|
|
small (250x250 max)
medium (500x500 max)
Large
Extra Large
large ( > 500x500)
Full Resolution
|
|
Centre for Nursing and Allied Health Research 2014: our journey The ailment of advancing years ‘though I should try to hide Some day the thread will break The pearls scattered far and wide Age cannot be denied (Princess Shokusk 100 Verses from Old Japan Tuttle Publishers p. 89). Table of contents Introduction 1 The Year in Review: Highlights of 2014 2 Research: Improving Care for People with Diabetes 5 Sharing Knowledge: Publications and Presentations 13 Important Events 19 Supporting Colleagues to Engage in Research 24 Higher Degree Student Supervision 26 Contributions to the Profession 28 Our Key Collaborations 32 In the News 33 The CNAHR Team 38 Acknowledgements 39 The 2014 CNAHR annual report reflects the ‘visible’ contributions CNAHR made to research, teaching and clinical care at Deakin and Barwon Health during 2014. However, a great deal of the work is ‘invisible,’ does not qualify as university research output, and is often not acknowledged. The invisible work is important to Barwon Health and its strategic focus on becoming a recognised research hospital through education, research and care. Consequently, the significant amount of invisible time spent supervising and mentoring clinicians to undertake clinical research, largely concerned with quality and safety projects, is very important. Our highly visible outputs include implementing the McKellar Guidelines in the McKellar Centre, where they are now policy and advising other aged care service providers throughout Australia about implementing the guidelines in their services. We presented our work in national and international conferences, and commenced work on our successful Department of Social Services grant to develop information about glucose lowering medicines for older people with diabetes, nurses and personal care workers. The information will be evaluated in aged care settings and in the community in 2015/16. Our focus on diabetes research in older people is significant because diabetes is the most prevalent chronic disease globally and is one of the top 10 causes of death in Australia. Diabetes is the underlying cause of other common health problems such as cardiovascular disease, dementia, some forms of cancer and renal disease and is the leading cause of death in people with these complications. Significantly, the prevalence of diabetes is higher in the Barwon Region and the population is older than the rest of Victoria. We developed an ambitious five year strategic plan that will guide our work for the next five years. Other outputs include 17 peer-reviewed publications, one book, one book chapter, 20 invited presentations, consultancy and committee work and media presentations; all of which enhance the profile of Barwon Health, the Centre for Quality Patient and Safety Research and Deakin University. 1 CNAHR Annual Report 2014 Kitchener House, Barwon Health Waterfront Campus, Deakin University 2 CNAHR Annual Report 2014 CNAHR made a significant contribution to research, teaching, learning and clinical care in 2014. Key highlights of the year were: Implementing The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings were implemented in the McKellar Centre where they became policy for managing older people with diabetes in the McKellar Centre in July 2014 (see page 7). Completing the draft suite of information and commencing data collection for the Quality Use of Glucose Lowering Medicines: Q-Med Study (see page 11). Publishing 17 peer-reviewed papers, one book, one book monograph, four other publications, presenting nine peer-reviewed conference presentations and delivering 20 invited presentations (see pages 13-18). Holding four research and writing professional development workshops throughout the year. Between 10 and 21 people attend each workshop (see page 25). Participating in three interviews conducted on 94.7 The Pulse FM Geelong public radio station to raise public awareness about Diabetes and to promote Diabetes Awareness Week and World Diabetes Day (see page 22). Delivering the Annual World Diabetes Day Professorial Address, Medicines: The Human Side, during Smart Geelong Research Week at Barwon Health (see page 24). Professor Trisha Dunning was inducted to the Victorian Honour Roll of Women on March 6 in the lead up to International Women’s Day 2014 (see page 20). 3 CNAHR Annual Report 2014 4 CNAHR Annual Report 2014 Research: Improving the Care of Older People with Diabetes Key CNAHR‒led research projects are featured in the report including: The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings at The McKellar Centre The Quality Use of Glucose Lowering Medicines: The Q-Med study Pain in Older People with Diabetes—The POP-D study 5 CNAHR Annual Report 2014 Guidelines are designed to be used with clinical judgement after undertaking a comprehensive assessment to plan personalised care. (Dunning 2014) 6 CNAHR Annual Report 2014 The McKellar Guidelines CNAHR staff undertook many activities to disseminate The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings (The McKellar Guidelines) throughout 2014. Publications to inform stakeholders about the McKellar Guidelines included: Dunning T, Savage S, Duggan N. (2014) Managing older people with diabetes: can age-specific guidelines help health professionals plan proactive individualised care? The Hive 5 Autumn Dunning T, Savage S, Duggan N. (2014) New look on an old foe Nursing Review 2:22. Dunning T, Savage S, Duggan N. (2014) The McKellar Guidelines The Senior (accepted to be published in August). Key presentations: Dunning T. (2014). Key issues when managing diabetes in older people. On Line International Diabetes Forum; January 14–15, 2014. Dunning T. (2014). The McKellar Guidelines for Managing Older People with Diabetes. Tasmanian Diabetes Association and Managers from Aged Care Facilities in Hobart; February 3–4, 2014; Hobart. Dunning T. (2014). Caring for older people with diabetes: conception and development of The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings. 3rd Biennial Australian Capital Region Nursing and Midwifery Research Centre Conference; October 16-17, Canberra. The Guidelines go live on PROMPT The McKellar Guidelines became the official policy for managing older people with diabetes in residential aged care in Barwon Health in August when they went live on PROMPT – the system for storing and managing documents approved as Barwon Health policies and guidelines. The McKellar Guidelines were also incorporated into the Platinum V electronic system, which is used to store and manage Barwon Health’s residential aged care facility patient files. The McKellar Way A new document, The McKellar Way. How to use the McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings, was developed in 2014. The McKellar Way includes general and specific information about how to use the McKellar Guidelines to plan care for Facility and Nurse Unit Managers, Nursing staff and Personal Care Workers. The McKellar Way can be accessed at Barwon Health via PROMPT. The McKellar Guidelines and the McKellar Way are available on the Australian Disease Management Association (ADMA) Integrated Chronic Disease Management Online Clearinghouse: http://www.adma.org.au/clearinghouse/cat_view/4- guidelines.html We acknowledge the support of the Percy Baxter Philanthropic Trust, which funded the development of the McKellar Guidelines. The evaluation of the McKellar Guidelines was funded by the Quality Improvement Unit, Ageing and Aged Care Branch of the Victorian Government Department of Health. 7 CNAHR Annual Report 2014 Pain is a subjective, emotional experience specific to the individual. Self-report is the most reliable measure of an individual’s pain. (Australian Pain Society, 2005) 8 CNAHR Annual Report 2014 The POP-D Study: Pain in Older People with Diabetes Diabetes, especially diabetes complications, is associated with pain such as neuropathic and cardiac pain and significant emotional distress. We developed a diabetes- specific pain risk tool to be included in the McKellar Guidelines, the tool was used in the POP-D study with other pain assessment tools. Data were collected from a medical record audit and 33 individual interviews with residents with diabetes at the McKellar Centre and older people with diabetes attending the Diabetes Referral Centre at Barwon Health. When undertaking preliminary data analysis, we examined missing data patterns among the various tools included in the interview to identify which tools could be removed to reduce the burden on participants without compromising the study when continuing the interviews. Madhu Subramaniam, a volunteer, cleaned and analysed the data. Madhu read the interview transcripts, that contained a large amount of missing data to confirm the data were actually missing, which increased the trustworthiness of the data. The data suggests that the participants under-reported their pain and used various terms other than pain to describe their pain. 9 CNAHR Annual Report 2014 10 CNAHR Annual Report 2014 The Quality Use of Glucose Lowering Medicines: The Q-Med Study In 2013 the CNAHR received funding from the Commonwealth Department of Health and Ageing (now the Department of Social Services) Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) totalling $600,000 over three years. The focus of the The Quality Use of Medicines (QUM) and Glucose Lowering Medicines (GLM) in Aged Care (the Q-Med study), is developing and evaluating information about safe GLM use for nurses, personal care workers and older people with diabetes and family carers. Progress on the Q-Med study during 2014 included: Obtaining ethics approval from the Barwon Health Human Research Ethics Committee (HREC) in July. Developing four versions of the information in consultation with the Health Professional Interdisciplinary Advisory Group, personal care workers and