Stress, burnout and job satisfaction in rural psychiatric nurses: a Victorian study

OBJECTIVE: To measure the level of stress, burnout and job satisfaction in rural psychiatric nurses in Victoria, Australia. METHOD: This present study presents the findings of a research study undertaken with rural psychiatric nurses (n = 136) in two rural mental health services in Victoria. The study designed to measure their level of stress, burnout and job satisfaction using the Maslach Burnout Inventory (MBI), the Nursing Stress Scale (NSS) and Job Satisfaction Scale (JSS). RESULTS: The findings indicated that a low number rural psychiatric nurses suffered from 'high' level of burnout and the majority of nurses reported 'low level' of emotional exhaustion and depersonalisation scores. On the personal accomplishment subscale, only 11% recorded a 'high' score and 87% recorded 'low' score. On the Nursing Stress Scale, the 'workload' was the highest perceived stressor followed by 'inadequate preparation'. CONCLUSIONS: Paradoxically, the majority of rural psychiatric nurses stated that they were satisfied with their job, particularly with current situation at work, aspects of support and the level of involvement in decision making.     

Policy barriers for advanced practice nurses in rural health care

ObjectivesThe objective of this paper was to examine rural health access to care, barriers to practice for Advanced Practice Nurses (APNs) in rural health, explore solutions, and arrive at a policy change that would improve rural citizens′ access to health care. This policy change should improve access to care, be cost-efficient, and have ease of implementation.MethodsMethods used for research included online health care journals, original research, and government statistics and websites. Sources were PubMed, Google Scholar, state Boards of Nursing publications including Scope of Practice statutes, and Rural Health Associations′ publications.ResultsBackground information and evidence was gathered, and 3 alternatives were explored: (1) Increasing incentives to practitioners to practice in rural areas, (2) Removing regulatory barriers to practice for APNs in rural health, and (3) Funding original research to determine optimal provider mix in rural health care. Advantages and disadvantages to these alternatives were examined with respect to population benefit, cost-effectiveness, administrative feasibility, and resource allocation equity. The 2nd alternative was determined to be the most effective.ConclusionAccess to health care for rural citizens is significantly worse than for urban dwellers, and the current methods of improving it are inadequate. The situation will be worsened by the projected shortage of primary care providers in the future, and therefore action to improve this is imperative. This situation can be greatly improved by removing barriers to practice for APNs to enable them to better provide care in rural areas, thus increasing rural citizens′ access to health care.     

Charting the future course of rural health and remote health in Australia: Why we need theory

Objective: This paper argues that rural and remote health is in need of theoretical development. Design: Based on the authors’ discussions, reflections and critical analyses of literature, this paper proposes key reasons why rural and remote health warrants the development of theoretical frameworks. Results: The paper cites five reasons why theory is needed: (i) theory provides an approach for how a topic is studied; (ii) theory articulates key assumptions in knowledge development; (iii) theory systematises knowledge, enabling it to be transferable; (iv) theory provides predictability; and (v) theory enables comprehensive understanding. Conclusion: This paper concludes with a call for theoretical development in both rural and remote health to expand its knowledge and be more relevant to improving health care for rural Australians.     

Work practices of rural and remote physiotherapists

ABSTRACT: Physiotherapists in rural and remote areas face challenges in their service delivery. The challenge is to provide accessible and comprehensive services to rural and remote Australians. Research was undertaken regarding the work practices of physiotherapists and the availability of other health professionals in rural and remote South Australia and Northern Territory. Rural and remote area physiotherapists in this study are likely to be sole practitioners with a gener-alist practice. The high number who have practising rights at public hospitals gives rise to service delivery with a wide range of clients and reduced opportunity for specialisation. In addition, the demand for physiotherapists to be multiskilled is increased with the lower number of resident medical specialists and allied health professionals in rural areas. Greater access to other professionals for rural and remote Australians may come from the development of resource networks supported by regional organisation of resources and infrastructure.     

