own without support on day two.

The stories of several nurses will be discussed and the way in which both they, and their employer, dealt with the situation that they found themselves in as a ‘new’ nurse. Common characteristics and qualities explicated from their stories provide an overview of orientation that goes beyond the merely technical or the ‘passing on’ of information.

CONCURRENT SESSION 2 Thursday 18 October 3.30pm – 4.45pm


The development of a primary health care framework for a neurological support service

Julie Crack FACN, Launceston General Hospital

There is an estimated 2,500 Tasmanians living with Parkinson’s disease. This condition impacts financially, emotionally and physically on not only the person affected by the disease but also families and carers. In September 2010 the Minister for Health in Tasmania responded to longstanding lobbying by the Parkinson Support Group and announced funding of 1.6 million dollars over 4 years for the recruitment of four Specialist Nurses to improve the treatment of people with Parkinson’s disease and other neurodegenerative disorders.

This paper will discuss the process of developing a framework utilising primary health care principals that emphasises every person’s uniqueness and places the individual and their family at the centre of the care model. The framework helped prevent nurses becoming so immersed in their roles that they lack an objective reference for what constitutes primary health care. The importance of social networks and relationships and the emotional toll affecting people when dealing with a chronic condition cannot be overlooked. The framework requires nurses to weave multiple strands of professional knowledge and flexibility into their practice in order to optimise client wellbeing and quality of life. Neurological Support Nurses need to recognise that health is both complex and non-linear and that all people bring with them a diversity of experiences and need to be approached in different ways. The framework recognises personal care management has multiple, simultaneous and complex outcomes

The number of people diagnosed with a chronic debilitating condition is increasing. This paper will stimulate discussion on the challenges faced by nurses involved in setting up a new service based on self-referral, the promotion of self-management and the challenge to evaluate the service using the key criteria that the service contributes meaningfully to the client / cohort care outcomes.

Roaming education and community health

Julie Fereday MACN, Central Institute of Technology

‘Reach’ aims to provide an innovative option for the delivery of primary health care (PHC) services to the community whilst expanding upon the current clinical training models

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used. The model of care for ‘reach’ has been developed to meet the key elements of the National Primary Health Care Strategy a key component of the Australian Government health reform agenda. A number of arms make up the project including satellite PHC centres, community population health checks and the integration of nurse practitioner clinics.

A range of PHC services are provided at onsite satellite clinics for the socially disadvantaged, homeless, migrant population and aged. Partnerships with agencies have been established and these have formed the foundation and building blocks for the development of the service delivery model. Services include health assessment and screening, health education, social and emotional wellbeing support, wellness sessions and support with the management of chronic disease.

Services provided through the satellite PHC centres have improved the access to PHC services for participants, engaged participants in the self-management of chronic disease and have helped participants to identify and achieve health goals.

The community population health checks provide student nurses with the opportunity to develop communication, health assessment and problems solving skills whilst providing a very important exposure to the PHC sector – an often under-utilised and neglected area in nursing education programs. It has also enabled members of the community to undertake health checks and access health education in an easily accessible environment.

The integration of the nurse practitioner model into ‘reach’ is planned for 2013. They will work in a collaborative arrangement with GPs who currently provide services for these groups.

An overview will be provided of the research, needs analysis, implementation, collaboration and sustainability model for the project.

Effectiveness and acceptability of nurse managed long term condition planning in primary care

Professor Jeffrey Fuller FACN, Flinders University

Co-authors Dr Mark Morgan, Greater Green Triangle University Department Rural Health

Dr Michael Coates, Greater Green Triangle University Department Rural Health

Kate Schlidt, Greater Green Triangle University Department Rural Health

Professor James Dunbar, Greater Green Triangle University Department Rural Health

Professor Prasuna Reddy, University of Newcastle, Centre for Rural Remote Health

Sharon Parker, Flinders University

The increase in co-morbid long term conditions is shifting health care towards collaborative models located in primary care and community settings. The objective of this study was to determine the effectiveness and acceptability of nurses as case managers for primary care clients with co-morbid depression and diabetes or heart disease.

Methods 1. A rapid review on the evidence of nurses’ role in care coordination in primary care.

2. A cluster randomised wait list trial in 11 Australian primary care clinics involving 12 month follow up of 404 adult clients diagnosed with diabetes or heart disease with depression. The intervention involved training and resourcing nurses as case managers against best practice guidelines to assess, facilitate goal setting, educate


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and refer clients as needed. Change in levels of depression was the main effectiveness outcome.

3. Interviews and focus group with practices nurse and GPs post the trial to determine the acceptability of the model.

Results Intervention clients had a greater decrease in PHQ9 depression scores at six months (3.9 cf 2.8, p=0.012), with exercise rates and referrals for mental health assistance also greater. All clients identified at suicidal risk or unchanging/ worsening depression by the nurse were provided an appropriate response according to the stepped care protocol. Interviews revealed the model was acceptable by providing an enabling structure for the nurse. Goal setting with patients extended the nurses’ role and enabled enhanced communication with clients and with other health professional inside and outside of the primary care clinic.

Conclusion Nurses undertake long term condition care management probably more than any other discipline. With the provision of training and resources against best practice guidelines, this study found client, nurse and other team member benefit in a model of nurse managed care planning for clients with comorbid depression and diabetes or heart disease.


Primary health care as a philosophical framework for nursing education: Rhetoric or reality?

Dr Sandra Mackey MACN, University of Western Sydney

Co-authors Dr Deborah Hatcher MACN, University of Western Sydney

Associate Professor Michelle Cleary, National University of Singapore

Professor Brenda Happell, Central Queensland University

This presentation will examine the philosophical shift to a primary health care (PHC) framework in pre-registration nursing curricula and discuss factors identified in the literature which may hinder or promote full integration of PHC as a course philosophy and a 21st century approach to professional practice.

Nurse education has traditionally focused on preparing graduates for practice in the acute care setting. In the 21st century however, there is increasing emphasis on preparing nurses for practice in the community setting, with a focus on illness prevention and health promotion. This is driven by growing evidence that health systems are not responding adequately to the needs and challenges of diverse populations, as well as economic imperatives to reduce the burden of disease associated with the growth of chronic and complex diseases and reduce the costs associated with the provision of health care. Nursing pre-registration programs in Australia and internationally are increasingly adopting PHC as a curriculum model for preparing graduates with the necessary competencies to function effectively in both the community and acute care settings.

The evidence suggests that when adopted as a program philosophy PHC is not well integrated across the curriculum, but presented as a stand-alone topic. Orientation of curricula toward a PHC philosophy requires fundamental attitudinal change in how nursing, health and health care are conceptualized. Faculty require preparation and support to develop units of study consistent with curriculum philosophy. Furthermore, learning outcomes and practice

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competencies need to be oriented toward PHC, health promotion and community based care.

