Health Times January 2018

January 2018

New Year, New Career Feature + Nurses’ growing role in helping support victims of domestic violence + Life as a NICU Nurse + Defining the role of the Nurse Care Coordinator + Learning paediatric dietetics guidelines for everyday practice

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January 2018 We hope you enjoy perusing the range of opportunities included in this Issue.

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HealthTimes - January 2018 | Page 07

Re-examining disordered videogame use

T

he pitfalls of regular videogame use were once again highlighted late last year with the World Health Organisation (WHO) releasing details of the beta-draft of the 11th iteration of the International Classification of Diseases, the ICD-11, which included proposed diagnostic criteria for “gaming disorder”.

This is slightly different to the current inclusion in the Diagnostic and Statistical Manual of Mental Disorders – the DSM-5, which included “internet gaming disorder” as a condition for future study back in 2013. With 93% of Australian households now containing one or more gaming devices, and 67% of the total population regularly playing games (Digital Australia Report 2018), it is time that condition was further studied.

Psychiatrist Dr Jennifer Hazel is founder and Executive Director of CheckPoint, a non-profit organisation connecting mental health care with videogame technology that provides education, consultation and resources to games industry and clinical professionals.

Including an everyday practice such as videogames into the two major diagnostic guidelines for mental health practice is an important step forward in the health profession gaining better understanding of something that is often left up to parents, teachers and caregivers to deal with.

“It opens up an important conversation.

What is it about games that can be addictive?

Page 08 | HealthTimes.com.au

And if there are bad games, are there notbad games? These sorts of questions will start to validate the work we have been doing at CheckPoint to reduce the stigma against games and introduce more balanced information about the risks and benefits of gaming.”

“On the other hand, I don’t particularly like the idea of lots of healthcare professionals suddenly feeling empowered to diagnose Gaming Disorder.

“Videogames are vast and varied, as are their players.

Many people (80% in a study we did) feel games improve their mental health and wellbeing.

If you are a healthcare professional and you are reading this, I would really implore you to consider these factors in your practice. Could you be doing more harm than good?”

Dr Hazel has highlighted a few points, and you can read further detail on the CheckPoint website. Consider the following regarding the ICD-11 draft: - The research is weak: evidence is based on small group research; rarely considering the differences between types of games (Minecraft vs Call of Duty are very different); not to mention technical difficulties are enough to make anyone angry!

-There are no exclusion criteria: gaming death from deep vein thrombosis has been noted, however positives including depression and anxiety therapy, social phobia or autistic spectrum disorder socialisation benefits has

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been studied – but not included in the draft.

-There is no guidance provided on treatment.

-Games have clear psychological (and cognitive) benefits. CheckPoint has access to studies on the benefits of games in mood, depression, creativity and social benefits.

Dementia Australia’s immersive The Virtual Forest is designed for aged care residents and has shown improvements in memory and mood; and ReachOut has resources on the social and educational benefits of gaming.

“That is not to say that games can’t be addictive – there is plenty of anecdotal and good quality research evidence to suggest that they definitely can be misused. And for that reason, I do support the move toward understanding gaming addiction better. I just hope we don’t get swept away again with how terrible video games are.”

“Function includes the things we really

should be doing, as a responsible person, to be safe, secure, healthy and happy. This includes going to work or school, showering and eating well, maintaining friendships and relationships, paying the bills, etc. If gaming has prevented someone from achieving these things, there is an obvious problem.”

“However it is super important to note that you can play games for as many hours as you may please and not be addicted – as long as you are still doing all these things.”

