issue 104 | summer/wet season 2016
magazine RRP: $10.00 the voice of remote health
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Aboriginal and Torres Strait Islander readers are advised that this publication may contain images of people who have died. connect 82 CALL FOR ABSTRACTS from the editor INVITATION NOW OPEN The Summer/Wet Season edition is, as always, a bumper edition, packed CRANAplus invites you to submit Abstracts with stories, information and advice to sustain you over the summer. for the 2017 Annual CRANAplus Conference Our cover photo of Nursing Student Katarina Samotna was too good to pass up. It will surely catch the eye of our international readers. Katarina’s report (page 40) tells of her clinical placement experiences in Central Australia and her future 35TH ANNUAL CONFERENCE career direction. THE FUTURE OF REMOTE HEALTH Members, students and stakeholders have contributed to this edition and it all AND THE INFLUENCE OF TECHNOLOGY makes great reading. We introduce Project Officer Judy Whitehead in this edition. Judy is spearheading the Rural Nursing Project and their goals in 2017. Dr. Shannon Broome Western Australia Nott shares exciting details and photos of his participation in the Mongol Derby Ride and how it tied into fundraising for services for the bush. Professional Services October 18-20 2017 outline their achievements this year and major projects for 2017 and CRANAplus Bush Support Services offers a range of articles: identifying Burnout; the connection www.crana.org.au between art and health; and the growing challenge of ‘ICE’ in remote and rural Australia. Feedback from CRANAplus short course participants continually tells us the caliber and expertise of the Faciliator team ‘value adds’ to their learning experience. We chat to two longtime Facilitators to find out why they chose to volunteer with CRANAplus and what they get from the role. The CRANAplus education | support | professional services Education Schedule 2017 (pages 72 and 73) outlines details of courses and locations. Some courses are already heavily booked or full. Avoid disappointment and register soon for a course or preferred location. By its very nature, remote and isolated areas generate unique, If you weren’t able to join us in Hobart we have a wrap up of events and photos for you. Last but not resourceful and innovative approaches to the delivery of health care. least a sincere thank you to our Sponsors and Exhibitors who supported the Hobart Conference and Technology is advancing at a rapid rate, and we must ponder the question – Has, does or will contributed to the success of the event. this change the way healthcare is supplied, experienced and performed in remote Australia? Check out the CEO’s letter (over page) for details of a chance to win two full registration passes to our 35th Conference in Broome in October! • What does the future of remote health look like, We encourage submissions from: Anne-Marie Borchers are we leading the way or stuck in the past? • Remote and isolated health professionals Manager Communications and Marketing • What are the innovative ways in which CRANAplus technology is utilised in the bush? • Consumers • Is technology the answer for improved • Remote or isolated health and community access, safety, quality and affordability Service Providers of remote healthcare? • Aboriginal and Torres Strait Islander • What are the benefits, risks and challenges that health services present to health professionals and consumers? • Undergraduate and postgraduate students
• Are our consumers getting healthier? • Researchers and education providers improving remote health • What’s coming, what’s just over the horizon? • Professional bodies and associations Email: [email protected] CRANAplus graciously acknowledges the Australian • Are we moving away from meaningful • State, Territory & Local Governments Government Department of Health for making this human interactions, what are the Phone: (08) 8408 8200 | Fax: (08) 8408 8222 magazine possible through grant funding. Presentations are 15 minutes with additional time CRANAplus Magazine, PO Box 127, Prospect SA 5082 long-term implications? CRANAplus’ Patron is The Hon. Michael Kirby AC CMG. for questions at the completion of each session. Every effort has been made to ensure the reliability of content. • What forseeable support will the remote The views expressed by contributors are those of the authors About the Cover: Nursing Student Katarina Samotna shares health workforce need in the future? and do not necessarily reflect the official policy or position of her photos and story of her clinical placement in the NT. CLOSING DATE any agency of CRANAplus. Read article on page 40. • How is data changing the way we think and MONDAY 15 MAY 2017 Magazine circulation 15,000. provide healthcare? 1 education | support | professional services from the ceo
Dear CRANAplus Members and Stakeholders,
I hope you are reading the latest edition of the CRANAplus Magazine as you enjoy the festivities that mark the ending of one big year in Remote Health, SUPPORTING YOUR and celebrate the opportunities that 2017 will bring. We routinely hear about emerging or new remote health professionals, desperately EDUCATION searching for the support, education and advice that CRANAplus offers. It is a constant challenge to access and support these individuals, as we attempt to COMMUNICATION prevent burn out or them leaving disillusioned with remote health as a career choice. I see CRANAplus members as the solution to this, CRANAplus members are WELLBEING generally engaged and professionally ‘linked in’, providing us deep penetration into the remote and isolated health industry. Not dissimilar to the principle of herd immunity, we strive to maintain a critical mass of CRANAplus members across our industry, they in turn advise and link their colleagues with networks, resources and supports. To help improve this we are asking for your help to encourage membership, by placing Toll free 24hr phone a CRANAplus poster (as per opposite page – they come pre-laminated and with wall mounts) in every counselling for all remote health providers and their remote, rural and isolated health service across the country. Just email [email protected] with families on 1800 805 391. the number of free posters you’d like sent to you. We encourage you to take a photo of yourself and/or your team with it on your workplace noticeboard and we will put it on our FACEBOOK page and in May we’ll choose names for a prize of two full registrations, for our Broome Conference, 18–20 October 2017. Advocating for and providing One of the many new initiatives that CRANAplus is implementing is the ‘Mates of CRANAplus’ professional support, practical information, and membership category. This new category will be for organisations and businesses that support remote advice for members. health and agree with the CRANAplus’ values and priorities. Another example of how we are weaving a broad web of support and protection around our challenging yet essential remote and isolated healthcare workforce. Innovative, affordable, local At the recent CRANAplus Conference, we were pleased to launch the Gayle Woodford Memorial and relevant education to your context of practice. Scholarship, a joint initiative between CRANAplus and the Centre for Remote Health, to provide free tuition to one person each year to undertake the Graduate Certificate in Remote Health Practice. I believe this is an enduring and fitting memorial to help us remember one of our remote health family who was tragically taken from us. I hope you enjoy this edition of the CRANAplus magazine, and keep safe and well over the festive, While you're summer and/or wet season. taking care of Cheers others, we'll take Christopher Cliffe CEO, CRANAplus facebook.com/CRANAplus care of you.
CRANAplus acknowledges the Aboriginal and Torres Strait Islander Peoples as the traditional custodians of Australia, many of whom live in remote areas, and pays its respect to their Elders both past and present. BECOME A MEMBER www.crana.org.au 2 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 3 All have involved clinical services and nursing care access considerations and I am certain the foundation of my chosen profession continues to serve me well in my decisions. Some of you would recall the early days of HIV in Australia. For Far North Queensland in the beginning of the 90s this brought many challenges in care access and delivery. Introducing care standards and community prevention interventions was not a well sought after public health nurse role, as you can imagine. However it was many a colleague Photo: Steve Batten. engage in our rural and remote profession who led the way to ease local opinion and inform communities, by soundly returning to the reflections basic right of care access for all. There are many stories of remote road side Paul Stephenson, newly appointed to show pride in our sector and services. retrievals, births in not so desirable places, Chair of CRANAplus reflects on both his I believe this was truly demonstrated across difficult emergency care decisions, difficult career and developments within the the presentations and from within the management decisions, as well as some good organisation over the past few years. discussions generated from the floor. old ‘common sense prevails’ moments that In March 2012, I was writing about looking Back in the early 2000s I was fortunate to I will share another time. The foundations to closely at the potential impacts and be invited to do a clinical services review of resilience and perseverance in some of the opportunities of the then ‘National Health infection control systems at a fully operating most challenging of times and decisions for Reform’. How time gets away. We didn’t see hospital in a remote province in PNG. I was me has been shared values and an ear to a major ‘National Health Reform’ In the years overwhelmed at the standard of care and hear out the worst and best of it. that have followed, however, CRANAplus did clinical skill in an environment so challenging and Enough of the chat, CRANAplus this season see significant advancement in the recognition made very few suggestions for improvement. continues to make gains on the Safety and of our agenda around education, support and A most notable sight was the need to hang the Security project consultations, the Rural Nursing advocacy. Some things change for the better washed (and subsequently reused) disposable project and this season we launch the ‘Mates of while others seem to suffer little progress. (intact) gloves higher on the line and off the CRANAplus’ as a new initiative to capture the ground to avoid the dogs and kids playing Today our organisation is more strongly than interest of the broader remote and rural sector with them. A true example of practicality ever recognised and consulted on health care that associates with health care. as a foundation to supporting care access. improvement strategies. Many are broader in Hope this finds you all in good spirits and that scope and consequence and this only happens I reflect on a career geographically spanning the season has been kind to you. through sheer determination and dedication from Palm Island to Mornington Island, of our membership at work. At our recent North Queensland up to Saibai Island in the Paul Stephenson Conference we were asked to be proud and Torres Strait and now the Northern Territory. Chair, CRANAplus
4 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 5 rural nurses voices need to be heard TOP END HEALTH SERVICE CRANAplus is reaching “So I am out there, sourcing nurses who out to rural nurses in may be interested in becoming part of the Australia, with the consultation process. We want to speak to as aim of giving them many nurses as possible.” a voice, identify any professional gaps, Surveys, forums and consultations will be a then work together large part of this 12-month fact-finding project. to bridge those gaps. About 30 per cent of CRANAplus members have self-identified as having an interest in rural “We plan to leverage nursing. “We need rural nurses to engage the vast amount of with us, and tell us their stories, so that we experience and expertise can ascertain their needs,” says Judy. we have in catering for the remote health workforce,” says Judy Whitehead (pictured), who recently joined CRANAplus to Judy says she is very lead the Rural Nursing Project. excited by the opportunity Life changing “CRANAplus excels in providing education, to undertake this project support and professional development to with CRANAplus… the remote workforce, and we believe these opportunities services are translatable into the rural sector.” Judy says she is very excited by the opportunity Judy’s work will build on an extensive to undertake this project with CRANAplus and literature review already undertaken. she has ‘hit the ground running’. A Summative Literature Review has been posted on the CRANAplus website. Judy, who grew up on a farm outside Quorn, Experience the NT outback a small country town in rural South Australia, “CRANAplus excels in knows the benefits of such a lifestyle. But she Right now we have great prospects for also recognises that people from urban areas providing education, often don’t see a rural posting as a viable nurses who are looking to lead the way in support and professional career option. Remote Health Practice. development to the Judy has spent most of her nursing career with remote workforce…” the Royal Flying Doctor Service and she has Challenge yourself to make a difference worked in the rural and remote areas out of Port “The literature says that rural nurses feel they Augusta, Broken Hill, Alice Springs and Adelaide. become a Primary Health Care Nurse today! are not receiving the recognition for the roles For the past 12 years she has been the Director they perform,” says Judy, who is undertaking of Nursing at RFDS South Eastern Section based an extensive consultation process. in Broken Hill.
She aims to meet with rural nurse leaders She has also been a REC facilitator with and clinicians (Registered Nurses, Registered CRANAplus for many years. Midwives, Enrolled Nurses), across the entire rural health setting – not only in hospitals The Summative Literature Review can be found but also in general practice, community on our website crana.org.au/professional/ health centres, and aged care facilities. research/rural-research For enquiries contact recruitment by emailing [email protected]
6 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 7 “We have 3000 plus volunteer pilots and aircraft Jarrod Roesler had been on the kidney transplant milestone for angel flight and another 3000 plus volunteer drivers and waiting list for three years and travelled to cars that assist us to complete our missions,” Sydney on a regular basis for dialysis. Angel Flight is a charity that coordinates non- Angel Flight CEO Marjorie Pagani said. September brought about an amazing One week after the milestone flight, Jarrod emergency flights for country people who are milestone for the Angel Flight community finally received the call he had been waiting dealing with the triple threat of bad health, poor with the completion of its 20,000th mission. “We have 3000 plus for to receive his new kidney. finances and daunting distances. Wagga Wagga teenager Jarrod Roesler and his volunteer pilots and aircraft Angel Flight flew him back to Sydney to mum Linda had the pleasure of sharing this and another 3000 plus receive the life-saving transplant and he milestone with pilot and former RBA Governor To date, Angel Flight now has the chance to live a normal life. Glenn Stevens on their flight home after Jarrod’s have transported more volunteer drivers and treatment in Sydney. than 60,000 passengers… cars that assist us to “There will be no more dialysis for him and he has a bright future ahead of him,” To date, Angel Flight have transported more complete our missions…” Ms Pagani said. than 60,000 passengers from their rural All flights are free for country patients attending medical appointments in the city. Angel Flight “We receive no Government funding, we don’t residences to their city medical appointments “Angel Flight will continue to fly him back pilots donate their time and their aircraft to pay for marketing or promotions and we don’t and home again. and forth to Sydney for his check-ups.” complete these missions while Earth Angels, sell merchandise meaning that the majority of Pilot Glenn has completed 38 of these flights and also known as drivers, donate their time and money donated goes straight back into Angel If you would like to volunteer with Angel Flight Jarrod has flown 16 times, while driver Patricia cars to transport patients from the airport to Flights to pay for the fuel which the pilots and or to make a donation, please visit our website has delivered 131 patients to their destinations. their appointments and back again. drivers use on our missions,” she said. www.angelflight.org.au or visit us on Facebook.
Pilot and former RBA Governor Glenn Stevens with Angel Flight CEO Marjorie Pagani prior to take-off for Mission 20,000. Volunteer driver Patricia Clarke, Jarrod Roesler and Linda Roesler.
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34TH CONFERENCE GRAND CHANCELLOR HOBART 12–14 OCTOBER 2016 conference round up
This year’s annual Conference once Issues directly affecting our clients and steps our again was the launching pad for new members take to address them featured throughout ventures and areas for our organisation the Conference. On both days, Rheumatic Heart to explore, as well as providing indepth Disease was a specific issue that surfaced in a information and opportunities for number of presentations, highlighting the disturbing discussion on important ongoing topics fact that Australia, an affluent country, still has Expressions of affecting our members and clients a problem with this preventable disease. Interest to participate throughout Australia. Our Patron, The Hon. Michael Kirby, human rights expert and a champion of HIV education, Participants, as always, enthusiastically CRANAplus once again endeared himself to Conference embraced the challenge to not only listen to participants, and our other keynote speaker, the varied presentations but also to contribute Dr Bob Brown, renowned environmentalist, information and opinions, from big-picture collaborative, was also warmly welcomed. They were perfect topics to honing in on specific issues. figureheads for this year’s Conference, Going to engaging and connected workplaces A common big-picture thread, not surprisingly, Extremes, as they have both spent their lives focused on work health and safety, and pushing the boundaries, and the line-ups to CRANAplus will be hosting a symposium in April 2017 on Collaborative, Engaging and Connected Workplaces was featured on both days. It culminated sign their books afterwards said it all. (CECW). The Symposium is aimed at addressing issues that create toxic workplaces. We are calling for in a symposium with guest speakers from expressions of interest from middle to senior management and human resource professionals in the The annual Conference is ideal for CRANAplus organisations with vast experience in this area: remote health sector who deal with bullying, workplace conflict and harassment on a regular basis. members to meet fellow rural and remote health Red Cross, Australian Antarctic Division, police, workers. It is also a key once-a-year opportunity The CECW Symposium will focus on highlighting the psychological importance of healthy workplaces. It ambulance and hospital environments. to discover new options for work and study and will explore the specific context of remote health and draw on the combined expertise of the participants. perhaps to take steps to contribute to CRANAplus This Q&A session on maintaining staff safety in It will explore ways that leaders in remote health utilise evidence-based measures to further prevent and projects and special interest groups. manage conflict, in order to maintain and create safe, productive and sustainable workplaces. complex and diverse environments provided a powerful finale to Friday’s offerings. See you in Broome in 2017! If you feel you would like to participate in this exciting two-day event. Please contact: Colleen, Director of CRANAplus Bush Support Services email: [email protected] mobile: 0448 011 956 the voice of remote health 11 annual conference 2016
34TH CONFERENCE GRAND CHANCELLOR HOBART 12–14 OCTOBER 2016
Joanne Caruana HESTA Representative. Welcome to Country and networking event.
Aunty Brenda Hodge gives the Welcome to Country. CRANAplus Chair Paul Stephenson and CRH Prof Sue Geri Malone, Francine Douce (CNMO Tasmania) Danni-Lee Dean and Kadee Jones. Lenthall display the Galyle Woodford Memorial Plaque. and Conference MC Karen Cook.
