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.

Sociodemographic and Clinical Characteristics Associated with Suicidal Behaviour and Relationship with a Nurse-Led Suicide Prevention Programme.

Suicidal behaviour is a major public health problem that needs to be tackled by all health agents including mental health nurses. AIMS: The purpose of this study was to analyse the relationship between demographic and clinical characteristics and different kinds of suicidal behaviour with a nurse-led suicide prevention programme. METHODS: The design was a cross-sectional study, performed in the region of Osona (Catalonia) in the five-year period 2013-2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt or completed suicide. RESULTS: The sample included 753 patients (of whom 53 completed suicide) who experienced 931 suicidal behaviour episodes. Men represented only 38.4% of the sample but 81.1% of completed suicides. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. Two thirds (66.4%) of the individuals (0.8% (n = 4) of whom completed suicide) were participants in a nurse-led suicidal behaviour case management programme. CONCLUSION: The main risk factors were being a woman for suicidal behaviour and being a man and being older for completed suicide. Mental disorders, widowhood and retirement were also associated with completed suicide. The completed suicide rate was lower among participants in the nurse-led programme.

Black Nurses Rock: Leaders in Caring for Our Communities.

A nurse leader who is president of the Twin Cities Chapter of Black Nurses Rock, the largest minority nursing association in the country, recounts her journey to professional nursing and the leadership positions and experiences that have been the most passionate part of her career.

Enfermería familiar y comunitaria, cronología de una especialidad / Family and community nursing, chronology of a specialty

Desde que en 1987 se publicase el primer real decreto que regulaba las especialidades de enfermería hasta hoy mismo han transcurrido más de 30 años. Es el real decreto publicado en 2005 el que realmente permitió el desarrollo formativo de parte de las especialidades reconocidas en el mismo (enfermería familiar y comunitaria, enfermería pediátrica, enfermería geriátrica y enfermería del trabajo) ya que las enfermeras especialistas obstétrico-ginecológicas (matronas) y las especialistas de salud mental ya habían iniciado sus procesos formativos por vía de enfermero interno residente desde tiempo atrás. Hoy día, la formación de la especialidad de enfermería familiar y comunitaria ha logrado implementarse en todas las comunidades autónomas, pero no ha tenido idéntico desarrollo en cuanto a la incorporación de las especialistas en las instituciones sanitarias de los respectivos servicios de salud de las comunidades autónomas. Esta circunstancia está generando una gran desmotivación entre las enfermeras comunitarias, tanto las especialistas como quienes esperan poder obtener el título a través de la prueba excepcional. Muchos de los objetivos alcanzados hasta la fecha han sido posibles gracias al trabajo de las sociedades científicas de enfermería comunitaria (Asociación de Enfermería Comunitaria [AEC] y Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria [FAECAP]), que han permitido avanzar y que el proceso no se paralizase, aunque aún son muchos los logros por alcanzar en los que las citadas sociedades científicas siguen trabajando. En una sociedad en la que el cuidado enfermero es cada vez más necesario y demandado, este debe tener una mayor consideración y posición en las políticas sanitarias, ya que ha demostrado su eficacia, y puede ser el modelo que permita hacer sostenible el sistema sanitario y, por tanto, las enfermeras especialistas en enfermería familiar y comunitaria deben dejar de ser una oportunidad para pasar a ser una realidad

