The practice of rural and remote nurses in Australia: A case study.

AIM AND OBJECTIVE: To delineate contemporary practice of registered nurses working in rural and remote areas of Australia. BACKGROUND: Despite the implementation of strategies to address challenges reported by rural and remote nurses, concern remains over safety and quality of care, the well-being of nurses and retention of the nursing workforce. Twenty years on, geographically dispersed nurses still experience scarce human and material resources. DESIGN: A multiple case study design was implemented. METHODS: Nurses were recruited from 240 sites. The study comprised three phases of data collection. First, a content analysis of 42 documents relating to the context of nursing, specifically rural and remote nursing; second, a content analysis of an online questionnaire (n = 75); and third, a thematic analysis of semi-structured interviews (n = 20). COREQ reporting guidelines were used. RESULTS: Each phase of data collection informed subsequent data collection and analysis within the study. Following triangulation of data from each phase of the study, the major themes reported are "a medley of preparation for rural and remote work"; "being held accountable"; "alone, with or without someone"; and "spiralling well-being." CONCLUSIONS: Regardless of strategies, challenges of nursing in rural and remote areas persist. Issues of isolation, stress, burnout and a lack of organisational commitment to employees affect the retention of rural and remote nurses. While useful, professional development courses and graduate certificates are yet to make an impact on reducing these issues. RELEVANCE TO CLINICAL PRACTICE: Registered nurses argue for more experience rather than more education to facilitate transition into this nursing area. The finding that experience is perceived as more valuable than education suggests the need for innovative ways to gain experience to practice in rural and remote nursing. Lack of organisational commitment requires attention to promote the well-being of nurses and patient safety.

Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service.

BACKGROUND: Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. METHODS: Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. RESULTS: Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. CONCLUSIONS: This study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.

Personal qualities needed by undergraduate nursing students for a successful work integrated learning (WIL) experience.

BACKGROUND: International research has shown that during work integrated learning (WIL) undergraduate nursing students may experience stress, self-doubt, and coping issues, however personal qualities these students bring to their WIL journey or those needed to succeed during WIL remain unknown. OBJECTIVE: To describe the views of students midway through their Bachelor of Nursing program regarding personal qualities they bring to and need for WIL success. DESIGN: This article reports on a descriptive study that used an electronic questionnaire to collect the data. SETTINGS AND PARTICIPANTS: Bachelor of nursing students (n = 421), who were studying fulltime or part time equivalent, at a regional university in Queensland Australia, were invited to complete the anonymous electronic questionnaire that was developed by the research team following an extensive review of literature. Inclusion criteria required participants to have completed at least one WIL experience and be midway through their three-year Bachelor of Nursing program. METHODS: Data were collected during January and February 2017. The electronic questionnaire consisted of demographic, forced choice questions, and open-ended questions. This paper presents the qualitative analysis of responses to two of the open-ended questions that focused on personal strengths and work integrated learning experiences. Data were analysed using the inductive content analysis approach. RESULTS: Six personal qualities were identified including: enthusiasm to succeed, commitment to learning, self-motivation, confidence, effective communication skills, and compassion. CONCLUSIONS: Pre-entry screening of applicants to bachelor level nursing programs and the delivery of learning opportunities that encourages both reflection and debriefing may assist in describing personal qualities needed to succeed in WIL.

Women's successful transition to motherhood during the early postnatal period: A qualitative systematic review of postnatal and midwifery home care literature.

OBJECTIVE: To undertake a systematic review of available qualitative research literature to determine what women need to successfully transition to motherhood during the early postnatal period and whether postnatal home care delivered by midwives supports this process. DESIGN: The transition from woman to mother is a significant occurrence, one that requires adjustments on physical, psychological and social levels. A qualitative systematic review design was chosen to ensure both humanistic and interactive concepts related to what women need to successfully transition to motherhood during the early postnatal period were identified. The systematic and structured search uncovered 33 research articles for detailed review. Two team members, using the qualitative research checklist from the Critical Appraisal Skills Programme, appraised the quality of the research articles. A total of 19 articles met the quality criteria and were included in the data evaluation process. SETTING AND PARTICIPANTS: Research teams from Asia-Pacific, Europe, Middle East and North America generated the 19 qualitative journal articles. MEASUREMENTS AND FINDINGS: Data evaluation included identification of research aim, presence of a research question, type of methodology, data collection processes, sample information, data analysis techniques and study outcomes. Data was analysed using an inductive content analysis approach. Four themes were identified from the qualitative systematic review process including: women and midwives connecting, identification and meeting of women's individual needs, family and cultural influences and, education and support. KEY CONCLUSIONS: The ability of women to connect with midwives during the early postnatal period assisted them overcome barriers and to successfully transitioning to motherhood. Although all four themes were determined to be key to effective postnatal transition, overwhelmingly the findings showed postnatal midwifery home care to be important in women's successful transition to motherhood in the early postnatal period. IMPLICATIONS FOR PRACTICE: Strategies are needed ensure women have access to midwives in the early postnatal period.

