Rural Health Care Settings Research Articles

Simplifying trauma airway management in South African rural hospitals.

South African emergency centres witness high levels of trauma. Successfully managing a compromised trauma airway requires considerable skill and expertise. In the rural healthcare setting, clinics and hospitals are often staffed by junior doctors without formal advanced airway training. Current airway management algorithms tend to ignore lack of resources and skill. We therefore propose a simplified guideline for the rural hospital practitioner. Our algorithm offers a step-by-step approach, with the aim of providing an easy sequence to follow that will ensure successful airway management and patient safety. The lack of advanced airway equipment in most rural hospitals is taken into consideration.

The experiences of Aboriginal health workers and non-Aboriginal health professionals working collaboratively in the delivery of health care to Aboriginal Australians: a systematic review

Background Effective partnership between Aboriginal health workers and non-Aboriginal health care providers is critical in reducing the health inequity facing Aboriginal Australians. Many factors can obstruct successful workplace partnerships causing them to be damaging and unproductive. Understanding the elements of best practice in forming and maintaining successful working partnerships between Aboriginal health workers and non-Aboriginal health professionals is essential. Objectives To systematically review the qualitative evidence on the lived experience of interprofessional collaboration between Aboriginal health workers and health professionals delivering care to Aboriginal Australians, with a view to identifying the perceived skills, knowledge, attitudes, management practices and institutional policies that enable successful interprofessional partnership. Inclusion criteria Types of participants The review considered qualitative studies that included Aboriginal health workers, Aboriginal liaison officers, Aboriginal community health workers and health professionals working collaboratively to deliver clinical care to Aboriginal Australians across a variety of Australian health care settings. These studies were conducted across a variety of rural, remote and urban Australian health care settings and included both Aboriginal community controlled and mainstream health organisations. Types of intervention(s)/phenomena of interest The review considered studies that described the experiences of delivering/receiving care from Aboriginal health workers and non-Aboriginal health care providers in collaborative work practices, told from the perspectives of non-Aboriginal health care providers, Aboriginal health workers and the Aboriginal clients receiving care. Types of studies Qualitative studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were included in this review. There was adequate evidence in the qualitative studies included in this review, so text and opinion papers were not considered. Types of outcomes The review focussed on qualitative research findings reported as themes/categories in the included studies that related to the perspectives of the Aboriginal health workers, non-Aboriginal health care providers and Aboriginal clients regarding their experiences receiving/delivering care as a result of a clinical collaboration between an Aboriginal health workers and non-Aboriginal health care providers. It was also concerned with the experiences within the workplace, to identify those elements that support or obstruct collaboration between Aboriginal health workers and non-Aboriginal health care providers in order to enable the provision of culturally safe care. Search strategy Using a three-step search strategy, databases of CINAHL, Pub Med, Scopus, Embase, Mednar, TROVE, ProQuest dissertation and Thesis, NHMRC, Department of Health and Ageing, Australian Indigenous Health Infonet and Conference proceedings and Australian Digital Theses where searched for published and unpublished studies in English from 1995 to2012. Hand-searching the Aboriginal and Islander Health Worker Journal was also included in the searching process. Methodological quality Qualitative papers were assessed by two independent reviewers for methodological validity prior to inclusion in this review using standardised critical appraisal instruments from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data collection Qualitative data was extracted from papers included in this review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (QARI). Data synthesis Qualitative research findings where pooled using QARI The process of meta-synthesis involved the extraction of qualitative findings of significance to the review question, which were grouped into categories, then analysed to generate synthesised findings. Results Thirteen qualitative papers met the inclusion criteria for this review. From these studies, 429 findings were extracted and aggregated to from 39 categories. Seven meta-syntheses were derived from the categories with key themes relating to the benefits of effective partnership for the practitioner, the health service and the Aboriginal community, negative experiences as a result of a disabling work environment, and empowering factors at the organisational, workforce and interpersonal/practitioner TRUNCATED AT 600 WORDS

