Western Nurse Magazine May June 2018

May – June 2018

incorporating western midwife

GAIL YARRAN IS HESTA'S NATIONAL NURSE OF THE YEAR PLUS THE WA NURSING AND MIDWIFERY AWARDS FULL COVERAGE PAGE 4

western nurse is the official magazine for ANF members in WA

ANF Members can save $1000s in tax

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Secretary's Report May - June 2018 on the

cover

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State Secretary Mark Olson

FEATURED 4

Nurses and Midwives Awards

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ANF Compared to the Rest

10 High School Nursing 14 Mark’s Q & A Nurses and Midwives Awards

28 Recipe Corner

Photo: Bohdan Warchomij

FAVOURITES

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Internet Watch

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

ANF Compared to the Rest

HOLIDAY ANF

Mark’s

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Due to popular demand we’re bringing back Mark’s question and answer section as regular feature in western nurse. Tax deductions have been a common subject in many inquiries recently, so we’ll cover a repeatedly occurring question this edition.

Q:

A:

Can we claim home internet costs as a tax deduction because we have to do CPD each year, much of which is online; and I also often need to access work emails and often I do most of my mandatory competencies at home because work is too busy?

It’s a very good question given the amount of online learning now being done. And the answer is yes, a claim can be made – as long as the education is related to current employment, such as either keeping up-to-date or enhancing earning capacity. The education cannot be for a different field outside the scope of current work e.g. a nurse studying to be a doctor.

31 ANF Contact Details

9 ANF Holiday Units – book now!

You may also be able to claim for some home office expenditure: Home office – You can claim the set rate of 45c per hour for heating, cooling, lighting; Mobile phone – percentage of bill for work purposes. You need to keep records for a 4-week representative period in each income year to claim a deduction of more than $50; Internet – percentage for work purposes; Specific office equipment – percentage claim based on work/private usage i.e. computer; Consumables – percentage based on work usage. i.e printer cartridges, paper, pens etc; You would need to ensure that any other people using the equipment, internet etc are factored into your calculations, so you only claim your own work-related usage as a deductible amount. 

Mark’s Q & A

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WIN! 31 Win Blu-rays, ANF Futures Survey Comp

CLINICAL UPDATES 13 Listeria (Listeriosis) 16 Managing pleural drains 21 Murray Valley encephalitis

With more than 5000 members already completing the ANF Futures Survey, what I can say right now is it’s quite clear that a big priority for members continues to be getting nurse-to-patient ratios made part of the law, and that goes for the public, private and aged care health sectors.

That means the ANF is going to continue fighting to ensure our members are in a workplace where there are enough staff to care for patients or residents properly.

I’m really encouraged to see so many of you participating in the survey, because this is a key poll which will influence policies regarding the direction of your ANF for the next five or so years – so I’d love if all of our 31,000-plus members had their say.

You, our members, will be the first to know what the results are before we release them publicly. We will be strategic in their release because we know the Government and others will be interested in many of the results.

We have the biggest membership of any individual industrial organisation in WA – so what you think and what you want to do about what you think matters a great deal to decision-makers.

This power in numbers has greatly assisted the ANF to achieve terrific results for you despite the minefield that is industrial relations in 21st century WA. Given we now have more than 31,000 members and are growing in number weekly, we will continue to be a force to be reckoned with.

In other news, our public sector members know we are continuing the fight to ensure the WA Health Minister’s commitment to abolish annual performance appraisal meetings is kept by the Health Department bureaucrats – despite their best efforts to defy his edict.

I’ll keep you up to date on these and other key matters as usual in direct emails and in this magazine.

24 The urinary system - assessing renal and bladder function Recipe Corner

May–June 2018 western nurse |

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OUR NURSES AND MIDW CONGRATULATIONS TO OUR WA AWARD WINNERS The ANF pays tribute to those recognised at State and national nursing and midwifery awards. But as ever, we also thank all the other nurses, midwives, carers and health educators out there for their seemingly indefatigable efforts.

WA Nursing and Midwifery award winners for 2018

Our State’s hardworking public and private health sectors and education institutions have produced the 12 worthy winners of this year’s WA Nursing & Midwifery Excellence Awards.

The Lifetime Achievement Honour went to Professor Phillip Della, the Head of Curtin University’s School of Nursing, Midwifery and Paramedicine.

Brett Hayes – a regional specialist palliative care clinical nurse manager – was named WA’s 2018 Nurse/Midwife of the Year.

“Over his 40-year career, Professor Della has been a trailblazer – as Western Australia’s first Chief Nurse and Midwifery Officer, where he created new career pathways for nurses and midwives and oversaw the creation of the Nurse Practitioner role in Western Australia, and then moving into the academic environment,” it was said of his achievements.

A long-time ANF member who is originally from York and works for the WA Country Health Service in the Wheatbelt, Brett also won the Excellence in Rural and Remote Health category at the awards, announced at the Perth Convention and Exhibition Centre on May 12.

He was described during the awards as having a “commitment to providing best-practice palliative care (that) has made him a role model for other nurses”.

Brett’s work resulted in the “development of a TelePalliative Care Service, whose clients were four times more likely to fulfil their wish to die at home”.

He told western nurse that nurses have “the unique privilege and responsibility to help people when they are most in need” and “to make a real difference to people’s lives”.

“Everyone we help deserves the best practical support we can offer,” Brett said. “And there is fantastic opportunity in regional areas. There are unique challenges that require unique solutions.

“Recent advances in technology are providing the opportunity to meet some of these challenges, an opportunity to develop new ideas that make a real difference – opportunities that have not existed before.”

Brett said it is an exciting time to be working in the country. TelePalliative Care, he said, is only one of the Telehealth programs “reaching out to people like never before, bringing equitable health care closer to home”.

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Other award winners included Barbara O’Callaghan for Excellence in Registered Nursing, Alison Jennings for Excellence in Midwifery, and Amanda Major for Excellence in Enrolled Nursing.

Dr Caroline Nilson won the award for Excellence in Aboriginal Health, while Graduate of the Year was awarded to Christian Wright and Amber Murphy.

The Excellence in Education and Research award went to Emma Arnold, Trulie Pinnegar received the Excellence in Leadership award, and the Consumer Appreciation award went to Simon Hulatt.

Susan Pettigrew won the Excellence in Primary, Public and Community Care award.

Health Minister Roger Cook said the WA awards provided West Australians with an opportunity to publicly acknowledge the 38,000 nurses and midwives across the State.

Approximately 500 people gathered at the ceremony, which was held on May 12 – International Nurses Day, which is celebrated annually on the anniversary of Florence Nightingale’s birth. International Day of the Midwife is celebrated on May 5. 

WIVES RECOGNISED THE LONG ROAD TO RECOGNITION – OUR NATIONAL WINNER Being born indigenous in small-town Western Australia in the 1950s meant Gail Yarran had to surmount numerous life hurdles merely to get to do the job she loves. But she not only achieved her dream career – the local registered nurse has now been awarded HESTA’s national Nurse of the Year for 2018.

Major challenges came early to Gail Yarran.

She was delivered in a hospital – but as a newborn had to survive 40 degree heat with her mum outside on the hospital verandah, because they were black.

Then she experienced the likes of being relegated to the “black seat” on the school bus and in the classroom, and continuing ostracisation into adulthood.

But she persevered with her childhood dream of being a nurse – including eventually achieving a university nursing degree, in a career spanning more than 50 years that continues to this day at the Derbarl Yerrigan Health Service Aboriginal Corporation in East Perth.

Now, this Ballardong and Wadjuk woman, originally from tiny Quairading in WA’s central Wheatbelt, has won national Nurse of the Year at the 2018 HESTA Australian Nursing & Midwifery Awards.

The judges didn’t hold back on praise for the registered nurse, who is a longstanding ANF member, at the awards ceremony in Melbourne on May 10, saying: “Gail’s tireless work has contributed to substantial improvements in the way Aboriginal people are treated when accessing health care, and through her work, she continues to help Aboriginal people living across Western Australia reach health parity.

“Gail has established herself as a prominent Aboriginal health care leader and nurse ambassador. Her extensive breadth of work includes holding multiple advisory roles, as well as developing clinical research projects and pilot programs designed to meet the specific needs of Aboriginal and Torres Strait Islander patients.”

were among the first indigenous nurses, and I have enjoyed a very long career as such.”

Gail said she loves nursing because she gets “to make a difference, right at the coal face of patient and nurse contact” and also with advocacy “for creating change”.

“In a day’s work I might give wound care or an immunisation, hear an antenatal heartbeat, sit with patients who have just had a heart attack, or give some education,” she said. “I get to reassure clients that they can take control of their lives. Giving people back power and control is hugely satisfying to me.”

“I GET TO REASSURE CLIENTS THAT THEY CAN TAKE CONTROL OF THEIR LIVES” Liesl Baxter, Coordinator of Maternal and Child Health at Derbarl Yerrigan, who nominated Gail for the award, said in recent years Gail’s passion has been for maternal and child health and as a Heart Foundation Ambassador.

“She has been involved in many King Edward Memorial Hospital, Princess Margaret Hospital and Royal Perth Hospital advisory committees, a huge antenatal screening tool based around yarning, community connect groups and clinic assessments, implementation of health care models, plus, plus, plus,” said Liesl, who is also an RN, as well as a midwife.

