Background
Diabetes educators provide self-management education for people living with diabetes t... more Background Diabetes educators provide self-management education for people living with diabetes to promote optimal health and wellbeing. Their national association is the Australian Diabetes Educators Association (ADEA), established in 1981. In Australia the diabetes educator workforce is a diverse, interdisciplinary entity, with nurses, podiatrists, dietitians and several other health professional groups recognised by ADEA as providers of diabetes education. Historically nurses have filled the diabetes educator role and anecdotally, nurses are perceived to have wider scope of practice when undertaking the diabetes educator role than the other professions eligible to practise diabetes education. The nature of the interprofessional role boundaries and differing scopes of practice of diabetes educators of various primary disciplines are poorly understood. Informed by a documentary analysis, this historical review explores the interprofessional evolution of the diabetes educator workforce in Australia and describes the major drivers shaping the role boundaries of diabetes educators from 1981 until 2017.
Methods This documentary analysis was undertaken in the form of a literature review. STARLITE framework guided the searches for grey and peer reviewed literature. A timeline featuring the key events and changes in the diabetes educator workforce was developed. The timeline was analysed and emerging themes were identified as the major drivers of change within this faction of the health workforce.
Results This historical review illustrates that there have been drivers at the macro, meso and micro levels which reflect and are reflected by the interprofessional role boundaries in the diabetes educator workforce. The most influential drivers of the interprofessional evolution of the diabetes educator workforce occurred at the macro level and can be broadly categorised according to three major influences: the advent of non-medical prescribing; the expansion of the Medicare Benefits Schedule to include rebates for allied health services; and the competency movement.
Conclusion This analysis illustrates the gradual movement of the diabetes educator workforce from a nursing dominant entity, with an emphasis on interprofessional role boundaries, to an interdisciplinary body, in which role flexibility is encouraged. There is however, recent evidence of role boundary delineation at the meso and micro levels.
Keywords
Diabetes educator Diabetes education Interdisciplinary Interprofessional Role boundaries
Australian Health Review 39(5) 494-507 http://dx.doi.org/10.1071/AH14137
Background
District ho... more Australian Health Review 39(5) 494-507 http://dx.doi.org/10.1071/AH14137
Background District hospitals are important symbolic structures in rural and remote communities; however, little has been published on the role, function, or models of care of district hospitals in rural and remote Australia. Objective To identify models of care that incorporate district hospitals and have relevance to the Australian rural and remote context. Design A systematic, rapid review of published peer-reviewed and grey literature using CINAHL, MEDLINE, PsychInfo, APAIS-Health, ATSI health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms included rural, small general, and district hospitals, rural health services organization & administration, medically underserved area, specific conditions, interventions, monitoring, and evaluation, regional, rural and remote communities; NSW, Australia, other OECD countries. Models of teaching and education, multi-purpose services centres, recruitment / retention were excluded. Results The search yielded 1626 articles and reports. Following removal of duplicates, initial screening, and full text screening 24 data sources remained, 21 peer reviewed publications and 3 grey literature. Identified models of care related specifically to maternal -child health, end of life care, cancer care services, Aboriginal health, mental health, surgery and emergency care. Conclusion District hospitals play an important role in the delivery of care, particularly at key times in a person’s life (birth, death, episodes of illness). They enable people to remain in or near their own community with support from a range of services. They also play an important role in the essential fabric of the community and the vertical integration of the health services. Keywords: rural and remote services, models of care, district hospitals.
Background
Lack of teamwork skills among health care professionals endangers patients and enables... more Background Lack of teamwork skills among health care professionals endangers patients and enables workplace bullying. Individual teamwork skills are increasingly being assessed in the undergraduate health courses but rarely defined, made explicit or taught. To remedy these deficiencies we introduced a longitudinal educational strategy across all three years of the Bachelor of Midwifery program. Aim To report on students’ experiences of engaging in team based assignments which involved mark-related peer feedback. Methods
Stories of midwifery students’ experiences were collected from 17 participants across the three years of the degree. These were transcribed and analysed thematically and interpreted using feminist collaborative conversations. Results Most participants reported being in well-functioning teams and enjoyed the experience; they spoke of ‘we’ and said ‘Everyone was on Board’. Students in poorly functioning teams spoke of ‘I’ and ‘they’. These students complained about the poor performance of others but they didn’t speak up because they ‘didn’t want to make waves’ and they didn’t have the skills to be able to confidently manage conflict. All participants agreed ‘Peer-related marks cause mayhem’. Conclusion Teamwork skills should be specifically taught and assessed. These skills take time to develop. Students, therefore, should be engaged in a teamwork assignment in each semester of the entire program. Peer feedback should be moderated by the teacher and not directly related to marks.