More the 30 years have passed since the first Royal Decree that regulated nursing specialties was published in 1987. It is the Royal Decree published in 2005 that really allowed the training development of part of the specialties recognized in it (family and community nursing, paediatric nursing, geriatric nursing and occupational health nursing) since the obstetric-gynaecological specialist nurses (midwives) and mental health specialists had long since already started their training processes through the resident internal nurse model, today, training in the specialty of family and community nursing has been implemented in all the autonomous communities, but has not had the same development in terms of the incorporation of specialists in the health institutions of the respective health services of the autonomous communities. This circumstance is generating a great lack of motivation among community nurses, both specialists and those who hope to obtain the qualification through a specialty exam. Many of the objectives achieved to date have been made possible thanks to the work of the scientific societies of community nursing (Association of Community Nursing [AEC] and Federation of Associations of Community Nursing and Primary Care [FAECAP]), which have allowed progress to be made and the process not to be halted, although there are still many achievements to be made on which the aforementioned scientific societies continue to work. In a society in which nursing care is increasingly necessary and demanded, it must have greater consideration and position in health policies, since it has demonstrated its effectiveness and can be the model that allows the health system to be sustainable. Therefore, nurses who specialize in family and community nursing must cease constituting an opportunity and become a reality

Nutritional counselling interactions between health workers and caregivers of children under two years: observations at selected child welfare clinics in Ghana.

BACKGROUND: This study evaluated the Health Works (HWs) nutritional counselling skills and information shared with caregivers. This was a cross-sectional study in which an observation checklist was used to examine Growth Monitoring and Promotion (GMP) activities and educational/counselling activities undertaken by health workers (HWs) to communicate nutrition information to caregivers, depending on the ages of the children. METHODS: A total number of 528 counselling interactions between health workers and caregivers in 16 Child welfare Clinics (CWCs) in two rural districts in Ghana were observed. Frequencies were presented for the information that was obtained from each caregiver and those that were provided by the HWs during the nutritional counselling sessions. RESULTS: About 95.1 and 61.8% of the caregiver-HW interactions involved mothers of children who were less than 6 months of age and those above 6 months respectively. HWs counselled the caregivers on appropriate nutrition for the child. Health talk messages that were shared with caregivers focused mainly on the importance of attending CWCs and vaccination of children and rarely included any teaching materials. In most of the interactions, HWs made of child's feeding practices the past 1 month; and also did not provide advice on specific issues of IYCF. Nutritional counselling information given for non-breastfeeding children was inadequate and in some cases absent. Little attention was given to the feeding of children with animal products during counselling. CONCLUSION: Generally nutritional information given to caregivers who had children above 6 months was inadequate.

La formación especializada en enfermería familiar y comunitaria: oscuro objeto de deseo / Specialised training in the field of community and family nursing: dark object of desire

La formación especializada en Enfermería Familiar y Comunitaria viene desarrollándose desde que en 2010 se publicó su Programa Oficial. Se ha integrado en las Unidades Docentes Multiprofesionales de Atención Familiar y Comunitaria, lo cual ha supuesto ciertas ventajas pero también inconvenientes. La especialidad tiene unas amplias competencias que abarcan integralmente a las personas, las familias y las comunidades en el entorno en el que desarrollan su vida. Algunas competencias vienen a cubrir áreas actualmente no atendidas por el sistema sanitario e implican una cierta complejidad para su adquisición. La oferta formativa se ve incrementada paulatinamente desde los inicios de la especialidad. Está pendiente de que se dé el paso para que las especialistas formadas desarrollen sus competencias en el sistema sanitario; las Comunidades Autónomas avanzan en ese sentido

Specialised training in the field of community and family nursing has been developed since 2010, when its Official Programme was published. It has been integrated in the Multiprofessional Training Units of Family and Community Care, which implies certain advantages, but also some drawbacks. This specialised training covers a wide range of competences that involve people, family and communities in their living environment. Some of these competences cover areas that are currently not taken into account by the medical system and they imply certain complexity in their acquisition. The training programme has been gradually increased since the beginning of this specialised training. The acquisitions of these competences by the professionals working in this field are still pending and the regions of Spain are making progress in this direction

Efficacy of a Technology-Enhanced Community Health Nursing Intervention vs Standard of Care for Female Adolescents and Young Adults With Pelvic Inflammatory Disease: A Randomized Clinical Trial.

