Western Nurse Magazine October 2021 by ANF WESTERN NURSE MAGAZINE

October 2021

incorporating western midwife

SYSTEM IN CRISIS

Rallying for ANF Members – Achievements, Progress and Disappointments as Frontline Nurses and Midwives Battle to Improve Conditions Nurses and Doctors Unite To Fight PCH Injustice PAGE 6

More for Midwives, Mums, and Babies, at KEMH PAGE 10

western nurse is the official magazine for ANF members in WA

Secretary's Report

October 2021

State Secretary Mark Olson

FEATURED AND FAVOURITES

Welcome Back

Secretary’s Report

PCH Rally

I know it’s been a while since the last edition of the western nurse and I want to thank all our members for their patience. During the pandemic we have seen an unprecedented demand on ANF services with a need to make the organisation as flexible as possible to meet the changing circumstances and changing needs of our membership during these difficult times. We’ve had to create new services and adapt many of our existing services but now it’s time for the western nurse to return.

10 KEMH Rally 12 Internet Watch 14 WA Nursing and Midwifery Excellence Awards 15 HESTA Midwife of the Year 20 Across the Nation & Around the Globe 22 Olympian Nurse 24 Recipe Corner 26 The Brain Buster Crossword CONTINUING PROFESSIONAL DEVELOPMENT: CLINICAL UPDATES 18 Identification and management of falls-related risk factors 28 Diagnostic tests for Cryptococcosis 29 Dabigatran - A medication update WIN! 31 ‘A Year of Loving Kindness to Myself’ and ‘Everyday Madness’ books!

Talk to us... It’s your magazine. We want your feedback and story ideas! Editor Phone Email Web

Mark Olson 08 6218 9444 editorwesternnurse@anfiuwp.org.au anfiuwp.org.au

Australian Nursing Federation 260 Pier Street, Perth WA 6000

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Health System in Crisis We are all now familiar with the crisis that is the WA Health System. And we also know this crisis would have occurred 12 to 18 month ago were it not for the advent of COVID and the subsequent. As the deadly Delta variant of COVID-19 creeps towards our state’s borders, it poses the second largest threat to our collapsing health system as conditions across WA hospitals have deteriorated to the worst I have seen in my time as State Secretary. We have risen to fight the largest threat to our system, to you, and to the patients you care for - complacency and chaos - from the office of the Minister for Health (who, in the middle of it all, has taken on the busy portfolios of State Development, Jobs and Trade; and Science), down to WA Health, Hospital Service Provider Boards and hospital executives. Times have never been tougher. Every day the ANF has listened to and acted for members who are stressed, exhausted, broken, and in shock over how bad things have become in our hospitals in aged care. You have reported you have never seen worse conditions in our health system – record overtime and double shifts, burn out, daily code yellows, ambulances ramping in record numbers, extended waiting times, delays, angry and grieving families, blame and injustice, your colleagues thrown under a bus to cover up the failures of their management. How has it come to this? The chaos? Complete disorder and confusion. The complacency? Letters and approaches by the ANF, detailed plans provided, and ignored; assurances given but not delivered; as you have all experienced yourselves with your own employers. It is a brave new world in WA politics. It took us – a record rally of nurses and midwives as well as by doctors, at Western Australia's specialist paediatric hospital and trauma centre, Perth Children’s Hospital (PCH) - the stark images of which have made WA history – to apply a life or death jolt to the system forcing the State Government into action – but barely. October 2021 western nurse |

Secretary's Report continued A young life was lost, and with it, hope in our health system; and things have sadly gone from bad to worse. How many more shocks do they need before we flat line? Our colleagues have been condemned, despite many of you, and us, raising the red flags in the weeks and months leading up to the PCH tragedy. No less than 12 formal emails to management, that went as high as the Executive, offered solutions and warned that lives would be lost.

department nurses and a triage desk administration officer would be put in place. Despite our questions, he cannot say who will staff his new beds. He also promised a designated resuscitation team rostered on every shift, a staff development nurse in the ED and an increase in clinical nurse specialist shifts to offer more supervision for junior staff. A promise is one thing, but the system is struggling to keep up with the Minister’s promises.

The Executive did nothing.

A ministerial advisory panel is also to be established to include senior health officials, including members of the ANF and AMA.

The HSP did nothing.

We have provided many solutions including calling for:

WA Health did nothing – apparently they didn’t even know. The Health Minister did nothing - until it was too late. Then, they were quick to act. The first thing they did was apportion blame on those who had warned them, even before a proper investigation was completed they reported junior nurses and a junior doctor to the Australian Health Practitioner Regulation Agency (AHPRA). The AMA subsequently reported senior doctors and the ANF reported the nursing executive to AHPRA.. Investigations are pending while an internal inquiry that was meant to happen before any blame was apportioned has been delayed by months. There is an important coronial inquiry to come. Nothing can shock me now, and nothing will stop me fighting for change every day as I have done since becoming State Secretary – change not in a year’s time, not in two, but now. As I, and most of you pledged at the start of our careers in nursing, “I will do all in my power to maintain and elevate the standard of my profession”. Thousands of you are bravely coming forward contacting us and writing to us to do as above. The actions of the ANF over the past year, particularly the rallying of members at PCH, have won us some ground. Sadly, that, and our relentless media campaign, despite hundreds of letters, calls and meetings, is what it has taken to have any issues members or the ANF have raised even acknowledged. We must keep on holding the State Government and the bureaucrats to account as conditions improve and they let them slip away again. After the PCH rally, the Health Minister conceded to our ongoing demands and announced an additional 20 beds, 16 emergency

western nurse October 2021

• The Minister for Health to drop his portfolios of State Development, Jobs and Trade; and Science, and focus on health • Nurse and midwives shortage numbers, and Code Yellows to be published alongside emergency department live activity • An invitation to the State Government’s Skills Summit • A job for every graduate and graduates sent to vaccination and testing centres to free up skilled nurses • The Refresher Pathway to be reopened • Employment permanency for those who want it • A moratorium on performance appraisals to free up nursing hours • For recruitment to be fast tracked by removing the need to fill in selection criteria with employment offers based on CVs and references instead And in COVID times: • Priority for health workers to be vaccinated and a choice of vaccine • Priority G2G for nurses and midwives and details on numbers and results • Limited crowds at public events including football • A field hospital to be built in case of an outbreak to protect our hospitals from collapsing We exposed the biggest lie in public sector history - the State Government’s “biggest nurse recruitment campaign in history” as a farce, a major oversight that will slight our system over the next decade. We are still waiting for details on this plan, which the Government insists is underway. If the government fails to move sufficiently quickly, we will support members who are forced and have no alternative than to close beds on the grounds of concerns for patient safety.

We have also called for other initiatives including removing the need for job candidates to complete selection criteria and providing permanency to staff who want it by calling for the CI23 industrial instrument to be reinstated. Midwives and nurses followed PCH, and rallied last month at WA’s major tertiary hospital for women and newborns, King Edward Memorial Hospital (KEMH). We forced the State Government to announce a $1.9 billion boost for health and mental health in its State Budget – even though only $960 million was new money to help address unprecedented demand in the health system. Part of that, importantly was an extra $100 million for our struggling Emergency Departments. We have also developed new industrial strategies to protect members including simplifying the workload grievance process by developing a Workloads app (see ifolio) – the first of its kind in Australia – and taking less than a few minutes to lodge a grievance.

We are working with Phil Della, formerly the Chief Nurse in Western Australia and currently Head of School at Curtin University School of Nursing to convert the current NHPPD to a ratio, and we have created documents to protect you from liability when you are understaffed, where you are sent to an unfamiliar area, or where your area is making changes motived by lack of staff rather than what is in the best interests of the patient. Nothing will stop me continuing to fight for the changes needed to retain and expand our workforce and improve conditions for all of us.

Mark Olson State Secretary

Your 2022 ANF Diary is yours for FREE with your ANF membership in WA. Keep track of all your important appointments and events. Just log in to your iFolio to order a copy. We'll post you one with the western nurse

ifolio.anfiuwp.org.au October 2021 western nurse |

HISTORIC RALLY: NURSES AND DOCTORS UNITE TO FIGHT PCH INJUSTICE The tragic death of Aishwarya Aswath exposed the plight of hard-working nurses and doctors across a WA Health system in crisis, and how the Department and State Government ignored their desperate cries for help for more than six months, until now … Nurses from across Perth rallied on Tuesday 25 May to support their colleagues at Perth Children’s Hospital (PCH) after three junior colleagues were reported to the Australian Health Practitioner Regulation Agency (AHPRA) over the tragic death of a seven year-old girl. On Easter Saturday 2021, Aishwarya Aswath was presented at the PCH Emergency Department (ED) by her terrified parents, and waited almost two hours to be seen, before she died of sepsis after being admitted.

