Experience of Patients With Rheumatoid Arthritis: A Qualitative Study of a Nurse-Led Clinic.

Rheumatoid arthritis (RA) is an extremely prevalent chronic inflammatory rheumatic disease. This study explores the experiences of patients with RA under nurse-led care, the roles that nurses play, and the outcomes achieved when applying the patient-centered care (PCC) approach. A purposive sample of 12 participants who had been diagnosed with RA for at least 1 year were recruited from a nurse-led rheumatology clinic. They were also receiving treatment with disease-modifying antirheumatic drugs. All of the participants reported high levels of satisfaction with the care they received in the nurse-led clinic, along with high levels of medication adherence. The nurses were highly accessible to the participants, and they regularly communicated information regarding their symptoms, medication, and treatment management. These findings illustrate the importance of the holistic care that nurses provide to their patients, as the participants agreed that nurse-led services could have a wider outreach in hospitals and the community.

Experiences of nurses working in nurse-led clinics in Traditional Chinese Medicine hospitals: A focused ethnographic study.

BACKGROUND: Traditional Chinese Medicine (TCM) nurse-led clinics (NLC) is an innovative working model in China, representing the specialization and extension of nurses' role. However, as a pioneer in TCM nursing, this new model of working is facing both opportunities and challenges because it is known little about the operational status of NLCs. AIMS: To explore the experiences of nurses who work in NLC in TCM hospitals. MATERIALS & METHODS: A focused ethnographic study was conducted in three TCM hospitals affiliated with Guangzhou University of Chinese Medicine. We interviewed eleven nurses in those hospitals and observed seven of them working with patients. We used snowball sampling for data collection including interview, non-participant observation and documents from medical records. All the data were processed as following steps: (a) coding for descriptive labels; (b) sorting for patterns; (c) identifying outliers or negative cases; (d) generalizing with construction and theories and (e) noting reflective remarks. RESULTS: Nurse-led clinics help nurses develop their skills and knowledge that are highly recognized by public since they meet the growing needs of patients and also relieve the workload of physicians in the hospitals. However, lack of specialization is still a major challenge in NLCs due to insufficiency of full-time staff with specialized education, nurse-led practice without standardized guidelines, restrictions on prescription right of nurses, and also inadequate support from hospitals. DISCUSSIONS: As a revolutionary innovation of working model for nurses in TCM hospitals, NLCs could improve quality of care and lead to a comprehensive promotion of nursing career. However, there are several challenges on providing high quality care for patients whilst improving educational development of nurses. This study suggests that nurses, hospital administration and the government should cooperate with each other to develop standard nursing programs for NLCs. CONCLUSIONS: It is imperative to identify nursing roles, collect available resources, and develop supportive policies and training programs to enhance the quality of NLCs.

Nurse Led Clinics; a Novel Model of Care for Compensated Liver Cirrhosis: A Qualitative Analysis.

A nurse-led cirrhosis clinic model for management of stable, compensated cirrhotic patients is practised in our unit since 2013, wherein these patients are reviewed every six months by specialist nurses in community clinics under remote supervision of hepatologists. We evaluated the experiences of patients and healthcare providers involved in the model to understand the acceptability, strengths, and limitations of the model and obtain suggestions to improve. A qualitative design using in-depth interviews was employed, followed by thematic analysis of eight patients, one attending physician both nurse and hospital clinics, four hepatologists, and three experienced specialist nurses running the nurse-led cirrhosis clinic. Patients expressed satisfaction and a good understanding of the nurse-led cirrhosis clinic, preferring it to hospital clinics for better accessibility and the unique nurse-patient relationship. Upskilling and provision of professional care in a holistic manner were appreciated by specialist nurses. The hepatologists expressed confidence and satisfaction, although they acknowledged the difference between the medical training of specialist nurses and hepatologists. The greater availability of hospital clinic time for sick patients was welcomed. Increased specialist nurse staffing, regular forums to promote specialist nurse learning, and formalization of the referral process were suggested. No adverse experiences were reported by patients or staff. The nurse-led cirrhosis clinic model for compensated liver cirrhosis was well received by patients, hepatologists, and specialist nurses. Wider implementation of the model could be considered after further investigations in other settings.

