Tracks to Postgraduate Rural Practice: Longitudinal Qualitative Follow-Up of Nursing Students Who Undertook a Rural Placement in Western Australia

The nursing workforce is the backbone of healthcare provision in rural and remote Australia. Introducing student nurses to rural clinical placements is one strategy used to address the shortfall of healthcare workers outside of major cities, with the goal of improving the training, recruitment and retention of nurses in rural areas. The aim of this qualitative, longitudinal study was to better understand personal and professional decision-making around rural nursing practice intentions and subsequent rural employment and retention. The study methodology consisted of repeated semi-structured interviews with student nurses who had completed at least one rural placement and following them on their journey to becoming graduate nurses over a 6-year period. Thematic longitudinal analysis was undertaken, with three main themes developing, each with further subthemes: (1) participants' satisfaction with rural placements; (2) their challenges with gaining employment; and (3) considerations regarding 'going rural' for work. The participants engaged in both prospective and retrospective reflection around several professional, personal, and wider systemic barriers and enablers to rural practice, which are discussed in detail in this paper. The insights from this longitudinal study have the potential to assist the development of a sustainable rural nursing workforce through informing rural workforce programs, strategies and policies.

Identifying features of quality in rural placements for health students: scoping review

OBJECTIVES

To explore and synthesise the evidence relating to features of quality in rural health student placements.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, CINAHL, Embase, ProQuest, Informit, Scopus, ERIC and several grey literature data sources (1 January 2005 to 13 October 2020).

STUDY SELECTION

The review included peer-reviewed and grey literature from Organisation for Economic Co-operation and Development listed countries that focused on quality of health student placements in regional, rural and remote areas.

DATA EXTRACTION

Data were extracted regarding the methodological and design characteristics of each data source, and the features suggested to contribute to student placement quality under five categories based on a work-integrated learning framework.

RESULTS

Of 2866 resulting papers, 101 were included for data charting and content analysis. The literature was dominated by medicine and nursing student placement research. No literature explicitly defined quality in rural health student placements, although proxy indicators for quality such as satisfaction, positive experiences, overall effectiveness and perceived value were identified. Content analysis resulted in four overarching domains pertaining to features of rural health student placement quality: (1) learning and teaching in a rural context, (2) rural student placement characteristics, (3) key relationships and (4) required infrastructure.

CONCLUSION

The findings suggest that quality in rural health student placements hinges on contextually specific features. Further research is required to explore these findings and ways in which these features can be measured during rural health student placements.

Effective use of an audit tool devised to optimize the management of syphilis in an integrated sexual health clinic

The objective of this study was to audit the management of syphilis in our integrated sexual health clinic according to the British Association for Sexual Health and HIV (BASHH) guideline using the ‘Treponemal Infection Care’ (TIC) audit tool devised by our clinic. The case notes of patients diagnosed with all stages of syphilis during an 18-month period were reviewed. At the time of diagnosis, the departmental TIC proforma was filled in: this proforma details BASHH auditable outcomes. The case notes of 83 patients diagnosed with syphilis during the audit period were reviewed. The majority of patients were men (76), men who had sex with men (69), HIV-negative (59) and were British (68). In line with current guidance all patients had a baseline Venereal Disease Research Laboratory (VDRL) titre at the start of treatment (target: 100%) and 97% of diagnosed patients completed treatment (target: 95%). A ‘response to treatment’ according to the decrease in VDRL was demonstrated in 50 (60%) patients with two (2%) patients failing to respond according to these criteria. However, 19 (23%) patients failed to return for their VDRL tests before demonstrating an adequate response to treatment, despite repeated attempts to contact them by letter and telephone. Fifty-four patients had at least 50% of their partners documented as traceable. Of those who were contactable, 100% attended for screening or treatment (target: 60%). In conclusion, our department performed well against BASHH auditable outcome targets. The introduction of the TIC proforma greatly facilitated the ease of audit and is a valuable tool within our clinic setting, which may have positively influenced our audit outcomes. Further action is required to highlight the importance of follow-up VDRLs to patients.