NO TRIAGE POLICY IN PLACE AT PCH On that night, one nurse was covering eight ED cubicles, another called to help administer life support to a critical patient, leaving a junior colleague alone at the busy triage desk with no triage policy in place at Perth’s largest children’s hospital.

western nurse October 2021

Despite acknowledging the risk of a death or disaster in the PCH ED was formally and specifically communicated by frontline nursing staff to the Child and Adolescent Health Service (CAHS) executive 12 times since October 2020, after Aishwarya’s tragic death, CAHS and WA Health prematurely reported the two junior nurses, and one junior doctor, who briefly saw the seven-year old in the waiting room, to AHPRA, the most powerful professional watchdog which deals with serious misconduct and malpractice, and before a proper internal and coronial inquiry was undertaken. The move has been widely acknowledged as akin to “pushing” junior staff “under the bus”, particularly after their concerns about significant risks were ignored more than 12 times over six months in the lead up to the death. The ANF WA supports these and the other PCH nurses.

WHAT THE EXECUTIVE AND THE HEALTH MINISTER KNEW CAHS and WA Health have admitted that workforce shortages, acuity and increasing patient presentation numbers at PCH had been formally and specifically communicated to the medical and nursing stream leadership group, and members of the executive team, on a number of occasions from October 2020 – way before Aishwarya’s tragic death in April 2021. Meetings had occurred between the ED staff and the executive, and data was presented to illustrate the concerns, specifically concerns around the safety of children in the waiting room. Minister for Health Roger Cook addresses the angry crowd

WHERE WAS THE TRIAGE SUPPORT NURSE PROMISED AFTER THE MOVE FROM PMH? WA Health admitted that during the transition from Princess Margaret Hospital to PCH in 2018, a “triage support nurse” was supposed to be added to conduct vital signs, complete an initial assessment, and initiate care at the commencement of the patient’s journey, but, due to the establishment numbers, this was not progressed. There had been ongoing and well-known concerns about the design of the PCH waiting room, resource capacity, about education and clinical supervision of nursing staff – and let’s not forget – not even a triage policy at Perth’s premier children’s hospital.

IN DENIAL But WA Health Director General, David Russell-Weisz, denied any knowledge of the issues in the PCH ED until after the tragic death, as did Health Minister and Deputy Premier, Roger Cook, who was directly contacted by ANF WA State Secretary, Mark Olson, about the issues in October 2020 – again - way before Aishwarya’s tragic death in April 2021. The chair of the hospital board, Debbie Karasinski, stepped down after an initial report on Aishwarya’s death was handed down, however Dr Russell-Weisz refused to accept the resignation of PCH Chief Executive, Aresh Anwar, who admitted he knew about the ongoing and serious concerns of frontline workers over many, many months.

ANF ACTION

THE LARGEST DEMONSTRATION OF ITS KIND

With no action resulting from the ANF concerns raised with the Health Minister in October 2020 days after Aishwarya’s tragic death, the ANF acted swiftly to ensure staff in the PCH ED were adequately supported, and their concerns acknowledged, by successfully lobbying the Health Minister, Roger Cook, to implement a life-saving 10-point plan.

On 25 May 2021, more than 1,000 nurses and other hospital workers rallied outside PCH.

Among the changes requested was a minimum of one nurse for every three patients, specifically trained paediatric security staff, and, on top of normal staffing levels, a dedicated resuscitation team. He also promised the Paediatric Critical Care Unit would be opened to its full capabilities, and nurse applications would be fast-tracked to four weeks.

ANF State Secretary talks to members at the PCH rally

They cried, they raged, they wrapped their arms around each other for support, and they demanded the Health Minister, Roger Cook, act immediately to address the critical issues they had been facing for months, and reported, months before Aishwarya’s tragic death. They waved placards and demanded justice, and acknowledgement of their concerns about the crumbling WA Health system, the risks posed to their patients, their own careers, morale and mental health, and the lives of everyday West Australians – namely WA’s children. For the first time in WA history, the Australian Medical Association, and its members, joined nurses in protest, along with sick patients and members of the public. News of the huge rally led every nightly news bulletin in Western Australia, and was broadcast across the nation, and around the world, with a large number of nurses standing up strongly to speak to the media, even on camera, about the critical issues. The rally was described as the largest demonstration of its kind in WA in a decade. ANF WA State Secretary Mark Olson refused to go on camera after the rally to allow brave nurses to speak out. He had announced to nurses at the rally: • The ANF would refer the PCH Executive Nursing Team to AHPRA • The Health Minister would be notified of issues where members were advising they were chronically under-resourced or where member concerns were being ignored by the relevant Executive • The ANF would develop 10-Point Plans for other wards, units and areas – in consultation with its members in those areas

NURSES THROWN UNDER THE BUS

• There would be more rallies where requested by members including rallies in regional areas

Then came the shocking news about the premature, and arguably unnecessary reporting of junior nursing staff, and a junior doctor, to AHPRA – which WA Health claims was merely a notification.

• To continue to contact him directly about issues that needed to be addressed, so that workplace meeting could be organised at times that suited staff and their colleagues

The ANF acted swiftly to understand members’ concerns that those in power were unfairly putting the blame for Aishwarya’s tragic death on the junior staff, and held a survey with 96 per cent in favour of taking industrial action and rallying outside PCH to:

HISTORIC REPORT

• Show support for the nurses under fire from the PCH Hospital Executive • Have the WA Health Minister acknowledge serious systemic problems in the public health system that require everyone working together to fix them – that includes the ANF and the AMA. • Have the WA Health Minister listen to concerns being raised by Members • Have role of the PCH Executive Nursing Team also looked at by AHPRA. • Request the WA Health Minister to drop his other portfolios and become a full-time health Minister for the next 12 months so that he can focus solely on fixing the problems.

On Friday 28 May 2021, the ANF WA reported three members of the CAHS executive to AHPRA after an overwhelming demand by ANF members at the PCH rally. Those reported make up the nursing contingent of the CAHS executive whose professional conduct is regulated by the Nursing and Midwifery Board of Australia. ANF WA State Secretary, Mark Olson, said members called for the registered nurses on the CAHS executive to also be looked at after the publicly released SAC 1 report identified that workforce shortages, acuity, and increasing patient presentation numbers at PCH, had been formally and specifically communicated by frontline nursing staff to the executive team, on a number of occasions since October 2020.

October 2021 western nurse |

“It is the first time in ANF history that we have reported executive nurses to the regulatory authority,” Mr Olson said. “Frontline nurses directed the ANF to do this. It is not personal. It is simply untenable that AHPRA only look into the practice of frontline staff, and not those who are responsible for the system in which those frontline staff work, and in circumstances where nurses have identified their specific concerns to management over and over again, including no less than 12 times since October last year.”

WHAT NOW? The ANF is surprised and deeply concerned by the State Government’s approach in investigating the tragic death of Aishwarya Aswath. On 25 May 2021, the day of the rally, Health Minister, Roger Cook, outlined Terms of Reference for an Independent Inquiry into the PCH Emergency Department following the death, which was due to hand down its findings in August but has been significantly delayed and is now expected to be completed at the end of September 2021.

Patients from PCH joined the rally

THE ANF’S TEN POINT PLAN FOR PCH ED 1. Implement a staff allocation of one nurse for every three patients 2. Shift coordinators and triage nurses not included in floor numbers of dot point one – which means they don’t take a patient load 3. Supernumerary resuscitation team – minimum of 4 nurses for the resuscitation team would also be available to assist the floor staff with category 2 patients and patients with behavioural problems 4. Engagement from the PCH Executive team on a PCH Emergency Department Taskforce that includes nursing representation. This will be a Staff Led Taskforce with key performance indicators to manage the transition and oversee the implementation of the above dot points aswell as looking at ways to recruit additional staff to the department in a timely manner 5. Double the number of Staff Development Nurses in the Emergency Department 6. Open the Paediatric Critical Care Unit to its full capabilities to that it can function as an Intensive Care Unit and High Dependency Unit

western nurse October 2021

7. A clearly articulated Winter/Surge Bed Management Strategy that is published and available to all staff and the community. 8. Fast track recruitment with a maximum turnaround time of 4 weeks. That is no more than 4 weeks from application to working the first shift. 9. 3C (the short stay surgical unit) that currently closes at 3.30pm on Saturday needs to be kept open 24/7 on the weekend and staffed appropriately as this will reduce access block. 10. Additional numbers of specifically trained paediatric security staff for the Perth Children’s hospital.

