City slick with country know-how: implications of supporting students from urban backgrounds for the future of rural nursing

Canberra, AC

Twenty-five years since the Shearman Report: How far have we come? Are we there yet?

© 2015 Published by Elsevier Australia. Background: In 1989, the first major state-wide report into maternity services, known as the Shearman Report after its author, was released in New South Wales, the most populous state in Australia. Aim: This paper reflects upon the report and tracks the progress of five of its key recommendations. The recommendations are still some of the major issues facing maternity services across the country. These are: community-based maternity care, rural maternity services, hospital visiting rights for privately practising midwives, obstetric intervention, and midwifery continuity of maternity care. Findings: In some ways, much has changed in 25 years including the terminology used in the report, the importance of midwifery continuity of care and the woman-centred nature of many services. However, in other ways, there is still a long way to go to address these major issues. Despite more than a quarter of a century, many recommendations have not been fulfilled, especially access to care in rural areas, rates of obstetric intervention, and the issue of visiting rights for privately practising midwives which has gone backwards. Conclusion: A continued and renewed effort is needed to ensure that the forward thinking recommendations of the Shearman Report are ultimately realised for all women and their families

Preparing Students in Professional Programs for Rural Practice: A Case Study

Understanding the supports and constraints available in rural communities is integral to the education of professionals who choose to practise in rural settings. Previous research has indicated that many professionals do not have an accurate understanding of rural contexts and how rural settings impact personal life and professional practice. To address this gap, an interprofessional course centring on professional practice in rural and remote communities was developed. This course was designed to be reflective of rural practice, not only in content but also in the way the course was delivered. Findings from this case study indicated that students’ understanding of the complexity of rural settings was enhanced on multiple levels. The interactive and experiential nature of the course allowed students to develop working relationships that increased both their understanding of the value of interprofessional collaboration as well as the professional opportunities that are available in rural areas.  Comprendre les soutiens accessibles dans les communautés rurales et leurs contraintes fait partie intégrante de la formation des professionnels qui choisissent de pratiquer en milieu rural. Des recherches antérieures ont indiqué que de nombreux professionnels n’ont pas une compréhension adéquate des contextes ruraux ni des répercussions de ces paramètres sur la vie personnelle et la pratique professionnelle. Pour combler cette lacune, un cours interprofessionnel centré sur la pratique professionnelle dans les collectivités rurales et éloignées a été créé. Ce cours se veut le reflet de la pratique rurale, non seulement dans son contenu mais aussi dans sa façon d’être enseigné. Les résultats de cette étude de cas ont indiqué que la compréhension qu’ont les élèves de la complexité du milieu rural a été renforcée à plusieurs niveaux. La nature interactive et expérientielle du cours a permis aux étudiants de parfaire leurs relations de travail, ce qui a augmenté à la fois leur compréhension de la valeur de la collaboration interprofessionnelle ainsi que celle des occasions professionnelles disponibles dans les zones rurales

What influences nurses' decisions to work in rural and remote settings? A systematic review and meta-synthesis of qualitative research

Introduction: Due to global nursing shortages, recruitment and retention of nurses is a major international concern, exacerbated in rural and remote areas. Existing research reveals that individual factors influence healthcare professionals’ decision making to work in rural and remote settings. However, existing evidence does not fully consider the multiple influences that may impact nurses’ decisions to remain or leave rural and remote areas. This limits the effectiveness of recruitment and retention strategies. The objectives of this study were to explore the influences on nurses’ decisions to work in rural and remote healthcare settings, using a systematic review and thematic meta-synthesis of qualitative studies. Methods: Databases Medline, Journals@OVID Full text, PsycInfo and specialist journals were searched from January 1990 to January 2020. Inclusion criteria were applied to all records by two independent reviewers. The Critical Appraisal Skills Programme checklist for qualitative studies was used for independent quality critique by two reviewers. Thematic synthesis was conducted using a three step process: (1) the results sections of each article were extracted and inductively coded line by line; (2) master themes and subthemes were organised into tables; (3) relationships between the themes were identified and examined to develop an overarching analytical framework. Results: A total of 121 articles were screened and 40 were included for data extraction and thematic synthesis. Thematic analysis identified three interrelated dimensions that influenced nurses’ retention and migration decision-making, namely ‘person/al’, ‘profession/al’ and ‘place’ with 18 inter-related domains. The ‘person/al’ dimension contained five domains: a sense of belonging/connectedness, knowledge of rural culture, blurring of personal and professional lives, anonymity and job satisfaction/stress. The ‘profession/al’ dimension contained eight domains: expert generalist, advanced nurse practitioner, professional isolation, mentorship, education, autonomy and empowerment, role conflict, and recruitment and retention. The ‘place’ dimension identified five domains: terrain and weather, fewer resources, geographical isolation, safety and rural culture. The data informed the development of the MacKay’s 3P (person/al, profession/al and place) model to capture the complex phenomenon of the influences on nurses’ decision making to work in rural and remote settings. Conclusion: Multiple dimensions and domains influence nurses’ decision making to work in rural and remote settings. MacKay’s 3P model provides a theoretical framework to explore the complex interplay between the person/al, profession/al and place-related dimensions of rural nursing. These findings can inform the development of future recruitment and retention initiatives

