Australia BLOG #1, Orientation week Adelaide, Australia Jan 4-8, 2011 Australia 2011 Group U of S Nursing Students in Australia Left to Right: 1. Chelsea Lipinski, 2 Ashley Boyko, 3 Stephanie Bryden, 4 Mallory Luscombe, 5 Kristyn Wiebe, 6 Teneille Ledding, 7 Bailey Wolfe, 8 Rachelle Chin, 9. Ashlie Carder 1 Sydney Wildlife World Sydney Opera House Sydney, Australia. G’day mate from across the world! As we arrived into Australia on Dec. 28, 2010, we have been here for almost two weeks. It has been great so far. Before going to Adelaide we spent one week in Sydney. Sydney was great! There are a lot of touristy things to do there. We went to the Sydney Wildlife world and the Aquarium where we saw a number of Australian animals that were quite different from home. We toured around the Sydney Harbour Bridge and the Opera house, and took a lot of great pictures (Stephanie B., 2011). Arriving in Sydney, Australia was the first time I have ever been overseas. The flight was long, but it was exciting to step out of the airport and feel the heat of Australia! The jet lag was evident but not too bad due to all the excitement to go and experience this beautiful country (Kristyn W., 2011). After enduring a long 31 hour flight we landed in Sydney. The first few days in Sydney were filled with jet-lag and sight-seeing. We woke up late, went to bed early and in the time in between we visited Darling Harbour, Sydney Wildlife World and Sydney Aquarium. It was so great to see all the ‘Australian Critters’ like kangaroos, emus, koala bears and kookaburras. Hopefully as the trip goes on we will be able to observe these animals in their natural settings instead of in a glass cage (Bailey W., 2011). 2 New Year’s Eve in Sydney Harbour Bondi Beach, Sydney , Australia New Years Eve. New Years in Australia is a way bigger event then it is back in Canada (probably because it is celebrated here first, after New Zealand). It is advertised all over the place and every business is hosting some sort of event that night (Bailey W., 2011). New Years was spectacular! We spent it on a boat in Sydney Harbour watching fireworks. We also spend a few days at Bondi Beach, the weather was great! It was really hot, and a relaxing week before heading into Adelaide to start our nursing adventure! (Stephanie B., 2011). Culture Shock. As the first few couple of days went by, I started to experience some the culture shock I had been warned about. It may have been influenced by the tourist attractions we were visiting, but the price of food here is unbelievable expensive. I am also having difficulty getting used to the lingo and accents here. I didn’t think it would be much of a problem but I am finding it takes longer to process/translate even in brief interactions. Simple things like ‘bathroom/washroom’ are simplified even further to just ‘toilet’ and every meal of the day seems to be called ‘tea.’ I’m sure once we get into the hospital setting these changes will be even more prominent. I also experience a withdrawal of Ketchup in our first two weeks, we can’t seem to find it anywhere (Bailey W., 2011). 3 Orientation week in Adelaide, Australia Jan 4-8, 2011 Glenelg Beach, Adelaide, South Australia Glenelg Beach Hostel Glenelg Beach Hostel. We headed to Adelaide on Jan 2, 2011 for orientation week. We booked into the Glenelg Beach Hostel and met up with the rest of our group of nine. We had a blast getting to know each other - spending many nights talking and laughing in the hostel like we are kids at summer camp! We navigated our way through the city, enjoyed time at the beach and tried surfing (Kristyn W., 2011). We were thrilled with our accommodations because everyone we met was friendlier than they were then in Sydney. Glenelg is beautiful, the beach is located only 200 meters away from our hostel. The streets of Glenelg are always busy along Jetty Road and the atmosphere is quite remarkable. However, I did notice that the food in Glenelg as well as Sydney was very expensive. I thought that maybe the fruit would be cheaper here but as it turns out, since Queensland is flooding fruit is more expensive because they are some of Australia’s major fruit producers. We were told that through our stay here we would continuously see the food prices increase (Ashlie C., 2011). Adelaide. Orientation week began January 4th at Sturt Campus in Adelaide (Ashlie B., 2011).We used the very ‘tourist-friendly’ public transit system to the campus, which is accessible from most areas of the city for a rate of $2.30 (which is comparable to Saskatoon’s system) (Bailey W., 2011). At the university we met for the first time met Annette Stenberg (international program manager) and Prof. Linda Starr (Associate professor in Nursing and Midwifery program). We were broken into two groups and given the roster for our placements in Gawler and Berri. (Bailey W., 2011). Prof. Linda Starr gave us a presentation on Australia and their health care system. Interesting facts learnt from the presentation about Adelaide included: Adelaide is the capital of South Australia, it contains approximately 1, 000, 000 people, it is located on 60 kms of coast line and it contains a Mediterranean climate (Ashlie B., 2011). Linda had our Flinders University uniforms for us to wear in the clinical setting (that we purchased for $36 each before we came) (Stephanie B., 2011). 