Ncah issue 01 2015

Page 1

Issue 1 27/01/14 fortnightly

Regional & Remote Health Feature Working remote as a physiotherapist Labor pledges nurse to patient ratios for Queensland More health risks for nurses working night shifts Nurses applaud move to abandon Medicare rebate cut

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Nursing Careers Allied Health relaunches as HealthTimes ! $ # $ " " "

Nursing Careers Allied Health has been the premier nursing and allied health careers publication since it was founded more than 20 years ago, with a national distribution of over 43,000. More recently, the NCAH.com.au website has grown to become the number 1 careers website for nurses, midwives and allied health professionals in Australia receiving over 80,000 visits per month. In February 2015, Nursing Careers Allied Health relaunches as Health Times. www.ncah.com.au

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Midwifery& & Maternal Next Publication: Regional Remote feature Next Publication: Education feature Next Publication: feature 9th February 2015 Publication Date: MondayEducation 3rd 2013

Publication Date: Monday 9th September 2013 Monday 2nd 2015 Colour Artwork Tuesday 28thFebruary January Publication Date:Deadline: Monday 9th September 2013 2013 Colour Artwork Deadline: Monday 2nd September 2013 4th February 2015 Mono Artwork January2013 2013 Colour Artwork Deadline: Deadline: Wednesday Monday 2nd29th September Mono Artwork Deadline: Wednesday 4th September 2013 Mono Artwork Deadline: Wednesday 4th September 2013

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Nursing Careers Allied Health - Issue 1 | Page 7

Peripheral Arterial Disease More health risks for nurses By Bonnie Fraser BSc, BNURS, RN working night shifts Peripheral arterial disease (PAD) is a conBy Karen Keastprogressive occlusion of dition arising through the arteries of the lower limbs.1 PAD is caused A large study in the UnitedinStates hasof found by atheroma or fatty deposits the walls the nurses working rotating night shifts face an inarteries leading to arterial rigidity and progrescreased risk of cardiovascular disease and lung sive narrowing of the arterial lumen, limiting cancer.flow to the muscles and other tissues in blood The study of almost 75,000 registered nurses distal extremities, in particular the legs.2 Insufspanning 22 years shows nurses working rotating ficient blood flow can produce ischemia. The night shifts, of at least three nights a month along subsequent decrease in oxygen and nutrients with day and evening shifts, for five or more years to the affected limb may lead to impaired tissue had a modest rise in all-cause and cardiovascular integrity and ulceration.3 Arterial ulcers may disease mortality. also be the result of minor trauma resulting in The study, published in the American Journal a wound. Poor healing capacity due of Preventive Medicine, also found nurses workto reduced peripheral perfuing rotating night shifts of 15 or more years had a sion and local wound conmodest increase in lung cancer mortality. ditions (reduced oxygen, Researchers state the study is further evinutrients, temperature, dence of the potentially detrimental effects of roinfection and devitating night shift work on health and longevity. talised or necrotic An international team of researchers used data tissue) leads to the from the Nurses’ Health Study, which is based at development of a Brigham and Women’s Hospital, and began colnon-healing wound lecting night shift data in 1988. or ulcer.3 After excluding women with pre-existing carSome orpatients diovascular other than non-melanoma skin canwith PAD have sympcer, 74,862 women were included in the analysis. tomsReviewing but others are of follow-up data, they the 22 years asymptomatic. The comfound 14,181 deaths documented, with more than mon symptom, intermittent 3000 of those attributed to cardiovascular disease claudication, characterised and more thanis5400 to cancer. by leg pain and weakness brought on cent by rise in Researchers discovered an 11 per walking, disappearance of the all-causewith mortality for women with 6 tosymptoms 14 years or following Riskoffactors increasing more thanrest.1 15 years rotatinginclude shift work. age Cardiovascular-related (>50) with a history of mortality diabetes plus also one apother atherosclerotic factor such as cent smokpeared to increase 19 risk per cent and 23 per for ing, hyperlipidaemia, hypertension, hyperchrothese groups, respectively. mocysteinemia or elevated C-reactive There was no association betweenprotein; rotating or agework overand 70 any years; leg symptoms with exshift cancer mortality, except for lung cancer in nurses who worked nights for 15 ertion (suggestive of claudication) or ischemic or more years - dorsalis with a 25pedis per cent higher risk. pain, abnormal and/or posterior

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tibial pulses; and a history of stroke, myocardial infarction or renal artery disease.1 Ischemia, if left untreated, may lead to ulThe especially World Health Organisation ceration, around the toes, classified the foot night shift work as a probable carcinogen in 2007 (phalangeal heads, the malleoli region (ankle) as a result of circadian disruption. or mid tibia. The ulcer appears punched out study’s authorsrolled point edges to sleep andmay the with The well-demarcated and circadian system for playing a vital role in cardiobe deep. The wound is characterised by pale vascular health and anti-tumour activity. non-granulating often necrotic tissue (eschar) “The circadian system and its prime marker, and gangrene (wet or dry) may be present in melatonin, are considered to have anti-tumour advanced stages. Gangrene (wet) may be aseffects through multiple pathways, including ansociated with inflammation and cellulitis, an intioxidant activity, anti-inflammatory effects, and fection in the underlying tissues. Exudate level immune enhancement,” it states. is usually low. The surrounding skin “They also exhibit beneficial actions on cardimay exhibit dusky erythema or ovascular health by enhancing endothelial funchave a deep red to purplish tion, maintaining metabolic homeostasis, and mottling effect, be cool reducing inflammation. to touch, hairless, thin “Direct nocturnal light exposure suppresses and often with a shiny melatonin production and resets the timing of the appearance. Toenails circadian clock. may be thickened, “In addition, sleep disruption may also acopaque and discolcentuate the negative effects of night work on oured or missing. health. Patients “Taken together, substantial biologicalwith eviarterial ulcers dence supports the role of night shift workinvariin the ablyconditions, experience pain, development of poor health including even without infection. cancer, CVD, and ultimately, mortality.” Pain may be by The study shows women withalleviated longer durahanging the foot over the tions of rotating night shift work tended to be oldside of were the bed sleepingactive in a er, had a higher BMI, moreorphysically chair. Pain usually distal to likely the after standardising for agebegins and were more obstruction, moving proximally asalcohol ischemia to be smokers, while they drank less and progresses. ulcer itself is oftentopainful. ate less dailyThe cereal fibre compared women Whilst is not common in PAD, patients withoutoedema night shift work. with These mixednurses aetiology ulcers (combination or had also gained more weight arterial and disease or heart since the agevenous of 18 and were more likelydisease) to have a oedema may be present. Critical limb ischemia history of diabetes, hypertension and hypercho(CLI), the consequence of poorly managed lesterolemia. PAD, is the sustained and severe decrease in For the full effected article visit NCAH.com.au blood flow to the extremity.2 CLI is

