€5.75 Vol 22 No 10 December 2014 / January 2015
Latest course information from Journal of the Irish Nurses and the INMO PDC Midwives Organisation See centre pages
World of Irish Nursing & Midwifery
Campaign against NMBI fee hike intensifies page 7
Overcrowding reaches crisis point page 10
INMO’s Dean Flanagan heads up ENSA page 46
Festive money saving tips page 71
Solidarity in the new year Nurses and midwives reject NMBI fee increase CONTENTS 3
News & views 46 interview Alison Moore speaks to Dean Flanagan 5 Editorial about his new role as president of ENSA Now more than ever, after five years of austerity, nurses and midwives must 51 Media Watch remain united. This is our challenge and Ann Keating reviews INMO activities we are equal to it, writes INMO general reported in the news secretary Liam Doran 55 Midwifery focus 6 News Mary Higgins reports on the recent EMA More than 2,000 nurses and midwives AGM held in Estonia demonstrate against NMBI fee increase... Campaign against fee hike 57 Life story intensifies… Taskforce on nurse staffing A life of love, learning and travelling. Ann completes first phase... INMO issues Keating met with Patricia Marteinsson new mission statement... Hospital who shared her story overcrowding now at crisis point... Update 8 Report from INMO SDC in Croke Park... 65 Round-up of Irish and international news Beaumont ED staff at breaking point... items Unsafe ratios highlighted in St Patrick’s in Waterford... Flawed management structures in HSE revealed... HSE service plan fails to address critical Clinical issues... Shift work hits brain function... 59 Clinical focus Water charges – the straw that broke Clare Shields and Declan Lyons discuss the camel’s back? Courting media Merry Christmas the management of treatment-resistant attention at hearings is beyond remit of depression NMBI... Message of solidarity to Ebola and happy new carers... Severe overcrowding in Naas 61 Cardiology sparks protest... Drogheda ED action A team from Trinity College Dublin year to members suspended pending talks describes the protocol involved in Plus: Section news, page 25 the assessment of elderly patients for transcatheter aortic valve implant from all at the 30 international news The INMO hosted three major European meetings in Dublin recently. Elizabeth Living INMO Adams reports 69 Book review Niall Hunter reviews the biography 49 From the President Ada English Patriot and Psychiatrist by INMO president Claire Mahon rounds Brendan Kelly up news from the Executive Council and Plus: Monthly crossword competition beyond
52 student news 71 Finance Dean Flanagan updates readers on Ivan Ahern has some tips on how to save news and events for students and new money over the Christmas period and graduates into the new year
Features Jobs & Training 33 Legal focus Edward Mathews outlines how the 37 Professional Development Criminal Justice Act 2012 will affect the Eight-page pull-out section from the practice of nurses and midwives INMO PDC 27 Questions and answers 72 Diary Bulletin board for industrial relations Listing of meetings and events nationally 46 queries and internationally 29 Quality and safety 73 recruitment & Training This month Maureen Flynn discusses the L atest jobs and training opportunities in WIN value of patient and family-centred care Ireland and overseas Vol 22 No 10 Dec 2014/Jan 2015
WIN – World of Irish Nursing & Midwifery is distributed by controlled circulation to over 36,000 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 Just what will the new Journal of the Irish Nurses and Midwives Organisation World of Irish Nursing & Midwifery year bring us? As we approach the end of 2014, the fifth (ISSN: 2009-4264) consecutive year of austerity, contraction Volume 22 Number 10 and cutbacks, we are entitled to wonder December 2014 / January 2015 what 2015 will bring for us, as nurses, mid- WIN, wives, public servants and citizens. MedMedia Publications, If we begin by attempting to be posi- 17 Adelaide Street, tive, 2015 promises a stabilisation of the Dun Laoghaire, Co Dublin. health budget (at a very low level), a slight Website: www.medmedia.ie reduction in taxation leading to a marginal increase in take-home pay, and the prob- ability of discussions, with government, in our demand for restoration of pay cuts be restored and additional staff to be and reduced working hours. However, recruited is required. any positive feelings must be tempered The challenge, which I believe has been by the likelihood that any proposals from underestimated by policy makers and the Editor Alison Moore Email: [email protected] government or public service manage- HSE, is where we will find the additional Tel: 01 2710216 ment will be marginal and inadequate. nurses/midwives required to restore safe Production editor & news Tara Horan A further positive in the 2015 Service staffing levels right across our services. Plan is the effective lifting of the recruit- There has been a complete underestima- Sub-editor Sharon Murphy ment moratorium and the commitment to tion of the brain drain within nursing and Designers Fiona Donohoe, Paula Quigley increase the number of nurses/midwives midwifery. It will not be possible to sim- Advertising manager Leon Ellison in 2015. This, however belated, is very ply reverse this in the short-term. Email: [email protected] welcome, particularly as we face compe- The new year will also see the Taskforce Tel: 01 2710218 tition from the NHS, which is seeking to on Nurse Staffing and Skill Mix, established Publisher Geraldine Meagan recruit 12,000 nurses immediately. last September, issue its first report to the WIN – World of Irish Nursing & Midwifery If we look at the negatives – and this Minister. This report has the potential is published in conjunction with the is undoubtedly dominating households to bring forward evidence that supports Irish Nurses and Midwives Organisation by – 2015 also promises further attacks on a level of minimum staffing required to MedMedia Group, Specialists in Healthcare living standards. If we look outside the optimise patient care in an environment Publishing & Design. health service, we will have new water conducive to best nursing practice. The charges, the possibility that the local implementation of this report will be a property tax will increase as house val- key measure of the Minister’s recognition ues rise, and probable increases in utility that the current nursing workforce is not charges. These will erode any increase in optimal and care is being compromised. take-home pay resulting from a marginal A separate report, on midwifery staffing, reduction in taxation. is also due in 2015. This must also lead to In relation to the health service budget additional midwives being employed, in and service plan for 2015, these offer, order to meet the Birthrate Plus standard. Editor-in-chief: Liam Doran at best, the continuation of service at While nurses/midwives are overworked INMO editorial board: 2014 levels. As we all know, this has and demoralised, now more than ever, we Claire Mahon; Geraldine Talty; David O’Brien; been wholly inadequate and has resulted must remain united and solid. This will Moira Craig; Theresa Dixon; Martina Harkin-Kelly; in a severe increase in overcrowding, ensure that we can extract, from 2015, Eileen Kelly; Martin McCullough; waiting times and contractions of com- every single resource possible, both as cit- Catherine Sheridan; Mary Leahy munity-based services. The latest trolley izens and health professionals, to improve INMO journal co-ordinator: Ann Keating watch figures, for November, covered on our lives at home and at work. This is our
Email: [email protected] page 10, make for stark reading for those challenge and I believe we are equal to it. WIN INMO photographer: Lisa Moyles who formulate and implement policy On behalf of the president, Executive for our health service. The increase in Council and staff can I take this opportu- Vol 22 No 10 Dec 2014/Jan 2015 INMO correspondence to: overcrowding, resulting in over 7,000 nity to wish each and every member, and Irish Nurses and Midwives Organisation, admitted patients being left on trolleys your loved ones, a happy and peaceful Whitworth Building, North Brunswick Street, in November, cannot be ignored and can- Christmas and may good health follow Dublin 7. not be corrected by high level reviews, you throughout 2015. Tel: 01 664 0600 strategies or working groups. A signifi- Fax: 01 661 0466 cant increase in funding, sustained over Email: [email protected] an extended period, that allows closed Liam Doran Website: www.inmo.ie beds to be open, community services to General Secretary, INMO 6 NEWS
Protest outside NMBI head office: INMO make their voices heard about the Board’s unjustified hike in the retention fee Unions protest at NMBI fee increase More than 2,000 nurses and midwives voice their outright opposition
The INMO, SIPTU and the is saying it must seek this tion fee of €100, which is the INMO general secretary PNA, on behalf of all of nurses increase despite the fact that: same retention fee levied on Liam Doran said: “This pro- and midwives, held a pub- • Nurses and midwives have all allied health professionals test gave nurses and midwives lic protest outside the head suffered at a minimum a • The need for a regulatory the opportunity to directly offices of the Nursing and Mid- reduction in salary of over body that protects the pub- demonstrate their disagree- wifery Board of Ireland (NMBI) 14% in the past four years lic by ensuring that nurses ment with this fee increase to last month. • Inflation is running at less and midwives can practise in the NMBI.” This was the latest step than 1%. an environment conducive The INMO had previously in the nationwide campaign The reaction to this to the highest quality care called on its members to cancel of opposition mounted by attempt to increase the reten- through safe practice direct debits for the payment of the three unions, against the tion fee has confirmed to the • That all expenditure by the the registration fee. NMBI’s decision to increase its three unions that the NMBI statutory regulatory body is Ahead of the protest, at a retention fee for 2015 by 50% does not currently have the subject to openness and full meeting of the Health Service to €150. support and confidence of transparency with tighter Oversight Body, the INMO and This increase means that the the professions it was estab- controls of public relations other health service unions Board is seeking an increase lished to regulate. In fact the and legal costs met raised the contentious of almost 80% in two years view of the vast majority of • Their collective commit- issue of the NMBI notifying from all registered nurses and nurses and midwives is that ment to agreeing a long term its intention to raise the regis- midwives. the Board charges them an funding model for NMBI, tration fee from €100 (current The protest saw over 2,000 annual registration fee only to which ensures the costs of rate) to €150 next year. nurses and midwives from fund the legal costs in fitness regulation is properly shared At the meeting, Mr Doran, all over the country turn up to practise hearings. between the professions, ser- emphasised the difficulties outside NMBI head office in Despite the past five years of vice providers and the Board facing nurses and midwives Blackrock, Co Dublin to con- cutbacks, loss of nursing and in the interests of the general already subjected to pay cuts firm their outright opposition midwifery posts and under- public. and increased hours while to this totally inexplicable, funding of the health system, The aim of the protest at remaining fully compliant unjustified and indefensible the NMBI has remained silent NMBI head office was to pub- with all the provisions of the increase in fees being sought about the impact of such cuts licly display the disquiet of Haddington Road Agreement. by the regulatory body. on the ability of nurses and nurses and midwives about He also stressed the unfair- The registration fee for all midwives to practise safely in the decision of the registration ness of placing this additional other health professionals is the interests of patients. body to increase the retention cost on nurses and midwives, remaining at €100, until at In mounting this campaign fee without any consultation while they continue to work least January 2017. However of opposition, the three unions or consideration of the finan- in overcrowded and under- Vol 22 No 10 Dec 2014/Jan 2015 Vol the NMBI, due to its failure to have consistently reaffirmed: cial hardship faced by working staffed circumstances on a
WIN control legal and other costs, • Their support for a reten- nurses and midwives. daily basis. WIN Vol 22 No 10 Dec 2014/Jan 2015 ------7 NEWS wards, maintain maintain wards, for for nurses. es are treated equitably equitably es treated are . . fully supports a strong supports a strong fully by other health profes health other by ses and midwives have have ses and midwives report early in the new year, early in the report new year, “Stay solid with the cam that mem “It is imperative on mid working group The This campaign is not only This campaign is not only “From a member’s view point a member’s “From eeds of nurses and midwives midwives and nurses of eeds paign, pay €100 – the same fee fee the same paign, pay €100 – paid in surgical beginning bers, and medical expected staffing is also wifery to laid standards the by informed Plus. Birthrate by down in clinical practice and it must must it and practice clinical in be open more and transparent particularly costs, its about relations. public and legal said. he regulator,” our by a close watching brief on the and, in Taskforce the of work the participate in particular, second of consultation phase February”. late in beginning regulatory body which pro body regulatory tects the public ensuring by nur to prac adequate resources the highest and at tise safely quality to join. campaign is simple this the advice given follow Simply after €100 the pay and here the This ensure will January 5. its position to review NMBI has as the health service cannot without function registered midwives. and nurses for about the fee retention also is “It Doran. Mr said 2015, the that ensuring about NMBI does not think it can the raise The Board must year. every fee sup also show much greater the and of, awareness for, port n and nurses ensure and sionals, midwiv levels to optimise levels patient out within a manageable comes workload as no one enjoys a dispute as no one enjoys a dispute and mid between nurses The regulator. our and wives INMO - - - -
al secretary al secretary ealth, is absolutely absolutely is ealth, , is very regrettable regrettable very is , H s objective from this this from objective s d considera for meeting INMO gener INMO general secretary, secretary, INMO general eady done so should done so should eady ter may be put before the next the next ter may be put before Boar critical to in our efforts stabi lise the nursing The workforce. INMO’ bring would that it is Taskforce recommendations forward consistent, which will ensure adequate staffing and stable Liam Doran said: “This cam said: “ThisLiam Doran tion in March/April. March/April. in tion paign, although absolutely necessary and Taskforce member, Liam Liam member, Taskforce and Taskforce, said: “ThisDoran which will the to report Min for ister commence a second phase of of commence a second phase across meetings, consultative / in late February country, the the of early March year. new - - e asked to make no payment before January January no payment before to make e asked the new year badges will be distributed to all all to distributed will be badges year new the nationwide workplace social media event will take social media event will take workplace nationwide he matter will also be raised at the next meeting of the next at the will also be raised he matter place on Wednesday, December 17, as part of this of as part this December 17, Wednesday, place on ofDetails in involvement workplace individual campaign. by the INMO and the directly this event will be circulated other unions to local representatives display that workplaces to allow members to publicly NMBI. the to €100 paid have and registered have they a show through will allow members to collectively, This in their participation publicly indicate of mutual solidarity, they have made this €100 the campaign and the fact that payment is Oversight Body which Service Haddington Road Health context the in is This 19. December Friday, for scheduled providing clearly Agreement of the Haddington Road fee of the for €100 regulation professionals health a for ofduration the agreement a make should members 5, January After 2015. 5, payment of fee) to NMBI by cheque, €100 (existing to the NMBI bank transfer credit or a direct postal order for NMBI bank details) account (contact the INMO In T Members who have not alr Members who have the with have they debit direct any cancel immediately NMBI for office contact any INMO NMBI (if required, bank details) Members ar A aving formulated draft draft aving formulated first week first of February. • • • • • As we were going to press to going As we were press A further 28 days is then further A 28 days is then H Updated union advice in campaign of union advice Updated to opposition fee increase retention NMBI proposed its first newsletter detailing first its newsletter detailing to issue its activities. It plans until it newsletters monthly which is final report, issues its 2015. May in expected was the Taskforce continuing to two weeks to meet every on which factors finalise the on ranges/ratios staffing any can wards medical and surgical critical phase This is a be built. work willand Taskforce’s the of February. into continue allowed for payment after payment after for allowed the mat which, if necessary, findings, the Taskforce will will findings, Taskforce the ond reminder goes out around out around goes ond reminder the renewal notice issues and, if notice issues and, if renewal a sec received, payment is not ------the INMO and and INMO the
consultation phase in consultation phase in
Taskforce to inform its its inform to Taskforce
alth and the INMO and and INMO the and alth The Taskforce has issued has issued Taskforce The At the same time, contact the At same time, contact The last meeting in the first first the in meeting last The In giving this advice the In this giving advice the every applied The process, Therefore, the call to all the call to all Therefore, Further to the very well well very Further to the e st month. The feedback from from feedback The st month. y the Minister and announced y ll advice given, pay the €100 €100 the pay given, advice ll he time of of time he this to going press, future deliberations. deliberations. future was continuing between the was continuing between the the NMBI, of Department Table the Table in out as set is advice opposite. the seven consultative meet consultative the seven
at the INMO annual confer completed has May, last ence its initial hospitals country. the across phase of the consultation pro Tullamore in place took cess la by collated being now is ings the Taskforce on nurse staffing completes first phase on nurse staffing Taskforce after January 5 or when your January after 5 or when your allow and circumstances the NMBI to force thereby decision. flawed this reverse that all members INMO remind the NMBI has acknowledged fee the annual retention that full paid in to be not have does January by 1. initial an that is NMBI, by year members full members is for participa tion follow in the campaign, a H other unions but no progress made. been yet had supported protest held on on held supported protest November 18 outside the offices, NMBI campaign of opposition of opposition The campaign 50% increase the proposed to the fee by in the retention NMBI continues and, at the time of going to further press, steps were finalised. being Campaign against fee hike intensifies fee hike against Campaign At members. to advice ther t Taskforce on The Taskforce Nurse Staff established Skill Mix, ing and b the other two unions involved the other two unions involved in the campaign, fur issued 8 NEWS
INMO special delegate conference 2014: Opportunity to debate key issues between annual conferences Delegates updated on current issues Over 200 key activists attend INMO special delegate conference
The INMO held a very success- ful special delegate conference, attended by more than 200 delegates in Croke Park, Dublin last month. The following is a brief sum- mary of the issues discussed. New statement of our mission, vision and values After detailed debate the conference adopted, by major- ity vote, a new Statement of Delegates vote on key issues our mission, vision and values for the organisation. plus one-sixth premium and social policy Edward Membership recruitment This statement (see opposite between 6pm and 8pm Mathews (see page 16). The conference also saw the page) will now form the intro- • Update on other public ser- The Organisation will be launch of a new recruitment duction to the Organisation’s vice wide issues, including the holding a number of 30-min- campaign, which will run until rule book. It summarises the new sick pay scheme. ute lunchtime workshops in December 31, which will see: goals and intent behind all of The conference also agreed, workplaces to advise members • Each new member recruited the Organisation’s activities. again after debate, that all of the revised approach in the will be entered in a draw for This statement will be sub- branches and sections will new Act to this critical issue. €300 ject to ongoing review and can be asked at the forthcoming The Richmond Education • Each existing member who be further examined at future annual delegate conference Centre and PDC update recruits a new member will delegate conferences. to examine the priorities, for Elizabeth Adams, INMO be entered for a separate Haddington Road Agreement INMO members, ahead of any director of professional devel- draw also for €300. Phil Ní Sheaghdha, INMO talks, with the government, opment, updated delegates Special application forms director of industrial relations, on a post-Haddington Road on the ongoing development in relation to this recruitment updated delegates on all issues scenario. of the Richmond as the INMO drive can be obtained from arising from the implementa- Nursing and Midwifery Education and Event Centre, IROs, through local INMO tion of the Haddington Road Board of Ireland (NMBI) and the significant increase offices or from INMO HQ in Agreement. She covered: The conference unani- in programmes and activities, Dublin. • The ongoing implementation mously endorsed the ongoing within the Organisation’s pro- Delegates raised a number of the overall agreement campaign of opposition to fessional development centre. of questions and points under • Nurse/midwife specific issues the proposed 50% increase in Ebola each agenda item. Many of including: retention fee by the NMBI (see The conference unanimously these were addressed in the – the reintroduction of the pages 5-6). adopted a statement of sup- question and answer sessions. senior staff nurse/midwife The conference also con- port and solidarity, for all Any outstanding issues will be salary (5% increase for sidered all issues arising frontline healthcare workers, further responded to directly those with 20 years service) from the commencement currently involved in providing to delegates in relation to local – Regularisation of long of public hearings under care to those who are suffering issues raised. term actors into the higher the Fitness to Practise pro- from the Ebola virus anywhere Overall the conference was post cedures and a detailed in the world. This statement is a very worthwhile gathering Vol 22 No 10 Dec 2014/Jan 2015 Vol – Task transfer exercise presentation, was made by available on the INMO website between annual conferences
WIN required to restore the time INMO director of regulation (www.inmo.ie). for key activists. Irish Nurses and Midwives Organisation The Professional Trade Union for Nurses and Midwives Statement of our Mission, Vision and Values
Our Mission Industrial The INMO – the professional trade union for nurses • To protect each member in every workplace by the and midwives – will promote and defend the industrial, presence of an active, responsive and dynamic workplace professional, social, political and democratic values and infrastructure. interests of members in the workplace and wider society. • To facilitate, coordinate and maintain this empowerment of members by achieving pay and career structures which reflect Our Vision the responsibilities and accountability carried by nurses and The Irish Nurses and Midwives Organisation (INMO) – the midwives as professionals. professional trade union for nurses and midwives – seeks: • To provide effective industrial leadership and representation • To provide a unified and assertive single voice for members at local/national level. to work collectively to achieve excellent pay and conditions • To achieve, maintain and protect positive working conditions appropriate for regulated professionals and manageable workloads. • To further develop and maintain a strong, vibrant and • To work towards achieving positive workplace environments dynamic presence in every workplace and to achieve security, for all workers in the interests of a fair and just society. fairness, equality and opportunity for our members • To advance our collective vision of a health system that Professional supports and respects the efforts of nurses and midwives in • To promote and provide services to facilitate members providing high quality care to all – based on healthcare needs achieve their professional and educational goals/objectives. - through a role that is recognised, valued and rewarded, as an • To provide leadership in the development and advancement equal partner, within a social model of health of nursing and midwifery through best practice, education, • To promote the overall health and wellbeing of nurses and policies and standards. midwives and to seek a future for their families and communities • To provide effective and influential representation on that is secure and economically and socially equitable. all educational/professional matters and to provide programmes/courses relevant to the needs of members. Our Values • To support the regulation and practice of nursing and The INMO commits to the following values: midwifery through a regulatory body that recognises, respects and supports nurses/midwives in their clinical practice. Union Values Professional Values • To provide effective representation, to members, with regard to all Fitness to Practise issues. • Collectivism • Caring
• Equality • Professionalism Social • To facilitate positive, and sustainable, social change through • Fairness • Advocacy action, education and policy development. • Opportunity • Excellence • To influence and contribute to health, disability and aged care • Sustainability • Compassion policy at all levels. • To influence and contribute to the development and • Respect • Respect implementation of positive and sustainable social policies, • Communication • Communication both domestically and internationally.
