Supporting nursing and allied health student placements in rural and remote Australia: a narrative review of publications by university departments of rural health.

University departments of rural health are Commonwealth-funded to improve recruitment and retention of the rural allied health and nursing (including midwifery) workforce, primarily through student placements. We examined publications by university departments of rural health that were focused on allied health and nursing students undertaking placements in rural Australia, to understand the characteristics, main findings and implications of the research conducted. Interprofessional learning was a key feature of placements and placement education, although other activities such as community engagement added to placement experiences. Factors such as quality supervision and being involved in the community contributed to a positive placement experience and increased rural practice intention. Tracking studies showed a relationship between rural placements, rural practice intention and rural practice. Rural placements occurred across a variety of settings and in locations consistent with the policy framework. Embedding university departments of rural health in rural communities enabled staff to build relationships and increase placement capacity.

Why patients attend emergency department for primary care type problems: views of healthcare providers working in a remote community.

INTRODUCTION: Emergency department (ED) utilisation continues to increase, particularly for primary care presentations that do not require high level ED services. The reasons for this are complex, and research has focused on patient perspectives in choosing where to seek care rather than those of ED and general practitioner (GP) providers. This study aimed to address this gap by exploring the views of ED and GP providers regarding ED utilisation for primary care type health conditions in a small, remote Australian city with perhaps unique population demographics and service configuration. METHODS: Service providers from the ED and general practice clinics were invited to participate in focus groups and semi-structured interviews exploring their views on ED utilisation for primary-care-type health presentations. The data were analysed using thematic content analysis. RESULTS: In total, 24 healthcare providers (five GPs, seven ED practitioners, seven community nurse navigators, four Aboriginal and Torres Strait Islander Health Workers and one Indigenous Liaison Officer) participated in focus groups discussion and interviews. The analysis identified three themes: access and logistic barriers, rational decision-making and self-perceived urgency. While there was some overlap in the healthcare providers' perceptions, there were also strong differences between ED and GP groups. In particular, the ED group believed that GP services are less accessible for urgent appointments, whereas GPs believed that such arrangements were in place. Both groups agreed on the need for clear communication between the ED and general practice. CONCLUSION: ED and GP providers demonstrate similarities and differences in understanding patients' reasons for choosing which service to access. The differences may stem from ED providers' focus on offering a rapid resolution of acute presentations and GP providers' focus on offering comprehensive and continuing care. Effective communication between general practice and the ED services and clearer referral pathways may help in reducing ED utilisation for less urgent primary-care-type problems.

Impact of COVID-19 on rural and remote student placements in Australia: A national study.

OBJECTIVE: To investigate students' perceptions of the impact of coronavirus SARS-CoV-2 on rural and remote placements facilitated by 16 University Departments of Rural Health in Australia in 2020. DESIGN: A mixed-method design comprising an online survey and semi-structured interviews. SETTING: Australia. PARTICIPANTS: Allied health, nursing and medical students with a planned University Departments of Rural Health-facilitated rural or remote placement between February and October 2020. INTERVENTION: A planned rural or remote placement in 2020 facilitated by a University Departments of Rural Health, regardless of placement outcome. MAIN OUTCOME MEASURES: Questionnaire included placement outcome (completed or not), discipline of study (nursing, allied health, medicine), and Likert measures of impact to placement (including supervision, placement tasks, location, accommodation, client contact and student learning) and placement experience (overall, support, supervision, university support). Semi-structured interviews asked about placement planning, outcome, decisions, experience and student perceptions. RESULTS: While coronavirus SARS-CoV-2 reportedly impacted on the majority of planned placements, most students (80%) were able to complete their University Departments of Rural Health-facilitated placement in some form and were satisfied with their placement experience. Common placement changes included changes to tasks, setting, supervisors and location. Allied health students were significantly more likely to indicate that their placement had been impacted and also felt more supported by supervisors and universities than nursing students. Interview participants expressed concerns regarding the potential impact of cancelled and adapted placements on graduation and future employment. CONCLUSIONS: The coronavirus SARS-CoV-2 pandemic was reported to impact the majority of University Departments of Rural Health-facilitated rural and remote placements in 2020. Fortunately, most students were able to continue to undertake a rural or remote placement in some form and were largely satisfied with their placement experience. Students were concerned about their lack of clinical learning and graduating on time with adequate clinical competence.

