Introducing First Year Nursing Students to Regional and Rural Interprofessional Health care

Mrs Helen Goodwin1

1Southern Queensland Rural Health, Toowoomba, Australia

 

It is well documented that there is a shortage of health professionals worldwide and that challenges exist in recruiting nurses to rural areas. Research has highlighted the correlation between students with a rural background and the choice to pursue rural practice.  However, evidence is growing that providing a positive and supported rural placement experience, whether for a week or a semester, can be a stronger predictor of future rural practice than having a rural background.

This study aims to explore how introducing first year nursing students to an observational placement opportunity, in regional and rural Queensland, at the beginning of their university degree program could influence their intention to choose rural clinical placement opportunities in the future.

The four-day observational placement introduces first year nursing students to health services across a variety of domains and settings within an interprofessional context. The observational placement, supported by Southern Queensland Rural Health, includes site visits to acute health services such as hospital emergency and maternity, chronic health services such as mental health and aged care as well as community services such as homelessness and disability care.  The four-day experience also includes community involvement and events, sessions on mindfulness and mental wellbeing, and visits to local landmarks.

Evaluation of the students’ experience is measured with pre and post questionnaires, aimed at identifying what aspects of the experience may inspire them to choose a rural placement later in their degree program.


Biography:

Helen has been a nurse and midwife in the UK, Canada and Australia. Rural practice in Canada which included independent midwifery practice offered a career high. She holds a bachelor degree in Nursing, a diploma in Midwifery and a masters degree in Women’s Health. She has been an educator in nursing and midwifery for The University of Queensland for the last ten years and her current role as a clinical educator for Southern Queensland Rural Health is allowing her to share her passion in the Darling Downs Health and Southwest Hospital and Health regions.

NSW Rural and Remote health workers and the burden of care in the drought: who cares for the carers? A report on the CRANAplus Bush Support Service 2019 Drought Support Roadshow across the state.

Dr Annmaree Wilson1,Dr Yoni Luxford1

1CRANAplus Bush Support Service, Cairns, Australia

 

The entire state of NSW is in drought. The human impacts of this environmental disaster in rural and remote communities are only beginning to be understood. It is no surprise that health workers are overloaded with demand for services in affected communities. Not surprisingly they also deal with their personal responses to the situation. Little is known about who cares for the carers during drought?

CRANAplus Bush Support Services has a unique depth of expertise in providing psychological support to rural and remote health workers. A BSS team of clinical psychologists and Aboriginal health workers delivered a Roadshow of mental health interventions and workshops across rural and remote NSW. Using a best practice/mindful/strengths-based approach to raise professional and personal awareness, the project aimed to increase resilience-building skills, capacity to manage stress and the burden of care associated with working in drought-affected communities.

Preliminary findings show that responding to drought is a workforce development issue. Health workers responded positively to the Roadshow. Findings include: participant’s significant appreciation of the team’s deep understanding of issues faced by rural and remote health workers; strategies provided were immediately useful to participants; and unlike other visiting drought support programs, BSS offered immediate and ongoing phone follow up.  Further, the team was confronted by tensions between resilience of health workers (mostly women) and the extent of the burden of care they carried for the drought. The team was exposed to racism while delivering the project, mostly in the form of unconscious bias. Predominantly there was a lack of awareness of how the drought was affecting Aboriginal people, including AHWs; statements that they might be affected at all, were shocking.

At the conference we will discuss our findings in relation to key health and social policy and with evidence from the literature make recommendations for further development.

NT Health – keeping remote nurses safe through policy and practice change

Ms Rhonda Powell1, Prof. Sue Hawes1

1NT Health, Darwin, Australia

 

The Northern Territory (NT) Department of Health has been unrelenting in its implementation of recommendations made following an independent review of remote area safety for nurses and midwives.  This presentation will detail the strategies implemented to date, challenges along the way and future plans. Featured in the presentation will be the on-line professional development modules that have been developed in partnership with Centre for Remote Health and NT Health, and funded by Primary Health Network NT.

In 2017 NT Health endorsed 14 recommendations that aimed to improve the safety, effectiveness and quality of care for nurses, midwives and other staff working in remote areas of the NT. This was supported by a robust governance framework to ensure timelines and deliverables are achieved.