an Advisory Group of older people with diabetes. The three versions of the information are: - Glucose Lowering Medicine Information for Older People with Diabetes and Their Family Carers. - Older People with Diabetes and Glucose Lowering Medicines: Information for Personal Care Workers. - Older People with Diabetes and Glucose Lowering Medicines: Information for Registered and Enrolled nurses. - Older People with Diabetes and Glucose Lowering Medicines: An Online Self-directed Learning Module for Nurses. The information will be evaluated in the McKellar Centre and in other organisations. Two partner organisations signed Memoranda of Understanding to participate in the project: - Helping Hand (HH) Aged Care South Australia. - Uniting Care Life Assist Melbourne (formerly Uniting Care Community Options). The medical record audit of residents with diabetes in RACFs was completed in the McKellar Centre and in Helping Hand facilities. In addition, Helping Hand and Life Assist will each audit between 10 and 20 medical records of older people with diabetes receiving aged care packages and living in the community. In November we held a start-up meeting to formally introduce the Q-Med study and the evaluation process to Residential Aged Care Facility Managers and Nurse Unit Managers in the McKellar Centre. Dr Sam Korn is the Project Manager and Ms Nicole Duggan is the Project Leader for the McKellar Centre. Susan Streat and our volunteers, Mathuri (Madhu) Subramaniam and Clare Bennett assisted with the medical record audit. 11 CNAHR Annual Report 2014 Medicine-related adverse events are a common cause of admission to hospital. Hypoglycaemia is the most common, significant life-threatening adverse event associated with insulin and sulphonylureas. Hypoglycaemia is often missed in older people with diabetes because of age-related changes and inability to mount a counter-regulatory response to low blood glucose. (Seaquist et al. 2013) 12 CNAHR Annual Report 2014 Sharing Knowledge: Publications and Presentations 13 CNAHR Annual Report 2014 Peer-reviewed publications Dunning T. (2014). Complementary and alternative medicine: how reliable is the information? Australian Diabetes Educator, 17(2), June, 22-24. Dunning T. (2014). Complementary and alternative therapies – use by women with diabetes during pregnancy and women with gestational diabetes. Australian Diabetes Educator, 17(3), August, 30-33. Dunning T. (2014). Overview of complementary and alternative medicine and diabetes. Practical Diabetes. 31(9):381–386. Dunning T, Cukier K. (2014). HbA1c: Chasing numbers or considering context? Journal of Diabetes Nursing. 18(1):13-18. Dunning T, Sinclair A. (2014). Glucose lowering medicines and older people: the importance of comprehensive assessments and pharmacovigilance. Journal of Nursing and Care.3:1-4. Dunning T, Sinclair A. (2014). The IDF global guideline for managing older people with type 2 diabetes: implications for nurses. Journal of Diabetes Nursing. 18(4):145-150. Dunning T, Sinclair A, Colagiuri S. (2014). New IDF Guideline for managing type 2 diabetes in older people. Diabetes Research and Clinical Practice. 103(3):538-540. Dunning T, Savage S, Duggan N, Martin P. (2014). Palliative and end of life care for people with diabetes: a topical issue. Diabetes Management. 4(5):449–460. Gill SD, Dunning T, McKinnon F, Cook D, Bourke J. (2014). Understanding the experience of inpatient rehabilitation: insights into patient-centred care from patients and family members. Scandinavian Journal of the Caring Sciences. 28(2):264-272. Claydon-Platt K, Manias E, Dunning T. (2014). Development and evaluation of a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence. Contemporary Nurse. 48(1):10-25. Claydon-Platt K, Manias E, Dunning T. (2014). The barriers and facilitators people with diabetes from a non-English speaking background experience when managing their medications: a qualitative study. Journal of Clinical Nursing. 23(15-16):2234-2246. Moore KJ, Doyle CJ, Dunning TL, et al. (2014). Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors. Australian Health Review. 38(3):325-331. Ostaszkiewicz J, O'Connell B, Dunning T. (2014). Ethical challenges associated with providing continence care in residential aged care facilities: findings from a grounded theory study. Australian and New Zealand Continence Journal 20(4):179–186. 14 CNAHR Annual Report 2014 Sinclair A, Dunning T, Rodriguez-Manas L. (2014). Diabetes in older people: new insights and remaining challenges. The Lancet Diabetes and Endocrinology, Early Online publication, 24 Nov, doi:10.1016/S2213-8587(14)701 Aguirre Seret FM, Dunning T, Belton A, McLaughlin S. (2014). Preparing health professionals to work in diabetes education and care: a situation analysis. International Journal of Health Promotion and Education. doi.org/10.1080/14635240.2014.932671. Yodchai K, Dunning T, Savage S, Hutchinson AM, Oumtanee A. (2014). How do Thai patients receiving haemodialysis cope with pain? Journal of Renal Care. 40(3):205-215. Wong SF, Norman R, Dunning TL, Ashley DM, Lorgelly PK. (2014). A protocol for a discrete choice experiment: understanding preferences of patients with cancer towards their cancer care across metropolitan and rural regions in Australia. BMJ Open.4(10):e006661. doi:10.1136/bmjopen- 2014-006661 Non-peer reviewed publications Dunning T, Sinclair A, Colagiuri S. (2014). Overview of the IDF Global Guideline for Managing Older people with Type 2 Diabetes. Diabetes Voice 22 (1):58–61. Dunning T, Savage S, Duggan N. (2014). Managing older people with diabetes: can age-specific guidelines help health professionals plan proactive individualised care? The Hive 5 Autumn, 30-31. Dunning T, Savage S, Duggan N. (2014). New look on an old foe. Nursing Review 2:22. Guidelines, Position Statements and Philosophies Dunning T, Duggan N, Savage S. (2014). The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings. CNAHR, Geelong. http://www.adma.org.au/clearinghouse/doc_details/133- the-mckellar-guidelines-for-managing-older-people-with- diabetes-in-residential-and-other-care- settings_9dec2013.html Dunning T, Duggan N, Savage S. (2014). The McKellar Way: How to use the McKellar Guidelines. CNAHR, Geelong. http://www.adma.org.au/clearinghouse/doc_details/156- the-mckellar-way-final_how-to-use-the-mckellar- guidelines_e_24-7-14.html Dunning T, Savage S, Duggan N. in collaboration with Palliative Care Australia and Diabetes Australia (2014) Caring for People with Diabetes at the End of Life: A Position Statement. Centre for Nursing and Allied Health Research, Deakin University and Barwon Health, Geelong. Dunning T, Sinclair A, Savage S, Duggan N. (2014). A philosophical framework to Guide the Care of Older People with Diabetes. Centre for Nursing and Allied Health Research, Deakin University and Barwon Health, Geelong and Institute for Diabetes and Older People (IDOP), University of Bedfordshire , United Kingdom. 15 CNAHR Annual Report 2014 Books Dunning T. (2014). Care of People with Diabetes: a Manual of Nursing Practice (4th ed.). Chichester, England: Wiley-Blackwell. Book Monograph Dunning T. (2014) Lavender. In L Braun & M Cohen (Eds.), Herbs and Natural Supplements: An Evidence Based Guide. Volume 2 (4th ed.). Sydney, Churchill Livingston (pp613-623). Invited Presentations Dunning T. (2014). Key issues when managing diabetes in older people. On Line International Diabetes Forum; January 14–15, 2014. Dunning T. (2014). The McKellar Guidelines for Managing Older People with Diabetes. Tasmanian Diabetes Association and Managers from Aged Care Facilities in Hobart; February 3–4, 2014; Hobart. Dunning T. (2014). Managing diabetes at the end of life - People with diabetes' perspectives. Gold Coast Palliative Care Network; April 30, 2014; Gold Coast. Dunning T. (2014). Juggling diabetes and complicated medical conditions. AUSMEd Education; May 1, 2014; Melbourne. Dunning T. (2014). Academic and creative writing: the interface. Deakin Literary Society; May 10, 2014; Geelong. Dunning T. (2014). Diabetes and its complications. Geelong Rotary Group; July 21, 2014; Geelong. Dunning T. (2014). Glucose lowering medicines and older people with diabetes: the imperative for quality use of medicines and pharmacovigilance. Australian Aged Care Quality Agency Better Practice Conference; May 29-30, 2014; Melbourne. Dunning T. (2014). Communicating Risk. Biological Nurses Group – July 26, 2014; Melbourne Dunning T. (2014). Medicines and older people with diabetes: the imperative for quality use of medicines. Australian Aged Care Quality Agency Better Practice Conference; July 31, 2014; Adelaide. Dunning T. (2014). Complementary medicines and diabetes. Australian Diabetes Educators Association Vic Branch Meeting; August 1, Melbourne. Dunning T. (2014) How to Judge Presentations and Abstracts. Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting 27th – 29th August, Melbourne. Dunning T. (2014). Diabetes: What do we measure ? Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting 27th – 29th August, Melbourne. Dunning T. (2014). Moderate the consumer forum. Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting 27th – 29th August, Melbourne. 16 CNAHR Annual Report 2014 Dunning T. (2014). Older People with Diabetes and the IDF Global Guideline. Foundation of European Nurses in Diabetes Annual Conference, 12-13 September, Vienna, Austria. Dunning T. (2014). Caring for older people with diabetes: conception and development of The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings. 3rd Biennial Australian Capital Region Nursing and Midwifery Research Centre Conference; 16-17 October, Canberra. Dunning T. (2014). Complementary therapies and mental health care. Victorian Mental Health Nurse Practitioner Network; October 31, 2014; Caulfield Medical Centre. Dunning T. (2014). Diabetes and end of life care. General Practice Conference and Exhibition and Practice Nurse Clinical Education, November 15, Melbourne. Dunning T. (2014). Issues to consider when planning care for older people with diabetes. International Diabetes Federation Western Pacific Region Biennial Conference; November 21–24, Singapore. Invited Public Presentations Peer-reviewed Oral Presentations Dunning T. (2014). Measuring beyond glycaemia: the importance of other quality indicators. Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting, 27th-29th August, Melbourne. Duggan N, Dunning T, Savage S. (2014). Community- dwelling older people with diabetes’ perspective of diabetes self-care. Australian Diabetes Society and Australian Diabetes Educators Association, Annual Scientific Meeting, 27th-29th August, Melbourne. Dunning T. (2014). Implementing the McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings: Some quality use of medicine issues. National Medicines Symposium 22nd May, Brisbane. Dunning T, Savage S, Duggan N. (2014). The McKellar Guidelines: developed, evaluated and launched – what now? Australian Aged Care Quality Agency Better Practice Conference, 29-30 May, Melbourne. Dunning T, Savage S, Duggan N. (2014). Caring for older people with diabetes: do guidelines help health professionals individualise care? Australian Diabetes Society and Australian Diabetes Educators Association Dunning T. (2014). How to manage 'diabetes medicines'. Diabetes Australia-Victoria Public Plenary; March 1, Annual Scientific Meeting 27th – 29th August, Melbourne. Melbourne. Dunning T. (2014). Complementary therapies and diabetes. Fitzroy Diabetes Education Centre Public Lecture; May 2, 2014; Melbourne. Dunning T, Savage S, Duggan N. (2014). Implementing the McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings: Some quality use of medicine issues. Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting 27th – 29th August, Melbourne. 17 CNAHR Annual Report 2014 Dunning T, Savage S, Duggan N. (2014). Caring for older people with diabetes: do guidelines help health professionals individualise care? International Diabetes Federation, Western Pacific Regional Conference 21st-24th November, Singapore. Ostaszkiewicz J, O’Connell B, Dunning T. (2014) Providing continence care in long term care facilities: findings from a grounded theory study. 44th Annual Meeting of the International Continence Society (ICS), 20-24 October, Rio de Janiero, Brazil. Savage S, Dunning T, Duggan N, Waddell J. (2014) Individualised medicine education for people with type 2 diabetes. Australian Diabetes Society and Australian Diabetes Educators Association, Annual Scientific Meeting, 27th-29th August, Melbourne. The list does not include abstracts co-authored with students. Peer-reviewed Poster Presentations Savage S, Dunning T, Duggan N, Muir P, Waddell J. (2014) Tailored medicine education for people with type 2 diabetes. Poster presented at Smart Geelong Research Week, November 10-14, Barwon Health, Geelong. Other presentations Dunning T. (2014). 'Ethical and methodical issued that arise when involving very vulnerable people in research'. School of Nursing and Midwifery Critical Conversations, September 25, Deakin University, Burwood, Melbourne. Dunning T. (2014) Lecture - Graduate Certificate Diabetes Education, Aged Care Guidelines and End-of- life Research in Diabetes Practice. 15th August, Deakin University, Burwood, Melbourne. Dunning T. (2014) Annual World Diabetes Day Professorial Address, Medicines: The Human Side. November 14, Centre for Nursing and Allied Health Research, Deakin University and Barwon Health, Geelong. 18 CNAHR Annual Report 2014 Important Events 19 CNAHR Annual Report 2014 Trisha Dunning inducted in to the 2014 Victorian Honour Roll of Women Since 2001, The Victorian Honour Roll of Women has contributed to the public recognition of inspirational women from all walks of life. Women who have demonstrated extraordinary leadership and excellence in their field of work and expertise or commitment to a cause or interest. By doing so, these women have created a positive difference to the lives of other women in Victoria, Australia and internationally. On March 6, in the lead up to International Women’s Day, celebrated on March 8 each year, Professor Trisha Dunning was one of twenty women inducted into the 2014 The Victorian Honour Roll of Women joining 518 women who have been inducted since its inception. It was noted in the Victorian Honour Roll commemorative booklet that Professor Dunning was recognised for her expertise and commitment to diabetes and nursing since the commencement of her career as a diabetes educator in 1984. Trisha has made an extensive contribution, nationally and internationally, to the development of nursing and health policy practice; patient education and care; evidence-based research; and health professional education. Trisha is highly regarded by her peers as an outstanding role model and leader. Professor Dunning stated, “I want to be the best nurse I can possibly be. That means continuing to learn new things, reading widely, constantly questioning, reflecting on a broad range of issues – and often little sleep! I work in a profession I love, in a role that enables me to blend art, science, teaching and clinical care. This constantly challenges me to do more, however I could not achieve this without the support of my colleagues, my friends and my four and two legged family members.“ “I am deeply honoured to be admitted to the Victorian Honour Roll of Women. I just do a job I love, and if it helps others that is a huge reward” Professor Trisha Dunning 20 CNAHR Annual Report 2014 Nicole Duggan Graduates with a Master of Nursing Practice, Deakin University October 9th 2014 Professor Dunning and her team were delighted to attend and celebrate with their colleague, Nicole Duggan, who graduated with a Master of Nursing Practice, Deakin University on October 9, 2014. Nicole has worked with the CNAHR since December 2008 when she commenced as a Research Assistant for the project: Managing Diabetes at the End of Life. Since then Nicole has worked on projects such as: Medicines Education for People with Type 2 Diabetes; The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings and, The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings – Small Rural Residential Aged Care Facilities. Professor Dunning and Dr. Sally Savage supported and supervised Nicole to complete her Master of Nursing Practice and Professor Dunning supported her to fulfil the criteria to become a Credentialed Diabetes Educator in 2011. Nicole has presented six posters and four oral presentations at conferences and co-authored six peer- reviewed journal articles since commencing with the Centre for Nursing and Allied Health Research. Nicole currently works with the CNAHR as the Q-Med Study Nurse Researcher and Project Leader at the McKellar Centre and as a Credentialed Diabetes Educator at Newcomb Community Health Centre. Ms Nicole Duggan at her graduation 21 CNAHR Annual Report 2014 Professor Trisha Dunning delivering the 2014 World Diabetes Day Professorial Address in November 22 CNAHR Annual Report 2014 7th Annual World Diabetes Day Professorial Address The Annual World Diabetes Day Professorial Address is delivered each year on the Friday closest to World Diabetes Day (WDD). WDD occurs on the 14th November every year to commemorate Frederick Banting’s birthday (Banting and George Best discovered insulin) and to highlight the significant global burden diabetes represents. The lectures are well attended by an interdisciplinary audience and some attendees tell us the address is the ‘highlight of the year.’ The title of the Annual WDD Professorial Address in 2014 was: Medicines: The human side. Professor Dunning presented a thought provoking insight into the personal and social issues surrounding the quality use of medicines for both consumers and clinicians. Professor Trisha Dunning delivering the Annual WDD address Dr Lucy Cuddihy, Executive Director, Nursing, Midwifery and Residential Aged Care, Barwon Health, thanking Professor Dunning 23 CNAHR Annual Report 2014 24 CNAHR Annual Report 2014 Staff from CNAHR continue to support colleagues from both Barwon Health and Deakin University in various ways and delivered four professional development research and writing workshops in 2014. Workshop 1 Thursday 6th March 9:30am-12pm Writing great abstracts Presented by Professor Trisha Dunning Attended by 13 people Workshop 2 Thursday 12th June 9:30am-12pm Tips for preparing power point presentations Presented by Dr Sally Savage Attended by 23 people Workshop 3 Thursday 7th August 9:30am-12pm Bugs in writing: big bugs, little bugs and what to do about them Presented by Professor Trisha Dunning Attended by 12 people Workshop 4 Thursday 9th October 9:30am-12pm How to do a basic audit Presented by Professor Trisha Dunning Attended by 18 people 25 CNAHR Annual Report 2014 PhD Candidates Yen Yang, supervised by Professor Trisha Dunning and Assoc Professor Bodil Rasmussen, submitted her thesis titled, The lived experience of Chinese people with diabetes living in Australia in December 2013 and had her degree awarded in 2014. Kantaporn Yodchi, supervised by Professor Trisha Dunning, Dr Sally Savage and Assoc Professor Alison Hutchinson, submitted her thesis titled, How do Thai patients with End Stage Renal Disease Adapt to Being Dependent on Haemodialysis? and had her degree awarded in 2014. Roslyn Gillies, supervised by Professor S Groves and ProfessorTrisha Dunning, will submit her thesis in 2015. Roslyn’s project is entitled, Nurses and medicine dose calculations. Lisa-Jane Moody, supervised by Professor Trisha Dunning and Dr Sally Savage, will submit her thesis in 2015. Lisa-Jane’s project is entitled, The Impact of Hearing Loss on Quality and Safety in Hospital. Trish Mant, supervised by Professor Trisha Dunning and Dr Lucy Cuddihy, commenced her candidature in 2015. Trish’s project is entitled, Implementing a falls prevention strategy using the knowledge to action framework—an evaluation. MD Thesis Shu Fen Wong, supervised by Professor David Ashley, Dr Paula Lorngelly and Professor Trisha Dunning will submit her thesis in June 2015. Her project is entitled, Choices that influence cancer care in metropolitan and rural areas. 