Models of remote professional supervision for psychologists in rural and remote locations: A systematic review.

INTRODUCTION: Psychology workforce shortages in geographically rural or remote contexts have highlighted the need to understand the supervisory experiences of psychologists practising in these locations, and the models of supervision employed to support their practice and improve client safety. OBJECTIVE: To review the models of remote professional supervision and the supervisory experiences of psychologists practising in rural and remote locations. DESIGN: Using the Joanna Briggs Institute methodology for mixed-methods systematic review, 8 health and education databases were searched using keyword and subject heading searches. FINDINGS: The initial search identified 413 studies. A full-text review identified 4 papers that met the inclusion criteria and were subjected to a methodological appraisal by 2 reviewers. Three studies included qualitative data, with 2 using transcribed interviews. Two studies reported quantitative data, with only one study including a statistical analysis of the outcomes. DISCUSSION: The results for the efficacy of the current models of remote supervision being used within the allied health and psychology professions are limited, with methodological limitations cautioning generalisability of results. The experiences of psychologists engaged in remote supervision do not appear to have changed over the past decade despite technological advances. CONCLUSIONS: Quality professional supervision is critical for the sustainability of the psychology workforce in rural and remote locations, reducing professional isolation, and for improved patient outcomes. This review identified a need for improved evidence for remote supervision models for psychologists working in geographically rural and remote locations. Lessons can be learned from other health professions' models of remote supervision.

Drivers of general practice-type presentations to the emergency department in a remote outback community.

OBJECTIVE: To estimate the number of general practice-appropriate attendances in a remote emergency department and explore the reasons for patients' choice of service. DESIGN: A four-step case study approach was adopted, focusing on hospital emergency department (ED) attendances that were potentially manageable in general practice. SETTING: A large, remote community with substantial populations of Indigenous peoples and fly-in, fly-out mining industry workers. The ED is experiencing rapid growth in demand for services for lower urgency. PARTICIPANTS: Patients attending the emergency department with lower urgency problems. INTERVENTIONS: ED attendance data for 2016 were reviewed to identify lower urgency presentations. Patient records for 400 randomly selected presentations were subject to deeper analysis. A prospective survey was conducted over 6 months of 369 ED patients with lower urgency presentations. MAIN OUTCOME MEASURES: The proportion of patients attending the ED with GP-appropriate problems and influences on their decisions to attend the ED. RESULTS: About 48% of all attendances met the agreed definition of GP-appropriate problems. About half of presentations were during the normal work hours and about half of patients stated that GP services were unavailable. Younger age, lack of information about local GP services, and perceptions of convenience contributed significantly to seeking ED care. CONCLUSION: Increasing the availability of GP services alone is unlikely to be sufficient to change service utilisation. Strategies should include raising community awareness of how and when to utilise the appropriate service, understanding different models of care, and the need to register with a general practice.

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia.

CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. STUDY DESIGN: Rapid review of articles published between January 2000 and May 2020. DATA SOURCES: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. DATA SYNTHESIS: Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding. CONCLUSION: Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. STUDY DESIGN: We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. DATA SOURCES: We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. DATA SYNTHESIS: Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. CONCLUSION: There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. STUDY DESIGN: Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews. DATA SOURCES: We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria. DATA SYNTHESIS: Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma. CONCLUSION: We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities. STUDY DESIGN: Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2 . DATA SOURCES: We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway. DATA SYNTHESIS: We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3). CONCLUSION: Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce. STUDY DESIGN: We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool. DATA SOURCES: We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites. DATA SYNTHESIS: During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool. CONCLUSION: We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings. STUDY DESIGN: Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards. DATA SOURCES: English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing,deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar. DATA SYNTHESIS: Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation. CONCLUSION: Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes.

