December 13, 2024

nurses and midwives in victoria

Victorian response to COVID-19 an international envy

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Victoria dealt with its second wave of COVID-19 extremely well by international standards.

Only Vietnam and Hong Kong did as well as Victoria in defeating a second coronavirus wave.

Of the 215 nations and territories that have reported COVID-19 cases, 120 have experienced clear second waves or late first waves that began in July or later according to data from national ministries of health and the World Health Organization.

Of these 120, only six have definitively emerged from their second wave: Australia, South Korea, Japan, Hong Kong, Vietnam and Singapore.

In other parts of the world the severity of the second COVID wave has been grim. By late October, the worldwide tally of cumulative cases was adding one million new cases every three or four days. Just seven countries reported fewer than 50 new cases: Australia, China, Nigeria, Singapore, Ivory Coast, Zambia and Senegal.

At the same time, France and the United Kingdom each reported more than 26,000 new cases, and 20 European countries posted all-time daily record numbers.

Some European countries have reported daily case numbers 25 to 30 times higher than during their first wave.

Stephen Duckett, Director of the Health Program at the Grattan Institute says Victoria’s achievement in getting down to zero or near-zero community transmissions is unprecedented.

“No other place in the world has tamed a second wave this large. Few have even come close.”

Catching a break with “The Nurse Break”  

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The Lamp Online caught up with Jackson Heilberg from The Nurse Break. 

The Lamp: Thanks so much for catching up with us from not-so-sunny Melbourne! 

You started The Nurse Break midway through last year, and I must say, you’ve done a stellar job with it. Can you tell us a bit about the blog, and what you wanted to achieve with it? 

Jackson: Firstly, thank you for the kind words and opportunity to speak with The Lamp. The Nurse Break was born out of frustration during my nursing studies and graduate year as a Registered Nurse. Frustration with the fact that some healthcare professionals and the public didn’t fully realise the capacity, complexity and variety of the role of a nurse.  

The blog was also created out of a desire to capture the amazing stories and careers from nurses I was meeting early on in my studies and graduate year. Larelle is a trauma nurse at The Alfred Hospital and has been so for 20+ years. As an undergraduate student under her wing, and then as a colleague with her during my graduate year on the Trauma Ward, she oozed a passion unmatched by many for both education and nursing alike. I wanted to capture her experiences or those like her, because after 20 years of nursing – what amazing knowledge, wisdom and experiences they must have to share! 

So it was born, The Nurse Break. The goal is to have content from amazing Australian nurses and other healthcare professionals from all clinical backgrounds, specialties and levels of experience that inspires and educates about the role of nursing.  

Who has been the most interesting person you’ve interviewed? 

J: This is a difficult question because I have interviewed such a variety of health professionals from all walks of life, specialities and experiences. I have found that the Australian nursing community has really enjoyed hearing from nurses working in areas that are less talked about and with little content online about them. 

To remain diplomatic, I must say I do not have a favourite interview. However, if I had to choose a couple that I know people will really enjoy, these include the LIVE Q&A interview with Melanie Davies who is a Palliative Care Clinical Nurse Consultant. She gave an amazing insight into the role of a palliative care nurse and provided a down to earth reasoning as to why palliative care is “everyone’s business”.  

The written interview with the CEO of the Royal Flying Doctors Service (QLD) Meredith Staib gave amazing insights into leadership and management roles that nurses can hold. While the written Q&A by Jo Scott who is a Neonatal Intensive Care Nurse Practitioner & Paediatric Infant Perinatal Retrieval Nurse gave amazing in-depth insights into the clinically advanced roles that nurses can have. 

You’ve had an incredibly varied career, despite having been in the profession for one and a half years. What is it that drew you to nursing as a career? 

J: I have been a Registered Nurse since July 2019 after completing the post-graduate entry to nursing degree. I also applied for and became a Nursing Officer in the Australian Defence Force, through the Undergraduate Civil Schooling Student (LTS program) during my final years of study. My graduate year was at The Alfred Hospital in Melbourne in both the Trauma Ward and General Medical Ward. I now work as an Emergency Nurse (Adults & Paediatrics) in one of Melbourne’s busiest Emergency Departments. 

When thinking about what I wanted to do for a career, there were a few ‘requirements’ that I wanted. It must allow me to help people, allow me to travel and allow me to have endless career variety. 

