Does Indigenous health education have an impact on student’s attitudes? Second results from a longitudinal study

Prof. Janie Dade Smith1, Dr Shannon Springer1

1Bond University, Varsity Lakes, QLD, Australia

 

Introduction
There are many initiatives occurring in Australia to teach cross cultural education to health professionals. However there is little evidence that any of these programs have a long term impact on the cultural safety of the students practice once graduated, with recent research indicating that some education is having the reverse effect and creating hostility and racism [1],[2].

Method
Since 2012 Bond University has been conducting an Indigenous health program for its medical and allied health students; as well as a 5 year longitudinal study to measure the impact on student’s attitudes and behaviours using a validated cultural awareness and competence scale survey, which is administered pre and post immersion at year 1, in year 3 and year 5.

Results
Initial findings of the cultural awareness study (n=280) revealed positive shifts in various dimensions of cultural awareness amongst first and third year undergraduate medical students. The most notable differences occurred within knowledge acquisition, retention and dissemination (items 18–20, p<0.001). It also found that students made more effort to learn about how cultural factors affected health, delivery and behaviour; as well as positive shifts in institutional and curricular influences following the cultural immersion in Year 1 [3].

Conclusion
Cultural immersion has a great potential to elicit positive shifts in attitudinal and knowledge related aspects of cultural awareness in the early stages of a medical curricula.

References
1. McDermott D, S.D., Managing a diverse student discomfort with an Indigenous health curriculum, in LIME good practice case studies. 2012, LIME Network: Melbourne. p. 26-28.
2. Sears KP, Improving cultural competence education: the utility of an intersectional framework. Medical Education, 2012. 46: p. 545-551.
3. S Sargeant, JD Smith, and S. Springer, Enhancing cultural awareness education for undergraduate medical students: Initial findings from a unique cultural immersion activity. Australasian Medical Journal, 2016. 9(7).



Biography:

Professor Janie Dade Smith is the Professor of Innovations in Medical Education at Bond University where she was instrumental in establishing their award winning Indigenous health program for the Faculty of Health Sciences and Medicine. Previously Janie ran her own national company – RhED Consulting Pty Ltd – where she undertook consultancies for health departments, universities, professional colleges, government and not for profit organisations. Janie is well published, being author of the very successful text Australia’s Rural, Remote and Indigenous Health: which is used by most Australian universities and organisations. Janie is the immediate past president of CRANAplus.

Gayle Woodford Oration & Award Cocktail Event

Gayle Woodford Scholarship

Gayle was a committed, proactive and professional Remote Area Nurse (RAN). She worked for Nganampa Health Service for 5 years before her sad death in 2016.  Her role as a RAN was the fulfilment of a ‘dream’ to undertake community work with disadvantaged people. Gayle was well educated and well prepared as a Diabetes educator and a Graduate of Centre for Remote Health and Flinders University with a Graduate Certificate in Remote Health Practice

This scholarship is jointly sponsored by CRANAplus and the Centre for Remote Health and is open to registered nurses, Indigenous health practitioners,  allied health practitioners and medical officers.

Applicants must meet the entry requirements of the Graduate Certificate in Remote Health Practice offered through the Centre for Remote Health (FUSA)

Working in remote practice is desirable.

The scholarship covers all course fees for the Graduate Certificate in Remote Health Practice.

One scholarship will be awarded annually, for study to commence the following year

 

Gayle Woodford Oration

This inaugural Oration to be held at the CRANAplus Conference is to honour the memory of Gayle Woodford.

This Oration will be delivered by

 

Adjunct Professor Debra Thoms

FACN(DLF) FACHSM(Hon)RN RM Adv Dip Arts BA MNA Grad Cert Bioethics

Debra Thoms is the Commonwealth Chief Nursing and Midwifery Officer, a role she commenced in August 2015.  She was formerly the inaugural Chief Executive Officer of the Australian College of Nursing, a position she was appointed to in May 2012 following six years as the Chief Nursing and Midwifery Officer with NSW Health.

During her career Debra has gained broad management and clinical experience including as a clinician in remote and rural Australia, as CEO of a rural area health service, general manager of the Royal Hospital for Women in Sydney as well as Chief Nursing and Midwifery Officer within the Health Departments of South Australia and New South Wales.