Learn what your patients are playing: The Digital Australia Report 2018 conducted

by Bond University is an interesting read on who plays games, what they play and why they play – you can download it here. http://www.igea.net/wp-content/ uploads/2017/07/

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HealthTimes - January 2018 | Page 11

Life Life as as a a NICU NICU Nurse Nurse

N N

ursing as a profession brings with it all ursingofasmixed a profession all types emotions,brings often with on a it daily types of mixed emotions, often on a daily basis, but life as an Neonatal Intensive Care Unit basis, but asto anintense Neonatal Intensive Carelows, Unit nurse canlife lead highs and deep nurse can lead to intense highs and deep lows, with each day literally a matter of life and death. withBorn eachatday a matter of life death. justliterally 27 weeks herself, andand weighing just 27 weeks herself, and weighing just Born 630 at grams, NICU nurse Bernadette Mich just 630 grams, NICU nurse Bernadette was always going to follow the path ofMich the was always goingher tolife. follow the path of the nurses that saved nurses that saved her life. a neonatal nurse to “I wanted to become “I wanted to become a neonatal nurse to give back to the community that nursed me to give back to the community that nursed me to health and to help people,” she says. health and to help people,” she says.

After completing her nursing Afterand completing her her nursing degree, undertaking degree, andplacement undertakinginher first year first NICU, year Ms placement the Mich now in the NICU, Ms Mich now works alongside some works alongside some of the nurses that of the after nurses looked her asthat a looked after her as a premature baby. premature baby.

And while there’s And whilethe there’s no mistaking love no mistaking Ms Mich has the forlove her Ms Mich fornurse, her role as an has NICU role as an NICU nurse, it’s a career path that’s it’s a career path that’s fraught with intensity and fraught with intensity and emotion. emotion.

“I have looked after 24 “I prems have looked after 24 600 week that have been week prems have been 600 grams or less,”that she says. grams or stressful, less,” she tiring says. and rewarding to look “It is “It is stressful, tiring rewarding to look after these babies, as a lotand of work is required to after these babies, as a lot of work is required to keep them alive. keep“Itthem alive. feels rewarding to look after these “It feels rewarding to them look fight aftersothese premature babies to watch hard premature babies to watch them fight so hard to stay alive. It is amazing to see.” to stay alive.

It is amazing see.”

Sadly though, a happyto home-coming is not Sadly a happy home-coming is not always thethough, end result. always thevery end upset result.and emotional if a baby I “I get “I get very upset andmake emotional a baby am looking after doesn’t it,” saysif Ms Mich.I am looking after doesn’t make it,” says Ms Mich.

“I cope by having a cry and debriefing to “I cope by having a cry and debriefing to colleagues. I also cope by getting a certain colleagues. I also cope by getting a certain

Page 12 | HealthTimes.com.au

sense of relief knowing I did everything I could sense of relief to try and save knowing the baby.”I did everything I could to try and save Of course the it’s baby.” not every day that a baby Of course it’s not everypasses day that a Most baby either goes home, or sadly away. either goes home, or sadly passes away.

Most days are filled with the in between - the caring, days are holding filled with the in between - the caring, nursing, and feeding of these tiny, little nursing, holding and feeding of these tiny, little babies. babies.

“I do 8 hour day shifts and 10 hour night “I do 8 hour day shifts and 10 hour night shifts. shifts.

“We receive handover at the start of the handover at the our startshifts, of the shift,“We thenreceive plan out our day. During as shift,part then plan out our day.

During our shifts, as of the care we take baby’s temperature part of the care we take baby’s temperature and change nappies and do obserand change vations. nappies and do observations.“Depending on whether “Depending on whether you are in special care or you are in special carethe or NICU and how sick NICU and how sick the babies are, the patient babies the patient ratio isare, 1 nurse to 4 ratio is 1 nurse to 4 babies. babies.

“Depending on “Depending on baby’s gestation and baby’s gestation and condition, we feed condition, we hours. feed them every 1-5 them every 1-5 hours.

We give medications at We give medications at certain times and change certain times and change fluids. Bath and weights are fluids.

Bath and weights are done on certain days as well.” done on certain days as well.”

That’s the practical side of things.

That’s the practical of things.

For Ms Mich, the difficulty lies in side knowing the For Msare Mich, the difficulty lies in in pain. knowing the babies so unwell, and often babies are so unwell, andbaby oftenI infeel pain.

“When I see a sick sorry and “When I see a sick baby I feel sorry and upset for them because they are just babies, upset for them because they are just babies, they are helpless. they“Iare alsohelpless. feel determination to help them in the “I also possible feel determination to help the best way for that shift.

I trythem and in think best way possible for that shift.

