Establishment of radiation therapy services in North West Tasmania: a community need or election strategy?

BACKGROUND: This case study examines the impetus for policy change that resulted in the establishment of a radiation therapy service in rural North West Tasmania, Australia. Provision of local radiation therapy services improves accessibility for those in rural and regional areas. However, providing these services and maintaining them is not achievable for all areas. The drivers to establish services in more regional locations are not always well understood. This article presents a case study of how a radiation therapy service was established in North West Tasmania. It applies a health policy analysis model (the Advocacy Coalition Framework) to examine the impetus for policy change and draws conclusion about how the framework can be applied to the development of health services in rural areas. Understanding the impetus for policy change allows health service planners to apply this knowledge to influence the health agenda. Knowing the way in which policy change can be driven creates an opportunity to become more strategically involved in policymaking. METHOD: Documents related to the case study were analysed for expressed beliefs, using the Advocacy Coalition Framework, to determine any identifiable coalition of actors that held consistent, shared beliefs and were engaged in non-trivial action to the establish radiation therapy services in North West Tasmania. RESULTS: Document analysis confirmed the presence of a Health Policy Coalition that was concerned about sustainability and safety in establishing the service. No additional coalition was identified. Instead, the possible role of the media and the marginal nature of the local Federal electorate were likely to have impacted the subsequent policy change. CONCLUSIONS: The study found evidence that policy change was achieved primarily as a result of a political strategy designed to win support during a Federal election. This has important implications for health policy in rural areas, especially for those population centres located in marginal seats. During an election cycle the decision to establish new health services may not be wholly influenced by an identified coalition or issue such as sustainability, community needs or rationality.

Mothers' views of health problems in the 12 months after childbirth: A concept mapping study.

AIMS: To identify the health problems that women feel require help and subsequent help-seeking behaviour during the 12 months period after childbirth. BACKGROUND: Many women experience physical and mental health problems after childbirth, but there is a gap in understanding how they perceive their health after childbirth. Studies suggested they are inhibited in expressing their needs and so seek informal rather than professional help for their health problems. DESIGN: A mixed method concept mapping study. METHOD: Two groups of Australian women were recruited by an online platform and purposive sampling (N = 81) in 2017-2018, based on an established concept mapping methodology. A first group created 83 brainstorm statements about post-childbirth health problems and help-seeking and a second group sorted and rated the statements based on their perception of the prevalence of the issues and the help-seeking advice they would offer to others. Bradshaw`s Taxonomy of Needs was used to theoretically underpins the explanation of the results of women's felt need after childbirth. RESULTS: Multidimensional scaling resulted in six clusters of issues which were categorized into three domains: 'health issues and care', 'support' and 'fitness'. Despite being directly asked, about two-thirds of the women did not report experiencing any health problems. CONCLUSION: Our findings showed women had a broader perception of healthcare needs which included support and fitness. There is a potential gap in services for women who do not have good social support. IMPACT: Family and friends were a key source of help-seeking. Post-childbirth routine care was focused on infant care and limited to the first 6 weeks after childbirth. The content of current post-childbirth care must be reviewed.

Investigating the referral of patients with non-urgent conditions to a regional Australian emergency department: a study protocol.

BACKGROUND: Australia's only island state, Tasmania, experiences one of the nation's highest incidences of non-urgent emergency department (ED) presentations in a healthcare system regularly faced with service demands that exceed resource availability. Service-demand mismatches are acknowledged to contribute to ED crowding which in turn, has been documented to have a correlation with poorer patient outcomes. Crowding within EDs is complex, non-urgent presentations alone are not the primary cause, but have been reported to be a contributing factor. In 2015-16 Tasmania recorded over 153,000 ED attendances, 55% of these fell into the two least urgent triage categories. Recent research in the State's North established that 29% of non-urgent presentations were referred, formally or informally, from primary healthcare providers and that, for many patients (39%), the ED was not their first choice of service provider. This study aims to identify the service needs of patients referred to a regional Australian ED and subsequently triaged as non-urgent. METHOD: In order to achieve this aim, three objectives have been identified. The first two objectives use an explanatory sequential mixed-method approach while the third objective will incorporate an implementation science approach. These three objectives are: first, a retrospective analysis of seven years of routinely collected hospital data to identify trends in referral of patients with non-urgent conditions; second, focus group interviews with patients and primary care providers to further understand perceived need and service requirements of those referred to the ED, and third, translation of findings into local health service recommendations. DISCUSSION: Identification of the needs of patients referred to the ED with non-urgent conditions will inform future service planning aiming to facilitate access to the right service at the right time and in the right place.

The 'fallacy of normalcy': A content analysis of women's online post-childbirth health-related support.

BACKGROUND: Online forums have changed traditional sources of seeking help because they provide an anonymous and non-judgemental environment particularly suited for women with post-childbirth problems. QUESTION: What support is given to mothers who have posted questions about post-childbirth morbidities? METHODS: A total of 333 messages posted on a post-childbirth online forum were loaded into NVIVO 12 Pro and were analysed using content and thematic analysis. Content analysis identified the major health problems, and thematic analysis was used for identifying motivations and the support offered. FINDINGS: Seventeen different health problems were discussed on posts, with a strong emphasis on pelvic problems, followed by mental health concerns. The key motivation for seeking online help identified using 'typology of advice solicitation' was request for opinion or information (48.85%). The two main support themes were: peer to peer support (82%) and normalisation (not always appropriate) of post-childbirth problems (18%). Most of the support offered was emotional (56.9%) followed by practical (22.7%) and informational support (20.4%). DISCUSSION: Postpartum adjustment of post-childbirth experiences can be supportive but if ill-informed may provide a barrier to safe and reliable health care. CONCLUSION: We recommend women have access to online forums moderated by healthcare providers who can notify participants when a problem requires support from a relevant health professional opinion.