I was drawn to nursing through my time as a Volunteer First Responder with St John Ambulance Victoria. It was here that I was working within a limited scope of practice as a First Responder Medic, alongside RN’s, Critical Care RN’s, Doctors and Paramedics at major high-risk events and music festivals. The nurses played such a central role to the patients care especially critically ill patients and had such a broad skill set. This, alongside the knowledge that nursing would allow me to travel Australia and the world was the reason’s I decided to become a Registered Nurse. 

What has been your most memorable experience so far? 

J: I’ve had several memorable experiences through my time as a nurse. My time learning to nurse multi-trauma patients and acute and chronically ill patients in general medicine at The Alfred Hospital was a very rewarding experience. However, I have always wanted to work in the Emergency Department, so my current position has been a very memorable time indeed – especially starting as a new member of the team in the middle of the COVID-19 pandemic. This required my orientation and much of my training to be held online. All my colleagues already were wearing masks and face shields, so I relied on people writing their names on their face shields to recognise my new colleagues! Every day I am seeing new faces in the tearoom I have never met before! Nonetheless, it has been a crazy year 2020 and one I will never forget. 

Speaking of COVID-19, how has it been on the frontlines of the pandemic in Melbourne? 

J: I was at The Alfred Hospital in the general medical ward when COVID-19 kicked off. The hospital was having outbreaks, hundreds of staff were being furloughed and acutely unwell outliers from trauma, through to thrombolised stroke patients were coming to our ward. We were managing not just very sick general medical patients but also multiple new outliers from speciality areas. We managed well and had lots of support; The Alfred Hospital did a stellar job at managing the rapidly evolving situation.  

Then, during the peak of COVID-19’s first wave, I moved to my current hospital into the emergency department. It’s been a busy time of uncertainty and anxiety for many, dripping sweat and dehydration in the gowns and masks, hundreds of emails and rapidly changing protocols. It has shone a light on how adaptable and solid the Australian healthcare system is.  

One of your focuses on The Nurse Break is assisting early-career nurses with securing and maintaining a job. What is your advice for new nurses entering the field as graduates? 

J: My advice for new nurses would be: 

  • You are not meant to know heaps about the clinical area you are rotating into. So, don’t stress too much about spending hours and hours reading up on the clinical area. You will learn most when you are there;
  • Don’t take shortcuts when time poor and don’t become complacent and comfortable. That’s when your practice become dangerous; 
  • Take time to learn from allied health about their roles, how they help our patients recover and how we can all work better together;   
  • You are now a health professional, not a student. The things you say to patients, their visitors and colleagues will represent how that person views the profession – so portray the nursing profession well!  
  • Never, ever say “I am just a nurse”. Correct others if they say that also!
  • Come across confident even if you are not to patients and visitors. However, if you don’t know the answer go find it. You need to do this to gain their trust but also never feel embarrassed to say you don’t know something; 
  • Look after your mental and physical wellbeing;
  • Work to live, not live to work; 
  • Join your union!

And on a totally different note: I know you’re a bit of a globetrotter! Where would you recommend our readers jet off to once borders open back up again? 

J: I do love travel and backpacking random places! My favourites include Cuba, Laos, Columbia, Nepal, Spain and Vietnam. If you are travelling for the first time then I suggest Cambodia, Thailand and Vietnam as a round trip, or Europe.  

And where would you like to head off to next? 

J: I would love to go to Tonga, Samoa or somewhere in this part of the world to go waterfall and isolated beach hunting! 

Thanks so much for the chat Jackson! Fingers crossed for the recovery in Melbourne, and all the best with The Nurse Break! 

J: Thank you so much! 

 You can check out Jackson’s blog, The Nurse Break, here.

 

Many more health workers than we ever thought are catching COVID-19 on the job

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The Victorian government released much-anticipated figures showing the proportion of the state’s health-care workers who caught COVID-19 at work.

Victoria’s chief medical officer Andrew Wilson said that 70-80% of health workers testing positive to COVID-19 were infected at work. That’s compared with 22% in the first wave.

That figure, which equates to at least 1,600 people infected in the workplace, is shocking and tragic. This is because occupational exposure of health-care workers to SARS-CoV-2, the virus that causes COVID-19, represents a failing of hazard control in many workplaces — across multiple locations, in hospital and in aged care.

We also need to acknowledge this problem is fundamentally an occupational health and safety issue rather than simply an infectious disease problem. This means experts in occupational health and safety need to be intrinsically involved in recommendations and guidance to government and employers.

