Spiritual support for people living with HIV/AIDS: a Brazilian explorative, descriptive study.

In this exploratory and descriptive research, we identified the meaning of religion and spirituality in the experience of patients at a public health service for treatment of HIV/AIDS in a Brazilian upcountry town. Eight participants were selected through theoretical sampling. Data were collected through semistructured interviews, and analyzed by means of qualitative content analysis. The emerging themes were religion: a path to support, and God is everything. Religion, as a path that leads patients to different sources of support, included exploration of different churches, acknowledgment of guilt, and finding strength to cope with the disease, rationalization of the disease process, meeting other churchgoers, and finding God and faith. God, an important source of support, was present in prayers, in the belief in healing through faith, and in the feeling of comfort and relief. Because spirituality and religion were seen as important sources of support, in this study we that health professionals include these aspects in care planning.

Diversity and challenges in the management of maternity care for migrant women.

AIM: To illuminate midwives' and public health nurses' perceptions of managing and supporting prenatal and postnatal migrant women in Norway. BACKGROUND: Migrant women are affected by social inequalities and likely to have had experiences during and after the migration process that could influence their physical, mental and social well-being. METHODS: Multistage focus group interviews were conducted and data were analysed in accordance to conventional interpretative qualitative content analysis. RESULTS: The overarching theme 'Managing and supporting educational, relational and cultural diversity in maternity care' was characterized by two themes 'Health challenges' and 'Cultural challenges'. Each theme contained several subthemes. The interviews revealed that Norwegian maternity care is not adjusted to migrant women's needs. The management is the same for everybody who avails of the service. CONCLUSION: The Norwegian model for managing cultural diversity in maternity care needs to be developed. Capacity building and a closer cooperation between maternity care services is necessary. IMPLICATIONS FOR MIDWIVES AND NURSING MANAGEMENT: Maternity care requires reflection at several levels to reduce disparities in individual health. In order to ensure continuity and a trusting relationship, it is necessary to organize leadership and adopt flexible models that support migrant women's health.

District nurse role in end-stage COPD: a review.

District Nurses (DNs) are core providers of end-stage care in the community but appear to have little contact with patients suffering from non-malignant diseases, such as chronic obstructive pulmonary disease (COPD). This review found limited literature describing the role of DNs in end-stage COPD care, and the studies that did touch on the subject restricted their discourse to the frequency of interaction. A clear bias of end-of-life services to patients with malignancy was noted, as well as a call for community services to extend care to all end-stage patients regardless of underlying disease. In addition, there was a further call for DNs to apply a more holistic approach to care, as described in the literature. Finally, it was clear that while ongoing community intervention is necessary for end-stage COPD patients, support and training is essential to equip DNs to care for these vulnerable patients.

Regulation of herbal medicines.

Complementary and alternative medicine is an increasingly popular form of health intervention used by millions of people in the UK each year. The demand for such therapies has seen their use grow and many have been adopted by district nurses as a supplement to the treatment and care they provide their patients. The use of complementary and alternative medicine is largely unregulated and this has led to increasing call for more effective regulation to ensure patient safety. Of particular concern recently has been the need to regulate the use of herbal medicines. This article considers the proposals for the reform of herbal medicines and professional and legal implications for district nurses who use complementary and alternative medicine in their practice.

High-fidelity simulation and emergency preparedness.

Ongoing threats of bioterrorism and the consequences of natural disasters require nurses entering the workforce to be competent in emergency preparedness. Nurses need to collaborate with multidisciplinary teams and use their critical thinking skills to provide safe nursing care during potentially chaotic public health emergencies. Using Institute of Medicine recommendations and Quality and Safety Education for Nurses competencies, the authors describe a public health emergency simulation exercise with undergraduate senior nursing students enrolled in a public health clinical course. Students applied chronic disease, mental health, and pharmacology knowledge acquired in previous nursing courses to an unfolding infectious disease outbreak while practicing their assessment, treatment, delegation, organizational, and leadership skills. The students' quantitative evaluation of the experience indicated that 90.36% thought the purpose of the experience was clear, 91.5% thought the importance of delivering safe care during a public health emergency was stressed, and 79.5% thought the presimulation briefing and postsimulation debriefing helped them understand and participate in the drill. Qualitatively, the students' reflections of the exercise indicated that although they initially felt overwhelmed and anxious, they realized the importance of participating in emergency preparedness and recognized their ability to apply nursing skills learned in previous courses.

