Remote Area Nurses Research Articles

What stresses remote area nurses? Current knowledge and future action

Review and synthesise the literature identifying the stresses experienced by remote area nurses (RANs). Identify interventions implemented to address identified stresses. Explore the use of the job demands-resources (JD-R) model. A comprehensive literature review was conducted using the meta-databases Ovid and Informit. Remote Australian primary health care centres. The reported demands experienced by RANs can be grouped into four themes: (i) the remote context; (ii) workload and extended scope of practice; (iii) poor management; and (iv) violence in the workplace and community. In this high-demand, low-resource context, the JD-R model of occupational stress is particularly pertinent to examining occupational stress among RANs. The demands on RANs, such as the isolated geographical context, are immutable. However, there are key areas where resources can be enhanced to better meet the high level of need. These are: (i) adequate and appropriate education, training and orientation; (ii) appropriate funding of remote health services; and (iii) improved management practices and systems. There is a lack of empirical evidence relating to stresses experienced by RANs. The literature identifies some of the stresses experienced by RANs as unique to the remote context, while some are related to high demands coupled with a deficit of appropriate resources. Use of models, such as the JD-R model of occupational stress, might assist in identifying key areas where resources can be enhanced to better meet the high level of need and reduce RANs' levels of stress.

The ‘Australian rural health education revolution’

The ‘Australian rural health education revolution’

ARNM: On voice, views and valuing rural nurses and midwives: Strength in collaborations

[Extract] Australian Rural Nurses and Midwives Inc. provides a voice for rural nurses and midwives in the wider nursing world and in government. We believe that rural nursing is a distinct practice specialty, and we strongly advocate for its recognition. ARNM has an established relationship with CRANA. Over the years there has been a great deal of confusion about why there are two organisations that represent, to outsiders from either rural or remote nursing, the same constituency. Recent developments in the Northern Territory have illustrated the role of the remote area nurse more eloquently than writing a dot point list of differences here. Needless to say rural and remote area nurses face different challenges and need individual representation, while acknowledging the common issues they share.

Core drivers of quality: a remote health example from Australia

In July 2005 the National Rural Health Alliance released a discussion paper on advanced nursing practice in rural and remote areas of Australia. The paper called for more debate and research about advanced nursing practice roles, especially on how the roles contribute to quality care and patient health outcomes. Monash University School of Rural Health, Victoria, Australia, completed two studies exploring the role and practice of remote area nurses working autonomously in bush nursing centres in East Gippsland, Victoria. The studies confirmed the nursing role as advanced and expanded, and the care effective and of high quality. The studies also revealed the contribution of the remote area nurse to quality care involved more than demonstrating effective healthcare delivery and evidence based clinical practice. The significance of context emerged as an important determinant. Articulating measures for quality care in Australian remote health practice is problematic. The concept 'quality' is multidimensional and time and context specific. Current Australian health service and professional competency standards fail to combine external structural and organisational factors, and the social and economic situation of a given remote community. Together, these factors create the context, and influence practice and remote health service delivery. It is accepted that context shapes remote nursing practice, however the term 'context' is commonly interpreted as an environmental, structural or geographical construct. These terms are valid; however, they do not describe other drivers that impact on remote area nursing and service delivery. In practice, therefore, to what extent does context influence the contribution of remote nursing roles to quality care? Four core drivers that model the remote area nursing context were identified: the system, the organisation, the community and the individual. An integrated conceptual model consisting of the core drivers is presented, and this provides a broad framework to illustrate factors influencing the delivery of quality remote health care, in an attempt to crystallise the role of context. Central to the model is the remote area nurse. This article outlines the core drivers and discusses how these drivers impact on remote area nursing practice in Victoria and the provision of quality care. The model is transferable to other remote nursing contexts and provides an alternative approach to evaluate the contribution of a remote area nursing role. Enhancing our understanding of the influence of context may assist in identifying relevant indicators to measure the quality of remote health care delivered by nurses in advanced practice roles.

What are the effects of distance management on the retention of remote area nurses in Australia?

