Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: a qualitative descriptive study.
J Clin Nurs. 2017 May;26(9-10):1385-1394
Authors: Girard A, Hudon C, Poitras ME, Roberge P, Chouinard MC
AIMS AND OBJECTIVES: To describe nursing activities in primary care with patients affected by physical chronic disease and common mental disorders.
BACKGROUND: Patients in primary care who are affected by physical chronic disease and common mental disorders such as anxiety and depression require care and follow-up based on their physical and mental health condition. Primary care nurses are increasingly expected to contribute to the care and follow-up of this growing clientele. However, little is known about the actual activities carried out by primary care nurses in providing this service in the Province of Quebec (Canada).
METHODS: A qualitative descriptive study was conducted. Data were obtained through semistructured individual interviews with 13 nurses practising among patients with physical chronic disease in seven Family Medicine Groups in Quebec (Canada).
RESULTS: Participants described five activity domains: assessment of physical and mental health condition, care planning, interprofessional collaboration, therapeutic relationship and health promotion.
CONCLUSION: The full potential of primary care nurses is not always exploited, and some activities could be improved. Evidence for including nurses in collaborative care for patients affected by physical chronic disease and common mental disorders has been shown but is not fully implemented in Family Medicine Groups. Future research should emphasise collaboration among mental health professionals, primary care nurses and family physicians in the care of patients with physical chronic disease and common mental disorders.
RELEVANCE TO CLINICAL PRACTICE: Primary care nurses would benefit from gaining more knowledge about common mental disorders and from identifying the resources they need to contribute to managing them in an interdisciplinary team.
PMID: 28000321 [PubMed - indexed for MEDLINE]
Interventions for prevention of bullying in the workplace.
Cochrane Database Syst Rev. 2017 01 30;1:CD009778
Authors: Gillen PA, Sinclair M, Kernohan WG, Begley CM, Luyben AG
BACKGROUND: Bullying has been identified as one of the leading workplace stressors, with adverse consequences for the individual employee, groups of employees, and whole organisations. Employees who have been bullied have lower levels of job satisfaction, higher levels of anxiety and depression, and are more likely to leave their place of work. Organisations face increased risk of skill depletion and absenteeism, leading to loss of profit, potential legal fees, and tribunal cases. It is unclear to what extent these risks can be addressed through interventions to prevent bullying.
OBJECTIVES: To explore the effectiveness of workplace interventions to prevent bullying in the workplace.
SEARCH METHODS: We searched: the Cochrane Work Group Trials Register (August 2014); Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2016, issue 1); PUBMED (1946 to January 2016); EMBASE (1980 to January 2016); PsycINFO (1967 to January 2016); Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus; 1937 to January 2016); International Bibliography of the Social Sciences (IBSS; 1951 to January 2016); Applied Social Sciences Index and Abstracts (ASSIA; 1987 to January 2016); ABI Global (earliest record to January 2016); Business Source Premier (BSP; earliest record to January 2016); OpenGrey (previously known as OpenSIGLE-System for Information on Grey Literature in Europe; 1980 to December 2014); and reference lists of articles.
SELECTION CRITERIA: Randomised and cluster-randomised controlled trials of employee-directed interventions, controlled before and after studies, and interrupted time-series studies of interventions of any type, aimed at preventing bullying in the workplace, targeted at an individual employee, a group of employees, or an organisation.
DATA COLLECTION AND ANALYSIS: Three authors independently screened and selected studies. We extracted data from included studies on victimisation, perpetration, and absenteeism associated with workplace bullying. We contacted study authors to gather additional data. We used the internal validity items from the Downs and Black quality assessment tool to evaluate included studies' risk of bias.
MAIN RESULTS: Five studies met the inclusion criteria. They had altogether 4116 participants. They were underpinned by theory and measured behaviour change in relation to bullying and related absenteeism. The included studies measured the effectiveness of interventions on the number of cases of self-reported bullying either as perpetrator or victim or both. Some studies referred to bullying using common synonyms such as mobbing and incivility and antonyms such as civility. Organisational/employer level interventionsTwo studies with 2969 participants found that the Civility, Respect, and Engagement in the Workforce (CREW) intervention produced a small increase in civility that translates to a 5% increase from baseline to follow-up, measured at 6 to 12 months (mean difference (MD) 0.17; 95% CI 0.07 to 0.28).One of the two studies reported that the CREW intervention produced a small decrease in supervisor incivility victimisation (MD -0.17; 95% CI -0.33 to -0.01) but not in co-worker incivility victimisation (MD -0.08; 95% CI -0.22 to 0.08) or in self-reported incivility perpetration (MD -0.05 95% CI -0.15 to 0.05). The study did find a decrease in the number of days absent during the previous month (MD -0.63; 95% CI -0.92 to -0.34) at 6-month follow-up. Individual/job interface level interventionsOne controlled before-after study with 49 participants compared expressive writing with a control writing exercise at two weeks follow-up. Participants in the intervention arm scored significantly lower on bullying measured as incivility perpetration (MD -3.52; 95% CI -6.24 to -0.80). There was no difference in bullying measured as incivility victimisation (MD -3.30 95% CI -6.89 to 0.29).One controlled before-after study with 60 employees who had learning disabilities compared a cognitive-behavioural intervention with no intervention. There was no significant difference in bullying victimisation after the intervention (risk ratio (RR) 0.55; 95% CI 0.24 to 1.25), or at the three-month follow-up (RR 0.49; 95% CI 0.21 to 1.15), nor was there a significant difference in bullying perpetration following the intervention (RR 0.64; 95% CI 0.27 to 1.54), or at the three-month follow-up (RR 0.69; 95% CI 0.26 to 1.81). Multilevel InterventionsA five-site cluster-RCT with 1041 participants compared the effectiveness of combinations of policy communication, stress management training, and negative behaviours awareness training. The authors reported that bullying victimisation did not change (13.6% before intervention and 14.3% following intervention). The authors reported insufficient data for us to conduct our own analysis.Due to high risk of bias and imprecision, we graded the evidence for all outcomes as very low quality.
AUTHORS' CONCLUSIONS: There is very low quality evidence that organisational and individual interventions may prevent bullying behaviours in the workplace. We need large well-designed controlled trials of bullying prevention interventions operating on the levels of society/policy, organisation/employer, job/task and individual/job interface. Future studies should employ validated and reliable outcome measures of bullying and a minimum of 6 months follow-up.
PMID: 28134445 [PubMed - indexed for MEDLINE]
Social Media and Population Health Virtual Exchange for Senior Nursing Students: An International Collaboration.
Stud Health Technol Inform. 2016;225:975-6
Authors: Procter PM, Brixey JJ, Honey ML, Todhunter F
The authors have all engaged in using social media with students as a means for collaboration across national and international boundaries for various educational purposes. Following the explosion of big data in health the authors are now moving this concept forward within undergraduate and postgraduate nursing curricula for the development of population health virtual exchanges. Nursing has a global presence and yet it appears as though students have little knowledge of the health and social care needs and provision outside their local environment. This development will allow for explorative exchange amongst students in three countries, enhancing their understanding of their own and the selected international population health needs and solutions through asking and responding to questions amongst the learning community involved. The connection of the students will be recorded for their use in reflection; of particular interest will be the use of information included by the students to answer questions about their locality.
PMID: 27332439 [PubMed - indexed for MEDLINE]
The New Issue of Social Media in Education and Health Behavior Change - Virtual Visit of Tele-Nursing.
Stud Health Technol Inform. 2016;225:625-6
Authors: Chen BL
Tele-Nursing is a kind of virtual visits, to our nursing professional developed as a new future, based on Who's policy that is to deal with nursing shortage in the worldwide. Then how to connect the clinical phenomena to synthesis concept is top urgent. The systemic review method and case manager interview to collect the clinical phenomena, the concepts analyzed by Norris Method to analyze the virtual visit. Finally the results of research finding were five categories which were available; security; science and technology derived consequences for nursing; to monitor quality of nursing care; support from social network. The Virtual Visit of Tele-Nursing's concept will be leading nursing knowledge to theory.
PMID: 27332282 [PubMed - indexed for MEDLINE]
Responding to the support needs of frontline public health nurses who work with vulnerable families and children: A qualitative study.
Contemp Nurse. 2017 May 13;:1-19
Authors: Austin J, Holt S
BACKGROUND: This paper reports on a research study to inform the development of a specialist role designed to lead and support front line public health nurses (PHNs) working with vulnerable families and at risk children in Ireland. PHNs in Ireland provide a programme of intervention that promotes optimum health and wellbeing for all children in their early years under the governance of the Health Service Executive. This universal access places the PHN as a central participant in the safeguarding of young children, particularly those working in disadvantaged communities where frequent exposure to difficult situations is a common factor.
AIMS: The aims of this study were to identify best practice, investigate the position of a leading role and to explore the implications of such change.
METHODS: This study was conducted using a qualitative research design to collect informative data through focus group and semi-structured individual interview formats. The sample of ten participants was purposively selected from line management in public health nursing, social work and a non-governmental children's organisation who work in some of the most disadvantaged areas in Dublin.
RESULTS: Supported by empirical evidence, findings from the data indicate that assistant directors of public health nursing with significant experience in child protection and welfare are in a key position to inform decisions pertaining to the provision of services for children.
CONCLUSION: This study concluded that access to support and appropriate supervision are fundamental resource requirements for PHNs who work with vulnerable families and at risk children. The study further recommended that the introduction of a specialist- leading role to support these public health nurses was essential to sustaining best practice.
PMID: 28504060 [PubMed - as supplied by publisher]
Nurse practitioners and intent to retire.
J Am Assoc Nurse Pract. 2017 Mar;29(3):130-135
Authors: Falk NL, Rudner N, Chapa D, Greene J
BACKGROUND AND PURPOSE: Demand for primary care services is rising. Nurse practitioners (NPs) serve vital roles in meeting primary care demands. Workforce planning requires understanding NP retirement intentions. This study examines factors that relate to NPs, aged 55 years and older, and their intent to retire within 5 years.
METHODS: We used the 2012 National Sample Survey of Nurse Practitioners to examine the relationship between NP demographic characteristics (gender, race/ethnicity, marital status, nursing degree), work environment characteristics (part-time vs. full-time status, primary or specialty care, earnings, job satisfaction), and intent to retire. Descriptive, bivariate, and multivariate analyses were conducted. A total of 3171 working NPs, 55 years of age and older, were included.
