July 2018
Theatre & Critical Care Feature + Theatre Nursing - rewards and challenges of a unique role + Confronting mental health in critical care + Cognitive behavioural therapy for addiction + Better access to psychosocial support crucial for people with brain tumours
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July 2018 We hope you enjoy perusing the range of opportunities included in this issue. If you are interested in pursuing any of these opportuities, 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 DISTRIBUTION 46,300
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Cosmetic Injectables: 3 Days, $4990 Cosmetic Injectables Training is a 3-day introductory workshop to prepare you for a career in cosmetic injectables. We provide you with a solid grounding in the assessment of facial aesthetics, anti-wrinkle injections and dermal fillers. The clinical component of our training is very hands on - we have you treating live models under strict supervision early on the first day. Our training days are capped at 3 students so you'll receive one-on-one attention from the clinical trainers. 23, 24 & 25 October | 20, 21 & 22 November
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1300 221 971 | smartnurses.com.au *Based on the following assumptions: living in NSW 2560, salary: $85,000 gross p.a., travelling 15,000 kms p.a., lease term: 60 months, using the Employee Contribution Method for FBT purposes. All figures quoted include budgets for finance, fuel, servicing, tyres, maintenance and reregistration over the period of the lease. Also includes Vero by Suncorp comprehensive motor insurance, 2 year extended warranty (except for all Mitsubishi, Honda, Hyundai, Kia and Skoda models) and Hydro Platinum Pack (incl Driver Safety Kit & Window Tint), as part of the offer. Vehicle residual, as set by Australian Taxation Office, payable at the end of lease term. Vehicle pricing is correct as of May 2018, and may be subject to change based on availability. #Terms & Conditions apply, for full details visit smartleasing.com.au. Promotion period is 02.07.18 at 00:01am – 28.09.18 at 11:59pm. Joint promoters are: Smartsalary Pty Ltd (Smartleasing is a registered trademark of Smartsalary), AccessPay Pty Ltd, Salary Packaging Solutions Pty Ltd, Salary Solutions Australia Pty Ltd, Selectus Pty Ltd and Autopia Management Pty Ltd. The prize pool is shared among the six named joint promoters. This means, for example, that an eligible entrant who is a customer of Salary Solutions will be competing for one (1) Grand Prize adventure holiday with all other eligible entrants, who may be customers of any other of the joint promoters. The shared prize pool consists of (a) one adventure holiday (choice of an African Safari and an Alaskan Cruise) and (b) sixty-five $100 BP Fuel Cards. Permit numbers: ACT TP 18/01142, NSW LTPS/18/25096, SA. Licence No: T18/1047.
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Great opportunities for Theatre Nurses Are you a skilled and passionate Theatre Nurse? We are looking for talented and dynamic Theatre Nurses to join our growing team: • Scrub Scouts • PACU Nurses • Anaesthetic Nurses • Full-time and part-time positions available • Modern facilities and great Bayside location Join us today. peninsulahealth.org.au/careers
HealthTimes - July 2018 | Page 07
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Be part of the change – join GV Health now • $169 million redevelopment • Various positions available • Attractive regional location, close to wineries, snow fields and rivers. Change is coming to GV Health, with the health service undergoing a $169 million redevelopment. This exciting transformation of our Graham Street site includes three new operating theatres, two new wards, a four storey tower and an expanded Emergency Department. GV Health is located in Shepparton, Victoria and has various positions available. Currently we are looking for professionals in the following areas: • Mental Health • Medical Imaging • Nursing • Midwives • Nursing Management • Allied Health
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HealthTimes - July 2018 | Page 09
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Flight Nurses Unique career opportunity Permanent full time role Based in Alice Springs, NT Join a great Australian icon. As a Flight Nurse with the Royal Flying Doctor Service (RFDS) you will be joining a team of dedicated professionals providing and enhancing health care to people living and working in regional, rural and remote Australia. Working in a diverse, fulfilling and rewarding environment, RFDS flight nurses are at the forefront in delivery of aeromedical health services, providing primary response, intensive care, obstetrics and trauma services, including emergency retrievals, as part of our high performance aeromedical team. We are seeking motivated and experienced Registered General Nurses with a relevant second qualification in Midwifery (highly desirable), ED or ICU. The right person will also actively demonstrate and reinforce our values, and enjoy working collaboratively with other professionals to provide high quality health care in a remote environment. We offer relocation assistance, attractive remuneration and salary packaging benefits. The RFDS is committed to the development and career progression of its people. If you want to join our team in providing the finest care to the furthest corner, for more information and to apply please visit our website at: https://www.flyingdoctor.org.au/careers/job/flight-nurse-alice-springs/ The Royal Flying Doctor Service is an Equal Opportunity Employer
HealthTimes - July 2018 | Page 11
