Health Times March 2017

H

March 2017

Mental Health special feature + Reviewing seclusion and restraint in mental health practice + Calls for nurses and midwives to be upskilled in mental health + What do mental health occupational therapists do? + Mental health within the walls

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HealthTimes - March 2017 | Page 31

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When it rained, I shone.

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Worst of all, the storm hit the clinic during the night, so nobody realised the roof was damaged.The next day, we found the reception counter drenched.

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HealthTimes - March 2017 | Page 03

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March 2017 We hope you enjoy perusing the range of opportunities included in this Issue.

If you are interested in pursuing any of these opportunities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or would like to receive our publication, please email us at contact@healthtimes.com.au DISTRIBUTION 46,300

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ABN 29 071 328 053. Š 2017 Seabreeze Communications Pty Ltd. All right reserved. No part of this publication may be copied or reproduced by any means without the prior written permission of the publisher. Compliance with the Trade Practices Act 1974 of advertisements contained in this publication is the responsibility of those who submit the advertisement for publication.

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HealthTimes - March 2017 | Page 07

Dating in a healthcare workplace What are the risks of a romance in a hospital, practice or clinic setting?

By Karen Keast

R

omances between nurses, midwives and their health practitioner colleagues are the lifeblood of countless television dramas, from A Country Practice to The Flying Doctors, All Saints and Grey’s Anatomy.

In reality, while romances in healthcare settings are common albeit often without all the intense melodrama you see on TV, there can be professional and legal ramifications from workplace dating for both health practitioners and their employers.

While there is no part of the Health Practitioner Regulation National Law that references issues relating to a nurse or midwife conducting a workplace relationship, nurses and midwives are required to adhere to the Nursing and Midwifery Board of Australia’s (NMBA) Codes of Conduct.

A NMBA spokesperson says the revised Codes, now open for public consultation, cover areas such as bullying and harassment.

Nurses and midwives embarking on a workplace relationship must ensure they continue to abide by the legal requirements, professional behaviour and conduct expectations outlined in the Codes.

“Speaking in general terms, the NMBA will hold nurses to account who fail to meet their professional obligations, and will take regulatory action to limit their registration if their health, conduct or performance fails to meet the expected standards,” the spokesperson says.

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“It would (be) up to the nurses’ professional judgement to determine what is appropriate, in line with NMBA’s standards – and in addition to this I am aware that most employers have policies in place to provide guidance in this area.”

Professional pitfalls Workplace romances can lead to accusations of distracted patient care and favouritism, especially when it comes to pay rises, promotions and workplace opportunities, and can also spark gossip and resentment from colleagues.

And when relationships crumble, the workplace environment can be uncomfortable or, at worst, hostile.

The breakdown of relationships can lead to allegations of harassment and sexual harassment. It can also prompt an employee to resign, lead to disciplinary action, or even termination.

Andrew Jewell, Principal Lawyer at employment lawyers McDonald Murholme, says it’s important for employees entering into a workplace relationship to consider the legal risks.

Mr Jewell says workplace relationships can bring about perceptions of bias from coworkers.

“It can affect the reputation of someone who is perceived to be getting favourable treatment

but it could also be a form of misconduct for a supervisor,” he says.

“If there is an allegation that someone receives a promotion and then the allegation is that they were biased because of a private relationship, that could be seen as a potential disciplinary issue.”

Mr Jewell says legal cases often arise when the personal relationship dissolves and begins to negatively impact on an individual’s professional life.

“If there is a break-up, that can often affect the working relationship. I’ve seen sexual harassment claims and I’ve seen bullying claims arising out of relationship break-ups,” Mr Jewell says.

“The most common example we have is where there is that break-up and then there’s a nastiness in the relationship, and that spills over into work and becomes bullying and harassment issues in the workplace.”

In one case, Mr Jewell says a workplace relationship ended with the male then deciding to send messages to his former girlfriend.

“The male was sending messages to the female and they were the normal sort of messages that you might expect from an ex-boyfriend to his ex-girlfriend but then she made an allegation of sexual harassment because they had met at work, they had dated, and they worked at the same working place,” Mr Jewell says.

“I think that it’s really important for employees who date to remember when they break-up it might become a workplace issue.”

How to handle it If you want to pursue a relationship in the workplace, it’s a good idea to first consider your employer’s policies. More employers are now creating policies around workplace relationships to ensure their organisation is not adversely affected.