Using cohort studies to investigate rural and remote mental health

This paper, presented at the 2010 rural health researchers' National Scientific Symposium on Rural and Remote Health, provides an overview of large Australian population mental health cohort studies which have a focus on climate-related and environmental adversity, social factors and mental health. These studies highlight the value of exploiting multiple exceptional datasets to better understand the drivers of rural health, including how to use population-level research to improve health resources in non-metropolitan areas. We show how the key characteristics of rural and remote mental health might be explored by exploiting the following cohort studies: Household, Income and Labour Dynamics in Australia Survey; Australian Rural Mental Health Study; Hunter Community Study; and Extending Treatments, Education and Networks in Depression study. Existing cohort studies that focus on significant rural and regional characteristics can be creatively analysed to better understand geographic variation in mental health. They have the potential to move understanding beyond simple prevalence to building knowledge about the trajectories of psychological distress and determinants of mental disorders and outcomes over time.     

Innovative rural and remote primary health care models: What do we know and what are the research priorities?

This paper examines the literature pertaining to 'innovative' primary health care models in rural and remote areas in order to identify areas where knowledge is lacking and describes future research priorities. Although a number of reviews have identified successful primary health care models and synthesised principles that help to understand why they are successful, there is generally a dearth of rigorously collected information regarding rural and remote health service delivery. The evidence base that supports the superiority of any one model or models in a given context is thin because of the lack of systematic, policy-informing evaluation of primary care innovations. The paper identifies the need for more rigorous health services evaluation information, including examination of optimal financing systems, the optimal range and mix of providers, and supports for team practice, appropriate community participation mechanisms, improved health information systems and relevant performance indicators.     

A comparison of a hospital outpatients department and general practice in remote Queensland

A survey of all ambulant patients attending the hospital outpatients' department and the private general practice in a remote town in Queensland sought information on patients' reasons for attending. Patients handed the completed questionnaires to their practitioner, who indicated the type of visit and the focus of the encounter. There was little difference between the facilities in terms of patient demographics, except that males accounted for a higher proportion of encounters at the Outpatients' Department (OPD), mainly as emergency encounters. Excluding emergency encounters, patients appeared to perceive the facilities as alternative practices. The practitioners' reports suggested some differences in practice and/or experience between the two facilities, which were in line with commonly held perceptions about OPD and private general practice. The data suggest that the similarities between the two facilities may outweigh the differences. Moreover, the differences between rural hospital practice and rural general practice should be seen as providing the opportunity for more rounded training, rather than mutually exclusive forms of practice.     

Therapeutic massage: an education program for rural and remote workers in the palliative care field

This paper, drawing upon data from a Rural Health, Support, Education and Training (RHSET) funded project, focuses on the evaluation of a massage education program developed specifically for rural and remote palliative care workers. An 8 week pilot massage education course was run for palliative care workers in the Albury–Wodonga area and, from this course, an instructional video education package on massage has been developed. The program was evaluated by using a questionnaire, journals and focus group interviews. Feedback from participants was incorporated into both the pilot course and final education package, which was consistent with the action research framework. The major findings of the project were that skill development in the therapeutic use of massage was attained and that job satisfaction was indeed achieved by palliative care workers.     

Going rural but not staying long: Recruitment and retention issues for the rural dietetic workforce in Australia

Aim: To determine the recruitment and retention issues for rural based dietetic services. Methods: A sequential explanatory mixed methods approach was used to examine six case study sites of dietetic practice, in a geographical area covering 30 000 km² in rural New South Wales, Australia. Quantitative data were obtained from document searches of human resource records between 1991 and 2006. Data were tabulated and counts and proportions used. Qualitative data were obtained from in-depth semistructured individual interviews conducted with 40 key informants including past and present dietitians (n = 28), dietetic managers (n = 3), health service managers (n = 6) and other key influencers (n = 3). The interviews were thematically analysed using the NVivo 7 program. Themes were coded into common categories, using a constant comparison inductive approach. Results: Ninety individual dietitians (94% female) were employed across the six sites over 15 years. The majority were new graduates with less than 1 year of experience. Approximately one-third remained in their position for less than 6 months while 32% remained for 2 years or longer. Key themes emerged from the qualitative data around the characteristics of a rural role, line management of dietitians in a rural site and establishing and maintaining rural staff. Conclusion: Recruitment and retention in rural areas may be improved in the future through strategies to reduce perceived professional isolation, improve management support, access to continuing education and the development of career pathways.     