I try and think positive and that they will make a recovery.” positive and that make a recovery.”

Ms Mich saysthey withwill some babies remaining Ms ward Mich for saysupwith some babies it’s remaining on the to four months, easy to on the ward for up to four months, it’s easy to form an attachment, making it difficult both form an attachment, making it difficult both when they don’t make it, and when they leave. when theyattached don’t make whenespecially they leave.

“I get to it, theand babies of “I get attached to the babies especially of

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they have been long term prems. they“Ifhave beenlook longafter term them prems.on a particular I don’t “If I don’t look after them on athey particular shift I sometimes go into the nursery are in shift I sometimes go into the nursery they are in just to see them. just “You to seefeel them. so proud watching them grow feel getting so proud watching support them grow and “You progress, off breathing and and progress, getting off breathing support and feeding well by discharge. feeding well by discharge.

“I feel happy when they leave to go home “I feel when leave go everyhome but sad as happy you won’t be they seeing the to baby but sad as you won’t be seeing the baby everyday anymore.” day An anymore.”

NICU nurse’s caring role extends beyond An NICU nurse’s caring in role extends beyond the infant, often resulting close bonds with the infant, often resulting in close bonds with parents who are struggling to come to terms parents who are struggling to come to terms with their baby’s medical condition. with“Having their baby’s medical condition. a sick baby has a great impact on “Having a sick baby has a great impact on the parents. the parents.

“It puts a lot of stress and worry on them puts lot ofand stress andatworry and “It they areaoften unsure timeson of them what and they are often and unsure at times of what the outcome will be, although they try and the outcome will be, although they try and remain positive.” remain Ms positive.”

Mich says the sheer overwhelm many Ms Mich says the sheer overwhelm many

parents experience as a result of a premature parents experience as astruggle result oftoaunderstand premature birth means they often birth means they often struggle to understand all of the information they’re given by doctors. all of“As the information they’re given and by doctors. nurses we try and comfort reassure “As nurses we try and comfort and reassure them. them.

“The biggest part is supporting the parents “The biggest partoutcome. is supporting the parents no matter what the It is like a roller no matter what the outcome.

It is a roller coaster ride for them up and downlike good and coaster ride for them up and down good and bad days.” bad Ms days.”

Mich says NICU nursing differs from Ms Mich roles says in NICU from other nursing that itnursing is a verydiffers specialised other nursing roles in that it is a very specialised field, focusing solely on sick and premature field, focusing solelyfamilies, on sickasand premature neonates and their compared to neonates and their families, as compared to adult nursing with can be quite varied. adult nursing with can be quite varied.

“I would certainly recommend NICU “I would certainly recommend NICU nursing to others. nursing to others.

“Although it is challenging and tiring at “Although challenging and tiringand at times it is worthitit is and it is a very rewarding times it is worth it and it is a very rewarding and satisfying job.” satisfying job.”

HealthTimes - January 2018 | Page 13

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Nurses’ growing role in helping support victims of domestic violence

T

he relationship between a nurse and their patient is unique, often developing into an unparalleled bond between the two.

As a result, patients may turn to nurses for support in areas beyond their medical requirements, and similarly, nurses’ concern for their patients often goes further than their core duties of care.

A growing understanding of this relationship has prompted an expansion of the nursing role, in particular with regards to identifying and intervening in situations where domestic violence is suspected, or reported.

“Until recently, proactive identification of DV has been poor for a variety of reasons,” says Dr Kathleen Baird, Director of Midwifery and Nursing Education, Women’s and Newborn and Children’s Services/Gold Coast University Hospital.

Dr Baird says nurses have previously been reluctant to approach patients with their suspicions due to a belief that domestic violence enquiry is not within their professional remit.

Other reasons include fear of offending the patient, as well as anxiety and nervousness about dealing with a positive disclosure.

“And importantly, a lack of training and education,” Dr Baird says.

In contrast, women experiencing domestic abuse consistently identify health professionals, including nurses and midwives, as a potential

Page 18 | HealthTimes.com.au

source of support.

“It is known that women are not offended by being asked about a history of domestic violence, when the question is asked by a caring and knowledgeable nurse or midwife,” Dr Baird says.

