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Diabetes education has been found to impact positively on self-management by people with diabetes although little is known about the process by which they assimilate information. The aim of this study was to generate a theory explaining the process by which people with diabetes learn about their disease in Indonesia. This study employed a grounded theory methodology influenced by constructivism and symbolic interactionism. A total of twenty-eight face-to-face or telephone interviews with participants from Indonesia that included people with diabetes, healthcare professionals, health service providers and families of people with diabetes were conducted in both Indonesia and Australia. This study discloses a core category of Learning, choosing, and acting: self-management of diabetes in Indonesia as the basic social process of how people learn about their diabetes. The process includes five distinctive major categories. People with diabetes acted after they had received recommendations that they considered to be trustworthy. Factors that influenced their choice of recommendations to adopt are also identified. Awareness of the complexity involved in their decision making will assist healthcare professionals to engage effectively with people living with diabetes.

The use of contraceptives for family planning improves women’s lives and may prevent maternal deaths. However, many women in low and middle-income countries, including the Pacific region, still die from pregnancy-related complications. While most health centres offer family planning services with some basic contraceptive methods, many people do not access these services. More than 60% of women who would like to avoid or delay their pregnancies are unable to do so. This scoping review identifies and analyses evidence about family planning service provision in Pacific Island Countries and Territories (PICTs), with the aim of better informing family planning services for improved maternal health outcomes in the Pacific. We used Arksey and O’Malley’s scoping review guidelines, supported by Levac, Colquhoun and O’Brien to identify gaps in family planning service provision. Selected studies included peer-reviewed publications and grey literature that provided information about family planning services from 1994 to 2019. Publication data was charted in MS Excel. Data were thematically analysed and key issues and themes identified. A total of 45 papers (15 peer-reviewed and 30 grey literature publications) were critically reviewed. Five themes were identified: i) family planning services in the Pacific; ii) education, knowledge and attitudes; iii) geographical isolation and access; iv) socio-cultural beliefs, practices and influences; and v) potential enabling factors for improved family planning, such as appropriate family planning awareness by health care providers and services tailored to meet individual needs. While culture and religion were considered as the main barriers to accessing family planning services, evidence showed health services were also responsible for limiting access. Family planning services do not reach everyone. Making relevant and sustainable improvements in service delivery requires generation of local evidence. Further research is needed to understand availability, accessibility and acceptability of current family planning services for different age groups, genders, social and marital status to better inform family planning services in the Pacific.

Objective: Identify factors relevant to the implementation of nasal high flow for infants with bronchiolitis in rural and remote contexts. Background: Healthcare services in rural and remote Australia must be resilient in responding to paediatric respiratory illness and provide equitable access of care to the tertiary contexts. Retrievals cannot be the only option to provide equitable care, particularly in examples of cyclones reducing aeromedical retrieval services. Nasal high flow (NHF) therapy is available for use in tertiary contexts for treating infants with respiratory illness. However, its use in rural and remote services is inconsistent and implementations to support routine implementation into this context are unknown. Study design and methods: An integrative review was completed using an adapted implementation science framework. The COM-B (Capability, Opportunity, Motivation - Behaviour) framework was used to structure and analyse the results in alignment with translatable clinical care setting implementations. Seven databases were searched using specified search terms such as nasal high flow therapy, bronchiolitis, and implementation. Results: The original search terms 'rural' and/or 'remote' yielded zero results and were therefore removed from the search criteria. Sixteen publications were included in the final analysis that yielded 73 implementation factors. Eight related to capability, 61 were opportunity factors and four were motivation factors. Many of the factors were reLating to the local context level, such as using observation regimes. One study (two publications) explicitly reported using an implementation framework where context was considered as an important component in identifying implementation strategies. Discussion: Implementation strategies included staff training (capability). The opportunity for staff to use NHF was the most common factor with using guidelines. The least represented motivation strategies focused on the clinician's confidence to use NHF therapy. Conclusion: The lack of reported NHF studies in rural and remote hospitals highlights a knowledge gap. Implementation science is recommended for use in contexts such as the rural/remote setting where the context is unique and requires targeted implementation strategies. Implications for research, policy, and practice: Research exploring the use of NHF therapy should consider the unique rural and remote context using appropriate implementation strategies. Implementation science has shown that factors such as local champions, guidelines, use of observational data, and having locally tailored training and supportive approaches does improve the implementation of NHF therapy. The authors recommend these strategies be applied in rural and remote contexts to inform future research, policies, procedures, and practices that will promote and support clinicians' confidence and ability to implement NHF therapy. What is already known on the subject: - NHF therapy is used for infants with bronchiolitis within the tertiary environment. - NHF is used outside of paediatric intensive care units. - Implementation science frameworks hasten evidence-based clinical practice routine uptake. What this paper adds: - Identifies a gap in the literature reporting implementation factors relevant for NHF therapy. - Identifies no published literature reporting NHF use in rural and remote contexts. - Describes, using an implementation framework, relevant factors for the use of NHF therapy in rural and remote hospitals.

