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Journal of Rural Studies
, Pages 467-473
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To gain a deeper understanding of rural health social workers' professional judgement and decision-making in the complex rural and regional environments within which they work. Methods: In-depth semi-structured interviews were undertaken with South Australian rural health social work leadership team members (n=10), with focus groups (n=14) before and after the interviews. Findings: Rural health social workers drew on both spatial and temporal understandings of their professional judgements and decision-making when explaining their rural health social work practice. Concepts of rural time, rural social space and acts of resistance were identified within the rich descriptions of professional judgement and decision-making in practice provided by the rural health social workers. ‘Rural time’ refers to the additional work that is done by rural health social workers across both their rural personal and professional social spaces. Conclusions: Institutional, systemic and spatial factors, constituted as they are of power dynamics, have implications for the skills needed to maintain a social justice practice. Clear-sighted analysis of these complexities, in the context of social power, can support this ongoing and longer-term project.
Rural health social workers (RHSW) occupy a professional space framed by the dynamic situations for the people with whom they work, limited resources, multiple and often competing institutional demands on their time, and, values dissonance (Cleak and Turczynski, 2014; Harvey and Jones, 2021; Saltman et al., 2004; Waltman, 2011). Belonging-in-place (Malatzky et al., 2020) and embeddedness in rural places and cultures can be productive but also generate practice tensions and dilemmas. Saltman et al. (2004, p.526-528) in their US/Australian comparative study of rural social work, report that Australian respondents' comment on the stresses of ‘ … being constantly visible’ within the rural community. Waltman (2009) in a review of papers published about rural social work, highlights dual relationships, boundaries and confidentiality as common themes. She writes: ‘[M]aintaining confidentiality, observing appropriate professional boundaries, and dealing with multiple overlapping relationships are issues that are intensified in rural areas’ (2009, p.237).
The nature of health social work practice in rural settings has elevated the need for integrative thinking, adaptability, flexibility, and the creative use of resources (Dellemain et al., 2017; Green et al., 2009; Harvey and Jones, 2021; Mason, 2011; Saltman et al., 2004). Mason (2011) contends that much of the ingenuity and creativity unique to rural practice is made possible through social workers being embedded in the life and identity of the communities they live and work in, simultaneously inhabiting professional spaces, organisational spaces and social spaces. Each rural hospital setting has its own organisational culture (Farmer, Bourke, et al., 2012). Australian rural social work researchers (Dellemain et al., 2017, p. 55) found that rural case managers' ability to make decisions, and to think outside of the box in terms of solutions for clients, was ‘ … highly dependent on collective and cooperative relationships with other rural professionals, particularly those prepared to work flexibly with eligibility criteria’. Australian rural researchers note the issues with attracting health workers to take up posts in rural areas (Brown and Green, 2009; Malatzky et al., 2020; Roberts et al., 2020).
Moreover, by virtue of geography and distance, the dynamics of time and space considerations are paramount. For the RHSW, distances to capital cities are considerable and distances between communities, that are geographically dispersed, have implications for the everyday ordering and use of time, and social connections (Phillips, 2009). Australian rural social work researcher Dellemain et al. (2017) highlighted the travel time that rural case managers were undertaking and explored the construct of travel time. Understandings and experiences of time are culturally located and have multiple meanings. In his study of busyness, US psychologist Robert Levine explored the cultural manifestations of time and the links between time, money and power, and found that time is connected to social status, however this was not consistent cross-culturally (Levine, 2005).
In this paper, we explore concepts of time within the context of the rural health social worker in South Australia and draw on the understanding of social space as defined by the French sociologist Pierre Bourdieu. For Bourdieu social space refers to how people are related to each other with respect to their occupation and their social positioning (Bourdieu, 1991). Social space is examined in the context of the rural health social worker and their professional judgement and decision-making. Bourdieu connects social practices, modes of sociality and physical space and states: ‘Space as we inhabit it, and as we know it, is socially constructed and marked’ (Bourdieu, 1991, p. 108). The concepts of both time and social space intersect in the rural and are imbued with power.
This research was initiated by the rural social work leadership group to seek greater understanding of their experiences in enacting the social work role in a rural health setting. This study provides an exploration of the dimensions of time, social space and power within the social workers particular rural context. This is a small-scale qualitative study which allows for in-depth exploration. The findings may be generalisable to other rural health practitioner contexts.