HESTA has sponsored the Welcome Ceremony for the past six years. SCHOLARSHIP “It is an absolute honour to be involved with CRANAplus,” Joanne said, “and to continue SUPPORT our commitment to the organisation and these scholarships.” FROM HESTA HESTA, the superannuation fund for health HESTA has 800,000 members, mostly in TH workers, has made a commitment to the health and community service sector. 34 CONFERENCE HOBART continue its sponsorship of three annual GRAND CHANCELLOR Undergraduate CRANAplus scholarships. 12–14 OCTOBER 2016 FRANCINE’S 5 Speaking at the Opening Ceremony last 1 night, Joanne Caruana, general manager of CHALLENGE Member Education of HESTA, said the fund DAILY NEWS A record 220 delegates are attending this was proud to support this initiative. 13 NEW PHASE OF year’s CRANAplus conference in Hobart, CONFERENCE The scholarships assist with such essentials as officially opened last night by Francine THURSDAY 13 OCTOBER 2016 EXPANSION FOR transport, accommodation and mentoring. Douce, Acting Chief Nurse and Midwife with Tasmania’s Department of Health CRANAplus and Human Services. KEYNOTE ADDRESSES HIT THE MARK 4 The new Chair of the CRANAplus Board of Issuing a challenge at the opening “Why is isolation and remoteness so keenly Directors is Paul Stephenson, who has held ceremony, Francine said: “I want you sought after by the rich end of the tourism the position of Vice President since 2010. to share your pride and joy. Connect industry, yet a prescription for poverty and Paul, elected at the annual general with someone you don’t know and ask poorer health for many of the people who meeting yesterday,6 said his forthcoming what makes them proud to be a health live in it?” term was an important phase in the professional. And then share yours.” This is the question posed by former Greens organisation’s development. leader Bob Brown, who opens our 34th The Welcome to Country was given by “Our remote workforce is the anchor of annual Conference today as our first keynote Tasmanian elder Aunty Brenda Hodge, who CRANAplus,” he said. “Our next phase speaker. He has a few answers – including wished the delegates success for the evening is to expand our support and services to POP UP 12 and the event. As she pointed out: “The the need for proper funding of remote area include our rural workforce, which faces country, the waterways and the seas are health services. similar challenges. MARKETS our connection to the past and the present. 2 7 14 Bob, who was once heading for a medical “My vision is to be as inclusive of the entire Joanne Caruana. If the country, the waterways and the seas Check out our pop-up markets 12: career, says the shift to becoming an membership and the communities of 13: Francine Douce. are not well, our people become unwell.” on the Mezzanine level, environmental8 activist was a case of getting interest as much as we can.” 14: Aunty Brenda Hodge. 4: New Board: Front row (L–R): Dr Kathryn Zeitz, THANKS TO out of direct medicine and going into featuring Tasmanian artisans. Belinda Gibb, Paul Stephenson, Lynnette Byers. 9 Paul, a Registered Nurse with management Back row (L–R): John Wright, Dr Nick Williams, Associate Partner preventive medicine. qualifications, is currently General Manager Find handmade jewellery John Ryan, Fiona Wake . His address will no doubt reflect our Conference of the Australian Regional and Remote 5: Geri Malone, Francine Douce and Karen Cook. made by three local women; promise for this year ‘Going to extremes’. Community Services, Northern Territory. 6: Sally Wakeling, Claire Boardman and Jane Davies. work by milliner Holly Mason; He has worked in rural and remote locations 7: Jenny Costigan and Karen Schnitzerling. And we wouldn’t expect anything less Welcome Ceremony Sponsor since 1990. Smitten superfine merino 8: Dr Kathryn Zeitz and Monica Frain from tomorrow’s keynote speaker, our garments; and items from the New CRANAplus Fellows. organisation’s patron The Hon. Michael Kirby. Strickland Gallery, permanently 9: Caitlin O’Connor, Louise Patel and Kerry Copley. He has spent the past year working for a 1: Paul Stephenson situated in the Hotel foyer. 10: Midori Kamizato (Japan), Naomi Kikkawa major UN panel, looking at ensuring people New Chair CRANAplus Board of Directors. (Brisbane) and Tomoko Miyazato (Japan). in poor and developing countries get access 2: Bob Brown. 11: Janie Dade Smith, Pam Lenthall and Heather Moore. The Hon. Michael Kirby. Take a local handmade 10 to patented medicines, quite a challenge 3: Sponsor 3 memento of Tasmania home considering the prohibitively expensive costs 1 with you. 2 of pharmaceuticals. CRANAplus 2016 CONFERENCE DAILY NEWS | THURSDAY 13 OCTOBER 2016 11 GOING TO EXTREMES HOW ISOLATION, GEOGRAPHY & CLIMATE, BUILD RESOURCEFULNESS & INNOVATION IN HEALTHCARE
#CRANAplus2016 New CRANAplus Fellows Dr Kathryn Zeitz and Monica Frain. Jenny Costigan and Karen Schnitzerling. Caitlin O’Connor, Louise Patel and Kerry Copley. GOING TO EXTREMES HOW ISOLATION, GEOGRAPHY & CLIMATE, BUILD RESOURCEFULNESS & INNOVATION IN HEALTHCARE
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34TH CONFERENCE GRAND CHANCELLOR HOBART 12–14 OCTOBER 2016
Keynote and CRANAplus Patron The Hon. Michael Kirby. Mr Tony Zappia MP, Assistant Shadow Minister for Medicare.
Q&A panel ‘Maintaining Staff Safety in Complex and Diverse Environments’.
The Hon. David Gillespie MP, Assistant Minister Lauren Gale, Director Programs & Policy, RFDS. for Rural Health.
MELTING THE ICE IN REMOTE CARE Whether they are safe, their families are safe, whether children or domestic violence Health professionals in remote areas need to #CRANAplus2016 is involved. Are they paranoid or moving be informed about best practices for dealing towards a psychotic episode? FITTING with the impacts of methamphetamine (ice) use, according to clinical psychologist “Keep calm, and discuss the concerns they Amanda Akers. MEMORIAL POP UP MARKETS are bringing up. Take them aside, away At the opening of our Conference“While the use of heroin and powder-based from other clients. yesterday, CEO Christopher Cliffe called Check out our pop-up markets Robyn Carmichael and Nola Fisher. Dr Bob Brown. amphetamines are on the decline, ice use “Accessing support, residential services for a minute’s silence inis honour on the of increase,” work said Amanda, who is on the Mezzanine level, and other services such as Chrystal Meth colleague Gayle Woodford, murdered in part of the team of psychologistsfeaturing used by Tasmanian 3 artisans. TH tragic circumstances earlier this year. 34 CONFERENCEAnonymous is an issue in rural and remote CRANAplus Bush Support Services. “It’s HOBART Amanda advises remote area healthGRAND workers CHANCELLORareas,” she said. Following this, Professorreadily Sue Lenthallavailable and it’s cheap.”Find handmade jewellery 4 to take a holistic approach when dealing12–14 with OCTOBER 2016 of the Centre for RemoteStatistics Health show (CRH) that seven per centmade by three local women; Another service that is developing 5 announced a joint scholarship with patients using ice. “Sometimes it is important around the nation is the Smart Recovery 6 of Australians over 14 have usedwork by milliner Holly Mason; CRANAplus to honour Gayle. not to get into a debate, as this can fuel the programme, and the Be Smart programme 7 amphetamines at least once in their life. Smitten superfinefire,” shemerino said. “We see a lot of aggression The scholarship will cover the fees for aimed at families and friends of DAILYusers. NEWS “It is so important to know how togarments; detect andout items there infrom the community, the in the hospitals 1 the Graduate Certificateuse and in toRemote deal with Health it,” Amanda pointed CONFERENCE and clinics, and it’s vital that we keep Amanda has written a book, to be released Practice at CRH. Strickland Gallery, permanently out. “People will present for support but ourselves safe as well as the users FRIDAYsafe, 14 inOCTOBER December, 2016called Frozen Families 22 situated in the Hotel foyer. Applications opendon’t next necessarilyweek and closewant to stop using,” and the community safe. providing seven essential tips for survival, TODAY’S
at the end of November.said Akers. “People need to be ready when there is an ice user in the family. to make changes. Take a local“We handmade have to be well educated and THE LINK HIGHLIGHTS Gayle undertook her studies at the Centre informed. We have to know what is going She also recommended Breaking the Ice “In the meantime, health professionalsmemento of Tasmania home The Hon. Michael Kirby, our organisation’s and the scholarship is a fitting memorial. on. What stage of ice use they may beBETWEEN at. written by Matthew Noffs, which provides, need to be aware of the effects and visiblewith you. patron and this morning’s keynote speaker, information on the use of ice in Australia. signs of methamphetamine abuse – to CLIMATE CHANGE will talk to us, among other things, about Christopher Cliffe. 8 22: manage situations appropriately, and to 9his role with the UN, working on a macro 23: Professor Suekeep Lenthall. themselves safe.” AND HEALTH level to look at the delivery of health worldwide. It is a nice fit for the work of 10 A national strategy dealing with climate 11 CRANAplus members, striving to deliver 3: Amanda Akers change and health is paramount, according . health care in often difficult and challenging 4: Anneliese Cusack. to former Greens leader Bob Brown. circumstances in some of the most remote 5: Rod Menere. Speaking after his keynote address at the areas of the planet. CRANAplus conference in Hobart yesterday, 6: Dr Jeff Ayton. 2 7: Sandy McElligott. he criticised the Federal government’s In a Q&A session this afternoon, experts 8: Claire Boardman. shortsighted approach. in their fields will discuss and answer levels will rise between 1–3 metres by the 9: Karen Dieninger and Vanessa De Landelles. questions around staff safety in complex “Climate change isn’t going to happen, it end of the century – and those predictions 10: Lauren Gale. 12 and diverse workplaces. They include police, is happening right now,” he said. “And it is are always conservative.” 11: 13 Australian Red Cross, ambulance services, a 23 Dr Janie Dade Smith. going to escalate. We need to be prepared. 12: 14 Bob said it was ‘culpable’ that the major hospital and the Australian Antarctic Karen Cook. 15 13: Christopher Cliffe – Bush Support Services is “The health issues are numerous. Apart from Queensland government this week had Division. This session will enable us to THANKS TO engaging with delegates to knit a square to be EDUCATION temperature rises, and we know that the fast-tracked the Adani Carmichael coalmine build on16 the experiences and knowledge stitched together for a ‘mate in need’. heatwaves in Melbourne in recent years have project in western Queensland. of organisations and services working in 17 Associate Partner 14: Kim McCreanor. cost hundreds of lives, there is the impact complicated environments. The much anticipated 2017 “Globally, it would cost us 2 per cent of 15: Naomi Kikkawa. of the spread of new diseases, such as our wealth to turn climate change around, And the numerous presentations during 16: Robyn Carmichael and Nola Fisher. CRANAplus Education schedule dengue fever and other diseases spread by to go to renewable energies and move the day will continue the high standard 17: Simone O’Brien and Linda Blair. With hasour ebeenxper treleasedise, and b andack gisro und mosquitoes. It’s happening now in the north we enjoyed yesterday. 18: in both recruitment and nursing we away from fossil fuels,” he said. Welcome Ceremony Sponsor WTonye ’Barnett.re there for you! available on our website of the country, and they are heading south. JOY AND PRIDE 19: Jessie Cummins. know what is important to you. But, Bob is optimistic about the future. We have you covered whatever https://crana.org.au/education/ “Then there are the storms, the bushfires, 20: Chris Zeitz. 1: The Hon. Michael Kirby. Take time today to share a your next career move may be. We courses/course-schedule the cyclones – these are all health “Youngsters I run into ask me why I’m 21: Stewart Roper. 2: Dr Bob Brown. currently have a range of Nursing emergencies. There should be a prohibition not depressed,” he said. “I say to them: positive story about your vacancies whether you are looking 18 put in place now on building within three ‘Don’t get depressed – get active’.” 1 experience as a remote health 2 CRANAplusfor full 2016tim eCONFERENCE, partti mDAILYe, cNEWSont r| a FRIDAYct or 14 OCTOBER 2016 metres of high tide. Predictions are sea professional – and make a new Guest speaker Prof Debra Thoms, Commonwealth Chief Dr Jeff Ayton, Chief Medical Officer, Austalian Sponsor agency shifts. 19 GOING TO EXTREMES HOW ISOLATION, GEOGRAPHY20 & CLIMATE, BUILD RESOURCEFULNESS & INNOVATION IN HEALTHCARE friend in the process. 21
Nursing & Midwifery Officer. Antarctic Division. Naomi Kikkawa, R&R Project Coordinator, QCPIMH. GOING TO EXTREMES HOW ISOLATION, GEOGRAPHY & CLIMATE, BUILD RESOURCEFULNESS & INNOVATION IN HEALTHCARE
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felt she had been propelled to another planet. Trusted by the community, people sought her Mentoring is not a newly mastered skill of She moved to Ntaria (Hermannsburg) for seven advice knowing she would follow things up as Joanne’s as she has mentored many staff years then worked with Batchelor College, she could, always seeking the most appropriate from a variety of disciplines over this time, Old Timers and Central Australian Aboriginal solution or plan of care for them and their the very low turnover rates of her team is an Congress in Alice Springs, but the urge to return individual situation. Remote nursing is not easy, acknowledgement of her success and support. to Ntaria proved too strong and she returned often challenging, and she held invaluable Her colleagues believe Joanne is an exceptional 34TH CONFERENCE there until August this year when she retired experience, knowledge and wisdom that allowed professional role model. GRAND CHANCELLOR HOBART her to provide invaluable care to mothers, babies, 12–14 OCTOBER 2016 after 21 years in Central Australia. children and all community members. Her colleagues say of her that she is a true The support and energy generously given to ‘quiet achiever’. Working quietly behind the budding practitioners, visiting health services scenes, others often unaware of the work she CRANAplus and researchers was also highly valued; anyone had been slowly, gently, thoughtfully doing working with children in Ntaria will have heard award winners until you realised what has been nipped in of her and her work. She was an invaluable the bud, or artfully resolved. asset to the community, and greatly appreciated. Aurora Award Her colleagues say Excellence in Mentoring in Remote Winner: Glenda Lucas Health Award Travelling to Utopia in Central Australia in 1993 of her that she is a Winner: Joanne Mahony for 12 months proved a massive learning curve true ‘quiet achiever’. Sponsor: Remote Area Health Corps (RAHC) and introduced our winner, Glenda Lucas, to a way of life she came to love. Ignorant of the Her decades of work in the community meant Joanne is a Nurse Practitioner who has been Central Australian way of life and unaware that that she was well known, understood and also employed for 13 years with the Royal Flying people still spoke in Traditional languages she knew and understood the community well. Doctors Service in Charleville, Queensland. Joanne Mahony (right) with Emma Wex.
Glenda Lucas, then… …and now, with longtime friend Marion Swift.
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for the remote midwives and non-midwives, The RFDS Nursing teams community knowledge and placement with the RFDS. They would like assisting them to navigate the often-complicated and long-term stability ensures the best possible the Scholarship to be called the Cooper Basin journey from conception, pregnancy, birth, outcomes and constructive collaborative RFDS Scholarship. through to post natal care. Her peers believe that engagement during the Medical Officer visits, Rita’s contribution is invaluable to the ongoing to the benefit of the remote population. Outstanding Novice/ review and updating of the Remote Primary Encouragement Award Health Care Manuals. Rita is a positive role model, The Cooper Basin RFDS Team wish to donate and a wonderful exemplar of a remote midwife. the $500 prize and will donate a further $500 Winner: Daphne De Jersey to support a student undergraduate scholarship Sponsor: Aussiewide Economy Transport Collaborative Team Award Winner: Cooper Basin RFDS Team Sponsor: Brad Bellette Design mapoon health worker The Cooper Basin RFDS Team has been together for the past 10 years delivering daily wins national award primary and emergency health care to the “It turns out I was going to Hobart which was Tobias Speare. remote and isolated Cooper Basin. The team Mapoon Maternal and Child Health looks after local residents, pastoralists and Worker, award-winning artist, mum of great as my dad and grandfather were born Excellence in Education or Research tourists as well as developing the first remote seven and grandmother of five Daphne there. I still have aunties and cousins there in Remote Health Award industrial service in Australia. The stability De Jersey, has won the CRANAplus and I managed to catch up with them when of the team has ensured a consistent front- (the peak professional body for the I was there. The last time I was in Tasmania Winner: Tobias Speare line service, fostering a strong therapeutic remote and isolated health workforce of was 26 years ago, when I was 21 and it was a Sponsor: Centre for Remote Health (CRH) relationship with all key stakeholders. Australia) Novice/Encouragement Award shock going back there from the Cape. We get Toby works as a pharmacist academic at for completing her Cert. IV in Aboriginal cold weather on the Cape but it’s different to the Centre of Remote Health and has a keen and Torres Strait Islander Health Care Tasmanian cold weather – my fingertips froze, interest improving the quality use of medicines CRANAplus award Practice, her outstanding potential as my face was red with cold and I think I lost a through education. sponsors 2016 a future clinician and leader in remote kilo as I had to walk fast to keep warm health, enthusiasm and commitment to whenever I was outside.” His colleagues believe that one of his major remote health, willingness to learn and achievements has been the development of Excellence in Mentoring in Remote positive influence on the health of her ”It was really interesting reconnecting with my an on-line course ‘Pharmacotherapeutics for Health Award community which is far beyond what is aunties. One told me that before I was born, my Sponsored by: Remote Area Nurses’. The course is of a very expected of early career Health Workers. parents (dad was white, mum was Aboriginal high standard, popular with demand increasing, Remote Area Health Corps (RAHC) and Solomon Islander) went to the doctor to find and is mandatory for RANs working in the The award was presented to Daphne at a Excellence in Education or Research out what colour their child would be if they were Departmental remote clinics in the NT. special ceremony at the end of the CRANAplus in Remote Health Award to have a baby. This was in the 1960s, when He strives to improve patient care through annual Conference which was held in Hobart Sponsored by: they were still removing half-caste children from the judicious use of medications. n the 12–14 October. Centre for Remote Health (CRH) their families. They were very frightened, my Excellence in Remote Health Daphne, who is currently enrolled in a Diploma Excellence in Remote Health Practice Award auntie said, that if they had a child, it would be Practice Award Sponsored by: of Aboriginal and Torres Strait Islander Health taken away. In the end my sister and I weren’t Care Practice, said she had no idea she had been Winner: Rita Appelt Mt Isa Centre for Rural take away but it was a real fear for my parents.” nominated for the award and was stunned to Sponsor: Mount Isa Centre for Rural and Remote & Remote Health (MICRRH) learn she had won. “I gave a speech when I accepted my award, Health (MICRRH), James Cook University Collaborative Team Award sharing my family connection to Tasmania, “It was a bit of a shock when I found out I had Rita works in Central Australia Primary Health Sponsored by: the history of Mapoon and my family’s history won the award,” she explained. as a relief Outreach Midwife for remote clinics. Brad Bellette Design there. My mother and grandmother were born in Mapoon but our family is part of the stolen Rita’s background includes remote area nursing, Outstanding Novice/Encouragement Award “My colleague said, ‘can I give you a hug?’ although she now focuses on remote outreach Sponsored by: I thought it was because she had good news, generation – Mapoon is not our traditional midwifery and women’s health. Rita is seen as Aussiewide Economy Transport but then she said, ‘you’re going to Melbourne, country but because some of us were born wonderful resource for remote women but also you’ve won an award!’ there, it’s home.”