Political These values to be achieved through the following actions: • To ensure that nurses and midwives, as appropriate, are represented on all local, regional and national working groups, Organisational taskforces and other fora. • To achieve organisational growth, influence and power • To maximise the influence of the INMO in all political through the provision of quality assured services and supports processes at local, regional, national and international level to for members. achieve our mission. 10 NEWS
Overcrowding now at crisis point INMO calls for ED overcrowding to be declared a national emergency
The INMO has called on the INMO trolley/ward watch November 2013-2014 – 10 largest increases nationwide Department of Health and the HSE to declare the soar- ing levels of overcrowding in emergency departments (EDs) throughout the country a national emergency requiring an immediate, sustained and extensive response. The INMO trolley/ward November November Hospital % increase watch figures for November 2013 2014 this year compared to previous Mayo General Hospital 18 198 1,000% years show: • A 44% increase in trolley Sligo Regional Hospital 32 223 597% numbers this year compared Portiuncula Hospital 21 121 476% to November 2013, with a total of 7,124 admitted Wexford General Hospital 39 197 405% patients on trolleys through- Midland Regional Hospital, Tullamore 65 272 318% out the country St Vincent’s Hospital, Dublin 63 250 297% • The level of overcrowding is significantly worse (53%) St James’s Hospital, Dublin 62 231 273% than 2006 when the situa- Kerry General Hospital 36 128 256% tion was declared a national emergency. Naas General Hospital 104 315 203% The figures show that in Our Lady’s of Lourdes Hospital, Drogheda 248 584 135% November 2014, there were significant increases in every September, 19% in August and a monthly basis to agree “This must now be declared ED in the Eastern area, with 8% in July 2014 as compared strategies, to be used locally, a national emergency. It must the starkest jumps recorded to the same months in 2013. regionally and nationally, to see additional funding being in St Vincent’s University Hos- The INMO contends that ED address the problem with allocated above and beyond pital – up 297%, St James’s overcrowding has now become absolute urgency. anything being spoken of in Hospital – up 273% and Naas a national emergency that INMO general secretary the HSE Service Plan, so that General Hospital – up 203%. requires a sustained, exten- Liam Doran said: “The over- closed beds can be opened, Beaumont Hospital had the sive and nationwide response crowding of our country’s community supports increased single largest number of immediately. This must involve EDs is now, undoubtedly, a and the additional staff patients on trolleys during the allocation of resources, national emergency and must required to maintain patient November, recording a shock- in addition to the €25 million be viewed as a crisis. We must care, dignity and privacy can ing 729 patients on trolleys referred to in the HSE’s Service stop pretending that patients be deployed without delay.” – the highest number in the Plan for 2015. can be properly looked after, in Mr Doran acknowledged past decade at least. The Organisation said that departments that have 10, 20, that the country was facing The situation in the rest this blight on the health ser- 30 and 40 people on trolleys, many challenges, not least the of the country also saw sig- vice – which results in patient in addition to their normal plight of the homeless high- nificant increases in the care being compromised, workload. We must also recog- lighted recently. “However, we number of trolleys, including patients losing dignity and nise that patients suffer a loss cannot ignore the compromis- in Drogheda, Limerick, Galway, staff being overworked – can of dignity and privacy, which ing of care that accompanies Wexford, Mullingar, Tullamore, be tackled at its source, which should not be acceptable in every patient who, following Sligo, Mayo, Portiuncula and is the lack of bed and commu- any place at any time. admission, is left on a trolley Kerry (see Table). nity capacity. “The Department of Health or chair in EDs all over this These figures confirm that The INMO is also calling and the HSE must acknowl- country. Reviews, words and for the fifth month in a row, on the Minister for Health to edge that staffing levels in plans are not enough. Firm, the crisis has been deepening, re-establish the National ED these overcrowded EDs and decisive and sustained action, even ahead of the peak win- Forum, which was replaced wards is now unacceptably in the form of additional bed ter period. The 44% increase by the Special Delivery Unit. low, dangerous and contrary to capacity, staffing and com- Vol 22 No 10 Dec 2014/Jan 2015 Vol in November follows a 34% The ED Forum would allow the best possible outcomes for munity supports must be
WIN increase in October, 32% in all stakeholders to meet on patients. allocated immediately.” 12 NEWS
‘Flawed’ management structures in HSE revealed
INMO calls for urgent review of senior management layers
The latest figures on HSE increasing layers of ‘super’ sen- health system but do nothing increased, times for outpatients’ staffing confirm the funda- ior management structures, to improve, and in fact delay, appointments have increased mentally flawed policy that while potentially reducing decision making, must be and the number of day care pro- has underpinned workforce the number of frontline nurse reversed. The current HSE pol- cedures has decreased. This is a planning in the health service managers, is just the latest icy, which overtly attempts to direct result of cutting frontline for the last five years, accord- example of the abject failure reduce the number of frontline services. Therefore these addi- ing to the INMO. of workforce policies, in recent nurse managers, while increas- tional senior managers have not Confirmation that the years to protect frontline ser- ing the number of general resulted in improved services for number of senior managers vices,” said INMO general managers, must be challenged patients”. increased by 10% in the same secretary Liam Doran. by the Department of Health Mr Doran concluded: “The period that the number of In calling for this review, in this review and reversed. Department of Health must frontline staff, including nurses, the INMO fully supports the “These figures will only immediately review the cur- reduced by 3% only confirms need for frontline admin- serve to further undermine rent approach of the HSE to the increasing bureaucracy istrative staff in such areas the morale of frontline staff, organisational reform, which is within the Irish health system. as emergency departments, including nurses and midwives. blatantly designed to increase This increased bureaucracy has medical records, pay and pen- While they have been repeat- the number of senior manag- left frontline services under- sions, outpatients and wards. edly told in recent years that ers. The Department must insist manned, under-resourced and These frontline staff are abso- they must do more with less, that frontline posts are restored, overstretched. lutely essential to ensuring it is now proven that senior management structures are “This flawed policy, which that nurses and midwives managers, are doing less with reduced and frontline profes- sees senior management con- are allowed to provide direct more while presiding over sionals are allowed to manage, sistently increase its numbers, patient care instead of having health services that are not fit with autonomy, the delivery of was further underpinned in the their time spent doing essen- for purpose,” said Mr Doran. direct care to patients”. recent publication by the HSE tial administrative duties. “While the number of senior The INMO is seeking an of its structures for new com- However, the growth of managers has increased, the early meeting with Minister for munity health organisations. senior management staff, number of people on trolleys Health, Leo Varadkar on this This structure, which sees who only create layers in the has increased, waiting lists have and other issues. HSE service plan fails to address critical issues
While welcoming the increase during the month of October vice are now in, leading to the under-resourced health service in funding announced in the (a 34% increase on the same compromising of patient care to continue managing crises HSE Service Plan for 2015, the month last year) on a daily basis. every day. INMO warned that the plan • More than 2,000 acute and The INMO believes that to “Faced with this reality the will not address the critical continuing care beds closed address six years of unman- health service requires addi- problems that have contin- across the country aged contraction of the health tional resources. This will ued to grow throughout 2014, • 5,000 less nurses working service, the government must ensure patients presenting for with a very negative impact on in the system compared to urgently provide emergency care can be assured that they patient care. 2009. funding. This must be targeted will be treated with dignity These problems include: The INMO acknowledged at overcrowded EDs, the open- and be cared for by a front- • A significant increase in that the plan provides for the ing of closed beds and the line professional who has the emergency department (ED) direct, permanent employment further enhancement of com- resources necessary to ensure overcrowding of nursing staff instead of the munity nursing and support their speedy return to health • Extended waiting times for employment of staff through structures. and wellbeing.” treatment the more expensive agency “Maintaining existing ser- The INMO is now awaiting • Contraction of community arrangement. The Organisation vices, after a year in which the the directorate reports, which nursing and other support said this is most welcome and HSE’s own internal reports are due in mid-December. The services something it had been calling have said the health system is Organisation will be seeking • A reduction in staffing levels for over five years. doing less with less, is simply an early meeting with both in care of the elderly facilities. The service plan should not good enough,” said INMO the HSE and the Minister for The INMO said the back- ensure the health service does general secretary Liam Doran Health, to discuss continuing ground against which the not suffer any further con- “This service plan is more serious concerns on the critical plan was drawn up cannot be traction. However, it fails to focused and realistic. However patient care issues still fac- Vol 22 No 10 Dec 2014/Jan 2015 Vol ignored. This includes: address the critical state that it simply provides for an over- ing the health system and the
WIN • 7,000 patients on trolleys many areas of the health ser- stretched, overworked and need for further funding. WIN Vol 22 No 10 Dec 2014/Jan 2015 í í ------N he he T MPI) MPI) “ E xpend U Bien are Ser are E C xecutive xecutive CT E MO as one MO as one est (F pperary has pperary has N i reports INMO INMO reports 13 NEWS orm, Brendan orm, Brendan T ef MO he Organisation he Organisation R N T for Public for MO has welcomed welcomed MO has sponsoring unions of sponsoring unions of ommunity onf N mergency Measures in in Measures mergency C MO director of MO director indus C E his is particularly wel his is particularly e I e N T I esent job sharing/flexible esent job sharing/flexible legislative basis, is not not is basis, legislative ouncil. mergency Measures in the the in Measures mergency of the Minister ment for this measure on this on for measure ment a vice, South agement to call proposal all pr also appreciates the fact also fact the appreciates now the government that that the recognises require Th a man averted successfully working public health time nurses back to full-time employment, Mary Power. IRO cial deleted. be will 2009, Act come to the I the Financial repeal ately Phil trial relations, C necessary”. South Tipp PHNs flexible retain working Changes to Changes Act FEMPI welcomed Th announcement Howlin’s Finan the of 2B section that the I a motion at following also and 2013 in own annual to its a motion in conference May of this inBelfast erence on the which called year, to government “immedi E 2013, Act Public Interest ministers to granted which without alter, to power the and agreement, consultation terms and conditions of of public employment servants”. announcement the by Minister is very welcome and will considered be I the by iture and iture nial the Public Inter Sheaghdha, said: - - - - - e e O O h M T N pay in ects shift ects shift MO refused MO refused learly those those learly N C ese are issues that that issues are ese Sheaghdha, I Sheaghdha, í one-sixth for hours hours for one-sixth h N T work, time plus a quar MO will most certainly certainly will most MO he issues raised in this this in he issues raised N y retirement options, and and options, retirement y T MO walked out of the talks the talks out of MO walked “ N the I relations. industrial of director to be acknowledged from an an from to be acknowledged wellbe and on health impact at that time time that at and recommended of the this rejection proposals, the of dou secured protection Sunday and bank for time ble holiday great a require certainly study deal of consideration and not conditions a pay and from just view. point of who obliged to work are shift with facilitated work should be consid enhanced payment but to also be given must eration earl while support medical ongoing work. at raise with the Department of Health on behalf of members,” Phil said work of shift effects Chronic 1. Reference: VISAT the cognition:on findings from Med Occup Environ longitudinal study. oemed-2013-101993. Published Online First:2014 November 3 early 2013, the I 2013, early pre to reduction a accept to workers shift for pay mium considering the eff work has on workers. duty shifts, and night for ter time plus 8pm. after worked I ing. During the most recent most recent the ing. During on national discussions - - - O mem O M N O has long held an an held long has O researchers state state researchers M e study observed that that e observed study he N h T T e I e learly these findings are these findings learly are he authors of the study he of the authors study h he research also looked at at also looked he research ety issues that would arise would arise that ety issues C T T T ound that this process would ound that this would process opinion that shift work has has work that shift opinion that medical surveillance of of that medical surveillance shift for particularly workers, work in shift who remain those than would for more 10 years, important. very be pay of premium Protection work shift for very worrying for I for worrying very take at least five years after after years five at least take stopping work. shift also concerns to raise relating on the the effect shift general quality of out life workers those who for are their under care. side of of side work the and possible saf patterns, ie. rotating between between rotating ie. patterns, to shifts, compared when those who had worked never showed shift,of again type this affected this negatively that cognitive and memory their skills. the study work, and ing shift f bers who work who shift bers patterns. those on shift patterns of work had of a decline in years 6.5 to these when compared areas did who work not shift workers patterns. of recovering the possibility the cognitive abilities lost dur
1 - - -
ome, and some cancers. cancers. ome, and some
he study looked at 3,000 at 3,000 he study looked he study also showed that that he study also showed he study results show that that show he study results T T T Shift work has been known has been known work Shift he age of the participants he the of age participants his examined the study little eal health effects for people people for effects eal health Getting the message across: the message across: Getting the of Members INMO Council Executive HQ INMO in recently training media receiving Eccles Karen Butler, Helen Byrne, Ailish (l-r): Frahill Margaret and those working rotational shift shift working rotational those T or working who currently those varying had worked, previously shifts had lower scores rostered speed processing on memory, than brain and overall power, worked those who only had office normal hours. varied from 32, 42, 52 and 62. 62. and 52 42, 32, from varied people working or retired in in or retired working people a for of sectors wide range a to 2006. period spanning 1996 Just under this of 1,484, half, shifts worked group sample for at least of the year. 50 days viduals posses. viduals T on have it might effects known and function brain memory, which indi speed the process for some time to disrupt the for some time to disrupt the internal clock circadian body’s and it has been linked rhythms, such as to health problems, of car the development ulcers, disease, diovascular metabolic syndr who work a shift pattern as a shift pattern as work who their of part normal work. Study backs INMO’s protection of pay protection premium INMO’s backs Study published study A recently Shift work hits brain function hits brain work Shift has once again looked at the the at looked again once has of effects shift work on work the and has highlighted ers r 14 NEWS NEWS XX
At the second INMO LGBT conference: (above, l-r): Senator Katherine Zappone, Dr Ann Louise Gilligan, Edward Mathews, Claire Mahon, and Senator David Norris. Three of the speakers who addressed the conference (right, l-r): Brian Sheehan, GLEN; Moninne Griffith, Marriage Equality; and Eilis Ní Chaithnia, NWCI Gaps in law remain for LGBT persons INMO LGBT conference focuses on marriage equality and healthcare
The important issues of mar- campaign and spoke about gender Equality Network strive to recognise and meet riage equality and access to the alignment of interests Ireland (TENI). the diverse healthcare needs of healthcare for LGBT persons between trade unions and the The keynote address was LGBT persons, and this agenda were the main issues high- LGBT community while striv- delivered by Senator Kath- will populate the work of the lighted at the second annual ing for true equality. erine Zappone who spoke INMO Social Policy Commit- INMO LGBT conference held in Access to healthcare both on the marriage equality tee in the coming years. Dublin last month. Another important theme of campaign and her experiences The conference organising As well as addressing these the conference was the health of accessing healthcare in committee was inspired by issues, the speakers focused issues affecting LGBT persons Ireland. Senator Zappone the success of the event and on inequalities faced by LGBT and their experience of access- is a respected social justice paid tribute to the hard work persons in the workplace and ing healthcare in Ireland. The campaigner and her efforts, of Clare Treacy, INMO IRO, in society generally. INMO recognises the right alongside those of her wife who did so much to make the Legal equality to health as a fundamental Dr Ann Louise Gilligan, have INMO inaugural LGBT confer- The conference opened with human right and the con- represented a fundamental, ence a reality last year. an inspirational address from ference explored healthcare timely and invaluable contri- Edward Mathews, INMO INMO president Claire Mahon, issues affecting gay men, les- bution to the achievement of director of regulation and who gave a moving personal bians, transgendered persons, full legal equality and marriage social policy said: “While many expression of support for mar- HIV positive persons, LGBT equality for LGBT persons. advances have been made riage equality in the context of persons with mental health She spoke about the jour- in the achievement of legal her own family experience. difficulties and the responses ney she has taken with her equality for LGBT persons The INMO fully supports the of the HSE and Irish health wife to obtain legal recogni- there are notable gaps in the campaign for marriage equal- system, in meeting the needs tion of their relationship. In law, particularly relating to ity and the conference heard of this part of our population. recognition of their crucial and the equal recognition of LGBT from a range of speakers about Eilis Ní Chaithnia of the inspirational contribution to family status. The refusal to the upcoming referendum for National Women’s Council of the achievement of full legal recognise marriage equality marriage equality in 2015, how Ireland (NWCI) spoke about equality for LGBT persons, the and to extend the full range of to make marriage equality a the importance of gender as a INMO presented Senator Zap- family rights and protections reality and how nurses and social determinant of health pone and Dr Gilligan with the to LGBT persons, and their midwives can contribute to and the importance of a gen- inaugural Norris Award, which children, represents a linger- achieving this important goal. der sensitive health service. was presented by Senator ing and detrimental prejudice Moninne Griffith from Dr Grainne Courtney, con- David Norris. This award will which must be eliminated. Marriage Equality and Brian sultant at St James’s Hospital, be given annually to persons or “In addition, we must, as a Sheehan from Gay and Les- addressed the conference in groups who have made an out- society, respond to the particu- bian Equality Network (GLEN) relation to healthcare issues standing contribution to the lar healthcare needs of LGBT warned the conference not specific to the lesbian popu- LGBT community. persons. Societal inequality, to be complacent about the lation. In addition, Lysander Access to healthcare stigma and many other factors upcoming the referendum. Preston from Positive Now Overall the conference create unique circumstances, Notwithstanding positive poll- spoke on the experience of HIV reminded all present that and it is important that both ing data, they said nurses and positive persons within the while major strides towards the healthcare system and midwives needed to be mes- health services. LGBT equality have been the staff within the system sengers in their communities A thoughtful and moving made, there remains some are responsive, respectful and in relation to a yes vote. presentation on transgender distance to go. In addition, the accommodating so that LGBT Vol 22 No 10 Dec 2014/Jan 2015 Vol David Joyce of the ICTU healthcare issues was provided healthcare system, and the persons are able to realise their
WIN outlined the ‘register to vote’ by Patricia O’Connell of Trans- staff within that system, must human right to health.” WIN Vol 22 No 10 Dec 2014/Jan 2015
------and USC USC and E executive (IR) executive 15 NEWS – Dave Hughes, INMO – Dave – Colette Mullin, INMO Colette – public sector workers workers public sector backs? e are we supposed to get to get we supposed e are deputy general secretary deputy general information and research and research information E combined PAY combined happy happy knowledge that the Since 2010, public health Since 2010, public health Will the current Will the current public anger Given the Given fig impact of the ommissioners Annual ommissioners Report of Working Time Act 1997 Time of Act Working 1997 to who allow employees leave on long-term sick are annual to accrue and retain months 15 to up for leave year the of in end the from accrued. it which been have employees service forward carry to entitled during accrued annual leave into new leave paid sick leave cycle. year over three a years be sustained into a campaign campaign a into sustained be USC or the achieve to reverse tax distribution of the fairer a or will the burden, government this with the con sail through cessions on water charges in the the money to pay this water charge? PAY and will con self-employed collected. Public servants addi collected. Public servants through paid €1 billion tionally pension the public service had related levy each year, January 2011 cut in their pay in reductions further pay and 2013. the Revenue in revealed ures C this article, it outlined in and that hundreds wonder is little and of thousands of workers, in par workers public sector are asking the question, ticular, wher tinue to carry this nation on their workforce – which is thought thought which is – workforce work the of 15% be about to force – contributed 32% of of contributed – force 32% the - - - work E sector, have have sector, E billion coming from billion coming from tax figures, tax figures, PAY U. E mployment, Ged Nash, Ged Nash, mployment, uropean Commission, the Commission, uropean E E Following a complaint to Following a complaint to The Minister for Business Business for The Minister An amendment to Irish law law Irish to amendment An In 2013, the public sector the public sector In 2013, So those who derive their their So those who derive he relevant provisions of the the of he provisions relevant INMO deputy general secretary, INMO deputy general secretary, Dave Hughes: anger public “Willthe current to campaign a into sustained be the universal charge social reverse or achieve the distribution of a fairer burden?” tax the of issued a letter Commission indi to Ireland notice formal and is to Organisation amend the cating that it considered that cating that that it considered t Organisation of Working Time Time Organisation of Working the with incompatible are Act Time Working Directive. to bring required is therefore of the rulings with it into line CJ the the self-employed, including including the self-employed, farmers. same period increased by only only by same period increased no involved and million €326 reflected but merely taxes new profitability. increased work, whether from income or employed self-employed the PAY within contributed most, with the from other many collection dur falling actually heads tax ing the Within the period. income ers paid €9.508 billion with with billion paid €9.508 ers €1.039 - - sector sector uropean uropean E E U qualified U qualified E U) ruled that the U) ruled that the E of limited sources as as of limited sources In 2009, however, the Court Court the In 2009, however, In CJ 2011 the On the spending side, pub the spending On On the revenue raising side, side, raising the revenue On that of entirety the Almost ocial welfare payments and and payments welfare ocial of Justice of the of to avoid decision so as this accumulating paid workers sick on while annual leave an unlimited period for leave 15 month that a – it ruled was not period over carry Time Working the to contrary Directive. Union (CJ accrual for provides Directive irrespective of annual leave has worker the whether of not.or worked and the self-employed. It did the and did It self-employed. not to companies or apply corporations and the tax yield the them for from achieved their low hanging fruit when when fruit hanging low their it comes to savings or revenue raising. lic service pay and numbers, numbers, lic service pay and s government, like so many gov so many like government, it, has seen a ernments before number the health service have been been the health service have and served least protected the with cuts. highest almost of comes 70% all taxes from value of combination a income and (VAT) tax added These the taxes paid are tax. people and the ‘ordinary’ by 2010 and between VAT while yielded an additional 2013 to increasing billion €1.295 tax income billion, €10.325 times three as increased by the same period, for much €3.913 billion by increasing the year bringing 2013 to for it billion. €15.752 the from came take increased (USC). charge social universal only USC was of course The applied to the PAY
------ges for the the for ges to provide that that to provide Working Time Time Working of four weeks’ weeks’ of four U E
are the many thousands the thousands are many will not significantly ben significantly will not
not want to pay for water water to for not want pay n short, are people just say just people n short, are The Organisation of Working The Organisation of Working An examination of the Or I Is the government on the Is the on the government But the campaign are lead evealing evealing and the that suggests vides for a statutory minimum a statutory minimum for vides entitlement paid annual leave by reference reference by paid annual leave to ‘timeworked’. The Organisation of Work to be is 1997 Act Time ing amended so as can be accrued annual leave when and carried over an their cannot take employee paid to annual due leave illness. which trans Time Act 1997, posed the
Directive into Irish law, pro into Irish law, Directive Right to accrue annual leave while on sick leave Right to accrue annual leave ing, “this is a tax too far”? too tax ing,“this a is Com the of report Revenue very 2013, is for missioners r participating in the protests the protests participating in for help out crying simply because of the multiple hits the over they past taken have to econ an revive years five viduals and households? households? and viduals are they revision, whose omy told, them efit individually. and related services? related and the other hand interpreting capping the by mood correctly total for amount chargeable services, and water and related of exposure the limiting indi
fundamental right to have a a to have fundamental right and a sanitary water supply service. that people simply right, ers’ do broke the camel’s back? camel’s the broke middle of The sleeping giant as awoken, finally has Ireland thousands of taken tens have months in recent the streets to their vent to anger cre at the Water charges – the straw that that – the straw charges Water the and of ation Water Irish imposition of char 16 NEWS