A bitter pill to swallow: registered nurses and medicines regulation in remote Australia.

INTRODUCTION: Access to essential medicines is a human right and an objective of the National Medicines Policy in Australia. Health workforce distribution characteristics in remote Australia implies registered nurses (RNs) may find themselves responsible for a broader range of activities in the medication management cycle than they would be elsewhere in the nation. The regulation of health professionals and their training requirements provides essential but complex protections for the public. These protections include the National Registration and Accreditation Scheme for health practitioners and the Australian Health Practitioner Regulation Agency. Other levels of control or regulation are also exerted over health professionals via mechanisms such as salaries and funding arrangements, insurance requirements, admitting rights to healthcare facilities, and legislation controlling the use of medicines and therapeutic devices. This study aimed to examine national legislation and regulations concerning the use of medications from a nursing perspective, focusing on the context of health service delivery in remote areas. METHODS: Australian state and territory medicines legislation and regulations was interrogated for answers to the questions 'Can an RN prescribe a medication?', 'Can an RN dispense a medication?', 'Can an RN supply or issue a medication?' and 'Can an RN administer a medication?' RESULTS: Inconsistencies were identified nationally in the names and general structure of the legislation, the location of information relating to authorised roles with regards to medications and key terms used to describe medicines and the elements of the medication management cycle. Administrations of Schedule 4 and 8 medicine according to an order from an authorised prescriber are the only nationally consistent roles RNs are authorised to undertake with regards to medicines. Twenty-eight variations were identified with regards to additional authorisations for RNs. CONCLUSION: RNs make up more than half of the registered Australian health professional workforce and are the most consistently distributed across the nation, yet their legislated responsibilities in relation to working with medicines are inconsistent. Given the inconsistencies, RNs providing health care in remote Australia may be unable to undertake aspects of the medication management cycle that their work environment demands in the best interest of their patients and absence of other healthcare providers. The lack of legislative consistency nationally for medicines in Australia is likely to impede timely access to medications for patients. Regulatory inconsistencies may also result in RNs working well below or beyond their legal scope of practice, thereby creating clinical and workforce risks. Such risks are a significant matter for remote health service provision. Resolving these issues will require a collaborative national approach with consideration given to how the health workforce is distributed, current nursing responsibilities and relevant service delivery models for remote Australia.

Positive placement experience and future rural practice intentions: findings from a repeated cross-sectional study.

OBJECTIVE: To identify the constituents of positive placement experience and explore the association between positive placement experiences and rural and remote practice intentions. METHODS: A repeated cross-sectional study was conducted between January 2014 and December 2017. Medical, nursing, dentistry, and allied health students who completed a rural/remote placement were invited to complete a survey questionnaire on placement experience. Information on students' sociodemographic factors, discipline, placement experience, placement satisfaction, and rural/remote practice intentions was collected. Modified Poisson regression was performed to determine the relationships between placement satisfaction and future rural practice intentions. Qualitative data were analyzed by thematic analysis. RESULTS: A total of 873 students responded. The majority of the survey respondents were females (70.06%), with a median age of 22 years (IQR 21-25 years), and 44.46% of respondents were medical students. Students satisfied with their placement were 2.10 times more likely to have rural/remote practice intention than their counterparts. Of all components of rural/remote placement experience, satisfaction with the placement supervision had the highest impact on changing students' rural/remote practice intentions from negative to positive. The major themes from qualitative analysis were as follows: "wide variety of experience and hands-on learning opportunities," "multidisciplinary exposure at home and workplace," "support from the local University Department of Rural Health (UDRH)," "learning of indigenous culture," and "experiencing challenges of rural health care services." CONCLUSION: There is a strong association between positive placement experience and future rural/remote practice intentions. Therefore, facilitation of positive placement experiences in remote and rural locations could be a key strategy in addressing rural health workforce maldistribution.

