Conception in Kadjina to Birthing in Broome ~ one woman’s journey thread through the complexities of delivering remote health care in a high risk pregnancy

Ms Kristy Newett1

1Kimberley Population Health Unit, Broome, Australia

 

The issue of geographical location in remote communities across Australia can impact on antenatal and postnatal care. The women who choose to receive antenatal and postnatal care in the Kimberley region are also often confronted with the status of the label ‘high risk pregnancy’ due to the highly diverse health requirements that our Indigenous clientele often face. Combining multifaceted health issues are social and cultural complexities that can also impact on one’s care. Climatic extremes combined with poor road infrastructure often lead to difficult access to care scenarios which is evident in this case study of one woman’s journey living remotely in a Kimberley community.

Combining my own previous clinical experience working across the Fitzroy Valley involving a large cohort of antenatal women under my care, and in my current role with the Nini Hethiwan project, has enabled me to reflect on regional systemic issues & factors impacting on women’s pregnancy care with the aim of improving maternity services for mothers’ and their babies.

The Nini Project is between both Western Australia Country Health Service (WACHS) and Kimberley Aboriginal Medical Services (KAMS), which involves working across the region covering all communities and clinics. As a Research Midwife, I have a role assessing processes and implementing peer led targeted support for antenatal and postnatal care providers. In the context of this presentation following a woman’s journey, I will navigate the complexities of receiving remote health care whilst incorporating a pregnancy with numerous risk factors. I am wanting to illuminate some of the challenges faced by women and clinicians which include:

  • Access to services
  • Cultural considerations
  • Distances of travel
  • The necessity for collaborative work amongst clinicians

This will encompass the systemic factors that clinicians often face within a remote setting in such a large region called the Kimberley.

 


 

Biography

Kristy has worked across the Kimberley region for 9 years however the work undertaken as the Community Midwife in the Fitzroy Valley for 5 years allowed her to take the title of Winner in the Western Australia 2015 Excellence in Midwifery awards. In 2016 Kristy commenced and completed a Masters in Women’s Health Medicine, drawing on the current services and clientele of the Kimberley and linking it very closely with her current position on the Nini Helthiwan project. As a Research Midwife for KPHU, Kristy is currently looking at ways to improve maternity care for women across the region.

Orientation to Remote Primary Health Care Manuals

Mr Tobias Speare1, Mrs Lyn Byers1

1Central Australian Rural Practitioners Association (CARPA) Inc., Alice Springs, Australia

 

The presentation will demonstrate the use of technology in improving orientation to remote health, specifically to the purpose and use of the Remote Primary Health Care Manuals (RPHCMs).

The remote health workforce has been characterised by high turnover, low stability and high use of short-term and agency staff particularly nurses, which has major implication on service delivery. The orientation of new staff to remote health services has historically been poorly executed, with up to 70 % of nurses in very remote areas in one survey stating orientation was inadequate.

The Remote Primary Health Care Manuals, a suite of clinical guidelines for primary health care practitioners in remote and Indigenous health services, guide clinical practice in many areas of rural and remote Australia. They are grounded in evidence based practice and shaped by the practicalities of the remote context.

Remote health services and stakeholders have identified an absence of standardised and appropriate orientation to the correct and proper utilisation of the manuals.

The development of an orientation video to the RPHCMs was undertaken to address the identified need. The Orientation to the Remote Primary Health Care Manuals video is freely available with the aim of improving delivery of health care in remote Australia through improved use of recommended clinical guidelines.

Research projects to ensure on-going evaluation of the Remote Primary Health Care Manuals, including the manual development process and impacts in terms of health outcomes are under way. The orientation video project arose from and will integrate into the Remote Primary Health Care Manual evaluation processes.

 


 

Biography

The presenters are representatives of the Central Australian Rural Practitioners Association (CARPA), a voluntary organisation involved in primary health care education, training and support of rural and remote health practitioners of various specialities and experience levels.