Australian remote area nurses (RANs) are specialist advanced practice nurses. They work in unique, challenging and sometimes dangerous environments to provide a diverse range of healthcare services to remote and predominantly Aboriginal communities. There is an emerging skills gap in the remote nursing workforce as experienced and qualified RANs leave this demanding practice. There is a shortage of new nurses interested in working in these areas, and many of those who enter remote practice leave after a short time. Distance management was examined in order to gain a better understanding of its effects on the retention of RANs in the Australian states of Northern Territory (NT), Western Australia (WA) and South Australia (SA). Distance management in this context occurs when the health service's line management team is located geographically distant from the workplace they are managing. The study used a mixed method design, with a combination of anonymous surveys and interviews conducted by telephone and face to face. Qualitative and quantitative data were collected. The data were thematically analysed and basic descriptive statistics were also used. All RANs who worked in government and other non-Aboriginal controlled remote health services in NT, SA and WA were included in the sample. Sixty-one RANs (anonymous survey, 55% response rate) and 26 ex-RANs (telephone interview) participated in the research. The ex-RANs were sampled using a snowball technique where interviewees recommended former colleagues for interview. Nine nursing executives with expertise in distance management of remote health services also contributed (face-to-face interview), and they are referred to as 'the experts'. Respondents expressed a dichotomy in their reactions to remote area nursing. On one hand, they expressed a strong sense of pleasure and satisfaction in the nature of their work; while, on the other, they expressed dissatisfaction with aspects of infrastructure, support and management practices. Positive aspects included autonomy of practice, working in a small team, cross-cultural practice, and the beauty and isolation of the setting. Negative aspects included poor orientation, high stress, inadequate resources, poor systems, unrealistic expectations from communities and managers leading to excessive workload, and perceived lack of support from management. The greatest negative issue raised was poor handling of leave replacement, where RANs on leave were not replaced with appropriately qualified and skilled nurses. Respondents noted a frequent change in managers, and reported that the lack of stability in management contributed to lack of support for both RANs and their managers. Lack of support from managers was frequently cited as a main cause for ex-RANs leaving their employment. Despite this, almost all respondents indicated a willingness to remain in the remote workforce if possible. Experts noted that where management was dysfunctional, RAN retention rates fell. They also acknowledged the need for good communication, interpersonal skills, availability of staff development, leave, relief staff, feedback, debriefing, professional support and working conditions. Experts believed managers should make use of available and emerging technology to communicate with RANs, and work to improve RANs' understanding of the role of the management team. Remote Australian Aboriginal communities are mainly served by RANs in a health system that is sometimes ill-equipped and at times poorly managed. The theme of a second-class health system being serviced by RANs who felt they were treated as second-class health practitioners appeared throughout the data. Poor distance management practices may contribute to the high turnover of staff in remote Australia. Retention of RANs may increase with better managerial practices, such as effective communication and leadership, staffing replacement and leave, prompt attention to infrastructure issues, and staff development and appraisal. These are the keys to ensuring that RANs feel supported and valued. Remote area nursing is a rewarding career and, with systemic support, RANs may stay longer in remote practice.

Taking Pharmacy on Tour in Vanuatu

ABSTRACTRemote villages and health facilities in Vanuatu are visited to help train pharmacy officers, update remote area nurses on pharmaceutical issues and provide community education about appropriate use of medicines and general health issues. Limited communications and irregular visits by medical staff makes a visit by the principal pharmacist and a trainee an occasion for the community. Updates for nurses include latest treatments for common conditions such as malaria, pneumonia, and non‐communicable diseases which are increasing in these communities. Training includes blood glucose machines, repair of medical equipment and cold chain management. Touring allows the trainee pharmacy officers to observe first‐hand the needs of the remote communities. They learn how to assist clinic nurses with their stock ordering and store management. Direct involvement in the medical care of some patients has reinforced their knowledge of drug treatments.

