Public Health Nursing Practice in the Affordable Care Act Era: A National Survey.
Public Health Nurs. 2017 Jan;34(1):50-58
Authors: Edmonds JK, Campbell LA, Gilder RE
OBJECTIVES: To explore public health nurses' knowledge, perceptions, and practices under the Affordable Care Act (ACA).
DESIGN AND SAMPLE: A cross-sectional, web-based survey was completed by a sample of 1,143 public health nurses (PHNs) in the United States.
MEASURES: Descriptive statistics were analyzed for variables related to general knowledge and perception of the ACA and for the extent of involvement in activities related to the implementation of the ACA. Qualitative analysis was conducted on free text comments to two open-ended questions about current and future PHNs involvement in the ACA.
RESULTS: Approximately 45% of PHNs reported changes in their daily work due to the ACA. PHNs reported being very or somewhat involved in these activities of the ACA: integration of primary care and public health (62%), provision of clinical preventive services (60.3%), care coordination (55.4%), patient navigation (55.3%), establishment of private-public partnerships (55.3%), population health strategies (53.6%), population health data assessment and analysis (53.8%), community health assessments (49%), involvement in medical homes (37.8%), provision of maternal and child health home visiting services (32.1%), and involvement in Accountable Care Organizations (29.2%).
CONCLUSION: PHNs are making substantial contributions to implementation of the ACA.
PMID: 27444260 [PubMed - indexed for MEDLINE]
Community Health Needs Assessments: Expanding the Boundaries of Nursing Education in Population Health.
Public Health Nurs. 2017 Jan;34(1):69-77
Authors: Evans-Agnew R, Reyes D, Primomo J, Meyer K, Matlock-Hightower C
BACKGROUND: Conducting federally mandated community health needs assessments through academic-practice partnerships provides new opportunities for developing population health nursing competencies.
OBJECTIVES: The purpose of this article was to describe how a baccalaureate practicum experience within such an assessment process, involving health care system partners, re-affirms the importance of community and population health assessment in the development of future nursing leaders.
RESULTS: Student evaluations indicated an emerging appreciation for the social determinants of health, the power of partnerships, and the importance of diversity. Integrating health care and public health system perspectives on assessment meets both public health and nursing accreditation standards and extends student leadership experiences. Such integration also improves regional capacity for improving population health.
CONCLUSIONS: Federal mandates for community health needs assessments provide opportunities to advance leadership roles for nursing graduates throughout the health care system, and for confirming the importance of community assessment as an essential nursing competency.
PMID: 27686878 [PubMed - indexed for MEDLINE]
Collaborative Care in Melanoma: The Essential Role of the Nurse .
Clin J Oncol Nurs. 2017 Aug 01;21(4):4-6
Authors: Kirkwood JM, Ribas A
This article provides perspective from medical oncologists on the importance of this supplement from the Melanoma Nursing Initiative. The authors (a) delineate the challenges inherent in addressing adverse event (AE) management with newer melanoma therapies, particularly in the community setting; (b) illustrate how advanced practice providers with extensive clinical trial experience in melanoma are in a key position to set the agenda and educate colleagues on best practices in AE management; and
PMID: 28738052 [PubMed - in process]
Education and training to support the use of clinical telehealth: A review of the literature.
J Telemed Telecare. 2017 Feb;23(2):273-282
Authors: Edirippulige S, Armfield NR
Introduction Despite a growing literature base, substantial investment, and policy changes within governments, the integration of telehealth into routine clinical care has been limited. The availability of appropriate systematic education and training for practitioners has been highlighted as necessary for strong adoption. However, the availability and nature of telehealth-related education and training for practitioners is not understood. By reviewing the literature, we aimed to describe the delivery of education and training in telehealth, with particular focus on content, modes of delivery, types of institutions, and target clinician groups. Methods We performed searches using PubMed, Scopus, Embase, Web of Science, PsycINFO, the Cochrane Library, and ERIC. We included studies that were focused on the delivery of telehealth-related academic or vocational education and training. We extracted information pertaining to country, programs and their participants, and tabulated the results. Results Altogether 388 articles were identified, of which nine studies were selected for final review. Programs from five countries were represented and articles were spread across telemedicine and clinically oriented journals. Education and training in telehealth has been provided as both university level and vocational courses using conventional classroom based delivery methods and e-learning. Reported curriculum items included terminology, clinical applications, the evidence-base, and technological aspects. Conclusions Published evidence in peer-reviewed literature on telehealth education and training is limited. According to this review, a number of topics relating to telehealth have been covered by existing education programs both within tertiary and professional development levels.
PMID: 26892005 [PubMed - indexed for MEDLINE]
Nurse and Physician Involvement in Health Risk Appraisals: An Integrative Review.
West J Nurs Res. 2017 Jun;39(6):803-824
Authors: Simpson V, Pedigo L
Unhealthy lifestyle behaviors continue to be a strong contributor to chronic illness and death in the United States. Despite the health care system's efforts to refocus on prevention, primary care visits remain acute care focused. Health risk appraisals are tools that can be used by primary care providers to enhance lifestyle behavior change and prevention efforts. The purpose of this integrative review is to examine nurse and physician use of health risk appraisals in primary care. A total of 26 national and international papers, selected through an electronic database and ancestry search, were reviewed. Identified nurse and physician interventions in addition to other programming included helping participants understand and interpret feedback, behavioral counseling, and development of plans to address unhealthy lifestyle behaviors. The most common intervention was provision of telephonic nurse advice lines. Overall outcomes were positive. The use of these tools could be key to enhancing primary care prevention.
PMID: 27445043 [PubMed - indexed for MEDLINE]
Professional values of nurse lecturers at three universities in Colombia.
Nurs Ethics. 2017 Mar;24(2):198-208
Authors: López-Pereira A, Arango-Bayer G
OBJECTIVE: To describe the professional values of the nurse lectures according to 241 nursing students, who participated voluntarily, in three different universities of Bogotá.
METHODOLOGY: This is a quantitative, descriptive cross-sectional study that applied the Nurses Professional Values Scale-permission secured-Spanish; three dimensions of values were applied: ethics, commitment, and professional knowledge. Ethical consideration: Project had ethical review and approval from an ethics committee and participants were given information sheets to read before they agreed to participate in the project.
FINDINGS: It was concluded that nursing students, in general, do perceive these values in their professors, and they give priority to the dimension of ethics, followed by the knowledge dimension, and finally, commitment.
DISCUSSION: It is evident that professional values are transmitted by professors and students place importance to such values. Values related to the other's care are paramount in nursing training in Colombia as well as in other countries.
CONCLUSION: It was found that participating students observed professors directly in relation to values focused on direct patient care, respect for privacy, respect for life, while matters related to professional improvement, participation in unions were not actually analyzed may be due to poor promotion activities and unions during undergraduate studies. The results obtained are primary approach to the study of values related to nursing, a topic which needs to be researched, something vital to all the country offering nursing training programs.
PMID: 26038378 [PubMed - indexed for MEDLINE]
Education for Developing and Sustaining a Health Care Workforce for Disaster Readiness.
