Health times may edition

H

May 2017

Aged Care Special Feature + Catching older people at risk of falls post-discharge + How to discuss end-of-life care with Indigenous Australians + Union keeps fighting for registered nurses in aged care + Purple House nurse named Nurse of the Year

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May 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

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Physiotherapists treat more iHunch pain New Zealand’s peak physiotherapy organisation has urged people using smart phones, tablets and laptops for extended periods of time to avoid ‘iHunch’ with good posture and regular movement.

Physiotherapists and chiropractors in the nation are reporting increasing numbers of teenagers and adults seeking treatment for severe neck and upper back pain, labelled ‘iHunch’, ‘tech neck’ and ‘text neck’, as people spend more time with their shoulders hunched over their handheld and mobile devices.

Physiotherapy New Zealand said while there’s little research examining the impact of handheld devices on the body, technology alone is not to blame.

“We believe that this is about more than just

technology use. Poor posture, a sedentary lifestyle and limited physical activity/exercise are not good for our health and can contribute to neck and back issues,” it said in a statement.

“Whenever you are in a fixed position for too long, your muscles are under stress. It could be sitting at a desk for six hours straight, working on a production line or using your cellphone for extended periods.

“It is not about ditching technology but about making sure people and particularly children are educated about not putting the body into fixed postures for extended periods and encouraging them to break up their day with movement/physical activity.”

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HealthTimes - May 2017 | Page 07

Purple House nurse named Nurse of the Year

S

arah Brown is the 2017 Nurse of the Year.

The remote area nurse, who reshaped ‘on country’ dialysis services for Aboriginal people in central Australia, has been awarded the top honour at the 2017 HESTA Australian Nursing and Midwifery Awards.

A non-Indigenous nurse who was born in England and grew up in Queensland, Ms Brown helped establish the Alice Springsbased Western Desert Dialysis, known as Purple House.

Purple House provides renal dialysis six days a week, social support and allied health services, but it’s also a place that patients can call their own - and make bush medicine, cook damper and kangaroo tails on a camp fire, and organise hunting trips.

“Recognition like this is great for us and for what we are trying to achieve - we’re communitycontrolled, and we raise money ourselves and we’re always looking for the right sort of nurses who want to come and work for us and have some fun,” Ms Brown said.

“Things like this are not only lovely personally but really fabulous for the whole organisation and our story - which is really about Aboriginal people working really hard against the odds to make life better for their family members and their communities.”

The Aboriginal community-controlled venture has 24 dialysis machines at 11 places, from Wanarn and Warburton in Western

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Australia to Yirrkala in Arnhem Land.

It also has a mobile dialysis unit, the Purple Truck, which rolls out to visit other remote communities.

Ms Brown said the prize money will help fund the creation of a new dialysis service at Ernabella in South Australia for the Pukatja community. The service also plans to open the doors of a dialysis unit at Ampilatwatja, in the Utopia region of the Northern Territory, early next year.

Other award winners include Rebecca Rich, of Perth Clinic in Western Australia, who was named Outstanding Graduate, while The Mater (Sydney) Preadmission Midwife A p p o i n t m e n t Program at The Mater Hospital won the award for Team Excellence.

Ms Rich was recognised for her commitment to achieving patient-centred care in mental health nursing, and now plans to use the prize money to visit hospitals around Australia to research treatment for mental health and personality disorders.

“I plan to visit hospitals that treat personality disorders, find out how they’ve been successful and bring this back to the Perth Clinic to help us improve,” she said The Mater was awarded for developing and implementing an holistic multidisciplinary care program to women in the third trimester of their pregnancies.

The program provides women with a

range of health settings.

HESTA CEO Debby Blakey said this year’s winners exemplify the best qualities of their professions, and demonstrate the outstanding impact nurses and midwives have in achieving new standards of health care in Australia.

“These winners stood out from an exceptional group of finalists for their outstanding leadership and innovation, in implementing new services and practices that provide enhanced health care outcomes and the highest standard of care to patients across Australia,” she said.

