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Fail fast & Retry, Retry & Retry again… Rural health professional tenacity in a nutshell

I heard a leading rural public health professor speak last night (at the Robb College (@robbcollege) annual Health Lecture and Dinner  – University of New England @healthune) about the challenges and opportunities that exist in rural and regional health in Australia and across the world. I was spurred on… motivated… inspired… to keep pressing forward in contributing to rural health progress. Professor Ian Wronski, Deputy Vice Chancellor  – James Cook University, shared some of what he has learnt along the way while working in public health in rural Australia.

Some of what got me thinking…

  • When you get stuck without many resources… try new things!
  • Rural politics… often not enough marginal seats to attract funding and resources…
  • Sustainability in the primary care workforce is vital for the health of rural communities. Not limited to a sending-in style of health care delivery… but embedding and internally generating health workforce within rural communities.

My entire health career has been played out in rural committees… These three points struck a chord with me because they aligned with what I know of rural communities. A dollar, please, for every time I have had to innovate my practice because the oily rag needed to be squeezed a little tighter!

Trying new things is something that rural people are good at! Using our strengths! That is, the skills that are so much second nature to us that we sometimes forget that they are indeed special skills. Trying something new, and finding a way to make something work, finding the work-around solution, finding a new way using the resources we have at hand… that is innate rural culture. That is… what rural people do extremely well… but of course – there are limits!

Rural people conduct themselves resourcefully. They are not wasteful of resources because they work hard to obtain the resources that are carefully matched to the needs, ensuring they get the last drop of ‘oil out of the rag’. They make do!  Where I grew up we had one (thinking back – very small!) water tank to collect rain water for household use. Nobody wasted a drop – it was valuable, it was used wisely and recycled where possible. Never a tap was left to drip… the sentiment permeates and translates to rural life and culture in general. I think these are key characteristics of rural people and communities, and these attributes help to make up the social capital and the human ecology of rural communities. I have written a bit about that...  and have explored the contributions that nurses in particular make to the mental health care of young rural people.

There is something to be said about the dynamics of rural politics though. Political pressures underpin resources allocation for public health and especially in regard to mental health of rural people. The national and state spend on rural mental health (or mental health generally) is consistently poor. Nationally this bears out with a stable suicide rate over the past ten years  – not a reduction… but rather a complacent stability, with rural communities bearing a disproportionate burden. The reality is that many rural political seats are ‘safe’… and one of the limitations that is associated with this political condition impacts adversely on public health resource allocation. It is a bit like the water tank of my childhood never benefiting from sufficient rains to fill it up… and for us constantly monitoring the water level by tapping the sides of the tank to listen for the tympanic changes to signal volume levels.   Worrying about how much water was left and guessing how far it might need to go before the rain came again… reducing our use to reflect the remaining residue, and not having enough to do anything extra. I could still show you the corrugation groove around the one third full mark that changed the mood in our family to austere use of water and restrictions for our family – indelibly marked in my psyche! When the rain doesn’t fall in the rural mental health budget – there is never enough resource to do the prevention, mental health promotion and early intervention care because those elements of health care provision can be thought of as when the tank is only one third full – so restrictions need to heeded and the valuable resource only used for the most serious circumstances – often too little, too late. But – in marginal seats – it appears that the weather forecast is often more promising… Try someone new might be a good rural political slogan for the future… ?

Professor Wronski had Six Tips to enhance rural public health:

1. Invest in locally driven solutions because local proximity to the problem drives finding solutions. (Rural people are close to the problem so they are likely to also be close to the solution)

2. Take intellectual risks. (Think about things and then do things!)

3. Use evidence to drive decision making. (Not whims and hunches… but take the time and effort to generate and gather the evidence  – then apply it!)

4. Fail fast and use it to learn from. Then, Retry, Retry and Retry again. (Fail fast… I like that… but don’t give up especially if you are doing 3 & 4 above… learn more – try again… love it!)

5. Facilitate collaboration and co-creation. (Working together) 

6. Identify scalable solutions that will have disproportionate impacts as you scale them up. (‘From little things – big things grow’)

A lot of good advice! Some good signposts for keeping public health on track  – out back!

writing where the energy is

Originally posted on patter:

The conventional writing advice offered to people who have some trouble writing is to engage in free writing. Write, usually in timed sessions, whatever comes into your head about a particular topic. Write without stopping. Write perhaps to prompts about a particular aspect of your work. Write without stopping to think, because it is the thinking that gets you into trouble. Shut off your inner editor and just write.

There are many versions and modifications to free writing. One that I like is what is called “Writing without a parachute”. Parachute-free writing, or what Barbara Turner-Vessalago calls free fall writing, is a process designed for creative writers. It has five basic tenets, three of which are easily applicable to academic writing:

1. write what comes up for you – this suggests that you don’t have a plan or prompts, you just write what comes into your mind

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A new generation of qualitative researchers

Originally posted on Jane Mills:

This blog post is an excerpt from our new book (Mills, J & Birks, M. Qualitative Methodology: A practical guide, 2014. SAGE Publications). When it came to the final chapter for the book one of the issues I wanted to address was the impact of generational difference on how groups of scholars think about qualitative research. In particular, I wrote about the thorny issue of research impact and how receptive or otherwise qualitative researchers are to appraising the impact of their work and why that might be so. If you are interested in reading more about the politics of evidence and generational difference you can source the book from SAGE, Amazon or Footprint Books in Australia.