In a context of education focused on skill mastery and graduate-level competence in preparation f... more In a context of education focused on skill mastery and graduate-level competence in preparation for professional practice, the notion of professionalism could be reduced to measurable and rules-based concepts, and the values, ethical decision making and professional autonomy that underpin it could be overlooked. Using a blend of hermeneutic phenomenology and discourse analysis, this article explores how professionalism is understood, talked about and experienced by lecturers and students in physiotherapy and dietetics courses at an Australian university. The findings of the study highlight the complex and evolving nature of professionalism. Understandings of professionalism appeared to be influenced by opportunities to think about and discuss values that inform them. Moreover, issues like cultural competence and environmental sustainability were not part of participants' understandings of professionalism, suggesting a need to rethink philosophical approaches and pedagogical strategies to develop a notion of professionalism that adequately prepares students for the demands of contemporary professional practice.
The increasing use of complementary and alternative medicine (CAM) in developed countries has bee... more The increasing use of complementary and alternative medicine (CAM) in developed countries has been attributed more to contemporary cultural trends than to inherent problems in mainstream medicine. The aim of this study was to examine the impact of post-modern values on relationships between practitioners and clients in integrative medicine (IM) clinics in Australia.This research used hermeneutic phenomenology to uncover experiences of practitioner–client relationships in IM and the meanings clients and practitioners attached to these relationships. Data were collected using cumulative case studies, focus groups and key informant interviews. Data analysis consisted of reading and re-reading texts derived from interview transcripts and field notes and constantly comparing texts to identify meanings and patterns. Themes extracted from the data set were continually refined, discarded and elaborated until meta-themes emerged.Australian IM clinics where general medical practitioners and CAM practitioners were co-located.Post-modern values were evident in practitioner–client relationships in Australian IM clinics and were manifested in two ways. (1) Clients did not bring an expectation that they would receive prescriptive treatment regimens. They regarded consultations as opportunities for obtaining information or advice, or for monitoring their health. (2) Practitioners valued clients’ knowledge and judgments and respected clients’ right to choose and direct their health care.In the IM clinics in this research, the traditional role of the practitioner as sole possessor of expertise had changed. Practitioners had become one among a number of resources that informed clients used when designing personal health care plans or negotiating health care with practitioners.
Journal of alternative and complementary medicine (New York, N.Y.), 2006
This study aimed to determine the extent to which complementary and alternative medicine (CAM) pr... more This study aimed to determine the extent to which complementary and alternative medicine (CAM) practitioners in Australia are trained in and use CAM and Western medical diagnostic techniques, and the influence this may have on their role as primary contact practitioners. A 45-item questionnaire was mailed to members of the Australian Natural Therapists' Association and the Australian Traditional Medicine Society. We received 617 responses (22%). Respondents reported high frequency of training in and use of Western case history taking, observation, taking blood pressure and pulses, palpation, postural assessment, orthopaedic testing, in addition to naturopathic case history taking, iris diagnosis, and face, tongue, and nail diagnosis. We found a significant relationship between the confidence practitioners had in identifying clients requiring referral and their training in these areas. Despite the reported high frequency of training in and use of Western medical and CAM diagnostic techniques, 32% of respondents reported a lack of confidence in identifying patients requiring referral. This could compromise the safety of clients and the effectiveness of practice.
The Journal of Alternative and Complementary Medicine, 2010
Integrative medicine (IM) is an emerging model of health care in Australia. However, little is kn... more Integrative medicine (IM) is an emerging model of health care in Australia. However, little is known about the contribution that IM makes to the quality of health care. The aim of the research was to understand the contribution IM can make to the quality of primary care practices from the perspectives of consumers and providers of IM. This interpretive research used hermeneutic phenomenology to understand meanings and significance that patients and practitioners attach to their experiences of IM. Various qualitative research techniques were used: case studies; focus groups; and key informant interviews. Data sets were generated from interview transcripts and field notes. Data analysis consisted of repeatedly reading and examining the data sets for what they revealed about experiences of health care and health outcomes, and constantly comparing these to allow themes and patterns to emerge. The setting for this research was Australian IM clinics where general medical practitioners and CAM practitioners were co-located. From the perspective of patients and practitioners, IM: (1) provided authentically patient-centered care; (2) filled gaps in treatment effectiveness, particularly for certain patient populations (those with complex, chronic health conditions, those seeking an alternative to pharmaceutical health care, and those seeking health promotion and illness prevention); and (3) enhanced the safety of primary health care (because IM retained a general medical practitioner as the primary contact practitioner and because IM used strategies to increase disclosure of treatments between practitioners). According to patients and practitioners, IM enhanced the quality of primary health care through its provision of health care that was patient-centered, effective (particularly for chronic health conditions, nonpharmaceutical treatments, and health promotion) and safe.
