Building the capacity of rural allied health generalists through online postgraduate education: a qualitative evaluation

INTRODUCTION

Workforce development is a key strategy for building the capacity and capability of a workforce. Accordingly, rural and remote practising allied health professionals require relevant and accessible continuing professional development to enhance their knowledge and skills and improve consumer health outcomes. This study explored the impact of an online postgraduate allied health rural generalist education program, from the perspective of allied health professionals participating in the program and their supervisors and managers.

METHODS

A qualitative, exploratory descriptive study design was employed using semistructured interviews. This study formed the qualitative component of a larger convergent mixed-methods evaluation study aimed at evaluating the reach, quality and impact of an online rural generalist education program for allied health professionals in Australia. Allied health professionals from seven professions enrolled in an online postgraduate rural generalist education program, the rural generalist program (RGP). Their designated work-based supervisors and their managers who were responsible for the operational management of the study sites were invited to participate in the study. All participants were employed in rural and remote health services in 10 sites across four Australian states. Study participants' experience and perceptions of the impact of the RGP on themselves, the healthcare service and the broader community were explored using semistructured interviews. Data were thematically analysed site by site, then across sites using Braun and Clarke's (2012) systematic six-phase approach. Provisional codes were generated and iteratively compared, contrasted and collapsed into secondary, more advanced codes until final themes and subthemes were developed.

RESULTS

Semistructured interviews were conducted with 23 allied health professionals enrolled in the RGP and their 27 work-based supervisors and managers across the 10 study sites. Three final themes were identified that describe the impact of the RGP: building capability as rural generalist allied health professionals; recruiting and building a rural workforce; enhancing healthcare services and consumer outcomes.

CONCLUSION

Allied health professionals working in rural and remote locations valued the RGP because it provided accessible postgraduate education that aligned with their professional and clinical needs. Integrated into a supportive, well-structured development pathway, the experience potentiated learning and facilitated safe clinical practice that met the needs of consumers and organisations. The findings demonstrate that effective work-integrated learning strategies can enhance the development of essential capabilities for rural practice and support early-career allied health professionals' transition to rural and remote practice. These experiences can engage allied health professionals in a way that engenders a desire to remain working in rural and remote contexts.

Evaluation of the Allied Health Rural Generalist Program 2017-2019

OBJECTIVE

To evaluate the development and implementation of the Allied Health Rural Generalist Program, a two-level online post-graduate education program, which includes Level 1, an entry-level non-award pathway program, and Level 2, a Graduate Diploma in Rural Generalist Practice.

DESIGN

A convergent mixed methodology evaluation in two overlapping stages: a process evaluation on quality and reach, together with a mixed method case study evaluation on benefits, of the program.

SETTING

Rural and remote Australia across ten sites and seven allied health professions: dietetics; occupational therapy; pharmacy; physiotherapy; podiatry; radiography; speech pathology.

PARTICIPANTS

Process evaluation included 91 participants enrolled in all or part of the Rural Generalist Program. Case study evaluation included 50 managers, supervisors and Rural Generalist Program participants from the ten study sites.

INTERVENTIONS

The Allied Health Rural Generalist Program.

MAIN OUTCOME MEASURES

Process evaluation data were derived from enrolment data and education evaluation online surveys. Case study data were gathered via online surveys and semi-structured interviews. Quantitative and qualitative data were collected concurrently, analysed separately and then integrated to identify consistency, expansion or discordance across the data.

RESULTS

The Rural Generalist Program was viewed as an effective education program that provided benefits for Rural Generalist Program participants, employing organisations and consumers. Key improvements recommended included increasing profession-specific and context-specific content, ensuring Rural Generalist Program alignment with clinical and project requirements, strengthening support mechanisms within employing organisations and ensuring benefits can be sustained in the long term.

CONCLUSION

The Rural Generalist Program offers a promising strategy for building a fit-for-purpose rural and remote allied health workforce.

Retaining early career registered nurses: a case study

Background

A core objective of the Australian health system is to provide high quality, safe health care that meets the needs of all Australians. To achieve this, an adequate and effective workforce must support the delivery of care. With rapidly changing health care systems and consumer demographics, demand for care is increasing and retention of sufficient numbers of skilled staff is now a critical priority to meet current and future health care demands. Nurses are the largest cohort of professionals within the health workforce. Reducing the rates at which nurses leave the profession and supporting nurses to practice in their profession longer will have beneficial implications for the sustainability of a nursing workforce and, ultimately, to patient outcomes. The aim of the study was to describe and explain early career registered nurses’ (ECRNs) experiences and support requirements during the first five years of practice for the purposes of identifying strategies that would support greater retention of ECRNs.