Courting media attention at hearings is beyond remit of NMBI The INMO has raised concerns which would state the name company at fitness to practise about the manner in which the of the nurse/midwife, the hearings,” said Mr Mathews. Nursing and Midwifery Board names of their representatives, “Overall, the duty of the of Ireland (NMBI) is intending those representing the chief Board is to hold a hearing in to manage the holding of pub- executive officer in presenting public, which is harrowing lic hearings into nurses and evidence against the nurse/ enough for nurses and mid- midwives’ fitness to practise. midwife and also a full list of wives. It is not to court the Ahead of its first ever pub- allegations against the nurse/ media at these hearings, to lic hearing, the NMBI issued midwife. solicit the media’s attendance a draft protocol for the man- “This is a very damaging or to offer any special facilities agement of public hearings. move as it is often the case to the media, over and above The INMO objected to the that allegations are with- that which should be available contents of this draft proto- drawn prior to a hearing, at to the public generally. There col, and made a submission the beginning of a hearing or is no necessity to issue a press Edward Mathews, INMO director to the NMBI in November on during the hearing,” said Mr of regulation and social policy: release – a notice on the web- how such hearings should be Mathews. “If a document is Circulation of a document detailing site is sufficient. There is no all allegations against an individual managed. circulated to all present, then prior to a fitness to practise hearing is necessity to circulate detailed In particular, the Organisa- there is a permanent record a very damaging exercise documents concerning allega- tion objected to the NMBI’s in the public domain of alle- tions against the nurse/midwife intention to issue a press gations that were put forward to engage somebody from an at the hearing as these can be release each time a public against a nurse/midwife, but external consultancy company heard in the spoken word of the hearing was to take place, which could not be substan- to simply tell the media where hearing. Given the propensity which would, in effect, be tiated, and thus did not form they can stand, can’t stand, for allegations to be changed soliciting the media to attend. the subject matter of a hearing and what they can and can’t or withdrawn, their availability “This goes well beyond the into their fitness to practise. do etc. You do not have to pay to members of the public or the duty of the Board, which is to We believe this to be a gross an external consultancy firm media in a permanent written simply hold a public hearing,” invasion of privacy, deeply to do this,” said Mr Mathews. format at the beginning of the said Edward Mathews, INMO prejudicial and very unfair.” “Even if it is not the inten- hearing, creates great unfair- director of regulation and In addition, the NMBI has tion of the NMBI to use this ness for the nurse/midwife.” social policy. engaged a public relations external public relations com- Mr Mathews continued: The Organisation under- company, Q4 Communications, pany to craft a media message “Finally, the presence of an stands that such hearings purportedly to manage the that is suitable to the NMBI external public relations com- must be notified to the public media’s attendance at fitness as these hearings progress, it pany, paid for out of nurses and agrees with the NMBI’s to practise hearings. However, is the impression of this that and midwives’ subscription approach of simply placing a for the entire duration of the does the damage. An individ- fees to the NMBI, creates a notice on its website. first public fitness to practise ual employed on behalf of the perception that the NMBI is “However, to go beyond hearing, the individual from Q4 Board, who engages only with crafting a message to suit placing this notice and to Communications, who is pur- the Board in relation to the itself arising out of fitness to actively solicit the attend- portedly there to manage the management of media and practise hearings, when these ance of the media, creates a overall media presence, never whom has been assisting the are strictly independent statu- public spectacle out of fitness once spoke to the nurse/mid- Board in its media relations tory hearings, which take place to practise hearings, rather wife who was the subject of the on other matters such as at pursuant to legislation, and than them simply being held hearing nor to their represent- the recent protest outside the should be subject to no media in public, which is intended atives. However, the person NMBI by nursing unions, cre- manipulation.” to improve confidence in the was seen speaking to members ates the perception that this The INMO made a strong transparency and fairness of of the media and staff of the individual is not there simply submission to the NMBI seek- the regulation of important NMBI. to manage media presence, ing that it changes the way in professions within our soci- The INMO concluded from but is there to serve the inter- which it manages hearings in ety,” said Mr Mathews. this action that the NMBI ests of the NMBI in creating respect of its duties pursuant In addition, the INMO took engaged Q4 Communica- a message around fitness to to the Nurses and Midwives serious exception to the inten- tions to manage a message on practise processes. Act 2011 and in fairness to tion of the NMBI to circulate a behalf of the Board and not “This is a waste of money, it nurses and midwives, who document to all present at the the registrant, in relation to is deeply unfair and the INMO already face an incredibly Vol 22 No 10 Dec 2014/Jan 2015 Vol hearing, including members the conduct of these hearings. has asked the Board to dis- stressful process arising out of
WIN of the public and the media, “It is a total waste of money pense with the services of this these hearings. 18 NEWS
Message of solidarity to Ebola carers HSE called on to ensure all vacant infection control posts are filled
INMO members sent a strong message of solidarity to col- league healthcare workers dealing with Ebola across the globe, but particularly in west Africa. Speaking at the recent special delegate conference, INMO president Clare Mahon said: “As nurses and mid- wives, we know how difficult INMO president Clare Mahon addressing the INMO SDC: the current situation is, both “We urge all governments around the world to fight against Ebola by providing funding and expertise to the countries that now need them most” for healthcare workers and those they care for. This task is caring for patients with this On November 12, nurses that INMO members should made much more difficult by deadly virus. in the US, who are members expect all measures to be in the lack of resources available Most global nursing and of National Nurses United place to protect them such in west Africa to combat this midwifery organisations report (NNU), staged actions across they need to deliver this care. deadly virus, and this situation a low level of preparedness, the US to highlight their con- While calling on all gov- is not, it would appear, getting leading to a high level of dis- cerns at the lack of hospital ernments around the world any better. For this reason we satisfaction among frontline preparedness for Ebola. These to join in the fight against urge all governments around healthcare workers relating to: concerns are shared by mem- Ebola by providing funding the world to join in the fight • Availability of suitable per- bers of the INMO. While and expertise to the coun- against Ebola by providing sonal protective clothing and the Organisation has been tries that now need those funding and expertise to the equipment frequently reminded by the the most, INMO members countries that now need them • Unclear guidelines relating HSE, that the likelihood of a also called on the Depart- most.” to exposure times for health- patient presenting to an Irish ment of Health and the HSE INMO members were care workers when nursing hospital or healthcare facility to immediately ensure all advised that the Organisa- a patient with Ebola, which is very low, the INMO does vacant infection control nurs- tion is in regular contact with requires wearing of restrictive not accept this complacency, ing posts are filled, and that nursing and midwifery organ- protective clothing considering that members they apply a greater degree of isations across the globe in • Low emphasis by employers will be required to provide urgency in preparing the Irish respect of best practice advice on training and practice care if this situation arises. health system for suspected and lessons learned from scenarios. Therefore, it is not unrealistic cases of Ebola. ICN calls for safe working conditions in Ebola areas The International Council of Pace said: “Politicians and known to have been infected Nurses (ICN) has called on international organisations with Ebola up to November 10, authorities to provide a safe were more interested in 2014; 320 of whom have died. working environment for nurses achieving political mileage The ICN board of directors working in locations where the and putting the public’s minds declared its solidarity and sup- Ebola virus has spread. at rest than actually seeing port to all nurses delivering The ICN board of directors the true interest and the safe- healthcare to people and com- highlighted the major public guards of the nurses who are munities during the serious health risk and the essential on the frontline in the care of public health crisis caused by need for significant strength- the Ebola patients.” the Ebola virus. ening of safety policies, and In almost all countries nurs- In particular, the ICN the provision of appropriate ing and midwifery services are stressed the need to mobi- protective equipment and estimated to comprise over The ICN highlighted the major lise support for the families of public health risk and the essential training. It also stressed the 80% of the healthcare ser- need for significant strengthening health workers who have lost need for nurses to be actively vices. As a result, nurses and of safety policies, and the provision their loved ones. The act of of appropriate protective equipment involved in policy deci- midwives are the personnel and training providing care to others has sion-making debates at all who are most at risk of infec- left dependants and children Vol 22 No 10 Dec 2014/Jan 2015 Vol levels. tion from Ebola while caring World Health Organization, without a means of financial
WIN ICN board member Paul for patients. According to the 564 healthcare workers are security into the future. WIN Vol 22 No 10 Dec 2014/Jan 2015 ------and and otest otest for a bal for care and a bet care ail to address ail to address D are at break D are oblems in Beau E NMO is calling on the D. Our members are are Our members D. I E have completed the have acute to immediately bring for bring immediately to
n addition, a process was was process a addition, n E “Nurses in “Nurses “The Considering these develop Considering I S ommencing in January 2015. January in ommencing tests, is necessary to highlight to highlight tests, is necessary the serious pr Minister for Health and the the Health and for Minister H to to phase of their care move setting, appropriate a more with necessary either at home supports or to a community much needed to increase bed, hospital.” the in capacity mont situation. the with faced they are ing point as unmanageable workloads they that mounting pressure They will over. have no control no tolerate longer patient care due to being compromised and insufficient staffing levels Management overcrowding. plan devise a strategic to needs to the overcrowding address vacancies and nursing problem urgently. filled be must also seeking sanction also seeking sanction ward funding to allow patients patients allow to funding ward who lot for industrial action should should action industrial for lot management f ments, members postponed postponed ments, members the planned lunchtime pr agreed which could provide which could agreed provide open, consultative ongoing an to for members environment This includes issues. progress and levels staffing reviewing its delivery. care on impact c to facilitate further further discussions facilitate to Their with local management. appro to secure is objective priate staffing to deliver levels optimum patient for ter all. working environment
- - - - - SE n fact, the the fact, n I the full range full range the ahead of the the ahead of eview of staff eview NMO and H I NMO members are are members NMO I main contributor to the main contributor to the time nurses was secured. was secured. time nurses “This protest, which is the the which is “This protest, A Following a meeting a meeting Following first of a number of rolling pro of rolling of a number first overcrowding is the fact that that fact the is overcrowding about 80 patients in are there time one the hospital at any discharged who clinically are but who continue to occupy acute inpatient beds due to funding and community cuts in the lack of facilities. step down their ability to deliver safe their ability to deliver safe such “chaotic, in care patient unmanageable conditions”, said Ms Monaghan. “However, has been no response there the management and from persists. problem situation fur is deteriorating months.” winter the in ther independent r This is ensure to necessary ing. that patients get management the perma planned protest, nent appointment of three full One of these commenced imme hospital the at working two with a subsequent diately of care required to meet their of care required needs. of levels excessive suffering stress and to this due burnout environment. work intolerable the between - - - - D D D D E E
of admitted of admitted me admitted me admitted o D,” she said. she D,” S D regularly goes goes D regularly E E
D. The department does The department does D. E NMO members demanded NMO demanded members The situation is com The situation is The number I “On a regular basis there there basis “On a regular the department on a daily on department the a daily The situation for members was members for The situation INMO IRO Lorraine Monaghan: Lorraine INMO IRO wait they as conditions to horrendous subjected are patients frail and ill “Acutely vulnerable” corridors,noisy and along crowded, exposed chairs and trolleys on pounded by staff shortages shortages staff by pounded in working in basis. Nurses of advised management have about concern serious their patients in the beyond number that would “This is ward. inpatient an fill of the function not or purpose an or the not the capacity, have staffing, operate to as a ward an as well as tient beds”, said Ms Monaghan. Ms said beds”, tient ratios. ceptable nurse-patient “ vulnerable. vulnerable. due to the unavailability of inpa patients are spending their their spending are patients the in stay hospital entire an immediate increase in nurs an immediate increase intolerable and caused them intolerable and caused them to occasions have distress great when patients must remain in bed during the day because were not enough there tonurses said. Power Ms them,” for care on rostered one nurse was just 34 patients in for care to duty through 4pm right from ward a morn following the to 8am added. she ing,” pending an ing staff levels
------D. D. E ater NMO NMO I W O, Mary D. “They “They D. IR E s, exposed and s, exposed and NMO I a number of of g a number NMO members at at NMO members n e exposed to in exposed e I s took this action to s took this action to of lunchtime protests protests lunchtime of wi
omising care. patient Lorraine Monaghan. Lorraine NMO members began at began at NMO members
I However, this action was this action was However, A total of 729 admitted A total of 729 admitted Nurses are gravely con gravely are Nurses O, ollo t Patrick’s Hospital, t Patrick’s lunchtime protest outside outside protest lunchtime ford took the decision to to decision the took hold ford a since averted. many were there said Power were when occasions nurses to unable to optimal care give resident persons older 96 the because of unac facility, in this S the hospital to highlight the and poor staffing levels very times at envi work intolerable F is which nurses for ronment compr Unsafe ratios highlighted in St Patrick’s, Waterford Patrick’s, in St highlighted Unsafe ratios meetings, are subjected to horrendous to horrendous subjected are conditions as they wait on trol IR for patients waited on trolleys an inpatient bed last month the highest number in any – This is up hospital nationally. the same period for 661 from frail ill and Acutely in 2013. patients four to spend three the waiting in days leys crowded, chairs and along noisy corridor Beaumont is one of the worst Beaumont the of one is worst the hospitals in overcrowded country and nothing has been this to done serious address to according problem,
by by Hospi of Beaumont the gates December. early in Dublin tal, Member highlight the conditions unsafe department emergency the in overcrowding to due severe shortages. staff and cerned that conditions the at patients ar Beaumont ED staff at breaking point breaking ED staff at Beaumont series A “Nurses working in the emergency department are at breaking point as they are faced faced are they as point breaking at are department emergency the workingin “Nurses over control they have no that pressure and mounting workloads unmanageable with INMO members protest outside Beaumont Hospital, Dublin: outside Beaumont protest INMO members Annual Delegate Conference 2015
The Barbican Suite, The Knightsbrook Hotel, Trim, Co Meath Wednesday-Friday, May 6-8, 2015
In accordance with Rules 5.9, 5.11 and 12.3.2, motions for debate at Annual Conference must be submitted to the General Secretary, no later than 12 weeks prior to Annual Delegate Conference (Wednesday, February 18, 2015 at 5.00pm)
BRANCH/SECTION GENERAL MEETINGS
Each Branch/Section should hold an Annual General c) Each Section may nominate TWO official delegates to attend the Meeting in order: Conference. Branch and Section Delegate nominations must be submitted to the INMO, on the appropriate form, no later than a) To consider motions for submission to the Annual Delegate 5.00pm on Wednesday, February 18, 2015 Conference. Motions must be submitted to the General Secretary, on the appropriate form, no later than 5.00pm on Wednesday, February 18, 2015 b) To nominate delegates to attend the Annual Delegate Conference on the following basis:
Membership less than 50 - 1 delegate Membership of 50-100 - 2 delegates 101-200 - 3 delegates 201-300 - 4 delegates 301-400 - 5 delegates 401-500 - 6 delegates 501-700 - 7 delegates 701-900 - 8 delegates 901-1,000 - 9 delegates over 1,000 - 10 delegates For every 500 members, or part thereof over 1,000, each Branch may have one further delegate
ELECTION OF STANDING ORDERS COMMITTEE
In accordance with Rule 7.1 “The Standing Orders Committee for the Annual Delegate Conference shall consist of three members elected by the Annual Delegate Conference.” In accordance with Rule 7.2, there shall be an election for all three seats of the committee, at Annual Delegate Conference, and the elected members shall hold office for a period of two years. Therefore, an election for all three seats of the Standing Orders Committee will be held at Annual Delegate Conference 2015.
HOTEL RESERVATIONS FOR ANNUAL DELEGATE CONFERENCE 2015
This year the accommodation will be provided in The Knightsbrook Hotel, Trim, Co Meath. Accommodation will be reserved for all nominated delegates, from Wednesday May 6, 2015, to Saturday, May 9, 2015, inclusive. Accommodation is available on a shared basis only. The INMO will not be responsible for any expenses incurred by delegates, other than the agreed package negotiated with the hotel. Delegates who wish to have a single room will be asked to pay the single person supplement. Delegates who are unable to arrive on the Wednesday evening, or who are departing earlier than the Saturday morning, May 9, 2015, must inform the hotel and Oona Sugrue, ADC Co-ordinator, as early as possible, but no later than Tuesday, May 5, 2015. Branch and Section Secretaries should reserve the required accommodation for their appointed delegates, clearly indicating the number of nights required by delegates, by sending the official INMO Booking form direct to: Central Reservations, The Knightsbrook Hotel, Trim, Co Meath prior to Friday, March 27, 2015. All reservations will be made through the Central Reservations Team. All rooms will be allocated on a first-come, first-served basis. Confirmation of hotel bookings will be made direct to the Branch/Section Secretaries, by The Knightsbrook Hotel Reservations Team.
For all enquiries regarding Annual Delegate Conference, please contact Oona Sugrue, INMO HQ Tel: 01 664 0636 Email: [email protected] NEWS XX
Naas overcrowding at all time high: “The levels of overcrowding and staff shortages at Naas General Hospital are now the worst in the hospital’s history. The rise in overcrowding is unprecedented and the HSE has no plan in place whatsoever to deal with this crisis,” said INMO IRO Derek Reilly
Major recruitment Severe overcrowding in drive underway at Tallaght Hospital Naas sparks protest A major recruitment cam- INMO members protested paign is now under way outside Naas General Hospital Table 1: INMO trolley watch for Naas General Hospital for Tallaght Hospital. The last month to highlight severe emergency department Jan to Oct , 2013-2014 hospital is recruiting staff overcrowding at the hospital, Month 2013 2014 Difference % difference nurses to all areas. staff shortages and inadequate This follows on from an bed capacity. January 239 215 -24 -10% agreement reached with The INMO trolley/ward February 229 245 +16 +7% the INMO last month. The recruitment of additional watch figures for Naas Hospi- March 227 234 +7 +3% tal for October 2014 show a nurses has been welcomed April 158 190 +32 +20% worrying 71% increase in the by the INMO as “a first step in the right direction follow- number of admitted patients May 152 218 +66 +43% ing years of austerity.” waiting on a trolley in the June 140 221 +81 +58% emergency department for a July 146 169 +23 +16% hospital bed in comparison to Vehicle checks October 2013. August 40 230 +190 +475% beyond remit of The situation in Naas ED September 118 249 +131 +111% nurses from January to October 2014 October 187 320 +133 +71% compared with the same Management at St John period in 2013 is shown in the Total 1,636 2,291 +655 +40% of God, Kildare Services has Table and reveals an overall The INMO has called on ever to deal with this crisis,” attempted to introduce a increase of 40% on trolleys in the HSE to immediately fund said Mr Reilly. policy whereby members this 10-month period. these beds and to recruit an “The INMO has written would have to carry out The significant increase in additional 50 nurses for Naas to all public representatives daily vehicle checks. overcrowding in Naas General General Hospital as a matter in the Kildare region seek- The INMO, represented Hospital in 2014 has resulted of urgency. ing a meeting with them to by Eileen Lawrence, Execu- tive Council member, made in patients being cared for on “INMO members are gravely see what plans they have to it absolutely clear that trolleys on corridors for the concerned for the wellbeing address this problem and bring nurses would never carry first time ever. This practice is of patients who have to suffer pressure to bear on the gov- out these checks. unacceptable and unsafe. the indignity of being nursed ernment to provide adequate Nurses drive vehicles with The issue of overcrowding is on a corridor for days at a funding for Naas Hospital. clients in St John of God further compounded by severe time. The levels of overcrowd- “Our members are extremely and this will be kept under staff shortages. While 46 beds ing and staff shortages at Naas worried at what lies ahead for review and withdrawn if within the hospital are now General Hospital are now the the winter months and call on management seeks to con- open in response to the crisis, worst in the hospital’s his- our local politicians and local tinue to put forward this these beds are unfunded and tory. The rise in overcrowding representatives to devise an agenda. are not adequately staffed, is unprecedented and the HSE action plan to deal with the cri- – Derek Reilly, INMO IRO said Derek Reilly, INMO IRO. has no plan in place whatso- sis in the hospital.” INMO 22 NEWS
Action suspended pending talks LRC talks aim to address chronic overcrowding in Drogheda ED
The lunchtime protest and agement, the Department of Table 1: R oot causes of overcrowding in Drogheda industrial action due to com- Health, HIQA and politicians, mence by INMO members at • The closure of 97 beds in Louth County Hospital with no improvement. Our Lady of Lourdes Hospital, • The closure of step down beds in care of the older person hospitals, In a letter to HIQA, the Drogheda last month were such as St Oliver Plunkett’s, Dundalk; St Mary’s, Boyne View; Cottage INMO outlined its concerns. suspended pending further Hospital, Drogheda; and St Joseph’s, Ardee and Trim However, HIQA advised that, talks. • The curtailment of community services, ie. inadequate public health while appreciating the serious- The Labour Relations Com- nursing services and the cutting of home help hours ness of the risk and sharing our mission (LRC) chaired talks concern, it did not have the between the INMO and the • The curtailment of services in other acute hospitals in the north east resources to undertake any resulting in all patients being directed towards Drogheda HSE ahead of the protest last supplementary programmes of month. • An ageing and growing population within the catchment area work at present. Members of the INMO had INMO members at OLOL taken the decision to com- already staged a lunchtime mence the action to highlight protest in August of this year the seriously overcrowded and however the problems not dangerous conditions at the only persist but are getting hospital’s emergency depart- worse. ment that are negatively “A HIQA investigation in Tal- affecting patient care. OLOL members held a protest at laght Hospital in 2012 severely Further direct talks were the overcrowding back in August, criticised that hospital say- warning of the worsening situation taking place between the ing that patients’ lives were INMO and management as we in order to be heard. The pri- an indefinite work to rule, being put at risk because they went to press and the LRC was mary concern of nurses is their during which all essential care were being treated on trolleys due to reconvene on Decem- patients who have to endure required by patients would on corridors. The situation is ber 10. inhumane and undignified continue to be provided but similar in OLOL and is deterio- INMO IRO, Tony Fitzpatrick treatment. Nurses simply non-essential/administrative rating on a daily basis. The risk said: “The INMO welcomes want to work in an environ- work would not be done by of a death in the ED increases the proactive engagement of ment that is conducive to the overworked nursing staff. In by 30% when this level of management in talks under delivery of safe quality care,” the absence of concrete initia- overcrowding exists and it is the auspices of the LRC on said Mr Fitzpatrick. tives from management aimed becoming impossible for our the complex and challeng- “The problem of over- to ease this crisis, the action members to provide safe care ing issues that need to be crowding can be solved but would be escalated to a two to patients,” Mr Fitzpatrick addressed to end the severe it requires a concerted effort hour work stoppage. said. and deteriorating overcrowd- on the part of senior manage- Trolley/ward watch figures “The INMO is calling on ing in Our Lady of Lourdes ment within the HSE and the for the month of October for the Minister for Health and Hospital. However, matters Department of Health. The Our Lady of Lourdes Hospital the HSE to end the inhumane require significant further INMO has written to the Min- show a massive 243% increase treatment of patients within engagement and action. It ister for Health, Leo Varadkar in 2014 compared with Octo- this overcrowded depart- is necessary that the parties seeking a meeting and asking ber 2013. During the month ment. Substantial numbers work to agree resolutions in him to intervene in this crisis of October, 631 patients who of patients are clinically dis- order to protect patients and by involving all parties to end had been admitted had to charged but remain in acute ensure the health, safety and the suffering of patients on wait on a trolley for a hospital beds in the hospital due to the wellbeing of overstretched trolleys for days at a time.” bed. “Elderly patients, some in lack of step down facilities. staff.” The INMO is calling on the their 80s and 90s, spent three Since 2010 acute and non- He said OLOL has become Minister for Health and the to four days, head to toe, on acute beds have been closed one of the worst overcrowded HSE to take urgent action to trolleys on corridors with no in the catchment area, with emergency departments in the end the inhumane treatment privacy and no dignity. The 97 beds closed in the Louth country and that the failure of of patients on trolleys in hos- problem is compounded by County Hospital alone. There management to proactively pital corridors in the interests the department being short was €25 million allocated in engage with the INMO in of patient safety. staffed on a daily and continu- the budget for 2015 to tackle recent months had seen the The INMO has suspended ing basis,” Mr Fitzpatrick said. the overcrowding issue but situation deteriorate. “It left the action pending the out- Prior to voting to take this money needs to be used Vol 22 No 10 Dec 2014/Jan 2015 Vol members with no choice but come of talks. However, the industrial action the INMO now to open some of the
WIN to ballot for industrial action planned action had included highlighted the crisis to man- closed beds”. XX NEWS
Caption head: “quote” Vol 22 No 10 Dec 2014/Jan 2015 Vol WIN 24 NEWS
