Rural health care has been affected by health care changes. Twenty-seven percent of the U.S. population live in rural areas (Adams, 1993; Weinert & Long, 1991). The purpose of this study was to examine the tenure of rural Directors of Nursing (DONs) in the DON position, to examine the tenure of rural DONs in the organization, and to profile the personal system of the DON in a rural hospital. The significance of the study was that little is known about rural DONs.The Neuman Systems Model (Neuman, 1989) provided the theoretical. framework for the study using the personal system level. The sample included all rural acute care DONs in one midwestern state. The Assessment of DON Tenure Questionnaire (Rowles, 1992) was the instrument used to collect data. Thirty-three questionnaires were mailed to rural acute careDONs with a return rate of 100%.Rural DONs were found to have a longer tenure in the DON position than the tenure data in the nursing literature. Tenure in the organization was also found to be longer. The typical DON was found to be female, married, with children,45 years old, with a BSN in nursing. The rural DONS were found to be slightly dissatisfied with the job.The return rate of questionnaires demonstrated the rural DONs interest in nursing education, practice and research. The research implication called for further investigation into the tenure measure of rural DONs in other geographic location along with urban DONs tenure measure for comparative analysis. Rural DONs have limited education opportunities based on geographic location. Continuing education programs in nursing administration and practice that are accessible in the rural setting via TVs or computers would be beneficial. / School of Nursing

In the context of a country and a continent that is largely rural, education for rural medical practice in Africa is relatively undocumented and poorly conceptualized. The arena of medical education in South Africa has been largely unchanged by the transition to democracy, despite intentions of reform. The literature reveals a lack of empirical evidence as well as theory in education for rural health, particularly in developing countries. This report presents twelve original papers on a range of key issues that represent the author’s contribution to filling this gap in South Africa. It aims to contribute to the development of a discourse in education for rural medical practice in an African context, and culminates in a theoretical paper regarding pedagogy for rural health. A conceptual framework is utilized that is based on the standard chronological steps in the initial career path of medical doctors in South Africa. Beginning with the literature that is focused around the need to recruit and retain health professionals in rural and underserved areas around the world, the report then addresses the policy context for medical education in South Africa, examining the obstacles to true reform of a transformatory nature. The selection of students of rural origin, and the curricular elements necessary to prepare graduates for rural practice are then investigated, including the actual career choices that medical graduates make in South Africa. Out in the workplace, the educational components of the year of compulsory community service are described, including organizational learning and apprenticeship as novice practitioners, placed under severe pressure in rural hospitals in the South African public health service. A community-oriented type of medical practice is described amongst exemplary individuals, indicating the aspiration towards a different kind of educational outcome. Finally the thesis as such is presented in the final paper regarding a theoretical basis for education for rural health, consisting of the combined notions of placed-based and critical pedagogy. It is argued that while the geographic elements of rural practice require a pedagogy that is situated in a particular rural context, the developmental imperatives of South Africa demand a critical analysis of health and the health care system, and the conceptual basis of this position is explained. / Thesis (Ph.D.) - University of KwaZulu-Natal, Durban, 2010.

The goal of the dissertation research was to understand and conceptualize the process of developing palliative care in rural communities from the perspective of health care providers. Canadian research about rural palliative care is timely and important. Since 1995, two Senate committees and two national reviews of the health care system have called for increased access to palliative care throughout Canada. Several provinces have subsequently launched strategies aimed at improving access to palliative or end-of-life care; however practical models for developing rural programs are lacking. This research contributes to improving access to palliative care for people dying in rural Canada by generating practical and theoretical knowledge about developing local programs in rural communities. Data were transcripts of nine group interviews of interdisciplinary providers involved in providing rural palliative care in six different provinces and territories of Canada. The outcome of the research was an original model called Developing Rural Palliative Care that conceptualized four sequential and incremental phases of development: antecedent community conditions, a catalyst, creating the team and growing the program. The model articulates the major processes and activities within each phase. Throughout the developmental process, the nature of the rural community both supported the work of providers and created their challenges. Working together and being community-focused emerged as the overarching keys to success. Most of the palliative care work utilized existing local resources. Throughout the analysis, the research used ideas of community capacity development as sensitizing concepts. The research concluded that developing palliative care can be understood and represented as a process of community capacity development, offering an innovative way of thinking about developing health services that can guide the process of implementing palliative care services. Ultimately, the research findings suggest that access to palliative care can be improved in rural communities by creating local palliative care teams and supporting them to develop services.