In order to enhance graduate preparation for practice in both acute and community settings pre-registration nursing programs need to comprehensively consider and address the factors impacting on the curricula integration of PHC philosophy.

Barriers and enablers in general practice to nurses working in advanced roles: A multiple case study

Professor Karen Francis FACN, Charles Sturt University

Co-author Dr Judith Anderson FACN, Charles Sturt University

A funded multiple case study research project was undertaken to identify the barriers and enablers in general practice to nurses working in advanced roles. Five geographically diverse general practice settings (RA2-5) were utilised to identify the current role/s, scope of practice of nurses and the barriers and enablers to advancing their practice. Data generation involved: mini environmental scans of the communities in which the general practices were located, activity based diary data produced by the nurses, interviews and focus groups with practice principals, practice managers and practice nurses. Descriptive statistical and thematic analysis techniques were used to make sense of the data. Findings revealed that individual, organisational and structural/social level barriers and enablers to advancing nursing practice were present in general practices. As individuals, practice nurses were enabled by their personal motivation; desire to achieve patient outcomes, ability to reflect

on practice, ability to create opportunities and their own personalities. Other aspects of their personalities however were barriers together with their personal circumstances and workloads. Organisationally, knowledge about advanced practice, a supportive group or network, an encouraging and supportive organisational structure, other staff to delegate work to and an underlying knowledge of the system were enabling factors. Poor team support, lack of knowledge of what nurses could do, task oriented nursing roles and isolation from other practice nurses were highlighted as organisational barriers. At the structural level guidelines and pathways which demonstrate expectations for advancing practice, funding that promotes advancement of nursing practice were enabling factors whereas fee for service arrangements were perceived to be a barrier to advancing practice. Resources developed as an outcome of the project included: 1) a framework for advancing nurses in general practice; 2) an advanced practice nurse job description, 3) recommendations of activities for general practices to help support the development of advanced practice.

Wound prevalence amongst the metropolitan EACH Client populations, Silver Chain

Susannah Mulligan, WoundsWest

Co-authors Vicky Brewer, Silver Chain (Co-Speaker)

Professor Jenny Prentice, WoundsWest

Lyn Scott, WoundsWest

Purpose This paper describes methods used to determine the epidemiology of wounds within Silver Chain’s metropolitan Extended Aged Care at Home (EACH) Client populations in February 2012.


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Methods In February 2012, all consenting metropolitan clients enrolled in an EACH package with Silver Chain underwent a skin examination to determine if the client had a wound. Wounds were categorised into 6 groups: acute wounds, pressure injuries, skin tears, burns, or malignant and other wounds. Wounds not documented within 24 hours of admission were considered service-acquired. Surveyors were educated and tested for competency in recognising and classifying wounds, staging pressure injuries and audit processes to ensure consistency in audit and data collection methods comparable with that used in WA public hospitals.

Results In total, 60 clients consented to a skin inspection, a response rate of 96.8%. Results identified a wound prevalence of 43.3%, similar to that of in-patient populations at WA public hospitals (41.6%) and a community-acquired wound prevalence of 41.7%. Skin tears were the most commonly occurring wound; a prevalence rate of 45.1%. Further results will be reported in terms of other wound prevalence rates as well as pressure injury prevention, and compliance with pressure injury guidelines. Recommendations for lowering the prevalence of preventable community-acquired skin tears, pressure injuries and improving wound management will be discussed.

Conclusion Data collected on wound prevalence and community-acquired wound prevalence will facilitate strategic direction in terms of educational requirements for staff, guidelines for clinical care and resource allocation for pressure devices to Silver Chain.

STREAM 3 The Role of the Consumer

An exploration of the barriers and facilitators of community access and social inclusion for disabled and socially-marginalised population groups

Nick Arnott MACN, EACH – Social and Community Health

This presentation will discuss the results of a review of research into the barriers and facilitators of community access, participation and inclusion for socially marginalised population groups. People residing in Pension-level Supported Residential Services in Victoria were used as a reference point for this review, recognising that the resident profile of such facilities shows a close correlation to various disability and marginalised population groups that commonly reside in community-based settings across different national and international domains.

Baum (1999) described a new approach to public health, which emphasises social justice, self-determination, participation, and community capacity-building. Within this paradigm, social inclusion and community participation are recognised as important precursors to positive health and wellbeing, and there is now compelling empirical evidence to support this assertion.

Conversely, it is now widely accepted that poverty, inequality, social exclusion, low levels of communal and civic participation, substandard or inaccessible public health and leisure facilities, and poor access to affordable housing and transport all impact negatively on health outcomes. It is also accepted that people with disabilities, mental ill-health or complex needs are more likely to experience, and be affected by, these factors.

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This review synthesised data from 20 research papers, with the identified barriers and facilitators being summarised into four key themes: (1) person-specific factors; (2) societal factors; (3) physical, structural and environmental factors; and (4) service-system practice and process factors.

Through a discussion of these themes, this presentation aims to reorient our thinking and planning toward this important health determinant. Various ideas and strategies will be presented to inform and stimulate system and practice improvements that contribute to improved community access, inclusion and participation for socially-marginalised population groups.

Getting to know you: Understanding the work of nurses in Australian general practice

Lynne Walker MACN, Australian Medicare Locals Alliance

Co-authors Associate Professor Rhian Parker, Australian Primary Health Care Research Institute, Australian National University

Dr Nasser Bagheri, Australian Primary Health Care Research Institute

Dr Ian McRae, Australian Primary Health Care Research Institute

Dr Ginny Sargent, Australian Primary Health Care Research Institute

Background The Australian Primary Health Care Research Institute (APHCRI) in a collaboration with Australian Medicare Locals Alliance (AMLA)were funded by the Department of Health and Ageing (DoHA) to develop a survey to increase the understanding of the work, education and careers of nurses working in general practices or Aboriginal medical services in Australia.

Aim The survey aimed to answer the following key questions: what are the demographic characteristics of nurses working in the general practice; what hours do they work and what is their remuneration; why do they work in general practice; what education and training do nurses undertake to prepare them for their role; what tasks do they currently undertake as part of their role; what other activities could they undertake to serve the needs of their patient population and; what are their perceptions regarding their careers in primary health care.

Method A technical review, of published and unpublished materials, was carried out to identify descriptions of existing/previous nursing workforce surveys. A survey was developed and stakeholder feedback sought. The survey was also tested with general practice nurses and was sent to a representative sample of practices in June/July 2012. The sample was proportionally representative of rural, remote, regional and urban practices.

Results 798 surveys were returned. Data on the specific tasks undertaken by practice nurses, their educational preparation for those tasks and their satisfaction with their work will be presented. Data on their remuneration and how this is related to their tasks, education and work satisfaction will also be discussed.

