Western Nurse Magazine March April 2020 by ANF WESTERN NURSE MAGAZINE

March â&#x20AC;&#x201C; April 2020

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200 years since Florence Nightingaleâ&#x20AC;&#x2122;s birth PAGE 12

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Secretary's Report

March – April 2020

State Secretary Mark Olson

FEATURED AND FAVOURITES

The past few months have been the strangest most of us have ever experienced.

Secretary’s Report

Dorothy’s Stories

We have completely changed our lives in such a short time – with nothing seemingly left untouched by the COVID-19 virus.

Mark’s Q & A

ANF Out ‘n’ About

12 Florence Nightingale – 200 years 14 Special ANF Fitness Feature 24 Pet Page 26 Recipe Corner 28 Businesses Say Thank You 30 Internet Watch CONTINUING PROFESSIONAL DEVELOPMENT: CLINICAL UPDATES 18 Endometriosis 20 The problem with opioids 22 Alteplase – A medication update 23 Staphylococcus aureus WIN! 31 Win ANF Gourmet Packs and DVDs!

Talk to us... It’s your magazine. We want your feedback and story ideas! Editor Mark Olson Phone 08 6218 9444 Freecall 1800 199 145 Email editorwesternnurse@anfiuwp.org.au Web anfiuwp.org.au

Australian Nursing Federation 260 Pier Street, Perth WA 6000

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Aside from the weirdness of the pandemic, I also often wonder what weird world our politicians are living in. This State Government has told us to stop travelling internationally, interstate and even between regions in WA. We’ve also been told to practise social distancing, to completely alter or halt our normal routines, and to generally try to protect ourselves. I agree, emphatically, with all that. Yet this same Government has asked our members to repeatedly risk their lives by caring for diagnosed COVID-19 patients and testing others suspected of having the disease without the appropriate personal protective equipment. The WA Health Department policy enforcing this madness indicates it’s an effort to save PPE for any future outbreak. But aren’t we at risk of bringing on such an outbreak by putting our frontline health staff at risk of infection because they do not have the right PPE, such as N95 masks? I have repeatedly told the WA Health Minister that this is an unacceptable situation and that I am gravely concerned about whether we have enough PPE to get through any such outbreak or likely "second wave". But I worry our State Government feels or wants to hope that the pandemic has passed for WA. That’s unrealistic. It’s a pandemic. It’s still out there in the world. That means West Australians are still at risk, and will remain so until we have a vaccine or possess, at the very least, a proven medicine or combination of medicines with which to treat this highly infectious and lethal illness. I know our politicians are human, that they are to a degree, just like all of us, flying by the seat of their pants when guessing and hoping about what will happen next. They are balancing the advice and projections from the many health experts around them and the available economic data, and are trying to save WA both health-wise and financially. I don’t doubt their intentions. But I question their optimism. I would rather that they be hopeful about, and prepare for, the best outcome, but also prepare for the worst. That way we will be as ready as we can be for a disease that seems to have taken the entire world by surprise. I am not going to let up about PPE. Our members still contact me daily about their concerns, so I will keep going until our members tell me they have enough PPE or the disease truly evaporates, whichever comes first.

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March – April 2020 western nurse |

50 Years Of Caring

Dorothy Dyall decided the double celebration of her five decades in nursing and the 200th anniversary of Florence Nightingale’s birth deserved a book on this tough but highly rewarding profession. Her anthology of 50 short stories describes exploits such as creating makeshift teddy bears for anxious patients and warding off a knife-wielding assailant. Dorothy Dyall’s mum and dad clearly weren’t thrilled when their daughter told them she wanted to be a nurse. “To them, nursing was one of the worst jobs, as I would have to take care of sick people,” she writes in the introduction to her amusing and sometimes touching tale of her half century in the profession. “They wanted me to take up a career as a teacher or office worker. (But) at age 16, while I was an inpatient in a hospital, I sneaked out for my nursing application interview.” She turned 17 on January 2, 1970, and started nursing training at Singapore General Hospital a month later. After working in Singapore, Papua New Guinea, the Northern Territory and Victoria, she arrived in Perth in 2005. Dorothy still works 32 hours a fortnight at Fremantle Hospital where she has been since 2007, because, as she says in her book: “As I venture into a season of semi-retirement, I am still a nurse and will always be one”.

western nurse March – April 2020

Dorothy enjoying the Victorian country area while working at Bunyip Hospital in 1979 as a triple-certificated nursing sister

We at western nurse wanted to share a couple of Dorothy’s real life stories during these strange times when providing real care is now in focus more than it has ever been in our lifetimes. Cat and Dog Bill lived alone at home. He had a cat and a dog that slept at the foot of his bed every night. He was admitted for an overnight stay in the Short Stay Surgical Unit, post-surgery. At midnight, Bill stated that he could not sleep because he did not have his pets looking at him and sleeping at the foot of the bed. I drew a picture of a dog and a cat. I stuck them separately at the foot of his bed and asked him to pretend that they were his pets. Bill was so happy. He had a good laugh, went to sleep, and did not stir until 0600 hrs. Hairless Teddy Bear Harry was being admitted for major abdominal surgery. Harry lived at home. Every night he slept with his soft toy teddy bear for company. He forgot to bring it to hospital with him. He told me that he missed his teddy bear very much. As it was already time for him to be collected by a pre-operation room nurse, I could not get his relatives to bring the bear in time. So, I improvised, and used a pair of disposable underpants and a towel to make a teddy bear. I presented it to Harry and said “Sorry! Harry this is a hairless teddy bear, made in China.”

Dorothy at her midwifery graduation, at the Royal Women's Hospital, Melbourne, in December 1978 with her father Kit Leng Wee and mother Kim Suan Huan (both front left)

Harry burst out laughing, then hugged the hairless teddy bear all the way to the operating theatre. The bear stayed with Harry throughout his hospital journey until he was discharged. A couple of years later, Harry’s daughter-in-law, who worked in the same hospital as me, told me that Harry slept with the hairless teddy bear every night until he passed away. His relatives even put the bear in the coffin with him.  The Diary of Nurse Dorothy is $5.00 a copy + $2.20 (postage in Australia) with all profits donated to the Harry Perkins Institute of Medical Research. Dorothy’s email address is caring4eastw@yahoo.com.au

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Mark’s

COVID-19: FREQUENTLY ASKED QUESTIONS The ANF is continuing to assist members with as many services as possible during the COVID-19 crisis. We know many of you have concerns about how the disease has changed your work environment. This edition of Q&A addresses some of the most common queries we have been receiving. As always, the information in this section is a general guide and answers can vary

My employer has not provided me with satisfactory personal protective equipment. What are my rights?

All employers have a duty to provide, as far as is practicable, a safe working environment. Employers who fail to do this breach Occupational Safety and Health laws which can expose them to penalties including fines and prosecution.

In the context of COVID-19, this includes gloves, medical masks, safety goggles, gowns, respirators (N95 of FFP2 standard) and fluid resistant aprons. If you believe your employer is failing to provide a safe system of work or is directing you to do something unsafe, and you have raised the issue through occupational safety and health processes without resolution, you are entitled to refuse to work – though you should seek ANF advice first.

western nurse March – April 2020

depending on factors such as your contractual conditions. For information specific to your circumstances, contact the ANF Helpline or email us your questions. If your employer is not doing something correctly, the ANF wants to know, so I can raise this with the employer directly and, if need be, politicians and the media.

Q: A:

Can my employer direct me not to wear a mask? No. This is not a lawful and reasonable direction. You are entitled to refuse this direction. Please contact the ANF if your employer has told you not to wear a mask.

The ANF has had discussions with the State Government and most major employers in relation to this issue, and they have been told that staff should not be directed not to wear a mask.

What can I do if I have an underlying medical condition and have received medical advice to avoid all possible exposure to COVID-19?

Your first step should be to approach your manager, preferably with a medical certificate or letter from your doctor, to explain the situation and request alternative working arrangements. If your request is refused, then

you can consider using available forms of leave (e.g. annual leave, long service leave, etc.) to cover any absence. The ANF has spoken to the major public and private employers and they have said where possible, they will accommodate such requests. If you are not satisfied with the answer you receive, please let the ANF know and we will follow this up.

I work in the public health system and want to know when can I use my COVID-19 Leave?

All WA public health system employees, including casual employees, are entitled to up to 20 days of COVID-19 Leave. You can use it:

However, if you are a part-time employee, or a full-time employee that has been stood down, and your current employer prohibits you from accepting any other work during this pandemic, we think this is unreasonable. There are several ways to challenge such a directive. Please contact the ANF to discuss your options. If you are already working two part time jobs, neither employer can make you give up either of the jobs.

I work in the Private Sector and have been told I am being “stood down”. Is this allowed?

The Fair Work Act states your employer may stand you down during a period in which you cannot usefully be employed because of a stoppage of work for which the employer cannot reasonably be held responsible.

If you have been diagnosed with COVID-19 and have no personal leave left. If you are not sick, but are required to self-isolate because of an Australian Government requirement. This includes exposure to a confirmed case of COVID-19. If you have no remaining personal leave and are caring for someone who has COVID-19 or is in self-isolation. If you have no personal leave left and your child’s school has closed or other care arrangements are unavailable because of COVID-19.

I work in the Private Sector. Is there any special leave available to me?

