Ncah issue 09 2015

Issue 9

18/05/2015

Education special feature + OVA system fails nurses, midwives and paramedics + Facing up to anxiety disorders + Pathologists applaud myHealth Record

Hundreds of great jobs for nurses, midwives & AHPs you won’t ďŹ nd anywhere else

+ Clostridium Difficile: staying alert to the threat

Page 18 | www.HealthTimes.com.au

healthtimes.com.au

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1

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Become an Infant Massage Instructor Soaring Demand for

Infant massage has been shown to reduce stress, regulate sleep patterns, increase weight gain in preterm infants, enhance bonding and assist children with special needs such as Autism, Cerebral Palsy and Down syndrome.

Infant Massage Instructors

As awareness for the benefits of infant massage continues to grow, so too has the demand from parents wanting to learn it. In 2014 an estimated 60,000 Australian parents learned how to massage their babies – a 6,000% increase on 5 years ago.

To meet the growing demand, the Infant Massage Information Service (IMIS) is holding 3-day workshops across Australia where students can learn to become qualified Infant Massage Instructors. Following successful completion, students will run massage classes and take private appointments with parents.

“The course is great for health professionals looking to add to their current skills or looking for flexible and rewarding work”, says IMIS founder Heidi McLoughlin.

2015 programs are planned for the following venues: Westmead Hospital, Royal Melbourne Hospital Function Centre, Royal Brisbane & Women's Hospital, Griffith University, and Perth Convention & Exhibition Centre. Training can also be completed at home via correspondence study.

There are no prerequisites for the program and limited positions remain in 2015.

To find out more call IMIS on 1300 558 608 or visit babymassage.net.au

HealthTimes - Issue 9 | Page 03

Issue 9 – 18 May 2015 We hope you enjoy perusing the range of opportunities included in Issue 9, 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.

Advertiser list CCM Recruitment International CPD Institute of Australia CQ Nurse Critical Care Education Services DHHS Tasmania Education Cruises at Sea ENA Care Group Geneva Health Hamilton Island Hays Healthcare Health Recruitment Specialists Infant Massage Information Service Jane Lewis Lifescreen Medacs Australia NSW Health - Northern NSW Local Health District Nurse at Call Oceania University of Medicine Quick and Easy Finance Skin Science Australia Smart Salary Swan Hill District Health Service The University of Sydney Unified Healthcare Group University of Derby University of Tasmania University of Western Sydney

Next Publication: Mental Health & Nurse Leaders Publication Date:

Monday 22nd of June 2015

Colour Artwork Deadline: Monday 15th of June 2015 Mono Artwork Deadline:

Wednesday 17th of June 2015

Page 04| www.HealthTimes.com.au

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HealthTimes - Issue 9 | Page 05

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Registered Nurses and Midwives

Gold Coast & South Brisbane

Nurse at Call is seeking REGISTERED NURSES & MIDWIVES to join its team of casual agency staff. You will be allocated shifts of your choosing at facilities on the sunny Gold Coast and South Brisbane.

Experience in one or more in the following areas is required: • Emergency • Mental health • ICU • Paediatrics • Midwifery • General medical / surgical Minimum requirements: • Current AHPRA registration • Evidence of immunity to hepatitis B • Minimum 12 months post-graduate experience We offer you: • Agency $$$ • Flexibility - we work around you!

• Ongoing support & personalised service by an experienced family focused organisation Join the Nurse at Call team today!

For more information, contact our friendly team.

Email your CV to recruit@nurseatcall.com.au Visit us at www.nurseatcall.com.au Australia, PH: (07) 55787011. NZ, phone toll free: 0800 740 758.

Page 06| www.HealthTimes.com.au

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Geneva Healthcare

HealthTimes - Issue 9 | Page 07

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CliniCal Care Coordinator enhanCe quality of Care This is a wonderful opportunity to work in a small residential aged care facility within a supportive Victorian based group with a focus on quality care. This NFP organisation is looking for an energetic, knowledgeable and experienced CCC to lead the team and further enhance the quality of care provided.

With current AHPRA Registration as an RN you’ll be passionate about person-centred care and demonstrate strong clinical knowledge. You’ll also possess good people management skills and an in-depth knowledge of the relevant policies, procedures and ACFI. Working within a supportive management team, you’ll have a positive approach and ability to identify opportunities for continual improvements.

Contact Sharyn Cox at sharyn.cox@hays.com.au or 03 9946 3577.

hays.com.au

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INTERNATIONAL

UK Nurse Jobs

At Leading NHS Trust in Manchester, England The Job & Location...

