Skills4Nurses Recruitment Exhibition Review Skills4Nurses

ISSN 1756-5979
Issue 22- 2011
Skills4Nurses Recruitment
Exhibition Review
Mental Health vacancies in Guernsey
Overseas Recruitment
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News
CONTENTS
4
National and local news
10
Abbot
Pictures from 2nd Clinical Educational
Symposium for IBD Nurses and information on
the 7th Annual Neonatal Nurse Study Day
12
ACAP
An opportunity for Acute Care Advanced
Practitioners to have a voice
by Julie Smith & Elaine Headley
16
Skills4Nurses Recruitment Exhibition
Review and 2011 event details
18
Challenges and and possibilities in
treating overgranulation in primary care
Published by:
Global Media & Exhibitions Ltd.
Gibbs Yard
Auchincruive Estate
Ayr
Ayrshire
Scotland
KA6 5HN
by Melanie Martin BSc (Hons), MRPharmS
20
Independent Midwives UK
Carrying a caseload without breaking your back
22
Mental Health Nurses’ Attitudes towards
Personality Disorder
by Colin Hughes and Stephen Hamilton
24
Overseas Recruitment - Australia
27
Recruitment - Guernesy
28
Overseas Recruitment - New Zealand
31
General Recruitment
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3
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News
ARE GPS MISSING A TRICK WHEN IT
COMES TO LACTOSE INTOLERANCE?
Survey suggests better outcomes for patient
and GP could be achieved through improved
understanding of lactose intolerance
A new survey, commissioned by
Lactofree, has identified a potential
‘quick win’ in terms of dealing with
patients complaining of recurrent
bouts of bloating, wind, nausea,
diarrhoea and stomach cramps.
Three quarters of GPs (76 per cent)
faced with such symptoms would
diagnose IBS, however it is
estimated that up to 20 per cent of
IBS cases may actually be lactose
intolerance.2 Furthermore, with
half of GPs describing the condition
in more general terms as ‘dairy
intolerance’, patients are at risk
of missing out on the important
nutrients found in dairy produce by
unnecessarily eliminating all dairy
produce from their diets (instead
of converting to lactose-free dairy
products such as the Lactofree
range*); thereby damaging their
long term health and adding to GP
workloads further down the line.
With only one in ten (11 per cent)
GP surgeries in the UK benefitting
from an in-house dietician,
responsibility for diagnosis and
management of food allergies and
intolerances often falls to the GP.
However, the symptoms of lactose
intolerance can be similar to those
associated with IBS, as well as a
number of other conditions such as
delayed milk protein allergy. In fact,
the survey revealed that 60 per cent
of GPs are unable to differentiate
between lactose intolerance and
delayed milk protein allergy, largely
due to the lack of any validated
tests for delayed allergies and the
similarity of symptoms.
4
Lactose intolerance occurs when a
patient has a deficiency of lactase,
an enzyme produced by the small
intestine which is responsible for
breaking down lactose, the main
sugar (carbohydrate) found in milk.
Undigested lactose therefore
passes through the gut into the
large intestine where it is fermented
by colonic bacteria, resulting in
uncomfortable symptoms including
stomach cramps and diarrhoea.
Two thirds of GPs also observe
temporary lactose intolerance
in patients, often following a
disturbance to the normal function
of the gut such as surgery, gastroenteritis, IBS, uncontrolled coeliac
disease or cancer and its treatment.
Unlike lactose intolerance,
cow’s milk protein allergy is an
immune response, usually to one
or more of the proteins found in
milk. Depending on the antibodies
involved it can have immediate and
sometimes severe effects (where
IgE antibody is present) or cause
delayed gastrointestinal symptoms
which can be difficult to distinguish
from lactose intolerance.
Dr Patricia Macnair, community
physician and Lactofree Advisory
Board member commented, “The
results of the survey suggest that
GPs could improve management
in these cases by helping lactose
intolerant patients to understand
the nature of their condition better.
Once they have a clear diagnosis
of lactose intolerance, they may not
have to eradicate all dairy products
forever, but may benefit from simply
converting to lactose-free dairy
products. Now that we have
lactose-free alternatives for most
dairy foods it’s much easier for
people with lactose intolerance to
maintain their intake of calcium and
other important nutrients that most
of us get from dairy.”
The most common recommendation
for diagnosing lactose intolerance
is an elimination diet - a two phase
elimination programme, endorsed
by the British Dietetic Association.
The first phase requires the patient
to cut out all products containing
lactose, including dairy, from their
diet (although lactose-free products
such as Lactofree can still be
consumed). This is followed by a
period of gradual reintroduction
of dairy foods to help determine
the level of lactose that can be
tolerated. A simple and effective
elimination diet for your patients
can be found at
www.lactofree.co.uk
Asthma research proposal which aims to develop deeper
understanding of how asthma affects adolescents, leading
to improved future treatment guidelines wins esteemed
Asthma Society award.
The Asthma Society of Ireland
recently held an award ceremony
awarding Nurse Mary Hughes from
Cork the Órán Ó Muiré Research
Bursary of €1,500. The Órán Ó
Muiré bursary competition, which is
awarded annually and is named in
honour of the Asthma Society
founder, is open to all registered
nurses in the Republic of Ireland.
The focus of the 2010 awards was
to support a new nurse led research
project which when implemented
will improve the quality of care
delivered to people with asthma
and/or their families.
Nurse Mary Hughes’ bursary
submittal entitled “Adolescent
Asthma Symptom Control; A
Grounded Theory”, was chosen as
the winner when the adjudicating
panel saw great potential for
developing appropriate information
and support that targets the
specific concerns of adolescents
with asthma.
Speaking at the awards ceremony,
winner, Nurse Mary Hughes said,
“The focus of my research proposal
is to link the data with existing
knowledge. I hope developing this
combination of new research and
current management guidelines
will lead to future national and
international treatment guidelines
specific to adolescent asthma
management and care for adolescents. I am delighted my submittal
was chosen as the bursary winner.”
This is the first year the Asthma
Society of Ireland awarded the
“Volunteer of the Year” award.
Mrs Anne Robinson from
Enniscorthy, County Wexford,
was chosen as the winner of this
award which recognises the outstanding contribution and achievement of one of the Asthma Society’s
volunteers. Mrs Anne Robinson
has been an avid volunteer and
fundraiser for the Society since
1998, after the sudden death of her
son Alex as a result of an asthma
attack. In the years that have followed, Anne has worked prolifically
to raise awareness of asthma and
the importance of good asthma
control. Her goal is to help prevent
other unnecessary asthma deaths.
Asthma Society CEO, Dr Jean
Holohan speaking at the awards
ceremony commented; “This
evening is a very special occasion
for the Asthma Society. We are
honoring our late founder through
awarding the Órán Ó Muiré Bursary
and recognising the incredible work
of volunteers who often don’t
receive recognition for their crucial
contribution. Tragically there is
more than one asthma related death
in Ireland every week. “Volunteer
of the Year” winner, Mrs Anne
Robinson is one of the many people
in Ireland whose life has been
tragically affected by poor asthma
control, when her son Alex died of
an asthma attack. The Asthma
Society of Ireland hopes that this
bursary will lead to an improvement
in asthma management guidelines
for adolescents, positively influencing how young people manage their
asthma, and thus avoiding unnecessary asthma deaths in the future.”
Órán Ó Muiré, the Asthma
Society founder, was a tireless and
outstanding advocate for people
with asthma in Ireland throughout
l-r, Mary Hughes, Kathleen Ó Muiré
(the late Órán's wife), and Anne Robinson.
his life. It is very appropriate that
the research bursary established in
Órán Ó Muiré’s name, recognises
the role of nurses in improving the
quality of care for people with
asthma and their families. The
submissions this year give a clear
indication of the potential to
promote quality asthma related
nursing research.
The head of the adjudicating panel,
Asthma Society Asthma Nurse
Specialist, Nurse Frances Guiney
commented on the winning
submittal; “The primary objective
of the Asthma Society is to see
asthma well managed in line with
international best practice. Of
the almost half a million people in
Ireland with asthma, almost 60%
do not have their asthma controlled.
Adolescents with asthma have
been recognised as a particularly
vulnerable group which suffers
with poor asthma control. This new
research aims to address the control levels of this group, which we
hope will lead to improved treatment
guidelines and quality of live for
adolescents with asthma in Ireland.”
5
News
Asthma Society of Ireland Awards Research Bursary,
in Honour of Founder, to Cork Nurse, Mary Hughes &
Presents Inaugural Volunteer of the Year Award
82.4% of all Men use Wrong-sized Condoms
News
Let's assume all English men walk
around in wrong-sized shoes simply
because there is only one standard
size available. In that case people
would rather walk barefoot, because
a tight shoe is pain and no
pleasure! Absurd?
Not when it comes to condoms.
82.4% of all English men don't look
at the size issue and have had
negative experiences when either
wearing loose or too tight standard
condoms. Therefore they refrain
from using important protection. But
size does matter!
A survey carried out by
condomadvisor.com interviewing
2,539 men found the typical penis
length ranged from 9 to 22cm with
an average of 14.67cm, which
means there is just is no standard
size. Men are not aware of their own
size and use an ill-fitting standard
sized condom with the negative
consequences.
The survey shows that a standard
condom fits only 17.6% of men.
All other men should use a tailored
condom that fits the size of their
penis.
13.5% of all men have a penis
length of less than 11.5cm. These
men should choose a smaller
condom. On the other hand men
with a larger than average penis
size should use an equivalently
large condom.
Condomadvisor.com provides the
first solution to solve the size issue:
a made-to-measure condom:
My.Size condoms come in different
sizes, offer a perfect fit, are great to
wear and provide good protection.
How do men find the right condom?
It's simple. To find the right condom
men should firstly find out what
size they are. That is easily
achieved by measuring themselves
and noting width and length of their
penis. This could be done with a
measuring tape which can be
downloaded from
http://www.condomadvisor.com
After measuring and entering the
size details on
http://www.condomadvisor.com
men will be offered a selection of
condoms of all major brands
including the tailored My.Size range
that certainly will fit their size.
BRITISH POLIO FELLOWSHIP HELPS
VULNERABLE STAY WARM THIS WINTER
Following one of the coldest
November’s on record and with
continually rising fuel prices, the
British Polio Fellowship, a charity
dedicated to the support of those
living with the effects of polio and
Post Polio Syndrome (PPS), has
launched its vital winter warmth
appeal.
The Winter Warmth Appeal aims to
help keep British Polio Fellowship’s
members warm during the harsh
winter by raising money to fund
means-tested heating grants, as
Government winter fuel payments
are unavailable to those under the
age of 60.
It is estimated that more than
120,000 people in the UK are
currently living with PPS and can
suffer greater intolerance to cold
than those of a similar age without
the disease, due to severely weakened limbs. Plus, the need to use a
wheelchair or callipers and walking
sticks can result in poor circulation
and lack of mobility during the cold
weather.
6
fatigue and pain.
Commenting on the appeal, Dr.
John Hooper, CEO of the British
Polio Fellowship, said: “The funds
generated by the Winter Warmth
Appeal are vital to our members,
who find it a real battle to stay
warm and in good health during
the colder months, and never more
so than this year when we have
experienced particularly early
cold spells.
