July 2019
Theatre & Critical Care special feature + Theatre Nurses need their work ‘family’ amid specialist shortages + Supporting the loved ones of patients in the ICU + Animals help ease the burden for children in therapy + Supporting weight management before, during and after pregnancy
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HealthTimes - July 2019 | Page 03
July 2019 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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Life in the Clarence Valley…. Tired of commuting? Looking for a change of scenery, or a smaller community to raise your family? When life speeds up and becomes more complicated we yearn for simple things, like time, a sense of connection, stability, belonging to a community. Whether you're looking for a relaxing tree-change, a family destination or an adventure, the Clarence Valley has something to suit every lifestyle. If you're thinking about relocating, maybe we're just what you need. For more information on what living in the Clarence Valley is all about, visit http://nnswlhd.health.nsw.gov.au/about/employment/lifestyle-locations/ Enquiries: Sharon Wright on Sharon.Wright@health.nsw.gov.au Requisition ID: REQ113178 Applications Close: 12 August 2019 Apply online at https://healthnswgov.referrals.selectminds.com/jobs/registered-nurse-icuccu-grafton-base-hospital-46733
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HealthTimes - July 2019 | Page 07
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HealthTimes - July 2019 | Page 09
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The Latrobe Regional Hospital (LRH) Mental Health Service is the regional provider of mental health services in Gippsland. LRH Mental Health Service operates an integrated specialist mental health program across ten sites and provides inpatient and community mental health care for adults, children and young people, and older persons. LRH Mental Health Service also operates a Community Residential Care Unit, Prevention and Recovery Care Unit and a Parent and Infant Unit. We currently have vacancies for: Graduate Positions - Community Mental Health Navigator Roles Nurse Practitioner - Grade 6 - Acute Adult High Dependency Assessment Unit Registered and Enrolled Nurses - Adult and Aged Care Graduate Nurse Position - Mother and Baby Unit Graduate Enrolled Nurse - Community Aged Mental Health Community Mental Health Clinicians
Please visit www.lrh.com.au and go to our employment sections to view current vacancies and register your interest. For enquiries please contact Cayte Hoppner, Executive Director of Mental Health/Chief Mental Health Nurse on (03) 5173 8549 or email choppner@lrh.com.au.
HealthTimes - July 2019 | Page 11
Animals help ease the burden for children in therapy
M
ental health professionals working with children should consider incorporating outside-the-box therapies into their treatment plans to help ease the natural fears and anxiety commonly experienced by young patients. “Treating a child is considerably different than treating adults,” says psychotherapist, Dr Karen Phillip. “Children do not have the developed mind ability to logicise, understand or disclose what they may truly feel. “Often, they are unable to link the words to how they feel. “Children can tell a practitioner what they think the practitioner wants to know and this can create additional anxiety in the child, further preventing true disclosure. “Children may not understand their own feelings or emotions, and some may be told not to tell the therapist certain truths. “This is when a trained therapist can aid the child to safely talk about what is happening to them or in their life.” Increasingly, therapists are incorporating treatment methods such as sand play therapy, clay therapy and drawing or art therapy, to help encourage children to engage. “These can be used if the child is either unable to articulate their feelings and thoughts or are apprehensive to vocalise what is occurring in their life. “A picture or creation can start a conversation more safely.” As therapists understand the impact of children specific treatment plans, the use of animal therapy is being incorporated by some practitioners, with amazing results. “Children respond very positively to animal use within therapy,” says Dr Phillip. “We also know that pets and working with
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an animal has positive effects on the child’s development, self-esteem and self-confidence.” Animals can be used as a support animal or for therapeutic purpose within the practitioner rooms. “If the practitioner has a small cuddly animal used for therapy purposes, the child can develop a connection and disclose issues to the animal they may feel uncomfortable sharing with their therapist. “An animal may also provide the child with the love and acceptance the child has not experienced in their life. “The child can develop a feeling of safety and connection which can be utilised by the therapist to enable the child to feel more comfortable to talk and share their thoughts and feelings.” Pet and animal therapy can be used to assist with numerous issues, including abuse, trauma, anxiety, grief and loss or matters dealing with physical illness of themselves or family member. “They may suffer a variety of mental or emotional health issues. “Self-harm, suicide prevention, social anxiety, behavioural issues are just some of the problems a practitioner can treat.” Whilst specialist training can aid the practitioner to form a healthy connection and understanding of what the child is experiencing, most practitioners are qualified to work with children. However, the evaluation, interviewing and treatment of a child differs from an adult. “While many therapists work with children as part of their therapeutic practice, to specialise in children can involve specific training.” For therapists wishing to incorporate animal or pet therapy, it is advisable they attend a training session on the dos and don’ts of animals