Note: / AIDS Service Organizations (ASOs) have a central role in providing HIV/AIDS related services to rural communities in Ontario, Canada. To date, very little information has been published on the experience of people employed by ASOs who work in rural Canadian communities. In an effort to learn more about this important topic, this research explored the challenges, risks and benefits people in the field associate to their work. Using A. Giorgi (1985) and B. Giorgi (2006) phenomenological method a purposive sample of three participants were interviewed on two separate occasions. From 179 significant statements, 23 themes emerged to be part of three categories that included: Rural Communities, AIDS Service Organizations, and Workers' Experiences. Through the unfolding of the participants' experiences it became apparent that HIV / AIDS remains a complex phenomenon that is influenced by the structural aspects of Society. / Les organismes offrant des services dans le domaine du VIH/SIDA jouent un rôle central dans l'offre de services en matière de VIH/SIDA auprès des communautés rurales de l'Ontario, au Canada. Jusqu'à présent, très peu d'infonnation a été publiée sur l'expérience vécue par les gens employés par ces organismes dans les communautés rurales canadiennes. Afin d'en apprendre davantage sur ce sujet d'un grand intérêt, la présente recherche a pour but d'explorer les défis, les risques et les bénéfices que ces gens perçoivent dans leur travail. En se basant sur une méthode phénoménologique de A. Giorgi (1985) et de B. Giorgi (2006), un échantillon de trois participants a été ciblé. Pour ce qui est des entrevues, elles ont été conduites auprès de chaque participant à deux occasions différentes. Les 179 commentaires des participants qui étaient pertinents ont pennis d'identifier 23 thèmes qui ont été divisés en trois catégories: les communautés rurales, les organismes offrant des services dans le domaine du VIH/SIDA et l'expérience vécue par les gens employés par ces organismes. En parcourant l'expérience décrite par les participants, il est apparu évident que le VIH/SIDA demeure un phénomène complexe qui est grandement influencé par les structures et les caractéristiques de la société.

This study is an examination of services in previously disadvantaged rural areas of South Africa with special reference to health and education. The case study approach was used in this study and Okhombe Ward of the Amazizi area in Northern Kwazulu-Natal was selected for this research project. The purpose of the study was firstly to determine the socio-economic profile of the people in Okhombe. Secondly, the study intended to identify whether services that enhance well-being are available in the Okhombe. Thirdly, the study aimed at assessing the quality and adequacy of the services that are available. Fourthly, the study aimed at ascertaining the concerns, problems and needs of people. Fifthly, the study intended to establish whether power dynamics compete with each other in the acquisition and accessibility of services and; lastly to forward recommendations based on findings from this research. The research found that the people were happy with the manner in which decisions were taken regarding the village. Meetings are called up at the community hall and every household is invited. There is consultation and negotiation with the people. This study found that, the health needs of the people are being catered for by the many traditional healers in the area and a mobile clinic that visits the Okhombe Ward on two Wednesdays a month. The main clinic that services the Okhombe Ward and entire Amazizi area is located some ten kilometers from Okhombe. There are no emergency and hospital services available in the area. While the people are happy with services of the many traditional healers in the area, they are not satisfied with the present health provisions by the Department of Health. It is recommended that a full tinle clinic be established in Okhombe to replace the mobile clinic and that provisions be made for hospital and emergency services in the Amazizi area. There is a primary and a high school that caters for the educational needs of the children. The high school lacks electricity, water supply and an administration building. The Principal and the heads of departments at the high school make use of space in the adjacent community hall. Both schools did not have their full complement of educators in January 2001. The primary school has electricity and a standpipe for water. Further, the schools did not have resources such as properly maintained sports fields, laboratories, libraries and good toilet and sanitation facilities. There also was a shortage of desks and chairs at both schools. The Okhombe community places great stress on education and this is borne by the fact that they would like both boys and girls to be educated. They would like a skills training centre for school leaving children to be established in the area. The people believe that education and skills training would enable the youth to secure employment in the competitive labour market. The community also wants Adult Basic Education to be reintroduced in the area. The Department of Education must provide the necessary infrastructure in terms of furniture, administration buildings, ablution facilities, libraries and equipped specialist rooms. It must also provide a full complement of educators for the schools at the beginning of each year in order that the schools function at an optimal level. Schools must offer subjects like woodwork, agricultural science, metalwork, computer studies, etc. that will help prepare youth for later employment. To this end schools must be equipped with the necessary workshops, specialist rooms and qualified educators. A traditional hierarchical system exists in Okhombe. At the local level, the Induna is in charge. Above the Induna is the Chief. The chief is the most powerful person in the area under his control and all disputes are taken to the Chief's court. / Thesis (M.A.)-University of Durban-Westville, 2002.

