Health Times April 2017

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Southern Way

THE ATRE

NURSES...

RE ADY FOR YOUR SHIF T?

T

o a rent that leaves plenty for lifestyle, to a community spirit that’s welcoming, to a historic city that’s rich in culture. It’s all here in Dunedin.

Right now Southern DHB has exciting openings at Dunedin Hospital for experienced theatre nurses to join our perioperative team. With nine main operating theatres and two day surgery theatres providing tertiary level elective and acute surgery, you’ll have the opportunity to either showcase or develop your skills in a wide range of surgical specialties. So if you want to move up in your nursing career and get ahead in life, make the move South. To apply please visit our website: www.southerndhb.govt.nz/careers

For further information please contact Kylie Edwards, Recruitment Advisor – Surgical Directorate. Phone: 03 470 9571 or Email: kylie.edwards@southerndhb.govt.nz

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MOVE SOUTH. MOVE UP.


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Advance your nursing career online

Find your speciality with further study. Study with one of Australia’s leading providers of online postgraduate nursing education with over 20 specialisations to choose from. We provide you with more choice and more flexibility to pursue a specialist practice in a variety of clinical areas. There are pathways and exit points to suit professionals at any stage of their career with online and part-time options. Start your studies this July 2017.

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HealthTimes - April 2017 | Page 03


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April 2017 We hope you enjoy perusing the range of opportunities included in this Issue. If you are interested in pursuing any of these opportunities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or would like to receive our publication, please email us at contact@healthtimes.com.au

Advertiser list Austra Health Australian Bridge Federation Australian Catholic University Australian Medicines Handbook CCM Recruitment International

DISTRIBUTION 46,300

Forensicare

The HealthTimes magazine is the most widely distributed national nursing and allied health publication in Australia. For all advertising and production enquiries please contact us by telephone on 1300 306 582, email contact@healthtimes.com.au or visit www.healthtimes.com.au Published by Seabreeze Communications Pty Ltd trading as HealthTimes. ABN 29 071 328 053. Š 2017 Seabreeze Communications Pty Ltd. All right reserved. No part of this publication may be copied or reproduced by any means without the prior written permission of the publisher. Compliance with the Trade Practices Act 1974 of advertisements contained in this publication is the responsibility of those who submit the advertisement for publication.

Next Publication: Aged Care Publication Date:

Monday 29th of May 2017

Artwork Deadline:

Monday 22nd of May 2017

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Medacs Healthcare Australia NSW Health - Northern Sydney LHD Oceania University of Medicine Officeworks Pulse Staffing Quick and Easy Finance SkinScience Smart Salary Southern District Health Board University of Derby University of Tasmania WA Country Health Service


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HealthTimes - April 2017 | Page 05


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Aesthetic Training Australia www.aesthetictrainingaustralia.com

We provide students with a programme that leads to real opportunities and excellent understanding of Aesthetic procedures. Our trainers and staff provide students with knowledge and ongoing support vital to success in this field. On successful completion of the Cosmetic Injectables Workshop each delegate will be competent in the delivery of basic techniques to treat with Botulinum Toxin and Dermal Fillers. Skin Science now offer one day workshops in Sclerotherapy and Platelet Rich Plasma therapy. Expand your clinical skills as a healthcare professional. Enjoy additional income by offering rewarding treatments that can improve clients self esteem. Upcoming workshops: Cosmetic Injectable workshops (3 Day) 31 July, 1 & 2 August 2017 11, 12 & 13 September 2017 23, 24 & 25 October 2017 4, 5 & 6 December 2017 Sclerotherapy workshop: (1Day) 9 June 2017 4 September 2017 Platelet Rich Plasma Therapy (1 Day) Mon 9 October Visit www.aesthetictrainingaustralia.com for more information, call 1300 817 524 or email info@skinscience.co

