Western Nurse Magazine July August 2018

July – August 2018

incorporating western midwife

BUREAUCRATS FINALLY ON BOARD WITH ABOLISHING APPRAISALS PRIVATE HOSPITALS AND AGED CARE NEXT

PLUS:

ANF GETS ALLOWANCES RESTORED ALL THE DETAILS PAGES 8-11

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Secretary's Report July - August 2018

State Secretary Mark Olson

FEATURED

By now you should have received emails from me outlining recent important results for ANF members.

4 Giving To Those Most In Need – ANF Humanitarian Fund

In terms of getting rid of those dreaded annual appraisal meetings, we finally have the bureaucrats on board with that goal and now working with us to create a process in public hospitals that is free of mandatory meetings.

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Appraisal Meetings Gone At Last

14 Mark’s Q & A 28 Recipe Corner

FAVOURITES 6

Internet Watch

18 ANF Out ‘N’ About 22 Across the Nation 26 Around the Globe 30 Research Roundup 31 ANF Contact Details

HOLIDAY ANF

And we’ve also managed to put money back in members’ pockets, by restoring midwifery qualification allowances that had been stripped away by the actions of the WA Nursing and Midwifery Office.

On appraisals, the Office of the WA Health Department Director General has now definitively ordered senior health executives to proceed with creating a new performance review process that excludes compulsory meetings.

Pivotally, the Director General’s office has also stressed to those senior people that meetings are not part of hospital accreditation regulations – once and for all refuting the excuse some bureaucrats had been peddling to keep the meetings.

You might be thinking: "Didn’t WA Health Minister Roger Cook already state appraisals were gone, both in an election promise and in a ministerial directive in November?"

That’s true. But the reality – which many of you know firsthand – is bureaucrats all over the public health sector have been resisting abolishing meetings and also started constructing new reviews – just appraisals by other names – in order to try to coerce our members into attending meetings.

And despite being told by the Minister to work with the ANF to resolve this issue, the Nursing and Midwifery Office and other senior bureaucrats just strung out negotiations over many months.

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In the end, after so many months of stalemate, I had no choice but to take the matter directly back to the Health Minister who made the promise in the first place, and let him know what had been happening with his commitment.

WIN!

The result is a definitive directive from the Director General’s office that there will be no more meetings – which is the most positive movement I’ve seen on this matter in nearly one and a half years of negotiations.

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CLINICAL UPDATES 13 Bladder scan – a screening tool 16 Best practices in ethical treatment during palliative care 20 Norovirus 24 Assessment for trachoma

With the bureaucrats now on board, we’re at last on a clear path to a meeting-free review process.

On the matter of allowances, many members will know – again firsthand – that the Nursing and Midwifery Office has also been busy removing the majority of midwifery qualifications from the official list that hospitals use when approving or denying applications made by nurses and midwives for their qualification allowances.

After I let the Minister know what had been occurring also on this front, the Director General’s office quickly restored previously approved qualifications that had been erased from the list.

Now we’ve resolved the lion’s share of the allowance issue and the matter of abolishing appraisal meetings is finally on the right track, we can turn our minds to the replacement of the public sector wages and conditions agreement that expires later this year. I have already written to the Director General of Health to commence negotiations.

And we can now also move towards removing appraisal meetings from the private sector and aged care.

July–August 2018 western nurse |

3

ANF Humanitarian Aid Volunteers Fund

GIVING TO THOSE MOST IN NEED Last year Amy Fraser fulfilled her dream of making a difference in a developing nation – Malawi in southeastern Africa. The Karratha nurse is one of many ANF members assisted by the ANF Humanitarian Aid Volunteers Fund to put their skills to work in regions of need. Here’s Amy’s story in her own words.

I’m Amy Fraser. I’m an Emergency Clinical Nurse at Nickol Bay Hospital. I’ve been an ANF member for about seven years – basically since I started nursing.

Ever since I was a teenager I’ve always wanted to give something back to those less fortunate than me. And I’ve always wanted to do something that helped people in a developing country.

So getting the opportunity to volunteer for four months last year in the Billy Riordan Memorial Clinic in Cape Maclear, Malawi, in this small fishing village on Lake Malawi, was a dream come true for me.

One of the reasons I chose to become a nurse was so that I would have skills that I could use to give to others. I didn’t want

Amy (on the right) with one of her patients alongside Engish doctor Charlotte Colley

Amy with one of her patients

to just give money to a charity, I wanted to go somewhere and use my skills and experience to make a difference.

The clinic – set up by Mags Riordan in 2004 after her son Billy drowned in Lake Malawi five years earlier – provides healthcare for the village and beyond with a population of approximately 16,000 people.

Prior to the development of the clinic, adults and children were dying of largely preventable diseases such as malaria, dysentery, asthma and HIV. Work in the clinic involved primary care, as well as caring for inpatients. The clinic has a small “Close Observation Room” for high-dependency patients, as well as a female and male ward (each consisting of one room with six and three beds respectively).

At times there are three patients per bed. Unlike the facilities at home the clinic had no ECG machine, defibrillator or ventilator and only one small suction unit.

Fortunately the clinic has a few oxygen cylinders and an oxygen concentrator. All the supplies and equipment are donated by volunteers.

With the help of generous friends and family, I raised funds which were used to purchase medical supplies such as spacers for bronchodilators, dressing supplies, thermometers, oxygen saturation machines, urine analysis sticks, a sphygmomanometer and medications.

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western nurse July–August 2018

“The whole experience was very humbling, eye–opening and rewarding”

The clinic is run by mostly volunteers, with the exception of a medical director, nurse manager and local Patient Care Assistants (PCAs).

The whole experience was very humbling, eye-opening and rewarding. Living in the village and getting to know the beautiful Malawian people was such a privilege.

The PCAs collect observations and are used as interpreters. My role included assessing patients (both adults and paediatric patients), formulating impressions and treating diseases with consultation with a medical officer as required.

I would love the opportunity to go back and volunteer there again. At the moment I am studying, but next year I would love to do some more volunteering. I’d really recommend the Billy Riordan Memorial Clinic for others who want to go volunteering.

One to two times a week one volunteer would do a 24-hour shift, where we were responsible for overseeing care of all inpatients, and being on call for emergencies.

This involved sleeping in the clinic and waking up to complete ward rounds, review unwell patients, as well as to manage emergency presentations. Fortunately the clinic always had a medical officer on call if I needed advice or assistance.

One thing I really want to say is that after having four months off work to do the volunteering, it was a lovely surprise to receive support from the ANF Humanitarian Aid Volunteers Fund. It’s great the fund is there for people who want to make a difference outside their normal work environment.

The ANF fund is open to members who have done or are about to undertake humanitarian volunteer work in Australia or overseas.  See page 21 for more information.

July–August 2018 western nurse |

5

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western nurse July–August 2018

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The folks at Vox explain the news. There’s a lot of information out there, lots of noise and not a huge amount of clarity. This US-based site steers the reader through global politics, business and pop culture, food, science, and everything in between. https://www.vox.com/

Saturday Night Live

The late-night comedy show is here for another year of laughs, surprises and great performances. The cast of recurring characters and take on pop culture targets remain spot-on.

Check out heaps of full episodes, and much more, here … https://www.nbc.com/saturday-night-live

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July–August 2018 western nurse |

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BREAKING NEWS

Bureaucrats finally say YES to abolishing appraisal meetings and also restore qualification allowances The Health Director General’s Office has now told senior executives there won’t be mandatory meetings in any new review process. This means the days of public sector nurses and midwives being bullied in appraisal meetings are gone. The ANF will now move to remove appraisal meetings in the private sector and aged care.

Despite the Health Minister’s promise to abolish annual appraisals 17 months ago, it’s only now that the bureaucrats are finally really moving to get rid of the appraisal meetings that have been a source of bullying for nurses and midwives.

This is because the Office of the WA Health Department Director General has now definitively stated in a written directive to senior health executives that any replacement for appraisals will exclude compulsory meetings.

This breakthrough came about after ANF State Secretary Mark Olson approached the Minister face-to-face recently, telling him that despite many months of the ANF trying to work with the Nursing and Midwifery Office and other senior Health Department bureaucrats to get rid of appraisals, the process was going nowhere.

Mark then had meetings and discussions with the Minister and the Office of the Health Department Director General.

“The result is a definitive directive from the Director General’s office that there will be no more (appraisal/review) meetings – which is the most positive movement I’ve seen on this matter in nearly one and a half years of negotiations,” Mark said.