CONCLUSIONS: Fifty-nine percent of NPs 60 years and older and 15% of NPs 55-59 intend to retire in the next 5 years. Working part-time and having less than a master's degree were associated with intent to retire. Being "very satisfied" with one's job was related to lower odds of intent to retire versus being "satisfied." Being "dissatisfied" with one's job and working in primary care were related to intending to retire for the NPs 55-59.
IMPLICATIONS FOR PRACTICE: Given the relationship between higher job satisfaction and lower intent to retire, efforts to increase NPs' job satisfaction may result in less early retirement.
PMID: 27717220 [PubMed - indexed for MEDLINE]
Professional online community membership and participation among healthcare providers: An extension to nurse practitioners and physician assistants.
J Am Assoc Nurse Pract. 2016 Dec;28(12):639-645
Authors: Betts KR, O'Donoghue AC, Aikin KJ, Kelly BJ, Boudewyns V
BACKGROUND AND PURPOSE: Professional online communities allow healthcare providers to exchange ideas with their colleagues about best practices for patient care. Research on this topic has focused almost exclusively on primary care physicians and specialists, to the exclusion of advanced practice providers such as nurse practitioners and physician assistants. We expand this literature by examining membership and participation on these websites among each of these provider groups.
METHODS: Participants (N = 2008; approximately 500 per provider group) responded to an Internet-based survey in which they were asked if they use professional online communities to dialogue with colleagues and if so, what their motivation is for doing so.
CONCLUSIONS: Nearly half of the participants in our sample reported utilizing professional online communities. Select differences were observed between provider groups, but overall, similar patterns emerged in their membership and participation on these websites.
IMPLICATIONS FOR PRACTICE: Nurse practitioners and physician assistants utilize professional online communities in similar proportion to primary care physicians and specialists. Providers should be cognizant of the impact this use may have for both themselves and their patients. Researchers are urged to take into account the various professional roles within the healthcare community while developing research on this topic.
PMID: 27214569 [PubMed - indexed for MEDLINE]
Using Education Technology as a Proactive Approach to Healthy Ageing.
Stud Health Technol Inform. 2016;225:193-7
Authors: Rodger D, Spencer A, Hussey P
Bone Health in the Park was created in Ireland and is an online health promotion education resource focussing on bone health, healthy ageing and falls prevention. The programme was designed by an Advanced Nurse Practitioner in collaboration with an Education Technologist and primarily uses storytelling to promote education specifically on bone health and falls risk prevention for health care professionals, clients, families and informal carers. This paper reports on core deliverables from this programme from 2010 to 2015, and provides insight into their development, in addition to details on its clinical effectiveness by using technology enhanced learning to underpin health promotion initiatives.
PMID: 27332189 [PubMed - indexed for MEDLINE]
Glycemic control: Can nurse practitioners on interprofessional collaborative practice teams enhance clinical outcomes?
J Am Assoc Nurse Pract. 2016 Dec;28(12):652-658
Authors: Parker RA, Hook LD, Jones ME
BACKGROUND AND PURPOSE: Care coordination and specialized knowledge of prescriptive authority are fundamental to advanced nursing practice. Little research documents patient clinical outcomes in primary care when nurse practitioners are members of an interprofessional education and collaborative practice (IPECP) team. This cross-sectional study examined differences in glycemic control among Texas patients who received care by a Family Nurse Practitioner (FNP) and an IPECP team in one calendar year.
METHODS: A convenience sample of 120 adult volunteers with diabetes was followed in a community-based clinic by an FNP; of these, 34 received additional care by an IPECP team. Data on selected demographic indices and HgbA1c were derived from the health center's Electronic Medical Record using a retrospective review, and linkage with the federally funded IPECP Project database.
CONCLUSIONS: Patients with two or more FNP visits and two or more visits with the IPECP team had statistically significant reductions in HgbA1c levels at the end of 1 year.
IMPLICATIONS FOR PRACTICE: Actualizing point-of-care treatment adjustments is a particular strength of advanced practice nurses but potentially a missed opportunity on interprofessional teams. Further study is needed on clinical outcomes of nurse practitioner contributions to IPECP team care.
PMID: 27479873 [PubMed - indexed for MEDLINE]
Transition Program to Promote Incoming Nursing Student Success in Higher Education.
Nurse Educ. 2016 Nov/Dec;41(6):319-323
Authors: Latham CL, Singh H, Lim C, Nguyen E, Tara S
A new model for addressing first-generation and minority student issues when starting nursing school was implemented using an interactive, peer-developed, 2-day program to create a sense of community and relieve anxiety. The program focused on students' needs, engagement, networking, first-hand experience with resources and methods to reduce cultural dissonance. Participation included critiquing modeling of proper clinical attire, meeting with peer mentors, and locating important campus resources. The program, conducted by minority students under the supervision and guidance of faculty mentors, received excellent evaluations.
PMID: 27022684 [PubMed - indexed for MEDLINE]
Review of the International Council of Nurses (ICN) Framework of Disaster Nursing Competencies.
Prehosp Disaster Med. 2016 Dec;31(6):680-683
Authors: Hutton A, Veenema TG, Gebbie K
The International Council of Nurses (ICN; Geneva, Switzerland) and the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) joined together in 2014 to review the use of the ICN Framework of Disaster Nursing Competencies. The existing ICN Framework (version 1.10; dated 2009) formed the starting point for this review. The key target audiences for this process were members of the disaster nursing community concerned with pre-service education for professional nursing and the continuing education of practicing professional nurses. To minimize risk in the disaster nursing practice, competencies have been identified as the foundation of evidence-based practice and standard development. A Steering Committee was established by the WADEM Nursing Section to discuss how to initiate a review of the ICN Framework of Disaster Nursing Competencies. The Steering Committee then worked via email to develop a survey to send out to disaster/emergency groups that may have nurse members who work/respond in disasters. Thirty-five invitations were sent out with 20 responses (57%) received. Ninety-five percent of respondents knew of the ICN Framework of Disaster Nursing Competencies, with the majority accessing these competencies via the Internet. The majority of those who responded said that they make use of the ICN Framework of Disaster Nursing Competencies with the most common use being for educational purposes. Education was done at a local, national, and international level. The competencies were held in high esteem and valued by these organizations as the cornerstone of their disaster education, and also were used for the continued professional development of disaster nursing. However, respondents stated that five years on from their development, the competencies also should include the psychosocial elements of nurses caring for themselves and their colleagues. Additionally, further studies should explore if there are other areas related to the disaster nursing practice (in addition to psychosocial concerns) that may be missing or not fully developed. Finally, the authors of this report recommend that future research explore how the ICN Framework of Disaster Nursing Competencies do or do not assist in maintaining best practices in this field and improve outcomes for victims of disaster. Hutton A , Veenema TG , Gebbie K . Review of the International Council of Nurses (ICN) Framework of Disaster Nursing Competencies. Prehosp Disaster Med. 2016;31(6):680-683.
PMID: 27646611 [PubMed - indexed for MEDLINE]
Evaluation of ConPrim: A three-part model for continuing education in primary health care.
Nurse Educ Today. 2016 Nov;46:115-120
Authors: Berggren E, Strang P, Orrevall Y, Ödlund Olin A, Sandelowsky H, Törnkvist L
BACKGROUND: To overcome the gap between existing knowledge and the application of this knowledge in practice, a three-part continuing educational model for primary health care professionals (ConPrim) was developed. It includes a web-based program, a practical exercise and a case seminar.
AIM: To evaluate professionals' perceptions of the design, pedagogy and adaptation to primary health care of the ConPrim continuing educational model as applied in a subject-specific intervention.
METHODS: A total of 67 professionals (nurses and physicians) completed a computer-based questionnaire evaluating the model's design, pedagogy and adaptation to primary health care one week after the intervention. Descriptive statistics were used.
RESULTS: Over 90% found the design of the web-based program and case seminar attractive; 86% found the design of the practical exercise attractive. The professionals agreed that the time spent on two of the three parts was acceptable. The exception was the practical exercise: 32% did not fully agree. Approximately 90% agreed that the contents of all parts were relevant to their work and promoted interactive and interprofessional learning. In response to the statements about the intervention as whole, approximately 90% agreed that the intervention was suitable to primary health care, that it had increased their competence in the subject area, and that they would be able to use what they had learned in their work.
CONCLUSIONS: ConPrim is a promising model for continuing educational interventions in primary health care. However, the time spent on the practical exercise should be adjusted and the instructions for the exercise clarified. ConPrim should be tested in other subject-specific interventions and its influence on clinical practice should be evaluated.
PMID: 27621201 [PubMed - indexed for MEDLINE]
Participants' perceptions of an intervention implemented in an Action Research Nursing Documentation Project.
J Clin Nurs. 2017 Apr;26(7-8):983-993
Authors: Vabo G, Slettebø Å, Fossum M
AIMS AND OBJECTIVES: The aim of this study is to describe healthcare professionals' experiences and perceptions of an intervention implemented in an action research project conducted to improve nursing documentation practices in four municipalities in Norway.
BACKGROUND: Documentation of individualized patient care is a continuing concern in healthcare services and could impacts the quality and safety of healthcare. Use of electronic systems has made some aspects of documentation more comprehensive, but creation of an individualized care plan remains a pressing issue.
DESIGN: A qualitative descriptive design was used.
METHODS: An action research project was conducted between 2010-2012 to improve the content and quality of nursing documentation in community healthcare services in four municipalities. One year after the project was completed four focus group interviews were conducted with healthcare professionals, one for each involved municipality. Two unit managers were interviewed individually. Qualitative content analysis was used.
RESULTS: Three themes emerged: healthcare professionals perceived competing interest; they experienced that they had to manage complexity and changes; and they highlighted a clear and visible leader as important for success.
CONCLUSIONS: Quality improvement activities are essential. Healthcare professionals experience a complicated situation when electronic health record systems do not support workflow. Further research is recommended to focus on the functionality and user interface of electronic health record systems, and on the role of leadership when implementing changes in clinical practice.
RELEVANCE TO CLINICAL PRACTICE: Stronger cooperation among policymakers, electronic health record system vendors, and healthcare professionals is essential for improving electronic health record systems and documentation practices. Involvement of end-users in these improvements can make a difference in the way the systems are perceived in the clinical workflow.
PMID: 27192412 [PubMed - indexed for MEDLINE]
Healthcare students as innovative partners in the development of future healthcare services: An action research approach.
