Challenges and triumphs in expanding Undergraduate Nursing Placements in the Northern Territory – Workforce development in Remote Health

Ms Jessie Anderson1

1Centre For Remote Health, Alice Springs, NT

 

In recent years, the Commonwealth government has committed additional funding to encourage nursing and allied health students to undertake placements in Rural and Remote regions throughout Australia through the Rural Health Multidisciplinary Training Program (RHMTP). This is in line with research that indicates a positive placement experience is a factor in the decision to work in rural and remote areas on graduation and beyond.

While a focus of this funding is on encouraging local health students to remain in their rural area after graduation, for remote regions of the Northern Territory there is not enough local graduates to supply the health workforce needs. In addition, many NT students chose to leave the Territory to study. In addition to supporting local students, the Flinders NT Remote Inter-Professional Placement Learning (RIPPL) Team has developed a program of supporting Nursing and Allied Health students from over 30 different universities to experience a placement in the NT.

Challenges have abounded in the complexities of coordinating students, academics, universities and health services across the vast distances of the Northern Territory. Ensuring supervisors are supported and students have the necessary preparation, orientation, supervision and support is essential.

However the triumphs continue. Student demand is high, allowing for a selective process aimed at identifying students that will not only benefit from the remote experience but also those who are best able to manage the challenges of remote life. Student feedback indicates a high level of satisfaction with the educational and cultural outcomes of the placements. Applications for Graduate Programs and data from student satisfaction surveys indicates that student intention to return to the NT on graduation is also high.

This Paper discusses the development of a unique program to create pathways for student nurses interested in a career in remote health in the Northern Territory and beyond.


Biography:

Jessie Anderson, RN, BN (Hons), MNurs (Emerg)
Nursing Lecturer at the Centre for Remote Health, Flinders NT, Alice Springs.
Coordinator of RHMT supported Nursing placements in the Northern Territory.
Jessie.Anderson@flinders.edu.au

The Emerging Nurse Leader program through the Australian College of Nursing – an experience of a path to professional and personal extension

Ms Emma Bugden1,2

1Flinders University, Alice Springs, NT

2Menzies School of Health Research, Alice Springs, NT

 

In the context of the challenges of providing quality and effective healthcare in rural and remote areas, innovative and committed leadership is integral to making the best use of available resources and finding ways to connect meaningfully with the population. The Emerging Nurse Leaders (ENL) program through the Australian College of Nursing allows nurses early in their careers to extend their leadership skills through a variety of well chosen challenges. Support is provided through ACN staff and the selection of a mentor from the Australian nursing community. In 2017 the presenter was a stage three candidate ENL and completed the program with a High achiever’s award. In this presentation she will discuss her experience including:

• spending time with nurse leaders in their work environment and gaining an understanding of the activities, strategies and structures involved in their daily routines – including the ethos and commitment guiding their practice.
• the opportunity to see how nursing policy and guidelines are discussed at an executive and national level
• engaging in a professional mentoring relationship
• acting as an informal mentor and career coach
• engaging in interprofessional collaboration
• contributing to nursing knowledge through engagement with conferences and journals
• encouraging nurses throughout SA and NT to embrace leadership at all levels

Nurses reaching individually and collectively their potential as leaders in the workplace and community provides capability for our healthcare system to be compassionate, effective and responsive.


Biography:

In 2017 Emma Bugden was awarded the Gayle Woodford scholarship and graduated with a High Achievement award from stage 3 of the Emerging Nurse Leader(ENL) program. She is the Chair of the ACN NT South region leadership group and a candidate for stage 4 of the ENL program in 2018. Emma has worked in Central Australia for Flinders Uni, Menzies School of Health Research and the Alice Springs Hospital. Having raised two children, with has a background in nursing and ethics, she is committed to inspired leadership, effective and supportive management, building strong communities and rural and remote nursing practice.

The global lessons of healthy country, healthy people

Dr David Campbell1

1Charles Darwin University

 

Introduction
Noncommunicable disease has become a global pandemic, with the burden of this condition bearing most heavily on socioeconomically disadvantaged. While Aboriginal people have greater risk of being socioeconomically disadvantaged they suffer an ongoing history of colonisation and socioeconomic disenfranchisement. Those living in remote to very remote Australia suffer the additional burden of isolation from services and costly transport and the expense of limited food sources Yet, under certain conditions, Aboriginal people can have better health outcomes.

