(Re)creating spaces within rural general practice : Women as agents of change at the organisational and practitioner levels
- Authors: Schwarz, Imogen
- Date: 2005
- Type: Text , Thesis , PhD
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- Description: This thesis examines how women, as agents of change, contest the male-dominated structures at the organisational and practitioner levels of rural medicine in Australia. The premises for this study are that females now outnumber males as medical graduates and general practice trainees, yet women are significantly less likely than men to occupy rural and remote practice positions in Australia. Furthermore, the organisation of medicine remains strongly patriarchal. A feminist qualitative design underpins this empirical study involving: in-depth interviews with seventeen women activists and thirteen rural women general practitioners; grounded theory analysis of transcribed interviews; and interpretation of findings through a feminist poststructural lens. Findings uncover the gendered organisational and practitioner environment through which change is negotiated. At the organisational level, male exclusionary practices – played out through the ‘male as norm’ and the ‘problem is women’ discourses – position women in highly contradictory ways and marginalise their voices. Yet simultaneously, activists are challenging entrenched interests through individual and collective strategies of change which include: initiating gender-awareness projects; claiming legitimacy by using male-centred tactics and women-defined discourses; developing female-friendly initiatives; and mentoring of and building alliances between women. At the practitioner level, results reveal how women’s everyday lives as rural general practitioners are shaped by oppositional tensions. However, beyond the struggle of ‘fitting in’, women are altering rural medicine by (re)shaping meanings and (re)constructing work practices. Furthermore, their narratives suggest that rural spaces are integral to ways women carve out women-defined practice. A key innovation of this thesis is analysis of change at dual levels, both organisational and practitioner. This thesis marks a significant advancement upon the usual themes that attend only to the marginalisation of women and rural areas. It highlights the transformative process through which women (re)create the discursive spaces of rural general practice.
- Description: Doctor of Philosophy
- Authors: Schwarz, Imogen
- Date: 2005
- Type: Text , Thesis , PhD
- Full Text:
- Description: This thesis examines how women, as agents of change, contest the male-dominated structures at the organisational and practitioner levels of rural medicine in Australia. The premises for this study are that females now outnumber males as medical graduates and general practice trainees, yet women are significantly less likely than men to occupy rural and remote practice positions in Australia. Furthermore, the organisation of medicine remains strongly patriarchal. A feminist qualitative design underpins this empirical study involving: in-depth interviews with seventeen women activists and thirteen rural women general practitioners; grounded theory analysis of transcribed interviews; and interpretation of findings through a feminist poststructural lens. Findings uncover the gendered organisational and practitioner environment through which change is negotiated. At the organisational level, male exclusionary practices – played out through the ‘male as norm’ and the ‘problem is women’ discourses – position women in highly contradictory ways and marginalise their voices. Yet simultaneously, activists are challenging entrenched interests through individual and collective strategies of change which include: initiating gender-awareness projects; claiming legitimacy by using male-centred tactics and women-defined discourses; developing female-friendly initiatives; and mentoring of and building alliances between women. At the practitioner level, results reveal how women’s everyday lives as rural general practitioners are shaped by oppositional tensions. However, beyond the struggle of ‘fitting in’, women are altering rural medicine by (re)shaping meanings and (re)constructing work practices. Furthermore, their narratives suggest that rural spaces are integral to ways women carve out women-defined practice. A key innovation of this thesis is analysis of change at dual levels, both organisational and practitioner. This thesis marks a significant advancement upon the usual themes that attend only to the marginalisation of women and rural areas. It highlights the transformative process through which women (re)create the discursive spaces of rural general practice.