Nurse Educ Today. 2016 Nov;46:4-9
Authors: Norbye B
BACKGROUND: Health care systems in Norway and the western world have experienced extensive changes due to patients living longer with complex conditions that require coordinated care. A Norwegian healthcare reform has led to significant restructuring in service delivery as a devolution of services to municipalities.
ACTION RESEARCH DESIGN: Partners from three rural healthcare services, students from four professional programmes, and one lecturer from each of the professional programmes used a collaborative approach to obtain new knowledge through interprofessional practice. Using an action research design, the research group facilitated democratic processes through dialogues with healthcare services and students. The design is visualised as a cyclical process in which each cycle contributes to improvements, innovations, and increased understanding. A total of 32 students and 3 supervisors were interviewed before and after the clinical practice experiences. Fieldwork was conducted during three clinical periods.
FINDINGS: Inter-professional student groups formed small healthcare teams and assessed patients with chronic and long-term conditions. Students prepared and negotiated patient follow-up. The teams' responsibilities led to reflective practices that enhanced their professional knowledge. The teams achieved a new understanding of patient situations, which influenced "second opinions" for patients with complex conditions and led to innovative practices. The change in perception of patient needs led to a changed professional approach. The students' perceptions changed as they learned from and about each other and in collaboration with the health service; this led to more coordinated care of patients with complex conditions. Inter-professional learning in community settings provided a platform to improve both healthcare education and rural healthcare services.
CONCLUSION: This research contributes to knowledge of how students' placement in inter-professional teams can enhance students learning from, with and about each other. The student teams promoted new ways of approaching and delivering complex patient treatment and care in community healthcare service. Collaborative partnerships in inter-professional learning have potential in the wider international arena as a means for practice improvement.
PMID: 27427864 [PubMed - indexed for MEDLINE]
Using blogs for facilitating and connecting nurse educator candidates.
Nurse Educ Today. 2016 Oct;45:35-41
Authors: Papastavrou E, Hamari L, Fuster P, Istomina N, Salminen L
BACKGROUND: Social media includes blog applications, which can be used as online journals or diaries that encourages interaction and collaboration within an online community. The aim of this study was to explore and describe the use of blog writing as learning journals during a short course for nurse educator candidates about social media.
METHOD: A qualitative descriptive design was used. The participants were nurses, Bachelor, Master's and Doctoral students who intended to follow a career in education (N=24, female n=21, male n=3, Mean age 37) from four different countries of the European Union. The blogs written during the course were used as a data collection method and the data was analyzed with qualitative content analysis.
RESULTS: A total of 260 blogger posts and 372 peer comments were analyzed. Four main categories emerged from the analysis: 1) Course content, new knowledge, and changed views, 2) Reflection and critical thinking, 3) Encouraging and peer support and 4) Expressing feelings, experiences, and expectations.
CONCLUSION: Blogs are potential learning spaces in short courses in nurse educator education, especially in sharing feelings and experiences, enhancing an encouraging atmosphere, critical thinking, and reflection.
PMID: 27429401 [PubMed - indexed for MEDLINE]
Impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults: A Quasi-experimental study.
Nurse Educ Today. 2016 Nov;46:17-23
Authors: Koehler AR, Davies S, Smith LR, Hooks T, Schanke H, Loeffler A, Carr C, Ratzlaff N
BACKGROUND: With an aging population, it is critical that nurses are educated and prepared to offer quality healthcare to this client group. Incorporating gerontology content into nursing curricula and addressing students' perceptions and career choices in relation to working with older adults are important faculty concerns.
OBJECTIVES: To examine the impact of a stand-alone course in gerontological nursing on undergraduate nursing students' perceptions of working with older adults and career intentions.
DESIGN: Quasi-experimental, pre- and post-test design.
SETTING: Medium-sized state university in the Mid Western United States PARTICIPANTS: Data were collected from three student cohorts during the spring semesters of 2012 (n=98), 2013 (n=80) and 2014 (n=88) for a total of N=266 with an average response rate of 85%.
METHODS: A survey instrument was administered via Qualtrics and completed by students prior to, and following completion of the course.
RESULTS: There was an overall significant increase (p=0.000) in positive perceptions of working with older adults among nursing students following completion of the course. The majority of participants (83.5%) reported having previous experience with older adults. Those with previous experience had higher perception scores at pre-test than those without (p=0.000). Post-test scores showed no significant difference between these two groups, with both groups having increased perception scores (p=0.120). Student preferences for working with different age groups suggested an overall increase in preference for working with older adults following the course.
CONCLUSIONS: A course in gerontological nursing, incorporating learning partnerships with community dwelling older adults, promotes positive perceptions of working with older adults, independently of the quality of prior experience. There was some evidence that students changed their preferences of working with different age groups in favor of working with older adults. Further research should be conducted to determine the mechanisms through which this takes place.
PMID: 27475123 [PubMed - indexed for MEDLINE]
The impact of educational experiences on nursing students' knowledge and attitudes toward people with Alzheimer's disease: A mixed method study.
Nurse Educ Today. 2016 Nov;46:57-63
Authors: Kimzey M, Mastel-Smith B, Alfred D
BACKGROUND: As the population ages, the effects of Alzheimer's disease will be felt by all nurses. Providing proper care for people with Alzheimer's disease is difficult and requires specific skills, attitudes, and knowledge. Limited data exists regarding nursing students' attitudes and knowledge toward people with Alzheimer's disease, whether undergraduate education prepares students to care for this population, or the best methods to support students in learning in an innovative and interactive environment.
OBJECTIVES: The aim of this study was to determine the effect of different educational experiences on nursing students' knowledge and attitudes toward people with Alzheimer's disease and to explore nursing students' knowledge and attitudes surrounding the care of people with Alzheimer's disease.
DESIGN: A convergent mixed method design. A three group (Alzheimer's disease clinical experience, online learning module, and no dementia-specific intervention), pretest and posttest design served as the quantitative arm of the study. A focus group discussion with themes extracted served as the qualitative piece of the study.
SETTING: College of Nursing in North Texas.
PARTICIPANTS: Convenience sample of 94 senior level nursing students enrolled in the undergraduate nursing program's Community Health course.
METHOD: Students completed pre and posttest surveys which included Alzheimer's Disease Knowledge Scale, Dementia Attitudes Scale, and demographic questionnaire. Content analysis was conducted on focus group responses to qualitative interview questions.
RESULTS: The Alzheimer's disease clinical group experienced increased knowledge and improved attitudes toward people with Alzheimer's disease compared with students who completed the online module or had no dementia-specific intervention. Four themes emerged from focus group data: Basic Alzheimer's disease knowledge, need for Alzheimer's disease experiential learning, negative feelings related to behaviors, and appropriate responses to behavioral and psychological symptoms of dementia.
CONCLUSION: Experiential learning in the form of clinical placements increased knowledge and improved attitudes about Alzheimer's disease compared with an online module and no dementia-specific intervention.
PMID: 27598794 [PubMed - indexed for MEDLINE]
A pilot study exploring the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life and wellbeing among UK community nurses.
Nurse Educ Today. 2016 Nov;46:109-114
Authors: Durkin M, Beaumont E, Hollins Martin CJ, Carson J
BACKGROUND: Compassion fatigue and burnout can impact on performance of nurses. This paper explores the relationship between self-compassion, self-judgement, self-kindness, compassion, professional quality of life, and wellbeing among community nurses.
AIM: To measure associations between self-compassion, compassion fatigue, wellbeing, and burnout in community nurses.
METHOD: Quantitative data were collected using standardised psychometric questionnaires: (1) Professional Quality of Life Scale; (2) Self-Compassion Scale; (3) short Warwick Edinburgh Mental Wellbeing Scale; (4) Compassion For Others Scale, used to measure relationships between self-compassion, compassion fatigue, wellbeing, and burnout.
PARTICIPANTS: A cross sectional sample of registered community nurses (n=37) studying for a postgraduate diploma at a University in the North of England took part in this study.
RESULTS: Results show that community nurses who score high on measures of self-compassion and wellbeing, also report less burnout. Greater compassion satisfaction was also positively associated with compassion for others, and wellbeing, whilst also being negatively correlated with burnout.
CONCLUSION: High levels of self-compassion were linked with lower levels of burnout. Furthermore when community nurses have greater compassion satisfaction they also report more compassion for others, increased wellbeing, and less burnout. The implications of this are discussed alongside suggestions for the promotion of greater compassion.
PMID: 27621200 [PubMed - indexed for MEDLINE]
Predictors of cultural competence among nursing students in the Philippines: A cross-sectional study.
Nurse Educ Today. 2016 Nov;46:121-126
Authors: Cruz JP, Estacio JC, Bagtang CE, Colet PC
BACKGROUND: With the continued emigration of Filipino nurses and increasing globalization, there is a need for globally competent nurses. Thus, the development of cultural competence among nursing students is critical in their preparation to assume their future responsibilities in the profession.
OBJECTIVES: This study investigated the predictors of cultural competence among nursing students in the Philippines.
DESIGN: This is a descriptive, cross-section study.
PARTICIPANTS AND SETTING: This study included 332 Bachelor of Science in nursing students in three nursing schools situated in the northern Philippines.
METHODS: The Cultural Capacity Scale was used to gather data from the respondents. The demographic characteristics and cultural background of the students were entered in a regression analysis to predict their cultural competence.
FINDINGS: The respondents manifested appreciably good cultural competence with a mean score of 68.98±11.73. The ability to understand the beliefs of various cultural groups received the highest mean of 3.65±0.86, while the ability to identify the care needs of patients with diverse cultural backgrounds received the lowest (mean, 3.31±0.74). Living in an environment with culturally diverse people, prior diversity training, being in the latter years of the nursing program, and with experience of caring for patients from diverse cultures and special population groups, were identified as predictors, accounting for 68.1% of the variance of cultural competence.
CONCLUSIONS: Nursing education should devise strategies to ensure future culturally competent Filipino nurses. Considering the fact that most of the Filipino nurses will potentially work overseas, they should be well prepared to provide competent care that is culturally sensitive.
PMID: 27636832 [PubMed - indexed for MEDLINE]
Augmented Nurse Care Management in CKD Stages 4 to 5: A Randomized Trial.
