Burley Mollie B, Greene Phillippa
Centre for Multi-disciplinary Studies, Monash University School of Rural Health, Moe, Victoria, Australia.
Rural Remote Health. 2007 Jul-Sep;7(3):611. Epub 2007 Aug 7.
In July 2005 the National Rural Health Alliance released a discussion paper on advanced nursing practice in rural and remote areas of Australia. The paper called for more debate and research about advanced nursing practice roles, especially on how the roles contribute to quality care and patient health outcomes. Monash University School of Rural Health, Victoria, Australia, completed two studies exploring the role and practice of remote area nurses working autonomously in bush nursing centres in East Gippsland, Victoria. The studies confirmed the nursing role as advanced and expanded, and the care effective and of high quality. The studies also revealed the contribution of the remote area nurse to quality care involved more than demonstrating effective healthcare delivery and evidence based clinical practice. The significance of context emerged as an important determinant.
Articulating measures for quality care in Australian remote health practice is problematic. The concept 'quality' is multidimensional and time and context specific. Current Australian health service and professional competency standards fail to combine external structural and organisational factors, and the social and economic situation of a given remote community. Together, these factors create the context, and influence practice and remote health service delivery. It is accepted that context shapes remote nursing practice, however the term 'context' is commonly interpreted as an environmental, structural or geographical construct. These terms are valid; however, they do not describe other drivers that impact on remote area nursing and service delivery. In practice, therefore, to what extent does context influence the contribution of remote nursing roles to quality care?
Four core drivers that model the remote area nursing context were identified: the system, the organisation, the community and the individual. An integrated conceptual model consisting of the core drivers is presented, and this provides a broad framework to illustrate factors influencing the delivery of quality remote health care, in an attempt to crystallise the role of context. Central to the model is the remote area nurse. This article outlines the core drivers and discusses how these drivers impact on remote area nursing practice in Victoria and the provision of quality care. The model is transferable to other remote nursing contexts and provides an alternative approach to evaluate the contribution of a remote area nursing role. Enhancing our understanding of the influence of context may assist in identifying relevant indicators to measure the quality of remote health care delivered by nurses in advanced practice roles.
2005年7月，澳大利亚国家农村卫生联盟发布了一份关于澳大利亚农村和偏远地区高级护理实践的讨论文件。该文件呼吁就高级护理实践角色展开更多辩论和研究，特别是这些角色如何促进优质护理和患者健康结果。澳大利亚维多利亚州莫纳什大学农村卫生学院完成了两项研究，探讨在维多利亚州东吉普斯兰地区丛林护理中心自主工作的偏远地区护士的角色和实践。研究证实了护理角色是高级且扩展的，护理是有效且高质量的。研究还表明，偏远地区护士对优质护理的贡献不仅仅体现在展示有效的医疗服务提供和循证临床实践上。背景的重要性成为一个重要的决定因素。
阐明澳大利亚偏远地区医疗实践中优质护理的衡量标准存在问题。“质量”概念是多维度的，且因时间和背景而异。澳大利亚当前的卫生服务和专业能力标准未能将外部结构和组织因素以及特定偏远社区的社会经济状况结合起来。这些因素共同构成了背景，并影响实践和偏远地区的卫生服务提供。人们公认背景塑造了偏远地区的护理实践，然而“背景”一词通常被解释为一种环境、结构或地理构造。这些说法是正确的；然而，它们并未描述影响偏远地区护理和服务提供的其他驱动因素。因此，在实践中，背景在多大程度上影响偏远地区护理角色对优质护理的贡献？
确定了塑造偏远地区护理背景的四个核心驱动因素：系统、组织、社区和个人。提出了一个由这些核心驱动因素组成的综合概念模型，这提供了一个广泛的框架来说明影响优质偏远地区医疗服务提供的因素，试图明确背景的作用。该模型的核心是偏远地区护士。本文概述了核心驱动因素，并讨论了这些驱动因素如何影响维多利亚州的偏远地区护理实践以及优质护理的提供。该模型可应用于其他偏远护理背景，并提供了一种评估偏远地区护理角色贡献的替代方法。加强我们对背景影响的理解可能有助于确定相关指标，以衡量高级实践角色护士提供的偏远地区医疗服务的质量。
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