A comparative study of PhD and DNP nurses in an integrated health care system.

BACKGROUND: A vast literature exists on doctorally-prepared RNs in academia, but little is known about those in practice settings. PURPOSE: The purpose of this study was to explore demographic, educational, and employment characteristics, as well as practice patterns and professional accomplishments of doctorally-prepared RNs in one practice setting. METHODS: Survey of approximately 100 doctorally-prepared RNs in an integrated health system were surveyed. DISCUSSION: Doctors of Nursing Practice (DNPs) outnumber PhDs three to one in the institution. Several statistically significant differences exist between them: DNPs are younger and most likely hold advanced practice nursing positions; PhDs are 10 years older and more likely hold administrative or leadership positions. Little evidence exists that neither nurses nor administrators understand the skills and knowledge that doctorally-prepared RNs bring to the organization. This is particularly true for DNPs who predominantly hold clinical positions also held by master's-prepared RNs. CONCLUSION: Advocates for continued growth of DNPs in academia and practice should partner more closely to clarify the skills and talents that doctorally-prepared nurses bring to clinical settings.

Atuação de enfermeiros na estratégia saúde da família às crianças que sofrem maus-tratos: uma revisão integrativa / The performance of nurses in the family health strategy for children suffering maltreatment: an integrative review / El desempeño de las enfermeras en la estrategia de salud familiar para niños que sufren maltrato: una revisión integrativa

Objetivo: analisar na literatura científica as evidências sobre a assistência de enfermeiros que atuam na estratégia saúde da família às crianças que sofrem maus-tratos. Método: Revisão integrativa realizada nas bases de dados: Web of Science, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cumulative Index to Nursing and Allied Health Literature e Medical Literature and Retrivial Sistem online, no período de março a maio de 2021.Resultados: Foram selecionados oito estudos que emergiram as categorias: conhecimento da prática profissional dos enfermeiros em casos de violência infantil; despreparo e desproteção dos enfermeiros com relação à tomada de decisão frente aos casos de violência e dificuldades enfrentadas pelos enfermeiros da atenção primária à saúde mediante o encaminhamento de casos de violência. Conclusão: A falta de preparo assistencial pelos enfermeiros é identificada pela ausência de um protocolo operacional padrão para nortear a assistência a crianças vítima de violência infantil.

Objective: to analyze the evidence in the scientific literature about the assistance provided by nurses who work in the family health strategy to children who suffer abuse. Method: Integrative review carried out in the following databases: Web of Science, Embase, Latin American and Caribbean Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature and Medical Literature and Retrivial Online System, from March to May of 2021. Results: Eight studies were selected that emerged in the following categories: knowledge of nurses' professional practice in cases of child violence; nurses' unpreparedness and lack of protection regarding decision-making in cases of violence and difficulties faced by nurses in primary health care through the referral of cases of violence. Conclusion: The nurses' lack of care preparation is identified by the absence of a standard operational protocol to guide the assistance to children who are victims of child violence.

Objetivo: analizar la evidencia en la literatura científica sobre la asistencia brindada por enfermeras que trabajan en la estrategia de salud familiar a los niños que sufren maltrato. Método: Revisión integrativa realizada en las siguientes bases de datos: Web of Science, Embase, Literatura Latinoamericana y Caribeña en Ciencias de la Salud, Índice Acumulativo de Literatura en Enfermería y Afines en Salud y Literatura Médica y Sistema Retrivial Online, de marzo a mayo de 2021. Resultados: Se seleccionaron ocho estudios que surgieron en las siguientes categorías: conocimiento de la práctica profesional del enfermero en casos de violencia infantil; la falta de preparación y desprotección de las enfermeras en la toma de decisiones en casos de violencia y las dificultades que enfrentan las enfermeras en la atención primaria de salud a través de la derivación de casos de violencia. Conclusión: La falta de preparación asistencial de las enfermeras se identifica por la ausencia de un protocolo operativo estándar que oriente la atención a los niños víctimas de violencia infantil.

