Ncah issue 16 2014 by Seabreeze Communications

Issue 16 18/08/14 fortnightly

Working Abroad Feature More graduate nursing training places needed Tasmanian nurses and midwives plan industrial action New camera technology for Victorian ambulances The colour of wounds and implications for healing

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Alcohol Detoxification and Rehabilitation: challenges for www.ncah.com.au health professionals www.ncah.com.au Issue 26August August2014 2013 16–18 117– –20 January 2014 ByIssue Glynis Issue 17 – 26Thorp August 2013

We hope you enjoy perusing the range of opportunities We hope you enjoy perusing included in Issue 17, 2013. the range of opportunities s health professionals we must never under16,2014. 2014. 1, included in Issue 17, 2013. If you are interested in pursuing any of these opportunities, estimate the dangers of withdrawal. Ifplease you are interested in pursuing anyalcohol ofvia these contact the advertiser directly the opportunities, contact details Alcohol is a central nervous system please contact the advertiser directly via the contact details provided. If you have any queries about our depressant publication or provided. Ifcessation you anycan queries about ourplease publication or if you would likehave to receive ouroverstimulate publication, us and abrupt theemail autoifatyou would like to receive our publication, please email us careers@ncah.com.au nomic nervous system. at careers@ncah.com.au

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A DISTRIBUTION respected doctor I had the pleasure of DISTRIBUTION 34,488 learning from once told me a story which high34,488 lights the importance of recognizing and treating The NCAH Magazine is the most widely distributed national alcohol withdrawal: The NCAH is the most widely distributed national nursing andMagazine allied health publication in Australia Imagine putting people in a glass room nursing and allied healthfour publication in Australia that can seeand and hear through sitcontact back Foryou all advertising production enquiriesand please For all advertising and8700, production contact us observe. on +61 (0) 3 One 9271 email enquiries and of these people please is addicted us on +61 (0)306 3 9271 email 1300 5828700, careers@ncah.com.au or visit www.ncah.com.au to careers@ncah.com.au opiates, the second is www.ncah.com.au addicted to amphetaor visit If you would like toischange your mailing address, mines, the third addicted to benzodiazepines Iforyou likeon toour change your mailing address, be would included distribution, please email and the fourth is an alcoholic. Over a period of or be included on our distribution, please email careers@ncah.com.au time if deprived of their drug of choice they will careers@ncah.com.au experience withdrawal. The person who is adPublished Seabreezewill Communications Pty Ltd Trading as NCAH. dicted to by opiates sweat profusely, have sePublished by 328 Seabreeze ABN 29 071 053. Communications Pty Ltd Trading as NCAH. vere stomach cramps and desperately beg you ABN 29 071 328 053. © 2013 Seabreeze Communications Pty Ltd. to ©help them with pain relief so that they can start 2014 Seabreeze Communications Pty Ltd. 2013 All rights reserved. No part of this publication may be copied or to Allfeel again. This is an may important point rightsnormal reserved. part of this publication bepermission copied or reproduced by anyNo means without the prior written of that must remember: itthe isprior not to get reproduced byCompliance any means without written permission of thewe publisher. with the Trade Practices Acthigh 1974 ofanythe publisher. Compliance with thepublication Trade Act 1974 of adadvertisements contained in this is the responsibility of more, it is to feel normal. ThePractices amphetamine advertisements contained in this publication is the responsibility of those who submit the advertisement for publication. Quick andofEasy Finance dict will be very angry, probably hitting the walls University Tasmania TR7 Health those who submit the advertisement for publication. Quick and Easy Finance Medications that may be prescribed to asand demanding medication while they scratch at Royal Flying Doctor Service UK Pensions Royal Flying Doctor Service sist patients suffering from alcohol detoxification their skin, causing abrasions. The person with a TR7 Health Unified Healthcare Group symptoms include: benzodiazepine addiction will be very frightened, TR7 Health Pensions Wimmera Group UK Pension Transfers • UK Anti-anxiety medicines Healthcare (benzodiazepines shake, twitch and not be able to sleep. The alcoUK Pension Transfers Unifi Healthcare suchedas diazepam)Group which treat withdrawal holic will probably sit in a corner, terrified and suUnified Healthcare Group symptoms such as delirium tremens (DTs). per sensitive to noise; have visual hallucinations; • Seizure medicines to reduce or stop severe feel like things are crawling over them; slump Education feature feature Next Publication: Regional & Remote Publication: feature withdrawal symptoms during detoxification. over;Next and possibly have a fitEducation and die. Next Publication: feature 1st September 2014 Publication Date: MondayEducation 3rd February 2013 • Medicines for recovery include Disulfiram ItPublication is important to Monday remember that patients Date: 9th September 2013that Monday 25th Colour Artwork Tuesday 28th August January 2013 Publication Date:Deadline: Monday 9th September 2013 2014 go through alcohol Deadline: withdrawal under2nd ourSeptember care will 2013 (Antabuse), which makes the person sick Colour Artwork Monday 27th August 2014 Mono Artwork January 2013 Colour Artwork Deadline: Deadline: Wednesday Monday 2nd29th September 2013 likelyMono not have been admitted specifically for al- 2013 (vomit) if they consume alcohol. Artwork Deadline: Wednesday 4th September Mono Artwork Deadline: Wednesday 4th September 2013 • Naltrexone (ReVia, Vivitrol), which interferes cohol detoxification. Withdrawal is more likely to

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with the pleasure one gets from alcohol. Acamprosate (Campral), which may reduce cravings for alcohol. Thiamine supplements are recommended. Alcohol abuse can cause the body to become low in certain vitamins and minerals especially Thiamine (vitamin B1). Thiamine helps prevent Wernicke-Korsa koff syndrome which causes brain damage. (WE was first identified in 1881 by the German neurologist Carl Wernicke,although the link to Thiamine was not discovered until the 1930s. Russian psychiatrist SergiKorsakoff described a similar presentation in 1887-1891).

Patients and health professionals dealing with alcohol detoxification will also face systemic challenges, such as: • Limited access to rehabilitation centres • Significant distance between treatment and rehabilitation centres, particularly in regional and remote areas • Navigating the rules and requirements that rehabilitation centres impose prior to admission (which ensure a patient’s level of readiness for change) • Limited access to family support, as many patients suffering from severe alcoholism and requiring rehabilitation have often lost contact with friends and family. The prevalence of alcohol abuse and dependence in our society means that as health professionals many of us will be confronted with alcohol withdrawal symptoms. It is vital that we are familiar with the warning signs and symptoms of alcohol withdrawal as mismanagement or the absence of appropriate care can have severe consequences. References Sydney Alcohol Treatment Group-http:// www.alcpharm.med.usyd.edu.au/ accessed 2010 2/8/2014.

