Context Of Care Research Articles

Improving the integration of care for trans adults: ICTA a mixed-methods study.

This research concerns improving the National Health Service health services trans adults need. These include the national specialist Gender Identity Clinics that support people making a medical transition. Not all trans people need to make a medical transition, and transition can take many different paths. Waits to be seen by Gender Identity Clinics are, however, several years long, and there may be significant problems of co-ordination between different aspects of transition-related care, and between transition-related care and general health care. The main objectives were to understand: Which factors make services more or less accessible and acceptable to the variety of trans adults? How initiatives for providing more person-centred and integrated care can be successfully implemented and further improved? An online and paper screening survey was used to gather data on demographics and service use of trans people across the United Kingdom, with 2056 responses. Researchers used survey data to construct five purposive subsamples for individual qualitative interviews, identifying groups of people more likely to experience social exclusion or stigma. There were 65 online interviews. In addition, 23 trans Black people and people of colour attended focus groups. Six case studies were completed: four on initiatives to improve care and two on experiences of particular trans populations. Fifty-five service provider staff and 45 service users were interviewed. The following undermine person-centred co-ordinated care and can lead to experiences of harm: lack of respectful treatment of trans people by general practitioner practices; inadequate funding of services; lack of support during waiting; the extended and challenging nature of Gender Identity Clinic diagnostic assessments, sometimes experienced as adversarial; breakdowns in collaboration between Gender Identity Clinics and general practitioner practices over hormone therapy; lack of National Health Service psychological support for trans people. Case studies indicated ways to improve care, although each has significant unresolved issues: training in trans health care for general practitioners; third-sector peer-support workers for trans people who come to National Health Services; gender services taking a collaborative approach to assessing what people need, clarifying treatment options, benefits and risks; regional general practitioner-led hormone therapy clinics, bringing trans health care into the mainstream; psychology services that support trans people rather than assess them. Some contexts of care and experiences of particular groups of trans people were not addressed sufficiently within the scope of the project. While efforts were made to recruit people subject to multiple forms of stigma, there remained gaps in representation. The findings have significant implications for commissioners and providers of existing National Health Services gender services, including recently established pilot services in primary care. In particular they point to the need for assessments for access to transition care to be more collaborative and culturally aware, implying the value of exploring informed consent models for accessing transition-related care. Further research is needed to investigate how far the findings apply with particular subpopulations. This study is registered as Research Registry, no. 5235. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/51/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 28. See the NIHR Funding and Awards website for further award information.

Impact of family-centered Care on Parenting Role and Sense of Competence in Parents of Preterm Neonates: a quasi-experimental study

BackgroundImplementing a family-centered care approach can empower parents to care for their premature infants, positively influencing their sense of competence and parenting role. This study aims to investigate the impact of family-centered care within the context of newborn care on the sense of competence and parenting role of parents with preterm infants who were hospitalized in neonatal intensive care units (NICUs) in Iran. MethodsThis quasi-experimental study employed a design with two groups in neonatal intensive care units (NICUs) located in Kerman, Iran. The research sample consisted of 90 parents. The intervention group received training based on the principles of family-centered care and actively participated in caring for their infants in the intensive care unit. Both groups completed the Parenting Sense of Competence Scale and the Parenting Role Tasks Questionnaire before the intervention, seven days after the intervention, and three months after the intervention. ResultsFollowing the implementation of the family-centered care intervention, the experimental group exhibited a relatively higher increase in the sense of competence score (83.42±6.66) compared to the control group (57.60±9.45). Similarly, the experimental group had a higher mean parenting role score (87.95±6.45) than the control group (54.77±11.80). ConclusionThe study findings suggest that implementing the family-centered care program develops training packages based on the principles of family-centered care for nurses working in neonatal intensive care units. This training will help parents of hospitalized infants enhance their sense of competence and improve their parenting role.

