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 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.

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.

The Flying Doctor 90 years on

Ms Lauren Gale1

1Royal Flying Doctor Service of Australia, Kingston, ACT

 

Purpose:
This year, the RFDS celebrates 90 years of delivering essential health services to rural and remote Australians, and our research shows these services are still needed now more than ever.

Scope:
In 2015, the RFDS established a Research and Policy Unit, tasked with gathering national RFDS and broader population data about rural health inequities, and identifying gaps in service access for those living in remote and rural areas. This presentation will look at the findings of this research, the way the RFDS has grown over time to be much more than a flying doctor, and the journey of the RFDS to implementing evidence-based programs.

Issue:
The RFDS has now released six policy research papers, on topics including oral health (March 2015) and mental health (March 2017) outcomes and access to services in rural and remote areas, each of which demonstrate the persistent and significant disparities in service access and health outcomes of those in remote and rural Australia. Based on this evidence and supported by the RFDS’s innovative Service Planning and Operational Tool (SPOT),. which maps existing services in remote and rural Australia overlayed with population data, the RFDS has been focused on developing, recommending and advocating policy solutions to improve service access for remote and rural Australians.

Outcome:
Based on the evidence presented in these policy research papers as the foundation for engagement with the Commonwealth government, the RFDS has been successful in the last two Federal Budgets in securing new funding for national oral health and mental health programs. This presentation will briefly outline the findings of these reports, the use of SPOT, and through the framework of the policy cycle, and the current task of implementing evidence-based policies through these two new programs.


Biography:

Lauren is the Director of Programs & Policy for the RFDS, responsible for leading the Research and Policy Unit.
Lauren was previously a Policy Adviser in the Department of the Prime Minister & Cabinet with responsibility areas including rural health, mental health, indigenous health and women’s health.
Lauren completed a Master of Public Policy (Social Policy) at the Australian National University in 2013 and previously completed a Bachelor of Arts and Sciences (Hons.) at the University of Sydney, including an honours thesis on Australian rural health policy and persistent health workforce shortages in rural areas.

Enabling successful transition of dental graduates to regional and remote practice through curriculum design and clinical practice

Dr Felicity Croker1

1James Cook University, Cairns, QLD

 

The Bachelor of Dental Surgery (BDS) at James Cook University (JCU) was established in 2009 as a socially accountable program with the mission to address the population health needs and workforce shortages of rural, remote and tropical Australia. This presentation will focus on how aligning curriculum design and clinical experiences enables and encourages transition to graduate careers in rural, remote and regional areas.

An ongoing process of evaluation involving data gathered from participatory action research, student feedback surveys, clinical partners, and graduates has informed development of the innovative curriculum design of the JCU program. The rural and remote focus is embedded into the dental curriculum across the pre-clinical and clinical years. In addition to clinical and cultural competency, the course prepares dental graduates for interdisciplinary teamwork in rural and remote practice. This pioneering dental program also embeds education on domestic violence (DV-RRR) and authentic medical emergency simulations. Final year students complete extended clinical placements in rural and remote communities; this is essential if graduates are to feel comfortable and competent to join the remote health workforce.

Ongoing feedback is informing program design and delivery to optimise engagement and preparedness for practice. With student input, learning opportunities and clinical experiences can prepare ‘fit for purpose’ graduates whose distinctive profile and capabilities enable them for transition to the rural and remote workforce. Destination data and GIS mapping of graduate destinations reveals the significant contribution JCU dental graduates have made to the rural and remote oral health workforce since 2013. However, given the given the challenge of funding rural and remote student placements, further research is required to evaluate the impact of the current policy and budgetary environment on the viability of the current curriculum. This may reduce the capacity to continue contributing work-ready graduates to the future rural health workforce.


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.

Caring for the carers, are we there yet? Reaffirming resilience, redesigning and revealing the 4P’s remote workforce safety training road trip

Mrs Brenda Birch1

1CRANAplus, Wonga, VIC

 

If you’ve ever spent any time with the remote Australian health workforce, you will very quickly conclude that they are some of the most resilient, inspiring and committed people you’ve ever met. But how resilient are the system in which they work? Are they adaptable to such complex and dynamic environments? The purpose of this presentation is to challenge the need for a safety maturity model designed specifically for remote and isolated health sector.

This presentation will inform participants of the current journey to transition workforce safety and security legislation, research and guidelines into practice within the remote and isolated health workforce in Australia with a specific focus on aggression and violence. The 4P’s approach is an inclusive and innovative risk assessment methodology to create a shared understanding of preventative, recovers and supportive controls.

How will remote or isolated clinicians, managers, educators, researchers and decision makers know if we are doing enough to protect the health and safety of remote and isolated workers? Are we measuring what matters?

Imagine having certainty of a resilient safety culture supported by a maturity assessment tool that alignments patient, workforce, systems and community safety. It’s time to transition global knowledge and work with communities to develop, deploying and be proud of safety strengths and a shared safety the vision for the future.

References:
1. Foster, P., & Hoult, S., (2013) The Safety Journey: Using a Safety Maturity Model for Safety Planning and Assurance in the UK Coal Mining Industry. Minerals, 3(1), 5972.
2. Law, MP et al (2010) Assessment of safety culture maturity in hospital setting. Healthcare Q Spec No: 110-5.
3. Reason, J. (1998). Achieving a safe culture: theory and practice. Work and Stress, Volume 12(3), 293-306.
4. Hollnaguel, E., et al (2006) Resilience Engineering, Concepts and Precepts. Aldershot, UK: Ashgate.