WHAT ABOUT US? The ANF acknowledges that systemic issues are occurring right across the WA health system, and we are here for you. If you do have issues that need to be addressed, contact us immediately so we can organise a workplace meeting at a time that suits you and your colleagues. If you are not a member, now more than ever, it is time to join the ANF and unite with your colleagues to ensure the future is brighter and lives are saved. Let us know how you feel and we will support you individually, or as a group, including demanding a 10-Point Plan for your wards and rallies at your hospitals.

OUR VOICES Brave nurses stood up at the rally and spoke to the Western Australian media about their concerns. Here’s a snapshot of what they said: “They’re always telling us how are we going to pay for more nurses? But, that’s what we need. Healthcare should not be run like a business. This is about people, and we can’t take care of people if you keep cutting the rug out from under us financially.” “We’ve been chronically understaffed and not enough’s really been done, even though we’ve been begging for help.”

“The nurses are struggling, everything is being micro-managed now, everything is being looked at, the nurses are being blamed. It’s just not the same anymore, it’s just not the ‘family’ we used to have. We used to be a happy team and now everyone is just going home upset and they’re afraid to come to work.” “We feel threatened. I’ve been in nursing for 50 years and Florence Nightingale — where I trained — would be ashamed. Those two nurses did nothing wrong. Am I going to be next?”

is my staff and other staff say I don’t want to come to work.” “Not only is there a problem here, but there is a problem through all of WA Health.” “Give us our nurses back.” “Our base level of staffing was never enough to begin with, let alone being short-staffed.” “I feel threatened. A mistake might be made and I’m going to be the next.”

“Withdraw the report.”

“Do something.”

“I’ll come onto a shift as a coordinator I’ll be told that we’re down eight staff and they’re not replacing them and we somehow have to run a department without staff. It’s scary. It’s scary for the patients, it’s scary for the staff, it’s just not fair.”

“I don’t want to do it any longer. So the nurses in the ED are the first. Am I going to be the third? I’m angry.”

“I want our emergency department to be united again, working together again, to support each other again.”

“I’ve been here 35 years, and when I came here I wanted to come to work, and these days all I hear

“I’ve been in nursing 50 years, and I feel betrayed by the executives.”

THE SIGNS

Here’s a snapshot of their signs:

Nurses at the rally were angry, they were furious, they cried and shouted and heckled the Health Minister, some threw their arms around each other for support.

They remain devastated by Aishwarya’s death and its aftermath. They waved placards with their messages, and featuring the faces of those they feel are responsible for WA’s hospital crisis, PCH CEO Aresh Anwar, Health Minister Roger Cook, and WA Premier Mark McGowan.

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October 2021 western nurse |

KEMH Midwives and Nurses rally highlighting escalating crisis In August, more than 300 Nurses and Midwives rallied at the State’s premier women’s and babies hospital, King Edward Memorial, to publicly demonstrate their dissatisfaction over worsening working conditions.

What did Midwives and Nurses highlight at the rally?

Their action followed the May rally at Perth Children’s Hospital that heralded meaningful and ongoing action by health workers to protect patient safety and improve frontline conditions at WA hospitals.

• The things the government can be doing to recruit more staff right now at KEMH, including -

It came as private hospitals moved to drastic measures to address urgent staffing issues, including payments of $6,000, to recruit nurses. ANF State Secretary, Mark Olson, said the further impact of such measures on the crumbling WA public health system would be nothing short of critical.

• Dangerous staff shortages, record overtime and double shifts (AINs are not the answer) • Burn out and poor staff morale

− Short term contracts to be converted to permanent contracts − Better access to leave

− Midwife to Patient/Mother Ratios (that includes counting the babies) − Nurse to Patient Ratios

− Staff Development retention and expansion

− Flexibility in rostering to retain existing staff and attract others back − Car park issues – the return of better lighting and improved access for staff We are continuing to fight for improved conditions at KEMH.

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western nurse October 2021

Our Voices Brave Midwives and Nurses stood up at the rally and spoke to the Western Australian media about their concerns. Here’s a snapshot of what they said: “There is no way that it is safe for patients, or safe for staff.” “We’re getting to a point where we are burnt out and we are sick and tired of it.” “If we finish our shifts late and ask for overtime, we are told it’s because of our own poor time management. It’s actually because we are completely overwhelmed and unsupported.” “The stress is awful.” “We’re here today because we need to address the staffing issues that are happening here. Women aren’t getting the care they deserve. Women are not being respected anymore by the health system because we’re not staffed adequately.” “I work with some wonderful, wonderful people that just want to help mums and help babies and get good outcomes, and we’re not being supported in getting that, we’re short-staffed., we’re doing double shifts.” “These are midwives doing a really important job, it’s a scary job anyway, but it’s a scary job if you don’t have enough staff around you. You need your colleagues to work as a team, and if they’re not there, it doesn’t work.” “My graduation’s already been delayed just because of the cuts in nursing shifts, there’s not enough nurses to supervise us on the wards, so I might graduate in two years, it may be three years.”

“Let-down.” “Forgotten.” “Exhausted.” “Panicked.”

The ANF Parking Bees are buzzing back! Staff also protested at the lack of parking at KEMH, which leaves them no option but to park in suburban streets – and leave the hospital every few hours to move their cars. “When you’re busy and understaffed on the wards, it just feels like such a huge waste of time.” “Just trying to park and come in and deliver a baby is outrageous I mean, we have to park the car, there’s no other way around it.” “I’ve had a couple of parking fines this year already - $100 each – because the parking situation here isn’t good enough.”

The Signs Midwives and Nurses at the rally waved placards with their messages. Here’s a snapshot of their signs: Fix KEMH More midwives now

Flexible hours for midwives and mums Mr Cook, KEMH is crook

Babies count

We deliver, management doesn’t

More nurses now Double shifts = Dangerous Push harder Minister

We deliver, Minister doesn’t

Code Yellow is no joke We deliver, Labor won’t Midwives - hear our cry! More for Midwives Double shifts are deadly Over-worked, Overwhelmed, Over it Midwives – hear us cry

October 2021 western nurse |

AMAZING APPS + ONLINE NEWS

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FIVESuperSites Tourism Western Australia

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The West Australian Good Food Guide

Go no further than the WAGFG to find recommendations for restaurants and bars located in this vast State. Reviews of food and wine are completely independent of advertising content. The ‘best’ lists are reviewed regularly. www.wagoodfoodguide.com

Britannica Kids

Who knew that the Encyclopaedia Britannica is over 250 years old and comes in an online version? This is the children version where kids can either go digging for information or simply browse the categories. Comes with an 18+ version and a companion app. www.kids.britannica.com

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western nurse October 2021

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October 2021 western nurse |

Like a lot of nurses, Ashly Grabski is humbled by her work. She told the western nurse she entered the profession because she wanted to “make meaningful connections with people”, and have the “flexibility and opportunity to work in a variety of areas” that best suited her interests. Now, as the Nurse Unit Manager of St John of God (SJOG) Mt Lawley Hospital’s Ursula Frayne Unit, a mental health facility that cares for adults over 65 years of age, she has been awarded the 2021 Excellence in Registered Nursing Award at the WA Nursing and Midwifery Excellence Awards. Nominated for her passion for mental health nursing, and her natural leadership style, she told the western nurse it was a “huge honour” to be awarded “given there are so many fantastic nurses and midwives working across WA”.

“All nurses know that our profession would not function without team work, and the incredible bonds I have made with colleagues is a definite highlight of my career. I learn something new every single day,” Ashly told the western nurse. The Ursula Frayne Unit at SJOG Mt Lawley provides public inpatient services and recovery-focused care for older adults with mental health challenges. The 12-bed unit was established to service the inner Perth metropolitan area, and is managed by the East Metropolitan Health Service’s Older Adult Mental Health program. It is publically funded to support patients with depression, suffering grief, social isolation and dementia.

