Ncah issue 07 2015

Issue 7

20/04/2015

Regional & Remote Health + Preparing nurses for the Ebola frontline + Surgical Wounds – Part 2 + Nurse & son face deportation over autism diagnosis

Formerly

Nursing C areers Allied Health ncah.com.au

+ Pain management program targets Indigenous people

healthtimes.com.au

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10/03/2015 10:13:22 HealthTimes - Issue 7 | AM Page 3

Issue 7 – 20 April 2015 We hope you enjoy perusing the range of opportunities included in Issue 7, 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 The HealthTimes magazine is the most widely distributed national nursing and allied health publication in Australia.

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 HealthTimes.

ABN 29 071 328 053. Š 2015 Seabreeze Communications Pty Ltd. All right reserved. No part of this publication may be copied or reproduced by any means without the prior written permission of the publisher. Compliance with the Trade Practices Act 1974 of advertisements contained in this publication is the responsibility of those who submit the advertisement for publication.

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HealthTimes - Issue 7 | Page 7

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Surgical Wounds Live – Part Surgical your2: passion.

Be part of a proud Australian tradition.> site infections, post-operative wound complications and their management

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

P

art one of this series focused on types of surgical wounds, their healing intention and factors that influence healing. In this article we will consider post-operative wound complications including surgical site infections (SSIs) and briefly touch on management.

By definition, a surgical site infection (SSI) is an infection that develops within 30 days after a surgical procedure or within one year if an implant Australia was Western inserted and the infection appears The Royal Flying Doctor Service (RFDS) to behighly related to the the contribution and dedication values of its people, who enjoy working together surgery (Gottrup, to provide high quality health care in a Melling & Hollander, unique 2005).

SSIs environment. can be su-

Flight Nurses

RFDS staff enjoy perficial (occurring in theenriching work which broadens their horizons, builds professional dermal and sub-cutaneous experience and delivers the personal layers) or deep incisional inrewards of knowing they are making a fections involving muscle and fasdifference to rural and remote Australia. cia. Organ space SSIs occur in the body If you’re a spaces.

Nurse/Midwife readyfactors for a organs or organ Some general rewarding new challenge, the RFDS has will increase a patient’s risk for SSI such as age, a position for the right person to join our obesity, malnutrition, malignant disease, imdynamic Flight Nurse Team. munosuppression, smoking, prolonged preYou’ll stay be working with amazing disand operative endocrine andanmetabolic motivated team of professionals dedicated orders e.g. diabetes, hypoxia and anaemia. .

LocalFor factors and periwound) include futher(wound information: the presence of necrotic tissue, Paul Ingram (08) 9417 6300foreign bodies, tissuenursing@rfdswa.com.au ischemia, haematoma formation and poor flyingdoctor.org.au surgical technique (Gottrup, Melling & Hollander, 2005). The degree of microbial contamination, Page 8 | www.HealthTimes.com.au

host susceptibility, type and virulence of organisms; and antibiotic resistance will impact risk (Gottrup, Melling & Hollander, 2005). Therefore, it is important to monitor surgical wounds closely for infection in order to prevent more serious complications. Indications that the patient has developed a SSI include classic signs of inflammation (redness, swelling, heat, erythema and increased pain); increased exudate that is cloudy, discolor malodorto providing primary careoured and emergency ous;and increase evacuations to those living workingininthe rural and remote areas. size of the wound or wound dehiscence Applicants are required to have: (the wound breaks > Dual Nursing and Midwifery registration down at the site of the > Significant postgraduate experience surgical incision); fever and and/or qualifications in critical care a general feeling of being un(ED or ICU) well or lethargic..

The successful candidate will receive a Other wound complications that one comprehensive two-week orientation, might encounter in the post-operative pagenerous salary and salary packaging tient include surgical woundwith dehiscence, dead benefits, and assistance relocation space, incisional hernias, fistula formation, conif necessary. tact dermatitis; and haematoma formation and Applications close: Ongoing in 2014/15 bleeding. Surgical wound dehiscence and enterocutaneous fistula will be dealt with in the next article due to the complexity of these complications.

Sometimes due to the nature of the wound, wound edges beneath the skin cannot be closely approximated and separate resulting is dead space.

406-010 405-013 1PG FULL COLOUR CMYK PDF 404-011 402-036 323-022 1PG FULL COLOUR CMYK PDF 401-003 321-014 1320-006 1PG FULL COLOUR CMYK PDF (RPT) 407-013 324-020 322-035 403-015 423-007 506-002 419-006 417-007 409-012 412-005 420-005 415-007 413-010 411-011 414-005 408-007 504-002 501-009 503-006 424-005 422-005 418-004 505-003 416-004 421-007 502-003 507-003 Air and/or fluid can get trapped between the tissue layers, especially the fatty layer which has a poor blood supply. Consequently serum or blood may collect in the space providing an excellent medium for the growth of microorganisms that cause infection. Many post-operative wounds will have a drain inserted to facilitate drainage while the subcutaneous tissues heal.

New or increased pain, induration on palpation and spreading erythema around the site of the surgical incision and increased temperature may indicate a collection has occurred. The patient may require systemic antibiotics or return to theatre to have the collection drained and/ or a drain inserted to facilitate drainage until the wound heals.