Some employers have workplace relationship policies that outline the requirement for the

disclosure of workplace relationships. These policies may also detail a range of strategies, such as moving employees involved in workplace relationships to separate departments, to cover the potential for any actual or perceived conflicts of interest.

Other employers also have non-disclosure policies, outlining steps and disciplinary action for staff who fail to disclose their relationship, especially when workplace relationships have the potential to generate conflicts of interest.

Mr Jewell advises employees to review their organisation’s policies and to disclose the relationship with HR, particularly when the relationship involves a supervisor and their subordinate employee.

“The safest thing is to notify your employer when something becomes serious,” he says.

“So apart from looking at the policies that are in place, I’d say unless there’s a reason not to, I would err on the side of advising your employer just so you can’t be said to have been hiding anything.

“Some organisations can take it very seriously.

When things get very tense in a workplace and if it is a stressful situation, an employer might have a perception that you wouldn’t be as clear thinking if your personal partner is involved,” he adds.

“That is an important word as well perception. It’s not always that there is bias or there is an issue but from an employee’s perspective my advice would be to err on the side of telling your employer so that they can just remove that as an issue.”

When it comes to workplace relationships, it’s always best to be professional - keep your private life out of your working life.

Avoid public displays of affection, don’t divulge confidential work information to your partner, and avoid using work technology, such as emails, to communicate personal information.

For the full article visit HealthTimes.com.au HealthTimes - March 2017 | Page 09

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Stay up to date with the 2017 aMh Book or online AMH 2017 includes up-to-date drug information to help you stay informed in your profession. Every edition has hundreds of amendments, updates and additions to reflect the latest shifts in evidence and practice.

More than 20 new drugs have been added to the latest edition, including Ulipristal for emergency contraception, Idarucizumab for reversal of dabigatran anticoagulation and Paritaprevir with ritonavir, ombitasvir and dasabuvir for chronic hepatitis C. Therapeutic topics have been reviewed and updated, eg Dyslipidaemia now includes evolocumab and a table comparing lipid-lowering drugs.

There is also new safety information, eg severe skin reactions with bromhexine.

New to AMH online is a drug interactions search capability, for interactions between drug/drug or drug/class pairs.

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optiMiSe Care to the elderly with the aMh aGed Care CoMpanion The AMH Aged Care Companion is a trusted, practical reference for doctors, nurses and pharmacists who work with older people. It contains the latest evidencebased information and is useful when conducting medication reviews and other activities (eg case conferencing) aimed at improving patient outcomes.

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Page 10| www.HealthTimes.com.au

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HealthTimes - March 2017 | Page 11

Innovative cancer home nursing service expands

A

unique West Australian nursing service that provides chemotherapy and immunotherapy in the comfort of patients’ homes has expanded to South Australia.

Perth-based private service chemo@home, the brainchild of specialist oncology pharmacist Julie Adams and registered nurse Lorna Cook, launched its Adelaide service with one registered nurse in February, amid plans to expand across the nation.

Ms Adams said Adelaide patients have already embraced the innovative service.

“The Adelaide patients are increasing in number and we are doing more and more of them each week - they are loving the service,” she said.

“We employ one nurse, and the idea is we will increase staff as we need to.”

Launched three years ago, chemo@home aims to revolutionise the provision of healthcare to patients - reducing patient fatigue and risk of infection while cutting patient travel and parking costs, and decreasing patient reliance on carers or childcare.

As well as treatment for a range of cancers, including breast, colon and lung cancer along with leukaemia, lymphoma and myeloma, the service also provides infusions for chronic conditions, such as rheumatoid arthritis, multiple sclerosis, osteoporosis, Crohn’s Disease and iron deficiency anaemia, alongside infusions for a range of other conditions.

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Most health funds cover the service, with no gap, and more than 80 specialist doctors now refer to chemo@home in Perth.

The service has been such a success, it now employs 17 mostly casual staff in Perth, including nine chemotherapy-trained nurses who administer 300 treatments a month.

Ms Adams established the now-defunct WA Health Department-funded home chemotherapy service, enabling oncology and haematology patients from several hospitals to receive treatment while at home.

Building on her experience and expertise, Ms Adams, who was named the WA 2016 Telstra Business Woman of the Year, saw an opportunity to increase the availability of home treatments.

“If you’d asked me when I first started my career, I would never have envisaged this,” she said.

“But from the first time I started doing any home treatment, I always believed that this was the way forward - and at some point in time it would become the norm that most patients would get treated at home, because it’s where people are most comfortable.”

