In the remote setting effective, safe, and quality care requires an understanding of the unique needs of the community within its cultural context. Therefore, your professional role and responsibilities, and scope of practice will differ, influenced by the needs of the community and health service’s location.
In remote and isolated areas, nurses, midwives and Aboriginal and Torres Strait Islander Health Practitioners and Workers deliver most of the frontline health care. Professional practice in this context requires generalist clinical expertise, integrating a comprehensive primary healthcare approach, inclusive of acute and emergency care, chronic disease, and public health, across the life span.
When preparing to practise in a remote setting for the first time there are some things to consider. You can and should do some research on the context and health needs of the community. Contacting your potential employer or health service staff can be one great way to help understand your role. You may be able to ask someone who has worked in the community for information and you can often gather service and demographic detail online. Questions to ask include the following:
- Will you be provided with a full orientation, inclusive of cultural orientation?
- What kinds of services are available at the health service/clinic? E.g., physiotherapy, mental health, pre/postnatal care, emergency care, immunisation, etc.
- What are the health priorities in the community?
- What is the composition of the local clinical health team? Become familiar with the important role of Aboriginal Health Worker and Aboriginal Health Practitioner. Start you research with this NAATSIHWP resource.
- What knowledge, skills and experience do I need to work in this community (including capacity to drive 4WD/manual ambulance if needed)?
- How do I go about filling skill, knowledge or experience gaps and updating my skills and education? Are there a preferred courses or programs?
- What kinds of support are available for me within the community?
- What are the ‘on‐call’ and ‘after‐hours’ requirements?
- What are the health service safety and security policies, particularly ‘always accompanied’ policies?
- What is the availability and nature of accommodation?
- Will I have internet access and what is access like?
- If you are considering taking partners, children and pets ensure you check this is possible. Capacity for employment, accommodation, schooling, and resources for animals may mean this is not possible in the community.
Get to know your community and your environment
Culturally Safe Practice
Gaining a solid understanding and appreciation of a specific remote community context takes a long time. It is both essential and respectful to approach the cultural context of the community with humility. Building good relationships requires listening and waiting.
- Find out about the demographics of the local community and surrounding area. This should include a history of the community (important in terms of the impact of colonisation, the forced removal of generations of Aboriginal and Torres Strait islander children and associated intergenerational trauma).
- Ask others ‘What do I need to know about this community?’
- Ask what cultural information you need to know to practise and live respectfully when working in this community.
- Ask to be provided with a cultural orientation to the community.
- Ask to be introduced to community leaders and people of importance.
- Is the community dry (no alcohol)? You will need to meet the expectations of the community.
- Seek to develop an awareness of, and respect for, cultural places and practices.
CRANAplus strongly recommends that nurses and midwives adequately prepare themselves for culturally safe practice. Such preparation can include the CATSINaM training package Murra Mullangari. Enrolments open on Monday 14th March.
Remote Australia is environmentally diverse and comes with beautiful locations to see and experience along with some challenges and risks you should be aware of and prepared for:
- What is the yearly weather cycle like in community and what resources are there to manage the climate such as air conditioning, particularly in accommodation (wet/dry seasons, fires, isolation and intermittent road access, heat and cold and more)?
- Be aware of climate safety practices applicable in your community. Carry water supplies when travelling, protective clothing and footwear and fire protection strategies
- What other services exist besides health services, e.g. police, service station, fuel access and type, school, recreation centre, and landline/satellite mobile/internet access?
- The range and scope of food available in remote communities is not like major urban centres. If you have specific dietary requirements or preferences, you may need to confirm these can be met in the community. Be aware you will pay more than you are accustomed to and there is often a limited range of goods.
- Is there community access by road/air? If you arrive by air, is there access to transport for you while you are in the community? If you are arriving by car what is the state of the roads and is your car suitable? You may be required to undertake 4WD and two‐way radio training courses prior to commencing employment or once employed.
- There is often less privacy in shared accommodation.
Personal planning and self-care
Going remote, particularly for the first time, can be exciting. To get the most of your time practising in a remote setting it is a good idea to plan, recognising you may need to adapt and change your usual self-care practices. Isolation can be a challenge and your normal healthy actions may take a bit more planning. Anticipating challenges is a helpful start to minimising them where possible. The following is an incomplete list of things to consider. As you go along you may think of more. Don’t ignore these; make a plan to suit you:
- Does my phone carrier offer coverage in community (check with someone in the community such as your employer, and your mobile carrier)? You may need to switch provider.
- Take a supply of your prescription medication. Delays in deliveries are not unheard of.
- Talk with family, friends, and supports about your expectations and make concrete plans on how you will maintain these relationships from a distance (video calls, phone calls, snail mail).
- Service your car before leaving if driving and ensure someone knows when and where you will arrive. Check how far it is and how long it will take so you are not surprised by the distance!
- Some hobbies you have will be able to continue in community, other may not be suitable. If not possible, consider trying a new hobby that will help you ‘decompress’.
- Investigate self-care strategies and supports. CRANAplus has a range of helpful resources. These include:
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