Yes. The Nurses Award and the Aged Care Award have been temporarily varied to provide the following:

Two weeks of unpaid pandemic leave. The ability to take twice as much annual leave at half your normal pay if your employer agrees.

But this does not mean that your employer can stand you down simply because their business is struggling due to COVID-19 or because they voluntarily choose to temporarily cease operations. However, if your employer’s business is no longer allowed to operate due to a Government directive, then they would be able to argue there has been a stoppage of work which permits them to stand you down. But the ANF believes employers are only able to this in very limited circumstances. Based on what we have seen during the COVID-19 pandemic, some employers have been abusing the stand down provisions of the Fair Work Act. So please contact us to get advice in relation to this issue.

I am a casual employee. Do I qualify for the JobKeeper payment?

Casual employees who have worked for their current employer for less than 12 months are not eligible to receive the JobKeeper payment. This payment is also not available to casual employees who work for private hospitals or in the public health system. The ANF has been, and is right now, working with public and private employers to address what we see as an inequitable situation.

The pandemic leave is available if you are prevented from working because of: A direction to self-isolate from government, medical authorities or a medical practitioner. Measures introduced by government or medical authorities responding to the pandemic such as an enforceable government direction restricting non-essential businesses. The ANF have applied to the Fair Work Commission to have Pandemic Leave as paid leave. This matter will be determined in coming weeks. For the time being, the above types of leave will be available from April 8 until June 30, 2020.

Q: A:

I have lost my job. How do I claim Centrelink benefits? If you have lost your job you will most likely be eligible to claim the JobSeeker Payment. The easiest way to do this is to log on to my.gov.au, which is the myGov website. You can then use your myGov account to make a Centrelink claim. If you do not have a myGov account, then you will first need to set one up, which can also be done at this website.

I am a part-time employee, and my employer says I am prohibited from working elsewhere during the COVID-19 pandemic. Are they allowed to do this?

You can also contact Centrelink for assistance by phone on 132 850. However, Centrelink has advised that this number currently still has long wait times, and as a result, are encouraging people to use their myGov account.

Your employment contract may state you are prohibited from accepting other employment without prior approval from your current employer. Such a provision is fairly common and is legal.

The information provided in this column is general advice only. If you want information specific to your circumstances you should contact the ANF Helpline or send us your questions by email. March – April 2020 western nurse |

ANF Out 'n' About Our members love taking their ANF products everywhere – including London! Susan Pettigrew is pictured in that wonderful world city with her ANF roll-up shopping bag at the Florence Nightingale Museum. We’ve published the photo just in time for the celebrations commemorating 200 years since the birth of the founder of modern nursing on May 12, 1820. We also have various ANF competition winners, including Akiko Evensen, who won the ANF Cooking Pack Competition plus a bonus Lantern Cookery Classics box set. Akiko has been nursing for more than 20 years, 10 of those in WA. She has been with Bentley Hospital for the last seven years. Akiko said she is going to enjoy reading the cookery books and will be cooking some of the dishes with her daughter. Denise Ricardo Tousa was one of our western nurse Jamie Oliver prize pack winners. Denise said she has been a nurse and ANF member for four years, and was working at Graylands Hospital before switching to Brightwater Redcliffe aged care. When we presented her with her ANF prizes, she said she was planning a “gourmet cookout” with her friends.

Akiko Evensen won the ANF Cooking Pack Competition plus a bonus Lantern Cookery Classics box set

Susan Pettigrew took her ANF roll-up shopping bag to the Florence Nightingale Museum in London

Our workplace photos in this edition were obviously taken preCOVID-19 at Albany, Augusta, Denmark, Geraldton Regional and Fiona Stanley hospitals. We also feature members at Bethel Residential Care and Gwen Hardie Lodge, both in Albany, and at Northam’s Juniper Bethavon Residential Care. We're looking forward to when we can start our workplace visits again, because we love meeting our members and giving out free ANF goodies. We'll let you know as soon as the visits can start again. See you soon! Albany Hospital Hayley Bolton, Jenny Bevan and Kristy Pilgrim

DAYCARE DAILY OR CASUAL WEEKEND AND OVERNIGHT CARE

0407 890 590

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western nurse March – April 2020

Denise Ricardo Tousa was one of our western nurse Jamie Oliver prize pack winners

Albany Hospital Jackie Beeley, Colleen Donovan and Sarah Griffin

Augusta Hospital Rhonda Kitson and Leisa Prangnell

FSH Gretchen Lindemann and Dr Alison McCluskey

Bethel Residential Care Albany Tatenda Mahachi

Denmark Hospital Barbara Lucas

To Australiaâ&#x20AC;&#x2122;s healthcare heroes, we say thank you

March â&#x20AC;&#x201C; April 2020 western nurse |

ANF Out 'n' About

Geraldton Regional Hospital Angela Baxby, Alana Horsham and Tegan Booysen

Geraldton Regional Hospital Doreen Colvin and Zoe Wright

Juniper Bethavon Northam Maria Seed and Nicolette Meyer

Juniper Bethavon Northam Tony Carter

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western nurse March â&#x20AC;&#x201C; April 2020

Gwen Hardie Lodge Albany Mathew Abu

Bethel Residential Care Albany Rosta Mulela FSH Dominique O'Flynn and Mala Eligon

Augusta Hospital Alison Abbey and Marisa Van Der Horn

Bethel Residential Care Albany Vanessa Joseph

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March – April 2020 western nurse |

2 0 0 TH A N N I V E R S A R Y O F T H E B I R T H O F F L O R E N C E N I G H T I N G A L E

The woman who modernised nursing Every year, nurses worldwide gather to celebrate International Nurses Day on May 12, which is Florence Nightingale’s birthday. In 2020, the date has extra significance – marking 200 years since the birth of Nightingale, who is often referred to as the ‘Mother of Modern Nursing’. Nightingale revolutionised treatment for wounded soldiers during her time in the Crimean War and later established the world’s first professional nursing school at London’s St Thomas’ Hospital. In this edition of western nurse, we look at the life behind the legend of the ‘Lady with the Lamp’.

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I N T E R N A T I O N A L N U R S E S D A Y M AY 1 2

Florence Nightingale was in her 34th year before she started to achieve real fame. It was in the midst of the brutal Crimean War that Nightingale attained recognition while saving lives at the barracks hospital at Scutari, now called Üsküdar, in Turkey, by “introducing proper discipline among the nurses and better sanitation”, according to King’s College London. That conflict, fought by the Russian Empire against the British, French and Ottoman empires, and the Kingdom of Sardinia, led to more than half a million deaths – many slain by disease rather than their enemies.

themselves could affect the health and recovery of patients, through to pioneering infection control measures and the championing of a healthy diet as a key factor for recovery”. She is also credited with inventing a type of pie-chart to show statistics visually which she called a coxcomb diagram – and she was the first woman to be elected to the Royal Statistical Society. Nightingale was born in 1820 to wealthy parents in Italy’s Florence, after which she was named.

"She is a ‘ministering

Nightingale had gone to the war in 1854 with 38 nurses and sisters, and it was there she earned her famous title “The Lady with the Lamp”. The UK National Archives cite an article in The Times newspaper on Thursday, February 8, 1855, describing her role among wounded soldiers afflicted with diseases such as typhus, cholera and dysentery: “She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor every poor fellow’s face softens with gratitude at the sight of her. When all the medical officers have retired for the night, and silence and darkness have settled down upon these miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.”

angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor every poor fellow’s face softens with gratitude at the

Nightingale’s nightmarish workplace is graphically described in this excerpt sourced from the UK National Army Museum, where Assistant Surgeon Henry Bellew, in January 1855, said of Scutari hospital: “All were swarming with vermin, huge lice crawling all about their persons and clothes. Many were grimed with mud, dirt, blood and gunpowder stains. Several were completely prostrated by fever and dysentery. The sight was a pitiable one and such as I had never before witnessed.” London’s Florence Nightingale Museum says her influence on modern nursing ranges from her ward designs, known as Nightingale Wards, after she realised that “hospital buildings

sight of her"

At the time she was growing up, paid nursing was seen as “a job for poor, often elderly women, and the popular image was one of drunkenness, bad language and a casual attitude to patients”, the Nightingale museum said. Despite resistance by her parents because of nursing’s poor status, she “persisted in her ambition, reading anything she could about health and hospitals. Eventually, she persuaded them to allow her to take three months’ nursing training at an inspirational hospital and school in Dusseldorf”. She later became superintendent of a hospital for gentlewomen in Harley Street, London, aged 33. Nightingale went on to establish the world’s first professional nursing school at St Thomas’ Hospital in 1860, with King’s College labelling that early institution the “direct ancestor” of King’s current Florence Nightingale School of Nursing & Midwifery.

“From the beginning, her aim was that Nightingale nurses should go on to found training schools in Britain and throughout the world,” King’s College said of the heroine nurse who died in her sleep in London in 1910, aged 90.  The World Health Assembly has designated 2020 the International Year of the Nurse and the Midwife. The WA Nursing and Midwifery Excellence Awards Gala Ball is normally held on a weekend near the dates of International Day of the Midwife on May 5 and International Nurses Day on May 12. This year’s ball has been postponed till Saturday, May 15, 2021, because of the COVID-19 situation. March – April 2020 western nurse |

SPECIAL ANF FITNESS FEATURE

Keeping in shape during COVID-19 and beyond Here at western nurse we’ve researched some of the best home training tips around – including from Arnold Schwarzenegger! Whether it’s for this period of self-isolation, future restrictions, or just because you and your family have discovered you enjoy the convenience of training without driving to the gym, read on and enjoy.