UCC ordered to EC probes lower pay scales pay back-dated incremental credit for nurses moving from EU The Labour Court has awarded recognition and The INMO has supported a On October 17, the EC retrospection of incremental complaint to the European stated that it would now pur- credit to nurses employed Commission (EC) on behalf of sue the matter within the in UCC. This transpired on two members who opposed framework of a new infringe- appeal of a Rights Commis- the imposition of 2011 ‘new ment procedure, which may sioner recommendation entrant’ pay scales on return result in the case being raised which rejected an INMO to work in Ireland from the UK before the European Court of claim. The Labour Court rec- in spring 2012. Justice (ECJ). ommendation is binding on The government attached “The INMO is very keen to the parties under the Had- this 10% reduction in pay support these nurses in their dington Road agreement. scale to anyone who had not complaint. The Organisation The INMO has welcomed worked in the Irish public ser- contends that the 2010 pay the Labour Court recommen- vice on or before December 31, scale should have been applied dation as this reflects the Patsy Doyle, INMO IRO: considerable experience and 2010 in either a temporary or to these nurses and will perse- The INMO is very keen to support expertise which the members permanent capacity. these nurses in their complaint” vere with the case before the have invested in their roles as The two nurses approached IR fora in Ireland,” said Patsy well as reflecting EU norms. the INMO when they believed Article 45 of the Treaty on the Doyle, INMO IRO. The Organisation is now that their previous service as Functioning of the European Any other INMO members pressing the university for a RNs in the UK was being dis- Union (TFEU) on the freedom who wish to query the impo- speedy implementation date. regarded on calculation of pay of movement of workers. The sition of 2011 pay scales after – Patsy Doyle, INMO IRO scales. The Organisation urged matter has progressed simul- they previously worked in the the HSE to engage on the claim taneously through the Irish EU, should contact the INMO Coombe agrees to as it formed the view that it industrial relations fora and via through their IRO to explore release member to was a significant breach of a complaint to the EC. the matter further. sit on NMBI The Coombe Women and Leave cancelled due to staffing crisis Infants University Hospi- Parental leave at Midland an already overburdened staff. agement accepts that 10 tal recently confirmed the Regional Hospital, Mullingar The INMO will continue to nurses need to be recruited to release of an INMO member who had been elected to the was cancelled at short notice monitor the situation carefully the emergency department Nursing and Midwifery Board and in breach of the Parental into the future,” said Derek and 22 midwives to the mater- of Ireland (NMBI). Following Leave Act, 1998. Reilly, INMO IRO. nity unit. The INMO is seeking the election, the Coombe Management has agreed Management also agreed the recruitment of a further cited service requirements that overtime would now to no further cancellations of 22 nurses and 10 paediat- as a barrier to releasing leave and made a commitment be paid as per the national ric nurses. These figures are the person, who works in a that it will abide by the Act. An agreements. Previously man- being contested by manage- specialised midwifery role. acute shortage of staff and an agement refused all requests ment. However, the INMO However, the Coombe had overcrowded hospital led to for overtime payments. views them as a conservative allowed her to attend NMBI the decision to cancel leave. An internal review of staffing estimate of what is needed to by using her own annual “This was short-sighted and levels throughout the hospital address the staffing crisis at leave. The INMO referred placed even more pressure on is currently taking place. Man- the hospital. this issue to the Rights Com- missioner Service, seeking the application of Circular Several areas of concern in St James’s 10/71, which covers all such A number of areas of concern to a staff/patient ratio for In addition, the INMO has appointments. The Coombe in St James’s Hospital, Dublin admitted patients as currently referred two areas to the has now recruited an addi- have been the subject of various exists in a number of EDs Health Information and Qual- tional consultant obstetrician meetings and correspondence in around the country. Therefore, ity Authority for investigation who can undertake some recent weeks, according to Joe the staff have no expectation – the theatre recovery room of the role our member is Hoolan, INMO IRO. as to what management would and the Cath Lab in an out of involved in. The hospital has The emergency department believe is safe, or not. hours setting. INMO members now given the midwife full continues to struggle with This matter has been have clinical concerns in both release to NMBI and returned all of her annual leave used additional admitted patients referred to the Labour Rela- these areas and, despite local
Vol 22 No 10 Dec 2014/Jan 2015 Vol for her NMBI role. in the ED at 8am. There is no tions Commission and local discussions, these concerns – Joe Hoolan, INMO IRO
WIN agreement in place in relation discussions are continuing. have not been addressed. Section News 25 10th TT conference held in Portlaoise
The 10th annual telephone tri- available to us through the age nurse conference was held educational programmes and in the Portlaoise Heritage Hotel library services. The INMO has in October. The day was fully recently launched a new web- accredited by the NMBI, and site, specifically for educational it carried five CEUs this year. and professional purposes, and Just over 100 nurses gathered members are asked to visit in Portlaoise for the event with www.inmoprofessional.ie to representation from Shannon- see all that is available. doc, Caredoc, Southdoc, Midoc, Una O’Neill, clinical nurse Pictured at the The Telephone Triage Section conference Westdoc, Nowdoc, Milford specialist, gave a presentation in Portlaoise (l-r):Hazel James, education officer; Carmel Murphy, Section chairperson; Claire McMahon, secretary; Claire Care Centre and we were also on ‘Symptoms, diagnosis and Mahon, INMO president; Breege Clarke, speaker; Mary Burke; Karen delighted to welcome a number management of HSS’ (hypergly- McTague; and Elizabeth Adams, INMO director of professional development of GP practice nurses. caemia hyperosmolar state). A The conference, which presentation entitled ‘Paediatric covered various aspects of head injuries” was given by Karen telephone triage, was opened McTague, clinical facilitator with The cake by Claire Mahon, INMO presi- Crumlin’s ED, outlining that designed to dent. Ms Mahon addressed head injury is the most com- celebrate the 10th the attendees by outlining the mon cause of trauma deaths in Telephone difficulty nurses have experi- one-to-five-year-olds, however Triage enced over the past two years. 80% of head injuries are mild conference She argued that, as nurses and and managed without trauma midwives, we must continue or critical care physicians. to be advocates for patients Dr Cathriona Hechion, from and for the profession so that the Irish Family Planning Asso- The final presentation ‘Dif- thank all speakers who took international best practice can ciation, provided a practical ficult symptoms in palliative part in the conference. be attained. guide for triage nurses for the care; management of delirium’ As this was the 10th anniver- Elizabeth Adams ,INMO most up-to-date contraceptive was delivered by Hilary Smith, sary celebrations were marked director of professional devel- management. John Leahy,drug regional co-ordinator with end- with balloons and specially opment, provided information education officer, gave a com- of-life residential care in Milford designed cake which was raf- on maintaining registration prehensive overview of the Hospice. She said that :“delirium fled. A small presentation was and competency. While the most commonly misused drugs can be found wherever there are made to Jean Carroll, INMO exact criteria are yet to be out- and their short- and long-term sick patients, it is reversible in section officer, for all her hard lined by the NMBI, it should be side-effects, stating that at up to 50% of cases, and up to work in co-ordinating the noted that there are excellent least 15.3 million people glob- 83% of cases if drug induced.” efforts of all involved in making resources within the INMO ally have drug-use disorders. The Section would like to all the conferences a success. National Children’s Nurses Section up and running The inaugural meeting of the interested nurses who provide newly named National Chil- care for neonates/infants or dren’s Nurses Section took children. place at INMO HQ in Dublin A committee was formed to on November 3, 2014. The represent the new section. The meeting was attended by a next meeting of the National group of enthusiastic children’s Children’s Nurses Section WIN nurses representing various takes place on February 2, Pictured at the inaugural meeting of the National Children’s Vol 22 No 10 Dec 2014/Jan 2015 specialist areas, including a Nurses Section were (l-r): Anne McLaughlin and Elaine O’Rourke, 2015 at 11am in INMO head member of a community- both from Our Lady’s Children’s Hospital (OLCH), Crumlin; office in Dublin. based organisation. Kathleen Fitzmaurice, Jack and Jill; Saundra Nolan, Linda Phelan and Claire The Section is hoping that Magner, all from OLCH; Catherine Sheridan, Galway; and Eileen Tiernan, OLCH It was agreed that the re- more members align them- establishment of this section engagement by all nursing that there would be regu- selves with the group and it will give children’s nurses a professionals caring for chil- lar articles published in WIN welcomes attendance by any stronger voice while providing dren both in the acute hospital relating to any aspect of chil- nurse working in the area of chil- a nationwide educational plat- and community settings. dren’s nursing. The Section dren’s nursing, neonatal care form and allowing for wider There was also agreement welcomes articles from any or in the community setting. 26 Questions & Answers
Bulletin Board With INMO director of industrial QA relations Phil Ní Sheaghdha
• Step 2: Apply for benefits under the Occupational Inju- from member ries Scheme. If you are not able to work after an accident Query or an occupational illness, you should claim injury benefit I recently suffered an injury at work and was on paid from the Department of Social Protection. All employees sick leave. My employer tells me that I should have who pay PRSI will be eligible for this benefit. Injury ben- claimed social welfare for some of this and reimbursed efit is a weekly payment and is payable from the seventh them the amount I received on social welfare. I was day of injury or commencement of the disease for up to 26 not aware of this and I wonder could you explain the weeks. In the event that you are still unable to work after requirements and also if my employer was responsible. 26 weeks, you may be entitled to illness benefit, disability How do I lodge a claim against them for compensation? allowance or supplement allowance from the Department of Social Protection. • Step 3: Notify your employer that you have applied for injury benefit. The current rate of injury benefit is €188 a Reply week and this would then be repaid to your employer in the The whole area of injury at work is very complicated as it event that you were on full pay from your employer during involves the Department of Social Welfare, your employer this period. under the Pension Scheme and Sick Leave Scheme and also Personal injuries compensation the area that you raise in respect of personal injuries and If you believe that your employer failed in their duty of compensation from your employer. I will set out each of the care to you as an employee, and you sustained a workplace areas separately. injury as a result, you are entitled to claim personal injury Superannuation (Pension) Scheme compensation from the Injury Board. You must apply to All nurses and midwives employed in the public health ser- the Injuries Board for this in addition to your application for vice contribute to a superannuation scheme applicable to their social welfare or indeed, anything relating to your sick leave, employment. via your employer. Certain public service superannuation schemes provide for The INMO has an insurance scheme for members to the payment of an allowance where an employee suffers an assist in processing such claims. This is a free service to occupational injury or contracts an occupational disease where members and your industrial relations representative can certain conditions are met. advise you on it. Before you can take any action, you must The INMO has had difficulty in getting members’ enti- have filled out an accident form at work and notified your tlements in this area secured and is pursuing a number of employer that you believe your injury results from this acci- cases to third parties currently. It is important that mem- dent, which is recorded as happening in your workplace. bers understand that the period of time during which a You should also obtain a medical report from your doctor person receives an injury grant is not recognised for pension and as with any scheme, it is important that you keep per- purposes. sonal records.
Social welfare Conclusion In respect of social welfare, the general information and These schemes are complicated as some benefits are guidelines the INMO has given to members are that there derived from social welfare, some from your workplace are three steps that should be followed in the event that sick pay scheme and some from your pension scheme. you have an accident at work or you acquire an illness/dis- Therefore, you may need to meet with your IRO, who ease at work. can go through the particular details of your case and • Step 1: Notify your employer as soon as possible following advise on your best option. The INMO holds information the occupational accident/onset of occupational disease. sessions on these schemes for members in local Contact your employer and notify them immediately. Even workplaces. Contact your local nurse representative o 10 Dec 2014/Jan 2015
N if you are not immediately incapacitated following the acci- or branch officer about organising this and we would be dent, you should still notify your employer so as to preserve happy to hold such a session to ensure members know your future entitlements to the benefits you may require at their entitlements, and these are upheld and implemented Vol 22 Vol a future date. by the employer. WIN Questions & Answers 27
simply a matter of enforcing your agreement. It you don’t, Query from member it would be a matter of arguing that despite the absence of a written agreement, an agreement was arrived at which I work in a public service hospital and have been taking now has to be honoured. every Friday as parental leave for the past six months. The arguments you make in respect of a disturbance Recently my employer has advised that this is not a are all arguments that can be made to support your case. formal agreement and is seeking to review the manner In the first instance, you should have a meeting with your in which I take parental leave. This method of granting line manager. me parental leave was agreed with my line manager and I have planned my childminding around this If you are not satisfied with the outcome of this meet- arrangement. I would be grateful if you could set out ing, seek to meet your assistant director of nursing or my entitlements in this regard. director of nursing to appeal the decision of your line manager. In the event that this does not resolve the situ- ation, contact your INMO industrial relations officer and request that they represent you in respect of this matter. The INMO can then contact your employer with a view to Reply seeking the best outcome for you. If needs be, we can refer As you are aware, the manner in which parental leave is the matter to a third party, a Rights Commissioner, with a taken, if not taken as a block of leave, has to be agreed view to having the approach your employer has taken to with the employer. A formal document should be signed this examined. by both the employee and the employer, setting out the All of this takes time so therefore, you should imme- terms on which this agreement is arrived at and how it diately engage with your employer and seek to have will apply. the matter addressed. Do not hesitate to contact us if From your question, it is not clear as to whether you you have any further questions or queries in respect of have this formal documentation or not. If you have, it is this issue. QUALITY & SAFETY 29 Ouality A column by & Maureen Flynn Safety Patient and family centred care
This month’s column focuses on a prac- tical example of partnering with families Figure 1. Patient and family centred care poster and patients. During a recent visit to the All About Me Things I may need help Patient and Family Centred Care (PFCC) with (include fears)… Innovation Centre I had the opportunity Items that comfort me… to visit the intensive care unit (ICU) at Magee-Womens Hospital (University of Pittsburgh Medical Centre). Here I learned about how the team views all care as Spiritual beliefs / an experience ‘through the eyes of the practices patient and family’. You may be What is a patient and family centred surprised to know… care? Internationally, patient and family-cen- tred care, as a concept, is described as My support team healthcare that is compassionate, includes My favourite things (friends, family, patients and families as partners and col- (activities, food, movies, games, pets, etc…) I prefer to be books, music, tv, etc) laborators, is provided with respect, and called treats patients and families with dignity. It is care that revolves around the needs and desires of patients and families rather than around the organisations and systems in Based on poster at Magee-Womens Hospital, which encourages patient, family and friends which it is provided. to share information, pictures, etc about the patient’s life In Ireland the National Healthcare Char- family members. Rather than talking Could you use the ‘All About Me’ in ter, You and Your Health Service, sets out impersonally about patients as ‘bed num- your area of practice? The PFCC team the commitment by the HSE describing: ber’, they wanted to personalise care for advocate ‘borrowing brilliantly’ and • What patients and families can expect patients who often cannot talk as they are ‘sharing splendidly’ by providing resources, when using health services in Ireland ventilated. to accelerate the adoption and spread of • What patients and families can do to The PFCC Project Team with represent- PFCC projects and impact more patients, help Irish health services to deliver more atives from all touchpoints developed a families and caregivers along the way. effective and safe services. simple poster with prompts which is dis- Check out the website for further details The charter has a common goal – aim- played at each patient’s bed (see Figure 1). at www.pfcc.org or email [email protected] ing to inform and empower people to This is completed by the family and helps For more information on the visit contact actively look after their own health and staff in getting to know the patient on a Maureen Flynn, at [email protected] to influence the quality of healthcare in personal level. To learn more about Irish resources for Ireland. The charter describes patient cen- This co-design between staff, patients patient and family centred care, visit the tred care as care that is based on eight and families is about making things good National Advocacy Unit section of the HSE principles: access, dignity and respect, safe (and then better) and right (and fantas- website at www.hse.ie/eng/about/Who/ and effective services, communication tic) for the people who use and encounter qualityandpatientsafety/nau and information, participation, privacy, them. Maureen Flynn is the director of nursing (national lead WIN improving health, and accountability. Opportunity to get involved for quality and safety governance development) at the Office of the Nursing and Midwifery Services Director, Patient and family centred care: The PFCC Innovation Centre Vol 22 No 10 Dec 2014/Jan 2015 Quality and Patient Safety Division, HSE ‘All About Me’ recommends thinking about PFCC as a Acknowledgements: The ICU team at Magee-Womens circle that never ends as opposed to a A special thanks to Michelle Giarrusso, Director Patient and Family Centered Care Innovation Centre UPMC and Hospital used the PFCC methodology straight line that goes from start to finish Lauren Gorman, ICU Manager Magee-Womens Hospital to understand what it is like to be cared and thinking about ‘project improvement for their very warm welcome, generosity in sharing for in ICU by ‘shadowing’ patients and teams’ as mini ‘tornadoes’ of change. experiences and their assistance in preparing this column.
About the HSE Quality and Safety Division: The Quality and Patient Safety (QPS) Division of the Health Service Executive (HSE) was established in January 2011, on the appointment of the National Director, Dr Philip Crowley. The role of the QPS Division is to provide leadership and be a driving force by supporting the statutory and voluntary services of the HSE in providing high quality and Quality and Patient Safety Division safe services to patients, their families and members of the public. LEGAL FOCUS 33 Know your obligations
Failing to report concerns regarding children and vulnerable persons is now a criminal offence. Edward Mathews discusses how this relates to nurses and midwives
It has long been recognised as an attempt to commit any such information on certain offences against essential part of nurse and midwife’s offence. children, and Section 3 creates an identical practice that a duty exists to ensure the A child in this context is a person offence save that it applies to information safety and dignity of those for whom they under the age of 18, and a vulnerable per- concerning offences against vulnerable care. Existing policies and procedures in son means either a person who is suffering persons. the health services include within this from a disorder of the mind, whether as a The offences arise where one knows or duty the mandatory reporting of concerns result of mental illness or dementia, or has believes that a relevant offence has been regarding the abuse of children and an intellectual disability, which is of such committed, and one has information vulnerable persons. In addition to these a nature or degree as to severely restrict that one knows or believes would be of professional obligations, there now exist the capacity of the person to guard him- material assistance in the apprehension, criminal offences in this area by virtue self or herself against serious exploitation prosecution or conviction of a person who of the Criminal Justice (Withholding of or abuse, whether physical or sexual, by committed such an offence, and one fails Information on Offences Against Children another person. without reasonable excuse to disclose that and Vulnerable Persons) Act 2012. A vulnerable person may also be information to a member of the Gardaí. In This is a relatively short piece of leg- one who is suffering from an enduring this sense, liability arises not upon mere islation that came into force on August physical impairment or injury, which is suspicion that an offence has been com- WIN 1, 2012 and provides, in connection with of such a nature or degree as to severely mitted, rather one must at least believe children and vulnerable adults, for offences restrict the capacity of the person to it has been and one must in addition have Vol 22 No 10 Dec 2014/Jan 2015 of withholding information relating to the guard himself or herself against serious material information to assist the Gardaí commission of certain arrestable offences; exploitation or abuse, whether physical in the apprehension and prosecution of the Act applies to all persons. For the pur- or sexual, by another person or to report the offender. poses of this Act, an arrestable offence is such exploitation or abuse to the Garda The ranges of offences in relation to one for which a person of full capacity and Síochána, or both. which one may have information, and not previously convicted may be punished Offences which create the obligation to disclose by imprisonment for a term of five years or The Act creates two offences, Sec- the information to the Gardaí, differ in by a more severe penalty and includes an tion 2 creates an offence of withholding respect of children and vulnerable adults. 34 LEGAL FOCUS
In respect of children, there are 19 dif- age of 14, their own view on reporting will a fine of €5,000 and/or 12 months impris- ferent offences including: rape, sexual not amount to a defence. onment, up to 10 years imprisonment assault, incest by a male or female, false Another important defence arises where • The range of offences where this obliga- imprisonment, child sexual abuse, assault, a parent or guardian makes known their tion arises is wide and covers all forms endangerment, abduction, child traf- own view, or a view on behalf of a child or of sexual offence or abuse, trafficking, ficking, child pornography, cruelty, and vulnerable person, that the matter should assault, and other exploitative offences female genital mutilation, among others. not be reported, where they are acting in • You may have a defence where your In respect of adults, the relevant offences the best interests of the child or vulnera- failure to report results from a wish include rape, sexual assault, incest, traf- ble person, and the alleged perpetrator is expressed by a child over 14 or a vulner- ficking and assault. not a family member. Where the alleged able person who has capacity that the The duty to disclose information in perpetrator is a member of the family, matter not be reported, similarly such relation to the foregoing sexual offences a person will have a defence for failing views may be expressed on behalf of arises whether they occurred in this juris- to disclose where a designated profes- another by a parent or guardian diction or not. In addition, it should be sional has made known a view, on behalf • Specifically, nurses and midwives who noted that liability under the Act arises of the child or vulnerable person, that the are caring for persons in relation to the where the information comes to one’s offence should not be disclosed. injury or harm arising from the alleged attention after the Act enters into force, Furthermore and importantly, where a offence, and where they form the view ie. post August 2012, irrespective of member of a designated profession, includ- in the best interest of the health and when the offence was committed – either ing nursing and midwifery, who is treating a wellbeing of that person that the offence before or after that date. child or vulnerable person for the harm aris- should not be reported, and their actions If convicted for failing to disclose infor- ing from the alleged offence has reasonable are in accordance with best practice, will mation, the penalty on conviction in grounds for forming a view that the mat- not be liable under the Act. the District Court is a maximum fine of ter concerned should not be reported for The Act places onerous obligations on €5,000 and/or 12 months imprisonment. the purposes of protecting the health and all persons to ensure that information Where convicted on indictment, ie. in a wellbeing of that child or vulnerable per- relating to the commission of serious higher court, the penalty imposed is var- son, and they act in the manner expected offences against children and vulnerable iable depending on what the maximum of their profession, then they will have a persons does not go undisclosed. This is penalty would be for the person who com- defence under the Act. In addition, the Act an important obligation, and one which mitted the underlying offence, and the makes special provision, in similar terms to should be in the mind of nurses and mid- penalties range from three to 10 years’ those relating to nurses and midwives, for wives in the context of their day to day imprisonment. persons working with organisations that are practice. Accordingly, one should be mind- Defences recognised by the Minister as providing ser- ful that the obligations under this Act are There are a number of defences which vices to these persons. not displaced by the reporting obliga- may be available to a person, including Key points tions that exist within the health services a nurse or midwife, who fails to disclose The key points that emerge from the currently. information in relation to such an offence. Act, and which have the potential to Thus, while in many circumstances the The first arises where the child is over 14 impinge upon the practice of nurses and workplace reporting of information in years, or they are a vulnerable adult, and midwives, are: relation to abuse, which amounts to one they have expressed a view that they • If you know or believe any of the listed of the offences mentioned, may be suffi- do not want the offence disclosed, and offences have been committed, and you cient, it is still important that where the the person relies on that view and does have information which may assist the nurse or midwife has information of the not report the matter to the Gardaí. This Gardaí in the apprehension and prosecu- type described above, then they must defence will only apply where the child tion of the alleged perpetrator, then you assure themselves that some profes- over the age of 14 was capable of form- have a duty to disclose this information sional in the chain of care has reported ing a view as to reporting the matter, and • A person who fails to disclose this infor- the matter to the Gardaí, unless one of similar provisions apply in relation to vul- mation, without reasonable excuse, can the exceptional circumstances militating nerable adults. Where a child is under the face a penalty on conviction ranging from against reporting exists.
You are not alone Counselling, legal advice, domestic assistance and bodily injury cover WIN
Vol 22 No 7 September 2014 Free helplines provided by DAS, 365 days a year, 24/7 Vol 22 No 10 Dec 2014/Jan 2015 Vol Tel: 1850 670 407 for counselling or 1850 670 707 for other services WIN See www.inmo.ie for further details Pull Out
Continuing Professional Development for Nurses and Midwives
Maintaining your competency – Maintaining your registration inmoprofessional.ie
Welcome to the December/January issue of the INMO Professional Development Centre eight-page pull out featuring opportunities to support nurses’ and midwives’ continuing professional development requirements. The INMO Professional Development Centre is a dedicated education and professional development hub, offering access to professional networks, educational programmes, conferences, library services and focused research for nurses and midwives. Your Invitation to Subscribe to the New INMO Professional e-Newsletter Our first INMO Professional e-Newsletter, recently launched, features up-to- date relevant reports, research and guidance from our expert librarians. The section development officer provides up and coming discipline-specific networking opportunities, section meetings and conferences and the course co-ordinator provides details on the new range of education programmes Elizabeth Adams for 2015 with Category 1 approval from the Nursing and Midwifery Board of Director of Professional Ireland (NMBI) with Continuing Education Units (CEUs). To receive your copy of the quarterly e-Newsletter by email, you are invited to subscribe on our Development, INMO INMO Professional Website: inmoprofessional.ie/Library. The INMO Professional website, inmoprofessional.ie, provides a one-stop-shop to an extensive range of education programmes and research services that are tailored to meet your educational needs. It provides a facility to maintain your professional profile, supporting you to demonstrate evidence of your on-going learning with your CEUs accumulated. You can browse the programme content anytime which includes outlines, aims, objectives and reading lists. A safe and secure online booking system, with discounts for booking on the website will be available from January 2015. In addition to the Education and Continuing Professional Development Directory for Nurses and Midwives – Maintaining Your Competency; Maintaining Your Registration, there is a newly published calendar of events titled Continuing Professional Development, Education Programmes Calendar 2014/2015 which provides a list of over 70 education programmes up July 2015. Details of date, event, venue, and cost all with CEUs are included. Of particular importance to nurses and midwives is the new Code of Professional Conduct and Ethics for Registered Nurses and Midwives (NMBI 2014) that came into effect December 10, 2014. The Code sets the principles of what is expected from a nurse and midwife and their professional responsibilities in caring for patients in a safe, ethical and effective way. Further information on the Code is accessible from the NMBI at: www.nursingboard.ie or email [email protected] for specific information about the Code. Finally, Season’s Greetings from all the staff of the Professional Development Centre and Library. We wish you and your family health and happiness for the New Year.