Nursing Careers Allied Health - Issue 16 | Page 5

Tasmanian nurses and midwives plan industrial action Tasmania’s nurses and midwives will remove goodwill in their planned industrial action as the state government considers introducing a public sector wage freeze. The move comes after the Australian Nursing and Midwifery Federation’s (ANMF) Tasmanian branch recently met with members across the state to endorse a log of claims, as it prepares to negotiate a new EBA for public sector nurses and midwives. The ANMF is also joining forces with other unions to hold ‘bust the budget’ rallies on August 28 at Parliament House in Hobart and on September 4 at both Devonport and Launceston. ANMF branch secretary Neroli Ellis said members will put a halt to unpaid administration work in hospitals from August 25, in a move designed to put pressure on the system without impacting on patients. “If you take the goodwill of nurses and midwives out of the system, it will put a lot of pressure on the system, particularly around the admin - computer entries, computerised admission systems, etcetera, so potentially they may have to employ more admin staff after hours,” she told abc.net.au. Ms Ellis was unavailable for comment at the time of publication but the branch’s website states the government’s proposed wage freeze amounts to a “real wage cut” for nurses and midwives. “Inflation and the price of goods and services continues to rise and your salary buys less over time - the value of what you earn is cut,” it states. The government has proposed a one-year wage freeze for all public servants, followed by a move to two per cent increases, in a bid to save $50 million a year and safeguard around 500 jobs. The freeze will take affect when the legislation passes both houses of the Tasmanian parlia-

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ment, which the union fears could occur as soon as October. “The government has the constitutional power to rip up contracts with its public sector workers through legislation,” the ANMF branch states. “It’s a radical unprecedented action but if they can get special legislation through both houses of state parliament, then they have the ultimate power over your wages and conditions.” The branch is also fighting legislation, which has already passed the Lower House, that aims to outlaw reasonable protest action. The union states the new legislation includes penalties such as $10,000 on-the-spot fines and three-month mandatory jail terms for disrupting workplaces. “We’re seeking legal advice about the implications of this legislation and what it could mean for ANMF (Tas branch) members and activities in education and training workplaces.”

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The colour of wounds and its implication for healing By Bonnie Fraser RN BSc, BNURS view ourselves and communicate with others. Wounds are very common across the specAny failure in skin integrity results in a wound. trum of health care settings, with a range of presAll wounds, regardless of their cause and healentations including traumatic or surgical wounds ing intention (discussed in a future article), must and chronic wounds such as diabetic foot ulcers progress through the stages of healing in order and leg wounds (in particular venous stasis ulcers to close and restore skin integrity. The following and arterial ulcers), ischemic wounds (gangrene) provides a guide to understanding various tissue and pressure injuries. Less common wounds types associated with wounds. may include vasculitic ulcers, necrotising fasTissue types and wound healing ciitis, pyoderma gangrenosum and calciphylaxis. Management of a patientâ&#x20AC;&#x2122;s wound will be deWith any wound it is important to understand termined by the wound tissue present and exuthe aetiology in order to develop an appropriate dates. The different types of tissue can easily be management plan, but also to properly manage remembered by colour. Necrotic tissue, termed any comorbidities that may be associated with eschar, is easily identified as black or dark brown the development of the wound or limit the healing in colour. Eschar may be dry or moist and prepotential.Locally, the type of tissue in the wound sents as thick and sometimes leathery necrotic bed may give important clues about the stage of tissue cast off from the surface of the wound. healing or whether the wound will heal. Wound Eschar inhibits the proliferative and maturation assessment must therefore be holistic and incorUNE aspects preparesoffuture serviceand managers, leaders and health healing policy makers to learn the forphases of wound by preventing porate key both health the patient the work within increasingly delivery systems.granulation Our Mastertissue of Health mation of healthy and inhibitwound and to ensure the best possibleintegrated, outcomehealth for care ingprovides wound contraction and necessary epithelialisation the individual. Whileis holistic is the which Management a highlyassessment regarded program the qualification for (new skin growth). foundation for thorough wound assessment, this individual membership with the Australasian College of Health Services Management (ACHSM). Moist eschar supports bacterial growth inarticle will focus on wound characteristics, in parIt is designed to give you the skills to innovate, lead and manage in complex regulatory creasing the risk of infection and ideally should ticular tissue types and the condition of the surenvironments. be debrided. Dry eschar, on the other hand, rounding skin. The Master online, giving you the opportunity to obtain a microan impervious barrier to external Healthy Skin of Health Management can be studied forms bialstudy contamination. In patients with compromised As the outer layer of the body, skinflexibility providestoabalance world-class qualification and the with your commitments. circulation, for example patients with peripheral protective barrier to environmental influences alWhether you are an allied health professional, nurse, medical practitioner, researcher arterial disease or diabetes, it is best to leave lowing us to respond to a myriad of environmenor policy Health Management program will indevelop and can dethe eschar place your until knowledge investigations tal stimuli. Skin analyst, forms anUNEâ&#x20AC;&#x2122;s impervious barrier to skills to progress yourasprofessional career intermine health management. the degree of arterial disease. Wounds changing weather conditions well as chemical with a poor blood supply have minimal oxygen and bacterial assault. Skin contains thousands and nutrients being delivered to the wound bed of sensory nerve endings that detect changes and surrounding tissues, limiting wound healing in temperature, pain and pressure, and facilitate potential and removal of a dry eschar may cause thermoregulation. Skin has metabolic functions further deterioration of the wound and increase producing vitamin D in response to sunlight and the risk of infection. secreting salts through sweating. Skin plays Slough (also necrotic tissue) is a non-viable an important cosmetic role,influencing how we

