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Yassi A, Barker S, Lockhart K, Taylor D, Harris D, Hundal H, Grant JM, Okpan AI, Pollock S, Sprague S, Sing CK. Urban-rural divide in COVID-19 infection and vaccination rates in healthcare workers in British Columbia, Canada. CANADIAN JOURNAL OF RURAL MEDICINE 2023; 28:47-58. [PMID: 37005988 DOI: 10.4103/cjrm.cjrm_24_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Introduction Healthcare workers (HCWs) play a critical role in responding to the COVID-19 pandemic. Early in the pandemic, urban centres were hit hardest globally; rural areas gradually became more impacted. We compared COVID-19 infection and vaccine uptake in HCWs living in urban versus rural locations within, and between, two health regions in British Columbia (BC), Canada. We also analysed the impact of a vaccine mandate for HCWs. Methods We tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates and vaccine uptake in all 29,021 HCWs in Interior Health (IH) and all 24,634 HCWs in Vancouver Coastal Health (VCH), by occupation, age and home location, comparing to the general population in that region. We then evaluated the impact of infection rates as well as the mandate on vaccination uptake. Results While we found an association between vaccine uptake by HCWs and HCW COVID-19 rates in the preceding 2-week period, the higher rates of COVID-19 infection in some occupational groups did not lead to increased vaccination in these groups. By 27 October 2021, the date that unvaccinated HCWs were prohibited from providing healthcare, only 1.6% in VCH compared with 6.5% in IH remained unvaccinated. Rural workers in both areas had significantly higher unvaccinated rates compared with urban dwellers. Over 1800 workers, comprising 6.7% of rural HCWs and 3.6% of urban HCWs, remained unvaccinated and set to be terminated from their employment. While the mandate prompted a significant increase in uptake of second doses, the impact on the unvaccinated was less clear. Conclusions As rural areas often suffer from under-staffing, loss of HCWs could have serious impacts on healthcare provision as well as on the livelihoods of unvaccinated HCWs. Greater efforts are needed to understand how to better address the drivers of rural-related vaccine hesitancy.
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Affiliation(s)
- Annalee Yassi
- School of Population and Public Health, University of British Columbia; Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Stephen Barker
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Lockhart
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Devin Harris
- Interior Health, Kelowna, British Columbia; Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harsh Hundal
- Interior Health, Kelowna, British Columbia, Canada
| | - Jennifer M Grant
- Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health; Department of Pathology and Laboratory Medicine, Vancouver Coastal Health; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arnold Ikedichi Okpan
- School of Population and Public Health, University of British Columbia; Medical Practitioners Occupational Safety and Health (mPOSH), Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Sue Pollock
- School of Population and Public Health, University of British Columbia, Vancouver; Interior Health, Kelowna, British Columbia, Canada
| | - Stacy Sprague
- Employee Safety, Health and Wellness, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Chad Kim Sing
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia; Medicine, Quality and Safety, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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What challenges and enablers elicit job satisfaction in rural and remote nursing in Australia: An Integrative review. Nurse Educ Pract 2022; 64:103454. [PMID: 36162301 DOI: 10.1016/j.nepr.2022.103454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/21/2022] [Accepted: 09/15/2022] [Indexed: 11/22/2022]
Abstract
AIM To explore challenges and stressors experienced by rural and remote area nurses and identify any interventions that aided in decreasing stress and increasing job satisfaction. BACKGROUND Demand for a generalist nursing workforce in rural and remote locations exposes nurses to the same conditions as people residing there: higher mortality rates and higher incidence of chronic diseases and inadequacies in accessing health services. DESIGN Christmals and Gross's integrative review framework was used with specified inclusion and exclusion criteria. Four databases were searched with no date limits. Only Australian studies were searched as international scope of practice differences for nurses could have distorted findings. FINDINGS Eighteen studies identified three broad themes: access to education; isolation (geographical, professional and personal) and recognition of role. DISCUSSION Interlinked themes showed positives and negatives from differing viewpoints. Ambivalence to education stemmed from inadequate exposure to learning and was linked with geographical isolation. Isolation was found to be less of a challenge to nurses who had an existing emotional connection with the community. CONCLUSION The themes identified were recurrent and interconnecting. The benefits of working in small rural and remote communities are being used as a driver for recruitment. These benefits include higher wages, providing a sense of belonging and allowing nurses to work to their full scope and develop generalist nursing skills. The geographical isolation generates challenges through inequality in access to education and professional support, working outside their scope of practice, safety and vulnerability that comes with living remotely and adapting to extreme weather conditions. TWEETABLE ABSTRACT What are the challenges and enablers of rural and remote working and living that influence job satisfaction for rural and remote area nurses in Australia?