Methodology and method
There were three stages in the study as part of a Living Lab research design (Dutilleul et al., 2010). A Living Lab approach involves participants in the design of the research and was selected as part of a participatory approach (Donetto et al., 2015; Gibbs et al., 2008). The Social Work Leadership group participated in the design of the research. Their expertise was valued and provided them with capacity building in research processes. This approach fits within a critical interpretive
The results are reported in two parts; the demographics of the sample followed by the three themes identified from analysis of the interviews and focus groups.
The concepts of ‘rural time’ and ‘rural social space’ have been identified in this study to describe the work of the RHSW that occurs solely because of rurality. For example, focusing on the patient's access to services, rather than on their presenting social issue. Across epistemic fields time is conceptualised with various meanings (Evans, 2005) and structure; e.g. chronological time, historical time, synchronous time, time as a passage, time as a commodity, social time. In this study time is
Building on previous research examining rural social work practice, this paper explores the concept of ‘rural time’ and ‘rural social space’, a recognition of the way time is spent by RHSWs because of being rural across both their professional and personal social spaces. These findings have implications for metrocentric health policies, where there is a need to acknowledge notions of rural time.
RHSWs have engaged in ‘creative’ social work practice (Dellemain et al., 2017) or as Bourdieu and
Please indicate the specific contributions made by each author (list the authors’ initials followed by their surnames, e.g., Y.L. Cheung). The name of each author must appear at least once in each of the three categories below.
Conception and design of study: M Jones, acquisition of data: M Jones, E Harvey, analysis and/or interpretation of data; M JonesE Harvey, F Verity.
Drafting the manuscript: M Jones, revising the manuscript critically for important intellectual content: F Verity,E Harvey,
All persons who have made substantial contributions to the work reported in the manuscript (e.g., technical help, writing and editing assistance, general support), but who do not meet the criteria for authorship, are named in the Acknowledgements and have given us their written permission to be named. If we have not included an Acknowledgements, then that indicates that we have not received substantial contributions from non-authors.
- S. DuckettHospital payment arrangements to encourage efficency: the case of Victoria, Australia
- J. Dellemain et al.Time, terrain and trust: impacts of rurality on case management in rural Australia
J. Rural Stud.
- Australian Bureau of Statisics
The Australian Statistical Geography Standard (ASGS) Remoteness Structure
- P. Bourdieu
Social space, symbolic space and appropriate physical space. Presentation at the Russel Sage/Maison des Sciences de l’Honne, Maison Suger, Paris, 10-11 May 1991 in Wacquant, L (Trans). 2018. Social space and the genesis of appropriated physical space [Social space, symbolic power and appropriated physical space]
Int. J. Urban Reg. Res.
- P. Bourdieu
Acts of resistance: against the new myths of our time
- V. Braun et al.
Using thematic analysis in psychology
Qual. Res. Psychol.
- V. Braun et al.
Reflecting on reflexive thematic analysis
Qual. Res. Sport, Exercise Health
- G. Brown et al.
Ensuring the future of rural social work in Australia
- B. Cheers
Social Care Practice in Rural Communities
- H.M. Cleak et al.
Hospital social work in Australia: emerging trends or more of the same?
Soc. Work. Health Care
2018-2019 Annual Report
Experience-based co-design and healthcare improvement: realizing participatory design in the public sector
Unpacking European Living Labs: analysing innovation's social dimensions
Cent. Eur. J. Publ. Pol.
The meaning of time: polysemy, the lexicon and conceptual structure
Culture and rural health
Aust. J. Rural Health
Theory in rural health
Aust. J. Rural Health
Distanciation and the recontextualization of space: finding one's way in a small western community
J. Am. Folklore
Area of Australia - States and Territories
Are the potential benefits of a community-based participatory approach to public health research worth the potential costs?
Time and Space in social theory. Lebenswelt und soziale Probleme: Verhandlungen des 20: Deutschen Soziologentages zu Bremen
Research articleOn the pressure decline analysis for hydraulic fractures in elasto-plastic materials
Geomechanics for Energy and the Environment, 2022, Article 100421
In this paper the problem of a plane strain hydraulic fracture in elasto-plastic material is analyzed. The analysis is based on Finite Element Method computations of crack propagation and closure to simulate the Mini-Frac calibration test. The basic trends of fracture evolution are identified for both, the propagation and the closure stage in elasto-plastic materials and compared with the results obtained for purely elastic deformation of rock. Pressure decline analysis is conducted to identify the closure stress and leak-off coefficient. The results show that the standard techniques of pressure decline analysis can be adopted also for the case where the fractured material deforms inelastically.