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416-015 1PG FULL COLOUR CMYK PDF sue inhibits the migration of epithelial cells across fibrous yellow tissue(which may be pale,greenish the wound surface and increases the risk of scar in colouror have a washed out appearance) tissue formation by preventing the wound edges formed as a result of infection or damaged tisfrom closing. Hyper-granulation tissue may be sue in the wound. The presence of slough may the result of prolonged inflammation due to infecindicate the wound is stuck in the inflammatory tion or the presence of an irritant or foreign body; phase (chronic wounds) or the body is attempting overuse of occlusive dressings; constant rubbing to cleanthe wound bed in preparation for healing. of dressings or tubes against the skin causing an Slough is usually a combination of leucocytes, inflammatory response (e.g. a peg tube or supra bacteria, devitalised tissue or debris and usually pubic catheter); allergy to dressings; or imbalhas a moist, shiny stringy appearance or may be ance of cellular activities that regulate the profirmly attached to the wound bed. duction of healthy tissue. Granulation is a collagen rich Location: Coffstissue Harbour Health Campus any hyper-granulation tissue forming at the siteclinical of anleadership and coordination of care withinWith • Provide management, the Maternity Services • Promote values of MNCLHD and NSW Health, leading in atissue mannerit which encourages is important to ideninjury during the the CORE proliferative the adoption of these standards in all staff tify and treat the cause and phase. As the wound heals • In consultation with midwifery and medical staff within the Maternity Services, develop the strategic to eliminate this direction tissue fills in Maternity the for the Services and inspire a shared sense of purpose amongst all staff malignancy. If occlusive dresswound deficit replacing Enquiries: Joanne Uttley, (02) 6656 7024 or email Joanne.Uttley@ncahs.health.nsw.gov.au ings have been used theReference blood clot formed number: 201904 change to a vapour during haemostaClosing date: 1 September 2014 permeable dresssis and eventually Coffs Harbour is located on the North Coast of New ing. The application forming scar tissue. South Wales, midway between Sydney and Brisbane of light pressure to Healthy granulation with multiple daily flights to both capital cities. The area boasts mountain scenery, heritage the wound bed using tissue is superb bright beaches, red listed rainforests, fine restaurants and a near idyllic a foam dressing with with a grainy appearclimate. It is a family friendly area with outstanding tubigrip compression ance, due to the budding schools and recreational facilities. may reduce the overgrowth or growth of new blood The Coffs Harbour Health Campus is a modern of tissue. Additionally, hypervessels into facility the tissue. 208 bed whichThis provides a broad range of specialty care has services. These include tonic dressing (e.g. Mesalt) may tissue is firm to health touch and a emergency medicine, intensive to care, dehydrate the overgranulation. In case shiny appearance. It is essential pro-coronary care, general medicine, general surgery and orthopaedics, tect the granulation tissue topaediatrics, allow the epithelialiobstetrics/gynaecology, stroke and of infection, antimicrobial dressings such as silsation process to proceed in order to close rehabilitation, renal and mental health and the a wide ver, iodosorb or medical honey may also help to range Granulating of clinical support services community dehydrate the wound. Apply light pressure to the wound. wounds requireand adequate based services. Recent additions to the facility include wound bed. It is important to swab the wound tissue perfusion; a slightly acidic environment; the Coronary Angiography Unit and the North Coast a stable wound temperature; good bioburden Cancer Institute (NCCI) which provides oncology to determine bacterial burden and to eliminate services, radiotherapy and breast screening. Come infection as a causative agent. control; moisture balance; a reduction of factors and may enjoy prevent the rewards of working as part of a highly Epithelialisation is the regeneration of new which healing (e.g. the underlying dedicated team committed to the provision of world skin (epithelium) over a wound and signifies cause of the wound);and protection from physiclass health services. the final stage of healing. Epithelial tissue, light cal trauma. pink in colour, usually migrates inwards from the Hyper-granulation tissue (often called overwound margins or may appear as small islands of granulation) is an excess of granulation tissue tissue over the surface of the wound. over and above that required to fill the wound Apply online at: cavity. Hyper-granulation tissue may appear dark nswhealth.erecruit.com.au red and devitalised (due to poor oxygenation) or pale due to lack of oxygen. Hyper-granulation tisFor the full article visit NCAH.com.au N43668

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Nursing Careers Allied Health - Issue 16 | Page 9

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Adelaide’s city centre is surrounded by parklands and is a blend of historic buildings, wide streets, parklands, cafes and restaurants. Adelaide is easy to get around with rolling hills to the east and beaches to the west. With a population of slightly more than one million, Adelaide is the “20 minute city”. The airport is only seven kilometres from Adelaide city. The Adelaide Hills and major beaches are less than half an hour away by car. That’s what we call liveable! So what’s stopping you – apply today?

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Successful applicants will possess: • Registration with AHPRA to practice as a Registered Nurse in Australia • A minimum of two years' experience as a Scrub/Scout or Anaesthetics • Strong interpersonal and communication skills • Proven ability to work effectively both in a team and autonomously • Intermediate computer skills • Full rights to work in Australia

Benefits include: • An attractive salary with on-call component • Salary packaging Further information please contact: Kay McDonald, Peri-operative & Angio Service Manager Tel (08) 8412 2045 or Email: Kay.McDonald@calvarycare.org.au Applications close: 30th September 2014 In the Tradition of the Sisters of the Little Company of Mary with values of hospitality healing, stewardship and respect

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Support for Noarlunga Hospital nurses Nurses working at an Adelaide hospital have been offered counselling and support after a patient was charged with the murder of another patient. South Australia Police have arrested and charged a 23-year-old Woodcroft man with murder after the death of a man, aged in his 40s, at the Noarlunga Hospital. A nurse doing her rounds at the Morier Ward of the hospital found a man collapsed around 1am on August 12. He was unable to be revived and was pronounced dead. Australian Nursing and Midwifery Federation South Australian branch secretary Adj Assoc Professor Elizabeth Dabars AM said nurses who work at the ward are receiving support. “Our understanding is the nurses, whilst of course it’s been quite a shocking experience, have at least been getting some appropriate support from their managers,” she said. “That includes some appropriate offers of counselling, and also getting people home in an appropriate way rather than expecting them to drive in a state of shock. “The support that’s been offered by management has been positive and one that we’ve welcomed. “Obviously our hearts and minds also go out to those who are affected and have been involved in this situation.” In a statement, Southern Adelaide Local Health Network chief executive officer Belinda Moyes said the incident took place in a contained area of the health service.

