The need for integration nursing theories into pressure ulcer care in the community.

Pressure ulcers are injuries to the skin requiring integrated care, particularly when patients are at home. Pressure ulcers have been a nursing concern for years, and several strategies have been proposed for its prevention and management. Nursing theory, which is essential for nursing practice, recommends plausible approaches to health problems. However, literature describing steps to integrate nursing theory into pressure ulcer care has not yet been explored. For this reason, this article discusses the six steps on how to apply nursing theory in community practice. A case study is also discussed to help gain a better understanding of these steps.

Referral criteria: perceptions and experiences of district nursing students in Northern Ireland.

An ever-ageing population and widening health inequalities intensify the complexity of care that is now delivered within community settings by district nurses. Appropriate referral criteria are required to facilitate the enhancement of efficient and equitable district nursing service provision. This study aimed to explore district nursing students' perceptions and experiences of district nursing referral criteria in Northern Ireland. A qualitative phenomenological approach was adopted using a purposive convenience sample of 10 district nursing students. Data were collected during online focus group interviews and analysed using a thematic framework. Four themes emerged: referral criteria; insight and inconsistency; task versus patient-centred care; and misunderstanding the service and referral quality. The themes reflect a lack of consensus with respect to referral criteria, contributing to inappropriate and poor-quality referrals. Appropriate and quality referrals to district nursing services are key to assuring sustainable service provision. Suitable access to district nursing services may be enhanced by developing consensus referral criteria.

Role and support needs of nurses in delivering palliative and end of life care.

The coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in the demand for palliative and end of life care, particularly in the community. Furthermore, palliative and end of life care services face growing pressures due to the increasing number of older people and increasing prevalence of chronic illness. Palliative and end of life care cannot be provided solely by specialists but needs to be integrated into mainstream healthcare. All nurses have a role in supporting patients with life-limiting conditions, and their families, by providing what is termed 'generalist palliative care'. However, some nurses may feel unprepared, unsupported or lacking the confidence and skills for that role. This article explores the definitions of palliative and end of life care, as well as the changes and challenges in service provision brought about by the COVID-19 pandemic. It also considers how nurses who have not specialised in this area of practice can be supported to care effectively for patients with life-limiting conditions, and their families, notably through workforce development initiatives such as training programmes and clinical supervision. This could not only increase the skills of the nursing workforce but also improve patient care.

Digital transformation in community nursing.

Digital transformation has been making its mark on organisations in healthcare and beyond over the last few years, with no signs of stopping. In the NHS, much of the focus has been on acute services until recently, but this focus is now shifting towards community services, with Sussex Community Foundation Trust (SCFT) being named as the first community Digital Aspirant Trust by NHSx. This article explores what digital transformation is and uses SCFT's experiences to illustrate how this can provide benefits for community nurses. It considers what the future of digital transformation might look like and how clinicians can help to ensure patients remain central to any change.

Reflections on lymphoedema deployment into community services during the pandemic.

During the second wave of the COVID-19 pandemic, district nursing teams were overwhelmed with their caseload due to the palliative care needs of their patients. This led to patients with wet legs and chronic wounds deteriorating due to staffing levels. Therefore, the Swansea Bay University Health Board and Lymphoedema Network Wales teams redeployed two working time equivalents (WTE) into the community to take over the management of these patients with chronic wounds for 4 months. The clinicians came from a variety of different backgrounds, including nursing, physiotherapy, emergency medicine and occupational therapy. Between the teams, 866 visits were carried out over the 4-month period, where patients' compression therapy was altered to promote healing and reduce oedema. At the end of the 4-month period, 21% of the patients were discharged off the district nursing caseload completely, while of the 60% who were still active caseload patients, 35% were in increased compression and 20% had reduced need for visits.

Management of work stress and burnout among community nurses arising from the COVID-19 pandemic.

The COVID-19 pandemic has increased workload demands for many NHS staff including those working in the community. Nurse managers can make a difference by being authentic leaders, nurturing a supportive organisation where the workload is managed participatively and self-kindness is legitimate. Unfortunately some staff may experience burnout and this article presents a personal management plan to address the symptoms of burnout and aid recovery, although it cannot promote a total recovery if the cause of the symptoms remains unaddressed.

[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.

Impact of technology on community nursing during the pandemic.

The purpose of this article is critical analysis, reflection and discussion in regards to the uses and impacts technology has had in community settings, specifically care homes during the COVID-19 pandemic. This will be investigated and supported with special emphasis on virtual assessment platforms and their use within the care homes settings, furthermore reviewing specific data collected in relation to the usage within community care homes. The article will outline the positive attributes and critically reflect upon the benefits of using audio and video conferencing when assessing patients and the beneficial impacts this has had on patients and the wider health community. While conversely addressing the obstacles and threats faced by clinicians in the use of assessment software.

Medication interventions for African-American adults: Practice-based evidence from two nurse-led clinics.

