Critical Discussion on Rural Nursing Practice - Coursework Example

Critical Discussion on Rural Nursing Practice Name Institution Date Critical Discussion on Rural Nursing Practice Introduction Residents of remote and rural communities experience health outcomes that are poorer and display higher need of health (AIHW, 2008). Shortages as well as maldistribution in health workforce and greater out-of-pocket costs are specific barriers, particularly in very remote areas like Tennant Creek in Australia (AIHW, 2008). The percentage of Aboriginal people rises with rising remoteness and Aboriginal outcomes of health lag well after those of the other Australians (Smith, 2007). Lower incomes, lower socio-economic situations and poorer outcomes of education contribute to poorer outcomes of health (Smith, 2007). Significantly, services’ access is worse within regions of greatest need. Improving accessibility to acceptable, sufficiently resourced, PHC models that are sustainable in rural and specifically remote regions, where outcomes of health are worse and the proportion of Aboriginal residents is high, will restore the health outcomes’ gap in a nation that otherwise positions well globally with regards to its system of health as well as life expectancy (Wakerman & Humphreys, 2011). This paper will address various factors that pertain to rural and remote nursing particularly Tennant Creek and how these issues impact the scope of practice of the nurse working in this setting. Description of the Setting Tennant Creek According to the Australian Standard Geographic Classification (ASGC) Remoteness Areas, Tennant Creek is classified as very remote with a population distribution of 1% (Australian Institute of Health and Welfare, 2013a). Tennant Creek has a regional and local population of nearly 8,310 (Australian Institute of Health and Welfare, 2013a). Tennant Creek is a region of the Barkly Tablelands within the Northern Territory and its location is 510km on the north of Alice Springs and 670km on the south of Katherine (Australian Institute of Health and Welfare, 2013a). The National Census in 2001 showed that Tenant Creek consisted of a populace of 3,286 individuals from which 1,196 classified themselves as Aboriginal people and 727 individuals showed they conversed in a language that was not English (Australian Institute of Health and Welfare, 2013a). Apart from English, other languages that were commonly spoken in Tennant Creek included Tagalog (12 people), German (35 individuals), and Australian Indigenous languages (614 individuals) (Australian Institute of Health and Welfare, 2013a). According to Australian Institute of Health and Welfare (2013a), isolated and remote practice regions like Tennant Creek present specific challenges to quality services’ delivery, including: diverse culture; poor status of health; dispersed population; social erosion; problematic transport; geographic isolation; poor infrastructure; inadequate political influence; small economic foundation, high unemployment, poverty; harsh climate extremes; and high workforce turnover specifically healthcare. Overview of the Nurse’s Role According to Lenthall et al., (2011) the nurse’s role in remote regions is diverse, and differs with regards to the practice’s context. Whereas the nursing practice nature is influenced by numerous factors, substantial agreement is present involving Australian territories and states around the nurses’ role in isolated and remote communities (Lenthall et al., 2011). The diseases higher burden in isolated and remote regions of Australia like Tennant Creek impacts on the practice of nursing, and this is why nurses are exceptionally placed to help in minimizing the disease burden (Lenthall et al., 2011). Rural nurses are considered to have an abundance heritage of resourcefulness, creativity, adaptability and resilience (Wakerman & Humphreys, 2011). Historically, their area of speciality in practice is considered being ‘an expert generalist’ (Wakerman & Humphreys, 2011). Their biggest attribute is to understand the informal and formal community resources and the way of accessing these for the systems of the client (Smith, 2007). Besides being resource brokers, nurses who practice in rural and remote settings ought to have a wide knowledge foundation of caring for patients with various conditions of health all over the span of life. However, rural and remote nurses ought to be effective and flexible team players (Wakerman & Humphreys, 2011). Nonetheless, since there other kinds of health professionals are fewer, these nurses are likely to work more autonomously within expanded roles of nursing (Smith, 2007). Globally, the scope and role of practice of nursing is expanding (Wakerman & Humphreys, 2011). Bigger numbers of nurses are generally being made ready for practice roles that are advanced, particularly: certified registered nurse anaesthetist (CRNA), certified registered nurse midwifery (CRNM), and nurse practitioner (NP) (Mills et al., 2011). Role expectations and precise titles for different specialties differ to some extent from one country to another. In return, nurse educators are planning curricula that are related to expanded roles of practice (Mills et al., 2011). The Nurse’s Scope of Practice The CRANAplus is in support of the following scope of practice definition: a job’s scope of practice entails the entire spectrum of functions, roles, activities, decision-making ability and responsibilities which people in the profession are taught, competent and approved to perform (CRANAplus, 2013a). The professional scope of practice is designed by legislation- professional standards like standards of competency, codes of conduct, ethics & practice and public demand, need and expectation (CRANAplus, 2013a). It