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Murrell-McMillan, K. A. (2006). Why nurses in New Zealand stay working in rural areas. New Zealand Family Physician, 33(3), 173–175.
Abstract: The author investigates why nurses in New Zealand stay working in rural areas when their Australian counterparts and medical colleagues are leaving rural areas at alarming rates. She looks at international recruitment and retention issues, and particularly compares rural nursing in Australia with New Zealand. Local research shows that over 50% of rural nursing is in the practice environment. Practice nurses report high job satisfaction, specifically around working with diverse populations, autonomy, and working with GPs, the local community, and local iwi. The only perceived barrier identified in the New Zealand literature to job satisfaction and collaborative team behaviour has been the funding of nursing services in rural areas. This contrasts with many barriers to rural nursing in Australia, and the author suggests New Zealand policy makers may learn from Australia's retention issues.
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Beasley, C., & Dixon, R. (2013). Phase II cardiac rehabilitation in rural Northland. Nursing Praxis in New Zealand, 29(2), 4–14.
Abstract: Reports a descriptive, exploratory, qualitative study of the perceptions and experiences of nurses who delivered cardiac rehabilitation in a rural health-care setting in Northland. Gathers data from two focus groups of 12 nurses in which five themes relating to cardiac rehabilitation are identified using a general inductive approach.
Keywords: Cardiac rehabilitation; Rural nursing
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Hylton, J. A. (2005). Relearning how to learn: Enrolled nurse transition to degree at a New Zealand rural satellite campus. Nurse Education Today, 25(7), 519–526.
Abstract: This paper reports a study that examined the factors that assisted or hindered the transition of a group of enrolled nurses to registration/degree programmes, via a flexible course developed by a North Island tertiary institution. The study follows ten enrolled nurses, primarily Maori and working in rural settings, as they continued to work while studying at a small satellite campus. The study was exploratory and descriptive, and utilised focus group interviews. Two major categories emerged from comparative analysis of the data. One category entitled 'relearning how to learn', demonstrated the cognitive and behavioural adaptations made and is the focus of this paper. The other category 'barriers and catapults', demonstrated the physical and environmental factors that influenced the students' transition but is outside the scope of this paper. Recent changes in New Zealand nursing education have witnessed the clarification of scopes of nursing practice and the controversial development of a new Certificate in Health Science (Nurse Assistant). Currently enrolled nurses are again facing threats to employment and it is envisaged that many will be seeking to undertake transition to registered nurse in the near future.
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Connor, M. J., Nelson, K. M., & Maisey, J. (2009). Impact of innovation funding on a rural health nursing service : the Reporoa experience. Nursing Praxis in New Zealand, 25(2), 4–14.
Abstract: Examines the impact of innovation funding through the MOH primary health-care nursing innovation funding scheme on Health Reporoa Inc, which offers a first-contact rural nursing service to the village of Reporoa and surrounding districts. Looks at funding impact during the project period of 2003-2006, and in the two years that followed.
Keywords: Primary health care; Rural nursing; Innovation; Advancing practice
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Spence, D., & Fielding, S. (2002). Win-win-win: Collaboration advances critical care practice. Contemporary Nurse, 13(2/3), 223–228.
Abstract: This paper provides an overview of the structure and processes of an eighteen month, distance education course focused on developing advanced practice in the context of critical care nursing. Within the framework of a Master of Health Science, the postgraduate certificate (critical care nursing) was developed as a collaboration between Auckland University of Technology and two regional health providers. Students enrol in science and knowledge papers concurrently then, in the second half of the course, are supported within their practice environment to acquire advanced clinical skills and to analyse, critique and develop practice within their specialty. This course is set against a background of increasing interest in education post registration. The acquisition of highly developed clinical capabilities requires a combination of nursing experience and education. This requires collaboration between clinicians and nurse educators, and approaches to address accessibility of relevant educational opportunities for nurses outside the country's main centres.
Keywords: Nursing specialties; Rural nursing; Nursing; Education; Curriculum
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Barber, M. (2007). Exploring the complex nature of rural nursing. Kai Tiaki: Nursing New Zealand, 13(10), 22–23.
Abstract: This article reports the results of a research study undertaken to examine how nurses manage their professional and personal selves while working in small rural communities. The participants were a small group of rural nurses on the West Coast. The rationale for the study was the long-term sustainability and viability of the service to this remote area. The research showed that the rural nurse specialists' role is a complex and challenging one, performed within the communities in which nurses live.
Keywords: Rural nursing; Scope of practice; Community health nursing
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Ross, J. (2001). Perspectives on developing the advanced role of rural nursing in New Zealand. Health Manager, 8(1), 19–21.
