Bush medicine

The work of bush nurses in isolated areas goes largely unnoticed, but Monash research is aiming to improve funding, training, conditions and support for rural nurses so they can continue their vital work. ALLISON HARDING reports

A small child is badly scalded in a bath.

Her distraught mother rings the bush nurse – the only health professional for hundreds of kilometres.

It is a Sunday, and the nurse, who is on call, swings into action. She calls the ambulance service and the local doctor – both more than three hours away – to advise of the emergency.

When she arrives at the farmhouse, in remote bushland in far north-eastern Victoria, the child is screaming in pain and in shock.

The nurse administers pain relief to the child and begins assessing the injuries. She calls for an air ambulance, then describes the life-and-death situation to the doctor over the phone, who advises the best immediate treatment.

Welcome to the world of Australia’s bush nurses – a small but dedicated band of health professionals serving the needs of tiny, remote communities around the country.

For the past two years, Monash University’s Faculty of Medicine, Nursing and Health Sciences, through its School of Rural Health at the Gippsland campus, has been involved in a project to investigate the vital role of bush nurses.

The first academic rural health unit of its kind in Australia, the school was established in 1992 through a collaboration between Monash University and Latrobe Regional Hospital in eastern Victoria. Since then, the school has raised the profile of rural health practice, developed training and education for health professionals and organisations, conducted research into rural health issues and established strong rural health networks.

The Victorian Rural Nurse Project, which aims to address the needs of isolated communities, began in 1999 with a survey to identify the distribution and characteristics of nurses in rural communities throughout the state. In its initial stages, the study set out to investigate recruitment and retention issues – and discovered many nurses were leaving the country workforce.

In its second phase this year, the project researchers have looked at the lifestyles and work-related issues of nurses in remote areas. The study is also exploring the advanced practice role of the bush nurses, as well as looking at health outcomes and satisfaction with the service.

Funded by the Department of Human Services Victoria, the project in the long term aims to improve funding, training, conditions and support for rural nurses.

Project officer Mrs Mollie Burley says the current study is already producing results, with certain recommendations having been implemented. For instance, teleconferencing facilities have been introduced to reduce nurses’ professional and clinical isolation. The project has also resulted in funding now being available for nurses to attend professional development courses.

“Clearly, we need to be serious about the clinical, financial and personal support for these isolated practitioners in order to maintain the excellent standard that bush nurses currently provide to their communities and that their communities totally rely upon,” Mrs Burley says.

“If you look at the type of work they do, their role is vital for the survival of these communities. If the bush nurses move out, the communities will have absolutely nothing in health care.”

So far the research has focused on six bush nursing centres – Buchan, Cann River, Dargo, Gelantipy, Swifts Creek and Dingee. Five of these are in the state’s far east and one is in the northwest, and all have fewer than 1000 residents.

Both patients and other health providers – such as doctors, physiotherapists and pharmacists in nearby regional centres –were surveyed to assess the service and common health outcomes.

The survey revealed that the nurses generally work eight-hour days but were on call 24 hours a day. They also service a massive area, including visits to extremely isolated families as part of their work practices, and care for an ageing population.

Residents in the survey said they also relied heavily on medical guidance, advice and service from nurses, because they did not have easy access to doctors, pharmacists or hospitals.

In any one week, a bush nurse might be called to advise a new mother on caring for her baby, check on an elderly resident discharged from hospital after major surgery, attend to a road trauma victim, and keep an eye on a hypertensive patient.

Not surprisingly, the research has shown that relief staff are essential, not just to give nurses a break but also to enable them to pursue further training and education, benefiting both themselves and their communities.

“To upgrade their qualifications, nurses usually have to leave their communities – but who takes over? We’re recommending there be a pool of relief staff who can fill the void,” Ms Burley says.

The surveys revealed that the health providers, including general practitioners, specialists, ambulance officers, physiotherapists and pharmacists, were all impressed with the professionalism of the nurses, most of whom have significant hospital experience.

And while many of the patients in the survey described the nurses as “thorough, knowledgeable, caring and friendly”, they were concerned about reduced services and having to call nurses after hours.

“We feel guilty asking for service after hours because the nurses do this out of the goodness of their hearts,” one patient said.

Monash University’s School of Rural Health will host the fifth World Association of Family Doctors World Conference on Rural Health in Melbourne in 2002.

ACTION: For information about other projects of the School of Rural Health, visit www.med.monash.edu.au/crh/

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