Referral criteria: perceptions and experiences of district nursing students in Northern Ireland.

An ever-ageing population and widening health inequalities intensify the complexity of care that is now delivered within community settings by district nurses. Appropriate referral criteria are required to facilitate the enhancement of efficient and equitable district nursing service provision. This study aimed to explore district nursing students' perceptions and experiences of district nursing referral criteria in Northern Ireland. A qualitative phenomenological approach was adopted using a purposive convenience sample of 10 district nursing students. Data were collected during online focus group interviews and analysed using a thematic framework. Four themes emerged: referral criteria; insight and inconsistency; task versus patient-centred care; and misunderstanding the service and referral quality. The themes reflect a lack of consensus with respect to referral criteria, contributing to inappropriate and poor-quality referrals. Appropriate and quality referrals to district nursing services are key to assuring sustainable service provision. Suitable access to district nursing services may be enhanced by developing consensus referral criteria.

[Gorgeous Colorful Rainbow: The Beauty and Sorrow of Indigenous People`s Health].

Residing across this island for over 8,000 years, Taiwan`s indigenous people represent the world`s northernmost population of Austronesian islanders. Although Taiwan`s more than 500,000 indigenous citizens today account for only 0.11% of the 300 million Austronesians worldwide, Taiwan and Taiwan`s long-thriving Austronesian culture played an indispensable role in the historical migrations of ancient Austronesian peoples from Mainland Asia and their proliferation throughout the Pacific (Council on Indigenous Peoples, n.d.). The cultural diversity of Taiwan`s indigenous people allowed their many ethnic groups to adapt to the island`s climatic and environmental diversity, ranging from high, temperate mountains to tropical coastlines, for thousands of years. These groups have adapted well to local conditions, developing living habits, livelihood patterns, life customs, and ceremonies suited to their lives. Traditional wisdom and knowledge, like a colorful rainbow, have shone from ancient times up through the present and are woven deeply through the unique life values of the 16 ethnic tribal groups on Taiwan Island. However, the modernization and transformation of Taiwan`s economy during the past three decades have left indigenous citizens significantly behind mainstream society in many important aspects, including average lifespan, income, education level, and access to medical resources, with mainstream society enjoying more social advantages and a longer average life span (Health Promotion Administration, 2017). Thus, social determinants have promoted various inequalities in health, and the rainbow is no longer beautiful under the impact of modern values. The inequitable distribution of healthcare resources and inadequate human resources have cast a shadow of sadness over this originally beautiful rainbow. Some scholars have raised the cultural security model as a possible framework for formulating policies and regulations to protect the health rights of disadvantaged groups (Coffin, 2007). Using knowledge and values to emphasize cultural safety in the health field and cultural awareness holds the potential of reversing the role of traditional wisdom and knowledge transmitters to gain a deep understanding of the health needs of ethnic groups and of implementing related strategies in acute, chronic, and long-term medical care. This issue is rooted in the current, inequitable deployment of long-term care resources and provision of policy recommendations. In this paper, we discuss strategies for considering and actualizing the main concerns and priorities of ethnic groups, cultivating long-term care 2.0 cultural safety seed tutors, and employing ethnically indigenous nurses in their hometowns / communities. Furthermore, in terms of caring for minorities, we also discuss the long-term care needs of disadvantaged groups such as individuals with mental health needs to achieve the goal of holistic care. We look forward to seeing the bright and colorful rainbow once again. From systemic, educational, and practice perspectives, we will jointly promote public health for all and work to let the beauty of the rainbow surpass the traces of sorrow.

The Practice of Home Visiting by Community Health Nurses as a Primary Healthcare Intervention in a Low-Income Rural Setting: A Descriptive Cross-Sectional Study in the Adaklu District of the Volta Region, Ghana.

BACKGROUND: Home visit is an integral component of Ghana's PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural district in the Volta Region of Ghana. Methodology. This descriptive cross-sectional study used 375 households and 11 community health nurses in the Adaklu district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self-designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analysed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analysed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion. RESULTS: Home visit is a routine responsibility of all CHNs. The factors that influence home visiting were community members' education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not adequately attend to minor ailments as 78% benefited from the service and wished more activities could be added to the home visiting package (24.5%). CONCLUSION: There should be tailored training of CHNs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants can also be trained to identify and address health problems in the homes.

