Health Times April 2018

April 2018

Education Feature + New program to help nurses cope with ICE epidemic + The value of Emotional Intelligence in a nursing career + Using telehealth in remote oncology clinical trials + Future health care offers exciting range of nursing roles

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April 2018 We hope you enjoy perusing the range of opportunities included in this issue.

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HealthTimes - April 2018 | Page 11

Future health care offers exciting range of nursing roles

By Dr John Smithson Senior lecturer in the College of Healthcare Sciences and the Centre for Nursing and Midwifery Research at James Cook University

L

ook around you at work, and then try imagining how things will be 10 or 15 years from now.

There’ll be some important changes – technology for monitoring patients living great distances away, connections to vast stores of clinical data, fellow nurses in new clinical specialties, others leading diverse teams of professionals in collaborative care protocols.

Will you have the skills to manage all this? The demographic and technological changes coming our way mean nurses will need to adapt, learn and grow to take their place in the new world of health care.

Tomorrow’s nurses will need to understand fields such as data management, patient privacy and predictive analytics to forecast patient demand and support clinical and operational decisions.

Many will have to learn how to operate technologies that deliver care, educate and connect with patients and efficiently apply limited resources for individual and community benefit.

With such a revolution in the wings, the industry can’t simply wait for the next generation of nurses to gradually gain the

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experience they need to move into positions being vacated by senior nurses preparing for retirement.

The solution is postgraduate study.

Nurses can seed up their skills acquisition and their career progression, and as described in research by Deloitte Access Economics, be financially rewarded.

The report, The future of work: Occupational and education trends in nursing in Australia, examines present and future job numbers and incomes in five related occupations: registered nurses; registered midwives; nurse managers; nurse educators and researchers; and general managers in the health care and social assistance industry.

Deloitte found that nurses with postgraduate qualifications in the five occupations were earning $95,391 in 201617, 45 per cent more than workers with no postgraduate qualifications.

Deloitte predicts that by 2021-22, postgraduate-qualified nurses in these occupations will be earning $111,235 – a 17 per cent increase. Over a career, the difference will compound to a lifetime earnings premium worth 129 per cent compared to nurses with no postgraduate

qualifications.

Total employment is also expected to rise. In 2016-17, the five categories employed about 308,000 nurses, but Deloitte predicts this figure will be 354,000 in 2021-22, an increase of 46,000 jobs and equivalent to a 2.8 per cent increase each year over the five years, above the overall Australian workforce jobs growth forecast of just 1.5 per cent growth per annum.

Demand for nursing workforce also means increased demand for nurse leaders.

Postgraduate study can enable nurses to take up leadership opportunities earlier in their careers.

As well as accelerating career advancement, the upskilling should improve retention of midcareer nurses in the profession.

With an ageing population placing increased pressure on existing health-related services, nurses who are qualified to deliver advanced care and extended practice – as well as those with leadership and management

s kills – will be in high demand.

Postgraduate qualifications can help accelerate the acquisition of high-demand skills and attributes in additional areas such as advanced patient assessment, diagnostic reasoning, data management, financial and human resource management and leadership.

HealthTimes - April 2018 | Page 13

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HealthTimes - April 2018 | Page 15

New program to help nurses cope with ICE epidemic

A

s Australia continues to grapple with the societal consequences of methamphetamine, or ICE, addiction, health care workers remain at the forefront of the problem, frequently encountering patients under the influence of the drug.

Unfortunately, dealing with a person affected by methamphetamines presents a unique set of risks and challenges to nurses, which can leave them vulnerable if they do experience such an encounter, particularly as the effects of the drug vary depending on when it was taken, and how much.

Which is why the Australian Nursing and Midwifery Federation (Victoria Branch) has teamed up with Turning Point to introduce a series of seminars, designed to complement the standard Frontline Worker Ice Training Package.

The seminars, funded by the Victorian Government as an outcome of the Premier’s Ice Action Taskforce, involve face to face training with nurses and midwives, providing them with a deeper understanding of Ice addiction.

Nurse Caroline Duggan attended the seminar, which she says all health care workers should attend, and says she’s gained an insight into the use of Ice that she didn’t have prior to taking part.

“I feel that all nurses should attend a course like this as Ice use is a ongoing health problem that all nurses, whether they work in emergency, cardiac, midwifery or mental health or other areas, are at some point going to have to deal with,” says Ms Duggan.

“They are going to come across individuals who are either using Ice or have used in the past.

This makes attending a seminar like this almost compulsory.”

How often a nurse deals with a patient or client on Ice can range from a daily occurrence,

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for example in mental health and emergency departments, to less often in other areas just such cardiac or midwifery.

