Better Care Delivery Research Articles

Telemedicine and time management in primary care.

Information and communication technologies (ICTs) can enable workers to structure work in novel ways, allow for better time management, and increase work scheduling autonomy. Time management and work scheduling are important factors in the field of clinical practice in primary care. Time limits on consultation are a key constraint on the delivery of good care since the length of patient-physician consultation impacts its quality. This research aimed to examine the experiences of primary care physicians (PCPs) when using telemedicine technologies (TTs), a type of ICT, in their communication with patients. During 2023 in-depth interviews were conducted with 20 Israeli PCPs: family physicians and pediatricians. Perception and management of time emerged as a focal subject in the interviews. The PCPs interviewed described several effects of TTs on time management in primary care. They portrayed TTs as saving time for patients and having a mixed effect on the healthcare organization: both saving and wasting their work time. TTs were described as impacting their time management in the context of work-life balance, allowing them to manage their time during and between appointments. For PCPs, TTs can be beneficial for managing time in the clinic, which can contribute to better healthcare. This article, concerning TTs as a type of ICT, contributes to the existing literature which suggests that ICTs can allow for better time management and increase work scheduling autonomy. It also presents several recommendations for better implementation of TTs in healthcare organizations.

PALTC Industry Partners: A Formula for Better Delivery of Care

PALTC Industry Partners: A Formula for Better Delivery of Care

Implementing and evaluating resources to support good maternity care for parents with learning disabilities: A qualitative feasibility study in England

ProblemParents with learning disabilities are often disadvantaged and their needs not well understood in maternity services. BackgroundDespite a global vision to improve maternity care, current evidence confirms poor pre- and post-natal care for parents with learning disabilities and their families. Midwives have expressed a need for support in the delivery of good care to this population of parents. AimTo test the feasibility of implementing and evaluating two evidence-based and values-based resources – the Together Toolkit and Maternity Passport - to support good maternity care for people with learning disabilities. MethodsA qualitative feasibility study employing semi-structured interviews with 17 midwives and 6 parents who had used the resources in practice in four NHS Trusts in the south of England. FindingsMidwives and parents described how the resources positively impacted maternity care by enabling midwives, connecting networks and empowering parents. Factors affecting effective implementation of the resources were reported at an individual and setting level. DiscussionStaff training to raise awareness and confidence in supporting parents with learning disabilities, and improved systems for recording parent's individual needs are required to enable the delivery of personalised care. ConclusionReasonable adjustments need to be prioritised to facilitate implementation of resources to support personalised maternity care and to address inequity for parents with learning disabilities. Aspirations for equity suggested commitment from midwives to challenge and overcome barriers to implementation. Recommendations were made to improve the resources and their implementation. These resources are free and accessible for use [www.surrey.ac.uk/togetherproject].

Surveillance Capitalism in Mental Health: When Good Apps Go Rogue (and What Can Be Done about It)

Research shows that a large proportion of the world’s population has experience with mental health difficulties, and reliable as well as scalable care is urgently needed. Digital mental health seems to be an obvious solution to provide the better delivery of care but also the delivery of better care. With an imagined future of real-time information sharing, improved diagnosis and monitoring of mental health conditions, and remote care, supported by advances in artificial intelligence, many tech companies have emerged over the last three decades to plug the treatment gap and provide services. The evidence base seems compelling: some online treatments have the capability to treat individuals quite successfully. However, the introduction, utilisation, and expansion of digital mental health technologies have not always focused on public health only. Using a surveillance capitalism perspective, this paper approaches the democratisation–privatisation dichotomy in digital mental health with a critical lens. In particular, the paper details how (commercially valuable) mental health data are extracted, “shared”, and claimed as an asset by big tech companies. Reviewing the terms, conditions, and practices of ten popular mental health apps, the paper polemically argues that mental digital health cannot unlock real value for society—better treatment, good quality care, and efficient delivery—if power, politics, and profits remain in the hands of big tech companies. To conclude, the paper draws attention to contemporary discourses that seek to promote democracy and public value for digital mental health apps, technologies, and solutions.

