Perioperative project in the Pacific – collaboration in action


 

group work

group work

What a wonderful few days we have just had in Suva, Fiji presenting at the workshop on implementing the Pacific Perioperative Practice Bundle (PPPB). We have been working with our colleagues within the organisation, Strengthening Specialised Clinical Services in the Pacific (SSCSiP) developing six infection prevention standards which formed the bundle, together with audit tools for each standard. The workshop was aimed at assisting our Pacific perioperative nursing colleagues implement the bundle within their own workplaces.

SSCSiP’s project coordinator, Mabel Hazelman Taoi and her team did a wonderful job coordinating the workshop and all the travel and accommodation for the twenty participants – no mean feat when you see where they all came from. You will need to get the map out to locate all fourteen countries of the Pacific region represented – Cook Islands, Fiji, Kiribati, FS Micronesia, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tokelau, Tuvalu and Vanuatu. Some of the participants had travelled for a couple of days with many connecting flights via places such as Honolulu and Auckland! Nothing like our 4 hours direct flight from Sydney!

book signing

book signing

webinar with Jed Duff in Sydney

webinar with Jed Duff in Sydney

We had two and half days with our colleagues working through key elements of the standards and strategies for implementation. Each participant received a copy of the 2nd edition of the perioperative text book, Perioperative Nursing: An Introduction. Our fingers were well and truly crossed that technology would work and with the assistance of ACORN’s Education Officer, Dr Paula Foran, we arranged a live webinar with Dr Jed Duff (ACORN President) back in Sydney. He gave a great presentation on putting knowledge into action with excellent practical information on implementing change. It is one thing to have a bundle of standards, it’s quite another to implement them and we spent a lot of time looking and enablers and barriers to implementing change in the workplace based on Jed’s presentation. Another key element to the bundle were the audit tools and for many of our colleagues this was new territory for them. We were able to practice undertaking audits using the tools by carrying out observations in the local operating theatre, around the hospital and by watching videos.

location, location!

location, location!

One additional topic discussed was the formation of a professional association to connect all the perioperative nurses within the Pacific, encouraging sharing of ideas and progress on implementation. We tapped into the experiences of Phyllis Davis who was instrumental in assisting the perioperative nurses of Papua New Guinea form of their association. Another live webinar with Sydney based Phyllis got the ball rolling and served to inspire the group to the next step.

During our workshop we learnt more about the environments that our colleagues work in and the challenges they face in implementing the standards. Some of them work in large units and some come from small facilities with only one operating theatre and minimal staff. It wasn’t all work and we had a lot of fun along the way, including a night out with the group at a local Chinese restaurant.

a night out with the group - note Vane's NSW OTA shirt!

a night out with the group – note Vane’s NSW OTA shirt!

Mabel receiving one of our gifts

Mabel receiving one of our gifts

Unfortunately we were not in Fiji to join in the celebrations for their victorious, gold medal winning 7s rugby team! That would have been an experience judging by the obvious excitement still bubbling amongst the local population. We left Suva exhausted after a full on couple of days, but feeling very satisfied that we had provided the group with lots of information, strategies and encouragement for the next step of their journey. A journey that will bring a consistency to the standards of perioperative nursing practice to their workplace and ultimately a safer environment for their patients.

lovely necklaces and a Fiji banner as gifts

lovely necklaces and a Fiji banner as gifts

We have already had lots of emails from the group who have already organised meetings with their hospital administration to report on the workshop and submit implementation plans. So lots of positive steps are happening already.

We hope to see a few of the group at the South Pacific Nurses Forum to be held in Honiara, Solomon Islands in early November where Sally and Mabel will present a paper on the PPPB Project.

ACORN 2016 – A memorable gathering

Sally, Heather, Lois Hamlin, Menna and Ruth Melville

Sally, Heather, Lois Hamlin, Menna and Ruth Melville

Menna Davies

Having just returned from the ACORN Conference in Hobart where over 1000 perioperative nurses gathered for 3 days it got me thinking about why, in this electronic age we still find value in meeting together at conferences. Couldn’t we obtain all the information imparted at a conference via webinars, podcasts or YouTube? Why do we spend hundreds of dollars to travel hundreds of kilometres to spend three days with a thousand fellow perioperative nurses? I think the answer is simple, nothing compares to being in the company of like-minded people, who understand the challenges of being a perioperative nurse in 2016 and who also enjoy having a good time! And so it was at ACORN 2016 in Hobart. Phew, what a buzz! Lots of memorable moments.