Families' experiences of interaction with the public health nurse at the child health clinic in connection with mother's post-natal depression.

The birth of a new family member causes many changes in the way a family functions. Annually some 10% of mothers giving birth suffer from post-natal depression. This depression affects the mother herself, the baby and the functioning of the entire family. The healthcare personnel are faced with an important task in supporting the family in the course of changes occasioned by the birth of a baby. According to earlier studies, families with small children are fairly satisfied with the service provided by the child health clinics. The purpose of the present study was to form a theory of interaction with the public health nurse in the child health clinic when the mother is suffering from post-natal depression from the viewpoint of family. The data for the study were gathered by interviewing nine families (nine mothers and five fathers) where the mother had displayed symptoms of post-natal depression. The data were analysed using continuous comparative analysis of grounded theory. The concepts of the theory emerged as a lack of continuing relationship, a need to be equal partners, a lack of individuality and a lack of family care. The relationships between categories were lack of discussing, lack of being confidential and lack of getting help enough. The core category emerging was lack of holistic cooperation with unique family. In spite of the emphasis placed on family centeredness in the operating principles of the work in child health clinics, its implementation in practical work cannot be taken for granted. Because of the limited resources available to the clinics, it is the experience of depressed mother in particular that they are not treated sufficiently as individuals and that they are subjected to adjudication in the clinics. The parents felt that the personality of the public health nurse was crucial to how they felt about the service they obtained from the clinic.

District nurses' involvement in pain care: a theoretical model.

AIM: To explore district nurses care of chronic pain sufferers and to create a theoretical model that can explain the variation in district nurses experiences when caring for these patients. BACKGROUND: Many people suffer from chronic pain, which greatly affects their wellbeing and causes physical suffering and psychosocial limitations. District nurses frequently meet patients who suffer from chronic pain and consequent problems. District nurses often feel powerless and ill-equipped, and they experience difficulties during interactions with these patients. METHOD: This is a qualitative study with a theory-generating approach. Data were collected from interviews with 20 district nurses in five focus groups. Interviews were taped, transcribed and then analysed as per the grounded theory method. RESULTS: The result is a theoretical model of district nurses' involvement in pain care. The model: (1) illustrates three main conditions in the care situation that influence district nurses' involvement in pain care and (2) explains the connection between how district nurses actively or passively detect and actively or passively respond to patients with pain problems. CONCLUSIONS: The model explains why district nurses sometimes feel powerless or ill-equipped in dealing with chronic pain problems. Insufficient conditions make it difficult for district nurses to become involved with pain problems and thus result in passive detection of and passive response to pain problems. Supporting patients to communicate their pain, collaboration with and involvement from other professionals regarding pain care, the organisation's guidelines and support for pain care and training in pain care are interventions that will contribute to district nurses' involvement in pain care. RELEVANCE TO CLINICAL PRACTICE: Through the model, chronic pain care can be better explained and understood; consequently chronic pain care can be improved. The model can be used in each, unique, case-study analysis. Nursing staff and students can also use the model as a basis for discussions about chronic pain sufferers.

Qualitative study on the role of nurses as health case managers of children in foster care in California.

This qualitative study on nurses who provide health case management for children in foster care examined their vision for the care needed to improve health outcomes. A purposive sample of eight public health nurses was selected to participate in semistructured interviews. Data were analyzed using content analysis to formulate a narrative description of the nurses' vision. Two themes emerged from the data: (1) the desire to give holistic care with an emphasis on mental health care and (2) the difficulty with providing preventive care as a result of multiple causes of health problems.

