Ncah issue 05 2015

Issue 5

23/03/2015

Working Abroad feature + Study puts nursing resilience under the microscope + Indigenous boost to nursing and allied health + Physiotherapy in the emergency department

Formerly

Nursing C areers Allied Health ncah.com.au

+ Labor promises legislating nurse to patient ratios

healthtimes.com.au

Advertisement

Now Recruiting Health Professionals Tess Demunk In any environment, healthcare is a challenge but during military operations that challenge can take on a new perspective. As a Nursing Officer in the Australian Army, Tess Demunk plays a vital role in the ongoing health and welfare of people in the Army.

“I joined the Army because I wanted to do something different with my nursing. I’m interested in trauma nursing and obviously the Army is a great place to go for that. It’s also a great opportunity to ‘give something back’; you can care for the soldiers out there protecting us and our country,” Tess said.

“I completed the Defence University Sponsorship (DUS) through Monash University. It is a fantastic scheme that allowed me to study at university as a full time student and get paid by the Army while doing that.”

With a career in the Army, Tess has enjoyed the sort of variety, challenges and travel that a civilian nurse would never have the

www.HealthTimes.com.au

opportunity to experience.

“Deployments are a big opportunity.

³

reason that most people join is to do nursing in the field and on deployment,” Tess said.

I'm interested in trauma nursing and obviously the Army is a great place to go for that Nursing overseas and being able to look after a lot of trauma injuries are two of the main reason I joined the Army. There is a lot of primary healthcare stuff that we do as well, but the

“In the Army you get free healthcare, free dental and all the things that go along with that. The mates you make along the way, the courses that you get to do, and the opportunities for

deployment and the field exercises are other benefits.”

Nursing Officers are employed across a range of clinical, clinical management and broader health management duties.

The Army has built a formidable reputation based on the core values of courage, initiative, respect and teamwork.

The Army is currently recruiting for Nursing Officers. For further information on military training and careers in the Army visit: defencejobs.gov.au/ army or call 13 19 01.

GT13437C

As a Nursing Officer in the Navy, Army or Air Force, you’ll have opportunities that you won’t get in the private sector.

For instance, your patients will be your co-workers, as well as civilians on deployment. You will get the chance to lead a team of health professionals and provide humanitarian aid. You’ll have the opportunity to further your career, specialise and progress into senior roles. Along with adventure, you’ll enjoy job security and excellent working conditions. You’ll also receive a favourable salary with subsidised accommodation and free medical & dental care. If you’re a Registered Nurse and would like further information call 13 19 01 or visit defencejobs.gov.au/graduate

NURSING OFFICER

IT’S NOT YOUR GENERAL PRACTICE

NOW RECRUITING: NURSES. HealthTimes - Issue 5 | Page 3

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NOT ALL HOSPITALS HAVE WARDS.

Issue 5 – 23 March 2015 We hope you enjoy perusing the range of opportunities included in Issue 5, 2015 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 43,219

For all advertising and production enquiries please contact us by telephone on 1300 306 582, email contact@healthtimes.com.au or visit www.healthtimes.com.au Published by Seabreeze Communications Pty Ltd trading as Health Times.

ABN 29 071 328 053. Š 2015 Seabreese 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 - Issue 5 | Page 5

Physiotherapy in the emergency department

P

hysiotherapists first began working in emergency departments in Australia about 10 years ago.

Since then, a growing number of health services and hospitals have embraced physiotherapists working in an advanced practice role in the ED. In this new model of care, advanced musculoskeletal physiotherapists assess patients and treat minor injuries. Their work has proven to be effective in reducing wait times, achieving higher patient satisfaction rates, and in freeing up medical specialists to manage more serious life-threatening presentations.

Katherine Maka, Australian Physiotherapy Association (APA) Emergency Department National Group chair and a musculoskeletal senior physiotherapist, says physiotherapists working in an advanced practice role in EDs care for the patient directly from triage right through to discharge.

“We see them without the doctor referring to us, which is a new role in ED,” Ms Maka says.

“Historically a physiotherapist would provide what we call a secondary contact service, so we would be paged to see a patient as ordered by a doctor or nurse.

“But now in these advanced practice roles we work independently, so we determine which patient would be suited to the knowledge and skills that we have and hence best practice treatment can be provided.”

Page 6 | www.HealthTimes.com.au

Paula Harding, a grade four musculoskeletal physiotherapist working at one of the nation’s busiest emergency departments, The Alfred Hospital in Melbourne, says the growth of the role in Australia follows its successful implementation in parts of the United Kingdom.

A physiotherapist with more than 20 years’ experience working in both the public and private sectors, Ms Harding was the project manager for the Health Workforce Australia Expanding Scope of Practice for Physiotherapists in Emergency Departments project, of which The Alfred was a lead site.

After the success of introducing the advanced musculoskeletal physiotherapy service to The Alfred in 2008, Ms Harding says The Alfred now has a team of 10 physiotherapists working in advanced practice roles, in a model of care that involves working in more than one area of advanced musculoskeletal service, such as in the outpatient setting.

The physiotherapy team provides a sevenday-a-week service in a primary care role in the ED between 9.30am and 6pm.

“We’ve been able to fill a gap in the ED, where there’s an increasing rate of people with musculoskeletal conditions presenting, and the doctors are dealing with more complex sick patients who need their attention more urgently.”