But one moment stood out for me and happened by chance, a case of me being in the right place at the right time. One day a woman approached me during the lunch break, ‘Do you recognise me?’ she asked. It is a question I am often asked, usually by post graduate students who I have facilitated on line and who know me, but who, due to only having an online presence, I rarely get to meet face to face! Unfortunately I did not recognise the woman at first and had to tactfully ask (I have become quite good at this over the years) to give me a clue as to where we may have met before.   ‘I’m Heather Moon’ she replied. I don’t think many people at the conference would have known that Heather Moon is a former ACORN President (1986-89). Fortunately I did (perhaps I have just been around ACORN for more years than I care to remember)! What a treat to meet her again, not many perioperative nurses from that era attend ACORN Conferences and her appearance that day was only by accident. She and her husband, David, had been staying at the conference venue the previous week for another event that he was attending. Returning for a further night’s stay, she saw the signs for the ACORN Conference and thought she would pop in to say hello! Heather comes from Queensland and I tracked down the ACORN Board members from the sunshine state, along with Ruth Melville, IFPN President and also a Queenslander who were equally thrilled to meet her. Current President, Jed Duff met Heather and a number of other conference attendees made her so welcome. She was escorted around the trade exhibition in awe at the array of latest equipment and medical devices. Later that day several of us met Heather and David again at the bar and over a few glasses of wine, shared memories of her time as ACORN President using photos I had as part of a montage prepared for a previous conference.

Sharing memories with Heather

Sharing memories with Heather

Heather was thrilled to have met up with so many perioperative colleagues and friends. We all left energised at meeting one of ACORN’s living treasures. It occurred to me after we had said our farewells, how much we owe our predecessors who nearly forty years ago, paved the way for where ACORN is in 2016 by their administrative skills, vision and commitment. In Heather’s day, ACORN was run by volunteers from each state/territory using telephone (no mobiles), snail mail (no email) and fax as the only means of communication, managing to coordinate the publication of the journal and standards, not to mention the enormous task of organising the national conference. Today, ACORN has a secretariat, email, webinars, video/teleconferences and external conference organisers – how times have changed and how much we take for granted!

When it all comes down to it, the conference is all about the people who attend – the networking, renewing of friendships, making new ones, gaining knowledge, sharing solutions to common challenges, meeting people who have influenced your career, have been your mentors or perhaps people you have mentored and above all lots of fun!

I always return from conferences with new ideas and a renewed approach to my work that I feel makes me more effective and efficient. Stephen Covey, in his influential book ‘The 7 Habits of Highly Effective People’, identifies this as ‘sharpening the saw’ – renewing yourself through making meaningful social connections with others, learning, increasing your capacity to face the challenges of life and work. The analogy – a sharp saw will cut more effectively than a dull one! And I think that is so true. ACORN Conference 2016 – memorable!

Reference:

Covey, S. (1989) The 7 habits of highly effective people. USA:Running Press.

Another reason we continue to celebrate nurses on May 12th

Each year on May 12th as I celebrate International Nurses’ Day I’m reminded of Florence Nightingale’s legacy.

All of us in society, whether we are nurses, patients or family, share a debt of gratitude to Nightingale for laying the foundations of nursing and establishing many of its principles we value today.Florence_Nightingale_monument_London_closeup_607

I was reminded of this recently when I visited the Nightingale Museum housed in the Selimiye Barracks at Scutari, Istanbul. It contains many relics from the Crimean War between Russia and the combined forces of Britain, France and Turkey. This war is remembered not only for the Charge of the Light Brigade but also for the terrible troop losses from disease which led to a Royal Commission into Military Hospitals. Florence Nightingale’s association with the Crimean War is also justly famous because of her attention to the nutritional and hygiene needs of the sick and wounded troops. She fought authority wherever she found it to be misguided. She made a difference.

I was able to visit this most historic museum when I travelled to Greece and Turkey to commemorate Australian and New Zealand nurses’ achievements during WWI. Like Nightingale half a century before them, the nurses of WWI skilfully cared for the physical and emotional needs of our wounded soldiers, and improved their survival rates so that many of these young men could return home and contribute to our growing society. In recent months, I’ve written more about this trip in the Journal of Perioperative Nursing in Australia and I’ve posted some photos on the NSWNMA Blog Nurse Uncut.

So this year, let’s all remember our debt of gratitude to Florence Nightingale for establishing what we know today as the profession of nursing and consider the many ways that nurses contribute to our society.

Would love to read your comments here about how you celebrate International Nurses’ Day – thanks for reading, Sally.

The journey begins

The journey begins at last. After many months of anticipation, reading, chatting, planning and farewells we are now followinFarewell from Greek Consulg the footsteps of the nursing sisters of WWI.

These photos were taken recently at the Greek Consulate in Sydney. Liz Kaydos of the Lemnos Assoc NSW is seen here with cruise organiser Clare Ashton and Dr Stavros Kirimis, the Greek Consul, and I appear in with the second pic below.