Incisional hernias are complications occurring at the site of a previous incision that develops in the abdominal wall. Muscles at the incision site become weakened allowing internal tissues to protrude through the muscle (Millikan, 2003). The hernia protrudes under the skin and can be painful or tender to touch. SSI and surgical wound dehiscence are the most commonly reported risk factors for incisional hernia (Millikan, 2003). Other risk factors include male gender, age, obesity, abdominal distension, post-operative pulmonary complications, early re-operation, underlying disease process, suture material used in closure, choice of original incision and patient post-operative activity that may place undue stress on the deeper tissues of the abdominal wound (Millikan, 2003). Surgery may be required to repair the defect, especially if the hernia is causing problems. The use of lumbar and abdominal support belts after abdominal surgery can reduce the risk of incisional hernia as they support the abdomen post-operatively.

Holding a pillow or rolled up towel against the surgical site while coughing and moving can also provide support and protect internal structures from undue stress and strain.

Haematoma formation and bleeding in and around the surgical site is common.

Postoperative haematoma is basically a localised collection of blood at and/or around the surgery site. It is defined as the collection or pooling of blood under the skin, in body tissues or an organ. Haematomas form when capillaries, arteries or veins rupture, allowing blood to leak into the surrounding tissues, causing a pool of blood which eventually clots. Symptoms usually appear within the first 24 hours – bruising, pain, swelling and tightness over the area. In most cases the haematoma will be reabsorbed, however some require drainage or surgical intervention. If left untreated some haematomas get large enough to compress the tissues preventing oxygen from reaching the skin, increasing the risk of other complications such as infection, wound dehiscence and necrosis.

Contact dermatitis is a localised rash or irritation of the skin caused by contact with a foreign substance. The skin becomes red, sore or inflamed after direct contact with a substance, for example a dressing adhesive or retention tapes e.g. micropore; or latex gloves. Contact dermatitis can be irritant or allergic – always ask the patient if they have allergies before application of dressings or use of surgical gloves which contain latex. Many hospitals now have latex-free gloves for general use on the ward and latex-free surgical gloves are available.

While most surgical wounds undergo primary closure, some are left to heal by secondary intention or undergo delayed primary closure. Regardless of the method of closure, the aims of treatment are to disturb the wound as little as possible to allow healing and prevent infection, optimise patient comfort, encourage early return to full functional activity and provide education regarding the wound and self care (Davies, 2005).

For the full article visit HealthTimes.com.au HealthTimes - Issue 7 | Page 9

Clinical Governance Guide for remote and isolated health Nurses, midwives and allied health professionals have a practical guide to help them navigate the unique challenges of clinical governance while working in Australia’s remote areas.

CRANAplus, the peak professional body for the nation’s remote and isolated health workforce, has developed a Clinical Governance Guide for health managers and clinicians.

The guide, designed for health centre managers, nurses, midwives, allied health professionals, doctors, Aboriginal and Torres Strait Islander health care practitioners and health workers, outlines the components and processes for appropriate and effective clinical governance and quality improvement for remote and isolated health services.

CRANAplus professional officer Marcia Hakendorf, a registered nurse and former SA Health Department Nursing and Midwifery policy advisor, says the resource simplifies what clinical governance means to health practitioners’ workplaces and their practices.

“There’s been a lot written about clinical governance and it’s absolutely like a maze to put the pieces together,” she says.

“So this was about demystifying and grounding it for clinical managers and clinicians working in the bush.

“What we really wanted to do was to ensure that there was an effective and consistent standard of health service throughout remote and isolated areas of Australia, and it was also about improving the capacity of the remote health workforce in providing an effective, consistent standard of health care to remote Australians.”

Page 10 | www.HealthTimes.com.au

The guide is based on the National Safety and Quality Health Service (NSQHS) Standards, which came into force in January 2013, and particularly focuses on Standard One Governance for Safety and Quality in Health Service Organisations and includes a reference to Standard Two - Partnership with Consumers.

The Standards mainly cover hospital services. CRANAplus received funding from the Australian Government to produce a resource, designed to compliment the Standards, that would shine the spotlight on the complex issues facing remote and isolated area health service delivery.

The guide was conceived, researched and written with direct input from clinicians working daily in the remote health context.

Since its completion in September 2013, CRANAplus has distributed more than 930 of the guides, which are also available online, into the remote sector.

Ms Hakendorf says while health practitioners often understand what clinical governance is and why they need it, they can struggle to comprehend the ‘how’ of its implementation when it comes to remote and isolated health.

“Remote areas have complexities including implications of geographical location, the vast distances, the social and cultural influences, the professional isolation, and limited infrastructure and communication resources,” she says.

“It’s a resource for managers and clinicians to use to clarify - what does this mean, what should be in place, what’s my responsibility as a clinician and what’s my responsibility as a clinical manager.

“This actually helps them to look at what needs to be in place to provide safe, quality care to remote and isolated communities.”

The guide provides clinicians with direction and guidance to ensure their health service has robust clinical governance processes focusing on the four pillars of remote clinical governance - workforce effectiveness, clinical performance and evaluation, clinical risk management, and consumer participation.

“It also talks about the five components of quality improvement for the remote sector such as organisational leadership and strong management, quality improvement, workforce development, environment and cultural safety, and consumers and community.”

The challenge when creating the guide was to ensure it would be user-friendly, logical and a practical resource for managers and clinicians to refer to that complimented the work of the NSQHS Standards from the Australian Commission on Safety and Quality in Health Care (ACSQHC).

