Understanding and meeting the needs of rural and regional radiotherapy patients with educational multimedia

Ms Jacinta Krstic1Ms Amelia WanEmily Whillance,1 Adrian Mendoza,1 Jane Honey,1 Richard Oates.

1Radiation Therapist at the Peter Maccallum Cancer Centre, Bendigo campus



Studies show that cancer patients fear radiation therapy due to a limited understanding of its purpose and its accompanying side effects, even after consultation with a Radiation Oncologist and a simulation session with a Radiation Therapist.  This project aims to address the need for rural and regional patients to be informed of their treatment plan and processes prior to commencing radiotherapy.


Patients were given Patient Education Satisfaction Survey 1 during the course of radiotherapy treatment to identify education needs.  Using this information, videos were created for distribution to patients prior to commencing radiotherapy. The videos included footage of the radiotherapy department and team, as well as footage of a virtual radiotherapy environment with enhanced visualisation from commercially available software. Patient Education Satisfaction Survey 2 was conducted subsequently to evaluate the videos.


Fifty patients completed survey 1 and their education needs were identified.  Four videos were created which focussed on palliative/general radiotherapy, breast, prostate and upper gastrointestinal tumours. Fifty patients completed survey 2 to evaluate the videos and provided feedback on their content.


This project enabled the production of patient education materials which aimed to meet patient education needs and allowed for patient feedback in their development. These videos will provide improved understanding of the radiotherapy process and may help to reduce patient fears.  Final versions of the videos will be distributed via DVD and online to the relevant patient groups and their families who may not be able to attend the department.


Jacinta Krstic is a Radiation Therapist at the Peter MacCallum Cancer Centre in Bendigo. She completed a Bachelor of Applied Science in Radiation Therapy at RMIT and has been working as a qualified radiation therapist for 2 years. She is currently working on a project funded by LMICS to develop patient and GP radiation therapy education videos to promote increased awareness about radiation therapy in the regional and rural environment.

Measuring balance in children aged 4 to 12 years of age using the Balance Master: Normative values and associations.

Ms Jessica Kolic1, Ms Kaitlyn O’Brien1, Dr Kelly-Anne Bowles2, Dr Ross Iles1,4, Dr Cylie Williams1,3

1Department of Physiotherapy, School of Primary Health Care, Faculty of Nursing, Medicine and Health Sciences, Monash University Peninsula Campus, Frankston, Australia, 2Department of Paramedicine, School of Primary Health Care, Faculty of Nursing, Medicine and Health Sciences, Monash University Peninsula Campus, Frankston, Australia, 3Department of Allied Health, Peninsula Health, Frankston, Australia, 4Insurance, Work and Health Group, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia


Aims:To establish normative values for children aged four to twelve years for three common clinical balance tests on the Balance Master®. The secondary aim was to analyse the influence of age, gender, height and BMI on balance.

Methods: Ninety-one typically developing children with a mean age of 8 years ± 4 (46% female) were recruited in Victoria, Australia. Data collected, generated normative values for the Rhythmic Weight Shift (RWS), modified Clinical Test of Sensory Integration (m-CTSIB) and Limits of Stability (LOS) balance tests on the Balance Master®. Backward stepwise multiple regression analysis was performed to determine the association between balance variables against age, gender, height and BMI.

Results:Normative values for the RWS, m-CTSIB and LOS on the Balance Master® machine were established for each age year. Balance and postural control was shown to improve with age (p<0.05), with girls demonstrating mature balance strategies earlier (p<0.05). Increased BMI was associated with poor balance and postural control, particularly when vision was occluded (p<0.05).

Discussion:Adequate static and dynamic balance is a prerequisite for participation in many childhood activities essential for development. The Balance Master® is a portable and clinically feasible system that accurately and reliably measures balance in adults, however there exists limited normative data for children. The normative values established by this study may be used to support clinical paediatric assessment. Natural variation in balance ability exists as children continue to develop and clinicians should consider the individual impact of anthropometry in children when assessing balance.


Recent graduate of the Bachelor of Physiotherapy (Honours) Advanced Research stream from Monash University. Currently working as a physiotherapist in the graduate program at Cabrini Health. Has a special interest in Indigenous health and neurological rehabilitation, and would love the opportunity to extend this pilot study being presented today to rural and remote communities.