INSPIRING ASHLY GRABS REGISTERED NURSING EXCELLENCE AWARD An ANF member since university, Ashly Grabski, is giving rise to the importance of dedicated older adult mental health nursing across WA

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“I started my career at SJOG and actually commenced as a post anaesthesia care unit (PACU) nurse,” Ashly told the western nurse. “I absolutely love perioperative nursing, and am glad I can integrate my acute medical care skills into my mental health nursing. As an Older Adult Mental Health specialist, I find this is important as many of our patients live with comorbidities.” Ashly completed her undergraduate nursing studies at Curtin University, Clinical Nursing and Mental Health post graduate studies at Notre Dame and Edith Cowan Universities, and is currently studying Health Leadership at Notre Dame. “I have been an ANF member since I was a student,” Ashly told the western nurse, encouraging all nurses and nursing students to join the union. “It is important. It feels like being part of a community and provides support when needed.” Ashly is passionate about reducing the stigma associated with mental health and nursing in the sector, and nurturing emerging mental health specialists so that quality care can be provided to some of our community’s most vulnerable members. She has been commended by her colleagues for her compassion, the care she delivers, not only to patients, but to their loved ones, allowing them to partner in treatment; and inspiring others in the job she loves. “Where do I start? It’s so humbling to be in a position where we can advocate for our patients, and be instrumental in providing true patient-centred care. I love watching our patients getting better,” Ashly said. Join the ANF today at anfiuwp.org.au

The midwife changing lives in Kalgoorlie Janelle Dillon has been awarded the HESTA Midwife of the Year for always going above and beyond to provide antenatal and postnatal care to the Indigenous women of Kalgoorlie. For Janelle Dillon, being a midwife is not just a nine-to-five job. Whether it’s staying up late text messaging a young mother or travelling on the weekend to help a woman in labour in a remote area, she always goes the extra mile. Her efforts have now been recognised with a HESTA Midwife of the Year Award. “Winning this award feels a bit surreal,” she says. “It’s a privilege and an honour just to be named as a finalist. There are so many amazing midwives out there, so I was lucky to be nominated.” For the past four years, Janelle has worked at the Bega Garnbirringu Health Service in Kalgoorlie. For most of that time she has been the centre’s only midwife and she is passionate about working with the Wongatha women. “I coordinate all their care,” she says. “I’ll organise their medical appointments and go with them because they get a bit worried stepping out of their culture into our Western culture.” She also travels up to Leonora and Laverton once a month as part of a maternal outreach program and, as a diabetes educator, she monitors any patients with gestational diabetes and helps to run a monthly diabetes clinic. Janelle says through the work she and her colleague, GP-obstetrician Dr Joanna Keen, are doing to create a safe space for Indigenous women, their birthing outcomes are now as good as the non-Indigenous births in Kalgoorlie. “If these girls are coming in early, they’re engaging

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and that gives us heaps of time to work out any problems in pregnancy and deal with them,” she says. Janelle is passionate about engaging with her patients even if it means communicating with them in different ways and outside of work hours. “When teenage girls come in for an antenatal check-up, they don’t do a lot of talking – there’s a lot of shame in this culture. But then at nighttime, they’ll start texting. So, it’s about working with them and changing how I go about my day-to-day work,” she says. She and Dr Joanna Keen have even inspired two of their patients to begin studying to become health workers. “One of them wants to become a midwife, so we’re going to help her achieve that. My big passion is building relationships with these women and empowering them.” She also has plans to continue studying and will be using her prize money to start a graduate certificate in domestic violence studies. A single mum, Janelle says her two kids, aged 14 and 17, are very proud of her. “They were jumping for joy when I called to tell them I’d won,” she says. “It’s good for them to see that a single mother can achieve this.” She says seeing all the hardships Indigenous women go through in their daily life is tough. “Sometimes I’ll shut my door and have a few tears,” she says. “But I’m in this job for the good and the bad. These women know I’m not going to judge them or laugh at them. Even if it’s two o’clock in the morning, whatever that woman is facing at that time, she knows I’ll be there.” 

the total invoice when you present your ANF membership card. Applicable to any service including Financial Obligations, Tax Planning, Superannuation, Retirement and much more. One use per member, per financial year. Your ANF cards needs to be presented when finalising your invoice.

For appointments or enquiries, please call 08 9219 1300 or email info@cvwaccounting.com.au. For a full list of our services, please visit our website https://www.cvwaccounting.com.au Visit our offices at: 5/40 Lord Street, East Perth WA 6005

OPPOSITE ROYAL PERTH HOSPITAL

October 2021 western nurse |

Real People, Real Stories This is about YOU! The western nurse (incorporating Western Midwife) is all about you – our members – Registered Nurses, Midwives, Enrolled Nurses, Assistants In Nursing, Carers, and Students. For more than 20 years, I have been sharing your stories, and I encourage you to continue sharing your stories and photos with me. Please email me at editorwesternnurse@anfiuwp.org.au with information that you would like me to consider sharing. To be considered for publication, please ensure your items are about your profession, practice, research, achievements, milestones, celebrations, units, teams, and would be of general interest to your fellow members, that they are 150-200 words maximum, and limit photos to five or six (min 500KB in size per picture). I look forward to hearing from you!

Regards Mark

Wittenoom...

Urgent message to all travellers to the Pilbara region of WA Do not visit Wittenoom, not even to take a photo, it is NOT SAFE. The town and surrounding areas are heavily contaminated with blue asbestos fibres from CSR’s mining and milling operations. Scientists have established that there is no safe level of asbestos exposure. Sadly the death toll from Wittenoom won’t stop until visitors stop. www.asbestosdiseases.org.au | www.facebook.com/AsbestosDiseasesAus

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October 2021 western nurse |

CONTINUING PROFESSIONAL DEVELOPMENT

ANFClinical Updates Identification and management of Identification falls-relatedand riskmanagement factors of falls-related risk factors 1 iFolio hour ANF iFOLIO CLINICAL UPDATE:

Read this article and complete the quiz to earn

Read this article and complete the quiz to earn 1 iFolio hour Effective falls prevention strategies rely on the clinician’s ability to assess an individual, identify risk factors, and implement solutions to reduce the chance of falling.1,2 It is essential that all clinicians are aware of falls-related risk factors and prepared with solutions to help manage them. A wide range of solutions are required as not every option will be appropriate or realistic for all patients. Person-centred plans should be multifactorial, fully resourced, and achievable in order to promote ongoing patient safety and reduce the risk of a fall.1-3

WHAT ARE FALLS-RELATED RISK FACTORS? Falls-related risk factors are potential reasons or causes for a fall.4 Modifiable risk factors are those that are amenable to intervention. Even if a risk factor cannot be completely eliminated, strategies can be used to minimise the risk of a fall and prevent injury associated with a fall. There are three types of falls-related risk factors and each has its own set of risk factors matched with interventions that may be useful to help prevent a fall:4 • Environmental • Physical function and health • Psychological function

ENVIRONMENTAL RISK FACTORS Environmental hazards are responsible for up to one third of falls in older adults.5 They include:1,2,4 • Absence of bed and hand rails • Chairs, lounges, showers, and bathtubs that are difficult to get in to and out of • High bed heights • Inaccessible light switches • Inadequate lighting • Long distances to reach the toilet or access meals

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• Pets • Poorly maintained floor covering • Presence of trip hazards, such as loose rugs, cords, floor clutter, or obstacles • Slippery surfaces • Unfamiliar environments At home, the bathroom and stairs are most likely to be associated with injuries from falls.5 This is often because these areas require older adults to turn and transfer frequently. They also are more likely to have structural features that increase the risk of falls, such as uneven stairs, slippery floors, and lack of transfer assist aids.5 Environmental hazards can be assessed using a home safety screening tool, such as the Home Falls and Accidents Screening Tool (Home FAST).1,2,5 Once environmental hazards have been identified, they can be removed or managed. Unfortunately, research to understand the impact of managing or removing environmental hazards on the rates of falls has had conflicting results. This may be because there is no standard definition of environmental hazards for falls and no consistent approach to assessing these hazards in the community. Falls prevention experts are calling for a more consistent approach to the assessment and management of environmental hazards in the future.5

PHYSICAL FUNCTION AND HEALTH RISK FACTORS Physical function and health risk factors for falls include:1-4 Balance and mobility limitations (including limited physical activity and history of falls) • Continence issues • Dizziness and vertigo • Feet and footwear • Impaired vision • Medications • Syncope