18 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 19 annual conference 2016
Daphne De Jersey (left) receiving award from Prof Janie Dade Smith at this year’s annual CRANAplus Conference.
“I also talked about how many hats people Maternal and Child Health Team Leader wear when they live in remote areas. In small (North Cape) Johanna Neville, who secretly communities, those that do stuff, get called nominated Daphne for the award, said the on to do everything. I am a full time Health win was well-deserved. Worker, Chair of the Justice Group, run an arts More people in health and organisation and a weekly Women’s Group “…She always puts with my sister. Last year I got a real urge to do something for the women of Mapoon so my her heart and soul into community services choose sister and I started this group and ran it three everything she does. times a week. It’s open to all women and as my sister and I are both artists we do art I could not think of anyone HESTA for their super therapy with the women which relaxes them else who deserves this and gives them space to be creative and Supports your industry | Low fees | A history of strong returns share their stories.” accolade more.” “We’ve dropped down to once a week but the “Daphne is not only an amazing worker but also Women’s Group is really successful and families an inspiring mother and artist. She always puts have noticed a positive change in the women her heart and soul into everything she does. who attend.” I could not think of anyone else who deserves this accolade more.” “While my job title is Maternal and Child Health WORKPLACE SUPER PRODUCT OF THE YEAR - VALUE CHOICE Worker my role encompasses a lot more than “She has been with us since 2010 and has been WINNER that. In small communities, there is often a staff studying the whole time. She is a dedicated, 2015 RAINMAKER EXCELLENCE AWARDS shortages and you are called on to deal with a committed worker, mother, grandmother and Issued by H.E.S.T. Australia Ltd ABN 66 006 818 695 AFSL 235249, the Trustee of Health Employees Superannuation Trust Australia whole range of health issues – because you can community member and we are so proud to (HESTA) ABN 64 971 749 321. Investments may go up or down. Past performance is not a reliable indicator of future performance. Product ratings are only one factor to be considered when making a decision. See hesta.com.au for more information. Before making a and because you’re there.” have her on our team.” decision about HESTA products you should read the relevant Product Disclosure Statement (call 1800 813 327 or visit hesta.com.au for a copy), and consider any relevant risks (hesta.com.au/understandingrisk)
20 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 21
HESTA_Midwife_CRANAplus_148x210.indd 1 21/09/2016 4:07 PM annual conference 2016 prize recipients
Chronic Disease Prize Highest achiever in the topic Chronic Disease in Remote & Indigenous Join the best Country Nursing Primary Health Care Sponsor: Therapeutics Guidelines 2016 Agency today! Recipient: Janet Hunter PERSONALISED SERVICE TRAINING & COURSES Mediserve values all of our nurses We are aware of the importance and offers a very personalised service. of ongoing education and training. Our dedicated country recruitment Mediserve pays for the full or major team will ensure we meet all your needs. cost of all training/courses undertaken by our nurses. BEST RATES OF PAY Matthew Busbridge (left) with Prof Sue Lenthall. We offer the best rates of pay as we FREE TRAVEL* believe in rewarding our nurses for Mediserve arranges and pays for the cost Centre for Remote Health Prize the fantasic work they do. of travel to and from country placements. Outstanding Masters Graduate Master of Remote & Indigenous Health 2016 Recipient: Matthew Busbridge Register Healthcare Australia Prize Most outstanding student in the topic today and Remote Advanced Nursing Practice 2016 secure work Refer your Recipient: Claire Alcorn to receive friends and a $500 receive a bonus* $300 bonus*
*Conditions apply Photo: Steve Batten. Claire Alcorn (left) with Michelle Morgan of HCA.
22W mediserve.com.auCRANAplus magazine issue 104 |E summer/wet [email protected] season 2016 P (08) 9325 1332 the voice of remote health 23 annual conference 2016 Japanese connection
Professor Midori Kamizato, involved “Your focus on rural and remote nursing is in setting up a nursing programme to growing,” she said during a break in the serve hundreds of remote islands in Conference. “This has been a very interesting Conference for me.” 34TH CONFERENCE the southernmost part of Japan, was GRAND CHANCELLOR HOBART so impressed with the CRANAplus 12–14 OCTOBER 2016 Associate Professor Miyazato was similarly Conference she attended in Alice impressed. “I am interested to learn about Springs in 2009 that she has spent the kind of work that the nurses in rural and years planning a return visit. remote areas of Australia are doing, and the This year, she brought Associate Professor experiences they have when they graduate Tomoko Miyazato, a colleague at the Okinawa from university and start working in Prefectural College of Nursing. remote areas.” Professor Kamizato, in 2009, was looking for Okinawa is the southernmost prefecture of factors shared between rural and remote health Japan, comprising hundreds of islands in a care in Australia and island nursing in Japan, chain over 1,000 kilometres long from the as she strived to set up a nursing programme southwestern most of Japan’s four main at the College of Nursing, a public university in islands to Taiwan. The Okinawa Prefecture Naha, Okinawa’s capital. covers the southern two thirds of that chain.
October 28, 2016
Gimli ROC 1BO Canada
CRANAplus PO Box 127 Prospect SA 5082 Australia
Dear All for the initial invitation to speak at the 2016 I wish to thank everyone at CRANAplus
conference and then for the support and interest in my presentation.
Also thank you for the financial e support beginning (Grant) of given my presentation to me to attend the conference. but I think I did enjoy the time there even if I fumbled at th everyone enjoyed seeing my workplace through pictures. A big thank you for the pearl drop earrings.....unexpected but wonderful.
Once again thank you
A. Cusack Midori Kamizato (Japan), Naomi Kikkawa (Brisbane) and Tomoko Miyazato (Japan). Anneliese Cusack
24 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 25 annual conference 2016 sharing a common goal
As a representative for Indigenous Allied Will’s first challenge, after getting permission Health Australia (IAHA), Will Kennedy, from Biripi, was to secure funding for this trip. a mental health worker in Taree on “My role (with SRC) has helped me develop the mid north coast of NSW was on a professionally and personally in gaining the mission when he attended this year’s confidence to approach people and organisations CRANAplus Conference in Hobart. to find out whether there is any support for students to attend such events,” says Will, who He was determined to get as much out of the secured an Indigenous student grant at CSU Conference as possible; promote the IAHA to and an offer from CRANAplus to waive the cost students at the University of Tasmania through of registration fees. Riawunna, the uni’s Indigenous Student Centre; and visit the Tasmanian Aboriginal Health In his free time on his first day in Hobart, it was Service in the city. off to Riawunna at the University of Tasmania for Will. “I was there to help share information Will, 37, works with the Chronic Disease team at in my role at IAHA and advocate for IAHA in Biripi Aboriginal Corporation Medical Service, and regards to Allied Health and the copious amount Leona McGrath, Belinda Gibb and Will Kennedy. is a second-year student at Charles Sturt University of support you get when you are part of the (CSU) Wagga Wagga, studying a Bachelor of Health IAHA family,” he said. “With a little luck I also From his initial visit, Will was invited back by a Will said that, as a student, he felt nervous Science (Mental Health). He is also on the Student hoped to maybe entice a few new student senior staff member “to come and have another attending the Conference on his own for the Representative Committee (SRC) at IAHA. members to IAHA.” yarn so they too can learn more about IAHA and first time, not knowing what to expect. my role”. “Well I needn’t have felt nervous, because “The passion displayed by all staff there gives you what I got was really spoilt.” a sense of belonging and pride in knowing that JOURNEY MANAGEMENT such driven people are there,” he said. “This will “For any student that may be feeling a little only lead to great outcomes for all indigenous nervous about new beginnings and the students in Tasmania. I am grateful for this unknown I say ‘go and trust those around SOFTWARE relationship, which I know I will grow from.” you who have walked this road before’. I feel everyone has the same vision and The next place on Will’s list was to pop into the shares the common goal of helping provide Tasmanian Aboriginal Health Service. “What a better care and services to not only clients/ place,” he said. “It was vibrant, felt warm and patients but also to friends, colleagues and inviting, and I was lucky that the staff there, FEEL STAY SAFE family as no one is left behind.” PROTECTED from the admin staff on the front counter to in rural and their male health worker Aaron Everett, made “I would like to extend a thank you to my work me feel at home. Aaron has a massive role to place employers Biripi Aboriginal Corporation isolated fill but from all I could see he does it with pride, Medical Service, Charles Sturt University environments passion and with a big smile on his face.” Indigenous Student Grants and Scholarship The CRANAplus Conference itself, he said, was team, the staff at CRANAplus for a wonderful “priceless in regards to the information shared opportunity, all my extended family at w Find out ho and what I learned in a short time. Indigenous Allied Health Australia and also www.jesi.io everyone I was lucky enough to meet and “Again I felt part of a big family that in reality yarn with.” +61 7 4774 7149 actually feels quite small. The keynote speakers [email protected] were varied and were all just as interesting as Madaang Guwu the one before them.” (Thank you in Wiradjuri language)
26 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 27 annual conference 2016 member insights staying safe around dogs
In many remote Indigenous communities Eileen shows the viewer different kinds of dogs are free to roam, along roads and dog behaviour that indicate whether a bite footpaths, and around other public places is likely to happen. 34TH CONFERENCE like playing fields, schools and shops. GRAND CHANCELLOR HOBART She goes on to demonstrate ways to avoid 12–14 OCTOBER 2016 Dogs are often seen outside homes and or defuse potentially dangerous situations yards where they gather unrestrained and including the protective actions to take should unaccompanied by their owners. These can be a dog try to attack. unusual and worrying sights for people new to living and working in a remote community. AMRRIC’s aim is to improve the health of animals in remote Indigenous communities AMRRIC’s Staying Safe Around Dogs video series which in turns improves the health of the explains how these free-roaming animals are people too, hence the strategies aim to avoid not strays but rather an important part of their harm to dogs and people by using practical Testimonial about owners’ lives. Just as non-Indigenous people GRANT steps to risk management. to attend Conference value dogs for companionship and protection, The Staying Safe Around Dogs series comes so do Indigenous people, but there are also additional reasons including hunting skills and in two parts: I am writing to thank CRANAplus and the sponsors of the NMFSA spiritual beliefs. Part 1 – Working with Dogs is designed Grant that enabled me to attend the recent CRANAplus conference The videos explore the significance of dogs for people going to work in communities in Hobart. through a range of interviews with elders, locals Part 2 – Living with Dogs targets people and visitors in Ti Tree, Tennant Creek, Milingimbi and the Dreamtime home of dogs, Ali Curung. residing in communities The 2 day conference program was truly a memorable learning They then move on to give practical advice on The video series can be accessed at experience, with some wonderful resourceful, inspirational assessing and minimising the risk of dog bites. http://www.amrric.org/our-work/ and varied speakers from a vast range of backgrounds and “Dogs have evolved to live with people over staying-safe-around-dogs-0 work environments. thousands of years and so they’ve learned to Thank you to the Northern Territory Government understand some of our behaviour,” Behaviour for funding the Staying Safe Around Dogs DVD. expert, Eileen Fletcher says. “We can also learn I have come away with my head full of ideas that may inform and about dog body language to recognise what Staying Safe Around Dogs was produced for promote and hopefully improve my own practice as a locum RAN in they’re trying to tell us.” AMRRIC by David Darcy www.mongrel.com.au the NT. It was also an excellent opportunity to engage with many
other conference attendees who also work in extremes and isolation.
Once again please express my gratitude to the sponsors of my
Grant.
P. Bird Philippa (Pip) Bird
28 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 29 member insights a paramedic intern in the Northern Territory – a personal experience ‘Do you want a job as a paramedic in Half of the Foxtrot family would work in Darwin?’... ‘Yes please! Where do I sign?’ Alice Springs and the other half would stay A few weeks after travelling to Darwin in Darwin. This was the beginning of our for an intensive two-day interview own on-road journey. process, Trent Ramsay received the This was also the beginning of the ‘firsts’; above call from the St John Ambulance when we all were very jealous in a ‘sick’ Australia Northern Territory (SJAANT) recruitment officer. paramedic way of the first person to perform intravenous (IV) cannulation, insert an laryngeal Working as a paramedic in the Northern Territory mask airway (LMA) down someone’s throat, had been my dream and goal for a number of use the Intraosseous (IO) (bone) cannulation years… dreams do come true! drill, first big motor vehicle accident (MVA), first resuscitation. The first question friends and family asked me was: ‘Why the Northern Territory?’ The land, according to local lore, where every creature Working as a paramedic in not only wants to kill you but has more than the Northern Territory had enough ability to follow through… been my dream and goal The NT has a lot to offer. It’s a place of great beauty, amazing waterfalls, stunning coastlines, for a number of years… terrific camping, friendly people, delicious dreams do come true! food. And for paramedics – a great diversity of patient presentations. I had one of the firsts – I was the first to have my bum pinched by a patient. When I mentioned During the first day of paramedic induction all this during my patient handover at the hospital the fresh new graduate interns walked into bedside it caused a sudden giggle from the half the classroom nervous and excited. We called a dozen female staff present. I was also the first, ourselves ‘The Foxtrots’, after we found out but not the last, to drop a stretcher on scene (not ‘Foxtrot’ was the clinical call sign on the radio with a patient on it). This is a common newbie for interns. mistake as a result of not locking a latch on the The Foxtrots instantly united as our new stretcher properly when lowering it to half way. family away from home. The next five weeks As I turned red, the very experienced Intensive of induction were full of laughs. This was Care Paramedic (ICP) I was working with calmly followed by the non-clinical week at the end – and reassuringly said with a slight grin, ‘Oh no, the part that everyone was looking forward my mistake Trent. I meant to say let’s half-height to… the driver training. This included: spinning the stretcher’. From that point I realised the out of control in a skid car, speeding as fast paramedics in the NT had a great personality as possible in an ambulance around a race and cheeky sense of humour. track, and heading into the bush for some My next two months were split between epic 4WD training. two excellent paramedics, a Scot and Jeff, Then the sad part came… the day the new the experienced South African ICP from my family of Foxtrots was separated. first job.
30 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 31 member insights
During these first two months I was The sooner a paramedic understands that and frustrated at not being as competent as these enjoys the different elements of the job and the two experienced paramedics. Both laughed at unique side of people we encounter, the more my frustrations and mistakes and then we all enjoyable the job will become. Paramedicine laughed knowing that every paramedic starts can be a funny job at times – so don’t forget their journey at the beginning. to laugh and smile every moment you can”. The next four months were with Phil, an experienced paramedic from England. We would We would reassure our reassure our patients that between the two of patients that between us ‘we have twenty-seven and a half years’ experience. Phil has twenty seven and I have the two of us ‘we have half a year! I learned from Phil how to become twenty-seven and a confident and competent in the job and how to keep my approach simple and appropriate. half years’ experience. The following six months were with Dave, Phil has twenty seven another experienced paramedic from Scotland. and I have half a year! Dave taught me how to make patients laugh and feel comfortable while assessing and treating Then there are the station officers, managers, them. Dave emphasised the importance of and education team. These people support working within a team. He also led by example and keep the interns in line. I may have been in demonstrating the importance of keeping guilty of needing to be kept in line on the odd everyone happy – from the cleaner, to the occasion. The relationship with the bosses made Simulated accident. nursing home staff, to the bosses, to the hospital it hard to get through a shift without having a staff, to the police… and most importantly the laugh. They were always there to support me, At one accident when a pedestrian had been It was an eerie feeling… I just drilled into a coffee shops. When reflecting with Dave on my discussing research, answering my thousands hit by a car travelling at night on a 100 km/hr person’s bone... I drew back the bone marrow into practice and what I needed to improve on he of questions and challenging their staff in a road I had been tasked by the lead treating a syringe… Relief! It was successful and now we said, “Trent, we do a very quirky and diverse job. number of ways. paramedic to insert the IO (bone needle). were able to administer medications and fluids I had practised this skill hundreds of times to hopefully bide her time before the emergency in the simulation room. Now I had to step up operations she would need at hospital. and apply this skill in real life. The station officer gently guided my trembling hand as I felt the For the majority of the Aboriginal patients, it is pressure of the importance that this IO needle important to speak simple English and commonly be inserted correctly to give this patient the known phrases unique to the Northern Territory. best chance of survival. I warily peered past I take my hat off to this ‘mob’ (group of people), my colleagues to the unresponsive person many speaking English as their third, maybe lying in front of me. The scent of alcohol was fifth, language, and many coming from hardship prevalent. I closed my eyes for a second, took a and trauma. But boy do these people know how big breath and reassured myself that if she was to have a laugh, and the kids can certainly be unfortunate enough to feel the very painful and cheeky and full of fun. almost medieval procedure it might mean she is not as sick as we were suspecting and the Common phrases you learn in the NT include outcome for her might be survival… I pierced the pain scale – ‘small, medium, or big mob’s the needle through the skin; made contact with pain’, homeless/no fixed address – ‘long-grasser’, the hardness of the bone, I cautiously drilled short of breath – ‘short wind’, assaulted by the needle until I felt a pop of the bone and the two or three people, ‘double banged’ or The Foxtrots. needle was in the right place. ‘triple banged’.