Using the cultural appeal of bush tucker to market healthy food

Ms Maxine  Daley1, Renee Watts1

1Queensland Health, Palm Beach, Australia


Adequate fruit and vegetable intake helps to prevent chronic health problems such as cardiovascular disease, some cancers and obesity. According to the 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey, ninety five percent (95%) of Aboriginal and Torres Strait Islander people did not meet the recommended serves of vegetables a day, and less than half (43%) consumed adequate serves of fruit. Health promotion campaigns aimed at increasing fruit and vegetable intake amongst Aboriginal and Torres Strait Islander communities need to consider the sociocultural aspects of food choices. The Bush Tucker Calendar involved utilising the cultural appeal of bush tucker to market seasonal fruit and vegetables to the Gold Coast Aboriginal and Torres Strait Islander Community. Each calendar month featured a local, seasonal bush tucker ingredient featured in a healthy, convenient and affordable recipe. Promoted throughout the community via a series of cooking demonstrations at cultural events and health centres, uptake of the calendar has been overwhelmingly positive, with survey respondents reporting outcomes such as using elements of the calendar to embed Indigenous perspectives into school based programs; cooking the recipes at home; and encouraging a feeling of pride and ownership of food culture for some community members who have used the information based in the calendar to promote the foods to family and friends. However, further work is required to increase access to bush tucker, with possible future directions involving school and community bush tucker garden programs.


Maxine Daley

I have worked as a dietitian/nutritionist within the Gold Coast Aboriginal and Torres Strait Islander community for the past 12 years. I have merged my passion for cooking and nutrition with my passion for bush tucker to create strategies aimed at engaging consumers in nutrition promotion activities.

Renee Watts

I am a Wiradjuri woman and my family come from Darling Point and Leeton in New South Wales. I was born in Sydney and moved to the Gold Coast in 1994.

I am an Aboriginal and Torres Strait Islander Child Health Worker focussing on antenatal. I am passionate about working with families to support them to bring their babies into the world with the best start in life and helping to set them on a pathway to grow into great leaders of the future.

Teaching and Assessment of Clinical Reasoning of Health Science Students on Clinical Placement: A Systematic Literature Review

Mrs Kathryn Fitzgerald1

1WA Centre For Rural Health, Geraldton, Australia


The aim of this study was to examine how health science students develop clinical reasoning skills whilst on clinical placements, and how this learning is assessed.

A systematic literature review was undertaken centred on teaching and assessing clinical reasoning for health science students while undertaking a clinical placement. After a preliminary screen, 137 articles were critically appraised and 23 articles were included for further detailed analysis.

Key results will be presented describing models of clinical reasoning, and how these can be used as a foundation for teaching and assessment. Several themes were identified focusing on teaching, including experiential learning, narrative approaches, prompts and questions, and visual systems. An integrated model of clinical reasoning will be discussed. There was limited evidence linking assessment of clinical reasoning to clinical placement outcomes.

The results will be discussed in relation to teaching and assessment of clinical reasoning when students are on rural clinical placements.  Having a shared understanding of clinical reasoning models and access to quality teaching of clinical reasoning, will enhance students’ ability to become effective and competent rural clinicians. Best practice methods for teaching clinical reasoning in rural placements may be through multidisciplinary approaches reflecting current models of interprofessional practice and assessment of clinical reasoning should be linked to students’ overall assessment of clinical performance when on clinical placement.


Kathryn Fitzgerald has worked in rural and remote areas as an  Allied Health professional in clinical practice,  in policy and program development and in health professions’ education for over 30 years, and has been involved with SARRAH since the organisation’s early days. She currently works as the Clinical Education Manager for the WA Centre for Rural Health based in the Midwest of Western Australia.

Cultural Mentoring for Students on Clinical Placement: A critical component of learning and practice

Mrs Kathryn Fitzgerald1, Ms  Carole Minney1, Ms Sarah-Jane  Dymond1

1WA Centre For Rural Health, Geraldton, Australia


Allied Health Students on placement at the WA Centre for Rural Health who complete all or part of their work integrated learning placements in Mt Magnet, Western Australia, complete a local program “Understanding Yamatji” and a Clinical Yarning workshop prior to commencing in Mt Magnet. Once in the community, they are supported by a local Aboriginal staff member who works as a cultural mentor alongside the clinical supervisors. This presentation will outline the role of the cultural mentor. The cultural mentoring program is based on the six key capabilities of the Indigenous Allied Health Australia’s Cultural Responsiveness Capability Framework and has the following aims for the students who participate;
• increased confidence in working with Aboriginal people within the students’ disciplines.
• integrating knowledge about cultural awareness to practice.
• appreciation of the diversity within Indigenous peoples and families and reflect on how this impacts on their practice.
• build on existing knowledge of Aboriginal culture in relation to individuals and groups they are working with.
• have an opportunity to practise yarning
• experience peer support and learn interprofessionally about each other’s disciplines in culturally responsive practice.
The guidelines and format for the cultural mentoring will be described, as well as an outline of how this program supports the students’ professional learning and the collaboration with the community.


