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Background: The use of telehealth has proliferated to the point of being a common and accepted method of healthcare service delivery. Due to the rapidity of telehealth implementation, the evidence underpinning this approach to healthcare delivery is lagging, particularly when considering the uniqueness of some service users, such as those in rural areas. This research aimed to address the current gap in knowledge related to the factors critical for the successful delivery of telehealth to rural populations. Methods: This research used a qualitative descriptive design to explore telehealth service provision in rural areas from the perspective of clinicians and describe factors critical to the effective delivery of telehealth in rural contexts. Semi-structured interviews were conducted with clinicians from allied health and nursing backgrounds working in child and family nursing, allied health services, and mental health services. A manifest content analysis was undertaken using the Framework approach. Results: Sixteen health professionals from nursing, clinical psychology, and social work were interviewed. Participants mostly identified as female (88%) and ranged in age from 26 to 65 years with a mean age of 47 years. Three overarching themes were identified: (1) Navigating the role of telehealth to support rural healthcare; (2) Preparing clinicians to engage in telehealth service delivery; and (3) Appreciating the complexities of telehealth implementation across services and environments. Conclusions: This research suggests that successful delivery of telehealth to rural populations requires consideration of the context in which telehealth services are being delivered, particularly in rural and remote communities where there are challenges with resourcing and training to support health professionals. Rural populations, like all communities, need choice in healthcare service delivery and models to increase accessibility. Preparation and specific, intentional training for health professionals on how to transition to and maintain telehealth services is a critical factor for delivery of telehealth to rural populations. Future research should further investigate the training and supports required for telehealth service provision, including who, when and what training will equip health professionals with the appropriate skill set to deliver rural telehealth services. [ABSTRACT FROM AUTHOR]

Aim: To explore Remote Area Nurses' experiences of the implementation of workplace health and safety policies and risk mitigation strategies in Australian very remote primary health clinics. Design: This qualitative study used online semi‐structured interviews, with participants purposively sampled to maximize variation in work location and service type. Data were analysed using a reflexive thematic analysis approach. Coding was carried out inductively, with NVivo 12 aiding data management. Setting: The interviews were conducted from 24 Februrary 2021 to 06 March 2021 with Remote Area Nurses from very remote primary health clinics in Australia. Participants: Fifteen Remote Area Nurses participated in the study. Results: Thematic analysis revealed varied approaches to workplace safety among the different health services and regions. While the spread of 'never alone' policies in many clinics addressed one of the significant risks faced by Remote Area Nurses, gaps remained even for hazards specifically highlighted in existing work health and safety legislation. Meaningful collaboration with staff and the community, local orientation, preparation for the role and providing quality care were protective factors for staff safety. Understaffing, unsafe infrastructure and inadequate equipment were common concerns among Remote Area Nurses. Conclusion: Health services need to prioritize workplace safety and take a continuous quality improvement approach to its implementation. This will include ensuring safety strategies are appropriate for the local context, improving infrastructure maintenance, and establishing sustainable second responder systems such as a pool of drivers with local knowledge. Implications for the Profession: Poor personal safety contributes to burnout and high turnover of staff. Nurses' insights into the barriers and enablers of current workplace safety strategies will aid policymakers and employers in future improvements. Reporting Method: COREQ reporting guidelines were followed. PIPE Statement: A panel of six Remote Area Nurses collaborated in the development of this project. [ABSTRACT FROM AUTHOR]

Background: Nurse Practitioners work independently and collaboratively within multidisciplinary teams to fill unmet service delivery needs. Despite strong evidence of the benefits of the nurse practitioner service model, organisational support for nurse practitioners varies in terms of resources and support from leadership and other healthcare professionals. Aims: The study aimed to explore healthcare practitioners' experiences of implementation of a NP service in a rural setting. Methods: Semi-structured interviews were conducted with ten healthcare practitioners to investigate their perspectives of a recently implemented NP service. Data were analysed inductively using thematic analysis. Findings: Themes emerged related to facilitating collaborative practice, person-centred continuity of care and positive health outcomes for the community. Challenges and limitations related to operational role clarity, scopes of practice and leadership. Conclusion: Healthcare practitioners were mostly satisfied with the service however challenges caused tension. Change management principles provide a framework to strengthen the effective clinical alignment of the service. [ABSTRACT FROM AUTHOR]

Objective: To clarify the knowledge and practical skills needed for cancer pain management among nurses on remote islands in Japan and related factors nationwide. Setting: Due to geographical factors, nurses working on remote islands in Japan have few opportunities to attend training programs, which makes it difficult to acquire the knowledge and practical skills needed to provide pain management for patients with cancer. Methods: We conducted a self‐administered questionnaire survey regarding knowledge and practical skills in pain management for patients with cancer. Design: Cross‐sectional study. Participants: Nurses working in cancer pain care in medical facilities and home care on remote islands throughout Japan. Results: We analysed 128 responses. Regarding knowledge, the average accuracy level was 49.1%. Items with a low accuracy rate included selecting medicine according to the type of pain and the patient's condition. Regarding practice, the items with low scores included analgesics appropriate for the type of pain and relating physical pain to mental, social and spiritual aspects. The most common significant factor in both knowledge and practice was related to postgraduate training. Conclusions: These findings suggest that to improve the knowledge and practical skills for cancer pain management among nurses on remote islands in Japan, it is necessary to incorporate clinical reasoning into basic education and establish remote education systems and consultation systems with other facilities. [ABSTRACT FROM AUTHOR]

Developing political engagement among nurses who care for rural and underserved communities can help mitigate health inequities. An experiential learning opportunity informed by Lobby Day was developed to prepare primary care advanced practice nursing students with the policy skills needed to actively serve as advocates for their patients and communities. [ABSTRACT FROM AUTHOR]

Background: Access to mental and physical healthcare in rural areas is challenging for Veterans and their families but essential for good health. Even though recent research has revealed some of the challenges rural Veterans face accessing healthcare, a complete understanding of the gap in access is still unclear. Methods: This qualitative study aimed to explore participants' perceptions of healthcare access. Structured interviews were conducted with 124 Veterans and spouses of Veterans from rural qualifying counties in South Carolina and Florida. Results: The study's results revealed five main dimensions of access: geographic proximity, transportation, communication, cultural competence, and resources. Distance to service needed can negatively impact access for Veterans and their families in general, especially for those whose health is declining or who cannot drive because of their age. Lack of transportation, problems with transportation services, and lack of public transportation can lead to delays in care. Additionally, the lack of communication with the Veterans Affairs (VA) Health System and with the healthcare team, as well as inefficient communication among the healthcare team, lack of coordination of care between the VA health system and community providers, and the lack of cultural competence of healthcare providers and contracted personnel made access to services even more challenging. Conclusions: Improving communication can help to develop a sense of trust between Veterans and the VA, and between Veterans and spouses with the healthcare team. It can also lead to increased patient satisfaction. Ensuring healthcare providers and contracted personnel are culturally competent to talk and treat Veterans can improve patient trust and adherence to treatment. Lastly, resource-related challenges included financial problems, lack of prompt access to appointments, lack of providers, limited access to local clinics and hospitals, limited local programs available, and reimbursement issues. [ABSTRACT FROM AUTHOR]

Background: Limited access to specialist medical services is a major barrier to healthcare in rural areas. We compared rural-urban specialist doctor consultations outside hospital by older adults (≥ 60 years) across South Australia. Methods: Cross-sectional data were available from the South Australia's Department of Health. The Modified Monash Model (MM1-7) of remoteness was used to categorize data into rural (MM 3–4), remote (MM5-7), and urban (MM1-MM2) of participants in urban and non-urban South Australia. The analysis was conducted on older adults (n = 20,522), self-reporting chronic physical and common mental health conditions. Results: Specialist doctor consultation in the past 4 weeks was 14.6% in our sample. In multivariable analysis, increasing age (odds ratio 1.3, 95% CI: 1.2-1.4), higher education (odds ratio 1.5, 95% CI: 1.3-1.9), physical health conditions [diabetes (odds ratio 1.2, 95% CI: 1.1-1.3); cancer (odds ratio1.8, 95% CI: 1.7-2.0); heart disease (odds ratio 1.9, 95% CI: 1.6-2.1)], and common mental disorders [depression (odds ratio 1.3, 95% CI: 1.1-1.5); anxiety (odds ratio 1.4, 95% CI: 1.1-1.6)] were associated with higher specialist care use. Specialist care use among rural (odds ratio 0.8, 95% CI: 0.6–0.9), and remote (odds ratio 0.8, 95% CI: 0.7–0.9) older people was significantly lower than their urban counterparts after controlling for age, education, and chronic disease. Conclusion: Our findings demonstrate a disparity in the use of out of hospital specialist medical services between urban and non-urban areas. What is already known • Specialist care is crucial in chronic disease management • Ageing is associated with higher care needs, including specialty care • There is limited evidence relating to factors associated with specialist services use in old age What this paper adds • This study demonstrates a disparity in the use of specialty services between urban and rural environments • Beside availability of specialty services, socioeconomic factors are associated with specialist care visits Application of study findings: • Interprofessional care coordination could be a vital resource in chronic health management • Appropriate specialty care provision and use in rural areas could help reduce the rural-urban health disparities. [ABSTRACT FROM AUTHOR]