Purple House nurse one of HESTA award finalists A remote area nurse who transformed dialysis services for Aboriginal people in central Australia is one of 12 finalists announced for the 2017 HESTA Australian Nursing and Midwifery Awards. Sarah Brown, a non-Indigenous nurse who was born in England and grew up in Queensland, helped establish the Alice Springs-based Western Desert Dialysis, known as Purple House. Purple House provides renal dialysis six days a week, social support and allied health services, but it’s also a place that patients can call their own - and make bush medicine, cook damper and kangaroo tails on a camp fire, and organise hunting trips. The Aboriginal community-controlled venture has 24 dialysis machines at 11 places, from Wanarn and Warburton in Western Australia to Yirrkala in Arnhem Land. It also has a mobile dialysis unit, the Purple Truck, which rolls out to visit other remote communities. Now in its 11th year, the annual awards recognise the outstanding contribution of graduates, individuals and teams for their professionalism, innovation and care across a range of health settings. HESTA CEO Debby Blakey said finalists were selected from an exceptional field of nominations, demonstrating the highest standards of care, ongoing commitment and innovative practices. “This year’s finalists demonstrate the profound impact individuals and teams have on the communities they operate in and the patients they care for,” she said.

for the full article visit HealthTimes.com.au Page 06| www.HealthTimes.com.au


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Mental Health Nursing Opportunities Are you an experienced registered nurse interested in advancing you career in mental health nursing? Royal North Shore Hospital is part of the Northern Sydney Local Health District, located in the trendy lower north shore suburb of St Leonards. The Mental Health service at Royal North Shore Hospital currently has a range of exciting career opportunities for experienced nurses working across the Mental Health Inpatient Unit, Psychiatric Emergency Care Centre and the Emergency Department in brand new purpose built facilities. The current full time leadership vacancies include: - Clinical Nurse Consultant Level 2 - Clinical Nurse Educator - Clinical Nurse Specialist Level 2 As part of your position Northern Sydney Local Health District offers salary packaging, education support and professional development opportunities and short term accommodation (subject to availability). To find out more about these exciting career opportunities come and visit the unit and meet the staff or if you wish to apply for a position contact us today! Contact: Alison Sutton (Inpatient Services Manager) Phone: 0404 026 516 Email: Alison.Sutton@health.nsw.gov.au https://facebook.com/nslhd.mhda http://www.nslhd.health.nsw.gov.au/ We look forward to welcoming you into our friendly and supportive team!

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More and more, people are choosing the salary packaging specialists at Smartsalary to help them make their pay packet go further, whether they’re spending a little or a lot. That’s because Smartsalary does salary packaging differently: customers are at the centre of everything they do -and they have the awards to prove it -so when people choose Smartsalary, they stay. Making set-up and management of your benefits easy Mobile apps and online tools for easy claims on the go Fast payment with funds in your bank account within 48 hours Award-winning customer service when and where you need it Exclusive discounts across a range of national retailers

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OPTIMISING FETAL WELLBEING CONFERENCE NOVOTEL MELBOURNE - 6 MAY 2017 For more information and to book tickets, go to Bit.do/fetal

Enquiries: Contact HealthTimes 1300 306 582 contact@healthtimes.com.au

STARTING WITH INTERNATIONAL DAY OF THE MIDWIFE WALK FROM FEDERATION SQUARE

PROGRAM & SPEAKERS INCLUDE Optimising fetal wellbeing with a positive birth environment & the provision of midwifery continuity of care Professor Maralyn Foureur, Professor of Midwifery, UTS Lessons learnt from CCOPMM’s review of perinatal outcomes in Victoria Professor Jeremy Oats, Chair Consultative Council on Obstetric and Paediatric Mortality & Morbidity (CCOPMM) Protecting fetal wellbeing through use of appropriate fetal surveillance Mark Beaves, Manager, Fetal Surveillance Education Program RANZCOG Care of the critically ill pregnant woman and optimising the wellbeing of her fetus Dr Wendy Pollock, Critical care nurse and midwife; honorary Senior Fellow, Department of Nursing, University of Melbourne

HealthTimes - April 2017 | Page 09


Education that cares for nurses and midwives

W

ant to try mindfulness to combat workplace or home pressures, improve your sleep, or step up your level of activity? Need help with addiction, such as alcohol, drugs or gambling, or with stress, anxiety, depression or post-traumatic stress disorder (PTSD), with diabetes, chronic pain or menopause, or with compassion fatigue or workplace violence? A new national service, Nurse & Midwife Support, features online education and provides an aroundthe-clock telephone support and referral service specifically d e s i g n e d for nurses, midwives, students, employers, educators, or concerned friends or relatives. Mark Aitken, a registered nurse of 30 years and stakeholder engagement officer at Nurse & Midwife Support, says the site provides Australia’s 380,000 nurses and midwives with the latest educational resources from leading health organisations. “We encourage nurses and midwives to engage in health promotion, so take responsibility for your own health and wellbeing - eating well, getting enough rest, getting enough hydration, and getting enough exercise,” he says. “Some nurses and midwives will probably laugh at that because clinical nursing is a