What is happening
A strong relationship exists between risky behavioural choices of lack of exercise, poor food selection, excess alcohol consumption and smoking. Risky behavioural choices might be attributed to a preference for short term satisfaction rather than, for instance, undertaking long-term self-investment in education with better employment and health possibilities. Failure to make such choices has been identified with overwhelming chronic stress, including loss of control and disenfranchisement. This is important given the higher stress levels suffered by Aboriginal people. Biomedical studies, however, show instances of better health outcomes for Aboriginal people in remote to very remote Australia. These studies demonstrate an inverse relationship between disease condition and traditional cultural connection with country, as through participation in traditional land management.
Using an economic framework, data from these and other studies showed substantial cost savings in chronic disease, plus additional private and public good benefits including meeting food and shelter needs, meeting cultural responsibilities, biodiversity, mitigation of dust storms, and biosequestration of greenhouse gases.

Conclusion
These results exemplify the possibility of nonmedical primary preventative health interventions as a cost-effective complement to curative health interventions. Or, lessons on how we might address the global noncommunicable disease pandemic.


Biography:

Most of David’s professional life has been in regarding bio-economics, with a particular focus in fisheries. During this time, he wrote one of the earliest works in optimal harvest of a density independent species and the application of individual transferable quota; when these works required a micro and public economics view point. The last ten years were with the Centre for Remote Health, Alice Springs, where he supervised the remote post graduate course in Remote Health Economics. During this time his research and publication focus was on the social benefits of healthy country, healthy people, through Aboriginal involvement in traditional land management or caring for country. This and following work allowed him to recently finish up with a PhD by publication.

Preparing for Rural Practice: Exploring JCU dental students’ perceived preparedness following dental simulated emergency medical training (DSEMT)

Kalen Chao1, Hanin Musbah1, Israel Needham1, Patricia Tan1, Stephanie Wong1, Felicity Croker2, Luke Croker2

1Year 4 Bachelor of Dental Surgery Students at James Cook University; researchers

2Supervisors

 

Introduction

Increasing medical advancements coincide with increased life expectancy, leading to an aging population with a higher proportion of medically compromised patients. As rural and remote areas tend to have fewer resources and personnel, dental professionals must be capable of pre-empting, adequately identifying, and managing patients experiencing both medical and dental emergencies.

What is happening in your project/health service/or what has been your experience

While effective management of medical emergencies is a requirement of the Professional Competencies for a Newly Graduated Dentist, studies suggest that many dentists upon graduation do not feel adequately prepared for managing real life medical emergencies, which likely reflects a discrepancy in the course curriculum. As such, it is crucial to ensure a curriculum which best prepares students to manage clinical emergency situations. James Cook University (JCU) aims to amend this disparity through dental simulated emergency medical training (DSEMT) sessions. These are provided to students in their clinical years in small groups by emergency trained nurses, who simulate patients experiencing medical emergencies in a dental setting.

This research aims to explore the perceptions of fourth and fifth year JCU Bachelor of Dental Surgery (BDS) students on their level of preparedness in identifying and managing medical emergencies in a clinical setting, following a DSEMT program.

Conclusion

This paper will analyse students’ perceptions of the effectiveness of DSEMT through data collected from written surveys and focus groups. This research will also compare the differences in perception between fourth and fifth year students who have experienced different clinical settings. It will provide evidence-based research that may contribute to future dental emergency medical training for undergraduate dental curriculum, to allow for more competent dental graduates.


Biography:

Felicity Croker (PhD; B.Ed (Hons1), RN, RM. Felicity.croker@jcu.edu.au

Felicity is a Senior Lecturer in Dentistry at JCU who is passionate about growing socially accountable health professionals who are ‘fit for purpose’ for regional and remote practice. She is actively involved in applied research on rural oral health, domestic violence, and graduate preparedness for rural practice. Felicity has initiated and established work integrated placements for students. With the first dental cohort graduating in 2013, Felicity has evaluated four years of final year students’ intentions and the impact of rural and remote experiences on graduate destinations.

