February 2007

Mental illness means a
new set of rules
Mental disorder in some form affects
far more of us than most realise and
for medical practitioners it can mean
a new set of rules.
Speaking at a Taranaki OHN regional
seminar recently, Helen Bingham, Mental
Health Nurse Educator for the Taranaki
DHB, told Occupational Health Nurses
that 40% of New Zealanders are
predicted to meet the criteria at some
time in their lives and 20% will have
some form of mental illness.
Diagnosing or recognising the outward
signs required positive engagement, Helen
said, “You need to provide an
environment that encourages honesty, as
admitting to mental illness can be a
massive hurdle to many.”
The longer the problem goes untreated, the
longer it will take to respond to treatment,
and the greater chance it will affect both
work and social skills. “For most sufferers,
there is a lead-up period and sometimes
the changes can be so subtle they become
part of normality. For others the changes
are dramatic and dysfunctional.”
If a mental health problem is indicated,
she said it can show up as a change in
concentration, work atitude, or
interaction with others. Stress can
become a more serious mental health
problem. The change in a person’s
attitudes or behaviour are often only seen
on reflection by those close to the person,
so you need to discover how the person
functions in the workplace and socially,
and look for stressors in their lives.
Screening tools, said Helen, are only
useful if they are answered honestly. They
are: 10 Quick Steps, anxiety and
depression scale, Audit, Eight gambling
screen, *Cannabism screening test,
Readiness to change questionaire (*
excessive use of cannabis).
If you are dealing with an existing mental
illness, you need to know what it is, the signs
and symptoms, treatment options in use, the
likely cycles, triggers, how much insight the
patient has, and whether there are
indications that medication is not working.
Helen told the nurses that a certain
amount of stress and anxiety is normal in
most peoples’ lives but those normal
conditions can lead to greater problems if
they are allowed to go on unabated. If
someone isn’t coping with stress they will
show symptoms of: changes in coping
with stress, listless or lacking interest,
treating others differently, changes in
sleeping patterns, twitches and spasms,
physical pain and more of the ‘run-down’
symptoms like colds, shortness of breath
and loss of confidence.
While anxiety is a normal reaction to
danger, Helen said it could escalate into
reaction to perceived, as opposed to real,
danger and lead to panic attacks.
Depression is common
Depression is one of the most common
disorders and can result in impaired
social or occupational functioning. The
classic symptoms are: changes in sleep
patterns, feeling ‘down’, loss of enjoyment
in usual activities, loss of energy, poor
concentration and ability to make
decisions, changes in appetite and
thinking patterns.
Helen told the nurses that probing for
suicidal thinking was delicate but
important. It was important to discover
how often someone had thought about
suicide, what factors brought on the
suicidal factors and what factors
prohibited further action, did they have a
plan and had they carried out any actions
around that plan?
Bipolar disorder was characterised by
dramatic mood swings from manic to
deep depression, but she said mixed
mania can display both conditions at
once. The manic phase often exhibited
inflated self-esteem, high confidence, less
sleep required, rapid thought and speech,
paranoia and vindictiveness, irritable and
easily distracted, hyperactive and restless,
impulsive and reckless.
Managing these risks and other
conditions such as schizophrenia required
good interdepartmental interaction and
seeking best advice. But OHNs had to be
aware that a high risk flare-up may
require the police or ambulance. And
OHNs must also be prepared to go
against years of habit and discipline and
consider disclosure of pertinent
information if the risks dictate it.
OHNs tried the ‘at risk’ alcohol and
substances questionnaire - and overall the
results were very reassuring!
National President Barbara Haywood
discussed ethics and business practice
with the regional seminar. See her
editorial on page 2.
February 2007
February 2007
Editorial COPD prevalent
As a New Year’s resolution, I would like all
NZOHNA members to resolve to behave
legally and ethically – not only to other
members but to all nurses, health
professionals, employees and our employers.
I believe there are several aspects to this.
Some areas are:
Competence. It is a legal requirement to
maintain your practicing certificate by
meeting the requirements set by Nursing
Council. It is also ethical to keep your
knowledge and competence up to date. This
means updating your knowledge, keeping
well read and informed about current issues.
It is also ethical to practice only in your
scope of practice – that is general or
comprehensive nursing
The Commerce Act. Many of us now manage
our own businesses which means we need to
behave in accordance with the Commerce
Act. This means we, as a group, cannot price
fix or participate in non–competitive
practices such as price-fixing; neither can
one group of members act against another to
prevent them doing business. We are each
only as good as our last contact with a
client. If a competitor is selling a service for
less than you consider sensible or equitable,
you need to find another point of difference.
Maybe you can sell that you are more
qualified, offer a more comprehensive service
or just provide better customer service.