“This guide gives them a comprehensive understanding of what needs to be in place for the remote workforce covering all aspects of clinical care from the recruitment processes, use of evidence-based practice, the reporting of incidences and having an incident management system in place, audits, how you go about continuous quality improvement, to the importance of engaging consumers in their care.”

The guide not only assists clinical managers and nurses, midwives and allied health professionals on the ground, it ultimately results in better care for patients, Ms Hakendorf adds.

“It’s about the practices, so that people practice safely, reducing risks and ensuring quality of care is given to clients and patients.”

CRANAplus will conduct a one-day workshop on the Clinical Governance Guide in the lead up to the 2015 CRANAplus Conference being held in Alice Springs from October 15-17.

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HealthTimes - Issue 7 | Page 11

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Preparing nurses for the Ebola frontline

Everyday work, life-changing workplaces

Australian health professionals are combatting the worst outbreak of the world’s deadliest disease in a foreign and inhospitable landscape. An Aussie nurse is behind the training that prepares our nurses and doctors for the challenges of working in the Australian-run Ebola Treatment Centre.

By Sierra Leone It takes resilient, adaptable, kind people The training provides a grounding in areas ane Armstrong and her team and at Aspen Medi- to volunteer overseas. Think you’ve got what it takes? such as using the vital PPE, along with water, cal had about 10 working days to pull togethPeople suited to rural or remote nursing tend to have the can-do sanitation and hygiene, clinical standard oper the training designed to educate and prepare attitude that’s vital for international development work. erating procedures, child protection health professionals beingindeployed Right now assignments nursing, midwifery and public health areAustralian-flagged available in Cambodia, Fiji & Vanuatu. We’ll support you withawareness, post deployment to the frontairfares, accommodation awareness and Aspen Mediline in the fight against Ebola. and allowances.

Visit www.redcross.org.au/aidwork or call (03) 9345 1834 cal’s Employee Assistance With almost 40 years’ to explore options.

Program. clinical and your training The Australian Volunteers program is an Australian Government initiative.

What’s more, the experience, the regprogram aims to preistered dfat.gov.au/australianvolunteers nurse and pare health workAspen Medical trainers for more than ing education and the clinical practice development manof caring for paager had already be-OPPORTUNITY FOR REGISTERED UNIQUE NURSES tients and halting the gun researching Ebola Are you a self-motivated registered nurse spread of Ebola. It also when the Federal Govsearching for work/life balance? focuses on the grim reernment announced Are you an ICU, ED, recovery, HITH, or even remote ality of this extraordinary in November 2014forthat it to earn income, and fit in nurse searching a way and dangerous working enviplanned toyour establish an lifestyle?

Ebola around existing ronment, including the preparaTreatment (ETC) Services in the Lifescreen Centre provides Health to the Insurance Industry, and Clinicalnation Servicesof forSierra severalLeone. pharmaceutical companies. tion of wills.

West African We are looking for nurses to join our expanding operations to The training also considers the cultural The Aspen Medical services International Deployprovide community-based for our clients. sensitivities of working in Sierra Leone, from ment Induction (AMIDI) for Sierra Leone was Lifescreen can offer you: To be considered for a role created to$$$ complement three days of intensive as a nurse contractor forsupporting the families of the deceased to the • Extra Lifescreen you must haveburial the practices related to Ebola. training on the ground in West Africa, where • Work/life balance following: The medical company, which has a track there’s a focus on personal protection equip• Continuity of patient care • Registered nurse with >5 record of working with government and nonment (PPE) coupled with four days of superviyears experience • Job satisfaction government organisations to deliver essential sion• inCertifi work areas.

For enquiries or to apply, please call • Australian Citizen ed CPR/anaphylaxis training no cost health care wake of resume conflicts The twoprovided and a athalf day •pre-deployment 1800services 673 123inorthe send your ABN to you or natural disasters, was awarded the contract training program, based at Aspen Medicalcompetent in to evaluations@lifescreen.com.au • Cannulation to run the 100-bed ETC for eight months. It Canberra, has been built on the organisation’s • Strong written and verbal communication experience combined with consultation from itsskills received more than 1000 applications from • Own car andthe mobile phone health professionals wanting to join the Aussubject matter experts and resources from tralian response. international aid sector.

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507-009 1PG FULL COLOUR CMYK PDF Aspen Medical has so far delivered five training sessions to 76 health professionals and environmental health officers, including 49 nurses.

Once trained, health professionals are deployed for six to eight weeks, creating a team of about 30 staff at the ETC. When they return, workers begin a 21 day period of self-monitoring for any Ebola symptoms.

Ms Armstrong, who worked as a nurse in various public and private practices for 20 years before moving into health promotion and then into clinical educating, training and lecturing roles, joined Aspen Medical in 2012.

She says some nurses and doctors often enter the training with a level of uncertainty.

“However after three days of face to face training and particularly the practical scenario settings that we had prepared, it turned people around so that staff ended up relieved that they had some knowledge transfer and also felt more confident and ready to be deployed,” she says.

“That to me was really a hallmark of the expert training we were able to offer.”

The training provides the latest Ebola information for staff deploying to the area, including an overview of the disease and its transmission, and also covers protocols and policies, comprising media relations and also the use of social media.

Staff are taken through clinical treatment guidelines, infection control, the process of putting on the PPE, which includes gumboots, long cuffed double gloves and double masks, and its safe use.

