Academic literature on the topic 'Remote Australia'

Pulmonary rehabilitation, consisting of exercise training and education, is one of the most effective strategies for improving the health outcomes of people with chronic obstructive pulmonary disease (COPD) and reducing associated healthcare costs. Prior to the work presented in this thesis a description of the structure and content of pulmonary rehabilitation programs in Australia had not been published. In addition, whether existing programs met Australian recommendations for practice such as those contained in the Pulmonary Rehabilitation Toolkit, was unknown. Despite the significant benefits for both individuals with COPD and the community, access to pulmonary rehabilitation is limited, particularly for those in rural and remote regions. A lack of adequately trained healthcare professionals may contribute to difficulties with establishing and maintaining pulmonary rehabilitation. However, the effect of healthcare professional training on the availability of pulmonary rehabilitation had not been previously investigated. There were no published reports documenting existing knowledge and skill levels, evaluating training strategies to up-skill rural/remote healthcare professionals or evaluating the impact of such training on the delivery of pulmonary rehabilitation. The aims of the studies presented in this thesis were to: describe the current provision of pulmonary rehabilitation in Australia and the alignment of these pulmonary rehabilitation programs with evidence-based recommendations; determine the level of knowledge and skills of rural and remote healthcare professionals in the management of people with chronic lung disease; investigate the ability of an educational training program for healthcare professionals to improve knowledge and confidence and improve the availability and delivery of pulmonary rehabilitation in rural and remote regions and explore the attitudes, opinions and concerns of healthcare professionals regarding the delivery of pulmonary rehabilitation. The first study (Chapter 2) was a cross sectional, observational study using a purpose designed anonymous paper-based survey. The national database of pulmonary rehabilitation programs, maintained by Lung Foundation Australia (LFA), was used to identify known programs in all states and territories of Australia. All pulmonary rehabilitation programs listed on the database at that time were included (n=193). Healthcare professionals who coordinated pulmonary rehabilitation were invited to participate. This study had a response rate of 83% (n=163) and all states and territories in Australia were represented. The responses enabled the structure and content of Australian pulmonary rehabilitation programs to be elucidated. Most Australian pulmonary rehabilitation programs broadly met recommendations for practice contained in the Pulmonary Rehabilitation Toolkit in terms of included components (exercise training and education), program length, patient assessment and exercise training (duration, frequency and mode). Many respondents were not aware of major evidence-based practice guidelines (including the Pulmonary Rehabilitation Toolkit). Interestingly, despite not being aware of guidelines, most respondents indicated that they perceived a gap between current evidence and their practice in terms of exercise prescription and training. The studies presented in Chapters 4-7 were undertaken as individual components of a mixed methods study to evaluate the impact of the Breathe Easy Walk Easy (BEWE) program on healthcare professional knowledge and confidence, service delivery and patient outcomes in rural and remote Australian regions. The BEWE program was an interactive education and training program related to providing components of assessment and management (in particular pulmonary rehabilitation) for people with chronic respiratory disease. The BEWE program consisted of a training workshop, access to online resources, provision of community awareness-raising materials and ongoing telephone/email support. Details of the development of the BEWE program are presented in Chapter 1. Further information regarding the content and structure of the BEWE program along with relevant methods for the studies contained in Chapters 4-7, are presented in Chapter 3. The evaluation process was conducted by a researcher (the PhD candidate) who was independent of the development and delivery of the BEWE program. The study presented in Chapter 4 was a descriptive cross-sectional, observational survey design using a written anonymous questionnaire. Participants were healthcare professionals (n=31) who registered to attend the BEWE program initial workshop in either one rural or one remote Australian region. The main outcomes were participant attitudes, objective knowledge (case vignette-based) and self-rated experience, training, and levels of confidence. Participants were from a variety of professional backgrounds (allied health, medical, nursing) but were predominantly nurses (n=13) or physiotherapists (n=9). The main findings of this study were that that rural and remote healthcare professionals had low levels of experience, training, knowledge and confidence in providing