背景:澳大利亚偏远的卫生部门存在长期的人员不足问题,具有高疾病负担的文化多样性人群。工作场所健康与安全(WHS)影响远程卫生劳动力的福祉和可持续性。此外,可怜的WHS会导致职业倦怠,员工流失率高,护理质量下降。2016年,偏远地区护士(RAN)GayleWoodford被谋杀,突显了澳大利亚非常偏远的初级保健诊所的不良WHS问题。在她死后,由高峰机构和盖尔家族领导的全国变革呼吁导致了许多针对偏远卫生部门的WHS建议和战略的制定。然而,目前尚不清楚这些措施是否已经实施。这项研究的目的是确定哪些WHS建议已经实施,从RANs的角度来看。
方法:在2020年12月和2021年1月期间对173个RAN进行了横断面在线调查。这项调查对所有在澳大利亚一个非常偏远的初级健康诊所(改良莫纳什(MM)模型的MM7)工作的RAN开放,最近比2019年1月更多。使用了一种方便的抽样方法。调查工具是由项目团队使用经过验证的工具和远程特定工作场所安全建议的组合开发的。广泛的建议,比如有一个安全的诊所大楼,安全的员工住宿,当地定位,和“从不孤单”政策,被分解为具体的安全标准。这些标准用于生成工作场所安全评分,以量化每个建议的满足程度。并分为以下几个领域:员工的准备,安全工作环境和安全工作实践。使用描述性统计数据,并比较了不同州和地区之间的安全性得分。
结果:总体而言,国家工作场所安全平均得分为53%(标准差(SD)19.8%)的参与者在最近的工作场所遇到的建议,员工准备建议的中位数为38.5%(四分位数间距(IQR)15.4-61.5%),安全工作环境建议的中位数为59.4%(IQR43.8-78.1%),和中位数50.0%(IQR30.0-66.7%)的安全工作实践建议满足。在域内,一些建议比其他建议更受欢迎,不同州/地区的安全评分也各不相同。北领地之间存在显著差异(57.5%,SD18.7%)和昆士兰州(41.7%,SD16.7%)(p<0.01),和南澳大利亚(74.5%,IQR35.9%)和昆士兰州(p<0.05)。最后,许多RAN仍被期望自己参加下班后的调出,只有64.1%(n=107/167)的参与者在他们的工作场所报告了“永不孤单”的政策或程序。
结论:这项研究的证据表明,已经实施了一些推荐的安全策略,但是在员工准备方面仍然存在巨大差距,疲劳管理和基础设施安全。持续糟糕的WHS可能会导致RAN的持续高营业额,对偏远社区医疗保健的质量和连续性产生负面影响。地区之间安全评分的差异警告说,偏远卫生部门的WHS方法支离破碎,尽管不同州/地区的WHS立法几乎相同。这些差距凸显了在偏远卫生部门建立和执行国家工作场所安全最低标准的必要性。
BACKGROUND: Australia\'s remote health sector has chronic understaffing issues and serves an isolated, culturally diverse population with a high burden of disease.
Workplace health and safety (WHS) impacts the wellbeing and sustainability of the remote health workforce. Additionally, poor WHS contributes to burnout, high turnover of staff and reduced quality of care. The issue of poor WHS in Australian very remote primary health clinics was highlighted by the murder of remote area nurse (RAN) Gayle Woodford in 2016. Following her death, a national call for change led by peak bodies and Gayle\'s family resulted in the development of many WHS recommendations and strategies for the remote health sector. However, it is unclear whether they have been implemented. The aim of this study is to identify which WHS recommendations have been implemented, from the perspective of RANs.
METHODS: A cross-sectional online survey of 173 RANs was conducted during December 2020 and January 2021. The survey was open to all RANs who had worked in a very remote (MM 7 of the Modified Monash (MM) Model) primary health clinic in Australia more recently than January 2019. A convenience sampling approach was used. The survey tool was developed by the project team using a combination of validated tools and remote-specific workplace safety recommendations. Broad recommendations, such as having a safe clinic building, safe staff accommodation, local orientation, and \'never alone\' policy, were broken down into specific safety criteria. These criteria were used to generate
workplace safety scores to quantify how well each recommendation had been met, and clustered into the following domains: preparation of staff, safe work environment and safe work practices. Descriptive statistics were used and the safety scores between different states and territories were also compared.
RESULTS: Overall, the average national
workplace safety score was 53% (standard deviation (SD) 19.8%) of recommendations met in participants\' most recent
workplace, with median 38.5% (interquartile range (IQR) 15.4-61.5%) of staff preparation recommendations, median 59.4% (IQR 43.8-78.1%) of safe work environment recommendations, and median 50.0% (IQR 30.0-66.7%) of safe work practices recommendations met. Within domains, some recommendations had greater uptake than others, and the safety scores of different states/territories also varied. Significant variation was found between the Northern Territory (57.5%, SD 18.7%) and Queensland (41.7%, SD 16.7%) (p<0.01), and between South Australia (74.5%, IQR 35.9%) and Queensland (p<0.05). Last, many RANs were still expected to attend after-hours call-outs on their own, with only 64.1% (n=107/167) of participants reporting a \'never alone\' policy or process in their workplace.
CONCLUSIONS: The evidence from this study revealed that some recommended safety strategies had been implemented, but significant gaps remained around staff preparation, fatigue management and infrastructure safety. Ongoing poor WHS likely contributes to the persistently high turnover of RANs, negatively affecting the quality and continuity of health care in remote communities. Variation in safety scores between regions warns of a fragmentation of approaches to WHS within the remote health sector, despite the almost identical WHS legislation in different states/territories. These gaps highlight the need to establish and enforce a national minimum standard of
workplace safety in the remote health sector.