On-site Training: Let us come to you
The Professional Development Centre successfully delivers on-site training throughout the country each year. On-site training is a more cost-effective solution for larger group training. We currently have 99 tailored education programmes which can be brought directly to you for a standard fee. We use highly skilled facilitators, who are experts in their fields. Each participant on completion of a course is awarded with a certificate that is Category 1 approved by the Nursing and Midwifery Board of Ireland with Continuing Education Units (CEUs). For further information on our courses please contact: Marian Godley, Course Co-ordinator, Email: [email protected] Tel: 01 664 0642 inmoprofessional.ie
2 (CEUs) 3.5 (CEUs) 4/4.5 (CEUs) 5 (CEUs) 5.5 (CEUs) 6 (CEUs) 7 (CEUs) 10 (CEUs) 13 (CEUs) inmoprofessional.ie Education Programmes
Venue: INMO Professional Development Centre, The Whitworth Building, North Brunswick Street, Dublin 7 Tel: 01 664 0641/2. Email: [email protected] Registration for most courses will take place at 9.45am unless otherwise stated. All programmes have Category 1 approval from the Nursing and Midwifery Board of Ireland (NMBI) with Continuing Education Units (CEUs). Courses are colour coded for ease of reference. 2 (CEUs) 3.5 (CEUs) 4/4.5 (CEUs) 5 (CEUs) 5.5 (CEUs) 6 (CEUs) 7 (CEUs) 10 (CEUs) 13 (CEUs) CEUs = Continuing Education Units Check out our New Courses at the Professional Development Centre! For more information log onto inmoprofessional.ie
Date Programme Fee (CEUs) Jan 15, 2015 Assessment and Care Planning in Residential Care €80 members; €140 non-members 6 Settings for Older People
This workshop is aimed at providing nurses working in this sector with the most up-to-date information regarding policy and standards in older person care and will focus on the need for comprehensive assessment, including risk assessment and care planning for older people in residential care settings. Jan 20, 2015 Intravenous Administration of Drugs €80 members; €140 non-members 5
This course discusses accountability in undertaking this role along with the task of undertaking drug calculations will be outlined and demonstrated. Principles of aseptic technique, providing the patient with information on the procedure, gaining consent and complications that may arise before, during and after the procedure will also be explored. The ultimate aim is for participants to learn how to carry out the procedure in a competent and safe manner. Jan 21, 2015 Introduction to Clinical Audit €80 members; €140 non-members 5
This one-day course is designed to equip participants with the necessary skills to implement Clinical Audit in their practice and to be able to deliver evidence of improved performance for safer and better care for patients. Participants will be provided with an overview of Clinical Audit and be taught about each stage in the Clinical Audit Cycle - topic selection, standards development, data collection, data analysis, reporting, implementing changes and re-audit. Jan 27, 2015 Introduction to Palliative Care €80 members; €140 non-members 6
This one-day course will introduce participants to the basic concepts of palliative care – caring for people suffering from a terminal illness as well their families. It will focus on physical, psychosocial and philosophical aspects of palliative care. Specifically, the ethos of palliative care, symptom control and psychological care will be examined.. Jan 27, 2015 Pressure Ulcer Prevention and Management €80 members; €140 non-members 5
This course provides an informal learning environment for nurses/midwives to broaden their knowledge and understanding of pressure ulcer wound assessment and management. It allows participants to ensure professional competency in pressure ulcers, it also provides participants with continuing professional development to ensure that their best practice is founded in the latest research and guidance as per the Health Service Executive’s National Best Practice and Evidence-Based Guidelines for Wound Management. Jan 28/29, 2015 Art and Science of Antenatal Education €150 members; €280 non-members 10 This two-day workshop will prepare midwives to design an effective antenatal education programme for expectant mothers and fathers. The philosophy of this course is based on the principles of adult learning and on the belief that antenatal education is a health promotion activity. This course will prepare midwives to encourage expectant parents to see themselves as competent and able to make informed choices for themselves and for their baby. Jan 30, 2015 Caring for Patients with Renal Impairment €80 members; €140 non-members 7
This study day focuses on developing nurses’ competency in the assessment and management of patients presenting with impaired renal function. Common causes of acute kidney injury and chronic renal failure are sepsis, diabetes and hypertension which are extremely prevalent in the acute hospital, older person and community patient populations. This study day will both inform and equip nurses to more comprehensively assess and care for patients with renal dysfunction. 9.30am-4.45pm. inmoprofessional.ie Official Sponsor of the Professional Development Centre All programmes have Category 1 approval from the Nursing and Midwifery Board of Ireland
Date Programme Fee (CEUs) Feb 5, 2015 Delegation and Clinical Supervision €80 members; €140 non-members 5
This workshop explores the issues surrounding delegation and decision making, including appropriate clinical supervision for delegated functions. Participants will learn what is meant by delegation and how it differs from assignment of a task. The course also provides an understanding of the professional, legal and quality of care issues involved when deciding to delegate a function to a healthcare assistant. Feb 6, 2015 Healthcare Provider CPR and AED €125 members; €195 non-members 6 (including cost of book)
This Healthcare Provider Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillation (AED) course provides the information, rationale and practical skills training for the 2010 CPR and ECC guidelines. Nurses and midwives are required to adhere to the two-year certification period for both basic and advanced life support, as recommended by International Liaison Committee on Resuscitation as the best practice standard. Limited to six participants per instructor. A fee of €50 will be charged if you wish to cancel your booking 10 days before the course begins. Time: 9.15am-4.00pm Feb 10, 2015 Caring for a Person with Parkinson's €80 members; €140 non-members 4
This one day interactive course is designed to deliver up-to-date information while outlining care practices to all nursing staff with an interest in the management of a patient with Parkinson’s. It covers process of diagnosis, clinical features, holistic care approaches, medication therapy, assessment, care planning and evaluation across all activities of daily living. The course outlines the role of the nurse and the interdisciplinary health care team in assessment, planning, implementing and evaluating care with the patient and their carer/family. Feb 12, 2015 Management Skills for Clinical Managers €80 members; €140 non-members 5 and Staff Nurses
This course is focused on the key competencies required for ward managers to be effective in their roles as leaders and managers in healthcare delivery. Clinical managers perform both managerial and leadership functions in order to provide effective healthcare delivery to patients. For this reason, this workshop explores both management and leadership functions and how these are applied in practice so as to promote quality and safety of care. It also highlights the importance of the role of ward manager in leading a team and its role in both national and international initiatives aimed at improving care. Feb 17, 2015 Competency-based Interview Training €80 members; €140 non-members 6
This one-day course helps participants prepare for a competency-based interview. Competency-based interviews, which are based on the premise that past experience can predict future behaviour, are an increasingly common style of interviewing that enables candidates to show how they would demonstrate certain behaviours/skills in the workplace, by answering questions about how they have reacted to, and dealt with, previous workplace situations. This course is suitable for all levels of nurses/midwives. Feb 17, 2015 Understanding Obesity and Weight Management €80 members; €140 non-members 5
This one-day workshop aims to provide a comprehensive understanding of the causes of obesity and knowledge of the physiological principles involved in the onset of obesity and associated illnesses. Lifestyle treatment options such as dietary, exercise and behavioural interventions will be covered in depth on the day, as well as non-pharmacological, pharmacological and surgical interventions. Feb 18, 2015 Nutritional Requirements for Community and €65 members; €120 non-members 3.5 Residential Care Settings
This three hour workshop is aimed at nurses working in community and residential settings. This workshop will focus on a number of key areas in implementing standards and meeting regulations outlined in HIQA’s Food and Nutritional Requirements. The basic nutritional needs of residents will be covered, as well as an introduction to the HIQA guidelines. A brief explanation of feeding practices, therapeutic diets, nutritional screening, safe handling of food, monitoring and documenting food/fluid intake will be covered. There will also be some discussion on sample policies and audit tools. 9.45am-1.00pm. Feb 18, 2015 Presentation Skills €80 members; €140 non-members 6
Presenting yourself and your ideas with confidence, impact and great conviction is of primary benefit for all nurses and midwives. This course provides you with strategies on how to make an effective presentation; how to speak in order to hold interest while remaining professional in your tone as well as how to effectively compile and deliver presentations. Time: 9.15am-4.30pm. Feb 19, 2015 HIQA (2009) Health Care Associated Infections €80 members; €140 non-members 4.5 Standards – Completing Audits and Developing Quality Improvement Practices This workshop aims to educate community facilities with regard to the importance of auditing, continuous quality improvement, the importance of infection prevention, and their responsibilities with regard to HIQA Infection Prevention & Control standards. This knowledge will assist when they are planning the delivery of care to clients, and also how they manage their infection prevention and control. 9.45am-4.00pm. inmoprofessional.ie inmoprofessional.ie
Date Programme Fee (CEUs) Feb 24, 2015 Preparing for HIQA Inspections within the Acute €80 members; €140 non-members 6 Services
The National Standards for Safer Better HealthCare (HIQA, 2012) drive continuous improvement in Ireland’s health and personal social care services within the acute setting. This one day programme aims to assist staff to identify strengths and challenges within their services and create a clear framework for quality improvement. From this perspective the monitoring of safety and quality within these services can enhance a person-centred care approach to all service users and individuals within the hospital setting. Time: 9.30am-4.15pm. Feb 24, 2015 Subcutaneous Administration of Fluids €80 members; €140 non-members 5
The role and responsibilities of the nurse’s role has expanded rapidly during the last few years, this course aims to provide the nurse with the competencies necessary to administration fluid by the subcutaneous route. 9.30am-2.30pm. Mar 6, 2015 Healthcare Provider CPR and AED €125 members; €195 non-members 6 (including cost of book)
This Healthcare Provider Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillation (AED) course provides the information, rationale and practical skills training for the 2010 CPR and ECC guidelines. Nurses and midwives are required to adhere to the two-year certification period for both basic and advanced life support, as recommended by International Liaison Committee on Resuscitation as the best practice standard. Limited to six participants per instructor. A fee of €50 will be charged if you wish to cancel your booking 10 days before the course begins. Time: 9.15am-4.00pm Mar 10, 2015 Wound Care Management €80 members; €140 non-members 5
This programme will allow participants to ensure professional competency in the area of wounds as per NMBI’s Code of Professional Conduct and Scope of Practice for Nursing and Midwifery, which state that nurses/midwives must work within their competence. Furthermore, it will provide participants with continuing professional development to ensure that their practice is founded in the latest research and guidance as per the Health Service Executive National Best Practice and Evidence-based Guidelines for Wound Management. Mar 11, 2015 Principles and Practices of Infection Control €80 members; €140 non-members 5
This study day has been developed in response to the many challenges nurses/midwives face regarding infection control. It is suitable for nurses/midwives working in acute care and community care settings. Mar 12, 2015 Practical Skills in the Management of People with €80 members; €140 non-members 5 Diabetes
This course aims to provide nurses/midwives with understanding, knowledge and confidence when delivering care to individuals with diabetes. This course offers a practical approach to diabetes, whether based in the hospital or community setting. Many theoretical aspects of diabetes are covered such as: the different types of diabetes, national and international guidelines, how to offer lifestyle advice to patients, treatment options, and understanding blood results, as well as dealing with complications in diabetes. Mar 19, 2015 Nursing the Cardiac Patient €80 members; €140 non-members 6
This study day provides a forum to update nurses on national and international trends in the holistic management of patients with cardiac disease. A particular focus on the day is to ensure that presentations are based on current evidence-based practices within the field of cardiology. The day is designed to examine new developments in cardiac nursing, particularly in the area of medications and chronic heart failure. This reflects the diversity of, and challenge in, providing quality care which is individualised to cardiac patients. 9.15am-4.15pm. Mar 20, 2015 ECG Interpretation €80 members; €140 non-members 6
This one-day workshop is aimed at enhancing the general nurse’s knowledge of cardiac electrophysiology. It will provide participants with knowledge of cardiac rhythms, rhythm analysis and ECG interpretation. It is advisable to complete the‘Nursing the Cardiac Patient’ course prior to registering for this course. 9.15am-4.15pm. Mar 24, 2015 Assessment and Care Planning in Residential Care €80 members; €140 non-members 6 Settings for Older People
This workshop is aimed at providing nurses working in this sector with the most up-to-date information regarding policy and standards in older person care and will focus on the need for comprehensive assessment, including risk assessment and care planning for older people in residential care settings. Mar 25, 2015 Best Practice in Medication Management €80 members; €140 non-members 5
This programme has been developed to support nurses in providing safe evidenced-based practice in the area of medication management. It supports nurses/midwives by ensuring that they are up to date and meet the requirements of the Nursing and Midwifery Board of Ireland (NMBI) and HIQA in the area of medication management. inmoprofessional.ie Official Sponsor of the Professional Development Centre Education programmes coming to the Cork Office, Sheraton House, Hartlands Avenue, Glasheen, Co Cork
Date Programme Fee (CEUs) Jan 20, 2015 Preparing for HIQA Inspections within the Acute €80 members; €140 non-members 6 Services The National Standards for Safer Better HealthCare (HIQA, 2012) drive continuous improvement in Ireland’s health and personal social care services within the acute setting. This one day programme aims to assist staff to identify strengths and challenges within their services and create a clear framework for quality improvement. From this perspective the monitoring of safety and quality within these services can enhance a person-centred care approach to all service users and individuals within the hospital setting. Time: 9.30am-4.15pm. Jan 22, 2015 Nutritional Requirements for Community and €65 members; €120 non-members 3.5 Residential Care Settings
This three hour workshop is aimed at nurses working in community and residential settings. This workshop will focus on a number of key areas in implementing standards and meeting regulations outlined in HIQA’s Food and Nutritional Requirements. The basic nutritional needs of residents will be covered, as well as an introduction to the HIQA guidelines. A brief explanation of feeding practices, therapeutic diets, nutritional screening, safe handling of food, monitoring and documenting food/fluid intake will be covered. There will also be some discussion on sample policies and audit tools. 9.45am-1.00pm. Feb 11, 2015 Non-Violent Crisis Intervention €80 members; €140 non-members 7
This one-day programme is designed to assist staff to provide the best care, safety and security for staff working in healthcare environments. The programme identifies behaviours that contribute to the development of a crisis and outlines appropriate staff intervention for each response. It also identifies verbal and non-verbal techniques to de-escalate behaviour. In addition, the course outlines break-away techniques that can be adopted in a physical crisis situation while maintaining the care, welfare, safety and security of clients and staff. It also helps participants to identify the triggers and patterns of behaviour and, therefore, develop a person-centred care plan and a consistent approach in order to prevent the behaviour from reoccurring. Time: 9.15am-5.00pm. Feb 25, 2015 End of Life Thematic Inspections €80 members; €140 non-members 6 The aim of this workshop is to outline the legal and professional requirements for end of life care in designated centres and to identify how to apply this to practice, so as to provide effective, evidence-based care to residents. HIQA standards, regulations and guidance will be used to prepare participants for thematic inspections. Time: 9.30am-4.00pm. Feb 26, 2015 Food and Nutrition Thematic Inspections €80 members; €140 non-members 5 This course is aimed at nurses working in residential care settings for older people. It aims to enable participants to implement national standards, regulations and professional guidance for meeting residents’ food and nutrition needs. During the course participants will learn how to apply these standards and regulations to assessment, care planning and monitoring of resident’s nutritional needs. Mar 5, 2014 Delegation and Clinical Supervision €80 members; €140 non-members 5 This workshop explores the issues surrounding delegation and decision making, including appropriate clinical supervision for delegated functions. Participants will learn what is meant by delegation and how it differs from assignment of a task. The course also provides an understanding of the professional, legal and quality of care issues involved when deciding to delegate a function to a healthcare assistant.
To book a Cork course call the INMO Professional Development Centre at Tel: 01 664 0641/2
Applying for PDC Courses
Places can by booked by credit/visa/visa debit card by calling 01 664 0641/2. For more information log on to inmoprofessional.ie inmoprofessional.ie inmoprofessional.ie
Education programmes coming to the Limerick Office, Unit 4B, Courtfields, Raheen, Limerick
Date Programme Fee (CEUs) Feb 23, 2015 Assessment and Care Planning in Residential Care €80 members; €140 non-members 6 Settings for Older People
This workshop is aimed at providing nurses working in this sector with the most up-to-date information regarding policy and standards in older person care and will focus on the need for comprehensive assessment, including risk assessment and care planning for older people in residential care settings. Mar 30, 2015 Non-Violent Crisis Intervention €80 members; €140 non-members 7
This one-day programme is designed to assist staff to provide the best care, safety and security for staff working in healthcare environments. The programme identifies behaviours that contribute to the development of a crisis and outlines appropriate staff intervention for each response. It also identifies verbal and non-verbal techniques to de-escalate behaviour. In addition, the course outlines break-away techniques that can be adopted in a physical crisis situation while maintaining the care, welfare, safety and security of clients and staff. It also helps participants to identify the triggers and patterns of behaviour and, therefore, develop a person-centred care plan and a consistent approach in order to prevent the behaviour from reoccurring. Time: 9.15am-5.00pm. April 15, 2015 Understanding Obesity and Weight Management €80 members; €140 non-members 5
This one-day workshop aims to provide a comprehensive understanding of the causes of obesity and knowledge of the physiological principles involved in the onset of obesity and associated illnesses. Lifestyle treatment options such as dietary, exercise and behavioural interventions will be covered in depth on the day, as well as non-pharmacological, pharmacological and surgical interventions.
To book a Limerick course call the INMO Professional Development Centre at Tel: 01 664 0641/2
All programmes have Category 1 approval from the Nursing and Midwifery Board of Ireland (NMBI) with Continuing Education Units (CEUs)
INMOP Safe ractice Workshops The Professional Development Centre is providing a nationwide series of workshops in venues across the country. This programme provides safe practice tools to protect the nurse and midwife and patient within current healthcare settings. This is an awareness session to ensure all staff have an understanding of the process involved regarding patient alerts, clinical incidents and thorough assessment, while remaining focused on patient and individual staff. The programme addresses patient safety and staff safety and provides five key tools on areas of documentation, clinical incident reporting, safety statements, best practice guidelines regarding assessment, and communication practices in a complex multifaceted healthcare arena. ‘Tools for Safe Practice’ is Category 1 approved by the Nursing and Midwifery Board of Ireland and awarded with 4 CEUs. Dates and venues for safe practice workshops: Dec 10 – Education Centre, Merlin Park Galway; Jan 7 – Letterkenny (Venue to be confirmed); Jan 8 – Sligo (Venue TBC); Jan 12 - O’Donovan Hotel, Clonakilty; Jan 14 – Beaumont Hospital (Venue TBC); Jan 15 – INMO Cork office; Jan 16 – Midleton Park Hotel, Cork More dates and venues are available on our website inmoprofessional.ie If you would like to arrange this workshop in your area and can guarantee a minimum of 25 participants, please contact your IRO. To book a place please email Helen O’Connell at [email protected] or Tel: 01 664 0616 Fee: INMO members FREE; €150 non-members inmoprofessional.ie Official Sponsor of the Professional Development Centre INMO Professional Development Centre – Library Services intellectual disability nursing resources The Professional Development Centre Library is a valuable resource for information on intellecual disability nursing, write assistant librarians Edel Reynolds and Niamh Adams
To coincide with the RNID workshop entitled Multi Element Behaviour Support: Positive Behaviour Support Training. Part 1 facilitated by Kathleen Byrne, clinical nurse tutor from Trinity College Dublin taking place in December, the library staff are tak- ing the opportunity to focus on the topic of intellectual disability nursing. This article briefly outlines some of the most recent and topi- cal literature from Ireland and from an international perspective. A selection of research/review articles, key reports and guidance documents have been identified. Also outlined in the article are some of the key available e-resources – including databases and e-Journals – from the PDC Library. All of the articles and reports listed below can be accessed in full text via our online library. Log on to www.inmoprofessional. ie/library and then select Nurse2Nurse or log on directly to www. nurse2nurse.ie with your username and password. TILDA – findings on the ageing of people with an intellectual Recent Irish Literature disability. 2014 Articles • McCarron M, et al. Growing older with an intellectual disability Clinical Nurse Specialist in Ireland 2011: first results from the intellectual supplement of • Ryan P, Doody O. Clinical nurse specialists: a reflection on prac- the Irish longitudinal study on ageing. 2011 tice. Learning Disability Practice 2014; 17(1): 26-31 Standards Residential Care • HIQA. National standards for residential services for children and • McConkey R, Kelly F, Craig S, Mannan H. A longitudinal study of adults with disabilities; 2013. the intra-country variations in the provision of residential care • HSE. Time to move on from congregated settings: a strategy for for adult persons with an intellectual disability. Journal of Intel- community inclusion; 2011. lectual Disability Research 2013; 57(10): 969-979. Day Services Special Irish Issue • HSE. New directions: review of HSE day services and implemen- • Salmon N, Iriarte E. Special Irish Issue of British Journal of Learn- tation plan 2012-2016. Personal support services for adults with ing Disabilities. British Journal of Learning Disabilities 2013; disabilities; 2012. 41(3): 167-170 RNID e-Resources Older Person Electronic databases • Doody CM, Markey K, Doody O. The experiences of registered • Ebsc o Cinahl intellectual disability nurses caring for the older person with • Medline intellectual disability. Journal of Clinical Nursing 2013; 22(7/8): • Internurse 1112-1123 E-Journals Positive Behavioural Support • Journal of Intellectual Disability Research, 1992 > Present (12 • McGrath A. Role of carers' assessments in behaviour analysis. month delay) Learning Disability Practice 2013; 16(8): 24-26. • British Journal of Learning Disabilities, 2000 > Present (12 • LaVigna G, Willis T. The efficacy of positive behavioural sup- month delay) port with the most challenging behaviour: The evidence and its • Journal of Intellectual and Developmental Disability, 1996 > (18 implications. Journal of Intellectual and Developmental Disabil- month delay). ity 2012; 37(3): 185-195. INMO Professional Development Centre Library service • Crates N, Spicer M. Developing behavioural training services to For further information on the library services available, meet defined standards within an Australian statewide disability or in relation to search assistance, please contact the library. service system and the associated client outcomes. Journal of You can access the online library by logging on to www. Intellectual and Developmental Disability 2012; 37(3): 196-208 inmoprofessional.ie/library and then selecting Nurse2Nurse. • Baker P, Allen D. Use of positive behaviour support to tackle Contact the Professional Development Centre Library, on challenging behaviour. Learning Disability Practice 2012; 15(1): 01 664 0614/25 or by email: [email protected]. Opening hours: 18-20 Monday to Thursday: 8.30am-5.00pm, Friday: 8.30am-4.30pm.
