Rural and Remote Nursing - Essay Example

Assignment on Rural and Remote Nursing Name Institution Date Introduction Despite many remote initiatives over the recent years, the health needs of people living in remote communities are still inadequately addressed. Residents on remote communities still show poorer health outcomes compared to people residing in metropolitan centres (Conger & Plager, 2008). Shortages and maldistribution of health workforce, as well as increase in out-of- pocket expenses are some of the barriers, particularly in extremely remote areas (Winters & Lee, 2010). Continuous employment of registered nurses in these areas to perform different roles is essential in ensuring that people in rural and remote areas have access to quality health care services (Mills, Lindsay & Gardner, 2011). Equally, nurses need to be prepared and supported through continuous staff development programs to help meet the needs of people living in rural and remote communities, despite the fact that remote practice is challenging (Taylor, Foster & Fleming, 2008). Based on my experience of working in a remote area, this paper discusses the issue of rural and remote nursing, particularly what needs to be done to promote an optimal remote practice in order to achieve quality provision of health care services by nurses. My current practice context The place where I used to perform remote nursing practice is the Maningrida Region of the Northern Territory. The Maningrida region has a population of more that 2000 people (Remote Area Health Corps, 2009). Various languages are used by residents in the region, including Burarra, Djinang, Kriol, Yanyangu, Gurrgoni to name but a few. However, Kriol is used as a first language by most Aboriginal people living in the region. Maningrida region has a large community health centre where I used to work as a nurse (Remote Area Health Corps, 2009). The health centre provides different health services to the people in the community and those in outstations. The services available in the community health centre include acute care and regular clinic programs, such as Well-Baby clinic, aged care, Under 5’s, Antenatal care, immunization among others (Remote Area Health Corps, 2009). The centre also provides preventive health projects, such as STD programs and school screening. The clinic had two doctors, several remote area nurses and Health Workers from the Aboriginal Community (Remote Area Health Corps, 2009). While at the clinic, we tried to work closely with the people in the community to ensure that we provided quality health services to the residents. My professional practice in the Maningrida Region was remote. The reason is that I used to provide health care services to people in the remote areas away from the community health centre. The basis for defining remoteness in the practice is the geographical parameters, especially measures of the distance from the community health centre. Access to the community centre in Maningrida via road is restricted in the Wet, usually between June and November. It takes at least 2 hours to travel from Maningrida to the community centre. Additionally, my practice was remote due to difficulties to access to amenities, such as leisure activities, non-medical services and shopping for myself, socio-demographic features of the communities in the Maningrida Region. There were also limited resources for health care, such as medical transportation, equipment and facilities, and staff, which explains the remoteness of my practice. The most frustrating aspects of my clinical practice were the issue of working for long hours. I spent a lot of time traveling from one location to another, providing health care services and educating people in the community. Although the community considered me to be part of them, I often felt a conflicting mix of social exposure and social isolation. Tying to maintain a professional distance often conflicted with the desire to be accepted as a member of the community. This increased my feelings of remoteness. Still, it was very challenging to communicate to the people in the community. Most of them knew only their local languages and therefore they could not express themselves in English, which made it very difficult for me to understand them. In fact, even reaching out to people in the community to educate them about health issues was really frustrating due to communication challenges. These issues, in one way or another, affected the provision of best care for the clients in the community centre. Optimizing practice context to enable nurses to provide the best care and health outcomes for the clients There are various components that need to be in place to ensure nurses provide appropriate, effective and sustainable health care services for their clients in rural and remote areas, especially in the Maningrida Region. For the purpose of this paper, we shall discuss multidisciplinary practice, workforce, infrastructure, transportation, and management issues. Multidisciplinary practice should be encouraged in rural and remote areas to ensure more efficient and appropriate practice to help maximize quality management. In this case, the issue of quality and safety should not be compromised at all (Winters & Lee, 2010). Although, the role of doctors is very important, the delivery of services involves many non-physician providers of health care (Wakerman & Davey, 2008). In order to promote multidisciplinary practice, nurses must be educated and trained to be able to provide health care services. Although many professional development programs are multidisciplinary, there is yet less comprehensive interdisciplinary undergraduate education related to health sciences in Australia (Humphreys & Wakerman, n.d). When this is enhanced in the practice context, it will contribute highly on quality care for clients. There is need to increase the health care workforce in rural and remote areas to facilitate the provision of better health outcomes for clients (Opie et al., 2010). The problem of insufficient numbers of the health workforce is still persistent today, even in the community healthy centre I used to work as a remote area nurse. This exposes nurses to more pressure of working for long hours (Humphreys & Wakerman, n.d). To overcome the problem of limited workforce, the health care model