Remote Setting in Australia - Essay Example

Name: Subject of Study: Date: Scope of nursing practice is never constant. It largely depends on the state of factors in demography, politics, economic and cultural fields that are specific to a region, community or place. Diverse cultural, political and economic challenges that keep changing necessitate the need to widen scope of nursing all over the world to suit healthcare consumers in certain areas. Nurses play undisputable role in achieving health targets (Fairman, Rowe, Hassmiller, & Shalala, 2011). They do so by adopting client specific and friendly scope that enable them address specific needs of a society. Nurses keep changing their practice to provide services that are community friendly. Generally, in Australia, nursing roles and scope of practice keep changing depending on the zone. An example is the Guyra community. It comprises of Guyra town dwellers and villagers in Ben Lomond, Black Mountain, Ebor, Llangothlin and Tingha main villages. Guyra is located in New England Region of New South Wales, Australia. It is the coolest part of Australia located on the New England Highway (Shiu, Lee, & Chau, 2012). Guyra is one of the remote and rural areas in Australia basing on the government classification of remote areas. Its inhabitants are the Anaiwan group of indigenous Australians. It receives ample rainfall. Therefore, farming is the main economic activity. Health challenges include higher occupational risks due to farming and people living hundreds of kilometres away from their nearest health care centres. Remote areas lack adequate nursing experts due to hardships experienced in living there(White et al., 2008). Determination of nurses’ role depends on the workplace and level of health service delivery. For example, a nurse working in a hospital plays a different role from a nurse working on home based care programs. However, the utmost goal of nursing is to promote wellbeing of all people and to provide quality healthcare to the sick. A public health nurse plans, delivers, evaluates and documents home nursing care. It is also the goal of nurses to perform community health education alongside other services that promotes wellbeing of people and reduces disease burden (Association, 2010). The role of a nurse practitioner is quite diverse. Nurses provide holistic services suited to individual community, group of people or an individual person needs. These services aim at prevention of diseases, promotion of wellbeing, curing diseases, rehabilitation as well as advocating for policies that favour community health improvement. Nursing practice as a profession has established its own areas of specialisation to include acute care nursing, psychiatry nursing, geriatric nursing, paediatric nursing, obstetric nursing, neonatal nursing among others (Fry et al., 2012). The scope of nursing practice differs from one country to the other. This is because the scope of professional practice is set by established professional bodies in a country. Professional bodies use professional standards such as code of ethics, public needs, demand and expectation as well as competency standards to establish boundaries within which their professionals with operate. Moreover, the level of qualification and individual experience, consumer health needs, service provider’s policy, cultural setting and public useful in determining an individual nurse’s scope of practice (Shiu et al., 2012). The scope of practice for a profession defines roles, responsibilities given, activities, functions and decision-making capacity which an individual in a profession trains, is competent and is given mandate to perform. The scope of nursing practice mandate nurses to obtain medical histories, conduct physical examinations, order diagnostic studies, and provide antenatal care and family planning services. Others include, child welfare care, counsel, educate patients, and provide care for patients in acute setting among others (Mills & Hallinan, 2009). The Australian government extends scope of nursing practice to include rural and remote health programs that offer mainly home based care, education campaigns, care for the elderly and those with disabilities among many others. Nurses conduct some of the public health responsibilities in remote areas to ensure environmental measures and sanitation measures are upheld to standards (Henderson, Koehne, Verrall, Gebbie, & Fuller, 2013). Through home visiting, nurses are able to assess presence of toilets and pit latrines in addition to determine hygiene levels. Demographic statistics is a major contributor to the scope of nursing practice in Guyra. In the 2011 Census, total population was four thousand, three hundred and ninety seven persons. Of these, 50.1% were male people and 49.9% were female. Aboriginal and Torres Strait Islander people comprise 10.0% of the population. People concentrate in the urban centre and the median age is forty one years (Australian Bureau of Statistics, 2011). There is a high percentage of people