501-007 1/2PG FULL COLOUR CMYK PDF include non-healing ulceration, gangrene, rest characterised by ischemic rest pain, non-healpain and progression of claudication.4,5 Deing ulcers and/or gangrene which may result pending on co-morbidities, pharmacological in amputation if left untreated.2 If able, when interventions may include antiplatelet therapy your patient is lying in bed, ask them to lift their (usually clopidogrel or aspirin), lipid modifying leg above the level of their heart for a couple of agents, antihypertensive agents, hypoglycaeminutes. If the toes and forefoot become pale mic agents, folic acid and vitamin B6 (to lower on elevation and then turn a purplish-red when homocystiene levels) and transdermal nitro placed back on the bed this is an indication the patches (nitroglycerine) to improve blood flow patient has PAD. to the affected limb and improve claudication Early diagnosis and intervention is the key symptoms.4,5 Lifestyle modifications generalto successfully managing PAD. Wound assessly revolve around ongoing education regarding ment should be holistic involving a comprediet and exercise, weight reduction and smokhensive patient history (medical, medications, ing cessation.4,5 surgical and psychosocial); wound assessAccurate diagnosis of aetiology, management with a clinical description of the wound ment of contributing factors and other co(ulcer); assessment of the limb (appearance of morbidities, and thorough wound assessment nails and skin temperature and colour); pain are prerequisites for successful wound manassessment; vascular assessment including agement. History of past wound dressings is capillary refill time; presence or absence of necessary to ascertain the efficacy of previous dorsalis pedis and posterior tibial pulses and management plans and to inform new manthe presence/absence of bruits in the proxiagement strategies.4 If infection is present mal leg arteries; ankle brachial pressure index or suspected, wound swabs and cultures are (ABPI); and assessment of vascular status required to identify pathogens present and to (determined by the vascular specialist or surfacilitate effective antimicrobial management. geon). Infected wounds may need treatment with Patients with PAD and arterial ulcers gensystemic antimicrobial therapy plus or minus erally have a decreased or absent pulse in the the use of topical antimicrobials. Cadexomer dorsalis pedis and/or posterior tibial arteries, iodine, medical honey, silver and prontosan have bruits in the proximal leg arteries indicat(polyhexamethylene biguanide (PHMB), an aning the presence of atherosclerosis, reduced timicrobial agent) are effective against a broad capillary refill time (< 2 seconds) and low ABPI. # " of infective pathogens which may be ABPI is usually conducted to rule out ve range present in wounds and provide gentle autolytic ! " # nous # disease with values < 0.8 indicative of $ $ # $ $ debridement of sloughy, devitalised tissue. significant PAD % $ while a # value less than 0.5 sigDo not use iodine or silver on wounds nifies critical limb ischemia requiring surgical # " ! " with exposed tendons, ligaments or bone intervention.3 Once diagnosed, the manage $ as once incorporated these products rement of PAD is multi-factorial, incorporating a ! main in the tissues. Prior to use of any topicombination of surgical and pharmacological $ '% $#, #( !!+ ($ ( !( & &) ( #

cal agent it is important to ask the patient if interventions, lifestyle modifications and bet *% &( # +$)& !$ ! & $#( ( )' ( )' +' $" )

they have allergies to the intended product. ter management of co-morbidities.1 Surgical $& interventions to increase blood flow include reconstructive surgery (revascularisation or +' $" ) bypass graft surgery) and angioplasty. Operative indications for critical limb ischemia For the full article visit NCAH.com.au

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Nursing Careers Allied Health - Issue 1 | Page 9

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Nursing Careers Allied Health - Issue 1 | Page 11

Labor pledges nurse to patient ratios for Queensland By Karen Keast Queensland will legislate nurse to patient ratios under a Labor state government. Opposition leader Annastacia Palaszczuk has pledged to legislate safe patient ratios in public hospitals if Labor wins the January 31 election. Under its Nursing Guarantee policy, Labor will fund an extra 400 nursing positions at a cost of $110 million over four years. The policy also outlines a plan to establish a benchmark ratio of one nurse per four patients in acute wards during day shifts and one nurse to eight patients overnight, as a starting point for this year’s new EB9 enterprise agreement with nurses and midwives. Labor will also legislate in its first term for safe nurse to patient ratios and workload provisions to ensure patient safety and quality health care. Ms Palaszczuk said Labor will rebuild health services slashed under the Newman Government, which cut more than 4800 positions from hospitals and health services including about 1800 full-time equivalent nursing and midwifery positions. She said evidence showed mandated nurse to patient ratios improved quality of care and resulted in better health outcomes for patients, reduced re-admission rates and reduced post-operative mortality rates. “The additional cost of ensuring appropriate nurse bedside hours is recouped through the reduced costs of better service delivery and better patient outcomes,” she said. Queensland Nurses’ Union (QNU) acting secretary Des Elder said no legislation currently exists to govern how many patients can be allocated to a single nurse or midwife.