Clinicians spend three hours wearing the PPE, where they participate in three different scenarios.

The exercise is not designed to replicate the experience of working at the ETC but gives health workers an understanding of what it’s like to provide treatment in the PPE, Ms Armstrong explains.

“You’ve just got a really hot environment, you are in tremendously weighty gear and gumboots. It’s trying to do all of those wonderful things that clinicians do but with all the gear on,” she says.

At the ETC, health professionals are required to wear the PPE in searing 40° heat. Due to the sweltering conditions and the risk of heat stress, clinicians spend 40 minutes working in the ETC and then take a 40 minute break. Even so, some workers have reported losing a kilo to a kilo and a half within an hour.

“The bottom line is around raising awareness on how that PPE feels and to experience that - so the glasses fogging up, feeling sweaty and feeling uncomfortable in the gear,” Ms Armstrong says.

The training also drives home the importance of team-work and protecting your work ‘buddy’ in the ETC. “You could be in the red zone, treating West Africans with Ebola, and your buddy notices that your goggles have fogged,” Ms Armstrong says.

“Now immediately you have to stop what you are doing and both you and the person with the fogged goggles, so you and your buddy, must leave the treatment centre, that’s the rule.

“That way there’s no opportunity for anything to happen to you, we’d both leave the red zone together.”

Facing language barriers and cultural differences, Australian nurses and doctors are also culturally orientated about the area that they’re about to enter. It’s often a hostile environment, where relatives of patients can shout and rattle the cage surrounding the ETC in an attempt to gain access, despite the risk of contracting Ebola.

Importantly, clinicians are taught effective communication and how to diffuse aggression within the ETC.

Geneva Healthcare

For the full article visit HealthTimes.com.au HealthTimes - Issue 7 | Page 13

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507-029 1/2PG FULL COLOUR CMYK PDF Registered Nurse Division 1 & 2 Wyndham Clinic Private Hospital Wyndham Clinic is a purpose built private inpatient and day patient adult mental health service and day procedure centre located in Werribee, 30 km west of Melbourne, easily accessible by train and only 2 minutes from the freeway. Our mental health and drug and alcohol services offer a range of evidence based interventions to clients both inpatient and day program. Due to an expansion of our service, we have exciting opportunities for experienced Registered Nurses Division 1 and 2, both full and part time, to join our inpatient mental health team.

We offer: Full Time and Part Time Positions are Available Â&#x2021; $Q H[SHULHQFHG IULHQGO\ DQG ZHOFRPLQJ WHDP ZKR ZRUN together to achieve quality care delivery Â&#x2021; $ VXSSRUWLYH PDQDJHPHQW WHDP ZKR HQFRXUDJH DQG VXSSRUW VWDII initiative and suggestions for service improvement Â&#x2021; 0RQWKO\ &OLQLFDO 6XSHUYLVLRQ Â&#x2021; ([FHOOHQW ([FHOOHQW VDODU\ VDODU\

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For more information, please contact MCooper@wyndhamclinic.com.au, call 03 9731 6646.

Page 14 | www.HealthTimes.com.au

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Hamilton, the Heart of the Western District Hamilton is strategically located 3.5 hours from Melbourne and 5 hours from Adelaide. Southern Grampians spans the heart of Victoriaâ&#x20AC;&#x2122;s renowned ŧ9GUVGTP &KUVTKEVŨ CPF DQCUVU OCIPKĆ&#x2019;EGPV UEGPGT[ CV GXGT[ VWTP 9&*5 JCU VJG HQNNQYKPI RQUKVKQP CXCKNCDNG

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HealthTimes - Issue 7 | Page 15

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Pain management program targets urban Indigenous people Two Queensland allied health professionals have developed a culturally appropriate chronic pain management program for urban Aboriginal and Torres Strait Islander people.

Psychologist Tabinda Basit, who works at Brisbane’s Institute for Urban Indigenous Health, and Dr Emma Campbell, an occupational therapist and associate lecturer at the University of Queensland, created the Pain Heroes self-management chronic pain program due to a lack of culturally responsive programs for urban Indigenous people.

Ms Basit said research into chronic pain prevalence in Aboriginal and Torres Strait Islander people suggests Indigenous people have a unique experience when it comes to chronic pain and its response to different treatments.

“If we know that the way they respond to treatment is different then we should have a treatment program that is distinctive for that group of people and not a one-size-fits-all approach,” she said.

The two non-Indigenous allied health practitioners consulted with Aboriginal health workers, dietitians, nurses, exercise physiologists and GPs to develop the health behaviour change program for Aboriginal and Torres Strait Islander people.

The Pain Heroes program, which provides six information and discussion sessions, has now been piloted at two health clinics.

Page 18 | www.HealthTimes.com.au

The sessions feature topics covering - what is chronic pain, the body systems that involve chronic pain, relaxation strategies for pain and medication, and also introduce clients to GPs and allied health professionals in an informal setting.

“I think one of the big aims of the program is to actually increase access to allied health for those clients,” Ms Basit said.

“They might have chronic pain and only be seeing their GP. It’s kind of about opening their eyes and saying - well, there are a lot of health professionals that can help you with this and these are the different things that they do - so it’s not so confronting.”