26 CNAHR Annual Report 2014 Master’s Candidates Nicole Duggan, supervised by Professor Trisha Dunning and Dr Sally Savage, was awarded her Master of Nursing Practice from Deakin University in October 2014. Her thesis was titled, Community-dwelling older people with diabetes’ perspective of diabetes self-care. Claire Gatto, co-supervised by Professor Trisha Dunning with principal surpervisor, Bodil Rasmussen. Claire is completing a minor research thesis as part of her Master degree. Honours Student Robyn McLey, supervised by Professor Trisha Dunning, intermitted her Honours project in late 2014. Robyn’s project is entitled, A qualitative study to explore the elderly patient’s experience of opioid-induced constipation (OIC) after total joint replacement (TJR) surgery. Master’s Candidate – Other Universities Donna Lever, co-supervised by Professor Trisha Dunning. Donna is enrolled in the University of Sydney. Her principle supervisor is Kate McMaster and her thesis is about cancer survivorship and the needs of young adults. Donna is hoping to convert to a PhD. 27 CNAHR Annual Report 2014 Some Key Committees* Barwon Health Member, Research Week Organising Committee 2007–. Member, Research Review Committee (Professor Dunning 2007–, Susan Streat 2012– ). Member, Nursing Leadership Committee (LINC) 2008– Member, Research Professoriate Committee 2012– Member, Barwon Health and Deakin Research Committee 2013– Member, Teaching, Training and Research Governance Committee 2014– Member, Hand Hygiene: Clean Hands, Best Care Research Working Group 2013– (Professor Dunning and Dr Savage). Deakin University Member, School of Nursing and Midwifery, Professoriate 2007– Member, University Human Research Ethics Committee Geelong (DUHREC) 2007– Chair, Faculty of Health Human Ethics Advisory Group (HEAG) 2012– Member, Executive and General Committees, Centre for Quality and Patient Safety Research (QPS) 2009– Member, Student Supervision, Research and Teaching 2014- Australian Diabetes Educators Association (ADEA) ADEA representative on the Deakin University Advisory Committee for the Graduate Certificate in Diabetes Education 2008– Member, Graduate Certificate in Diabetes Education Curriculum Advisory Committee (CASP) 2007– ADEA Representative to the International Diabetes Federation Western Pacific Regional Council 2009– ADEA member, Research Advisory Group 2014– National and State Committees Member, Diabetes Australia International Affairs Committee 2009– Member, Board of Management Diabetes Australia - Victoria 2011– Member, Diabetes Australia – Vic Clinical Advisory Committee 2014– Member, Diabetes Australia Policies and Programs Committee 2014– * Professor Dunning unless otherwise stated 28 CNAHR Annual Report 2014 International Committees Professor Dunning Vice President, International Diabetes Federation (IDF) Board of Management 2009– Member, IDF Consultative Section on Diabetes Education 2013– Member IDF Committee Fred Hollows Foundation Collaboration and subsequently appointed as a member of the IDF Fred Hollows Advisory Committee 2013– Member IDF Programme Committee Education and Behaviour Stream World Diabetes Congress (WDC) 2013– Member IDF Organising Committee Abstract Selection Committee, WDC 2013– Chair, IDF Ethics Committee 2012– Member, IDF International Affairs Committee 2012– Member, IDF Science Taskforce 2012– 29 CNAHR Annual Report 2014 Reference , Consultant and Expert Advisory Groups Professor Dunning Department of Health and Ageing (DoHA) Pharmaceutical Policy Branch Post market review of PBS medicines and products used for the treatment of diabetes 2013–2015 Australian Commission for Quality and Safety in Health Care National insulin Inpatient chart pilot test advisory group 2013– Council of Therapeutic Advisory Groups Rethinking medicines decision-making in Australian Hospitals: Guiding Principles for the quality use of off- label medicine 2013–2014. Bergen University College International Expert on Diabetes Research Strategy: DiaBest Group, 2011– Steno Diabetes Centre Expert Advisory Group to Steno-REACH project established to develop diabetes training programs for health professionals in Malaysia 2014– Koc University, Turkey Expert panel to apply for an EU grant for continuing education for diabetes educators. 2014– Grant and Conference Abstract Assessment Panels Professor Dunning Grants Australian Diabetes Educators Association Barwon Health Sydney Parker Smith Grant Application Reviews Deakin University Grant Application Reviews Diabetes Australia Research Trust Grants (DART) Coordinate review of the education and behavioural research grant applications 2011– NHMRC Panel: Translational Research in Low and Middle Income Countries. Sigma Theta Tau International. Conference abstracts Australian Diabetes Educators Association International Diabetes Federation Sigma Theta Tau International Theses During 2014 Professor Dunning examined four PhD theses, three Master’s theses and one Honours thesis. 30 CNAHR Annual Report 2014 Journal Review Panels and Editorial Boards—Professor Dunning Member Review Panel (review 2 or more papers per year): Australian Journal of Primary Health BMC Family Practice Collegian Diabetic Medicine Diabetes Research and Clinical Practice European Diabetes Nursing Health Promotion International Health Expectations Journal of Diabetes Nursing Journal of Holistic Nursing Journal Palliative Medicine Journal of Nursing and Care Journal Nutrition, Health and Ageing Medical Sciences Nursing and Health Sciences Practical Diabetes Scandinavian Journal of Caring Sciences The Australian Diabetes Educator World Views on Evidence Based Nursing Editor-in-Chief: Global Journal of Health Science Member of the Editorial Board of: Diabetes Conquest 2000–2014 European Diabetes Nursing International Journal Clinical Aromatherapy Journal of Advanced Nursing Online Alternative Medicine World Journal of Diabetes Practice During 2014 Professor Dunning reviewed a total of 94 papers submitted to these journals. In addition, she reviewed 12 papers for McMaster Online Rating of Evidence. 31 CNAHR Annual Report 2014 Our Key Local Collaborations During 2014 we collaborated with: Barwon Health Palliative Care McKellar Centre Staff Infectious Diseases Oncology Allied Health GP Practitioners Dr. Mark Kennedy Deakin University Colleagues from School of Nursing and Midwifery Australian Centre for Behavioural Research in Diabetes School of Medicine University of Melbourne, Department of General Practice Associate Investigator on NHMRC grant: Structured monitoring to achieve glycaemic targets in people with type 2 diabetes using insulin in primary care. 32 CNAHR Annual Report 2014 Making Waves, Barwon Health’s Quarterly Publication, Edition 1, 2014 33 CNAHR Annual Report 2014 Deakin Nexus, March 27 2014 34 CNAHR Annual Report 2014 Diabetes Australia – Vic media release 35 CNAHR Annual Report 2014 Australian Ageing Agenda, August 19, 2014 36 CNAHR Annual Report 2014 Interviews with Professor Trisha Dunning and Ms Nicole Duggan on the Pulse Geelong Community Radio: February 4th June 27th October 6th Professor Trisha Dunning and Ms Nicole Duggan interview with Greg McHenry ‘Roads to recovery’ program to discuss blood glucose testing, medicines management, managing diet and physical activity, problem solving and decision making. Professor Trisha Dunning and Ms Nicole Duggan interview with Greg McHenry ‘Roads to recovery’ program to highlight living well with diabetes, preventing complications and where to seek support. Professor Trisha Dunning and Ms Nicole Duggan interview with Greg McHenry ‘Roads to recovery’ program to highlight local, national and global programs for World Diabetes Day (pre-recorded for World Diabetes Day in November). 37 CNAHR Annual Report 2014 The video of interviews conducted with Dr Sally Savage, Ms Nicole Duggan and Professor Trisha Dunning at the Australian Diabetes Society/Australian Diabetes Educators Association Annual Scientific Meeting placed on the Diabetes Educators Update website in August 2014. The interviews were about the paper presented by Sally entitled Individualised medicine education for people with type 2 diabetes. 38 CNAHR Annual Report 2014 The CNAHR Team Professor Trisha Dunning, AM Chair in Nursing, Deakin University and Barwon Health and Director, CNAHR Dr Sally Savage Research Fellow Ms Susan Streat Research Assistant Ms Nicole Duggan Project Leader Victorian Arm of The Q-Med Study Dr Sam Korn Project Manager The Q-Med Study 39 CNAHR Annual Report 2014 Our work would not be possible without support from many colleagues and departments in both Deakin University and Barwon Health. We especially thank Professors Maxine Duke and Lucy Cuddihy for their support, advice and encouragement throughout the year. It has been an honour to work with and learn from our professorial colleagues in The School of Nursing and Midwifery and our clinical nursing, medical and allied health colleagues in Barwon Health. We are very grateful to the older people with diabetes from Barwon Health Wise Group and from the North Geelong Medical Centre for providing valuable advice about our glucose lowering medicine information. Two volunteers joined our team in 2014 and have made an important contribution to data collection for the Q- Med Study and data analysis for The POP-D Study. We thank Madhu Subramaniam and Clare Bennett for their generous contribution. We are grateful for the support from the IT and Communications Departments of both institutions as well as the ‘mail room’, Finance and HR departments and Lyn Browne at Barwon Health. 40 CNAHR Annual Report 2014
Click tabs to swap between content that is broken into logical sections.
