Issue 22 10/11/14 fortnightly
Education Feature Nurses let books do the talking Nurses say tougher penalties are not the answer Hundreds of nurses and midwives keen to combat Ebola Taking leisure more seriously
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Nursing Careers Allied Health - Issue 22 | Page 7
Survey reveals missed patient care concerns nurses A new study shows New Zealand nurses are concerned about missed patient care. The Eastern Institute of Technology survey of nurses working in hospitals, aged care and the nation’s primary health care sector found nurses hold concerns about missed care, which is often the result of nurses’ skill mix, ineffective methods for determining staffing levels and competing demands that reduce care time with patients. The After Hours Nurse Staffing, Work Intensity, and Quality of Care study, led by Dr Clare Harvey, discovered missed nursing care is more likely to occur across all shifts, and not just night shifts when staffing levels are reduced. The survey of mostly female nurses aged 45 years or over, in line with statistics that show the average age of nurses in New Zealand is 46 years, found a link between nurses who work despite feeling unwell, stressed or fatigued and a higher rate of missed nursing care. “Nearly 50 per cent of respondents feel obligated to colleagues to work despite feeling unwell, and qualitative data also reveals a nursing workforce whose inadequate sick leave entitlements means they have to work,” the Institute states. “The researchers say much of nurses’ care work has become invisible in the face of escalating costs and that an international approach is needed to achieve a balance in care that is truly patient-centred, appropriately managed and cost effective.” The results come after the New Zealand Nursing Organisation (NZNO) blamed care rationing in the under-resourced health sector for an increase in the number of serious adverse events (SAEs) reported by District Health Boards (DHBs) in 2013-14.
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The Health Quality and Safety Commission’s 2013-14 report shows the number of serious adverse events increased four per cent from 2012-13, from 437 up to 454. The Commission attributed the slight increase in SAEs to the health sector’s commitment to improve its reporting of cases. NZNO professional nursing adviser Kate Weston said the number of serious adverse events has more than doubled since the first report in 2007. “There is increasing confidence in the reporting system however we are not convinced that the increase in reported events over the last seven years can be solely attributed to better reporting,” she said. “The research demonstrates that there are some patient indicators that are particularly sensitive to nursing numbers and skill mix these include patient falls, infections and pressure areas. “There is an urgent need to address nursing resourcing in hospitals and communities to reduce these adverse events.” Ms Weston said nurses are not blasé about falls and other serious harmful events. “These accidents are the result of care rationing and sadly it happens every day - the number of nursing hours is just insufficient to meet nursing needs of patients, both in hospitals and in the community,” she said. “The decision as to what care to prioritise or leave out because of insufficient resourcing is an all too frequent moral dilemma for nurses. “The report is silent on this issue and we hope the HQSC undertakes further analysis of why and how these serious events happen.”
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Nursing Careers Allied Health - Issue 22 | Page 9
Paramedics push for national registration By Karen Keast
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aramedics Australasia is continuing to lobby for the paramedic profession to be included in the national registration and accreditation scheme. Fourteen health professions, including nurses and midwives, occupational therapists, Chinese medicine practitioners, physiotherapists and medical radiation practitioners, are now regulated under the Australian Health Practitioner Regulation Agency (AHPRA). In a letter to Paramedics Australasia, Western Australia Health Minister Dr Kim Hames said he supports paramedics becoming registered health professionals. “The DOH (WA Department of Health) will continue to work on a proposal for a national approach for consideration by Health Ministers in early 2015,” the letter states. “This is complex work which has never been undertaken before as a national approach for any unregistered health profession.” The letter comes as the Victorian state government recently called for public comment on its proposal to establish a state-based scheme with a Paramedics Board for the registration and regulation of paramedics. Victorian Health Minister David Davis said the Victorian scheme could lead to a national registration scheme for paramedics. “If agreement is reached across govern-
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ments then the Victorian-registered paramedics could transition to national registration,” he said. Paramedics Australasia has continued to call for national registration of Australia’s estimated 3000 paramedics in a bid to improve public safety and maintain a strong professional environment for paramedics. National registration under AHPRA would also protect the title of ‘paramedic’. Under the Health Practitioner Regulation National Law, it is an offence for people to pretend to be a registered health practitioner. Associate Professor Richard Brightwell, vice president of Paramedics Australasia, said while the Victorian proposal recognises the need for the registration of paramedics, a national scheme is paramount. “If we had national registration, there would be a national set of standards that everyone would fall under and that would guarantee that everyone is getting the same treatment,” he said. “The other thing is national registration will prevent a paramedic, who maybe has lost a position in one state, from going over the state border and getting exactly the same position.” Assoc. Professor Brightwell said paramedics are the forgotten health profession.
