A rural health education, training and research network

The purpose of the Rural Health Education, Training and Research Network is to support the education and training of rural health practitioners and research in rural health through the optimum use of appropriate information and communication technologies to link and inform all individuals and organisation involved in the teaching, planning and delivery of health care in rural and remote Queensland. The health care of people in rural areas has the potential to be enhanced, through providing the rural and remote health professionals in Queensland with the same access to educational and training opportunities as their metropolitan colleagues. This consultative, coordinated approach should be cost-effective through both increasing awareness and utilisation of existing and developing networks, and through more efficient and rational use of both the basic and sophisticated technologies which support them. Technological hardware, expertise and infrastructure are already in place in Queensland to support a Rural Health Education, Training and Research Network, but are not being used to their potential, more often due to a lack of awareness of their existence and utility than to their perceived costs. Development of the network has commenced through seeding funds provided by Queensland Health. Future expansion will ensure access by health professionals to existing networks within Queensland. This paper explores the issues and implications of a network for rural health professionals in Queensland and potentially throughout Australia, with a specific focus on the implications for rural and isolated health professional.

Improved rural health through a collaborative model of care – qualitative findings

INTRODUCTION Health disparity between urban and rural regions in Australia is well-documented. In the Wheatbelt catchments of Western Australia there is higher incidence and rate of avoidable hospitalisation for chronic diseases. Structured care approach to chronic illnesses is not new but the focus has been on single disease state. A recent ARC Discovery Project on general practice nurse-led chronic disease management of diabetes, hypertension and stable ischaemic heart disease reported improved communication and better medical administration.[1] In our study we investigated the sustainability of such a multi-morbidities general practice –led collaborative model of care in rural Australia. METHODS A QUAN(qual) design was utilised. Eight pairs of rural general practices were matched. Inclusion criteria used were >18 years and capable of giving informed consent, at least one identified risk factor or diagnosed with chronic conditions. Patients were excluded if deemed medically unsuitable. A comprehensive care plan was formulated by the respective general practice nurse in consultation with the treating General Practitioner (GP) and patient based on the individual’s readiness to change, and was informed by available local resource. A case management approach was utilised. Shediaz-Rizkallah and Lee’s conceptual framework on sustainability informed our evaluation.[2] Our primary outcome on measures of sustainability was reduction in avoidable hospitalisation. Secondary outcomes were patients and practitioners acceptance and satisfaction, and changes to pre-determined interim clinical and process outcomes. RESULTS The qualitative interviews highlighted the community preference for a ‘sustainable’ local hospital in addition to general practice. Costs, ease of access, low prioritisation of self chronic care, workforce turnover and perception of losing another local resource if underutilised influenced the respondents’ decision to present at local hospital for avoidable chronic diseases regardless. CONCLUSIONS Despite the pragmatic nature of rural general practice in Australia, the sustainability of chronic multi-morbidities management in general practice require efficient integration of primary-secondary health care and consideration of other social determinants of health. What this study adds: What is already known on this subject: Structured approach to chronic disease management is not new and has been shown to be effective for reducing hospitalisation. However, the focus has been on single disease state. What does this study add: Sustainability of collaborative model of multi-morbidities care require better primary-secondary integration and consideration of social determinants of health.

'Not a Local Win': Rural Australian perceptions of the sustainable impacts of forest plantations

Australian forestry plantations have doubled in the past 15 years, with rural communities harbouring a diverse range of positive and negative of economic, environmental and social impacts – the so-called triple bottom line (TBL). Utilising two Australian rural communities in Eden/Gippsland and Tasmania as qualitative case studies, this research explores how 23 non-forestry affiliated rural residents perceived and experienced the TBL economic, environmental and social impacts of plantation forestry. Residents criticised the economic plantation forestry benefits because of lengthy periods of inactivity and limited local employment, explaining that their community was reliant on the industry yet the promised economic benefits had never fully materialised. There was a sense the industry ‘plant and walk away.’ Residents were concerned about the environment impact on water quality, water tables and fire hazards, although they praised plantation forestry for carbon sequestering, eradicating erosion and water run-off. Negative social impacts were described, specifically how the land-use change from farming to forestry had significantly reduced the local population, employment and need for services. Natural resource management and communication strategies are offered, derived from non-forestry affiliated rural resident perspectives on how best to ensure sustainable forest development in their community.

Degree of value alignment : a grounded theory of rural nurse resignations

INTRODUCTION: The shortage of nurses willing to work in rural Australian healthcare settings continues to worsen. Australian rural areas have a lower retention rate of nurses than metropolitan counterparts, with more remote communities experiencing an even higher turnover of nursing staff. When retention rates are lower, patient outcomes are known to be poorer. This article reports a study that sought to explore the reasons why registered nurses resign from rural hospitals in the state of New South Wales, Australia. METHODS: Using grounded theory methods, this study explored the reasons why registered nurses resigned from New South Wales rural hospitals. Data were collected from 12 participants using semi-structured interviews; each participant was a registered nurse who had resigned from a rural hospital. Nurses who had resigned due to retirement, relocation or maternity leave were excluded. Interviews were transcribed verbatim and imported into NVivo software. The constant comparative method of data collection and analysis was followed until a core category emerged. RESULTS: Nurses resigned from rural hospitals when their personal value of how nursing should occur conflicted with the hospital's organisational values driving the practice of nursing. These conflicting values led to a change in the degree of value alignment between the nurse and hospital. The degree of value alignment occurred in three dynamic stages that nurses moved through prior to resigning. The first stage, sharing values, was a time when a nurse and a hospital shared similar values. The second stage was conceding values where, due to perceived changes in a hospital's values, a nurse felt that patient care became compromised and this led to a divergence of values. The final stage was resigning, a stage where a nurse 'gave up' as they felt that their professional integrity was severely compromised. The findings revealed that when a nurse and organisational values were not aligned, conflict was created for a nurse about how they could perform nursing that aligned with their internalised professional values and integrity. Resignation occurred when nurses were unable to realign their personal values to changed organisational values - the organisational values changed due to rural area health service restructures, centralisation of budgets and resources, cumbersome hierarchies and management structures that inhibited communication and decision making, out-dated and ineffective operating systems, insufficient and inexperienced staff, bullying, and a lack of connectedness and shared vision. CONCLUSIONS: To fully comprehend rural nurse resignations, this study identified three stages that nurses move through prior to resignation. Effective retention strategies for the nursing workforce should address contributors to a decrease in value alignment and work towards encouraging the coalescence of nurses' and hospitals' values. It is imperative that strategies enable nurses to provide high quality patient care and promote a sense of connectedness and a shared vision between nurse and hospital. Senior managers need to have clear ways to articulate and imbue organisational values and be explicit in how these values accommodate nurses' values. Ward-level nurse managers have a significant responsibility to ensure that a hospital's values (both explicit and implicit) are incorporated into ward culture.