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in therapy. “Like any modality, training for approved and accepted use is imperative.” While using animals is not yet common practice, this type of therapy has been shown to have very positive results. “We know animals can release endorphins that produce a calming effect on the individual, producing a relaxing feeling. “There are a variety of substantial benefits using animals therapeutically for children. Pets and animals in therapy can help alleviate pain, both physical and emotional, reduce levels of stress and improve the child’s psychological state.” Unfortunately though, it can be challenging for therapists to find the correct pet or animal for use within the therapy room. “For those using a therapy pet, time is required, ongoing care and cost is needed, and
this may not be possible for some families given location and limited finances. “There are several animals for therapy areas that can benefit children. “Most all children respond positively when interacting with an animal albeit cat, dog, horse, birds and so on.” For therapists specialising in children, it’s worth a thought. “Children need specialised care, communication and interaction, different to teens and different again to adults. Therapy needs to adjust as the child’s brain maturity changes.”
HealthTimes - July 2019 | Page 13
CPD FACE-TO-FACE COURSES
Make an early start on your CPD this year With dozens of topics on offer across the country we look forward to you or your colleagues joining us at a course near you. For more information head to our website www.acn.edu.au/htjulcpd2019 or reach out to us on 1800 061 660 or at cpd@acn.edu.au.
www.acn.edu.au/htjulcpd2019
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PROMOTING NORMAL BIRTH STUDY DAY For more info and to book tickets go to: http://bit.do/normalbirth
PROGRAM & SPEAKERS INCLUDE Tanya Farrell - Midwife. Senior Maternity Advisor to Safer Care Victoria and Chair Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM); Adjunct Professor La Trobe University
Enquiries: Fiona Faulks - Midwife. Lecturer in Nursing and Midwifery at La Contact HealthTimes Trobe University Rural Health School, Bendigo 1300 306 582 Contact@healthtimes.com.au Hazel Keedle - Midwife. Lecturer, School of Nursing and Midwifery Western Sydney Unviersity. PhD candidate. Hazel’s research examins women‘s experiences of VBAC.
PRESENTED BY
Showcase of rural and regional midwifery! Midwives who are working in midwifery-led models in rural and regional contexts will present their work. The day will conclude with a panel discussion with a focus on the future of midwifery care in rural and regional settings.
HealthTimes - July 2019 | Page 15
From good to great: how an understanding of clinical governance can greatly impact your care
L
et’s face it, for most of us ‘clinical governance’ is an unattractive term. As clinicians devoted to providing the best care to patients, the impact of good clinical governance is difficult to appreciate. In reality, it is far more important than just honing clinical skills. The clinical governance knowledge gap contributes to a startling statistic; 1 in 4 people in Australian hospitals who stay overnight suffers a complication; about 725,000 patients each year. Mistakes happen to the best of us, but research shows that most mistakes are generally system errors. As an example, a colleague of ours, Dr Cameron Knott, who was training in Intensive Care Medicine at the time tells a compelling story of such an occasion. He was part of a team that treated a middle-aged man for cardiogenic shock, the result of which was an unrecognised oesophageal intubation. The man sustained a severe hypoxic brain injury and died. Dr Knott reflects that a culmination of inter and intra-hospital system problems and failures in team planning and communication contributed to the incident. We asked Professor Harvey Newnham, a Physician at a major Victorian hospital what he sees as being the biggest challenge with clinical governance. “The biggest challenge is for frontline staff
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to understand that they’re working in a system, and no matter how hard they work as an individual, it’s going to be difficult to deliver the highest quality care without an understanding of the system they’re working in.” For clinicians it’s important to understand the processes of care and the patient episode in total, not just in isolation of their immediate working environment. A focus on clinical governance processes creates opportunities for continuous improvement activities, for clinicians to collaborate and to foster a culture of excellence and to realise a comfort level and confidence as an emerging leader. The Certificate in Clinical Governance for Patient Safety and Quality Care offered by the Australasian Institute of Clinical Governance addresses these foundations through online learning and interactive workshops “I’ve never really understood the term ‘clinical governance’. I now realise that it is imperative that my colleagues and I apply it to our practice to ensure better patient safety and quality care”. Participant June 2019 To enrol in the AICG Certificate Course or to read Dr Cameron Knott’s full story, visit aicg.edu.au .