Impact of technology on community nursing during the pandemic.

The purpose of this article is critical analysis, reflection and discussion in regards to the uses and impacts technology has had in community settings, specifically care homes during the COVID-19 pandemic. This will be investigated and supported with special emphasis on virtual assessment platforms and their use within the care homes settings, furthermore reviewing specific data collected in relation to the usage within community care homes. The article will outline the positive attributes and critically reflect upon the benefits of using audio and video conferencing when assessing patients and the beneficial impacts this has had on patients and the wider health community. While conversely addressing the obstacles and threats faced by clinicians in the use of assessment software.

Medication interventions for African-American adults: Practice-based evidence from two nurse-led clinics.

OBJECTIVE: This study was conducted to describe and examine the impact of medication intervention practices among African-American clients in two nurse-led community nursing centers (CNCs). METHODS: This study used a retrospective-descriptive design. Omaha System data from visits of 196 African-American adults living with chronic disease and having two or more CNC visits in which medication regimen was an identified problem and the main reason for the visit was analyzed. RESULTS: The sample had a mean age of 53.1 (6.67) and was primarily women (82%), uninsured, and with high school or less education. A total of 9,259 Medication regimen interventions were documented and implemented during 1,146 client CNC visits. A paired samples t test revealed statistically significant improvements in Knowledge (t = 2.434, p < .01). Behavior (t = 0.077, p = .94) and Status (t = 1.489, p = .14) remained unchanged, although the ratings trended toward improvement for each. CONCLUSION: This study provides evidence that the nursing center model of care does improve the knowledge of medications among African-American clients. The study also demonstrated the Omaha System's utility to evaluate the impact of nursing interventions in community settings.

Tavistock Neighbourhood Nursing Network: collaboration across settings.

The modern matron role in Tavistock has been developed to extend beyond the community hospital to oversee the provision of high-quality care across community nursing services by promoting a collaborative approach to learning and development, via the establishment of a Neighbourhood Nursing Network (NNN). The Tavistock NNN helps nurses to support each other to improve practice and work collaboratively. The aim is to target health promotion and ill health prevention where it will be most effective in order to make services sustainable for the future, including engaging with young people for the purpose of preventing illness. By being part of the network, the nurses have greater power to identify patients or groups of patients at risk of health inequalities and develop innovative ways to promote good health and prevent ill health. The project aims to ensure that high-quality care is delivered throughout the neighbourhood, giving patients and residents the confidence that standards will be consistent in all settings. The network has removed barriers between nursing services and facilitated multidisciplinary working for the benefit of the community they serve.

The Global Year of the Nurse and Midwife.

A closer look at the impetus for this designation and implications for U.S. nurses and midwives.

Caseload management framework for public health nurses in the Republic of Ireland.

This article outlines the steps taken in a change management project to develop and implement a national caseload management framework for clinical nursing activities within public health nursing services in the Republic of Ireland. It involved the development of metrics, definitions, data collection resources and relevant written procedures. It was developed and implemented over a period of 12 months and involved the engagement and involvement of approximately 2000 frontline, management and administrative staff. Implementation was challenging due to the lack of software systems to collect and return data and support caseload management. Alternative IT-based data collection systems were identified, and work is ongoing to develop additional metrics and resources that will continue to support caseload management.

Implementing an adapted Buurtzorg model in an inner city NHS trust.

District nursing in inner city areas faces many challenges, particularly with regard to sustaining the nursing workforce, and ensuring nurses gain satisfaction and enjoyment from their work. The Dutch Buurtzorg model of self-managing teams offers a potential solution to address these problems. In this article, the authors, as nurse leaders, reflect on their experience of implementing a 'test and learn' pilot of such a model in the NHS in London, and then on a further scaling up of the model. This paper offers insights related to such issues as governance and assurance as well pragmatism in supporting a process of change. It is hoped that these reflections will guide other nurse leaders in setting up and sustaining this excellent model of team management and care.

The implementation of the Mental Health Nursing Specialty in Andalusia. A community approach. / La implantación de la especialidad de Enfermería de Salud Mental en Andalucía desde un enfoque comunitario.

