The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services.
BMJ Open. 2017 Aug 11;7(8):e015049
Authors: Riordan F, McHugh SM, Murphy K, Barrett J, Kearney PM
OBJECTIVES: International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement.
DESIGN: A cross-sectional survey of hospital and community-based DNS in Ireland.
METHODS: Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave.
RESULTS: The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration.
CONCLUSIONS: Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed.
PMID: 28801394 [PubMed - in process]
The Headache Action Plan Project for Youth (HAPPY): School Nurses as Facilitators of System Change in Pediatric Migraine Care.
NASN Sch Nurse. 2017 Aug 01;:1942602X17719300
Authors: Connelly M, Bickel J, Wingert T, Galemore C
Migraine is a common health problem in youth that is ranked highest for disability among neurological conditions and is one of the leading reasons for school absences. Children with migraines frequently are seen by the school nurse for care, sometimes before ever being seen by another healthcare provider for evaluation and treatment. As such, school nurses have the unique opportunity to provide education and resources to children with migraines and their family. This article provides information on the Headache Action Plan Program for Youth (HAPPY), a project involving the provision of live and online migraine education and management resources to school nurses, children, families, and primary care providers in an effort to improve migraine recognition and care in the community.
PMID: 28777680 [PubMed - as supplied by publisher]
Short rest between shift intervals increases the risk of sick leave: a prospective registry study.
Occup Environ Med. 2017 Jul;74(7):496-501
Authors: Vedaa Ø, Pallesen S, Waage S, Bjorvatn B, Sivertsen B, Erevik E, Svensen E, Harris A
OBJECTIVES: The purpose of this study was to use objective registry data to prospectively investigate the effects of quick returns (QR, <11 hours of rest between shifts) and night shifts on sick leave.
METHODS: A total of 1538 nurses (response rate =41.5%) answered questionnaires on demographics and personality and provided consent to link this information to registry data on shift work and sick leave from employers' records. A multilevel negative binomial model was used to investigate the predictive effect of exposure to night shifts and QR every month for 1 year, on sick leave the following month.
RESULTS: Exposure to QR the previous month increased the risk for sick leave days (incidence rate ratio (IRR)=1.066, 95% CI 1.022 to 1.108, p<0.01) and sick leave spells (IRR=1.059, 95% CI 1.025 to 1.097, p<0.001) the following month, whereas night shifts did not. 83% per cent of the nurses experienced QR within a year, and on average they were exposed to 3.0 QR per month (SD=1.6). Personality characteristics associated with shift work tolerance (low on morningness, low on languidity and high on flexibility) were not associated with sick leave, and did not moderate the relationship between QR and sick leave.
CONCLUSIONS: We found a positive linear relationship between QR and sick leave. Avoiding QR may help reduce workers' sick leave. The restricted recovery opportunity associated with QR may give little room for beneficial effects of individual characteristics usually associated with shift work tolerance.
PMID: 27827302 [PubMed - indexed for MEDLINE]
Student Perceptions and Acceptance of Mobile Technology in an Undergraduate Nursing Program.
Healthcare (Basel). 2017 Jul 21;5(3):
Authors: George TP, DeCristofaro C, Murphy PF, Sims A
Mobile technology allows healthcare students to access current evidence-based resources. The purpose of this study was to evaluate the student experience of implementing point-of-care (POC) smartphone applications in a first-semester undergraduate nursing program. Teaching methods included using case studies in the laboratory to familiarize students with the apps. At community screening sites, evidence-based guidelines were referenced when students discussed screening results with patients. Surveys were administered prior to implementing this innovation and after the students utilized the apps in direct patient interactions. Survey results were analyzed to evaluate student perceptions and acceptance of mobile technology. Students felt that healthcare smartphone apps were a helpful and convenient way to obtain evidence-based clinical information pertinent to direct care settings. Over 90% of students planned to continue using healthcare smartphone apps. In conclusion, healthcare smartphone apps are a way for students to become comfortable accessing evidence-based clinical resources. It is important to encourage students to use these resources early in the curriculum. Community screenings are an independent health promotion activity which assists in the attainment of health equity and fosters nursing leadership.
PMID: 28754011 [PubMed]
Confidence and clinical judgement in community nurses managing venous leg ulceration - A judgement analysis.
J Tissue Viability. 2017 Jul 19;:
Authors: Adderley UJ, Thompson C
BACKGROUND: The variation in the management of venous leg ulceration in the UK is partly attributable to an uncertain clinical environment but the quality of judgements is influenced by the how well nurses' confidence and accuracy are aligned.
