Editor: Marianne Cummins

NEWSLTRTHE ASSOCIATION FOR NURSES WORKING IN OLDER PEOPLE’S MENTAL HEALTH, AGED AND DEMENTIA CARE

AUGUST 2019

IN THIS EDITION

www.pgna.org.au Psychogeriatric Nurse’s Association Newsletter

The Psychogeriatric Nurses’Association Australia (Inc)

RAISE YOUR VOICE Conference details & booking information

HEALTH AWARENESS 2019 calendar dates (days & months)

A FAREWELL TO BRIAN DRAPER UNSW Kensington

Collaboration working in Older People’s Mental Health, Aged and Dementia Care

RAISE YOUR VOICE

University of WollongongFRIDAY, 13 SEPTEMBER 2019

Collaboration working in Older People’s Mental Health, Aged and Dementia Care

RAISE YOUR VOICE

University of WollongongFRIDAY, 13 SEPTEMBER 2019

PGNA is now on LinkedIn – see ouradvertising for Conference/events.

Continued website improvementsMembers Only area is up and running with all members having received login details via email. This will separate information for members and non-members. Members can access and enjoy

Collaboration and ties with FPOAWe are liaising closely with Faculty of Psychiatry of Old Age providing joint education which is continuing into the future.

PGNA are working on Increasing Multidisciplinary ties.

Education Sub Committeeif anyone would like to join or suggest Topics, please contact any of the Executive Committee Members.

PGNA is represented at CoNNMO, the Coalition of National Nursing and Midwifery Organisations. Draft minutes, presentations and reports from meetings are all available on the CoNNMO website: http://connmo.org.au/

Register now @

MESSAGEFROM THE EXECUTIVE

SUMMARY: What the Executive Committee are working on over the next few months.

The Psychogeriatric Nurses’Association Australia (Inc)

AUGUST 2019, Page 1www.pgna.org.au Psychogeriatric Nurse’s Association Newsletter

2019 EDUCATION EVENTS

AGM - FRIDAY 13 SEP 19

The 2019 Executive meetings will be held:Every second Month the Second Thursday of the month at 6pm.

DATES FOR 2019: AGM 13 September at Conference 14 November

If you have any agenda items you would like discussed or feedback you would like to provide, please contact the secretary by email: secretary@pgna.org.auDESIGNED BY:

Winner Announced for Free Conference Rego At the PGNA Executive meeting in June the draw for the free conference registration was undertaken. The process was done through the website Random Result (http://www.randomresult.com/pick.php) By uploading of all names who paid their membership before the end of June 2019. That website then picked a random winner. The winner of the free Conference Registration “Raise Your Voice” on 13th September 2019 in Wollongong is Marianne Cummins. Congratulations! P.S. MARIANNE has donated back her winning prize to the PGNA so that another WINNER will be REDRAWN during the CONFERENCE on the 13th September.

NOTICEBOARD

DID YOU KNOW?

CONTRIBUTE

Congratulations to Nerida Adams for being therecipient of a PGNA Scholarship. She attended a 2-day conference in Brisbane last April on thelatest updates on mental health illness andhealth promotion for older persons.Read her report in this special edition newsletter.

PGNA is also represented at the Older Person’s Mental Health Working Group (OPMH WG).More about this to come.

To contribute to the next Newsletter please forward the information to: newsltr@pgna.org.au

AUGUST 2019, Page 2www.pgna.org.au Psychogeriatric Nurse’s Association Newsletter

Welcome to our New Members:

Allyson Ward, CNC, Allyson Ward Anita Westera, Research Fellow,

Australian Health Services Research Institute

Caitlin Knight, EN, NSW Health Chenjerai Chikara, RN, Western Sydney LHD Emma Underwood, CNC Emma-Jane Nash, RN Community OPMH, NSW Health Hailey Carpen, Aged Care NP, Nepean Hospital Hazel Bucher, NP, Hazel Bucher

NP Consultancy Jacquelene Cook, RN, Concord Hospital Jacqueline Salmons, CNC Joanne Macmillan, CNC Dementia, NSHNS Judy Groom, CNS for BAMS -

OPMHS, NSLHD Karen Rae, RN, SESLHD Karl Stamp, CNC, NSW Health Katherine Paulette, CNC, NBMLHD Kay Northcott, AARCS CNS,

Bathurst Health Service Kerrin Mary O'Grady, CNC OPMH, Manning Mental Health Services Liz Robinson, RN, Bathurst

Community OPMH Marie Lee, RN Educator, UOW College Meaghan Burnett, Clinical Advisor, Australian Aged Care Quality and Safety Commission Penelope Callaghan, CNC, Hornsby Kuringgai Hospital Richard Baldacchino, CNC OPMH,