“Indeed, evidence now suggests that women experiencing violence can feel let down if they are not given an opportunity to disclose about their experiences of violence.

“More recently there has been an increase in research from Australia around the efficacy and value of the healthcare professional’s response to domestic violence.

“There has been an overwhelming drive for healthcare professionals to acknowledge the reality of domestic violence and the effect domestic violence can have on health.”

With healthcare services now acknowledging the consequences and costs of domestic violence, many healthcare professionals are beginning to recognise and discuss domestic violence within their workload.

“There is a strong message and expectation that health will work with and alongside statutory and community organistions to recognise, respond to domestic and family violence,” says Dr Baird As a result, nurses and midwives must be made aware of the close links between domestic violence and child abuse.

“And whilst the child protection role is not

without its challenges, acceptance of this role means the health care professionals involved with working with children must accept their professional responsibilities in addressing domestic violence within their practice,” says Dr Baird.

With health services often the first point of contact for many domestic violence victims, it’s crucial to their long term health and safety that nurses are able to effectively offer support and guidance.

“Without a doubt, within some sectors of the health service such as maternity and emergency departments, there has been a growing awareness of health professionals becoming more pro-active around domestic violence with an enhanced knowledge and understanding around its consequences and impact on health,” says Dr Baird.

Unfortunately, there is still some reluctance among health workers to engage in this sensitive area, most likely due to a lack of confidence, knowledge and support within health organisations.

“It is thought that clinicians remain unclear about their role in addressing domestic violence; many may find it difficult to listen or understand a woman’s disclosure from a fear of knowing what to do when a woman discloses about a history of partner or family violence.

“Domestic violence is a very sensitive issue and to be able to deal with it effectively staff require the tools to do so.”

Although many government and professional bodies are now promoting routine enquiry in many clinical areas, Dr Baird says this cannot be safely and effectively carried out without an effective training programme for staff, and relevant multi- agency policies and guidelines in place.

“Ongoing staff support is also fundamental in order to sustain this work.”

If a nurse suspects domestic violence, there are several important steps they should follow.

“Sensitive questioning should take place in a safe and private environment, without the presence of a partner or a child who could repeat the conversation to another person.

When a nurse receives a positive disclosure, they must be aware of the appropriate referral pathways, which Dr Baird says should to be multi-agency and developed in collaboration with nongovernment organisations (NGOs), such as local women’s support groups.

Nurses should also be aware of their local hospital guidelines and protocols, and the referral pathways to community domestic violence agencies.

Unfortunately, for a variety of reasons, some women may choose not be honest in their first response.

“A woman may decide to withhold the information as they often feel stigmatised and fear that they won’t be believed,” says Dr Baird.

“Some women will also be reluctant to disclose because opening up and telling someone about the violence can pose a threat to the woman.

“Indeed, it is important to remember that when they leave or attempt to leave a violent partner that most women who will be, are murdered at this time.”

As a result, women should never be encouraged to leave a violent relationship until a full risk assessment has been performed and a robust safety plan put in place to protect both her and her children.

“Unless there are child protection concerns, women should not be forced to make any decisions about their future until they feel ready and it is safe for them to do so.”

Health care professionals should work in collaboration with other agencies to ensure women’s safety. Nurses should also ensure that information is provided regarding local women’s support agencies and, if a patient is in immediate danger, call the police.

HealthTimes - January 2018 | Page 19

Unprecedented action by Bupa nurses and carers leads to 11.5% wage increase Following an unprecedented strike by Bupa aged care nurses and carers, a wage increase of 11.25% over three years has been approved, along with significant improvements to workplace entitlements and workload management, under a new enterprise agreement.

Australian Nursing and Midwifery Federation (Victorian Branch) Acting Secretary Paul Gilbert said staff had negotiating with Bupa Aged Care for more than 14 months, after rejecting Bupa’s original offer for the new EBA of just 2.1 per cent in a one year agreement, with no other changes.

“Nurses and carers only take industrial action as a last resort, but Bupa was not listening to them and our members felt stretched and undervalued,” said Mr Gilbert.

