€5.75 Vol 24 No 6 July/August 2016
Latest course information from Journal of the Irish Nurses and the INMO PDC Midwives Organisation See centre pages
World of Irish Nursing & Midwifery
Call for investment in public services page 6
Meet the new INMO president page 18
Who’s who on Executive Council 2016-18 page 21
Nurse volunteers report from the Calais ‘jungle’ page 46 Renewed focus with new Executive Council Restoration of pay and working hours top of the agenda CONTENTS 3
News & views 46 Focus Four Irish volunteer nurses report from 5 Editorial the infamous ‘jungle’ in Calais, which is Notwithstanding the fallout of ‘Brexit’, home to 4,500 refugees/asylum seekers the accelerated restoration of pay and reduction of the working week for 49 Media Watch nurses and midwives remain an absolute Ann Keating reviews INMO activities priority, writes Liam Doran, INMO reported in the news general secretary 50 Midwifery matters 6 News Joan Devin on whether today’s maternity ICTU demands investment in public services reflect the commitment made to services at National Economic women and children in 1916 Proclamation Dialogue… INMO welcomes additional health funding… Pilot staffing studies 52 Standardised terminology set to commence… INMO participating Dr Pamela Hussey reports on the progress in HSE review groups… ED overcrowding of the DCU SNHS ICNP user group 18 eases off in May… Talks continue to amend policy on safeguarding persons 55 Focus at risk of abuse… Refurbishment John Corcoran on why nurses and of Richmond building set to start… midwives must be ever-questioning to New IRO appointed to western area… further expand their knowledge Nursing/medical interface on transfer 56 Focus of tasks… Talks on measurement of all hours worked… Changes in community As codeine dependency in Ireland rises, it care structures…Who exactly stands to is important to understand the harmful gain from TTIP? effects it can have, writes Gerry Ryan 16 International news 60 Update Elizabeth Adams discusses a report from Round up of healthcare news items the Safeguarding Health in Conflict Coalition and reports from the 69th World Health Assembly Clinical 43 CPD Features This month our continuing professional 15 Section focus education series focuses on the The Occupational Health Nurses Section management of type 1 diabetes mellitus is the focus this month 29 18 Interview Living Taking the helm at a critical time for the Book review Irish health service, new INMO president 59 Sonja Storm reviews When your child Martina Harkin-Kelly sets out her priorities is sick – What you can do to help by Alf 21 Executive Council Nicholson and Grainne O’Malley Introducing the new INMO Executive Plus: Monthly crossword competition Council for 2016-18 65 Finance 25 Questions and answers Ivan Ahern on how to protect your Bulletin board for industrial relations beneficiaries against inheritance tax queries 26 Quality and safety Jobs & Training Maureen Flynn introduces the ‘Framework for Improving Quality in Health Service’ 33 Professional Development Eight-page pull-out section from the 29 Hate crime legislation INMO PDC Shane O’Curry calls on the government to urgently enact hate crime legislation 66 Diary Listing of meetings and events nationally 30 Focus and internationally Dr Philippa Ryan Withero and Liz Roche 46 on the pilot phase of the safe staffing 67 Recruitment & Training and skill mix on medical/surgical wards Latest career and training opportunities WIN Vol 24 No 6 July/August 2016 WIN – World of Irish Nursing & Midwifery is distributed by controlled circulation to more than 32,000 members of the INMO. It is published monthly (10 issues a year) and is registered at the GPO as a periodical. Its contents in full are Copyright© of MedMedia Ltd. No articles may be reproduced either in full or in part without the prior, written permission of the publishers. The views expressed in this publication are not necessarily those of the INMO. Annual Subscription: e145 incl. postage paid. Editorial Statement: WIN is produced by professional medical journalists working closely with individual nurses, midwives and officers on behalf of the INMO. Acceptance of an advertisement or article does not imply endorsement by the publishers or the Organisation. EDITORIAL 5 Pay and hours restoration Journal of the Irish Nurses and Midwives Organisation remains top priority World of Irish Nursing & Midwifery
(ISSN: 2009-4264) Volume 24 Number 6 The accelerated restoration of pay and the July/August 2016 reduction of the working week of nurses WIN, and midwives, must, notwithstanding MedMedia Publications, recent developments involving the UK and 17 Adelaide Street, the EU, remain an absolute priority for the Dun Laoghaire, new government. Co Dublin. In the immediate aftermath of the UK’s Website: www.medmedia.ie decision to leave the EU there is much uncertainty about the actual implication of this decision. In addition, and unique to Ireland, we are the only land border the UK has with a fellow member state and the to public servants, thus increasing their Acting Editor Tara Horan impact of ‘Brexit’ upon that border must spending power and stimulating growth Email: [email protected] be reviewed. and production within local communities. Tel: 01 2710205 Firstly it must be noted that whatever It is also imperative that the UK decision Sub-editor Sinéad Makk, Anne Savage agreement is reached between Ireland and is not used as a barrier to delay the invest- Designers Fiona Donohoe, Paula Quigley the UK, there must not be any return to the ment in essential public services here after Advertising manager Leon Ellison restrictions that were the norm a little over seven years of austerity. This period of Email: [email protected] 20 years ago. The removal of checkpoints austerity has resulted in more than 1,000 Tel: 01 2710218 and their replacement with open roads families being homeless, increased over- Publisher Geraldine Meagan which allows and encourages movement crowding in our emergency departments between Northern Ireland and the Republic and cuts to all sectors within education. WIN – World of Irish Nursing & Midwifery must never be taken for granted. Increased investment in all of these areas is published in conjunction with the In that context, the new agreements must include the restoration of pay and Irish Nurses and Midwives Organisation by MedMedia Group, Specialists in Healthcare that will be decided upon arising from other conditions of employment of public Publishing & Design. ‘Brexit’ must reflect the will of the vast servants who have shouldered so much of majority of the people which is set out in the burden over the past seven years. the Good Friday Agreement and allows It has to be acknowledged that the deci- unfettered movement in the interests of sion of the UK has created uncertainty, normal relations, mutual respect and soci- however the reality is that business and etal wellbeing. trade will re-establish equilibrium and will It is also necessary for the EU to reflect reach new agreements that will ensure on why the citizens of a member state, goods and services are traded in a free Editor-in-chief: Liam Doran when given the opportunity, decided to market with no unnecessary, or new, bar- INMO editorial board: leave. It must be acknowledged, as stated riers introduced. This is why, when all the Martina Harkin-Kelly; Mary Leahy; Margaret Frahill; Frances Cullen; Kay Garvey; by the ICTU delegation to the recent current rhetoric dies down, the govern- Mary Gorman; Karen McGowan; Deirdre Munro National Economic Dialogue (see page 6), ment must, without delay, establish an INMO editor: Ann Keating that the decision to put financial Europe environment which attracts and retains Email: [email protected] before social Europe was a major factor. nurses, midwives and other health profes- INMO editorial assistant: Freda Hughes The recent years of austerity and retrench- sionals that are in short supply. ment, where those in need suffered most In tandem with this, it must also be INMO photographer: Lisa Moyles while banks and bond holders were saved hoped that the bureaucrats within the INMO correspondence to: Irish Nurses and Midwives Organisation, and protected, must now be the source of EU realise that their ivory towers, from Whitworth Building, some reflection by those who made these where they constantly speak down to the North Brunswick Street, flawed choices. ordinary people of Europe, must be dis-
Dublin 7. Notwithstanding any uncertainty, there mantled. The basic social needs of every WIN Tel: 01 664 0600 must be early acceleration of pay restora- community across the continent must be Vol 24 No 6 July/August 2016 Fax: 01 661 0466 tion and the reduction in the working week given equal treatment while ensuring con- Email: [email protected] for nurses and midwives. It can already be tinued economic growth. The purpose of Website: www.inmo.ie sensed that employers are voicing the need every economy is to serve society and not for caution, financial stringency and further the other way around. This lesson must be www.facebook.com/ fiscal correction. However, it is now more relearned quickly. irishnursesandmidwivesorganisation important than ever, in order to continue to build upon our improving economy, that Liam Doran twitter.com/INMO_IRL government moves to restore the pay cuts General Secretary, INMO 6 NEWS
Call for investment in public services ICTU sets out its demands at National Economic Dialogue
The second National Economic repeatedly stressed the need employers and other commu- The INMO representatives Dialogue took place, in Dublin, for the new government to nity groups, under a number of specifically contributed to the on June 27-28 2016. prioritise investment in quality headings, as follows: following sub-groups: At this meeting the INMO public services in this country. • Tax reform for balanced eco- • Sensible spending chaired was represented, as part of In particular, with regard to nomic growth by Pascal Donohoe, Minister the delegation from the Irish health, the ICTU has fully sup- • Sensible spending; for Public Expenditure and Congress of Trade Unions, by ported the INMO demand that • Planning for the future – a Reform, (Liam Doran) our INMO director of industrial the public health service must, digital economy and climate • The role of education and relations Phil Ní Sheaghdha, as a minimum, be allocated change training in securing oppor- and general secretary Liam 10% of GDP over a sustained • Economic policies to best tunity chaired by Richard Doran. period. The ICTU has stressed achieve our full employment Bruton, Minister for The opening submission this is 10% of GDP being goal Education and Skills, (Phil Ní from the ICTU (see below) devoted to the public health • The role of education Sheaghdha). summarises, in a very short and service and is in addition to and training in securing A full report on the findings/ succinct format, the priorities, any expenditure in the pri- opportunity consensus emerging from the as seen by ICTU, at this time. vate healthcare sector in this • Delivering on Foodwise 2025 two days of intensive engage- In this submission, and in all country. • Housing, homelessness, ment, will be published on the of the contributions at the ple- The National Dialogue urban regeneration and INMO website, www.inmo.ie, nary and group sessions during saw very detailed discus- planning and in forthcoming issues of the two day meeting, the ICTU sions involving trade unions, • Sustainable infrastructure. WIN.
ICTU opening submission to National Economic Dialogue Firstly, I think it is appropri- with sufficient resources tar- and this should be a matter of the loss of high quality skills, ate that I make brief reference geted to support the delivery great shame. experience and knowledge to the outcome of the UK ref- of quality public services. The market has failed within the workforce. Equally erendum particularly given Notwithstanding the (Brexit and the State needs to step the poor working conditions in our role as an all-island body. referendum) outcome, the pro- in immediately and accel- the sector must be addressed. It is our view that the triumph posed increase of current and erate construction with a While there is little or no ref- of the ‘Leave campaign’ is as capital spending by just 2% substantial increase in the cap- erence to this issue in the a direct consequence of the for 2017 is in our view wholly ital budget for 2017. This is not Summer statement, not to persistent pursuit of auster- inadequate. The investment a matter of policy choice – it is invest is a false economy. ity policies and the erosion target should be at least 4% an absolute necessity requir- Low pay and precarious of social progress which which is achievable given cur- ing rapid delivery for all those work define the labour market alienated workers across the rent economic growth levels. affected. for too many, especially young continent. As has been the case in other Our broken Health Service workers. The Living Wage must ‘Social Europe’ was sacri- countries, our government will only be fixed by moving be the ‘floor’ for pay across the ficed to save ‘Financial Europe’ needs to persuade the EU to to a universally accessible economy. Low hour and pre- and there has been a resultant stretch the current fiscal rules, single-tiered public system carious work practices must be loss of confidence in the entire in order to achieve this. funded to a minimum of 10% outlawed. European project. EU authori- Over the last eight years, of GDP on a sustained and The Pension crisis requires ties need to grasp this reality working people have paid a continuous basis. the creation of a National and urgently develop a pro- huge price for a crisis they did Investment in an accessible, Superannuation Fund, with gramme of substantial public not create. While undoubt- inclusive Education system is a contributions from workers, investment together with a edly our economy has recently pre-requisite for an equal soci- employers and government. suite of measures to secure experienced strong growth, ety and thriving economy. In our view the pursuit of workers rights and decent our society is deeply fractured Policy failure in childcare these policy choices would, jobs. and unequal. can be remedied by raising at least, begin to address the Congress believes that this Ireland is one of the rich- investment to European levels. social fractures and inequali- country’s first priority must be est countries in the world, The very high cost of childcare ties so evident in our society investment in our public ser- yet somehow we are unable in this country is a major bar- today. vice infrastructure, through a to house our people. We now rier to labour market entry and – Patricia King, Vol 24 No 6 July/August 2016 July/August No 6 24 Vol progressive taxation system, have a housing emergency significantly contributes to General Secretary, ICTU WIN NEWS 7
Call for investment in public services Additional health funding welcomed The additional allocation of reducing emergency depart- nurses and midwives to vacant frontline nursing and midwifery €500 million to the public ment overcrowding later this posts and assist in recruiting posts,” said INMO general sec- health service announced last year. staff to ensure safe patient care retary Liam Doran . month has been welcomed by The INMO is seeking early and manageable workloads for “The additional allocation, the INMO. meetings with Ministers of staff, according to the INMO, . particularly earmarked funding This allocation should allow State at the Department of “This additional alloca- for a renewed winter initiative, for the maintenance of existing Health Helen McEntee and tion is most welcome and is must now be subject to early service levels as well as addi- Finian McGrath to discuss required by the health ser- discussions with the ED Imple- tional funding for such critical issues affecting older people vice which continues to face mentation Group. This will areas as homecare and disa- and disability services, increasing levels of demand. ensure the system utilises this bility services. The additional respectively. The subject of much confusion additional resource efficiently allocation contains funding This additional allocation in recent weeks, it is impera- and effectively, on the front- earmarked for a winter initia- should also remove any con- tive that the HSE immediately line, in the interests of patient tive to be targeted at further fusion over the recruitment of recommences recruitment to care and standards of service.”
Pilot staffing studies set to commence on wards
The INMO is currently leading to improved recruit- before and during the pilot INMO general involved in finalising the ment and retention. study to demonstrate/con- secretary Liam arrangements for the pilot The context for the pilot firm the positive impact of Doran: “The INMO views the work of staffing studies, taking place studies is the implementation safe consistent staffing levels the Taskforce as in three hospitals, as the next of the interim recommenda- on patient care. absolutely critical step in implementing the tions, which provide for a range The pilots are due to last for in addressing serious staff Taskforce on Nurse Staffing of measures including: approximately four months at shortages existing recommendations for medical/ • A 100% supervisory role for which time a full report will be right across the service at this time” surgical wards. the CNM2 issued to the National Task- The pilot studies are taking • The measurement, using an force which will then meet, The pilot studies will allow for place in Beaumont Hospital (two agreed dependency tool, of in October/November, to the testing, of these recom- wards), Our Lady of Lourdes patient acuity and depend- review the feedback, finalise its mendations over a three to Hospital, Drogheda (two wards) ency, by the CNM2, which, report and issue its final set of four month period, before the and St Columcille’s Hospital, combined with the CNM2’s recommendations. National Taskforce completes Loughlinstown (one ward). professional judgement, will INMO general secretary its work and issues a final report The purpose of the pilot lead to a determination of the Liam Doran said: “The Taskforce before the end of the year. studies, which were recom- required staffing levels on Nurse Staffing was estab- “The INMO views the work mended in the Interim Report • All staff on the five pilot wards lished as a direct result of the of this Taskforce, on which we of the Taskforce on Nurse to be permanent thus mini- INMO Safe Staffing Campaign have been represented at all Staffing, involved the alloca- mising need for agency staff commenced in May 2014. The stages, as absolutely critical tion of €2 million to assess • A nurse to HCA ratio of 80% Taskforce interim recommen- in addressing the serious staff whether the Taskforce recom- to 20% once safe nurse dations set a clear context shortages existing right across mendations deliver improved staffing levels have been for determining staffing in all the service at this time and for patient care, an improved determined and are in place medical/surgical wards for the creating, and maintaining, a working environment for staff • Close measurement of safety primary purpose of improving greatly improved working envi- and, fundamentally, stable CLUEs (Care Left Undone patient care and the working ronment for our members”. consistent staffing levels Events) in all five wards, both environment of nursing staff. • See also update on page 30
INMO participating in several HSE review groups WIN In recent weeks the INMO Vision and Educational Frame- Hospitals/Units – INMO to this group Patricia Hayes, Executive Council has submit- work for Nurses Working with nominee to this group is Mary Athlone Branch and staff nurse, Vol 24 No 6 July/August 2016 ted nominations to a number Older People – INMO nominee Gorman, Executive Council South Westmeath Hospice. of important working groups, to this group is Eileen Kelly, Exec- member and CMM2, Our Lady The Organisation will being established by the HSE, utive Council member and staff of Lourdes, Drogheda actively support our nominees to address a range of impor- nurse at Sacred Heart Home • Development of a Framework to these three areas of impor- tant issues. The details of these Roscommon to Determine Staffing and Skill tant work and regular updates working groups are: • National Review of Maternity Mix Requirements for Palliative will appear in WIN and on the • The Development of a Strategic Care Assistants in Maternity Care Nursing – INMO nominee INMO website, www.inmo.ie 8 NEWS
ED overcrowding eases off in May The INMO trolley/ward • The continued implemen- capacity, which will exacer- Doran said: “Any reduction in watch figures for May show a tation of the ED agreement, bate pressures on emergency the number of sick patients on 14% reduction in the number between the INMO, the departments. trolleys must be welcomed, of admitted patients on trol- Department of Health and The INMO has repeated its particularly after the worst leys compared to May 2015. the HSE, which has prioritised call on both the Minister for winter on record for ED over- The figures (see Table 1) the ED crisis at a system wide Health Simon Harris and the crowding. Everyone must now confirm that 6,627 patients level. HSE, to immediately lift any re-affirm their commitment admitted for care were on However, the INMO warned restriction on recruiting front- to implementing the recent trolleys this year, compared to that this positive develop- line staff and to ensure that all ED agreement and continue 7,713 in May 2015. ment in trolley figures may be hospital managements proceed to prioritise the crisis facing The INMO welcomed the short lived if the recent HSE to fill all vacant frontline posts. emergency departments in all fact that the level of over- recruitment freeze is not lifted The Organisation is also decision making. The confusion crowding in emergency immediately. calling for immediate engage- that now exists over recruit- departments has eased but The consequence, of any ment on finalising initiatives ment must be removed so that also noted some factors that delays in recruitment of nurses to expand bed capacity and we can attract the 4,000 Irish may have contributed to the and other frontline staff will services for the forthcoming nurses and midwives needed to fall in figures: result in the curtailment of autumn/winter period. fill vacant posts and safely staff • Improved weather this year services and a reduction in bed INMO general secretary Liam our services.”