What else did the report find?

The report found infection of health-care workers was greatest in areas where there were many patients with COVID-19 being cared for together (known as “cohorting”), and where health-care workers congregated, such as tea rooms.

Other contributing factors were the increased risk associated with putting on and taking off (donning and doffing) personal protective equipment (PPE), staff moving between health-care facilities, and poor ventilation systems with inadequate air flow.

The report tells us health-care workers in aged care accounted for around two in five infections, and hospital workers around one-third.

However, further details were not provided. These include the actual number of health-care workers infected at work, and a detailed breakdown of the category of health-care worker infected, as well as their age ranges and gender.

We also don’t know the severity of health-care worker infections (number of people who are or have been hospitalised, in ICU, or died).

How big a problem is this?

The number of health-care workers infected with COVID-19 in Victoria has reached 2,799. That makes a seven-day average of 43 new cases each day.

This means that while the state’s total number of new cases continues to decline, health-care worker infections make up around 30% of new cases each day.

Controlling the number of new health-care worker infections is essential, not only for health-care workers but for the sustainability of our health-care system, and to reduce the overall number of cases.

As the total number of health-care worker infections has risen, key groups representing doctors and nurses have called on the government to produce data on the number of health-care workers infected at work and a breakdown of the data by health-care worker type, age, location and severity.

Yesterday the government released its keenly awaited analysis.

What should we do about it?

In light of the report, the Victorian government has established a new health-care worker infection prevention and well-being taskforce.

This is an important step forward and hopefully includes representation from all expert groups, especially occupation health and safety exerts.

Data from earlier in the year, and indeed prior experiences with SARS (severe acute respiratory syndrome), have already given us a blueprint for how to protect health-care workers today.

The blueprint includes implementing a system of hazard control measures (called a hierarchy of control model) in all health-care settings using experts in the field of occupational health and safety, including occupation hygienists.

The government report also outlines plans to develop ventilated and heated marquee-type tents for workers to have their tea breaks in, which is also good news. This recognises the contribution poor air flow makes to the transmission of SARS-CoV-2.

The planned introduction of PPE “spotters” in workplaces is also positive but further details are needed to understand exactly what they will do.

This will hopefully reduce staffing pressure in the workplace and ensure correct donning and doffing of PPE.

What about ‘fit testing’ respirators?

The report also included the surprising announcement that the government was going to undertake a fit-testing trial of respirators.

Testing that respirators, such as N95 face masks, fit and that staff are trained to use them are essential parts of workplace safety, in any industry. It is required as part of Australian standard AS 1715.

So, there is no need to trial fit testing. This is clear from experience in other industries where workers are exposed to hazards such as asbestos or dangerous laboratory fumes.

What is needed is immediate implementation of fit testing and training so health-care workers can be assured their masks fit correctly and do not allow the virus in. This is especially important for females, with many reporting the standard respirator size does not fit properly.

The government needs to do more

The government’s report acknowledged the likelihood of aerosol spread as a mechanism for the transmission of SARS-COV-2. So it has engaged the Victorian Health and Human Services Building Authority to conduct a study aimed at investigating aerosols and their spread on surfaces.

We do not have to wait for the results of this research. The government can act now and take the next step and immediately change its guidelines for PPE for health-care workers.

The Victorian PPE guideline for health-care workers still does not recommend universal PPE designed to protect health workers from aerosols when caring for COVID-19 suspected or positive patients.

The guidelines instead recommend PPE to protect against droplet transmission (such as surgical masks), even in the situation where a person with COVID-19 is severely coughing.

Disappointingly, national guidance still remain unchanged regarding its advice for health-care workers caring for COVID-19 suspected or positive patients. It too does not recommend universal aerosol precaution PPE (including respirators) when health-care workers care for patients with COVID-19.

These guidelines need to be urgently updated to protect health-care workers.

There is also an urgent need for a comprehensive, publicly accessible state and national registry of health-care worker infections that provides regularly updated disaggregated data about health-care worker infections.

This is essential so the magnitude of the problem can continue to be addressed and immediate preventative strategies put in place.

Finally, now the problem of occupational exposure of health-care workers to SARS-CoV-2 has been acknowledged, we must make all these changes immediately.

Alicia Dennis, Associate Professor MBBS, PhD, MPH, PGDipEcho, FANZCA, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

We can’t ignore mental illness prevention in a COVID-19 world

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Despite the incremental easing of restrictions, it’s clear the journey towards COVID-normal is far slower than many people had hoped.

