Australia is a very big country. The population is very high in city areas, but the population is very spread out in rural Australia. There are many villages and towns which are many hundreds of miles away from bigger cities and towns. The population of these rural towns is very small. Some may have only a few hundred people and some may have only a thousand or two thousand. Due to this, health is a very big problem in those places. It is not possible to have a good hospital with all facilities in such areas. The purpose of this paper is to study rural health care in a remote place in Queensland. The report is prepared as the writer is applying for a job in a rural area as said in the next section.
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Background of the study
The study will be referencing a lady called Mary. She has type two diabetes and only now has to know that she is terminal, that she may die soon. Her father is Italian and her mother is a local aboriginal person. She has five children and lives in a very small town, i.e. 25 km from a small town with only 2500 persons. Only one 10 bed hospital is there. The nearest tertiary hospital is 500 km far. She had to be admitted to a tertiary hospital because the local hospital has no facility to manage her type 2 diabetes. In the local hospital only one doctor, one registered nurse and one enrolled nurse. The latest news is that Mary is dying because of advanced disease and she knows about it. She had been told about diet, medication, exercise, and other things by experts when in a tertiary hospital.
Primary health care initiatives in rural areas
Primary health care in rural areas and urban areas is very important. It is more important in rural areas because if one falls sick to serious diseases there is no facility for proper treatment in rural areas. Primary health care is defined as “socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those most in need, maximizes community and individual self-reliance and participation and involves collaboration with other sectors. It includes health promotion, illness prevention, care of the sick, advocacy, and community development.” (Sibthorpe, Glasgow, and Wells 2005).
This is a very detailed definition and self-explaining. A perfect rural primary health care plan will include all factors said in the above definition. But it is seen that all these facilities are not available for Mary in a local hospital. She has only one doctor, one registered nurse, and one enrolled nurse for help. She also has availability of some medication like insulin injection which she has to take daily. She learned and is doing this on her own.
Qualification for enrolled nurse
The writer of this report is an enrolled nurse (EN) at the local hospital for Mary. A registered nurse/cannot medicate Mary alone. The EN has to follow instructions from the registered nurse and sometimes the doctor. So, EN is under the direct control of the registered nurse. But EN is held responsible for own actions and so has to be careful in carrying out orders of superiors. A registered nurse is fully qualified with a degree or master’s degree in nursing.
Practicing even without supervision is allowable for such qualified nurses. The EN is much lower qualified. “Enrolled nurses in Australia are primarily educated through advanced certificate or associated diploma level courses in colleges of technical and further education, of which the duration is less than three years”. (Enrolled nurse 2008). If not a native English speaker EN should also pass recognized language proficiency tests like IELTS. So this writer is only qualified to assist the registered nurse in helping Mary.
For preventing Mary’s admission to a tertiary hospital, the following things should be done. once diabetes is detected which is possible in a local hospital, it is the education of disease that is important. Mary should be taught that diabetes especially types 2 be fatal. She is educated that treatment is difficult in a rural area so diet and exercise are very crucial. Taking insulin tablets is also very important. Checking glucose levels every day is also important.
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This is what might prevent Mary from her disease from getting serious. Moreover, Queensland people have more chance of getting type 2 diabetes because of race, genetic factors, diet, lifestyle, etc. they are also less educated, especially aborigines, and will not usually take disease control and prevention factors seriously. These are also steps to be taken for all diseases, that is educating people for control and more importantly prevention. Steps like informing people of the dangers of smoking, obesity should be taken.
According to John Menadue (former head of the following organizations in Australia: Department of Immigration and Ethnic Affairs, Centre for Policy Development, Quantas, etc) the country’s health policy should have focused more on wellness-centered treatment along with illness-centered treatment. He is correct in saying that a change be made and a wellness model be developed for the country. A model on wellness and illness will be given later in the paper. The shift should be made from hospitals and disease to more focus on primary health and wellness. The community should also be involved very much in these activities. These points are taken from a speech by the person to the CS & H Industry Skills Conference on 7 June 2005.
Recently many changes have taken place in primary and rural health care due to initiatives from the government and also not for profit organizations. From 1992 a Rural Health Education Foundation has been set up by a not for profit organization. It provides “accredited education services to general practitioners and other health professionals working in rural and remote Australia”. (Rural health educational foundation 2008). It focuses on providing latest education, information and news to all people (doctors, nurses etc) in health care in remote rural areas. The biggest facility is the satellite and internet linking facility.
Through this, experts from various fields educate the latest news and trends to professionals in rural areas. It also receives inputs from these rural areas. Another initiative is the Australian Primary Care Collaboratives Program (APCCP) and The Australian Primary Health Care Research Institute (APHCRI) set up by the government. According to the website of the former, their aims are to “improve clinical health outcomes, reduce lifestyle risk factors, maintain health for chronic and complex conditions and improve access to Australian general practice”. The latter organization is aimed at increasing research in primary health care.