Dual mastering and labour exploitation: Life and work stories of Romanian women in home care in Italy from Romania

The study analyses the dual nature of mastering in the specific context of home care with reference to Romanian women employed in Italian families through life stories collected in Italy and Romania. This duality stems from the overlap between personal and work time in the home environment. The surveillance of Romanian domestic workers by the employers are combined with prejudices and sometimes sexual urges, expressed through verbal and non-verbal language, to define a coercive and segregating way of life and work, with consequences for workers in terms of exploitation, mental health and dependence on the employers' needs, even to the extent of defining specific workers'transnational relationships with the family of origin and its social network. The processes of dehumanisation and exploitation will be analysed by interviewing women who have worked in care of Romanian nationalities and who have lived or still live in Italy. The analysis of the concept of dor, a Romanian word meaning the longing for what one has left behind and the yearning for what one will no longer find, leads to the formulation of a hypothesis while considering Romanian women employed in Italy in the ethnicized labour market: their being considered as less ‘immigrant'. In other words, as European care givers' flows are not well controlled, it creates more favorable conditions for irregular work. This is a condition of masking or hiding persistent conditions of marginality and subordination.

Histopathological-Based Analysis of Human Kidney Spatial Transcriptomics Data: Toward Precision Pathology

The application of spatial transcriptomics (ST) technologies is booming and has already yielded important insights across many different tissues and disease models. In nephrology, ST technologies have helped to decipher the cellular and molecular mechanisms at work in kidney diseases and have allowed the recent creation of spatially anchored human kidney atlases in healthy and diseased kidney tissues. During ST data analysis, the obtained computationally annotated clusters are often superimposed on a histologic image without their initial identification being based on the morphologic and spatial analyses of the tissues and lesions. In this study, we conduct a histopathologic-based analysis of ST data on a human kidney sample corresponding as closely as possible to the reality of the interpretation of a kidney biopsy sample in a health care or research context. This study shows the feasibility of a morphology-based approach to interpreting ST data, helping to improve our understanding of the lesion phenomena at work in chronic kidney disease at both the cellular and the molecular level. Finally, we show that our newly identified pathology-based clusters can be accurately projected onto other slides from nephrectomy or needle biopsy samples. They thus serve as a reference for analyzing other kidney tissues, paving the way for the future of molecular microscopy and precision pathology.

Evaluation of Patient Outcomes after Pharmacological Intervention in Home Health Care Utilizing Pharmaceutical Care Records

The purpose of this study was to identify patient outcomes after pharmacist interventions in the home health care context using pharmaceutical care records accumulated during daily operations. We focused on 591 cases at Nakajima Pharmacy from April 2020 to December 2021, where dispensing fees were charged to prevent duplication of medication and unnecessary interactions of home patients (excluding those related to adjustment of ongoing medications). The study investigated the content and background of prescription changes, the follow-up rate, and patient outcomes. The most common circumstances that led to pharmacist intervention for homebound patients were symptom occurrence (uncontrolled symptom, new symptom, drug adverse event). Of the patients for whom pharmacist intervention was provided for symptoms, 72.8% received follow-up according to the pharmaceutical care records. Furthermore, 59.2% of patients with follow-up showed an improvement of their symptoms. In addition, many patients had their medications discontinued or the dosage reduced by the pharmacist despite stable symptoms. More than 90% of these patients showed no change in symptoms. Besides interventions associated with the occurrence of symptoms, many interventions related to medication adherence were found to result from the patient's physical condition, such as poor swallowing function. The results suggest that tracking pharmacy drug histories may help pharmacists to better understand the need for follow-up implementation and the changes in patient outcomes after interventions.

Convalescing from SAM: The pitfalls and possibilities of caring for vulnerable children in Harare's high-density neighbourhoods

It is widely recognised that children recovering from Severe Acute Malnutrition (SAM), remain vulnerable to risk of death following hospital discharge due to a wide range of biological and social factors. In light of this heightened risk, we report here on a qualitative study which aimed to better understand the caring contexts that children recovering from SAM were recuperating in within the high density urban and suburban districts of Harare, Zimbabwe. Undertaken with the mothers and other primary caregivers of 10 children enrolled on a large observational cohort study (HOPE-SAM), this paper identifies several dimensions of the women's lives that impede their caring capabilities. Given the country's status as a global ‘hunger hotspot’ (FAO/WFP, 2022), it should not be surprising that food insecurity featured prominently amongst these. Beyond this, the paper highlights the women's uneven access to informal social protection, experiences that are reflective of what recent scholarship refers to as examples of ‘uncaring’ or ‘noncaring,’ as well as their responses to discourses of shame and stigma within the community and hospital settings. The paper concludes by considering what this means for understanding of, and responses to, the bodies encountered in the place of global health research and interventions.