Australians  have shown remarkable resilience, but many are suffering emotionally.

The mental health impacts of COVID-19

During the early days of the pandemic, surveys showed a sharp increase in symptoms of anxiety and depression across Australia. These difficulties continued into mid-August. More than 40% of Australians aged 18 years and older feel high levels of anxiety, and around one in six report depressive symptoms.

To target this, federal and state governments have increased telephone, online and face-to-face mental health supports. While this is vital, more needs to be done to prevent people suffering severe mental health problems in the first place.

Prevention is better than cure

There’s good evidence we can prevent many cases of depression, anxiety and substance abuse. But Australia doesn’t have a mental health prevention plan or policy, and government funding for prevention is just 1% of the total mental health budget.

The Fifth National Mental Health and Suicide Prevention Plan, the government’s key mental health blueprint, focuses on improving mental health-care services and suicide prevention, but not on preventing the mental health conditions that are a major risk factor for suicide.

What about illness prevention?

Last month the federal government released a consultation paper on its proposed National Preventive Health Strategy, setting out what the strategy will aim to achieve and how it might be done.

The document’s exciting because it focuses on health promotion and illness prevention, acknowledging we can’t improve the health of the Australian community through health-care measures alone.

But unfortunately, the proposed strategy’s fundamentally focused on physical health issues. In its 20 pages, the consultation paper only mentions mental health three times.

The same principles outlined in the strategy to prevent conditions such as diabetes also apply to preventing mental health conditions such as depression. To prevent either, we need to minimise risk factors and increase protective factors linked to the condition, before it occurs. But some adaptation would be needed for the plan to address both physical and mental health.

What prevention measures should be added?

A focus on physical activity, healthy eating, and non-smoking will help to promote good mental health as well as physical health.

To prevent mental health issues we should focus on building people’s health literacy and self-care skills through public information campaigns and online learning programs. Supportive social environments can be encouraged by parenting programs, and school and workplace mental health promotion initiatives.

Local communities could also be mobilised to take positive action on local issues that contribute to poor health and mental health through place-based strategies. Place-based strategies aim to tackle issues existing at a neighbourhood level, such as social isolation and poor housing.

Services could be reoriented towards prevention. Primary care professionals might provide advice on self-care and use social prescribing to address stress and enhance social supports. Social prescribing involves medical professionals linking patients to non-medical supports. For example, they may provide an “exercise prescription” or “art prescription”.

Finally, appropriate public policy solutions, such as JobSeeker and JobKeeper, that tackle the social and economic determinants of ill-health are needed.

Social factors matter too

Research also points to a strong link between mental health conditions and experience of childhood adversity, family violence, loneliness, racism, homophobia and transphobia. Workplace stressors, financial stress, unemployment and homelessness are also risk factors.

Many of these issues are on the increase because of COVID-19, so to safeguard mental health we need to tackle them and their impact. This will require the use of evidence-based preventive programs outlined above – many of which already exist but are not being implemented well or to sufficient scale. It will also require public policies to soften the economic blow and ease financial stress.

Targeting these issues will not only help to prevent mental health conditions, but physical health conditions as well.

While better access to mental health-care services is important, it can’t solve all the mental health challenges posed by COVID-19. We also need to strengthen the factors that buffer people against stress, and tackle the underlying factors that contribute to poor mental health.

Whether we create a National Preventive Mental Health Plan, or embed mental health in the current National Preventive Health Strategy, one thing’s for sure: continuing to ignore the prevention of mental health conditions is not an option in a COVID-19 world.The Conversation

Stephen Carbone, Honorary, School for Population and Global Health, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

“We have to beat it together”: A heartfelt plea from a Victorian nurse for COVID cooperation

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Dan Collins, a registered nurse from Victoria, has posted a heartfelt plea for greater community cooperation with COVID-19 containment efforts after having been diagnosed with the virus.

Speaking from hotel quarantine six days after testing positive from COVID-19, Dan describes his experience in an attempt to help “beat the virus quickly”.

In the video, he describes having lost his sense of taste and feeling like he had “just had a short jog” after getting out of the shower.

“Currently, I’m just watching if I get a fever, or that it doesn’t get too hard to breathe”, Dan says.

“I’m lucky that I’m young and that I can bounce back”.

