Australian Journal of Rural Health最新文献

Objective: This study aims to investigate in patients over 65 with neck of femur (NOF) fractures in Rural Australia, does initial presentation to a peripheral hospital result in a delay to surgery?

Design: Retrospective cohort study.

Setting: Dubba Base Hospital, Trauma Hospital Rural Australia (Modified Monash Model (MMM) 3) and catchment area (MMM 3-7), NSW, Australia.

Participants: The study includes 350 patients over 65, presenting with closed, unilateral NOF fractures who underwent operative management at the operating centre, 203 from peripheral hospitals.

Main outcome measures: Primary outcomes include time to surgery and adherence to recommended timeframes for NOF fixation. Secondary outcomes encompass complications, hospital length of stay and a subgroup analysis to identify causes of surgery delay.

Results: Patients transferred from peripheral hospitals experienced a statistically significant delay in time from presentation to surgery compared to those presenting directly to the operating centre (42 h vs. 24 h, p < 0.001) and were more likely to be outside of current guidelines for NOF fixation within 36 h of presentation (OR 5.1, p < 0.001). There were no differences in mortality at 1 year between the two groups (15% vs. 18%, p = 0.5). On subgroup analysis, distance from the operating centre, time to x-ray and after-hours presentation were associated with increased likelihood of surgery outside of 36 h in the peripheral hospital group.

Conclusion: This study underscores an inequity in service delivery for rural patients with NOF fractures, particularly those requiring transfer. Pre-arrival delays necessitate targeted interventions to address diagnostic service delays, logistical challenges and transport issues in rural health care.

Introduction: The Australian alcohol and other drug (AOD) regional, rural and remote (RRR) workforce experiences chronic workforce retention challenges. However, little is known about the characteristics of RRR AOD workers nationally, or factors associated with retention.

Objective: To examine the personal and professional characteristics of RRR AOD workers and identify factors that predict intent to remain in the workforce.

Design: Secondary analysis of Australian National AOD Workforce Survey data, a cross-sectional online survey of AOD workers (N = 1506).

Participants: AOD workers employed in RRR Australia (N = 447).

Main outcome measures: Demographic and professional characteristics; intent to remain in current job for the next year.

Results: The majority of RRR AOD workers were female (72%) and worked full time (65%) in the NGO sector (58%). Most (56%) intended to stay in their job. There were not only high rates of poor job engagement (33%) and high burnout (42%) but also high job satisfaction (80%). Significant predictors (p < 0.05) of retention intention were job satisfaction, low burnout, employment security and respect in the workplace.

Conclusions: Workforce initiatives and benefits tailored to the current composition of the RRR AOD workforce are needed. Retention of workers may be facilitated by increasing job satisfaction, security and respect, and decreasing burnout.

Objective: The client-practitioner relationship is the cornerstone of nurse home-visiting programs. Little is understood about how relationship-based maternal and early childhood health care is perceived by women in remote Aboriginal communities. As part of an evaluation of nurse home-visiting in the Northern Territory, this research examines how relationships are established with clients, and what elements are valued most by women.

Setting: Maternal Early Childhood Sustained Home-visiting (MECSH) is an Australian model of nurse-led home-visiting targeted at women facing adversity who need extra support. The model provides parenting information, health education and psychosocial support during pregnancy and the first 3 years of children's development.

Participants: Interviews were conducted with 92 Aboriginal women and 11 practitioners including nurses, social workers and community workers.

Design: Qualitative semi-structured interviews were conducted with convenience samples of MECSH clients and practitioners. Data were analysed using a two-step process of structural coding and thematic analysis.

Results: Trust was the foundation of clients' positive perception of the relationship with their MECSH provider. Relationships took time to develop, often beginning with practical support to meet clients' basic needs. Practitioner dependability and flexibility to client priorities, communication, confidentiality and being helpful to the woman and her family was important. Clients emphasised emotional support and friendship.

Conclusion: The relationship-based approach was valued and consistent with culturally safe and trauma informed ways of working with Aboriginal families. Effort is required to commit to the model to address ongoing healthcare engagement and health outcomes in remote Northern Territory communities.

Aim: The aim of this revision was to update the Remote Area Nurse (RAN) Model of Consultation (MoC) and was prompted by publication of the National Rural and Remote Nursing Generalist Framework (2013-2018), shifts in RAN workforce patterns, community health patterns and technology use.

Context: Rural and remote residents face higher rates of hospitalisations, deaths and poorer access to health care with a significant burden of avoidable fatal conditions among Aboriginal and Torres Strait Islander peoples. Health care is mostly provided by RANs and Aboriginal and Torres Strait Islander Health Practitioners (ATSIHPs), addressing diverse health needs, a mobile population and navigating cross-cultural situations. Despite challenges such as clinician shortages, RANs manage a significant portion of non-emergency consultations. The RAN MoC was developed to ensure comprehensive, systematic and person-centred care and to mitigate risk to the client, the nurse and the health service.

Approach: The 11 expert panel members, all authors, revised the RAN MoC through a series of Microsoft Teams meetings, one face-to-face meeting and an exchange of emails. The principles were reorganised under the four domains of the National Rural and Remote Nursing Generalist Framework and mapped against the National Safety and Quality Primary and Community Health Care Standards.

Conclusion: The revised RAN MoC is designed to provide evidence based culturally informed care, standardise RAN consultation best practice and improve the health outcomes of their clients. With the increased turnover and number of nurses 'new' to remote, more innovative approaches to education and dissemination of the model is necessary.

