Tony Barnett

A critical review of the nursing shortage in Malaysia.

OBJECTIVE This paper describes and critically reviews steps taken to address the nursing workforce shortage in Malaysia. BACKGROUND To address the shortage and to build health care capacity, Malaysia has more than doubled its nursing workforce over the past decade, primarily through an increase in the domestic supply of new graduates. METHODS Government reports, policy documents and ministerial statements were sourced from the Ministry of Health Malaysia website and reviewed and analysed in the context of the scholarly literature published about the health care workforce in Malaysia and more generally about the global nursing shortage. RESULTS An escalation in student numbers and the unprecedented number of new graduates entering the workforce has been associated with other impacts that have been responded to symptomatically rather than through workplace reform. Whilst growing the domestic supply of nurses is a critical key strategy to address workforce shortages, steps should also be taken to address structural and other problems of the workplace to support both new graduates and the retention of more experienced staff. CONCLUSION Nursing shortages should not be tackled by increasing the supply of new graduates alone. The creation of a safe and supportive work environment is important to the long-term success of current measures taken to grow the workforce and retain nurses within the Malaysian health care system.

The evaluation of a successful collaborative education model to expand student clinical placements.

Worldwide, universities have been encouraged to increase the number of students enrolled in nursing courses as a way to bolster the domestic supply of graduates and address workforce shortages. This places pressure on clinical agencies to accommodate greater numbers of students for clinical experience who, in Australia, may often come from different educational institutions. The aim of this study was to develop and evaluate a collaborative model of clinical education that would increase the capacity of a health care agency to accommodate student placements and improve workplace readiness. The project was undertaken in a medium sized regional hospital in rural Australia where most nurses worked part time. Through an iterative process, a new supported preceptorship model was developed by academics from three institutions and staff from the hospital. Focus group discussions and interviews were conducted with key stakeholders and clinical placement data analysed for the years 2004 (baseline) to 2007. The model was associated with a 58% increase in the number of students and a 45% increase in the number of student placement weeks over the four year period. Students reported positively on their experience and key stakeholders believed that the new model would better prepare students for the realities of nursing work.

A comparison of the information needs of women newly diagnosed with breast cancer in Malaysia and the United Kingdom

Little is known about the information needs of women with breast cancer in non-Western societies. This study examined the priority information needs of 100 women with breast cancer in Malaysia and compared the findings to previous work involving 150 women diagnosed with breast cancer in the United Kingdom. The study used a valid and reliable measure, the Information Needs Questionnaire (INQ). The INQ contained 9 items of information related to physical, psychological, and social care, used successfully in Canada and the United Kingdom. The INQ was shown to have cross-cultural relevance and sensitivity. For Malaysian women, information about likelihood of cure, sexual attractiveness, and spread of disease were the most important information needs. For UK women, similar priorities were evident, apart from the item on sexual attractiveness, which was ranked much lower by women in the United Kingdom. The cultural similarities and differences that emerged from this study have implications for nurses in the cancer field caring for people from a diversity of cultural backgrounds. Breast care nurses are not a feature of the Malaysian healthcare system, although the findings from this study support the view that specialist nurses have a vital role to play in meeting the psychosocial needs of women with breast cancer in non-Western societies.

Yoga management of breast cancer-related lymphoedema: a randomised controlled pilot-trial.

BackgroundSecondary arm lymphoedema continues to affect at least 20% of women after treatment for breast cancer requiring lifelong professional treatment and self-management. The holistic practice of yoga may offer benefits as an adjunct self-management option. The aim of this small pilot trial was to gain preliminary data to determine the effect of yoga on women with stage one breast cancer-related lymphoedema (BCRL). This paper reports the results for the primary and secondary outcomes.MethodsParticipants were randomised, after baseline testing, to receive either an 8-week yoga intervention (n = 15), consisting of a weekly 90-minute teacher-led class and a 40-minute daily session delivered by DVD, or to a usual care wait-listed control group (n = 13). Primary outcome measures were: arm volume of lymphoedema measured by circumference and extra-cellular fluid measured by bioimpedance spectroscopy. Secondary outcome measures were: tissue induration measured by tonometry; levels of sensations, pain, fatigue, and their limiting effects all measured by a visual analogue scale (VAS) and quality of life based on the Lymphoedema Quality of Life Tool (LYMQOL). Measurements were conducted at baseline, week 8 (post-intervention) and week 12 (four weeks after cessation of the intervention).ResultsAt week 8, the intervention group had a greater decrease in tissue induration of the affected upper arm compared to the control group (p = 0.050), as well as a greater reduction in the symptom sub-scale for QOL (p = 0.038). There was no difference in arm volume of lymphoedema or extra-cellular fluid between groups at week 8; however, at week 12, arm volume increased more for the intervention group than the control group (p = 0.032).ConclusionsAn 8-week yoga intervention reduced tissue induration of the affected upper arm and decreased the QOL sub-scale of symptoms. Arm volume of lymphoedema and extra-cellular fluid did not increase. These benefits did not last on cessation of the intervention when arm volume of lymphoedema increased. Further research trials with a longer duration, higher levels of lymphoedema and larger numbers are warranted before definitive conclusions can be made.