Ms Adams said chemo@home will continue to expand its reach across the nation within the next 12 to 24 months.

The service has already received nursing job applications from right across the nation.

For the full article visit HealthTimes.com.au

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Register at marceconference.com.au HealthTimes - March 2017 | Page 13

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Health workers missing due to underfunding Emergency nurse Nico Woodward is travelling New Zealand to talk with people about the risks of underfunding health services.

Mr Woodward is the face of the YesWeCare roadshow campaign, an alliance of unions and community organisations, which is travelling to 38 towns, equipped with 200 life-size cut-outs designed to showcase the number of paramedics, allied health professionals, nurses, doctors and support staff ‘missing’ due to a lack of government funding for health.

“I went into nursing to help people, but when I can’t help someone, even though I know I can, due to issues of understaffing, it’s incredibly distressing,” he stated in his campaign travel blog.

“So I’ve put my nursing career on hold to travel round the country talking to local people

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about the risks faced by underfunding of our health service.

“I’m excited to meet people and hear their stories, even though they will likely not be easy to hear.

“But this is part of my role as a nurse, to advocate for my patients, and I see this as an opportunity to take that advocacy to a national level.”

The Council of Trade Unions (CTU) estimates health is underfunded by more than $1.85 billion in New Zealand - the equivalent of 9,250 doctors or 22,840 nurses or 74,000 hip operations.

The roadshow campaign comes as nine in 10 health workers, including paramedics, nurses, mental health workers and support staff, revealed they feel understaffed and under-resourced.

for the full article visit HealthTimes.com.au

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HealthTimes - March 2017 | Page 15

Mental health within the walls

C

orrectional mental health, also known as forensic mental health, is a highlyspecialised field of nursing practice focussed on the mental and physical health care needs of people in a correctional setting. The correctional environment provides unique challenges for nurses as they balance the need to provide evidence based, Recovery oriented mental health care within a secure environment.

Nurses working in correctional mental health services work closely with patients who may be suffering from severe and enduring mental illness, have complex needs, are difficult to engage and often have comorbid diagnosis. As with any community, the men and women with mental illness in prison have varying levels of acuity and a diverse set of mental health needs. This diversity provides nursing staff with a wide range of career options.

Opportunities include: • • • • • • •

caring for patients within bed-based mental health services case management of mainstream and protection prisoners mental health crisis assessment suicide and self-harm risk assessment initial reception mental health assessments providing early intervention and prevention programs discharge planning and community linkage work

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Correctional officers work in partnership with mental health teams to deliver complimentary case management, and maintain the safety and security of the prison environment. Nurses and other clinicians are supported by correctional staff to deliver care, treatment and therapeutic programs in a way that maintains staff and patient safety and wellbeing in an atmosphere of collegiality. As new facilities open, correctional based models of offender rehabilitation, together with mental health frameworks of care such as Recovery, are bringing anticipated improvement in the levels of mental health and reintegration into the community upon release from prison.

As treatment for mental health issues in Victorian prisons is voluntary, nursing skills are focussed on building strong relationships with patients to encourage and support therapeutic outcomes.

Correctional nursing staff develop advanced interpersonal and collaborative skills which allow them to work with a person experiencing difficult life circumstances and maintain a focus on supporting patients to achieve their Recovery goals.

Multidisciplinary teams within correctional mental health services provide a wide range of therapeutic programs focused on the mental health Recovery journey of their patients. These programs are provided by all members of the team, including nurses, and are flexible in their delivery.

For the full article visit HealthTimes.com.au

HT-703-CTR-00675 1PG FULL COLOUR CMYK PDF “I never cease to feel humbled by my patients. Their trust in me when sharing their most troubled thoughts and experiences at the toughest time of their lives is a privilege beyond words. Our best tool is our time: time to sit, time to listen, time to give hope, time to care.”

Tanya Mularczyk, RPN Ballerrt Yeram-boo-ee Forensic Mental Health Operations Manager Ravenhall Correctional Centre

TAKE YOUR MENTAL HEALTH NURSING TO THE NEXT LEVEL WITH FORENSICARE Do you want to work in a cutting-edge environment where you are always challenged and learning? Are you looking for opportunities to experience the full spectrum of mental health nursing? Would you like to take your nursing career to the next level? Then Forensicare’s prison mental health services are for you.

