Effects of a perioperative educational pathway on ostomy self-care, level of independence and need for visiting nurse services: a comparative observational cohort study.

AIM: Most new ostomy patients are not able to manage ostomy self-care when they are discharged and rely on visiting nurse services for ostomy care. The aim of this study was to determine if a perioperative ostomy educational pathway increases the level of independence and decreases the need for visiting nurse services in new ostomy patients. METHOD: A prospective longitudinal study was conducted between July 2018 and February 2020. Patients who received a colostomy or ileostomy and were treated on the surgery ward were included. Patients who followed a perioperative ostomy educational pathway were compared to a historical control group. The primary outcome measure was the level of independence in ostomy care and the need for visiting nurse services. RESULTS: After discharge, 67.6% of patients in the intervention group (n = 244) were able to independently perform ostomy care and were therefore not relying on visiting nurse services, compared to 15.2% of the patients in the control group (n = 33). The need for visiting nurse services was higher in patients aged ≥70 years (OR 3.20, P < 0.001), those who did not attend the preoperative practice session (OR 3.02, P = 0.002), those with a history of transient ischaemic attack (OR 10.22, P = 0.045) and those with mild cognitive impairment (OR 28.98, P = 0.002). CONCLUSION: A perioperative ostomy educational pathway effectively increased the level of independence and decreased the need for visiting nurse services in new ostomy patients.

Establishing a community-academic nursing partnership to lead a healthcare response during a human trafficking extraction operation.

A community-academic nursing partnership formed to care for the urgent healthcare needs of individuals extracted from human trafficking during a multidisciplinary team operation. During past human trafficking extraction operations, law enforcement and the state sexual assault nurse examiner coordinator recognized the need to meet the patients' immediate physical and emotional needs while providing essential comfort to the newly extracted individuals. To meet the immediate holistic healthcare needs during the recovery operation, the nursing faculty partnered with a local nonprofit community clinic to provide onsite trauma-informed, patient-centered healthcare and comfort items. The healthcare team consisted of advanced practice nurses, mental health nurses who triaged the patient's immediate psychological needs, sexual assault nurses who collected forensic specimens, and nurses with expertise in substance use disorder who evaluated the patient's treatment needs. The patient's physical comfort was met by providing hygiene kits, blankets, socks, food, and drinks. Trauma-informed language was utilized to help the patient feel safe and to convey respect for the patient's autonomy in making decisions during the extraction process. The innovative community-academic nursing partnership laid the groundwork for providing healthcare to future human trafficking extraction operations with plans to incorporate nursing students and graduate nursing students to increase the number of patients served while providing a rich learning experience to the students.

Educational needs of community visiting nurses for infection prevention and control: Application of the Borich needs assessment and the Locus for Focus models.

OBJECTIVES: This study aimed to assess the educational needs and analyze the priorities of infection prevention and control (IPC) for community-visiting nurses. DESIGN: This is a cross-sectional descriptive study. SAMPLE: This study was conducted with 144 visiting nurses working in public health centers and long-term care facilities in South Korea. METHOD: A total of 23 questions in five subcategories were used to measure the current knowledge and perceived importance of IPC in community-visiting nursing. Data were collected from June 23 to October 30, 2021, during the COVID-19 pandemic. Data were analyzed paired t-test, the Borich needs assessment, and the Locus for Focus models. RESULTS: Top-priority content was defined as content belonging to two models, the first 10 contents of Borich needs assessment and the contents located in the Quadrant I of the Locus for Focus models. "Reporting in case of infection-related accidents," "Mandatory vaccination for visiting nurses," "Standard precaution," "Airborne precaution," "Contact precautions," "Respiratory infection control," and "Post-visit management." CONCLUSIONS: This study suggests that it is necessary to provide visiting nurses with more opportunities for IPC education and to develop standardized IPC programs that consider educational priorities.

Effectiveness of a Community-Based Ostomy Nursing Technique to Enhance the Delivery of Patient Care and Quality of Life.