“Bupa’s initial offer would have kept its nurses’ and carers’ wages in the bottom 10 percent of aged care facilities.”

More than 1000 aged care nurses and carers across Victoria took part in the protected industrial action across Bupa’s 26 nursing homes in Victoria.

“Nurses and carers took 37-days of action, including three days of full shift strike action and a 400-strong rally outside Bupa’s Melbourne corporate headquarters, following stop work and community rallies held across the state,” said Mr Gilbert.

Page 20 | HealthTimes.com.au

“ANMF members also wore ANMF red Value Recognise Reward campaign t-shirts, handed out campaign materials to residents, relatives and the community and spoke to the media as part of their campaign for improved staffing levels, skill mix and better wages and conditions.”

Along with the wage increase and backpay, the enterprise agreement also sees significant changes to entitlements, including changes to the workload clause, Sunday penalty rate, protection of accrued long service leave entitlement for employees transitioning to retirement, recognition of part-time employees’ regular additional hours, ability to use personal leave as family violence leave, improved parental leave clause and improved e-learning clause.

While the ANMF is pleased with the outcome, they were also seeking better staffing levels of registered nurses, enrolled nurses and personal care workers every shift to improve resident care.

“Inadequate staffing levels in aged care has become so normalised in a profit-driven aged care sector that employers appear blind to the consequences,” said Mr Gilbert.

“Bupa nurses and carers should be so proud that their unprecedented industrial action has put a spotlight on aged care staffing numbers and is prompting people to ask what is a safe number of nurses and carers to look after our elderly loved ones? “Their action has set a new precedent for engagement in the aged care sector and sent a strong message to private aged care employers still to negotiate agreements.”Mr Gilbert said the ANMF will keep trying to achieve safe nursing levels via an industrial instrument, however would prefer enforced minimum nursing levels in the Aged Care Act.

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Learning paediatric dietetics guidelines for everyday practice

T

he Dietitians Association of Australia (DAA) has developed a paediatrics dietetics management course for clinicians designed to present current guidelines and evidence alongside best-practice ‘how-to’ guidelines for everyday practice.

Running in 2018 as a partnership with the DAA and Child Health in Life & Disease Dietetics (ChildD), the course is suitable for health students, GPs, nursing and allied health professionals – with more advanced modules targeted towards dietitians and doctors.

I interviewed one of the course facilitators Joanna Munro, Accredited Practising Dietitian and Program Manager for ChildD to get a feel for how the course is suited to clinicians both with and without specific dietetics training.

Why is it important for non-dietitians to undertake this kind of training?

Module 1 provides participants with a working knowledge and experience of evidence based practice in the areas of growth, infant feeding (breast feeding and introduction of solids), nutrition assessment and common childhood issues such as obesity, faltering growth and feeding difficulties.

From how to accurately weight/height an infant/child to accurately identifying faltering growth to having the necessary skills to address a weight issue with a child and their family, the course provides a wide range of knowledge

Page 22 | HealthTimes.com.au

and skills highly relevant to non-dietitians such as nursing staff who play a key role in the assessment and monitoring of growth and nutrition in paediatrics.

Dietitians are eligible for attendance at Modules 2 and 3 – this is where they will enhance their advanced practice skills in Medical Nutrition Therapy in a range of paediatric areas of practice.

What kinds of allied health clinicians (other than dietitians and nutritionists) do you often see in your training? Ie. speech pathologists?

We are still maturing and developing our courses and have only conducted 3 so far which have been focussed on dietitians. However, as the courses have evolved, it has become apparent the content is very relevant across disciplines and we are so excited to be able to target other allied health professionals, specifically speech pathologists and nursing staff who are involved in feeding and nutrition in every day practice.

Pre-course preparation includes literature reviews – how in-depth will this be? Is it something that someone who hasn’t been to university for a while will be able to manage with ease?

A list of reading material focussed on guidelines, strategic documents and key evidence is provided with links to the relevant

documents, papers and websites. They provide an excellent introduction to the topics that are worked through in the courses and would be easily managed by all trained health professionals. In fact, there is no systematic review or own searches required. The hard work is already done.

