District Nurses Research Articles

Опыт Казахстана в формировании социально ориентированной модели первичной медико-санитарной помощи

Primary health care is recommended as a global strategy to provide basic health care to all people. Kazakhstan has begun to implement the phased creation of multidisciplinary teams. Improving the competencies of nurses, social workers, and psychologists will ensure that primary health care responds more effectively to fully meet people's health care needs. We studied tthe experience of the Republic of Kazakhstan in the formation of a socially oriented model of primary health care. We also analyzed statistical data on staffing provided by the health departments of the regions of the Republic of Kazakhstan over the past 5 years. According to the data provided by the regions, it is clear that over the past 5 years from 2018 to 2022, the number of nursing staff in the area has increased both regionally and city-wise. For example, the number of district nurses at the regional level increased by 14.7% (from 11673.5 in 2018 to 13394.75 in 2022), at the village level increased by 10.1% (from 6635.3 in 2018). to 7308.75 in 2022). However, the total number of nurses conducting independent consultations at the village level decreased in 2022 to 510 compared to 2018. Over the past 5 years, the number of psychologists and social workers has been increasing both in cities and in rural regions of the country. Combining traditional primary care services with psychological and social care, as well as expanding the functions of nurses in the Republic of Kazakhstan, has made it possible to optimize the use of limited healthcare resources. The creation of multidisciplinary teams has been a key element of the socially oriented model of primary health care provision and allows for the successful implementation of a holistic patient-centered approach.

EXPERIENCES OF DISTRICT NURSES WITH MAKING DECISIONS ABOUT THE USAGE OF INVOLUNTARY TREATMENT

Abstract District nurses play a key role in care of older Persons Living with Dementia (PLWD) who still live in their own home environment. Studies show that they often have to deal with decision-making about and the usage of involuntary treatment. Involuntary treatment is care provided that they resist to and/or have not given consent to, such physical restraints, psychotropic medication. This study aimed to describe district nurses’ experiences regarding the decision-making processes about and the usage of involuntary treatment among PLWD. A qualitative study design with a grounded theory approach was used. During semi-structured interviews, 16 district nurses shared experiences in 31 different cases of involuntary treatment use among PLWD. Results show that district nurses were often not involved in the decision-making process. In most cases, family caregivers decided solely to use involuntary treatment, and district nurses were asked to do also. District nurses experienced these situations as difficult to deal with. They felt that they were torn between providing “good care”, wishes of PLWD, and meeting the expectations of family caregivers. Their experiences were negatively affected if PLWD verbally rejected the care provided, they were unable to enter into a dialogue with the caregivers about the care provided, and if they did not have sufficient knowledge about how to deal with PLWD. These findings indicate the importance, of proactive case management in dementia care at home. District nurses can facilitate this by going into dialogue between PLWD and his caregivers, in order to provide person-centered dementia care at home.

DISTRICT NURSES’ ATTITUDES TOWARD INVOLUNTARY TREATMENT IN DEMENTIA CARE: A CROSS-SECTIONAL STUDY

Abstract Persons Living with Dementia (PLWD) prefer to live in their home environment, making their own choices and living a self-determined life for as long as possible. However, recent studies have shown that one in two PLWD receives involuntary treatment. Involuntary treatment is care provided that they resist to and/or have not given consent to, such as physical restraints, psychotropic medications. Although district nurses play a key role in the care of PLWD, it is unknown how their attitudes and opinions influence the use of involuntary treatment. This study aims to investigate the attitudes of district nurses towards the use of involuntary treatment in dementia care at home, determinants, and their opinion about its restrictiveness and discomfort. In a cross-sectional study, data were collected in a convenient sample of 296 Belgian district nurses using an online version of the Maastricht Attitude Questionnaire - Home Care. Results show that district nurses perceive involuntary treatment as a regular part of nursing care, having neither positive nor negative attitudes towards its appropriateness. They consider involuntary treatment usage as moderately restrictive to PLWD and feel moderately uncomfortable when using it. Nursing staff with more years of experience in dementia care, perceiving care for PLWD as burdensome, and having a lower educational background were more accepting towards involuntary treatment, rating it as a regular measure in the nursing care repertoire. These findings underscore the need to increase the awareness of district nurses regarding the negative consequences of involuntary treatment use to PLWD.

Overlooked and under-evidenced: Community health and long-term care service needs, utilization, and costs incurred by people with severe obesity.