Table 1. INMO trolley and ward watch analysis May 2016
Hospital May 2006 May 2007 May 2008 May 2009 May 2010 May 2011 May 2012 May 2013 May 2014 May 2015 May 2016 Beaumont Hospital 324 559 733 601 638 622 722 453 341 782 535 Connolly Hospital, Blanchardstown 189 126 161 201 214 398 416 568 499 382 215 Mater Misericordiae University Hospital 366 507 467 270 483 345 449 323 223 497 371 Naas General Hospital 218 113 75 358 215 524 116 152 218 138 218 St Colmcille’s Hospital 59 96 22 179 226 115 189 139 n/a n/a n/a St James’s Hospital 53 79 110 139 35 151 121 190 83 258 92 St Vincent’s University Hospital 314 552 504 340 538 599 354 462 116 427 194 Tallaght Hospital 293 323 352 591 527 566 223 489 363 325 337 Eastern 1,816 2,355 2,424 2,679 2,876 3,320 2,590 2,776 1,843 2,809 1,962 Bantry General Hospital n/a n/a n/a n/a n/a n/a n/a n/a 0 4 10 Cavan General Hospital 174 199 156 71 165 446 318 126 68 38 48 Cork University Hospital 434 393 341 212 629 653 444 353 400 454 397 Kerry General Hospital 102 20 33 11 38 56 26 42 77 169 85 Letterkenny General Hospital 204 26 33 15 22 38 56 59 334 93 38 Louth County Hospital 10 0 0 6 2 n/a n/a n/a n/a n/a n/a Mayo General Hospital 192 36 111 77 123 65 90 128 191 64 211 Mercy University Hospital, Cork 129 65 145 40 93 138 160 183 140 253 175 Mid Western Regional Hospital, Ennis 33 61 12 113 54 1 6 30 n/a 3 7 Midland Regional Hospital, Mullingar 10 7 8 23 134 171 242 389 309 435 445 Midland Regional Hospital, Portlaoise 35 21 31 9 11 178 33 56 212 167 307 Midland Regional Hospital, Tullamore 0 14 2 2 65 220 95 130 426 116 448 Monaghan General Hospital 25 35 16 7 n/a n/a n/a n/a n/a n/a n/a Nenagh General Hospital n/a n/a n/a n/a n/a n/a n/a n/a n/a 0 9 Our Lady of Lourdes Hospital, Drogheda 297 270 196 160 172 649 683 272 375 718 451 Our Lady’s Hospital, Navan 17 50 9 118 17 137 25 109 23 42 50 Portiuncula Hospital 42 8 27 0 97 66 40 58 23 101 19 Roscommon County Hospital 9 66 46 58 48 84 n/a n/a n/a n/a n/a Sligo Regional Hospital 47 76 40 0 152 54 237 101 162 245 180 South Tipperary General Hospital 40 27 45 55 75 27 184 321 161 223 448 St Luke’s Hospital, Kilkenny n/a n/a n/a n/a n/a 34 23 159 77 297 159 University Hospital Galway 154 209 218 186 378 510 493 282 410 524 349 University Hospital Limerick 112 98 80 181 233 193 263 755 502 538 592 University Hospital Waterford n/a n/a 40 13 147 129 124 221 83 357 195 Wexford General Hospital 332 15 151 194 212 222 56 137 75 63 42 Country total 2,398 1,696 1,740 1,551 2,867 4,071 3,598 3,911 4,048 4,904 4,665 National total 4,214 4,051 4,164 4,230 5,743 7,391 6,188 6,687 5,891 7,713 6,627 Comparison with total figure only: Increase between 2015 and 2016: –14% Increase between 2012 and 2016: 7% Increase between 2009 and 2016: 57% Increase between 2014 and 2016: 13% Increase between 2011 and 2016: –10% Increase between 2008 and 2016: 59% Vol 24 No 6 July/August 2016 July/August No 6 24 Vol Increase between 2013 and 2016: –1% Increase between 2010 and 2016: 15% Increase between 2007 and 2016: 64% Increase between 2006 and 2016: 57% WIN WIN Vol 24 No 6 July/August 2016
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T her effects of the the of effects O 9 NEWS the policy was T ecutive Coun ecutive nne members con members he he in the Western A NM Ex T I ffice, have prior to this have prior to this an officer of the an officer of the O y 11. O ect and now needs needs now and ect of reporting any sus any reporting of ext meeting is pro is meeting ext reacy reacy in which NM Jul I HQ in Dublin. T been would O he n he ea, who is moving back to to back who is moving ea, r – Phil Ní Sheaghdha, INMO Sheaghdha, INMO – Phil Ní T NM cil for the past six years, and and years, the past six for cil has A I New IRO for IRO New Area Western open Following competition, takes up the Burke post of industrial officer, relations the in based Galway 2016. 4, July from has been a member Ms Burke the of recent in Branch Galway is replacing Ms Burke years. Clare director of industrial relations of industrial relations director policy. Members are advised advised are Members policy. on this that training policy such place until take cannot time as the amendments that made. are required are introduced unilaterally, with unilaterally, introduced out discussion or dialogue, any incorr was corrected. to be that the agreed policy to needs be amended. without changes introduced, agreement, will be discussed amended policy and any realistic to provide will have protected as such supports, staffing time and increased duties, if services nursing to other than those held prior to assigned December 2014, are to them in these areas. engaged in a working discus working engaged in a sion which that the accepts manner visionally scheduled to take visionally scheduled to take place that requests advice and the with tinue practice pected abuse incidences as they
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rent out rent thus providing a further income a thus providing to the stream develop to continue services and supports for members. works will development be WIN in of details and covered the opening of the new Educa tion and Event Centre will be will be Centre tion and Event announced of the competency assurance of the competency assurance which will be requirements the near in forward, brought and Nursing the by future, of Board Midwifery the allow will also ing addition, • •
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Education and Event Education and Event the building become will see the expanded education greatly development and professional services, for members. a little under six months and building refurbished the newly will be open quarter first in the of 2017. of lecture theatres, an audito theatres, of lecture and and allow the range wider much a members of cognisant fully programmes, rium, café/restaurant together together rium, café/restaurant with mentation of this policy for this of mentation for policy nur the the the meantime, that issues the imple of arise in respect consultation on the following: following: consultation on the • unions, and this would then be CH to all notified firming this position in writing writing in position this firming to
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he i he his policy e’ remained the sole policy sole policy the e’ remained accepts that consul that accepts proper arding its impact on staff. staff. on impact its arding there is no agreement on on is no agreement there s were advised that ‘ advised were s onsultation took place with T Meanwhile, the third the third Meanwhile, meet T t t s Matter ing grades roll out of this policy for out of this roll for nurs policy I tation, as is required, did not did not tation, as is required, tak C social worker grades, however, however, grades, worker social the that it accepts and regrets fol was not process correct lowed with nursing grades with nursing lowed Richmond Hospital set to become Richmond Hospital set and Eventnew INMO Education Centre
has announced The tendering, planning, design, being works other finance and completed, the refurbishment on the project Richmond Build ing is due to commence. now Richmond refurbishment set to start to set refurbishment Richmond mond, to make it the it to make mond, • • reg until national training in selves discussions concluded. ber Car of use in allegations for agreed abuse against staff. ing on the new policy took place on again confirmed that: • the policy, the unions advised the unions advised the policy, them members to not involve A unions on the new national unions on the new national vulnera policy on safeguarding of abuse. at risk ble persons sultation or negotiation with the December 2014 without con safeguarding persons at risk of risk at persons abuse safeguarding Natio Talks continue to amend policy on policy amend to continue Talks between the HSE and nur the HSE between New INMO IRO for Western Area Western for IRO INMO New 10 NEWS
Phil Ní Sheaghdha, INMO director of industrial relations, reports on current national IR issues
Changes in community Nursing/medical interface care structures on the transfer of tasks The structures within THE chairman’s note of the press verification meetings had staff and also difficulty with community healthcare Lansdowne Road Agreement been held with: staffing levels in some loca- organisations have altered and the Haddington Road • National Children’s Hospital tions. However, it is clear that and there are now nine com- Agreement allows for savings Group there are no impediments to munity care organisations, that accrue as a result of the • SAOLTA Hospital Group the roll out other than those each led by a chief officer. transfer of certain tasks to • Mid West Hospital Group that would prevent the safe The INMO and other be applied to the restoration • Southern Hospital Group. delivery of this service to health service unions of premium pay, which was There are three remaining patients. attended a WRC concilia- removed from nursing grades hospital groups to be exam- There is a great degree of tion conference on June 9 for working the hours between ined: Ireland East, the RCSI and nurse involvement confirmed to to discuss the roll out and 6 and 8pm. the Midlands, which are sched- the verification group, mainly in other changes envisaged A composite document was uled to take place soon. first dose IV, phlebotomy (out for community healthcare negotiated, on foot of the To date the feedback to the of hours period) and IV cannula- organisations and how these chairman’s note, by the INMO, verification group is positive tion. Nurse/midwife facilitated would affect staff employed SIPTU Nursing and the IMO. in that there is no resistance discharge is taking slightly within these structures. This document, which can be to the roll out of the specific longer but is well advanced in The INMO sought all infor- found on www.inmo.ie, allows duties. It is clear from the the maternity services. mation that currently exists for the orderly transfer of four documentation and the agree- The next step is that the in respect of the structures identified tasks on condition ment reached at national national committee is due to and all correspondence relat- that training has been provided level that this agreement does meet to review the information ing to the chief operations to nurses/midwives and staff- not require the transfer of all obtained through the verifica- officers’ appointments and ing levels are adequate. responsibility for these duties tion meetings. It is the business other management grades Local implementation to nursing staff from medical of the committee to decide if to the community care struc- groups have been set up in staff. The agreement is quite the verification process, as set tures to date. Management acute hospitals in order to specific that medical staff will out in the agreement, has been has agreed to furnish this agree certain aspects of this remain involved and the most completed and to sanction information to the INMO. implementation process, and appropriate staff member, ie. a payment. The INMO has also secured that work is ongoing. trained nurse or doctor, should If there are any disputes, a forthcoming separate This framework document provide this particular service the independent chair, Sean meeting dealing specifically also provides for a verifica- where necessary. McHugh, will be requested to with nursing issues, including tion process and the national The feedback from the arbitrate on such matters as is nursing management struc- implementation group is in the groups whom the verification allowed for in the agreement. tures and their implications, process of conducting verifi- team have met to date advises The INMO will keep mem- if any, for staff in the commu- cation meetings with hospital of real difficulty in access to bers updated and informed on nity structure. groups. At the time of going to training for nursing/midwifery progress.
Talks on measurement of all hours worked AS part of the Lansdowne Road per week, with effect from July of attendance hours, includ- the first meeting did not take Agreement, a chairman’s note 1, 2013. Discussions will com- ing unpaid lunch breaks and place in relation to this until recorded agreement between mence immediately on how hours attended prior to and April 2016 (not in September the employers and trade to measure all time worked after rostered shift times. The 2015 as per the chairman’s unions that clause 1.1 of the by nurses and midwives to most recent meeting was held note). The unions are keen to Haddington Road Agreement ensure all attendance hours are on June 10 and further work progress this matter and have would be activated in Septem- captured.” is required in respect of this sought that all matters relat- ber 2015 and completed by These discussions have com- aspect of the agreement. ing to it are prioritised with June 2016. menced and there have been a The unions and management the employer. The INMO will Clause 1.1 states: “The stand- number of meetings at which have agreed to extend the keep members updated on all Vol 24 No 6 July/August 2016 July/August No 6 24 Vol ard working week for nurses the trade unions and manage- timeframe to allow this work aspects of the implementation
WIN and midwives will be 39 hours ment have explored all aspects to be conducted correctly, as of this chairman’s note. 12 NEWS
Who exactly stands to gain from TTIP? ICTU warns of the potential effects of this proposed trade deal
TTIP is the Transatlantic Trade who have largely been Changes Everything’, she EU and US to remove barriers and Investment Partnership, a bypassed in the negotiation argues the passage of NAFTA to trade, the fact that the US proposed trade deal between process, would merely be (North American Free Trade refuses to ratify core Interna- the US and the EU that has able to seek a ‘letter of criti- Agreement) in 1994 has been tional Labour Organisation been in negotiation since 2013, cism’ from a group of eminent the single biggest roadblock (ILO) conventions such as and is arguably the largest and experts if objections are raised. to effective action on global collective bargaining and free- most significant trade deal in Regulation and public policy warming in the past two dom of association is gravely modern history. Another concerning ele- decades. worrying. How is something which has ment of the agreement is the Given the massive public While EU negotiators have potentially far-reaching con- establishment of an unelected interventions that will be moved quickly to give assur- sequences for working people ‘Regulatory Cooperation required to tackle the biggest ances that no watering down and governments throughout Board’, which would seek to challenges of our time – under- of standards in this area is Europe largely escaped public align regulations and stand- investment in public services, imminent, recent leaks of discussion for so long? ards and curtail those deemed economic inequality, and cli- secret TTIP papers by Green- Firstly, the detail of trade a ‘barrier to trade’. mate change – this is simply peace would suggest the ‘red agreements is not something In light of this, it is worth incompatible with the direction lines’ which our negotiators that is easy to get the media considering some public policy in which TTIP proposes to take are putting forward in public or the general public excited measures that have been dis- us and the restrictions it will are not being reflected in the about. Secondly, there has cussed in Ireland in recent impose on public policy. ongoing negotiations. Many been a deliberate strategy by years: the introduction of plain As a small open economy commentators argue that the political classes to curtail packaging for tobacco, mini- that is heavily reliant on for- opposition to TTIP equates to debate on TTIP – it warrants mum unit pricing for alcohol, eign direct investment, Ireland being ‘anti-trade’ – this is quite not even a reference in the and a ‘sugar tax’. is particularly sensitive and simply not the case. It is much 155-page Programme for Gov- Whether you agree or not exposed in this area. more about the type of trade ernment recently published, with these proposals, their Public services we are talking about, and who and the negotiations have stated intention is to introduce The risks posed to public stands to benefit from it. been conducted under a cloud regulations in the interests of services under TTIP are of par- Even organisations like the of secrecy with widespread public health, which should ticular concern. Irish Farmers Association (IFA) objections on the grounds surely be a function of sov- All previous major trade are raising significant concerns of democracy, openness and ereign governments. This agreements have utilised about the impact on the Irish transparency. function would be put at great what is known as a ‘positive food and agriculture indus- What does TTIP involve? risk under TTIP. list’ approach. In other words, tries of further opening up A motion passed at the ICTU Examples of states being public services are protected of markets to US producers. Biennial Delegate Conference sued by corporations in simi- from privatisation unless Greater availability and access in July 2015 stated the belief lar circumstances are already explicitly referred to. TTIP takes to cheaper but more chemi- of Congress that ‘the primary evident in Canada, Australia, the opposite approach – a ‘neg- cally produced US meats could purpose of TTIP is to extend Germany and elsewhere, ative list’, meaning all services quite feasibly lead to a global corporate investor rights’. largely due to robust commit- are open to future privatisation ‘race to the bottom’ in food It is hard to object to this ments to prioritise renewable unless explicitly exempt. standards. statement when you consider energies in a bid to tackle cli- This means all future service Where next? that TTIP confers special legal mate change, or to legislate areas will not be protected. The ICTU has formed a rights to corporations through to tackle the harmful effects Some 20 years ago broad- working group to coordinate a access to a new investment of cigarettes. Powerful fossil band infrastructure was not public awareness campaign on court system, where private fuel and tobacco lobbies use a factor, but it is now a core the dangers associated with corporations have the right to investor-state dispute settle- public service need for busi- TTIP and CETA. The INMO will sue governments for financial ment mechanisms to stand in ness and quality of life. New be participating in this cam- compensation if they believe their way. Granting corpora- and emerging public services paign and would encourage their rights have been violated, tions further powers to prevent could therefore be liberalised members to actively engage when government actions or public policy actions through by default. with their political representa- policy ‘interfere’ with their objections and lawsuits does Labour standards tives in relation to the dangers ability to make a profit. This not make sense in this context. Another area of significant highlighted in this article. is without doubt the most Indeed, in the powerful concern is that of labour stand- – Deputy general secretary controversial provision being book recently published by ards. Given that the stated goal Dave Hughes is the INMO Vol 24 No 6 July/August 2016 July/August No 6 24 Vol proposed in TTIP. Canadian author and social of TTIP is to align regulations representative on the ICTU
WIN Meanwhile, trade unions, activist Naomi Klein, ‘This and standards between the working group Section focus 15
Spotlight on Section Officers OHN Section Chairperson Vice chairperson THE Occupational Health Nurses Section is very proactive within the INMO. It represents more than 200 OHNs, both in the public and private sectors. Occupational health is a specialty that provides a holistic approach to employee health, safety and well- being. It looks very specifically at the effects of work on health and health on work. Occupational health nurses are ideally and uniquely positioned to support and help Una Feeney Anne Marie Graham employees stay in work and live full and healthy lives by [email protected] [email protected] empowering them to take ownership of their own health, safety and wellbeing. With increasing legislation, government initiatives and Secretary business operational targets, a holistic and coordinated approach in this discipline has never been more important to ensure cost-effective compliance in delivering a duty of care to our employees. Research shows that good health is good for business and healthier workplaces have more engaged employees with better financial results. Occupational health has become a ‘need-to-have’ rather than a ‘nice-to-have’ for employers, and OHNs have a unique opportunity, by integrating occupational health into an organisation, to play a significant role in overall business strategy. Margaret Morrissey On a European level, Margaret Morrissey and Una Feeney represent [email protected] Ireland on the board of the Federation of Occupational Health Nurses within the European Union (FOHNEU).
