Community Nurses Research Articles

The challenge of community care: evidence from the Family and Community Nurse model in Tuscany

Abstract Background The strengthening of primary care is one of the solutions proposed to increase the resilience of healthcare systems in Italy. Tuscany was the first region in Italy to use this model based on the results of a Regional Agency for Regional Health Services study. The aims is to describe the FCN model implementation across the three Local Health Authorities (LHAs) through the four C's framework of primary care. The regional resolution on FCN relabeled these milestones based on the FCN's role: transversality, proximity, continuity, customization. Methods A mixed method study was conducted with in-depth interviews of regional managers and surveys administered to middle nurse managers of the three LHAs. Results The interviews revealed a different state of progress of the FNC organisational model implementation, with one LHA pioneering, another LHA dealing with the implementation stage, and the third with a more recent, non-gradual implementation. The first two LHAs interpret the transversality as a strategic and the proximity as a vicinity feature. The other LHA sees the FNC as a tool for patient empowerment and proximity as service availability. The quantitative analysis shows a continuous take in charge in the pioneer LHA 54.8% (IC95% 46.8%-62.9%) with a lower temporary taking charge, 25.9% (IC95% 19.8%-31.9%), compared to the others, respectively 34.3% (IC95% 21.7%-47.0%) and 36.39% (IC95% 26.9%-45.8%). Places where the FCN provides care: the pioneering LHA as most of the home care and a 12% (IC95% 1.4%-22.5%) of intermediate care facilities use, the implementing LHA is totally home-based: 99% (IC95% 97.6%-100.3%) and with a continuous take in charge 48.6% (IC95% 34.5%-62.8), the recently implemented LHA a 6.8% (IC95% 2.2%-11.3%) of others. Conclusions Even in the same regional context, ruled by the same features’ model defining resolution, there have been different implementations and interpretations related to the different LHAs’ organizational histories. Key messages • In spite of the model’s implementations, the assistance provided doesn’t focus on single diseases but on people in the broader context of their family and community. • The FCN model is designed to strengthen the timely care of patients at home by coordinating activities and care interventions through a multidisciplinary team.

Policy mechanisms and types of participation in the implementation of the Brazilian pay-for-performance programme PMAQ

PurposeThe study compares how distinct mechanisms that connect pre-established policy objectives to professionals' practices, and the health policy implementation context influenced different approaches to frontline staff participation. The authors analysed 26 teams in six cities from two Brazilian states, during the last cycle of the National Program for Improving Access and Quality of Primary Care (PMAQ).Design/methodology/approachAbout 172 in-depth interviews were conducted with frontliners – community health workers (78), nurses (37), doctors (30) – and managers (27). Interview guides were based on key issues identified in the implementation and pay-for-performance (P4P) literature. Drawing on thematic analysis and synthesis of the literature, three types of participation mechanisms were identified: relational, motivational and incremental learning. They were analysed considering distinct contexts at the local level to understand how they influenced different forms of participation: mere adherence, result-oriented and transformative.FindingsAdministrations with stronger institutional organizational structures were able to control work processes and reduce professional discretion. However, sustained participation was more likely where there was greater integration between management and frontline health care teams. Motivation based only on financial incentives could not bring about transformative participation. This depended on the degree of professional's ideational motivation towards primary care. Finally, contexts with unfavourable working conditions tend to demotivate professionals, but incremental learning helps teams cope with these obstacles.Originality/valueThe study overcomes gaps in the literature in relation to PMAQ's implementation process. Overall, the study delves into which/how mechanisms alter frontliners participation in performance-oriented health programs.

Occupational Stress and Professional Quality of Life Among Community Health Nurses During the COVID-19 Pandemic.

Purpose: This study aimed to identify the correlation between occupational stress and professional quality of life (Pro-QOL) among community nurses during the pandemic COVID-19. Design: This study was conducted with a correlational design of 120 community health nurses. The research sample was obtained using a nonprobability purposive sampling technique following the research inclusion criteria. Expanded Nursing Stress Scale and Pro-QOL were used in this study. The research hypothesis: there is a correlation between occupational stress and the Pro-QOL of community health nurses. Methods: Pearson's correlation coefficient was used to analyze the correlation between occupational stress and Pro-QOL. Findings: The results of correlation analysis showed that there was a statistically significant positive correlation between occupational stress and Pro-QOL. Despite being in a difficult situation due to the pandemic and vulnerable to occupational stress, nurses significantly had high compassion satisfaction. Conclusions: Occupational stress affects nurses' Pro-QOL, it can be considered for public healthcare organizations to promote healthcare workers' well-being. Mobilizing the existing workforce, changing work patterns, support from colleagues and supervisors, clear communication of directives, and precautionary measures can reduce psychiatric symptoms.