Introduction Objective Design Finding Discussion/Conclusion Many experts and communities have concerns about how National Disability Insurance Scheme services are provided to Aboriginal and Torres Strait children. This study was undertaken at the request of the NPY Women's Council in partnership with the researchers, to explore supports for Aboriginal and Torres Strait Islander children living with a disability in their remote areas.This scoping review aims to (a) explore the barriers and enablers to accessing disability support services for families of young Aboriginal and Torres Strait Islander children (0–8 years) living in regional, rural and remote settings, and (b) summarise best practice approaches for accessing support for young children in these settings.The search was run in three electronic databases, as well as grey literature sources. We assessed the quality of included publications using the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange tool. A narrative synthesis was supported by thematic analysis.From an initial search (557 citations), we identified 13 eligible documents. Most documents were peer‐reviewed articles of qualitative studies. Key themes identified included the following: (1) Holistic approach, (2) Understanding disability, (3) Consistent relationships, (4), Flexibility, (5) Simplify system and (6) Enhance communication.This scoping review has revealed gaps in the provision of quality, culturally responsive disability services for families of Aboriginal and Torres Strait Islander children living in regional, rural and remote areas of Australia. A family‐centred, flexible approach will help address their needs. Future research is required to design and evaluate models of care for Aboriginal and Torres Strait Islander children. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONAcquired brain injuries (ABIs) can have devastating effects on children and their families. Families living in rural communities experience unique barriers to receiving and coordinating care for complex medical needs, but little research has examined those barriers for rural youth with ABIs.This qualitative study explored the experiences of rural adults caring for children with ABIs through interviews with six caregivers, three school staff members, and three medical professionals who had treated at least one child with an ABI.Themes in their accounts include difficulty navigating complex situations, support from small communities, isolation and loneliness, the need for more professional education about ABI, and feelings of hope. Barriers to quality care coordination include navigating complex situations, access to transportation, and a lack of communication and education from healthcare agencies. Facilitators of rural care coordination include support from small communities and interagency communication.The results support the need for more comprehensive coordination among rural agencies involved in ABI care. Suggestions for care improvement include providing flexibility due to transportation barriers, capitalizing on the benefits of a small and caring community, and providing healthcare and education professionals with more education about ABI interventions.Practitioners should implement tailored support systems that include initiatives to facilitate direct communication between rural medical agencies and schools.Expanding the role of care coordinators to bridge gaps across healthcare, education, and community services could enhance care coordination for children with acquired brain injuries in rural areas.Schools in rural areas should develop formal reintegration programs tailored to the needs of children with mild acquired brain injuries, leveraging existing sports protocols for non-sports-related injuries.Collaborative efforts between schools, medical teams, and community agencies can provide comprehensive education programs tailored to the rural context.The development of online options for follow-up appointments would be particularly beneficial in rural areas, where transportation barriers are more pronounced.Practitioners should implement tailored support systems that include initiatives to facilitate direct communication between rural medical agencies and schools.Expanding the role of care coordinators to bridge gaps across healthcare, education, and community services could enhance care coordination for children with acquired brain injuries in rural areas.Schools in rural areas should develop formal reintegration programs tailored to the needs of children with mild acquired brain injuries, leveraging existing sports protocols for non-sports-related injuries.Collaborative efforts between schools, medical teams, and community agencies can provide comprehensive education programs tailored to the rural context.The development of online options for follow-up appointments would be particularly beneficial in rural areas, where transportation barriers are more pronounced. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results Conclusions So What? The oral glucose tolerance test is the ‘gold standard’ for detecting gestational diabetes in Australian and International guidelines. Test completion in regional, rural and remote regions may be as low as 50%. We explored challenges and enablers for regional, rural and remote antenatal clinicians providing gestational diabetes screening to better understand low oral glucose tolerance test completion.We conducted a qualitative descriptive study using semi‐structured interviews. Participants eligible for the study were doctors or midwives providing antenatal care in regional, rural and remote Western Australia, between August 2019 and November 2020. Interviews were recorded digitally and transcribed into a Word document. We conducted a thematic analysis after initial categorisation and deduction of themes through workshops involving the research team.We found a diversity of viewpoints on oral glucose tolerance test reliability for detecting gestational diabetes. Themes that emerged were; good collaboration between antenatal clinicians is required for successful screening; screening occurs throughout pregnancy using various tests; clinicians make significant efforts to address barriers; clinicians prioritise therapeutic relationships.Effective universal screening for gestational diabetes in regional, rural and remote Western Australia is difficult and more complex in practice than guidelines imply. Detecting gestational diabetes requires creative solutions, early identification of at risk women and trust and collaboration between clinicians and women.Detection of gestational diabetes in regional, rural and remote Western Australia remains poorly completed. New strategies are required to adequately identify women at risk of adverse birth outcomes relating to hyperglycaemia in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound imaging is an important aspect of antenatal care, though access to antenatal ultrasound imaging is limited in many developing countries. The objective of this study was to evaluate a pilot programme which aimed to improve access to antenatal ultrasound for rural Ethiopians through enhanced training of healthcare providers (including midwives, nurses and clinical officers) with support remotely provided by obstetricians using a tele-ultrasound platform. Methods: Thirteen healthcare providers in the North Shoa Zone in Ethiopia completed training to enable them to perform antenatal ultrasound with the remote supervision of an obstetrician via a tele-ultrasound platform. Pregnant women attending an antenatal appointment at two facilities were offered an antenatal ultrasound exam performed by one of the healthcare providers. Image interpretations between obstetricians and healthcare providers were compared. Participants and healthcare providers were invited to complete a questionnaire regarding their experience with tele-ultrasound, and participants, healthcare providers and obstetricians were interviewed regarding their experience with the tele-ultrasound pilot programme. Results: 2795 pregnant women had an antenatal ultrasound exam. Of 100 exams randomly selected to assess concordance between healthcare providers' and obstetricians' image interpretations, concordance ranged from 79% to 100% for each parameter assessed. 99.4% of participants surveyed indicated that they would recommend antenatal ultrasound using tele-ultrasound to friends and family. Themes relating to participants' experiences of having a tele-ultrasound exam were reduced travel and cost, equivalence in quality of virtual care to in-person care and empowerment through diagnostic information. Conclusion: Healthcare provider–performed antenatal ultrasound – supported by obstetricians via tele-ultrasound – showed high levels of concordance, was well-received by participants and provided rural Ethiopian women with enhanced access to antenatal imaging. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionsHospital at home (HaH) is an innovative approach to healthcare delivery that brings specialized services to patients’ homes. HaH services are typically available in urban areas where hospitals can easily reach nearby patients. An integrated care model that utilizes the public primary healthcare system may extend HaH services to include patients residing further away from hospitals. However, there is limited evidence of primary healthcare employees’ views on integrating HaH care into primary healthcare services. This study aimed to explore the reflections of primary healthcare employees on integrating HaH care into primary healthcare services.Ten focus group interviews were conducted with homecare nurses and managers of primary healthcare services in five municipalities in Mid-Norway. Reflexive thematic analysis was used to analyze the data.The analysis resulted in three key themes regarding the integration of HaH care into primary healthcare. Participants discussed how they capture the distinctiveness of HaH care within the primary healthcare landscape. Moreover, they identified that the introduction of HaH care reveals opportunities to address challenges. Lastly, the study uncovered a strong primary healthcare commitment and a sense of professional pride among the participants. This resilience and dedication among primary healthcare employees appeared as an incentive to make the integration of HaH work.This study offers valuable insights into integrating HaH into primary healthcare services, highlighting opportunities to address challenges. The resilience and dedication of primary healthcare employees underscore their commitment to adapting to and thriving with HaH care. To establish a sustainable HaH care model, it is important to address geographical limitations, consider the strain on providers, maintain robust relationships, enhance funding, and formalize decision-making processes. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Implications for the Profession and/or Patient Care Impact Reporting Method Patient or Public Contribution To describe key features of a co‐designed nurse‐led model of care intended to improve access to early medication abortion and long‐acting reversible contraception in rural Australian general practice.Co‐design methodology informed by the Experience‐Based Co‐Design Framework.Consumers, nurses, physicians and key women's health stakeholders participated in a co‐design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six‐step process for thematic analysis.Fifty‐two participants took part in the co‐design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient‐approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications.Our approach to experience‐based co‐design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse‐led model of care.The co‐designed nurse‐led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice.Nurse‐led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse‐led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025.Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.Two consumer representatives contributed to the development of the co‐design methodology as members of the ORIENT Intervention Advisory Group Governance Committee. [ABSTRACT FROM AUTHOR]