Affiliation Form for INMO Section Membership
Name: Tick ONE relevant Section you wish to affiliate with INMO membership No: Assistant Directors of National Rehabilitation Home Address: Nursing/Midwifery/ Nurses Public Health Nursing/ Nurse/Midwife Education Night Superintendents Occupational Health Care of the Older Person Operating Department Clinical Placement Tel (work): Co-ordinators Orthopaedic Tel (home/mobile): CNM/CMM PHN Email: CNS/CMS Radiology Nurses Place of employment: Community RGN Nurses Retired Nurses/Midwives Job title: Directors of Nursing/ RNID Midwifery/Public Health School Nurses Second section option (to obtain information Nursing Emergency Nurses Student Allocation Liaison only): Officers Network GP Practice Nurses Student Section International Nurses Telephone Triage Nurses Forward completed form to: Midwives Third Level Student Health Mary Cradden, membership services officer, National Children’s Nurses Nurses INMO, Whitworth Building, North Brunswick St, Dublin 7 16 INTERNATIONAL NEWS
Safeguarding health for all citizens of the world Elizabeth Adams discusses a report from the Safeguarding Health in Conflict Coalition and reports from the 69th World Health Assembly
‘No Protection, No Respect’ groups to be champions for their right to VIOLENCE against health. healthcare workers, As part of the Safeguarding Health in facilities and patients is Conflict Coalition, we have consistently one of the most serious focused on driving the agenda and lob- and overlooked humanitarian challenges bying international bodies including the globally. The Safeguarding Health in Con- UN, the World Health Organization and flict Coalition was established in 2010 to other key stakeholders including govern- address the under-reporting of attacks ments throughout the world. Recently, the on health workers and facilities in conflict United Nations Security Council adopted areas. The INMO is a member of the coa- Resolution 2286 (2016), strongly con- killed medical workers lition with over 30 leading international demning attacks against medical facilities and patients, deci- nongovernmental organisations, including and personnel in conflict situations. The mated medical infrastructure and robbed the International Council of Nurses (ICN). Resolution was co-sponsored by more countless civilians of vital medical care in In recent years, the international com- than 80 member states, along with medi- 19 countries around the world, including: munity has witnessed an increase in cal and humanitarian personnel exclusively • 122 hospitals attacked in Syria attacks and interference with hospitals, engaged in condemning attacks and • 100 health facilities attacked in Yemen health workers including nurses, patients, threats. The UN Resolution 2286 is acces- • 200 plus humanitarian compounds and ambulances and transport of sup- sible at: www.un.org transports attacked and looted in Central plies. Aside from the human toll they In its third annual African Republic take, these attacks compromise the report, No Protec- • 28 polio vaccination workers murdered in ability to deliver care to populations tion, No Respect, Pakistan in great need, impede efforts to the Coalition found • 60 women detained and raped in a hospi- reconstruct health systems after war, that during 2015 tal in Sudan. and lead to the flight of health work- and the first three The report also found that, in many ers whose presence in a time of great months of 2016, instances, parties to conflicts failed to take social stress is essential. Such violence deliberate or indis- required steps to avoid harm to medical is in violation of international law, the criminate strikes facilities, staff and patients, and obstructed Geneva Convention and customary on healthcare have access to healthcare. international humanitarian laws. The laws date back over 150 years and state that parties must not attack or interfere Table 1: Members of the Safeguarding Health with health workers, facilities, ambulances in Conflict Coalition and people who are sick or wounded. ACBAR (Agency Coordinating Body for Afghan Relief and Development), Alliance of Health Our goal is to promote adherence to Organizations (Afghanistan), Center for Public Health and Human Rights at the Johns Hopkins international humanitarian and human Bloomberg School of Public Health, Consortium of Universities for Global Health, Defenders for rights laws that protect health facilities, Medical Impartiality, Doctors for Human Rights (UK), Doctors of the World USA, Egyptian Initiative health workers, ambulances, and patients for Personal Rights, Friends of the Global Fund Africa (Friends Africa), Global Health Council, Global during conflict. The coalition promotes Health through Education, Training and Service (GHETS), Human Rights Watch, International Council the security of health workers and ser- of Nurses, International Federation of Health and Human Rights Organisations, International Health vices threatened by war or civil unrest. Protection Initiative, International Rehabilitation Council for Torture Victims, International Rescue It monitors attacks on and threats to Committee, IntraHealth International, Insecurity Insight, Irish Nurses and Midwives Organisation, civilian health; strengthens universal Karen Human Rights Group, Management Sciences for Health, Medact, Medical Aid for Palestinians, norms of respect for the right to health; North to North Health Partnership (N2N), Pakistan Medical Association, Physicians for Human Rights, Vol 24 No 6 July/August 2016 July/August No 6 24 Vol demands accountability for perpetrators; Physicians for Human Rights – Israel, Save the Children, Surgeons OverSeas (SOS), Syrian American Medical Society, University Research Company, and World Vision
WIN and empowers providers and civil society INTERNATIONAL NEWS 17
The after effects of attacks are far reach- and senior health officials from among the this major public health threat. ICN called ing and negatively impact the health of 194 WHO member states, as well as rep- for coordinated and sustained efforts in people in specific areas in need of urgent resentatives from civil society and other reducing global AMR and promotes the care. Healthcare deprivation is one of the stakeholders. collaboration of nurses, consumers, phy- major effects, due to a loss of facilities and ICN made interventions and state- sicians, pharmacists, and veterinarians, as medical staff. Such losses are detrimental ments on the draft global plan of action well as the environmental and agricultural to the public as a single closure can leave on violence; Health in the 2030 Agenda sectors. an entire population without access to a for Sustainable Development Goals; the Promoting the health of migrants health facility and the appropriate staff. In draft global strategy and plan of action on The inclusion of migrants’ health in the recent months, UN agencies have reported ageing and health; the global action plan development of regional and national an appalling number of people in dire need on antimicrobial resistance; promoting the health strategies is essential for the dia- of healthcare access. Population displace- health of migrants; health workforce and logue and cooperation necessary to address ment, lack of resources and civilian injuries services; and the Global Strategy on Wom- their specific health challenges. Nurses play are all contributing factors. en’s, Children’s and Adolescent’s Health. a central role in addressing the physical and Urgent action is needed and harsher Draft global plan of action on violence mental health challenges of refugees and measures need to be taken in order to end Highlighting the leading role that nurses migrants. Therefore, ICN encouraged WHO such violence. Although there has been play in addressing violence, as the first and governments to continue to work progress on raising awareness, progress point of care for elder abuse, intimate co-operatively with nurses in their exami- is lacking on taking the correct measures partner violence, conflict, post-conflict nation of the extent of the problem in their to prevent gruesome attacks on health- and humanitarian settings, the ICN con- countries. care workers, patients and facilities, and firmed its commitment to working with Health workforce and services to ensure that those inflicting violence are governments to implement this action The strategy to reorient health systems held fully accountable for their actions. plan, which calls for improved access to towards primary healthcare and peo- The Safeguarding Health in Conflict Coa- quality healthcare by eliminating dis- ple-centred health services was strongly lition’s report: No Protection, No Respect crimination and violence in the health supported by ICN. Strengthening health can be found at: www.safeguardinghealth. workplace, patient-centred and gender systems can only be achieved through org/report2016 sensitive services, and promotion of human investing in nursing and midwifery as rights. part of strengthening human resources Health in the 2030 Agenda for for health (HRH), which is a fundamental Sustainable Development Goals strategy for the successful achievement of WHO and governments were called on the sustainable development goals. ICN, to continue to actively involve nurses in therefore, affirmed its commitment to con- Nursing and midwifery contributing to the planning and development of relevant tinue working with WHO and governments the 69th World Health Assembly policies and strategies, and advocated for to strengthen health systems through HRH Nursing and midwifery has been his- a system-wide investment in universal strengthening capacity. It urged WHO and torically recognised within the WHO. healthcare (UHC), with a primary focus on its member states to ensure that nurses The World Health Assembly (WHA) is the health promotion and prevention of illness. are involved in every aspect of the policy supreme decision-making body of WHO. ICN emphasised the central role of nurses making agenda of these proposed health The professions have been central to deci- in addressing non-communicable diseases workforce strategies. sions of governing bodies and the adoption (NCDs), substance abuse, traffic acci- Operational plan to take forward the of WHA resolutions which have culminated dents and injuries, sexual and reproductive Global Strategy on Women’s, Children’s in 10 WHA resolutions since 1948 specific health, environmental safety, and afforda- and Adolescent’s Health to nursing and midwifery. ble, accessible models of care. The World Health Professions Alliance The ICN has been a collab- Multisectoral action for a life course (WHPA) made an intervention supporting orating partner since the approach to healthy ageing: draft global the Global Strategy on Women’s, Children’s establishment of WHO and strategy and plan of action on ageing and and Adolescent’s Health, emphasising the the INMO is a member of ICN health essential need for effective planning and for over 90 years. ICN encour- A strong primary healthcare system is financing for an adequate and competent ages and supports nurses to key to improving the health and wellbeing health workforce that meets the current attend the WHA as part of their of older people. With this intervention, ICN and future needs of populations. country’s delegation, or as part of ICN’s called on governments to remove regu- The WHA concluded with several reso- delegation, in order to ensure that nurses, latory barriers in order for nurses to carry lutions adopted on a broad range of health WIN the largest health profession in the world, out their role in preventing, identifying and issues. Vol 24 No 6 July/August 2016 have a voice in high-level decision making treating age-related illnesses, thereby facil- Elizabeth Adams is INMO director of professional and policy development. itating the shift to primary healthcare. development The INMO was a member of the ICN del- Global action plan on antimicrobial The ICN Congress 2017 takes place in Barcelona, Spain on egation with 69 participants and spoke to resistance (AMR) May 27-June 1, 2017. The theme is ‘Nurses at the forefront a number of key agenda items at the 69th The success of the global efforts to transforming care’. See www.icncongress.com for session of the WHA in Geneva in May. The combat AMR largely depends on the extent instructions on submitting abstracts for the scientific programme and details on the themes to be addressed. six days of discussions involved over 3,500 to which the millions of nurses around the Online submission of abstracts will close on October 10, participants, including health ministers world are mobilised and diligent in tackling 2016 WIN Vol 24 No 6 July/August 2016 attended secondaryschoolinLoreto Con north of Letterkenny, Co Donegal,and istration opportunities here now thanhereistration opportunities too, although there are more post-reg spreadwings their hunger to having that she r she ing, was anxious to spread her wings, she gotsomehours in Sligo after qualify recession. long While a nearing theendof 86, qualifying at a time when nur vent, Letterkenny. She trained asageneral M up in so it wasn’t a huge leap into nursing,” had. families afterlookingwithin otal our community elderly mother. one another ment –my sisters andbrother caring for at home. would have liv M and midwifery conference inFarmleigh,” reaffirmed at the recent nationalnursing was as and commitment, compassion, care coming backtothecorefull circle values of would f ble that herself andher twin sister Carmel into nursing, youngest of sixsiblings,all of whom went the very lifeblood that makes her tick. On meetingnew out her priorities. pr the T commitment care and Compassion, XX I18IN Harkin-Kell artina said. artina said. aking the helm at a critical time in “ M “ “ I se in T I n nur esident can artina gr ecalls. hese T hat ollow public health service, new n Sligo that mayhave hadless than we sing andmidwifery today, we are TER understand today’sstudents T ter was the mindset arekey three elementsthat her y, itis evident that nursing is
ew upnear , m in the familyin tradition. G M e was always a caring ele ed andbreathed every day VI ener artina says vi M y mother caring for her E INM y mother e M al Hospital from 1983- W w O president artina G lenmaquin, just it was inevita I was very piv
was brought I re land was M T Harkin-Kelly sets artina artina ara Hor
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perspective. We are the only healthprofes and certainly noparity on a working hours perspective,perspective,a financial from Yet, there is no parity from a professional with a degree from a third level institution. t physiotherapist,pational therapist,the opment or post-registrationopment or education.” professionalusuallyare continuing devel further afield.Locked into those packages packages on offerwith the fromand the UK nurses/midwives goingabroad. a factor foras qualifying yearacademic start oftheand the between qualifying lapseabroad.points to the time goShe diploma courses to goaheadasstudents always enough uptake for somehigher she said it is worrying that there is not said. at thetime,”she post-registration courses on offerin the UK spectrum ofbroadin comparison to the available here in1986-87 was minimal ther Continuing education care professionals. me is on the samelevel asall other health professionaltheir which to qualifications, nurse/midwifea and onvalue on the put within thiscountry. look atincentivisingnurses andmidwives absolutely up to date with everythingup todate absolutely nurses and midwives do. You have to keep sionals with a39-hour week,” or midwif or h e radiographer. How can we How can moment“Weat the cannotcompete While there is a much wider choice now, “CPD e were then. an reports is now pivotal toeverything thatnow is e as any differentas e totheoccu INM address this? “Weaddresshave this? to T T he T he I he don’t see the nurse O y have all come out amount ofcourses government has to has to government M artina said. - - - - back,” shesaid, rosanct, asitis with the medicalprofession. perspective, CPD isnotlocked inasasac going on. Unfortunately, from alegislative drain from a wound then wound care isan involvedin, afor been example,takingout thing that you’ve already done. So if E about thosetwoentities.get confused people oftenbut role expansion ofthe the advancednurse/midwife practitioner. r cally illindividual. And there isstillnot the a criti immediate care of still dictates the the medical model of care in I readjust tothe diately. post backat Sligo pioneering eye hospital,returning to Diploma in Ophthalmic Hospital, London, where she obtained a up astaffnurse positionin prompted in ophthalmics managers.”line at thediscretion of behind due to staffing shortages. is fallingand even this – mandatory training are released for at the momentis their T the hierarchyand very differenttened wise to she land with herhusband Alan in1991, when r e xtending somethingis he onl eland. We have moved on abitnow from cognition there should be of the rolebe of of the cognitionshould there “We talk about the extension and“Weabout theextension talk Shortly after a strongqualifying, interest M “ “ I T settledbackinto was successfulinsecuringastaffnur handmaiden artina he systemin y training that nurses and midwives and nursesy training that I t was a wonderful feeling being spent a total of fourspent yearsat this I while admittingshehad to rish system G E ener way ofdoingthings. ngland Sligo N al Hospital. extending some I ur
came back to in M G M sing. sing. was very flat artina totak ener I oorfields r eland but it T al imme he I rest is ha I E r y ve e se se e e ------INTERVIEW 19
extension of that role. Whereas expanding professions that the role is taking on something that we as allow you to nurses or midwives have never done before. travel. But I think So advanced practitioners, for example an there is a journey ANP in dermatology, would be in theatre at home as well doing biopsies – they are minor operatives. that needs to be This is a huge expansion of the role of what completed. As the profession would have been seen as.” well as incentiv- Recognition of extended role ising graduates to She believes society needs to be edu- stay by setting up cated on what the role of the nurse and CPD programmes, Civic honour: At a Civic Reception held by Sligo County Council to honour her becoming president midwife is today. The Commission on Nurs- there should of the INMO, Martina Harkin-Kelly is pictured (above, left) with Councillor Rosaleen O’Grady, Cathaoirleach of Sligo County Council, and (above, right) with her son Robbie and husband Alan ing in 1998 fundamentally transformed the also be greater management structures within the profes- encouragement of healthcare assistants • A campaign for additional beds, staff and sions, she said. “However, we now need to wanting to do nursing/midwifery through services across the healthcare system look at the role of the nurse/midwife and national scholarships. We need to look at • Zero tolerance of verbal or physical abuse give recognition to the extended, expanded more avenues if we want to build up the of staff in all care settings. role. The importance of care needs to be potential number of nurses and midwives “There is currently an overwhelming linked to the wellbeing of the individual into the future.” feeling of disquiet among members due patient. I want the vital roles of the nurse Believing in the importance of the wider to their pay and conditions. Not only can and midwife to be put out there in neon outlook, Martina undertook a degree in we not recruit nurses and midwives from lights. I want us to be acknowledged pro- economics and sociology from 1995-1999 abroad, we are losing members who have fessionally, financially and above all for and more recently completed a Masters in many years of experience on the frontline. the time and commitment we give to the Humanities, looking at the culture of nurs- This is due to the ongoing impact of wage professions.” ing. “It’s important to have a wider angle on restraint where members find the cost of Clinical teaching what’s going on from a political economic living extremely difficult to manage. After working in the clinical area in perspective – it gives you a helicopter view “I intend to be a strong and vocal advo- Sligo for three years or so, Martina was of why policymakers do what they do.” cate, on behalf of members and patients, approached by Kay Craughwell, then direc- INMO involvement demanding a clinical environment where tor of nursing at Sligo General and INMO Martina has been a member of the safe practice can be delivered by our mem- president from 1991-96, to work at the INMO since her student days, becoming bers and safe care for our patients can School of Nursing in Sligo General. “As I extremely involved in 1999 during the always be maintained. Our recent ADC had done a clinical teaching course during nurses strike. She subsequently became clearly identified our agenda for the next my time in London, this was a natural pro- the INMO rep for the Centre of Nurse year, and I will begin immediately, with gression for me. However, I always kept my Education and has been a rep ever since, the Executive Council, to implement the toes dipped in the clinical area, supervising with her office becoming known as a agenda given to us by delegates.” the students in their clinical proficiency. repository for information of all kinds. She is also looking forward to plan- So I enjoyed the clinical and classroom She was also very involved in the Sligo ning the INMO’s centenary celebrations side of it – being a natural born talker,” she Branch, which she chaired for four years. in 2019, when the Organisation will be quipped. Martina has served on the INMO Exec- celebrating 100 years since its inaugural She took a permanent position in the utive Council for the past four years and meeting in February 1919. School of Nursing in 1996, just prior to the took over as second vice president in Importance of family Diploma in Nursing coming to Sligo Gen- December 2015. Martina has been elected On a personal level, Martina loves her eral. Being good at maths, she was given as president for the 2016-2018 period, adopted county of Sligo, where she lives the job of rostering the students from 1996 taking the helm at a critical time in the with her husband Alan and 16-year-old onwards, allocating the places for all three Irish public health service. In recent years, son Robbie in the village of Grange. In cohorts of students (certificate, diploma nurses and midwives have been hit by this area of outstanding beauty between and degree). a 16% pay reduction, the loss of 5,200 Benbulben and the sea, Martina is very “Further education is now the linchpin to posts and an increase in working hours – involved locally with training people from keep our newly qualified graduates. While all of which has led to the current crisis in the local GAA club, athletics club and there has been a review of the degree pro- recruitment and retention. schools in basic life support. She was hon- gramme, I feel it didn’t go far enough with Martina’s key objectives for her time in oured recently by Sligo County Council at a WIN regards to linking in a post-reg year on office are: recent civic reception to mark her achieve- Vol 24 No 6 July/August 2016 a higher diploma with a choice of going • For the INMO to take a leading role in ment of becoming INMO president. into a specialist field of nursing/midwifery a national health summit, involving all Family is what is most important to automatically, so that we are not losing stakeholders, in order to gain consensus Martina – and she would see nursing as an newly qualified nurses and midwives in on the shape, structure and funding of a extension of her family. With 225 years of October while waiting to start something public health service fit for purpose combined family nursing experience – in the following year. • Early, positive movement on pay and general, midwifery and psychiatric nursing “There will always be natural attrition. working hours to address the severe – it is evident that Martina’s journey to the Nursing and midwifery have always been recruitment and retention problems INMO presidency is etched in her DNA. WIN Vol 24 No 6 July/August 2016 - - - All photos by LisaAll photos by Moyles Ex-officio Claire Mahon, outgo- Mahon, Claire CNM3, ing president, University Waterford. Hospital as an RGN and trained Claire has a diploma in higher edu- issues professional and cation She has and a BSc in nursing. Council served on Executive two served and 2008 since has Claire terms as president. care, community in worked wards medical and surgical a been has She theatre. and member ofherINMO since the for a and worked student years industrial relationsan period as she received In 2002, officer. Award. the Gobnait O’Connell - 21 COUNCIL EXECUTIVE , RN, works as a staff works nurse in Ballina RN, Cullen, Frances service a short-term care Mayo, Co District Hospital, and is an advocate for patients and for the elderly, has served as hospital Frances staff in the hospital. vice-chairper and is currently for the last six years rep She is qualifiedson of the Ballina/Belmullet Branch. gerontol in degree a postgraduate has and RN an as CNM3, CNM3, Frahill, Margaret University Hospital Mercy in trained Margaret Cork. nursing at the Mercy general University Hospital and in midwifery at the Doncaster Infirmary in the UK. Royal - in the thea She has worked department oftre the Mercy University Hospital since has been Margaret 1986. with the involved actively and hasINMO for many years from held positions ranging and chairperson to secretary This level. at branch treasurer Execu on term second her is tive Council. Second-vice president ogy and a certificate in teaching and assessing in clinical practice. This is her first is her This practice. clinical in and assessing teaching in certificate and a ogy Council. term on Executive - Clinical Officers First-vice president First-vice RGN, RM, RPHN. RPHN. RM, RGN, Mary Leahy, Marymediator. Qualified works Pri Doughiska at PHN a as mary Care Centre, Galway. She Galway. Centre, mary Care staff as a and nurse worked midwife in Galway and also nurse in as a practice worked roles managerial and clinical Mary holds a hDip in the UK. She nursing. health public in as a experience has 20 years in a busyPHN and now works in Galway. team primary care Mary is chairperson of the and vice chair Galway Branch She has of the PHN Section. Council been on Executive since 2012. - Founda Muiriosa senior staff nurse, Ailish Byrne, as Ailish trained Support Services. Family Laois tion, com- before Monasterevin Abbey, an RNID in Moore nursing in University in general pleting her training in areas in surgical She has worked Kerry. Hospital, Carlow/ Luke’s, and St Waterford University Hospital - in Laois Disability Com and was a local rep Kilkenny, is the Ailish munity Services for the past 10 years.