The sessions are designed to build knowledge and selfmanagement skills in Indigenous people experiencing chronic pain through a culturally responsive framework that is group-focused, features a holistic model of health, and also uses ‘yarning’ for peer-to-peer information sharing.

“One of the practices that is highly valued amongst Aboriginal and Torres Strait Islander people is having a yarn,” Ms Basit said.

“That is really the sharing of experiences and it’s a real mutual process - which is what we are trying to emulate.”

Ms Basit said the program, which has received positive feedback, is continuing to evolve from clients’ feedback, and is likely to be rolled out at more clinics in Queensland.

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We are better than ever before!

Umoona Tjutagku Health Service Aboriginal Corporation are among the first Community Controlled Aboriginal Health Services to have achieved

ISO 9001 Accreditation in South Australia

Priscilla Larkins (CEO) Dilshan Perera (BS & HR Manager) Michael Fernando (Practice Manager)

A big thanks to the Board, Management & staff who made this happen.

HealthTimes - Issue 7 | Page 19

Preparing nurses for the Ebola frontline Australian health professionals are combatting the worst outbreak of the world’s deadliest disease in a foreign and inhospitable landscape. An Aussie nurse is behind the training that prepares our nurses and doctors for the challenges of working in the Australian-run Ebola Treatment Centre.

By Sierra Leone

J

ane Armstrong and her team at Aspen Medical had about 10 working days to pull together the training designed to educate and prepare health professionals being deployed to the Australian-flagged frontline in the fight against Ebola.

With almost 40 years’ clinical and training experience, the registered nurse and Aspen Medical training education and development manager had already begun researching Ebola when the Federal Government announced in November 2014 that it planned to establish an Ebola Treatment Centre (ETC) in the West African nation of Sierra Leone.

The Aspen Medical International Deployment Induction (AMIDI) for Sierra Leone was created to complement three days of intensive training on the ground in West Africa, where there’s a focus on personal protection equipment (PPE) coupled with four days of supervision in work areas.

The two and a half day pre-deployment training program, based at Aspen Medical in Canberra, has been built on the organisation’s experience combined with consultation from its subject matter experts and resources from the international aid sector.

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The training provides a grounding in areas such as using the vital PPE, along with water, sanitation and hygiene, clinical standard operating procedures, child protection awareness, post deployment awareness and Aspen Medical’s Employee Assistance Program.

What’s more, the program aims to prepare health workers for more than the clinical practice of caring for patients and halting the spread of Ebola. It also focuses on the grim reality of this extraordinary and dangerous working environment, including the preparation of wills.

The training also considers the cultural sensitivities of working in Sierra Leone, from supporting the families of the deceased to the burial practices related to Ebola.

The medical company, which has a track record of working with government and nongovernment organisations to deliver essential health care services in the wake of conflicts or natural disasters, was awarded the contract to run the 100-bed ETC for eight months. It received more than 1000 applications from health professionals wanting to join the Australian response.

Aspen Medical has so far delivered five training sessions to 76 health professionals and environmental health officers, including 49 nurses.

Once trained, health professionals are deployed for six to eight weeks, creating a team of about 30 staff at the ETC. When they return, workers begin a 21 day period of self-monitoring for any Ebola symptoms.

Ms Armstrong, who worked as a nurse in various public and private practices for 20 years before moving into health promotion and then into clinical educating, training and lecturing roles, joined Aspen Medical in 2012.

She says some nurses and doctors often enter the training with a level of uncertainty.

“However after three days of face to face training and particularly the practical scenario settings that we had prepared, it turned people around so that staff ended up relieved that they had some knowledge transfer and also felt more confident and ready to be deployed,” she says.

“That to me was really a hallmark of the expert training we were able to offer.”

The training provides the latest Ebola information for staff deploying to the area, including an overview of the disease and its transmission, and also covers protocols and policies, comprising media relations and also the use of social media.

Staff are taken through clinical treatment guidelines, infection control, the process of putting on the PPE, which includes gumboots, long cuffed double gloves and double masks, and its safe use.

Clinicians spend three hours wearing the PPE, where they participate in three different scenarios.

The exercise is not designed to replicate the experience of working at the ETC but gives health workers an understanding of what it’s like to provide treatment in the PPE, Ms Armstrong explains.

“You’ve just got a really hot environment, you are in tremendously weighty gear and gumboots. It’s trying to do all of those wonderful things that clinicians do but with all the gear on,” she says.

At the ETC, health professionals are required to wear the PPE in searing 40° heat. Due to the sweltering conditions and the risk of heat stress, clinicians spend 40 minutes working in the ETC and then take a 40 minute break. Even so, some workers have reported losing a kilo to a kilo and a half within an hour.

“The bottom line is around raising awareness on how that PPE feels and to experience that - so the glasses fogging up, feeling sweaty and feeling uncomfortable in the gear,” Ms Armstrong says.

The training also drives home the importance of team-work and protecting your work ‘buddy’ in the ETC. “You could be in the red zone, treating West Africans with Ebola, and your buddy notices that your goggles have fogged,” Ms Armstrong says.

“Now immediately you have to stop what you are doing and both you and the person with the fogged goggles, so you and your buddy, must leave the treatment centre, that’s the rule.

“That way there’s no opportunity for anything to happen to you, we’d both leave the red zone together.”

Facing language barriers and cultural differences, Australian nurses and doctors are also culturally orientated about the area that they’re about to enter. It’s often a hostile environment, where relatives of patients can shout and rattle the cage surrounding the ETC in an attempt to gain access, despite the risk of contracting Ebola.