But no matter how often it happens, it can be scary if nurses aren’t equipped with the knowledge or skills to manage it.

“Dealing with a individual on Ice can be scary if you have no knowledge of the effects, and the symptoms of withdrawal and cravings.

“From my limited experiences, people on using Ice can be pleasant, cooperative and easy to deal with if they have just used. “(They) can be quiet, sleepy and withdrawn when coming down.

“Or agitated, pacing and aggressive when withdrawing or can’t access their next hit.

“This requires multiple skills of the nurse to recognise where the patient is in the cycle and how to adjust their nursing to best benefit the patient. “(Through the seminar), I feel I have developed more in-depth knowledge about the effects of Ice and how an individual who has recently used is different to someone that might be looking for their next hit.”

Ms Duggan says along with learning about the impact of Ice on patients, the seminar also taught nurses about the importance of compassion.

“Most Ice users already feel very ashamed, they feel that people are judging them and the choices that they have made,” she says.

The seminar also provides valuable resources which can be accessed by nurses 24 hours a day 7 days a week.

Despite the benefits of this seminar, Ms Duggan says more education is needed for nurses, given the seriousness of issue, and the potential consequences for patients and health care workers alike.

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HealthTimes - April 2018 | Page 17

The value of Emotional Intelligence in a nursing career

I

n the United Kingdom, the 2013 Francis report ruled that poor care was endemic in the region of Mid Staffordshire, and suggested the recruitment of student nurses should be based on those possessing “values, attitudes and behaviours appropriate for the profession”.

As a result, Health Education England developed a values-based student recruitment program, and Scotland researched recruitment approaches too.

If you can understand why someone might feel a certain way, then you are on your way to emotional intelligence (EI). There are a number of tests available for measuring EI – so should we be using these as part of the application process?

Emotional Intelligence (EI) is generally defined as the ability to monitor and evaluate emotions in one’s self and others and to act appropriately in response.

Some psychology and management thinkers use terms like social intelligence or people skills and describe how some people can be naturally emotionally intelligent, yet all have the ability to learn it. Much of the academic literature on the topic is in consensus that people can improve their EI capability.

Edinburgh Napier University and the University of West Scotland studied first year nursing students, measuring their EI scores on

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commencement of their studies and taking into account their previous care experience. As the students progressed through their program, this score and their performance were recorded again and compared to determine if the highscoring EI students were at an advantage.

They were not.

“Students’ emotional-intelligence scores appeared not to make any difference to their performance on the course, yet changes in their scores over their first year made a difference as to whether they continued or not,” said lead researcher Professor Austyn Snowden.

“It is widely known that the empathy of student medics and nurses drops when they are exposed to patients. It seems that their emotional intelligence does too.”

“As for previous caring experience, more than half of our group had some sort of relevant experience prior to becoming a student nurse.

Surprisingly, perhaps, we found that those who had past experience tended to perform more poorly in the course in their first year.”

“The true nature of emotional intelligence matters greatly in our context. If it is a trait, it could be important for recruitment purposes. If it more like an ability, it could be developed and nurtured through nurse education.”

In managing the hardships With increasing nursing turnover being linked to decreased job satisfaction due to physical demands, job stress and the failure to nurture nurses, the four guiding principles of emotional intelligence can be used to manage a variety of situations.

By identifying the emotions in ourselves and others, it can help us better identify the situation.

Is your NUM constantly on your back, asking you to do completely unreasonable things –

and never willing to negotiate? Maybe she needs a little compassion thrown her way. She might be struggling with the pressure of leadership, or with the adolescent anxieties of needing to be perfect.

What is your gut telling you? Some psychologists believe in the intuition, or the ability to use your emotions as a way to reason.

If you are constantly responding to a particular situation, this might be telling you something about how you feel about the facts or the people involved.

Inherent or learned, being able to understand our emotions is one of those big steps in life. As nurses take on the emotional toll of their patients’ suffering, some find it hard to switch off, and combined with the elevated cortisol levels from a high-stress job are not able to adequately regulate their emotional response. The outcome is depression, anxiety, and compassion fatigue when dealing with

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patients. Emotions change, overlap and sometimes trap us for long periods of time, when we can get stuck in phases of professional or personal burnout. Everyone should learn how to understand their emotions.

It can be difficult to admit that as a caring professional, you have run out empathy for those in your charge. But the final step to master in becoming emotionally intelligence is the ability to manage emotions. Rather than denying or ignoring emotions you might be having, such as anger with a patient who won’t take their medications as directed, it means finding ways to deal with that emotion – perhaps getting a teammate who has a repour with that patient to find out why he won’t take his meds.