ECG INTERPRETATION WORKSHOP BRISBANE, SEPTEMBER 19 2018 For more information and to book tickets go to: http://bit.do/ECGBRIS
Enquiries: Contact HealthTimes 1300 306 582 Contact@healthtimes.com.au
PRESENTED BY
In this clinically based workshop you will have the opportunity to develop skills and confidence to examine ECGs and readily identify abnormalities associated with cardiac or lung disease or associated with toxicological or biochemical disorders. The workshop is delivered using an interactive, problem based approach that first allows participants to examine a series of ECGs in a small group before joining a large group discussion led by the facilitators that explores the ECG findings in detail. Suited to Nurses and Medical officers (GP, Registrars, TMOs, SMOs). It is also likely to be of assistance to final year medical / nursing students and to paramedics. Price - $250 (Early Bird $199) Tickets strictly limited
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HealthTimes - July 2018 | Page 13
Cognitive Behaviour Therapy for addiction
A
s societal and medical understanding of addiction grows, particularly in relation to its link to mental health, Cognitive Behaviour Therapies are increasingly being used as treatment for substance and alcohol abuse. “Mental health problems are intrinsically linked to alcohol and other drug problems,” says drug and alcohol policy and practice expert, Professor Nicole Lee. “Up to 80% of people in alcohol and other drug treatment have some kind of mental health symptoms, most commonly anxiety or depression,” says Dr Lee. “Alcohol and other drug use cause or can exacerbate mental health problems. “We also know that existing mental health issues increase the risk of developing alcohol and other drug, including things like the effects of childhood or adult trauma.” As a result, CBT has become one of the most common, effective treatments for alcohol and other drug addictions. “I’ve definitely noticed a resurgence of interest in CBT in the last few years, especially as people realise that the quite rigid forms of CBT that were developed in the 1960s have evolved significantly over the last 40-50 years, with a lot more attention paid to process in therapy and the role of emotions, and a lot more flexibility. “There’s a lot more art to the science now.”
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According to Dr Lee, Cognitive Behaviour Therapy is an umbrella term that encompasses a number of solution oriented therapies, with the common underlying theory that emotions are influenced by thoughts and behaviour, and that the way to address difficult emotions is to modify thinking -or cognitions - and behaviours. The different therapies include behaviour therapy, cognitive therapy, acceptance and commitment therapy (ACT), Dialectical behaviour therapy (DBT), metacognitive therapy and mindfulness based cognitive therapy. They differ mainly in the emphasis they put on the importance of different components and the strategies they use to enable cognitive and behavioural change. “CBT is used for a wide range of problems, including common mental health issues like anxiety and depression. “Along with more complex mental health issues like substance use problems and psychotic disorders; behavioural disorders such as ADHD and as well as health problems like chronic pain, sleep problems and eating disorders, just to name a few.” “CBT is now one of the most effective treatments for alcohol and other drug problems, including dependence. “It’s also the most researched therapy for alcohol and other drug problems.” Dr Lee says CBT helps people with alcohol and other drug problems recognise unhelpful patterns of thinking and behaving that can increase problematic use. It can also help people to regulate emotions that may also lead to problematic drinking or drug taking. “CBT for alcohol and other drug problems is effective as group or individual therapy, typically weekly in Australia. “Most people receive CBT in non-residential
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counselling settings. “It is also a common component of treatment in residential rehabilitation and day rehabilitation settings.” When it comes to the public perception of alcohol and drug treatment, often the first assumption is AA or one of the other 12-step programs. “Probably because they feature heavily in movies and TV a lot. “But there’s virtually no evidence that this approach is effective, and also not everyone needs to be or wants to be abstinent. “The best estimates are less than 10% of people are successful in 12-step. “CBT is well researched and is known to be effective and I believe it should be used widely for that reason. There are lots of different varieties of CBT to choose from.” According to Dr Lee, one of the most beneficial aspects to CBT is that it can be used for people who meet criteria for substance use disorder and for
people who have milder problems. “For example, I recently saw a 40 year old woman who was experiencing some anxiety, especially when she saw her parents and siblings at family gatherings where there was a lot of arguing and tension. “So she would have a few drinks before she went to see them to calm herself. “But they would criticise her for drinking which would make her more anxious and drink more. “She wasn’t dependent on alcohol but she was using alcohol in a way that wasn’t helpful for her. “She had over time started to drink more heavily at other times as well. “So we worked on anxiety management, reducing her drinking and some strategies to manage the family dynamics all using CBT. “I only saw her for 5 sessions as she had improved so much over that short time and was able to continue on her own. “CBT is really about teaching the client to be their own therapist.”