Nurs Adm Q. 2017 Apr/Jun;41(2):118-127
Authors: Langan JC, Lavin R, Wolgast KA, Veenema TG
The United States needs a national health care and public health workforce with the knowledge, skills, and abilities to respond to any disaster or public health emergency in a timely and appropriate manner. This requires that all of our nation's nurses and health care providers have unrestrained access to high-quality, evidence-based, competency-driven education and training programs. Programs of study for disaster readiness in both the academic and service sectors are limited in number. Those that do exist may be based upon consensus rather than competency and be price prohibitive. They may fail to fully capitalize on existing educational technologies and may not be accessible to all providers. Nurse leaders are ideally positioned to recognize, advocate, and support the need for a broad array of learning options to strengthen the readiness of the health care workforce for disaster response. This article reviews current challenges and opportunities for the expansion of evidence-based education and training opportunities for health care workforce disaster readiness.
PMID: 28263269 [PubMed - indexed for MEDLINE]
Disaster-Related Community Resilience: A Concept Analysis and a Call to Action for Nurses.
Public Health Nurs. 2017 May;34(3):295-302
Authors: Heagele T
A paucity of nursing literature is available on disaster-related community resilience. Using a nursing method for analyzing concepts, this article attempts to clarify the meaning of this novel concept to encourage nursing research and practice. This concept analysis provides an introduction to the phenomenon of disaster-related community resilience for nurses and consumers of nursing research. The article proposes the definition, antecedents, attributes, consequences, and empirical referents of disaster-related community resilience and provides suggestions for nursing research and practice. It also provides nurses a foundation for participating in resilience-building activities that may save lives and allow communities to recover more rapidly postdisaster.
PMID: 27646475 [PubMed - indexed for MEDLINE]
School Nurse Workload.
J Sch Nurs. 2017 Feb;33(1):43-52
Authors: Endsley P
The purpose of this scoping review was to survey the most recent (5 years) acute care, community health, and mental health nursing workload literature to understand themes and research avenues that may be applicable to school nursing workload research. The search for empirical and nonempirical literature was conducted using search engines such as Google Scholar, PubMed, CINAHL, and Medline. Twenty-nine empirical studies and nine nonempirical articles were selected for inclusion. Themes that emerged consistent with school nurse practice include patient classification systems, environmental factors, assistive personnel, missed nursing care, and nurse satisfaction. School nursing is a public health discipline and population studies are an inherent research priority but may overlook workload variables at the clinical level. School nurses need a consistent method of population assessment, as well as evaluation of appropriate use of assistive personnel and school environment factors. Assessment of tasks not directly related to student care and professional development must also be considered in total workload.
PMID: 27932601 [PubMed - indexed for MEDLINE]
Integrating Quality and Safety Competencies to Improve Outcomes: Application in Infusion Therapy Practice.
J Infus Nurs. 2017 Mar/Apr;40(2):116-122
Authors: Sherwood G, Nickel B
Despite intense scrutiny and process improvement initiatives, patient harm continues to occur in health care with alarming frequency. The Quality and Safety Education for Nursing (QSEN) project provides a roadmap to transform nursing by integrating 6 competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As front-line caregivers, nurses encounter inherent risks in their daily work. Infusion therapy is high risk with multiple potential risks for patient harm. This study examines individual and system application of the QSEN competencies and the Infusion Nurses Society's 2016 Infusion Therapy Standards of Practice in the improvement of patient outcomes.
PMID: 28248812 [PubMed - indexed for MEDLINE]
Establishing a Nurse Mentor Program to Improve Nurse Satisfaction and Intent to Stay.
J Nurses Prof Dev. 2017 Mar/Apr;33(2):76-78
Authors: Jones SJ
Mentoring is an intervention to foster development and socialization of new registered nurses to an organization or unit. A nurse mentor program was developed and implemented with the purpose to improve new registered nurse satisfaction and intent to stay. A pre- and postintervention design was used in a rural emergency department to evaluate nurse job satisfaction and intent to stay in the job. Intent to stay in the job mean scores increased, and the registered nurse participants reported program satisfaction through verbal and written feedback.
PMID: 28252485 [PubMed - indexed for MEDLINE]
Exploring the attitudes, knowledge and beliefs of nurses and midwives of the healthcare needs of the LGBTQ population: An integrative review.
Nurse Educ Today. 2017 Jun;53:67-77
Authors: Stewart K, O'Reilly P
OBJECTIVES: To explore current literature surrounding the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) patients and their influence on equal and non-discriminatory care for LGBTQ individuals.
DESIGN: Systematic integrative review.
DATA SOURCES: CINAHL, MEDLINE, PubMed, InterNurse.
REVIEW METHODS: This integrative review used Wakefield's (2014) framework to establish the knowledge, beliefs and attitudes of nurses and midwives of the healthcare needs of LGBTQ patients. Qualitative, quantitative and mixed methods primary studies carried out between 2006 and 2015 from 7 countries were included. Four databases were searched and 98 studies were screened for eligibility by two researchers. Level of evidence was assessed by the Scottish Intercollegiate Guidelines Network (SIGN, 2010) criteria and quality was assessed by a screening tool adapted from Noyes and Popay (2007) for qualitative papers and Quality Assessment Tool for Quantitative Studies adapted from the Effective Public Health Practice Project (EPHPP, 2010). Following PRISMA guidelines, this integrative review analysed and synthesised evidence using thematic analysis to generate themes.
RESULTS: 24 papers were included in the final synthesis which revealed four primary themes: Heteronormativity across Healthcare; Queerphobia; Rainbow of Attitudes; Learning Diversity.
CONCLUSIONS: Nurses and midwives possess a wide spectrum of attitudes, knowledge and beliefs which impact the care received by LGBTQ patients. Many issues of inadequate care appear to be due to a culture of heteronormativity and a lack of education on LGBTQ health. Further research is needed on interventions which could facilitate disclosure of sexual orientation and interrupt heteronormative assumptions by staff. It is recommended that LGBTQ issues be included within undergraduate nursing and midwifery education or as part of continued professional development.
PMID: 28448883 [PubMed - indexed for MEDLINE]
District nurses deserve better support to ensure safe care.
Nurs Stand. 2016 Sep 07;31(2):3
Campaigns for safe nurse staffing levels have focused invariably on our hospitals, where the absence of sufficient suitably qualified nursing staff is often easy to identify. However, the problem is just as prevalent in the community, where patients and other service users are suffering because district nurses and those in similar roles are overstretched.
PMID: 27794712 [PubMed - indexed for MEDLINE]
Pre-registration nursing student's quality of practice learning: Clinical learning environment inventory (actual) questionnaire.
Nurse Educ Today. 2017 Aug;55:58-64
Authors: Shivers E, Hasson F, Slater P
BACKGROUND: Clinical learning is a vital component of nurse education and assessing student's experiences can provide useful insights for development. Whilst most research in this area has focused on the acute setting little attention has been given to all pre-registration nurses' experience across the clinical placements arenas.
OBJECTIVES: To examine of pre-registration nursing students (first, second and third year) assessment of their actual experiences of their most recent clinical learning clinical learning experience.
DESIGN: A cross sectional survey involving a descriptive online anonymous questionnaire based on the clinical learning environment inventory tool.
SETTINGS: One higher education institution in the United Kingdom.
PARTICIPANTS: Nursing students (n=147) enrolled in an undergraduate nursing degree.