Self-isolation can be frustrating, but it’s also an opportunity to discover new ways to stay or get fit. Significant results are possible without any equipment, or with just a few items, such as a pair of dumbbells and an exercise bike. In this edition of western nurse, we run through three levels of training, lighter home and garden activity, short traditional exercise routines and also fitness at home with equipment.

USING WHAT’S AROUND TO STAY ACTIVE The Australian Heart Foundation reinforces the theme of keeping on the move to stay healthy and suggests you: Catch up on gardening Use an exercise bike or a swimming pool if you have these.

Try to put aside the same time each day and also the same amount of time – even if it’s just for a certain period, such as a period of shifts. If you can, also designate a place specifically for your exercise.

If you have any equipment such as an exercise bike and a pair of dumbbells, if possible keep them in that place for ease of access. That way, you’re not discouraged from training because you need to spend lots of time setting up.

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western nurse March – April 2020

Develop your own short exercise routine and do it several times a day, for a total of at least 30 minutes. Use YouTube to find a home workout that suits your needs. Declutter your house. Paint a room or restore a piece of furniture.

It’s important to get your health checked before setting out on any strenuous program. But lots can be achieved without putting yourself through torture and stop if you feel joint pain. Keeping moving and consistency over time are key to gains. Routine is an important factor for facilitating consistent exercise. So:

Don’t worry if you don’t have a lot of space. Dr Kianoush Missaghi, a training specialist at the German fitness app Freeletics, recently told GQ UK magazine, that as little as two-by-two metres will suffice for a home workout area.

Restore any rusty bikes around your home. Practise your golf-putting skills. Play indoor bowls, if you have room.

If you can access an activity tracker, watch your steps – aim for 10,000 a day. Perhaps introduce a ‘most steps/active minutes challenge’ with family or friends.

Sit less. Avoid sitting for long periods. Break it up by moving about the house and set timers or reminders so you get up and move. Walk around the house as you talk on your mobile phone.

Try standing for other activities where you normally sit, such as watching TV, or folding or washing clothes.

Children

1. Sit-ups

The Australian Heart Foundation says children aged five years to 17 need at least an hour a day of moderate physical activity and “more is better”. TV or movie sessions can be broken up with some fun activities with the kids. Examples include:

Do these on the floor or with a gym ball. Focus on keeping your back in a neutral position, contract your stomach muscles, lift your shoulders and curl your chest towards your knees. Then slowly lower to start position. Remember to breathe out and squeeze your abs on the way down.

Play catch or handball in your driveway or other outside areas.

2. Squats

Devise your own outdoor games.

Standing with feet slightly wider than shoulders, engage your stomach muscles, keep your back straight and lower your bottom as if you are going to sit on a chair. After that, come back up to standing. Breathe in on the down motion and out on the way up.

Use hula hoops, or practise juggling with the kids. Play your children’s favourite music and dance together.

3. Jumping jacks

Play backyard cricket. Play the Twister game or Wii Sports.

Have a family competition where you use a tennis ball to knock over plastic bottles filled with water. Climb trees or swing on monkey bars. Build a cubby house together using re-purposed materials from around the house and yard. Get kids helping with gardening or housework.

Stand with feet together and arms by your side, and jump in the air, split your legs and raise arms so you look like a star shape. Jump again to return to the first position. Repeat continuously, keep breathing. Keep knees slightly bent at all times. But watch your knees if you have joint issues.

4. Punches Stand with feet shoulder-width apart. Make a fist, bend your arms with elbows at your waist. Extend one arm in front of you at shoulder height. Return to starting position. Repeat with other arm. Breathe out on each punch.

5. High knees Jog on the spot and raise knees to waist height so your legs are pumping up and down. Keep stomach muscles engaged to help keep your balance. Remember to keep breathing. Again take care if you have joint issues.

TRADITIONAL EXERCISE The Australian guideline for adults is to build up over 150 minutes a week of moderate intensity physical activity, says the Australian Heart Foundation. That should be the equivalent of a brisk walk – “enough to make you puff a little, but still be able to conduct a conversation”. Muscle strengthening exercises are recommended for at least two days each week. For strengthening muscles and bones, the foundation recommends skipping, yoga jumping, push-ups, sit-ups, lifting weights, lunges and squats. You can do: Water bottle weights workouts. Fill a water bottle, milk carton or similar with water and use them as light weights in various movements. Resistance exercises. Do them against a wall or chair. Push-ups, sit-ups or half-squats. Do these during TV ad breaks. A simple program of yoga and exercises. Combine yoga, step-ups using a makeshift step, modified push-ups or sit-ups, lifting weights, lunges, calf raises and half squats. The British Heart foundation suggests the following heart-healthy workout. But if you haven’t done much exercise in a while, perhaps first ease into training by building in 10 minutes of activity each day. You can start with gentle activities such as walking, gardening or climbing stairs. The routine can be done with each movement executed for 30 seconds at a moderate intensity. Then you rest for 30 seconds, and repeat the same exercise. After that move to the next exercise. When exercises get easier, increase the number of times you repeat each, and/or increase the time spent doing it. Or, decrease time spent resting between exercises and/or add more exercises.

ARNOLD'S HOME EXERCISE PLAN Bodybuilding legend Arnold Schwarzenegger said on US website Reddit in March: “Even without a gym, we can also control our physical fitness during this pandemic. Body weight, or freehand training is the oldest method in the world … I started my own fitness journey with chinups on a tree branch by a lake in Austria.” The 72-year-old Hollywood star gave his fans his own home workout, stressing if an exercise says 50 reps (repetitions), you need to get that amount, “however you can”. That’s whether it’s “10 sets of five reps, five sets of 10 reps” or “two sets of 25 reps”. Once you complete those reps, move on to the next exercise. Arnold adds: "You can do it every other day and it will cover all of your muscle groups." Push-ups. Beginner: 25 Reps. Advanced: 50 Reps Dips between chairs. Beginner: 20 Reps. Advanced: 50 Reps Row between chairs. Beginner: 30 Reps. Advanced: 50 Reps Sit-ups. Beginner: 30 Reps. Advanced: 100 Reps Bent-leg raises. Beginner: 25 Reps. Advanced: 50 Reps Bent-over twists. Beginner: 25 Reps. Advanced: 50 Reps Knee bends (squats). Beginner: 25 Reps. Advanced: 50-70 Reps Calf raises. Beginner: 25 Reps. Advanced: 50 Reps Chin-ups. Beginner: 10 Reps. Advanced: 30 Reps Demonstrations of each exercise are at this link: https://imgur.com/gallery/yYmEOnO?s=sms

March – April 2020 western nurse |

SPECIAL ANF FITNESS FEATURE

FITNESS AT HOME WITH EQUIPMENT This stops short of a full home gym, but is for ANF members who are either already a little bit hardcore with exercise, or just didn’t put everything out for verge collection last time you dumped a fitness kick.

Yoga mat. “Yoga blocks and a mat is plenty to get a good home workout in, there is so much you can do with these,” says Marine Constant, climbing yoga teacher at Westway Climbing, a rock climbing gym in London. “You can work on strength, flexibility, cardio and mindfulness without breaking the bank. There are plenty of videos on YouTube to follow along to, from beginner to expert. Staying healthy from home doesn’t have to be complicated.”

Skipping rope. James Stark, a personal trainer and co-founder of Bristol-based gym chain Starks Fitness, says if your ceiling height permits or you’ve got a decent garden, use a skipping rope. “They’re very cost efficient, they’re very easy to come by,” he says. It’s probably not worth paying a fortune for a fancy weighted one or something with rotating handles. “Those are probably for people with a bit more experience skipping … Initially you just need a decent quality standard skipping rope which can be adjustable based on height. If you get good at skipping rhythm then you can master some of the drills.”

It provides “a great cardio workout that challenges your legs and core muscles” and “has been proven to benefit folks who have osteoarthritis". So when “your joints can’t take the impact of running or walking, cycling can help decrease pain and increase your aerobic capacity”.

Pair of dumbbells. “A pair of small dumbbells should definitely be in your home equipment arsenal,” says Angela Ioannou, area fitness

Stationary bicycle. “Cycling is not only fun, it’s a way to look good and feel good. Whether it be on the road or on a stationary bike, we’re cycling towards better brain and heart health,” says the American Stroke Association. The Mayo Clinic website says: “Studies have found that cycling indoors for 45 minutes, three times a week can raise HDL cholesterol (the good kind) and lower body fat percentage in just 12 weeks.” The website adds: “Cycling outdoors or indoors is a great way to get your heart pumping while putting minimal impact on your joints.”

manager and personal trainer at the UK’s Everyone Active. “One, two and five kilogram dumbbells are a great weight to add additional resistance to exercises like lunges, side raises, bicep curls and tricep extensions. You don’t need to go heavy, if you keep your repetitions strict then you can get an amazing full body workout with them. Adjustable dumbbells are an amazing alternative, as you can create one heavy dumbbell and use for unilateral training, overloading one side.” If you haven’t got dumbbells, tins of beans and other items might come in handy. “Large bags of rice or sugar can even be used to make any exercise that bit more difficult,” Ioannou says. “Combine weighted squats with shoulder presses, lunges and upright rows, press-ups and bent over rows for a full body workout that, when done in quick succession, will be sure to get your heart racing.”