Job Requirements...

Qualified Nurse. Band 5.

Registered General Nurse

Salford Royal NHS Foundation Trust (SRFT).

Candidate will need to register with NMC

Greater Manchester, UK.

1 year post graduate experience

Awarded ‘Outstanding’ rating.

Effective communicator with good leadership & interpersonal skills

The Benefits...

How To Apply...

Band 5 salary. £21k - £28k.

Email:

2 year contract.

International@JaneLewis.co.uk

Full time permanent position.

Telephone:

Induction & training.

Professional development Personal experience.

Travel UK & Europe.

+44 (0) 1244 40 40 80 option 4 Website:

www.JaneLewisOz.com

Sydney & Melbourne Interviews Interview Dates..

Interview Details..

Melbourne: 29 June - 1 July 2015.

Interview with SRFT representatives.

Sydney: 3, 6 & 7 July 2015.

Offer decision given at interview.

International Healthcare Recruitment Since 1987 HealthTimes - Issue 9 | Page 09

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HealthTimes - Issue 9 | Page 11

Looking for a change?

...then make the move to cosmetic nursing CPD Institute of Australia is an organization, based in Melbourne, that facilitates and offers a variety of courses for the nursing profession specific to cosmetic injectable specialized nursing.

• Introduction To Cosmetic Aesthetic Injectable Procedures • Provide First Aid (Level 2) • Provide Cardiopulmonary Resuscitation • Skin Needling Workshop • Platelet Rich Plasma (PRP) Introduction Course • Training in Cosmetic tattooing “When I found CPD institute for training in injectables I was over the moon.

I had completed my Diploma in beauty and being a Registered Nurse I was looking to combine my skills. CPD ticked all the boxes for me. They were professional and supportive.

Since completing my injectables course with CPD I have been given some ` wonderful opportunities. I have started my own business and also work for a company doing injectables.

From day one CPD have been nothing but supportive not only with additional training but also with trouble shooting and just being there when I needed them.

Without them I wouldn't be where I am and I am very excited about my future and CPD being part of it.”

- Victoria Geeves, NSW (Diploma in Beauty Therapy)

Call (03) 90413 782 for more information or email: info@cpdinstitute.com.au Page 12| www.HealthTimes.com.au

"When I found CPD institute for training in injectables I was over the moon."

Hands on training

No upfront fees

9 Central Ave, Moorabbin, Victoria, 3189 www.cpdinstitute.com.au HealthTimes - Issue 9 | Page 13

509-019 1/2PG FULL COLOUR CMYK PDF Thinking about a Graduate Diploma of Midwifery?

Think about UWS. The School of Nursing and Midwifery is a national leader in nursing and midwifery education, research, and scholarship in Australia. In addition to a strong reputation for quality, relevant and contemporary education, the school has well established industry partnerships with midwifery leaders and health and community services.

UWS provides diverse teaching and learning experiences along with state of the art clinical labs that encourage academic success and practice ready midwives.

Online applications via applyonline.uws.edu.au/ connect/webconnect are now invited.

For further information or enrolment inquiries about the Graduate Diploma in Midwifery please contact Fiona Arundell via telephone 02 9685 9567 or email f.arundell@uws.edu.au

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Take your knowledge to a whole new level There’s no better time to organise your continuing professional development with the leaders in acute care education • Face-to-face teaching and hands-on workshops to maximise learning and skills development • Learn from highly qualified, experienced, and motivated expert professionals • Tailor-made courses for your organisation

Registrations are now open for all courses Australia-wide via our website.

Alternatively, stay informed by signing up to our eNews at criticalcare.edu.au

Page 14| www.HealthTimes.com.au

509-012 1/2PG FULL COLOUR CMYK PDF F_UOD_0367 UDOL Health Times Advert Amends 125x85_Layout 1 08/05/2015 11:57 Page 1

READY TO PROGRESS YOUR CAREER? Achieve a globally recognised degree to advance your career as a health and social care professional. We offer a wide range of courses that can be studied part time, 100% online.

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Make the dream of becoming a doctor a reality, earn your MD at Oceania University of Medicine. n Attractive fee structure for our Graduate Entry Program. n Over 150 students currently enrolled and over 50 graduates in Australia, New Zealand, Samoa and USA. n Home-based Pre-Clinical Study under top international medical school scholars, using world leading Pre-Clinical, 24/7 online delivery techniques. n Clinical Rotations can be performed locally, Interstate or Internationally. n Receive personalised attention from an Academic Advisor. n OUM Graduates are eligible to sit the AMC exam or NZREX.