Rating | |
Title | Centre for Nursing and Allied Health Research Annual Report 2014 |
Subject | Annual Report |
Description | Contents: Introduction, The Year in Review: Highlights of 2014, Research: Improving Care for People with Diabetes, Sharing Knowledge: Publications and Presentations, Important Events, Supporting Colleagues to Engage in Research, Higher Degree Student Supervision, Contributions to the Profession, Our Key Collaborations, In the News, The CNAHR Team, Acknowledgements |
Author | Barwon Health |
Publisher | Barwon Health |
Date | 2014 |
Type | Text |
Format | |
Language | English |
Rights | CC BY-NC-ND 4.0 licence |
Transcript | Centre for Nursing and Allied Health Research 2014: our journey The ailment of advancing years ‘though I should try to hide Some day the thread will break The pearls scattered far and wide Age cannot be denied (Princess Shokusk 100 Verses from Old Japan Tuttle Publishers p. 89). Table of contents Introduction 1 The Year in Review: Highlights of 2014 2 Research: Improving Care for People with Diabetes 5 Sharing Knowledge: Publications and Presentations 13 Important Events 19 Supporting Colleagues to Engage in Research 24 Higher Degree Student Supervision 26 Contributions to the Profession 28 Our Key Collaborations 32 In the News 33 The CNAHR Team 38 Acknowledgements 39 The 2014 CNAHR annual report reflects the ‘visible’ contributions CNAHR made to research, teaching and clinical care at Deakin and Barwon Health during 2014. However, a great deal of the work is ‘invisible,’ does not qualify as university research output, and is often not acknowledged. The invisible work is important to Barwon Health and its strategic focus on becoming a recognised research hospital through education, research and care. Consequently, the significant amount of invisible time spent supervising and mentoring clinicians to undertake clinical research, largely concerned with quality and safety projects, is very important. Our highly visible outputs include implementing the McKellar Guidelines in the McKellar Centre, where they are now policy and advising other aged care service providers throughout Australia about implementing the guidelines in their services. We presented our work in national and international conferences, and commenced work on our successful Department of Social Services grant to develop information about glucose lowering medicines for older people with diabetes, nurses and personal care workers. The information will be evaluated in aged care settings and in the community in 2015/16. Our focus on diabetes research in older people is significant because diabetes is the most prevalent chronic disease globally and is one of the top 10 causes of death in Australia. Diabetes is the underlying cause of other common health problems such as cardiovascular disease, dementia, some forms of cancer and renal disease and is the leading cause of death in people with these complications. Significantly, the prevalence of diabetes is higher in the Barwon Region and the population is older than the rest of Victoria. We developed an ambitious five year strategic plan that will guide our work for the next five years. Other outputs include 17 peer-reviewed publications, one book, one book chapter, 20 invited presentations, consultancy and committee work and media presentations; all of which enhance the profile of Barwon Health, the Centre for Quality Patient and Safety Research and Deakin University. 1 CNAHR Annual Report 2014 Kitchener House, Barwon Health Waterfront Campus, Deakin University 2 CNAHR Annual Report 2014 CNAHR made a significant contribution to research, teaching, learning and clinical care in 2014. Key highlights of the year were: Implementing The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings were implemented in the McKellar Centre where they became policy for managing older people with diabetes in the McKellar Centre in July 2014 (see page 7). Completing the draft suite of information and commencing data collection for the Quality Use of Glucose Lowering Medicines: Q-Med Study (see page 11). Publishing 17 peer-reviewed papers, one book, one book monograph, four other publications, presenting nine peer-reviewed conference presentations and delivering 20 invited presentations (see pages 13-18). Holding four research and writing professional development workshops throughout the year. Between 10 and 21 people attend each workshop (see page 25). Participating in three interviews conducted on 94.7 The Pulse FM Geelong public radio station to raise public awareness about Diabetes and to promote Diabetes Awareness Week and World Diabetes Day (see page 22). Delivering the Annual World Diabetes Day Professorial Address, Medicines: The Human Side, during Smart Geelong Research Week at Barwon Health (see page 24). Professor Trisha Dunning was inducted to the Victorian Honour Roll of Women on March 6 in the lead up to International Women’s Day 2014 (see page 20). 3 CNAHR Annual Report 2014 4 CNAHR Annual Report 2014 Research: Improving the Care of Older People with Diabetes Key CNAHR‒led research projects are featured in the report including: The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings at The McKellar Centre The Quality Use of Glucose Lowering Medicines: The Q-Med study Pain in Older People with Diabetes—The POP-D study 5 CNAHR Annual Report 2014 Guidelines are designed to be used with clinical judgement after undertaking a comprehensive assessment to plan personalised care. (Dunning 2014) 6 CNAHR Annual Report 2014 The McKellar Guidelines CNAHR staff undertook many activities to disseminate The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings (The McKellar Guidelines) throughout 2014. Publications to inform stakeholders about the McKellar Guidelines included: Dunning T, Savage S, Duggan N. (2014) Managing older people with diabetes: can age-specific guidelines help health professionals plan proactive individualised care? The Hive 5 Autumn Dunning T, Savage S, Duggan N. (2014) New look on an old foe Nursing Review 2:22. Dunning T, Savage S, Duggan N. (2014) The McKellar Guidelines The Senior (accepted to be published in August). Key presentations: Dunning T. (2014). Key issues when managing diabetes in older people. On Line International Diabetes Forum; January 14–15, 2014. Dunning T. (2014). The McKellar Guidelines for Managing Older People with Diabetes. Tasmanian Diabetes Association and Managers from Aged Care Facilities in Hobart; February 3–4, 2014; Hobart. Dunning T. (2014). Caring for older people with diabetes: conception and development of The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings. 3rd Biennial Australian Capital Region Nursing and Midwifery Research Centre Conference; October 16-17, Canberra. The Guidelines go live on PROMPT The McKellar Guidelines became the official policy for managing older people with diabetes in residential aged care in Barwon Health in August when they went live on PROMPT – the system for storing and managing documents approved as Barwon Health policies and guidelines. The McKellar Guidelines were also incorporated into the Platinum V electronic system, which is used to store and manage Barwon Health’s residential aged care facility patient files. The McKellar Way A new document, The McKellar Way. How to use the McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings, was developed in 2014. The McKellar Way includes general and specific information about how to use the McKellar Guidelines to plan care for Facility and Nurse Unit Managers, Nursing staff and Personal Care Workers. The McKellar Way can be accessed at Barwon Health via PROMPT. The McKellar Guidelines and the McKellar Way are available on the Australian Disease Management Association (ADMA) Integrated Chronic Disease Management Online Clearinghouse: http://www.adma.org.au/clearinghouse/cat_view/4- guidelines.html We acknowledge the support of the Percy Baxter Philanthropic Trust, which funded the development of the McKellar Guidelines. The evaluation of the McKellar Guidelines was funded by the Quality Improvement Unit, Ageing and Aged Care Branch of the Victorian Government Department of Health. 7 CNAHR Annual Report 2014 Pain is a subjective, emotional experience specific to the individual. Self-report is the most reliable measure of an individual’s pain. (Australian Pain Society, 2005) 8 CNAHR Annual Report 2014 The POP-D Study: Pain in Older People with Diabetes Diabetes, especially diabetes complications, is associated with pain such as neuropathic and cardiac pain and significant emotional distress. We developed a diabetes- specific pain risk tool to be included in the McKellar Guidelines, the tool was used in the POP-D study with other pain assessment tools. Data were collected from a medical record audit and 33 individual interviews with residents with diabetes at the McKellar Centre and older people with diabetes attending the Diabetes Referral Centre at Barwon Health. When undertaking preliminary data analysis, we examined missing data patterns among the various tools included in the interview to identify which tools could be removed to reduce the burden on participants without compromising the study when continuing the interviews. Madhu Subramaniam, a volunteer, cleaned and analysed the data. Madhu read the interview transcripts, that contained a large amount of missing data to confirm the data were actually missing, which increased the trustworthiness of the data. The data suggests that the participants under-reported their pain and used various terms other than pain to describe their pain. 9 CNAHR Annual Report 2014 10 CNAHR Annual Report 2014 The Quality Use of Glucose Lowering Medicines: The Q-Med Study In 2013 the CNAHR received funding from the Commonwealth Department of Health and Ageing (now the Department of Social Services) Aged Care Services Improvement Healthy Ageing Grant (ACSIHAG) totalling $600,000 over three years. The focus of the The Quality Use of Medicines (QUM) and Glucose Lowering Medicines (GLM) in Aged Care (the Q-Med study), is developing and evaluating information about