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.

Drawing blood from young children: lessons learned from a trial in Ghana.

This paper reflects on lessons learned from a trial in Ghana assessing the impact of vitamin A supplementation on children's immune responses to tetanus and polio vaccines. There were more losses to follow-up than was anticipated at visits during which blood was drawn, owing to concerns or misconceptions about blood draw. The trial initially planned to recruit 960 children but had to recruit more because the proportion of infants lost to follow-up was greater than the anticipated 15%, resulting in a longer recruitment period. Of 1085 infants who were randomised into the trial, 767 (71%) completed follow-up at 6 months of age. It was notable that at the first (6 weeks) and fourth (6 months) visits at which blood was drawn, losses to follow-up were greater than at the second (10 weeks) and third (14 weeks) visits during which blood was not drawn. Losses to follow-up pose a threat to the validity of trials as there is a chance that those lost to follow-up may differ from those who remain in the trial. Monitoring losses to follow-up as they emerged and allowing mothers to witness the blood draw, as well as holding community meetings, helped to allay anxieties in the community.

Does supplementary prenatal nursing and home visitation support improve resource use in a universal health care system? A randomized controlled trial in Canada.

BACKGROUND: The addition of supplementary prenatal support may improve the health and well-being of high-risk women and families. The objective of this randomized controlled trial was to examine the impact of supplementary prenatal care on resource use among a community-based population of pregnant women. METHODS: Pregnant women from three urban maternity clinics were randomized (a) to current standard of physician care, (b) to current standard of care plus consultation with a nurse, or (c) to (b) plus consultation with a home visitor. Participants were 1,352 women who received 3 telephone interviews. The primary outcome was resource use (e.g., attended prenatal classes, used nutritional counseling). RESULTS: Overall, those in the nurse intervention group were more likely to attend an "Early Bird" prenatal class and parenting classes, and to use nutrition counseling and agencies that assist with child care. Women provided with extra nursing and home visitation supports were more likely to use a written resource guide, nutrition counseling, and agencies that assist with child care. Among women at higher risk (e.g., language barriers, young maternal age, low income), the nurse intervention significantly increased use of early prenatal classes, whereas the nurse and home visitor intervention significantly increased use of the written resource guide and nutrition counseling. The intervention substantially increased the amount of information received on numerous pregnancy-related topics but had little impact on resource use for mental health and poverty-related needs. Among those with added support, resource use among low-risk women was generally greater than among high-risk women. CONCLUSIONS: Additional support provided by nurses, or nurses and home visitors, can successfully address informational needs and increase the likelihood that women will use existing community-based resources. This finding was true even for high-risk women, although this intervention did not reduce the difference in resource use between high- and low-risk women.

[An experimental weekly visit of the ward at Higashi Yamato Hospital--a holistic cooperation].

The city of Higashi Yamato is located in the northern part of Tama, Suburbs of Tokyo, and the population of Higashi Yamato is approximately 80,000. The Higashi Yamato visiting nursing station was opened in April 1998. As of April 2006, we have over 100 patients, and the aggregate visiting nursing services have provided more than 600 cases. Our station's uniqueness is that forty percent of the patients have malignant neurological disorders and are terminal stage patients, and that they are all covered by medical care insurance. We also provide nursing services to patients who are expected to be dying peacefully at home averaging 4 patients per month. Higashi Yamato Hospital, attached to the visiting nursing station, is an acute phase hospital and has 274 beds. The average hospital stay for our patients was 13 days in 2005. We promote an early discharge from the hospital for patients who have a high need of medical and nursing care and for the patients who are at the terminal stage. However, there were many cases where visiting nursing care services were provided because of a local care manager's request rather than a visiting nursing care need for patients who will be discharged soon from the hospital and for those expecting to have the service. In reality, we have observed a family being felt that his or her patient was pushed out from the hospital, a family who has no confidence in taking a nursing task at home, and a family who could not cope with the patient's changing condition. Therefore, we wanted resolve these observed problems urgently to create close cooperation with the hospital in order to provide continued nursing care after a patient is discharged from the hospital and to have home medical care safely. As a result, we planned a visit to the ward on a weekly basis starting on February 2006. We report here because we had a good result.

