SWH research makes its mark

Recognising the vital role research plays in progressing healthcare, South West Healthcare has achieved remarkable results on the research front in the past 12 months. We’ve won awards, made notable headway for treatment and care options for our patients and clients and made our mark globally.

In 2009-10 the work of two of our staff was deservedly rewarded:

• SWH Perioperative Education Clinical Facilitator Paula Foran was awarded the 2009 Johnson & Johnson Victorian Perioperative Nurses Group Research Scholarship for her PhD research on the Benefits of Operating Theatre Experience for Undergraduate Nurses. She investigated the educational benefits of witnessing and participating in surgery, and its ability to then provide information useful to caring for patients before and after their operations. Her completed findings revealed undergraduate nurses who participated in a guided learning experience in the operating suite achieved a 77 per cent pass rate when tested on areas of pre and post operative nursing care, compared to a 56 per cent pass rate for those who did not.

  Paula was also awarded the 2009 Deakin University–Health Super Excellence in Nursing Leadership (Rural) Award (photo 1), following in the footsteps of SWH Redesigning Care Manager Leanne McCann who won the title a year earlier (see Redesigning Health Care, below).

• Our prestigious 2009 SWH AEW Matthews Memorial Travelling Scholarship was awarded to Psychiatric Services Division Primary Mental Health Team Leader Catriona Campbell (photo 2). This November she will attend the 10th International Forum on Mood and Anxiety Disorders in Vienna. This conference will be supplemented with attendance at the Primary Care Live and Nurses Working in Clinics 2010 conferences in London. Her international study tour also includes time in Gloucestershire to revisit the team who developed the stress management course Catriona and her colleagues deliver at SW TAFE and SWH. This site visit will ensure course materials are current and continue to grow valuable international relationships.

Other international research in 2009-10 included:

• Redesigning Health Care by SWH Redesigning Care manager Leanne McCann who used her 2008 Deakin University–Health Super Leadership in Nursing (Rural) Award grant to fund a two-week study tour of the United Kingdom. Last July she visited a number of hospitals recognised for well-established redesign work to gain further insight into establishing this method of improvement. She also met with NHS Institute of Innovation and Improvement staff to investigate practical application of redesign in a variety of settings, leadership strategies for introducing redesign methodology, ideas for successfully-introduced solutions and hints for overcoming barriers. Returning to SWH, Leanne commenced the roll-out of the internationally successful Releasing Time to Care–Productive Ward program making our Warrnambool and Camperdown hospitals the first hospitals in Victoria to implement it and our Psychiatric Services Division the first mental health service in Australia to do the same.

• Review of the Memphis Police Crisis Intervention Team by SWH Psychiatric Services Division Director Caroline Byrne. This internationally-recognised team’s training program assists police to deal more effectively and sensitively with people experiencing acute mental health difficulties. The 2010 review included a shift of challenging call-outs riding alongside a Memphis team member to observe interactions with the public and assist with managing these difficult situations.

National research included:

• A Very Early Rehabilitation Trial (AVERT) is a world-first, stroke-specific research project involving our nationally acclaimed interdisciplinary Stroke Team. This trial concentrates on very early rehabilitation (with a focus on mobility) versus standard care after stroke. A range of combined facts make AVERT an important study to undertake including evidence that stroke units reduce death and disability but little evidence about the factors responsible for this effect; the promotion of the concept of very early rehabilitation/mobilisation in a range of acute stroke guidelines with limited evidence; recognition that simple and widely applicable interventions to reduce the burden of stroke our needed; recognition that poorly designed rehabilitation studies have failed to contribute evidence needed to support these interventions, and acknowledgement that the cost effectiveness of any new intervention must also be considered. One of 30 health services involved worldwide, our AVERT team has recruited six stroke survivors to participate.

• Australian Stroke Clinical Registry (AusCR) sees our Stroke Liaison Nurse Patrick Groot engaged in this nationwide stroke and TIA data collection process. The primary purpose is to collect information that will lead to a better understanding of clinical care and health outcomes, the development of interventions and policies to improve the quality and safety of stroke care delivery in Australia and the assessment of changes in clinical practice and health outcomes over time. In the future, AuSCR may also provide a framework for other research.

• Benefits of Operating Theatre Experience for Undergraduate Nurses (see research awards, above).

• Carer Perception of Cognitive Functioning in the Aged by our Psychiatric Services Aged Persons’ Mental Health Services in collaboration with Deakin University. This study was aimed at increasing the accuracy of cognitive screening in the elderly. It involved testing the cognitive functioning of 52 aged clients (aged 65 and above) with the comprehensive and recently-developed cognitive screen, NuCog. The nominated carer of the client was also interviewed with carer questionnaire CogRisk and the results of these questions compared directly with NuCog. The information provided by the carer was found to add accuracy and strength to the cognitive screen. The benefit of more accurate cognitive testing for the clients and family is that memory enhancing medication can be commenced to slow the progression of dementia. The advantage to the community is that this early detection of cognitive impairment and commencement of memory enhancers reduces the cost of caring for people with dementia.

