Nurse Home Visits Research Articles

<br/> IMPACTO DA VISITA DOMICILIÁRIA DE ENFERMAGEM AO RECÉM-NASCIDO/LACTENTE /FAMÍLIA: UMA REVISÃO SISTEMÁTICA DA LITERATURA

Objective : To identify the impact of the home visit to the new born/infant/family, when performed by nurses, on the health and well-being of the child and family. Methodology : A systematic review of the literature was carried out following the Joanna Briggs Institute methodology, based on a research on the EBSCO and pubmed platform, and bibliographical references of the articles found, with the chronological frieze 2010 and 2017. W ere included Randomized controlled trials evaluating the impact of the home visit of nursing performed when they were new borns/infants, in the health and wellbeing of the child and family, in children/adolescents/families. Results : We selected 11 articles, randomized controlled trials, 7 experimental and 4 follow -up. The data systematization process was carried out using tables that facilitated the analysis of the studies. We have found studies that evaluate the impact of the home visit to the new born/infant/family in the short (2) and long (9) term, dev eloped with great heterogeneity in the intervention of the home visit performed and evaluated impacts, but the results show gains in the well-being of children and families. Conclusions : It is evident from the results found that the home visit of the new born/ infant/family, performed by nurses, has a positive impact on the health and well-being of the child and the family. Keywords : Nursing home visit; new born/infant/family ; child/family health and wellbeing; systematic review of the literature.

Postdischarge Nurse Home Visits and Reuse: The Hospital to Home Outcomes (H2O) Trial.

Hospital discharge is stressful for children and families. Poor transitional care is linked to unplanned health care reuse. We evaluated the effects of a pediatric transition intervention, specifically a single nurse home visit, on postdischarge outcomes in a randomized controlled trial. We randomly assigned 1500 children hospitalized on hospital medicine, neurology services, or neurosurgery services to receive either a single postdischarge nurse-led home visit or no visit. We excluded children discharged with skilled home nursing services. Primary outcomes included 30-day unplanned, urgent health care reuse (composite measure of unplanned readmission, emergency department, or urgent care visit). Secondary outcomes, measured at 14 days, included postdischarge parental coping, number of days until parent-reported return to normal routine, and number of "red flags" or clinical warning signs a parent or caregiver could recall. The 30-day reuse rate was 17.8% in the intervention group and 14.0% in the control group. In the intention-to-treat analysis, children randomly assigned to the intervention group had higher odds of 30-day health care use (odds ratio: 1.33; 95% confidence interval: 1.003-1.76). In the per protocol analysis, there were no differences in 30-day health care use (odds ratio: 1.14; confidence interval: 0.84-1.55). Postdischarge coping scores and number of days until returning to a normal routine were similar between groups. Parents in the intervention group recalled more red flags at 14 days (mean: 1.9 vs 1.6; P < .01). Children randomly assigned to the intervention had higher rates of 30-day postdischarge unplanned health care reuse. Parents in the intervention group recalled more clinical warning signs 2 weeks after discharge.

Universal infant health interventions and young adult outcomes.

Three recent studies have documented short- and long-run benefits of early-infancy health interventions in Norway, Sweden, and Denmark: Universal nurse home visiting (NHV) and well-baby center care decreased infant mortality and positively impacted long-run survival (DK, S), morbidity (DK, N), and educational and labor market outcomes (N). Using Danish conscription data, this paper examines intermediate outcomes to assess both potential mechanisms and the importance of selective survival for the long-run health effects of NHV. We do not find strong effects of NHV for young adult's height or obesity status, but we find that NHV increases treated individuals' probability of emigration. As emigrants in our sample are positively selected and as they are not part of the samples used in long-run analyses, this finding suggests that the established long-run health benefits of NHV may be lower bounds.

Designing, testing, and implementing a sustainable nurse home visiting program: right@home.

Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence-based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems.

CULTURAL ADAPTATIONS OF EVIDENCE-BASED HOME-VISITATION MODELS IN TRIBAL COMMUNITIES.