“As a charity, we do not receive any
Government funding, so donations
are the only way we can work to
reach our annual target of £20,000
to enable us to continue providing
this service.”
Polio is an infectious disease that
can invade the central nervous
system, destroying or damaging
the nerve cells that control muscle
movement potentially leading to
muscle paralysis. In later life, those
who have had polio can go on to
develop PPS, a neurological
condition which can create
weakness, stamina problems,
Dr. Hooper concluded: “Many of
our members are housebound and
in these cold winter months so need
to have their heating on for longer
than average. It is believed that the
optimum temperature for thermostats is 19 degrees centigrade but
this is not warm enough for someone living with the effects of polio.
And with heating costs increasing
by as much as eight per cent for
each degree rise in temperature it
makes it incredibly hard for our
members to make ends meet.”
The British Polio Fellowship, which
has 10,000 members from across
the UK , has been working to
support those with polio and PPS by
providing information, advocacy
and welfare since its inception in
1939.
To donate to the Winter Warmth
Appeal, and find out more about the
British Polio Fellowship you can go
to www.britishpolio.org.uk.
Diabetes drug could reduce cancer
risk by 30 per cent
Research has shown that people
with Type 2 diabetes could have up
to a 27 per cent increased risk of
developing cancer, particularly
breast, colorectal, endometrial, liver
and pancreatic cancer. Common
risk factors associated with Type 2
diabetes, such as obesity and diet,
could help to explain this increased
risk. However it has also been
suggested that increased blood
glucose levels could also have an
effect.
Previous studies have suggested
that metformin (taken by people
with Type 2 diabetes as a first line
medicinal treatment, after diet and
exercise, to lower blood glucose)
lowers the increased risk of cancer
for people with Type 2 diabetes by
30 per cent, but these studies are
not definitive. Therefore Diabetes
UK has awarded funding to
researchers at Oxford University to
collate information from the largest
and best clinical trials of metformin
in the hope that a way to tackle this
increased cancer risk can be found.
Dr Richard Stevens, lead researcher
at the University of Oxford, said:
“The complications of diabetes are
commonly thought of in terms of
the heart, eyes, nerves and kidneys.
However some people with diabetes
could also be at higher risk of
developing cancer than those
without the condition.
“Many studies have suggested that
metformin lowers the risk of cancer
by 30 per cent in people with Type
2 diabetes, but to date there has
been nothing to back up this claim.
Our approach aims to provide solid
evidence to validate these claims.
It is hoped our findings will be able
to help develop a means of tackling
the increased risk of cancer,
alongside the other complications of
diabetes, while also shedding light
on pathways and mechanisms for
wider cancer research.”
Dr Iain Frame, Director of Research
at Diabetes UK said: “We know
that good diabetes management
can help to prevent the serious
complications diabetes can lead
to, such as heart disease, stroke,
kidney disease, blindness and
amputation. However, while there
are various approaches to minimise
the effects diabetes can have on
specific organs, little is known
about what preventative measures
can reduce the risk people with
diabetes face of developing some
forms of cancer.
“This is why Dr Stevens’ work at the
University of Oxford is so important.
If it is found that metformin can help
to reduce the risk people with Type
2 diabetes have of developing
cancer then this will be a big step
forward in terms of how we can
help people manage the condition
and hopefully allow us to develop a
means to tackle the increased risk
for all people with diabetes. It will
also be important to understand the
effects of metformin on its own and
in combination with insulin and other
treatments.”
Diabetes is one of the biggest
health challenges facing the UK
today with one person being
diagnosed with the condition every
three minutes. There are 2.8 million
people diagnosed with diabetes in
the UK, of which 2.5 million have
Type 2 diabetes. It is also estimated
that there are a further 850,000
undiagnosed people with the
condition. Risk factors for developing Type 2 diabetes include being
overweight or having a large waist,
being over 40 years old (or 25 for
people of Black or South Asian
origin), being of Black or South
Asian origin and having a family
history of the condition.
Healthcare heroes deliver hygiene message
sporicidal wipes which were featured at the conference earlier this
year.
Twelve ‘healthcare heroes’ who won Vernacare’s comic book
caption competition have received framed copies of their winning
creations.
“There was a serious message behind the comic book theme”,
said Chris Socratous, Vernacare Product Manager. "Our mission
was to highlight innovation in infection prevention and present
solutions to the challenges of
improving standards of hospital
hygiene.”
The winners entered the competition at the comic book themed
Vernacare City stand at the recent Infection Prevention Society
2010 Conference. All visitors to the stand were invited to share
their top tips on hospital hygiene in comic style, with hundreds joining in the light-hearted challenge.
Among them Linda Woodward-Stammer, Lead Infection Prevention
and Control Nurse at West Middlesex University Hospital, who is
pictured receiving a copy of her very own comic caption:
“Cleaning used to be such a chore. Now we have Tuffie I want to
clean more and more”.
Tuffie wipes are a range of multi-surface cleaning and disinfecting
wipes, available across the UK, including the new Tuffie 5
Other competition winners from
across the UK included Michelle
Turner, Infection Control and
Prevention Nurse at James Paget
Hospital and Julie Singleton,
Infection Control Nurse at Imperial
College Healthcare NHS Trust, who
were both delighted to have been
selected from such a large group
of entrants.
7
News
Leading health charity Diabetes
UK is aiming to address the
increased risk people with Type 2
diabetes have of developing
cancer by funding new research
to determine whether a popular
diabetes drug can prevent one out
of three cases of cancer in people
with the condition.
News
Parents ‘face barriers’ in seeking help for their
child’s mental health problems
New research suggests parents
may be deterred from seeking help
for their children’s mental health
problems because of embarrassment, stigma, and the fear of their
child being ‘labelled’. They may also
find it difficult to get an appointment
with their GP, or feel unable to raise
their concerns during a short
appointment.
These are the findings of a study
carried out by researchers from the
University of Nottingham and King’s
College London. Their research is
published in the December issue of
the British Journal of Psychiatry.
Mental health problems are
common in children and
adolescents – affecting around a
quarter of children in primary care.
However, children are dependent on
adults to recognise their problems,
and very few parents of children
with mental health problems raise
their concerns during GP
consultations.
The research team, led by Dr Kapil
Sayal, held focus groups with 34
parents who had concerns about
their child’s mental health. The
parents identified a number of barriers that stopped them seeking help
from their GP, including: embarrassment, stigma of mental health problems, concerns about receiving a
diagnosis or being judged a poor
parent, and concerns their child
may be removed from the family.
Appointment systems caused
problems for some parents – they
had difficulty getting an appointment, and felt appointments were
too short for the GP to observe their
children’s behaviour or for them to
raise their concerns fully. Other
parents saw GP’s surgeries as
being ‘medical places’ and so did
not feel it was necessary to raise
their children’s emotional and
behavioural problems with their GP.
The researchers found that parents
were more likely to seek help if they
had built a good relationship with
their GP and saw the same doctor
regularly. They were also more likely
to raise concerns if their GP showed
interest in their family life and gave
them time to talk about emotional
issues.
Dr Sayal said: “Not recognising
children’s mental health difficulties
can mean their problems persist
into adulthood. Our study shows
that parents value GPs showing
interest in their family situations,
and listening to and taking their
concerns seriously.
“This means that most GPs should
be able to help parents who have
concerns about their child’s mental
health. This could be achieved
through GPs taking a family-oriented
approach to consultations as well as
putting more emphasis on children’s
mental health in postgraduate
GP training. Allowing parents to
pre-book longer appointments
may also be helpful.”
Praise as epilepsy charity celebrates its success
Health professionals have praised a
charity service which is celebrating
a decade of providing information
to people with epilepsy.
The National Society for Epilepsy
(NSE) launched its Epilepsy
Information Network in 2000 and
now has more than 200 volunteers
manning 180 stands in hospitals,
clinics and health centres
throughout England.
A recent evaluation of the service
has revealed that neurologists,
nurses and people with epilepsy
value and recognise the importance
of this volunteer run information
service.
The survey showed that 100% of
nurses and 97% of neurologists
8
said they would like to see the network continue to provide support
and information, while 94% of those
visiting the stand found the
information useful and relevant.
Health professionals and people
affected by epilepsy describe the
EIN as ‘fantastic’, ‘excellent’ and
‘essential’, NSE’s community
outreach manager Elaine Falkner
attributed the network’s success
story to the tireless efforts of the
volunteers who really make a
difference to the lives of people
with the condition.
She said: “We are so lucky to have
such wonderful volunteers working
with us. Their commitment and
enthusiasm is incredible – not
only do they provide invaluable
information to people visiting their
consultant or epilepsy nurse, but
they also provide a friendly face
and listening ear.
“When we first set up the network,
many hospitals were quite wary of
us and queried how valuable a
volunteer and information stand
would be. But thanks to the
dedication of our team we have
made tremendous inroads and are
now very much welcomed as a
valuable and essential service.”
Anyone wanting more information
about NSE or epilepsy can visit
www.epilepsysociety.org.uk or
telephone the helpline on
01494 601400.
Home treatment for elderly patients with
depression ‘cheaper and more effective’
Depression is a major mental
health problem among older people,
affecting around 12% of people
over the age of 64. Evidence shows
that a combination of antidepressant
medication and psychological
treatments such as cognitive
behavioural therapy can be effective
in treating elderly people with
depression. However, there has
been less research into how these
treatments should be delivered, and
whether it is better to provide them
in patients’ homes or in hospitals.
Researchers studied 60 patients
with major depression, who were
aged over 64 and living in Graz, a
town in Austria. Half the participants
received home treatment over a
12-month period. Treatment was
delivered by a team consisting of
one psychiatrist, two psychologists,
and one social worker. The team
UK IS TOLD ‘don’t
wait for A rash’
Up to 34 million adults in the UK are risking
death with the mistaken belief that the main
symptom of meningitis is a rash.
visited each patient once or twice
a week, or up to 4 times a week in
crisis situations. There was also
telephone support available for
the patient and their carer.
The other half of the participants
acted as a control group. They
received conventional out-patient
care, with free access to out-patient
appointments with psychiatrists.
They also had an initial meeting
with a psychologist, where they
were given information about how
to access health and social services
in their local area.
All the participants in the study
were assessed for symptoms of
depression at the start of the study,
after 3 months and after 12 months.
The researchers found that patients
who received home treatment had
significantly fewer symptoms of
depression and a better quality of
life at 3 months and 12 months.
In the home treatment group, one
person was admitted to a nursing
home during the study period. The
admission was temporary and the
person was discharged after 27
days. In the control group, eight
Other symptoms of meningitis can include
fever with cold hands and feet, drowsiness,
confusion, pale blotchy skin, stiff neck, dislike
bright lights and seizures. In babies symptoms are often floppy and unresponsive, dislike being handled, rapid breathing, moaning
cry and a bulging fontanelle (soft spot on the
top of the head).
Believing the rash is the only symptom is
costing lives; as the rash, that does not fade
under pressure, (a sign of blood poisoning)
does not always appear. When it does it can
be one of the last symptoms to be displayed,
often too late.