Frailty in community-dwelling older people and nursing home residents: An adaptation and validation study.

The aim of this was to psychometrically adapt and evaluate the Tilburg Frailty Indicator to assess frailty among older people living in Slovenia's community and nursing home settings. A cross-cultural adaptation and validation of instruments throughout the cross-sectional study. Older people living in the community and nursing homes throughout Slovenia were recruited between March and August 2021. Among 831 participants were 330 people living in nursing homes and 501 people living in the community, and all were older than 65 years. All items were translated into the Slovene language, and a slight cultural adjustment was made to improve the clarity of the meaning of all items. The average scale validity index of the scale was rated as good, which indicates satisfactory content validity. Cronbach's α was acceptable for the total items and subitems. The Slovenian questionnaire version demonstrated adequate internal consistency, reliability, and construct and criterion validity. The questionnaire is suitable for investigating frailty in nursing homes, community dwelling and other settings where older people live. The Slovenian questionnaire version can be used to measure and evaluate frailty among older adults. We have found that careful translation and adaptation processes have maintained the instrument's strong reliability and validity for use in a new cultural context. The instrument can foster international collaboration to identify and manage frailty among older people in nursing homes and community-dwelling homes. The Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting cross-sectional studies was used. No patient or public involvement in the design or conduct of the study. Head nurses from nursing homes and community nurses helped recruit older adults. Older adults only contributed to the data collection and were collected from nursing homes and community dwelling.

‘Whose role is it anyway?’ Experiences of community nurses in the delivery and support of oral health care for older people living at home: a grounded theory study

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.

Ethical conflicts experienced by community nurses: A qualitative study.

Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals. To identify ethical conflicts experienced by community nurses. Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage ethical conflict. Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed. Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities. Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences. Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion.

Nursing Specialists Training at Universidad de Ciencias Médicas de La Habana

Introduction: the academic training process for nursing professionals in the organizational form of the specialties has shown in recent years a rapid development that becomes a transformative element that promotes higher links in the development and consolidation of Nursing as a science. Objective: characterize the training of Nursing specialists at the University of Medical Sciences of Havana. Methods: observational, descriptive, retrospective study. The primary source for data collection was the databases of the Postgraduate Directorate of the UCMH. Results: six nursing specialty training programs developed in nine faculties of Medical Sciences and a Postgraduate Study Center, with 19 teaching scenarios, were included. The specialty of comprehensive community nursing is the one with the largest number of training settings, with a total of 103 residents, of which 56,3 % are in their first year of training. The specialties of comprehensive community and intensive nursing and emergency are the ones with the highest student enrollment. Of the total number of professors that make up the faculty, 37,6 % are graduates and 24,5 % are nursing specialists. 14,1 % have a scientific degree and 66,2 % have a master's degree in science. 29 (11,0 %) are full professors, 163 (61,9 %) are assistant professors, 55 (21,0 %) are assistants, and 16 (6,1 %) are instructors. Assistant professors represent more than 50 % of the total faculty in all nursing specialties. Of the total number of teachers, 37 have doctorate degrees in particular sciences and 174 have master's degrees in sciences related to training. Conclusions. Postgraduate nursing training at UCMH was characterized by the development of six specialties in several training centers, with a faculty with a high teaching and research level.

Caring for a person living with dementia: identifying and assessing a carer's needs.

As the population ages and so do the numbers of people with dementia, there will also be an increase in the number of unpaid family carers. Estimates suggest that one in three of us will become a carer for someone with dementia during our lifetime, some caring for more than one person diagnosed with dementia in their family. There are currently over 700 000 people in the UK acting as primary unpaid carers for people with dementia, all of whom make a substantial contribution, both financially and physically, to their care and support. Carers of people with dementia can experience high levels of carer burden and distress as well poor health and wellbeing due to their caring roles. However, they can sometimes be less than visible to health and social care services as they may not identify themselves as carers or their needs may not be easily recognised which leaves them at risk. Identifying people in caring roles and assessing their needs are the first two steps in supporting them. Community nurses are well placed to do this within their roles.

Legal responsibilities relating to isolation.