Gail Yarran has won HESTA's national Nurse of the Year award.

Liesl said meeting Gail was her “watershed moment”.

“That’s when I truly realised that racism and disparity between indigenous Australians and non-indigenous counterparts was deeply ingrained in the framework of our society,” she said. “Racism was no longer something that was relegated to a history book in eras past – my friend and colleague was the kid whose mother birthed her in a hospital and was accommodated on the hospital verandah in 40 degree heat, because she was black, (while) the other Australian women were sheltered inside.

“She endured ostracism and bullying, and yet through her strong and united family, a nursing matron who believed in her and a deep faith, she was supported through nursing training to gain her qualification.

“Gail has become strong in both worlds – her own ancient culture and mainstream society, to become an amazing role model, not just to her family and her community, but to the nursing profession and wider society.” 

Gail told western nurse she feels very strongly that more indigenous nurses are needed.

“Like all industries, indigenous employment in nursing is very under-represented,” she said.

“I am passionate and dedicated to advocacy for opportunities to train and educate indigenous nurses and am proud to see that there are more and more nurses in our industry. My sister and I

Gail with one of her young patients in Princess Margaret Hospital in 1973

May–June 2018 western nurse |

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InternetWatch AMAZING APPS + ONLINE NEWS

Grease Stickers Grease is the word! The much loved movie turns 40 years old this year. Be cool, download the official Grease 40th anniversary stickers and add Danny, Sandy, Rizzo, Frenchie, Kenickie and the rest of the gang to your messages. Free

Grease Song Lyrics While we’re on the topic, why not have a Grease singalong?

All the lyrics are here from ‘You’re the One That I Want’ through to ‘Summer Nights’. Careful now, we feel a nostalgia overload coming on!

Free

Q*bert Rebooted One of the most critically acclaimed and commercially successful arcade games of the 1980s is back with state-of-the-art gameplay and graphics that remain faithful to the original concept. Free

Tinycards Introducing a new twist on an old concept – the flash card. Create your own decks and share them with friends, or pick from a variety of ready-made collections. You’ll find flashcards for biology, chemistry, geography, history, and more. Free

Wikicamps Australia Here’s the ultimate camping companion whether you're heading away for a weekend camping trip or planning a big adventure.

Importantly, it works offline so you don't have to worry about a phone signal or WiFi connection. The database is crowd sourced, meaning sites are added and shared by thousands of users. Free

Magic Jigsaw Puzzles Jigsaw puzzle lovers unite! This is the largest online jigsaw puzzle platform around, consisting of more than 20,000 puzzles curated from National Geographic, Sony Pictures and the Cartoon Network.

You can make a personalised puzzle using your own photo. Free

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western nurse May–June 2018

Australian Taxation Office The ATO can help you record and manage expenses and trips, relating to your work as an employee or other general expenses.

Upload your deduction records to your tax return or email a copy to your tax agent. Work out key dates and set important reminders and alerts for tax and super obligations. Free

Miraculous Ladybug & Cat Noir Join Miraculous Ladybug and Cat Noir on their rescue mission to save Paris from ruin and destruction. Turn into awesome superheroes and run through the streets of Paris as you avoid obstacles and defeat villains. Free

Recolor Adult colouring books are everywhere and here’s a palm-sized version. Take a break and channel your energy into satisfying, creative accomplishment. Featuring over 2000 unique colouring pictures and new pictures daily. Organised into categories and complexity, the pictures feature mandalas, animals, flowers, and more. Free

Spotify We love Spotify. It’s a music streaming platform. You can listen to artists and albums or create your own playlist. Want to discover new music? Choose a ready-made playlist that suits your mood or get personalised recommendations.

Free, or $6.99 per month with no ads, or $11.99 for premium.

FIVESuperSites Melanoma Risk Predictor

Designed to provide an estimate of a person's risk of developing melanoma over the next 3.5 years. Simply answer the questions and a risk rating will be calculated for you. The tool is not a substitute for your doctor's advice. https://publications.qimrberghofer. edu.au/Custom/QSkinMelanomaRisk

Life in the Fast Lane

One of the best known blogs around, LITFL specialises in emergency and critical care. It contains an excellent collection of libraries including ECG, toxicology and trauma. You’ll find an intriguing section of biographical eponyms such as Virginia Apgar, an anaesthetist affiliated with the Apgar score. https://lifeinthefastlane.com/

Fremantle Arts Centre

Built by convicts in Fremantle, this splendid example of Australian Gothic architecture first opened in 1864 … as a lunatic asylum. Before you head into Freo check out the website and get a taste of what’s on offer. You’ll find a detailed history of the building, events and exhibitions and the latest artists in residence. https://www.fac.org.au/

Your Move

The folks at the Department of Transport reckon by swapping a few car trips a week for walking, cycling and catching public transport, we are building more physical activity into our lives, finding more quality time to spend with friends and families, and saving money to spend on things we enjoy. Have a look, there are some great ideas here! https://yourmove.org.au/

Your Health in Mind

Written by the Royal Australian and New Zealand College of Psychiatrists, here you’ll find expert information about mental illness and how to get help. Specifically, the difference between a psychiatrist and a psychologist, what psychiatrists do and how they can help with mental health problems. https://www.yourhealthinmind.org/

Wherever your workplace, whatever your role, don’t put yourself or patients at risk.

Get your free flu vaccination today.

Join the growing number of health workers who get the flu vaccine each year.

It is safe, effective and reduces your risk of catching flu and passing it to patients and colleagues.

health.wa.gov.au

May–June 2018 western nurse |

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ONLY THE BEST FOR ANF MEMBERS –

AND AT THE LOWEST CO$T There’s been no fee increase at the ANF for 14 years, yet the range of services continues to expand – putting us even further in front of other WA unions and also the ANF in other states.

The ANF has recently completed our annual services audit – the good news is ANF membership still costs way less than other industrial organisations, yet with tonnes more services.

When we take a look at what’s on offer elsewhere and what it costs, we don’t only scrutinise other unions, we also examine the ANF in other States.

That way we get a complete picture – and we use that information to stay miles ahead of the pack, whoever they are.

HERE ARE THE KEY RESULTS: COST: The absolute most you’ll pay for ANF membership is about $412 (registered nurse), and it’s much cheaper for our enrolled nurses ($298) and students ($125) – with all paid members eligible for the full range of services. And our fees haven’t increased in 14 years.

COMPARISON: Our fee of $412 is more than $200 lower than the cheapest of all the other State ANF divisions – and we are nearly half price compared to some States.

And as for other unions, their members can pay more than double what you pay. An enrolled nurse has to shell out $720 a year for United Voice membership, compared with $298 for ENs at the ANF. Members at the Health Services Union WA and the local teachers’ union can pay double or more than the ANF’s very top rate of $412, let alone our lesser rates.

SERVICES AND PRODUCTS: We can’t fit in everything the ANF does on these pages, but we’ll give you a sample. For example, you can easily spend $1000 or more yearly just for Professional Indemnity Insurance and Continuing Professional Development (CPD) units elsewhere – but you get them for free as part of your ANF membership. So you’ve recouped your fees only with these two features, that are also compulsory for maintaining your registration.

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Free comprehensive in-house, specialised legal representation for workplace matters, and free journey cover insurance for travelling to and from work, are other pivotal benefits. That’s on top of our strong base of industrial advice, support, advocacy and negotiation – that has led to our members having the best package of wages and conditions in Australia.

There are numerous other cash-saving ANF services, including a choice of 77 high-quality, heavily discounted holiday apartments situated in central locations in the famous beach resorts of Margaret River and Kalbarri. What you pay for a whole week staying with us, you can pay for merely one or two nights elsewhere. So you can get the cost of your membership back yet again and then some with one short holiday.

Then there’s the brand new Member Rewards and Offers page on iFolio where just for being an ANF member you have access to the likes of special mortgage and credit card deals, bestprice online appliance shopping, and discounts on groceries, manchester, stationery, giftware, furniture, and optometry services.

Offers on car leasing and private insurance are also included, and we’re in negotiations with a major utilities supplier for a better deal for ANF members. You even get a 20 per cent discount at Nando’s WA chicken restaurants.

Your iFolio website, which has the clinical update units for your CPD, also has a downloadable evidence record of your CPD, a tool to help you build your own CV, a list of what pay rates should be at workplaces and various competitions where you can win prizes.

Don’t forget all the free ANF merchandise for members – from reference cards and fob watches, to shopping bags and water bottles.

COMPARISON: You get all your CPD for free with the ANF in WA. But you have to pay for at least some CPD, if not all of it, at other ANF State divisions, the ANF federal office, and other organisations. We still get members complaining they’ve accidentally enrolled for paid CPD elsewhere thinking it was with us.

ANF MEMBERSHIP FEES COMPARISON WA

WA UNIONS MEMBERSHIP FEES COMPARISON ANF

Tasmania SA

(RNs) (ENs)

United Voice

NSW ACT

Teachers Union

NT Victoria

HSU

Queensland $100 200 300 400 500 600 700 800

“Your work insurances, professional development and work legal cover are all for free – on top of our specialised industrial advice and representation.

You also get heavily discounted holiday resort accommodation and heaps of free merchandise. And you get access to great deals – from mortgages to discounted chicken dinners. All that with the lowest membership fees. I kind of feel like a guy on an infomercial – ‘but wait there’s more!’”