This study aimed to develop and validate a community-based ostomy care training program for nursing staff, with the goal of enhancing their ostomy nursing competencies and improving patient satisfaction. Between March 2021 and October 2021, 20 registered nurses and 50 patients with enterostomy surgery who took part in the promotion of a new nursing technique in five community health service centers in the Wuxing District, Huzhou City, were enrolled in this study (forming the intervention group). In addition, 15 registered nurses and 40 patients with enterostomy surgery from four community health service centers with similar economic and health conditions in the same area were randomly selected as the control group. All community health service centers were independent institutions. The indexes before and after the promotion of the technique were compared, and the effectiveness of the training was evaluated by observing the improvement in nursing skills and changes in patient quality of life after the training. The "quality-of-life scale" was used to analyze the quality of life of patients who had undergone colostomy surgery. The new approach to ostomy care delivered in a community setting was found to improve staff knowledge and skill in ostomy care (p < 0.001), improve the quality-of-life scores of patients and reduce patient travel time and medical expenses. The promotion of ostomy nursing techniques in community health service centers has several benefits. It improves the ostomy nursing skill levels of community medical staff. This reduces the occurrence of ostomy complications. Additionally, it establishes an effective connection between tertiary hospitals and community health service centers. This connection is conducive to better nursing care for patients who have undergone ostomy surgery. The hospital - community - family nursing model can improve self-management abilities and reduce the incidence of complications of enterostomies.

Learning Outcomes of Flipped Classroom on Community Health Nursing Course.

PURPOSE: To improve the quality of community health nursing practice, the learning outcomes of nursing students in community health nursing courses must be enhanced. Although the flipped classroom is considered an effective innovative teaching strategy, evidence of its application in community health nursing courses is limited. Therefore, this study aimed to examine the effects of a flipped classroom approach on community nursing competence, academic performance, course engagement, and learning satisfaction for a community health nursing course. DESIGN: A quasi-experimental study design was adopted between September 2021 and January 2022. METHODS: Two classes of nursing students (n = 92) from a 2-year nursing program at a university in Taiwan were recruited. The classes were randomly assigned to the intervention group (n = 50) that attended a flipped classroom and the control group (n = 42) that received traditional lecture-based instruction. FINDINGS: Compared with the control group, the intervention group demonstrated significantly greater improvements in community nursing competence (p = .012) and significantly higher academic performance (p = .005). In addition, the course engagement and learning satisfaction of the two groups were high, but not significantly different. CONCLUSIONS: A flipped classroom can be an important strategy to enhance community nursing competence and academic performance. CLINICAL EVIDENCE: The flipped classroom strategy can enhance community nursing competence of nursing students, which may improve the quality of population-based healthcare.

Researching the Effectiveness of an Online COVID-19 Educational Module among Community Health Nursing Students.

PURPOSE: The purpose of this research study was to determine the effectiveness of an innovative online COVID-19 educational module among community health nursing students. DESIGN: Mixed-methods study. METHODS: The sample (N = 86) consisted of prelicensure and postlicensure community health nursing students, who completed a pretest, COVID-19 educational intervention, and posttest. FINDINGS: The majority of participants' scores increased from pretest to posttest, and most participants strongly agreed that the COVID-19 educational module was effective. Strategies to address vaccine hesitancy, information learned and found most helpful, and plans for application and utilization of this knowledge were revealed. CONCLUSIONS: An online COVID-19 community health nursing educational intervention was effective at improving participants' knowledge, confidence, and attitudes regarding COVID-19. CLINICAL EVIDENCE: Online COVID-19 community health nursing education was an effective strategy for increasing preparation for this pandemic and the format can be useful to utilize for future public health emergencies.

Effective evaluations of community nursing on rehabilitation for stroke survivors: A meta-analysis.