might therefore be wider than that of whichever person in the profession. According to CRANAplus (2013a), the definite scope of a person’s practice is actually influenced by the: context within which they perform; health needs of the consumer; level of education, competence; individual’s qualifications and experience; organizational culture; and service provider’s guidelines, risk and quality management framework. With regards to the health workforce, currently there is narrow data presented around the isolated and remote health workforce within Australia that precisely mirror the vacancy rates, characteristics, numbers and facilities/settings within which they operate. According to Lenthall, et al (2011) sequence of papers, the characteristics of workforce in nursing within remote areas has been illustrated. The available data shows that remote Australia like the Tenant Creek has an unreasonably reduced number of professionals of health per person of populace, compared to rural and urban Australia. This maldistribution is thought to be all over the groups of health professional and even as nurses are considered to be the most uniformly distributed all over the geographical regions and make up 50 percent of entire workforce; their figures as well as the ones of midwives are reducing in remote regions (AIHW, 2010). Health workforce in remote regions like Tenant Creek work longer periods, and are actually older compared to those working in urban areas (Lenthall et al., 2011). Health professionals in remote areas are basically flexible, resourceful, adaptable, passionate concerning their work and hard-working (Wakerman & Humphreys, 2011). Their practice entails every challenge and significant rewards of this outstanding and specialized area of healthcare (Wakerman & Humphreys, 2011). Health professionals in remote areas are led by ‘health’ as an entire concept of life, encompassing spiritual, emotional and physical well-being of people, family, environment and community (CRANAplus, 2013a). According to their scope of practice, health professionals in remote areas are expert practitioners who offer and/or coordinate a wide range of services in health care for a mixture of population clusters (CRANAplus, 2013a). The rationale of credentialing the health professional in remote setting is to guarantee the public and the professional that the nurse has obtained established levels of experience and practice, has practice’s recency within the area/specialty of practice of nursing, and has fulfilled established levels of education as well as continuing requirements of professional development (CRANAplus, 2013a). The nurses in remote areas are expected to work according to the Remote Area Nurse/Midwife’s professional standards as described by the CRANAplus RAN competencies (CRANAplus, 2013a). They are also expected to practice within a framework that is culturally respectful; practice in a Comprehensive Primary Health Care approach of service provision; work in care pathways and devise collaborative practice networks; have a degree of clinical knowledge as well as skill to carefully carry out the role; have a phase of current health practice within an isolated/remote location; have a continuous dedication to education to practice within the remote setting; and practice within a quality and safety framework (CRANAplus, 2013a). According to the RAN competency standards particularly domain 1, the scope of practice necessitates that the nurse offers high standard healthcare that is safe all over the lifespan of communities and individuals within remote regions (CRANAplus, 2013b). Competency element 1.1 in the RAN competency standards dictates that the nurse makes clinical judgments and compound professional decisions separate from other professionals of health (CRANAplus, 2013b). This would be achieved when the nurse demonstrates a series of advanced medical skills; uses standards protocols of treatment to direct practice; undertakes precise and timely assessment independently or in partnership with relevant team members; ascertains a scheme of confirming that actions are able to be justified (e.g. drugs, diagnosis, dosage) when other health professional are not available; utilizes the knowledge of local community including family knowledge, concerning clients to obtain the best health care while maintaining cultural safety and confidentiality; supports mutual problem solving as well as clinical decision making; employs numerous skills to obtain optimum health outcomes; and makes suitable referrals where applicable (CRANAplus, 2013b). According to competency element 1.2 of the RAN competency standards, the nurse should be able to balance clinical treatment’s demands with the obligation for preventive activities of health within the service’s parameters (CRANAplus, 2013b). The cues for this element are that the nurse is able to identify elements required for comprehensive and holistic health care within remote regions; demonstrates the ability to move assertively between different aspects of health care; consistently uses the primary health care principles (CRANAplus, 2013b); develops strategies that address health issues of the public in a collaborative method; takes the concerns and requirements of stakeholders into consideration when designing health care; identifies interventions that do not add to the advancement of health of communities and individuals; and notifies the employer regarding team and community requirements to offer health care that is effective (CRANAplus, 2013b). Demographic Factors Individuals living in remote and rural areas face specific challenges of health, a lot of which are actually attributable to social isolation, living conditions, distance from health services, and socio-economic