Medical students and rural general practitioners: congruent views on the reality of recruitment into rural medicine

OBJECTIVE: In-depth exploration of the perceptions, experiences and expectations of current long-term rural GPs and medical students intent on a rural career, regarding the current and future state of rural medicine. DESIGN: Qualitative study using semistructured interviews. SETTING: Rural and remote towns in Central and Southern Queensland and the School of Medicine, University of Queensland. PARTICIPANTS: Thirteen rural GPs with 10-40 years experience. Medical students (five second- and seven third-year), all of whom are members of a rural students' club and have an intention to pursue rural practice. Interviews were conducted between August and December 2004. MAIN OUTCOME MEASURES: Emergent themes relating to participant perceptions of the current and future state of rural medicine. RESULTS: Despite large differences in generation and experience, medical students and rural GPs hold similar perceptions and expectations regarding the current and future state of rural practice. In particular, they cite a lack of professional support at the systems level. This includes specific support for: continuing medical education to obtain and retain the skills necessary for rural practice; dealing with the higher risks associated with procedural work; and consequences of medico-legal issues and workforce shortage issues such as long hours and availability of locums. CONCLUSIONS: Issues relating to recruitment and retention of the rural health workforce are identified by both cohorts as relating to professional support. Medical schools and institutional support systems need to join forces and work together to make rural practice a viable career in medicine.     

Patient education and consumer medicine information: a study of provision by Queensland rural and remote area Registered Nurses

Aims and objectives. The aim of the larger study was to ascertain the medication practices of registered and enrolled nurses in rural and remote areas of Queensland after the introduction of the Health (Drugs and Poisons) Regulation. This paper reports on the findings of the role of registered nurses and their confidence in the ability to provide information on medications in a way that the client understands; the frequency of the provision of information to clients prior to discharge; and the frequency of Indigenous Health Workers or interpreters for people without English as a first language. Background. Queensland employs approximately 17% of the Australian registered nurse workforce. In 1996 Queensland changed the Health (Drugs and Poisons) Regulation to allow specific registered nurses, who had undertaken approved postgraduate education and training programmes, to become endorsed for an expanded medication practice role. In particular, it allowed endorsed nurses to administer and supply (but not prescribe) drugs listed in a drug formulary to certain clients using protocols. It was not clear, however, whether the changes to the Regulation reflected the scope of practice, thereby providing adequate legal protection for the nurse. Design. During 2001–02 an exploration of the medication practices of rural and remote area nurses was conducted by the use of a cross‐sectional postal survey. Phase 1 of the study used a facility audit to ascertain facility medication practices and phase 2 of the study used a postal survey to ascertain nurses’ medication practices. Method. All nurses employed in rural and remote health facilities in Queensland were eligible to participate in the study. The nurse registering authority's (the Queensland Nursing Council) register was used to generate a non‐proportional stratified random sample. Of the 1999 questionnaires sent, there were 668 respondents. Of these, 520 were registered nurses. Results. The data indicated that there was a difference between endorsed and unendorsed registered nurses’ medication practice. In particular, it was apparent that endorsed registered nurses were more likely to believe they could explain the side‐effects of medication to clients in a way the patient understood; provided medication education to clients on discharge; and used Indigenous Health Workers or interpreters to explain medications to those clients for whom English was not a first language. However, it was apparent that <50% of all Registered Nurses were providing client medication education or using Indigenous Health Workers or interpreters. Conclusion. It is apparent that the changes to the Regulation have ensured that Registered Nurses who have undergone postgraduate education to enhance their medication practice are more likely to provide client education and consumer medication information. However, the results suggest that the majority of registered nurses in Queensland, whilst believing they have sufficient knowledge of pharmacology to provide client education, often do not provide appropriate medication advice to clients, particularly on discharge from the acute setting. Relevance to clinical practice. It is well recognized that the provision of medication education to clients has several benefits to both the client and the health care system. The lack of client medication education indicated in this study compromises patient's safety as well as their compliance with their medication regime.     

Aged care nursing in Queensland - the nurses' view

Aims and objectives. Through comparison of two studies undertaken three years apart the opinions of nurses working in aged care facilities in Queensland were determined. Results will support policy planning for the Queensland Nurses Union. Background. An ageing population in Australia is placing increased demands on residential aged care facilities. In Queensland, the national situation is exacerbated by an influx of retirees from other states and territories. The ongoing problem of shortages of nurses in the workforce may be addressed by gaining further insight into the nurses’ own views of their conditions and experiences. Methods. One thousand nurses working in public and privately owned residential aged care facilities were surveyed by postal questionnaire in 2004. Results were compared with data collected in an identical study in 2001. Results. Respondents offered their opinions on working hours and conditions, professional development and experiences in nursing. The predominately female aged care nursing workforce is ageing. Reported workplace violence has increased substantially since 2001. Some improvements are reported in staff numbers, skill mix and workplace policies. Nurses expressed very serious concerns about pay, workload, stress, physical and emotional demands and staff morale. Conclusion. Working conditions for nurses in the residential aged care sector in Queensland must be addressed to retain the current nurses and to encourage new nurses to replace those that retire. Relevance to clinical practice. The findings of this study provide information not only for the Queensland Nurses Union but also policy makers and nurse managers both nationally and internationally on areas that need to be addressed to maintain the required workforce within the aged care sector.     