Of all falls in older people, 50 to 70% occur when the individual is mobile.2 There are a variety of screening tools that can be used to assess balance, mobility, gait, and strength. Exercise may be beneficial for patients with low levels of physical activity, impaired mobility, and gait.6,7 While independent, general exercise may not make a significant difference, strength and mobility training programs, including Tai Chi, are likely beneficial and costeffective for individuals at risk.6,7 The identification of physical function and health related risk factors often suggests the need for referral to other health professionals.1,2 For example, any patient with ongoing concerns about their physical function should be reviewed by a medical practitioner.1,2 The underlying causes of conditions, such as loss of consciousness, syncope, black outs, or seizures need to be investigated and treated.1 Other health professionals that may be involved include a physiotherapist, occupational therapist, podiatrist, or continence nurse.1,2 However, there is limited evidence to support some of these referrals. For example, visual assessments are not beneficial as a single intervention for preventing falls, but may be useful as part of a multifactorial falls prevention plan. A referral to a continence nurse, in isolation of other interventions, may not be effective.8 There are two ways that medication use may increase the risk of a fall. The first is through polypharmacy, or the use of multiple medications that increase the risk of a fall.1,2 The second is from the use of individual medications that increase the risk of a fall.1,2 Psychotropic drugs, including benzodiazepines, antidepressants, and antipsychotics are most commonly associated with falls.1,2 However, medications that affect heart rate or blood pressure may also increase the risk of a fall.5 The most common intervention for risk factors related to medications is a medication review.1,2 To date, medication

reviews have not been conclusively linked to an improvement in the risk of a fall or rates of falls in hospital or aged care settings.9 Many sites recommend that a nurse, pharmacist or doctor undertake the review.1,2 This is only beneficial if the multidisciplinary team environment is conducive to medical practitioners implementing changes suggested by other professionals.1,2 As such, a general medication review may not be helpful. However, a targeted medication review with modifications, such as reduced use of psychoactive medications, titrated dosing of medications that affect heart rate and blood pressure, and prescription of vitamin D, calcium, and osteoporosis medication (as indicated) may be effective.9

PSYCHOLOGICAL FUNCTION RISK FACTORS One of the most significant falls related risk factors is impaired cognition.5 Other psychological risk factors include fear of falling, low mood or affect, and an overall poor quality of life.5 Individuals who experience a new onset cognitive impairment or deterioration of their condition require a review by a medical practitioner to assess for underlying causes, such as medications, delirium, or dementia.1,2 Interventions to increase surveillance of people with cognitive impairment, such as frequent monitoring,

high observation rooms, sitters/carers/ family members at the bedside or electronic bed, or chair alarms may be useful for some patients.1,2 However, at present there is insufficient evidence to suggest these interventions have a significant impact on the rates or risk of falls in any setting.9 Overall, while screening and assessment are the first steps of falls prevention, they must be followed by the selection and implementation of multifactorial personcentred interventions in order to prevent falls in healthcare settings.

REFERENCES 1. Australian Commission on Safety and Quality in Healthcare. Preventing falls and harm from falls in older people. Best practice guidelines for Australian residential aged facilities 2009. Canberra: Commonwealth of Australia; 2009. 220p. 2. Australian Commission on Safety and Quality in Healthcare. Preventing falls and harm from falls in older people. Best practice guidelines for Australian community care 2009. Canberra: Commonwealth of Australia; 2009. 202p. 3. Hopewell S, Adedire O, Copsey BJ, Boniface GJ, Sherrington C, Clemson L, Close JCT, Lamb SE. Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD012221. DOI: 10.1002/14651858.CD012221.pub2. 4. Prevention of Falls Network Earth. Falls & fracture prevention [Internet]. West York-

shire: ProFaNE.co; 2012 [cited 2019 Jul]. Available from: http://profane.co/wp-content/uploads/2012/12/Map_of_Falls_Fracture_Prevention_December_2012.pdf. 5. Blanchet R, Edwards N. A need to improve the assessment of environmental hazards for falls on stairs and in bathrooms: results of a scoping review. BMC Geriatrics. 2018:18(27);1-16. Available from: https:// doi.org/10.1186/s12877-018-0958-1 6. Sherrington C, Fairhall NJ, Wallbank GK, Tiedemann A, Michaleff ZA, Howard K, Clemson L, Hopewell S, Lamb SE. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD012424. DOI: 10.1002/14651858. CD012424.pub2. 7. Winser SJ, Chan HTF, Ho L, Chung LS, Ching LT, Felix TKL, Kannan P. Dosage for cost-effective exercise-based falls prevention programs for older people: A systematic review of economic evaluations. Ann Phys Rehabil Med. 2019 Jul 12. doi: 10.1016/j. rehab.2019.06.012. [Epub ahead of print] 8. National Institute for Health and Care Excellence (NICE). Falls in older people: assessing risk and prevention [Internet]. CG161. NICE; 2013 June [cited 2019 Aug]. Available from https://www.nice.org.uk/guidance/cg161/ chapter/About-this-guideline. 9. Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD005465. DOI: 10.1002/14651858.CD005465.pub4.

October 2021 western nurse |

ACROSS THE NATION & AROUND

Biloela family thanks PCH nurses As if nurses at Perth Children’s Hospital (PCH) hadn’t been through enough in recent times, in June they came face to face with the harrowing, complex and unmet health, mental health, social and emotional needs of a young child who has spent most of her life behind bars. Four year-old Tharnicaa Murugappan was flown to Perth from immigration detention on one of Australia’s most remote and isolated territories, Christmas Island (CI). She’d been held there, with her family, behind razor wire, at the Australian Government’s offshore immigration detention facility, kept away from the local CI community, and their home town of Biloela in Queensland, for the past two years. At least PCH nurses were able to help her celebrate her fourth birthday, the only one since she was born that she has spent outside of a detention centre, in hospital. Apparently, unbeknown to the Australian Government’s Department of Home Affairs, and its enforcement agency Border Force, both responsible for the detention of the Tamil asylum-seeker family, which also includes another child, six year-old child Kopica, Tharnicaa was gravely ill in the island prison, more than 2,500 treacherous kilometres away from the nearest tertiary hospital. What most Australians don’t know about CI and its neighbouring coral atoll, the Cocos (Keeling) Islands (CKI), collectively called the Indian Ocean Territories (IOT), is that like the Australian Capital Territory (ACT), and Northern Territory (NT), as well as the renowned Norfolk Island (NI) off the east coast of the country, it does not have state government, and therefore state services are delivered directly or by contract by the Australian Government. This includes health care.

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The locally managed health authority on CI, and CKI, the Indian Ocean Territories Health Service (IOTHS), staffed mainly by West Australian nurses, is run by the Australian Government Department on Infrastructure, Transport, Regional Development and Communications (DITRDC), and its on-island sub-set IOTA, the Indian Ocean Territories Administration. Despite being based in the most far-flung and treacherous Australian communities on the map, the IOTHS is only equipped to provide primary and short-term acute care, and only has a limited and relatively new partnership arrangement with WA Health. Basically, if you have anything more serious than a common cold, you are medically evacuated off the islands to Darwin or Perth. Maternity services are also not available in the IOT. Another thing most would not know, not even the locals, is that the IOTHS is not allowed to provide health care to those incarcerated in the CI immigration detention centre, or outside of it for that matter, as their lives and conditions, including their health, are governed and managed by the Australian Government’s Departments of Home Affairs and Border Force, way outside the auspices of even DITRDC, let alone the IOTHS. Imagine what managing peoples’ health in full quarantine facilities, let alone full immigration detention facilities, managed by these monolithic agencies in the IOT, would look like? It’s not pretty. The multi-billion dollar facility on CI is a white elephant, and certainly not an option for COVID quarantine. It’s not viable and it’s not safe, the main reason being it’s at least 2,605 kilometres away from the nearest Australian tertiary health services. When the facility is full, or even fuller than its most recent two adult and two child residents, the Feds bring in medical contractors, for example IHMS (International Health and Medical Services), to deliver health services inside. No wonder it cost more than $90 million to imprison the Tamil family there.

THE GLOBE What a mess. Tharnicaa Murugappan recovered from the blood infection she suffered, reported to be caused by untreated pneumonia, after being medically evacuated from CI to PCH in a serious condition. Her mother Priya accompanied her to Perth, but she was not reunited with her father Nades and older sister Kopika until weeks later when PCH medical staff called for the rest of the family to be released and brought to Perth as part of the sick child’s treatment. Tharnicca was been released from hospital requiring ongoing specialist care, and the family is being held in community detention in Perth, but is reportedly desperate to be allowed to return to Biloela in outback Queensland. Both Tharnicca, and her older sister Kopica, were born in Australia, to two asylum seekers who travelled here, allegedly illegally, by boat. They managed to settle in Biloela, got jobs in a town struggling to find workers, and had a family. But under Australian law the parents are apparently doomed to be deported, causing great trauma for their two Australian-born children, however injunctions have prevented it while the courts determine whether Tharnicaa is eligible for refugee protection. Former High Court chief justice, Sir Gerard Brennan, told the Sydney Morning Herald recently that cruelty was being inflicted upon Tharnicaa to punish her parents. Federal Labor leader Anthony Albanese has said the Australian Government Minister for Home Affairs, formerly Peter Dutton, and now Karen Andrews (both Queenslanders themselves), has the power to grant the family visas and should do so. Queensland Premier, Annastacia Palaszczuk, and West Australian Premier, Mark McGowan, have both called on the Australian Government to make a decision about the family’s residency. 