4 Flinders University logo School of Nursing and Midwifery Flinders University. Linda also presented information of Flinders University. We discovered that Flinders opened in 1966. It now holds 15,500 students of which 18% are international, 654 academic staff and 94 other staff members. Flinders offers 54 bachelor degrees and every program or degree has a PhD course. Flinders campus is a total of 165 hectares (Ashlie B., 2011). Flinders University Campus. Annette then took us for a tour of the campus, it is beautiful, there is a national park right on campus or between the main campus and Sturt campus where the School of Nursing and Midwifery are. We got to see the library and the student centers, they remind me of the U of S which is interesting how similar they can be. The flora and fauna on campus I found to be beautiful, much like at home but I think the U of S campus is much more planned and maintained while Flinders I found to be more natural and had a bush feeling to it. We got to go see the International Student Center so if we had problems they would be able to help us (Teneille L., 2011). Flinders School of Nursing and Midwifery. The degree program was established in 1975 and has about 2400 students (23.6% international). The nursing degree here is a three year degree. There is also an option of four years which would earn you a “double degree”. A double degree would include a nursing degree as well as mental health and midwifery courses. They do not take paediatric courses like we do in Canada, but they can obtain a child and adolescent certificate (Stephanie B., 2011). Australia’s Legal system. II also learned quite a bit about Australia’s Legal system. They have a federal (commonwealth) government, which governs the whole country, and a state law government, which governs each state. 5 “Sim Man” “Sim Baby” Simulation labs. Annette gave us a tour of the university’s new state-of-the-art simulation labs for the health science colleges. They have a complete replica of a hospital unit including a medication room, patient bathroom, numerous beds with simulation dolls, electronic charting system and a maternity suite. Each bedside allows 4-5 students to work inter-collaboratively on patient assessments and mock situations. There is also an area in which the nursing students can work with other health sciences such as the paramedics and occupational therapists in an inter-professional environment (Bailey W., 2011). Clinical Placements. The federal government now has control over clinical placements as opposed to the university faculty. This was to manage the many nursing students from the many Uni’s so that the hospitals are coordinated (Rachelle C., 2011). Apparently, this initiative will provide high quality clinical placements in diverse settings to attract students to different areas of Australia and to provide the opportunities of access to healthcare, regardless of the area (Mallory L., 2011). Also now there is national regulation of the professions and the students (Rachelle C., 2011). Aboriginal population. It is very interesting to hear that Aboriginals here have many of the same health problems and like in Canada have detriments to their living situations such as lower education, high morbidity rates and poverty (Teneille L., 2011). Some aboriginal people live in more rural areas, and may even stay in “humpies” which are like little open shacks with a fire outside the door for cooking. Partly due to weather conditions, the Indigenous in Australia can live outside. This is a more traditional way of living and is not exclusive to the entire aboriginal population (Mallory L., 2011). We were told some seem to resist the western conventions of housing and work culture. For example, when offered government housing they are likely to break windows, pull out appliances and make stone fireplaces to make the house more like a humpy. However, this causes many to view the Aboriginals as ungrateful and primitive (Rachelle C., 2011). 