Ncah issue 21 2014

Issue 21 27/10/14 fortnightly

Aged Care Feature Nurses voice concerns over Dying with Dignity Bill Pharmacists applaud immunisation move Mental health inside a police cell The art of listening as affirmation

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Nursing Careers Allied Health - Issue 21 | Page 3

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www.ncah.com.au www.ncah.com.au Issue 21 26January August Issue 27 October2013 2014 117––20 2014 Issue 17 – 26 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 21,2014.

2014.

1, included in Issue 17, 2013.

If you are interested in pursuing any of these opportunities, Ifplease you are interested in pursuing any ofvia these contact the advertiser directly the opportunities, contact details please contact the advertiser directly via the details provided.

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The NCAH Magazine is the most widely distributed national The NCAH is the most widely distributed national nursing andMagazine allied health publication in Australia nursing and allied health publication in Australia For all advertising and production enquiries please contact For all advertising and8700, production us on +61 (0) 3 9271 email enquiries please contact us on +61 (0)306 3 9271 email 1300 5828700, careers@ncah.com.au or visit www.ncah.com.au careers@ncah.com.au or visit www.ncah.com.au If you would like to change your mailing address, Iforyou likeon toour change your mailing address, be would included distribution, please email or be included on our distribution, please email careers@ncah.com.au careers@ncah.com.au Published by Seabreeze Communications Pty Ltd Trading as NCAH. Published by 328 Seabreeze ABN 29 071 053. Communications Pty Ltd Trading as NCAH. ABN 29 071 328 053. © 2013 Seabreeze Communications Pty Ltd. 2014 Seabreeze Communications Pty Ltd. © 2013 All rights reserved. No part of this publication may be copied or All rights reserved. part of this publication may bepermission copied or of reproduced by anyNo means without the prior written reproduced byCompliance any means without prior written permission the publisher. with thethe Trade Practices Act 1974 ofof the publisher. Compliance thepublication Trade Practices Act 1974 of of advertisements containedwith in this is the responsibility advertisements contained in this publication is the responsibility of those who submit the advertisement for publication. those who submit the advertisement for publication.

Advertiser List Advertiser List Advertiser List Advertiser List AHNFlight Recruitment Care AHN Recruitment Belmore Nurses Bureau Ausmed CCM Recruitment International Bupa Ausmed Austra Health CQ Nurse Calvary AustraWakefield Health Hospital AustralianCruises College of Nursing Education CCM Recruitment International Australian College of Nursing Employment Office International Australian Volunteers Chadwick Group Australian Volunteers International Geneva Health CCM Recruitment International Charles Sturt University CCM Recruitment International Griffith University CQ Nurse CQ CQNurse Nurse Health and Fitness Recruitment CRANAplus First State Super CRANAplus Koala NursingOffi Agency Employment ce INurse Employment Office Lifescreen eNurse Lifescreen eNurse Australia Medacs Kate Cowhig International Medacs Australia Kate Cowhig International Medibank Health Solutions Medacs Australia Miwatj Health Service Medacs Australia Northern Sydney Local Health District Oceania University of Medicine No Roads to Health No Roads HealthHealth Rural Locum Nursing andtoAllied Oxford NSW Aunts HealthCare - Illawarra Shoalhaven Scheme NSW Health - Illawarra Shoalhaven Pulse Staffing Oceania University of Medicine Oceania OceaniaUniversity University of of Medicine Medicine Quick andAunts Easy Finance Oxford Care Oxford Aunts Care Oxford Aunts Care Silver Chain Pulse Staffing Pulse PulseStaffing Staffing Smart Salary Health Queensland Quick and Easy Finance Queensland Health UK Pension Quick andTransfer Easy Finance TR7 Health Quick Healthcare and Easy Finance Unified Group Royal Flying Doctor Service UK Pensions Royal Flying Doctor Service TR7 Health Unified Healthcare Group TR7 Health UK Wimmera Healthcare Group UKPensions Pension Transfers UK Pension Transfers Unified Healthcare Group Unified Healthcare Group

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Nursing Careers Allied Health - Issue 21 | Page 7

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The Art of Listening as Affirmation OUM’s innovative RN to MD teaching style is

By Ellen Rosenfeld fantastic and exciting.

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Make the dream of becoming a doctor a reality, earn your MD at Oceania University of Medicine.

n aAttractive fee structure for our Graduate Entrywhose Program. interviews re-traumatised people memos a public health researcher I worked for OUM allows the student riesof their currently admission wereand very painful.

One of time in an acute inpatient ward of a large n Over 150 students enrolled over 50 graduates to benefit from Zealand,was Samoa USA. call perhaps these New strategies a and telephone mental health facility. In this both ward some of thein Australia, local andwith international n Home-based Pre-Clinical Study under top international two days post interview, simply asking particistaff had worked particularconsumers over medical school scholars, using world leading Pre-Clinical, resources. pants how they were travelling. I was struck by many years, knowing their capacities and dif24/7 online delivery techniques.

Brandy Wehinger, how frequently people would say that on the conficulties well.

A keen observerRN of human intern Clinical Rotations can be performed locally, Interstate or OUM Class of 2015 trary, rather than feeling anxious or traumatised, action, I was particularly struck by two nurses:Internationally. they deeply appreciated able toAdvisor. tell their one a young man in his late thirties, n Receive personalised attention frombeing an Academic to someone who really listened, as if this and the other a woman in n herOUM stories Graduates are eligible to sit the AMC exam or NZREX. was a rare occurrence. I interpreted these comsixties, who listened inments in the context of the relative luxury I had tently to their patients’ Applications are now open for courses starting in January and July - No age restrictions as a researcher speaking to people individually stories, the kind of or in focus groups, in contrast to nurses, who “active listening” juggle a myriad of clinical tasks and obligations. you observe in INTERNATIONALLY ACCREDITED For information visit www.RN2MD.org or 1300 665 343 How hard must it be for nurses to really attend to people wholly consumers on wards, when their minds are rolling engaged in the through a list of tasks to be achieved prior to their language of the change of shift? person they are TheREGISTERED fundamentaltenet of therapeutic listenrelating to. The FOR UNIQUE OPPORTUNITY NURSES ing is nothing new in clinical spheres. There is nurses’ body Are you a self-motivated registered nurse a wealth of academic literature promoting the language was searching for work/life balance? therapeutic benefits of listeningwell in any clinical calm emAre you an ICU, ED, recovery, HITH,and or even remote (Hirdes A, 2003; Stickley and Freshwater, pathic.