- Description: Doctor of Philosophy
Collaboration between nurses and physicians in an Indonesian Emergency Department
- Suryanto, Plummer, Virginia, Copnell, Beverley
- Authors: Suryanto , Plummer, Virginia , Copnell, Beverley
- Date: 2016
- Type: Text , Journal article
- Relation: Australasian Emergency Nursing Journal Vol. 19, no. 2 (2016), p. 82-89
- Full Text: false
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- Description: Background: Positive collaboration between nurses and physicians is essential in emergency practice because it has a significant relationship with the quality, safety, accountability, and responsibility of care. The aim of this study was to examine nurses' and physicians' attitudes towards collaboration in the Emergency Department in the Indonesian context. Methods: The study was a comparative study using a modified Jefferson Scale of Attitude towards Physician-Nurse Collaboration. Data were collected from 47 nurses and 24 physicians of one of 25 general hospitals in Malang, Indonesia, by anonymous survey. Results: Emergency nurses had significantly more positive attitudes towards collaboration than emergency physicians (P < 0.001). Emergency nurses had significantly higher scores in three of four domains of the instrument, "physician dominance", "nurse autonomy", and "caring as opposed to curing". The effects of gender, age, and education on nurses' and physicians' attitude towards collaboration were not statistically significant. However, experience in the Emergency Department of the general hospital was significantly related to participants' attitudes towards collaboration (P = 0.023). Conclusions: The findings of this study indicate that attitudes towards collaboration among the two professions should be enhanced. Inter-professional education and promotion of teamwork may be solutions to improve the relationship, not only between nurses and physicians, but also other healthcare providers. © 2016 College of Emergency Nursing Australasia.
To remain, migrate abroad or resettle : a complex dynamic process affecting Pakistani physicians' career decisions
- Arif, Muhammad, Cruickshank, Mary, Fraser, John
- Authors: Arif, Muhammad , Cruickshank, Mary , Fraser, John
- Date: 2019
- Type: Text , Journal article
- Relation: Asia Pacific Journal of Health Management Vol. 14, no. 3 (2019), p.
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- Description: OBJECTIVE This study investigated Pakistani physicians' decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. METHODS This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as 'stayers', 'leavers' and 'resettlers' were interviewed via telephone to explore their lived experience in 2008-2009. RESULTS Results show a dynamic nature of the physicians' career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians' can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. CONCLUSIONS The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals. © 2019 Asia Pacific Journal of Health Management. All Rights Reserved.
- Authors: Arif, Muhammad , Cruickshank, Mary , Fraser, John
- Date: 2019
- Type: Text , Journal article
- Relation: Asia Pacific Journal of Health Management Vol. 14, no. 3 (2019), p.
- Full Text:
- Reviewed:
- Description: OBJECTIVE This study investigated Pakistani physicians' decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. METHODS This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as 'stayers', 'leavers' and 'resettlers' were interviewed via telephone to explore their lived experience in 2008-2009. RESULTS Results show a dynamic nature of the physicians' career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians' can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. CONCLUSIONS The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals. © 2019 Asia Pacific Journal of Health Management. All Rights Reserved.
Government doctor absenteeism and its effects on consumer demand in rural north India
- Authors: Iles, Richard
- Date: 2019
- Type: Text , Journal article
- Relation: Health Economics Vol. 28, no. 4 (2019), p. 475-491
- Full Text: false
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- Description: Government doctor absenteeism from their public posts is a sizable problem across developing economies. The consumer demand estimation for outpatient fever treatment presented in this paper investigates the interrelationship between government doctor absenteeism and the large informal healthcare sector. Using a counterfactual framework, this paper estimates treatment effect of eliminating government doctor absenteeism. The effects are measured by changes to the market share of government Bachelor of Medicine and Bachelor of Surgery (MBBS) providers and resulting own‐price elasticities of demand for government MBBS providers and unqualified providers. Modelling incorporates patients expected health outcomes by provider via the use of a qualitative measure of word‐of‐mouth recommendations. Results indicate that eliminating government MBBS provider absenteeism in North India would increase utilisation of government outpatient fever treatments from 18% to 50%.
