[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.

Nurses and Churches Are Essential to Postdisaster Recovery.

Two nurses, a mother and daughter, each participated in disaster relief efforts after Hurricane Andrew in 1992 and Hurricane Dorian in 2019. In recounting their experiences, both nurses demonstrate the vital contributions nurses can make at the sites of disasters. The invaluable role of churches in contributing to the disaster recovery effort is also described.

Social prescribing: a 'natural' community-based solution.

This paper discusses social prescribing as part of the wider NHS England universal personalised care model, and it describes how community nurses can engage with social prescribing systems to support community resilience. A case study based on the example of gardening, as a nature-based social prescription provided by the RHS Bridgewater Wellbeing Garden, is provided to illustrate the scope, reach and impact of non-medical, salutogenic approaches for community practitioners. The authors argue that social prescribing and, in particular, nature-based solutions, such as gardening, can be used as a non-medical asset-based approach by all health professionals working in the community as a way to promote health and wellbeing. They consider how the negative impact of social distancing resulting from COVID-19 restrictions could be diluted through collaboration between a holistic, social prescribing system and community staff. The paper presents a unique perspective on how community nurses can collaborate with link workers through social prescribing to help combat social isolation and anxiety and support resilience.

Using the Omaha System to Evaluate the Integration of Behavioral Health Services into Nurse-Led Primary Health Care.

Integrating behavioral health services into nurse-led primary care at one location ensures that individuals receive a comprehensive array of preventive and restorative services, based on their varying needs. A formative program evaluation of a federally funded behavioral health integration (BHI) project in a small nurse-led clinic used the Omaha System taxonomy to explore the changes in the documented practice of providers due to the BHI implementation. The evaluation provided evidence of the benefits of a collaborative care model to urban low-income, underserved, adults who were predominantly African American/Blacks.

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.

Transforming community nursing services in the UK; lessons from a participatory evaluation of the implementation of a new community nursing model in East London based on the principles of the Dutch Buurtzorg model.

BACKGROUND: Buurtzorg, a model of community nursing conceived in the Netherlands, is widely cited as a promising and evidence-based approach to improving the delivery of integrated nursing and social care in community settings. The model is characterised by high levels of patient and staff satisfaction, professional autonomy exercised through self-managing nursing teams, client empowerment and holistic, patient centred care. This study aimed to examine the extent to which some of the principles of the Buurtzorg model could be adapted for community nursing in the United Kingdom. METHODS: A community nursing model based on the Buurtzorg approach was piloted from June 2017-August 2018 with a team of nurses co-located in a single general practice in the Borough of Tower Hamlets, East London, UK. The initiative was evaluated using a participatory methodology known as the Researcher-in-Residence model. Qualitative data were collected using participant observation of meetings and semi-structured interviews with nurse team members, senior managers, patients/carers and other local stakeholders such as General Practitioners (GP) and social workers. A thematic framework analysis of the data was carried out. RESULTS: Implementation of a community nursing model based on the Buurtzorg approach in East London had mixed success when assessed against its key principles. Patient experience of the service was positive because of the better access, improved continuity of care and longer appointment times in comparison with traditional community nursing provision. The model also provided important learning for developing service integration in community care, in particular, how to form effective collaborations across the care system with other health and social care professionals. However, some of the core features of the Buurtzorg model were difficult to put into practice in the National Health Service (NHS) because of significant cultural and regulatory differences between The Netherlands and the UK, especially the nurses' ability to exercise professional autonomy. CONCLUSIONS: Whilst many of the principles of the Buurtzorg model are applicable and transferable to the UK, in particular promoting independence among patients, improving patient experience and empowering frontline staff, the successful embedding of these aims as normalised ways of working will require a significant cultural shift at all levels of the NHS.

Development and delivery of a clinical leadership programme for integrated community teams.

Neighbourhood teams were formed throughout Worcestershire in early 2018, which led to a change in staff roles and responsibilities, as these are multidisciplinary community teams. It became apparent during the transition that many of the staff in band 6 roles required additional support and education to enable them to develop their knowledge and skills. Therefore, a clinical leadership programme was developed specifically for these staff. The programme followed the principles of the NHS Leadership Framework and consisted of six full-day training sessions. During the programme, staff identified issues within their team and developed a plan to address these issues over the following 6-12 months. The next two cohorts of the programme included staff from out-of-hours community nursing teams. The feedback from all delegates and managers was overwhelmingly positive, and delegates continue to implement their plans.

Integrated care systems and nurse leadership.