Confidentiality. All of us who gain
information while going into and out of other
companies must respect what we learn and
not pass on information. This applies not
only to an individual’s personal information
but to company specific information such as
policies and procedures. Electronic
transferring of these without specific
permission is irresponsible.
Business ethics. Please do not talk down
about your competitors to clients, especially
those belonging to the same organisation and
profession as yourself. If you are concerned
about another’s practice, there are formal
channels that address this. Clients are free to
contract with whomsoever they wish but
avoid deliberately poaching another
member’s client. But remember, if a
customer knows that you have ‘poached’
another’s business, they may wonder how
loyal you will be to them if a better
opportunity comes around.
There are many more areas to legal and
ethical behaviour – perhaps your group can
discuss other aspects?
I wish all members a good and prosperous
2007.
– Barbara Haywood. National President
An English research project has identified
that 13.3% of people aged 35 or over who
were participating in the Health Survey for
England had COPD via spirometric
assessment, although 80% of them had
reported no respiratory disease.
smoking was not different. This study
suggests that COPD is common in this
population and is largely undiagnosed.
In participants with severe or very severe
COPD, only 46.8% reported having a
respiratory disease. Increasing severity of
COPD was correlated with increasing
prevalence of smoking. Over 34.9% of
participants with COPD were smokers,
compared with 22% without the diagnosis.
New Zealand’s Respiratory Research Review
comments that the study highlights the
extent to which COPD is not diagnosed in the
population, and this can only be realistically
achieved with the implementation of
spirometry in general practice, for use in
population screening, especially smokers.
Due to the prevalence, morbidity and
mortality from COPD in New Zealand, such
an initiative could be considered a public
health priority.
Dependence on cigarettes was greater in
smokers with COPD, but motivation to stop
For the full report, http://horax.bmj.com/
cgi/content/full/61/12/1043.
Therapeutic products consultation continues
Consultation on the proposed joint regulatory
scheme under the Australia New Zealand
Therapeutic Products Authority (ANZTPA)
will continue throughout the year.
Good progress has been made on the analysis
of the 225 submissions received on the draft
rules for medicines, medical devices and
administrative matters, along with the
discussion paper on the proposals for fees
and charges.
Submissions have now closed on more
documents: the proposed medicines
scheduling provisions of the draft
Administration and Interpretation Rule; the
consultation paper on the proposed
regulation of blood under the ANZTPA; and
the consultation paper on the proposed
product vigilance arrangements.
The New Zealand Therapeutic Products and
Medicines Bill has been referred to Select
Committee – a significant step towards the
establishment of a world-class trans-Tasman
regulatory scheme that will provide better
health and safety.
Executive contacts
National president
Barbara Haywood
jelora@central.co.nz
East Coast
Jane O’Kane
jane.okane@hawkesbaydhb.govt.nz
National secretary
Marlene Thomson
marlene.thomson@paradise.co.nz
National treasurer
Andrea McMillan
andrea.mcmillan@stonebow.otago.ac.nz
Taranaki
Davina Jones
davina@explorationsolutions.co.nz
Central
Allyson Harwood
mohsl@xtra.co.nz
Wellington
Gabrielle Stott
stottys@xtra.co.nz
Auckland
Janice Riegen
janice.riegen@waitematadhb.govt.nz
Nelson
Bay of Plenty
Ken White
ken.white@fonterra.com
Canterbury
Terry Buckingham
terry.buckingham@triex.co.nz
Waikato
Jo Cottrell
cottrelj@waikatodhb.govt.nz
Otago
Andrea McMillan
andrea.mcmillan@stonebow.otago.ac.nz
Keep
up-to-date
Marguerite Besier
marguerite@ramazzini.co.nz
For the latest information important to you as an occupational health nurse, you
should make regular visits to the website - www.nzohna.org.nz. It contains a
wealth of relevant and topical information, is updated regularly on current
issues – and jobs.
February 2007
ACC to pilot general practitioner
certification process change
ACC has agreed to pilot a process
improvement initiative focused on achieving
changes in GP certification of time off work
and improvements in the process of
vocational rehabilitation.
The propsed process is particularly suited
for, and targeted to, small and medium-sized
employers who are less likely to have
dedicated staff to manage occupational
health and safety matters.
This will enable a GP to refer claimants to
Occupational Health Nurses for early
intervention in the return to work process.
The aim is to keep people at work after
injury, where appropriate.
It has been noted that a small number of
claimants cannot cope with their injuries or
It is thought current vocational
rehabilitation may be occuring too late for
some claimants, and there are delays in
getting some onto the Graduated Return to
Work programme.
The pilot will run to the end of June 2007.
The process is:
1. The GP certifies the claimant as fit for
selected work.
2. The GP refers the claimant to the
Occupational Health Nurse.
3. The OHN makes initial contact with the
claimant’s employer to identify the availability
of suitable work tasks for the claimant.
