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Issue 152 - 14 Sept 2010

Library Stand - NZNO AGM and Conference
Duxton Hotel in Wellington
Wednesday 15th and Thursday 16th September 2010

Come and check us out


1. Use of chronic disease management plans in rural practice
Australian Journal of Rural Health, Aug 2009, Vol. 17 Issue 4: p173
The author offers observations on "best practice" management of chronic diseases in rural Australia. He discusses management plans given to patients, the shortage of medical personnel in rural areas, and various roles that practice nurses can undertake with patients to achieve health goals and offer self-management resources for patients.

2. Approach to treatment of mental illness and substance dependence in remote Indigenous communities: Results of
a mixed methods study
By Nagel, Tricia et al. Australian Journal of Rural Health, Aug 2009, Vol. 17 Issue 4: p174-182
To develop and evaluate a culturally adapted brief intervention for Indigenous people with chronic mental illness. Design: A mixed methods design in which an exploratory phase of qualitative research was followed by a nested randomised controlled trial.
Setting: Psycho-education resources and a brief intervention, motivational care planning (MCP), were developed and tested in collaboration with aboriginal mental health workers in three remote communities in northern Australia.
Participants: A total of 49 patients with mental illness and 37 carers were recruited to a randomised controlled trial that compared MCP (n = 24) with a clinical control condition (treatment as usual, n = 25).
Intervention: The early treatment group received MCP at baseline and the late treatment group received delayed treatment at six months.
Main outcome measures: The primary outcome was mental health problem severity as measured by the health of the nation outcome scales. Secondary measures of well-being (Kessler 10), life skills, self-management and substance dependence were chosen. Outcome assessments were performed at baseline, six-month, 12-month and 18-month follow up.
Results: Random effects regression analyses showed significant advantage for the treatment condition in terms of well-being with changes in health of the nation outcome scales (P < 0.001) and Kessler 10 (P = 0.001), which were sustained over time. There was also significant advantage for treatment for alcohol dependence (P = 0.05), with response also evident in cannabis dependence (P = 0.064) and with changes in substance dependence sustained over time.
Conclusions: These results suggest that MCP is an effective treatment for Indigenous people with mental illness and provide insight into the experience of mental illness in remote communities. [ABSTRACT FROM AUTHOR]

3. Do rural hospitals lag behind urban hospitals in addressing community health needs? An analysis of recent trends in US community hospitals
By Zhang, Wanqing et al. Australian Journal of Rural Health, Aug 2009, Vol. 17 Issue 4: p183-188
This study examined whether rural and urban hospitals differ in their level of responsiveness to community health needs. Design: This study used a multivariate, longitudinal research design.
Research setting: A cross-sectional survey was the setting for this study.
Participants: The participants were rural or urban hospitals in the United States.
Main outcome measures: The dependent variables were selected from the American Hospital Association hospital survey questions that are related to community health needs. The independent variable was rural or urban location.
Results: Rural hospitals improved more than urban hospitals in
addressing community health needs from 1997 through 2006 for most of the indicators, especially in working with other providers to conduct a community health assessment. However, rural hospitals still lag significantly behind urban hospitals in tracking health information.
Conclusions: This study suggests that rural hospitals do not lag behind urban hospitals in addressing community health needs. Further research is needed to understand the role of community hospitals in influencing local health delivery system activities regarding the potential community benefits and their impact on improving health of local populations. [ABSTRACT FROM AUTHOR]

4. At work or play: A comparison of private property vehicle crashes with those occurring on public roads in north Queensland
By Blackman, Ross et al. Australian Journal of Rural Health, Aug 2009, Vol. 17 Issue 4: p189-194
To define characteristics of vehicle crashes occurring on rural private property in north Queensland with an exploration of associated risk factors.
Design: Descriptive analysis of private property crash data collected by the Rural and Remote Road Safety Study. Setting: Rural and remote north Queensland.
Participants: A total of 305 vehicle controllers aged 16 years or over hospitalised at Atherton, Cairns, Mount Isa or Townsville for at least 24 hours as a result of a vehicle crash.
Main outcome measure: A structured questionnaire completed by participants covering crash details, lifestyle and demographic characteristics, driving history, medical history, alcohol and drug use and attitudes to road use.
Results: Overall, 27.9% of interviewees crashed on private property, with the highest proportion of private road crashes occurring in the North West Statistical Division (45%). Risk factors shown to be associated with private property crashes included male sex, riding off-road motorcycle or all-terrain vehicle, first-time driving at that site, lack of licence for vehicle type, recreational use and not wearing a helmet or seatbelt.
Conclusions: Considerable trauma results from vehicle crashes on rural private property. These crashes are not included in most crash data sets, which are limited to public road crashes. Legislation and regulations applicable to private property vehicle use are largely focused on workplace health and safety, yet work-related crashes represent a minority of private property crashes in north Queensland. [ABSTRACT FROM AUTHOR]

