Sabina Knight

Psychosocial safety climate as an antecedent of work characteristics and psychological strain: A multilevel model

Abstract Psychosocial safety climate (PSC) refers to a specific organizational climate for the psychological health of workers. It is largely determined by management and at low levels is proposed as a latent pathogen for psychosocial risk factors and psychological strain. Using an extended Job Demands-Control-Support framework, we predicted the (24 month) cross-level effects of PSC on psychological strain via work conditions. We used a novel design whereby data from two unrelated samples of nurses working in remote areas were used across time (N=202, Time 1; N=163, Time 2), matched at the work unit level (N= 48). Using hierarchical linear modelling we found that unit PSC assessed by nurses predicted work conditions (workload, control, supervisor support) and psychological strain in different nurses in the same work unit 24 months later. There was evidence that the between-group relationship between unit PSC and psychological strain was mediated via Time 2 work conditions (workload, job control) as well as Time 1 emotional demands. The results support a multilevel work stress model with PSC as a plausible primary cause, or “cause of the causes”, of work-related strain. The study adds to the literature that identifies organizational contextual factors as origins of the work stress process.

An implementation framework for using OSCEs in nursing curricula

The implementation framework outlined in this paper has been developed from feedback of a trial across three different nursing and midwifery programmes and is designed to assist educators to incorporate OSCEs within their curricula. There is value in flagging the pedagogical principles embodied in the framework and alerting educators to their importance for more meaningful student learning. For each step practical advice is provided contributing to the utility of this approach. Considerations are systematic ensuring that the use of OSCEs in health care curricula assures judicious use of resources to achieve desired student outcomes.

OSCE best practice guidelines—applicability for nursing simulations

BackgroundObjective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students’ and clinicians’ clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation.MethodsA mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students’ opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources.ResultsFew changes were made to the existing simulation plan and format. Students’ responses from surveys (n = 367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice.DiscussionSimilarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations.ConclusionsFindings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students’ needs in rehearsing the registered nurse role.

Occupational stress in remote area nursing: development of the Remote Area Nursing Stress Scale (RANSS).

Background and Purpose: The purpose of this study was to develop a measure that would adequately and sensitively measure the occupational stress experience of nurses working in very remote health care facilities. Because no existing nursing stress tool is suitable to assess the unique stressors of remote nursing practice, the aim was to address this gap in psychometric measurement capacity and develop the Remote Area Nursing Stress Scale (RANSS). Method: A focus group (n = 19) of remote area nurses identified potential questionnaire items through open discussion and by later listing the stressors they experienced individually in their day-to-day functioning. Subsequently, the Delphi method was employed to further refine the questionnaire (n = 12 experts). The RANSS was successfully pilot tested and was afterward administered to nurses working in very remote Australia in 2008 (n = 349) and in 2010 (n = 433). Results: Principal components analysis and confirmatory factor analysis were performed for both waves of survey administration, demonstrating a robust 7-factor structure consistent across samples and accounting for significant variance in dependent measures. Conclusion: The development and validation of the RANSS is a significant advancement in remote area nursing research. The RANSS should be administered on an ongoing basis to monitor occupational stress among nurses working in very remote Australia. The RANSS should also be administered internationally in countries that also accommodate remote health care facilities. This would determine whether the RANSS is a psychometrically valid stress measure beyond the context of very remote Australia.

Factors to be considered in developing occupational regulations for quad bikes in Australia

ABSTRACT Quad bikes are popular vehicles in agricultural occupational settings. Quad bike rollovers are a leading cause of deaths in the Australian agricultural industry; current regulations appear to have had limited impact on quad bike deaths. The objectives of this study were (1) to explore whether regulation is perceived by regulators, users, retailers, and health professionals as an effective approach to quad bike safety in North West Outback Queensland, Australia; and (2) to consider the ways that perceptions of quad bike safety and use in North West Outback Queensland could inform the development of regulatory guidelines for the occupational use of quad bikes in agricultural industries. Focus group sessions and interviews were conducted November 2011 to May 2012 with farmers, health care providers, regulators, and retailers. Participants displayed a variety of opinions about perceived impacts of current regulatory changes to enhance quad bike safety, including changes to local induction processes and use of personal protective equipment on local enterprises. Many users perceived that policing the use of quad bikes would be difficult and regulators acknowledged the challenges to development of regulatory requirements and their ability to monitor and regulate use. Regulators also discussed the challenges of differentiating between work-related incidents and recreational incidents on farms. If regulation is going to be effective in improving the safety of quad bikes, there are some key moments times where this could occur, including at production, point of sale, within business policies, and everyday use by farm workers. The results highlight mixed reactions to regulatory change as a safety approach for occupational quad bike use. The interactions between regulators and the agricultural community are key in the development of sound policies that meet the standard required by regulation, monitoring, and implementation of safety policies into practice on farms.