Research by the Meningitis Trust has indicated that 71% of people immediately think of a
rash when identifying meningitis - and are so
worried by the findings that it is hammering
home the message ‘Don’t Wait for a Rash’.
National charity the Meningitis Trust is
launching a campaign today to stop this
deadly misconception.
The charity is also frightened to find that up
to 5.3 million adults in the UK cannot name a
single sign or symptom; causing serious
concern to health professionals.
Knowing and recognizing the other signs and
symptoms of meningitis and getting medical
help quickly is the only way to reduce the
devastating impact meningitis can have.
Symptoms can appear quickly and rapid
deterioration is sign of a medical emergency.
Meningitis can start with ‘flu like’ symptoms;
fever, headache, vomiting and muscle pain.
Pete Rowlands from the East Riding of
Yorkshire knows only too well the devastation
that the disease brings after his 16 year-old
son, Gareth, died of meningitis whilst at
boarding school in May 2003.
From an early age Gareth enjoyed any type
of sport. The day before his death he had
phoned home as normal saying he had just
people were admitted to a nursing
home and seven stayed there until
the end of the study. The total costs
of care per participant were
8,751.44 (about £7,430) for the
home treatment group and
21,031.84 (about £17,855) for the
control group.
Lead researcher Dr Günter Klug
said: “Home treatment was not only
associated with lower depression
scores and more positive clinical
outcomes, but also with substantially lower costs of care. Participants
in the home treatment group had
fewer admissions to nursing homes
and spent fewer days in psychiatric
in-patient care. Because of the
successful prevention of admissions
to psychiatric inpatient care and
nursing homes, home treatment
was a very effective and costeffective form of treatment.”
Dr Klug concluded: “The findings
from our trial are very positive and
encouraging. Although they need
to be replicated in other settings
and with larger samples, our study
supports the case for investing in
such services to improve patient
outcomes and reduce costs.”
completed his AS Level Sports Studies exam
and was confident that he had done well
enough to secure a pass (and he did).
“Gareth told us that he had just got back to
his room from the gym and felt as if he had
burst a blood vessel behind his eye from
working out with weights. He also thought
that he had a bout of flu coming on as he
had a headache. Gareth tragically was found
dead in his bedroom later that evening”
said Pete who is backing the campaign.
“Carrying my son’s coffin into a church is
the most difficult thing I have had to do and
is something a parent should never have to
undertake. Meningitis is a disease which
strikes in an instant. The symptoms are so
similar to the flu that it’s not always spotted
in time. The famous rash that everyone
thinks of does not always appear.
Lifesaving information is provided free by the
Meningitis Trust by calling its freephone 24hour nurse-staffed helpline on 0800 028 18
28 and requesting information or a signs and
symptoms card, downloading the free iPhone
app or visiting www.meningitis-trust.org.
9
News
Treating elderly people with
depression in their own homes
could be cheaper and more
effective than conventional
out-patient treatment, according to
an Austrian study published in the
December issue of the British
Journal of Psychiatry.
Abbot
Pictured at the 2nd Clinical Educational Symposium for IBD Nurses held at the Trinity
Education Centre of Tallaght Hospital , the event was kindly sponsored by Abbott.
Mary Forry (Beaumont Hospital) & Karen Kemp (Manchester Royal
Infimary) & Mary Hamzawi (Crumlin Hospital)
Yvonne Bailey (Tallaght Hospital) & Dr.Sinead
Byrne (Tallaght Hospital) & Mary Kennedy
(Tallaght Hospital)
(Back Row) - Margaret Connolly (St.James's) & Michelle Loughrey (Vincent's
Hospital) & Yvonne Bailey (Tallaght Hospital) & Kathleen Sugrue (Mercy Hospital
Cork) & Mary Kennedy (Tallaght Hospital) - (Front Row) - Colette Regan (Tullamore
Hospital) & Mary Forry (Beaumont Hospital) & Karen O'Driscoll (Crumlin Hospital) &
Mary Hamzawi (Crumlin Hospital)
Yvonne Bailey (Tallaght Hospital) &
Mary Kennedy (Tallaght Hospital)
Yvonne Bailey (Tallaght Hospital), Brenda Egan
(Abbott) & Mary Kennedy (Tallaght Hospital)
& Ciara O'Shea (Abbott)
Potential role for vitamin B1 in preventing heart
problems in people with diabetes
Diabetes UK-funded research shows
that a dietary supplement of the
synthetic derivative of vitamin B1 has
the potential to prevent heart disease
caused by diabetes. Scientists believe
vitamin B1 may help the body to
dispose of toxins and therefore protect
cells of the heart from becoming
damaged.
Diabetes leaves the heart more
vulnerable to stress as less oxygen
and nutrients are delivered to the heart
and other organs. Heart damage can
be caused by high levels of glucose
entering cardiovascular cells, which
forms toxins that accelerate the ageing
of the cell.
Around 50 per cent of people with
diabetes die from cardiovascular
disease, and this complication is the
leading cause of death among people
with diabetes. Researchers warn that
with increasing prevalence of diabetes,
with around one in twenty people in the
UK now diagnosed with the condition,
diabetes will result in a new epidemic of
10
heart failure unless new treatments are
developed.
A team of researchers at the University
of Bristol gave a synthetic derivative of
vitamin B1 called benfotiamine to mice
with and without diabetes. They found
that treating mice with Type 1 or Type
2 diabetes with benfotiamine from the
early stages of diabetes can delay
progression to heart failure. They also
found that the vitamin B1 derivative
improved survival and healing after
heart attacks in Type 1 mice (and even
in the mice without diabetes too). Foods
rich in vitamin B1 include Marmite,
yeast and Quorn, but it is not yet known
whether changes to diet alone would
provide enough of the vitamin to see the
same effects as supplements achieved
in mice.
Previous Diabetes UK-funded research
at the University of Warwick was the first
to show that people with Type 1 and
Type 2 diabetes have around 75 per
cent lower levels of vitamin B1 than
people without diabetes (4). It is thought
that this may not be due to diet, but
due to the rate at which the vitamin is
cleared from the body. Small scale
clinical trials of people with Type 2
diabetes have also discovered a link
between taking vitamin B1 supplements
and a reduction in the signs of kidney
disease
The latest Diabetes UK-funded research
has been published in the Journal of
Molecular and Cellular Cardiology.
Professor Paolo Madeddu who led this
research at the University of Bristol said
“Supplementation with benfotiamine
from early stages of diabetes improved
the survival and healing of the hearts
of diabetic mice that have had heart
attacks, and helped prevent cardiovascular disease in mice with both Type 1
and Type 2 diabetes. We conclude that
benfotiamine could be a novel treatment
for people with diabetes, and the next
step in this research will be testing
whether similar effects are seen in
humans.”
CAP
Acute Care
Advanced Practitioners
An opportunity for Acute Care
Advanced Nurse Practitioners
to have a voice
Julie Smith & Elaine Headley
ABSTRACT Advanced nurse practitioner roles are not a new concept, however in the last decade the UK has witnessed
unprecedented increases in the number and types of advanced practitioner roles (Bryant-Lukosius et al 2004, Mantzoukas 2007).
Consequently, it has never before been so important that Acute Care Advanced Practitioners are afforded the opportunity to have
a “voice”. To this end, Acute Care Advanced Nurse Practitioners in Ayrshire & Arran and Lanarkshire, working in collaboration
are in the process of setting up a forum for all Acute Care Advanced Practitioners (ACAP) in Scotland. The main aims of this new
exciting forum are to afford ACAPs the opportunity for networking, sharing best practice, an opportunity for education, a link to
major stakeholders, and ultimately enabling ACAPs to have a voice.
Introduction
The notion of advanced nursing practice emerged in the
United States of America (USA) in the 1960s, mainly in
response to socio-political and professional forces, namely
a shortage in primary physicians (Mantzoukas 2007, Mc Gee
& Castledine 2003). Mc Gee & Castledine (2003) further
present the idea that the history of the development of
advanced practice in the United Kingdom (UK) is patchy
and poorly documented but suggest that the concept of
advanced practice didn’t develop until the 1970’s, and took
the form of nurse specialists, with the 1980’s and 1990’s
seeing the emergence of advanced nurse practitioners (ANP’s)
and nurse consultants. The last decade has witnessed an
unprecedented increase in the volume and types of advanced
nurse practitioner, leading to some confusion amongst both
major stakeholders and patients alike, as to the differing
roles and the levels of practice that could be expected from
practitioners. The Scottish Government (2008), recognising
this confusion and identifying the need to conceptualise
advanced practice, developed the “Advance Practice Toolkit”,
(www.advancedpractice.scot.nhs.uk) to support clarity and
consistency. More recently, The Scottish Government (2010)
acknowledged that Advanced Practice roles are pivotal in the
delivery of services. However, ensuring good governance
relies on consistency and benchmarking of practice against
both national and local standards. Current legislation and the
increases in advance practice roles can lead to confusion and
anxiety amongst practitioners themselves. Consequently, it has
never before been more important that ACAPs are afforded
the opportunity to have a voice.
At present there is nothing in Scotland of this nature, solely
dedicated to ACAP’s, recognising a gap, we resolved to set
up a Scottish forum devoted to all ACAP’s. Having a vision of
establishing a Scotland wide forum to incorporate all acute
care advanced practitioners was a daunting thought, but when
enquiring whether or not such a service would be sought after
by ACAP’s it became obvious that there was indeed a need
and a desire for such a provision. The aim of this article is
twofold, firstly to inform all Acute Care Advanced Practitioners
of an exciting new Scottish forum, and what that forum will
offer them as members. Secondly we aim to discuss and
explore the steps taken to date, in setting up this forum.
Getting the message out
Communication as always is the key to so many avenues
12
of success. It doesn’t have to be complicated or incredibly
scientific, keeping things straight forward and simple avoids
ambiguity and uncertainty. People, organizations and
workforces normally communicate to get their message to
others and expect a response. This was the case with ACAP
Scotland, and as suggested by Hovland (2005) we also
wanted to inspire as well as inform our target audience. It was
equally important to avoid under-communication of everything
that we were trying to convey, this would inhibit our message
being received, understood and responded to (Kotter,J. 2010).
In essence, sourcing advanced practitioners that would be
enthusiastic to work in collaboration with each other to get
the idea of the forum off the ground became crucial. Although
there was a recognised need for the forum, finding motivated
enough people to work together could have been a little
more problematic, however this turned out not to be the
case. Simply through discussion with some previous work
colleagues, allowed us to network with others from different
NHS trusts that were eager to establish such a forum. This
was communication at it most basic, but opened the doorway
for the foundation of the forum to exist.