Due to advances in detection and treatment, increasing numbers of women are diagnosed with, and surviving, breast cancer each year, making women with breast cancer one of the largest groups of cancer survivors. Hence, ensuring good healthrelated quality of life (HRQoL) following treatment has become a focal point of cancer research and clinical interest. While our understanding about the impact of breast cancer is improving, little is known about the HRQoL among survivors in non-urban areas. This is important locally, as 45% of breast cancer survivors in Queensland, Australia, live outside major metropolitan areas. Therefore, this study investigated the HRQoL and accompanying correlates among regional and rural breast cancer survivors, and made comparisons with urban breast cancer survivors as well as women from the general population without a history of breast cancer. Three population-based studies comprise this project. Original data were collected by way of self-administered questionnaire from 323 women, diagnosed with a first, primary, invasive, unilateral breast cancer during 2006/2007 and residing in regional or rural areas of Queensland, 12 months following diagnosis. HRQoL was assessed using the Functional Assessment of Cancer Therapy, Breast plus additional concerns (FACT-B+4) questionnaire. Data from two existing data sources were also utilised. Women diagnosed with a first, primary, invasive, unilateral breast cancer in 2002 and residing within 100kms of Brisbane provided information on HRQoL, measured by the FACT-B+4, via self-administered questionnaire at six (n=287), 12 (n=277) and 18 (n=272) months post-diagnosis. Data at 12 months post-diagnosis was utilised for comparison with region and rural women with breast cancer. General population data for HRQoL, collected by self-administered questionnaire in 2004 using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, were derived from a subgroup of female residents without a history of breast cancer from urban (n=675), regional (n=184) and rural (n=281) Queensland. The two studies involving women with breast cancer were recruited sequentially through the Queensland Cancer Registry, whereas the study involving the general population used telephone survey methods initially to identify participants. Women who participated in all studies were aged between 30 and 74 years. Raw scores for overall HRQoL (FACT-B+4, FACT-G) and subscales were computed. According to developers of the instrument, raw score differences of eight points between groups on the FACT-B+4 scale and five points on the FACT-G scale reflect a clinically meaningful differences in HRQoL. Age-adjusted, mean HRQoL was similar between regional and rural women with breast cancer 12 months following diagnosis (e.g., FACT-B+4: 122.9 versus 123.7, respectively, p=0.74). However, younger regional and rural survivors reported lower HRQoL scores compared with their older counterparts (e.g., FACT-B+4: 112.0 and 115.8 versus 129.3 and 126.2, respectively, p<0.05 for all). In addition to age, other important correlates of lower overall HRQoL (FACT-B+4) among regional/rural breast cancer survivors included: receiving chemotherapy, reporting complications post-surgery, poorer upper-body function than most, higher amounts of stress, reduced coping, being socially isolated, not having a confidante for social-emotional support, unmet healthcare needs, and low self-efficacy. Multiple linear regression analysis was used to address the hypothesis regarding similarity of HRQoL following breast cancer among women residing in regional and rural locations. After adjusting for the above factors, there was no statistically significant or clinically important difference in overall HRQoL (FACT-B+4) between regional and rural women with breast cancer 12 months following diagnosis (122.1 versus 125.1, respectively, p=0.07). Data from regional and rural women were pooled, based on the above analyses, and compared with urban women. Multiple linear regression analysis was used to test the hypothesis that HRQoL following breast cancer among women residing in regional/rural locations would be lower than that reported by women residing in urban locations. Potential confounders of the association between overall HRQoL (FACT-B+4) and place of residence included: marital status, upper-body function, amount of stress and perceived handling of stress. After adjusting for factors that differed between urban and regional/rural survivors, overall HRQoL (FACT-B+4) was lower among younger regional/rural survivors than their urban peers, and the findings were both statistically significant and clinically important (115.3 versus 123.7, respectively, p=0.001). Older women reported similar mean HRQoL, regardless of regional/rural or urban residence (128.2 versus 131.6, respectively, p=0.03). Further multiple linear regression analyses were undertaken to investigate whether women with breast cancer would report HRQoL equivalent to that reported by similarly-aged women in the general population. After adjusting for potential confounding factors that are known or suspected risk factors for breast cancer (age, marital status, education level, private health insurance, smoking status, physical activity, body mass