ADVANCED LIFE SUPPORT: ROLE OF THE RURAL REGISTERED NURSE

ABSTRACT: This paper provides a human face to advanced life support (ALS) and its assention within rural nursing practice. Over the past 5 years the issue of defibrillation and who performs it has been debated. This paper will add to the discussion. It examines the history surrounding the development of ALS, education within the hospital and isolated rural setting competency testing. It questions the limited role of current nursing practice and makes recommendations for stretching the boundaries of the nursing role in ALS. Emphasis is placed on the rural perspective and its consequent implications for individuals living in a rural environment.     

WORKING TOGETHER: THE ADVANCED RURAL NURSE PRACTITIONER AND THE RURAL DOCTOR

ABSTRACT: This paper discusses the complex and interrelated roles of the rural nurse and doctor. These roles are viewed as being complementary to each other in any healthcare setting, but more so within the context of rural Australia. The current move towards the development of advanced nurse practitioner roles is often clouded by unnecessary medical fears that nurses are attempting to displace doctors. In contrast, this paper argues that the development of new rural nursing roles identifies rural nursing as a major specialist area within the wider profession of nursing and, at the same time, recognises the reality of practice for many rural nurses. Individual public figures may perceive the solution to the shortage of rural doctors to lie in their replacement with nurses. The nursing profession, however, will resist this approach. Nursing is not the first rung on the ladder to a career in medicine. Nurses are educated and acknowledged to focus their practice on the clients' responses to healthcare problems and not the practice of medicine. The primary role of the nurse is to provide care. The primacy of care should not be set aside by those nurses seeking to develop their practice, nor should advanced practice be defined in terms of taking on tasks previously carried out by other healthcare professionals.     

THE EFFECTIVENESS OF A PRECEPTORSHIP MODEL IN POSTGRADUATE EDUCATION FOR RURAL NURSES

ABSTRACT: This retrospective study was designed to evaluate the effectiveness of a preceptor program in meeting the needs of first-year graduate nurses employed in a large rural hospital. In particular, this project aimed to assess whether the program leads to improvement in the clinical skills of the graduate over the 12-month period of the program: the suitability of the program to meet the graduates' needs; and the perceptions of nursing unit managers, preceptors and enrolled nurses regarding the program. Questionnaires were designed and distributed to the above categories of nurses, as well as graduates. Results indicated that the graduates considered the program to be excellent and that it met their needs to a high degree, while the clinical nurses rated the program, between adequate and good. The paper will define the strengths and limitations of the program and the effect on recruitment and retention of nurses in a rural area.     

TRAINING AND SUPPORT PROGRAM FOR PHARMACISTS IN RURAL VICTORIA

ABSTRACT: The 'Rural Pharmacist Training and Support Program' was a pilot project that was conducted by the Monash University Centre for Rural Health. It examined the implementation of Pharmacy Board of Victoria Guidelines to Residential Care Facilities in the Loddon Mallee region of Victoria. Through a series of workshops, pharmacists were encouraged to discuss and address difficulties that were impeding implementation of the guidelines. These included upskilling in clinical pharmacy and ways to overcome the shortage of pharmacists in rural areas. Furthermore, the project was a catalyst for eight additional outcomes. This project highlighted the challenges facing rural pharmacists as they seek to implement the guidelines and resulted in a number of recommendations that addressed workforce issues, training and continuing education, Pharmacy Board requirements, improved communication with other health professionals and undergraduate training.     

PALLIATIVE HOME CARE IN A RURAL SETTING: REFLECTIONS ON SELECTIVE INTERACTIONS

ABSTRACT: Despite the fact that terminally ill patients are approaching the end-stage of their lives, the need for information and continuing involvement in their own care remains paramount and does not necessarily diminish as their dependency increases. This paper supports the view that nurses working in the area of rural palliative care are in an optimum position to establish the kind of relationship with patients and informal carers that augments a sense of involvement, self determination, equity and trust. This is of particular significance to rural palliative care where service provision may be under-resourced and where domiciliary nurses are often the key provider for continuing care and support.     