President
tor of industrial relations. Back row (l-r): Eileen Kelly; Karen Clarke; Bridget O’Donnell; Frances Cullen; Claire Mahon (ex officio); Gráinne Walsh; Bernadette Stenson; Karen Walsh; Bernadette Stenson; Karen officio); Gráinne Mahon (ex Claire Cullen; Frances O’Donnell; Clarke; Bridget Karen (l-r):of industrial relations. Back row Eileen Kelly; tor Gorman; Ailish Byrne; Helen Butler; Mary photo:O’Cearruill; Eccles;Garvey. from Missing Maria Hernandez; Munro; Karen McGowan; Eilish Fitzgerald;and Kay Darren Deirdre Sheridan;Catherine Kate Finnamore . Front row (l-r): Oona Sugrue, ADC co-ordinator and secretary and secretary ADC co-ordinator Oona Sugrue, (l-r): row first. Front June meeting in group’s the after and staff 2016/18 for pictured Council The incoming INMO Executive vice-president; Liam Doran, second Frahill, development; Margaret secretary; general Dave Hughes,deputy of professional director Adams, Elizabeth Council; the Executive to direc and social policy; Ni Sheaghdha, and Phil of regulation president;vice-president; firstdirector Mathews, Mary Leahy, Edward Martina Harkin-Kelly, secretary; general chairperson of RNID Section. This is her second term on Executive Council. is her second term on Executive This chairperson of RNID Section.
- spe Martina Harkin-Kelly, nurse and co-ordinator cialist Sligo/Leitrim CNME educator, HSE Cregg Cavan, West and is her This House Campus. havingfirst term as president Council served on Executive Martina qualified since 2012. aas an RGN in 1986 and holds in economics and sociologyBA in human- MA and a research in the She has worked ities. specialities of ophthalmics, orthopaedic care, coronary and nursing admin- theatre She is also a dual istration. qualified BLS instructor and community first responder. Incoming Executive Council 2016/2018 Council Executive Incoming 22 EXECUTIVE COUNCIL
Clinical
Karen Eccles, staff nurse, Kate Finnamore, staff Eilish Fitzgerald, PHN, South Kay Garvey, acting manager, Mary Gorman, CMM2 for Cavan General Hospital. nurse, Letterkenny Univer- Lee Community Care Cork. MiDoc, Athlone, facilitator maternity/gynaecological She qualified as an RGN sity Hospital on surgical 2. Eilish qualified as an RGN for stress management, Mid- OPD, foetal assessment, Our in Kent and completed the During her student years, and RM from the Univer- lands HSE. Kay is a long-term Lady of Lourdes Hospital, ENB 183 theatre and anaes- Kate became active in the sity Hospital and University member of the INMO and Drogheda. Mary qualified thetic course in St Thomas’s, Drogheda Branch. She was Maternity Hospital, Limerick. started her career in Jervis as an RGN from Beaumont London. Karen also worked the student representative She worked as a staff mid- Street Hospital. She has also Hospital and an RM from the in the Blackrock Clinic and has undertaken rep wife in St Finbarr’s Hospital, worked in the Rotunda, St Rotunda Hospital. She holds and as a CNM in theatre training. Kate was an active Cork and later completed a Brendan’s and Texas. She is a postgraduate diploma in in St Vincent’s Hospital, member of the Student hDip in public health nurs- currently a member of the midwifery clinical practice and Dublin. This is her second Section and attended the ing from University College INMO Athlone Branch. Kay a diploma in health service term on Executive Council. LRC in support of the claim Cork. Eilish also works as has been a member of Execu- management. In 2015, Mary Karen has attended joint for internship students pay a school PHN. She holds a tive Council for three separate was appointed by the Minis- reviews, the LRC and the to be reinstated. Addition- diploma in nursing manage- terms. She has also worked ter for Health, to the Maternity Labour Court representing ally, Kate has completed ment from RCSI and is the in most areas of Midland Strategy Steering Committee members, as well as being media training with the education officer for the Cork Regional Hospital, Tullamore, as a midwife representative. involved in the recent ED INMO. This is her first term HSE Branch. This is her first including the coronary care She is vice chairperson of the negotiations. on Executive Council. term on Executive Council. unit and administration. Drogheda Branch.
Maria Hernandez, staff nurse, Eileen Kelly, staff nurse, Deirdre Munro, staff mid- Bridget O’Donnell, staff Catherine Sheridan, staff St Columcille’s Hospital. Maria Sacred Heart Hospital, wife, University Hospital nurse, ED, University Hospital nurse, University Hospital graduated from Unciano Col- Roscommon. Eileen Galway. Deirdre graduated Limerick. She believes that Galway. Catherine trained leges Manila, Philippines with trained as a nurse in Beau- with a masters in health 100 years on from the 1916 in St James’s Hospital and a BSc in nursing. She then mont hospital and holds a systems research from NUIG Rising, nurses and midwives completed postgraduate passed the Professional Reg- certificate in psychology, and was recently awarded are involved in their own training in sick children’s ulation Commission Licensure a diploma in gerontology, an international fellowship rebellion; there is a constant nursing at the National exam and has worked in St a bachelor’s degree in in leadership and innova- battle with understaffing, Children’s Hospital. She Martin de Porres Charity Hos- journalism and a masters tion in Canterbury, England. overcrowding and layers is the lead instructor and pital in the Philippines. Maria degree in international She founded the global of bureaucracy that nurses training site co-ordinator at is currently chairperson of law and human rights from village of midwives network and midwives must wade Croí, West of Ireland Cardiac the Dublin East Coast Branch. National University of Ire- on Twitter and is a certified through. She thinks nurses Foundation and is also an She was very involved in the land, Galway. She has been change agent (School for and midwives need to unite. honorary clinical fellow at the 39-hour working week dis- a member of Executive Health Care Radicals). Deir- On Executive Council since School of Medicine, NUIG. pute in St Columcille’s, which Council since 2012 and dre is education officer for 2012, Bridget will continue Catherine is also the educa- had a favourable outcome for has been secretary of the the Midwives Section. This to advocate for nurses and tion officer for the Galway members. This is Maria’s first Roscommon Branch for a is her second term on Exec- midwives seeking better Branch. This is her second term on Executive Council. number of years. utive Council. working conditions. term on Executive Council.
Bernadette Stenson, CNM2, St Vincent’s Univer- Gráinne Walsh, PHN, Waterford Commu- sity Hospital, Dublin. Bernadette’s professional nity Care (WCC). Gráinne completed a higher qualifications include, RGN, St Vincent’s Univer- diploma in nursing in 1993 and a higher sity Hospital, Dublin; RSCN, Children’s University diploma in midwifery in 1997 followed by a Hospital, Temple Street; hDip adult emergency postgraduate diploma in theatre nursing in nursing; hDip children’s emergency nursing; and 2003. She did her PHN training in Waterford a BSc nurse management/leadership/healthcare where she has been employed as PHN for the planning and organisation. She has been active last nine years. Gráinne has been an active
Vol 24 No 6 July/August 2016 July/August No 6 24 Vol with the INMO for 14 years and is currently involved in the ED Forum at the member of the INMO for over 18 years and is currently secretary of the Ireland East Hospital Group. This is her first term on Executive Council. Waterford Branch. This is her first term on Executive Council. WIN EXECUTIVE COUNCIL 23
Education Student
Karen Clarke, CPC, CNM2, Our Lady of Lourdes Darren Ó Cearuill is a third-year integrated chil- Hospital, Drogheda. Karen trained as an RGN dren’s and general nursing student, Dublin City and has worked in London and Galway. She has University, affiliated with the Children’s University a degree in business studies and healthcare Hospital, Tempe Street and the Bon Secours Hos- management and has worked as a staff nurse, pital, Dublin. Darren is actively involved in the CNM1, infection control nurse and overseas Dublin Northern Branch and in student and new nurse facilitator. Karen has been the secre- graduate issues. He has attended the LRC and tary of the Drogheda Branch of the INMO for four years and an active Labour Court meetings and has met and lobbied the Minister for Health member of the INMO since 2001. This is her second term on Executive and the Chief Nursing Officer during campaigns on student/new graduate Council. issues. This is his second term on Executive Council. Management
Helen Butler, DoNM, St Luke’s Hospital, Carlow/Kilk- Karen McGowan, candidate advanced nurse practi- enny. Helen trained in London and has a diploma in tioner, ED, Beaumont Hospital, Dublin. Karen trained HR and industrial relations, a BSc in health services as an RGN in Beaumont Hospital and completed management and a diploma in executive coaching her Bachelor’s of Nursing Science in Dublin City Uni- training with LIT. Helen has been a member of the versity. She later undertook a PGDIP in emergency INMO since 1987, having served as chairperson, nursing and an MSc in the RCSI. Karen has also com- treasurer and secretary at branch level. She is the pleted a certificate in drug prescribing and ionising chairperson of the Directors of Nursing/Midwifery/PHN Section. This is Helen’s radiation, as well as a certificate in advanced assessment in UCD. Additionally, second term on Executive Council. she serves a local nurse representative. This is her first term on Executive Council.
Rep Training RepAre you Training interested in representing the INMO? Are you interested in representing the INMO? Letterkenny (Mount Errigal Hotel) • July 14, 2016 (am): Refresher group • July 14 (pm)/July 15 (Full day), 2016: Basic reps training course Dublin • September 19, 2016: Health and safety representatives training course. Full day course • October 5/6, 2016: Basic rep training course • October 26/27, 2016: Advanced rep training course • November 10/11, 2016: Basic rep training course Galway • October 18/19, 2016: Basic rep training course Limerick • September 20/21, 2016: Basic rep training course. 6pm on September 20 and full day on September 21
For all enquiries email: [email protected] Questions & Answers 25
Bulletin Board With INMO director of industrial QA relations Phil Ní Sheaghdha
are facilities to transfer pension credits from private sector Query from member pensions to the public service scheme, these are weighted and what is termed purchase tables set the rate or value of I have recently joined the public health service in a staff same in the context of public service pension benefits. nurse position. I was not employed in the public service before and I am trying to get information on how I As part of the Public Service Committee of the ICTU, the transfer my private pension to the public service pension. INMO has had a number of meetings on this issue with the Can you give me any information on this? Department of Public Expenditure and Reform (DPER). The most recent meeting was held on June 14. The DPER has advised us that purchase tables are currently being prepared. The ICTU Public Service Committee has engaged an actuary Reply who is liaising with, and in consultation with, the actuary for As you correctly state a new ‘single scheme pension’ was DPER and they have now reached agreement in respect of introduced to the Irish public service in 2013. New entrants the purchase tables that will apply. It is anticipated that these to the public service, including nurses and midwives work- tables will be prepared and circulated to the Public Services ing in the public health services, will be entered into this Committee and, following that, employers will be notified. pension scheme. As with the current pension scheme there We will notify members when this facility is in place.