32 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 33 member insights
Common patients’ illnesses in the Northern persons, and one dog. As I stepped through the Territory include: missed dialysis complications; remote clinic door as the designated treating rural doctor completes world’s toughest cardiac problems including rheumatic heart paramedic, I remember thinking the place disease; assaults; infected wounds exacerbated looked like a M*A*S*H-style army clinic. and longest horse race, for rural by tropical weather and dirt; road trauma; and non-adherence with medication and treatment. As the youngest person in the room by at least ten years, no-one was more surprised than me mental health – with a broken neck! The Northern Territory has a road toll four that people were waiting for my next suggestion times larger than the national average. The or asking my opinion on the next step that road toll was 49 for 2015. A number of factors should be made including: the best way to appear to contribute to this: alcohol; speed; assess and stop one of the patients bleeding, lack of seat belt use; excessive persons in cars; establishing a difficult IV cannulation, which non pedestrian-friendly roads; and generally medications to give, and which patients need to silly people. have aero-medical evacuation. If you’re thinking of coming This was a challenge that tested my leadership. to the Northern Territory It was a nice feeling when nurses expressed their sincere thanks for the help when we for routine work, think a bit were leaving. more... it’s an adventure!!! Other unique experiences for me included: An adventure that’s hard running in uniform in the heat of Darwin for not to love! the emergency services race; donating blood for the emergency services challenge; helping The Northern Territory has ambulance stations with the first aid in the schools program; reading in Darwin, Katherine, Nhulunbuy, Tennant an ambulance picture book to primary school Creek, and Alice Springs. I had the opportunity kids; my crewmate Dave and I becoming the to work at all except Katherine. Nhulunbuy was new faces of the ambulance service on their a magical experience; a stunning costal mining television ad (the irony is neither of us had town in North East Arnhem Land, a 15-hour drive a TV to watch it); providing a ‘tool box chat’ from Darwin – ‘down the track’. This is a town of to construction workers on heat injury and great community and culture. dehydration; and having my belly washed Dr Shannon Nott has returned to Dubbo Genghis Khan’s infamous postal route system Whilst I was there, I had the opportunity to in crocodile-infested water as a welcome to NSW after completing the world’s where a rider would ride between urtuus experience the power, authority, and strength country during a remotely located CRANAplus longest and toughest horse race, the (horse stations) over a period of days to pass of this mob’s culture at the four-day Aboriginal Maternity Emergency Care course. Mongol Derby, albeit with a broken messages across the expanding Mongol festival, Garma. This festival includes great Empire. Riders this year rode across 28 urtuus Of course there is the big test – the Authority neck! Dr Nott completed the gruelling music, storytelling, dancing, art, basket weaving, 1008 km journey across the wild and spread 30–40 km apart over the 1008 km route to Practice final assessment. This consisted of spear making, and political chats. rugged Mongolian Steppe in a race changing their horse at each urtuu. Of the 44 a very nerve-wracking day including a written where organisers reported the highest riders who began the race, only 26 finished with After Nhulunbuy was my Tennant Creek test, panel oral assessment and scenario. broken bone rate since the race began. the remainder retiring due to injury or fatigue. experience. This town is 500 km north of Alice Springs and the locals here are proud ‘desert Following successful completion you get pats The Mongol Derby is renowned in the Guinness Dr Nott, who works out of Dubbo Base Hospital people’. I never knew what to expect at the on the back from everyone and a welcome to World Records as the world’s longest and as a District Medical Officer, rode in the lead pack beginning of a shift and one job in Tennant the qualified paramedic team. If you’re thinking toughest horse race. In 2016 it saw 44 riders throughout the race, leading the race with up to Creek was a great learning experience for me. of coming to the Northern Territory for routine from around the world compete for bragging 300 km to go. It was at this stage when Shannon We were dispatched to a motor vehicle accident work, think a bit more... it’s an adventure!!! rights in who could conquer the epic 1008km lost his horse, following an attempt to remount 30 km out of town. This involved one car, six An adventure that’s hard not to love! course the quickest. The Mongol Derby recreates it after collecting a fallen raincoat.
34 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 35 member insights
“I was on an incredibly strong gelding that day and unfortunately my raincoat fell out of my bag forcing me to get off him,” the Western NSW doctor remarked. “I knew it would be tough to get on the guy again as it took three Mongolian horse herders to hold him from bucking too much when I jumped on him originally. Sadly my assumptions were right and he turned into a bronc as I was swinging my leg over forcing me to bail.” By the time Dr Nott received help from local horse herders to catch his horse, the lead pack were too far ahead to close the gap. The former finalist for Young Australian of the Year commented, “Words cannot really begin to describe how amazing competing in the race is. The horses, whilst small and stocky are the most “The race was unlike anything I have ever incredible animals. Some of them would go for done before. Whilst it was such an amazing hours galloping across boggy marshes, clearing experience, it was also one fo the most marmot holes and dodging wild dogs. Some intense physical and mental challenges that nomadic Mongolian families on five nights, only days you would literally feel like you’ve been I have had to put myself through. Some days Some days your body staying in the designated urtuus on two occasions. strapped to a rocket, one that could self-destruct your body ached all over and the slightest at any minute.” wrong movement would cause you to cry. ached all over and the Upon his return to Dubbo, Dr Nott underwent slightest wrong movement MRI scans for ongoing neck pains following a fall at 350 km into the race. He soon discovered would cause you to cry. that he had broken three of the vertebrae in Other days you would be his neck prompting spinal specialist input. so overwhelmed by the “In hindsight, I probably had a concern deep down that I had done some serious damage beauty of the landscape, to my neck. I’m incredibly lucky that I could the friendliness of the continue the race and tolerate the pain it was generating and even more lucky that I didn’t Mongolian people or the end up with permanent neurological damage.” athleticism of your horses to Despite the broken neck, Dr Nott was one of you would shed tears of joy. the lucky ones with multiple riders requiring aeromedical retrieval with injuries ranging from Other days you would be so overwhelmed by internal damage to bleeding on the brain. the beauty of the landscape, the friendliness of the Mongolian people or the athleticism of your Shannon Nott participated in this years’ Mongol horses to you would shed tears of joy. It was an Derby raising funds to help run rural-specific emotional rollercoaster ride and that was one wellbeing training for youth with the hope that of its biggest surprises.” these programs can address the increased rates of self–harm and suicide seen in the bush. Shannon finished the race in seventh position on day eight of the race, only three hours For comments contact Shannon directly: behind the winners and some two days in Dr Shannon Nott front of the final riders. Of his nights out on Email: [email protected] the Mongolian Steppe, he found shelter with Mobile: 0409 903 325
36 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 37 scholarship program scholarships 2016
The CRANAplus scholarship program specifically identifies criteria that needs to be met both Scholarship sponsor Recipient Placement location Discipline targets undergraduate students studying in by the student and the hosting location. a health discipline at an Australian university Colleen Van Onselen Steve Arnold Carnarvon Hospital WA Nursing who have a genuine interest in remote and The purpose of the scholarships is to assist with Memorial Scholarship isolated health. the cost of travel, meals and accommodation, Katarina Samotna Alice Springs Hospital, Nursing which may be incurred when undertaking such HESTA Haast Bluff and Titjakala Through the generous support of members and a placement. The scholarship does not cover Clinics organisations these scholarships offer students loss of wages, University fees or textbooks. the opportunity to experience health service CRANAplus Elizabeth Pressley Coomealla Aboriginal Nursing delivery in a remote location. Eligibility for our Scholarships includes Health CRANAplus membership and membership Opportunities to undertake a clinical placement ZEITZ ENTERPRISES Gabby Tentye Mount Gambier Hospital Nursing of a Rural Health Club www.nrhsn.org.au in a remote setting are quite limited. The travel CRANAplus Katie Louise Conway Kununarra Hospital Nursing cost, especially for students who do not receive At the completion of their placement, students financial assistance, is also prohibitive. are required to write a short report which is Michael Ilijash Perpetual Kate Tran Alice Springs Hospital Nursing Scholarship – sponsored Another challenge can be finding a remote published in the CRANAplus Magazine. by Jan Ilijash health service that has the capacity and interest These positive clinical experiences for students in supporting student placements. HESTA Dennis Nguyen Tennant Creek Hospital NT Bachelor have changed their awareness and passion to Medicine/Surgery We know the importance of a positive clinical potentially work in this exciting sector. Lily Sideris Riverland General Hospital Nursing placement experience and the impact that CRANAplus Are you inspired? Berri SA can have on a health professionals’ career path. We also know that the success of clinical If you think you would like to sponsor a CRANAplus Anthea Gibson Alice Springs Hospital Nursing placement is based on many factors and it is scholarship, you can contact Anne-Marie Borchers Colleen Van Onselen Melissa Gina Mellan Carnarvon Public Hospital Nursing why CRANAplus supports the approach of the ([email protected]) to discuss the options. Memorial Scholarship and Mount Magnet National Health Rural Students Network (NRHSN) who recently developed their document CRANAplus has DGR status (Designated CRANAplus Claire Matheson Alice Springs Hospital Medicine “Optimising Rural Placements Guidelines”. Gift Recipient) and any donations over $2 CRANAplus Jennifer June Turner Thursday Island Hospital Nursing This document, endorsed by CRANAplus, are tax deductable.
Are you ready for a remote placement???
The CRANAplus Undergraduate Student Remote Placement Scholarship is available to students who, as part of their undergraduate course of study through an Australian University, undertake a remote location placement.
The Scholarship provides financial assistance of up to $1000 per successful applicant, and is intended to provide assistance towards the cost of fares, accommodation and other incidental costs incurred by a student while undertaking a remote placement.
The Scholarship may be claimed for placement undertaken for the current calendar year and may be retrospective to the closing date, and funds awarded on provision of tax invoices for costs incurred.
Email [email protected] for more details. Photo: Steve Batten.
38 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 39 student insights multiple positive experiences
Indigenous health has always been I gained multiple positive experiences from a passion for Katarina Samotna, a this placement, which have influenced my 3rd-year Bachelor of Nursing student practice. For example, I developed excellent at Charles Darwin University. And cross-cultural communication skills when her recent placement in the remote dealing with Indigenous clients. This is a Indigenous communities of Haasts valuable asset to my future practice as Bluff and Titjikala in the Northern I am planning to work in remote Indigenous Territory and at Alice Springs Hospital communities after my graduation. (ASH) has cemented her commitment. I would like to sincerely This four-month placement entirely exceeded my expectations. thank CRANAplus for
The remote area nurses at Haasts Bluff and supporting me with the Titjikala, who provide primary health care costs of undertaking and primary clinical care for approximately 200 community members, are highly-educated this wonderful clinical and experienced nurses with outstanding placement experience. clinical skills. During my placement, I felt very supported and comfortable, and gained My skills in assessing the patients’ health have a lot of understanding and knowledge from also significantly improved, as I developed these nurses. confidence in respiratory assessment, auscultation, and eye and ear examination. During my placement, I had several opportunities to run patient consultations, becoming more systematic I felt very supported and when obtaining patients’ medical history comfortable, and gained and recording it in the progress notes. Also, I learned how to assess the patients’ a lot of understanding symptoms effectively and identify their and knowledge from diagnosis, including the most suitable these nurses. medication required. Hence my knowledge of pharmacology significantly improved.
I learned and practised a variety of skills, At ASH, I worked closely with Aboriginal such as health assessments, running patient health practitioners to develop cultural consultations, prescribing and dispensing competence when dealing with Indigenous Also, this activity might increase their desire dealing with isolation, when working in very medication, administering vaccinations, clients. I joined the Alcohol and Other Drugs to be physically active, which might prevent remote settings. I am now confident that suturing, organising medical evacuations and team, experienced retrieval medicine with the them from developing chronic conditions, these experiences have provided me with the retrievals, performing child health assessments Royal Flying Doctor Service, and participated in such as obesity, hypertension, and diabetes. knowledge and skills required to work with and antenatal examinations, and chronic health promotion and education programs for Furthermore, spending all day outside, in the Indigenous people in remote and rural settings as disease management. All these experiences Indigenous youth in remote communities. For bush, emphasises Aboriginal culture and their a well-rounded and qualified Registered Nurse. and the professional benefits of working in example, in Haasts Bluff, the initial interest in spiritual connection with the land and nature. remote areas, such as greater autonomy and the community services is to take Aboriginal I would like to sincerely thank CRANAplus for responsibility, sparked my desire to become children and youth for a trip into a bush, and I also realised that engagement with the supporting me with the costs of undertaking this a Remote Area Nurse. so prevent them from boredom. community is the most efficient strategy wonderful clinical placement experience.
40 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 41 student insights step out of your comfort zone
Being a student is the perfect time for intimidating prospect. However my keen interest stepping out of your comfort zone and in rural and community health overruled this taking new opportunities, says 3rd-year unease and I was enthusiastic to undertake my nursing student Lilly Sideris. eight-week placement at the Riverland General Hospital in Berri, South Australia. Lilly admitted feeling slightly intimidated and a little uneasy about venturing into a rural The Riverland General Hospital provides a environment for her placement. Then she was broad range of medical and surgical care to sent into a foreign medical environment. local residents. I was excited to be placed within the perioperative unit, even though, I had no But the placement, she says, has provided her recovery or theatre experience. If it were not with the experience and confidence she needs for the friendly and encouraging staff, I would to begin her career as a registered nurse. not have gained nearly as much confidence I think I am speaking on behalf of all registered or clinical experience as I did. I appreciated nursing students when I say that placement is the warm friendly atmosphere of this country often a daunting yet exciting experience. As a hospital, and I found it to be a positive working student in my third and final year of studies at environment. The nurses, anesthetists, and Flinders University, I found the thought of working surgeons were always willing to share their at a small rural hospital in an unfamiliar town an knowledge and include me in their work.
my knowledge by working a day within the A placement in a small accident and emergency service, the dialysis country hospital offers unit, and undertaking venipuncture training particular opportunities for with the IMVS service. advancing clinical skills and I also had a chance to explore a new part of South increasing knowledge that Australia, spending the weekends by the riverside, visiting national parks and neighbouring towns. may not be available within I was fortunate to stay at the accommodation a metro or city hospital. supplied by the hospital, and everything was conveniently within walking distance. Being one of the two students within the I would encourage all students to undertake unit, I was exposed to all nursing roles within perioperative care: admissions, scouting, a rural or remote placement. It improves both scrubbing, anesthetic assistance and recovery. nursing practice and personal development. A placement in a small country hospital offers The Riverland General Hospital was my final particular opportunities for advancing clinical placement and concluded my studies as a student skills and increasing knowledge that may not nurse. I cannot thank CRANAplus enough for be available within a metro or city hospital. making this experience possible under the I undertook various opportunities to broaden Undergraduate Remote Placement Scholarship.
42 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 43 student insights sobering statistics
If you live away from a major metropolitan opportunity to take my own patients under the area you are 42 per cent more likely to die supervision of the head doctor which allowed prematurely due to a preventable disease. me to be better involved in the healthcare team The life expectancy in metro areas is 83.6 and patients’ management plans. In addition years whilst in rural locations it is as low as to the clinical opportunities, there were plenty 78.2 years. Rural and remote Australians have of academic activities such as extra teaching fewer years of completed education and lower sessions, tutorials and emergency simulations in incomes alongside higher levels of disability, which we, as students, were actively involved. smoking and risky alcoholic drinking. Nearly 10 I must say I also really enjoyed the fresh air, the per cent of Victoria’s Murray region missed out space and the scenery. It was such a nice change on GP visits because they were too expensive, from the chaos of Sydney city, where everyone compared with their city counterparts. And to is living on top of each other. I visited the huge top it all off, people working in rural and remote now defunct Nobles Nob mine, Kunjarra/The areas, especially farmers, are 1.5–1.8 more times Pebbles, Alice Springs Desert Park and camped likely to experience psychological stress and and trekked through Trephina Gorge Nature commit suicide. Park. It’s such a beautiful country and you don’t garner a sense of real appreciation until you go It is difficult to teach for a run and can see the horizon 360 degrees the intricacies of rural around you. Living in the city, you also forget just how many stars there are out there behind all and remote health to the smoke. city medical students on PowerPoint slides It’s such a beautiful in air-conditioned country and you don’t lecture theatres. garner a sense of real appreciation until you These are just a few of the sobering statistics well known to many, ones that are frequently go for a run and can see reported to students during medical school. the horizon 360 degrees It is difficult to teach the intricacies of rural The only real way to develop an and remote health to city medical students around you. Living in the understanding of the sobering health on PowerPoint slides in air-conditioned city, you also forget just statistics differentiating urban from lecture theatres. rural and remote areas in Australia how many stars there is to be physically exposed through Whether it be vaccine preventable mumps, are out there behind electives and placements, says Dennis scabies or end stage renal failure - I was Nguyen, 3rd-year medical student at the exposed during my placement to a variety of all the smoke. University of Notre Dame, Sydney. medical conditions that are far less common in I know the best way to contribute to changing Sydney and metropolitan areas. This is why he was so grateful that CRANAplus those sobering statistics is to eventually come provided him with funding for his remote The adage that the rural experience for students back. It was such a wonderful, eye-opening two-week placement in Tennant Creek, is more hands-on is absolutely true. During my experience and it has reinforced my desire to Northern Territory. time in the Emergency Department, I had the work rurally during my medical career.