AGED CARE REFORMS: POLICY IMPLICATIONS FOR RURAL AND REMOTE AUSTRALIA

ABSTRACT: In 1996, the Federal Government announced a draft of reforms in the aged care sector, including the controversial proposal to introduce upfront bonds for new nursing home residents with assets of more than $23 000. Following effective lobbying from welfare and church groups and pensioner organisations, the Prime Minister announced the axing of the bonds policy for nursing home residents in November 1997 and its replacement with an accommodation charge of $4380 per annum for 5 years. The social justice and ideological underpinnings of these Aged Care Reforms remain contentious, and have fundamental and long-term policy implications for the provision of aged care services in rural and remote areas.     

重庆市统筹城乡医疗保障的实践探索

[目的]总结和分析重庆市在医疗保障城乡统筹实践探索中的经验。[方法]选取重庆市九龙坡区城乡居民合作医疗保险管理中心作为现场进行实证调查。收集医疗保险城乡统筹前后有关的政策文件和报表数据与参保人员的信息等。[结果]农村居民财政补助资金未及时到位;补偿比例、封顶线设置较低,起付线设置较高;基金使用率较低;补偿基金主要流向基层医疗机构;获得住院补偿的参保居民总体的受益率仅6.06%左右,且Ⅰ档和Ⅱ档之间受益情况差异较大。[结论重庆市在实践探索中已取得的成果和存在的问题:打破身份界限,统一城乡居民医疗保险待遇标准;整合现有资源,统一城乡医疗保险经办操作;促进了基层医疗资源的有效利用;政府财政投入未能及时到位,实际报销比例较低;基金沉淀问题;统筹层次较低,"穷帮富"的现象较为突出。     

成都市3所农村中学学生食品安全知信行调查

[目的]了解成都市农村中学生对食品安全的知识、行为、态度,为进一步开展农村中学生健康教育和行为干预提供理论依据.[方法]随机整群抽取成都市近郊3所农村中学的3900人.以自行设计的调查问卷进行调查.[结果]食品安全卫生知识知晓率为85.22%,行为形成率77.68%,男女生差异有统计学意义,女生较男生高;有93.55%的学生表示愿意改变不良生活习惯;80.17%的学生愿意接受健康培训讲座.[结论]成都市近郊农村中学生的知识知晓率较高,行为形成率较高,健康教育是提高学生食品卫生知识知晓率的有效方法.     

International Perspective: ISSUES FOR NURSES IN RURAL AND REMOTE CANADA

ABSTRACT: Canada is a vast country with great diversity in its landscape, industry, culture and communities. The healthcare issues and concerns of people living in rural and remote areas are as fully diverse as the people and the landscape. This article describes the context of rural and remote nursing practice in Canada and discusses issues of health status and the social determinants of health, geographical isolation, professional isolation and cultural safety. It concludes with current initiatives in practice, education, research and policy. Particular issues facing nurses in rural and remote First Nations communities are highlighted.     

TECHNOLOGY IN EDUCATION: WHAT IS APPROPRIATE FOR RURAL AND REMOTE ALLIED HEALTH PROFESSIONALS?

ABSTRACT: Recent technological advances provide exciting opportunities for the delivery of education to rural and remote allied health professionals. Distance education modes can overcome barriers of distance and cost. However, the use of technologies may allow distance education to be more interactive for rural and remote professionals. Technologies that can be used are audioconferencing, videoconferencing, electronic mail (email), CD-ROM and the Internet. Combinations of any of these technologies and traditional forms of educational delivery are possible. The important objective is to create a learning environment that maximises interactivity and develops information literacy.     

Evaluation of dietetic activity analysis (DAA)—a system for data collection in clinical dietetics

A system of data collection and analysis based on patient visits was evaluated over a four-week period in five districts and a six-month period in one district by twenty-five dietitians. Each patient visit was analysed by diagnosis (the problem), by diet (the treatment) and by nutritional care level (the action). The system was seen to encourage self analysis by dietitians and proved a useful educational tool in addition to providing dietetic managers with data on clinical dietetic activity. It was considered successful and well accepted in four of the six districts.     