Am J Kidney Dis. 2017 Apr 07;:
Authors: Fishbane S, Agoritsas S, Bellucci A, Halinski C, Shah HH, Sakhiya V, Balsam L
BACKGROUND: Outcomes for patients with late-stage chronic kidney disease (CKD) in the United States are suboptimal. There is poor education and preparation for end-stage kidney disease, as well as a high rate of hospitalization in this group of patients.
STUDY DESIGN: A randomized, parallel-group, 2-arm, controlled trial.
SETTING & PARTICIPANTS: The study was conducted at 3 sites: a clinic of an academic medical center, a public hospital academic clinic, and a community-based private practice. All participants had late-stage CKD (stages 4-5 CKD). Patients were excluded only if they had significant cognitive impairment.
INTERVENTION: The care management intervention involved nurse care manager coordination aided by the use of a disease-based informatics system for monitoring patients' clinical status, enhancing CKD education, and facilitating preparation for end-stage kidney disease. The comparison control group received usual late-stage CKD care alone.
OUTCOMES: The primary outcome was rate of hospitalization.
MEASUREMENTS: Rates of preemptive transplantation, home dialysis, hemodialysis (HD) starts without a hospitalization, and HD therapy initiation rates with catheters or with functioning accesses.
RESULTS: 130 patients were randomly assigned. The hospitalization rate was significantly lower in the intervention group versus controls: 0.61 versus 0.92 per year, respectively (incidence rate ratio, 0.66; 95% CI, 0.43-0.99; P=0.04). Peritoneal dialysis or preemptive transplantation was the initial end-stage kidney disease treatment in 11 of 30 (37%) participants receiving the intervention versus 3 of 29 (10%) receiving usual care. Among HD starts, treatment was initiated without hospitalization in 11 of 19 (58%) participants in the intervention group versus 6 of 26 (23%) in the control group. At the time of HD therapy initiation, a catheter was present in 7 of 19 (37%) participants in the intervention group versus 18 of 26 (69%) in the control group. A functioning arteriovenous access was in place in 10 of 19 (53%) participants in the intervention group and 7 of 26 (27%) in the control group LIMITATIONS: Moderate sample size, limited geographic scope.
CONCLUSIONS: The augmented nurse care management intervention resulted in reduced hospitalizations in late-stage CKD and there were suggestions of improved end-stage kidney disease preparation. Given suboptimal outcomes in late-stage CKD, care management interventions could potentially improve patient outcomes.
PMID: 28396108 [PubMed - as supplied by publisher]
Prison nursing and its training.
Rev Esp Sanid Penit. 2016 Dec;18(3):110-118
Authors: Sánchez-Roig M, Coll-Cámara A
The main task of nurses is to take care of sick and healthy people and evaluate changes in their health conditions. The goal is to take the appropriate measures to help their recovery or guarantee a dignified death, and if possible, help them regain autonomy and independence. Nursing is present in different areas: primary health, mental health, accident and emergencies, intensive and coronary care, surgical care, paediatrics, geriatrics, public health, occupational health, teaching, etc. In our case, prison nursing, one of the least known branches of the profession, we wanted to investigate more deeply the work of nurses in prisons, which aspect of health care they are responsible for and to what type of population they are geared towards, as well as the necessary training to be able to work in such a particular environment. To conclude, we have seen that university degrees in general nursing do not include knowledge in this area, and that authors from different countries support the specialization of prison nursing and the need for nurses to be trained according to the health conditions of inmates and the characteristics of prisons.
PMID: 27831598 [PubMed - indexed for MEDLINE]
Clinical and cost effectiveness of nurse-led self-management interventions for patients with copd in primary care: A systematic review.
Int J Nurs Stud. 2017 Mar 31;71:125-138
Authors: Baker E, Fatoye F
BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease is increasing in prevalence and constitutes a major cause of morbidity and mortality globally. As well as contributing to a significant decline in health status in many patients, this condition creates a considerable burden on healthcare providers. Self-management interventions are frequently implemented in community settings to limit the impact of chronic obstructive pulmonary disease on everyday life of individuals and to manage pressure on health systems. Nurses are the most likely professional group to provide self-management support. This systematic review aims to evaluate the clinical and cost effectiveness of nurse-led self-management for patients with chronic obstructive pulmonary disease in primary care.
DESIGN: A systematic review was conducted to identify randomized controlled studies comparing nurse-led self-management interventions to usual care DATA SOURCES: Seven electronic databases, including British Nursing Index, MEDLINE, CINAHL, AMED, EMBASE, Cochrane Library and NHS Economic Evaluation Database, were searched for relevant studies.
REVIEW METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to guide the structure of the review. The relevance of citations was assessed based on inclusion criteria, with full texts retrieved as required to reach a decision. Data extraction was performed independently by two reviewers. The Cochrane risk of bias tool was used to undertake a quality review. A narrative summary method was used to describe review findings.
RESULTS: Twenty-six articles describing 20 randomised controlled trials were included in the analysis. Self-management interventions were heterogeneous, with a variable number of components, level of support, mode of delivery and length of follow up. The review demonstrated that nurse-led self-management programmes may be associated with reductions in anxiety and unscheduled physician visits and increases in self-efficacy, but definitive conclusions could not be reached. Few studies addressed economic outcomes and the diverse perspectives, time frames and settings made comparisons difficult. Evidence on cost-effectiveness was inconclusive.
CONCLUSIONS: Some nurse-led self-management programmes in this systematic review produced beneficial effects in terms of reducing unscheduled physician visits, lowering patients' anxiety and increasing self-efficacy, but there is insufficient evidence to reach firm conclusions on the clinical or cost-effectiveness of the interventions. Further research should aim to identify the optimal components of these programmes and to identify those patients most likely to benefit. The inclusion of economic analyses in future studies would facilitate decisions by policy makers on the implementation of self-management interventions.
PMID: 28399427 [PubMed - as supplied by publisher]
Characteristics of Nurse Directors That Contribute to Registered Nurse Satisfaction.
J Nurs Adm. 2017 Apr;47(4):219-225
Authors: Burke D, Flanagan J, Ditomassi M, Hickey PA
OBJECTIVE: The aim of this study was to explore RNs and nurse directors' (NDs') perceptions of leadership on units with high RN satisfaction scores.
BACKGROUND: Identifying the characteristics of NDs that contribute to RN satisfaction is important in the recruitment and retention of RNs and in the selection and role development of NDs.
METHODS: This study used a qualitative design using appreciative inquiry-guided data collection.
RESULTS: Nine RNs and 9 NDs met the inclusion criteria. Each group identified 4 themes.
CONCLUSIONS: Registered nurse and ND participants identified similar themes representative of leadership attributes and behaviors that contribute to RN satisfaction.
PMID: 28333790 [PubMed - indexed for MEDLINE]
Impact of Participation in Community-Based Research Among Undergraduate and Graduate Students.
J Allied Health. 2017;46(1):e15-e24
Authors: George CL, Wood-Kanupka J, Oriel KN
Participation in community-based research provides college students with a high-impact experience involving both research and service learning. Presently, the impact of participation in community-based research projects has been measured most often through the use of post-learning course evaluations and case studies. The authors describe the impact of participation in community-based research, at a small liberal arts college, on undergraduate education students and graduate physical therapy students using the Community-Based Research Student Learning Outcomes Survey. Results from 2 years of survey responses and open-ended responses suggest that participation in such an experience may impact professional and personal growth, educational experiences, and civic engagement. This study provides support for universities and colleges to continue offering high-impact learning experiences for students by utilizing community-based research experiences while collaborating between academic departments.
PMID: 28255600 [PubMed - indexed for MEDLINE]
Exploring healthcare assistants' role and experience in pain assessment and management for people with advanced dementia towards the end of life: a qualitative study.
BMC Palliat Care. 2017 Jan 19;16(1):6
Authors: Jansen BW, Brazil K, Passmore P, Buchanan H, Maxwell D, McIlfatrick SJ, Morgan SM, Watson M, Parsons C
BACKGROUND: Pain assessment and management are key aspects in the care of people with dementia approaching the end of life but become challenging when patient self-report is impaired or unavailable. Best practice recommends the use of observational pain assessments for these patients; however, difficulties have been documented with health professionals' use of these tools in the absence of additional collateral patient knowledge. No studies have explored the role, perspectives and experiences of healthcare assistants in pain assessment and management in dementia; this study provides insight into this important area.
METHODS: A qualitative approach was adopted, using key informant interviews with healthcare assistants caring for people with advanced dementia approaching the end of life in hospice, nursing home and acute care settings. Thematic analysis was the analytic approach taken to interpretation of interview data. Data were collected between June 2014 and September 2015.
RESULTS: Fourteen participants took part in the study. Participants' average length of caring experience was 15.4 years and most were female. Three key themes emerged: recognising pain, reporting pain, and upskilling. Participants were often the first to notice obvious causes of pain and to detect changes in patient norms which signified hidden causes of pain. Comprehensive knowledge of resident norms enabled participants to observe for behavioural and nonverbal indicators of pain and distinguish these from non-pain related behaviours. Pain reporting was heavily impacted by relationships with professional staff and the extent to which participants felt valued in their role. Positive relationships resulted in comprehensive pain reports; negative relationships led to perfunctory or ambiguous reporting. Participants emphasised a desire for further training and upskilling, including in the use and reporting of basic pain tools.
CONCLUSIONS: Healthcare assistants are frontline staff who have a key role in direct patient care, spending a considerable amount of time with patients in comparison to other health professionals. These staff are often first to notice changes in patients that may signify pain and to alert professional staff. However, to ensure the quality of these reports, further efforts must be made in reversing stigma attached to this role and in upskilling these members of the healthcare team.
PMID: 28103847 [PubMed - indexed for MEDLINE]
Developing an outcomes framework for the dietetic service.
Br J Community Nurs. 2016 Dec 02;21(12):599-605
Authors: Prendiville V
Demonstrating our value as individual practitioners and services is a key priority. Developing robust process and outcome measures supports us to achieve this. Outcomes also enable us to provide the highest level of patient-centred care by helping us to re-model the relationship between user and provider through capturing and using patient-related experience and outcome measures to inform service development. This article discusses our journey as a dietetic service in developing and implementing an outcomes framework utilising quality improvement methodology. This work was undertaken as part of a Silver 'Improving Quality Together' (IQT) project, a 1000 Lives initiative ( NHS Wales, 2013 ). Find out more about improving quality together at www.IQT.wales.nhs.uk .
PMID: 27922778 [PubMed - indexed for MEDLINE]
Nursing home nurses' and community-dwelling older adults' reported knowledge, attitudes, and behavior toward antibiotic use.
