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Webber J, Finlayson M, Norman KE, Trothen TJ. How Community-Based Health and Social Care Professionals Support Unpaid Caregivers: Experiences From One Health Authority in Ontario, Canada. QUALITATIVE HEALTH RESEARCH 2024; 34:977-988. [PMID: 38419528 PMCID: PMC11375905 DOI: 10.1177/10497323241231425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In Ontario, Canada, rising rates of caregiver distress have been the 'canary in the coal mine' for a health system out of balance with the needs of an ageing population. Community-based health and social care professionals are well placed to play an important role in the caregiver support process; however, a gap has remained in the understanding of if and how caregiver support strategies are operationalized or experienced by community service providers (CSPs). The goal of this study was to describe how CSPs interpreted policy and how those interpretations may enable their work in supporting unpaid caregivers. Using a qualitative constructionist design, we interviewed 24 participants and reviewed 92 publicly available documents. Braun and Clarke's method of thematic analysis was used for analysis strategy. Four overarching themes were identified: (1) community care as a priority, (2) sidewalk accountability, (3) creative care planning through partnerships, and (4) challenges to care delivery. We found that the importance of caregivers to the health system was reflected in organizational policy and strategy. There is an opportunity to improve health outcome for caregivers and the population alike through strong leadership and a clear shared vision. Our findings also suggested that social capital was a significant factor in enabling providers in their work, leveraging long-standing relationships, and accumulated local knowledge to implement highly creative care plans.
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Affiliation(s)
- Jodi Webber
- School of Social Work, Algoma University, Sault Ste. Marie, ON, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Kathleen E Norman
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Tracy J Trothen
- School of Rehabilitation Therapy and The School of Religion, Queen's University, Kingston, ON, Canada
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Argent J, Lenthall S, Hines S, Rissel C. Perceptions of Australian remote area nurses about why they stay or leave: A qualitative study. J Nurs Manag 2022; 30:1243-1251. [PMID: 35312130 DOI: 10.1111/jonm.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/24/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to examine the perspectives of experienced Australian remote area nurses about remote nursing staff retention strategies. BACKGROUND There is low retention of remote area nurses in remote Australia. Retention of remote area nurses can be improved by a supportive environment including good management, professional development and supervision. METHOD This is a qualitative study using in-depth interviews with seven registered nurses with a minimum of 3 years remote area nursing experience. Participants were interviewed by phone, with the interviews audio-recorded then transcribed and analysed thematically. RESULTS Participants had on average 12 years of experience as a remote area nurse. They valued teamwork, effective and flexible management practices and the ability to maintain their own cultural and social connectedness. A flexible service model with regular short breaks, filled by returning agency nurses to enable continuity of care and cultural connections, was seen as a viable approach. CONCLUSION Flexible management practices that encourage short breaks for remote area nurses may increase retention. This would need to occur within a supportive management framework. IMPLICATIONS FOR NURSING MANAGEMENT Management strategies that reduce isolation from personal and social networks can increase the retention of skilled remote area nurses.