Migration and stopover in a small pelagic seabird, the Manx shearwater Puffinus puffinus: insights from machine learning

The migratory movements of seabirds (especially smaller species) remain poorly understood, despite their role as harvesters of marine ecosystems on a global scale and their potential as indicators of ocean health. Here we report a successful attempt, using miniature archival light loggers (geolocators), to elucidate the migratory behaviour of the Manx shearwater Puffinus puffinus, a small (400 g) Northern Hemisphere breeding procellariform that undertakes a trans-equatorial, trans-Atlantic migration. We provide details of over-wintering areas, of previously unobserved marine stopover behaviour, and the long-distance movements of females during their pre-laying exodus. Using salt-water immersion data from a subset of loggers, we introduce a method of behaviour classification based on Bayesian machine learning techniques. We used both supervised and unsupervised machine learning to classify each bird's daily activity based on simple properties of the immersion data. We show that robust activity states emerge, characteristic of summer feeding, winter feeding and active migration. These can be used to classify probable behaviour throughout the annual cycle, highlighting the likely functional significance of stopovers as refuelling stages.

Do familiar landmarks reset the global path integration system of desert ants?

It is often suggested that animals may link landmark memories to a global coordinate system provided by path integration, thereby obtaining a map-like representation of familiar terrain. In an attempt to discover if desert ants form such associations we have performed experiments that test whether desert ants recall a long-term memory of a global path integration vector on arriving at a familiar food site. Ants from three nests were trained along L-shaped routes to a feeder. Each route was entirely within open-topped channels that obscured all natural landmarks. Conspicuous artificial landmarks were attached to the channelling that formed the latter part of the route. The homeward vectors of ants accustomed to the route were tested with the foodward route, either as in training, or with the first leg of the L shortened or extended. These ants were taken from the feeder to a test area and released, whereupon they performed a home vector. If travelling the latter part of a familiar route and arriving at a familiar food site triggers the recall of an accustomed home vector, then the home vector should be the same under both test conditions. We find instead that the home vector tended to reflect the immediately preceding outward journey. In conjunction with earlier work, these experiments led us to conclude in the case of desert ants that landmark memories do not prime the recall of long-term global path integration memories. On the other hand, landmark memories are known to be linked to local path integration vectors that guide ants along a segment of a route. Landmarks thus seem to provide procedural information telling ants what action to perform next but not the positional information that gives an ant its location relative to its nest.

MonoFIX-VF, a new mono-component factor IX concentrate: a single-centre continuous-infusion study

MonoFIX-VF, a monocomponent factor IX concentrate, has replaced the use of Prothrombinex-HT as the treatment of choice for patients with factor IX deficiency in Australia. The haemostatic effect of MonoFIX-VF, administered by continuous infusion, was assessed in four subjects being treated for 10 bleeding episodes including five surgical procedures. MonoFIX-VF was found to be a safe and effective treatment for patients with haemophilia B.

The guidance of desert ants by extended landmarks

Desert ants (Cataglyphis fortis) were trained to follow a fixed route around a barrier to a feeder. Their homeward trajectories were recorded on a test field containing a similar barrier, oriented either as in training or rotated through 22 or 45. Under one set of experimental conditions, the homeward trajectories rotated with the orientation of the barrier, implying that the visual features of this extended landmark can determine the route independently of compass cues: the barrier provided a “visual scene” that controlled the trajectories of the ants. Under other conditions, the trajectories after rotation were a compromise between the habitual compass direction and the direction with respect to the rotated barrier. Trajectories were determined primarily by the visual scene when ants were allowed to return close to the nest before being caught and tested. The compromise trajectories were observed when ants were taken from the feeder. It seems that ants exhibit at least two separate learnt responses to the barrier: (i) a habitual compass direction triggered by the sight of the barrier and (ii) a visual scene direction that is compass-independent. We suggest that the weighting accorded to these different learnt responses changes with the state of the path integration system.

Path integration in insects

The most notable advance in our knowledge of path integration in insects is a new understanding of how the honeybee measures the distance that it travels during its foraging trips. Data from two groups show that the bee's odometer records distance in terms of the net amount of image motion over the retina that is accumulated during a flight. Progress has also been made in clarifying the relation between path integration and other navigational strategies. On unfamiliar ground, path integration is the only available means of navigation. In familiar surroundings, however, guidance by landmarks may override guidance by path integration. Path integration then becomes a back-up strategy that is used primarily when landmarks fail.