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very physical job, and nurses and midwives are walking around virtually their entire shift providing care, so that if you put a pedometer on them they probably cover a lot of kilometres, but I think there’s other exercises that nurses and midwives need to engage in, if they are not already, to stay healthy. “Our tag line is - your health matters. I really like that because it kind of says to me as a nurse that just as the health of my patients is important - so is mine, and it reminds me that I need to take care of that, and I need to take care of the health of my colleagues when I am able to or when they seek support and assistance.” The website features information and tips on staying healthy, addiction, workplace issues, mental health, life, professional obligation, and accessing support. It also provides information for nurses, midwives and students in LGBTI (lesbian, gay, bisexual, trans, and/or intersex), culturally and linguistically diverse (CALD), rural and remote, or Aboriginal and Torres Strait Islander communities. Importantly, the service is designed to ensure nurses and midwives can continue to provide professional, safe and quality care to patients. Nurse & Midwife Support is the first national dedicated telephone and online service that provides confidential advice and referral to nurses and midwives about their health and wellbeing. The service, run independently by Turning Point, is an initiative of the Nursing and Midwifery Board of Australia (NMBA) and comes after a research project reviewed the referral, treatment and rehabilitation services for nurses and midwives with a health impairment.


The report found 66 per cent of 10,000 nursing and midwifery survey respondents had either witnessed or experienced a health impairment, while nurses and midwives reported they were uncertain about where and how to seek support, and were also uncertain about the mandatory notification threshold. Most respondents also believed health support services could be improved, while many were unaware of existing mental health, drug and alcohol support services able to provide help. Since it launched in March, the service has received numerous calls of support as well as calls from health services and managers seeking information about the service. Mr Aitken says the service has received calls from nurses and midwives experiencing occupational violence, bullying and harassment, drug and alcohol problems, and health issues including chronic diabetes and musculoskeletal problems. “Just like many nurses and midwives work 24/7, that telephone service is available 24/7, so if you’re a nurse working nightshift and you’ve got your night off or you are in your tea break and you need to call us, there will be somebody to answer your call at four in the morning,” he says. “The majority of our call centre staff are very experienced nurses and midwives and that’s important because nurses and midwives like to think they are speaking to a nurse or a midwife about a health issue.” As part of the education component of the service, Mr Aitken’s role involves meeting with nurses and midwives, students and stakeholders

to promote the service, while also providing education on how nurses and midwives can look after their own health to prevent their risk of health impairment. “We are very keen to engage in the health promotion space or early intervention space for nurses and midwives and students of the professions because we actually want to support people before a health issue develops, or much earlier.” Mr Aitken says nurses and midwives regularly undertake incredibly stressful work, and cumulative stress can lead to major health issues. “Like the rest of society, nurses and midwives aren’t immune from drug and alcohol issues or gambling problems or other health issues, such as musculoskeletal issues around back injuries,” he says. “I believe that now we’re giving nurses and midwives permission to say - ‘I’m actually not okay, and I want to seek help early, and sometimes, the work I do, I find it stressful, that it’s compounding those problems’. “Nurses and midwives care for other people, so why wouldn’t we do our utmost to care for them? “Now we can proudly say this service does, hopefully your colleagues do, hopefully your manager does, and hopefully nurses can be kind and supportive to each other, and therefore enjoy much better health and a much better quality of life.” * To access call 1800 667 877 or visit www. nmsupport.org.au

HealthTimes - April 2017 | Page 11


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Stay up to date with the 2017 aMh Book or online AMH 2017 includes up-to-date drug information to help you stay informed in your profession. Every edition has hundreds of amendments, updates and additions to reflect the latest shifts in evidence and practice. More than 20 new drugs have been added to the latest edition, including Ulipristal for emergency contraception, Idarucizumab for reversal of dabigatran anticoagulation and Paritaprevir with ritonavir, ombitasvir and dasabuvir for chronic hepatitis C. Therapeutic topics have been reviewed and updated, eg Dyslipidaemia now includes evolocumab and a table comparing lipid-lowering drugs. There is also new safety information, eg severe skin reactions with bromhexine. New to AMH online is a drug interactions search capability, for interactions between drug/drug or drug/class pairs. To find out more, go to www.amh.net.au