6 Koala Bear Yunggorendi First Nations Student Centre Flinders University Koala Bear. We then went to tour the student library and got our Flinders university student ID cards. As we were walking we saw a wild Koala Bear in a tree, it was pretty cool! We toured around the main campus- seeing the plaza, library, shops, buildings, etc. We also stopped into the International Student Services unit to say Hello from Canada (Stephanie B., 2011). Yunggorendi First Nations Centre. We then went down to the Yunggorendi First Nations centre and were given some information about the services offered for the Aboriginal students in the university. It is a very nice centre with a variety of Aboriginal art hanging on the walls and 12 staff available in a variety of positions to help the students throughout their University experience. This support included an orientation session, tutoring services, and some financial support through scholarships. Professors were also hired through this service and offered a few classes that focused on Aboriginal studies. I think this is similar to the First Nations centre offered at home which also offers support to our First Nations population (Chelsea L., 2011). They only have 160 Indigenous students (Stephanie B., 2011). Nurse Practitioner. Particularly, I found interesting the process to become a Nurse Practitioner. Similarly to Canada, NPs have experienced much resistance from the medical profession, making it hard to advance their practice in Australia. In South Australia, if an RN wants to become an NP, he/she must collect a ton of information and create a very large profile, submit it and present it to a board that decides if he/she will become an NP or not. If NP status is granted, that NP status only applies to the nurse's current position and will not transfer over if a nurse wants to change jobs. This may differ in other parts of Australia, as an RN I was speaking with, Fiona, has a friend in another part of the country that went through a different process to become an NP, more similar to the one Canada has in place (Kristyn Wiebe, 2011). Another challenge is that NPs have great difficulty getting insurance to cover their practice; most insurance companies refuse to cover NPs (Rachelle C., 2011). 7 Tram on Jetty Road to downtown Downtown Adelaide Windshield Survey/ Scavenger Hunt. We met Annette for breakfast this morning in Glenelg beach, where she gave us a list of tasks for our scavenger hunt around Adelaide. This exercise was basically as an opportunity to use the public transit system, explore the city and make all of our travel arrangements for getting to our clinical placements. It was very helpful for us (Kristyn W., 2011). We were to take a tram to the central railway station and find which train would take us to Gawler, and then we needed to find the Royal Adelaide Hospital (RAH). The RAH is one of the public hospitals in this city and it provides many of the specialized services, such as cardiology, burns unit, etc. On the way to the RAH we passed by the Adelaide State Library, the museums and Government House, one of the University of South Australia many Campuses, Botanic Gardens and the historic buildings in that area (Rachelle C., 2011). Smoking. I have noticed a lot of people smoking since coming to Australia. When looking at the statistics, they show that in 2008, 20% of South Australians aged 15 years and over were smokers (Cancer Council SA, 2008). This is two percent higher than Saskatchewan’s statistic of 18% of 15 years or older (Canadian Cancer Society, 2010) (Chelsea L., 2011). Health Care Acts. Prof. Starr told us that the consent to Medical Treatment and Palliative Care Act was created in 1995 and states that anyone over 16 years of age has the right to refuse medical treatment. The Children’s Protection Act of 1995 states that individuals are mandated to report any type of abuse. The policy is to directly report to the police. The Age Care Act of 1997 states that elder abuse is also mandated to report but only if you are an employee (Ashlie B., 2011). 8 Flinders Medical Center Flinders Medical Center Flinders Medical Centre (FMC). In the afternoon we met up with Prof. Linda Starr and Annette Stenberg for a tour of the Flinders Medical Centre (FMC). Kim Dixon and another staff member of the hospital toured us through the ER, ICU, Liver Transplant Unit, and Cardiac Care Unit (Ashlie B., 2011). FMC is a partner with Flinders University and serves as a public teaching tool for its students. There is also a private aspect to the hospital, as Australia’s health care system is both private and public. FMC has approximately 550 beds, served by 1,300 staff members and 500 volunteers (Bailey W., 2011). As I walked through the hospital to our next area to tour, I noticed a lot of Aboriginal artwork on the wall. It looked bright and cultural (Kristyn W., 2011). A & E (Accident and Emergency). In the A & E they did all their charting on computers at the bedside, and it seemed to be much more efficient (Stephanie B., 2011. They have a 24/7 access to mental health services and have 3 mental health nurses on each shift. When a patient presents with a cardiac emergency, a nurse specialized in cardiac care is sent down to emergency to assist with care (Chelsea L., 2011). Public and Private healthcare system. We also discussed the healthcare system. Australia offers