Rural Clinical School - Research Publications
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ItemBeing in two minds: Staff's perspectives of paperwork in group homes for people with intellectual disabilities(WILEY-BLACKWELL, 2016-07-01)Aim: Paperwork is an important technology in group homes for people with intellectual disabilities. This study explored frontline staffs’ perceptions of paperwork in two Australian group homes. Method: Researchers used a constructivist grounded theory methodology. Data were collected from nine group home staff (1 supervisor and 8 support workers) using semi-structured interviews and observations. Open and focussed coding was used to identify participants’ perception of paperwork. Results: Participants described being in two minds about paperwork; considering it a useful yet problematic technology in group homes. They described paperwork as having particular characteristics and used these to evaluate the usefulness of different pieces. Conclusions: Frontline group home staff actively evaluate paperwork technologies in their workplace. Understanding staff perceptions of paperwork might better enable it to be better designed or help better equip staff with meaningful technologies to provide good resident support, rather than paperwork detracting staff from their core work of providing support to residents.
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ItemNo Preview AvailableStaff perspectives on paperwork in group homes for people with intellectual disability(Routledge, 2019-08-20)This book gathers together recent international research in intellectual disability (ID), examining the diverse modes of existence that characterise living with intellectual disabilities in the 21st century.
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ItemBeing a valuable contributor on the frontline: The self-perception of staff in group homes for people with intellectual disability(WILEY, 2018-05)BACKGROUND: Group home frontline staff have a critical role in implementing service policies, yet research typically examines implementation issues from an organisational perspective. The aim of this study was to explore the self-perception of frontline staff about their role in group homes for people with intellectual disability. METHOD: Constructivist grounded theory methodology guided the study. Data were collected with frontline staff through semistructured interviews and participant observations. Coding and sorting methods were used to analyse participants' self-perception. RESULTS: Frontline staff felt they were valuable contributors who knew the service setting and residents well. Despite this staff felt powerless in their roles, excluded from organisational dialogue, stressed and exhausted. CONCLUSIONS: Frontline staff have critical insight into service implementation although disability service organisations may limit their capacity to contribute to this. Further action could explore new ways to better nurture frontline staff engagement in organisational dialogue.
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ItemStaff perspectives on paperwork in group homes for people with intellectual disability(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2018)Background: Paperwork can transform organisational aims into action in group homes, but it can also be problematic for staff. The aim of this study was to explore frontline staff perspectives on paperwork in group homes for people with intellectual disability. Methods: Constructivist grounded theory methodology guided the study. Data were collected from 29 participants through semi-structured interviews, participant observations and journaling. Coding and sorting methods were used to analyse participants’ perspectives. Results: Staff have nuanced paperwork perspectives. They described and evaluated paperwork in terms of its value and fit with resident-focused practice. They identified gaps in paperwork and reimagined its design and use. Conclusions: Frontline staffs’ reflection suggests some paperwork hinders them from supporting residents well. This suggests organisations could consult better with staff to design paperwork that has a goodness of fit to their practice. Further research could explore how staff manage the limiting characteristics of paperwork.