Importantly, clinicians are taught effective communication and how to diffuse aggression within the ETC.

For the full article visit HealthTimes.com.au HealthTimes - Issue 7 | Page 21

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Clinical Governance Guide for remote and isolated health The guide is based on the National Safety Nurses, midwives and allied health profesand Quality Health Service (NSQHS) Standsionals have a practical guide to help them ards, which came into force in January 2013, navigate the unique challenges of clinical and particularly focuses on Standard One governance while working in Australia’s refor over 20 years.

It has three Governance for Safety and Quality in Health mote Adelaide areas. Eye and Retina Centre has been established Ophthalmologists specialising in medical and surgical retina and oncology and is supported by Service Organisations and includes a referCRANAplus, the peak professional body 23 additional staff with plans for further expansion. We’re seeking a Practice Manager to join ence to Standard Two - Partnership with Confor the and isolated health thisnation’s successfulremote Adelaide based organisation. sumers. workforce, has developed a Clinical GovernYou’ll lead a team of administrative and clinical staff and will have Standards mainly cover hospital serance responsibility Guide for health managers and clinifor managing the day to day operationsThe of the clinic. vices. CRANAplus received funding from the cians.

Experience within a medical environment is essential. You’ll have Australian Government to produce a resource, The guide, designed for commercial health centre strong people management, and organisational skills. designed to compliment the Standards, that managers, nurses,andmidwives, alliedyou’ll health As a strategic inspiring leader, be capable of supporting a dynamicdoctors, and growing business.and Torres would shine the spotlight on the complex isprofessionals, Aboriginal sues facing remote and isolated area health Strait Contact IslanderLynsey health careat practitioners and White lynsey.white@hays.com.au 08 7221 4144. service delivery. healthorworkers, outlines the components and hays.com.au The guide was conceived, researched and processes for appropriate and effective cliniwritten with direct input from clinicians workcal governance and quality improvement for ing daily in the remote health context. remote and isolated health services.

Since its completion in September 2013, CRANAplus professional officer Marcia CRANAplus has distributed more than 930 of Hakendorf, a registered nurse and former SA NORTHEAST the guides, which are alsoHEALTH available online, Health Department Nursing and Midwifery into the remote sector. policy advisor, says the resource simplifies WANGARATTA MsNURSE Hakendorf UNIT says while health practitionwhat clinical governance means to health MANAGER Associate Nurse Unit Manager ers oftenMaternity understand what clinical practitioners’ workplaces and their practices.

Unit, Full-time, Ref No:governance 15/16 St John of God Bendigo Hospital, a division of St is tand whycareer theyopportunity need it, they can struggle to “There’s been Care a lotis awritten clinical Exciting John of God Health leader inabout the provision t Great countrythe lifestyle in aof beautiful rural location of health within hospitals, pathology like and community comprehend ‘how’ its implementation governance and it’s absolutely a maze to services throughout Australia and New Zealand. As a t Salary packaging available when it comes to remote and isolated health. put the pieces together,” she says.

Catholic not-for-profit group, SJGHC returns profits As NUM you will provide clinical leadership, to the serve through our extensive “Remote areas have complexities including “Socommunities this wasweabout demystifying and operational management & strategic Social Outreach and Advocacy programs. implications location, the vast grounding it for clinical managers and clinidirectionofforgeographical the Unit including antenatal 11764working - ANUM -in Theatre distances, the social and cultural influences, cians the bush. clinics/classes, the Community Midwifethe An exciting opportunity has arisen for a permanent Program, Lactation Clinic andinfrastructure safe and professional isolation, and limited full time individual, to join our committed leadership team in this dynamic and busy Theatre to unit.do You was will effective Domiciliary services.

Cost and communication resources,” she says.

“What we really wanted be responsible for assisting in the overall clinical effective service delivery and high quality “It’s a resource for managers and clinicians to ensure ofthat there wasandan effective management the Main Theatre supervision of patient outcomes will also be required. care given by junior staff. to use to clarify - what does this mean, what and consistent standard of health serContact: (03) 57225330 should be in Meryn place, Pease, what’s DON, my responsibility as a vice throughout and isolated A minimum of five years’remote perioperative experience and/or a relevant graduate qualification is essential Closing Date: 1 May 2015as a cliniclinician and what’s my responsibility areas of Australia, and it was also about for further consideration.

The successful applicants will have undergone a WWC cal manager. improving the capacity of the remote & police check. For further details including a For enquiries about this position, contact Karen “This actually position helps description them tovisit: look at what health workforce Millsom-Ryan, NUM on in (03)providing 5434 3481 an effecneeds to be in place to provide safe, quality care tive, consistent standard of health care To access the position description or to apply, visit to remote and isolated communities.” to remote Australians.” www.sjog.org.au and click on careers tab, reference