Primary Health Care Nurses as Change Agents: The Impact of Supportive Partnerships

Ms Inara Beecher1, Ms Sabine Drilling2, Ms Vanessa Poulsen2, Ms Noelene Cooper1

1Country SA PHN, Torrensville, SA

2Heart Foundation SA , Adelaide, SA

 

Introduction:
Regional SA has high levels of burden of CVD and despite this, screening for cardiovascular disease using the Absolute Risk (AR) tool has had limited uptake. Mortality due to the cardiovascular condition of ischaemic heart disease remains the leading cause of death in SA. Based on this data Country SA PHN (CSAPHN) engaged with the Heart Foundation (HF) in SA to determine potential approaches to address this.

The HF has a long-standing reputation for generation and translation of evidence-based guidelines for prevention and treatment of cardiovascular disease. The Nurse Ambassador program (NAP), running since 2004, provides a model for facilitating effective knowledge translation, change management and quality improvement. Discussions with the HF highlighted that there had been limited access by rural primary health care (PHC) nurses to join NAP. Reasons included distance, employer’s capacity to release nurse and limited PD budget.

Strategies:
CSAPHN formed a partnership with the HF in SA to provide scholarships for regional PHC nurses to participate in the NAP. The scholarships program is for 2 years (2017/18) with the aim to target 16 country SA regions. Each scholarship was determined using the Modified Monash Model approach. The scholarship funding was to be used for travel/accommodation/at discretion (babysitter etc). Scholarship nurses are tasked with implementing AR assessments in their practice and are supported via workshop sessions including change management and clinical updates.

Outcomes:
November 2017, 7 PHC nurses completed the NAP under the CSAPHN scholarship. 8 PHC nurses are currently participating. All have stated they would not have been able to attend if not for scholarship.

In these regions, general practices are now doing primary prevention with patients being actively managed and supported to make lifestyle changes. The PHC nurses have identified the opportunity they have to be ‘change agents’ in their rural communities.


Biography:

Noelene Cooper CSAPHN Project Manager has worked in health for thirty years including; Pharmacy, General Practice, Divisions of General Practice and Medicare Locals. Noelene has a Diploma in Population Health and manages the After Hours Program and the Chronic Pain Management Project.
Presenters email address : ncooper@countrysaphn.com.au

Incivility and bullying in rural and remote health workplace culture in Australia – Through the lens of appreciative inquiry

Ms Therese Forbes1,2, Dr Yoni Luxford2, Dr Annmaree Wilson1,2

1Cranaplus, Broome, WA

2University of New England, Armidale, NSW

 

Workplace ostracism, incivility and bullying have been increasing in incidence and concern in Australian health workplaces despite concerted efforts to address it on a range of organizational levels and professional approaches. Most policy and professional development strategies have been developed in centralized health departments and rolled out with little attention to specific contexts of practice.

This paper examines remote and rural health workplaces in Australia, giving special attention to research investigating factors that have been contextualized, or emphasized localized solutions to the wicked problem of workplace bullying and its antecedents. Factors that impact on collaboration, engagement and connectedness in the workplace are particularly relevant.

An integrated literature review was undertaken and found that incivility, ostracism and bullying can thrive in highly stressful and small inter-dependent team work environments. Ignoring these factors can be perilous for teams. Remote health professionals were also more concerned about bullying by colleagues than they were about physical violence from community members – another significant issue in remote practice.

Stressful working environments are fertile ground for ostracism and incivility and management may feel ill equipped to respond and resolve conflict within teams. If this is poorly handled it can result in the use of behaviours that are passive and even more difficult to detect.

Strong support for implementing values based practice strategies to mitigate the wicked problem of ostracism, incivility and bullying has been found. Using an Appreciative inquiry approach to engage with remote and rural health professionals to improve workplace culture has been useful.


Biography:

Therese Forbes is an experienced psychologist who has lived and worked in remote areas in Western Australia and Queensland. She has worked in primary health care settings and in private practice and is currently Bush Support Line Psychologist with CRANAplus. Therese is currently a candidature in the Masters of Philosophy (Research) program at UNE.
Therese provides counselling and mentoring services to rural and remote health workers and delivers workshops on resilience, mindfulness and connected, engaged and collaborative workplaces.

Therese is passionate about improving workplace culture in rural and remote health care settings.