“Pivotally, the Director General’s office has also stressed to those senior people that meetings are not part of hospital accreditation regulations – once and for all refuting the excuse some bureaucrats had been peddling to keep the meetings.”

Up till now, the ANF has been fighting not only stalling tactics from bureaucrats, but also individual hospitals creating various new reviews that are simply appraisals under a different name, in an effort to coerce members into attending meetings.

“The bureaucrats had been told by the Minister to solve this issue with us, and the ANF created a meeting-free declaration that could replace appraisals. We amended that declaration repeatedly to try to get to some common ground, but they just kept stalling,” Mark said.

“It’s been stressful for some of our members, but we let them know that if at any time they felt they were being bullied into a meeting that they should contact us and we’d deal with the bullies,” Mark said. “Our members were heartened that they could not be pushed around.”

“They’d pull tricks like not answer emails for weeks on end, or throw up objections that were untrue, such as that appraisal meetings were needed for hospital accreditation.

THE LIES AROUND ERODING STANDARDS AND PERFORMANCE MANAGEMENT

THE BUREAUCRATS’ TRICKS COME TO AN END

Mark said there have been “other nonsensical murmurings” such as that abolishing appraisals will somehow affect performance management and standards.

“In the end, after so many months of stalemate I had no choice but to take the matter directly back to the Health Minister who made the promise in the first place, and let him know what had been happening with his commitment.”

“Logically, shouldn’t performance management be occurring at the time a staff member does something wrong, and not wait until a once-a-year chitchat? And aren’t there already existing performance management processes?” he said.

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“After so many months of stalemate I had no choice but to take the matter directly back to the Health Minister who made the promise in the first place … the result is a definitive directive from the Director General’s office that there will be no more meetings”

Agenda Item 9.1 ATTACHMENT A

July–August 2018 western nurse |

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BREAKING NEWS

“Some members had been waiting many months for allowances that were due for qualifications that had been previously on the list”

“We are now examining other qualification allowances where there may be unfair treatment of our members”

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western nurse July–August 2018

“As for standards, our members’ professions are among the most heavily regulated, with random audits and professional development requirements from the Australian Health Practitioner Regulation Agency. Appraisal meetings that take our members away from their patients and waste public money are certainly doing nothing to enhance standards, but certainly do provide an opportunity for bullying.”

THE WAY FORWARD Mark said he is heartened that at last there is “a clear path to a meeting-free review process”.

“A working group is to be formed that includes the ANF, with a view to having a 12-month trial of a new Performance Review Process for Registered Nurses and Midwives, that in the words of the DG’s office: ‘will not require or mandate a meeting as part of the performance review process’ – words which are music to my ears after so many months of haggling,” Mark said.

“That doesn’t mean we aren’t going to be vigilant to ensure that meetings do not somehow find their way back into the process, but we are definitely on the right track now.

“And we can now start moving towards removing appraisal meetings from the private health care and aged care sectors. The discussions I’ve already had about this matter with private health providers are promising – I’ll be pursuing this while we continue working on the public sector process.”

QUALIFICATION ALLOWANCES RESTORED

qualifications will have to be back-paid for the time that the qualification has been relevant to their job.

Mark said he had been tipped off by some members in recent weeks that this situation was occurring and then a subsequent ANF email had flushed out numerous cases.

“Some members had been waiting many months for allowances that were due for qualifications that had been previously on the list,” he said.

“Others had shifted jobs and were being denied an allowance that they’d previously received.

“After I let the Minister know what had been occurring also on this front, the Director General’s office quickly restored previously approved qualifications that had been erased from the list.

“We are now examining other qualification allowances where there may be unfair treatment of our members.”

THE NEXT EBA AND RATIOS FOR ALL – INCLUDING AGED CARE Mark said the public sector wages and conditions agreement that expires in October is among other impending challenges.

He has already written to the Director General about setting up negotiations for a replacement agreement.

“Our recent survey, which had more than 8000 respondents, will guide us in the coming negotiations,” Mark said. “And after that agreement is finalised, we will start building on all the work we did during our campaign at the last State Election.

This had deprived significant numbers of nurses and midwives of qualification allowances they had every right to claim.

“Our State Election campaign won us the abolition of those bullying appraisal meetings. It also laid the foundation for getting clear ratios made part of the law. The next phase of our ratios campaign will extend to all areas of nursing and midwifery, and will be in the public sector, the private sector and aged care.

We’re already part of a federal aged care campaign and we will be building on this in the lead-up to the next Federal Election.

The ANF recently got the list restored and members who have been deprived of allowances pertaining to previously approved

“We have a lot more work to do on the ratios, but make no mistake we are going to get them made law.” 

Meanwhile, at the same time the ANF had been fighting to remove appraisal meetings, the Nursing and Midwifery Office had “been busy” removing the majority of previously approved midwifery qualifications from the official list.

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July–August 2018 western nurse |

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PLASTIC BAG BAN NOT A WORRY YOUR ANF HAS ALL THESE FOR YOU COMING SOON TO YOUR HOSPITAL!

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western nurse July–August 2018

update: Bladder Scan – A screening tool Read this article and complete the online quiz to earn 0.5 iFolio hour

A bladder scan is a portable ultrasound.

It is a non-invasive screening tool used to measure the volume of urine in the bladder.1,2 It is indicated for individuals with low urine output and those at risk of post-void residual urine, and replaces the much more risky, time consuming and costly procedure of intermittent catheterisation to determine urine volume.1,2 Benefits of bladder scanning include a reduction in unnecessary catheterisations, improved patient outcomes such as reduced trauma, decreased hospital length of stay and decreases the risk of hospital acquired urinary tract infections.2 Low urine output. A bladder scan is used to distinguish between low urine production and urinary retention. Those with a low volume of urine in the bladder are more likely to have a problem with urine production, while those with a high volume of urine in the bladder may have retention.1 Urinary retention is an inability to empty the bladder, even when it is full.3 It is a common post-operative complication, which causes discomfort, atony of the bladder wall, and damage to the bladder. Bladder scanning allows practitioners to monitor urinary volume and reduce the risk of urinary tract infection by limiting catheterisation to patients who require it most.3 Screening for post-void residual volumes.

Post-void residual (PVR) urine occurs when there is urine left in the bladder following urination. It is associated with an increased risk of infection, hydronephrosis and renal insufficiency.1 A normal PVR is less than 50100mL, depending on age. Greater volumes may indicate dysfunction.1 Pre- and post- void bladder scans are used to measure the volume of residual urine and determine if intervention is necessary to prevent complications.

PORTABLE BLADDER SCANNERS Portable bladder scanners are simple and cost-effective devices that are commonly used in hospitals and community settings.1,2 They generally contain an integrated digital

ultrasound transducer, a screen for displaying urine volumes and a printer for documenting results.1 As the device is indicated for multipatient use, appropriate cleaning is required between patients.1

COMPETENCE Bladder scanning should only be performed by a suitably competent practitioner. Check local policies to determine requirements.

GUIDELINES FOR PERFORMING A BLADDER SCAN Step 1. Check patient identification, obtain consent and explain the procedure.

Step 2. If the scan is to screen for PVR urine, ask the individual to void into a collection device in order to measure the volume. Note: this step is not required when the scan is indicated for low urine output.

Step 3. Lie the patient flat and expose the lower abdomen to the level of the symphysis pubis.

Step 4. Turn the machine on. Select the female or male setting. Note: the male setting should be used for females who have had a hysterectomy.

Step 5. Apply ultrasound transmission gel to the head of the bladder scan transducer or on the abdomen of the individual.

PITFALLS Falsely elevated bladder scan results may occur in patients with pelvic or abdominal pathologies.4 Ovarian cysts, adenomyosis, myomas, hydrosalpinges, benign cystadenomas, intestinal malignancies and abdominal ascites have all been associated with elevated bladder scan readings.4 In some cases, these findings have resulted in insertion or re-insertion of an indwelling urinary catheter.

In order to prevent this, bladder scan results should always be considered alongside total urine output. Discrepancies between the two findings suggest a need for further medical imaging to explain the results.4

REFERENCES

Step 6. Place the transducer on the central abdomen, 2.5cm above the symphysis pubis.

Angle the head down and apply gentle pressure. Newer scanning devices will show where the volume is on the screen. Align the greatest volume with the centre of the screen to achieve the most accurate results.