aMh Children’S doSinG CoMpanion - aVailaBle in hard Copy or online The AMH Children’s Dosing Companion is Australia’s national independent dosing guide for prescribing and administering medicines to children from birth to 18 years. The evidence-based and peer-reviewed content provides detailed dosing information to assist health care practitioners in hospital and community settings. Clearly written and concisely laid-out, it offers: • detailed dosing information for around 370 drugs • drug monographs for over 90% of PBS paediatric prescribing in Australia • detailed dosages by indications & by age groupings • off-label uses • practical tips and other hard-to-find data on paediatric prescribing.

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HT-704-00805 1/2PG FULL COLOUR CMYK PDF Clinical Nurse Manager - After Hours WA Country Health Service - Carnarvon Hospital Positon Number: 00613570

Position Profile: Carnarvon Hospital is recruiting Clinical Nurse Managers' responsible for providing after hours administration and bed management. The position will demonstrate leadership, role modelling, and promote and ensure maintenance of clinical standards of quality of care. Area Profile: Carnarvon is a coastal town north of Perth and north of Geraldton with an approximate population of 6000. It lies at the mouth of the Gascoyne River and Indian Ocean. The popular Shark Bay world heritage area lies to the south of the town and the Ningaloo Reef lies to the north. The Kennedy Ranges and Mt Augustus lie to the East. Carnarvon is a year-round holiday destination with a beautiful environment and experiences as diverse as the many travellers. Carnarvon Hospital is a 39 bed facility which provides Maternity, Permanent Care, Paediatrics, Palliative Care, General Care, Perioperative services, Accident and Emergency Services to the local community Gascoyne pastoral region. Gascoyne Population Health and Primary Health Care is also based at the Carnarvon Hospital providing a vast range of Allied Health services. Images of Carnarvon area: http://www.gdc.wa.gov.au/image-galleries/carnarvon/ Selection Criteria: See Job Description at www.jobs.health.wa.gov.au Further Information: Please contact Karen Anstey on 08 9941 0301 Application Instructions: Apply online at www.jobs.health.wa.gov.au

Graduate nurses need training and support: NZNO The New Zealand Nursing Organisation (NZNO) has called for an injection of funds to ensure all graduate nurses are guaranteed nursing placements with additional training and mentoring support. The NZNO’s call comes after the November 2016 results of the national recruitment system, the ACE scheme, showed 853 students, or 61 per cent, of the 1404 nurse graduates seeking employment are now employed on the government-subsidised new graduate placement in 2017— leaving 551 nurses seeking employment. NZNO Associate Professional Nursing Manager Hilary Graham-Smith said while the November figures showed a small increase in the percentage of new graduates gaining places on NEtP (Nursing Entry to Practice) and the New Entry

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to Speciality Practice Mental Health and Addiction Nursing Programme (NESP), significant numbers of new graduates remain waiting in the talent pool. “While the Ministry tells us that quite a number of these nurses will be employed, our concern is that it will be outside of the NEtP/NESP programs, which is a risk in terms of them being properly coached and mentored as newly registered nurses,” she said. Ms Graham-Smith said while Health Workforce New Zealand funding for nursing, the largest health workforce, is $14 million - excluding NEtP and NESP funding, the spending for medicine is $113 million.

for the full article visit HealthTimes.com.au


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HealthTimes - April 2017 | Page 15


Telerehabilitation boosts chronic heart failure patients

A

ustralian physiotherapy research shows telerehabilitation is just as effective for improving exercise capacity, strength and quality of life in chronic heart failure patients as traditional hospital outpatient-based rehabilitation. A randomised trial, conducted through Brisbane’s Princess Alexandra Hospital and The Prince Charles Hospital, also found another significant benefit of telerehabilitation - patients were much more likely to attend most of their sessions. The pioneering study, published in the Australian Physiotherapy Association’s Journal of Physiotherapy,is the first to test a group-based video telerehabilitation program delivered into patients’ homes against a traditional centre-based rehabilitation program for people with chronic heart failure. The control group received a traditional heart failure physiotherapy-led rehabilitation program spanning 12 weeks, with patients completing 60 minutes of prescribed exercise twice weekly, plus education sessions delivered by a multidisciplinary team, including a nurse, dietitian, physiotherapist, occupational therapist, social worker and pharmacist. In comparison, the telerehabiliation group’s program was delivered twice-weekly for 12 weeks via a synchronous videoconferencing platform to groups of up to four participants in their own homes. Educational topics were delivered as electronic slide presentations with