Swiss ball or exercise ball. “I’d say a Swiss ball is probably my top pick for home workouts,” says James Stark. “There’s a lot of different exercises that can be done with a Swiss ball, especially stuff that’s core based. They generally come in 55cm, 65cm, or 75cm. You can work out whether you’re short, medium or tall to choose which one you need.” Nigel Stockill, performance director of fitness company Firstbeat, says: “A Swiss ball can provide you with a slightly unstable but safe and fun platform to sit on, lie on, stretch on, push and lunge from.”

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Weighted vest. Bodyweight workouts like press-ups and squats are some of the easiest workouts to do at home because they don’t need any equipment. However, for those accustomed to lifting at a gym, they don’t really cut the mustard. Why not consider a weighted vest? They are compact enough to be easily delivered and can be used for all the same exercises as hand weights or kettlebells, and more. And they also keep your hands free. The weight of the vest is generally created with small sand bags weighing about 300g which can be added or removed, allowing you to customise your workout, and add more when things start getting easier. Great for squats and press-ups.

Of course, staying in shape and maintaining good health also heavily depends on having a healthy diet with smaller portions. Staying away from the gym can even help you lose weight. How? The answer is simple: Training in a gym makes many people think they need to eat more. They start to believe they need extra protein to build muscle or the suchlike. That might be true for bodybuilders or competitive sportspeople, but for most of us, the reality is we already eat too much, whether or not we think it’s “healthy”.

Kettlebell. “The kettlebell is one of the most versatile pieces of equipment out there,” says Tommy Wanless, head of training at UK group training outfit, Speedflex. “Training the whole body, it is great for building muscle and also working your cardiovascular system – really getting the heart pumping.” Wanless recommends using a kettlebell for squats, deadlifts, swings, and shoulder presses to start with, before graduating to more complex moves like the clean and press, and snatches. “An eight to 12kg kettlebell will be plenty for most exercises,” he says. If you don’t have a kettlebell, Wanless suggests using a rucksack or other bag with packs of sugar or rice in them. He added: “Creating a distance between the weight and the handle is key to having the weight offset – to recruit those extra stabilising muscle groups.”

Resistance bands. They’re hugely popular and so portable. These large elastic bands can be used to exercise all areas of the body, says the British Heart Foundation. They can be good for people with limited mobility, because many of the exercises can be done either seated or standing. Among movements that are possible with the bands are lateral raises, squats, seated or standing chest presses, leg presses, bicep curls, seated calf presses and tricep presses.

A tablet or laptop. You might not be able to go to a gym or a trainer, but they might be able to come to you via the Net, if you have a tablet or other device with access to social media. Gyms are jumping online to offer livestreamed training classes via social media and YouTube is full of fitness videos. You might also consider getting on social media and exercising alongside friends, virtually. So rather than a video chat, have a video workout session with your besties.

So removing another motivation for eating too much (eg: not eating that “healthy” burger that was to provide allegedly necessary extra protein) is a great move for weight loss.

BEYOND THE LIVING ROOM

Also, it’s just really inefficient to try to lose weight through exercise alone. Professor Paul Gately, of the Carnegie Weight Management institution in Leeds, put this theme into context in The Guardian newspaper a few years ago.

Of course the next step can be a fully-equipped home gym. But as you can see, you can do so many different kinds of exercise with very little or no equipment.

“It’s simple maths. If you want to lose a pound of body fat, then that requires you to run from Leeds to Nottingham, but if you want to do it through diet, you just have to skip a meal for seven days,” he said.

Again, a big secret to keeping healthy is to keep moving, whatever program you choose.

with Jack Rear/The Telegraph/The Interview People March – April 2020 western nurse |

CONTINUING PROFESSIONAL DEVELOPMENT

ANF iFOLIO CLINICAL UPDATE:

ANFClinical Updates Endometriosis Endometriosis

Read this article and complete the quiz to earn 1 iFolio hour Read this article and complete the quiz to earn 1 iFolio hour

Endometriosis is a common gynaecological condition characterised by the growth of endometrial tissue outside of the uterus. It affects around one in ten Australian women and is associated with the formation of adhesions, ovarian cysts, infertility, subfertility, and pain.1 There is no cure for endometriosis. Medical and surgical interventions aim to reduce extrauterine endometrial tissue growth, minimise pain, and enhance fertility. While effective treatments are available, endometriosis remains a severe and debilitating condition with a significant impact on quality of life for many affected women.2

PATHOGENESIS Endometriosis is a chronic, oestrogen dependent, inflammatory condition. It occurs when endometrial tissue proliferates and forms lesions in extrauterine areas including the ovaries, anterior/posterior cul-de-sac, ovarian ligaments, uterus, fallopian tubes, sigmoid colon, and appendix.3 Endometrial tissue growth is dependent on oestrogen, and therefore primarily affects women of childbearing age (see Illustration 1). There are several theories to describe the pathogenesis of endometriosis. They can be broadly categorised into two groups; those that argue extra-uterine tissue originates in the uterus and those that purport that extrauterine tissue has arisen from another organ or area of the body.2 No single theory can explain all presentations. At present, the strongest theory is known as the retrograde menstruation hypothesis.4 It suggests that fragments of endometrial tissue from the uterine cavity travel up the fallopian tubes to the peritoneal cavity during menstruation. The tissue then implants itself into the peritoneum and abdominal organs and begins to grow. These growths induce chronic inflammation and the formation of adhesions.4 Retrograde menstruation occurs in the majority of women, not just those with endometriosis. Therefore, other factors are thought to be required for the onset of disease such as genetic predisposition and hereditary or acquired changes to the endometrium, peritoneal epithelium, and/or immune clearance.2

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SIGNS AND SYMPTOMS OF ENDOMETRIOSIS The two key symptoms of endometriosis are pain and subfertility. Types of pain include dysmenorrhoea (pain on menstruation), dyspareunia (pain on sexual intercourse), dysuria (painful urination), dyschezia (straining with stools), and generalised pelvic and abdominal pain.1 Other symptoms include bowel and bladder complications, nausea, fatigue, and premenstrual syndrome.5

INTERVENTIONS There is no cure for endometriosis. Treatment is targeted at minimising pain and treating infertility associated with the disorder. Options include surgical interventions and medical therapies. Surgical interventions are used to reduce or remove external endometrial tissue, for the division of adhesions and to interrupt nerve pathways, while medical therapies are used for pain relief, prevention of disease progression, and to support for subfertility.5,6

Box 1. Endometriosis and infertility 3,6

SURGICAL INTERVENTIONS

Endometriosis is associated with subfertility and infertility. Up to 50% of women with infertility have endometriosis and vice versa (up to 50% of women with endometriosis have infertility). The exact relationship between endometriosis and infertility is not clearly understood. It is known that women with advanced endometriosis have altered pelvic anatomy, poor ovarian reserve, low oocyte quality, and poor implantation. Women with mild to moderate cases may be able to conceive without intervention. In severe cases, pregnancy rates are significantly lower. There is no evidence to support the use of medical therapies for endometriosis-associated infertility. Instead, treatment options include watchful waiting, surgery to remove ectopic implants and restore normal anatomy, ovulation induction and in vitro fertilisation. Selection of interventions is based on age, severity of the condition, and individual preference.

Surgery has been demonstrated to be effective for relieving pain associated with endometriosis and is an option for the treatment of endometriosis-associated infertility.3 Laparotomy (open surgery) and laparoscopy (minimally invasive surgery) are equally effective. However, laparoscopy is typically preferred as it is associated with fewer complications and improved outcomes.5

DIAGNOSIS Preliminary diagnosis of endometriosis involves past medical history, signs and symptoms, physical examination, and medical imaging. Physical examination may include a vaginal and/or rectal exam. Transvaginal ultrasound may also be useful for viewing ovarian endometrioma (cysts) and rectal endometriosis, when performed by a highly experienced clinician. Further imaging of the ureters, bladder and/or bowel may also be indicated in some cases. The confirmed presence of endometrial tissue in the abdominal cavity is often considered gold standard for the diagnosis of endometriosis. This is obtained through laparoscopic surgery and histological verification of an implant sample collected during surgery.5

Surgical procedures that may be performed during laparoscopy include:5 - Removal/destruction of endometrial implants or ovarian endometriomas (cysts) - Division of adhesions - Cystectomy • Surgical removal of all or part of the bladder • May be recommended for women with ovarian endometrioma (cysts) as it reduces pain and has a lower recurrence rate than other treatment options - Hysterectomy, with or without oophorectomy • Removal of the uterus and all visible endometriosis lesions, with or without one or both ovaries • Women should be aware that symptoms may persist even after a complete hysterectomy - Uterine nerve ablation (LUNA) or presacral neurectomy (PSN)

Ectopic tissue may be removed via excision or ablation. Excision is the surgical removal of endometrial implants. Ablation destroys the tissue through melting or evaporation, for

Illustration 1. Endometriosis

example, using a laser or diathermy.5 Excision is required for histological verification and may be preferred for more advanced conditions. It has also been associated with improved rates of spontaneous pregnancy at nine to 12 months, when compared with ablation.6 The recommended type of surgery depends on the patient characteristics, location of the ectopic endometrial tissue, and associated symptoms. For example, hysterectomy is recommended for all women who have completed their family and have not adequately responded to alternative treatments.5

REFERENCES 1. Hayes P (ed.). Endometriosis timely management [Internet]. Melbourne: The Royal Australian College of General Practitioners; 2015 Mar. Available from: http://www.racgp.org.au/ publications/goodpractice/archive/201503/ endometriosis-timely-management/ Accessed July 2017. 2. Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012 Sep;98(3):10.1016/j.fertnstert.2012.06.029 3. Macer LM, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am. 2012 Dec; 39(4): 535–549.