Background Most individuals prefer to spend their final moments of life outside a hospital setting. This study compares the places of care and death of long-term care (LTC) home residents in Ontario in the last 90 days of life, according to LTC home rurality. Data and methods This retrospective cohort study was conducted using health administrative data from ICES (formerly known as the Institute for Clinical Evaluative Sciences). The study population, which was identified through algorithms, included all Ontario LTC home residents with a dementia diagnosis who died between April 1, 2014, and March 31, 2019. The location of death was categorized as in an acute care hospital, an LTC home, a subacute care facility, or the community. Places of care included emergency department visits and hospitalizations in the last 90 days of life. Statistical tests were used to evaluate differences in location of death and places of care by rurality. Results Of the 65,375 LTC home residents with dementia, 49,432 (75.6%) died in an LTC home. Residents of LTC homes in the most urban areas were less likely to die in an LTC home than those in more rural homes (adjusted relative risk: 0.84; 95% confidence interval: 0.83 to 0.85). A higher proportion of residents of the most urban LTC homes had at least one hospitalization in the last 90 days of life compared with rural residents (23.7% versus 9.9% palliative hospitalizations and 28.3% versus 15.9% non-palliative hospitalizations [p < 0.001]). Interpretation Individuals with dementia residing in urban LTC homes are more likely to receive care in the hospital and to die outside a LTC home than their counterparts living in rural LTC homes. The findings of this work will inform efforts to improve end-of-life care for older adults with dementia living in LTC homes. [ABSTRACT FROM AUTHOR]

Background Hospital at home (HaH) is an innovative approach to healthcare delivery that brings specialized services to patients’ homes. HaH services are typically available in urban areas where hospitals can easily reach nearby patients. An integrated care model that utilizes the public primary healthcare system may extend HaH services to include patients residing further away from hospitals. However, there is limited evidence of primary healthcare employees’ views on integrating HaH care into primary healthcare services. This study aimed to explore the reflections of primary healthcare employees on integrating HaH care into primary healthcare services.Methods Ten focus group interviews were conducted with homecare nurses and managers of primary healthcare services in five municipalities in Mid-Norway. Reflexive thematic analysis was used to analyze the data.Results The analysis resulted in three key themes regarding the integration of HaH care into primary healthcare. Participants discussed how they capture the distinctiveness of HaH care within the primary healthcare landscape. Moreover, they identified that the introduction of HaH care reveals opportunities to address challenges. Lastly, the study uncovered a strong primary healthcare commitment and a sense of professional pride among the participants. This resilience and dedication among primary healthcare employees appeared as an incentive to make the integration of HaH work.Conclusions This study offers valuable insights into integrating HaH into primary healthcare services, highlighting opportunities to address challenges. The resilience and dedication of primary healthcare employees underscore their commitment to adapting to and thriving with HaH care. To establish a sustainable HaH care model, it is important to address geographical limitations, consider the strain on providers, maintain robust relationships, enhance funding, and formalize decision-making processes.

Aim Design Methods Results Conclusion Impact Reporting Method No Patient or Public Contribution The focus of this paper is to provide a detailed ethnographic exploration of rural nurses' experiences of their resuscitation preparedness and the subsequent post‐resuscitation period.An ethnographic study across two small rural hospital sites in New South Wales, Australia.Fieldwork was undertaken between December 2020 and March 2022 and included over 240 h of nonparticipant observation, journalling and interviews. Data were analysed using reflexive thematic analysis.The first key theme—‘Sense of Preparedness’—included three subthemes: ‘Gaining experience’, ‘Issues with training and education’ and ‘Lack of warning’. The second key theme ‘Aftermath’ comprised two subthemes: ‘Getting on with it’ and ‘Making sense of the resus’.This study has highlighted the intricate relationship between resuscitative preparedness and the post‐resuscitation period in shaping rural nurse's experiences and their well‐being. Rural nurses are asking for an authentic and contextually relevant training experience that mirrors the unique rural challenges they experience. In the absence of frequent resuscitation presentations, the post‐resuscitation period should be viewed as a crucible moment that can be leveraged as a valuable learning opportunity enhancing rural nurses' sense of preparedness and the provision of quality resuscitation care.Having a greater level of insight into the challenges that rural nurses experience in the pre‐ and post‐resuscitation period is critical. This insight opens the door for fortifying policies and work processes that will better support rural nurses in the resuscitation environment.Reporting complied with COREQ criteria for qualitative research.This study explored the experiences of rural nurses. No patient data were collected. [ABSTRACT FROM AUTHOR]

Background: The population is aging, leading to an increased need for palliative care and end-of-life care. There is a lack of research on the use of video consultations for knowledge transfer between specialist and general palliative care. The aim of this study was to describe healthcare professionals' experiences of video consultations in palliative care in community homecare and nursing homes in rural areas. Methods: Individual interviews (n = 11) were conducted with five community nurses, one occupational therapist, two specialist palliative nurses, and three specialist palliative care physicians. The data were analysed using reflexive thematic analysis. Results: The analysis identified three themes: feeling comfortable with increased availability of specialist expertise; seeing each other facilitates communication; and being supported by physically present care professionals is essential. Conclusion: HCPs suggest that video consultations are an effective way to increase access to specialist palliative care and provide more equal care to patients with palliative care needs in rural community care. [ABSTRACT FROM AUTHOR]

Background: Staff shortages limit access to health services. The bidirectional benefits of allied health clinical placements are understood in the domains of student learning, health service delivery, and future workforce development. Still, the benefits to current workforce outcomes remain unknown. This review provides insights into the effects of allied health student placements in acute and primary care settings, particularly on healthcare staff's knowledge and procedural skills. Methods: This search was based on the integrative review process established by Whittemore and Knafl in 2005. In October 2023, the first author (MH) searched five major electronic databases: Medline-EBSCO, PubMed, CINAHL, Embase, and Scopus. The CLUSTER model was used to track additional references. The first three authors (MH, SM, and SC) were involved in screening, quality appraisal, and synthesis of the studies. Data were thematically synthesised and analysed. Results: MeSH headings and keywords were used in key search areas: health education, health professional training, clinical placements, and allied health professions. The systematic search yielded 12 papers on allied health student placements across various healthcare settings in rural and metropolitan areas, with no high-quality methodologies measuring student placements' impact on staff knowledge and skills. Four main themes were identified from the analysis: meaningful student integration in service delivery, targeted educational support to healthcare staff, development of staff procedural skills and confidence, and the mechanisms of why student placements work in this aspect. Conclusions: This review suggests that offering allied health student placement could be a promising approach to supporting rural healthcare staff in performing patient assessments and treatments proficiently and collaboratively. However, this requires further investigation to confirm. [ABSTRACT FROM AUTHOR]

Aim: To reflect on the inclusion of an advanced practice nurse (APN) on a clinical leadership team in rural Vermont during the COVID‐19 pandemic. Background: During the COVID‐19 pandemic, APNs contributed to the reimagining of healthcare delivery. In response to pandemic‐related organizational needs, one rural health center in Vermont promoted an APN to a leadership position. Sources of evidence: This critical reflection describes the experience of one APN promoted to a clinical leadership role during the COVID‐19 pandemic in rural Vermont in the United States. We use the four stages of crisis (escalation, emergency, recovery, and resolution) and the healthcare leadership framework proposed by Geerts et al. (2021) to consider how APN leaders can contribute in the "recovery stage" of the pandemic. Discussion: APNs who took on leadership roles during the pandemic may have had fewer opportunities to participate in formal leadership development. However, in the case of our rural health center, an APN was able to seek out mentorship, address operational challenges, and provide representation for advanced practice providers. Conclusion: This article contributes to the literature on APN leadership during the COVID‐19 pandemic, by describing a leadership opportunity that helped build APN leadership capability and capacity in our organization. Implications for nursing practice: APNs offer a valuable perspective on health leadership teams. As organizations move toward the recovery stage of the pandemic, different leadership styles and skills may be required. Implications for health policy: The COVID‐19 pandemic provided unexpected leadership opportunities for APNs. Healthcare organizations now have opportunities to reimagine clinical leadership in ways that include APNs. [ABSTRACT FROM AUTHOR]

The article discusses the implementation of the Authentic Nurse Leadership (ANL) model in a rural health network. Topics covered include the development and testing of the ANL Questionnaire (ANLQ) to measure ANL perceptions among rural nurses, and results showing nurses' average perception of ANL most of the time. Also noted are authentic nurse leaders' fostering of autonomy, decision-making, and open communication within the staff and multidisciplinary teams to keep everyone informed.