Sodium crocetinate does not alter gut hypercapnic responses or renal energy stores during transient sub-diaphragmatic ischaemia

OBJECTIVES: To evaluate the protection afforded by trans-sodium crocetinate against dysoxia in an animal model of recurrent sub-diaphragmatic ischaemia. DESIGN: Prospective experimental animal study. SETTING: University research laboratory SUBJECTS: Adult male Sprague-Dawley rats. INTERVENTIONS: Twelve adult male Sprague-Dawley rats (340-510 g) were anaesthetised with sodium pentobarbitone 60 mg/kg i.p. and ventilated with oxygen and isoflurane via tracheostomy. Six 2-min episodes of sub-diaphragmatic hypotension (mean pressure 30 mmHg) were induced using a sling around the proximal aorta. Before the third and sixth episodes, saline 1.5 ml/kg was injected into the aortic cannula. In six rats, this saline contained trans-sodium crocetinate 50 microg/ml. MEASUREMENTS AND MAIN RESULTS: Ileal luminal PCO(2) and distal aortic pressure were monitored continuously. Following ischaemic episodes trans-sodium crocetinate had no discernible effect on either degree of PCO(2) elevation or the time to peak PCO(2). No effects on renal energy charge or nucleotide concentrations were detected. UV-visible spectroscopy of the crocetinate preparation showed that some cis isomer was present. CONCLUSIONS: The findings, although limited to one drug dosage in one animal model, bring into question whether trans-sodium crocetinate affects plasma oxygen diffusivity in vivo. Alternative explanations for the negative findings include a TSC-induced exacerbation of arterio-venous oxygen shunting, the brevity of the dysoxic episodes, and the presence of cis isomer.     

Separation of conjoined twins: experiences of perioperative nurses and their recommendations

BACKGROUND: Within an 8-month period, an unprecedented and historical first in Queensland, Australia, the perioperative nurses were members of teams involved in the surgical separation of two sets of conjoined twins. Little is known about the (dis)stress that some of these perioperative nurses experienced nor how best to support them during such experiences. AIM: The aim of this paper is to report on the qualitative study that explored the experiences of those perioperative nurses involved in the surgical separation of cojoined twins and from their stories propose recommendations to support perioperative nurses who are confronted with such workplace experiences. METHODS: Using a narrative methodology, nine perioperative nurses shared their stories of being involved in the surgical separation of conjoined twins in Australia. Narrative and thematic analyses were conducted and recommendations to support perioperative nurses through workplace (dis)stress were identified. Participants validated the findings and recommendations. FINDINGS: The analyses revealed the themes of professionalism, teamwork, 'them vs. us' and emotional loads. DISCUSSION: The sensationalism around the rarity of conjoined twins brought an intensive intrusiveness from the world media. As a result, secrecy within the hospital about the conjoined twin cases created divisions between those perioperative nurses on the teams and those not. The processes and outcomes of the two surgical cases were in contrast to each other. For some perioperative nurses this caused distress. It is essential that professional support is offered in a way in which the perioperative nurse can take it up without fear of negative judgement.     

A survey of sedation assessment and management in Australian and New Zealand paediatric intensive care patients requiring prolonged mechanical ventilation

INTRODUCTION: A retrospective analysis of sedation management for children receiving prolonged ventilation in one Australian paediatric intensive care unit (PICU) revealed no identifiable pattern in sedation management and an inadequacy in the sedation scoring system. Therefore, the investigators sought to explore the current practice of sedation in critically ill children in PICUs across Australia and New Zealand. METHOD: This study used a mail-out survey to audit sedation management within the eight dedicated Australian and New Zealand PICUs. Results: 100% of the units surveyed replied (n=8). There were a total of 6,133 admissions to 8 Australian and New Zealand PICUs, where 3036 (49.5%) required ventilation. Of these children, 888 (29.2%) required ventilation > or =72 hours. Only 4 units had written guidelines for sedation management. A combined sedation regime of benzodiazepines and opioids was employed in six units. Administration and titration of sedation agents was managed by nursing staff alone in six units. All units indicated that they aimed to achieve a 'moderate level' of sedation. Two units used designated assessment tools for sedation and withdrawal assessment. One unit utilised Bispectral Index (BIS) monitoring. CONCLUSION: There were similarities observed in the methods and types of sedation agents used within Australian and New Zealand PICUs. However, only half of the units had guidelines for sedation management, and most units did not use validated paediatric scales to assist staff in assessing patient sedation and pain levels. Therefore it is recommended that a standardised approach to sedation assessment and management of critically ill children requiring prolonged ventilation be developed and tested.