Public support for anti-smoking legislation varies with smoking status.

OBJECTIVE: Rural Australians have higher rates of smoking than their urban counterparts, contributing to poorer health outcomes. In 2004, the Queensland Government introduced legislation to reduce the impact of environmental tobacco smoke on the community. The aims of the study were to describe smoking behaviours and associations between smoking behaviour and agreement with current anti-smoking laws. PARTICIPANTS: A total of 1208 people over the age of 18 years and living in rural, remote and very remote central Queensland participated in this telephone survey. RESULTS: About 22% (n = 130) of female and 21% of male (n = 125) participants identified themselves as smokers. No difference existed between the mean age of smokers (47.3 years) and non-smokers (47.1 years). While there is high level of support for smoking restrictions in public places (75%), attitudes vary with smoking status. Smokers were less likely than smokers to agree that the legislation would create a healthier environment, reduce exposure to passive smoking or agree that 'it is right to ban smoking in public places'. Smokers were significantly more likely to agree that the legislation had gone too far. CONCLUSION: The gradual implementation of the anti-smoking legislation is changing social beliefs on what are acceptable smoking practices. It is likely that the legislation within Queensland and the subsequent forced changes in social conditions for smokers will continue to reduce the number of people smoking and reduce exposure to environmental tobacco smoke.

Indicators of undergraduate nursing students' satisfaction with their learning journey: An integrative review.

OBJECTIVES: In Australia Bachelor of Nursing programmes are delivered via both internal and distance modes yet there is little knowledge of the indicators of undergraduate nursing students' satisfaction with the learning journey. This integrative review was undertaken to uncover the indicators of undergraduate nursing students' satisfaction with their learning journey. DESIGN: Integrative review. A review of key papers was undertaken. Only peer-reviewed papers published in scholarly journals from 2008 onwards were included in this integrative review. DATA SOURCES: Pubmed, CINAHL, Google Scholar, Cochrane, Wiley Online and ProQuest Central databases were searched for relevant papers. REVIEW METHODS: 49 papers were appraised, by a minimum of two team members. CASP tools were used when evaluating qualitative research, systematic and integrated reviews while survey research was evaluated using a tool specifically developed for this purpose by the research team. All tools used to assess the quality of the research studies contained comprehensive checklists and questions relevant for the particular type of study. Data related to these checklists was extracted and the research team appraised the quality of each article based on its relevance to the topic, internal and external validity, appropriateness of data analysis technique(s), and whether ethical considerations were addressed. Seventeen papers were included in the final analysis. Data analysis involved a systematic approach using content analysis techniques. RESULTS: This integrative review sought to identify indicators of nursing students' satisfaction with their learning journey. Authentic learning, motivation, resilience, support, and collaborative learning were identified by this integrative review as being key to nursing students' satisfaction with their learning journey. Sub themes were identified within each of these themes that assist in explaining nursing students' views of their learning journey. CONCLUSION: The findings showed that higher satisfaction levels are attained when nursing students feel included and supported during their learning journey.

The write stuff: A proactive approach to increasing academics' writing skills and outcomes.

An important way to advance the profession of nursing, to promote best practice and to improve the quality of nursing care, is for nurses to publish. A publication track record is necessary to gain competitive research funding, build knowledge, disseminate new insights and advance the profession. However, academics often experience obstacles in publishing ranging from a pervasive teaching culture, lack of confidence in writing, and lack of strategies to write more strategically. The benefits of writing retreats have been discussed within the nursing and other academic literature but the specifics about the method as well as the unplanned benefits have not been explored. More exploration and discussion is needed about factors assisting writers to complete papers and successfully publish. This paper discusses a novel intervention which aimed to seed the beginnings of a flourishing scholarly community at a regional Queensland University. The paper also presents qualitative and quantitative evaluation data.

What were the outcomes of home follow-up visits after postpartum hospital discharge?

OBJECTIVES: To assess health outcomes of home follow-up visits after postpartum discharge and assess relationships between the number of home visits and selected outcomes among women who gave birth at two Queensland, Australia, regional hospitals. DESIGN: A cross sectional study. Services provided during the home visits were responsive to a woman's need rather than having a structured protocol of services. MAIN OUTCOME MEASURES: The four measured health outcomes were: 1) postpartum depression; 2) confidence to undertake maternal roles; 3) breastfeeding; and, 4) satisfaction with postpartum care. RESULTS: Of 210 women who were invited to participate in the study, 143 (68.1%) provided information. Women who received a higher number of home visits had significantly lower confidence to undertake maternal roles than those who received fewer home visits. There was a positive correlation between the number of home follow-up visits and postpartum depression among women who gave birth at one hospital (Hospital B), but not at the other (Hospital A). No relationship was found between the home postpartum visits and the other outcomes. CONCLUSION: These results could be explained in that home follow-up visits were offered to all women at Hospital A while Hospital B only provided home visits to women who had a health risk due to their social, physical and psychological characteristics. The lack of protocol home visits and the characteristics of women receiving the visits were probably the major factors which influenced these limited beneficial outcomes.