There was nurse searching for a way to earn income, and fit setting in around your existing lifestyle?

2006). Attending closely to other people, patients no visible attempt to Lifescreen provides Health Services to the Insurance Industry, or friends, is a skill that some people are innately formulate responses, and Clinical Services for several pharmaceutical companies. better at than others, with ongoing debate about something Freud promoted We are looking for nurses to join our expanding operations to whether or not listening skills can be learned. Ac(Purdy, 2011).

Nor was there conprovide community-based services for our clients. tive listening is a core component of clinicians’ descension or offer a sense difference Lifescreen can you: of the innate To be considered for a role as ano nurse contractor of speaker and listener. There was way, or in- forcommunications skills training in undergraduate • Extra $$$ Lifescreen you must have the modules. deed to quantify of these in• need, Work/life balance the outcomes following: Deep attentive listening is also a skill we need teractions.It was clear that this attentive listening • Continuity of patient care • Registered nurse with >5 in life generally, but one we tend to take for grantwas•nurturing and deeply appreciated. years experience Job satisfaction consider It seems later I had the privilege of coorForthan enquiries or closely. to apply, please comcall • Australian Citizen ed rather •Some Certifiyears ed CPR/anaphylaxis training providedproject at no cost 1800 123 send your mon sense that673 when weorperceive the resume listeneras dinating a research exploring • ABNthe experito you to evaluations@lifescreen.com.au wholly focussed on us, we are acknowledged ence of people with mental illness had been • who Cannulation competent and respected by them. Equally all of us have admitted involuntarily to hospital,• a Strong predominantwritten and verbal ly qualitative project. The project communication team createdskills had the experience of recognising the distraction • Own andmy mobile of phone a listener, and how this seems to negate us. a number of “safety net strategies,” in car case

OCEANIA UNIVERSITY OF MEDICINE

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406-010 405-013 1PG FULL COLOUR CMYK PDF 404-011 402-036 323-022 1PG FULL COLOUR CMYK PDF 401-003 321-014 1320-006 1PG FULL COLOUR CMYK PDF (RPT) 407-013 324-020 322-035 403-015 419-006 417-007 409-012 412-005 420-005 415-007 413-010 411-011 414-005 408-007 418-004 416-004 421-007 Philosophers like Martin Buber emphasised the deep need of all of us to be affirmed by the people we speak to, to be acknowledged irrespective of the kind of social encounter (Gordon, 2011).

How then to translate this very basic life and clinical skill into core practice? The enduring debate about the gap between policy and practice is relevant here. Nurses are often simply too busy, understaffed, and inundated with paperwork to be as attentive to patients as they would wish.

Psychiatrists bemoan the current medication focus at the expense of more reflective therapeutic modalities of twenty or thirty years ago.Clinical settings are often noisy and hyper-stimulating, offering little in the way of calm, reflective space.

There are additional cultural factors posing challenges. This is very obvious when reading anything written in the nineteenth century or before, when writers such as Charles Dickens went to what seems to our current sensibilities extraordinary lengths to describe a person’s physical self, their face, voice, gait and general manner.

People today are far more inclined to be intently focussed on small rectangular screens than on peoples’ faces and voices.Medical students on rotation in a mental health facility in which I worked would attend the staff tea room, a place where psychotherapists and nurses would frequently discuss various theoretical approaches, their challenges, utility and acceptability to consumers. This seemed a perfect milieu for students to listen, to ask questions and to learn from people with lengthy experience in a range of psychological treatments. Instead they sat heads down, thumbs frenetically tapping a phone, wholly engaged in their digital devices.Will the skill of attentive face-to-face communication simply atrophy as people fixate more on screens and less on other human beings?

For the full article visit NCAH.com.au

Nursing Careers Allied Health - Issue 21 | Page 9

TRIAGE Time is Critical

By Glynis Thorp Triage is a well-embedded process in contemporary hospital settings. However, historically, administrative clerks conducted the processing of visitors to emergency departments and patients were subsequently seen in the order in which they arrived.

Increased demand for emergency healthcare services, and the clear need to apply risk management principles in order to prevent the detioration of high risk patients, has led to the development of the modern triage system.

Triage is a risk management process used to determine the priority and urgency with which patients will be treated based on an evaluation of the symptoms and severity with which patients present. The term ‘triage’ is derived from a French verb, trier, meaning to separate, sift or select. It is believed that triage may have originated during the Napoleonic Wars.

French doctors treating the battlefield wounded at the aid stations behind the front also used the term during World War 1. The basic triage process applied was to treat those for whom immediate care might make a positive difference to their outcome, while those who were likely to die regardless of the care provided, and those who were likely to live regardless of the care provided, were not provided with any treatment.

This concept of evaluating and dividing patients has been developed and enhanced over many years, culminating in the modern triage system.

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The Australian Triage Scale Categories are: Time to be seen Australian Triage Scale 1 - Immediate Australian Triage Scale 2 - 10 minutes Australian Triage Scale 3 - 30 minutes Australian Triage Scale 4 - 60 minutes Australian Triage Scale 5 - 120 minutes Members of the Australian public that visit emergency department often do not understand the triage process that they are subject to, and very little information is provided to mitigate this.

By comparison, in some parts of the world such as Mexico the triage codes with colour codes are displayed in waiting rooms so that patients know what is happening.

They are told which triage category they have been allocated to.

The triage nurse must be very experienced and highly skilled. Some facilities even go so far as to say they must be the most highly skilled nurse in the emergency department.

Knowledge and experience will give the nurse the necessary skills to recognize the differences between a headache caused by sinusitis or a migraine from that of a brain hemorrhage; or a potential anaphylaxis as opposed to a mild allergic reaction.

For the full article visit NCAH.com.au

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Nursing Careers Allied Health - Issue 21 | Page 11

Physiotherapist pavesa the wayCell in Mental Health Inside Police mental health

By Camille Dowling – Clinical Nurse Specialist 2

By Karen Keast

H S

ealthcare professionals working in a custodial environment typically exposed eventeen years ago, are Kevin Lau had a few to areservations confrontingabout set of symptoms and condiworking as a physiothertions,in the not mental limitedhealth to: anxiety, panic attacks, apist field. hearing voices, low or depressed mood, decryToday, as the head of the physiotherapy ing, screaming, delusions and paranoia.