3 REASONS WHY FORENSIC MENTAL HEALTH NURSING IS FOR YOU: 1. Your nursing skills and experience will be taken to new heights As a nurse in Forensicare’s prison mental health services, you work closely with patients who may be suffering from severe and enduring mental illness, have complex needs and dual diagnosis and are difficult to engage. Treatment for mental health issues in Victorian prisons is voluntary so your skills are focussed on building strong relationships with patients to encourage and support Recovery based, therapeutic outcomes.

2. Rewarding patient-centred approach Our exceptional prison services teams work together to deliver life changing clinical and therapeutic work. Our prison staff: > are passionate about mental health, > believe in our Recovery model; and > are advocates for ensuring prisoners with mental illness access the care and treatment they need.

3. Strong, supportive team environment and career opportunities You will be working within a highly skilled and knowledgeable multi-disciplinary team who will support you in your development and your ability to deliver the best care to our patients.

You will be given opportunities to develop the skills and confidence to work as an individual in a range of environments.

About Forensicare Forensicare (Victorian Institute of Forensic Mental Health) is Victoria’s leading provider of forensic mental health care.

We work to meet the needs of consumers with serious mental illnesses across the justice system, mental health sectors and the community.

Our services deliver a range of mental health programs targeted at patients with different needs at different stages of Recovery; from early intervention and prevention, inpatient care, rehabilitation and community transition support.

Career Opportunities Forensicare is expanding and we need more mental health nurses. We are currently recruiting a number of suitably qualified mental health nurses for our forensic mental health service at the new Ravenhall Correctional Centre, scheduled for completion at the end of 2017.

If you’re a mental health nurse looking to take your career to the next level visit: www.forensicare.vic.gov.au/careers

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

www.forensicare.vic.gov.au HealthTimes - March 2017 | Page 17

Reviewing seclusion and restraint in mental health practice

M

ental health nurses will be able to have their say on some of the barriers and enablers when it comes to the use of seclusion and restraint in mental health wards.

The Australian College of Mental Health Nurses (ACMHN) will gauge the views of mental health nurses through an online survey as part of a project it’s conducting for the National Mental Health Commission.

In 2005, all Australian governments agreed to move to reduce and, where possible, eliminate the use of seclusion and restraint interventions for people with mental health issues.

“There is a lack of evidence internationally to support seclusion and restraint in mental health services,” the Commission states on its website.

“There is strong agreement that it is a human rights issue, that it has no therapeutic value, that it has resulted in emotional and physical harm, and that it can be a sign of a system under stress.”

ACMHN chief executive Kim Ryan says while the Commission has conducted research investigating the consumer experiences of seclusion and restraint, it’s paramount that the views and the safety of mental health nurses, working at the healthcare coalface, are also examined.

“Nurses keep hearing that we’ve got to reduce seclusion and restraint, but they’re at the frontline, wondering - what’s going to happen to me if I can’t do that?

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“We need to look at whether all the things that we know help to reduce seclusion and restraint practices are actually in place, and whether nurses are getting the support that they need to change their practice and to keep patients, themselves and others safe… what are the alternative practices and what is it that we need to do to support nurses in this task,” she says.

“Nurses don’t like being involved in seclusion and restraint; and it’s important to note that some reduction in seclusion and restraint rates has occurred. But until we explore what the nurses’ perceptions are around some of the well known barriers and enablers to reduction and elimination, we are not going to be able to support them to go the next step. We need to know more about how we do all we can to support nurses and keep everyone safe.”

Ms Ryan says it’s a complex issue, particularly in the face of significant drug problems, including the ice epidemic.

“Methamphetamine is, for one, a serious problem that causes distress for the community at large and in health care settings is a very, very difficult issue to manage,” she says.

“We need to know how we can address situations where people are vulnerable, staff are vulnerable, and a difficult situation raises safety issues for everyone.”

Seclusion and restraint The Commission defines seclusion as interventions used in mental health facilities and other settings to control or manage an individual’s behaviour: “Seclusion is when someone is isolated and confined in a specific room from which they cannot leave. Restraint is when someone’s movements are restricted by another person or persons, or the use of straps or belts (physical or mechanical restraint) or sedation medication (chemical restraint).”

Health Ministers have backed the National safety priorities in mental health - a national plan for reducing harm, which outlined four key priorities - including reducing the use of and, where possible, eliminating restraint and seclusion.

In its 2016 position statement on seclusion and restraint, the College states the “use of seclusion and restraint, as defined in this document, in acute and all mental health services settings, is a harmful practice that is traumatic for consumers, their families as well as staff, which should be reduced and ultimately ended”.