The road to registration: Aboriginal and Torres Strait Islander health practitioner training in north Queensland.

CONTEXT: In 2012, the new profession of Aboriginal and Torres Strait Islander health practitioner (ATSIHP) was registered under the Health Practitioner Regulation National Law Act 2009. The project in this present study evolved out of the Australian Government\'s recognition of the need for the existing Indigenous health worker (IHW) workforce to meet the minimum qualification requirements for registration as ATSIHPs through recognition of prior learning and/or further education. A total of 53 IHWs participated in the upskilling project between June 2014 and June 2015, with approximately 200 IHWs from Queensland expressing an interest in undertaking the training. This demonstrated a clear need for further training programs such as this one. The project was coordinated by the Indigenous Health Unit at James Cook University (JCU) with training being delivered by TAFE Cairns in collaboration with the College of Medicine and Dentistry, JCU. Students travelled from as far north as the Torres Strait and as far west as Mount Isa. ISSUES: The key issues for discussion were associated with the ATSIHP role being relatively new including the limited preparedness of training providers to deliver the upgraded qualification requirements and uncertainty about the registration process. Compounding this was a general undervaluing and underutilisation of the IHW role within the current primary healthcare system. Other challenges included the variations of IHW roles, scope of practice and educational standards held by individuals, as well as the associated complexities of providing training to IHWs from the large and diverse geographic area that is rural and remote Australia. Program and student evaluation was undertaken with each of the three cohorts via a course experience questionnaire, TAFE evaluation forms and opportunistic student feedback. LESSONS LEARNED: Lessons learned as a result of this project include the need to continue to recognise and promote understanding of the contribution that IHW/ATSIHPs make in improving health, the importance of conducting a comprehensive student selection process, the benefits of working collaboratively between the university and vocational education training sectors, the need to continue to strengthen partnerships between higher education and health industry, the need for flexible funding and training models that enable adequate learning support, and the identification of a significant unmet training need.

Are primary healthcare services culturally appropriate for Aboriginal people? Findings from a remote community.

This study explored the views of key stakeholders on cultural appropriateness of primary health care (PHC) services for Aboriginal people. A total of 78 participants, including healthcare providers, administrative team members (n=24, ~30% of study sample) and Aboriginal community members (n=54, ~70% of study sample) living in remote North West Queensland participated in the study. Outcome measures were assessed by administering survey questionnaires comprising qualitative questions and various subscales (e.g. provider behaviours and attitudes, communication, physical environment and facilities, and support from administrative staff). Descriptive statistics were used to present quantitative findings, whereas inductive thematic analysis was used for qualitative data. In contrast to the views of PHC providers, a significant number of Aboriginal people did not perceive that they were receiving culturally appropriate services. Although PHC providers acknowledged cultural awareness training for familiarising themselves with Aboriginal culture, they found the training to be general, superficial and lacking prospective evaluation. PHC providers should understand that culturally inappropriate clinical encounters generate mistrust and dissatisfaction. Therefore, a broad approach involving culturally respectful association between PHC providers, Aboriginal consumers and administrative staff is required to bring sustainable changes at the practice level to improve the health of Aboriginal people.

Building a sustainable workforce in a rural and remote health service: A comprehensive and innovative Rural Generalist training approach.