The Irish Longitudinal Study on Ageing (TILDA) Edel Reynolds and Niamh Adams are assistant librarians at the Irish Nurses and • Burke E, et al. Advancing years, different challenges: Wave 2 IDS- Midwives Organisation inmoprofessional.ie 46 INTERVIEW
Aiming high
Dean Flanagan spoke to Alison Moore about his new role as president of the European Nursing Student Association
Dean Flanagan, INMO new graduate “Following work at the conference ing as a gender equal profession.” and student officer, was elected as the we’ve prepared questionnaires on gender Of those males who do enter nursing, president of the European Nursing Student equality to be sent, hopefully within the according to Dean, they tend to see their Association (ENSA) at its recent annual next month, to the ENSA Board where career path leading to management rather meeting which was hosted by the INMO we’ll prepare a working document and a than clinically-based roles, so ENSA is try- in Dublin. statement for EU. ing to encourage them to see that there While ENSA is more than 30 years in “Next year, we will look to make a is a future for them in the clinical end of existence, it only recently became a statement to the EU that the degree nursing rather than just administrative. legally recognised body and Dean will be should be the level that all European To this end, ENSA currently has a mini the first president leading the association countries should look to achieve for nurs- video series in production that promotes under a legal constitution that enables ing students,” said Dean. males in clinical practice. lobbying and involvement in projects The issue of gender equality in nursing “We got the nurses from across Europe affecting nursing students across Europe. has been high on ENSA’s agenda for sev- to do little webcasts of why they have The AGM took place over four days from eral years now. Dean explained why this joined nursing and why they’re sticking in October 24 to 28, with representatives from issue was so important to the group. nursing, and we’re compiling them into a 18 countries taking part. As ENSA is now “For example, until a few years ago, it short film,” said Dean. working in close collaboration with EFN was illegal for men in Turkey to become He explained that Ireland was no differ- (the European Federation of Nurses Associ- nurses. Then we examined the experi- ent to the rest of Europe with only about ations), it took place at the same time as the ences in other countries where they have 7-10% of the profession being male and EFN Conference, also hosted by the INMO. changed the way nursing has been adver- with a high percentage going down a man- Dean explained that the conference tised, which has encouraged more men to agerial path. focused on two main themes: standardis- come on board. In Croatia this has had a While ENSA won’t become involved in Vol 22 No 10 Dec 2014/Jan 2015 Vol ing nursing education at degree level and big influence, with 27% more men taking any issues on a national level, they will
WIN gender equality within nursing. it up since they’ve started marketing nurs- be working toward a better standard of INTERVIEW 47
undergraduate education across the conti- nent. According to Dean, Ireland compares very well in terms of education. “We have a degree programme in place and the research shows that patient mortal- ity rates are lower when nurses are degree educated. While Ireland’s education system did fare better than the likes of Spain, Por- tugal, Croatia and Germany, we still have a bit to be improved on to catch Scandina- vian countries, in particular,” he said. However, Dean stressed that the level of clinical practice time that Irish students benefit from, is not afforded to most other European students who simply do not get the clinical experience that Irish nurses get before registration. “It is easy to see why the Irish degree is so valued, even in the likes of the UK where the training is three years. That extra year that we have along with our internship really does pack a punch in our degree when competing with the Euro- pean mainland countries. “In Germany they have two different steps to nursing. One is a degree but only 7% of nurses take this option. So ENSA would like to standardise education across Europe so that it means a nurse in Germany, the UK or Spain would be the same as the nurse from Ireland and the same as a nurse from the Scandinavian countries. “And because we now have that piece of paper to say that we’re a legalised body, we can do that by lobbying at the EU,” he said. These are very much long-term goals for ENSA and in order to achieve them Dean explained that the Board’s terms of office would have to be extended from one to two years in order to achieve continuity. Pictured at the ENSA annual meeting in INMO HQ in Dublin recently were (top photo, l-r): Newly elected ENSA “We will be looking to make it far more Board members – Delphine Thézé, France; Mia Andersen, Norway; Dean Flanagan, Ireland; Erdinc Demirer, Turkey; and Sanne Nyquist, Denmark consistent where the immediate Board (Lower photo) ENSA delegates from 18 European countries hard at work during the conference that leaves is still involved in the Organi- sation before fully handing over the reins. relationship with the other European stu- This collaboration of student organi- So, I’m hoping to still be involved this time dent organisations such as the European sations will ultimately strive to embed a next year for a second term.” Pharmaceutical Organisation, the Dental multidisciplinary approach in undergrad- One of the challenges facing the new Doctors Association, the Student Doctors uate training and in student organisation ENSA board is how to get its business Association and the Student Physiothera- interaction.
done when the members are scattered pists Association. “We don’t want people to approach WIN across the continent. “We are working to create a summit healthcare anymore with the view that “My vice-president is from Norway. The where we’re all going to meet. We have the various professions are completely Vol 22 No 10 Dec 2014/Jan 2015 other board members are from Denmark, already had our first meeting, via Skype separate, rather that everyone works France and Turkey. Thankfully, with the to discuss this. The aim of this summit is together,” he said. invention of Skype, it is very easy to keep going to be about the inter-professional Dean explained that because ENSA has in contact. So, we have meetings every collaboration not only at the national level not been promoted very much in the past, second week and update people on where but at the European level. This would be the average student in Ireland would not we are,” said Dean. the first time that all the student organi- know much about the group and its work, One of Dean’s aims for his ENSA pres- sations have ever got together to discuss but he plans to change that by raising idency is to establish a good working healthcare in their countries,” said Dean. awareness here. FROM THE PRESIDENT 49
On the ground with the president
Season’s greetings Disability It is so hard to believe that Christmas is almost here and 2015 is just The Joint North South ICTU Disability around the corner. I would like to take this opportunity to wish you Seminar, which I co-chaired with all a happy and peaceful Christmas and New Year. We have, yet Bernie McCrea, chair of the Northern again, had a very difficult year and as we head into the holiday Ireland Committee, was held season I hope that each and every one of you will be able to recently in Derry City. This was a take some time out with your families and loved ones. We have great opportunity for the sharing of many obstacles to overcome as we face into 2015. As our economy information and networking. is improving, let us embrace the challenges facing us together as a More than 50 delegates attended unified group and look forward to the next year with positivity. and the theme was ‘The contribution that the United Nations Conven- NMBI protest tion on the Rights of Persons with We recently had our Disabilities can make to the lives protest at NMBI head of people on the island of Ireland’. quarters in Blackrock as part There was also a discussion on the of our campaign to reverse comprehensive employment strategy the decision to increase the for people with disability from the retention fee for members National Disability Authority which by €50. There was a fantastic also held its annual conference in turnout of more than 2,000 recent weeks in Croke Park. protesters on the day. I would ask all members to please Claire Mahon, president of the INMO, pictured addressing EFN INMO members and staff who attended the protest at the keep themselves updated by NMBI HQ in Blackrock in Dublin last month Iast w a great honour to host the checking the website and our ENS4Care, EFN and ENSA meetings in newsflashes. It is extremely important that we all work together to reverse this decision Dublin in October. You may be aware for now and into the future. We will keep you fully informed of developments. that EFN represents more than one million nurses across 34 European Midwifery Section conference countries. Some 78 participants from 27 Our Sections play a major role within the Organisation and the highlight for many of countries attended. Leo Varadkar, Minis- them each year is their annual conference, which is a great opportunity for members ter for Health, formally opened the EFN within various disciplines to network. These very valuable education days are impor- General Assembly, which was his first tant events in our calendar and I always welcome an opportunity to attend. It was a official engagement with the INMO. great pleasure that this year we hosted the annual North South Midwifery Confer- ENSA – the European Nursing Student ence in Dublin in October. More than 120 midwives from across the island of Ireland Association held its meeting concur- attended an excellent day. rently with the EFN and I would like WIN We welcome all sections and are delighted to see that our National Children’s to congratulate our student and new Vol 22 No 10 Dec 2014/Jan 2015 Nurses Section (formerly Paediatric Nurses Section) has re-established its network graduate officer, Dean Flanagan on his and held their first meeting in November. If you have an interest in any of our sections election as president of ENSA. See more please keep up to date on their meetings and events on the website and in WIN. on these meetings on pages 46-47
Get in touch You can contact me at the INMO headquarters at Tel: 01 6640 600, through the president’s corner on www.inmo.ie or by email to: [email protected] MEDIA WATCH 51
Health funding falls short
Hospital and ED overcrowding increases and beds continue to close, all while more senior managers are recruited. Ann Keating reports
A headline in the Irish Independent Increase in number of senior managers told IRN that members have made it clear (November 28) was €3m to try to reduce The Irish Sun (November 27) covered a that they want to get back to where they trolley queues in A&E. “The aim is to press release issued by the INMO under were in regard to pay and hours before the transfer some of the 850 patients who are the heading 10% more bureaucrats, HRA. The INMO never made a secret of in acute hospital beds, who no longer need 34% extra on trolleys. “Official figures the fact that it regarded the one and half to be there, said Junior Health Minister released yesterday showed that the num- hour increase in the working week agreed Kathleen Lynch… However, nurses warned ber of senior managers in HSE hospitals under the HRA as “a temporary measure”, that the A&E overcrowding was getting had increased by more than ten per cent she said. worse and said the numbers of patients on since 2011. The data, obtained under a “Ms Ni Sheaghdha said that the union hospital trolleys in October rose by 34% Freedom of Information request, also would consult with branches over the compared to the same month last year. revealed that, at the same time as the coming months to agree a strategy in the The HSE service plan will not address this extra 30 bureaucrats were being hired, the talks. She added that they will also consult kind of overcrowding. While the HSE plans number of staff nurses on the payroll fell with the Public Services Committee of the to employ more nurses directly rather than by 744 – down 3%. ICTU in advance. However, she said that hire them through an agency it would not “Demanding a review of top level struc- while Public Expenditure & Reform Min- lead to a rise in numbers, said Liam Doran tures in the HSE, the Irish Nurses and ister, Brendan Howlin, had indicated that of the INMO. He said that the background Midwives Organisation warned that the he intends discussing pay with the unions to the plan, which cannot be ignored, was figures would ‘further undermine the next year, there has been no formal invi- that there were 7,000 people on trolleys morale of frontline staff’. tation as yet and no union has lodged an during the month of October. There were “Union chief Liam Doran directly linked official claim.” more than 2,000 acute and continuing nursing cuts to the spiralling number of NMBI protest care beds closed across the country and hospital patients on trolleys and in over- The Dun Laoghaire Gazette (November there were 5,000 fewer nurses working in crowded wards – 6,977 last month, up 27) covered the NMBI protest under a the system, compared to 2009. 34% on a year ago.” He said: “While we headline – Nurses and midwives take to “This service plan should ensure the have increased the number of senior man- street over 50% fee rise – Registration health service does not suffer any fur- agers, the number of people on trolleys Board cites legal bills for hike in levy. ther contraction. However, the plan, and has increased, waiting lists have increased “About 2,000 nurses and midwives par- the budget allocated, failed to recognise, and the number of day-care procedures ticipated in a march in Blackrock recently let alone address, the critical state that has decreased. This is a direct result of opposing a 50% increase in registration many areas of our health service were cutting frontline services. Therefore these fees from January 2015.” Liam Doran said: now in, leading to the compromising of additional senior managers have not “We pay €100 of a fee but we’re not going patient care on a daily basis. The INMO resulted in improved services for patients.” to pay €150 to a Board that does not enjoy believes that in order to address six years 37-hour working week the confidence of INMO because they of unmanaged contraction of our health An article in the Industrial Relations haven’t supported them… the average service, the government must acknowl- News (November 27) stated – Nurses nurse and midwife feels that the fee is sim- WIN edge, without further delay, the need for to seek roll back on HRA concession ply a compulsory charge used to prosecute Vol 22 No 10 Dec 2014/Jan 2015 emergency funding. This must be targeted on working hours. “The Irish Nurses and them in the event that they might have at overcrowded emergency departments, Midwives Organisation will be seeking a done wrong. There is no empathy between the opening of closed beds and the further reversion to the 37-hour week that existed the professionals and the board at the enhancement of community nursing and prior to the Haddington Road Agreement moment and the attempt to increase the support structures. Maintaining existing in ‘pay restoration’ talks that are set to fee is just a step too far, and is reflected services, after a year in which the HSE’s be held between the public service unions in 2,000 people on the street outside the own internal reports said the health sys- and the Department of Public Expendi- board offices.” tem was doing less with less, was simply ture & Reform in 2015. INMO director of Ann Keating is the INMO media relations officer, not good enough.” industrial relations, Phil Ni Sheaghdha, email [email protected] 52 STUDENT FOCUS
UDENT Staying on FOCUS top of stress
INMO student and new graduate officer Dean Flanagan reports on news concerning rosters on clinical placements and offers advice on coping with stress
I have just about completed my round student nurses/midwives should have a your work with much more confidence. of visits to the colleges and universities 35-hour-week roster for clinical placement If you’re feeling overwhelmed by all the around the country to meet as many of on the wards. This is the total number of things you have to do, make a plan. Start the new first years as I could. I would like hours that they can be assigned to ward by making a list of tasks and prioritising to say a huge hello to everyone I have met duties; reflective time is separate. them. Putting a ‘to-do’ list down on paper so far and a big thank you to the busy lec- Supernumerary rosters: It has come to will give you a checklist to keep track and turers and allocation staff who allotted the INMO’s attention of late that many also give you a sense of accomplishment time for the INMO. first, second and third-year-student every time you get to tick something off. However, I know I haven’t met every- nurses/midwives are being approached Keep a notepad by your bed so if you are one yet and if you know anyone who was with a view to being rostered for night lying awake worrying about things you missed out on, they can always join up duty and weekends. This was never part have to remember, you can sit up, write it online at www.inmo.ie/Membership. of the supernumerary agreement for down and then put it out of your mind and European Nursing Students Association student nurses/midwives. At conciliation go back to sleep. At its recent AGM in Dublin, I was on October 24, it was confirmed that first Make sure you finish a task through to delighted to be elected president of the second and third-year-student nurses/ the end. Leaving work half-finished and European Nursing Student Association midwives can only be rostered for their putting it off until later will only increase (ENSA) for 2014/2015. My role for clinical placement on Monday to Friday, your feeling of stress about it. the following year is challenging, and during normal nurse/midwife working Be proud of the things you have done I will seek to bring ENSA into a new hours, excluding night duty and bank rather than worrying over the things you working partnership with the European holidays. haven’t yet done. Yes, it’s important to Federation of Nurses (EFN), and ensure It is important that where student work, but it’s just as important to relax. that nursing students are represented at nurses/midwives (first, second and third Make sure you’re setting aside time to a European level, both professionally and years) are rostered already for night duty get away from the stress, to unwind your competently. or weekends, they should bring this confir- mind and your body. Outcomes at the Labour Relations mation to the attention of their employer If you do feel that you are being given Commission (LRC) and revert to the Monday to Friday roster. too much responsibility or not getting The INMO recently received two out- If you have any difficulty in respect of this enough support, talk to someone – your comes relating to students from the LRC. matter, please contact your INMO indus- preceptor, tutor or a senior person at Reflective time: It has long been stated trial relations officer (IRO) who will assist work. Everyone has to cope with pressure, by students that their clinical roster is for you in this regard. but when it becomes full-on stress that 39 hours, or prior to the introduction of How to cope with stress as a student dictates your life and you can’t get it out a 39-hour-week, 37 hours. In most cases nurse or midwife of your mind, it’s time to tell someone and students have advised that reflective time Many of you will begin clinical place- seek help. is not separated from their roster on a ments shortly and may be feeling a little Be flexible – nobody’s perfect and pre-determined basis. There is now agree- stressed. While a little stress can be okay, nobody is able to do everything. Give ment that the four hours reflective time too much stress is damaging. Everyone yourself a break if you mess up or when constitutes a predetermined and sched- deals with stress differently. Knowing things don’t go according to plan. It uled block of four hours outside of the how you react to stressful situations, happens to us all. Vol 22 No 10 Dec 2014/Jan 2015 Vol 35-hour-week clinical roster. and developing good habits for coping • See page 46 for more details on Dean
WIN What this means is that fourth-year with the pressure will help you approach Flanagan’s role as ENSA president MIDWIFERY MATTERS 55
Promoting midwifery standards Europe-wide Mary Higgins reports on the recent EMA AGM held in Estonia
The European Midwives Association fied both with the location and the content. tions and advocating for the development (EMA) is a non-governmental organisation The venue for the next EMA Education Con- of midwifery education, practice and regu- of midwifery associations from member ference is London in 2016 and it will be lation in Europe. states of the EU, members of the Council hosted by the Royal College of Midwives. There was a very interesting presenta- of Europe, the European Economic Area There was a report on the EMA and the tion by Maret Voites from the Estonian (EEA) and EU applicant countries. It pro- use of social media and this generated Midwives Association. She described the vides a forum for midwives to meet and debate on the EMA website which was website for pregnant and postpartum discuss issues relating to midwifery and recently revamped. women and their families hosted by the women’s health. It promotes minimum A proposed EU project on association association. It is a wonderful resource for standards for midwifery education and twinning was considered. It is likely that families, providing them not only with practice and contributes to EU discussions funding could be obtained for such an information on pregnancy and birth, but affecting health policy and midwifery. undertaking. Delegates were reluctant to also advice on social welfare entitlements This year the meeting was held in commit their associations to taking part and other issues as required. Tallinn, Estonia on September 26-27. Del- without a clear description of what would The preliminary results from the Nordic egates from 23 countries representing 26 be involved. It was decided that the twin- Homebirth Study were presented by Ellen midwifery associations attended. Tallinn is ning concept could be re-considered at Blix from Norway and there were short the capital of Estonia and its largest city. a later date. It has worked very well for presentations on developing midwifery The Old Town is a UNESCO World Herit- the associations that have taken part in practice standards and changing maternity age site and a beautiful place to visit. north-south ventures. However, it was policies by delegates from Germany, Swit- The meeting was opened by Mervi acknowledged that twinning can be very zerland, Malta and Greece. Jokinen, president of the EMA, and Pille time consuming. Mervi Jokinen presented practice issues Teesalu, president of the Estonian Mid- Following elections and a decision on relating to continuing midwifery education wives Association. The delegates were also the venue for AGM 2015, a press release in the EU. She also spoke about the World welcomed to Estonia by Urmas Kruuse, relating to the meeting was prepared. This Health Organization draft document on Estonia’s Minister of Social Affairs, who stated that the EMA had supported Esto- nursing and midwifery that had been the joined the meeting by video link. nian midwives in the process of amending subject of a technical briefing at the Euro- There was a change to the usual meet- the legislation that regulates midwives pean Committee Meeting in Copenhagen ing format. In previous years the business and midwifery practice. Such legislative earlier in the month. of the meeting was interspersed with changes have allowed women to choose The afternoon was devoted to work- sessions relating to midwifery practice their place of birth and had provided them shops with each delegate able to attend issues. This year all the business was done with more options for the type of mater- two of the four workshops. Three of the on the opening day of the meeting and nity care they can access. The role of the topics focused on the morning presenta- practice matters were the focus for the midwife is now fully recognised: their tions: homebirth, midwifery practice second day. autonomy and their ability to practice standards and changing maternity poli-
The annual and financial reports were independently fulfilling the activities of cies. The fourth considered the available WIN discussed and the budget for 2014-2015 the midwife as outlined in the EU Directive tools for elearning and professional com- agreed. The discussion of the annual 2013/55/EU and in accordance with Inter- munication. The feedback session ensured Vol 22 No 10 Dec 2014/Jan 2015 report was linked to the strategic plan, an national Confederation of Midwives (ICM) that delegates had an overview of how the approach that was very helpful as it was core documents. discussions in each group had progressed. easy to see what had been accomplished. The European Midwives Association The day ended with thanks offered to the Franka Cadeé from the Netherlands strongly commends the current devel- host association. It was a well organised presented an evaluation of the EMA Edu- opments that have been attained by the meeting and was positively evaluated. Next cation Conference held in Maastricht in Estonian Midwives Association in rela- year the AGM will be held in Romania.
November 2013. tion to midwifery in Estonia, in its role in Mary Higgins is international officer of the INMO Midwives Overall, participants had been very satis- strengthening other midwifery associa- Section LIFE STORY 57 A life lived is a life loved
A life of love, learning and travelling. Ann Keating met with Patricia Marteinsson who shared her story
P atricia Marteinsson works as a child When their health deterio- health and lactation consultant in the rated they would move to Midlands. She loves her job and believes a higher level of care. The nursing is a wonderful career. She took a same people looked after very exciting path to where she is today. them for years so they She left school in 1979 and worked as a became like family. nurse’s aide in the local hospital in Tullam- In heavy snow it was ore before she did her nurse training in St impossible to get to work.
Vincent’s Hospital, Dublin. She had three One day Patricia woke up Patricia Marteinsson fantastic years there and made friends for to find a tank outside the life. She then moved back to the Midland window to bring her to work where she Nephew Award jointly with another col- Regional Hospital in Tullamore where she would stay the whole weekend. The Red league in the class. She then got a job as worked in the ICU and CCU. She later got a Cross could bring her home. When she designated PHN for Travellers in Laois and permanent job in the Royal Hospital, Don- worked on the maternity ward she could Offaly. She found this job exceptionally nybrook and subsequently worked in the expect police to come and pick her up for interesting. Coombe Women’s Hospital for two years. work. She would bring her kids with her and She loves her current job where she Following her stint in the Coombe she did they rocked the babies in the cots. works with a huge population group. She is agency work as there were lots of opportu- She was in the hospital one day and delighted to be in a position to work near nities in Dublin at the time and she wanted a woman came and threw her baby, home as she can look after her 87-year-old to see what she liked best. She worked in Thomas, at her – apparently lifeless. She mother and her youngest son. She works St John of God, the Irish Cancer Society, the resuscitated him for an hour and a half. with children from birth to school-going Mater Private ICU and Beaumont ICU. He was six weeks old with a heart condi- age, and children with disabilities from six She then decided to go abroad and tion and was flown by air ambulance to to 18. She is happy that the breastfeeding did her US exams. However, she met her England where he had heart surgery. She rate is increasing and she derives great sat- husband-to-be Marteinn, a fisherman gets a letter every Christmas from Thomas isfaction from her work. from Iceland, on a Spanish holiday and and his mother. She calls him ‘one of her She is involved in local groups such as everything changed. According to Patricia angels on earth’. ‘Parents First’ – a group that supports their eyes met across a crowded room and Patricia had two children while in Ice- parents and first time mothers and also that was it! He proposed and she moved land – both premature. She felt it was a the St Vincent de Paul. She likes to go to to Iceland and found it an amazing experi- really lovely community to live in and the gym and swim, is an avid reader and ence. Marteinn organised a job for her. She a great safe place to rear children with loves to cook and travel. She has trav- had to learn the language and it was diffi- plenty of fresh air, fresh fish and costs for elled extensively including camping with cult in the beginning, but she soon settled play school were paid in addition to salary, the Bedouins in the desert in Wadi Rum in in. Iceland has a population of 360,000 which itself was good. Taxes amounted to Jordan where pillows were placed in front people in total. She worked on a surgical €120 a year which covered A&E attend- of the tent to keep out the snakes! She and medical ward combined, eventually ance. It cost €3 to see a GP. has travelled to the Red Sea, the Far East, WIN becoming the night sister. She imported aloe vera into Iceland and America and has even tried sky diving.