To date the project has delivered; policy reform; 90% completion of repairs and maintenance works; GPS tracking and roll over devices fitted into 189 remote government vehicles and ambulances; internet installation to 318 dwellings; and the development and implementation of 9 bespoke on-line professional development modules. The on-line modules aim to improve the assessment, management, safety effectiveness and quality of care for after-hours clients in remote communities.

Implementation work has now been going for 18 months and continues to be a priority for NT Health. Maintaining momentum and engagement across multiple agencies with competing priorities can be both a barrier and opportunity. Delivering outcomes within expected timeframes can often be in contradiction, as new and unexpected complexities are revealed – to what was thought to be simple and straightforward.

NT Health is committed to the implementation of the 14 recommendations and the journey has led to learnings and further opportunities that we hope to embrace. Providing a safe work environment enhances our ability to recruit and retain highly skilled, experienced and qualified staff.


Biography:

Ms Rhonda Powell; RN  BSC RPN, MRN

Director of Nursing/Deputy General Manager Primary Health Care – Top End Health Service, Northern Territory

rhonda.powell@nt.gov.au

Adj Prof Sue Hawes; FACN, RN, BHlthSc(Nurs), Grad Cert Disability Nursing, Executive MBA

Chief Nursing and Midwifery Officer – NT Health, Northern Territory

sue.hawes@nt.gov.au

Perceived Preparedness of Recent Dental Graduates in Recognising, Responding and Referring Patients who have Experienced Domestic Violence

Miss Nausheen Mohamed Muhajir1

1James Cook University, Smithfield , Australia

 

Objectives:

  1. Investigate whether the alumni feel more prepared following the DDV-RRR educational program
  2. Evaluating the difference in self-perceived preparedness between 2016 and 2017 dental graduates
  3. Ascertain participants’ knowledge, perceived gaps in education and understanding of application in practice

Design: Within a participatory action framework, a reliable and validated online survey with 17 core questions was distributed by email to evaluate the difference in self-perceived preparedness between 2016 and 2017 BDS graduates. The hypothesis was 2017 graduates would have a higher perception of preparedness than their 2016 counterparts, having participated in a more current version of the program.

Results: Independent sample T-tests were conducted via SPSS to analyse responses. The 2017 cohort demonstrated an increased perceived preparedness in recognizing, responding and referring patients who experienced domestic violence, thereby proving our hypothesis correct. The majority of respondents identified that the program has made a positive and significant impact on their graduate practice. Feedback from the graduates on the program were largely positive and constructive. The results confirmed our hypothesis since 2017 graduates felt more prepared than their 2016 counterparts.

Conclusions: The program has made a positive and significant impact on graduates. Ongoing evaluation and co-designing will ensure that it continually meets the needs of the students.

Implications for public health: Findings of this study can inform domestic violence continuing professional development (CPD) programs to prepare dentists who can manage patients who are experiencing DV.


Biography:

This project was conducted by fourth year dental students Nausheen Mohamed Muhajir, Aviral Aggarwal, Gurleen Boparai, Manesha Mahendran and John Dawoud under the supervision of Dr Croker and Dr Carrington at James Cook University. This project was presented at “Are You Remotely Interested Conference” in 2018.

This project evaluated the Dentistry Domestic Violence Recognise, Respond and Refer programme (DDV-RRR) program that is run at James Cook University for Year 3 to 5 dental students to equip students to manage situations where they see patients who have experienced domestic violence. The participants of the study are 2016 and 2017 BDS graduates who have undergone DDV-RRR training.

SCARS – Skin Cancer Assessment Remote Service – Nurse led clinics

Miss Sheena Christensen1

1Silverchain, Walpole, Australia

 

Skin Cancer deaths in farmers 65yr + are double that of other Australians, with presentation so late that intervention is generally palliative. In 2012, the Australian Institute of Health and Welfare identified that: “a higher priority should be given to maximizing the expertise of health professionals in rural and remote areas including the early detection, early treatment, and management of skin cancer”. In 2014, the National Health Rural Alliance recommended: “people in rural and remote Australia should be recognized as a priority group”.

The Skin Cancer Assessment Remote Service (SCARS) was designed by Sheena Christensen (2017) following professional involvement in 2 devastating skin cancer cases: one a misdiagnosed invasive facial squamous cell carcinoma and another rare BRAF type melanoma and metastasis.