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Affiliation(s)
- Jacki Argent
- Flinders Northern Territory, Flinders University, Katherine, Northern Territory, Australia
| | - Sue Lenthall
- Flinders Northern Territory, Flinders University, Katherine, Northern Territory, Australia
| | - Sonia Hines
- Flinders Rural and Remote Health, Alice Springs, Northern Territory, Australia
| | - Chris Rissel
- Flinders Northern Territory, Flinders University, Royal Darwin Hospital Campus, Tiwi, Northern Territory, Australia
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Carey TA. Solving the Puzzle of Global Health Inequity: Completing the Picture Piece by Piece by Piece. ACTA ACUST UNITED AC 2021; 1:195-208. [PMID: 34622214 PMCID: PMC8397854 DOI: 10.1007/s43477-021-00022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
Achieving health equity is an ongoing priority for the global community. Understanding, supporting, and addressing the challenges that face health workers is a critical component of the solution to this problem. The University of Global Health Equity (UGHE) in Rwanda has established the Institute of Global Health Equity Research (IGHER) to contribute to the generation of new knowledge through high-quality research and research training that seeks to improve our understanding of the important issues that influence the distribution of health and healthcare globally. With an unrelenting emphasis on increased impact by prioritizing implementation research, IGHER is particularly interested in amassing a compendium of important research lessons to increase the likelihood that effective implementation strategies will be employed to enhance healthcare service provision. IGHER organizes research according to five foundational research questions, which address different elements that are pivotal to a comprehensive approach to appreciating the nuanced realities of effective healthcare service provision. UGHE outputs for 2020 indicate that: appropriate resourcing of healthcare services is critical for the eradication of global health inequities; policy reform is required for many healthcare innovations and initiatives to be implemented adequately; and high-quality research that is applicable to different contexts is essential for eradicating global health inequities. Furthermore, reimagining healthcare delivery will benefit from an intentional, ongoing, bidirectional influence between evidence-based pedagogy (methods and practices of teaching, education, and instruction) and supporting research activity such that education and instruction inform the research conducted and research findings are fed back to the classroom to help improve education and instruction. As IGHER continues to grow, the valuable insights afforded by high-impact implementation research will increase. These insights will help to inform the development and use of evidence-based implementation strategies for the adoption, scaling, and sustainability of equitable, effective, and efficient health services globally.
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Affiliation(s)
- Timothy A Carey
- Institute of Global Health Equity Research, University of Global Health Equity, PO Box 6955, Kigali, 20093 Rwanda
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Russell D, Mathew S, Fitts M, Liddle Z, Murakami-Gold L, Campbell N, Ramjan M, Zhao Y, Hines S, Humphreys JS, Wakerman J. Interventions for health workforce retention in rural and remote areas: a systematic review. HUMAN RESOURCES FOR HEALTH 2021; 19:103. [PMID: 34446042 PMCID: PMC8393462 DOI: 10.1186/s12960-021-00643-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/10/2021] [Indexed: 05/05/2023]
Abstract
BACKGROUND Attracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and workforce retention. METHODS The review considers studies of rural or remote health workers in HICs where participants have experienced interventions, support measures or incentive programs intended to increase retention. Experimental, quasi-experimental and observational study designs including cohort, case-control, cross-sectional and case series studies published since 2010 were eligible for inclusion. The Joanna Briggs Institute methodology for reviews of risk and aetiology was used. Databases searched included MEDLINE (OVID), CINAHL (EBSCO), Embase, Web of Science and Informit. RESULTS Of 2649 identified articles, 34 were included, with a total of 58,188 participants. All study designs were observational, limiting certainty of findings. Evidence relating to the retention of non-medical health professionals was scant. There is growing evidence that preferential selection of students who grew up in a rural area is associated with increased rural retention. Undertaking substantial lengths of rural training during basic university training or during post-graduate training were each associated with higher rural retention, as was supporting existing rural health professionals to extend their skills or upgrade their qualifications. Regulatory interventions requiring return-of-service (ROS) in a rural area in exchange for visa waivers, access to professional licenses or provider numbers were associated with comparatively low rural retention, especially once the ROS period was complete. Rural retention was higher if ROS was in exchange for loan repayments. CONCLUSION Educational interventions such as preferential selection of rural students and distributed training in rural areas are associated with increased rural retention of health professionals. Strongly coercive interventions are associated with comparatively lower rural retention than interventions that involve less coercion. Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.