aged above 65 years. This fact poses a great challenges for the younger generation who have to take care of the older generation. Old age conditions are also very common. Nursing practice has to incorporate geriatric nursing to take care of this old generation needs. People aged sixty five years and over make up 17.9% of Guyra population. Children aged less than fourteen years comprise 22% of Guyra population (CSIRO PUBLISHING - Australian Health Review, 2013). The median age of married people is fifty four years while that of people never married is twenty seven years. Most men get married at the age between twenty eight years and thirty four years. However, girls get married as early as between fifteen years and nineteen years. This has posed a big challenge in management of teen pregnancy. There is high likelihood of abortion if pregnancy is acquired at teenage. Nursing practice has to incorporate the youth in education programs to prevent early pregnancies. Moreover, nursing service are made youth friendly to accommodate needs of the youth (Coyle, Al-Motlaq, Mills, Francis, & Birks, 2010). There is a high percentage of people who are not in registered marriages. Married people less than forty one year comprise the largest group of people in de facto marriages. This has reduced turn up for utilisation of couple prenatal, antenatal and child welfare care services. Being in a marriage that is not registered increases chances of divorce and separation that greatly ruin the health of family members. This has compelled nurses to expand their scope into family health care practice that aims at guaranteeing physical, psychological and emotional wellbeing of members of the family (Aglietta, 2013). There is a high proportion of couple families without children. Forty three percent of couples do not have children whereas only forty percent of couples had children. These facts are attributed to gynaecological problems, fear of expenses to care for children, de facto marriages and high proportion of aged generation. Divergence of nursing scope to include competency and experience in addressing gynaecological challenges is of utmost importance. Paediatric nursing is also vital in reducing under five year children mortality rates (Begg, Vos, Barker, Stanley, & Lopez, 2008). A small proportion of people has attained tertiary level education compared to those who achieved primary and secondary education. About 30% of Guyra population did not go to school. Therefore, their level of understanding of origin of diseases, prevention and curative practices is low. Nurses have to diversify their scope into performing massive campaigns on the need to practice healthy behaviours (Bell, Wilson, & Charles, 2011). 6.5% of people are unemployed. Moreover, 29% of Guyra population are in part time employment. These people cannot be able to meet their daily needs. Healthy practices such as healthy eating, physical activities, regular check-ups and reduction of stress levels depend largely on an individual’s income. Unemployed people lack the ability to practice healthy behaviour. They cannot manage to cater for their hospital bills especially where quality and expensive healthcare is needed. Nurses often engage themselves in lobbying to subsidise or reduces health practice and healthcare expenses from the government facilities (Begg et al., 2008). There is a trend for young people to migrate from villages to urban centres. This movement reduces workforce to produce food in the villages. In addition to that, it increases crime rate in the urban centres. Incidences of rape and gender based violence as well as transmission of sexually acquired conditions are on the rise. Sexuality and gender based violence is a specialty that has attracted nurses attention. High population in towns burden health facilities with post traumatic psychiatric conditions that require nurses who are competent in psychiatry (Bell et al., 2011). High concentration of people in urban centres and low sanitation has increased the risk of spreading communicable diseases. Town dwellers of low social-economic status live in poor environmental conditions that are source of infections. Lack of adequate facilities like housing and overcrowding increase spread of diseases. Poor sanitation in urban centres highly contribute to disease burden (Bell et al., 2011). Through outreach services, nurses are able to mobilise and educate the public to ensure clean environment that promotes healthy living. Economic factors in Guyra (local government area) have contributed to development of nursing scope. The most common occupations include, farmers, managers, labourers, technicians, trade workers, professionals, administrators as well as clerks. Every occupation has medical conditions and risks associated with it. Casual labourers usually present with injury acquired in course of duty. Emergency service departments are manned by nurses who are competent and experienced in trauma and emergency services (Kowal & Paradies, 2010). Of the employed people, majority