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“A commitment to install safe nurse to patient ratios provides a ray of sunshine after three bleak years of hospital and health service job cuts in Queensland,” he said.

“The nurses and midwives who have survived the LNP health cull have told us they are overworked, fearful for patient safety, tired and demoralised. “The ALP’s announcement they will introduce nurse ratio legislation if elected will no doubt brighten their day.” The newly elected Labor government in Victoria has also vowed to enshrine nurse to patient ratios in legislation. The Queensland announcement comes after renowned US patient safety researcher Dr Linda Aiken visited the state in December to discuss her research, which shows nurse staffing levels contribute to a ‘seven-fold difference’ in patient mortality rates between hospitals. As part of its nursing policy announcement, Labor has pledged to create a Queensland Bureau of Health Statistics to publicly report key indicators of public and private hospitals and health services, and it will also review the role of the Health Ombudsman. Health Minister Lawrence Springborg said the government has already pledged another 2000 health workers.

For more articles visit NCAH.com.au

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Working Pharmacies remote - theas right a medicine physiotherapist for Medicare? By Melbourne-trained Karen Keast physiotherapist Rob Curry wanted a bush lifestyle - one far away from the daily grind of the commute at ommunity pharmacists equippedto towork provide a metropolitan physiotherapy practice. vaccinations, basic health checks, mental “I was interested the bush and a rural health support, repeatinprescriptions and treatlife, mias philosophical rathertothan living noraailments could approach be the remedy Australia’s in a city and care all ofcosts. the things that that entails,” rising health he says. The Pharmacy Guild of Australia says enRob services venturedattothe Port Lincoln in South Aushanced nation’s 5450 community tralia and had brief stint working in Queenspharmacies willadeliver a more affordable and acland before moving to Darwin in late 1983. cessible health system. Rob went on toafter spend 30 Minister years working The call comes Health Sussan in Northern Territory, mostly as Leythe recently vowed to consult with practising health profesasionals physiotherapist Aboriginal on reformsindesigned to commake Medicare munities outside of Darwin. more sustainable. “I liked Darwin The Guild says straight pharmacists could provide away,” he says. repeat prescriptions for stable, long term condiworked several tions“I such as diabetes and high blood pressure. years at the Royal Pharmacists could also dispense medicines Darwin to treat aHospital range of and minor ailments such as urinary then in about 1990 tract infections, middle ear infections and minor Iskin took the remote irritations, which make up about 26 million physio job working GP consultations every year. in Aboriginal comTrained community pharmacists could admunities. minister the flu and other vaccinations, through did Immunisation that for the “INational Program for at-risk about decade, patientagroups, andtravelprovide vaccines privately for ling from Darwin to remote the wider population. communities Under a like trial,Maningrida, Queensland pharmacies are Tiwi Islands, Oenpelli -whooping those cough and delivering the influenza, sorts of places. measles vaccines, while Western Australian and “That was a flying job really - lots flying South Australian pharmacists were alsoof recently in lightthe aircraft driving 4WD vehicles ocgiven greenor light to administer the flu and vaccine. casionally boats to get topharmacies places.” could also The Guild proposes Rob awas the onlyapproach physiotherapist for about provide systematic to medicines rec14,000 people living in remote communities. onciliation. He would post visit the largerand communities It argues hospital transitionalevery care few months, spending asupport few days each area, medicine reconciliation willinaddress the prioritising his practise andhospital focusing on aged 230,000 medicine-related admissions care and that disability care. annually, comes with a $1.2 billion price tag.

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“As a physio it was a bit frustrating really because I would have liked to have worked morePharmacies on the sports injuries of thebasic people out could deliver health there because remote Aboriginal people play a checks, risk assessments, lifestyle counselling, lot of footy a lot ofalongside sport,” he says. support andand referrals initial screening “The main problems were people with disfor diseases such as bowel cancer. abilities people role whoinhad strokes orhealth lost “Thisand increased preventative limbs or intervention who had other major injuries or pailland early will help identify at-risk nesses. tients earlier and, with the necessary follow-up, were the to things I really to priorihave“They the potential reduce the had prevalence of tise as being the things would either mean expensive, chronic healththat conditions,” it states. that The people would up in hospital, if Guild saysend pharmacists with either the apthey didn’tqualifications get some physiotherapeutic inputalso or propriate and training could sometimes people would referral pass away provide early intervention, support, and because theywith hadmental lacked indecontinuity of care for people illness. pendent movement. The Guild national president George Tambass“They in would get presis said community pharmacies Australia have suretosores or chest inalready proven their ability provide enhanced fections or something medication support, diabetes services, asthma like thatmonitoring. and ultimatemanagement and blood pressure ly endofup hospital “The outstanding success theinrecent flu or pass vaccination pilot in Queensland is away. the latest ex“Disabled kids ample of how pharmacies can deliver high quality was a real focus and more convenient and cost-effective services kids who have had to patients,” he said. injuries or men“However, Australia head is lagging many other ingitis or decountries in terms of making thesome mostother effective velopmental problem. use of its highly accessible physical pharmacy really the prinetwork and the skills“They of itswere pharmacist profeshealth issues - it with meant peosion, working ority in close collaboration doctors ple health could professionals. either stay living in the comand other munity would have to go to hospital go “Theorgovernment’s Medicare reforms, or comto some sort institutionnew or aged care facility bined with theofupcoming community pharin Darwin.” macy agreement, aged care reforms, primary Robnetworks recalls treating and assisting anto older health and potential changes the Aboriginal woman with arthritis and deformities private health insurance rebate provide the right as a result of leprosy, who found incredibly climate to transform pharmacies intoit true health difficult to walk. destinations.” Rob worked with a clinic in Darwin to develFor amore articles visitfor NCAH.com.au op and trial motorised buggy the woman.