THU001 Novel Interactive Text-messaging Curriculum For Endocrinology Board Review

Abstract Disclosure: P. Majety: None. A. Ajayi: None. A. Modest: None. M. Vamvini: Grant Recipient; Self; MV was supported by F32-DK126432, and Joslin Diabetes Center P&F. J. Freed: None. Background: The ABIM certification exam is one of the measures to ensure that physicians have the clinical skills for good care delivery. The five-year average pass rate for the ABIM Endocrinology & Metabolism subspecialty exam is 86%, relatively lower when compared to other subspecialties. The pass rate for first time test takers significantly decreased from a usual range of 84-91% over 2017-2020 to a nadir of 74% in 2021 compared to a mean of 84% for other medicine subspecialties. This represents the lowest pass rate in 2021 for any internal medicine subspecialty exam. Objectives: The primary purpose of our study was to assess the feasibility of a unique text messaging curriculum for endocrinology fellows and its utility in improving their knowledge. We also assessed their study habits and resources available to them for ABIM subspecialty exam preparation. Methods: In 2021, endocrinology fellows from 51 programs across the country were invited to participate in our curriculum. They completed a pre-test, joined a texting group via Remind application and received 1 multiple choice question daily (total n = 78). At the end of curriculum, fellows received a post-test questionnaire, and a feedback survey. After 15 weeks, they completed a post-test and survey. Paired results from pre- and post-test were compared. Results: A total of 89 fellows from 27 programs responded. Of these, 82 fellows, predominantly females (n=60; 73%), filled out the pre-test. On an average, 42 fellows (SD = 12) responded to the questions daily. Thirty fellows completed the post-test. The median number of correct responses on the pre-test was 5 (IQR 3-6), compared to 8 (IQR 6-9) in the post-test. There was a significant improvement (p-value <0.0001) in fellows’ performance in the post-test when compared with the pre-test following our intervention.Final feedback survey was filled out by 33 of them. Ninety-seven percent responded that they use question banks as a resource for exam preparation followed by PowerPoint presentations (52%), journals (48%), online videos (39%), textbooks (33%) and lecture notes (33%). 23 fellows (70%) preferred mobile friendly question bank applications; 5 fellows (15%) preferred online question banks available through company websites only. None of them preferred paper-based question banks.Nineteen of the 33 fellows (58%) found the curriculum very useful. 17 fellows (52%) said it served as a discussion tool sometimes, while 9 fellows (27%) said they used it as a discussion tool often. Thirty two out of 33 fellows (97%) responded that they would like to continue to receive a question daily for the rest of their fellowship. Conclusions: Text-messaging based curriculum for exam preparation is feasible and can improve test performance. Fellows find receiving a daily high yield multiple choice question via text-message as a useful tool for exam preparation. Presentation: Thursday, June 15, 2023

Novel interactive text-messaging curriculum for endocrinology board review

BackgroundThe ABIM certification exam is one of the measures to ensure that physicians have the clinical skills for good care delivery. The 5-year average pass rate for ABIM Endocrinology exam is 82%. The pass rate significantly decreased to a nadir of 74% in 2021 and 2022, lowest of all medicine subspecialties. ObjectivesTo assess the feasibility of text messaging curriculum for fellows and its utility in improving their test performance. MethodsIn 2021, endocrinology fellows from 51 programs across the country were invited to participate in our curriculum. They completed a pre-test, joined a texting group via Remind application and received 1 multiple choice question daily (total n = 78). After 15 weeks, they completed a post-test and survey. Paired results from pre- and post-test were compared. ResultsA total of 89 fellows from 27 programs responded. Of these, 82 fellows, predominantly females (n = 60; 73 %), filled out the pre-test. On an average, 42 fellows (SD = 12) responded to the questions daily and 57 % of them answered the questions within 24 h. Thirty fellows completed the post-test. The median number of correct responses on the pre-test was 5 (IQR 3–6), compared to 8 (IQR 6–9) in the post-test. There was a significant improvement (p-value < 0.0001) in fellows’ performance in the post-test when compared with the pre-test following our intervention. ConclusionsText-messaging based curriculum for exam preparation is feasible and can improve test performance. Fellows find receiving a daily high yield multiple choice question via text-message as a useful tool for exam preparation.