What are the IOT? The Indian Ocean Territories (IOT) of Christmas Island (CI) and Cocos (Keeling) Islands (CKI) are situated 2,605 and 2,936 kilometres, respectively, north-west of Perth, and 490 and 1,270 kilometres, respectively, south-west of Jakarta, Indonesia. The Australian Government has responsibility for the external territories, and through the Department on Infrastructure, Transport, Regional Development and Communications (DITRDC), facilitates the delivery of services normally expected from a state government. State-type services are delivered through Service Delivery Arrangements (SDAs) with the Western Australian (WA) State Government and its agencies, directly by the private sector under contract, or by DITRDC. Additional government services, such as those involving quarantine and customs, and even police (Federal) are the responsibility of the relevant Australian Government agencies.

What is the IOTHS?

The Australian Government, through the Department of Infrastructure, Transport, Regional Development and Communications (DITRDC), funds and operates the Indian Ocean Territories Health Service (IOTHS). A range of services are offered from facilities on Christmas Island and the Cocos (Keeling) Islands, including: • primary healthcare, pathology, radiology, pharmacy and acute in-patient care • public, community and child health programs, and antenatal services • aged care, including home and community care • disability services • accident and emergency care, patient assisted travel and emergency medical evacuation • oral healthcare, social work services • telehealth and access to visiting specialist medical care and allied healthcare. These services are supplemented through a Service Delivery Arrangement with the Western Australian Department of Health, which provides for: • regulatory, policy, governance and specialist medical advice • in-hospital services and care in Western Australia • additional pathology services • mammography screening and assessment services through BreastScreen WA. The Christmas Island Health Centre comprises of six general ward beds, two of which are currently being used for residential aged care, and two emergency department beds. Services are provided by three General Practitioners and 12 nurses to deliver 24/7 acute and primary care to the community. On the Cocos (Keeling) Islands, services at the Home Island and West Island Clinics are provided by one GP and four nurses. Each of the clinics has one emergency bed and multiple consulting rooms. There is limited capacity for inpatient treatment with overnight care only provided in the event of awaiting medical evacuation to Perth.

What’s the difference?

The IOTHS is the only health system in Australia that is governed, managed and delivered by public servants as part of an Australian Government agency, and that is not a health agency. It is managed from Canberra by the Department of Infrastructure, Transport, Regional Development and Communications (DITRDC), via its on island presence IOTA, the Indian Ocean Territories Administration. In the mix also is the Administrator of the Territories of Christmas Island (CI) and the Cocos (Keeling) Islands (CKI), Mrs Natasha Griggs. She is the most senior Australian Government representative residing in the Indian Ocean Territories (IOT). The Administrator is a statutory appointee of the GovernorGeneral of the Commonwealth of Australia, made on the recommendation of the Government, and whose key function is to represent the Federal Assistant Minister of Regional Development and Territories, Nola Marino (whose electorate is actually Forrest in WA). Mrs Griggs chairs the IOT Regional Development Organisation, Emergency Management Committees, the Interagency Coordination Committee and newly established Health Advisory Groups. Mrs Griggs commenced as Administrator on 5 October 2017, and has been reappointed for a further two years from 5 October 2020.

October 2021 western nurse |

Olympian nurse is on the ball Fresh from the Tokyo Olympics, Hockeyroo goalkeeper and Olympian for Life, Rachael Lynch, talks about how she balances her nursing work with her hockey career. Rachael Lynch may be one of the only people in the world who enjoys quarantine. “I actually love it,” she says. “It’s the ultimate gift to have that time to reflect.” This may be because it’s the only time in her action-packed life that she slows down. When she’s not representing Australia as the Hockeyroos goalkeeper, Lynch is also a registered nurse, mental health ambassador and hockey coach. “I like to be busy,” she says. “I wake up in the morning and think, ‘How many things can I fit into my day?’ I’m not very good at sitting still.” And she’s certainly been busy. Lynch has just returned from Tokyo, where her team, ranked second in the world, had a shock quarter-final loss to India. “It was very frustrating but I’ve moved on from that with the knowledge that the girls played so well,” she says. “The group was really united. We’ve had a pretty horrible 12 months, so to see the progress as a group and to see the girls so happy was just wonderful.” While she says it was certainly a very different Olympics from her previous one in Rio in 2016, she says all the extra testing and precautions around COVID-19 just became part of the routine. “We’re used to wearing masks all the time. The saliva test every day was a challenge for some people, but it was just part of the day.” She says her team chose to have many of their meals in their rooms and avoided some of the teams who weren’t as diligent about wearing masks. She says there was still a good atmosphere and the lack of crowds actually helped the team. “It reduced a lot of the pressure for everyone.”

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Lynch says being a nurse gives her valuable perspective on her sporting career. “The perspective I gain from my nursing work allows me to think about other people and the real world. Sport is not a real world sometimes. Winning and losing can feel like the end of the world but it’s definitely not.” In July, Lynch was one of only five international athletes to be inducted as an Olympian for Life for her outstanding contribution to society. “The award is really special to me because I was acknowledged for what I do off the field and my contribution to the community,” she says. “I’m very proud of my career as a Hockeyroo and an athlete but the thing I really hang my hat on is the fact that I’m a nurse and I can really help to make people’s lives better. That’s what gets me out of bed in the morning.”

yourself and others and it’s inspired me to implement it in my hockey environment, in my work environment and with my family and friends, to create a culture where people feel comfortable to check in on each other and to be honest when they’re not doing well.” She says juggling her nursing with her athletic career can be a challenge. “I’ve had coaches who have questioned my commitment to hockey because I wanted to work. But nursing helps me to be more balanced as a person.” When to comes to her nursing career, she says, “I’ve had to be really organised and have good communication. I’ve been fortunate to have had amazing bosses along the way who have supported me. It’s the support of my colleagues and bosses that makes it doable. When I’m at work, I really try to give it everything.”

She says she hopes the award will also help to “shine some light on the health sector and nurses and all the fabulous work they do”. Lynch previously worked on the neuro-rehab ward at Perth’s Fiona Stanley Hospital and last year she moved to a management role, running the COVID-19 testing program for a large mining company. “It’s a huge project,” she says. “We ran a private testing program for our staff and some other mining companies all of last year. I think we did well over 100,000 swabs and it allowed us and other companies to ensure their staff were getting to and from the mine safely in the middle of a pandemic and we could keep the industry open. It’s a huge industry that really contributes to Australia’s, and especially WA’s, economy.

“Part of the challenge with COVID-19 is that people feel really helpless, whereas for all nurses and frontline workers, you can actually get out there and do something about it, so I feel really privileged to be in that position,” she says. Lynch says one of the things she loves about nursing is the relationships she builds with people. “You can make a difference in someone’s life, not just through the physical care but through the mental side, and that’s why I really enjoyed rehab nursing. It’s a bit like my sport – the harder the patients work, the quicker they can get out, and to be able to help with the highs and lows and the motivation was something I really enjoyed.” Mental health is something that’s very important to Lynch. She has been an ambassador for RU OK? Day for about nine years and Lifeline for about two years. “It ties in nicely with my nursing. RU OK’s messaging is about prevention and general day-to-day care for

When she’s not working as a nurse or playing hockey, Lynch runs a coaching business for goalkeepers and also enjoys cycling, reading and cooking. “I also really prioritise my relationships with my family and friends,” she says. “I ring my mum in Melbourne every single day.” She adds: “I’m very fortunate to have wonderful friends, family and supporters around me and I feel blessed to be able to do all the things I do.” She says while it may seem as though she has little time to relax, “I get so much joy out of all the things I do, for me, that is a form of relaxation.” 

October 2021 western nurse |

EQUIPMENT

Corner SLOW ROASTED LEG OF LAMB RECIPE With most of us spending more time cooking at home these days, why not try a delicious dish that won’t disappoint with its melt-in-the-mouth, tender meat. It’s heartily seasoned with herbs, spices and veggies and the bones lend lots of amazing flavour to the meat as they roast away.

Digital scale Measuring cups and spoons Food processor Non-stick roasting pan Griddle pan Oven mitts Cling wrap Aluminium foil Mixing bowl Wooden spoon Chef’s knife Cutting board

INGREDIENTS

This Turkish-style roast leg of lamb recipe takes five hours to cook but needs only a little attention and love from time to time. An elegant yet homely dish, this leg of lamb is as delightful to cook as it is to share with the family this spring.

For the marinated lamb 125ml olive oil

Serves up to six and includes full recipes for homemade hummus and cucumber with yoghurt. Best served with olives, sun-dried tomatoes and fresh radishes.