We are seen here discussing arrangements for the laying of wreaths for the Australian nurse buried in Thesalonica and for the New Zealand nurses lost at sea when the Marquette was torpedoed. Dr Kirimis told us about the additional commemorations planned by the Greek Consulate for the later in the year including the battle for Crete and evacuation of Australian troops during the Second World War. Farewell from the Greek Consul in SydneyThe third pic is from Sydney University School of Nursing, where Clare and I met Prof Donna Waters who was delighted to see us in the replica nurses’ uniforms. Bit too tight for comfort but they have incredible impact visually.Clare Ashton with Sally Sutherland-Fraser at School of Nursing History display, Sydney UniThe ANZAC nurses spent months at sea travelling via Fremantle, Colombo and the Suez Canal before the real hardships began. In the coming days, our greatest hardship will be navigating the sea of faces in crowded departure lounges and customs halls. Watch this his space for more posts and be sure to check out Clare’s Facebook page First World War ANZAC Nursing Sisters, as well as Dom Sheridan’s page Australian Great War Poetry. Bye for now, Sally.

Real ANZAC Girls

I’m heading off in search of the Real Anzac Girls, joining a 7-day cruise from Athens to Istanbul with a group of Aussies and Kiwis. Not being one for cruises, I am more than a little surprised by this, but this really is a cruise with a difference…

It’s a once in a lifetime opportunity to commemorate the achievements of the Anzac nurses and to visit the WWI sites I have reReal Anzac Girlsad about in so many books, not least of which is Anzac Girls by Peter Rees. Some of you will have seen the TV mini-series based on Peter’s book. Or perhaps you have read Menna’s post from last year ANZAC GIRLS – WARTIME SOAP? If so, then you’ll have an idea of some of the places that we’ll be visiting. Iff not, here’s a quick itinerary:

Professor Christine Hallett of Manchester University and leading authority on First World War nursing will be on board delivering lectures throughout the cruise. We intend to lay wreaths to those New Zealand nurses who perished at sea when the SS Marquette was sunk by torpedoes. On 3 September, 30 of us dressed in replica WWI dress will land at the site of the Third Australian General Hospital on the Greek island of Lemnos to commemorate the ‘bag-piped’ arrival of the ANZAC nursing sisters of 1915.

I will be squeezing myself into one of the replica nurses uniforms for this re-enactment (donated by the producers of the mini-series – the tag inside the collar tells me that I will be wearing Elsie Cook’s replica uniform!). The photograph here will give you an idea of the moment we are re-creating. We expect to have a reception on ‘Turks Head’ that will include an official welcome from the Mayor of Lemnos. From here, we make land in Turkey, and visit the main Allied landing sites – Suvla Bay, Anzac Cove and Cape Helles. The itinerary continues with our passage through the Dardenelles. On arrival at Istanbul, we’ll be visiting the Florence Nightingale Museum in the Selimiye Army Barracks.

The purpose of the cruise is to draw attention to the sick and injured of the Gallipoli campaign and those who cared for them – the real Anzac girls, on hospital ships, on Lemnos and at bases in Salonika and in Egypt. The nurses on Lemons worked in unprecedented circumstances. Posted there to deal with the wounded of the battles we now know as Lone Pine and Chanuk Bair, those actions were already underway when they arrived to find their hospital supplies were delayed. They were ‘making do’, ministering to the wounded on stretchers, kneeling on the stony ground and using their own cups to give the men fluids. Day and night, they could hear the guns booming continuously on the Peninsula. ‘I could weep hysterically now it is over’ wrote Sister McMillan of Sydney in her first letter home two weeks later. The sisters of the Australian Army Nursing Service with the Third Australian General Hospital lived and worked in tents on the shores of Mudros Harbour, Lemnos for five months in 1915.

Well, it doesn’t get much better than that. Watch this space for more posts and pics from this cruise in the coming weeks. I understand that Antonia Prebble, one of the actresses from the Anzac Girls mini series will be on the cruise so that will be a brush with fame. She played the Kiwi nurse Hilda Steel – a real Anzac girl, who trained as an anaesthetist (with some success it seems), so I’m sure there’ll be some good stories about that! Bye for now, Sally.

There are a few berths still available for the voyage. If you would like more information contact Wild Earth Travel

The cruise organisers are indebted to the producers of the TV drama ANZAC Girls for the replica uniforms; as well as the Greek Consul General in Sydney and the Lemnian Association of NSW for their support. Photo credit: SLNSW Ref No. PXE 698.

Lister, Carbolic Acid & Alcohol– have we come full circle?

I recently received my annual Nurses’ League Journal from my training hospital, Kings College Hospital, London – the same one featured in one of my previous blogs on the TV show, ’24 hours in Emergency’. The League is essentially the ‘old girls’ association which we joined on completion of our training. The journal is full of news of us ‘old girls’, the reunions that have taken place and general news of the hospital’s activities. The journal usually features an aspect of the hospital’s history, a South London institution since the early 1800s. In this edition, the story of the eminent 19th century surgeon, Joseph Lister was featured. He is widely regarded as transforming surgery into a practice governed by science due to his pioneering work on antisepsis.