Numbers of people with severe obesity (BMI ≥ 40 kg/m2 ), with need for community health and long-term care (LTC) services, are increasing, but documentation is lacking. We identified individuals with severe obesity known to community health and care professionals in a representative United Kingdom region and used an investigator-administered questionnaire to record needs and use of community health and LTC services. Data were verified against health and LTC records. Local and published sources informed detailed micro-costing. Twenty-five individuals (15 women) consented, aged 40-87 (mean=62) years, BMI 40-77 (mean=55) kg/m2 : 20 participants (80%) were housebound. Twenty-two different cross-sector community health and LTC services were used, including community equipment service (n=23), district nursing (n=20), occupational therapy (n=14), and LTC (n=12). Twenty-four (96%) participants used three or more services, with longest care episode lasting over 14 years. Total annual service costs incurred by participants varied from £2053 to £82 792; mean £26 594 (lower estimate £80 064; mean £22 462/upper estimate £88 870; mean £30 726), with greatest costs being for LTC. Individual costs for equipment (currently provided) and home adaptations (ever provided) ranged widely, from zero to £35 946. Total mean annual costs increased by ascending BMI category, up to BMI 70 kg/m2 . This study provides a framework with which to inform service provision and economic analysis of weight management interventions. People with severe obesity may need sustained care from multiple community care services.

Pre-Testing Muhammadiyah COVID-19 Guidelines in Jakarta Province

Muhammadiyah, being one of the religious-based organizations, has its affiliated members comprising 14,9% of the general Indonesian population. The Muhammadiyah Central Board declared an ad-hoc group called the Muhammadiyah COVID-19 Command Centre (MCCC) to combat COVID-19. Among the used media were the third COVID-19 guidelines publications by the MCCC. This study aimed to determine the Muhammadiyah members’ understanding of the COVID-19 Revision III Guidelines based on their consistency, clarity, relevance, credibility, and interest. This research was a descriptive qualitative type of study. The eleven informants who participated in this study, determined by purposive sampling, were Muhammadiyah members who lived and worked in the Jakarta. These Informants consisted of various professions, including health workers, teachers, district board members, nurses, drivers, traders, housewives, and students. Data collection was by online focus group discussions through the zoom cloud meetings platform. Informants discussed the five aspects of the guideline which included consistency, clarity, relevancy, credibility and interest. The contents of the guideline were found to be consistent with other similar guidelines published by the Ministry of Health (MOH). In addition, being affiliated members of the Muhammadiyah group, informants felt more comfortable trusting the Muhammadiyah-published COVID-19 guidelines. From the clarity and relevance aspect, the informants had positive perspectives on the guidelines. The design of the published guidelines attracted their interest in reading, implementing, and sharing the guidelines with others. However, the guideline did not contain the names of its drafting team nor the introduction by the Central Board leadership. It would have been a very important strategy in strengthening the credibility of the media published by the MCCC. The MCCC needed more enticing plans and methods in the dissemination of its online or printed media to the population. For online media, the published number of pages should be fixed to a less readable number.

A district nurse's reflection on pre-registration nursing education: a troubling position.

This article explores the author's observations as a qualified district nurse and senior lecturer in pre-registration nurse education. Perceived 'troubling' reflections suggest pre-registration nurse education appears very hospital focussed. Additionally, the role of the district nurse has become synonymous with the term 'community nurse', hiding the historical specialism it represents. Media representations of the term 'frontline' was particularly noted in relation to COVID-19, suggesting a heroism of nursing that only happened in hospital. More discussion will take place around how nursing is viewed within education by students, such as what we do to patients (catheterisation, blood sugars etc) rather than how we can work with them. All these areas appear to strengthen lingering historical myths around district nursing and student perceptions of this specialist profession.

District nursing using neighbourhood care principles in practice: reflecting on our experience.

There is much interest in the UK, and elsewhere, in the Dutch Buurtzorg model of providing district nursing, and there a number of published, external evaluations of pilot projects. We are nurses who worked in one such pilot that used an adapted Buurtzorg model called neighbourhood nursing using neighbourhood care principles. This article reflects on our experience and describes how we organised ourselves and, our experiences of working in such ways as well as the challenges. This article also offers advice for others who are considering introducing such models.