 

Emergency Medicine Education – a virtual program using VC technology and flexible, blended learning techniques for rural and remote clinicians in WA Country Health Service.

Mrs Yvonne Zardins1, Doctor Stephanie Schlueter1

1WA Country Health Service, Perth, Australia

 

The WA Country Health Service (WACHS) commenced the Emergency Telehealth Service (ETS) in 2012 aiming to improve emergency medical care delivered to patients who present to remote hospitals.  ETS Physicians provide direct patient consults and Emergency Medicine Specialist advice to doctors working in remote and rural hospitals.

Apart from restricted access to specialist services, health practitioners working in rural locations have limited opportunities to access formal education sessions and interactive simulation scenarios.  Following on from the telemedicine component of the ETS, a dedicated education program has evolved.  Using the dedicated video conferencing infrastructure of the ETS, a flexible blended learning program is delivered using educational lectures, workshops and simulation interactive sessions for doctors and nurses working in rural and remote sites.  Delivering the education directly to the sites improves access and also offers the benefit of education and practice in a familiar environment.

Combined with contributions from the ‘Emergency Medicine Education Program (EMET)’ funded by the Commonwealth through the Australasian College for Emergency Medicine (ACEM),  Emergency Medicine Consultants in collaboration with the ETS Nurse Educator have developed and delivered a successful program across WACHS, the largest area health service in Australia covering 2.5 million square kilometres.

The purpose of this presentation is to demonstrate the capacity of a dedicated ‘virtual’ education program using VC technology to deliver a successful multi-disciplinary emergency medicine training program.

 


 

Biography

Dr Stephanie Schlueter, an Emergency Physician working in WA, is a Co-Director Emergency Medicine Training, the Emergency Medicine Clinical Lead- WACHS Kimberley and a clinician for Emergency Telehealth Service.  She is involved in education and clinical governance across WACHS.  Born in Germany, Dr Schlueter’s love for Australia began as an exchange student and when doing a medical elective at Fremantle Hospital.  Stephanie completed her Emergency Medicine training at Sir Charles Gairdner Hospital.  With a passion for medical education, Stephanie is a course instructor for a variety of emergency medicine courses including the Western Trauma and WATEC Trauma Team Simulation Course.

The National Preventing Aboriginal and Torres Strait Islander Maternal Smoking portal supporting improved access, safety, quality and affordability for the remote Maternal and Child health and Tobacco Prevention workforce.

Mrs Patricia Amaranti1

1The Australian Indigenous Healthinfonet, Kalamunda, Australia

 

Tobacco use among pregnant Aboriginal and Torres Strait Islander women in Australia is disproportionately high. In 2014, 45% of Aboriginal and Torres Strait Islander women in Australia reported smoking during pregnancy, compared to 13% of non-Aboriginal pregnant women [1]. The Preventing Aboriginal and Torres Strait Islander Maternal Smoking (PATSIMS) portal aims to support the Maternal and Child health and Tobacco prevention workforce to reduce smoking among pregnant women and promoting smoke-free environments which is critical to improve health outcomes for Aboriginal and Torres Strait Islander women and their babies. In the past accessing appropriate culturally safe resources and information has been identified as a barrier to the success of their work [2] and the recently updated PATSIMS portal which is an extension of the successful original Preventing Aboriginal Maternal Smoking WA (PAMSWA) portal program, was initially designed to address this problem [3]. The recently expanded portal provides high quality, culturally appropriate information and resources for individuals, communities and practitioners, working with Aboriginal and Torres Strait Islander women, their families and communities, along with a national workshop program offering hands on training to make best use of the resources. The portal links to a free Yarning place chat forum, to encourage information sharing and collaboration, allowing rural and remote health workers wider interactions with like-minded professionals involve in maternal and child health for Aboriginal and Torres Strait Islander women and babies.