For the full article visit NCAH.com.au
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Nursing Careers Allied Health - Issue 22 | Page 11
Taking leisure Update more seriously Liver Disease
By Clare Wilding By Mary Hickson Mary is also NUM of Endoscopy St isGeorge Hospital andmay NSW In the areainofSydney health, leisure be seen as eisure, known as recreation orat play, an Regional Committee member of the Gastroenterological Nurses College something additional or extra but not the coreof work important category of doing that can signifiAustralia (GENCA). Mary hashealth worked educator, manager and clinician therapists – helping a person return to productive cantly and positively affect people’s and asofan across metropolitan, regional remote settings in NSW and Queensland. roles and assisting people to be independent in lookwellbeing. There is a growing body of and research
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that illustrates the benefits of engaging in leisure. diseaseparticipating is more prevalent in Australia than For iver example, in leisure may help is generally recognised, and the financial, social people better manage stress, provide pleasure and personal costs are dramatic. and relaxation, engage people’s creativity, and More than six million Australians, or over a help them maintain important social connections quarter of the population, are now affected by liver that are supportive. Occupational therapists disease, according to the Gastroenterological have a valuable role to play in asSociety of Australia’s (GESA) report, sisting people to find and par“The Economic Cost and Health ticipate in leisure activities. Burden of Liver Diseases in Sadly, the importance Australia” commissioned of leisure as a restoraby GESA and the Austive and therapeutic tralian Liver Association endeavour is some(ALA) in 2013. times overlooked by With this high contemporary serincidence, nurses vice providers and and allied health care funders. There are a workers in any field of number of reasons for practice are likely to find this. Over time, ideas themselves caring for paabout the role tients who haveofa leisure form of have changed and currently hepatitis or liver disease. Unitderstanding may mistakenly be seen as a liver disease enables luxury rather than as a necessity for health care workers to have informed health. discussions with these patients and facilitate holisIn the time of Aristotle, leisure was about tic care. contemplation andareeducation modernchronic interThe statistics alarming. –In aAustralia, pretation of this typeover of leisure may be the liver disease claims 20 lives each daynotion –more ofthan self-development and self-actualisation. As 7,000 deaths annually. Despite the commonlyconcepts work there were draheld beliefof that liverchanged disease isand related to alcohol use, matic developments in society and technology, the GESA report found that Non-Alcoholic Fatty the concept of leisure has evolved to become Liver Disease (NAFLD) is now our most prevalent one is focused on more 5.5 passive formthat of liver disease. Impacting millionpursuits Australsuch being 40% entertained (for aged example, watchians, as including of all adults 50 years and ing television being awith sport spectator) and over, NAFLD is or associated diabetes mellitus, inconsuming leisure products (for example, sulin resistance, obesity and lifestyle factors,shopand is increasingly common in children. ping and tourism as leisure activities).
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ing after themselves are given much higher status as The financial burden of is parestitherapeutic goals. However, forliver somedisease peoplefull mated to be $50.7 billion per annum, exceeding ticipation in work may be an unattainable goal, this the costs of diabetes and chronic kidney disease includes some people with disability, people disadcombined. Direct costs to the health care system vantaged by poverty or homelessness, and people include hospitaland non-hospital services, phardisadvantaged because of their geographical lomaceuticals, immunisation programs and cation (such as people living in remote related research, while other costs and rural communities). Therefore, include loss of productivity, abparticipation in leisure may fill senteeism, carer and family the void that is left because costs, other welfare proaccess to work activities gram payments, and palis blocked. liative care. In addition, as we The personal and are an aging society, social burdens of liver there are an increasing disease are immeasnumber of people who urable. Liver disease no longer need or want can affect people in to work and yet they still the prime of their lives need to be meaningfully when they may be workoccupied: participating in ing or building a career, activities labelled as leisure is have young families or other one possibility for meeting this aim. significant responsibilities, and However, we maytoneed to change our be contributing family, community concepts about leisureofmight like when and society in awhat multitude ways.look As symptoms we think about the appear needs ofuntil people spend the generally do not the who disease is well majority of their engaging in leisure. advanced, thetime impact can be devastating. Loss The leisure needs ofregimes, people who most of of income, treatment painspend and suffering, their time working versus the leisure needsfrailty of people emotional distress, anxiety, premature and who of theirburdens time participating leisure earlyspend deathmost are heavy faced byinthe sufare likely be very different. For example, it may be ferer andtotheir family and community. quiteAplausible for people to passivelyreveals watch televibrief review of liver disease that it sion after a tiring day of working, yet of watching includes both acute and chronicand forms hepatitelevision all day is fatty likelyliver to be an unsatisfying and tis, non-alcoholic disease and alcoholic ultimately boring activity for may people who are not liver disease (each of which progress to perworking on holidays, enmanent full-time. scarring Going and cirrhosis) andattending liver cancer. tertainment events, orfrom shopping as leisure might be Adults andchildren any social economic or