Silver Chain was identified as being able to play a key role in all matters aimed at the detrimental effects of sun exposure. The service, SCARS provide biannually, nurse led, qualified skin cancer screening to remote locations in WA. This includes individual comprehensive risk assessment, full body skin cancer screening with dermatoscopy and one to one education on skin cancer detection, skin self-examination (SSE), sun protection and how to locate skin cancer qualified health professionals. SCARs also provide community education sessions and upskilling of nurses.

The initial pilot service screened 54 patients in 4 days

  • 47% male and 53% female: 20% high risk and 79% medium risk for melanoma and NMSC.
  • 49% had no previous history of skin cancer screening-
  • 6 malignant melanomas have been excised, 8 lesions of varying types SCC and 7 lesions of varying types BCC have been professionally treated and managed.

The provision of nurse led clinics is a professional and effective program to address the early detection, early treatment and management of skin cancer in rural and remote Australia.


Biography:

Remote Area Nurse Walpole Silverchain Primary Health WA – responsible to provide emergency nursing care, routine clinical assessments, domiciliary nursing care and plan and participate in Health Promotional activities.

Certificate in Primary Care Skin Cancer Medicine. (2016 University Qld and Healthcert)

Professional Certificate Dermoscopy (2017 Healthcert)

Advanced Certificate Dermoscopy (2018 Healthcert)

Professional Diploma Dermoscopy (2019 Healthcert)

Graduate Certificate Medicine – Skin Cancer (current 2019 University Qld)

Should I stay or should I go?: Midwifery workforce in Rural and Remote Australia

Ms Alicia Carey1,2, Dr Alison Teate1, Professor Deborah Davis1

1University of Canberra, Canberra, ACT, Australia

2Charles Sturt University, Wagga Wagga, Australia

 

Introduction:

There is a significant shortage of both nurses and midwives and particularly in rural and remote Australia (Department of Health, 2013).  Across Australia there are 294,390 practicing Registered Nurses, 26,438 Registered Nurse/Registered Midwife with dual registration and 5,243 Registered Midwives who are currently practicing (Nursing and Midwifery Board of Australia, 2019). Attracting and retaining midwives in rural and remote locations is a constant challenge for health services (Francis, Badger, McLeod, Fitzgerald, Brown & Staines, 2016).

Maintaining healthcare services in rural areas is crucial to enabling women and their families’ access healthcare that is close to their home (Francis, McLeod, McIntyre, Mills, Miles &Bradley, 2012). With staffing shortages there is ongoing pressure with maintaining healthcare and in particular maternity services and with this escalation of ever decreasing numbers of maternity services in rural facilities there is a concern that it is leading to deskilling of practitioners (Francis et al., 2016). Some factors that have been identified to contribute to the issue include: the lack of preparedness for recently graduated nurses and midwives; the lack professional development and the lack of mentoring (Douglas, 2014).

What is happening in your project / what has been your experience?

There is minimal research that looks at Midwifery alone in the rural and remote setting. This research will explore midwives experience working in rural and remote health services and provide recommendations for stakeholders to assist in the recruitment and retention of staff to ensure that women and their families are able to access high quality maternity care.

Conclusion:

With rural and remote health services facing additional challenges it is important that there is further research on how midwives can be supported to gaining employment and remaining in the rural and remote workforce to allow woman and families the opportunity to receive high quality, safe care.


Biography:

Alicia is a PhD candidate at the University of Canberra. Alicia has extensive experience as a registered nurse/midwife and has worked in forensic mental health, rural and remote locations in New South Wales (NSW) and also experience as a remote area nurse/midwife in the Northern Territory (NT).

Alicia has been a Lecturer in Nursing and Midwifery at Charles Sturt University since 2015.

Alicia’s current research includes perinatal mental health tools for isolated women and her PhD focuses on workforce issues for early career Midwives in rural and remote Australia.

The availability of chronic disease management and dialysis services, and the patient characteristics of aeromedical retrieval for renal disease within rural and remote, Australia

A/Prof. Fergus Gardiner1

1Royal Flying Doctor Service, Canberra, Australia

 

Objective: To determine the geographical coverage of chronic disease management and dialysis services available to the rural and remote Australian population; and the characteristics of Royal Flying Doctor Service (RFDS) patients that underwent an aeromedical retrieval for renal disease.

Method: To determine provision of chronic disease management and dialysis services by geographic area, data from RFDS, the Australian Bureau of Statistics, and Health Direct were used. Patient diagnostic data were recorded using ICD-10 coding from 2014 to 2018. Descriptive statistics and Chi-square analysis were used in data analysis, with significance determined at p <0.01.

