Nursing Resources Australia is an independent nursing education and consultancy service. It was established on the premise that it is logical and cheaper to take continuing education to where nurses live and work, rather than expect them to travel to Perth at considerable cost and time.
With all the high tech education resources now available and regular new developments, I believe that the most complex and so far unbeaten teaching resource we have is the human teacher! While various technological advances are making distance education strategies varied and interesting, people in remote areas still need real human contact. They need someone who will share their working context with them, even if only briefly.
Let us go out there now in our imaginations and share some of those places and the people who work in them ...
In Derby ... it is 10.00 am, 6th June. It is 27 degrees, clear and sunny ... a slight breeze, bird song, bouganvillea and expressive builders over the road working on hospital extensions. The Kimberley region is unique, picturesque, isolated and still frequently hazardous for the unwary, especially during the "wet". The welcome is warm and hospitable and includes being collected at airports and having accommodation laid on. The real buzz in teaching up here is dropping into the smaller centres.
With a 4-seater Cessna 172 hired for a week, I usually do the circuit, Derby to Fitzroy Crossing, Halls Creek, Wyndham, Kununurra and back to Derby, with a side trip to Broome. The equivalent in road distances is 2200 km, so flying is the way to go!
The first case study involves a visit to Halls Creek two years ago. Starting out early in the morning from Fitzroy in beautiful flying conditions, and with lecture notes, handouts and a small overhead projector, it was up to 5000 feet and 90 minutes cruising to Halls Creek. On the ground by 8.30 am, the hospital orderly was waiting with transport into the hospital. This small town, with a gold mining history has a hospital with six beds and about 10-12 staff during the "dry" season. Most of the staff are transient, experiencing the "top-end" during the southern winter. In some years, the hospital can experience a 350% staff turnover, so seminar and workshop content is planned at the last minute.
We have to run an afternoon session here because with an average of 120 outpatient attendances per day, the mornings are too busy for staff to be released. Things are quieter after lunch, and the off duty staff turn up by about 1 pm. The venue was the staff tea room, about 7 m by 5 m in size. A child's cot sheet pinned to a curtain rail made a good projector screen and we started with the on duty staff eating lunch. The doctor usually drops in to listen, and a staff member brought her 10 month old baby daughter. There are no child care facilities, so it was her only option. The baby's interjections were sometimes disturbingly apt, particularly the raspberry during a description of needed improvements in documentation.
On another visit we shared the session with a sick white cockatoo. It was having fluids through an eye dropper every half hour and was recovering nicely. Its carer thoughtfully provided a blue incontinence pad for the bird to sit on, which was just as well ...
With occasional interruptions when someone slipped out to respond to the casualty bell, the session proceeded in a fairly informal way. Observation of a casualty with head injuries, initial management of a hypothetical elderly tourist with a heart attack and new techniques for healing ulcers. Side issues arose and were discussed, anecdotes shared and analysed.
After the session there was time for a cup of tea with the Director of Nursing. This is the professional networking aspect of such visits, and is an essential part of the tour because senior management staff are particularly isolated up here. The sharing of information sometimes goes on into the evening, called to a halt by a 9 pm curfew. A reasonably early night is essential, with take off for Wyndham at first light the next morning.
Conducting education sessions in the context of the client means applying the three Rs: relevance, responsiveness and realistic expectations. Tightly structured teaching plans don't work and distractions are frequent and sometimes hilarious. Like the time in Wyndham when a water storage tank in the ceiling over the empty ward we were using ruptured. Hundreds of litres of rusty red water cascaded down the walls and began flooding out into the corridor. The class rapidly became a bucket and mop brigade which presented excellent opportunities for demonstrating correct lifting and work posture techniques.
For the second case study, we'll go south. The central region of WA is quite different. Towns are closer and the terrain is less rugged. Kellerberrin is a small town on Great Eastern Highway about 2.5 hours drive from Perth. Here we offer a full study day, usually starting at 9 am and finishing by 4 pm.