HealthTimes - July 2018 | Page 15
Are you a RN, Midwife or EN? We need you! Apply today and find out what Carnarvon Health Campus and their unique location has to offer. Enjoy the great benefits of working with Carnarvon Health Campus including: • salary sacrificing • recreational leave packages • shift allowances (+ travel days) • locality allowances • subsidised housing • professional development assistance • flexible working arrangements • and more! Email applications to Christopher.Stockdale@health.wa.gov.au Or call Christopher Stockdale / 08 9941 0406 or Ngaire McCallum / 08 9941 0302
Government of Western Australia WA Country Health Service
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Swimming with the whale sharks in Carnarvon
I
n 2015, Carnarvon Health Campus underwent massive redevelopment with the goal of providing high-quality medical care to the local community through modern, well-equipped health services located under one roof. The redevelopment saw upgrades in the Emergency Department, dialysis services, mental health, child health and outpatient facilities as well as a range of allied health services such as dental, and physiotherapy. The upgrades have also brought new opportunities for a range of health professionals to experience the benefits of living in a tropical town with an outback vibe. Ngaire McCallum, a new Clinical Nurse Manager at Carnarvon Health Campus, has already made the most of the region’s unique lifestyle after moving here 2 months ago. “I was able to go to the Ningaloo Coast and swim with the whale sharks. I was literally only 2 meters away from them” she said. “Your first reaction is to be somewhat afraid, but soon after swimming with them I was amazed by their beauty”. Carnarvon is situated in the heart of the Gascoyne Region, on the doorstep of the Indian Ocean, approximately 904km north of Perth. It is the gateway to Australia’s Ningaloo Coast, and in close proximity to the Ningaloo Reef and World Heritage areas. Thanks to its unique location it is a tropical oasis commonly recognised for its banana plantations, tropical fruits, fine seafood and warm climate Ngaire says there’s much she still hasn’t seen. “I would love to swim with the Dolphins next now that I’ve crossed whale sharks off my bucket list”. She’s also looking forward to visiting the majestic Kennedy Ranges and Monkey Mia
Reserve, which are just the down the road. With an exceptional climate (average yearly temp of 26°C) and a vibrant and diverse community that offers exciting culinary delights, it’s safe to say Ngaire is enjoying Carnarvon. Carnarvon Health Campus is currently seeking RNs, ENs and Midwives to join their dedicated team. They are committed to providing a wide range of rewarding career opportunities to their employees and encourage professional development. To attract and retain a workforce, Carnarvon Health Campus is offering a generous remuneration package with great employment benefits. These include salary sacrificing options, attractive recreational leave packages, shift allowances (+ travel days), locality allowances, air conditioning subsidies for when things start to heat up, subsidised housing, professional development assistance, flexible working arrangements, the employee assistance program, and even financial incentives to stay longer! Carnarvon Health Service currently has vacancies in all areas including emergency department, general medical ward, midwifery and aged care. They are also looking for highly skilled registered nurses for Clinical Nurse positions. If you want to find out more about the opportunities at Carnarvon Health Campus contact their CNMs Chris Stockdale on 08 9941 0406 or Ngaire McCallum on 08 99410347. Alternatively, visit their website at: www.carnarvon.wa.gov.au. Apply directly today by emailing Chris Stockdale, CNM on: Christopher.stockdale@health.wa.gov.au
HealthTimes - July 2018 | Page 17
Theatre Nursing - rewards and challenges of a unique role
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orking with patients at their most vulnerable time, makes the role of theatre nursing both unique and challenging, requiring a diverse set of skills and calmness under pressure. For Angela Fischer, an Anaesthetic Nurse at Logan Hospital, working as a theatre nurse has been a natural choice, despite concerns from colleagues that her extroverted personality may not be a good fit. “My NUM along with my colleagues said I would not like it in theatre as I liked my patient interaction and I enjoyed dressing up on special occasions to cheer up my patients. “They said I would not be able to do this in theatre - 9 years later and I am still a theatre nurse and I have managed to bring my own style to theatre by wearing my own colourful scrubs and hats, and even managed to dress up as an elf over Christmas which the staff and patients loved.” When Ms Fischer first began her nursing studies, she planned to work in a cancer ward, but after following a patient on their journey through the operating theatre, she found the experience both intimidating and interesting. “I was amazed at how many people were in the operating theatre and was glad when the long procedure was over and the patient was in recovery.”