Nurses, physicians and patients' knowledge and attitudes about nurse prescribing
- Haririan, Hamidreza, Seresht, Deniz Manie, Hassankhani, Hadi, Porter, Joanne E., Wytenbroek, Lydia
- Authors: Haririan, Hamidreza , Seresht, Deniz Manie , Hassankhani, Hadi , Porter, Joanne E. , Wytenbroek, Lydia
- Date: 2022
- Type: Text , Journal article
- Relation: BMC Nursing Vol. 21, no. 1 (2022), p. 112-112
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- Description: One of the roles that nurses have acquired in recent years is the role of prescribing. This study aimed to investigate the knowledge and attitudes of critical care nurses, physicians and patients about nurse prescribing. A descriptive cross-sectional study with the participation of 152 nurses, 53 physicians and 75 patients was carried out. Participants were selected by stratified random sampling from the critical care units of six hospitals in Tabriz, Iran. Demographics and participants' knowledge and attitudes about nurse prescribing questionnaires were used to collect data. The collected data were analyzed using SPSS-22 software. The mean scores of total knowledge about nurse prescribing in nurses, patients and physicians' were 15.41 ± 1.85,16.45 ± 2.31, 14.74 ± 1.7 respectively (from a range of 10 -20), and the mean score of knowledge by physicians was significantly higher than others (P = 0.000) and they had more knowledge about nurse prescribing. The mean scores of the attitudes towards nurse prescribing in nurses, physicians and patients were 40.62 ± 3.68, 37.98 ± 5.92 and 39.38 ± 4.39 respectively (from a range of 10 -50). However, the total mean score of attitudes among nurses was significantly higher than others (P = 0.000) and nurses had more positive attitudes toward prescribing. The results showed that the participants have a good understanding and attitudes toward nurse prescribing. Nurse prescribing as a new duty and authority can be considered in providing more effective care by specialist nurses. The results of this study can also be used in the future planning of health policy for nurses to have the right to prescribe and ultimately improve the quality of patient care.
- Authors: Haririan, Hamidreza , Seresht, Deniz Manie , Hassankhani, Hadi , Porter, Joanne E. , Wytenbroek, Lydia
- Date: 2022
- Type: Text , Journal article
- Relation: BMC Nursing Vol. 21, no. 1 (2022), p. 112-112
- Full Text:
- Reviewed:
- Description: One of the roles that nurses have acquired in recent years is the role of prescribing. This study aimed to investigate the knowledge and attitudes of critical care nurses, physicians and patients about nurse prescribing. A descriptive cross-sectional study with the participation of 152 nurses, 53 physicians and 75 patients was carried out. Participants were selected by stratified random sampling from the critical care units of six hospitals in Tabriz, Iran. Demographics and participants' knowledge and attitudes about nurse prescribing questionnaires were used to collect data. The collected data were analyzed using SPSS-22 software. The mean scores of total knowledge about nurse prescribing in nurses, patients and physicians' were 15.41 ± 1.85,16.45 ± 2.31, 14.74 ± 1.7 respectively (from a range of 10 -20), and the mean score of knowledge by physicians was significantly higher than others (P = 0.000) and they had more knowledge about nurse prescribing. The mean scores of the attitudes towards nurse prescribing in nurses, physicians and patients were 40.62 ± 3.68, 37.98 ± 5.92 and 39.38 ± 4.39 respectively (from a range of 10 -50). However, the total mean score of attitudes among nurses was significantly higher than others (P = 0.000) and nurses had more positive attitudes toward prescribing. The results showed that the participants have a good understanding and attitudes toward nurse prescribing. Nurse prescribing as a new duty and authority can be considered in providing more effective care by specialist nurses. The results of this study can also be used in the future planning of health policy for nurses to have the right to prescribe and ultimately improve the quality of patient care.
- Ngo, Tuan, Nguyen, Huy, Pham, Thanh, Nguyen, Tien, Vu, Kien, Pham, Minh, Phung, Dung, Thi Tran, Anh, Nguyen, Phuong, Le, Phuong, Thi Dao, An, Ngo, Hiep, Hoang, Minh
- Authors: Ngo, Tuan , Nguyen, Huy , Pham, Thanh , Nguyen, Tien , Vu, Kien , Pham, Minh , Phung, Dung , Thi Tran, Anh , Nguyen, Phuong , Le, Phuong , Thi Dao, An , Ngo, Hiep , Hoang, Minh
- Date: 2022
- Type: Text , Journal article
- Relation: International Journal of Health Planning and Management Vol. 37, no. 5 (2022), p. 2684-2696
- Full Text: false
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- Description: Objective To determine the relationship between team dynamics with healthcare coordination and clinical job satisfaction of the community health workers (CHWs). Methods A cross‐sectional study was conducted among 133 health workers (including doctors, nurses, or midwives) at 21 Commune Health Cent in Quoc Oai District, Vietnam, from July 2015 to May 2017. A self‐administered questionnaire consisting of 5‐Likert items regarding team dynamics and healthcare coordination clinical work satisfaction was utilised. Descriptive statistics and correlation matrix were applied for seven factors of team dynamic, clinical work satisfaction, and patient care coordination queried by primary care providers. Bayesian model averaging (BMA) was used to identify the predictors of