1. Forbes H, Watt E, editors. Jarvis’s physical examination & health assessment. Australian and New Zealand Edition. Chatswood, NSW: Elsevier Australia; 2012. 914p.

Step 7. Record the urine volume identified on the scan and print if required. Be sure to label the document appropriately with patient identification, date, time and volume voided. Use tissues to wipe the abdomen and clean the transducer head in preparation for the next use.

3. Widdall DA. Considerations for determining a bladder scan protocol. Journal of the Australasian Rehabilitation Nurses Association. 2015 Nov; 18(3):22-7.

2. Palese A, Buchini S, Dermoa L, Barbone F. The effectiveness of the ultrasound bladder scanner in reducing urinary tract infections: a metaanalysis. J Clin Nurs. 2010 Nov:19(21-22);2970-79.

4. Bhatia D, Winter M, Dias M, Chalasani V. Bladder scanner pitfalls: beware ovarian cysts. Br J Hosp Med. 2014 Apr;75(4):232-4.

July–August 2018 western nurse |

13

Mark’s

As mentioned in my editorial this edition, we recently thwarted efforts by the Nursing and Midwifery Office to deprive hundreds of midwives of their qualification allowances Though the ANF succeeded in getting previously approved qualifications back on the list hospitals use when deciding whether or not you get an allowance, the issue raised various questions from members.

So I thought it would be timely to go over how the system works to help ensure our members get paid any allowances to which you’re entitled.

Q. What is a qualification allowance?

A. It is an allowance paid to nurses and midwives who hold or acquire an additional qualification that is relevant to their current practice, position or role.

Q. Is this only paid in the public sector?

A. No. Most private hospital agreements contain clauses on qualification allowances, as do some aged care agreements.

Q. What are the criteria for receiving a qualification allowance?

A. It must be an approved qualification and it needs to be relevant to the employee’s current practice, position or role. However, the level of qualifications differ and each has their own criteria including duration of study and the recognised place of study. For example, a postgraduate qualification awarded by a university taken over at least two semesters is a level 2 qualification allowance.

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Q. Is there a list of approved qualifications?

A. Yes, that’s the one the ANF got restored after the NMO stripped it. It is a list for the public sector and can be found at: http:// ww2.health.wa.gov.au/articles/N_R/qualifications-allowance Q. How do I apply for a qualification allowance?

A. Submitting a letter or the relevant form at your workplace to your direct line manager is usually the best approach – and attach the relevant certificate.

Q. What if my application is not successful?

A. Contact the ANF Helpline so we can assist as most agreements contain clauses regarding review. For example, in the public sector you can submit an application for review of the decision to an Independent Review Panel. In the private sector it would usually involve using the dispute settlement procedure which we can assist with.

Q. If my application is approved, to when are payments backdated?

A. Payment should be backdated to the date from when the qualification became relevant to your employment.

Q. I have been waiting a long time for approval, what should I do?

A. Please contact the ANF Helpline so that an ANF Industrial Officer can assist you, firstly in getting the allowance paid, but also to ensure you receive back pay.

Q. I am an enrolled nurse, am I entitled to any qualification allowance?

A. That’s not happening yet in the public sector, though we have pursued and will continue to pursue this issue with the Health Department each time the agreement is negotiated. However, some allowances are paid to ENs in the private sector, for example at Ramsay hospitals.

The information provided in this column is general advice only. If you want information specific to your circumstances you should contact the ANF Helpline or send us your questions by email.

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July–August 2018 western nurse |

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update: Best practices in ethical treatment during palliative care Figure 1: The types of issues affecting patient end-of life1 Read this article and complete the online quiz to earn 1 iFolio hour

Physical Issues

Palliative care practitioners help dying and terminally ill patients to approach the end of life in a way acceptable to the individual. Their work focuses on how care interventions can improve quality of life, rather than cure disease.1 Palliative care providers are often asked to respect personal dignity, autonomy, and familial agency as much as, or more than the individual aspects of physical care.1 This can sometimes create instances of moral ambiguity. Therefore, it is important that practitioners place ethics at the centre of their care in this practice. The philosophy of palliative care is grounded in neither hastening nor postponing death.1 As a result, the moral centre of its practitioners is sometimes slightly different from that of other healthcare professionals.

Because palliative care is central to our collective healthcare experience, especially as it pertains to cancer treatment and end‑of‑life chronic care, society ought to consider how the moral guidelines that govern its caregivers are constructed.2 The following principles may be used to help guide practitioners to provide ethical care to the dying.

HOW DOES PALLIATIVE CARE WORK? Palliative care is more than just a practice. It is also a philosophy; an approach for how to provide optimal care to patients with life‑ limiting illness in a way that will address their holistic needs.1 Many physical, psychological, social, spiritual, and practical challenges face the dying and their families (see Figure 1).1 One important aspect of care is how to address the expectations, needs, hopes, and fears that are associated with the end of life as they affect each individual patient. Healthcare professionals must attempt to prepare for, and manage the dying process, and help those affected to cope with loss and grief during illness and bereavement.3 Ultimately, the goal is to improve quality of life for patients and their families.4 In almost every health sector it is part of the caregiver’s role to cultivate a therapeutic relationship with individuals and their families.

Through ongoing assessment, intervention, and evaluation of treatment, a continuity of

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Practical Issues

Patient End-of-life

Spiritual Issues

care can be established that is responsive to the needs of those with a life‑limiting illness.1 As a result, nurses have a unique opportunity to make a significant contribution to the life of an individual nearing death and to his or her family before, during, and after they die.1

THE USE OF ETHICS IN PALLIATIVE PRACTICE All practitioners in palliative care assist patients towards what is termed a “good death”. This has been defined as “an end to life that can be characterised by the absence of distress, a general accordance with the wishes of the patient and their family, and a consistency with the healthcare standards that apply to the patient’s scenario”.5 Palliative care practitioners are responsible for avoiding distress‑causing influences of any kind to their patients, and work to reduce the suffering of patient, family, and caregivers as much as possible. Where possible, they ensure that the patient’s death is in general accordance with their stated wishes and reasonably consistent with the clinical, cultural, and ethical standards with which they are faced.1

Psychological Issues

Social Issues

USING ETHICAL PRINCIPLES TO ACHIEVE A GOOD DEATH Achieving a good death for any patient can be incredibly difficult, because there are so many different perspectives, priorities, and personalities that contribute to care at the end of the life.

When palliative care causes conflict, one best practice is to partner the work with an ethical moral code. This is the role that is played by the philosophy of ethics in palliative care.1, 6 The four ethical principles that guide end‑ of‑life care are beneficence, least harm, respect for autonomy, and justice (see Table 1). 1, 6 Beneficence is the practitioner’s ethical mandate to do good, and least harm is the practitioner’s mandate to do the least harm possible, and to harm the fewest people possible overall. At the end of life, the palliative care practitioner’s ethical principle of respect for autonomy is their mandate to allow people to make their own decisions, where those decisions apply to their own lives. Finally, the principle of justice is their ethical mandate to attempt to be fair. 1, 6

Table 1: Ethical principles for healthcare practitioners1,6

Palliative Care Practitioners

Definition

Beneficence

To do good

Least harm

To do the least harm possible, and to do harm to the fewest people

Respect for autonomy

To allow people to make decisions that apply to their own lives

Justice

To be fair

Following these ethical principles does not remove palliative care practitioners from all conflict or difficulty. Moral dilemmas may arise, and when they do the confusion and conflict that surrounds this sort of care planning has the potential to stifle or impede communication. It can easily create a significant challenge for the healthcare provider. Difficult decisions about whether or not to tell the truth, fully disclose the facts of a situation, or employ the use of medication can arise (see Box 1).2 Box 1: Ethical dilemmas in palliative care2

Areas of ethical difficulty

Conflict can generally be avoided through the use of effective communication, focusing on offering clear and detailed explanations, and giving full respect to the rights of the individual.2 They are often resolved when work is done to ensure and respect that patients have the fundamental ability to understand their prognosis, as well as the options they face for treatment and all of the possible outcomes they may face.2 For palliative care to succeed, it needs to be focused on a commitment to preventing and relieving suffering by restoring and engaging the moral agency of patients and their family members.7

Truth Disclosure Use of medication Decision making Nutrition Treatment practices

CONCLUSION The nature of palliative care causes it to be surrounded by conversations about ethics and morality. Its nature as a beneficial activity for society allows us to consider it through the lens of morality, and its practice frequently brings up moral quandaries.7 For the practitioner, this can add to the importance of holding

onto a unified moral paradigm demonstrated through open communication and respect for the autonomy of the individual and their family.2

REFERENCES 1. Registered Nurses’ Association of Ontario.