3 rosemary sprigs, leaves removed

45ml lemon juice 2 garlic cloves, finely crushed 8 mint leaves 2.4kg leg of lamb (bone-in) Salt and freshly ground pepper 4 large heads of garlic 250g soft Turkish dried apricots 4 limes, cut in half 150g pomegranate seeds For the homemade hummus 125ml tahini paste 60ml lemon juice 2 garlic cloves, finely crushed Two 400g tins chickpeas, drained 250ml boiling water Salt and freshly ground black pepper Olive oil Paprika For the cucumber with yoghurt 1 small Mediterranean cucumber 250ml Greek-style yoghurt 6 mint leaves, finely chopped 1 garlic clove, finely chopped Salt and freshly ground black pepper For serving 425g Kalamata olives 240g sun-dried tomatoes 150g radishes

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INSTRUCTIONS To make the marinated lamb Add olive oil, lemon juice, crushed garlic, rosemary leaves and mint in a food processor and blitz until well blended. Place the leg of lamb in a non-stick roasting pan. Marinate the meat, cover the roasting pan with cling wrap and refrigerate for at least 2 hours. Preheat the oven to 160C. Remove the cling wrap from the roasting pan and season the meat with salt and pepper. Cover the roasting pan with foil and place into the oven to roast for 3 hours. Remove from the oven and take off the foil. Cut the garlic heads to expose the cloves. Arrange the garlic around the meat and spoon some of the meat juices over. Roast open for another 2 hours until the meat is tender. Scatter apricots in the roasting pan and heat through. Fry the limes in a griddle pan and arrange in the roasting pan. Scatter pomegranate seeds over the meat and serve with hummus, cucumber with yoghurt, olives, sun-dried tomatoes and fresh radishes.

To make the homemade hummus In the bowl of a food processor, combine the tahini, garlic cloves and lemon juice. Process for 1 minute, scrape the sides and bottom down, then process for 30 seconds more. Add chickpeas and blitz, then add boiling water and process until smooth. Season with salt and pepper and spoon into a mixing bowl. Cover with cling wrap and refrigerate. Just before serving, spoon the hummus into serving bowls with a drizzle of olive oil and a sprinkle of paprika on top. To make the cucumber with yoghurt Remove the ends of the cucumber, then cut it in half lengthwise and scrape out the pips. Slice and place into a bowl. Mix yoghurt, mint and garlic in a mixing bowl and season with salt and pepper. Spoon the yoghurt over the sliced cucumber and mix well. Serve the lamb with olives, sun-dried tomatoes and fresh radishes too. Pro tip: Make your hummus the day before serving; the taste will be better the next day. Recipe and image adapted from Le Creuset, supplied by Kitchen Warehouse

OFF October 2021 western nurse |

THE BRAIN BUSTER

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CLUES 1 Disruptions of the electrical impulses that control the beating of the heart (6) 5 Small arachnid that can cause paralysis (4) 9 Total animal and plant life of a region (5) 10 Picture produced by the use of X-rays (5) 11 First name of the Director-General of the World Health Organization (6) 13 Radio-frequency identification (1,1,1,1) 15 Soft cadence to a voice (4) 16 Process of an insect impregnating another creature with poison (12) 20 Veil-like membranous partitions (4) 22 Unfasten, separate (6) 24 Aetiology (5) 25 Group of tissues with similar functions (5) 27 Sensory structures responding to environmental stimuli (9) 28 Becomes liquid due to heat (5) 30 Forceps (5) 31 Pestilence, disease of high mortality (6) 33 Colourless amide used in fertilisers, an excretory product of many animals (4) 35 Instance of very serious arrhythmia (7,6) 39 Final (4) 41 Ants inject poison after clamping down with these body parts (4)

46 47

ACROSS

42 --- of Langerhans, pancreatic regions (6) 45 Narrow cleft (5) 46 Measured amounts of a medicinal substance (5) 47 Diabetes classification (4) 48 Combining word part indicating the excision of a body part (6) DOWN 1 Bone marrow transplantation (1,1,1) 2 Long in the tooth (3) 3 TV network that broadcast the show Medicine or Myth (1,1,1) 4 Main trunk of the arterial system (5) 5 Foot bones (5) 6 --- syndrome, very rare disorder characterized by progressive corneal opacification (1,1,1) 7 Dry watercourse (4) 8 Devices used to prevent patients from injuring themselves (10) 12 Comedy Dame who formed the non-profit group ‘Friends of the Prostate’, in honour of her husband Norm (4) 14 Electrically charged atom (3) 15 Large, reddish brown glandular body part that plays an important role in all metabolic processes (5)

17 Those who give others titles or monikers (6) 18 Relating to the science or practice of medicine (7) 19 Nickname of the most famous pharaoh of all (3) 21 --- diagnosis, also known as co-occurring disorders (4) 23 Acute and potentially fatal infectious disease mentioned in the title of a Gabriel Garcia Marquez novel (7) 24 One of the coronavirus strategies to prevent treatment interference in adults (10) 25 Person who takes care of horses at an inn (6) 26 Sequence of nucleotides (4) 29 Bundle of nerve fibres (5) 31 Chicken ---, pub dish (5) 32 State in western India (3) 34 Immediately! (4) 36 Health problem (5) 37 --- 19, respiratory disease that’s caused havoc around the world in 2020 (5) 38 Lift up (5) 40 Acute form of pneumonia (4) 41 --- lag, traveller’s disruption of circadian rhythms (3) 43 Self opinion (3) 44 Home for a pig (3)

24 Camouflage 25 Ostler 26 Gene 29 Tract 31 Parma 32 Goa 34 Stat 36 Issue 37 Covid 38 Raise 40 SARS 41 Jet 43 Ego 44 Sty. DOWN 1 BMT 2 Old, 3 SBS 4 Aorta 5 Tarsi 6 KID 7 Wadi 8 Restraints 12 Edna 14 Ion 15 Liver 17 Namers 18 Medical 19 Tut 21 Dual 23 Cholera 28 Melts 30 Tongs 31 Plague 33 Urea 35 Cardiac arrest 39 Last 41 Jaws 42 Islets 45 Gorge 46 Units 47 Type 48 Ectomy. ACROSS 1 Blocks 5 Tick 9 Biota 10 Image 11 Tedros 13 RFID 15 Lilt 16 Envenomation 20 Vela 22 Detach 24 Cause 25 Organ 27 Receptors

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western nurse October 2021

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CONTINUING PROFESSIONAL DEVELOPMENT

ANF iFOLIO CLINICAL UPDATE:

Diagnostic tests for Diagnostic tests for Cryptococcosis Cryptococcosis Read this article and complete the quiz to earn 0.5 iFolio hour Read this article and complete the quiz to earn 0.5 iFolio hour

Cryptococcosis is an infectious disease caused by Cryptococcus neoformans or Cryptococcus gattii; two encapsulated yeast species of the genus Cryptococcus.1 Although the organisms can infect healthy individuals, cryptococcosis is more common in immunocompromised indiviudals.2 The disease is usually associated with conditions such as acquired immunodeficiency syndrome (AIDS), diabetes, organ transplantation, malignancy, steroid or immunosuppressive therapy, defects in cell-mediated immunity, and chronic liver, kidney or lung diseases.2 The organisms can also cause meningitis, pneumonia and disseminated infections.1-3

DIAGNOSTIC TESTS Diagnosis of cryptococcosis relies on medical history, clinical symptoms, and laboratory tests.1-4 India ink examination is used to detect Cryptococcus in cerebrospinal fluid (CSF) for the diagnosis of cryptococcal meningitis. Since India ink cannot stain the yeast capsule surrounding the yeast cell, the ink can only stain the background and this results in a zone of clearance around the cells. Cryptococcus can be visualised as spherical cells with a halo against a dark background. False positive results can occur due to yeast cells being similar in appearance to lymphocytes and other tissue cells. 1-4 Culture helps isolate and identify Cryptococcus from specimens including CSF, blood, and sputum. Cryptococcus can grow within 48 to 72 hours at 20°C to 37°C on solid media (such as Blood Agar, Sabouraud Dextrose Agar and Bird Seed Agar). Colonies are usually creamy white in colour and turn yellow-tan to brown following a prolonged incubation period. The mucoid appearance of colonies indicates the capsule surrounding the yeast cell. However, most non-pathogenic Cryptococcus strains are unable to grow at these temperatures. Cerebrospinal fluid culture can be negative in cryptococcal