A task service and a talking service: A qualitative exploration of bereaved family perceptions of community nursing care at the end of life

Background: Greater emphasis on community-based care at the end of life is supported by the premise that most people want to be cared for and die at home. As such, it is important to understand the current state of palliative care nursing within an integrated generalist-specialist model of care in the community. Aim: To explore bereaved family perceptions and experiences of community nursing at the end of life, with a particular focus on service integration. Design: A qualitative study design using semi-structured telephone interviews with bereaved family. A critical realist framework was used to inform the analysis of interview data and thematic analysis of data was used to identify key themes. Setting/participants: Participants were the family carers of patients who had died within the catchment area of two large District Health Boards in Auckland, New Zealand. Results: Twenty-three participants were interviewed. Participants described their experiences of community nursing in terms of the service they provided. Hospice nursing roles were described in terms of a “talking service” and District Nursing as a “task service.” There was minimal expectation of the general practice nurse in terms of palliative care support and little evidence of service integration. Conclusion: Findings from this study support the need for a new integrated model of palliative care nursing which utilizes the unique skill set of nurses working across all community care settings including general practice, hospice and district nursing services. Accommodating different models of nursing care which can be responsive to patient need rather than limited to a defined service delivery model.

The challenges homeless people face when accessing end-of-life care: what district nurses need to know.

People experiencing homelessness have poorer physical and mental health compared with the rest of the population. Mortality rates are significantly higher, yet there is a dearth in suitable places for the delivery of palliative and end-of-life (EOL) care. Homeless people are being failed by the current healthcare system. The stigma associated with being homeless negatively impacts these marginalised people, affecting care given from healthcare professionals (HCP). Services are often inflexible and have little tolerance for substance misuse. District Nurses (DN) are often experienced EOL care practitioners and well-placed to give person-centred care with a focus on collaborative decision-making. However, many homeless people die without input from DNs or specialist palliative support. It is important to understand why this is happening to address what can be done to help.

The use of leg elevation in the treatment of chronic peripheral oedema.

Chronic peripheral oedema is a common long-term condition, with conflicting evidence on how it is best managed. It is crucial to establish the cause of the oedema to decide on the most appropriate intervention for its management. If the oedema is not managed, it can lead to unwanted complications for the service user. The District Nurse (DN) is pivotal in the management of patients with long-term conditions, both directly and indirectly. It is important that a multi-disciplinary approach is used, although nurses are now more autonomous due to advances in practice. The present study focuses on leg elevation as a form of intervention in the treatment of chronic peripheral oedema. As with any intervention, there are some risks with leg elevation that must be considered. This should be disseminated and monitored effectively.

District nurses’ experiences of advanced medical technology in home care: A qualitative interview study

The escalation in the number of medical devices in home care increases the demands on district nurses’ knowledge and skills. This qualitative interview study with 13 district nurses from Sweden aimed to describe their experiences of advanced medical technology in home care. The COREQ checklist for qualitative studies was applied. The results showed two categories: district nurses’ experiences of collaborating in teams and district nurses’ experiences of performing safe care. The safe use of advanced medical technology in home care required good collaboration between all the parties involved. This resulted in a certain amount of freedom and increased quality of life for the patients. District nurses needed time, continuity, practical training, and repeated education to be able to provide safe care. Distinct leadership was important at all organizational levels. The results can generate a safe and sustainable work environment for district nurses, almost independent of their technical background.

Applying the Consolidated Framework for Implementation Research to Identify Implementation Determinants for the Integrated District Evidence-to-Action Program, Mozambique.

The Integrated District Evidence-to-Action program is an audit and feedback intervention introduced in 2017 in Manica and Sofala provinces, Mozambique, to reduce mortality in children younger than 5 years. We describe barriers and facilitators to early-stage effectiveness of that intervention. We embedded the Consolidated Framework for Implementation Research (CFIR) into an extended case study design to inform sampling, data collection, analysis, and interpretation. We collected data in 4 districts in Manica and Sofala Provinces in November 2018. Data collection included document review, 22 in-depth individual interviews, and 2 focus group discussions (FGDs) with 19 provincial, district, and facility managers and nurses. Most participants (70.2%) were nurses and facility managers and the majority were women (87.8%). We audio-recorded all but 2 interviews and FGDs and conducted a consensus-based iterative analysis. Facilitators of effective intervention implementation included: implementation of the core intervention components of audit and feedback meetings, supportive supervision and mentorship, and small grants as originally planned; positive pressure from district managers and study nurses on health facility staff to strive for excellence; and easy access to knowledge and information about the intervention. Implementation barriers were the intervention's lack of compatibility in not addressing the scarcity of human and financial resources and inadequate infrastructures for maternal and child health services at district and facility levels and; the intervention's lack of adaptability in having little flexibility in the design and decision making about the use of intervention funds and data collection tools. Our comprehensive and systematic use of the CFIR within an extended case study design generated granular evidence on CFIR's contribution to implementation science efforts to describe determinants of early-stage intervention implementation. It also provided baseline findings to assess subsequent implementation phases, considering similarities and differences in barriers and facilitators across study districts and facilities. Sharing preliminary findings with stakeholders promoted timely decision making about intervention implementation.

