Reflections on Christmas in palliative practice.

<b>PB-PG-1207-15081 – NIHR Research for Patient Benefit Programme – Final report</b><br /> <br /> <b>Project title: </b>The development of a decision tool to improve the management of urinary incontinence in women in the community<br /> <br /> <b>Authors</b>: Professor Dawn Dowding - University of Leeds<br /> Professor Francine Cheater - Glasgow Caledonian University<br /> Professor Joanne Booth - Glasgow Caledonian University<br /> Professor Ian Watt - Hull York Medical School/University of York<br /> Mrs Rosemary Horseman - North Yorkshire and York Primary Care Trust<br /> Professor John Martin Bland - University of York<br /> Professor David Torgerson - University of York<br /> Mrs Anne Siddle - Leeds Community Healthcare<br /> <br /> <b>Plain language summary</b><br /> Background<br /> Urinary Incontinence (UI) affects about 15% of the general population and is more common in women.&nbsp; It is a condition that can cause a great deal of distress to sufferers, and costs the NHS about &pound;563 million a year.&nbsp; Whilst there are different types of UI, each with its own way of being treated, many women with urinary incontinence currently don’t seem to be getting the best treatment for their condition. The aim of this study was to design and develop a decision tool to help health care professionals identify which type of UI people have more effectively, with the aim of improving management of the condition.<br /> <br /> Findings<br /> In the first stage of the study we developed three different versions of the tool based on existing research evidence. We carried out interviews with groups of health care professionals who work in the community (General Practitioners, Practice Nurses and Community (district) Nurses). We asked them to discuss how they currently assess and manage UI in women, and also got them to evaluate the different versions of the tool. At the end of this stage of the study we had a decision tool that health care professonals thought they could use when treating a woman with UI.<br /> <br /> In the second stage of the study we developed 25 fictional descriptions of women with different bladder symptoms and asked doctors and nurses to use the tool to say how they would treat the women.&nbsp; We then examined what they decided to identify whether or not the tool helped health care professionals agree on what treatment would be appropriate, and whether or not it improved their ability to identify the type of incontinence.&nbsp; We found that health care professionals who used the tool were more likely to identify the type of UI correctly than professionals who did not use the tool.<br /> In the third stage of the study we tested the tool in real General Practice settings, to see whether or not it was useful to health care professionals in practice and what effect it may have on the type of care that women with UI receive. We found that it was used mainly by practice nurses, who felt that it helped to improve the care that women received.<br /> <br /> Conclusions<br /> The tool that has been developed in this study has the potential to help health care professionals assess and manage UI in women in community settings more effectively. It could be translated into an electronic tool for all community practitioners to access.&nbsp;<br /> &nbsp;<br /> <b>Keywords</b><br /> Urinary incontinence, evidence based practice, clinical decision tool, decision algorithm, primary care.<br /> <br /> <b>Summary of research findings</b><br /> Background<br /> Urinary incontinence (UI), defined as ‘the complaint of any involuntary leakage of urine’ is a common symptom and represents a major public health concern. Evidence suggests that most UI symptoms in women are treatable or can be ameliorated in primary care settings by conservative measures such as lifestyle advice and behavioural strategies. However, adherence to guidance is very variable and women are frequently referred to secondary care without an adequate trial of these interventions.&nbsp;<br /> <br /> Identifying the type of incontinence that a woman may have is based on a judgement. Judgement processes commonly involve the integration of information from a variety of sources, which are then evaluated to reach a conclusion; in this case evaluating information about the characteristics of a woman’s urinary symptoms, to identify what type of UI (stress, urgency, mixed, functional and overflow) is the most probable. On the basis of this judgement a decision would be taken regarding what treatment to recommend. Using formal, structured tools to assist with the judgement process may reduce the likelihood of errors, as they encourage clinicians to focus on relevant information in a consistent fashion. Decision tools to assist primary/community health care clinicians in diagnosing the type of UI and that are accurate, acceptable and cost-effective to use in practice do not currently exist.<br /> <br /> Aims and Objectives<br /> The aim of this study was to develop and validate a decision tool to assist health care practitioners identify the type of urinary incontinence (UI) experienced by women living in the community, leading to improved management of a woman’s UI.<br /> It addressed the following research questions:<br /> Does the use of a decision tool to assist with the assessment and management of UI in women in the community:<br /> i) Increase the accuracy with which health care practitioners identify the type of UI a woman is experiencing?