BACKGROUND: Long-term rehabilitation of stroke survivors is often difficult and new tools to improve quality of life should be proposed. Community nursing can be a cost-effective tool to positively impact the lives of stroke survivors. This meta-analysis aimed to comprehensively evaluate the effects of community nursing on rehabilitation for stroke survivors. METHODS: The Cochrane Library, PubMed, Web of Science, CINAHL Plus, Embase, PEDro, China Knowledge Resource Integrated Database (CNKI), WANFANG, and WEIPU databases were comprehensively searched from their inception to April 18, 2023. The revised Cochrane risk-of-bias tool for RCTs(RoB 2 tool) was used to assess the quality of the included studies. Meta-analysis was conducted using the Stata 12.0 software package and Review Manager v5.3 software. RESULTS: A total of 25 randomized controlled trials with 2537 participants were included in the meta-analysis. Compared with the control group, community nursing combined with routine nursing had a significantly superior effect on the Barthel Index(BI), Fugl-Meyer(FMA), National Institutes of Health Stroke Scale(NIHSS), Self-rating Anxiety Scale(SAS), and Self-rating Depression Scale(SDS) scores for stroke survivors (BI: MD: 18.48, 95 % CI [16.87, 20.08], P < 0.00001; FMA: MD: 12.61, 95 % CI [10.44, 14.78], P < 0.00001; NIHSS: MD: -2.94, 95 % CI [-3.50, -2.37], P < 0.00001; SAS: MD: -8.19; 95 % CI: [-9.46, -6.92], P < 0.00001; SDS: MD: -6.46 95 % CI [-7.23, -5.70], P < 0.00001). Subgroup analysis demonstrated that routine nursing, health education, exercise rehabilitation nursing and psychological nursing combined with different community nursing measures were significant in rehabilitation for stroke survivors and there was no heterogeneous in the studies of each subgroup(P > 0.1, I2 < 50 %). CONCLUSION: This meta-analysis demonstrated that community nursing combined with routine nursing might improve activities of daily living, motor function and nerve function, and relieve anxiety and depression in stroke survivors. Overall, community nursing had a significant effect on rehabilitation of stroke survivors. However, this study still has limitations such as the overestimation effects caused by the sample size and the risk of bias caused by interventions. Future research will attempt to overcome these limitations and comprehensively assess the effect of community nursing on the rehabilitation of stroke survivors.

Review of recently published articles.

Aysha Mendes provides a synopsis and brief review of a selection of recently published research articles that are of interest to community nurses, highlighting key points to keep you up to date; a full reference is provided for those who wish to read the research in more detail.

Nursing care in patients with dependency-related skin injuries in the community: a scoping review.

PURPOSE: Dependency-related skin injuries (DRSI) occur in people who need a high level of support to carry out day-to-day activities. Owing to the ageing population, the number of people at risk of DRSI is increasing. Most wound care is performed by nurses in the community. This scoping review aimed to identify the extent of literature on nursing care for patients with or at risk of developing DRSI living in their own home. MATERIALS AND METHODS: A scoping review was conducted. RESULTS: A total of 28 studies met the inclusion criteria and four main themes emerged: features of the community setting; wound types, causes and management; prevention strategies around aetiology and holistic care; care management and local wound care. CONCLUSION: Although most wounds occur in and are treated in the community, there is a paucity of research on wounds in this setting. The care of patients with DRSI in the community is complex and prevention according to the individual aetiology of each lesion is the key factor in wound care.

Community nursing and the digital technology revolution: the past, present and future.

While very much in its infancy in terms of becoming an established tool, the use of digital technology in community nursing is steadily growing, despite the persistent barriers to, and challenges encountered in its uptake and implementation. The mobile nature and high workload of a community nurse's daily practice should facilitate the rapid uptake of time-saving technology. However, there are indications that technology may not be the panacea it was originally proclaimed to be. Francesca Ramadan elaborates on the past and present applications of digital technology in community nursing and delves into the principles that should shape the future potential of tools such as artificial intelligence, automation technologies and clinical decision support systems.

The law in relation to safeguarding and the community nurse.

In this article, Iwan Dowie discusses the role of the community nurse in relation to safeguarding. The key principles of safeguarding are discussed, and how the community nurse can approach various incidences where they feel their patients may be at risk.

Legal duty of care and the community nurse.

In this month's Policy column, the author explores the concepts of duty of care, forseeability and proximity, and how the community nurse can be better prepared when caring for the patient.

Legal aspects of dying and the community nurse.

In this month's Policy column, Iwan Dowie explores the legality behind caring for those approaching end of life.

Exploring the barriers to oral healthcare promotion and provision in the community.

