Challenges in Rural Healthcare Delivery
Discuss about the Role of Nurses to improve Rural Health.
The population living in remote and rural areas of Australia has short life expectancies and lack increased rate in the number of premature deaths. This statistic could be the cause for lack of accessibility and inadequate infrastructure in the government funded healthcare settings. Fewer number of practitioners and nurses are enthusiastic to work in rural areas to lack of resources and transport. The condition is worsening to due to budget cuts an lack of funding from the government to help the patients have better access to good healthcare. The literature review will focus of the problems faced in rural Australia in detail and the role of nurse practitioner to provide the patients with positive health outcome
A paper published by Elsevier in 2012, from the University of Melbourne, reflects the detailed discussion of the current rural and remote population health in Australia. The paper provides conceptual framework of understanding the scenario (Bourke et al., 2012). The authors discussed six discrepancies faced by the healthcare providers in Australia. Geographical isolation, local of the rural population, repercussion of local health, wide array of health systems, power and social hierarchy using Gidden’s theory to understand the interplay of these factors in rural health. Geographical location plays determines the level of accessibility and spatial isolation and proximal distances of healthcare. The lack of adequate transport facility hampers the health providence in the area. Health is also affected by the effect of locale on the population. The effect of cultural beliefs, norms, reproductive styles all depend of the locale of the area and its inhabitants. Development of healthcare delivery systems according to the specific needs of the area. One such policy developed was by the government called “Flying Doctor Service”, which would fly in or fly out patients with their doctors for emergency medical attention. The policy benefits the rural areas and their population for some time, but the majority of the mainstream healthcare policies do not help the rural population in the long run. The social hierarchical conditions of the rural population also play when the health is concerned. The social, economic education, residential area and employment affect the affordability of efficient healthcare.
Another paper published by the Australian Journal of Rural Health in 2018 investigated the need of the funding in the rural health. The paper also reflects whether or not the invested amount satisfies the requirement of the rural health population. The authors of the paper investigated the number of government-funded projects aimed to benefit the rural population of Australia from the year 2005-2014. The authors analysed the public datasets to estimate the number of the projects by the National Health and Medical Research Council Rural and Remote Health Research. The authors found 16,651 government-funded projects, the success rate of these projects increased from 1 % previously to 2.4% that presented potential benefits. These rates of the research project implementation are still very low and the deficit of the healthcare facilities in the rural part of Australia is about 30% of the population. The Australian government invested $800 million in the research for the improvement of health but the complete sum of money is not directed towards the rural population health development. The authors found 232 individual grants funded by the NHMRC for the development of rural health, out of which 193 projects received sanction and about 184 commenced the research after receiving the funds. The amount for the funding money was observed to increases from $2 million annually to $11million in the year 2014. Among this the 5.5% of the NHMRC funding was provided to the benefits off indigenous population in Australia. The research and developments investments for the rural and indigenous health has increased over the past decade but more money needs to be funded to ensure that the requirement for the positive health is met.
Healthcare Funding in Rural Areas
The Journal of health organization and management in 2015 by Richard Norman and Suzanne Robinson reflected whether the Australian government can solve the inequality in the health benefits seen in the rural population from England’s approach to solving their health discrepancy issue (Norman and Robinson, 2015). The English health policy has improved over the years which can be benchmark for the development of better health policies which can be implemented for the rural health development as well. The two countries although have different geographical needs and socio-economic perspective of society, some of the developments in the English health policies like the focus of the government should be on the reward system based on the quality of the policy and not just activity as well as focussed concern on the volume of the efficiency. The general practitioners play a pivotal role in the primary healthcare and provide entrance for the specialised secondary care. The actions of the government to implement the utilization of price signal in the profession of general practitioners have been proven a political decision instead of a public centred decision. The English health policy applies a more restrained policy towards the remuneration of GPs, where the GPs get a fixed salary. However Australia’s approach to this is payment of GPs on the fee in lieu of service. The Australian government needs to focus their funding on the skill and focussed development of health care practitioners which would minimise the risk of mismanagement in the primary healthcare and prioritize more explicitly considering the stakeholders of the system.