components of management for people with COPD. Most participants reported that they had minimal or no experience or training in this area of practice. The scores in the measured knowledge quiz were generally poor, with mean knowledge score (number of correct answers out of 19) being 8.5 (SD=4.5). There were higher numbers of correct responses for questions relating to COPD disease pathophysiology and diagnosis than for questions relating specifically to pulmonary rehabilitation. In addition, most participants reported particularly low confidence in the delivery of pulmonary rehabilitation. Based on the findings of the study, the need for an education and training program for rural and remote healthcare professionals in the evidence-based management of people with COPD with an emphasis on pulmonary rehabilitation was evident. The effects of the delivery of an education and training program on healthcare professional knowledge and confidence in the management of people with COPD and on the availability of pulmonary rehabilitation were investigated and are presented in Chapter 5. This study was a quasi-experimental, before and after repeated measures design. Healthcare professionals (n=33) from various backgrounds who participated in the BEWE program were eligible to participate. The BEWE program was delivered in one rural and one remote region. Participant knowledge, confidence and attitudes were assessed via anonymous written questionnaire before, immediately after and at three and 12 months following the BEWE workshop. Participation in the BEWE program resulted in significant improvements in participants’ self-rated knowledge and confidence immediately after the workshop, and at three and 12 month follow-up. Measured knowledge (case vignette score out of 19) improved significantly immediately after the workshop compared to before (mean difference 7.6 correct answers, 95% CI 5.8 to 9.3). At 12-month follow-up, three locally run pulmonary rehabilitation programs had been established in participating regions. The availability of pulmonary rehabilitation following delivery of the BEWE program, as well as patient outcomes and the factors contributing to the change in service delivery were further explored and results are presented in Chapter 6. Data were collected regarding the provision of pulmonary rehabilitation services before and after delivery of the BEWE program and patient outcomes (six-minute walk test and health related quality of life) before and after pulmonary rehabilitation. Pulmonary rehabilitation was not available in any of the participating sites before the BEWE program. At 12-month follow-up three sites had established locally-run pulmonary rehabilitation programs which had a structure and content broadly meeting Australian practice recommendations for pulmonary rehabilitation. Initial patient outcome data for the six-minute walk test and the St George’s Respiratory Questionnaire demonstrated evidence of the effectiveness of these pulmonary rehabilitation programs in improving functional exercise capacity and health related quality of life. Providing targeted specific training, the retention of key staff and strong local healthcare organisational support were important factors which contributed to the successful establishment of pulmonary rehabilitation. A study involving interviews with key healthcare professionals involved in the delivery of pulmonary rehabilitation in rural and remote regions was conducted and is presented in Chapter 7. Those healthcare professionals who participated in the BEWE program and who were identified as key informants, were invited to participate in semi-structured interviews. The purpose of the interviews was to gain a deeper understanding of the participants’ attitudes and opinions regarding developing, establishing and delivering pulmonary rehabilitation in rural and remote regions. This study was designed to add perspective to the quantitative data rather than to inform the design of the evaluation process. Interviews occurred at three and 12 months following the BEWE workshop in the remote region and at 12 months following the BEWE workshop in the rural region. Interviews were recorded and transcribed verbatim. A process of thematic analysis was used to analyse the transcripts. Healthcare professional staffing levels, time and case load constraints, knowledge and confidence, ensuring sustainability, individual and community attitudes, and practical issues related to the setting, structure and content of pulmonary rehabilitation were identified as the main concerns of informants. The results of this study indicate that dedicated funding to support additional healthcare professional staffing and to assist with providing specific education and training may facilitate the availability and delivery of pulmonary rehabilitation in rural and remote regions. The body of work contained in this thesis has contributed to a greater knowledge of the practice and availability of pulmonary rehabilitation in the Australian rural and remote context and has provided evidence that the provision of a training program for healthcare professionals can facilitate the delivery of effective pulmonary rehabilitation in rural and remote Australian regions.