There will be significant changes to the way in which primary and community health services are provided in the wake of the NHS Long Term Plan published in January 2019. Community nurses are already preparing themselves for these changes by exploring models of care that are patient-centred and link to neighbourhood, place and system levels. This article discusses two examples of such models of care, the Buurtzorg and Embrace model, both from the Netherlands. Styles of leadership and associated development, both within nursing and on a multi-professional basis will be crucial to ensure success. This article outlines Alban-Metcalfe's engaging transformational leadership model as a potential platform to move to flatter, more diverse teams and collective leadership.

The effects of chair yoga with spiritual intervention on the functional status of older adults

Objective: "Functional status" is an individual's ability to fulfill his/her needs and to perform the activities of daily life independently. Functional decline can lead to a higher level of dependency. This study aims to investigate the effects of chair yoga with spiritual intervention on the functional status of older adults. Method: This quasi-experimental study employed a pre- and post-test design using a control group. The study involved an intervention group of 42 respondents and a control group of a further 42 respondents. The sample was selected using multistage random sampling. The data were analyzed using a t-test. Results: The results of the study show that the mean score for the intervention group was higher after the intervention (p=0.000). Furthermore, the mean score for functional status after the intervention was significantly higher for the intervention group than for the control group (p=0.000). Conclusions: It is concluded that the use of chair yoga with spiritual intervention is a useful preventive measure against functional decline in older adults. The study also suggests that this form of intervention should be considered as a complementary nursing therapeutic practice for older adults in the community

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Introducing community integrated nursing teams: How one Clinical Commissioning Group applied an evidence-based approach.

The present day collection of financial and demographic challenges confronted by health and social care mean that integrated services are undoubtedly essential to sustain adequate care. However, the impact of integrated care upon healthcare staff and patients as well as new ways of working will need to be demonstrated, with collaboration and engagement throughout any transition. This paper provides an overview of the evidence relating to the delivery of effective, integrated out-of-hospital care, with a discussion of the literature. It also considers how one Clinical Commissioning Group has begun the process of integration with the focus on community nursing services for the provision of better care for patients with an evidence-based approach.

Parish nursing: a unique resource for community and district nurses.

This paper examines the effect of parish nursing as a faith community initiative to support the work of district and community nurses and improve health outcomes. It discusses the reasons why faith communities might embark upon health initiatives, and describes the practice of parish nursing and its history and development in the UK. With reference to both quantitative and qualitative outcomes, the relevance of the practice in the UK health scene is assessed. The paper suggests that connecting with the third sector through parish nursing could enhance the work of community and district nurses; this would present additional sources of holistic care and health promotion and can be offered in an optional but complementary manner to the care provided through the NHS.

Nursing students' experiences of clinical placement in community settings: a qualitative study.

BACKGROUND: Changing community demographics and the rising incidence of chronic and complex conditions has exacerbated the primary care workload. Encouraging beginning nurses to view primary care nursing as a viable career option will help alleviate the workforce stress of this specialty. Whilst higher education institutions (HEI's) have increased the exposure of pre-registration nurses to community settings, there has been limited exploration of this experience from the perspective of pre-registration nurses. As potential key service providers, it is important to identify factors which influence how pre-registration nurses view primary care placements in the community. AIM: This study seeks to explore the experiences of pre-registration nursing students following community based clinical placements and to explore the impact of this placement on their learning. DESIGN: A qualitative design was employed in this study. PARTICIPANTS: Nine pre-registration nursing students were recruited from a research intensive single campus of an Australian university. METHODS: In-depth semi-structured interviews. FINDINGS: Findings are presented in the following four themes: (1) autonomy in practice: "you make your own decisions", (2) working with highly skilled nurses: "their knowledge was just incredible", (3) focusing on holistic care: "they'd obviously built rapport with these people", and (4) showing genuine interest in educating students: "they got me involved". CONCLUSION: Exposure to community settings was a positive learning experience for pre-registration nursing students. Further research needs to focus on the impact of these placements on both clinical skills acquisition and job choices into the future.

Faith community nursing scope of practice: extending access to healthcare.

The role of the Faith Community Nurse (FCN) is a multifaceted wholistic practice focused on individuals, families, and the faith and broader communities. The FCN is skilled in professional nursing and spiritual care, supporting health through attention to spiritual, physical, mental, and social health. FCNs can help meet the growing need for healthcare, especially for the uninsured, poor, and homeless. The contribution of FCNs on, primary prevention, health maintenance, and management of chronic disease deserves attention to help broaden understanding of the scope of FCN practice.