Research articleThe utility of conceptualisations of place and belonging in workforce retention: A proposal for future rural health research
Health & Place, Volume 62, 2020, Article 102279
This paper explores the utility of sense of place, place attachment and belonging-in-place for research into rural health workforce retention. One of the key contributors to health disparities between rural and metropolitan-based residents is inadequate staffing of rural health services, and many rural places around the world struggle to retain health professionals. Despite some recognition of the complex array of factors and circumstances impacting rural workforce retention, research focuses primarily on organisational and role-based causes. Health geography and concepts associated with place currently being used in some rural research may offer much to workforce retention research, especially when applied alongside person-centred approaches.
Research articleRegionalisation and general practitioner and nurse workforce development in regional northern Australia: Insights from 30 years of census migration data
Journal of Rural Studies, Volume 91, 2022, pp. 98-107(Video) How to provide holistic healthcare at home, give back, AND get reimbursed by the schemes
The purpose of this research is to investigate the extent to which Australia's northern cities have become increasingly important mediators of migration of nurses and general practitioners (GPs) to the regional north since the 1980s. Over that period, national and provincial policy has focused on ‘regionalisation’ of health workforce development, including creating education and training infrastructure outside of metropolitan areas. This paper hypothesises that the effectiveness of regionalisation in northern Australia should be reflected in an increased net flow of GPs and nurses from northern cities (which are the hubs of education and training) to the regional north. Data from the seven Australian Census between 1986 and 2016 are used to model changing patterns of migration. Overall, there was limited evidence of substantial change in migration patterns, although for GPs there was a reduction in migration from the key metropolitan source markets (Brisbane and Adelaide) matching an increase in supply from northern cities. Northern cities have consistently been the source of about one quarter of new nurse and GP migrants to the regional north, but the regional north has become a much less favoured destination for professionals leaving northern cities as cities' populations have grown much faster than regional populations. Net flows have remained small and for nurses have favoured the cities while for GPs favoured the regional north. The paper concludes that, while there is limited evidence of increased ‘spillover’ of labour from the cities to the regional north, there is also no evidence of the cities increasingly ‘spongeing’ regional labour. Cities and regional migration systems may be increasingly disconnected as labour demands diverge, but new connections are being created with the rest of non-metropolitan Australia. The research is the first to analyse health professional migration over such a long period, and contributes to the debates about the roles of cities in sparsely populated areas in the development of their rural and remote hinterlands.
Research articleImpact of the tangential traction for radial hydraulic fracture
European Journal of Mechanics - A/Solids, 2022, Article 104896
The radial (penny-shaped) model of hydraulic fracture is considered. The tangential traction on the fracture walls is incorporated, including an updated evaluation of the energy release rate (fracture criterion), system asymptotics and the need to account for stagnant zone formation near the injection point. The impact of incorporating the shear stress on the construction of solvers, and the effectiveness of approximating system parameters using the first term of the crack tip asymptotics, is discussed. A full quantitative investigation of the impact of tangential traction on solution is undertaken, utilising an extremely effective adaptive time-space solver.
Research articleProceedings of the signature series event of the international society for cellular therapy: “Advancements in cellular therapies and regenerative medicine in digestive diseases,” London, United Kingdom, May 3, 2017
Cytotherapy, Volume 20, Issue 3, 2018, pp. 461-476
A summary of the First Signature Series Event, “Advancements in Cellular Therapies and Regenerative Medicine for Digestive Diseases,” held on May 3, 2017, in London, United Kingdom, is presented. Twelve speakers from three continents covered major topics in the areas of cellular therapy and regenerative medicine applied to liver and gastrointestinal medicine as well as to diabetes mellitus. Highlights from their presentations, together with an overview of the global impact of digestive diseases and a proposal for a shared online collection and data-monitoring platform tool, are included in this proceedings. Although growing evidence demonstrate the feasibility and safety of exploiting cell-based technologies for the treatment of digestive diseases, regulatory and methodological obstacles will need to be overcome before the successful implementation in the clinic of these novel attractive therapeutic strategies.