Importance: Pelvic inflammatory disease (PID) is a common reproductive health disorder that disproportionately affects female adolescents and young adults. Despite data indicating poor adherence and adverse outcomes among those who experience subsequent Neisseria gonorrhoeae and Chlamydia trachomatis infection, few trials have been designed to address this public health need. Objective: To examine the efficacy of a technology-enhanced community health nursing (TECH-N) intervention vs standard of care for improving PID self-management behaviors and 90-day longitudinal prevalence of N gonorrhoeae and C trachomatis infection. Design, Setting, and Participants: This randomized clinical trial of the TECH-N intervention was conducted among female patients 13 to 25 years of age diagnosed with mild to moderate PID who were being discharged to outpatient treatment from September 6, 2012, to December 8, 2016, at a large academic medical center. The final analysis of data was completed in November 2018. This study compared the efficacy of the intervention with that of the standard of care using an intention-to-treat analysis. Interventions: Enrolled participants completed an audio computer-assisted self-interview, provided specimens for N gonorrhoeae and C trachomatis testing, and were randomized to standard treatment (n = 137) or the TECH-N intervention (n = 149). Intervention participants received text-messaging support and a community health nurse visit within 5 days of diagnosis. Change in the prevalence of N gonorrhoeae and C trachomatis infection was estimated with logistic regression. The N gonorrhoeae and C trachomatis positivity rate over time was evaluated using generalized estimating equations. Main Outcomes and Measures: The primary outcome was the prevalence of N gonorrhoeae and C trachomatis infection at 90-day follow-up. The secondary outcome was adherence to the Centers for Disease Control and Prevention recommendations for self-care. Results: A total of 286 patients (mean [SD] age, 18.8 [2.5] years; 268 [93.7%] African American) participated in the study. Although the study groups were demographically similar, the intervention group had a higher baseline rate of C trachomatis infection (45 of 139 [32.4%] vs 25 of 132 [18.9%], P = .01). Although N gonorrhoeae and C trachomatis positivity was not statistically different between groups at 90-day follow-up (6 of 135 [4.4%] vs 13 of 125 [10.4%], P = .07), the differential rate of decrease was significantly higher in the intervention group (48 of 140 [34.4%] to 6 of 135 [4.4%] compared with 34 of 133 [25.6%] to 13 of 112 [10.4%], P = .02). Intervention participants were more likely to receive the Centers for Disease Control and Prevention-recommended short-term follow-up visit compared with the control group (131 of 139 [94.2%] vs 20 of 123 [16.3%], P < .001). Conclusions and Relevance: Adolescent and young adults with PID in the TECH-N intervention were more likely to experience decreases in N gonorrhoeae and C trachomatis positivity compared with the control group and to receive short-term clinical assessment. These findings suggest that the TECH-N intervention should be considered as a potential enhancement of standard of care approaches for management of female adolescents and young adults with mild to moderate PID in urban communities facing significant sexually transmitted infection disparities. Trial Registration: ClinicalTrials.gov identifier: NCT01640379.

From organisational justice to turnover intention among community nurses: A mediating model.

AIMS AND OBJECTIVES: To identify the situation of organisational justice, organisational support, work engagement and turnover intention among community nurses and clarify the relationship among them. BACKGROUND: Nurse shortage has become a worldwide issue, and the shortage of community nurses is more serious. Nurse turnover is one important factor for this situation. While previous studies about turnover intention mostly focused on hospital nurses, few involved community nurses. DESIGN: A descriptive, cross-sectional design was adopted. METHODS: Questionnaire investigation was implemented among 410 community nurses to collect data about organisational justice, organisational support, work engagement and turnover intention. Structural equation modelling was applied to test the hypothesised model. The STROBE statement for observational studies was followed. RESULTS: Results showed the average score of turnover intention was 2.50 ± 0.75. The final model indicated: (a) work engagement had a direct negative effect on turnover intention; (b) organisational support had both direct and indirect effects on turnover intention, and the indirect effect was mediated by work engagement; and (c) organisational justice had an indirect effect on turnover intention mediated by organisational support. CONCLUSION: Turnover intention could be reduced directly or indirectly by improving work engagement, organisational support and organisational justice. RELEVANCE TO CLINICAL PRACTICE: This study provides evidence for community health centre managers and policymakers to improve the level of nurses' engagement and to retain more nurses in primary healthcare service.