the level of team dynamics and healthcare coordination. Results The mean score of overall team dynamics among the study participants was 4.08. Clinical work satisfaction and patient care coordination scores among resident physicians were higher than those of attending clinicians however, the differences were not statistically significant. The results of BMA analysis indicated that team dynamics significantly associated with clinical work satisfaction, and it explains 9% of the total variance in clinical work satisfaction. Team dynamics level was also positively associated with patient care coordination. Patient care coordination was not a significant mediator between team dynamics and clinical work satisfaction. Conclusion Team dynamics is a potential contributor to improving patient care coordination and clinical job satisfaction of CHWs. As no significant correlation between patient care coordination and clinical job satisfaction was observed, to improve team performance, providing conditions that facilitate team building and teamwork should be conducted for CHWs in CHCs. Highlights Team dynamics, healthcare coordination and clinical work satistsfaction among health professionals are critical to quality of healthcare. In lower‐middle income countries like Vietnam, little has been known about these contributors at community‐based healthcare system. Identifying that team dynamics significantly associated with both patient care coordination and clinical work satisfaction among community health workers, but this association being not mediated by patient care coordination informs healthcare planning at community level. As team dynamics is a contributor to both patient care coordination and clinical job satisfaction, improving team dynamics should be considered as one of priorities for better community healthcare in low or middle resource setting.
Burnout, stress and resilience of an Australian regional hospital during COVID-19: a longitudinal study
- Armstrong, Samantha, Porter, Joanne, Larkins, Jo-Ann, Mesagno, Christopher
- Authors: Armstrong, Samantha , Porter, Joanne , Larkins, Jo-Ann , Mesagno, Christopher
- Date: 2022
- Type: Text , Journal article
- Relation: BMC health services research Vol. 22, no. 1 (2022), p. 1-1115
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- Description: Abstract Coronavirus disease 2019 (COVID-19) has placed huge strain on hospital staff around the world. The aim of the current longitudinal study was to investigate the resilience, stress and burnout of hospital staff located at a large, regional hospital in Victoria, Australia during the COVID-19 pandemic over time via cross-sectional surveys. The surveys were disseminated six times from August 2020 to March 2021, with the first three data collection points distributed during a state-wide lockdown. A total of 558 responses from various professional roles within the hospital over the survey period were included in the sample. Analysis of variance indicated significant main effects for the psychological variables across time, age, and workload. Hospital staff reported an increase in burnout levels throughout the eight-months. Significant negative relationships were observed between resilience and burnout, and between resilience and stress. A backward regression highlighted the contribution of resilience, stress, age, and nursing roles on burnout. Hierarchical regression analysis indicated that resilience contributed to the stress-burnout relationship. This study strengthens the evidence between resilience and burnout among healthcare workers and hospital staff and highlights the need for psychological wellbeing programs to be implemented for hospital staff impacted by a prolonged worldwide pandemic.
- Authors: Armstrong, Samantha , Porter, Joanne , Larkins, Jo-Ann , Mesagno, Christopher
- Date: 2022
- Type: Text , Journal article
- Relation: BMC health services research Vol. 22, no. 1 (2022), p. 1-1115
- Full Text:
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- Description: Abstract Coronavirus disease 2019 (COVID-19) has placed huge strain on hospital staff around the world. The aim of the current longitudinal study was to investigate the resilience, stress and burnout of hospital staff located at a large, regional hospital in Victoria, Australia during the COVID-19 pandemic over time via cross-sectional surveys. The surveys were disseminated six times from August 2020 to March 2021, with the first three data collection points distributed during a state-wide lockdown. A total of 558 responses from various professional roles within the hospital over the survey period were included in the sample. Analysis of variance indicated significant main effects for the psychological variables across time, age, and workload. Hospital staff reported an increase in burnout levels throughout the eight-months. Significant negative relationships were observed between resilience and burnout, and between resilience and stress. A backward regression highlighted the contribution of resilience, stress, age, and nursing roles on burnout. Hierarchical regression analysis indicated that resilience contributed to the stress-burnout relationship. This study strengthens the evidence between resilience and burnout among healthcare workers and hospital staff and highlights the need for psychological wellbeing programs to be implemented for hospital staff impacted by a prolonged worldwide pandemic.
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