Questionnaires
In order to create a shared vision, it is crucial to provide a
common purpose which will inspire and motivate. Without
the combined motivation and inspiration of others, a vision
will remain just that (McGee & Castledine 2003). In creating
a new initiative there is no substitute for optimism and energy
(Baker and Porter 2005); indeed the pioneers of the forum
have encouraged, motivated, inspired and provided
extraordinary amounts of energy which has allowed the vision
to become a reality. As a result informing as well as inspiring
is paramount in the success of the forum. To facilitate this
step in the process, fliers and questionnaires were sent to all
known ACAP’s, who were subsequently asked if they would
disseminate the information to everyone they knew who may
be interested in this venture. It is acknowledged that this
process of information dissemination may lead to ACAP’s
receiving numerous emails regarding the forum, however in
communicating a vision of any new project, repeatability is
crucial, in reality the message may have to be repeated on
numerous occasions before it starts to take hold (Baker and
Porter 2005).
An e-mail questionnaire data collection method was chosen in
this instance to facilitate an inexpensive and quick return from
a large amount of people scattered over a large geographical
area (Parahoo 1997). Burns & Grove (2003), advise however
that response rate to questionnaires is commonly low. In reality
we expect around a 25 –30% response rate, which, although
Burns & Grove (2003) state, will not allow for a representative
sample, will allow us to make general observations and
conclusions which will guide future activities.
The questionnaires were designed for two reasons; firstly to
elicit advanced practice practices nationally and secondly to
discover what ACAP’s would like from a forum of this nature.
Questionnaire returns to date have shown that ACAP’s have
similar needs, with replies mirroring the proposed objectives
(table 1).
Objectives
Developing highly trained, motivated, intelligent nurses
provides essential service development within the NHS
and also enhances patient care at a level once considered
pertinent to doctors. Investing in this level of education and
professional development is then often difficult to sustain.
However, failure to continue to build and develop these highly
skilled nurses can be detrimental to their motivation. Therefore
providing an opportunity for ACAP’s to have their own say with
regard to what they want from the forum will build in the ability
to endorse empowerment (Marquis & Huston 2000).
Empowerment and motivation will allow ACAP’s to develop the
forum as they deem necessary, through the use of their own
personal knowledge, skills and experience. Subsequently, the
forum will foster a culture of support and protection which will
empower and encourage creativity amongst members.
Some of the influencing factors that may result in staff feeling
demotivated have been identified as lack of empowerment,
lack of autonomy, and changes that affect your organization
(Marquis & Huston 2000). Many organizational changes can
result in speculation and feelings of uncertainty. Undeniably,
the current financial climate we are all currently working under
has caused many NHS employees to feel insecure in their
current roles. However, failure to continue to invest in ones
organisation, industry or service, will only contribute to the
failure of its development. In a report by Howard and Wellins
(2008) their focus on growth and development in organisations
is paramount. They identify that 95% of the UK market and
69% of the global market places emphasis on growth.
Although the NHS is not a business of commerce, does not
necessarily mean that it cannot follow a similar ethos. On
reflection of this, ACAP Scotland, although independent of
the NHS, recognises the importance on the growth and
development of its members and will facilitate just that.
Subsequently, it became apparent that setting of objectives
would prove necessary, to provide focus and direction (table
1). Thorpe et al (1997) report that objectives can be viewed
as quantifiable, operational statements, as a result, setting
objectives ensures that forum members will understand what it
is we wish to achieve and will additionally allow the committee
to audit and measure that outcomes are being met. (Fry et
al 2001). However, Fry et al (2001) warns that one of the
Table 1
OBJECTIVES:
To provide a platform for sharing evidenced based practice.
To provide a link between Acute Care Advanced
Practitioners (ACAP’S) and major stakeholders.
To provide an arena for networking.
To provide ACAPs with a “voice”.
To provide an opportunity for education
downfalls of setting objectives is that it can be viewed as
author orientated. In an attempt to overcome this pitfall,
objectives were set not by one person but through a
shared vision of the steering group.
Future Plans
Although initially a small steering group, consisting of 7
members across 3 health boards, allowed for preliminary
establishment of ideas and setting of forum foundations, it
quickly became apparent that a larger group would be
necessary to facilitate and generate additional ideas.
Consequently ACAP’s from other heath boards were invited
to join. The selection incorporated representation from a
large geographical area.
The initial steering group generated and accepted the
following proposals, which although are in essence still
under construction, will be discussed to date:
Website
The construction of the website would have to facilitate
members from multi regions throughout Scotland. To gain
support from one health board to achieve this proved to be
problematic. So providing a stand alone website was agreed
as the preferred option.
The web site will provide members with unlimited access,
with the threads continuing to focus on education. There will
also be facilities for online forum and BLOGS, as well as links
to relevant key organisations. A calendar of events and venue
information will also be accessible. Although the web site is
still work in progress, it can now be viewed at
http://www.acapscotland.org
Newsletter
Publishing of a newsletter every 3 months will provide
concise up to date information. It will inform it’s readers of
advancements or service developments in a variety of NHS
trusts throughout Scotland. Give information and links for
formal educational courses. Provide feedback from forum
events. Discuss topical issues, look at current evidence based
practices and present a feature article in each edition. The
newsletter will be emailed directly to each member individually.
Web site access and email news letters are an excellent form
of communication, effective for dissemination and sharing of
information between wide audiences. Additionally, Revankar
and Gandedkar (2010) state “The Internet is an effective
platform transcending all dimensions—space, time, and
matter”. Establishing a web site and an e news letter proved
relatively easy to execute, which serves two extremely
important purposes; firstly it demonstrates tangible results,
which encourages a sense of accomplishment within the
steering group, thereby promoting sustained motivation and
empowerment within the group, (Baker and Porter 2005).
Secondly, it allows members the opportunity, early on in the
project, to examine what the forum will offer, subsequently
reinforcing the vision.
Forum Events
ACAP Scotland is dedicated to the members and will be
developed as members require, as such forum events will
be shaped by the needs of the members. It is anticipated
that forum events will incorporate ; masterclasses, (which will
have both educational and seminar components), sharing
of best practice, the ability to network with other ACAP’s and
importantly the provision of links to major stakeholders,
allowing ACAP’s the opportunity to have a “voice”.
Although, bi-annual forum events are the ultimate aim, it
is acknowledged that the first forum event will take longer to
13
co-ordinate; as a result the initial forum event is scheduled
for July 2011. It is anticipated that this delay will allow for
sufficient questionnaire returns to guide the event, and also
allow time for the message to reach a larger target audience.
References
Baker, E. L., Porter, J. (2005) “Practicing Management and
Leadership: Creating the Information Network for Public Health
Officials”, Journal of Public Health Management and Practice,
Vol. 11, no.5, pp. 469 – 473.
Support
ACAP Scotland is an independent forum, which is not affiliated
with any particular health board, established by ACAP’s for
ACAP’s, however, we recognized the importance of having
support from our respective line managers. This support
proved beneficial in many ways; the proffering of ideas and
suggestions when invited to do so, and importantly by putting
us in touch with Clinical leads in other health boards which
opened significant lines of communication with ACAP’s we
may otherwise not have reached.
Bryant-Lukosius, D., DiCenso, A., Browne, G., Pinelli, P. (2004)
“Advanced practice nursing roles: development, implementation and evaluation”. Journal of Advanced Nursing, Vol.48,
no.5, pp. 519 – 529.
Support for ACAP Scotland has come in a number of guises.
The Clinical Skills Managed Educational Network (CSMEN)
and, The Association of Advanced Nursing Practice Educators
(AANPE) have proven to be a remarkable source of support,
with AANPE posting a forum flier on their site, as well as being
mentioned as part of a conference paper in Brisbane,
Australia. CSMEN are also posting a notification regarding
the inception of the forum on their e -news page, and further
agreeing to publish an article on their forth coming news letter.
It is anticipated that this additional level of publicity will attract
a wider audience. Support has already been ascertained with
regards to the forum events, with various individuals from a
range of professional disciplines already confirmed to present
at master classes.
Conclusion
Current guidance (Scottish Government 2010) and the
present financial climate has undeniably led to confusion
and insecurity for Acute Care Advanced Practitioners,
subsequently the time has come to provide a forum where
ACAP’s can have a voice and be empowered, to date
Scotland has no such provision. Recognising the gap and
through a shared vision the authors determined to set up such
a forum. Although translating a vision into reality seemed a
daunting prospect, in reality the enthusiasm and support we
have gained has inspired and motivated us to drive this
project forward. To date the response we have had has
been extremely positive, proving that ACAP’s desire such
a provision.
Initial steering group meetings have resulted in the
acronym ACAP Scotland as a forum name, the setting of
forum objectives and the dissemination of questionnaires to
ACAP’s throughout Scotland. However, although the initial
steering group have generated a firm foundation for the
forum, it is apparent that a forum of this magnitude will
require a larger number of steering group members to
facilitate the proposals; subsequently invites have been
conveyed to other health boards to join this venture. There
are a number of strategies currently under construction which
will enable us to meet the set objectives of the forum; a web
site, a newsletter which we anticipate will be prepared every
three months, and bi – annual forum events. The first of
which, we are currently organising, in response to ACAP
questionnaire results.
In conclusion, this is an exciting time for ACAP’s in Scotland,
a time to take the lead and have our say in ACAP role
development.
To gain membership to the forum, or for further information
contact: [email protected]/[email protected]
14
Burns, N., Grove, S. K. (2003) Understanding Nursing
Research, 3rd edn., Saunders: Philadelphia.
Fry, H., Ketteridge, S., Marshall, S. (2001) A Handbook for
Teaching & Learning in Higher Education: Enhancing
Academic Practice, 3rd edn., Kogan Page: London.
Hovland, I. (2005) Successful communication: A toolkit for
researchers and civil society organisations www.odi.org.uk
[online] available [accessed] 2010-08-09
Howard A., Wellins,R, S. ( 2008) UK highlights global leadersforecast 2008-2009- The Typical , The Elite and The Forgotten.
www.dddiworld.com [online] available [access] 2010-08-13
Kotter, J. (2010) Because Change is essential www.kotterinternational.com [online] available [accessed] 2010-08-09
Mantzoukas, S. (2007) “Review of advanced nursing practice:
the international literature and developing the generic features”, Journal of Clinical Nursing, Vol. 16, no. 1, pp. 28 – 37
Marquis, B.L., Houston,C.J. ( 2000) Leadership Roles and
Management Function in Nursing: theory and Application, 3rd
edn. , Lippincott Williams and Wilkins: Philadelphia.
McGee, P., Castledine, G. (2003) Advanced Nursing Practice,
2nd edn., Blackwell Publishing: Singapore.
Parahoo, K. (1997) nursing Research: Principles, Process and
Issues, Palgrave MacMillan: Hampshire.
Revankar, A. V., Gandedkar, N. H. (2010) “Effective communication in the cyberage”, American Journal of Orthodontics and
Dentofacial Orthopedics, Vol. 137, no. 5, pp. 712 – 714.
Scottish Government (2008) Supporting the Development of
Advanced Nursing Practice: A Toolkit Approach, Scottish
Government: Edinburgh.
Scottish Government (2010) Advanced Nursing Practice
Roles: Guidance for NHS Boards, Scottish Government:
Edinburgh.
Thorpe, M., Edwards, R., Hanson, A. (1997) Culture and
Process of Adult Learning, 3rd edn,. Routledge: London.
About the authors
Julie Smith is currently an Advanced Nurse Practitioner
on the Hospital at Night (HAN) team across Ayrshire &
Arran - Having worked within this team for 4 1/2 years,
since its inception.
