Australian Journal of Rural Health最新文献

Introduction

First Nations Peoples consistently demonstrate strength and resilience in navigating systemic health care inequities. Acknowledging racism as a health determinant underscores the urgent need for a counterforce—cultural safety. Indigenous Allied Health Australia (IAHA) contends that with cultural responsiveness, the health workforce can take action to create a culturally safe environment.

Objective

To explore features of culturally responsive occupational therapy (OT) practice when providing a service with First Nations People and examine alignment of those features with the IAHA Cultural Responsiveness in Action Framework.

Design

A systematic scoping review was undertaken using CINAHL, Emcare, MEDLINE, PsychInfo and Scopus databases. Examples of culturally responsive OT practice with First Nations Peoples were mapped to the six IAHA Framework capabilities and confirmed by First Nations co-authors.

Findings

OT practice with First Nations Peoples aligned with the six capabilities to varying degrees. The importance of OTs establishing relationships with First Nations People, applying self-reflection to uncover cultural biases, and addressing limitations of the profession's Western foundations was evident.

Discussion

Recognising the interrelatedness of the six capabilities, the absence of some may result in a culturally unsafe experience for First Nations People. OTs must acknowledge the leadership of First Nations Peoples by privileging their voices and consider how established practices may reinforce oppressive systems.

Conclusion

To ensure a culturally safe environment for First Nations People, the OT profession must respect the leadership of First Nations Peoples and address the limitations of the profession's Western foundations to uphold the profession's core value of client-centred care.

Introduction

In 2018, the Australasian College for Emergency Medicine (ACEM) and the Royal College of Pathologists of Australasia (RCPA) produced a guideline to encourage appropriate pathology requesting in the Emergency Department (ED).

Objective

To assess adherence to the ACEM/RCPA pathology testing guideline in a regional ED.

Methods, Design, Setting and Participants

This was a retrospective observational study conducted at a regional Australian ED over 7 days. Adults with a presenting complaint encompassed by the guideline were included. All blood tests were audited against the guideline recommendations and classified as indicated or non-indicated. Chi-squared analyses were performed to explore the association between presenting complaint and non-indicated testing.

Main Outcome Measure

The primary outcome was the number of non-indicated blood tests.

Results

Forty percent of tests ordered were not clinically indicated, with non-indicated testing occurring during 87% of encounters. The C-reactive protein (CRP) was the test most frequently ordered outside of guidelines (94% non-indicated). Patients presenting with lower abdominal pain accounted for nearly one-quarter of all non-indicated tests.

Conclusions

Blood tests were commonly requested outside of the guideline recommendations and interventions to improve pathology stewardship are required.

Objective

To clarify the knowledge and practical skills needed for cancer pain management among nurses on remote islands in Japan and related factors nationwide.

Setting

Due to geographical factors, nurses working on remote islands in Japan have few opportunities to attend training programs, which makes it difficult to acquire the knowledge and practical skills needed to provide pain management for patients with cancer.

Methods

We conducted a self-administered questionnaire survey regarding knowledge and practical skills in pain management for patients with cancer.

Design

Cross-sectional study.

Participants

Nurses working in cancer pain care in medical facilities and home care on remote islands throughout Japan.

Results

We analysed 128 responses. Regarding knowledge, the average accuracy level was 49.1%. Items with a low accuracy rate included selecting medicine according to the type of pain and the patient's condition. Regarding practice, the items with low scores included analgesics appropriate for the type of pain and relating physical pain to mental, social and spiritual aspects. The most common significant factor in both knowledge and practice was related to postgraduate training.

Conclusions

These findings suggest that to improve the knowledge and practical skills for cancer pain management among nurses on remote islands in Japan, it is necessary to incorporate clinical reasoning into basic education and establish remote education systems and consultation systems with other facilities.

Design

A multi-methods, single-centre pilot comprising a quasi-experimental pre-/post-test design and an exploratory qualitative study.

Setting

A rural Australian hospital and health service.

Participants

Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months.

Intervention

The intervention comprised a 12-week virtual care program delivered via teleconference by a specialist nurse, using a pre-existing connected care platform. The program was tailored to the post-operative recovery journey targeting post-operative care, psychoeducation, problem-solving and goal setting.

Main Outcome Measures

Primary outcome: program acceptability.

Secondary outcomes: quality of life; prostate cancer-related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post-intervention (T2); and 12 weeks post-intervention (T3).

Results

Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3.

Conclusions

This pilot has shown that a tailored nurse-led virtual care program, incorporating post-surgical follow-up and integrated low-intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes.

Objective

To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers.

Design

A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings.

Setting

Victoria, Australia.

Participants

Semi-structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023.

Results

Providers reported multi-level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models.

Conclusion

Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity-based funding models for perinatal services regardless of geographical location.

Objective

Evaluate research capacity and culture among regional hospital dietitians, develop a team specific research strategy, and build research skills of novice researchers.

Methods

The Research Capacity in Context Tool was used to assess current research capacity and culture at organisational, team and individual levels. Results were analysed using descriptive statistics and content analysis of free text responses. A modified Delphi method gained consensus regarding research capacity building.

Design

Mixed method study.

Setting

Dietetics department of a regional tertiary hospital (Modified Monash Category 2).

Participants

All clinical dietitians currently employed within the hospital (n = 20) regardless of employment duration.

Main Outcome Measures

Self-rated response to research capacity and culture to produce a dietetics-specific research strategy.

Results

Fifteen dietitians (75%) completed the Research Capacity in Context Tool. The overall mean score was highest at an organisational level at 7.9 (IQR 2), and lowest at team and individual levels at 4.3 (IQR 2.7) and 4.9 (IQR 3.3) respectively. Common barriers to research included time, lack of skills, knowledge and support. Using the modified Delphi method 39 statements relating to research capacity building met consensus and informed the creation of a research strategy.

Conclusion

The results of the Research Capacity in Context Tool from this regional study reflect those reported in the literature at metropolitan sites. A dietetic-specific research strategy was developed to assist with increasing research capacity at a team and individual level in a regional setting. Evaluation of long-term outcomes post implementation will be the subject of further research.

Objective

The aim of the study was to identify continuing professional development (CPD) needs of allied health professionals (AHP) in regional and rural Victoria.

Design

This study was an online cross-sectional design conducted between December 2022 and February 2023.

Settings and Participants

AHPs employed at a large multi-site regional public health service providing acute, subacute, community and outpatient care in Victoria, Australia.

Main Outcome Measure(s)

The online questionnaire included four sections investigating satisfaction of CPD, prioritised topics for CPD, preference for CPD sourcing and perceived capabilities in delivering education. To investigate prioritised topics of CPD, a tool was adapted from the Hennessy Hicks Training Needs Analysis questionnaire to align with allied health (AH) career pathways. For organisational alignment, a second questionnaire was sent to AH managers.

Results

The response rate was 17% (53/316 AHPs) from members of 10 AH professions. The median years of clinical experience for participants was between 2 and 5 years. Participants with 6–10 years of clinical experience reported the lowest level of satisfaction. Research and education were identified as areas of highest training need. Self-perceived competence in education delivery was proportionately lower in areas of assessment, developing digital learning and constructive alignment.

Conclusion

CPD needs for AHPs in a regional and rural health service were shown to vary by career stage and weighted towards developing research and education delivery capabilities. Findings from this study may support public health sector and policy investment in CPD opportunities to support horizontal career progression opportunities, a balance of internal and externally sourced professional development and strategic investment in education delivery capabilities.