Kathryn Fitzgerald has worked in rural and remote areas as an Allied Health professional in clinical practice, in policy and program development and in health professions’ education for over 30 years, and has been involved with SARRAH since the organisation’s early days. She currently works as the Clinical Education Manager for the WA Centre for Rural Health based in the Midwest of Western Australia.

The changing landscape of physiotherapy student clinical placements: An exploration of geographical distribution and student outcomes across settings.

Dr Catherine Johnston1, Mr Clint Newstead2, Dr Luke Wakely3

1Discipline of Physiotherapy, School Of Health Sciences, The University of Newcastle, Callaghan, Australia, 2Discipline of Physiotherapy, School of Community Health, Charles Sturt University, Orange, Australia, 3University of Newcastle Department of Rural Health, Tamworth, Australia


Background: As numbers of physiotherapy students in Australia increase, there may be a greater reliance on rural healthcare facilities to provide clinical education experiences. It is unknown as to whether a shift in placement distribution away from a historically metropolitan dominated pattern has occurred in recent years and whether placement outcomes are equivalent. This study aimed to describe the geographical distribution of physiotherapy clinical placements and to investigate the relationship between geographical setting and placement assessment outcomes. Methods: A retrospective cohort design was used. Study year, type, geographical location and grade were recorded for all block clinical placements undertaken by physiotherapy students at The University of Newcastle between 2003 and 2014. Geographical locations were further classified using the Modified Monash Model (MMM). Results: Data from 3964 placements were included. From 2003 to 2014 the proportion of clinical placements undertaken in metropolitan areas (MMM1) decreased from 78% to 59% and increased in rural areas (MMM3-6) from 22% to 40%. There were significant differences in grades between placements classified as MMM1 and all other categories, with lower median marks in MMM1. Conclusion: The change in distribution of placements may reflect increasing student numbers, more regional physiotherapy programs and greater efforts to enable students to undertake rural placements, for example, by University Departments of Rural Health. The resultant shift in geographical distribution of placements may have a positive effect on the rural workforce. Further research is required to determine the specific training and support needs of students and clinical educators in rural settings.


Luke Wakely is a Lecturer in Physiotherapy at the University of Newcastle Department of Rural Health (UONDRH). He recently completed his PhD examining the experience of parenting a premature infant in a rural area. Luke co-ordinates the physiotherapy program at the UONDRH. He also has a masters in paediatric physiotherapy and works clinically as a paediatric physiotherapist. He is passionate about rural health equity especially for children.

Mealtime dangers; assessing food allergy practices within a sub-regional hospital.

Miss Elizabeth Walker1, Ms Eleanor  Capel1

1Northeast Health Wangaratta, Wangaratta, Australia


Introduction: In 2011-12, 17% of Australians reported avoiding a food due to food allergy or intolerance¹, with safe management of hospital patients with food allergies essential in reducing risk of adverse outcomes. Current food allergy practices at Northeast Health Wangaratta (NHW) remain unclear and inaccurate, increasing risk of allergen exposure.
Objectives: This study aimed to improve patient safety, minimise harm, and standardise food allergy management at NHW.
Method: Interview-style surveys of admissions and nursing staff (n=8), foodservice staff (n=7), dietitians (n=2) and patients (n=1) was conducted with thematic analysis and process mapping of current management systems completed. A point prevalence study on documentation compliance with key performance indicators occurred on inpatients at NHW (n=85).
Results: Process maps (n=7) identified multiple areas of communication breakdown and system errors, including lack of staff ownership and responsibility. Survey results highlighted the need for improved communication between ward and foodservice staff, and a streamlined process for food allergy management. Foodservice staff training was recommended. Point prevalence results identified 5 patients with food allergies, with 40% documentation compliance with key performance indicators. Alarmingly, 0% of these allergies were entered into the foodservice system.
Conclusions: Establishment of a multidisciplinary food and nutrition committee was recommended to develop food allergy guidelines, initiate staff training, conduct auditing processes, and complete a menu review. Finally, multiple areas of risk within the current foodservice system at NHW were highlighted, indicating the need to investigate the management of other high risk diet codes.

1.Australian health survey. Australian Bureau of Statistics. 2014.


Elizabeth Walker works as a clinical dietitian at Northeast Health Wangaratta. She has worked across multiple regional and metropolitan health services over the past 5 years in acute and sub-acute care. Elizabeth has a passion in improving nutrition outcomes of hospital patients and improving nutritional care within a multi-disciplinary context.