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A Theatre Nurse has many different roles, and therefore lots of different roles and responsibilities. “As a PeriOperative Nurse (Theatre Nurse) you are responsible for providing care to a patient during their Peri-Operative journey. “So from the admission to theatre for their surgery, their anaesthetic, surgery, recovery, and discharge home if a day case or to the ward.” While theatre nurses have many roles and responsibilities, and some theatre nurses work in all areas, most will complete the transition program and stay in one of the following areas: • Day Surgery Holding Bay Nurse • Recovery Nurse • Anaesthetic Nurse • Scrub Scout Nurse After completing the transition to Peri Operative Nursing program, Ms Fischer has spent most of her time as a scrub nurse, with the last three years being spent as an anaesthetic nurse. “I enjoyed working as a scrub Scout Nurse and especially scrubbing for the big open cases such as abdominal hysterectomies and bowel surgery. “The role of the Scrub nurse is to assist the surgeon by passing them the instruments, sounds simple but is a lot more involved than that. “As a Scrub nurse you are multi-tasking at its best, you are making sure the patient is safe, you’re making sure the sterile field remains that way, your counting instruments, sponges, raytec, sutures, you’re watching the medical student gown and glove, you’re keeping an eye on the resident and the registrar, you’re prepping the area for surgery, draping, handing instruments to the surgeon. “The Scrub nurse also needs to have an understanding of what the operation is and the anatomy of the patient so you can preempt what
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the surgeon needs next and give it to them.” Ms Fischer says despite the challenges, she’s glad she fell into a role she had no intention of ever getting into. “I did not know what to expect and I am glad I took the opportunity that was given to me, as I love working as a theatre nurse,” she says. “I enjoy the dynamics of the theatre environment and the close working relationship with my colleagues, I enjoy the variety and the fact every day is different and has its challenges but we work together as a team to provide life saving care for out patients. Due to the nature of theatre nursing, those working in this area require a unique set of skills to manage the dynamic and often challenging environment. “As an Anaesthetic Nurse you need to have a calm and friendly nature in order to gain the trust of your patients in a short period of time, you need to be able to reassure the patient that they are safe and we will do everything we can to
make sure they are safe. “As a Scrub Scout nurse you need to be able to control your bladder as you can’t Unscrub during an operation to go to the bathroom. And you can be scrubbed for long periods of time. “The operating theatre is a very unique area and can be very stressful. “To the outside eye, it can appear very messy during a crisis event, as there can be lots of people and lots of noise. “As a theatre nurse you need to be able to remain calm in a crisis situation. There are lots of big personalities in the operating theatre.” But while the theatre environment can indeed be stressful, Ms Fischer says it’s also extremely rewarding. “Your team is like family and we have our bad days and good days but we are there for each other and help each other during the bad times. Every day is different and has its challenges and rewards.