Dan says that he had worked in hospital, aged care, community swabbing, door-to-door testing, and in the Flemington and North Melbourne quarantines through the pandemic.

“Every day, there was this air of nervousness among my colleagues,” he mentions regarding his time working on the frontlines.

“I’d be lying if I said there wasn’t a bit of fear and trepidation right now”.

His hope is that people will have a better understanding of the virus and effects, and comply with public health orders designed to stop the spread.

“It might suck that we have to stay inside or wear masks, but the end goal is that we  reduce the cases and that life can return to some semblance of normal”.

“We have to beat it together”.

Increasing number of Victorian COVID-19 outbreaks linked to healthcare sites

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Nearly 400 Victorian healthcare workers have caught the coronavirus since the beginning of the pandemic.

When Victoria reached a new height of 428 new COVID-19 cases on 17 July, Victoria’s Chief Health Officer Brett Sutton said positive cases among aged care and health care workers were driving some of the outbreaks.

Just three days earlier, an article in the Medical Journal of Australia reported that health worker infections represented six per cent of all infections to date.

In mid-July, Victoria’s Department of Health and Human Services announced that 388 Victorian healthcare workers had caught the virus since the pandemic began, and 150 of the cases were still active.

While the department said the “vast majority” of the workers testing positive had been infected outside their workplaces, increasing numbers of Victorian outbreaks have been linked to healthcare sites, including the Northern and Alfred public hospitals, the Brunswick Private Hospital, and the Royal Children’s Hospital. At the time of writing, 27 clusters had been linked to aged care homes in Victoria.

Lisa Fitzpatrick, the Victorian branch secretary of the Australian Nursing and Midwifery Federation, told The Lamp increased community transmission meant that Victorian nurses, midwives and carers are dealing with uncertainty.

However, she said, “It’s important to remember nurses and midwives are well educated in infection control and know how to protect themselves against the risks at work.

“The Victorian health depart-ment’s close-contact tracers are working on understanding the source of infection for each healthcare worker who has tested positive with COVID-19.”

Lisa said that while healthcare workers are contracting the virus in the community and at work, significant numbers are self-isolating and awaiting results of tests. In the meantime, she said Victoria is well prepared in the event a surge workforce is needed.

“There are more than 4000 nurses on the health department’s pandemic surge workforce register, and the federal government has funded critical care education for more than 20,000 nurses, plus refresher education for registered and enrolled nurses who were no longer in clinical practice.”

The importance of PPE

The surge in infections occurred as the Medical Journal of Australia published a paper by University of NSW infectious diseases expert Raina MacIntyre and co-authors, calling for all health workers treating COVID-19 patients to be provided with respirators.

They write that a “growing body of scientific evidence around transmission and prevention of SARS-CoV-2 infection” was challenging beliefs that droplet and airborne transmission were distinct modes of transmission.

“Newer studies show that droplets and aerosol particles exist in a continuum,” they write. “Even a single large droplet may reduce in diameter and become airborne during its trajectory, because of evaporation.”

They propose that “N95 respirators offer significantly better protection (96 per cent) than surgical masks (67 per cent) against SARS, MERS and SARS-CoV-2”.

The authors add: “Our health workers are a precious asset and warrant the highest protection – not simply for their occupational health and safety, but for a functional and resilient health system.”

In mid-July the federal health minister, Greg Hunt, announced five million masks from the national medical stockpile to support Victoria’s response.

Lisa Fitzpatrick says the “state health department has confirmed that delivery of masks and PPE from the national stockpiles to private aged care nurses, carers and other aged care workers will be coordinated through existing Victorian mechanisms once approved for release by the Commonwealth Government”.

“Ninety per cent of deliveries are occurring within 24 hours of being ordered.”

The crucial importance of PPE was highlighted by Victorian nurse Lisa Peters, who wrote about her experience testing residents of the Flemington and North Melbourne public housing towers for the ABC online.

Going into the towers, Lisa writes: “We were assembled in teams of two nurses and two police officers, and each of us had a trolley containing everything we needed.

“When each floor was completed, we went back downstairs to ‘doff’ — remove our PPE in a particular way so as not contaminate ourselves or others.

“Teams of paramedics were on hand to assist with every step. They possibly thought their job was insignificant, but it was just as important as ours.

“One little break in our PPE and we could become the next source of community transmission.”

Lisa wrote that with both her own safety and that of her immediate family weighing on her mind, “she had never felt so anxious about doffing in all my decades of nursing”.

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