Joseph Lister

Joseph Lister

Why am I telling you all this? Well, at the time I was reading about Lister in the journal, I was also editing the chapter on asepsis and infection prevention for the forthcoming second edition of ‘Perioperative Nursing: An Introductory Text’, due for release in May 2016 at the ACORN Conference in Hobart. I was interested to read about Lister’s infection control practices in 1867 and how they contrast with our present day practice. He, like many of his contemporaries, were appalled and puzzled by the high rates of surgical site infections (SSI) which often led to post op death.
It was the work of French chemist of Louis Pasteur’s that influenced Lister’s thinking about what might cause infection. Pasteur had postulated that fermentation of wine and milk was due to bacteria found floating in the air and not just the air itself that caused infection, as had been traditional thinking. Armed with this light bulb moment, Lister’s next step was to experiment with a variety of antiseptic agents which he thought might kill the bacteria that infected surgical wounds. He settled on carbolic acid (phenol) after hearing about its success in cleaning up the city’s stinking sewers. He introduced it into his operating theatre at the Glasgow Royal Infirmary, Scotland, which must have been a most uncomfortable place to work as he sprayed carbolic acid over the operative field (and all the assistants) continuously during surgery and soaked dressings in the solution. His breakthrough moment came when treating a compound tibial fracture in an 11 year old boy, James Greenlees using dressings soaked in carbolic acid. After a few days there was no evidence of the usual infection that blighted such procedures and James made a full recovery.

Lister spraying carbolic acid during surgery

Lister spraying carbolic acid during surgery

Lister continued this type of wound dressing on other surgical patients and his post-operative infection rates dropped dramatically. If Lister had access to the internet, news of this dramatic breakthrough in infection prevention would have spread like wildfire and perhaps been accepted a little sooner, but it was two years before he published a number of articles about his work in the Lancet medical journal. Even then his results were viewed with a degree of scepticism, by many colleagues, particularly in London and it would be another 20 years of further experimentation before the medical profession accepted Lister’s theory and practical application of antisepsis.
Lister carried out much of his research at my old training hospital, King’s College, where he was appointed Chief of Surgery in 1877 and confronted many of his fiercest critics. The hospital had prohibited open surgery into joints due to the high risk of infection, but Lister believing in his antisepsis methods bucked the system (after all he was the boss!), forging ahead with his work, which eventually paid off, laying the foundations for our modern understanding of antisepsis and ultimately aseptic technique.

operating theatre at Kings College Hospital, London

operating theatre at Kings College Hospital, London

Even though we have come a long way since Lister in our understanding of antisepsis and infection prevention, SSIs are still of great concern in the 21st century. Hand washing continues to be a vital strategy in the fight to reduce the risk of infection and what struck me about surgery in Lister’s era, the late 19th century was the use of alcohol as a hand hygiene product. Three to five minutes pre-operative cleansing of the hands using 90% ethanol was common practice amongst surgeons of that era. The efficacy of alcohol to kill microorganisms on the skin has therefore been known for sometime and with the recent introduction of alcohol based surgical scrub solutions (ABSS) in many Australian operating theatres, it feels like we are back to the future!
Moving to ABSS will require a change of culture in our operating theatres – the ritual of the surgical scrub is one which many instrument nurses may be somewhat reluctant to give up – that five minutes or so at the sink was good thinking time when you could gather your thoughts and prepare yourself mentally for the procedure ahead. Replacing that with a 90 second rub with alcohol based product will not come easy to some! For the surgeons too, it is a big change, although having witnessed some surgeons undertake what passes for a surgical scrub by a momentary waving of hands under running water, an application of alcohol will at least kill a few bugs!

Alcohol based surgical scrub

Alcohol based surgical scrub

Many of you have perhaps already been involved in trialling the variety of ABSS products that medical companies are now clamouring the sell us. It’s big business for them! What’s important is to ensure that we make choices based on available evidence of the efficacy of the products and not the hard sell and promises of the company reps. There are many different products on the market –some containing differing percentages of alcohol and those that combine alcohol with other antimicrobial products eg chlorhexidine. Which one to choose? Don’t be afraid to ask the reps for research evidence to back up their claims, but it’s also important to do your own independent research – there is plenty out there and World Health Organisation has some good resources too.
It seems we have come a full circle in the 150 years since Lister first laid the foundations of infection prevention with the introduction of ABSS in the 21st century. It will become one more strategy we can use to reduce the risk of SSIs that continue to be a cause of morbidity and mortality in our hospitals.
Let us know if you are using ABSS in your workplace and how this new procedure is being received.
Bye for now
Menna