Main outcome measures: Chronic disease and dialysis service coverage in rural and remote areas, and patient disease type and prevalence (by age, gender, and Indigenous status).

Results: Mapping demonstrated that there are many rural and remote areas that may be without regular chronic disease management or dialysis services. The RFDS conducted 4139 aeromedical retrievals for diseases of the genitourinary system, which represented 3.9% of all aeromedical retrievals. Males were more likely than females (53.9% vs. 46.1%, p<0.01) to be retrieved. Indigenous patients (n=1337, 32.3%), were significantly younger then the wider population (40.2 vs. 58.3, p<0.01). Detailed ICD-10 2-item diagnoses were recorded for the majority (58.2%) of patients. There were significant diagnosis differences (all p<0.01) between genders, including although not limited to, males being more likely (all p<0.01) then females to have acute renal failure, calculus of the kidney and ureter, renal colic, obstructive and reflex uropathy, and kidney failure, conversely females were more likely (all p<0.01) to have chronic kidney disease, disorders of the urinary system, acute nephritic syndrome, tubulo-interstitial nephritis, and cystitis.

Conclusion: The majority of retrievals were from areas without access to regular chronic disease management services or dialysis units, with many rural and remote patients required to travel extensive distances to access services.


Biography:

Fergus Gardiner has completed a PhD (medicine) specialising in chronic kidney disease management. Fergus has been the lead author on research projects, involving emergency and military medicine, rural and remote healthcare, pathology, and obstetrics and gynecology.  Prior to commencing with the Flying Doctor, Fergus served in the Australian Defense Force before employment in large teaching hospitals and the Department of Health.  Fergus is an academic at the Australian National University were he conducts epidemiology and clinical research. Furthermore, he is a consultant associated with applications to the Federal Government’s Medical Services Advisory Committee, in the field of chronic disease management.

The lived experience of a child diagnosed with type 1 diabetes in DKA in a remote area of QLD

Mrs Emma Turner1

1University of Southern Queensland, Toowoomba, Australia

 

2015 was meant to be ‘my year’, all three boys had finally started school & I had been accepted into Medicine at OUM. However, things don’t always go to plan. Freddie was 7 & we had all been unwell with a virus, but he did not recover. He was taken to the GP & the hospital on numerous occasions, but we were just told it was viral & to keep up fluids & paracetamol. On ANZAC Day at the Dawn Service, he was very unwell & I finally figured out the diagnosis. On admission, his BGL was 39.5mmoL, with ketones of 6.6

My passion and career direction has since changed to support of families with children diagnosed with T1D, and also regular BGL checks. If Freddie had just had ‘one small prick’, he might have been diagnosed much sooner, and in less traumatic circumstances.

Type 1 Diabetes (T1D) is a common chronic disease in childhood. Management of this condition requires a daily routine of monitoring blood glucose levels, administration of appropriate dosages of insulin, carbohydrate counting and regulation of physical activity.  Meeting the demands of T1D in a child can increase the stress felt by immediate family members, which can then lead to poor management of T1D and feelings of isolation. Geographical isolation and lack of access to appropriate services only compounds these feelings.

Our story describes the transition from diagnosis at DKA necessitating a RFDS flight to Brisbane, to treatment options and a family move to a larger town to be closer to health care.


Biography:

emma.turner@usq.edu.au

BN (QUT), MMid (USQ), GCert Paediatric, Child & Youth Health Nursing (QUT),

GCert Mid (Flinders), GCert Diabetes Education & Management (SCU), RiPRN

Current Masters of Science Research (Applied) student, researching the support mechanisms that families in South-West Queensland identify as necessary in the ongoing care and management of their child with type 1 diabetes.

Position: Clinical Academic Lecturer in Nursing and Midwifery at University of Southen Queensland, teaching into undergraduate and postgraduate nursing.

Why do nurses stay in Australia’s small rural hospitals? Why do they leave?

Miss Sarah Smith1, Professor  Elizabeth  Halcomb1, Dr  Jenny Sim1, Dr Sam Lapkin1

1University of Wollongong, Wollongong , Australia

 

Access to healthcare for rural populations depends on an adequate, skilled workforce, however recruiting to rural areas can be difficult. Rural areas depend on nurses to provide much of the healthcare from small rural hospitals, however it can be a stressful occupation with its own unique issues and work environments. These issues can make rural nursing  particularly susceptible to increased turnover and shortages which is an ongoing concern worldwide. Australia is not immune to this phenomenon with ongoing difficulties in recruiting and retaining nurses to rural areas and significant shortfalls of nurses predicted in the future .