The winners, who each receive $10,000 for further education or team development, were selected from 12 finalists across Australia.

For more articles visit healthtimes.com.au

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free 45-minute appointment with a specially trained midwife to discuss the women’s expectations and concerns around their pregnancy, birth and early parenting, which also includes screening for depression and anxiety, domestic violence screening, and assistance with other concerns.

Antenatal midwife coordinator Sarah Tooke said the prize money will be used to continue to run the program, fund research, and improve services.

“We want to provide ongoing training for staff, conduct formal research to self-evaluate and we would like to fund a translator to help with linguistically diverse patients.”

Now in its 11th year, the annual awards recognise the outstanding contribution of graduates, individuals and teams for their professionalism, innovation and care across a

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HealthTimes - May 2017 | Page 11

How to discuss end-of-life care with Indigenous Australians

N

ew resources about end-of-life care for Aboriginal and Torres Strait Islander people will assist nurses and other health professionals begin the conversation in a culturally-safe way.

The Dying to Talk resources, developed as part of a collaboration between the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) and Palliative Care Australia (PCA), has been designed to assist nurses and their patients discuss end-of-life - a special time in Aboriginal and Torres Strait Islander culture.

While all Aboriginal and Torres Strait Islander people have different end-of-life wishes, many prefer to return to country at the end of their lives.

CATSINaM CEO Janine Mohamed says the resource aims to ensure Aboriginal and Torres Strait Islander people can die with dignity and respect.

“Like many people, I have my own endof-life experience. For my mum, she wasn’t even told that she was now on a palliative care regime,” Ms Mohamed says.

“I think some very big barriers around misconceptions of Aboriginal people and missed steps can really affect the care that a person receives and their ability to be involved in the decision-making.

“I think this in itself gives a step by step approach to being able to ensure that those steps aren’t missed, that people’s voices are privileged in their end-of-life, that people are

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treated respectfully, and, ultimately, die with respect.”

Ms Mohamed says the guide will help Aboriginal and Torres Strait Islander people to consider and voice their end-of-life care wishes.

“We know that Aboriginal and Torres Strait Islander people have a reluctance to engage in end-of-life health care and palliative care endof-life services,” she says.

“That’s mainly due to past experiences of culturally inappropriate care that has caused psychological distress and unnecessary suffering for Aboriginal and Torres Strait Islander patients, and their families and carers, at a time that’s very vulnerable - where the clients themselves are probably feeling depressed and vulnerable with their diagnoses.

“But it’s also a culturally and spiritually significant time for many Aboriginal and Torres Strait Islander people as well, and if that’s not respected that only perpetuates the reluctance to engage.”

The resources feature a downloadable step by step Aboriginal and Torres Strait Islander Discussion Starter from the Dying to Talk website, which encourages patients to think about themselves and their family, consider their health care, prepare for talking about end-of-life care with family, friends or health professionals, and to review their discussion.

It also outlines a range of other planning activities, such as a preparing an advance care

our members are comments made by health professionals, such as - Aboriginal people don’t feel pain the same way…and that my way is the right way,” she says.

“These are both barriers to not only the care that Aboriginal people receive but them engaging in the services ever again.”

Ms Mohamed says she hopes the resources will not only bridge the gap in conversation but build better relationships between health professionals and Aboriginal and Torres Strait Islander communities.

“So that community-based local approaches to end-of-life care, which are generally preferred, will then become a part of the health care system,” she says.

“It’s beginning conversations with individuals but we hope that individual nurses will think further beyond this resource and think about whole of services approaches to end-of-life care, as well as their own individual ongoing training, such as thinking about doing cultural safety training as well.”

Have your say!

Leave a comment on this or other articles by visiting healthtimes.com.au

HealthTimes - May 2017 | Page 13

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plan, organising a legal will, registering as an organ and tissue donor, planning for social media accounts, and planning a funeral.

Developed with the support of Indigenous Allied Health Australia and the Australian Indigenous Doctors’ Association, the resources also include a set of cards that can be used as a tool to start the conversations.

The resources will be distributed across the nation to Aboriginal Medical Services and Aboriginal Health Services.