Introduction: Nurse Navigators were introduced in Queensland, Australia, in 2016. Nurse Navigators coordinate person‐centred care, create partnerships, improve care coordination and outcomes and facilitate system improvement, independently of hospital or community models. They navigate across all aspects of hospital and social services, liaising, negotiating and connecting care as needed. People stay with Nurse Navigators for as long as required, though the intent is to transition them from high‐care needs to self‐management. Nurse Navigators are a working model in rural and remote areas of Queensland. Objective: To describe where the rural and remote Nurse Navigator position fits within the Rural Remote Nursing Generalist Framework and to define the depth and breadth of the rural and remote Nurse Navigator's scope of practice. Design: Using template analysis, data from focus groups and interviews were analysed against the domains of the recently released National Rural and Remote Nursing Generalist Framework. Navigators working in rural and remote areas across Queensland Health were invited to an interview (n = 4) or focus group (n = 9), conducted between October 2019 and August 2020. Findings: Rural and remote Nurse Navigators are proficient in all domains of the framework and actively champion for their patients, carers and the communities where they live and work. Discussion: This research demonstrates that rural and remote Nurse Navigators are a working model of advanced nursing practice, acting as 'champions' of The Framework. Conclusion: The Nurse Navigator model of care introduced to Queensland exemplifies proficient registered nurse practice to the full extent of their knowledge and skill. [ABSTRACT FROM AUTHOR]

Background: During the 1990–2000, Kazakhstan experienced a decline in the number of healthcare professionals working in rural areas. Since 2009, the national government has been implementing financial incentives to encourage healthcare professionals to relocate to rural areas. This study aims to investigate the temporal and spatial patterns in the distribution of the rural healthcare workforce and evaluate the impact of this incentive scheme. Methods: Interrupted Time Series Analysis using ARIMA models and Difference in Differences analyzes were conducted to examine the impact of the incentive scheme on the density of different categories of the healthcare workforce in rural Kazakhstan in the period from 2009 to 2020. Results: There was a significant increase in the number of rural healthcare professionals from 2009 to 2020 in comparison to the period from 1998 to 2008. However, this increase was less pronounced in per capita terms. Moreover, a decline in the density of internists and pediatricians was observed. There is substantial variation in the density of rural nurses and physicians across different regions of Kazakhstan. The incentive scheme introduced in 2009 by the government of Kazakhstan included a one-time allowance and housing incentive. This scheme was found to have contributed insignificantly to the observed increase in the number of rural healthcare professionals. Conclusion: Future research should be undertaken to examine the impact made by the incentive scheme on other medical subspecialties, particularly primary practitioners. Addressing the shortage of healthcare workers in rural areas is a complex issue that requires a multifaceted approach. Aside from financial incentives, other policies could be considered to increase relocation and improve the retention of healthcare professionals in rural areas. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic had a major impact on healthcare services globally. In care settings such as small rural nursing homes and homes care services leaders were forced to confront, and adapt to, both new and ongoing challenges to protect their employees and patients and maintain their organization's operation. The aim of this study was to assess how healthcare leaders, working in rural primary healthcare services, led nursing homes and homecare services during the COVID-19 pandemic. Moreover, the study sought to explore how adaptations to changes and challenges induced by the pandemic were handled by leaders in rural nursing homes and homecare services. Methods: The study employed a qualitative explorative design with individual interviews. Nine leaders at different levels, working in small, rural nursing homes and homecare services in western Norway were included. Results: Three main themes emerged from the thematic analysis: "Navigating the role of a leader during the pandemic," "The aftermath – management of COVID-19 in rural primary healthcare services", and "The benefits and drawbacks of being small and rural during the pandemic." Conclusions: Leaders in rural nursing homes and homecare services handled a multitude of immediate challenges and used a variety of adaptive strategies during the COVID-19 pandemic. While handling their own uncertainty and rapidly changing roles, they also coped with organizational challenges and adopted strategies to maintain good working conditions for their employees, as well as maintain sound healthcare management. The study results establish the intricate nature of resilient leadership, encompassing individual resilience, personality, governance, resource availability, and the capability to adjust to organizational and employee requirements, and how the rural context may affect these aspects. [ABSTRACT FROM AUTHOR]

Purpose: Caring for someone with cancer has a significant impact on usual routines, including caregivers' ability to maintain their own health and wellbeing. Caregivers living in rural areas face additional challenges in supporting someone with cancer, and little is known about the impact of caregiving on the health behaviors of rural caregivers. Therefore, this study explored how caring for someone with cancer affected rural caregivers' health behaviors. Methods: Through semi‐structured interviews, 20 rural caregivers described changes in their health behaviors while caring for someone with cancer and the factors underlying these changes. Specific prompts were provided for diet, physical activity, alcohol, smoking, sleep, social connection and leisure, and accessing health care when needed. Interviews were audio‐recorded and transcribed verbatim. Content analysis was used to identify changes in health behaviors and the factors underlying these changes. The factors identified were mapped to the socioecological framework, identifying areas for intervention across multiple levels (individual, interpersonal, organizational, community, and policy). Results: Rural caregivers reported both positive and negative changes to their diet, physical activity, alcohol, and smoking. Sleep, social connection and leisure, and accessing health care were negatively impacted since becoming a caregiver. Conclusions: Designing interventions to address rural caregivers' coping strategies, reduce carer burden and fatigue, improve access to cooking and exercise facilities and social support while away from home, reduce the need to travel for treatment, and increase the financial support available could yield widespread benefits for supporting the health and wellbeing of rural caregivers. [ABSTRACT FROM AUTHOR]