In 2005 Debra was selected to attend the Johnson and Johnson Wharton Fellows Program and the Wharton School of Business at the University of Pennsylvania. Her contribution to nursing and health care has been recognised by an Outstanding Alumni Award from the University of Technology, Sydney and she also holds appointments as an Adjunct Professor with the University of Technology, Sydney.

Lived experiences of women with primary infertility in rural Limpopo Province, South Africa

Dr. Ramakuela NJ1
1Department of Advanced Nursing, University of Venda, Thohoyandou, South Africa

Women who had never achieved pregnancy after adequate exposure to unprotected sex without using contraceptives tend to suffer primary infertility. It is a global reproductive health issue that affects individuals and couples. Among other factors contributing to primary infertility is sexually transmitted infections. The nature of research was alarmed with the experiences of women with primary infertility with a purpose of describing and exploring lived experiences of women with primary infertility. The study adopted a qualitative, and phenomenological approach using explorative design. The population was all women with primary infertility. Non-probability purposive convenient sampling was employed to select the participants aged 25 – 45 years attending infertility clinic based on the personal judgment of the researchers. Data was collected through in-depth one to one interview and guided by one central question was aked. Field notes were taken as the researcher met face to face with participants. Data was analyzed using Tesch eight steps of data analysis. Measures of trustworthiness were adhered to and ethical principle considered. Two main themes emerged: Spouses/ husbands not ready to test for infertility and lack of consistent consultations at fertility clinics. Conclusion and recommendations Government and policy makers to train more health professionals specializing in fertility to enhance quality care and provide human and material resources in all public health facilities providing fertility services. Participants to seek medical intervention immediately after 12 months of unsuccessful pregnancy and disclose their infertility status to lessen self-discrimination.


Biography

Dr. Ramakuela NJ is currently working as Senior Lecturer at the University of Venda. Dr Ramakuela received his Doctoral degree or PhD on 2012 from the University of Venda. Dr Ramakuela completed his Masters in Nursing from the University of Venda. She then worked at the University of Venda, served as Senior Lecturer. Dr. Ramakuela has authored several publications in various journals and books. Her publications reflect her research interests in Reproductive and Women’s Health. Dr. Ramakuela is also an Associate Editor of the African Journal for Physical, Health Education, Recreation and Dance. Dr. Scientist is serving as a member or fellow in Association of Women Empowerment in Vhembe District. She is currently in charge of ongoing scholarly project Palliative Care for Dignified Dying survey, Knowledge of water, health and Sanitation. Dr. Scientist is awarded or honored by The University of Venda Research and Innovation Excellence Awards.

Research Interest: Dr Ramakuela is a healthcare Professional who specialized in reproductive and women’s’ health. Her PhD Model is entitled “A MODEL TO FACILITATE WOMEN’S COPING WITH MENOPAUSE”. Her model is being utilised by rural community based women to help cope with menopausal challenges they encounter.

The trials & tribulations of a relief nurse – why should you care?

Greta Webb1, David Schultz2,3

1Aspen Medical

2Rural Locum Assistance Program (Rural LAP)

3Health Care Australia

 

Introduction
A relief nurse gets off a small plane on an island they have never been to before and walks to the clinic. The handover is “these are the things I have found since I got here a couple of weeks ago, and I am on Thursday’s plane out of here.” The waiting room is full, the Webster packs need to be ordered and a woman in labour after no antenatal care has begun haemorrhaging after delivering.

What is happening?
• A short term relief nurse faces the same challenges as a new nurse – but every few weeks.
• Some orientations are very good but often the reliever is expected to just start working because they are only there for a couple of weeks and often it is another reliever handing over
• Challenges in a new community/workplace
o Where am I?
o Who are you?
o Where do I find …?
o What is the password for …?
• Extra hours/on call because the regulars are exhausted

Why should you care?
• A good reliever can make your life easier
• A good reliever has skills that are very marketable – if you want them to come back you need to make their life a bit easier
• Putting systems in place to help relievers will also help new permanent staff and will make orienting all new staff easier

What can you do?
• A comprehensive, up to date Orientation folder is a valuable resource for all staff, but it needs to be kept up to date.
• Do a quick check of the allocated accommodation – if you wouldn’t want to move in it’s not very welcoming for the reliever
• Don’t take them for granted – a good reliever will happily pitch in and take on the extra to give you a break, but it’s nice to have this recognised


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.