Specialist cancer hospital-based smoking cessation service provision in Ireland

BackgroundWhile much progress has been made in reducing tobacco use in many countries, both active and passive smoking remain challenges. The benefits of smoking cessation are universally recognized, and the hospital setting is an ideal setting where smokers can access smoking cessation services as hospital admission can be a cue to action. Consistent delivery of good quality smoking cessation care across health services is an important focus for reducing the harm of tobacco use, especially among continued smokers.AimsOur objective was to document the smoking cessation medication and support services provided by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal.MethodsA cross-sectional survey based on recent national clinical guidelines was used to determine smoking cessation care delivery across eight specialist adult cancer tertiary referral university hospitals and one specialist radiotherapy center. Survey responses were collected using Qualtrics, a secure online survey software tool. The data was grouped, anonymized, and analyzed in Microsoft Excel.ResultsAll responding hospitals demonstrated either some level of smoking cessation information or a service available to patients. However, there is substantial variation in the type and level of smoking cessation information offered, making access to smoking cessation services inconsistent and inequitable.ConclusionThe recently launched National Clinical Guideline for smoking cessation provides the template for all hospitals to ensure health services are in a position to contribute to Ireland’s tobacco endgame goal.

69 ‘The model ward’: a stroke and specialist gerontology ward in a level three hospital in Ireland

Abstract Background A model ward adheres to formal processes and combines input from all members of the Multi-Disciplinary Team (MDT) from admission to discharge ensuring high quality patient care. A stroke and specialist gerontology ward in a level three hospital in Ireland leads this approach with MDT meetings every morning. Research has demonstrated that pre-round MDT meetings decreases length of stay, increases patient safety and enhances patient and staff experience. This audit evaluated the impact of pre-round MDT meetings on a stroke and specialist gerontology ward in a level 3 hospital in Ireland, as per NICE and New South Wales guidelines. Methods The audit was conducted between 25/04/2023 and 26/04/2023 via questionnaire consisting of 10 closed and 2 open ended questions. Staff members who attend meetings completed questionnaires and responses were confidential. 20 questionnaires were completed. Results 100% of members (n = 20) found pre-round MDT meetings useful, aided with better delivery of care, reduced daily stresses and all key disciplines were represented. 85% (n = 17) stated it hastened patient discharge. 90% (n = 18) reported all opinions are brought together openly and patient-centred goals are established. 95% (n = 19) found overall aims, next steps and timeframes are agreed and the meetings make them feel unified. 80% (n = 15) of members previously worked on wards with no pre-round MDT meetings. Of those 15, 87% (n = 13) saw an improvement in patient care compared to other wards. 50% (n = 10) of members recommended no improvements necessary for meetings, 30% (n = 6) recommended earlier meetings, 15% (n = 3) would like more disciplines represented and 5% (n = 1) recommended alteration of seating positions for inclusivity. Currently consultants and registrars sit at the main table. Conclusion The results highlight the valuable impact of pre-round MDT meetings in providing continuous patient-centred care. This suggests further exploration by potential implementation of these meetings on other wards in hospitals.

Improving Confidence in Dementia Care by Helping Care Staff Articulate Skills They Already Possess: The Value of the Communication and Interaction Training (CAIT) Programme

This article discusses the findings from a training programme called ‘Communication and Interaction Training’ (CAIT). CAIT was designed to improve the confidence of carers in their use of communication skills with people living with dementia, particularly when managing behavioural agitation. This pre/post assessment study employed a mixed design, and showed positive effects in terms of quantitative and qualitative features. The participants were mainly from a specialist team who were experienced in managing episodes of agitation in care home settings. Twenty-three staff were assessed on the Confidence in Dementia Scale (CODE), which is a measure for assessing carers’ confidence in communicating with people living with dementia. The findings showed increased levels of confidence in communicating and interacting with people with dementia following the training. The qualitative findings showed improvements in participants’ abilities to articulate their communication strategies (i.e. higher degrees of specificity in their communication skills), indicative of improved dementia ‘literacy’ regarding their interventions. As a consequence of such improvements, it is suggested that greater confidence and literacy would lead to the delivery of better care due to enhanced self-awareness of good practices, and enhanced communication skills both within the staff group and between staff and residents.