Abstract: The author traces the development of rural nursing, which began as an assistant role for general practitioners, to the present role which incorporates advanced nursing practice. She reports the results of two surveys of nurses' roles and skills, from 1996 and 1999-2000. Specific rural competencies are identified, in managing isolation, professionalism in a small community, nurse/patient relationships in a small community, and independence.
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Ross, J. (1999). International perspective: The development of the advanced role of rural nurses in New Zealand. Australian Journal of Rural Health, 7(4), 253–257.
Abstract: This paper offers an insight into the development of the advanced role of rural nursing practice in New Zealand. The concept of advanced nursing practice is discussed within the context of the interdisciplinary healthcare team. It is argued that as nurses take on advanced practice, it is essential they receive appropriate clinical and theoretical skills to ensure they are in a position to provide competent and clinically safe, effective health care in an ethical, efficient manner. A description of a survey, undertaken by the author, studying rural nurses' skills provides the recommendation for the development of an appropriate postgraduate course at Masters level, designed specifically for primary rural nurses for the advanced role.
Keywords: Nursing; Education; Rural nursing; Advanced nursing practice
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Howie, L. (2008). Rural society and culture. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 3-18 ). [Dunedin]: Rural Health Opportunities.
Abstract: The author takes a multidisciplinary approach to examine how the location and concept rural is defined and provides a critique of the disparate definitions available. Definitions encompass different disciplines such as sociology and anthropology, and there are national distinctions based on historical factors. The chapter also investigates the way researchers speak about rural people, particularly as the human aspect of health is a primary concern to nursing. The focus is on the socio-cultural, occupational, ecological, and health aspects of rurality. The Rural Framework Wheel is introduced, which is a method to categorise rural contextual definitions. Rurality is presented as a variable and evolving concept that provides particular challenges to nursing practice.
Keywords: Rural nursing; Culture
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Dillon, D. R. (2008). Rural contexts: Islands. In Jean Ross (Ed.), Rural nursing: Aspects of practice (pp. 19-30). [Dunedin]: Rural Health Opportunities.
Abstract: This chapter explores the concept of islands particularly in relation to rurality, individual and community identities, and nursing. The author argues that all New Zealanders are islanders, and considers the implications of this on personal and community values, when they are shaped by geographic isolation and structural separateness. She explores commonalities between islanders and rural peoples in areas such as identity, isolation, and health, and outlines the impacts this has on rural nursing practice and competencies. A case study of a nurse on Stewart Island is briefly discussed.
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Lindley, G. (2007). Using frameworks to critically analyse the advancement of rural practice: One nurse's experience. Ph.D. thesis, , .
Abstract: The process of describing her scope of practice led the author to become interested in just how she has advanced her practice and the journey that unfolded. The author was introduced to a number of models or frameworks and these frameworks have been critiqued within this dissertation.
Keywords: Rural nursing; Nursing models
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Armstrong, S. E. (2006). Exploring the nursing reality of the sole on-call primary health care rural nurse (PHCRN) interface with secondary care doctors. Ph.D. thesis, , .
Abstract: A qualitative framework was used to explore the nature and the quality of interactions between sole on-call primary health care rural nurses and secondary care doctors as a component of rural nursing practice and representative of the primary-secondary care interface. Crucial to patient centred care, the premise was that the quality of this interface would be variable due to multiple influences such as: the historical nurse/doctor relationship that has perpetuated medical dominance and nursing subordination; current policy direction encouraging greater inter-professional collaboration; and changing role boundaries threatening traditional professional positioning. A total of 11 nurses representing 10 separate rural areas participated in semi-structured interviews. Rural nurses typically interact with secondary care doctors for acute clinical presentations with two tiers of interaction identified. The first tier was presented as a default to secondary care doctors for assistance with managing primary care level clinical presentations in the absence of access to a general practitioner or an appropriate Standing Order enabling appropriate management. The second tier presented itself as situations where, in the professional judgement of the nurse, the client status indicated a need for secondary level expertise and/or referral to secondary care. The needs of the rural nurse in these interactions were identified as access to expertise in diagnosis, therapy and management, authorisation to act when intervention would exceed the nurse's scope of practice; the need to refer clients to secondary care; and the need for reassurance, encompassing emotional and professional issues. The quality of the interactions was found to be variable but predominantly positive. Professional outcomes of positive interactions included professional acknowledgement, support and continuing professional development. For the patient, the outcomes included appropriate, timely, safe intervention and patient centred care. The infrequent but less than ideal interactions between the participants and secondary care doctors led to professional outcomes of intraprofessional discord, a sense of invisibility for the nurse, increased professional risk and professional dissatisfaction; and for the client an increased potential for deleterious outcome and suffering. Instead of the proposition of variability arising from interprofessional discord and the current policy direction, the data suggested that variability arose from three interlinking factors; appropriate or inappropriate utilisation of secondary care doctors; familiarity among individuals with professional roles and issues of rurality; and acceptance by the primary care doctor of the sole on-call primary health care rural nurse role and the responsibility to assist with the provision of primary health care. Recommendations for improving interactions at the interface include national, regional and individual professional actions.