Fostering digital participation in regional and rural Australia

The deployment of high speed broadband around Australia offers opportunities to extend digital participation among and between regional and rural communities. Full realisation of these opportunities requires a greater understanding about community members’ current digital participation and development needs, to underpin innovative community-driven initiatives. This paper outlines the Fostering Digital Participation Project’s initial undertakings to determine current digital participation and the future digital aspirations of a number of regional and rural communities.

Parent-child communication: The impact of globalisation and rapid social transformation in Khulais – Saudi Arabia

This qualitative study of parent-child communication examined the views of parents and children in a province of Saudi Arabia concerning how family interactions, parental authority and children’s behaviours are affected by the globalising influences of media and technology. Impacts reported include how tension in family communication arises as children develop a hybrid culture through accessing Western ideas and ideologies that are profoundly challenging to traditional Islamic culture.

Science, ICT and Mathematics Education in Rural and Regional Australia: The SiMERR National Survey

The SiMERR National Survey was one of the first priorities of the National Centre of Science, Information and Communication Technology and Mathematics Education for Rural and Regional Australia (SiMERR Australia), established at the University of New England in July 2004 through a federal government grant. With university based ‘hubs’ in each state and territory, SiMERR Australia aims to support rural and regional teachers, students and communities in improving educational outcomes in these subject areas. The purpose of the survey was to identify the key issues affecting these outcomes. The National Survey makes six substantial contributions to our understanding of issues in rural education. First, it focuses specifically on school science, ICT and mathematics education, rather than on education more generally. Second, it compares the different circumstances and needs of teachers across a nationally agreed geographical framework, and quantifies these differences. Third, it compares the circumstances and needs of teachers in schools with different proportions of Indigenous students. Fourth, it provides greater detail than previous studies on the specific needs of schools and teachers in these subject areas. Fifth, the analyses of teacher ‘needs’ have been controlled for the socio-economic background of school locations, resulting in findings that are more tightly associated with geographic location than with economic circumstances. Finally, most previous reports on rural education in Australia were based upon focus interviews, public submissions or secondary analyses of available data. In contrast, the National Survey has generated a sizable body of original quantitative and qualitative data.

Digital revolution or digital divide: Will rural teachers get a piece of the professional development pie?

In order to sustain the rural education community, access to high quality professional development opportunities must become a priority. Teachers in rural areas face many challenges in order to access professional learning equitable to their city counterparts. In the current climate, the Federal government of Australia is committed to initiatives that support the use of ICT in education. These include initiatives such as the Digital Education Revolution, including the National Broadband Network. This "revolution" includes the committal of $2.2 billion funding over six years from 2008 - 2013 which purports to bring substantial and meaningful change to teaching and learning in Australian schools. Of this funding, the Prime Minister (former Minister for Education), Julia Gillard, has committed $40 million of the total budget to ICT related professional development for teachers. But how will rural teachers ensure they get a piece of the PD pie? Access to professional learning is critical and isolation from colleagues, professional associations and support structures can affect the retention of teachers and in turn affect the sustainability of rural communities. This research paper describes the findings of the first phase of a study that investigates access to professional learning from rural and remote areas of Western Australia, the efficiencies of this approach including teacher perceptions and possible opportunities for improvement through the application of technologies. A survey instrument was administered and the results from104 principals and teachers within the Remote Teaching Service and the Country Teaching Program of the Department of Education and Training (WA) are discussed. Qualitative data was collected by semi-structured interviews and emailed questionnaires. Phase One findings highlight the principals and teachers? perceptions of their access to professional development opportunities, professional learning communities and their use of information and communication technologies (ICT) to bridge the gap

Social Living Labs for Digital Participation: Designing with Regional and Rural Communities [workshop proceedings]

“Fostering digital participation through Living Labs in regional and rural Australian communities,” is a three year research project funded by the Australian Research Council. The project aims to identify the specific digital needs and practices of regional and rural residents in the context of the implementation of high speed internet. It seeks to identify new ways for enabling residents to develop their digital confidence and skills both at home and in the community. This two-day symposium will bring together researchers and practitioners from diverse backgrounds to discuss design practices in social living labs that aim to foster digital inclusion and participation. Day one will consist of practitioner and research reports, while day two will provide an opportunity for participants to imagine and design future digital participation strategies. Academic participants will also have an opportunity to contribute to a refereed edited volume by Chandos Publishing (an imprint of Elsevier).