Health Information Systems: Past, Present, Future - Revisited.

Health information systems (HIS) represent an essential part of the infrastructure for the delivery of good health care. To present the author's personal views on HIS developments over the last decades and on the opportunities and priorities for future HIS developments. Reflecting on his views, the author identified relevant semantic dimensions, which are denoted as development paths, and searched for appropriate periods to characterize HIS development leaps. HIS developments were divided into the periods past (1961-2016), present (2017-2022), and future (the next decades). Eight development paths for HIS were considered as being relevant to presenting the author's views: life situations related to health care, entities for health care, health care facilities, settings of health care, data to be processed, features for functions, architectures of HIS, and management of HIS. For each of these paths, the past and present states as well as challenges and opportunities for future HIS developments were outlined. The presented views on HIS developments and the selected development paths and periods are by nature subjective 'avant la lettre'. The views were, however, formed over almost half a century during which the author has been engaged with HIS developments, and thus may be worth reporting and discussion. If past is prologue, the tremendous HIS developments in the past and in the present may predict a similar development intensity in the future. Present HIS are significantly better than HIS of the past, however they leave room for continued improvement with an end of HIS developments far from sight.

Delivering compassionate care in nursing

Compassion is a cornerstone of nursing practice. Lindsey Lister and Catherine Best look at the effect of compassion fatigue and how this can be overcomeCompassion is essential to the delivery of good patient care. However, due to the demands faced by the nursing workforce, many are at risk of compassion fatigue. Cultivating self-compassion can promote resilience and there are several models of compassion which can encourage compassion in the workforce. Compassion training may be needed to support nurses.

Investigation of Mental and Physical Health of Nurses Associated with Errors in Clinical Practice.

Background: Errors are common among all healthcare settings. The safety of patients is linked directly with nursing errors because nurses stand by them more often than any other healthcare professional. The role of mental and physical health of nurses is of great interest for a good and efficient job performance, but also for maintaining good patient care delivery. This study aimed to investigate the association between nurses’ general health and making errors during clinical practice. Methods: A total of 364 nurses completed a specially designed questionnaire anonymously and voluntarily. The sample consisted of nurses with all educational degrees. The questionnaire included demographic data and questions about general health issues, resilience status and nurses’ possible experience with errors within a hospital. Results: 65,8% of the participants stated that at least one error had happened at their workplace, and 49,4% of them reported that the error was caused by them. Somatic symptoms were found to have a positive correlation with making errors (p < 0.001). However, the other aspects of general health, which were anxiety/insomnia, social dysfunction and severe depression, had no statistical significance with adverse events. The most common type of error reported (65,5%) was a medication adverse event. Resilience level was found to be statistically significant (p < 0.001) when correlated with all aspects of general health (anxiety/insomnia, severe depression, somatic symptoms), but not with social dysfunction. Conclusion: Nurses are affected by their somatic symptoms in their daily clinical practice, making them vulnerable to making errors that compromise patient safety. A high resilience level could help them cope with unfavorable situations and prevent them from doing harm to a patient or themselves.

Durable Medical Equipment, Pharmaceutical, and Practitioner Connections: A Formula for Better Delivery of Care

Caring for the Ages is the official newspaper of AMDA and provides long-term care professionals with timely and relevant news and commentary about clinical developments and about the impact of health care policy on long-term care medicine.

Eat Walk Engage: Enabling acute care teams to deliver consistent fundamentals of care for older people.