For the full article visit HealthTimes.com.au

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10/03/2015 10:13:22 AM 7 HealthTimes - Issue 5 | Page

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Stain on our Nation: Domestic and Family Violence

By Ellen Rosenfeld

M

I was in awe of the calm manner of triage y ďŹ rst public health research position years nurses faced with a constant stream of patients: ago involved gathering injury surveillance the elderly man assaulted during a theft in a statistics in the Emergency Department (ED) of a car park; the highly anxious mother holding a major metropolitan hospital. My role entailed dethree year old bitten in the face by the family scribing the context of a wide range of injuries: dog; the woman pacing in psychotic agitation. sporting, domestic, industrial, vehicular, dog bite, The range of possible illness, debility and injury drowning, to name just a few. The fundamental seemed inexhaustible. In this setting emermechanism of most injuries could be condensed gency service nurses educated me into a string of codes entered into a about the appalling extent of computer for later aggregation domestic violence-related and analysis. Ever the nerd, injury in (mostly) women this was a time when I who came through our could rapidly translate doors. There were any injury into nuwomen who had premeric “code-speakâ€? sented to the departreferenced from my ment on multiple occoding bible: “Fell on casions with terrible netball court fracturinjuries who cynically ing UNIQUE right radius,â€? or OPPORTUNITY FOR REGISTERED NURSES considered restraining “Forklift truck severed Are you a self-motivated registered nurse orders worth little more section of right foot.â€? balance? searching for work/life than the proverbial paper I tried to clearly estabAre you an ICU, ED, recovery, HITH, or even remote they were written on. Their lish nurse the searching circumstances of to earn income, and fit in for a way around your existing lifestyle? partners habitually contrathese injuries, either from famLifescreen provides Health to the Insurance Industry, vened these orders, and police, no ily members or from the Services patients and Clinical Services for several pharmaceutical companies. matter how well meaning, seemed inadthemselves once they were stabilised, We are looking for nurses to join our expanding operations to equately resourced to ensure their safety. These treated, and willing to speak withforme. had the provide community-based services our Iclients. nurses did their best to provide support, congood fortune be you: working inToan Lifescreen cantooffer be emergency considered for a role as a nurse service led by a supportive director withcontractor public fornecting women with hospital social workers and s %XTRA Lifescreen you must have the community agencies. The hospital served a mulhealth qualiďŹ cations who understood the need s 7ORK LIFE BALANCE following: ti-ethnic community of lower socio-economic for data on which to base injury s prevention initis #ONTINUITY OF PATIENT CARE 2EGISTERED NURSE WITH status. We saw white Russian and Asian women, atives.

Nevertheless the audible groans emanatyears experience s *OB SATISFACTION For enquiries to apply, pleaseofcall Cambodians, Latvians, or Cypriots, a sample the ing s from busy ED nursing, medical and reception s !USTRALIAN #ITIZEN #ERTIl ED #02 ANAPHYLAXIS training provided yet at noanother cost s piece 673 123 or of send your resume broader1800 community, many whom had very lit!". of paper staff contemplating to you to evaluations@lifescreen.com.au s and #ANNULATION COMPETENT tle English and were completely unaware of exin their extraordinarily busy lives, their pals 3TRONG WRITTEN AND VERBAL isting supports. pable relief when assured this task was entirely communication skills This initial workplace exposure to the my responsibility, became a running joke among s /WN CAR AND MOBILE PHONE emotional and physical trauma associated us for years.

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The recently produced Queensland report “Not Now, Not Ever,” for example, suggests that in 2013-14, an alarming 66,016 occurrences of domestic and family violence were reported to Queensland Police, making over 180 incidents of domestic and family violence reported daily.

Shockingly, there were 17 homicides relating to domestic and family violence in Queensland in 2012-13. The report cites the often quoted, appalling statistic that on average across Australia, one woman is killed by her partner every week.

There are 140 recommendations applicable to a broad range of agencies focusing on the functions and responsibilities of the Queensland Government.

There is no doubt that domestic and family violence is commanding the nation’s attention.

Australian of the Year, Rosie Batty, is an extraordinary woman who has used the murder of her

son by his father, an unimaginable grief, to work on behalf of all Australians facing the threat of family violence. Commonwealth and state governments are allocating $30 million towards a public awareness campaign, and Victoria is currently conducting a Royal Commission into family violence.

As critically important as these government responses are, they need to be underpinned by a powerful and fundamental cultural shift in our appreciation of the sanctity of human life. This lofty ambition may seem unattainable, but the fact is that we are already seeing changes. It’s wonderful, for instance, to see great sporting champions of our nation endorsing the White Ribbon campaign, or to hear of primary schools where anti-bullying programmes are core curriculum, changing behaviour in both classroom and school yard.

For the full article visit HealthTimes.com.au

HealthTimes - Issue 5 | Page 9

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HealthTimes - Issue 5 | Page 11

Surgical Wounds – Part 1: Wound classification, healing intention and risk factors for complications.

By Bonnie Fraser, RN, BSc, BNURS, Grad Dip ED

S

urgical wound complications including surgical site infections (SSIs) occur in an arena where an aging population with chronic comorbidities and high acuity severely compromise the playing field. This article, the first of a two part series, will focus on types of surgical wounds and their healing intention, and factors that influence healing. Part 2 will consider surgical site infections, common wound complications and their management.