cultural backgrounds may be affected. Hepaactivities that could beofengaged in for lengthy titis, or inflammation the liver, is caused periods of time, but most people lack the finanby viral infections, alcohol or drug use, other cial resources to sustain such a lifestyle. Indeed, toxins, or an auto-immune response. Viral for people including who work none or only a few hours in hepatitis, chronic hepatitis B and paid employment, modest in C, was confirmed even by the GESAengagement report as our these activities may be unsustainable. second most common form of liver disease, The type leisure may be most suitaffecting moreofthan halfthat a million Australians. able when it is aBperson’s type can of occupaBoth hepatitis and C main viruses cause tion may bechronic learninginfections and self-improvement. acute and and lead to This cirrequiresliver active and effortful There rhosis, cancer or liver engagement. failure. are many types of leisure activities that fit this “It is important to de-stigmatise hepatiprofile: playing sport (rather than just spectating), tis” says Dr. Sarah Gardner, Gastroenteroldancing, making music (rather than just listenogy Trainee at St George Hospital in Sydney. ing to it), making art and craft (rather than just She explains that many patients feel embarbuying/shopping for products), writing and sharrassment or shame about their condition, ing stories, or learning a new language or skill particularly when they are treated as infec(for the pure enjoyment of learning and sense of tive. “As a result, some patients may not desatisfaction of accomplishment). Occupational clare their condition and leave it untreated.” therapists can assist people to engage in this Many people have acquired the disease range of activities. inadvertently, some through mass vacciPeople can face barriers to participation in nation programs, or medical equipment or leisure activities for a variety of reasons. People blood products in countries without strict may experience physical, cognitive, or emotional infection control protocols. Others may have challenges that affect their participation (for exacquired the disease through poor lifestyle ample, low vision, movement problems, mental choices and risky behaviour, but it is imporillness, or learning difficulties).They may lack tant not to pigeonhole patients with hepatitis. awareness, knowledge, or skill in occupations asbe‘infectious’”, they“Treating would likethese to do. patients There may environmennotes Dr. Gardner, “damages their confital challenges to participation such as lack of dence and makes them less willing to discuss universal access to buildings, lack of access to and manage condition”. In thestigma, hospital activities at a their convenient time, social or or health care setting, standard precautions lack of affordably-priced activities. Occupational should generally sufficient, asskills transmistherapists have thebe problem-solving to assion does not occur through casual contact. sist people with overcoming such challenges B isparticipation. preventable with a vacandHepatitis enabling their cine,Occupational but no vaccine for Hepatitis C has yet therapists have a valuable contribeen developed. New, direct-acting antiviral bution to make by advocating for the leisure needs treatment forfacilitating Hepatitispeople C is available and efof people and to be active leisure fective for 50–90% of persons treated, and participants. They can do this as part of routine ochas been shown reducebythe development cupational therapy to positions ensuring that they of liver and cancer cirrhosis. However these assess treatand problems of engaging in leisure medications are notproblems yet available on the occupations alongside of doing self-care Pharmaceutical Scheme (PBS) in and work activities.Benefits They could also specialise in Australia. helping people to engage in leisure activities.
NAFLD is an accumulation of fat in liver cells. are include opportunities for occupational theraRiskThere factors obesity, insulin resistance, pists to develop the scope of occupational therapy diabetes, high blood pressure, cardiovascular through helping participateage in and/or leisure.high For disease, high-fatpeople diet, increasing example, in the burgeoning area of aged care, occucholesterol. Less common causes include pregpationalmedications therapists have a lot offer in helping older nancy, such astocorticosteroids, and peoplediseases. age well through participating in leisure occuother NAFLD can be best managed pations in their retirement. therapists with lifestyle changes andOccupational appropriate treatment might also be able to assist people with planning for of associated conditions. Fatty liver (NAFLD)inretirement. Deciding what to do and finding ways creases the risk of developing liver cirrhosis and to participate liver cancer. in the activities that one is interested in can be daunting, even for people without impairAlcoholic Liver Disease (ALD) is caused by ments, and occupational therapists may be able to the chronic consumption of high levels of alcohol. assist. Variceal haemorrhage, ascites and neuropsychiThere is also a role for occupational therapists atric conditions are associated with ALD, and it is to help design, develop, and problem-solve regardthe main cause of death from long-term alcohol ing participation in leisure as part of community deabuse. velopment, health promotion, and town planning. Liver canceris the second leading cause of Geographically isolated communities can lack accancer death worldwide, according to the Cancess to a range of leisure occupations and to redress cer Council of Australia. Although its incidence this issue, occupational therapists could work with is relatively low in Australia compared with other communities to help galvanise and organise them to regions of the world, Associate Professor Amany develop their own local solutions, based on the inZekry, Chairperson of the ALA and Liver Specialterests of each community. In the area of health proist at St George Hospital, notes that liver cancer motion, engaging people in leisure activities could is increasing faster than any other form of cancer be part of the solution for coping with the incidence in this country. of problems such as obesity and drug abuse. OcOur indigenous population carries a disprocupational therapists could also contribute to town portionate of liver with planning byload ensuring thatdisease.Compared facilities and grounds in non-indigenous people, Australian Aboriginals which leisure occupations are undertaken are fully have a 5 to 10 broad times range higherofpopulation-based accessible to the people who need incidence rate of liver cancer, a 12 times higher access to them. mortality rate, and for higher chronic HBV Leisure is good body,rates mind,ofand soul. Even infection. though it is fun in nature, health professionals may cancer isitalmost always fatal. In develneedLiver to consider more seriously as an imporoping countries, most people with liver cancer tant factor in helping individuals and communities die within months of diagnosis. high-income achieve health and wellbeing. There In is great potential countries, surgery and chemotherapy can profor occupational therapists and other health profeslong life for up to a few years. sionals to include addressing leisure needs as part of their daily work practices.