1 in 9 patients in Australian hospitals suffers a complication. Despite the expectation of good health outcomes that comes with being a highly-developed nation.
CLINICAL GOVERNANCE EDUCATION FOR PATIENT SAFETY AND QUALITY CARE Our CPD programs and certificate course are designed for all health professionals and encompasses online courses and face-to-face workshops in clinical governance competencies.
2019 course dates now open. Enrol now. T. 03 9134 0150 E. info@aicg.edu.au
aicg.edu.au
HealthTimes - July 2019 | Page 17
Theatre Nurses need their work ‘family’, amid specialist shortages and lack of continuity of care
T
heatre nurses are particularly reliant on their nursing ‘family’ as they manage the challenges of their field, such as lack of continuity of care and low numbers of specialist perioperative nurses. As the title suggests, Theatre Nurses work in an operating environment, but their specific duties vary depending on where they work and what speciality they choose. Generally, they have exceptional skills in the areas of scrubbing, scouting, anaesthetics and recovery. “Their knowledge and ability extends to expertise in instruments, implants, sterilisation, ordering, coordination, problem solving, critical thinking, clinical judgement, education and leadership, to name just a few,” says Fiona Sewell, Adjunct Associate Professor, Executive Director of Nursing & Midwifery Services “Theatre nurses have close relationships with surgeons, anaesthetists and theatre wardsman, forming a mutually respected and highly valuable part of the perioperative team.” The requirements of a theatre nurse differ from that of an acute care inpatient unit nurse. “Nursing is such a diverse occupation with many roles differing in knowledge, skills and flow. “Registered nurses working in theatre receive the same initial training and education as all registered nurses. “They are registered to work in any nursing role, however have chosen the speciality of theatre. “As such, they have undertaken additional training in the area of perioperative nursing.” Whilst a beginning registered nurse specialising in theatre requires the same
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degree as all other RN’s - Bachelor of Nursing, they will receive ‘on the job training and development’, as well as opportunities to attend a PIP course (perioperative intensive program - 5 day intensive perioperative training). “And it is highly desirable that they undertake a post graduate certificate or masters in the field of perioperative education,” says Associate Professor Sewell. A typical day for a Theatre Nurse might start at 8am and begin with scrumming at the coordination board followed by a discussion around any new or revised internal processes. “They will then be allocated a theatre and theatre team; once in the theatre, they’ll plan the session, check equipment, call for first patient, prepare for first case, do the case, clean the theatre and prepare for next case and so on. “During each case the scrub nurse prepares the instruments, ensuring all are working, in good condition, sequenced appropriately, counted and passes the instruments as required to the surgeon. “A good scrub nurse anticipates what the surgeon requires and has it prepared and ready for them before and most often without being asked. “This saves time and uses the collective knowledge of all team members to achieve the best patient outcomes.” Unfortunately, there’s a national shortage or trained and experienced perioperative nurses – one of several challenges faced by Australian Theatre Nurses. “There are also operational challenges with ensuring the most effective and timely