Isolation can cause harm in everyday life, even in the most benign conditions. Taking on responsibility for a patient in the community who is isolated can entail a responsibility to steer them on a course, which they might otherwise not have taken and which might redound to their benefit. In this article, John Finch, a freelance journalist specialising in clinical law and ethics, examines some of the legal responsibilities which are added by the effects of isolation to the already heavy burden carried by community nurses.

Investigating community-based care service factors delaying residential care home admission of community dwelling older adults and cost consequence.

To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programmes, Veterans' Affairs Community Nursing (VCN) and Home Care Package (HCP). Our national, population-based retrospective cohort study and cost analysis used existing, de-identified veterans' claims databases (2010-19) and the Registry of Senior Australians Historical Cohort (2010-17), plus aggregate programme expenditure data. This involved 21,636 VCN clients (20,980 aged 65-100years), and an age- and sex-matched HCP cohort (N = 20,980). Service factors associated with lower risk of care home admission in the VCN cohort were periodic (versus continuous) service delivery (HR 0.27 [95%CI, 0.24-0.31] for ≤18months; HR 0.89 [95%CI, 0.84-0.95] for >18months), and majority care delivered by registered nurses (versus personal care workers) (HR 0.86 [95%CI, 0.75-0.99] for ≤18months; HR 0.91 [95%CI, 0.85-0.98] for >18months). In the matched cohorts, the time to care home admission for VCN clients (median 28months, IQR 14-42) was higher than for HCP clients (14, IQR 6-27). Within 5years of service access, 57.6% (95%CI, 56.9-58.4) of HCP clients and 26.6% (95%CI, 26.0-27.2) of VCN clients had care home admission. The estimated cost saving for VCN recipients compared to HCP recipients over 5years for relevant government providers was over A$1 billion. Compared to an HCP model, individuals receiving VCN services remained at home longer, with potentially significant cost savings. This new understanding suggests timely opportunity for many countries' efforts to enhance community-based care services.

Overcoming lymphorrhoea: a step to achieve a better life with lymphoedema.

Lymphorrhoea-otherwise known as 'wet' or 'leaky' legs-is an increasingly common condition that many community nurses will encounter in their daily practice; however, until relatively recently, evidence-based literature on its management was limited, and treatment modalities only tackled the symptoms instead of addressing the cause. In this article, Francesca Ramadan highlights the devastating impact of this condition, and the resources available to community practitioners to assist their patients to live well with lymphoedema.

Promoting Connection in the Faith Community Through Letter Writing.

Faith community nurses can reduce loneliness and provide connection for homebound members of faith communities through promotion of letter writing. Undergraduate nursing students who were matched with members of their own faith community wrote letters to older adults for 10 weeks as a community service-learning project. Data from the UCLA Loneliness Scale pre- and post-intervention showed reduced loneliness and greater connection among recipients of the letters.

Community Nursing Home Program Oversight: Can the VA Meet Increased Demand for Community-Based Care?

The US Department of Veterans Affairs (VA) Community Nursing Home (CNH) program provides in-person oversight monitoring the quality of care of veterans in VA-contracted community-based skilled nursing homes. The number of veterans receiving CNH care is projected to increase by 80% by 2037. Retrospective observational data describing the distance between contracted facilities and VA medical centers (VAMCs) were linked to Centers for Medicare and Medicaid monthly Nursing Home Compare and Brown University Long Term Care: Facts on Care in the US data. Qualitative interviews with CNH-based staff and VA-based CNH program oversight team members were conducted using a semistructured interview guide. Quantitative and qualitative data were analyzed independently and integrated during the interpretation of results. The number of CNHs per VAMC ranged from 1 to 68 (mean, 18). One in 4 CNHs were > 70 miles from the associated VAMC; among CNHs with 2 to 5 veterans, 44% were located > 50 miles away. Four qualitative themes emerged regarding VA CNH oversight: (1) benefits of VA CNH team engagement/ visits, including quality assurance and care coordination; (2) burden of VA CNH oversight due to geographic dispersion with too few or too many veterans at each to achieve efficiency; (3) oversight burdens and limited staffing restricted ability to add CNHs; and (4) remote access and interoperability of electronic health records and balancing the number of CNH veterans with staffing could facilitate successful oversight. The success of the CNH program will depend on the exchange of information and matching available resources to veterans' needs. At a time when strategies to ease the burden on NHs and VA CNH coordinators are needed, the VA needs to improve to properly scale the program.

Needs and influence factors of medical-nursing-pension of disabled elderly.