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embedded audio files. Patients were asked to watch the presentations in their own time, which were followed up with online group discussions. Lead researcher Rita Hwang, a physiotherapist with the Heart Recovery Service at the PAH who is undertaking a PhD at the University of Queensland, says telehealth technology enabled patients to not only remain in the comfort of their own homes, reducing the time and costs of transportation to hospital, but enabled them to participate in group sessions where they could interact with the physiotherapist as well as the other participants. “The patients would be talking to each other and encouraging each other - like what you see in a normal exercise class,” she says. “When we do this telehealth virtual class, we still saw a lot of that coming through. I was pretty surprised to see that.” As part of the telerehabilitation approach, participants were guided to self-monitor and verbally report their blood pressure, heart rate and oxygen saturation levels at the start of each rehabilitation session. Patients were also asked to monitor their weight, blood sugar levels, peripheral oedema and general wellbeing. In the 53 participants, who were mostly male patients aged about 67 years, researchers found no major differences when it came to six-minute walk distance gains.

For the full article visit HealthTimes.com.au


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HealthTimes - April 2017 | Page 19


Health groups tackle physical health of people with mental illness

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ncreasing access to dietary and exercise interventions coupled with psychological and medical treatment is vital for people with mental health illness. That’s the message from three key health professional organisations, the Dietitians Association of Australia (DAA), Exercise and Sports Science Australia and the Australian Psychological Society (APS), to encourage nurses and other clinicians to embrace holistic multidisciplinary treatment to improve the quality of life, and the physical and mental health outcomes, of people experiencing mental health illness. The peak bodies have released a joint position statement, Addressing the physical health of people with mental illness, which calls for regular screening and ongoing monitoring of both physical and mental health, strengthening referral networks and collaboration between core professionals in the mental health treatment team. Research shows high rates of physical illness, such as diabetes, respiratory illness, cardiovascular disease and cancer exist among people with serious mental illness, with people experiencing serious mental illness two to three times more likely to have diabetes and four times more likely to have cardiovascular disease compared to the general population. Depression is known as an independent risk factor for coronary heart disease, and can also impact on the recovery of people with coronary

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heart disease, increasing their risk of further heart problems. Gabrielle Maston, Accredited Practising Dietitian (APD) and spokesperson for the DAA, said people living with serious mental health illness often experience lifestyle-related conditions impacted by poor diet and lack of activity. Ms Maston, a dietitian and exercise physiologist, said she works with a variety of clients with comorbid conditions associated with mental health illness at her Sydney private practice, Changing Shape, “We know that people who suffer from mental health illness are more likely to suffer from diabetes and cardiovascular disease, therefore people usually come to see me for those reasons rather than the mental health side of things,” she said. “If people are taking antipsychotic medications, they tend to have an increased appetite and an disinhibition for eating itself so it becomes a big problem with weight control in particular. “So it’s just understanding the role, for example, that medications have in appetite stimulation and also people’s coping mechanisms with things in everyday life. “For example, people with depression sometimes cope by eating more and then they end up with weight problems,” she said.

For the full article visit HealthTimes.com.au


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Free CPD Portfolio tool HealthTimes is pleased to offer all HealthTimes subscribers free access to the best CPD Portfolio tool available. What makes it so good? • It’s free • It’s very easy to use • It’s designed to align with AHPRA’s registration requirements, so if you ever get audited, provided you’ve entered your details, you will be well prepared to sail through the audit • You can easily create links to your course bookings, certificates and other evidence, so you can be sure everything is contained in a single document. You must be a HealthTimes subscriber to access the tool. After you complete the subscription form at healthtimes.com.au/subscribe/ you will receive a welcome email, and in the welcome email a link to the tool will be included. If you are already a subscriber, just subscribe again to receive the welcome email.