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REGISTERED WITH !(02! 0U YL[\YU ^L HYL VMMLYPUN HU H[[YHJ[P]L ZHSHY` PUJS\KPUN ZHSHY` with the Australian Health Practitioner Regulation Agency. You will also have comprehensive more about being aexperience flight nurse contact 0/ "OX -ARLESTON "# 3! o #OMPANY MOTOR VEHICLE AND RELOCATION ASSISTANCE o #OMPANY MOTOR VEHICLE AND RELOCATION ASSISTANCE !UGUSTA registered with the Australian Health Practitioner Regulation Agency. You will also have 9LWVY[PUN [V [OL .LULYHS 4HUHNLY /LHS[O :LY]PJLZ [OPZ WHJRHNPUN ILULĂ„[Z PU H Z\WWVY[P]L LU]PYVUTLU[ ^OLYL Z[HMM Gabrielle West, Director of Nursing on o #OMPREHENSIVE EXPERIENCE IN AEROMEDICINE AND A exciting part of your life,â€? he says. While working as a physiotherapist in reand/or post graduate qualifications in a critical care area, together with high level customer service skills (08) 9417 6300. 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MULTI DISCIPLINARY TEAM 0OST 0/ "OX -ARLESTON 3! ence for people and would really encourage Professionally, RobKLSP]LY` developed a crosso 0ARTICIPATION IN RECRUITMENT ACTIVITIES Closing date for applications is Monday it.â€? ‹ -HJPSP[H[PUN [OL WSHUUPUN HUK L]HS\H[PVU VM [OL )F YOU ARE KEEN TO MOVE YOUR CAREER INTO AN ORGANISATION )F YOU ARE KEEN TO MOVE YOUR CAREER INTO AN ORGANISATION your confidential enquiries totoGreg McHugh Ph:Ph: (08) 8150 1313 o #ONĂź DENT IN DECISION MAKING ABILITIES Please direct your confidential enquiries Greg McHugh (08)8150 1313 6th February 2012. %MAIL CAREERS o ,IAISON WITH OTHER (EALTH 3ERVICES ]HYPV\Z WYVNYHTZ PU JVSSHIVYH[PVU ^P[O [OL YLSL]HU[ cultural and multidisciplinary approach to his THAT MAKES A REAL DIFFERENCE TO ALL !USTRALIANS APPLY NOW THAT MAKES A REAL DIFFERENCE TO ALL !USTRALIANS APPLY NOW o 0OST GRADUATE QUALIĂź CATIONS IN AEROMEDICINE DESIRABLE Applications to: Operations mYINGDOCTOR NET Applications to:Kate KateGuerin, Guerin,HR HRCoordinator CoordinatorRFDS RFDSCentral Central Operations PUKP]PK\HS WYVNYHT JVVYKPUH[VYZ" o 0ROVIDE SUPPORT TO STAFF AFTER HOURS !PPLICATIONS CLOSE o 'ENERAL COMPUTER LITERACY Rob’s tips for physiotherapists working practise. PO Box 381 Marleston Marleston DC DC SA SA5033 5033 ‹ :LLRPUN UL^ VWWVY[\UP[PLZ MVY OLHS[O WYVNYHT KLSP]LY` " 0LEASE DIRECT YOUR CONĂź DENTIAL ENQUIRIES TO DENTIAL ENQUIRIES TO 3EPTEMBER remote: The CATIONS AND EXPERIENCE experience also sparked Rob’s inter- 'REG -C(UGH 0H ‹ 7YLWHYPUN YLWVY[Z YLX\PYLK MVY LHJO WYVNYHT" 1UALIĂź careers@flyingdoctor.net careers@flyingdoctor.net Email: 'REG -C(UGH 0H The RFDS is an Equal CATIONS ‹ o 'ENERAL AND -IDWIFERY .URSING QUALIĂź +H` [V KH` THUHNLTLU[ VM OLHS[O WYVNYHT Z[HMM !PPLICATIONS TO +ATE 'UERIN (2 #OORDINATOR !PPLICATIONS TO +ATE 'UERIN (2 #OORDINATOR est inRoyal the philosophy and practise of primary Employer Opportunity Employer The FlyingFlying Doctor Service Equal Opportunity Employer TheRoyal DoctorIs An Service is an Equal Opportunity REGISTERED WITH !(02! 0/ "OX -ARLESTON "# 3! 0/ "OX -ARLESTON "# 3! 1. Maintain your professional skills. 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o 0OST GRADUATE QUALIĂź CATIONS IN CRITICAL CARE ESSENTIAL sional development. “Don’t just roll along and Diploma in Aboriginal Studies and a Masters in !PPLICATIONS CLOSE !PRIL !PPLICATIONS CLOSE !PRIL o !BILITY TO LEAD AND MANAGE A GROUP OF STAFF let it happen,â€? he says. “In remote areas you Primary Health Care, left physiotherapy to work o !BILITY TO WORK BOTH INDEPENDENTLY AND AS PART OF A 4HE 2OYAL &LYING $OCTOR 3ERVICE IS AN %QUAL /PPORTUNITY %MPLOYER might get away a bit from your specific clinical in MULTI DISCIPLINARY TEAM management and public health roles in Abo- 4HE 2OYAL &LYING $OCTOR 3ERVICE IS AN %QUAL /PPORTUNITY %MPLOYER o #ONĂźhealth DENT IN DECISION MAKING ABILITIES practice and you get into other roles, you deriginal in the Territory. o 0OST GRADUATE QUALIĂź CATIONS IN AEROMEDICINE DESIRABLE velop services, you advocate for services, you He worked for the Tiwi Health Board and o 'ENERAL COMPUTER LITERACY do a lot of multidisciplinary work, but you might then with the Aboriginal Medical Services Alliactually back off your specific work like spinal ance of the Northern Territory (AMSANT). work or musculoskeletal work. Keep your proOver the years, Rob has been a board memover 100 years Silver Chain has been changing improvingskills lives,up.â€? today we are fessionaland development berFor of the Australian Physiotherapy Association one of the largest community health and are providers in Western Australia (WA). The 2 .Make connections. Physiotherapists may (APA) and the National Rural Health Alliance. Country Services Division provides a range of support services including Nursing, be working remotely but can connect with other Rob is an inaugural member and current Allied Health, Domestic Assistance and much more. professionals in different physiotherapy fields. vice president of Services for Australian Rural current vacancies in Country Services “Keep are: your connections with them so that you andThe Remote Allied Health (SARRAH). Albany - Physiotherapist, Registered Nurse and Therapy Assistant can update your knowledge and check your While Rob is semi-retired, lives on the midBeacon - Remote Area Nurse knowledge,â€? says. “Otherwise you can north coast- of New South no longer (Full Hyden Remote AreaWales Nurseand Practitioner Time, with Rob on-call requirements get professionally a bit isolated or lose touch practises physiotherapy, he remains passionate Northam - Nurse Practitioner a bit. It’s a really full working life but it’s not so about models of rural allied health practice, mulPilbara - Case Co-ordinator Shark Bayprimary - Remote Areacare, Nurse (Part Time, withason-call requirements) clinically focused say urban practice is. You ti-disciplinary health andPractitioner health Western Australia - Remote Area Nurse need to be wary of that.â€? workforce issues. remote as a physiotherapist wasto make a difference to Australian IfWorking you’re passionate, dedicated and want then visit silverchaincareers.org.au today. notcommunities only incredibly enriching - the experience shaped Rob’s entire career. For the full article visit NCAH.com.au