As the population ages, the incidence of disabled elderly persons increases, and the need for medical-nursing-pension services among disabled senior persons increases. The purpose of this study is to determine the needs and affecting factors of disabled elderly living in community homes in Nanning, Guangxi, China. The study utilized the descriptive comparative cross-sectional study. Stratified random sampling was utilized, based on inclusion and exclusion criteria, a total of 168 disabled elderly were randomly selected and investigated using a self-designed questionnaire which included basic nursing services domain, professional nursing services domain, rehabilitative nursing services domain, living nursing services domain, and spiritual nursing services domain. The t test, one-way ANOVA, and multivariate logistic regression were used to determine the influencing factors of medical-nursing-pension demands for community-dwelling disabled elderly. Majority of impaired seniors have a moderate to high-level of demand for medical-nursing-pension services. Age (t = 2.369, 95% confidence interval [CI]: 0.673-7.414), educational level (t = -16.946, 95% CI: -31.247 to -24.726), monthly income (t = -16.273, 95% CI: -22.104 to -17.320), economic source (t = 8.891, 95% CI: 16.850-26.470), time spent disabled (t = -11.151, 95% CI: -31.845 to -22.264), living with children (t = 10.852, 95% CI: 24.491-35.521), and medical insurance participation (t = 4.556, 95% CI: 9.032-22.848) all influence the demand for medical-nursing-pension services for disabled seniors in the community (P = .05). Majority of community-dwelling impaired seniors have a moderate to high demand for medical-nursing-pension services. Relevant departments and community nurses should pay increased attention to the elderly who are older, have a low educational level, a low monthly income, have an economic source of pension from their own, have been disabled for long period of time, are single, and do not have children, to improve the health care system for disabled elderly by implementing more personalized home visits in medical-nursing-pension on health education about oxygen inhalation and wound dressing.

Dementia care practices among community healthcare workers in Vietnam: a qualitative descriptive study

BackgroundVietnam is one of the most rapidly aging countries in the world and the likelihood that someone may have dementia rises dramatically as the population ages. Although caring for persons living with dementia is important, little is known about the circumstances under which community healthcare professionals in Vietnam provide dementia care. This study aimed to describe the practice of caring for persons with dementia among community healthcare professionals in Vietnam.MethodsThis qualitative descriptive study was conducted with 23 community healthcare professionals recruited from 10 primary healthcare centers, representing 10 of 24 districts in Ho Chi Minh City, Vietnam. Participants were physicians (n = 11), physician’s assistants (n = 8) and community nurses (n = 4). Data were collected through in-depth face-to-face semi-structured interviews. Interview data were audio recorded, transcribed verbatim, and analyzed using content analysis.ResultsThe mean age of the 23 participants was 44.6 ± 8.8 years; most were female (n = 16, 69.6%); and the mean time of working in the field of dementia care was 15.9 ± 8.4 years. Analysis of the interview data revealed five categories, which informed how care was provided: 1) Knowledge about dementia and its prevalence among older adults; 2) Identification of dementia in Vietnam; 3) Lack of attention to early diagnosis of dementia and difficulty in providing continuous care; 4) Dependence on family members for prompt and continuous care; and 5) challenges to providing dementia care. Despite having knowledge about dementia, some healthcare professionals incorrectly viewed dementia as an inevitable part of the ageing process. Participants reported that their limited training and practical experience in caring for persons with dementia caused a lack of confidence in dementia care.ConclusionsThe quality of care provided to persons living with dementia was negatively impacted by the limited training of healthcare personnel. The diagnosis, treatment, and provision of supportive services to persons living with dementia and their families are substantial challenges for the Vietnamese healthcare system. It is crucial to initiate and cultivate dementia care education programs aimed at expanding curricula for physicians, physicians’ assistants, and nurses.

O.4.1-4 Integrated geriatric care - a community approach to preventing falls and frailty of elderly Slovenian