Ms Mohamed says many Aboriginal and Torres Strait Islander people prefer to consult extensively with family about end-of-life care, and the resources will better prepare them to tackle the discussions.

“I think it’s an opportunity for the health care provider to also see the pace at which the client is working and why they are working at that pace, to ensure that there are no missed steps,” she says.

“Often, it’s a rushed process from our perspective, and decisions are made for the client, not with the client.

“It’s important the client is empowered in this very important decision-making time.”

“There is no cookie-cutter approach. We are individuals and I think that’s one of the pitfalls we fall into thinking - that all Aboriginal and Torres Strait Islander people are all the same but we are not a homogenous culture.”

Ms Mohamed says health practitioners’ misconceptions about Aboriginal and Torres Strait Islander people can significantly affect the care of their Indigenous patients.

“Some of the things that we’ve heard from

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Telehealth boost for rural and remote psychology services

A

new Medicare rebate for online videoconferencing consultations with psychologists will provide people living in rural and remote areas of Australia with the same psychological access as those living in the nation’s major cities.

The Federal Government has unveiled a new telehealth initiative, which will be funded in the upcoming Federal Budget at a cost of $9 million over four years between 2017-18 and 2020-21.

From November 1, people living in rural and regional Australia will be able to claim a Medicare rebate for up to seven of the 10 rebatable mental health sessions for telehealth consults.

The telehealth boost will enable patients to remain in their own homes, reducing the time and costs of transportation to larger regional centres or cities for sessions with their psychologist.

Australian Psychological Society (APS) president Anthony Cichello said the move will provide greater equity of access to evidence-based psychological care for Australians living in small country towns, remote and very remote Australia.

“The number of people with mental health and behavioural problems, and high psychological distress is roughly the same regardless of where people live in Australia,” he said.

“But people living in rural and remote regions have far greater difficulty accessing effective psychological treatment than those living in cities.”

Mr Cichello said the announcement will also

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bolster the existing psychology workforce in rural and remote Australia.

“It will substantially assist the current workforce to meet the needs of people living outside urban regions, and attract more psychologists to work in regional Australia.”

A joint announcement from Federal Health Minister Greg Hunt and Minister for Regional Communities Fiona Nash states the demand for psychological services in rural and regional parts of the country is growing but a key barrier to accessing services is the lack of local mental health professionals.

The Medicare rebatable psychological services via telehealth will be available for patients living in Modified Monash Model regions four to seven, which cover smaller country towns and remote and very remote locations.

“This will ensure that the services go to areas with the biggest access challenges, not to larger regional centres that are more likely to have resident psychologists and other health professionals,” the Ministers said in a statement.

“We know that people living in rural and regional areas often have reduced access to health care.

“They have to travel greater distances to receive medical services, experience higher rates of ill health, and demonstrate higher death, illness and health and disease risk factors than people living in major cities.”

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HealthTimes - May 2017 | Page 17

Catching older people at risk of falls post-discharge

A

home-based intervention that catches older people returning home after a hospitalisation for a fall could reduce their potential risk of future falls.

The RDNS Institute aims to further examine the use of a home-based intervention, including an individualised balance exercise program, medication review and education, after a soon-to-be published pilot study showed promising results.

Dr Claudia Meyer, a Research Fellow at the RDNS Institute with a background in clinical physiotherapy, says a gap exists for older people transitioning to home after hospitalisation for a fall - when care is often, and understandably, focused on the person’s injury or illness as a priority over their heightened falls risk.

Dr Meyer says the study found older people returning home either failed to receive any information about falls prevention or were possibly unable to recall whether they received falls prevention information while in hospital.

“That’s quite striking because they’re in hospital as a result of a fall but it was almost like the fall didn’t matter,” she says.

“So, for example, somebody had a fall, they were transported to hospital in an ambulance, they did some tests on the person and found she had had, coincidentally, a silent heart attack – but not the cause of the fall.

“But then they addressed that problem as the priority, which is totally understandable, but the fact that she had fallen - first - wasn’t considered as part of the equation.”