<br /> ii) Improve the appropriateness of subsequent management of a woman’s UI?<br /> iii) Lead to better outcomes for women such as improved quality of life and amelioration of urinary symptoms?<br /> <br /> The study had the following research objectives:<br /> 1. To develop an evidence based decision tool to assist health practitioners working in primary care/community to identify the type of UI experienced by women and appropriate management strategies for the woman’s UI.<br /> 2. To test the decision tool for reliability and validity with practitioners working in primary care/community who treat women with UI.<br /> 3. To carry out a feasibility study to assess the acceptability of the tool in clinical practice, and the feasibility of carrying out any further research studies.<br /> <br /> Methods<br /> The study was in three stages;<br /> <br /> Stage 1: Development of the decision tool.<br /> Prototypes for possible decision tools were developed with the assistance of two continence specialists, based on evidence based guidance and systematic review evidence. The content and format of the tools were then evaluated using focus groups and in-depth interviews with 52 primary and community health care professionals (6 GPs; 3 practice nurses; 38 community nurses, 3 health care assistants) whose role includes the assessment and management of women with symptoms of urinary incontinence. Interviews and focus groups were audio-recorded and transcribed. Transcripts were analysed using the ‘Framework’ approach, based on a series of sequential steps: familiarisation with the data; thematic analysis to develop the coding scheme; systematic coding and charting of data to develop a coding matrix; mapping and interpretation of the data in order to explore relationships between the codes.<br /> <br /> Stage 2: Testing of the tool for reliability and validity<br /> The decision tool derived from stage 1 was then tested for reliability and validity using 25 clinical scenarios portraying cases of women with symptoms of urinary incontinence. The scenarios were evaluated for face validity by continence specialist nurses. Health care practitioners who consented to take part in the study were randomised either to receive or not receive the decision tool; they were then asked to record their decisions about assessment and management for each of 17 cases presented to them in the first round of testing. Four weeks later, each participant was sent a second set of 17 cases (including 9 repeat cases to test for intra-rater reliability).<br /> &nbsp;&nbsp;<br /> Stage 3: Feasibility study&nbsp;<br /> Two General Practices consented to take part in the feasibility study. In each practice GPs and practice nurses were trained to use the decision tool. In each practice, 600 women who met the inclusion criteria (over 18 years and not pregnant), stratified by age, were sent information about the study and asked to contact the research team if they had symptoms of UI. They were then sent them further information and a consent form. Patients were asked to make an appointment with a relevant practitioner, who then used the decision tool during the consultation to assess and manage their UI. Outcome data for impact of UI symptoms and quality of life were collected from all patients using the ICIQ-SF and IQoL and EQ-5D questionnaires. Interviews were carried out with health care professionals and patients to evaluate the acceptability of the tool in practice.<br /> <br /> Key Findings<br /> 1. Four main themes were identified from the focus group data, relating to patient reporting of UI symptoms to clinicians and patterns of referral, health care professionals’ perceptions about adequacy of their knowledge and training to assess and manage UI symptoms in women, implementation of (NICE) clinical guidance and health care professionals’ perceptions regarding the need for a decision tool.<br /> <br /> Current care pathways in the UK mean that the first port of call for most women with incontinence will be their GP or practice nurse/ nurse practitioner. Despite this most practice nurses and GPs highlighted their lack of up to date knowledge in this area. None of the study participants, mentioned having seen, or used, the NICE ‘Quick Reference Guide’, none of the practice nurses or GPs reported using validated instruments to assess UI symptom severity and impact on quality of life and most were unaware of the existence of these tools. All groups of practitioners welcomed an easy to use tool that could assist them with the process of assessing and managing UI. The tool developed on the basis of the focus group interviews was a one page decision algorithm.<br /> <br /> 2.&nbsp; 94 health care professionals were sent copies of the scenarios for completion; 30 GPs; 44 Community Nurses; 20 Practice Nurses. Thirty-one completed sets of scenarios were returned in the first round of testing (12 GPs, 12 Community Nurses, 7 Practice Nurses) and another 24 completed sets at the second round (11 GPs, 10 Community Nurses, 3 Practice Nurses), providing 24 sets for intra-rater reliablity analysis. Participants using the tool had a higher level of agreement and identified the type of UI more accurately (Kappa range without tool 0.2-0.65; with tool 0.69-0.84).&nbsp;<br /> <br /> 3. 1200 patients were included in the mail out; 236 returned a 'decline' form, mainly because they did not have UI symptoms; 58 women contacted the research team, of whom 15 were eligible and assessed by a health care professional. All GPs and practice nurses in both practices were trained in the use of the decision tool, but practice nurses carried out the consultations. Training comprised a 45 minute long session and a pack with information for every individual member of staff.