Community Nurses Research Articles

Factors Related to Evidence-Based Practice among Community Nurses in Greece: A Cross-Sectional Study

Assessing knowledge, attitudes and practices towards evidence-based practice (EBP) is a challenge for healthcare professionals. However, the existing literature focuses on nurses working in acute hospital settings, with nurses working in community and primary healthcare settings receiving comparatively less attention. The purpose of the study was to explore factors that related to attitudes, knowledge and practice of community nurses toward EBP. A cross-sectional study was conducted with a sample of community nurses in Greece. Community nurses around the country were invited to complete an online questionnaire during the period of February to April 2022. To measure nurses’ attitudes, practices and knowledge/skills regarding EBP, the Evidence-Based Practice Questionnaire was used. A total of 164 nurses took part in the study. The mean age of nurses was 41.6 years, with 42.7% having either an MSc or a PhD degree. The overall internal consistency for the EBPQ questionnaire was 0.91. The sample demonstrated a high level of knowledge/skills (mean score of 5.5 on a 7-point scale) and positive attitudes (mean score of 5.5 on a 7-point scale) towards EBP, while the level of EBP practice was moderate (mean score of 4.5 on a 7-point scale). A higher educational level showed a positive relationship with the “practice of EBP” subscale (p = 0.005) and the “knowledge/skills about EBP” subscale (p = 0.003). Additionally, an increase in the knowledge/skills score was associated with a more positive attitude towards EBP (p < 0.001) and better practice of EBP (p = 0.003). The identification of educational level as the main factor related to the knowledge/skills and implementation of EBPs in community nurses emphasizes the necessity for educational initiatives in EBP at both undergraduate and postgraduate levels. Informed nurses who are familiar with current guidelines and evidence can effectively train patients about chronic disease management and prevention. Additionally, creating incentives to motivate participation in lifelong learning programs can indeed play a crucial role in enhancing the proficiency of community nurses in evidence-based practice.

Level of Well-Being among School Going Adolescents

The adolescence state is the progressive transition from childhood to adulthood. They have specific needs which vary with gender, life circumstances, and socioeconomic level. In this stage, they suffer from various forms of problems and conflicts, which ultimately impair normal development and move to a depressive state. This study assessed the level of well-being among school-going adolescents in the south region of Tamilnadu; The uni-variable, descriptive- cross-sectional research design was adopted. Through the convenient sampling technique,120 school-going adolescents responded to the adolescent’s well-being questionnaire (11-16 years) through online Google forms. The collected data were analyzed through the SPSS package. In the results, the majority of school-going adolescents (77%) were depressed and there is a significant association found between gender and grade (P= 0.05%). The nursing fraternities of community and public health nurses and stakeholders in the community take the initiation of remedial measures to support and promote the mental health of adolescents. Keywords: Well-being, School going Adolescents, Conflicts, Depression, and mental Health.

Mediating effect of social support between COVID-19 stress on the mental health of older adults using customized care services: A cross-sectional study

Purpose: This study examined the mediating effects of social support on the relationship between COVID-19 stress and the mental health of older adults using customized care services. Methods: A cross-sectional study was conducted with 179 older adults receiving services at two senior welfare centers in Korea. Data were collected from April 1 to 30, 2022, using self-report questionnaires. Data were analyzed using descriptive statistics, and correlations, multiple regression using Baron and Kenny steps for mediation, with the SPSS 22.0 program. Results: The COVID-19 stress of the study participants was significantly correlated with social support (r=-.16, p<.001) and mental health (r=.30, p<.001). Social support showed partial mediating effects in the relationship between COVID-19 stress and mental health (Z=-3.43, p<.001). Conclusion: These findings indicated that mental health programs could improve community social support resources for older adults in vulnerable groups after the COVID-19 pandemic. In the nursing practice, community nurses suggest the development of programs that can be operated in the community by proposing governmental policies for the mental health management of vulnerable older adults in the blind spot.

