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.

The contribution of decentralised nursing education to social responsibility in rural Arctic Norway.

This study explores and analyses decentralised nursing education in Finnmark County, Northern Norway, from 1991 to 2018. The study may have relevance for educational policy discussions and strategic planning. Our research question has been how decentralised nursing education can contribute to social responsibility by educating nurses rurally. The data collection includes documentation of 15 decentralised classes. The decentralised nursing education programme has been completed in nine rural communities in Finnmark County over 28 years and has resulted in 191 graduated nurses. Educating nurses locally influences recruitment and stability. The location of the study site determines where the recruited students come from. In future decentralised programmes, study sites should be located close to regions with a shortage of nurses. This is especially true of the eastern part of Finnmark, where recruitment to regular on-campus programmes is lowest. Limiting decentralised nursing programmes to local applicants should be considered. By prioritising local applicants, we will fulfil the university's responsibility to place qualified nurses in all parts of Finnmark.

Rural Nurse Managers' Perspectives into Better Communication Practices.

The aim of this qualitative study was to describe the communication perceptions of nurse managers in rural areas. Prior research in tertiary settings was the impetus for studying viewpoints in other settings. Grounded theory methods were used to collect and analyze interview data with nine managers from regional, critical access hospitals, and home health settings in central Pennsylvania. Nurse Managers associated successful communication with job satisfaction, work efficiency, and employee retention. Circumstances influencing communication involved discussion tones, techniques, resources, and environmental factors. Recommended techniques included regular conversations, diverse messaging, and conferencing huddles to improve information dissemination and workflow in rural settings.

End of life planning for 'hard to reach' communities.

Do 'hard to reach' communities exist? Or is more required of us as healthcare professionals to explore creative ways of engaging those who experience significant barriers in accessing health services?

Nursing in rural India.

Nursing in India is evolving, and the inequality of practice and standards between cities and villages affects the health of the population. This article describes the challenges of providing healthcare in rural parts of India, and how nurses have made the best use of available resources to strive to achieve healthcare goals.

Recruitment and Retention in Rural Nursing: It's Still an Issue!

A perennial issue for rural and remote communities in Canada and in other parts of the world is access to a healthcare delivery system including healthcare personnel to provide care to their residents. In total, 18% of Canadians live in rural locations but by proportion have fewer healthcare providers compared with urban settings. Relying on a recently completed documentary analysis of published reports and grey literature on rural and remote nursing practice from Canada and around the world, we recognize that recruitment and retention will be a recurring issue. However, a variety of programs and initiatives have been developed to address this age-old problem. A discussion is provided about educational opportunities, financial incentives and enhanced infrastructure that have been developed to address recruitment and retention challenges. Ongoing evaluations of each of these areas are necessary but require cooperation across provincial and national settings.

Striking a balance between in-person care and the use of eHealth to support the older rural population with chronic pain.

New and existing information communication technologies (ICT) are playing an increasingly important role in the delivery of health and social care services. eHealth has the potential to supplement in-person home visits for older, rural adults with chronic pain. The Technology to support Older Adults' Personal and Social Interaction project-TOPS-examines interactions between older people and their health/social care providers and considers how eHealth could play a part in enhancing the life experiences of older people with chronic pain, who live in remote/rural areas. This paper reports findings from the TOPS study, drawing upon observations of health/social care home visits to chronic pain patients and interviews with patients and health/social care providers in rural Scotland. Patients and care professionals believe in-person care promotes the general well-being of older people with pain. However, our findings show that the potential recipients of eHealth are open to the use of such technologies and that although they cannot be expected to replace existing models of care, eHealth may provide opportunities to sustain and enhance these interactions.

Job satisfaction and retention of midwives in rural Nigeria.