(2011). End‑of‑life Care During the Last Days and Hours. Toronto, ON: Registered Nurses’ Association of Ontario.

2. Chater, Kerri & Tsai, Chun‑Ting. (2007). Palliative care in a multicultural society: a challenge for western ethics. Australian Journal of Advanced Nursing, 26 (2).

3. Ferris FD, Balfour HM, Bowen K, Farley J, Hardwick M, Lamontagne C, Lundy M, Syme A, West P. A Model to Guide Hospice Palliative Care. Ottawa, ON: Canadian Hospice Palliative Care Association, 2002.

4. Wiener, L., Weaver, M. S., Bell, C. J., & Sansom‑ Daly, U. M. (2015). Threading the cloak: palliative care education for care providers of adolescents and young adults with cancer. Clinical Oncology in Adolescents and Young Adults, 5, 1–18. http://doi.org/10.2147/COAYA.S49176 5. Leung et al. (2010) Can a good death and quality of life be achieved for patients with terminal cancer in a palliative care unit? Journal of Palliative Medicine, 13(12):1433‑8. doi: 10.1089/jpm.2010.0240 6. Summers, Jim. (2014). Principles of Healthcare Ethics. Health Care Ethics: Critical Issues for the 21st Century.

7. Ferrell et al. (2016). Textbook of Palliative Care Communication. Oxford University Press.

July–August 2018 western nurse |

17

ANF Out ‘N’ About

Armadale Hospital ANF bells with Janet Vince, Adelene Choo, Jane West, Rachel Tyrer, Debra Jeavons, Jessica McDonnell and in bed Lee Hamwood.

Our tally of contenders continues to grow for the western nurse Out ‘N' About photo competition which will have a grand prize draw at the end of the year.

You’ll notice in one of the photos this edition, a group of members who work at Armadale Hospital with some of our famous ANF bells.

The story behind that picture: Senior staff at Armadale Hospital asked if the hospital could have 50 of our bells for use when the nurse call system fails.

We were told that previously when the system has gone down they've had to go out to Fremantle Hospital to borrow some ANF bells from them.

So we turned up with a pile of bells and our members immediately tested them with a dress rehearsal – complete with a “patient” in bed.

This edition we’ve also got photos from the now-closed Princess Margaret Hospital and from the Fiona Stanley and Sir Charles Gairdner hospitals.

We’re looking forward to seeing you in coming months – come up and get some ANF goodies!

ANF members receive 10% DISCOUNT on any online or instore purchase. Please enter or mention the code: ANF10.

Excludes sales items.

Perth’s largest range of designer chairs, stools & tables. View our full range at www.sittingprettyfurniture. com.au or visit our showroom warehouse at 7 Keegan Street, O’Connor. Ph: 6162 9356.

Fiona Stanley Hospital Sevan Smith, Linda Giwa, Martin Paloma, Jake Von Knoll, Ellie Smart, Olyvia McLaughlin, Blossom Innocent, Adut Ajak and Reena Kulathunkal Thomas.

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western nurse July–August 2018

Princess Margaret Hospital Cassandra Hansen.

Sir Charles Gairdner Hospital Huaping Wang, Bev De Souza, Olive Siva and Viki Link.

Exclusive ANF deal 10% discount off the Original and Best Wine Tours in Margaret River

For bookings and enquiries call Adam on 0419917166 or visit margaretrivertours.com

Please enter or mention the code: ANF10

Seeking Trainer/ Assessor - Diploma of Nursing The Institute of Health & Nursing Australia is a nationally Registered Training Organisation (RTO). We are currently seeking Full-time and Parttime Trainer and Assessors (Nurse Educators) to join our Academic Team to deliver the Diploma of Nursing program in our Perth Campus.

Minimum skills and experience required · Bachelor or Master Degree in Nursing · Certificate IV in Training and Assessment - TAE40110 or TAE40116 · Minimum one year's experience in a clinical setting, as RN Div 1 Additional skills and experience advantageous for this role · Current experience in teaching nursing or other related health courses · In-depth understanding of ASQA/ANMAC regulatory guidelines and standards

ANF members receive 20% OFF everything, plus buy one pair of prescription glasses and get a free pair of prescription sunglasses*.

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Candidates should submit expressions of interest to atif@healthcareers.edu.au

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July–August 2018 western nurse |

19

Norovirus

Read this article and complete the online quiz to earn 0.5 iFolio hour

Noroviruses are a group of RNA (ribonucleic acid)Â viruses that infect the human intestine.1,2 They are a leading cause of acute gastroenteritis, childhood and travel-associated diarrhoea, and are associated with more than 200,000 deaths annually worldwide.1 Despite the significant public health burden caused by norovirus, significant gaps persist in our knowledge of the virus, as well as our ability to prevent and treat infections. Greater research on epidemiological data, diagnostic testing, genetic susceptibility, natural immunity to infection, and vaccination strategies is required to reduce the burden of infection in the future.1

NOROVIRUSES Noroviruses are non-enveloped, singled stranded RNA viruses that belong to the Caliciviridae family. They are separated into genogroups, based on the composition of their major structural protein, and further divided into genotypes (see Table 1).3 Each genogroup contains up to 21 genotypes of the virus.3 Evidence suggests genogroup II, type 4 is responsible for the majority of human gastroenteritis outbreaks.3

TRANSMISSION Norovirus is extremely contagious.1-4 It is spread by individuals with or without symptoms, via direct or indirect contact. Direct contact may occur via person-to-person or faecal-oral transmission, or following exposure to aerosolised vomitus. Indirect transmission occurs via contaminated food, water, or environmental surfaces.4 Viral shedding (the process of replication and release of viral particles) begins within eight

hours of infection and may continue for up to 30 days.4 It is estimated that as few as 18 particles are required to cause infection, which equates to 5 billion infectious doses per gram of faecal matter.3 Each infected individual has the potential to infect hundreds, and potentially thousands, of others.4

CLINICAL FEATURES Symptoms of norovirus include diarrhoea, nausea, vomiting, and abdominal cramps.3,4 Onset of symptoms typically occurs abruptly after a 12 to 24 hour incubation period.3 Although cases tend to be quite severe, the majority resolve spontaneously in one to three days. Prolonged cases, up to six days may also occur.3 Individuals at risk of norovirus associated mortality include elderly people exposed to healthcare-associated viral outbreaks, immunocompromised and transplant patients, and children in low-income settings.1

DIAGNOSIS Norovirus is diagnosed by polymerase chain reaction (PCR) or enzyme immunoassay (EIA) testing on a stool or vomitus sample.4 These diagnostics are the gold standard. They can detect small amounts of viral particles in individuals who are asymptomatic or who have recovered from acute symptoms.4 Enzyme immunoassay are less sensitive and generally reserved for testing in outbreak situations where a high volume of samples can be acquired.4 The usefulness of individual testing is limited by the fact that only approximately 10% of individuals with norovirus gastroenteritis seek medical attention, and that the majority of cases

Table 1. Norovirus classification.3 Classification

Description

Family

Caliciviridae

This family is inclusive of many genera that cause acute gastroenteritis in humans

Genus

Norovirus

Norovirus has been previously known as Norwalk-like viruses or small round-structured viruses

Genogroups

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GI, GII, GIII, Genogroups GI, GII, GIV cause acute gastroenteritis in humans.

GIV, GV Other genogroups may infect cows, mice, pigs and dogs.

western nurse July–August 2018

self-resolve.4 It is more useful in a suspected outbreak, where laboratory-confirmed diagnoses from at least two ill individuals is required to confirm the cause of infection.3

PREVENTION Prevention is essential to reduce the spread of norovirus. Key interventions include effective hand hygiene, exclusion and isolation of infected individuals, and environmental Unfortunately, resistance disinfection.3 has been documented to some cleaning products. Sodium hypochlorite (chlorine bleach) is recommended for surfaces at risk of contamination, such as bathrooms, doorknobs, and hand rails.3 A vaccine against norovirus is under development. In order to be effective, it must protect against diverse strains of the virus.4 Oral and nasal vaccines have been demonstrated to induce immunity and prevent infection.

