S.TRUEMAN PhD THESIS 2016

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Statement of Access	2
Statement on Sources	3
Electronic Copy	4
Copyright Declaration	5
Statement of the Contribution of Others	6
Declaration on Ethics	7
Acknowledgements	8
Acknowledgements	8
Professor Jane Mills	8
Dr. Tanya Park	10
Dr. Allison Stewart	10
Dr. Karen Yates	10
Professor Kim Usher and Professor Adrian Esterman	11
Dr. Jennifer Chamberlain-Salaun and Marnie Hitchins	11
Professor Melanie Birks	11
Frieda Marfleet	12
Abstract	13
Table of Contents	15
List of Tables	20
LIst of Figures	24
LIst of Appendices	26
Definitions and Abbreviations	27
Chapter 1: Introduction	31
1.1 Introduction	1
1.2 Personal Experience that Informs the Study	1
1.3 Aim of the Study	1
1.4 Purpose of the Study	1
1.5 Research Questions	1
1.6 The Field of Study	1
1.6.1 What is ‘remote’?	1
1.6.2 Profile of Australia’s remote population	1
1.6.3 Aboriginal and Torres Strait Islander populations living in remote and very remote Australia	1
1.6.4 What is meant by remote health?	1
1.6.5 What is mental health and illness?	1
1.6.6 Current profile of the remote nursing workforce	1
1.6.7 Generalist remote nurses caring for mental health clients	1
1.6.8 Current profile of remote mental health nursing workforce	1
1.6.9 Current profile of remote mental health non-nursing workforce	1
1.7 Overview of the Study Design	1
1.8 Rationale	1
1.9 Significance of the Study for the Nursing Profession	1
1.10 Organisation of the Thesis	1
1.11 Summary	1
Chapter 2: Background	68
2.1 Introduction	1
2.2 Remote Population Health Profile in Australia	1
2.2.1 Remote illicit drug use and excessive alcohol us	1
2.2.2 Alcohol use	1
2.3 Summary of Remote Drugs and Alcohol Use	1
2.3.1 Tobacco	1
2.4 Treatment Facilities for Drugs and Alcohol	1
2.5 Suicide	1
2.6 Mortality Rate by Remoteness	1
2.7 Life Expectancy for Non-Indigenous Australians by Remoteness	1
2.8 Hospital Infrastructure by Remoteness	1
2.9 Mental Health Hospital Separations by Remoteness	1
2.10 Hospital-Based Mental Healthcare Service Provision By Remoteness	1
2.11 Expenditure on Remote Mental Health Services by Remoteness	1
2.12 The Mental Healthcare System	1
2.13 Profile of Mental Healthcare Delivery in Remote Australia	1
2.14 Drivers of Change in Delivery of Remote Healthcare	1
2.15 Primary Healthcare	1
2.16 Primary Healthcare Delivery Models in Remote Australia	1
2.17 Formation of Remote Professional Representation	1
2.18 Nature of Remote Nursing	1
2.19 Summary of Chapter	1
Chapter 3: Review of Literature	111
3.1 Introduction	1
3.1.1 Article	1
3.1.2 Declaration by co-authors	1
3.2 Article: Australian Rural And Remote Generalist Nurses Caring for Mental Health Clients: An Integrative Review	1
3.2.1 Keywords	1
3.2.2 Introduction	1
3.2.3 Aims	1
3.2.4 Methods	1
3.2.5 Search strategy	1
3.2.6 Findings	1
3.2.7 Discussion	1
3.2.8 Conclusion	1
3.2.9 Disclosure	1
Chapter 4: The Case and Methodology	141
4.1 Introduction	1
4.2 Philosophical Underpinnings	1
4.2.1 Epistemology	20
4.2.2 Axiology	20
4.2.3 Rhetoric	20
4.2.4 Ontology	20
4.2.5 Methodology	20
4.3 Theoretical Underpinnings	20
4.3.1 The researcher’s position	20
4.4 History of Case Study Design	20
4.4.1 Definitions of case study	20
4.4.2 Choosing the research methodology	20
4.4.3 Identifying the case	20
4.4.4 Boundaries of the case	20
4.4.5 Case study design	20
4.4.6 Criticisms of case study as a methodology	20
4.5 Conclusion	20
Chapter 5: Methods	167
5.1 Introduction	1
5.2 Role of the Researcher	20
5.3 Case Study Data	20
5.4 Participants	20
5.4.1 Inclusion criteria	20
5.4.2 Sample	20
5.4.3 Recruitment	20
5.4.4 Communication with potential participant	20
5.4.5 Arranging interviews	20