Relationships matter in the caring professions. The evidence grows with each passing day that the relationship we have with ourselves affects how we relate to each other – and this needs to be integrated into professional development.

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2018 AMH Aged Care Companion Coming Soon The AMH Aged Care Companion is a practical reference for health professionals working with older people. It contains the latest evidence-based information on the management of over 70 conditions common in older people, along with general principles of medicines use in this population, including deprescribing. It also includes non-drug treatment advice.

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HealthTimes - April 2018 | Page 21

DID YOU KNOW? Bendigo Health is the lead provider of a new eight bed dual diagnosis residential rehabilitation facility opening early 2018. This facility will be Victoria’s first regional dual diagnosis service aiming to provide treatment to clients with co-existing mental health and substance use issues.

Bendigo Health has a variety of positions available for Registered Nurses and Enrolled Nurses to work in our new eight bed dual diagnosis residential rehabilitation facility. If you are a registered nurse or enrolled nurse with a special interest or previous qualification/experience in dual diagnosis this is an exceptional opportunity for you.

For more information or to apply

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HealthTimes - April 2018 | Page 23

Using telehealth in remote oncology clinical trials

C

linical trials generate around $1 billion for the Australian medical industry from pharmaceutical investment, and yet the Australian rate of enrolment in clinical trials is lower than international recommendations and benchmarks; even lower for rural centres and trials including rare cancers.

The oncology industry considers the inclusion of clinical trials in a clinic’s regular practice to be important for research, innovation and funding for the research industry, with a clinic’s track record in trials being seen as an indicator of quality care.

A report into the recruitment and retention for Australian clinical trials revealed an unpredictable retention rate for trials, which makes it hard for trials to gain significant data, funding to be obtained for future trials, and innovations in treatments to be developed. Medicines Australia reported a decline in the number of pharmaceutical industry sponsored trials from 2007 to 2013.

While some barriers to recruitment and retention for clinical trials laid around leadership or clinical infrastructure to conduct the trials, Professor Sabe Sabesan, Director of Medical Oncology, Townsville Cancer Centre, decided to tackle the awareness issue, and lead the way combining his experience in rural health and telemedicine to bring oncology clinical trials to the GPs in Mount Isa from his base in Townsville.

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Using Clinical Oncology Society of Australia (COSA), Royal Australasian College of Physicians (RACP) and Australian College of Rural and Remote Medicine (ACRRM) guidelines for delivering oncology care in rural and remote settings, Prof. Sabesan met with patients over video conferencing, who alongside their GP and primary care team, were administered chemotherapy dose intensity and toxicity under Prof.

Sabesan’s instructions.

“There was no resistance from the clinicians in Mount Isa. The GPs were keen to get involved.

They already care about their patients on a personal level, and they have the appetite to connect with the hospital network that they are so far removed from,” says Prof. Sabesan.

He believes the rural health workforce has what it takes to carry out clinical trials, and investing in their skills will only build and strengthen the health communities of allied health, nursing staff and medical officers.

“Telehealth is not an intervention.” Prof.

Sabesan notes.

“I want to avoid the confusion. Telehealth is a new method of care, connecting services and resources that are already in use, developed with a governance of standards and processes. We are not asking you to change anything about the way you care. “ He notes that the method is not restricted

to patients who live in regional or remote areas. It could be applied to patients who live in the same city as the trial specialist, but are limited by transport or mobility issues. It is simply a way to access trials close to home.

“And you can do it within your department without too much fuss. Get your colleagues on board and you’re set to go. Just focus on your own thing and don’t stress about how it will work across the whole system. Making change within your own department is not that difficult.”

Prof. Sabesan was instrumental in developing the Australian Teletrial Model – Guide for implementation for COSA, which outlines the roles and responsibilities for carrying out clinical trials from the primary site to a satellite site using telehealth as a communication method.

A number of state health departments have joined the oncology teletrial network, which now spans the east coast of Australia. Prof Sabesan hopes the Australian Department of

Health will take up the model to ensure it is built into a sustainable model of care across the country, and the progress made on telehealth in these communities is not lost.

The Cancer Nurses Society of Australia has endorsed the COSA clinical practice guidelines for teleoncology, which also include models of care for nursing and allied health services.

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HealthTimes - April 2018 | Page 25

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About us At Murrumbidgee Local Health District we provide a range of public health services to the Riverina and Murray regions of New South Wales. Our Mental Health, Drug and Alcohol (MDHA) teams provide critical services within acute, sub-acute and community settings. We are known for our innovative models of care designed for the rural and regional population we serve. Some of our locations include Wagga Wagga, Griffith, Young, Deniliquin, Tumut, Temora and more.