Fundamentals of care are particularly important for older people in acute inpatient settings, who are at increased risk of serious hospital-associated complications like delirium and functional decline. These complications occur due to interactions between clinical complexity and the complex processes and context of hospital care and can be reduced by consistent attention to the fundamentals of care. This paper aims to illustrate of how multi-level nursing leadership of fundamentals of care can be supported to emerge within complex multidisciplinary delivery systems in acute care. Discussion paper informed by clinical and organizational experience of a multidisciplinary leadership team and complexity leadership theory. We provide a series of vignettes as practical illustrations of a successful multidisciplinary improvement program called Eat Walk Engage which supports the delivery of better care for older inpatients, significantly reducing delirium. We argue that taking a broader complexity-based approach including collaborative multidisciplinary engagement, iterative and integrated interventions and appropriate knowledge translation frameworks can enable emergent leadership by nurses at all levels. This promising approach to improving care for older patients requires organizational support for facilitation and reflective practice, and for meaningful data to support change. Our discussion challenges nursing leaders to support the time, agency and connections their nursing staff need in order to emerge as local leaders in fundamental care. The debate around scope and responsibilities for fundamentals of care in hospital care has important practical implications for conceptualizing leadership and accountability for improvement. Our discussion illustrates how a structured multidisciplinary approach that acknowledges and navigates complexity can empower nurses to lead and improve outcomes of older patients in acute care.

995 MULTIPLE ORGANISATIONAL FACTORS IMPROVE MULTI-DISCIPLINARY CARE DELIVERY TO PATIENTS WITH HIP FRACTURES: A QUALITATIVE STUDY

Abstract Introduction Hip fractures are devastating injuries which incur high healthcare costs. Despite national standards and guidelines, there is substantial variation in hospital delivery of hip fracture care and in patient outcomes. This study aimed to understand organisational processes that facilitate successful delivery of hip fracture services. Method Forty qualitative interviews were conducted with healthcare professionals involved in delivering hip fracture care at four English hospitals. Interview data were supplemented with documentary analysis of 23 anonymised British Orthopaedic Association hospital-initiated peer-review reports of services. Data were analysed thematically, with themes transposed onto key components of the care pathway. Results We identified multiple aspects of service organisation that facilitated good care delivery. At admission, standardisation of training in nerve block administration impacted care delivery. During hospital stays, service delivery was improved by integrated, shared-care between orthopaedics and orthogeriatrics, and by strategies to improve trauma list efficiency. Adequately staffed orthogeriatric services and the ‘right’ skills and seniority mix were important to holistic care provision. Placing patients on designated hip fracture wards concentrated staff expertise. Collaborative working was achieved through multi-disciplinary team (MDT) meetings between key staff, protocols and care pathways that defined roles and responsibilities, MDT documentation, ‘joined-up’ IT systems within hospitals and with primary care, and shared working spaces such as shared offices and onwards. Trauma and hip fracture coordinators organised care processes and provided a valuable central point of contact within teams. Nominated leads, representing diverse specialties, worked together in MDT planning meetings to develop joint protocols, establish audit priorities, and agree shared goals. Routine, comprehensive monitoring and evaluation of service delivery, with findings shared throughout the MDT, was beneficial. Conclusion Our study has characterised potentially modifiable elements of successful hip fracture service delivery. Findings are intended to help services overcome organisational barriers towards delivery of high-quality hip fracture services.

Exploring oral care practices, barriers, and facilitators in an inpatient stroke unit: a thematic analysis

Purpose Oral care is essential to support the health and rehabilitation of stroke survivors but is often performed poorly in the inpatient setting. This article examines the current practices, barriers and facilitators to oral care on an Australian stroke unit to inform future knowledge translation interventions within this setting. Methods Qualitative semi-structured interviews were conducted with nursing staff members and speech-language pathologists with experience delivering oral care to stroke survivors. Reflexive thematic analysis was used to analyse the data. Results Three themes were developed from the data. In the first theme, participants described current oral care practices within their stroke unit and acknowledged that there is room for improvement. In the second theme, participants identified the multiple overlapping barriers to oral care delivery on the ward. Finally, the third theme explored participants’ suggestions for improving oral care, including both local and organisational change. Conclusions This study illustrates the complexities of oral care in the inpatient stroke setting and gives voice to the perspectives of nursing and speech-language pathology staff. It is clear that future oral health interventions in this setting require a comprehensive approach to addressing barriers and should prioritise the concerns of staff delivering the care. IMPLICATIONS FOR REHABILITATION The delivery of good oral care post-stroke is essential, but in practice is difficult due to limited time and supplies, inadequate education, fear of harm to patient and self, and perceived low priority of the care. Speech-language pathologists are often involved in oral care, but their role is not clearly delineated, and they are not provided with formal training in oral care provision. Oral care interventions should be comprehensive, including organisational policies, clear practice guidelines, structured multi-disciplinary education, and appropriate supplies.