should consider the issues of non-health sector that make many rural and remote communities unattractive to health professionals. Such issues include opportunities for housing, education, childcare, and spouse employment (Opie et al., 2010). In addition, there is need to increase retention of nurses and other health professionals in rural and remote areas. Measures that promote better reward service, professional satisfaction and provide career paths would help maximize retention of staff, which will in turn benefit clients since they will receive quality and continuous care (World Health Organization, 2010). Infrastructure that can be used to support communication, care co-ordination, quality improvement, information technology, and staffing are very important in rural and remote areas. This is meant to ensure quality service provision by nurses (Humphreys & Wakerman, n.d). Workforce limitations in many rural and remote areas, such as the Maningrida Region include inadequate accommodation for both health professionals working in the community and visiting health professionals (Mills et al., 2011). Provision of this basic infrastructure requirements and co-location of health professionals, accommodation and single point-of entry can help improve coordination and team practice among nurses and other health care professionals (WHO, 2010). This is because nurses working in remote areas would easily share information on the requirements of residents in remote areas to facilitate the delivery of health care to residents in remote communities. One of the barriers to access to better health services in remote areas is lack of transportation (Taylor et al., 2008). Yes, it is not realistic to expect all specialist and allied health services to be present in all communities, but equity of access does not mean disadvantaging individuals who live in rural and remote regions (Wakerman & Davey, 2008). According to Humphreys and Wakerman (n.d), there are many problems with the patient transport schemes, especially for residents in rural and remote areas. Consistency in the provision of support for patients in need of care away from home is essential if we need to improve access to health care services for people in remote areas (Winters & Lee, 2010). Allocation of escorts to Regional Health Authorities should be streamlined according to the size of the population, its dispersion and remoteness of the region to help improve local response (Humphreys & Wakerman, n.d). Some communities, such as the Maningrida Region should also be well thought-out. Since such areas have Indigenous population, it would be necessary to provide liaison officers to enable health professionals, including nurses to provide best care to their clients (Wakerman & Davey, 2008). According to Wakerman and Davey (2008) lack of quality and vigor of management are serious problems that hinder effective provision of health services in rural and remote areas. Health services managers are supposed to have accreditation and employment requirements that are consistent with the requirements of other disciplines in health (Mills et al., 2011). Nurses and nurse managers should be given support for ongoing professional development like other health professionals (Humphreys & Wakerman, n.d). Additionally, nurse managers should be competent and act professionally when dealing with other health professionals in the community health centres. The success of the clinical practice will depend on how the management conducts it duties and responsibility, especially in coordination of activities and functions in the rural and remote communities (Mills et al., 2011). Appropriate model of care that could be implemented in the practice context Based on my research, the appropriate model of health care for populations living in rural and remote areas is a regional approach to service delivery. This model of care is able to meet range of service and threshold requirements in community nursing centres (Humphreys & Wakerman, n.d). This means making sure that there is sufficient population to support service range required (Conger & Plager, 2008). In Australia perspective, regional approach to service delivery in rural and remote areas will aggregate population that is enough to support range of health, community and aged care services (Taylor et al., 2008). According to Humphreys, Wakerman, Wells, Kuipers, Jones and Entwistle (2008), a regional approach to health care takes into consideration the district nature and many differences that characterize many regions in Australia. It is also a powerful identification residents would use to identify with their surroundings. Implementing a regional model to care in rural and remote areas will help optimize community input. It would also increase access for residents who are intra-regionally mobile and responsiveness to the needs of the local population (Wakerman & Davey, 2008). In this model, it may be inevitably important to centralize some service functions, such as recruitment and financial services. Alternatively, decentralization of services provision may be maximized to help meet the requirements of access to health care services by rural and remote communities (Humphreys & Wakerman, n.d). According to Humphreys et al (2008), various model of care can actually co-exist within the regional model of care, which makes it more appropriate. To effectively implement this model, it is necessary that the population size in the region is limited to the extent that it does not affect responsiveness to issues of local communities. Additionally, it should not be so small to the extent that the population threshold can not support a significant range of services required (Humphreys & Wakerman, n.d). The focus of a regional model would be to ensure that essential service requirements of people living in rural and remote areas and the community are achieved in stead of focusing more on how the model itself is configured (Conger & Plager, 2008). This model may not be superior to other models, but when consistent principles are applied, it would often lead to successful health outcomes in rural and remote communities (Humphreys et al., 2008). Therefore, while there has been more focus on clinical and health outcomes in stead of structural changes, a change in approach to service delivery is required