Social capital, rural nursing and rural nursing theory

The notion of social capital focuses attention on social connectedness within communities and the ways that this connectedness may affect health and well-being. There are many competing definitions of social capital but most suggest that it involves trust, social networks and reciprocity within communities, not necessarily geographically defined. The usefulness of social capital and related theories that help in understanding the function of nurses in rural communities are explored in this paper. Nurses and health service planners are becoming increasingly aware of the potential contribution of community nurses in rural and/or remote areas, as evidenced in the development of nurse practitioners. Through their interrelational role and status in rural communities, nurses are often 'immersed' or 'embedded' in the social networks that make up the fabric of rural life and may therefore be important contributors to social capital. For a concept such as social capital to be useful in nursing research, it must have distinct attributes, delineated boundaries, and well-described preconditions and outcomes in multiple contexts.

Distance learning – meeting Africa's need for quality nursing care

Distance learning – meeting Africa's need for quality nursing care

Patient education and consumer medicine information: a study of provision by Queensland rural and remote area Registered Nurses

The aim of the larger study was to ascertain the medication practices of registered and enrolled nurses in rural and remote areas of Queensland after the introduction of the Health (Drugs and Poisons) Regulation. This paper reports on the findings of the role of registered nurses and their confidence in the ability to provide information on medications in a way that the client understands; the frequency of the provision of information to clients prior to discharge; and the frequency of Indigenous Health Workers or interpreters for people without English as a first language. Queensland employs approximately 17% of the Australian registered nurse workforce. In 1996 Queensland changed the Health (Drugs and Poisons) Regulation to allow specific registered nurses, who had undertaken approved postgraduate education and training programmes, to become endorsed for an expanded medication practice role. In particular, it allowed endorsed nurses to administer and supply (but not prescribe) drugs listed in a drug formulary to certain clients using protocols. It was not clear, however, whether the changes to the Regulation reflected the scope of practice, thereby providing adequate legal protection for the nurse. During 2001-02 an exploration of the medication practices of rural and remote area nurses was conducted by the use of a cross-sectional postal survey. Phase 1 of the study used a facility audit to ascertain facility medication practices and phase 2 of the study used a postal survey to ascertain nurses' medication practices. All nurses employed in rural and remote health facilities in Queensland were eligible to participate in the study. The nurse registering authority's (the Queensland Nursing Council) register was used to generate a non-proportional stratified random sample. Of the 1999 questionnaires sent, there were 668 respondents. Of these, 520 were registered nurses. The data indicated that there was a difference between endorsed and unendorsed registered nurses' medication practice. In particular, it was apparent that endorsed registered nurses were more likely to believe they could explain the side-effects of medication to clients in a way the patient understood; provided medication education to clients on discharge; and used Indigenous Health Workers or interpreters to explain medications to those clients for whom English was not a first language. However, it was apparent that <50% of all Registered Nurses were providing client medication education or using Indigenous Health Workers or interpreters. It is apparent that the changes to the Regulation have ensured that Registered Nurses who have undergone postgraduate education to enhance their medication practice are more likely to provide client education and consumer medication information. However, the results suggest that the majority of registered nurses in Queensland, whilst believing they have sufficient knowledge of pharmacology to provide client education, often do not provide appropriate medication advice to clients, particularly on discharge from the acute setting. It is well recognized that the provision of medication education to clients has several benefits to both the client and the health care system. The lack of client medication education indicated in this study compromises patient's safety as well as their compliance with their medication regime.

Distance difficulties

WELL WRITTEN, THIS BOOK shows that two of the most vulnerable groups from either side of the health agenda are at risk. Cramer has identified the professional and personal risks of the health professionals who provide health services to Australia?s most disadvantaged group. In providing service, nurses are put into some of the most difficult situations and have to cope with added stress of providing health care that is outside their training and professional dimensions. Decision making is made difficult by having little or no health history; language barriers; and poor communication with the support service. Prevention and maintenance services are poorly delivered because of lack of time and resources. Visiting medical officers only have enough time to see acute patients, and review of medication is not done. To add to this predicament, the nurses have to contend with a very mobile community, unable to provide payment and fulfil other commitments of the client. Their workload and expected duties are not always appreciated by management and other support services. Where there should be two registered nurses, only one is employed. They often have to travel long distances to follow up clients, be on duty for long hours, or participate in community discussions outside the clinic times. The nurses who continue to work in isolated Aboriginal communities are special and over time have developed their practice. The question is, is it best practice or more an ad hoc practice? Nurses in remote areas work under stressful work and living conditions and continue to provide the only health service for the community, if they don?t give up and leave. Nursing in remote Aboriginal communities is not romantic or exotic, but can be rewarding for some of the nurses. This book should be read by all health care professionals, especially those considering working in rural or remote areas.