Impact of primary care management on nursing documentation.

AIM: The aim was to investigate whether perceptions of electronic nursing documentation and its performance differed because of primary health care management. BACKGROUND: Success in leading people depends on the manager's personality, the context and the people who are led. Close proximity to clinical work, with manager and personnel sharing the same profession, promotes the authority to carry out changes. METHODS: This study comprised a postal questionnaire to district nurses and an audit of nursing records from two primary health care organizations, one with a uniprofessional (nursing) organization, and one with multidisciplinary health care centres with general practitioners and/or another profession as managers. RESULTS: Uniprofessional nurse management increased district nurses' positive perceptions of nursing documentation but did not affect documentation performance, which was inadequate regardless of management type. CONCLUSIONS: Positive perceptions of nursing documentation are bases for further development to a nursing documentation including a holistic view of the patient.

Using cooperative inquiry and clinical supervision to improve practice.

District nurses and a nurse lecturer used the process of co-operative inquiry (Heron, 1996; Reason and Heron, 2001) to research the value of regular, critical reflection in developing their practice. Stories and metaphor were shared and appraised through (i) supportive challenge and (ii) talking that critically informed learning (rather than reinforcing opinions or moaning). These methods were informed by clinical supervision and action research literature. The co-inquiry process made overt our tendencies to hide and the merit in sharing and in being ourselves, authentic (Hartrick 1997; McCormack 2003). In place of professional attitudes that present a 'we know best' stance, we are improving our nursing and education work through engaging more personally with others. Our relationships and humour help us to seek more holistic appreciation of experience than solitary self-reflection can provide, and we need dedicated time for this social, more critical appreciation.

Barriers to population-focused health promotion: the experience of public health nurses in the province of Manitoba.

There is growing evidence that population health is influenced by broad socio-environmental factors that require population-focused health promotion strategies. The author reports on a study of the perspectives of public health nurses (PHNs) on the nature of their health promotion practice in the Canadian province of Manitoba, highlighting their perceptions about barriers to population-focused health promotion. A descriptive, exploratory research design was used to conduct standardized open-ended interviews with 24 PHNs in 3 geographically and demographically diverse health authorities. There were remarkable similarities in PHNs' perceptions about their practice. Three categories of barrier to population-focused health promotion were identified: barriers at the level of individual PHNs; organizational barriers (culture, policies, processes); and extra-organizational barriers at the level of the community or province. The results point to a gap between the theory that population-focused health promotion is at the heart of PHN practice and the experience of PHNs at the 3 sites. A concerted effort to address the barriers is needed so that PHNs in Manitoba can play a leadership role in creating a health-care system that truly invests in population health.

Quality in preventive and health-promoting services: constructing an understanding through process.

AIM: To develop a model of service quality for health-promoting services. In assessing quality, there are difficulties in taking account of the views of multiple stakeholders, the process of the service and the organizational context within which the service is provided. This study set out to address these difficulties. METHODS: A collective case study that incorporated national data from public health nurses (n = 946; response rate 54%) and public health nurse managers (n = 24; response rate 75%) and four case study sites which included data collected from 27 mothers with infants. RESULTS: A model of service quality that takes account of multiple stakeholder constructions, organizational context, service process and consequences was developed. CONCLUSIONS: Seven steps of process coupled with five concepts around which quality is judged can provide a basis for understanding service quality in a predominantly preventive and health-promoting type service.

Managing long-term conditions: non-cancer-related lymphoedema.

This article outlines the assessment and management of this underpublicized condition using three cases as examples. It also highlights the requirement for healthcare services to be responsive and personalized to the needs of individuals suffering from lymphoedema, thus improving their quality of life and reducing the impact of those needs on health- and social-care services.