The delivery of primary health care in remote communities : A grounded theory study of the perspective of nurses

Journal article


McCullough, Kylie, Whitehead, Lisa, Bayes, Sara, Williams, Anne and Cope, Vicki. (2020) The delivery of primary health care in remote communities : A grounded theory study of the perspective of nurses. International Journal of Nursing Studies. 102, p. 103474. https://doi.org/10.1016/j.ijnurstu.2019.103474
AuthorsMcCullough, Kylie, Whitehead, Lisa, Bayes, Sara, Williams, Anne and Cope, Vicki
Abstract

Background
Australia has vast areas of desert, wilderness and offshore islands where nurses provide the majority of health care services. The residents of Australia's remote communities generally have poorer health status than their metropolitan counterparts. Despite recognition of Primary Health Care as a comprehensive model of acute and preventative care well suited to areas of high health and social need, there is little known about how nurses employ the Primary Health Care model in practice.

Objectives
This study described and explained from the perspective of nurses, the actions and interactions involved in the delivery of Primary Health Care in remote communities.

Design
This study was conducted from a Constructivist Grounded Theory perspective.

Settings
The setting was community health centres or Aboriginal Medical Services located in ‘remote’ or ‘very remote’ areas. Communities with inpatient health services were excluded.

Participants
Twenty four Nurse Practitioners, Registered Nurses and nursing academics participated. Participants had worked or were working, in a variety of remote communities across Australia. Length of service ranged from three months to over 15 years nursing in remote areas.

Methods
Data were collected through 23 telephone interviews and an expert reference group. Theoretical sampling and constant comparative analysis were used to reach theoretical saturation.

Results
The core issue participants faced was the inability to provide Primary Health Care. Four conditions impacted on the core issue: understanding the social world of the remote community, availability of resources, clinical knowledge and skill and, shared understanding and support. The process of doing the best you can with what you have, emerged as the way participants dealt with the inability to provide Primary Health Care. The process involved four primary activities: facilitating access to health care, continually learning, seeking understanding, and home-making in a work environment. The outcome of this process was considered to be making compromises to provide Primary Health Care.

Conclusions
This study describes the substantive theory: making compromises to provide Primary Health care services in the remote Australian setting. Understanding the process of making compromises could direct employers and educators in their efforts to improve the provision of Primary Health Care in a variety of settings. Increased attention to the education, resources and support of nurses is likely to increase access to safe, quality care for remote communities.

Keywordsadvanced practice nursing; community nursing; constructivist grounded theory; health promotion; indigenous health; nurse practitioners; primary health care; primary care remote area nurse
Year2020
JournalInternational Journal of Nursing Studies
Journal citation102, p. 103474
PublisherElsevier Ltd
ISSN0020-7489
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ijnurstu.2019.103474
Scopus EID2-s2.0-85076054064
Open accessPublished as ‘gold’ (paid) open access
Research or scholarlyResearch
Page range1-9
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online13 Nov 2019
Publication process dates
Accepted04 Nov 2019
Deposited09 May 2021
Permalink -

https://acuresearchbank.acu.edu.au/item/8vzw8/the-delivery-of-primary-health-care-in-remote-communities-a-grounded-theory-study-of-the-perspective-of-nurses

Download files


Publisher's version
OA_McCullough_2020_The_delivery_of_primary_health_care.pdf
License: CC BY-NC-ND 4.0
File access level: Open

  • 3
    total views
  • 1
    total downloads
  • 0
    views this month
  • 1
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