With their wide breadth of expertise and the ability to leverage the therapeutic relationship, community nurses are ideally placed to provide treatment and support to an extensive variety of patients with a diverse range of conditions. However, to date, oral health has remained a neglected domain in the community, especially in older demographics. Francesca Ramadan explores the barriers to community nurse provision of oral healthcare and the solutions proposed to overcome these challenges.

A global approach to promoting research and evidence-based practice for community nurses.

Community health nurses world-wide provide health promotion and preventative care, support and guidance as well as clinical care for people with long-term conditions or needing acute care at home and end-of-life care, across all age groups. The importance of health care in the community has been growing globally as health systems recognise both the economic and human need for people to remain in their communities rather than in hospital. Research in community nursing provides evidence to support policy, practice and education. This article describes the global contribution that the International Collaboration for Community Health Nursing makes towards disseminating evidence that could improve the lives and health of communities.

The role of the district nurse providing care to service users with obsessive compulsive disorder.

Service users living with Obsessive compulsive disorder (OCD) often delay or avoid seeking diagnosis or treatment because of a fear of judgement or feelings of shame associated with their obsessions and compulsions. They may feel that their behaviour defies societal norms, which can lead to social isolation, and in turn, further contribute to health inequality. When such individuals present with physical illness and are seen by district nurses, it is imperative that behaviours are understood and approached appropriately. It is important to develop therapeutic relationships and consider their holistic wellbeing. Developing a close working relationship with the mental health team as a multidisciplinary team and using the team as a resource may contribute to the overall health outcome of service users with OCD.

Self-neglect as a significant public health issue: exploring the responsibility of the SPCDN.

Self-neglect is a recognised form of abuse affecting individuals across the lifespan. Gaps are evident within current data to support its prevalence; thus, it is considered to be an under-researched and under-reported phenomenon. Evidence suggests that there are multiple risk factors which contribute to self-neglect and sources recognise it leads to poorer health outcomes. Specialist Community Practitioner District Nurses (SCPDNs) deliver care across a diverse demographic and continuously assess risk for individuals in complex environments leading and managing the care of individuals who self-neglect. It is therefore essential that SCPDNs are equipped with the knowledge and skills required to therapeutically assess the health needs of this patient group and lead on the coordination of care. This article aims to explore the subject of self-neglect as a public health concern and appraise the role and responsibilities of the SCPDN within community nursing practice.

Falls prevention in older people and the role of nursing.

Falls among older individuals pose a significant public health challenge globally, impacting both individual wellbeing and healthcare systems. This article examines the importance of falls prevention in older people and the pivotal role of nursing in this domain. It presents statistics indicating the high prevalence of falls among older adults, highlighting their substantial impact on morbidity, mortality and healthcare costs. Furthermore, it discusses the multifactorial nature of fall risk factors, including age-related changes, chronic health conditions, medication use, impaired mobility, sensory deficits and environmental hazards. Nursing interventions encompass comprehensive assessments, personalised care plans, patient education and advocacy efforts aimed at reducing fall risks and enhancing safety. By addressing intrinsic and extrinsic factors contributing to falls, nurses contribute significantly to improving the quality of life for older adults and reducing the economic burden associated with fall-related injuries.

Discharging older patients from hospital to homecare: conflicts in collaborative practices among nurses across sectors.

BACKGROUND: Collaboration is a key factor influencing the quality and safety in patients transition between sectors. However, specific collaborative practices may give rise to conflict between hospital nurses and community nurses. AIMS: To gain a deeper understanding of collaborative practices which have the potential to fuel tension in collaboration between hospital nurses and community nurses during discharge of older patients from hospital to homecare. METHODS: A meta-ethnography approach was used in this study and a systematic literature search was conducted in 2022. RESULTS: Five themes were identified in the analysis. These themes revealed how uncertainty, limited confidence in information and personal attitude in communication may fuel tension between hospital nurses and community nurses. Tensions arising from a negative loop emerged because of uncertainty, causing a growing rift between hospital nurses and community nurses, leaving them as opponents rather than collaborators. The authors suggest that policy makers and managers can break this loop by underpinning shared policies and awareness of common objectives.

'No health without mental health': where are we now?

Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training.