METHODS: This questionnaire included demographic questions and the Clinical Learning Environment Inventory (CLEI) a 42 item tool measuring student's satisfaction with clinical placement. SPPS version 22 was employed to analyse data with descriptive and inferential statistics.
RESULTS: Overall students were satisfied with their clinical learning experience across all placement areas. This was linked to the 6 constructs of the clinical learning environment inventory; personalization, innovation, individualization, task orientation, involvement, satisfaction. Significant differences in student experience were noted between age groups and student year but there was no difference noted between placement type, age and gender.
CONCLUSIONS: Nursing students had a positive perception of their clinical learning experience, although there remains room for improvement. Enabling a greater understanding of students' perspective on the quality of clinical education is important for nursing education and future research.
PMID: 28528125 [PubMed - indexed for MEDLINE]
First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service.
Am J Hosp Palliat Care. 2017 Mar;34(2):166-172
Authors: Pouliot K, Weisse CS, Pratt DS, DiSorbo P
BACKGROUND: There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers.
AIM: To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine's community hospital serving New York's Capital District.
METHODS: This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees.
RESULTS: Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P < .05) and stable symptom management over time. Fewer emergency department ( P < .001) and inpatient hospital admissions ( P < .001) occurred among enrollees while on the palliative care service.
CONCLUSION: An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home and avoid hospital admissions.
PMID: 26656032 [PubMed - indexed for MEDLINE]
Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review.
BMJ Open. 2017 Jul 16;7(7):e015257
Authors: Handley M, Bunn F, Goodman C
OBJECTIVES: To identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with dementia.
DESIGN: A realist review conducted in three phases: (1) stakeholder interviews and scoping of the literature to develop an initial programme theory for providing effective dementia care; (2) structured retrieval and extraction of evidence; and (3) analysis and synthesis to build and refine the programme theory.
DATA SOURCES: PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, NHS Evidence, Scopus and grey literature.
ELIGIBILITY CRITERIA: Studies reporting interventions and approaches to make hospital environments more dementia-friendly. Studies not reporting patient outcomes or contributing to the programme theory were excluded.
RESULTS: Phase 1 combined findings from 15 stakeholder interviews and 22 publications to develop candidate programme theories. Phases 2 and 3 identified and synthesised evidence from 28 publications. Prominent context-mechanism-outcome configurations were identified to explain what supported dementia-friendly healthcare in acute settings. Staff capacity to understand the behaviours of people living with dementia as communication of an unmet need, combined with a recognition and valuing of their role in their care, prompted changes to care practices. Endorsement from senior management gave staff confidence and permission to adapt working practices to provide good dementia care. Key contextual factors were the availability of staff and an alignment of ward priorities to value person-centred care approaches. A preoccupation with risk generated responses that werelikely to restrict patient choice and increase their distress.
CONCLUSIONS: This review suggests that strategies such as dementia awareness training alone will not improve dementia care or outcomes for patients with dementia. Instead, how staff are supported to implement learning and resources by senior team members with dementia expertise is a key component for improving care practices and patient outcomes.
TRIAL REGISTRATION NUMBER: CRD42015017562.
PMID: 28713073 [PubMed - in process]
GP views on strategies to cope with increasing workload: a qualitative interview study.
Br J Gen Pract. 2017 Feb;67(655):e148-e156
Authors: Fisher RF, Croxson CH, Ashdown HF, Hobbs FR
BACKGROUND: The existence of a crisis in primary care in the UK is in little doubt. GP morale and job satisfaction are low, and workload is increasing. In this challenging context, finding ways for GPs to manage that workload is imperative.
AIM: To explore what existing or potential strategies are described by GPs for dealing with their workload, and their views on the relative merits of each.
DESIGN AND SETTING: Semi-structured, qualitative interviews with GPs working within NHS England.
METHOD: All GPs working within NHS England were eligible. Of those who responded to advertisements, a maximum-variation sample was selected and interviewed until data saturation was reached. Data were analysed thematically.
RESULTS: Responses were received from 171 GPs, and, from these, 34 were included in the study. Four main themes emerged for workload management: patient-level, GP-level, practice-level, and systems-level strategies. A need for patients to take greater responsibility for self-management was clear, but many felt that GPs should not be responsible for this education. Increased delegation of tasks was felt to be key to managing workload, with innovative use of allied healthcare professionals and extended roles for non-clinical staff suggested. Telephone triage was a commonly used tool for managing workload, although not all participants found this helpful.
CONCLUSION: This in-depth qualitative study demonstrates an encouraging resilience among GPs. They are proactively trying to manage workload, often using innovative local strategies. GPs do not feel that they can do this alone, however, and called repeatedly for increased recruitment and more investment in primary care.
PMID: 28093421 [PubMed - indexed for MEDLINE]
Whoever holds the purse strings holds the power.
Nurs Stand. 2016 Jun 29;30(44):38-9
Authors: Dean E
An average ward has a budget of about £1 million a year for staffing and supplies. With responsibility for its allocation often with the ward manager or sister, budgeting skills are essential.
PMID: 27353933 [PubMed - indexed for MEDLINE]
GPs' perceptions of workload in England: a qualitative interview study.
Br J Gen Pract. 2017 Feb;67(655):e138-e147
Authors: Croxson CH, Ashdown HF, Hobbs FR
BACKGROUND: GPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable.
AIM: To gather an in-depth understanding of GPs' perceptions and attitudes towards workload.
DESIGN AND SETTING: All GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached.
METHOD: Semi-structured, qualitative interviews were conducted. Data were analysed thematically.
RESULTS: In total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload.
CONCLUSION: This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved.
PMID: 28093422 [PubMed - indexed for MEDLINE]
Assessment of Barriers for Midwives to Achieve Professional Management Positions from Midwives' Point of View.
Iran J Nurs Midwifery Res. 2017 May-Jun;22(3):173-177
Authors: Pourkazemi R, Beigi M, Kohan S
BACKGROUND: Despite the effects of midwives on the health of family and community through promotion of maternal and child health indicators, they are not in the position of professional decision making. Therefore, this study was aimed to determine the barriers to achieve professional management positions by midwives.
MATERIALS AND METHODS: This study was a descriptive and cross-sectional study. The members of board commission of midwifery and reproductive health, the academic members of midwifery department and midwives working at the adjutancy of health and treatment were selected from eight Iranian universities of medical sciences. Data was collected through demographic characteristics questionnaire, a researcher-made questionnaire about administrative barriers, and management skills. Validity and reliability of this tool was confirmed through content validity and Cronbach's alpha coefficient, and the results were analyzed using inferential statistics (analysis of variance and Kruskal-Wallis test).
RESULTS: The results of this study showed that the barriers for midwives to achieve professional management positions in order of preference were organizational barriers (71.4%), cultural barriers (42.4%), and individual barriers (30.8%).
CONCLUSIONS: Based on the findings of this research, organizational barriers are the most important obstacle to achieve professional management positions. Therefore, the role of the authorities is emphasized to eliminate organizational barriers and provide more resources to reduce this problem.
PMID: 28706539 [PubMed]
Social capital in Japan: What characteristics do public health nurses see in their communities?
Jpn J Nurs Sci. 2017 Jul 13;:
Authors: Honda H, Kawaharada M, Shindo Y, Tanaka R, Nakajima A, Nimura Y
AIM: A concept of social capital that accounts for a community's cultural background and incorporates social capital into public health nursing practice are needed. This study aimed to describe the characteristics of social capital in the context of public health nursing in Japan.