Rural and Remote Area Nursing: An Australian Perspective

Rural and Remote Area Nursing: An Australian Perspective

Characteristics of chemotherapy practice in rural and remote area health facilities in Queensland

The overall objective of this study was to document the nature of the chemotherapy nursing practice of rural and remote area nurses in Queensland. A questionnaire survey that elicited descriptive quantitative and qualitative data. Forty-seven rural and remote area health facilities in Queensland involved in the administration of chemotherapy. Sixty-seven Queensland rural and remote area nurses involved in the administration of cytotoxic drugs. Characteristics of chemotherapy practice including context of practice, amount and type of chemotherapy administered, logistical problems, level of support from referral centres, policies and procedures, safety issues. The results indicate that the risks to nursing staff and the potential for poor patient outcomes are higher than in specialist chemotherapy facilities. This is largely due to the human and material resource constraints characteristic of rural practice. These include a lack of understanding on the part of metropolitan-based health departments and the specialist cancer centres that refer patients to rural areas of the constraints that may adversely influence patient outcomes. It is essential that steps are taken to ensure that rural and remote area cancer patients have equitable access to safe and competent chemotherapy care delivered in their choice of context, and the results of this study provide guidance on ways that this can be achieved.

CHARACTERISTICS OF CHEMOTHERAPY PRACTICE IN RURAL AND REMOTE AREA HEALTH FACILITIES IN QUEENSLAND

Objective The overall objective of this study was to document the nature of the chemotherapy nursing practice of rural and remote area nurses in Queensland. Design A questionnaire survey that elicited descriptive quantitative and qualitative data. Setting Forty-seven rural and remote area health facilities in Queensland involved in the administration of chemotherapy. Subjects Sixty-seven Queensland rural and remote area nurses involved in the administration of cytotoxic drugs. Main outcome measures: Characteristics of chemotherapy practice including context of practice, amount and type of chemotherapy administered, logistical problems, level of support from referral centres, policies and procedures, safety issues. Results The results indicate that the risks to nursing staff and the potential for poor patient outcomes are higher than in specialist chemotherapy facilities. This is largely due to the human and material resource constraints characteristic of rural practice. These include a lack of understanding on the part of metropolitan-based health departments and the specialist cancer centres that refer patients to rural areas of the constraints that may adversely influence patient outcomes. Conclusions It is essential that steps are taken to ensure that rural and remote area cancer patients have equitable access to safe and competent chemotherapy care delivered in their choice of context, and the results of this study provide guidance on ways that this can be achieved.

COUNCIL OF REMOTE AREA NURSES OF AUSTRALIA

COUNCIL OF REMOTE AREA NURSES OF AUSTRALIA

Northern nursing practice in a primary health care setting.

This paper explicates the nature of outpost nursing work, and/or the day-to-day realities of northern nursing practice in a primary health care setting in Canada. The study was carried out to systematically explore the work of nurses in an indigenous setting. Institutional ethnography, pioneered by Dorothy Smith was the methodology used to guide this research. The theoretical perspective of this methodology does not seek causes or links but intends to explicate visible practices. It is intended to explicate the social organization of specific discourses that inform work processes of nurses working in remote indigenous communities. The data originated from various sources including spending 2 weeks in a northern remote community shadowing experienced nurses, taking field notes and audio taping interviews with these nurses. One of the two researchers was a northern practice nurse for many years and has had taught in an outpost nursing programme. As part of the process, texts were obtained from the site as data to be incorporated in the analysis. The lived experiences have added to the analytical understanding of the work of nurses in remote areas. Data uncovered documentary practices inherent to the work setting which were then analysed along with the transcribed interviews and field notes derived from the on-site visit. Identifying disjuncture in the discourse of northern nursing and the lived experience of the nurses in this study was central to the research process. The results indicated that the social organization of northern community nursing work required a broad generalist knowledge base for decision making to work effectively within this primary health care setting. The nurse as 'other' and the invisibility of nurses' work of building a trusting relationship with the community is not reflected in the discourse of northern nursing. Trust cannot be quantified or measured yet it is fundamental to working effectively with the community. The nurses in this study saw building trust to promote health and well-being in communities as very important, yet very difficult to achieve. The difficulty in part stems from the constraining, structural, administrative, historical, cultural and political contextual realities that have shaped northern community nursing.