to ensure the model adopted have the right components to promote quality and sustainable care to clients (Humphreys & Wakerman, n.d). Impact of social determinants of health, social justice, primary health care and health policy on the model There exist diverse environments and communities in rural and remote Australia, which are characterized by significant differences in social, economic and geographical perspectives (Winters & Lee, 2010). As such, the development of a regional model must consider the specific circumstances in the communities. The issues of social justice, health policy, primary health care, and social determinants of health will make it difficult for the model to be responsive to the wishes and choices of people. It is also likely to prevent community health centre from delivering the best health outcomes (Queen’s Nursing Institute, 2011). The demographics of our population and the problems of health we encounter in the communities are changing very fast. As such, it would be necessary to use innovative approaches to this model of care to satisfy the needs of people that arise from such changes (Humphreys & Wakerman, n.d). Health policy contains various aspects that affect health provision within the Australian communities. This model needs to take this into consideration. In addition, factors such as social and environmental practices can affect the provision of health services within the rural and remote communities and therefore they should be captured into the model (Queen’s Nursing Institute, 2011). According to Foster and Fleming (2008), the government of Australia links the goals of strategic policy to administrative process so as to address problems in the health system. This means that the regional model should be developed in respect to the policy requirements to facilitate the provision of quality care and improve health outcomes. Benefits of the model for health staff, the clients/patients and the communities The model will help the health staff to improve service delivery to people living in rural and remote areas in my area of practice. The regional model consist of components that are linked and interconnected, such as financing, infrastructure and multidisciplinary practice which will help maintain effective health care services in rural and remote communities (Humphreys & Wakerman, n.d). Service sustainability requires systematic solutions that reflect workforce requirements, governance, funding arrangements, management and community participation, which a regional model encompasses. Through this model, health professionals in rural and remote areas can develop and maintain appropriate health care services that help meet the needs of the residents in these areas (Wakerman & Davey, 2008). Access to care is essential for all people implying that health services require some level of local presence and this model would help achieve it. This model would enable health staff to provide population interventions to help improve the health and wellbeing of the community (Humphreys et al., 2008). In addition, it would help provide leadership and prioritization of care that is supportive to assist clients to stay well and to manage their health while at home. Through the model, health staff will be able to work together with their clients in handling complex issues as they arise, such as meeting long-term health needs (Queen’s Nursing Institute, 2011). The regional approach to service delivery builds on the strong foundation. As such, it would provide opportunities for health staff to develop new ways of working, including maximizing efficiency, delivering complex care, and working in integration with partners to maximize resources to the benefit of clients and the community at large (Queen’s Nursing Institute, 2011). Conclusion In conclusion, my practice context was based in remote region where I encountered several challenges as a remote area nurse. Although it was a tough experience, I leant a lot as a nurse professional. Nevertheless, there is need to promote multidisciplinary practice, increase workforce, improve infrastructure, and transportation, as well as management issues to enable health staff working in rural and remote communities to provide quality care and improve health outcomes for residents in these communities. The situations in rural and remote areas, requires the use of a regional approach to service delivery. This model will ensure that essential service requirements of people living in rural and remote areas and the needs of the entire community are achieved. However, it should consider the unique needs of each community in the rural and remote areas. References Conger, M. M., & Plager, K. A. (2008). Advanced practice nursing practice in rural areas: Connectedness versus disconnectedness. Online Journal of Rural Nursing and Health Care, 8(1), 24–38. Foster, M., & Fleming, J. (2008). The policy context of health care practice, in S Taylor, D Wilkinson & B Cheers (eds), Health care practice in Australia, Oxford University Press, New York. Humphreys, J & Wakerman, J n.d. Primary health care in rural and remote Australia: achieving equity of access and outcomes through national reform: a discussion paper, accessed 17 March 2015, . Humphreys, J.S., Wakerman, J., Wells, R., Kuipers, P., Jones, J., & Entwistle, P. (2008). Beyond workforce: a systemic solution for health service provision in small rural and remote communities, Medical Journal of Australia, 188 (8 Suppl): S77-S80. Mills, J., Lindsay, D., & Gardner, A. (2011) Nurse practitioners for rural and remote Australia: Creating opportunities for better health in the bush. Australian Journal of Rural Health, (19), 54. Opie, T., Dollard, M., Lenthall, S., Wakerman, J., Dunn, S., Knight, S., & Macleod, M. (2010). Levels of occupational stress in the remote area nursing workforce, Australian Journal of Rural Health, (18), 235–41. Remote Area Health Corps (2009). Community Profile: Maningrida. Taylor, S., Foster, M., & Fleming, J. (2008). Health Care Practice in Australia, Oxford University Press, Sydney. Wakerman, J., & Davey, C. (2008). Rural and Remote Health Management: The Next Generation Is Not Going To Put Up With This Australia Pacific Journal of Health Management, 3: 13-18. Winters, C. A., & Lee, H.J. (2010). 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