4. Vercellini P, Vigano P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014 May;10(5):261-75. 5. Dunselman GA, Vermeulen N, Becker C, CalhazJorge C, D’Hooghe T, De Bie B, Heikinheimo O, Horne AW, Kiesel L, Nap A, Prentice A, Saridogan E, Soriano D, Nelen W. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014 Mar;29(3):400-12. doi: 10.1093/humrep/det457. 6. Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD009590. DOI: 10.1002/14651858. CD009590.pub2.

MEDICAL THERAPIES The primary medical therapies for the relief of endometriosis-related pain include analgesics, such as non-steroidal anti-inflammatories (NSAIDs), and combined hormonal contraceptives or prostagens (for example, medroxyprogesterone acetate, DepoProvera).5 Guidelines recommend empirical treatment for symptomatic women, once other potential causes of chronic pelvic pain have been excluded.5 Other agents including anti-progestogens, levonorgestrel-releasing intrauterine devices, gonadotrophin-releasing hormone (GnRH) agonists, and aromatase inhibitors may also be considered.6 No single agent is preferred in all cases. The appropriate treatment should be based on a woman’s symptoms, her preferences, medication efficacy and side effects, costs, and availability of treatment.2 March – April 2020 western nurse |

CONTINUING PROFESSIONAL DEVELOPMENT

The problem with opioids

The problem with opioids Read this article and complete the quiz to earn 1 iFolio hour

Read this article and complete the online quiz to earn 1 iFolio hour

Opioids, including both illicit and pharmaceutical agents, are the most harmful drugs to human health (see Table 1). Use of opioids increases the risk of overdose, infectious diseases, and the onset of other medical and psychiatric conditions.1 Table 1. Types of illicit and pharmaceutical opioids7

Illicit opioids

Pharmaceutical opioids

Heroin Opium

Alfentanil Buprenorphine Codeine Dextropropoxyphene Fentanyl Hydromorphone Methadone Morphine Oxycodone Pethidine Remifentanil Tapentadol Tramadol

There is increasing global misuse of pharmaceutical opioids resulting in rising accidental deaths.1 Evidence from the United States suggests that while the prevalence of chronic pain has remained stable over the past 15 years, the amount of prescription opioids sold has quadrupled.2 Although opioid use in Australia is not at the epidemic proportions of the United States, similar patterns have also been documented. There has been a four-fold increase in the use of opioids in Australia over the past 25 years (4.6 to 18.0 DDD/1000 pop/ day) and the rates of accidental deaths due to opioids (namely, pharmaceutical opioids) have doubled in Australian adults aged 35 to 44 years over the past decade.3,4 Not all opioid use is considered misuse. There are clear indications for pharmaceutical opioids in individuals with acute and cancerrelated pain. However, evidence to support efficacy in chronic pain is inconclusive.5 The Australian Pain and Opioids in Treatment

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(POINT) study demonstrated that opioid use in individuals with chronic pain did not improve workplace functionality and was associated with a high risk of adverse outcomes including abuse, dependence, overdose, and death.6 Despite this, studies have shown that almost 44% of opioid prescriptions in Australia are for chronic pain.7 This suggests there is room for further regulation and a greater emphasis on guidelines for prescribing opioids and nonopioid interventions for the management of chronic pain.

PHARMACEUTICAL OPIOIDS There are 13 different types of opioids available for use in Australia (see Table 1). They act on opioid receptors in the central nervous system and the gastrointestinal (GI) tract to reduce the transmission of pain. They also cause respiratory depression, sedation, and GI complications like constipation, nausea, and vomiting.8 The most commonly prescribed opioids in Australia include codeine (in combination with paracetamol), oxycodone, and tramadol.3 Buprenorphine, morphine, and fentanyl are also common.3 Each type of opioid has a different dose equivalent (compared to morphine) and duration of action. Many opioids are available under different trade names, in variable doses, and as combination agents, meaning there are hundreds of different formulations available.5 Variable

use of multiple opioids, including immediate and/or controlled release formulations, and use of opioids in combination with other psychoactive substances has resulted in many opioid-related deaths.1

CONTRIBUTING FACTORS TO INCREASING USE OF PHARMACEUTICAL OPIOIDS A wide range of explanations have been cited for the increasing use of prescription opioids. They include demographic changes, patient characteristics, and factors related to physician prescribing. Demographic factors include longer cancer survival periods and an ageing population, with increased rates of arthritis.10 Individual risk factors for prescription opioid abuse include; • Obtaining multiple prescriptions from different providers and pharmacies • Daily use of high dose prescription pain relief • History of substance abuse • Current mental illness • Living in rural areas • Low income 9 Some suggest that there is a medical culture towards pain that prevents practitioners from questioning an individual’s experience of pain and equates pain management with compassion for patients.5 Other factors, such

Table 2. Comparative doses of opioid analgesics8

Type of opioid

Dose equivalent to 10mg of morphine (IM (intramuscular) or SC (subcutaneous))

Duration of action

Codeine

200mg oral

3-4 hours

Oxycodone

15-20mg oral

3-4 hours 12 hours (CR (controlled release)

Tramadol Buprenorphine

100-120mg IM or IV (intravenous)

3-6 hours

150mg oral

12/24 hours (CR)

0.4mg IM

6-8 hours

0.8mg sublingual Fentanyl

100-150mcg SC

as systemic under-treatment of mental health conditions and aggressive promotion of opioids by pharmaceutical companies may also influence opioid prescribing.10

CURBING OPIOID USE AND IMPROVING OUTCOMES FOR PATIENTS WITH CHRONIC PAIN Regulation of opioids is essential to reduce individual risk and improve public safety. Scheduling opioids under the National Poisons Standard ensures safe storage, dispensing, and administration across Australia. Individual states and territories can also implement regulations, such as real-time dispensing monitoring for controlled drugs.5 Examples of the use of regulation to curb opioid use and improve safety in Australia include; • Change of codeine from a Schedule 2/3 to Schedule 4 drug to improve patient safety and prevent abuse (in place since 1 February 2018) • Availability of over-the-counter naloxone to support greater access to life-saving, overdose treatment in the community (commenced 1 February 2016)

1-2 hours Prescribers may require authority from a state-based pharmaceutical services unit in order to prescribe two months or more of some opioids. Central to gaining authority is an assessment of drug dependence. Drug dependence is defined differently in each state and Territory but usually requires identification of drug seeking behaviour.5 Unfortunately, drug seeking behaviour is poorly defined and often difficult to identify. When opioid use is supported, regular monitoring, promotion of nonpharmacological interventions, and exit strategies for opioid cessation, may improve safe and effective pain management.5 Increased use and misuse of opioids is a problem that is affecting Australia and much of the rest of the world. Without intervention, the rates of overdose and accidental deaths associated with pharmaceutical opioids may continue to rise. National and statewide regulation, in combination with appropriate prescribing, dispensing, and administration of opioids is required to improve outcomes for Australians.

REFERENCES

• Electronic Recording and Reporting of Controlled Drugs (ERRCD), Tasmania’s realtime dispensing monitoring system.

1. United Nations Office on Drugs and Crime, World Drug Report 2017. (ISBN: 978-92-1148291-1, eISBN: 978-92-1-060623-3, United Nations publication, Sales No. E.17.XI.6).

Appropriate prescribing, dispensing, and administration of opioids are also required. First, it is important to determine if there is a clinical indication for opioids. Before considering opioids a plan of management and goals of treatment should be nominated. Non-pharmacological interventions and nonopioid analgesics may be safer and improve outcomes for patients with chronic pain.

2. Centers for Disease Control and Prevention. Opioid overdose: Understanding the epidemic [Internet]. Atlanta: CDC; 2016 Dec 16 [cited 2017 Aug]. Available from: https://www.cdc.gov/ drugoverdose/epidemic/index.html.

If opioids are indicated, psychosocial factors, the potential for drug interactions, and risk factors for dependence should be considered.

