The challenges confronting clinicians in rural acute care settings: a participatory research project
- Paliadelis, Penny, Parmenter, Glenda, Parker, Vicki, Giles, Michelle, Higgins, Isabel
- Authors: Paliadelis, Penny , Parmenter, Glenda , Parker, Vicki , Giles, Michelle , Higgins, Isabel
- Date: 2012
- Type: Text , Journal article
- Relation: Rural and Remote Health Vol. 12 (online), no. (2012), p.
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- Description: In Australia, as in many other developed countries, the current healthcare environment is characterised by increasing differentiation and patient acuity, aging of patients and workforce, staff shortages and a varied professional skills mix, and this is particularly so in rural areas. Rural healthcare clinicians are confronted with a broad range of challenges in their daily practice. Within this context, the challenges faced by rural acute care clinicians were explored and innovative strategies suggested. This article reports the findings of a study that explored these challenges across disciplines in acute healthcare facilities in rural New South Wales (NSW), Australia. METHODS: A mixed method approach, involving a consultative, participatory 3 stage data collection process was employed to engage with a range of healthcare clinicians from rural acute care facilities in NSW. Participants were invited to complete a survey, followed by focus group discussions and finally facilitated workshops using nominal group technique. RESULTS: The survey findings identified the respondents' top ranked challenges. These were organised into four categories: (1) workforce issues; (2) access, equity and opportunity; (3) resources; and (4) contextual issues. Participants in the focus groups were provided with a summary of the survey findings to prompt discussion about the challenges identified and impact of these on their professional and personal lives. The results of the final workshop stage of the study used nominal group process to focus the discussion on identifying strategies to address identified challenges. CONCLUSIONS: This study builds on research conducted in a large metropolitan tertiary referral hospital. While it was found that rural clinicians share some of the challenges identified by their metropolitan counterparts, some identified challenges and solutions were unique to the rural context and require the innovative solutions suggested by the participants. This article provides insight into the working world of rural healthcare clinicians and offers practical solutions to some of the identified issues. The findings of this study may assist rurally based healthcare services to attract and retain clinical staff.
The challenges confronting clinicians in rural acute care settings: a participatory research project
- Authors: Paliadelis, Penny , Parmenter, Glenda , Parker, Vicki , Giles, Michelle , Higgins, Isabel
- Date: 2012
- Type: Text , Journal article
- Relation: Rural and Remote Health Vol. 12 (online), no. (2012), p.
- Full Text:
- Reviewed:
- Description: In Australia, as in many other developed countries, the current healthcare environment is characterised by increasing differentiation and patient acuity, aging of patients and workforce, staff shortages and a varied professional skills mix, and this is particularly so in rural areas. Rural healthcare clinicians are confronted with a broad range of challenges in their daily practice. Within this context, the challenges faced by rural acute care clinicians were explored and innovative strategies suggested. This article reports the findings of a study that explored these challenges across disciplines in acute healthcare facilities in rural New South Wales (NSW), Australia. METHODS: A mixed method approach, involving a consultative, participatory 3 stage data collection process was employed to engage with a range of healthcare clinicians from rural acute care facilities in NSW. Participants were invited to complete a survey, followed by focus group discussions and finally facilitated workshops using nominal group technique. RESULTS: The survey findings identified the respondents' top ranked challenges. These were organised into four categories: (1) workforce issues; (2) access, equity and opportunity; (3) resources; and (4) contextual issues. Participants in the focus groups were provided with a summary of the survey findings to prompt discussion about the challenges identified and impact of these on their professional and personal lives. The results of the final workshop stage of the study used nominal group process to focus the discussion on identifying strategies to address identified challenges. CONCLUSIONS: This study builds on research conducted in a large metropolitan tertiary referral hospital. While it was found that rural clinicians share some of the challenges identified by their metropolitan counterparts, some identified challenges and solutions were unique to the rural context and require the innovative solutions suggested by the participants. This article provides insight into the working world of rural healthcare clinicians and offers practical solutions to some of the identified issues. The findings of this study may assist rurally based healthcare services to attract and retain clinical staff.
How health professionals conceive and construct interprofessional practice in rural settings : A qualitative study
- Parker, Vicki, McNeil, Karen, Higgins, Isabel, Mitchell, Rebecca, Paliadelis, Penny, Giles, Michelle, Parmenter, Glenda
- Authors: Parker, Vicki , McNeil, Karen , Higgins, Isabel , Mitchell, Rebecca , Paliadelis, Penny , Giles, Michelle , Parmenter, Glenda
- Date: 2013
- Type: Text , Journal article
- Relation: BMC Health Services Research Vol. 13, no. 500 (2013), p.1-11
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- Description: Background Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. Methods Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. Results There was clear evidence of diversity and complexity associated with IPP in the rural settings that was supported by descriptions of collaborative integrated practice. There were instances where IPP doesn’t and could happen. There were a number of characteristics identified that significantly impacted on IPP including the presence of a shared philosophical position and valuing of IPP and recognition of the benefits, funding to support IPP, pivotal roles, proximity and workforce resources. Conclusions The nature of IPP in rural contexts is diverse and determined by a number of critical factors. This study goes some of the way towards unravelling the complexity of IPP in rural contexts, highlighting the strong motivating factors that drive IPP. However, it has also identified significant structural and relational barriers related to workload, workforce, entrenched hierarchies and ways of working and service fragmentation. Further research is required to explicate the mechanisms that drive successful IPP across a range of diverse rural contexts in order to inform the implementation of robust flexible strategies that will support sustainable models of rural IPP.