work in sheep, beef cattle and grain farming. Others are employed in mushroom and vegetable growing. Guyra is highly dependent on agriculture. Agriculture as an occupation poses healthy risk to workers. There is risk of transmission of infections from animals to people. A common example is anthrax. Infection with tetanus is also rampant to food crop farmers. The scope of nursing practice is thereby expanded to include providing occupation health services and immunization to prevent transfer of infections from livestock to people (Director, 2012). Cafes, restaurants and take away food services are established businesses in Guyra. Their services are crucial to the health of Guyra population. High sanitation and hygiene standards are expected from them. The health of chefs is also a concern to the health of consumers. Regular inspection of cafes and restaurants to ascertain the level of sanitation is part of community nursing duties. Nurses are also expected to screen food preparers to ascertain they are not carriers of communicable diseases such as typhoid. Guyra harbours road junctions. Roads from the west cross New England Highway. Transport activities are high in Guyra. About 2.3% of people are employed in the transport sector. Majority of people travel to work to and from using vehicles either as drivers or as passengers. This trend has led to increased motor vehicle accidents involving school children as they cross the busy roads. Nurses in Guyra are involved in school health programs to educate them on safety in roads and other healthy living practices (Aglietta, 2013). Grapes are produced in Guyra. Hence, wine is locally produced. People in the villages have a tendency to drink wine and alcohol to harmful quantities. This has fuelled upsurge of chronic illnesses such as liver hepatitis, cardiomegaly and diabetes and alcohol related illnesses such as HIV/AIDs. Nurses are engaged in treatment, care and follow of people with chronic illnesses in various health centres and in home based care programs (Capital, 2010). Industries in Guyra attract a large workforce. There are industries in wool production, fat lamb production, glasshouse production of tomatoes and many others. In addition to that, mineral industries involved in production of copper, lead, and diamond among others have attracted large populations in various workplace stations. In relation to that, specific disease morbidity patterns have changed. For example, tuberculosis infection can be traced to be at high rate in people working in such places. Nurses have diverged their scope to conduct research and trace these patterns that will influence disease management approaches (King, Smith, & Gracey, 2009). Culture among the Aboriginal and Torres Strait Islanders has been the major impediment in provision of health care and guaranteeing healthy people. Gender taboos and patriarchal system has interfered with women empowerment to seek reproductive health services. This has led to change of nursing approach to reproductive health to include men. Moreover, measures are undertaken to enable nurses train secondary school students such to enable them make informed choices when they get married. House to house reproductive services are promoting privacy thus increasing utilisation of health services (Altman & Hinkson, 2010). Guyra people are known for going to hospitals when need be. This has been associated with hurried and insensitive assessment and treatment that do not take into account the privacy and cultural provisions. This trend has changed nursing scope to provision of nursing care in an individual friendly environment. Home based care programmes are now operating. This is aimed at reversing the culture where people seek health services to the future situation where healthcare providers will look for clients in their normal routines to administer treatment (Altman & Hinkson, 2010). People living in Guyra villages have a culture of refusing to participate in research. This is attributed to earlier experiences where research data was taken and no response was made. They believe participating in a study is agreeing to be misused by the government or researchers. Due to those complains, nurses have formed a community link to encourage local people participate in research. This link also provides an opportunity for the local people to get feedback for studies they have participated in (Mills & Hallinan, 2009). A few o Guyra people have embraced modern midwifery practices. Mothers give birth under the care of skilled midwifes operating in rural health centres. They have accommodated the need to perform caesarean sectioning to mothers who develop complications. Although transport system is not efficient, those who manage to get to hospital and develop complications are operated. Nurses specialised in theatre nursing or anaesthesiology take charge (Mills, Birks, & Hegney, 2010). Annual cultural events are rich part of Guyra culture. During January Lamb and Potato Festival, many people travel from villages to the town