This thesis examined police and Indigenous relations in rural and remote contexts in Australia which historically and in contemporary times have often been contentious. Using a grounded theory approach, the police participants of this qualitative research provided insight as to how social factors such as ecological, organizational and occupational culture influenced their responses in discrete Indigenous communities. The findings revealed that ecological factors such as community dynamics and Indigenous culture heavily influenced police in how they responded to situations, more so than the influence of organizational and occupational culture. It found that ecological factors played a large role in shaping policing responses in discrete Indigenous communities.

The solitary position of nurses who practise in geographically isolated communities to provide direct health care to a predominantly Aboriginal population characterises nursing in remote areas. Munoz & Mann (1982) described this practice as unique. The uniqueness of this practice, however, has remained shrouded in superficial descriptions featuring service delivery at a one or two-nurse-post, the physical distance of nursing posts from hospital facilities and the autonomy with which nursing is performed. Only glimpses of the reality of nursing practice in a remote area have been revealed through the study of the educational needs of remote area nurses (Munoz & Mann 1982, Cameron-Traub 1987, Philp 1988, Kreger 1991a, Bell, Chang & Daly 1995). A key problem is the lack of a systematic description and detailed analysis of nursing as it is practised in a remote area.The purpose of this study was to explore, describe and analyse nursing practice in a remote area. The research was undertaken at Warburton, an isolated community mainly inhabited by the Ngaanyatjarra people in the Central Desert of Western Australia. An ethnographic design was chosen for this exploratory inquiry into the social and cultural pattern of everyday nursing practice. In a pre-entry study a suitable setting and informants were found. Fieldwork was conducted at the Warburton nursing post by the researcher and involved living on site for a year. Data gathering techniques were participant observation together with interviewing, collection of pertinent documents and the daily chronological recording of fieldnotes, memos and a personal journal. Data analysis was performed concurrently with data gathering. The process followed the Developmental Research Sequence Method by Spradley (1980). Through a cyclical process of data collection and analysis the domains, taxonomies and componential variables in the culture of remote area nursing practice emerged.Amorphous practice was the overall theme revealed in the underlying cultural patterns that shaped the practice of nursing in the remote area. The term amorphous practice is defined as the changeable nature of practice from nurse to nurse, from situation to situation, from time to time. This was observed in the recurrent differences between nurses in their knowledge, abilities and attitudes as well as in the variability between nurses in their management of client care. Contributors to the phenomenon of amorphous practice were found in three distinct, but inter-related, tributary themes termed detachment, diffusion and beyond the nursing domain. Detachment explained the nurses' feelings of separateness from the usual professional and organisational structures needed for the enactment of nursing. Diffusion encapsulated the broad spread of the nurses' role in remote area practice. Beyond the nursing domain described an unregulated practice considered to be outside the responsibilities of nursing care. The substantive theory of amorphous practice provided a detailed description of how nursing was practised in the remote area. It also explained why it was so different from nursing as it is generally understood by the profession.

The concentration of phytoplankton in waters off the Western Australian coastline contrast with the coastal waters west of southern Africa and South America. The lack of favourable upwelling conditions results in the majority of the southeastern Indian Ocean surface waters being nutrient poor. Which is reflected in their low productivity. Several areas either on or in close proximity to the coastline are notably more productive. The associated forcing terms generating phytoplankton favourable conditions differ between areas. as do the seasons in which they occur. Measurements of chlorophyll a concentration. the major photosynthetic pigment contained in phytoplankton, may be directly related to oceanic bioproductivity. Using data collected by the Coastal Zone Color Seamier between 1979-86, this work aims to improve the understanding of the spatial and temporal changes that occurred in chlorophyll a abundance in the southeastern Indian Ocean. The highest seasonal mean concentrations occur in Summer (January-March) and Autumn (April-June); the former occurring in waters of the North West Shelf and the latter in close coastal areas of Western Australia south of North West. Cape. Concentrations observed in the offshore oceanic regions are mostly poor. Exceptions to this occur in proximity to the adjacent Indonesian islands and directly south of Albany (possibly due to northwards flow of subantarctic nutrient-rich waters). A considerable interannual variation was also noted, with the highest mean chlorophyll concentrations occurring in 1981. 1982 and 1983.The influence of the forcing terms on chlorophyll a appears to vary significantly among the waters of North West Shelf, Western and southern Western Australian coastline. This is most notable in the interseasonal variations. The changes observed interannually and their influence on chlorophyll a are not easily discernible. but there may be some connection with the La Nina/El Nino related changes in both currents and winds.