4. Where the employer agrees and the need
is determined, a worksite assessment will be
arranged and conducted. A graduated return
to work plan may then be developed.
5. The early intervention feedback and
workplace assessment report will provide key
information to the GP at the 5-7 day clinical
review of the injury.
New book:
Asthma changeover
not successful
A New Zealand study of 36 asthma
patients who changed their medication
from Ventolin to Salamol, has concluded
this was not satisfacory course of action
for these patients.
The Respiratory Research Review notes that of
the 36, 17% withdrew due to lack of efficacy
of Salamol and 42% were unable to complete
the treatment period and returned to Ventolin.
Of the 15 patients who completed the study,
92 percent reported deterioration in the
symptoms.
The report authors conclude that
‘psychological features’ associated with
changing inhalers, and possible lack of
pharmacological efficacy may have resulted in
the findings.
Commenting on the findings the Review
says that until convincing data can be
provided to demonstrate comparable
efficacy of Salamol, Ventolin will have to
remain the preferred short-acting beta
agonist for use in New Zealand.
Advanced Nursing Practice
A new book from the International Council of Nurses is about one of the most dynamic and
exciting developments in nursing and highlights the key role nurses with advanced knowledge
and skills play in developing health care services worldwide.
Now a global phenomenon, advanced nursing practice has captured not only the attention of
nurses, but of key decision-makers and health care planners worldwide.
Advanced Nursing Practice addresses the key issues in practice, education, regulation,
research and role/practice development, which are central to defining the distinctive nature of
advanced nursing practice (ANP) and explores international developments in the field of ANP.
Vignettes and contributions from key informants provide an international perspective of the
success, failures, hopes and aspirations of various advanced nursing practice initiatives.
The co-authors, Fadwa Affara and Madrean Schober, are consultants with extensive
international experience. They track the evolution of new advanced practice nursing roles and
innovative practice models. In exploring strategies for implementing ANP in the context of
countries’ health care needs, Advanced Nursing Practice addresses legal and ethical challenges
and commonalities and differences in advanced nursing practice, while examining the
implications, obstacles and facilitative strategies in maintaining, implementing and supporting
the development of ANP.
ICN’s online bookshop www.icn.ch/bookshop.htm
make either temporary or permanent life and
adjustments. Also, the SAW and RTW
process is sometime ill-suited to detect and
effectively address the most important issues
related to the outcome. Therefore the process
needs to shift away from ‘managing’ the
disability to ‘preventing’ it.
The project will test:
a – direct referral by a GP to an OHN who is
eligable to provide servcies under the GRW
contract;
b – a timely intervention by the OHN to
assist the SAW/RTW process.
A secondary opportunity of the pilot is to
explore ACC’s utilisation of OHN skills.
International nursing
centre opened
The International Centre for Human
Resources in Nursing has been launched in
Geneva with the aim of addressing the
critical imbalances in the global health
workforce.
It will offer a unique, online resource serving
policy-makers, planners, educators,
associations, employers, regulators,
researchers and practitioners.
The Centre marks a new phase in the
International Council of Nurses’ longstanding commitment and well-established
programme of activities to address nursing
workforce issues around the world.
The ICHRN launching comes just weeks
after Dr. Margaret Chan, the World Health
Organisation’s Director-General designate,
highlighted the priority need to strengthen
human resources for health.
“All the donated drugs in the world won’t do
any good without an infrastructure for their
delivery,” remarked Dr. Chan in her
acceptance speech.
Shanghai conference in May
NZ OHNs have been invited to the 2007
Shanghai International Nursing Conference
& International Nursing Staff Recruitment
Fair, from 13 -16 May.
The conference will be an excellent
opportunity for nursing academics,
researchers, practitioners and students from
China and abroad to learn and to share
knowledge and skills, especially in the areas
of nursing education, clinical nursing,
palliative nursing and community nursing.
www.shinc.cn
visit our website www.nzohna.org.nz
February 2007
Auckland
Two professional development courses were run recently. The first was
an audiology course facilitated by Dora Smith of New Plymouth. It
was a lot of work to get up and running but the attendance was good.
The second course was called a ‘Reflection of Practice’ and it was
designed to give our members confidence in preparing their portfolios
for the Nursing Council. We ran it as a four-hour workshop ending
with a shared lunch and networking. The content was well prepared
and presented by some of our own members, namely Jan Barrett, Libi
Pearce, Janice Tucker and Jan Tighe. Fisher & Paykel provided us
with a lovely venue for the day. We had 35 members attend and had
to turn some away, but are planning to run it again in March .
The committee has done some long-term planning on meeting dates,
speakers and increased the number of meetings. There is also a
professional development calendar in place, but these courses will only
be run if there is sufficient interest to make them financially viable.