Use of an Advance Chart Preparation Process Improves Overall Care in Pediatric Patients with Sickle Cell Disease

Background: Clinics have mostly used pre-clinic chart reviews to increase efficiency of patient appointments and typically only include the provider the day the patient is seen in the clinic. Additionally, these pre-clinic chart reviews tend to focus only on the biomedical needs of the patients and do not often account for the patients' needs relating to social determinants of health (SDoH). Objective: To improve clinical care consistent with national guidelines and enhance comprehensive care coordination for patients with sickle cell disease (SCD) through an advanced chart preparation process incorporating multi-disciplinary team members (Community Health Worker, Research Coordinators, Nurses, and Medical Providers). Methods: Scheduled chart-prep meetings (CPMs) are held approximately 2 weeks before SCD clinic, and are routinely attended by the SCD team spanning multiple disciplines: community health worker (CHW), research coordinators (RC), nurses, and providers. If additional personnel, such as palliative care, counseling, exercise physiology, dietitian, etc., are needed for CPMs, they are invited in advance to the meeting. In preparation for the CPM, a nurse care coordinator conducts a chart review of each scheduled patient to complete a standardized guided chart prep sheet (Fig. 1). During CPMs, the chart prep sheet is used to discuss each patient to ensure all standard of care guidelines are met along with quality improvement objectives. The guided sheet also addresses personalized medical needs for the individual patient, social needs, school/career plans, transition, subspecialty referrals, and screening for eligibility to participate in open QI and research projects. The CPMs assure optimal completion of the following pre-appointment activities: (1) order placement, (2) acquiring external patient data relevant to the upcoming visit, (3) coordinating other same-day testing/appointments, and (4) accommodating social needs (i.e., transportation). After closing any care gaps, the CPM sheet is incorporated into the clinic appointment flow for brief provider review immediately prior to seeing the patient and to assure completion of all needed assessments. Results: CPMs have improved a variety of patient care metrics, making patient appointments more efficient, comprehensive, and patient-focused, and improving pre and post-appointment coordination of care. The advanced chart preparation process increases efficiency for patients, families, and providers. One example has been the increase of annual TCD completion rates from 50% to 93%, largely accomplished by coordinating TCD and clinic appointments, especially for patients living hours from the clinic. Combining other services and appointments on the same appointment day minimizes transportation needs and maximizes completed referral appointments. Incorporating a patient immunization database into CPMs has improved immunization completion rates significantly, more than doubling the rates for some (Men A from 11% to 93%, Men B from 15% to 83%) (Fig. 2). Overall, the CPMs: 1) maximize quality time with patients, 2) assure discussion of non-medical (interpersonal, school, etc.) issues, 3) encourage patient and family medical education opportunities, 4) emphasize attention to each patient's individual SDoH needs, 5) increase successful care coordination, 6) enhance collaboration among members of the SCD care team, 7) provide ongoing focus on QI initiatives, and 8) facilitate patient enrollment in open clinical studies and research trials. Conclusions: Our multidisciplinary SCD care team found that CPMs result in more efficient, effective, and comprehensive patient- and family-centered care while promoting care collaboration by team members. They promoted adherence to guidelines, as evidenced by significant increases in TCD (up 43%) and immunization rates (average improvement 36%, with biggest improvements 82% and 68%, shown above). In addition, the time put into appointment preparation has allowed us to use more clinic time to develop trusting relationships with the patients and families we serve. Furthermore, this process has facilitated patient participation in QI efforts, new databases, and clinical trials. Such chart prep meetings are easily adaptable to a variety of clinical care teams and health delivery settings.

Investigation and Analysis of Factors Influencing the Quality of Community Nursing Services in Laishan District, Yantai City

Objective: The purpose of this study is to conduct an in-depth investigation and analysis of the factors affecting the quality of community nursing services in Laishan District, Yantai City, and provide suggestions for improving the quality of the services. Method: The community nursing services in Laishan District, Yantai City were investigated through questionnaires and on-site observations. Result: The content of nursing services was correlated with the professional titles of the staff. The guidance given to patients and caregivers was significantly correlated with the educational level of community nursing personnel. Therefore, this indicates that the professional titles and educational backgrounds of the community nursing personnel have a significant impact on the quality of service provided. Conclusion: The role of professional title evaluation can be optimized, further enhancing the educational level of nurses in surrounding communities, optimizing service content and methods, etc., in order to improve the quality of community nursing services in the region.