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HT-704-00833 1PG FULL COLOUR CMYK PDF HT-703-CTR-00675 1PG FULL COLOUR CMYK PDF “I never cease to feel humbled by my patients. Their trust in me when sharing their most troubled thoughts and experiences at the toughest time of their lives is a privilege beyond words. Our best tool is our time: time to sit, time to listen, time to give hope, time to care.” Tanya Mularczyk, RPN Ballerrt Yeram-boo-ee Forensic Mental Health Operations Manager Ravenhall Correctional Centre

TAKE YOUR MENTAL HEALTH NURSING TO THE NEXT LEVEL WITH FORENSICARE Do you want to work in a cutting-edge environment where you are always challenged and learning? Are you looking for opportunities to experience the full spectrum of mental health nursing? Would you like to take your nursing career to the next level? Then Forensicare’s prison mental health services are for you. 3 REASONS WHY FORENSIC MENTAL HEALTH NURSING IS FOR YOU: 1. Your nursing skills and experience will be taken to new heights As a nurse in Forensicare’s prison mental health services, you work closely with patients who may be suffering from severe and enduring mental illness, have complex needs and dual diagnosis and are difficult to engage. Treatment for mental health issues in Victorian prisons is voluntary so your skills are focussed on building strong relationships with patients to encourage and support Recovery based, therapeutic outcomes. 2. Rewarding patient-centred approach Our exceptional prison services teams work together to deliver life changing clinical and therapeutic work. Our prison staff: > are passionate about mental health, > believe in our Recovery model; and > are advocates for ensuring prisoners with mental illness access the care and treatment they need. 3. Strong, supportive team environment and career opportunities You will be working within a highly skilled and knowledgeable multi-disciplinary team who will support you in your development and your ability to deliver the best care to our patients. You will be given opportunities to develop the skills and confidence to work as an individual in a range of environments.

About Forensicare Forensicare (Victorian Institute of Forensic Mental Health) is Victoria’s leading provider of forensic mental health care. We work to meet the needs of consumers with serious mental illnesses across the justice system, mental health sectors and the community. Our services deliver a range of mental health programs targeted at patients with different needs at different stages of Recovery; from early intervention and prevention, inpatient care, rehabilitation and community transition support.

Career Opportunities Forensicare is expanding and we need more mental health nurses. We are currently recruiting a number of suitably qualified mental health nurses for our forensic mental health service at the new Ravenhall Correctional Centre, scheduled for completion at the end of 2017. If you’re a mental health nurse looking to take your career to the next level visit: www.forensicare.vic.gov.au/careers

More information For more information about working for Forensicare: w: www.forensicare.vic.gov.au e: hr@forensicare.vic.gov.au p: 9495 9123

www.forensicare.vic.gov.au HealthTimes - April 2017 | Page 23


Choosing wisely - increasing the value of physiotherapy

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ow back pain is one of the most prevalent health conditions in our nation, with about a quarter of all Australians experiencing the condition in any one day. While the cause of acute low back pain is often benign, and the prevalence of underlying serious causes, including nerve or bone damage, infection or cancer, is very low, many patients are still being routinely sent for diagnostic imaging, such as an X-ray, CT or MRI scan. A recent Australian study revealed most people experiencing low back pain believe imaging will pinpoint the cause of their pain but trials show there are no benefits, and some potential harms, for routine imaging of low back pain. Physiotherapists are now being urged to avoid referring patients for imaging for non-specific low back pain, where there are no indicators of a serious cause for the pain. It’s one of the key recommendations from the Australian Physiotherapy Association (APA) as part of the Choosing Wisely Australia campaign. Physiotherapy’s peak professional body has outlined six recommendations and one proposed recommendation in a bid to eradicate low-value healthcare services that are often unnecessary and expensive, and also lead to potential harms, such as exposure to radiation. The recommendations range from urging physiotherapists to avoid imaging for the

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cervical spine in trauma patients to not using spirometry after upper abdominal and cardiac surgery. The latest proposed recommendation, now being reviewed, urges physiotherapists not to prescribe massage or electrotherapy, such as ultrasound, laser or transcutaneous electrical nerve stimulation (TENS), for older people experiencing pain from knee or hip osteoarthritis. Instead, physiotherapists are being encouraged to swap the over-use of imaging, diagnoses and ineffective treatments with more effective patient consultations and physiotherapy treatments. C l i n i c a l physiotherapist Dr Adrian Traeger is a member of the APA Choosing Wisely Panel who is also a Research Fellow at the Sydney School of Public Health, University of Sydney, where he’s conducting research investigating the causes of and solutions to problems of overdiagnosis and overtreatment in modern healthcare systems. Dr Traeger says evidence suggests most clinicians know imaging for low back pain is not useful but still recommend it in a bid to reassure patients. In an editorial on low-value healthcare about to be published in the APA’s Journal of Physiotherapy, Dr Traeger states research shows drivers of low-value care include advanced improvements in technology, as well as professional and commercial factors.