Building capability in paediatric palliative care and enhancing education through the voice of parents: the Quality of Care Collaborative Australia.

Background:The greater proportion of children with a life-limiting condition (LLC) and their families want to remain at home as much as possible. Building capability in paediatric palliative care (PPC) for generalist health and social care professionals in nonmetropolitan regions through the Quality of Care Collaborative Australia (QuoCCA) has improved access to palliative care for families, regardless of where they live.Aim:To understand the experience of families whose child has received specialist PPC, to ensure future service capability development is informed by lived experience.Design:A retrospective, descriptive study in which parents participated in a semi-structured telephone interview guided by Discovery Interview methodology. Inductive thematic analysis identified the major learnings from participants.Participants:Parents caring for a child referred to the specialist PPC service, who received a pop-up visit and whose child is stable or who are more than 6 months bereaved.Results:Eleven parents (n = 9 mothers; n = 2 fathers) of children with an LLC (n = 5) or whose child had died (n = 6) participated in an interview. The overarching themes and subthemes were as follows: (1) burden of suffering, in which parents described grieving for the life once anticipated, confronting many life transitions and seeking quality of life for their child and (2) umbrella of support, in which parents built partnerships with professional support, activated a network of care around their family and sought responses to their whole family’s needs.Conclusion:Parents caring for a child with an LLC described significant personal, familial, social and existential adjustments. This study integrates a relational learning approach with QuoCCA education grounded in the relationships between children, families and professionals. Learning from lived experience in PPC education enhances the preparedness of generalist health and social care professionals to join a child and their family throughout their various life transitions and facilitates the goal to remain at home within their community for as long as possible. Education in PPC is an imperative component of service models, enabling regional services to gain confidence and capability in the context of a dying child and their family, empowered and informed through the voice of the family.Plain Language Summary Enhancing palliative care for children through education informed by the experience of families It is often the wish of many children/young people with a life-limiting condition to stay at home with their families as much as possible. It is important that specialist palliative care services provide training and mentoring to the family’s local care professionals to support the delivery of good care, particularly those in rural and remote areas.This article aims to integrate the lived experience of families with palliative care education, so that the education reflects and addresses the needs that they express.Parents were interviewed by telephone using a method called Discovery Interviews. This is an open interview process, guided by a spine that describes the main points of palliative care. Parents can openly talk about their experience, focusing on the areas that are important to them. Interviews were studied by four researchers, and emerging themes were discussed and summarised.The study included parents whose child/young person was receiving support from specialist palliative care and bereaved parents whose child had died more than 6 months ago. In total, eleven parents (nine mothers and two fathers) were interviewed, five participants had children currently receiving palliative care and six were bereaved.The overarching themes were as follows:Burden of suffering, in which parents described grieving for the life they had expected, confronting transitions and seeking good quality of life for their child.Umbrella of support, in which parents built partnerships with care teams and activated a network of care to address the needs of their whole family.This study allowed the families’ perspectives to be integrated into the palliative care education of care professionals in the family’s local area. The lived experience of families prepared care professionals to support families with the care of their child/young person, allowing them to remain at home as long as possible.

The Paradox of Political Accountability and Deficits in the Preconditions for Service Delivery in Elderly Care: A Qualitative Study of Swedish Politicians.