to celebrate and participate in the festival. Others festival include, the annual show in February and Christmas carnival. During these festival majority of people celebrate by abusing drugs to harmful levels. There is increase in hospital admissions with alcohol toxicity. Such situations prompt nurses to be good counsellors in order to manage such patients (Sutton, 2012). Many elderly people live on their own. They have no children to take care of them either because they never gave birth or because there children are married and occupied by jobs. Nurses in Guyra intervene and provide daily care to the elderly as well as palliative care to those who are chronically ill. This encompasses giving them food, hygiene environment and good clothing (Mills et al., 2010). Excessive alcohol taking among the village men is a culturally accepted order of the day. This has seen young men venture into alcohol abuse at tender age. They end up not able to take care of their financial needs, complete schooling to tertiary level and attend to needs of their families. This trend has greatly influenced their health and those of the people they are responsible of. Rehabilitative centres provide an opportunity for nurses to interact with clients addicted to alcohol in an effort to liberate them from alcohol menace (Shiu et al., 2012). Guyra is an area under local government. The top leadership is provided by a mayor who is elected by councillors. There are six councillors representing three wards. Each ward is represented by two councillors. Local government participates in promoting health of its people through activities such as environmental management, public safety, regulating number of bars and illicit alcohol brewing as well as consolidating funds to provide subsidised or free services to the disadvantaged groups (Henderson et al., 2013). The Australian Government and the local are government share responsibilities in health care provision. The Australian Government is responsible for funding health service, regulating health products, workforce, services and national health policy leadership. On the other hand, the states and territories are responsible management delivery of public health services (that includes public hospitals), regulating health care providers in public and private health facilities. Local are government fund projects such as environment management. In the recent past, rural health has generated a lot of political debate in Australia. Since 1990, there has been conferences and meeting to deliberate on the rural health especially on the health of indigenous people who have been racially discriminated in the past in regard to distribution of state resources. A variety of taskforce involving nurses have been recruited by the government to investigate rural health and recommend measures to be undertaken (Fry et al., 2012). While pursuing public health agenda, the current government has declared support for Primary health Care pillars and disease prevention. Through the ministry of health, the federal government has put policies that emphasize preventive measures of chronic illnesses and consolidation of efforts to ensure effective secondary prevention. These policies provide for shift on nursing focus in hospitals to communities. (Change from curative to preventive nursing services) (Mills et al., 2010). Rural healthcare reform initiatives have led to establishment of multiple health centres in rural areas to reduce the distant that rural people have to travel in order to receive health care. However, those health care centres do not have adequate human resources. Nurses are left in charge of those facilities to offer administrative and managerial roles. Nursing scope of practice has enlarged to include those who have specialised in administration and management (Parker, Walker, & Hegarty, 2010). Increased government facilities has necessitated increase in establishment of nursing schools and upsurge of enrolment (Bell et al., 2011). Some nurses have opted to specialise in training skills to increase nursing workforce that meets demand of the society. Specialisation fields are in all healthcare subjects and range from fundamentals of nursing, paediatric, pathology, anatomy and many others. The government is under pressure to curb shortage of health care providers. This is the right time to stop underutilising nursing workforce by expanding its scope of practice to include private practice. The gap between health service demand and supply together with pressure from economic forces necessitate expansion of nurses’ scope of practice. Nurses are cheaper to train than doctors. Therefore, it is necessary to utilise them to their fullest capacity to reduce government expenditure in health as well as improve the wellbeing of citizens (Fairman et al., 2011). In conclusion, nursing as a profession is valued and recognized globally for its dedication to provision for healthcare not only to individuals, families and communities at risk buts also to marginalized members of the