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ItemExploring infant deformational or positional plagiocephaly prevention and management by Maternal Child Health Nurses and Paediatric Physiotherapists(AUSTRALIAN NURSING FEDERATION, 2016-12-01)Objectives To explore Maternal Child Health (MCH) nurses’ and Paediatric Physiotherapists’ (Physiotherapists) experience with infant deformational or positional plagiocephaly (plagiocephaly). Design Cross-sectional online survey. Setting Community health setting in Victoria, Australia. Subjects MCH nurses and Paediatric Physiotherapists in Victoria were invited to participate. Main outcome measures Survey results were collated and analysed descriptively. Results Surveys were completed by 183/961(19%) MCH nurses and a sample of 16 Physiotherapists, from a cross section of metropolitan (62%), regional (18%) and rural/remote (24%) Victoria. All MCH nurses and Physiotherapists reported seeing infants with plagiocephaly in the previous 12 months. Responses indicated MCH nurses saw between 11-50 infants with plagiocephaly (n=110). These were first diagnosed by MCH nurses at one to three months. Infants first presented to Physiotherapists on average at four to six months. All MCH nurses and Physiotherapists implemented prevention strategies and both groups thought it was effective subject to parents’ implementing the advice. Strategies for prevention and management of plagiocephaly included early prone play (tummy-time) and counter positioning. Physiotherapists also included gross motor exercises, stretches if torticollis was present and, if appropriate, referral for helmet therapy. Referrals of infants with plagiocephaly by MCH nurses were made to Physiotherapists, General Practitioners, Chiropractors and Osteopaths. Conclusions All MCH nurses and Physiotherapist respondents see infants with plagiocephaly, MCH nurses earlier than Physiotherapists. The effectiveness of plagiocephaly prevention advice can be called into question because of the high numbers of infants presenting and subsequent referrals to different health professionals. Recommendations from respondents included a review of past initiatives including extensive education for Maternal Child Health Nurses, Pamphlets in their Home visiting pack and video for demonstration at first time mothers group and the provision of clearer early prevention advice in the Government Key Ages and Stages (KAS) Framework for MCH nurses.
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ItemThe need for a culturally-tailored gatekeeper training intervention program in preventing suicide among Indigenous peoples: a systematic review(BIOMED CENTRAL LTD, 2016-10-21)BACKGROUND: Suicide is a leading cause of death among Indigenous youth worldwide. The aim of this literature review was to determine the cultural appropriateness and identify evidence for the effectiveness of current gatekeeper suicide prevention training programs within the international Indigenous community. METHOD: Using a systematic strategy, relevant databases and targeted resources were searched using the following terms: 'suicide', 'gatekeeper', 'training', 'suicide prevention training', 'suicide intervention training' and 'Indigenous'. Other internationally relevant descriptors for the keyword "Indigenous" (e.g. "Maori", "First Nations", "Native American", "Inuit", "Metis" and "Aboriginal") were also used. RESULTS: Six articles, comprising five studies, met criteria for inclusion; two Australian, two from USA and one Canadian. While pre and post follow up studies reported positive outcomes, this was not confirmed in the single randomised controlled trial identified. However, the randomised controlled trial may have been underpowered and contained participants who were at higher risk of suicide pre-training. CONCLUSION: Uncontrolled evidence suggests that gatekeeper training may be a promising suicide intervention in Indigenous communities but needs to be culturally tailored to the target population. Further RCT evidence is required.
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ItemThe rural pipeline to longer-term rural practice: General practitioners and specialists(PUBLIC LIBRARY SCIENCE, 2017-07-07)BACKGROUND: Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates' longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists. METHODS: A cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002-2011. The outcome of interest was primary place of graduates' practice categorised as rural for at least 50% of time since graduation ('Longer-term Rural Practice', LTRP) among GPs and medical specialists. The main exposures were rural background (RB) or metropolitan background (MB), and attendance at a metropolitan clinical school (MCS) or the Rural Clinical School for one year (RCS-1) or two years (RCS-2). RESULTS: Independent predictors of LTRP (odds ratio [95% confidence interval]) were RB (2.10 [1.37-3.20]), RCS-1 (2.85 [1.77-4.58]), RCS-2 (5.38 [3.15-9.20]), GP (3.40 [2.13-5.43]), and bonded scholarship (2.11 [1.19-3.76]). Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21-0.57]). The effects of RB and RCS were additive-compared to MB and MCS (Reference group): RB and RCS-1 (6.58[3.32-13.04]), RB and RCS-2 (10.36[4.89-21.93]). Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner's background were apparent. CONCLUSIONS: Among both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan-based medical schools can enhance both specialist and GP rural medical workforce by enrolling rural background medical students and providing them with long-term rural undergraduate clinical training. Policy settings to achieve optimum rural workforce outcomes may differ between specialists and GPs.