NBMLHD Ross Conlan, RN,

St Vincent de Paul Society Sonia Heath, RN, Pulse Staffing Sonya Baumgarten, RN DBAMS Therese Woodward, CNC, NNSWLHD Vanessa Cawis, RN, Braeside Hospital Xolani Maloi, Facility Manager,

RSL Life Care

WINNER ANNOUNCED

JOB VACANCIESHas your service any Job

If the time frame

advertised in the PGNA Newsletter!

info@pgna.org.au

AUGUST 2019, Page 3www.pgna.org.au Psychogeriatric Nurse’s Association Newsletter

IN THE NEWSFROM THE EDITOR

Top stories - Tuesday, 18 June 2019 Geriatric outreach service avoids unnecessary ED presentations An outreach service running out of Bankstown-Lidcombe hospital in Sydney is saving the NSW government $2 million a year and reducing pressure on its emergency department. According to the Australian Institute of Health and Welfare, Read more:https://www.agedcareinsite.com.au/2019/06/geriatric-outreach-service-avoids-unnecessary-ed-presentations/

What is My Health Record?My Health Record is an online summary of your key health information.When you have a My Health Record, your health information can be viewed securely online, from anywhere, at any time – even if you move or travel interstate. You can access your health information from any computer or device that’s connected to the internet.Whether you’re visiting a GP for a check-up, or in an emergency room following an accident and are unable to talk, healthcare providers involved in your care can access important health information, such as: allergies medicines you are taking medical conditions you have been diagnosed with pathology test results like blood testsThis can help you get the right treatment.

from having a My Health Record. It’s a convenient way to record and track your health information over time.BUT did you know My Health Record need to be “Activated” when you see your GP ask about it!

JOURNAL ARTICLES OF INTEREST

Delirium what do you know about it?Did you receive the email with the link to a brief (10 minute) online survey on nursing practice in delirium treatment?These are the articles from the survey (if you have not read them already).

delirium prevention and treatment: A systematic review of current evidence. European Journal of Internal Medicine 2016Neufeld KJ, Yue J, Robinson TN, et al. Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis. Journal of the American Geriatric Society 2016

symptoms of delirium among patients in palliative care: A randomized clinical trial. JAMA Internal Medicine 2017Burry L, Mehta S, Perreault MM, et al. Antipsychotics for treatment of delirium in hospitalised non-ICU patients. Cochrane Database of Systematic Reviews

One of the aims of PGNA is to promote and facilitate funding/resources for Rural and Remote education. If you are thinking of going to a Conference, or maybe doing some research or training, PGNA has scholarships available.

The value of a Scholarship has increased up to $800.This is to enable members to attend conferences, seminars, education courses & scholarships are available throughout the year on application.If you are interested in applying for a scholarship please check the website for details. Requires you to have been a member for more than 1 year. www.pgna.org.au

PGNA has become a champion organisation for StepUp For Dementia ResearchStepUp for Dementia Research is an online, postal and telephone service that connects people interested in dementia research with researchers conducting studies into dementia prevention, diagnosis, treatment, care and cure. This new matching service is set to revolutionise research participation, fast-tracking more effective and inclusive dementia research across Australia.StepUp for Dementia Research is free and anyone aged 18 and over – both with and without dementia – can register their interest. Based on characteristics such as age, location and diagnosis, volunteers will be matched to any studies they may be eligible for. Registration is simple and by answering some questions about yourself, you can be part of the next dementia breakthrough.To sign up for StepUp for Dementia Research, please visit https://stepupfordementiaresearch.org.au or call 1800 7837 123.

2019 “HEALTH AWARENESS” DAYS / MONTHSl February 13-24 Seniors Weekl April 16-22 National “Advanced Care Planning Weekl May 12 International Nurses Dayl May 20-26 Dementia Action Week previously Dementia Awarenessl June 11-17 Carers Weekl June 15 World Elder Abuse Awareness Dayl July 3 NADOC Weekl August 20-26 Be Medicinewise Weekl September Dementia Awareness Monthl September 13 RU OK Dayl September 21 World Alzheimer’s Dayl October Mental Health Monthl October 8-14 Mental Health Weekl October 10 World Mental Health Dayl Year 2020 Year of the Nurse and Midwife

SCHOLARSHIPS

AUGUST 2019, Page 4www.pgna.org.au Psychogeriatric Nurse’s Association Newsletter

STEPUP FOR DEMENTIA

AUGUST 2019, Page 5www.pgna.org.au Psychogeriatric Nurse’s Association Newsletter

NOTES FROM SCHOLARSHIP RECIPIENT NERIDA ADAMS

Earlier this year I was honoured by PGNA to be awarded an educational scholarship to attend the Mental Health Conference on the 29th-30th April 2019 in Brisbane. The conference was convened by Ausmed Education and aimed to give participants up-to-date evidence-based information on common mental health disorders and conditions. My intention for attending the conference was to enhance my mental health nursing knowledge and skills, share new insights and new knowledge with my colleagues, translate this into my nursing practice and improve the outcomes of the patients/residents entrusted in my care. A number of content experts collaborated to put this excellent two day programe together and the topics covered included: Trauma; Practical de-escalation techniques; Drug dependence; Taking a drug and alcohol history; Legal & professional issues; Antidepressant use in the elderly; Performing a mental state examination; Eating disorders; Suicide & self-harm; Psychotropic medications and metabolic

syndrome and; Unconscious bias.

