Queensland Maori, Pasifika Families and Child Health Service Providers narrating (talanoa) about culturally safe service delivery; a journey using an Indigenous Conceptual Framework Underpinning Decolonisation, Cultural Safety Methodology and Talanoa Methods

Ms Wani Erick1, Ms Carol Windsor2

1Queensland University Technology, Brisbane, Australia,

2Queensland University Technology, Brisbane, Australia

 

A Queensland Health report identified Maori and Pacific Island groups in Queensland as two priority groups due to social disadvantage. One key performance disadvantage among Maori and Pacific Island communities in Queensland is disengagement from child and family health services.  A qualitative study was undertaken, to explore this issue, drawing on a theoretical lens which combined   Decolonization and Cultural Safety methodologies  and Talanoa  methods.  Interviews were conducted with twenty-nine Maori and Pacific Island Families in Townsville and eight Child Health Service Providers in Brisbane and Townsville to produce greater insight into the conceptualisation of culturally safe health service delivery.

A combination of Charmaz’s constructivist approach and Bronfenner’s ecological model underpinned  data analysis. Power dynamics, socio-contextual realities, identity versus cultural difference, deficit discourse and cultural disconnection were key categories that depicted  health service delivery to Queensland Maori and Pacific Island Families. The theoretical framework shifted the focus from service users (Maori and Pacific) to examine child health service providers’ experiences in their work with Maori Pacific Island families. Simultaneously shifting a mindset from being victimized a vulnerable population, a lalaga (work in partnership) methodology was introduced; centring Maori Pasifika Island Families’ stories (tutala-aga) in ensuring they are complemented as experts of their experiences.


Biography:

Wani an RN and researcher worked for over 25 years in New Zealand and Australia having completed her Bachelor of Health Science Nursing degree, a Graduate Diploma and Postgraduate Diploma in New Zealand (MIT and Massey University).

She holds a Masters Degree from James Cook University in Townsville North Queensland with specialisation in Advanced Nursing Practice in Indigenous Primary Healthcare and Child Family Health.

Wani is currently completing her doctoral thesis at Queensland University Technology Brisbane under the supervision of an Associate Professor, titled “Queensland Maori Pasifika and Child Health Service providers narrating (talanoa) about culturally safe child health services”.

A Tiwi experience of antenatal/postnatal working together

Ms Marie Daniel1

1Doh Top End Central, Wurrumiyanga. Tiwi Islands, Australia

 

This presentation is about a Tiwi experience which we undertook with antenatal ladies and then the follow up post natally in the community. This is in essence a presentation about how the midwife and the Strong woman, strong babies, strong culture (SWSBSC) worker, a Tiwi lady, work together.

Being a mother in a remote part of Australia is fraught with challenges, distractions, humbug, family problems, money, food security. Then there is th e social media and lack of concentration listening to messages about antenatal care. People calling out, driving past, phones ringing. Jealousy issues. This is a common scenario in many communities. we took then out bush to get them away from the everyday distractions that exist in their lives, away from the mobile phones, the humbug, the unnecessary interruptions.

With the SWSBSC worker we took them out hunting, then cooked the hunted food by a waterhole and swam. Relaxed and in a natural environment that was familiar to them they listened. They also became a strong network among themselves and supported each other.

We are a Primary Health Care service and what we learnt was the traditional way of presenting ante & postnatal education at a clinic level in a room is not practical for these women – they become bored with pictures and words. We found that out in the bush, in a place they respected and they loved, they relaxed and messages were heard and that assists us to provide better outcomes.

None of this would be possible without the SWSBSC worker and my presentation would like to enforce how we do that and the show the outcomes that benefit the families involved when we work together.


Biography:

Marie Daniel is an experienced Remote Area Nurse and Midwife. She holds a Bachelor in Health Science, a Graduate Diploma in Child and Family Health Nursing and a Diploma in Community Health Nursing. Marie has had a varied and long career mainly in primary health care in rural and remote Australia and South Africa. She is now into her fifteen year on the Tiwi Islands, previously as the Primary Health Care Manager and the last three years in the role of Remote Area Midwife.

Transforming Grief and Self Care for Midwives

Mrs Stacey O’Brien1

1A Kiss From An Angel, Glasshouse Mountains, Australia

 

Background

Stillbirth and Miscarriage are devastating events of childbirth which leaves everyone involved shattered from this heartbreaking loss.  After the stillbirth of her first son, Finn, in 2002, Stacey O’Brien used writing as a healing tool and created her book, “A Kiss From An Angel”.

Stacey has spent 15 years offering this inspirational education through workshops and is so passionate that she wrote her second book “The Healer’s Workbook” to answer many of the questions that midwives have asked her.  This book also offers many self care practices for Midwives to help sustain this demanding career and offers support to the industry which cared for her so well.