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Affiliation(s)
- Deborah Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia.
| | - Supriya Mathew
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia
| | - Michelle Fitts
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia
| | - Zania Liddle
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia
| | - Lorna Murakami-Gold
- Poche SA & NT, Flinders Northern Territory, Flinders University, Alice Springs, Australia
| | - Narelle Campbell
- Flinders Northern Territory, Flinders University, Darwin, Australia
| | - Mark Ramjan
- Northern Territory Department of Health, Darwin, Australia
| | - Yuejen Zhao
- Northern Territory Department of Health, Darwin, Australia
| | - Sonia Hines
- Flinders Northern Territory, Flinders University, Alice Springs, Australia
- The Centre for Remote Health: A Joanna Briggs Institute Affiliated Group, Alice Springs, Australia
| | | | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Australia
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Fitts MS, Humphreys J, Dunbar T, Bourke L, Mulholland E, Guthridge S, Zhao Y, Jones MP, Boffa J, Ramjan M, Murakami-Gold L, Tangey A, Comerford C, Schultz R, Campbell N, Mathew S, Liddle Z, Russell D, Wakerman J. Understanding and responding to the cost and health impact of short-term health staffing in remote and rural Aboriginal and Torres Strait Islander community-controlled health services: a mixed methods study protocol. BMJ Open 2021; 11:e043902. [PMID: 34408027 PMCID: PMC8375723 DOI: 10.1136/bmjopen-2020-043902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 05/05/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Access to high-quality primary healthcare is limited for remote residents in Australia. Increasingly, remote health services are reliant on short-term or 'fly-in, fly-out/drive-in, drive-out' health workforce to deliver primary healthcare. A key strategy to achieving health service access equity, particularly evident in remote Australia, has been the development of Aboriginal Community Controlled Health Services (ACCHSs). This study aims to generate new knowledge about (1) the impact of short-term staffing in remote and rural ACCHSs on Aboriginal and Torres Strait Islander communities; (2) the potential mitigating effect of community control; and (3) effective, context-specific evidence-based retention strategies. METHODS AND ANALYSIS This paper describes a 3-year, mixed methods study involving 12 ACCHSs across three states. The methods are situated within an evidence-based programme logic framework for rural and remote primary healthcare services. Quantitative data will be used to describe staffing stability and turnover, with multiple regression analyses to determine associations between independent variables (population size, geographical remoteness, resident staff turnover and socioeconomic status) and dependent variables related to patient care, service cost, quality and effectiveness. Qualitative assessment will include interviews and focus groups with clinical staff, clinic users, regionally-based retrieval staff and representatives of jurisdictional peak bodies for the ACCHS sector, to understand the impact of short-term staff on quality and continuity of patient care, as well as satisfaction and acceptability of services. ETHICS AND DISSEMINATION The study has ethics approval from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (project number DR03171), Central Australian Human Research Ethics Committee (CA-19-3493), Western Australian Aboriginal Health Ethics Committee (WAAHEC-938) and Far North Queensland Human Research Ethics Committee (HREC/2019/QCH/56393). Results will be disseminated through peer-reviewed journals, the project steering committee and community/stakeholder engagement activities to be determined by each ACCHS.
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Affiliation(s)
- Michelle S Fitts
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - John Humphreys
- School of Rural Health, Monash University, Strathdale, Victoria, Australia
| | - Terry Dunbar
- Indigenous Social and Wellbeing Centre, School of Population Health Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Edward Mulholland
- Miwatj Health Aboriginal Corporation, Nhulunbuy, Northern Territory, Australia
| | - Steven Guthridge
- Centre for Child Development and Education, Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Yuejen Zhao
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Michael P Jones
- Psychology Department, Macquarie University, North Ryde, New South Wales, Australia
| | - John Boffa
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - Mark Ramjan
- Top End Health Service, Northern Territory Government, Casuarina, Northern Territory, Australia
| | - Lorna Murakami-Gold
- Poche SA + NT, Flinders University, Alice Springs, Northern Territory, Australia
| | - Annie Tangey
- Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
| | - Clarissa Comerford
- Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
| | - Rosalie Schultz
- Ngaanyatjarra Health Service, Alice Springs, Northern Territory, Australia
| | - Narelle Campbell
- Flinders Northern Territory, College of Medicine and Public Health, Flinders University, Darwin, Northern Territory, Australia
| | - Supriya Mathew
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Zania Liddle
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Deborah Russell
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - John Wakerman
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
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