Health systems have a responsibility to respond to the new health needs of the population, which are characterized by factors such as aging, chronicity and/or dependency situations and which requires quality and specialized care adapted to different areas where care is provided, care offered by trained and increasingly qualified professionals to improve the health outcomes of the caregivers. In 2016, in Andalusia the regulatory framework by which is created the statutory professional category of nurse/specialists is published, including the specialty of Mental Health Nursing in the Andalusian Health Service. In the field of Mental Health, the development of this normative framework and the definition and occupation of positions, will allow the health system to combine the role of nurse specialist nurses with that of nurses who provide general care, registered nurses, in order to advance in the best response to the health needs of citizens in this area of care. The development of the specialty will be an added value both to improve the health outcomes of people with mental health problems, and to improve the quality of care, efficiency and sustainability of health systems.

The Process of Structuring Community Health Needs by Public Health Nurses Through Daily Practice: A Modified Grounded Theory Study.

PURPOSE: It is extremely difficult to apply the model learned in basic education for public health nurses (PHNs) to conduct community health assessments. The purpose of this study was to clarify the process by which community health needs can be structured through PHNs' daily practice. METHODS: Semistructured interviews were conducted in 29 PHNs, and continuous comparative analysis using a qualitative study was performed with a modified grounded theory approach. RESULTS: The participants "used their five senses to understand the relationship between the health and life of people" and "considered those who do not attend" by "learning from stakeholders." To verify such subjective feelings sourced from vague phenomena within the communities, subjective phenomena were converted into qualitative data. CONCLUSION: The application of the findings to organizational continuous education systems may not only help appropriately improve community health assessment methods but can also help improve the evaluation of daily practice and contribute to professional human-resource development.

Getting the best out of staff in a district nursing team: nurturing resilience.

District nursing (DN) teams deliver high-quality, complex care under extremely difficult circumstances. DN team resilience depends on the balance between capacity (funding and staff availability) and demand (workload and both clinical and quality standards). The caseload is where capacity and demand meet. Resilience in teams is stretched to the limits and often breached, despite which district nurses remain positive about their role. The overwhelming issue appears to be high workload exacerbated by staff shortages and increasing referrals to DN services. The time is rapidly approaching when district nurses may not be able to keep their caseloads open. If demand and capacity are to be better aligned, the demand should be better predicted, so that lead times are considered and resources are available.

A Slovenian Model of Comprehensive Care for Patients with Difficulties Accessing Healthcare: A Step Towards Health Equity.

Patients that cannot come to their family medicine practice (i.e. who have difficulties with access) do not receive the same preventive screening activities and management of their chronic diseases as those who can. Community nurses who provide healthcare to patients in their homes were trained in additional competencies, including screening for risk factors for selected diseases and the management of patients with selected chronic diseases. The presented model enables equal management of all registered patients, regardless of accessibility. It also fosters exchange of information within the team members and thus improves the quality of the team management of patients.

Getting anticipatory prescribing right in end-of-life care.

There is a growing number of people who need access to high-quality endof-life care in the home setting. This requires timely assessments of needs, ensuring good symptom management and recognising the roles undertaken by carers. For some patients, a range of medications may need to be put in place to relieve end-of-life symptoms, using 'anticipatory prescribing'. District nurses must ensure that they acknowledge the patient's voiced preferences and be mindful of the safety issues that arise with the supply of controlled drugs in the home. This article highlights the challenges faced by district nurses providing or dealing with anticipatory prescribing during end-of-life care.

Working with an environmental justice community: Nurse observation, assessment, and intervention.

Environmental justice (EJ) is the concept that all people and communities, regardless of their race and socioeconomic status, are entitled to enjoy an equally clean environment and resources. Communities where residents face environmental injustice and a higher risk of being exposed to environmental hazards due to their race, ethnicity, and socioeconomic status are called EJ communities. The purpose of this manuscript is to provide an example of nurses' involvement in observation, assessment, and intervention of an EJ community using a community-based participatory research (CBPR) model. Utilizing a multistage CBPR approach along with a mixed methods design, the project was carried out in three stages. Within the three stages, we conducted a thorough observation of the community, identified possible environmental issues, and collected health data and drinking water samples. Citizens' complaints included coal ash, failed sewer system, health issues, including kidney disorders and neuropathy. Drinking water samples (n = 59) showed lead levels higher than the health limits in 10.4% of samples. We intervened based on our short-term goal, reducing citizens' exposure to lead by education, and our long-term goal, reducing disparities, and exposures. We recommend that nurses increase their knowledge about EJ communities and environmental exposures and their health effects and be advocates for EJ communities.