The day is planned well in advance and advertised with an eye catching poster distributed to other hospitals in the region. Nursing staff arrive in from surrounding towns, some from as far away as Wyalkatchem and Narrogin. The usual attendance is 40 - 45 nurses from all over the region. There's a big sports centre in Kellerberrin which has a large function room available for various community activities. The stackable chairs are metal, and fairly hard, so regular "pressure-care" breaks are essential, 40 - 45 minutes of sitting is long enough even for well-padded bottoms!
In some respects the content of the study day is secondary to the networking that goes on between the nurses during the breaks. Again, anecdotes are shared and analysed, gratuitous advice is given on how to cope with problems, and community social events are discussed.
The usual expectation of the teacher is to give information. Updates on nursing practice, new ideas and gadgets and as much realistic illustration as possible. Even though reasonably close to Perth, there is relative isolation here. In emergencies, a patient needs to be cared for with available resources for several hours if Royal Flying Doctor Service evacuation is used. Road transport of patients is an alternative, but three hours in a moving ambulance (with essentially first aid equipment and one nurse as escort) is not really an option for very ill or seriously injured patients.
Kellerberrin is on the main highway, so the residents have their share of motor vehicle accident trauma. The staff in these hospitals also have to deal with the high incidence of asthma in children and a whole range of agricultural hazards, so these subjects make up the usual content of study days. They aren't really interested in advanced medical technology. It is more useful for them to learn how to manage emergencies with the facilities they have available. There is also an increasing population of frail aged people who are looked after in permanent care units in the District Hospitals, so the staff are interested in frail aged care topics too.
For the third case study we'll go further south and the Great Southern region is different again. Towns are further apart, isolation is a greater problem and farm management cycles dictate the pattern of life of the people. Study days are not usually planned during harvesting!
Ravensthorpe is a small town between Albany and Esperance. It is six hours drive from Perth but only two hours in a light aircraft. However, this part of the region is subject to morning fogs and unpredictable weather, which makes visual flight rules flying an unreliable means of keeping appointments.
The hospital at Ravensthorpe has 11 beds and the venue for the study day is usually the patients' lounge. Comfortably padded cane chairs and a good sized space make it a nice classroom. We don't start until 9.30 am, to give people time to drive in from Lake Grace, Munglinup and even Gnowangerup and Esperance, and we finish by 3.30 pm so they can get home in daylight.
The hospital is surrounded by trees which shelter a big population of frequently noisy birds. Bickering crows are a different sort of distraction! Again the networking amongst the attending nurses is valued, and it takes determination to get the group back to work after coffee breaks.
The nursing staff of the hospitals and nursing posts in this region are relatively permanent. Most work part time and have family commitments which limit their access to continuing education outside the region. As with many small country hospitals, staff experience routine, often quiet working days most of the time and fear loss of skills. Then there are the occasional emergencies, short periods of acute overload which test clinical decision making to the limit. The doctor in Ravensthorpe also covers Hopetoun so if he is away, the nursing staff manage the emergency.
The three case studies outlined illustrate a common theme, that face to face continuing education offers opportunities to present relevant information which can be discussed, clarified or argued in the context of the learner.
Portable education offers continuing challenges, ensuring teaching aids are graphic, light-weight and reasonably small, keeping content up to date and retaining a sense of humour when the unexpected intrudes. Nevertheless it is fun, certainly never dull, and always rewarding to see the commitment of nurses to maintaining the best possible health care services in isolated communities in WA.
|Author: Beverley M Scott, RN, MAppSc(WAIT), FRCNA was a nurse educator at WAIT among other things, before she launched into the world of private education and started Nursing Resources Australia.
Please cite as: Scott, B. (1990). Portable education: Taking continuing nursing education to the bush. In R. Atkinson and C. McBeath (Eds.), Open Learning and New Technology: Conference proceedings, 290-293. Perth: Australian Society for Educational Technology WA Chapter. http://www.aset.org.au/confs/olnt90/scott.html