Introduction: Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women are unable to attend a maternity facility, registered nurses (RNs) are required to fill the void. While maternity education can attempt to prepare RNs for such encounters, there is little documented to suggest it meets all their physical and psychological needs. The existing challenges for health professionals, practising a vast generalist scope of practice while living and working in a rural and remote location, have been well researched and documented. How nurses feel about the expectation that they work outside their scope of practice to provide maternity care in a rural and remote setting in Australia has not been asked until now. This study explores the perceptions and experiences of RNs who find themselves in this situation. Methods: The study utilised a hermeneutic phenomenological methodology to examine the experiences and perceptions of rural and remote nurses providing care for pregnant women. RNs working in rural and remote health facilities that had no maternity services were recruited by a purposive sampling method. Semistructured conversational interviews were recorded and transcribed verbatim. Data analysis was guided by van Manen's analytical approach. Results: Eight nurses participated, and from the data three themes, each with several subthemes, emerged: 'being-in-the- world of the rural and remote nurse' - described how participants viewed rural and remote nursing as an entity with unchangeable aspects that could not be considered in isolation; 'scope of practice - unprepared or underprepared' described how, despite their existing and extensive nursing skills, participants felt ill- equipped theoretically, practically and mentally to care for pregnant women; 'moral distress' - participants expanded their feelings of unpreparedness to include inadequacy, fear, and appropriateness of care delivery. Discussion: The realism of rural and remote nursing practice demonstrates that at some point in their career, rural and remote nurses will care for a labouring and/or pregnant woman at high risk for complications. Participants in this study appeared open and honest in their interviews, displaying pride at their extensive nursing skills and job satisfaction. However, they were unanimous in their discussions of what being a nurse and providing maternity care in a rural and remote setting meant to themselves and to pregnant women. They suggested care was fragmented and inadequate from a workforce that is inadequately prepared and stressed. Conclusion: This study has highlighted another concerning aspect of rural and remote midwifery care - the experiences and perceptions of eight nurses delivering care that has previously been overlooked. The united voice of the RNs in this study warrants a platform to speak from and deserves acknowledgement and attention from government and midwifery policy drivers. These nurses, and the women receiving their care, deserve more.