status (Wakerman & Humphreys, 2011). Nurses make up the biggest group within the remote and rural health workforce; therefore people there rely heavily on them for services of health. Nurses in remote areas offer clinical and health care in a range of roles, in a framework of nursing and in partnership with other professionals of health. Whist nurses in urban settings might occasionally practice in separation from peers; remote area nurses experience the additional isolating issues of distance from related health practitioners and health services (Wakerman & Humphreys, 2011). Geographical and cultural isolation are considered to have substantial effects on the well-being, practice, and professional growth of nurses who work in remote communities. Additionally, geographical isolation may influence the manner in which services of health care are offered as well as the services available and infrastructure’s level to sustain nurses within their practice (Wakerman & Humphreys, 2011). It is imperative for development of policy to consider the profile of population within the remote and rural setting. Matters such as ageing, sex ratios’ changes, population growth and changes in the percentage of Aboriginal Australian have effects for status of health, policy as well as resources’ allocation (Smith, 2007). Life expectancy for people living in remote areas like Tenant Creek is lower (Lenthall et al., 2011). The decreased life expectancy of Aboriginal Australians which is around 17 years compared to that of every Australian together with the higher percentage of Aboriginal Australians who reside in areas that are very remote adds to the reduced life expectancy in regions outside major towns (Australian Institute of Health and Welfare, 2013c). Geographical location (availability of and accessibility to suitable health services) and remote and rural settings (including lifestyles, indigeneity, and socioeconomic status) are certainly the hallmark features of remote and rural Australia (Wakerman & Humphreys, 2011). There is sufficient evidence regarding how remote and rural contexts form the character of service delivery and practice. Thus the call for tailoring responses of PHC service policy to the environment of remote and rural populations is imperative (Wakerman & Humphreys, 2011). Lack of transport together with tyranny of distance, are the major obstruction to health care accessibility for various remote and rural Australians (Lenthall et al., 2011). Systems of health care that service the remote and rural Australians’ needs are not able to be seen with the exception of the system of transport that either brings clients to the services or takes services to the individuals (Lenthall et al., 2011). Health transport might be needed at various points in the system of health care, for instance at the entry point; at the edge of various parts of the system of health care (like patients’ transfer among institutions); where ongoing patient access is needed (like day care, rehabilitation, care of patients who are critically ill); and for psychological and social health maintenance (including access to cultural, social as well as recreational amenities) (Lenthall et al., 2011). Since the population of Tenant Creek is diverse in gender, ethnicities, and age, it is imperative that the nurse practicing in this region posses specialized skills. The least resources and support make remote nursing a challenging and demanding profession calling for a broad range of experience and knowledge (Lenthall et al., 2011). On occasion, remote nurses need some creativity in handling unique circumstances where they might find that they are the primary caregivers (Lenthall et al., 2011). Remote and rural nurses practice in remoteness; hence, they ought to be enthusiastic and display initiative (Lenthall et al., 2011). Unfortunately, the responsibility and complexity of these professionals is still unacknowledged. Economic Factors The major income’s source for the communities in Northern Territory is derived from production of agriculture (AIHW, 2008). Other income sources within the Tenant Creek region include tourism and mining. The agricultural generation and industries of mining have a lasting history within Tennant Creek and the neighboring area and the surrounding community are intending to take advantage of the large-scale presence within the area (AIHW, 2008). Employment within Tennant Creek is ruled by public administration (nearly 23 percent), with just eight percent employment in both the service and accommodation industries and retail trade (AIHW, 2008). In Tennant Creek, mining takes up two percent of employment. The rate of unemployment in Tennant Creek (seven percent) is greater compared to Darwin and there is no skilled and semi-skilled individuals in the available workforce. Both the higher exposure to injury as well as poorer quality of roads in remote and rural regions possibly contributes to the differential of rural health (AIHW, 2008). Agriculture, as an individual rural industry, is amongst the leading risk clusters for occupational disease and injury and the reality that farms are considered workplaces and homes as well impacts upon the statistics (AIHW, 2008). Farms are identified as dangerous workplaces, with various agricultural mortalities connected to machinery. Patterns of injury tend to mirror the employment nature, with beef and dairy farms distinguished by injury that is animal related. Injury rates related to transport, specifically among young men, are considerably greater in remote and rural areas compared to their counterparts within the city (AIHW, 2008). Because of mining and agricultural activities that take place in Tennant Creek, nurses working in this area ought to have the required skills to