BackgroundGeographical isolation compounds limited access to healthcare services and skilled workforce for the provision of rural aged care. Residents have complex chronic disease management and end‐of‐life care needs. An undersupply of general medical practitioners due to retirement, attrition or unfilled training places in Australia has impacted recruitment to rural areas. Nurse practitioners have been identified as a potential solution.AimTo describe and explore the inner (local and organisational) and outer (wider health system) contexts of healthcare, from the perspective of care staff and residents' families. This, in turn, aims to inform the planned implementation of a nurse practitioner model, in several aged care facilities, operating within rural and remote settings, in Queensland Australia.DesignA convergent mixed methods design.MethodsQualitative data were collected, in 2022–2023, using semistructured interviews with staff focusing on role, knowledge development, workplace culture and care relationships with local community. Resident's family's perspectives were obtained as a secondary analysis of organisational feedback data. Quantitative data were collected from direct care workers using the Alberta Context Tool for Long‐Term Care. Data were analysed according to type and integrated.ResultsRelational care for residents and families is highly valued but provision of quality is challenging where time‐poor staff are perceived to be doing the best they can. Scarce local healthcare services make it difficult to meet resident healthcare needs. Despite the supportive organisational culture, evolving policy requirements have impacted already difficult staff recruitment in rural settings.ConclusionIdentifying contextual needs of organisations in readiness for change highlights geographical and sectoral nuances influencing any future implementation. As government policy changes to improve the older adult care sector, rural and remote facilities are forced to increasingly adapt.Implications for the ProfessionContext‐specific needs extend far beyond a nurse practitioner providing additional expertise in care provision.Impact StatementsWhat problem did the study address? Nurse practitioners have been successfully implemented into residential aged care facilities in metropolitan and major regional centres but translating this role into rural and remote Australia requires being cognisant of the needs, unique challenges and context of this setting.What were the main findings? In an organisational culture of support, the importance of staff providing relational care and having connection with older adult residents and families was a central driver. It was challenging for staff to meet complex care requirements in the absence of local healthcare options and support. Time pressures, from inadequate staffing and changing structural aged care sector, force the prioritising of care requirements.Where and on whom will the research have an impact? Older adults, policy makers and aged care providers will benefit from understanding the context of rural and remote settings, particularly in identifying potential solutions when there are gaps in primary and secondary healthcare.Reporting MethodThe GRAMMS checklist was followed in reporting of this study.Patient or Public ContributionTwo lived experience consumers were involved as research team members. One was involved during the development and submission of the funding application and another during project activities including data collection and analysis and the development of publications.

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解释农村和偏远老年护理设施中的环境，为新的护理模式做好准备：一项混合方法研究


背景地理隔离加剧了获得医疗保健服务和提供农村老年护理的熟练劳动力的机会。居民有复杂的慢性病管理和临终关怀需求。由于澳大利亚的退休、减员或培训名额空缺，全科医生供不应求，这影响了农村地区的招聘。执业护士已被确定为一种潜在的解决方案。目的从护理人员和居民家庭的角度描述和探索医疗保健的内部（本地和组织）和外部（更广泛的卫生系统）环境。反过来，这旨在为澳大利亚昆士兰州在农村和偏远地区运营的几个老年护理机构中计划实施执业护士模式提供信息。方法在 2022-2023 年期间，使用对员工的半结构化访谈收集定性数据，重点关注角色、知识发展、工作场所文化和与当地社区的护理关系。居民家庭的观点是作为组织反馈数据的二次分析获得的。使用 Alberta Context Tool for Long-Term Care 从直接护理工作者那里收集定量数据。根据类型分析数据并整合数据。结果对居民和家庭的关系关怀受到高度重视，但提供质量具有挑战性，因为人们认为时间匮乏的员工正在尽其所能。稀缺的当地医疗保健服务使其难以满足居民的医疗保健需求。尽管有支持性的组织文化，但不断变化的政策要求已经影响了农村地区本已困难的员工招聘。结论确定组织为变革做好准备的背景需求突出了影响任何未来实施的地理和行业的细微差别。随着政府政策的变化以改善老年人护理部门，农村和偏远设施被迫越来越多地适应。对 ProfessionContext 特定需求的影响远远超出了执业护士在护理提供方面提供额外的专业知识。影响陈述该研究解决了什么问题？执业护士已经成功地在大都市和主要区域中心的住宅老年护理设施中实施，但将这一角色转化为澳大利亚的农村和偏远地区，需要认识到这种环境的需求、独特挑战和背景。主要发现是什么？在支持的组织文化中，员工提供关系护理以及与老年居民和家庭建立联系的重要性是一个核心驱动力。在没有当地医疗保健选择和支持的情况下，员工要满足复杂的护理要求是一项挑战。人员不足和老年护理行业结构变化带来的时间压力迫使优先考虑护理需求。研究将在何处以及对谁产生影响？老年人、政策制定者和老年护理提供者将受益于了解农村和偏远地区的背景，尤其是在初级和二级医疗保健存在差距时确定潜在的解决方案。报告方法在报告本研究时遵循 GRAMMS 检查表。患者或公众贡献两名生活体验消费者作为研究团队成员参与其中。 一名参与资助申请的制定和提交，另一名参与项目活动，包括数据收集和分析以及出版物的开发。