 

  1. Australian Institute of Health and Welfare (2016) Australia’s mothers and babies 2014: in brief. Canberra: Australian Institute of Health and Welfare
  2. Passey M, Sanson-Fisher RW (2015) Provision of antenatal smoking cessation support: a survey with pregnant Aboriginal and Torres Strait Islander women. Nicotine & Tobacco Research;17(6):746-749
  3. Wilkins A (2015) Preventing Aboriginal Maternal Smoking Western Australia: baseline evaluation survey results. Perth, WA: Preventing Aboriginal Maternal Smoking Western Australia

 


 

Biography

Trish Amaranti is a Research Officer with the Australian Indigenous HealthInfoNet (AIH) with over 25 years’ experience working in Aboriginal and Torres Strait Islander health and education. Trish’s current AIH responsibilities include the Eye health topic and the West Australian health topic areas, as well as the development of the Preventing Aboriginal and Torres Strait Islander Maternal Smoking portal, Yarning place and national workshop training program.

The Treatment Tracker app: reminders, motivation and challenges for young people at risk of rheumatic heart disease

Miss Catherine Halkon1, Mrs Claire  Boardman1

1RHDAustralia, Menzies School Of Health Research , Casuarina , Australia

 

Acute rheumatic fever and rheumatic heart disease (RHD) are preventable conditions which have been largely eliminated from developed countries yet Australia has one of the highest rates of acute rheumatic fever (ARF) in the world, primarily affecting Indigenous Australians, many living in remote areas. Treatment Tracker is a smartphone app designed to remind and encourage young people to get their regular benzathine penicillin G (BPG) injections to prevent recurrences of ARF.

ARF is caused by an autoimmune response to a group A streptococcal infection. Recurrent episodes of ARF can lead to heart valve damage known as RHD. RHD is a chronic, often fatal, disease. The regular administration of BPG, known as secondary prophylaxis, is the proven strategy to prevent ARF. Injections must be given at least every 28 days for 10 years or until the person is 21 years old – whichever is longer. A missed injection leaves them risk of repeat episodes of ARF and further heart damage.

RHDAustralia developed the Treatment Tracker app to support young people, most at risk and facing multiple challenges in sticking to their treatment. This paper discusses how the app is designed to motivate people to get their injections and discusses some of the challenges in development specifically in relation to the nature of the treatment regimen; equity and access to technology; reaching and engaging the target audience; and, with still limited evidence of the effectiveness of eHealth technology to improve medication adherence, the importance and challenge of evaluation.

 


 

Biography

Catherine Halkon is Projects Manager at RHDAustralia, the National Coordination Unit for the Australian Government Rheumatic Fever Strategy, based at Menzies School of Health Research. Catherine he works on the development and implementation of education and training projects and is involved in the operational and strategic management of the project. Catherine has a Masters of International Management and extensive experience in not-for-profit management and research management. Before joining RHDAustralia in 2012, she worked on a number of Indigenous education and training research projects in the Northern Territory, including the management of a large scale literacy intervention project.

Evaluation of Oral Health Literacy and Comprehension in Rural Year 8 High School Students

Mr Ethan Zappala1

1James Cook University, Cairns , Australia

 

This research aims to explore the oral health literacy of rural-dwelling adolescents in North Queensland. Health education interventions carried out during early adolescence have been shown to have long lasting effects on the development of good oral health behaviours into adulthood; oral health is fundamental to overall systemic health. However, to date, most studies surrounding these topics haven’t included adolescents. Furthermore, the literature surrounding rural Australian adolescents is scarce and this gap is addressed in this study.

Results

Participants were found to have varying knowledge surrounding oral hygiene and prevention of oral disease. Results demonstrated participants having knowledge on how and how often to carry out oral hygiene, however not understanding the reasoning to do so. Survey results suggest that 13% of participants reported of the dentist making them nervous. The focus group data however indicated that all participants were nervous depending on the dental procedure. The participants reported of having above average dental attendance, 93% attending the dentist in the past 12 months. Data indicated the most common reason for dental appointments was for a dental check up and restorative work. Toothache was also reported consistently amongst focus groups as a reason to visit the dentist. Evidence suggested the participants’ oral health knowledge was reasonable, however, their oral health behaviour required improvement.