METHODS: The study interviewed 11 veteran public health nurses from five municipalities across Japan and undertook a qualitative research analysis. A digital voice recorder was used to collect qualitative data by using a background data sheet and semistructured interviews. Trustworthiness in interpreting the data was ensured by conducting 13 additional interviews with residents and collating the two sets of results.
RESULTS: All the participants were female: 10 were veterans with ≥15 years' experience. Nine worked in management. The methods yielded six categories: (i) the richness of the interactions among the residents; (ii) the community residents who showed concern for those in need; (iii) community civic activities; (iv) the residents' willingness to contribute to the community; (v) the health promotion volunteers who work alongside the public health nurses; and (vi) an enriched community environment.
CONCLUSION: The results contribute to an understanding of social capital in the context of public health nursing activities and further research on social capital. It also is discussed how social capital can be incorporated into public health nursing activities in the future.
PMID: 28707390 [PubMed - as supplied by publisher]
A participatory action research study exploring women's understandings of the concept of informed choice during pregnancy and childbirth in Ireland.
Midwifery. 2017 Mar;46:1-7
Authors: O'Brien D, Butler MM, Casey M
OBJECTIVE: to explore women's understandings and definitions of the concept of informed choice during pregnancy and childbirth.
METHODS: a three-phase action research approach. In the first phase of the study (reported in this paper), fifteen women were interviewed to establish their understandings and experiences of informed choice.
SETTING: Dublin, Ireland in a large maternity hospital.
PARTICIPANTS: fifteen postnatal women who gave birth to a live healthy infant, women attended obstetric or midwifery-led care.
FINDINGS: we found that multiple factors influence how women define informed choice including; their expectations of exercising choice, their sense of responsibility towards their infant, their sense of self and the quality of their relationships with maternity care professionals. The interdependence of the mother-baby relationship deems that in the context of pregnancy and childbirth, women's definitions, perceptions and experiences of informed choice should be considered to be relational. Women consider that informed choice means more than just the provision of information; rather it requires an in-depth discussion with a professional who is known to them. Women's understandings reveal that informed choice, is not only defined by but contingent on the quality of women's relationships with their caregiver and their ability to engage in a process of shared decision-making with them.
KEY CONCLUSION: Informed choice is defined and experienced as a relational construct, the support provided by maternity care professionals to women in contemporary maternity care must reflect this.
PMID: 28092814 [PubMed - indexed for MEDLINE]
Validation of the Policy Advocacy Engagement Scale for frontline healthcare professionals.
Nurs Ethics. 2017 May;24(3):362-375
Authors: Jansson BS, Nyamathi A, Heidemann G, Duan L, Kaplan C
BACKGROUND: Nurses, social workers, and medical residents are ethically mandated to engage in policy advocacy to promote the health and well-being of patients and increase access to care. Yet, no instrument exists to measure their level of engagement in policy advocacy.
RESEARCH OBJECTIVE: To describe the development and validation of the Policy Advocacy Engagement Scale, designed to measure frontline healthcare professionals' engagement in policy advocacy with respect to a broad range of issues, including patients' ethical rights, quality of care, culturally competent care, preventive care, affordability/accessibility of care, mental healthcare, and community-based care.
RESEARCH DESIGN: Cross-sectional data were gathered to estimate the content and construct validity, internal consistency, and test-retest reliability of the Policy Advocacy Engagement Scale. Participants and context: In all, 97 nurses, 94 social workers, and 104 medical residents (N = 295) were recruited from eight acute-care hospitals in Los Angeles County. Ethical considerations: Informed consent was obtained via Qualtrics and covered purposes, risks and benefits; voluntary participation; confidentiality; and compensation. Institutional Review Board approval was obtained from the University of Southern California and all hospitals.
FINDINGS: Results supported the validity of the concept and the instrument. In confirmatory factor analysis, seven items loaded onto one component with indices indicating adequate model fit. A Pearson correlation coefficient of .36 supported the scale's test-retest stability. Cronbach's α of .93 indicated strong internal consistency.
DISCUSSION: The Policy Advocacy Engagement Scale demonstrated satisfactory psychometric properties in this initial test. Findings should be considered within the context of the study's limitations, which include a low response rate and limited geographic scope.
CONCLUSION: The Policy Advocacy Engagement Scale appears to be the first validated scale to measure frontline healthcare professionals' engagement in policy advocacy. With it, researchers can analyze variations in professionals' levels of policy advocacy engagement, understand what factors are associated with it, and remedy barriers that might exist to their provision of it.
PMID: 26396141 [PubMed - indexed for MEDLINE]
Integrating Correctional and Community Health Care: An Innovative Approach for Clinical Learning in a Baccalaureate Nursing Program.
Nurs Forum. 2017 Jan;52(1):38-49
Authors: Bouchaud MT, Swan BA
PROBLEM: With an evolving focus on primary, community-based, and patient-centered care rather than acute, hospital-centric, disease-focused care, and recognition of the importance of coordinating care and managing transitions across providers and settings of care, registered nurses need to be prepared from a different and broader knowledge base and skills set. A culture change among nurse educators and administrators and in nursing education is needed to prepare competent registered nurses capable of practicing from a health promotion, disease prevention, community- and population-focused construct in caring for a population of patients who are presenting health problems and conditions that persist across decades and/or lifetimes. While healthcare delivery is moving from the hospital to ambulatory and community settings, community-based educational opportunities for nursing students are shrinking due to a variety of reasons, including but not limited to increased regulatory requirements, the presence of competing numbers of nursing schools and their increased enrollment of students, and decreasing availability of community resources capable and willing to precept students in an all-day interactive learning environment.
METHODS: A detailed discussion of one college of nursings' journey to find an innovative solution and approach to the dilemma of limited and decreasing available community clinical sites to prepare senior level prelicensure baccalaureate nursing students for healthcare practice in the twenty-first century.
FINDINGS: This article demonstrated how medium/maximum prisons can provide an ideal learning experience for not only technical nursing skills but more importantly for reinforcing key learning goals for community-based care, raising population-based awareness, and promoting cultural awareness and sensitivity. In addition, this college of nursing overcame the challenges of initiating and maintaining clinical placement in a prison facility, collaboratively developed strategies to insure student and faculty safety satisfying legal and administrative concerns for both the college of nursing and the prison, and developed educational postclinical assignments that solidified clinical course and nursing program objectives. Lastly, this college of nursing quickly learned that not only did nursing students agree to clinical placement in an all-male medium- to maximum-security prison despite its accompanying restrictive regulations especially as it relates to their access to personal technology devices, but there was an unknown desire for a unique clinical experience.
CONCLUSION: The initial pilot program of placing eight senior level prelicensure baccalaureate nursing students in a 4,000-person all male medium- to maximum-security prison for their community clinical rotation has expanded to include three state-run maximum all male prisons in two states, a 3,000-person male/female federal prison, and several juvenile detention centers. Clinical placement of students in these sites is by request only, resulting in lengthy student waiting lists. This innovative approach to clinical learning has piqued the interest of graduate nurse practitioner (NP) students as well. One MSN, NP student has been placed in the federal prison every semester for over a year. Due to increasing interest from graduate students to learn correctional health nursing, the college of nursing is now expanding NP placement to the other contracted maximum-security prisons. This entire experience has changed clinical policies within a well-established academic culture and promoted creative thinking regarding how and where to clinically educate and prepare registered baccalaureate nurses for the new culture of health and wellness.
