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    Understanding the impact and causes of 'failure to attend' on continuity of care for patients with chronic conditions
    (PLOS, 2021-03-02) Byrne A-L; Baldwin A; Harvey C; Brown J; Willis E; Hegney D; Ferguson B; Judd J; Kynaston D; Forrest R; Heritage B; Heard D; Mclellan S; Thompson S; Palmer J; Vaingankar JA
    AIM: To understand the impact and causes of 'Failure to Attend' (FTA) labelling, of patients with chronic conditions. BACKGROUND: Nurse navigators are registered nurses employed by public hospitals in Queensland, Australia, to coordinate the care of patients with multiple chronic conditions, who frequently miss hospital appointments. The role of the nurse navigator is to improve care management of these patients. Evidence for this is measured through improvement in patient self-management of their conditions, a reduction in preventable hospital admissions and compliance with attendance at outpatient clinics. Failure to attend (FTA) is one measure of hospital utilisation, identifying outpatient appointments that are cancelled or not attended. METHOD: The cohort for this study was patients with multiple chronic conditions, and nurse navigators coordinating their care. Data describing the concept of FTA were thematically analysed twelve months into this three year evaluation. RESULTS: Although the patient is blamed for failing to attend appointments, the reasons appear to be a mixture of systems error/miscommunication between the patient and the health services or social reasons impacting on patient's capacity to attend. Themes emerging from the data were: access barriers; failure to recognise personal stigma of FTA; and bridging the gap. CONCLUSION: The nurse navigators demonstrate their pivotal role in engaging with outpatient services to reduce FTAs whilst helping patients to become confident in dealing with multiple appointments. There are many reasons why a patient is unable to attend a scheduled appointment. The phrase 'Failure to Attend' has distinctly negative connotations and can lead to a sense of blame and shame for those with complex chronic needs. We propose the use of the neutral phrase "appointment did not proceed" to replace FTA. IMPLICATIONS FOR NURSING MANAGEMENT: This article advocates for further consideration of collaborative models that engage the patient in their care journey and for consideration of the language used within the outpatient acute hospital setting, proposing the term 'appointment did not proceed.'
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    Evaluation of a nursing and midwifery exchange between rural and metropolitan hospitals: A mixed methods study
    (Public Library of Science, 2020) Byrne A-L; Harvey C; Chamberlain D; Baldwin A; Heritage B; Wood E
    Introduction This paper reports on the findings of the Nursing and Midwifery Exchange Program, initiated to promote rural and remote nursing and midwifery, and to facilitate clinical skills development and clinical collaboration between health services in Queensland, Australia. The project was undertaken over an 18-month period in one state of Australia, offering structured, temporary exchange of personnel between metropolitan and rural health services. Background Globally, there is an increasing awareness of nursing shortages, and with it, the need to ensure that nurses and midwives are prepared for specialist roles and practice. This is particularly important in rural and remote areas, where there are pre-existing barriers to access to services, and difficulties in attracting suitably qualified, permanent staff. Methods A mixed methods approach to the evaluation was undertaken with two cohorts. One cohort was the nurses and midwives who participated in the exchange (n = 24) and the other cohort were managers of the participating health services (n = 10). The nurses and midwives who participated in the exchange were asked to complete a questionnaire that included questions related to embeddedness and job satisfaction. The managers participated in a Delphi series of interviews. Results Those who participated in exchange reporting a higher score on the reported degree of understanding of rural client, which was accompanied with a moderate-to-large effect size estimate (d = 0.61). Nurses/midwives in the exchange group reported higher scores on their perceptions of aspects of their home community that would be lost if they had to leave, which was accompanied with a large effect size (d = 0.83). Overall, NMEP was reported by the participants to be a positive way to improve professional development opportunities for nurses and midwives. The findings also show the program supported practical collaboration and raised the profile of nursing and midwifery in rural areas. Conclusion Exchange programs support clinical and professional development, raising the awareness of different contexts of practice and related skills requirements, and thereby supporting a greater understanding of different nursing roles. In the light of increasingly complex care required by patients with chronic conditions being managed in community-based services, programs such as NMEP provide the opportunity to build collaborative networks between referring and referral centres as well as contribute to the ongoing skills development.