$100 200 300 400 500 600 700 800 900 1000

And other unions might have a holiday unit or two somewhere, but there’s no comparison to the ANF property portfolio that not only gives you heavily discounted holiday accommodation today, but also guarantees the future of the ANF for many years to come.

Additionally, the services available to members on iFolio, the free merchandise and the deals we’ve sourced for you comprise a combination we’ve not seen anywhere else.

CONCLUSION: ANF WA State Secretary Mark Olson said: “We’ve wanted this to be an organisation where we’re here to help you in every way possible at work, but we’re also there for you when you just want some services that ease the load in your busy life.

“Your work insurances, professional development and work legal cover are all for free – on top of our specialised industrial advice and representation. You also get heavily discounted holiday resort accommodation and heaps of free merchandise. And you get access to great deals – from mortgages to discounted chicken dinners. All that with the lowest membership fees. I kind of feel like a guy on an infomercial – ‘but wait there’s more!’

“There is more! We haven’t increased our fees in 14 years. So we are pretty proud of what we’re doing for our members.” 

KALBARRI PERFECT RIGHT NOW From less than $50 per night for ANF members.* BOOKINGS AND INFORMATION ON YOUR IFOLIO

ifolio.anfiuwp.org.au

*Rates may vary depending on room type and season.

For the full pricing list please see the terms and conditions on your ANF iFolio.

May–June 2018 western nurse |

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BACKTO

The incidence of teenagers presenting with mental health issues at school health centres is becoming more common. Adolescent mental health specialist Anita Moyes believes school nurses can play a significant role in supporting troubled young people.

As an adolescent the last thing Anita Moyes wanted to do was spend any more time in high school than she had to.

But in adulthood, after “falling” into nursing following a false start with business studies, she soon realised working with teens in schools was exactly what she wanted to do.

Her 13-plus years of nursing in the public high school system have been less about bandages, grazed knees and aspirin, and more about counselling youngsters over the likes of suicidal thoughts, child abuse, drug use or unplanned pregnancy.

In recent years, Anita has been the Clinical Nurse Specialist in Adolescent Mental Health for the WA Health Department’s Child and Adolescent Community Health (CACH) section, where she provides clinical education and strategic direction in adolescent mental health.

PERFECT FOR SHIFT WORKERS

Right now she’s also in the middle of a PhD at Curtin University about the experiences of high school nurses with youngsters who have mental health problems.

So, when western nurse wanted to know more about this largely unsung area within the nursing profession – we asked Anita.

Q: Anita, firstly please tell us something about your experience as a secondary school nurse.

A: I’ve worked in nursing since the early 1990s, but I’ve been in the WA public sector as a high school nurse since 2004, most recently last year. I’ve worked in a couple of different high schools, all in the southern corridor of Perth.

Professionally, I’ve experienced high school nursing as both the best of times and the worst of times. The worst because some

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western nurse May–June 2018

I’ve had plenty of scary moments.

CPR in the grass waiting for an ambulance, EpiPens for anaphylaxis and life-threatening bronchospasm.

Anita Moyes performing an Otoscopy Photo :Bill Hornsby

young people experience horrendous and distressing experiences in adolescence. I feel privileged to have been able to provide them with nursing care, but the emotional impact sometimes stretched me. The best because I’ve also had the most incredible fun – hilarious times teaching sex ed classes with condoms and bananas, and wearing out my socks teaching Michael Jackson’s Thriller moves to promote physical activity. Often there was more drama than Home and Away. I like teenagers and am drawn to their complexity. I like getting to know a young person and understanding their life from their perspective.

Q: Have there been any scary moments?

A: I’ve had plenty of scary moments. CPR in the grass waiting for an ambulance, EpiPens for anaphylaxis and life-threatening bronchospasm. Some cases have been tough in other ways – I’ve supported a young woman trying to choose between parenthood and termination, I’ve sat with a young person bereaved by the suicide of a parent, I’ve asked difficult questions, and reported child abuse and suicidal ideation.

Q: What’s changed since you first started school nursing?

A: High school nurses have always needed a broad skill set, but maybe now more than ever before, because they never know what’s going to walk in the door. Adolescent mental health problems have become more common since I started nursing in the early 1990s.

But it was as a teenage student nurse that I first met an adolescent who had tried to take their life. He was a year younger than me and I remember being really shocked.

20

ANF MEMBERS RECEIVE

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Q: Why are you doing a PhD about high school nurses and why is it important?

A: A lot of what high school nurses do is invisible, and that’s what led me to undertake my doctoral research: Exploring the experiences of secondary school nurses who encounter young people with mental health problems. My research is important because high school nurses are on the frontline and mental health problems have become a common presenting concern. Very little has been published about the work of secondary school nurses in WA, but I’m hoping to change that.

Interested in knowing more about this topic? You can follow Anita on Twitter at @anita_moyes

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May–June 2018 western nurse |

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JUST SAY NO

The Minister has abolished appraisal meetings. Don't let anyone bully you into attending these meetings no matter what they call them. If you feel you are being bullied or harassed into doing such meetings, call the ANF right away. You can also do the ANF's Professional Development Annual Declaration, which is on iFolio, under Documents, and hand that in instead.

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western nurse May–June 2018

Listeria (Listeriosis)

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

Listeria monocytogenes (L. monocytogenes) is a common foodborne bacterium that causes significant public health and economic challenges in Australia.1 It is associated with major foodborne outbreaks, which can be difficult to manage. Contaminated food has the potential to cause a serious infection known as listeria (listeriosis) in populations at risk including older and immunocompromised adults, newborns, and pregnant women.1 Food avoidance by high-risk individuals, compliance with optimal food handling, consumption and storage guidelines, and frequent monitoring for bacterial contamination is required to limit the incidence and spread of infection.2

LISTERIA MONOCYTOGENES Listeria monocytogenes is an extremely common gram-positive bacterium.

It grows on a wide range of foods including those with a low moisture content or high salt concentration, and can continue to thrive despite refrigeration.3 The ability of L. monocytogenes to cause infection is dependent on the serotype (bacterial strain) and characteristics of the host. There are 13 different serotypes of L. monocytogenes; three are known to cause the majority of human listeriosis cases.3 While the specific bacterial load required to cause infection is unknown, it is thought to be relatively high compared to other organisms.3

TRANSMISSION Listeria monocytogenes is primarily transmitted through the consumption of contaminated food.1-4 Foods at high risk of contamination include those that support the proliferative growth of L. monocytogenes, such as takeaway items that do not require further cooking at home, food items with an extended shelf life, and fresh foods that require refrigeration.3 Listeria has been documented following the consumption of contaminated readyto-eat seafood, raw seafood, premixed raw vegetables (salads), meat products that are not home cooked, such as hot dogs or deli meat, as well as unpasteurised milk, ice cream, and soft cheese.3

MECHANISMS OF INFECTION Listeria monocytogenes invades the host through macrophages, epithelial cells and endothelial cells in the gastrointestinal tract. The incubation period for infection is variable and often long (see Table 1).3 Once contaminated food is consumed, bacteria passes through the lining of the small intestine and enters the lymph nodes causing widespread dissemination throughout the body.3 Table 1. Reported incubation periods for listeriosis cases3 Type of case

Incubation period

Pregnancy-associated

17 – 67 days

Central nervous system 1 – 14 days infections Septicaemia

1 – 12 days

Febrile gastrointestinal disease

6 hours – 10 days

Exposure and colonisation may occur in anyone. However, infection in healthy adults is rare. Individuals with predisposing risk factors (see Table 2) may develop meningitis, focal infections, septicaemia and/or febrile gastrointestinal disease as a result of invasive listeriosis.3 Pregnant women are at highest risk and are twenty times more likely to develop listeria than other healthy adults due to a reduction in cellular immunity.3 Table 2. High risk groups for invasive listeriosis.3

headache, stiff neck, confusion, and loss of balance.2 In pregnant women, infection may result in a miscarriage, stillbirth, premature delivery, or life-threatening infection in the mother or newborn.2 First-line treatment for listeriosis includes benzylpenicillin, with or without trimethoprim and sulfamethoxazole.4 Carbapenem antibiotics may also be used. Treatment is generally prescribed for between two to six weeks. Overall, the fatality rate in both pregnant and non-pregnant cases is estimated to be around 30%.4 Management of all cases should be guided by an appropriately trained physician, such as an infectious disease specialist to ensure optimal treatment.4

PREVENTION While listeria is rare (three infections per million people), the impact of bacterial food contamination is severe.1-3 In Australia, foodborne microbial pathogens cost $1.2 billion annually and Listeria monocytogenes is responsible for more than half of all organismassociated food recalls.1 Compliance with optimal food handling and storage guidelines is recommended. Regular food testing is also used to monitor for contamination in readyto-eat foods.4 Avoidance is the most common prevention tool for individuals at risk of infection. Pregnant and immunocompromised individuals are encouraged to avoid all highrisk foods, including ready-to-eat seafood, salads, pre-cooked meats, unpasteurised milk, soft-serve ice cream, and soft cheeses.4

• Pregnant women, their fetuses and neonates

REFERENCES

• Elderly people

1. Popovic I, Heron B, Covacin C. Listeria: An Australian perspective. Foodborne Pathogens and Disease. 2014; 11(6): 425-32.