Future research is required to determine the optimal dose and route of vaccination, support widespread testing in at-risk populations, and ensure multivalent protection against all noroviruses.4

REFERENCES 1. Lopman BA, Steele D, Kirkwood CD, Parashar UD. The vast and varied global burden of norovirus: prospects for prevention and control. PLoS Med. 13(4): e1001999. doi:10.1371/journal.pmed.

April 2016.

2. Karst SM, Tibbetts SA. The vast and varied global burden of norovirus: prospects for prevention and control. J Med Virol. 2016 May 5;88:1837-43.

3. Hall AJ, Vinje J, Lopman B, Park GW, Yen C, Gregoricus N, Parashar U. Updated norovirus outbreak management and disease prevention guidelines [Internet]. Atlanta: Centre for Disease Control and Prevention; 2011 Mar 4 [cited 2016 Dec]. Available from: https://www.cdc.gov/ mmwr/preview/mmwrhtml/rr6003a1.htm.

4. Pringle K, Lopman B, Vega E, Vinje J, Parashar UD, et al. Noroviruses: epidemiology, immunity and prospects for prevention. Future Microbiology.

2015 Jan;10(1):53-67.

Are you an ANF member who does humanitarian volunteer work?

VOLUNTEER FUNDING

ANFIUWP Humanitarian Aid Volunteers Fund provides financial help to ANF members who are undertaking humanitarian volunteer work in Australia or overseas. The closing date for applications is the 15th December 2018.

The fund may be used for planned or completed volunteer work.

For more information about the fund or to get a copy of the application form and selection guidelines, call the ANF office on 6218 9444, email anf@anfiuwp.org.au or log on to iFolio.

July–August 2018 western nurse |

21

AcrosstheNation NEWS, VIEWS AND GOSSIP FROM ALL OVER AUSTRALIA

NSW CANNABIS CAN BE INEFFECTIVE PAINKILLER Cannabis has “no clear role” in treating pain among sufferers of chronic non-cancer conditions – and can actually lead to more pain and anxiety.

NSW researchers concluded this after conducting one of the world’s longest community studies of its type – the four-year Pain and Opioids IN Treatment (POINT) analysis of pharmaceutical opioids and chronic non-cancer pain.

Participants using cannabis reported “experiencing greater pain and anxiety, were coping less well with their pain”, and also said “pain was interfering more in their life, compared to those not using cannabis”.

And there was “no clear evidence that cannabis led to reduced pain severity or pain interference or led participants to reduce their opioid use or dose”, said the researchers from the

NSW ORANGE A DAY KEEPS MACULAR DEGENERATION AT BAY People who eat at least one serving of oranges daily are much less likely to develop macular degeneration than others who never consume them, according to new research.

Flavonoids found in oranges seem to help protect against the incurable condition, according to a study which saw more than 2,000 Australian adults aged 50-plus interviewed and also monitored over a 15-year period.

The risk of developing late macular degeneration 15 years later is reduced by more than 60 per cent if you chow down one or more portions of the juicy citrus every day, the study showed.

“Even eating an orange once a week seems to offer significant benefits,” said University of Sydney

QLD STOP SMOKOS SAYS CANCER COUNCIL Cancer Council Queensland wants smoke-free workplaces.

The call to ban work smokos followed the release in July of a new study from Monash University assessing years of life lost and workplace productivity lost from the habit.

A total of $388 billion was the estimated cost of lost productivity because of smoking over the period of the current Australian population’s working lives, according to the council, referencing the study.

Smoking was still the top cause of preventable death and disease in Australia, said the council’s chief executive officer Chris McMillan.

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western nurse July–August 2018

National Drug and Alcohol Research Centre at the University of New South Wales Sydney.

“Chronic non-cancer pain is a complex problem. For most people, there is unlikely to be a single effective treatment,” said the study’s lead author, Dr Gabrielle Campbell.

“In our study of people living with chronic non-cancer pain who were prescribed pharmaceutical opioids, despite reporting perceived benefits from cannabis use, we found no strong evidence that cannabis use reduced participants’ pain or opioid use over time.”

The researchers said the results, published in the journal Lancet Public Health, suggest “a need for caution because a clear role for cannabis in treating chronic non-cancer pain was not found”. 

Associate Professor Bamini Gopinath, the lead researcher of the study recently published in the American Journal of Clinical Nutrition.

She said the study – undertaken by Sydney’s Westmead Institute for Medical Research – differed from previous work, by focusing on flavonoids and macular degeneration, rather than the effects of common nutrients such as vitamins C, E and A. “Flavonoids are powerful antioxidants found in almost all fruits and vegetables, and they have important anti-inflammatory benefits for the immune system,” said Associate Professor Gopinath.

“We examined common foods that contain flavonoids such as tea, apples, red wine and oranges.

“Significantly, the data did not show a relationship between other food sources protecting the eyes against the disease.” 

“Today, we’re calling on workplaces to consider going smoke-free and provide their staff with support to quit to help reduce the burden of tobacco and associated diseases, including cancer,” Ms McMillan said.

“Having a smoke-free workplace not only improves the health of those that smoke, but this will increase productivity and protect employees from being exposed to second-hand smoke.

“A smoke-free workplace also provides a supportive environment for people that smoke to reduce their habit, or quit altogether.

“In Queensland alone around 3700 people die from a tobacco-related disease each year from smoking or second-hand smoke.” 

WA “TAKE-HOME” METH CURE

including cocaine, cannabis and tobacco, by targeting glutamate changes in the brain responsible for drug craving and addiction.

A new medication intended to help people beat crystal methamphetamine addiction is being trialled in a study led by WA researchers.

“When someone first takes ice they experience the desirable effects of intoxication,” Associate Professor McKetin said. “But if they continue to use, and become dependent, changes occur in the brain that cause cravings, making it hard to stop using ice.

Amino acid derivative N-Acetyl Cysteine (NAC) is hoped to stop people craving and using meth – also known as ice.

Led by the National Drug Research Institute (NDRI) at Curtin University and in collaboration with other Australian universities and Melbourne’s Burnet Institute, the N-ICE Trial is underway at “frontline” clinics in Wollongong, Geelong and Melbourne. Participants take two capsules, morning and night for 12 weeks.

Lead researcher and NDRI Associate Professor Rebecca McKetin said studies showed NAC can reduce cravings for meth and other substances

WA WORLD-FIRST EARLY MELANOMA BLOOD TEST A lifesaving blood test capable of identifying melanoma in its early stages has been developed by Perth researchers.

The world-first test detects autoantibodies produced in response to melanomas.

It uncovered early stage melanoma in 79 per cent of cases investigated during a trial that involved 105 people with the disease and 104 healthy controls.

Lead researcher and Edith Cowan University PhD candidate Pauline Zaenker said identifying melanoma early was the best way to preventing deaths.

“NAC helps to reduce cravings by restoring the balance of chemicals in the brain that are involved in craving and drug seeking, making it easier for people to manage their desire for the drug.”

Burnet Institute’s Dr Brendan Quinn said the researchers hope “this take-home medication” can help people who aren’t accessing conventional treatment options.

It is expected recruitment of participants will continue until the end of 2019. 

disease that in Australia has 14,000 new diagnoses and nearly 2000 deaths each year.

“Whereas if it is not caught early and it spreads around the body, the five-year survival rate drops to less than 50 per cent."

Ms Zaenker, from ECU’s Melanoma Research Group (MRG), said the new blood test could provide doctors with a powerful new tool to detect melanoma before it spreads throughout the body – additional to visual scans and biopsies.

MRG head Professor Mel Ziman said a follow-up clinical trial to validate the findings was being organised which should take about three years.

“Patients who have their melanoma detected in its early stage have a five year survival rate between 90 and 99 per cent,” she said of the

If successful this would hopefully result in a test ready for use soon after. 

WA ALL WA FAST FOOD KILOJOULE LABELLED UNDER GOVT PLAN

Mr Cook’s announcement said the proposal came out of the State Government's Preventive Health Summit, held in March, and that “mandatory kilojoule labelling is in place in NSW, the ACT, SA, Queensland and Victoria”.

You’ll soon know exactly how unhealthy your fast food fix is – if a proposal by the WA Government is enacted.

WA’s Health Department is investigating “the feasibility of including kilojoule labelling on menus to help consumers make better, informed choices about the foods they buy”, according to an announcement in July by State Health Minister Roger Cook.

The Minister’s announcement conceded some WA food outlets within national franchises already provide some “point of sale kilojoule labelling”.

His move for a “sugar tax” on sugary drinks has so far been rejected by the Federal Government.