The Tribal Maternal, Infant, and Early Childhood Home Visiting (Tribal MIECHV) Program provides federal grants to tribes, tribal consortia, tribal organizations, and urban Indian organizations to implement evidence-based home-visiting services for American Indian and Alaska Native (AI/AN) families. To date, only one evidence-based home-visiting program has been developed for use in AI/AN communities. The purpose of this article is to describe the steps that four Tribal MIECHV Programs took to assess community needs, select a home-visiting model, and culturally adapt the model for use in AI/AN communities. In these four unique Tribal MIECHV Program settings, each program employed a rigorous needs-assessment process and developed cultural modifications in accordance with community strengths and needs. Adaptations occurred in consultation with model developers, with consideration of the conceptual rationale for the program, while grounding new content in indigenous cultures. Research is needed to improve measurement of home-visiting outcomes in tribal and urban AI/AN settings, develop culturally grounded home-visiting interventions, and assess the effectiveness of home visiting in AI/AN communities.

Defining and Assessing Geriatric Risk Factors and Associated Health Care Utilization Among Older Adults Using Claims and Electronic Health Records.

Using electronic health records (EHRs), in addition to claims, to systematically identify patients with factors associated with adverse outcomes (geriatric risk) among older adults can prove beneficial for population health management and clinical service delivery. To define and compare geriatric risk factors derivable from claims, structured EHRs, and unstructured EHRs, and estimate the relationship between geriatric risk factors and health care utilization. We performed a retrospective cohort study of patients enrolled in a Medicare Advantage plan from 2011 to 2013 using both administrative claims and EHRs. We defined 10 individual geriatric risk factors and a summary geriatric risk index based on diagnosed conditions and pattern matching techniques applied to EHR free text. The prevalence of geriatric risk factors was estimated using claims, structured EHRs, and structured and unstructured EHRs combined. The association of geriatric risk index with any occurrence of hospitalizations, emergency department visits, and nursing home visits were estimated using logistic regression adjusted for demographic and comorbidity covariates. The prevalence of geriatric risk factors increased after adding unstructured EHR data to structured EHRs, compared with those derived from structured EHRs alone and claims alone. On the basis of claims, structured EHRs, and structured and unstructured EHRs combined, 12.9%, 15.0%, and 24.6% of the patients had 1 geriatric risk factor, respectively; 3.9%, 4.2%, and 15.8% had ≥2 geriatric risk factors, respectively. Statistically significant association between geriatric risk index and health care utilization was found independent of demographic and comorbidity covariates. For example, based on claims, estimated odds ratios for having 1 and ≥2 geriatric risk factors in year 1 were 1.49 (P<0.001) and 2.62 (P<0.001) in predicting any occurrence of hospitalizations in year 1, and 1.32 (P<0.001) and 1.34 (P=0.003) in predicting any occurrence of hospitalizations in year 2. The results demonstrate the feasibility and potential of using EHRs and claims for collecting new types of geriatric risk information that could augment the more commonly collected disease information to identify and move upstream the management of high-risk cases among older patients.

Interprofessional collaboration in nursing homes (interprof): development and piloting of measures to improve interprofessional collaboration and communication: a qualitative multicentre study

BackgroundGiven both the increase of nursing home residents forecast and challenges of current interprofessional interactions, we developed and tested measures to improve collaboration and communication between nurses and general practitioners (GPs) in this setting. Our multicentre study has been funded by the German Federal Ministry of Education and Research (FK 01GY1124).MethodsThe measures were developed iteratively in a continuous process, which is the focus of this article. In part 1 “exploration of the situation”, interviews were conducted with GPs, nurses, nursing home residents and their relatives focusing on interprofessional interactions and medical care. They were analysed qualitatively. Based on these results, in part 2 “development of measures to improve collaboration”, ideas for improvement were developed in nine focus groups with GPs and nurses. These ideas were revisited in a final expert workshop. We analysed the focus groups and expert workshop using mind mapping methods, and finally drew up the compilation of measures. In an exploratory pilot study "study part 3" four nursing homes chose the measures they wanted to adopt. These were tested for three months. Feasibility and acceptance of the measures were evaluated via guideline interviews with the stakeholders which were analysed by content analyses.ResultsSix measures were generated: meetings to establish common goals, main contact person, standardised pro re nata medication, introduction of name badges, improved availability of nurse/GP and standardised scheduling/ procedure for nursing home visits. In the pilot study, the measures were implemented in four nursing homes. GPs and nurses reviewed five measures as feasible and acceptable, only the designation of a “main contact person” was not considered as an improvement.ConclusionsSix measures to improve collaboration and communication could be compiled in a multistep qualitative process respecting the perspectives of involved stakeholders. Five of the six measures were positively assessed in an exploratory pilot study. They could easily be transferred into the daily routine of other nursing homes, as no special models have to exist in advance. Impact of the measures on patient oriented outcomes should be examined in further research.Trial registrationNot applicable.