Pemanfaatan Hidrotherapy Jahe Merah untuk Menurunkan Tekanan Darah pada Keluarga di Kelurahan Legok

Based on profile data from Jambi Province, it shows that the incidence of hypertension ranks first from 2018 to 2020. The increasing incidence of hypertension requires community nurses to teach the public how to treat it with red ginger hydrotherapy. Research Before results show that red ginger hydrotherapy has an effect on blood pressure. For this reason, it is necessary to carry out community service regarding the use of red ginger hydrotherapy to treat hypertension problems. This service aims to provide education to the public on how to treat hypertension with red jehe hydrotherapy. This service will be carried out on 22-25 May 2022 to 15 people in Legok Village, Jambi City. The method for implementing this activity is 1). Pretest 2). Providing education about how to treat hypertension with red ginger hydrotherapy, 3). Post test. Education is carried out for 60 minutes. Based on the results of checking the highest systolic blood pressure before treatment was 180 mmHg and the lowest 140 mmHg, while the results of measuring diastolic blood pressure it can be concluded that the highest blood pressure before treatment was 100 and after giving hydrotherapy there was the highest change, namely 80 mmHg. These results indicate that there was a change in blood pressure after administering red ginger hydrotherapy. So red ginger hydrotherapy can be recommended as a therapy for hypertensive patients. For further service, research on red ginger and salt hydrotherapy to treat hypertension is recommended

Giving Life to Learning Through Rural Maternal Health Immersion Experiences.

Recruiting, retaining, and educating nursing students is essential to meet the growing need for nurses in rural communities. A nursing school enhanced its prelicensure education in rural and public health nursing, and interprofessional care by expanding experiential learning opportunities. To describe longitudinal community health-based rural immersion experiences for prelicensure nursing students. A prospective, correlational design evaluated students' knowledge and confidence in understanding rural characteristics, confidence in achieving public health nursing, and interprofessional education competencies. Fourteen prelicensure nursing students participated in rural maternal health immersion experiences and reported being more confident (21/27 items) than knowledgeable (18/27) in understanding rural characteristics. Over 85% reported competency in interprofessional interactions, and there was a significant difference in confidence in achieving public health nursing competencies between the beginning and end of the immersion. Using immersion experiences may be effective in enhancing students' knowledge, confidence, and competency in rural and public health, and interprofessional care.

Correlation of the Dietary Protein Intake between Those Estimated from a Short Protein Food-Recall Questionnaire and from 24-Hour Urinary Urea-Nitrogen Excretion in Stages 3-4 Chronic Kidney Disease Patients.

High protein intake may accelerate progression of chronic kidney disease (CKD). Estimation of dietary protein intake (DPI) is indispensable for management of CKD, but to achieve optimum DPI is quite challenging in routine clinical practice. We recently studied a beneficial effect of utilizing integrated care on the management of CKD at the rural community level. In that study, we created a short protein food-recall questionnaire (S-PFRQ) as a working tool to estimate DPI of the CKD patients during home visit by community health personnel. Herein, we reported the initial evaluation of the reliability of S-PFRQ from our previous study. We compared the amount of DPI obtained from S-PFRQ with that obtained from protein-equivalent of total nitrogen appearance (PNA). In the previous ESCORT-2 study, 914 patients with CKD stage 3 or 4, who were living in the rural area of Thailand, were prospectively followed while receiving integrated care for 36 consecutive months. During home visits by community nurses from subdistrict health centers, dietary food recall was made, recorded in S-PFRQ, and DPI was obtained. Among these, sixty patients were randomly selected, and 24-h urine was collected for urinary urea-N and estimation of PNA. A correlation was made between DPI obtained from S-PFRQ and PNA. The DPIs derived from S-PFRQ and PNA were 28.8 ± 14.8 and 39.26 ± 17.79 g/day, respectively. The mean difference and 95% CI between the 2 methods was -10.43 (-7.1 to -13.8) g/day, respectively (P < 0.001). Interclass correlation between these 2 methods was 0.24, P = 0.007. The difference between the 2 methods remained constant across different amounts of DPI. The DPI estimated from S-PFRQ significantly correlated to that from PNA. However, the S-PFRQ method yielded a DPI value which was about 10 g of protein or 25% less than the PNA method. Despite this amount of difference, this S-PFRQ is user-friendly and could be used during field work as an easy and simple tool for DPI estimation in resource-limiting condition.