index, co-morbidities), overall HRQoL (FACT-G) among breast cancer survivors was comparable to the general population 12 months following diagnosis (urban: 88.0 versus 86.9, respectively, p=0.28; regional/rural: 86.2 versus 85.8, respectively, p=0.79). However, 26% of survivors experienced worse overall HRQoL (FACT-G) compared with normative levels. HRQoL subscales contributing most to this deficit were physical well-being, with 29% of breast cancer survivors reporting scores below the norm, and emotional well-being among younger women, with 46% reporting scores below the norm. Logistic regression analysis was used to identify subgroups of breast cancer survivors who reported HRQoL below normative levels; reporting poorer upper-body function than most and not handling stress well increased the odds of reporting overall HRQoL (FACT-G: odds ratios (ORs) = 4.44 and 4.24, respectively, p<0.01 for both), physical well-being (ORs = 5.93 and 2.92, respectively, p<0.01 for both) and emotional well-being (among younger women: ORs = 2.81 and 5.90, respectively, p<0.01 for both) below normative levels. The cross-sectional nature of the study design for regional and rural breast cancer survivors, and the potential selection and response biases in all three studies, represent the main limitations of this work. The cross-sectional design precludes causal inference about observed associations, but even characterising relevant correlates allows for adjustment of potential confounding and provides insight into factors that may be important in contributing to HRQoL among breast cancer survivors. Moreover, the potential impact of the latter limitations is in the conservative direction, whereby differences in HRQoL between groups will be more difficult to identify. Since these biases are expected to be present to a similar degree across all study groups, the absolute difference in HRQoL by residence and cancer status observed are likely to exist. In contrast, the work is supported by a population based, state-wide sample of breast cancer survivors, comparisons with the general population, and use of standardised instruments. Therefore, the conclusions derived from this research are likely to be generalisable to the wider population of women in Queensland with unilateral breast cancer, aged 74 years or younger, and perhaps to similar women in other western countries, depending on variations in healthcare systems and the provision of oncology services. This research supports the initial supposition that while some findings may generalise to all breast cancer survivors, non-urban breast cancer survivors also have distinct experiences that influence their HRQoL. Results from this work highlight the HRQoL domains and characteristics of breast cancer survivors most in need of assistance to facilitate recovery following diagnosis and treatment. Characteristics include some already established and reconfirmed here, namely, emotional wellbeing among younger women, and other novel subgroups, including regional/rural survivors who receive chemotherapy or have a low self-efficacy and all survivors, regardless of residence, with upper-body problems or a low perception of handling stress. These results demonstrate the potential for identifying subgroups of women with breast cancer at risk for low HRQoL who may benefit from additional attention and possible tailored recovery interventions to increase their overall HRQoL. As such, researchers and clinicians need to consider the role of these factors when designing interventions to assist women as they deal with the challenges imposed upon them by their breast cancer. However, it was found here that the FACT-G instrument has ceiling effects. This means that positive changes reflecting improved status, such as those achieved through recovery interventions, will often fail to be measured appropriately if there is no room to indicate improvements. Overall HRQoL results indicated that there is room for improvement past 12 months following treatment, with a significant proportion of breast cancer survivors reporting HRQoL below normative levels. HRQoL concerns 12 months following diagnosis are likely to be distinct from the more acute issues reported earlier on in the literature. Therefore, the development of a cancer survivorship module to accompany the FACT-G would be useful to counteract the ceiling effects observed as well as to capture issues distinct to cancer survivorship. This is the first study to describe in detail the HRQoL of breast cancer survivors across all areas of Queensland and to compare it to the HRQoL reported by the general population of Queensland. Therefore, it represents a unique and substantial contribution to the existing knowledge on survivorship issues following diagnosis and treatment for breast cancer in Australia. Through this research, a number of questions remain that could be addressed by relevant investigations and which are likely to be important in the future to ultimately guide practice. Specifically, implementation of the concept of HRQoL in practice is the next important step forward. Furthermore, the development of a survivorship care plan that incorporates guidelines on HRQoL recovery could provide options for referral and support.