a public and private healthcare system – this allows patients to choose which type of healthcare they would prefer. The public healthcare system has minimal costs but does implement waiting lists; this is a Medicare Model and is similar to the Canadian healthcare system. Private healthcare allows for more choice in practitioners and enforces fees for care. Private hospitals provide about 1/3 of all hospital beds in Australia and about ½ of Australians have private healthcare insurance (Australian Government, 2008). I think that there may be a positive side to this model and that is one can choose what type of healthcare works better and fits better with one’s lifestyle (Mallory L., 2011). However, if the person does not have private health care insurance they will be charged more on their taxes each year (Chelsea L., 2011). 9 Nursing Uniforms in Australia Nursing Uniforms in Canada Nursing Uniforms. The first thing I noticed was the uniforms. They were button up blue blouses that the Registered Nurses wore, so everyone looked the same. I also noticed that they seemed to be advanced with their technology compared to us (Stephanie B., 2011). Job shortage. Currently there is zero vacancy spots, but they are predicting a shortage in about 5-10 years (Stephanie B., 2011). Infection Control. Although there are carpets in the hallways, for hand washing they had many posters saying, “I care, I save lives, I clean my hands”. These signs made it clear that infection control is also a priority in Australia (Ashlie B., 2011). I did find Isagel around the hospital a bit and by the bedside, however not nearly as frequently as I would see at home. In Saskatoon's hospital there are a lot of signs encouraging family, visitors and staff to Isagel before coming on a ward and going into anyone’s rooms but I did not see any of these signs around for visitors (Kristyn W., 2011). Volunteers. I noticed that Flinders Medical Centre relies on a lot of volunteers as well and have many services such as the gift shop run by volunteers. It looks to me like Flinders electronics and technology are advanced beyond what I have seen in Canada. For example, the electronic bedside charts as well as a smart board trial that was being tried in the Hepatic Transplant ward. However we were told that the larger cities of the same size as Adelaide in Canada would be a similar comparison. There is a variety of shifts from 8, 10 and 12 hours which is similar to home, however I notice there to be much more 8 and 10 hour shifts in Australia vs. the 12 hours that have seemed to be the norm where I have had clinical placements at home. Overall the Flinders Medical Center was a great tour and I learned a lot from it about Australia and health care (Kristyn W., 2011). 10 Health Promotion motto ‘Slip, Slap, Slop’ Skin cancer Prevention Health promotion “Slip, Slop, Slap” motto. “slip, slop, slap”, refers to slip on a shirt, slop on sunscreen, and slap on a hat. Skin cancer is a major issue in Australia so many catchy slogans are produced (Ashlie B., 2011; Stephanie B., 2011). English Language. Although English is the official language, I still find there to be a language barrier at times. Australia is a very multicultural country and I noticed many different cultures and languages as we travel. Some Australians have a very strong accent that can make having a conversation difficult. Also, they use many terms that are different from us - this can be very fun to decipher what they are saying! For example, a Pharmacy is a CHEMIST, a cooler for food or drinks is an ESKIE, mosquitoes are MOZZIES, to have supper or dinner means to have TEA, etc! They also greet you with "How ya goin?" and say "No worries" a lot! (Kristyn W., 2011) Health Care System. South Australia has recently gone through an amalgamation in July 2010 which turned the health care system into the hands of the federal government instead of the state (Chelsea L., 2011). Australia recently implemented the Australia Health Regulating Authority Act on January 1st, 2011 (Stephanie B., 2011). 11 Adelaide Hills Adelaide Hills “The Hills”. Thursday, January 6 was an opportunity to experience some of Adelaide’s surrounding countryside and wineries. We were fortunate enough to have a Flinders’ nursing student Cassie as our driver, and Annette as our guide while we drove through the Adelaide Hills. Our destinations included Mount Lofty (the peak of the Cleland Park), Hahndorf (a small German settlement), and several other wineries (Rachelle C., 2011). The wine culture here is very strong. Annette said that it is common for people to have a glass of wine with their meals, as it might be in parts of Europe. Everyone seems to have some idea about a good wine (Rachelle C., 2011). AUSTRALIA CANADA Official Language. English Food /Restaurants. Food is more expensive. Even in nice restaurants you order at the till and they bring out the food to us (Kristyn W., 2011) No Official Language. English and French (bilingual) Food /Restaurants. Food is 10% less expensive. Waitresses and waiters in restaurants take your order. Tipping is expected 10%. Driving. Drive on the left side of the road. Steering wheel is on the right side of the car. Right of way. Pedestrians do not have right of way. Intersections. Roundabouts are common at intersections. Driving. Drive on the right side of the road. Steering wheel is on the left side of the car. Right of way. Pedestrians have right of way. tipping! Intersections. Four way stops or lights are common at intersections. 