OBJECTIVE: This study was conducted to describe and examine the impact of medication intervention practices among African-American clients in two nurse-led community nursing centers (CNCs). METHODS: This study used a retrospective-descriptive design. Omaha System data from visits of 196 African-American adults living with chronic disease and having two or more CNC visits in which medication regimen was an identified problem and the main reason for the visit was analyzed. RESULTS: The sample had a mean age of 53.1 (6.67) and was primarily women (82%), uninsured, and with high school or less education. A total of 9,259 Medication regimen interventions were documented and implemented during 1,146 client CNC visits. A paired samples t test revealed statistically significant improvements in Knowledge (t = 2.434, p < .01). Behavior (t = 0.077, p = .94) and Status (t = 1.489, p = .14) remained unchanged, although the ratings trended toward improvement for each. CONCLUSION: This study provides evidence that the nursing center model of care does improve the knowledge of medications among African-American clients. The study also demonstrated the Omaha System's utility to evaluate the impact of nursing interventions in community settings.

Proyecto de rotación electiva

El presente informe tiene como objetivo describir el proceso de rotación que desarrollado en la Dirección de Medicina Asistencial de la Secretaría de Salud del Municipio de Tigre durante el período entre el 12 de Abril y el 8 de Julio de 2021. Se toma como punto de partida el proyecto presentado y se abordarán los objetivos planteados contemplando las actividades realizadas que contribuyeron al logro de los mismos. (AU)

Attracting Israeli nursing students to community nursing.

BACKGROUND: The shift from inpatient care to community patient care has had an essential impact on the nursing profession. Despite the growing demand for community nurses in many countries, their number remains relatively low and many students do not perceive this field as an interesting career to pursue. In this review we aimed to understand if exposure of undergraduate nursing students to various nursing work settings during their studies affects their work setting choices after graduation. METHODS: A literature search of papers relating to work setting preferences of nursing students in Israel and other countries was performed. Israel Ministry of Health, Nursing Administration documents and other related documents were also reviewed, with a focus on the nursing training program in Israel. FINDINGS: While most first-year nursing students have limited knowledge regarding the profession, in later years, their preferences for post-graduation work settings are affected by their exposure to the various clinical fields through knowledge gained in courses together with clinical practice placements. In Israel, specific classroom courses in community nursing are allocated only 6% of the total time allocated to all classroom courses in nursing, and a single clinical placement in community nursing takes place during the third or fourth year of the nursing program, exposing students to a single aspect of community nursing during their nursing training. Studies in other countries have reported that students' experience during clinical placement contributes to shaping students' opinions of nurses' roles within that field. Nursing students who had a primary healthcare placement showed greater intention for working in this setting after graduation. CONCLUSIONS: The lack of exposure to the various aspects of community nursing during undergraduate studies contributes to a lack of motivation for entering this field. Therefore, a profound change is needed in nursing training programs' curricula to prepare graduates to face future challenges in community nursing. Whilst both hospital and community nursing are equally important, nursing leaders and policy makers must be made aware of the various factors that contribute to new registered nurses' preferences of hospital over community nursing and build strategies for directing nurses to work in the community in order to respond to the expected nurse shortage in this setting.

Community Care and COVID-19: A Case Study.

Community Care City of Kawartha Lakes provides primary care through its Community Health Centre, a range of hospice services and numerous community support services. Along with other essential service providers, our organization has continued to operate throughout the pandemic. As a community-based health services provider, we recognized the imperative and the privilege for our organization and the larger home and community care sector to support individuals, especially those most vulnerable due to health status, socio-economic circumstances or isolation, to safely remain at home during the pandemic, in compliance with public health directives. This article describes the strategies and approaches we implemented along with reflections on the leadership practices and principles that emerged. It does not purport to be an exemplar for crisis management of the COVID-19 pandemic. Rather, it seeks to draw attention to the contributions made by community-based organizations and potentially serve as a case study for debate.

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.

Safety huddle in a community nursing setting.

A safety huddle is a meeting held among district nurses, allied health professionals, specialist nurses, administrative staff, community matrons and healthcare assistants, also known as the wider multidisciplinary team. This article aims to identify and discuss the importance of safety huddles within a community nursing team. The author, a Specialist Community Practitioner District Nurse (SCPDN), explores why safety huddles were introduced and the implications of staff and patient safety if a safety huddle is not performed. The article also discusses the role of the SCPDN, how patient harm is sustained when communication failures occur within a team, new technologies implemented into practice and the implementation of safety huddles electronically.

Community nursing services during the COVID-19 pandemic: the Singapore experience.

Community nurses in Singapore support vulnerable older persons with chronic health condition(s). In the situation of scaled-down community health and social services during the COVID-19 outbreak, the community nursing team adopted measures for pandemic preparedness. This report is to share the Singapore General Hospital community nursing experience, preparation and transforming efforts during the pandemic. Team segregation, active screening and triage before visits and other precautionary measures were executed to minimise the risk of exposure to COVID-19. There was a shift from face-to-face to teleconsultation to meet the requirement of safe social-distancing. Community nursing teams continued to play an active role in supporting older persons during the pandemic, despite the challenges. Moving to the lockdown phase ('circuit breaker'), teleconsultation, virtual meetings and integrated partnerships were essential to ensure healthcare accessibility and continuity of care. The experience gleaned was valuable to advance future community nursing services in the evolving healthcare landscape. Structured teleconsultation and technology advancement are useful to complement the service.

Los pilares irrenunciables de la práctica enfermera en el ámbito comunitario tras la crisis del COVID-19 / The essential pillars of nursing practice in the community setting after the COVID-19 crisis

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