Surgical wounds, also known as incisions, are wounds made by a cutting instrument such as a scalpel or laser, ideally in a sterile environment where many variables can be controlled such as bacteria, size, location and the nature of the wound itself. Surgical wounds are classified as acute wounds with closure generally occurring by primary intention i.e. clean wounds where the wound edges are able to be closely aligned and secured with sutures, staples or adhesives and where the healing cascade is naturally activated. Little or no tissue is lost from the wound. Simple enough one might say? Think again! Some wounds are unable to be closed in this manner. Traumatic, contaminated or infected wounds or wounds with large tissue defects may need to be left open until such times as the wound can be safely closed

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either by surgical approximation and securing of the wound edges or grafting. Called delayed primary closure (or tertiary closure), the wound is left open for serial debridement, to allow drainage and/or granulation. Closure usually occurs within 5 days of the initial surgery unless there are ongoing complications or reconstruction is required. Other wounds, for example, chronic wounds (leg ulcers, diabetic foot ulcers and pressure injuries) as well as some surgical wounds, such as toe or forefoot amputation or dehisced wounds, may need to heal by secondary intention, i.e. the wound is left to granulate and epithelialise due to the fact that the skin edges cannot be easily approximated and healed by primary intention.

Accordingly, surgical wounds are classified relative to the degree of complexity – clean, cleancontaminated, contaminated and dirty. The risk of SSI and other complications increases with the type of surgery. Clean wounds generally heal without complications, however they too are not without risk. Abscess formation or dead space (fluid collection) below the surgical incision can often necessitate unplanned readmission to hospital requiring further surgery with or without drain insertion, the need for antibiotics and increased length of hospital stay. Clean surgical

healing. Intra-operatively, the surgical classification, skin preparation, site, duration and complexity of surgery, pre-existing infection (local or systemic) and mechanical stressors on the wound impact wound healing capacity. Perioperatively, time to surgery, body temperature, blood loss, hydration status, perfusion, pain, oxygenation and pre-operative nutritional status all influence wound healing outcomes. Patientrelated factors are numerous: age; smoking; alcohol consumption; any co-morbidity that impairs the delivery of oxygen to the periphery (peripheral arterial and other cardiovascular disease, asthma, emphysema, chronic obstructive pulmonary disease, renal failure and anaemia); malignant disease; diabetes; BMI; poor general health; medications; previous history of chemo and/or radiotherapy; and immunosuppression.

Decreased tissue perfusion and collagen synthesis and deposition decrease wound tensile strength while immunocompromised patients have reduced wound healing capacity due to impaired neutrophil activity. Collectively these factors increase the risk of wound infection and breakdown with poor healing outcomes. Wound complications are costly to the health system and may be associated with an increased risk for further surgery, significant pain and suffering psychosocially for the patient, and may prolong postoperative length of stay or necessitate unplanned early re-admission.

Thinking about the potential risks of particular surgeries, identifying those most likely to be at risk early, and timely implementation of interventions to minimise risk may mitigate much of these sequelae. To coin a phrase A stitch in time saves nine.

Geneva Healthcare

For more articles visit HealthTimes.com.au HealthTimes - Issue 5 | Page 13

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wounds often result from elective or planned surgery, under aseptic conditions, and where the viscera are not opened. These wounds involve incision of normal non-inflamed tissue with closed drainage systems (if required) and are closed primarily. Infection rates are generally low. Examples are hemiarthroplasty, open reduction of fractures with or without pin and plate, stabilisation of fractures with external fixators, endoscopy and surgical removal of skin lesions.

Clean contaminated wounds are wounds that are otherwise clean but created as a result of the need for emergency surgery or resurgery through a previous clean incision site within a short period of time (usually within 7 days), viscera are opened with no spillage of gut contents, or there is a minor break in aseptic technique. Hemicolectomy, division of adhesions and cholecystectomy are examples.

Moving along the continuum, contaminated wounds are wounds that have been left open and include penetrating trauma less than 4 hours old, opened viscera with spillage of gut contents or infection, for example, appendectomy or where there has been a major break in aseptic technique. Dirty wounds are classified as such in the presence of pus, intraperitoneal abscess formation or visceral perforation (for example abscess formation around a recent appendectomy site) or penetrating trauma greater than 4 hours old. As one might conclude, infection rates and the potential for other wound complications post-surgery increase with the degree of complexity, the nature of the surgery and the manner in which it is performed (surgical technique).

Risk factors for wound complication in addition to infection also need to be considered, where possible, prior to surgery or anticipated post-surgery and management plans developed to minimise risk. Surgical and anaesthetic considerations as well as patient-related factors should be taken into account when ascertaining risk. Many factors impair perfusion and wound

Aussie and Kiwi nurses help in cyclone-ravaged Vanuatu

A

handful of Australian and New Zealand nurses are being deployed to Vanuatu as part of international disaster response efforts in the wake of Tropical Cyclone Pam. The Royal Darwin Hospital-based National Critical Care and Trauma Response Centre (NCCTRC) has deployed an Australian Medical Assistance Team (AUSMAT), comprising three registered nurses and two doctors, to the devastated South Pacific region.

The rapid assessment team and the initial treatment team (pictured) left Darwin on March 15 and are now providing medical assistance at the hospital in the battled capital of Port Vila.

The team includes NCCTRC trauma coordinator and nurse Bronte Martin who was involved in AUSMAT’s disaster deployment to the Philippines in the aftermath of Typhoon Haiyan in late 2013.

The Australian Red Cross expects to deploy registered nurses within days while the New Zealand Red Cross has deployed one Kiwi nurse as part of its Field Assessment Coordination Team (FACT).

As Australian tourists returned home in the aftermath of the severe tropical cyclone, which razed the island nation on March 13 with wind gusts of up to 320 kilometres an hour, relief flights from Australia and New Zealand continued to arrive.

The AUSMAT team has been deployed for up to 14 days and will provide immediate relief and assistance to local authorities.

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The NCCTRC is also on standby to deploy its full field hospital capability, which was referred to as Camp Kookaburra when it was established next to Tacloban airport, to treat victims of Typhoon Haiyan.