Keywords: Rural nursing; Rural health services; Relationships
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Dillon, D. R. (2006). Islands, islandness and nursing: Advanced nursing practice in rural remote and small island areas. Ph.D. thesis, , .
Abstract: This dissertation focuses on the concepts of island, island-ness, and isolation. It aims to further advance the national and international literature relating to the health beliefs of island people as linked to the provision of primary health care services within New Zealand. New Zealand is an island nation made up of two main islands and numerous outlying islands, relatively isolated from the rest of the world by water. This geography means going anywhere from New Zealand involves traveling either “over” or “on” the sea. All people of New Zealand since the first inhabitants, whether residents or visitors, have arrived to New Zealand either by sea or more recently by plane. The population of New Zealand is 25% rural, with most of these rural dwellers residing in the South Island, and several of the smaller off shore Islands. This builds a sense of culture of the people, or tangata whanua (the people of the land), for whom there are degrees of island-ness, and the characteristics of this can be seen amongst the people of New Zealand. A further challenge which is discussed comes in the form of the “island penalty” which encompasses high transport costs, long distances to travel to main centres, lack of specialists and trained health workers, effects of migration and tourism, and communication difficulties. The more isolated people are, the tougher the challenges become. Most rural island populations are served by lay care workers, volunteers, and rural and remote nurses. Nurses are often the main health care providers to small island populations, and they demonstrate advanced nursing practice which is acknowledged internationally as meeting Nurse Practitioner competencies. As a group these nurses possess knowledge of the extrinsic and intrinsic factors involved in the health needs and health determinants of these island communities. Researching these advanced nursing roles adds to the body of knowledge around isolated and island communities. The author suggests that studying the concepts of islands, islandness, and isolation in relation to health beliefs will bring more understanding of services for the advanced rural nurse to consider in developing appropriate, accessible, affordable and adaptable Primary Health Care which is fair and equitable.
Keywords: Rural nursing; Primary health care
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Robertson, A. M. (2006). Meeting the maternity needs of rural women: Negotiating the reality of remote rural nursing and midwifery practice. Ph.D. thesis, , .
Abstract: Recent changes to the way that health services are provided and issues related to the rural health workforce are creating an international crisis in the availability of rural maternity care. International trends show a workforce decline in rural general practitioner obstetric specialists and rural midwives, as well as a decline in rural births. The aim of this study is to highlight the maternity needs of rural New Zealand women. Further, it discusses how the changes to maternity services in New Zealand, over the last sixteen years, have impacted on the rural nurse and midwife role and therefore on service provision. This information is intended to identify issues that could be used as the basis for development of a uniquely rural model of maternity care.
Keywords: Rural nursing; Midwifery
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Boyd, M. E. (2005). Advancing nursing knowledge: The experience of a nurse working with dying people in a highly remote rural area. Ph.D. thesis, , .
Abstract: By describing and gaining insight into one rural nurse's experience working with dying people in a highly, remote rural area, this project seeks to advance nursing practice. Key findings indicate that, through community partnership and teamwork, nurses can act to assist rural people by: increasing public awareness of health resources; exposing barriers to access; and identifying different health service needs. The author makes a case that some rural nurses may feel insufficiently prepared for rural nursing. To understand death and dying, key ideas from Kuebler-Ross's (1969) framework for dying are examined: denial, fear of dying, spirituality, hope, depression and how to die well. Nurses require a blend of end-of-life and rural nursing postgraduate education and skills, to manage well. Key findings imply that dying people can be helped by: improving function and independence to promote autonomy; encouraging faith, hope, and love within the person's personal concept of spirituality; listening to dying people, to oneself, to one's own reactions, and knowing oneself. Parse's theory (1981) indicates nurses can help rural dying people by the following key factors: encouraging the person to live life to the full while dying; accepting humans cannot be separated from their perspectives, circumstances or environments; focusing on quality of life from the person's perspective: encouraging the person to live life fully while dying; and offering new possibilities. The author goes on to say that Parse's human-universe-health process aids nurses to live their beliefs indicating Parse's theory could guide and advance nursing practice.
Keywords: Terminal care; Rural nursing; Rural health services
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