implications of their health problem in relation to their work Query from member • Ensure that they are supported in securing early and effec- I recently made a self-referral to occupational health tive treatment where appropriate as I did not want my manager to be aware that I was • Provide them with advice and to provide their managers attending. Occupational health assured me that they with advice on managing the employee’s attendance. would not notify management. Subsequently I have been on sick leave and have been out for six weeks. Yesterday Page 17 of the Managing Attendance Policy for the health I was notified by phone from work that an occupational service states “the employee should be made fully aware of health appointment has been arranged for me in two the reasons for the referral and given a copy of the referral days time. I was surprised as I had no indication that form”. Therefore, it should not be a surprise that you are being this referral was being considered. Do I need to attend referred to occupational health; management is obliged to this appointment as I have, only very recently, attended notify you of that fact and also set out the reasons for the occupational health following my self-referral? referral. There is no obligation on you to attend, however, not attending can be viewed as non-compliance with the attendance policy. Therefore, the INMO always advises that Reply if your manager refers you to occupational health, you should attend. In the event that you have recently attended and There are two ways that employees may be referred to, or your condition has not changed, you can, if you wish, notify have access to, the occupational health department. One is management of the fact that you have recently attended and WIN a management referral, and the other a self-referral. Self-re- would they be happy to receive the report from that visit. If Vol 24 ferrals do not have to be notified to management, unless the they require you to attend on the referral that you have been employee specifically requests same. Under the managing notified of, our advice is that you should attend and raise N attendance and sick leave policies, management is obliged to with your HR department the fact that you were not notified o 6 July/August 2016 refer to occupational health where appropriate. It is normal in advance and that it is a bit unreasonable to expect you to that management would notify the employee in question of attend at very short notice, without any correspondence from their referral being made. The purpose of a referral to occupa- your employer in relation to the reason for the occupational tional health is to: health referral. I hope this is helpful and if you have any fur- • Ensure that employee has access to competent advice on the ther queries, please do not hesitate to contact us. 26 QUALITY & SAFETY
A column by uality Maureen Flynn O&Safety Framework for Improving Quality in our Health Service
This month’s column introduces the knowledge also means that staff are often ‘Framework for Improving Quality in our best placed to develop creative, practical Figure 1: Framework for Health Service’. The framework (see Figure and sustainable solutions when given the Improving Quality 1) is about creating an environment in which time to do so. An engaged workforce is one a culture of person-centred quality of care where staff are valued, listened to and pro- continuously improves, where change and vided with the tools, resources and skills to improvement can thrive. It is about leading do meaningful work Leadership differently and in a way that fosters inno- • Use of improvement methods – having a for quality vation; and it is about providing you with structured approach to delivering improve- Person and the tools, techniques and support that will ment helps to accelerate improvement Governance family enable you and your colleagues to imple- and ensure that solutions address the root for quality engagement ment ideas for improvement. cause rather than the symptoms of the What is the framework? problem. There are different methods, eg. A culture of person-centred The framework is not a method. It is model for improvement, microsystems, quality care that not prescriptive. It explains the six crit- etc. What method you use is not impor- continuously ical success factors for delivering and tant – what is important is that you have improves supporting continuous improvement. It a structured approach and you use it in Measurement Staff is evidence-based following research into tandem with the other five success factors for quality engagement international and local best practice. The outlined in the framework six drivers are: • Measurement for quality – there are many Use of • Leadership for quality – championing views on how to improve healthcare but improvement change in the current environment can it is critical that those views are objective methods be demanding. Management is not lead- and focus on the proven root cause of ership but managers can be leaders. issues rather than the accepted perceived Leadership can happen at any level. Any wisdom. Knowing how to use data to to enhance patient and staff experiences. staff member can provide leadership in analyse and illustrate variation in patient Our health services are currently under improving patient experience in the same safety, experience and outcomes and considerable strain and it is exactly in such way as a chief executive can. Everyone demonstrating improvement is key an environment where a focus on improve- can benefit from understanding lead- • Governance for quality – methods and ment is critical to orientate the planning and ership skills and behaviours. The key is data are not sufficient to sustain change. delivery of healthcare away from crisis man- creating the space to develop leadership Direction and oversight is central. Ques- agement to proactive service improvement. skills and providing the time to allow tions that must be considered include: The quality improvement division of the leaders to lead Who is accountable for managing a HSE will provide information sessions over • Person and family engagement – in what- pathway and actioning variation in data? the coming months to raise awareness of ever we do, we must strive to continually At what meeting is the quality improve- the framework across all service areas and deliver and improve safety, experience ment data discussed? Who chairs these will partner with frontline care teams to and outcomes. Service users are the only meetings and with what frequency? translate the framework into useful actions people who know what it is like to expe- Clear governance ensures that the energy to guide improvement. More information rience our services end to end. They can for change does not dissipate as people on the help and support available can be see both the strengths and weaknesses involved in initiatives move on. accessed at www.qualityimprovment.ie of the whole pathway while staff tend to As with care bundles for clinical practice, Alternatively, contact Deirdre O’Keeffe at have a only a partial view of the pathway. it is the combined force of the framework Tel: 021 4928527/086 7872212 or email: Engaging with service users to understand drivers applied that creates the environ- [email protected] their experience, needs and suggestions ment and acceleration for improvement. Maureen Flynn is the director of nursing and midwifery, provides unique insight Benefits Quality Improvement Division lead, governance and staff engagement for quality • Staff engagement – each individual work- The framework has been developed to ing in the service has a unique insight bring together a collection of proven tools Acknowledgements Dr Mary Browne would like to thank all the staff who into the challenges faced by their service and techniques to help staff design and informed the development of the Framework for and knows what can be improved. This implement quality improvement projects Improving Quality in our Health Service Vol 24 No 6 July/August 2016 July/August No 6 24 Vol About the HSE Quality Improvement Division (QID): the division led by Dr. Philip Crowley was established
WIN in January 2015. The mission of the QID team is to provide leadership by working with patients, families and all who work in the health system to innovate and improve quality and safety of care by championing, educating, partnering and demonstrating quality improvement. Our vision is working in partnership to Quality Improvement Division create safe quality care. WIN Vol 24 No 6 July/August 2016 - - - - FOCUS 29 FOCUS e that Victoria Curtis Curtis Victoria e that vation by delegates when delegates vation by o and other forms of forms bias, of and other which would ensur Hate crime laws are not a panacea. On On panacea. not a are crime laws Hate Information about the hate crime cam , the WIN, the in last month’s As reported acism, ne O’Curry of the O’Curry Shane is director European Against Network 50 civil society over of a network Racism in Ireland, organisationsworking together to The combat racism. whose members of many the INMO, network includes work to ENAR Ireland’s contribute significantly recent INMO annual delegate conference recent INMO annual delegate conference passed a motion, presented unanimously the by International Section, calling Nurses and urging campaign the for support for crime leg to pass hate the government The was which motion, greeted islation. with a standing development the latest was passed, is it and gaining that is growing campaign in a The of the support INMO momentum. campaign this in and leadership grassroots development welcome and significant a is equality and justice in for fight the in Ireland. their abil will be limited in they own their institutional and structural address to ity r violent manifestation. a crimes are hate UK, the from the experience However, have such laws where and Finland, Sweden such that longest,enacted shows been our criminal legislation can justice provide of instruments with a better range system these to target behaviours and to safe in a manner diversity of culture a guard that could live Jane and challenge bigotry, could her raise and neighbourhood a in work and without fear. children, at: enarireland.org/ found be can paign hatecrime/ thousands of signatures. There will be a will be a There of signatures. thousands this contingent at Not Hate Love strong Dublin Pride march. year’s - - - e been working working e been the INMO. To lead To the INMO. s hav racism. Some of the key Some of the racism. key on her living room window and front front window and on her living room e experienced ’ The campaign has produced promotional promotional campaign has produced The Jane’s experience is not unusual. The The unusual. not is experience Jane’s which is unaccept This is a situation ganisations, including the fight against racist and other forms of of forms other and fight against racist the crime, hate we formation supported the cam a (AAR), Racism Against Action of who comprising people paigning group hav the INMO of members AAR are activists in promote to hard working been have and AAR launched the This year ‘Love its work. Not enact the Hate’ campaign to for push ment of hate crime legislation, a campaign which INMO member support and promote. to resource, actively that has gone video material, including a explaining viral, how On hate crime works. Against Day to mark European 19, March as love dressed AAR of Racism, members to amused hugs free offered and hearts Grafton Street. on shoppers Dublin’s an promoting in effective was tactic The collected that has already online petition able to ENAR Ireland and its 54 member and its 54 member to ENAR Ireland able or out and door, slashing on all the tyres her car. in relationships of investing years After six in the threw in Jane her community local towel, took out of her children school, and In in Donegal. relatives with to stay fled Gardaí the will and intentions, of best spite to powerless were authority local the and children. her Jane and protect incident confidential racist iReport.ie ENAR by system administered reporting criminal acts 137 around records Ireland State The year. each motivated by racism than 45 fewer logs with all its resources our from The deafening silence such acts. the crime reflects and hate on racism State silence of wider society. ------with the with the of support Council, INMO Executive broke a story story a broke ective. Examiner the EU Agency for Funda for Agency the EU ernment has been criticised criticised ernment has been The eland lacks effective hate crime crime hate effective eland lacks Victims Dir ope, Ir ore the law, Ireland isn’t yet an equally equally an yet isn’t Ireland law, the ore mmittee for the the of Elimination for mmittee Racial f Last July, July, Last Almost uniquely among member states states member among uniquely Almost Ms Curtis’s post went viral. It grabbed It grabbed viral. went post Curtis’s Ms o nated in two masked men spraying ‘blacks ‘blacks spraying men masked two in nated pean Commission against Racism and against Racism and Commission pean Intolerance, United Nation’s the mental Rights, and C to be is also likely Discrimination. Ireland Deci the 2008 EU Framework of in breach the and Xenophobia, on Racism and sion 2012 EU for this by the Council of Europe’s of Euro Council this Europe’s the for by safe place for all who live here. who live all for place safe of the Union European and the Organ in Cooperation Security and for isation Eur Incite 1989 inoperable The legislation. cannot Act ment to be counted. Hatred The Irish gov calls on the Irish enact to government hate crime legislation urgently 8, ON MARCH International Women’s Curtis posted a photograph Victoria Day, on Facebook, face bruised of her recently looks what misogyny “This is wrote: and looks like. faggot what being a This is like. This is what Saturday on happens women friends. their with walking home nights told to me after I did what a man This is him for him to tell cool it us to take wasn’t pull down our off our trousers, and knickers 2016.” This is Ireland our arses... show him and of national radio the attention much needed re-opened momentarily The discussion debate about hate crime. that, mar post a sober reminder provided Shane O’Curry, Shane O’Curry, riage equality, in spite of formal equality equality in riage equality, formal spite of be about ‘Jane’, a working mother living in mother living in working a about ‘Jane’, been had family young whose Dublin west to escalating and subjected year-long a harassment, bullying, racist of campaign This culmi threats and criminal damage. 30 FOCUS
Safe staffing in practice
Several elements are being tested in the pilot phase of the safe staffing and skill mix framework, write Dr Philippa Ryan Withero and Liz Roche
The Taskforce on Safe Staffing and Skill hospitals selected are: Beaumont Hospi- As a first for Ireland, the pilot and its out- Mix for Nursing was established by the tal, Dublin; Our Lady of Lourdes Hospital, comes are critical to inform future national Minister for Health as a direct result Drogheda; and St Colmcille’s Hospital, roll-out decisions. To ensure robust eval- of the INMO Safe Staffing Campaign Loughlinstown. A total of six wards, drawn uation of the pilot, the Pilot Planning and launched in May 2014. It is currently in from across the three hospitals, are partici- Implementation Group collaborated with its pilot phase, following the publication pating in the pilot. the Health Research Board to develop a of the Taskforce’s report in February Each of the hospitals has established its research call. The successful research team 2016. The Taskforce, which the INMO was own local pilot planning and implemen- is that led by Prof Jonathan Drennan, Uni- instrumental in establishing, is one of the tation team, chaired by group directors versity College Cork, with a collaborative most important developments for nursing of nursing, Sheila McGuinness and Ann team between UCC, University of South- and midwifery since the Commission on Donovan, and supported by local direc- ampton, University of British Colombia and Nursing. Here representatives from the tors of nursing and the management team. University of Technology Sydney. Department of Health and the HSE give These teams, like the other groups above, The purpose of the research is to meas- an update on the pilot phase are using a partnership approach with ure the impact of implementing the pilot of The Taskforce report, published in Feb- membership from: directors and assis- the framework on nurse-sensitive patient ruary 2016 complete with a framework tant directors of nursing, clinical nurse outcomes, staff outcomes and organi- and recommendations, set out for the first managers from participating wards, CEO/ sational factors. It will also measure the time, an evidenced-based approach to hospital manager, HR, finance, ICT, the economic impact, along with providing an determine safe nurse staffing and skill mix INMO, SIPTU, nurse practice development, evidence-based assessment of the adop- levels across general and specialist med- quality and safety and the ONMSD pro- tion and implementation of the framework ical and surgical inpatient care settings in ject lead. These local teams have regular in practice. acute hospitals. A key report recommenda- meetings, and their chairs are part of the Finally, research in this area finds that tion was piloting of the framework across Taskforce Pilot Planning and Implemen- patients and nurses in the quartile of hos- a range of acute hospitals of varying size. tation Group, so there is communication pitals with the most favourable staffing On February 2, the Taskforce Pilot between all groups. levels had consistently better outcomes Planning and Implementation Group was There is a range of components being than those in hospitals with less favoura- established to plan, implement and evalu- tested in the pilot and a few of the critical ble staffing.1 For each of the participating ate the pilot. The group is chaired by chief ones are discussed here. To determine safe wards, safe staffing and a healthy work nursing officer Dr Siobhan O’Halloran. nurse staffing and skill mix levels requires environment will be the order of the day Similar to the Taskforce Steering Group, the collection of fundamental pieces of to test the robustness of the framework to this group has a partnership approach that evidence, not only about the workforce but deliver on its intended outcomes. includes: representation from acute hos- equally about the demand for workload The pilot is due to conclude in December pitals, national human resources from the intensity related to patients. 2016, with a report and recommendations HSE and the Department of Health, the After all, this new way to determine on its outcomes and impact in January office of the chief financial officer (HSE), safe nurse staffing is all about the evi- 2017. The process that has been engaged in the office of the chief information officer dence to inform these decisions safely and to pursue a safe nurse staffing and skill mix (HSE), the office of the nursing and mid- effectively. The framework maps out this approach, is one that we expect will lead to wifery services director, group directors of information under each of the four core a sustainable and stable workforce for the nursing, academic expertise, the INMO and assumptions along with the use of this future. The taskforce would like to take this SIPTU. information to inform appropriate nursing opportunity to thank all those supporting As an initial step, the group developed workforce governance decisions from ward its work across all services.
a detailed project plan. One of the first to board and board to ward. As this data is Dr Philippa Ryan Withero is deputy chief nursing officer at actions was the selection of pilot hospitals. critical, the Pilot Planning and Implemen- the Department of Health and Liz Roche is area director, This was a challenging task, as the level of tation Group, in conjunction with the office Nursing and Midwifery Planning and Development, ONMSD HSE. (For further information contact: enthusiasm across hospitals to be included of the chief information officer, tendered Dr Philippa Ryan Withero, Tel: 01 635 4131 or via email: in the pilot was clearly articulated to the for an ICT application capable of collecting [email protected]) group. To ensure a robust and transparent and collating this information. A company References process, the group developed a set of crite- called Trendcare is working with all pilot 1. Rafferty et al. Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of Vol 24 No 6 July/August 2016 July/August No 6 24 Vol ria based on the outputs from the pilot, to groups to train and tailor the tools to cap- survey data and discharge records. Int J Nursing Studies 2007 (Feb); 44(2): 175-182 WIN select the three pilot hospitals. The three ture the data outlined in the framework. WIN Vol 24 No 6 July/August 2016
------en oot, oot, ocial, S well as n childr I 43 CPD variety of insulin of insulin variety with diabetes are diabetes are with 1 diabetes is caused reatment is individ reatment 1 T life expectancy for for expectancy life which are taken which taken vary at are should be assessed. F s type I A M diabetes assessment should diabetes assessment should B or 21% of deaths in people with with people in deaths of 21% or 1 f vascular disease, medication his dio ximately 7% of people who are regis who are of people 7% ximately lthough the n initial People with diabetes are estimated estimated diabetes with are People and can also be affected Mental health Vascular risk factors, smoking status, smoking status, factors, risk Vascular treatment Life-long insulin essential is A A egimen options, and young people, behavioural and conduct and people, behavioural young and well as risk-taking as can present, disorders can include non-adher which behaviour, to be up to 30 times more likely to have to have likely times more to 30 to be up an with the compared amputation gen conditions such as anxiety, can include depression disorders. and eating ualised and includes a ing intervals. tered blind in the UK. the blind in tered has generally diabetes type 1 with people increased, it is still lower than that of the population. general Assessment and examination examination and review include a general long-term medical history, the person’s of other med diabetes history, and/or recent diabetes and/ of history family ical history, or car medications. current tory and/or history should also be and lifestyle cultural discussed. weight and be examinations should vision and eye for urine undertaken and tests carried out urine on dip albumin excretion, protein Psychological creatinine. serum stick and wellbeing should be assessed as to medication and self-care, attitudes and social relationships, family immediate support. of informal and availability plans Treatment diabetes. type 1 for r at a higher risk of stroke and myocardial and myocardial of stroke at a higher risk infarction. accounts cause is a leading diabetes. Diabetes type 1 work of blindness in people of preventable for accounts ing age. Diabetic retinopathy appro ence to treatment. recommended eral population. Cardiovascular risk is risk is Cardiovascular population. eral people also increased;
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E e management C I Further research is needed Further research ndeed, disability 5 I - with hyperglycae esents to N and one or with hyperglycaemia (random (random with hyperglycaemia the disease should be diagnosed 1 son pr oximately one in four people with with people four one in oximately ding type as develop can 1 diabetes , tiredness. weight loss or excessive a child or young type a child or young person, 1 dia 1 diabetes. variety of variety can complications potential ears at onset, a body mass index ( at ears ppr ccording ccording
st for suspecting type 1 diabetes include diabetes include type 1 suspecting for y n slea A A A I Risk factors include factors Risk a combination of esents in this the true cause of the to confirm area disease. Diagnosing type 1 diabetes diabetes, betes should be suspected if the child child the betes should be suspected if pr plications can often be early by prevented detection and activ ease during their lifetime. Kidney disease occur in people with type 1 diabetes. 1 type with occur in people chronic diabetes kidney dis will develop plasma glucose more than 11mmol/L) and than 11mmol/L) and plasma glucose more (abnor polyuria of features characteristic of mally volume large urine), excessive thir reduced complications is greatly of risk to as glucose levels circulating keeping by to reduce order near normal as possible in tissue damage. below 25kg/m², or personal and/or family family and/or personal or 25kg/m², below history of autoimmune disease. mia (random plasma glucose more than than plasma glucose more mia (random 11mmol/L) mi largely on clinical largely grounds. ria if a per during adulthood and some people with with some people during adulthood and with insulin. treated diabetes are type 2 genetic and factors. environmental 15% of people diagnosed with type 1 dia (parent, relative first-degree a have betes sibling or child) with the condition. immediately referred to a diabetes special to a referred immediately ist team or a team. paediatric diabetes care Complications diabetes is suspected the per diabetes is suspected genetically susceptible people, unknown susceptible people, unknown genetically diet of or agents infectious features some develop the trigger can childhood early in of ment causes then which autoimmunity type is evidence that some ing: ketosis, rapid weight loss, aged under loss, aged under weight rapid ing: ketosis, 50 Type 1 diabetes 1 Type mellitus
3 ------e 2 dia 2 e eland is eland is r he most I ncidence term dia term T yp I T he T 2 2 diabetes is clas eam, which causes causes which eam,
cells in the pancreas are are the pancreas cells in through, and ‘mellitus’ and ‘mellitus’ through, esults in an inability to to esults in an inability absence of insulin allows allows insulin of absence he T total of number people his r 1 he T T the blood str