BMC Nurs. 2017;16:12
Authors: Kistler CE, Beeber A, Becker-Dreps S, Ward K, Meade M, Ross B, Sloane PD
BACKGROUND: Antibiotic overuse causes antibiotic resistance, one of the most important threats to human health. Older adults, particularly those in nursing homes, often receive antibiotics when they are not indicated.
METHODS: To understand knowledge, attitudes, and behaviors of nursing home (NH) nurses and community-dwelling older adults towards antibiotic use, especially in clinical situations consistent with antibiotic overuse, we conducted a mixed-method survey in two NHs and one Family Medicine clinic in North Carolina, among English-speaking nurses and community-dwelling, cognitively intact adults aged 65 years or older. Based on the Knowledge-Attitude-Practice model, the survey assessed knowledge, attitudes, and behavior towards antibiotic use, including three vignettes designed to elicit possible antibiotic overuse: asymptomatic bacteriuria (ASB), a viral upper respiratory illness (URI), and a wound from a fall.
RESULTS: Of 31 NH nurses and 66 community-dwelling older adults, 70% reported knowledge of the dangers of taking antibiotics. Nurses more often reported evidence-based attitudes towards antibiotics than older adults, except 39% agreed with the statement "by the time I am sick enough to go to the doctor with a cold, I expect an antibiotic", while only 28% of older adults agreed with it. A majority of nurses did not see the need for antibiotics in any of the three vignettes: 77% for the ASB vignette, 87% for the URI vignette, and 97% for the wound vignette. Among older adults, 50% did not perceive a need for antibiotics in the ASB vignette, 58% in the URI vignette, and 74% in the wound vignette.
CONCLUSIONS: While a substantial minority had no knowledge of the dangers of antibiotic use, non-evidence-based attitudes towards antibiotics, and behaviors indicating inappropriate management of suspected infections, most NH nurses and community-dwelling older adults know the harms of antibiotic use and demonstrate evidence-based attitudes and behaviors. However, more work is needed to improve the knowledge, attitudes and behaviors that may contribute to antibiotic overuse.
PMID: 28293145 [PubMed]
Two Essential Roles: Health Care Network Nurse Leaders and Local Nurse Leaders.
Nurs Adm Q. 2016 Oct-Dec;40(4):312-5
Authors: Schneider M
American health care organizations are experiencing increasing change driven by emerging partnerships, market demographics, population health initiatives, and merger and acquisition trends. The health care business environment necessitates alterations in how companies operate on a larger scale. New regional leadership roles are being created to provide leadership to systematize networks, build market share, and strengthen market needs. It is important and necessary to explore, review, and contrast the roles, skills, and behaviors of regional leader's roles and the solo organization leaders. It is also imperative to review the benefits of new affiliations for the community and hospital entity.
PMID: 27584890 [PubMed - indexed for MEDLINE]
Gendering Guilt among Dependent Family Members' Caregivers.
Span J Psychol. 2016 Nov 17;19:E80
Authors: Brea MT, Albar MJ, Casado-Mejia R
This study analyzes guilt among family caregivers of dependent patients, from a gender perspective. A qualitative design was used, conducting in-depth interviews and focus groups. Using purposive sampling, we selected 73 family caregivers and 23 health professionals (family medicine, community nursing, and social work) from the Primary Care District of Seville. The content of the information collected was analyzed in terms of the following categories: a) guilt for abandoning family and friends; b) guilt for the relationship with the dependent person; and c) guilt for placing the relative in a nursing home. To validate the findings, data sources, methodological techniques, and researchers' disciplines were all triangulated. Results indicated that women report more guilt than men for abandoning family and friends, and because of their relationship with the dependent person. However, with respect to nursing home placement, no difference was observed as a function of gender. The high incidence of caregiver guilt needs to be addressed by health professionals to avoid the emergence of other mental health issues.
PMID: 27852347 [PubMed - indexed for MEDLINE]
Community nurse's knowledge, confidence and experience of the Mental Capacity Act in practice.
Br J Community Nurs. 2016 Dec 02;21(12):615-622
Authors: Marshall H, Sprung S
The Mental Capacity Act (MCA) is statutory legislation introduced in 2007 to protect and empower people to make decisions for themselves and those who were deemed as unable to make choices would have decisions made on their behalf, often by health professionals. All health professionals must follow the guiding principles of this legislation. Yet a scrutiny report by the House of Lords concluded this legislation was under-used with a lack of knowledge among professionals regarding applying the legislation in practice. A review of the literature also supports these findings. A mixed method study was carried out among adult community nurses to explore if these findings were applicable within a health trust in the North West region. An electronic questionnaire (n=60), focus group (n=7) and a paired interview (n=2) were utilised to collect data regarding community nurse's experience and confidence of using the MCA in practice. Analysis identified key themes: training, knowledge and confidence among staff, working together with the wider multidisciplinary team, empowerment and improving documentation. While findings suggest clear examples of self-appraised confidence and excellent patient care, there is also scope for development regarding the knowledge and utilisation of the MCA in the clinical practice of community nurses.
PMID: 27922781 [PubMed - indexed for MEDLINE]
Simulation in undergraduate paediatric nursing curriculum: Evaluation of a complex 'ward for a day' education program.
Nurse Educ Pract. 2017 Feb 04;23:40-47
Authors: Gamble AS
Simulation in health education has been shown to increase confidence, psychomotor and professional skills, and thus positively impact on student preparedness for clinical placement. It is recognised as a valuable tool to expose and engage students in realistic patient care encounters without the potential to cause patient harm. Although inherent challenges exist in the development and implementation of simulation, variability in clinical placement time, availability and quality dictates the need to provide students with learning opportunities they may otherwise not experience. With this, and a myriad of other issues providing the impetus for improved clinical preparation, 28 final semester undergraduate nursing students in a paediatric nursing course were involved in an extended multi-scenario simulated clinical shift prior to clinical placement. The simulation focussed on a complex ward experience, giving students the opportunity to demonstrate a variety of psychomotor skills, decision making, leadership, team work and other professional attributes integral for successful transition into the clinical arena. Evaluation data were collected at 3 intermittent points; post-simulation, post clinical placement, and 3 months after commencing employment as a Registered Nurse. Quantitative and qualitative analysis suggested positive impacts on critical nursing concepts and psychomotor skills resulted for participants in both clinical placement and beyond into the first months of employment.
PMID: 28214431 [PubMed - as supplied by publisher]
Hospital Administration and Nursing Leadership in Disasters: An Exploratory Study Using Concept Mapping.
Nurs Adm Q. 2017 Apr/Jun;41(2):151-163
Authors: Veenema TG, Deruggiero K, Losinski S, Barnett D
Strong leadership is critical in disaster situations when "patient surge" challenges a hospital's capacity to respond and normally acceptable patterns of care are disrupted. Activation of the emergency operations plan triggers an incident command system structure for leadership decision making. Yet, implementation of the emergency operations plan and incident command system protocols is ultimately subject to nursing and hospital leadership at the service- and unit level. The results of these service-/unit-based leadership decisions have the potential to directly impact staff and patient safety, quality of care, and ultimately, patient outcomes. Despite the critical nature of these events, nurse leaders and administrators receive little education regarding leadership and decision making during disaster events. The purpose of this study is to identify essential competencies of nursing and hospital administrators' leadership during disaster events. An integrative mixed-methods design combining qualitative and quantitative approaches to data collection and analysis was used. Five focus groups were conducted with nurse leaders and hospital administrators at a large urban hospital in the Northeastern United States in a collaborative group process to generate relevant leadership competencies. Concept Systems Incorporated was used to sort, prioritize, and analyze the data (http://conceptsystemsinc.com/). The results suggest that participants' institutional knowledge (of existing resources, communications, processes) and prior disaster experience increase leadership competence.
PMID: 28263273 [PubMed - in process]
Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis.
PLoS One. 2017;12(3):e0173617
Authors: Massimi A, De Vito C, Brufola I, Corsaro A, Marzuillo C, Migliara G, Rega ML, Ricciardi W, Villari P, Damiani G
The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies-3,881 patients) and HbA1c reduction (7 studies-2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01--1.06), DBP -1.42 (95% CI -1.42--0.49) and HbA1c -0.15 (95% CI -0.32-0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive.
PMID: 28282465 [PubMed - in process]
Setting health priorities in a community: a case example.
Rev Saude Publica. 2017 Mar 02;51(0):11
Authors: Sousa FA, Goulart MJ, Braga AM, Medeiros CM, Rego DC, Vieira FG, Pereira HJ, Tavares HM, Loura MM
OBJECTIVE: To describe the methodology used in the process of setting health priorities for community intervention in a community of older adults.
METHODS: Based on the results of a health diagnosis related to active aging, a prioritization process was conceived to select the priority intervention problem. The process comprised four successive phases of problem analysis and classification: (1) grouping by level of similarity, (2) classification according to epidemiological criteria, (3) ordering by experts, and (4) application of the Hanlon method. These stages combined, in an integrated manner, the views of health team professionals, community nursing and gerontology experts, and the actual community.
RESULTS: The first stage grouped the identified problems by level of similarity, comprising a body of 19 issues for analysis. In the second stage these problems were classified by the health team members by epidemiological criteria (size, vulnerability, and transcendence). The nine most relevant problems resulting from the second stage of the process were submitted to expert analysis and the five most pertinent problems were selected. The last step identified the priority issue for intervention in this specific community with the participation of formal and informal community leaders: Low Social Interaction in Community Participation.
CONCLUSIONS: The prioritization process is a key step in health planning, enabling the identification of priority problems to intervene in a given community at a given time. There are no default formulas for selecting priority issues. It is up to each community intervention team to define its own process with different methods/techniques that allow the identification of and intervention in needs classified as priority by the community.
Nurse practitioner screening for childhood adversity among adult primary care patients: A mixed-method study.
J Am Assoc Nurse Pract. 2017 Jan;29(1):35-45
Authors: Kalmakis KA, Chandler GE, Roberts SJ, Leung K
BACKGROUND AND PURPOSE: Researchers have demonstrated an association between experiencing childhood abuse and multiple chronic health conditions in adulthood, yet this evidence has not been routinely translated to practice. The purpose of this research study was to examine nurse practitioner (NP) practices, skills, attitudes, and perceived barriers associated with screening adult patients for childhood abuse to determine the extent to which evidence of the association between childhood abuse and negative health outcomes has been translated to NP practice.