Prevention of Clostridium difficile infection in rural hospitals

Prevention of Clostridium difficile infection (CDI) remains challenging across the spectrum of health care. There are limited data on prevention practices for CDI in the rural health care setting. An electronic survey was administered to 21 rural facilities in Wisconsin, part of the Rural Wisconsin Health Cooperative. Data were collected on hospital characteristics and practices to prevent endemic CDI. Fifteen facilities responded (71%). Nearly all respondent facilities reported regular use of dedicated patient care items, use of gown and gloves, private patient rooms, hand hygiene, and room cleaning. Facilities in which the infection preventionist thought the support of his/her leadership to be "Very good" or "Excellent" employed significantly more CDI practices (13.3 ± 2.4 [standard deviation]) compared with infection preventionists who thought there was less support from leadership (9.8 ± 3.0, P = .033). Surveillance for CDI was highly variable. The most frequent barriers to implementation of CDI prevention practices included lack of adequate resources, lack of a physician champion, and difficulty keeping up with new recommendations. Although most rural facilities in our survey reported using evidence-based practices for prevention of CDI, surveillance practices were highly variable, and data regarding the impact of these practices on CDI rates were limited. Future efforts that correlate CDI prevention initiatives and CDI incidence will help develop evidence-based practices in these resource-limited settings.

Proportion of Depression Among the Elderly Population in A Rural Health Care Setting

Depression among elderly has serious public health implications. Integration of mental health into primary care may help in reaching the elderly population better and in identifying depression among them. This study was done to determine the proportion and the correlates of depression among the elderly population which attended the rural psychiatry services and to compare the proportion with that of the middle aged population. The outpatient data of the past one year in the rural psychiatry centre was analysed. Correlates of depression among the elderly were studied by Chi square test and the proportion in elderly was compared with that of the middle aged population using Z-test. Depression among the elderly attendees was significantly higher than that in the middle aged group. Depression was more common among the young old and females and co-morbidities were more commonly seen in males and the young old compared to those who were aged 80 years and above.

Development of job satisfaction scale for health care providers.

Job satisfaction is a hypothetical construct that is measured on both cognitive and affective parameters. Job satisfaction has been defined as an affective reaction to one's job and an attitude toward it. To develop the job satisfaction scale for health care providers. After exploring existing job satisfaction scales, extensive review of the literature and detailed discussion with different health providers, the statements were prepared for developing the job satisfaction scale. The data were collected on a sample of 333 and analysis was done using SPSS to calculate the Cronbach's alpha value for reliability and validity of the scale. Principal Component analysis and factor analysis of job satisfaction scale were also done. Reliable and valid scale with Cronbach's alpha value of 0.909 was developed. Scale was tested on a mixed group of health care providers in government health facilities in 2013. In the factor analysis, seven components were identified out of 49 items related to job satisfaction. The seven factors emerged from the analysis. These are: Factor (1) privileges attached with job, (2) interpersonal relation and cooperation, (3) working environment, (4) patient relationship, (5) organization facilities, (6) career development, (7) human resource issues. The job satisfaction scale having high reliability and validity is a good tool; it could be used in the health sector for understanding the satisfaction level of health care providers. Study provides a good starting point for standardization of scale in both urban and rural health care setting.

Mental Health First Aid USA: The Implementation of a Mental Health First Aid Training Program in a Rural Healthcare Setting

Mental Health First Aid USA: The Implementation of a Mental Health First Aid Training Program in a Rural Healthcare Setting

Complexity or meaning in health professional education and practice?

Objectives: Discourses of complexity have entered health professional education. This paper explores the meaning of complexity by asking how health professionals are educated and some of the consequences of that education. Design: A qualitative study was carried out drawing on reflexivity, discourse analysis and grounded methodology. Setting: Two rural healthcare settings in Western Australia. Methods: Seventeen health professionals were interviewed using semi-structured open-ended questions based on a theoretical framework developed from the analysis of three case studies of education in healthcare practice. The interview responses were transcribed then analysed. Themes were identified using an iterative process of reflexivity. Narratives of health professional identity were explored within the context of health professional education. Results: The responses from the participants indicated that they managed discourses of autonomy, control and empowerment alongside their own narratives of passivity and powerlessness. Management of different discourses seemed to make other discourses recede. For example, reference to broader issues such as race, gender, ethnicity, socioeconomic determinants of health and age were minimal. Conclusions: Health professional education discourses could be seen as obscuring broader issues that impact on healthcare practice. Health professional curricula occupy a privileged location within society and as such need to provide a socially accountable practice. Ways to develop socially accountable practices are explored within the context of the widening gap between disadvantaged and advantaged people on a global level.