use of the theatre suite, ensuring the most emergent patient receives their required procedure at the appropriate time. Associate Professor Sewell says the perioperative suite is a close working environment, meaning everyone has an absolute reliance on every other team member. “As such the ‘family’ within the perioperative suite know each other well and quickly work out how best to work with each other’s skill set and personalities. “Frequent changing of the team creates a change in the team dynamic’s and challenges with building those critical relationships.” It also results in a lack of continuity of care for patients, posing challenges for both the patient and the nurse. “Continuity of care provides the patient with a familiar nurse. The nurse gains a deeper understanding of the patient and the needs and goals of the patient. “Continuity of care within a perioperative setting is a little more challenging. “Continuity of care within a theatre setting is most likely in relation to having the same nurses work within a particular speciality for example, orthopaedics. “This enables a highly specialised nurse for each area, enabling the anticipation of challenges and problem solving to be exceptional and expert mentoring, coaching and educational development of other nurses learning this speciality. “However, in non-tertiary hospitals, it also creates a challenge operationally, as smaller
perioperative suites have a smaller number of nursing staff and therefore they are required to have expert knowledge and be able to efficiently work in all areas.” Due to the vast challenges and special requirements of a Theatre Nurse, those who choose to enter the field should be flexible and adaptable. “They should have the ability to manage a multitude of differing personalities at close range, excellent problem-solving skills, be honest, reliable, have high integrity and accountability, be able to work on little sleep and have a large bladder! “Self-leadership with emotional intelligence is the key to navigate the challenges present along with responsibility and accountability.” While there are challenges, Associate Professor Sewell says the profession is also extremely rewarding due to the involvement of total patient care and caring for the most vulnerable patients. “They are asleep and put their total trust in your hands. “You work closely with the medical team, very team orientated. “It’s highly specialised, so there’s a degree of respect given to you. “Theatre nurses are very proud people, they sincerely care beyond their duty requirements - after all people’s lives are in their hands.”
HealthTimes - July 2019 | Page 19
What’s on at Family Planning NSW Professional development courses in 2019
Family Planning NSW is a leader in providing reproductive and sexual health education to over 1200 professionals annually in health, community and education sectors across NSW. Our clinical education courses equip doctors, nurses and midwives to provide clinical advice and management of reproductive and sexual health to clients. Many of our programs comprise online learning, workshops, simulated practice and/or clinical practice components to provide hands-on learning experience.
Cervical Screening Program Update Webinars 7 Aug, 4 Sept, 6 Nov IUD Case Discussion Evening 8 Aug (Ashfield) Refresher Day for Doctors A one day high-level forum for doctors covering the latest research and best practices 31 Aug (Ashfield) FPAA National Certificate in Sexual & Reproductive Health for Doctors - Face-to-face Course includes online learning, five day workshop and clinical placements. Workshop dates for course: 9 - 13 Sept (Ashfield) FPAA National Certificate in Sexual & Reproductive Health for Doctors - Distance Mode Course includes a two day workshop, online learning, assessment and clinical placements. Workshop dates for course: 15 - 16 Nov (Ashfield) Reproductive and Sexual Health Clinical Accreditation Program for Nurses Course includes online learning, assessment, two day workshop and clinical placement Workshop dates for course: 5 - 6 Sept (Newcastle) Reproductive and Sexual Health Professional Development Day for Nurses and Midwives A one day course for clinicians covering contemporary reproductive and sexual health topics 13 Sept (Newcastle) Doctors Short Course in Reproductive and Sexual Health Course includes online learning and two day workshop Workshop dates for course: 30 - 31 Oct
Please check our website for full course details, course fees and to register your place. www.fpnsw.org.au. All dates correct at the time of printing.