- Authors: Parker, Vicki , McNeil, Karen , Higgins, Isabel , Mitchell, Rebecca , Paliadelis, Penny , Giles, Michelle , Parmenter, Glenda
- Date: 2013
- Type: Text , Journal article
- Relation: BMC Health Services Research Vol. 13, no. 500 (2013), p.1-11
- Full Text:
- Reviewed:
- Description: Background Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. Methods Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. Results There was clear evidence of diversity and complexity associated with IPP in the rural settings that was supported by descriptions of collaborative integrated practice. There were instances where IPP doesn’t and could happen. There were a number of characteristics identified that significantly impacted on IPP including the presence of a shared philosophical position and valuing of IPP and recognition of the benefits, funding to support IPP, pivotal roles, proximity and workforce resources. Conclusions The nature of IPP in rural contexts is diverse and determined by a number of critical factors. This study goes some of the way towards unravelling the complexity of IPP in rural contexts, highlighting the strong motivating factors that drive IPP. However, it has also identified significant structural and relational barriers related to workload, workforce, entrenched hierarchies and ways of working and service fragmentation. Further research is required to explicate the mechanisms that drive successful IPP across a range of diverse rural contexts in order to inform the implementation of robust flexible strategies that will support sustainable models of rural IPP.
Looking after yourself : Clinical understandings of chronic-care self-management strategies in rural and urban contexts of the United Kingdom and Australia
- Carr, Susan, Paliadelis, Penny, Lhussier, Monique, Forster, Natalie, Eaton, Simon, Parmenter, Glenda, Death, Catharine
- Authors: Carr, Susan , Paliadelis, Penny , Lhussier, Monique , Forster, Natalie , Eaton, Simon , Parmenter, Glenda , Death, Catharine
- Date: 2014
- Type: Text , Journal article
- Relation: Sage Open Medicine Vol. 2, no. (2014), p.1-9
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- Description: Objectives: This article reports on the outcomes of two similar projects undertaken during 2011–2012 in Australia (Rural Northern New South Wales) and the United Kingdom (Urban Northern United Kingdom) that sought to identify the strategies that health professionals employ to actively involve patients with chronic conditions in the planning and delivery of their care. In particular, this study explored understandings and contexts of care that impacted on the participants’ practices. This study was informed by the global shift to partnership approaches in health policy and the growing imperative to deliver patient or client-centred care. Methods: An ethnomethodological design was used, as ethnomethodology does not dictate a set of research methods or procedures, but rather is congruent with any method that seeks to explore what people do in their routine everyday lives. Focus groups and interviews were employed to explore the strategies used by a range of primary health-care providers, such as general practitioners, nurses, social workers, diabetes educators, dieticians and occupational therapists, to support clients to effectively manage their own chronic conditions. Results: Data from both studies were synthesised and analysed thematically, with the themes reflecting the context, similarities and differences of the two studies that the participants felt had either facilitated or blocked their efforts to support their clients to adopt self-care strategies. Conclusion: Supporting patients/clients to engage in actively self-managing their health-care needs requires changes to clients’ and clinicians’ traditional perspectives on their roles. The barriers and enablers to supporting clients to manage their own health needs were similar across both locations and included tensions in role identity and functions, the discourse of health-care professionals as ‘experts’ who deliver care and their level of confidence in being facilitators who ‘educate’ clients to effectively manage their health-care needs, rather than only the ‘providers’ of care.
- Authors: Carr, Susan , Paliadelis, Penny , Lhussier, Monique , Forster, Natalie , Eaton, Simon , Parmenter, Glenda , Death, Catharine
- Date: 2014
- Type: Text , Journal article
- Relation: Sage Open Medicine Vol. 2, no. (2014), p.1-9
- Full Text:
- Reviewed:
- Description: Objectives: This article reports on the outcomes of two similar projects undertaken during 2011–2012 in Australia (Rural Northern New South Wales) and the United Kingdom (Urban Northern United Kingdom) that sought to identify the strategies that health professionals employ to actively involve patients with chronic conditions in the planning and delivery of their care. In particular, this study explored understandings and contexts of care that impacted on the participants’ practices. This study was informed by the global shift to partnership approaches in health policy and the growing imperative to deliver patient or client-centred care. Methods: An ethnomethodological design was used, as ethnomethodology does not dictate a set of research methods or procedures, but rather is congruent with any method that seeks to explore what people do in their routine everyday lives. Focus groups and interviews were employed to explore the strategies used by a range of primary health-care providers, such as general practitioners, nurses, social workers, diabetes educators, dieticians and occupational therapists, to support clients to effectively manage their own chronic conditions. Results: Data from both studies were synthesised and analysed thematically, with the themes reflecting the context, similarities and differences of the two studies that the participants felt had either facilitated or blocked their efforts to support their clients to adopt self-care strategies. Conclusion: Supporting patients/clients to engage in actively self-managing their health-care needs requires changes to clients’ and clinicians’ traditional perspectives on their roles. The barriers and enablers to supporting clients to manage their own health needs were similar across both locations and included tensions in role identity and functions, the discourse of health-care professionals as ‘experts’ who deliver care and their level of confidence in being facilitators who ‘educate’ clients to effectively manage their health-care needs, rather than only the ‘providers’ of care.
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