Conclusions

The evaluation suggested main points delivered during the oral health promotion were received well. This indicates that teens have the ability to obtain and learn basic health information. It is hard to determine whether this will parallel to the appropriate health care decisions. As oral health literacy involves both the ability to obtain information and apply it, it is difficult to draw conclusions about the adolescents’ oral health literacy levels. Whether these positive oral health behaviours will be adopted is a significant opportunity for further research.

 


 

Biography

Ethan Zappala is a James Cook University Dental student enrolled in his fifth and final year of study. He is currently undertaking placement in the public sector in rural North Queensland. Growing up in a country town within North Queensland, Ethan developed a passion for a career as a health professional. With his rural upbringing, he has a particular interest in rural and remote health.

 

Reducing the ‘tyranny of distance’ and enhancing patient outcomes through innovative use of new technology options in rural and remote locations

Mr Alistair Crowe1

1Wa Country Health Service, Broome, Australia

 

Introduction:

The provision of fast effective data connections in remote locations can prove costly and difficult with a lack of data and telecommunications infrastructure in many remote locations making connections slow, unreliable and expensive. With many services moving ‘online’ and a reliable data connection considered for granted in many industries and situations the lack of these services in rural and remote locations hampers the provision of effective data services that support new technologies and reduce the tyranny of distance for remote medical staff. Recent and on-going improvements in this field have opened up new opportunities for a faster connected service to remote clinics and new technologies to improve patient care and reduce the requirement for patients to travel out of their communities to receive some services and care which can now be provided locally.

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

  • Telstra Satellite Data Connectivity and NBN Skymuster connectivity
  • Point of Care testing and results transmission – iStat devices
  • Introduction of voice over IP telephony
  • Telehealth including Emergency Telehealth services
  • Improved remote support availability
  • Improved reliability of data services and ‘direct’ connectivity

Conclusion:

Case studies to demonstrate technology:

Case Study: Kalumburu Remote Area Clinic

  •  Telstra and NBN Satellite connectivity
  • TIPT and VOIP in the clinic and nurses homes (including January outage example)
  • Trial of Telehealth and future Emergency Telehealth
  • ICT remote support connectivity
  • Remote CCTV and duress
  • Future challenges
  • Cost reduction to provide services
  • Increases in bandwidth requirements
  • Mobile telephone communications

 


 

Biography

Alistair Crowe is the current Regional ICT Manager for the WA Country Health Service in the Kimberley Region supporting over 30 rural and remote health locations across WA with the local ICT team. Alistair Crowe has a Bachelor of Science majoring in Computer Science, a Graduate Diploma of Education and qualifications in Youth Work, Protective Care and Juvenile Justice and is currently working towards a Master’s in Business Administration.  Alistair has a particular interest in remote communication technologies and the improvement in health outcomes and working conditions for remote health workers that technology can bring.

Leveraging Technology for RAN Safety

Ms Heather Keighley1

1NT Health, Darwin, Australia

 

In 2016 the death of Remote Area Nurse Gayle Woodford triggered widespread concern about the safety and security of nurses and midwives working in remote communities across Australia.  In response to these events the Northern Territory (NT) Department of Health initiated a review into safety policies and practice across NTG Health services.  This paper will discuss the recommendations and consider the impact of technological advances in protecting staff safety and security.

The implementation process so far will be presented including technological challenges and how innovative solutions can provide safety supports for nurses and midwives in remote and isolated settings.  The recommended strategies include communication systems, information and data technology solutions.  The experience of the Chief Nursing and Midwifery Office in leading the review and implementation process across the NT will be discussed.

The future plan to monitor and evaluate the effectiveness of initiatives will be presented.

 


 

Biography

Heather is a Registered Nurse over forty years of experience in nursing and midwifery, mainly in the NT with an emphasis on primary health care, clinical education, clinical governance, and quality improvement. She is currently working as the Acting Chief Nursing and Midwifery Officer for the Northern Territory Department of Health in Darwin, NT.

