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The objective of the study was to investigate the types of workplace health and safety issues rural community nurses encounter and the impact these issues have on providing care to rural consumers. The study undertook a narrative inquiry underpinned by a phenomenological approach. Community nursing staff who worked exclusively in rural areas and employed in a permanent capacity were contacted among 13 of the 16 consenting healthcare services.

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All community nurses who expressed a desire to participate were interviewed. Data were collected using semistructured interviews with 15 community nurses in rural and remote communities. Thematic analysis was used to analyse interview data.

The role, function and structures of community nursing services varied greatly from site to site and were developed and centred on meeting the needs of individual communities.

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In addition, a number of workplace health and safety challenges were identified and were centred on the geographical, physical and organisational environment that community nurses work across. In addition, other issues included encountering, managing and developing strategies to deal with poor client and carer behaviour; working within and negotiating working environments such as the poor condition of patient homes and clients smoking; navigating animals in the workplace; vertical and horizontal violence; and issues around workload, burnout and work-related stress.

Many nurses achieved good Old man take care nurse 9 to meet the needs of rural community health consumers. Managers were vital to ensure that service objectives were met. Despite the positive outcomes, many processes were considered unsafe by community nurses. It was identified that greater training and capacity building are required to meet the needs among all staff. These health workers are more vulnerable to occupational injury, Old man take care nurse 9 instigated disability, and are at higher risk of experiencing prolonged work absence due to workplace health and safety WHS issues.

It has been suggested that the greater demand of the health workforce in rural areas is due to a number of intrinsic and extrinsic rural challenges. These include poorer health outcomes and lower life expectancy within the rural population.

In addition, rural healthcare delivery systems are often different in terms of resources availability and models of care than larger urban healthcare systems.

Background

This diversity of delivery systems, delayed health-seeking and poorer overall health in rural areas has implications for community nurses. In addition, their nursing practice in rural areas has developed to be more around crisis management rather than preventative care. WHS seeks to protect the safety and health of all individuals in the work environment from exposure risks and hazards resulting from work.

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These stressors may include poor quality of care, dissatisfaction with employment and healthcare workload. Other critical stressors include cognitive, physical, behavioural and emotional stressors within the healthcare workplace.

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In addition to the day-to-day demands of health practice, community nurses may experience inadequate staffing levels, frequent overtime, on-call duties, violence in the work place, limited opportunities for career development, professional isolation, concerns for personal safety, and limited management support and supervision. Stress is a common issue in community nurse populations which leads to nurses having a greater likelihood of taking time away from work.

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Other reasons leading to stress, particularly in rural areas, may include lack of replacement staff and Old man take care nurse 9 inability to take leave for personal, medical or professional development. Stress and difficult workload management tend to relate to excessive work, rather than challenging care situations. Increased workload has shown to adversely impact the quality of attention community nurses give to their patients which leads to dissatisfaction and guilt. In most cases, no time was allocated or taken for morning or afternoon breaks.

An additional impact on workload is that community nurses have to travel long distance to and from each client's house that may often be time-consuming and exhausting.

To add to their difficulties, the road conditions in these areas are not always well developed or maintained. In some cases, weather-related illness and injury lead to high levels of absenteeism from work.

In addition to environmental hazards, physical hazards are experienced by community nurses, such as smoke, chemical, mechanical and exposure to biological infectious agents that increases the risk to safety. They also reported receiving limited or delayed support following critical incidents, such as violence. However, there is no indication if working in rural healthcare settings has an impact of healthcare workers being at a higher risk of workplace violence.

Workplace violence in the health sector is destructive and has a negative impact on the professional and personal lives of healthcare workers, but also on the quality and coverage of care provided.

This leads to deterioration of quality of care provided to clients with degeneration of working environment. These factors lead to reduction in health services available to the rural population as more nurses and a propensity to leave the profession.

Although nurses in general experience many WHS Old man take care nurse 9, much of the literature has focused on remote area nurses and there is little evidence that focused specifically on WHS among rural community nurses. To achieve this aim, the study sought to address a number of objectives, which included identifying the key WHS issues that community nurses encounter; highlighting the impact WHS issues play on nursing practice and provision of care; and what strategies community nurses develop and use to overcome the WHS issues in their practice.

The research examined the WHS issues that are encountered by rural community nurses using a narrative inquiry that was underpinned by a phenomenological approach. This study drew on phenomenology as it allows Old man take care nurse 9 more developed understanding of the complexities concerning the discourse of community nurses working in rural Tasmania.

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Phenomenology is a philosophy where reality is viewed to be constructed from our own experiences and beliefs. These services employ approximately 36 full-time equivalent staff provided across approximately two-thirds of the state where Participants were experienced, registered nurses working in rural areas of north and northwest Tasmania.

As the main purpose of the qualitative research was to provide an understanding of WHS issues within the rural community nursing workforce, it was not deemed necessary to recruit a large number of participants. Currently, 56 community nurses were identified working across the two rural regions in full-time and part-time capacities.

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To achieve the aims of Old man take care nurse 9 study, those community nurses who worked exclusively in rural areas and employed in a Old man take care nurse 9 capacity were invited to participate in the project. All directors of nursing across the study area were approached for their support to the study in with additional communication occurring in Each nurse unit manager or community nursing staff who met the inclusion criteria were contacted, with 13 of the 16 community nursing services consenting to participate in the study.

