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One-on-one nursing: opportunities for personalised care in the remote setting
Remote clinics can be the ideal environment for nurses to encourage patients to be involved in decisions about their health, says retired clinical nurse consultant Helen Walker.
“One-on-one nursing in these remote clinics can bring this quality to the fore, a crucial skill to help patients ‘own their own health’,” she says.
“When it happens, the results are brilliant,” says Helen, a Registered Nurse and Midwife who has worked extensively in remote areas, particularly in the Torres Strait.
“But it requires the right attitude: one of respect for the patient; and teamwork with both the local health workers and the doctor on the end of the phone.”
This one-on-one care is where Helen believes remote small clinics have a chance to give more personalised care than clinics and hospitals in the big towns and cities, where patients may see a whole stream of different health professionals.
“You want the best for each of your patients, you want them to follow through with your advice, care for their own health, and you are connected and committed to the outcomes.”
Helen is keen to pass on knowledge from her working life “to talk about what has worked for me to allow others the opportunity to approach remote nursing in the same way”.
Early in her nursing career, Helen undertook ophthalmic training in London, spent two years in Jamaica as an ophthalmic nurse, and later volunteered as one of two ophthalmic nurses doing pre and post surgery work aboard Mercy Ships in Benin, West Africa.
Helen has worked in outback hospitals in Queensland and in remote primary healthcare clinics throughout the country.
Her introduction to Torres Strait Island nursing began in 2008 when she was invited to work there by the Queensland Hospital hub for rural and isolated nursing relief.
Since 2013 until her retirement, Helen was an agency nurse, replacing staff on leave or filling in until a vacant position was filled, working on every inhabited Torres Island many times over.
“To be truly competent, attitude is the No.1 thing,” Helen says. “One problem is if a nurse arrives and takes everything away from the local health workers, not liaising with the staff that is there. Another is coming just for the money.“
If you are in a clinic as the sole nurse or in a two-nurse clinic, you always have a doctor on the end of the phone and local Islander or Aboriginal health workers on hand.
“It’s important you liaise with the doctor: they rely on us to do the best job we can and we rely on them. And you have to work as part of the team with the local health workers, helping facilitate their skills development, showing them perhaps how to do something, and listening to them. They taught me so much in return with their local expertise. They know the language, the culture and their own community and they are crucial in helping prevent health issues arising.
Helen gives a detailed example of the approach she uses, emphasising that she is just ‘one small cog in the wheel’. Here’s her story:
A patient came to me at the clinic, complaining of sores that would not heal. I gave him a finger prick. He was diabetic Type 2, was not taking his medicine and his blood sugar levels were sky high.
I sat alongside him, taking notes, at that stage not turning my back to type into the computer.
I opened the Primary Clinical Care Manual, which is updated every two years, and showed him the page relating to his situation, so he knew
I wasn’t just talking off the top of my head, I was using a reputable source. I first used this manual for my specialist training back in 2005 when I trained as a Rural and Isolated Practice Endorsed Registered Nurse.
I then told him I was going to type up my notes and asked him to check with me that I had put everything down that we had spoken about. This not only helped him maintain input and control of his situation, it was good for me too, to make sure I was covering every detail.
I phoned the doctor at Thursday Island Hospital, giving him all the details and he was then able to access the patient’s history and my notes from this visit. He told me to tell the patient that if he didn’t get those levels down he was shortening his life expectancy.
That’s what I did and the patient and I spoke about what he would have to do.
He came back the next day and said – I’ll do it. He had taken everything on board about looking after his own health, eating healthy food and exercise.
Then we had a three-way phone call with the doctor. Once again, the patient was involved. It wasn’t just a white nurse telling him what to do.
I can say, every time, the consequences were brilliant. In this case, I was away from the island for a few days and when I returned, there he was, walking up and down the airstrip.
I later met him carrying shopping bags filled with tinned fruit and vegetables – it’s not easy to get fresh on the islands.
I told him he was a great role model and, in the days that followed, a number of men came to see me, talking about their issues. It was like ripples in a pond. They saw he had a lot more energy, and they wanted that too.
“Of course I miss nursing, says Helen who retired last year. “But I recognised the time to call it quits at 74 years of age. I always enjoyed what I did and I guess my energy came from the enjoyment.
“It was a terrific job. Not always easy, I can say. There were many instances where I had to stabilise patients who were extremely ill waiting for medivac, for example. It is always one step at a time. But it is so fulfilling.”
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