Focus of discussion

Through education we can learn to transform grief, to process it, feel it and learn how to allow it to visit our life without destroying our hearts.  Grief’s best friend is anger and part of the transformational journey of grief is managing this beast and learning ways to feel, revisit and manage the destructive way it can develop in your days.  Learning how to turn pain and resentment into gratitude and love can be a valuable transformation.

Implications

This brave and very rare insight into grief and loss has offered midwives a depth of understanding that has transformed the level of compassion they can offer bereaved parents.  Stacey offers in depth practical healing tools which help midwives capture memories and honor the families during this time of crisis.

Stacey’s next project is to create an educational video series that will support and sustain the midwifery workforce into the future.

Leadership with Love and Healing.


Biography:

Stacey O’Brien is an Inspirational Speaker and Author of 2 Books – “A Kiss From An Angel, an inspirational journey through grief and the loss of a child” and “The Healer’s Workbook”.

Dedicated to Transforming Grief and Self Care for Midwives, Stacey has created “The Midwife’s Insight” an e-learning platform for midwives to gain a glimpse into Stillbirth and add to their skill set with invaluable confidence in supporting parents and the child affected by stillbirth.

Stacey is a Gifted and Intuitive Healer, Massage Therapist and Fitness Instructor with Training in Mental Health and Suicide Prevention.

Leadership with Love.

akissfromanangel02@gmail.com

NSW Rural Doctors Network provides services and support for rural and remote nurses and midwives, come and hear what RDN’s strategies are for the sector and what they can do for you

Ms Carolyn Ripper1

1NSW Rural Doctors Network, Hamilton, Australia

 

The purpose of the presentation is to raise awareness of the strategies NSW Rural Doctors Network (RDN) are undertaking to address nursing and midwifery workforce needs and challenges in rural and remote NSW.  RDN is the designated Rural Workforce Agency for health in NSW whose aim is to ensure the highest possible standard of healthcare is provided to rural and remote communities through the provision of a highly skilled health workforce and assisting communities, general practices and health services to find suitably skilled and qualified General Practitioners (GPs), nurses, midwives and allied health professionals to work in their towns.  Nurses and midwives, being the largest and the most geographically dispersed workforce in Australia are highly skilled to provide communities with access to health care across all age groups and RDN aim to ensure nurses and midwives are embedded in workforce solutions.

RDN’s vision for nursing and midwifery is that community and primary health care nurses and midwives work to their full scope of practice to enable more effective use of skills and experience to improve patient management and outcomes to meet the needs of rural, regional and remote communities in NSW.  This vision requires a number of RDNs pillars working on objectives and strategies such as;

  • Grow the community and primary health care nursing and midwifery workforce to meet the health needs of rural, and remote NSW communities.
  • Planning for the health workforce as a unified system with locally developed, innovative approaches to the delivery of primary health care that meets communities’ needs
  • Health workforce planning needs, incorporate practitioner scope of practice matched to community health needs.
  • A mechanism for dissemination of effective approaches to improved patient centred, team-based care exists
  • Improved capability and wellbeing of primary care nursing and midwifery workforce

Biography:

Carolyn Ripper is a registered nurse and midwife who has a background working in rural and regional communities in primary care roles, health care redesign, project and change management and program implementation.  Carolyn is leading NSW Rural Doctors Network’s (RDN) Nursing and Midwifery Strategy, working with key stakeholders to implement RDN’s Nursing and Midwifery Workplan objectives to embed nursing and midwifery solutions to ensure rural, remote and regional communities have access to quality primary health services.

Tasmanian Rural Hospitals – Safe Staffing Project

Ms Karen Schnitzerling1, Ms Fiona Young1, Ms Cate Pel1

1Tasmanian Health Service, Australia

 

Tasmania has 13 small Rural Hospitals which are all unique in regard to regional characteristics, bed numbers, bed types, emergency activity, medical support, outpatient presentations, community services, and visiting health services.  One thing our Rural Hospitals do share is the passion and commitment of staff and the support and investment of the local communities.

With the competing demands on our health system we have needed to maximize the use of our Rural Hospitals to assist with patient flow throughout our health system and to have the ability to accept patient transfers from metropolitan sites particularly in periods of high demand.  To manage this patient flow, we have had to review the clinical staffing of Rural Hospitals and have embarked on establishing a ‘Safe Staffing Model’.

With no identified comparative staffing model that would transpose across the Rural Hospitals, a state-wide working group was formed in February 2018 to define a proposed model.  I will outline how we defined a staffing model, how we consulted, the outcome, and the next steps.


Biography:

Karen Schnitzerling is the Director of Nursing for Beaconsfield District Health Service and George Town Hospital & Community Centre in northern Tasmania.   Both sites have small rural hospitals.