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OUR VISION To move forward as one, to heal our people and improve our health Wurli-Wurlinjang Health Service is an Aboriginal Community Controlled Health Organisa�on, located in Katherine and established over 40 years ago. Wurli currently delivers a wide range of primary health care services coupled with an array of Community Service programs in our endeavor to provide effec�ve, quality, culturally appropriate and progressive health care services to our clients. Katherine is a modern, thriving regional center with as popula�on of around 11,000. The popula�on of the region is just over 24,000 people, of which 60% iden�fy as Indigenous. Located 314 km from Darwin and 1180 km from Alice Springs, the town is situated on the banks of the Katherine Rive. This region also boasts magnificent Aboriginal rock art, Nitmiluk (Katherine Gorge) Na�onal Park, Cu�a Cu�a Caves Nature Park and Elsey Na�onal Park. Wurli is currently seeking appropriately qualified health professional to join the team in the following specialised roles:-: o
Optometrist
Wurli-Wurlinjang Health Services offers a suppor�ve and team orientated work environment and is dedicated to the ongoing professional development of our staff. To apply please visit www.wurli.org.au to access a full posi�on profile and other details required to submit your applica�on or simply contact Human Resources on 08 89729 195
HealthTimes - July 2019 | Page 21
Supporting the families of patients in the ICU
T
he intensive care unit (ICU) is a highpressure environment, but taking care of the patient isn’t what is most challenging for many critical care nurses. Surprisingly, it is taking care of the emotional wellbeing of the patient’s loved ones that can be most difficult. ICU Nurse Zara Lord said anxiety, depression and even post-traumatic stress syndrome occurs in ICU families, but the signs can go unnoticed because the focus is on the critically ill. “I just spent a 12-hour shift glued to the bedside of a critically unwell young person. “The day had its highs and lows, but as the patient slipped into delirium towards the end of my shift, the patient’s parent exhibited all the typical signs of anxiety. “As ICU nurses, we don’t just nurse the patient, but the family as well, particularly in these situations,” said Ms Lord. Delivering information with compassion and caution is vital to supporting families in the ICU, explained Ms Lord. “When providing information, be cautious not to overwhelm the family member by gauging how much each individual wants to know and divert attention away from things that may be troubling for them.” The use of patient journals, successful in many international hospitals, is being piloted in Australian hospitals and could be instrumental in supporting ICU families. “The journal stays in the room with the
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patient for the duration of their stay, and we encourage family members to jot down information about what the patient likes such as music and hobbies. “More importantly, family members are encouraged to journal about things that happen each day, such as scans, improvements, deteriorations, funny moments, sad moments and anything they would like to reflect on.” This refection is helpful for families to process the situation at hand but is also beneficial for patient recovery to fill in time gaps. It’s also important to engage family members as active carers, explained Ms Lord, which can involve combing hair, talking to their loved one and handholding. “When a patient is not going to survive an illness, we help families to preserve tangible memories of their loved ones with handprints, locks of hair and photographs,” said Ms Lord. Senior ICU Nurse Lyn Hopper said rapport building with families and working collaboratively with colleagues is key to ensuring a consistent and caring environment in the ICU. “It’s important to work as a team and to give the same message to families. “Participate in family conferences and medical rounds, so all messages to families are clear and consistent. “Nurses also need to make use of allied
health services that can support families, such as religious personnel, social workers and volunteers. “When patients are critically ill, death does occur, and families need to be prepared early for this outcome. “The worst deaths are when nurses are unable to build rapport with families,” said Ms Hopper. Unfortunately, when ICU families don’t receive adequate support, they can experience increased distress at an already traumatic time. Loreena Walsh believes the behaviour of ICU nurses caring for her critically ill father created further trauma for her family. “When we were given a 24-hour deadline that life support would be terminated, a nurse said: ‘’Oh, I’m so glad I don’t have to pretend anymore.’ “Being told she’d been tired of pretending and keeping up appearance was a heartbreak I’ll never forget,” said Ms Walsh. Inclusiveness in the treatment process was also what made Ms Walsh and her family feel supported. “The nurses that explained the process and told us what to look for in case Dad’s breathing tubes slipped were helpful, but not those who kept us in the dark or treated us as though we couldn’t be there.” Unfortunately, when termination of life support took place, Ms Walsh said there was no emotional support offered. “Today, I’m sure I suffer mentally because of our decision as there was no follow up or assistance. “We simply walked out, left Dad behind, and it was done. “I believe where long-term ICU visits and end-of-life are experienced there should be a counsellor on board before the termination of life,” said Ms Walsh.
