Rural Remote Health
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Rural Remote Health · Jan 2009
The changing nature of nursing work in rural and small community hospitals.
The nursing literature includes descriptions of rural nursing workforces in Canada, the United States of America and Australia. However, inconsistent definitions of rural demography, diverse employment conditions and health care system reorganization make comparisons of these data difficult. In 2007, the Ministry of Health and Long-term Care in Ontario, Canada, transferred responsibility for decision-making and funding to 14 regional governing bodies known as Local Health Integration Networks (LHINs). Little is known about rural-urban variations in the nursing workforces in the LHINs because existing data repositories do not describe them. This study investigated the influence of demographic characteristics, provincial policies, organizational changes and emerging practice challenges on nursing work in a geographically unique rural region. The purpose was to describe the nature of nursing work from the perspective of rural nurse executives and frontline nurses. The study was conducted in 7 small rural and community hospitals in the Hamilton Niagara Haldimand Brant LHIN. ⋯ This study has implications for health human resource planning in rural and small community hospitals. The findings indicate that demographic trends pose an immediate threat to the sustainability of the nursing workforce in the rural setting. Many nurses are nearing retirement, but the lack of opportunities for full-time positions as well as specialized and expanded nursing practice are attracting younger nurses to urban centres. Government policies focussing on the retention of clinical expertise, the recruitment of new graduates and expanding the role of registered practical nurses have been more difficult to implement in the rural setting. Implications for future research include the need to address data gaps to facilitate workforce planning and to evaluate the effectiveness of provincial recruitment and retention strategies in the rural context.
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There is growing evidence that in rural areas cancer mortality is higher and referral occurs later, indicating different patterns of care. In Scotland services to rural areas have been organized through 'managed clinical networks'. In some cases, these organizational networks have been structured so that the referral hospital is not the one nearest to the patient's home. This study set out to discover if access to cancer specialist care in mainland Scotland altered with distance to tertiary care facilities. The aim was to explore the relationship between hospital admission rates, type of hospital and travel time. ⋯ Differences in tertiary cancer care obtained may explain some of the reasons behind late presentation and higher mortality rates. This study provides evidence that the recognized increased cancer mortality in rural patients is indeed compounded by an increased travel burden.
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Rural Remote Health · Oct 2008
Improving trauma care in rural Iran by training existing treatment chains.
Iran has a major land mine injury problem in its border areas. Mine injuries have a high mortality and morbidity, and the injuries generally occur in remote areas. Iran has a well developed system of rural health workers and clinics, covering most border areas. These have mainly had prevention, immunization and curative treatment for medical conditions as their focus. We hypothesized that adding a short training in trauma care to the already existing system of rural health workers would improve the care for trauma victims. The objective of the present study was to describe the training and evaluate its effect using mortality and change in physiological function of victims after prehospital treatment as outcome measures. ⋯ We found that the existing rural healthcare system in Iran's western border area could be upgraded to care for mine victims and victims of other injuries by using available resources. This system improved the physiological status of the victims during transportation, and was able to handle penetrating as well as blunt injury. The use of existing health structures should be considered when planning improvements.
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Rural Remote Health · Oct 2008
Availability of difficult airway equipment to rural anaesthetists in Queensland, Australia.
Since 1990 several airway devices have become available to assist in difficult intubation. Multiple surveys have assessed difficult airway equipment availability in international anaesthetic departments and emergency departments. The practice of GP anaesthetists is unique in both its multidisciplinary nature and geographical isolation. ⋯ We suggest standardisation of difficult airway equipment for rural practitioners. This could be supported by increased availability of airway management workshops in remote areas. Such an intervention would be in line with other initiatives to standardise medical equipment in rural and remote Queensland hospitals. Familiarity with infrequently used equipment may assist practitioners and their locums. Standardisation of equipment and practice is a recognised method of improving patient safety.
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Rural Remote Health · Oct 2008
Sharing after hours care in a rural New Zealand community--a service utilization survey.
As the rural general practice workforce in New Zealand changes, after hours services are under pressure to change. This is an international problem. This article reports on an initiative in a rural New Zealand community to meet the need for after hours care. First contact for patients is with a community nursing team operating from the local health centre, complemented by on-call advice from GPs and GP clinics twice daily at weekends. ⋯ A collaborative service providing after hours care to a rural community is described and utilization rates assessed. The model of first on-call nurse with GP back up provides a sustainable service and reduces the burden on rural doctors without reducing patient access.