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 16 | Page 13

London - no ordinary challenge Salt injection ‘kills cancer cells’ for paramedics

“This work shows how chloride transportScientists have created a molecule that can ers can work with sodium channels in cell memcause cancer cells to die by carrying sodium and It’s one of the world’s most famous cities with landmarks such as Tower branes to cause an influx of salt into cell. of We chloride ions into the cells. Bridge, Big Ben, Buckingham Palace and The Shard. It’s also home to aone found- we can death with salt,” said have created aservices techniquein which the Scientists busiest ambulance the world and it trigger wantscell our paramedics. study co-author Professor Philip Gale, of the UnicanKaren cause cancer cells to self-destruct by injectBy Keast versity of Southampton. ing them with salt. Cells in the human bodyService work hard to mainResearchers from the University of SouthThe London Ambulance is home to ondon has always been a working destinatain aemployees, stable concentration of ions inside their ampton are part of an international team that has 4,500 with 3,300 frontline staff worktion for Australians and New Zealanders. cell membranes. Disruption of this delicate balhelped to create a molecule that can cause caning across 70 ambulance stations spanning 620 While the London Ambulance Service has ance can trigger cells to go through apoptosis, cer cells to die by carrying sodium and chloride square miles, from Heathrow in the west to Uplong attracted Aussie and Kiwi paramedics known as programmed cell death, a mechanism ions into the cells. minster in the east, and from Enfield in the north searching for a career change, now, the body uses to rid itself of damaged or dangerSynthetic ion transporters have been created to Purley in the south. for the first time, the organisaous cells. before but this is the first time researchers have It receives around 4,000 calls a day, and tion is actively recruiting One way of destroying cancer cells is to trigdemonstrated how an influx of salt into a cell trigalmost a quarter of those are immediately lifeparamedics from either ger this self-destruct sequence by changing the gers cell death. threatening. side of the Tasman ion balance in cells. These synthetic ion transporters, described The organisation this year launched its redivide. this week in the journal Nature Chemistry, could cruitment campaign, ‘London - no ordinary chalThe service point the way to new anti-cancer drugs while also lenge’, as it works to fill about 250 vacancies for will send a team benefiting patients with cystic fibrosis. For the full article visit NCAH.com.au registered paramedics. to interview

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Its recruitment website reveals London parand assess amedics face unique challenges ranging from paramedics in open chest surgery at the side of the road to takAustralia and ing patients to hospital by boat. New Zealand OUM’s innovative Paramedics have the opportunity to work next month as it teaching style is Make the dream of ofbecoming a doctor reality, fast amid all walks London life via the a service’s works to bridge fantastic and exciting. earn your MD atcars, Oceania of Medicine. response as a University flight paramedic and in its its paramedic shortTruly foreword thinking, n Attractive feeresponse structure for our Graduate Entry Program. cycle unit. age. OUM allows the student n Over 150 students currentlytoenrolled and over as 50 graduates “We respond emergencies quickly as Ambulance to benefitService fromLondon both in Australia, New Zealand, Samoa and USA. possible and deliver the highest level of care…in operations director local and international n Home-based Pre-Clinical Study under top international the air, on the road, by foot,” it states. Jason Killens says the organisamedical school scholars, using world leading Pre-Clinical, resources. Killens says the London Ambulance Sertion hasn’t recruited from overseas before.24/7 onlineMr delivery techniques. Brandy Wehinger, RN vice has changed a lot since he started. “This is an unique opportunity for Australian n Clinical Rotations can be performed locally, Interstate or OUM Class of 2015 Internationally. “There’s now a clear career development paramedics,” he says. n Receive personalised attention structure in place,” hefrom says.an Academic Advisor. “There is a national shortage of paramedics n OUM Graduates are eligible to sit the AMC or NZREX. “But the qualities needed toexam succeed are the in the UK and therefore we are looking to recruit

RN to MD

same - persistence, personal resilience and the paramedics from Australia and New Zealand as are now open for courses starting in January - No age opportunity restrictions you can.” abilityand to July seize every their Applications skills and training closely match those in the

OCEANIA UNIVERSITY OF MEDICINE

Those wanting to apply for the positions must be at a paramedic level. “I’d urge them to apply now for a chance to For information visitaccept www.RN2MD.org 665current343 “We applications or if 1300 they are work INTERNATIONALLY ACCREDITED for the world’s busiest ambulance service in ly completing a paramedic science degree or one of the most famous cities in the world.” UK.

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416-014 1PG FULL COLOUR CMYK PDF equivalent,” Mr Killens says. “All applicants will need to obtain UK paramedic registration before joining – but they can still apply while their registration is in process.” During assessments, candidates will need to demonstrate their knowledge and decisionmaking ability. Mr Killens says candidates are first required to take a multiple choice clinical assessment paper on areas ranging from anatomy to advanced life support and trauma. “This is followed by a lifting assessment and, finally, they will do a practical assessment on advanced life support,” he says. “Candidates will be observed on how safe, effective and logical their decision-making is while working in a team. “They will also be interviewed by someone from human resources along with an operational team member.” Mr Killens says the service has so far received about 100 applications from across Australia and New Zealand and he expects all suitable candidates will receive a job offer. “We expect to be able to offer a job to everyone who is successful at the interview and assessment,” he says.

them to treat patients in the UK. Mr Killens says the full training package will enable paramedics to operate as registered paramedics in London. “This will include a conversion course, blue light driving, responding to incidents on the London Underground and an operational placement as a third person with an ambulance crew.” The London Ambulance Service will attend the PAIC conference on the Gold Coast, from September 18-20 September, running interviews and assessments, and answering questions. The service will also visit Sydney from September 8-9, Adelaide from 12-13, Melbourne from 15-16, and Auckland from September 1213. Paramedics wanting to apply can visit www. noordinarychallenge.com, and for more information can visit the London Ambulance Service’s Facebook at www.facebook.com/noordinarychallenge or speak to a member of the recruitment team by emailing recruitment@londonambulance.nhs.uk.

“A team from the service will be in Australia and New Zealand in September for interviews and assessments and by the end of the day paramedics could walk away with a job in London. “We expect to complete the process of receiving their references, pre-employment checks and their UK registration by December, with their start date in January after been granted a visa.” The service is offering candidates support with their application, visa and relocation costs, while it will also cover the Health and Care Professions Council paramedic registration fee. Paramedics who secure jobs will be required to complete a short conversion course enabling

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Nursing Careers Allied Health - Issue 16 | Page 15

Australian nurses in Ebola response By Karen Keast Australian nurses are on the frontline in the health response to the Ebola epidemic sweeping West Africa. As the death toll from the virus continues to climb, Australian Red Cross aid worker and nurse Amanda McClelland is on the ground in Sierra Leone, heading up the international Red Cross response. Ms McClelland is one of a small team of Australian Red Cross health professionals sent to West Africa, including nurse and epidemiologist Marshall Tuck, while an anaesthetist is also on the way. An International Federation of Red Cross (IFRC) emergency health senior officer, Ms McClelland is working to set up the first Red Cross isolation unit. Ms McClelland said nurses are wearing full personal protection equipment (PPE) from overalls and goggles to two pairs of gloves and apron gumboots while they work, and using social distancing and good hand washing practices in the community. Nurses receive specialised training on arrival, including use and removal of PPE, and are then supervised in the isolation unit for up to two days. “The ideas may be frightening, and the consequences of a mistake can be high, but the care of Ebola patients comes down to the basics that all nurses should have,” she said. “Many of our African colleagues have died - 21 so far in the hospital that we are about to support. “This is because of lack of quality education, quality equipment and extremely long hours causing fatigue and possible errors.