Socioeconomic disadvantage as a driver of non-urgent emergency department presentations: A retrospective data analysis.

BACKGROUND: Globally, emergency departments (EDs) are struggling to meet the service demands of their local communities. Across Australia, EDs routinely collect data for every presentation which is used to determine the ability of EDs to meet key performance indicators. This data can also be used to provide an overall picture of service demand and has been used by healthcare planners to identify local needs and inform service provision, thus, using ED presentations as a microcosm of the communities they serve. The aim of this study was to use ED presentation data to identify who, when and why people accessed a regional Australian ED with non-urgent conditions. METHOD AND MATERIALS: A retrospective data analysis of routinely collected ED data was undertaken. This included data obtained over a seven-year period (July 2009 to June 2016) in comparison with the Australian Bureau of Statistics census data. Analysis included descriptive statistics to identify the profile of non-urgent attendees and linear regression to identify trends in ED usage. RESULTS: This study revealed a consistently high demand for ED services by people with non-urgent conditions (54.1% of all presentations). People living in the most disadvantaged socioeconomic decile contributed to 36.8% of these non-urgent presentations while those under 25 years of age contributed to 41.1%. Diagnoses of mental health and behavioural issues and of non-specific symptoms significantly increased over the study period (p < 0.001) for both diagnostic groups. CONCLUSION: The over-representation by those from the most socioeconomically disadvantaged areas highlights an inequity in access to services. The over-representation by those younger in age indicates behavioural patterns based on age. These key issues faced by our local community and the disparity in current service provision will be used to inform future health policy and service planning.

Women's help-seeking behaviours within the first twelve months after childbirth: A systematic qualitative meta-aggregation review✰.

INTRODUCTION: Women within the first 12 months after birth often do not seek professional help for post-childbirth morbidities. This systematic review uses the Behavioural Model of Health Services Use (BMSHU) to assess the barriers and facilitators to women's help-seeking from health professionals during the first twelve months after childbirth. METHOD: A qualitative meta-aggregation was used for the review. Systematic searching of Medline via Ovid, CINAHL, EMBASE and Web of Science revealed an initial 691 papers, of which 48 were reviewed. Nine qualitative papers, peer-reviewed, English papers and published from 2000 to 2017, were identified. Studies selected according to the pre-defined protocol were assessed using The Joanna Briggs Institute Critical Appraisal Tools (JBIQARI). RESULTS: Seventy-five findings were identified from the approved articles and aggregated into seven categories. Key themes that emerged were that women did not seek help because they accepted problems as a part of the motherhood role or because they feared being judged negatively. Women shared their issues with family and friends as trusted people. Low health literacy was a barrier to seeking help, as was lack of access to proper care and poor advice from families. The women's cultural context was an essential influence in whether or not they sought help. According to BMSHU, a model of key influences on women's help-seeking for maternal morbidities introduced.

An investigation of nursing students' knowledge of dementia: A questionnaire study.

BACKGROUND: Globally, rising rates of dementia indicate the need for more nurses skilled in caring for people with this condition. However nursing students may not acquire the requisite knowledge from existing undergraduate curricula. OBJECTIVES: To investigate the dementia knowledge of second-year nursing students before and after a supported placement in a residential aged care facility. Assessment of the level of knowledge of dementia is important to provide evidence of the need to enhance dementia learning in the nursing curriculum. DESIGN: A pre-post control-intervention questionnaire study. SETTINGS: 16 Tasmanian residential aged care facilities (RACFs). PARTICIPANTS: 99 Tasmanian second-year nursing undergraduate students (52 intervention, 47 control). METHODS: Second year nursing students were engaged in a three week RACF clinical placement at one of the 14 control facilities or one of the 2 involved in the development of teaching aged care facilities. Pre/post data were collected using the 21-item 'Dementia Knowledge Assessment Tool 2.0' and demographic survey questions, and analysed using descriptive analyses and nonparametric significance tests. RESULTS: The data showed that these nursing students had a poor knowledge of dementia, with limited understanding of key items relevant to their clinical practice. Knowledge of dementia was significantly improved after students' participation in supported clinical placements at an intervention residential aged care facility. This knowledge improvement was significantly higher than that of students who attended clinical placements at control facilities. CONCLUSIONS: A well-supported clinical placement at a residential aged care facility can improve nursing students' knowledge of dementia, in particular in relation to aspects directly relevant to their clinical practice.

Learning opportunities in a residential aged care facility: the role of supported placements for first-year nursing students.

The residential aged care sector is reportedly a less attractive career choice for nursing students than other sectors. Research shows that students are often fearful of working with residents with dementia when they are inadequately supported on clinical placements by aged care staff. Thirty first-year nursing students attended a 2-week placement in one of two Tasmanian aged care facilities as part of the Wicking Dementia Research and Education Centre Teaching Aged Care Facilities Program, which aims to provide students with a quality aged care placement focusing on dementia palliation. Placement experience and dementia knowledge were evaluated through preplacement and postplacement questionnaires and weekly feedback meetings with mentors and students. Students had more positive attitudes related to aged care and higher dementia knowledge at the end of placement. Students described their interactions with residents with dementia and thought that the placement had increased their capacity to provide quality care to these residents. The findings indicate that residential aged care placements can be productive learning environments for novice nursing students.