For fullarticles article visit NCAH.com.au Forthe more Nursing Careers Allied Health - Issue 22 | Page 13
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Nursing Careers Allied Health - Issue 22 | Page 17
Nurses let books do the talking Nurses at Victoria’s Royal District Nursing Service (RDNS) will soon be using two new talking books to overcome language barriers with another culturally and linguistically diverse (CALD) community. The RDNS, which provides health care to people from more than 150 countries, has developed Italian, Greek and Macedonian talking books on diabetes. The organisation is now developing Vietnamese talking books for diabetes and dementia. The new talking books will be released early next year, after the RDNS worked with members of the Australian Vietnamese Women’s Association and Melbourne’s Vietnamese community to ensure the books’ content is language and culture appropriate for older people. RDNS diabetes senior clinical nurse advisor Tracy Aylen said RDNS nurses are able to access the talking books, an audio visual multimedia product, on their tablet devices to help convey vital health information to clients. Ms Aylen, a nurse of 30 years, said the books are easily accessible and also assist people with low school and literacy levels as well as vision impairments. “Even within the general Australian community, research has identified that issues with health literacy probably occur with about 60 per cent of the Australian population generally,” she said. “We know that when there’s language barriers or issues for people not having had the opportunities for schooling that perhaps some of their peers or other people from different backgrounds might have had, that those barriers are then additional.
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“The ability to be able to grasp the key concepts around diabetes care and then build on those concepts, so that they get the best possible health outcomes, is really important. “It also means that there’s more equity and access of information as well.” Ms Aylen said while anyone can access the talking books online at the RDNS website, the information in the books is designed to be delivered in the presence of a health professional. “That way, if the person has any questions there can be an interchange of information and also obviously for people from non-English speaking backgrounds we also recommend the use of a qualified interpreter so that there’s a comprehensive exchange of information,” she said. “The idea is that nurses can tailor the information for that particular client’s needs. “The person might have, for example, a good understanding of the basics around diabetes… but they may not have an understanding of the different people in the health care team or they may not understand about the best way to look after their feet. “What we can do with this process is pull out the relevant information and concentrate on that so it’s meeting the needs of that particular individual and their carer.”
For the full article visit NCAH.com.au
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Liver Disease Taking leisureUpdate more seriously
By Mary Hickson By Clare Wilding Mary is NUM of Endoscopy at St George Hospital in Sydney and NSW Regional Committee member of the Gastroenterological Nurses College of In the area ofmanager health, leisure may be seen as eisure, also known asMary recreation play, is anas an educator, Australia (GENCA). hasorworked and clinician additional or extra not the core work important category of doing that can signifiacross metropolitan, regional and remotesomething settings in NSW andbut Queensland.
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cantly and positively affect people’s health and wellbeing. There is a growing of research iver disease is more prevalentbody in Australia than that illustrates the benefits of engaging in leisure. is generally recognised, and the financial, social Forpersonal example, participating in leisure may help and costs are dramatic. people better manage stress, provide pleasure More than six million Australians, or over a and relaxation, engage people’s creativity, and quarter of the population, are now affected by liver help them maintain important social connections disease, according to the Gastroenterological that are supportive. Occupational therapists Society of Australia’s (GESA) report, have a valuable role to play in as“The Economic Cost and Health sisting people to find and parBurden of Liver Diseases in ticipate in leisure activities. Australia” commissioned Sadly, the importance by GESA and the Ausof leisure as a restoratralian Liver Association tive and therapeutic (ALA) in 2013. endeavour is someWith this high times overlooked by incidence, nurses contemporary serand allied health care vice providers and workers in any field of funders. There are a practice are likely to find number of reasons for themselves caring for pathis. Over time, ideas tients of aboutwho the have role aofform leisure hepatitis or liver disease. Unhave changed and currently derstanding liver disease enables it may mistakenly be seen as a health workers to ahave informed luxurycare rather than as necessity for discussions with these patients and facilitate holishealth.