Biography:

Brenda Birch (National Remote Safety and Security Educator) is passionate about safe, high quality and inclusive healthcare for both patients and the people who provide the care. Brenda has held several key quality, safety and risk leadership roles in VIC, NT and QLD health sector. Brenda has implemented risk management across a large and diverse health service which has been externally recognised as having areas of advanced maturity.
Qualifications include: RN, non-practising RM, Certificate IV Training and Assessment, Green Belt Six Sigma, Lead Auditor in Quality Management System, Certificate IV WHS, Graduate Certificate Health Service Management and Graduate Diploma Engineering.

Enabling successful transition of dental graduates to regional and remote practice through curriculum design and clinical practice

Dr Felicity Croker1

1James Cook University, Cairns, Australia

 

The Bachelor of Dental Surgery (BDS) at James Cook University (JCU) was established in 2009 as a socially accountable program with the mission to address the population health needs and workforce shortages of rural, remote and tropical Australia. This presentation will focus on how aligning curriculum design and clinical experiences enables and encourages transition to graduate careers in rural, remote and regional areas.

An ongoing process of evaluation involving data gathered from participatory action research, student feedback surveys, clinical partners, and graduates has informed development of the innovative curriculum design of the JCU program.  The rural and remote focus is embedded into the dental curriculum across the pre-clinical and clinical years. In addition to clinical and cultural competency, the course prepares dental graduates for interdisciplinary teamwork in rural and remote practice.  This pioneering dental program also embeds education on domestic violence (DV-RRR) and authentic medical emergency simulations. Final year students complete extended clinical placements in rural and remote communities; this is essential if graduates are to feel comfortable and competent to join the remote health workforce.

Ongoing feedback is informing program design and delivery to optimise engagement and preparedness for practice. With student input, learning opportunities and clinical experiences can prepare ‘fit for purpose’ graduates whose distinctive profile and capabilities enable them for transition to the rural and remote workforce.  Destination data and GIS mapping of graduate destinations reveals the significant contribution JCU dental graduates have made to the rural and remote oral health workforce since 2013.  However, given the given the challenge of funding rural and remote student placements, further research is required to evaluate the impact of the current policy and budgetary environment  on the viability of the current curriculum.  This may reduce the capacity to continue contributing work-ready graduates to the future rural health workforce.


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.

“Facilitating remote student nurse placements in Central Australia – a wealth of experiences.”

Ms Emma Bugden1,2, Ms Jessie Anderson3

1Flinders University, Alice Springs, Australia,

2Menzies School of Health Research, Alice Springs, Australia

3Centre for Remote Health, ALICE SPRINGS

 

In response to the challenge of recruiting a nursing workforce to provide care in remote areas, more nursing students are being given the opportunity to experience this unique working environment through their Professional Experience Placements. Research into the decision making processes of new graduate health students regarding returning to practice in remote locations indicates that student perception of the placement experience is significant. This experience is shown to be impacted by the quality of supervision and support.

With large investments by the Commonwealth government, universities and other organisations such as CRANAplus aimed at encouraging students to undertake remote placements to increase the possibility they will choose to work in remote locations on graduation, it is essential that the quality of supervision is such that the experience for students is both positive and supported.

Barriers to this include a lack of qualified or available staff to facilitate student placements in person.  Many universities adopt a preceptor-led model of facilitation where the health facility staff are responsible for both the learning and assessment of the student. Flinders University aims where possible to provide a dedicated facilitator that is employed by the university.  With placement settings across the Northern Territory it is often necessary for facilitation to be provided using technology including telephone and video conferencing.

To outline the issues involved, this presentation will discuss the challenges and triumphs of providing meaningful and accurate facilitation to students in remote areas of the NT.  Approach and techniques utilised, challenges to communication and interaction encountered and the valuable and educational experiences some of these students have achieved will be included.


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.

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

Rheumatic Heart Disease Australia – 2018

Ms Diana Mosca1

1Rheumatic Heart Disease Australia, Darwin, Australia

 

Rheumatic Heart Disease Australia (RHDAustralia) is funded under the Australian Government’s Rheumatic Fever Strategy to support the control of rheumatic heart disease (RHD) in Australia. The aim of this hotspot is to highlight the current activities of RHDAustralia. Australia has among the highest prevalence of RHD in the world, largely in rural/remote communities. Resources are available to support people with RHD, and those who work with them.

What we are doing:

⦁              The Australian ARF/RHD Guideline is being updated and expanded. The new edition will be based on the latest evidence-based research, with a focus on culturally-appropriate practice.

⦁              The current Guideline, a rheumatic fever diagnosis app, and an injection treatment tracker app are freely available online.

⦁              We work in partnership with RHD control programs across Australia to deliver workshops for the health workforce to increase capacity around RHD prevention and management.

⦁              Free e-learning modules, short movies, and many other resources are available on our website.

⦁              RHDAustralia works closely with its partners, stakeholders, patients, families and communities to develop culturally-appropriate information for disease prevention and support. The current focus is on peer support initiatives, self-management tools and health promotional material for people living with RHD and their communities.

Visit the RHDA booth in the trade displays and let us know how we can support you and your community.


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.

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