A comparison of middle managers' and paediatric nurses' satisfaction with organisational communication
Doleman, Gemma, Twigg, Di and Bayes, Sara. (2020) A comparison of middle managers' and paediatric nurses' satisfaction with organisational communication. Journal of Nursing Management. 28(6), pp. 1223-1232. https://doi.org/10.1111/jonm.13064
We have the program, what now? Development of an implementation plan to bridge the research-practice gap prevalent in exercise oncology
Kennedy, Mary A., Bayes, Sara, Newton, Robert U., Zissiadis, Yvonne, Spry, Nigel A., Taaffe, Dennis R., Hart, Nicolas H., Davis, Michael, Eiszele, Aileen and Galvão, Daniel A.. (2020) We have the program, what now? Development of an implementation plan to bridge the research-practice gap prevalent in exercise oncology. International Journal of Behavioral Nutrition and Physical Activity. 17(1), p. 128. https://doi.org/10.1186/s12966-020-01032-4
Sociocultural practices affecting the care of preterm infants in the Ghanaian community
Adama, Esther Abena, Sundin, Deborah and Bayes, Sara. (2020) Sociocultural practices affecting the care of preterm infants in the Ghanaian community. Journal of Transcultural Nursing. pp. 1-8. https://doi.org/10.1177/1043659620975098
If you build it, will they come? Evaluation of a co-located exercise clinic and cancer treatment centre using the RE-AIM framework
Kennedy, Mary A., Bayes, Sara, Galvão, Daniel A., Singh, Favil, Spry, Nigel A., Davis, Michael, Chee, Raphael, Zissiadis, Yvonne, Hart, Nicolas H., Taaffe, Dennis R. and Newton, Robert U.. (2020) If you build it, will they come? Evaluation of a co-located exercise clinic and cancer treatment centre using the RE-AIM framework. European Journal of Cancer Care. 29(4), pp. 1-12. https://doi.org/10.1111/ecc.13251
“I love being a midwife; it's who I am” : A Glaserian Grounded Theory Study of why midwives stay in midwifery
Bloxsome, Dianne, Bayes, Sara and Ireson, Deborah. (2020) “I love being a midwife; it's who I am” : A Glaserian Grounded Theory Study of why midwives stay in midwifery. Journal of Clinical Nursing. 29(1-2), pp. 208-220. https://doi.org/10.1111/jocn.15078
Midwives' use of best available evidence in practice : An integrative review
De Leo, Annemarie, Bayes, Sara, Geraghty, Sadie and Butt, Janice. (2019) Midwives' use of best available evidence in practice : An integrative review. Journal of Clinical Nursing. 28(23-24), pp. 4225-4235. https://doi.org/10.1111/jocn.15027
Factors associated with midwives’ job satisfaction and intention to stay in the profession : An integrative review
Bloxsome, Dianne, Ireson, Deborah, Doleman, Gemma and Bayes, Sara. (2019) Factors associated with midwives’ job satisfaction and intention to stay in the profession : An integrative review. Journal of Clinical Nursing. 28(3-4), pp. 386-399. https://doi.org/10.1111/jocn.14651
Skills for Midwifery Practice
De-Vitry Smith, Sally and Bayes, Sara. (2019) Skills for Midwifery Practice Elsevier Australia.
Australian midwives’ experiences of implementing practice change
Bayes, Sara, Juggins, Elaine, Whitehead, Lisa and De Leo, Annemarie. (2019) Australian midwives’ experiences of implementing practice change. Midwifery. 70, pp. 38-45. https://doi.org/10.1016/j.midw.2018.12.012
“Doing magic with very little” : Barriers to Ghanaian midwives' ability to provide quality maternal and neonatal care
Ismaila, Yakubu, Bayes, Sara and Geraghty, Sadie. (2019) “Doing magic with very little” : Barriers to Ghanaian midwives' ability to provide quality maternal and neonatal care. International Journal of Childbirth. 9(4), pp. 211-224. https://doi.org/10.1891/IJCBIRTH-D-19-00028
Parents’ experiences of caring for preterm infants after discharge with grandmothers as their main support
Adama, Esther Abena, Bayes, Sara and Sundin, Deborah. (2018) Parents’ experiences of caring for preterm infants after discharge with grandmothers as their main support. 27(17-18), pp. 3377-3386. https://doi.org/10.1111/jocn.13868
Registered nurses’ experiences of caring for pregnant and postpartum women in general hospital settings : A systematic review and meta-synthesis of qualitative data
Bayes, Sara and Ewens, Beverley. (2017) Registered nurses’ experiences of caring for pregnant and postpartum women in general hospital settings : A systematic review and meta-synthesis of qualitative data. Journal of Clinical Nursing. 26(5-6), pp. 599-608. https://doi.org/10.1111/jocn.13524
Ghanaian fathers' experiences of caring for preterm infants ; journey of exclusion
Adama, Esther Abena, Sundin, Deborah and Bayes, Sara. (2017) Ghanaian fathers' experiences of caring for preterm infants ; journey of exclusion. Journal of Neonatal Nursing. 23(6), pp. 275-281. https://doi.org/10.1016/j.jnn.2017.05.003
Examples of health practitioners’ approaches to planning and evaluating CPD
Bayes, Sarah, Devey, Lisa, Bidgood, Síobhán, Gilbert-Hunt, Sue, Acker, Joe and Gleadhill, Kearney. (2017) Examples of health practitioners’ approaches to planning and evaluating CPD. In In Andre, Kate, Heartfield, Marie and Cusack, Lynette (Ed.). Portfolios for health professionals pp. 98-123 Elsevier Australia.
Readiness for practice change : Evaluation of a tool for the Australian midwifery context
Bayes, Sara, Fenwick, Jennifer and Jennings, David. (2016) Readiness for practice change : Evaluation of a tool for the Australian midwifery context. Women and Birth. 29(3), pp. 240-244. https://doi.org/10.1016/j.wombi.2015.11.001
Parents' experiences of caring for preterm infants after discharge from Neonatal Intensive Care Unit : A meta-synthesis of the literature
Adama, Esther Abena, Bayes, Sara and Sundin, Deborah. (2016) Parents' experiences of caring for preterm infants after discharge from Neonatal Intensive Care Unit : A meta-synthesis of the literature. Journal of Neonatal Nursing. 22(1), pp. 27-51.
Exploring midwives' perception of confidence around facilitating water birth in Western Australia : A qualitative descriptive study
Nicholls, Sarah, Hauck, Yvonne L., Bayes, Sara and Butt, Janice. (2016) Exploring midwives' perception of confidence around facilitating water birth in Western Australia : A qualitative descriptive study. Midwifery. 33, pp. 73-81. https://doi.org/10.1016/j.midw.2015.10.010