44 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 45 student insights
CHAC holds regular programs for groups It has taught me to ‘actively listen’, and to pass a life changing experience including: Mums and Bubs, Elders, Mens’ Group, no judgement on others. I hope to further my and a Nutrition Group (also known as Cook N nursing career within the rural and remote Elizabeth Pressley, Bachelor of Nursing behind poor management in disease and Yarn) and I assisted with a number of these areas of Australia. Student at the University of SA, learned medication management. weekly sessions. My background in Personal to provide holistic care to the patients at Training has given me the extra skills and A lot of the clients that present to CHAC have I had the most fulfilling Coomealla Health Aboriginal Corporation knowledge to be able to teach the importance (CHAC) clinic in Dareton NSW during her very similar health conditions and diseases with of exercise, and I taught two of the clients in the experience working at placement. But she reckons her greatest many poorly managing their health conditions. Women’s Group how to use the gym equipment CHAC during this eight- lesson has been to change her approach Rather than trying to tell them to change, I have that CHAC provides. learned to be more encouraging and supportive and care for Aboriginal people and I assisted in making lunches for these regular week placement. I feel it of their lifestyle choices and management. There learning to ‘actively listen.’ activities and also worked alongside some are so many clients that have diabetes mellitis has changed my way on of the regular clients and taught them how to During my eight-week placement in Coomealla and hypertension, as well as being heavy make simple, nutritional meals such as frittatas how to approach and care Health Aboriginal Corporation (CHAC) I smokers and alcohol drinkers. I have learnt to and lasagne. developed many clinical skills such as wound encourage the patients to receive regular health for Aboriginal patients. care, health checks and managing chronic checks and monitoring, either with the nursing During my placement, I spent time learning When I left, one of the women in Women’s disease. I learnt about the different types of team visiting them at home or for the client to about the Aboriginal culture and history and sat Group made me a necklace of the Aboriginal wounds that are common within the community come into CHAC. with some of the Aboriginal Health Workers and such as Impetigo (school sores) and boils. As Elders, listening to stories of their family history. colours. I keep this on top of my dressing well as this I learnt reasons why these wounds I was regularly part of the home visits, I had the most fulfilling experience working at table now as a reminder of how special my had developed, such as sanitation standards, monitoring their chronic disease and checking CHAC during this eight-week placement. I feel it experience was at CHAC. I advise all nursing poor hygiene etc. As a student Registered on their wellbeing. I developed a strong rapport has changed my way on how to approach and students to be part of an Aboriginal community Nurse, this experience has helped me develop a with the clients and was able to give a more care for Aboriginal patients. It has taught me as part of their nursing placement. It is a life- stronger empathy in understanding the reasons personal approach to their care. to be much more patient and understanding. changing experience. Photo: Di Holley. Photo: Amy Hill.
46 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 47 why advertise with CRANAplus?
CRANAplus is the only organisation with Currently our quarterly publication enjoys a remote health as our sole focus. Our extensive circulation of 15,000 copies each quarter (and membership and stakeholder database growing). It reaches those who are passionate means CRANAplus is uniquely placed to reach about remote health in Australia. Australia’s remote health professionals. Our beautiful design provides a quality The CRANAplus Magazine – environment for your ad. We are a content-rich The voice of remote health publication, so yours will not get lost in a sea Pharmacotherapeutics of other ads. “I read it cover to cover” is a statement we for Remote Area Nurses hear again and again from our readers. See below for more information. advertising rates
Black & White rates One issue 2 issues 3 Issues 4 Issues (- 10%) (- 15%) (- 20%) Full page Type: 128mm W x 183mm H 1,600 2,880 4,080 5,120 Trim: 148mm W x 210mm H Online course Bleed: 154mm W x 216mm H Half page Horizontal: 128mm W x 90mm H 880 1,584 2,244 2,816 Vertical: 65mm W x 183mm H A course in the practical use of medicines in Third page Horizontal: 128mm W x 59mm H 600 1,080 1,530 1,920 disease management developed specifically for Vertical: 65mm W x 121mm H Double page 3,040 5,472 7,752 9,728 Registered Nurses who work in or are planning Colour rates One issue 2 issues 3 Issues 4 Issues to work in remote and isolated practice. (- 10%)* (- 15%)* (- 20%)* Full page as above 2,240 4,032 5,712 7,168 Half page as above 1,232 2,218 3,142 3,942 Third page as above 840 1,512 2,142 2,688 Double page 4,256 7,661 10,853 13,619
For further information visit Magazine colour insert 15,000 single-sided 15,000 double-sided Centre for Remote Health website Full size Trim: 148mm W x 210mm H 1,500 2,000 Artwork must be supplied or contact Short Course *Discounts apply to consecutive issues only. Administrator Magazine is printed in A5 format. Other advertising sizes can be negotiated. *Corporate members receive further discount on these rates. Contact [email protected] for further information. Publication Dates: March, June, September, and December Submission Dates: First day of February, May, August and November (08) 8951 4700 Rates are in AUD$ and are inclusive of GST. All artwork to be submitted by close of business on the published deadline date. [email protected] Full colour ads to be submitted in high resolution PDF format with all fonts embedded and all colours separated into CMYK. www.crh.org.au 48 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 49 CRANAplus corporate members
Working with our many partners, Abt implements bold, innovative solutions to improve the lives of the community The Centre for Remote Health aims to contribute to the and deliver valued outcomes for our clients. We provide a improved health outcomes of people in remote communities comprehensive range of services from policy to service through the provision of high quality tertiary education, training delivery in the public and private sectors contributing to and research focusing on the discipline of Remote Health. long term benefits for clients and communities.
NSW Air Ambulance located in Sydney is currently recruiting. NT Dept Health – Top End Health Service Primary If you are a dual Registered Nurse and Registered Midwife with Health Care Remote Health Branch offers a career pathway additional critical care experience, contact the Senior Flight Nurse in a variety of positions as part of a multi-disciplinary primary Margaret Tabone on 0413 019 783. healthcare team.
AMRRIC (Animal Management in Rural and Remote Tasmania Health Service (DHHS) manages and Indigenous Communities) is a national not-for-profit charity delivers integrated services that maintain and improve that uses a One Health approach to coordinate veterinary and the health and wellbeing of Tasmanians and the Tasmanian education programs in Indigenous communities. community as a whole. www.amrric.org Ph: 08 8948 1768
Apunipima Cape York Health Council is a community WA Country Health Services – Kimberley Population controlled health service, providing primary healthcare to Health Unit – working together for a healthier country WA. the people of Cape York across eleven remote communities.
CAPE YORK HEALTH COUNCIL
Belmore Nurses Bureau specialises in placing all Gidgee Healing delivers medical and primary health categories of nurses and care staff in a range of acute care, care services to people living in Mount Isa and parts of the aged care, corporate health, primary health care and mental surrounding region. Gidgee Healing is a member of the health settings facilities throughout Australia. Ph: 1300 884 686 Queensland Aboriginal and Islander Health Council (QAIHC) Email: [email protected] and focuses on both Indigenous and non-Indigenous people. http://belmorenurses.com.au
Central Australian Aboriginal Congress was Healthcare Australia is the leading healthcare recruitment established in 1973 and has grown over 30 years to be one solutions provider in Australia with operations in every state of the largest and oldest Aboriginal community controlled and territory. Call 1300 NURSES/1300 687 737. 24 hours 7 days. health services in the Northern Territory. Work with us today!
50 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 51 HESTA is the industry super fund dedicated to health Ngaanyatjarra Health Service (NHS), formed in 1985, is a and community services. Since 1987, HESTA has grown to community-controlled health service that provides professional become the largest super fund dedicated to this industry. and culturally appropriate healthcare to the Ngaanyatjarra Learn more at hesta.com.au people in Western Australia.
North and West Remote Health (NWRH) is a vibrant, not-for-profit company employing multidisciplinary teams to Indigenous Allied Health Australia’s vision is to achieve provide health, support, aged care and wellbeing services in the same quality of health for Aboriginal and Torres Strait remote Queensland and Northern Australia. A pioneer in the Islander peoples. provision of outreach health service since 2001, NWRH currently services over 39 communities, spanning from Queensland’s East Coast to the Northern Territory border.
KAMS (Kimberley Aboriginal Health Service) is a Northern Territory PHN (NTPHN) leads the development regional Aboriginal Community Controlled Health Service and coordination of an equitable, comprehensive primary (ACCHS), providing a collective voice for a network of member health care system and an engaged health workforce driven ACCHS from towns and remote communities across the by community need. Kimberley region of Western Australia.
The Nurses’ Memorial Foundation of SA Inc has its Katherine West Health Board provides a holistic clinical, beginnings in one of the world’s first official Registration preventative and public health service to clients in the Katherine bodies for Nurses; The British Nurses’ Association established West Region of the Northern Territory. in London in 1887. http://www.nmfsa.net/
Marthakal Homelands Health Service (MHHS), One Disease is a privately funded non-profit organisation based on Elcho Island in Galiwinku, was established in 2001 that has a simple but ground-breaking vision: to systematically after Traditional Owners, lobbied the government. MHHS target and eliminate one disease at a time. is a mobile service that covers 15,000 km2 in remote East Arnhem Land. 08 8970 5571 http://www.marthakal.org.au/ Email: [email protected] Ph: 02 9240 2366 homelands-health-service http://onedisease.org/
On Island Health Service Accreditation and Nursing The Mount Isa Centre for Rural and Remote Health provides recruitment and accreditation services to assist remote, (MICRRH) James Cook University, is part of a national network usually island-based, health services. The experienced and qualified Remote Area Nurses working with On Island can hit of 11 University Departments of Rural Health funded by the the ground running in any remote setting. Ph: 0459 518 280/ DoHA. Situated in outback Queensland, MICRRH spans a drivable (08) 86261807 Email: [email protected] round trip of about 3,400 kilometres (9 days). https://www.facebook.com/On-Island-Health-Service- Accreditation-and-Nursing-Pty-Ltd-368633760011342/
52 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 53 Silver Chain is a provider of Primary Health and Emergency The Remote Area Health Corps (RAHC) is a new and Services to many Remote Communities across Western Australia. innovative approach to supporting workforce needs in remote With well over 100 years’ experience delivering care in the health services, and provides the opportunity for health community, Silver Chain’s purpose is to build community professionals to make a contribution to closing the gap. capacity to optimise health and wellbeing.
At RNS Nursing, we focus on employing and supplying The Spinifex Health Service is an Aboriginal Community- quality nursing staff, compliant to industry and our clients’ Controlled Health Service located in Tjuntjuntjara on the Spinifex requirements, throughout QLD, NSW and the Northern Territory. Lands, 680 km north-east of Kalgoorlie in the Great Victoria Ph: 1300 761 351 Email: [email protected] Desert region of Western Australia. http://www.rnsnursing.com.au
The Torres and Cape Hospital and Health Service The Royal Flying Doctor Service Central Operation provides health care to a population of approximately 24,000 provides 24-hour emergency aeromedical and essential people and 66% of our clients identify as Aboriginal and/or primary healthcare services to those who live, work and travel Torres Strait Islander. We have 31 primary health care centres, in rural and remote South Australia and the Northern Territory. two hospitals and two multi-purpose facilities including outreach services. We always strive for excellence in health care delivery.
The Royal Flying Doctor Service has been ensuring equitable access to quality comprehensive primary health care for 80+ years to remote, rural and regional Queensland.
Rural Health West is a not-for-profit organisation that focuses Your Nursing Agency (YNA) are a leading Australian owned and managed nursing on ensuring the rural communities of Western Australia have agency, providing staff to sites across rural and remote areas and in capital cities. access to high quality primary health care services working Please visit www.yna.com.au for more information. collaboratively with many agencies across Western Australia and nationally to support rural health professionals.
Rural Locum Assistance Programme (Rural LAP) “Making our families well” Faced with the prospect of combines the Nursing and Allied Health Rural Locum Scheme their family members being forced to move away from country (NAHRLS), the Rural Obstetric and Anaesthetic Locum Scheme to seek treatment for End Stage Renal Failure, Pintupi people (ROALS) and the Rural Locum Education Assistance Programme formed the Western Desert Dialysis Appeal. Their aim (Rural LEAP). Ph: (02) 6203 9580 Email: [email protected] was to support renal patients and their families and return http://www.rurallap.com.au/ them to their country and families where they belong.
54 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 55 It’s difficult not to know the names of your neighbours in a small community. As well, as health professionals you learn about the personal lives of those around you.
For others, the experience of working remote is a lonely one. They discover that it requires a lot of time and effort to make new friends. Other people in the work context may not have the energy to commit to new relationships as they are overcommitted and support busy or caught up in their own family life. These limitations can result in feelings of social and emotional isolation.
Surviving well in working remote challenges loneliness you to think about the interpersonal skills that you need to build and maintain positive The issue of loneliness is an important relationships. Perhaps one of the most important one to address in the modern world and the issues can be, at times, magnified issues to reflect on is how you can be a friend for people working in remote health. to others. You have to give to get. That means Unlike previous eras, people in Australia giving time to having meals, exercising and move a lot, frequently multiple times. attending cultural events with others. As well, Family members are often hundreds you have to be flexible about how you maintain of miles away. As well, this nomadic important relationships with loved ones a long lifestyle makes it very difficult to retain way away. You have to work out flexible ways, long-term friendships. through telephone, email and letter writing, to continue to have intimate conversations where The whole fabric of community has changed as a you can share feelings, values and dreams. result. Although it is the case that we all differ in terms of how much social interaction we need, Reaching out to others is a survival skill. To some the reality of human existence is that enduring extent we all need other people to continue to connections to others is a central ingredient to grow as people, for our sense of identity, for our feeling content with life. careers, for psychological and physical health, to cope with stress and for our humanity. Take the In a situation where health workers are working time to reach out and let others reach out to you. time-limited contracts there are many instances of having to start afresh. For some, this is an easy Dr Annmaree Wilson experience as working remote sometimes offers Senior Clinical Psychologist
an antidote for the impersonality of city life. Photo: Steve Batten. CRANAplus Bush Support Services
56 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 57 the ice challenge arts and health
Amanda Akers, clinical psychologist with increased energy. In high doses, ice will keep a Bush Support Services outlines here the person awake for days. Eventually, in some cases prevalence of ice (methamphetamine) it leads to paranoia and psychosis, and that’s in rural and remote areas, reasons for its when the real difficulties start: managing severe use, reactions to its use and how health paranoia or a major psychotic episode. professionals can respond. Ice causes the brain to release these chemicals A key finding in the National Drug Strategy and it also prevents the brain from reabsorbing Household Survey 2013, was that people living them. In the short term, for example, about in remote and very remote areas were twice three days after ice use, there’s a shortage of as likely to smoke daily, drink alcohol in risky these neurotransmitters while the brain works quantities and use meth/amphetamines in the to manufacture more. This can result in low previous 12 months than people in major cities. mood, reduced attention and concentration, The ABS 2011 Australian Statistical Geography irritability, and sleep problems for several days Standard, which allocated remoteness categories after ice use. to areas across Australia, found that, overall, people living in rural and remote areas are In high doses, ice will not only disadvantaged in relation to access to keep a person awake for primary health-care services, educational and employment opportunities and income, but they days. Eventually, in some have higher rates of risky health behaviours, cases it leads to paranoia such as smoking and heavy alcohol use, as found in the National Drug Strategy Household and psychosis… Survey, but also face difficulties accessing drug treatment services. With longer term ice use, the brain struggles to produce dopamine, noradrenaline, and The behaviour we’re seeing in rural and remote serotonin. It takes longer to reproduce these areas from ice (methamphetamine) users chemicals and the brain produces a smaller includes: aggressive presentations, crime, amount of the chemicals. There are, therefore, theft to pay for drugs, assaults, drug dealing, chronic long-term shortages of these brain There is an increasing amount of research activities show an increase in a variety of clinical domestic violence, verbal abuse, physical abuse, chemicals to keep the ice user alert, feeling evidence that is showing that arts based skills. These include: clinical observation skills, eating problems and other health- and injury- positive, energetic, focused, relaxed, able to creativity needs to be an essential part of communication skills, increased empathy across related presentations. sleep well and manage their impulse control. health workplaces. Research is showing gender and culture, improved staff/patient After the ice user ceases their ice use altogether, Looking at the reactions in the brain of an ice that there are two sides to the mental relationships and an increase in job satisfaction. or for a period of time, Dopamine takes user can assist us to understand why people health benefits of creativity. It is becoming increasingly apparent in the several months to return to its normal levels. are presenting in this manner. The main literature that regular immersion in creativity, When an ice user’s Dopamine, Derotonin, and Observing creativity and participating in it chemicals affected in the brain are: Dopamine including drawing, painting, singing and drama Noradrenaline are low the ice user craves ice to have been shown consistently to reduce, which regulates pleasure, motivation, reward, feel alert and regain energy and concentration stress, anxiety, depression and alleviate pain. results in a decline in the need for medication in attention, and cognitive planning; Noradrenaline and so the cycle keeps going. There is a higher Individuals from a wide range of backgrounds, many patients and a reduction in visits to the GP. which regulates attention, arousal, and mood; risk of lapse and relapse than most other drugs who engage in creative, artistic pursuits have and Serotonin which assists Noradrenalin to In recognising this fact, the challenge faced by due to the desire to re-establish a ‘normal’ or been shown to be better able to engage socially. regulate mood, cognition, learning, perception CRANAplus Bush Support Services is considering pre-ice-using state. This is why we see ice users appetite, and sleep. When a person uses ice, The more compelling evidence for health ways of introducing creativity to remote health returning to ice abuse time and time again. there’s a major increase of dopamine, resulting practitioners is the research showing that those staff as both personally and professionally useful in feelings of euphoria, alertness, focus and Continued on page 94 health workers who engage in regular creative and evidence-based.