Statistics show falls account for 70 per cent of hospitalisations resulting in injury to people aged 65 years and older, and 87 per cent for people aged 85 years and older.

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Dr Meyer says a person living with dementia has a 50 to 80 per cent chance of having a fall, a person with Parkinson’s disease has up to an 80 to 90 per cent chance of a fall, and a stroke survivor has a 60 per cent chance of experiencing a fall, over the course of one year.

Falls also result in substantial injuries for five to 10 per cent of older people, with 92 per cent of hip fractures attributed to falls.

Dr Meyer says older people face an increased risk of falls post-discharge - up to 40 per cent fall within six months of discharge, while 34 per cent fall within three months of discharge from aged care inpatient rehabilitation.

“Also from a psychological point of view, there’s a potential to develop a fear of falling, so people who have this fear of falling can get into a spiral where they reduce or stop activity because they are essentially afraid of moving.

“That potentially leads to muscle weakness and functional decline, which can predispose them to more falls - so this fear of falling can be quite a vicious cycle.”

The RDNS pilot study aimed to improve the health-related quality of life of participants, reduce rate and risk of falls, improve balance and physical function, and review medications to identify and potentially change medications known to increase the risk of falls.

It also aimed to increase knowledge about participants’ individual risk factors and implement management strategies, and develop hospital discharge strategies targeted to older people hospitalised for falls.

Ten people aged over 65, who had been

being discharged from hospital are assessed for falls risk.

“Often they are not even assessed for falls risk and that should be considered part of routine assessments,” she says.

“From there, the big gap is actually putting some strategies in place and that requires a coordinated service and follow up.”

Dr Meyer, who has researched falls prevention in older adults with diabetes and those living with dementia, says it’s important to give older people choice in deciding which falls prevention risk factors they would like to address.

She says a long list of recommendations can be overwhelming for older people while targeting one or a few risk factors, that they want to tackle, may be more effective.

“As a physiotherapist, I can come in and insist on exercise but that might be what they don’t want to do they might hate exercising or they’d rather address another risk factor instead,” Dr Meyer says.

“And by addressing any of the risk factors they are reducing their overall risk.

“It’s about giving people choices in falls prevention but also making them aware it’s not the end of the road - there’s lot of things that can be done, there’s lots of strategies, and it’s about convincing them that those strategies may be helpful.”

For more articles visit HealthTimes.com.au HealthTimes - May 2017 | Page 19

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discharged home from an acute or rehabilitative hospital in Melbourne, and were an existing or new RDNS client, participated in the six-month study.

Five participants were randomly assigned to receive the home-based intervention, comprising exercise such as balance and strength exercises over four sessions with an exercise physiologist, education, and a Home Medicines Review with a pharmacist, while five participants received usual RDNS care.

After six months, half of the participants who were initially deemed frail, at a high or intermediate level, had returned to a level of intermediate or non-frailty.

The study resulted in an overall improvement in participants’ quality of life, reduced falls risk, a slight increase in fear of falling, and a substantial increase in physical activity levels.

“We had very low numbers in the study so it was difficult to get any kind of real conclusions out of it but what we did work out was that when people come back home - that is actually the perfect time to talk to them about falls, rather than in the hospital setting,” Dr Meyer says.

“That’s because it’s just too busy in the hospital - it’s too overwhelming for them.

“We’re hoping to extend that project at some point, and work with our liaison nurses, and catch people when they first come back home, when it’s still on their mind, before they get back into their normal routine and begin to not worry about falls any more.”

Dr Meyer says it’s important older people

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1300 221 971 | smartnurses.com.au Page 20| www.HealthTimes.com.au

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Mental Health Nursing Opportunities Are you an experienced registered nurse interested in advancing you career in mental health nursing?

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The current full time leadership vacancies include: - Clinical Nurse Consultant Level 2 - Clinical Nurse Educator - Clinical Nurse Specialist Level 2 As part of your position Northern Sydney Local Health District offers salary packaging, education support and professional development opportunities and short term accommodation (subject to availability).