Conclusion The survey provides the first comprehensive data set in Australia on practice nurse tasks, education and work satisfaction and will support the development of policies to support general practice nurses.


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Engaging consumers in the aged care nurse practitioner journey

Associate Professor Rosemary Saunders, University of Western Australia

Co-authors Sheila Craik, Bethanie Group Inc (Co-Speaker)

Hayley Haines, University of Western Australia (Co-Speaker)

Anne McKenzie, University of Western Australia (Co-Speaker)

The focus of this presentation will be sharing the journey and the process of engagement of consumers as part of the development of a Nurse Practitioner service in aged care.

The Bethanie Group Inc was awarded funding by the Department of Health and Ageing (DoHA) in 2011 as part of the national Nurse Practitioner – Aged Care Models of Practice Program. The project funded under this program has enabled the implementation a Nurse Practitioner service in aged care that has aimed to improve access to primary health care for clients of residential and community aged care service.

The initiative is part of a larger project “Beyond the Teaching Nursing Home”. The Nurse Practitioner service is located within a clinical learning environment of the Teaching Nursing Home and provides a community clinic for residents in the two co-located hostels and the co-located Independent Living Units (ILU) as well as clients in the wider community. The NP service has both a preventative and clinical care focus for individuals and groups. The NP works within clinical protocols to provide care including assessment, diagnostics, referrals, procedures and prescription of medication to help support the GP as well as nursing and other staff within the residential aged care setting to provide a quality service through

a the sharing of clinical care responsibility. Health Promotion activities including Continence, Falls Prevention, and Medication Awareness are also planned to be delivered.

Consumer and community engagement has been a key part of establishment of the Nurse Practitioner Service. Consumers and communities including local stakeholders were engaged through community conversations and community newsletters. Residents are also actively engaged by participation on a project reference group.

CONCURRENT SESSION 3 Friday 19 October 11.00am – 12.15pm


Improving access to coronary artery bypass grafts for aboriginals living in remote areas in the top end of the Northern Territory

Deborah Geary, Royal Darwin Hospital

Co-authors Dr Marcus Ilton, Royal Darwin Hospital

Dr Nadarajah Kangaharan, Royal Darwin Hospital

Suresh Sharma MACN, Royal Darwin Hospital

Jeffery Tinsley, Royal Darwin Hospital

Introduction Cardiovascular disease (CVD) is the leading cause of mortality for Indigenous Australians. The Northern Territory (NT) has a significant Aboriginal population, which 72% reside in remote areas. Whilst mortality from CVD can be delayed by surgical interventions such as Coronary Artery Bypass Grafts (CABG), this is not currently available within the NT. Interstate travel for remote dwelling Aboriginal people is a significant logistical challenge, given

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remoteness, lack of communication, transient health workforce, competing priorities for clinical staff and individuals. This results in minimal CABGs being performed on remote dwelling Aboriginal people. In 2009, funding under the “Closing the Gap” initiative ensured Aboriginal people in the NT received improved access to health care. A nurse was employed to streamline and coordinate care for those requiring surgical intervention in a culturally safety and to ensure clinical follow-up occurs resulting in better health outcomes.

Method We describe the numbers of Aboriginal people in remote areas undergoing CABG from 2009 to 2011, and the number of post-surgical reviews conducted by the nurse prior to returning to their home community from 2010. We also discuss the number of cardiology reviews attended and the number of discharge summaries forwarded to communities.

Result In 2009 30 clients travelled, 27 clients had cardiology R/V, 2010 30 clients travelled, 28 had nurse assessment, 26 had cardiology review and in 2011 73 clients travelled, 60 had nurse assessment, and 42 had cardiology follow up. All clients interstate discharge summaries where forwarded to their CHC.

Conclusion Remote indigenous clients now receive access to services routinely provided to urban clients. All remote clients receive cardiology review appointments and Community Health Clinics are receiving discharge summaries prior to the client arriving back in their communities. This ensures improved access, quality of care and appropriate ongoing medical care for remote indigenous clients.

Breathe – Community Based Respiratory Program

Frank Nelson, Northern Sydney Home Nursing Service

Co-author Wendy Siddall, Northern Sydney Home Nursing Service (Co-Speaker)

Prior to 2002, Chronic Obstructive Pulmonary Disease patients had no dedicated program of support. Patients were frequently presenting to hospital, increasing financial pressure for both patients and the health system. NSW Health provided funding to address this situation through the Chronic and Complex Care Program initiative (2002).

A community nursing service, an Acute Post Acute Care (APAC) team and pulmonary rehabilitation services joined in creating a program to assist in the management of the COPD patient. The program is three tiered, to provide hospital substitution, service provision of a pulmonary rehabilitation program and ongoing support and monitoring.

The community nursing service component comprises of a Clinical Nurse Consultant (Program Manager), a small multidisciplinary team (several Physiotherapists and an Occupational Therapist and a Community Care Aide. This organisation (comprising of 200 clinical staff, services a metropolitan Local Health District via 7 area based centres) utilising their community nursing team by providing long term respiratory monitoring and support to the patient group, including symptom and palliative management as part of the care continuum. The Community Care Aide assists patients to attend medical appointments and runs several walking groups for patients post Pulmonary Rehabilitation.


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APAC manage the hospital substitution arm of this team by providing intensive short term respiratory management with the aim of avoiding hospitalisation wherever possible and clinically appropriate. The team comprises of Registered Nurses (RN), and Allied Health.

Pulmonary Rehabilitation is managed by physiotherapists who run this 8 week group program in several locations. Included in this program is a clinical psychologist (part time), providing home based therapy, including cognitive behaviour therapy and smoking cessation assistance.

The combined effort of the teams have produced a significant reduction in hospital presentations of 45% from 1999- 2009 with improved patient outcomes and quality of life indicators. (www.healthstats.doh.health.nsw.gov.au)

Applying population health needs in acute emergency setting

Doris Graham, SilverChain

Co-authors Coralie Spark,SilverChain (Co-Speaker)

Cheryl Branch, SilverChain

Svetla Gotchev, SilverChain

Joanne Rigby, SilverChain

This will be an oral presentation to address the integrated provision and interdisciplinary collaboration that can be achieved by the Primary Health Care Services that can reduce unnecessary hospital presentations and admissions.

On average, we care for 60-70 patients per day who would otherwise be hospitalised for conditions that can be managed with 24-hour medical governance at home.

This service is a 24/7 hospital avoidance service available in this region that will provide advanced clinical assessment for patients who are referred for non-inpatient acute or complex care services. As a part of the assessment it may be necessary to provide immediate care interventions to address an acute clinical need and may lead to discharge or admission to other services, including in-patient facilities if required.