&nbsp; Interviews with practice nurses suggested the tool was a useful guide to taking a relevant history/increasing confidence in managing UI symptoms.&nbsp; The ICIQ-Short Form was new to all HCPs in the study; they appreciated its comprehensiveness and brevity and the direct link to the related website.&nbsp; Nurses reported bladder diaries were often incomplete and difficult to interpret. They commented that the decision tool would need to be supplemented by written material relating to pelvic floor muscle and bladder training (sourced by links to websites). The need for the tool to be electronically available was strongly emphasised.&nbsp;<br /> HCP's decisions: women's symptoms were accurately categorised according to UI symptoms; recommended treatments (mainly PFMT) / referrals were appropriate.<br /> Patient completion rates for ICIQ-SF, EQFD and IQoL were high, with some attrition over time&nbsp;<br /> <br /> Overall feasibility: the decision tool functioned well in practice; feedback suggested participants would find an electronic version more user friendly.&nbsp;<br /> <br /> Findings from 10 patient interviews indicated the ICIQ-SF was seen as quick and easy to complete, and the bladder diary inconvenient; patients found leaflets on PFMT and bladder training useful.&nbsp;<br /> <br /> Expected Impact<br /> The tool developed and tested in this study has the potential to improve the assessment and management of UI in women in community settings. It has been shown to be useful for GPs and practice nurses who highlighted their lack of education and training in the management of UI in women. It also has the potential to be transferred into electronic format and added to existing EHR systems in primary care; where it can be available to all health care staff for the initial assessment and management of UI in women.&nbsp;<br /> <br /> Conclusions<br /> This study has developed and tested a decision tool for the initial assessment and management of UI in women in the community.&nbsp; It has produced a tool that practitioners find easy to use, with minimal training, that is acceptable in practice and improves the accuracy of identification of the type of UI. The feasibility study identified that it would be practical to test the tool further in GP practice settings. Further evaluation of the tool with other areas of community nursing practice (who proved difficult to recruit to this study) and using it in electronic format, would be beneficial.&nbsp;<br /> <br /> <b>Patient and public involvement</b><br /> We identified a group of service users who expressed a willingness to participate in the study through existing continence services.&nbsp; We have met with this group at various points throughout the project to gain their views on the content and format of the decision tool.&nbsp; The group also commented on the content and presentation of the 'patient pictures' representated in the clinical scenarios in stage 2 of the study. Their input and advice was used to design the pilot tools for the focus groups in stage 1, and in the content of scenarios for stage 2. The group were also asked to evaluate the symptom questionnaires used to assess patient outcomes during the feasibility study for 'user-friendliness'.<br /> <br /> Input of service users has been extremely useful during the conduct of this study, and ensured that at all stages our process used tools that patients found easy to use and understand.&nbsp;&nbsp;<br /> <br /> The next stage of our work with the user group is to discuss the findings of the feasibility study with them, and ask their advice regarding dissemination of the tool to relevant user groups.&nbsp; We will also contact the Bowel and Bladder Foundation, to ask for their input into further dissemination of the tool.<br /> <br /> Part of our planned trajectory is to further develop the tool in an electronic format (with links to information such as guidance on bladder training, UI symptom scores online). We would then plan to evaluate the implementation of the tool in practice, in a larger study, using the lessons learned from our feasibility study.&nbsp; The user group will be involved in all of these developments, with one member of the group potentially being a co-applicant on further grant applications.<br /> <br /> <b>Data sharing statement</b><br /> See link <a href="https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253">[https://www.nihr.ac.uk/documents/nihr-position-on-the-sharing-of-research-data/12253</a>] for the NIHR position of the sharing of research data.&nbsp; The NIHR strongly supports the sharing of data in the most appropriate way, to help deliver research that maximises benefits to patients and the wider public, the health and care system and which contributes to economic growth in the UK.&nbsp; All requests for data should be directed to the award holder and managed by the award holder.<br /> <br /> <b>Disclaimer</b><br /> This project is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-1207-15081). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.<br /> <br /> This project was carried out between May 2009 and October 2011. This final report has not been peer-reviewed. The report was examined by the Programme Director at the time of submission to assess completeness against the stated aims.