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ItemCommon mental disorders among Indigenous people living in regional, remote and metropolitan Australia: a cross-sectional study(BMJ PUBLISHING GROUP, 2018-06)OBJECTIVE: To determine, using face-to-face diagnostic interviews, the prevalence of common mental disorders (CMD) in a cohort of adult Indigenous Australians, the cultural acceptability of the interviews, the rates of comorbid CMD and concordance with psychiatrists' diagnoses. DESIGN: Cross-sectional study July 2014-November 2016. Psychologists conducted Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision Axis I Disorders (SCID-I) (n=544). Psychiatrists interviewed a subsample (n=78). SETTING: Four Aboriginal Medical Services and the general community located in urban, regional and remote areas of Southern Queensland and two Aboriginal Reserves located in New South Wales. PARTICIPANTS: Indigenous Australian adults. OUTCOME MEASURES: Cultural acceptability of SCID-I interviews, standardised rates of CMD, comorbid CMD and concordance with psychiatrist diagnoses. RESULTS: Participants reported that the SCID-I interviews were generally culturally acceptable. Standardised rates (95% CI) of current mood, anxiety, substance use and any mental disorder were 16.2% (12.2% to 20.2%), 29.2% (24.2% to 34.1%), 12.4% (8.8% to 16.1%) and 42.2% (38.8% to 47.7%), respectively-6.7-fold, 3.8-fold, 6.9-fold and 4.2-fold higher, respectively, than those of the Australian population. Differences between this Indigenous cohort and the Australian population were less marked for 12-month (2.4-fold) and lifetime prevalence (1.3-fold). Comorbid mental disorder was threefold to fourfold higher. In subgroups living on traditional lands in Indigenous reserves and in remote areas, the rate was half that of those living in mainstream communities. Moderate-to-good concordance with psychiatrist diagnoses was found. CONCLUSIONS: The prevalence of current CMD in this Indigenous population is substantially higher than previous estimates. The lower relative rates of non-current disorders are consistent with underdiagnosis of previous events. The lower rates among Reserve and remote area residents point to the importance of Indigenous peoples' connection to their traditional lands and culture, and a potentially important protective factor. A larger study with random sampling is required to determine the population prevalence of CMD in Indigenous Australians.
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ItemTackling the wicked problem of health networks: the design of an evaluation framework(BMJ PUBLISHING GROUP, 2019-05)Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.
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ItemHome-Based Transabdominal Interferential Electrical Stimulation for Six Months Improves Paediatric Slow Transit Constipation (STC)(WILEY, 2018-10)BACKGROUND: Transcutaneous electrical stimulation (TES) for one to two months has produced some improvement in treatment-resistant slow-transit constipation (STC) in children. Optimal parameters for treatment are not known. It is possible that more improvement would occur with stimulation for longer. This study examined the effectiveness of stimulation for six months. METHODS: Children with STC confirmed by nuclear transit study (NTS) were enrolled prospectively. All had chronic constipation for greater than two years and had failed medical treatment. TES was performed for one hour/day for six months using the INF 4160 (Fuji Dynamics) portable stimulator and 4 cm × 4 cm electrodes near the belly button and on the back. Families kept bowel diaries and completed PEDSQLCore QOL (4.0) questionnaires before and at end of treatment. RESULTS: Sixty-two children (34 females; seven years, 2-16 year) with STC were studied. Defecation frequency increased in 57/62 (91%, mean ± SEM pre- 1.49 ± 0.20 vs. post- 3.25 ± 0.25 defecation/week, p < 0.0001) with the number with ≥3BA increasing from 6 to 37 (10-59%). Soiling frequency decreased from 4.8 to 1.1 days/week (p <0.001). Abdominal pain decreased from 1.7 to 0.3 days/week (<0.0001), and spontaneous urge to defecate improved. Quality of life (p < 0.01), mean transit index and gastric emptying on NTS improved (p < 0.005). CONCLUSION: Treatment-resistant STC responds to TES using interferential current across the abdomen when given daily for many months. Battery operated stimulators allowed stimulation at home for an hour each day. Stimulation for six months produced clinically significant improvement in defecation frequency, soiling, abdominal pain, urge to defecate, and quality of life in half of these chronic patients.