We receive more than 250 referrals from general practitioners (GPs) and medical specialists for sub-acute conditions every month. Without our sub-acute in-home care services, it’s likely that these patients would require ongoing treatment in a public inpatient or outpatient facility.

More than 2,200 people were assessed by our emergency response team in their home or residential aged care facility. This reduces the demand on our community’s ambulance service and the emergency departments in local hospitals.

In conclusion, every year, thousands of people benefit from our community focused approach to care. That makes a huge difference to patients and their families, as well as the broader WA community – this service alleviates the strain on our finite public health and hospital resources.

This is a virtual hospital in the community. Our team delivers integrated and co-ordinated acute and sub-acute care services for patients who would otherwise require hospitalisation, providing a host of benefits for patients and their families, as well as benefits for GPs and Perth’s health system.

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Closer to home – Moree Oncology and Chemotherapy

Bronwyn Cosh, Moree District Health Service

Aim To increase the availability and complexity of chemotherapy treatments delivered on site by establishing an Outreach Oncology Service at Moree District Hospital.

Problem People with cancer who live in rural areas have up to 35% poorer survival rates than people living in major metropolitan centres. Rates of mortality from cancer are up to 45% higher for Australian Aboriginal people. Treatment disparity accounts for most of the survival deficit.

Moree persons living with cancer had to travel to the Rural Referral Hospital (a 600km round trip) to access Oncology Services for review and prescription of chemotherapy before starting their treatment regime. Limited chemotherapy service was available at Moree for patients with established treatment regimes.

Moree has a large (33%) Aboriginal population and the community identified that lack of specialised cancer service access had a significant personal, emotional and financial impact

Solution A working party, which included consumer representation, was established to implement a monthly Outreach Oncology Clinic in Moree. The Moree Outreach Oncology Clinic operates monthly, with telehealth consultation support between clinic sessions.

The Moree community donated funding for resources to support the clinic, including chemotherapy nurse training; clinic medical equipment and clinic ‘fitout’

Conclusion The establishment of an Outreach Oncology and chemotherapy clinic at Moree District Hospital has resulted in a significant increase in service access for rural and Aboriginal people with cancer.

� Since Outreach Clinic established in 2010, there have been over 350 patients seen in their local community

� Bi-weekly chemotherapy treatments provided at Moree have increased by 36%

� Additional cancer support resources (Oncology Registrar and Social Worker) available

� Access to local services have saved Moree people 1.8 million km and 16, 740 hours travel time Jong,V., Vale, P.,Armstrong, BK,(2005), “Rural inequalities in cancer care and outcomes”, Med J Aust 2005; 182(1): 13-14

Linking cultural safety and clinical governance during an international clinical placement

Hazel Rands, Griffith University

Co-author Dr Elisabeth Coyne MACN, Griffith University

International clinical placements to developing countries provide students with opportunities to gain insight into health care systems where the patient safety agenda is often less apparent than in Australia, where it is integral to clinical governance. In domestic practice placements, students often struggle to see the bigger picture relating to health policies and can be overwhelmed by the


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complex bureaucracy of clinical governance. Subsequently, students may not gain sufficient understanding of overarching quality and safety issues or an adequate grasp of cultural safety. Griffith University offers undergraduate nursing students a unique Primary Health Care placement to a community development project in Laos, where students observe basic clinical governance in a setting where cultural safety is pivotal.

The provision of health care to remote Lao villages places students out of their comfort zone, but they quickly adapt as they learn more about local culture and beliefs. As students gain insight into community health issues and observe the low levels of health literacy, they understand the importance of providing culturally safe health care. Students are given significant responsibility in planning and resourcing mobile clinics and use a family based approach to undertake health assessments and provide basic nursing care. They develop an appreciation of the significant planning with community leaders and health workers to ensure sustainability of the project, by continuing to build relationships and increase local capacity. In this context, both planning and implementation are less mired in bureaucratic structures than in the Australian context.

In addition, the primacy of cultural safety and client focused care are visible throughout all stages of clinical governance. Experiential student learning from observing basic clinical governance in a less complex system consolidates their knowledge of important community concepts, which are then applicable to providing quality patient care within the Australian health system.

Supporting integrated service provision: How does care coordination by registered nurses “fit” within the general practice context?

Associate Professor Winsome St John FACN, Griffith University

Co-authors Professor Elizabeth Kendall, Griffith University

Dr Carolyn Ehrlich MACN, Griffith University

Aim The aim of this study was to develop understanding about how a registered nurse-provided care coordination model can “fit” within organisational processes and professional relationships in general practice.

Background In this project, registered nurses were involved in implementation of registered nurse-provided care coordination, which aimed to improve quality of care and support patients with chronic conditions to maintain their care and manage their lifestyle.

Method Focus group interviews were conducted with nurses using a semi-structured interview protocol. Interpretive analysis of interview data was conducted using Normalization Process Theory to structure data analysis and interpretation.

Results Three core themes emerged: (1) pre-requisites for care coordination, (2) the intervention in context, and (3) achieving outcomes. Pre-requisites were adequate funding mechanisms, engaging organisational power-brokers, leadership roles, and utilising and valuing registered nurses’ broad skill base. To ensure registered nurse-provided care coordination processes were sustainable and

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embedded, mentoring and support, as well as allocated time were required. Finally, when registered nurse-provided care coordination was supported, positive client outcomes were achievable, and transformation of professional practice and development of advanced nursing roles was possible.

Conclusion Registered nurse-provided care coordination could “fit” within the context of general practice if it was adequately resourced. However, the heterogeneity of general practice can create an impasse that could be addressed through close attention to shared and agreed understandings. Successful development and implementation of registered nurse roles in care coordination requires attention to educational preparation, support of the individual nurse, and attention to organisational structures, financial implications and team member relationships.

STREAM 3 Safety and Quality in Clinical Governance

An electronic solution for safe client outcomes

Sandy Ryan, Hunter New England Local Health District

Following the dramatic expansion of the Community Acute Post Acute Care (CAPAC) Service, the management team was faced with a challenge of managing in excess of 150 community based clients over a large geographical area. A risk management strategy was required to ensure client safety and to support the clinical managers in the daily allocation of client visits.

The aim of the project was to ensure client safety through the provision of efficient and

reliable service delivery, via the successful implementation of an electronic planning and scheduling system called eScheduler.

CAPAC is a community based service (with 3 programs – Hospital in the Home, Healthy at Home, Transitional Aged Care Program) providing an early discharge/hospital avoidance model of care. CAPAC has a large, complex and variable client population requiring caseload management and care planning on a daily basis. The eScheduling project was initiated in response to the unacceptable risk of overlooking client visits by manually performing these tasks in a busy and challenging clinical environment.

