The Rural and Remote Nursing in Australia - Term Paper Example

Assignment on rural and remote nursing in Australia Name of Student Institution Date Introduction There is confusion in Australian’s health service community concerning categorization and scope of practice for the roles of Advanced Practice Nurse (APN). The development of APN in the health service in Australia needs to be informed by a clear scope of practice description and thus health care contribution (Gargdner, Chang & Duffield, 2007). The roles of standard Registered Nurse (RN) and the APN may be complementary but they pursue different functions. It is important to clarify APN in order to avoid the confusion that occurs with the establishment of a new nursing service and to maintain and implement both roles in response to health service needs (Manias, Happell & Elsom, 2006). Using the Strong Model of Advanced practice, this essay discusses and evaluates the application of newly created and innovative APN roles within the context of remote area nursing practice in Australia. Description of my context of practice 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. This is what I experienced while working in the remote area as explained in this section. I used to perform my remote nursing practice in Maningrida Region of the Northern Territory which has a population of more than 2000 people (Remote Area Health Corps, 2009). The region comprise of different Indigenous ethnic groups that speak different languages, including Djinang, Burarra, Yanyangu, Kriol, Gurrgoni. Most Aboriginal people living in the region use Kriol as their first language. Maningrida has a large community health center where I performed my remote nursing practice. The community health centre provides an array of health services to the local people both within the health centre and in outstations (Remote Area Health Corps, 2009). The service provided in the health centre include regular clinic programs, such as aged care, Antenatal care, Under 5’s, Well-Baby clinic, and immunization. It also provides acute care services to the local community (Remote Area Health Corps, 2009). Other health services provided by the community health center include preventive health projects, such as school screening and STD programs. At the time of my practice, the clinic had only two doctors, several remote nurses and Health Workers from the Aboriginal Community (Remote Area Health Corps, 2009). While at the clinic, I provided health care services to people in the remote areas away from the health centre. The distance from the community health centre to the remote areas was long. It takes at least 2 hours to travel from Maningrida to the community centre. In addition access to the community centre by use of road transport is restricted in the wet session, usually between June and November (Remote Area Health Corps, 2009). There were limited resources for health care, such as medical transportation, staff, and equipment facilities which made our work very challenging. Nevertheless, as remote nurses, we tried to work closely with people in the community in providing quality health services to the local people. Professional preparation for delivery of advanced practice Being a professional in nursing requires a lot of dedication from an individual. Additionally, there are various components that need to be in place to ensure nurses provide appropriate, effective and sustainable health care services for their clients. This section illustrates my professional preparation for delivery of advanced practice in remote areas. The preparation I am making to practice APN in remote areas in acquiring a graduate degree in nursing. According to Conger and Plager (2008), this is the minimum educational preparation for the APN profession. This graduate preparation will enable me to develop a thorough understanding in the theoretical foundation of nursing, enhance nursing research, new knowledge generation and use them to interpret and encompass new knowledge into clinical practice in remote areas (World Health Organization, 2010). Despite the fact that a graduate degree is significant for APN, it is true that this does not make such a nurse to assume that his or her practice is advanced. For me, combining my graduate degree in nursing and clinical experience will allow me to develop the competences necessary in advanced practice in remote areas. The health needs of clients, especially in remote areas has increased and APN are supposed to promote better health outcomes by providing appropriate health services. Promoting improved health outcomes in remote areas requires professionalism in the provision of health services to the local people (WHO, 2010). By preparing professionally in APN, I will be able to use my education and experience to take nursing practice in remote areas to new levels, since I will move from simply being supportive to a more leading role in client care. Most importantly, I will play an important role in improving the outcomes of client and health-care system that are related to functional status, health status, quality of life, and satisfaction with care (Conger & Plager, 2008) among the local people in remote areas. Applicability of Strong Model in remote nursing The Strong Model of Advanced Practice proposes a framework that supports description of the APN role service parameters. The five domains of practice in Strong Model include direct comprehensive care, support systems, professional leadership, research and education (Chang, Gardner, Duffield & Ramis, 2011). But how well does this model fit or does not fit the reality of remote nursing practice? This can be examined by looking at each of the domains in the Strong Model of Advanced Practice as follows. Direct care of clinical practice is central to advanced nursing in remote areas. The domain of direct comprehensive care involves caring for individuals and families, which is integral to advanced practice (Chang et al., 2011). Clinical care is an important part of the role of nurses in remote practice. Although nurses may have different specialties and roles to play in nursing practice, such as consultancy, education, management and direct patient care, their expertise is drawn upon proficiency in patient care (Gargdner et al., 2007). To achieve better health outcomes in remote areas, health professionals need to be proficient in provision of patient care, which is highlighted in the Strong Model of Advanced Practice. The support of systems domain contributes to optimal functioning of nursing service community in Australia, including remote areas. The domain requires promotion of innovative patient care and ensuring that patients optimally progress through the existing health care system (Spross & Hanson, 2009). This is very important in remote nursing since the Indigenous people highly vulnerable to poor health and therefore require maximum support from APNs and health care system. APN in remote areas may be required to spend some time managing patients and ensuring that they have full information through consultation to promote improved access and sustainable health care to the residents. Professional leadership domain in Strong Model is to some extent applicable in remote nursing. The domain requires nurses to share and disseminate knowledge within their area of expertise and beyond their institutional setting (Chang, Gardner, Duffield & Ramis. 