Mapping simulation-based activities for health professionals in rural and remote contexts in high-income countries: a scoping review protocol.

This scoping review will aim to map the existing academic literature on simulation-based activities that are designed with and delivered for health professionals in geographically rural and remote contexts in high-income countries. Simulation-based health care activities are implemented in health services to increase patient safety because they allow health professionals to prepare, learn, practice, rehearse, and improve clinical performance and teamwork. Simulation-based activities are increasingly being used in rural and remote areas, where resources are limited compared with metropolitan areas. This review will include all primary and peer-reviewed research articles and abstracts that report health simulation methodologies and activities that have been used in rural and remote health care contexts in high-income countries. The proposed review will follow the JBI guidelines for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. Databases to be searched will include Embase, Emcare, and MEDLINE (all searched via Ovid), Scopus, PubMed, and the Cochrane Database. Titles and abstracts will be screened independently by 2 reviewers, followed by full-text screening. Data will be extracted and analyzed to address the review questions. Open Science Framework https://osf.io/pu6gv.

Dimensions of clinical leadership among pre-registration nursing students: a cross-sectional study between two countries

To explore a) pre-registration students' self-perceptions of clinical leadership behaviours and b) differences in students' self-perceptions of leadership behaviours between two countries (UK and Israel). Effective leadership has been associated with high-quality and compassionate care provision in health and social care contexts. This has led to a common acceptance that teaching leadership in nursing education is essential if students are to develop competencies in this area. Worldwide, there is limited research on nursing students' perception of clinical leadership behaviours as well as on the development of leadership behaviours during the study years. A cross-sectional survey design was used among two convenience samples of UK and Israeli pre-registration nursing students. Closed questionnaires were uploaded in the format of a commercial internet survey provider (Qualtrics.com) and distributed through the virtual learning platforms in the two participating universities. In total 656 students were invited to participate and the response rates were 28.1 % (Israel) and 17.9 % (England). Overall, 140 students completed the questionnaires. Significant differences were found between the two sites in the leadership dimensions "Emotional Intelligence" and "Impact and Influence" (p < .05), with UK students scoring higher than Israeli students. Among the Israeli sample, significant differences were found in leadership dimensions according to years of study, with higher scores reported in the 3rd and 4th year students compared with the 1st and 2nd Year students in the referred dimensions (p < .05). Differences in students' clinical leadership perception exist between the two cohorts examined. Nurse educators should expand international research on this subject to identify possible antecedents in developing clinical leadership behaviours. At the same time, there is a need to continue efforts to enhance the development of clinical leadership behaviours during all study years through curriculum updating to prepare future nurses better to provide quality, safe and person-centered care.

Peer Support Interventions for People With CKD: A Scoping Review

Formalized peer support is a promising approach for addressing the emotional and practical needs of people living with chronic kidney disease (CKD). We aimed to systematically identify and summarize peer support interventions studied in individuals with CKD with or without kidney replacement therapy (KRT). We searched electronic databases and grey literature sources in March 2023. Studies of any design were eligible if they reported sufficient detail on peer support interventions and outcomes for adults with CKD with or without KRT and/or their caregivers. We extracted information on study and intervention characteristics and reported outcomes using established frameworks. We summarized quantitative data descriptively and qualitative data thematically. Our approach observed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. We included 77 studies describing 56 unique peer support interventions. Most reports were program evaluations (39%) or randomized controlled trials (27%) published after 2013. Two thirds of interventions focused on in-centre hemodialysis or mixed CKD populations, and three quarters were integrated within a kidney care clinic or program. Whereas most peer interactions centered on informational support, few programs offered focused support in areas such as transplant navigation or dialysis modality selection. Only one third of outcomes were assessed against a comparator group, with results suggesting improvements in psychological health with peer support. Heterogeneity of included studies; lack of rigorous program evaluation. This review suggests recent growth in peer support programming with a variety of formats and delivery methods to address the diverse needs of people living with kidney disease. Notable gaps in peer support availability for transplant and home dialysis recipients and the lack of rigorous evaluations present opportunities to expand the reach and impact of peer support in the kidney care context.