Tips on supporting the families of patients in ICU Former ICU Nurse Willow Ramsey, now an End of Life Doula, said nursing the patient is relatively straight-forward compared to the task of supporting family members of the critically ill. Ms Ramsey offers the following advice to ICU Nurses: Explain what you are doing and why The majority of equipment and routine in ICU is unfamiliar to most people. So, explanations can reduce the level of anxiety in family members and help them to put things into perspective. Be approachable and accessible Open the door to questions and conversation. If you’re unable to answer a question asked by a family member, find someone who can. This brings a greater level of respect over saying, ‘’I don’t know’. If you’re unable to speak with them in the moment, arrange a time to talk and stick to it. Forgetting or letting it slide loses their respect. Involve the family members in appropriate personal care Family members have often said they feel useless standing or sitting by the bedside. Involving them in simple tasks like applying moisturiser or doing passive exercises (if clinically appropriate and safe for the patient) provides relatives with a feeling of usefulness. It’s an opportunity for them to see just how unwell their family member is and aids in the acceptance of the possibility of death. Meet them where they are at Explain the situation in terms that they can understand. If you’re unsure, ask the family what they understand of the situation to obtain a starting point and an idea of how
HealthTimes - July 2019 | Page 23
much detail they can handle. Be honest while being compassionate Don’t fill them with false hope. If the situation is grim with a likely poor outcome, that’s what they need to hear. Families I have worked with appreciate honesty while delivering the news compassionately. They are grateful and can begin preparing for what is about to happen. Be authentic Just because we deal with this every day doesn’t mean we need to appear hard and cold or without emotion. If a particular case tugs at your heartstrings, it’s ok to shed a tear. We are human, and families like to see the softer side of us too. Be an advocate for their family member At times family members can be quite strong in what they wish for their relative. They may want extraordinary measures to be taken when the patient’s quality of life is already poor. Stand up for your patient and ask their relative if this is really what their loved one would want if they were able to speak for themselves. Likewise, if you think the treating team is pushing too hard, speak up and remind them there is a human being under all the machinery. Families look to nursing staff to be the voice they feel they don’t have in these situations. Show them where they can take time
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out in a quiet space, get a drink or use the restroom Providing access to tea or coffee making facilities and a restroom is invaluable to families. Being able to freshen up after a long day of difficult conversations can make a huge difference. Encourage them to go home to rest/ sleep/eat Families sometimes need to be persuaded to take rest. They worry about things happening while they are gone. Remind them that death or “a turn for the worst” can generally be predicted by monitoring equipment and that you will call them if anything changes. Also, when the patient returns home, they will need a lot of assistance. So, remind them that they need to start preparing while experts look after their loved one in the meantime. Facilitate requests as best you can within policies and guidelines I have had strange requests from family members and have always done my best to accommodate where it will not impact on the safety of the patient or other patients and staff. Where it has a potential impact on others, I have always provided an alternative, aiming for win-win where everyone is happy. “These tips are a great way to earn respect and trust of your patients and their family. “It will help you support them in ways they didn’t know they needed,” said Ms Ramsey.
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HealthTimes - July 2019 | Page 25
Supporting weight management before, during and after pregnancy
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eight management before, during and after pregnancy has a considerable impact on individual health outcomes for women and their baby. As a result, education and advice on healthy weight-management at all stages of conception and pregnancy are vital in the care of pregnant women. Accredited Practising Dietitian Stefanie Valakas said while gestational weight gain is normal, natural and necessary for a healthy pregnancy to support expanding tissues, blood volume and the growing baby, being under or overweight can have negative health consequences. “Eating too much or too little during your pregnancy can lead to too much or too little weight gain, which is not ideal for the mother, her baby or the birth. “Too little weight gain during pregnancy has an increased risk of preterm birth and a baby small for gestational age, with a potential for lifelong effects on the baby. “The Dutch Famine in 1944-45, showed that children born to mothers who were pregnant during a period of poor food availability led to increased risk of being obese and numerous chronic diseases later in life such as type 2 diabetes, heart disease and renal dysfunction 40 to 50 years later,” said Ms Valakas. Fertility and Prenatal Dietician Melanie McGrice said gaining too little weight during