2010). In the context of remote nursing, APN can use professional leadership by involving with activities that facilitate public participation and awareness of specific issues related to health, such as how to prevent chronic illness and unhealthy behaviour. Another domain in Strong Model that is highly applicable in remote nursing practice is education. The education domain is related to promoting public, caregiver, and student knowledge by sharing with them current scientific information. It also encompasses the issues of public health and health promotion (Gargdner et al., 2007). Individuals in remote areas are vulnerable to disease because most of them lack knowledge on how they can maintain quality life by practicing healthy behaviour. Education domain, according to Por (2008), allows APN clinician working in remote areas to educate patients and communities how to promote wellness and to cope with their health conditions and self care. The last domain in Strong Model is research. This is an activity that supports the development of knowledge and the application of research findings into clinical practice (Duffield, Gardner, Chang & Catling-Paull, 2009). The domain is also applicable in remote nursing. Like in any other clinical environment, APN working in remote areas need to create and support a culture that not only challenges, but also strives to identify better ways to provide care to the Indigenous people and families based on research (Por, 2008). They have to sustain a best environment for nursing practice both for patients and community care. In summary, the Strong Model of Advanced Practice is highly applicable in remote nursing in Australia. Clients in remote areas are vulnerable to many diseases because of their social demographics. As such, they need to be provided with comprehensive care, support, and health education through professional nursing practice. The need for advanced nurse practice roles in remote setting Despite applicability of Strong Model Advanced Practice in remote nursing practice, the role of APN in these clinical environments can not be underestimated. Individuals living in remote areas face specific health challenges and many of these challenges occur due to their living conditions, socio-economic status, social isolation and distance from services (Mills, Lindsay & Gardner, 2011). Consequently, advanced nursing role should be implemented in remote areas in order to meet the demands of individuals from local communities for various options of health care and improve access to health service. Working with Indigenous people is likely to be an important aspect of the role of APN in remote areas. In this context, advanced nursing practitioner would be required to use their knowledge and expertise to provide a comprehensive, holistic and collaborative care to individuals and families within the context of community and family, as well across the lifespan (Mills et al., 2011). According to National Rural Health Alliance Inc (2005), most nurses practicing in remote areas have inadequate knowledge and competency to enable them function at an advanced level. As such, they may not be in a position to effectively provide health care services in a range of areas, such as emergency care, mental health, retrieval and transfer, and chronic illness management among others (NRHA, 2005). This means that it is necessary to institute advanced nurse practice roles in remote areas because of their knowledge and competencies. Analysis and discussion on Chang (1994) statement The introduction of advanced practice nursing roles in the Australian health care system have been influenced by societal factors, rising consumer demands, changing demographics, shortages in healthcare workforce and most importantly government (Holloway, Baker & Lumby, 2010). The introduction of new roles has made the nursing profession to evolve so as to meet these demands, which is well thought. Nevertheless, this has also resulted to increase in poorly defined APN roles (Chang et al., 2010). In the context of Australia, the role standard RN and midwife is well regulated but advanced roles, such as clinical nurse specialist and clinical nurse consultant are still poorly supported and defined, hence likely inappropriately utilized (Chang et al., 2011). This implies that there is need for relevant stakeholders in Australian health care system to use appropriate organizational framework in developing, implanting and evaluating effectively APN roles. The introduction of advance APN roles have many potential advantages to nursing profession as indicated above, but the need for clarity concerning these roles remains important as well. There are various terms used to denote advanced practice and specialization. They include expanded, extended, generalist, advanced, enhanced, endorsed and specialist (Heartfield, 2006 cited in Manias et al., 2006). This indicates that there is in deed ‘ad hoc’ implementation of poorly defined new roles of advanced nursing positions as postulated by Chang et al (2011). Actually, it is not simply the number of terminologies used to denote advanced practice; nevertheless, the difference in meanings given to them is where the problems exist. For example, nursing practitioner (NP) and advanced nursing are usually used interchangeably forgetting the possible impact it has on other advanced nursing roles. Nevertheless, the role of APN remains critical in the nursing profession because of its high level of practice. Advanced practice is considered by some authors to mean the level of autonomy the nurse enjoys in terms of extended and expanded roles of practice (Day & Carnwell cited in Manias et al., 2006). However, others consider the level of expertise of the nurse than the scope of clinical practice to be more important in defining APN role. The state of confusion in the definition of the APN role is also witnessed in the Position Statement by the Royal College of Nursing Australia (RCNA). According to