• Immunocompromised individuals (e.g. those on corticosteroids, chemotherapy, haemodialysis) • Post-transplant patients • Individuals with diabetes, HIV, or drug dependency

2. Centers for Disease Control and Prevention.

Listeria (Listeriosis) [Internet]. Atlanta: CDC; 2016 Aug [cited 2016 Dec]. Available from: https:// www.cdc.gov/listeria/.

LISTERIA (LISTERIOSIS)

3. Mateus T, Silva J, Maia RL, Teixeira P. Listeriosis during pregnancy: a public health concern. ISRN Obstet Gynecol. 2013;2013:851712.

Listeria is a potentially fatal condition.4 It is diagnosed using bacterial cultures from blood, cerebrospinal fluid, placenta, meconium, or fetal gastrointestinal contents.4 Symptoms include fever, muscle aches, diarrhoea,

4. Victoria State Government. Listeriosis [Internet].

Melbourne: State of Victoria; 2015 [cited 2016 Dec]. Available from: https://www2.health. vic.gov.au/public-health/infectious-diseases/ disease-information-advice/listeriosis.

May–June 2018 western nurse |

13

Mark’s

Your ANF has 77 fully equipped high quality, heavily discounted holiday apartments situated in central locations in the famous beach resorts of Margaret River and Kalbarri.

Here are a few common questions answered that will help you on your way to planning a terrific ANF holiday. However, before making a decision check your iFolio which has the complete details you need.

Q. What are the bed configurations for the Margaret River and Kalbarri units?

A. Margaret River: The three-bedroom units have two queen beds and two single beds. The two-bedroom units have one queen bed and two singles.

Kalbarri: The three-bedroom units have two queen beds and three singles. The two-bedroom units have one queen bed and three singles.

Q. When is the bond returned?

A. Your bond is usually returned to your credit card within 48 hours of your departure. Occasionally it takes longer because of bank delays.

Q. Where are the ANF Holiday Apartments?

A. Margaret River: Leeuwin and Darby Park resorts.

Kalbarri: Kalbarri Beach Resort.

Q. How do I change the dates of my booking?

A. We are unable to swap dates because it is an automated system. You will need to cancel an existing booking on iFolio and make another.

Q. How do I book an ANF Holiday Apartment?

A. You book on iFolio with your credit card under ‘Holiday Units’.

That’s where you’ll find the most up-to-date list of vacancies, unit categories, prices and terms and conditions. A new ‘Frequently Asked Questions’ section is also there – providing all the information here, plus more.

Q. Can my friends or family members stay at the units without me there?

A. Yes, they can. But they will need to follow the ANF instructions and terms and conditions. The member making the booking is liable for any loss or damage, including through your bond, as per the normal terms and conditions.

Q. How long are booking periods for Margaret River and Kalbarri?

A. Margaret River: Two to five-night periods.

Kalbarri: Three to seven-night periods. You can also combine two consecutive half weekly or weekly bookings. Specific days and combinations are detailed on iFolio.

Q. How will I know if I’ve been successful in a school holiday ballot?

A. Ballots are normally drawn seven months before the respective holiday – and then an email is sent only to successful applicants. But we also have a second and third round for members unsuccessful in the first round – which are drawn five months and four months respectively before the relevant holiday. Then an email is sent only to successful applicants.

Remaining vacancies are available to all members three months before the start of the school holidays.

Q. How many people can stay in the units?

A. Margaret River: Up to six people depending on the options you select. Otherwise a standard booking sleeps only two people.

Please note that Margaret River no longer has a bring-your-ownlinen option.

Kalbarri: Up to seven people, depending on what room type you choose. All details are on iFolio.

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western nurse May–June 2018

The information provided in this column is general advice only. For more specific information please check your ANF iFolio ‘Holiday Units’ section, or send us your questions by email.

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May–June 2018 western nurse |

15

Managing pleural drains

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

The purpose of a pleural drain is to remove fluid and/or air from the cavity surrounding the lung to restore optimal lung expansion (see Illustration 1).1,2 Indications for drainage include pneumothorax, tension pneumothorax, pleural effusion, haemothorax, empyema, or post-operatively following thoracic, cardiac, oesophageal, or spinal surgery.1 Care for patients with a pleural drain in situ is complex and specific management is required to prevent clinical complications.

NURSING REQUIREMENTS Patients with a pleural drain should be cared for by nursing staff who have the knowledge, skills, and expertise required to manage the indwelling catheter and preferred drainage system.1 Opportunities for education, training, mentorship, and competency assessment of newly employed or junior staff are important to ensure all nurses in relevant practice areas are supported to gain the necessary skills for the management of future patients.

Box 1. Pleural drains and underwater seal drainage systems.

A pleural drain is a medical device that is inserted into the pleural cavity. It is also referred to as a chest drain or intercostal catheter. It is typically connected to an underwater seal drainage system which facilitates the one way movement of fluid and air out of the cavity and into a collection canister.

MANAGING EQUIPMENT Some patients have multiple drains in situ simultaneously. Each drain should be identified by location, (such as apical or basal) and date of insertion.1 The equipment required at the bedside includes: • Clamps (as per local protocol) • Bottle frame or carrier, which for most devices, is incorporated into an underwater seal drainage (UWSD) system • An observation chart to document monitoring • Tape to secure connections

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western nurse May–June 2018

Many patients with a pleural drain will require supplemental oxygen and are at high risk for respiratory compromise. A stethoscope and oxygen equipment such as nasal prongs, a facemask, or non-rebreather mask are recommended.

CARE FOR PATIENTS WITH AN UWSD When taking over the care of a patient with an UWSD, it is important to check that the system is intact. Assess all dressings and tubing connections to ensure they are patent and secure.1 Tubing should be loose, free, and long enough to allow comfortable patient movement.1 Particular notice must be taken of the clamps or taps in situ. Large bore catheters have clamps that must be open for the drain to function, but may be closed in an emergency situation. Smaller catheters often have a three way tap that may be opened or closed as required.1 On the drainage system, check that there is water in the underwater seal chamber and that the outlet from the drain is open (see Illustration 2). Suction tubing connected to wall suction may or may not be required and is prescribed by the medical officer.2 The use of wall suction with an UWSD is decreasing in many settings as it has been described as unreliable, and associated with an increased risk of trauma, and persistent air leaks.2,3 However, at times, wall suction may still be applied to encourage the removal of fluid and air, and re-establish negative pressure in the pleural space.1,2 The suction pressure is controlled on the UWSD or at the wall. Low wall suction at 20mmHg or 3Kpa is most common.2

TRANSFER OF CARE Specific verbal and written handover is required when transferring a patient with a pleural drain.1 The UWSD system should be kept below the patient’s chest at all times.

Clamps are to remain open throughout the transfer. If wall suction is in situ, medical advice may be required to guide patient care between wards, departments and facilities.1

CARE CONSIDERATIONS Patients with pleural drains require close monitoring. Four hourly vital signs, regular respiratory assessments, and pain management are recommended.1 Continuous pulse oximetry is essential. Observations related to the UWSD include suction, bubbling, the presence of an air leak, oscillation or swing, drainage amount and type, presence of surgical emphysema, air entry, and drainage connections.1 Air leak – The presence of an air exit or leak is manifested by bubbling in the underwater seal chamber. In many cases, including a large air leak, spontaneous exhalation or mechanical ventilation, the presence of a leak is normal.1 Bubbling also indicates that the collection of air is exiting the pleural space as planned. A sudden onset large air leak is a warning sign of a complication, such as a bronchopleural fistula. Sudden loss of an air leak also requires attention as it may suggest tube occlusion or disconnection.1 Oscillation or swing – Oscillation is the transient movement of the drainage fluid in the drainage tubing or collection canister.

It is a normal finding that occurs as a result of changes in intrathoracic pressure during breathing. A lack of oscillation may indicate that lung expansion is complete, that there is suction in situ, or that the tube is externally occluded, blocked, or dislodged.1 Drainage amount and type – Drainage amounts are a cumulative measure of the fluid volume that has been expelled from the pleural cavity. In post-operative patients, relatively small fluid losses over a short period of time may be significant, such as 100mls over one to two hours.1 In other patient populations, a litre of fluid may be drained before clamping is indicated.2 If fluid loss is less than expected, check tube patency to ensure there are no blockages or disconnections preventing drainage. The volume of fluid loss should decrease over time. The trend of fluid collection over 24 hours is often used to determine if tube removal is possible. Generally speaking, a loss of less than 400 to 500ml in 24 hours may indicate that it is safe to remove.2

Table 1. Types of pleural drainage.1

Drainage type Description Haemoserous

Blood and serum: red or pink, thin, watery, with or without blood clots

Haemopurulent Blood and purulent drainage: red or pink, milky, thick, with or without blood clots Purulent

Pus: white, yellow or green/grey tinged, milky, thick

Serous

Serum: pale yellow, thin, clear

Surgical emphysema – Surgical emphysema occurs when air enters beneath the subcutaneous layer of the skin.1 On palpation it feels like cracking or popping of air bubbles. If present, the extent of the surgical emphysema may be used to indicate improvement or deterioration (a reduction in surface area suggests healing). New or worsening cases may suggest the need for an additional pleural drain or the application of suction.1 Air entry – Auscultate the chest to determine if air entry is equal bilaterally, or if any adventitious sounds are present. Lung expansion should result in improved air entry to the affected side.