Methods

A single case study design focused on early career registered nurses (ECRNs) working in a hospital and health service in northern Australia. The research team adopted Djukic et al’s definition of ECRNs as “RNs who have practiced for less than 5 years”. Data was collected via three individual interviews and two focus groups. Thirty-five ECRNs participated in the study.

Results

Qualitative analysis of data generated during interviews and focus groups, identified the key themes of receiving career advice and choice or no choice. Analysis of study data in the context of the broader literature resulted in the researchers identifying six areas of focus for ECRN retention: 1) well-planned, supported and structured transition periods; 2) consideration of rotation through different areas with a six month minimum for skills development; 3) empowering decision making; 4) placement opportunities and choice in decisions of where to work; 5) career advice and support that considers ECRNs’ personalities and skills; and 6) encouragement to reflect on career choices.

Conclusions

Reducing turnover and improving retention relies on understanding the factors that influence nurses’ decisions to leave or remain within an organisation and the profession. Ensuring nurses in the current workforce remain engaged and productive, rather than leave the profession, is reliant on addressing factors that cause attrition and implementing strategies that strengthen retention rates and workforce sustainability.

Sharing success - understanding barriers and enablers to secondary prophylaxis delivery for rheumatic fever and rheumatic heart disease

BACKGROUND

Rheumatic fever (RF) and rheumatic heart disease (RHD) cause considerable morbidity and mortality amongst Australian Aboriginal and Torres Strait Islander populations. Secondary antibiotic prophylaxis in the form of 4-weekly benzathine penicillin injections is the mainstay of control programs. Evidence suggests, however, that delivery rates of such prophylaxis are poor.

METHODS

This qualitative study used semi-structured interviews with patients, parents/care givers and health professionals, to explore the enablers of and barriers to the uptake of secondary prophylaxis. Data from participant interviews (with 11 patients/carers and 11 health practitioners) conducted in four far north Queensland sites were analyzed using the method of constant comparative analysis.

RESULTS

Deficits in registration and recall systems and pain attributed to injections were identified as barriers to secondary prophylaxis uptake. There were also varying perceptions regarding responsibility for ensuring injection delivery. Enablers of secondary prophylaxis uptake included positive patient-healthcare provider relationships, supporting patient autonomy, education of patients, care givers and healthcare providers, and community-based service delivery.

CONCLUSION

The study findings provide insights that may facilitate enhancement of secondary prophylaxis delivery systems and thereby improve uptake of secondary prophylaxis for RF/RHD.

Using a community of inquiry framework to teach a nursing and midwifery research subject: An evaluative study

BACKGROUND

Postgraduate nursing students' negative perceptions about a core research subject at an Australian university led to a revision and restructure of the subject using a Communities of Inquiry framework. Negative views are often expressed by nursing and midwifery students about the research process. The success of evidence-based practice is dependent on changing these views. A Community of Inquiry is an online teaching, learning, thinking, and sharing space created through the combination of three domains-teacher presence (related largely to pedagogy), social presence, and cognitive presence (critical thinking).

OBJECTIVES

Evaluate student satisfaction with a postgraduate core nursing and midwifery subject in research design, theory, and methodology, which was delivered using a Communities of Inquiry framework.

SETTING, PARTICIPANTS, AND METHODS

This evaluative study incorporated a validated Communities of Inquiry survey (n=29) and interviews (n=10) and was conducted at an Australian university. Study participants were a convenience sample drawn from 56 postgraduate students enrolled in a core research subject. Survey data were analysed descriptively and interviews were coded thematically.

RESULTS

Five main themes were identified: subject design and delivery; cultivating community through social interaction; application-knowledge, practice, research; student recommendations; and technology and technicalities. Student satisfaction was generally high, particularly in the areas of cognitive presence (critical thinking) and teacher presence (largely pedagogy related). Students' views about the creation of a "social presence" were varied but overall, the framework was effective in stimulating both inquiry and a sense of community.

CONCLUSIONS

The process of research is, in itself, the creation of a "community of inquiry." This framework showed strong potential for use in the teaching of nurse research subjects; satisfaction was high as students reported learning, not simply the theory and the methods of research, but also how to engage in "doing" research by forging professional and intellectual communities.

Terminology used to describe health care teams: an integrative review of the literature

Purpose

Health systems around the world are struggling to meet the needs of aging populations and increasing numbers of clients with complex health conditions. Faced with multiple health system challenges, governments are advocating for team-based approaches to health care. Key descriptors used to describe health care teams include “interprofessional,” “multiprofessional,” “interdisciplinary,” and “multidisciplinary.” Until now there has been no review of the use of terminology relating to health care teams. The purpose of this integrative review is to provide a descriptive analysis of terminology used to describe health care teams.