Research articleOverview of stab injuries in Far North Queensland: A new insight into the demographics, injury patterns and management
Cairns Hospital is the northernmost tertiary referral hospital in Far North Queensland (FNQ) and manages trauma from a large catchment area. A large burden of stab injuries occurs in at-risk patient groups, such as Indigenous and mental health patients, in this region. This research aims to present an overview of the demographics, injury patterns, management and outcomes for stabbings injuries in FNQ.
A five-year retrospective single-centre study of all patients treated for neck, torso or junctional stab wounds in Far North Queensland was performed searching for all patients with a coded diagnosis of stabbing or knife injury from 1 March 2016 to 31 March 2021.
214 knife injuries were identified and 50.5% of those injured identified as Aboriginal and/or Torres Strait Islander. Stabbing injury locations were most commonly the abdomen/flank/pelvis (n=81) and the chest/thorax (n=77). Two-thirds of injuries that breached abdominal fascia had concurrent intra-abdominal injury. Hollow viscus injury commonly involved the small bowel (n=8), colon (n=5) and stomach (n=2), whilst the liver was the most frequently injured solid organ (n=6). There were 19 vascular injuries, excluding the extremities. 89.2% received diagnostic imaging in the emergency department. FAST scan had 76% sensitivity and 100% specificity for intra-abdominal injury at operation. Overall, 35% of patients required an operation. There were only two in-hospital deaths.
Stab injuries annually in FNQ are comparable to other centres in Australia. Overall injury severity was low, with excellent survival rates and outcomes for patients who reached hospital. Operative intervention rates for abdominal stab wounds were low in FNQ compared to available data and imaging again appears protective against negative laparotomy rate.
This project was funded by the Flinders University College of Education, Psychology and Social Work College Grants fund. The views expressed in this publication are the authors' own and do not necessarily reflect the views of the South Australian Government.
© 2022 Published by Elsevier Ltd.
Access to health care continues to be the most frequently identified rural health priority. Within this priority, emergency services, primary care, and insurance generate the most concern. A total of 926 respondents identified access as the no.What are 3 barriers to health care for rural areas? ›
- Higher poverty rates, which can make it difficult for participants to pay for services or programs.
- Cultural and social norms surrounding health behaviors.
- Low health literacy levels and incomplete perceptions of health.
- Primary healthcare or a generalist approach. In rural areas, the health professionals need to provide a range of care, for a range of conditions to people across the life cycle. ...
- Social accountability mandate of medical and nursing schools. ...
- Availability of rural training sites.
Rural Health Care Faces Numerous Challenges
Additionally, rural populations often have older patient populations, higher rates of substance use and mental health conditions, and a greater burden of chronic disease. In addition to worsening health outcomes, rural health infrastructure has been steadily depleted.
A shortage of healthcare professionals in rural areas of the U.S. can restrict access to healthcare by limiting the supply of available services. As of September 2022, 65.6% of Primary Care Health Professional Shortage Areas (HPSAs) were located in rural areas.What is the stronger rural health strategy? ›
The Stronger Rural Health Strategy (SRHS) aims to build a sustainable, high-quality health workforce that is distributed across the country according to community need. It focuses on rural and remote communities and other areas that have difficulty attracting doctors, nurses and other allied health professionals.What are 3 things that can be done in the healthcare system to reduce the impact of implicit biases on health disparities? ›
- Having a basic understanding of the cultures from which your patients come.
- Avoiding stereotyping your patients; individuate them.
- Understanding and respecting the magnitude of unconscious bias.
Rural communities in South Africa, similar to other countries worldwide, have less access to health care. Facilities are limited, the information insufficient and there are fewer health professionals to attend to the population, which results in them having a poorer health status.What types of healthcare services are frequently difficult to access in rural areas? ›
Services like detoxification centres are often hours away from rural communities. There are few counselling and rehabilitation services available in rural communities. Many small rural hospitals have been closed.What are two strategies to improve health and reduce disparities? ›
Improving access to high-quality education likely improves health. Early childhood interventions, such as early childhood education and parental support programs, have positive health impacts and help address economic disadvantage and health disparities.
- Reduce Medical Errors and Improve Patient Safety. ...
- Offer Telehealth and Other Technologies. ...
- Manage Chronic Diseases. ...
- Ensure Continuity of Care and Discharge Procedures. ...