This study is based on data collected for a large project that investigated social literacies and various aspects of the literacy culture of members of three rural communities in Queensland. This study draws on ideas from current critical literacy theory and research and post-structural writings. It reports a distinctive set of observations which aim to contribute to social and educational knowledge in respect of centre-margin relationships, literacy-empowerment relationships, the changing socio-economic and political landscape in rural Australia, and the need for a new conceptual landscape to define the foundations of a 'postprogressive pedagogy'. This study delineates some of the distinctive features of rural communities, and investigates the connections that people construct between schooling and economic change and the future, and between literacy and schooling and various aspects of the culture of the community. It interprets how schooling and literacy are socially constructed by members of the rural communities studied. One hundred and fifty-eight residents of three rural/remote communities were interviewed and their responses recorded and analysed. The residents represented the full range of ages and occupations. A selection of data from these interviews is taken for this study, based on themes and issues emerging from the data. A theoretical and empirical framework for the study is provided by reviewing current literature on rurality and rural living, on communities and schooling and cultural practices; literature on qualitative research methodology, specifically ethnomethodology, methods of interview analysis and the application of these methods, is also reviewed. Ethnomethodology is used for this study and the specific analytic procedures of Membership Categorisation Analysis. This specific type of qualitative research methodology is chosen because of its power to take the everyday conversations of community members and, through analytical procedures, to make explicit in those members accounts the interaction of their experiences with the organisational and social forces (the social realities) which permeate their relationships with one another and with the context of the community where they live, work and recreate. This study makes use of recent systematic procedures developed for interrogating interview data. It adds to the research literature on ideologies of family and community literacies and social practices in Australian rural communities. The study provides information relevant to rural development planners, and education policy developers and curriculum writers, for the purpose of enhancing schooling for rural students and better understanding of rural lifestyles. This study's focus on rural communities has highlighted the complexities and diversities of the rural communities that are studied. The different approaches and debates about 'defining rural' must continue, and researchers must avoid promoting a unidimensional category of 'rural'. The changing and developing nature of the rural communities has also been prominent in this study. The implications of these complexities and changes are that rural communities should be studied regularly so that the effects of the changes can be traced and documented. There is a varied set of understandings among rural dwellers about education. For some, education is bringing knowledge and skills to life in the rural location and enabling residents to avail themselves of the urban offerings that may enhance their occupations and leisure activities thus utilising the benefits of two cultures to their best advantage. For others, there are the expectations that education will enable them to move away from the rural areas, to go to the city, to take up other careers, to lead a different lifestyle. Hypotheses and generalisations that express negative approaches to rural cultures and to rural education must be reduced and the positive aspects promoted. Any centre-margin discourse must be scrutinised for its relevance and the feasibility of the assumptions on which it is based. Education policy developers, social researchers and rural policy planners need to re-evaluate the philosophical premises on which the current concept of success is based: success for the individual school student, success for education and schooling, and success in adult life. A number of recommendations are developed in an attempt to make a vision of excellence in rural education a central part of rural agenda. Curriculum in rural schools needs to be matched to rural resources and rural occupations and lifestyles, and to encourage enterprise. While education remains a centralised provision, it needs to provide a context for training in the communication skills that shape rural people's views of their communities. Rural secondary students may be disadvantaged by not having access to a wide range of curriculum offerings, and at tertiary level by inequities (mostly financial) of access, but technology could be used to assist in broadening the range of offerings at secondary level, and library resources across the country could be better utilised. Social and education research could benefit from further studies using this methodology, for example, studies in mining communities, rural ethnic communities, rural tourist communities.<br>Thesis (Masters)<br>Master of Philosophy (MPhil)<br>School of Cognition, Language and Special Education<br>Arts, Education and Law<br>Full Text