Adjusting for ACEs: services for rural children with Adverse Childhood Experiences

Ms Margaret Burgess1, Ms Jessica McGrath1, Dagney Hopp1

1Royal Far West, Manly, Australia


Studies have demonstrated a strong link between exposure to Adverse Childhood Experiences (ACEs) and poor health outcomes in adulthood. While there is growing evidence about the consequences of ACEs and the need for intervention, there is a need for further evidence on the prevalence of ACEs in rural and remote areas, including in Australia, and how interventions can be adapted for these rural and remote contexts.

Royal Far West (RFW) is an Australian charity based in Manly, New South Wales that has been providing paediatric and allied health services for children in rural and remote NSW for 94 years.

In 2017 RFW began a formal process of reorientating the organisation towards delivering care for families that recognizes the role of ACEs and traumatic experiences in child development. This process has included establishing an active working group to understand the prevalence of ACEs in our client population and to research and recommend ways to adjust practices within the organisation.

This work is now being used to inform RFW services and is also contributing to Royal Far West’s advocacy for increased investment nationally in understanding and reducing the impact of ACEs in rural and remote Australia.

Presenters will describe how learning more about this important area and the unique client population has led to key service changes and will share learnings about the change process.


Margaret Burgess is a Speech Pathologist working part time at the Royal Far West in Manly. She also works at the Dalwood Spilstead Service, an organisation providing intervention for children who have experienced early childhood trauma. Margaret studied at the National University of Ireland Galway and the University of Auckland before commencing work in Sydney in 2011. She has a strong focus on optimising the life outcomes of children who have experienced early childhood trauma. She is a member of the Northern Beaches Complex Trauma Network and is the Chair of the Royal Far West Trauma Working Party.

Stories from Experience, a new portal for safe storytelling

Ms Hilary Smith1

1National Eating Disorders Collaboration, Glen Iris, Australia


This poster presentation will give an overview of a new online tool that health professionals can use in their work with people recovering from eating disorders.
Stories from Experience (SFE) is a learning resource, designed to guide individuals who are recovering or have recovered from an eating disorder in telling their story. Research shows that many people view writing their story as an important process in eating disorder recovery, whether they write it for personal reasons or to share with others.
SFE provides an online space where people can experiment with ways to tell their story. Individuals create a user account and then step through modules that cover topics ranging from the meaning of a story, the process of crafting a story, steps for sharing a story and how to stay safe when sharing, as well as how to ensure that stories are told in ways that keep other safe such as avoiding triggering content.
Once a story has been created, the writer can choose whether or not to share it, and who to share it with. SFE includes guidance and suggestions for sharing stories with loved ones, health professionals and the general public, to help the person use their story in the way that works best for them.
This poster presentation will give a brief overview of why and how to use SFE and how to access it online.


Hilary Smith is the NEDC Workforce Development Coordinator. Her role is focused on introducing specific competencies for safe and effective responses to eating disorders in health and other workforces across the country.

Rural eMeds: achieving Smarter Safer Better approaches to medications

Angela Firth1, Miss Miriam Tan1

1NSW Health, Dubbo, Australia


Introduction: Medication-related incidents are the third highest reported incident type in Australian hospitals. Errors can be reduced by more than 55% with the introduction of electronic medication management (eMeds) systems to help manage medication prescribing, dispensing and administration. eMeds improves patient safety by reducing medication errors and adverse drug events during their stay in hospital. Automating the medication ordering process produces standardised, legible, complete orders and when combined with clinical decision support systems, can reduce medication errors.
Aim: To introduce the eMeds application to all inpatient hospital sites through a joint project involving six rural Local Health Districts (LHD). Rolling out in 2018-2019, the project is tackling the tyranny of distance: covering 150 inpatient facilities, across 650,000 km2, serving 1.3 million people
Method: This innovative and collaborative approach involving the six rural LHDs is a first for eHealth NSW. With a single design, governance model and a joint project team, we can ensure greater standardisation across rural NSW, removing clinical variation and practice therefore improving patient’s safety. We acknowledge differences in workflows between rural and metropolitan inpatient wards. Subsequently, we have consulted extensively, with over 400 clinicians across 31 locations, from base hospitals to small, remote facilities to residential aged care units to ensure the eMeds system works smoothly with rural workflows.
Conclusion: This approach will make eMeds a reality for the communities of rural and regional NSW sooner resulting in greater patient safety and outcomes of care.


Miriam grew up in Singleton, a small country town and moved to Dubbo, a regional centre, to pursue a career in rural health. She is passionate about health in rural and remote communities and introducing technology solutions into the healthcare sector in aim to improve patient outcomes and improve their satisfaction with their health care experience.


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