Patricia did several courses, including that business paid for her holidays home Patricia has been an active member of Vol 22 No 10 Dec 2014/Jan 2015 suturing, before moving to maternity. She to Ireland every year. She also did home the INMO for years. She is currently chair did a Masters in Science through long dis- births and water births. of the Offaly Branch and also chair of the tance learning and became an ANP. Patricia lived in Iceland for over 13 years, PHN Section. In addition, she worked in a nursing returning to Ireland in 2002 and to work According to Patricia “the day you stop home at the weekends as she missed in the community. She helped to set up learning is the day you should hang up the banter with older people. While each MIDOC in the Midlands. She had her third your boots”. Last year she did a diploma in elderly person had their own apartment, child and did the PHN course during her Child Psychology and a QQI Level 5 course they also had the benefit of nursing care. maternity leave. She won the Smith & in computer skills. Clinical Focus Continuing education and moving points in medicine Module 21: Brain disease Management of treatment- resistant depression
Many patients who do not respond to initial treatment for depression will subsequently find remission when prescribed alternative or supplemental antidepressants, write Clare Shields and Declan Lyons
Mental illness affects one in four people in their lifetime.1 Mood and information on the treatment steps in the management of disorders are the most common mental illnesses and depression is depression.3 the fourth highest cause of disability worldwide. It is an extremely According to this trial, the first choice in the treatment of common presentation to primary care with only upper respiratory depression is an SSRI. A typical choice would be citalopram 20mg tract infections and hypertension presenting more frequently.2 or escitalopram 10mg. If a patient does not respond to the initial A significant number of people with depression do not respond antidepressant or cannot tolerate it, it is recommended to switch to the initial treatment. In one trial, only 37% of patients antidepressant class. When switching class, you should taper and obtained remission with citalopram (a selective serotonin reup- then stop the initial antidepressant and start the new medication. take inhibitor – SSRI) alone.3 Treatment-resistant depression does There are many choices available when switching antide- not have a standardised definition but is widely considered to be pressant class. The most commonly prescribed would be the a failure to respond satisfactorily to two trials of antidepressant serotonin-norepinephrine reuptake inhibitor (SNRI), venlafaxine, monotherapy. followed by atypical antidepressants such as mirtazapine and It is important to be aware of the steps in the treatment plan bupropion. for depression, including the different antidepressant classes Tricyclic antidepressants such as amitriptyline and dothiepin and augmentation agents, the availability and benefits of are less commonly prescribed and tolerability issues, often arising psychotherapy, and the social supports surrounding the patient. It from anticholinergic side-effects, may be relevant. Monoamine is also vital to educate and give appropriate information about the oxidase (MAO) inhibitors, for example, phenelzine, are another treatment options available, such as electroconvulsive therapy option. (ECT), if a patient requires inpatient care and treatment. The role of venlafaxine when switching from an SSRI is well Important considerations researched. A meta-analysis compared switching from an SSRI to When making a diagnosis of treatment-resistant depression, another SSRI or to venlafaxine. It found remission was obtained it is important, firstly, to establish if the diagnosis of depression in more patients who received venlafaxine than a different SSRI.4 is correct. Other psychiatric diagnoses such as anxiety disorders, Changing to atypical antidepressants from an SSRI shows simi- dysthymia, personality disorders, adjustment disorders and alco- lar efficacy to switching to another SSRI.5 hol and drug abuse should be ruled out. It is also important to If a patient is tolerating the antidepressant well and has some ensure that there is no underlying medical disorder, for exam- symptom relief but it is not yet satisfactory, augmentation is ple, Parkinson’s disease, multiple sclerosis, dementia or thyroid recommended as first-line management. Augmentation agents disorders. include second generation antipsychotics such as quetiapine, arip- The importance of compliance to medications should be iprazole and olanzapine. Lithium or a second antidepressant, for explored with patients and they should be prescribed an ade- example, mirtazapine or bupropion can also be prescribed. Other quate trial of an antidepressant. This would usually be for six to 12 agents include buspirone and triiodothyronine. 3
weeks, however, if there is little response after four to six weeks, There is little difference in the efficacy of these medications, WIN it is advised to move to the next treatment step. therefore, it is important to take into account the past medical Biological treatment history of the patient, their previous treatment record, patient Vol 22 No 10 Dec 2014/Jan 2015 The STAR*D trial, (Sequenced Treatment Alternatives to Relieve preference and cost, safety, side-effects and interactions of the Depression), which was a collaborative study on the treatment of medications when prescribing. It is also reasonable to switch anti- depression, completed in 2006 and funded by the National Insti- depressant in this scenario.6 tute of Mental Health in the US, provides much of the evidence It is accepted too that augmentation of an antidepressant that 60 CLINICAL FOCUS
has not had any effect can be tried as first-line rather than switch- ing class. In both cases there is little difference in the outcomes between switching and augmentation in treatment-resistant depression.7 The STAR*D trial has shown that 67% of patients who fail to respond to an initial course of citalopram will achieve remission with up to four courses of successive treatment. Prognosis is worse for patients with prominent anxiety symptoms or a comor- bid anxiety disorder. Lack of social support also negatively impacts on patients. Psychotherapy Psychotherapy may be employed as an alternative to med- ication in mild to moderate depression and can be useful in severe depression in combination with medications. It is par- ticularly beneficial for relapse prevention. Models of therapy include cognitive behavioural therapy or interpersonal therapy. However, the availability of psychotherapy is frequently a lim- iting factor. Research has also shown that psychotherapy is more successful in certain patient groups. This includes patients with higher lev- els of education and patients who have a family history of mood disorders.8 A 12-week study compared CBT to an antidepressant (venlafaxine, bupropion or sertraline) in patients who did not obtain symptom relief with citalopram. It showed similar rates Conclusion of remission with both treatments. Similar numbers also stopped Depression is a very common presentation, affecting one in each treatment due to side-effects or incompatibility.8 four people in their lifetime. It is important to regularly review Social supports affected patients in relation to symptoms and side-effects of the It is important to explore with patients the social supports medications. We need to emphasise the importance of persisting available to them including family and friends. Education regard- with treatment trials. These patients require reassurance that ing depression and its symptoms is also vital for patients and their they will not be abandoned and they should be encouraged to families. have faith in the treatment. Organisations such as Aware (www.aware.ie) offer a range of Treatment-resistant depression can be challenging to manage services including information, education and formal supports and healthcare professionals need to draw on all the resources such as Aware’s Life Skills programme. Patients and families can available to them and remain up to date regarding the latest access these services online or can participate in support meet- developments in the management of this condition. ings through the nationwide network of local groups. Clare Shields is a psychiatry registrar and Declan Lyons is a consultant psychiatrist Other useful services include the crisis support agency, Samar- at St Patrick’s Hospital, Dublin itans (www.samaritans.org) and Pieta House (www.pieta.ie), an organisation with multiple locations around the country, which References helps to prevent suicide and self-harm. 1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replica- Referral and ECT tion. Archives of general psychiatry. 2005;62(6):617-27 If the above treatment steps have failed, referral to a psychi- 2. Cooke G, Valenti L, Glasziou P, Britt H. Common general practice presentations and atrist should be considered. It is recommended for patients who publication frequency. Australian family physician. 2013;42(1-2):65-8 3. Rush AJ, Trivedi MH, Wisniewski SR et al. Acute and longer-term outcomes in depressed do not respond to between two and four treatment trials. Refer- outpatients requiring one or several treatment steps: a STAR*D report. The American jour- ral is also required if psychosis, suicidal ideation or catatonia are nal of psychiatry. 2006;163(11):1905-17 4. Ruhe HG, Huyser J, Swinkels JA, Schene AH. Switching antidepressants after a first present. selective serotonin reuptake inhibitor in major depressive disorder: a systematic review. One treatment available if the patient is admitted to hospi- The Journal of clinical psychiatry. 2006;67(12):1836-55 tal is ECT. It can be particularly useful in patients with psychotic 5. Rush AJ, Trivedi MH, Wisniewski SR et al. Bupropion-SR, sertraline, or venlafax- ine-XR after failure of SSRIs for depression. The New England journal of medicine. depression and is first-line when persistent suicidal ideation is 2006;354(12):1231-42 present, there is dehydration or weight loss due to refusal to eat 6. Fang Y, Yuan C, Xu Y et al. Comparisons of the efficacy and tolerability of extend- or malignant catatonia.9 ed-release venlafaxine, mirtazapine, and paroxetine in treatment-resistant depression: a double-blind, randomized pilot study in a Chinese population. Journal of clinical psychop- It is the most effective treatment in patients with major depres- harmacology. 2010;30(4):357-64 sion and can be considered first-line for patients with severe 7. Fang Y, Yuan C, Xu Y et al. A pilot study of the efficacy and safety of paroxetine aug- 10 mented with risperidone, valproate, buspirone, trazodone, or thyroid hormone in adult treatment-resistant depression. Six to eight treatments are Chinese patients with treatment-resistant major depression. Journal of clinical psychop- usually required to achieve remission and two treatments are typ- harmacology. 2011;31(5):638-42 ically given per week. It is not available in all psychiatric centres 8. Wisniewski SR, Fava M, Trivedi MH et al. Acceptability of second-step treatments to depressed outpatients: a STAR*D report. The American journal of psychiatry. in Ireland. 2007;164(5):753-60 ECT has perhaps an unjustifiably negative public image, focus- 9. Kellner CH, Greenberg RM, Murrough JW, Bryson EO, Briggs MC, Pasculli ing particularly on concerns about adverse effects on cognitive RM. ECT in treatment-resistant depression. The American journal of psychiatry. 2012;169(12):1238-44 Vol 22 No 10 Dec 2014/Jan 2015 Vol function. However, it has not been shown to have an effect on 10. Lisanby SH. Electroconvulsive therapy for depression. The New England Journal of Medicine. 2007;357(19):1939-45 WIN long-term cognition. WIN Vol 22 No 10 Dec 2014/Jan 2015 - - - B Level 2 A 61 CLINICAL IB IIa B Class ICIC al vascular disease; prior cardiac vascular disease; al prior cardiac e are a number of inclusion and of inclusion and a number e are rotid/vertebral artery obstruction rotid/vertebral artery obstruction ontraindications for for ontraindications surgery because ymptomatic native aortic valve stenosis ymptomatic valve native aortic Ther emoral and subclavian approach) subclavian and emoral ter: 20-27mm ter: Echogr S 1cm < area valve aortic an with monary disease; chronic monary disease; chronic kidney disease; peripher (for aorta disease; and porcelain thoracic f Ca C of comorbidities including chronic pul and cardiologist with agreed (as surgery cirrhosis; hostile liver surgeon); cardiac cardio severe radiation; thoracic/chest >70% >70% Ascending aortic diameter < 43mm Ascending aortic • exclusion criteria for TAVI exclusion patients. criteria TAVI for criteria exclusion TAVI • • Iliac and femoral artery diameter diameter > 7mm artery femoral • Iliac and • • Surgical Risk Score - EuroSCORE - EuroSCORE Score Risk Surgical • criteria exclusion TAVI or aortic pathologies iliac • Femoral, aneurysm Aortic • • • • diame annulus valve aphic aortic • Co-agulopathy Co-agulopathy • impairment Cognitive • month previous CVA or • MI thrombus ventricular • Left - - - - ne of of ne O comorbidities egarding severe AS, TAVI risks, TAVI AS, severe egarding transcatheter aortic valve implantation aortic transcatheter Table 1: Recommendations for the use of 1: Recommendations Table TAVI is recommended under current current under recommended is TAVI 6 6 Clinical decision making should be a a decision making should be Clinical The first TAVI case performed in an Irish Irish an in performed case TAVI first The patients thor undergo TAVI, Prior to made by the patient and family. family. and patient the by made etermine their suitability for the the their proce for etermine suitability TAVI should be considered in high-risk patients with severe symptomatic AS AS symptomatic in high-risk patients with severe should be considered TAVI by a ‘heart is favoured TAVI but in whom who may still be suitable for surgery, and anatomic suitability based on the individual risk profile team’ Recommendations including team’ with a multidisciplinary ‘heart undertaken should only be TAVI and other specialists if surgeons and cardiac cardiologists necessary on-site surgery performed in hospitals with cardiac should only be TAVI not suitable AS who are symptomatic patients with severe is indicated in TAVI gain improvement to likely and who are team’ ‘heart by a as assessed AVR for in their quality of ofa life expectancy life and to have than one year more of consideration after their isk. the first roles of the cardiology CNS CNS is to cardiology of the first the roles partake in to education patient the assist an informed make family their patient and decision care. their about the patient and between process shared this is a As team. the multidisciplinary option in Ire treatment new relatively of a good level CNS should have the land knowledge r patient.the inform ficiently type of procedures, benefits, perioperative perioperative benefits, procedures, of type to suf complications and post procedural r ough assessment and preparation to to ough assessment and preparation d ESC 2012 Guidelines for these patients, patients, these for Guidelines 2012 ESC for deemed unsuitable been who have open conventional heart due to surgery comorbidities. multiple took place in December setting healthcare performed procedures TAVI 93 with 2008, then. since Dublin Hospital, James’s St in procedure TAVI dure dure and to ensure an decision informed is ------) in oth ) in R interven As a result, result, a As Elderly AS AS Elderly R oduced into oduced into 4 5 as the shift from from the shift as 3 diovascular condition, condition, diovascular lder age is an independ an age is lder O Transcatheter Transcatheter aortic valve 2 in cardiac populations. cardiac in Severe AS has been documented documented AS has been Severe - the most preva stenosis (AS) is elatively low mortality and mor elatively 1
ound tic
Untreated AS can lead to pulmonary AS can to lead Untreated pulmonary Aortic valve replacement (AV replacement valve Aortic The number of Irish people over the age the age over of Irish people The number This new innovative cardiology proce cardiology This new innovative heavy burden of co-morbid diseases, heavy of co-morbid diseases, burden implant (TAVI) was introduced for patients for was introduced implant (TAVI) AS in 2002, with severe the burden of cardiac disease the of cardiac among older burden will symptomatic highly who are people rise. to continue in 2-7% of patients greater than 65 years years 65 than greater patients of 2-7% in than men in higher incidence with age of in women. tion, have a >12 fold increase in mortality in mortality increase fold a >12 tion, have patients who do not have AV do not have who patients bidity rate. Elderly patients who have have who patients Elderly rate. bidity a erwise fit octogenarians can erwise be performed with a r endocarditis, hypertension, arrhythmias, heart congestive infarction, myocardial death. and sudden failure which to are lead to complications likely outcomes, of adverse risk and an increased AS is this option. However, are not offered without improve will not and progressive treatment. dure is rapidly evolving to treat to treat inoperable dure is evolving rapidly AS patients and has been intr this. in (CNS) specialist nurse ical Backgr almost by increase to expected is 65 of 2026. and 2011 between 50% some hospitals in Ireland. This article This article some hospitals in Ireland. and algorithms the protocol describes in the involved assessment of older and the of the clin role TAVI for patients surgery for highly symptomatic elderly elderly symptomatic highly for surgery procedures to less invasive patients, of field the valves. heart reached lent valvular valvular lent heart disease and the third most common car disease and hyper artery coronary after implant (TAVI) and the role of the cardiology CNS the and cardiology the of role implant (TAVI) Aor in the assessment of elderly patients for transcatheter the in transcatheter valve aortic elderly of assessment for patients tension. A team from Trinity College College the describes Dublin protocol involved Trinity from team A severe aortic stenosis stenosis aortic severe Management of of Management ent risk factor for higher mortality and higher mortality and for factor ent risk morbidity WIN Vol 22 No 10 Dec 2014/Jan 2015 ECG; tr screen;MRSA profile;liver and ulation blood physicalexamination; fullprehensive and processtions ofthischallengingdisease angina andsyncopeare latemanifesta f dence ofdiseased,tortuous, calcified anaesthetic. rograde transfemoral route underlocal TAVI ismainly performed usingaret over transapical approach. Percutaneous a mini-thoracotomy is the latest method and transaortic. vian transfemoral, transapical, trans-subcla transcatheter valvebe deployed: can are multipleaccessroutes whereby a most dure isperformed using the technique suitable and agree to TAVI, the proce is completed andpatientsare deemed outcomes. clinical ANP hasagoodunderstanding of TAVI bybe enhanced ensuring thecan CNS/ planning andinterventionassessment, assessed. Tailoring individualpatient also important to note,needalso to be underlying co morbidities, which are or as decreased exercisesuch toms tolerance Severity isindicatedby progressive symp is the first step in assessing AS severity. history takingclinic evaluation. Clinical f cated advancednurse practitioners (ANPs) in Ireland andacross Europe have dedi quality of life andlevel of frailty. Centres assessing theirphysical examination, full collating the patienthistory, performing a carotid doppler. aortogram; pulmonary function test and nary angiogram; transthoracic ECH compr sive work-upprior to TAVIa withfull cardiologya CNS. and sur a cardiothoracictional cardiologists, interven which currentlyincludes two performedbymultidisciplinary theteam; • Sepsis activeor endocarditis. • Uncontrolledatrial fibrillation 62 ar routesclavian, transapical, transaortic cor will need to be assessed. or patientscreening, assessment and ANP emoral and iliacarteries the trans-sub e assessed suitability.fore All three of Dir Additional symptomsassociated with The CNS currently playsamajorpartin Patients undergo a comprehen for TAVIassessment iswork-up The shortness of breath onexertion,shortness of geon, a cardiology Imaging consultanta cardiology geon, onary and peripheral angiogram; may also be present. CLINICAL ect transaortic insertion byway of insertion ect transaortic appropriate for the patient. There screen including FBC, screenincluding U&E, coag ehensive healthhistory, com ansoesphageal ECH ansoesphageal In cases whereIn cases is evi there O n ce the full work-up work-up full the ce 8 Heart failure, O ; CT coro 7 which O ------; curr eral anaesthetic. There are two valves these methods of insertion require gen outcomes toeitherconventional AV TAVIoutcomes patient unit (CCU) nurses for post procedural care. technicians andinaddition, coronary care team includingnurses, doctors and cardiac laboratoryexpert cardiac catheterisation pericardialbovine tissue. expandable cobaltchromium framewith The Edwards Sapien stenthasaballoon stent with porcine pericardium leaflets. Edwards Sapien. The CoreValve isanitinol and one-year mortality24.2% versus mortality: 3.4% versus 6.5%respectively compared to surgical patients; 30-day identified as reducing mortality, when patients. TAVIwaselderly symptomatic standard medical therapy, both for severe PA (PA P domised control trialof TAVIpatients, the lacement of Ao of lacement c The decisionshouldbemadeaccording toindividualclinicalcharacteristics andanatomy LV hypertrophy. present: markedly elevated natriuretic peptide levels; mean gradient increase with exercise >20 mmHg; excessive is following the of one progressionm/s/year.velocity ≥0.3 peak if + (IIbC) cification considered be may Surgery thefollowingispresent: peak velocity>5.5m/s;severe valvecal- oneof b Surgery shouldbeconsidered (IIaC)if TAVI =transcatheter aorticvalveimplantation. L AS =aorticstenosis The first multicentre prospective ran TAVI procedure requires a dedicated VEF =left ventricularejectionfraction R Figure severe aortic 1:Managementof stenosis R ently on the market; entlyCoreValve onthe and TN TNE E R R trial compared TAVIpatient ) trial, took placein2010. The R
t ic TraNscathetE ESC/EACTS Guidelines2012
AVR =aorticvalvereplacement
Med Rx=medicalther R
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death 14.3% versus 13%. TAVI and AV was nosignificant difference between patients to stroke. TAVI procedural suc atherosclerosispredisposes thesewhich have multiple co-morbidities including 26.8% respectively. between 0%-8%. periprocedural stroke rate ranged GA is consistent plicated cerebrovascularwhich accident, centre none of the patients had a com patients under 93Similarlycular complications. ofthe did observe areduction in cerebrovas between TAVIitbut and CABG patients a significant difference inmortality R of TAVI. and effectivenesssafety and toevaluate to review andgovern current outcomes in 3% of octogenarians, in note although AV egistry (GA apy Throughout the literature,Throughout the the Following this, the German Aortic Valve R BSA Y R =bodysurfacearea egistry 11 The GA R R inrelation to cardiovascular with theexperienceof Y . Trial, 2011) was designed going TAVI in this Irish R R 8,12,13 Y trialdid 9 stroke rate occurred After one year, there
Itisimportant to 10 14 TAVI patients not observe - - - WIN Vol 22 No 10 Dec 2014/Jan 2015 ------63 CLINICAL valve stenosis. Journal of Thoracic Cardiovascular Surgeon Surgeon Cardiovascular Thoracic of stenosis.valve Journal 2012; 60(5):319-325 Transcatheter al. , et Anson JB, Webb J, 12. Rodés-Cabau symp of severe treatment the implantation for valve aortic tomatic aortic stenosis in patients at very high or prohibitive very high at stenosis in patients aortic tomatic Acute and surgical risk. the late outcomes of multicenter 2010; 55:Cardiol 1080-1090 Coll Am J experience. Canadian al. Short-term A et Germing T, Gotzmann M, Hehen 13. of transcatheter effects valve aortic implantation on neu- of rohormonal activation, quality life and walk 6-minute aortic stenosis.and symptomatic Heart test in severe 2010; 96:1102-1106 valve Aortic al. R et De Palma 14. Di Eusanio D, M, Fortuna a of mortality from and predictors replacement: Results Thoracic of of 2256 patients.Journal series contemporary 2011; 940-947 Surgeon. 141: Cardiovascular of Quality al. M, Barbanti M et Massililiano GP, Ussia 15. valve implanta aortic after assessment percutaneous life 2009;J Heart Eur tion. 30 (5): 1790-1796 and al. Procedural et U Gerckens E, Grube 16. Piazza N, outcomes transcatheter valve aortic 30-day following (18 Fr)generation corevalve third the implantation using expanded multicentre, the from system: results revalving approval. CE mark following 1-year registry evaluation Intervention 2008; Euro 4(2): 242-249 out of patient Assessment JN. Cohn TS, Rector 17. with Heart Failure Living the Minnesota with come during a randomized, validity and questionnaire: reliability double-blind, placebo-controlled trial of Am pimobendan. J 1992; 1017-1025 Heart 124(4): meas of life C.quality 18. Macduff Respondent-generated Journal gold? fool’s or more nursing tools for useful ures: 2000; Nursing Advanced 32(2): 375-382 of Cohen 19. DJ. Health-related quality of life after tran in high-riskvalve replacement aortic vs. surgical scatheter PART The from results stenosis aortic severe with patients Investigators. of PARTNER On behalf A). (Cohort Trial NER Conference; Therapeutics Cardiovascular Transcatheter US Francisco, 2011. San 7, November - - References stenosis:and surgical Aortic medical H. 1. Baumgartner management.2005; Heart 9:1483-1488 survey A prospective al. G et A, Baron Cachier 2. Lung B, The Euro disease in Europe: heart valvular with of patients Heart European Heart Disease. Valvular on Heart Survey 1231-1243 2003;Journal 24(13): - Assafal. Percu P et A, Eltchaninoff H, Bash Cribier 3. taneous transcatheter implantation of an valve aortic calcific for aortic stenosis: firstprosthesis human cases 2002; 3006-3008 106(24): Circulation description. and Labour Office Statistics Population (CSO). Central 4. at http://www. Available Predictions, 2011-2041. Force cso.ie/newsevents/pr_poplabfor2011.htm Valve Aortic calcific of Spectrum CM. Otto R. Freeman 5. Treatment and Disease:Pathogenesis, Progression Disease 2005; 3316-3326 111(24): Circulation Strategies. of elderly Outcomes al. D et Gohil N, Barker P, 6. Kojodjojo with symptomatic, over aor patients aged severe 80 and aortic of refusing choice of patient’s tic stenosis: impact Medicine of Journal Quality survival. on replacement valve 2008; 101(7): 567-573 in valve replacement Aortic L,Cohn Narayanasamy N. 7. elderly patients: what the are Opinion limits? Current in 2007; 92-95 22(2), Cardiology the older patient in the of R. Needs S, Hawley Cope 8. in Progress heart surgery. Unit following Care Intensive Nursing 2001; 16(2): 44-48 Cardiovascular aor Transcatheter al. et M Mack CR, Smith M, Leon 9. who in patients stenosis aortic for implantation tic-valve 2010;JMed Engl New 363: surgery. undergo cannot 1597-1607 Transcatheter al. CR, Leon MB, Mack MJ et 10. Smith in high-risk replacement aortic-valve versus surgical of Medicine 2011;patients. 364 Journal New England 2187-98 (23): German The al. C,et HR Figulla A,Hamm Beckmann 11. for registry a nationwide (GARY); Registry Valve Aortic aortic severe for therapy intensive patients undergoing