METHODS: A mixed-method approach with web-based questionnaires and online focus groups was used to examine NP screening for histories of childhood abuse.
CONCLUSIONS: A total of 188 complete NP surveys were analyzed along with data from focus groups with 12 NPs. One third of the NPs regularly screened for childhood abuse and believed screening was their responsibility. Six barriers, including insufficient time and lack of confidence when inquiring about abuse, were significantly associated with NP screening practices. The focus group participants discussed how and when one should ask about childhood abuse, and the need for education about screening.
IMPLICATIONS FOR PRACTICE: Time constraints and NPs' lack of confidence in their ability to screen for histories of childhood abuse must be addressed to encourage routine screening in primary care practice.
PMID: 27221514 [PubMed - indexed for MEDLINE]
The Direct Observation of Nurse Practitioner Care study: An overview of the NP/patient visit.
J Am Assoc Nurse Pract. 2017 Jan;29(1):46-57
Authors: Weyer SM, Cook ML, Riley L
BACKGROUND AND PURPOSE: While there is a preponderance of studies that demonstrate the quality of nurse practitioner (NP) practice, little is known on the practice style of NPs. The Direct Observation of Nurse Practitioner Care study provided the first national direct observation and characterization of patient care delivered by primary care NPs.
METHODS: The setting for this study was ambulatory care practices of NPs located throughout the United States. A nested sample was utilized, consisting of 22 NPs during visits with 245 patients. Observational data were collected during each visit using the Davis observation code (DOC). Patient information was collected from chart reviews and postvisit surveys. Each NP filled out a demographic and practice survey.
CONCLUSIONS: Visits to NPs were 18 min on average, and were most frequently for new/acute problems (45.1%) or routine chronic problems (30.2%). Overall, NPs spent the most time planning treatment, history taking, and providing health education. Topics that NPs frequently provided health education about included medication action and side effects, disease process education, diet, and nutrition.
IMPLICATIONS FOR PRACTICE: Data from this study will allow for detailed characterizations of a patient-NP visit and average length of the visit and the time use based on the DOC.
PMID: 27973706 [PubMed - indexed for MEDLINE]
Screening and brief intervention for unhealthy substance use in patients with chronic medical conditions: a systematic review.
J Clin Nurs. 2016 Nov;25(21-22):3131-3143
Authors: Timko C, Kong C, Vittorio L, Cucciare MA
AIMS AND OBJECTIVES: This systematic review describes studies evaluating screening tools and brief interventions for addressing unhealthy substance use in primary care patients with hypertension, diabetes or depression.
BACKGROUND: Primary care is the main entry point to the health care system for most patients with comorbid unhealthy substance use and chronic medical conditions. Although of great public health importance, systematic reviews of screening tools and brief interventions for unhealthy substance use in this population that are also feasible for use in primary care have not been conducted.
DESIGN: Systematic review.
METHODS: We systematically review the research literature on evidence-based tools for screening for unhealthy substance use in primary care patients with depression, diabetes and hypertension, and utilising brief interventions with this population.
RESULTS: Despite recommendations to screen for and intervene with unhealthy substance use in primary care patients with chronic medical conditions, the review found little indication of routine use of these practices. Limited evidence suggested the Alcohol Use Disorders Identification Test and Alcohol Use Disorders Identification Test-C screeners had adequate psychometric characteristics in patients with the selected chronic medical conditions. Screening scores indicating more severe alcohol use were associated with health-risk behaviours and poorer health outcomes, adding to the potential usefulness of screening for unhealthy alcohol use in this population.
CONCLUSIONS: Studies support brief interventions' effectiveness with patients treated for hypertension or depression who hazardously use alcohol or cannabis, for both substance use and chronic medical condition outcomes.
RELEVANCE TO CLINICAL PRACTICE: Although small, the international evidence base suggests that screening with the Alcohol Use Disorders Identification Test or Alcohol Use Disorders Identification Test-C and brief interventions for primary care patients with chronic medical conditions, delivered by nurses or other providers, are effective for identifying unhealthy substance use and associated with healthy behaviours and improved outcomes. Lacking are studies screening for illicit drug use, and using single-item screening tools, which could be especially helpful for frontline primary care providers including nurses.
PMID: 27140392 [PubMed - indexed for MEDLINE]
Comparison of menstrual disorders in hospital nursing staff according to shift work pattern.
J Clin Nurs. 2016 Nov;25(21-22):3291-3299
Authors: Albert-Sabater JA, Martínez JM, Baste V, Moen BE, Ronda-Perez E
AIM AND OBJECTIVE: To assess the association between work in a rotating shift schedule and menstruation characteristics among nurse staff in a prospective study.
BACKGROUND: Rotating shifts have been linked to alterations in the reproductive cycle. In the case of menstrual alterations, the conclusions are not clear.
DESIGN: Prospective epidemiological study with follow-up over four months.
METHOD: All the female nurse staff (<40 years) in a hospital were interviewed, collecting sociodemographic and employment information. They were given a menstrual diary to keep a record of their shifts and characteristics of their menstruation (duration, amount of blood, dysmenorrhoea). They had two types of shifts: (1) Rotating shift schedule (two mornings, two afternoons, one night and two days off) including morning shifts (8:00-15:00), afternoon/evening shifts (15:00-22:00) and night shifts (22:00-8:00), and (2) Day shift schedule including morning shifts (8:00-15:00) and/or afternoon/evening shifts (15:00-22:00). The crude and adjusted odds ratios with 95% confidence interval were calculated using logistic generalised estimating equations (GEE) taking into account the correlations of multiple cycles per worker.
RESULTS: One hundred and thirteen workers on the rotating shift and 75 on the day shift participated, and information from 730 menstrual cycles were obtained. There were no differences in prolonged duration, dysmenorrhoea, prolonged duration dysmenorrhoea and excessive bleeding among nurses on rotating shift compared to those on the day shift. For prolonged duration of menstruation, workers with more than five years on the rotating shift showed a slightly lower (nonsignificant) risk compared with those with <5 years.
CONCLUSIONS: Nurse staff on the rotating shift did not show increased risk of having menstrual disorders comparing with day staff.
RELEVANCE TO CLINICAL PRACTICE: Shifts with short rotation cycles and a progressive sequence do not appear to cause menstrual disorders in nurse staff who work rotating shifts.
PMID: 27530371 [PubMed - indexed for MEDLINE]
Facilitating terminal discharge: fulfilling the hospitalised patient's wish for home death in the final hours.
Int J Palliat Nurs. 2016 Nov 02;22(11):541-548
Authors: Tan YY, Xu ZZ, Pang GS, Qu L, Xu Y, Zhang AM, Neo PS
BACKGROUND: Terminal discharge (TD) is the rapid discharge of a hospitalised patient when death is imminent. Its time-limited nature makes it challenging, particularly for ward nurses.
AIM: To report the development of a structured TD framework, and determine if the framework can expedite TD processes and improve nurses' experience in conducting TDs.
METHODS: A 3-phase audit was carried out in a Singapore hospital. The baseline and post intervention audits evaluated the time taken for TD, incidence of prescription errors, continuity of care, and timeliness of equipment arrangement. Nurse satisfaction was assessed through a written survey. Interventions encompassed the implementation of workflow changes and a TD guide.
RESULTS: The mean time taken to complete TDs was shorter in the post-compared to pre-intervention phase (2.9±1.4 vs. 4.6±2.3 hours respectively, p<0.01). Approximately 89% of nurses who used the TD guide were satisfied that it made TDs easier.
CONCLUSION: A structured TD framework is effective in expediting TDs and improving nurse satisfaction.
PMID: 27885905 [PubMed - indexed for MEDLINE]
Integrating nutrition into pathways for patients with COPD.
Br J Community Nurs. 2016 Nov 02;21(11):548-552
Authors: Hodson M
This article looks at the role of the community nurse in assessing the nutritional status of patients with COPD and in integrating nutrition into the COPD care pathway.
PMID: 27809578 [PubMed - indexed for MEDLINE]
Support for mentors-an exploration of the issues.
Br J Nurs. 2016 Nov 10;25(20):1095-1100
Authors: Clark L, Casey D
Nursing and midwifery mentors are fundamental to the process of ensuring future practitioners are adequately prepared and supported during the practice element of their degrees. However, there is evidence to suggest that the infrastructure and support for the mentoring role is not always adequate. This article provides a review of some of the issues including the emotional labour associated with supporting pre-registration students, difficulties in accessing protected learning time for mentoring, and lack of supportive networks for mentors to develop within the role. The authors make recommendations on what is required to ensure that the mentor role is better acknowledged, supported and resourced.
PMID: 27834526 [PubMed - indexed for MEDLINE]
Implications of the Working Time Regulations on district nurse practice.
Br J Community Nurs. 2016 Nov 02;21(11):579-581
Authors: Griffith R
In this article Richard Griffith considers the impact of two recent developments, in case law from the European Court of Justice and a professional misconduct from the nursing and midwifery council, on the application of the Working Time Regulations 1998.
PMID: 27809579 [PubMed - indexed for MEDLINE]
Discharge planning: best practice in transitions of care.
Br J Community Nurs. 2016 Nov 02;21(11):542-548
Authors: Pellett C
This article provides an overview of a project undertaken by the Queen's Nursing Institute (QNI) and funded by The Department of Health, to identify the barriers and challenges that prevent effective discharge from hospital to home. Unnecessary delays in discharging patients from hospital to home is an ongoing problem and for older people this can lead to worse health outcomes, which can increase their long-term care needs. Findings from the project illustrates that while there are challenges in achieving excellent practice in the transfer of a patient's care from hospital to home, there is a significant willingness and commitment from nurses based both in the community and hospital to improve the patient experience. Key recommendations are cited in the article that will enhance an improved discharge experience for patients, carers and their families.
PMID: 27809581 [PubMed - indexed for MEDLINE]
A Study of Role Expectations and Satisfaction With the Healthcare Coach Role.
J Nurs Adm. 2017 Feb;47(2):108-115
Authors: Kohlbry P, Daugherty JS, Gorzeman J, Parker J
OBJECTIVE: The research objective was to determine the expectations of and satisfaction with the healthcare coach (HCC) role among hospitalists and staff RNs, as well as expectations of case managers who collaborate with them.