Elaine Headley is currently a senior charge nurse
within the Hospital Emergency Care Team (HECT) in
Lanarkshire – having been part of this service since
its onset in May 2004.
Better control for eczema flare-ups
The most common cause of
a flare-up in atopic eczema
is Staphylococcus aureus.
Despite growing scientific
evidence that Staphylococcus
aureus makes atopic eczema
worse and hinders healing, a
survey conducted by YouGov in
August 2010 amongst over 642
eczema sufferers revealed that
71 per cent had never heard of
staphylococcus aureus and only
1 per cent of eczema patients
had discussed it with their GP
or healthcare professional.
Use of antimicrobial
emollients such as Eczmol
have an established role in
the prevention of infection,
but research shows only 11
percent have ever been
prescribed an antimicrobial,l
as opposed to 41 per cent who
have been prescribed steroids.
Launched in the UK in April
2010, Eczmol, which contains
chlorhexidine gluconate, does
not carry the irritant and allergic
risks associated with benzalkonium chloride (contained in
existing antimicrobial products)
and could provide even more
effective relief for patients.
In trials it was shown to kill
bacteria within 60 seconds
of application and provide an
enduring anti-microbial effect
as a leave on product (up to
4 hours) and as a soap substitute (up to 2 hours). Data and
references on file. A low
viscosity cream that spreads
easily and evenly across the
skin, Eczmol costs £3.70 for
250ml.www.eczmol.co.uk
ConvaTec Receives UK Product
Award for Flexi-Seal(R) FMS
ConvaTec has received a prestigious
product award for continence and
stoma care at the inaugural Nursing
Times Product Awards, during the
publication's awards ceremony in
London, UK. The Nursing Times
presented the Platinum Award to
ConvaTec for its Flexi-Seal(R) Faecal
Management System (FMS) product,
a temporary containment device
indicated for immobilised, incontinent patients with liquid or
semi-liquid stools. The innovative system was designed to
safely and effectively divert faecal matter, protect patients'
wounds from faecal contamination, and reduce the risk of both
skin breakdown and spread of infection, such as C. difficile.
The Nursing Times Product Awards recognise and reward
the products that are transforming patient care and helping
healthcare professionals work efficiently. According to one
judge: "This Company has really taken on board feedback from
nurses and product development. The product ticks all boxes
regarding Quality, Innovation, Productivity and Prevention
(QIPP) as well as significant potential cost savings." The
finalists were judged by a prestigious panel of clinical and
industry experts to determine the winners in each category.
The Nursing Times Product awards are organized by the
leading weekly magazine, Nursing Times. For more information
on The Nursing Times Product Awards go to:
http://www.nursingtimesproductawards.com
15
Are you looking for a new job
or to develop your career?
Skills4Nurses Jobs Fair was this year held at the prestigious
Mitchell Library, Glasgow on the 15th and 16th September 2010.
Visitors in 2010 met over thirty exhibitors from
primary care trusts, NHS trusts, charities, leading
recruitment agencies, armed forces, hospices
and international companies. Each offered
career advice and hundreds of jobs in the UK
and overseas. They also received FREE personal
career advice in our FREE career counselling
sessions, as well as seminars on a range of
topics. If you missed the seminars, the
presentations will be available online shortly
at www.Skills4Nurses.com
Skills4Nurses have great pleasure in announcing
our 2011 job fairs, again to to be held at one of
Glasgows prestigious venues "The Mitchell
Library" on Thursday 14th April we will be
announcing who and what employers are coming
in future editions of Skills4Nurses or log on to
www.Skills4Nurses.com where you will see in our
current vacancies section, or simply click onto
one of our current advertisers on the home page.
Our Irish nurses will also be well catered for in
2011, we have already booked the Fantastic
Berkeley Hotel, Dublin 4. This will be our 20th
year helping Irish nurses finding employment,
you can be sure that we be leaving no stoned
un-turned, in bringing employers from not only
Ireland and the UK, but also from USA,
Australia and New Zealand.........
A NEW JOB - look no further as our exhibitors
have hundreds of jobs both in the UK and
overseas available for you to discuss at the
event. From first-time jobs for students to
managerial positions, our events covers all
areas of the nursing profession.
MOVE OVERSEAS – speak to our international
exhibitors for on advice on why, where, when
and how you can make your exciting move.
Get FREE advice in our career workshops where
you will find a comprehensive seminar programme
running over both days as well as FREE personal
career advice in our FREE career counselling
sessions.
As a nurse employer you already know how
difficult recruiting nurses can be. Shortages of
good candidates continue to be an acute problem
across the country. To attract the best talent and
fill your vacancies in this gloomy climate, you
need a head start on the competition.
Skills4Nurses Job Fairs will give you a unique
opportunity to recruit nurses face-to-face in a
relaxed and friendly environment. Supported
by the market leading publication Skills4Nurses,
you will:
• Meet committed nursing professionals focussed
on their career progression
• Speak to nurses of every level and grade from
those soon to qualify to nurse specialist and
managers with extensive experience
• Find out about the nurses’ expectations and
match them to your current vacancies
• Build an immediate relationship with your
potential employee
For more information on our 2011 Expos call Elaine or Jim on 0044 1292 525970 or email [email protected]
16
CHALLENGES AND POSSIBILITIES IN TREATING
OVERGRANULATION IN PRIMARY CARE Melanie Martin BSc (Hons), MRPharmS
Overgranulation
“The optimist already sees the scar over the wound; the
pessimist still sees the wound underneath the scar.”
Ernst Schroder
Skin is the most frequently injured tissue.1 Overgranulation
of a healing wound is a common problem encountered by
wound care practitioners2, 3 and provides a challenging
situation.4
There is a lack of consensus about suitable treatments for
overgranulation and limited information available to help
guide treatment choices. A search for overgranulation by this
author in the Health Information Resources (formerly National
Library for Health) reveals no information, despite its inclusion
of search engines for Bandolier, Evidence Based Reviews,
NHS Evidence Specialist Collections, National Library of
Guidelines (includes NICE Guidance), NICE Guidance (only),
Clinical Knowledge Summaries. Information can only be
gleaned from a review of the few publications and case
reports that are available in this area of wound care.
What is granulation tissue?
The formation of granulation tissue is a central event during
the proliferative phase of wound healing.5 Granulation
tissue is a transitional replacement for normal dermis,
which eventually matures into a scar during the remodelling
phase of healing.6
Healthy granulation tissue, which is present in a wound
healing by secondary intention, is red, lumpy and almost
velvet-like in appearance and indicates that the wound is
healing.7 However, in some cases, it is possible for the
granulation tissue to continue forming within the wound
even after it has drawn level with the surrounding healthy
skin. This is known as overgranulation, hypergranulation,
exuberant granulation tissue, proud flesh, hyperplasia of
granulation and hypertrophic granulation.8, 9 It is said that
chronic, non-healing wounds can often develop
overgranulation.4
What is overgranulation?
Characterised by its extremely dense network of blood
vessels and capillaries, overgranulating tissue rises unevenly
above healthy tissue surrounding a wound.6 Overgranulation
tissue can be healthy or unhealthy. Characteristics of
unhealthy overgranulation tissue are shown in Table x.
The overgranulated tissue is likely to produce a clear or
yellow fluid that can also cause maceration of the
surrounding tissue and even skin stripping which
complicates the healing process.10
Table 1. Characteristics of an unhealthy overgranulation
tissue 4, 6, 8, 9, 11
Dark red, pale bluish/purple in colour
Bleeds easily, breaks easily
Infection often present, with malodour and exudates; also
increased risk of infection
Often dehydrated, dull surface
Uneven mass rising above level of surrounding skin
Examples of types of tissue in which overgranulation may
be seen 2
• Traumatic wounds on forearm, leg or neck
• Post-operative wounds on abdomen, back, forearm,
forehead
• Percutaneous endoscopic gastromy (PEG) stoma sites
• Supra-pubic catheter stoma sites
• Chronic abdominal sites
Possible Causes
When occlusive dressings, especially hydrocolloids, are
used for the treatment of heavily exudating wounds, the
likelihood of overgranulation increases considerably, thought
to be due to oedema.12 This has been described as
‘the over-efficiency of modern day dressings’.11
Infection is another commonly believed cause of
overgranulation, particularly in unhealthy overgranulation
tissue.6
Other possible explanations include the presence of a
prolonged inflammatory response 8 and the overgrowth of
fibroblasts and endothelial cells.6
Why does overgranulation tissue matter?
Overgranulation in a wound often presents a challenge as it
appears to cause a delay in healing. Furthermore, there is no
consensus on the most appropriate form of management.7
Management of overgranulation
With time, overgranulation may resolve itself. However, many
practitioners feel the need to treat the affected area to resolve
the overgranulating tissue. Clinical judgement is required for
the management of each individual patient.6
Wound healing is a complex science and many preparations
exist to advance the various stages of the healing process.13
Terra-Cortril Ointment was widely used for overgranulation
tissue before its withdrawal in 2004, forcing wound care
practitioners to find alternative treatment options for this type
of wound.2 Although there are many treatments that are now
commonly used for the treatment of overgranulation, the most
usual approach remains the use of silver nitrate. However, it
was recently stated by an experienced Tissue Viability Nurse
Consultant that “Silver nitrate sticks are not recommended in
the treatment of overgranulation as best practice and should
only be considered when all other options have failed as they
have a caustic effect.”4
Other commonly used treatments for overgranulation include
silver alginates, foams and various steroids. Recently,
steroid presented in the form of an adhesive tape has proved
effective in the treatment of overgranulation. However, all
current treatments have limitations and advantages (Table 2).7
Furthermore, there are few published studies regarding the
treatment of overgranulation and most of the existing evidence is based on case study reports in individual patients.
‘Cauliflower-like’ appearance
Slows wound healing
18
✒✒✒✒✒
PRODUCT
LIMITATIONS
Silver nitrate
• No definite
stick/tip/pencil:
recommended
topical silver
time for
nitrate
application
• can cause severe
pain, burns (caustic)
• black discolouration
may hinder interpretation
of healing
• damages healthy
tissue
• good evidence for
its use is lacking
• not for prolonged or
excessive use
• only use to treat areas
less than a thumbnail
size (topical)
• may need to be applied
on more than one occasion
due to recurrence
• surrounding skin needs
protection
• dressing may also be
required 4, 6, 10, 14, 15
ADVANTAGES
• inexpensive
• readily available
• application requires
minimal technical skill
• reduces fibroblast
proliferation
• immediate effect
• produced some
good results
in clinical practice
• applied once
every 1-4 days
(topical)6, 10, 14
Foam
dressings
• Lengthy courses of
• Absorbs excess
treatment - may take up
moisture
to six weeks to have effect
• flattens tissue
• double hydrocolloid layers
via pressure4
often required – can increase
oedema to wound site4, 6, 7
Corticosteroid
preparations
• Unlicensed indication
– responsibility for use
lies with the user
• may alter wound quality
• not licensed for use on
open wounds
• long-term continuous
therapy should be avoided
in all patients irrespective
of age3, 6, 16
• Quick-acting
• reduces inflammatory
response6
Haelan Tape
(see below)
• Unit cost may be
considered expensive
if considered only in
isolation
• long-term continuous
therapy should be avoided
in all patients irrespective
of age
• occlusion may not always
be desired 6
• Licensed for
recalcitrant
dermatoses
• easy to apply
• cut shape to fit
around wound
• cost-effective6
• comfortable2, 6, 6, 7
exerted by the tape whilst in situ has a positive effect on the
reduction of overgranulation tissue.6 The tape also protects
the wound area preventing damage from scratching and
other irritation.