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Working remote as a physiotherapist Melbourne-trained physiotherapist Rob Curry wanted a bush lifestyle - one far away from the daily grind of the commute to work at a metropolitan physiotherapy practice. “I was interested in the bush and a rural life, as a philosophical approach rather than living in a city and all of the things that that entails,” he says. Rob ventured to Port Lincoln in South Australia and had a brief stint working in Queensland before moving to Darwin in late 1983. Rob went on to spend 30 years working in the Northern Territory, mostly practising as a physiotherapist in Aboriginal communities outside of Darwin. “I liked Darwin straight away,” he says. “I worked several years at the Royal Darwin Hospital and then in about 1990 I took the remote physio job working in Aboriginal communities. “I did that for about a decade, travelling from Darwin to remote communities like Maningrida, Tiwi Islands, Oenpelli - those sorts of places. “That was a flying job really - lots of flying in light aircraft or driving 4WD vehicles and occasionally boats to get to places.” Rob was the only physiotherapist for about 14,000 people living in remote communities. He would visit the larger communities every few months, spending a few days in each area, prioritising his practise and focusing on aged care and disability care.

Page 18 | www.ncah.com.au

“As a physio it was a bit frustrating really because I would have liked to have worked more on the sports injuries of the people out there because remote Aboriginal people play a lot of footy and a lot of sport,” he says. “The main problems were people with disabilities and people who had strokes or lost limbs or who had other major injuries or illnesses. “They were the things I really had to prioritise as being the things that would either mean that people would end up in hospital, either if they didn’t get some physiotherapeutic input or sometimes people would pass away because they had lacked independent movement. “They would get pressure sores or chest infections or something like that and ultimately end up in hospital or pass away. “Disabled kids was a real focus kids who have had head injuries or meningitis or some other developmental problem. “They were really the priority health issues - it meant people could either stay living in the community or would have to go to hospital or go to some sort of institution or aged care facility in Darwin.” Rob recalls treating and assisting an older Aboriginal woman with arthritis and deformities as a result of leprosy, who found it incredibly difficult to walk. Rob worked with a clinic in Darwin to develop and trial a motorised buggy for the woman.

“She needed one that could get across sand reasonably easy because it was quite sandy where she lived,” he says. “She was a beautiful old woman and it was worth working with her on that. “Eventually we did get the buggy developed but there were always issues with it in a remote community of keeping it going but she really appreciated those efforts, and it gave her a lot more independence for the time that she had the buggy before she passed away.” While working as a physiotherapist in remote communities came with its challenges, Rob says he loved the country, the people and especially the freedom that came with the role. Professionally, Rob developed a crosscultural and multidisciplinary approach to his practise. The experience also sparked Rob’s interest in the philosophy and practise of primary health care. Rob, who went on to complete a Graduate Diploma in Aboriginal Studies and a Masters in Primary Health Care, left physiotherapy to work in management and public health roles in Aboriginal health in the Territory. He worked for the Tiwi Health Board and then with the Aboriginal Medical Services Alliance of the Northern Territory (AMSANT). Over the years, Rob has been a board member of the Australian Physiotherapy Association (APA) and the National Rural Health Alliance. Rob is an inaugural member and current vice president of Services for Australian Rural and Remote Allied Health (SARRAH). While Rob is semi-retired, lives on the midnorth coast of New South Wales and no longer practises physiotherapy, he remains passionate about models of rural allied health practice, multi-disciplinary primary health care, and health workforce issues. Working remote as a physiotherapist was not only incredibly enriching - the experience shaped Rob’s entire career.