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pregnancy is problematic, with malnutrition, low birth weight and future weight problems for the baby common risks. “Contrary to what you may expect, childhood obesity may also be a side effect of not gaining adequate weight during pregnancy, as if a baby gains weight too quickly after being underweight, research suggests that it can impact the baby’s fat storage hormones,” said Ms McGrice. Similarly, gaining too much weight during pregnancy also increases future overweight and obesity risk for the baby. “When mothers gain too much weight during pregnancy, it significantly increases the baby’s risk of future weight battles. Excess weight gain during pregnancy also increases the risk of high blood pressure, gestational diabetes, development of diabetes later in life, difficulty losing weight post-partum, said Ms Valakas. “Women who gain too much weight during pregnancy are more likely to have a large baby, which increases the risk of delivery interventions, including C-sections. “In fact, for women with a BMI over 30, there is a 9-fold risk of gestational diabetes which can lead to a large for gestational age baby and increased birth complications and interventions,” said Ms Valakas. Women with a BMI over 30 are also twice as likely to undergo a C-section, have
a three-fold increased risk of developing preeclampsia, and 7 per cent increased risk of neural tube defects such as spina bifida and are also at an increased risk of pre-term birth and NICU admissions. Alarmingly, research shows that 70% of women do not gain within the recommended gestational weight guidelines during pregnancy, and less than 30 per cent of women knew what was appropriate for them to gain during pregnancy, explained Ms Valakas. “There is a huge opportunity for midwives and nurses to educate pregnant women on this topic to improve pregnancy and birth outcomes. “Midwives and maternity nurses can support appropriate weight gain during pregnancy by taking the weight of women at each appointment and plotting it on a pregnancy weight gain chart. “Research suggests that integrating a prompt into your medical records or checkup checklists is the best way to increase measurements being taken and recorded. “It may feel like a sensitive or emotional topic to talk about, but pregnant women are interested in knowing how much weight to gain for a healthy pregnancy. Of course, approaching it in a caring and empathetic way is the best course of action. “If weight gain is too much or too little, note that with the patient and have a discussion about lifestyle habits and flag it with their obstetrician. Then refer to an Accredited Practising Dietitian with expertise in pregnancy nutrition for further management and preventing birth complications and to reduce the future health risks for both mother and baby,” said Ms Valakas.
gestational weight gain, which reflects appropriate weight gain ranges based on prepregnancy body mass index (BMI). If the patient is pregnant with triplets or multiples, it can be more difficult to accurately determine optimal ranges of weight gain as there is little data available at present, according to Ms Valakas. “You can then calculate weekly target weight gain per week for pregnant women based on their pre-pregnancy BMI from the second trimester onwards. “Unless starting with a BMI below 18.5, the goal is for no more than 2 kilograms of weight gain for pregnant women in the first trimester as a pregnant woman’s calorie or energy needs are not increased at this time, and therefore weight gain should be minimal,” said Ms Valakas. Starting the conversation Although there are guidelines for weightmanagement, it’s important to remember that they are just guides, explained Ms Valakas. “They are a perfect starting point to have a conversation with pregnant women about gestational weight gain and their lifestyle. “Point out its importance for not only a healthy pregnancy but a healthy child and reducing the risk of complications during labour and delivery,” said Ms Valakas. Optimising weight before conception is ideal, said Ms McGrice, but not all pregnancies are planned, but the good news is, it’s not too late. “If a woman’s overweight at conception, gaining the right amount of weight during pregnancy can still help to reduce risks,” said Ms McGrice.
How much is too much? Health care professionals should refer to the Institute of Medicine guidelines on
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Exercise prescription powerful for mental health conditions
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xercise can have a profound effect on mental health conditions. In fact, exercise physiologists now understand that exercise can be just as effective as other forms of treatment for mild-to-moderate depression. Anita Hobson-Powell, ESSA Chief Executive Officer, said we know that physical inactivity is the cause of approximately 9 per cent of premature mortality worldwide, with people experiencing a mental illness being particularly vulnerable. “The benefits of exercise on mental health include improved memory, focus and thinking skills; improved sleep; reduced stress and anxiety; and prevention against depression and other mental health conditions. “It also incorporates the opportunity to be social with others and can be a handy distraction tool from negative thoughts,” said Ms HobsonPowell. Exercise Physiologist Greg Maserow said it is well-documented that exercise can be as effective as therapy and medication for treating mild to moderate depression and anxiety. A recent study published in JAMA Psychiatry provides the ‘strongest evidence’ yet that exercise has a protective effect against depression. Using the genetic data of 300,000 adult participants, researchers from Massachusetts General Hospital found those who exercised more lowered their risk of major depressive disorders. Lead researcher Dr Karmel Choi said: “We found evidence that higher levels of physical activity may causally reduce the risk for depression.” Surprisingly, the research also demonstrated that switching sedentary behaviour for as little as 15 minutes of vigorous physical activity per day can reduce depression risk by approximately 26