A core component of community nursing practice in Australia is the provision of palliative care, however this area of practice has been minimally researched. We, therefore, undertook a broader review of the contemporary literature in community nursing; palliative nursing; and community nursing palliative care. Literature was searched electronically in OVID, CINAHL and nursing databases and manually in relevant journals. Findings revealed community and palliative care nursing to be both complex and challenging. Community and palliative nurses ideals for care are compromised by competing practice demands. Changing health systems and philosophical views, limited resources and the perceived 'visibility/invisibility' polarity are identified as major job stressors. Therapeutic use of 'self' and interpersonal communication are recognized as contributing to job satisfaction. Community nurses providing palliative care is as an under researched area yet it is a role that arguably requires critical understanding and recognition. Further research is needed into the relationship between emotional well-being and professional satisfaction for community and palliative care nurses providing palliation.

Background Cellulitis is a painful infection of the skin and underlying tissues, commonly affecting the lower leg. Approximately one-third of people experience recurrence. Nurses who work in general practice (practice nurses) and see people at home (community or district nurses) could have an important role in managing risk factors for cellulitis, such as long-term leg swelling, wound care and skin care. Objective To explore practice and community nurses’ views and experiences of helping people to manage risk factors for recurrent lower limb cellulitis. Methods Semi-structured, telephone interviews with 21 practice and community nurses in England from October 2020 to March 2021. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Results Nurses face multiple challenges when supporting people to manage risk factors for recurrent lower limb cellulitis. Key challenges include limited time and access to resources such as Doppler equipment, and the physical and psychosocial capabilities of patients to self-manage. Nurses identified potential strategies to overcome these challenges, such as placing greater emphasis on prevention and supporting self-management by providing resources for patients and support networks (paid and unpaid carers) to reinforce knowledge post-consultation and develop skills to self-care. Conclusions We identified a need to develop and evaluate resources, such as support materials, for nurses to use to help patients reduce their risk of recurrent cellulitis.

Rural Community Nurses: Insights into Health Workforce and Health Service Needs in Tasmania

Managing competing philosophies with palliative care

Community (district) nurses play a significant role in assisting and supporting bereaved informal carers (family members and friends) of recently decease clients of palliative care. Bereavement care demands a wide range of competencies including clinical decision-making. To date, little has been known about the decision-making role of community nurses in Australia. The aim of this study was to conduct in-depth examination of an existing data set generated from semi-structured interviews of 10 community nurses providing follow-up bereavement care home visits within an area health service of a metropolitan region of Sydney, Australia. A grounded theory approach to data analysis generated a model, which highlights an interaction between 'the relationship','the circumstances' (surrounding the bereavement),'the psychosocial variant', 'the mix of nurses', 'the workload', and 'the support' available for the bereaved and for community nurses, and elements of 'the visit' (central to bereavement care). The role of community nurses in bereavement care is complex, particularly where decision-making is discretionary and contingent on multiple variables that effect the course of the family's grief. The decision model has the potential to inform community nurses in their support of informal carers, to promote reflective practice and professional accountability, ensuring continuing competence in bereavement care.