农村卫生适宜技术筛选方法的研究

[目的]寻找农村卫生适宜技术的科学筛选方法,为全国(各省市)地方农村卫生适宜技术的科学筛选提供参考依据。[方法]采用加权得分累加法、样品聚类分析法分析重庆市5个项目县农村卫生服务需求基线调查资料及德尔菲专家咨询结果。[结果]优选出了5个项目县的25项适宜技术,主要是针对呼吸、消化、心脑血管、妇女常见多发病等疾病的适宜技术。[结论]卫生服务需求基线调查、德尔菲专家咨询相结合是农村卫生适宜技术筛选的科学方法。     

《日行事历表》在创建优质护理服务示范病房中的应用

目的探讨《日行事历表》在创建优质护理服务示范病房管理工作中的应用方法及效果。方法将自行设计的《日行事历表》应用于护长的日常护理管理工作中,比较使用前后科室的临床护理服务质量、护理病历质量、患者满意度三方面的效果。结果使用《日行事历表》后本科室护士的基础护理、健康教育合格率明显高于使用前,护理病历合格率、患者对护理工作的满意度也较前显著提高,差异有统计学意义。结论护长应用《日行事历表》进行护理管理,能够提高临床护理服务质量,改善患者满意度,促进优质护理服务示范病房的创建。     

A REVIEW OF HEALTH INTERPRETER SERVICES IN A RURAL COMMUNITY: A TOTAL QUALITY MANAGEMENT APPROACH

ABSTRACT: The current focus in health care is on total quality management (TQM), a process that involves ongoing quality improvement and benefits both internal and external customers. In order to comply with the values of TQM, the Griffith Murrumbidgee Health Service set up a team to review the use of interpreters in a healthcare setting. Staff from a number of wards/units filled out a survey sheet regarding interpreter services for each patient/client presenting for service during a 1-month period. The results showed that (i) there was a marked tendency by staff to use non-accredited interpreters; and (ii) staff who used non-accredited interpreters tended to inappropriately assess patient/client interpreting needs and to be unfamiliar with the Health Care Interpreter Policy. The TQM team subsequently devised several strategies for change.     

RURAL ATTACHMENTS FOR STUDENTS IN THE HEALTH PROFESSIONS: ARE THEY WORTHWHILE?

ABSTRACT: In the period 1991–96, 156 undergraduates from 14 health disciplines at the University of Sydney completed rural attachments in rural and remote areas of Australia as part of the Rural Careers Project. On return from their attachment, students were encouraged to write a brief report of their experiences. Ninety-two available reports were analysed as one means of assessing the success of the attachments with respect to informing students about rural health issues and stimulating their interest in rural careers after graduation. A content analysis of the students' written comments about their perceptions and experiences was completed. Students were extremely positive about the value of the attachments and expressed more positive than negative comments regarding their perceptions of rural life and work. The results show that rural attachments are indeed worthwhile learning opportunities.     

构建三级医院知识管理平台 促进城乡卫生服务均等化

目的城乡卫生医疗服务均等化是新医改的重要内容之一,全面提升乡镇医疗机构的医疗技术水平需要建立持续而有效的知识支持体系。笔者结合实践,介绍我院通过构建基于网站、论坛、手机以及远程医疗等多维一体的三级医院与乡镇医院的知识管理与交流平台帮助基层医疗机构的医疗水平的全面提升,为促进城乡卫生服务均等化作有益的尝试。并对三级医院对基层医疗机构知识支援的意义与必要性进行了深入的探讨。     

A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States.

OBJECTIVE: Two recent Institute of Medicine reports highlight that the quality of healthcare in the US is less than what should be expected from the world's most extensive and expensive healthcare system. This may be especially true for critical access hospitals since these smaller rural-based hospitals often have fewer resources and less funding than larger urban hospitals. The purpose of this paper was to compare quality of hospital care provided in urban acute care hospitals to that provided in rural critical access hospitals. DESIGN: Cross-sectional study analyzing secondary Hospital Compare data. T-test statistics were computed on weighted data to ascertain if differences were statistically significant (P=0.01). SETTING: Centers for Medicare and Medicaid Services hospitals. PARTICIPANTS: US Acute Care and Critical Access hospitals. MAIN OUTCOME MEASURES: Differences between urban acute care hospitals and rural critical access hospitals on quality care indicators related to acute myocardial infarction, heart failure and pneumonia. RESULTS: For 8 of the 12 hospital quality indicators the differences between urban acute care and rural critical access hospitals were statistically significant (P=0.01). In seven instances these differences favored urban hospitals. One indicator related to pneumonia favored rural hospitals CONCLUSIONS: Although this study focused on only three disease states, these are among the most common clinical conditions encountered in inpatient settings. The findings suggested that there may be differences in quality in rural critical access hospitals and urban acute care hospitals and support the need for future studies addressing disparities between urban acute care and rural critical access hospitals.