"Fast foods are a major contributor to obesity,” Mr Cook said. “Given that two thirds of Western Australian adults are overweight or obese, we need to help people make healthier choices. There is strong public support for nutrition labelling in WA, and there is evidence that it encourages people to make healthier choices.” 

July–August 2018 western nurse |

23

Assessment for Trachoma

Read this article and complete the online quiz to earn 1 iFolio hour

Trachoma is an infectious disease of the eye caused by certain strains of the bacteria Chlamydia trachomatis.1-4 It is the leading cause of preventable infectious blindness in the world.1,4 Australia is the only developed country that has endemic rates (5% or more) of active trachoma.1-5 The focus of this clinical update is the identification and assessment of trachoma.

TRACHOMA Phases of Trachoma Trachoma has two key phases – active and late.1,2 Active trachoma is the infectious stage involving inflammation of the conjunctiva.1 It is usually found in young or school-aged children, with the highest pool of infection in children under five years of age.1-4 While the immune system can clear a single episode of active trachoma, frequent reinfection leads to chronic inflammation.4,6 In late trachoma, persistent or recurrent infection results in scarring and contraction of the upper eyelid, inturning of the eye margin and eyelashes, and scarring of the cornea.1-3 This eventually causes irreversible blindness.2,3,8 Chronic effects are usually seen in adults from around 40 years of age.1

PUBLIC HEALTH ISSUES Trachoma was eliminated from most of Australia in the 1930s. However, it is still prevalent in many rural and remote regions. Endemic trachoma continues to represent a significant public health problem in very remote Aboriginal and Torres Strait Islander communities.1-3,5,8 Community factors associated with trachoma include low socioeconomic status, crowded

Table 2. WHO SAFE strategy.1,2,5 S

Surgery

for trichiasis

A

Antibiotics

azithromycin for active trachoma and to reduce the community reservoir of infection

F

Facial cleanliness

promote clean faces to reduce spread of infection

E

Environmental health

improve community hygiene hardware and reduce overcrowding

housing, poor hygiene, reduced access to water, poor sanitation and waste disposal, and high numbers of flies.1,3-5

TRANSMISSION Trachoma only affects humans. It is generally spread through the exchange of nose and eye secretions between young children.1,4 Transfer can occur by direct contact, through fomites (e.g. shared towels, face-washers, or bedding), or via eye-seeking flies.1,4 Basic hygiene measures including routine face washing, nose blowing, and hand hygiene will reduce the spread of infection.1,2 The risk of infection increases progressively when sharing a house, sharing a bedroom, and sharing a bed with someone who has active trachoma.3,4

PREVENTION AND CONTROL In Australia, prevention and control of trachoma is based on the World Health Organization (WHO) SAFE strategy.1,4,5 This strategy combines biomedical, behaviourmodification, and social determinant based approaches (see Table 2).

ASSESSMENT Active trachoma may present with common symptoms like red or discharging eyes, or a runny nose.1,6 However, it is often asymptomatic (subclinical).1,6 For this reason, community-wide screening is recommended

Table 1: WHO trachoma grades by phase1,7 Tachoma phase

WHO trachoma grade

Active phase

TF

Trachomatous inflammation - Follicular

TI

Trachomatous inflammation - Intense

TS

Trachomatous conjunctival Scarring

TT

Trachomatous Trichiasis

CO

Corneal Opacity

Late phase

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western nurse July–August 2018

for all children aged five to nine years in communities where trachoma is common.

Treatment is required for the infected child and their contacts.1,3 A contact is anyone who is living and/or sleeping in the same household as a person with trachoma.1 Screening for trichiasis is also recommended for adults who were raised in a trachoma endemic area. It should be performed every two years between age 40 and 54 years and annually after age 55.3 Diagnosis is based on clinical findings guided by the criteria set out in the WHO simplified grading system (see table 3).3-5 Laboratory tests are not recommended as the results do not correlate well with clinical signs.1-3 * Take care not to confuse follicles with small scars, or degenerative deposits in the conjunctiva. Scars have angular borders with sharp corners, while follicles have rounded edges. Degenerative deposits include conjunctival concretions that are yellowish masses with clear cut edges, and cysts that appear as clear bubbles.8 ** Changes are due to diffuse inflammatory infiltration, oedema, or enlargement of vascular tufts (papillae). Do not confuse inflammatory thickening with thickening caused by scarring.8

PERFORMING AN ASSESSMENT Principles of assessment: • Each eye must be examined and assessed separately, • Use x2.5 magnification (e.g. binocular loupes) and good lighting (daylight or a torch), and • Signs must be clearly seen to be considered present.1,4,8 To examine an adult or older child, sit or stand opposite them so your heads are at about the same level.8 Sit with the chairs close enough

Table 3: WHO simplified grading system for trachoma1,4,7 GRADE Normal conjunctiva

SIGNS Pink, smooth, thin and transparent. Deep lying blood vessels run vertically over the tarsal conjunctiva.

• Dotted lines show the area to be assessed.

Trachomatous inflammationFollicular (TF)

Five or more follicles more than 0.5mm in diameter on the tarsal conjunctiva.

• Follicles are round swellings that are paler than the surrounding conjunctiva.

They may appear grey, white or yellow.*

Trachomatous inflammation – Intense (TI)

Pronounced inflammatory thickening of the tarsal conjunctiva obscuring more than half of the deep blood vessels.

• Tarsal conjunctiva appears red, rough and thickened.** • Follicles are usually present but may be partially or totally covered by the thickened conjunctiva.

Trachomatous conjunctival Scarring (TS)

Trachomatous Trichiasis (TT)

Corneal Opacity (CO)

Easily visible scarring of tarsal conjunctiva.

• Scars appear as glistening, fibrous white lines, bands, or sheets.

• Scarring, especially diffuse fibrosis, may obscure the deep blood vessels.

At least one inturned eyelash or evidence of recently removed eyelashes.

• Eyelashes rubbing on the eyeball cause scratching and scarring.

Easily visible corneal opacity blurring part of the pupil margin.

• Causes significant visual impairment (less than 6/18 or 0.3 vision).

• Leads to irreversible blindness.

together so the person’s knees almost touch your chair, and your knees straddle theirs.8 For younger children you will need help to hold the child still. Sit young children on a helper’s lap facing the examiner. Have the helper hold the child’s arms and body with one hand and fix their head with the other. Infants may be positioned on their back with their head towards the examiner.8 Perform hand hygiene. Examine each eye separately, starting with the right eye. Push the upper eyelid upwards slightly to expose

the lid margins and look carefully for inturned eyelashes or previously removed eyelashes (TT).4,8 Then carefully examine the cornea for opacity (CO).7,8 If either of these signs are present, test the patient’s visual acuity at the end of the examination.8 Now evert (turn over) the eyelid to examine the tarsal conjunctiva (covering the firm part of the upper eyelid) for follicles, intense inflammation and scarring (see Table 3).4,8 If eversion is not possible in a badly scarred eye, record this.8

How to evert the eyelid9

Ask the patient to look down and try not to blink. Holding the eyelashes between your thumb and first finger gently pull the upper eyelid forward to break the suction with the eyeball. With the other hand, hold an applicator stick or cotton bud across the eyelid above the fold. Push down slightly on the stick while pulling the eyelid out, up and back over the stick.

When the eyelid has been everted take the stick away and hold the lashes against the eyebrow. When finished, ask the person to blink their eyelid back to normal, or gently fold the eyelid back down.

REFERENCES 1. Communicable disease network Australia.

Trachoma: CDNA national guidelines for the public health management of trachoma. CDNA, 2014.

2. Warren JM, Birrell AL. Trachoma in remote Indigenous Australia: a review and public health perspective. Australian and New Zealand Journal of Public Health. 2016; 40(S1): S48-S52.

3. NACCHO/RACGP. National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 2nd edition. South Melbourne: RACGP; 2012.

4. World Health Organization. Trachoma. Fact sheet [internet]. Geneva: WHO; 2016 July [cited 2016 Nov]. Available from: http://www.who.int/ mediacentre/factsheets/fs382/en Australian Trachoma Surveillance 5. 2015 Preliminary report. Sydney: The Kirby Institute, University of New South Wales, 2016.

6. Taylor H, Stanford E, Lange F. Why is trachoma blinding Aboriginal children when mainstream Australia eliminated it 100 years ago? [internet].