HealthTimes - July 2018 | Page 19
Confronting mental health in critical care
C
ritical care nurses care for the sickest of the sick patients across a range of settings such as intensive care units, cardiac care units and emergency departments. Patients may be experiencing a variety of life-threatening conditions such as heart attack, stroke, trauma, sepsis or may be post surgery. As a result, critical care nurses can face a range of emotions as part of their role, as they come to grips with high levels of confronting medical situations, and often distressing outcomes. For Ballarat Health Services cardiac catheter laboratory nurse, Rebecca Taylor, learning how to deal with the mental health consequences that can arise in her critical care roles, has been an on-thejob experience. “I don’t think I did prepare before I started in critical care, and I have learned along the way what works for me to deal with what I see at work. “Knowing that the work you are doing really matters, you are making a difference for someone and I find that caring for patients with that in mind is helpful. “You can’t always change the outcome for a patient but you can make a negative experience a little more positive; that knowledge helps get you through the tough days. “The times I have found the most difficult
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have been when there is an unexpected negative outcome, particularly when a young person dies. “It is important to remember that despite the best efforts of modern medicine sometimes people do die, but we have done absolutely everything possible to try and change that outcome. “It’s also important to acknowledge that we work in an area that can be confronting but that’s not everyday life; its working in an extreme.” Ms Taylor says, when working in critical care, there is no average day, and nurses need to be able to be flexible and quick-thinking. “A patient may be stable at the beginning of a shift then deteriorate rapidly and you become very busy very quickly. “Or stable patients may move out of the critical care area and you are allocated other sick patients and your shift totally changes pace. “You are constantly on your toes, rapidly interpreting clinical data and responding to any changes. It’s never dull!” One of the key differences between critical care nursing, and other nursing roles is the number of patients in care. “In critical care you are often only allocated one, sometimes two patients; they are so sick that it is only possible to care for few patients.
“The sickest patients require constant observation; if you want to go to lunch or run to the loo you need to organise another nurse to monitor your patient while you are away.” Patients in critical care units may be experiencing heart attacks, stroke, sepsis, trauma or may be post surgery, amongst other indications, and the impact of this can be significant. “You are working with life and death, lifealtering diagnoses, serious surgery. It can take a toll.” In many critical care areas, communicating with and caring for families, is an important requirement. “It can be a hugely challenging but also super rewarding part of the role. “It can be really confronting; you are talking to people about their loved one who is seriously ill and may die. “Critical care units can be scary places, lots of wires and tubes and beeping machines; part of your role is helping families see past that and be with their loved one. “I have found that even when a patient passes you can still do something positive and make the experience a little easier for the family. “Give them time and space. You cannot change the outcome (death of a patient) but you can bring some light for the family.” But it’s not just the confronting nature of the critical care environment that has an impact, says Ms Taylor, the patients themselves - often experiencing a life-
changing event - can also affect nurses. “One patient was a young woman, 27, who had had a big heart attack, obviously totally unexpected when one is 27 years old. “I was on a night shift and she kept pressing the call bell but every time I went to her room she didn’t really need or want anything specific. “After several hours of this, at about 3am she said ‘I’m just really scared and lonely’. “I could do all the monitoring and observation my years of training had taught me, but all this patient needed was a person to listen and reassure.” Ms Taylor says debriefing, both formal and informal is important. “Speak with your colleagues in the tea room, have a drink after work. “Hospitals have services in place for staff to speak to a counsellor or psychologist if they need help. “Take a mental health day; use your sick leave to look after yourself. If you don’t look after yourself you can look after anybody else.”
HAVE YOUR SAY! Leave a comment on this and other articles by visiting the ‘news’ section of our website at healthtimes.com.au
HealthTimes - July 2018 | Page 21
CARING FOR THE CRITICALLY ILL CHILD: WORKSHOP BRISBANE, SEPT 17 & 18 2018 For more information and to book tickets go to: http://bit.do/CRITBRIS
Enquiries: Contact HealthTimes 1300 306 582 contact@healthtimes.com.au
Focusing on the clinical skills that are required and essential for the recognition and emergency management of the seriously ill infant and young child. Designed for medical officers, nurses, paramedics and allied health professionals in all medical fields. Course Accreditations:
PRESENTED BY
• • •
RACGP (Category 1 - 40 points) ACRRM (30 PRDP Points) Eligible for the Rural Procedural Grants Program
Price - $450 (Early Bird $399) Tickets strictly limited
Page 22 | HealthTimes.com.au
EMBRACE YOUR PASSION AND SPECIALISE WITH ACN
FEE-HELP
is available for all of our graduate certificate course s
A graduate certificate gets you a step closer to becoming an expert practitioner in your chosen clinical specialty, helping you work towards a higher grade position. ACN offers 14 graduate certificates created for nurses by nurses – which one will you enrol in today? www.acn.edu.au/htjunpostgraduate2018
HealthTimes - July 2018 | Page 23
Burnout in Midwifery: An Occupational Hazard?