with a combination of diet and 2 oducing ffect of of or deficiency insulin ffect resist essional development development essional series, theexamine we e insulin deficiency, which results which results deficiency, e insulin term type type term diabetes 1 has replaced e 1 diabetes can occur at any age, age, any at occur can diabetes 1 e insulin deficiency, which occurs when which occurs insulin deficiency, eland. he he e he yp - abso an as defined is diabetes 1 ype r n comparison, type I T T T I Diabetes is one of the most common T n the n clinical latest update continuingthis in elativ currently living with diabetes in with living currently estimated to be 225,840. estimated insulin-pr lute betes’, which are considered potentially potentially considered are which betes’, although it most commonly presents in in presents commonly although it most people. young and children in persistent hyperglycaemia. hyperglycaemia. persistent in oral drugs, changes, antidiabetic lifestyle and insulin. wise they would die within days or weeks. with a along sified as insulin resistance r childhood (age six months early peaks in during puberty. and again years) five to persistent elevated levels of glucose elevated of persistent levels glucose to circulate in the blood, (hyperglycaemia) which can cause both chronic and acute complications. with type People 1 diabetes other insulin replacement must receive secrete insulin into the body. the body. insulin into secrete meaning honeyed or sweet. meaning honeyed on is and its prevalence diseases chronic increase. the destroyed. destruction cell of cause common is auto immunity. a variety of harmful effects. of variety a effects. harmful mellitus is defined as a group as a group defined Diabetes mellitus is which either of are metabolic disorders secretion inadequate insulin caused by insulin of action the to resistance 1), (type (type 2), or factors. a combination of these Continuing Continuing Professional Development Currently there are approximately 14,000- approximately are there Currently diabetes type 1 with 16,000 people living in older labels such as ‘insulin-dependent older labels such as ‘insulin-dependent dia diabetes mellitus’ and ‘juvenile-onset betes can be managed using a stepwise stepwise a using managed can be betes approach ance is a persistent elevated level of of elevated level ance is a persistent glucose in ‘diabetes’ Latin, from comes mellitus betes to pass meaning prof diagnosis and management of type 1 diabetes mellitus diabetes 1 type of management and diagnosis I 46 Focus Out in the Calais jungle Four Irish volunteer nurses report from the infamous ‘jungle’ in Calais, which is home to 4,500 people seeking refuge and asylum
THE first thing we noticed about the for there and described feeling like human ‘jungle’ was the bitter cold – that sense of beings as we cared for each one of them cold that gets into your bones. We were with compassion. So many of these people glad of the layers of clothes we had worn were traumatised and had fled their homes, that protected us from the piercing chill. terrorised, to escape war, the Taliban, ISIS Myself and Sharon had no idea what to or Assad, and were now reduced to living in expect on arrival in Calais, on the north sub-human conditions in a former rubbish coast of France, even though Elena and dump on the outskirts of Calais. Fintan, nurses involved in the genesis of Conditions at the site are miserable, the first-aid support for refugees in Calais, with hardly the most elementary of ser- had tried their best to prepare us. All we vices available. Hygiene is basic, with knew was that we needed to be there to multi-function water troughs used for all help in whatever way we could. cleaning needs – pots and pans, clothes As veterans of the system, Elena and and personal hygiene. The toilet facili- Fintan ensured that we had all signed up ties are plastic booths which afford some Above: Deirdre Lang and Sharon Morrow in the ‘jungle’ caravan clinic with a Facebook group called Care4Calais, degree of privacy, but the pleasantries end with the Refugee First Aid and Care Team there, and to use these facilities is a stom- and with Ireland Calais Refugee Solidarity. ach-churning experience. This provided access to a great support Diagnosing the ailments that people network and allowed us to roster our- presented with in the caravans was often a selves to the caravans which are the site’s complicated affair, as many people didn’t first- aid clinics that provide a vital service speak much English and there is only so for the 4,500 people who call the ‘jungle’ much sign language one can employ when home. the condition is more than a cold, and has We had fundraised individually in the the potential to become a serious illness. weeks before we travelled out and, with We were so grateful for the skills and com- the help of family and friends, we were mitment of the men from the camp who able to take suitcases of supplies with us. translated for us from morning to night, Tallaght Hospital was particularly gener- as without them we would not have been ous and supplied us with a large number able to do any more than offer socks, loz- of dressings, which were put to good use in enges and tissues – things which we always treating the many injuries we encountered. seemed to run short of in the caravans. We were on-site for four days during which Through these translators, many of we saw approximately 180 people a day. whom spoke at least four languages, we The ailments ranged from head colds heard stories that the bruising and head and flu to lacerations, soft tissue injuries lacerations were caused by the guards and bruising, fractures, anaemia, scabies, at the entrance to the camp, who were lice and sexually transmitted infections liberal with their use of their batons on (STIs). Anyone with a serious ailment or these people fleeing terrorism. We were injury, the kind which required diagnostics told that many of the beatings happened or prescribed medication, could be referred when someone was caught trying to flee to a nearby health clinic run by French vol- to England on a lorry and, once discovered, unteers or to a nearby hospital. in addition to dealing with the disappoint- Vol 24 No 5 June 2016 No 5 24 Vol However, the first-aid caravans were the ment of not being able to leave the camp,
WIN first port of call for most; they felt cared they then had to deal with the possibility Focus 47
Conditions in the caravans are very basic of physical abuse and detention at the believed to be trafficked and there isn’t a hands of the French police. word about it! If these were white French Many people arrive at the camp after children, there would be an outcry and months of travelling from Sudan, Eritrea, they would have been found and returned Ethiopia, Syria, Pakistan or Afghanistan, home, and those who had dared to take and are tired and weak. Hence recovery them would be punished. from injuries and ailments takes longer Despite all of the horror, the people of than in normal circumstances. the jungle cling to the hope of a better French police patrol the camp Some of those we met in the camp were future. We met people of all nations, but young men fleeing the Taliban; their par- in truth they all belong to one – a nation ents selling all possessions so that their of humanity. They hold each other up. The sons could flee to a land where they might majority of the people in the camp, despite live. Many had witnessed their parents experiencing the stuff of nightmares, dust being murdered in front of their eyes, and themselves down, hold their heads high were now on the run, terrified and trauma- and walk like kings. tised. Yet despite all of this, these lovely And then there are those who can no human beings will look you right in the longer do it, who have run out of stam- eye and thank you with a level of sincer- ina and hope, who have seen and lost too ity that leaves you feeling humbled and much. But yet they smile as that’s the only inadequate. gift they have left to give you. Leaving When the children arrive and you realise them in the jungle has broken our hearts, they are only 10, 12 or 15-years-old, and and we each have left something of our- that they are unaccompanied – all alone in selves there. But we will be back, as once The head laceration of a 15-year-old boy who is unaccompanied in the camp the world – the impact really hits you. One they touch your heart you can never again group of Sudanese boys were at school be the same. when their village was attacked and burnt, We do not want history to remember and all their parents were murdered. They us as merely standing by and letting such fled and now live in terror in the Calais abuse and neglect continue. We are but a jungle, with no way home and no way out. generation away from the atrocities of the A 19-year-old boy has become their concentration camps. We do not want to be guardian and this boy prostitutes himself counted among those who did nothing, and to ensure the younger boys are fed. He we would urge you to do likewise. We urge cries to one of the volunteers that he is you to contact your local TD or MEP and not a bad boy and you can feel your heart raise the plight of these people and children. sink in your chest, followed by a sense of At the time of writing the authors were WIN intense anger and disbelief that this is planning a return trip to Calais. Contri- Vol 24 No 6 July/August 2016 actually happening. butions towards this cause can be made The south camp was bulldozed a few via the following gofundme link: www. months ago, and the displaced who had gofundme.com/23p93xmn been sheltering there were again displaced. A staggering 120 children are missing since Deirdre Lang is director of nursing, HSE national clinical then and no one can account for their programme for older people; Sharon Morrow, chief executive officer, Laura Lynn Children’s Hospice; Elena whereabouts. A mere hour from London Lydon, RANP, emergency department, Mayo General One camp resident showing what he said was the by car, and there are 120 children missing, Hospital, and Fintan Sheerin, Faculty of Nursing, TCD result of a beating MEDIA WATCH 49
Rising risk of assault The risk of assault faced by hospital staff and work to rule action at Our Lady of Lourdes Hospital, Drogheda hit the headlines this month. Ann Keating reports
Thirteen staff a week are attacked at working places under the Safety, Health until staff are recruited or a ward is closed. acute hospitals according to a report in and Welfare at Work Act, and we have We need every bed in the hospital but our the Irish Daily Mail on June 20. nurse health and safety reps elected in all members cannot ignore the fact that every “Thirteen staff members in the HSE are 26 EDs for the first time ever.” He added: ward is understaffed.” physically assaulted every week on aver- “The numbers of people who impose it May trolley/ward watch analysis age in Ireland’s acute hospitals, according [violence] on nurses are a minority but The Westmeath Examiner (June 18) to figures obtained by the Irish Daily Mail. the effect and impact when it occurs is gave coverage to our trolley/ward watch “In total there were 1,360 reported traumatic. The protections and miti- statistics for May – Overcrowding eases incidents of physical assaults on mostly gating actions are not sufficient and the in May. “The latest Irish Nurses and Mid- frontline HSE staff members, including overcrowding makes the environment wives Organisation trolley/ward watch nurses, doctors, porters and ambulance an agitating factor. In some situations, comparative analysis for May shows a personnel over the past two years. And departments can be like a powder keg.” 14% reduction in the number of admit- according to the Irish Nurses and Midwives Our Lady of Lourdes Hospital, Drogheda ted patients on trolleys compared to May Organisation, these figures represent only The Mid Louth Independent (June 8) gave 2015. The figures show that 6,627 patients the most severe cases and are ‘unlikely to space to the ongoing action at Our Lady admitted for care, were on trolleys this portray the actual level’ as there is signifi- of Lourdes Hospital, Drogheda under a year, compared to 7,713 in May 2015.” cant under reporting. headline Lourdes action set to escalate – According to Liam Doran: “This posi- “One of the more worrying figures is that work to rule protest at local hospital will tive development will be short lived if the there were 20 assaults perpetrated by staff continue until staff recruited or ward is recruitment pause recently announced members last year on their fellow workers closed. by the HSE is not stood down. The con- – compared with just one such incident in “Staff at Our Lady of Lourdes Hospital sequence of delays in recruitment will 2014. Meanwhile, in 2015 there were 448 in Drogheda will decide whether or not to result in the curtailment of services and occurrences of verbal assaults, verbal har- escalate their action over the coming days, a reduction in bed capacity which will assment and physical harassment reported it has been revealed. Members of the Irish exacerbate pressures on the emergency by healthcare staff across Ireland’s 33 Nurses and Midwives Organisation imple- departments.” acute statutory hospitals – compared to mented a work to rule at the hospital last He said: “Any reduction in the number 358 in 2014. Tuesday in protest at staff shortages at of sick patients on trolleys must be wel- “The figures provided did not break the hospital. There are currently over 100 comed, particularly after the worst winter down the nature of the physical assault or vacant posts at OLOL. on record for ED overcrowding. Everyone what may have been said in cases of verbal Speaking on LMFM recently Liam Doran, must now reaffirm their commitment to attacks. Assaults and harassment on staff general secretary of the INMO, said: implementing, on a 24/7 basis, the recent are reported using the National Incident “Whether we expand the work to rule to ED Agreement and continue to prioritise Management System which is hosted by include additional measures, that’s some- the crisis facing emergency departments the State Claims Agency on behalf of the thing members will decide over the coming in all decision-making. The confusion that HSE. There were 716 physical assaults days’ but he said this was a ‘distinct exists with regard to recruitment must be reported to that system in 2014 and 644 possibility.’ removed so we can attract back the 4,000 W in 2015. There were also 28 assaults by “At present, nursing staff say they are Irish nurses and midwives needed to fill IN Vol 24 members of the public, two by a staff focused on patient care as a priority and vacant posts.” member’s peer or student, and 47 by a the work to rule is affecting admin duties Meanwhile the Western People (June 13) N family member or relative. In 2014 there only. You can’t run a health service and noted Mayo trolley figures at highest in o 6 July/August 2016 were 28 assaults carried out by family leave posts vacant, said Mr Doran. The 10 years and the Limerick Leader (June 13) members. very first thing we said to the new Minister reported University Hospital Limerick over- Dave Hughes, INMO deputy general for Health is you have to get a handle on crowding highest in Ireland. secretary, said: “We have recently reached recruitment. He said the work to rule situ- Ann Keating is INMO media relations officer, agreement that all EDs are designated ation at Lourdes will continue indefinitely email: [email protected] WIN Vol 24 No 6 July/August 2016 in their firstlife, year dueto conditions of ceremony. In1916,81per 1,000infants died their life and death passed over without children were discovered inaseptic tank, remainsskeletal ofwidespread when the mental vaccination trials. mental vaccination including experi various abuse, forms of children in these homes were subjected to the years following the Rising.Babies and detained inmotherandbab pregnantunmarried womenweresands of most shamefullegaciesasa country. Thou is oneofourmarriage, born outsideof ‘illegitimate children’,so-called orthose were cherished. and The treatmentfate of contemporary Irishmaternity services. equally’ ‘cherishtion to nation thechildren ofthe Proclama the commitmentin the declared my speech, which I summarise below, was RebeccaNUIG. and O’Brien of The focus of of UL, Barry VanessaO’Shea of UCC, Ahern Devin of DKIT). We were opposed by Mary Roisin O’Mara of UCD and myself (Joan proposerswere Jennifer Corriganof TCD, children in the 1916 Proclamation. The andwomen made to the commitment contemporary maternityservices reflect O’Farrell. The debate itselfasked whether Fitzpatrick –grandniece of Elizabeth President Michael D Higgins, and Marie wife– of Higgins at theeventwere Sabina Dublin on May 4, 2016. Guests of honour delivered by midwife, Elizabeth O’Farrell. 2016, as the 1916 surrender itself was Midwife Debate during Midwives Week to base the annualNMBI Annual Student whicha fitting themeon was Republic.It of and commemoration ofthecentenary tion THUS far 2016hasbeena year of celebra to women and children in the 1916Proclamation whether contemporary maternityservicesreflect the commitmentmade Joan Devinshares her views from the Annual Student Midwife Debate on Cherish the children equally 50 MIDWIFERY MATTERS deaths. registered were796 during thoseyears,and open from 1925-1961. A total of 1,101 births Historically in Ireland, not all children The debate was heldin Trinity College The Tuam MotherandBaby Home was the 1916Rising 1 media coveragelast yearwas The , andhow this is demonstrated in , and the birth of the Irish 1 y homesin - - - -
services. dren were never cherished by the maternity ditions of the time. associated with the poorgeneral living con I inatal Epidemiology Centre auditsall of the lives of newborns. The National Per MMBRACE, which by association improves maternity servicesstatistics to CMACE, now birth outcomes. maternity servicesare working to improve professionalaccountability, contemporary and midwives. nuns in these homes were trained nurses once ble when motherandbaby homes were wrapped inashroud of fear, understanda professional.caring orcompetent of poverty and chastity did not guarantee a n mortality,main causesof are the maturity malf tation, notlegitimacy of birth. Congenital our statistics to reflect birth weight or ges is 6.7 births per 10,003. We break down of birth. Maternity and Inf born assessments provided for by the programmes, and postnatal GP new Initiative, extensive childhood vaccination birth uments which ultimately aim to improve research-basedboth Use of doc Oxytocin, National Guidelines ontheand Ireland, of bothaNationalMaternity inatal care. publication saw the This year type of maternity carewant. they type of important mostfactor when choosing the safety remainssay that babyfor the their an illegitimate child was 1 in 51. These chil born in a mother and baby home. survival than onebetter chanceof a had maternity centreswerematernity purpose. fit for was toensure1934 thatdesignated Act of Homes RegistrationMaternity aim ofthe of r ot eland’s maternity centres to improve per Since 2009,Ireland has volunteered its Childbirth inIreland hashistorically been malnutrition, diarrhoea or neglect. neglect. malnutrition, diarrhoea or The ormation outcomes. consider T 7 Even today, women in Ireland oday our perinatal mortality rate 5 Yet, a child bornin the slums ed to beadequateplaces and complications of pre and complicationsof The Baby Friendly Hospital ant 2 The mortalityrate for Care Scheme, aim Str 8 ategy for Through 1,6 Vows 4 The The ------ba able again. The heartbreaking sight of best interests ofthechild. best Child in1992,guaranteeing to actin the the UN ConventionRights ofthe onthe and children’s rights when itsignedup to indication. interventionswithout clinical longer than babies born in 1916. 25 yearsaveragelive on Ireland will today they are continually improving. resuscitation at the limits of viability, and morbidities suchas obesity, andneonatal complex perinatal cases associated with moreand culturally diversepopulation, changes since1916,suchasanincreasing Irish maternityserviceshave seenmany services. and maintain normality in the maternity allowing us to promote our philosophy midwifery firmly as a distinct profession, The Nurses andMidwives Act 2011placed also know when technology isunnecessary. a sound scans, electronic foetal monitoring to promote infant health. Access to ultra findings are responded to inpractice. do much to improve our services, when collaborative confidential enquiries can promoting long-termhealth. policies, therebynational changes to our to make evidence-based, midwifery-led our maternityservices,anda willingness improvementslargelyin due to continued of likelihoodreduce the and wives todetect References onrequest (quote: J. Devin WIN 2016; 24(6): 50 Technology Joan Devin is a studentmidwife at DundalkInstitute of childr made to reflecting thecommitment ished, all childr emphasise that land today. The modernmaternityservices septic tank; that would nothappen inIre rates of 100 years ago will never beaccept n Ireland committed to promoting infantpromotingIreland committedto Today professional accountabilityand The perinatalandneonatalmortality bi d foetal blood sampling,allows mid perinatal es’ and children’s bodies dumped in a en in 9 Babies today are not exposedto are Babies today the 1916Proclamation. morbidity and mortality. We en should be cher should en 10 Babiesbornin 11,12,13,14 10 2 This is This 11 - - - - -
52 FOCUS
ICNP – driving change in service delivery Dr Pamela Hussey reports on the progress of the DCU SNHS ICNP user group, including the work towards achieving a standardised language among healthcare professionals
The successful award of accreditation to the Dublin City University School of Nurs- ing and Human Sciences, International Classification for Nursing Practice (DCU SNHS ICNP) user group was reported in WIN earlier this year. The INMO, as a member of the International Council of Nurses, endorsed this accreditation and is working in partnership with DCU on the centre’s development. Here we report on the centre’s goals for year one and outline why healthcare pro- fessionals need to engage with informatics education and training, particularly in rela- tion to implementation of standardised Figure 1. Sample search on ICNP browser for the term ‘fluid in’ (available at www.icn.ch/ICNP-Browser-NEW.html language in service delivery. Standardised terminology associated with a section of the electronic Progress to date Across many services in Ireland similar record which deals with fluid intake or In the proposal to establish a national concepts and terms are reported in nurs- impaired nutritional intake. From a tech- ICNP accredited centre for research and ing and midwifery documentation. While nology perspective it has a code 10029873 development, we defined a set of goals they are alike and, from the healthcare which means that this information can to drive the deliverables over a four year professional’s perspective, have the same be transferred between computers and, timeframe. Here we present our progress meaning, they are presented differently more importantly, from a service delivery to date. across services, and from a national per- perspective it can be transferred across ser- Goal 1: Establish the DCU SNHS ICNP User spective have no shared concept definition. vices in a clear and unambiguous manner, Group Centre as a formal ICNP centre to For example, different organisations may optimising patient safety at transition of advance uptake and use of ICNP in Ireland. have different approaches to a referral, its care. • This centre will open over the summer purpose, and the core terms included in The Health Information and Quality of 2016 with first user group meetings the template. As we migrate to using more Authority (HIQA) is doing excellent work scheduled for the autumn information and communication technol- in this area, providing a set of shared • To facilitate knowledge transfer the ogy in our services, the computer based on data concepts. For further informa- INMO Professional Development Centre logic cannot handle different terms with tion see national data standards on the has developed two informatics work- similar meanings. It cannot for example HIQA website www.hiqa.ie/healthcare/ shops, which will be offered later this year compute ‘fluid intake poor’ and under- health-information/datasets – ‘Introduction to Nursing Informatics’ stand that it means the same as ‘minimal In this centre we wish to help practi- and ‘Introduction to International Classi- fluid intake’. We therefore need to present tioners identify the codes they need to fication for Nursing Practice (ICNP)’ this concept using a clear definition with deliver standardised language for future • To date we have presented at a number an associated set of pre-defined terms and service delivery. However, we also wish to of national team meetings including the codes. make sure that the concepts selected are Council of Clinical Information Officers Figure 1 shows that the ICNP browser the best ‘fit’ to demonstrate not only the www.ehealthireland.ie/Stakeholder-En- demonstrates that the concept of nursing and midwifery contribution but to gagement/CCIOs/ and the Office of the ‘inadequate fluid intake’ can be either achieve optimal patient-centred integrated Nursing and Midwifery Services Director documented in practice as a diagnosis or care. The resources available for standard- (ONMSD) Nursing and Midwifery Lan- an outcome. As it is presented in stand- ising language are vast. In the international guages and Terminology Forum and also Vol 24 No 6 July/August 2016 July/August No 6 24 Vol ardised format, it also has a preferred terminology dictionary SnomedCT there presented a masterclass in the School of
WIN term ‘impaired fluid intake’, and it can be are over 400,000 concepts and terms. Health and Social Science in the Institute FOCUS 53