PMID: 27102579 [PubMed - indexed for MEDLINE]
Consumers in mental health service leadership: A systematic review.
Int J Ment Health Nurs. 2017 Feb;26(1):20-31
Authors: Scholz B, Gordon S, Happell B
Contemporary mental health policies call for greater involvement of mental health service consumers in all aspects and at all levels of service planning, delivery, and evaluation. The extent to which consumers are part of the decision-making function of mental health organizations varies. This systematic review synthesizes empirical and review studies published in peer-reviewed academic journals relating to consumers in leadership roles within mental health organizations. The Cochrane Library, Medline, and PsycINFO were searched for articles specifically analysing and discussing consumers' mental health service leadership. Each article was critically appraised against the inclusion criteria, with 36 articles included in the final review. The findings of the review highlight current understandings of organizational resources and structures in consumer-led organizations, determinants of leadership involvement, and how consumer leadership interacts with traditional mental health service provision. It appears that organizations might still be negotiating the balance between consumer leadership and traditional structures and systems. The majority of included studies represent research about consumer-run organizations, with consumer leadership in mainstream mental health organizations being less represented in the literature. Advocates of consumer leadership should focus more on emphasizing how such leadership itself can be a valuable resource for organizations and how this can be better articulated. This review highlights the current gaps in understandings of consumer leadership in mental health, including a need for more research exploring the benefits of consumer leadership for other consumers of services.
PMID: 28093883 [PubMed - indexed for MEDLINE]
Changing lives-it starts with a plan.
Br J Nurs. 2017 Apr 27;26(8):481
Authors: Foster S
Sam Foster, Chief Nurse at Heart of England NHS Foundation Trust, discusses how nurse leaders can influence the Sustainability and Transformation Plan for the benefit of their local area population.
PMID: 28453331 [PubMed - indexed for MEDLINE]
RN Prescribing: An Expanded Role for Nursing.
Nurs Forum. 2017 Jan;52(1):3-11
Authors: Kooienga S, Wilkinson J
PURPOSE: With the implementation of the Affordable Care Act, recommendations of the Future of Nursing Report, and recent regulatory changes by state boards of nursing, registered nurse (RN) roles are expanding. In this article, we advocate for RN prescribing as an expanded role in the United States.
METHODS: We reviewed the literature on RN prescribing, the background in both high- and low-resource countries, levels of prescribing, specialized settings for RN prescribing, both RN and patients views/perceptions of prescribing, and evaluation research. From this review, we developed a proposal for RN prescribing.
FINDINGS: Due to expansion of RNs into prescribing worldwide to meet unmet healthcare needs in both primary and specialty settings, we propose a role for RN prescribing within both primary care and outpatient specialty settings. The differences between RN and advanced practice RN prescribing are defined, and U.S.-based regulatory challenges are examined.
CONCLUSION: Considering unmet healthcare needs and patients' need for medication and medication education, we advocate for RN prescribing as expanded scope and role change for experienced RNs to practice to the highest level of their education.
PMID: 27102376 [PubMed - indexed for MEDLINE]
A cross-sectional study investigating patient-centred care, co-creation of care, well-being and job satisfaction among nurses.
J Nurs Manag. 2017 Jul 11;:
Authors: den Boer J, Nieboer AP, Cramm JM
BACKGROUND: Developments in the community health nursing sector have resulted in many changes in the activities of these nurses. The concepts of patient-centred care and co-creation of care are gaining importance in the work of community health nurses. Whether patient-centred care also contributes positively to nurses' well-being and job satisfaction is not known.
METHOD: In 2015, a cross-sectional survey was conducted among 153 community health nurses employed by 11 health care organisations in the southern part of the Netherlands. Correlation and regression analyses were performed to identify relationships among patient-centred care, co-creation of care, background characteristics, job satisfaction and well-being of community health nurses.
RESULTS: Patient-centred care and co-creation of care were correlated positively with community health nurses' well-being and job satisfaction. Both variables were predictors of well-being, and patient-centred care was a predictor of job satisfaction. The length of time in the present position was related negatively to community health nurses' job satisfaction and well-being.
CONCLUSIONS: Investment in patient-centred care and co-creation of care is important for the well-being and job satisfaction of community health nurses.
IMPLICATIONS FOR NURSING MANAGEMENT: To safeguard or improve job satisfaction and well-being of community health nurses, organisations should pay attention to the co-creation of care and patient-centred care.
PMID: 28695703 [PubMed - as supplied by publisher]
Health visitors vital to child development.
Nurs Child Young People. 2017 Jul 10;29(6):6
The RCN says that health visiting must be a top government priority if children are to flourish.
PMID: 28691625 [PubMed - in process]
Politics and Professions: Interdisciplinary Team Models and Their Implications for Health Equity in Ontario.
Int J Health Serv. 2017 Jan 01;:20731417717384
Authors: Haydt SM
Ontario's efforts to reform primary care through interdisciplinary primary care teams are unprecedented in Canada. Since 2004, the provincial government has focused its reform efforts on three models: Family Health Teams (FHTs), Community Health Centres (CHCs), and Nurse Practitioner-led Clinics (NPLCs). These models vary by team structure, funding, and governance. I examine the strong preference for the FHT model by the government and medical profession, and the implications of this preference on health equity. The opportunity for teams to increase health equity in Ontario may be limited due to the preference for physician-centered FHTs over more egalitarian team models.
PMID: 28689472 [PubMed - as supplied by publisher]
Understanding the nurse's role in identifying children with intellectual disability.
Nurs Child Young People. 2017 Jul 10;29(6):33-36
Authors: Delahunty L
The early diagnosis of children who have intellectual disability (ID) is crucial to ensuring the varied and complex needs of these people and their families are met in a timely and appropriate way. The ability to easily identify all children who should be assessed for ID would increase the chances of children with ID being diagnosed early on in life. This article describes ID, the kind of support children with ID need, and how nursing staff might use the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q) to help identify children who should be formally assessed for ID. Nurses who would benefit from a greater ability to identify ID include health visitors, school nurses, practice nurses, and nurses working in paediatric clinics.
PMID: 28691634 [PubMed - in process]
Trust: an essential condition in the application of a caregiver support intervention in nursing practice.
BMC Psychiatry. 2017 Feb 02;17(1):47
Authors: Zegwaard MI, Aartsen MJ, Grypdonck MH, Cuijpers P
BACKGROUND: The recent policy of deinstitutionalization of health care in Western countries has resulted in a growing number of people - including elderly - with severe mental illness living in the community where they rely on families and others for support in daily living. Caregiving for partners, parents, children, and significant others can be a stressful experience and has been associated with psychosocial problems and poorer physical health. To support caregivers, a new, complex, nurse-led caregiver - centered intervention was developed. The intervention focuses on preventing deterioration in the wellbeing of caregivers. The objective of this study is to obtain a better understanding of the potentials of this new intervention.
METHODS: We applied an interpretative qualitative field study at two Dutch mental health care institutes. Thirteen caregivers participated in a one-time semi-structured interview.