I
t’s concerning that mental illness among healthcare professionals is exceptionally high compared to the national average1. A study of suicides over 12 years found female nurses and midwives had a suicide rate almost triple that of women in non-health professions2. These statistics are alarming. However, it’s not surprising that the physical and emotional demands of nursing and midwifery can lead to occupational burnout. Burnout depletes energy, leads to feelings of hopelessness and, at its worst, is a precursor to mental health problems like anxiety and depression. Marcela Slepica, Clinical Services Director, AccessEAP, a leading employee assistance provider, says the unique challenges that affect the mental wellbeing of health professionals includes exposure to trauma, threats of aggression and violence, shiftwork, dealing with grief and loss, allegations and complaints, compassion fatigue and mental health stigma. In the latest survey, What Nurses & Midwives Want: Findings from the National Survey on Workplace Climate and Well-being2, almost a third of nurses and midwives have considered leaving the profession due to rising work demands and burnout. According to the report, increasing workloads, work intensification and budget cuts leading to unrealistic nurse to patient ratios underscore leading triggers.
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Data also revealed 71% of nurses and midwives feel they often have to do more work than they can do properly, while 67% listed work intensification as a major issue. Alarmingly, 54% of nurses and midwives were apprehensive about reporting their concerns to management due to fear of negative consequences. A Psychologist’s Perspective Peter Charleston, a former psychologist in one of Australia’s largest tertiary hospitals, said nurses and midwives are at risk of burnout because they are altruistic and notoriously poor at selfcare. “They work hard, for long hours, in emotionally intense environments. I constantly had a long wait list of staff seeking therapy for their own distress and personal and professional issues.” “Midwives have stressful jobs in that they regularly deal with people with high anxiety. They are emotionally involved in the birth process. Their job also involves showing a lot of compassion, warmth and understanding, which can be emotionally taxing,” he said. Healthcare professionals are trained not to show vulnerability and being emotional is seen as a weakness in some workplaces. It is this bottling up of one’s emotions that leads to stress if there’s no outlet, according to Charleston. “Midwives are particularly at risk of burnout from the cumulative effect of dealing with peo-
ple’s anxieties and distress during the birth process. And the stakes are high; all midwives know what could go wrong. The potential death of a newborn baby is ever present.” Charleston advocates self-care in healthcare, including regular debriefing, time for rest and relaxation, and a conscious effort to satisfy one’s own practical and emotional needs. “Many healthcare workers, midwives included, don’t give themselves adequate time for these activities because they care more for others than for themselves. The common element is low self-worth. If you don’t feel good enough, you won’t invest enough time to take care of yourself.” “Helping others can be a legitimate way of avoiding yourself. So valuing yourself, and your needs, is a crucial aspect of improving the way you take care of yourself.” The combination of a stressful, high-pressure work environment and lack of self-care can lead to burnout, and is best prevented, as treatment is difficult, said Charleston. “Burnout involves complete physical and emotional shutdown. You cannot function, feel disconnected from your job, not unlike a machine going through the motions, and this is the result of accumulated stress over time,” he said. Burnout: A Midwife’s Story Andrea Fallon, a practicing midwife of 12 years, says burnout is an occupational hazard in her profession, and one she endured in her graduate year in a large public hospital. “I believe a combination of factors contributed. Firstly, full-time shift work is physically exhausting, and as a new practitioner trying to manage workload, on top of physical exhaustion, it’s difficult.” While support for graduates is generally good, within the birthing suite, the conflict between midwives trying to keep low-risk births normal and doctors wanting to intervene is dif-