Often partment at a large psychiatric hospital in Westthese people – patients or inmates – are in an ern Australia, he wouldn’t have it any other way. acute state of mental instability. A multidiscipli“The longer I worked in the area, I thought nary team consisting of nurses, medical and alwow, this is an area that a physiotherapist is lied healthcare professionals collabin a very unique position to be able orates to provide mental health to help people with mental health support by engaging other issues because of our trainstakeholders, assessing ing and expertise in physithe mental health stacal health care,” he said. tus of the inmate and “Sometimes I call implementing stratephysiotherapists workgies that reduce the ing in this area the risk of the inmate physical health gateharming themselves keeper of a person (JH&FMHN., 2010). with mental health isSo what is a mensues. tal health disorder “We can screen, we and how is it defined in can assess, can proa prison or we custodial setvide appropriate early interting? Mental health probventions to deal withathewide physical lems incorporate range co-morbidities a person substance with mentaluse, of behavioursofincluding health moodissues.” disturbances, anxiety and disturbances Mr Lau isand oneperception of just a few physiotherapists in thought (Neugebaur, 1999). nation-wide specialising in mental health. by the According to the information published OriginallyHealth from Hong Kong, MrReport Lau said he Australian and Welfare (2012) works to improve patients 46% of prisonersthe in physical Australiahealth were of diagnosed with range of mental health includwithamental health issues onconditions, entering the crimiing depression, bipolar disorder, schizophrenia, nal justice system. A high proportion of persons adjustment society and can borderline entering thedisorder criminal in justice system appear personality disorder. to the local community and stakeholders to lot of the time patients with mental be “A mentally disordered.

Therefore, it is health underissues are unmotivated due to a number standable that each stakeholder formsofareadifsons of their and mental health issues, so ferentbecause understanding definition of persons appearing to sedentary. have a mental health disorder. they are quite

Page 12 | www.ncah.com.au

It is well documented that people with mental health disorderstheare over-represented the “Sometimes person may suffer an in injury criminal justice system (McCausland et al., finan2013). and not go to work and then they suffer An Australian measuring prevalence cially and they study become stressedthe and that stressof mental health disorders among offenders nationcomponent needs to be addressed as well, not ally highlights this argument (Forsythe & Gaffney just the broken bones or the back injury as such 2012). The data collected by The Australian In- we also need to look at the person holistically. stitute of Criminology Drug Use Monitoring in “As a physiotherapist, we can inspire and Australia (DUMA) program captured the drug use empower an individual, say for example, of 690 detainees. Interestingly, half of through motivational interviewing, the detainees reported having encouragement and reassurbeen diagnosed with a histoance to help an individual ry of mental health disorder to achieve their goals to (Australian Government; improve their physical Australian Institute of activity level to proCriminology 2012). mote their recovery, The Mental Health not just physically Act 2007 (NSW) conbut also mentally.” tains specific legislaMr Lau said tion that governs how physiotherapists can mental health patients/ also provide safe and inmates are managed effective non-pharmain a custodial setting. It ceutical interventions also permits the Police and such as manual therapy Magistrates to recommend and dry needling to assist mental health assessment by with spepain. cialists such as psychiatrists prior to in“Sometimes their medication may affect carceration.

This process enables mentally distheir balance andthe musculoskeletal and ordered persons opportunity tosystem be correctly

sometimes a higher riskHowever, of falls diagnosed that and person treatedhas appropriately. because ofalways that,” he this is not theadded. case with people displaying “Especially ashealth they get older in aInpsychiatric unstable mental symptoms. my expesetting, people are more likely to have falls risk rience, when individuals in custodial environso that’s why we provide falls risk assessment ments are appropriately assessed by mental and effective intervention to improve their mobilhealth specialists they are often determined to ity prescribe necessarydespite walkingbeing aids difas notand be to mentally disordered, required.” ficult to manage in the context of a police or The environment.

Australian Physiotherapy prison For individuals Association already suf(APA) to play more of a feringwants from aphysiotherapists mental health condition, incarceration imposemental a significant additional stress role in can addressing health issues.

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Moreover,ranging paranoia is respiratory, and to orthopedic amusculoskeletal, common difficulty that may lead the inmateto neurological conditions,” he said. being convinced the healthcare professional is “Physical and mental well-being are insepa“out to get them”. rable - a person with mental health issues often The most important consideration for nurses suffers from a variety of physical conditions, or other healthcare professionals providing suplargely due to the side effects of psychotropic port or care to mentally unstable patients in acute medications and poor lifestyles.” settings such as police cells is to minimise the Mr Dripps said physiotherapists should have risk of harm to themselves, colleagues or the a stronger role in assisting people living with a patient. Risk management systems, procedures mental illness, from raising awareness to providand strategies must be in place, and all healthing pain and chronic disease management, facilicare workers in the custodial setting must be aptating self-management, and dealing with the copropriately trained. morbidities associated with mental illness.

Appropriate safety precautions will generally “Through greater funding, increased awareinclude placing a corrective services officer to ness, better referral pathways and more training monitor and observe the inmate closely (typically opportunities for physiotherapists to specialise in hourly observations) until further assessment by mental health, we can be part of the solution to the mental health team can be completed. Inthis issue.” mates Mrthat Laubecome agreed.acutely unstable will typically be transferred to aone hospital medical “In Australia, in fourfor or afive peopleand will mental health assessment.

More often than issue not, experience some sort of mental health the inmate returns to so their police you cell are where throughout their life, whether in aCorpsyrective Services are advised by the appropriate chiatric hospital setting or even in a normal comhealthcare to continue observe munity youprofessional will find people that mighttohave some the closely andissues,” to document the patient’s sortpatient of mental health he said. movements.

“I have been continuously working in this Evidence-based research, which area for so long and scientific I’m still enjoying every day governs clinical practice in health settings, conof my work.” tinues to provide healthcare professionals with an understanding of the efficacy of and mental health Leave a comment on this other interventions such as: providing the resources for articles by visiting the ‘news’ section correct diagnosis, compliance with medication of our website: www.ncah.com.au and engaging community mental health services To go to the article “Physiotherapist to deliver best practice (APS. 2010).

paves the way in mental health” directly, visit: http://tinyurl.com/q2pvylg For the full article visit NCAH.com.au

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Nursing Careers Allied Health - Issue 21 | Page 13

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Nursing in the war of Ebola YOU CAN MAKE A DIFFERENCE

By Karen Keast

L

“It’s tough because it’s still escalating, ibby Bowell was walking to the supermarket it’s not going away and it’s catastrophic rewhen a woman collapsed in front of her. ally,” she says.