RESULTS: From the caregivers' perspective, a trusting relationship between caregivers and the mental health nurse is an essential condition for the depth and hence the effectiveness of the caregiver-centered counseling intervention. In this trusting relationship three overlapping and mutually reinforcing phases were identified (1) phase of engagement, (2) recognition of personal needs and (3) hope and optimism. Each phase encompasses key experiences that enhanced trust in that phase.
CONCLUSIONS: Collaborative relationships between caregivers and mental health nurses provide a framework in which the mental health nurse can assess and help not only patients but also caregivers to gain insight into their situation and take on new roles and responsibilities in ways that promote their wellbeing.
PMID: 28148235 [PubMed - indexed for MEDLINE]
Communication With Limited English-Proficient Families in the PICU.
Hosp Pediatr. 2017 01;7(1):9-15
Authors: Zurca AD, Fisher KR, Flor RJ, Gonzalez-Marques CD, Wang J, Cheng YI, October TW
OBJECTIVE: Health care disparities have been described for children of limited English-proficient (LEP) families compared with children of English-proficient (EP) families. Poor communication with the medical team may contribute to these worse health outcomes. Previous studies exploring communication in the PICU have excluded LEP families. We aimed to understand communication experiences and preferences in the 3 primary communication settings in the PICU. We also explored LEP families' views on interpreter use in the PICU.
PATIENTS AND METHODS: EP and Spanish-speaking LEP families of children admitted to the PICU of a large tertiary pediatric hospital completed surveys between 24 hours and 7 days of admission.
RESULTS: A total of 161 of 184 families were surveyed (88% response rate); 52 were LEP and 109 EP. LEP families were less likely to understand the material discussed on rounds (odds ratio [OR] 0.32, 95% confidence interval [CI] 0.11-0.90), to report that PICU nurses spent enough time speaking with them (OR 0.15, 95% CI 0.05-0.41), and to report they could rely on their nurses for medical updates (OR 0.07, 95% CI 0.02-0.25) controlling for covariates, such as education, insurance type, presence of a chronic condition, PICU length of stay, and mortality index. LEP families reported 53% of physicians and 41% of nurses used an interpreter "often."
CONCLUSIONS: Physician and nurse communication with LEP families is suboptimal. Communication with LEP families may be improved with regular use of interpreters and an increased awareness of the added barrier of language proficiency.
PMID: 27979992 [PubMed - indexed for MEDLINE]
Realist evaluation of an enhanced health visiting programme.
PLoS One. 2017;12(7):e0180569
Authors: Doi L, Jepson R, Hardie S
BACKGROUND: The health visitors' role in many countries is changing. In Scotland, the role has undergone substantial changes through the introduction of an enhanced health visiting programme, which includes increased, structured home visits. This evaluation was conducted within NHS Ayrshire and Arran, one of the 14 Scottish Health Boards. Our aim was to understand and explain how, and why, the programme could contribute to improving health and wellbeing outcomes for children and families.
METHODS: We used a realist evaluation approach, conducted in three phases. In phase one, eight managerial staff involved in developing and implementing the programme provided data, which were used to develop initial programme theories. In phase two, the programme theories were tested using qualitative data from 25 health visitors and 22 parents. The programme theories were refined through analyses and interpretation of data in phase three.
RESULTS: The home visiting context provided by the programme interacted with the mechanisms of the programme and produced outcomes such as early identification of health and wellbeing issues amongst families who needed more support, leading to referral and engagement with sources of additional help. The home visits facilitated development of parent-health visitor relationships, and parents considered health visitors as their first point of contact on children's wellbeing and developmental-related issues. Moreover, the programme provided more clarity to health visitors' role, which in turn enhanced partnership working. However, there were aspects of the programme that may require further development. For instance, both parents and health visitors were concerned about the wide gaps between some home visits.
CONCLUSIONS: The enhanced health visiting programme increased opportunities for monitoring and early identification of health and wellbeing concerns. It created structures for a more efficient partnership working and ensured that the needs of children and families were supported. These benefits need to be evaluated further in an effectiveness study.
PMID: 28672013 [PubMed - in process]
The professional psychiatric/mental health nurse: skills, competencies and supports required to adopt recovery-orientated policy in practice.
J Psychiatr Ment Health Nurs. 2017 Mar;24(2-3):93-104
Authors: Cusack E, Killoury F, Nugent LE
WHAT IS KNOWN ON THE SUBJECT?: Nationally and internationally there has been a movement away from the traditional medical model towards a more holistic recovery-oriented approach to mental health care delivery. At every level of service provision the emphasis is firmly on recovery and on facilitating active partnership working and involvement of service users, their carers and family members. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to identify on a national level specific areas of care that are addressed most or least by psychiatric and mental health nurses in care planning for mental health service users in Ireland. In addition, this is the first study to identify nationally how the recovery approach is being implemented by psychiatric and mental health nurses in relation to current recovery-orientated policy. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare staff require more education on the recovery concept and this needs to be multidisciplinary team wide. Further research is required to establish how best to develop a shared approach to working with service users and their families within the mental healthcare environment. Further investigation is required to help determine how funding could be allocated appropriately for education and training and service development nationally.
ABSTRACT: Introduction The restructuring of national mental health policy to an integrated recovery ethos demands a clarification in the psychiatric/mental health nurse's role, skills and competencies. Aim/Question To explore the psychiatric/mental health nurse's role and identify skills, competencies and supports required to adopt recovery-orientated policy in practice. Method An exploratory mixed methods study in multiple health services in Ireland with N = 1249 psychiatric/mental health nurses. Data collection used a survey, focus groups and written submissions. Data analysis used descriptive statistics and thematic analysis. Results The medical profession use a symptom-focused approach to mental healthcare delivery. Nurses viewed this as a primary inhibitor to recovery-orientated practice. Professional development in prevention and earlier intervention within primary care environments requires development. Nurses require research support to measure the effectiveness of the mental health interventions they provide. Implications and conclusion The effective implementation of the recovery approach requires a multitude of strategies and narrative threads in an overall medical assessment. Nurses need support from medics in providing consistency of assessments/documentation of required psychosocial interventions. A greater range of specialist services provided by nurses including psychosocial interventions and health promotion is fundamental to quality care and improving service user outcomes in primary care.
PMID: 27860051 [PubMed - indexed for MEDLINE]
Expertise in action: Insights into the dynamic nature of expertise in community-based nursing.
J Clin Nurs. 2017 Jul 05;:
Authors: Dickson CAW, McVittie C, Kapilashrami A
AIM: To gain insight into community nurses' experiences and how they make sense of the expertise they offer in their role BACKGROUND: Globally, the spotlight is currently on community nursing expertise because of the movement of hospital-based to community- based care. Caring for people at home is no longer solely concerned with prevention, but delivering complex care to patients who are acutely unwell or at the end of their life. Little is known about the distinct expertise of community nurses, or their contribution to patient outcomes. There is a need to examine expertise in this group in order to inform current and future care provision within community settings.
DESIGN: A hermeneutic, phenomenological study.
METHOD: Semi-structured interviews were conducted with eight community nurses in Scotland, UK, who hold an additional post-registration, professional qualification. Participants also kept audio-journals. Data were analysed using Interpretive Phenomenological Analysis.