58 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 59 As an Art Therapist contracted by to employ art therapists on their staff. More CRANAplus Bush Support Services I have had remote health clinics could engage sessional art the opportunity to promote creativity in a therapists to provide input to staff and patients series of two day workshops aimed at self care alike. Finally, health services would prioritise and building resilience in the remote health the training of staff in creative activities both workforce.The quantitative and qualitative for their own personal development and for feedback from the workshops has been the enhancement of patient wellbeing. universally positive. Further reading: I see two challenges to remote health; the Staricoff, R., Clift, S. (2011) Arts and Music in first centres around how to continue to promote Healthcare: an overview of the medical literature arts and health as important partners. The 2004-2011, London: Chelsea and Westminster second involves promoting the coordination Health Charity. of the activities of art therapists in remote settings so that both individual therapy and VicHealth (2010) targeted arts-based programmes in remote Building health through arts and new media, communities are prioritised, rather than seen Carlton: Victorian Health Promotion Foundation as ‘fluffy’ after thoughts. Jenni Francis In an ideal world, health services would become Art Therapist familiar with current best practice and start CRANAplus Bush Support Services
For over 25 years Jenni Francis (pictured above right, with a Conference delegate at the ‘clay work’ table) has facilitated art-based community projects, events and workshops in pre-schools, primary schools, high schools, TAFEs, locally and regionally in NSW. As a community artist, she developed a unique approach to an individual’s response toward their creative expression, participation and involvement. As an Art Therapist working with CRANAplus Bush Support Services she supports psychologists conducting workshops for rural, remote and isolated health care workers through experiential workshops on self-care, building capacity for resilience, wellbeing and reflective practice.
60 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 61 burnout: a step beyond chronic stress a spotlight on the autonomic High achievers are the most at risk Freudenberger (1974) was the first to use the nervous system from workplace Burnout. Because term Burnout to denote a state of physical high-achievers are often so dedicated and emotional depletion that results from Our nervous system is made of two to their work, they tend to ignore the conditions of work. innate mechanisms the Sympathetic fact that they’re working exceptionally Nervous System (SNS) and the Para- He said Burnout is a state of chronic stress long hours, taking on exceedingly heavy sympathetic Nervous System (PNS) that which leads to: work loads, and putting enormous work in tandem to allow us to both get • Physical and emotional exhaustion. pressure on themselves to excel – all ready for action and respond to threat • Cynicism and detachment. of which make them ripe for Burnout. and help us unwind, reorganise and • Feelings of ineffectiveness and lack of regenerate after stress. There is a common misconception that Burnout accomplishment. is simply a more intense form of stress. While People working in high-stress environments, When in the throes of full-fledged Burnout, a chronic stress can lead to Burnout, they are in especially our medicos, nurses, first responders worker is no longer able to function effectively fact different conditions. This article has a focus including police and ambulance personnel, on a personal or professional level. Physical and on recognising what Burnout looks and feels like, would be readily able to identify when the emotional resilience is significantly depleted. as well as presenting some proven strategies to Sympathetic Nervous System kicks in and the And importantly, the condition does not ease prevent the development of the condition. whole body gets ready for action. The SNS after rest and relaxation. regulates arousal and is active when we’re alert Burnout saps energy and confidence, and However, Burnout doesn’t happen suddenly. excited or engaged in physical activity. reduces productivity. Clearly, this is a condition You don’t wake up one morning and all of a to be alert to for warning signs and to take It helps us to meet emergencies and threat by: sudden ‘have Burnout’. Its nature is much more steps to prevent its development. insidious, creeping up on us over time like a • Increasing our heart rate, respiration and What is Burnout? slow leak, and this makes it much harder to blood pressure. recognise. Still, our bodies and minds do give • Shifting blood away from our digestive A number of research studies have identified The Sympathetic branch has been described as us warnings, and if you know what to look for, systems to our muscles to allow for Burnout as a step well beyond what we typically the gas pedal of our nervous system. It gives you can recognise it before it’s too late. quicker movement. call stress, which is an inability to cope with the energy for any action we plan and it helps us demands and pressures placed on us. Burnout is Although closely related to exhaustion, Burnout • Constricting our blood vessels and draining prepare for threat. a more serious state and from which it is more is a stage beyond simply feeling tired. Common the blood away from the skin periphery to difficult to recover. Sometimes the condition is symptoms of the state are described by people prepare for potential injury. The Sympathetic branch referred to by the term ‘compassion fatigue’, feeling overloaded, unappreciated and helpless • Dilating our pupils, retracting our eyelids and many remote health practitioners will be to do anything about these feelings. has been described as and focusing our eyes. familiar with this state. The symptoms of Burnout generally fall into the gas pedal of our After the emergency is over the PNS allows three separate categories. There are physical, nervous system… The A number of research us to rest and unwind by: emotional and behavioural symptoms. Parasympathetic branch studies have identified • Helping us let go of muscle tension. Physical symptoms include tiredness and acts like the brake pedal… Burnout as a step well exhaustion which cannot be relieved with • Lowering heart rate and blood pressure. beyond what we typically usual rest and sleep. It also includes lowered • Aiding digestion. The Parasympathetic branch acts like the brake immunity with attendant tendencies to colds pedal for our nervous system. It helps us to • Returning blood to the peripheral vessels call stress… and infections. Headaches are a common relax, unwind and discharge the arousal of the response to Burnout, as are a change in • Allowing the immune system to fully sympathetic activation. Burnout has been most commonly defined by sleeping and eating patterns. function again. a symptom pattern which includes physical, A perfect healthy working system when it’s cognitive, emotional and behavioural symptoms. Continued on page 92 • Secreting bodily fluids. working well!
62 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 63 Short, not too frequent periods of stress and The problem we have is that the stress reaction adequate time for the PNS to kick in and restore response happens automatically while the stitch in time equilibrium – ongoing cycles of charge and relaxation response, in our modern hectic discharge with a full spectrum of resiliency. world, needs to be deliberately sought on some Flashes of bright red, yellow, blue, tea on the first day, the call went out for occasions. It becomes very important that purple and green appeared around more stocks of wool to be purchased to How do we know when our nervous system we have a number of strategies/activities in the lecture theatre at this year’s satisfy the demand. is in balance and at rest? our toolkit that help us to tap into and aid our CRANAplus Conference as nimble- Who could have known that this ancient craft • We are relaxed and at ease. relaxation response to kick in. fingered participants got knitting. • Our body and its senses are relaxed yet alert would prove such a hit? • We will be present – physically, emotionally, Knitters and would-be knitters were answering Enthusiastic ‘would be’ knitters who confessed psychologically and spiritually. the challenge from CRANAplus Bush Support Top 10 Strategies to Aid that they could not knit, were, in no time, relaxing Services to complete a square before the end • We have appropriate responses to a variety Relaxation Responses in the lounge chairs receiving instructions. Two of Conference. of circumstances. 1. Cultivating a practice of mindfulness. men who bravely fought their way into the • Our responses are fluid and resilient. 2. Exercise – get moving! So great was the response that the CRANAplus ‘knitting lounge’ simply got on with it. And scores • We are available for connection and are 3. Yoga – unifies the mind and body. Bush Support Services booth was mobbed, clicked and clacked in the lecture theatre as they emotionally stable. the knitting kits snapped up and, by morning listened to the presenters. • We experience that we have choices 4. Get creative. and options. 5. Avoid stimulants such as sugar, • We have the capacity for healthy relationships. caffeine, nicotine and simple carbohydrates such as white bread, Stress symptoms can arise when the normal cakes, biscuits, chocolates bars, regulatory symptoms are interrupted in some soft drinks and ice cream. way and symptoms can include: 6. Avoid packaged foods with high • Overactivation of the SNS: sodium – this can turn cortisone – increased heart rate into cortisol. – difficulty breathing 7. Set up a good sleep routine. – cold sweats 8. Be compassionate to yourself – tingling and others. – muscular tension – chronic pain 9. Stay connected to friends and family. – inability to sleep or relax 10. Reflect on your values regularly.
– tendency toward anxiety or panic attacks CRANAplus CEO Christopher Cliffe. CRANAplus Chair Paul Stephenson. – mania, rage outbursts – hypervigilience, racing thoughts Stress symptoms can – worry. arise when the normal • Overactivation of the PNS: – low energy regulatory symptoms are – exhaustion interrupted in some way… – numbness – low muscle tone As we move into the holiday season and head into 2017 a great commitment to make would – poor digestion be to support our nervous systems to assist it – poor immune system function with coping with the stress we have in our lives. – depression – dissociation Therese Forbes – apathy Psychologist CRANAplus Bush Support Services Director The completed blanket which is being donated to a refuge – disconnection in relationship. CRANAplus Bush Support Services Colleen Niedermeyer. in Tassie with a note explaining its origin.
64 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 65 A major plus is their authenticity and willingness to openly communicate their vulnerabilities, inviting participants to immerse themselves in the learning opportunities on offer. Each assessor brings their own uniqueness and this distinctiveness enables all participants the opportunity to find a connection with an expert nestled among the team.
Registered Nurse Rosemary Moyle, who became a facilitator about 20 years ago, around the time she started working for the Royal Flying Doctor Service (RFDS), and Ken Isles, with 37 years’ experience as an intensive-care paramedic in Newcastle, are two members of this band of volunteers.
“I’ve been delivering the courses since they started,” says Rosemary, a facilitator with REC Photo: Steve Batten. educate (Remote Emergency Care course) courses, and more recently with the PEC (Paediatric Emergency Care course) and Advanced Life band (of experts) on the run Support courses.”
The CRANAplus band of course “They are integral to the high standard and facilitators criss-crossing our continent delivery of the courses, bringing current throughout the year have hundreds clinical skills, research and best practice to the of years’ experience between them presentations and skills stations,” says Wendy. – and a common goal; to help health professionals and their teams improve “One of the greatest privileges of being a CRANAplus health outcomes in communities no Course Coordinator is the opportunity to work with matter how distant or how isolated. the most amazing team of educators,” says Anni. As they travel around Australia presenting the organisation’s courses to health professionals …they are united in their and ancillary staff in far-flung places, rural and goal and passion to impart inner-city locations, they are united in their goal and passion to impart their knowledge and their knowledge and experiences. And they all report it’s a two-way experiences… it’s a two- learning experience. way learning experience. The facilitators, who give their time, expertise and knowledge in a voluntary capacity, are They pointed out that participants shared their highly-valued members of the team, says views, with participant evaluations never failing Remote Clinical Educators Wendy Bowyer to acknowledge and recognise the incredible and Anni Kerr, who coordinate the extensive team of volunteer assessors who so willingly programme of courses throughout the year. share their personal and professional experiences. Left to right: Facilitators Monica Ostigh, Rosemary Moyle and Ken Iles with Coordinator Wendy Bowyer in Longreach QLD.
66 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 67 needs analysis survey results
CRANAplus undertook a training needs The existing foundation of CRANAplus courses analysis recently. clearly hits the mark in what respondents want. The response rate was extremely positive with Leadership and management courses were 70% response rate from members and 30% highlighted as a gap. CRANAplus have from non-members. 96% of respondents were responded to this by developing a suite of nurses and midwives with the other made up of modules that facilitate learning in the following students, educators, doctors and managers. 95% areas; action learning styles, leadership and of respondents indicated face-to-face workshops management, clinical governance and project were the preferred mode of education delivery management. The CRANAplus leadership and with respondents sighting access to skilled management course aims to enhance the health professionals to assist them in their skill skills of remote area professionals in the area development and the networking opportunity of leadership and management to ensure safe workshops provide as the reasons why. competent quality care. The needs analysis supported the existing methods The findings along with individual participant of delivery ie; the need to provide face-to-face course evaluations help CRANAplus to expand skills development opportunities for remote health its portfolio of courses while ensuring existing professionals. The use of simulation and skills courses remain contemporary and meet the stations to augment and application of theoretical education and training needs of members and learnings were well supported by the respondents. the remote workforce.
TransitionTransition fromfrom RNRN toto RemoteRemote AreaArea NurseNurse 20172017
Course Participant Karen O’Shea (left) with CRANAplus Trainer Jackie Matear.
“I find it very rewarding. I enjoy The facilitators, who give ABOUT THE SHORT COURSE meeting the rural and remote area nurses A face-to-face program that prepares Registered Nurses to work as and hearing their stories and I have to say their time, expertise and Remote Area Nurses and articulates with Flinders University Award courses. Content includes Framing Indigenous Health, Primary Health Care, I am in awe of what some of them cope knowledge in a voluntary Self Care and Remote Advanced Nursing Practice.* with at times. capacity, are highly-valued To be held in Alice Springs “I find I can relate to them and their questions Monday 19th June – Tuesday 4th July 2017 and issues because of my work with the RFDS. members of the team. I’ve been there, and understand the local That was seven years ago, and Ken looks forward Cost: $2,000 situations and challenges.” * To satisfy all the requirements of the program, participants will be required to complete Pharmacotherapeutics for to his stints, facilitating mainly at Remote RANS (online) and the CRANAplus Remote Emergency Care (REC) course. Emergency Care courses throughout Australia. No fees apply for students enrolled in Flinders Remote Health Award Courses following provision of a student number. Ken, now retired and working part-time in his Send your registration no later than 4 weeks prior to course start date. consultancy, said he really wanted to be part Ken and Rosemary will meet up in December For registration enquiries please contact: of the CRANAplus team when he learned of at the final CRANAplus course for the year, Short Course Administration Officer – Centre for Remote Health the organisation’s goals and achievements, to be held in Adelaide, a REC course developed E: [email protected] W: http://www.crh.org.au/ PO Box 4066 Alice Springs NT 0871 P: +61 8 8951 4700 F: +61 8 8951 4777 “and I haven’t regretted it one bit”. for nursing students.
68 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 69 DRABCD – don’t run a bush clinic down!
I recently attended the Remote Emergency Care course in Coober Pedy, thanks to CRANAplus support from the AMOS fund. This report acknowledges the positive experience I gained from participating in the training weekend. The Remote Emergency Care program was delivered by dedicated and experienced nurses with a passion for the challenges of health care in remote settings. The presentations reflected the content of the course manual (which I did read beforehand…), a comprehensive guidebook covering a range of emergency situations facing a remote nurse: Mental health to road trauma, paediatric to maternity emergency, alarming encounters with wildlife – no pressure immobilisation bandage for redback bites! – triage techniques, burns, spinal awareness, evacuation criteria, and most importantly of all… the Primary Survey DRABCD – Don’t Run A Bush Clinic Down! Being prepared and resourceful were central messages, paying special attention to accurate and effective communication, and don’t forget the family! The practical workshops brought our skills And remember that tracheal deviation is a feeling encouraged to pursue the bush road to to life, animated by late sign of pneumothorax so you’re better off rural and remote health, and as one midwife demonstrations from the knowing the early signs… said to me, “the bush gets in your blood”. It also gets stuck to your shoes, as we found out when At one point a beautiful tray of food was facilitators. My favourite visiting the Breakaways outside Coober, landing delivered from the Ghan train that was unable the car in a spot which required a few phone was the imaginative use to run its route due to heavy rain (in Coober calls, and a starlit picnic while we awaited our Pedy). During meal breaks there was time to of a sheep carcass to retrieval service! mix and hear each other’s stories, and I explored show the technique for future career pathways by listening to first-hand I have now enrolled in the CRANAplus mentoring inserting a chest drain… accounts and recommendations. I also learned program, and am looking up dates for the of safety issues due to isolated staffing in Maternity Emergency Care course. Thanks to all The practical workshops brought our skills to remote settings and cultural awareness as a key CRANAplus staff and Remote Area Nurses for life, animated by demonstrations from the competency for effective indigenous health care. blazing the trail. facilitators. My favourite was the imaginative use of a sheep carcass to show the technique for The weekend was an overall success for me Caroline Doerig inserting a chest drain… ”Just get the doctor on not only in terms of obtaining clinical skills and RN at Albury Wodonga Health Above: Caroline Doerig. Right: Coober Pedy main street. speaker and put your gloves on… you can do it!” confidence, but also making new contacts and Victoria
70 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 71 EDUCATION 2017 SCHEDULE COURSES ARE OPEN FOR REGISTRATION AT CRANA.ORG.AU Schedule subject to changes, please check website for updates.