A national education program for rapid genomics in pediatric acute care: Building workforce confidence, competence, and capability

PurposeTo develop and evaluate a scalable national program to build confidence, competence and capability in the use of rapid genomic testing (rGT) in the acute pediatric setting. MethodsWe used theory-informed approaches to design a modular, adaptive program of blended learning aimed at diverse professional groups involved in acute pediatric care. The program comprised 4 online learning modules and an online workshop and was centered on case-based learning. We evaluated the program using the Kirkpatrick 4-level model of training evaluation and report our findings using the Reporting Item Standards for Education and its Evaluation (RISE2) guidelines for genomics education and evaluation. ResultsTwo hundred and two participants engaged with at least 1 component of the program. Participants self-reported increased confidence in using rGT, (P < .001), and quiz responses objectively demonstrated increased competence (eg, correct responses to a question on pretest counseling increased from 30% to 64%; P < .001). Additionally, their capability in applying genomic principles to simulated clinical cases increased (P < .001), as did their desire to take on more responsibility for performing rGT. The clinical interpretation of more complex test results (such as negative results or variants of uncertain significance) appeared to be more challenging, indicating a need for targeted education in this area. ConclusionThe program format was effective in delivering multidisciplinary and wide-scale genomics education in the acute care context. The modular approach we have developed now lends itself to application in other medical specialties or areas of health care.

Machine Learning in Medical Triage: A Predictive Model for Emergency Department Disposition

The study explores the application of automated machine learning (AutoML) using the MIMIC-IV-ED database to enhance decision-making in emergency department (ED) triage. We developed a predictive model that utilizes triage data to forecast hospital admissions, aiming to support medical staff by providing an advanced decision-support system. The model, powered by H2O.ai’s AutoML platform, was trained on approximately 280,000 preprocessed records from the Beth Israel Deaconess Medical Center collected between 2011 and 2019. The selected Gradient Boosting Machine (GBM) model demonstrated an AUC ROC of 0.8256, indicating its efficacy in predicting patient dispositions. Key variables such as acuity and waiting hours were identified as significant predictors, emphasizing the model’s capability to integrate critical triage metrics into its predictions. However, challenges related to the complexity and heterogeneity of medical data, privacy concerns, and the need for model interpretability were addressed through the incorporation of Explainable AI (XAI) techniques. These techniques ensure the transparency of the predictive processes, fostering trust and facilitating ethical AI use in clinical settings. Future work will focus on external validation and expanding the model to include a broader array of variables from diverse healthcare environments, enhancing the model’s utility and applicability in global emergency care contexts.

Pilot Implementation of Guiando Buenas Decisiones, an Evidence-Based Parenting Program for Spanish-Speaking Families, in Pediatric Primary Care in a Large, U.S. Health System: A Qualitative Interview Study.

Adolescent substance use is a significant public health problem in the United States and Hispanic youth engage in substance use services at lower rates than other groups. For this under-served group, prevention services delivered in non-stigmatized, non-specialty care settings may increase access to the services. We describe findings from a feasibility pilot of the implementation of a virtual version of Guiando Buenas Decisiones (GBD), a universal, group-based substance use prevention program for parents. It was conducted with Spanish-speaking families and delivered, virtually, in pediatric primary care in a large healthcare system in the U.S. Through qualitative interviews with pediatricians (n =7) and parents (n = 26), we explored potential barriers and facilitators of GBD enrollment and engagement. Parents and pediatricians alike noted the dearth of universal prevention programming in Spanish and that GBD could help address the need for linguistically appropriate programming. Parents liked the curriculum content, materials and videos; they felt the focus on strengthening family bonds, setting clear expectations and guidelines, the use of family meetings, and the positive tools provided for navigating family conflict were well-aligned with their cultural and family values. Feedback from parents was helpful for informing more personalized and attentive approaches to program outreach and recruitment methods, and for adaptation of recruitment fliers and letters. In this pediatric primary care context serving an underserved population, we found virtual GBD feasible to implement, acceptable and appealing to parents, and judged by pediatricians as a promising, much-needed addition to their prevention armamentarium.

