Are rural and remote patients, families and caregivers needs in life-limiting illness different from those of urban dwellers? A narrative synthesis of the evidence.

This review aimed to assess the evidence to answer the question whether palliative end-of-life care needs of patients and caregivers in rural and remote communities differs from those of urban dwellers. Peer-reviewed studies from 1996 to the present dealing with the experience of rural and remote patients and caregivers at the end-of-life compared with that of urban people were extracted for narrative synthesis. The eight studies included showed that palliative needs of rural and remote residents are related to context. Diagnosis and treatment are less well managed in rural areas. Rural differences include: people are more accepting of death and less likely to intervene to delay death; caregivers tend to be younger and include friends as well as family and local support networks are important. Rural and remote end-of-life needs are shaped by reduced access and availability of services which has a negative influence on outcomes. This is counterbalanced by an acceptance of death and local support networks. Well-designed longitudinal studies with samples comprised of rural and urban residents for comparison are required to monitor how end-of-life need might change with the approach of death. Clinicians, health services and policy makers need a better understanding of rural attitudes and of how rural community networks mobilise to support end-of-life care in their rural and remote communities.

What do graduate registered nurses want from jobs in rural/remote Australian communities?

AIM: To explore and describe the needs of new graduate registered nurses in a rural and remote (R&R) setting within Australia. BACKGROUND: Rural practice has distinctive challenges for nurses. Nurses make up the largest and most widely distributed health workforce in Australia, outnumbering doctors 8:1 in R&R areas. EVALUATION: Literature was used to evaluate the graduate registered nurses' needs in R&R communities. KEY ISSUES: Three main themes emerged: expectations, support and workloads. Themes reflected enablers and disablers of retention of nurses as they transition from student role to new graduate practice. CONCLUSION: New graduates are aware of their limitations as new practitioners. There is an expectation that their employers will provide a supportive learning environment for them to gain the skills necessary to become proficient and valuable employees. IMPLICATIONS FOR NURSING MANAGEMENT: This commentary paper identifies the need for a structured, supported new graduate programme that recognizes and meets the needs, both clinical and social, of new graduate registered nurses in the R&R context.

Supporting rural/remote primary health care placement experiences increases undergraduate nurse confidence.

This paper reports on the analysis of data from undergraduate nursing students who participated in the Primary Health Care Intensive Programme (PHCIP) in far west New South Wales between 2006 and 2008. This analysis looks specifically at pre/post confidence levels of participants in relation to their grasp of underlying principles associated with primary health care practice and Indigenous health care delivery. Bachelor of nursing curricula remains heavily weighted towards acute care in large metropolitan facilities however; universities actively seek clinical fieldwork experiences in rural/remote and Indigenous communities for their students. The PHCIP was developed and delivered through the Broken Hill University Department of Rural Health, University of Sydney, and sought to address the disparity in student preparedness for practice in these settings through the provision of a structured and educational rural and remote clinical placement experience. Pre/post questionnaires, focus groups and three month post-placement phone interviews provided data on levels of participant confidence in the areas of primary health care delivery and culturally knowledgeable practice. This study indicates that structured preparation for practice, underpinned by authentic learning experiences and aligned with comprehensive education programmes can have a positive impact in the areas of skills, knowledge and attitudes and enhance the confidence of undergraduate nurses undertaking clinical placements in these settings. These findings are relevant to contemporary nursing education and evolving models of health care delivery for rural and remote communities.