Of particular interest to me was the session on Unconscious Bias – “we are all guilty of

I will now share with you my key insights from the session as well as learnings from additional readings that I have made since the conference. What is unconscious bias?Bias is multifaceted with approximately 150 documented types. Lieberman, Rock & Cox (2014) have narrowed these down to 4 types which are corner-cutting, objectivism, self-protection, time and money. Broadly

evaluation of one group and its member’s relative to another’ (Blair, Steiner & Havranek: 2011). It can manifest directly or indirectly, is unintentional, common and persistent, and can be activated quickly and unknowingly despite a person’s best intentions (Bucknor-Ferron & Zagaja: 2016).Biases have evolved as an adaptive mechanism to help us to make quick, and

minimal effort. They can impact on every decision we make. Although they can be helpful, on the downside they can be very detrimental and blind us to new information and limit our thinking and creativity.

Continue overleaf

“State of Play in Old Aged Psychiatry - A Farewell to Brian Draper” at UNSW Kensington on Friday 26.7.2019We had a great day celebrating this occasion with the Faculty of Psychiatry of Old Aged (FPOA). Photos: Professor Brain Draper and members of PGNA who attended conference. PGNA President, Roderick Pirotta, presented a small gift to Prof BRIAN DRAPER on behalf of all members for his support to PGNA.

FAREWELL BRIAN DRAPER

Conference clips on page 7

AUGUST 2019, Page 6www.pgna.org.au Psychogeriatric Nurse’s Association Newsletter

NOTES FROM SCHOLARSHIP RECIPIENT NERIDA ADAMS

How does unconscious bias present itself in a health care setting and affect care?Healthcare professionals typically do not view themselves as biased. However, studies have revealed that healthcare professionals unconsciously exhibit high levels of stereotypical beliefs, attitudes and prejudices, which raises serious concerns in the health care setting, as this has the potential to impact on the quality of care given to patients (Fitzgerald & Hurst: 2017; Stone, Moskowitz: 2011). Biases of particular concern for health professionals are those that operate to the disadvantage of those who are already vulnerable. For example, the poor, elderly and the mentally ill. Often there is a disconnect between the health professionals desire to provide equal treatment and the way their clinical decision making is influenced by the patients race, ethnicity, age, socio-economic status, or other social group membership traits which creates disparity in health care.According to Bucknor-Ferron & Zagaja (2016), the potential negative consequences of disparities in healthcare may result in a lack of preventative care, mismanagement of symptoms, being underserved, experiencing longer waiting times for appointments and diagnostic tests, and dealing with professional caregivers who don’t take the time to understand the language and cultural differences. The patients who experience these disparities perceive that the healthcare system presents insurmountable obstacles that they cannot easily penetrate. They may view the system as unwelcoming, uncaring, complex and difficult to navigate.How can we manage or mitigate our own unconscious biases attitudes or beliefs?If the goal in healthcare is to deliver impartial care we should therefore be wary of any kind of negative evaluations that we may possess. However, managing unconscious bias is difficult due to its intrinsic blind spots. It requires constant vigilance and commitment to make a difference. Lieberman, Rock & Cox (2014), propose a three step model for addressing bias.

These are:1. Accept: that people and systems are

deeply biased;2. Label: the biases according to the

four types;3. Mitigate: attack the bias with strategies

that go directly to the core mechanismsunderpinning the bias.

Five strategies have been suggested by Bucknor-Ferron, P. & Zagaja, L. (2016), to combat bias.Firstly, personal awareness: which entailslooking inwards to create an awareness of how you are perceived by others. Through this there is the development of self-regulation and a determination of what are acceptable and non-acceptable attitudes and behaviours. This lays the foundation for the development of a therapeutic relationship with the patient.Secondly, acknowledgement: which allowsacceptance of accountability and responsibility to make a difference.Thirdly, empathy: which involves a consciouseffort to understand the patient’s situation and to get a sense of what it is like to walk in their shoes.Next is advocacy: providing individualisedsupport to navigate the complexities of the healthcare system through collaboration with other healthcare providers, and ensuring patient rights are respected.Finally, education: raising the awareness ofothers to recognise unconscious bias to create an environment that fosters equal treatment for all patients with an open and accepting approach, resulting in high-quality patient care.I sincerely wish to thank all those who were responsible in approving my scholarship and allowing me the opportunity to attend the conference and to share this information with you.