Moral competence in nursing: An exploration of the Giving Voice to Values Curriculum

The development of moral competence is central to the profession of nursing and its practice. Nurses engage in moral decision making that impacts the health of people, families, and communities. It is important, then, to ensure that nursing graduates possess the necessary moral development for engaging in professional practice. To this end, research was conducted, the principle premise of which was to explore the use of the introduction of the Giving Voice to Values curriculum (Gentile, 2010) and its contribution to the development of moral competence in nursing. The Giving Voice to Values curriculum is a values-based methodology enabling students to find their voice, speak up, and act on their values effectively. The curriculum develops the students’ confidence in identifying moral issues during their professional education. This research explored the use of the Giving Voice to Values curriculum as a component of an undergraduate nursing program in Australia. The exploration of the Giving Voice to Values curriculum was undertaken within a wider investigation of moral theory, moral competence, and the profession of nursing. The research undertaken in this study analysed the perceptions and practices underpinning contemporary methodologies of moral competence in nursing, and the professional regulations that uphold and secure this. Using a mixed methods research design, this study draws on a collection of data from two sources: (a) a survey of first year nursing students’ understanding of moral competence at the completion of the GVV Curriculum; and (b) semi-structured interviews of nursing experts and stakeholders’ understandings of both moral development and the morally competent nurse. Findings from this study demonstrated that the students’ understanding of both the actions and influences of moral competence remained low on completion of the Giving Voice to Values curriculum. Specifically, the study revealed developments in students’ ability to reason or to ‘think ethically’ or to recognise ethical anomalies, as well as an increase in actions taken to ‘give voice’ to their values; however, these findings were not supported by a noticeable development in students’ capacity to identify their ethical position. Nonetheless, the study revealed a development in students’ moral awareness, thereby providing a basis for the development of moral competence. Nursing experts and stakeholders perceived moral competence in nursing as a circular developmental process that required solid foundations in moral theory and communication skills, as acquired and assessed throughout undergraduate nursing education. These participants proposed that a morally competent nurse must be able to uphold professional values, moral principles, and professional practices. They emphasised that the development of moral competence within nursing must be founded on the codes and regulations that govern and guide the profession. The participants also identified observed gaps between the theory and practice of moral competence, leading to weaknesses within professional practice and health care. The Giving Voice to Values curriculum is not a moral theory in itself. The introduction of this curriculum within undergraduate nursing education must be based upon the teaching of both moral theory and professional ethics, as foundational for ongoing development of moral competence

A deconstruction and reconstruction of advanced nurse specialisation and education

The purpose of this study was to present issues and the paradoxes surrounding advanced nurse specialisation (ANS) and education, This study was conducted in two parts. Part A examined the prospective experiences of 13 registered nurses (RNs) who were advancing in an area of special is III ion: they were working in a specialist area of practice and studying in II course specific 10 their specialisation. Two rounds of interviews were completed over six-month intervals. Part B examined the data gathered from a focus group interview and follow-up feedback from 10 nurse executives as stakeholders. The intersubjective data from this group of nurses expanded on the political, economic, and social complexities surrounding the same phenomenon of interest

What constitutes a good death?: implications for family nurse practitioners in rural British Columbia

Death in an inevitable part of each individual's life. It is how that final event occurs and the time prior to and during one's last phase of life that greatly influence the dying experience for everyone involved. This project aimed to methodically and critically review research evidence to identify key elements necessary for a good death from patients' perspectives. The final number of articles totaled 35, with a dimensional analysis technique used to review and theme data. A key message following data analysis was that there is a diversity of perspectives and subjective characterizations of what constitutes a good death within and across sociocultural groups. Contributions to a good death involved four overarching domains: 1) preparation for death, 2) sources of support, 3) communication, 4) quality of life issues. The rural family nurse practitioner (FNP) role in supporting a good death needs to be based on working to full scope engaging in end-of-life (EOL) care planning and anticipating life expectancy providing holistic and consistent care engaging in multidisciplinary collaboration and effective communication providing caregiver support and education engaging in continuing competence and providing leadership to ensure the best EOL care is available for all patients wishing to remain in their rural home community to die. --Leaf ii.The original print copy of this thesis may be available here: http://wizard.unbc.ca/record=b186345