Developing a theory of remote area nursing practice

Ms Kylie McCullough1, Professor Anne Williams2, A/Professor  Vicki Cope2, Professor Lisa Whitehead1

1Edith Cowan University, Joondalup, Australia, 2Murdoch University, Murdoch, Australia

 

The purpose of this poster presentation is to elicit feedback from RANs regarding the preliminary findings of this PhD research.

The aim of the study is to explore and describe, from the perspective of nurses in remote areas: the actions and interactions used to deliver PHC, the contexts and conditions where PHC is applied and to uncover the factors which enhance or inhibit PHC nursing practice. The outcome of this study is to develop a theory which explains the nature and process used by RANs to deliver PHC.

An important factor in the credibility of this research is providing opportunities for nurses to consider the findings in relation to their own practice and to facilitate feedback and collect data relevant to the substantive theory. Ethics permission has been granted to collect data in the form of written and verbal comments. The author intends to display the theory as a poster and encourage feedback in the conference break times. Unfortunately, the poster will not be able to be uploaded electronically due to copyright issues. Publications which arise from this research, including the final theoretical framework, will be made available to CRANAplus.

 


 

Biography

Kylie McCullough is a lecturer in Primary Health Care at Edith Cowan University in the School of Nursing and Midwifery. Kylie is nearing completion of her PhD research which aims to better understand the way RANs practice Primary Health Care nursing. She has previously worked as a RAN in the NT.

Using technology to provide support to new nurses and midwives in the bush; A novel innovative education and support program has been developed to augment current resources and overcome the barriers of distance experienced by nurses in the bush.

Dr  Pauline  Calleja1,2, Ms Cherie O’Brien1, Mr  Clayton Judd1, Ms Lee  Trenning1

1Retrieval Services Queensland, Brisbane, Australia, 2Griffith University, Menzies Health Institute, Nathan, Australia

 

Using technology to provide support to new nurses and midwives in the bush

Aim: Providing clinical education and support in isolated areas can be difficult due to resources and distances. This presentation showcases an innovative support program for novice and new graduate nurses and midwives.

Background: In an effort to improve recruitment and retention of staff in the bush, a support program using a blended approach has been developed and trialled by Retrieval Services Queensland, funded through the Office of The Chief Nursing and Midwifery Officer (QLD). The program implemented in four Queensland rural and remote health services, aims to assist new staff to practice and learn safely in a supported environment. Additionally, individual and group level education and development is provided for clinical staff and educators supporting these nurses and midwives. The program was developed as an overarching support service, augmenting current resources to improve outcomes and experiences. Strategies and models were chosen to help overcome geographical barriers and reduce professional isolation often experienced by staff in the bush, using face-to-face, digital and telehealth technologies. The blended, scaffolded and structured approach was chosen to enable delivery of deliberate, organised and timely learning.

Issues addressed: a lack of after-hours support; capacity of local clinical staff to provide needed support to novices and staff with teaching expertise located at hub sites far removed from areas of need. This is exacerbated by the wider scope of practice required in isolated settings. While novices report enjoying varied learning opportunities, they are not frequent enough to ensure mastery. Many new staff in these environments voice concerns about achieving their educational and clinical goals while meeting the patient’s needs and expectations.

Conclusion: Using a variety of technologies to deliver purposeful education and support may improve recruitment and retention of the future rural and remote workforce.


Biography

Pauline is a Lecturer at Griffith University and consults as a Nurse Educator with Retrieval Services Queensland (RSQ). Pauline is the Post Graduate Director for nursing programs, Program Director for Emergency Nursing and is leading the Rural and Remote Graduate and Novice Education Support Program at RSQ.

Cherie is a Nurse Educator with clinical and teaching experience in Emergency Departments and Primary Health Care clinics within Australia and UK. Cherie is working on the Rural and Remote Graduate and Novice Education Support Program at RSQ and has a Masters in Critical Care Nursing, with expertise in emergency and trauma nursing.

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