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Abstract
This chapter provides an overview of qualitative research approaches in the study of health, disease, and health service delivery and summarizes important considerations when designing research studies to address questions that ask the "how," "why," or "what" of a particular issue. As qualitative research encompasses distinct methodologies, brief descriptions of the main approaches and examples from the literature are provided. Guidance on how to evaluate quality in the design and reporting of qualitative studies is also discussed.
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Campbell KA, MacKinnon K, Dobbins M, Van Borek N, Jack SM. Weathering the rural reality: delivery of the Nurse-Family Partnership home visitation program in rural British Columbia, Canada. BMC Nurs 2019; 18:17. [PMID: 31073277 PMCID: PMC6498595 DOI: 10.1186/s12912-019-0341-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/12/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pregnant girls/young women and new mothers living in situations of social and economic disadvantage are at increased risk for poor health. Rural living may compound marginalization and create additional challenges for young mothers. Public health nurses (PHNs) delivering the Nurse-Family Partnership (NFP) to mothers living in rural communities may help to improve maternal and child health outcomes. The purpose of this analysis, grounded in data collected as part of a broader process evaluation, was to explore and understand the influence of rural geography on the delivery of NFP in British Columbia, Canada. METHODS For the analysis of this qualitative data, principles of inductive reasoning based on the methodology of interpretive description were applied. A total of 10 PHNs and 11 supervisors providing the NFP program in rural communities were interviewed. RESULTS The results of this analysis reflect the factors and challenges of providing the NFP program in rural communities. PHNs noted the importance of NFP in the lives of their rural clients, especially in the face of extreme financial and social disparity. Remaining flexible in their approach to rural nursing and protecting time to complete NFP work supported nurses practicing in rural environments. Rural PHNs were often the sole NFP nurse in their office and struggled to remain connected to their supervisors and other NFP colleagues. Challenges were compounded by the realities of rural geography, such as poor weather, reduced accessibility, and long travel distances; however, these were considered normal occurrences of rural practice by nurses. CONCLUSIONS PHNs and NFP supervisors are well-positioned to identify the modifications that are required to support the delivery of NFP in rural geography. NFP nurses need to articulate what classifies as rural in order to effectively determine how to best provide services to these populations. Environmental conditions must be considered when offering NFP in rural communities, particularly if they impact the time required to deliver the program and additional services offered to young mothers. Regular NFP meetings and education opportunities address common problems associated with rural nursing but could be enhanced by better use of technology.
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Affiliation(s)
| | - Karen MacKinnon
- School of Nursing, University of Victoria, Victoria, British Columbia Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Ontario Canada
| | | | - Susan M. Jack
- School of Nursing, McMaster University, Hamilton, Ontario Canada
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Penz KL, Stewart NJ, Karunanayake CP, Kosteniuk JG, MacLeod MLP. Competence and confidence in rural and remote nursing practice: A structural equation modelling analysis of national data. J Clin Nurs 2019; 28:1664-1679. [DOI: 10.1111/jocn.14772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Kelly L. Penz
- College of Nursing University of Saskatchewan Regina Saskatchewan Canada
| | - Norma J. Stewart
- College of Nursing University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Chandima P. Karunanayake
- Canadian Centre for Health and Safety in Agriculture University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Julie G. Kosteniuk
- Canadian Centre for Health and Safety in Agriculture University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Martha L. P. MacLeod
- School of Nursing University of Northern British Columbia Prince George British Columbia Canada
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Kulig JC, Townshend I, Kosteniuk J, Karunanayake C, Labrecque ME, MacLeod MLP. Perceptions of sense of community and community engagement among rural nurses: Results of a national survey. Int J Nurs Stud 2018; 88:60-70. [PMID: 30199840 DOI: 10.1016/j.ijnurstu.2018.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Variations in rural nurses' sense of community and engagement in rural communities are poorly understood, although there is evidence that these are linked to community cohesion and perceived community resilience. OBJECTIVE The aim of our research was to develop descriptive profiles of rural nurses who exhibit a sense of community and community engagement at low, average, and high levels, based on occupational, personal, community, and regional characteristics. These results were linked to levels of cohesion and resilience. DESIGN A survey questionnaire, including established scales, demographic information, and information about rural nursing practice was administered to rural nurses. SETTINGS Rural communities in all provinces and territories in Canada outside the commuting zone of urban areas with 10,000 or more inhabitants. PARTICIPANTS Multi-level systematic stratified sampling was employed for the national survey. A subsample of 2116 Registered Nurses, Nurse Practitioners, and Licensed Practical Nurses comprised the participants for this analysis. METHODS The analysis was conducted in two stages: (1) in the first subset, those (n = 2116) whose primary work community was rural, remote, or rurban with less than 10,000 inhabitants were grouped into a nine-group typology based on low, average, and high tertiles of Psychological Sense of Community and Community Engagement. The second subset (n = 993) represented those in three groups: low-low, average-average, and high-high scores on the two indices. Significant differences between the three groups were identified based on occupational, personal, community, and regional characteristics. Chi Square, ANOVA, and correlation tests were applied as required. RESULTS Nurses with low scores on both Psychological Sense of Community and Community Engagement were more likely to be from larger communities, single or divorced and living and working in the North. Those with average scores on both scales have been in their nursing positions for more than 20 years, are middle aged and are satisfied with their home community. Nurses in the third group have high scores on both indicators; they are more likely to be from a smaller childhood communities, married or living common-law, and are in the late middle age group. CONCLUSIONS By focusing on the key variables or traits of nurses, modifiable recruitment and retention practices can be implemented. For example, it is important to recruit nurses who are from smaller communities. Other initiatives for nurses include matching community activities with the age and stage of the family and developing a welcoming strategy for the workplace and community for newly arrived nurses.