Control of dog-mediated rabies relies on raising awareness, access to post-exposure prophylaxis (PEP) and mass dog vaccination. To assess rabies awareness in Moramanga district, Madagascar, where rabies is endemic, two complementary quantitative and qualitative approaches were carried out in 2018. In the quantitative approach, a standardized questionnaire was administered to 334 randomized participants living in 170 households located less than 5 km from the anti-rabies treatment center (ARTC) located in Moramanga city (thereafter called the central area), and in 164 households located more than 15 km away from the ARTC in two rural communes (thereafter called the remote area). Logistic regression models were fitted to identify factors influencing knowledge and practice scores. The qualitative approach consisted in semi-structured interviews conducted with 28 bite victims who had consulted the ARTC, three owners of biting dogs, three ARTC staff and two local authorities. Overall, 15.6% (52/334) of households owned at least one dog. The dog-to-human ratio was 1:17.6. The central area had a significantly higher dog bite incidence (0.52 per 100 person-years, 95% CI: 0.31–0.84) compared to the remote area (0.22 per 100 person-years, 95% CI: 0.09–0.43) (p = 0.03). The care pathway following a bite depended on wound severity, how the dog was perceived and its owner's willingness to cover costs. Rabies vaccination coverage in dogs in the remote area was extremely low (2.4%). Respondents knew that vaccination prevented animal rabies but owners considered that their own dogs were harmless and cited access and cost of vaccine as main barriers. Most respondents were not aware of the existence of the ARTC (85.3%), did not know the importance of timely access to PEP (92.2%) or that biting dogs should be isolated (11.1%) and monitored. Good knowledge scores were significantly associated with having a higher socio-economic status (OR = 2.08, CI = 1.33–3.26) and living in central area (OR = 1.91, CI = 1.22–3.00). Good practice scores were significantly associated with living in central area (OR = 4.78, CI = 2.98–7.77) and being aware of the ARTC's existence (OR = 2.29, CI = 1.14–4.80). In Madagascar, knowledge on rabies was disparate with important gaps on PEP and animal management. Awareness campaigns should inform communities (i) on the importance of seeking PEP as soon as possible after an exposure, whatever the severity of the wound and the type of biting dog who caused it, and (ii) on the existence and location of ARTCs where free-of-charge PEP is available. They should also encourage owners to isolate and monitor the health of biting dogs. Above all, awareness and dog vaccination campaigns should be designed so as to reach the more vulnerable remote rural populations as knowledge, good practices and vaccination coverage were lower in these areas. They should also target households with a lower socio-economic status. If awareness campaigns are likely to succeed in improving access to ARTCs in Madagascar, their impact on prompting dog owners to vaccinate their own dogs seems more uncertain given the financial and access barriers. Therefore, to reach the 70% dog vaccination coverage goal targeted in rabies elimination programs, awareness campaigns must be combined with free-of-charge mass dog vaccination. Author summary: Despite effective animal and human vaccines, rabies causes over 59,000 human deaths annually, mainly in children and in poor rural communities in Asia and Africa. World Health Organization and partners have recently launched the "Zero by 30" global plan which aims to end human deaths by dog-mediated rabies by 2030 by raising awareness, increasing access to post-exposure prophylaxis (PEP) and mass dog vaccination. In Madagascar, where rabies is endemic, a network of anti-rabies treatment centers (ARTC) delivers free-of-charge vaccines to exposed patients. As little is known on rabies awareness in Malagasy communities, we set up quantitative and qualitative surveys on rabies knowledge, attitudes and practices (KAP). Results showed that major hosts, main transmission routes, clinical signs and outcomes were known by most respondents. Yet knowledge on the existence of ARTC, the usefulness and availability of PEP, usefulness of confining and monitoring biting dogs was very low. Although bite incidence was lower, remote rural areas had more limited knowledge, poorer practices on rabies and extremely low dog vaccination coverage, so awareness campaigns should make sure remote rural populations are reached. If these campaigns are likely to succeed in improving access to ARTCs, their impact on dog vaccination seems more uncertain. Therefore, to reach dog vaccination coverage goals, the center-piece of rabies elimination strategies, awareness campaigns must be combined with free-of-charge mass dog vaccination. [ABSTRACT FROM AUTHOR]

Summary: Rural surgery is most commonly provided by general surgeons to the 29% of people (7 million) living in rural Australia.The provision of rural general surgery to enable equitable and safe surgical care for rural Australians is a multifaceted issue concerning recruitment, training, retention, surgical procedures and surgical outcomes.Sustaining the rural general surgical workforce will be dependent upon growing an increased number of resident rural general surgeons, as well as changed models of care, with a need for ongoing review to track the outcomes of these changes.To increase recruitment, rural general surgical training must improve to be less stressful for trainees and to be incorporated alongside a rural‐facing generalist curriculum.Rural general surgical outcomes (excluding some oncology conditions) achieve comparable results to metropolitan centres.Access to, and outcomes of, surgical oncology services continues to be inequitable for rural Australians and should be a major focus for improved service delivery. [ABSTRACT FROM AUTHOR]

Background: High-quality implementation evaluations report on intervention fidelity and adaptations made, but a practical process for evaluating implementation strategies is needed. A retrospective method for evaluating implementation strategies is also required as prospective methods can be resource intensive. This study aimed to establish an implementation strategy postmortem method to identify the implementation strategies used, when, and their perceived importance. We used the rural Transitions Nurse Program (TNP) as a case study, a national care coordination intervention implemented at 11 hospitals over three years. Methods: The postmortem used a retrospective, mixed method, phased approach. Implementation team and front-line staff characterized the implementation strategies used, their timing, frequency, ease of use, and their importance to implementation success. The Expert Recommendations for Implementing Change (ERIC) compilation, the Quality Enhancement Research Initiative phases, and Proctor and colleagues' guidance were used to operationalize the strategies. Survey data were analyzed descriptively, and qualitative data were analyzed using matrix content analysis. Results: The postmortem method identified 45 of 73 ERIC strategies introduced, including 41 during pre-implementation, 37 during implementation, and 27 during sustainment. External facilitation, centralized technical assistance, and clinical supervision were ranked as the most important and frequently used strategies. Implementation strategies were more intensively applied in the beginning of the study and tapered over time. Conclusions: The postmortem method identified that more strategies were used in TNP than planned and identified the most important strategies from the perspective of the implementation team and front-line staff. The findings can inform other implementation studies as well as dissemination of the TNP intervention. [ABSTRACT FROM AUTHOR]

Aims: The purpose of this study was to evaluate the preparedness of Iranian nurses for potential pandemics. Background: Nurses play a critical role in managing pandemics. They require adequate training, proper equipment, and organizational support to be well-prepared. Methods: A descriptive cross-sectional study was conducted in Ardabil, Iran, from July to September 2023, involving 233 nurses from five hospitals. The number of nurses required for each hospital was calculated based on the proportion of nurses in each hospital. Data was collected through a paper-based form that included information about the participants' demographic characteristics and their level of pandemic preparedness in health services. The collected data was analyzed using descriptive statistics to determine the demographic characteristics and levels of pandemic preparedness. Pearson's test was also conducted to establish a relationship between different dimensions of pandemic preparedness. Results: Most participants relied on clinical measures and supported using human resources and environmental methods to curb the transmission of a pandemic. They felt assured in their ability to explain the preventive measures against the pandemic. However, fewer respondents had access to healthcare improvement programs, and only a few worked remotely from home. Conclusions: According to our study, 90.1% of nurses believe hand washing is the most effective way to prevent spreading infections. Additionally, healthcare professionals can use various tools to respond to the pandemic, including screening for COVID-19 at work, health and wellness programs, telecommuting, COVID-19 Safe programs, social media, and posters. Nurses need continuous education in hand hygiene, health programs, remote work options, and pandemic-safe programs to control infections, reduce risks, and optimize patient care during the pandemic. [ABSTRACT FROM AUTHOR]

Introduction. Rural nursing careers offer a multitude of benefits for individuals. Despite this, there continues to be a growing deficit in the number of nurses choosing to practice in rural areas. As the first 12–18 months of a nursing career are fundamental in shaping career location decisions, it is important to explore factors that influence early career nurses' employment decisions. Methods. A phenomenological study was undertaken to explore early career nurses' experiences during their first year of rural practice and describe how the nurses' experiences influenced their decision to remain in rural employment. Data were collected via semistructured interviews and underwent inductive thematic analysis. Results. Seven early career nurses practicing in rural locations were interviewed and described several influences on their career location decisions, particularly related to whether they would stay in or leave their rural employer. The themes derived from the nurses' stories included the effect of their vulnerability entering a new workplace, the importance of connection to person, place, and profession and the nuances of rural nursing rhythms. These had implications on their employment decisions. Conclusion. This research demonstrates the distinct form of nursing practice that occurs in rural areas which was experienced by the early career nurses as a breadth of skills, volume of presentations, and continuity of care. The nurses described the importance of establishing connections to person, place, and their profession. These connections can support nurses through a period of vulnerability entering a new workplace. [ABSTRACT FROM AUTHOR]

Background:Since the decline in death rates from cardiovascular diseases has slowed down recently, promoting cardiovascular health in patients and the general public has become more important than ever, particularly for elder and rural patients. This study is a collaborative effort between a regional health network in Virginia and associated organizations to implement and assess telenursing and remote patient monitoring (RPM) to help home care patients better manage their own cardiovascular related diseases and promote sustainable health delivery options. Method:Eighty cardiovascular patients with diabetes, congestive heart failure, or both who had a recent disease-related hospital stay were enrolled in the RPM program to receive services, including care coordination, coaching, referral for behavioral health, and aging-related services for 90+ days. The program used telenursing and RPM through home care monitoring equipment to coach patients on effective measures to stay compliant with posthospitalization regimens, track and evaluate readmissions, and assess physiological status and mental health. Result:There was a decline in hospital admissions of 65%, 85% for observations and related inpatient services for enrolled CVD patients in the RPM program. In addition, the longer the patient was enrolled the less likely they were to readmit. The program saved ∼$615,127 in patient claims costs and had net savings of $390,296, ∼173% of the total program expenses. Discussion:Evidence showed that 90+ day enrollments are sufficient for realization of readmissions and Emergency Department reductions, increased health care access, and lower costs. This resulted from consistent monitoring using the technology to alert nurses and care coordinators who were able to respond and facilitate patients accessing care in the most helpful and generally less costly care environment. Conclusion: The study has confirmed that care coordination and RPM are effective in supporting self-management of chronic conditions and cost reductions through telenursing and RPM. [ABSTRACT FROM AUTHOR]