“I worked in amazing parts of Australia, was stimulated by that and was working in a different culture with different sets of rules and different ways people live their lives and I found that incredibly stimulating but challenging also,” he says. Rob advises students to take up opportunities to experience remote placements, and says physiotherapists who are prepared to go bush won’t look back. “I think if you do plan it, it can be a really exciting part of your life,” he says. “If you go into it with your eyes wide open, prepare and make sure you don’t get isolated professionally, then I think it’s a great experience for people and would really encourage it.” Rob’s tips for physiotherapists working remote: 1. Maintain your professional skills. Rob advises physiotherapists to plan their professional development. “Don’t just roll along and let it happen,” he says. “In remote areas you might get away a bit from your specific clinical practice and you get into other roles, you develop services, you advocate for services, you do a lot of multidisciplinary work, but you might actually back off your specific work like spinal work or musculoskeletal work. Keep your professional development skills up.” 2 .Make connections. Physiotherapists may be working remotely but can connect with other professionals in different physiotherapy fields. “Keep your connections with them so that you can update your knowledge and check your knowledge,” Rob says. “Otherwise you can get professionally a bit isolated or lose touch a bit. It’s a really full working life but it’s not so clinically focused as say urban practice is. You need to be wary of that.”

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 1 | Page 19

Nurses applaud move to abandon Medicare rebate cut By Karen Keast The Australian Nursing and Midwifery Federation (ANMF) has applauded the Federal Government’s decision to dump plans to cut the Medicare rebate for short GP visits. New Health Minister Sussan Ley has announced the move to cut $20.10 from the rebate paid to GPs for consultations lasting less than 10 minutes, due to take effect on January 19, will be taken off the table. “The government is responding to concerns that have been raised about the new Medicare measure to improve patient care and tackle the problem of ‘six minute medicine’,” she said. “The government is committed to encouraging doctors to spend more time with patients where appropriate, whilst ensuring that taxpayers’ dollars are effectively targeted.” ANMF acting federal secretary Annie Butler labelled it a “common sense decision”. “As nurses and midwives, we were extremely worried that these proposed changes would result in doctors passing on more out of pockets costs on to their patients,” she said. “We are now calling on Minister Ley to consult with the ANMF and other health professionals about how we can work together to protect Medicare and the future sustainability of Australia’s universal healthcare system.” In a statement, Ms Ley said Medicare will not survive in the long term without changes “to make it sustainable”. “In the last decade, spending on Medicare has more than doubled from $8 billion in 2004 to $20 billion today, yet we raise only $10 billion from the Medicare levy,” she said. “Spending is projected to climb to $34 billion in the next decade to 2024.”

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Meanwhile, the Australian Physiotherapy Association (APA) has put forward an alternative Medicare reform solution. The APA has reissued its call for physiotherapists to be able to refer patients directly to specialists with a Medicare rebate. APA CEO Cris Massis said the proposal will reap $13 million in savings a year. “The government’s said it will consult with the healthcare community for a sustainable plan - our solution is to enable physiotherapists to refer patients direct to specialists,” he said.

“It will lead to immediate and significant lasting changes that will benefit patients and our health care system. It’s a simple reform that could save the Medicare Benefits Scheme millions.” The APA has included the proposal in its 2015-16 pre-budget submission. It estimates the move will reduce the number of GP visits by about 737,000 a year and increase specialist medical practitioner consultations by 55,521. “The training and skills of physiotherapists mean that they are capable and well qualified to refer their clients to the right medical practitioner,” the submission states. The Australian Medical Association (AMA) said the government’s decision to ditch the rebate cut is a win for patients.

For more articles visit NCAH.com.au

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SA pharmacists to administer vaccinations By Karen Keast South Australian pharmacists are the latest to receive the green light to administer flu vaccinations. State Health Minister Jack Snelling has announced pharmacists will be able to administer the flu vaccine when it becomes available in late March. The move follows the success of last year’s Queensland Pharmacist Immunisation Project (QPIP) which delivered about 11,000 vaccinations. The Western Australian government has also allowed pharmacists to deliver the influenza vaccine and a parliamentary inquiry has recommended establishing a pharmacy immunisation trial in Victoria. Under the South Australian initiative, pharmacists will be able to vaccinate adults over the age of 16 who are not already eligible for a free flu shot as part of the National Immunisation Program. Pharmacists wanting to administer flu vaccines will undergo training to be equipped with the knowledge and skills needed to not only deliver the vaccine but to also be able to identify and treat any possible side effects. SA Health will also need to accredit any participating pharmacies, which will receive an audit every two years in line with pharmacy industry standards. Last year, South Australia reported its highest number of influenza cases on record with more than 11,000 cases - exceeding the 2009 swine flu epidemic. “Allowing pharmacists to directly administer the flu shot will encourage a greater uptake of the vaccine in 2015,” Mr Snelling said in a statement.

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“Having as many people as possible vaccinated against influenza each year will go a long way towards creating a healthier community and helping to reduce the additional burden on the health system.” Pharmacy Guild of Australia SA Branch president Nick Panayiaris said the move will make it easier for people to receive the flu shot. “The availability of vaccination by pharmacists in rural areas will greatly assist the community’s access to protection against influenza, where previously they may have not had accessibility,” he said. “South Australian pharmacists have always been a trusted source of health services and advice, and vaccination will now become another service pharmacists will take on and perform professionally for the benefit of the community.” While pharmacists have been unable to provide vaccines until the Queensland trial, community pharmacy groups have been using nurse immunisers in a bid to introduce their own flu vaccination programs. The QPIP moved into phase two last September, with more than 200 pharmacists across the state able to deliver whooping cough and measles vaccines. Pharmacists provide vaccinations in the United Kingdom, New Zealand, Canada and the United States.