Melbourne: The Conversation; 2016 Sep 14 [cited 2016 Nov]. Available from: http:// t h e c o nve r s a t i o n . c o m / w hy - i s - t r a c h o m a blinding-aboriginal-children-when-mainstreamaustralia-eliminated-it-100-years-ago-63526 7. Thylefors B. eds. Trachoma grading card. Geneva: World Health Organization; 1987. Available from: http://www.who.int/neglected_diseases/ resources/SAFE_documents/en/ 8. World Health Organization, London School of Hygiene & Tropical Medicine, International Trachoma Initiative. Trachoma control: a guide for programme managers. Geneva: WHO; 2006.

9. CRANAplus. Clinical Procedures Manual for rural and remote practice. Alice Springs: Centre for Remote Health; 2014.

July–August 2018 western nurse |

25

AroundtheGlobe WORLD NEWS

GOOD OLD CHOC MILK BETTER THAN SPORTS DRINKS Chocolate milk is as good or better than some “sports” drinks for performance and recovery in physical activity.

It can take up to six minutes longer to get puffed after drinking chocolate milk (CM) compared with some sports drinks, according to analysis by Iranian and Canadian researchers.

They also found consuming chocolate milk might lead to reduced lactic acid levels which cause cramps and the burning sensation associated with exhaustion.

FULL-FAT MILK MAY HELP PROTECT YOU FROM STROKES A fatty acid present in full-fat dairy products may reduce risk of dying from cardiovascular disease – particularly strokes, American research indicates.

“Higher plasma phospholipid heptadecanoic acid was associated with lower CVD (cardiovascular disease) mortality, especially stroke mortality,” specified the report of the research published in the American Journal of Clinical Nutrition in July.

Therefore, “enjoying full-fat milk, yogurt, cheese and butter is unlikely to send people to an early grave”, said The University of Texas Health Science Center at Houston, which conducted the study.

HOUSEFLIES HOVERING HINT THAT MEAT IS FREE OF ‘DEADLY DRUGS’ The presence or absence of houseflies in butcher shops is helping Ugandans decide what meat is safe to eat.

This is because houseflies hate the toxic preservative formalin that local meat purveyors have started smearing on their products, according to US-based international online magazine OZY. Local Ministry of Health officials warn that eating food preserved with formalin can cause chronic poisoning, kidney damage and even cancer “in the long run”.

Using the mixture of formaldehyde, methanol and water – normally a preservative for dead bodies – is becoming so common, that local food

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“TTE (time to exhaustion) significantly increases after consumption of CM compared to placebo … and carbohydrate, protein, and fatcontaining beverages,” said the researchers from Shahid Sadoughi University of Medical Sciences and Health Services and Brandon University.

“Furthermore, a significant attenuation on serum lactate was observed when CM was compared with placebo.”

Their study, published in June on nature.com within the European Journal of Clinical Nutrition, examined evidence regarding “efficacy of CM compared to either water or other ‘sport drinks’ on post-exercise recovery markers”.

The researchers concluded: “CM provides either similar or superior results when compared to placebo or other recovery drinks”.

But they cautioned “the evidence is limited and high-quality clinical trials with more well-controlled methodology and larger sample sizes are warranted”. 

The study evaluated how multiple biomarkers of fatty acid present in dairy fat related to heart disease and all-cause mortality in 2907 adults, aged 65 years and older, over a 22-year period.

“None of the fatty acid types were significantly associated with total mortality. In fact one type was linked to lower cardiovascular disease deaths. People with higher fatty acid levels, suggesting higher consumption of whole-fat dairy products, had a 42 percent lower risk of dying from stroke,” said the university.

UT Assistant Professor, Epidemiology, Human Genetics and Environmental Sciences Marcia Otto, one of the study’s authors, said: “… our results highlight the need to revisit current dietary guidance on whole fat dairy foods, which are rich sources of nutrients such as calcium and potassium”. 

experts and health officers are advising consumers to “visit only those shops where houseflies hover”, the magazine reported earlier this year.

Stanley Kiyemba, a public health officer in Kampala, said: “Houseflies swarming on meat is an indicator that such meat is not treated with deadly drugs”.

The magazine said investigations carried out by the Kampala City Council Authority, the Uganda National Bureau of Standards, the police and the Ministry of Health confirmed there was formalin in meat sampled from 95 of 125 butcher shops – and that levels were “shocking even for seasoned health professionals”.

Uganda’s government is cracking down on formalin-contaminated meat – saying that at least 15 butcher shops were closed down and six butchers arrested in a raid conducted by multiple agencies on January 4 and 5. 

OMEGA 3 SUPPLEMENTS PROBABLY DON’T WORK, SAY RESEARCHERS Consuming omega 3 supplements most likely does not reduce incidence of heart disease, stroke or death, a wide-ranging review of existing studies has found.

And “there is little evidence of effects of eating fish”, according to the respected non-profit medical research group who conducted the review.

The UK-based Cochrane organisation reviewed results of 79 randomised trials involving 112,059 healthy and ill men and women from North America, Europe, Australia and Asia.

Those trials had assessed effects on heart and circulation diseases when additional omega 3 fat was consumed, versus usual or lower omega doses.

“The review provides good evidence that taking long-chain omega 3 (fish oil, EPA or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause,” said Cochrane lead author Dr Lee Hooper from the University of East Anglia.

“The most trustworthy studies consistently showed little or no effect of long-chain omega 3 fats on cardiovascular health. On the other hand, while oily fish is a healthy food, it is unclear from the small number of trials whether eating more oily fish is protective of our hearts.

BLOOD TEST TO HELP IDENTIFY MORE FUTURE LUNG CANCER SUFFERERS

of future lung cancer patients among former and current smokers, compared with only 42 per cent using current eligibility criteria for CT screening in the USA,” said IARC scientist Dr Mattias Johansson, one of the study’s principal investigators.

Identifying individuals who will later develop lung cancer has become more accurate with a new blood test.

The test which measures “four protein biomarkers” has been proven to improve detection of future cancer patients “significantly”, according to a study by the World Health Organisation’s International Agency for Research on Cancer (IARC).

“By using information from four blood-based protein biomarkers together with smoking information, we were able to identify 63 per cent

JOHNSON & JOHNSON LOSES $6 BILLION TALCUM POWDER CANCER CASE More than $6 billion ($US4.7 billion) has been awarded to 22 women and their families in a case claiming asbestos in Johnson & Johnson talcum powder contributed to the women’s ovarian cancer.

However, six of the 22 plaintiffs in the latest trial – that was in St Louis Circuit Court in Missouri – have already died from ovarian cancer, reported ABC News in July.

Johnson & Johnson said it would appeal the verdict and that the ruling was the result of an unfair process that allowed the women to sue the company in Missouri despite most of them not living in the state.

“This systematic review did find moderate evidence that ALA (omega 3 fatty acid alphalinolenic acid), found in plant oils (such as rapeseed or canola oil) and nuts (particularly walnuts) may be slightly protective of some diseases of the heart and circulation.”

One of the experts who reacted to the research findings was Tim Chico, Professor of Cardiovascular Medicine and Honorary Consultant Cardiologist from the University of Sheffield, who said that "anyone buying [omega 3 supplements] in the hope that they reduce the risk of heart disease, I'd advise them to spend their money on vegetables instead". 

“Our study demonstrated that biomarkers have the potential to significantly improve the identification of those individuals who are most likely to benefit from screening.”

Cancer Council Australia chief executive Sanchia Aranda told the Australian Associated Press news agency: “If you can screen the healthy individuals who would be eligible for surgery and get them into surgery earlier, then their chances of survival just increases automatically”.

Australia does not have a national screening program for lung cancer. 

The ABC reported that medical experts testified asbestos, a known carcinogen, was intermingled with mineral talc.

But Johnson & Johnson spokeswoman Carol Goodrich said: “Johnson & Johnson remains confident that its products do not contain asbestos and do not cause ovarian cancer and intends to pursue all available appellate remedies”.

The Cancer Council WA’s website states “the current evidence is inconsistent and insufficient to conclude that the use of talcum powder on the external genitals increases the risk of cancer, specifically ovarian cancer”.  July–August 2018 western nurse |

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ITALIAN-STYLE LAMB SHANK RECIPE This lamb shank recipe makes a delicious and comforting winter meal. The lamb is cooked until the meat is so tender that it just falls off the bone. Perfect for dinner parties because it comes together with minimal fuss.