Detection of dengue viruses using reverse transcription-loop-mediated isothermal amplification

BackgroundEarly and rapid detection of dengue virus (DENV) infection during the febrile period is crucial for proper patient management and prevention of disease spread. An easy to perform and highly sensitive method is needed for routine implementation especially in the resource-limited rural healthcare settings where dengue is endemic.MethodsA single-tube reverse transcription-loop-mediated isothermal amplification (RT-LAMP) assay with a set of nine primers was developed for the detection of all four DENV serotypes and their different genotypes. The sensitivity and specificity of the RT-LAMP were evaluated. The clinical applicability of RT-LAMP assay for detection of DENV RNA was assessed in a total of 305 sera of clinically-suspected dengue patients. The test results of RT-LAMP were statistically compared to those of quantitative reverse transcription-polymerase chain reaction (qRT-PCR), IgM- and IgG-capture enzyme-linked immunosorbent assays (ELISA).ResultsAcute DENV infection was confirmed in 171 samples (n = 305); 43.3% (74/171) and 46.8% (80/171) of the samples were positive for DENV using RT-LAMP and qRT-PCR, respectively. The combination of RT-LAMP with the dengue IgM and IgG ELISA increased detection of acute DENV infection to 97.7% (167/171), in comparison to only 70.8% (121/171) when dengue IgM and IgG ELISA alone were used. The RT-LAMP assays showed high concordance (κ = 0.939) with the qRT-PCR. The RT-LAMP assay detected up to 10 copies of virus RNA within an hour but 100% reproducibility (12/12) was achieved with 100 copies. There was no cross reactivity of RT-LAMP with other closely related arboviruses.ConclusionThe RT-LAMP assay developed in this study is sensitive, specific and simple to perform. The assay improved the detection of dengue when used in combination with serological methods.

Hip-Fracture Care in Rural Southwestern Ontario: An Ethnographic Study of Patient Transitions and Physiotherapy Handoffs

To examine information exchange by physiotherapists during care handoffs of patients with hip fracture in a rural health care setting. This qualitative ethnographic study used observation and interviews of 11 networks of patients with hip fracture (n=11), family caregivers (n=8), and health care providers (n=24). Patients were followed from acute care through each subsequent care setting. Data were supplemented by health care records and policy documents. Findings revealed that handoffs were less successful when information transfer was untimely or incomplete. Family caregivers experienced challenges in obtaining information required to facilitate the handoff, especially when direct contact with physiotherapists was not possible as a result of distance or other factors. Physiotherapists had to navigate multiple data sources to retrieve important information, and managed information gaps in various ways. Information flow was often unidirectional and suggested no further clinical accountability for the discharging physiotherapist. Providing information in a structured and timely fashion facilitated physiotherapy handoffs. Inadequate handoffs compromised continuity of care, delayed progress in rehabilitation, and resulted in families' missing information of vital importance to their caregiving role. A multi-directional exchange of information is needed between patients, families, and health care providers across care settings.

CPR: STAT! OR STOP! THE END-OF-LIFE CARE ELECTRONIC RECORD (ELCER)

BackgroundAdvance Care Planning is about much more than CPR and the aspiration to support care planning and symptom management to improve care at the end-of-life; empowering and supporting patients in...

A study of rural upbringing and education on the intent of health professional students to work in rural settings

ObjectivesTo explore whether student rural upbringing, rural training were associated with their intent to practice in a rural health care setting after graduation in the disciplines of Dentistry, Dental Hygiene, Medicine, Nursing, and Pharmacy at a large university Health Sciences Center in Appalachia.MethodsGraduating healthcare professional students were surveyed to determine student rural background and training competency as compared to location of intended practice after graduation (N= 145). Differences were identified using descriptive statistics within and between healthcare disciplines using Spearman’s rank correlation and Kruskal-Wallis tests, Univariate, Chi-square and Pearson analyses for emergent themes or trends.ResultsPositive attitudes towards rural rotations and competency training were found. Twenty-one percent respondents graduated from high school in a rural setting (<2,500), while 4% reported their intent to practice in that setting. Conversely, 52% reported intent to practice in >50,000 population, while 12% grew up in this community size.ConclusionsStudent attitudes towards learning rural competency are positive; however, this survey suggests rural upbringing and training may not be sufficient to encourage health care professionals to practice in rural settings. More investigation is needed to determine effective incentives, perceived advantages or disadvantages and deterrents to rural healthcare practice.