- - R TNE R There is a There ; however, ; however, 17 R The PA 18 The Irish procedural The Irish procedural and Dr Orla Dempsey is and Dr Orla Dempsey 11 Presently procedural procedural Presently 12,15,16 Improvement in Improvement HRQOL is recognised
rial, Cohort A, highlighted a remarkable remarkable a A, highlighted Cohort rial, improvement in HRQoL within one within month in HRQoL improvement AV to compared when TAVI of similar benefits occurred over the one year the one year similar over benefits occurred groups. both in follow-up t Sinéad Teehan is a cardiology clinical nurse specialist clinical is a cardiology Teehan Sinéad is Gabrielle Dublin; McKee Hospital, at St James’s School of sciences, of biological associate professor ; TCD Nursing and Midwifery, for Practice lead at the Centre healthcare quantitative TCD Innovation, and Healthcare as a therapeutic benefit specifically for for specifically benefit therapeutic as a particularly patients, surgery valve elderly survival may be neither when increased patient.the by nor sought likely cess currently in the literature is achieved is achieved the literature in currently cess in cases of 86-100% transfem the using approach. oral mortality rate of 2% was in line with inter was in line of 2% mortality rate findings. national mortality rates account for <10% for for <10% for account rates mortality for implant and <14% transfemoral approach. transapical demonstrable lack of research focusing on on focusing demonstrable lack of research definition the on consensus no and HRQOL despite Macduff QOL of and measurement the highlighting to need assess care health outcomes using HRQoL in addition to mortality and morbidity. UPDATE 65
Award winning wound care innovation PICO system reduces post-operative infection rates and re-admission
A single-use, canister-free negative excess fluid, helping to reduce oedema patients undergoing surgery; it can also pressure wound therapy system, devel- (fluid build up underneath the incision), be used as an intervention on patients oped by Smith & Nephew, has been and the vacuum action stabilises the inci- suffering with an open wound. named ‘Most Innovative Product 2014’ sion site. These multiple modes of action To support the award submission, at the Irish Medical and Surgical Trade all work together to reduce complications Smith & Nephew provided evidence of Association medical technology awards. such as surgical dehiscence, seroma and clinician and patient success, and key The award was judged by a panel of top haematoma formation and surgical site evidence of how PICO is aligned to the clinicians, health service executives and infections (SSIs). key clinical and financial objectives of the medical companies. One week’s post-operative therapy new hospital groups within Ireland. Ben- Post-surgery complications can be with PICO is less than half the cost of a efits include the ability of PICO to enable devastating for the patient and costly single night’s stay in hospital and a major early discharge of patients from hospital, for the hospital. It is estimated that potential cost saving, considering the and helping to prevent costly readmis- complications can double the cost of the incidence of post-operative SSIs in Ireland, sions to hospitals following elective and initial surgery. PICO is a new approach SSIs are the second most common form of emergency surgery. to post-operative care that helps prevent hospital acquired infection, and can lead Sharon Wallace, Smith & Nephew sales complications post-surgery by applying to an average 10 days’ additional stay in director, Ireland, said: “PICO can have a negative pressure to the surgical incision. hospital. clear and direct impact on the clinical and Negative pressure works by stimulating PICO is not only used as a prophylactic health economic outcomes for patients, blood flow to the surgical site, removing therapy to help prevent complications in clinicians and payers.” New MAU opens at PHN rep retires from Waterford Branch Bon Secours, Cork A new €700,000 Medical Assessment Unit (MAU) has opened at the Bon Secours Hospi- tal, Cork. A modern seven-bed purpose-built facility, the MAU is open to patients five days a week, Monday to Friday, 8am to 6pm. The aim of the unit is to promote prompt and timely access for patients to expert con- sultant opinion, assessment and, if needs be, admission to consultant specialist care. It will considerably relieve the pressure on hospital EDs this winter. The consultant-provided service at the MAU is led by Prof Ronan O’Sullivan, consultant in emergency medicine. He explained the service that will be pro- vided. “Treatment begins immediately on arrival. There are no trolley waits. An early same-day assessment will be provided supported by a full range of diagnostic testing. If admission to the hospital and
specialist consultant care is required, this WIN will be arranged immediately”. The MAU unit is located close to the Vol 22 No 10 Dec 2014/Jan 2015 main hospital reception and has dedicated parking. It includes high quality accommo- dation, assessment treatment rooms and associated equipment. This marks the first Retirement at the recent Waterford Branch meeting: Members recognised the work done by Essene Cassidy, phase in the development of emergency PHN branch representative and marked her leaving the area with the presentation of a floral bouquet. Essene has left Waterford to work in HSE Dublin North in her new role as an early years inspector with Tusla. The Waterford Branch services at the Bon Secours Hospital, Cork membership wished her the very best of luck in her new position. Pictured (l-r) were: Claire Mahon, INMO president; that will improve choices for patients and Essene Cassidy; and Catherine Rotte Murray, branch chairperson GPs in the greater Munster area. 66 UPDATE
Guantanamo Bay nurse backed by ICN Council supports nurse’s stance on refusal to force feed prisoners
The International Council of Nurses said: “The WMA fully supports the ICN naval personnel will be making the decision (ICN) and the World Medical Association on the rights of health professionals on what action will be taken against the (WMA) have called on the US Navy to to refuse to force feed prisoners. Our nurse. respect the rights of the nurse who has position on force feeding is quite clear. The ICN affirms that individual nurses refused to take part in the force feeding of It is violent and against the principle of should be protected from reprisals related prisoners at Guantanamo Bay, and called individual autonomy and no physician to advocacy for detainees and prisoners or for his reinstatement. or nurse should be forced to take part in refusal to participate in forced care, cruel, Citing the UN Declaration on Human the practice. Quite apart from being an inhumane or degrading treatment. Rights, the ICN Code of Ethics for Nurses entirely unsuitable approach to save lives, The ICN has been working closely with and the ICN Position Statement on the the practice is a degrading treatment, the American Nurses Association (ANA) Nurses’ Role in the care of Detainees and inhumane and might amount to torture.” and Physicians for Human Rights in their Prisoners, Dr David Benton, ICN chief execu- According to the nurse’s attorneys, a US public support of the nurse. tive officer, said: “ICN strongly affirms that Naval nurse has refused to participate in ANA has stated that “The ANA Code of nurses should play no voluntary role in any the force feeding of a group of detainees at Ethics for Nurses clearly supports the pro- deliberate infliction of physical or mental Guantanamo Bay detention centre in Cuba fessional registered nurse’s right to make suffering. To do otherwise is a clear violation who are on a renewed hunger strike to an independent, ethical judgement about of nursing’s ethical code of practice.” protest their continued, open-ended deten- whether he or she should participate in Dr Xavier Deau, president of the WMA, tion without charges being filed. The chief of this or any other such activity.” New health literacy training programme Ireland’s first health literacy training programme for nurses, Health Literacy for Health and Social Care Settings, has been launched following the establishment of a new partnership between MSD, the National Adult Literacy Agency (NALA) and University College Cork (UCC). Two out of five people in Ireland have inadequate or problematic health literacy, which can significantly limit their ability to prevent and manage disease, and there is currently no specific programme for healthcare professionals that addresses Book launch: Last month saw the launch of ‘Preparation for Pregnancy, Birth and Motherhood’ by Nancy Murphy in INMO HQ. The book was launched by Jerry this issue. The principal aim of the Buttimer, TD (pictured centre). Liam Doran, INMO general secretary (right) was also in module, which was developed with input attendance. Author Nancy Murphy (left), a native of Boyle, Co Roscommon is a mother, general from the Irish Pharmacy Union, will be to nurse, midwife and clinic nurse manager of the Women’s Health Clinic in Newcastlewest, Limerick. The book was influenced by the changing characteristics of women’s lives and their expectations of pregnancy examine how healthcare professionals can better communicate and meet the needs
of patients with limited health literacy. The RCSI Commenting on the module, Dr Laura celebrated the Sahm, lecturer in clinical pharmacy, conferring of 354 candidates UCC, said: “This new module is an with postgraduate exciting development which we hope degrees in Nursing and Midwifery at will bring Ireland closer to its European November conferring peers in tackling levels of limited health ceremonies. literacy.” Pictured (l-r) were: Lenora Fitzgerald, The Health Literacy for Health and winner of the Mary Social Care Settings (MH5001) module Frances Crowley Award; is currently open for registration and the Prof Zena Moore, Head of RCSI School of Nursing first 20 applications will receive a bursary and Midwifery, and Declan Vol 22 No 10 Dec 2014/Jan 2015 Vol from MSD of €150 towards the overall fee. Magee, RCSI president
WIN To register, log on to www.ucc.ie UPDATE 67
Guantanamo Bay nurse backed by ICN Award for WIT nursing undergraduate Prestigious medal awarded to student nurse for ‘leading-edge research’
Dawn Smith, a nursing student from Waterford Institute of Technology (WIT), was awarded the George Berkeley Gold Medal by the international awarding body, the Undergraduate Awards, for her WIT student nurse takes the prize: leading-edge research and course work. Dawn Smith (right), Dawn received this prestigious award from Celbridge, Kildare, receives for her winning paper ‘Abortion: Exploring the prestigious the Ethical, Legal and Political Challenges’ international George in the nursing and midwifery category of Berkeley Gold Medal award from Patricia the Undergraduate Awards. Dawn was O’Brien, Irish ambassador the overall winner in her category and her to the UN and the work has been published in The Under- keynote speaker at the Undergraduate Awards graduate Journal 2014. ceremony held in Dublin The world’s only pan-discipline recently academic awards programme, the Under- graduate Awards (UA) recognises and rewards innovative young thinkers across 25 disciplines from business and engineer- ing to visual arts and midwifery. The 120 attendees were the top The Undergraduate Awards Programme Each year, the top performing students performing entrants out of the 4,792 2015 is now open for submissions. To are invited to the UA Global Summit – this submissions that UA received this year find out more visit www.undergradua- year hosted in Dublin – which provides from 209 universities across 27 countries. teawards.com them with an opportunity to meet their The attendees came from America, Austria, The Undergraduate Awards were peers and take part in a unique event with Australia, Bangladesh, Canada, Denmark, founded in partnership with Google, thought leaders from around the world. It Finland, Germany, India, Iran, Ireland, Italy, Digicel, the Higher Education Authority is a chance to build life-long relationships Malaysia, Nigeria, Netherlands, Singapore, and the Department for Employment and in the academic world. Slovenia, Sweden, Switzerland and the UK. Learning. Jervis St class Introduction to nursing informatics Dr Pamela Hussey, lecturer/researcher mation management from reunite in Killarney at School of Nursing at DCU, together a nursing perspective. The A group of nurses who trained in Jervis with international colleagues, launched area has never been more St met for a reunion at the Malton Hotel, the fourth edition of their book important as contem- Killarney in October. They recalled their Introduction to Nursing Informatics in porary healthcare offers first time arriving in Dublin in 1960, “when Dublin Castle recently. exciting opportunities for Dublin might as well have been a foreign According to the publishers, Springer, it: the nursing profession to destination”. Myra Garahan recounts: “We • Provides basic information on how to contribute to the design of were escorted from the various train sta- select and use information systems and emerging eHealth models tions by relatives to Jervis St Hospital where information management in all aspects of care and to ensure we met our classmates. You can imagine the of nursing practice resources such as electronic health records loneliness. Not many homes had phones so • Reflects the vast technological advances and mobile technology are pragmatic and no crying to parents, letters were the norm. achieved in healthcare in recent years, fit for purpose. This new edition contains
We bonded with one another as we started including new chapters on both HIS, the best available evidence to inspire and WIN a six-week PTS course, early morning call internet usage and meaningful use support nurses to think critically about 6.10am to breakfast supervised by matron, • Instructs readers on how to use com- both current and future practice. Vol 22 No 10 Dec 2014/Jan 2015 routine uniform inspection, roll call and then puters and information management The information is presented and to classroom where we acquired our various systems in their practices integrated in a purposeful manner to skills. Bed making, hygiene, hand washing • Provides guidance on implementing encourage readers to explore the key and ward cleanliness were emphasised. computerised solutions for information concepts of nursing practice, informa- Eventually the three years ended with us management strategies. tion management and its relationship to passing our final examinations. We started This book is a primer for nurses on the informatics. Critically, the content is also to meet as a class after 25 years and we topic of nursing informatics and presents linked to case-based examples to contex- have met on a regular basis since.” the fundamental concepts of health infor- tualise the theory presented. REVIEW 69 Pioneering psychiatrist Adeline (Ada) English (1875-1944) was Ada ultimately enjoyed much success in a psychiatrist who played an important improving the lives of patients. However, role in the development of healthcare in the asylum environment was far from Ireland in the first half of the 20th cen- ideal, with patients often living in very tury. Female doctors were a rare breed at poor conditions. The Ballinasloe asylum the times but many of these pioneering was not free of the type of administrative women went on to help shape healthcare difficulties, in-house political squabbling in Ireland at a time of great political, social and ‘blame-gaming’ that are a feature of and scientific change. Irish healthcare provision today. There was Ada was also a staunch nationalist who a sworn public inquiry in 1940 into the was active during the campaign for Irish running of the hospital. independence. She entered psychiatry in Assessing Ada English’s medical career, an era where the forbidding mental asy- Brendan Kelly, a consultant psychiatrist lum system – essentially a ‘warehousing’ himself, says she had notable achieve- of the mentally ill and socially unwanted ments, but had to cope with apparently – flourished. Ada managed to pioneer sig- intractable day-to-day problems common nificant improvements in the treatment of to asylums at the time, including chronic the mentally ill in her time at Ballinasloe overcrowding, industrial disputes and inter- District Asylum. staff conflict. Ada devoted her career to making a career, asylums like Ballinasloe had become Kelly’s book is an impressive account of better life for her patients. She promoted severely overcrowded and this problem the career of one of the key women medical occupational therapy and convulsive ther- persisted throughout subsequent decades. figures of the 20th century, and of health- apy, encouraged sports, entertainment Author Brendan Kelly says key issues care, society and politics at a time of great and greater levels of activity for patients, included the regulation of large numbers change. It includes a section outlining the and campaigned with zeal for improved of patients within enclosed spaces, the careers of other pioneering women doctors. conditions. spread of infectious diseases, and pres- - Niall Hunter Large asylums had been developed in Ire- sure on beds. Of necessity, the emphasis Ada English – Patriot and Psychiatrist by Brendan Kelly land in the 19th century. However, by the appears often to have been more on crowd is published by Irish Academic Press. RRPE24.95 early 20th century, when Ada started her control than on optimal treatment. ISBN 9780716532699 ! Sponsored by: Crossword Competition
1 2 3 4 5 6 7 Across Down 1 The cattle-sound is not high (3) 1 Lo, V and E define romantic Solutions to November crossword: 3 Draw constituency boundaries so as to correspondence! (4,7) Across: 1. Polling booth 9. Swam help one particular candidate or party 2 & 13a. In which to enclose a gift 10. Cockle 11. Spit 14. Forty 8 9 unfairly (11) decoratively (8,5) 15. Peach 16. Span 18. Riser 8 C apable of surviving (6) 3 This great ancient physician might 21. Adieu 22. Evita 23. Title 9 Give out medicine (8) have been an angel! (5) 24. Grey 25. Amaze 26. Satan 10 11 12 10 Flower whose name comes from the 4 12d & 17d Transport leader with Latin for wolf (5) clownish feature? (7,3,3-5,8) 29. Tuba 33. Alcove 34. Ruby 13 14 11 Happening, occurrence (5) 5 Cox’s Pippin, for example (5) 36. Rim 37. Barbiturates 13 See 2 down 6 Companion to 4 down you might find 15 Female big cat (7) at a disco (6) Down: 1. Pew 2. Limp 3. Inch 15 16 17 16 The one who holds you in high regard 7 Regret (3) 4. Gecko 5. Owlet 6. Harp 8. Dating agency 9. Stepdaughter 18 may be married, literally! (7) 12 See 4 down 20 Faint (5) 13 Sits, in order to be painted (5) 12. Facile 13. Shout 14. First aid 19 20 21 What the weather does when 14 Inert gas (5) 17. Primal 19. Stern 20. Relax precipitation comes down in flakes (5) 17 See 4 down 27. Ad lib 28. Aloft 30. Bomb 21 22 23 23 Material made from flax (5) 18 This might erupt, destroying the cool 31. Beer 32. Fret 35. Bus 24 A heavenly article identifies an van (7) ingredient (8) 19 Ran to keep fit (6) 24 25 25 She’s in charge of an orderly group! (6) 22 Volley of shots (5) 26 R abies will make body hair hop around 23 Sign of the Zodiac – The Scales (5) (11) 24 Wood traditionally used for making The winner of the 26 27 27 Angling stick (3) hurleys (3) November crossword is:
Name: The prize will go to the first all correct entry opened. Elizabeth Mooney Address: Closing date: Monday, January 19, 2015 Foxrock Post your entry to: Crossword Competition, WIN, MedMedia Publications, Dublin 17 Adelaide Street, Dun Laoghaire, Co Dublin € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € € FINANCE 71 € € € € € € € € € € € € € € € € € € € N € € M€ €EY€ Frugal€ € tips€ for€ the€ € € € € € € € € € € € € € €festive€ € season€ € € € € € € € € €
€ € € € € Ivan€ Ahern has€ some money-saving€ € tips to €help € € € € € € € € MATTERS you through the festive season With all the Christmas cheer, December • Catch up with family and friends who are and five star hotels in 250 locations. Visit is an exciting but expensive month. Come overseas via Skype instead of using your www.lastminute.ie for more information. January, everyone feels the effects on their mobile or landline. Tax relief on home renovations wallet. Here are some frugal festive tips to Credit card* If you need work done on your home or help you gain a little extra money back and If you need to use your credit card over your rental property in 2015, don’t forget minimise the effects of the celebrations. Christmas, then take a look at the National to take advantage of the Home Reno- Last chance to claim for your 2010 tax Consumer Agency’s credit card cost com- vation Incentive (HRI) Scheme. This tax return! parison. There are still some providers relief scheme was announced last year If you didn’t file your 2010 tax return offering 0% interest on balance transfers. and was extended to landlords in this then you only have until December 31, If you can’t afford to pay your Christmas year’s Budget. 2014 to claim. Don’t miss out on a pos- credit card bill in full, you could take advan- The scheme will run until December 31, sible refund. To file your return, see tage of one of these offers in the New Year. 2015 and allows homeowners and land- www.revenue.ie or contact the tax team See www.nca.ie for more details. lords to claim tax relief by way of a tax at Cornmarket at Tel: 01 408 6291 for Top 5 smartphone apps credit of 13.5% of qualifying expenditure more information. • Mydealpage.ie on any repair, renovation or improvement Reduce your phone bill • Vouchercloud work carried out on a principal private If you have a monthly phone plan, the • iTube (music) residence or rental property. The work following few tips could save you a good • All Recipes must cost a minimum of €5,000 which deal of money over the Christmas period: • My Fitness Pal. would attract a tax credit of €675. For • Check your account online regularly to Shopping for insurance more information, see www.revenue.ie see if you are near your limit Always ensure you make like-for-like Get a free financial review • Refresh your memory as to what is cov- comparisons when shopping for insurance. When was the last time you sat ered on your plan The policy offering the lowest premium is down with a professional financial advi- • Avoid making calls to directory enquiries not always the best. You should always sor to review your finances? Following and ‘1800’ numbers as they usually cost check that you are getting the best value the Budget and all the recent changes extra for money and cross-reference benefits in announced surrounding the public sector, • Use free messaging services such as detail when shopping around. a financial review will give you a clear pic- ‘WhatsApp’ and ‘Viber’ to reduce the Be realistic when insuring. Overestimat- ture of your sick pay, superannuation and cost of texting ing will increase your insurance premium tax entitlements and help you plan bet- and underestimating will make it difficult ter for the future. It could also save you a to cover the costs of replacing your lot of money and time in the process. To car or repairing your home should request a free financial review, call Corn- you need to. market at Tel: 01 470 8081.
Holidays Ivan Ahern is a director of Cornmarket Financial Services Ltd If you are planning for a trip away in the new year, *Source: www.nca.ie. This information is intended you can canvass all the air- only as a general guide and has no legal standing. lines at the click of a mouse to Money saving tips are correct on Nov 6, 2014. Please be advised that Cornmarket cannot be find out the cheapest flights WIN held responsible for the content contained on the to your destination by using websites listed in this article. Members who have Vol 22 No 10 Dec 2014/Jan 2015 the free comparison site specific questions relating to their personal finances, www.skyscanner.com. Superannuation entitlements, etc. are advised to When it comes to where seek professional advice and can contact Cornmarket at Tel: 01 408 4000. Midas is a tax based service you are going to stay, you can and not a regulated financial product. Cornmarket save up to 35% on your next Retail Trading Ltd. is a wholly-owned subsidiary of hotel as well as adding an Cornmarket Group Financial Services Ltd. Cornmarket Group Financial Services Ltd. is regulated by the element of surprise with Central Bank of Ireland. A member of the Irish Life ‘Top Secret Hotels’. This Group Ltd. Telephone calls may be recorded for offer is available on four quality control and training purposes. WIN Vol 22 No 9 November 2014 workshop GP Practice Nurses Section Saturday 31 Tel:01 [email protected] or Contact Section f Third Saturday 31 Tel:01 or [email protected] 11am. Contact Retired Section Thursday 29 01 or Tel:[email protected] Contact Limerick INMO office 11am. Telephone TriageSection AGM. Wednesday 28 [email protected] or Tel: 01 11am-1pm. Contact and PHN Saturday 24 f [email protected] or Tel: 01 INMO HQ 11am-1pm. Contact Community RGN Section meeting. Saturday 24 f [email protected] or Tel: 01 11.30am. Contact: from ODN Section, Saturday 24 attend memberswelcome to St Michael’s Hospital. All branch 7pm in the Education Centre at INMO Dublin East Coast Branch Tuesday 13 f [email protected] or Tel: 01 AGM. INMO HQ 11am. Contact CarePerson of the Older Section Wednesday 7 f [email protected] or Tel: 01 meeting. INMO HQ 11am. Contact DirectorsAssistant Section Wednesday 17 DIARY72 or further details or further or further details or further details or further details or further details or further
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. on March 13, 2015. speakers.confirmed The early-birdprice forregistration discount closes Visit nursing knowledge across specialties, cultures and countries. provideand to disseminate relationships opportunities build fornurses to of cross-cultural understanding and global co-operation in nursing and nursesimportance will explore gathering of thousands of the international host of options to learn about nursing practice and healthcare in Korea. This accepted through a highly competitive abstract selection process; and a Foundation, a wide range of concurrent sessions including dynamic papers biennial fundraising luncheon for the Florence Nightingale International registerParticipants can forspectacular opening ceremony, the popular the Conference website: www.icn2015.com. professionals, and members of the public may register online at the ICN Seoul, Republic of Korea. Members of nursing associations, other health on June 19-23, 2015 at the Coex Convention and Exhibition Centre in Nursing’ to be held ‘Global Citizen, Global international conference Council of Nurses’ (ICN) forInternational the Registrationis open Register now for ICN conference 2015 G
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