Following implementation of the eScheduler, benefits have included:

� Automated client information

� Time efficiencies and reduced risk from no longer relying on manual transcription

� The ability to sort clients, clinicians and geographies to support client allocation

� Highlighted discrepancies in client management which can be rectified

Implementation of the eScheduler has met the aim of the project by ensuring safe client allocation with the additional unforeseen benefits to the users, which include a reduction in clinical manager stress levels, staff access to a printed allocation lists and reporting mechanisms.


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Sustaining quality in secondary school nursing practice

Diana Guzys, La Trobe University

Co-authors Melanie Bish, La Trobe University

Associate Professor Amanda Kenny, La Trobe University

This interpretive descriptive qualitative study explored secondary school nurses’ perceptions of factors which impact on their role and their views on how their role can be best supported. Nine secondary school nurses from four Department of Human Services regions in Victoria, Australia were recruited and participated in semi-structured, in-depth interviews. Purposive sampling was used, requiring participants to have had a minimum of two years experience as secondary school nurses. Data was thematically analysed.

The key findings that emerged from this study indicate that Victorian secondary school nurses perceive that the effectiveness and quality of their practice is influenced by the environment in which they work. The nurses suggested that quality practice was supported when the complexity and expertise required for the role was duly recognised, nurses had the appropriate knowledge to undertake the role, as well as a suitable mechanism for facilitated reflection on practice. Critical companionship has been suggested as a model of facilitated critical reflection on practice which could address these concerns.

The Victorian Secondary School Nursing Program and similar school nursing programs have developed in recognition of the positive role nurses can have in reaching and working with young people. The health concerns targeted by secondary school nurses are multifaceted and diverse, reflecting the life

issues and multiple areas of decision making faced by young people during this stage of life. If we truly believe and are committed to primary health care and preventative health, as a means of promoting good health and addressing health inequities, then it is crucial to provide an effective, accessible and flexible service to young people. Failure to support secondary school nurses in this vital role through the provision of a practice environment which enables quality practice is myopic, socially irresponsible and suggests a lack of commitment to the healthcare reform agenda.

Preparing new to remote health professionals – lessons learned from the RAHC experience

Fiona Wake MACN, Remote Area Health Corps

Remote Area Health Corps (RAHC) is part of the Australian Government’s Stronger Futures Initiative to expand the delivery of primary health care (PHC) services in the Northern Territory (NT) to assist in closing the life expectancy gap between Indigenous and non-Indigenous Australians.

RAHC was established to supplement the recruitment efforts of the health services in the NT. RAHC was specifically designed to attract and mobilise urban based health professionals (HPs) to work in remote Indigenous communities in the NT. These placements are short term, from 3 weeks to 12 weeks.

RAHC ensures HPs are appropriately credentialed and provides cultural and clinical training as well as ongoing support while on placement. All logistical arrangements are managed by RAHC.

RAHC has delivered over 1500 placements in remote Indigenous communities. Experience


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has shown that well organised and supported short-term placement, particularly on a repeat basis, provide a valuable addition to health service delivery. Also, RAHC’s high repeat rate is evidence that our preparation of the HP is effective and the remote experience for most is rewarding and satisfying.

This presentation will:

1. How RAHC encourages HPs to self-determine their appropriateness for remote practice

2. Explain the importance of credentialing and preparation for the remote transition

3. Explain the development and benefits of RAHCs e-learning modules in preparation for a remote placement

4. Outline the importance of cultural and clinical orientation for the HP prior to their first remote placement

5. Analyse how feedback has influenced RAHC’s preparation and support processes

6. Discuss the role of the Clinical Educator for the new to remote HP

RAHC’s lessons have been valuable and allowed us to successfully respond to staffing requirements of the remote PHC setting. The preparation and support RAHC provides in collaboration with the Health Services has enabled us to achieve this successfully.

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If you’re in the business of caring for the aged, you’ll realise there’s a flip side to managing medication use.

And that, you’d find, could be a bitter pill to swallow.

Health care providers aspire to deliver top-line care to the aged through practising QUM while the financial controllers aim to return healthy bottom lines. And increasingly, every aged care facility is faced with the challenge of reconciling these goals.

The good news is, you can rely on Australian Medicines Handbook Drug Choice Companion: Aged Care Online (ACC Online) to help you achieve both without compromising the quality of QUM or sacrificing fiscal control.

The increasingly popular reference helps to avoid errors and prevent wastage, hence saving the facility from incurring unnecessary expenses. It contains easy-to-access, concise and independently reviewed information on more than 70 specific conditions common in older people. These include dementia and management of behavioural symptoms, cardiovascular diseases, fall prevention, osteoporosis, palliative care issues, COPD, insomnia, depression as well as some broader concepts. Drug choices are ranked as first line/other options or arranged by disease severity or symptoms, with dosing information specifically for the older person.

www.amh.net.au

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POSTER ABSTRACTS (Abstracts of poster presentations are printed here as submitted to ACN)

1. A toolkit to support the evaluation of nursing care in general practice


Co-author Associate Professor Rhian Parker, Australian Primary Health Care Research Institute

Background Nursing scope of practice is expanding in Australian general practice. Evaluation of these extended roles is essential to ensure the quality and safety of the care provided and to maintain a patient centred approach. This paper will describe a toolkit developed for the evaluation of nursing care in Australian general practice.

Methods A literature review examined methods employed internationally to evaluate primary health care nurse clinics, informing the scope and requirements of the toolkit. Framed within an ‘evaluation cycle’, a toolkit encompassing all of these methods was designed to guide and support the evaluation of nursing care in Australian general practice.

Principal findings Common to all evaluations were clinical audit, surveys examining patient satisfaction and other health outcomes, and interviews and/or focus groups with patients, clinicians and other stakeholders. The evaluation toolkit follows a systematic cycle of evaluation, each step of which is described and discussed. Keeping in mind the busy nature of general practice and the associated need for the toolkit to remain simple and accessible, it was

designed to support a brief, specific evaluation or a broader, triangulated evaluation, dependent on the time and resources available.

Conclusion The toolkit provides a sound foundation from which on the ground research can occur, empowering clinicians and practice managers to evaluate, inform and improve practice locally, or if more broadly applied, to inform practice and policy related to nurses in general practice at the Medicare Local or national level.

2. Community health networks: governance challenge for managers

Professor Jeffrey Fuller FACN, Flinders University

Care for long term conditions requires sustained and changing input from multiple services. In such contexts, community health networks are organisational forms that are proposed as solutions to the problem of un-integrated health care. The aim of these studies was to advance theoretical and methodological work that could assist managers to develop and then maintain quality governance in health service networks.