5. Asthma management in rural New South Wales: Perceptions of health care professionals and people with asthma
By Cvetkovski, Biljana et al. Australian Journal of Rural Health, Aug 2009, Vol. 17 Issue 4: p195-200
To investigate the perceptions and attitudes towards asthma management of general practitioners, pharmacists and people with asthma in a rural area.
Design: Qualitative semistructured interviews.
Setting: Small rural centre in New South Wales.
Participants: General practitioners, pharmacists and people with
asthma in a rural area.
Results: General practitioners perceived that the patient provided a barrier to the implementation of optimal asthma services. They were aware that other health care professionals had a role in asthma management but were not aware of the details, particularly in relation to that of the pharmacist and would like to improve communication methods. Pharmacists also perceived the patient to be a barrier to the delivery of optimal asthma management services and would like to improve communication with the general practitioner. The impact of the rural environment for the health care professionals included workforce shortages, availability of support services and access to continuing education. People with asthma were satisfied with their asthma management and the service provided by the health care professionals and described the involvement of family members and ambulance officers in their overall asthma management. The rural environment was an issue with regards to distance to the hospital during an emergency.
Conclusions: General practitioners and pharmacists confirmed their existing roles in asthma management while expressing a desire to improve communication between the two professions to help overcome barriers and optimise the asthma service delivered to the patient. The patient described minimal barriers to optimising asthma management, which might suggest that they might not have great expectations of asthma care. [ABSTRACT FROM AUTHOR]

6. Regional differences among employed nurses: A Queensland study
By Henwood, Tim et al. Australian Journal of Rural Health, Aug 2009, Vol. 17 Issue 4: p201-207
To ascertain differences in the working lives of geographically dispersed nurses.
Design: Cross-sectional.
Setting: Registered, enrolled and assistants-in-nursing members of the Queensland Nurses' Union employed in nursing in Queensland, Australia.
Participants: A total of 3000 members of the Union, equally stratified by sector (public, private, aged care). Among them, 1192 responded and 1039 supplied postcodes matching the Australian Standard Geographical Classification.
Main outcome measures: Statistically significant differences in working lives of nurses employed in different geographical locations.
Results: Nurses in outer regional/remote/very remote localities are more likely to be employed as permanent full-time staff and self-report higher levels of work stress. These levels could be explained by: lack of replacement staff for leave, longer working and on call hours and lack of support for new staff. Distance remains a major barrier to accessing continuing professional education. However, outer regional/remote/very remote nurses were more likely to be provided employer support for professional education. Inner regional nurses were more likely to work part time, would work more hours if offered and were more likely to have taken a break from nursing as a result of family commitments.
Conclusion: The data confirm that current policies are not
addressing the differences in the working lives of geographically dispersed nurses. Policies addressing orientation, mentoring and workloads should be implemented to address these issues. [ABSTRACT FROM AUTHOR]

7. What stresses remote area nurses? Current knowledge and future action
By Lenthall, Sue et al. Australian Journal of Rural Health, Aug2009, Vol. 17 Issue 4: p208-213
Review and synthesise the literature identifying the stresses experienced by remote area nurses (RANs) Identify interventions implemented to address identified stresses. Explore the use of the job demands–resources (JD-R) model. Methods: A comprehensive literature review was conducted using the meta-databases Ovid and Informit.
Setting: Remote Australian primary health care centres.
Results: The reported demands experienced by RANs can be grouped into four themes: (i) the remote context; (ii) workload and extended scope of practice; (iii) poor management; and (iv) violence in the workplace and community. In this high-demand, low-resource context, the JD-R model of occupational stress is particularly pertinent to examining occupational stress among RANs. The demands on RANs, such as the isolated geographical context, are immutable. However, there are key areas where resources can be enhanced to better meet the high level of need. These are: (i) adequate and appropriate education, training and orientation; (ii) appropriate funding of remote health services; and (iii) improved management practices and systems.
Conclusion: There is a lack of empirical evidence relating to stresses experienced by RANs. The literature identifies some of the stresses experienced by RANs as unique to the remote context, while some are related to high demands coupled with a deficit of appropriate resources. Use of models, such as the JD-R model of occupational stress, might assist in identifying key areas where resources can be enhanced to better meet the high level of need and reduce RANs' levels of stress. [ABSTRACT FROM AUTHOR]