As a nurse of 30 years, normally Libby would “It’s aproviders war of disease and it’s like cancer stopSilver and render Chainassistance. is one of the largest community health in Western Australia (WA).

Country Division provides a range of support - itChain doesn’t discriminate.

But, in The Liberia at the Services moment, these are of farSilver including Nursing, Allied Health, Domestic Assistance muchdisease, more. I’ve “It’s not a poor and person’s fromservices normal circumstances. seen expertsServices: die. It’s from the top to the bot“As a nurse I couldn’t hervacancies - you just within Listed below are the touch current Country tom and everyone in between.” can’t break the rules, and I found that really Albany - Physiotherapist, Registered Nurse and Therapy Assistant Libby’s role in Liberia did not involve any hard,” she says.

Beacon - Remote Area Nurse direct patient care.

“You have to- keep that distance Busselton Physiotherapist Instead, she worked to and Kalgoorlie/Esperance try and get the ambulance - Registered and Enrolled Nurses (expressions of interest) Northam support the emergency reto that person.”- Nurse Practitioner Pilbara - Area Case Co-ordinator, Senior AHP sponse for the Liberian The deadly EbolaManager, virus Shark Bay - Remote Area Nurse Practitioner (PT with on-call requirements) Red Cross. is reported to have killed Western Australia - Chronic Disease Co-ordinator, Remote Area Nurse (PT positions) Libby worked at least 2000 people in If you to make a difference to Australian with the dead body Liberia, andwant the World communities then visit silverchaincareers.org.au today. management team Health Organisation and assisted in (WHO) estimates the developing and indeath toll has risen troducing a new to more than 4500 strategy to teach people from the 9000 communities how to infected in West Africa. safely care for EbolaLibby returned from infected family members Liberia last week, where unable to access one of the she worked as an emergency limited number of treatment health coordinator for the InterCharles Sturt University (CSU) can help you gain the qualification beds. national Federation of Red Cross (IFRC) you need to advance your career caring for others.

“It meant changing tactic from the ‘no and Red Crescent Society for five weeks.

Become a leader in health care of older people through touch’ technique to the ‘touch with care’ Libby has previously worked for the Red CSU’s Graduate Certificate or Master of Gerontology: technique,” she explains.

Cross in deployments to South Sudan and Si• interdisciplinary study designed for health and aged care practitioners “That was teaching them about isolating erra Leone for cholera outbreaks, in the Philip• enhance your skills in promoting the health of older people the person immediately in the community pines in the aftermath of the typhoon, Haiti fol• build advanced theoretical foundations for the health and aged care sectors and only having one caregiver because in lowing•thecomplete earthquake, in care Papua New Guineaprojects health practice-based and assessments Liberiaand it’scurrent very culturally normal to have all and in •theapplicants Solomon may Islands, and in Aceh in the be granted credit for prior learning competencies. of the family wanting to provide care for the wake of the tsunami.

Visit: www.csu.edu.au/courses/master-of-gerontology sick family member.

Now in isolation for 21 days at her home in “That was quite a big change for us but Newcastle, New South Wales, Libby rates her www.csu.edu.au something that had to really be taken on.” experience in Liberia as one of the toughest de1800 334 733 In communities battling Ebola, people’s ployments she’s encountered as an Australian lives have been put on hold.

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Page 14 | www.ncah.com.au

421-017 1PG FULL COLOUR CMYK PDF Libby says children no longer attend school, public meetings and football matches have stopped, and people refrain from going to the gym, shopping or meeting friends.

She says fear of Ebola is rife, as is the stigma attached to those who contract the disease.

“One day, I saw a couple of kids immediately after their mother died,” she says.

“Their father had already died and then I saw their mother get taken out in a body bag.

“I just saw an eight-year-old boy holding his one-year-old sister and everybody in that community was several metres away from them.

“There’s a lot of Ebola orphans now and you’ve just got to hope that the community supports them and looks after them.”

While Libby was mostly involved in high level government and partnership meetings with stakeholders, there was no escape from the grim reality of Ebola.

“I was at a meeting at the Ministry of Health one day when I saw a dead body get rolled out of a taxi just because there were no beds,” she says.

“In the last two weeks I was there, I had to go into the Ministry of Health headquarters for meetings and two people - a chief medical officer and another person from the Ministry of Health - died from tables that I’ve been sitting at, and the floor that we met on was closed and quarantined.”

Libby says one of her Liberian colleagues, with a similar nursing background, had lost 16 friends, colleagues and mentors.

“She’s lost a medical director, she lost an anaesthetist, she lost several nurses, she lost physician assistants,” she says.

“Liberia only had 100 doctors, they are down to about 85 doctors now.

“What they are going through on a daily basis is very confronting and something that we couldn’t even imagine.

“They get up and go to work every single day because they believe that they have to make this horrible thing go away - they can’t hide from it at all.”

While WHO has now declared Senegal and Nigeria both free of Ebola, it’s also warned there could be as many as 10,000 new infections a week in West Africa before the end of the year.

Libby says more health professionals are desperately needed on the ground to help halt the spread of the disease.

“We need to help them. It’s a global emergency,” she says.

“If you’re seriously thinking about going, have the conversation with your family and think there is a risk involved, for sure, but the rules and the guidelines around it are very strict and you’re very well supported while you’re there.

“If you’re not going to go, then that’s fine as well, but find another way to support (the fight) because it takes a lot of money.”

Libby, who works as the director of education at CRANAplus, the peak body for remote health practitioners, says she’s exhausted from working 15-16 hour days, seven days a week, throughout her five week stint in Liberia.

Otherwise, she’s healthy and has no concerns that she will contract the infectious disease.

“It’s a risk but it’s a low risk because I followed very, very strict guidelines,” she says.

“I moved about in the community but you wash your hands in a chlorine-based solution at least 20 times a day, you have your temperature taken at least half a dozen times a day, you keep this distance between yourself and other people.

“I haven’t shaken a hand, I haven’t hugged a person, I haven’t kissed a person and I will keep a pretty low profile.”

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 21 | Page 15

Nurses voice concerns over Dying with Dignity Bill

T

he Australian Greens’ proposed voluntary euthanasia legislation has received a mixed response from nurses.