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506-025 505-004 1PG FULL COLOUR CMYK PDF 507-004 “This guide gives them a comprehensive The guide provides clinicians with direcunderstanding of what needs to be in place for tion and guidance to ensure their health serthe remote workforce covering all aspects of vice has robust clinical governance processes clinical care from the recruitment processes, focusing on the four pillars of remote clinical use of evidence-based practice, the reporting governance - workforce effectiveness, cliniof incidences and having an incident managecal performance and evaluation, clinical risk ment system in place, audits, how you go about management, and consumer participation. continuous quality improvement, to the impor“It also talks about the five components tance of engaging consumers in their care.” of quality improvement for the remote secThe guide not only assists clinical managtor such as organisational leadership and ers and nurses, midwives and allied health prostrong management, quality improvement, fessionals on the ground, it ultimately results in workforce development, environment and better care for patients, Ms Hakendorf adds. cultural safety, and consumers and commu“It’s about the practices, so that people nity.” practice safely, reducing risks and ensuring The challenge when creating the guide quality of care is given to clients and patients.” was to ensure it would be user-friendly, logCRANAplus will conduct a one-day workical and a practical resource for managers shop on the Clinical Governance Guide in the and clinicians to refer to that complimented lead up to the 2015 CRANAplus Conference the work of the NSQHS Standards from the being held in Alice Springs from October 15-17.

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HealthTimes - Issue 7 | Page 23

Surgical Wounds â&#x20AC;&#x201C; Part 2: Surgical site infections, post-operative wound complications and their management

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

P

art one of this series focused on types of surgical wounds, their healing intention and factors that influence healing. In this article we will consider post-operative wound complications including surgical site infections (SSIs) and briefly touch on management.

By definition, a surgical site infection (SSI) is an infection that develops within 30 days after a surgical procedure or within one year if an implant was inserted and the infection appears to be related to the surgery (Gottrup, Melling & Hollander, 2005). SSIs can be superficial (occurring in the dermal and sub-cutaneous layers) or deep incisional infections involving muscle and fascia. Organ space SSIs occur in the body organs or organ spaces. Some general factors will increase a patientâ&#x20AC;&#x2122;s risk for SSI such as age, obesity, malnutrition, malignant disease, immunosuppression, smoking, prolonged preoperative stay endocrine and metabolic disorders e.g. diabetes, hypoxia and anaemia. .

Local factors (wound and periwound) include the presence of necrotic tissue, foreign bodies, tissue ischemia, haematoma formation and poor surgical technique (Gottrup, Melling & Hollander, 2005). The degree of microbial contamination,

Page 24 | www.HealthTimes.com.au

host susceptibility, type and virulence of organisms; and antibiotic resistance will impact risk (Gottrup, Melling & Hollander, 2005). Therefore, it is important to monitor surgical wounds closely for infection in order to prevent more serious complications. Indications that the patient has developed a SSI include classic signs of inflammation (redness, swelling, heat, erythema and increased pain); increased exudate that is cloudy, discoloured or malodorous; increase in the size of the wound or wound dehiscence (the wound breaks down at the site of the surgical incision); fever and a general feeling of being unwell or lethargic..

Other wound complications that one might encounter in the post-operative patient include surgical wound dehiscence, dead space, incisional hernias, fistula formation, contact dermatitis; and haematoma formation and bleeding. Surgical wound dehiscence and enterocutaneous fistula will be dealt with in the next article due to the complexity of these complications.

Sometimes due to the nature of the wound, wound edges beneath the skin cannot be closely approximated and separate resulting is dead space.

Air and/or fluid can get trapped between the tissue layers, especially the fatty layer which has a poor blood supply. Consequently serum or blood may collect in the space providing an excellent medium for the growth of microorganisms that cause infection. Many post-operative wounds will have a drain inserted to facilitate drainage while the subcutaneous tissues heal.

New or increased pain, induration on palpation and spreading erythema around the site of the surgical incision and increased temperature may indicate a collection has occurred. The patient may require systemic antibiotics or return to theatre to have the collection drained and/ or a drain inserted to facilitate drainage until the wound heals.

Incisional hernias are complications occurring at the site of a previous incision that develops in the abdominal wall. Muscles at the incision site become weakened allowing internal tissues to protrude through the muscle (Millikan, 2003). The hernia protrudes under the skin and can be painful or tender to touch. SSI and surgical wound dehiscence are the most commonly reported risk factors for incisional hernia (Millikan, 2003). Other risk factors include male gender, age, obesity, abdominal distension, post-operative pulmonary complications, early re-operation, underlying disease process, suture material used in closure, choice of original incision and patient post-operative activity that may place undue stress on the deeper tissues of the abdominal wound (Millikan, 2003). Surgery may be required to repair the defect, especially if the hernia is causing problems. The use of lumbar and abdominal support belts after abdominal surgery can reduce the risk of incisional hernia as they support the abdomen post-operatively.

Holding a pillow or rolled up towel against the surgical site while coughing and moving can also provide support and protect internal structures from undue stress and strain.

Haematoma formation and bleeding in and around the surgical site is common.

Postoperative haematoma is basically a localised collection of blood at and/or around the surgery site. It is defined as the collection or pooling of blood under the skin, in body tissues or an organ. Haematomas form when capillaries, arteries or veins rupture, allowing blood to leak into the surrounding tissues, causing a pool of blood which eventually clots. Symptoms usually appear within the first 24 hours â&#x20AC;&#x201C; bruising, pain, swelling and tightness over the area. In most cases the haematoma will be reabsorbed, however some require drainage or surgical intervention. If left untreated some haematomas get large enough to compress the tissues preventing oxygen from reaching the skin, increasing the risk of other complications such as infection, wound dehiscence and necrosis.