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“Many of the nurses were actually infected from friends and family at home rather than at work where they had access to the right protection equipment.” The organisation has deployed a full field hospital and will open a 60-bed unit in Kenema, Sierra Leone’s third largest city. Ms McClelland said patients are presenting with fever, malaise, vomiting and diarrhoea. “Haemorrhagic symptoms are surprisingly rare and only come late in the condition but they can be confronting,” she said. “We haven’t started clinical care yet, as the hospital is being built and the focus has been on breaking community transmission through good public health practices.” Ms McClelland, who oversees safety, policy procedures and guidelines and manages the relationship with partners including the World Health Organisation and the Sierra Leone Ministry of Health, said the Red Cross has been involved since the first cases appeared in Gueckadou, in Guinea, in March, sending specialist aid workers from across the globe to the three affected countries. She said the Ebola response comes down to basic public health. “It is good hygiene, burial practices and a simple transmission cycle that can be broken through early case indication and treatment,” she said.

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“We utilise public health nurses with good community experience to assist the national Red Cross society in working with a large network of volunteers in communities, personal and psychological support and contact tracing activities. “It helps if these community nurses have a good understanding of infection control, and epidemiology. “In terms of clinical care, the nursing procedures are basic skills - good interpersonal communication, use of personal protective equipment and supportive care that includes treatment of sepsis and shock.” Ms McClelland said a lack of understanding about the disease has led to rumours and misinformation in the population, making clinical care difficult. “There have even been cases of civil unrest or the population attacking a vehicle or hospital,” she said. “This fear and lack of understanding makes bringing the outbreak under control very difficult.

“In terms of clinical care, the high case fatality rate is difficult and working in the personal protection equipment in hot conditions is a big challenge. “Nurses are losing up to two litres of fluid in one set of rounds, so keeping hydrated and avoiding heat stress is extremely important.” Regardless of the hurdles, Ms McClelland said it’s rewarding to work alongside Red Cross volunteers in the midst of the epidemic. “Despite the fear and stigma they turn up to work every day and do what they can to help their communities - they are amazing and an inspiration,” she said. The other highlights are the survivors. “There are big celebrations when someone survives,” she said. “The counters take them back to their village and assure everyone they are now safe and not infectious.”

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 16 | Page 17

London - no ordinary challenge for paramedics It’s one of the world’s most famous cities with landmarks such as Tower Bridge, Big Ben, Buckingham Palace and The Shard. It’s also home to one of the busiest ambulance services in the world - and it wants our paramedics. By Karen Keast

ondon has always been a working destination for Australians and New Zealanders. While the London Ambulance Service has long attracted Aussie and Kiwi paramedics searching for a career change, now, for the first time, the organisation is actively recruiting paramedics from either side of the Tasman divide. The service will send a team to interview and assess paramedics in Australia and New Zealand next month as it works to bridge its paramedic shortage. London Ambulance Service operations director Jason Killens says the organisation hasn’t recruited from overseas before. “This is an unique opportunity for Australian paramedics,” he says. “There is a national shortage of paramedics in the UK and therefore we are looking to recruit paramedics from Australia and New Zealand as their skills and training closely match those in the UK. “I’d urge them to apply now for a chance to work for the world’s busiest ambulance service in one of the most famous cities in the world.”

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The London Ambulance Service is home to 4,500 employees, with 3,300 frontline staff working across 70 ambulance stations spanning 620 square miles, from Heathrow in the west to Upminster in the east, and from Enfield in the north to Purley in the south. It receives around 4,000 calls a day, and almost a quarter of those are immediately lifethreatening. The organisation this year launched its recruitment campaign, ‘London - no ordinary challenge’, as it works to fill about 250 vacancies for registered paramedics. Its recruitment website reveals London paramedics face unique challenges ranging from open chest surgery at the side of the road to taking patients to hospital by boat. Paramedics have the opportunity to work amid all walks of London life via the service’s fast response cars, as a flight paramedic and in its cycle response unit. “We respond to emergencies as quickly as possible and deliver the highest level of care…in the air, on the road, by foot,” it states. Mr Killens says the London Ambulance Service has changed a lot since he started. “There’s now a clear career development structure in place,” he says. “But the qualities needed to succeed are the same - persistence, personal resilience and the ability to seize every opportunity you can.” Those wanting to apply for the positions must be at a paramedic level. “We accept applications if they are currently completing a paramedic science degree or

equivalent,” Mr Killens says. “All applicants will need to obtain UK paramedic registration before joining – but they can still apply while their registration is in process.” During assessments, candidates will need to demonstrate their knowledge and decisionmaking ability. Mr Killens says candidates are first required to take a multiple choice clinical assessment paper on areas ranging from anatomy to advanced life support and trauma. “This is followed by a lifting assessment and, finally, they will do a practical assessment on advanced life support,” he says. “Candidates will be observed on how safe, effective and logical their decision-making is while working in a team. “They will also be interviewed by someone from human resources along with an operational team member.” Mr Killens says the service has so far received about 100 applications from across Australia and New Zealand and he expects all suitable candidates will receive a job offer. “We expect to be able to offer a job to everyone who is successful at the interview and assessment,” he says.