FINDINGS: Participants described their expertise in three themes; negotiating a 'way in' to care, managing complexity, and 'thinking on your feet'. They did not refer to themselves as specialist practitioners, nor did they perceive that they were viewed as specialist by colleagues or management. They appeared to dismiss their range of expertise which included forming trusting relationships, anticipating care needs and problem-solving, enabling them to undertake complex care management.
CONCLUSIONS: Expertise of community nurses in this study is dynamic, contextualised and action-oriented enabling them to be creative problem-solvers. It reflects engagement with patients and families and all aspects of the setting where care is provided, rather than being solely an identifiable set of specialist skills, RELEVANCE TO CLINICAL PRACTICE: It is vital to recognize community-based expertise internationally, especially if current WHO aims for community-based health care are to be achieved. Highlighting this expertise contributes to current discourse and may be considered in education and practice reviews. This article is protected by copyright. All rights reserved.
PMID: 28677921 [PubMed - as supplied by publisher]
Cost-of-illness of patients with lymphedema.
J Eur Acad Dermatol Venereol. 2017 Jun 29;:
Authors: Gutknecht M, Herberger K, Klose K, Purwins S, Dietz D, Blome C, Augustin M
BACKGROUND: Chronic lymphedema is characterized by a continuous need for medical treatment, many comorbidities, and impaired quality of life. In Germany, about 4.5 million patients are affected by lymphedema. Thus, lymphedema causes high direct and indirect costs, even more in case of complications such as erysipelas and ulcers.
OBJECTIVE: The aim of this study was to determinate the costs of illness of community lymphedema patients living in the metropolitan area of Hamburg, Germany.
METHODS: An observational cross-sectional study in patients with lymphedema and combined lipolymphedema of any origin was performed analysing direct and indirect costs for the patients, the statutory health insurance, and society.
RESULTS: In total, 348 patients (90.8% female) were examined and interviewed. The mean age of the patients was 57.3 ± 14.5 years. On average, the total costs per patient and year were € 5784, of which € 4445 (76.0%) were direct costs and € 1338 indirect costs. Within the direct medical costs, € 3796 were accounted for the statutory health insurances and € 649 for the patient. The main cost drivers were costs for manual decongestive therapy and disability costs.
CONCLUSION: Chronic lymphedema is associated with high direct and indirect costs. This community based study is the first cost analysis of chronic lymph- and combined lipolymphedema giving insights to economic impact of lymphedema treatment. There is a high need for structured disease management programs in order to diagnose and treat lymphedema early and to avoid complications, thus limiting socioeconomic burden. This article is protected by copyright. All rights reserved.
PMID: 28662302 [PubMed - as supplied by publisher]
Project IMPACT Pilot Report: Feasibility of Implementing a Hospital-to-Home Transition Bundle.
Pediatrics. 2017 Mar;139(3):
Authors: Mallory LA, Osorio SN, Prato BS, DiPace J, Schmutter L, Soung P, Rogers A, Woodall WJ, Burley K, Gage S, Cooperberg D, IMPACT Pilot Study Group
BACKGROUND AND OBJECTIVES: To improve hospital to home transitions, a 4-element pediatric patient-centered transition bundle was developed, including: a transition readiness checklist; predischarge teach-back education; timely and complete written handoff to the primary care provider; and a postdischarge phone call. The objective of this study was to demonstrate the feasibility of bundle implementation and report initial outcomes at 4 pilot sites. Outcome measures included postdischarge caregiver ability to teach-back key home management information and 30-day reuse rates.
METHODS: A multisite, observational time series using multiple planned sequential interventions to implement bundle components with non-technology-supported and technology-supported patients. Data were collected via electronic health record reviews and during postdischarge phone calls. Statistical process control charts were used to assess outcomes.
RESULTS: Four pilot sites implemented the bundle between January 2014 and May 2015 for 2601 patients, of whom 1394 had postdischarge telephone encounters. Improvement was noted in the implementation of all bundle elements with the transitions readiness checklist posing the greatest feasibility challenge. Phone contact connection rates were 69%. Caregiver ability to teach-back essential home management information postdischarge improved from 18% to 82%. No improvement was noted in reuse rates, which differed dramatically between technology-supported and non-technology-supported patients.
CONCLUSIONS: A pediatric care transition bundle was successfully tested and implemented, as demonstrated by improvement in all process measures, as well as caregiver home management skills. Important considerations for successful implementation and evaluation of the discharge bundle include the role of local context, electronic health record integration, and subgroup analysis for technology-supported patients.
PMID: 28202769 [PubMed - indexed for MEDLINE]
The History of Evidence-Based Practice in Nursing Education and Practice.
J Prof Nurs. 2017 Jan - Feb;33(1):51-55
Authors: Mackey A, Bassendowski S
Beginning with Florence Nightingale in the 1800s and evolving again within the medical community, evidence-based practice continues to advance along with the nursing discipline. Evidence-based practice is foundational to undergraduate and graduate nursing education and is a way for the nursing discipline to minimize the theory to practice gap. This article discusses the concept of evidence-based practice from a historical perspective as it relates to nursing in the educational and practice domains. The concept evidence-based practice is defined, and the similarities and differences to evidence-based medicine are discussed. It is crucial that registered nurses be proactive in their quest for research knowledge, so the gap between theory and practice continues to close. Utilizing nursing best practice guidelines, reviewing and implementing applicable research evidence, and taking advantage of technological advances are all ways in which nursing can move forward as a well-informed discipline.
PMID: 28131148 [PubMed - indexed for MEDLINE]
"Awareness is the first step": An interprofessional course on mindfulness & mindful-movement for healthcare professionals and students.
Complement Ther Clin Pract. 2016 Nov;25:18-25
Authors: Kinser P, Braun S, Deeb G, Carrico C, Dow A
High levels of stress and related burnout in healthcare professionals (HCPs) are prevalent and costly conditions. Mindfulness training has received recent attention as a possible prevention/intervention strategy to enhance resilience to stress and reduce risk of burnout in HCPs. The purpose of this mixed-methods pilot study was to evaluate the preliminary feasibility, acceptability, and preliminary effects of an 8-week mindfulness curriculum for interprofessional HCPs and trainees (n = 27). Qualitative findings supported feasibility and acceptability of the course for a wide variety of HCP disciplines, including nursing, dentistry, medicine, pharmacy, social work, mental health, and clinical research. Despite being limited by a small sample size, there were statistically significant reductions in perceived stress, anxiety, and specific aspects of burnout from pre-to post-intervention and there was a trend in an enhanced sense of personal accomplishment over time.
PMID: 27863607 [PubMed - indexed for MEDLINE]
Home Visiting and Use of Infant Health Care: A Randomized Clinical Trial.
Pediatrics. 2017 Jan;139(1):
Authors: Kilburn MR, Cannon JS
BACKGROUND AND OBJECTIVES: Evaluations of home visiting models have shown that they can reduce children's health care use in the first year of life. Models that exclusively use nurses as home visitors may cost more and be infeasible given nursing shortages in some locations. The goal of this study was to test whether a universal home visiting model employing a nurse-parent educator team as home visitors reduces health care use in the first year of life.
METHODS: This study was a randomized controlled clinical trial of an intensive home visiting program delivered in homes of primary caregivers and their first-born children in Santa Fe, New Mexico. Intention-to-treat and contamination-adjusted intention-to-treat models were estimated, and 244 primary caregivers participated in the survey.