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tic care. In the time of Aristotle, leisure was about The statisticsand are education alarming. In–Australia, chronic contemplation a modern interliver disease over 20 livesmay each pretation of claims this type of leisure beday the –more notion than 7,000 deaths annually. the commonlyof self-development andDespite self-actualisation. As held belief that liver disease is related to alcohol concepts of work changed and there were use, drathe GESA report foundin that Non-Alcoholic Fatty matic developments society and technology, Liver Disease (NAFLD) is now our most prevalent the concept of leisure has evolved to become form liverisdisease. million pursuits Australone of that focusedImpacting on more5.5 passive ians, 40% of all adults 50 years and suchincluding as being entertained (foraged example, watchover, is associated diabetes mellitus,and ining NAFLD television or being with a sport spectator) sulin resistance, obesity and lifestyle factors, and is consuming leisure products (for example, shopincreasingly common children. ping and tourism asinleisure activities).
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of therapists – helping a person return to productive rolesThe andfinancial assistingburden people to independent in lookofbe liver disease is estiing after themselves are given much higher status as mated to be $50.7 billion per annum, exceeding therapeutic goals. However, for some peoplefull parthe costs of diabetes and chronic kidney disease ticipation in work may be an unattainable goal, this combined. Direct costs to the health care system includes some people with disability, people disadinclude hospitaland non-hospital services, pharvantaged by poverty or homelessness, and people maceuticals, immunisation programs and disadvantaged because of their geographical lorelated research, while other costs cation (such as people living in remote include loss of productivity, aband rural communities). Therefore, senteeism, carer and family participation in leisure may fill costs, other welfare prothe void that is left because gram payments, and palaccess to work activities liative care. is blocked. The personal and In addition, as we social burdens of liver are an aging society, disease are immeasthere are an increasing urable. Liver disease number of people who can affect people in no longer need or want the prime of their lives to work and yet they still when they may be workneed to be meaningfully ing or building a career, occupied: participating in have young families or otheris activities labelled as leisure significant responsibilities, one possibility for meeting this and aim. be contributing to need family, However, we may to community change our and societyabout in a multitude of ways. concepts what leisure might As looksymptoms like when generally do nottheappear the disease is well we think about needs until of people who spend the advanced, the impact can bein devastating. Loss majority of their time engaging leisure.
of income, treatment suffering, The leisure needs regimes, of peoplepain who and spend most of emotional distress,versus anxiety, premature frailty and their time working the leisure needs of people early death are heavy burdens faced by the sufwho spend most of their time participating in leisure ferer and to their and community. are likely be family very different. For example, it may be A brief review of livertodisease reveals it quite plausible for people passively watchthat televiincludes acute chronic and forms hepatision afterboth a tiring dayand of working, yetofwatching tis, non-alcoholic liver and alcoholic television all day isfatty likely to disease be an unsatisfying and liver disease (eachactivity of which progress to perultimately boring formay people who are not manent cirrhosis) and attending liver cancer. working scarring full-time. and Going on holidays, enAdults andchildren from any social economic tertainment events, or shopping as leisure might or be
activities that could be engaged in for lengthy culturalof backgrounds may be affected. periods time, but most people lack the Hepafinantitis, or inflammation of the liver, is Indeed, caused cial resources to sustain such a lifestyle. by people viral infections, drug use, other for who work alcohol none or or only a few hours in toxins, or an auto-immune response. Viral paid employment, even modest engagement in hepatitis, including hepatitis B and these activities may bechronic unsustainable. C, was by the report our The confirmed type of leisure thatGESA may be mostassuitsecond most liver able when it is common a person’sform mainof type of disease, occupaaffecting more thanand halfself-improvement. a million Australians. tion may be learning This Both hepatitis B and C can cause requires active and effortful viruses engagement. There acute andtypes chronic infections and lead to this cirare many of leisure activities that fit rhosis, liver cancer or liver failure. profile: playing sport (rather than just spectating), “It is important to de-stigmatise hepatidancing, making music (rather than just listentis” says Dr. Sarah Gardner, Gastroenteroling to it), making art and craft (rather than just ogy Trainee at St George Hospital in Sydney. buying/shopping for products), writing and sharShe explains that many patients feel embaring stories, or learning a new language or skill rassment or shame about their condition, (for the pure enjoyment of learning and sense of particularly when they are treated as infecsatisfaction of accomplishment). Occupational tive. “As a result, some patients may not detherapists can assist people to engage in this clare their condition and leave it untreated.” range of activities. Many people have acquired the disease People can face barriers to participation in inadvertently, some through mass vaccileisure activities for a variety of reasons. People nation programs, or medical equipment or may experience physical, cognitive, or emotional blood products in countries without strict challenges that affect their participation (for exinfection control protocols. Others may have ample, low vision, movement problems, mental acquired the disease through poor lifestyle illness, or learning difficulties).They may lack choices and risky behaviour, but it is imporawareness, knowledge, patients or skill in occupations tant not to pigeonhole with hepatitis. they “Treating would like these to do. There may be environmenpatients as ‘infectious’”, tal challenges to participation suchtheir as lack of notes Dr. Gardner, “damages confiuniversal access to buildings, lack of access to dence and makes them less willing to discuss activities at a convenient time, social or and manage their condition”. In thestigma, hospital lack of affordably-priced or health care setting, activities. standardOccupational precautions therapists have the be problem-solving to asshould generally sufficient, asskills transmissist with overcoming sionpeople does not occur through such casualchallenges contact. and enabling participation. Hepatitistheir B is preventable with a vacOccupational therapists a valuable contricine, but no vaccine for have Hepatitis C has yet bution to make by advocating for the leisure needs been developed. New, direct-acting antiviral of people and people to be activeand leisure treatment forfacilitating Hepatitis C is available efparticipants. They can do this as part of routine ocfective for 50–90% of persons treated, and cupational by the ensuring that they has been therapy shown positions to reduce development assess treat and problems of engaging in leisure of liverand cancer cirrhosis. However these occupations alongside problems of doing self-care medications are not yet available on the and work activities.Benefits They could also specialise Pharmaceutical Scheme (PBS) in Australia. helping people to engage in leisure activities.