Nerida Adams, Acting CNE/RN Lilli Pilli Older Persons Mental Health Unit NNSW LHDReferences: Blair, I.V., Steiner, J.F. & Havranek, E.P. (2011). ‘Unconscious (Implicit) bias and health disparities: where do we go from here?’ Perm J. 15:71. Bucknor-Ferron, P. & Zagaja, L. (2016). ‘Five strategies to combat unconscious bias’. Nursing. 46:11. Cherry, K. (2019). How cognitive biases influence how you think and act. https://www.verywellmind.com/what-is-a-cognitive-bias . Fitzgerald, C. & Hurst, S. (2017). ‘Implicit bias in healthcare professionals: a systematic review’. BMC Medical Ethics. 18:19. Lieberman, M.D., Rock, D. & Cox, C.L. (2014). ‘Breaking Bias’. NeuroLeadership Journal. 5. Stone, J. & Moskowitz, G.B. (2011). ‘Non-conscious bias in medical decision-making: what can be done to reduce it? Medical Education.’ 45: pp. 768-76.

CONFERENCE CLIPS

Prof Gordon Parker Observations of depression in oldiesFlourishers vs Languishers model instead of Integrity vs despair model (Erickson’s). Anxiety & Depression is the most common Mental Disorder in the older adults. Proposed to be “assertive in treating” – avoid ageism. Life-time events which are suppressed (‘locked’) can trigger symptoms in later life like a ‘key’ – Key and Lock model.

Dr Viviana Wuthrich Improving Social connectionsAnxiety/Depression = death, cognition , dementia social participation = isolation

= suicideStrong connection with family/community at age 50 = happy at age 80...Reflective comment: “be involved - you get back what you give“

Prof John Snowdon Suicide statistics - do we believe them2017- 3,000 adults suicided in Australia 1.9% of Australians suicide (2002-2017)1980 Justice Powell said: “Dementia is not a mental illness”. Some statistics about suicide rates from certain countries are not reliable. No evidence of overall increase in suicide rates in Australia – at least no ‘crisis’.However, the highest in male indigenous people in 20 years.Reflective comment: Why do some BPSD’s end up in psychiatric facilities in hospital?

Dr Perminder Sachdev/ Dr Yutang Shen Neuro-narratives - Depression in Older Aboriginal AdultsThe use of narrative in our clinical work: Narratives as evidence; Narratives as education; Narratives as healing; Narrative as societal idiom.“Forever effects of child sexual abuse”Reflective comments: Damaged young minds, stay damaged. Listening rather than prescribing is half the cure!

Dr Anne Wand “Gates of Delirium”Delirium costs Aust $8.8 Billion (Hosp +RACFs) ½ of all delirium have dementiaMost people who have experienceddelirium will NOT return to workSuggests delirium is a “TIA of Dementia “Delirium may lead to dementia. Delirium isa neurotoxic condition. 30 % of deliriumsare preventable by addressing cognitiveimpairment, visual & hearing loss, sleep,hydration & immobility.Diagnosis - fluctuating attention/awareness(distinct from fluctuations in LOC) especiallycognitive, behavioural & motor changes.Reflective comment: Normalise care, engage, specs, hearing aids, sleep, cuppas & a walk.

Prof Henry Brodaty Old Age Psychiatrists & the Nursing HomeCost 9.2 Billion by Government + 3.2 Billion by clients contribution. 170,000 Residents in 2,700 RACFs. Was 100% Occupancy now 91%. Was 50 % dementia now 70% . 140 Suicides in RACFs (2000-2013 - about 11 per year). RACF psychotropic medication. Consent 6.5% Written, 6.5% verbal, nil in hospital. 95% of clients in RACFs with dementia will have BPSD at least once. Managing BPSD - environment, policy & leadership matter. Engaging with residents is as effective as risperidone. Rate of stroke in people on psychotropic

medications. Rate of mortality in people on

psychotropic medications.Prof Brodaty was able to decrease psychotropic meds but 20-25% HAD to be re-prescribed. Not sure what happened after study?Use handovers as mini-tutorials.Need for: DO NOT Hospitalise (DNH) instructions in Aged Care Facilities similar to Not For Resuscitation (NFR) in hospitals.Reflective comment: Residents with BPSD need time - all other non-care things take time.

AUGUST 2019, Page 7www.pgna.org.au Psychogeriatric Nurse’s Association Newsletter