WHY NURSES ARE ATTRACTED TO RURAL AND REMOTE PRACTICE

ABSTRACT: This is the second paper of a larger study that examined the factors influencing the decisions of rural and remote area nurses, formerly employed by Queensland Health, to leave or to remain in this area of nursing. The study was a cross‐sectional survey that gathered data from nurses who had resigned from permanent positions in Queensland Health during the period February 1999 to May 2000. This paper reports only those factors that influenced their decision to remain in rural and remote area practice, which can be categorised into personal, professional and rural influences. The results of this study are congruent with previous national and international research findings into these issues for nurses in rural and remote areas. The paper makes recommendations to attract nurses to the rural and remote work force.

Why nurses are attracted to rural and remote practice.

This is the second paper of a larger study that examined the factors influencing the decisions of rural and remote area nurses, formerly employed by Queensland Health, to leave or to remain in this area of nursing. The study was a cross-sectional survey that gathered data from nurses who had resigned from permanent positions in Queensland Health during the period February 1999 to May 2000. This paper reports only those factors that influenced their decision to remain in rural and remote area practice, which can be categorised into personal, professional and rural influences. The results of this study are congruent with previous national and international research findings into these issues for nurses in rural and remote areas. The paper makes recommendations to attract nurses to the rural and remote work force.

Retaining rural and remote area nurses. The Queensland, Australia experience.

Because higher-than-average turnover rates for nurses who work in remote and rural areas are the norm, the authors conducted a study to identify professional and personal factors that influenced rural nurses' decisions to resign. Using a mail survey, the authors gathered qualitative and quantitative data from nurses who had resigned from rural and remote areas in Queensland, Australia. Their findings, categorized into professional and rural influences, highlight the importance of work force planning strategies that capitalize on the positive aspects of rural and remote area practice, to retain nurses in nonmetropolitan areas.

Silence – not so Golden?

In remote Australia, when the dust settles after a windstorm, nothing remains the same--everything becomes coated with the dust that penetrates all crevices and surfaces of life. So it is with remote area nursing--from the early 1980s until today, remote area nurse voices have stirred up the winds of change. This followed over almost two centuries of silence. Token support came from local community leaders and health ministers to strengthen remote area nursing voices. But why has it taken almost two centuries? This paper represents the results of my interaction with the public discourses of Australian nurses during the nineteenth century (when there were barely any nurses at all) and with remote area nurses of the twentieth century. This led to the development of a model to explore the process of agency and breaking silence. It became evident that within the ranks of nursing itself, a process of downward closure was enacted. A strategy of dual closure was enacted by nurses against their own colleagues at an intra-occupational level and was operationalised by legalistic (State registrations) and credentialist (exercising control over content and standards) tactics.

Why nurses are Resigning from rural and remote Queensland health facilities

This paper presents a selection of the results reported in the study "Factors Influencing the Recruitment and Retention of Rural and Remote Area Nurses in Queensland" (Hegney et al 2001). The main aim of this study was to determine why nurses in those rura and remote areas of Queensland that reported higher than State average turnover rates between February 1999 and May 2000, chose to leave their employment. The study therefore investigated the factors that influenced nurses' decisions to leave rural and remote area practice, the factors that influenced them to remain in practice and those factors nurses considered irrelevant to leaving or staying in rural/remote area nursing. This paper reports those factors the participants believed influenced them to leave rural and remote area nursing in Queensland. While the findings cannot be generalised to the Australian nursing workforce or to nurses not employed by Queensland Health, the study does confirm the findings of prev ous Australian research and formulates recommendations to assist future nursing workforce planning and policy.