How do insects use path integration for their navigation?

We combine experimental findings on ants and bees, and build on earlier models, to give an account of how these insects navigate using path integration, and how path integration interacts with other modes of navigation. At the core of path integration is an accumulator. This is set to an initial state at the nest and is updated as the insect moves so that it always reports the insect's current position relative to the nest. Navigation that uses path integration requires, in addition, a way of storing states of the accumulator at significant places for subsequent recall as goals, and a means of computing the direction to such goals. We discuss three models of how path integration might be used for this process, which we call vector navigation. Vector navigation is the principal means of navigating over unfamiliar terrain, or when landmarks are unavailable. Under other conditions, insects often navigate by landmarks, and ignore the output of the vector navigation system. Landmark navigation does not interfere with the updating of the accumulator. There is an interesting symmetry in the use of landmarks and path integration. In the short term, vector navigation can be independent of landmarks, and landmark navigation needs no assistance from path integration. In the longer term, visual landmarks help keep path vector navigation calibrated, and the learning of visual landmarks is guided by path integration.

Calibration of vector navigation in desert ants

Desert ants (Cataglyphis sp.) monitor their position relative to the nest using a form of dead reckoning [1] [2] [3] known as path integration (PI) [4]. They do this with a sun compass and an odometer to update an accumulator that records their current position [1]. Ants can use PI to return to the nest [2] [3]. Here, we report that desert ants, like honeybees [5] and hamsters [6], can also use PI to approach a previously visited food source. To navigate to a goal using only PI information, a forager must recall a previous state of the accumulator specifying the goal, and compare it with the accumulator's current state [4]. The comparison - essentially vector subtraction - gives the direction to the goal. This whole process, which we call vector navigation, was found to be calibrated at recognised sites, such as the nest and a familiar feeder, throughout the life of a forager. If a forager was trained around a one-way circuit in which the result of PI on the return route did not match the result on the outward route, calibration caused the ant's trajectories to be misdirected. We propose a model of vector navigation to suggest how calibration could produce such trajectories.

Spatial scales of desert locust gregarization

Central to swarm formation in migratory locusts is a crowding-induced change from a "solitarious" to a "gregarious" phenotype. This change can occur within the lifetime of a single locust and accrues across generations. It represents an extreme example of phenotypic plasticity. We present computer simulations and a laboratory experiment that show how differences in resource distributions, conspicuous only at small spatial scales, can have significant effects on phase change at the population level; local spatial concentration of resource induces gregarization. Simulations also show that populations inhabiting a locally concentrated resource tend to change phase rapidly and synchronously in response to altered population densities. Our results show why information about the structure of resource at small spatial scales should become key components in monitoring and control strategies.

Unexpected infant death in association with suspended rocking cradles

We report on the deaths of two infants aged 10 1/2 and 11 weeks who were found face down in the angle between the base and side of their frame-suspended rocking cradles. Locking pins designed to prevent tilting of the cradles were not in place in either case. Investigation of the two cradles associated with the infant deaths and six other similar rocking cradles available for purchase in South Australia revealed either marked angles of tilt or inadequate or nonchildproof locking devices in all cases. A study of live control infants placed in similar situations demonstrated support for the possibility of positional asphyxia. We consider that these cases represent another potentially lethal sleeping environment for infants and emphasize the importance of death scene examination in all cases of unexpected infant death.

The danger of freely rocking cradles

OBJECTIVE

To assist the Adelaide State Coroner with his inquest into the death of two infants in South Australia, and to assist the Department of Public and Consumer Affairs develop Australian Standards for rocking cradles.

METHODOLOGY

A sample of each brand of new cradle commercially available in South Australia was examined. Videotapes were made of 11 healthy infants in rocking cradles to examine how they moved and how they reacted in different positions.

RESULTS

Many cradles had insecure locking pins. Infants in a cradle tilted at 10 degrees greater, face down with the side of the face against the bars, and an aim trapped between the body and bars or through the bars, were unable to obtain a clear airway unless a dummy was in the mouth.

CONCLUSIONS

Infants should never be left unattended in freely rocking cradles. Australian Standards should recommend locking pins be bolted into place and that cradles cannot tilt to greater than 5 degrees.