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Salary Details: Remuneration value up to $149 668 p.a., comprising salary of $131 177 p.a., employer contribution to superannuation (up to 12.75%) and annual leave loading (17.5%) (Nurse Grade 9 [2]). Duties/Abilities: Accountable for leadership, innovation and excellence in the continuum of care for Rehabilitation Mental Health Services across multiple sites. Manage the operational delivery of clinical services in partnership with the relevant Clinical Medical Director. Be accountable for the administration, direction and control of the asset management and financial management of one or more of the relevant cost centres in the program stream. Assist the Nursing Director (Grade 9 [3]) in the provision of leadership of professional nursing services within the Mental Health Service Group. Enquiries: Michael Catt (07) 4433 3088. Job Ad Reference: TV138793. Application Kit: www.smartjobs.qld.gov.au or (07) 4750 6771 Closing Date: Sunday, 24 August 2014 (applications will remain current for 12 months). health â&#x20AC;˘ care â&#x20AC;˘ people Page 20 | www.ncah.com.au

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Expand your professional skills and knowledge with the exciting concept of Education at Sea. For full conference information and details please visit www.educationatsea.com.au Cardiology Care in the 21st Century South Pacific Cruise: Oct 26th - 3rd Nov 2014 Mothers, Babies and the Health Care Professional "Child Health Nurses and Midwives - Where do we fit in" South Pacific Cruise: Nov 8th - 15th 2014 Midwives On Board! 2015 Contemporary Issues In Maternity Care South Pacific Cruise: Feb 8th - 18th 2015 Dual Diagnosis: the complexity and importance of care Thailand & Vietnam Cruise: Feb 11th - 18th 2015 Diabetes and Nutrition within the Ageing Population: Personalising your approach to Prevention, Treatment and Care South Pacific Cruise: Mar 14th - 22nd 2015 The Australian College of Emergency Nursing: TNCC Trauma Nursing Core Course Seventh Edition South Pacific Cruise: Mar 14th - 22nd 2015 Perioperative Nursing South Pacific Cruise: June 8th - 18th 2015 Nurses for Nurses Network 2015 Annual Conference Western Caribbean Cruise: July 12th - 19th 2015 For conference information and bookings please visit www.educationatsea.com.au Nursing Careers Allied Health - Issue 16 | Page 21

Doctors urged to spot rheumatic fever Indigenous people are at increased risk of contracting acute rheumatic fever, which is preventable but leads to deadly heart disease if undetected. When Kenya McAdam’s joints started hurting when she was 15, she thought it was due to a recent soccer game, or growing pains. But within a week she had been rushed from Kununurra in the Kimberley to a Darwin hospital, where she suffered a cardiac arrest. She was diagnosed with rheumatic heart disease (RHD) and underwent heart surgery, which she may need every decade for the rest of her life. Australia has one of the highest rates of RHD in the world, with indigenous people 64 times more likely to contract it as a result of weakened immune systems due to poverty and deprivation. A seminar being held in Darwin this week is training health workers to be on the lookout for the preventable illness.

Acute rheumatic fever is caused by a reaction to a streptococcus bacteria, inflaming the heart, joints, brain and skin, and if untreated it can cause RHD, where the heart valves are stretched or scarred, interrupting blood flow. “I didn’t realise how sick I was at first, and then when I was told, I went `wow’. All of that inside of me and I didn’t even know,” Kenya, now 18, told AAP on Tuesday. Her mother Cherie says she had persistent sore throats as a child, which are a symptom of the disease that doctors failed to diagnose. Kenya’s brother Luke has rheumatic fever and her youngest sister Mercii has a congenital heart condition. Many Australian medical professionals have never seen a case of acute rheumatic fever because

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it has largely been eradicated in urban settings, said Professor Bart Currie, director of RHD Australia. Almost half a million new cases are identified each year around the world, especially in the Pacific region, and it kills 230,000 people annually. Cherie and Kenya are urging health professionals to be more aware. “Women, we share the same heartbeat as our kid,” Cherie said. “We know when something is up ... If she keeps coming back (to the doctor) you listen to her, and dig deeper.” An earlier diagnosis might have prevented Kenya’s condition becoming the disease, which will limit her in terms of employment and physical activity, Cherie said. Experts are also converging in Darwin for the largest study on RHD and pregnancy conducted across Australia and New Zealand. The disease is often undiagnosed but is unmasked by pregnancy when women’s hearts are under stress, and can make them very unwell. The study is ongoing, but preliminary results show that a limited access to specialist health care in remote communities, a high turnover of staff and multiple layers of health records are preventing pregnant women from getting the care they need. But in Kununurra now when children present with sore throats, they immediately receive injections to battle possible rheumatic fever, said Cherie. “We’ve been instigators of change for the better so other families don’t have to go through what we’ve been through,” she said. Copyright AAP 2014

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MERCY HEALTH: CARING FOR A LIVING Health services

Associate Nurse Unit Manager Operating Suite (Grade 3B) • Perioperative Services / Mercy Hospital for Women • Full time 76 hours/fortnight (Part time negotiable) Mercy Health is a Catholic organisation employing over 5,000 people who provide compassionate and holistic care through our acute hospitals, aged care facilities, mental health programs, palliative and respite services, maternity and women’s health services, early parenting services and home care services. An opportunity exists for a motivated and experienced Registered Nurse with Post Graduate qualifications in Perioperative nursing, to become part of our leadership team. Our unit caters for women who require specialist surgical care in Obstetrics, Urogynaecology, Reproductive Medicine, Gynaecological Oncology, Endosurgery and General Gynaecology. As a highly organised and motivated team member, you will possess excellent clinical and interpersonal skills coupled with a strong customer care focus. This is a fantastic opportunity to join an award winning organisation and take the next step in your career. Attractive salary packaging benefits and a wide range of health and wellbeing initiatives are available. Enquires to: Louise Alexander, Nurse Unit Manager, Perioperative Services on 8458 4108 Quote Ref No: MHW 04 Applications Close: Friday 15 August 2014

For more information and to apply, please visit careers.mercy.com.au Nursing Careers Allied Health - Issue 16 | Page 23

The colour of wounds and its implication for healing By Bonnie Fraser RN BSc, BNURS Wounds are very common across the spectrum of health care settings, with a range of presentations including traumatic or surgical wounds and chronic wounds such as diabetic foot ulcers and leg wounds (in particular venous stasis ulcers and arterial ulcers), ischemic wounds (gangrene) and pressure injuries. Less common wounds may include vasculitic ulcers, necrotising fasciitis, pyoderma gangrenosum and calciphylaxis. With any wound it is important to understand the aetiology in order to develop an appropriate management plan, but also to properly manage any comorbidities that may be associated with the development of the wound or limit the healing potential.Locally, the type of tissue in the wound bed may give important clues about the stage of healing or whether the wound will heal. Wound assessment must therefore be holistic and incorporate key aspects of both the patient and the wound to ensure the best possible outcome for the individual. While holistic assessment is the foundation for thorough wound assessment, this article will focus on wound characteristics, in particular tissue types and the condition of the surrounding skin. Healthy Skin As the outer layer of the body, skin provides a protective barrier to environmental influences allowing us to respond to a myriad of environmental stimuli. Skin forms an impervious barrier to changing weather conditions as well as chemical and bacterial assault. Skin contains thousands of sensory nerve endings that detect changes in temperature, pain and pressure, and facilitate thermoregulation. Skin has metabolic functions producing vitamin D in response to sunlight and secreting salts through sweating. Skin plays an important cosmetic role,influencing how we