of Technology Tralee. Active participation Goal 5: Disseminate information on teams can provide detailed insight by in social media can also be seen on Twitter research activity both nationally through monitoring implementation plans locally, @CCIO_HSE WIN, conferences and peer reviews. while identifying potential gaps which Goal 2: Establish a research cluster • Annual summary reports on the progress may impede future anticipated delivera- with existing partner services scaling to of the centre will be featured in WIN, of bles such as effective continuity of care. other partner services over the four year which this is the first Driving the agenda are top down standards timeframe. • The centre has also invested in telecon- ‘with teeth’ such as the EU Data Protection • At practice development level a number ferencing facilities to communicate legislation which took effect on May 27, of presentations have been delivered with interested practice development 2016 and which provides two years for all and have led to some early practice groups both across Ireland and the EU member states to set in place national leg- development initiatives which are now member states; the contact details will be islation to demonstrate compliance. underway. One example is a clinical posted on www.dcu.ie/snhs/icnpuser- What is not helpful are the ‘us and nurse specialist group with St Mary’s group.shtml (website is currently under them’ scenarios that detract from the core Campus for older persons services, revision). message, which is that this is everyone’s Phoenix Park. This group has recently Why get involved? business, this is our healthcare system and been established to explore the role of There is significant top down activity we want to ensure value for money for all CNS activity and how CNS participants underway in delivering the eHealth Ire- our citizens. can link in with the overarching centre’s land agenda, all freely available to view at Words in language are like instruments design approach. The focus to date in St www.ehealthireland.ie This service plan in a tool box, they can be used by nurses Mary’s Campus has been to consider the is the single most significant investment in and midwives to fit their requirements, CNS role and define a specific problem health and social care in Ireland since the but like tradesmen with tools, nurses and (analysis and formulation), and consider formation of the State. The success of sim- midwives need to understand the overall a selection of methods that can be used ilar national programmes has been variable design of the task at hand. The contribu- to predict the knowledge needed to and one of the key issues identified as crit- tion of practising nurses and midwives is solve the problem or attempt to do so. ical to success is early clinical involvement. required on early design and definitions to It is anticipated that the groups can grow The Council of Clinical Information select specific words (concepts and terms) organically over time with relevant aca- Officers (which comprises clinical leaders that will represent nursing and midwifery demics but a core principle for the group including more than 15 nursing and mid- activity for many years to come. is clinical leadership wifery members) has taken on the role of The ICNP user group team is happy to • Enquiries on national projects scheduled championing this nationally. They do this visit services for some focused discussion; for development within the HSE are also because they recognise that a bottom up just contact us to arrange a site visit or underway, with working group formation approach to service improvement and inte- for us to come to one of your meetings commencing in July. grated care is key to realising the proposed (number and email as below). Goal 3: Promote the use of ICNP equiva- strategy to optimise citizen’s health and Those who complete the INMO intro- lence tables with SnomedCT with national wellbeing. We cannot assume the role of ductory workshops on nursing informatics clinical programme objectives through the passive employees, waiting for senior HSE and International Classification for Nursing Integrated Services Framework in OCIO management and Department of Health Practice participants will be considered Directorate Authority. leaders to deliver top down strategic plans; as having recognised prior learning (RPL) • A number of activities relating to the to deliver eHealth Ireland in an isolated for future study on the DCU SNHS uptake and use of SnomedCT were com- fashion will not work. postgraduate modular framework. See pleted in quarter two of this year. Specific Nurses and midwives traditionally make www.dcu.ie/snhs/index.shtml for further projects relating to community support excellent change agents and can drive this information. include future design plans for integrating transformation; the healthcare systems Note that completion of the INMO patient outcome measures within clinical we create over the coming years will be workshops does not guarantee a place workflow. used for all our families in the future. Core on the DCU SNHS postgraduate modular Goal 4: Build on established relationships features that need championing include framework. Individuals may however wish with existing ICNP accreditation centres identification of the generic patient cen- to consider completing a Level 9 module and seek funding for future initiatives tred processes, which will break down entitled ‘Informatics in eHealth’ which is through research funding streams. traditional boundaries for safer care deliv- scheduled to commence in February 2017 • At a European level ICNP user groups met ery and integration of outcome measures (pending approval).Please contact the at the International Congress in Nurs- within clinical workflow initiatives. School of Nursing and Human Sciences at
ing Informatics held in Geneva in June, Evidence suggests that there is a need Tel: 01 7005947 or email: snhsenquiries@ WIN to develop specific projects and to seek for cross functional teams (clinical and dcu.ie for further details. Vol 24 No 6 July/August 2016 funding for future initiatives. This work technological) that can focus on the deliv- Dr Pamela Hussey is a lecturer in health informatics/ will be reported on as it progresses over ery of specific patient outcome measures nursing at Dublin City University, School of Nursing and the course of the year. to support individuals living in place. Such Human Sciences
Introduction to Nursing Informatics (6 CEUs) Venue: INMO Head Office; Date: October 5, 2016, 9.45am-4pm; For more information, please visit www.inmoprofessional.ie WIN Vol 24 No 6 July/August 2016 ------ses and midwives midwives and ses ur N one not asked and that that and one not asked
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between decision-making and personal decision-making and personal between we first reflection, need compre to fully actions and behaviours. and actions soned to attitudes critics. would-be pro cognitive a engage to beings human as choice cess, thought, and involving which allows them to come to and reflec rationality a understandings, their judgements, and times in tion at all rigorous structures: basic four has This undergo. • or midwives make should not be based on on should not be based make or midwives or their to Coming feel intuition. how they a decision in a hospital involves the ‘right’ more serious that task ongoing and requires to prioritise demands nurses/midwives complex often situations. characterise that R basis. a provide to midwives and nurses by reasoned on act and position their defend proposal a by underpinned is It insight. consistent sufficiently they must have that to and judgements ethical understandings they that decisions the justify take; nurses above rise to seek should midwives and their to other subjectivities and deference on their focusing atten by professionals advancing nursing and midwifery’s discipli and midwifery’s advancing nursing each nurse nary knowledge base, it is about being individuall and midwife detail the to tion they data and actually experience, b change possibilities for contemplation. change contemplation. possibilities for really is choice what setting,hospital a In about is the true extent of your recognising profes the having and freedom human sional courage and personal integrity to do what hend the cognitive process of decision of decision hend the cognitive process that all nur making tious towards, and accountable for, their their tious towards, and for, accountable ethical - - - - Per 1 All nurses and and All nurses es to re-evaluate to re-evaluate es that personal reflection that personal ofessional experiences experiences ofessional that reason, a nurse or or a nurse that reason, ses and midwiv their knowledge. every action as a nurse or midwife or midwife action as a nurse every
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eflecting on pr esearch suggests esearch R R A nurse or midwife’s interpretation interpretation midwife’s or nurse A In the past, nursing and midwifery work work midwifery and past,the nursing In aft sonal reflection would, at the very least, least, very the would, at reflection sonal compel nur or revisit some of their long-held beliefs.long-held their of some revisit or in a peer-review setting might present might present setting in a peer-review could of development the to lead a sound epistemology. midwifery and nursing surrounding their professional experien their surrounding professional of knowledge, but agents are midwives their those fall short of defending who assault under when learning experiential to reason taught how to be may need defend and positions knowledge their out decisions as being ‘right’. their professional existed, experience instead of professional making. decision self-directed and reflection Personal archical position within a hospital. The The within a hospital. position archical cr tial decision-making further is vital for expanding midwife may have chosen to ‘simply do midwife may do chosen to have ‘simply The acceptability of told’. what they were was system a such in contribution one’s based on their seniority or therefore hier we say something about the kind of person of person the kind we say something about we wish to be the and values kind of we action says something Every by. to live wish the people most we regard about how with people as – us with involved directly needs whose dignity different is equal to ‘superior’ who are or as individuals own, our end. an to means a only as worse, or, on the end focused was perhaps overly of a nurse the behaviour Consider result. what they knew presuming or midwife the was for patients best care under their and doing that, than rather interactively what was explaining best discovering and each on for focused patient. Being overly the end could result put on the a tension a nurse requiring of achievement, means entan to be of identity sense or midwife’s to good practice to good writes knowledge, professional our expand In our and patient process with procedure, gled expectation. For We continuously to must order in ever-questioning be We Questions – the key key – the Questions 56 FOCUS
from dealing with ‘stress and the physio- logical effects of stress on the body’. This can make identifying and intervening in codeine misuse/addiction difficult. People present with many common ailments, such as period pain, migraine, back pain and other mild to moderate pain concerns. This makes it hard for med- ical professionals to notice the signs of addiction or misuse. Add to this the many pharmacies in an area, making it easy to ‘pharmacy hop’. The behaviours the mis- user develops over time are especially adept at obtaining the substance, the more that tolerance develops. This means misuse often goes unnoticed, and makes it difficult to facilitate an early intervention. Causes of misuse Codeine – The easy availability of codeine is the main cause of misuse of the drug. Early introduction to codeine can be from man- aging symptoms of a hangover, minor the hidden aches and pains from sport or activity, and other such complaints that are normalised circumstances. Where prescription-only medications containing codeine are used, these prescriptions are often not fully con- addiction sumed for one reason or another. They are then left in the medicine cabinet ‘in case With the rising level of codeine dependencies someone needs one’. Family members and friends share these while confiding in in Ireland, it is important to understand each other about their ailments and con- the harmful effects this drug can have on a ditions. While naively meaning well, they cannot know how a person will be affected person’s health, writes Gerry Ryan by codeine. This is a similar naivety to how benzodiazepines were advertised as ‘moth- ADDICTION to codeine-containing med- used on an ad hoc or prescribed basis and er’s little helpers’ in the 1950s and 60s. ications, whether over the counter (OTC) in accordance with instructions, transition For the most part people who use or by prescription, is a problem in Ireland from use to misuse of codeine occurs at codeine-based medication use them prop- that manifests itself in all areas of society, the point when people begin to neglect erly and with the guidance and support of including among nurses and midwives. the directives set out with their doctor or a GP or pharmacist. However, addiction Codeine is a relatively mild analge- pharmacist. As with any other medication, to this substance is increasing with many sic used for pain relief in treating many addiction is defined as continued, compul- treatment services recording an increase in common ailments, however its potency sive abuse of a substance despite adverse OTC codeine use and dependence. cannot be underestimated. While far from consequences, which begin to mount. Addiction being as strong as morphine or its deriva- The who, how and why of codeine The stages of addiction include: tives, codeine is metabolised in the body in People use OTC codeine medications for experimentation, recreational use and the same way as morphine so it has a simi- many reasons. Guidelines have been intro- problematic use, through to physical and lar but milder opiate effect. duced in Ireland to help regulate usage psychological dependence. These stages Codeine is easily accessible. In Ireland of codeine and deal with addiction to are more difficult to spot with codeine it can be obtained without a prescription, codeine-based medications. These guide- addiction as the beginning of misuse may with most people being unaware of the lines regulate how OTC codeine products grow from a short-term prescription for an potential for addiction when starting to are sold by pharmacies. Those who develop injury or other common ailment. Pain relief use codeine. Neither are they aware of problems with codeine are often not the will always be needed so people will come the detrimental health effects and long- type we would consider typical drug mis- into contact with codeine. Understanding term damage it can cause to their organs. users. They hold down good jobs, many in codeine and how harmful it can be is vital. Many OTC preparations contain codeine, professions including healthcare, the legal People with a codeine addiction can for example Solpadeine and Nurofen Plus, world, the IT sector, teachers etc. They name a range of physical ailments to obtain as well as a wide range of prescription-only can have good family relationships and access to the drug. With new pharmacy Vol 24 No 6 July/August 2016 July/August No 6 24 Vol products such as Solpadol and Tylex. appear to be very ‘normal’. Many people codeine laws this is making it slightly more
WIN While these products can be legitimately have cited their codeine use developed difficult for people as they won’t want to be FOCUS 57
questioned by the pharmacist. However, may bring health issues for the user. Also Some people may need a detoxification I have known clients to drive to parts of any change in usage pattern (such as begin- drug to alleviate the symptoms; the use of Northern Ireland in order to access the drug, ning to use the drug intravenously, adding opioid substitution is rare but possible. A mainly because they could access packets other drugs or significantly increasing daily GP can support patients through the with- of 36 tablets there as opposed to the maxi- doses) brings with it more severe health drawal process. Ongoing rehabilitation in mum of 24 in the Republic of Ireland. implications. These may include exposure most cases is advisable, with many counsel- People can also stock up when abroad to hepatitis B or C, liver function problems, ling, self-help and other services available to as some other European countries are development of sleep apnoea, respiratory those wanting to remain abstinent. more lax with the sale of OTC codeine- disorders and effects on heart rhythm. Conclusion based medications. This ease of access Withdrawal Codeine has fast become a daily support only enables the addiction and tolerance of Withdrawal can be difficult to spot in for those living busy lives with high stress codeine to increase. It is often at this point the mild to moderate misuser, especially levels and also to those in isolation of of dependence that relatives and friends of when you don’t have a daily or weekly rela- some kind. What we do know is that most an individual begin to notice behavioural tionship with the individual. This makes misusers, if not all, initially use these med- changes, such as mood swings, loss of assessment difficult and is a key reason ications for relief from pain of some kind, appetite, loss of interest in positive activ- for pharmacist assessment with each but it fills a void and becomes a ‘friend’. ities, lack of organisation, confusion and individual who requests codeine. With- However, recovery is possible regardless flu-like symptoms. drawal symptoms and their severity vary of person, place or situation. Anyone can Tolerance builds quickly so people who from patient to patient and depend on the become addicted to codeine – the most use codeine would need to take more and level of usage. Symptoms include: mood important thing is to seek help. more to get the same effect. This leads the swings, restlessness, insomnia, depression, Gerry Ryan, project manager, Tolka River Project, individual to increase dosage to overcome runny nose, watery eyes, nausea, stomach Addiction Rehabilitation Centre, Mulhuddart, Dublin impending withdrawal symptoms. People cramps, vomiting, diarrhoea, aches, pains, Email: [email protected] Website: www.tolkariver.ie ; Tel: 01 640 5847 often state that they did not see the prob- loss of appetite and weight loss. lem becoming increasingly difficult to Treatment In addition to the Tolka River Project (details above), the manage as the entry point into codeine use Addiction to codeine can be treated. following organisations help those with an addiction: was via prescription or the use of a seem- Physical withdrawal can take up to seven • Rutland Centre, Addiction Treatment, Knocklyon, Dublin, Tel: 01 494 635 ingly innocuous OTC product. days, with individuals displaying a varying • National Drug Treatment Centre, Pearse Street, Dublin, As addiction develops, prolonged use degree of symptoms, from mild to severe. Tel: 01 648 8600 WIN Vol 24 No 6 July/August 2016 REVIEW 59 Helping your sick child In this second edition of When your child thinking and knowledge about an ailment. is sick – What you can do to help, Prof Alf The second part of the book discusses Nicholson and Grainne O’Malley reflect on what to expect of a child as he or she some of the changes in child health that grows. This starts with a Q&A section have taken place in the seven years since on ‘what’s normal’ in the newborn child. the first edition in 2009. This part of the book also discusses safety When the first edition was written, issues and the most common causes of and reviewed in this journal, Prof Nichol- accidents and how to prevent them, as well son expressed his concern about the as a chapter on dental growth and health. overcrowding in hospitals and parents The third part of the book discusses in bringing their children to the doctor more more detail what to look out for in the pre- frequently than ever, despite these children teen years, and parents may be surprised belonging to one of the healthiest genera- at how early children are exposed to drugs tions ever, thanks to vaccinations. and alcohol temptations. Prof Nicholson says the above is still The final part of the book discusses the case, but a major health concern that the value of natural therapies (and lack has received much attention since the thereof), what medicines to keep at home first edition is that of overweight and obe- and why vaccinating children is still so sity in children in Ireland. To reflect this, knowledge about these ailments, which, vital in order to avoid potentially lethal Prof Nicholson has made significant addi- according to Prof Nicholson, “crop up time illnesses. tions to the chapter on obesity, as well as and again” as the child progresses through This is a truly comprehensive guide for those on hyperactivity and allergies, which childhood and into adulthood. parents who want to be more knowledge- remain of big concern to many parents. Each one of the 20 ailments is described able about the most common childhood The aim of the book remains the same: in detail, includes a Q&A section, recom- ailments, and perhaps stick with ‘home to provide a clear and well-written over- mendations for home treatment, and a ‘red treatment’ as it is, most often, adequate. view of the 20 most common ailments in alert’ box which describes when a parent – Sonja Storm childhood, how to treat these at home and urgently needs to contact a doctor or hos- ‘When your child is sick – What you can do to help’, by Alf Nicholson and Grainne O’Malley, 2016 is published by when to call the doctor. pital. Each ailment also includes an ‘inside Gill Books, an imprint of MH Gill & Co, RRP €24.99 It also aims to provide parents with basic track’ box, which discusses the general ISBN 978-0-7171-6922-1 ! Crossword Competition 2 3 4 5 6 7 8 1 Across Down Solutions to June crossword: 9 1. Might this missionary saint snub a 1. Young horse (4) locum? (10) 2. Yesterday evening has a final Across: 10 11 6. Pack away (4) connotation (4,5) 1. How 3. Photocopier 8. Adonis 10 & 11. Therapeutic use of light to dispel 3. Wall painting (5) 9. Identify 10. Tiber 11. Rules the maternal retest (5,9) 4. Essential oil from flower petals (5) 13. Lapel 15. Re-elect 16. Agitate 12 13 14 15 12. Sporting fishermen (7) 5. Availed of (4) 20. Lagan 21. Raven 23. Bones 15. Chronometer (5) 7. Unit of heat, equivalent to 24. Coincide 25. Create 16 17 17. South American country (4) 100,000 BTU (5) 26. Desperadoes 27. Tot 18. In Greek mythology, the ship in which 8. As trundles beneath a float? (5,5) 18 19 20 Down Jason sailed (4) 9. Height and build (7) 1. Heart murmur 2. Woodbine 21 22 19. Get as far as (5) 13. Nervous, agitated (4) 21. Might the C.I.A. deny making poison 14. The plane is diverted by a dog (7) 3. Prior 4. Triceps 5. Owner 23 24 like this? (7) 16. American-style potato dish (4,6) 6. Icicle 7. Ray 12. Spreadsheet 13. Local 14. Log on 17. Abundant 25 23. Thumb a lift (5) 20. Consensus (9) 24. Soft French cheese (4) 21. Alms (7) 18. Egghead 19. Avoids 22. Niche 26 27 28 29 30 25 & 32d. This plant can be seen around 22. A minstrel poet turns up looking 23. Barks 24. Cod 31 32 the area, love (4,4) dull (4) 26. Cook a particular cereal in this utensil (5) 27. Ascend (5) 33 34 28. Large marine crustacean (7) 29. Peripheral kind of route (5) 33. Garment associated with snooker players (9) 30. Unemotional, uncomplaining type (5) 34. Overweight (5) 35. Weeps (4) 31. Perforation (4) The winner of the 35 36 36. One could possibly make a tractor eat 32. See 25 across June such colourful earthenware (10) crossword is: Jane Durkan, Name: The prize will go to the first all correct entry opened. Naas, Address: Closing date: Friday, August 19 Post your entry to: Crossword Competition, WIN, MedMedia Publications, Co Kildare 17 Adelaide Street, Dun Laoghaire, Co Dublin 60 UPDATE
PHNs recognised for outstanding care Five public health nurses were recognised recently for the exceptional care they pro- vide and their commitment to promoting public health nursing in the community at the recent AGM of the Institute of Com- munity Health Nursing (ICHN). The annual ICHN awards recognise nurses for their professional commitment to nursing in the community and for their work in the promotion and development of best practice and services for identified health needs of varying population groups. Clare Lewis, clinical care manager for the older people in Dublin North, was named the overall winner at the ICHN awards, in addition to being named regional winner for the east for her dedication to the Pictured at the ICHN Community Health Nursing Awards (l-r): Grainne O’Brien, clinical care manager, Cobh; patients in her local community and also Violet Hayes, director of public health nursing, West Cork; Johanna Downey, ICHN president; Marie Chambers, for the support and mentoring of com- public health nurse, Achill; Clare Lewis, clinical care manager, North Dublin; and Margaret Keogh, public health nurse, Longford/Westmeath munity nurses in dealing with older clients with complex care needs. The regional awards were presented to: Speaking at the ceremony, ICHN presi- A lifetime achievement award was pre- • Midlands – Margaret Keogh, PHN, Long- dent Johanna Downey said: “On behalf of sented to Violet Hayes, director of public ford Westmeath the ICHN and the public health nursing health nursing, West Cork, who was rec- • West – Marie Chambers, PHN, Achill service, we would like to congratulate all ognised for “always going that extra mile Island of our winners. Their initiative, motivation when dealing with the patients.” • South – Grainne O’Brien, Clinical Care and care given in the workplace is inspi- Ms Hayes was also recognised for the Manager, Cobh rational. Those awarded continually go huge support she has given to her staff at • East – Clare Lewis, clinical care manager for above and beyond in the care they provide both a professional and personal level. older persons, Dublin North, CHO Area 9. within their community.”