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Affiliation(s)
- Judith C Kulig
- Faculty of Health Sciences, University of Lethbridge, Canada.
| | - Ivan Townshend
- Department of Geography, University of Lethbridge, Canada.
| | - Julie Kosteniuk
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Canada.
| | - Chandima Karunanayake
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Canada.
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Mapping the information-coping trajectory of young people with long term illness. JOURNAL OF DOCUMENTATION 2013. [DOI: 10.1108/jd-10-2012-0133] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Akin-Otiko BO, Bhengu BR. Appraisal of observance of behaviour change communication programme for maternal and child health at first level of midwifery practice in kaduna state Nigeria. Nurs Midwifery Stud 2013; 2:28-33. [PMID: 25414873 PMCID: PMC4228538 DOI: 10.5812/nms.11361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 04/26/2013] [Accepted: 05/15/2013] [Indexed: 11/16/2022] Open
Abstract
Background: Behaviour Change Communication (BCC) is a key component of the roadmap adopted by the Nigerian government to address the high maternal and child mortality in the country. Objectives: The purpose of the study was to appraise the participation of midwives in BCC at the first level of health care in Kaduna State, Nigeria before planning a context specific and sustainable BCC capacity building programme. Materials and Methods: In-depth interviews were conducted with nine midwives selected by maximum variation technique across Kaduna State. Content analysis of the interviews was performed using a priory codes derived from the integrative framework. Results: The integrative framework provided a comprehensive appraisal of BCC in the facilities. Health talks were unplanned, difficult and more task-oriented than being behaviour change focused. The required skills, integrated services to enhance behaviour change by clients, and enabling environment, were missing. The findings were used, in collaboration with the midwives to develop and implement a context specific and efficient capacity building programme. Conclusions: The framework was adequate in identifying the gaps in the BCC activities of midwives at the facilities. There is a need to understand and support midwives with their BCC activities. Government policies should be brought closer to frontline staff who would implement them, by engaging such staff all through the process of developing the policies.
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Affiliation(s)
- Bridget Omowumi Akin-Otiko
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Corresponding author: Bridget Omowumi Akin-Otiko, Nursing Services Division, Room 613, Federal Ministry of Health, Abuja, Nigeria. Tel.: +234-8037213522, E-mail:
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Kenny A, Allenby A. Implementing clinical supervision for Australian rural nurses. Nurse Educ Pract 2013; 13:165-169. [DOI: 10.1016/j.nepr.2012.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 08/07/2012] [Accepted: 08/21/2012] [Indexed: 11/28/2022]
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Yonge OJ, Myrick F, Ferguson LM, Grundy Q. Nursing preceptorship experiences in rural settings: “I would work here for free”. Nurse Educ Pract 2013; 13:125-31. [DOI: 10.1016/j.nepr.2012.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 07/07/2012] [Accepted: 08/12/2012] [Indexed: 11/26/2022]
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Sustaining and growing the rural nursing and midwifery workforce: understanding the issues and isolating directions for the future. Collegian 2011; 18:55-60. [PMID: 21706992 DOI: 10.1016/j.colegn.2010.08.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Nurses and midwives represent the largest group of health professionals in the Australian health care system. In rural environments nurses and midwives make up a greater proportion of the health workforce than in urban settings, which makes their role in service provision even more significant. The role and scope of these nurses and midwives' practice is by necessity more generalist than specialist, which results in disciplinary strengths and weaknesses. As generalist health professionals they work in diverse settings such as public hospitals, multi-purpose services, community health, aged care and in non-government and private for profit and no-profit organisations including general practices. Their scope of practice covers prevention, intervention and rehabilitation and is lifespan inclusive. Rural nurses and midwives are older than their metropolitan based counterparts, work part-time and traditionally have limited access to professional development often due to ineffective locum relief programs. Workplace inflexibility, access to acceptable housing and partner employment are factors cited as inhibitors to growing this workforces. The future of the rural nursing and midwifery workforce will only be secured if Government invests to a greater degree in both education and training and the development of a nationally agreed remuneration scale that allows for part-time work.
