Yonge Olive, Jackman Deirdre, Luhanga Florence, Myrick Florence, Oosterbroek Tracy, Foley Vicki
Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
Faculty of Nursing, Research and Innovation Centre, Room 508, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan, S4S 0A2, Canada
Rural Remote Health. 2019 Jul;19(3):5347. doi: 10.22605/RRH5347. Epub 2019 Jul 31.
Travel safety culture is a vital aspect of nursing in rural western Canada, where long distances and severe weather are commonplace. However, this culture is poorly understood owing to the absence of official policy, and the tendency of rural nurses to take travel risks and burdens in stride, rather than advocating for change. Travel risks and burdens include extreme weather events such as tornadoes and blizzards; unmarked routes and hazards; distance, time and expense; and driver fatigue. In such rural settings, the safety and health of visitors, novices and students are of particular concern. The researchers sought to elicit the tacit knowledge of rural registered nurses, and their students undertaking rural nursing preceptorships, pertaining to rural travel issues and best practices for safety and wellbeing.
Through purposive and snowball sampling, the researchers recruited seven senior nursing students and five nurse preceptors. Seven rural acute and community care sites, between 42 km and 416 km distant from the students' primary place of study, were covered by the study. Photovoice, a participant action modality, was employed to collect photographic and qualitative interview data from participants over 10 weeks, between February and April 2016. The data were analyzed thematically, in collaboration with participants, who in turn validated the results. A digital storytelling initiative was attempted, to further involve participants in dissemination of findings, but only one participant took part in this phase of the project.
The central finding of the study was that nursing students learn to accept and manage limitations - and to recognize and capitalize on opportunities - when undertaking rural preceptorships. With regard to road safety, the students were found to be particularly vulnerable to long distances, hazardous conditions, fuel and cellular data expenses, and fatigue. These issues were compounded by the students' reluctance to speak up, or to miss shifts, when they felt unsafe or unwell. Their preceptors role modeled autonomy and community ethos as the foundations of a frontline, extemporaneous road safety culture. This entailed personal safety measures borne from rural experience and background, familiarity with the countryside, and community connectedness with other healthcare sites in place of any official public alert system. The preceptors furthermore benefited from strong union protection for occupational health and safety concerns, but students being taught in rural settings had no such advantage.
Nursing students should have the same occupational health and safety protections as their rural preceptors, especially the right to refuse travel, without penalty, in unsafe circumstances. Better travel subsidies and road safety measures during rural preceptorship may help increase the likelihood of students considering a rural career path. Furthermore, the frontline, community-based road safety experience of rural nurses is an untapped source of information for educators and policymakers. Such information will become more and more vital as a diminishing number of rural nurses are called upon to care for an aging client base.
在加拿大西部农村地区，旅行安全文化是护理工作的一个重要方面，那里路途遥远且恶劣天气很常见。然而，由于缺乏官方政策，以及农村护士倾向于从容应对旅行风险和负担，而不是倡导变革，这种文化并未得到充分理解。旅行风险和负担包括龙卷风、暴风雪等极端天气事件；未标记的路线和危险；距离、时间和费用；以及司机疲劳。在这样的农村环境中，访客、新手和学生的安全与健康尤其令人担忧。研究人员试图获取农村注册护士及其参与农村护理指导工作的学生关于农村旅行问题以及安全与福祉最佳实践的隐性知识。
通过目的抽样和滚雪球抽样，研究人员招募了七名高级护理专业学生和五名带教护士。该研究覆盖了七个农村急症和社区护理站点，距离学生的主要学习地点在42公里至416公里之间。2016年2月至4月期间，采用摄影声音法这一参与式行动方式，在10周内从参与者那里收集照片和定性访谈数据。与参与者合作对数据进行了主题分析，参与者随后对结果进行了验证。尝试开展了一项数字故事讲述活动，以进一步让参与者参与研究结果的传播，但只有一名参与者参与了该项目的这一阶段。
该研究的核心发现是，护理专业学生在进行农村护理指导工作时学会了接受和管理限制因素，并认识和利用机会。在道路安全方面，发现学生特别容易受到路途遥远、危险路况、燃油和手机数据费用以及疲劳的影响。当学生感到不安全或不适时，他们不愿发声或错过轮班，这使这些问题更加复杂。他们的带教护士树立了自主和社区精神的榜样，将其作为一线即时道路安全文化的基础。这包括源于农村经验和背景的个人安全措施、对乡村的熟悉程度以及与其他医疗站点的社区联系，以此取代任何官方公共警报系统。此外，带教护士受益于强大的工会对职业健康和安全问题的保护，但在农村环境中接受教学的学生却没有这样的优势。
护理专业学生应享有与农村带教护士相同的职业健康和安全保护，尤其是在不安全情况下无惩罚地拒绝出行的权利。在农村护理指导期间提供更好的旅行补贴和道路安全措施，可能有助于增加学生考虑从事农村护理职业道路的可能性。此外，农村护士基于社区的一线道路安全经验，对于教育工作者和政策制定者来说是一个未被挖掘的信息来源。随着越来越少的农村护士被要求照顾日益老龄化的客户群体，这些信息将变得越来越重要。