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view ourselves and communicate with others. Any failure in skin integrity results in a wound. All wounds, regardless of their cause and healing intention (discussed in a future article), must progress through the stages of healing in order to close and restore skin integrity. The following provides a guide to understanding various tissue types associated with wounds. Tissue types and wound healing Management of a patientâ&#x20AC;&#x2122;s wound will be determined by the wound tissue present and exudates. The different types of tissue can easily be remembered by colour. Necrotic tissue, termed eschar, is easily identified as black or dark brown in colour. Eschar may be dry or moist and presents as thick and sometimes leathery necrotic tissue cast off from the surface of the wound. Eschar inhibits the proliferative and maturation phases of wound healing by preventing the formation of healthy granulation tissue and inhibiting wound contraction and epithelialisation (new skin growth). Moist eschar supports bacterial growth increasing the risk of infection and ideally should be debrided. Dry eschar, on the other hand, forms an impervious barrier to external microbial contamination. In patients with compromised circulation, for example patients with peripheral arterial disease or diabetes, it is best to leave the eschar in place until investigations can determine the degree of arterial disease. Wounds with a poor blood supply have minimal oxygen and nutrients being delivered to the wound bed and surrounding tissues, limiting wound healing potential and removal of a dry eschar may cause further deterioration of the wound and increase the risk of infection. Slough (also necrotic tissue) is a non-viable

fibrous yellow tissue(which may be pale,greenish in colouror have a washed out appearance) formed as a result of infection or damaged tissue in the wound. The presence of slough may indicate the wound is stuck in the inflammatory phase (chronic wounds) or the body is attempting to cleanthe wound bed in preparation for healing. Slough is usually a combination of leucocytes, bacteria, devitalised tissue or debris and usually has a moist, shiny stringy appearance or may be firmly attached to the wound bed. Granulation tissue is a collagen rich tissue forming at the site of an injury during the proliferative phase. As the wound heals this tissue fills in the wound deficit replacing the blood clot formed during haemostasis and eventually forming scar tissue. Healthy granulation tissue is bright red with a grainy appearance, due to the budding or growth of new blood vessels into the tissue. This tissue is firm to touch and has a shiny appearance. It is essential to protect the granulation tissue to allow the epithelialisation process to proceed in order to close the wound. Granulating wounds require adequate tissue perfusion; a slightly acidic environment; a stable wound temperature; good bioburden control; moisture balance; a reduction of factors which may prevent healing (e.g. the underlying cause of the wound);and protection from physical trauma. Hyper-granulation tissue (often called overgranulation) is an excess of granulation tissue over and above that required to fill the wound cavity. Hyper-granulation tissue may appear dark red and devitalised (due to poor oxygenation) or pale due to lack of oxygen. Hyper-granulation tis-

sue inhibits the migration of epithelial cells across the wound surface and increases the risk of scar tissue formation by preventing the wound edges from closing. Hyper-granulation tissue may be the result of prolonged inflammation due to infection or the presence of an irritant or foreign body; overuse of occlusive dressings; constant rubbing of dressings or tubes against the skin causing an inflammatory response (e.g. a peg tube or supra pubic catheter); allergy to dressings; or imbalance of cellular activities that regulate the production of healthy tissue. With any hyper-granulation tissue it is important to identify and treat the cause and to eliminate malignancy. If occlusive dressings have been used change to a vapour permeable dressing. The application of light pressure to the wound bed using a foam dressing with tubigrip compression may reduce the overgrowth of tissue. Additionally, hypertonic dressing (e.g. Mesalt) may dehydrate the overgranulation. In case of infection, antimicrobial dressings such as silver, iodosorb or medical honey may also help to dehydrate the wound. Apply light pressure to the wound bed. It is important to swab the wound to determine bacterial burden and to eliminate infection as a causative agent. Epithelialisation is the regeneration of new skin (epithelium) over a wound and signifies the final stage of healing. Epithelial tissue, light pink in colour, usually migrates inwards from the wound margins or may appear as small islands of tissue over the surface of the wound.

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 16 | Page 25

New camera technology for Victorian ambulances Innovative reversing camera technology is being rolled out in new ambulances across Victoria. The technology, designed to provide paramedics driving ambulances with a clearer view of the rear cabin, is already installed in about 50 new ambulances across the state. Paramedics driving ambulances already view reversing camera vision directly on the rear vision mirror instead of on the dashboard. Under the new system, the images on the rear vision mirror will automatically switch from reversing vision to the interior view of the rear compartment when the ambulance is moved from reverse into drive. Ambulance Victoria says there is no camera located in the back of the cabin, instead a cam-

era in the front of the vehicle provides the driver with a view thatâ&#x20AC;&#x2122;s the same perspective as the rear vision mirror - albeit an improved view. The camera does not record any images but instead displays real-time images to the ambulance driver. The technology is being rolled out only in new ambulances as they enter the fleet after a successful trial of the technology in five ambulances last September. The Victorian initiative is possibly the first time reverse camera technology has been used to provide ambulance drivers with vision of the rear ambulance compartment.