Implementing Arts on Prescription at Home for People Living With Dementia: A Hybrid-Effectiveness Feasibility Study.

Arts on prescription at home (AoP@Home) is a participatory art-based approach involving a professional artist engaging a person with dementia (and their family carer) in art-making in their own home. This study evaluated the implementation of AoP@Home within a real-world community aged care context. A hybrid effectiveness-implementation design was used to simultaneously test both the AoP@Home intervention and the implementation process. AoP@Home program outcomes included person with dementia and family carer (dyad) health and wellbeing, and personal goal attainment. Implementation outcomes were evaluated according to feasibility, fidelity, acceptability, uptake, and costs via routinely collected data, artist notes, and interviews with program managers, artists, and participant dyads. Four dyads completed an AoP@Home program during the study period. All participants with dementia reported improvements in their overall health and wellbeing, and wellbeing scores improved for all carers from baseline to post-program. Implementation was feasible using existing government funding mechanisms, and programs were acceptable to all stakeholders. It is possible to deliver participatory arts programs for community-dwelling people with dementia and their family, in their home, using sustainable and available funding models. Programs such as AoP@Home should be made more accessible alongside broader allied health and care services.

Protocols for breaking bad news in health care: a scoping review protocol.

This scoping review will map the available evidence on communication protocols for breaking bad news to adult patients and their families in health care. Breaking bad news to adult patients and their families is a challenging task for health care professionals. To address these challenges, communication protocols have been developed to support health care professionals in breaking bad news in a compassionate and effective manner while respecting each patient's individuality. This scoping review will consider all studies that focus on communication protocols (original or adapted versions) to break bad news to adult patients and/or their families (adults) in any health care context, regardless of the approach (face-to-face, telephone, video, or other). Quantitative, qualitative, and mixed methods studies, systematic reviews, and text and opinion papers will be considered for inclusion in this review. This review will be conducted in accordance with the JBI methodology for scoping reviews. The search strategy will aim to locate both published and unpublished evidence in English, Spanish, and Portuguese. The databases to be searched include CINAHL Plus Complete (EBSCOhost), MEDLINE (PubMed), Academic Search Complete, Psychology and Behavioral Sciences Collection, Scopus, and Web of Science Core Collection. Gray literature will also be searched for. Two independent reviewers will independently perform study selection and data extraction. Data will be extracted using a data extraction tool developed by the reviewers. Any disagreements that arise between the reviewers will be resolved through discussion or with an additional reviewer. Data will be presented in tabular and narrative format. https://osf.io/s6ru7/.

Clinical pharmacy and telemedicine: an opportunity to improve epilepsy management.

Clinical pharmacy, as defined by the European Society of Clinical Pharmacy, is a comprehensive professional practice encompassing all pharmacist profiles regardless of the setting. It focuses on promoting optimal drug utilization for patient-centric clinical outcomes. Telemedicine leverages information and communication technologies for remote healthcare delivery, bridging geographical gaps. The integration of clinical pharmacy and telemedicine is crucial in modern healthcare paradigms, especially for patients with chronic illnesses. In 2021, marketing authorization was granted for cenobamate as adjunctive treatment for focal-onset seizures with or without secondary generalization in adults with epilepsy who have not been adequately controlled despite a history of treatment with at least two antiepileptic medicinal products. This review emphasizes the synergistic role of clinical pharmacists and neurologists in utilizing telemedicine for patient counselling, drug information dissemination, adverse drug reaction surveillance, and personalized medication management within the context of epilepsy care. This integration could enhance patient safety, therapeutic outcomes and address socio-economic challenges faced by chronic patients.

Leadership and Followership Dynamics in Interprofessional Health Care Teams: Attending Physician Perspectives.