However, despite being so easy to make, this lamb shank recipe is loaded with flavour. The orange gremolata adds a zesty touch while the parsnip mash rounds it up as a full meal. Having a glass of wine to go with it doesn’t hurt either!

Come and learn Jamie Oliver’s hints, tips and shortcuts to cooking delicious and affordable meals from scratch!

Edith Cowan University Bunbury Campus 585 Robertson Dr, East Bunbury WA 6230

Courses run in Bunbury from 5th September to 23rd October 2018 For more information and to book: jamiesministryoffood.com.au

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western nurse July–August 2018

EQUIPMENT • • • • •

Stovetop and oven-safe casserole Grater Pot Food processor Measuring cups and measuring spoons

INGREDIENTS • • • • • • • • • • • •

2 tbsp olive oil 8 lamb shanks french-trimmed 200g pancetta roughly chopped 4 garlic cloves 2 onions roughly chopped 2 tbsp fresh rosemary leaves 2 tbsp plain flour 2 cups red wine 3 cups beef stock 600ml tomato passata (sieved tomatoes) 2 bay leaves 1 tbs good quality balsamic vinegar

ORANGE GREMOLATA • • • •

1 grated orange zest ½ cup flat leaf parsley 2 garlic cloves cup toasted pine nuts

PARSNIP MASH • • • • •

4 parsnips, peeled and chopped ¼ cup pure thin cream 2 garlic cloves Pinch of grated nutmeg butter

INSTRUCTIONS 1. Preheat your oven to 170C. 2. Heat oil in a large casserole over medium heat. In two batches, brown the lamb shanks all over then set aside.

3. Meanwhile, chop the pancetta in a food processor with the onions, garlic, and rosemary.

4. Add the chopped mixture to the casserole and cook for 5-6 minutes or until onion is soft.

5. Add the flour and stir the mixture for a further minute.

Stir in the wine, stock, passatta, bay leaves, and vinegar.

6. Return shanks to the dish and bring to a boil. Season with salt and pepper. Cover with lid and transfer to the oven for 2-2 ½ hours until the lamb is very tender.

7. Meanwhile, chop the ingredients for the orange gremolata together to create a rough mixture.

8. For the mash, cook parsnips in boiling salted water for 8-10 minutes until tender. Drain and whiz in a food processor with some butter, cream, and nutmeg until smooth. Season to taste.

9. Sprinkle the orange gremolata over the lamb and serve with the parsnip mash.

Recipe published courtesy of Kitchen Warehouse

July–August 2018 western nurse |

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ResearchRoundup LATEST AND GREATEST FROM SCIENCE

NUTS MAKE SPERM HEALTHIER Eating nuts regularly “significantly improves” quality and function of human sperm, Spanish researchers believe.

The scientists ran a 14-week randomised trial where 119 healthy young men aged 18-35 had either their normal “western-style diet supplemented with 60 grams/day of mixed almonds, hazelnuts and walnuts”, or had that diet without nuts.

Subjects eating nuts saw their sperm count increase by about 16 per cent, sperm vitality go up by 4 per cent, sperm motility become 6 per cent higher, and there was a 1 per cent rise in morphology – parameters all associated with male fertility.

They also had a significant reduction in sperm DNA fragmentation, which is “closely associated with male infertility”.

The scientists said the results indicate “a beneficial role for chronic nut consumption in sperm quality", and a “research need for further male-specific dietary recommendations”.

Dr Albert Salas-Huetos, of the Universitat Rovira i Virgil in Reus, Spain, who presented the findings at the 2018 European Society of Human Reproduction and Embryology in Barcelona on July 4, said the significant improvements among the nut eaters were “consistent with improvements found in other recent studies with diets rich in omega-3, antioxidants (eg, vitamin C and E, selenium and zinc), and folate”. Nuts contain many of these nutrients and other phytochemicals. 

DESIRE FOR DASTARDLY DEEDS DEADENED

BY BRAIN SHOCK TREATMENT Administering “minimally invasive electrical currents” on the brain can reduce desire to commit physical and sexual assault, say US and Singaporean researchers.

And the scientists also reckon this shock treatment, called transcranial directcurrent stimulation, increases the “perception that such violence is morally wrong”.

“Stimulating the prefrontal cortex, the part of the brain responsible for controlling complex ideas and behaviors, can reduce a person’s intention to commit a violent act by more than 50 percent,” said the researchers from the University of Pennsylvania and Nanyang Technological University.

A trial was conducted on 81 healthy adults aged 18 or older, split into two

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groups. One group received stimulation on the dorsolateral prefrontal cortex in the top, front area of the brain for 20 minutes, while the placebo group received a low current for 30 seconds.

Participants were then asked to rate on a scale of 0 to 10 “the likelihood that they would act as the protagonist” in one hypothetical scenario about physical assault and another about sexual assault.

The experimental group “decreased their intent to carry out physical and sexual assault by 47 and 70 percent, respectively”.

“The ability to manipulate such complex and fundamental aspects of cognition and behavior from outside the body has tremendous social, ethical, and possibly someday legal implications,” said Roy Hamilton, a neurologist at Penn’s Perelman School of Medicine and senior author of the paper published in the Journal of Neuroscience in July. 

ALZHEIMER’S ASPIRIN CURE? Taking regular low doses of aspirin may reduce amyloid plaque in the brain – which reduces Alzheimer’s disease pathology and protects memory.

Neurological researchers from Rush University Medical Center administered aspirin orally for a month to genetically modified mice with Alzheimer’s pathology.

They then evaluated the amount of amyloid plaque in the parts of the brain affected most by Alzheimer’s disease and found that aspirin medications augmented a protein called TFEB – considered “the master regulator of waste removal”.

Aspirin also stimulated lysosomes – the components of animal cells that “help clear cellular debris” – and decreased amyloid plaque pathology in the mice.

“This research study adds another potential benefit to aspirin’s already established uses for pain relief and for the treatment of cardiovascular diseases,” said Kalipada Pahan, the lead research investigator and also senior author of the study published in the July issue of The Journal of Neuroscience.

Professor Pahan added: “More research needs to be completed, but the findings of our study have major potential implications for the therapeutic use of aspirin in AD and other dementia-related illnesses”. 

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BLACK PANTHER ON BLU-RAY 30 OF THEM JUST FOR ANF MEMBERS!

“Marvel's History-Making Superhero Movie's a Masterpiece” – that’s the unambiguous praise bestowed by Rolling Stone magazine on this recent instalment in the Marvel Comics universe.

all-female Special Forces known as the Dora Milaje.

Her head shaved, her eyes beaming like lasers and her weapons at the ready, she is the living definition of fierce.

The scenario is: After his father the King of Wakanda (fictional African country) is murdered, young Prince T'Challa (Chadwick Boseman) takes the throne and is soon after faced with the ultimate test, putting the fate of his country and the entire world at risk.

“And there's no beating the smarts and sass of the wonderous Letitia Wright, who brings scene-stealing to the level of grand larceny as Princess Shuri, T'Challa's kid sister. A scientist and tech-tinkerer, she's always the brainiest person in the room, giving Q from the James Bond series a run for his money by inventing the coolest gadgets.”

Pitted against his own family, the new king must rally his allies and release the full power of Black Panther to defeat his foes and embrace his future as an Avenger.

But Rolling Stone reviewer Peter Travers says if you're thinking this is “another macho power trip, forget it”.

“The women are more than a match for the men in this game, from the iconic Angela Bassett as Ramonda, T'Challa's widowed mother, to the ready-to-rumble Lupita Nyong'o as Nakia, T'Challa's ex love and a spy for Wakanda in the outside world,” Travers says.

“And wait until you see the dynamite Danai Gurira – Michonne on The Walking Dead – fire on all cylinders as Okoye, head of Wakanda's

The blokes in the film are all right as well, according to Travers, who says that besides the “brilliant Boseman”, some “superlatives” are also required for Michael B. Jordan, who is “blazingly good as Erik Killmonger”, the villain and figure from T'Challa's past.

“Daniel Kaluuya, an Oscar nominee for Get Out, is also aces as W'Kabi, T'Challa's friend and head of security. And screen giant Forest Whitaker brings soulful dignity to Zuri, the King's spiritual mentor,” Travers says.

To enter the Black Panther competition, the Paul Carroll voucher competition, or the ANF Holiday Unit Photo Competition, just log on to your iFolio and then click through to Resources – that’s where you’ll find the Competitions and Photo Competition sections.

July–August 2018 western nurse |

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