BACKGROUND: Nigeria is one of the 57 countries with a critical shortage of human resources for health, especially in remote rural areas and in northern states. The National Midwifery Service Scheme (MSS) is one approach introduced by the Government of Nigeria to address the health workforce shortage in rural areas. Since 2009, unemployed, retired and newly graduated midwives are deployed to primary health care (PHC) facilities in rural areas of Nigeria. These midwives form the mainstay of the health system at the primary health care level especially as it relates to the provision of skilled attendance at birth. This study followed up and explored the job satisfaction and retention of the MSS midwives in three Northern states of Nigeria. METHODS: this was a descriptive study. Data were collected using a mixed method approach which included a job satisfaction survey, focus group discussions (FGDs) and exit interviews to explore job satisfaction and retention factors. All 119 MSS midwives deployed by the National Primary Health Care Development Agency between 2010 and 2012 to the 51 Partnership for Reviving Routine Immunisation- Maternal and Child Health (PRRINN-MNCH) programme targeted PHC facilities were included in the study. RESULTS: MSS midwives were very satisfied with from the feeling of caring for women and children in the community (4.56), with the chance to help and care for others (Mean 4.50), the feeling of worthwhile accomplishment from doing the job (Mean 4.44) and the degree of respect and fair treatment they received from more senior staff and/or supervisor (Mean 4.39). MSS midwives were least satisfied with the lack of existence of a (established) career ladder (Mean 2.5), availability of promotional opportunities within the scheme (Mean 2.66), safety of accommodation (Mean 3.18), and with 'the degree to which they were fairly paid for what they contribute to the health facility' (Mean 3.41). When asked about future career plans, 38% (n=33) of the MSS midwives planned to leave the scheme within two years, of which 16 (18%) wanted to leave within one year. However, 39% of the midwives (n=34) indicated that they would be happy to continue working even after the scheme has ended. Of these 34 participants, 18 would like to continue working in the same facility where they are now whereas the remaining 16 would like to continue working in the north but not in the facility where they are working currently. Eight themes on job satisfaction and retention emerged from the FGDs conducted with current midwives, whereas six themes emerged from the exit interviews from midwives who have left the scheme. CONCLUSION: the MSS programme is a short-term solution to increase SBA coverage in rural Nigeria. MSS midwives were dissatisfied with the short term contract, lack of career structure, irregular payment, poor working condition, inadequate supervision and poor accommodation being offered by the programme, which all contribute to poor retention of MSS midwives. IMPLICATIONS FOR POLICY AND PRACTICE: midwives׳ job satisfaction and retention are critical to improving the health of mothers and their newborn. Poor job satisfaction and retention therefore requires improvements in financial and non-financial incentives, health systems, supportive supervision, ensuring job security and a career structure for midwives working in rural health facilities. Initiating effective strategies to motivate and increase the retention of rural health workers is important for Nigeria to achieve the Millennium/Sustainable Development Goals.

Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial.

BACKGROUND: Health outcomes for Indigenous Australians with diabetes in remote areas remain poor, including high rates of avoidable complications which could be reduced with better primary level care. We aimed to evaluate the effectiveness of a community-based health-worker led case management approach to the care of Indigenous adults with poorly controlled type 2 diabetes in primary care services in remote northern Australia. METHODS: Two hundred and thirteen adults with poorly controlled diabetes (HbA1c > 8.5%) and significant comorbidities in 12 remote communities were randomly assigned by service cluster to receive chronic care co-ordination from a community-based health worker supported by a clinical outreach team, or to a waitlist control group which received usual care. RESULTS: At baseline, mean age of participants was 47.9 years, 62.4% were female, half were Aboriginal and half identified as Torres Strait Islander, 67% had less than 12 years of education, 39% were smokers, median income was $18,200 and 47% were unemployed. Mean HbA1c was 10.7% (93 mmol/mol) and BMI 32.5. At follow-up after 18 months, HbA1c reduction was significantly greater in the intervention group (-1.0% vs -0.2%, SE (diff) = 0.2, p = 0.02). There were no significant differences between the groups for blood pressure, lipid profile, BMI or renal function. Intervention group participants were more likely to receive nutrition and dental services according to scheduled care plans. Smoking rates were unchanged. CONCLUSIONS: A culturally safe, community level health-worker led model of diabetes care for high risk patients can be effective in improving diabetes control in remote Indigenous Australian communities where there is poor access to mainstream services. This approach can be effective in other remote settings, but requires longer term evaluation to capture accrued benefits. TRIAL REGISTRATION: ANZCTR 12610000812099, Registered 29 September 2010.

No longer 'flying blind': how access has changed emergency mental health care in rural and remote emergency departments, a qualitative study.

BACKGROUND: Mental health presentations are considered to be a difficult aspect of emergency care. Although emergency department (ED) staff is qualified to provide emergency mental health care, for some, such presentations pose a challenge to their training, confidence, and time. Providing access to relevant and responsive specialist mental health care can influence care and management for these patients. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telepsychiatry program that was established to improve access to specialist emergency mental health care across rural and remote western NSW, Australia. METHOD: This study uses interviews with ED providers to understand their experience of managing emergency mental health patients and their use of MHEC-RAP. The lens of access was applied to assess program impact and inform continuing program development. RESULTS: With MHEC-RAP, these ED providers are no longer 'flying blind'. They are also more confident to manage and care for emergency mental health patients locally. For these providers, access to specialists who are able to conduct assessments and provide relevant and responsive advice for emergency mental health presentations was valued. Assessing the fit between the consumer and service as a requirement for the development, evaluation, and ongoing management of the service should result in decisions about design and delivery that achieve improved access to care and meet the needs of their consumers. The experience of these providers prior to MHEC-RAP is consistent with that reported in other rural and remote populations suggesting that MHEC-RAP could address limitations in access to specialist care and change the provision of emergency mental health care elsewhere. CONCLUSION: MHEC-RAP has not only provided access to specialist mental health care for local ED providers, but it has changed their practice and perspective. MHEC-RAP could be adapted for implementation elsewhere. Provider experience confirms that the program is accessible and offers insights to those considering how to establish an emergency telepyschiatry service in other settings.