Introduction: In remote Australian hospitals there are no onsite paediatric intensive care units (PICUs), increasing the reliance on aeromedical retrieval to access tertiary care. Nasal high flow (NHF) therapy is an oxygen therapy used in tertiary hospitals to treat paediatric patients with respiratory conditions. In rural and remote Queensland, Australia, the use of NHF therapy is inconsistent and there are no guidelines on how this therapy should be implemented in practice. Therefore, three remote hospitals within the Torres Strait and Cape York commenced a project to improve consistent and equitable access to NHF therapy. Implementing NHF therapy in remote hospitals May improve health and social outcomes for children with acute respiratory distress. A clinical guideline for the use of NHF therapy in the three participating remote hospitals was published on 28 October 2021. This study aimed to develop a clinical guideline for the use of NHF therapy in three remote hospitals. Methods: A modified Delphi technique was used to develop the guideline. Remote medicine and nursing clinicians at the three study sites, retrieval experts, a receiving tertiary-based paediatrician, PICU specialists and NHF therapy experts made up the expert panel of participants. These experts participated in an iterative round table discussion to develop remote-specific guidelines for the use of NHF therapy. Prior to the meeting, panellists were provided with an executive summary of the current literature on NHF therapy implementation with key questions for consideration. Participants were able to add relevant issues ad hoc. A final guideline representing the panellists' recommendations was submitted to the Torres and Cape Health Service for ratification. Results: Remote-specific decisions on the following topics were produced: environment of care, nasogastric tube usage, timings of chest X-ray, automatic approvals to arrange courier services for pathology, medication use, staff training; staff ratios, observations regimes, both tertiary and local medical consultation frequency and the experience level of the medical officer required to attend to these consultations, location of the on-call medical officer, documentation, escalation of care considerations and disposition of the patient in relation to retrievals. Discussion: Decisions were made to mitigate two highly representative remote factors: delays in the workplace practices, such as time to arrange treatment locally and delays in retrievals; and burden of the lack of access to services, such as lack of access to trained staff, staffing levels on-shift, adequate oxygen and equipment/consumable supplies. Conclusion: The aim was to develop a clinical guideline that was contextualised to the remote hospital. This outcome was achieved by using a modified Delphi technique, with a panel of experts providing the decision-making for the guideline. Consistency and safety were addressed by reducing delays in workplace practices; examples were time to arrange treatment locally and mitigate delays in an unknown time to retrievals, access to trained staff, staffing levels, and communication between remote and tertiary teams.

Context: In 2012, the new profession of Aboriginal and Torres Strait Islander health practitioner (ATSIHP) was registered under the Health Practitioner Regulation National Law Act 2009. The project in this present study evolved out of the Australian Government's recognition of the need for the existing Indigenous health worker (IHW) workforce to meet the minimum qualification requirements for registration as ATSIHPs through recognition of prior learning and/or further education. A total of 53 IHWs participated in the upskilling project between June 2014 and June 2015, with approximately 200 IHWs from Queensland expressing an interest in undertaking the training. This demonstrated a clear need for further training programs such as this one. The project was coordinated by the Indigenous Health Unit at James Cook University (JCU) with training being delivered by TAFE Cairns in collaboration with the College of Medicine and Dentistry, JCU. Students travelled from as far north as the Torres Strait and as far west as Mount Isa. Issues: The key issues for discussion were associated with the ATSIHP role being relatively new including the limited preparedness of training providers to deliver the upgraded qualification requirements and uncertainty about the registration process. Compounding this was a general undervaluing and underutilisation of the IHW role within the current primary healthcare system. Other challenges included the variations of IHW roles, scope of practice and educational standards held by individuals, as well as the associated complexities of providing training to IHWs from the large and diverse geographic area that is rural and remote Australia. Program and student evaluation was undertaken with each of the three cohorts via a course experience questionnaire, TAFE evaluation forms and opportunistic student feedback. Lessons learned: Lessons learned as a result of this project include the need to continue to recognise and promote understanding of the contribution that IHW/ATSIHPs make in improving health, the importance of conducting a comprehensive student selection process, the benefits of working collaboratively between the university and vocational education training sectors, the need to continue to strengthen partnerships between higher education and health industry, the need for flexible funding and training models that enable adequate learning support, and the identification of a significant unmet training need.\"