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    Mindful Self-Care and Resiliency (MSCR): protocol for a pilot trial of a brief mindfulness intervention to promote occupational resilience in rural general practitioners
    (BMJ Publishing Group Ltd, 2018-06-30) Rees C; Craigie M; Slatyer S; Heritage B; Harvey C; Brough P; Hegney D
    Introduction The Mindful Self-Care and Resiliency (MSCR) programme is a brief psychosocial intervention designed to promote resilience among various occupational groups. The intervention is based on the principles of mindfulness and also incorporates an educational self-care component. The current paper presents the protocol for a pilot study that will evaluate the effectiveness of this programme among general practitioners working in rural Queensland, Australia. Methods and analysis We will measure the impact of the MSCR programme on levels of employee resilience (Connor-Davidson Resilience Scale; State-Trait Assessment of Resilience STARS), compassion satisfaction and compassion fatigue (Professional Quality of Life Scale), self-compassion (Self-Compassion Scale) and mood (Positive and Negative Affect Scale). We will also assess the impact of the programme on job satisfaction (The Abridged Job in General Scale), absenteeism/presenteeism (The WHO Health and Work Performance Questionnaire) and general well-being (WHO Five Well-being Index). Repeated measures analysis of variance will be used to analyse the impact of the intervention on the outcome measures taken at pre, post, 1-month, 3-month and 6-month follow-ups. We will conduct individual interviews with participants to gather data on the feasibility and acceptability of the programme. Finally, we will conduct an initial cost-effectiveness analysis of the programme. Ethics and dissemination Approval for this study was obtained from the Curtin University Human Research ethics committee and the study has been registered with the Australian Clinical Trials Registry. Results will be published and presented at national and international congresses. Trial registration number ACTRN12617001479392p; Pre-results.
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    The use of telephone communication between nurse navigators and their patients
    (Public Library of Science (PLoS), 2020) Heritage B; Harvey C; Brown J; Hegney D; Willis E; Baldwin A; Heard D; Mclellan S; Clayton V; Claes J; Lang M; Curnow V
    Background Hospitals and other health care providers frequently experience difficulties contacting patients and their carers who live remotely from the town where the health service is located. In 2016 Nurse Navigator positions were introduced into the health services by Queensland Health, to support and navigate the care of people with chronic and complex conditions. One hospital in Far North Queensland initiated an additional free telephone service to provide another means of communication for patients and carers with the NNs and for off-campus health professionals to obtain details about a patient utilising the service. Calls made between 7am and 10pm, seven days per week are answered by a nurse navigator. Aim To report utilisation of the service by navigated clients and remotely located clinicians compared to use of navigators’ individual work numbers and direct health service numbers. We report the reason for calls to the free number and examine features of these calls. Methods Statistical analysis examined the call reason, duration of calls, setting from where calls originated and stream of calls. Interactions between the reasons for calls and the features of calls, such as contact method, were examined. Results The major reason for calls was clinical issues and the source of calls was primarily patients and carers. Clinical calls were longer in duration. Shorter calls were mainly non-clinical, made by a health professional. Setting for calls was not related to the reason. The most frequent number used was the individual mobile number of the NN, followed by the hospital landline. Although the free number was utilised by patients and carers, it was not the preferred option. Conclusion As patients and carers preferred to access their NN directly than via the 1800 number, further research should explore options best suited to this group of patients outside normal business hours.