Introduction: There is a pressing need for transitional care that prepares rural dwelling medical patients to identify and respond to the signs of worsening health conditions. An evidence-based warning signs intervention has the potential to address this need. While the intervention is predominantly delivered by nurses, other healthcare providers may be required to deliver it in rural communities where human health resources are typically limited. Understanding the perspectives of other healthcare providers likely to be involved in delivering the intervention is a necessary first step to avert consequences of low acceptability, such as poor intervention implementation, uptake, and effectiveness. This study examined and compared nurses' and other healthcare providers' perceived acceptability of an evidence-based warning signs intervention proposed for rural transitional care. Methods: A cross-sectional design was used. The convenience sample included 45 nurses and 32 other healthcare providers (e.g., physical and occupational therapists, physicians) who self-identified as delivering transitional care to patients in rural Ontario, Canada. In an online survey, participants were presented with a description of the warning signs intervention and completed established measures of intervention acceptability. The measures captured 10 intervention acceptability attributes (effectiveness, appropriateness, risk, convenience, relevance, applicability, usefulness, frequency of current use, likelihood of future use, and confidence in ability to deliver the intervention). Ratings ≥ 2 indicated acceptability. Data analysis included descriptive statistics, independent samples t-tests, as well as effect sizes to quantify the magnitude of any differences in acceptability ratings between nurses and other healthcare providers. Results: Nurses and other healthcare providers rated all intervention attributes > 2, except the attributes of convenience and frequency of current use. Differences between the two groups were found for only three attributes: nurses' ratings were significantly higher than other healthcare providers on perceived applicability, frequency of current use, and the likelihood of future use of the intervention (all p's <.007; effect sizes.58 -.68, respectively). Discussion: The results indicate that both participant groups had positive perspectives of the intervention on most of the attributes and suggest that initiatives to enhance the convenience of the intervention's implementation are warranted to support its widespread adoption in rural transitional care. However, the results also suggest that other healthcare providers may be less receptive to the intervention in practice. Future research is needed to explore and mitigate the possible reasons for low ratings on perceived convenience and frequency of current use of the intervention, as well as the between group differences on perceived applicability, frequency of current use, and the likelihood of future use of the intervention. Conclusions: The intervention represents a tenable option for rural transitional care in Ontario, Canada, and possibly other jurisdictions emphasizing transitional care. [ABSTRACT FROM AUTHOR]

Transportation tasks in nursing are common, often overlooked, and directly impact patient care time in the context of staff shortages and an aging society. Current studies lack a specific focus on transportation tasks, a gap our research aims to fill. By providing detailed data on transportation needs in nursing, our study establishes a crucial foundation for the development and integration of assistive robots in clinical settings. In July and September 2023, we conducted weekly observations of nurses to assess clinical transportation needs. We aim to understand the economic impact and the methods nurses use for transportation tasks. We conducted a participant observation using a standardized app-based form over a seven-day observation period in two rural clinics. N = 1830 transports were made by nurses and examined by descriptive analysis. Non-medical supplies account for 27.05% (n = 495) of all transports, followed by medical supplies at 17.32% (n = 317), pharmacotherapy at 14.10% (n = 258) and other other categories like meals or drinks contributing 12.68% (n = 232). Most transports had a factual transport time of under a minute, with patient transport and lab samples displaying more variability. In total, 77.15% of all transports were made by hand. Requirements to collect items or connect transports with patient care were included in 5% of all transports. Our economic evaluation highlighted meals as the most costly transport, with 9596.16 € per year in the observed clinics. Budget-friendly robots would amortize these costs over one year by transporting meals. We support understanding nurses' transportation needs via further research on assistive robots to validate our findings and determine the feasibility of transport robots. [ABSTRACT FROM AUTHOR]

Background: The participation and success of university health students in rural areas is critical in addressing the maldistribution of the rural health workforces internationally. Particular attention to the experiences of mature-aged health students is needed to build a sustainable rural health workforce, given the higher proportions of mature-aged university students in rural, regional and remote areas compared with metropolitan areas and rural mature-aged students wanting to stay in their communities. However, little is known about the kinds of supports rural mature-aged students require to succeed with their studies. Methods: Drawing on rural standpoint theory and using structural inequality as a retention lens, we explored the current and potential supports that rural mature-aged nursing and allied health students require to successfully participate and complete their pre-professional university course. A Stakian multicase study was undertaken with cases at three rural university campuses in Australia. The data collection was primarily qualitative, with semi-structured interviews, campus surveys and focus groups involving 36 participants (including students, academic and professional staff, and placement supervisors). Results: This study found supports were provided formally and informally by the university, by the community and manifested by students. Several support gaps as well as potential supports to alleviate them were identified. These include formally acknowledging the mature-aged cohort and their diverse experiences and non-university commitments; fostering connections between mature-aged students; making university affordable; preparing mature-aged students for university; adapting course content and delivery; and restructuring placements for mature-aged students. Conclusions: We argue that rural mature-aged nursing and allied health students require supports that are age-specific, appropriate to the community context, and harness existing relational processes of rural university campus activity. Rural university campuses need to involve rural mature-aged students and other stakeholders relevant to each context in the process of identifying and implementing student supports for this cohort. [ABSTRACT FROM AUTHOR]

Without rural hospitals, many patients may not have access to essential services, or even any health care. Rural hospitals provide a community hub for local access to primary care and emergency services, as well as a bridge to specialized care outside the community. The goal of this review was to demonstrate how the University of Arkansas for Medical Sciences supports and empowers rural hospitals through an alliance that provides cost savings through clinical networks, collaborative purchasing, and leveraged services; workforce recruitment and education; telemedicine and distance learning; community outreach; and access to best practices, resources, and tools for hospital transformation. Born out of grassroots efforts in the rural US South, this model alliance, the Arkansas Rural Health Partnership, with the University of Arkansas for Medical Sciences supporting as an academic medical center participant, offers resources and programs intended to help rural hospitals and healthcare providers survive and even thrive in the challenging landscape that is forcing many other rural hospitals to close. The Arkansas Rural Health Partnership model is relevant for rural states that are seeking to develop or reenvision rural hospital alliances with academic medical centers to the benefit of the hospitals and the health of their communities and state. [ABSTRACT FROM AUTHOR]

Background: Provision of critical care in rural areas is challenging due to geographic distance, smaller facilities, generalist skill mix and population characteristics. Internationally, the amalgamation telemedicine and retrieval medicine services are developing to overcome these challenges. Virtual emergency clinical advisory and transfer service (vCare) is one of these novel services based in New South Wales, Australia. We aim to describe patient encounters with vCare from call initiation at the referring site to definitive care at the accepting site. Methods: This retrospective observational study reviewed all patients using vCare in rural and remote Australia for clinical advice and/or inter-hospital transfer for higher level of care between February and March 2021. Data were extracted from electronic medical records and included remoteness of sites, presenting complaint, triage category, camera use, patient characteristics, transfer information, escalation of therapeutic intervention and outcomes. Data were summarised using cross tabulation. Results: 1,678 critical care patients were supported by vCare, with children (12.5%), adults (50.6%) and older people (36.9%) evenly split between sexes. Clinicians mainly referred to vCare for trauma (15.1%), cardiac (16.1%) and gastroenterological (14.8%) presentations. A referral to vCare led to an escalation of invasive intervention, skill, and resources for patient care. vCare cameras were used in 19.8% of cases. Overall, 70.5% (n = 1,139) of patients required transfer. Of those, 95.1% were transferred to major regional hospitals and 11.7% required secondary transfer to higher acuity hospitals. Of high-urgency referrals, 42.6% did not receive high priority transport. Imaging most requested included CT and MRI scans (37.2%). Admissions were for physician (33.1%) and surgical care (23.3%). The survival rate was 98.6%. Conclusion: vCare was used by staff in rural and remote facilities to support decision making and care of patients in a critical condition. Issues were identified including low utilisation of equipment, heavy reliance on regional sites and high rates of secondary transfer. However, these models are addressing a key gap in the health workforce and supporting rural and remote communities to receive care. [ABSTRACT FROM AUTHOR]