NSW Retrieval Transfusion

Mrs Sophie Shand1

1NSW Ambulance Aeromedical, Australia

 

Introduction:

Catastrophic haemorrhage is identified as the leading preventable cause of death. Rural and remote communities are particularly challenged by their distance to definitive care. NSW Ambulance has developed and introduced a Retrieval Transfusion Protocol to facilitate the delivery of blood products to pre-hospital scenes, during extended transfers and to hospital facilities.

Your Project:

There is limited evidence for transfusion specific to the pre-hospital environment however recent robust studies in hospitals broadly supports mixed transfusion in 1:1:1 ratios (Shand et al., 2018). NSW Ambulance Aeromedical services currently routinely carry only Packed Red Blood Cells and there are limited facilities which have access to additional products, particularly in rural and remote areas. With approximately 35 per cent of the NSW population residing beyond the boundaries of the greater Sydney area, NSW Ambulance has developed and introduced a retrieval transfusion protocol which facilitates the provision and delivery of additional blood products from existing blood bank facilities to patients in need across the state. This process is the first of its kind worldwide.

Conclusion:

The development and processes of the NSW Ambulance Retrieval Transfusion Protocol will be discussed and demonstrated with the presentation of specific case studies. A clinical overview of the approximately 100 patients who have received extended blood product transfusion with NSW Ambulance will be presented.

References:

Shand, S., Curtis, K., Dinh, M., & Burns, B. (2018) What is the impact of prehospital blood product administration for patients with catastrophic haemorrhage: an integrative review. Injury.


Biography:

Sophie is a Clinical Coordinator at NSW Ambulance Aeromedical Operations. This CNS role is responsible for triage, coordination and clinical oversight of aeromedical transfers and medical retrievals throughout NSW/ACT, also providing telephone clinical support.

The position combines Sophie’s previous experiences in UK Critical Care and Emergency Nursing and as a Paramedic with London Ambulance Service before her search for warmer climates brought her to Australia in 2013.

Sophie has completed a BN(Hons) Nursing, FdSc Paramedic Sciences and GradCert Emergency and is currently undertaking post-graduate research studies with the University of Sydney relating to pre-hospital blood transfusion in NSW.

Sophie.Shand@health.nsw.gov.au

An educational commitment respecting cultural pluralism – leanings from the North African chapter

Ms Louise Woods1

1Country SA PHN, Nurriotpa, Australia

 

Tasked by a British company for an international commitment on location in a tribal community in the Eastern province of Libya denotes findings that relate to experiences in 2011 such as:

  1. The political and geographically isolated region challenged conventional clinical expectations honed our sharpened teaching methods in turbulent times.
  2. Meeting the challenge to up-skill local non-certified nursing staff by utilizing a structured, daily schedule of basic lectures
  3. Initial priorities were identified as paediatric, adult, midwifery, emergency departments and renal specialties
  4. The Advanced Life Support training practical and theory tests completed, and learners certified by UK standards.
  5. Due to language barriers and cultural differences, lectures necessitated interpreters on site. Four keen college students translated script whilst requiring medical terminology as we progressed.

Recounting events in this vivid time-capsule depicts similarities to any community in remote surroundings:

  • the wanting embrace of keen learners, courageously overcoming adversity.
  • experienced clinicians with the capacity to educate, independent of location and language barriers.
  • not dissimilar to Australia’s remote and unique communities, they too experienced challenges to obtain healthy outcomes for their elderly, children, the injured or those with poor mobility and those burdened with chronic illness.
  • unrestricted, culturally safe, high quality professional leadership to guide and support their adjustments with morally sound, professional guidance.

As such, I believe that all experienced clinicians are educators by default, positioned favorably to engender opportunities that keen learners could benefit from.

It was in North Africa where I learned never to underestimate the incredible educational influence that highly motivated and skilled clinicians possess.


Biography:

A nursing qualification started a journey from South Africa which gained momentum as I furthered my career, launching a trajectory of explorations across 10 countries. Leanings gained by my broad global exposure embedded the desire to share what I have learned

  • Master of Pub Health JCU, Cert IV Training&Educ
  • US-RN Licensed as Prof Nurse – NYSB
  •  Reg Nurse,  Midwife (S-Africa), Cert Occ Health-Stellenbosch University (S-Africa)
  • Cert Aviation Nursing, Institute for Aviation Medicine (S-Africa)
  • PG Dipl Remote&Offshore Medicine – Edinburgh Uni (UK)
  • NEBOSH Int Gen Certificate Health&Safety (UK)
  • PG Dipl Health Informatics – Otago University (NZ)
  • Certificate- Rehab&Return to Work Coordinator

The Role of the Female Rural Generalist

Dr Maria Capoluongo1, Dr  Sundar  Thavapalasundaram

1Royal Flying Doctors Service South Eastern Section, Broken Hill, Australia

 

What role does the female rural generalist play in the landscape of rural generalism?