8. Water conservation in surgery: A comparison of two surgical scrub techniques demonstrating the amount of water saved using a ‘taps on/taps off’ technique
By Petterwood, Joshua & Shridhar, Vivek. Australian Journal of Rural Health, Aug2009, Vol. 17 Issue 4: p214-217
Australia finds itself in the grip of its worst drought on record. The surgical profession has a responsibility to conserve water where possible. We tried to show how much water we saved through the simple measure of turning taps off while not in use during the surgical scrub.
Design: We conducted a prospective analysis of two different scrub techniques at the Gold Coast Hospital in Queensland, Australia. Ten participants completed two 5-min scrubs using standard ‘elbow on’ taps. In the first, they left the taps running throughout the scrub; in the second, they turned the taps on and off so that water ran only when rinsing the hands. Water was collected and the amount of time the hands spent under running water was recorded.
Main outcome measure: Amount of water used during the surgical scrub.
Results: A mean of 15.5 L was used during the ‘taps on’ scrub, with participants spending a mean of 47 s rinsing the hands. During the ‘taps on/off’ scrub, participants used a mean of 4.5 L, spending 40 s rinsing the hands. This represents a water saving of 11 L or 71% for each scrub (P < 0.001). There was a difference of 7 s in time rinsing the hands (P = 0.16).
Conclusion: A taps on/off technique is a simple and effective way of conserving large amounts of water during the surgical scrub. The technique should be adopted as standard practice. [ABSTRACT FROM AUTHOR]

9.Community-driven intervention to reduce injury rates in school-age snowboarders
By Slaney, Graham M.& Weinstein, Philip. Australian Journal of Rural Health, Aug 2009, Vol. 17 Issue 4:p218-219
The article discusses a study of injury rates of children involved in snowboarding accidents in Mansfield, Victoria. It looks at various policies used by schools in regard to the use of protective equipment by children in snow sports programs. It suggests that the use of wrist guards could reduce the number of wrist fractures.

10. Identifying and addressing barriers to the use of enhanced primary care plans for chronic disease in rural practices.
By Pierce, David. Australian Journal of Rural Health, Aug 2009, Vol. 17 Issue 4:p220-221
The article discusses the use of enhanced primary care (EPC) plans for chronic disease in rural Australia. Participants, methods and results are outlined. Elements that could limit the use of EPC plans in rural general practice are identified. The study stressed the major role of practice nurses in providing EPC plans.

Journals Table of Contents

11. From Australian Journal of Advanced Nursing, Volume 27, Number 1, September - November 2009
Australian practice nurse immunisation scholarships: an evaluation study.
This paper reports on an evaluation of an Australian Government program to improve immunisation services in primary care settings through the provision of scholarships to support access to education for Practice Nurses (PNs).
11B. Cardiac arrest resuscitation policy and practice: a survey of Western Australian hospitals.
To determine if cardiopulmonary resuscitation (CPR) policy and practice in Western Australian (WA) hospitals changed since the release of an operational directive from the WA Department of Health.
11C. Effectiveness of an advanced practice emergency nurse role in a minor injuries unit.
To evaluate the effect of an emergency department discharge initiative (EDDI) nurse on discharge processes and patient transition outcomes.
11D. Developing the Nurse Practitioner role in a rural Australian hospital - a Delphi study of practice opportunities, barriers and enablers.
To gain a consensus view of potential roles for Nurse Practitioners (NPs) in a rural Australian hospital and identify the barriers and enablers in their development and implementation.
11E. The breast or bottle? Women’s infant feedings choices in a subsequent birth after a previous Caesarean Section. 
The objective of the study was to explore, from mothers’ perspectives, the experiences and decision-making associated with a subsequent birth following a Caesarean Section (CS) of which feeding their newborns was a specific focus. This article presents the sub-set of findings on infant feeding choices.
11F. Farewell to the handmaiden? Profile of nurses in Australian general practice in 2007.
To describe the characteristics of nurses working in Australian general practice, including their backgrounds, working environments, tasks and duties..
11G. Surveying general practice nurses’ communication preferences in Tasmania.
11H. Barriers to the reporting of medication administration errors among nursing students.
The main aim of this study was to describe the perceived barriers to medication administration error (MAE) reporting among nursing students.
11I. Pursuing the golden mean - moral decision making for precarious newborns.
To demonstrate a need, and develop a process, for moral decision making regarding precarious newborns.
11J. The psychosocial needs of families during critical illness: comparison of nurses’ and family members’ perspectives.
To explore the needs of relatives whose family member is unexpectedly admitted to an Intensive Care Unit and compare ranked need statements between family members and nurses.
11K. Supporting the evolution of a research culture among nurses in Malaysia
This paper describes a project to promote a research culture amongst nurses in Malaysia. The project, funded by the Australian Government’s Australia Malaysia Institute, and implemented by a group of Australian nurse academics, provided a rare professional development opportunity to nurses in urban and remote areas of Malaysia
11L. Fear of falling
The purpose of the paper is to describe the ‘fear of falling’ phenomenon; to raise clinicians awareness; to consider the associated risk factors.