BACKGROUND: Historically it has been challenging to recruit and retain an appropriately trained medical workforce to care for rural and remote Australians. This paper describes the Queensland North West Hospital and Health Service (NWHHS) workforce redesign, developing education strategies and pathways to practice, thereby improving service provision, recruitment and retention of staff. CONCEPT: The Mount Isa-based Medical Education Unit sought accreditation for a Rural Generalist (RG) training pathway from Internship to Fellowship with the Australian College of Rural and Remote Medicine (ACRRM) and the Regional Training Provider (RTP). This approach enhanced the James Cook University (JCU) undergraduate pathway for rurally committed students while improving recruitment and retention of RMOs/Registrars. ACHIEVEMENTS: Accreditation was achieved through collaboration with training providers, accreditation agencies, ACRRM and a local general practice. The whole pathway from ignore Internship to Fellowship is offered with the RG Intern intake as a primary allocation site beginning in 2016. Comprehensive supervision and excellent clinical exposure provide an interesting and rewarding experience - for staff at all levels. RESULTS: Since 2013 RMO locum rates have been <1%. Registrars on the ACRRM pathway and Interns increased from 0 to 7 positions each in 2015, with similar achievements in SMO staffing. Three RMOs expressed interest in a Registrar position, CONCLUSIONS: Appropriate governance is needed to develop and advertise the program. This includes the NWHHS, the RG Pathway and JCU.

Culture, Health, and Science: A Multidisciplinary Liberal Arts Alternative to the Public Health Major.

Since the 2003 call by the Institute of Medicine to educate undergraduates in public health, various models have emerged for incorporating public health into the liberal arts and sciences. One model is a professionalized public health major that uses core public health competencies to prepare a workforce of health professionals. A second model offers a broad-based public health major rooted in liberal arts principles, resisting the utilitarian trend toward human capital formation. A third model resists even the label of "public health," preferring instead to introduce undergraduates to many ways of analyzing human health and healing. The multidisciplinary Culture, Health, and Science Program, based on six key commitments for preparing liberal arts students to analyze health and respond to global health challenges, is offered as an alternative to the public health major.

OSCE best practice guidelines-applicability for nursing simulations.

BACKGROUND: Objective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students' and clinicians' clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation. METHODS: A mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students' opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources. RESULTS: Few changes were made to the existing simulation plan and format. Students' responses from surveys (n = 367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice. DISCUSSION: Similarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations. CONCLUSIONS: Findings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students' needs in rehearsing the registered nurse role.

Factors to be Considered in Developing Occupational Regulations for Quad Bikes in Australia.

Quad bikes are popular vehicles in agricultural occupational settings. Quad bike rollovers are a leading cause of deaths in the Australian agricultural industry; current regulations appear to have had limited impact on quad bike deaths. The objectives of this study were (1) to explore whether regulation is perceived by regulators, users, retailers, and health professionals as an effective approach to quad bike safety in North West Outback Queensland, Australia; and (2) to consider the ways that perceptions of quad bike safety and use in North West Outback Queensland could inform the development of regulatory guidelines for the occupational use of quad bikes in agricultural industries. Focus group sessions and interviews were conducted November 2011 to May 2012 with farmers, health care providers, regulators, and retailers. Participants displayed a variety of opinions about perceived impacts of current regulatory changes to enhance quad bike safety, including changes to local induction processes and use of personal protective equipment on local enterprises. Many users perceived that policing the use of quad bikes would be difficult and regulators acknowledged the challenges to development of regulatory requirements and their ability to monitor and regulate use. Regulators also discussed the challenges of differentiating between work-related incidents and recreational incidents on farms. If regulation is going to be effective in improving the safety of quad bikes, there are some key moments times where this could occur, including at production, point of sale, within business policies, and everyday use by farm workers. The results highlight mixed reactions to regulatory change as a safety approach for occupational quad bike use. The interactions between regulators and the agricultural community are key in the development of sound policies that meet the standard required by regulation, monitoring, and implementation of safety policies into practice on farms.

Application of best practice guidelines for OSCEs-An Australian evaluation of their feasibility and value.