Northern Territory Health Minister John Elferink applauded the efforts of the group of health workers and others working to assist Australia’s Pacific neighbours.

“The hours, days and weeks which follow a natural disaster are always the most difficult, so it is important that help is quickly made available for those affected,” he said.

“The members of the team are leaving their families and homes behind to help others, something which is truly to be admired.”

The Australian Red Cross is likely to send nurses and psychologists, who will provide psychological assistance for those left traumatised by the cyclone, as part of its community health response to Vanuatu.

With an estimated 80 per cent of homes being destroyed and thousands in desperate need of food, shelter and water, the Red Cross has focused on deploying shelter specialists, water and sanitation experts, and disaster management specialists in its initial response.

The Australian Red Cross has launched the Cyclone Pam (Vanuatu) 2015 Appeal to provide humanitarian support. Donations can be made at www.redcross.org.au.

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HealthTimes - Issue 5 | Page 15

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HealthTimes - Issue 5 | Page 17

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Osteopathy in the Lion City of Singapore

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orking in Singapore has opened up Australian osteopath Kirsten Hannan’s eyes to the strong connection between osteopaths around the globe.

“I have had a number of patients see me in Singapore based on recommendations from my colleagues abroad, and have similarly been able to connect my patients with osteopaths around the world when they are relocated,” she says.

Originally from Sydney, Kirsten, 34, is working as an associate osteopath at Osteopathic Health Care, a private practice located within a biomedical and science hub in ‘the Lion City’.

Like many osteopaths, Kirsten’s practice is quite diverse.

“I do a lot of work with women in pregnancy and infant care, especially feeding problems and torticollis and plagiocephaly,” she says.

“I also see researchers who have very sedentary jobs or spend hours bent over microscopes in science labs, bankers, senior level professionals whose work involves a lot of desk time and travel, back and neck pain, sports injuries - a mixed bag.”

Kirsten says while practice in Singapore is similar to that in Australia, one key difference is that the healthcare system does not require a referral from a GP to see a medical specialist.

Most infants and young children are also under the care of paediatricians, enabling a close working relationship with medical professionals across a range of specialties.

Page 18 | www.HealthTimes.com.au

“Waiting times for specialists are also minimal, so when referral is necessary and we need answers, this happens very quickly,” she says.

Kirsten, who has been practising for 10 years and has completed her Masters of Osteopathy, has worked at the island country in south-east Asia for the past seven years, after moving there with her husband in 2008.

“At the time we were younger, debt free, didn’t have children yet and were feeling adventurous,” she says.

“He wanted to pursue a career opportunity and also has family who live in Singapore. I was happy to embrace the opportunity to work overseas and live in Asia in a country where English is widely spoken.

“Back then there were already several established osteopathic clinics in Singapore and the number of clinics and awareness of osteopathy has continued to grow over the seven years I have lived and worked here.”

Kirsten, a member of Osteopathy Australia, says there are no specific requirements for osteopaths working in Singapore as the health profession is not recognised or regulated by the Ministry of Health in Singapore.

“I maintain my professional registration with AHPRA and had to provide evidence of my professional qualifications in order to have my employment pass issued by the Ministry of Manpower in Singapore so that I could practice.”

For the full article visit HealthTimes.com.au

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New Zealand nurse cleared of Ebola A New Zealand nurse who recently returned from Sierra Leone has been officially cleared of the Ebola virus.

The nurse, who is in a stable condition in Christchurch Hospital, has tested negative for the deadly disease twice, and her partner has also been cleared to return to work.

Health Minister Dr Jonathan Coleman said it was “great news” that the second negative test had now returned.

“In line with international protocols, a second test was required to rule out Ebola,” he said in a statement.

Dr Coleman thanked Melbourne’s Victorian Infectious Disease Reference Laboratory for quickly turning around the test results.

“Their prompt work is much appreciated,” he said.

“This case has proven that New Zealand’s

well-practised procedures worked extremely well. It is a credit to all the health staff who were involved.”

The nurse returned from working in West Africa, as part of New Zealand’s contribution to the international response to Ebola, on March 8, and developed gastroenteritis symptoms on March 13, when she reported to the local Public Health Officer as part of the daily self-monitoring process.

The nurse was conveyed from her Christchurch home to hospital via helicopter and was transported in a specialist Iso-pod patient transfer unit.

The patient was then treated in a dedicated specialist medical isolation room at Christchurch Hospital while the tests were carried out.

For the full article visit HealthTimes.com.au HealthTimes - Issue 5 | Page 19

Surgical Wounds – Part 1: Wound classification, healing intention and risk factors for complications.

By Bonnie Fraser, RN, BSc, BNURS, Grad Dip ED

S

urgical wound complications including surgical site infections (SSIs) occur in an arena where an aging population with chronic comorbidities and high acuity severely compromise the playing field. This article, the first of a two part series, will focus on types of surgical wounds and their healing intention, and factors that influence healing. Part 2 will consider surgical site infections, common wound complications and their management.