Absent breath sounds may suggest the drain is not patent or that the patient’s condition is deteriorating. Therefore, regular re-assessment and reporting is required.

Illustration 1 - Pleural drain

Catheter tip within pleural space Tube Drainage bag

Illustration 2 - An example of a three chamber under water seal drain

Atrium Drain

Drainage connections – Drainage connections include the insertion point, connections between the tubing, and the drain. The whole system should be checked regularly to identify and reinforce potential areas of complication.

EMERGENCY INTERVENTIONS If the intercostal catheter comes out  Apply gloves, pinch the wound edges together, call for help, and apply an occlusive dressing.

Notify the relevant medical practitioner and continue to monitor.

Suction control chamber

Disconnected tubing  Call for help, clamp the tubing closest to the patient, and reconnect a new system. Notify the relevant medical practitioner and continue to monitor.

REFERENCES 1. ACI Respiratory Network. Pleural drains in adults: a consensus statement. Chatswood: Agency for Clinical Innovation; 2016 Nov 2. 60p.

2. George RS, Papagiannopoulos, K. Advances in chest drain management in thoracic disease. J Thorac Dis. 2016 Feb;8(S1):S55-64.

3. The Royal Children’s Hospital Melbourne. Chest drain management [Internet]. Melbourne: The Royal Children’s Hospital; 2012 [cited 2016 Dec].

Available from: http://www.rch.org.au/rchcpg/ hospital_clinical_guideline_index/chest_drain_ management/

Water seal chamber

Collection chamber May–June 2018 western nurse |

17

ANF Out ‘N’ About

Sir Charles Gairdner Hospital patient support services attendants Wayne Martin, Patricia Furnell, David Tilley, Jerome Carlowe, Esther Kyawhtut and Jose Ombrasine

At western nurse we really get a kick out of giving our members prizes.

So, in this edition’s spread we’ve included some snaps of ANF members getting their prizes for the Out ‘N’ About photo comp, as well as our usual photos from hospital visits.

We are also launching the ANF Futures Survey competition – where you can win a top range Dyson vacuum cleaner or a dinner for two!

All you have to do is fill out the survey and you’re automatically entered, it’s that easy.

And if you’ve already done the survey, you’re already in the draw.

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western nurse May–June 2018

Of course, the ANF Out ‘N’ About photo competition is running as we speak – you don’t have to do anything for that comp except be in a photo when we come out and visit your workplace. Prizewinners will be drawn at the end of the year.

And the ANF Holiday Unit Photo Competition, where we award 10 prizes each month for the best snaps at one of the ANF Holiday Units, either in Margaret River or Kalbarri, is ongoing – with additional major prizes such as laptops, iPads and holidays in the big end-of-year prize draw. Upload your photo in the photo competition link in the iFolio’s resources section.

Hope to see you at one of our ANF workplace visits!

Graylands (rear) Beth Fletcher, Rachel Goad, Sapuna Poudel, Safuratu Bakare, Danica Knott, Hannah Coles (front) Kellie Calton, Giordan Buzza, Rachel Goodliffe, Georgia Seragusana

WINNERS

Fiona Stanley Hospital Ancy Georgekutty with her ANF prize, an iPad Mini, and Karen Mattioli's prize

St John of God Subiaco Joseph Mathew getting his Out 'N' About prize

Sir Charles Gairdner Hospital iPad Mini ANF prize winners Heather Simmonds, Denise Fairclough, Natalie Goodman and Bronwyn Innes

EXCITING OPPORTUNITY FOR REGISTERED NURSES We want enthusiastic and passionate registered nurses to provide in-home care to children with complex care needs.

A minimum of two years of experience is required, preferably in paediatrics or critical care.

We offer very flexible and reliable rosters for these casual positions.

For more information call Susan King on: 0413 372 943 or email your CV to: info@hannahshouse.org.au FOLLOW US ON FACEBOOK

hannahshouseperth

www.hannahshouse.org.au

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

May–June 2018 western nurse |

19

PLASTIC BAG BAN NOT A WORRY WE’VE GOT PLENTY OF THESE ANF FAVOURITES

AND COMING SOON …

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western nurse May–June 2018

Murray Valley encephalitis

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

INTRODUCTION Murray Valley encephalitis (MVE) is classed as a vector-borne disease because the virus is transmitted via mosquito bites.1,2 The virus belongs to the Japanese encephalitis serological complex of flaviviruses (see Box 1) and is the most serious endemic flavivirus in Australia.1,3 Most infections are mild but in some cases can cause severe brain infection leading to longterm disability or death.2 There is currently no vaccine and no definitive treatment for MVE. The most effective prevention method is preventing mosquito-bites.1-3 Box 1. Flavivirus

The Flavivirus genus belongs to the family Flaviviridae. It is transmitted by arthropods including ticks and mosquitoes. Mosquito-borne flaviviruses such as Yellow Fever, Dengue Fever, Japanese encephalitis, West Nile viruses, Zika virus, and Murray Valley encephalitis virus cause significant outbreaks in affected regions.

THE BURDEN OF DISEASE There were six large outbreaks of MVE virus in south-eastern Australia in the 1900s.1 Since then, MVE infections have continued to occur across Australia. It is believed that changes in human movement and settlement patterns as well as ecological factors influence the epidemiology of the virus in Australia.3 Apart from Australia, MVE virus is also endemic to Papua New Guinea and Irian Jaya.1

SOURCE AND ROUTE OF TRANSMISSION Murray Valley encephalitis is constantly present in some animal populations in northern Western Australia and the top end of the Northern Territory.1,3 This presence, or ‘enzootic foci’, is specific to a cycle between waterbirds, such as the Rufous Night Heron and mosquitoes, mainly the species Culex annulirostris. The virus also infects other animals such as horses,

kangaroos, and non-water birds. Yet the role of these animals in maintaining and transmitting the virus is unclear.1,2 Rainfall and flooding are thought to introduce infected waterbirds to new areas and disseminate disease.1,3 Mosquitoes become infected after feeding on infected waterbirds. Infected mosquitoes bite a human and transmit the virus.2 Culex annulirostris is most active at sunset, in the early evening, and around dawn.2 People visiting or living around wetlands or rivers in affected areas are at increased risk of acquiring infection.2 Infected people cannot transmit the virus to other people or to mosquitoes.2

DIAGNOSIS Serological tests showing an increased level of antibodies against the virus in blood or cerebrospinal fluid sample are suggestive of MVE. Sometimes, the polymerase chain reaction test can be used to detect virus nucleic acids in these samples.1,4

MANAGEMENT Treatment of MVE is supportive as no specific treatment is available. People with severe MVE should be transferred to a hospital with intensive care facilities.1,4

PREVENTION

CLINICAL SYMPTOMS asymptomatic.1,2

Most infections are The period between exposure to MVE virus and the appearance of the first symptoms (incubation period) is between one to four weeks, around two weeks on average.1 Initial symptoms include high fever (often >40°C), headache, and tiredness.1 Patients may present with nausea, vomiting, diarrhoea, macular rash and cough.

The virus can induce severe brain infection in some patients.2 Neurological features usually occur early and include lethargy, irritability, and confusion. Although seizures mostly occur in children, seizures may occur in adults.1

There is no vaccine against MVE.2 To prevent infection, people should protect against mosquito bites; • Use mosquito repellent and wear a long sleeved shirt and long pants when outdoors • Take special precautions when travelling or camping in affected areas and during peak mosquito biting hours • Eliminate mosquito breeding sites around the home, and screen windows and doors.2,4

PROGNOSIS People with a mild case will totally recover.

Progression of severe brain infection varies including the four clinical patterns described in Table 1.1 Although there are no clear predictive factors for clinical outcomes, poor outcomes tend to be common in the young or the elderly.1 People who survive MVE infection will probably develop life-long immunity.2 Table 1. Progression of severe MVE infection Progression Relentless progression to death Prominent spinal cord involvement causing flaccid paralysis

Proportion of cases 15%–30%

30%-50%

Cranial nerve/brainstem involvement and tremor Encephalitis followed by complete recovery

40%

REFERENCES 1. Knox J, Cowan RU, Doyle JS, et al. Murray Valley encephalitis: a review of clinical features, diagnosis and treatment. The Medical journal of Australia. 2012;196(5):322-326.

2. Centers for Disease Control and Prevention.

Murray Valley Encephalitis virus. 2013; https:// wwwnc.cdc.gov/travel/diseases/murray-valleyencephalitis-virus. Accessed 30 April, 2017.

3. Selvey LA, Dailey L, Lindsay M, et al. The Changing Epidemiology of Murray Valley Encephalitis in Australia: The 2011 Outbreak and a Review of the Literature. PLoS Neglected Tropical Diseases.

2014;8(1):e2656.

4. NSW Health. Murray Valley Encephalitis (MVE) fact sheet. Infectious Diseases 2016; http://www. health.nsw.gov.au/Infectious/factsheets/Pages/ Murray-Valley-Encephalitis.aspx. Accessed 30 April, 2017.

May–June 2018 western nurse |

21

AcrosstheNation NEWS, VIEWS AND GOSSIP FROM ALL OVER AUSTRALIA

NSW NEW CAT HEP RELATED TO HUMAN DISEASE The discovery of a new cat virus could shed light on hepatitis B in humans.

University of Sydney scientists discovered hepadnavirus in an immunocompromised feline and later in banked samples – and realised it’s in the same family as the hepatitis B virus that afflicts people.