Community practice in nursing programs in the context of primary health care

Introduction: Praxis involves the work of individuals in which social, political, psychological, economic, historical, cultural, institutional, moral, and ethical configurations are intertwined. Nursing professionals and students materialize their praxis with people, families, and communities. Objective: To determine the categories extracted from the scientific literature on community praxis in nursing programs. Method: A narrative review was conducted to interpret scientific studies related to community nursing programs and their practices (2011-2022) in Spanish, English, and Portuguese, using the Virtual Health Library, PubMed, and also Google Scholar. Quality assessment was performed through critical reading based on analysis tools for various study types. The collected data were analyzed using ATLAS.ti version 8 software. Results: Three categories were extracted: the complexity and simplicity of community nursing practices; the contradictions between text and context; and finally, the action and relational creation for education in community nursing. Conclusion: It is necessary to give new meaning to community nursing practices based on the experiences learned and promote an attitude in students and teachers characterized by initiative, solidarity, and trust.

Attitudes and perceptions toward COVID-19 virus and vaccines among a Somali population in Northern Wisconsin.

The study's aim was to gain a qualitative understanding of vaccine beliefs and attitudes toward COVID-19 among Somali residents living in Northern Wisconsin (WI). While vaccination rates are significantly lower among Black and Hispanic populations, those with lower educational levels, and in rural areas, minimal is known about Somali population perspectives of COVID-19 vaccination rates. Through qualitative methodology employing focus groups for data collection and the inclusion of Somali interpreters, we explored Somali community viewpoints regarding these topics. Focus group interviews were transcribed verbatim with subsequent transcripts reviewed and analyzed by the research team to identify themes. The overarching theme was Protecting self, others, and community. Most participants accepted vaccinations, and the COVID-19 vaccine specifically, to protect themselves, others, and their community. Factors contributing to vaccine update included trusting local messengers, including public health nurses; valuing collective memory associated with previous communicable disease outbreaks; believing religion supported vaccine protective actions; and following recommended government and media advice. Study results suggest strategies for increasing community outreach to newly resettled refugee and immigrant minority groups, establishing trust between community members, nurses, and other public health personnel, and facilitators for connecting health messaging to Somali cultural and religious beliefs to promote public health and safety.

Working Together for a Common Goal: The International Armed Forces Community Nursing Research Collaboration

Over the past 19 years, millions of military service members from the United States (U.S.) and United Kingdom (U.K.) served alongside each other in Iraq and Afghanistan. The U.S. and U.K. clearly recognize the sacrifices that the members of their armed forces have made for their respective countries. Sir Winston Churchill described the special relationship which has facilitated cooperation between the U.S. and U.K. in economic activities (trade and commerce), intelligence sharing, and the planning and execution of military operations and military medicine. It would be to the benefit of all, especially the military members, veterans, and family members, if nursing also joined in this collaborative effort. Ensuring the efforts of NATO nurse scientists and educators working to advance military, veteran, and their families’ health are aligned requires outlining key priorities across nations and identifying resources that can facilitate collaborations. To that end, with the support of the American Academy of Nursing (AAN), the International Armed Forces Community Nursing Research Collaboration (IAFNRC) was established. This manuscript provides detailed insight into the work of the IAFNRC.

Analysis and prevention of falls among community-dwelling older adults in southern Thailand.

To analyse fall prevalence, risk factors and perceptions among Thai older adults to design a prevention model. Quantitative and qualitative data were collected using a convergent parallel mixed-methods design. A cross-sectional analysis was conducted using secondary data from health screenings of older adults in 20 subdistrict hospitals in southern Thailand from January 2018 to September 2019 (n = 12,130). In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with purposively sampled participants who were representatives of older adults and stakeholders (n = 50). The quantitative analysis showed that the prevalence of falls was 12.1%. The independent risk factors were female gender, employment status, cognitive impairment, semi-dependent functional ability, balance problems, vision impairment, hearing difficulties, use of medications, reliance on assistive devices and access to outdoor toilets. The qualitative analysis revealed misconceptions on falls and fall prevention measures among older adults and community stakeholders. In Thailand, healthcare providers and community nurses play a crucial role in providing primary advice and conducting interventions, yet they encounter obstacles due to lack of personnel, time constraints, limited resources, inadequate support and unclear policies. Stakeholders stress the urgency of improving practice guidelines, developing evidence-based strategies and aligning with government policies. Fall risk factors and prevention challenges among older adults were identified. Effective fall prevention programmes are needed. The identified fall events may guide public health agencies and local administrations in planning fall prevention programmes. For implementation in Thai communities, teamwork among leaders and stakeholders is key. IDIs and FGDs were conducted with older adults, village health volunteers, nurses, healthcare providers, local organization administrators and village headmen.