Client and Provider Discomfort With an Adverse Childhood Experiences Survey.

INTRODUCTION: Many service providers report concerns that questions about adverse events may upset clients. Studies indicate that most survey respondents answer sensitive questions without experiencing distress, although little is known about the prevalence or correlates of clients' discomfort when they are asked similar questions by direct care providers, such as home visitors. METHODS: This study used data collected between 2013 and 2018 from 1,678 clients and 161 providers in a network of home visiting programs in Wisconsin. Clients and home visitors completed an adverse childhood experience questionnaire that concludes by asking about discomfort with the questions. Analyses conducted in 2018 examined overall client discomfort and associations between discomfort and the endorsement of 10 distinct adverse childhood experiences. Multilevel regressions were performed to test whether client and provider factors were associated with client discomfort. RESULTS: More than 80% of clients were not at all or slightly uncomfortable with the adverse childhood experience questionnaire, and 3% reported extreme discomfort. Bivariate results showed that each adverse childhood experience, except parental divorce, was associated with greater discomfort; sexual abuse was the only adverse childhood experience associated with discomfort in a multivariate analysis. Multiple client variables were linked to increased discomfort, including higher adverse childhood experience scores (b=0.06, 95% CI=0.04, 0.08) and depression scores (b=0.01, 95% CI=0.00, 0.02). Home visitor discomfort was positively associated with client discomfort (b=0.16, 95% CI=0.01, 0.31). CONCLUSIONS: Results indicated that most clients in home visiting programs tolerated an adverse childhood experience questionnaire well. The findings point to clients who may be more likely to report discomfort and highlight an important association between client and provider discomfort.

Preferences for rural specialist health care in the treatment of Parkinson's disease: exploring the role of community-based nursing specialists.

People living with Parkinson's disease (PWPD) in rural areas have limited access to local condition-specific care. This paper examines the healthcare preferences of PWPD living in rural areas and how a community-driven initiative to employ a movement disorder nurse (MDN) functioned to address barriers to health services access. A qualitative design facilitated an understanding of how interactions with the health system shaped PWPD and their carer's experiences of living in a regional community. A total of 42 semi-structured interviews were conducted 6-9 months apart; 19 interviews with PWPD and 23 dyadic interviews. The findings support the contention that specialist care can be effectively delivered through allied health professionals in some settings. In particular, having access to a specialist MDN can cushion the effects of living with Parkinson's disease in regional and rural areas where continuity of care and access to timely support is often difficult for people to find. The quality of social support provided by the MDN may increase people's ability to cope in the face of an unpredictable disease course. This is consistent with prior research, which identified that a specialist nurse or allied health services for people living with chronic conditions is enhances quality of life.

Community health training for Family and Community Health Nursing residents in a Multiprofessional Teaching Unit. Three years of experience. / Desarrollo de la competencia de atención comunitaria para residentes de Enfermería Familiar y Comunitaria en una Unidad Docente Multiprofesional provincial. Tres años de experiencia.