It outlines that restricted practices “are never ‘therapeutic’, should ultimately be considered a ‘treatment failure’, and only implemented as a last resort. They should never be used for the purposes of punishment, discipline, negative inducement, coercion or staff convenience, or where less restrictive practices are accessible and achievable.”

The statement also says mental health nurses require appropriate training in de-escalation techniques and critical incident management, opportunities to implement alternatives or change to the environment, such as calming or safe spaces for consumers.

Nurses also require policies, procedures and adequate staffing levels to prevent and manage behavioural emergencies along with the implementation of alternatives to seclusion and restraint.

Ms Ryan says nurses can’t do it alone – significant leadership from every level of health is important.

Alternatives to seclusion and restraint A range of alternatives are being trialled and implemented in Australia and internationally, including de-escalation techniques, sensory modulation rooms or areas, and initiatives such as renowned UK evidence-based practice model, Safewards.

“There are processes that the wards can look at in terms of better identification of people who are at risk for increased aggression, and for those who may be escalating or becoming distressed,” Ms Ryan says.

“Nurses need to understand and respond to what are the drivers for people towards becoming agitated, and what are the triggers that affect people when they are in the hospital.

“There are alternatives, but the services have got to invest in and support these alternatives. If the inpatient unit is crowded, if there’s no space for people to go and be by themselves, if there’s no opportunity to go outside and get fresh air and let off steam…that puts everyone in a much more difficult situation. We need to work with people to try and manage their stress or their agitation, and services need to help by providing all the supportive mechanisms that can help too.”

Listening to nurses The College has commissioned a literature review, which will soon be submitted to the Commission, and will open up the online survey for mental health nurses in coming weeks.

The results of the survey will be sent to the Commission within the next few months.

Ms Ryan says mental health nurses have a crucial role to play in reducing and ultimately ending the use of seclusion and restraint.

For the full article visit HealthTimes.com.au HealthTimes - March 2017 | Page 19

What do mental health occupational therapists do?

O

ccupational therapists (OTs) specialising in mental health draw on a range of psychological and occupational therapy strategies to help people understand and cope with their daily function.

Mental health OTs assist people who are struggling with adverse life circumstances, such as grief and adjustment, emotions, stress and parenting, and can help people with severe and complex mental health conditions, from anxiety to depression.

These practitioners also assist with developmental conditions, such as Autism Spectrum Disorder (ASD), or can help children struggling with medical conditions, such as cystic fibrosis or juvenile diabetes.

Catherine Daly, a mental health OT and director of Brisbane private practice What About Play, says mental health OTs help understand how people function in their occupation, whether that’s as a child, student, parent or other adult - supporting them to engage more successfully in their roles.

“For instance, an OT would look at what is impacting someone’s functioning - their illness presentation, their current coping, their relationships, their development, or medical needs - and then assist them to adaptively function in their roles again,” she says.

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With about 17 years of clinical experience specialising in infant, child and parent mental health, Ms Daly helps children and their families with a range of developmental, psychosocial, mental health, academic and functional self-care difficulties, ranging from attachment behaviours to unsettled infants and parents with depression.

“Quite often, a baby might present with complaints of the child being irritable or difficult to settle,” she says.

“It might be that the child may have a developmental kind of difficulty, that’s identified or not identified, and it may be that the child is a hospital inpatient and the clinical team is struggling to find out how to make sense of what is going on for the child and the parent.

“You are looking at what is driving the child’s difficulties and also thinking a little bit about the parent’s struggles - thinking about grief and adjustment to their new parenting role.

“They may have fears about being in hospital and how they are going to manage a child with multiple disabilities or multiple medical issues or is difficult to settle, and then you help them think about the match between the two of them - so it makes it easy for them to get a sense of being together and enjoying each other.

“So, practically you may look at the child’s developmental play skills, or you may look at helping mum to feel confident in her role as parent, helping her as she becomes mother to this baby.”

Within sessions, Ms Daly says her role is to provide clients with a safe space to tell their story.

“This involves organising a client’s experiences, thinking with them about their intense feelings, giving voice to things left unsaid, and helping them make sense of how they can move forward,” she says.

For the full article visit HealthTimes.com.au

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Mental Health Job Opportunities Available at GV Health Several exciting opportunities exist within our Mental Health Service. Positions are available in Primary Mental Health, Enhanced Triage, Adult Inpatient Unit and more.

You will be well supported by the Nurse Unit Manager, Clinical Educators and an experienced team.