The politics of evidence

Current debates, largely conducted within the dominant North American qualitative research community, constitute a backlash against what is conceived as the growing dominance of positivistic science in major western…

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Ten Tips for a successful career…plus a one extra late edition!

Ten Tips I picked up this week from a very successful retiring academic colleague about securing a long and successful professional life:
1. “If you live long enough- things happen” – you’ll need endurance and tenacity
2. Make sure you can recognise luck when it comes along and don’t waste the opportunity it brings with it
3. Have broad interests – look beyond your own discipline and always be ready to learn
4. Travel
5. Networks are everything – build strong networks
6. Find innovative ways to manage difficult people
7. Choose your battles carefully – let some things ride…
8. Take risks…
9. For academics…Remember: Teaching pays the bills!
10. Be nice to people – listen to them… hear them… be quick to say thank you.

an 11th has been added by another highly regarded sage academic (retired) – Do not forget to privilege research and publication. Sequester time for this and guard it ferociously. So easy for it to be eaten into. Create research groups.

….and my observation to add to this list… wash all down with plenty of ‘faith’ and confidence in yourself/your abilities… and a moderate amount of Shiraz!

#headspace & #MentalHealth reform for #rural Australian young people. #nurses #heretohelp

At the moment, the media is laden with calls for reform for youth mental health in Australia. My research informs the debate:

My research specifically addressed the problem of rural young people accessing mental health care. Following one Masters (Hons) and one PhD examination of the problem, I have formed some evidence-based views on ways forward: Here is an extract (Thesis Chapter 5: pages195-197) one that relates to headspace and the potential nurses have to be a more effective contributors to early mental health care if funds were redirected from headspace for a more equitable distribution to help young rural people:

         Implications for policy…

  • The national mental health strategy headspace, does not currently possess the capacity to be extended to every rural community in Australia. E-headspace does have some scope to contribute a useful component to a rural youth mental health strategy if rural e-mental health knowledge brokers are available in community rural nursing settings or Medicare Local centres to facilitate this strategy in the rural environment.
  • The headspace initiative should be reviewed by the Department of Health and Ageing with an aim to facilitate the redistribution of federal funds to include a contribution to the operational costs of rural nurses to act as e-mental health knowledge brokers for young rural people on a per capita basis, so that at least population-based equity of distribution of youth mental health financial resources is available in all communities, rather than, as is currently the case, restricted to one service centre in one regional community in the study site region.
  • Further reform of youth mental health services is required to ensure that rural young people have reasonable access to mental health services in keeping with international progress and development about youth mental health services that challenge the traditional paradigms of youth mental health service delivery (Coughlan et al., 2011, 2013). There is wide agreement in the literature that young Australian people are underserviced in early mental health care, and that for rural young people this circumstance is further amplified (Coughlan et al., 2011; Mendoza et al., 2013; Rickwood, 2012; S. P. Rosenberg & Hickie, 2013).
  • Rural nurses should be adequately funded to support e-mental health kiosks in appropriate community settings such as hospitals, multi-purpose health facilities, community agencies, schools and police stations. Rural nurses are able to collaborate with professionals from all of these sectors in such a way that collaboration of mental health helping and capacity building in rural communities is achieved and coordinated. The architects of health, social and law policy will need to accommodate the inclusion of new and innovative roles in the future. In particular, the function, role description of rural nurses, and specifically the role of rural community nurses will need to be expanded so that meaningful mental health help can be provided to early mental health help-seekers.

In press now:

Wilson, R.L. & Usher, K. (2015) Rural nurses: A convenient co-location strategy for rural mental health care of young people. Journal of Clinical Nursing. (in press April 2015).

#nurses #heretohelp

#Research2015 . Days 2&3 in Nottingham @RCN Nursing Conference

Such a buzz to spend with international nursing colleagues – all gathered for the same reason… to improve the delivery of nursing care to people…

300 nursing brains all turned to nursing excellence… that has got to be good for world health!

The digital impact of our discussions is sizzling hot… there are countries smaller than our impact!

5,545,572 Impressions
4,916 Tweets
579 Participants
51 Avg Tweets/Hour
Avg Tweets/Participant

A few highlights:

Professor Siobhan Nelson (Canada) urged us to think about how we describe our work as nurses – simple but challenging – because the way we allow ourselves to be described influences how others will describe and collaborate with us… My tweet:

matters . How we describe ourselves will influence how others describe us too.