The Journal of Alternative and Complementary Medicine, 2010
Little is known about the implementation of integrative medicine (IM) in Australian health care a... more Little is known about the implementation of integrative medicine (IM) in Australian health care and the nature of interprofessional collaborations that have been established in IM. The aim of this research was to examine the relationships among general medical practitioners (GPs) and complementary and alternative medicine (CAM) practitioners and their respective roles in co-located integrative practices. This research adopted hermeneutic phenomenology as an effective methodology for revealing people's experiences of IM and the meanings they attached to these experiences. Three (3) data collection methods were used: cumulative case studies, focus groups, and key informant interviews. Data analysis consisted of constant comparison of data from multiple sources to identify patterns and meta-themes. The setting for this research was Australian IM clinics where GPs and CAM practitioners were co-located. Three (3) practice styles were identified among IM practitioners in this research: (1) mutually empowering when GPs and CAM practitioners regarded each other as peers, (2) GP-directed with varying levels of autonomy afforded CAM practitioners, and (3) limited collaboration where patients were offered mainstream medicine and CAM, which GPs performed themselves. IM practice styles differed in terms of interprofessional power-sharing and roles assigned to CAM practitioners. Practice styles where CAM practitioners were highly valued and able to exercise high levels of professional autonomy were perceived as making effective use of the available CAM workforce. Both GP-directed and intragrative practice styles (where GPs practiced CAM themselves without referral to CAM practitioners) were perceived by many GPs and CAM practitioners as enhancing patient safety.
Background
Diabetes educators provide self-management education for people living with diabetes t... more Background Diabetes educators provide self-management education for people living with diabetes to promote optimal health and wellbeing. Their national association is the Australian Diabetes Educators Association (ADEA), established in 1981. In Australia the diabetes educator workforce is a diverse, interdisciplinary entity, with nurses, podiatrists, dietitians and several other health professional groups recognised by ADEA as providers of diabetes education. Historically nurses have filled the diabetes educator role and anecdotally, nurses are perceived to have wider scope of practice when undertaking the diabetes educator role than the other professions eligible to practise diabetes education. The nature of the interprofessional role boundaries and differing scopes of practice of diabetes educators of various primary disciplines are poorly understood. Informed by a documentary analysis, this historical review explores the interprofessional evolution of the diabetes educator workforce in Australia and describes the major drivers shaping the role boundaries of diabetes educators from 1981 until 2017.
Methods This documentary analysis was undertaken in the form of a literature review. STARLITE framework guided the searches for grey and peer reviewed literature. A timeline featuring the key events and changes in the diabetes educator workforce was developed. The timeline was analysed and emerging themes were identified as the major drivers of change within this faction of the health workforce.
Results This historical review illustrates that there have been drivers at the macro, meso and micro levels which reflect and are reflected by the interprofessional role boundaries in the diabetes educator workforce. The most influential drivers of the interprofessional evolution of the diabetes educator workforce occurred at the macro level and can be broadly categorised according to three major influences: the advent of non-medical prescribing; the expansion of the Medicare Benefits Schedule to include rebates for allied health services; and the competency movement.
Conclusion This analysis illustrates the gradual movement of the diabetes educator workforce from a nursing dominant entity, with an emphasis on interprofessional role boundaries, to an interdisciplinary body, in which role flexibility is encouraged. There is however, recent evidence of role boundary delineation at the meso and micro levels.