Exploring nurse-sensitive patient outcomes in Dutch district nursing care: A survey study.

There is a lack of evidence to guide district nurses in using nurse-sensitive patient outcomes as it is unclear how these outcomes are currently used in daily district nursing practice. Therefore, we aimed to explore (1) which nurse-sensitive patient outcomes are measured and how these outcomes are measured, (2) how district nurses use the outcomes to learn from and improve current practice and (3) the barriers and facilitators to using outcomes in current district nursing practice. An exploratory cross-sectional survey study was conducted. The survey was distributed online among nurses working for various district nursing care organisations across the Netherlands. The responses from 132 nurses were analysed, demonstrating that different instruments or questionnaires are available and used in district nursing care as outcome measures. The nurse-sensitive patient outcomes most often measured with validated instruments are pain using the Numeric Rating Scale or Visual Analogue Scale, delirium using the Delirium Observation Scale, weight loss using the Short Nutritional Assessment Questionnaire and caregiver burden using the Caregiver Strain Index or a Dutch equivalent. Falls and client satisfaction with delivered care are most often measured using unvalidated outcome measures. The other nurse-sensitive outcomes are measured in different ways. Outcomes are measured, reported and fed back to the nursing team multiple times and in various ways to learn from and improve current practice. In general, nurses have a positive attitude towards using nurse-sensitive outcomes in practice, but there is a lack of facilitation to support them. Because insight into how nurses can and should be supported is still lacking, exploring their needs in further research is desirable. Additionally, due to the high variation in the utilisation of outcomes in current practice, it is recommended to create more uniformity by developing (inter)national guidelines on using nurse-sensitive patient outcomes in district nursing care.

Enhancing the clinical supervision experience of staff members working within primary and community care: a best practice implementation project.

The project aimed to assess compliance with evidence-based criteria regarding the use of clinical supervision amongst district nurses and to improve knowledge and engagement in clinical supervision activities within the workplace. It is important to provide clinical support to all healthcare workers that provide opportunities to develop and be listened to in a supervised environment. Clinical supervision is seen as a key element to provide this support. It provides a professional working relationship between two or more members of staff where the reflection of practice and personal emotion can be discussed, which is outlined in many policies and guidelines. A baseline audit was carried out using the JBI Practical Application of Clinical Evidence System program involving 16 participants in one district nursing team in South Wales. The first step involved the development of the project and generating the evidence. Following this, a baseline audit was conducted, and educational training on clinical supervision was undertaken followed by clinical supervision sessions. A postimplementation re-audit was conducted following implementation. A total of 16 participants enrolled on the project. Receiving basic training and participating in clinical supervision was much higher than the baseline audit with both increasing to 100% compliance. Furthermore, 94% of participants were aware of clinical supervision activities and 88% knew of existing records on clinical supervision. The project results show a large increase in compliance with all of the criteria. Overall the implementation project achieved an improvement in evidence-based practice regarding clinical supervision in primary care.

Expert appraisal and prioritization of barriers to mHealth use for older adults living with Alzheimer's disease and related Dementias: A Delphi study

IntroductionOlder adults living with Alzheimer's disease and related dementias (ADRD) can benefit from mHealth innovations in (daily) care. However, successful implementation and adoption of such innovations can be hindered by a lack of inclusive design. Inclusive design can be challenging, due to the variety of ADRD- and aging-related symptoms that can pose barriers to using mHealth. Previously, a literature-based model with 53 barriers to mHealth use for this population has been developed (“MHealth for OLder adults living with DEMentia – USability“ or MOLDEM-US). In this study, we aim to prioritize these through a Delphi study with ADRD experts (case managers, informal caregivers, hospital healthcare professionals, district nurses, and researchers). Methods: In the first round, participant characteristics and potentially new insights into barriers to mHealth use for older adults living with ADRD were gathered. The consensus questionnaire was submitted in the second round, containing barriers to mHealth use for this population (from MOLDEM-US) with questions inquiring its impact and frequency. In the third round, participants rejudged those barriers for which no consensus (<51 %) or minor consensus (51 % − 60 %) was reached. Results: Thirty-seven participants completed the three rounds of the study. Consensus was reached for eleven barriers after the second round, all having major impact and frequency: integration of functions during daily activities, perceived complexity, efficiency in seeing benefits, trust in own ability, restlessness and agitation, computer literacy, self confidence in using wearables, learnability, working memory, and visual acuity. Conclusion: After round three, consensus was achieved for all 53 barriers. Twenty-six barriers are considered to majorly affect mHealth use, most of which relate to cognition and frame of mind. This study contributes to the development of mHealth design guidelines that take into account the progressive and diverse ADRD- and aging-related symptoms negatively affecting mHealth implementation and adoption.