The aims of this qualitative grounded theory study were to explore how politicians accountable for Swedish elderly care viewed their assignment, their beliefs and knowledge regarding the psychosocial work environment for elderly care employees, the factors affecting their work environment, and how these politicians regarded elderly care during the COVID-19 pandemic. This study consisted of 41 interviews with politicians in municipalities across Sweden. Three categories emerged from the analysis: (1) interpretation of the assignment directs the focus; (2) recognizing shortfalls in the employees’ work environment; and (3) exposing deficiencies due to the COVID-19 pandemic. The strongest category was identified as interpretation of the assignment directs the focus and was described as the delivery of good and quality care. Nevertheless, this study highlights shortfalls in the delivery of care services where the employees’ work environment, especially in the home care sector, was frequently described as stressful. The COVID-19 pandemic adversely affected the work situation for staff in elderly care. In that setting, staff shortage and lack of competency were common. Nurses were particularly affected by high workload and responsibility. Further research should explore civil servant roles in the elderly care sector and how these actors view their collaboration with municipality politicians.

Rural influences on the social network dynamics of district nursing services: A qualitative meta-synthesis.

Background and AimsAs demands on healthcare services grow, fiscal restrictions place increased emphasis on services outside of traditional healthcare settings. Previous research into long‐term‐conditions suggests that social network members (including weaker ties such as acquaintances, community groups, and healthcare professionals) play a key role in illness management. There is limited knowledge about the engagement of social networks in supporting people who are receiving medical interventions at home. This qualitative metasynthesis explores the work and the interactions between district nurses (DN) and informal network members supporting people who are receiving medical interventions at home and living in rural areas.MethodsA search was undertaken on CINAHL, Medline, and PsychINFO for qualitative research articles from 2009 to 2019. Studies that examined DN in rural locations and/or social network support in rural locations were eligible. Fourteen articles were selected.ResultsThematic analysis of results and discussion data from the studies resulted in four themes being developed: the development of both transactional and friend‐like nurse‐patient ties in rural localities, engagement of the wider network in the delivery of good care, blurring of professional boundaries in close community relationships, and issues accessing and navigating formal and informal support in the context of diminishing resources in rural areas.These findings suggest that DNs in rural localities work beyond professional specialties and experience to provide emotional support, help with daily tasks, and build links to communities. There was also evidence that nurses embedded within rural localities developed friend‐like relationships with patients, and negotiated with existing support networks and communities to find support for the patient.ConclusionsFindings indicated that developing strong links with patients and members of their networks does not automatically translate into positive outcomes for patients, and can be unsustainable, burdensome, and disruptive. DNs developing weak ties with patients and building awareness of the structure of individual networks and local sources of support offers avenues for sustainable and tailored community‐based nursing support.

Supporting the delivery of good maternity care for parents with learning disabilities

Background and objectiveDespite directives to improve maternity care in general and to improve care for parents with learning disabilities, the maternity experience of parents with learning disabilities is often poor and lacking reasonable adjustments to care. The objective of this study was to develop resources - in collaboration with key stakeholders - to support the workforce in delivering good maternity care to parents with learning disabilities. DesignA two-phase mixed-methods study. ParticipantsPhase 1: 16 key stakeholders (health and social care professionals, parents with learning disabilities and their informal supporters/carers) were interviewed to understand views of best practice and inform resource development. Phase 2: 20 healthcare professionals engaged with the resources and gave feedback via online survey or discussion group to further refine them. FindingsThematic analysis of key stakeholder interviews indicated that good maternity care for parents with learning disabilities requires a positive and proactive approach to identifying need; reasonable adjustments to communication and providing information; and professionals working together to support and enable parents. Key conclusionsHealth and social care professionals identified barriers to the delivery of good maternity care for parents with learning disabilities, including how to identify whether a parent has learning disabilities. Professionals in maternity services require additional resources to ensure parents’ needs are recognised and they are provided with personalised preparation for parenthood and sufficient support. Implications for practiceThe Together Toolkit and Maternity Passport were coproduced to support the workforce to deliver good maternity care to parents with learning disabilities, these resources are free and accessible for use [https://www.surrey.ac.uk/research-projects/together-project-supporting-delivery-good-practice-maternity-services-parents-learning-disabilities]. Further evaluation will explore acceptability and perceived impact of these resources in maternity services.