There are opportunities for occupational therais anthe accumulation of fat in liver cells. pistsNAFLD to develop scope of occupational therapy Risk factors include obesity, insulin resistance, through helping people participate in leisure. For diabetes,inhigh blood pressure, cardiovascular example, the burgeoning area of aged care, occudisease, high-fat diet, increasing age and/or older high pational therapists have a lot to offer in helping cholesterol. Less common causesininclude pregpeople age well through participating leisure occunancy, medications such as corticosteroids, and pations in their retirement. Occupational therapists other also diseases. be with bestplanning managed might be ableNAFLD to assistcan people for with lifestyle changes andtoappropriate treatment retirement. Deciding what do and finding ways of participate associatedinconditions. liver is(NAFLD)into the activitiesFatty that one interested creases the risk of developing liver cirrhosis and in can be daunting, even for people without impairliver cancer. ments, and occupational therapists may be able to Alcoholic Liver Disease (ALD) is caused by assist. the chronic consumption of high levels of alcohol. There is also a role for occupational therapists Variceal haemorrhage, ascites and neuropsychito help design, develop, and problem-solve regardatric conditions are associated with ALD, and it is ing participation in leisure as part of community dethe main cause of death from long-term alcohol velopment, health promotion, and town planning. abuse. Geographically isolated communities can lack acLiver canceris the second leading cause of cess to a range of leisure occupations and to redress cancer death worldwide, according to the Canthis issue, occupational therapists could work with cer Council of Australia. Although its incidence communities to help galvanise and organise them to is relatively low in Australia compared with other develop their own local solutions, based on the inregions of the world, Associate Professor Amany terests of each community. In the area of health proZekry, Chairperson of the ALA and Liver Specialmotion, engaging people in leisure activities could ist at St George Hospital, notes that liver cancer be part of the solution for coping with the incidence is increasing faster than any other form of cancer of problems such as obesity and drug abuse. Ocin this country. cupational therapists could also contribute town Our indigenous population carries a to disproplanning by ensuring that facilities and grounds in portionate load of liver disease.Compared with which leisure occupations are undertaken are fully non-indigenous people, Australian Aboriginals accessible people who need have a 5 to to the 10 broad times range higherofpopulation-based access to them. incidence rate of liver cancer, a 12 times higher Leisurerate, is good body,rates mind,ofand soul. Even mortality and for higher chronic HBV though it is fun in nature, health professionals may infection. needLiver to consider more seriously as an imporcancer isit almost always fatal. In develtant factor in helping individuals and communities oping countries, most people with liver cancer achieve health and wellbeing. There is potential die within months of diagnosis. Ingreat high-income for occupational therapists and other health profescountries, surgery and chemotherapy can prosionals to include addressing leisure needs as part of long life for up to a few years. their daily work practices.
For fullarticles article visit NCAH.com.au Forthe more Nursing Careers Allied Health - Issue 22 | Page 21
Wound infection – what’s all the fuss about? By Clare Bonnie Fraser RN, BSc, BNURS
W
ound infection is a serious complication of wound healing. Infection may be localised, spread into surrounding tissues and bone, or manifest systemically as sepsis, a life-threatening condition. Infection not only delays healing but patient recovery in general; it increases scarring, causes undue pain and suffering and leads to complications such as wound breakdown and/or dehiscence. The added costs to the health care system through increased length of stay or unplanned readmission to hospital is considerable. It is vitally important for health professionals to recognise the signs and symptoms of infection early to minimise the risk of spreading and ensure reparative processes progress along the healing continuum as they should. Identifying wound infection All wounds are contaminated with surface microorganisms, the presence of which does not imply infection. Progression from contamination to infection depends on several factors including the patient’s ability to fight infection, wound characteristics and microbial virulence. Patient factors in addition to the immune response to invading microorganisms, the type of microbes present in the wound bed and the capacity of microbes to adhere to the wound surface and replicate, as well as virulence, all influence infection. Co-morbidities such as diabetes, rheumatoid arthritis, cardiovascular and respiratory
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disease, and renal impairment; and patient factors such as age, nutritional status, obesity and smoking status impact healing, increasing patient susceptibility to infection. Similarly, medications that suppress immune system responses such as corticosteroids, immunosuppressants, chemotherapy and radiotherapy will increase the risk of infection and delay healing. Conditions that limit peripheral perfusion and the delivery of oxygen and nutrients to the wound, for example peripheral arterial disease, ischemia, wound oedema and exudate levels, create a wound environment that supports microbial colonisation. Dirty wounds with devitalised and necrotic tissue and unhealthy slough provide the conditions conducive for microbial adherence and replication; and biofilm formation. Wounds will have various levels of microbial organisms which may or may not adversely affect wound healing. Contaminated and colonised wounds will generally heal without complications and it is important to remember that inflammation in the early stage of wound healing is normal and will continue for up to three days. Inflammation persisting beyond this time should be viewed with suspicion and be clinically reviewed.