The Nursing and Midwifery Exchange Program

Andrew Hughes1

1Queensland Government, QLD

 

Introduction

The Nursing and Midwifery Exchange Program is an innovative workforce program. NMEP inspires candidates to try different areas and arms aspiring leaders with the skills required to lead. NMEP journeys our workforce to different places; both professionally and geographically.
Objectives/Aims:
This state-wide program is aimed toward;
– Professional development for Queensland Health Nurses and Midwives
– Enabling networking between Queensland Health rural and metropolitan facilities and HHS’s
– Exposure to different clinical areas/locations and environments
– Fostering leadership and Mentoring
NMEP is available to staff from our EN’s to our DON’s. Leadership: Voice at all levels.

Description/Methodology:

Running four cohorts per year, we facilitate the matching and exchanging of nurses and midwives across the state in order to allow them to try each-others jobs. Candidates engage in a 12 week program and engage in a mentoring relationship.
Ultimately, we are growing a Queensland Health nursing and midwifery workforce with a wide variety of skills and experiences. We strongly believe that the cross pollination of skills across our state will have better outcomes for our rural/remote communities. NMEP takes nurses and midwives on the journey of leadership; through experiencing different and diverse areas, nurses/midwives refine and retain their skills.
Results Outcomes:
The date, NMEP has received 52 applications from nurses/midwives all over the state. NMEP has measured candidates self-assessed ability in areas such as leadership, mentoring, clinical skills and how likely an applicant is to seek employment in a rural/remote area. Preliminary results have shown favourable outcomes for rural/remote work with a growth in professional confidence and skill.

Conclusion:

The program has shown benefits to the individual, the facilities hosting exchange candidates and to health services engaging in exchange. The sharing of knowledge and skill across our diverse state ensures that our staff are inspired and grow within their leadership journey.


 

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.

Indigenous Engagement for Students

Ashley Brown1

1NRHSN

 

The National Rural Health Student Network (NRHSN) Indigenous Community Engagement Activity program provides opportunities for Rural Health Club (RHC) students to play a role in improving the health and education of rural communities. Each Rural Health Club must organise and participate in at least one Indigenous Community Engagement Activity each year

Aims
The aims of the Indigenous Community Engagement Activities program are to:
• Inspire Indigenous rural students to pursue health careers.
• Increase your knowledge of rural community health.
• Gain skills in working in a rural community.
• Gain further connections with rural health workers and communities.
• Gain positive rural experiences.
Types of activities
Indigenous Community Engagement Activities could include:
• Attendance at Indigenous Family Days.
• Working with Aboriginal and Torres Strait Islander students through youth clubs, Indigenous Community Health Services or other organisations.
• Indigenous Community Festivals.
• Assisting schools with a predominantly Indigenous student population with a series of health workshops including healthy eating, skills based sessions and highlighting health careers as options for future study.
The 2018 Executive Committee is in the process of creating an Indigenous Engagement Activity Guide to be published by August. It is headed by Rebecca Fatnowna, a woman of both Aboriginal and Torres Strait Islander decent and our Indigenous Officer. This guide will include the following components to be presented on:
• Welcome to, and acknowledgement of country
• Cultural Responsiveness
• Strategies for engaging with Aboriginal and Torres Strait Islander communities
• Aboriginal and Torres Strait Islander Events
• Dates of significance
• Case studies


Biography: 

Ashley Brown, Community & Advocacy Officer of the NRHSN

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.

Safety and quality in maternity care – developing a National Strategic Approach to Maternity Services

In Australia, the planning and delivery of maternity services is a State and Territory responsibility, with the Commonwealth playing an important role in providing national direction and coordinating efforts to improve care and outcomes.

Significant progress in improving Australian maternity care services was made under the National Maternity Services Plan 2010–2015 which concluded on 30 June 2016. Successes included Australian Health Ministers’ Advisory Committee (AHMAC) endorsement of national core maternity indicators and evidence-based antenatal care guidelines, expanding the range of maternity models of care, establishing the Pregnancy, Birth and Baby Helpline, identifying characteristics of culturally competent maternity care for Aboriginal and Torres Strait Islander peoples and developing a framework for birthing on country programs.

In 2017 AHMAC tasked the Australian Government to work with the jurisdictions on development of a National Strategic Approach to Maternity Services (NSAMS). Extensive consultations have been conducted and the resulting draft NSAMS is now the subject of further consultation. The NSAMS is intended to provide an overarching national approach to maintaining Australia’s high-quality maternity care and working towards further improvements.

1239