Abstract
Background
Advanced rural nursing roles have evolved in response to the international need to address the complex and dynamic health care system and to meet the demand for flexibility in health service delivery. There has been a shift in focus to more primary based health care, with rural nurses in both Australia and New Zealand providing dynamic and competent advanced nursing care. Community partnership models of rural Primary Health Care (PHC) are the new focus in collaborative health care teams.
Aim
The primary aim of this review was to examine the development of advanced rural nursing in the Australian and New Zealand rural primary health setting.
Methods
A comprehensive search of eleven electronic databases was preformed. A five stage integrative review process was then conducted, utilising the Joanna Briggs Institute (2011) quality and data extraction tools to review the literature which met the inclusion criteria namely articles published in English between 1996-2014 and focused on Australian and New Zealand rural PHC nursing roles.
This was followed by the data analysis and the thematic code process using Thomas' (2003) general inductive approach.
Results
The search strategy resulted in twenty-four articles which were appraised and met the inclusion criteria. The data extraction process resulted in the generation of three themes using Thomas' (2003) general inductive approach. Theme one explored the development of advanced rural PHC nursing in Australia and New Zealand. Theme two describes the factors influencing the development of advanced rural PHC nursing roles in Australia and New Zealand, and Theme three highlights aspects pertinent to the future of advanced rural PHC nursing in Australia and New Zealand.
Conclusion
This review included an exploration of nursing scopes of practice, titles, roles and functions. This was followed by a review of the numerous factors influencing advanced rural PRC nursing practice including the rural community, the rural health workforce, the need for support systems, education and career pathways, and finally funding and purchasing. The implications and the future progression of advanced rural PRC nursing in Australia and New Zealand are then discussed.
This integrative review found that there are significant opportunites for rural nurses in Australian and New Zealand PRC if the current barriers to advancing practice are addressed by continuing strategic planning and consultation to develop well defined clinical and educational career pathways for rural nurses. This integrative review has demonstrated and reinforced the importance of health planning, collaboration and consultation at all levels with ongoing evaluation and adaptation, which ensure advanced rural nurse-led care is successful, safe and benefical to rural communities in Australia and New Zealand.