Holistic Nursing and Quran Recitation and its Impact on Floods Survivors in Indonesia.

Purpose: The purpose of the study was aimed to explore the trajectory of thoughts and feelings related to religiosity and spirituality using a holistic approach following attendance at group-Quran Recitation (QR) sessions among annual flood victims. Design: This is a qualitative study with an in-depth retrospective interview conducted data in 2019. Methods: The purposive sampling was applied to conduct face-to-face individual video-recorded semistructured interviews. Seventeen participants followed six QR chanting sessions in Bandung, Indonesia. Data were transcribed verbatim and analyzed using inductive analysis. Findings: After extracting evidence expressions of participants, the research team generated the central theme of "Holism of Religiosity and Spirituality," using three influential sub-themes, including obedience to God's will, growing a positive mindset through spirituality and life started to be delighting from nine categories. Conclusion: The relationship of body-mind concepts of holism through QR among flood sufferers was explored. The effect of QR chanting is beneficial to change awareness about the wisdom of spirituality. The holistic approach of religiosity and spirituality in nursing care is recommended to promote all service settings, especially community and disaster nursing in the Indonesian context. Future research is needed to develop QR chanting activities among multiethnic and socio-cultural groups as alternative therapy quantitatively.

Enhancing the hospital at home experience

Background Hospital at Home programs have demonstrated to be safe, feasible and cost effective. However, challenges such as infection control, cleanliness, space constraints and insufficient resources may hamper the adoption and effectiveness of such programs. Aims To understand the challenges of providing and receiving healthcare in the community, design a solution to meet the challenges, and to pilot and evaluate the solution. Methods This is a three-phase mixed method study. Phase 1, nurses, patients and caregivers were surveyed to understand their challenges in providing or receiving healthcare at home. Results of the survey in Phase 1 were used in Phase 2 to design a solution. In phase 3, an integrated structure was designed and piloted for stakeholders’ evaluation. Results Twenty nurses and 50 patient-caregiver dyads responded to Phase 1 survey. Physical home environment was most cited by the nurses as their main challenge, particularly the lack of a dedicated and clean space to conduct nursing procedures. Medication management was the greatest challenge faced by the patient-caregiver dyads. Based on these findings, a prototype of an integrated structure was fabricated in Phase 2. Ten patient-caregiver dyads and nine community nurses tested the prototype in Phase 3. The participants found the structure useful to store and organize their healthcare items, and there was ample clean workspace to carry out nursing procedures. Conclusion An integrated structure that can fulfil the physical, spatial and interpersonal needs at an affordable price could be useful in facilitating the delivery of hospital care in the home setting. Patient Contribution Patient-caregiver dyads were key stakeholders in our study. They provided valuable feedback and suggestions on the prototype and design of the integrated structure.

Exploring the delivery of end-of-life care by community nurses.

To understand what aspects of care and support were important to bereaved relatives and to explore the experiences of nurses delivering end of life care. Interviews and focus groups were undertaken with 17 family members, 31 community nurses and 13 community hospital staff. A workshop was held with 6 family members, 13 community nurses and 3 hospital nurses to review findings and make recommendations for improvement. Four themes were identified: relationships and being treated as a whole person; being able to make choices; getting help when and where it is needed; specialist advice and care, especially at the very end of life. Seeking feedback from relatives was valued both by family members and the staff and has provided an effective model to lead to focussed improvements.

Sickle Cell Disease Education in Low and Middle Income Countries Using a Smartphone Clinical Case Discussion App