About GV Health Goulburn Valley Health (GV Health) is located in Shepparton in central Victoria and is just 2 hours’ drive north of Melbourne with proximity to alpine snowfields, rivers and lakes, wineries and the arts. We enjoy glorious weather, great lifestyle and the sports and attractions of a major regional city. GV Health employs approximately 2200 people and we are the largest employer in the region. GV Health has been successful in securing 168.5 million in funding for the hospital redevelopment. The Redevelopment of GV Health will deliver first class facilities and best practice models of care to meet the growing needs of the local community. The construction stage is anticipated to commence in 2018 with completion in 2020. Please see below a list of our current Mental Health vacancies: • • • •

Community Mental Clinicians - Adult Community and Child and Youth Mental Health Service (RPN Grade 3, OT Grade 2, Social Worker Grade 2 or Psychologist Grade 2) FaPMI Coordinator - Primary Mental Health (RPN Grade 4, Senior Clinician OT, Social Worker Grade 3 or Psychologist Grade 3) Triage Enhanced Team Leader - Enhanced Triage Nurse Unit Manager - Wanyarra - Adult Inpatient Unit (RPN Grade 5)

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For a confidential discussion regarding job opportunities in Mental Health at GV Health, please contact Kaylene Rowe, Divisional Operations Director Mental Health on 03 5832 2112 or via email kaylene.rowe@gvhealth.org.au If you want to make a real difference and work with great people, come and join us!

HealthTimes - March 2017 | Page 21

Calls for nurses and midwives to be upskilled in mental health

A

n Australian nursing leader has called for nurses and midwives to be upskilled through mental health education, in a bid to better identify, manage and care for people with mental health issues.

Australian College of Mental Health Nurses (ACMHN) chief executive Kim Ryan said all nurses and midwives, as the frontline of the nation’s healthcare, must be capable and confident of being able to provide care for people with mental health issues that fall within their scope of practice.

“It shouldn’t matter where people enter or exit the healthcare system, if their mental health conditions are associated with their health concern, the nurse or midwife should be cognisant of the fact that those things exist and that they do have some associated responsibility,” she said.

“When I say to nurses that myocardial infarct is associated with a markedly increased risk of suicide – whether the person has a mental health history or not, particularly in the first year after the heart attack, and with the risk remaining high for at least five years, people are quite surprised by that.

“If we turn around and say that about 18 per cent of women are affected by depression during pregnancy and 13-19 per cent after birth, people are surprised by those statistics, because many of those women won’t come into contact with a mental health service - they will go undiagnosed or they will go untreated,” she said.

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“If cancer nurses understand that depression and anxiety, which are common in people with cancer, are associated with reduced quality of life, poor adherence to cancer treatment and self-care, impaired physical, social, and family functioning, worse symptoms, diminished will to live and higher mortality – then that becomes important for the work that they do, not just the domain of the mental health nurse.”

The College is a member of the Commonwealth’s National Nursing and Midwifery Education Advisory Network, an advisory body providing high level strategic advice to Health Ministers on nursing and midwifery workforce planning, which recently established a Mental Health Working Group.

Ms Ryan said the Mental Health Working Group will consider the undergraduate educational preparation of nurses and midwives in the area of mental health, and how to better address mental health in the general practice setting, which is often the first point of patient contact.

Ms Ryan, who was recently awarded the inaugural Australian Mental Health Prize, said it’s imperative nurses and midwives across all healthcare settings work to improve the outcomes of people with mental health and cooccurring mental and physical health conditions.

For the full article visit HealthTimes.com.au

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Adding passion + possibilities to health

Effective online physiotherapy treatments prompt calls for Medicare change New research shows online physiotherapy treatment can significantly improve the symptoms and functioning for people with knee osteoarthritis.

Under the University of Melbourne research, published in Annals of Internal Medicine, participants received seven Skype sessions with a physiotherapist to learn home exercises, and also completed a three-month online pain-coping skills training program.

Compared to the control group, which only received access to internet educational materials, the online treatment group reported a substantial improvement in their pain, function and quality of life at the three and nine month marks.

“Currently many people with this condition are not receiving key treatments but are relying on drugs, which have serious side effects, and costly surgery,” Professor Kim Bennell, of the Department of Physiotherapy, said.

“About 30,000 Australians have knee replacement surgery each year, so helping people to better self manage can significantly reduce the need for surgery and drugs.”