Effect of preceding home-visit nursing on time to discharge in hospitalization for the treatment of behavioural and psychological symptoms of dementia among patients with limited familial care.

During hospitalization for behavioural and psychological symptoms of dementia (BPSD), it is imperative to build a support system for each patient in the community for after they obtain symptom remission. To this end, patients lacking adequate family support are less likely to be discharged to their own homes and need stronger support systems to be established. This study therefore investigated the effects of home-visit nursing before admission on time to home discharge among patients with limited familial care who were hospitalized for treatment of BPSD. A single-centre chart review study was conducted on consecutive patients admitted from home between April 2013 and September 2015 for treatment of BPSD and who had lived alone or with a working family member. Time to home discharge was compared between patients who had home-visit nursing before their admission and those who did not. In total, 58 patients were enrolled in the study, of whom 12 had preceding home-visit nursing (PHN group) and 46 did not (non-PHN group). Patients in the PHN group were younger (77.7 ± 4.9 vs. 84.1 ± 6.1 years, P = 0.0011) and had higher Mini-Mental State Examination scores (16.8 ± 7.2 vs 11.8 ± 7.3, P = 0.0287). A multivariate Cox proportional hazard regression analysis adjusted for age and Mini-Mental State Examination scores showed a higher likelihood of discharge to home in the PHN group (hazard ratio: 3.85; 95% confidence interval: 1.27-11.6;, P = 0.017) than in the non-PHN group. Home-visit nursing before admission of BPSD patients for treatment could improve the rate of discharge to home among patients with limited familial care after subsequent hospitalization. Home-visit nursing could also enhance collaborative relationships between social and hospital-based care systems, and early implementation could improve the likelihood of vulnerable patient types remaining in their own homes for as long as possible.

Extraction of Factors for Home-visiting Nurses to Determine Family Caregivers Who Need Support after Bereavement

Extraction of Factors for Home-visiting Nurses to Determine Family Caregivers Who Need Support after Bereavement

Extraction of Factors for Home-visiting Nurses to Determine Family Caregivers Who Need Support after Bereavement

Extraction of Factors for Home-visiting Nurses to Determine Family Caregivers Who Need Support after Bereavement

Performance of a Mobile Phone App-Based Participatory Syndromic Surveillance System for Acute Febrile Illness and Acute Gastroenteritis in Rural Guatemala

BackgroundWith their increasing availability in resource-limited settings, mobile phones may provide an important tool for participatory syndromic surveillance, in which users provide symptom data directly into a centralized database.ObjectiveWe studied the performance of a mobile phone app-based participatory syndromic surveillance system for collecting syndromic data (acute febrile illness and acute gastroenteritis) to detect dengue virus and norovirus on a cohort of children living in a low-resource and rural area of Guatemala.MethodsRandomized households were provided with a mobile phone and asked to submit weekly reports using a symptom diary app (Vigilant-e). Participants reporting acute febrile illness or acute gastroenteritis answered additional questions using a decision-tree algorithm and were subsequently visited at home by a study nurse who performed a second interview and collected samples for dengue virus if confirmed acute febrile illness and norovirus if acute gastroenteritis. We analyzed risk factors associated with decreased self-reporting of syndromic data using the Vigilant-e app and evaluated strategies to improve self-reporting. We also assessed agreement between self-report and nurse-collected data obtained during home visits.ResultsFrom April 2015 to June 2016, 469 children in 207 households provided 471 person-years of observation. Mean weekly symptom reporting rate was 78% (range 58%-89%). Households with a poor (<70%) weekly reporting rate using the Vigilant-e app during the first 25 weeks of observation (n=57) had a greater number of children (mean 2.8, SD 1.5 vs mean 2.5, SD 1.3; risk ratio [RR] 1.2, 95% CI 1.1-1.4), were less likely to have used mobile phones for text messaging at study enrollment (61%, 35/57 vs 76.7%, 115/150; RR 0.6, 95% CI 0.4-0.9), and were less likely to access care at the local public clinic (35%, 20/57 vs 67.3%, 101/150; RR 0.4, 95% CI 0.2-0.6). Parents of female enrolled participants were more likely to have low response rate (57.1%, 84/147 vs 43.8%, 141/322; RR 1.4, 95% CI 1.1-1.9). Several external factors (cellular tower collapse, contentious elections) were associated with periods of decreased reporting. Poor response rate (<70%) was associated with lower case reporting of acute gastroenteritis, norovirus-associated acute gastroenteritis, acute febrile illness, and dengue virus-associated acute febrile illness (P<.001). Parent-reported syndromic data on the Vigilant-e app demonstrated agreement with nurse-collected data for fever (kappa=.57, P<.001), vomiting (kappa=.63, P<.001), and diarrhea (kappa=.61, P<.001), with decreased agreement as the time interval between parental report and nurse home visit increased (<1 day: kappa=.65-.70; ≥2 days: kappa=.08-.29).ConclusionsIn a resource-limited area of rural Guatemala, a mobile phone app-based participatory syndromic surveillance system demonstrated a high reporting rate and good agreement between parental reported data and nurse-reported data during home visits. Several household-level and external factors were associated with decreased syndromic reporting. Poor reporting rate was associated with decreased syndromic and pathogen-specific case ascertainment.