Surgical wounds, also known as incisions, are wounds made by a cutting instrument such as a scalpel or laser, ideally in a sterile environment where many variables can be controlled such as bacteria, size, location and the nature of the wound itself. Surgical wounds are classified as acute wounds with closure generally occurring by primary intention i.e. clean wounds where the wound edges are able to be closely aligned and secured with sutures, staples or adhesives and where the healing cascade is naturally activated. Little or no tissue is lost from the wound. Simple enough one might say? Think again! Some wounds are unable to be closed in this manner. Traumatic, contaminated or infected wounds or wounds with large tissue defects may need to be left open until such times as the wound can be safely closed

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either by surgical approximation and securing of the wound edges or grafting. Called delayed primary closure (or tertiary closure), the wound is left open for serial debridement, to allow drainage and/or granulation. Closure usually occurs within 5 days of the initial surgery unless there are ongoing complications or reconstruction is required. Other wounds, for example, chronic wounds (leg ulcers, diabetic foot ulcers and pressure injuries) as well as some surgical wounds, such as toe or forefoot amputation or dehisced wounds, may need to heal by secondary intention, i.e. the wound is left to granulate and epithelialise due to the fact that the skin edges cannot be easily approximated and healed by primary intention.

Accordingly, surgical wounds are classified relative to the degree of complexity – clean, cleancontaminated, contaminated and dirty. The risk of SSI and other complications increases with the type of surgery. Clean wounds generally heal without complications, however they too are not without risk. Abscess formation or dead space (fluid collection) below the surgical incision can often necessitate unplanned readmission to hospital requiring further surgery with or without drain insertion, the need for antibiotics and increased length of hospital stay. Clean surgical

healing. Intra-operatively, the surgical classification, skin preparation, site, duration and complexity of surgery, pre-existing infection (local or systemic) and mechanical stressors on the wound impact wound healing capacity. Perioperatively, time to surgery, body temperature, blood loss, hydration status, perfusion, pain, oxygenation and pre-operative nutritional status all influence wound healing outcomes. Patientrelated factors are numerous: age; smoking; alcohol consumption; any co-morbidity that impairs the delivery of oxygen to the periphery (peripheral arterial and other cardiovascular disease, asthma, emphysema, chronic obstructive pulmonary disease, renal failure and anaemia); malignant disease; diabetes; BMI; poor general health; medications; previous history of chemo and/or radiotherapy; and immunosuppression.

Decreased tissue perfusion and collagen synthesis and deposition decrease wound tensile strength while immunocompromised patients have reduced wound healing capacity due to impaired neutrophil activity. Collectively these factors increase the risk of wound infection and breakdown with poor healing outcomes. Wound complications are costly to the health system and may be associated with an increased risk for further surgery, significant pain and suffering psychosocially for the patient, and may prolong postoperative length of stay or necessitate unplanned early re-admission.

Thinking about the potential risks of particular surgeries, identifying those most likely to be at risk early, and timely implementation of interventions to minimise risk may mitigate much of these sequelae. To coin a phrase A stitch in time saves nine.

Geneva Healthcare

For more articles visit HealthTimes.com.au HealthTimes - Issue 5 | Page 21

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wounds often result from elective or planned surgery, under aseptic conditions, and where the viscera are not opened. These wounds involve incision of normal non-inflamed tissue with closed drainage systems (if required) and are closed primarily. Infection rates are generally low. Examples are hemiarthroplasty, open reduction of fractures with or without pin and plate, stabilisation of fractures with external fixators, endoscopy and surgical removal of skin lesions.

Clean contaminated wounds are wounds that are otherwise clean but created as a result of the need for emergency surgery or resurgery through a previous clean incision site within a short period of time (usually within 7 days), viscera are opened with no spillage of gut contents, or there is a minor break in aseptic technique. Hemicolectomy, division of adhesions and cholecystectomy are examples.

Moving along the continuum, contaminated wounds are wounds that have been left open and include penetrating trauma less than 4 hours old, opened viscera with spillage of gut contents or infection, for example, appendectomy or where there has been a major break in aseptic technique. Dirty wounds are classified as such in the presence of pus, intraperitoneal abscess formation or visceral perforation (for example abscess formation around a recent appendectomy site) or penetrating trauma greater than 4 hours old. As one might conclude, infection rates and the potential for other wound complications post-surgery increase with the degree of complexity, the nature of the surgery and the manner in which it is performed (surgical technique).

Risk factors for wound complication in addition to infection also need to be considered, where possible, prior to surgery or anticipated post-surgery and management plans developed to minimise risk. Surgical and anaesthetic considerations as well as patient-related factors should be taken into account when ascertaining risk. Many factors impair perfusion and wound

Dietitians urge celebrity chef to reconsider Paleo cookbook

By Karen Keast The Dietitians Association of Australia (DAA) is calling on celebrity chef Pete Evans and the co-authors of his controversial Paleo cookbook for babies and toddlers to reconsider a plan to release a digital publication of their book.

The peak body representing more than 5700 nutrition and dietetic professionals urged the authors of ‘Bubba Yum Yum: The Paleo Way for new mums, babies and toddlers’ who “do not have formally-recognised medical or health qualifications” to rethink the move.

The call comes after publisher Pan Macmillan Australia announced it will not publish the cookbook, which was originally due for release on March 13.

“The authors of ‘Bubba Yum Yum: The Paleo Way - for new mums, babies and toddlers’ have decided to release a digital version of the book very shortly, and will, therefore, no longer publish the book, in any format, with Pan Macmillan Australia,” it said.

Evans, a judge on My Kitchen Rules, confirmed on his Facebook page that the book will go ahead.

“Charlotte, Helen and I are thrilled to announce that ‘Bubba Yum Yum: The Paleo Way’ will be a proudly independent digital worldwide release in April with print to follow,” he said.

“We didn’t want to wait, too many people are wanting this beautiful treasure trove of nutritional recipes and we are extremely thankful

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to all our followers and colleagues for their support.”

The DAA has been working to review the cookbook with the publisher since the end of February.