All community nurses from the 13 sites were individually approached regarding the study and those that expressed a desire to participate in the project were interviewed.

On receipt of their individual consent, an interview was arranged at a convenient date and time. Data were collected face-to-face or via phone between August and October using semistructured interviews. Semistructured interviews were used as they allow for flexibility within the interview, which can ensure probing of further data which may not have been on the interview schedule.

At times interviews were conducted within lunch hours, after work and as requested by nurse managers, not in peak nursing times. Owing to large distances or busy schedules, phone interviews were conducted with four community nurses, while the remainder were undertaken face-to-face.

The interview schedule was based from a previous study by the authors who examined general health workforce and health service needs among community nurses in Tasmania; however, the schedule was specifically developed to examine WHS issues rather than general workforce needs. Face-to-face interviews were held in a public place and were audio recorded with the permission of the participants.

Similarly, permission was gained to audio record phone interviews over loud speaker within a private office of the university.

Acknowledgments

The interviews were collected by a female registered nurse with interview training that was not a community nurse to reduce any bias.

The interviews Old man take care nurse 9 transcribed verbatim into Microsoft Word and then crosschecked by first and second researchers against audio recordings for anomalies or errors. The data were then imported to NVivo V. Throughout this process any hardcopy data were stored in a locked, secure location identified within the University, while electronic data were stored in a restricted folder located at the University.

Access to the hardcopy or electronic data is restricted to the designated Archives Officer where a registry of project data is held. Both face-to-face and phone data were then analysed to systematically identify recurring themes and experiences arising from the interviews by DT.

Grouped data will be subject to double-checking to ensure the integrity of the data. Additionally, thematic analysis of data was undertaken to identify key patterns and trends in the data and to compare expressed views. In the first stage, broad categories will be identified within an overall schema, and in the second stage, a detailed series of hierarchical nodes and subnodes were developed.

Data were coded and, where necessary, extra nodes will be built into the schema. A number of quotations are included in the paper to illustrate and support the accounts emerging from the textual responses.

Introduction

Qualitative research has been recognised, nowadays, as making a valuable contribution to improve healthcare practice and policy, but needs to establish different standards of rigour than quantitative studies. Some argue that Old man take care nurse 9 and reliability are important in qualitative research, 31 others argue that the reliability concept is misleading in qualitative research. Participants were also offered the opportunity to check their interview transcripts and reflect on situations where they did not understand or they need to decide what to do, etc.

In addition, to validate the findings, the major themes were presented to study participants and asked for responses to the major ideas. Additional literature was reviewed to provide perspective on emerging understanding. Sufficient contextual information about the fieldwork sites is provided to enable the reader to make a transfer to new situations that match study situations as judged by closeness of descriptive findings.

Dependability and confirmability of findings were tested by re-reading the data to determine the depth of evidence available for each of the final themes analysed by the research team.

The project received no external funding. Participants provided written consent after being informed of the study through a plain language statement and prior to their participation. Ten nurses were from the northern region, three nurses from the northwest Tasmanian region, one from the east coast and one from the west coast of Tasmania. The community nurses had worked an average of 8. The role, function and structures of community nursing services varied greatly from site to site.

For example, some nurses were sole practitioners working largely in isolation, others worked in small teams with other community nursing staff, while others worked with enrolled nurses or carers. In addition, some community nursing services were predominantly centre based with staff rarely providing nursing care in client homes, while others worked predominantly in the community with minimal or no centre-based service provision.

A number of key WHS themes were identified from the interview data that centred on geographical, physical and organisational environment issues as Old man take care nurse 9 in table 2 and discussed in detail below.

Among many community nurses, there were a number of WHS issues that centred on geography that were highlighted and included concerns around large travel distances and working in isolation. Driving was considered the greatest hazard within the workplace with major driving issues including great travel distances, long travel times, road condition and the impact that weather played in road safety.

Other issues included encountering wildlife when driving, lack of full attention while driving due to looking for client addresses particularly in rural and remote areas, or lack of concentration due to thinking about workload and prioritisation. Beyond other drivers and wildlife, the weather had an impact on staff safety. Some examples that were highlighted included extreme weather such as wild winds causing trees to fall across roads, flooding that impacted access to client homes, extreme hot and cold weather, fog, frost, and rain or snow causing slick and icy roads.

Although driving was considered stressful, nurses felt there was a level of acceptance concerning driving.

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If you have to go out to remote areas, then you just go. Another participant stated that it was the current process of vehicle use and mitigating vehicle theft and damage that left her, as a person, feeling vulnerable. After dark, sometimes I'm the only one there [at the compound]…I have to physically open and shut the gate by myself…I always ring my husband and say I'm on my way if I'm late so he knows…it is not safe.

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The concern of working in isolation and being vulnerable were echoed among other participants. Within this study, it was shown that community nurses were working on their own in client's homes that were quite remote. In these rural areas, mobile or cell phone coverage is often temperamental or non-existent.

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Nurses reported frequent dropout areas especially in very remote areas away from town centres. They were concerned for their safety when being out working on their own and losing communication with the administration staff.


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