Penelope Buykx

The FIRST2ACT simulation program improves nursing practice in a rural Australian hospital

OBJECTIVE To measure the impact of the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST(2) ACT) simulation program on nursing observations and practice relevant to patient deterioration in a rural Australian hospital. DESIGN Interrupted time series analysis. SETTING A rural Australian hospital. PARTICIPANTS All registered nurses (Division 1) employed on an acute medical/surgical ward. INTERVENTION The FIRST(2) ACT simulation program. OUTCOME MEASURES Appropriate frequency of a range of observations and administration of oxygen therapy. RESULTS Thirty-four nurses participated (83% of eligible nurses) in the FIRST(2) ACT program, and 258 records were audited before the program and 242 records after. There were statistically significant reductions in less than satisfactory frequency of observations (P = 0.009) and pain score charting (P = 0.003). There was no measurable improvement in the administration of oxygen therapy (P = 0.143), while the incidence of inappropriate nursing practice for other measures both before and after the intervention was too low to warrant analysis. CONCLUSION FIRST(2) ACT was associated with measurable improvements in nursing practice.

Helping policy‐makers address rural health access problems

This paper provides a comprehensive review of the key dimensions of access and their significance for the provision of primary health care and a framework that assists policy-makers to evaluate how well policy targets the dimensions of access. Access to health care can be conceptualised as the potential ease with which consumers can obtain health care at times of need. Disaggregation of the concept of access into the dimensions of availability, geography, affordability, accommodation, timeliness, acceptability and awareness allows policy-makers to identify key questions which must be addressed to ensure reasonable primary health care access for rural and remote Australians. Evaluating how well national primary health care policies target these dimensions of access helps identify policy gaps and potential inequities in ensuring access to primary health care. Effective policies must incorporate the multiple dimensions of access if they are to comprehensively and effectively address unacceptable inequities in health status and access to basic health services experienced by rural and remote Australians.

Public support for alcohol policies associated with knowledge of cancer risk

BACKGROUND Several options are advocated by policy experts to mitigate alcohol-related harms, although the most effective strategies often have the least public support. While knowledge of tobacco-related health risks predicts support for relevant public health measures, it is not known whether knowledge of alcohol health risks is similarly associated with the acceptability of policies intended to reduce alcohol consumption and related harms. This study aims to gauge public support for a range of alcohol policies and to determine whether or not support is associated with knowledge of a long-term health risk of alcohol consumption, specifically cancer. METHODS 2482 adults in New South Wales (NSW), Australia, participated in an online survey. Logistic regression analysis was used to examine the association between demographic data, alcohol consumption, smoking status, knowledge of alcohol as a risk factor for cancer and support for alcohol-related policies. RESULTS Most participants were supportive of health warnings, restricting access to internet alcohol advertising to young people, and requiring information on national drinking guidelines on alcohol containers. Almost half of participants supported a ban on sport sponsorship, while less than 41% supported price increases, volumetric taxation, or reducing the number of retail outlets. Only 47% of participants identified drinking too much alcohol as a risk factor for cancer. Knowledge of alcohol as a risk factor for cancer was a significant predictor of support for all policies, while level of alcohol consumption had a significant inverse relationship with policy support. CONCLUSION The finding that support for alcohol management policies is associated with awareness that drinking too much alcohol may contribute to cancer could assist in the planning of future public health interventions. Improving awareness of the long term health risks of alcohol consumption may be one avenue to increasing public support for effective alcohol harm-reduction policies.

How do small rural primary health care services sustain themselves in a constantly changing health system environment

BackgroundThe ability to sustain comprehensive primary health care (PHC) services in the face of change is crucial to the health of rural communities. This paper illustrates how one service has proactively managed change to remain sustainable.MethodsA 6-year longitudinal evaluation of the Elmore Primary Health Service (EPHS) located in rural Victoria, Australia, is currently underway, examining the performance, quality and sustainability of the service. Threats to, and enablers of, sustainability have been identified from evaluation data (audit of service indicators, community surveys, key stakeholder interviews and focus groups) and our own observations. These are mapped against an overarching framework of service sustainability requirements: workforce organisation and supply; funding; governance, management and leadership; service linkages; and infrastructure.ResultsFour years into the evaluation, the evidence indicates EPHS has responded effectively to external and internal changes to ensure viability. The specific steps taken by the service to address risks and capitalise on opportunities are identified.ConclusionsThis evaluation highlights lessons for health service providers, policymakers, consumers and researchers about the importance of ongoing monitoring of sentinel service indicators; being attentive to changes that have an impact on sustainability; maintaining community involvement; and succession planning.

Patients who attend the emergency department following medication overdose: self-reported mental health history and intended outcomes of overdose

Medication overdose is a common method of non-fatal self-harm. Previous studies have established which mental health disorders are commonly associated with the behaviour (affective, substance use, anxiety and personality disorders) and which medications are most frequently implicated (benzodiazepines, antidepressants, antipsychotics and non-opioid analgesics). However, few studies have explored patient experiences of medication overdose. We address this gap by examining patient stories of a recent medication overdose event, including severity of depression, intended outcomes and patient experiences of emergency medical care, in part to determine the unmet needs of this group of patients. Semi-structured interviews were conducted with 31 patients attending an urban Emergency Department (ED) in Melbourne, Australia, following a medication overdose regarding their mental health history, state of mind at the time of the overdose, circumstances of the overdose, and experiences of emergency medical care. Participants were heterogeneous regarding the severity of depressive symptomatology at the time of overdose. Participant ratings of how accidental or deliberate the overdose was and how strongly they intended to die were also diverse. Stories relating to the overdose usually covered the themes of precipitating events, negative feeling states, and intended outcomes (ambivalent or contradictory). Few problems were identified in relation to the care received in relation to the current overdose. However, histories of extensive mental health problems were commonly reported, along with unsuccessful treatment for these. While mental health problems are common among patients attending the ED following a medication overdose, there is considerable diversity in current levels of distress and intended outcomes, indicating a thorough suicide risk assessment is always warranted. Presentation to the ED for medication overdose should also trigger a mental health treatment review.

Staff perceptions of primary healthcare service change: influences on staff satisfaction

Strong primary healthcare (PHC) services are efficient, cost-effective and associated with better population health outcomes. However, little is known about the role and perspectives of PHC staff in creating a sustainable service. Staff from a single-point-of-entry primary health care service in Elmore, a small rural community in north-west Victoria, were surveyed. Qualitative methods were used to collect data to show how the key factors associated with the evolution of a once-struggling medical service into a successful and sustainable PHC service have influenced staff satisfaction. The success of the service was linked to visionary leadership, teamwork and community involvement while service sustainability was described in terms of inter-professional linkages and the role of the service in contributing to the broader community. These factors were reported to have a positive impact on staff satisfaction. The contribution of service delivery change and ongoing service sustainability to staff satisfaction in this rural setting has implications for planning service change in other primary health care settings. WHAT IS KNOWN ABOUT THIS TOPIC?: Integrated PHC services have an important role to play in achieving equitable population health outcomes. Many rural communities struggle to maintain viable PHC services. Innovative PHC models are needed to ensure equitable access to care and reduce the health differential between rural and metropolitan people. WHAT DOES THIS PAPER ADD?: Multidisciplinary teams, visionary leadership, strong community engagement combined with service partnerships are important factors in the building of a rural PHC service that substantially contributes to enhanced staff satisfaction and service sustainability. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Understanding and engaging local community members is a key driver in the success of service delivery changes in rural PHC services.