What kind of activities will the training include? Ie. simulations, workshops, lectures, etc.

The training will include lectures, case studies, role plays, workshops and simulated learning clips. We aim to make the training as interactive as possible to allow for plenty of questions and discussion. This is the point of difference of this course and the feedback on the multimedia nature of the course has been excellent.

What kind of take-home or followup material will be included with the course?

The take home package is extraordinary. It is designed to provide a paediatric training ‘manual’ that participants can add to as they progress in this career. Each participant will have access to all presentations, workshops and reference lists online which they can download for personal use following the course. They will also receive a folder containing all the workshop materials which they will complete during the course. We have had feedback that this provides an easy, ongoing, go-to that people refer to when they need help in practice following the course. We design the courses to ensure this can be used as a manual post training.

Do you offer your training online, or

have the ability to come to an organisation’s workplace to conduct training?

Online training is something we are definitely planning for the future. We are open to exploring all modes and methods of course delivery. We design each course to suit the particular participants and city we present to.

The course can be redesigned and modified to suit different requirements. There is a ‘bespoke’ element to this course, making it relevant to our audiences.

The content will cover breastfeeding, introduction to solids, growth issues, obesity and cerebral palsy difficulties – are there other common problems in childhood that it doesn’t cover, or that it might cover if you have enough time/ participant interest?

Within these topic areas, we touch on other common problems in childhood such as fussy eating, iron deficiency and provide relevant references and resource lists. As the course is interactive, we are able to discuss other relevant nutrition issues of interest to a participant either within the course or during breaks.

The course is held on the Gold Coast, with Module 1 starting on 5 March 2018. Registrations close 20 February 2018, and DAA members receive a substantial discount.

For more information see DAA’s website https://daa.asn.au/member-community/ blog/centre-for-advanced-learning/nationalpaediatric-dietetic-training-course/ or email learningcentre@daa.asn.au

HealthTimes - January 2018 | Page 23

The rise of music therapy intervention for terminally ill children

W

hile the use of music as medicine is not a new concept, having been used in abundance throughout the history of human evolution, its implementation as an academic discipline has seen an increase in acceptance in recent times.

“Music therapy is gaining more recognition, as awareness by both consumers and health professionals increases through research literature and media publications,” says Peter Maccallum Cancer Centre Music Therapist, Tom Buick.

“The support from multidisciplinary team members is also increasing as they work towards further promoting music therapy and increasing the number of referrals and access to music therapy in hospitals and out in the community.

“Philanthropic support through organisations such as Redkite and hospital and government funding has also assisted greatly in the increased number of music therapists in the hospital and how many days they are employed.

Mr Buick fell into Music Therapy almost by accident whilst studying to become a nurse.

“I worked as a patient carer in a nursing home, it was here in my spare time playing music for the residents.

“The smile that this brought to their faces and seeing those that were normally isolated or disengaged light up and start singing along or tapping their feet was priceless.”

Some years later, after a jamming session with a local busker, Mr Buick discovered he could make a career from his passion, and officially became

Page 24 | HealthTimes.com.au

a Music Therapist via Melbourne University’s masters program.

He now works at Peter Macallum Cancer Centre as a paediatric, adolescent and young adult Music Therapist, helping young people work through a range of physical and emotional difficulties.

“One is supporting the young person and their family during certain medical procedures such as a general anaesthetic or a CT-Scan, with the focus of my session aimed at reducing the anxiety and stress that might be experienced by the patient and their family/carers.

“The support is offered through providing them with choice and control over parts of their care as most of their decision making is taken away from them.”

Mr Buick says taking care of the emotional wellbeing of patients is vitally important as they experience challenges during their treatment or disease progression.

“A music therapy session that uses particular music or therapeutic conversations can provide the young person with a space to express themselves, have their feelings validated in a safe non-judgemental environment.

“With the right facilitation and ongoing support music therapists can provide patients with resources that can assist in coping with treatment side effects and ways to manage mood and stress. “

To read the full article visit HealthTimes.com.au

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HealthTimes - January 2018 | Page 27

Defining the role of the nurse care coordinator

E

ach year the Australian media covers the test cricket match played at the Sydney Cricket Ground where since 2008 the third day, or traditionally Ladies Day, has transformed the game into the Pink Test in support of the McGrath Foundation. After ten years of Pink Tests, the public are becoming familiar with the role of breast care nurses thanks to the McGrath Foundation which raises money specifically to fund the placement of breast care nurses in the community.