The medical care of patients with primary care home nursing is complex and influenced by non-medical factors: a comprehensive retrospective study from a suburban area in Sweden.

BACKGROUND: The reduced number of hospital beds and an ageing population have resulted in growing demands for home nursing. We know very little about the comprehensive care of these patients. The objectives were to identify the care, in addition to primary health care, of patients with primary-care home nursing to give a comprehensive view of their care and to investigate how personal, social and functional factors influence the use of specialised medical care. METHODS: One-third (158) of all patients receiving primary-care home nursing in an area were sampled, and 73 % (116) were included. Their care from October 1995 until October 1996 was investigated by sending questionnaires to district nurses and home-help providers and by collecting retrospective data from primary-care records and official statistics. We used non-parametric statistical methods, i.e. medians and minimum - maximum, chi2, and the Mann-Whitney test, since the data were not normally distributed. Conditional logistic regression was used to study whether personal, social or functional factors influenced the chance (expressed as odds ratio) that study patients had made visits to or had received inpatient care from specialised medical care during the study year. RESULTS: 56 % of the patients had been hospitalised. 73 % had made outpatient visits to specialised medical care. The care took place at 14 different hospitals, and more than 22 specialities were involved, but local care predominated. Almost all patients visited doctors, usually in both primary and specialised medical care. Patients who saw doctors in specialised care had more help from all other categories of care. Patients who received help from their families made more visits to specialised medical care and patients with severe ADL dependence made fewer visits. CONCLUSIONS: The care of patients with primary-care home nursing is complex. Apart from home nursing, all patients also made outpatient visits to doctors, usually in both primary and specialised medical care. Many different caregivers and professions were involved. Reduced functional capacity decreased and help from family members increased the chance of having received outpatient specialised medical care. This raises questions concerning the medical care for patients with both medical and functional problems.

Holism in community leg ulcer management: a comparison of nurses in Sweden and the UK.

Collaboration between Kronoberg County Council and Växjö University, Sweden, and Hull and East Riding Community NHS Trust and the University of Hull, UK, enabled an international comparison of care of patients with chronic leg ulcers in the two countries. An aim of the survey study was to compare what "holistic care" meant to nurses working in primary health care (PHC) and nursing home settings in Kronoberg County (KC) and the East Riding of Yorkshire and Hull (ER). A questionnaire, which obtained quantitative and qualitative data, was returned by 311 (222 completed) nurses in KC and 124 in ER (response rates of 54 and 50% respectively). Assessment and planning of wound management focused on the wound. Swedish nurses paid more attention to patients' experience of the wound, lifestyle factors and environment than UK nurses, but in both countries holistic care appeared to be lacking. Issues for nurse education concerning holistic care were identified. Revision of guidelines and consensus documents to facilitate holistic care is also suggested.

Identifying nurse and health visitor priorities in a PCT using the Delphi technique.

A three-stage Delphi investigation was undertaken over a 4-month period in a primary care trust to identify the perceived clinical needs of nurses. Practice nurses, district nurses, health visitors and community hospital nurses all participated. In round 1, there were 28 replies from these groups of nurses, in round 2 there were 31, and in round 3 there were 25 replies. In round 1, 77 issues (excluding duplications) were identified. These were separated into three themes according to the most appropriate method for addressing the issue: education (29 issues), research (16 issues) and management (32). In round 2, the issues were redistributed in the three areas and staff were asked to choose the ten most important issues from education, research and management. Finally, in round 3 the ten issues in education, research and management were prioritized in terms of the "most pressing". The most pressing education need was recognizing accountability; the most pressing research need was caseload/dependency scoring--matching staff levels to workload, and the most pressing management need was risk management, e.g. staff safety. The results have identified locally that there is a gap between the modernization agenda and what nursing staff consider to be the issues that need addressing locally. If measures are not put in place to address these local issues, there is a danger that nurses will not take a full and active role in the modernization of the NHS.