For the fullCMYK article visit NCAH.com.au 416-021 1/2PG FULL COLOUR PDF

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Nursing Careers Allied Health - Issue 16 | Page 27

Alcohol Detoxification and Rehabilitation: challenges for health professionals By Glynis Thorp

s health professionals we must never underestimate the dangers of alcohol withdrawal. Alcohol is a central nervous system depressant and abrupt cessation can overstimulate the autonomic nervous system. A respected doctor I had the pleasure of learning from once told me a story which highlights the importance of recognizing and treating alcohol withdrawal: Imagine putting four people in a glass room that you can see and hear through and sit back and observe. One of these people is addicted to opiates, the second is addicted to amphetamines, the third is addicted to benzodiazepines and the fourth is an alcoholic. Over a period of time if deprived of their drug of choice they will experience withdrawal. The person who is addicted to opiates will sweat profusely, have severe stomach cramps and desperately beg you to help them with pain relief so that they can start to feel normal again. This is an important point that we must remember: it is not to get high anymore, it is to feel normal. The amphetamine addict will be very angry, probably hitting the walls and demanding medication while they scratch at their skin, causing abrasions. The person with a benzodiazepine addiction will be very frightened, shake, twitch and not be able to sleep. The alcoholic will probably sit in a corner, terrified and super sensitive to noise; have visual hallucinations; feel like things are crawling over them; slump over; and possibly have a fit and die. It is important to remember that patients that go through alcohol withdrawal under our care will likely not have been admitted specifically for alcohol detoxification. Withdrawal is more likely to

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be inadvertent due to illness and lack of access to alcohol. Withdrawal symptoms usually occur 6–24 hours after the last alcoholic drink (however this can vary depending on the patient and the nature and extent of their alcoholism). The signs of alcohol withdrawal include anxiety, agitation, sweating, tremor, nausea, vomiting, abdominal cramps, diarrhea, craving, insomnia, elevated blood pressure, elevated pulse and elevated temperature, headaches, seizures, confusion, perceptual distortions, disorientation, hallucinations, delirium tremens, arrhythmias and Wernicke’s Encephalopathy (WE). WE symptoms include: opthalmoplegia, ataxia and confusion. The scales used to monitor withdrawal in Australia include: • AWS,Alcohol Withdrawal Scale • CIWA AR-Clinical Institute Withdrawal Assessment of Alcohol Scale (Ensure you use the scale that is recommended by your employer in their guidelines and policies and procedures.) Medications that may be prescribed to assist patients suffering from alcohol detoxification symptoms include: • Anti-anxiety medicines (benzodiazepines such as diazepam) which treat withdrawal symptoms such as delirium tremens (DTs). • Seizure medicines to reduce or stop severe withdrawal symptoms during detoxification. • Medicines for recovery include Disulfiram (Antabuse), which makes the person sick (vomit) if they consume alcohol. • Naltrexone (ReVia, Vivitrol), which interferes

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News in brief: Clotting drug may aid hip patients Giving hip or knee replacement patients a clotting drug may reduce the need for a blood transfusion during surgery, experts say. - tinyurl.com/kygr88q

Psychology leader develops app for headaches An international authority on the treatment of headache pain is leading the research into the use of the app, which acts as an electronic diary to record ratings of headache pain. - tinyurl.com/nr37unp

Swine flu cases rising in Australia Nearly 21,000 cases of flu have been confirmed in Australia so far this year, double the number of cases at this time last year. - tinyurl.com/ltqf4pz

Healthy ways of coping with night work Night workers who have trouble sleeping after their shifts shouldn’t rely on sleeping pills, a German psychologist warns. - tinyurl.com/oy4b6l7

Cancer survivors face challenges The prevalence of alcohol abuse and dependence in our society means that as health professionals many of us will be confronted with alcohol withdrawal symptoms. It is vital that we are familiar with the warning signs and symptoms of alcohol withdrawal as mismanagement or the absence of appropriate care can have severe consequences. References Sydney Alcohol Treatment Group-http:// www.alcpharm.med.usyd.edu.au/ accessed 2010 2/8/2014.

When GP Elysia Thornton-Benko suspected something wasn’t quite right with her body she did everything she tells her patients not to - ignored the symptoms and carried on. - tinyurl.com/m7roz7y

__________________________________ For more news and articles on nursing and allied health visit our website:

www.ncah.com.au

Nursing Careers Allied Health - Issue 16 | Page 29

More graduate nursing training places needed

he New Zealand government’s move to fund an extra 200 places in the nurse entry to practice program will still leave hundreds of trained nurses without work, according to nurses. The New Zealand Nurses Organisation (NZNO) is calling for the government to fund a one-year Nurse Entry to Practice (NEtP) program for all new graduate nurses, and has launched a petition which has received more than 7000 signatures. NZNO acting professional services manager Hilary Graham-Smith said while an extra 200 graduates will receive essential support and mentorship, others will miss out on the vital training. “Two hundred new NEtP positions still leaves too many nurse graduates without support,” she said. “These new positions do not start until 2015 by which time there will be another cohort of graduates, meaning more new grads in the market for places and a talent pool currently sitting at around more than 400 trained nurses without work.” The petition was launched after concerns that large numbers of graduate nurses are failing to secure work in a clinical setting due to a limited number of NEtP program places while employers are also seeking candidates with experience. Health Minister Tony Ryall said up to 200 additional places will be created in the program, taking the total number of places to 1300, and comes at a cost of $2.8 million. Mr Ryall said 160 of the places will be created at public hospitals and district health board-funded community health services while 40 places will be based at aged care facilities across the country. “Nurses are at the frontline of care providing

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roundthe-clock care and support to patients and their families,” he said in a statement. “As our ageing population grows and demand on health services increases, we need even more nurses working in our communities.” Mr Ryall also recently announced $1.5 million to fund an extra 25 scholarships for nurse graduates to work in general practices in some of the country’s high needs communities next year. Under the scholarships, 48 graduate nurses are this year working in Very Low Cost Access (VLCA) practices. “This was the first time scholarships like this has ever been offered,” he said. “The feedback from general practices and graduate nurses has been so positive we are investing extra money to offer scholarships again next year.” The recruitment process for the 12-month scholarships begins this month.

Leave a comment on this and other articles by visiting the ‘news’ section of our website: www.ncah.com.au To go to the article “More graduate nursing training places needed” directly, visit: http://bit.ly/1A92cq1

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EARN SOME EXTRA $$$ Nursing and Midwifery Educators and Clinical Specialists NCAH is looking to hire expert nurses and midwives to write nurse practice related articles on a freelance basis. If you are an experienced Australian nurse educator or nurse specialist, and you are interested in writing to complement your income on a very flexible basis we would love to hear from you. Nursing and Midwifery experts are sought to write articles covering one or more clinical areas including but not limited to: • Accident & Emergency • Aged Care • Paediatric Nursing • Healthcare IT & Information • Midwifery & Neonatal nursing • Nurse Leadership and Management

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Nursing Careers Allied Health - Issue 16

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NURSING & MIDWIFERY SCHOLARSHIPS Open 21 July 2014 â&#x20AC;&#x201C; Close 15 September 2014 Scholarships are available for nurses & midwives in the following areas: > undergraduate

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