BACKGROUND: Care transitions occur when patients move from 1 care setting or provider to another. The Centers for Medicare & Medicaid Services developed the Community-Based Care Transitions Program to address readmission, patient safety, improved quality of care, and cost savings.
METHODS: A cross-sectional study measured level of satisfaction and explored qualitatively the expectations regarding the HCC role among hospitalists and staffs RNs. Case managers were surveyed regarding expectations of the HCC role. The HCCs were surveyed regarding their new role experiences.
RESULTS: On a Likert scale of 1 to 5, satisfaction with the HCC role by staff nurses averaged 3 (neutral), whereas hospitalists' mean satisfaction was 4 (satisfied). From the qualitative data, 6 themes emerged among participants: personal qualities, care navigation, system perspective, collaboration/teamwork, challenges/role confusion, and future role benefits. Two additional themes were identified by the HCCs: new knowledge and helpful skill sets.
CONCLUSIONS: We recommend further evaluation of the HCC role in other organizations and across care settings.
PMID: 28067679 [PubMed - indexed for MEDLINE]
Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services.
J Alzheimers Dis. 2016;52(2):619-29
Authors: Eichler T, Hoffmann W, Hertel J, Richter S, Wucherer D, Michalowsky B, Dreier A, Thyrian JR
BACKGROUND: Little is known about the proportion and the characteristics of community-dwelling people with dementia (PWD) living alone in Germany.
OBJECTIVES: To analyze the prevalence of PWD living alone (with and without the support of an informal caregiver) and socio-demographical and clinical characteristics as well as health and nursing care utilization associated with living alone.
METHODS: DelpHi-MV (Dementia: Life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, randomized controlled intervention trial. The present analyses are based on baseline data of 511 patients (≥70 years, community-dwelling) who had screened positive for dementia (DemTect <9).
RESULTS: N = 251 (51%) of the patients lived alone. PWD living alone were statistically significantly more often female, older, and more often widowed than those not living alone. About 9% of the patients (n = 24) were not supported by any informal caregiver. Regarding the clinical variables (cognitive and functional impairment, depression, falls, number of drug-related problems, malnutrition, quality of life), there were no statistically significant group differences. Patients living alone utilized professional services such as home care, help with medication, home-delivered meals, or housekeeping assistance significantly more often. Multivariate analyses confirmed these findings.
CONCLUSION: Our results reveal the high proportion of PWD living alone in Germany. PWD living alone did not seem to be at an increased health risk. Our findings indicate that living alone with dementia is possible. In order to ensure the sufficient provision of health and nursing care services for PWD living alone, providers should consider the present results for future planning.
PMID: 27031480 [PubMed - indexed for MEDLINE]
Impacts of a navigation program based on health information technology for patients receiving oral anticancer therapy: the CAPRI randomized controlled trial.
BMC Health Serv Res. 2017 Feb 13;17(1):133
Authors: Gervès-Pinquié C, Daumas-Yatim F, Lalloué B, Girault A, Ferrua M, Fourcade A, Lemare F, Dipalma M, Minvielle E
BACKGROUND: The emergence of oral delivery in cancer therapeutics is expected to result in an increased need for better coordination between all treatment stakeholders, mainly to ensure adequate treatment delivery to the patient. There is significant interest in the nurse navigation program's potential to improve transitions of care by improving communication between treatment stakeholders and by providing personalized organizational assistance to patients. The use of health information technology is another strategy aimed at improving cancer care coordination that can be combined with the NN program to improve remote patient follow-up. However, the potential of these two strategies combined to improve oral treatment delivery is limited by a lack of rigorous evidence of actual impact.
METHODS/DESIGN: We are conducting a large scale randomized controlled trial designed to assess the impact of a navigation program denoted CAPRI that is based on two Nurse Navigators and a web portal ensuring coordination between community and hospital as well as between patients and navigators, versus routine delivery of oral anticancer therapy. The primary research aim is to assess the impact of the program on treatment delivery for patients with metastatic cancer, as measured by Relative Dose Intensity. The trial involves a number of other outcomes, including tumor response, survival, toxic side effects, patient quality of life and patient experience An economic evaluation adopting a societal perspective will be conducted, in order to estimate those health. care resources' used. A parallel process evaluation will be conducted to describe implementation of the intervention.
DISCUSSION: If the CAPRI program does improve treatment delivery, the evidence on its economic impact will offer important knowledge for health decision-makers, helping develop new follow-up services for patients receiving oral chemotherapy and/or targeted therapy. The process evaluation will determine the best conditions in which such a program might be implemented.
TRIAL REGISTRATION: NCT 02828462 . Registered 29 June 2016.
PMID: 28193214 [PubMed - in process]
A demonstration of mixed-methods research in the health sciences.
Nurse Res. 2016 Nov 18;24(2):24-29
Authors: Katz J, Vandermause R, McPherson S, Barbosa-Leiker C
Background The growth of patient, community and population-centred nursing research is a rationale for the use of research methods that can examine complex healthcare issues, not only from a biophysical perspective, but also from cultural, psychosocial and political viewpoints. This need for multiple perspectives requires mixed-methods research. Philosophy and practicality are needed to plan, conduct, and make mixed-methods research more broadly accessible to the health sciences research community. The traditions and dichotomy between qualitative and quantitative research makes the application of mixed methods a challenge. Aim To propose an integrated model for a research project containing steps from start to finish, and to use the unique strengths brought by each approach to meet the health needs of patients and communities. Discussion Mixed-methods research is a practical approach to inquiry, that focuses on asking questions and how best to answer them to improve the health of individuals, communities and populations. An integrated model of research begins with the research question(s) and moves in a continuum. The lines dividing methods do not dissolve, but become permeable boundaries where two or more methods can be used to answer research questions more completely. Rigorous and expert methodologists work together to solve common problems. Conclusion Mixed-methods research enables discussion among researchers from varied traditions. There is a plethora of methodological approaches available. Combining expertise by communicating across disciplines and professions is one way to tackle large and complex healthcare issues. Implications for practice The model presented in this paper exemplifies the integration of multiple approaches in a unified focus on identified phenomena. The dynamic nature of the model signals a need to be open to the data generated and the methodological directions implied by findings.
PMID: 27855575 [PubMed - indexed for MEDLINE]
Reproductive coercion, sexual risk behaviours and mental health symptoms among young low-income behaviourally bisexual women: implications for nursing practice.
J Clin Nurs. 2016 Dec;25(23-24):3533-3544
Authors: Alexander KA, Volpe EM, Abboud S, Campbell JC
AIMS AND OBJECTIVES: To describe prevalence of reproductive coercion, sexual risk behaviours and mental health symptoms among women reporting lifetime sexual experiences with men and women compared to peers reporting sex exclusively with men.
BACKGROUND: Reproductive coercion, a global public health problem, is understudied among sexual minority women. Violence against women remains high among women who have sex with women and men. Rates of sexual and physical violence among this population are higher than women reporting exclusive sexual partnerships with either men or women. Nurses and other healthcare providers often do not conduct comprehensive sexual histories; assumptions related to a sex partner's gender may provide indications of broader health implications.
DESIGN: Cross-sectional survey of low-income Black women ages 18-25 recruited from six community-based sites for a parent study focused on intimate partner violence and health.
METHODS: We analysed survey data from participants who reported lifetime sexual experiences with men and women (N = 42) and compared their outcomes to those of women reporting sexual experiences with men only (N = 107).
RESULTS: A greater proportion of women who have sex with women and men reported experiencing reproductive coercion. Women who have sex with women and men also reported a greater number of lifetime intimate partner physical and sexual violence experiences, traded sex for resources, and had post-traumatic stress disorder symptoms.
CONCLUSIONS: Findings provide vital information that can inform nursing clinical practice, specifically related to history-taking, screening protocols and counselling strategies for intimate partner violence and mental health among women who have sex with women and men.
RELEVANCE TO CLINICAL PRACTICE: Strategies for addressing reproductive coercion and intimate partner violence as well as the health consequences among women who have sex with women and men in clinical and community-based settings should include a longitudinal understanding of sexual behaviour and gender of sex partners.
PMID: 27272932 [PubMed - indexed for MEDLINE]
'We just do the dirty work': dealing with incontinence, courtesy stigma and the low occupational status of carework in long-term aged care facilities.
J Clin Nurs. 2016 Sep;25(17-18):2528-41
Authors: Ostaszkiewicz J, O'Connell B, Dunning T
AIMS AND OBJECTIVES: To systematically examine, describe and explain how continence care was determined, delivered and communicated in Australian long aged care facilities.
BACKGROUND: Incontinence is a highly stigmatising condition that affects a disproportionally large number of people living in long-term aged care facilities. Its day-to-day management is mainly undertaken by careworkers. We conducted a Grounded theory study to explore how continence care was determined, delivered and communicated in long-term aged care facilities. This paper presents one finding, i.e. how careworkers in long-term aged care facilities deal with the stigma, devaluation and the aesthetically unpleasant aspects of their work.
DESIGN: Grounded theory.
METHODS: Eighty-eight hours of field observations in two long-term aged care facilities in Australia. In addition, in-depth interviews with 18 nurses and careworkers who had experience of providing, supervising or assessment of continence care in any long-term aged care facility in Australia.
RESULTS: Occupational exposure to incontinence contributes to the low occupational status of carework in long-term aged care facilities, and continence care is a symbolic marker for inequalities within the facility, the nursing profession and society at large. Careworkers' affective and behavioural responses are characterised by: (1) accommodating the context; (2) dissociating oneself; (3) distancing oneself and (4) attempting to elevate one's role status.
CONCLUSION: The theory extends current understandings about the links between incontinence, continence care, courtesy stigma, emotional labour and the low occupational status of carework in long-term aged care facilities.
RELEVANCE TO CLINICAL PRACTICE: This study provides insights into the ways in which tacit beliefs and values about incontinence, cleanliness and contamination may affect the social organisation and delivery of care in long-term aged care facilities. Nurse leaders should challenge the stigma and devaluation of carework and careworkers, and reframe carework as 'dignity work'.
PMID: 27273341 [PubMed - indexed for MEDLINE]
Transitioning from acute to primary health care nursing: an integrative review of the literature.
J Clin Nurs. 2016 Aug;25(15-16):2114-25
Authors: Ashley C, Halcomb E, Brown A
AIMS AND OBJECTIVES: This paper seeks to explore the transition experiences of acute care nurses entering employment in primary health care settings.