Lessons Learned: Implementation of Pilot Universal Postpartum Nurse Home Visiting Program, Massachusetts 2013-2016.

Purpose Home visiting programs for new families in the United States have traditionally served high-risk families. In contrast, universal home visiting models serve all families regardless of income, age, risk or other criteria. They offer an entry point into a system of care for children and families, with the potential to improve population health. This paper describes lessons learned from the first threeyears of implementing a universal home visiting model. Description Welcome Family is a universal home visiting program in Massachusetts that offers a one-time visit by a nurse to new mothers up to eightweeks postpartum. The Massachusetts Department of Public Health (MDPH) is piloting Welcome Family in four communities with the goal of expanding statewide. Assessment Welcome Family served over 3000 families in its first threeyears. Program performance measures provided a framework to examine successes and challenges related to outreach and enrollment, program operations, and linkages with community resources. Early challenges included increasing referrals to a new program and limited capacity to serve all women giving birth. Local implementing agencies tested innovative strategies and MDPH made program modifications, such as developing quarterly data reports and establishing a learning collaborative, to address identified challenges. Conclusion MDPH is committed to the success of Welcome Family and uses continuous quality improvement to maximize the impact of the program on families and the system of care in Massachusetts. Lessons learned from the Massachusetts pilot can inform other states' efforts to enhance their early childhood systems of care through expanding universal home visiting.

Managing chronic oedema and wet legs in the community: a service evaluation.

To investigate the potential economic benefits of the OGEP and its effects on patients' quality of life. The OGEP was implemented between June 2016 and March 2017. During this time, 725 patients were assessed and chronic oedema was diagnosed in 426 (59%) of them. Of these, 100 patients were purposively recruited and 97 completed the pilot service evaluation. Data were collected observationally before and after the OGEP was implemented. Baseline measurements of resources, costs and outcomes were captured at the time the patients were initially identified and at a follow-up review three months later. The EQ-5D-5L tool was used to measure patients' health-related quality of life before and after the OGEP was implemented. Data were analysed using Microsoft Excel and SPSS Version 22. Following implementation of the OGEP, there was a significant decrease in the number of district nurse home visits, (P=<0.001), GP surgery appointments (P=0.003) and episodes of cellulitis (P=<0.001). The EQ-5D-5L utility scores showed that patients' quality of life improved after the OGEP was implemented, from a baseline of 0.401 (SD 0.254) to 0.537 (SD 0.231) at the three-month follow-up review. The OGEP may support the efficient use of community nurses' time and resources, reduce costs to the NHS, and improve the quality of life of patients with chronic oedema and wet legs.

Status of High Body Weight Among Nurse-Family Partnership Children

Increased prevalence of high levels of body weight in early childhood has become a public health concern, given its potential association with adult obesity and related comorbidities. Both socioeconomic status and race-ethnicity are related to increased prevalence. The purpose of this study was to identify additional risk factors common to children of low-income families; and to guide quality improvement initiatives within home visiting programs, potentially fostering more desirable physical development outcomes. A cohort of children (n = 14,318) of all mothers enrolled in Nurse-Family Partnership between 2007 and 2010 was evaluated. Measures consisted of demographics, health behaviors, and physical growth metrics collected by specially educated nurses during the course of home visits that also delivered the program model. Measures of weight (W) versus length (L) were converted to percentiles using the Centers for Disease Control and Prevention-World Health Organization norms with high W/L (≥97.7th percentile) defining a binary outcome. Multiple logistic regression modeling was then used to derive risk models for that outcome. Across each of the four time points for body measures (child's age 6, 12, 18, and 24 months), race-ethnicity, prepregnancy body mass index (BMI), maternal weight gain, and breastfeeding duration emerged as common risk factors. Moderation of weight gain during pregnancy, extending breastfeeding duration, and normalization of BMI before subsequent pregnancies may potentially serve as means of lowering the prevalence of high body weight levels in young children of low-income families served by home visitors.