Research utilisation in clinical practice: the experience of nurses and midwives working in public hospitals.

BACKGROUND: Nurses and midwives play a vital role to utilise research in clinical decision-making practice. However, limited support for research utilisation and barriers of research utilisation hamper to utilise up-to-date research findings in clinical practice. Therefore, this study aimed to explore nurses' and midwives' experience of research utilisation in public hospitals. METHODS: A qualitative descriptive approach was conducted to explore nurses' and midwives' experience of research utilisation in clinical practice within South Gondar Zone public hospitals from January 3 to June 28, 2020. A total of 20 interviewees, 40 participants of FGDs, and 8 observations were considered in the study. Data from the interview, FGD, and observation were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through thematic content analysis. RESULTS: Nurses' and midwives' experience of using research findings in clinical decision-making emerged as "the non-intentional research utilisation" the main theme. Data analysis produced as "the belief towards research utilisation", "the limited support for nurses and midwives", and, "the perceived barriers of research utilisation" as the three themes. Participants believed that the non-use of the primary research was recommended due to fear of accountability for client harm. The limited support for nurses' and midwives' experience of research utilisation decrease nurses' and midwives' confidence to utilise research in clinical practice. Knowledge, attitude, time mismanagement, and the lack of motivation were perceived barriers to research utilisation. The lack of training and access to systematic review and meta-analysis research findings limited the research utilisation in clinical practice. CONCLUSIONS: The experience of research utilisation indicated that there was limited support for nurses and midwives to utilise research. Nurses and midwives did not utilise research in their clinical practice intentionally. This study identified that knowledge, negative attitude towards research utilisation, lack of training; time mismanagement, and lack of motivation were the perceived barriers to research utilisation. Therefore, the promotion of adopting the research utilisation and training on the identified barriers are mandatory. Nurses and midwives play a vital role to utilise research in clinical decision-making practice. However, the limited support for research utilisation and barriers of research utilisation hamper the utilisation of up-to-date research in clinical practice. Therefore, this study aimed to explore nurses' and midwives' experience of using the knowledge obtained from research findings in clinical and healthcare decision-making practice within public hospitals. The experience of research utilisation among nurses and midwives working in public hospitals was studied. There was limited support for nurses' and midwives' experience of research utilisation. Nurses and midwives did not utilise research in their clinical practice intentionally. The knowledge, negative attitude towards research utilisation, lack of training, time mismanagement, and lack of motivation were the perceived barriers to research utilisation. Therefore, the promotion of adopting the research utilisation and training on the identified barriers are mandatory.

Defining Expertise in Cancer Nursing Practice.

BACKGROUND: Thirty-five years ago, Benner defined an expert nurse as one who applies deep knowledge and experience across different contexts and clinical situations. Since that time, there has been little exploration of expertise in cancer nursing. OBJECTIVES: To explore and describe characteristics of expert cancer nurses and to consider whether Benner's typology of an expert nurse remains relevant in today's complex oncology settings. METHODS: An exploratory, descriptive study using audio-recorded focus group methodology was undertaken. Audio-recordings were transcribed, and an inductive thematic analysis approach applied to the data. Nurses also documented key characteristics of expert practice on Post-it notes to illustrate dominant characteristics. RESULTS: Twenty-four registered nurses from a comprehensive cancer center in Australia took part in 1 of 3 focus groups. Seven key themes were identified: knowledge, leadership, adaptability, communication, motivation, patient-centered care, organization, and culture. Key word cloud characteristics included knowledge, compassion, motivation, experience, and communication. CONCLUSIONS: Many of the expert characteristics identified in this study reflect traits common to other nursing specialty groups. Of particular relevance to cancer nurses was "adaptability," reflecting the complexity of contemporary cancer care and reaffirming Benner's definition of an expert nurse as one who can fluidly connect knowledge and experience to unfamiliar practice contexts. IMPLICATIONS FOR PRACTICE: Understanding characteristics of expert cancer nurses may help inform and support professional practice advancement and guide future research about select characteristics of expert cancer nurses to patient- and system-level outcomes.