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Nursing Careers Allied Health - Issue 22 | Page 23
Paramedics pledge to campaign against government By Karen Keast Victorian paramedics have vowed to actively campaign against the state government in the lead up to this month’s election. Ambulance Employees Association Victoria (AEAV) and the Coalition have failed to come to an agreement over wages and conditions in their bitter two-year-long industrial relations dispute. AEAV general secretary Steve McGhie said members this week voted to campaign against the government, after the government failed to resolve the dispute before it went into caretaker mode in the lead up to the November 29 election. Mr McGhie said while the union had failed to reach an agreement with the Coalition, Labor has pledged to work with paramedics to finalise negotiations over pay and conditions if it wins government. Labor has promised to refer paramedic pay rates to the Fair Work Commission and to establish an Ambulance Performance and Policy Consultative Committee to work to improve ambulance response times, ramping and paramedics’ workload. “Clearly the indications for us is that we believe the better outcome for paramedics and probably for the ambulance service would be if Labor gets elected but we’re not telling people who to vote for,” Mr McGhie said.
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“We’ll be campaigning against the government in regards to this ridiculous situation of being in negotiations for two years and four months and we still can’t reach an agreement. “We will be campaigning against them not only for wages and conditions but because of the crisis within the ambulance service of poor response times, hospital ramping up times, the lack of resources and the low morale in the industry.” The government has offered a $3000 sign-on payment for full-time paramedics, a six per cent wage increase for 2014, a three per cent wage rise for July 2015 and another three per cent pay rise for July 2016. Mr McGhie said despite the government foreshadowing an imminent deal, negotiations had stalled over some final sticking points, including an extension of the $3000 sign-on payment to part-time paramedics and on the agreement’s expiry date. “They were seeking November 2017 and we thought that was too far into the future, we offered them November 2016 or a date earlier,” he said.
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Nursing Careers Allied Health - Issue 22 | Page 25
Hundreds of nurses and midwives keen to combat Ebola By Karen Keast Hundreds of Australian nurses and midwives want to join the fight against the deadly Ebola virus sweeping West Africa. An Australian Nursing and Midwifery Federation (ANMF) survey has revealed more than 350 nurses and midwives, out of 1375 respondents to the online poll conducted over five days, would volunteer to assist in the provision of medical care and work to halt the spread of the outbreak. The results come as a Roy Morgan poll shows 70 per cent of Australians support sending nurses and doctors to West Africa to assist in the epidemic, while 23 per cent are against the move and seven per cent are unsure. The federal government has refused to send health teams to West Africa to support the international response to Ebola. The landlocked country of Mali has become the sixth West African country to report a case of Ebola after the death of a two-yearold girl. The World Health Organisation (WHO) states the Ebola death toll remains unchanged at almost 5000. ANMF federal secretary Lee Thomas said the union’s poll results are proof that hundreds of nurses and midwives are ready and willing to assist with Ebola if the government coordinates the effort. “We have been overwhelmed by the response from our members, who continue to be deeply concerned by the government’s reluctance to join the international effort to fight what is rapidly becoming a devastating humanitarian crisis,” she said. “Our members feel a strong obligation, as health care professionals, to care for people
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with all types of illnesses regardless of their circumstances or where they are located. “As such, they are deeply disappointed by the government’s lack of response to calls for assistance from their own health experts and recently from other countries which have been leading the fight to control the outbreak.” The poll found almost 90 per cent of respondents want the government to guarantee the safe return of volunteers and do more to fight the epidemic. “Our members, who are experts in the field, have clearly told us that acting now to control the outbreak at the source is the only effective way to deal with the Ebola crisis,” Ms Thomas said. “They are ready now to use their skills and knowledge to assist in the fight if the government coordinates the effort and guarantees them support.” Ms Thomas said it’s vital the government avoids any further delays. “On October 1, world experts agreed we had 60 days to control the Ebola outbreak…30 of those days have slipped by,” she said. “Every day we delay acting to control this Ebola outbreak, we increase the risk that it will spread across the globe and reach Australia.” The ANMF has urged nurses and midwives along with the wider community to donate to the Red Cross Ebola Outbreak Appeal. Donations to the Australian Red Cross Ebola Outbreak 2014 Appeal can be made at www.redcross.org.au or by calling 1800 811 700.