Haelan Tape is presented in a cardboard dispenser,
containing either 50cm (green dispenser) or 200cm (yellow
dispenser) of tape that is 7.5cm wide and protected by a
removable paper liner. Haelan Tape should be applied to
clean, dry skin which is free of hair. The tape need only
remain in place for 12 out of 24 hours, but clinical practice
has shown that 24-hour use is more advantageous.6
Haelan Tape also provides the opportunity to cut the tape
to fit the wound, and particularly to fit around tubes such
as percutaneous endoscopic gastromy (PEG) tubes,
supra-pubic catheters, tracheotomies and around stoma
sites. This offers extreme flexibility of use.18 Requiring once
daily application, Haelan Tape is easier to apply than other
dressings used for overgranulation and offers a
cost-effective solution.6
Summary
Overgranulation of wounds is a challenging situation in
clinical practice. It is most commonly thought to be due
to infection or the use of occlusive dressing, although other
theories exist. Many different treatment options are available
for the management of overgranulation; however, firm
evidence for them is limited. Haelan tape offers an effective
alternative option for treatment of overgranulating wounds.
Continual assessment of the wound, ideally using photographs, will determine the success of any treatment used.
References
* List is not exhaustive; taken from reviewed papers listed.
Review of Haelan tape
Haelan tape is a protective, waterproof, self-adhesive tape
impregnated with 4mg/cm2 of the moderately potent steroid,
fludroxycortide.17 It is licensed as an adjunctive therapy
for chronic, localised, recalcitrant dermatoses that may
respond to topical corticosteroids and particularly dry,
scaling lesions.17, 13 Examples of previous treatment sites
include hypertrophic scars, pyoderma gangrenosum, and
overgranulation around stoma sites.6
As well as providing the therapeutic effect of the steroid in
the tape-covered area, it is also possible that the pressure
1. Ferguson M et al. Prophylactic administration of avotermin for
improvement of skin scarring: three double-blind, placebo-controlled,
phase I/II studies. Lancet 2009; 373; 1264-1274.
2. Johnson S. Overgranulation tissue: a new approach.
Poster ref DJ07/486.
3. Johnson S. Overgranulation in wounds. Skills 4 Nurses. ??.
4. Hampton S. Understanding overgranulation in tissue viability
practice. British Journal Community Nursing 2007; 12(9): S24–30.
5. Romo T et al. Wound Healing, Skin. eMedicine Otolaryngology and
Facial Plastic Surgery, 2008, at: http://emedicine.medscape.com/article/884594-overview. Date accessed 29.11.09.
6. Johnson S. Haelan tape for the treatment of overgranulation tissue.
Wounds UK 2007; 3(3): 70-74.
7. Oldfield A. The use of Haelan Tape in the management of an overgranulated, dehisced surgical wound. Wounds UK 2009; 5(2).
8. Dealey C. The Care of Wounds. 2nd Edn. Blackwell Science,
Oxford, 1999.
9. Dunford C. Hypergranulation tissue. J Wound Care 1999; 8(10):
506-507.
10. Borkowski S. G tube care: managing hypergranulation tissue.
Nursing 2005; 35(8): 24.
11. Collins F, Hampton S, White R. A–Z Dictionary of Wound Care.
Quay Books. Mark Allen Publishing, Wiltshire, 2002.
12. Vandeputte J et al. Observed hypergranulation may be related to
oedema of granulation tissue,
http://www.medline.com/Woundcare/products/dermagel/PDFs/Observ
ed%20Hypergranulation.pdf.Date accessed 04.12.09.
13. British National Formulary Sept 2009, Appendix 8,
http://bnf.org/bnf/bnf/current/58820.htm.
14. Hanif J et al. Silver nitrate: histological effects of cautery on
epithelial surfaces with varying contact times. Clin Otolaryngol Allied
Sci 2003; 28(4): 368-370.
15. Rollins H. Hypergranulation tissues at gastrostomy sites. Journal
of Wound Care. 2000; 9(3): 127-129
16. Kloth LE. Wound Healing Alternatives in Management. FA Davis,
Philadelphia, 1990.
17. Haelan Tape, Summary of Product Characteristics.
18. Layton A. Reviewing the use of Fludroxycortide tape
(Haelan Tape) in Dermatology Practice. Typharm Dermatology.
19
Overgranulation
Table 2.
Some limitations and advantages of current treatments*
Midwifery
CARRYING A CASELOAD WITHOUT BREAKING YOUR BACK
Looking at the painting with a mixture of pleasure,
disbelief and a parental glow of pride, I was so
pleased I’d had the time to call in to my daughters’
school to view her ‘A’ level art exhibition and deeply
impressed that I had managed to produce a child
with such wonderful talent when my own artistic
ability is virtually nonexistent.
Heading downstairs back to my car my pager went
off. Perfect timing I thought and, sure enough, the
message was from my midwifery partner. She was
letting me know that ‘Georgia’ was progressing
beautifully and would I like to join them for the
imminent second stage. I started driving towards
Georgia’s home relieved that I had remembered to
get some supper out of the freezer that morning.
A quick call home to remind various family members
to sort it out would ensure food on the table even
though mum wouldn’t be home for a while.
I am a midwife, more specifically; I am an independent
midwife and have been now for about ten years.
Being self-employed has given me the freedom over
the years to organise my day to suit myself and, if that
meant fitting in a dentist visit with one of my children,
or attending a school exhibition with another, I could
do it without having to justify taking ‘time off’- I simply
arranged my workload around such things. And,
because I was able to make most family events, my
children were generous and understanding when I
did miss one.
Although I fully support the ideals of the NHS, I have
absolutely no doubt that for me the decision to go
independent was the right one. I struggled within
the NHS to find the balance between being there for
women and being there for my family, oh and plus
a bit of time for myself. Of course there are still days
when everything goes pear shaped and I wonder
whether there isn’t an easier way to earn a living but
99.9% of the time I get total job satisfaction. I work in
a small practice with two other midwives and we are
able to offer genuine continuity of care to women,
care which is not continuously compromised by the
insatiable demands of the unwieldy and bureaucratic
monster that is maternity services in England today.
OK, maybe it’s not that bad everywhere. I know there
are amazing things happening in different parts of the
country but it seems to me they happen despite the
system not because of it and they are usually at the
expense of the sanity and work / life balance of the
dedicated and committed midwives working in such
schemes.
20
Does it have to be this way? If we want to do caseload
midwifery is it inevitable that we have to forfeit much
of the joyous mayhem that is family life or the right to
regularly recharge our batteries in order to practise
in the true spirit and definition of being a midwife:
Getting to know someone throughout their pregnancy,
travelling with them on their journey into motherhood,
being privileged to be part of the rite of passage that
is labour and then sharing the ups and downs of
those first early weeks of parenting.
The benefits and rewards of working in this way for
both the woman and the midwife are well documented
(Stevens et al 2001, Benjamin et al 2001, Sandall et al
2001) and yet the years roll on and the opportunities
for caseload remain on the fringes. There is a small
midwifery-led unit set up here or a new caseload
team there but for the vast majority of women using
the system and the midwives working in it, the most
common experience is still the fragmented care of
a busy consultant unit combined with an under
resourced and over stretched community service.
It works for some, possibly even for many, but what
about the significant number of women who want
real continuity plus the even bigger number who
would if they only knew what it was! What about all
Midwifery
those midwives who give up in despair because the
system defeats them and they feel unable to maintain
their midwifery skills in the face of increasingly rigid
and restrictive protocols (Kirkham, 2002).
I believe passionately that it is possible to have it
all – well, most of the time anyway – but that it is
only feasible to sustain a caseload and a life outside
it when we have much more control over our workload
and can organise it to suit our own individual and
family needs rather than those of a large, impersonal
institution.
Once I became a self-employed midwife working
in independent practice, my priorities have become
much easier to define and to manage. Now I have
only to balance my family / personal life against my
working commitments and, while my colleagues in the
practice are also part of the equation, because we are
a small and self-organising group, this does not create
a problem, indeed, more often than not it solves one;
we are able to help each other out when things crop
up unexpectedly, without it impacting on anyone else.
Much as I love being an independent midwife though,
I am acutely aware that it is a difficult decision for
any midwife to make. I practise without professional
indemnity insurance – because there is none available
- and can only care for those women who have the
ability to pay. Wouldn’t it be great, given the apparent
desire of past and present governments to see
women’s choices improved, if we could find a way
to contract in to the NHS and offer this option,
based on the way in which we work, to sit
alongside the current framework of services?
Well, Independent Midwives UK (IM UK) has
plans to do just that. It is still in its early stages
but we believe our proposal, which would see the
development of neighbourhood midwifery practices
setting up in communities across the country, can
instil some real direction and energy into the vexed
and difficult debate around the ongoing crisis in the
maternity services. It is time for some ‘thinking outside
the box’ and for midwives and women to demand a
better deal, one that is mutually beneficial for all.
Midwifery at its holistic best enables women and their
families to embark on the long and often bumpy road
through parenthood with the best possible start. When
a woman is well supported though her pregnancy, the
birth and the postnatal period, the long term benefits,
from both a public and personal health perspective
are extraordinary. Everyone gains and, if we can
spread this way of working, perhaps we might finally
begin to see normal birth rates rise as midwifery
reasserts itself as the natural partner for women
having babies within a social model of care.
References
Benjamin Y, Walsh D, Taub N (2001). A comparison of
partnership caseload midwifery care with conventional
team midwifery care: labour and birth outcomes.
Midwifery 17(3):234-40.
Kirkham M, Ball L, Curtis P (2002). Why do midwives
leave? London: RCM
Sandall J, DaviesJ, Warwick C, (2001). Evaluation of
the Albany Midwifery Practice: final report March 2001.
London: Florence Nightingale School of Nursing and
Midwifery, Kings College London.
Stevens T, McCourt C (2001). One to one midwifery
practice part 1: setting the scene.
British Journal of Midwifery 9(12): 736-40.
Annie Francis. MIDIRS Midwifery Digest, vol 15,
supplement 2, December 2005, ppS25-S26.
Original article. Copyright MIDIRS 2005.