Barriers and enablers for midwives to use the Nursing and Midwifery Board of Australia's Endorsement for scheduled medicines for midwives.

BACKGROUND: In 2010, the Nursing and Midwifery Board of Australia introduced a new registration standard: Endorsement for scheduled medicines for midwives. The endorsement enables midwives to provide women with Medicare-rebatable care, prescribe relevant medications, and order relevant Medicare-rebatable diagnostics. Translating endorsement education into clinical midwifery practice has been slow, indicating the presence of barriers affecting midwives' ability to use this standard, despite it increasing their scope for service provision. AIM: To discover the mechanisms affecting midwives' ability to work to full scope of practice after completing a programme of study leading to endorsement. METHODS: An observational (non-experimental) design was used. Midwives who had completed an education programme leading to endorsement were invited to complete a survey. Descriptive statistics were used to analyse the quantitative questions and content analysis was conducted on the qualitative data. FINDINGS: Results indicated that barriers - such as the limitations of Medicare provisions for endorsed midwives and a general lack of support for the role - restrict endorsed midwives' ability to provide quality maternity services. Having some form of support for the role may act as an enabler, in addition to midwives having personal determination and confidence in their ability to use the endorsement. Recommendations to strengthen the endorsed midwife's role include facilitating endorsement use in the public sector, relaxing Medicare Benefit Schedule and Pharmaceutical Benefit Scheme restrictions, raising awareness of the role and scope, and improving midwives' pre-endorsement preparation. CONCLUSION: This study highlights the need for an all-of-system approach to support and develop the endorsed midwife's role.

French annual national observational study of 2015 outpatient and inpatient healthcare utilization by approximately half a million patients with previous heart failure diagnosis.

BACKGROUND: Heart failure management guidelines have been published, but the degree of adherence to these guidelines remains unknown. AIMS: To study in 2015 healthcare utilization and causes of death for people previously identified with heart failure. METHODS: The national health data system was used to identify adult general scheme (86% of the French population) hospitalized for heart failure between 2011 and 2014 or with only a long-term chronic disease allowance for heart failure. The frequency and median (interquartile range) of at least one healthcare use among those still alive in 2015 was calculated. RESULTS: A total of 499,296 adults (1.4% of the population) were included, and 429,853 were alive in 2015; median age 79 (68-86) years. At least one utilization was observed for a general practitioner in 95% of patients (median 8 [interquartile range 5-13] consultations), a cardiologist in 42% (2 [1-3]), a nurse in 78% (16 [4-100]), a loop diuretic in 64% (11 [8-12] dispensations), an aldosterone antagonist in 21% (8 [5-11]), a thiazide in 15% (7 [4-11]), a renin-angiotensin system inhibitor in 68% (11 [8-13]), a beta-blocker in 65% (11 [7-13]), a beta-blocker plus a renin-angiotensin system inhibitor in 57%, and a beta-blocker plus a renin-angiotensin system inhibitor plus an aldosterone antagonist in 37%. Hospitalization for heart failure was present for 8% (1 [1,2]). Higher levels of healthcare utilization were observed in the presence of hospitalization for heart failure before 2015. Among the 13.9% of people who died in 2015, heart failure accounted for 8% of causes, cardiovascular disease accounted for 39%. CONCLUSIONS: General practitioners and nurses are the main actors in the regular follow-up of patients with heart failure, whereas cardiologist consultations and dispensing of first-line treatments are insufficient with respect to guidelines.

Key competences of outpatient nurses, as perceived by patients attending nurse-led clinics - An integrative review.