About our roles We are always on the lookout for dedicated mental health clinicians from an array of backgrounds and experiences including: • Mental Health Emergency Consultation Service Clinicians and Clinical Leaders • Registered Nurses, Nurse Practitioner and Enrolled Nurses • Allied Health – OT, Social Work, Pharmacy, Psychology • Youth Mental Health Workers • Adult Mental Health Workers • Child and Adolescent Mental Health Workers

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HealthTimes - April 2018 | Page 27

Australian women’s use of digital health tools in pregnancy and early parenting

P

rofessor Deborah Lupton from the University of Canberra has been researching social and cultural dimensions of health and medicine throughout her career, with a more recent focus on the patient use of digital technologies.

Presenting at the Australian Telehealth Conference (ATC) hosted by the Health Informatics Society of Australia (HISA), Prof. Lupton discussed the range of digital tools Australian women used as information sources for their pregnancies and early stages of motherhood as revealed by her research into the area.

With users starting from period and fertility trackers, pregnancy apps were highly popular tools – used by approximately 75% of women in the study – and 50% used infant caring apps such as growth, development, sleeping and feeding monitors.

Women loved these apps because of the reassurance they provided during a period when they were told they were at their most fragile, and for the instant answers they provided. One participant commented that she ‘didn’t have to pester anyone, like her Mum’ over concerns that may or may not need a midwife’s attention.

However, Prof. Lupton noted that the rise in popularity of fetal doppler smartphone attachments had raised concerns among the

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midwives she had presented to. Designed to provide reassurance to patients in monitoring their babies, the midwives were concerned that the devices could raise anxiety if negative results were detected in an environment without medical expertise to provide guidance.

A quick search on the pregnancy forums reveals many panicked posts relating to doppler use, some simply because the user didn’t know how to properly operate the equipment.

Another thing to keep in mind is the contextual nature of the data that is collected and presented to the user.

For some, these apps are just entertainment whereas, others use the data for action and decision-making. The type and amount of data submitted to such media platforms needs to be assessed in terms of privacy and the value of the information in terms of output.

“Healthcare professionals tend to have certain expectations of what health and medical data can offer them for their professional practice. In comparison, lay people value these data in other ways, based on their meaning and usefulness for their everyday lives.” (Lupton, 2016) On the other hand, the community that forms around pregnancy and parenting websites allow for the social and cultural needs of this group to be met through bonding and

even anonymity. Women whose families were overseas or estranged could talk with others who had been through similar situations as them. The communities allowed women to discuss embarrassing or perhaps frownedupon topics which they felt could not be discussed with their own mother or clinician.

YouTube was a popular tool for learning practical how-to’s such as assembling a cot, folding and unfolding a pram, nappy changing, and the all-important swaddling technique.

Being able to review the videos multiple times allowed the women to learn at their own rate, as opposed to being taught in a state of overwhelm by an experienced person who moves too fast.

Facebook, while good for sharing information on baby’s development with family and friends, has shown to be an excellent place for making new contacts with local mothers. Facebook groups are a way for hospital mothers’ groups to keep in touch, and also for local groups to facilitate face to face meetups, discuss the best playgrounds and childcare options, and recommend healthcare facilities.

Prof. Lupton also presented on other research she has conducted with people who use self-tracking tools for other reasons, noting that app usability design is lacking when considering users’ social and physical demands. The example given was an app that required all information be entered by midnight otherwise the day is entered as a nodata day, which can be difficult for someone who has a busy life and might prefer to enter the information the next day.

Other constraints included calorie trackers

that did not account for users on various medications (which affects the users’ nutrition or metabolism needs); fitness or weight loss apps not accounting for chronic illness or a user’s variance in day-to-day state of health; and ability to use the hardware or software such as apps that don’t have adjustments for touch, vision or speech inputs.

Interestingly, many of these health apps have the disclaimer ‘this app is for entertainment purposes only’ to remove any medical responsibility. The NHS has developed an accreditation system for healthcare apps in England, however research into mental health apps with such accreditation shows that the apps supported by clinicians in their development are twice as effective than those that are not.

Regulating health apps would be an enormous job for any health organisation, as thousands are released to the market every day.

Instead, patients need to be encouraged to seek out quality, and to be better educated about data privacy. Prof. Lupton’s research found that overall, Australian women were either unaware or uninterested in the My Health Record, which is due to be extended to all Australians by the end of the year. Security and privacy concerns have been repeatedly raised over the program by privacy spokespeople, yet the public remain mostly unaware of its existence, let alone the issues at stake.

HealthTimes - April 2018 | Page 29

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Page 30 | HealthTimes.com.au

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