Building a sustainable workforce in a rural and remote health service: a comprehensive and innovative Rural Generalist training approach

BACKGROUND Historically it has been challenging to recruit and retain an appropriately trained medical workforce to care for rural and remote Australians. This paper describes the Queensland North West Hospital and Health Service (NWHHS) workforce redesign, developing education strategies and pathways to practice, thereby improving service provision, recruitment and retention of staff. CONCEPT The Mount Isa-based Medical Education Unit sought accreditation for a Rural Generalist (RG) training pathway from Internship to Fellowship with the Australian College of Rural and Remote Medicine (ACRRM) and the Regional Training Provider (RTP). This approach enhanced the James Cook University (JCU) undergraduate pathway for rurally committed students while improving recruitment and retention of RMOs/Registrars. ACHIEVEMENTS Accreditation was achieved through collaboration with training providers, accreditation agencies, ACRRM and a local general practice. The whole pathway from ignore Internship to Fellowship is offered with the RG Intern intake as a primary allocation site beginning in 2016. Comprehensive supervision and excellent clinical exposure provide an interesting and rewarding experience - for staff at all levels. RESULTS Since 2013 RMO locum rates have been <1%. Registrars on the ACRRM pathway and Interns increased from 0 to 7 positions each in 2015, with similar achievements in SMO staffing. Three RMOs expressed interest in a Registrar position, CONCLUSIONS: Appropriate governance is needed to develop and advertise the program. This includes the NWHHS, the RG Pathway and JCU.

Are primary healthcare services culturally appropriate for Aboriginal people? Findings from a remote community

This study explored the views of key stakeholders on cultural appropriateness of primary health care (PHC) services for Aboriginal people. A total of 78 participants, including healthcare providers, administrative team members (n=24, ~30% of study sample) and Aboriginal community members (n=54, ~70% of study sample) living in remote North West Queensland participated in the study. Outcome measures were assessed by administering survey questionnaires comprising qualitative questions and various subscales (e.g. provider behaviours and attitudes, communication, physical environment and facilities, and support from administrative staff). Descriptive statistics were used to present quantitative findings, whereas inductive thematic analysis was used for qualitative data. In contrast to the views of PHC providers, a significant number of Aboriginal people did not perceive that they were receiving culturally appropriate services. Although PHC providers acknowledged cultural awareness training for familiarising themselves with Aboriginal culture, they found the training to be general, superficial and lacking prospective evaluation. PHC providers should understand that culturally inappropriate clinical encounters generate mistrust and dissatisfaction. Therefore, a broad approach involving culturally respectful association between PHC providers, Aboriginal consumers and administrative staff is required to bring sustainable changes at the practice level to improve the health of Aboriginal people.

Do not move the furniture and other advice for new remote area nurses (RANs).

Remote area nursing is a complex, highly skilled job where nurses are required to practice at an advanced level, that often takes place in an Indigenous community where there is a requirement to adapt skills, knowledge and attitudes to function effectively within a distinct local culture. To help new remote area nurses (RANs) adjust, we offer the following key pieces of advice: • Be prepared for advanced practice. Learn about primary health care, social determinants of health and cultural safety. These concepts enable you to achieve more than ‘bandaid’ type care. Advanced clinical skills are also essential. We recommend prior experience in emergency and paediatrics, and that you undertake the remote emergency care short course through CRANAplus and specialised education such as the Flinders University Remote Health Practice program at the Centre for Remote Health. The following comments do not replace the need for appropriate, formal preparation for RANs. • Find out about community facilities such as what is available in the store, what you need to take before you go. • Introduce yourself to significant people in the community, elders, health council members, traditional healers, school teachers, store manager and others. • Find a mentor or preferably two. Ask a health worker or community person to be a cultural and community mentor and ask another more experienced RAN from elsewhere to also be a mentor. • Expect culture shock. You will go through a variety of feelings in your first 12 months that are quite normal. Firstly a period of excitement or fascination; then a feeling of disenchantment; ‘what am I doing here’ is a common thought. Gradually you begin to develop relationships with Indigenous people and start to feel you are getting the hang of things. The final stage is when you have developed those relationships, and feel you know what you are doing. Sometimes called effective functioning, it is at this stage that you experience the privilege of working within such a rich cultural context. • Speak little and listen lots when you first arrive. It is especially important to listen to Indigenous health workers; they are often your greatest support and most important teachers. • Engage in professional loitering. Hang around the store and the large tree in front of the council offices and observe what goes on. Talk to the elders under the tree. • Learn about the local history, it helps to understand the community. • If an Indigenous language is spoken, attempt to learn it. It is a good relationship builder. • Recognise that you are not the expert and do not act as one. For a time, you will be a novice, take steps to be a learner. • Develop relationships. The importance of relationships in remote Indigenous communities cannot be overstated. It may be useful to use the four ‘Fs’ of family, food (hunting), football and fun to help establish relationships. • Seek out and use the best practice protocol manuals. • Give time to the team. Consider strategies that improve team functioning such regular meetings and social events. • Be respectful. Ask the health workers what the most respectful term is when addressing clients. Remember your manners when dealing with clients and staff. Be gracious to visitors and new staff, offer hospitality – a cup of tea and a friendly word. • Avoid burnout. Keep a journal, ensure you have another interest or outlet and keep in touch with families and friend. Take a break before you REALLY need it. If you are feeling stressed, talk to someone or contact Bush Support Services, a confidential 24-hour support and debriefing service. Ph 1800 805 391. Correspondence: Sue Lenthall, Centre for Remote Health, Flinders University, PO Box 4066, Alice Springs, Northern Territory, 0871, Australia. Email: sue.lenthall@flinders.edu.au