Objective To explore the application of experience type teaching in the practice teaching of 'Community Nursing’. Methods Perception, experience, sharing, integration and application models were used for the practice teaching of 'Community Nursing’ among undergraduate nursing students from December 2013 to May 2014. Teaching effects were evaluated. Results 72.1% (98/136) nursing students were satisfied with the experience type teaching. Self-evaluation of ability improvement aspects among 136 nursing students included cooperation (71.32%), communication (60.29%), independent learning (54.41%), and problem analysis (51.47%), etc. Conclusions Experience type teaching can help improve the students′ competency for community nurses and cultivate the students′ community professional quality and comprehensive ability. Key words: Students, nursing; Community Nursing; Experience type teaching

Objective To explore the status quo of evidence-based practice in community nurses in terms of knowledge, attitude and practice (KAP) and to analyze its influencing factors. Methods Totally 422 community nurses from Hangzhou and Shenzhen were selected by convenient sampling from October 2017 to April 2018, and their evidence-based KAP was investigated with the evidence-based knowledge, attitude and practice questionnaire. SPSS 20.0 was used for statistical analysis. The total score and scores of various dimensions and items were calculated. The t test and variance analysis were used to compare the scores of community nurses under different conditions, and multivariate linear regression analysis was employed to analyze the influencing factors of evidence-based practice in community nurses. Results The average scores of evidence-based knowledge, attitude and practice in community nurses were (3.86±0.32) , (4.27±0.45) and (3.76±0.25) , respectively. There was statistically significant difference in total KAP scores between community nurses with professional titles, management jobs, research experience and regular reading of literature, in total scores and evidence-based knowledge scores and practice in community nurses with different first degrees, in evidence-based practice scores and total scores between community nurses with different current degrees and in evidence-based attitude scores and total scores between community nurses with or without evidence-based training (P<0.05) . Multivariate linear regression analysis revealed that professional title and evidence-based training experience affected evidence-based knowledge, attitude scores and total scores (P<0.05) , and professional title and current degree affected evidence-based practice in community nurses (P<0.05) . Conclusions The evidence-based practice of community nurses needs to be improved. Degrees have impact on the evidence-based practice of community nurses. The evidence-based practice of community nurses with higher titles is better. Evidence-based training may facilitate the evidence-based knowledge and attitude of community nurses. Key words: Evidence-based medicine; Evidence-based practice; Community nurses; Questionnaire investigation

The ageing population and the changing disease profile have been driving the demand for community nurses. However, few nursing students in Singapore aspire to have a career in community nursing following graduation. To explore undergraduate nursing students' perceptions of a career in community nursing and to identify strategies to promote community nursing among nursing students. An exploratory qualitative design was used. Four focus group discussions were conducted with a purposive sample of 24 undergraduate nursing students from a university. Interview transcripts were analysed using thematic analysis. Four key themes emerged as follows: 'mid-life career', 'limited career progression', 'a difficult transition' and 'international nurses-dominated workforce'. While most participants rejected a career in community nursing immediately after graduation, they planned to join it at the later stages of their lives to accommodate changing life priorities. Limited career progression and increased difficulty in career transition from community nursing to acute care nursing were identified as deterrent factors in the participants' choices of community nursing as a career. Feelings of marginalization and a lack of role models in community nursing were perceived to be the result of the international nurses-dominated community workforce. Community nursing remains an underrated career. There is a need to foster an optimistic career outlook and mobility in community nursing to entice nursing students into this career track. Strategies to enhance community nursing recruitment should focus on providing more quality and diverse community placement opportunities in various community care settings, implementing a clearly defined career developmental plan to elucidate the role of community nurses, and improving community care and cultural competencies to develop a skilled and diverse community nursing workforce.

British Journal of Community Nursing Vol 18, No 2 77 The health system—and palliative care in particular— are facing difficult financial times due to spending cuts. It seems that when times are this hard one of the first things to go is staff education, which is disturbing considering that it takes years to train community palliative care nurses to function at specialist level. Attendance at courses, conferences and study days/seminars are all affected, which leaves one asking whether palliative care education among community nurses still has currency needed to enhance patient experience. However, despite these negative outcomes the Government has confidently stated that a positive patient experience is an important quality health outcome. The financial situation and the Government’s aspiration create tension, in that, to create a positive patient experience, there must be a well trained workforce to deliver the best services and care possible. But the Willis report (2012) concurs that there are no ‘major shortcomings’ in nursing education to affect the quality of care given to patients. The report goes on to recommend under theme 4: continuing professional development that all relevant bodies including employers and universities should recognise, fund, promote and support nurses development. This would include community nurses as a way of investing for the future. The issue may be how education is translated into practice to benefit patients. It was encouraging when, in January, the prime minster pledged £40million funding for ward managers, community team leaders and senior nurses to gain necessary skills to provide compassionate care. For community team leaders, compassionate care is even more crucial to patients at the end of their lives. However, considering the number of groups this money is intended for, one wonders whether it will be enough to see real change for all patients. Education of community nurses in palliative care is crucial if all patients are to be afforded a dignified and unique death. Education of community nurses ensures that patient experience can be enhanced at point of care delivery. Community nurses need to understand the patient’s needs, concerns, wishes and fears. Community nurses need to be equipped with skills that help them support the patient physically and emotionally. When death is impending, most patients want information so informational care is vital. The national cancer patient experience survey (2010) reported 43% of patients want more information about their diagnosis than what they are given (Department of Health, 2010). Informational care helps patients understand better their disease, its progression and palliative treatment plan where possible. Educated community nurses can provide evidence-based information, which has been tested for validity. However, in order to do so they need to be able to understand the evidence to decide on its clinical relevance. Education is one sure way of achieving this. The knowledge that death is imminent often evokes emotional responses for patients, and a community nurse may be the first professional to visit them at home, following confirmation of the diagnosis. Patient experience would be enhanced if the nurses recognise and address the emotions being expressed in a non-judgemental way. Emotions are expressions of feelings and at times a cry for help, which can be managed through information or a platform to talk and alleviate anxiety, worries and fears. Evidence from Armes et al (2009) suggests 50% of people (150 000 per year) experience anxiety and depression following a diagnosis of cancer. In order to support patients with emotional needs, community nurses’ communication skills need to be effective and this can be enhanced through training and refresher workshops. Some employers afford their staff sufficient education and training and demonstrate continual professional development. However, in some organisations—and I have experienced it personally—it is quite frustrating for nurses who are funded to attend palliative care courses, conferences and seminars to find that when they return, there is no appetite from management to implement the new evidence or facilitate knowledge exchange with other staff. Putting this into the context of real cost and time, it translates to a waste of resources, educating these nurses in this way. Similarly, when community nurses have completed a research project as part of their degree, there is no incentive to disseminate findings and implement changes in practice. A clear strategy is essential to ensure that such vital knowledge is put to good use that will benefit patients at the end of their life. One in five people develop significant long-term emotional difficulties (Macmillan Cancer Support, 2012), seriously affecting their quality of life, so it is vital community nurses are supported to improve the patient experience and do it right first time. BJCN

Community nurses deliver comprehensive nursing care to patients living outside of hospital settings and play a crucial role in meeting individual and public health needs. Research is essential in providing evidence-based care for patients; however, most community nurses are not research active, with few relevant studies and little funding for community nursing research. To address this, four National Institute for Health Research senior nurse researchers in England conducted a James Lind Alliance priority setting partnership in community nursing with the aim of raising the international profile of community nursing research through the identification of meaningful research priorities that matter to this community. Community nurses, patients, and carers were integral to the process, which aimed to identify the top ten unanswered questions to inform community nursing practice. The Priority Setting Partnership process utilised a coproduction, mixed-methods approach. It involved consultation meetings with stakeholder partners and nested quantitative surveys. The study ran from March 2020 until September 2021, and numerous unanswered evidence uncertainties were identified. The top ten priority questions included nursing and patient focussed issues, which reflect the complexity of care delivered to patients and the workforce pressures community nurses face. Findings reflect the views of community nurses, patients, and carers and highlight areas that need attention to ensure research is embedded within community nursing settings. Identification of the top ten priorities has provided an international platform for community nursing research. This must be sustained through engagement, collaboration, funding, and innovation and has widespread implications for developing the community nursing workforce and optimising the safety and quality of patient care.