Updated November 2010
Mental Health Nurses’ Attitudes towards
Personality Disorder
Authors: Colin Hughes and Stephen Hamilton
Mental Health
Colin Hughes is a Registered Nurse, Teaching Fellow and Cognitive Behavioural Psychotherapist (BABCP) based at
the School of Nursing and Midwifery, Queen’s University, Belfast; Stephen Hamilton is a Registered Nurse (part 3)
Address for correspondence: [email protected]
The International Classification of Mental and
Behavioural Disorders (ICD-10) (World Health
Organisation, 1993) defines personality disorder as
a severe disturbance in several areas of a person’s
characterological condition and behaviour, these
disturbances nearly always being associated with
considerable personal and social disruption. The issue
of treatment and indeed treatability of patients with a
diagnosis of personality disorder has throughout the
years proved to be contentious and controversial. Staff
perceptions of and attitudes towards this patient group
can impact either positively or negatively on treatment
efficacy. The National Institute of Clinical Excellence
(2009) highlights the importance of patients with a
personality disorder having equal access to treatment
within the Health and Social Care framework.
Traditionally, these individuals have been managed at
the fringes of the health care system, for example, via
accident and emergency departments and in-patient
psychiatric units. It has been further highlighted that
these patients experience limited follow-up contact
in the community from health and social services,
with staff rarely possessing the necessary skills to
adequately and effectively treat patients with a
personality disorder. Evidence suggests that these
patients experience isolation and exclusion as a
result of personality disorder not being viewed as a
psychiatric disorder by some (Lewis and Appleby,
1988).
The American Psychiatric Association (2000)
characterises personality disorder according to three
distinct groupings, namely (a) odd and / or eccentric
behaviour (b) dramatic, and / or erratic behaviour and
(c) anxious and / or avoidant behaviour. In this piece,
the authors aim to further explore staff attitudes in
relation to patients with cluster (b) personality disorder,
as well as examine the parallel issues of staff confidence, competence, training and supervision. Primary
care studies report the prevalence of personality
disorder to be between 10% and 30% (DHSSPSNI,
2008). In addition, approximately 10% complete
suicide, with 12% of those who completed suicide
having a diagnosis of personality disorder. Crucially,
the diagnosis of a personality disorder is linked with
poor treatment outcomes, increased risk of selfinjurious behaviour, completed suicide and continued
hospital readmission (DHSSPS, 2008). Fagan (2004)
states that there is considerable dichotomy of thought
surrounding whether or not personality disorder is
treatable in the first instance, and indeed if treatment
should be delivered in a specialist setting. Adshead
(2001) states that in no other branch of medicine
does the “treatability” of an illness equate with the
“curability” of that illness. Therefore, the emphasis in
the context of personality disorder should be on the
effective ongoing psychological management of the
illness, as would be the case with chronic physical
conditions such as heart disease or diabetes.
Research into the treatment of borderline personality
disorder has shown that over 50% of individuals who
receive treatment show signs of positive clinical
recovery (DHSSPS, 2008).
Mental health nurses working with this unique group
describe them as being among the most challenging
patients encountered in their clinical and community
practice (Cleary et al, 2002). Some of these
challenging behaviours include self-harm and suicide
attempts, extreme mood fluctuation, manipulation,
splitting, transference, and counter transference
(Greene and Ugarriza, 1995). If the challenging
behaviours displayed by patients with a borderline
personality disorder are not effectively managed,
patient treatment can be compromised and team
relations damaged (Cleary et al, 2002); hence, the
importance of effective clinical supervision for those
staff involved in the care of these patients. In light of
the NICE Guidelines (2009) and the Northern Ireland
Personality Disorder Strategy (DHSSPSNI, 2008), the
authors carried out a survey (January, 2010) in order
to harness staff attitudes towards patients with a
personality disorder. The sample consisted of 49
mental health nurses on part 3 of the Nursing and
Midwifery Council live Register, currently working in
the acute psychiatric inpatient sector with at least
one years’ post registration experience.
66% of respondents did not feel that patients with a
personality disorder should be treated in an acute
in-patient setting. Only 35% felt confident in terms
of their abilities when working with this patient group.
67% felt they lacked the necessary training and
relevant knowledge surrounding personality disorder
and a mere 27% of the sample felt they received
satisfactory clinical supervision, with 34% indicating
dissatisfaction with the standard of clinical supervision
they received. From a managerial supervisory perspective, 39% reported satisfactory levels of supervision;
with 24% of the sample expressing dissatisfaction. It
is of note and concern that following analysis of the
qualitative data generated by the audit, the majority
of the sample surveyed were essentially unsure as to
what constituted good quality clinical and managerial
supervision in the first instance. The authors suggest
that irrespective of patient diagnosis, effective clinical
and managerial supervision in any Health and Social
Care context is not only highly desirable but absolutely
essential if we are to protect staff and patients as well
as deliver the best service possible. Almost all
respondents (98%) called for extra knowledge and
information on the effective management of patients
with a personality disorder, in the form of awareness
sessions, skills escalation and specialist courses.
A variety of possible locations for the delivery of this
additional training were suggested by the sample,
namely University Institutions and Trust Hospital
Sites. The following tables display the percentage
responses to a small selection of the various
statements contained within the audit tool.
personality disorder (Laskowski, 2001). Within clinical
supervision, new therapeutic techniques can be
explored not only in relation to advancing the care
and treatment of patients with a borderline personality
disorder, but also as regards facilitating staff in coping
effectively with the many associated stresses. Exposure
to effective, regular and ongoing clinical supervision
will further enable and empower staff to accept
accountability for their practice and professional
development in this context and beyond
(Pesut and Herman, 1999).
Mental Health
Table 1: Patients with personality disorder should
be treated in acute in-patient wards
Reference List
Adshead, G. (2001) Murmurs of discontent:
treatment and treatability of personality disorder”
Advances in Psychiatric Treatment. 7, pp. 407 – 416
American Psychiatric Association (2000) Diagnostic
and statistical manual of mental disorders.
Compendium 2002. Washington DC, USA:
American Psychiatric Publishing
Table 2: I feel I am equipped with the necessary
knowledge and skills to work effectively with this
patient group
Cleary, M., Siegfried, M., and Walter, G. (2002)
Experience, knowledge and attitudes of mental health
staff regarding clients with a borderline personality
disorder. International Journal of Mental Health
Nursing 11(3), pp. 186-191
Department of Health, Social Services and Public
Safety Northern Ireland (2008) Personality Disorder:
A Diagnosis for Inclusion. Northern Ireland: DHSSPSNI.
Fagin, L. (2004) Management of personality
disorders in acute in-patient settings; part 1:
Borderline personality disorders. Advances in
Psychiatric Treatment. 10, pp. 93-99
Greene, H., and Ugarriza, D. (1995) The ‘stably
unstable’ borderline personality disorder: History,
theory, and nursing intervention. Journal of
Psychosocial Nursing 33(12), pp. 26-30.
Table 3: I feel that I receive satisfactory clinical
supervision
Laskowski, C. (2001). The mental health clinical nurse
specialist and the “difficult” patient: evolving meaning.
Issues in Mental Health Nursing 22(1), pp. 5-22.
Lewis, G. and Appleby, L. (1988) Personality disorder:
the patient’s psychiatrists dislike. British Journal of
Personality, 153, pp. 44-49.
National Institute for Health and Clinical Excellence
(2009) CG78. London: National Institute for Health
and Clinical Excellence
Pesut, D. J., and Heran, J. (1999) Clinical reasoning:
the art and science of critical and creative thinking.
New York: Delmar.
In conclusion, despite the apparent gaps which exist
in relation to supervision, knowledge and service
provision in the context of personality disorder, it is
encouraging to note the apparent desire on the part
of mental health staff to provide a better service for
this unique patient group. In light of this, clinical
supervision can provide valuable insight and support
for staff working with patients who have a borderline
World Health Organisation (1993) International
Classification of Mental and Behavioural Disorders
(ICD-10): WHO
23
Nursing in
Australia's economy has boomed in recent year.
Australia now needs at least 100,000 new people
to come to its cities each year from overseas
and lend their skills to the growing economy.
Nurses are currently in high demand in Australia. There are
excellent career opportunities whether you want to emigrate to
Australia, or just stay for a few years. Whether you have a high
level of skills and experience or need to gain additional skills,
there is a visa that will suit your circumstances.
Australian citizenship is acquired in two main ways, either
by birth, descent or adoption, or by grant after settlement.
Australian citizens have an unlimited right to enter, exit, and
re-enter Australia. All other people wishing to enter Australia,
i.e. non-citizens need a visa to lawfully enter and be in
Australia whether on a temporary or permanent basis.
Currently in Australia most visa applications for nurses
receive priority processing. You are able to come to Australia
independently, and look for work, or arrange a job with an
employer before you leave.
A large proportion of our clients are interested in travelling to
Australia to experience the Australian way of life and to decide
if they wish to make a permanent move to the land 'down
under'.
NURSING IN AUSTRALIA
Nursing in Australia is similar in many ways to the UK.
The public health system faces waiting lists and budget
constraints, similar shift patterns and drug names, and not
forgetting that a nurses' unique sense of humour and selfpreservation skills are easilytransferable to Australia.
The Australian Nursing Council (ANCI) has developed national
Competency Standards for the registered and enrolled nurse,
the ANCI Code of Ethics for Nurses in Australia and the ANCI
code of Professional Conduct.
All nurses have to be registered within the State or Territory in
which they work unlike the UK where nurses are registered with
the UKCC and can practice anywhere in the country.
‘Australia has the lowest
precipitation of any of the
world's inhabited continents.’
In Australia, to work as a nurse you need to be in good health
and have a certain level of education and experience. If you
wish to work in a hospital or other health care area, you will
also need to pass a health examination which includes a
chest x-ray.
To determine whether you can work in Australia as a nurse,
you will need to be assessed by either the Australian Nursing
Council (ANC) or the nurse regulatory body in the State or
Territory in which you wish to work. The ANC's website has
more information including links to State and Territory nurse
regulatory bodies.
FACTS....
THE VISA PROCESS
Around 24% of Australia's residents were born overseas.
This compares with 20% in New Zealand, 17% in Canada,
10% in the USA and 6% in the UK. Western Australia is the
biggest Australian state and covers one third of the continent.
Its total area is over 2.5 million square kilometres. That makes
it 3.6 times bigger than Texas, 4.6 times bigger than France
and 11 times bigger than the UK. It's an interesting fact that,
despite its large size, Western Australia is home to only around
two million people. Australia has the lowest precipitation of any
of the world's inhabited continents. (Antarctica gets less.) 70
percent of Australia gets less than 500 mm (20 inches) of
rainfall per year.
At Migration Matters we can assist you with our specialised
services for nurses, if you are interested in travelling to
Australia to enjoy a working holiday or if you have a more
permanent move in mind.
For further details on relocating to Australia please contact:
Cathrine Burnett-Wake on 020 3239 5940 or check out
www.migrationmatters.com
You can keep abreast of what's happening in the professional
arena by becoming a member of the Royal College of Nursing
Australia (RCNA). The RCNA runs a Program called 3LP - Life
Long Learning Program, which is similar to PREP although is
not mandatory for re-registration. It adds to your portfolio and
shows you are motivated and committed to personal and
professional development.
24
Australia
WHAT TO DO ONCE YOU ARRIVE IN AUSTRALIA
There are some very important things that you should do as
soon as you arrive in Australia. You will need to apply for a
Tax File Number, register with Medicare and possibly take
our Private Health Insurance. You will need to open a bank
account, possibly register with Centrelink, apply for a
Driver's Licence and enrol your children in school amongst
other things.