5.5 Ethical Requirements	20
5.6 Overview	20
5.7 Data Collection	20
5.7.1 Interviews	20
5.7.2 Interview questions	20
5.7.3 Interviews	20
5.8 Face-to-Face Interviews in Comparison to Telephone Interviews	20
5.8.1 Disadvantages of interviews	20
5.9 Data analysis	20
5.9.1 Data preparation	20
5.9.2 Coding	20
5.9.3 Identifying patterns and forming themes	20
5.9.4 Memo writing	20
5.9.5 Manual vs computer assisted coding	20
5.10 Summary	20
Chapter 6: Situational and Relational Analysis and Social World Theory	199
6.1 Introduction	1
6.2 Situational Analysis: Background	20
6.3 Social Worlds and Arenas	20
6.4 Situational Mapping	20
6.4.1 Abstract situational map: messy/working versio	20
6.4.2 From messy maps to (situational) ordered/working maps	20
6.4.3 Ordered/working maps	20
6.4.4 Relational analysis of situational maps	20
6.4.5 Overall situational (relational) map	20
6.4.6 Conclusion	20
6.5 Social Worlds Theory and Maps	20
6.5.1 Introduction	20
6.5.2 Social worlds/arenas	20
6.5.3 Social world and arena mapping theory	20
6.6 Creating the Social World/Arena Map	20
6.6.1 Situational matrix	20
6.6.2 Creating the social world/arena map	20
6.7 Positional Maps	20
6.8 Summary: How the Three Types of Maps Present Different Ways of ‘Interrogating’	20
6.9 Summary	20
Chapter 7: Findings	244
7.1 Introduction	1
7.2 Groups Within the Remote Nurse’s Social World of Delivering Mental Healthcare	20
7.2.1 Remote mental health patients	20
7.2.2 Remote general nurses	20
7.2.3 Psychiatrists	20
7.2.4 Mental health nurses (MHNs)	20
7.2.5 General (medical) practitioners (GPs)	20
7.2.6 Paramedics and ambulance officers	20
7.2.7 Aboriginal and Torres Strait Islander Health Workers (ATSIHW)	20
7.2.8 Nurse practitioners	20
7.3 The Actors’ Arena	20
7.3.1 Police	20
7.4 Other Groups Within the Healthcare System Arena	20
7.4.1 Administrators	20
7.4.2 Facilitators	20
7.4.3 Others	20
7.5 The Non-Human Arena	20
7.5.1 Influences in the non-human arena	20
7.6 Summary	20
Chapter 8: Actor-Network Theory	287
8.1 Introduction	1
8.2 Actor-Network Theory	20
8.2.1 Three underlying principles	20
8.2.2 History of actor-network theory	20
8.2.3 Actor-network	20
8.2.4 Networks	20
8.2.5 Commonalities of networks	20
8.2.6 Actor and actants	20
8.2.7 Increasing complexity of the remote nurse’s social world	20
8.2.8 Elements in the non-human arena	20
8.2.9 ‘Black boxes’ and ‘punctualisation’	20
8.2.10 Inscription in delivering mental healthcare	20
8.2.11 Irreversibility in delivering mental healthcare	20
8.2.12 Stabilisation in delivering mental health patient	20
8.2.13 Establishing and maintaining networks	20
8.2.14 Moments in translation	20
8.2.15 Obligatory passage point	20
8.3 Addressing Criticisms and Challenges to Actor-Network Theory	20
8.4 Summary	20
Chapter 9: Discussion	338
9.1 Introduction	1
9.2 Remote Nurses as Obligatory Passage Points	20
9.3 Self-Perceived Levels of Mental Healthcare Skills, Abilities and Confidence	20
9.4 The Unique Characteristics of Remote Nurses	20
9.4.1 Resourcefulness	20
9.4.2 Resilience	20
9.4.3 Responsiveness	20
9.4.4 Robustness	20
9.5 Summary	20
Chapter 10: Conclusion	372
10.1 Introduction	1
10.2 Researcher’s Reflection	20
10.3 Methodological Rigour10.3 Methodological Rigour	20
10.3.1 Credibility	20
10.3.2 Transferability	20
10.3.3 Dependability	20
10.3.4 Confirmability	20
10.4 Recommendations	20
10.4.1 Further research	20
10.4.2 Practice	20
10.4.3 Education	20
10.4.4 Policy	20
10.5 Limitations of the Study	20
10.6 Strengths of the Study	20
10.7 Role of the Researcher	20
10.8 Conclusion	20
References	395
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Appendices	482
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