Maternity Advanced Midwifery Remote Emergency Care Remote Upskilling Emergency Emergency Care Care WESTERN AUSTRALIA QUEENSLAND QUEENSLAND WESTERN AUSTRALIA • NEWMAN, 26-28 MAY • CAIRNS, 2-4 JUNE • CAIRNS, 19-21 MAY • NARROGIN, 12-14 MAY • BROOME, 15-17 OCT • BROOME, 21-23 OCT NORTHERN TERRITORY NORTHERN TERRITORY QUEENSLAND QUEENSLAND • ALICE SPRINGS, 5-7 MAY • ALICE SPRINGS, 11-13 AUG • ROCKHAMPTON, 10-12 MAR • CAIRNS, 16-18 JUNE • DARWIN, 22-24 AUG • CAIRNS, 15-17 SEPT NEW SOUTH WALES • LONGREACH, 10-12 NOV • BOWEN, 7-9 JULY • TAMWORTH, 17-19 MARCH NEW SOUTH WALES • M O U N T I S A , 25-27 A U G • DUBBO, 7-9 APRIL NORTHERN TERRITORY • TOOWOOMBA, 1-3 SEPT • ALICE SPRINGS, 20-22 MARCH; VICTORIA 14-16 JUNE & 28-30 SEPT NORTHERN TERRITORY • COLAC, 10-12 NOV • NHULUNBUY, 1-3 SEPT • NHULUNBUY, 5-7 MAY • DARWIN, 3-5 MAY & 11-13 OCT • DARWIN, 2-4 JUNE NEW SOUTH WALES • ALICE SPRINGS, 8-10 SEPT • BYRON BAY, 24-26 FEB VICTORIA VICTORIA • LORNE, 24-26 MARCH • BENDIGO, 4-6 AUG TASMANIA • HOBART, 17-19 NOV “ As usual, an excellent CRANAplus course, run by practitioners with an obvious passion for high standards of rural and remote health” ALS Broome 2014
Advanced Life Paediatric Triage Practical Support Emergency Emergency Care Care Skills WESTERN AUSTRALIA WESTERN AUSTRALIA WESTERN AUSTRALIA WESTERN AUSTRALIA • NARROGIN, 15 MAY • BROOME, 21-22 OCT • ESPERANCE, 2 MAY • BROOME, 16 OCT QUEENSLAND QUEENSLAND QUEENSLAND QUEENSLAND • CAIRNS, 29 JULY • CAIRNS, 4-5 NOV • MILES, 30 MARCH • MILES, 31 MARCH • LO N G R EA C H, 13 N OV NORTHERN TERRITORY • MOUNT ISA, 22 JUNE • MOUNT ISA, 20 JUNE NORTHERN TERRITORY • DARWIN, 8-9 APRIL NORTHERN TERRITORY • CAIRNS, 30 JULY • ALICE SPRINGS, 4 SEPT • TENNANT CREEK, 12-13 AUG • TENNANT CREEK, 14 AUG NORTHERN TERRITORY • DARWIN, 10 OCT NEW SOUTH WALES • ALICE SPRINGS, 3 SEPT • ALICE SPRINGS, 3 SEPT NEW SOUTH WALES • TAMWORTH, 23-24 SEPT SOUTH AUSTRALIA • BYRON BAY, 27 FEB VICTORIA • ADELAIDE, 19 FEB SOUTH AUSTRALIA • MELBOURNE, 27-28 MAY • ADELAIDE, 18 FEB CRANAplus Annual Conference Broome, WA 18-20th October 2017 The Future of Remote Health and the Influence of Technology
CRANAplus Bush Aspiring to a career CRANAplus Education Support Services in remote practice? CAIRNS Services 07 4047 6400 Pathways to Remote Professional Practice ALICE SPRINGS Check out the January 2015 To register for a course, visit Pathways to Remote 08 8955 5675 1800 805 391 Professional Practice www.crana.org.au/education ADELAIDE publication on 08 8408 8200 24/7 toll free counselling service our website or call 08 8408 8200 Are you aware of the range of scholarship and grant opportunities available to CRANAplus Members? The CRANAplus Under- graduate Remote clinical placement scholarships are generously sponsored by a range of individual donors, organisations and CRANAplus.
The scholarships present an opportunity for undergraduate students professional studying a health discipline at an Australian University, to gain remote clinical experience through here’s to another year! supporting the costs associated with travel Season’s greetings from the Professional Conference time is also when we announce see that continue to grow. It is especially and accommodation. Services team: Geri Malone, Marcia the Aurora Award and CRANAplus Awards pleasing to see the personal rewards gained Hakendorf, Judy Whitehead, Rod Menere winners. These Awards have been gaining by individuals who receive awards through The Nurses Memorial and Tracey Scott Jackson (Admin support). momentum over the years and we want to nomination by their peers. Foundation of South Australia Inc grants provide CRANAplus members The high caliber of presentations and speakers Award nominations will close earlier in 2017 the opportunity to gain support to attend at our 34th Conference in Hobart recently, to enable more lead in time for the winners to join us at Conference. CRANAplus short courses or our Annual Conference. contributed to its resounding success and saw our highest ever registration of Delegates. We Look out for when they open and consider More information and application forms consider our annual Conference an opportunity nominating a colleague. can be found at: https://crana.org.au/ membership/scholarships for first time speakers. CRANAplus has always Scholarships and Grants available offered assistance with writing an Abstract and through CRANAplus Certification of RAN’s Model will extend that support next year to additional support on presentations. This year we launched, in association with During our recent Conference the Certification the Centre for Remote Health, the Gayle of RAN process was presented to an audience It is great to see first time presenters get out of Woodford Memorial Scholarship. of over 200 people. The presentation provided their comfort zone by preparing and delivering an overview of the process involved for either The Scholarship will be awarded to a student a presentation on their specific areas of interest an individual nurse or midwife, to obtain to study the Graduate Certificate in Remote and we are committed to continuing this support. Certified RAN status. We have called for Practice and will be formally presented at the Selected presentations are available on our expressions of interest from our membership CRANAplus Broome Conference in 2017. website: https://crana.org.au/conference/ for nurses and midwives to take participate past-conferences The Gayle Woodford Memorial Scholarship. The recipient will commence study in 2017. in a pilot program.
74 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 75 This pilot program will not only provide us we are offering to conduct a workshop in Cairns with feedback about how we might improve (May 2017) and again in Broome (October 2017). rural nursing project our program, but also inform our IT support with For more information please visit our website: the build of an on-line system. It is anticipated The summary document https://crana.org.au/education/eremote COUNTRY NURSES = COUNTRY HEALTH the Certification of RAN on-line registration and produced from the literature The aim of the Rural Nursing Project assessment for Certified RAN status will go live Position Paper: Remote workforce review is now available is to identify opportunities for early in 2017. Gender Identity and Sexual on the CRANAplus website CRANAplus to be more relevant for Diversity Inclusion https://crana.org.au/ Remote Management Program: Nurses working in a rural context of professional essentials for remote managers CRANAplus’ Network of Interest: LGBTI group practice. The project commenced with actively contributed to the development of this The evaluation of the Remote Management pilot a narrative literature review to explore During the next stage of the position paper. The paper outlines the need program proved to be a successful investment factors effecting engagement and project we are undertaking for remote health services to actively commit for participants as well as CRANAplus. The two- disengagement of rural nurses in consultations with rural to the notion of social justice for all, whereby day workshop and the on-line modules equally both Australia and other developed nursing leaders, clinicians ‘zero tolerance’ and social inclusion are integral hit the mark in addressing the learning needs of countries who share similar systems. from a range of practice aspects of workplace culture. A consistent remote managers. settings – hospitals (public approach across the remote sector for ‘zero The key concept emerging from the literature and private), aged care, primary health and We are now offering remote managers the tolerance’ to discrimination based on gender review is that a career continuum/pathway in private practice and giving a voice to the rural opportunity to access individual modules or and sexuality diversity, whereby negative rural health begins with engagement of school nurses as to what they believe are the needs as a package. The modules include: attitudes, biases and stereotypes in the students and promoting nursing as a career. and opportunities. workplace and the wider community are Well supported, undergraduate and transition • Introduction challenged. This will only be evident, by the to professional practice programs, as well as The CRANAplus Conference provided me • Action learning behaviours health professionals demonstrate robust orientation programs are also essential the opportunity, as a new team member, to such as, positive engagement and respect to embed new nurses into a rural community. • Leadership and management commence engagement with a number of rural for the needs of LGBTI health professionals. It is well known that there are workforce nurses and student organisations regarding the • Clinical governance shortages of nurses, as with other professions, Rural Nursing Project. If you have any enquires To read more visit https://crana.org.au/ in rural areas, and this is a function of both • Project management professional/position-statements/2016/ about this project do not hesitate to contact me: recruitment and retention. Easily accessible and diversity-and-lgbqti [email protected] To obtain a Certificate of Completion for the acceptable continuing professional development Remote Management Program it is expected Marcia Hakendorf and Geri Malone opportunities for rural nurses, factors in Judy Whitehead managers will undertake the modules and Professional Services engagement and retention strategies to ensure Project Officer (Rural) attend a one-day workshop. If you are interested CRANAplus that we have safe, competent practitioners. CRANAplus
76 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 77 remote area workforce safety & security project It’s been a very active Initial project information was provided time for the Safety & to participants at the October CRANAplus Security Project. Conference in Hobart, with strategies for the further implementation of project activities As part of industry and being confirmed at the Expert Advisory stakeholder consultation, I’ve Committee meeting in early December. met with over one hundred ASANNA individual remote health With the project now approaching its half-way Australian Student And professionals from all states point, the focus is now moving from consultation Novice Nurse Association
and territories, along with and information collection to production and Empowering Nursing’s Future, Today! Empowerment
health service managers distribution of resources. These will include a • and representatives of literature review, safety and security guidelines, professional organisations. risk assessment tools, and educational resources.
Questionnaires have been completed by more It is easy to focus on problems, ponder past than 90 currently practising remote clinicians. negative experiences and identify what others ASANNA is an independent, Communication has involved group discussions, should be doing to make you safer. However, non-government, member-based organisation symposia, a videoconference and social media. safe & effective health service provision in Our members are student registered nurses, remote communities will come from everyone Safety and security involves many issues, enrolled in an approved nursing degree, and working together to implement positive including: business hours and on-call work novice nurses up to five years after graduation. Support responses to reduce risk. The project’s goal is to practices (Never alone), travel, transport and support all stakeholders with the resources to communications; consultation with community promote remote workforce safety and security. www.facebook.com/AsannaNurses representatives and other on-site agencies; secure clinic and accommodation facilities; For more information about the project, @AsannaNurses appropriate orientation of new staff; clearly contact [email protected] or join the [email protected] documented safety guidelines; and the positive Remote Area Workforce Safety & Security www.asanna.com.au contribution of managers and clinicians. Facebook page. Advocacy • Advocacy •
Proudly sponsored by Photo: Steve Batten.
improving Community 78 CRANAplus magazine issue 104 | summer/wet season 2016 remote health to the sustainability of the remote health health workforce as those who comprise it, what is a sustainable remote workforce according to remote health those who have a stake in it and those who professionals in various ways, including: filling manage it. This focus on ‘people’ was strong, health workforce? vacancies quickly, providing backfill, providing and their descriptions all aligned with an equitable remuneration and financial incentives, overall purpose for providing accessible health Leigh-ann Onnis, a their descriptions, it was clear that the current access to resources and models of practice services for rural and remote populations. PhD student at James remote health workforce, experienced health (e.g. FIFO). In addition, leadership was described Most importantly, the current remote health Cook University in professionals who understand the complexity as a key aspect of effective management workforce believes that a sustainable remote practices, particularly skills in managing a Cairns, has spent of remote practice, proposed that future health health workforce is achievable. the last three years workforce sustainability is achievable with team from a distance. thinking about this effective management practices focused on While HRM and recruitment practices offer very question. people, practice and place. …the provision of career health services the opportunity to attract sufficient appropriately skilled applicants, it is To find out the answer she People paths within the remote effective management practices that reduce asked health professionals When remote health professionals described the context would improve turnover and improve retention. who are currently working role of ‘people’ in workforce sustainability, they or managing people who described aspects of a person’s characteristics, sustainability. Using the HRM approach to investigate the were working in remote both personal and professional. These Clinical practice included methods of practice influence of management practices revealed Australia. After all, who would know better characteristics included: the person-fit within the (e.g. multi-disciplinary teams), being able to that managers were the key to workforce than those who are currently working there? health service and the community, their degree work to the full scope of their profession and sustainability. Furthermore, the findings from Health professionals working in rural and remote of individual sustainability (e.g. what internal continuity of professional staff. There was this research suggest that supporting remote Australia know that the narrative about the resources they have to keep themselves going) an emphasis on access to professional managers and developing future managers is difficulties in attracting, recruiting and managing and relationships. development and the suggestion that the essential for remote workforce sustainability. a workforce in geographically remote regions provision of career paths within the remote is not new. For too many years the challenges …leadership was context would improve sustainability. …the current remote health of maintaining health services with a consistent described as a key aspect Place supply of remote health professionals has been workforce believes that a When health professionals described the considered part of working life for those working of effective management role of ‘place’ in workforce sustainability, they sustainable remote health in rural and remote health. In undertaking this practices, particularly described aspects of a health professional’s research, it was proposed that if the issues are workforce is achievable. connection to the geographic location or the not new, then we need to find a new approach skills in managing a local community. Their connection with place In particular, the HRM approach brought the because workforce sustainability is a key team from a distance. was described as an emotional connection ‘person’ to the forefront of management element of being able to provide health services to place by the local workforce; however, practices, emphasising the role that managers in remote Australia. This new, Human Resource These are the characteristics of the person that those who moved to the remote area often play in localising policies and practices so that Management (HRM), approach complemented build resilience and contribute to an individual’s described an emotional attachment to either they are effective and appropriate to the remote the current health research and sought to add sense of belonging with the community and the the geographic location or the local community workplace, as well as being safe for health a different perspective. This HRM approach also health service. Professional attributes included: (and often both). sought to bring the collective voice of remote competence, professional development and professionals and their patients. The research health professionals to the conversation. career choices, all of which are the attributes These connections to place promote stability concluded that to have a sustainable remote of a person that contribute to their capacity to and according to the current remote health health workforce, managers must focus on When asked the question ‘What is a sustainable perform their work competently. workforce improve retention. people, practice and place. remote health workforce?’ more than 200 health professionals working in northern Australia, Practice One remote health professional said This article is based on the publication: described various ways in which the workforce When health professionals described the role ‘You have to be realistic with sustainability’ Onnis (2016) ‘What is a Sustainable Remote in rural and remote areas could be sustainable. of ‘practice’ in workforce sustainability they Remote health professionals provided a Health Workforce?: People, Practice and Place’ The research identified the common aspects described both clinical and management realistic and pragmatic contribution to the Rural and Remote Health (Online) 16, 3806. of their descriptions. After considering all of practices. Management practices contribute narrative, describing a sustainable remote Available online at: http://www.rrh.org.au
80 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 81 Optimal Cancer Care Pathways have been developed for 15 tumour streams: lung, colorectal, hepatocellular carcinoma, prostate, lymphoma, melanoma, pancreatic, ovarian, malignant glioma, head and neck, breast, oesophagogastric, basal cell and squamous cell carcinoma, endometrial, and acute myeloid leukaemia.
There are three versions for each Optimal Cancer Care Pathway – detailed clinical pathways for cancer specialists, quick reference guides for GPs and other primary health professionals, and guides for patients themselves.
The clear and integrated articulation of Photo: Steve Batten. connect best practice for cancer care will improve outcomes for patients across the country – and brings a huge range of collective experience optimal cancer care pathways and expertise together to ensure the best approaches and the best outcomes in cancer In a significant development in cancer addition, each specific pathway was developed by treatment apply across the country. care in Australia, national Optimal an expert group including clinicians specialising Cancer Care Pathways have been in treatment of the particular tumour, GPs and Links to the Optimal Cancer Care Pathways: developed to promote consistent, consumers, and in consultation with medical Detailed clinical pathways for cancer specialists, quality cancer care. They aim to improve colleges and peak health organisations. health professionals and health service patient outcomes by ensuring that all This is the most comprehensive set of guidelines administrators. http://www.cancer.org.au/ people diagnosed with cancer receive for cancer care in Australia. The Optimal Cancer health-professionals/optimal-cancer-care- the best care regardless of where they Care Pathways describe the key steps in a pathways.html live or receive cancer treatment. patient’s cancer journey and expected standards Quick reference guides for GPs to familiarise The Optimal Cancer Care Pathways have been of care at each stage. The pathways also ensure GPs and other primary care providers with the that those providing care understand how to developed through the National Cancer Expert cancer care pathways. http://www.cancer.org. coordinate the patient care between each stage. Reference Group and has achieved national au/health-professionals/optimal-cancer-care- endorsement of the Optimal Cancer Care Optimal Cancer Care Pathways can be used by pathways.html Pathways and national agreement to pilot the health services and professionals as a tool to adoption of some of these pathways in state and Patient ‘what to expect’ guides to help patients identify gaps in current cancer services and territory health services during 2016–2017. and their carers understand the cancer care inform quality improvement initiatives across pathway and what to expect at each stage. The pathways have been endorsed by the Cancer all aspects of the care pathway. They can also http://www.cancerpathways.org.au/ Australia, Cancer Council Australia, the Australian be used by clinicians and health professionals optimal-care-pathways Health Minister Advisory Council and the COAG as an information resource to promote discussion Health Council (comprising Health Ministers and collaboration with patients and people Further information can be obtained by
representing all Australian jurisdictions). In affected by cancer. Photo: Steve Batten. contacting [email protected]
82 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 83 what is PCACE?