From a Psychology of Working Theory (PWT) perspective, this study aims to explore how career adaptability and decent work mediate the effects of career calling on the resilience of rural-oriented pre-service teachers. The Career Calling Scale, Career Adaptability Scale, Decent Work Scale, and Resilience Scale were used to survey 393 rural-oriented pre-service teachers. The results found that career calling positively predicted the resilience of rural-oriented pre-service teachers; career adaptability mediated the relationship between career calling and resilience of rural-oriented pre-service teachers; decent work mediated the relationship between career calling and resilience of rural oriented pre-service teachers; and career adaptability and decent work play a chain mediating role between career calling and career adaptability of rural-oriented pre-service teachers. Therefore, this study concludes that career calling not only directly influences the resilience of rural-oriented pre-service teachers, but also indirectly influences the resilience of rural-oriented pre-service teachers through career adaptability and decent work. [ABSTRACT FROM AUTHOR]

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has had a significant impact on the elderly population, leading to both fatalities from the virus and delayed treatment of acute emergencies. Additionally, many elderly individuals have demonstrated poor health-seeking behaviour in managing chronic conditions. Reasons for this include fear, access barriers, and strain on healthcare resources and personnel. Aim: To evaluate the change in health-seeking behaviour among the elderly in rural areas of central Kerala during the pandemic and identify the associated factors. Materials and Methods: A community-based cross-sectional study was conducted in the rural field-practice areas of the Department of Community Medicine at a tertiary care Medical College in Kerala, India from May 2021 to August 2021. A total of 252 elderly individuals aged 60 years and above were interviewed using a structured pretested questionnaire. Socio-demographic details and responses on health-seeking behaviour during the pandemic were documented. Data were summarised using frequencies and percentages for categorical variables or mean and standard deviation for continuous variables. Associations were tested using the Chi-square test. results: The study revealed that 83.73% (211 out of 252) of the elderly participants had Non Communicable Diseases (NCDs), with hypertension in 130 (51.59%) and diabetes in 90 (35.71%) being the most prevalent. A significant change in the preference for healthcare facilities was noted (p<0.001), with a decline in appropriate health-seeking behaviour by 16.16%. Moreover, 9.13% (23 participants) resorted to self-treatment at home, and 49.21% (124 participants) opted for traditional remedies to boost their immunity. The type of family was significantly associated with the decline in health-seeking behaviour (p<0.05). Of the 16 participants who indicated a lapse in their regular follow-up since the onset of the pandemic, the primary reasons for missing appointments were fear of contracting COVID-19 in 14 cases (87.50%), lockdown restrictions in six cases (37.50%), and transportation challenges in three cases (18.75%). conclusion: The study revealed a high prevalence of chronic diseases like hypertension, diabetes, osteoarthritis, and Coronary Artery Disease (CAD) among the elderly. There was a decline in health-seeking behaviour by 16.16% among the elderly with chronic diseases due to various challenges posed by the pandemic. Implementing strategies such as utilising social media, promoting telemedicine, and adopting a comprehensive technological approach is crucial to enhance healthcare accessibility for elderly populations in rural areas. [ABSTRACT FROM AUTHOR]

Introduction: A novel randomized controlled trial tested the efficacy of a technology-assisted case management program in a low income, rural population previously where nurses titrated medication over the phone instead of in a clinic. The primary analysis showed significant improvement in glycemic control at 6 months post-randomization decreasing hemoglobin A1c by 1%. This study aimed to test if the intervention was also effective at decreasing blood pressure without compromising quality of life. Methods: A total of 113 adults with poorly controlled diabetes (hemoglobin A1c ≥ 8%) were randomly assigned to the technology-assisted case management intervention or usual care. Participants received a 2-in-1 telehealth system to monitor glycemic and blood pressure control, which was uploaded daily to a central server. A nurse case manager was trained to titrate medication under physician supervision every 2 weeks based on the readings. Outcomes were blood pressure and quality of life (12-item Short-Form Health Survey) at 6 months. Baseline adjusted mixed models using a random intercept were used to evaluate change at 6 months for the technology-assisted case management intervention group compared to usual care. Results: There were no statistically significant differences in systolic blood pressure, physical component of quality of life, or mental component of quality of life between the technology-assisted case management and control group. However, there was a significant change in diastolic blood pressure over time, with the technology-assisted case management group decreasing at 6 months (p =.05), whereas the control group remained stable. Conclusions: Technology-assisted case management by a nurse with medication titration under physician supervision was efficacious in improving diastolic blood pressure without compromising quality of life in low-income rural adults with diabetes. [ABSTRACT FROM AUTHOR]

Purpose: Does collecting and publishing rural nurse stories have impact? This article evaluates the impact of the design and content of a rural book capturing rural nurse stories across Aotearoa New Zealand. Did reading the book alter reader perception of rural nursing or have wider effects? Sample: Readers of a narrative book including rural nurses' stories and imagery from across Aotearoa New Zealand were invited to complete a survey of their impressions. There were 42 responses received, a 22 per cent response rate. Of these, four did not read the book, leaving 38 responses for analysis of impact. These included seven of the original nurse storytellers, other nurses, and non-nurses. Method: The primary method was a survey of recipients of the book. This included quantitative demographic data and qualitative open question responses. Surveys were sent via email using Qualtrics with a link for completion with two automated reminders. Findings: Reading and viewing the narratives in this book impacted positively on nurses and non-nurses' awareness of the breadth and complexity of rural nurse practice in Aotearoa New Zealand. The distribution of the book as a physical copy meant that on average each book was viewed by at least six people. The presentation of the book was important, with readers valuing the wide variety of narratives including images, maps, poetry, and stories. Over half of respondents identified that the Maori (indigenous peoples of New Zealand) content reinforced the importance of Maori health particularly in the rural setting. This narrative resource will continue to impact future health professionals' awareness of rural nursing as over one third of participants intended to use the book as a teaching resource. Conclusion: There is intrinsic and extrinsic value to rural nurses telling their stories to both nurses and a broader audience. These stories increase awareness and can influence future policy and action. To add value to the stories, include multiple narratives of place and context, including visual images. Amplify the voice of indigenous peoples with indigenous nurses' stories and wider narratives. [ABSTRACT FROM AUTHOR]

Purpose: Agricultural communities experience elevated suicide rates and lack access to behavioral healthcare. FarmResponse is an online, interactive program designed to educate rural healthcare providers about the economic stressors and cultural aspects of working in agriculture. The curriculum is based on the Total Farmer Health model as it relates to factors for mental health in agriculture. The purpose of this report is to examine the quality of the measures used to assess training impact, quantify the effectiveness of the training, and assess participant perceptions in applying the training. Sample: The sample was comprised of those who registered for the training between February, 2022 through February, 2023. A total of 621 completed the pretest and 520 completed the pretest and posttest. Although nearly all U.S. states were represented, 45.6% of participants resided in Texas and Pennsylvania. Method: Classical test theory measures of difficulty and discrimination were used to examine the quality of the test questions at pretest. Distractor analysis was applied to the posttest questions to evaluate the quality of the incorrect responses compared to correct responses. Grounded theory was used to identify themes related to how participants viewed applying the training to their profession. Findings: The test questions covered a broad range of difficulty and a tighter range for discrimination. Distractor analysis revealed two questions that could be improved. Participants significantly increased their knowledge of agricultural culture with a within person increase of 5.05 points (95% CI 4.81, 5.29). Seven themes were identified in response to benefits and challenges expected when employing the training. Conclusions: FarmResponse increased participant knowledge of farming culture based on quality measures of effectiveness. Participants reported feeling positive about gaining needed resources and developing cultural competency, but also expressed concerns related to accessing farmers and ranchers to provide services and the stigma that reduces help-seeking. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine rural nurse practitioner (NP) workforce issues and explore practicing rural registered nurses (RNs) as a potential untapped resource to address the rural primary care provider shortage. Sample: A purposeful and snowball sample of rural RNs, rural nurse practitioners, critical access hospital (CAH) administrators, and rural community residents from diverse geographical areas of Idaho, a rural, Western state, was utilized as the source of data. Methods: Twenty qualitative, semi-structured interviews were conducted, recorded, and transcribed verbatim. Transcript content was then analyzed for major thematic identification. Findings: Four major themes were identified through the data analysis process. "Need exists", "Money matters", "Relationships", and "It's just you" were the four major themes illustrated throughout the interview transcripts. Conclusions: Knowledge achieved from this study may be utilized to enhance supports and address barriers cited by rural RNs when considering pursuit of advanced degrees. Likewise, those factors identified by nurse practitioners as positive and challenging aspects of rural practice may inform recruitment efforts. The information gained may be utilized to increase the number of rural RNs who consider becoming nurse practitioners as well as the number of nurse practitioners who choose to practice, or continue to practice, in a rural setting and thus improve rural access to care. [ABSTRACT FROM AUTHOR]

Portable breast monitoring devices, which could be used outside the hospital and even for self-monitoring of risk groups, are considered as promising eHealth applications for future telemedicine. Microwave technique is one of the most promising emerging techniques for portable monitoring devices since it enables low-cost, high accuracy, and user-friendly devices. The technique is based on detecting differences in radio channel responses since tumors have different dielectric properties than the breast glandular or fat tissues. Breast density categories affect the detectability of the tumors with also microwave technique. This paper presents a study on breast tumor detectability with different simulation and measurement models tailored to correspond different breast types. The simulations are carried out using electromagnetic simulation software with human voxel models as well as developed breast models. The evaluation results show that even small-sized breast tumors can be detected with microwave technique within all the breast density categories. Differences in channel responses caused by tumors are breast-type dependent. The results highlight the importance of developing extensive reference databank covering all the breast density categories for microwave-based breast tumor detection applications.