RCNA, advanced practice nursing uses extended and expanded skills and that they can work in generalist or specialist capacity (Manias et al., 2006). Daly and Carnwell (2003) cited in Chang et al (2011) tried to overcome some confusion concerning ANP roles and the terms used to denote them by developing an operational framework. According to this framework, terms role extension, role development and role expansion are use to describe and categorize the shifts in boundaries and skills nursing. Role extension is the inclusion of a skill or responsibility in a role of a nurse which was not initially a role of nursing. Alternatively, role expansion involves adding more skills and responsibilities to a role of a specialist hence promoting greater autonomy and accountability without changing the core aspects of nursing practice (Duffield et al., 2009). Role development includes aspects both expansion and extension. However, it incorporates more clinical autonomy due to the need to solve existing challenges concerning improving patient care (Manias et al., 2006). According to McKenna et al (2008), clarity of role description in essential to nurses who hold new and innovative roles of APN. This is because failure to support and properly define these roles is likely to cause distortion of activities and responsibilities. This could in turn lead to confusion in nursing role and conflict, hence a risk to the safety of patients (McKenna et al., 2008). According to Chang et al (2011), the problem of shortage of skilled nurses in not only in Australia, but also internationally. As such, managing the issues of supply and demand may not imply simply increasing the number of nurses, but requires embracing effective management and planning initiatives in order to match the skills of nurses to an the increasing patient population has become more complex (Holloway et al., 2010). This can be made possible by clearly defining the activities of APN. As indicated earlier, there is still no nationally accepted framework for APN roles in Australia (Duffield et al., 2009). However, the fact that the introduction of APN roles in Australia is well intended, the nursing profession has to use the experience of other nations to plan for and take control of these roles in a manner that does not causes conflict of interest among nursing professionals, at the expense of patient safety. Recommendations In summary, the health-care needs of Australians, especially of individuals residing in remote areas are growing. This is characterized by increase in the aging population, continuous shortages in supply of nurses, complexity of health care system and pressure to reduce the cost of health (Mills et al., 2011). APN is helping to achieve these increasing needs. However, to have a lasting impact, ANP should be promoted and sustained in remote areas. In particular, the following recommendations will help achieve this: There is need to effectively coordinate the preparation and roles of APN in remote areas to increase access (Canadian Nurses Association, 2008). The educational goals and programs for APN should be developed and aligned across territories in order to increase their place in overall health care and enhance labour mobility across Australia. All stakeholders in Australian health care system should work in partnership to evaluate APN in various contexts as well as different scopes of practice in remotes areas in order to determine the resulting health outcomes and quality of care (NRHA, 2005). Higher learning institutions, such as Universities should identify and promote their current education programs on APN in order to help employers, nurses and other health institutions to recognize right training pathways. This would help increase knowledge and competency of nurses practicing in remote areas (NRHA, 2005). Conclusion Conclusively, the development of the APN role in Australia was meant to meet the health needs of Australians. This is a good initiative given that the healthcare system is experiencing many challenges. However, a clear definition of the APN roles and a supportive framework has to be established to improve its efficiency. It is definite that there is lack of uniformity in the definition of the APN roles, but this does not make them irrelevant. Both standard RN and APN have different functions to play although their roles may complement each other. Therefore, they are all relevant and their contribution to health service needs is highly required in remote areas. References Canadian Nurses Association, (2008).Advanced Nursing Practice: A National Framework. Canadian Nurses Association, Ottawa. ISBN 978-1-55119-212-3. Chang, A., Gardner, G., Duffield C., & Ramis M.A. (2010). A Delphi study to validate an advanced practice nursing tool. Journal of Advanced Nursing, 66(10), 2320–2330. Chang, A.M., Gardner, G., Duffield, C. & Ramis, M. (2011). Advanced practice nursing role development: factor analysis of a modified role delineation tool. Journal of Advanced Nursing, 68(6), 1369-1379. 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. Duffield, C., Gardner, G., Chang, A. M., & Catling-Paull, C. (2009). Advanced nursing practice: a global perspective. Collegian, 16(2), 55-62. Gargdner, G., Chang, A., & Duffield, C. (2007). Making nursing work: breaking through the role confusion of advanced practice nursing. Journal of Advanced Nursing, 57(4), 382–391. Holloway, K., Baker, J., & Lumby, J. (2010). Specialist nursing framework for New Zealand: a missing link in workforce planning. Policy Politics & Nursing Practice, 10(4), 269–275. Manias, E., Happell, B., & Elsom, S. (2006). The clinical nurse specialist and nurse practitioner roles: room for both or take your pick?. McKenna, H., Richey, R., Keeney, S., Hasson, F., Poulton, B., & Sinclair, M. (2008). The managerial and development issues of nurses and midwives in new roles. Scandinavian Journal of Caring Science, (22), 227–235. 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. NRHA (National Rural Health Alliance Inc.) (2005). Advanced nursing practice in rural and remote areas. Por, J. (2008). A critical engagement with the concept of advancing nursing practice. Journal of Nursing Management, (16), 84–90. Remote Area Health Corps (2009). Community Profile: Maningrida. Spross, J.A., & Hanson, C.M. (2009). Clinical, professional and systems leadership. In Advanced Practice Nursing: An Integrative Approach (Hamric A.B., Spross J.A. & Hanson C.M., eds), Saunders Elsevier, St Louis, MO, pp. 249–282. World Health Organization, (2010). Increasing access to health workers in remote and rural areas through improved retention: Global Policy Recommendations. Geneva, World Health Organisation. Read More