society. Emergence of new diseases, culture, policies and approach to delivery of care calls for revision of nursing scope of practice in order to keep abreast with the community needs especially in the rural areas. Since demographic, economic, cultural and political facts are not easy to change, nurses should adopt their practice to them. Continuous education seminars and trainings are important to educate nurses on the changing scope of practice. Furthermore, it will enhance quality provision of care that respects client culture and is tailored to meet client needs. An overhaul of nursing practice to suit community culture will go a long way in bringing nurses closer to the patients to enhance utilisation of healthcare services and general quality of health among residents and visitors of Guyra (Lowe, Plummer, O’Brien, & Boyd, 2012). References Aglietta, M. (2013). ABS (Australian Bureau of Statistics)(2008) Perth: A Social Atlas. Catalogue number 2030.5. Canberra.——(2011) Regional Population Growth, Australia, 2009–10 Population Estimates:[Totals] by Geographic Classification [ASGC 2010], 2001 to 2010. Report no. 3218.0. Transforming Urban Transport: The Ethics, Politics, and Practices of Sustainable Mobility, 7, 234. Altman, J., & Hinkson, M. (2010). Culture crisis: Anthropology and politics in Aboriginal Australia. NewSouth Publishing. Association, A. N. (2010). Nursing: Scope and standards of practice. Nursesbooks. org. Retrieved from http://books.google.com/books?hl=en&lr=&id=N6F7_zSOQccC&oi=fnd&pg=PT4&dq=nursing+scope+of+practice&ots=6hreaOSzAr&sig=eGKwH9XXejMQ5k-BFhUU5VMUchY Begg, S. J., Vos, T., Barker, B., Stanley, L., & Lopez, A. D. (2008). Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors. Medical journal of Australia, 188(1), 36. Bell, M., Wilson, T., & CHARLES-EDWARDS, E. (2011). Australia’s population future: probabilistic forecasts incorporating expert judgement. Geographical Research, 49(3), 261–275. Capital, A. (2010). Australian Bureau of Statistics. Victoria, 5(529.4), 106–8. Coyle, M., Al-Motlaq, M. A., Mills, J., Francis, K., & Birks, M. (2010). An integrative review of the role of registered nurses in remote and isolated practice. Australian Health Review, 34(2), 239–245. CSIRO PUBLISHING - Australian Health Review. (n.d.). Retrieved August 26, 2013, from http://www.publish.csiro.au/paper/AH09743.htm Director, C. (2012). Australian Census: Indigenous Australia improves, but closing the gap is a long way off-CAEPR-ANU-CAEPR-ANU. Retrieved from http://caepr.anu.edu.au/Seminars/medialinks/12_06_25_4781.php Fairman, J. A., Rowe, J. W., Hassmiller, S., & Shalala, D. E. (2011). Broadening the scope of nursing practice. New England Journal of Medicine, 364(3), 193–196. Fry, M., Duffield, C., Baldwin, R., Roche, M., Stasa, H., & Solman, A. (2012). Development of a tool to describe the role of the clinical nurse consultant in Australia. Journal of Clinical Nursing. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2012.04264.x/full Henderson, J., Koehne, K., Verrall, C., Gebbie, K., & Fuller, J. (2013). How is Primary Health Care conceptualised in nursing in Australia? A review of the literature. Health & Social Care in the Community. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/hsc.12064/full King, M., Smith, A., & Gracey, M. (2009). Indigenous health part 2: the underlying causes of the health gap. The Lancet, 374(9683), 76–85. Kowal, E. E., & Paradies, Y. C. (2010). Enduring dilemmas of Indigenous health. Medical Journal of Australia, 192(10), 599–600. Lowe, G., Plummer, V., O’Brien, A. P., & Boyd, L. (2012). Time to clarify–the value of advanced practice nursing roles in health care. Journal of Advanced Nursing, 68(3), 677–685. Mills, J., Birks, M., & Hegney, D. (2010). The status of rural nursing in Australia: 12 years on. Collegian: Journal of the Royal College of Nursing Australia, 17(1), 30–37. Mills, J., & Hallinan, C. (2009). The social world of Australian practice nurses and the influence of medical dominance: an analysis of the literature. International journal of nursing practice, 15(6), 489–494. National Regional Profile : Guyra (A) (Statistical Local Area). (n.d.). Retrieved August 26, 2013, from http://www.abs.gov.au/AUSSTATS/abs@.nsf/781eb7868cee03e9ca2571800082bece/0e4cd9af4e4ff760ca2571cb000aeb87!OpenDocument Parker, R., Walker, L., & Hegarty, K. (2010). Primary care nursing workforce in Australia. Australian family physician, 39(3), 159–160. Shiu, A. T., Lee, D. T., & Chau, J. P. (2012). Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study. Journal of advanced nursing, 68(8), 1780–1792. Sutton, P. (2012). The Politics of Suffering: Aboriginal Health in Contemporary Australia. In Perspectives on Human Suffering (pp. 181–203). Springer. Retrieved from http://link.springer.com/chapter/10.1007/978-94-007-2795-3_15 White, D., Oelke, N. D., Besner, J., Doran, D., Hall, L. M., & Giovannetti, P. (2008). Nursing scope of practice: descriptions and challenges. NURSING LEADERSHIP-ACADEMY OF CANADIAN EXECUTIVE NURSES-, 21(1), 44. Read More