Professor Bennell said the traditional model of visiting a health professional is not practical for rural and remote patients or patients with mobility problems.

for the full article visit HealthTimes.com.au HealthTimes - March 2017 | Page 23

Advanced scope physiotherapy’s new role in rheumatology

By Karen Keast

A

dvanced scope physiotherapists are venturing into a new area - rheumatology.

While advanced scope physiotherapy roles have made their mark in Australia over the past 15 years in areas such as the emergency department and in orthopaedic and neurosurgery screening clinics, health providers have also begun expanding the dynamic role into rheumatology.

The Eastern States have led the way in implementing advanced scope physiotherapy model of care initiatives for rheumatology patients.

Now, Perth’s Sir Charles Gairdner Hospital in Western Australia has launched the state’s first advanced scope physiotherapy rheum-atology screening clinic.

In this service, patients with musculoskeletal conditions who are referred to see a rheumatologist may be directed to an experienced musculoskeletal physiotherapist working in an advanced scope role. The advanced scope physiotherapist will undertake assessment and diagnosis of these patients and determine a management plan.

Jennifer Persaud, clinical lead of the WA Musculoskeletal Health Network and an advanced scope physiotherapist in Sir Charles Gairdner Hospital’s orthopaedic outpatients department, says the initiative aims to reduce wait times, achieve high patient satisfaction, and improve health outcomes for patients, while freeing up space on the outpatients wait list

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for patients with rheumatic disease to access specialist rheumatolgist care.

Ms Persaud says the idea for the initiative came from a conversation at a meeting for the WA Musculoskeletal Health Network where Professor Hans Nossent, Head of the Department of Rheumatology at the hospital and member of the Network’s Executive Advisory Group, indicated that at least 40 per cent of patients on the rheumatology wait list had a general musculoskeletal condition, instead of a specific rheumatic disease.

“We were just having a conversation around the table about wait list pressures in general, along with some of the difficulty that patients experience with timely access to see a rheumatology specialist,” she says.

“The conversation developed and we spoke about the model that was occurring in Queensland and we were both keen to explore whether creation of a similar model might be possible in WA. “As lead of the network, I was able to connect the right key stakeholders together to enable the discussion to progress and to assist planning for the model to be implemented at its first site in WA.” From that discussion, the process to launch the advanced scope physiotherapy rheumatology screening clinic took about a year.

The service has been operating two clinics a week since it launched in December.

It will run until the end of March, when patient through-put and satisfaction data will be collated and analysed as part of a review into the new service delivery model.

Ms Persaud, who completed her primary physiotherapy degree in the United Kingdom and is a member of the Australian Physiotherapy Association, says advanced practice physiotherapy services offer multiple benefits - reducing waiting times for patients across a range of conditions to ensure timely access to appropriate care and treatment, which works to improve patient satisfaction and health outcomes.

“The benefit is that the advanced scope physiotherapist can assess the patient, direct treatment and link in directly with other clinicians to make advice and recommendations about the kind of treatment that the patient should be receiving,” she says.

“In addition, physiotherapists have expertise in delivering non-surgical/nonmedical management, so if referral on for conservative care is indicated, the advanced practice physiotherapist is extremely well placed to be making recommendations around the type of treatment they should be having.

“To use an old phrase, it’s about the patient receiving ‘the right care, delivered at the right time by the right team/person’.

“For example, if a patient has an orthopaedic requirement, they wouldn’t necessarily want to wait a long time on a public hospital list to access a neurosurgeon only to be referred on to someone with expertise in orthopaedics to deliver care.

“Likewise, if a patient has a general musculoskeletal complaint that requires non-

surgical and non-medical management, then the advanced scope physiotherapist is best placed to be able to assess and give advice and education right there, face to face, and then to guide treatment moving forwards.”

Ms Persaud says the initiative has received strong support from her medical and surgical colleagues.

“The doctors are patient-centred professionals who value initiatives that result in improvements for patients to access to appropriate care and they’ve really championed these services,” she says.

“It’s also a really useful opportunity for advanced scope physiotherapists to be able to liaise with very senior medical and surgical colleagues and for cross-fertilisation of learning to occur between professions.

“That inter-professional learning experience is a great opportunity in these clinics - where we can learn from each other.”

After witnessing advanced scope physiotherapy flourish in the United Kingdom, Ms Persaud says it’s exciting to see it being rolled out into emerging areas of need in Australia.

“I see patients at the interface who have been waiting a long time to see a medical or surgical specialist but don’t necessarily require that type of specialist management.

To be in a position of influence to change that for the benefit of patients, clinicians and the system - is exciting for me,” Ms Persaud says.