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Schnitzer G, Loots G, Escudero V, Schechter I. Negotiating the pathways into care in a globalizing world: help-seeking behaviour of ultra-Orthodox Jewish parents. Int J Soc Psychiatry 2011; 57:153-65. [PMID: 21343210 DOI: 10.1177/0020764009105291] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The study of the pathways into care as a social process subject to a wide range of influences is needed to build appropriate and effective mental health services for culturally diverse societies. MATERIAL Grounded theory and situational analysis of 21 in-depth interviews explores the help-seeking behaviour of ultra-Orthodox Jewish parents: which help-seeking pathways parents follow and how they make the decision to consult regular services for their child. DISCUSSION Three help-seeking pathways are influenced by globalization dynamics and gender: parents draw on diverse parenting discourses and strategies, socio-religious frameworks and cultural realities. CONCLUSION Strategies are suggested to enhance the accessibility of services.
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Affiliation(s)
- Gila Schnitzer
- Faculty of Psychology and Educational Sciences, Research Unit of Interpersonal, Discursive and Narrative Studies (IDNS), Vrije Universiteit Brussel, Brussels, Belgium.
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Ryan A, Goldberg L, Evans J. Wise women: mentoring as relational learning in perinatal nursing practice. J Clin Nurs 2010; 19:183-91. [DOI: 10.1111/j.1365-2702.2009.02852.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ross EL, Bell SE. Nurses' comfort level with emergency interventions in the rural hospital setting. J Rural Health 2009; 25:296-302. [PMID: 19566616 DOI: 10.1111/j.1748-0361.2009.00233.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT One quarter of the persons living in the United States receive their emergency care in a rural hospital. Nurses employed in these hospitals see few emergencies but must be prepared to provide expert and efficient care when they do occur. PURPOSE The purpose of this study was to determine the influence of registered nurses' certifications and years of experience on comfort level in emergencies. METHODS Data were collected using a survey design. The questionnaire gathered demographic data, number and type(s) of certifications held, and comfort level with 7 emergency interventions. The sample was recruited from registered nurses (RNs) working in 10 Critical Access Hospitals that represented different geographic locations and different distances to larger, more comprehensive hospitals in an upper Midwestern state. FINDINGS Mean comfort level of all respondents with the 7 selected emergency interventions ranged from 2.3 for assisting with thoracentesis to 3.6 for assisting with precipitous vaginal delivery, indicating only a moderate comfort level with the selected emergency interventions. While 70% of the 86 respondents answered "yes" when asked if they felt comfortable in emergency situations, the percentage of respondents who reported being comfortable ranged from 33% to 83%. CONCLUSIONS Number and type(s) of certifications and years of experience as an RN were associated with higher comfort levels. Responses to open-ended questions provided insight into the realities of rural emergency nursing and strategies for improving comfort levels of rural nurses in emergency situations.
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Henwood T, Eley R, Parker D, Tuckett A, Hegney D. Regional differences among employed nurses: A Queensland study. Aust J Rural Health 2009; 17:201-7. [DOI: 10.1111/j.1440-1584.2009.01072.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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The trajectory of cultivating and growing Australian rural nurses: Findings from a constructivist grounded theory study. SOCIAL THEORY & HEALTH 2009. [DOI: 10.1057/sth.2008.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mills J, Fitzgerald M. Renegotiating roles as part of developing collaborative practice: Australian nurses in general practice and cervical screening. J Multidiscip Healthc 2008; 1:35-43. [PMID: 21197331 PMCID: PMC3004554 DOI: 10.2147/jmdh.s3243] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper reports the findings from an action research study that used a reflective group method to work with nurses in general practice recently credentialed as cervical screeners. The research aimed to develop a new model of practice nurse service delivery within a multidisciplinary team. Findings demonstrated that poor interdisciplinary collaboration created barriers to changing the role of the practice nurse. Key themes identified were: renegotiating their roles, identifying and negotiating gendered patterns of cervical screening, and the effect of multidisciplinary teams and interdisciplinary collaboration on practice nurse retention. Recommendations from this study address the need for improved piloting of new initiatives and an increase in continuing professional development for practice managers who are potential change agents.
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Affiliation(s)
- Jane Mills
- Nursing and Midwifery, Faculty of Medicine, Health and Nursing Sciences, Monash University, Gippsland, Melbourne, Australia
| | - Mary Fitzgerald
- School of Nursing, Midwifery and Nutrition, Cairns Campus, James Cook University, Smithfield, Queensland, Australia
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