safe GLM use for nurses, personal care workers and older people with diabetes and family carers. Progress on the Q-Med study during 2014 included: Obtaining ethics approval from the Barwon Health Human Research Ethics Committee (HREC) in July. Developing four versions of the information in consultation with the Health Professional Interdisciplinary Advisory Group, personal care workers and an Advisory Group of older people with diabetes. The three versions of the information are: - Glucose Lowering Medicine Information for Older People with Diabetes and Their Family Carers. - Older People with Diabetes and Glucose Lowering Medicines: Information for Personal Care Workers. - Older People with Diabetes and Glucose Lowering Medicines: Information for Registered and Enrolled nurses. - Older People with Diabetes and Glucose Lowering Medicines: An Online Self-directed Learning Module for Nurses. The information will be evaluated in the McKellar Centre and in other organisations. Two partner organisations signed Memoranda of Understanding to participate in the project: - Helping Hand (HH) Aged Care South Australia. - Uniting Care Life Assist Melbourne (formerly Uniting Care Community Options). The medical record audit of residents with diabetes in RACFs was completed in the McKellar Centre and in Helping Hand facilities. In addition, Helping Hand and Life Assist will each audit between 10 and 20 medical records of older people with diabetes receiving aged care packages and living in the community. In November we held a start-up meeting to formally introduce the Q-Med study and the evaluation process to Residential Aged Care Facility Managers and Nurse Unit Managers in the McKellar Centre. Dr Sam Korn is the Project Manager and Ms Nicole Duggan is the Project Leader for the McKellar Centre. Susan Streat and our volunteers, Mathuri (Madhu) Subramaniam and Clare Bennett assisted with the medical record audit. 11 CNAHR Annual Report 2014 Medicine-related adverse events are a common cause of admission to hospital. Hypoglycaemia is the most common, significant life-threatening adverse event associated with insulin and sulphonylureas. Hypoglycaemia is often missed in older people with diabetes because of age-related changes and inability to mount a counter-regulatory response to low blood glucose. (Seaquist et al. 2013) 12 CNAHR Annual Report 2014 Sharing Knowledge: Publications and Presentations 13 CNAHR Annual Report 2014 Peer-reviewed publications Dunning T. (2014). Complementary and alternative medicine: how reliable is the information? Australian Diabetes Educator, 17(2), June, 22-24. Dunning T. (2014). Complementary and alternative therapies – use by women with diabetes during pregnancy and women with gestational diabetes. Australian Diabetes Educator, 17(3), August, 30-33. Dunning T. (2014). Overview of complementary and alternative medicine and diabetes. Practical Diabetes. 31(9):381–386. Dunning T, Cukier K. (2014). HbA1c: Chasing numbers or considering context? Journal of Diabetes Nursing. 18(1):13-18. Dunning T, Sinclair A. (2014). Glucose lowering medicines and older people: the importance of comprehensive assessments and pharmacovigilance. Journal of Nursing and Care.3:1-4. Dunning T, Sinclair A. (2014). The IDF global guideline for managing older people with type 2 diabetes: implications for nurses. Journal of Diabetes Nursing. 18(4):145-150. Dunning T, Sinclair A, Colagiuri S. (2014). New IDF Guideline for managing type 2 diabetes in older people. Diabetes Research and Clinical Practice. 103(3):538-540. Dunning T, Savage S, Duggan N, Martin P. (2014). Palliative and end of life care for people with diabetes: a topical issue. Diabetes Management. 4(5):449–460. Gill SD, Dunning T, McKinnon F, Cook D, Bourke J. (2014). Understanding the experience of inpatient rehabilitation: insights into patient-centred care from patients and family members. Scandinavian Journal of the Caring Sciences. 28(2):264-272. Claydon-Platt K, Manias E, Dunning T. (2014). Development and evaluation of a screening tool to identify people with diabetes at increased risk of medication problems relating to hypoglycaemia and medication non-adherence. Contemporary Nurse. 48(1):10-25. Claydon-Platt K, Manias E, Dunning T. (2014). The barriers and facilitators people with diabetes from a non-English speaking background experience when managing their medications: a qualitative study. Journal of Clinical Nursing. 23(15-16):2234-2246. Moore KJ, Doyle CJ, Dunning TL, et al. (2014). Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors. Australian Health Review. 38(3):325-331. Ostaszkiewicz J, O'Connell B, Dunning T. (2014). Ethical challenges associated with providing continence care in residential aged care facilities: findings from a grounded theory study. Australian and New Zealand Continence Journal 20(4):179–186. 14 CNAHR Annual Report 2014 Sinclair A, Dunning T, Rodriguez-Manas L. (2014). Diabetes in older people: new insights and remaining challenges. The Lancet Diabetes and Endocrinology, Early Online publication, 24 Nov, doi:10.1016/S2213-8587(14)701 Aguirre Seret FM, Dunning T, Belton A, McLaughlin S. (2014). Preparing health professionals to work in diabetes education and care: a situation analysis. International Journal of Health Promotion and Education. doi.org/10.1080/14635240.2014.932671. Yodchai K, Dunning T, Savage S, Hutchinson AM, Oumtanee A. (2014). How do Thai patients receiving haemodialysis cope with pain? Journal of Renal Care. 40(3):205-215. Wong SF, Norman R, Dunning TL, Ashley DM, Lorgelly PK. (2014). A protocol for a discrete choice experiment: understanding preferences of patients with cancer towards their cancer care across metropolitan and rural regions in Australia. BMJ Open.4(10):e006661. doi:10.1136/bmjopen- 2014-006661 Non-peer reviewed publications Dunning T, Sinclair A, Colagiuri S. (2014). Overview of the IDF Global Guideline for Managing Older people with Type 2 Diabetes. Diabetes Voice 22 (1):58–61. Dunning T, Savage S, Duggan N. (2014). Managing older people with diabetes: can age-specific guidelines help health professionals plan proactive individualised care? The Hive 5 Autumn, 30-31. Dunning T, Savage S, Duggan N. (2014). New look on an old foe. Nursing Review 2:22. Guidelines, Position Statements and Philosophies Dunning T, Duggan N, Savage S. (2014). The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings. CNAHR, Geelong. http://www.adma.org.au/clearinghouse/doc_details/133- the-mckellar-guidelines-for-managing-older-people-with- diabetes-in-residential-and-other-care- settings_9dec2013.html Dunning T, Duggan N, Savage S. (2014). The McKellar Way: How to use the McKellar Guidelines. CNAHR, Geelong. http://www.adma.org.au/clearinghouse/doc_details/156- the-mckellar-way-final_how-to-use-the-mckellar- guidelines_e_24-7-14.html Dunning T, Savage S, Duggan N. in collaboration with Palliative Care Australia and Diabetes Australia (2014) Caring for People with Diabetes at the End of Life: A Position Statement. Centre for Nursing and Allied Health Research, Deakin University and Barwon Health, Geelong. Dunning T, Sinclair A, Savage S, Duggan N. (2014). A philosophical framework to Guide the Care of Older People with Diabetes. Centre for Nursing and Allied Health Research, Deakin University and Barwon Health, Geelong and Institute for Diabetes and Older People (IDOP), University of Bedfordshire , United Kingdom. 15 CNAHR Annual Report 2014 Books Dunning T. (2014). Care of People with Diabetes: a Manual of Nursing Practice (4th ed.). Chichester, England: Wiley-Blackwell. Book Monograph Dunning T. (2014) Lavender. In L Braun & M Cohen (Eds.), Herbs and Natural Supplements: An Evidence Based Guide. Volume 2 (4th ed.). Sydney, Churchill Livingston (pp613-623). Invited Presentations Dunning T. (2014). Key issues when managing diabetes in older people. On Line International Diabetes Forum; January 14–15, 2014. Dunning T. (2014). The McKellar Guidelines for Managing Older People with Diabetes. Tasmanian Diabetes Association and Managers from Aged Care Facilities in Hobart; February 3–4, 2014; Hobart. Dunning T. (2014). Managing diabetes at the end of life - People with diabetes' perspectives. Gold Coast Palliative Care Network; April 30, 2014; Gold Coast. Dunning T. (2014). Juggling diabetes and complicated medical conditions. AUSMEd Education; May 1, 2014; Melbourne. Dunning T. (2014). Academic and creative writing: the interface. Deakin Literary Society; May 10, 2014; Geelong. Dunning T. (2014). Diabetes and its complications. Geelong Rotary Group; July 21, 2014; Geelong. Dunning T. (2014). Glucose lowering medicines and older people with diabetes: the imperative for quality use of medicines and pharmacovigilance. Australian Aged Care Quality Agency Better Practice Conference; May 29-30, 2014; Melbourne. Dunning T. (2014). Communicating Risk. Biological Nurses Group – July 26, 2014; Melbourne Dunning T. (2014). Medicines and older people with diabetes: the imperative for quality use of medicines. Australian Aged Care Quality Agency Better Practice Conference; July 31, 2014; Adelaide. Dunning T. (2014). Complementary medicines and diabetes. Australian Diabetes Educators Association Vic Branch Meeting; August 1, Melbourne. Dunning T. (2014) How to Judge Presentations and Abstracts. Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting 27th – 29th August, Melbourne. Dunning T. (2014). Diabetes: What do we measure ? Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting 27th – 29th August, Melbourne. Dunning T. (2014). Moderate the consumer forum. Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting 27th – 29th August, Melbourne. 