I was inspired by Shirley Baah-Mensah, who reminded nurses in minority groups to aspire to success. My tweet:

We have to be brave, have courage to make thing better for the future:equal in value, no matter what their color -Mensah

Dr Kay Currie from Glasgow described the use of nominal group techniques to build a survey instrument… that got me thinking! I got a little distracted by some creepily disturbing entomology though…

Andrew Grundy presented soem mental health research findings about Mental Health care planning that struck a chord… my tweet:

talks abt #care#planning being abt what the provider needs, not serviceusers’

Prof Lesley Wilkes presented some disturbing research findings… very confronting – commendable research. Must have been hard for the researchers to keep hearing about the topic over and over again – but yet an important contribution to improve nursing knowledge and practice. My tweet:

Confronting but needed: Results of 1st study in Australia abt experiences of among African migrant woman

Professors: Carole Haigh, Debra Jackson and Graeme Smith share some very useful tips about the job of a peer reviewer… very helpful tips…

At the end of April 22, 2015

“>day two… still smiling!

Day three… My presentation day…. two presentations done and dusted. Thank you to the nurses that came and asked interested questions and engaged with my work – much appreciated. :) Here are some tweets by others about my work:








… super engagement… have had a great time – thinking, considering, scheming, plotting and planning abotu future research to continue to contribute to a better future for nursing and for our patients…

and – kind of got invited back I guess

Edinburgh 2016… book me in!

About Nursing: At the RCN in Nottingham, UK – Day One

I love the buzz of a nursing conference… I am attending this one:

These days – a prerequisite to getting the most out of conference attendance is making sure you have a Twitter handle – here is mine @rhondawilsonmhn You need one of these so you can follow the Twitter concurrent Twitter conversation which extends the discussions a great deal. Conferences usually have a hashtag to follow… this one is #research2015. Putting the hashtag in the twitter search engine and saving it allows you to visit and participate in the conversation. I think I got about 25 new followers yesterday alone by doing this – that extends my professional network and puts me in touch with nursing colleagues around the world. Meeting people #IRL (In Real Life) is then made easier – because you already have had an introduction connection. Here are the social media analytics for yesterday!

2,074,580  Impressions
1,860  Tweets
307  Participants
78  Avg Tweets/Hour
6  Avg Tweets/Participant

My twitter network started to expand at breakfast yesterday with meeting Dr Camille Cronin from Essex –@CamilleCronin – sharing some ideas about nursing scholarship.

Then – at registration, caught up with a colleague that I first met on Twitter a couple of years ago (in Perth Australia!)… We follow each other on Twitter… a mental health nurse academic @AustynSnowden from Scotland.

My own Colleagues from Australia turned up next… (we Australians have a radar to find each other in a crowd!) @KimUsher3 , @debraejackson , @LizHalcomb , and Prof Lesley Wilkes… all great to see.

Then the snowballing commenced! So many interesting people to meet over coffee and so many mints to collect in exhibition area.

Day one (yesterday) 20 April, 2015 was a buzz! Here are my highlights from the sessions:

The big theme shining though: The essential and most valued work of nursing are the invisible interventions, actions, the caring, the listening, the being with and sitting with, the provision of kindness and comfort, being engaged and present… those are the nursing attributes that matter to our patients. Nursing is not limited to bunch of skills: how well we can write our notes, administer a pill, insert a tube… it is about how we engage when we are doing the technical work… Very motivational.

  • Prof Jill Maben spoke about the soulless factories of healthcare… and called for a humanising of health care for patients and nurses…a refreshing reminder to value the listening and being with our patients – to engage, connect and care. My tweet:

 Love the idea of applying to

  • Aussie Nurse, Elizabeth McCall – presented her research findings about brief interventions to address alcohol harms in a rural A&E department… she urged ED nurses to take the opportunity to ensure that they deliver appropriate brief interventions in A&E. A good qualitative study by a research active practitioner. My Tweet:

McCall says doesn’t support 2 conduct adequately:system needs reform

  • Then – off to hear Dr Paul Gill (Cardiff) give a great presentation encouraging Nurse PhD success. My tweet:

Packed audience hear about how to do a such strong interest in nursing scholarship -bodes well

  • Jill Taylor (somewhere in Scotland) gave a impassioned presentation of her PhD about the work of Health Visitor nursing and the emotional labour involved – the stories in her data were compelling listening. My Tweet:

research: designed to support systems rather than assist to build resilience

  • Prof Lesley Wilkes (Australia) gave a fascinating report of her research about the experience of Refugee Health Nurses working in NSW, Australia. Loved this one… and really made me think… I wondered how it might be if the Refugee Health Nurses of the future had their own lived experiences of asylum seeking…
  • John McKinnon (Lincoln, UK,) spoke about empathy… my pick of the day… I was glued to the whole presentation – the ways that nurses use empathy as a vital nursing intervention is a critical nursing experience… I heard a rumour he has a book coming out…. I will be lining up to buy it!
  • Austyn Snowden gave a terrific presentation about the challenges of achieving ethics approvals – very impressive presentation: View it here

The bar has been set high… Day two is about to start… I am inspired by my colleagues and the company I am in here…

…. no Robin Hood sightings yet…