12. From Journal of Infection Prevention, September 2010
12A. Moving forward with confidence [The Editorial in this issue presents the perspectives of the outgoing and incoming Presidents of the Infection Prevention Society (IPS) on the theme of this year’s conference.]
12B. Moving forward with confidence: 2009 IPS insight survey of the membership
12C. Climate change and communicable disease: what are the risks?
12D. The increasing role of DNA molecular technologies in infection control-related medical bacteriology: what the infection prevention specialist needs to know
12E. The prevalence of meticillin-resistant Staphylococcus aureus in long-term care facilities: is there a need for tailored glycopeptide prophylaxis?
12F. Independent health care: using a board-to-ward approach to achieve improvement in infection prevention standards
12G. Supporting infection prevention in Romania: working together with Spitalul Judeţean de Urgenţă Zalău
12H. Syringe and needle safety?
12I. Occupational transmission of bloodborne diseases to healthcare workers in developing countries: meeting the Challenge

Conferences, Seminars, Courses

13. 17th International Conference of the Nursing Network on Violence against women
Stopping Violence: Innovations & Partnerships for Sustainable Change
Date: 16-18 February 2011
Venue: Heritage Hotel, Auckland
More information:

14. NZIHM and ACHSM International Health Management Conference
World Class Health Management - Kicking for Goal
24 - 26 August 2011
Venue: Energy Events Centre, Rotorua |

15. Rule of Law Conference
LexisNexis in cooperation with the American Bar Association
Section of International Law, The World Justice Project and the
NZLS Rule of Law Committee.

Date: 18-19 November 2010  
Venue: Holiday Inn, Wellington

Latest News from the Ministry of Health

16. Christchurch Earthquake - Coping with stress
These factsheets will help you, your family and community to:
- Understand common emotional reactions to the earthquake
- Learn positive ways of coping
- Identify when to get extra help that will enable you to cope better.
- There are also factsheets for emergency response workers, health staff and volunteers.

17. Pandemic Influenza H1N1 2009 (swine flu) - Update 207
Media Release - 9 September 2010

18. Alcohol and Pregnancy: A practical guide for health professionals
Date of publication (online): September 2010

Latest News from the Department of Labour

As the clean up continues and more businesses look to return to operation following Saturday’s earthquake in Canterbury, there is a range of health and safety and employment relations issues that employers and employees may be considering.

20. Safety and Wellbeing Check List for Returning to Work
Canterbury Earthquake Department of Labour Advice

News - National

21. Canterbury earthquake: Current priority areas
13 September 2010 2:45pm

22. Junior doctors set date for strike
Dominion Post 14 September 2010
Junior doctors are preparing to strike as contract talks hit a wall. The Dominion Post understands they will strike on October 1 – a move that is likely to cause major disruption in public hospitals around the country.  The Resident Doctors' Association, which represents the country's 2000 junior doctors, would not comment on whether strike action was planned.

23. Late-September meeting to replace Hodgson
ODT - 11 September 2010
The Labour Party will have a new Dunedin North electorate candidate to replace Pete Hodgson by the end of the month. Party general secretary Chris Flatt yesterday said party members would pick their candidate at a meeting on September 25. They will choose from New Zealand Nurses Organisation national industrial adviser Glenda Alexander, Selwyn College head Dr David Clark and former Otago University Students Association president Simon Wilson.

24. Southland Times - 14 Sept, 2010
High demand has reduced the quality of party drugs, putting recreational at greater risk, the Alcohol Drug Association says. Alcohol Drug Association service manager Mel Johns, of Christchurch, said yesterday other chemicals quickly filled the gaps when authorities clamped down on new party drugs. The latest New Zealand Customs Service figures reveal two Queenstown-bound shipments of the party drug mephedrone were intercepted at the International Mail Centre in Auckland. Forty grams of suspected mephedrone were found in two 20g packages
sent from Ireland to Auckland in April.

News - International

25. Aspirin can be a life saver: study 
Sydney Morning Herald - September 14, 2010
Australian researchers have weighed into the aspirin debate, with a study showing the humble painkiller can save lives and significantly reduce rates of stroke and heart attack. Dr Meg Jardine from the George Institute for Global Health said there has been "uncertainty" over whether the analgesic, which has blood-thinning properties, should be used more broadly to combat cardiovascular disease.

26. Cyber bullying reaches epidemic level 
Sydney Morning Herald - September 13, 2010
Cyber bullying is reaching epidemic levels, says a Melbourne youth worker, amid new claims about young girls being pressured to provide pornographic images of themselves. Police are investigating a case at St Joseph's College boys school in Geelong, in which it is believed a computer hacker stole an older student's Facebook identity and then pressured a grade five pupil to provide pornographic images of himself to a Facebook "friend".

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