- Communicate with Patients and Educate Them About Their Health. ...
- Analyze Data.
The major problems that have been identified by literature review in many rural areas are poverty, illiteracy, unemployment, homelessness, crime, social evils, lower living standards, lack of facilities, services, and health.What is the biggest challenge for rural areas? ›
- A disproportionate burden of chronic disease relative to the general public.
- Restricted access to quality health care.
- Insufficient or lack of health insurance coverage.
- Geographic isolation.
- Lack of public transportation.
- Poor infrastructure.
- Low educational attainment.
- Limited Access to Mental Health Support. ...
- Difficulty Finding Physician Care. ...
- Higher Levels of Poverty. ...
- Greater Risk of Overdose. ...
- Telehealth Adaption Disparities. ...
- Reaching Children across Great Distances.
- The High Cost of Health Care. The problem: Perhaps the most pressing issue in health care currently is the high cost of care. ...
- The Concerns of Health Equity. ...
- The Promise (and Pitfalls) of Technology. ...
- The Move Toward Value-Based Care. ...
- The Growing Provider Shortage.
People in rural areas generally have less access to healthcare than their urban counterparts. Fewer medical practitioners, mental health programs, and healthcare facilities in these areas often mean less preventative care and longer response times in emergencies.What causes lack of access to healthcare in rural areas? ›
The technical and social infrastructure in rural areas is much poor, and as a result, the access to doctors, particularly specialists, hospital service, preventative care and emergency services, is limited [16,17].Why is rural health important Australia? ›
People in regional, rural and remote areas generally face challenges accessing health care. Compared with those in metropolitan areas, people living in rural areas have: shorter lives. higher levels of disease and injury.What are some methods of improving efficiency in the Australian healthcare system? ›
- Improve health technology assessment processes and reviews. ...
- Promote evidence-based clinical practice. ...
- Improve financial incentives for better quality patient care. ...
- Encourage cost-effective investment in preventive health. ...
- Increase health workforce flexibility.
Improvements could include interventions that effectively enhance mobility of rural dwellers from rural roads to intermediate means of transport (IMT) as well as interventions that bring the facilities, goods and services closer to the people such as schools, health centers, markets and improved water supplies.
What is the most important thing that healthcare workers can do to help reduce the spread of infection? ›
Proper hand washing is the most effective way to prevent the spread of infections in hospitals. If you are a patient, don't be afraid to remind friends, family and health care providers to wash their hands before getting close to you.What are the strategies to overcome challenges in health and social care? ›
- Take early planning steps. Leaders who are contemplating such a change can take some early planning steps to ensure successful deployment of the strategy. ...
- Look at the big picture. ...
- Get the right people on board. ...
- Outsource needed expertise. ...
- Work on a small scale, focused on small wins. ...
- Be real.
Preventing healthcare associated infections
correct and frequent hand hygiene measures by all staff and patients. keeping the healthcare environment and equipment clean.
Interventions to increase access to health care services — like lowering costs, improving insurance coverage, and increasing use of telehealth — can help more people get the care they need.How can rural areas be improved? ›
The primary area to improve should be providing employment in rural areas and improving the productivity of the agricultural sector. Often villages in our countries are not in sync with the urban areas because of bad connectivity. Eventually, this leads to segregation and a social divide between urban and rural areas.How can you improve patient access to care? ›
- #1: Create a Patient Access Task Force. ...
- #2: Assess Barriers to Patient Access. ...
- #3: Turn Access Barriers into Opportunities. ...
- #4: Implement an Improved Patient Access Plan. ...
- #5: Scale and Sustain Better Patient Access.
They include poverty and its correlates, geographic area of residence, race and ethnicity, sex, age, language spoken, and disability status. The ability to access care—including whether it is available, timely and convenient, and affordable—affects health care utilization.What are the 4 barriers to accessing health services? ›
- Insufficient insurance coverage. A lack of insurance often contributes to a lack of healthcare. ...
- Healthcare staffing shortages. ...
- Stigma and bias among the medical community. ...
- Transportation and work-related barriers. ...
- Patient language barriers.
- Right-size your staffing and improve productivity.
- Increase efficiency and access to care.
- Reduce length of stay and improve patient satisfaction.
- Reduce wait times for acute episodes.
- Nurse Scribes. Increase quality of worklife and reduce stress on nurses.