A paper published written by John Humphreys and David Lyle from the Centre of Research excellence in Rural and Remote Primary Care, Bendigo (Barclay, Phillips & Lyle, 2018). Out of the 12, multi-professional university departments of rural health in Australia. The aim of these programs is to provide training and education in the rural and remote areas of Australia to improve the health outcomes of the healthcare givers. The researchers conducted investigative studies and found that the combination of the data provided by the administration the UDRH departments had a vast number of workforces who published 220 peer-reviewed journals as of 2013 containing both applied research addressing one or more issues of the rural health. The government has doubled the funding to aid the projects of the UDRH research. The combined efforts of these UDRH departments would surely improve the health of the rural and remote areas (Humphreys, Lyle and Barlow, 2017).
Government Policy and Healthcare
Providing care to the ailing patients in the rural and remote areas has its pitfalls. The healthcare workforce has to overcome many physical and environmental barriers while providing care for the patients in remote areas. A paper published in BMC Palliative Care, in 2016 reflects a pilot study conducted by the authors to evaluate the outcome of the nurse practitioner led GP supported rural palliative care provision in Australia (Mitchell et al., 2016). The rural set up was selected fifty kilometres to study the efficacy of the healthcare workforce in providing care to the critically ill patients and the improvement of health in teams lead by nursing practitioners. The researchers set up interview with the service providers and assessed efficacy by recording the medical plans. The assessment of 62 patients showed the reduction in pain severity of about 25%, depression was reduced to 23% were the most commonly treated the workforce successfully formulated ten new care plan techniques to provide better health outcomes to the patients. The participants were satisfied with the care plan provided to them. However, it was observed that the cost of service surpassed the income from the health insurances. The study research reflected the efficiency of the supervisory mediated healthcare service and reduce the risk of rehospitalisation among the participants.
In order to understand the impact of the different stressors associated with the acute staff shortage and burnout while practicing in the rural Australian health sectors, the affected quality of work-life needs to be discussed. According to the article by Bragard et al. (2015), in the rural health sector emergency departments the impact of the stressors in the emergency departments are very high, facilitated by difficult work conditions including significant workload and psychological demands, lack of resources, limited access to specialized care, geographical distance from specialized centers, poor emergency transport capabilities, and limited training and poor support. Hence all these stressors have a significant impact in the quality of work life and it has a significant impact on their professional competence and resilience as well. This pilot study confirmed that quality improvement and continuing education strategies demonstrated that providing training opportunities yielded a 10% improvement in performance and positively affected their quality of work life as well. The only drawback of this study had been that it had a very small population being a pilot study and there is a chance that diverse population will lead to alterations in the result.
Role of Nurse Practitioners in Rural Healthcare
With respecting to the training and educational skill enhancement needs of the rural nursing workforce, the suggested meta-speciality framework can be discussed. Meta-speciality has been defined as the first initiative taken by the health care authorities belonging to both national and international governing bodies in order to categorize the diverse clinical roles into a limited grouping or more specifically a set of broad specialties. According to the article by Gardner et al. (2013), the primary focus of the study had been to articulate a CLLEVER study to explore the quality of clinical education for the nursing workforce. The authors in here have specified that in order to implement the concept of meta-speciality based grouping of the clinical education and training, it is very important for the authorities to understand that the multi-speciality grouping cannot be intended as mutually exclusive groups. Along with that any nursing professional within practice in a particular cognate area may as well need to draw specialty competencies from more than one meta-specialty. In most cases, the training and skill enhancement programs are fixated on a particular clinical domain, narrowing down the opportunity for the nursing workforce to enhance their skills on a more broad perspective. In support, Leipert and Anderson, (2012), have stated that for the rural community nurses their opportunity to participate in the educational training and skill enhancement processes are very rare and minimal given the tremendous workload. Hence, if the few educational training procedures they can attend from overcoming the demographic limitations are not advanced and inclusive focusing on different clinical domains, their chances of optimal education is hampered. Hence, as outlined by the Gardner et al. (2013), areas of practice for individual nurse practitioners must encompass several skill domains and they need to draw competencies from more than one meta-specialty.