Abstract Purpose The need for geriatric treatment is increasing with the aging of the population. Multimorbid patients with social care problems and increased need for rehabilitation and paliative care are more common. Mortality of the elderly, due to falls is 2.5 times higher in Slovenia than in the other EU countries. Until the national regulation of integrated geriatric care in Slovenian health system and in other relevant environments (community, long-term care, social care) and the establishment of appropriate, licensed postgraduate training for health professionals, it is necessary to start educating wider range of health and social care personnel, for most common geriatric syndromes such as frailty, falls and NCDs. Establishing a community approach to health is one effective way to address vulnerability of elderly population. Project description Project Integration of geriatric care for the elderly is implementing the existing commitment from WHO Decade of healthy ageing and the Slovenian Health Care Plan until 2025. With planned activities, it will ensure equal access to quality and safe health services, integrated and comprehensive treatment and will contribute to the deinstitutionalization of the Slovenian eldest population. It will develop a unified set of tools, for the systematic identification of elderly needs, new digital tools for optimization and better communication between different levels of providers and training a wider range of new and already employed health and social care personnel, for optimal health care. Evaluation of new competency models for health care personnel, training methods and proposed clinical pathways will be carried out at the end of the project. Based on final proposals, we will establish a new approach to the system level of integrated geriatric care and bring the treatment closer to the patient's home. Conclusions Project will also contribute to upgrading competences of physiotherapists, kinesiologists, standard health teams in Health Promotion Centers, community nurses, family medicine and internal medicine doctors and social care workers for the integrated geriatric care for the elderly. It will address especially treatment of the physical component in geriatric syndrome, such as decreased muscle strength, balance, impaired walking and frailty, at different levels of health care and communities.

O.5.3-7 Evaluation of implementation strategies promoting Interprofessional Collaboration Practices among social and health professionals involved in fall prevention in the community

Abstract Purpose Fall prevention practices (FPPs), including exercised-based programs, are effective in reducing fall rates among community-dwelling older adults, but they are not implemented enough to reach their full potential. Given the multifactorial nature of falls, these FPPs should have an integrated approach where multiple social and health professionals achieve good Interprofessional Collaboration Practices (ICP). The aim of the current study is to evaluate implementation strategies promoting ICP among professionals involved in fall prevention. Methods We performed longitudinal process evaluations with a mixed-methods approach including document study, dynamic learning agenda (DLA), and a social network analysis (SNA) survey in four communities in the region of Utrecht, the Netherlands. Professionals involved in fall prevention participated in regular meetings and responded to SNA surveys. This survey was distributed at baseline, after six, 12 and 18 months, which measured, among other things, the number of links between professionals. Evaluation whether the implementation strategies, such as training, providing a social care map and establishing referral pathways, improved ICP were guided by The Conceptual Framework ICP. Results Data collection is ongoing and results will be updated. Until now, the SNA shows that in all communities physical therapists and primary care and community nurses play a central role, and that over time more professionals were included in the network. The DLA showed that changes in barriers for ICP differed per community; in one community time and budget remained main barriers, while in another community barriers were successfully transformed in facilitators. For example, initially professionals did not know each other well, but after using the implementation strategies they understood each other's role better, which highly facilitates efficient ICP. Conclusions The effect of implementation strategies are dependent on local contexts. Furthermore, continuous evaluations, such as insight in present barriers and facilitators, and reflections are necessary to select the implementation strategies that fit best to the current context. These findings will help professionals involved in fall prevention to implement and upscale FPPs in the community. Support/Funding Source This research is co-financed by Regieorgaan SIA, part of the Netherlands Organisation for Scientific Research (NWO) (project number RAAK.PRO03.099).

Legal issues related to heat.

Health problems related to climate change are with us to stay, some say for a good while. The effect of excessive heat on the human frame are manifold and they are encountered first in the home. During hot weather, community nurses are likely to be faced with an array of health issues not encountered in more temperate conditions. Those very health issues can also impact on legal issues. John Finch, a freelance journalist specialising in clinical law and ethics, examines how.

Community nursing and wound care: from TIME to TIMERS

Renata Batas disusses the implications of using the TIMERS assesment tool in practice

Disaster preparedness of Hiroshima community health nurses: A mixed-method study

The number of natural disasters has increased globally as a result of climate change. Community nurses become frontline workers in disaster-struck areas, protecting their clients from harm and risk. The number of community-based healthcare providers in Japan has increased in recent years, along with the shift from cure-focused acute healthcare to home-based care settings. Many studies have investigated the preparedness and willingness to provide care in the aftermath of a disaster. However, there is still a dearth of knowledge on disaster preparedness among community-based healthcare professionals globally. This study investigated the preparedness of community nurses in Hiroshima, Japan, focusing on nurses providing home-based care. A mixed method design was employed, and data were collected through surveys and interviews. The survey results indicated a positive association between disaster experience and training, as well as training and the existence of a disaster plan. Further, participants reported that healthcare providers neglected the preparation of disaster plans due to time constraints and a lack of incentives; our results suggest that incentives may promote disaster preparedness.