Applications are now open for courses starting in January and July - No age restrictions

OCEANIA UNIVERSITY OF MEDICINE INTERNATIONALLY ACCREDITED For information visit www.RN2MD.org or 1300 665 343 HealthTimes - Issue 9 | Page 15

509-018 1PG FULL COLOUR CMYK PDF Skin Science www.skinscience.co 1300 817 524

Interested in aesthetic treatments?

Skin Science ensures delegates will be fully equipped to confidently & proficiently provide facial aesthetic treatment to clients.

The training programme strikes the perfect balance between theory and practical hands on training. At Skin Science we recognise the importance of supporting each participant once certified. We will assist with recruitment and offer advanced one day workshops regularly. Payment plan options now available with Macredit.

Skin Science three day workshop is ideally suited to Registered Nurses who wish to become certified to treat as Cosmetic Injectable Nurses.

Over the three days we cover theory & practical injecting of Botulinum Toxin & Dermal Fillers in addition to Facial Assessment and The ageing process. We proudly offer Galderma products for the students practical training.

Melbourne course dates: 1- 3 June 2015 27 - 19 July 2015 Register your interest by calling 1300 817 524 Or email info@skinscience.co

Page 16 | www.HealthTimes.com.au

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PAIN MANAGEMENT RESEARCH INSTITUTE ROYAL NORTH SHORE HOSPITAL

Specialising in Clinical Pain Management FORMAL DEGREE PROGRAM - ONLINE Graduate Certificate, Graduate Diploma and Masters Online degree course available to students worldwide. Recently endorsed by the International Association for the Study of Pain (IASP). Study commences in March & July each year (enrolments close end January & June respectively).

CONTINUING EDUCATION OPPORTUNITIES Putting Cognitive Behavioural Skills into Practice This webinar skills training program consists of 6 online sessions aimed at developing your cognitive behavioural therapy skills to help patients manage chronic pain conditions. (see website for program dates in 2015)

Emerging Trends in Neuropathic Pain Symposium (October 2015) This one-day symposium brings together leading experts in the field to discuss and present the latest evidence and emerging trends in understanding, assessing and treating neuropathic pain.

Pain Management Multidisciplinary Workshop (February 2016) 2 x four day face-to-face workshops that explore the extent of the problem, pain constibutors & current principles of pain assessment, treatment & management.

CME and PD credits available

For dates & further information visit: sydney.edu.au/medicine/pmri/education

T: +61 2 9463 1516 E: paineducation@sydney.edu.au

HealthTimes - Issue 9 | Page 17

OVA systems fail nurses, midwives and paramedics

By Karen Keast

T

he systems and processes designed to protect health care workers are not as robust and comprehensive as those in place for patients, according to the Victorian Auditor-General’s report.

Auditor-General John Doyle, in his Occupational Violence Against Healthcare Workers report, found safety initiatives and actions targeting occupational violence and aggression (OVA) are failing nurses, midwives and paramedics.

Mr Doyle found shortcomings in all audited agencies, including public health services, Ambulance Victoria, the Department of Human Services (DHHS) and WorkSafe, which have all implemented recent reforms aimed at preventing and managing occupational violence.

Alarmingly, his report found incidents categorised as ‘mild’, ‘near miss’ or ‘no harm’ included cases ranging from attempted strangulation to a pregnant worker being kicked in the stomach, workers being punched in the jaw, face, chest, head and kicked in the head, hit with an object, slapped in the face, personal threats and sexually inappropriate conduct.

“How is it that these sorts of incidents can be assessed as only ‘mild’ or ‘no harm’? Categorising these incidents in this way understates the seriousness of these occurrences and does not enable future incidents or risks to be prevented and managed.”

Mr Doyle criticised training for staff, excluding mental health and emergency department staff, for being inadequate.

The report also found under-reporting is widespread due to cumbersome incident

Page 18 | www.HealthTimes.com.au

reporting systems, logistical barriers and a perceived lack of inaction from management to respond to “all but the most serious of incidents”.

Mr Doyle stated employers should actively identify and address barriers to under-reporting and called on health care workers to report any incidents that threaten their health and safety whether the incident was intended or not.

“One reason for this under-reporting is staff compassion for patients whose aggression arises from a clinical condition,” he stated.

“Staff commonly reason that the patient ‘couldn’t help it’. Despite relevant policies and procedures highlighting the need for health care workers to report occupational violence incidents, there is still a widely held view - consistently reported by staff across all the audited agencies - that clinically caused violence is an inevitable ‘part of the job’.