Cultural factors also play a part - such as ordering tests as a matter of habit, having a fear of litigation in the event a serious disease is overlooked, and feeling pressured by patients. “Certainly some patients want a scan or want a test but others just want a good explanation. I think sometimes clinicians wrongly assume that every patient wants a scan without having actually discussed it with them,” he says. “Unfortunately we know that those tests don’t tell us very much about where the pain is coming from, and they don’t really inform management - so they can’t lead to more specific treatments that will help people recover better. “In actual fact, they can be harmful. Imaging results can make you worry more because they often detect changes in your spine that are normal for age but might not look that pretty on a scan. That can lead to treatments that target those incidental findings from the scan, and these treatments usually cause more harm than good. “We know from large scale research that when people with low back pain have scans they tend to feel worse afterwards, they tend to use more healthcare, and that healthcare doesn’t improve their outcome.” Dr Traeger says physiotherapists can detect the potential risk of more serious causes of low back pain with a thorough consultation. “A good clinical history, examination, and explanation by the physiotherapist can replace a lot of these tests,” he says. “If you take a good history and do a good physical examination, and explain to the patient exactly what you think is going on - that has actually been shown in the research to be more reassuring than providing someone with the results of imaging tests. “That’s why we discourage imaging and we encourage talking about the problem a little bit more.” The Choosing Wisely campaign, an initiative of NPS MedicineWise, is designed to encourage

conversations between health practitioners and their patients about the tests and procedures of low value - that provide patients with little or no benefits and which may even cause harm. The APA’s six recommendations are the result of a survey of almost 3000 physiotherapists, which were put to the APA’s panel of clinicians and researchers. The physiotherapy body states the recommendations are not prescriptive - they should be used as a guide to prompt clinicians and consumers to question and discuss what is appropriate care in each individual case. The recommendations join an evolving list of recommendations for tests, treatments and procedures to question, from a range of colleges and societies representing health practitioners, including nurses, hospital pharmacists, pathologists, radiologists, GPs, surgeons and palliative care specialists. Dr Traeger says the Sydney School of Public Health, as part of the NHMRC-funded Wiser Healthcare Research Collaboration, is now examining a range of tools that may be able to assist physiotherapists and their patients make wiser choices. “We are looking at methods that have worked in other health areas, and investigating how we can apply these methods to physiotherapy problems,” he says. “This involves talking to physiotherapists, GPs, radiologists and the public, and finding out why they use certain tests and treatments.” Dr Traeger says it’s vital physiotherapists are supported to provide patients with the right care at the right time - to improve health outcomes. “It’s difficult – there are significant time pressures, patient pressures - physiotherapists treat lots of different conditions and it can be difficult to manage these pressures and stay on top of the current evidence base,” he says.

For the full article visit HealthTimes.com.au HealthTimes - April 2017 | Page 25


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HealthTimes - April 2017 | Page 27


Transforming birth rooms to advance normal birth

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irth rooms with projected images on surrounding walls, moving the bed out of the centre of the room, adding baths for water immersion, and including a mantel for the woman to lean on during birth. These are just some of the ways birth rooms are gradually being redesigned in Australia and overseas in a bid to facilitate normal birth, and drive down medical interventions during labour in hospitals. Other options for birth rooms range from concealing medical equipment, removing overt surveillance, to adding a private corridor that leads to the birth rooms to guarantee privacy. Maralyn Foureur, a Professor of Midwifery at the University of Technology Sydney, is a midwifery researcher who has contributed to the design of birth rooms in Wellington, New Zealand, and at the Royal North Shore Hospital, in New South Wales. Professor Foureur says more hospitals are now beginning to embrace innovative and evidence-based designs that promote a more comfortable, private and safe way for women to give birth. “We know already from The Birthplace Study in the UK that women are much more likely to have a straightforward normal birth without intervention if they are birthing out of tertiary hospitals, we are repeating a similar study here in Australia, and I imagine we will find similar things,” she says.