Palliative Care Nurses Australia (PCNA) is at odds with the Medical Services (Dying with Dignity) Exposure Draft Bill 2014 now being considered while the Australian College of Nursing (ACN) has welcomed the Bill but called for changes and greater consultation.

A Senate committee is reviewing the draft Bill that proposes to allow doctor-assisted suicide for terminally ill patients.

PCNA president John Haberecht said the organisation does not support the Bill.

Mr Haberecht said health professionals and the community, unless they’ve had a direct experience, are often unable to understand just how well supported patients and their families can be at end of life.

“The very title of the Bill suggests that the only way to die with dignity is through euthanasia or assisted suicide, which is offensive to health professionals who work every day to ensure that patients at or near end of life have their symptoms managed as effectively as possible, that they have the best psychosocial care possible, and that their families are supported through this difficult time,” he said.

“The experience of many of us working in palliative care is that one of the main reasons people ask about help to die sooner than they would naturally, is that they fear unmanageable pain or other distress.

Page 16 | www.ncah.com.au

“When reassured that this won’t be the case, most patients are satisfied.”

Despite the organisation and most of its members not supporting the Bill, Mr Haberecht said it’s healthy for the community, palliative care nurses and other health professionals to have the debate.

“Part of that debate will be about the question of choice – whether each one of us has the right to choose euthanasia/assisted suicide, and whether we can expect others to administer the medication that would shorten our life?”

Mr Haberecht called for consultation about the Bill with Aboriginal and Torres Strait Islander communities.

PCNA wants all Australians, who need it, to have access to specialist palliative care services.

Mr Haberecht said improved palliative care, especially pain management, in aged care facilities is needed while every aged care facility should use a palliative approach with appropriately trained staff.

He said adequate resourcing of palliative care community services, both specialist and non-specialist, is important along with support for families and carers of people wanting to die at home.

For the full article visit NCAH.com.au

39149

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Nursing Careers Allied Health - Issue 21 | Page 17

Nursing in the war of Ebola

By Karen Keast

L

ibby Bowell was walking to the supermarket when a woman collapsed in front of her.

As a nurse of 30 years, normally Libby would stop and render assistance.

But, in Liberia at the moment, these are far from normal circumstances.

“As a nurse I couldn’t touch her - you just can’t break the rules, and I found that really hard,” she says.

“You have to keep that distance and try and get the ambulance to that person.”

The deadly Ebola virus is reported to have killed at least 2000 people in Liberia, and the World Health Organisation (WHO) estimates the death toll has risen to more than 4500 people from the 9000 infected in West Africa.

Libby returned from Liberia last week, where she worked as an emergency health coordinator for the International Federation of Red Cross (IFRC) and Red Crescent Society for five weeks.

Libby has previously worked for the Red Cross in deployments to South Sudan and Sierra Leone for cholera outbreaks, in the Philippines in the aftermath of the typhoon, Haiti following the earthquake, in Papua New Guinea and in the Solomon Islands, and in Aceh in the wake of the tsunami.

Now in isolation for 21 days at her home in Newcastle, New South Wales, Libby rates her experience in Liberia as one of the toughest deployments she’s encountered as an Australian Red Cross aid worker.

Page 18 | www.ncah.com.au

“It’s tough because it’s still escalating, it’s not going away and it’s catastrophic really,” she says.

“It’s a war of disease and it’s like cancer - it doesn’t discriminate.

“It’s not a poor person’s disease, I’ve seen experts die. It’s from the top to the bottom and everyone in between.”

Libby’s role in Liberia did not involve any direct patient care.

Instead, she worked to support the emergency response for the Liberian Red Cross.

Libby worked with the dead body management team and assisted in developing and introducing a new strategy to teach communities how to safely care for Ebolainfected family members unable to access one of the limited number of treatment beds.

“It meant changing tactic from the ‘no touch’ technique to the ‘touch with care’ technique,” she explains.

“That was teaching them about isolating the person immediately in the community and only having one caregiver because in Liberia it’s very culturally normal to have all of the family wanting to provide care for the sick family member.

“That was quite a big change for us but something that had to really be taken on.”

In communities battling Ebola, people’s lives have been put on hold.

Libby says children no longer attend school, public meetings and football matches have stopped, and people refrain from going to the gym, shopping or meeting friends.

She says fear of Ebola is rife, as is the stigma attached to those who contract the disease.

“One day, I saw a couple of kids immediately after their mother died,” she says.

“Their father had already died and then I saw their mother get taken out in a body bag.

“I just saw an eight-year-old boy holding his one-year-old sister and everybody in that community was several metres away from them.

“There’s a lot of Ebola orphans now and you’ve just got to hope that the community supports them and looks after them.”

While Libby was mostly involved in high level government and partnership meetings with stakeholders, there was no escape from the grim reality of Ebola.

“I was at a meeting at the Ministry of Health one day when I saw a dead body get rolled out of a taxi just because there were no beds,” she says.

“In the last two weeks I was there, I had to go into the Ministry of Health headquarters for meetings and two people - a chief medical officer and another person from the Ministry of Health - died from tables that I’ve been sitting at, and the floor that we met on was closed and quarantined.”

Libby says one of her Liberian colleagues, with a similar nursing background, had lost 16 friends, colleagues and mentors.

“She’s lost a medical director, she lost an anaesthetist, she lost several nurses, she lost physician assistants,” she says.

“Liberia only had 100 doctors, they are down to about 85 doctors now.

“What they are going through on a daily basis is very confronting and something that we couldn’t even imagine.

“They get up and go to work every single day because they believe that they have to make this horrible thing go away - they can’t hide from it at all.”

While WHO has now declared Senegal and Nigeria both free of Ebola, it’s also warned there could be as many as 10,000 new infections a week in West Africa before the end of the year.

Libby says more health professionals are desperately needed on the ground to help halt the spread of the disease.

“We need to help them. It’s a global emergency,” she says.

“If you’re seriously thinking about going, have the conversation with your family and think there is a risk involved, for sure, but the rules and the guidelines around it are very strict and you’re very well supported while you’re there.

“If you’re not going to go, then that’s fine as well, but find another way to support (the fight) because it takes a lot of money.”

Libby, who works as the director of education at CRANAplus, the peak body for remote health practitioners, says she’s exhausted from working 15-16 hour days, seven days a week, throughout her five week stint in Liberia.