OBJECTIVE: To determine the interest of nursing residents in the training areas of Family and Community Nursing (EFyC) at the beginning of their training, to evaluate community activities in health centres and to determine satisfaction with the training received and activities carried out. METHOD: We present the experience of training in the public and community health competencies of EFyC Nursing from 2014 to 2017 in a multiprofessional teaching unit. The training was divided into 3theoretical modules. The training was completed with 2activities: the design and development of a health education programme and an asset mapping in the basic health area. A questionnaire was completed on satisfaction with the course and the activities carried out. RESULT: During this period, 27 residents received training. As part of the training process, 26 health education programmes and 17 asset mappings were conducted in accredited health centres. The areas of intervention addressed were: lifestyles, life transitions and health problems. The overall satisfaction with the course was 4.5 ±.1 out of 5. CONCLUSIONS: The results show a high degree of interest in this area, as well as high evaluation of the activities carried out and the training received. Training in community health and health education during the period of residence is essential to include these competencies in the professional role. The dedication and involvement of the multiprofessional teaching units is essential in the development of these competences, training the residents through the integration of a biopsychosocial approach, community health and teamwork in primary care.

[Nurses' perspectives on outpatient palliative care in Vorarlberg, Austria]. / Ambulante Palliativversorgung aus Sicht der Pflege in Vorarlberg, Österreich.

BACKGROUND: Due to the demographic development the need for palliative care in the outpatient setting will increase and challenge general practitioners and community nurses. AIM: This study investigated the state of outpatient palliative care in Vorarlberg, Austria from the perspective of outpatient community nurses. The key points of the survey covered the burden of symptoms suffered by palliative patients. Another key focus was the cooperation and communication between community nurses and general practitioners. METHODS: Between 8 February and 7 March 2016 all 50 community-based nursing services in Vorarlberg were invited to participate in an online survey designed to estimate outpatient palliative care. The survey collected quantitative and descriptive data and 38 nursing services returned the questionnaire (76 %). RESULTS: According to community-based nurses, the proportion of patients in need of palliative care was 5.7 %. This assessment of needs correlates well with the proportion of personnel qualified in palliative care (p = 0.02). Nursing personnel estimated a high prevalence of symptom burden (76 %). Communication between outpatient nursing personnel and general practitioners relied primarily on telephone calls (79-90 %), less on joint rounds (13-21 %) and case reviews (26-45 %). According to 63 % of the nursing personnel the rate of hospitalization could be reduced with better interprofessional cooperation. DISCUSSION: Symptom burden in the outpatient setting was similar to that of patients being cared for in hospitals. Healthcare personnel in general palliative care should be adequately qualified. The quality of communication via telephone calls should be critically examined in further studies.

Experiences of Dutch general practitioners and district nurses with involving care services and facilities in palliative care: a mixed methods study.

BACKGROUND: Generals practitioners (GPs) and district nurses (DNs) play a leading role in providing palliative care at home. Many services and facilities are available to support them in providing this complex care. This study aimed to examine the extent to which GPs and DNs involve these services, what their experiences are, and how involvement of these services and facilities can be improved. METHODS: Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 108 GPs and 258 DNs, followed by three homogenous online focus groups with 8 GPs and 19 DNs, analyzed through open coding. RESULTS: Most GPs reported that they sometimes or often involved palliative home care teams (99%), hospices (94%), and palliative care consultation services (93%). Most DNs reported sometimes or often involving volunteers (90%), hospices (88%), and spiritual caregivers (80%). The least involved services and facilities were psychologists and psychiatrists (51% and 50%) and social welfare (44% and 57%). Main reason for not involving services and facilities was 'not needing' them. If they had used them, most GPs and DNs (68-93%) reported solely positive experiences. Hardly anyone (0-3%) reported solely negative experiences with any of the services and the facilities. GPs and DNs suggested improvements in three areas: (1) establishment of local centers giving information on available services and facilities, (2) presentation of services and facilities in local multidisciplinary meetings, and (3) support organizations to proactively offer their facilities and services. CONCLUSION: Psychological, social, and spiritual services are involved less often, suggesting that the classic care model, which focuses strongly on somatic issues, is still well entrenched. More familiarity with services that can provide additional care in these areas, regarding their availability and their added value, could improve the quality of life for patients and relatives at the end of life.

