Welcome to the rural research blog – brought to you by the Section of Rural Health.
The postcards from the edge series has come to an end. However, if you have something to contribute then please be in touch.
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I'm still here: that's probably the best part
Doolan-Noble F, Noller G, Nixon G, Stokes T. ‘I’m still here, that’s probably the best part’. Lives of those living rurally with an implantable cardioverter defibrillator: a qualitative study. Rural and Remote Health 2021; 21: 5659. https://doi.org/10.22605/RRH5659
This (open access) New Zealand study is the first to consider the lives of those who live rurally following the insertion of an implantable cardioverter device (ICD). Overall, place of residence did not significantly impact the lives of recipients, however, the influence of the care recipient and caregiver dyadic relationship on the recovery journey was an important association identified in the data analysis. The significance of the care recipient and care giver dyad on health, illness appraisal and symptom management has only been acknowledged recently. Health professionals caring for ICD recipients need to consider the health and wellbeing of caregivers who are frequently older and living with their own health conditions.
Abstract
Introduction: The use of implantable cardioverter defibrillators (ICDs) is increasing in both New Zealand and Australia. Also, both countries are experiencing an ageing of their rural populations. Much of the ICD literature focuses on the experience of those living in urban environments, with little known about the experiences of those living in rural contexts. This study aimed to answer the following questions: ‘Does living rurally impact the ICD recipient experience and that of their partners?’ and ‘Can understanding their experiences inform best practice care for those living rurally with an ICD?’
Methods: This qualitative study employed purposive sampling and semi-structured interviews to produce rich narrative data. A general inductive approach was then used to analyse data, producing a series of coded themes through an iterative strategy, to generate an understanding of the rural lived experience after ICD implantation. Interpretations and conclusions were tested with participants at a debriefing meeting at the conclusion of the study.
Results: In total 14 ICD recipients and nine partners/carers/whānau (family) were interviewed. One recipient was Māori (indigenous New Zealander) and one female, and overall age range was 57–89 years. The length of time from ICD insertion varied from less than 1 year to 12 years. The final analysis highlighted the substantial role played by partners/carers of recipients. How this recipient–partner/carer dyad managed the post-ICD insertion experience was a major theme in this study. The perennial challenges of advance care planning and ICD deactivation conversation, unmet need for peer support and gaps in the provision of health-related information were all highlighted as challenges to these rural participants. The rural locale, however, posed limited challenges. Loss of a driving licence following receipt of shock therapy was irksome due to the unavailability of public transport but the impediment posed by the device on the practicalities of rural living, such as the need to use power tools and move electric fences, was, for some, more of an issue.
Conclusion: This is one of the few studies that has considered the influence of rural location on the post-ICD insertion experience of patients and their partners/carers. ICD insertion did not appear to substantially negatively impact on the lives or experiences of rural recipients and their partners/carers. While this study did not set out to explore the role of informal carers who live rurally, the study findings suggest that female partners of rural ICD recipients undertake a significant role in terms of shouldering varying responsibilities including medication management, emotional support and transportation. As the age of ICD recipients increases, so does the age of their partners, therefore, they are also likely to be living with one or more long term conditions. Health professionals need to be aware of this additional burden as research suggests rural informal caregivers are less likely to report associated issues.
Two jobs: Closing Soon
Clinical director for Rural GP network and Rural Cohort Manager for Vaccination rollout.
Both jobs require a quite a bit of time in Wellington, but understand that the Clinical Director role can be based from your usual residence. Both adverts are linked above.
Contact RPGN for more information.
Clinical director Rural Health
The New Zealand Rural General Practice Network is currently seeking a Clinical Director Rural Health for a two year fixed term position.
This is an exciting opportunity to help drive a rural perspective into strategic thinking, planning and advocacy as the Government implements the Health and Disability System Review.
Reporting directly to the Chief Executive, the role can be based in either Wellington or regionally, with the ability to travel regularly.
Please see the full advert for this role attached.
Rural Cohort Manager
This is a reminder about the exciting opportunity available to help drive the rural perspective into the planning, design and roll out of the COVID-19 vaccination programme to rural communities.
Between now and the end of July, the Ministry of Health’s Covid-19 Vaccine and Immunisation Programme Team (CVIP) will be designing and implementing a staged vaccination programme across New Zealand. It is recognised that rural communities have unique challenges and needs, and as such require specialist advice in ensuring that the systems are designed to meet those needs.
The New Zealand Rural General Practice Network is working with the Ministry to identify the right person for this role.
Based in Wellington for three days a week, or travelling regionally to visit stakeholders, the Ministry will cover travel and accommodation to make this position possible for the right person.
The Rural Cohort Manager will be responsible for assisting with the identification of appropriate delivery models and any variations required. The position will also support engagement with DHBs, PHOs and national bodies and provide advice to implementing partners where needed.
This is a flexible position, with the opportunity to be employed by the Ministry through secondment from an existing role, or by fixed term contract.
This position is available immediately so see the full advert for the Rural Cohort Manager role attached and apply today.
Procedural sedation
Kiuru S, Gutenstein M, Withington S. Exploratory survey of procedural sedation and analgesia practice in sample of New Zealand rural hospitals: existing guidelines do not support current rural practice. Rural and Remote Health 2021; 21: 6320. https://doi.org/10.22605/RRH6320
A nice open-access paper by Sampsa, Marc and Steve that shows that resources at NZ rural hospitals varies and that current procedural sedation guidelines are not fit-for purpose.
PS09 is currently under review as rural hospitals are not the only context that the current guidelines do not work. This updated document will likely be re-released end of 2021 as a co-badged document and have a sibling document that defines the skills required for competence to perform procedural sedation.
Abstract
Aim: Rural hospitals in New Zealand provide broad generalist clinical services, including procedural sedation and analgesia (PSA). This study was designed to explore patterns of procedural sedation use including indications, equipment, medications, logistical and medical staff support available by rural hospitals, and whether current professional guidelines support rural sedation practice.
Methods: Through the New Zealand Rural Hospital Research Network, 17 rural hospitals were enrolled in an online survey during February 2018. The electronic survey consisted of 31 questions, regarding general information, staffing level and procedural sedation practice. Further questions sought information on clinical documentation and training guidelines.
Results: Most participating sites represented larger rural hospitals and were distributed equally throughout New Zealand. All performed procedural sedation. The distance of rural hospitals to their referral hospitals varied, with the closest being 65 km and the furthest at 326 km away. This study found that staffing and equipment available for rural procedural sedation varied, with the majority of rural hospitals having access to only one doctor out of hours, and only half having access to two doctors within daytime hours. A majority of the respondents felt that a minimum safe level for procedural sedation in their rural hospital required only a single doctor. Procedural sedation is frequently performed in rural hospitals in New Zealand, with the majority of respondents performing PSA at least once a week or more. Ketamine is the preferred PSA agent. A wide variety of procedures are undertaken including orthopaedic and injury treatments, abscess incision and drainage, and cardioversions. Patient transfer to another centre for the purpose of PSA is infrequent, occurring a few times a month or less for all hospitals.
Conclusion: This exploratory survey of rural hospital PSA practice demonstrated that PSA is a commonly performed procedure for a variety of indications. Staffing, equipment and techniques available for rural PSA vary according to institution. There is no current professional framework that suitably defines minimum standards for rural PSA practice, and specific training resources are limited. Providing procedural sedation and analgesia is an essential rural hospital service which is patient and whānau (Māori-language word for extended family) centred, saves patient transfers, and should be supported by a safe, pragmatic and realistic framework of tools, recommendations and training for rural practitioners.