Otherwise, she’s healthy and has no concerns that she will contract the infectious disease.

“It’s a risk but it’s a low risk because I followed very, very strict guidelines,” she says.

“I moved about in the community but you wash your hands in a chlorine-based solution at least 20 times a day, you have your temperature taken at least half a dozen times a day, you keep this distance between yourself and other people.

“I haven’t shaken a hand, I haven’t hugged a person, I haven’t kissed a person and I will keep a pretty low profile.”

For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 21 | Page 19

Mental Health Inside a Police Cell Physiotherapist paves the way in

By Camille Dowling – Clinical Nurse Specialist 2 mental health

By Karen Keast H S

ealthcare professionals working in a custodial environment are typically exposed to a confronting set of symptoms and condiyearsto:ago, Kevin panic Lau had a few tions,eventeen not limited anxiety, attacks, reservations about as amood, physiotherhearing voices, low or working depressed cryapistscreaming, in the mental health field. ing, delusions and paranoia. Often Today, as the head of the physiotherapy dethese people – patients or inmates – are in an partment at a large psychiatric hospital in Westacute state of mental instability. A multidiscipliern Australia, he wouldn’t have it any other way. nary team consisting of nurses, medical and al“The longer I worked in the area, I thought lied healthcare professionals collabwow, this is an area that a physiotherapist is orates to provide mental health in a very unique position to be able support by engaging other to help people with mental health stakeholders, assessing issues because of our trainthe mental health staing and expertise in physitus of the inmate and cal health care,” he said. implementing strate“Sometimes I call gies that reduce the physiotherapists workrisk of the inmate ing in this area the harming themselves physical health gate(JH&FMHN., 2010). keeper of a person So what is a menwith mental health istal health disorder sues. and how it defined “We is can screen, in we acan prison or custodial assess, we can setproting?

Mental health vide appropriate early probinterlems incorporate a the wide range ventions to deal with physical ofco-morbidities behaviours including substance use, of a person with mental mood anxiety and disturbances healthdisturbances, issues.” in thought perception 1999).

Mr Lauand is one of just a (Neugebaur, few physiotherapists According tospecialising the information published nation-wide in mental health. by the Australian Health Report (2012) Originally fromand HongWelfare Kong, Mr Lau said he 46% in Australia worksoftoprisoners improve the physical were healthdiagnosed of patients with issues on entering the includcrimiwithmental a rangehealth of mental health conditions, nal justice system.

A high proportion of persons ing depression, bipolar disorder, schizophrenia, entering the criminal system appear adjustment disorder justice in society andcan borderline to the localdisorder. community and stakeholders to personality be mentally Therefore, it is under“A lot ofdisordered. the time patients with mental health standable each stakeholder forms of a difissues are that unmotivated due to a number reaferent understanding definition persons sons because of theirand mental healthofissues, so they are quite sedentary. appearing to have a mental health disorder.

Page 20 | www.ncah.com.au

It is well documented that people with mental health disorders are over-represented in the criminal justice system (McCausland et al., 2013).

“Sometimes themeasuring person may an injury An Australian study the suffer prevalence of and not go to work and then offenders they suffer finanmental health disorders among nationcially and theythis become stressed and & that stress ally highlights argument (Forsythe Gaffney component needs to be addressed as well, not 2012). The data collected by The Australian Injust the broken bones or the back injury as such stitute of Criminology Drug Use Monitoring in - we also need to look at the person holistically.

Australia (DUMA) program captured the drug use “As a physiotherapist, we can inspire and of 690 detainees. Interestingly, half of empower an individual, say for example, the detainees reported having through motivational interviewing, been diagnosed with a histoencouragement and reassurry of mental health disorder ance to help an individual (Australian Government; to achieve their goals to Australian Institute of improve their physical Criminology 2012). activity level to proThe Mental Health mote their recovery, Act 2007 (NSW) connot just physically tains specific legislabut also mentally.” tion that governs how Mr Lau said mental health patients/ physiotherapists can inmates are managed also provide safe and in aeffective custodialnon-pharmasetting. It alsoceutical permits theinterventions Police and Magistrates recommend such as to manual therapy mental health assessment by speand dry needling to assist with cialists pain. such as psychiatrists prior to incarceration.

This process enables mentally dis“Sometimes their medication may affect ordered persons themusculoskeletal opportunity to be correctly their balance and system and diagnosed However, sometimesand thattreated person appropriately. has a higher risk of falls this is not of always with people displaying because that,”the he case added. unstable mental as health my expe“Especially theysymptoms. get older inIna psychiatric rience, when individuals in custodial setting, people are more likely to haveenvironfalls risk ments arewhy appropriately by mental so that’s we provideassessed falls risk assessment health specialists they aretooften determined to and effective intervention improve their mobilnot be mentally disordered, despite being ity and to prescribe necessary walking aidsdifas ficult to manage in the context of a police or required.” prison environment. individuals already sufThe Australian For Physiotherapy Association fering a mental health condition, incarcer(APA) from wants physiotherapists to play more of a role incan addressing healthadditional issues. stress ation impose amental significant

421-022 420-033 1/2PG FULL COL APA president Marcus Dripps said physifactor which further underminechronic the mental otherapists arecan experts at managing and health of the inmate and culminate in a particupreventable diseases, musculoskeletal conditions, larlyacute difficult environment. and andhealthcare chronic pain - conditions that can Psychosis, either drug otherwise, also affect people living with induced a mentalor illness. is often a factor in short-term custodial “We’re in an ideal position to detect, settings assess and manage can be associated with a rangeranging of behaviours and physical conditions, from including aggressiveness, inappropriate laughing musculoskeletal, respiratory, and orthopedic to and talking, conditions,” and delusions. paranoia is neurological he Moreover, said. a common that may lead toare theinsepainmate “Physicaldifficulty and mental well-being being convinced the healthcare professional rable - a person with mental health issues oftenis “out to from get them”. suffers a variety of physical conditions, The most important consideration for nurses largely due to the side effects of psychotropic or other healthcare professionals providing supmedications and poor lifestyles.” port or care to mentally unstable patients in acute Mr Dripps said physiotherapists should have settings such as police cells is to minimise the a stronger role in assisting people living with a risk of harm to themselves, colleagues or the mental illness, from raising awareness to providpatient. Risk management systems, procedures ing pain and chronic disease management, faciliand strategies must be in place, and all healthtating self-management, and dealing with the cocare workers in the custodial setting must be apmorbidities associated with mental illness. propriately trained.