PCACE stands for ‘Palliative Care in Aged Care Evidence’ and is a project being funded by the Department of Health and undertaken by CareSearch. It will create a new online resource linking health and aged care professionals to palliative care/aged care evidence and practice resources. Why is it important? The APRAC (2006) and COMPAC (2011) When will it be available? Guidelines brought together the evidence The new online resources will be released around palliative care for older people living before 30 June 2017. in residential aged care and in the community. As new research has been published, there is a You can find out more and sign up for the need to update the guidance. There is also the PCACE Project News at www.caresearch.com.au opportunity to make the content available online making it accessible when it is needed and to link through to tools, projects and education options relevant to the sector. What does it means for rural and remote nurses? Rural and remote nurses will have information about palliative care for older people at their fingertips. There will also be resources and information specific to providing care in rural and remote settings. Get involved! The PCACE Project is being supported by a National Advisory Group comprising leaders from aged care, palliative care and community organisations and an Expert Advisory Group with experts in clinical practice, aged care, research design and evaluation. You can help by: • suggesting tools, resources or projects that need to be included in the online guidance, • reviewing project content and pages or by joining user testing activities, and • promoting the PCACE project to friends and colleagues. Get in touch by emailing us at
[email protected] Photo: Steve Batten.
84 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 85 86 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 87 employees at Rumbalara to walk off
Rumbalara Aboriginal Cooperative “On average Aboriginal and Torres Strait Islander and the Heart Foundation have peoples have a 10-year life expectancy gap engaged in a partnership to launch when compared to the rest of the Australian the free Rumbalara Heart Foundation population. Cardiovascular disease accounts Walking group. for a quarter in the gap of life expectancy and remains the number one killer of Aboriginal Open for all members of the community to join, and Torres Strait Islander peoples. this walking group aims to engage the largest Indigenous community in regional Victoria to tackle health issues in a social environment. “…It’s fun, it helps maintain Rumbalara Aboriginal Cooperative Chief fitness, it’s suitable for Executive Officer Kim Sedick said the team all ages and it’s free.” were proud to be setting a best practice standard for active workplaces. “This is why the Heart Foundation has committed “We’re committed to allowing our workforce to this innovative and unique partnership with of more than 200 people to take an hour out Rumbalara Aboriginal Cooperative.” of their work day to participate in Heart Rumbalara Aboriginal Cooperative Healthy Lifestyles Foundation Walking,” Mr Sedick said. Team Leader Hope Briggs said being a part of the walking group helps you stay motivated. “With the Australian Bureau of Statistics data Photo: Steve Batten. showing that 77% of adults in the Shepparton “It’s easy to say ‘I’ll give my walk a miss region are not getting enough physical activity, today’, however, knowing there is a group this partnership is going to be a critical one in encouraging the Shepparton people to move of people waiting for you can provide that more and sit less.” extra motivation needed to get out the door,” Pathway to Nurse Practitioner Ms Briggs said. “We’re committed to Rumbalara Aboriginal Cooperative Chronic Are you interested in becoming Disease Nurse Rebecca Kellehar added that allowing our workforce a Nurse Practitioner with a of more than 200 people walking the steps together to tackle chronic disease was a step towards strengthening remote scope of practice? to take an hour out connections, health and wellbeing in the community. of their work day to The Centre for Remote Health has now established a participate in Heart For information about Heart Foundation Walking pathway to becoming a Nurse Practitioner visit http://walking.heartfoundation.org.au with a remote area ‘scope of practice’ Foundation Walking.” Heart Foundation Walking is Part A - Graduate Diploma in Remote Part B - Master of Nursing (Nurse Practitioner) (MNNP) The MNNP (Charles Darwin University) is designed to equip funded nationally by Fitbit and Health Practice (GDRHP) Heart Foundation Victoria CEO Kellie-Ann Jolly The GDRHP (Flinders University) is designed specialist nurses with the advanced and extended skills and said the Heart Foundation was committed to the Queensland Government. for remote area nurses to advance knowledge required to become NPs. This course is designed the health of the Aboriginal and Torres Strait their knowledge of the discipline to build on the specialisation practice of remote area practice Islander community. of Remote Health. within a systematic and coherent body of NP knowledge and (2 years part time) skills. (2 years part time) “The Heart Foundation walking program is an http://www.flinders.edu.au/courses/ http://www.cdu.edu.au/health/ postgraduate-nursing effective way to improve health outcomes for rules/postgrad/gdprhp.cfm all members of the community. It’s fun, it helps For further information please contact: Sue Lenthall maintain fitness, it’s suitable for all ages and it’s free,” Ms Jolly said. [email protected] P: 08 8951 4707
88 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 89 90 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 91 Move your body frequently – don’t sit for more How to Relieve Burnout burnout: a step beyond chronic stress than an hour. Recent studies have found that we should ideally sit for no longer than 20 minutes So what do we do when despite our best efforts we see signs of this insidious condition Continued from page 62 How to Prevent Burnout at a time. Get up and stretch, walk around or change tasks if possible. developing and affecting our outlook and Emotional symptoms may involve lowered There are several approaches which could be work satisfaction? The strategy used will ideally self confidence, motivation and self-doubts. An considered as structured measures to combat Reduce your intake of alcohol, nicotine, and suit the stage of Burnout reached. increasingly negative and cynical outlook is also stress and prevent Burnout from developing. caffeine. When stressed, there can be an increased reliance on alcohol or other drugs. a feature of Burnout. A very common emotional These suggestions will hopefully assist in Properly used these substances can be a It is common for a newly symptom is that of detachment and apathy, warding off initial symptoms… pleasurable and valuable part of relaxing, but especially toward patients and other people in arrived practitioner in Take a close look at your work-life balance. when they become a routine coping strategy it the workplace. As the condition further develops If your job takes up too much of your time and is time to look for healthier alternatives. Alcohol a remote or isolated there can be a decrease in satisfaction and you are putting in too much effort, then consider and caffeine for example can interfere with community to have accomplishment in the workplace. which steps can redress the imbalance. Prioritise sleep patterns and lead to irritability. time out for those activities which you enjoy. unrealistic expectations The behavioural symptoms can embrace a Schedule time for relaxation or exercise. Get all the restful sleep that you need to feel pattern of reactions to the condition, including of what can be achieved The principle which applies here is ‘If you don’t refreshed and clear headed. This can be tricky isolation from others, withdrawing from work plan it, it won’t happen’. when coping with shift rosters and pagers, but in managing patient and personal responsibilities, procrastinating, good sleep hygiene is important. irritability and frustrations, using alcohol or other Set a time each day when you completely workloads and health. disconnect from technology. Many of us This means no caffeine late in the day, going to drugs as a coping mechanism, and poor work Recent and key research (Leiter and Maslach, check emails and phone messages regularly, bed at regular times and eating heavier meals attendance. This can be evident in increased earlier in the day. It is especially important to 2016) indicates that we need to restore our reliance on sick leave or poor work attendance. even when we don’t need to. Naturally, if an on-call roster requires a pager or phone to be reduce or avoid nicotine. Smoking when you’re sense of engagement with work, and do it It is clear that although these symptoms are monitored, clearly that is a firm requirement. feeling stressed may seem calming, but nicotine in a way which is consistent with the situation is a powerful stimulant, leading to higher, not similar to stress or physical tiredness, Burnout But when off duty, and in break periods, set and our personalities. Given that there is lower, levels of anxiety. is a more significant and serious state. a time for checking in with social media or no ‘one-size-fits-all’ strategy, nevertheless, emails and then disconnect. This allows clearer Make laughter and play a priority. Yes, it can be we do know that a variety of approaches are Stages in development of Burnout headspace and more meaningful relaxation. difficult to take part in social activities when in generally effective. Researchers Jerry Edelwich and Archie Brodsky remote areas, and this activity may need some It is common for a newly arrived practitioner (1980) described how people go through a Smoking when you’re creative application. Find an exercise or activity in a remote or isolated community to have series of predictable stages in their relationship where you can let your hair down and escape unrealistic expectations of what can be achieved feeling stressed may the demands of work. to work. The first stage isenthusiasm , a period in managing patient workloads and health. The of high hopes, unrealistic expectations and over seem calming, but nicotine Support your mood and energy levels by eating magnitude of the task can be overwhelming and identification with the job. The second stage is a powerful stimulant, a healthy diet. What you put in your body can daunting. It is important that we assess what is stagnation in which personal, financial, and have a huge impact on your mood and energy is achievable. If there is a realistic framework career development needs begin to be felt. leading to higher, not levels throughout the day. Minimise sugar and put in place for tackling and managing the This stage is followed by frustration, in which lower, levels of anxiety. refined carbohydrates. You may crave sugary workload, more can be ultimately accomplished. one questions one’s effectiveness in the face snacks or comfort foods such as pasta or French Ensure you have adequate social support. If you fries, but these high-carbohydrate foods quickly Assess whether there is a mismatch between of obstacles to meaningful accomplishment. feel isolated at work and in your personal life, you lead to a crash in mood and energy. Reduce your your job and your interests and skills. Is it time Frustration is regarded as the crossroad that might feel more stressed. This is an obvious issue high intake of foods that can adversely affect to consider a new direction? If your values differ can either lead back to enthusiasm or down for many who work remotely from family and your mood, such as caffeine, trans-fats, and from the way your employer does business to the fourth stage of apathy, an abyss of friends, and it means a higher commitment to foods with chemical preservatives or hormones. or handles grievances, the mismatch can chronic indifference that defies most efforts keeping in touch despite the distances. Put a priority Eat more Omega-3 fatty acids to give your eventually take a toll. Admittedly there are at intervention. It is clear that intervention on face-to-face social contact with supportive mood a boost. The best sources are fatty fish situations when it is difficult to leave such a needs to occur well before there is an effect people. This can include phone contact with (salmon, herring, mackerel, anchovies, sardines), workplace, for many reasons. But when there on health and wellbeing. friends or colleagues who are at a distance. seaweed, flaxseed, and walnuts. are options for change, explore them fully.
92 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 93 Work on an exit plan to control how you work environment, rediscover forgotten skills It can be compared to having a debate with a If family members have been abused or manage and depart from a workplace which has and develop new skills for managing stress, person who’s highly intoxicated with alcohol: assaulted by the ice user they may require a different value system. preventing Burnout and promoting vitality. you know they’re not fully comprehending what referral to a safe setting, and follow-up you’re saying, they have tunnel vision towards regarding their ongoing safety. This should If there are dysfunctional workplace dynamics, Christine Martins their argument, they can’t perform lateral be to a non-ice using area of the community. Psychologist it is critical outside support and advice is sought. thinking to see your point of reasoning, so you Give them a brochure regarding DV and ice use, CRANAplus Bush Support Services There are agencies and organisations set up to choose not to engage with them while they’re and refer them for domestic violence support provide this support. There are always options References and further reading drunk. It’s similar with people intoxicated with if it’s available. Free brochures on domestic for managing work stressors. CRANAplus has ice, and for some time after their ice use, but violence can be ordered and mailed to your Edelwich, J., & Brodsky, A. (1980). Burnout their presentation is different. We don’t see a team of trained psychologists who can help service or clinic. you to work through the available options and stages of disillusionment in the helping happy ice users in the same way that we see develop a plan to tackle these issues. professions. New York: Human Sciences Press. a happy drunk. …most rural and remote The CRANAplus Bush Support Line is a free and Freudenberger, H.J. (1983). Burnout: In an ideal world, referral might include: workers have a good confidential service available 24 hours a day contemporary issues, trends, and concerns. Outpatient Drug and Alcohol Service, residential drug and alcohol rehabilitation, Narcotics by ringing 1800 805 391. Staffed by registered In Farber, A. (Ed.) Stress and Burnout in the understanding of how to Anonymous (NA), Crystal Meth Anonymous, professionals, the line provides telephone service profesions. (pp.23–28). New York. Pergamon Press. SMART Recovery and, in some cases, gaol may manage alcohol and other counselling for all remote health practitioners/ be the only option to address the associated drug presentations. The workers and their families. Freudenberger, H.J. Staff Burn-out. Journal of criminal behaviour. In rural and remote settings Social Issues Volume 30, Issue 1, April 2010 It can feel as though many situations are out of such referrals are just not an option due to same principles are used distance, funding, lack of services and lack of our control. Therefore, one of the major objectives Leiter, M., and Maslach, C.(eds) 2016. [for ice presentations]. staff. Health practitioners therefore have to in decreasing the impact or development of Latent Burnout profiles: A new approach to use their existing skills and creativity to use If you’ve had an aggressive ice user come Burnout is to recognise that we generally have understanding the Burnout experience. Work what is available. to your service or clinic make sure you some control over how we respond to the in progress, Burnout Research, (pp 89–100) debrief after aggressive presentations. Call To start with, most rural and remote workers your Employee Assistance Program (EAP) or have a good understanding of how to manage Employee Assistance Service (EAS) provider, call alcohol and other drug presentations. The Bush Support Services 1800 805 0391 or other the ice challenge same principles are used. With the addition counselling support if you have a preferred of adherence to the aggression management Continued from page 58 There’s also reduced aggression control; reduced provider, or talk with a colleague and your guidelines for your workplace, rural and remote empathy and consideration for others; and reduced manager. These presentations are stressful, Have you ever asked yourself why people use health workers may have limited referral options insight into the consequences for their behaviour. emotionally taxing, and exhausting so make ice? They will tell us it’s because they’re bored, but they do have some options to implement sure you look after you. Keep up with your referrals after addressing medical issues. or it’s peer pressure, or that no other drugs self-care strategies. Check in to the CRANAplus were available. When we look at the effects of Have you ever asked Firstly, the ice user can be referred to a safe website to remind yourself of these strategies. ice we get a better idea of what’s occurring for yourself why people use setting. This setting must be safe for them and Book some leave for time out if you have the ice user. When a person uses ice they feel safe for others. If domestic violence has occurred multiple aggressive presentations. an immediate sense of euphoria: nothing else ice? They will tell us it’s it should preferably be a place where adults matters, their worries dissolve, they feel alert, because they’re bored, or reside and is not necessarily inhabited by children. Thirdly, if you’re a resilient health professional they feel self-confident, they have energy, and bounce back well and have energy for Secondly, it would be good if the setting could prevention strategies there are several options and their sex drive increases. But with these it’s peer pressure, or that no include a non-ice-user, whether that is a friend for you to explore with the support of your pleasant effects also comes the negatives other drugs were available. or family. Of course, if the ice user is in the full colleagues and community. of having a dry mouth; teeth grinding; poor throws of an ice using cycle, this will be virtually impulse control (for example, scratching or We might think that the negatives would impossible. If they are coming down from ice To improve access to community-based group picking, resulting in sores and scabs); and outweigh the positives of ice use, but the lack use, or if they’ve been injured, they may need a treatments, see if you can identify anyone reduced insight into repetitive behaviour of insight in the ice user doesn’t assist them to safe place to sleep, and ice users when coming who may have been involved with Narcotics (scratching, rocking, pacing) as ice users don’t think in the same way we think, at least not down can sleep solidly for two to four days after Anonymous (NA) or Alcoholics Anonymous (AA) realise they’re engaging in these behaviours. while they’re using ice. an ice binge. who could start up an NA meeting.
94 CRANAplus magazine issue 104 | summer/wet season 2016 the voice of remote health 95 It might not be Crystal Meth Anonymous The Australian Drug Foundation has a community (CMA does exist in Melbourne, Sydney, Northern program guide on their website that supports Rivers of NSW, and the Gold Coast), but NA community project engagement. www.druginfo. meetings address all drugs, not just narcotics, adf.org.au and is worth a look if you are when other options are not available. interested in starting or supporting community action with drug prevention strategies. SMART Recovery is another option for community treatment. These groups are run by a health Starting a community project is also a positive professional who has attended training offered way to provide distraction and stress reduction by SMART Recovery. The treatment is based on a when communities get bogged down with the cognitive behaviour therapy model and consists negative events of the ice epidemic. of a weekly group meeting. For some communities these suggestions may SMART Recovery offers training for people to run seem simplistic or even impossible. If you’re Aboriginal and Torres Strait Islander groups as working in a community where there’s an ice well. They also offer training for a Be Smart group problem, it’s important for you to stay safe, stay which is designed to support family members emotionally strong, use the skills you already suffering from the effects of having a drug user have, work with what’s available to keep in the family. making change, one step at a time, and know that baby steps can help. There is a cost involved with the SMART Recovery training, which is based in Sydney, but if eight Above all, maintain hope that the community or more people require the training then SMART in which you live and work will move through Recovery will come to you. this ice epidemic. 4
Phone: 07 4047 6404 Email: [email protected] Web: www.crana.org.au/support phone e ail bss crana.org.au 96 CRANAplus magazine issue 104 | summer/wet season 2016 www.bss.crana.org.au YOUR HANDS At the Heart of Better Outcomes
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1Davis DP, et al. Resuscitation. 2015;92:63-69. © 2015 ZOLL Medical Corporation, Chelmsford, MA, USA. Real CPR Help and ZOLL are trademarks and/or registered trademarks of ZOLL Medical Corporation in the United States and/or other countries. MCN HP 1502 0116 98 CRANAplus magazine issue 104 | summer/wet season 2016