For more articles 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 22 | Page 27
How to become an aged care nurse Looking to become an aged care nurse? There are a range of education pathways that lead into a variety of roles in aged care nursing. Aged care nursing is an increasing area of demand in Australia as a result of the nation’s rapidly ageing population and escalating rates of dementia. It’s a career path that’s not only rewarding but is also challenging, interesting and engaging, enabling health care workers to care for older people in a variety of settings, such as aged care residential facilities to district nursing as well as home and community care. There are several education pathways that lead into a career in nursing in the aged care sector. The first is to complete a TAFE or RTO qualification, usually a Certificate III or IV in aged care, that provides basic theory and practice content. As this nursing workforce is unregulated in Australia, the course content, which includes a mix of theory and practice in the aged care setting, often significantly varies between different education providers and works similar to that of an apprenticeship model. Courses often train students in how to look after an older person’s care needs, support people’s health and well-being, recognise healthy body systems in a health care context, and to also support people living with dementia. These certificates enable students to work in residential or community aged care settings as an assistant in nursing (AIN) which is also known as a personal care worker (PCW) and personal care attendant (PCA).
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Fran McInerney, a registered nurse and Professor of Dementia Studies and Education at the University of Tasmania’s Wicking Dementia Research and Education Centre, says personal care workers, personal care attendants and assistants in nursing are not nurses but deliver essential daily care to aged care residents, providing an estimated 70 per cent of the hands-on care for older people in aged care. “There’s a little bit of interstate variation and the titles vary but the role is fairly much the same - that’s assisting people with various activities around quality of life, activities of daily living, nutrition and hydration, hygiene and mobility,” she says. Another pathway is to become an enrolled nurse (EN). Enrolled nurses are regulated under the Australian Health Practitioner Regulation Agency (AHPRA) and registered with the Nursing and Midwifery Board, and deliver more complex client care than personal care workers. Enrolled nurses are educated at the Diploma of Nursing level through a board-approved program of study at either university, TAFE or RTOs. The courses are designed to equip students with the theoretical knowledge and the practical skills required for their nursing career, and range from one year to 18 months and up to two years in duration depending on the education provider.
For the full article visit NCAH.com.au
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Nursing Careers Allied Health - Issue 22 | Page 29
Nurses say tougher penalties are not the answer The Queensland Nurses’ Union says the state government’s new double penalty laws will do little to deter violent offenders who are often not competent to stand trial. The government has doubled the maximum sentence to 14 years in prison for people who assault nurses, paramedics and doctors. More than 24,500 health workers reported being a victim of violence at work in the past five financial years, with more than 2800 nurses - or 8.51 per cent of Queensland’s 33,000 nursing workforce - attacked in the workplace in 2013-14. Health Minister Lawrence Springborg said thousands of nurses and paramedics are punched, stabbed, bitten and spat on every year in Queensland, with data showing much of the violence is fuelled by alcohol and drugs. The government has launched a campaign as part of its Safe Night Out strategy, including online advertising that features graphic images of injuries to nurses, paramedics and doctors. QNU secretary Beth Mohle welcomed the tougher penalty for assaults against health workers but doubted the new laws would halt the increase in violence. “We think it’s akin to putting an ambulance at the bottom of a cliff rather than having a fence at the top of it to stop people from falling over,” she said. “Very few prosecutions for attacks on nurses and midwives and other health workers ever see it through the courts and have successful prosecutions - they are normally the more extreme of the cases that end up going through the courts.” Ms Mohle said violent offenders range from drug and alcohol-affected patients right through to dementia patients and patients with other health and mental health conditions.
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“Increasingly the people who are assaulting members are people who either have dementia or mental health issues and they are not competent to stand trial,” she said. “The person who assaulted me when I was a nurse was an 80-odd year-old fellow who was adversely affected by an anaesthetic - he would be horrified that he’d lashed out and hurt someone. “We’ve had cases in maternity units where there’s been apprehended violence orders against people, where the mother has gone in and given birth and the partner is turning up at the maternity unit demanding to see the newborn baby and perpetrating violence. “It can happen anywhere - in geriatric facilities, in mental health wards, I don’t think that anywhere is immune from it and that’s the problem, it isn’t a simple problem to solve. “If it was a simple problem to solve it would have been solved by now.” Ms Mohle said the union has written to the director-general of Queensland Health and the state’s auditor-general, calling for a systemic review into the increasing trend in violent assaults against nurses and midwives. “We need to have a total review because we think each of the hospital and health services are dealing with these issues in a different way and there is no one consistent approach, even in relation to which cases they are going to prosecute,” she said. “We need to have a coordinated and quite a sophisticated response because the nature of violence is really changing.
For the full article visit NCAH.com.au
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