16 CNAHR Annual Report 2014 Dunning T. (2014). Older People with Diabetes and the IDF Global Guideline. Foundation of European Nurses in Diabetes Annual Conference, 12-13 September, Vienna, Austria. Dunning T. (2014). Caring for older people with diabetes: conception and development of The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings. 3rd Biennial Australian Capital Region Nursing and Midwifery Research Centre Conference; 16-17 October, Canberra. Dunning T. (2014). Complementary therapies and mental health care. Victorian Mental Health Nurse Practitioner Network; October 31, 2014; Caulfield Medical Centre. Dunning T. (2014). Diabetes and end of life care. General Practice Conference and Exhibition and Practice Nurse Clinical Education, November 15, Melbourne. Dunning T. (2014). Issues to consider when planning care for older people with diabetes. International Diabetes Federation Western Pacific Region Biennial Conference; November 21–24, Singapore. Invited Public Presentations Peer-reviewed Oral Presentations Dunning T. (2014). Measuring beyond glycaemia: the importance of other quality indicators. Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting, 27th-29th August, Melbourne. Duggan N, Dunning T, Savage S. (2014). Community- dwelling older people with diabetes’ perspective of diabetes self-care. Australian Diabetes Society and Australian Diabetes Educators Association, Annual Scientific Meeting, 27th-29th August, Melbourne. Dunning T. (2014). Implementing the McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings: Some quality use of medicine issues. National Medicines Symposium 22nd May, Brisbane. Dunning T, Savage S, Duggan N. (2014). The McKellar Guidelines: developed, evaluated and launched – what now? Australian Aged Care Quality Agency Better Practice Conference, 29-30 May, Melbourne. Dunning T, Savage S, Duggan N. (2014). Caring for older people with diabetes: do guidelines help health professionals individualise care? Australian Diabetes Society and Australian Diabetes Educators Association Dunning T. (2014). How to manage 'diabetes medicines'. Diabetes Australia-Victoria Public Plenary; March 1, Annual Scientific Meeting 27th – 29th August, Melbourne. Melbourne. Dunning T. (2014). Complementary therapies and diabetes. Fitzroy Diabetes Education Centre Public Lecture; May 2, 2014; Melbourne. Dunning T, Savage S, Duggan N. (2014). Implementing the McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings: Some quality use of medicine issues. Australian Diabetes Society and Australian Diabetes Educators Association Annual Scientific Meeting 27th – 29th August, Melbourne. 17 CNAHR Annual Report 2014 Dunning T, Savage S, Duggan N. (2014). Caring for older people with diabetes: do guidelines help health professionals individualise care? International Diabetes Federation, Western Pacific Regional Conference 21st-24th November, Singapore. Ostaszkiewicz J, O’Connell B, Dunning T. (2014) Providing continence care in long term care facilities: findings from a grounded theory study. 44th Annual Meeting of the International Continence Society (ICS), 20-24 October, Rio de Janiero, Brazil. Savage S, Dunning T, Duggan N, Waddell J. (2014) Individualised medicine education for people with type 2 diabetes. Australian Diabetes Society and Australian Diabetes Educators Association, Annual Scientific Meeting, 27th-29th August, Melbourne. The list does not include abstracts co-authored with students. Peer-reviewed Poster Presentations Savage S, Dunning T, Duggan N, Muir P, Waddell J. (2014) Tailored medicine education for people with type 2 diabetes. Poster presented at Smart Geelong Research Week, November 10-14, Barwon Health, Geelong. Other presentations Dunning T. (2014). 'Ethical and methodical issued that arise when involving very vulnerable people in research'. School of Nursing and Midwifery Critical Conversations, September 25, Deakin University, Burwood, Melbourne. Dunning T. (2014) Lecture - Graduate Certificate Diabetes Education, Aged Care Guidelines and End-of- life Research in Diabetes Practice. 15th August, Deakin University, Burwood, Melbourne. Dunning T. (2014) Annual World Diabetes Day Professorial Address, Medicines: The Human Side. November 14, Centre for Nursing and Allied Health Research, Deakin University and Barwon Health, Geelong. 18 CNAHR Annual Report 2014 Important Events 19 CNAHR Annual Report 2014 Trisha Dunning inducted in to the 2014 Victorian Honour Roll of Women Since 2001, The Victorian Honour Roll of Women has contributed to the public recognition of inspirational women from all walks of life. Women who have demonstrated extraordinary leadership and excellence in their field of work and expertise or commitment to a cause or interest. By doing so, these women have created a positive difference to the lives of other women in Victoria, Australia and internationally. On March 6, in the lead up to International Women’s Day, celebrated on March 8 each year, Professor Trisha Dunning was one of twenty women inducted into the 2014 The Victorian Honour Roll of Women joining 518 women who have been inducted since its inception. It was noted in the Victorian Honour Roll commemorative booklet that Professor Dunning was recognised for her expertise and commitment to diabetes and nursing since the commencement of her career as a diabetes educator in 1984. Trisha has made an extensive contribution, nationally and internationally, to the development of nursing and health policy practice; patient education and care; evidence-based research; and health professional education. Trisha is highly regarded by her peers as an outstanding role model and leader. Professor Dunning stated, “I want to be the best nurse I can possibly be. That means continuing to learn new things, reading widely, constantly questioning, reflecting on a broad range of issues – and often little sleep! I work in a profession I love, in a role that enables me to blend art, science, teaching and clinical care. This constantly challenges me to do more, however I could not achieve this without the support of my colleagues, my friends and my four and two legged family members.“ “I am deeply honoured to be admitted to the Victorian Honour Roll of Women. I just do a job I love, and if it helps others that is a huge reward” Professor Trisha Dunning 20 CNAHR Annual Report 2014 Nicole Duggan Graduates with a Master of Nursing Practice, Deakin University October 9th 2014 Professor Dunning and her team were delighted to attend and celebrate with their colleague, Nicole Duggan, who graduated with a Master of Nursing Practice, Deakin University on October 9, 2014. Nicole has worked with the CNAHR since December 2008 when she commenced as a Research Assistant for the project: Managing Diabetes at the End of Life. Since then Nicole has worked on projects such as: Medicines Education for People with Type 2 Diabetes; The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings and, The McKellar Guidelines for Managing Older People with Diabetes in Residential and Other Care Settings – Small Rural Residential Aged Care Facilities. Professor Dunning and Dr. Sally Savage supported and supervised Nicole to complete her Master of Nursing Practice and Professor Dunning supported her to fulfil the criteria to become a Credentialed Diabetes Educator in 2011. Nicole has presented six posters and four oral presentations at conferences and co-authored six peer- reviewed journal articles since commencing with the Centre for Nursing and Allied Health Research. Nicole currently works with the CNAHR as the Q-Med Study Nurse Researcher and Project Leader at the McKellar Centre and as a Credentialed Diabetes Educator at Newcomb Community Health Centre. Ms Nicole Duggan at her graduation 21 CNAHR Annual Report 2014 Professor Trisha Dunning delivering the 2014 World Diabetes Day Professorial Address in November 22 CNAHR Annual Report 2014 7th Annual World Diabetes Day Professorial Address The Annual World Diabetes Day Professorial Address is delivered each year on the Friday closest to World Diabetes Day (WDD). WDD occurs on the 14th November every year to commemorate Frederick Banting’s birthday (Banting and George Best discovered insulin) and to highlight the significant global burden diabetes represents. The lectures are well attended by an interdisciplinary audience and some attendees tell us the address is the ‘highlight of the year.’ The title of the Annual WDD Professorial Address in 2014 was: Medicines: The human side. Professor Dunning presented a thought provoking insight into the personal and social issues surrounding the quality use of medicines for both consumers and clinicians. Professor Trisha Dunning delivering the Annual WDD address Dr Lucy Cuddihy, Executive Director, Nursing, Midwifery and Residential Aged Care, Barwon Health, thanking Professor Dunning 23 CNAHR Annual Report 2014 24 CNAHR Annual Report 2014 Staff from CNAHR continue to support colleagues from both Barwon Health and Deakin University in various ways and delivered four professional development research and writing workshops in 2014. Workshop 1 Thursday 6th March 9:30am-12pm Writing great abstracts Presented by Professor Trisha Dunning Attended by 13 people Workshop 2 Thursday 12th June 9:30am-12pm Tips for preparing power point presentations Presented by Dr Sally Savage Attended by 23 people Workshop 3 Thursday 7th August 9:30am-12pm Bugs in writing: big bugs, little bugs and what to do about them Presented by Professor Trisha Dunning Attended by 12 people Workshop 4 Thursday 9th October 9:30am-12pm How to do a basic audit Presented by Professor Trisha Dunning Attended by 18 people 25 CNAHR Annual Report 2014 PhD Candidates Yen Yang, supervised by Professor Trisha Dunning and Assoc Professor Bodil Rasmussen, submitted her thesis titled, The lived experience of Chinese people with diabetes living in Australia in December 2013 and had her degree awarded in 2014. Kantaporn Yodchi, supervised by Professor Trisha Dunning, Dr Sally Savage and Assoc Professor Alison Hutchinson, submitted her thesis titled, How do Thai patients with End Stage Renal Disease Adapt to Being Dependent on Haemodialysis? and had her degree awarded in 2014. Roslyn Gillies, supervised by Professor S Groves and ProfessorTrisha Dunning, will submit her thesis in 2015. Roslyn’s project is entitled, Nurses and medicine dose calculations. Lisa-Jane Moody, supervised by Professor Trisha Dunning and Dr Sally Savage, will submit her thesis in 2015. Lisa-Jane’s project is entitled, The Impact of Hearing Loss on Quality and Safety in Hospital. Trish Mant, supervised by Professor Trisha Dunning and Dr Lucy Cuddihy, commenced her candidature in 2015. Trish’s project is entitled, Implementing a falls prevention strategy using the knowledge to action framework—an evaluation. MD Thesis Shu Fen Wong, supervised by Professor David Ashley, Dr Paula Lorngelly and Professor Trisha Dunning will submit her thesis in June 2015. Her project is entitled, Choices that influence cancer care in metropolitan and rural areas. 