“It is not just ‘part of the job’. Without reporting, how can employers know the true level and impact of occupational violence and take appropriate action?”

Mr Doyle made 10 recommendations aimed at improving protection for health care workers and warned the audited agencies will be reviewed again in two years’ time.

The Australian Nursing and Midwifery Federation (ANMF) Victorian Branch labelled occupational violence an “urgent and critical health care issue” and called for immediate action to implement the recommendations.

“The DHHS, WorkSafe and employers have failed to take this issue seriously in the past,” secretary Lisa Fitzpatrick said in a statement.

For the full article visit HealthTimes.com.au

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Find new challenges and rewards in beautiful, liveable Tasmania

Mental Health and Statewide Services Royal Hobart Hospital, Hobart, Tasmania

Salary: $95,153 - $99,594 p.a. plus superannuation and access to salary packaging Contact person: Barry Nicholson, phone (03) 6166 0844 or email barry.nicholson@dhhs.tas.gov.au.

Vacancy No: 508623

Nurse Unit Manager Older Persons Community Mental Health Service (OPCMHS) and Dementia Behaviour Management Advisory Service (DBMAS) Mental Health and Statewide Services South (OPCMHS) and Statewide (DBMAS) Tasmania Salary: $88,861 - $95,153 p.a. plus superannuation and access to salary packaging Contact person: Frans van Wessel, phone (03) 6166 0825 or email frans.van.wessel@dhhs.tas.gov.au.

Vacancy No: 522188

The Tasmanian Health Organisation - South seeks to permanently appoint two Nurse Unit Managers within Mental Health and Statewide Services. These leadership roles are critical to ensuring the efficient and effective provision of care to clients of the Services. They include management of human, material and financial resources in addition to the determination of appropriate milestones in accordance with the business units’ strategic and operational plans.

Tasmania offers an unbeatable lifestyle free of the congestion in today’s big cities.

Thousands of kilometres of World Heritage Area hiking trails, wilderness river rafting, and pristine beaches are on your doorstep.

Add to this Tasmania’s renowned local seafood and produce all less than one hour’s flight from Australia’s second largest city of Melbourne and two hours from Sydney.

Freycinet Experience Walks – Tourism Australia & Hugh Stewart

Nurse Unit Manager Department of Psychiatry

Come and join us in a flexible work environment where high quality work and high quality life are both strongly valued.

If these attributes appeal to you then talk to us.

Apply online: www.jobs.tas.gov.au Applications close: Friday 29 May 2015

>> Make a career move and enquire now >> www.dhhs.tas.gov.au/career/home HealthTimes - Issue 9 | Page 19

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ISLAND - OF -

O P P O RT U N I T Y

Nurse Practitioner Hamilton Island is seeking a Nurse Practitioner to join our new Medical Practice team from August 2015.

Situated in the heart of the Great Barrier Reef, Hamilton Island offers a lifestyle change like no other.

The successful candidate will be registered with the Australian Health Practitioner Regulation Agency (AHPRA) and will be required to provide evidence of: Current and appropriate AHPRA registration | Masters of Nursing (Nurse Practitioner) Specialising in either Emergency or Rural and Remote Nursing

For more information, visit www.hamiltonisland.com.au/careers or call 1800 681 120

F I N D YO U R C A R E E R O N

405-006 403-007 1320-018 324-015 401-009 322-014 1/2PG FULL COLOUR CMYK PDF 413-001 423-011 411-001 409-003 407-0031/2PG 412-040 422-024 504-021 503-001 424-025 421-010 1/2PGFULL FULLCOLOUR COLOURCMYK CMYK(repeat) PDF 509-001 419-011 417-021 507-002 506-033 505-001 UNIQUE OPPORTUNITY FOR REGISTERED NURSES Are you a self-motivated registered nurse searching for work/life balance?

Are you an ICU, ED, recovery, HITH, or even remote nurse searching for a way to earn income, and fit in around your existing lifestyle?

Lifescreen provides Health Services to the Insurance Industry, and Clinical Services for several pharmaceutical companies.

We are looking for nurses to join our expanding operations to provide community-based services for our clients.