The effect of yoga on women with secondary arm lymphoedema from breast cancer treatment

BackgroundWomen who develop secondary arm lymphoedema subsequent to treatment associated with breast cancer require life-long management for a range of symptoms including arm swelling, heaviness, tightness in the arm and sometimes the chest, upper body impairment and changes to a range of parameters relating to quality of life. While exercise under controlled conditions has had positive outcomes, the impact of yoga has not been investigated. The aim of this study is to determine the effectiveness of yoga in the physical and psycho-social domains, in the hope that women can be offered another safe, holistic modality to help control many, if not all, of the effects of secondary arm lymphoedema.Methods and designA randomised controlled pilot trial will be conducted in Hobart and Launceston with a total of 40 women receiving either yoga intervention or current best practice care. Intervention will consist of eight weeks of a weekly teacher-led yoga class with a home-based daily yoga practice delivered by DVD. Primary outcome measures will be the effects of yoga on lymphoedema and its associated symptoms and quality of life. Secondary outcome measures will be range of motion of the arm and thoracic spine, shoulder strength, and weekly and daily physical activity. Primary and secondary outcomes will be measured at baseline, weeks four, eight and a four week follow up at week twelve. Range of motion of the spine, in a self-nominated group, will be measured at baseline, weeks eight and twelve. A further outcome will be the women’s perceptions of the yoga collected by interview at week eight.DiscussionThe results of this trial will provide information on the safety and effectiveness of yoga for women with secondary arm lymphoedema from breast cancer treatment. It will also inform methodology for future, larger trials.Trial registrationACTRN12611000202965

Using overseas registered nurses to fill employment gaps in rural health services: quick fix or sustainable strategy?

OBJECTIVE This study sought to identify and evaluate approaches used to attract internationally trained nurses from traditional and non-traditional countries and incentives employed to retain them in small rural hospitals in Gippsland, Victoria. DESIGN An exploratory descriptive design. SETTING Small rural hospitals in Gippsland, Victoria. PARTICIPANTS Hospital staff responsible for recruitment of nurses and overseas trained nurses from traditional and non-traditional sources (e.g. England, Scotland, India, Zimbabwe, Holland, Singapore, Malaysia). RESULTS AND CONCLUSION Recruitment of married overseas trained nurses is more sustainable than that of single registered nurses, however, the process of recruitment for the hospital and potential employees is costly. Rural hospitality diffuses some of these expenses by the employing hospitals providing emergency accommodation and necessary furnishings. Cultural differences and dissonance regarding practice create barriers for some of the overseas trained nurses to move towards a more sanguine position. On the positive side, single overseas registered nurses use the opportunity to work in rural Australian hospitals as an effective working holiday that promotes employment in larger, more specialized hospitals. Overall both the registered nurses and the employees believe the experience to be beneficial rather than detrimental.

Expanding the clinical placement capacity of rural hospitals in Australia: Displacing Peta to place Paul?

In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines. Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE). Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.

Interprofessional practice and learning in a youth mental health service: a case study using network analysis

Abstract Few studies have examined interprofessional practice (IPP) from a mental health service perspective. This study applied a mixed-method approach to examine the IPP and learning occurring in a youth mental health service in Tasmania, Australia. The aims of the study were to investigate the extent to which staff were networked, how collaboratively they practiced and supported student learning, and to elicit the organisation’s strengths and opportunities regarding IPP and learning. Six data sets were collected: pre- and post-test readiness for interprofessional learning surveys, Social Network survey, organisational readiness for IPP and learning checklist, “talking wall” role clarification activity, and observations of participants working through a clinical case study. Participants (n = 19) were well-networked and demonstrated a patient-centred approach. Results confirmed participants’ positive attitudes to IPP and learning and identified ways to strengthen the organisation’s interprofessional capability. This mixed-method approach could assist others to investigate IPP and learning.

An analysis of the readability characteristics of oral health information literature available to the public in Tasmania, Australia

BackgroundThe effectiveness of print-based health promotion materials is dependent on their readability. This study aimed to assess the characteristics of print-based oral health information literature publically available in Tasmania, Australia.MethodsOral health education brochures were collected from 11 dental clinics across Tasmania and assessed for structure and format, content and readability. Reading level was calculated using three widely-used measures: Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease, and Simple Measure of Gobbledygook (SMOG) reading grade level.ResultsThe FKGL of the 67 brochures sampled ranged from grade 3 to 13. The grade level for government health department brochures (n = 14) ranged from grade 4 to 11 (5.6 ± 1.8). Reading levels for materials produced by commercial sources (n = 22) ranged from 3 to 13 (8.3 ± 2.1), those from professional associations (n = 22) ranged from grade 7 to 11 (8.9 ± 0.9) and brochures produced by other sources (n = 9) ranged from 5 to 10 (7.6 ± 1.5). The SMOG test was positively correlated with the FKGL (rs = 0.92, p < 0.001) though consistently rated materials 2-3 grades higher. The reading level required to comprehend brochures published by government sources were, on average, lower than those from commercial, professional and other sources. Government materials were also more likely to contain fewer words and professional jargon terms than brochures from the other sources.ConclusionA range of oral health information brochures were publically available for patients in both public and private dental clinics. However, their readability characteristics differed. Many brochures required a reading skill level higher than that suited to a large proportion of the Tasmanian population. Readability and other characteristics of oral health education materials should be assessed to ensure their suitability for use with patients, especially those suspected of having low literacy skills.

Non-dental primary care providers’ views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study

Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. Results In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Conclusions Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities.