Care Clients Research Articles

The mobilization of nurse-client therapeutic relationships in injectable opioid agonist treatment: Autonomy, advocacy and action

IntroductionInjectable opioid agonist treatment (iOAT) is an evidence-based treatment that serves an important minority of people with opioid use disorder who require specialized care. Unique to iOAT care is the consistency with which clients access treatment (up to three times daily), a condition that creates repeated opportunities for health care engagement. To date, no study has examined therapeutic relationships in this life saving, nurse-led treatment that can have lasting implications in the equitable delivery of other forms of addictions care. MethodsThis study used grounded theory to generate a dynamic framework for therapeutic relationship building in iOAT. Researchers collected semi-structured interviews from registered nurses working in iOAT sites (n=24) form January 2020 through June 2022. The study analyzed collected data through a constant comparative analysis; explored through open, axial, and selective coding; and assessed in a conditional relationship matrix. The team reviewed key findings with stakeholders through formalized processes of engagement to confirm saturation of coding categories. Throughout data collection and analysis, researchers integrated feedback from additional knowledge users and member checking. Reported findings adhered to the COREQ1 standardized checklist. ResultsWe identified five interrelated categories that created a distinct culture of care for iOAT nurses: Ways of Knowing, Personal Investment, Leveraging Empathy, Finding Flexibility, and Collaborating to Overcome. Through creating a safe, nonjudgmental environment, nurses establish therapeutic relationships that build trust to identify client needs outside of medication administration. In turn, nurses participate in team-based problem solving to advocate for client needs. If nurses cannot find flexibility within and outside of the health care system to improve client engagement, tensions can arise and therapeutic relationships can be strained. ConclusionsTherapeutic relationships are an integral part of building and maintaining trust with a population that has been precariously involved with other forms of health care. Nurses make a substantial effort to create a safe and nonjudgmental environment to manifest a culture of care that bridges client needs and program access. Without the expansion of access to iOAT programs and their embedded services, nurses are limited in their ability to provide individualized care for clients with diverse needs.

The impact of COVID-19 restrictions on the delivery of occupational therapy: How technology use affected practice during COVID-19 among occupational therapists in British Columbia.

COVID-19 activity restrictions altered clinical practice around the world. Anecdotal evidence observed by the Canadian Association of Occupational Therapists - British Columbia (CAOT-BC) suggested a rapid adjustment to virtual care technologies occurred among occupational therapists in the initial restrictions. The purpose of the study was to determine the scope of how COVID-19 restrictions impacted the use of technology to provide client care in British Columbia. It will inform the future provision of occupational therapy in the developing technological landscape related to heath care provision. This descriptive cross-sectional survey was completed using Qualtrics, an online survey tool. Registered occupational therapists received the survey via email invitations. The data were analysed using descriptive statistics in IBM SPSS Software. Of 342 participants, 98.4% reported increased technology use to support practice with the advent of COVID-19 restrictions. Those with some technology experience prior to COVID-19 reported higher intent to continue using technology following COVID-19 restrictions. Overall, occupational therapists were confident in their perceived abilities to use technology in their practice. Occupational therapist-related, client-related, and practice area considerations occurred with the rapid uptake of technology. Some components of practice were perceived to be improved and others impaired with the use of technology. Occupational therapists substantially increased their use of technology to enable ongoing client care during the Covid-19 restrictions. Implications for improvements and reduction of limitations in care delivery are substantial, given the intent to continue using technology going forward. These implications can be further explored to understand how the advances in occupational therapists' ability to use technology may impact rural or remote care, which practice areas may be most amenable technology use, and how policies and funding can facilitate effective and appropriate use of technology to support clinical care in public and private settings.

Applying a Power and Gender Lens to Understanding Health Care Provider Experience and Behavior: A Multicountry Qualitative Study.

A limited but growing body of literature shows that health care providers (HCPs) in reproductive, maternal, and newborn health face challenges that affect how they provide services. Our study investigates provider perspectives and behaviors using 4 interrelated power domains-beliefs and perceptions; practices and participation; access to assets; and structures-to explore how these constructs are differentially experienced based on one's gender, position, and function within the health system. We conducted a framework-based secondary analysis of qualitative in-depth interview data gathered with different cadres of HCPs across Kenya, Malawi, Madagascar, and Togo (n=123). We find across countries that power dynamics manifest in and are affected by all 4 domains, with some variation by HCP cadre and gender. At the service interface, HCPs' power derives from the nature and quality of their relationships with clients and the community. Providers' power within working relationships stems from unequal decision-making autonomy among HCP cadres. Limited and sometimes gendered access to remuneration, development opportunities, material resources, supervision quality, and emotional support affect HCPs' power to care for clients effectively. Power manifests variably among community and facility-based providers because of differences in prevailing hierarchical norms in routine and acute settings, community linkages, and type of collaboration required in their work. Our findings suggest that applying power-and secondarily, gender lenses-can elucidate consistencies in how providers perceive, internalize, and react to a range of relational and environmental stressors. The findings also have implications on how to improve the design of social behavior change interventions aimed at better supporting HCPs.

Nursing Care for Clients Suffering from Non-Hemorrhagic Stroke with Impaired Physical Mobility in the Neurology Room, 6th Floor, Block B Koja Regional Hospital, North Jakarta

Non-Hemorrhagic Stroke is a blockage of blood vessels which causes blood flow to the brain to partially or completely stop, causing Non-Hemorrhagic Stroke sufferers to experience muscle weakness in some parts of their body. Based on the number of non-hemorrhagic strokes that occurred at Koja District Hospital from January to July 2017, there were 52 patients. The actions taken by nurses to reduce muscle tone weakness are Range of Motion (ROM) exercises which aim to increase muscle tone strength. In this study the author carried out a case study research design method by comparing 2 clients who experienced Non-Hemorrhagic Stroke with impaired physical mobility. To overcome this physical mobility disorder, the author provided Range of Motion (ROM) nursing actions to 2 clients for 6 days. After carrying out nursing actions for 6 days, the author compared the two clients to determine the client's response to Range Of Motion (ROM) nursing actions. In carrying out data analysis, the author collected data from interviews, observations, physical assessments, supporting data, medical records, nursing actions for 2 clients who would receive nursing care who experienced Non-Hemorrhagic Stroke with impaired physical mobility. The research results obtained were that there was an increase in muscle tone strength in client 1 (Mr. S) because Mr. S has high motivation, there is support from the family, sufficient knowledge, and the family's willingness to train ROM independently. Meanwhile, there was no change in increasing muscle strength in client 2 (Mrs. T) due to the client's low motivation to recover, lack of support from the family, lack of knowledge, and lack of family willingness to train ROM independently. Suggestions for nurses, especially Koja Regional Hospital nurses, are expected to be able to provide ROM exercises to Stroke clients.

Nursing Care of Chronic Kidney Disease with Activity Intolerance Nursing Problems: A Case Study

Nursing care for patients who experienced chronic kidney disease with intolerance of activities and nursing problems in the Bougenville Room at Dr.H.Koesnadi General Hospital, Bondowoso Regency. Chronic Kidney Disease (CKD) is an irreversible disease that develops slowly and progressively. The main factor causing this disease is adults with Diabetes Mellitus and Hypertension. Symptoms are pain, hematuria, anuria, and anemia. This of course results in a feeling of weakness and fatigue so that the problem of Activity Intolerance can arise. This study aims to carry out nursing care for clients who experience chronic kidney disease with activity intolerance nursing problems. The research design was a case study of one patient with chronic kidney disease with Activity Intolerance nursing problems in the internal care room (Bougenvile) Dr.H. Koesnadi Bondowoso. Data was collected on 15-16 May 2023 using interviews, observation, physical examination, documentation studies, and questionnaire techniques. The results of this study were obtained from the assessment, which then formulated a diagnosis in accordance with the theoretical review. Nursing interventions using SIKI adapted to the client's conditions, implementation, and evaluation referring to the results criteria obtained are 99% O2 saturation, RR 19 x/minute, decreased complaints of fatigue, and decreased feeling of weakness. Clients are expected to always maintain their health condition, especially fluid intake, and balanced nutrition to support kidney function and fulfill daily activities.

Acceptability of the routine use and collection of a generic patient reported outcome measure from the perspective of healthcare staff: a qualitative study

BackgroundPatient-reported outcome measures (PROMs) provide a measure of self-perceived health status or health-related quality of life. They have been used to support provider-patient decisions, healthcare delivery, and value-based healthcare models. A barrier to routine collection of PROMs is the perception that PROMs lack clinical utility. As such, it is important to establish clinicians’ acceptability of the PROM prior to large-scale implementation. This study explored the acceptability of the routine use and collection of a generic PROM in healthcare services from the perspective of healthcare staff.MethodsIndividual semi-structured interviews were completed from September 2020 to March 2021 with 26 staff from two multi-disciplinary community healthcare services in Melbourne, Australia. Interviews explored their experiences of using the EQ-5D-5L in their routine care. Interviews were recorded and transcribed verbatim. Data were analysed according to a framework approach, using inductive and deductive techniques.ResultsParticipants discussed the acceptability of the EQ-5D-5L with reference to four themes: practicalities of use; holistic nature; influence on client care; and influence on health service. Participants found the EQ-5D-5L quick and easy to administer, and appreciated that it measured multiple domains of health that were relevant to their clients’ care. They believed the EQ-5D-5L helped to identify client problems, and inform service delivery. They also reported features that were less acceptable, including a lack of item specificity to some healthcare disciplines. Participants reported the challenge of managing conflict between their assessment of the client’s health and the client’s perspective of their own health, leading some to question whether the client could provide an accurate reflection of their own health.ConclusionsThe EQ-5D-5L has several features that healthcare staff viewed as acceptable for routine collection and use in healthcare. Training on the validity of the patient reported perspective and broadening the scope of PROMs collection beyond the EQ-5D-5L should be considered to facilitate large-scale implementation.

Experiences and perceptions of everyday decision-making in the lives of adults with intellectual disabilities, their care partners and direct care support workers.

Background: Decisional support is important to people with intellectual disabilities. This review explores: i) how everyday decision-making is perceived and/or experienced by adults with intellectual disability, their care partners and direct care support workers (DCSWs); ii) techniques/approaches used to support everyday decision-making; and iii) barriers/facilitators encountered. Method: PRISMA systematic review methodology using PsycInfo, PubMED, Web of Science, CINAHL and Scopus. Results: Eighty-one papers were included [qualitative (n = 69), quantitative (n = 7), mixed methods (n = 5)]. Adults with intellectual disability reported wanting to make decisions and needing support. Care partner support was affected by concerns about safety and decisional capacity. DCSWs reported difficulty balancing client decisions and care partner concerns when providing support. Supported Decision-Making (SDM) was identified as a key method of support. Barriers and facilitators were interconnected and impacted by stressors. Conclusion: This topic is under-researched and ill-defined. Supported decision-making is an increasingly popular approach whose application requires further exploration.

Disrupting Racism in Ontario Midwifery.

There are a limited number of Canadian studies that explore the experiences of racism among health care providers who are Black, Indigenous, or people of color (BIPOC), and specifically within the context of midwifery in Ontario. More information is needed to better understand how to achieve racial equity and justice at all levels of the midwifery profession. Semistructured key informant interviews were conducted with racialized midwives in Ontario to understand how racism manifests in the midwifery profession and to conduct a needs assessment of interventions required. The researchers used thematic analysis to identify patterns and themes within the data and to develop a better understanding of participants' experiences and perspectives. Ten racialized midwives participated in key informant interviews. The vast majority of participants reported experiences of racism in their work as a midwife, including being subject to or witnessing racism from clients and colleagues, tokenism, and exclusionary hiring practices. More than half of participants also emphasized their commitment to providing culturally concordant care for BIPOC clients. Participants relayed that access to BIPOC-centered gatherings, workshops, peer reviews, conferences, support groups, and mentorship opportunities constitute important supports for improving diversity and equity in midwifery. They also expressed a need for midwives and midwifery organizations to actively work to disrupt racism and the power structures in midwifery that enable racial inequity to proliferate. The manifestations of racism in midwifery have negative impacts on the career trajectory, career satisfaction, interpersonal relationships, and well-being of BIPOC midwives. It is crucial to understand the role of racism in midwifery and make meaningful changes toward dismantling interpersonal and systemic racism in the profession. These progressive changes will serve to create a more diverse and equitable profession, where all midwives can belong and thrive.

Clients in Uganda accessing preferred differentiated antiretroviral therapy models achieve higher viral suppression and are less likely to miss appointments: a cross-sectional analysis.

The Uganda Ministry of Health recommends facility- and community-based differentiated antiretroviral therapy (DART) models to support person-centred care for eligible clients receiving antiretroviral therapy (ART). Healthcare workers assess client eligibility for one of six DART models upon initial enrolment; however, client circumstances evolve, and their preferences are not routinely adjusted. We developed a tool to understand the proportion of clients accessing preferred DART models and compared the outcomes of clients accessing preferred DART models to the outcomes of clients not receiving preferred DART models. We conducted a cross-sectional study. A sample of 6376 clients was selected from 113 referrals, general hospitals and health centres purposely selected from 74 districts. Clients receiving ART accessing care from the sampled sites were eligible for inclusion. Healthcare workers interviewed clients (caretakers of clients under 18), over a 2-week period between January and February 2022 using a client preference tool to elicit whether clients were receiving DART services through their preferred model. Treatment outcomes of viral load test, viral load suppression and missed appointment date were extracted from clients' medical files before or immediately after the interview and de-identified. The descriptive analysis determined the interaction between client preferences and predefined treatment outcomes by comparing outcomes of clients whose care aligned with their preferences to outcomes of clients whose care misaligned with their preferences. Of 25% (1573/6376) of clients not accessing their preferred DART model, 56% were on facility-based individual management and 35% preferred fast-track drug refills model. Viral load coverage was 87% for clients accessing preferred DART models compared to 68% among clients not accessing their preferred model. Viral load suppression was higher among clients who accessed the preferred DART model (85%) compared to (68%) clients who did not access their preferred DART model. Missed appointments were lower at 29% for clients who accessed preferred DART models compared to 40% among clients not enrolled in the DART model of their choice. Clients who accessed their preferred DART model have better clinical outcomes. Preferences should be integrated throughout health systems, improvement interventions, policies and research efforts to ensure client-centred care and client autonomy.

Addressing Quality-of-Life Issues for OT Clients with Lymphedema

Abstract Date Presented 04/21/2023 This study investigated how OTs who were certified lymphedema therapists addressed quality-of-life (QOL) issues for clients with lymphedema. Participants tended to administer occupation-based interventions but not QOL assessments despite how important they rated addressing client QOL. Because lymphedema affects QOL, it is important to understand practice trends to improve client care and justify the need for OT in this specialty area of practice. Primary Author and Speaker: Mackenzie Feldhacker Contributing Authors: Keri B. Kamphoff

Regression Discontinuity Designs in Counseling Intervention Research and Program Evaluation: A Primer on a Strategy for Making Causal Inferences

The move toward evidence-based practice within counseling intervention research continues to grow. However, there are many practical barriers to implementing research designs that can support causal claims regarding counseling intervention efficacy. Overcoming these hurdles serves a larger goal of improving client care and further legitimizing the counseling profession. This article outlines an underused research design called regression discontinuity (RD), one of the strongest quasi-experimental designs available. RD allows researchers to use a cutoff score to determine treatment group assignment in situations where a randomized control trial is not feasible or ethical, such as when assigning care based on need consistent with the social justice values of the field. Historically, RD is rarely employed in counseling research. Therefore, to facilitate use, we provide a primer on key RD design concepts along with a concrete demonstration of the design, data analysis, and interpretation. We review the causal logic of the basic RD design followed by two data outcomes for a hypothetical scenario. Data and SPSS syntax are provided to allow readers to follow along and conduct their own analyses.

The Relationship of Family Knowledge and Attitude with Diabetes Mellitus Prevention in Puskesmas Bengo, Bengo District, Bone District

Knowledge is the result of knowing, and this happens after people sense certain objects. The five human senses are the senses of sight, hearing, smell, taste and touch. Most of human knowledge is obtained through the eyes and ears, namely the process of seeing and hearing. This study aims to determine the relationship of family knowledge and attitudes with the prevention of Diabetes Mellitus at the Bengo Health Center, Bengo District, Bone Regency. The variables in this study include knowledge, family attitudes and prevention of diabetes mellitus. This study was sectional and a sample of 41 people was carried out from 1 August to 1 September 2022. The research method used was quantitative research with a cross-sectional design. Data collection used a purposive sampling technique. Variables were measured using a questionnaire containing questions and statements. Results of the study: the results showed that there was no relationship between family attitudes and the prevention of diabetes mellitus with a significance level of p = 0.446 where p> 0. 05, while for knowledge there was a relationship with p = 0.007 where 0.007 <0.05. It is a sign that knowledge of the client’s family very important to take care of the diabetes mellitus clients.

Penerapan Communication Skill Training pada Pelaksanaan Psikoedukasi Keluarga yang Merawat Klien dengan Hipertensi

This study aims to provide an overview of the application of communication skills training in the implementation of family psychoeducation that treats clients with hypertension. The research method used in this study is a case report which describes and analyzes in depth the benefits of applying family communication methods in caring for clients with hypertension. The results showed that there were changes in healthy lifestyles and an increase in the quality of care for clients with hypertension after implementing communication skill training in the implementation of family psychoeducation. In conclusion, the application of communication skill training in the implementation of family psychoeducation that treats clients with hypertension can improve healthy lifestyles and the quality of health care services for clients with hypertension.
 
 Keywords: Hypertension, Communication Skills, Therapeutic Communication, Psychoeducation

Optimizing Weekend Schedules in Home Health Care: The Essential Care on Weekends for Personal Support Quality Improvement Project

The availability of personal support workers (PSWs) is a limiting factor for home care system capacity, as this workforce provides 70% to 80% paid care in this sector. Without sufficient support to live at home, many seniors and people with disabilities experience poorer outcomes and require care in more expensive and less preferred institutional long-term care or hospital settings. Insufficient PSW availability is limiting access to necessary care in the community. Capacity challenges are particularly pronounced on weekends. The Essential Care on Weekends (ECoW) program was co-developed as one solution to adapt current PSW scheduling practices to increase the number of clients with high-intensity care needs who can be served within the constraints of PSW availability. ECoW focused on increasing weekend capacity and care consistency, particularly for clients with the highest care needs, through prioritizing essential care and moving less time sensitive tasks to weekdays. ECoW was operationalized through 4 activities: communication and engagement, clinical care plan review, geographic review of PSW schedules and the creation of the ECoW schedule. Implementation of ECoW demonstrated success in increasing access to and consistency of care for clients with the highest care needs: weekend capacity increased, access to care improved for clients requiring daily or near-daily care and missed care rates decreased both on weekends and weekdays. This strategy represents a change in scheduling practices that organizations can use to provide consistent service to a growing number of clients with high-intensity care needs in the context of increasingly limited health human resource capacity.

Implementation of Family Nursing Care for Clients with Rheumatoid Arthritis to Physical Mobility Disorders with Active and Passive Movement Exercises

Background: Rheumatoid Arthritis (RA) is a disease characterized by a chronic autoimmune inflammatory disorder or autoimmune response that causes weakening of the joints and synovial lining, especially in the hands, feet, and knees. Patients with RA often experience impaired physical mobility, a condition where a person cannot move freely due to conditions that hinder movement (activity). One of the interventions that can be given to RA patients is Range of motion (ROM) exercises, which are exercises performed to maintain or improve the perfection of the ability to move joints normally and completely to increase muscle mass and muscle tone. research to assess the effectiveness of implementing family nursing care with active and passive movement exercises against impaired physical mobility in Rheumatoid Arthritis sufferers in the work area of Taba Health Center, Lubuklinggau City, in 2022. Methods: This study uses a qualitative design with a case study approach to describe information descriptively. In-depth and explores nursing problems for families with rheumatoid arthritis with impaired physical mobility due to joint stiffness. Results: After implementation by giving active and passive motion exercises to both subjects (Mr. S and Mrs. E) for five consecutive days with a time of 10-15 minutes, both subjects said that stiffness in the extremities was reduced and the value of muscle strength increased to 5 and 4. Conclusion: Implementing nursing care with active and passive motion exercises can increase joint strength in clients with rheumatoid arthritis.

APPLICATION OF FAMILY CENTERED CARE (FCC)

The role of the family in the theoretical system is as a caregiver for sick family members. Family involvement in client care is applied in care known as the Family Centered Care concept. The application of Family Centered Care can increase knowledge and attitudes of families in the care of clients who are hospitalized. The purpose of the study was to determine the level of application of Family Centered Care. The research method used is a descriptive study. The research sample was 100 respondents. The sampling technique used is accidental sampling. The data collection tool used is a family centered care questionnaire. The research analysis used univariate analysis in the form of a frequency distribution. The results showed that the application of family centered care was in the good category as many as 71 respondents (71%), and in the medium category as many as 29 respondents (29%). From the results of the study, it was stated that nurses had involved the family in care, where the family participated in making decisions on support plans, recovery and helping patients not to be anxious. The conclusion is that the application of family centered care is in the good category.

Identifying the critical physically demanding tasks performed by personal support workers in Canada

Due to increased work demands, personal support workers (PSWs) are experiencing more work-related injuries. However, little is known about PSW work tasks and their corresponding physical demand. The purpose of this study was to identify critical tasks that are physically demanding and completed frequently as identified by PSWs. Additionally, we identified contextual factors (i.e., environmental-, situational-, patient-related) that influenced physical demands. We surveyed 443 community-based PSWs working in Canada who rated the physical demand associated with client care tasks and identified contextual factors that can increase task specific physical demands. Transferring/repositioning patients, dressing, and bathing were perceived as most demanding. Patient weight and mobility influenced the level of physical demand required for most tasks. These data provide a foundation to develop physical employment standards and task specific education and training to prevent PSW injuries.

Implementation of Nursing Care for Clients with Stadium IIA Cervic Cancer in Anxiety Disorders with Benson's Relaxation in The Pavilion of Faith Sudjudi Floor II Gatot Soebroto Army

Cervical cancer is a malignant process that occurs in the cervix, so that the surrounding tissue cannot carry out its functions as it should. The high incidence of cervical cancer in Indonesia has made cervical cancer a major health problem and one of the highest causes of death. It is noted that the incidence of cervical cancer in Indonesia is 36,000 cases or 9.2% of the total cancer cases and ranks second after breast cancer. Cervical cancer is a disease that causes psychological disturbances in the form of anxiety. One therapy that can reduce anxiety is benson relaxation. The purpose of this writing study is to describe nursing care for cervical cancer patients in anxiety disorders with Benson relaxation. The method used is descriptive research in the form of a case study. The characteristics of the subjects of this study were patients who experienced postoperative anxiety about cervical cancer with the HARS scale rating, with a score of 39 with a severe level of anxiety decreasing to 19 with mild anxiety. The results of this study found that in cervical cancer patients. after applying the Benson Relaxation technique can reduce the anxiety experienced by patients. The conclusion from this case study is that Benson's Relaxation Therapy is effective for reducing anxiety, from a score of 39 with a severe level of anxiety there is a decrease to 19 with mild anxiety.

Enhancing palliative care at home: a generalist community nursing case study

Objective: This quality improvement project aimed to explore the experience of home care nurse managers implementing a general palliative approach to care. Implementation comprised several interlinking activities encompassing stakeholder engagement and an education program in the outer eastern region of a home care and nursing organisation in Melbourne, Australia, between September 2019 and December 2020. Background: High quality provision of community based palliative and end-of-life care means people are much more likely to die at home, supported by family, friends and services. To achieve this, care staff must be adequately trained and supported, alongside a collaborative approach with other generalist and specialist providers. Study design and methods: This Case Study reports on the participant perspectives of the stakeholder engagement and education program. Focus groups and an interview were used to elucidate the experience of nursing and allied health professionals providing a general palliative approach in the community. The 2006 National Institute of Clinical Studies framework to identify barriers to best practice healthcare guided the development of focus group questions and the deductive analysis of data. Results: Seven Nursing Care Managers and one Social Worker participated in two online focus groups and one interview. Three overarching themes highlighted the value of tailored education in increasing staff knowledge and confidence, the factors for a successful generalist-specialist partnership, and the unique nature of the home care setting which requires accessible systems and processes. Discussion: This project supports assertions that generalist services can play a valuable role when a palliative approach to care is incorporated. It also underscores the importance of collaborative working partnerships between generalist and specialist services in providing quality community-based palliative care. Future research should examine the needs and perspective of clients, carers and families receiving a general palliative care approach in the community. Implications for research, policy and practice: Investment in developing the capacity and capability of generalist service staff to deliver palliative care is vital, particularly when caring for people in their homes. Although small, this study demonstrates that consideration should be given to embedding staff with specialist palliative care training within generalist organisations to drive and champion evidence-based palliative care provision, training, policies and procedures that meet the unique needs of mobile workforces. Future research should examine the effectiveness of different models and methods for education and generalist-specialist partnerships that meet the needs of mobile home nurses, particularly regarding long-term impact and sustainability. What is already known about the topic? Most Australians prefer to be cared for and die in their own home. Home care nurses are key generalist health professionals who support community-based palliative and end-of-life care, organising and providing care, coordinating the input of other health and social care professionals. Home care nurses face challenges in meeting their clients’ palliative care needs (such as symptom management and communication) and have deficits in their knowledge and confidence of caring for palliative clients. What this paper adds: This case study demonstrated that facilitating ongoing education opportunities that draw on the expertise of local palliative care champions or internal specialists can enhance care provision. Nurse care managers believe the value of generalist services, particularly home care services, in the generalist-specialist palliative care partnership, needs to be understood and respected. Tailored investment in home care to provide a general palliative approach would be beneficial given the unique challenges of this mobile workforce.

Mental Health Client Experiences of Telehealth in Aotearoa New Zealand During the COVID-19 Pandemic: Lessons and Implications.

The COVID-19 pandemic and consequent lockdowns disrupted mental health service delivery worldwide, accelerating the adoption of telehealth services to provide care continuity. Telehealth-based research largely highlights the value of this service delivery method for a range of mental health conditions. However, only limited research exists exploring client perspectives of mental health services delivered via telehealth during the pandemic. This study aimed to increase understanding of the perspectives of mental health clients around services provided via telehealth over the 2020 COVID-19 lockdown in Aotearoa New Zealand. Interpretive description methodology underpinned this qualitative inquiry. Semistructured interviews were conducted with 21 individuals (15 clients and 7 support people; 1 person was both a client and support person) to explore their experiences of outpatient mental health care delivered via telehealth during the COVID-19 pandemic in Aotearoa New Zealand. A thematic analysis approach supported by field notes was used to analyze interview transcripts. The findings reveal that mental health services delivered via telehealth differed from those provided in person and led some participants to feel they need to manage their own care more actively. Participants highlighted several factors affecting their telehealth journey. These included the importance of maintaining and building relationships with clinicians, the creation of safe spaces within client and clinician home environments, and clinician readiness in facilitating care for clients and their support people. Participants noted weaknesses in the ability of clients and clinicians to discern nonverbal cues during telehealth conversations. Participants also emphasized that telehealth was a viable option for service delivery but that the reason for telehealth consultations and the technicalities of service delivery needed to be addressed. Successful implementation requires ensuring solid relationship foundations between clients and clinicians. To safeguard minimum standards in delivering telehealth-based care, health professionals must ensure that the intent behind telehealth appointments is clearly articulated and documented for each person. In turn, health systems must ensure that health professionals have access to training and professional guidance to deliver effective telehealth consultations. Future research should aim to identify how therapeutic engagement with mental health services has changed, following a return to usual service delivery processes.