12 Differences AUSTRALIA CANADA Expressions Hello How are you? No Problem Terminology A & E (Accident & Emergency) ER (Emergency Room) Amber Beer Barbie Barbaque Bottle store Liquor board store Chips Fries Chemist Pharmacy Cozzie Swimsuit Chrissie Christmas Din Dins or Tea Dinner EN (enrolment nurse) LPN Eskie Cooler Fort-night 2 week stay “Humpy” aboriginal shelter camping ground Kiwi New Zealander Mozzie Bite Mosquito bite Panadol Tylenol Pictures Movies Rollaway Cot Roo Kangaroo Roster Schedule Rubbish Garbage Special Care Aid (SCA) Personal Care Aid (PCA) Station Farm Toilets/dunee Washroom Tomato paste Ketchup Uniforms Scrubs G’day mate How you going? No Worries 13 Nursing Practice Differences AUSTRALIA CANADA Nursing. Average age of nurses in Australia is 45 years (Ashlie B., 2011). Number of registered nurses and enrolled nurses employed in Australia in 2008 was estimated at approx 250, 000. Male nurses in Australia represent 9.8 of the profession. Shifts. 12 hrs shifts are uncommon Mindset that “kids are just little adults”, therefore paediatrics not part a big part of their general nursing curriculum (Kristyn W., 2011). Smoking Policy. Adelaide health care facilities became smoke free including their grounds May 31, 2010 [Ashlie Boyko, 2011). Five “R”s of Medication Administration. The 5 “R”s came from the legal system (Ashlie B., 2011). (1) RIGHT drug; (2) RIGHT client (Two Identifiers) (3) RIGHT dose (4) RIGHT time (5) RIGHT route Nursing. Average age of nurses in Canada is 45 yrs in 2009 (CNA, 2009). 274, 274 Registered nurses in Canada; 432 (0.2 % doctorate prepared; male nurses represent 5.7% of RNs employed in nursing in 2007 (CNA, 2007). Shifts. 12 hrs shifts are common Outlook that “kids are unique and complex”, therefore pediatrics are a big part of the general nursing curriculum. Smoking Policy. Saskatoon Health Region mandated their Smoke Free Policy of hospitals and grounds in 2007. Seven “R”s of Medication Administration. In Canada we have the 7”R”s, which is recently new (Ashlie B., 2011). (1) RIGHT drug; (2) RIGHT client (Two Identifiers) (3) RIGHT dose (4) RIGHT time (5) RIGHT route (6) RIGHT reason (7) RIGHT documentation. A & E. 1 to 5 scale, Australia has a likely to discharge vs. likely to admit policy. ER. Triaging scale of 1-5 points Thank You to Our Hosts at Flinders We thanked Annette for setting up our clinical placements and for being so welcoming. It was sad to leave her as she was always so nice to our group and always very understanding of any concerns we had. It was an awesome orientation week and I felt like I learned a lot about South Australia. I learned a lot about the culture of the people and some of their interests. I liked talking to Australians and finding out all about South Australia. I think the experience that we have had so far has been wonderful and I'm so thankful I got the chance to come to Australia on an adventure like this (Teneille L., 2011). Orientation was fascinating and opened my eyes to some cultural and healthcare differences (Mallory L., 2011). We had a great presentation by Prof Linda Starr. She is an extremely bright nurse and lawyer, and I learned a ton from her in a few short hours that first day alone. I won't even be able to share half of it in this journal. We got an introduction to Australia and South Australia and the nursing here; then, we learned a lot of the nursing politics in South Australia and of the legal and political barriers that stand in the way of providing the best care to patients, and in protecting the nurses that provide that care (Kristyn W., 2011). 14 References Australian Government. (2008). About Australia. Retrieved from http://www.dfat.gov.au/facts/healthcare.html Canadian Cancer Society. (2010). Canadian Tobacco Statistics. Retrieved from http://www.cancer.ca/Saskatchewan/Prevention/Quit%20smoking/Canadian 20tobacco%20stats.aspx?sc_lang=e&r=1 Canadian Nurses Association. (2007). 2007 Workforce profile of registered nurses in Canada. Retrieved from http://www.cnanurses.ca/CNA/documents/pdf/publications/2007_RN_Snapshot_e.pdf Cancer Council SA. (2008). Key smoking statistics for SA, 2008. Adelaide, Australia: Tobacco Control Research and Evaluation. Retrieved from URL:http://www.quitsa.org.au/cms_resources/FastFacts_Tobacco_july09.pdf 15