3. Karanges EA, Blanch B, Buckley NA, Pearson SA. Twenty-five years of prescription opioid use in Australia: a whole of population analysis using pharmaceutical claims. Br J Clin Pharmacol. 2016 Jul;82(1):255-67. 4. National Drug & Alcohol Research Centre. More Australians dying of accidental overdose of pharmaceutical opioids [Internet]. Sydney:

UNSW; 2017 Jul [cited 2017 Aug]. Available from: https://ndarc.med.unsw.edu.au/news/ more-australians-dying-accidental-overdosepharmaceutical-opioids 5. Jammal W, Gown G. Opioid prescribing pitfalls: medicolegal and regulatory issues. Aust Prescr. 2015;38:198-203. 6. Ballantyne JC. What can the POINT study tell us? Pain. 2015 Feb;156(2):201-2. 7. Harrison CM, Charles J, Henderson J, Britt H. Opioid prescribing in Australian general practice. Med J Aust 2012;196:380-1. 8. Australian Medicines Handbook 2017 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2017 July. 9. Centers for Disease Control and Prevention. Opioid overdose: Prescription opioids [Internet]. Atlanta: CDC; 2016 Mar 16 [cited 2017 Aug]. Available from: https://www.cdc.gov/ drugoverdose/opioids/prescribed.html. 10. Monheit B, Pietrzak D, Hocking S. Prescription drug abuse – A timely update. Aust Fam Phys. 2016 Dec;45(12):862-66.

March – April 2020 western nurse |

CONTINUING PROFESSIONAL DEVELOPMENT

ANF iFOLIO CLINICAL UPDATE:

Alteplase medication update Alteplase ––AAmedication update Readthis this article and complete quiz earn 0.5 Read article and complete the quiz the to earn 0.5to iFolio hour Alteplase is a recombinant tissue plasminogen activator (rt-PA, Alteplase). Generic name: Alteplase Trade name: Actilyse Drug Class: Thrombolytics / Fibrinolytics

INDICATIONS

Table 1. Indication and dose of alteplase1

Indication

Recommended dose (mg or mg/kg)

Acute ischaemic stroke

IV bolus: 0.1mg/kg Followed by Infusion (over 60 minutes): 0.8mg/kg To a maximum total dose of 90mg

Acute STEMI

IV bolus: 10mg Followed by Infusion (over 60 minutes): 50mg Then Infusion (over 120 minutes): 40mg (reduce dose to less than 1.5mg/ kg for patients under 65kg) OR Accelerated version (over 90 minutes total) IV bolus: 15mg Followed by Infusion (over 30 minutes): 0.75mg/kg (maximum 50mg) Then Infusion (over 60 minutes): 0.5mg/kg (maximum 35mg)

Pulmonary embolism

IV bolus: 10mg Followed by Infusion (over 120 minutes): 90mg (reduce dose to less than 1.5mg/ kg for patients under 65kg)

Alteplase is a thrombolytic agent, used to breakdown a thrombus (blood clot) in patients with acute ischaemic stroke, acute ST segment elevation myocardial infarction (STEMI), and massive pulmonary embolism. In patients with acute ischaemic stroke, it has been shown to reduce disability at three months.1 In Australia, many states and Territories have their own indications and eligibility criteria for the use of thrombolysis in the treatment of an acute ischaemic stroke. Examples of eligibility criteria include; • Onset of ischaemic stroke within 4.5 hours • Presence of a potentially disabling neurological deficit • CT that rules out haemorrhage or non-vascular cause of stroke

MECHANISM OF ACTION Thrombolytic agents enhance the process of fibrinolysis. Fibrinolysis is the body’s natural way of breaking down a thrombus (see Box 1).2 It involves producing tissue plasminogen activator (t-PA), which binds to and breaks down fibrin within a blood clot. The clot breaks apart as the fibrin strands disintegrate. Alteplase is a synthetic form of t-PA. It is an exact copy of naturally produced t-PA and binds directly to fibrin and fibrinogen to dissolve a clot.2

PRECAUTIONS AND CONTRAINDICATIONS Alteplase is associated with an increased risk of bleeding including intracranial haemorrhage. There is Box 1. Normal physiological fibrinolysis. Alteplase is a synthetic t-PA that induces fibrinolysis. High doses are required to overcome the inhibitory effects of plasminogen activator inhibitors2 Thrombus is formed which contains fibrin and plasminogen Damaged blood vessels release tissue plasminogen activator (t-PA) t-PA binds to fibrin and breaks down plasminogen into plasmin

Plasmin activator inhibitors inactivate t-PA

Plasmin dissolves fibrin and causes thrombolysis (break down of a clot)

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iFolio hour

limited data to support the use of alteplase in people over the age of 80 with acute ischaemic stroke as it has been associated with worse outcomes, including an increased risk of intracranial haemorrhage and mortality, compared to younger people.1 Caution should be observed when using alteplase in patients taking angiotensin converting enzyme (ACE) inhibitors as concurrent use may increase the risk of allergic reactions.1 Absolute contraindications to alteplase include; • Active, suspected, or known bleeding disorders • Co-morbid conditions with an increased risk of bleeding such as severe uncontrolled hypertension, severe liver disease, or thrombocytopenia1 There is limited data to support the use of alteplase in pregnancy. However, as it is indicated for the treatment of life-threatening conditions it may be used as required.1 Many protocols for the administration of alteplase in emergency departments have additional evidence based relative precautions and contraindications.

ADVERSE EFFECTS Most adverse effects of alteplase are related to bleeding. Bleeding at the injection sites, intracranial bleeding, and/or internal bleeding may arise. Transient hypotension may also occur.1 Infrequent and rare adverse effects include allergic reaction and cholesterol embolism.1

DOSING AND ADMINISTRATION The recommended dose of alteplase is dependent on the indication and weight of the patient (see Table 1). It is delivered via intravenous administration, with an initial bolus followed by an infusion over 60

to 180 minutes.1 Nursing considerations include ensuring that patients have two reliable and well secured intravenous cannulas in situ, and that patients are regularly monitored for the onset of bleeding. If severe bleeding occurs and cannot be controlled with direct pressure, the infusion should be stopped.1

ALTEPLASE OR OTHER DRUGS FOR THE TREATMENT OF ACUTE ISCHAEMIC STROKE? At present, alteplase is the only thrombolytic agent used to treat acute ischaemic stroke in Australia.1 One barrier to timely treatment in rural areas is that patients may not be able to safely transfer while alteplase is running. A multisite, randomised control trial is currently underway in Australia to determine whether tenecteplase, which is administered as an IV bolus, could be used as a superior alternative to alteplase to improve clinical outcomes.3 Tenecteplase is well established as a single IV dose thrombolytic treatment for STEMI.

REFERENCES 1. Australian Medicines Handbook 2017 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2017 July. 2. Waller DG, Sampson AP. Medical pharmacology and therapeutics. 4th edition. London: Elsevier Health Sciences; 2014. 744p. 3. Heart Foundation. Tenecteplase versus alteplase for stroke thrombolysis evaluation trial [Internet]. Phillips, ACT: Heart Foundation; n.d. [cited 2019 Nov]. Available from: https:// www.heartfoundation.org.au/research-project/ tenecteplase -versus-alteplase -for-stroke thrombolysis-evaluation-trial

CONTINUING PROFESSIONAL DEVELOPMENT

ANF iFOLIO CLINICAL UPDATE:

Staphylococcus aureus Staphylococcus aureus Read this article and complete the quiz to earn 0.5 iFolio hour

Read this article and complete the quiz to earn 0.5 iFolio hour INTRODUCTION Staphylococcus aureus (usually called “staph” for short) is a gram-positive, round-shaped, non-motile bacteria and belongs to the family Staphylo-coccaceae.1 Staph can cause a wide range of infections which can be serious or fatal.2 Staph can also produce toxins that cause food poisoning.3,4 Staph is a serious cause of healthcare associated infections and community associated skin and soft tissue infections.3 Treatment of staph infection can be challenging as it can become resistant to several antibiotics.2

SOURCES AND ROUTES OF TRANSMISSION Staph is found in 30% of healthy people and animals, and in most cases it cannot cause any diseases.2,4 Yet, if staph gets into the body through broken skin such as wounds or grazes, it may lead to an infection.3 Staph can spread through person-to-person contact including direct contact with healthy people who carry staph, an infected wound, and contaminated hands of health care professionals, or by touching contaminated surfaces.3,5 Food is contaminated by people who carry staph.4 Unpasteurised milk and cheese products are also a common source of staph. It produces toxins when multiplying in food. Although staph is killed by heat, the toxins are resistant to heat.4 Anyone can acquire a staph infection. Yet, staph infection is common in people with chronic conditions such as diabetes, cancer, vascular disease, eczema, and lung disease; immunocompromised conditions; or have undergone invasive procedures such as surgery; or have prosthetic device (For example, intravenous catheters, artificial joints, heart valves, and vascular devices).5

CLINICAL MANIFESTATIONS Invasive infections Staph can cause serious infections which may lead to death including bacteraemia (bloodstream infection), pneumonia (lung infection), osteoarticular infection (bone and joint infections), infective endocarditis (infection of the endocardial surface of the heart), and toxic shock syndrome (toxinmediated acute life-threatening illness).3

Table 1. Suggested treatments for staph infections3,4,6

Infections

Management

Invasive infections

Hospitalisation Prolonged intravenous antibiotic therapy which depends on the specific manifestation and clinical response

Skin and soft tissue infections

Most infections will heal without treatment Some cases may require incision and drainage of the infected site and antibiotics

Staphylococcal food poisoning

Rehydration and other supportive treatments Antibiotics are not useful

Healthy people who carry staph

Antibiotics are only required under special circumstances

Skin and soft tissue infections Clinical manifestations vary and can range from benign (Such as pimples, boils, impetigo, and uncomplicated cellulitis) to severe conditions including surgical site infections, cutaneous abscesses, and purulent cellulitis.3 Food poisoning Symptoms usually develop within 30 minutes to six hours and lasts for only 24 hours. Patients may have vomiting, nausea, stomach cramps, and diarrhoea. Severe illness is rare.4

DIAGNOSIS Based on the specific clinical manifestation, a staph infection is diagnosed by growing the bacteria from specimens such as pus, blood, stool, or vomitus. Since staph bacteria are becoming resistant to certain antibiotics, antimicrobial susceptibility tests should be used to identify these drug-resistant bacteria including Methicillin-resistant Staph, Vancomycin-intermediate Staph, and Vancomycin-resistant Staph.5 In food poisoning, although toxins can be detected in foods, the diagnosis is usually based on the clinical symptoms of the patient.4,6

MANAGEMENT Staph infection can be treated with appropriate antibiotics such as glycopeptides (Vancomycin and teicoplanin), antistaphylococcal penicillins (Oxacillin and methicillin), or daptomycin.3 Antimicrobial susceptibility tests are used in case of antibiotic resistance (see Table 1).