Methods Two Australian participatory case studies were conducted, examining management of service networks in community health. One examined networks in Aboriginal mental health and diabetes, while the other examined the colocation of services a new urban community health centre to better manage chronic illness.


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Findings The case study networks varied in management type, level of member commitment and in their joint working processes. Network analysis revealed instabilities, that while difficult for managers, did show the need to regularly resolve conflict, reaffirm commitment and articulate accountability to network goals. Some evidence from other studies shows that networked servicing is helped if members’ first focus on the intended network products rather than get stuck on their value differences.

Conclusion Understanding how to develop networks will help managers as they attempt to bring the range of health and human services together that often operate with different assumptions about health care and team values. Participatory network analysis was a useful tool for managers but this needed careful facilitation to ensure constructive outcomes and the wise use of boundary spanners.

3. Development of the Patient Enablement and Satisfaction Survey (PESS)


Co-authors Dr Michelle Banfield, Australian Primary Health Care Research Institute

Associate Professor Rhian Parker, Australian Primary Health Care Research Institute

Background In Australia, primary health care is largely provided in the general practice setting, where

in response to policy initiatives the presence of nurses has increased significantly. In order to evaluate the impact on patients of nursing care provided in general practice, The Australian Primary Health Care Research Institute (APHCRI) in collaboration with the Australian Medicare Local Alliance (AMLA) developed the Patient Enablement and Satisfaction Survey (PESS). The processes utilised to develop, refine and validate this tool are presented in this paper.

Methods The Patient Enablement and Satisfaction Survey (PESS) was adapted from two instruments: the Client Satisfaction Tool (Bear & Bowers 1998) developed using Cox’s (1982) interaction model of client health behaviour, a nursing framework; and the Patient Enablement Tool (Howie 1998), validated in the United Kingdom general practice setting. Refinement and validation of the survey for the Australian context was achieved through conducting focus groups and pre-survey evaluation interviews with patients who access nursing services in a variety of general practice settings, and feedback from general practice nurses. The reliability of the survey was established through the use of test-retest and alternate form methods.

Results Feedback from patients and nurses resulted in fourteen changes being made to the first draft survey, including the removal of questions, insertion of additional questions, changes to wording and the sequence of questions.

Conclusion The PESS incorporates elements of nurse-patient interaction; ‘affective support’, ‘health information’, ‘decisional control’,

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and ‘professional/technical competencies’. It also measures patients’ experiences of accessing nursing care and time spent with nurses. Combined with other measures of patient satisfaction and enablement, the PESS provides a comprehensive and robust tool through which patient outcomes of nursing care in Australian general practice can be evaluated.

4. Effects of a motivational interviewing weight loss programme for school aged overweight children

Dr Emmy Man Yee Wong, The Hong Kong Institute of Education

Co-author Professor May May Hung Cheng, The Hong Kong Institute of Education

Aims This study is to assess the effects of a motivational interviewing (MI) programme to promote weight loss in overweight children.

Background Given the growing evidence of childhood obesity is a worldwide health problem that leads to serious metabolic and physiologic consequences, an effective intervention to manage obesity is essential. Motivational interviewing (MI) is designed to enhance intrinsic motivation and promote confidence in a person’s ability to make behaviour changes. MI has also been proposed as an effective method for improving weight loss of overweight children.

Design A pre-test, post-test, quasi-experimental design with repeated measures was used.

Methods The study was conducted in four primary schools over an 11-month period. Overweight children (n=185) were screened from 791

school children studying equivalent to Australian years 5 and 6. MI group was an experimental group (n=70) that was provided MI counselling to overweight children. The control group did not received any intervention (n = 49).

Findings Children in the MI group showed significant improvement in their eating behaviour and exercise activity. There was a significant decrease in their average calorie intake from food in the past seven days (mean difference: 389.57; p < 0.01). It also showed a significant increase in the average calories consumed due to an increase in physical exercise in the past seven days (mean difference: 2052.10; p < 0.01) from baseline to 14-week intervention. Significant differences in means were found between the pre- and post-intervention for medium weight-for-height (t = 8.67, p < 0.01) and BMI (t = 5.36, p < 0.01) while the control group had significant deterioration in these measures.

Discussion MI appears to be a very promising intervention for weight control in overweight children. The MI programme may be extended to other age overweight children for weight loss management.

5. Enhancing undergraduate students’ communication skills during an international primary health care placement

Hazel Rands

Co-author Dr Elisabeth Coyne, Griffith University

Internationalisation of curriculum is promoted by many universities and in responding to this agenda, international clinical experiences provide an opportunity to strengthen and


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refine communication skills. Griffith University has developed an international placement program in Laos where final year nursing and midwifery students provide primary health care clinics to villagers with limited access to any health care. Griffith students participating in this international placement are provided with supportive preparation, including strategies for working with translators and an introduction to Lao culture and language.

The students travel to remote villages in rural Laos, where almost no English is spoken. Initially, the language barrier seems insurmountable; however students quickly learn the value of using non-verbal communication strategies in the context of basic assessment, as they observe visual cues, facial expressions and body language. A further opportunity to cultivate communication skills lies in students’ responding to the need for health education and health promotion for people with limited health literacy. The placement focuses on building relationships and trust with community members by including Lao health workers, villager leaders and translators in the planning and delivery of these client-centred education sessions to ensure information is communicated at an appropriate level. Students are immersed in the culture, living in local home-stays, further developing their understanding of village structure and social conventions and learning new ways to communicate through interaction with their ‘families’. The students gain increasing confidence in their ability to navigate their way through this new culture and are supported throughout the placement by experienced academic supervisors, Lao translators and local health workers.

On their return to Australia, students demonstrate increased confidence and identify strategies to incorporate their refined communication skills into their nursing

practice. This attribute will be invaluable as new graduates in providing appropriate patient-centred care for clients from culturally diverse backgrounds.

6. Homeless assertive outreach: A collaborative approach

Jane Bonfield, Reaching Home

This service is an initiative of the NSW Homelessness Action Plan, developed from the Commonwealth’s White Paper on Homelessness. This model is a new, multiagency outreach service staffed by experts in the field’s mental health, drug & alcohol, primary care, legal aid, an outreach team and Housing NSW. The service works in collaboration to assist a specific group of people; those living on the street or at risk of homelessness. In this outreach approach, homelessness is being tackled by taking the services to the people, linking clients into housing and wrapping continued support services around them to help them maintain their tenancies.

Data including general demographics, number of clients’ assisted and/or case-managed referrals to support networks, legal assistance, housing outcomes and length of support provided is being collected on an ongoing basis. Research used for the operational guidelines included the Australian Housing and Urban Research Institute Positioning Paper on the integration of Homelessness, MH and D&A services in Australia. This pilot service has been funded for three years under the National Partnership on Homelessness Agreement between the Commonwealth Government and NSW Government.