RESULTS: In their first year of life, treatment group children were one-third less likely to visit the emergency department (control group mean, MC = 0.42, treatment group mean, MT = 0.28, P = .02) and were also 41% less likely to have visited a primary care provider ≥9 times (MC = 0.49, MT = 0.29, P < .001). We found no differences between the treatment and control groups for hospitalizations or injuries requiring medical attention. The universal program reduced infant health care use for high-risk and lower-risk families.
CONCLUSIONS: Children in families randomly assigned to the program had less health care use in their first year, demonstrating that a universal prevention home visiting model delivered by a nurse-parent educator team can reduce infant health care use.
PMID: 27980028 [PubMed - indexed for MEDLINE]
The Practice Environment Scale of the Nursing Work Index: An updated review and recommendations for use.
Int J Nurs Stud. 2017 Jun 12;74:76-84
Authors: Swiger PA, Patrician PA, Miltner RSS, Raju D, Breckenridge-Sproat S, Loan LA
OBJECTIVES: The Practice Environment Scale of the Nursing Work Index (PES-NWI) is an instrument, which measures the nursing practice environment - defined as factors that enhance or attenuate a nurse's ability to practice nursing skillfully and deliver high quality care. The purpose of this paper is to provide an updated review of the Practice Environment Scale of the Nursing Work Index's use to date and provide recommendations that may be helpful to nursing leaders and researchers who plan to use this instrument.
DESIGN: A narrative review of quantitative studies.
DATA SOURCES: PubMed, EMBASE, and the Cumulative Index to Nursing & Allied Health Literature were searched to identify relevant literature using the search terms, Practice Environment Scale of the Nursing Work Index and PES-NWI.
REVIEW METHODS: Studies were included if they were published in English between 2010 and 2016 and focused on the relationship between the Practice Environment Scale of the Nursing Work Index and patient, nurse, or organizational outcomes. Data extraction focused on the reported survey scores and the significance and strength of the reported associations.
RESULTS: Forty-six articles, from 28 countries, were included in this review. The majority reported significant findings between the nursing practice environment and outcomes. Although some modifications have been made, the instrument has remained primarily unchanged since its development. Most often, the scores regarding staffing and resource adequacy remained the lowest.
CONCLUSION: The frequency of use of this instrument has remained high. Many researchers advocate for a move beyond the study of the connection between the Practice Environment Scale and nurse, patient, and organizational outcomes. Research should shift toward identifying interventions that improve the environment in which nurses practice and determining if changing the environment results in improved care quality.
PMID: 28641123 [PubMed - as supplied by publisher]
Obtaining service user feedback for student nurses in the community setting.
Br J Community Nurs. 2017 May 02;22(5):248-251
Authors: Carr J, Pitt M, Midgley K, Baker H
Seeking service user feedback for student nurses who are engaged in community learning experiences is an important part of a mentor's role. This paper discusses what is currently advocated, the mentor's role in obtaining and managing feedback and makes recommendations to improve the process in the community practice setting.
PMID: 28467245 [PubMed - indexed for MEDLINE]
Cost-effective wound management: a survey of 1717 nurses.
Br J Nurs. 2017 Jun 22;26(12):S44-S49
Authors: Newton H
Delivering high-quality wound care requires a mix of knowledge and skills, which nurses aim to update by attending educational events such as conferences and study days. This article describes the data obtained from 30 educational study days, which took place across England, Scotland and Wales. It will explore nurses' knowledge in relation to the cost-effectiveness and clinical efficacy of current wound care practices, based on the answers of 1717 delegates that attended the events. It will also outline the results in relation to reducing expenditure on wound dressings and the importance of performing an accurate wound assessment.
PMID: 28640734 [PubMed - in process]
Student nurse preferences for their first clinical experience: a thematic analysis.
Br J Nurs. 2017 Jan 26;26(2):104-108
Authors: Gillespie M
Shifts in demographic profiles and in the understanding of how to best deliver health care have seen nurses increasingly caring for non-acute client groups outside traditional clinical settings. Evidence suggests that this does not always sit well with nurses, or with nurses in training. This study sought to investigate the influences on student nurse perceptions of the worth of working with various client groups. Thematic analysis of a focus group discussion led to the identification of several themes suggesting that unhelpful opinions are present in some students on entry to the programme; however, programme-related influences also contribute towards unhelpful attitudes. To create a more positive framing of working within such specialisms will require significant focus across nursing, nurse education and society in general.
PMID: 28132547 [PubMed - indexed for MEDLINE]
Service development of a nurse-led community-based PICC insertion service.
Br J Nurs. 2017 Jan 26;26(2):S22-S27
Authors: Bedford E, Waterhouse D
Patients receiving intravenous therapy require reliable venous access. Typically patients with poor peripheral access or requiring long-term treatment from an outpatient antibiotic therapy (OPAT) service need to receive secondary care input for safe central line placement, and radiological confirmation of the correct line tip placement where necessary, if treatment is to proceed as planned. Technological developments that enable accurate ultrasound-guided vein selection and electrocardiograph (ECG)-guided central line tip placement have eliminated the need for radiological or fluoroscopic confirmation of correct tip placement for peripherally placed central catheters (PICCs). This article outlines the development of an out-of-hospital nurse-led PICC insertion service using the Sherlock 3CG(®) Tip Confirmation System (C.R Bard) to meet the needs of patients requiring long-term intravenous treatment from an OPAT service, and its impact on reducing treatment delays and the need for secondary care intervention.
PMID: 28132552 [PubMed - indexed for MEDLINE]
Contraceptive counselling of women seeking abortion - a qualitative interview study of health professionals' experiences.
Eur J Contracept Reprod Health Care. 2017 Feb;22(1):3-10
Authors: Kilander H, Salomonsson B, Thor J, Brynhildsen J, Alehagen S
OBJECTIVES: A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalś experiences of providing contraceptive counselling to women seeking an abortion.
METHODS: We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis.
RESULTS: Three clusters were identified: 'Complex counselling', 'Elements of counselling' and 'Finding a method'. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method.
CONCLUSIONS: HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.
PMID: 27689407 [PubMed - indexed for MEDLINE]
Avoiding hospital admission in COPD: impact of a specialist nursing team.
Br J Nurs. 2017 Feb 09;26(3):152-158
Authors: Cox K, Macleod SC, Sim CJ, Jones AW, Trueman J
Chronic obstructive pulmonary disease (COPD) is a common, preventable and incurable disease. The costs of caring for patients with COPD is estimated to be more than £800 million a year for acute hospital admissions alone ( Department of Health, 2012 ). The hospital-at-home model is increasingly being adopted for COPD patients following British Thoracic Society (BTS) guidelines for the delivery of hospital admission-avoidance schemes ( BTS, 2007 ). The aim of this case-note review was to evaluate the safety and effectiveness of a specialist nurse-led acute respiratory assessment service working with COPD patients in the community. The review recorded patient flow through the service and documented assessments and treatments. It was able to document potential benefits and cost savings.
PMID: 28185492 [PubMed - indexed for MEDLINE]
The NMLN recently launched The Power of Conversation: Nursing and Midwifery Leadership in Action, which portrays four big group conversational events, the outcomes of which were configured around themes.