Objective: This study was the first phase of a broader project designed to develop a new tool to screen social and emotional well-being (SEWB). Its objective was to identify words used by First Nations people living in the Torres Strait (Zenadth Kes) and Northern Peninsula Area (NPA) to describe and discuss SEWB. We pay our respects to Elders past and present. We acknowledge the First Nations peoples who took part in this project as holders of their cultural knowledge now and forevermore.

Setting: This study took place in community and primary health care settings located on islands of the Torres Strait and NPA of Australia.

Participants: Twelve yarns with 35 community members and health professionals were led by Torres Strait Islander members of the project team between August and December 2022.

Design: This study employed a descriptive qualitative design. Yarning, an Australian First Nations relational method, was used to share stories about SEWB. All but one yarn was audio recorded and subsequently professionally transcribed. Inductive thematic analysis was used to analyse the yarns.

Results: Worry, sad and stress were the words most often used by participants to describe feelings of low SEWB. Signs of low SEWB included behaviour change, particularly significantly reduced community engagement.

Conclusions: Worry is not a word that is used in Australian mainstream tools that screen for psychological distress. Findings of this study indicate that a question that asks about worries should be included when screening for low SEWB in Australian First Nations peoples living in the Torres Strait and NPA.

Introduction: Growing the mental health peer workforce holds promise for rural communities, but we currently lack an understanding of the guidance available to support the development, implementation and sustainability of this workforce in rural settings.

Objective: Study aims are to: (1) determine the extent and nature of the literature that provides guidance for growing the peer workforce in rural mental health services; and (2) identify and explore any guidance relevant to rural peer work services dedicated to First Nations communities, including those promoting social and emotional well-being within this body of literature.

Design: A scoping review method was employed to identify relevant peer-reviewed and grey literature published between 2013 and 2022 across PsychInfo, Medline, Embase and CINAHL, Scopus and Informit HealthInfoNet databases, as well as targeted organisation websites and Google Advanced Search.

Findings: A total of 26 unique studies/projects were included from the US, UK, Canada and Australia with public mental health, non-government/for purpose and private sector service settings represented in the literature. Grey literature, such as reports of evaluations and frameworks, formed the majority of included texts. While there is a lesser volume of rurally focused literature relative to the general peer work literature, this is a rich body of knowledge, which includes guidance concerning services dedicated to First Nations communities. Via synthesis critical considerations were identified for the development, implementation and sustainability of peer work in rural mental health services across six domains: 'Working with community members and stakeholders', 'Organisational culture and governance', Working with others and in teams, Professional expertise and experience, Being part of and working in the community and 'Local mental health services capacity'.

Discussion: While there are considerations relevant across a range of settings, the domains of: 'working with community members and stakeholders', 'being part of and working in the community' and 'local mental health services capacity', capture additional, distinct and nuanced challenges and opportunities for growing the peer work in rural services.

Conclusion: The literature offers insights valuable for service planning, policy development and the allocation of resources to support rural peer workforce growth.

Objective: The objective of this study was to determine what professional factors impact the retention of pathology workers in regional, rural and remote Australia.

Design: A cross-sectional survey was used to collect data regarding the professional factors that impact the retention of regional, rural and remote pathology workers in Australia (n = 95). The survey focused on pathology workers' satisfaction with specific professional factors and how long they intended to stay in their current position.

Setting: Regional, rural and remote (MM2-7) pathology laboratories in Australia.

Participants: There were a total of 95 participants, including 24 phlebotomists/laboratory assistants, 34 medical laboratory scientists and 29 supervisors/managers, with the majority of participants being from New South Wales, Queensland and Western Australia.

Results: Significant positive associations were found between satisfaction with career advancement opportunities, workplace culture and maintaining professional skills with the retention of regional, rural and remote pathology workers. Open-ended responses indicated that personal factors also played an important role in pathology worker retention in regional, rural and remote communities.

Conclusion: This study provides important insights into the professional factors that impact the retention of pathology workers in regional, rural and remote Australia. Personal factors were also found to play an important role in retention. These findings have highlighted the need for further research to be conducted to explore the relationship between professional and personal factors and how this impacts the retention of pathology workers in regional, rural and remote Australia.

Objectives: There is very little literature examining the workload and impact of nurse practitioners (NPs) working in emergency departments (ED) in regional and rural Australia. The aim of this paper was to review the ED NPs scope of practice in the ED discharge stream and patient outcomes at Cairns Hospital over a 7-month period.

Methods: This retrospective study examined the ED electronic medical record between 14 May 2019 and 31 December 2019. Cases managed by ED NPs, referrals, procedures performed, representations and disposition data were collected. Adverse events were sought from the Qld Health adverse events register (Riskman), the department complaints register and the ED M&M meeting minutes.

Results: A total of 1443 patients were treated by NPs, with ages ranging from 0 to 98 years (median 40 years). Australasian Triage Score (ATS) 3 cases made up 30% of the workload. Other than ATS 3 cases, time to being seen was better than the general department. There were very few unexpected representations, complaints or adverse events.

Conclusions: This study supports the view that NPs working in a regional emergency department can safely manage a variety of patients outside a fast-track model, with a wide age range and a variety of triage categories and diagnoses. We believe this has important implications for the provision of emergency care, especially in regional and rural Australia.