The association recently joined other health groups in raising concerns about the book’s recipes, particularly its DIY baby formula based on a liver, cod liver oil and bone broth.

The DAA states an independent analysis of the baby milk formula reveals that it’s not comparable to breast milk, as claimed in the cookbook.

Tests showed the DIY formula was 749 per cent higher in Vitamin A, 2326 per cent higher in Vitamin B12, 220 per cent higher in protein, 1067 per cent higher in iron, and 879 per cent higher in sodium.

“This formula could be very harmful to infants, their immature immune and digestive systems could not cope with this formulation and the levels of these nutrients it contains,” the DAA stated.

“In a newborn, the formulation could cause permanent damage and possibly result in death.”

The DAA has also raised concerns about the cookbook using ingredients, such as honey, runny eggs and raw liver, not recommended for infants in the first year of their life due to microbiological risks.

For the full article visit HealthTimes.com.au

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HealthTimes - Issue 5 | Page 23

Stain on our Nation: Domestic and Family Violence

By Ellen Rosenfeld

M

y first public health research position years ago involved gathering injury surveillance statistics in the Emergency Department (ED) of a major metropolitan hospital. My role entailed describing the context of a wide range of injuries: sporting, domestic, industrial, vehicular, dog bite, drowning, to name just a few. The fundamental mechanism of most injuries could be condensed into a string of codes entered into a computer for later aggregation and analysis. Ever the nerd, this was a time when I could rapidly translate any injury into numeric “code-speak” referenced from my coding bible: “Fell on netball court fracturing right radius,” or “Forklift truck severed section of right foot.”

I tried to clearly establish the circumstances of these injuries, either from family members or from the patients themselves once they were stabilised, treated, and willing to speak with me. I had the good fortune to be working in an emergency service led by a supportive director with public health qualifications who understood the need for data on which to base injury prevention initiatives. Nevertheless the audible groans emanating from busy ED nursing, medical and reception staff contemplating yet another piece of paper in their extraordinarily busy lives, and their palpable relief when assured this task was entirely my responsibility, became a running joke among us for years.

Page 24 | www.HealthTimes.com.au

I was in awe of the calm manner of triage nurses faced with a constant stream of patients: the elderly man assaulted during a theft in a car park; the highly anxious mother holding a three year old bitten in the face by the family dog; the woman pacing in psychotic agitation.

The range of possible illness, debility and injury seemed inexhaustible. In this setting emergency service nurses educated me about the appalling extent of domestic violence-related injury in (mostly) women who came through our doors. There were women who had presented to the department on multiple occasions with terrible injuries who cynically considered restraining orders worth little more than the proverbial paper they were written on. Their partners habitually contravened these orders, and police, no matter how well meaning, seemed inadequately resourced to ensure their safety. These nurses did their best to provide support, connecting women with hospital social workers and community agencies. The hospital served a multi-ethnic community of lower socio-economic status. We saw white Russian and Asian women, Cambodians, Latvians, Cypriots, a sample of the broader community, many of whom had very little English and were completely unaware of existing supports.

This initial workplace exposure to the emotional and physical trauma associated

with domestic violence occurred over two decades ago; many years later it remains a public health issue of enormous national importance.

The recently produced Queensland report “Not Now, Not Ever,” for example, suggests that in 2013-14, an alarming 66,016 occurrences of domestic and family violence were reported to Queensland Police, making over 180 incidents of domestic and family violence reported daily.

Shockingly, there were 17 homicides relating to domestic and family violence in Queensland in 2012-13. The report cites the often quoted, appalling statistic that on average across Australia, one woman is killed by her partner every week.

There are 140 recommendations applicable to a broad range of agencies focusing on the functions and responsibilities of the Queensland Government.

There is no doubt that domestic and family violence is commanding the nation’s attention.

Australian of the Year, Rosie Batty, is an extraordinary woman who has used the murder of her

son by his father, an unimaginable grief, to work on behalf of all Australians facing the threat of family violence. Commonwealth and state governments are allocating $30 million towards a public awareness campaign, and Victoria is currently conducting a Royal Commission into family violence.

As critically important as these government responses are, they need to be underpinned by a powerful and fundamental cultural shift in our appreciation of the sanctity of human life. This lofty ambition may seem unattainable, but the fact is that we are already seeing changes. It’s wonderful, for instance, to see great sporting champions of our nation endorsing the White Ribbon campaign, or to hear of primary schools where anti-bullying programmes are core curriculum, changing behaviour in both classroom and school yard.

504-010 1/2PG FULL COLOUR 324-026 505-027 PDF For the full articleCMYK visit HealthTimes.com.au Nurse Unit Manager District Nursing Our client, Swan Hill District Health (SHDH), is seeking an experienced nursing professional to join their team. SHDH is a small innovative public health service providing a wide range of health services ideally located on the Murray River in northern Victoria. In this role, you will provide the District Nursing Service with day-to-day operational leadership and management and ensure quality and safety in clinical care delivery.

The ideal applicant will possess: 5HJLVWHUHG 1XUVH 'LYLVLRQ $XVWUDOLDQ +HDOWK 3UDFWLWLRQHU 5HJXODWLRQ $JHQF\ &XUUHQW 'ULYHU·V /LFHQFH ([SHULHQFH LQ GRPLFLOLDU\ QXUVLQJ %URDG 0HGLFDO DQG 6XUJLFDO 1XUVLQJ H[SHULHQFH &RPSXWHU OLWHUDF\ :HOO GHYHORSHG LQWHUSHUVRQDO VNLOOV You will enjoy a great working environment with modern facilities, excellent management support, backed by highly competent and permanent staff. An attractive remuneration package is being offered to secure the right candidate.