Lifescreen can offer you: • Extra $$$ • Work/life balance • Continuity of patient care • Job satisfaction • Certified CPR/anaphylaxis training provided at no cost to you

To be considered for a role as a nurse contractor for Lifescreen you must have the following: • Registered nurse with >5 years experience • Australian Citizen • ABN • Cannulation competent • Strong written and verbal communication skills • Own car and mobile phone

Page 20 | www.HealthTimes.com.au

For enquiries or to apply, please call 1800 673 123 or send your resume to evaluations@lifescreen.com.au

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Respect - Professionalism - Care - Commitment - Collaboration Position Vacant – Nurse Unit Manager – Midwifery Unit (Full-time) An exciting opportunity exists for a Nurse Unit Manager wishing to work to work within our 8 bed, 2 birthroom Midwifery Unit and all areas of midwifery care. The primary aim of this challenging and rewarding role is to provide leadership and effective management within the Midwifery Unit which has around 250 births per annum. The Unit also provides general medical/surgical care for low acuity patients including paediatrics.

Swan Hill District Health, ‘My Hospital’ Swan Hill District Health provides a wide range of clinical services including medical and surgical, aged care, community and primary health, emergency, renal dialysis, chemotherapy and radiography diagnostic services.

Work/life balance is what you get working at Swan Hill District Health. As well as lifestyle comes:

 A professional, committed workforce and highly supportive community

 Variety in work and a sense of achievement

 Competitive Remuneration based on skills, knowledge and experiencethis can be changed to include relocation or salary packaging available Swan Hill - An ideal place to work and play We are located on the majestic Murray River, around 3.5 hours from Melbourne. Swan Hill is a safe place where you will be greeted with a warm smile from our friendly local community.

Our main street boasts a vibrant shopping district with high quality restaurants and little traffic congestion. You’ll find affordable housing, safe spaces for kids, swimming pools, quality education options and a healthy lifestyle.

Imagine breakfast by the riverside, 18 holes at the renowned Murray Downs Golf Club, yachting or waterskiing at one of Swan Hill’s surrounding lakes and fishing for the mighty Murray Cod. All this could be available at your doorstep!

See website www.shdh.org.au for detailed position description, selection criteria, and ‘How to Apply’ information.

For Further information contact Mrs. Kathy Wright, Executive Officer – Clinical Services, 035033 9250 or email kwright@shdh.org.au Applications close COB Wednesday 27 May 2015.

HealthTimes - Issue 9 | Page 21

Boosting Indigenous midwifery education Australia has just 200 Aboriginal and Torres Strait Islander midwives.

Statistics from the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) shows at least 1096 Indigenous midwives are needed - 5.5 times the number we now have to reach population parity.

The Rhodanthe Lipsett Indigenous Midwifery Trust is working to address the severe shortage, providing vital financial assistance to Aboriginal and Torres Strait Islander midwifery students in a bid to increase the number of Indigenous midwives.

Midwifery advocate Pat Brodie AM, chair of the Trust and an Adjunct Professor at the University of Technology Sydney, says just four per cent of the Australian population giving birth are Aboriginal or Torres Strait Islander women and the percentage of Aboriginal and Torres Strait Islander midwives stands at 0.7 per cent.

“Pregnancy and childbirth is a critical moment in women’s lives and all Australians need to think about the numbers of Aboriginal and Torres Strait Islander mothers and babies who need that extra support,” she says.

“That support comes from having access to a midwife that they know and trust, which is more often than not going to be an Aboriginal and Torres Strait Islander midwife.

Page 22| www.HealthTimes.com.au

“We currently have a shortage and we need to address that urgently. Every woman deserves the care of a skilled professional midwife and when that happens birth outcomes are improved.”

The Federal Government’s Maternity Services Review in 2009 shone the spotlight on the need to provide more culturally specific care for Indigenous women through expanding the maternity services workforce.

Australia has high rates of infant and child mortality among Aboriginal and Torres Strait Islander communities.

Indigenous babies are more than two times likely to die in their first year while their mothers are between two to five times more likely to die during pregnancy and childbirth, compared to non-Indigenous babies.

Some Aboriginal and Torres Strait Islander women either don’t access or delay accessing mainstream midwifery services, as the services often fail to provide culturally appropriate care.

“What we are seeing is that if women can’t find suitable services that meet their need then they stay away,” Professor Brodie says.

“Not only that, the public health issues of smoking and poverty and homelessness and lack of social support - often pregnancy is an opportunity for women to address those issues but only if there’s a culturally appropriate care provider they can trust and work with.

“We’re looking for more Aboriginal and Torres Strait Islander midwives to be available to women to provide that culturally appropriate care that enables them to make healthy life choices as well as be able to access services that are acceptable and appropriate to them.”