Methods

An integrative review of the literature was conducted because it allows for the inclusion of literature related to studies using diverse methodologies. The authors searched the literature using the terms interprofessional, multiprofessional, interdisciplinary, and multidisciplinary combined with “health teams” and “health care teams.” Refining strategies included a requirement that journal articles define the term used to describe health care teams and include a list of health care team members. The literature selection process resulted in the inclusion of 17 journal articles in this review.

Results:

Multidisciplinary is more frequently used than other terminology to describe health care teams. The findings in this review relate to frequency of terminology usage, justifications for use of specific terminology, commonalities and patterns related to country of origin of research studies and health care areas, ways in which terminology is used, structure of team membership, and perspectives of definitions used.

Conclusion:

Stakeholders across the health care continuum share responsibility for developing and consistently using terminology that is both common and meaningful. Notwithstanding some congruence in terminology usage, this review highlights inconsistencies in the literature and suggests that broad debate among policy makers, clinicians, educators, researchers, and consumers is still required to reach useful consensus.

Nurses in Australian acute care settings: experiences with and outcomes of e-health. An integrative review

The World Health Organization (WHO) defines e-health as the use of information and communication technology for health [1]. The use of e-health, including electronic medical records (EMR), is a growing trend. This integrative review of the literature examines nurses experiences of e-health in Australian acute care settings. A search of the literature identified 21 papers for inclusion in this review. Two discernable themes in the literature are apparent. Research to date largely focuses on nurses experiences of e-health, including its usefulness in their work. Findings indicate that nurses attitudes to e-health and computer usage are positive, however there are indications that nurses currently using e-health in practice are often dissatisfied with the implementation of new e-health systems in their workplace and that there are a number of barriers to its successful implementation. Secondly, a discernable gap in the literature regarding the impact of e-health, and in particular EMRs, on nursing outcomes is identified with research to date limited to findings related to nursing documentation and multi-disciplinary discharge planning. Future research that considers nurse experiences in implementing e-health and applies focused strategies across a range of health settings, both in Australia and around the world, can influence successful adoption and implementation of e-health.

Australian nurses in general practice, enabling the provision of cervical screening and well women's health care services: a qualitative study

Background

The role of Australian general practice nurses (PNs) has developed exponentially since the introduction of service based funding in 2005. In particular, their role has expanded to include cervical screening and well women’s health care services provided under the supervision of a general practitioner (GP). While previous research identifies barriers to the provision of these services, this study sought to investigate enablers for nurse led care in this area.

Methods

A number of grounded theory methods including constantly comparing data, concurrent data collection and analysis and theoretical sampling are utilised in this qualitative, exploratory study. A purposive sample of PNs who completed the required program of education in order to provide cervical screening and well women’s health care services was recruited to the study. Data is presented in categories, however a limitation of the study is that a fully integrated grounded theory was unable to be produced due to sampling constraints.

Results

Four enablers for the implementation of a change in the PN role to include cervical screening and well women’s health checks are identified in this study. These enablers are: GPs being willing to relinquish the role of cervical screener and well women’s health service provider; PNs being willing to expand their role to include cervical screening and well women’s health services; clients preferring a female practice nurse to meet their cervical screening and well women’s health needs; and the presence of a culture that fosters interprofessional teamwork. Seven strategies for successfully implementing change from the perspective of PNs are also constructed from the data. This study additionally highlights the lack of feedback on smear quality provided to PNs cervical screeners and well women’s health service providers.

Conclusions

The influence of consumers on the landscape of primary care service delivery in Australia is of particular note in this study. Developing interprofessional teams that maximise each health care provider’s role will be fundamental to comprehensive service delivery in the future.

Mental health nurses employed in Australian general practice: dimensions of time and space

Almost half the Australian population, aged 16-85 years, are affected by mental illness at some point in their life, and general practice plays a key role in providing effective mental health care. This paper presents the findings from a study that explored how people living with mental illness are supported in Australian general practice. A descriptive, exploratory study was conducted using semistructured interviews to gather data. The role of mental health nurses in the care and support of people with mental illness emerged from the data. This was explored further and resulted in two key themes: dimensions of time and dimensions of space. Findings from this study present key similarities and differences in the role of mental health nurses, as compared to general practitioners, in relation to dimensions of time and space. Dimensions of time and space are important considerations for general practices when planning to introduce a mental health nurse into their interprofessional team.