Nursing Consultation in a Public Bathhouse: A Community Resource for the Vulnerable Population in a European Capital.

BACKGROUND: In Portugal's capital, Lisbon, there are 19 public showers (PS) attended by a vulnerable population. AIM: To describe the assessment and interventions performed during nursing consultations. METHOD: This is a quantitative, observational, and cross-sectional study. FINDINGS: In a convenience sample of 77 users, 52% are females, 43% are single, 52% do not possess any economic resources, 87% have mental health issues, and 32% are homeless. The main nursing focuses found were: arterial hypertension, disease management skills, and emotional suffering. The most used nursing intervention is listening, followed by the expression of feelings, valuing the individual and his/her story, analyzing causes, providing support, and comforting. CONCLUSIONS: This study shows that the main focus of the nursing care in these facilities is the human being. The respect for individuality and dignity was the primary concern, in an attempt to empower the individual to better manage his/her health and illness processes.

Family burden, social support and community health in caregivers of people with serious mental disorder. / Sobrecarga familiar, apoyo social y salud comunitaria en cuidadores de personas con trastorno mental grave.

OBJECTIVE: To identify caregivers' level of burden and analyze the factors associated with family care in mental health. METHOD: A cross-sectional descriptive study was conducted between January and July 2016. A sample of caregivers from seven public institutions and an association of relatives and patients was evaluated by identifying their burden and the contributing factors for reduction of these levels through the Zarit Burden Inventory instrument. The study was conducted according to recommendations of the ethics committees of the participating institutions. RESULTS: Participation of 107 caregivers. The main contributions refer that caregivers' active participation in associative dynamics, their attendance at psychoeducational activities and territorial connection to metropolitan areas with community resources decrease their level of burden. CONCLUSION: Community nursing is highly important and responsible for preventing levels of burden and increasing health levels. In addition, many proposals are formulated in order to favor social support networks by combining treatments and increasing public health programs in contact with the community.

The sustainability of a community nurses programme aimed at supporting active ageing in mountain areas.

BACKGROUND: Community Nurse Supporting Elderly iN a changing SOciety is a project funded by the European Union, which is aimed at developing an innovative care model based on community nurses to support active ageing in mountain areas. The planned sustainability of this innovative approach relies on social entrepreneurship, and this work highlights the necessary conditions for the existence of these entrepreneurial initiatives on the market, with community nurses' services purchased by the public health care system. METHODS: The authors propose a sustainability framework for this project based on three relevant dimensions (ie, health, organisation, and context), highlighting the necessary conditions for continued provision of health services beyond project conclusion. Then, considering the Piedmont Region and those aged 65 or older as target population, health outcomes are analysed, proposing a break-even analysis to calculate expected levels. RESULTS: According to our results, in order to care for 191 977 elderly people for 3 years, a successful pro-active approach is needed to prevent 1657 falls with hip fracture, reducing the prevalence of this adverse outcome by 36%. These are the expected health outcome levels for the existence of a social market, which can be achieved through the successful involvement of local public health organisations and stakeholders. CONCLUSIONS: Policy makers need clear information on the economic impact of extending this new intervention to the whole target population and on the required preconditions for its financial sustainability in terms of health outcomes. However, a participatory process involving all relevant local stakeholders and organisations is crucial to extend current achievements beyond project conclusion.

Challenges and Opportunities for Ex-Offender Support Through Community Nursing.

This study was a qualitative case study underpinned by "The Silences Framework" aimed at mapping the ex-offender health pathway towards identifying "touch points" in the community for the delivery of a nurse-led intervention. Participants meeting the study inclusion criteria were quantitatively ranked based on poor health. Participants scoring the lowest and endorsing their ranking through a confirmation of a health condition were selected as cases and interviewed over 6 months. Individuals in the professional networks of offenders contextualized emergent themes. The study indicated that pre-release, offenders were not prepared in prison for the continuity in access to healthcare in the community. On release, reintegration preparation did not routinely enquire whether offenders were still registered with a general practitioner or had the agency to register self in the community. Participants identified the site of post-release supervision as the "touch point" where a nurse-led intervention could be delivered.