For more articles visit NCAH.com.au

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Nursing Careers Allied Health - Issue 1 | Page 23

Peripheral Arterial Disease By Bonnie Fraser BSc, BNURS, RN Peripheral arterial disease (PAD) is a condition arising through progressive occlusion of the arteries of the lower limbs.1 PAD is caused by atheroma or fatty deposits in the walls of the arteries leading to arterial rigidity and progressive narrowing of the arterial lumen, limiting blood flow to the muscles and other tissues in distal extremities, in particular the legs.2 Insufficient blood flow can produce ischemia. The subsequent decrease in oxygen and nutrients to the affected limb may lead to impaired tissue integrity and ulceration.3 Arterial ulcers may also be the result of minor trauma resulting in a wound. Poor healing capacity due to reduced peripheral perfusion and local wound conditions (reduced oxygen, nutrients, temperature, infection and devitalised or necrotic tissue) leads to the development of a non-healing wound or ulcer.3 Some patients with PAD have symptoms but others are asymptomatic. The common symptom, intermittent claudication, is characterised by leg pain and weakness brought on by walking, with disappearance of the symptoms following rest.1 Risk factors include increasing age (>50) with a history of diabetes plus one other atherosclerotic risk factor such as smoking, hyperlipidaemia, hypertension, hyperchromocysteinemia or elevated C-reactive protein; or age over 70 years; leg symptoms with exertion (suggestive of claudication) or ischemic pain, abnormal dorsalis pedis and/or posterior

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tibial pulses; and a history of stroke, myocardial infarction or renal artery disease.1 Ischemia, if left untreated, may lead to ulceration, especially around the toes, the foot (phalangeal heads, the malleoli region (ankle) or mid tibia. The ulcer appears punched out with well-demarcated rolled edges and may be deep. The wound is characterised by pale non-granulating often necrotic tissue (eschar) and gangrene (wet or dry) may be present in advanced stages. Gangrene (wet) may be associated with inflammation and cellulitis, an infection in the underlying tissues. Exudate level is usually low. The surrounding skin may exhibit dusky erythema or have a deep red to purplish mottling effect, be cool to touch, hairless, thin and often with a shiny appearance. Toenails may be thickened, opaque and discoloured or missing. Patients with arterial ulcers invariably experience pain, even without infection. Pain may be alleviated by hanging the foot over the side of the bed or sleeping in a chair. Pain usually begins distal to the obstruction, moving proximally as ischemia progresses. The ulcer itself is often painful. Whilst oedema is not common in PAD, patients with mixed aetiology ulcers (combination or arterial and venous disease or heart disease) oedema may be present. Critical limb ischemia (CLI), the consequence of poorly managed PAD, is the sustained and severe decrease in blood flow to the effected extremity.2 CLI is

characterised by ischemic rest pain, non-healing ulcers and/or gangrene which may result in amputation if left untreated.2 If able, when your patient is lying in bed, ask them to lift their leg above the level of their heart for a couple of minutes. If the toes and forefoot become pale on elevation and then turn a purplish-red when placed back on the bed this is an indication the patient has PAD. Early diagnosis and intervention is the key to successfully managing PAD. Wound assessment should be holistic involving a comprehensive patient history (medical, medications, surgical and psychosocial); wound assessment with a clinical description of the wound (ulcer); assessment of the limb (appearance of nails and skin temperature and colour); pain assessment; vascular assessment including capillary refill time; presence or absence of dorsalis pedis and posterior tibial pulses and the presence/absence of bruits in the proximal leg arteries; ankle brachial pressure index (ABPI); and assessment of vascular status (determined by the vascular specialist or surgeon). Patients with PAD and arterial ulcers generally have a decreased or absent pulse in the dorsalis pedis and/or posterior tibial arteries, have bruits in the proximal leg arteries indicating the presence of atherosclerosis, reduced capillary refill time (< 2 seconds) and low ABPI. ABPI is usually conducted to rule out venous disease with values < 0.8 indicative of significant PAD while a value less than 0.5 signifies critical limb ischemia requiring surgical intervention.3 Once diagnosed, the management of PAD is multi-factorial, incorporating a combination of surgical and pharmacological interventions, lifestyle modifications and better management of co-morbidities.1 Surgical interventions to increase blood flow include reconstructive surgery (revascularisation or bypass graft surgery) and angioplasty. Operative indications for critical limb ischemia

include non-healing ulceration, gangrene, rest pain and progression of claudication.4,5 Depending on co-morbidities, pharmacological interventions may include antiplatelet therapy (usually clopidogrel or aspirin), lipid modifying agents, antihypertensive agents, hypoglycaemic agents, folic acid and vitamin B6 (to lower homocystiene levels) and transdermal nitro patches (nitroglycerine) to improve blood flow to the affected limb and improve claudication symptoms.4,5 Lifestyle modifications generally revolve around ongoing education regarding diet and exercise, weight reduction and smoking cessation.4,5 Accurate diagnosis of aetiology, management of contributing factors and other comorbidities, and thorough wound assessment are prerequisites for successful wound management. History of past wound dressings is necessary to ascertain the efficacy of previous management plans and to inform new management strategies.4 If infection is present or suspected, wound swabs and cultures are required to identify pathogens present and to facilitate effective antimicrobial management. Infected wounds may need treatment with systemic antimicrobial therapy plus or minus the use of topical antimicrobials. Cadexomer iodine, medical honey, silver and prontosan (polyhexamethylene biguanide (PHMB), an antimicrobial agent) are effective against a broad range of infective pathogens which may be present in wounds and provide gentle autolytic debridement of sloughy, devitalised tissue. Do not use iodine or silver on wounds with exposed tendons, ligaments or bone as once incorporated these products remain in the tissues. Prior to use of any topical agent it is important to ask the patient if they have allergies to the intended product.