Contact dermatitis is a localised rash or irritation of the skin caused by contact with a foreign substance. The skin becomes red, sore or inflamed after direct contact with a substance, for example a dressing adhesive or retention tapes e.g. micropore; or latex gloves. Contact dermatitis can be irritant or allergic â&#x20AC;&#x201C; always ask the patient if they have allergies before application of dressings or use of surgical gloves which contain latex. Many hospitals now have latex-free gloves for general use on the ward and latex-free surgical gloves are available.

While most surgical wounds undergo primary closure, some are left to heal by secondary intention or undergo delayed primary closure. Regardless of the method of closure, the aims of treatment are to disturb the wound as little as possible to allow healing and prevent infection, optimise patient comfort, encourage early return to full functional activity and provide education regarding the wound and self care (Davies, 2005).

For the full article visit HealthTimes.com.au HealthTimes - Issue 7 | Page 25

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HealthTimes - Issue 7 | Page 27

Scheme attracts nurses and midwives to rural areas Graduate nurses, midwives, sonographers and specialists are continuing to be attracted to rural and other hard-to-staff communities in New Zealand.

Registrations for the 2015 intake of the nation’s Voluntary Bonding Scheme, the seventh intake of the incentive-based scheme, closed on March 13.

The Health Workforce New Zealand initiative works to encourage nurses, midwives, doctors, radiation therapists and medical physicists into hard-to-staff specialities and communities faced with higher vacancy rates, greater locum use, longer waiting periods, and a higher use of overseas trained professionals.

For the first time, sonographers were added to the list of high-demand professions this year.

Health Workforce New Zealand manager Ruth Anderson said more than 3500 graduates have signed up to the scheme since it was first introduced in 2009.

“When the scheme was first introduced, there were 350 registrants on the scheme across the eligible professions,” she said.

“Those numbers have been exceeded every year and all eligible registrants have been accepted on to the scheme, to date.

“Registrations generally fluctuate between 400-500 each year in response to the changes in the hard-to-staff communities and specialties.”

Ms Anderson said hard-to-staff communities and specialties are revised each year, through a nationwide stakeholder consultation, and are based on the needs of the New Zealand workforce.

“The scheme is not just focused on specific areas but is aimed at communities as a whole,” she said.

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“Rurality is a contributing factor with the majority of hard-to-staff communities encompassing rural areas.

“The scheme is an important component of an overall strategy to ensure New Zealand has a workforce that is serving the needs of rural and remote communities.

“The steady number of applicants to the scheme shows that health professionals are going where they are needed most.”

Under the scheme, graduates are bonded for a period of up to five years with participants able to apply for reward payments after completing their bonding period.

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HealthTimes - Issue 7 | Page 29

Nurse and son face deportation over autism diagnosis Growing up in the Philippines, Maria Sevilla dreamed of one day becoming a nurse.

“The nurses used to travel using the public transport and they were all wearing white dresses,” she recalled.

“I said - ‘one day I am going to be in that uniform and I’ll be a nurse’, but because at the time my mum can’t afford to send me to a nursing school, I ended up doing an engineering course in the public school.”

Years later, Maria’s aspirations became a reality, when her mother and step-father urged her to join them and move with her son Tyrone, then aged two, to Townsville in Queensland.

“They offered to me if I wanted to study nursing here in Australia. I was really overwhelmed. I said - ‘yes, of course’.”

Maria studied the Diploma of Nursing at TAFE and went on to complete her certificate three in aged care before completing her Bachelor of Nursing Science at James Cook University.

Fast forward four years and Maria is a registered nurse working in the rehabilitation ward at the Townsville Hospital.

But Maria’s dreams of working as a nurse and living with her family in Australia are at risk after the Federal Government’s Migration Review Tribunal denied her request for a Skilled Regional Provisional visa because of Tyrone’s autism, which he was diagnosed with in Australia six months after their arrival.

Maria said the Immigration Department, in a letter, rejected the visa application because her son’s autism could be ‘a burden on the Australian health system’.

Federal Immigration Minister Peter Dutton now has the final say on Maria and Tyrone’s future, and a decision on their deportation is expected within 28 days.

Page 30 | www.HealthTimes.com.au

“I’m just hoping that they will give Tyrone a fair go and not label Tyrone as a burden to the Australian society or any society because of his autism,” Maria said.

“How would the Minister feel if his son was labelled as a burden to society? You are stripping away his chances of getting a bright future in a safe environment and being with the rest of his family.”

Tyrone does not speak Filipino and deportation would force Maria and the 10-year-old away from their family in Australia to the Philippines, where they have no close remaining relatives or reliable health services.

Maria said deportation would also be extremely stressful for Tyrone who, due to his autism, struggles with even small changes to his routine.

The Queensland Nurses’ Union (QNU) has rallied behind Maria and Tyrone.

QNU secretary Beth Mohle called on the Minister to protect Tyrone instead of punishing him for his condition.

“Tyrone’s mother Maria is a hard-working and highly valued rehabilitation nurse who helps patients who have lost limbs and suffered spinal and brain injuries to rebuild their lives,” she said.

“The QNU and the Australian public will rail against any move to deport this child to the Philippines.”

Maria said she’s been overwhelmed by the support of her nursing and medical colleagues and also the wider Australian community.

“Being a permanent nurse, that’s really a part of my dreams and a part of it as well is being a resident here in Australia. I want to own my own house for me and Tyrone.

for the full article visit HealthTimes.com.au

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