Evaluation of oral health literacy and comprehension in rural grade seven high school students – an analysis of an oral health education program

Mr James Macdonald1, Mr Connor Smith1, Mr Simon Wilkinson1, Mr Jason Park1, Ms Pegah Shafieekhazaneh1, Dr Felicity Croker1, Dr Karen Carlisle2

1James Cook University – The College of Medicine and Dentistry (Cairns), Smithfield, Cairns, QLD

2Australian Institute of Tropical Health & Medicine (James Cook University – Townsville), Douglas, Townsville, QLD

 

The purpose of the presentation:

This paper presents the findings from an evaluation of an oral health education program currently implemented by dental students in a rural high school in North Queensland, Australia.

The nature and scope of the topic:

Rural adolescents are identified as “at risk” of experiencing poor oral health. School-based oral health (OH) education programs have the potential to reduce the risk factors, however, evaluation is required to monitor their impact and potential outcomes.

Issue(s) under consideration:

This ongoing study aims to deliver and evaluate a recurring oral health education program currently implemented at Ingham State High School (ISHS), in North Queensland, Australia. This program is run concurrently with the school vaccination schedule. Recommendations for improvements to the program are focused on increasing engagement with young people to improve OH behaviours.

This mixed methods study comprised of an OH literacy survey and focus groups with Grade 7 students, along with interviews with school teachers involved in the program. Focus group and interview transcripts were thematically analysed. Data from this study provides a valuable contribution to the understanding and knowledge of oral health literacy and behaviour amongst rural adolescents.

Outcome / Conclusion:

The current oral hygiene program was well received. Students demonstrated high levels of OH knowledge, thoroughly participated and enjoyed the program. Additionally, this study reinforces the value of oral health education programs in high schools, and illustrates several ways to improve future oral health education programs. To increase the validity and generalisability of future studies, a before-and-after survey approach should be used. Given the ease and cost-effectiveness of the program, it may be successfully implemented in other rural schools alongside their respective vaccination programs.


Biography:

James Macdonald is a current 5th Year Dentistry student at James Cook University. He was first admitted to course in March 2013, and is expected to graduate December 2018. Prior to that time, he was a Radiotherapist working in the state of Victoria. His responsibilities included the planning of, and administration of radiation treatments for cancer patients. A graduate of Deakin University in 2003, Mr. Macdonald received a Bachelor of Science (Biomedical) (First Class Honours) before completing a Masters Radiation Therapy at Monash University in 2008.

Local Activities Support Global Goals

Ms Diana Mosca1

1Rheumatic Heart Disease Australia, Darwin, NT, Australia

 

This presentation will highlight some local health promotion activities that are contributing to the global goal of eliminating rheumatic heart disease (RHD). An estimated 32 million people live with RHD. Each year, about 275,000 develop the disease and that number again die from RHD. Approximately 80% of the global burden of RHD is seen in underdeveloped countries, yet Australia has some of the highest prevalence in the world.

The adoption of the Sustainable Development Goals (SDG) and the World Heart Federation goal of 25×25<25 (a 25% reduction in premature deaths from acute rheumatic fever (ARF) and RHD among individuals aged <25 years by 2025) validates local work.
Rheumatic heart disease follows ARF (often undiagnosed), which results from an auto-immune reaction to a streptococcal infection (often untreated). Repeated episodes of ARF can lead to more severe RHD. This is a disease of damage to the valves of the heart, leading to heart arrhythmias, stroke, bacterial endocarditis and premature death. Heart surgery to repair or replace damaged heart valves is commonplace.

Rheumatic heart disease is a dangerous condition for pregnant women and has a significant impact on child and maternal mortality. Consistent with SDG 3.1, two culturally-appropriate short films have been developed to educate young women and their families about important considerations for women with RHD who want to start a family.
Consistent with SDG 4, a language centre in a Top End Aboriginal community has created a program to educate children and the community about RHD. Community members used the complex concepts of RHD and developed their own story to be shared with children in their own languages, using lessons, activities and games.
We aim to inspire and motivate the audience to assess the possibilities for RHD prevention activities in their workplace.


Biography:

Diana Mosca currently works as a nurse advisor for Rheumatic Heart Disease Australia. She qualified at Princess Margaret Hospital for Children in 1985, and in 30 years her career has taken her from paediatrics, to public health, and back again via perioperative nursing, projects and nursing education. She has worked most of her career in the NT and regional Queensland. She has a Masters in Public Health and Tropical Medicine, Graduate Certificates in Perioperative Nursing and Clinical Leadership, and a Cert IV Training and Assessment.