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 1 | Page 25

Dietitians and nurses oppose fresh food GST By Karen Keast A proposal to expand the GST to fresh foods is a recipe for poor health for Indigenous Australians, low income earners and pensioners, according to the peak bodies for dietitians, nurses and midwives. The Dietitians Association of Australia (DAA) and the Australian Nursing and Midwifery Federation (ANMF) have criticised Liberal backbencher Dan Tehan’s proposal to widen the GST from most processed foods to also include fresh fruit and vegetables, meat, eggs, bread and some dairy products. DAA CEO Claire Hewat said people living in remote communities, especially Indigenous Australians, already pay too much for fresh food. “Adding an extra cost through the GST would only make matters worse - these are the same groups with the poorest health outcomes,” she said. “Access to adequate nutritious food is a basic human right and adding the GST to fresh, healthy food puts this right at risk for many Australians.” Latest Australian Bureau of Statistics data shows around one in 10 Australians, or just 6.8 per cent, aged two years and over eat enough vegetables while just over half, or 54 per cent, eat enough fruit. Ms Hewat said many Australians already fail to consume enough fruit and vegetables. “Bumping up the price of these healthy staples will make it more difficult for some people to eat these foods,” she said. ANMF acting federal secretary Annie Butler said a GST on fresh food will lead to

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highe r levels of chronic disease and obesity. “Australia currently has one of the highest rates of obesity in the world, with a quarter of children and more than 60 per cent of adults overweight,” she said. “The fact is, we don’t consume enough fruit and vegetables now - adding an extra 10 per cent to the cost will simply make fresh food even more expensive for Australians and their families in the long term, particularly for lower income earners and pensioners.” Researchers at the University of Queensland in 2013 found axing the GST exemption on fresh food could reduce people’s consumption of fruit and vegetables about five per cent. Dr Lennert Veerman said failure to eat enough fruit and vegetables was associated with increases in the risk of heart disease, stroke and cancers of the lung, oesophagus, stomach and colon. “We’ve estimated that adding GST to fruit and vegetables could add about 90,000 cases of heart disease, stroke and cancer over the lifetime of the current Australian population and add another billion dollars to the country’s health care bill,” he said. The Federal Government will consider the tax reform proposal as part of its taxation white paper.

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Nursing Careers Allied Health - Issue 1 | Page 27

Midwives and Registered Nurses Required for both permanent roles and short or long term contract opportunities in all areas of nursing over the next 12 months. Mackay Hospital and Health Service offers the opportunity to work in a dynamic environment including rural facilities and experience a diverse range of services including midwifery, renal, coronary care and cardiac interventional services, general medical/rehabilitation, ambulatory care and hospital in the home, mental health, alcohol and other drugs, oncology, general surgical, operating theatre and extended day surgery unit, emergency department, women’s and children/adolescent services, sexual health and cancer screening and rural nursing. There are seven rural hospitals with opportunities for a unique rural experience in a supported environment to develop and enhance a wide range of clinical skills. We provide education and training to assist our staff to develop their skills, advance their career and work to their full scope of practice. Mackay Base Hospital has undergone major development of clinical services and facilities to ensure it is a state of the art facility including wireless technology and electronic medical records and is in the process of becoming a fully digital hospital. Mackay is a tropical setting situated halfway between Brisbane and Cairns, is the gateway to the Whitsundays and offers the opportunity for a lifestyle change in one of Queensland’s most liveable regional cities. Please email your resume and expression of interest to Mackay.Recruitment@health.qld.gov.au or call Lynne Cameron on 07 4885 7712 and reference this advertisement Please note: only applications from candidates will be accepted; applications that may result in an agency fee will not be considered

Check out our facebook page - facebook.com/mackayhhs Page 28 | www.ncah.com.au

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Reforms needed to improve end-of-life care By Karen Keast Vital reforms to end-of-life care are essential to assist the majority of Australians who want to die ‘a good death’ at home. A Grattan Institute perspective published in the Medical Journal of Australia, based on its earlier Dying Well report, states dying has become highly institutionalised in Australia, with 54 per cent of people dying in hospitals and 32 per cent in aged care. Professors Hal Swerissen and Stephen Duckett state only 14 per cent of people die at home in Australia despite up to 70 per cent of people preferring a non-institutionalised death. “Dying is not discussed, and we are not taking the opportunity to help people plan and prepare for a good death,” they write. “As a result, many experience a disconnected, confusing and distressing array of services, interventions and relationships with health professionals when they are dying.” Professors Swerissen and Duckett recommend a public education campaign that encourages people to consider, discuss and document their end-of-life preferences with their families and appropriate health care professionals. They propose trigger points for mandatory discussions about end-of-life care, including during health assessments for people aged over 75, for all aged care residents and high-needs recipients of home-based care packages, and for all hospital inpatients who are likely to die within a year. Measures must be introduced to ensure patients’ plans are implemented, while they also suggest health professionals are in the best position to initiate the discussion. “They must shift their focus from prevention, cure and rehabilitation at appropriate points in time if these conversations are to occur.

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“It is therefore important that it becomes normal and expected practice for health professionals to discuss and plan for end-of-life with their patients when it is appropriate.” Professors Swerissen and Duckett say improvements are needed to better coordinate end-of-life care while legislative frameworks and guidelines for advance care plans must change. “They should include clear mechanisms for assigning specific responsibility to health care professionals to coordinate and implement plans when people enter end-of-life care.”

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For the full article visit NCAH.com.au

Registered Nurse – Forensic Mental Health Malabar Permanent Full Time, Permanent Part Time JH No: 232954 Salary: Public Health System Nurses & Midwives (State) Award, RN 2–8: $30.16–$40.17 ph. Enquiries: Louise Flemming on (02) 9700 3123. Closing Date: 8 February 2015. To apply for this position please visit http://nswhealth.erecruit.com.au NSW Health Service – Justice Health & Forensic Mental Health Network is committed to Work Health & Safety, EEO, Ethical Practices, and the Principles of Cultural Diversity. Personal criminal records checks will be conducted. Prohibited persons as declared under the Child Protection (Prohibited Employment) Act 1998 are not eligible to apply for child-related employment.

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