Discourses within the roles of Remote Area Nurses in Northern Territory (Australia) government-run health clinics

The Northern Territory (NT) government operates remote clinics which are primarily staffed by Aboriginal Health Practitioners and Remote Area Nurses (RANs). RAN practice has been described as particularly complex due to high health needs, workforce shortages and high levels of turnover in remote Aboriginal communities. While individual incentives are offered, there has been little examination of the role and why the work takes such a toll on RANs. This study aims to identify dominant discourses underpinning RAN practice and how these discourses reflect tensions and reinforce power relations that impact on the RAN role. Discourses were identified from a Foucauldian-inspired discourse analysis of 29 interviews with RANs in six remote NT communities. Five dominant discourses were identified, namely, that permanent RANs are preferred to agency RANs, RANs portray themselves as experienced and certain, RANs use autonomous clinical judgement, Aboriginal staff are important and RAN’s belief in making a difference. However, the experience of RANs suggested that there are many types of employment that learning from was also important, RANs often struggled to work with Aboriginal staff and they were unsure if they were making a difference. Furthermore, these discourses created tensions between RANs who were permanent–agency, older–younger, experienced–newer and certain–reflexive. Deconstructing these rigid discourses could allow the RAN role to be reconstructed in ways that lead to better retention, job satisfaction and health outcomes.     

Use of the 8 French Simmons-2 guide catheter for carotid artery stent placement in patients with difficult aortic arch anatomy

Inability to achieve vascular access is a common reason for failure to perform carotid artery angioplasty and stent placement. The authors report their experience with the use of an 8 Fr Simmons-2 catheter to gain carotid artery access in the setting of complex aortic arch anatomy. This guide catheter was used successfully to perform carotid artery angioplasty and stent placement in 10 patients with markedly tortuous aortic arches or supra-aortic branches. As the authors gained experience with this catheter, they used it as a first option in patients with the appropriate aortic arch anatomy.