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    Leading with local solutions to keep Yarrabah safe: a grounded theory study of an Aboriginal community-controlled health organisation's response to COVID-19
    (BioMed Central Ltd, 2021-12) McCalman J; Longbottom M; Fagan S; Fagan R; Andrews S; Miller A
    BACKGROUND: Pandemics such as COVID-19 are a serious public health risk for Australian Aboriginal and Torres Strait Islander communities, yet primary healthcare systems are not well resourced to respond to such urgent events. At the start of the COVID-19 pandemic, a federal government advisory group recommended a rapid, tailored Indigenous response to prevent predicted high morbidity and mortality rates. This paper examines the efforts of one ACCHO, which in the absence of dedicated funding, pivoted its operations in response to COVID-19. Gurriny Yealamucka Health Service (Gurriny) is the only primary healthcare service in the discrete Indigenous community of Yarrabah, Far North Queensland. METHODS: The research was conducted at the request of the Chief Executive Officer of Gurriny. Using grounded theory methods, thirteen Gurriny staff and five Yarrabah and government leaders and community members were interviewed, transcripts of these interviews and 59 documents were imported into NVIVO-12 and coded, and key concepts were compared, organised into higher order constructs, then structured into a theoretical framework. RESULTS: Gurriny responded to COVID-19 by leading with local solutions to keep Yarrabah safe. Four key strategies were implemented: managing the health service operations, realigning services, educating and supporting community, and working across agencies. These strategies were enabled or hindered by five conditions: the governance and leadership capacity of Gurriny, relying on the health taskforce, locking the door, "copping it", and (not) having resources. A year after the first case was experienced in Australia and on the eve of vaccine rollout to Indigenous communities, there have been no COVID-19 cases in Yarrabah. DISCUSSION: The success of the locally led, holistic, comprehensive and culturally safe response of Gurriny suggests that such tailored place-based approaches to pandemics (and other health issues) are appropriate, but require dedicated resourcing. Key challenges were the fragmented and rapidly changing government processes, poorly coordinated communication and resource allocation channels, and bottlenecks in hierarchical funding approval processes. CONCLUSIONS: The COVID-19 response in Yarrabah demonstrates the need for governance reform towards greater resourcing and support for local decision making by Aboriginal community-controlled health organisations.
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    Problems in promoting the professional development of staff in New Zealand secondary schools (a prima facie study) : a thesis presented in partial fulfilment of the requirements for the degree of Master of Educational Administration at Massey University
    (Massey University, 1988) Cardno, Carol E M
    This study examines the problems which exist in promoting the professional development of staff in New Zealand secondary schools. It has been approached as a first phase study to establish an initial knowledge base in a field which has not hitherto been the subject of wide research in New Zealand. The introduction clarifies the use of the term 'professional development' in the context of this study and a review of overseas literature draws attention to themes and developments common to this field. An overview of the structures and the systems used to provide and promote professional development and the listing of current provisioning for professional development opportunity lead to a multi-disciplinary analysis of data as a comment on the state of the art in New Zealand. A study fellowship to Australia in 1986 enabled comparative research to be conducted and alerted the author to some of the problem areas in this field in New Zealand. The study concludes with the suggestion of tentative solutions to resolve problems identified in this phase of the research. It recommends that further research at a later stage be undertaken to eliminate error from conjectures made in the concluding chapter of this study.
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    Opening up : a grounded theory on how urban indigenous men of Australia respond to cardiovascular disease : a thesis presented in fulfilment of the requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2013) Hoerara, Roy
    Cardiovascular disease is a silent killer which disproportionately affects indigenous communities and families. This research aims to understand how urban Indigenous men of Australia respond, and relate, to cardiovascular disease. The prevalence of heart disease and mortality rate are sixteen times greater for Indigenous aboriginal men aged 25-44 than their non-Aboriginal counterparts. Responses and attitudes toward this disparity are also shaped by the social, economic, and cultural realities which urban Indigenous men of Australia confront on a daily basis. An emergent or grounded theory methodology, informed by an indigenous centred approach was used for this research. Information from twenty in-depth interviews across two community cohorts (New South Wales and Queensland) was gathered, analysed and compared. A number of thematic categories emerged from the data resulting in the observation that urban Indigenous Australian men respond and comprehend cardiovascular disease through the social phenomenon of Opening Up which emerges as both a barrier and a facilitator to improved cardiovascular outcomes. This research has formulated a theory that the relationship between cardiovascular diseases and urban Indigenous males of Australia is a manifestation and consequence of colonisation. This relationship is characterised thematically by four Core Categories of Knowing, Being Indigenous, Being Male and Doing Nothing. The phenomenon observed is one of ‘Opening Up’ which is characterised by three Key Processes of Making Sense, Making Sure and Making Connections. Opening Up is contextualised within a myriad of complex realities. The theory generated by Opening Up is grounded in the data collected and further reinforced by the literature sourced. While not intended to be generalisable, this theory is consistent with this community’s views, needs and expectations. The promotion of Opening Up as a process for consideration is far reaching, perhaps contributing to the Closing the Gaps policy agenda within an Australian public health domain. It may also lend itself to a wider global public health deliberation to better understand the impact of heart disease throughout the world today.