AIM: The aim of this review was to identify key competences of outpatient nurses, as perceived by patients attending nurse-led clinics. BACKGROUND: The increased demand for nurses to manage treatment and care in hospital outpatient clinics requires a better understanding of nurses' competences important to outpatients. DESIGN: An integrative review using Whittemore and Knafl's five-stage model. METHODS: Relevant studies were located by systematically searching PubMed, CINAHL and Scopus. A group of three researchers assessed the studies found and the quality of the included studies using the CASP tool. Data were extracted and analysed by thematic analyses. The current study was evaluated using PRISMA checklist. RESULTS: Nine studies met the inclusion criteria. Three key competences emerged: providing access, sharing knowledge and establishing relationships. The key competences were supported by ten sub-themes that were characterised by nurses' actions and qualities, derived from the included studies. CONCLUSIONS: The identified key competences reflected a holistic approach that encompasses knowledge, skills and attitudes, indicating outpatient nurses being able to manage different ways of involving patients, which may lead to the consideration of outpatient consultations as a kind of negotiation, based on a respectful dialogue. RELEVANCE TO CLINICAL PRACTICE: The findings are usable when optimising the performance and quality of the health workforce, including outpatient nurses, as recommended by WHO (World Health Organization, Global strategy on human resources for health: Workforce 2030, 2016). Furthermore, the identified knowledge emphasises the need for clinical skills training and academic education, specially targeted outpatient nurses, in order to enable the nurses to become experts in specific practice settings.

The experiences of privately practising midwives in Australia who have been reported to the Australian Health Practitioner Regulation Agency: A qualitative study.

BACKGROUND: In Australia the majority of homebirths are attended by privately practising midwives (PPMs). In recent years PPMs have been increasingly reported to the Australian Health Practitioner Regulation Agency (AHPRA) mostly by other health professionals. PURPOSE: to explore the experiences of PPMs in Australia who have been reported to the AHPRA. METHODS: A qualitative interpretive approach, employing in-depth interviews with eight PPMs was undertaken and analysed using thematic analysis. A feminist theoretical framework was used to underpin the research. RESULTS: The majority of reports made to AHPRA occurred when midwives supported women who chose care considered outside the recommended Australian College of Midwives (ACM) Consultation and Referral Guidelines. During data analysis an overarching theme emerged, "Caught between women and the system", which described the participants' feelings of working as a PPM in Australia. There were six themes and several sub-themes: The suppression of midwifery, A flawed system, Lack of support, Devastation on so many levels, Making changes in the aftermath and Walking a tight rope forever. The findings from this study reveal that midwives who are under investigation suffer from emotional and psychological distress. Understanding the effects of the process of investigation is important to improve the quality of professional and personal support available to PPMs who are reported to AHPRA and to streamline processes. CONCLUSION: It is becoming increasingly difficult for PPMs to support the wishes and needs of individual women and also meet the requirements of the regulators, as well as the increasingly risk averse health service.

A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis.

OBJECTIVE: To determine whether a patient-initiated DMARD self-monitoring service for people on MTX is a cost-effective model of care for patients with RA or PsA. METHODS: An economic evaluation was undertaken alongside a randomized controlled trial involving 100 patients. Outcome measures were quality of life and ESR assessed at baseline and post-intervention. Costs were calculated for healthcare usage using a United Kingdom National Health Service economic perspective. Sensitivity analysis was performed to explore the impact of nurse-led telephone helplines. Uncertainty around the cost-effectiveness ratios was estimated by bootstrapping and analysing the cost-effectiveness planes. RESULTS: Fifty-two patients received the intervention and 48 usual care. The difference in mean cost per case indicated that the intervention was £263 more expensive (P < 0.001; 95% CI: £149.14, £375.86) when the helpline costs were accounted for and £94 cheaper (P = 0.08; 95% CI: -£199.26, £10.41) when these costs were absorbed by the usual service. There were, however, statistically significant savings for the patient (P = 0.02; 95% CI: -£28.98, £3.00). When costs and effectiveness measures of ESR and quality of life measured, using the Short Form-12v1, were combined this did not show the patient-initiated service to be cost-effective at a statistically significant level. CONCLUSION: This patient-initiated service led to reductions in primary and secondary healthcare services that translated into reduced costs, in comparison with usual care, but were not cost-effective. Further work is needed to establish how nurse-led telephone triage services are integrated into rheumatology services and the associated costs of setting up and delivering them. TRIAL REGISTRATION: ClinicalTrials.gov, http://clinicaltrials.gov, ISRCTN21613721.