Keywords
Diabetes educator Diabetes education Interdisciplinary Interprofessional Role boundaries
Australian Health Review 39(5) 494-507 http://dx.doi.org/10.1071/AH14137
Background
District ho... more Australian Health Review 39(5) 494-507 http://dx.doi.org/10.1071/AH14137
Background District hospitals are important symbolic structures in rural and remote communities; however, little has been published on the role, function, or models of care of district hospitals in rural and remote Australia. Objective To identify models of care that incorporate district hospitals and have relevance to the Australian rural and remote context. Design A systematic, rapid review of published peer-reviewed and grey literature using CINAHL, MEDLINE, PsychInfo, APAIS-Health, ATSI health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms included rural, small general, and district hospitals, rural health services organization & administration, medically underserved area, specific conditions, interventions, monitoring, and evaluation, regional, rural and remote communities; NSW, Australia, other OECD countries. Models of teaching and education, multi-purpose services centres, recruitment / retention were excluded. Results The search yielded 1626 articles and reports. Following removal of duplicates, initial screening, and full text screening 24 data sources remained, 21 peer reviewed publications and 3 grey literature. Identified models of care related specifically to maternal -child health, end of life care, cancer care services, Aboriginal health, mental health, surgery and emergency care. Conclusion District hospitals play an important role in the delivery of care, particularly at key times in a person’s life (birth, death, episodes of illness). They enable people to remain in or near their own community with support from a range of services. They also play an important role in the essential fabric of the community and the vertical integration of the health services. Keywords: rural and remote services, models of care, district hospitals.
Background
Lack of teamwork skills among health care professionals endangers patients and enables... more Background Lack of teamwork skills among health care professionals endangers patients and enables workplace bullying. Individual teamwork skills are increasingly being assessed in the undergraduate health courses but rarely defined, made explicit or taught. To remedy these deficiencies we introduced a longitudinal educational strategy across all three years of the Bachelor of Midwifery program. Aim To report on students’ experiences of engaging in team based assignments which involved mark-related peer feedback. Methods
Stories of midwifery students’ experiences were collected from 17 participants across the three years of the degree. These were transcribed and analysed thematically and interpreted using feminist collaborative conversations. Results Most participants reported being in well-functioning teams and enjoyed the experience; they spoke of ‘we’ and said ‘Everyone was on Board’. Students in poorly functioning teams spoke of ‘I’ and ‘they’. These students complained about the poor performance of others but they didn’t speak up because they ‘didn’t want to make waves’ and they didn’t have the skills to be able to confidently manage conflict. All participants agreed ‘Peer-related marks cause mayhem’. Conclusion Teamwork skills should be specifically taught and assessed. These skills take time to develop. Students, therefore, should be engaged in a teamwork assignment in each semester of the entire program. Peer feedback should be moderated by the teacher and not directly related to marks.
In a context of education focused on skill mastery and graduate-level competence in preparation f... more In a context of education focused on skill mastery and graduate-level competence in preparation for professional practice, the notion of professionalism could be reduced to measurable and rules-based concepts, and the values, ethical decision making and professional autonomy that underpin it could be overlooked. Using a blend of hermeneutic phenomenology and discourse analysis, this article explores how professionalism is understood, talked about and experienced by lecturers and students in physiotherapy and dietetics courses at an Australian university. The findings of the study highlight the complex and evolving nature of professionalism. Understandings of professionalism appeared to be influenced by opportunities to think about and discuss values that inform them. Moreover, issues like cultural competence and environmental sustainability were not part of participants' understandings of professionalism, suggesting a need to rethink philosophical approaches and pedagogical strategies to develop a notion of professionalism that adequately prepares students for the demands of contemporary professional practice.
The increasing use of complementary and alternative medicine (CAM) in developed countries has bee... more The increasing use of complementary and alternative medicine (CAM) in developed countries has been attributed more to contemporary cultural trends than to inherent problems in mainstream medicine. The aim of this study was to examine the impact of post-modern values on relationships between practitioners and clients in integrative medicine (IM) clinics in Australia.This research used hermeneutic phenomenology to uncover experiences of practitioner–client relationships in IM and the meanings clients and practitioners attached to these relationships. Data were collected using cumulative case studies, focus groups and key informant interviews. Data analysis consisted of reading and re-reading texts derived from interview transcripts and field notes and constantly comparing texts to identify meanings and patterns. Themes extracted from the data set were continually refined, discarded and elaborated until meta-themes emerged.Australian IM clinics where general medical practitioners and CAM practitioners were co-located.Post-modern values were evident in practitioner–client relationships in Australian IM clinics and were manifested in two ways. (1) Clients did not bring an expectation that they would receive prescriptive treatment regimens. They regarded consultations as opportunities for obtaining information or advice, or for monitoring their health. (2) Practitioners valued clients’ knowledge and judgments and respected clients’ right to choose and direct their health care.In the IM clinics in this research, the traditional role of the practitioner as sole possessor of expertise had changed. Practitioners had become one among a number of resources that informed clients used when designing personal health care plans or negotiating health care with practitioners.