26 CNAHR Annual Report 2014 Master’s Candidates Nicole Duggan, supervised by Professor Trisha Dunning and Dr Sally Savage, was awarded her Master of Nursing Practice from Deakin University in October 2014. Her thesis was titled, Community-dwelling older people with diabetes’ perspective of diabetes self-care. Claire Gatto, co-supervised by Professor Trisha Dunning with principal surpervisor, Bodil Rasmussen. Claire is completing a minor research thesis as part of her Master degree. Honours Student Robyn McLey, supervised by Professor Trisha Dunning, intermitted her Honours project in late 2014. Robyn’s project is entitled, A qualitative study to explore the elderly patient’s experience of opioid-induced constipation (OIC) after total joint replacement (TJR) surgery. Master’s Candidate – Other Universities Donna Lever, co-supervised by Professor Trisha Dunning. Donna is enrolled in the University of Sydney. Her principle supervisor is Kate McMaster and her thesis is about cancer survivorship and the needs of young adults. Donna is hoping to convert to a PhD. 27 CNAHR Annual Report 2014 Some Key Committees* Barwon Health Member, Research Week Organising Committee 2007–. Member, Research Review Committee (Professor Dunning 2007–, Susan Streat 2012– ). Member, Nursing Leadership Committee (LINC) 2008– Member, Research Professoriate Committee 2012– Member, Barwon Health and Deakin Research Committee 2013– Member, Teaching, Training and Research Governance Committee 2014– Member, Hand Hygiene: Clean Hands, Best Care Research Working Group 2013– (Professor Dunning and Dr Savage). Deakin University Member, School of Nursing and Midwifery, Professoriate 2007– Member, University Human Research Ethics Committee Geelong (DUHREC) 2007– Chair, Faculty of Health Human Ethics Advisory Group (HEAG) 2012– Member, Executive and General Committees, Centre for Quality and Patient Safety Research (QPS) 2009– Member, Student Supervision, Research and Teaching 2014- Australian Diabetes Educators Association (ADEA) ADEA representative on the Deakin University Advisory Committee for the Graduate Certificate in Diabetes Education 2008– Member, Graduate Certificate in Diabetes Education Curriculum Advisory Committee (CASP) 2007– ADEA Representative to the International Diabetes Federation Western Pacific Regional Council 2009– ADEA member, Research Advisory Group 2014– National and State Committees Member, Diabetes Australia International Affairs Committee 2009– Member, Board of Management Diabetes Australia - Victoria 2011– Member, Diabetes Australia – Vic Clinical Advisory Committee 2014– Member, Diabetes Australia Policies and Programs Committee 2014– * Professor Dunning unless otherwise stated 28 CNAHR Annual Report 2014 International Committees Professor Dunning Vice President, International Diabetes Federation (IDF) Board of Management 2009– Member, IDF Consultative Section on Diabetes Education 2013– Member IDF Committee Fred Hollows Foundation Collaboration and subsequently appointed as a member of the IDF Fred Hollows Advisory Committee 2013– Member IDF Programme Committee Education and Behaviour Stream World Diabetes Congress (WDC) 2013– Member IDF Organising Committee Abstract Selection Committee, WDC 2013– Chair, IDF Ethics Committee 2012– Member, IDF International Affairs Committee 2012– Member, IDF Science Taskforce 2012– 29 CNAHR Annual Report 2014 Reference , Consultant and Expert Advisory Groups Professor Dunning Department of Health and Ageing (DoHA) Pharmaceutical Policy Branch Post market review of PBS medicines and products used for the treatment of diabetes 2013–2015 Australian Commission for Quality and Safety in Health Care National insulin Inpatient chart pilot test advisory group 2013– Council of Therapeutic Advisory Groups Rethinking medicines decision-making in Australian Hospitals: Guiding Principles for the quality use of off- label medicine 2013–2014. Bergen University College International Expert on Diabetes Research Strategy: DiaBest Group, 2011– Steno Diabetes Centre Expert Advisory Group to Steno-REACH project established to develop diabetes training programs for health professionals in Malaysia 2014– Koc University, Turkey Expert panel to apply for an EU grant for continuing education for diabetes educators. 2014– Grant and Conference Abstract Assessment Panels Professor Dunning Grants Australian Diabetes Educators Association Barwon Health Sydney Parker Smith Grant Application Reviews Deakin University Grant Application Reviews Diabetes Australia Research Trust Grants (DART) Coordinate review of the education and behavioural research grant applications 2011– NHMRC Panel: Translational Research in Low and Middle Income Countries. Sigma Theta Tau International. Conference abstracts Australian Diabetes Educators Association International Diabetes Federation Sigma Theta Tau International Theses During 2014 Professor Dunning examined four PhD theses, three Master’s theses and one Honours thesis. 30 CNAHR Annual Report 2014 Journal Review Panels and Editorial Boards—Professor Dunning Member Review Panel (review 2 or more papers per year): Australian Journal of Primary Health BMC Family Practice Collegian Diabetic Medicine Diabetes Research and Clinical Practice European Diabetes Nursing Health Promotion International Health Expectations Journal of Diabetes Nursing Journal of Holistic Nursing Journal Palliative Medicine Journal of Nursing and Care Journal Nutrition, Health and Ageing Medical Sciences Nursing and Health Sciences Practical Diabetes Scandinavian Journal of Caring Sciences The Australian Diabetes Educator World Views on Evidence Based Nursing Editor-in-Chief: Global Journal of Health Science Member of the Editorial Board of: Diabetes Conquest 2000–2014 European Diabetes Nursing International Journal Clinical Aromatherapy Journal of Advanced Nursing Online Alternative Medicine World Journal of Diabetes Practice During 2014 Professor Dunning reviewed a total of 94 papers submitted to these journals. In addition, she reviewed 12 papers for McMaster Online Rating of Evidence. 31 CNAHR Annual Report 2014 Our Key Local Collaborations During 2014 we collaborated with: Barwon Health Palliative Care McKellar Centre Staff Infectious Diseases Oncology Allied Health GP Practitioners Dr. Mark Kennedy Deakin University Colleagues from School of Nursing and Midwifery Australian Centre for Behavioural Research in Diabetes School of Medicine University of Melbourne, Department of General Practice Associate Investigator on NHMRC grant: Structured monitoring to achieve glycaemic targets in people with type 2 diabetes using insulin in primary care. 32 CNAHR Annual Report 2014 Making Waves, Barwon Health’s Quarterly Publication, Edition 1, 2014 33 CNAHR Annual Report 2014 Deakin Nexus, March 27 2014 34 CNAHR Annual Report 2014 Diabetes Australia – Vic media release 35 CNAHR Annual Report 2014 Australian Ageing Agenda, August 19, 2014 36 CNAHR Annual Report 2014 Interviews with Professor Trisha Dunning and Ms Nicole Duggan on the Pulse Geelong Community Radio: February 4th June 27th October 6th Professor Trisha Dunning and Ms Nicole Duggan interview with Greg McHenry ‘Roads to recovery’ program to discuss blood glucose testing, medicines management, managing diet and physical activity, problem solving and decision making. Professor Trisha Dunning and Ms Nicole Duggan interview with Greg McHenry ‘Roads to recovery’ program to highlight living well with diabetes, preventing complications and where to seek support. Professor Trisha Dunning and Ms Nicole Duggan interview with Greg McHenry ‘Roads to recovery’ program to highlight local, national and global programs for World Diabetes Day (pre-recorded for World Diabetes Day in November). 37 CNAHR Annual Report 2014 The video of interviews conducted with Dr Sally Savage, Ms Nicole Duggan and Professor Trisha Dunning at the Australian Diabetes Society/Australian Diabetes Educators Association Annual Scientific Meeting placed on the Diabetes Educators Update website in August 2014. The interviews were about the paper presented by Sally entitled Individualised medicine education for people with type 2 diabetes. 38 CNAHR Annual Report 2014 The CNAHR Team Professor Trisha Dunning, AM Chair in Nursing, Deakin University and Barwon Health and Director, CNAHR Dr Sally Savage Research Fellow Ms Susan Streat Research Assistant Ms Nicole Duggan Project Leader Victorian Arm of The Q-Med Study Dr Sam Korn Project Manager The Q-Med Study 39 CNAHR Annual Report 2014 Our work would not be possible without support from many colleagues and departments in both Deakin University and Barwon Health. We especially thank Professors Maxine Duke and Lucy Cuddihy for their support, advice and encouragement throughout the year. It has been an honour to work with and learn from our professorial colleagues in The School of Nursing and Midwifery and our clinical nursing, medical and allied health colleagues in Barwon Health. We are very grateful to the older people with diabetes from Barwon Health Wise Group and from the North Geelong Medical Centre for providing valuable advice about our glucose lowering medicine information. Two volunteers joined our team in 2014 and have made an important contribution to data collection for the Q- Med Study and data analysis for The POP-D Study. We thank Madhu Subramaniam and Clare Bennett for their generous contribution. We are grateful for the support from the IT and Communications Departments of both institutions as well as the ‘mail room’, Finance and HR departments and Lyn Browne at Barwon Health. 40 CNAHR Annual Report 2014 |
|
|
|
O |
|
R |
|
S |
|
|
|