Missed care en la enfermería comunitaria: analizando aquello que no se hace o se demora / Missed care in community nursing: An analysis of what is not being done or is being delayed

OBJETIVO: Conocer la prevalencia del cuidado omitido (missed care) entre las enfermeras comunitarias. ANTECEDENTES: Estudios previos han usado el marco del missed care para identificar los retos de la práctica enfermera habitual en entornos de atención aguda. Varios aspectos relacionados son la calidad de la atención, la dotación de personal, la satisfacción laboral y el escaso trabajo en equipo. Sin embargo, este concepto no se ha estudiado en el contexto de la enfermería comunitaria. DISEÑO: Se usó una encuesta transversal para conocer el concepto del missed care en la enfermería comunitaria utilizando información demográfica, roles de enfermería comunitaria y las razones para el missed care. MÉTODOS: Se enviaron cuestionarios en línea (del 31 de julio al 25 de septiembre de 2015) para determinar la prevalencia y las razones del missed care y fueron completados por 458 enfermeras comunitarias de la República de Irlanda. RESULTADOS: Con una tasa de respuesta del 29%, los hallazgos fueron del 70% en varias responsabilidades de cuidado habitual. Otros hallazgos apuntan niveles más altos de missed care en enfermeras que tenían menos de 5 años de experiencia y otras variables como la edad, las que trabajaban horas adicionales no renumeradas y algunas variaciones regionales. CONCLUSIÓN: Los resultados indican una alta prevalencia del missed care entre las enfermeras comunitarias encuestadas, y la atención preventiva fue el tipo de cuidado con más probabilidad de ser omitido. Esto tiene serias implicaciones para un servicio enfermero cuya naturaleza es preventiva y sugiere que el marco del missed care podría beneficiar la planificación de la plantilla de enfermeras comunitarias tanto en Irlanda como en otros países. En consecuencia, las políticas, la práctica y las reformas educativas son fundamentales para satisfacer las necesidades actuales y futuras de la población

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The roles of, activities of, and competencies for, community nursing services in rural Vietnam: Implications for policy decisions.

Community health workforce plays a vital role in providing primary health care services as per the needs of residents; however, few studies have examined how nurses work within commune health centers (CHCs). Using qualitative methods including interviews and focus group discussions with key stakeholders, this study explores the roles, activities, and competencies required of community nursing services in rural districts within Vietnam. Two primary roles were identified: CHC nursing and family nursing. For the latter, in addition to providing people with general health care and health communication, they were expected to also deliver psychological care. CHC nursing fulfilled more roles and required four specific competencies: clinical care, communication, management, and planning/coordination activities. Despite these various roles serving people within a community, few ongoing efforts at either the local or national level are aimed at supporting these nurses. The study highlights the need for policy decisions via either developing a new job position policy or adapting the existing policy by integrating new roles into the existing positions of CHC nurses in Vietnam.

Record of the circumstances of falls in the community: perspective in the Iberian Peninsula.

OBJECTIVE: to determine the diagnosis of the situation regarding documentation of falls and risk of falls in people older than 75 years in basic health units in Spain and Portugal. METHOD: mixed exploratory study in two stages: (i) quantitative descriptive of randomly selected fall records produced in one year (597 records; 197 Spanish and 400 Portuguese); and (ii) qualitative, with the purpose of knowing the perception of health professionals employing semi-structured interviews (72 professionals, 16 Spanish and 56 Portuguese). The study areas were two basic health units in southern Spain and northern Portugal. RESULTS: in the fall records, the number of women was higher. The presence of fall was associated with the variables age, presence of dementia, osteoarticular disease, previous falls and consumption of antivertiginous medication. Health professionals perceived an absence of risk assessment instruments, as well as lack of prevention programs and lack of awareness of this event. CONCLUSION: falls are perceived as an area of ​​priority attention for health professionals. Nonetheless, there is a lack of adherence to the registration of falls and risk assessment, due to organizational, logistical and motivational problems.