Living with breast cancer: the influence of rurality on women's suffering and resilience. A postmodern feminist inquiry

This paper focuses on rural living as a dimension of women's experiences of living through breast cancer. The findings presented emanate from a feminist narrative research project that examined the experiences of rural women from south-west Queensland who were long-term survivors of breast cancer. This project aimed to listen, report and interpret rural women's stories of resilience in surviving breast cancer and moving on with their lives. The participants reported that there were both positive and negative aspects of living in a rural setting, especially when ill. Eight of the nine participants, however, felt strongly that the positive aspects of rural living outweighed the difficulties. This suggests that rurality in the context of health and illness must be considered as a multifaceted dimension, with resources to support cancer survivors building on the existing strengths in rural communities

Evaluation of the role of the breast care nurse at Toowoomba Base Hospital

[Executive Summary]: The Supporting Rural Women with Breast Cancer Project started in Toowoomba in January 2005 with a Breast Care Nurse in a full time position in July 2005. The aim of the project is to develop and implement a revised multidisciplinary model of care resulting in the reorganisation and enhanced coordination of breast care services provided by Toowoomba Health Service District. A key deliverable under the service agreement with the Australian Government is the implementation of an evaluation plan and the compilation of an evaluation report. A decision on continuation of project initiatives will be informed in part by the results of the evaluation reported herein which was conducted by the Centre for Rural and Remote Area Health (CRRAH) based at the University of Southern Queensland. Structured questionnaires were used for both patient and stakeholder feedback. Fifty-one former breast cancer patients were interviewed by telephone. Twenty questions polled patients’ views on their access to the Breast Care Nurse and the nurse’s role in coordinating care, referral to other health professionals, and in providing information and psychosocial, emotional and practical support. Stakeholders received the questionnaire through the Toowoomba Health Services internal email system and returned completed questionnaires by reply paid mail to CRRAH. The questions were designed to provide views on the support that the Breast Care Nurse had made to a multi disciplinary treatment regimen. Views on the reasons for success or failure of the programme were also elicited. Widespread knowledge of the Breast Care Nurse prior to breast cancer treatment was poor; patients were unaware of the Breast Care Nurse until their first contact with her which was usually at the Surgical Outpatients Clinic held at the BreastScreen Toowoomba Service. More information about the position and role could be made available through GPs. Results from the patients revealed enormous gratitude for the support that they received from the Breast Care Nurse. There was overwhelming agreement that the timing of contact, ease of accessibility, information provided and support offered was extremely valuable in making their treatment and recovery easier. The vast majority of participants would recommend to their friends that they should attend hospitals with a Breast Care Nurse. Similar sentiments about the value of the Breast Care Nurse were received from stakeholders who recognised the benefit of the position not only to patients but also to the multidisciplinary team members in terms of coordination and liaison. However stakeholders did believe that a multidisciplinary team approach had not yet been fully achieved. The importance of maintaining a full time position of Breast Care Nurse was noted by both patients and stakeholders as accessibility of the nurse to patients was a key feature of the success of the programme. The study was in agreement with several other Australian reports all of which have demonstrated the success of dedicated Breast Care Nurses. The recommendation from the evaluation team is that the position of a full time Breast Care Nurse should be maintained. The Breast Care Nurse model is one that could be used successfully to support other medical condition

The value of a breast care nurse in supporting rural and remote cancer patients in Queensland

The role of the Breast Care Nurse in Queensland's Supporting Rural Women with Breast Cancer Project was evaluated by mixed methodology. Through questionnaire and interview patients provided views about the nurse's role under categories of Awareness, Access, Coordination, Information and Psychosocial, Emotional and Practical support. Of the 51 participants 37 resided in rural and remote areas with 18 living between 100 and 500 miles from specialised breast care services. The BCN met with patients at their regular hospital visits and was available by telephone at any time. There was overwhelming agreement among the participants that the timing of contact, ease of accessibility, information provided and support offered were extremely valuable in making their treatment and recovery easier. The vast majority of participants would recommend hospitals with a BCN to their friends. Members of the multidisciplinary care team provided views on Awareness of the BCN, Influence on Care Management, Communication and Patient Outcomes. They recognised the benefits of the BCN to patients and to coordination and liaison of the team. The findings concur with unpublished Australian reports that demonstrate the success of dedicated Breast Care Nurses. The BCN model of care could be used successfully to support other medical conditions