“Through greater funding, increased awareAppropriate safety precautions will generally ness, better referral pathways and more training include placing a corrective services officer to opportunities for physiotherapists to specialise in monitor and observe the inmate closely (typically mental health, we can be part of the solution to hourly observations) until further assessment by this issue.” the mental health team can be completed. InMr Lau agreed. mates that become acutely unstable will typically “In Australia, one in four or five people will be transferred to a hospital for a medical and experience some sort of mental health issue mental health assessment.

More often than not, throughout their life, so whether you are in a the inmate returns to their police cell wherepsyCorchiatric or evenby in the a normal comrective hospital Servicessetting are advised appropriate munity you will find people that might have some healthcare professional to continue to observe sort mental healthand issues,” he said.the patient’s the of patient closely to document “I have been continuously working in this movements. area Evidence-based for so long and I’m still enjoying everywhich day scientific research, ofgoverns my work.” clinical practice in health settings, continues to provide healthcare professionals with a comment this of and other anLeave understanding of the on efficacy mental health articles bysuch visiting the ‘news’ sectionfor interventions as: providing the resources of our website:compliance www.ncah.com.au correct diagnosis, with medication and engaging community mental health services To go to the article “Physiotherapist to deliver best practice (APS. 2010).

paves the way in mental health” directly, visit: http://tinyurl.com/q2pvylg

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For the full article visit NCAH.com.au Nursing Careers Allied Health - Issue 21 | Page 21

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Nursing Careers Allied Health - Issue 21 | Page 23

The Art of Listening as Affirmation

By Ellen Rosenfeld

A

s a public health researcher I worked for a time in an acute inpatient ward of a large mental health facility. In this ward some of the staff had worked with particularconsumers over many years, knowing their capacities and difficulties well. A keen observer of human interaction, I was particularly struck by two nurses: one a young man in his late thirties, and the other a woman in her sixties, who listened intently to their patients’ stories, the kind of “active listening” you observe in people wholly engaged in the language of the person they are relating to. The nurses’ body language was calm and empathic. There was no visible attempt to formulate responses, something Freud promoted (Purdy, 2011). Nor was there condescension or a sense of the innate difference of speaker and listener. There was no way, or indeed need, to quantify the outcomes of these interactions.It was clear that this attentive listening was nurturing and deeply appreciated.

Some years later I had the privilege of coordinating a research project exploring the experience of people with mental illness who had been admitted involuntarily to hospital, a predominantly qualitative project. The project team created a number of “safety net strategies,” in case my

Page 24 | www.ncah.com.au

interviews re-traumatised people whose memoriesof their admission were very painful. One of these strategies was a telephone call perhaps two days post interview, simply asking participants how they were travelling. I was struck by how frequently people would say that on the contrary, rather than feeling anxious or traumatised, they deeply appreciated being able to tell their stories to someone who really listened, as if this was a rare occurrence. I interpreted these comments in the context of the relative luxury I had as a researcher speaking to people individually or in focus groups, in contrast to nurses, who juggle a myriad of clinical tasks and obligations.

How hard must it be for nurses to really attend to consumers on wards, when their minds are rolling through a list of tasks to be achieved prior to their change of shift?

The fundamentaltenet of therapeutic listening is nothing new in clinical spheres. There is a wealth of academic literature promoting the therapeutic benefits of listeningwell in any clinical setting (Hirdes A, 2003; Stickley and Freshwater, 2006). Attending closely to other people, patients or friends, is a skill that some people are innately better at than others, with ongoing debate about whether or not listening skills can be learned. Active listening is a core component of clinicians’ communications skills training in undergraduate modules.

Deep attentive listening is also a skill we need in life generally, but one we tend to take for granted rather than consider closely. It seems common sense that when we perceive the listeneras wholly focussed on us, we are acknowledged and respected by them. Equally all of us have had the experience of recognising the distraction of a listener, and how this seems to negate us.

Philosophers like Martin Buber emphasised the deep need of all of us to be affirmed by the people we speak to, to be acknowledged irrespective of the kind of social encounter (Gordon, 2011).

How then to translate this very basic life and clinical skill into core practice? The enduring debate about the gap between policy and practice is relevant here. Nurses are often simply too busy, understaffed, and inundated with paperwork to be as attentive to patients as they would wish.

Psychiatrists bemoan the current medication focus at the expense of more reflective therapeutic modalities of twenty or thirty years ago.Clinical settings are often noisy and hyper-stimulating, offering little in the way of calm, reflective space.

There are additional cultural factors posing challenges. This is very obvious when reading anything written in the nineteenth century or before, when writers such as Charles Dickens went to what seems to our current sensibilities extraordinary lengths to describe a person’s physical self, their face, voice, gait and general manner.

People today are far more inclined to be intently focussed on small rectangular screens than on peoples’ faces and voices.Medical students on rotation in a mental health facility in which I worked would attend the staff tea room, a place where psychotherapists and nurses would frequently discuss various theoretical approaches, their challenges, utility and acceptability to consumers. This seemed a perfect milieu for students to listen, to ask questions and to learn from people with lengthy experience in a range of psychological treatments. Instead they sat heads down, thumbs frenetically tapping a phone, wholly engaged in their digital devices.Will the skill of attentive face-to-face communication simply atrophy as people fixate more on screens and less on other human beings?

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Nursing Careers Allied Health - Issue 21 | Page 25

Pharmacists rate high in customer satisfaction

By Karen Keast Pharmacists have received top marks in yet another public poll - this time for customer satisfaction.

The Roy Morgan Customer Satisfaction Awards reveal Australia’s big-name chain pharmacies have received satisfaction ratings ranging from 85 per cent to more than 91 per cent.

The latest gold star comes after pharmacists, on 86 per cent, rated second to nurses, at 91 per cent, for ethics and honesty in the Roy Morgan Image of Professions Survey earlier this year.

Roy Morgan Research general manager Geoffrey Smith said 50 per cent of Australians aged 14 and over made at least one purchase from a chemist/pharmacy in an average four-week period in the past year.

“That’s a whole lot of customers - and for so many of them to be satisfied with the service they received speaks volumes for the high standards of this particular retail category,” he said.

“Pharmacies are heavily regulated by a range of codes and guidelines designed to ensure the customer’s well-being when buying pharmaceuticals.

