Sue Lenthall

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.

Levels of occupational stress in the remote area nursing workforce

OBJECTIVE   To identify key workplace demands and resources for nurses working in very remote Australia and measure levels of occupational stress in this population. METHODS   The study used a cross-sectional design, utilising a structured questionnaire. SETTING   Health centres in very remote Australia. RESULTS   Nurses working in very remote Australia experience significantly higher levels of psychological distress and emotional exhaustion, compared with other professional populations. Paradoxically, results also highlight higher than average levels of work engagement. Nurses working in very remote regions in Australia further report moderate levels of job satisfaction. Most significant job demands identified were emotional demands, staffing issues, workload, responsibilities and expectations, and social issues. Key job resources included supervision, opportunities for professional development, and skill development and application. CONCLUSION   In a context of high stress, high levels of work engagement and moderate levels of job satisfaction do not obviate high workforce turnover for this population. There is a need to reduce job demands and increase job resources in order to foster long-term work engagement and reduced emotional exhaustion. This might subsequently decrease remote area nursing workforce turnover.

Cost of best-practice primary care management of chronic disease in a remote Aboriginal community

Objective: To estimate the cost of completing all chronic care tasks recommended by the Central Australian Rural Practitioners Association Standard Treatment Manual (CARPA STM) for patients with type 2 diabetes and chronic kidney disease (CKD).

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.

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