Journal of alternative and complementary medicine (New York, N.Y.), 2006
This study aimed to determine the extent to which complementary and alternative medicine (CAM) pr... more This study aimed to determine the extent to which complementary and alternative medicine (CAM) practitioners in Australia are trained in and use CAM and Western medical diagnostic techniques, and the influence this may have on their role as primary contact practitioners. A 45-item questionnaire was mailed to members of the Australian Natural Therapists' Association and the Australian Traditional Medicine Society. We received 617 responses (22%). Respondents reported high frequency of training in and use of Western case history taking, observation, taking blood pressure and pulses, palpation, postural assessment, orthopaedic testing, in addition to naturopathic case history taking, iris diagnosis, and face, tongue, and nail diagnosis. We found a significant relationship between the confidence practitioners had in identifying clients requiring referral and their training in these areas. Despite the reported high frequency of training in and use of Western medical and CAM diagnostic techniques, 32% of respondents reported a lack of confidence in identifying patients requiring referral. This could compromise the safety of clients and the effectiveness of practice.
The Journal of Alternative and Complementary Medicine, 2010
Integrative medicine (IM) is an emerging model of health care in Australia. However, little is kn... more Integrative medicine (IM) is an emerging model of health care in Australia. However, little is known about the contribution that IM makes to the quality of health care. The aim of the research was to understand the contribution IM can make to the quality of primary care practices from the perspectives of consumers and providers of IM. This interpretive research used hermeneutic phenomenology to understand meanings and significance that patients and practitioners attach to their experiences of IM. Various qualitative research techniques were used: case studies; focus groups; and key informant interviews. Data sets were generated from interview transcripts and field notes. Data analysis consisted of repeatedly reading and examining the data sets for what they revealed about experiences of health care and health outcomes, and constantly comparing these to allow themes and patterns to emerge. The setting for this research was Australian IM clinics where general medical practitioners and CAM practitioners were co-located. From the perspective of patients and practitioners, IM: (1) provided authentically patient-centered care; (2) filled gaps in treatment effectiveness, particularly for certain patient populations (those with complex, chronic health conditions, those seeking an alternative to pharmaceutical health care, and those seeking health promotion and illness prevention); and (3) enhanced the safety of primary health care (because IM retained a general medical practitioner as the primary contact practitioner and because IM used strategies to increase disclosure of treatments between practitioners). According to patients and practitioners, IM enhanced the quality of primary health care through its provision of health care that was patient-centered, effective (particularly for chronic health conditions, nonpharmaceutical treatments, and health promotion) and safe.
The Journal of Alternative and Complementary Medicine, 2010
Little is known about the implementation of integrative medicine (IM) in Australian health care a... more Little is known about the implementation of integrative medicine (IM) in Australian health care and the nature of interprofessional collaborations that have been established in IM. The aim of this research was to examine the relationships among general medical practitioners (GPs) and complementary and alternative medicine (CAM) practitioners and their respective roles in co-located integrative practices. This research adopted hermeneutic phenomenology as an effective methodology for revealing people's experiences of IM and the meanings they attached to these experiences. Three (3) data collection methods were used: cumulative case studies, focus groups, and key informant interviews. Data analysis consisted of constant comparison of data from multiple sources to identify patterns and meta-themes. The setting for this research was Australian IM clinics where GPs and CAM practitioners were co-located. Three (3) practice styles were identified among IM practitioners in this research: (1) mutually empowering when GPs and CAM practitioners regarded each other as peers, (2) GP-directed with varying levels of autonomy afforded CAM practitioners, and (3) limited collaboration where patients were offered mainstream medicine and CAM, which GPs performed themselves. IM practice styles differed in terms of interprofessional power-sharing and roles assigned to CAM practitioners. Practice styles where CAM practitioners were highly valued and able to exercise high levels of professional autonomy were perceived as making effective use of the available CAM workforce. Both GP-directed and intragrative practice styles (where GPs practiced CAM themselves without referral to CAM practitioners) were perceived by many GPs and CAM practitioners as enhancing patient safety.