A Primary Care Primer for Cancer Prevention in Rural Populations

rimary care providers have central roles in cancer prevention, risk odification activities, screening and early detection, posttreatment urveillance, palliative care, and end-of-life care. Whereas medical ncologists and other cancer specialists deliver various cancer curative nd palliative treatments, primary care providers have supporting and oordinating roles in the staging, treatment, and prognostication of ancer. The focus of this article is the role of primary care providers in rimary and secondary cancer prevention in rural populations. Preventive medicine focuses on promoting health and preventing isease in individuals and defined populations by helping them enhance heir own health. Typically, 75% of the United States population sees a hysician each year, with the majority of the visits to primary care roviders who are the dominant source of health care and health nformation. Given that cancer is the leading cause of death in the United tates for those under the age of 85, interventions to prevent cancer are f utmost importance to improving the health of individuals and populaions. It is estimated that 50% of cancer is preventable, which heightens he need for greater application of cancer prevention services. Despite a rowing body of evidence on the efficacy of cancer preventive services in mproving health, rates of delivery of preventive services remain low in rimary care practices, particularly in rural health care settings. ancer Prevention Can Be Classified into 3 Levels

Patient perceptions of innovative longitudinal integrated clerkships based in regional, rural and remote primary care: a qualitative study

BackgroundMedical students at the University of Wollongong experience continuity of patient care and clinical supervision during an innovative year-long integrated (community and hospital) clinical clerkship. In this model of clinical education, students are based in a general practice ‘teaching microsystem’ and participate in patient care as part of this community of practice (CoP). This study evaluates patients’ perceptions of the clerkship initiative, and their perspectives on this approach to training ‘much-needed’ doctors in their community.MethodsSemi-structured, face-to-face, interviews with patients provided data on the clerkship model in three contexts: regional, rural and remote health care settings in Australia. Two researchers independently thematically analysed transcribed data and organised emergent categories into themes.ResultsThe twelve categories that emerged from the analysis of transcribed data were clustered into four themes: learning as doing; learning as shared experience; learning as belonging to a community; and learning as ‘becoming’. Patients viewed the clerkship learning environment as patient- and student-centred, emphasising that the patient-student-doctor relationship triad was important in facilitating active participation by patients as well as students. Patients believed that students became central, rather than peripheral, members of the CoP during an extended placement, value-adding and improving access to patient care.ConclusionsRegional, rural and remote patients valued the long-term engagement of senior medical students in their health care team(s). A supportive CoP such as the general practice ‘teaching microsystem’ allowed student and patient to experience increasing participation and identity transformation over time. The extended student-patient-doctor relationship was seen as influential in this progression. Patients revealed unique insights into the longitudinal clerkship model, and believed they have an important contribution to make to medical education and new strategies addressing mal-distribution in the medical workforce.

Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia

Government–community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.

Focused Community-based Research for Eliminating CVD Risk Disparities in a Rural Underserved Population

Background Cardiovascular disease (CVD) is the leading cause of death and chronic illness in the U.S. In parts of the rural south disparities in both health care access and CVD health outcomes are pervasive. Descriptive analyses of community-based CVD risk factors are valuable to begin to unfold the complex nature of CVD mortality in specific rural, underserved populations. Objective To evaluate the prevalence of cardiovascular disease (CVD) risk factors among patients age 25 and over at a primary rural healthcare setting in a specific rural, medically underserved population to guide the development of community-based CVD treatment and prevention strategies. Methods This study used a descriptive retrospective explorative design. Data were collected through chart audits from a random sample of 197 patients at a rural health center in northwest Alabama, U.S. Cardiovascular risk factors were identified using health data, anthropometric measures and ICD-9 codes. Prevalence was evaluated and descriptive statistics were used to describe cardiovascular risk factors as well as socio-demographics variables. Findings In this rural medically underserved cohort (n= 197), the prevalence of selected cardiovascular risk factors was: smoking: 39.1%; hypertension: 58.4%; dyslipidemia: 15.1%; diabetes mellitus: 27.9%; and obesity: 44.5%. Smoking, hypertension and diabetes were noted to be higher in men, while women had higher rates of dyslipidemia and obesity. Rates of hypertension and diabetes increased with age as seen in similar studies. More than 48% of the study population ages 41-55 years were noted to have dyslipidemia. Conclusions This community-based CVD risk factor assessment can be used to guide future community-based research and interventions. The high prevalence and inadequate control of CVD risk factors seen in this population coupled with an existing shortage of physicians is an opportunity for nursing interventions. The use of advanced practice nurses for CVD assessment and interventions may be one practical strategy for this rural, medically underserved population. Key Words Prevalence, Cardiovascular Disease, Risk Factors, Disparities, Community-based research, Rural, Underserved, Appalachian