Predicting in-home time of community care professionals.

The aim of this study was to test whether the client homebound score (CHS), the case management intensity score (CMIS) and the client priority visit score (CPVS) could be used to predict in-home time of professional caregivers in the Aspen community care program. A random sample of 34 community care clients from the different geographical areas of the Aspen Regional Health Authority was selected and the home visits for each client were tracked for three months. Information such as client demographics, the client diagnostic category, number and in-home time of visits was collected. In addition, the CHS, the CMIS and the CPVS were measured for each client. Data were analyzed, using a robust variance estimator regression model. CMIS was found to be the best predictor of in-home time (coefficient 9.521, p > 0.001), followed by the CHS and the CPVS.

Spirituality and spiritual care provided by parish nurses.

The high level of religious participation in the United States provides a venue for parish nursing, a holistic nursing specialty that emphasizes the relationship between spirituality and health. This descriptive study measured two aspects of spirituality (spiritual perspective and spiritual well-being) in a national sample of parish nurses and described variables related to their practice. Furthermore, it qualitatively examined the provision of spiritual care to clients in this parish nurse sample. Parish nurses scored high in spiritual perspective and spiritual well-being and reported an emphasis on health promotion and education in their activities. Three views of spiritual interventions (ideal, general, and specific) were reported. Types of spiritual interventions typically fell into one of four categories: religious, interactional, relational, and professional.

Frequency of and indications for wholly compensatory nursing care related to enteral food intake: a secondary analysis of the Belgium National Nursing Minimum Data Set.

This study describes the frequency of and indications used for total feeding assistance and tube feeding in a national representative sample of Belgian hospital patients (n = 421 314). Data from the 1990 national minimum nursing data registration was used. Orem's self-care model was used to describe and categorize types of nursing care and related indications. The scope of wholly compensatory nursing care was limited to total feeding assistance and tube feeding. This type of nursing care is indicated when self-care agency is undeveloped or cannot be used and when self-care demands are significantly increased. Based on review of the literature, hypotheses to indicate nursing care were formulated and tested. Wholly compensatory nursing care related to enteral food intake is given to 14.4% of the total patient population in Belgian hospitals. If self-care demand increases due to malnutrition, then this is an indication for total feeding assistance. If self-care agency decreases due to blindness, mental retardation, disorientation or upper extremity dysfunction, then this is also an indication for total feeding assistance. If self-care agency decreases due to impaired chewing, then this is an indication for tube feeding. This study has generated the first representative national nursing statistics about total feeding assistance and tube feeding in hospitals.

Health education and the immigrant Haitian mother: cultural insights for community health nurses.

Lack of information about health education from the perspective of immigrants was the basis of a descriptive survey of 30 Haitian mothers in southeast Florida. Subjects were interviewed regarding the value of health education received while seeking preventive health care for infants and preschool children in community health settings, their access to other sources of health education, and their perceptions of what community health care providers could do to assist them in improving child health. Ninety-seven percent took children for well-child care to medical facilities, and 66% received health education during the visits. Seventy percent had access to health-education programs through clinics or the media. Impediments to effective health education were lack of providers who speak Haitian Creole, need for more nurses, and long clinic waiting periods. Nurses were considered the best persons to do health teaching; radio and clinic lectures were the preferred media. Teaching was valuable if it was understandable and practical, reinforced parenting abilities, and allowed time for questions. Results are related to socioeconomic and political factors, traditional Haitian health culture, and cultural views of the cognitive development in children. Culture-specific strategies related to the modes and foci of health education are discussed.