A Qualitative Evaluation of Engagement and Attrition in a Nurse Home Visiting Program: From the Participant and Provider Perspective.

Beginning parenting programs in the prenatal and early postnatal periods have a large potential for impact on later child and maternal outcomes. Home-based parenting programs, such as the Nurse Family Partnership (NFP), have been established to help address this need. Program reach and impact is dependent on successful engagement of expecting mothers with significant risks; however, NFP attrition rates remain high. The current study qualitatively examined engagement and attrition from the perspectives of NFP nurses and mothers in order to identify mechanisms that enhance service engagement. Semi-structured interviews were conducted in focus groups composed of either engaged (27 total mothers) or unengaged (15 total mothers) mothers from the NFP program. NFP nurses (25 total nurses) were recruited for individual semi-structured interviews. Results suggest that understanding engagement in the NFP program requires addressing both initial and sustained engagement. Themes associated with enhanced initial engagement include nurse characteristics (e.g., flexible, supportive, caring) and establishment of a solid nurse-family relationship founded on these characteristics. Factors impacting sustained engagement include nurse characteristics, provision of educational materials on child development, individualized services for families, and available family support. Identified barriers to completing services include competing demands and lack of support. Findings of this study have direct relevance for workforce planning, including hiring and training through integrating results regarding effective nurse characteristics. Additional program supports to enhance parent engagement may be implemented across home-based parenting programs in light of the current study's findings.

Animal-Assisted Interventions in Audiology

Animal-Assisted Interventions in Audiology

Maintaining capacity for in-practice teaching and supervision of students and general practice trainees: a cross-sectional study of early career general practitioners.

Objectives Expanding learner cohorts of medical students and general practitioner (GP) vocational trainees and the impending retirement of the 'baby boomer' GP cohort threaten the teaching and supervisory capacity of the Australian GP workforce. Engaging newly qualified GPs is essential to sustaining this workforce training capacity. The aim of the present study was to establish the prevalence and associations of in-practice clinical teaching and supervision in early career GPs. Methods The present study was a cross-sectional questionnaire-based study of recent (within 5 years) alumni of three of Australia's 17 regional general practice training programs. The outcome factor was whether the alumnus taught or supervised medical students, GP registrars or other learners in their current practice. Logistic regression analysis was used to establish associations of teaching and supervision with independent variables comprising alumnus demographics, current practice characteristics and vocational training experiences. Results In all, 230 alumni returned questionnaires (response rate 37.4%). Of currently practising alumni, 52.4% (95% confidence interval (CI) 45.6-59.0%) reported current teaching or supervisory activities. Factors significantly (P<0.05) associated with alumni currently undertaking in-practice clinical teaching and supervision were: Australian medical graduation (odds ratio (OR) for international graduates 0.36; 95% CI 0.14-0.92), working in a regional or remote area (OR 2.75; 95% CI 1.24-6.11) and currently undertaking nursing home visits, home visits or after-hours work (OR 2.01; CI 1.02-3.94). Conclusions Rural-urban and country-of-graduation differences in the engagement of early career GPs in practice-based apprenticeship-like teaching or training should inform strategies to maintain workforce training capacity. What is known about the topic? Projected changes in the demand for and supply of clinical teaching and supervision within Australian general practice will require greater uptake of teaching and supervision by recently qualified GPs to ensure sustainability of this teaching model. Although interest in and undertaking of teaching roles have been documented for GP or family medicine trainees, studies investigating the engagement in these clinical roles by GPs during their early post-training period are lacking. What does this paper add? This paper is the first to document the prevalence of teaching and supervision undertaken by early career GPs as part of their regular clinical practice. We also demonstrate associations of practice rurality, country of medical graduation and undertaking non-practice-based clinical roles with GPs' engagement in teaching and supervisory roles. What are the implications for practitioners? Establishing current teaching patterns of GPs enables appropriate targeting of new strategies to sustain an effective teaching and supervisory capacity within general practice. The findings of the present study suggest that exploring focused strategies to facilitate and support international medical graduates to engage in teaching during their vocational training, aided by focused supervisor support, may be of particular value.