BACKGROUND: Objective Structured Clinical Examinations (OSCEs) are widely used in health professional education and should be based on sound pedagogical foundations. OBJECTIVES: The aim of this study is to evaluate the feasibility and utility of using Best Practice Guidelines (BPGs) within an OSCE format in a broad range of tertiary education settings with under-graduate and post-graduate nursing and midwifery students. We evaluated how feasible it was to apply the BPGs to modify OSCEs in a course; students' perspective of the OSCE; and finally, if the BPG-revised OSCEs better prepared students for clinical practice when compared with the original OSCEs. DESIGN: A mixed method with surveys, focus groups and semi-structured interviews evaluated the BPGs within an OSCE. SETTINGS: Four maximally different contexts across four sites in Australia were used. PARTICIPANTS: Participants included lecturers and undergraduate nursing students in high and low fidelity simulation settings; under-graduate midwifery students; and post-graduate rural and remote area nursing students. RESULTS: 691 students participated in revised OSCEs. Surveys were completed by 557 students; 91 students gave further feedback through focus groups and 14 lecturers participated in interviews. At all sites the BPGs were successfully used to modify and implement OSCEs. Students valued the realistic nature of the modified OSCEs which contributed to students' confidence and preparation for clinical practice. The lecturers considered the revised OSCEs enhanced student preparedness for their clinical placements. DISCUSSION AND CONCLUSIONS: The BPGs have a broad applicability to OSCEs in a wide range of educational contexts with improved student outcomes. Students and lecturers identified the revised OSCEs enhanced student preparation for clinical practice. Subsequent examination of the BPGs saw further refinement to a set of eight BPGs that provide a sequential guide to their application in a way that is consistent with best practice curriculum design principles.

Mount Isa statement on quad bike safety.

CONTEXT: Quad bikes are the leading cause of death in Australian agriculture, with half of these deaths resulting from rollovers. Between 2001 and 2012, there were more than 160 such deaths in Australia, representing a significant burden. ISSUES: There is a diversity of public opinions offered about quad bike safety. The Are You Remotely Interested … in Prevention; Building a Culture of Safety conference held in Mount Isa, Queensland, in August 2012 brought together subject matter experts from across Australia to discuss a range of issues relevant to rural Australia (including quad bikes). During this conference, the Mount Isa Statement for Quad Bike Safety was produced. The intent of the Statement was to draw on existing evidence to highlight solutions and provide a direction for future efforts to reduce the burden of death and injury related to quad bike use. The conference provided an opportunity for those with an interest in quad bike safety to come together in one location, discuss the issues and develop a common direction (the Statement). The Statement is presented in three sections: a statement of the facts that were available at the time of development; a set of recommendations; and what needs to happen next. LESSONS LEARNED: We believe to the best of our knowledge this is the first time where many potential solutions for keeping people safe while operating quad bikes in agriculture have been explored in a public forum. There are some immediate solutions that people can undertake to keep themselves and those in their care safe when using a quad bike: initially selecting safer vehicles to use; fitting quad bikes with crush protection devices; not carrying passengers or overloading the quads; and wearing helmets.

The value of best-practice guidelines for OSCEs in a postgraduate program in an Australian remote area setting.

INTRODUCTION: Nurses in remote areas of Australia are the primary healthcare professionals, who need to be able to deliver comprehensive and culturally sensitive care to clients, many of whom are Indigenous Australians. Adequate and specific preparation for practice is crucial to the quality of care delivered by remote area nurses (RANs). Objective structured clinical examinations (OSCE) provide an excellent opportunity for student practice in a simulated environment that is safe, authentic, fair and valid when well constructed. Seven integrated best practice guidelines (BPGs), previously developed by project team members to inform OSCEs within educational programs, provided guidance in restructuring the OSCE. This paper provides a detailed analysis of the value of BPGs used in the development, teaching and learning, and evaluation of OSCEs in a rural and remote postgraduate course for RANs. METHOD: A pre-site visit to the Centre for Remote Health, Alice Springs, Northern Territory, was conducted with modification of the course and previous OSCE according to BPGs. Following delivery of the course and OSCE, evaluations occurred via a mixed method approach. Student surveys (n=15) and focus groups (n=13) and staff interviews (n=5) provided an in-depth analysis of their perceptions of the revised OSCE. Descriptive statistics were used to describe the student sample. The narrative data were transcribed verbatim and analysed using content analysis. Triangulation was achieved with the convergence of the separate data sources focusing on themes and patterns within and between students and tutors. RESULTS: All 15 students and five tutors provided feedback. The majority of student participants had limited experience in working in remote area nursing prior to participation and therefore the opportunities that availed themselves were critical in adequately equipping them with the requisite knowledge, skills and abilities. Three themes emerged from the data: (1) value of common and significant events in OSCE; (2) power of deliberate actions; and (3) learning cultural sensitivity. DISCUSSION: OSCEs in this setting proved to be a good way for students to learn the skills required by RANs. Overwhelmingly, the modifications using the BPGs were highly valued by students and staff. Three themes emerged and were clearly linked to specific BPGs, indicating the positive impact the BPGs had on the OSCEs and student learning. The authentic content for the scenarios was seen as relevant and motivational for student learning. The practice element of the OSCEs enhanced the learning experience and feedback supported learning. CONCLUSIONS: OSCEs developed, taught and assessed using BPGs were highly valued. The BPGs provided an integrated approach with real-life scenarios with a strong cultural perspective - all important features to the RANs' future success in providing individualised care to clients in remote areas of Australia. Further use of BPGs is recommended.