deal with health issues related to these activities. It is not easy to make compare income rates across geographical borders, because of the various income make-up between metropolitan and rural areas (AIHW, 2008). On the other hand, socioeconomic status that is low is the sole best premature death indicator amongst males in Australia and this is proved by Socio-Economic Indexes for Areas that generally display a sample of rising disadvantage as populace density declines (AIHW, 2008). Difficult circumstances of economy certainly impact upon demand for and access to health services specifically rehabilitation services. This is particularly applicable during the economic downturn era that remote regions have actually been subject to presently (AIHW, 2008). Evidence indicates that levers of funding can be effective in influencing driving changes needed to guarantee the delivery of effective nursing services (Lenthall et al., 2011). Political Factors The recruitment and retaining of professionals of health is a major concern for every governmental level in Australia (Usher & Marriott, 2011). There are various numbers of national initiatives carried out in Australia in present years that attempt to handle issues that nurses working in remote and rural communities face (Usher & Marriott, 2011). Some of the initiatives handle rural health as well as health care in general; some handle issues of nursing human resources; and some handle matters in remote and rural communities (Usher & Marriott, 2011). In order to rise the undergraduate health students’ number to put into consideration rural practice, some incentive systems have actually been put in place. The instance, the government of Australia has funded programs of scholarship such as the Undergraduate and Postgraduate Rural and Remote Nurses Scholarship Scheme (CURRNS) (Usher & Marriott, 2011). Several local governments within rural Australia have taken action to the serious shortage of professionals of health and devised practices and policies intended to appeal staff (Usher & Marriott, 2011). Obviously, it appears that an approach that is multi-sectorial for recruitment as well as retention is required in case the issues of workforce are intended to be handled (Usher & Marriott, 2011). Cultural Factors For nurses who work in remote and rural settings like Tennant Creek, the cultural disparities between individuals residing within remote and rural areas unlike those in metropolitan regions indicate that in a number of cases major barriers of communications ought to be overcome (Lenthall et al., 2011). This is because they in turn affect service delivery since the nurses involved may not be in a position to understand the client’s need. A number of services of health have founded effective programs of preceptorship for the new staff induction. (Lenthall et al., 2011) As a concept, preceptorship is more frequently used in urban centers with their very reputable clinical education programs of post registration and traditions of mentorship (Lenthall et al., 2011). In general, equity and social justice are the nursing foundation. Nurses work on behalf of or with individuals, communities, and groups to decrease inequalities and promote health for everyone. Remote and rural nurses understand that caring is considered a social justice principle and a significant and international human requirement which is demonstrated in various ways across domains of practice and cultures (Smith, 2007). Nursing services in remote areas will simply be sustainable and effective in a continually changing economic and demographic environment once planning considers the necessity for sustainable and comprehensive solutions that deal with every component in an incorporated way (Lenthall et al., 2011). It is important for nurses working in remote areas to comprehend the impact social determinants of health have on people and groups they deal with and incorporate these factors within their assessments (Wakerman & Humphreys, 2011). Eventually, this information might influence the intervention’s choice and the community’s need. As a wider level, remote nurses should know the way the patients’ health is able to be improved through advancing progressive strategies that deal with the health’s social determinants (Lenthall et al., 2011). Conclusion In conclusion, this paper has discussed about rural and remote nursing with particular interest to Tennant Creek in relation to demographic, economic, political and cultural factors that impact on the scope of practice of the nurses who work in this setting. It is evident that remote and rural Australia is made up of a diverse series of communities and environments characterized by major economic, geographical and social differences. Hence, the formulation as well as implementation of whichever remote and rural health program or policy ought to consider the particular circumstance of every region. Every Australian has a right to get fair health services. Generally, it is acknowledged that with rising remoteness services’ diversity that is able to be offered is restricted when scale’s economies underpin mechanisms of funding. Reference Australian Institute of Health and Welfare. (2013a). Remoteness classifications. Retrieved from http://www.aihw.gov.au/rural-health-remoteness-classifications/ Australian Institute of Health and Welfare. (2013b). Death. Retrieved from http://www.aihw.gov.au/rural-health-death/ Australian Institute of Health and Welfare. (2013c). Life expectancy. Retrieved from http://www.aihw.gov.au/rural-health-life-expectancy/ AIHW. (2008). Rural, regional and remote health: indicators of health status and determinants of health. Cat. no. PHE 97. Canberra: AIHW. AIHW. (2010). 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