Fundamentos Nightingaleanos, cuidado humano e políticas de saúde no Século XXI / Nightingale fundamentals, human care and health policies in the 21st century / Fundamentos Nightingaleanos, atención humana y políticas de salud en el siglo XXI

Objetivo: estabelecer relações entre os fundamentos Nightingaleanos na sustentabilidade de uma clínica de cuidado humano em diálogo com conceitos que sustentam duas atuais políticas de saúde brasileiras. Conteúdo: a ciência da enfermagem se afirma em uma abordagem holística do ser humano, com vistas à saúde integral, ressaltando a pessoa na sua dimensão física, mental, emocional e espiritual. Este princípio sustenta práticas humanizadas de cuidado e também integrativas, na proposição de cuidados integrais centrados na pessoa e relacionamento terapêutico para promover a saúde e o bem-estar. As fontes principais foram a obra seminal de Nigthingale, teorias de enfermagem, textos aplicados da Política Nacional de Humanização e de Práticas Integrativas e Complementares de Saúde. Conclusão: os princípios básicos do cuidado propostos por Nightingale refletem-se em atuais políticas de saúde, contribuindo para ampliar a autonomia dos profissionais de enfermagem, na oferta de cuidados baseados em conceitos próprios, em favor de uma Enfermagem Integrativa e Humana.

Objective: to establish relations between Nightingale fundamentals on the sustainability of human clinical care in dialogue with concepts underpinning two of Brazil's current health policies. Content: nursing science is grounded on a holistic approach of the human being, with a view to comprehensive health, emphasizing subjects in their physical, mental, emotional and spiritual dimensions. This principle underpins integrative, humanized care practices in proposing comprehensive care centered on the human person and a therapeutic relationship designed to promote health and wellbeing. The main sources were Nightingale's seminal work, nursing theories, and applied texts from Brazil's National Policy of Humanization and Integrative, Complementary Healthcare Practices. Conclusion: The basic health care principles proposed by Nightingale, reflected in current health policies, contribute to expanding the autonomy of nursing personnel in the providing care based on concepts specific to nursing, in favor of Integrative, Human Nursing.

Objetivo: establecer relaciones entre los fundamentos de Nightingale sobre la sostenibilidad de la atención clínica humana en diálogo con los conceptos que sustentan dos de las políticas de salud actuales de Brasil. Contenido: la ciencia de la enfermería se fundamenta en un enfoque holístico del ser humano, con miras a la salud integral, enfatizando los sujetos en sus dimensiones física, mental, emocional y espiritual. Este principio sustenta las prácticas de atención integral y humanizada al proponer una atención integral centrada en la persona humana y una relación terapéutica orientada a promover la salud y el bienestar. Las fuentes principales fueron el trabajo fundamental de Nightingale, las teorías de enfermería y los textos aplicados de la Política Nacional de Humanización y Prácticas de Atención Integrativa y Complementaria de Salud de Brasil. Conclusión: Los principios básicos del cuidado de la salud propuestos por Nightingale, reflejados en las políticas de salud vigentes, contribuyen a ampliar la autonomía del personal de enfermería en la prestación de cuidados basados en conceptos propios de la enfermería, a favor de la Enfermería Integrativa, Humana.

A Nurse-Led Population-Based Health Education Project to Improve Infant Care Knowledge for an Old Order Mennonite Community.

Population health is changing the focus of nursing practice as nurses are challenged to focus on health promotion and education for communities rather than limiting their practice to restorative care for individual acute care patients. This new focus is necessary to improve knowledge of maternal and infant health among vulnerable populations. One particularly vulnerable population is members of Old Order Mennonite communities, who frequently rely on self-trained local midwives in the community for home births and home remedies when caring for their infants. Providing evidence-based education to members of this isolated population can be a challenge because they do not typically access information outside of the community. The purpose of this article is to share the process of developing, publishing, and disseminating a culturally sensitive infant care manual for an Old Order Mennonite community using a community-based participatory model and to highlight the impact nursing outreach can have on improving health knowledge.