As mentioned above, the status of the funding for the rural health sector is very low which has a significant impact on the staffing scenario and the workload. And as a direct result of the both of the factors has resulted into a detrimental impact on the care quality that is provided to the patient population in the rural regions of Australia. There are various reform activities that are being arranged for improving the finding scenario for the rural sectors if Australia, however it is undoubtedly a long procedure, hence in the meantime there is need for improvements in the competence, resilience and professional approach of the nurses to revive the care quality and access in the rural regions of Australia and contributing to the health promotion of the rural Australians (Fitzgerald & Townsend, 2012).
Improving Healthcare Infrastructure in Rural Areas
According to Roden, Jarvis, Campbell-Crofts and Whitehead (2015), the rural community nursing professionals do have a more positive attitude towards health promotional activities and the clinical implementation of the same, when compared to the urban nurses with a more narrow focus on caring for different individuals. This article had emphasized on two particular sample populations, community nurses from Sydney urban area and community nurses from rural south Wales. The data collection method for the paper had been based on survey questionnaires and 10 qualitative interviews. The authors in the article have mentioned that there is a optimistic caring approach in the rural nurses when it comes to community based health promotion, although they lack educational training and skill enhancement opportunities as compared to the urban area nurses which limits their role in the health promotional context. Hence, there is a pressing need for better training and educational opportunities for the nursing workforce practicing in the rural sectors
References
Barclay, L., Phillips, A., & Lyle, D. (2018). Rural and remote health research: Does the investment match the need?. Australian Journal Of Rural Health, 26(2), 74-79. doi: 10.1111/ajr.12429
Bragard, I., Fleet, R., Etienne, A. M., Archambault, P., Légaré, F., Chauny, J. M., … & Dupuis, G. (2015). Quality of work life of rural emergency department nurses and physicians: a pilot study. BMC research notes, 8(1), 116. doi.org/10.1186/s13104-015-1075-2
Fitzgerald, C. E., & Townsend, R. P. (2012). Assessing the continuing education needs and preferences of rural nurses. The Journal of Continuing Education in Nursing, 43(9), 420-427. Doi: 10.1186/s13104-015-1075-2
Gardner, A., Gardner, G., Coyer, F., Henderson, A., Gosby, H. and Lenson, S. (2013). Metaspecialties developed as an outcome of the Educating nurse practitioners: advanced specialty competence, clinical learning and governance CLLEVER Study (Nurse Practitioner CLinical LEarning & GoVERnance). [online] Health.qld.gov.au. Available at: https://www.health.qld.gov.au/__data/assets/pdf_file/0014/160133/metaspecialties.pdf [Accessed 7 May 2018].
Humphreys, J., Lyle, D. and Barlow, V. (2017). University Departments of Rural Health: is a national network of multidisciplinary academic departments in Australia making a difference?. Rural and Remote Health, 18(1). https://doi.org/10.22605/RRH4315
Leipert, B., & Anderson, E. (2012). Rural nursing education: a photovoice perspective. Rural and Remote Health, 12(2061), 1-4. Retrieved from https://www.rrh.org.au/journal/article/2061
Mills, J., Birks, M., & Hegney, D. (2010). The status of rural nursing in Australia: 12 years on. Collegian, 17(1), 30-37. Retrieved from https://www.collegianjournal.com/article/S1322-7696(09)00088-2/abstract
Mitchell, G., Senior, H., Bibo, M., Makoni, B., Young, S., Rosenberg, J. and Yates, P. (2016). Evaluation of a pilot of nurse practitioner led, GP supported rural palliative care provision. BMC Palliative Care, 15(1). 10.1186/s12904-016-0163-y
Norman, R. and Robinson, S. (2015). Lessons from Albion. [online] www.emeraldinsight.com. Available at: https://www.emeraldinsight.com/doi/abs/10.1108/JHOM-01-2015-0013 [Accessed 7 May 2018]. https://dx.doi.org/10.1108/JHOM-01-2015-0013
Roden, J., Jarvis, L., Campbell-Crofts, S., & Whitehead, D. (2015). Australian rural, remote and urban community nurses’ health promotion role and function. Health promotion international, 31(3), 704-714. doi.org/10.1093/heapro/dav018
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