To find out more about these exciting career opportunities come and visit the unit and meet the staff or if you wish to apply for a position contact us today!

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HealthTimes - May 2017 | Page 21

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Novel app targets asthma and boosts mental health

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unique asthma management and goals app is the latest innovative tool to assist young people with asthma improve their quality of life.

The free Kiss MyAsthma app, launched on World Asthma Day, is designed to help the 11 per cent of young Australians with asthma manage the physical, social and emotional impacts of the condition.

Asthma Australia funded the app, which was developed by a team of researchers, clinicians and app developers led by the University of Sydney and the Woolcock Institute of Medical Research.

The app is believed to be the first asthma app co-designed with a group of young people with asthma, right from the beginning of the design process. It’s also the first app to address the selfmanagement and psychological issues linked to asthma.

Kiss MyAsthma enables young people with asthma to outline their asthma management and goals. It sends notifications from a cast of monster characters that provide friendly reminders and opportunities to adjust their goals to keep them on-track.

The app also features symptom and mood tracking, emergency support, diarises asthma attacks, and enables young people to share their tracked data with health practitioners.

It comes after a 2014 survey of more than 500 people aged 12 to 25 with asthma found 63 per cent had poorly controlled asthma, 52 per cent were likely to experience mental health is-

Page 22| www.HealthTimes.com.au

sues, while 56 per cent revealed asthma affected their enjoyment of life.

Research conducted as part of the app development process, recently published in the Journal of Medical Internet Research, highlighted the importance of mental health support for young people with asthma.

Associate Professor Lorraine Smith, a research psychologist at the University of Sydney and lead investigator on the app project, said workshop activities with the co-designers highlighted the importance of mental health issues and broader psychological issues for young people living with asthma.

“The guiding principle that we had for this project was that we wanted to develop an app for young people that was developed by young people from the very beginning of the design process, and not from the perspective of a whole bunch of researchers, who think they know better and usually they don’t,” she said.

“Through those workshops, we got to know what was important for them, what a typical day looked like, what their challenges were in their life, what role asthma played in their life.”

Researchers applied psychological principles, including autonomy, relatedness and competence, to the information gathered at the workshops to help create a range of features within the app.

For the full article visit healthtimes.com.au

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HealthTimes - May 2017 | Page 23

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Private Union keeps fighting for registered nurses in aged care

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he New South Wales Nurses and Midwives’ Association (NSWNMA) has vowed to continue its fight to have one registered nurse on duty at all times in the state’s residential aged care facilities.

NSWNMA general secretary Brett Holmes labelled the Nationals and Liberal Party MPs’ move to recently vote down a bill, which aimed to reverse a 2014 State Government change to the Public Health Act 2010 that removed the requirement for one registered nurse to be on duty around-the-clock at facilities, as “disappointing”.

“We’ll continue, whether it’s in the state or in the federal jurisdiction, to make sure that we can do everything we can to provide the highest quality of care to the people who are most vulnerable in our residential aged care services,” he said.

“It’s a just battle and it’s one that the community of New South Wales should continue to support.”

The Shooters Fishers and Farmers Party bill passed the state’s Upper House before it was defeated in the Lower House.

Mr Holmes said registered nurses perform an essential role in overseeing and delivering high level care, and the defeat of the bill will erode the quality of care for the state’s most vulnerable people.

“What this obviously means, and the irony for the government is that it picks up the bill in terms of the numbers of admissions to our public hospitals that are there unnecessarily be-

Page 24| www.HealthTimes.com.au

cause these aged care facilities choose not to have registered nurses on duty 24 hours a day,” he said.

“In fact, they place them on call and there can be no registered nurses in some facilities all over a weekend. So all of that period, the assistants-in-nursing, the carers, the choices they have are simply to send these patients to the closest emergency department.

“That’s an unfriendly place for an aged person. There are situations where they obviously need to be there but there are many situations where they would be far better cared for in their own home, with the registered nurse there to direct care, to make the proper assessments of them, and to ensure that their lives are not disrupted, unnecessarily.”