What role do we play if anything in shaping the provision of primary care?

Being a female GP who works remotely I can say that we add so much to our communities we serve. It is so important to be representative. Im lucky enough to work for the RFDS who unashamedly fly the flag for this cause. I am also lucky enough to work with some great female colleagues.

Female medics account for half the general practice work force if not more and our numbers are growing.

How do we attract more female GP’s to these rural roles , I will explore some of these ways in this presentation and hope to find new ways to help fill the gaps we are facing in medical workforce in the bush.

  1. Talent finding- novel ideas, advertising, recruitment drives, conferences, courses, sending questionnaires out to city GP’s- offer sabbaticals in rural areas.
  2. Proactive – medical schools, promotional work, target newly qualified GP’S
  3. Incentives – financial, relocation, childcare for mothers, childcare very important, spousal employment opportunities
  4. Stigma professional isolation talking this, discussions, forums, rural generalist pathway- stream lining this

5 Retention- professional development, work life balance. lifestyles choices.

  1. Leadership Roles- offering more to females, management roles teaching and academic.

A general push is needed in this area at a local and government level, we need more GP’S and we will soon be facing crisis in primary care provision. Something needs to be done.


Biography:

Dr Capoluongo MBBS, BSc, MRCGP, FRACGP

Uk traine GP, interest in mental health and service development, moved to Australia with family to work for RFDSSE. Currently GP with RFDS, delivering primary to the outback

 

Coordinated Veterans’ Care: A collaborative approach to managing chronic conditions

Ms Carolyn Campbell1, Ms Anna Polson1

1Department Of Veterans’ Affairs

 

The Department of Veterans’ Affairs Coordinated Veterans’ Care (CVC) Program is a team-based program encouraging partnership and collaboration between the participant, GP, nurse coordinator and a wide range of health professionals and community supports. CVC involves a proactive approach to improve the management of participants’ chronic conditions and quality of care for eligible Gold Card holders at risk of unplanned hospitalisation.

CVC Care Teams use a person centred approach to care planning, coordination and review, as the model to support better outcomes and self-management of the veterans’ health. The program emphasises a coordinated approach, partnering and utilising a multidisciplinary team to provide tailored and flexible support based on an individual’s goals.

The coordination of care for those living with chronic conditions is pivotal in the empowerment of participants by promoting self-management, providing education and linking participants with other health providers for a holistic approach.

Through the CVC Program and the coordination of the care plan, participants can access a wide range of health services to assist in the management of their chronic conditions. The sharing of health information amongst all partnering health care providers enables better health outcomes for participants. Regular communication, empowerment and coaching are key to the success of the team.

The CVC Program has proven to be effective in reducing hospitalisations and is considered to be a leading practice approach to the coordination of health care services facilitating and promoting partnerships to support health outcome. Amid the changing landscape of health care and the emergence of different chronic conditions, the CVC Program will continue to lead the way in delivering high quality coordinated care to the veteran population.


Biography:

Carolyn Campbell and Anna Polson are in the Nursing Programs and Operations section at the Department of Veterans’ Affairs and oversee the Coordinated Veterans’ Care (CVC) Program.

cvcprogram@dva.gov.au

How the NP and RN-led ATC in a small rural hospital is fulfilling the needs of their local community

Ms Jodie Cameron1, Ms Michelle  Cruse1

1Southern NSW Local Health District, Pambula District Hospital, Australia

 

Across Australia, many rural health regions are facing the dilemma of providing safe high quality health services to their populations in the wake of hospital downgrades and/or the loss of medical practitioners in rural small hospitals. Evidence, and service description supporting or describing the implementation and outcomes of Nurse Practitioner services in Australian rural small hospitals with no on-site medical staff is lacking. In addition, public health policy to close or downgrade small hospitals and concentrate services in main centres often causes community angst and significant hardship in rural areas where people have previously relied on their local community hospital and GP services to provide for their health needs.

This presentation describes the first 6 months of data post successful addition of Nurse Practitioners to a nurse led Assessment and Treatment Centre at a small downgraded NSW rural hospital. With no doctor on site or available on call, and with a limited Scope of Practice for the RN-led service, the addition of NPs has improved ATC patient numbers, improved community confidence, filled a service gap between overloaded local GP services and the regional hospital ED, and has significantly reduced the load on the regional hospital by reducing transfers and presentations, particularly important in periods of high tourist activity.

To date the service has demonstrated safe, cost effective, community based care and is proving to be an excellent alternative to GP or ED presentation, including collaboration with the GPs and ED to co-manage their scheduled re-presentation patients. There is potential for growth and development for the RNs to further increase their scope and work satisfaction, and provides a potential training pathway for aspiring NPs. The success of this service has positive implications for many smaller rural and remote services needing innovative solutions for provision of safe and cost effective care.