Essential oncology nursing care along the cancer continuum.

Oncology nurses are at the heart of tackling the increasing global burden of cancer. Their contribution is unique because of the scale and the diversity of care roles and responsibilities in cancer care. In this Series paper, to celebrate the International Year of the Nurse and Midwife, we highlight the contribution and impact of oncology nurses along the cancer care continuum. Delivering people-centred integrated care and optimal communication are essential components of oncology nursing care, which are often played down. More oncology nurses using, doing, and leading research will further show the key nursing impact on care as part of a team. The oncology nurse influence in saving lives through prevention and early detection of cancer is noteworthy. Supportive care, the central pillar of oncology nursing, enables and empowers people to self-manage where possible. Globally, oncology nurses make a great positive difference to cancer care worldwide; their crucial contribution throughout the continuum of care warrants the inclusion and promotion of nursing in every country's cancer strategy. 2020 is the year of the nurse: let us take this learning to the future.

The completion of partograms: knowledge, attitudes and practices of midwives in a public health obstetric unit in Bloemfontein, South Africa.

INTRODUCTION: most maternal and 24.3% of infant deaths occur during childbirth. Interventions during childbirth may reduce maternal and neonatal deaths. The Guidelines for maternity care in South Africa (2015) stipulates that all observations during labour should be recorded on a partogram. The objective of this study was to assess the knowledge and attitudes of nursing personnel and to evaluate their practices of completing partograms at National District Hospital, South Africa. METHODS: a two-phase, quantitative, cross-sectional, descriptive study design was used. In phase 1, the knowledge and attitudes of midwives and nurses were evaluated. Midwives and nurses completed anonymous, self-administered questionnaires that assessed their knowledge and attitudes. In Phase 2, partogram practices were measured by assessing completed partograms using a data collection tick sheet. RESULTS: twelve of the 17 nursing personnel completed the questionnaires. More than 90% of participants answered basic partogram knowledge questions correctly, but only two thirds knew the criteria for obstructive labour and just more than half that for foetal distress. Participants displayed a positive attitude toward the use of partograms. Of the 171 randomly selected vaginal deliveries during the study period, only 57.1% delivered with a completed partogram. Most elements of foetal monitoring and progress of labour scored above 80%, however, for maternal monitoring scored poorly in 26.4% of cases. CONCLUSION: although 71.4% of partograms scored more than 75% for completion, the critical components that influence maternal and foetal death, like the identification of foetal distress, maternal wellbeing and progress of labour, were lacking.

Maternity connect: Evaluation of an education program for rural midwives and nurses.

BACKGROUND: Rural and regional health services often find it difficult to maintain their maternity service and skills of their maternity workforce and enable women to give birth close to home. The Maternity Connect Program is a professional development initiative aimed at supporting and upskilling rural and regional maternity workforces to meet their maternity population care needs. AIM: To evaluate the Maternity Connect Program from the perspectives and experiences of participating midwives/nurses and health services. METHODS: A retrospective audit of data routinely collected as part of the Maternity Connect Program: initial needs assessments (baseline survey), and one month and six months post-placement surveys completed by participants, placement health services and base health services. The main outcome measures were: participants' (midwives and health services) level of satisfaction with the Program; and changes in midwives'/nurses' perceived level of confidence in performing key midwifery skills after participating in the program. RESULTS: Respondents (n = 97 midwives/nurses; n = 23 base health services; n = 4 placement health services) were satisfied with the program and there was an increase in midwives/nurses' confidence when providing specific aspects of maternity care (birthing, neonatal and postnatal). Midwives/nurses report transferring skills learnt back to their base health service. CONCLUSION: The Maternity Connect Program appears to be a successful educational model for maintaining and increasing clinician confidence in rural and regional areas.

Experiences of registered nurse prescribers; a qualitative study.