BACKGROUND: Internationally the provision of care in primary health care settings is increasing. Nurses are moving from acute care settings to meet the growing demand for a primary health care workforce. While there is significant research relating to new graduate transition experiences, little is known about the transition experience from acute care into primary health care employment.
DESIGN: An integrative review, guided by Whittemore and Knafl's (2005) approach, was undertaken. Following a systematic literature search eight studies met the inclusion criteria.
METHODS: Papers which met the study criteria were identified and assessed against the inclusion and exclusion criteria. Papers were then subjected to methodological quality appraisal. Thematic analysis was undertaken to identify key themes within the data.
RESULTS: Eight papers met the selection criteria. All described nurses transitioning to either community or home nursing settings. Three themes were identified: (1) a conceptual understanding of transition, (2) role losses and gains and (3) barriers and enablers.
CONCLUSION: There is a lack of research specifically exploring the transitioning of acute care nurses to primary health care settings. To better understand this process, and to support the growth of the primary health care workforce there is an urgent need for further well-designed research.
RELEVANCE TO CLINICAL PRACTICE: There is an increasing demand for the employment of nurses in primary health care settings. To recruit experienced nurses it is logical that many nurses will transition into primary health care from employment in the acute sector. To optimise retention and enhance the transition experience of these nurses it is important to understand the transition experience.
PMID: 27125727 [PubMed - indexed for MEDLINE]
Promoting Bedside Nurse-Led Research Through a Dedicated Neuroscience Nursing Research Fellowship.
J Nurs Adm. 2016 Dec;46(12):648-653
Authors: Stutzman S, Olson D, Supnet C, Harper C, Brown-Cleere S, McCulley B, Goldberg M
OBJECTIVE: We hypothesized that nurses would benefit from the fellowship model traditionally used to engage physicians in clinical research. The Neuroscience Nursing Research Center (NNRC) fellowship program was created as a model for engaging nurses at all levels of clinical practice to become active in clinical research.
BACKGROUND: The NNRC was established in 2013 as a novel approach to promote bedside nurses as primary investigators in clinical research.
METHODS: The NNRC developed 4 pathways to nursing research success: research fellowship, student-nurse internship, didactic training, and research consultation.
RESULTS: Fellows have enrolled more than 900 participants in 14 studies. Nurses have presented more than 20 abstracts at 12 conferences and submitted 11 manuscripts for publication. The NNRC has provided research training to more than 150 nurses.
CONCLUSIONS: The NNRC program is successful in engaging nurses in research. It shows promise to continue to develop nursing research that is applicable to clinicians and thus improve patient care.
PMID: 27851706 [PubMed - indexed for MEDLINE]
A Nurse Transitional Home Visit Following Pediatric Hospitalizations.
J Nurs Adm. 2016 Dec;46(12):642-647
Authors: Pickler R, Wade-Murphy S, Gold J, Tubbs-Cooley H, White CM, Statile A, Hoying C, Sauers-Ford H, Shah SS, Simmons J
By incorporating focused feedback from families and other stakeholders a multidisciplinary team redesigned a single nurse home visit to improve transitions to home for pediatric patients following short-stay, acute care hospitalizations. Refinements to the nurse-led transitional home visit included standardization of teaching focused on condition- and medication-specific concerns, the use of red flags or warning signs to prompt caregiver action, and the provision of reassurance.
PMID: 27851705 [PubMed - indexed for MEDLINE]
A Multidisciplinary Initiative to Increase Inpatient Discharges Before Noon.
J Nurs Adm. 2016 Dec;46(12):630-635
Authors: Kane M, Weinacker A, Arthofer R, Seay-Morrison T, Elfman W, Ramirez M, Ahuja N, Pickham D, Hereford J, Welton M
OBJECTIVE: The aim of this study is to evaluate the effect of 2 hospital-wide interventions on achieving a discharge-before-noon rate of 40%.
BACKGROUND: A multidisciplinary team led by administrative and physician leadership developed a plan to diminish capacity constraints by minimizing late afternoon hospital discharges using 2 patient flow management techniques.
METHODS: The study was a preintervention/postintervention retrospective analysis observing all inpatients discharged across 19 inpatient units in a 484-bed, academic teaching hospital measuring calendar month discharge-before-noon percentage, patient satisfaction, and readmission rates. Patient satisfaction and readmission rates were used as baseline metrics.
RESULTS: The discharge-before-noon percentage increased from 14% in the 11-month preintervention period to an average of 24% over the 11-month postintervention period, whereas patient satisfaction scores and readmission rates remained stable.
CONCLUSIONS: Implementation of the 2 interventions successfully increased the percentage of discharges before noon yet did not achieve the goal of 40%. Patient satisfaction and readmission rates were not negatively impacted by the program.
PMID: 27851703 [PubMed - indexed for MEDLINE]
Cancer Survivors: The Success Story That's Straining Health Care.
IEEE Pulse. 2017 Jan-Feb;8(1):14-17
Authors: Allen SE
Since President Richard Nixon declared a "War on Cancer" in 1971, the number of cancer survivors in the United States has quadrupled  and is still rising. Thanks to advance in cancer detection and treatment, the almost 15 million cancer survivors in the United States today could grow to some 19 million by 2024 . Increasing survival rates have resulted in a shift: cancer is often treated as a chronic illness rather than a death sentence. However, having so many cancer survivors to monitor, track, and treat has led to growing pains for healthcare providers-forcing them to develop new ways to treat this increasing yet still vulnerable population.
PMID: 28129136 [PubMed - indexed for MEDLINE]
Comparative Analysis of the Perception of Family Functioning by Heads of Families with and without Cancer Members During Illness.
Asian Pac J Cancer Prev. 2016;17(9):4275-4279
Authors: Sahebihagh MH, Amani L, Salimi S, Feizi A, Khalkhali HR, Atri SB
BACKGROUND: Cancer is a major health problem due to the aging population with increasing deaths. Family functioning is affected by cancer diagnosis and treatment. The aim of this study was to comparative analysis of the perception of family functioning by heads of families with and without cancer members during illness, focusing on changes or probable changes.
MATERIALS AND METHODS: This comparative study was conducted on two groups (families with a member of the cancer and controls without a family member with cancer). The families were of patients referred to the clinics and hospitals of Imam Khomeini, Taleghani and Omid of Urmia city, the number of samples being 148 for cases and 176for the control group. To collect the data, valid and reliable family functioning (FAD) was applied, a 60-item questionnaire with seven dimensions, with heads of families. To analyze the data SPSS- 23 Software was used for descriptive and analytical statistics. Significance level was defined p<0.05.
RESULTS: Among the seven items : problem solving, communication, roles, emotional response, emotional involvement, behavior control and overall functioning, only differences for average scores of problem-solving were statistically significant.
DISCUSSION: Contrary to common perception of severe damage for family functioning in families with cancer members, results of this study indicate that functioning in terms of family caregivers is more or less similar to that of the families with other diseases. Only in problem-solving item do these families experience more difficulty.
CONCLUSION: According to the research findings, in nursingfrom families with cancer patient, it is recommended to focus more on the problem-solving item of the families.
PMID: 27797230 [PubMed - indexed for MEDLINE]
An Explanatory Study on the Concept of Nursing Presence from the Perspective of Patients Admitted to Hospitals.
J Clin Nurs. 2017 Feb 08;:
Authors: Mohammadipour F, Atashzadeh-Shoorideh F, Parvizy S, Hosseini M
AIMS AND OBJECTIVES: The aim of this study is to clarify the concept of nursing presence through patients' perception.
BACKGROUND: The holistic caring process at the bedside must incorporate the concept of nursing presence. Most of the research about nursing presence is based on nurses' experiences and research into patients' experiences is minimal. According to goals of patient-centeredness, the association between the patient satisfaction and nursing presence, and patients' ability to understand this concept, it is important to explore this concept from the patients' perspective.
DESIGN: A qualitative approach.
METHODS: Based on purposive sampling technique, 12 patients were recruited. After participant observation, 15 interviews were carried out with participants. Data were transcribed verbatim and analyzed using conventional qualitative content analysis.
RESULTS: Five main categories were drawn from the data including informed concentration, task-centered/patient-centered relationship, clarification of meanings, comprehensive participation, and accountable encounter. Data analysis alongside the authors' reflections resulted in the emergence of one overarching theme, 'co-constructed interaction', which shows the notion that effective nurse-patient interaction enhances cooperation, coordination, and collaboration in caring and improves nursing outcomes.
CONCLUSIONS: Accordingly, the nursing presence would be ideal for patient-centered caring. This article is protected by copyright. All rights reserved.
PMID: 28178371 [PubMed - as supplied by publisher]
Being in togetherness: meanings of encounters within primary healtcare setting for patients living with long-term illness.
J Clin Nurs. 2016 Oct;25(19-20):2854-62
Authors: Nygren Zotterman A, Skär L, Olsson M, Söderberg S
AIMS AND OBJECTIVES: The aim of this study was to elucidate meanings of encounters for patients with long-term illness within the primary healthcare setting.
BACKGROUND: Good encounters can be crucial for patients in terms of how they view their quality of care. Therefore, it is important to understand meanings of interactions between patients and healthcare personnel.
DESIGN: A phenomenological hermeneutic method was used to analyse the interviews.
METHODS: Narrative interviews with ten patients with long-term illness were performed, with a focus on their encounters with healthcare personnel within the primary healthcare setting. A phenomenological hermeneutical approach was used to interpret the interview texts.
RESULTS: The results demonstrated that patients felt well when they were seen as an important person and felt welcomed by healthcare personnel. Information and follow-ups regarding the need for care were essential. Continuity with the healthcare personnel was one way to establish a relationship, which contributed to patients' feelings of being seen and understood. Good encounters were important for patients' feelings of health and well-being. Being met with mistrust, ignorance and nonchalance had negative effects on patients' perceived health and well-being and led to feelings of lower confidence regarding the care received.
CONCLUSIONS: Patients described a great need to be confirmed and met with respect by healthcare personnel, which contributed to their sense of togetherness. Having a sense of togetherness strengthened patient well-being.
RELEVANCE TO CLINICAL PRACTICE: By listening and responding to patients' needs and engaging in meetings with patients in a respectful manner, healthcare personnel can empower patients' feelings of health and well-being. Healthcare personnel need to be aware of the significance of these actions because they can make patients experience feelings of togetherness, even if patients meet with different care personnel at each visit.
PMID: 27383692 [PubMed - indexed for MEDLINE]