“Apart from its relevance for feline health, this discovery helps us understand how hepatitis viruses – which can be deadly – are evolving in all species,” said Julia Beatty, Professor of Feline Medicine at the university, who co- authored the study of the research that was recently published in the journal Viruses.

“This is a very exciting discovery. Until now, we didn’t know that companion animals could get this type of infection. We obviously need to understand the impact of this infection on cat health.”

Professor Beatty said similar viruses could cause hepatitis and liver cancers in other species, but humans and other pets were not at risk from the new virus.

VIC FIBRE FIGHTS FLU Fibre may protect against the influenza virus – taking this basic dietary component well beyond its traditional role of maintaining intestinal health.

A Monash University study found that fibre fermented by bacteria in the gut of mice “countered influenza A”, one of the world’s most common viral diseases.

Monash said the findings “suggest that fermented fibre and byproducts of this process, called shortchain fatty acids (SCFAs), could be investigated further for potential use in preventing and treating viral infections, including the flu”.

QLD ZIKA MOSQUITO DETECTOR A LIFE SAVER Mosquitos infected with the Zika virus can now be detected faster than ever before with a potentially life-saving tool developed by Australian scientists.

Near Infrared Spectroscopy (NIRS) is “18-times faster and 110times cheaper than the current detection method”, according to the researchers who uncovered the method – Dr Maggy SikuluLord and Dr Jill Fernandes, of the University of Queensland.

“We can quickly identify mosquitoes that are infected with Zika virus so public health authorities can treat affected areas before disease spreads to humans,” Dr Sikulu-Lord said.

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western nurse May–June 2018

Her team found the virus in a feline immunodeficiency virus (FIV) positive cat that died of lymphoma – a common cancer in cats.

They then tested stored blood samples from adult pet cats and found evidence of infection with the hepadnavirus even in the banked samples.

The new virus was identified in 10 percent of the FIV-infected cats and 3.2 percent of non-FIV infected cats. 

They might also be used as a “supplement to improve the efficacy of the flu vaccine”. Additionally, the results could have potential in the treatment of other viruses.

“What is produced in the gut doesn’t just change what’s in the gut,” said Professor Benjamin Marsland from Monash’s Department of Immunology, one of the researchers who did the work, whose findings were published in the journal Immunity in May. “It goes into the circulation and changes the immune system at one of the most fundamental levels – the bone marrow – where a lot of our immune cells develop.”

Professor Marsland and other researchers have previously found that mice fed a high fermentable fibre diet were protected against asthma. 

“It only involves shining a beam of light onto mosquitoes and using that information to determine if the mosquito is infected.

“This is definitely going to be a game-changer in disease surveillance … we hope public health authorities can use it to predict future disease outbreaks and save lives by treating mosquito populations in time, especially in the prediction of disease outbreaks.”

Dr Sikulu-Lord hopes the World Health Organization will use NIRS in countries where the virus – which can cause abnormalities in unborn babies and is linked to the rare paralysing condition called GuillainBarre Syndrome (GBS) – is endemic.

She said the technology potentially could also detect other diseases and they hoped to have results for detecting dengue and malaria in mosquitoes in the coming months. 

SA TRYING TO GET PREGNANT – PUT THE BURGER DOWN

For those who ate fast food four or more times a week, the risk of infertility increased from 8 per cent to 16 per cent.

Women who frequently feast on fast food or neglect fresh fruit take longer to conceive than their healthier eating counterparts.

“We recommend that women who want to become pregnant should align their dietary intakes towards national dietary recommendations for pregnancy. Our data shows that frequent consumption of fast foods delays time to pregnancy,” said Dr Jessica Grieger, postdoctoral research fellow at the university and first author of the study recently published in in the journal Human Reproduction. 

This is the conclusion of University of Adelaide researchers who spoke to 5598 women in Australia, New Zealand, the UK and Ireland about their diet.

They said women who ate fruit less than one to three times a month took half a month longer to become pregnant, compared with women who ate fruit three or more times a day in the month before conception.

Those consuming fast food four or more times weekly took nearly a month longer to become pregnant than women who never or rarely ate fast food.

Among the participants, 468 (8 per cent) were classified as “infertile” which was defined in the study as “taking longer than a year to conceive”.

The researchers found that in women with the lowest fruit intake the risk of infertility (as defined in the study) increased from 8 per cent to 12 per cent.

WA HIGH BLOOD PRESSURE AFFLICTS ONE IN THREE More than a third of people have high blood pressure – but many don’t know they have the condition that contributes to more than 10 million deaths yearly.

Among subjects observed in a global study, 34.5 per cent had elevated blood pressure – above 140/90mmHg. University of WA and the Royal Perth Hospital Medical Research Foundation researchers found that 17 per cent of those sufferers were not receiving treatment.

About 46 per cent were receiving treatment, but still had “uncontrolled blood pressure”.

VIC ‘SMART SOCKS’ HELPING TREAT REGIONAL PATIENTS

The researchers analysed data collected from 1.2 million of people aged 18 and older from 80 countries.

“What’s really alarming is that almost half of the people who were already being treated for hypertension still had blood pressure above recommended levels,” said UWA Professor Markus Schlaich, Australasia’s lead author of the study that was published in the medical journal LANCET Global Health in May. “In other words, half of the world’s high blood pressure patients are inadequately treated.

This is despite the availability of numerous blood pressure lowering medications and is largely due to people not taking the medication, because they have had side effects or worry that they will have side effects.” 

Her father injured his ankle in his small Indian hometown and was unable to seek professional treatment due to the cost of travelling to a city.

Ms Aggarwal said: “What was lacking in video consultations was the ability to observe the subtle differences in patients’ lower limb movements, such as shifts in weight distribution and range of foot movements.

Socks embedded with sensors are facilitating better diagnosis and treatment of injured people in remote areas.

The ‘smart socks’ are providing real-time information on the lower body movements of patients to physiotherapists who may be located great distances away and are relying on video consultations.

“This meant that physiotherapists had limited understanding of the patient’s actual recovery, leading to less specific treatment. The physiotherapists were also reluctant to try out new exercises with the patients over video.”

SoPhy consists of a pair of socks embedded with three sensors that capture information about weight distribution, range of movement and foot orientation for the patient’s lower limb movements.

Deepti Aggarwal with her"smart socks"

The invention by University of Melbourne PhD candidate Deepti Aggarwal, is called SoPhy and it was inspired by her observations of physiotherapists at the Royal Children’s Hospital and her father’s experience.

The socks are then coupled with a web-interface that presents the captured information to physiotherapists using foot sketches.  May–June 2018 western nurse |

23

The urinary system: Assessing renal and bladder function Read this article and complete the online quiz to earn 1 iFolio hour

Renal and bladder function are important indicators of overall health and wellbeing.

Urine characteristics are used to identify clinical conditions such as electrolyte imbalances, hyperglycaemia, and urinary tract infections.1,2 The volume of fluid output is an important indicator for a wide range of conditions including dehydration, hypovolaemia, sepsis, and shock.1,2 Evaluation of intake and output, as in fluid balance monitoring, is also commonly used to manage particular patient populations, especially post-operative patients and those with heart failure.1,2 Therefore, the ability to perform a comprehensive renal and bladder assessment is an essential skill for all nurses in primary and acute healthcare and aged care settings.

ANATOMY AND PHYSIOLOGY The urinary system is comprised of the kidneys, ureters, bladder, and urethra (see Illustrations 1 and 2).1,2 As a whole, it contributes to homeostasis through regulating blood volume, blood pressure, and blood glucose, and ensuring the appropriate excretion of waste.1,2 The kidneys are a pair of fist-sized, bean shaped organs found in the retroperitoneal space behind the abdominal contents.1,2 They filter blood and extracellular fluid, and produce hormones, such as calcitriol and erythropoietin.2 Once filtered, urine leaves the kidneys through the ureters. The ureters are muscular tubes, 24 to 30cm long and approximately four millimetres in diameter. Movement of urine through the tubes into the bladder is stimulated by peristalsis.1 The bladder is a round, hollow muscular organ responsible for storing urine.1 In adults, normal bladder capacity is 300 to 400mL.3 Normal micturition (a term used synonymously with ‘urination’) occurs eight times per day with urine exiting the bladder via the urethra.1-3 In males, the urethra is as long as the ureters and passes through the prostate and penis to allow for urination.1 In females, the urethra is shorter and smaller in diameter than

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Table 1. Typical volumes of human fluid intake and output in healthy adults.4 Fluid

Volume

Oral intake (food and drinks)

+2000mL/day

Urine output

1mL/kg/hr (eg 1440mL/day for 60kg person)

Faeces

-100mL/day

Perspiration

-200mL/day

the ureters. The entire tube, as well as the bladder neck, external urethral sphincter, and pelvic floor muscles contract to assist with continence.1,3

SUBJECTIVE ASSESSMENT Subjective assessment of the urinary system involves a discussion between the patient and practitioner regarding the history of the problem and presenting signs and symptoms.1 Presenting concern. Did the patient present with a urinary problem? Do they describe abnormal urine characteristics, volumes, or function?

Usual urinary pattern. How often does the patient usually go to the toilet to urinate? Do they often empty their bladder over night?