The presentation will provide an insight into the factors that impact on nurses’ intention to leave rural hospitals. Both quantitative and qualitative data will be presented which was collected as part of a large national study of the experiences of nurses working in rural hospitals throughout Australia. Besides investigating nurses’ intention to leave their workplace the national online survey also explored what factors impact job satisfaction, missed care in rural hospitals and examined the professional practice environment within small rural hospitals.

Participants were registered and enrolled nurses and dual registered nurse/midwives working in Australian small rural public hospitals. 543 nurses responded to the online survey however 160 responses were removed due to less than 50% of the survey being completed leaving 383 total responses for analysis.

The findings of this study will provide an understanding as to why nurses choose to leave rural hospitals and may be used to inform future initiatives to increase successful recruitment and retention of skilled clinicians. The findings may also assist in developing future nursing curricula and campaigns to attract nurses to rural hospitals and better prepare them to work in these unique and rewarding environments.


Biography:

Sarah is a PhD candidate with the University of Wollongong.  She is an early career nurse researcher who completed nursing honours with UOW in 2015 and was awarded runner up of the Australian Primary Health Nurses Association’s new graduate Nurse of the year award in 2016. Sarah has experience in general practice nursing and rural hospital nursing and she currently works as a registered nurse in a NSW rural hospital where she was nominated for a NSW Health Rising Star Award. Her current research is investigating the nursing workforce in Australian rural hospitals.

Embracing Nursing’s Diversity to build Stronger Pathways for the Rural Generalist Registered Nurse

Ms Deborah Grant1, Mrs Michelle Gunn2, Mrs Michelle Garner1

1Queensland Health – North West Hospital and Health Service, Mount Isa, Australia,

2Queensland Health – Clinical Excellence Division Office of the Chief Nurse and Midwifery Officer, Brisbane, Australia

 

Introduction:

In rural and remote communities, the effective and safe delivery of comprehensive Primary Heath Care services is dependent on the strength, capacity and capability of the health workforce. The International College of Nursing (ICN) (2010) recognises that Nurses are effective practitioners, health coaches, spokespersons, and knowledge suppliers for patients and families throughout the life course. Rural Generalist Registered Nurses (RGRN) are valued as essential members of the multidisciplinary healthcare team and recognised as crucial at maintaining links between individuals, families, communities and other areas of the healthcare system.

The Queensland Health RGRN Program is being established as a professional pathway for post graduate registered nurses (from novice to expert). It articulates multiple entry points, acknowledges the capability requirements, and provides a mechanism to enable registered nurses to work in Rural Generalist Nurse positions across a diverse range of rural, remote and isolated locations and communities within Queensland Health. It is envisaged that this will lead to the development of a Nationally Recognised Rural General Registered Nurse Pathway.

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

The RGRN Pathway builds on National and International information as well as the experience of Registered Nurses working in diverse Rural, Remote and Isolated environments. The development has incorporated environmental scanning, exploration of curriculum frameworks and generation of combined workforce and educational pathway options.

Conclusion:

This presentation walks the reader through the development of the Queensland Health RGRN Program and proposed implementation as an opportunity to embrace Nursing’s Diversity to build Stronger Pathways for the Rural Generalist Registered Nurse.

Reference:

ICN AND NURSING NOW STATEMENT

Astana Declaration on Primary Health Care: From Alma-Ata towards Universal Health Coverage and the Sustainable Development Goals. International College of Nursing (ICN) (October 2018) downloaded on 22 April 2019 from https://www.nursingnow.org/wp-content/uploads/2018/01/PHC-statement-ICN-NN.pdf


Biography:

Deborah Grant

Certificate in Nursing, Bachelor Applied Science (Nursing Science) , Masters  of Health Practitioner, Grad Diploma  Diabetes, Grad Cert Management(QH). RN, RM, RIPRN, NP, ADEA DE,

Nursing Director Rural Pathways Project

North West Hospital and Health Service

Queensland Health deborah.Grant@health.qld.gov.au

Deborah is a Nurse Practitioner and Midwife with extensive experience across a range of health service contexts. Currently Nursing Director Rural Pathways Project North West Hospital and Health Service she has lead the development of a multi-level rural generalist registered nurse pathway for Queensland Health.