The experiences of Indigenous people in health care encounters in Western settings and contexts: A systematic review of qualitative evidence

Review question/objective The objective of this review is to analyse and synthesise the best available evidence on the experiences of Indigenous people who engage in health care encounters in Western settings and contexts. The review question is: What are the experiences of Indigenous people engaged in health care encounters in Western settings and contexts? Inclusion Criteria Types of Participants Studies including two groups of participants, regardless of age or gender, will be considered for this systematic review. The first group is persons of Indigenous descent from the following countries and continents appearing most frequently in the literature: North America, South America, New Zealand, Australia, and Scandinavian countries. These countries include peoples such as First Nations, Native Americans, Metis, Inuit, North American Indians, South American Indians, Inca, Maori, Aboriginal and Torres Strait Islander peoples of Australia, and Sapmi. This list is not exhaustive, and any Indigenous population identified in a study will be included. Indigenous populations who immigrate to new countries will be excluded, given that immigrant status can confound Indigenous status. The second group of participants to be considered for inclusion is health care providers who work in Western settings and context, including, but not limited to, nurses, physicians, nutritionists, midwives, social workers, physiotherapists, occupational therapists, speech and language therapists, and respirologists. Phenomena of Interest The phenomenon of interest is the experience of Indigenous people in health care encounters in Western health care settings and context. Health care encounters refer to any interactions between an Indigenous person and a health care provider within the scope of Western health care services. All reasons for health encounters will be considered. Context The context will be Indigenous persons seeking health care services in Western settings and context. These services may be located within urban, rural, or remote health care settings where Western health care services are delivered.

The experiences of Indigenous people in health care encounters in Western settings and contexts: A systematic review of qualitative evidence.

Review question/objective The objective of this review is to analyse and synthesise the best available evidence on the experiences of Indigenous people who engage in health care encounters in Western settings and contexts. The review question is: What are the experiences of Indigenous people engaged in health care encounters in Western settings and contexts? Inclusion Criteria Types of Participants Studies including two groups of participants, regardless of age or gender, will be considered for this systematic review. The first group is persons of Indigenous descent from the following countries and continents appearing most frequently in the literature: North America, South America, New Zealand, Australia, and Scandinavian countries. These countries include peoples such as First Nations, Native Americans, Metis, Inuit, North American Indians, South American Indians, Inca, Maori, Aboriginal and Torres Strait Islander peoples of Australia, and Sapmi. This list is not exhaustive, and any Indigenous population identified in a study will be included. Indigenous populations who immigrate to new countries will be excluded, given that immigrant status can confound Indigenous status. The second group of participants to be considered for inclusion is health care providers who work in Western settings and context, including, but not limited to, nurses, physicians, nutritionists, midwives, social workers, physiotherapists, occupational therapists, speech and language therapists, and respirologists. Phenomena of Interest The phenomenon of interest is the experience of Indigenous people in health care encounters in Western health care settings and context. Health care encounters refer to any interactions between an Indigenous person and a health care provider within the scope of Western health care services. All reasons for health encounters will be considered. Context The context will be Indigenous persons seeking health care services in Western settings and context. These services may be located within urban, rural, or remote health care settings where Western health care services are delivered.

P1-11-09: Effects of a Multidisciplinary Breast Cancer Clinic in an Appalachian Based Medical Center.