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Papers by Sandra Grace
Diabetes educators provide self-management education for people living with diabetes to promote optimal health and wellbeing. Their national association is the Australian Diabetes Educators Association (ADEA), established in 1981. In Australia the diabetes educator workforce is a diverse, interdisciplinary entity, with nurses, podiatrists, dietitians and several other health professional groups recognised by ADEA as providers of diabetes education. Historically nurses have filled the diabetes educator role and anecdotally, nurses are perceived to have wider scope of practice when undertaking the diabetes educator role than the other professions eligible to practise diabetes education. The nature of the interprofessional role boundaries and differing scopes of practice of diabetes educators of various primary disciplines are poorly understood. Informed by a documentary analysis, this historical review explores the interprofessional evolution of the diabetes educator workforce in Australia and describes the major drivers shaping the role boundaries of diabetes educators from 1981 until 2017.
Methods
This documentary analysis was undertaken in the form of a literature review. STARLITE framework guided the searches for grey and peer reviewed literature. A timeline featuring the key events and changes in the diabetes educator workforce was developed. The timeline was analysed and emerging themes were identified as the major drivers of change within this faction of the health workforce.
Results
This historical review illustrates that there have been drivers at the macro, meso and micro levels which reflect and are reflected by the interprofessional role boundaries in the diabetes educator workforce. The most influential drivers of the interprofessional evolution of the diabetes educator workforce occurred at the macro level and can be broadly categorised according to three major influences: the advent of non-medical prescribing; the expansion of the Medicare Benefits Schedule to include rebates for allied health services; and the competency movement.
Conclusion
This analysis illustrates the gradual movement of the diabetes educator workforce from a nursing dominant entity, with an emphasis on interprofessional role boundaries, to an interdisciplinary body, in which role flexibility is encouraged. There is however, recent evidence of role boundary delineation at the meso and micro levels.
Keywords
Diabetes educator Diabetes education Interdisciplinary Interprofessional Role boundaries
Background
District hospitals are important symbolic structures in rural and remote communities; however, little has been published on the role, function, or models of care of district hospitals in rural and remote Australia.
Objective
To identify models of care that incorporate district hospitals and have relevance to the Australian rural and remote context.
Design
A systematic, rapid review of published peer-reviewed and grey literature using CINAHL, MEDLINE, PsychInfo, APAIS-Health, ATSI health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms included rural, small general, and district hospitals, rural health services organization & administration, medically underserved area, specific conditions, interventions, monitoring, and evaluation, regional, rural and remote communities; NSW, Australia, other OECD countries. Models of teaching and education, multi-purpose services centres, recruitment / retention were excluded.
Results The search yielded 1626 articles and reports. Following removal of duplicates, initial screening, and full text screening 24 data sources remained, 21 peer reviewed publications and 3 grey literature. Identified models of care related specifically to maternal -child health, end of life care, cancer care services, Aboriginal health, mental health, surgery and emergency care.
Conclusion
District hospitals play an important role in the delivery of care, particularly at key times in a person’s life (birth, death, episodes of illness). They enable people to remain in or near their own community with support from a range of services. They also play an important role in the essential fabric of the community and the vertical integration of the health services.
Keywords: rural and remote services, models of care, district hospitals.
Lack of teamwork skills among health care professionals endangers patients and enables workplace bullying. Individual teamwork skills are increasingly being assessed in the undergraduate health courses but rarely defined, made explicit or taught. To remedy these deficiencies we introduced a longitudinal educational strategy across all three years of the Bachelor of Midwifery program.
Aim
To report on students’ experiences of engaging in team based assignments which involved mark-related peer feedback.
Methods
Stories of midwifery students’ experiences were collected from 17 participants across the three years of the degree. These were transcribed and analysed thematically and interpreted using feminist collaborative conversations.
Results
Most participants reported being in well-functioning teams and enjoyed the experience; they spoke of ‘we’ and said ‘Everyone was on Board’. Students in poorly functioning teams spoke of ‘I’ and ‘they’. These students complained about the poor performance of others but they didn’t speak up because they ‘didn’t want to make waves’ and they didn’t have the skills to be able to confidently manage conflict. All participants agreed ‘Peer-related marks cause mayhem’.
Conclusion
Teamwork skills should be specifically taught and assessed. These skills take time to develop. Students, therefore, should be engaged in a teamwork assignment in each semester of the entire program. Peer feedback should be moderated by the teacher and not directly related to marks.