Aims: This study aimed to investigate the experiences of registered prescribers and their perceptions of the enablers and barriers to registered prescribing and the value of this fledgling role. Background: The role of prescribing has been extended to registered nurses in New Zealand. By adding the designated prescribing role to a nurse's role, their scope of practice expands and nurses are able to provide patients with holistic care while achieving greater independence and role satisfaction. Yet new nurse prescribers can experience anxiety and fear when confronted with the reality of the responsibility of prescribing. Methods: Sixteen semi-structured interviews were conducted with registered nurse prescribers across New Zealand. Data were analysed using a general inductive approach and thematic analysis utilised to identify themes and sub-themes. Results: Sixteen registered nurse prescribers participated in the study. Three main themes emerged with sub-themes: ability to expand practice, improving access to care, and importance of working in a collaborative team. Participants explained how they enjoyed the challenge and responsibility of the new prescribing role yet were frustrated with the realities of the restrictions of what they could actually prescribe and in some cases lack of role recognition. Registered nurse prescribing also improved access to care as nurses felt they provided more comprehensive care, resulting in reduced wait times, better continuity of care and a reduction in patient costs. The participants highlighted the importance of working in a collaborative team and believed their ability to prescribe maximised clinician time, however cautioned the need for on-going clinical mentorship and a prepared and supportive work environment. Conclusions: The addition of registered nurse prescribing provides a number of advantages to individual nurses in terms of career development and job satisfaction, and to patients and the health care system. The benefits to health care consumers and the health care system align directly to health care priorities of improving equity and access to care. Impact statement: Registered nurse prescribers perceive a number of advantages to the addition of prescribing to their own practice and benefits to patients and the health care system by enabling more accessible and cost-effective care.

Nurse- and Midwife-Led HIV Services in Eastern and Southern Africa: Challenges and Opportunities for Health Facilities.

In eastern and southern Africa, much is unknown about implementation of nurse-initiated and managed antiretroviral therapy (NIMART). The purpose of this study was to identify perceived barriers and facilitators of NIMART for the prevention of mother-to-child transmission and pediatric HIV services in high-volume, high HIV-burden health facilities across this region. A total of 211 nurses, midwives, and nurse midwives and 62 supervisors from 30 health facilities in 11 countries participated in this mixed-methods evaluation. The findings show that although nurses, midwives, and nurse midwives clearly had the authority to provide NIMART services, they did not necessarily feel that they were well prepared and supported to do so. Deficits in supportive supervision and clinical mentorship were viewed as substantial challenges to effective provision of NIMART for the prevention of mother-to-child transmission and pediatric HIV services-particularly with respect to pediatric HIV services. Health facilities have important opportunities to advance NIMART practice through strengthening these aspects of in-service support.

Achieving Hepatitis C Elimination By Using Person-Centered, Nurse-Led Models of Care: A Discussion of Four International Case Studies.

Nurse-led models of care are an important strategy in the management of patients with chronic disease because of the person-centered approach that allows the needs of the individual to be prioritized and addressed in accessible settings. Hepatitis C is caused by a blood-borne virus that can cause liver disease and liver cancer; it predominantly affects marginalized populations, including people who inject drugs. Since 2013, all oral, direct-acting antiviral regimens have been available to cure hepatitis C. Nurses are well placed to be involved in the delivery of hepatitis C testing and treatment because of their extensive reach within marginalized communities and holistic approach to patient care. Four case studies of nurse-led models of care operating in Australia, Canada, the United Kingdom, and the United States are presented to illustrate the important role nurses have in delivering accessible, person-centered hepatitis C testing and treatment. Each case study demonstrates the success of overcoming barriers to hepatitis C testing and treatment such as geographic isolation, incarceration, social marginalization, and inflexible healthcare systems. Achieving the global target to eliminate hepatitis C by 2030 will require the nursing profession to embrace its role as the first point of contact to the healthcare system for many members of marginalized communities potentially at risk of hepatitis C. Nurses are well placed to reduce barriers and facilitate access to healthcare by scaling up activities focused on hepatitis C testing and treatment.