Fluid intake. How much fluid has the patient consumed in the past 24 hours? Are they experiencing thirst? It is often difficult for individuals to accurately estimate the fluid they’ve consumed in one day. For hospital inpatients, a 24-hour fluid balance chart may be required to accurately monitor intake.

Past medical history. Does the patient or close relatives have a history of urinary or renal complications, such as recurrent infections, urinary stones, or renal cancer? Do they suffer from any other conditions that may affect renal function, such as diabetes? Are they on any medications that may affect the urinary system? For females of reproductive age, is she pregnant?

Pain. Does the patient have pain? What is the nature and severity of pain? Are there any contributing or alleviating factors?

Symptoms. Does the patient complain of symptoms associated with renal function?

How long have the symptoms been present?

Are there any related symptoms such as fever, lethargy, or peripheral oedema?

OBJECTIVE ASSESSMENT Objective assessment of the urinary system includes vital signs, abdominal examination, assessment of urine, and fluid balance charts.1 Blood pressure, temperature, and the presence of pain are particularly important vital signs.

Fever and hypotension may indicate infection and sepsis, while hypertension is associated with renal failure.1 Abdominal assessment via inspection, percussion, and palpation may help to identify renal complications. Non-invasive investigation using a portable bladder scanner may also be useful for identifying bladder volume and postvoid residual urine volumes.1 Box 1. Post-void residual urine volume Post-void residual urine volume is the amount of urine left in the bladder after micturation and is typically less than 100mL. Greater volumes are suggestive of retention and may increase the risk of infection, hydronephrosis, and renal insufficiency.1 Urine characteristics include volume, colour, clarity, and odour.1 Normal urine is clear, yellow, and odourless. Signs of infection include concentrated urine, as well as the presence of sediment and foul odour.1 In non-catheterised patients, urine samples are collected in a clean container. For those with an indwelling catheter in situ, samples are collected from the sampling port on the tube rather than the collection canister.1 Urine cultures are sent

Illustration 1 - Female urinary system

to the laboratory to assess for bacterial or fungal growth. A spot urinalysis may also be performed to obtain additional information about bladder and kidney function, and overall health.1 In healthy humans, fluid intake is equal to output.4 In patients at risk of complications, fluid balance charts may be used to monitor fluid balance. Total fluid intake includes food and drinks, parenteral or intravenous fluids including maintenance fluids, intermittent medications, and flushes, and enteral fluids

Illustration 1 - Male urinary system

administered through feeding tubes.4 Output includes urine output, faeces, perspiration, gastric secretions, wound and drain losses, and respiratory secretions (see Table 1).4 It is impossible to measure insensible losses such as perspiration; however, estimates are acceptable in diaphoretic patients.

LOWER URINARY TRACT SYMPTOMS Lower urinary tract symptoms occur as a result of abnormal urine storage, voiding, or

complications post-micturition (see Table 2). They are caused by a range of conditions including an overactive bladder, bladder outlet obstruction, interstitial cystitis, urinary tract infection, and bladder cancer.3 Many people who experience these symptoms fail to report them to a healthcare professional, which results in the progression of symptoms and recurrence of infections.3 Education, awareness, and assessment of all patients is required to address individual patient symptoms and improve overall bladder health of the entire population.

Table 2. Lower urinary tract symptoms.3 Symptom

Description

Urgency

Sudden need to urinate

Frequency

Need to urinate often

Nocturia

Frequent need to pass urine in the night

Incontinence

Poor bladder control

Slow stream

Slow passing of urine

Splitting

Urine divides into multiple streams

Intermittent stream

Starting and stopping of urination

Hesitancy

Delay between trying to urinate and commencing urination

Straining

Increased pressure required to commence urination

Terminal dribble

Persistent drops of urine at the end of urination

Post micturition dribble

Involuntary loss of small volumes of urine after voiding

Incomplete emptying

Post-void residual urine volume

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

2. Rhoades RA, Bell DR, editors. Medical Physiology: Principles for Clinical Medicine. 4th edition.

Baltimore, MD: Lippincott Williams & Wilkins; 2013. 820p.

3. Lukacz ES, Sampselle C, Gray M, MacDiarmid S, Rosenberg M, Ellsworth P, Palmer MH. A healthy bladder: a consensus statement. Int J Clin Pract.

2011 Oct;65(10):1026-36.

4. Lister S, Dougherty L. The Royal Marsden manual of clinical nursing procedures. Hoboken: Wiley; 2015 Mar 5. 231p.

May–June 2018 western nurse |

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AroundtheGlobe WORLD NEWS

BONE DISEASE BALM BATTLES BALDNESS

Baldness may soon be curable – thanks to an anti-osteoporosis drug.

The compound WAY-316606 has a “dramatic stimulatory effect on human hair follicles donated by patients undergoing hair transplantation surgery”, according to University of Manchester researchers.

They started a study on possible treatments by examining another drug, Cyclosporine A (CsA), which is used to suppress transplant rejection and autoimmune diseases, and has the side effect of unwanted hair growth, but also other more detrimental outcomes.

They found that CsA suppresses SFRP1, which is a protein inhibiting development and growth of hair follicles.

The researchers – Dr Nathan Hawkshaw and colleagues from the university’s Centre for Dermatology Research – then found the osteoporosis treatment WAY-316606 acted similarly, also “antagonising SFRP1”, thus also enhancing human hair growth.

“This new agent … could one day make a real difference to people who suffer from hair loss,” said Dr Hawkshaw of the findings published in the journal PLOS Biology in May. “(But) a clinical trial is required next to tell us whether this drug or similar compounds are both effective and safe in hair loss patients.”

The university said only two other drugs – minoxidil and finasteride – are available for male-pattern balding treatment but both have moderate side effects and often produce “disappointing” regrowth results. 

EXTREME WEIGHT LOSS JAB

Those hormones are reproduced by the new therapy – which mirrors the lap band effect without surgery.

Losing more than 7kg a month could soon be as easy as a regular injection that replicates the effects of lap band surgery.

Lead researcher Professor Sir Steve Bloom was reported in The Telegraph as saying he hoped to create a therapy as effective as bariatric surgery, but which could be given “as a small painless monthly injection”.

Candidates in a UK study lost between 1.8kg and 7.6kg after ingesting three different types of hormones for 28 days through a patch and a pump.

The 20 candidates ate 30 per cent less food after being treated with the hormonal mixture, during the Imperial College trial, according to London’s The Telegraph.

Gastric band surgery was initially thought to work solely by reducing amounts of food that could be held in one’s stomach.

But band recipients also have higher levels of “satiety hormones, the chemical signals released by the gut to control digestion and hunger cravings in the brain”, and start preferring less fatty foods.

HISTORIC HEADACHE FROM WORLD’S MOST PUNGENT PEPPER Eating the hottest chilli pepper in the world has landed a healthy 34-year-old man in a US hospital emergency room – and cemented his place in medical history.

His case of “thunderclap headache secondary to reversible cerebral vasoconstriction syndrome” made it into the medical journal BMJ Case Reports in April, because doctors have never before identified peppers to be a cause of the condition.

“His symptoms began with dry heaves but no vomiting immediately after participation in a hot pepper contest where he ate one ‘Carolina Reaper,’ the hottest chilli pepper in the world,” said the journal.

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western nurse May–June 2018

BEFO RE

A F TE R

“It is going to be the most exciting agent for improving health that has yet been discovered,” said Prof Bloom, who heads Imperial’s diabetes, endocrinology and metabolism division. 

Intense neck and occipital head pain then hit him, and in the next few days “he experienced brief intense thunderclap headaches”, with the “excruciating” pain eventually forcing him to attend the ER. He was diagnosed with “thunderclap headache secondary to reversible cerebral vasoconstriction syndrome (RCVS)”, based on his severe acute headache and after a CT angiography showed no aneurysm but revealed “segmental cerebral arterial vasoconstriction”.

After five weeks his symptoms subsided, and a subsequent CT angiography showed his “luminal narrowing consistent with RCVS” had gone.

The medicos said no cases of RCVS caused by peppers or cayenne had previously been reported, but because the symptoms developed soon after he chowed down on the chilli, “it is plausible that our patient had RCVS secondary to the ‘Carolina Reaper’”.

The researchers added that “treatment is observation and removal of the offending agent” – in other words, lay off the chillies. 

HUMANS’ BEDS GRUBBIER THAN CHIMPS’ Chimpanzees’ beds are less likely to contain “fecal, oral or skin bacteria” than human ones, according to a US study.

“We know that human homes are effectively their own ecosystems, and human beds often contain a subset of the taxa – or types – of organisms found in the home,” said Megan Thoemmes, who is lead author of a paper published about the study and a North Carolina State University PhD student.

“For example, about 35 percent of bacteria in human beds stem from our own bodies, including fecal, oral and skin bacteria.

“We wanted to know how this compares with some of our closest evolutionary relatives, the chimpanzees, which make their own beds daily.”

She got her answer after researchers collected swabs of 41 chimpanzee beds and nests in Tanzania, which were then tested for microbial biodiversity.

The chimp beds had very different biodiversity from human ones – with “a greater diversity of microbes”, and types of microbial life reflecting “the arboreal environments where the nests were found”.

“However, chimpanzee beds were much less likely to harbor fecal, oral or skin bacteria,” said a statement released by the university in May. Thoemmes added: “We found almost none of those microbes in the chimpanzee nests, which was a little surprising.