For the full article visit HealthTimes.com.au

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Looking for Nurses, Paramedics and Pathology Collectors

Locations: NSW - Dubbo 2830, Griffith 2680 VIC - Shepparton 3630 NT - Alice Springs 0870, Darwin 0800 WA - Geraldton 6530, Karratha 6714, Margaret River 6285 QLD -CBD,Emerald 4720, Billa Billa 4390, Townsville 4810

• Solid nursing background for health check services (min 2yrs post grad) • Solid venepuncture experience for blood screening services (min 2yrs exp) • Excellent general medical knowledge and terminology • Professional presentation and communication, along with impressive time management skills • • National Police Check • ABN •

Danielle Le Fevre HealthTimes - Issue 9 | Page 23

509-022 1/2PG FULL COLOUR CMYK PDF Expand your skills and knowledge with the exciting concept of Education at Sea The 12 Hour Standard Mental Health First Aid Course South Pacific Cruise: Sept 27th-Oct 4th 2015 Cardiac Nursing & ECG Interpretation South Pacific Cruise: Nov 7th-17th 2015 Palliative And End Of Life Care South Pacific Cruise: Nov 26th-Dec 4th 2015 Australian College of Emergency Nursing Emergency Care South Pacific & Fiji Cruise: Jan 30th-Feb 9th 2016 Visit: www.educationatsea.com.au Email: info@educationatsea.com.au

509-032 508-012 1/2PG FULL COLOUR CMYK PDF Senior Midwifery Manager Grade 3 Maternity Services Lismore Base and Grafton Base Hospitals

In conjunction with the Directors of Nursing and Midwifery you will be responsible for the provision of strategic and operational direction of maternity services at the Lismore Base and Grafton Base Hospitals.

The position is responsible for maintaining quality professional practice and for ensuring that appropriate clinical, educational and managerial midwifery systems are established and maintained. You will work with the Directors of Nursing / Midwifery Unit Managers to facilitate evidenced based, appropriate , efficient and effective service delivery across both campuses, as well as assess, plan, co-ordinate and monitor the outcomes of best practice. This will be achieved through a number of modalities: support person, advisor, advocate, resource person, mentor and internal coach. Lismore Base Hospital is a major referral hospital located on the beautiful North Coast of NSW. Lismore is close to beaches and rivers, rainforest and provides the best of a country lifestyle near a major centre. With a pleasant year-round sub-tropical climate, it has a relaxed lifestyle and is close to the beaches on the Eastern Seaboard and to the rainforest hinterland. It is well-served by air and other transport links and is in easy driving distance of the major metropolitan centre of Brisbane. In addition to all the professional, social and cultural benefits that this proximity offers, Brisbane is also home to an international airport assuring convenient access to international travellers.

To apply: Contact Narelle Gleeson - Director of Nursing and Midwifery, Lismore Base Hospital. Phone 02 6620 7577 or email Narelle.Gleeson@ncahs.health.nsw.gov.au To apply online: https://nswhealth.erecruit.com.au/ViewPosition.aspx?Id=250443 Closing Date: 25th May

Page 24| www.HealthTimes.com.au

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The University of Tasmania offers 20 postgraduate nursing specialisations that are flexible, part time and 100% online - allowing you to enhance your career while maintaining a work and family life balance.

To find out more visit utas.edu.au/nursing-postgraduate today or phone 13 UTAS. Applications now open for Semester 2

utas.edu.au/nursing-postgraduate

URSM12684rj CRICOS Provider Code: 00586B

Breathe new life into your nursing career.

HealthTimes - Issue 9 | Page 25

Clostridium Difficile: staying alert to the threat

By Mary Hickson Clostridium difficile (C. difficile) is a bacterium that is the most common pathogen causing diarrhoea in hospitalised patients and residents of aged care facilities (1). This bacterium causes the gastrointestinal infection commonly known as ‘C. difficile infection’ (CDI), sometimes abbreviated to ‘C. diff’. CDI can result in a spectrum of conditions from uncomplicated diarrhoea right through to pseudomembranous colitis, fulminate colitis, toxic megacolon, colon perforation, septic shock and even death.

In healthcare facilities, CDI can spread rapidly amongst vulnerable patients, yet whilst we recognise and manage other healthcare-associated infections such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE), the question to be considered is: are we as knowledgeable and alert in relation to CDI and its transmission?

A gram-positive spore-forming, anaerobic bacillus, the primary mode of transmission of C. difficile is person to person via the faecal–oral route. However C. difficile has been isolated on environmental surfaces such as clothes, eating utensils and furniture, where it can exist in its spore form for several months, surviving well under a range of conditions. C. difficile has also been cultured from the hands of healthcare workers.

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Hand hygiene, high standards of environmental cleanliness, prompt isolation of infected patients, preventative strategies and appropriate antimicrobial stewardship are critical to the control of CDI and protection of those people in our healthcare facilities.