Generational attitudes of rural mental health nurses

Objective:  To determine how attitudes of rural mental health nurses differ across generations.
Design:  Survey.
Setting:  Mental health services in rural New South Wales.
Participants:  Practising mental health nurses.
Main outcome measures:  Survey responses.
Results:  Survey response rate 44%. A total of 89 mental health nurses, clustered in inpatient units and community health centres, responded. Of these nurses, 4 were veterans, 52 baby boomers, 17 Generation X and 5 Generation Y.
Conclusions:  There are significant differences in how mental health nurses from different generations view their work, and in what is expected from managers. Managers need to modify traditional working styles, allowing greater flexibility of employment. They must also accept lower staff retention rates, and facilitate the development of younger staff.     

From 'problem-describing' to 'problem-solving': challenging the 'deficit' view of remote and rural health

Objective: Rural and remote health research has highlighted the many problems experienced in the bush. While attention to problems has raised awareness of the needs of rural and remote health, embedding a deficit perspective in research has stereotyped rural and remote health as poor environments to work in and as inherently problematic. The objectives of this paper are to challenge this thinking and suggest that a more balanced approach, acknowledging strengths, is beneficial. Design: This discussion identifies why the deficit approach is problematic, proposes a strengths‐based approach and identifies some key strengths of rural and remote health. Results: This study suggests alternative ways of thinking about rural and remote practice, including the rewards of rural and remote practice, that rural and remote communities can act as change agents, that these disciplines actively address the social determinants of health, that rural and remote areas have many innovative primary health care services and activities and that rural and remote contexts provide opportunities for evaluation and research. It is proposed that rural and remote health can be viewed as problem‐solving, thus dynamic and improving rather than as inherently problematic. Conclusion: Critical of a deficit approach to rural and remote health, this paper provides alternatives ways of thinking about these disciplines and recommends a problem‐solving perspective of rural and remote health.     

Oral health workforce in rural and remote Western Australia: practice perceptions

OBJECTIVE: In this study an analysis was undertaken to determine: (i) the major factors that influence oral health professionals to practise in rural areas and determine practice location; (ii) what assists the professional oral health workforce to remain in rural practice; and (iii) what the main reasons are for leaving rural practice. DESIGN: A postal survey was undertaken among all registered oral health professionals in Western Australia. SETTING: Rural and remote Western Australia. PARTICIPANTS: Registered dental therapists, dental hygienists and dentists in rural and remote Western Australia. RESULTS: Results indicated that there are various factors that attract people to rural and remote areas, other than financial incentives. Incentives to remain in rural practice include the need for professional development. The most common reason for leaving rural practice was to access children's educational facilities. CONCLUSIONS: This study emphasises that many factors contribute to recruitment and retention of dental professionals in rural practice. A broad integrated retention strategy is needed to address oral health workforce shortage issues in rural and remote Western Australia.     

基层医务人员职业认同、职业规划与工作满意度的关系

目的：探究内蒙古自治区基层医务人员职业认同与工作满意度的关系。方法：采用整群随机抽样方法,在内蒙古自治区的东部、中部和西部地区卫生系统抽取523名基层医务人员为调查对象,运用问卷调查、匿名填写的方法收集资料。结果：内蒙古基层卫生人员的工作满意度平均分为（3.70±0.74）分,工作满意度在民族、学历、职称、年龄方面的差异有统计学意义。基层卫生人员的职业认同平均分为（4.01±0.73）分,不同民族医务人员的职业认同有统计学意义（P〈0.05）,蒙古族医务人员职业认同感高于汉族。职业认同、职业规划和工作满意度呈显著正相关。职业规划在职业认同和工作满意度之间起部分中介作用。结论：改善薪酬和环境,制定有利的职业生涯发展政策,增强医务人员职业认同感,从而提升内蒙古基层医务人员的工作满意度。