No description available.

Remote area staff performing manual patient handling tasks in the absence of patient lifting hoists available in most health care settings are at an elevated risk of musculoskeletal injuries. The objective of this project was to identify the patient handling methods that have the lowest risk of injury. The patient handling task of lifting a patient from floor to a chair or wheelchair is a common task performed in a remote health care setting. The task was performed utilising three methods, these being: (1) heads/tails lift, (2) use of two Blue MEDesign?? slings and (3) use of a drawsheet. The task of the heads/tails lift was broken down into two distinctly separate subtasks: lifting from the (1) head and (2) tail ends of the patient load. These techniques were selected based on criteria including current practice, durability, portability, accessibility, ease of storage and cost to supply. Postural data were obtained using a Vicon 370 three - dimensional motion measurement and analysis system in the Biomechanics & Gait laboratory at the University of New South Wales. Forty reflective markers were placed on the subject to obtain the following joint angles: ankle, knee, hip, torso, shoulder, elbow, and wrist. The raw data were converted into the respective joint angles (Y, X, Z) for further analysis. The postural data was analysed using the University of Michigan???s Three-Dimensional Static Strength Prediction Program (3D SSPP) and the relative risk of injury was based on the following three values: (1) a threshold value of 3,400 N for compression force, (2) a threshold value of 500 N for shear force, and (3) population strength capability data. The effects on changes to the anthropometric data was estimated and analysed using the in-built anthropometric data contained within the 3D SSPP program for 6 separate lifter scenarios, these being male and female 5th, 50th and 95th percentiles. Changes to the patient load were estimated and analysed using the same computer software. Estimated compressive and shear forces were found to be lower with the drawsheet and tail component of the heads/tails lift in comparison to the use of the Blue MEDesign?? straps and head component of the heads/tails lift. The results obtained for the strength capability aspect of each of the lifts indicated a higher percentage of the population capable of both the drawsheet and tail end of the heads/tails lift. The relative risk of back injury for the lifters is distributed more evenly with the drawsheet lift as opposed to the heads/tails (tail) lift where risk is disproportionate with the heavier end being lifted. The use of lifter anthropometrics does not appear to be a realistic variable to base assumptions on which group of the population are capable of safely performing this task in a remote setting. This study advocates the use of the drawsheet lift in a remote setting based on the author???s experience and the biomechanical results obtained in this study. The drawsheet lift is both more accessible and provides a more acceptable risk when more than two patient handlers are involved, in comparison to the other lifts utilised lifting patients from floor to a chair.

No description available.

No description available.