CDI is thought to occur when C. difficile spores are ingested and germinate in the gut, releasing toxins and overwhelming normal gut flora that has been compromised in some way, usually by one or more risk factors. These risk factors include recent exposure to antibiotic drugs (for unrelated infections); gastric acid-suppression treatment; advanced age; prolonged hospitalisation; chemotherapy; weakened or suppressed immune systems; abdominal surgery; nasogastric tubes; and multiple comorbidities. It is understandable then that CDI occurs most frequently in healthcare settings where patients and/or elderly residents are vulnerable and the risk of transmission is high.

The incidence and severity of CDI are increasing around the world. In the United States, C. difficile now rivals MRSA as the most common healthcare-associated infection. The C. difficile bacterium was first identified clinically in the United States in the late 1970s and since then, new and more virulent strains have continued to emerge globally. Patterns of increased antibiotic usage and environmental factors such

disease can include toxic megacolon, high fevers, renal failure, hypotension, lactic acidosis and overwhelming sepsis. CDI is rare in children and young adults; the risks and severity increase with age.

Diagnosis can only be confirmed by laboratory testing for C. difficile’s specific toxins in stool cultures; in many cases, examination and testing are performed via colonoscopy procedures. Healthcare providers should be alert to the early symptoms of CDI in ‘at risk’ patients, and take precautionary measures even while waiting for the results of laboratory tests.

Treatment of CDI depends on the severity of the disease. In mild cases, treatment may be as simple as discontinuing the implicated antibiotic along with symptomatic relief. In more severe cases, treatment with metronidazole, vancomycin and other antibiotic agents may be employed. Symptomatic and supportive care is also necessary for pain, fluid and electrolyte management, and other associated complications.

Surgery may be necessary in fulminant disease; total colectomy may be required as a lifesaving procedure.

Preventing the spread of the infection is crucial to the management of C. difficile and CDI. There are several strategies that work together in this process. These include: isolation of symptomatic patients, contact precautions, appropriate antibiotic management, high standards of environmental cleanliness and, of course, diligent hand hygiene practices. Prevention and control strategies include antimicrobial stewardship policies and protocols, surveillance practices for the early recognition of infected patients, prompt testing of patients with suspected disease and education of healthcare workers, patients and their families.

For the full article visit HealthTimes.com.au

509-034 507-030 1/2PG FULL COLOUR CMYK PDF 324-026 DIRECTOR OF NURSING Beaufort Campus

Reporting to the Chief Executive Officer of Beaufort and Skipton Health Service, the Director of Nursing at the Beaufort Campus undertakes the overall management and administration of nursing practices at the Beaufort Campus and works effectively with the Director of Nursing at the Skipton Campus to ensure continuity of care and practice across both sites. The role also seeks to ensure safe and high quality patient centred care is delivered by supervising and directing activities of nursing staff and ensuring all staff participate in the organisation’s quality improvement processes.

Eligible candidates will hold current nursing registration with AHPRA and hold formal tertiary qualifications in management (or working towards the same). As well as being able to demonstrate clinical nursing experience in a variety of settings, you will have relevant administrative experience at a senior level, with a demonstrated understanding of policy formulation, financial and human resource management, strategic planning and appropriate liaison with other senior health professionals and management staff.

Full position details can be obtained from our website at:

www.hrsa.com.au

Enquiries should be made in the first instance to Peter McGregor on 0407 139 257 or applications can be forwarded to: hrsa@hrsa.com.au

Closing date:

PO Box 83 Ocean Grove 3226

Applications close 22 hrsa@hrsa.com.au May 2015 24 March 2014 www.hrsa.com.au

HealthTimes - Issue 9 | Page 27

Surgical wound dehiscence and enterocutaneous fistula – risk factors, nursing assessment and management.

By Bonnie Fraser, RN, BSc, BNURS, Grad Dip ED Surgical wound dehiscence is mostly associated with abdominal surgery where mechanical failure of wound healing results in the separation of all layers of the abdominal wall. However mechanical skin breakdown can occur in any location with increased pressure or tension at the wound (from oedema for example) as is often the case with hip and knee operations. Abdominal wound dehiscence confers a great degree of morbidity leading to increased length of hospital stay increasing the risk for hospital acquired infections and in some cases may result in death.

Risk factors include wound infection, obesity, diabetes, male gender, anaemia, smoking, malnourishment, low albumin levels, pulmonary complications, steroid medications and increased pressure or tension at the surgical site. Increased abdominal pressure resulting from the patient’s postoperative activity can also place undue stress and strain on the healing wound.