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per cent. “This research is the first of its kind that helps solidify whether depression causes a lack of physical activity or lack of physical activity causes depression - and this genetic study appears to prove the latter. “The study also proves that exercise can help those who are more genetically susceptible to mental health problems,” said Mr Maserow. In addition to helping prevent the onset of depressive illness, exercise can also improve sleep hygiene, which also impacts mental health, said Mr Maserow. “When you rest fully at night, and you feel more energised during the day, which helps you to cope better under the daily stresses that life presents. “A good night’s sleep also helps to reregulate your mood. “Exercise can also give you a sense of accomplishment as your fitness improves, and you start achieving your goals. “Being part of a fitness community made up of like-minded people who are all trying to better their well-being can have a positive influence on your mental health. “It’s a place filled with positivity, strength and constant messages of change - for the better. That can be very contagious and has powerful flow on effect,” said Mr Maserow. While the evidence supporting the benefits of exercise for mental health is conclusive, it can be difficult to motivate those struggling psychologically to engage in physical activity. “I’ve found that people with depression and anxiety are more likely to adhere to an exercise program where they feel a part of something bigger than themselves. Small group training has been incredibly effective in doing this. “It is all well and good to be ‘aware’ of the
benefits and the research that exercise has on one’s mental health, but if an exercise is not being performed, then what is the point? “I feel the focus should be on creating an environment that is conducive to exercise adherence. The rest will naturally take care of itself,” said Mr Maserow. So, what about the application of exercise as a prescription for mental health recovery in the real world? Mr Maserow said because most people are private about mental health struggles, it can be difficult to see results in the same way as weight-loss. “The improvements are subjective and much harder to measure. That is, until you get a client who walks through the doors and is open and honest about their struggles and experiences. “I was lucky enough to have one of these young ladies walk through my door about four years ago. “During our initial consultation, she was shy and quiet, although I do remember being surprised at how honest she was about her mental health struggles. “She went from keeping to herself to this confident, sociable, assertive young lady, and as time went on, I could start to see some serious changes in her outlook. “Four years on, she has lost over 20 kilos and more impressively has managed to keep it off. “She is one of the fittest and strongest clients we have at our studio. “There have been ups and down, but that’s not unique to her and her mental health history. “We all go through periods where our motivation is low, or life gets too busy, and our exercise and well-being takes a hit. “What impresses me about her, though, is that even when these external distractions are going on in her life, she has kept her exercise routine and has pushed through those difficult patches. “She is one of my most consistent and dedicated clients, and I feel a lot of that has to
do with her feeling part of something,” said Mr Maserow. Sally*, Mr Maserow’s client, said she had experienced mental health issues from the age of five, including obsessive-compulsive disorder and severe depression. “I hit such a low that I left school in year 10 and spent all my time on the couch sleeping. “Sleeping was the only time that I was free — no obsessive thoughts. No compulsions. No feelings of numbness. “When I was awake, food was a way of comforting me. So, imagine, no moving around and a hell of a lot of eating. “Not to mention a cocktail of medications that increased my hunger substantially. “It got so bad that suicide started to sound like a good idea and that I wouldn’t be upset if my life just suddenly ended,” said Sally. It was at this point that Sally’s mother introduced her to Mr Maselow in the hope that he could help with an exercise routine. “I did not want to go at all. I remember sitting in the induction listening to Greg explain that I needed to commit to every session and put in a lot of hard work, and in my head, I was saying ‘yeah right, I’m not coming back here.’ “Somehow, I made it to my first session. By the end of it, I was tired, sweaty and sore. “However, what I felt more, was a wave of endorphins rushing through my body. It was an amazing feeling. “Slowly, as I attended more sessions consistently, my mental health was improving tenfold. “It’s no secret that it’s been scientifically proven that exercise has profound positive effects on mental health, but actually feeling the improvement was amazing! “I now never miss a session because I feel the effects immediately on my mind if I don’t exercise. “Four years later, I’m 21 kilos down, and in the best mental state I have ever been,” said Sally.
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