Diabetes educators provide self-management education for people living with diabetes to promote optimal health and wellbeing. Their national association is the Australian Diabetes Educators Association (ADEA), established in 1981. In Australia the diabetes educator workforce is a diverse, interdisciplinary entity, with nurses, podiatrists, dietitians and several other health professional groups recognised by ADEA as providers of diabetes education. Historically nurses have filled the diabetes educator role and anecdotally, nurses are perceived to have wider scope of practice when undertaking the diabetes educator role than the other professions eligible to practise diabetes education. The nature of the interprofessional role boundaries and differing scopes of practice of diabetes educators of various primary disciplines are poorly understood. Informed by a documentary analysis, this historical review explores the interprofessional evolution of the diabetes educator workforce in Australia and describes the major drivers shaping the role boundaries of diabetes educators from 1981 until 2017.
Methods
This documentary analysis was undertaken in the form of a literature review. STARLITE framework guided the searches for grey and peer reviewed literature. A timeline featuring the key events and changes in the diabetes educator workforce was developed. The timeline was analysed and emerging themes were identified as the major drivers of change within this faction of the health workforce.
Results
This historical review illustrates that there have been drivers at the macro, meso and micro levels which reflect and are reflected by the interprofessional role boundaries in the diabetes educator workforce. The most influential drivers of the interprofessional evolution of the diabetes educator workforce occurred at the macro level and can be broadly categorised according to three major influences: the advent of non-medical prescribing; the expansion of the Medicare Benefits Schedule to include rebates for allied health services; and the competency movement.
Conclusion
This analysis illustrates the gradual movement of the diabetes educator workforce from a nursing dominant entity, with an emphasis on interprofessional role boundaries, to an interdisciplinary body, in which role flexibility is encouraged. There is however, recent evidence of role boundary delineation at the meso and micro levels.
Keywords
Diabetes educator Diabetes education Interdisciplinary Interprofessional Role boundaries
Background
District hospitals are important symbolic structures in rural and remote communities; however, little has been published on the role, function, or models of care of district hospitals in rural and remote Australia.
Objective
To identify models of care that incorporate district hospitals and have relevance to the Australian rural and remote context.
Design
A systematic, rapid review of published peer-reviewed and grey literature using CINAHL, MEDLINE, PsychInfo, APAIS-Health, ATSI health, Health Collection, Health & Society, Meditext, RURAL, PubMed and Google Scholar. Search terms included rural, small general, and district hospitals, rural health services organization & administration, medically underserved area, specific conditions, interventions, monitoring, and evaluation, regional, rural and remote communities; NSW, Australia, other OECD countries. Models of teaching and education, multi-purpose services centres, recruitment / retention were excluded.
Results The search yielded 1626 articles and reports. Following removal of duplicates, initial screening, and full text screening 24 data sources remained, 21 peer reviewed publications and 3 grey literature. Identified models of care related specifically to maternal -child health, end of life care, cancer care services, Aboriginal health, mental health, surgery and emergency care.
Conclusion
District hospitals play an important role in the delivery of care, particularly at key times in a person’s life (birth, death, episodes of illness). They enable people to remain in or near their own community with support from a range of services. They also play an important role in the essential fabric of the community and the vertical integration of the health services.
Keywords: rural and remote services, models of care, district hospitals.
Lack of teamwork skills among health care professionals endangers patients and enables workplace bullying. Individual teamwork skills are increasingly being assessed in the undergraduate health courses but rarely defined, made explicit or taught. To remedy these deficiencies we introduced a longitudinal educational strategy across all three years of the Bachelor of Midwifery program.
Aim
To report on students’ experiences of engaging in team based assignments which involved mark-related peer feedback.
Methods
Stories of midwifery students’ experiences were collected from 17 participants across the three years of the degree. These were transcribed and analysed thematically and interpreted using feminist collaborative conversations.
Results
Most participants reported being in well-functioning teams and enjoyed the experience; they spoke of ‘we’ and said ‘Everyone was on Board’. Students in poorly functioning teams spoke of ‘I’ and ‘they’. These students complained about the poor performance of others but they didn’t speak up because they ‘didn’t want to make waves’ and they didn’t have the skills to be able to confidently manage conflict. All participants agreed ‘Peer-related marks cause mayhem’.
Conclusion
Teamwork skills should be specifically taught and assessed. These skills take time to develop. Students, therefore, should be engaged in a teamwork assignment in each semester of the entire program. Peer feedback should be moderated by the teacher and not directly related to marks.