There is currently no evidence of undergraduate nursing students' self-efficacy and performance in self-management support for chronic diseases in rural primary care. Using the Self-Efficacy and Performance in Self-Management Support instrument, this quasi-experimental study assessed students' self-efficacy and performance in self-management support before and after implementation of a primary care enhanced curriculum. Nursing students (n = 140) reported a significant increase in totalmean scores (pretest,M= 268.01; posttest,M= 289.51), p = .0001. Providing a primary care enhanced curriculumincreased nursing students' self-efficacy and performance in self-management support. [ABSTRACT FROM AUTHOR]

Background: Inequities of health outcomes persist in rural populations globally. This is strongly associated with there being less health coverage in rural and underserviced areas. Increasing health care coverage in rural area requires rural health system strengthening, which subsequently necessitates having tools to guide action. Objective: This mapping review aimed to describe the range of tools, frameworks and resources (hereafter called tools) available globally for rural health system capacity building. Methods: This study collected peer-reviewed materials published in 15-year period (2005–2020). A systematic mapping review process identified 149 articles for inclusion, related to 144 tools that had been developed, implemented, and/or evaluated (some tools reported over multiple articles) which were mapped against the World Health Organization's (WHO's) six health system building blocks (agreed as the elements that need to be addressed to strengthen health systems). Results: The majority of tools were from high- and middle-income countries (n = 85, 59% and n = 43, 29%, respectively), and only 17 tools (12%) from low-income countries. Most tools related to the health service building block (n = 57, 39%), or workforce (n = 33, 23%). There were a few tools related to information and leadership and governance (n = 8, 5% each). Very few tools related to infrastructure (n = 3, 2%) and financing (n = 4, 3%). This mapping review also provided broad quality appraisal, showing that the majority of the tools had been evaluated or validated, or both (n = 106, 74%). Conclusion: This mapping review provides evidence that there is a breadth of tools available for health system strengthening globally along with some gaps where no tools were identified for specific health system building blocks. Furthermore, most tools were developed and applied in HIC/MIC and it is important to consider factors that influence their utility in LMIC settings. It may be important to develop new tools related to infrastructure and financing. Tools that have been positively evaluated should be made available to all rural communities, to ensure comprehensive global action on rural health system strengthening. [ABSTRACT FROM AUTHOR]

Objective: To identify self-reported influences and drawbacks for early career nurses to work in a rural location. Background: The international shortage of rural nursing workforce is increasing. As a result, evidence that focuses on mechanisms to recruit early career nurses to these areas is important. This research focuses on the influences and drawbacks for early career nurses to undertake a rural graduate nursing program, aimed at providing evidence that can inform the design of rural nurse recruitment programs. Study design and methods: Manifest content analysis of open-ended questions in a cross- sectional survey that was administered in two rural Local Health Districts (LHDs) in New South Wales, Australia. Early career nurses commencing employment in either of the research locations in 2019 and 2020 were eligible to complete the survey. In two open-text questions, respondents were asked to respectively describe what the most influential factor was in their decision to commence employment in their location, and what were the drawbacks of this location, if any. Results: Of the 175 early career nurses invited to complete the survey, 165 (94.29%) returned a completed survey. Four themes were identified as influencing rural early career nurse employment; proximity to social and/or familial ties, being attracted to rural clinical practice, taking advantage of a job offer in a limited market, and wanting a rural lifestyle. Where drawbacks were described, themes referred to distance from social and/or familial ties, rural lifestyle factors, resource challenges, and a perception of less professional opportunity. Discussion: There may be an opportunity to attract and retain rural nurses through targeted social initiatives and creating community ties, particularly among those early career nurses who have no close friends and family nearby. This reflects other literature and the growing understanding of the importance of social connection, familial ties and life course in early career nurse decision making. Conclusion: The results of this research demonstrate that proximity to social and/or familial ties is both the biggest influence and drawback for early career nurses to accept employment in a rural location. Implications for research, policy, and practice: Strategies that capitalise on practical ways to integrate social connection and life course approaches in early career nurse onboarding in rural areas should be explored in future research with a view to creating guidance for rural health organisations and policy makers. What is already known about the topic? • Australia is facing a significant and growing deficit in the number of nurses choosing to practice rurally. • Rural origin and rural placements influence rural practice intention. • Early career nurse programs are an initiative aimed to support the transition of nurses into practice from undergraduate study and can act as a pathway for nurses to enter rural careers. What this paper adds: • Family and social ties are the most influential reasons for choosing a rural location for early career nurses. • Commensurate with this is the greatest drawback for choosing a rural location for early career employment was being away from family and/or friends. • Future research should explore practical strategies that capitalise on the importance of social connections, familial ties, and life course for rural nurse career decisions. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to illuminate the meaning of being a nurse in the archipelago. Methodological Design and Justification: A phenomenological hermeneutical design was applied, as there is a need to understand the lifeworld and the meaning of being a nurse in the archipelago. Ethical Issues and Approval: Approval was granted by the Regional Ethical Committee and local management team. All participants provided consent to participate. Research Method: Individual interviews were conducted with 11 nurses (Registered Nurses or primary health nurses). The interviews were transcribed, and the text was analysed by means of phenomenological hermeneutical method. Results: The analyses ended in one main theme: Standing alone on the frontline, and three themes: 1. Combating sea, weather and the clock with the sub‐themes: Fighting to give care to patients despite harsh conditions and Fighting against time; 2. Standing firm but wavering with the sub‐themes: Embracing the unexpected and Calling out for support; and 3. Being a lifeline throughout the entire lifespan with the sub‐themes: Having responsibility for the islanders and Having an intertwined private and work life. Study Limitations: The interviews may be considered few, but the textual data were rich and assessed suitable for the analysis. The text may be interpreted differently, but we deemed our interpretation as more probable than others. Conclusion: Being a nurse in the archipelago means standing alone on the frontline. Nurses, other health professionals and managers need knowledge and insight about working alone and the moral responsibilities thereof. There is a need to support the nurses in their lonely work. Traditional means of consultations and support could preferably be supplemented by modern digital technology. [ABSTRACT FROM AUTHOR]

A challenge confronting northern nursing is delivery of equitable and culturally competent nursing education. Advances in technology support distributed approaches for decentralised learning and enhance the feasibility of nursing education in rural and remote regions. However, there is limited scholarship on distributed/decentralised technologies in nursing education, particularly in northern and circumpolar regions. The purpose of this constructivist grounded theory research was to develop an enhanced understanding of the unique experiences of students, faculty and administrators who use distributed/decentralised methods and technology. Open-ended interviews were completed in 2015–17 with nursing students (n = 8), faculty and administrators (n = 6) at two universities using distributed/decentralised educational strategies in northern and circumpolar regions. Interviews, journal entries, field notes and memos, were analysed using grounded theory procedures. Findings indicated that distributed/decentralised programs offered rural and remote students educational possibilities that "fit" which would not have otherwise existed. However, Balancing Two Worlds created a collision of roles resulting in the potential loss of balance. Students rectified the Fear of "Falling Off" of their program through four subprocesses: Being Disciplined, Having Realistic Expectations, Planning Ahead and Staying Motivated which provided structure and predictability. Findings support the development of empirical knowledge regarding distributed/decentralised technologies in nursing education and a foundation for future research. [ABSTRACT FROM AUTHOR]