Introduction Sickle cell disease (SCD) is one of the world's most common hemoglobinopathies, affecting over 400,000 newborns annually (Archer et al., 2022). Despite the World Health Organisation's (WHO) 2006 long-term goals to address the SCD burden, the disease's mortality, particularly within low- and middle-income countries (LMICs) such as India and Sub-Saharan Africa (SSA), remains high (WHO 2006). Barriers to improving outcomes for SCD patients in LMICs include a lack of awareness around treatment guidelines and inadequate clinical knowledge among healthcare professionals (HCPs). While effective medical education programs are essential to the provision of high-quality healthcare services, the delivery of such programs in LMICs is challenging due to limited budgets, poor training infrastructure and equipment, and insufficient educators (Barteit et al., 2020). Recently, consideration has been given to the role that digital learning platforms could play in supporting medical education in LMICs (Nicoll et al., 2018). Aim To assess the impact of a smartphone app delivered medical education program in improving HCP clinical knowledge around SCD in LMICs, focused on SSA (Kenya, Ghana, Zambia, Uganda,Tanzania) and India. Methods The SCD program was developed by subject matter experts with MedShr, a secure app- and web-based clinical case discussion platform freely accessible to HCPs worldwide. The program's focus was determined at the outset through a needs-based approach. Analysis of MedShr's proprietary data enabled the identification of key knowledge gaps among HCPs that could be addressed with case-based education, forming the basis for three themes: 1) Acute SCD presentations 2) Chronic SCD complications 3) Long-term SCD management 9 clinical cases comprising a patient vignette, open question and integrated poll were developed by MedShr in line with the program themes. A case example is displayed in Figure 1. Content delivery via the MedShr platform was from August 2022 to February 2023, during which time the cases were promoted to relevant HCPs via email, push notifications and social media. All content was featured within a SCD Global Education Network group on MedShr, connecting target HCPs and facilitating peer-to-peer discussion. Results During the 6 month program, over 173,000 HCPs were reached globally with the educational content, including 75,070 clinicians in SSA and 64,210 in India. HCPs reached included community health workers (28%), GPs (24%), acute physicians (16%), emergency physicians (32%), pediatricians (13%), hematologists (3%), and nurses (8%). The program achieved over 73,000 engagements (case follows, likes, votes and comments) from target HCPs, including 26,419 engagements from HCPs in SSA and 11,173 from those in India. Stand-alone poll questions aligned to the three educational themes were implemented pre- and post-program delivery to assess the program's educational impact. An improvement in clinician knowledge was demonstrated across all three themes (Figure 2). Participant surveys were also used to determine the program's impact on HCP knowledge and clinical behaviors. 84% of participants deemed the content ‘very valuable’ to their clinical decision-making, while 90% stated that they had implemented knowledge obtained from the program in clinical practice. Conclusions The SCD program delivered via the MedShr smartphone app provided a low-cost, high-impact mechanism to deliver effective medical education in LMICs. MedShr's unique SCD professional network provides a digital interface for HCPs, through which peer engagement, interactive discussion and sharing feedback drive learning and behavioral change. The program's metrics highlight the potential scale for digital learning platforms to reach and engage HCPs across diverse geographies, and the program polling and participant surveys demonstrate impact, and that there is scope to improve HCPs' knowledge and practice without costly face-to-face education. Future work should aim to develop tailored learning programs designed to fit local contexts in LMICs, and explore the use of technology-based learning programs in other commonly encountered disease areas. The educational program was funded by an unrestricted educational grant from Novartis. Novartis had no input into content development and their employees could not access the MedShr platform or members.

Whole versus hole: enabling community nurses to implement holistic wound care.

To improve wound-related quality of life (QoL) in clients with hard-to-heal wounds in their lower limbs and to increase referrals to multidisciplinary teams in the management of care for these clients. This was a quality improvement project with a two-group pretest-posttest interventional evaluation design. We implemented a package of interventions including the WounDS app, education related to wound care, and client engagement through a QoL self-assessment. Wound-related QoL was measured using the Cardiff Wound Impact Schedule and referrals to the multidisciplinary team were tracked through chart audits. We explored nurses' experiences with the interventions through semi-structured interviews. Clients' average ratings for 'wellbeing', 'physical symptoms and daily living', and 'overall QoL' improved by 27%, 38% and 54%, respectively. The number of referrals increased by 78% post intervention. Nurses described the interventions as effective strategies that motivated them to implement a holistic approach to care. The project was successful in creating a culture shift to practice holistic wound care. This package of interventions (WounDS app, education and client self-assessment of QoL) led to improvements in the QoL of clients with hard-to-heal wounds. Further studies are needed to generalise the findings. Strategies for sustainability include forming a champion group and providing the education and decision supports based on nurses' educational needs assessment.

Grasping a new approach to older persons' dignity: A process evaluation of the Swedish Dignity Care Intervention in municipal palliative care.