Excessive tension on the fascia due nausea and vomiting, trying to void or defecate, postoperative ileus or bowel obstruction; and coughing can cause the incisional wound to break apart.

In addition, pulmonary complications such as atelectasis or hospital acquired pneumonia

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post surgery may increase the risk of dehiscence as poor oxygen delivery predisposes the wound to ischemia (devitalised tissue) and infection.1 Obesity is associated with increased risk of infection and technical difficulties associated with wound closure while some medications (long term steroids) decrease the tensile strength of the healing wound rendering it more susceptible to breakdown. People with diabetes are at a higher risk for wound infection and dehiscence due to the derangement of the normal healing cascade. They also produce less collagen with decreased collagen deposition in the wound bed reducing wound tensile strength. People with diabetes also have reduced leucocyte and neutrophil function interfering with wound healing particularly during the early stages of healing (inflammatory and proliferative stages).1 Signs and symptoms indicating your patient may develop SWD include a tearing sensation or the feeling that something has given way, increased exudate oozing from the wound, signs of inflammation and lack of a healing ridge beneath the surgical incision site (hardness that extends approximately 1 cm either side of the wound).

Management usually involves healing by primary intention or delayed primary closure and incorporates the principles of postoperative wound care - maintaining a moist healing environment, managing exudate (use of appropriate dressings suited to the size, depth, location and level of exudate), removal of devitalised tissue, reducing the risk of infection or treating if clinically indicated and pain management.3 There is also a need to reassure the patient that their wound will heal and provide education to encourage self-care.

Enterocutaneous fistulae are an abnormal communication between the bowel lumen and skin often associated with infection and/or sepsis, fluid and electrolyte abnormalities, and malnutrition.2 Some fistulas are left to heal by secondary intention while others can be surgically closed (depending on the location and age of the fistula). Suitable drainage systems may need to be applied as it is important to protect the perifistula skin from the damaging effects of effluent (maceration, excoriation, cellulitis, cutaneous ulceration and necrosis). Accurate measurements of effluent output and its characteristics must be documented to ensure adequate fluid and electrolyte management.

Referral to the dietician is important to ensure adequate nutrition and hydration. Often patients with ECC and SWD may require nutritional supplementation such as total parental nutrition to rest the bowel while healing takes place. The dietician aims to prevent malnutrition while the bowel is rested and the fistula or SWD heals.

The dietician will assess for nutritional deficiencies, calculate nutritional requirements, advise on feeding route, maximise individualised nutritional support and monitor nutritional intake and needs.

For patients with ECF and SWD of the abdomen with a leaky bowel odour control is an important aspect of care ensuring patient comfort and assists with maintaining quality of life. The nurse may also be required to assess need for counselling, social worker or pastoral care input; and assessment of the patient and/or family

members’ ability or desire to participate in their own care to promote independence and selfcare.1, 2 It is important to encourage mobility as this will contribute to quality of life and limit further morbidity. For fistulae and SWD that can be surgically closed negative pressure wound therapy is often applied to aid healing or to facilitate granulation in the wound base prior to definitive closure.

Nursing assessment of ECF will focus on fistula location and complexity, maturity, volume and characteristics of drainage, condition if the peri-fistula skin, size of the fistula and/or surrounding wound, adequacy of the containment device and availability of supplies/devices (this will influence treatment options).2 The periwound skin has the potential to break down as a result of constant exposure to moisture. Skin and wound barriers will help protect the peri-fistula skin from excoriation, sealing healthy skin from body fluids preventing peri-wound maceration and breakdown that may result from exposure to corrosive effluent. Barriers can also help prevent the stripping of fragile skin by decreasing the separation force from aggressive adhesives/ dressings.2 In closing, optimal management of postoperative patient with a surgical wound is paramount to preventing potential complications.

The ward nurse plays a pivotal role in the provision of essential postoperative wound care including assessment and monitoring of nutritional intake, patient postoperative activities that may increase risk of SWD in addition to wound healing progression. Knowledge of common postoperative wound complications and their management coupled with an understanding the principles of postoperative wound care will facilitate early referral and treatment should complications arise.

For more articles visit HealthTimes.com.au HealthTimes - Issue 9 | Page 29

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Ambulatory Nurses (inpatient clinic) with experience in one or some the following specialities: Pain Management, Allergies, Respiratory/Pulmonary, Cardiology, Surgical/Entero/Wound/Urology/Nephrology, Haematology, Rheumatology, Infectious Diseases and Ophthalmology, Infection Control Practitioners.

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