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PO Box 83 Ocean Grove 3226 Closing date: Contact Mr Andrew Hanson on: 0409 137 315 hrsa@hrsa.com.au 24 March 2014 (PDLO DSSOLFDWLRQV PD\ EH ORGJHG DW KUVD#KUVD FRP DX www.hrsa.com.au HealthTimes - Issue 5 | Page 25

Indigenous boost to nursing and allied health

By Karen Keast

A

new workforce development and research centre aims to grow the number of Indigenous graduates in nursing and allied health.

The University of Queensland’s recently opened Poche Centre for Indigenous Health will also focus on the health of south-east Queensland’s urban Indigenous population - the largest Aboriginal community in Australia.

UQ Pro Vice-Chancellor (Indigenous Education) Professor Cindy Shannon said the centre will train and develop a larger workforce in Indigenous health across nursing, medicine, public health, dentistry, pharmacy, speech therapy, occupational therapy, physiotherapy, exercise physiology and psychology.

“The workforce agenda is for both pathways and aspiration building for Aboriginal and Torres Strait Islander kids into careers in health, as well as for all our non-Indigenous students doing health courses,” she said.

The centre’s programs will provide outreach and engagement with secondary school students and pathways into university health courses, provide professional mentoring and support, and assist Indigenous students into research and higher degrees.

The centre will also collaborate with primary health care and hospital providers to ensure career opportunities and placements for UQ students studying Indigenous health care.

Page 26 | www.HealthTimes.com.au

The university, which provided the nation’s first professional degree program for Indigenous health workers in the 1990s and graduated the state’s first Indigenous doctor in 1991, has a strong commitment to Indigenous education, Professor Shannon said.

“We have partnered with the 16 clinics across south-east Queensland that form part of the Institute for Urban Indigenous Health and we have an arrangement with them whereby they place University of Queensland students from our health disciplines for clinical and other project placements,” she said.

“That process is turning out to be an extremely valuable learning experience for the students as well as some early evidence that it is actually converting into employment after the students graduate.”

Professor Shannon, a descendent of the Ngugi people from Moreton Island, said while it’s important to increase the Indigenous health workforce, improving the health outcomes of Indigenous Australians is not an issue limited to Aboriginal and Torres Strait Islander peoples.

For the full article visit HealthTimes.com.au

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Theatre Nurses (Scrub/Scout, Anaesthetics & PACU) Part-Time & Casual Positions – AM, PM & Weekend Shifts Available

Western Private Hospital has numerous opportunities and vacancies for theatre nurses with a range of peri-operative skills who are experienced within the speciality areas of Anaesthetics, Recovery and Scrub/Scout. Come and work with a multidisciplinary team including great surgeons and anaesthetists and a highly skilled and specialised nursing team to advance your professional career.

Equipped for a comprehensive range of surgical procedures WPH is recognised as a provider of high level of patient care and support. This is a fast paced environment with a variety of surgical specialties including general, colorectal, ear nose and throat, gastroenterology, ophthalmology, orthopaedic, gynaecology, oral and maxillofacial, plastic & reconstructive, vascular & urology.

As the successful candidate you will possess: • Current registration with AHPRA as a Registered Nurse • Minimum 2 years experience as a theatre/peri-operative nurse • Excellent written and verbal communication and interpersonal skills • Proven ability to work in a multidisciplinary health care team • Demonstrated ability to deliver high quality patient care • Flexibility and availability to work across all shifts and participate in a rotating roster • Demonstrated commitment to own personal and professional development • Post-graduate certificate/diploma (peri-operative) is advantageous We offer: • A variety of AM, PM & Weekend shifts offering that work-life balance • Supportive leadership, management and workplace culture • Commitment to ongoing education, training and professional development • A variety of staff benefits and discounts as well as on-site car parking • Great rates of pay and superannuation salary sacrificing

We are looking for team oriented nurses who would find satisfaction from helping shape the future direction of our hospital as we continue to grow.

If this sounds like you … what are you waiting for?? APPLY NOW!!

To apply you must submit your resume along with a cover letter outlining your suitability and interest for this position via: hr@westernprivate.com.au

HealthTimes - Issue 5 | Page 27

Study puts nursing resilience under the microscope

By Karen Keast

W

hy are some nurses more resilient than others?

That’s the question a group of Australian and international researchers are working to answer.

Researchers, as part of the International Collaboration on Workforce Resilience, hope to develop tailored interventions to help nurses and other health professionals build resilience in high stress work environments.

Associate Professor Clare Rees, of the School of Psychology and Speech Pathology at Curtin University, said thousands of nurses across Australia, Hong Kong, Singapore and Canada are expected to participate in a psychological study of resilience this year.

Assoc. Professor Rees, a clinical psychologist, said the study aims to increase resilience in nurses and other health professionals at risk of anxiety, depression, secondary traumatic stress and burnout.

“Basically health professions are all in that category but nursing in particular has got a lot of unique stresses around that job,” she said.

“Sometimes even the work hours in itself, working shifts and working with sometimes really confronting clinical cases…we know there’s high rates of burnout among nurses.”

Assoc. Professor Rees said nurses working in “high death” areas of practice such as intensive care and emergency departments can burnout and experience compassion fatigue, hindering their ability to care for their patients.

“They actually don’t have the resources to tend to their patients in the way that they need to - so, in a way, helping the nurse directly is going to help their patients.”

Researchers have developed a new theoretical model to test individual workforce resilience,

Page 28 | www.HealthTimes.com.au

recently published in Frontiers in Psychology, which identifies key psychological variables related to individual workforce resilience, including neuroticism, mindfulness, self-efficacy and coping.