It wants to place the research habit inside the primary health care sector and the general practice sectors in the country. But the greatest service for health education and for treatment for rural areas is the world famous Royal Flying Doctor Service dedicated to give health care and treatment to rural areas throughout the country. They also visit the town where Mary stays in case of emergencies or if some special treatment is needed. This is also a non-government, not for profit organization. It could be said that if the formation of all these organizations existed when Mary first had this diabetes, she will not need to be admitted to tertiary hospital. Maybe her life itself be saved through proper care and disease management.
Wellness and illness models
A wellness model released by the National Wellness Institute based in the United States. (Hetller).
They give six dimensions to wellness. Physical refers to optimum physical activity (exercise, yoga, aerobics etc) to maintain and better health. Spiritual refers to the spiritual mind of the person which can be better by activities like meditation etc. Intellectual refers to harnessing creativity and talents. Social means how the person has a healthy social life which is important for good health. Emotional health can be increased with inputs from spouse, family, friends, community etc. Occupational means doing a job that a person enjoys which will be in tune with his talent, education etc. It also means learning to enjoy the job. A combination of all these things is a sure way to wellness.
The most well known illness model is developed by John Rolland called Family Systems Illness Model. (Mengel, Holleman and Fields 2002).
The innermost circle is about personal understanding of disease, like type, if any disability may come or death may come. Next the understanding of the family of the situation comes in outer circle. Third in the outermost circle comes their belief systems and culture that should be used to understand and manage the situation. (Mengel, Holleman and Fields 2002).
Role of enrolled nurse
The qualification needed and responsibility of enrolled nurses already been mentioned in earlier section. This includes patient care, giving medications, injections and all other duties required by a nurse and only under the supervision of the registered nurse. But there are other things an enrolled nurse can do. This is by mainly giving primary education to the community. This is also practical because people number in communities like Mary stays is very small.
Each day a few houses can be visited and careful explanation can be given to the inmates of the houses. This can be done only with the authority of the registered nurse. Maybe the doctor and the registered nurse can also do this and the EN can go to help them. In such communities education levels will be low. Aborigines will also be poor and may not have internet in homes. Far off places may also be cut off from technology even if money is there.
So educating community about health is the most important thing that an EN can do. EN cannot give medications or injections without okay from registered nurse. So services mentioned above are one way to help people. All this should be done with reference to Mary. A visit to her house (25 kms away) should be done two times a week. This is now more important since she is terminal now. Her family should also be prepared to take care of her and also understand and come to terms with the serious condition of her.
It can be seen that there will a plenty of job in rural areas for nurses. This is because only serious service minded nurses be willing to work in remote areas. They will be away from their own families and friends. They will also have not too much recreation facilities to enjoy after duty hours. The writer will apply for job because service is a passion. Moreover, people will be close in small communities. The friends can be close and also people will also help and assist each other more than city areas. There are many ways in which to apply for job in rural areas. There are many classified in print and on the internet that asks for EN to work in rural community.
The pay may be lesser than what is given in cities. There are also government jobs and advertisements for rural enrolled nurses. With so much demand there would be no problem in getting a nursing job in rural areas.
Education and preparation
The education qualification for enrolled nurses is already given in earlier sections. Preparation is a lot for such posts. As mentioned earlier, life will be lonely in case a lot of friends are needed by the person applying for the job. Basic facilities for living will be very little available. The climate will be a problem without air conditioning and heating. Even electricity might be a problem Because of size, the community may be far off from the family of the nurse. Travel facilities will be basic mainly only by road or small airplanes. The health of the nurse himself is also risk if he himself gets sick. This is a possibility if the disease treated is contagious.
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So, apart from education qualification, the EN has to mentally prepare for handling the job efficiently. The nurse will also have to work with different cultures and races and give equal treatment to all. Moreover service minded persons will prefer such jobs more than money minded people. The writer feels that as a nurse, service is the most important thing. Hence the writer is well qualified to work in such an area.
Support services of the organizations mentioned earlier can be used. Also the internet which is available in most communities (at least few connections will be there) is also a very useful tool. Using private radio and HAM is also very useful. This can be used to ask for assistance and also to learn how other rural health professionals manage their duties and responsibilities.
The health care situation in rural Australia with special reference to Queensland and terminally ill Mary has been done. it can be seen that the recent developments in rural health in the country may prevent Mary’s present condition, if only applied much earlier in her life. But situation is now improving and the story of Mary may not be repeated. High technical facilities will never come in rural areas. Hence education and prevention is the key for health improvement in rural areas and many steps being now done. to make it possible. This will make life healthier in rural Australia.
Enrolled nurse. (2008). ASA Group: Australian Nursing Council. Web.
HETLLER, Bill. Six dimensional model of wellness. National Wellness Institute. Web.
MENGEL, Mark B., HOLLEMAN, Warren and FIELDS, Scott A. (2002). Managing Chronic Illness. Fundamentals of Clinical Practice. P.286. Web.
Rural health educational foundation. (2008). Rural Health Educational Foundation. Web.
SIBTHORPE, Beverly., GLASGOW, Nicholas J., and WELLS, Robert W. (2005). Sustainability of reforms is the key to progress. The Medical Journal of Australia: Questioning the sustainability of primary health care innovation. Web.