ficult for many midwives, said Fallon. “New midwives graduate with the training to manage the care of low-risk birthing women; the reality of practice in a hospital setting is vastly different and many graduate midwives struggle with this and, in my group, many left the profession.” “We are also trained that best practice is continuity of care, seeing women from pregnancy through to postpartum, but the reality is a fragmented system.” “The signs of burnout for me were: dreading going to work, anxiety when I arrived at work, feeling shaky, nauseous and generally like I didn’t have much to give emotionally.” “I made the decision to become a child health nurse while continuing part time in midwifery.” “This dramatically improved things for me. I enjoyed the continuity of care in child health while still caring for mums as a midwife. I believe women should be able to access all the information on health for themselves and their baby.” Fallon said she strongly encourages midwives to learn at the major hospitals and then get out into the low-risk settings. “Get involved with a professional colleague who will support you, and know that it takes a long time for the system to change but do what you can for each individual woman and family in your care.” Beating the Burn: Nurse & Midwife Support Mark Aitken, Registered Nurse and Consultant for Nurse & Midwife Support: a national support service for nurses and midwives, said common issues include stress, compassion fatigue, depression and anxiety. “Midwives may be exposed to particularly challenging and stressful situations. One moment you are sharing a family’s joy with the birth of a healthy baby. However, on the same shift, you might be providing support to a mother
HealthTimes - July 2018 | Page 25
with a stillborn baby. Managing that range of emotions can be difficult,” he said. “It is important to identify the signs of burnout early, so preventative measures can be put in place. Both your physical and mental health is of great importance,” he said. Professor Anne Williams, School of Health Professions, Murdoch University, has counselled nurses on how to manage stress and burnout for many years. She said the nature of the work is rarely mentioned when it comes to stress and burnout. “It is workload and environmental factors, such as lack of equipment and resources, challenging behaviours of patients, relatives and staff, workload, parking, and insufficient time because of a lack of qualified staff.” “Worldwide research in this area supports these local findings. In addition, factors such as nursing team relationship issues and difficulties interacting with medical staff are apparent,” she said. “Nurses and midwives can minimise the risk of burnout by reducing stress, both at home and at work, and by removing prolonged causes of stress. This isn’t always possible, so focusing on what can be controlled is essential,” said Prof. Williams. “Nurses and midwives have limited control over many aspects of the work environment. Most nurses have no control over staffing levels.” A staff shortage on shift is stressful but might be minimised by consciously modifying
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their thinking about this challenging situation. This might be achieved by thinking, ‘Well I can’t do everything today because we are short of staff, so I’m going to do the best that I can with the time that I have, prioritising patient safety,’ said Prof. Williams. Nurses and midwives can maintain physical and mental health by eating healthy, exercising regularly, getting adequate sleep, and finding ways to relax, she said. “Try deep breathing, meditation, mindfulness, laughter, singing, listening to music, reading a book, or spending time with friends or family,” she said. However, the prevention of burnout should not be the sole responsibility of nurses and midwives. Hospital managers need to be constantly aware of sources of environmental stress and implement strategies to address concerns, said Prof. Williams. “The provision of resources to support staff, such as educational courses about various aspects of wellbeing, and counselling services are essential.” Slepica agreed, saying “Healthcare organisations need to tackle the unique challenges their employees face, including patient care and mortality, workplace stress and worryingly, a stigma around asking for support with their mental wellbeing.” “It makes sense for healthcare organisations to invest in the mental health of their staff, as the benefits are seen in reduced absenteeism, sick leave, and work related psychological injuries,” said Slepica. Burnout is a serious and debilitating condition that needs treatment, warned Prof. Williams. “It’s essential that nurses are aware of the signs and know where to get help for themselves and their colleagues. Sources of help include: General Practitioners, Beyond Blue, Headspace and Black Dog. In addition, most healthcare workplaces offer free counselling services,” said Prof. Williams.