Effective interprofessional health care team (IHT) members collaborate to reduce medical errors, use resources effectively, and improve patient outcomes, making interprofessional collaboration imperative. Because physicians are often designated as the positional leaders of IHTs, understanding their perspectives on collaboration within IHTs could help to mitigate the disconnects between what is suggested in theory and what is happening in practice. This study aimed to explore leader-follower dynamics within medical teams that are commonly working in clinical care contexts. Using a constructivist approach, the authors conducted 12 individual, semistructured interviews from November 2022 to September 2023 with attending physicians who have led IHTs in perioperative (i.e., preoperative clinic, operating room, postoperative and recovery unit) or emergency department settings. The transcripts were analyzed from December 2022 to December 2023 using inductive thematic analysis. Three themes explained the physician perceptions of IHT leadership-followership dynamics: (1) physicians are comfortable sharing leadership intraprofessionally, (2) the clinical culture and environment constrain interprofessional followership and shared leadership, and (3) hierarchical models hold true even while active followers are appreciated, when appropriate. The data in this study suggest that, in perioperative and emergency department settings, shared leadership largely may not occur interprofessionally but occurs intraprofessionally. Participants suggested that the clinical culture and environment (i.e., legal concerns, hierarchical assumption, patient care ownership responsibilities) constrained interprofessional followership and shared leadership. On the basis of the study's findings and how they align with previous research, future research into interprofessional collaboration and followership roles should focus on what factors enable and constrain active followership and shared leadership. Such collaboration can only be achieved when active followership and shared leadership are allowed and promoted. These findings and others suggest that not all contexts are enabling such types of interprofessional collaboration due to legal concerns, hierarchical traditions, and patient ownership considerations.

Nutritional Status, Eating Behaviors, and Gastrointestinal Symptom Cluster Among Children Receiving Cancer Chemotherapy in Thailand: A Descriptive Study

Background: Most children undergoing chemotherapy for cancer experience gastrointestinal (GI) tract symptoms that affect their eating habits, nutritional status, and quality of life (QOL). Previous research on the connections between these factors has primarily focused on Western countries. As a result, there is limited understanding of these issues among Thai children. Objective: To describe GI symptoms, eating, nutritional status, and QOL for Thai children with cancer. Methods: This descriptive study used multiple methods. Quantitative data were collected through (1) standardized measures of GI symptoms and QOL and (2) extraction of medical history and clinical data from the child’s medical records, then analyzed using descriptive statistics. Qualitative data were collected with semistructured interviews with each child, then their parent, and analyzed using a directed content analysis. Results: Sixteen child-parent dyads participated in this study. Most children exhibited reduced food intake and weight loss, primarily attributed to GI symptoms and environmental factors. Underreporting of symptoms was identified, contributing to suboptimal symptom management. Clinician-recommended low-bacterial diets posed challenges to maintaining children’s food intake. Additionally, hospital food with repetitive menus and plain flavors was generally undesirable for children during hospitalization. Conclusions: Multifaceted factors influencing the nutritional status and QOL of children with cancer within the unique care context of Thailand were identified. Implications for Practice: The study findings inform the development of multi-level interventions targeting to optimize eating, nutritional status, and QOL for children with cancer. What is Foundational: The model, informed by cultural considerations, could be adapted for research in other countries with distinctive cultures.

Paramedics Providing Palliative Care at Home: A Retrospective Cohort Study Comparing Symptom Management of Breathlessness and Pain in Cancer Versus Non-Cancer Conditions.