BackgroundCOVID-19's high infectivity and fatality rates have generated a plethora of mental health problems worldwide. Hoarders accumulate products such as masks and daily necessities due to anxiety and restrictions on going out, which further exacerbate their symptoms. Since community nurses often visit patients' homes, they can identify hoarding symptoms in the early stages and provide support. Community nurses' knowledge pertaining to the prevention and management of hoarding can provide insight for mental health professionals.MethodsThe terms ‘hoarding', ‘prevention', and ‘public health nurse/community nurse/home nurse' were searched on PubMed, ProQuest, Science Direct, CINAHL, Medline Complete, and six Japanese databases (Ichushi Web, NDLonline, CiNii, J-stage, J-DreamIII, Saishin-kango-sakuin web) in April 2021.ResultsI selected 13 articles on community nurses' roles from the abstracts of 302 academic articles identified by the search results. The articles were categorised based on research objectives, research methods, and community nurses' roles. It was suggested that prevention requires supporting mothers, who are at risk for hoarding. Research on measures to prevent hoarding behaviour from becoming severe found that family-based interventions (harm reduction approach), education programs for collaborators, and group reminiscence therapy for elderly individuals with dementia are effective. It was also suggested that cooperation and hoarding education among non-medical providers are important.ConclusionsCommunity nurses' roles in treating hoarding should be based on support and health education through cooperative relationships with families, neighbours, and establishment of related organisations.Key messages In the COVID-19 pandemic and aftermath, it is important to learn various practical activities for mental health.Community nurses may be able to help prevent hoarding behaviour to reduce psychological stress among hoarders, their families, and neighbours, thus prevent further hoarding deterioration.

To explore activities performed by community nurses in community health centre clinics and during home visits. Cross-sectional, observational using time and motion technique. Data collected during lockdown in 2020. Community nurses' work in clinics and during home visits were observed and recorded. The purposefully designed data collection tool covered six categories (Administration, Communication, Direct care, Documentation, Indirect care and Other) and 35 activities relative to community nurses' work. Eight hundred and ten complete timings were obtained. Community nurses' time was most often (86.5%) spent on Direct care, Communication, Documentation and Other activities. Patient education occurred more often in the home. The type, frequency and time taken to complete community nursing activities provides insight into the community nurse role. Addressing inefficient practices such as documentation and travel could serve to improve workload. Adheres to EQUATOR guideline STROBE for cross-sectional studies. No patient or public contribution.

A response to L. Kemp, E. Harris &amp; E. Comino Changes in community nursing in Australia: 1995–2000. <i>Journal of Advanced Nursing</i><b>49</b>(3), 307–314.

BackgroundOlder people who receive care at home are likely to require support with oral health care. Community nurses, who are also referred to as district or home care nurses, have an important role with this population. This is because they are the healthcare professionals who are most likely to encounter this population, who may also not be receiving regular dental care or oral health promotion. However, few studies have explored community nursing experiences in the delivery and support of oral healthcare for older people living at home.MethodsA grounded theory approach was used to explore experiences of community nurses in the delivery and support of oral health care for older people living at home. Fifteen practising community nurses from the United Kingdom participated in one-to-one semi-structed interviews from May 2021 to December 2021. These interviews were audio-recorded, transcribed verbatim and analysed using constant comparative analysis. Ethical approval was obtained for this study prior to data collection.ResultsFour categories emerged from the data to support development of the core phenomena. These four categories were: (1) Education, in relation to what community nurses knew about oral health, (2) Practice, with regards to how community nurses delivered oral health care to older people in their own home, (3) Confidence, with consideration to the extent to which this supported or impeded community nurses in providing oral healthcare to older people and (4) Motivation, in terms of the extent to which community nurses thought they could or should influence future practice improvement in the area. The core category was (C) Uncertainty as it was both present and central across all four categories and related to community nursing understanding about their specific role, and the role of other professionals, with reference to oral health of their patients.ConclusionsThis study reveals community nurses' uncertainty in providing oral healthcare to older adults at home. Emphasising comprehensive and continuous oral health education can boost nurses' confidence in patient support. Interprofessional collaboration and clear role definitions with oral health professionals are crucial for improving oral health outcomes in this vulnerable population.