Association between home-visit nursing utilization and all-cause hospitalization among long-term care insurance beneficiaries: A retrospective cohort study

BackgroundEnsuring and improving long-term care services that use limited healthcare resources more efficiently is a major concern for many aging societies. ObjectivesThe aim of this study was to investigate the relationship between use of home-visit nursing services and all-cause hospitalization in a home-visit nursing-recommended group. DesignA retrospective cohort study. SettingPopulation-based sample of long-term care insurance beneficiaries from the long-term care insurance 2002–2013 claims database in South Korea. ParticipantsLong-term care insurance beneficiaries who need one or more types of nursing care were defined as the home-visit nursing −recommended group (n=4173). MeasurementsThe dependent variable in this study was all-cause hospitalization in the home-visit nursing-recommended population. Multivariate Cox proportional hazards regression analysis was used to identify the association between home-visit nursing service use and all-cause hospitalization. ResultsA total of 3.8% of the subjects used home-visit nursing services. When participants who used home-visit nursing services were set as the reference group, participants who did not use home-visit nursing services had a higher risk of hospitalization (hazard ratio [HR]=1.25, 95% confidence interval [CI]=1.07–1.47). Additionally, participants who did not use home-visit nursing services and who did not have a caregiver showed a marked increase in the risk of hospitalization (HR=6.81, 95% CI=1.17–39.66). Participants who did not use home-visit nursing services with greater comorbidity showed a considerable increase in risk of hospitalization (HR=1.36, 95% CI=1.09–1.70). ConclusionsNon-use of home-visit nursing services was associated with an increased risk of all-cause hospitalization in the home-visit nursing-recommended population. The present results suggest that the use of home-visit nursing services reduced the risk of hospitalization. Moreover, home-visit nursing may play an essential role in reducing hospitalization risk in the absence of caregiver support.

COMMUNICATION LEADING TO SHARED MEANING IN THE NURSING HOME

Patterns of communication between nurses and physicians directly impact nursing home (NH) resident quality of care. Nurses not fully explaining clinical change and physicians not eliciting needed information has compromised effective communication. This qualitative study used a Sensemaking model of communication between NH nurse/physician to understand shared meaning informed by oral and written strategies. Sample-19 nurses, 22 MDs. 33 communication events were the focus of 16 interviews, 17 nurse notes, 22 MD orders, and 16 MD notes. Using grounded theory and ethnographic interviewing (1st & 2nd cycle coding, constant comparative analysis, analytic memos) with a Sensemaking-based semi-structured interview guide and examination of related medical records, communication events were analyzed. Cases were created to illustrate communication processes. Trustworthiness was addressed through an audit trail of decision-making memos, triangulation of prolonged interviews with medical records, and using Sensemaking to guide interpreting codes and developing theory. Nurses established relationships by intentionally approaching MDs at monthly NH visits, creating individualized communication exchange, contact lists, and MD information sharing. MDs noted nurses’ availability or phone contacts directed their coming to know the nurse and their capabilities. Case analysis yielded contrasting views by nurse and MD of the same event. Nurses described symptoms, and MD orders or transfer requests. MDs noted importance of crafting resident information for decision-making. Nurses and physicians sought agreement about next steps or decisions. Education should emphasize how to reach shared meaning. Research should examine impact of nurse/MD communication on resident outcomes.

사회경제적 취약계층의 건강불평등 해소를 위한 지역사회 건강증진사업 평가

Objectives: This study was to evaluate effectiveness of and challenges to community interventions to reduce health inequity in socioeconomically vulnerable populations. Methods: A total of 41 participants involved in community interventions related to a slum of Seoul were recruited using purposive and snowball sampling methods from June to September, 2015. Participants included residents and stakeholders working for governments, public hospitals, welfare institutions, civil societies, and faith-based organizations. We conducted semi-structured, one-on-one interviews with 18 stakeholders and three focus group interviews with 23 residents. Qualitative data were analyzed using thematic analysis. Results: Effective community interventions were community-driven, empowerment-based interventions followed by provision of home-visiting nurses, improvement of living conditions, and integrated health-social welfare services. Affordable health care services, including home-visits by community nurses and increase in housing quality and neighborhood safety were identified as important factors to address to reduce health inequalities. Challenges to community interventions are as follows: (1) unmet healthcare and social welfare needs, (2) insufficient livelihood welfare system, (3) lack of intersectoral collaboration. Conclusions: Community-driven, empowerment-based interventions and supportive social health policies could have the potential to improve health inequities, thereby enhancing community resilience and providing a seamless safety net for the socioeconomically vulnerable populations.