Good practices in Blood Bike volunteers help to relieve pain management pressure on local hospitals Active Citizenship Network is launching BLOOD Bike South, a charitable the first ‘EU Civic Prize on Chronic Pain – organisation run by a group of motorbike Collecting Good Practices’, which aims to enthusiasts, operating primarily in give evidence of existing good practices the southern region of Ireland, assists in European countries in terms of pain hospitals and other medical facilities management. by providing a voluntary motorcycle The prize will represent the recognition transport service of blood and other of ongoing excellence in the treatment and urgent medical materials on an out-of- management of chronic pain. hours basis. Healthcare workers who wish to enter Their services are provided by volun- should fill in a form (available at www. teers, who have advanced training and activecitizenship.net/bp/2016/form/ undergo regular reviews of their skills. new.php) in which they should detail Similar to existing blood bike groups their guide to best practice, including in Ireland and the UK, Blood Bike South Pictured (l-r): Volunteers Joe Curtin, Jim McAuliffe the development of good practice in pain acts as a voluntary rider service that helps and Pat Murphy of Blood Bike South management and obstacles which may relieve sickness and protect health by come in the way of good practice. The providing the transportation of blood, rising costs in transporting these goods closing date for submissions is August 31, blood products, patient records, drugs and hopes that this saved money will be 2016. and other medical requirements between redirected into primary care areas such See www.activecitizenship.net/ hospitals and blood transfusion banks, as staffing and facilities. It also aims to patients-rights/projects/204- primarily, but not exclusively in the relieve the use of emergency vehicles in european-civic-prize-on-chronic-pain- southern region. the transport of these items so that they Vol 24 No 6 July/August 2016 July/August No 6 24 Vol collecting-good-practices.html for more It aims to take some of the pressure are always available and ready to answer
WIN information. off local hospitals in relation to their emergency calls. UPDATE 63
Investing in nursing and midwifery A SERIES of recent meetings, held by the International Council of Nurses (ICN) in advance of the World Health Assembly, highlighted the need for governments to invest in nursing and midwifery in order to achieve universal health coverage and the sustainable development goals. Nursing regulators from 28 countries attended the ICN’s Credentialing and Regulators Forum, co-hosted by the International Confederation of Midwives The International Council of Nurses sent a delegation of 69 people to the 69th World Health Assembly (ICM), to discuss key topics including evidence-based regulation and creden- on the regulator and the employer to agreement – of the Investor State Dispute tialing; how regulation can advance ensure nurses and midwives are provided Settlement (ISDS) and want to see our the professions and protect the public; with the opportunity and resources, such government send a clear and unequivocal continuing professional development; as study leave and funding to maintain message that it should be removed. This and addressing the future of the nursing their CPD and lifelong learning.” proposal is an affront to democracy as and midwifery workforce in light of global The ICN and ICM also co-hosted the it allows investors to sue governments health mandates. sixth Triad meeting, the purpose of which in secret courts composed of corporate Elizabeth Adams, INMO director was to address issues of common interest lawyers, at which other people have no of professional development, was an and concern resulting in sharing of ideas representation, for compensation over invited speaker and presented to the and experiences and collaborative actions. national laws or rules that affect their global regulators on the comprehensive Speaking in relation to TTIP, Liam activities. Health and education services services provided by the INMO to support Doran, INMO general secretary, said: are already spread between public and nurses and midwives in maintaining their “Our attitude is in line with that of the private providers – often on a competitive continuing professional development and Irish Congress of Trade Unions in that basis. The risk is that TTIP could lock in lifelong learning. She stated that: “Funda- we are strongly opposed to the inclusion existing arrangements and leave States mental to ensuring quality and safe care in Transatlantic Trade and Investment and public service providers open to legal for every patient, there is a responsibility Partnership (TTIP) – or indeed any trade challenge via private tribunals.”
Registered Nurse in Intellectual Disability Section Conference
Date: Tuesday, November 1, 2016 Venue: Dublin
Topics will include, amongst others, the following:
• Federation of Voluntary Bodies • Assisted Decision Making (Capacity) Bill 2013 • Behaviours that challenge
‘RNID Nurses in the community’ sessions will include:
• Early intervention • Palliative care • Breast check • Dual diagnosis
For further information please contact INMO section development officer at email:[email protected] € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € FINANCE€ 65 € € € € € € € € € € € € € € € € € € € € € € € € € M € NEY € € € € € € Inheritance€ € € € tax:€ € € € € € € € € € € € € a€ practical€ € € guide€ € € € € € € € € € € € € € € € € € € € € € € € € € € MATTERS Ivan Ahern discusses how to protect your € € € € € beneficiaries€ € against€ inheritance€ tax € € € € € € € € € Ireland has one of the highest inher- itance taxes in the world. Changes in Table 1: Capital acquisitions tax group thresholds (after 14/10/15) inheritance tax rules commenced in 2009 but it is only now that people are start- Group Beneficiary Tax-free amount* ing to realise the impact this is having as A Son or daughter €280,000 property prices and asset values begin to recover. B A parent, brother, sister, niece, nephew or grandchild of the €30,150 person giving the gift The tax bill faced by beneficiaries can (In certain circumstances, a parent taking an inheritance from a be substantial, depending on three main child can qualify for group A threshold) factors: • The relationship between the deceased C All other relationships, other than those mentioned in A or B €15,075 and the beneficiary (this determines the *CAT only applies to amounts over the relevant group threshold (Source: www.revenue.ie) maximum tax-free threshold that applies, eg. the group threshold) Table 2: Example of how inheritance tax works • The net/taxable value of the inheritance • Any previous gifts or inheritance received. Net/taxable value of inheritance €700,000 What many people don’t realise is Number and type of beneficiaries: Two (son and daughter) payment of this tax bill needs to be paid soon after the inheritance. The onus is on Breakdown of inheritance due Jamie Deirdre the beneficiary to pay it and complete a Gross inheritance to each beneficiary €400,000 €300,000 full tax return. If you do not plan ahead, your family could lose part of their inher- Less tax-free amount (threshold for €280,000 €280,000 itance or be faced with a difficult decision relationship: child, eg. Group A) between having to sell part of the inher- Gross taxable inheritance per child €120,000 €20,000 itance, or borrow the money to pay the tax Less personal capital gains tax exemption €1,270 €1,270 bill. If your family is likely to have to pay Net taxable inheritance per child €118,730 €18,730 inheritance tax when you die, it may be Tax payable at 33% per child €39,181 €6,181 a good idea to protect them against this beforehand. Overall inheritance tax due €45,362 What are the thresholds and capital acquisitions tax rate? tax liability that arises on the benefits euro in tax by encouraging them to move Inheritances can be received tax-free inherited from your estate and the pro- into any second homes or investment from capital acquisitions tax up to a cer- ceeds of this are exempt from inheritance properties you intend to leave to them. tain amount. The tax-free amount varies tax. This policy is relatively straightfor- It is important to note that different depending on your relationship to the ward to set up, however it is subject to guidelines apply for those passing on a person giving the gift (group threshold). medical underwriting and therefore the business or farm to a child, for which one There are three different groups. Each earlier this is done, the better should seek professional advice. WIN group has a threshold that applies to the • Gifting a maximum of €3,000 per person Ivan Ahern is a director of Cornmarket Group Financial total value of the inheritances you have annually: Your beneficiaries can each Services Ltd. Vol 24 No 6 July/August 2016 received in that group. The current rate of get gifts of up to €3,000 a year from capital acquisition tax is 33% (see Table 1). you without paying tax. This exemp- For more information on Cornmarket’s Inheritance What are your options to protect your tion, which is known as the small gift Planning Service, Tel: 408 6275 family against inheritance tax? exemption, is useful if you can afford to Cornmarket Group Financial Services Ltd. is regulated The tax liability for beneficiaries can be drip-feed your inheritance while you are by the Central Bank of Ireland. Cornmarket is part of the Great-West Lifeco group of companies, one of the avoided in a number of ways: still alive world’s leading life assurance organisations. Telephone • Affecting a ‘Section 72 life assurance • Gifting the family home to a child: You calls may be recorded for quality control and training policy’: This funds the capital acquisitions could save your children thousands of purposes 66 DIARY
conference. Castletroy Park Hotel, July Limerick. Contact jean.carroll@ inmo.ie for further details Library Opening Hours Thursday 14 Assistant Directors of Nursing/ Midwifery/Public Health Nursing/ October July/August Night superintendents Section Saturday 8 Monday-Thursday: For further information on the library meeting. INMO HQ. 11am. Contact ODN Section meeting. 11.30am. 8.30am-5pm and its services, please contact: [email protected] or Tel: Cavan General Hospital. Contact Friday: 01 6640648 for further details [email protected] or Tel: Tel: 01-6640-625/614 8.30am-4.30pm Wednesday 27 01 6640648 for further details Fax: 01-01 661 0466 Email: [email protected] Clinical Placement Co-ordinators Thursday 13 Section meeting. INMO HQ. 11am. All Ireland Annual Midwifery Contact [email protected] or Conference. Crowne Plaza Hotel, Tel: 01 6640648 for further details Dublin. Contact [email protected] or Tel: 01 6640648 for further details September INMO Membership Fees 2016 Tuesday 6 Reunion Care of the Older Person Section A Registered nurse €299 meeting INMO HQ. 11am. Session v A class reunion for nurses (Including temporary nurses in prolonged employment) on pensions. Denis Brophy, who trained at the Limerick B Short-time/Relief €228 financial consultant. Contact jean. University Hospital between [email protected] or Tel: 01 6640648 February 1976 and May 1979 This fee applies only to nurses who provide very short for further details is being held on Saturday, term relief duties (ie. holiday or sick duty relief) Wednesday 7 October 15, 2016 at Bunratty C Private nursing homes €228 Castle Hotel. Overnight stay RNID Section meeting. 11am. INMO D Affiliate members €116 HQ. Contact [email protected] or with dinner. Contact Eilish Tel: 01 6640648 for further details Fitzgerald (née O’Doherty) Working (employed in universities & IT institutes) at Tel: 0868423301 or email E Associate members €75 Saturday 10 [email protected] Midwives Section meeting. 2pm. Not working Limerick Regional Maternity F Retired associate members €25 Hospital. Contact jean.carroll@ Conference G Student nurse members No Fee inmo.ie or Tel: 01 6640648 for further details v A special one-day conference on maternal morbidities will take Saturday 10 place on Tuesday, November Congress CNM/CMM Section meeting. 8, 2016. The conference INMO HQ. 11am. Contact jean. v The 7th Congress on Women’s Mental Health will take place from March theme is ‘Minding Mothers [email protected] for Tel: 01 6640648 6 to March 9, 2017 in the RDS, Dublin and will coincide with International with Morbidities’. For more for further details Women’s Day on March 8. For further information see www.iawmh2017. information see org/wp/ or contact Jacqueline Healy at email: [email protected] Thursday 15 www.trinityhirc.com Emergency Department Nurses’ Section meeting. INMO HQ. 11.30am. Contact jean.carroll@ Training programme Condolences inmo.ie or Tel: 01 6640648 for further details v One-day ear irrigation v The INMO would like to extend its sincere condolences to Assunta Mc- Carthy (CUMH) and Lar McCarthy (Brothers of Charity) on the recent Tuesday 20 training programmes with death of their mother Anna McCarthy. RIP Retired Nurses/Midwives Section Category 1 NMBI approval meeting. INMO HQ. 11am. Contact and four continuing education v INMO president, Martina Harkin-Kelly, Executive Council, members [email protected] or Tel: units will be held on and staff of the INMO would like to extend their sincere condolences 01 6640648 for further details September 22 and November to Executive Council member Catherine Sheridan on the death of her 17, 2016 in the Education and father, Paraic Corbett. May he rest in peace Saturday 24 Conference Centre, Royal School Nurses Section meeting. v INMO staff and colleagues would like to extend sincere sympathy to Victoria Eye and Ear Hospital, Jean Carroll on the death of her beloved father Milo Carroll. RIP INMO HQ. 10.30am. Contact jean. Adelaide Road, Dublin 2. v [email protected] or Tel: 01 6640648 For further details contact Sincere sympathy, from all her INMO colleagues, to Jude Maher on the for further details Sabrina Kelly, nurse tutor at loss of her beautiful baby girl Pearl Patricia. May she rest in peace Wednesday 28 Tel: 01 6644652 or email: v The INMO would like to extend its deepest sympathy to Mary Connor Telephone Triage Section annual [email protected] and her family on the recent passing of her father Thomas Connor. RIP
• Annual leave Know your rights and entitlements • Sick leave • Maternity leave The INMO Information Office offers same-day responses to all questions • Parental leave • Pregnancy-related Contact Information Officers Catherine Hopkins and Karen McCann at sick leave Tel: 01 664 0610/19 • Pay and pensions • Flexible working Email: [email protected], [email protected] • Public holidays Mon to Thur 8.30am-5pm; Fri 8.30am-4.30pm • Career breaks • Injury at work • Agency workers • Incremental credit