District nurses’ attitudes towards involuntary treatment in dementia care at home: A cross-sectional study

One in two persons living with dementia (PLWD) at home receive care which they resist to and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in the use of involuntary treatment. However, little is known how their attitudes and opinions influence the use of involuntary treatment. This cross-sectional study aims to investigate the attitudes of district nurses towards the use of involuntary treatment in dementia care at home, determinants and their opinion about its restrictiveness and discomfort. Results show that district nurses perceive involuntary treatment as regular part of nursing care, having neither positive nor negative attitude towards its appropriateness. They consider involuntary treatment usage as moderately restrictive to PLWD and feel moderately uncomfortable when using it. These findings underscore the need to increase the awareness of district nurses regarding the negative consequences of involuntary treatment use to PLWD at home.

District nurses' perspectives on health-promotive and disease-preventive work at primary health care centres: A qualitative study.

Health promotion and disease prevention are of utmost importance for sustainable health care and primary health care. District nurses play a key role in primary health care centres, where they meet people suffering from, and/or having risk factors for, non-communicable diseases. The study aim was to describe district nurses' perspectives on their health-promotive/disease-preventive work at primary health care centres. Interviews were conducted with 16 district nurses at primary health care centres in Sweden. An interpretive descriptive approach was employed for the analysis. The district nurses integrated a focus on health-promotive and disease-preventive work into every patient encounter, which manifested through four intertwined themes: finding opportunities and striving for visibility; building relationships; considering patients' life situations; and inviting patients to share responsibility. Our findings show how, through a flexible approach, the district nurses strived for equal health and care for all, and how the care was built on a shared responsibility between the district nurse and patient, where district nurses aimed to empower patients to take action for their own health. The district nurses described health-promotive endeavours, in line with person-centred care in prioritising building relationships with patients, starting from their lived experience. They spoke of barriers, at both micro and macro levels, to health-promotive/disease-preventive work. These included language barriers, the impact of the media, and the overall organisation of primary health care. The work at primary health care centres should be restructured to clarify the district nurse's role, and to strengthen community outreach, and thereby improve individuals' access to support in lifestyle changes.

The role of the district nurse in managing blocked urinary catheters.

This article will investigate the district nurse's role in managing urinary catheter blockages, looking at why people require long-term catheterisation and the causes of blockages and then reviewing treatment methods. Current practice will be critically analysed and compared to the most up to date research and literature to inform district nurses of best evidence-based practice in the hopes of improving service user outcomes and quality of life and reducing the impact this problem has upon district nursing services with regards to time and resources.

The use of digital devices by district nurses in their assessment of service users.

District nursing services are relentless in adapting to change and continuously seek different methods to improve the care they offer to service users. One of the relatively new changes where adaptation has been necessary is the use of digital devices to record assessments and work in real time. As documented in The NHS Long Term Plan (NHS) (2019), the NHS is being required to grow into the new digital age and, subsequently, district nurses (DNs) have needed to embrace the use of a paper-lite system. Although beneficial overall, the use of technology is a threat to the person-centred nursing approach used in assessment, which is the highest fundamental value in nursing. This article will seek to conceptualise the importance of a person-centred initial assessment with a service user who has either a long-term and/or a lifelong condition whilst considering the use of digital devices, benefits, and drawbacks of their use. It will emphasise the role of the DN, encompassing the multidisciplinary services throughout, whilst also considering any recommendations for further development.

Sublingual apomorphine therapy as an alternative to complex continuous infusion pumps in advanced Parkinson's disease treatment: a district nurse-led intervention.

In the UK, Parkinson's disease (PD) is estimated to affect an annual incidence of 15-20 per 100 000 of the population over the age of 60. Service users living with advanced-stage PD require the use of apomorphine, which is generally used to control symptoms. The district nursing service plays a key role in monitoring and in the administration of apomorphine therapy. Although apomorphine is effective, skin problems such as nodules are commonly reported adverse events that can complicate efficiency of treatment. A sublingual delivery route to apomorphine has been known for years as a feasible alternative to subcutaneous route. Collaboration between the multidisciplinary team is essential to meet the complex needs of service users with advanced PD. However, due to the increase in demands of the district nurse service, this time crucial intervention can be unpredictable to meet. An alternative route can enable district nurses to become less task-orientated. However, an increased risk of oral cavity related adverse events should be taken into consideration with the sublingual administration of apomorphine.