Acting as the patient’s clinical navigator to the world of healthcare, there are nurses working in many fields of care providing education about disease and self-management; behaviour change or health coaching principles to promote the uptake of recommended health maintenance practices.

So-called nurse care coordinators can also conduct physician collaboration providing education to patients about how to communicate with healthcare team or communicating with members of the healthcare team on the patient’s behalf if it is required.

While definitions of role responsibilities can differ between fields and facilities, there has been many studies done on measuring the effectiveness of specialist-trained nurses in transition care at levels of both patient satisfaction and service provider outcomes.

A systematic review of this literature was carried out by the QUT School of Nursing in

Page 28 | HealthTimes.com.au

collaboration with the Queensland Government Office of the Chief Nursing and Midwifery Officer to develop key recommendations for these ‘nurse navigator’ roles.

The review, authored by Aaron Conway (QUT), Chris O’Donnell (Queensland Government) and Patsy Yates (QUT), covered 45 articles published after 2009, including participants receiving care in hospital and/or community settings in the United States, Australia and the United Kingdom.

Conditions included in the review covered multiple comorbid conditions and were all commonly identified as ‘high risk’ conditions such as diabetes, dementia, terminal illness, children requiring special care, stroke recovery, COPD, bipolar disorder, disabled with functional impairments, requiring care in an aged care facility.

The patient-reported outcomes of this study indicated that patients with a variety of conditions receiving treatment from nurse care coordinators felt a reduction in their depressive symptoms, and better able to cope with pain and medication management.

COPD patients in particular indicated lower symptom distress, such as reduced pain and improvement in sleep quality.

There was a higher satisfaction reported by elderly and bipolar patients with the quality of care received by nurse care coordinators.

Elderly patients with impaired ability to manage their medications reported a higher quality of

life and ability to manage their medications – when provided more frequent nurse contact.

The reporting of outcomes for health services was more reserved, noting the patients were already ‘high-risk’, suggesting concentrated care was already appropriate.

The integration of the nurse care coordinator did not indicate an impact on hospitalisations or a reduction of the length of stay in readmissions or emergency department use however positive results were recorded in long-term outcomes.

Treatment adherence was more likely to be carried out, especially in diabetic patients, and one randomly controlled trial reported a 29% reduction in home healthcare use for those receiving transition care.

The authors of the review note that while there are some excellent results in the smaller studies, such as certain programs producing cost savings of nearly $300 per month; reductions in length of hospital stay; and improvement in survival rates, the range of individual components of nurse care coordinator roles differed considerably across the studies that were examined.

The findings of the review have been used to develop practice guidelines for the nurse care coordinator role in order to improve the effectiveness within the health services. The Queensland Office of the Chief Nursing and Midwifery Officer has developed a checklist to help conduct self-assessments and to support implementation for the Nurse Navigator role into health and hospital services. The full report can be read at https://eprints.qut.edu.au/104760/

Effective targeting of resources Foster a system that facilitates effective targeting of navigation for high-risk patients (e.g. elderly, with chronic disease, poor health literacy, impaired ability to manage treatment, medications or self-care/self-management).

Establish confidence Enable the participants to establish a sense of confidence in the navigator by providing regular and in-person contact over the course of the follow-up.

Promote integration Promote the integration of the navigator role within the health care team. For example, ensure communication channels are available so that the navigator can facilitate collaborative development of treatment goals and corresponding care plans with the multidisciplinary care team efficiently.

Support self-management Apply interventions to promote the uptake of health maintenance practices that are informed by principles from behaviour change theory (e.g., motivational interviewing).

Transition management Provide transition management for patients being discharged from acute care. A number of evidence-based transition care models can be applied to practice, including Naylor’s Transition Care Model and Coleman’s Four Pillars for Care Transitions.

HealthTimes - January 2018 | Page 29

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