Abstract Background: Adena Health System is a not for profit 250 bed institution that provides health care for a 13 county region in southeast, Appalachia Ohio. Access to health care in rural setting is an ongoing challenge. Several barriers to health care access affect this region. Socioeconomic burden and lack of higher education are two of the most dominant barriers. The age-adjusted beast cancer rates are 5.3% higher in the Appalachian region and the stage at presentation is more advanced. In December of 2009, we held our first Multidisciplinary Breast Cancer Clinic (MDBCC). The goal of the MDBCC is to facilitate prompt diagnosis and effective treatment. The MDBCC is staffed by a team of physicians consisting of surgeons, medical oncologists, and radiation oncologists. The team meets with the patient in a one on one setting. That same day the patients are discussed by the team with input from pathology and radiology in order to tailor a treatment plan specifically for each patient. After the conference, the recommendations are discussed with the patient before treatment is initiated. Material and Methods: In a retrospective review, we evaluated the effect of a MDBCC on days to diagnosis, days from diagnosis to treatment, percentage of patients receiving neoadjuvant chemotherapy, and stage at diagnosis. Since December 2009, there have been over 90 breast cancer patients evaluated in the MDBCC. We randomly selected 60 breast cancer patients treated prior to MDBCC between 2008–09 and 66 patients evaluated at the MDBCC between December 2009–2011 from the tumor registry database. Results: The average number of days to diagnosis pre-MDBCC was 15.5 days as compared to 4 days post-MDBCC. In 2008–09, the average days to treatment (pathology result to a-port placement, surgery or chemotherapy) was 18 days as compared to 12 days post-MDBCC. The percentage of patients receiving neoadjuvant chemotherapy has not changed significantly, however, there is an upward trend approaching statistical significance (10% per-MDBCC vs. 12% post-MDBCC). The stage at presentation has not changed significantly since the start of the MDBCC. Discussion: The development of the MDBCC has proven to be a successful team oriented approach to breast cancer diagnosis and treatment. Time to diagnosis and initiation of treatment has improved. Providing patients with access to multiple specialists and forming a treatment plan the same day improves quality of care and lessens economic burden. The MDBCC is clearly feasible and particularly suited to the rural hospital setting. System wide, we hope to see a decrease in the stage at presentation and are confident based upon our current data that this in a realistic goal. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-09.

Expanding Access To Rural Healthcare Services And Benefits Through Secure, Interactive Video Links: A Case Study Of Video Claims Taking Implementation In The Great Plains

Context: Between 2003 and 2008, the University of North Dakota Center for Rural Service Delivery (RSD) increased access to a number of vital government services for citizens in rural communities and Native American reservations through the Video Claims Taking (VCT) program, which allowed claimants in rural healthcare settings to apply for benefits over secure interactive video networks to distant government offices. VCT helped increase healthcare reimbursement, social and related public service benefits to 31 underserved communities in six states and leveraged a significant increase in applications for government services and monetary benefits to these communities. Methods: A case-study examines the implementation, use and impact of the VCT technology over the RSD’s five year operation. Findings: The authors offer five principal findings which center on the relationships between government agencies and rural claimants, some cultural considerations posed by this electronic form of service delivery, the program’s potential to realize certain efficiencies, the technical challenges faced during implementation and overcoming a number of organizational and communications barriers. Conclusions: The foregoing analysis of the RSDs initiative and its VCT program contributes to a better understanding of how to leverage an interactive video platform to provide government healthcare reimbursement services to underrepresented groups in rural contexts for public agencies and private healthcare providers that are interested in adopting a similar model of service delivery to their stakeholders

A qualitative systematic review of the experiences of Australian advanced practices nurses working in acute care settings.

Review question/objective Internationally, advanced practice nurses are practicing in many different contexts and under a variety of position titles. Due to ambiguity within the field it is difficult to equally compare evidence in this field from different countries. The aim of this review therefore, is to examine the qualitative evidence regarding the field of advanced practice within Australian acute care settings only. More specifically, the question which this review intends to answer is: - 'What are the experiences of Australian advanced practice nurses working in acute care settings?' Inclusion criteria Types of participants This review will consider publications of qualitative studies on nurses recognised as working in advanced practice roles in acute care settings throughout Australia. Due to the ambiguity in nomenclature, different titles of APN will be considered, including but not limited to clinical nurse consultant and nurse practitioner. Studies on nurses working in roles within acute, hospital or tertiary care centres will be the focus of this review, including those that specify different units within the acute setting, such as intensive care and critical care units as well as hospital emergency departments. Advanced practice nurses working in specialty fields, such as mental health, will be included only if their practice setting is specified as acute care or hospital. Studies that are undertaken in primary care, transitional care or aged care settings will be excluded. Phenomena of interest The phenomena of interest for this review are the experiences felt and reported by advanced practice nurses working within the acute care setting in Australia. This may include patient care related experiences or experiences involving the organisation or context of practice. Context Urban and rural acute health care settings in Australia.