Background Palliative care aims to alleviate pain and distressing symptoms, affirm life, and offer support to patients and their caregivers. For many, the expressed preference is to die at home. As a result, there is growing recognition that paramedics can play an integral role at the end of life for symptom relief. Paramedic comfort with symptom management in the palliative care context is suspected, based on past work, to be higher for cancer as opposed to non-cancer life advanced disease. The objective of this study was to explore the paramedic management of patients with cancer and non-cancer advanced disease, using pain and breathlessness as key symptoms. Methods A retrospective cohort study was conducted. Paramedic electronic patient care records were queried for calls with palliative goals of care between July 1, 2015, and June 30, 2016, in Nova Scotia, Canada, which was the first year of the Paramedics Providing Palliative Care program. A manual chart review of a subgroup of 100 consecutive charts was completed to gain deeper insight. A descriptive analysis was conducted to understand practice variation within this population. Results The electronic query returned 1909 calls with a palliative approach. A total of 765 (40.1%) had cancer. The most common non-cancer disease category was respiratory. The top chief complaint was respiratory distress in both cancer and non-cancer populations. Medication was administered more often for pain (80%) compared to breathlessness (46.5%). Paramedics were more likely to call Medical Oversight Physicians for pain control advice. Post-treatment pain scores were documented infrequently. In the chart review, symptom management using the patient's own medications occurred in 17% of cases while an additional 5% of cases involved a combination of the patient's medications and paramedic service formulary. Conclusion The non-cancer population was less likely to have a non-transport outcome. Opportunities for improvement of symptom management were noted for pain and particularly so for breathlessness. Increased comfort with a palliative approach in the non-cancer disease cohort as well as with this key symptom will be a key to the success of the program.

Homosexualität im Alter – Wahrung der Identität im Pflegekontext. Eine Literaturübersicht.

ZusammenfassungFür ältere und hochaltrige homosexuelle Menschen ist die Wahrung der Identität im Pflegekontext häufig erschwert. Neben der generell vorherrschenden Tabuisierung oder Abwertung von Sexualität im Alter sind homosexuelle Personen zusätzlich oft mit heteronormativen Strukturen bis hin zu Diskriminierungserlebnissen konfrontiert. Literatur zum ethischen Handeln im Gesundheitswesen greift den Anspruch der Nichtexklusivität auf. Achtung und Würde stehen hierbei an erster Stelle und sollen allen Personen gleichermaßen zukommen.Diese systematische Literaturübersicht verfolgt das Ziel, anhand von wissenschaftlicher Literatur ethische Ansätze und pflegerische Unterstützungsangebote herauszuarbeiten, die bei der Wahrung der Identität älterer und hochaltriger (> 60) homosexueller Menschen helfen können. Forschungsfrage: „Wie kann die Identität homosexueller älterer Menschen durch die Unterstützung von Pflegepersonen gewahrt werden?“Anhand eines narrativen Reviews konnten sechs relevante Studien identifiziert werden. Die Recherche wurde in den Datenbanken PubMed und CINAHL durchgeführt.Drei Hauptkategorien wurden identifiziert, die für das Thema Homosexualität im Alter mit seinen Herausforderungen übergreifende Maßnahmenempfehlungen darstellen: Aufklärung und Schulung von Fachkräften, strukturelle Rahmenbedingungen und ein sicheres Umfeld durch eine bedarfsgerechte Versorgung.Pflegepersonen können die Wahrung der Identität homosexueller älterer Personen durch Anerkennung in Form von Zuwendung durch pflegerische Betreuung und soziale Wertschätzung fördern. Zudem ist es wichtig, dass eine rechtliche sowie strukturelle Gleichstellung homosexueller Personen im Pflegekontext und darüber hinaus erfolgt. Eine Auseinandersetzung mit ethischen Grundsätzen und Ansätzen ist hierfür unerlässlich.

Profiles and Characteristics of Mental Health Nurses in Community-Based Health Care for People with Mental Illness - Integrative Review and Thematic Framework Analysis

To examine the specific scope of practice of community mental health nurses (CMHNs) across CMHN roles and care contexts. Systematic literature searches in CINAHL, PubMed/Medline, Google and Google Scholar, supplemented by a search of various publishers' databases. Data were analyzed and synthesized using the framework analysis method. This paper identifies two role profiles in CMHN practice that describe distinct functions in the outpatient care of people with mental illness: (A) Primary Care CMHN and (B) Specialized Care CMHN. For each role profile, contextual factors and specific role content are described and analyzed for similarities and differences. The described role profiles can serve as a template for the development of curricula in the field of CMHN. It is important to consider the national context as well as the current and future need for psychosocial care.