Dignity in older persons is a goal of palliative care. This study aimed to perform a process evaluation of the Swedish Dignity Care Intervention (DCI-SWE) in municipal palliative care in Sweden, focusing on implementation, context, and mechanism of impact. This study had a process evaluation design. The Knowledge to Action framework supported the implementation of the DCI-SWE. The intervention was used by community nurses with older persons (n = 18) in home healthcare and nursing homes. Data were collected by focus groups- and individual interviews with community nurses (n = 11), health care professionals (n = 5) and managers (n = 5), reflective diaries, and field notes. Grasping the DCI-SWE was challenging for some community nurses. Enhanced communication training and increased engagement from managers were requested. However, the DCI-SWE was perceived to enhance professional pride in nursing. In terms of fidelity, dose and reach the project was not fully achieved. Regarding mechanism of impact the DCI-SWE contributes to address older persons' loneliness and existential life issues, as it put conversations with older persons on community nurses' agenda. The DCI-SWE provided opportunities to maintain older persons' dignity and quality of life. However, with refinements of design and the DCI-SWE, the sustainability in the context may increase.

The impact of theory of mind, stress and professional experience on empathy in Romanian community nurses—a cross-sectional study

BackgroundHigh empathy levels in health professionals represent an important factor in patient satisfaction and compliance, reducing patient anxiety and pain, enhancing diagnostic and clinical results and strengthening patient empowerment. Our purpose was to determine empathy level and to identify which of the socioeconomic status (SES) and psychological factors were able to predict highest empathy levels in a Romanian sample of community nurses.MethodsCommunity nurses were invited in January-February 2023 to provide an answer to an online survey, using an advertisement in a professional network. 1580 participants voluntarily agreed to take part in this study, with a response rate of 85.8%. The survey included the Toronto Empathy Questionnaire, the Reading the Mind in the Eyes Test and socio-economic status items. A multivariate model for the prediction of belonging to the highest quartile of empathy as opposed to lowest quartile was constructed using SES and psychological variables as factors.ResultsThe mean (SD) empathy level was 49.1 (6.7), with 74.7% of participants over the threshold of high empathy level. In the multivariate analysis, predictors of belonging to the highest quartile of TEQ, as opposed to the lowest quartile were: low self-perceived stress level (OR = 2.098, 95%CI 1.362–3.231), higher experience as a community nurse (OR = 1.561, 95%CI 1.120–2.175) and higher levels of the theory of mind (OR = 1.158, 95%CI 1.118–1.199), when controlling for gender, age, relationship status, presence of children in families, education, and income.ConclusionsTraining programs targeting to increase emotional competences, reduce levels of stress and encourage personnel retention have the potential to increase the quality of community nursing in Romania.

Information networks of healthcare professionals in Europe on older adult vaccines: Network analysis

Abstract Background and objectives Healthcare professionals (HCP) have a key role in raising awareness and informing older adult patients about vaccines. However, HCPs are sometimes unaware of existing vaccines or have little knowledge on them. This study aimed to identify the information flows within HCP networks and to find out which HCPs play a key role in interprofessional information transfer. Methods An online questionnaire was distributed in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR) among HCPs, such as general practitioners (GP), medical specialists (MS), public health physicians (PHP), pharmacists, specialists elderly care (SEC) and nurses. The questionnaire included a case study in which a new vaccine for older adults was about to be made available. HCPs were asked whom they would contact for additional information and by whom they would be contacted on their turn, to reveal the information flow. Data were analyzed using social network analysis, comparing the results between countries. Results Preliminary results show the top three information providers. These were identical for NL and IT, with the MS being contacted by the highest number of different HCP-types, followed by the GP and PHP. FR and HU had GP ranked first and MS second. The PHP ranked also third in HU, but in FR it was the geriatrician instead. The main requesters of information were pharmacists (IT, HU), GPs (NL) and community nurses (FR). Hospital nurses (IT, FR), SEC (NL) and GPs (HU) ranked second on the number of HCP-types they would contact for information on a new vaccine. Conclusions In each country GPs and MS were the most important information providers in the HCP network when a new vaccine is introduced. Main information requesters varied per country and were pharmacists, GPs, nurses, and SEC. Thus, GPs were both main information providers and requesters (NL, HU). Key messages • Our study identified the HCP-(information)network regarding (new) vaccines for older adults. GPs and MS are the main providers of information, while pharmacists, nurses, and GPs are main requesters. • Identifying the HCPs in the information network makes it possible to specifically target key HCPs and to provide them with tailormade information on new vaccines.