• Department of Health Victoria Review of Access to Emergency Surgery saw SWH selected as the only regional health service of six Victorian health services to participate in research designed to advance understanding of emergency surgery. Site visits to our Warrnambool hospital operating theatres were conducted last December to develop a profile of existing models for emergency surgical services and identify issues and challenges impacting high quality, safe and timely emergency surgery. In addition, models of emergency surgery delivery interstate and overseas were reviewed and existing statewide data and health service level data examined. (Perioperative Education Clinical Facilitator Paula Foran represents SWH on the Department of Human Services’ Emergency Surgery Working Party.)

• Healthy Hearts, our Community Health program aimed at addressing the higher-than-state-average rate of cardiovascular disease in men in our Corangamite and Warrnambool catchment areas, shows encouraging results. Data, co-analysed by Deakin University’s Department of Rural Health, indicates participants reassessed three months after the program’s end had statistically reduced their cardiovascular disease risk with significant improvement in systolic blood pressure measurements, weight, waist circumference, hip circumference, body fat measurement (BMI), total cholesterol levels and low density lipid levels. Six months after, statistically significant improvements remained in weight, waist circumference, body fat measurements, systolic blood pressure and BMI and 12 months after, statistically significant improvements remained in waist and hip circumference. This indicates the 80+ Macarthur, Lismore, Camperdown and Warrnambool Community Health participants have made lifestyle modifications to reduce their risk of developing Type 2 Diabetes and cardiovascular disease. The challenge now is to motivate them to maintain these improvements long term.

• Intervention for Depression among Palliative Care Patients and their Families: Training Program for Care Staff sees SWH’s Palliative Care Unit partnering with Deakin University researchers David Mellor and Tanya Davison to develop a new training manual to better equip palliative care workers in identifying inpatients at risk of, or experiencing, depression. Data collated from the interviews of recruited carers, staff and managers will lead to the development of an education package staff will be trained in this month. Follow up interviews with participating carers will be conducted in November. By March next year, a three-month training post-test will have been conducted with staff and the control group. The research report will be written by Deakin in April.

• Older Persons Music Therapy, believed to be rural Victoria’s only acute-setting Music Therapy Program, is enhancing the cognitive, physical and social behaviours of our Medical/Palliative Care Unit inpatients. An ongoing evaluation of this SWH Improving Care for Older Persons initiative demonstrates a 100 per cent success rate in settling restless inpatients and a 100 per cent increase in participating inpatients being fully orientated (knowing day, person and place).

• Utilising Outcome Measures in Public Mental Health by SWH Psychiatric Services Division Psychologist Joy Atkins. This study evaluated a clinician training program to improve compliance with national outcome measures. The training program was developed in conjunction with consumers and clinicians in response to specific issues associated with the use of measures including lack of perceived worth, limited understanding about how the measures might be used and a sense that measures were more a bureaucratic than clinical tool. Following the training program, clinicians were more likely to perceive outcome measures as worthwhile and useful tools to use with consumers and were more likely to collect both clinician and client rated outcome measures post-training.

Published research for 2009-10:

• Excellence in Regional Stroke Care: An Evaluation of the Implementation of a Stroke Care Unit in Regional Australia was authored by SWH’s Redesigning Care Manager Leanne McCann, Stroke Liaison Nurse Patrick Groot, Stroke Physician Chris Charnley and James Cook University Professor of Nursing – Tropical Health Anne Gardner. Published in August 2009 by the Australian Journal of Rural Health, this study demonstrated the introduction of formalised stroke care to a regional hospital resulted in improved compliance with key performance indicators and better patient outcomes. The results included improved timeliness of brain catscans and assessments by multidisciplinary specialists (including care and discharge planning with patients/families) proving evidence-based specialised stroke care can be offered with confidence in regional populations.

• The thesis of Monash University School of Rural Health Associate Professor Daryl Pedler was also published in 2009-10. His Acute Farm Injury: Implications for Rurally-Based Health Services 2009 was based on six years of farm injuries data collected while employed as our Emergency Department Director. In that 1996–2001 period, 997 people were treated at SWH Warrnambool as a result of preventable local farm accidents. It is hoped his key findings will lead to the development of new farm injury-prevention activities.

photo 1 Deakin University Head of School–Nursing and Midwifery, Professor Maxine Duke, presents SWH Perioperative Education Clinical Facilitator Paula Foran (left) with one of two research awards she won in 2009-10.

photo 2 Delighted with the awarding to Primary Mental Health Team Leader, Catriona Campbell, of the SWH AEW Matthews Memorial Travelling Scholarship is her Psychiatric Services Division colleagues (from left) Community Adult Mental Health Services Manager Nicholas Place, Staff Development Officer Janet Punch and Director Caroline Byrne.

photo 3 Former SWH Emergency Department (ED) Director Dr Daryl Pedler (seated) returned this year to gift a copy of his thesis to our Education Resource Centre in recognition of the role SWH played in assisting his research. This included support provided by Director of Medical Services Dr Peter O’Brien, Warrnambool ED Unit Manager Kate Sloan and recently-retired Education Resource Centre Manager/Medical Librarian Judy Dalton (seated).