Assoc. Professor Rees said while neuroticism, the tendency to experience enduring negative emotional states such as anxiety, guilt, anger and depression on a more intense and frequent level, is usually genetic and inherited, the other variables are factors that health professionals can control.

“You can change your level of mindfulness, the type of coping that you engage in - whether you use adaptive coping or maladaptive coping,” she says.

“Adaptive coping is things like seeking social support and using humour and so forth, whereas maladaptive coping is more passive - it’s giving up, taking sick days, taking drugs, that sort of thing.

“The other component is self-efficacy which basically means how much you believe you can do something about your situation.

“These are the key variables in the model that we want to measure in terms of predicting who is actually more resilient - we think those various variables come together to inform which nurse or which psychologist or other health professional is going to be more resilient when you measure them.”

The model will be tested on thousands of student nurses and employed nurses using questionnaires.

For the full article visit HealthTimes.com.au

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For futher information: Paul Ingram (08) 9417 6300 nursing@rfdswa.com.au Å`PUNKVJ[VY VYN H\ HealthTimes - Issue 5 | Page 29

Labor promises legislating nurse to Advertisement patient ratios in NSW Now Recruiting Health Professionals

By Karen Keast Tess Demunk

Wagga Wagga Base Hospital, Shoalhaven District New South Wales could become the third In any environment, Memorial Hospital, Grafton Base Hospital and Australianhealthcare state to is have nurse to patient ratios a Health Service, and Gunnedah District Hospital. enshrinedchallenge in legislation. but during Mr Holmes said the announcement to introLabormilitary leaderoperations Luke Foley has pledged to emthat challenge duce legislated ratios protects new and existing ploy an extra 840 nurses in emergency departcan take on a new perspective. a nurse to patient ratios. ments and paediatricAswards under legislated raNursing in the bid to provide safe “We cannot reiterate the importance of tios, as part of a Offi $96cermillion Australian Army, Tess nurse to patient ratios enough,” he said. patient care, if Labor Demunk plays wins a vitalthe state’s March 28 “Legally enforcing ratios in NSW will provide election. role in the ongoing health and welfare of security to patients throughout the public health The election commitment comes as Victoria people in the Army. system and prevent future governments from and Queensland are also moving towards legis“I joined the Army undoing the hard-fought work of our members.” lated nurse to patient ratios under newly-elected because I wanted In an announcement at St George Hospital, Labor governments. to do something erent Wales with myhas ratios in selected Mr Foley said nurses are unable to deliver the New diff South nursing. I’m interested care that patients deserve if their workloads are wards as part of itsnursing enterprise in trauma and agreement. On the too high. back of aobviously lengthy New South Wales Nurses and the Army a great place(NSWNMA) to go “More nurses means better care for patients, Midwives’isAssociation campaign, rafor that. It’s also a reason that most times deployment opportunity to improved waiting and more and livesthesaved,” tios were great introduced in medical, surgical, mental opportunity to field exercises are people join is to do experience. ‘give something back’; he said. health and palliative care wards in 2010. other benefits.” nursing in the field you can care forincludes the “Deployments are a and on deployment,” “These additional staff will take pressure off Labor’s pledge 735 full-time Nursing Officers are soldiers out there big opportunity.

Tess said. staff and patients in over-stretched emergency equivalentprotecting (FTE) nurses employed across us and in ouremergency departa range clinical, country,” Tess said. departments, and provide more of care for children ments across Peer Group A, B and C hospitals, clinical management in our paediatric wards across NSW.” to achieve a ratio ofthe one nurse to every three “I completed and broader health Labor has also pledged to employ an extra patients. Defence University management duties.

Sponsorship (DUS) has built a I 'm interested trauma 500 paramedics if it winsThe theArmy election.

NSWNMA general secretary Brett Holmes in through Monash formidable reputation The additional come at a said the move will Itresult ratioobviously nursing and the Armyparamedics University. is a in a one-to-one based on will the core fantastic scheme thatbeds and a one-tocost of for $46.6 million, including $2.1 million to for patients in resuscitation values of courage, is a great place to go that allowed me to study initiative, respect and defund additional resources such as vehicles, four ratio at foruniversity medicalas assessment units. a teamwork. fibrillators and stretchers.

A further 105student FTE nurses will provide infull time and get paidhours by theper Army The Army is currently toget add 125 paramedics a year will creased nursing patient day inoverseas paediat-and “InThe Nursing the pledge Army you while doing that.” recruiting for Nursing beingPeer able to look freetohealthcare, free add the state’s paramedic workforce, ric wards at hospitals also spanning Group Officers. For further which after a lot of trauma dentalat and all the3400 paramedics, With a career in information on stands about and aims to A, B and C. injuries are two of the things that go along the Army, Tess has military training and care. response times and bolster patient Underenjoyed the plan, the ofratios main would be introreason I joined improve with that.

The mates the sort careers in the Army the Army.

There you make along the challenges duced atvariety, 75 hospitals including the Prince of visit: is a lot of primary and travel that a way, the courses that Wales Hospital, Westmead Hospital, Royal North civilian nurse would healthcare stuff that you get to do, and the defencejobs.gov.au/ Shore Hospital, John Sydney never have the Hunter Hospital, we do as well, but the opportunities for army or call 13 19 01.

Hospital & Eye Hospital, Blacktown Hospital, Lismore Base Hospital, Orange Base Hospital, for the full article visit HealthTimes.com.au

“

Page 30 | www.HealthTimes.com.au

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