Mr Holmes also rejected the government’s argument that the requirement to have a registered nurse on duty around-the-clock would force many small regional aged care facilities to close their doors.

“We know that the Commonwealth Government squibs this as well - its legislation only says ‘sufficient numbers of suitably qualified’, and that’s a complete out for many operators,” he added.

“They can choose then the level of qualification and many of them are obviously showing that they choose not to have registered nurses on duty 24 hours a day.”

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HealthTimes - May 2017 | Page 25

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

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Nutrition for the modern aged care resident

W

hat does the modern aged care resident look like and want?

New dietetic research shows while current dietary practices in residential aged care (RAC) mainly target managing malnutrition in older adults aged 85 and over, the emerging ageing population of baby boomers - adults aged 84 and under - are more likely to be overweight, while at least a third are likely to have diabetes.

Accredited Practising Dietitian (APD) Olivia Farrer, a PhD candidate and research dietitian at Flinders University, says the preliminary findings from her yet to be published research reveal the changing health needs and expectations of aged care residents.

Ms Farrer, who presented on the topic at the recent Dietitians Association of Australia (DAA) 34th National Conference, says the changing needs of residents presents new challenges around the quality and service of food for both dietitians and aged care providers.

“My study found that up to a third of current RAC residents have diabetes and those older adults aged <84yrs with type 2 diabetes were more likely to be admitted to RAC in the overweight or obese weight range and maintain this weight, or even gain weight, over a typical length of stay of two years,” she says.

“Whereas the oldest old (over 85yrs), were more likely to have been admitted within a healthy or underweight BMI weight range, and more likely to have lost weight over a similar

Page 28 www.HealthTimes.com.au

time period.”

Ms Farrer conducted two studies - one, an audit of resident demographics and, the other, a series of focus groups with older adults both in residential aged care as well as prospective residents (baby boomers living in the community).

The focus groups revealed while the older group are more likely to be passive in their experience of ageing, diet and diabetes, baby boomers want autonomy in their health management and food choices.

“What I found was that there is a lot of similarity between the cohorts, but while our oldest old in RAC are reluctant to vocalise their preferences and speak more wistfully of their ideal service, the baby boomers were much more firm about their expectations for diet and diabetes management,” she says.

Ms Farrer, who is also a privately practising dietitian, says the groups highlighted issues of choice and food quality.

“Ultimately baby boomers want flexible diet options, whereby they can choose to have a ‘healthy’ diet more aligned with their diabetes education and self-sought dietary knowledge but also indulge without restriction when they choose to.”

Both cohorts also expressed concerns over the quality and acceptability of food provided in aged care.

For the full article visit Healthtimes.com.au

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Musculoskeletal pain for Aboriginal patients When physiotherapist Dr Ivan Lin first began researching musculoskeletal pain among Aboriginal Australians, there was a belief in the research literature that Aboriginal people were protected from the disabling effects of low back pain.

In an under-researched field, the now senior lecturer and NHMRC Early Career Research Fellow at the Western Australian Centre for Rural Health (WACRH) at the University of Western Australia, is part of a team of Indigenous and non-Indigenous researchers shining the spotlight on the issue of musculoskeletal pain in Aboriginal communities.

A non-Indigenous musculoskeletal physiotherapist with the Geraldton Regional Aboriginal Medical Service, Dr Lin is also an adjunct senior lecturer with the Curtin University School of Physiotherapy and Exercise Science.

Musculoskeletal pain Musculoskeletal pain is the leading cause of disability in Australia. Statistics show 6.1 million people, or 28 per cent of the entire population, experienced arthritis or another musculoskeletal condition in 2011-12.

Back pain affects about 2.8 million people or 13 per cent of Australians. Those with back problems are 2.4 times more likely to report poor health than those without the condition, and 2.6 times more likely to report very high levels of psychological distress. They are also 2.5 times more likely to experience severe and very severe pain, and 3.4 times more likely to experience difficulty completing every-day tasks.

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For the full article visit Healthtimes.com.au HealthTimes - May 2017 | Page 29

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HealthTimes - May 2017 | Page 31

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