Rural men getting through adversity: stories of resilience

The aim of this study was to identiy the factors that have helped rural men to move through adversity. A total of ten men from Queensland took part in the study. Participants shared their experiences through in-depth, unstructured interviews. The participants shared a diverse range of difficulties in their lives, but on analysis it become apparent that there were similarities in how the participants overcame those difficult times. Two major themes identified in the study were: the individual and inner strength and support and strategies

Key issues in rural health: perspectives of health service providers in Queensland

The Centre for Rural and Remote Area Health (CRRAH) held interactive research workshops in eight towns in Southern Queensland. The purpose of the workshops was to determine what health providers considered were major issues affecting their service and for these results to inform future research strategy of CRRAH. Over 150 organisations identified as either providing health services or having a significant interest in health provision in one or more of the targeted towns were invited to attend. The workshops used the nominal group technique to identify what the participants considered were key health issues in the geographical area in which they worked. These issues were then prioritised by the participants. Thematic analysis of the issues generated a ranking of themes by importance. Results were compared with a similar exercise undertaken in 2003. Participants from organisation directly involved with health care were complemented at the workshops by representatives from local government, the police service and church groups. A total of 85 participants representing 47 services and 41 different organisations attended the eight workshops. Issues generated by the participants were pooled into seventeen themes. Workforce issues were by far the major concern of health providers. Recruitment and retention of health workers were a major concern. The other four highest ranked themes across all workshops were mental health, access to health services, perceptions and expectations of consumers of health services and interagency cooperation. Aged care was an additional theme that generated a lot of concern at several of the workshops. The workshops provided important information to CRRAH for developing research strategy. Additionally, several new alliances among health providers were developed which will support sharing of information and resources. The workshops enabled rural and remote organisations to meet and identify the key health issues and supported research planning. Much need alliances among health providers were forged and collaborative research avenues are being explored. The workshop forum is an excellent means of information exchange

The Registered Nurses' experiences of workplace culture and workplace climatic factors as influences on nursing workloads: a systematic review

The objective of this review is to identify and synthesise current evidence on workplace cultural and climatic factors that influence the daily work of nurses in an acute health care setting

Rural men and mental health: their experiences and how they managed

There is a growing awareness that a primary source of information about mental health lies with the consumers. This article reports on a study that interviewed rural men with the aim of exploring their mental health experiences within a rural environment. The results of the interviews are a number of stories of resilience and survival that highlight not only the importance of exploring the individuals' perspective of their issues, but also of acknowledging and drawing on their inner strengths. Rural men face a number of challenges that not only increase the risk of mental illness but also decrease the likelihood of them seeking and/or finding professional support. These men's stories, while different from each other, have a common thread of coping. Despite some support from family and friends participants also acknowledged that seeking out professional support could have made the recovery phase easier. Mental health nurses need to be aware, not only of the barrier to professional support but also of the significant resilience that individuals have and how it can be utilised

Becoming a mum: conflict between the ideal mother and the self

This paper explores the dominant narratives present in in-depth ante- and post- natal interviews with 10 first time mothers from south-east Queensland. Using a feminist post-structuralist paradigm, the idealised conceptions of motherhood adopted by these women are juxtaposed against their desires to maintain and regain an identity separate to their mothering one. Beliefs about what constitutes 'work' are also explored. These findings resonate with the tension between second-wave feminism’s view of the institution of motherhood as a primary means of women’s oppression, and later studies which attempted to validate women’s experiences and work. Furthermore, these mothers’ beliefs suggest that they are grappling with the integration of the often contradictory aspects of mothering into a workable whole. In some ways, repeating many of the struggles their own mothers faced. This hypothesis, along with current societal concerns with delayed mothering, picketfence families, and a return to paid work for mothers of school-aged children, suggest that the influences upon mothers, to be all things to all people remains

Once I became a pensioner I became a nobody - a non entity: the story of one woman's experience of the health care system

This article highlights one socially isolated older person’s experiences of ageing in a large metropolitan Australian location and the problems she encounters in attempting to access appropriate and timely health care. As society moves into a phase of rapid demographic ageing, this personal account provides health professionals with an in-depth insight in to what it can be like to live in social isolation as one ages and needs ever increasing health care. Win is part of a larger study investigating difficulties encountered by socially isolated older people in accessing health care needs, and preferred her real name to be used for this article. All other names used are fictitious to preserve anonymity