Using an Objective Structured Clinical Examination for Bachelor of Midwifery students' preparation for practice.

BACKGROUND: Contemporary midwifery practice needs a rigorous and standardised assessment of practical skills, and knowledge to ensure that safety is maintained for both women and neonates before, during and after childbirth. AIM: To evaluate the use of Best Practice Guidelines (BPG) for Objective Structured Clinical Examinations (OSCE) as a standardised tool to develop clinical competence of Bachelor of Midwifery students. METHOD: A pragmatic mixed method approach with surveys, focus groups and interviews was used to evaluate the OSCEs for first year students. Quantitative and qualitative data were combined to understand student and academic perceptions of students' confidence for clinical practice following the OSCE. FINDINGS: Thirty-four students responded to surveys (response rate 94%); and 13 participated in focus groups. Two academic lecturers participated in an interview (100%). Two main themes emerged (1) the OSCEs improved student confidence (2) the OSCEs were relevant and prepared students for practice. Most students indicated that they practised for the OSCE using an integrated approach (70%), and that this assisted them in their approach to the assessment of the neonate or post-partum mother. CONCLUSION: The use of BPGs to ensure that OSCEs focus on important aspects of knowledge and practice helped students to learn and to perform well. Students' confidence in their ability for the imminent professional experience placement was high. OSCEs designed with the BPGs should be implemented broadly across midwifery education to enhance students' competence and provide rigorous meaningful assessment.

Occupational stress in remote area nursing: development of the Remote Area Nursing Stress Scale (RANSS).

BACKGROUND AND PURPOSE: The purpose of this study was to develop a measure that would adequately and sensitively measure the occupational stress experience of nurses working in very remote health care facilities. Because no existing nursing stress tool is suitable to assess the unique stressors of remote nursing practice, the aim was to address this gap in psychometric measurement capacity and develop the Remote Area Nursing Stress Scale (RANSS). METHOD: A focus group (n = 19) of remote area nurses identified potential questionnaire items through open discussion and by later listing the stressors they experienced individually in their day-to-day functioning. Subsequently, the Delphi method was employed to further refine the questionnaire (n = 12 experts). The RANSS was successfully pilot tested and was afterward administered to nurses working in very remote Australia in 2008 (n = 349) and in 2010 (n = 433). RESULTS: Principal components analysis and confirmatory factor analysis were performed for both waves of survey administration, demonstrating a robust 7-factor structure consistent across samples and accounting for significant variance in dependent measures. CONCLUSION: The development and validation of the RANSS is a significant advancement in remote area nursing research. The RANSS should be administered on an ongoing basis to monitor occupational stress among nurses working in very remote Australia. The RANSS should also be administered internationally in countries that also accommodate remote health care facilities. This would determine whether the RANSS is a psychometrically valid stress measure beyond the context of very remote Australia.