“So, I can deliver patient care or assist others to set up similar services that improve access to the right care and streamline the patient journey.

“Any high value improvement to assist patients has to be a winner.”

For more articles visit HealthTimes.com.

HealthTimes - March 2017 | Page 25

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HealthTimes.com.au HealthTimes - March 2017 | Page 27

What is vicarious trauma?

Nurses, paramedics, psychologists and counsellors are often exposed to the traumatic experiences of their patients.

While there is widespread awareness and research into the effects of burnout and post-traumatic stress disorder (PTSD), there is increasing recognition of the impact of secondary exposure to trauma, including secondary traumatic stress and vicarious trauma on the caring workforce.

Dr Rebecca Diehm, a clinical psychologist and lecturer at Deakin University’s School of Psychology, has researched the impact of secondary traumatic stress and vicarious trauma on a range of mental health clinicians, including psychiatrists, nurses, social workers and psychologists.

Despite the terms secondary traumatic stress and vicarious trauma existing for some decades, Dr Diehm says it’s a field of research that remains in its infancy. Adding to the confusion, she says the research that exists often has different definitions and ways of measuring secondary traumatic stress and vicarious trauma.

Dr Diehm says while secondary traumatic stress, vicarious trauma and burnout are terms often used interchangeably, even in research, they appear to be associated, but separate concepts.

Secondary traumatic stress refers to psychological processes that are similar to those that occur in post-traumatic stress disorder, such as symptoms of intrusion, avoidance and hypervigilance, albeit to a lesser extent, and research shows that health workers may develop symptoms in similar ways to those who have directly experienced the traumatic events.

Research also indicates that levels of secondary traumatic stress vary from mild to clinically significant.

Vicarious trauma is an associated construct, which can develop as a result of clinicians

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engaging empathically on an on-going basis with their clients’ traumatic experiences, including child abuse, sexual assault, rape and other violence or accidents.

“The client or patient might not be telling you about their direct experiences of trauma, they might be telling you about the impact of that trauma on their life,” she says.

“As a clinician or a health worker, you can potentially start experiencing distress yourself, and over a long period of time it can start impacting on your beliefs about the world and the people around you.”

One of the key aspects of vicarious trauma is lasting changes to a person’s beliefs.

“Vicarious trauma is a little bit different (to secondary traumatic stress),” Dr Diehm says.

“It’s about how those experiences with clients change how you see the world. Because of repeated exposure to clients’ experiences of trauma, people are trying to make sense of how they can happen to people and it makes you question - that the world is safe, that life is meaningful or that people are essentially good.

“It can also lead to changes in how safe you feel, how much you want to be intimate with other people potentially, not sexually necessarily but intimate and connected to other people, how much control that you feel you have over yourself and other people.”

Research shows workers who are repeatedly, and for prolonged periods of time, exposed to clients or patients’ trauma are more at risk of developing vicarious trauma, while those practitioners who also have their own personal history of trauma are also more vulnerable to developing such difficulties.

While vicarious trauma does not appear prevalent based on a limited number of studies, Dr Diehm says it can result in some people experiencing significant disruptions to their beliefs.

“In the research I completed, on average the mental health clinicians in my sample experienced minimal levels of disruption but then there was five per cent that had quite high levels.”

Dr Diehm says her research indicates the psychological impact of secondary exposure to trauma may represent a developmental process that begins with the development of secondary traumatic stress, which could then lead to longer term vicarious trauma and, in addition, burnout.

A member of the Australian Psychological Society (APS), Dr Diehm says while there is little research evidence to show the most effective methods for mitigating the impact of vicarious trauma, it’s important for clinicians at risk of developing the condition to reduce their level of secondary exposure to trauma.

“So if you had a client load where the majority have experienced trauma then maybe

you would try and break up your work a little bit, so that you have a wider variety of clients or patients,” she advises.

“Or it might be that you break up your work so you do some patient work but you also do education or training, so it’s not what you are doing all the time.”

Other strategies include accessing supervision for your work, completing training on vicarious trauma, and increasing your social supports.

“Being self-reflective and self-monitoring noticing what is happening for you and being aware of your own personal vulnerabilities could also help,” she adds.

“So, if you know you’ve got a past history of trauma then you need to be aware you might be more likely to experience these difficulties.”

HT-703-CTR-00613 1/2PG FULL COLOUR CMYK PDF For the full article visit HealthTimes.com.au

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HealthTimes - March 2017 | Page 29

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