To receive any type of income in Australia, you need a Tax
File Number (TFN). Income includes wages or salary from
a job, payments from the government, and money earned
from investments including interest on savings accounts. In
Australia, you can telephone the Tax Office for the cost of a
local call and have a TFN application form sent to you.
Alternatively, you can apply for a TFN over the internet:
http://www.ato.gov.au
The Australian Government also provides help with basic
medical expenses through a scheme called Medicare. You
may be eligible to join Medicare and gain immediate access to
health care services and programs. These include free public
hospital care, help with the cost of out-of-hospital care, and
subsidised medicines. To enrol in Medicare, you should go into
a Medicare office 7 to 10 days after your arrival in Australia and
take with you, your passport or travel documents. There are
also many different private health insurance options you may
wish to consider as Medicare does not provide for other
services such as dental and optical care, ambulance.
In Australia, most income including salary or wages and
government benefits are paid directly into a bank account.
You will be required to open a bank account within six weeks
of your arrival, you usually need only your passport as
identification. After six weeks you will need extra identification
to open an account.
Centrelink is a government agency which pays social security
benefits and provides other forms of assistance. As a newly
arrived migrant, you are not immediately eligible for social
security (unless you are a refugee or humanitarian entrant).
You do not have access to the full range of government
employment services. If you are a permanent resident, you
may be eligible to access some services. Centrelink is able
to help you find a job, arrange for recognition of your skills
and qualifications, and to access certain courses. Centrelink
can also help you with family assistance payments to help
with the cost of raising children.
Under Australian law, children between the ages of 6 to 15
must attend school. You should enrol your children in a school
as soon as possible.
If you have a driver's licence from another country, in English
or with an official translation, you are allowed to drive for your
first three months as a resident in Australia. After the first three
months, if you want to drive, you will need to have the appropriate Australian approved driver's licence. To get one you will
usually need to pass a knowledge test, a practical driving test,
and an eyesight test. In Australia, drivers' licences are issued
by state and territory governments.
TESTIMONIALS.....
"This is a testimonial to Cathrine and Suzies's good work. We have
been hoping to migrate to Australia for five years, but did not know
how to start. This is where Migration Matters took over, they were able
to make what would have been a stressful matter as straight forward
as possible. They filled all the necessary forms in on our behalf,
because they are very complicated. There was nothing sweeter than
receiving the phone call to say that our visa had been granted, it felt
like we had won the lottery. I would recommend Migration Matters to
anyone trying to move abroad, as they would guide you all the way
there."
Nicolas Kesington & Family
"Dear Suzie and Cathrine, Once again Melvin and myself wish to
thank you both very much at Migration Matters for all your help and
guidance throughout the whole process of our application which
demonstrate your professionalism while handling our case. You have
been such a lovely team to know and work with throughout resulting
in great success. We wish well and continued success throughout
your careers. Keep up the excellent work. As for us we are really
looking forward for the challenge ahead. Many thanks again."
Jourdane and Melvin Guy
For further details on relocating to Australia please contact:
Cathrine Burnett-Wake on 020 3239 5940 or check out
www.migrationmatters.com
AUSTRALIAN QUICK FACTS:Area: 7.68 million sq km
Population: 19.5 million
Capital City: Canberra
People: 92% Caucasian,
7% Asian,1% Aboriginal
Language: English
Religion: 75% Christian, 1% Muslim,
1% Buddhist, 0.5% Jewish
Government: Independent member of
the Commonwealth of Nations
Head of State:Governor General Ms
Quentin Bryce AC
Head of Government: Prime Minister
Julia Gillard
GDP: US$418 billion
GDP per capita: US$22,000
Annual Growth: 4%
Inflation: 2%
Major Industries: Minerals, oil, coal,
gold, wool, cereals, meat, tourism
Major Trading Partners: Japan,
ASEAN countries, South Korea,
China, New Zealand, USA, EU
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Overseas Recruitment - Australia
27
Guernsey Recruitment
NURSING IN
Immigration is important to New Zealand and we welcome
committed migrants from across the globe. We value the
skills you bring and your capacity to add colour and
diversity to our young nation
To migrate to New Zealand, you will need to apply for a
Visa or Permit.
New Zealand has very similar aims with regard to its
migration program to Australia. New Zealand has identified
specific employment opportunities that it regards as
necessary for continued economic growth as a nation.
New Zealand is looking for people who have skills,
experience and relevant job offers to fill available positions.
The Skilled Migrant Category offers you the opportunity
to move to New Zealand to work and live permanently.
The 'Skilled Migrant' immigration category ensures that
both New Zealand and new migrants can experience
positive social, cultural and economic outcomes of living
and working together. Every year migrants from all over
the world make New Zealand their new home.
‘The New Zealand economy is
growing and is stronger now than
it has been for several years.’
If you are invited to apply for residence under the Skilled
Migrant Category the New Zealand Government make
another assessment of how well you are likely to settle into
life in New Zealand and make a contribution to the country.
The Immediate Skill Shortage List outlines the most current,
relevant and required occupational abilities with regard to
New Zealand's economy and includes: Nurses and midwives,
Occupational therapist, Dietitian, Medical practitioner,
Physiotherapist, Psychologist, Enrolled nurse etc.
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NEW ZEALAND
NEW OPPORTUNITIES IN A NEW LAND ....
New Zealand is a new and vibrant land. Our growing
economy is characterised by a willingness to innovate, adapt
and try new ideas. As a small nation distant from our major
markets, we have to be innovative to survive. And this can
do attitude has yielded some impressive results. In less than
a decade, our film industry has grown from tiny beginnings
into a producer of such international successes as The Lord
of the Rings Trilogy, Whale Rider and The World s Fastest
Indian. Similarly, our once unknown wine industry now
consistently produces award winning vintages that are
sought after internationally. Over the years we have
chalked up an impressive record of technical breakthroughs
in science and technology and the range and diversity of
our commercial products has burgeoned.
It is no accident that it was a New Zealander who first
scaled Mt Everest. With our can do spirit and record of
innovative commercial enterprise we offer fertile ground
for new ideas. As a small economy we also offer different
types of work opportunities. Our companies are small and
less formally structured and this calls for broadly-based skills
rather than narrow specialisation. Our lifestyle is also open
and expansive. New Zealand has a thriving cultural life,
with a unique mix of European, Maori, Polynesian, Asian,
and increasingly, other traditions. We are passionate about
sport and have a great love of the outdoors. The range of
activities available from sailing to fishing to mountaineering
is huge. Easy access to the great outdoors is a feature of
our way of life and even those living in the major cities are
often within less than a twenty-minute drive of open and
unspoilt countryside.
For further details on relocating to New Zealand please
contact: Cathrine Burnett-Wake on 020 3239 5940 or
log onto www.migrationmatters.com
WELCOME - HAERE MAI
As a migrant destination New Zealand has a lot to offer.
But life here will also be very different from what you are
accustomed to. New Zealand is a small and distant country.
Of all New Zealand s cities only Auckland with a population
of over a million, about 25% of the national total, would
qualify as a major city. For many migrants, our other
centres have more the feel of a country town and
provincial towns often seem more like villages.
MIGRANTS
All migrants are driven by the vision of a new life.
At the end of the day there's usually some time for a little
light jazz. At least that's how Indian migrant, Ashok Sharma
sees it. As a cardiothoracic surgeon with an international
reputation, Ashok could live anywhere in the world. He
chooses to live in New Zealand. "It's really a quality of life
issue. This is a good country to live in. We like the informal
way of life and the great open spaces. We've enjoyed
raising our children here. They are both at university
and doing well."
costs. And you can find out how to buy a house in New
Zealand ? it might be different from the process in your
home country
NATURAL BEAUTY AND NATIONAL PARKS
New Zealand has many wilderness areas, including National
Parks in Fiordland, Mt Cook, Tongariro and elsewhere, that
attract tourists from around the world. Exploring these
wilderness reserves is a great way to get a feel for the
dramatic scenic contrasts and unique outdoor
opportunities New Zealand offers.
As a New Zealander you will be expected not to stand on
your dignity and muck in like a good Kiwi, whatever the
occasion.
For further details on relocating to New Zealand please
contact: Cathrine Burnett-Wake on 020 3239 5940 or
log onto www.migrationmatters.com
Ashok Sharma - Chandigarh, India
New Zealand Quick Facts:-
Once you ve arrived in New Zealand you ll also have
access to our Settlement Support New Zealand network.
The network currently has co-ordinators in 19 locations
throughout the country. These co-ordinators work with
local government and other social agencies to provide new
migrants with expert guidance on how to access local
services.
Area: 268,680 sq km
Population: 4.2 million
Capital City: Wellington
People: 75% New Zealand European (Pakeha), 10% Maori, 5%
other European, 4.5% Polynesian, 5% Asian, 0.5% other
Language: English, Maori
Religion: Predominantly Christian (75%)
Government: Independent member of the Commonwealth of Nations
Head of Government: Prime Minister John Key
GDP: US$85 billion
GDP per capita: US$22,360
Annual Growth: 2%
Inflation: 2.7%
Major Industries: Food processing, wood and paper products, wool,
textiles, dairy products, iron and steel, machinery, tourism
Major Trading Partners: Australia, Japan, UK, China and the USA
HOUSING
Finding somewhere to live will be one of your highest
priorities when you first arrive in New Zealand. Lots of
people choose to rent a house first and then buy later.
It gives you a chance to become familiar with the city or
region you ll be living in before you buy. You can take some
time to discover the types of housing we have and what it
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General Recruitment
Overseas Recruitment - Australia
General Recruitment
Vista Healthcare Independent Hospital is a
Specialist Centre for people with Learning
Disabilities, Mental Health difficulties
www.vistahealthcare.co.uk
CLINICAL TEAM LEADERS (Salary range £30,000 - £35,000)
You will assist the Specialist Service Manager in providing high standard care and treatment to
patients, providing leadership to the ward team and day to day management and supervision.
STAFF NURSES – RMN/RNLD (Salary range £24,645 - £26,815)
You will work as a primary nurse, devise and review behavioural programmes, supervise
Therapy Assistants and be involved in a varied range of activities as part of a multi-disciplinary
team. There is plenty of opportunity to develop your skills with training and supervision so
nurses requiring preceptorship are as welcome as those with more experience.
DAY, NIGHT & ROTATIONAL POSITIONS AVAILABLE
Bank Staff opportunities also available flexible shifts
BASED IN HAMPSHIRE
The Hospital offers you the opportunity to work with a variety of services users including
forensic backgrounds and challenging behaviour. We also have a specialist autistic
unit. We offer a flexible working pattern plus generous holiday entitlement, and
on-opportunities. Vista Healthcare is within easy reach to a mainline station (Basingstoke/
with local links and M3/M4/A30 road networks.
For further information, please contact CareBridge on 0845 226 9903
email your CV to [email protected] www.carebridge.co.uk
A full enhanced CRB check would be carried out prior to appointment.
Vista Healthcare is an equal opportunities employer
Working in partnership