OBJECTIVES: To assess UK community nurses' confidence in the accuracy of their diagnostic judgements and treatment choices when managing venous leg ulceration.
DESIGN: Judgement Analysis.
SETTING: UK community and primary care nursing services.
PARTICIPANTS: 18 community non-specialist nurses working in district (home) nursing teams and general practitioner services and 18 community tissue viability specialist nurses.
METHODS: Using judgement analysis methods, 18 community non-specialist nurses and 18 community tissue viability specialist nurses made diagnoses and treatment judgements about compression therapy for 110 clinical scenarios and indicated their confidence for each judgement. An expert panel made consensus judgements for the same scenarios and these judgements were used as a standard against which to compare the participants. Confidence analysis was used to assess the nurses' confidence about their diagnostic judgements and treatment choices.
RESULTS: Despite being very experienced, both non-specialist nurses' and specialist tissue viability nurses' levels of confidence were not well calibrated with their levels of accuracy.
CONCLUSION: The results of this study are important as errors resulting from both over and under-confidence at the diagnostic phase of management may influence treatment choices, and thus increase the chances of treatment error.
PMID: 28747258 [PubMed - as supplied by publisher]
Sexual health in primary health care - a qualitative study of nurses' experiences.
J Clin Nurs. 2017 Jun;26(11-12):1545-1554
Authors: Klaeson K, Hovlin L, Guvå H, Kjellsdotter A
AIM AND OBJECTIVES: To illuminate nurses' experiences and opportunities to discuss sexual health with patients in primary health care.
BACKGROUND: Sexual health is a concept associated with many taboos, and research shows that nurses feel uncomfortable talking to patients about sexual health and therefore avoid it. This avoidance forms a barrier between patient and nurse which prevents nurses from giving satisfactory health care to patients.
DESIGN: A qualitative descriptive design.
METHOD: Semi-structured interviews were conducted with nine nurses in primary health care in Sweden. Data were analysed using qualitative content analysis.
RESULTS: During the analysis phase, five subcategories and two main categories were identified. The two main categories were as follows: 'factors that influence nurses' opportunities of talking to patients about sexual health' and 'nurses' experiences of talking to patients about sexual health'. Social norms in society were an obstacle for health professionals' opportunities to feel comfortable and act professionally. The nurses' personal attitude and knowledge were of great significance in determining whether they brought up the topic of sexual health or not. The nurses found it easier to bring up the topic of sexual health with middle-aged men with, for example, diabetes. One reason for this is that they found it easier to talk to male patients. A further reason is the fact that they had received training in discussing matters of sexual health in relation to diabetes and other conditions affecting sexual health.
CONCLUSION: Nurses in primary care express the necessity of additional education and knowledge on the subject of sexual health. The healthcare organisation must be reformed to put focus on sexual health.
RELEVANCE FOR CLINICAL PRACTICE: Guidelines for addressing the topic of sexual health must be implemented to establish conditions that will increase nurse's knowledge and provide them with the necessary tools for discussing sexual health with patients.
PMID: 27324221 [PubMed - indexed for MEDLINE]
Preparing Student Nurses as Parent-based Adolescent Sexual Health Educators: Results of a Pilot Study.
Public Health Nurs. 2017 Mar;34(2):130-137
Authors: Santa Maria D, Markham C, Crandall S, Guilamo-Ramos V
OBJECTIVES: While health promotion and patient education are central to the scope of practice of professional nurses, they often feel ill-equipped to assume the role of sexual health educator and lack adequate knowledge and skills to effectively engage parents in adolescent sexual and reproductive health efforts.
DESIGN AND SAMPLE: Employing a mixed-methods study consisting of both pre- and post-test survey and exit interviews, a pilot study was conducted to assess the impact of implementing a parent-based adolescent sexual health intervention on baccalaureate nursing student outcomes (N = 31).
RESULTS: We found statistically significant improvements in student outcome expectancies of parenting strategies, barriers to sexual health communication, self-efficacy, and sexual health counseling experience. Using thematic content analysis of exit interview content, emerging themes were (1) need for increased sexual and reproductive health (SRH) preparation, (2) wanting greater experience and opportunity for involvement in nursing research, and (3) educational gaps in family-focused community public health.
CONCLUSIONS: Incorporating adolescent sexual health education into public health nursing clinical training can prepare nurses as parent-based adolescent sexual health educators, a core competency for nurses working with families in communities and across all health care delivery settings.
PMID: 27030387 [PubMed - indexed for MEDLINE]
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]