PREVENTION The most effective preventive method is strict adherence to hand washing by health care

professionals and good personal hygiene by the infected person.2,5,6 In hospital settings, drug-resistant staph infected patients should be treated in a designated room. Staff and visitors should follow the hospital’s recommended precautions.6 Food safety practices must be followed during preparation and storage of food to prevent food contamination.4

REFERENCES 1. Chowdhury AN, Hossain N, Rahman M, Ashrafuzzaman. Prevalence of multidrug resistance in human pathogenic Staphylococcus Aureus and their sensitivity to Allamanda cathartica L. leaf extract. International Current Pharmaceutical Journal. 2013;2(11):185-188. 2. Centers for Disease Control and Prevention. Staphylococcus aureus in Healthcare Settings. Healthcare-associated Infections (HAI) 2011 [cited May 2019]. Available from:https://www.cdc.gov/ hai/organisms/staph.html 3. Tong SYC, Davis JS, Eichenberger E, Holland TL, Fowler VG. Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management. Clinical Microbiology Reviews. 2015;28(3):603-661. 4. Centers for Disease Control and Prevention. Staphylococcal Food Poisoning. Food Safety 2018 [cited May 2019]. Available from:https://www.cdc. gov/foodsafety/diseases/staphylococcal.html 5. Centers for Disease Control and Prevention. General Information About MRSA in Healthcare Settings. MRSA 2019 [cited May 2019]. Available from: https://www.cdc.gov/mrsa/healthcare/ 6. South Australia Health. Staphylococcus aureus including methicillin-resistant Staphylococcus aureus (MRSA) - including symptoms, treatment and prevention Infectious diseases 2017 [cited May 2019]. Available from: http://www.sahealth. sa.gov.au/

March – April 2020 western nurse |

PetPage Gwen Owen with Yam and Marlee

KEEP EMAILING THOSE PHOTOS OF YOU AND YOUR PETS TO WIN PRIZES! Pet Page this time round has yet another great array of characters from the animal world – courtesy of their ANF member owners. Look to the top of the page where ANF member Gwen Owen shares with us Yam, her “beautiful big chubby Lesmurdie lamb (kind of a large sheep now!)”, as well as her lovely kelpie Marlee. “Yam came to us a three day old abandoned lamb when my oldest son was doing seeding down south,” Gwen told western nurse. “He lived in the house for the first three months. Yam liked sitting in front of the fire on my grandmother’s chair. He then graduated to his own house (our old cubby house) in a pen in our garden. He roams all day eating my roses and generally making a mess of our driveway, spending all his time with our dogs, chooks and ducks. At night he beds down in his cubby.” Yam likes the cubby particularly because he “doesn’t do rain”, Gwen reckons. Shannara Wall is pictured with Archie, her PomeranianCavalier King Charles Spaniel-cross. Shannara said: “This is the first and most special man in my life! Archie has been loyal by my side for four years. He loves to run and chase his ball, then have a cuddle on the couch. I can depend on him always.”

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Shannara Wall with Archie

Karen Taylor with Izza Mystery and Furball

Karen Taylor said of her beloved cats: “This is a picture of Izza Mystery and Furball who my son put halos on when they wouldn’t leave my side when I was recovering from surgery. They always know when the kids and I need comfort.” Jay Granaderos said: “Our fur baby Mika livens up our lives with her daily mischief.” Jay, who is pictured with Mika and his wife Charine, added: “Mika is always plotting something naughty. Amidst that, she never fails to smother us with pure love and slimy kisses to cover up for her cheekiness. She is indeed a happy blessing that keeps our hearts young.”

Jasmine Meyerink with her border collie George during her pregnancy

Jay Granaderos with wife Charine and Mika

Don’t forget, to be eligible for a prize, members have to be in the photo with their pet and the photo needs to be about 1mb in size, but no bigger than 3mb. Also include your name, your pet’s name and no more than 50 words about your special friend. Email the photo of you and your pet(s) to editorwesternnurse@anfiuwp.org.au and if we publish the pic, you win a prize, including special ANF pet tags! See you all next time round!

And finally, we belatedly congratulate Jasmine Meyerink on her baby boy Nathaniel Theo Meyerink, who was born November 7, 2019, weighing 4040g. Jasmine is pictured here with her border collie George soon before giving birth.

March – April 2020 western nurse |

Corner VEGAN BURGER WITH AUBERGINE & LENTIL

This delicious vegan burger is perfect for grilling and is extremely flavourful. A sumptuous combination of aubergine and lentil, it can be garnished with your favourite toppings such as guacamole and watercress!

Equipment Blender Digital scale Measuring cups and spoons Saucepan Wooden spoon Chef’s knife Cutting board Baking sheet Strainer Spatula Mixing bowl Oven-safe frypan

Ingredients 100g (½ cup) dry lentils 4 sprigs thyme ½ carrot 100g (1 stalk) celery, diced ½ red onion, peeled and diced ½ tsp salt 3 aubergines 2 portobello mushrooms, gills cleaned 3 garlic cloves, peeled ½ tsp smoked paprika 30g (¼ cup) bread crumbs 1 tsp pomegranate molasses 10g (¼ cup) fresh coriander leaves 20g (¼ cup) mint leaves 15g (¼ cup) flat leaf parsley, finely chopped 26 |

western nurse March – April 2020

Instructions Preheat oven to 200C (400F). Place lentils, thyme, carrot, celery, and red onion in a small saucepan. Cover with water, add a pinch of salt or two, and simmer for 20 to 25 minutes or until lentils are soft. Roughly chop the aubergine and sprinkle with Â˝ tsp of salt. Let it sit for 10 minutes for the moisture to release. Dry and spread the aubergine onto a large baking sheet, along with the mushrooms and garlic. Sprinkle with paprika and bake for 20 minutes or until roasted. Drain the lentils and leave to steam dry while the vegetables are roasting. Pick the thyme sprigs out of the lentils and discard.

Place the aubergine mixture and the lentil mixture into a blender. Select Variable 1, start the machine and increase to its highest speed. Blend for 30 seconds. Use the tamper to push the ingredients into the blades. Reduce the speed to Variable 8 and blend for another 20 seconds. The mixture should be smooth. For more texture in your burger, blend for less time. Transfer into a mixing bowl. Add the breadcrumbs, pomegranate molasses and herbs then mix to combine. Portion into 6 patties (100g each) and place in the refrigerator to set for at least an hour. To cook, preheat the oven to 180C (375F). Place a frying pan over medium-high heat and add oil to the pan. Fry the burgers for 3 minutes on each side then place in the oven for 5 minutes or until completely heated through.

Recipe and image adapted from Vitamix, supplied by Kitchen Warehouse.

March â&#x20AC;&#x201C; April 2020 western nurse |

BUSINESSES SAY THANK YOU Businesses in our community really appreciate your efforts during this difficult period when everyone is relying on our frontline health staff to keep them safe. To show their appreciation, some respected names are giving special deals to our nurses, midwives and carers during the pandemic.

Here are eight new offers that are on top of the existing discounts available for ANF members on your iFolio in the ANF Member Rewards and Offers section. Accessing this section is really easy. Just click the ‘Member Offers’ picture on the landing page of your iFolio. Or, you can also click resources at the top of the page and then the tab called ‘Offers’. Then you are ready to save thousands of dollars, with great deals on everything from mortgages and electrical goods, to discounted dinners and haircuts – and even cut your power bills!

Here are some great new offers that businesses are giving to our Nurses, Midwives and Carers during the pandemic. Auto Masters are family owned businesses and we want to thank the health care community for their efforts during these unprecedented times with $75 off any service or repair until June 30, 2020. Not valid with any other offer. automasters.com.au Receive 50% off* our comfortable, easy to clean footwear for all healthcare workers, when you use the promo code: Healthcare50off upon check out. Promotion expires May 31, 2020. *T&Cs apply. Applicable to one time usage on regular priced footwear only. While stocks last.

crocsaustralia.com.au/c/work-shoes 28 |

western nurse March – April 2020

Hertz Australia is offering at least 30 free of charge rental vehicles in WA for up to 30 days, until June 30, 2020. Once the free of charge period expires, customers can continue at a special heavily reduced rate of up to 50 per cent off standard rental charges until further notice from Hertz. ANF members wishing to take up the offer can call: 1800 55 00 13 or email: ausres1@hertz.com.