The proposed target for the team is for 485 homeless people to be assisted per annum. Two years into the project we have seen 978

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people with 160 being active at any given time. The benefits of multi-agency/multi-disciplinary approaches and continued support assist these particularly vulnerable groups maintain tenancies, as well as linking them with community service providers.

The service has shown to extend initial expectations and population health needs in that complex individual and social problems have been defined, addressed and followed-up within a holistic framework, providing access, equity, housing and health care to some of the most disadvantaged members of our community. In effect, this benefits clients and the community, and provides more effective service delivery.

7. Practice Nurse Incentive Program – the impact of policy on practice

Lynne Walker MACN, Australian Medicare Local Alliance

Co-author Liz Meadley MACN, Primary Care Solutions

Introduction In January 2012 the rollout of new Australian Government policy saw the introduction of the Practice Nurse Incentive Program (PNIP). This Australian Government initiative provides incentive payments to general practices, Aboriginal Medical Services and Aboriginal Community Controlled Health Services to support an expanded and enhanced role for nurses working in general practices.

Description With funding support from the Department of Health and Ageing, the Australian Medicare Local Alliance facilitated over 107 PNIP workshops covering all states and territories. The workshops were delivered by a pool of speakers specifically upskilled in the content and were delivered to 2486 practice staff

including general practitioners. The aims of the workshop were to inform practices of the criteria for application for the PNIP as well as what roles the general practice nurses could undertake under the revised funding model.

Evaluations from the workshops indicated that 85% of attendees rated the workshop relevant or very relevant and 68% felt confident in being able to make changes to implement an expanded role for nurses.

Conclusions Consistent messages delivered directly to practice staff affected by policy changes are useful in assisting them to recognise opportunities that provide benefits to the patients, the practice and the nurses. The PNIP is an enabler to nurses undertaking an expanded and enhanced role in the general practice context.

8. Preparing the Australian nurse for their role in Primary Health Care- Sensitising the Curriculum

Lesley Andrew, Edith Cowan University

Presentation purpose Higher education providers have a key role in preparing a skilled emerging nursing workforce. The presentation will outline the newly revised curriculum of the undergraduate nursing degree programme at (names removed for peer review) University, Australia.

(Name) University is a modern university within (state) Australia. A rewrite and reaccreditation of the Bachelor of Science (Nursing) degree in 2012 has provided an ideal opportunity to increase the focus on Primary Health Care. In a shift away from an acute/illness nursing approach, the revised course has been guided by current Government Health Policy reforms and by changing population health needs.


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From semester one, year one, students are introduced to the concepts of health and wellness, with explicit reference to the importance of social determinants of health on individual, family and community wellbeing. A community of virtual families enables students to explore community and family health and relevant multi-agency service provision within an exciting and innovative learning environment. The pathway, being client rather than disease centred, concentrates on health and health needs across the lifespan. Changing demographics, in particular the ageing population, are discussed, as is the relevance of this to the increasing importance of chronic conditions prevention and management. Challenges and opportunities in rural and remote community nursing are included from year two, both in theory unit content and practicum opportunities. The final year Primary Health Care unit provides students with the skills and opportunities to complete a virtual community health needs assessment, accessing on-line epidemiological statistics and utilising relevant health needs assessment models to identify vulnerable populations and potential gaps in services.

Throughout the course; students are encouraged to recognise and embrace their future responsibilities in client empowerment and illness prevention, irrespective of their intended career path, preparing them for their role within Australia’s changing health climate.

9. Readiness to practice

Sarah Tillot, University of Wollongong

Co-authors Leeanne Heaton MACN, University of Wollongong

Joanne Joyce McCoach, University of Wollongong

Maria Mackay, University of Wollongong

Moira Stephens, University of Wollongong

Introduction Students undertaking degrees in nursing have long been required by their state and territory health services to demonstrate evidence of immunity or protection from specific infectious disease. Failure to comply with these standards in a timely manner result’s in student’s withdrawal from their clinical placements due to the adverse risks regarding patient safety from an infection control perspective.

Description Initial discussion and investigation has revealed that both students and staff in SNMIH, Wollongong University have found the current systems for vaccination information and compliance checking onerous and confusing. In addition, other health care professionals, who are well versed in public health and infectious diseases, are not always familiar with the policy. The lack of common understanding between the health services and faculty has contributed to student confusion and stress. This project aims to; address the shortfall in student’s readiness for clinical placement and improve the compliance rate for student’s vaccination. Enhancing compliance in this manner promotes patient safety from an infection control perspective.

Summary Our anecdotal findings confirmed confusion amongst both students and staff was evident. The literature highlighted poor compliance with vaccination programs amongst health care workers is linked to their limited knowledge of vaccinations and among students, a lack of time and forgetfulness. Nursing students intermingle with patients and health care workers on a regular basis. The university has a responsibility to educate

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students in regard to their vaccination requirements in preparation for clinical practice.

Conclusion Currently the literature is silent in regards to the specific needs of students re. vaccination, within this project we are seeking to investigate the gaps in vaccination compliance; implement an education intervention and evaluate the effectiveness of the intervention strategy. This innovative research will strengthen infection control for patients and students and aid in promoting the patient safety culture.

10. The Bindjareb Yorgas Health Program: Health promotion through a community based research intervention project

Caroline Nilson, Murdoch University School of Nursing and Midwifery

Co-authors Associate Professor Catherine Fetherston, Murdoch University

Professor Paul Morrison, Murdoch University

The presentation will highlight the holistic framework, the health promotion focus and the research agenda of the Bindjareb Yorgas Health Program (Program), which has been structured to be socially embedded to capitalise on the capacity of its community members.

The Program has been developed in collaboration between researchers from Murdoch University School of Nursing and Midwifery and the Bindjareb women Elders and Leader of the Murray District Aboriginal Association in Pinjarra, Western Australia. The framework is considerate to

the Aboriginal social determinants of health and was developed with a focus on the three major principles for guiding health promotion activity: advocacy, mediation and enablement; and the three action areas for undertaking health promotion: creating supportive environments to encourage equitable access; strengthening community actions to enable empowerment; and the development of personal skills in achieving and maintaining wellness.

The four components of the Program reflect the concerns of the community regarding the issues that are compromising their health. By developing health literacy in nutrition and chronic disease management, improved physical activity and a reduction in addictive behaviours the community can begin to tackle the high prevalence of chronic disease, obesity and addiction using preventative steps and solutions they themselves have engineered.

A pilot project funded by the Australian Government through the Swap It Don’t Stop iIt Campaign, is being conducted from September to December 2012, to ensure that the research processes for the yearlong intervention, commencing in February 2013, are suitable. An advisory group has been convened to assess, counsel and validate the Program processes, content and quality. In addition, the Bindjareb woman leader has been appointed as the research associate.