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immune reconstitution inflammatory syndrome (IRIS). This is a condition seen in individuals with AIDS, in which the recovery of the immune system after initiation of antiretroviral therapy responds to previously acquired opportunistic infections making clinical symptoms worse.1-4 Cytology is the microscopic examination of cells from centrifuged CSF sediment and other body fluids such as bronchoalveolar lavage. The sedimented CSF and other body fluids can be stained with periodic acid-Schiff (PAS) stain or mucicarmine stain which helps identify the yeast by labelling the capsule. This method is more sensitive than India ink staining.1-4 Histopathology involves the microscopic examination of tissues from the lung, skin and other organs. Specimens such as biopsies can also be stained with PAS stain or mucicarmine stain. In addition to PAS and mucicarmine stain, methenamine silver stain, which highlights the fungal cell wall, is a popular staining method to identify the yeasts in tissues.1-4 Serologic tests can detect polysaccharide capsular antigen of Cryptococcus in serum and CSF specimens. Serologic techniques that are commonly used for diagnostic purposes include latex agglutination test and lateral flow assay (LFA) 1-4. • Latex agglutination is widely utilised due to its high sensitivity and high specificity. False negative results, however, can occur due to low cryptococcal antigen concentrations. • Lateral flow assay also has high sensitivity and high specificity. Moreover, LFA has some advantages over other serologic techniques. Rapid turnaround time, low cost, no specimen preparation, and stability at room temperature means that LFA satisfies most of the criteria for a good point-ofcare test. For people with the Human Immunodeficiency Virus (HIV) who

are suspected to have cryptococcal meningitis, a rapid serological antigen assay (either latex agglutination or LFA) with rapid access to test results (less than 24 hours) is recommended as the preferred diagnostic approach.4 If rapid serological antigen assays are unavailable, CSF India ink examination is recommended as the preferred diagnostic test.4 When lumbar puncture is contraindicated, serum specimens can be used instead of CSF for serologic antigen assays.4

REFERENCES 1. Williamson P. R., Jarvis J. N., Panackal A. A., Fisher M. C., Molloy S. F., Loyse A., et al. Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. Nature reviews Neurology. 2017;13(1):13-24. [Accessed 2019 Sep]. Available from: https://www.nature.com/articles/nrneurol.2016.167 2. Maziarz E. K., Perfect J. R. Cryptococcosis. Infectious disease clinics of North America. 2016;30(1):179-206. [Accessed 2019 Sep]. Available from: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC5808417/ 3. Ruschel Marco A Pescador, Thapa Bicky. Meningitis, Cryptococcal. StatPearls [Internet]: StatPearls Publishing; 2018. [Accessed 2019 Sep]. Available from: https://www.ncbi. nlm.nih.gov/books/NBK525986/ 4. World Health Organization. Guidelines for the diagnosis, prevention and management of cryptococcal disease in HIV-infected adults, adolescents and children: supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection Geneva 2018. [Accessed 2019 Sep]. Available from: https://apps.who.int/iris/bitstream/ handle/10665/260399/9789241550277eng.pdf;jsessionid=99443D4FCFF811D79239CE762318D5E8?sequence=1

ANF iFOLIO CLINICAL UPDATE:

Dabigatran A medication update Dabigatran A medication update Read this article and complete quiz earn 0.5 iFolio hour Read this article and complete the quizthe to earn 0.5to iFolio hour Generic name: Dabigatran Brand name: Pradaxa Drug class: Direct thrombin inhibitors

INDICATIONS FOR USE

Dabigatran is used to prevent venous thromboembolism (VTE) in individuals with nonvalvular atrial fibrillation (AF) and a high risk of stroke and following elective total hip or knee replacement. It is also used to treat acute VTE and prevent further thrombus formation.1

MECHANISM OF ACTION

Direct thrombin inhibitors bind to thrombin and prevent the conversion of fibrinogen to fibrin as well as the aggregation of platelets in the bloodstream (see Illustration 1).1 Illustration 1: A simplified coagulation cascade

severe bleeding.1 Seek specialist advice prior to the insertion or removal of spinal or epidural catheters.1 In those who require surgery, stop dabigatran several days in advance depending on renal function (see Table 1).1 Intravenous heparin or subcutaneous low molecular weight heparin may be used up until surgery for those at high risk of blood clots.1 Table 1. Recommendations for the cessation of dabigatran prior to surgery1

Renal Function (CrCl)

Recommendations for stopping dabigatran prior to surgery

>50mL/minute

One to three days prior to elective surgery

30-50mL/minute

Three to five days prior to surgery

In emergencies, a reversal agent (idarucizumab) may be used to reverse the effects of dabigatran.2 Idarucizumab is a specific nonvitamin K antagonist oral anticoagulant reversal agent that has been shown to safe and effective in clinical trials. Safety data continues to develop as use in hospitals increases.2

PRECAUTIONS

Contraindications for dabigatran include gastrointestinal bleeding in the past 12 months, prosthetic heart valves, severe renal failure (creatinine clearance, CrCL<30mL/minute), and liver disease (liver enzymes more than two times the upper limit of normal).1 Alternate dosages may be required for the elderly (over 75 years of age) and those with renal impairment (CrCl 30-50mL/minute).1 Direct thrombin inhibitors should also not be used in individuals with severe acute bleeding or an increased risk of

Dabigatran is associated with several drugdrug interactions. Use is discouraged or contraindicated in those taking a variety of other medications including;1 • Oral ketoconazole (concurrent use is contraindicated) • P-gp inhibitors or inducers, such as amiodarone or carbamazepine (use cautiously or avoid use) • Verapamil (concurrent use is contraindicated) Evidence for use in pregnancy and breastfeeding is limited. Alternative medications are recommended.1 Compared to warfarin,

dabigatran has also been shown to increase the risk of myocardial infarction in clinical trials.1

ADVERSE EFFECTS

Dabigatran has the potential to cause gastritis, dyspepsia, and gastrointestinal bleeding. It may also cause oesophageal ulcers, increased liver enzymes and bilirubin, and an increased risk of bleeding. Severe bleeding is rare with dabigatran.1

DOSAGE AND ADMINISTRATION

Dabigatran is administered orally. The dose and duration of treatment is dependent on the indication (see Table 2).1

SWITCHING ANTICOAGULANTS It is common to switch between anticoagulants as a patient’s condition changes. For example, someone may start on parenteral anticoagulation prior to commencing long-term dabigatran or may switch between warfarin and dabigatran based on side effects.1 If changing from dabigatran to parenteral anticoagulation wait 12 to 24 hours before the last dabigatran dose (depending on the indication).1 If using dabigatran after parenteral anticoagulation, start dabigatran two hours before the next dose of parenteral anticoagulation would have been due.1 Changes between dabigatran and warfarin are based on INR and CrCl. When changing from warfarin to dabigatran, wait until INR is less than two.1 When changing from dabigatran to warfarin, start warfarin 1 to 3 days prior to stopping dabigatran depending on CrCl.1

ADVICE AND EDUCATION

Prevention of VTE post-hip and knee replacement

110mg within 1-4 hours of surgery, followed by 220mg once daily

10 days (post-knee replacement)

Dabigatran should be swallowed whole, at the same time every day, with water and food.1 Monitor renal function and for signs of bleeding, such as unexplained bruising, discoloured urine or faeces.1 In a medical emergency, it is essential that healthcare professionals know an individual is taking dabigatran. A medical alert bracelet may be recommended.1

With amiodarone or verapamil or CrCl 3050mL/minute: 150mg once daily

28-35 days (post-hip replacement)

REFERENCES

Atrial fibrillation

150mg twice daily

N/A

Table 2. Indication, dosage and duration of treatment for dabigatran1

Indication

Dosage

Duration of treatment

>75 years, CrCl 30-50mL/minute, severe risk of bleeding: 110mg twice daily Acute VTE and prevention of subsequent VTE

Commence dabigatran after five days of parenteral anticoagulation 150mg twice daily >75 years, CrCl 30-50mL/minute, severe risk of bleeding: 110mg twice daily

At least three months

1. Australian Medicines Handbook 2018 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2018 January. 2. NPS MedicineWise. Idarucizumab (Praxbind) for dabigatran (Pradaxa) reversal: what you should know [Internet]. Surry Hills: NPS MedicineWise; 2017 Apr 19 [cited 2018 Apr]. Available from: https://www.nps. org.au/medical-info/clinical-topics/news/ i d a r u c i z u m a b - p r a x b i n d - fo r- d a b i g a t r a n pradaxa-reversal-what-you-should-know

October 2021 western nurse |

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Western Nurse Magazine October 2021

Articles inside

Dabigatran - A medication update

Diagnostic tests for Cryptococcosis

Olympian Nurse

KEMH Rally

WA Nursing and Midwifery Excellence Awards

Across the Nation & Around the Globe

Recipe Corner

PCH Rally

Identification and management of falls-related risk factors

Internet Watch