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“What I suggest from the perspective of my research is that tertiary hospital labour wards are not designed to facilitate straightforward labour and birth, and either we set up more alternative birth centres so that women can birth out of tertiary hospitals or we have to majorly modify what we are designing in terms of hospital ‘labour wards’. Even the language of ‘labour ward’ has to change. “And it is possible - Royal North Shore Hospital has managed to design radically different birth spaces in a public hospital, so there is absolutely no reason why it can’t happen.” P r o f e s s o r Foureur says hospital birth spaces, which often resemble modified operating theatres, have a major impact on the way in which women give birth. “They are frightening spaces and from a neurophysiological level you can actually articulate what happens in terms of the neurohormones of labour,” she says. “If a woman is particularly fearful in labour… and these environments are fairly frightening on every level…the woman’s brain starts to secrete adrenalin and this interferes with the production of oxytocin, which is the hormone that makes her labour progress towards birth. “So, her labour slows down or may stop, which is one of the main reasons for intervention in childbirth, once labour has started. “The other thing that happens if she’s particularly frightened is that blood can be


diverted away from the abdomen in the automatic fight, flight or freeze response - and that means that blood is diverted away from the uterus and away from the placenta, and the baby’s oxygenation is interfered with,” she says. “The second main reason for all intervention in childbirth once labour has started is foetal distress. “So, there’s a nice plausible, theoretical pathway that suggests when putting women into spaces where they feel unsupported and frightened we may actually cause the very things that require us to intervene in childbirth.” Professor Foureur says her research shows birth room design also affects the way midwives practice, preventing midwives from providing the kinds of support women need in order to have a normal labour and birth. “There is hardly anywhere to move the bed out of its most prominent position, the place is so full of equipment there’s hardly room for the woman’s support person to sit down, let alone any space for the midwife to be able to spend time properly supporting the woman in labour, so the spaces we build inhibit good midwifery practice.” Effective birth unit design should consider every sense modality, ranging from what the woman might perceive through her sense of smell, or what she can hear, and also the visual messages the room communicates - such as the central position of the bed which may suggest to the woman that this is where she should passively position herself. “In thinking about designing spaces for birthing women, we have to start with the brain in mind - what is it that’s going to send messages of calmness, confidence, trust, and suggests this is a safe place? “Of course for some women, having emergency equipment on display around the bed makes them feel safe but those women are actually in the minority.

“For most women, having equipment, such as the neonatal resuscitaire or IV stands and pumps on display actually sends quite frightening messages.” Professor Foureur is now working with midwives in Denmark studying the stress reducing effect of projecting moving or still nature-based images of different environments, such as a beach or forest, on to the walls of birth rooms. A similar study will soon be conducted at Blacktown Hospital. Once birth rooms have been redesigned, she says it’s important to up-skill midwives on the potential use of each of the design elements to ensure they are able to assist and educate women on how to maximise the benefits of the birth space. “For example, in every one of the birth rooms at the Wellington Women’s Hospital in New Zealand and at Royal North Shore there is a mantel piece or a leaning place where women can stand and lean forward, which is the optimal position for helping the baby to rotate into the best position for birth,” she says. “However, only some of the midwives were part of the design team and understood what they were intended for.” Professor Foureur encouraged midwives interested in transforming hospital birth rooms into environments more conducive to normal labour and birth to speak up and be included in the design of new or the redevelopment of existing birth rooms. “It’s not a simple process and it’s not merely decoration - it’s much more profound than that,” she says. “There is plenty of material now that will provide midwives with information and insights that they can bring to the table, but fundamentally it’s about guaranteeing privacy and getting that bed out of central stage mode,” she says.

For the full article visit HealthTimes.com.au HealthTimes - April 2017 | Page 29


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When it rained, I shone. It was one of those fierce summer storms that comes after a week of hot weather. Worst of all, the storm hit the clinic during the night, so nobody realised the roof was damaged.The next day, we found the reception counter drenched. But I was all over it. I got hold of our Officeworks Business Specialist, who helped me organise what we needed to replace. She recommended plastic filing cases instead of cardboard folders, and a wireless keyboard that could be put away each night. And because everything was ordered online before 11.30am, it was delivered the same day.

Get all over it. Visit officeworks.com.au/business-solutions

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