This intervention aims to extend knowledge surrounding existing health promotion initiatives previously designed in Aboriginal communities by implementing a program that ensures community ownership and continued delivery of the program.


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11. Traditional Chinese postnatal rituals and modern health care: Implications for community and primary health care

Dr Jane Yeh, Taipei Medical University, College of Nursing, Tai

Co-authors Associate Professor Winsome St John FACN, Griffith University

Dr Lorraine Venturato MACN, Griffith University

This ethnographic study explored how the traditional Chinese postpartum practices of Tso Yueh Tzu (‘doing the month’) are reshaped and renegotiated by first-time mothers in the modern health care setting of a maternity care centre in Taiwan.

Tso Yueh Tzu is a traditional 30-day ritual involving physical and social prescriptions and taboos. Traditionally, a post-partum woman is assisted in this ritual by her family in her home, especially by her mother-in-law. The practices aim to bring the postpartum woman back to her pre-pregnancy state and achieve psychological adaptation of the whole family. Many Taiwanese women now follow Tso Yueh Tzu in maternity care centres.

Data collection included eight months of participant observation in a maternity care centre in Taipei, informal interviews, documentation, field notes, maps and photographs. Formal interviews were conducted with 27 first-time mothers. Analysis showed that adherence to the traditional practices varied in terms of dietary, hygiene, activity and social restrictions and prescriptions. Locating the ritual in a health care environment had an impact on roles and relationships, particularly relationships with their partners and mothers-in-law.

Nurses took on roles traditionally taken by family members. Some traditional Tso Yueh Tzu practices were maintained, based on traditional explanations. However, many practices were modified or challenged, based on explanations from contemporary scientific knowledge. Tso Yueh Tzu in a maternity care centre is a mixture of modern values and traditional beliefs, reshaped by changes to society, current scientific evidence and relocating the ritual from the home to a health care setting.

Findings inform culturally appropriate and sensitive postnatal care and support for Chinese women with traditional and contemporary cultural beliefs and attitudes to Tso Yueh Tzu in a range of care contexts.

12. Warning signs of heart attack: Heart Foundation resources for primary care

Julie Smith, Heart Foundation

Co-authors Carol Cunningham, Heart Foundation

Shelley McRae, Heart Foundation

Background Globally, heart attack is the leading cause of death and one of the major causes of disability (1, 3). Heart attack remains an often fatal event – over half of all deaths occurring before the person reaches hospital and about 25% of people dying within an hour of their first-ever symptom (2).

In 2009, The National Heart Foundation of Australia launched the comprehensive Warning Signs of Heart Attack campaign to help Australians identify, know and respond to the warning signs of heart attack and to address structural changes that influence patient delay. Health professionals in

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primary care as well as hospitals, emergency response, government and the community have been engaged in the campaign development, implementation and evaluation.

Innovative social marketing strategies (including television, radio, Facebook, Twitter, interactive website) have been utilised as part of the campaign. A wide range of resources have been developed including posters, fridge magnets, DVD, wallet cards and fact sheets with resources for CALD, Aboriginal and remote populations also available.

As 15% of patients who experience warning signs of heart attack or stroke call or attend general practice as a first response, BeAWARE resources were developed (4). These online learning modules help non-clinical staff promptly identify patients entering the practice system (by phone or in person) with suspected warning signs of heart attack and stroke.

Conclusion Treatment delay, due to people taking too long to recognise their symptoms of heart attack and not getting to hospital quickly is a major problem. The Heart Foundation’s comprehensive Warning Signs campaign includes many resources available for use in primary care to raise awareness of this issue and encourage appropriate action.

13. What does it mean to be an advanced general practice nurse?

Dr Kelly McGorm, Australian Primary Health Care Research Institute, Australian National University

Co-author Associate Professor Rhian Parker, Australian Primary Health Care Research Institute, Australian National University

Introduction Reaching agreement on what it means to be an advanced nurse poses a challenge. Terms, sometimes used synonymously, include: specialist nurse, nurse practitioner, advanced practice nurse, endorsed, enhanced, extended or expanded practice nurse. Are they the same or distinct? With organisations such as the Australian Institute of Health and Welfare releasing their latest data on the nursing and midwifery workforce, it is timely to aim for standard definitions underpinned by qualifications and scope of practice.

Method To provide a shared understanding to a team of researchers working on the development of a toolkit to support advanced nursing in general practice, a definition of an advanced nurse in general practice was required. A review of the literature was conducted, as were numerous discussions with stakeholders via email and in person during workshops.

Results A definition of an advanced general practice nurse was developed after a review of the literature and consultation with nursing academics and stakeholders working in the Australian general practice setting. It incorporates elements of education, broad experience, health promotion, leadership, management, education, and research, as well as progression of the nursing profession and


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influencing general practice service provision and design.

Conclusion We should reflect not only on what constitutes an advanced general practice nurse, but why are they required? The answer is to meet the changing and more complex needs of the population. As Australian health care policy evolves to meet these needs (e.g. the introduction of the Practice Nurse Incentive Program to support an expanded role for nurses), so too evolves the profession of general practice nursing. Thus it is important to get these definitions right as a starting point to support these nurses and inform the general practice team who work with them.

14. What’s my chance of having a heart attack, nurse? Using absolute CVD risk tools

Julie Smith, Heart Foundation

Background Absolute risk is the numerical probability of a cardiovascular (CV) event occurring within a five-year period, expressed as a percentage. The cumulative effects of multiple risk factors have been shown to be additive or synergistic (3-5) hence a moderate reduction in several risk factors is more effective in reducing overall CVD risk than a major reduction in one factor (7). In Australia, 64% of the adult population have three or more modifiable risk factors (6).

Overview New primary prevention of CVD guidelines (1, 2) offer recommendations for assessing and managing absolute CVD risk in adults (>45 years and >35 years for Aboriginal or Torres Strait Islander peoples) who are without known CVD. Advice for people with diabetes and chronic kidney disease is included.

A risk management table in the Quick Reference Guide is a useful tool for practice nurses developing management care plans. In patient discussions, visual (online or paper) risk tools can be helpful to motivate behaviour change by showing the probability of a future CV event occurring. Lifestyle advice always remains first-line therapy whether or not drug therapy is required. Those at higher risk require more frequent and sustained advice, support and follow-up. Consumer resources are also available.

For patients with diagnosed CHD the new Reducing Risk in Heart Disease 2012 guide has comprehensive clinical recommendations.

Summary Clinical decisions based on absolute risk can lead to improved health outcomes by identifying people most at risk and directing the right treatments to them. The new absolute risk management guidelines can be useful as a patient education tool.

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