“We also expected to see a significant number of arthropod parasites, but we didn’t.

“There were only four ectoparasites found, across all the nests we looked at. And that’s four individual specimens, not four different species.

“In some ways, our attempts to create a clean environment for ourselves may actually make our surroundings less ideal.” 

HOT AIR DRYERS ARE BACTERIAL HOT BEDS Hot-air dryers in toilets are spreading bacteria from toilet bowls to your hands, a study has found.

And “bacterial/spore deposition by hand dryers is a possible mechanism for spread of infectious bacteria, including spores of potential pathogens if present”, is the warning given by the University of Connecticut researchers who did the work.

“In most institutions, toilets don’t have lids and when you flush them you get a little bit of an aerosol. The hand dryers grab that air in the bathroom and accelerate it,” Dr Peter Setlow, one of the study’s authors, a molecular biology and biophysics professor at UConn Health, told NBC Connecticut.

The researchers screened dryers in multiple men’s and women’s bathrooms in three science research areas in an academic health center.

“Plates exposed to hand dryer air for 30 (seconds) averaged 18 to 60 (bacterial) colonies/plate,” the researchers said earlier this year in the journal Applied and Environmental Microbiology.

But plates exposed to bathroom air for two minutes “with hand dryers off” averaged less than, or equal to, only one colony.

On the other hand, plates exposed to bathroom air moved by a small fan for 20 minutes averaged 15 and 12 colonies per plate in two buildings.

“These results indicate that many kinds of bacteria, including potential pathogens and spores, can be deposited on hands exposed to bathroom hand dryers and that spores could be dispersed throughout buildings,” the researchers said.

They added that: “This study has implications for the control of opportunistic bacterial pathogens and spores in public environments including health care settings.”  May–June 2018 western nurse |

27

Recipe CHICKEN RENDANG Intensely aromatic and deeply flavourful, rendang is the stuff that true food love is made of. This dish originates from Indonesia, but is also widely served among the Malay community. Beef is commonly used for rendang, but chicken is a lighter and equally delicious option.

Rendang is made by slow-cooking meat in coconut milk and a mix of spices. The result is an amazingly tender, fragrant, and delicious thick stew you won’t soon forget.

Rendang is great for family meals and potlucks as it’s easy to double up the recipe to your needs. Its flavour also deepens with each day so it’s great to make ahead, cook in batches, and store for a rainy day. As if those are not enough reasons to try this recipe, rendang also cooks in one pot!

Learn to make this legendary dish that’s been named one of the world’s 50 best foods by CNN.

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

28 |

western nurse May–June 2018

INGREDIENTS

INSTRUCTIONS

• 1 whole chicken, chopped into pieces • 410ml coconut milk • 4 kaffir lime leaves • 1 lemongrass stalk, sliced

lengthways • 5 tbsp vegetable oil

1. Blend the spice paste ingredients in a mini food processor.

RENDANG SPICE PASTE

3. Add the chicken, lemongrass stalk, and kaffir lime leaves to the tagine. Mix to coat the chicken in the spice paste then add the coconut milk.

• 10 red chillies, deseeded • 15 dried chillies, softened in warm water then drained • 10 candlenuts • 5 garlic cloves • 3 red onions • 2 lemongrass stalks, sliced • 2cm fresh turmeric • 2cm piece of ginger • 3 kaffir lime leaves • 1 tsp of sugar

2. Add the vegetable oil to the tagine and heat over a low heat until it starts to warm.

Add the spice paste and fry until it becomes aromatic.

4. Cover the tagine with the lid and simmer for 20 minutes.

5. Use a spatula to stir the rendang. Cover it again and allow to simmer for another 25 minutes or until the oil separates.

6. Remove the lid and simmer until all the liquid evaporates and only the chicken and spice mix remain.

EQUIPMENT

7. Serve with steamed white rice and a refreshing cucumber raita on the side.

• Emile Henry tagine • Mini food processor • Spoon or spatula

Recipe adapted from Emile Henry Australia and published courtesy of Kitchen Warehouse.

May–June 2018 western nurse |

29

ResearchRoundup LATEST AND GREATEST FROM SCIENCE

PIGS’ BRAINS KEPT ALIVE OUTSIDE THEIR BODIES Brains of decapitated pigs have been kept “alive” for up to 36 hours by US scientists.

Dr Fuller said the findings, published in the American Journal of Clinical Nutrition in May, are important due to the potential health benefits of eggs for people with pre-diabetes and type 2 diabetes, “as well as the general population”. 

Yale University neuroscientist Nenad Sestan revealed at a National Institutes of Health meeting in March that his team had restored circulation in pig brains outside their bodies “using a system of pumps, heaters, and bags of artificial blood warmed to body temperature”.

The disembodied brains did not regain consciousness, but “billions of individual cells in the brains were found to be healthy and capable of normal activity”, the MIT Technology Review reported.

Professor Sestan reportedly said the technique was likely to work in any species, including primates.

He also said disembodied human brains could become guinea pigs for testing exotic cancer cures and speculative Alzheimer’s treatments that are too dangerous to try on the living.

A previous attempt at artificially maintaining a brain separated from its body involved guinea pigs, but Professor Sestan’s team “is the first to achieve it with a large mammal, without using cold temperatures, and with such promising results”, the Review said.

But Steve Hyman, director of psychiatric research at Massachusetts’ Broad Institute, said this work could “cause some to mistakenly view the technology as a way to avoid death”, when transplanting a brain into a new body “is not remotely possible”. 

EGGS NOT BAD FOR THE HEART Eating up to a dozen eggs weekly doesn’t put you at extra risk of heart disease – even if you have pre-diabetes or type 2 diabetes, according to new Australian research.

Participants with pre-diabetes or type 2 diabetes were put on a high-egg (12 eggs per week) or low-egg (less than two eggs per week) diet for 12 months.

Neither group showed “adverse changes in cardiovascular risk markers and achieved equivalent weight loss – regardless of their level of egg consumption”, according to the study’s lead author, the University of Sydney’s Dr Nick Fuller.

“Despite differing advice around safe levels of egg consumption for people with pre-diabetes and type 2 diabetes, our research indicates people do not need to hold back from eating eggs if this is part of a healthy diet,” Dr Fuller said.

“While eggs themselves are high in dietary cholesterol – and people with type 2 diabetes tend to have higher levels of the ‘bad’ low density lipoprotein (LDL) cholesterol – this study supports existing research that shows consumption of eggs has little effect on the levels of cholesterol in the blood of the people eating them.”

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western nurse May–June 2018

EUROVISION BOOSTS NATIONAL CONTENTMENT Participation in the Eurovision Song Contest is being linked to increases in a nation’s “life satisfaction”.

Imperial College London scientists found “people were four per cent more likely to be satisfied with their life for every increase of ten places on the final score board - e.g. their country finishing 2nd rather than 12th”.

Even doing badly “was associated with a greater increase in life satisfaction compared to not taking part at all”, Imperial said of the study that analysed data from more than 160,000 people from 33 European countries, and was published in the journal BMC Public Health in May. The researchers – who used data collected in the Eurovision period of May and June, between 2009 and 2015 – said the findings are in tune with previous research that show success in big events, such as sporting fixtures, “can boost a nation’s health and well-being”.

“Our ‘day job’ involves investigating the effect of public policies, environmental factors and economic conditions on people’s lifestyle and health,” said lead author of the research, Dr Filippos Filippidis, from Imperial’s School of Public Health, . “Around the time of the Eurovision Song Contest we were chatting about whether the competition could also affect a country’s national wellbeing. We looked into it and were surprised to see there may be a link.” 

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IN A ‘LIMITED EDITION’ BLU-RAY PACKAGE! “The Last Jedi delivers everything you want from a Star Wars movie – fierce lightsaber action, space dogfights, exotic creatures,” said Ian Freer, author and senior reviewer for respected UK film magazine Empire, when describing this blockbuster at the time of its cinematic release in December.

But the film is not merely thrills based special effects, and Freer adds all that comes with “story twists, character arcs and an emotional wallop that you could never have predicted”.

We also reckon Star Wars: The Last Jedi is a ripper – so we wanted to give ANF members a shot at winning one of 30 special Blu-ray copies.

These little beauties we are giving away are two-disc versions with all sorts of extra features, and if you’re a bit of a Star Wars fan, you’ll be enthused to learn they come in the limited edition 'The Resistance' sleeve.

Directed by Rian Johnson, the storyline of the eighth episode in this legendary series picks up after 2015’s Star Wars: The Force Awakens. Supreme Leader

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Freer’s Empire review says: “This is not going to go the way you think!” Luke Skywalker warns Rey on the Jedi Temple island of Ahch-To”, and that statement is correct for both Rey and the audience alike.

Freer continues that instead of Episode VIII starting with the “lightsaber handover” expected by some, it “launches into a breakneck sequence of the Resistance evacuating their base as the First Order attack”, and that “Out of the melee, everyone gets more to do” in this film than the previous installment.

“Even BB-8 gets bigger action licks rather than cute comedy asides,” exemplifies Freer.

Freer’s evaluation concludes thus: “If The Force Awakens raised a lot of questions, this tackles them head-on. Fun, funny but with emotional heft, this is a mouth-watering set-up for Episode IX and a fitting tribute to Carrie Fisher.” western nurse concurs!  To enter this competition just log on to your iFolio.

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