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HealthTimes.com.au HealthTimes - July 2018 | Page 27
Better access to post-treatment psychosocial support crucial for people with brain tumours
P
eople with brain tumours require access to extended and specialised psychosocial intervention to address the complex cognitive, behavioural, social and emotional consequences of brain tumour, according to Professor Tamara Ownsworth, from Griffith University’s Menzies Health Institute Queensland. “On average each day, 6 Australians are diagnosed with brain and other central nervous system cancers and 4 will die from such diseases,” says Professor Ownsworth. “Brain tumour has the combined effects of cancer and brain injury, with most people experiencing treatment side effects, such as nausea and fatigue, and impairments in their physical, thinking skills, behaviour and emotions. “Up to 50% of patients and their family members report clinical levels of anxiety and depression.” Studies have shown that for those people who have completed treatment for brain cancer, many are left unable to cope with the subsequent physical and emotional difficulties. “Over the last 10 years we have interviewed approximately 150 people with brain tumour and their family members,” says Professor Ownsworth. “These conversations highlight that people are typically discharged into the community after their medical treatment with very little support to cope with the everyday effects of the illness and the anxiety and uncertainty about the future. “Many of us struggle with the existential issues of life, death and meaning at different points in our lives. “These issues really come to the fore when you or a loved one is diagnosed with a life
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threatening illness.” Some of the key issues that lead to mental health difficulties including the stress associated with the diagnosis, an uncertain prognosis and complex neurological and functional impairments. Griffith University research identified that, as a rule, people grapple with the following issues at different stages of the illness: • What’s happening here? (leading up to diagnosis and noticing frightening symptoms such as slurred speech and loss of feeling down one side) • What does this mean for me? (soon after diagnosis and learning the ‘facts’ of the situation; will I survive? what will I tell my children?) • How things will be versus how things actually were (a comparison often made before and after treatment) • What could have been? (looking back on their diagnosis and treatment and reflecting on how the situation could have been different [both negative and positive outcomes]) • What does the future hold? (ongoing fears, concerns and hopes for the future) “People with brain tumour have longterm and complex support needs due to the combination of neurological and oncological effects and ongoing stressors,” says Professor Ownsworth. “In particular, for many brain tumours the concept of a ‘stable medical condition’ often does not apply due to the risk of progression.” Psychological support in this context refers to evidence-based ‘talking therapies’ that support the person and their family members to explore the impact and meaning of the illness. “People are encouraged to share their
values, hopes and fears about the future; topics that can be very difficult to discuss with close family and friends due to their own distress. “Our particular therapeutic approach aims to improve people’s understanding of the brain tumour and its everyday effects, their ability to manage or cope with these changes, and support them to find meaning in their life situation.” To date, the MAST program has only been delivered face-to-face and over the telephone, with the use of videoconferencing and other technologies the next logical step to overcome the barriers associated with face-toface therapy in a clinic, such as transport, distance, debilitating symptoms. “We have successfully trialled the feasibility of remote delivery of the MAST program and the use of a video conferencing platform,” says Professor Ownsworth. “People with brain tumour and their carers identified many benefits of receiving psychological support remotely, and all preferred videoconferencing over standard telephone due to visual features that increased their sense of connection.” Remote therapy technologies include telephone, messaging and email, or multi-modal systems such as videoconferencing, virtual therapists and interactive web-based platforms. “The person with brain tumour will use their home PC, laptop or tablet in a quiet and private location such as their own home, and will be able to see and hear the psychologist and view pictures and documents shown on the psychologist’s computer screen.
“They will also be able to share pictures and documents with the psychologist and involve family members in the therapy.” Videoconferencing support interventions are found to be beneficial and convenient for the broader cancer population; however, these are yet to be used in routine care for people with brain tumour. A collaborative project between Griffith University, Cancer Council Queensland and the Princess Alexandra Hospital, funded by National Health & Medical Research Council Partnership Project Grant, aims to to evaluate the benefits and costs associated with the telehealth intervention compared to existing cancer support services. “Participants will receive 10 weekly therapy sessions delivered via Zoom videoconferencing. “We have adapted therapy resources from the MAST program for remote delivery. “An initial training session will support participants to set up a Zoom account, receive a call, navigate the audio and visual features of the platform, and troubleshoot any difficulties.” Professor Ownsworth says she hopes continued research will improve access to specialised psychosocial support for the brain tumour population. “We expect to find that the telehealth program improves people’s mental health and quality of life and is beneficial to deliver from the perspective of the healthcare system. “Ultimately, we want to improve both the quality of and access to specialised psychological support for people with brain tumour and their family members.”
HealthTimes - July 2018 | Page 29
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