Eliminating Crusted Scabies: The One Disease Experience in Remote NT Communities

Ms Michelle Dowden1, Ms Meg Scolyer1, Ms Irene OMeara1, Ms Hannah Woerle1

1One Disease, Darwin, NT, Australia

 

Introduction:
Aboriginal communities in the Northern Territory, Australia, have some of the highest reported rates of scabies in the world. Secondary skin infections associated with scabies can lead to ongoing heart and kidney complications.
In 2014, scabies was added to the World Health Organisation’s list of Neglected Tropical Diseases (NTDs); and in 2017, the scabies classification was elevated from Category B to Category A in the NTD profile. Scabies is the only WHO Category A NTD that does not yet have a roadmap for Elimination.

What is happening:
To date, the not-for-profit One Disease is the only organisation with an informed, planned approach for addressing Crusted Scabies in the Northern Territory; and is leading the way in developing a framework for Elimination. One Disease aims to Eliminate Crusted Scabies from the NT by 2019, and across Australia by 2022.
Preliminary work in readiness for Elimination of Crusted Scabies has seen One Disease focus on two key aims: Improve detection and diagnosis of Crusted Scabies; and prevent recurrence of Crusted Scabies episodes requiring hospital.
Utilising a quality improvement framework, One Disease alongside local health services, is reshaping health systems, to better facilitate coordinated care for people with Crusted Scabies. One Disease are enabling systems change at multiple levels – family, community health centre, and hospital.

Conclusion:
Providing leadership for improvements in detection, diagnosis, treatment, and management of Crusted Scabies, has seen a more coordinated approach for controlling Crusted Scabies – the first step in Elimination of this debilitating, yet entirely preventable disease.


Biography:

Meg is an RN, with post grad experience and qualifications in community development and health promotion. Meg’s role at One Disease involves working in partnership with local communities in West Arnhem Land, to develop locally owned strategies for improving management of Crusted Scabies. A core element of this work is providing support and education to individuals, families, remote clinicians, and hospital staff; but also includes advocacy; care coordination; screening and active case finding; building the capacity of local people to manage scabies; development of care management plans for clinical information systems; updating clinical guidelines; and practice based research.

meg.scolyer@onedisease.org

Where are the nurses who will look after rural and remote when we are all gone?

Greta Webb1, David Schultz2,3

1Aspen Medical

2Rural LAP

3Healthcare Australia

 

Introduction
• There is a significant worldwide challenge in recruiting and retaining skilled nurses. This is especially true for rural and remote health services, which continue to experience significant, ongoing nursing shortages.

What is happening?
• The current workforce is aging with nearly one third due to retire in the next ten years
• One third of all nurses who graduate leave the profession within 5 years
• Nurses working in rural and remote settings need higher levels of knowledge and skills to provide first line primary and emergency health care due to the scarcity of doctors in these settings. The knowledge and skills, and ability to use them under pressure takes significant time to develop.
• A move to part time work by many experienced nurses further exacerbates the shortage and ability to transfer skills
• Critical shortages of nurses leads to those in the workforce working extra hours/on call increasing their fatigue and thoughts of retirement (and increasing risks of serious errors)

Conclusion
It’s a scary feeling being the person who responds to an emergency when there is no MET team to call. All the hero nonsense goes out the window as you put your knowledge, skills and experience on the line. We need to be developing a workforce ready for the challenge.

• Some good things are happening to address this issue, e.g. students undertaking placements in rural and remote, courses specifically designed to teach the knowledge and skills needed.
• Governments need to research appropriate incentives to attract and retain rural and remote nurses, such as the Rural LAP scheme.
• Employers need to ensure they have systems in place to address the needs of staff e.g. workforce development plans and support to study
• We as individuals must be supportive of new employees (and relievers) so that they will want to stay and develop into our future workforce.


Biographies:

Greta Webb is a Registered Nurse proudly working for Aspen Medical as a member of their Rural Locum Assistance Program (Rural LAP), in rural hospitals and remote clinics.

Rural LAP is a part of the Australian Government-funded service that focuses on supporting health professionals, nursing and allied health, working in rural and remote settings. The Rural LAP team recruits highly skilled and experienced locums to enable those health professionals to attend educational requirements to maintain registration and update their skills, and to be able to obtain their hard earned leave.

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