Auckland branch meeting dates: Tues 20 Feb, 5.30pm, NOD’s
requirements. Wed 14 March, 7am, Heart Foundation. Wed 18 April,
5.30pm, AGM (school holidays). Tues 22 May, 7am, Occ Med
physician. Wed 20 June, 5.30pm, PPE. Tues 17 July, 7am, Vision.
Wed 21 Aug, 5.30pm, social. September - conference in Napier. Wed
24 Oct, 5.30pm, EAP Services.
Canterbury
Another year has flown past and we have some great things planned
for 2007. In January we have ACC presenting the Discomfort Pain
and Injury (DPI) package to us as a group. Many of you will have
been to this seminar but some of our members have not had the
opportunity so we have invited ACC to present to us.
Nikki Edge has been instrumental in organising an audiometry
update session for OH nurses in February in association with
presenter Judith Vercoe from Dunedin. We do not have a regular
audiometry course in Christchurch that we can attend and this fulfills
a very important part of our professional development.
Pain group formed
A consultation group made up of clinical leaders working in the
area of persistent pain who currently provide contracted pain
services to ACC, as well as key representatives from ACC, has been
established.
The purpose of the new group is to promote and maintain an
overview of service expectations and strategies for matters of shared
interest between ACC and the pain specialists, with the intention of
promoting best possible outcomes for all stakeholders. It will do
this by providing a formal forum for discussing strategic directions,
current issues and/or new policy and processes; building
relationships between the groups; ensuring projects occur to address
raised issues; taking proposals to providers for consideration and
collective decision-making; and receiving feedback on purchasing
strategies and implementation.
Members of the group include Dr John Robinson (musculoskeletal
physican), Judy Leader (nurse practitioner, pain management), Lisa
Ford (physiotherapist), Diane Henare (occupational therapist) and
Dr Lorna Fox (anaesthetist). Anyone wanting to have input into
future service development should contact any of the
representatives, or go directly to the ACC programme manager,
Linda Shepherd
(04 9187397) or linda.shepherd@acc.co.nz
We welcomed some new members to our group last year with the
inception of the Timaru group meeting regularly and more
Canterbury region nurses keen to come along to our Christchurch
meetings. We hope to attract more members as we start 2007 and
would welcome anyone to attend our regular meetings on the last
Wednesday of every month.
East Coast
The East Coast Group would like to wish everyone a very happy,
healthy and safe New Year. Hopefully most people have had a lovely
break, and are now back to work and reality! In November we had
one of our local addiction services staff come and speak to us about
the addiction services available in our area, and how we can access
them for our clients. It was most interesting and insightful. We also
had a lovely dinner at Craggy Range (one of our gorgeous wineries) to
celebrate Christmas.
Our group has been meeting regularly, but our main focus has been the
2007 conference which we are madly planning. NZISM is working with
us and we are having an interesting time trying to accommodate all the
fabulous speakers that both groups want to have. Needless to say this is
going to be an excellent conference in a province that offers fantastic
weather, cuisine, and of course people - so please put it in your
calendars, and budgets now! The dates are 12, 13 and 14 September.
Nelson
We continue to go from strength to strength in our little group. Not in
numbers, as we believe we’ve recruited almost every Occupational
Health nurse in the wider district, but in our sense of togetherness
and networking.
We’ve all benefited from a training session with a specialist nurse
from Ear Health, a consultancy working in many areas. Almost all of
us now refer employees to the nurse for ear hygiene and get back
many reports of how wonderful it is to have one’s ears gently
suctioned clear rather than syringed (after seeing a rather nasty
perforation recently, this is the way to go).
We’ve also reviewed our competency preparation using Nursing
Council material and Barbara Heywood’s excellent conference
material. We are treating ourselves to a de-stressing session with
some wonderful new breathing techniques, stretches and tricks for
mind-talk management.
We are pleased with the way we’re working and are exploring for next
year some ideas for a men’s primary health care focus with our local
PHO, with offers of help from a recent nursing masters degree graduate
with a passion for evidence based practice. How good is that!
Otago
The Otago group has not met since the Christmas break, but can report
that work is underway to align the OHN membership database with the
respective group membership lists. Currently members can go on the
website and confirm their membership – if any of you are having
trouble with this, contact Andrea McMillan (national treasurer) phone:
03 4797380. The goal is that by the end of March, members will be
able to renew their membership or join NZOHNA online.
Both Jan Maw (guest speaker at 1999 conference) and Carol
Bannister (guest speaker at 2006) were in touch with Otago members
prior to Christmas. Jan reports she is being contracted four days a
week by the University of Sheffield to develop a distance learning
Masters degree for OH technicians – wonder what they do? David
Maslen-Jones has also been in touch – he is considering immigrating
to New Zealand and is looking for any employment opportunities! He
would be great to have on board our NZOHNA group and practicing
in New Zealand.