“This no doubt contributes to the generally high customer satisfaction ratings across the main chemist chains, as well as the widely held perception of pharmacists as trustworthy and ethical.”

Page 26 | www.ncah.com.au

Pharmaceutical Society of Australia (PSA) president Grant Kardachi said the organisation’s Code of Ethics underpinned consumer confidence in pharmacists.

Mr Kardachi said the code outlined the values of the pharmacy profession and expected standards of behaviour for pharmacists.

“The code is made up of a number of principles covering five areas of focus which are core to pharmacists and pharmacy practice,” he said.

“These areas are the consumer, the community, the pharmacy profession, business practices and other health care professionals.

“These principles apply to every pharmacist irrespective of their role, scope, level or location of practice.

“The application of ethics is not discretionary and I think the application of the code is being reflected in the latest Roy Morgan findings.”

Mr Kardachi urged pharmacists to display the code in their practices for consumers to read.

“Transparency and pride in operating to the principles of the code can only further increase the stature of the profession as a whole and to individual practices that display the code.”

For the full article visit NCAH.com.au

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Health Industry Satisfaction Survey (HISS)

The quarterly Health Industry Satisfaction Survey (HISS) is currently OPEN. This is your opportunity to have your say about the state of the health system, by answering a few short questions about your own personal experiences.

The survey will take about 3 minutes to complete, and will help to paint a picture of how health professionals think the health system is performing.

To complete the survey, please visit: http://tinyurl.com/lx38uws

Nursing Careers Allied Health - Issue 21 | Page 27

High risk medicines a bitter pill New Zealand health professionals are being urged to be more vigilant with how high risk medicines are prescribed, dispensed, supplied, stored, administered and taken.

The Health Quality & Safety Commission is shining the spotlight on internationally recognised high risk medicines including anticoagulants, such as warfarin and heparin, opioids such as morphine, oxycodone, fentanyl and methadone, as well as insulin, concentrated potassium injections and oral methotrexate.

The Commission has launched a new campaign, Open for Better Care, targeting health providers, practitioners and patients in a bid to promote ways to reduce medication errors.

High risk medicines are frequently involved in adverse drug events (ADEs) but 60 per cent of ADEs are believed to be preventable, while errors involving high risk medicines are more likely to result in more serious consequences for patients.

Figures show between July 2007 and June 2013, health providers reported 132 medicine-related serious adverse events - of these, 23 related to opioids, 19 to anticoagulants and seven to insulin.

But the Commission believes the figures are just the tip of the iceberg, as some medicationrelated events go unrecognised and unreported.

Dr John Barnard, the Commission’s clinical lead for medication safety, says while most people taking a medicine experience better health, for some the treatment is harmful.

“No health professional wants to make an error and yet errors happen,” he said.

Page 28 | www.ncah.com.au

“There are a surprising number of steps where things can go wrong - this is especially true for warfarin and other blood thinners.”

The campaign is one strand of a range of work streams focused on improving medication safety.

The National Medication Chart and medicine reconciliation are used in most District Health Boards (DHBs).

Four DHBs have introduced electronic medicine reconciliation and another four are implementing electronic prescribing and administration systems.

Dr Barnard said health practitioners across New Zealand are finding ways to improve medication safety with existing resources.

“However, despite New Zealand’s compact size, there is a lot of variability from one DHB to another,” he said.

“Some will have done excellent work with warfarin monitoring but aren’t doing so well with oxycodone prescribing.

“A major role of the Commission then, is to identify and highlight what is working well so that the best practices can be made available as widely as possible.”

Sue Waters, Auckland DHB chief of allied health professions, said the health organisation will do its part to drive the campaign.

“The harm done to individual patients is the major concern but so too is the annual cost of preventable ADEs in New Zealand - this could be as much as $158 million,” she said.

For the full article visit NCAH.com.au

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Pharmacists applaud immunisation move Victorian pharmacists have welcomed a move that could enable them to deliver immunisations to adults as early as next year.

The Legislative Council Legal and Social Issues Legislation Committee’s Inquiry into Community Pharmacy in Victoria has outlined a raft of recommendations supporting a greater role for pharmacists in improving health outcomes.

The report recommends the Department of Health establish a pharmacy immunisation trial targeting adults, ideally commencing in time for the 2015 influenza season, and a pilot of a minor ailments scheme involving community pharmacies in rural areas.

Pharmaceutical Society of Australia (PSA) Victorian president Michelle Lynch said the organisation would now work with The Pharmacy Guild in Victoria and the Department of Health to transition the recommendation into an action plan.

Ms Lynch, a pharmacist with independent specialist consulting company PharmConsult who also works in community pharmacy, said while any details are yet to be worked out, a trial will build on the success of phase one of the Queensland Pharmacist Immunisation Project (QPIP) held earlier this year.

“They’ve delivered over 10,000 immunisations at over 80 different sites as a pilot with very positive results,” she said.

Ms Lynch said she expects pharmacists will be keen to participate in a Victorian trial.

“I think there will be an overwhelming response from pharmacists to take up this service,” she said.

“One of the biggest findings from Queensland is the access that is provided to the public - the ease and convenience, especially for people who wouldn’t have normally gone to get their flu vaccine.

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“It’s a great opportunity not only for a practising pharmacist but also to improve the health outcomes of Victorians as well.”

Ms Lynch said the proposed pilot of a minor ailments scheme will enable pharmacists to treat a range of minor conditions in conjunction with GPs and other allied health professionals.

“It’s making sure that triaging of patients is in the community pharmacy and then being referred to a GP as opposed to an emergency department - it’s definitely utilising the resources that we have available to us.”

The Australian Medical Association has criticised the recommendations.

Ms Lynch said the committee’s recognition of the role of pharmacists in the community “is not to replace the decisions and very critical and important role that the GP plays”.

“This is about enhancing that relationship, ensuring the GP is absolutely part of that care and better utilising the resources available to again improve the health outcomes of Victorians.”

The report also recommended an expansion of the existing Continued Dispensing initiative, funding for medicines reviews when patients leave hospital, and a pilot of an evidence-based chronic disease screening and management program in community pharmacies.

Pharmacy Guild of Australia president George Tambassis labelled the report “a timely reinforcement” of the scope for community pharmacies to play a bigger role in our national health system.

“In particular, the determination to get a pharmacist vaccination trial up and underway by early next year is the right decision for the health of Victorians,” he said.

For the full article visit NCAH.com.au

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