The use of contraceptives for family planning improves women's lives and may prevent maternal deaths. However, many women in low and middle-income countries, including the Pacific region, still die from pregnancy-related complications. While most health centres offer family planning services with some basic contraceptive methods, many people do not access these services. More than 60% of women who would like to avoid or delay their pregnancies are unable to do so. This scoping review identifies and analyses evidence about family planning service provision in Pacific Island Countries and Territories (PICTs), with the aim of better informing family planning services for improved maternal health outcomes in the Pacific. We used Arksey and O'Malley's scoping review guidelines, supported by Levac, Colquhoun and O'Brien to identify gaps in family planning service provision. Selected studies included peer-reviewed publications and grey literature that provided information about family planning services from 1994 to 2019. Publication data was charted in MS Excel. Data were thematically analysed and key issues and themes identified. A total of 45 papers (15 peer-reviewed and 30 grey literature publications) were critically reviewed. Five themes were identified: i) family planning services in the Pacific; ii) education, knowledge and attitudes; iii) geographical isolation and access; iv) socio-cultural beliefs, practices and influences; and v) potential enabling factors for improved family planning, such as appropriate family planning awareness by health care providers and services tailored to meet individual needs. While culture and religion were considered as the main barriers to accessing family planning services, evidence showed health services were also responsible for limiting access. Family planning services do not reach everyone. Making relevant and sustainable improvements in service delivery requires generation of local evidence. Further research is needed to understand availability, accessibility and acceptability of current family planning services for different age groups, genders, social and marital status to better inform family planning services in the Pacific.

To explore challenges and stressors experienced by rural and remote area nurses and identify any interventions that aided in decreasing stress and increasing job satisfaction. Demand for a generalist nursing workforce in rural and remote locations exposes nurses to the same conditions as people residing there: higher mortality rates and higher incidence of chronic diseases and inadequacies in accessing health services. Christmals and Gross’s integrative review framework was used with specified inclusion and exclusion criteria. Four databases were searched with no date limits. Only Australian studies were searched as international scope of practice differences for nurses could have distorted findings. Eighteen studies identified three broad themes: access to education; isolation (geographical, professional and personal) and recognition of role. Interlinked themes showed positives and negatives from differing viewpoints. Ambivalence to education stemmed from inadequate exposure to learning and was linked with geographical isolation. Isolation was found to be less of a challenge to nurses who had an existing emotional connection with the community. The themes identified were recurrent and interconnecting. The benefits of working in small rural and remote communities are being used as a driver for recruitment. These benefits include higher wages, providing a sense of belonging and allowing nurses to work to their full scope and develop generalist nursing skills. The geographical isolation generates challenges through inequality in access to education and professional support, working outside their scope of practice, safety and vulnerability that comes with living remotely and adapting to extreme weather conditions. What are the challenges and enablers of rural and remote working and living that influence job satisfaction for rural and remote area nurses in Australia?

PurposeThe purpose of this paper is to discuss the practical use of theoretical sampling as a method for selecting data that provide a richer and deeper understanding of the phenomenon being investigated.Design/methodology/approachTheoretical sampling is a well-known method in grounded theory studies to seek additional data based on concepts developed from initial data analysis. This method involves following where the data have led to expand and refine the evolving theory during the analytical process. However, there is a dearth of information detailing the practical steps needed to undertake theoretical sampling.FindingsThe authors used the theoretical sampling method in their study in four ways: asking additional interview questions and/or widening the scope of existing interview questions; recruiting participants with additional diversity of attributes within the same group; and adding a new group of participants and expanding research settings.Originality/valueTheoretical sampling is a valuable and practical method for the purpose of addressing gaps in the data in qualitative research. When using theoretical sampling, it is essential to consider potential strategies for countering challenges that may arise. Practical recommendations are offered on the use of theoretical sampling during data analysis, for the purpose of achieving theoretical integration.

A storyline in a grounded theory study plays two important roles: an analytical tool and a research product. Using more than one language in a study affects the research, including the dissemination of its findings. Very little literature discusses how to develop and disseminate a storyline. This paper offers insight into the crafting of a storyline to disseminate a grounded theory study describing how people in Indonesia with diabetes learn about their disease. This paper explains how the researchers developed the storyline. The authors then address considerations in the storyline's development and explain how they disseminated it, as well as the factors that influenced that dissemination. Disseminating findings through a storyline written in the local language ensures that the target audience all have access to a study's outcomes through an easily readable publication. Sharing a storyline helps to disseminate the outcomes of a grounded theory study. It informs the wider community of new knowledge and enables it to review, understand and apply the outcomes of research.