FOR BEING THERE FOR WA McDonald’s Australia is shouting healthcare workers a free small McCafé hot drink or medium soft drink to say thank you to those on the frontline. Available until May 17, 2020. Available when you are in your uniform, or simply show your ID. One per transaction. Full T&Cs: macc.as/2XGbpKL

$10 OFF each consultation & $50 OFF any orthotics., as a way to say thank you during these tough times. Simply quote “ANF Deal” at the time of booking. If you are suffering from aching feet, ingrown nails, plantar fasciitis or heel pain, we can help. With 15 locations across Perth, we are your local podiatrist. Visit our website for information: podiatristperth.com.au or call 9258 8993

As a thank you to our health heroes on the frontline fighting coronavirus, enjoy 50% off the RRP of the menu, valid until June 30, 2020. T&Cs: ANF membership card must be shown at time of redemption. Offer is only available for redemption inrestaurant, and excludes delivery. Available at Oporto restaurants in Western Australia: Joondalup, Balcatta, South Perth, Bentley and Canning Vale. oporto.com.au

Perth Premium Cleaning Services is one of the only companies in WA that is properly carrying out Coronavirus (COVID-19) decontamination cleaning with approved products. ANF members get a further 5% off this and any other service. perthpremiumcleaning.com.au/corona-virusdecontamination-covid-19-cleaning-ppcs-techniciandivision/ Thank you to our healthcare heroes. We’re offering every West Australian frontline healthcare professional and first responder a free roadside assistance call out, should your car break down during COVID-19. This is our thank you for what you’re doing for our community and will help keep you moving. rac.com.au/car-motoring/roadside-assistance/ healthcare-workers March – April 2020 western nurse |

AMAZING APPS + ONLINE NEWS

InternetWatch Zoom Stay connected wherever you go with ZOOM Cloud Meetings. Start or join a 100-person meeting with crystal-clear, face-toface video, high quality screen sharing, and instant messaging – for free! Award winning Zoom brings video conferencing, online meetings and group messaging into one easy-to-use application. Free

Disney+ Disney+ gives you access to movies and TV series from Disney, Pixar, Marvel, Star Wars, National Geographic, and more. From the Lion King, to new originals like The Mandalorian, there’s something for everyone. 7-day free trial then $8.99 per month

AFL Fantasy Join the craze and have a crack at AFL Fantasy. You can play both ‘Classic’ and ‘Draft’ on the one account, manage your team and create and join leagues. Invite your mates to play for the fully interactive experience. Free

Forest: Stay focused Looking to ignore your phone, stay in the moment and actually talk to your friends? If you want to temporarily put down your phone and focus on what’s more important in real life, you can plant a seed in the Forest. As time goes by, this seed will gradually grow into a tree. However, if you cannot resist the temptation of using your phone and leave the app, your tree will wither. Free , $2.99

Brush Teeth with The Wiggles Australian Unity and The Wiggles have developed a tooth brushing app to assist parents and their kids with the daily task of tooth brushing. In a dentist-approved song, kids can perform the morning and night task with the assistance of The Wiggles. Get your Wiggle on! Free

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western nurse March – April 2020

Pocket God You’re the island god - it’s up to you whether you choose to be benevolent or vengeful. Pocket God contains multiple locations with many hilarious scenarios, exciting mini-games and hidden secrets for you to uncover. You have the power! $1.49

Puffin Web Browser Puffin Web Browser is a fast browser for mobile devices. It speeds up browsing by shifting the workload from the resource-limited devices to the cloud servers, and resource-demanding webpages can run fast on your phones or tablets. All traffic is encrypted, a protection from nearby hackers. Free , $7.99

Blinkest: Nonfiction Books Boost your knowledge and discover new perspectives to become a smarter you. Get the key insights from more than 3000 bestselling non-fiction books that cover leadership, history, psychology and much more. There’s an offline mode when Wi-Fi is unavailable and you can send books to your Kindle or other reader devices. Free

Hairy Maclary Hairy Maclary from Donaldson’s Dairy is now available as an interactive digital book with AUSLAN sign language in addition to the kooky narration by David Tennant. Includes all your favourites characters including Scarface Claw and Slinky Malinki. $4.59 , $5.99

Cisco Meet anywhere, anytime. Enjoy a rich meeting experience with integrated audio, high-quality video and content sharing on the go. Join and present from any meeting, event, or training session with hands-free voice commands with Google Assistant and Google Home Hub. There’s also seamless joining directly from your calendar or customizable widget. Free

FIVESuperSites 13 Minutes to the Moon

This site offers epic stories of NASA’s missions to the Moon and is now in its second podcast season. Season 1 tells the story of the 1969 Apollo 11 lunar landing by unpicking exactly what was going on in the 13 minutes just before Neil Armstrong and Buzz Aldrin landed on the surface of the moon. Amazing interviews with real astronauts and ground crews with exceptional narration. Dramatic musical score by Hans Zimmer.

bbc.co.uk/programmes/w13xttx2

Australian of the Year Award

Each year our nation celebrates the achievements and contributions of eminent Australians through the Australian of the Year Awards by profiling leading citizens who are role models for us all. Got someone in mind for 2021? Everyone has the opportunity to recognise any Australian who makes them proud.

australianoftheyear.org.au

Diply

Diply is a social news and entertainment community that creates cheeky, useful, and informative content across a vast array of channels and topics with the goal of making your day a little less bland. Super cute stuff here.

hello.diply.com

Oz Bargain

OzBargain is a community of online shoppers in Australia. This is the place where bargains are shared. Register an account, submit a new bargain, vote for deals you like or dislike and away you go!

ozbargain.com.au

Imgur

This one is great for those of you who like to browse or submit images to a shared online platform. Imgur has a history of playing pranks on its users. The first prank was the ‘Catification’ feature, which allowed users to automatically add cats to any image with one click. Meow!

imgur.com

PRIZES

Enter to WIN JOIN GRU AND HIS CREW IN A FOUR-FILM FAMILY FUN FEST – ENTER NOW! Family favourite Despicable Me – described as “funny, energetic (and) teeth-gnashingly venomous” by star film critic, the late Roger Ebert – plus that film’s two sequels and its popular spin-off, Minions, comprise the four-movie pack up for grabs. The first film sets the scene in a happy suburban neighbourhood, with well-kept gardens and white picket fences. Amongst this domestic bliss, sits a single black

house with a dead lawn that is the secret hideout of evil genius Gru (Steve Carell), who, with his army of excitable little yellow minions, and their arsenal of shrink rays, freeze guns and battleready vehicles for land and air, plans to take over the world. But then three little orphaned girls arrive and slowly soften Gru’s heart. The prize includes Blu-ray copies of Despicable Me, Despicable Me 2, Despicable Me 3 and Minions.

ANF GOURMET WIN PACKS UP FOR $15 GRABS! voucher

WIN one of 25 special ANF Gourmet Packs consisting of a $50 Kitchen Warehouse voucher plus a $15 voucher from The Good Grocer. To enter these ANF competitions, simply log on to your iFolio and click through to ‘Resources’. Then click the ‘Competitions’ section – that’s where you can enter.

A Perth-based, family-owned business supporting WA Nurses, Midwives and Carers. COVID-19 DECONTAMINATION CLEANING.

ANF MEMBERS GET 5% OFF ALL SERVICES – see the ANF Member Offers on your ANF iFolio.

We are currently conducting regular precautionary treatments for WA State Government Critical Infrastructure facilities as well as various commercial and private clients with confirmed cases of COVID-19 – all in the strictest confidence. If you have any location that you would like cleaned and decontaminated, please get in touch with us. Let us know your ANF membership number when booking. Call: 0488 032 199 – to make bookings or further inquiries.

perthpremiumcleaning.com.au March – April 2020 western nurse |

Lease a new car and save on tax Did you know that packaging your next car could save you thousands? Let the experts at Fleet Network take the hassle out of car buying – we’ll source your car, pass on national fleet discounts and package all your running costs, while you save on tax. We’ll even sell your trade-in for you, to make sure the changeover is seamless.

It’s worth a call – it’s your salary after all.

Your own dedicated Novated Leasing specialist

Save with exclusive National Fleet Discounts

We’ll sell your Trade-in for you

Save GST on your vehicle’s running costs^

Your Package includes Finance, Fuel, Insurance, Servicing, Tyres & Registration

ASK US ABOUT THIS MONTH’S

SPECIAL OFFER #

Get a free quote today!

1300 738 601 www.fleetnetwork.com.au/anfwa #To qualify for this offer, mention this ad to Fleet Network prior to the completion of your initial contract. Vehicle must be supplied by Fleet Network. Not valid with any other offers. Employees should consult their employer’s salary packaging policy before entering into a contract. ^ Subject to Employer policy.

Western Nurse Magazine March April 2020

Articles inside

Businesses Say Thank You

Internet Watch

Recipe Corner

Staphylococcus aureus

Endometriosis

Pet Page

The problem with opioids

Mark’s Q & A

Dorothy’s Stories

Special ANF Fitness Feature

Secretary’s Report