Factors Related to Burnout Among Perinatal Home Visiting Nurses.

PURPOSE: Risks for burnout among nurses have been understudied in public and community health settings. This qualitative descriptive study aimed to describe the experiences of nurses working in a perinatal community health program for high-risk families with a focus on challenges and risks for burnout. METHODS: We conducted field observation and semistructured individual interviews in 2019 with nurses at 2 sites implementing Prenatal Care Coordination (PNCC), a Medicaid benefit for high-risk pregnant people and infants in Wisconsin. A larger parent study assessed the implementation of PNCC overall through a thematic analysis process. Initial deductive coding was guided by the Consolidated Framework for Implementation Research. FINDINGS: Emergent themes demonstrated that PNCC nurses face several significant barriers and known risks for burnout, including role strain related to scope of practice and training, discordant racial and socioeconomic identities leading to role conflict, and low control combined with high psychological demand. CONCLUSIONS: Given that the COVID-19 pandemic has exacerbated burnout risk among nurses in hospital settings, and that nurses addressing social determinants of health may be at increased risk for burnout, these findings represent a critical perspective on the experiences and needs of perinatal nurses in public and community health settings.

"Helping Mentally Ill, a Reward Both in this Life and After": A Qualitative Study Among Community Health Professionals in Somaliland.

This study aimed to describe the experiences of community mental health workers, predominantly female, nurses and doctors providing community-based mental health services in Borama, Somaliland. A qualitative explorative study using focus group discussions was conducted. Data were collected from three focus group discussions with 22 female community health workers, two medical doctors, and two registered nurses and analyzed using content analysis with an inductive approach. Three main categories were identified from the analysis: (1) bridging the mental health gap in the community; (2) working in a constrained situation; and (3) being altruistic. Overall, the community mental health workers felt that their role was to bridge the mental health gap in the community. They described their work as a rewarding and motivated them to continue despite challenges and improving community healthcare workers' work conditions and providing resources in mental health services will contribute to strengthening mental health services in Somaliland.

Repercussões da pandemia no desenvolvimento infantil e nas ações dos visitadores do Programa Criança Feliz / Repercusiones de la pandemia en el desarrollo infantil y en la actuación de los visitantes del Programa Niño Feliz / Repercussions of the pandemic on child development and the actions of visitors to the Happy Kids Program

Resumo Objetivo apreender as repercussões da pandemia da COVID-19 no desenvolvimento infantil e nas ações de visitadores do Programa Criança Feliz. Método pesquisa qualitativa, ancorada na Teoria Bioecológica do Desenvolvimento Humano de Bronfenbrenner, com oito visitadoras do referido programa, em uma cidade paraibana. Os dados foram coletados no período de janeiro a junho de 2021, por meio de um roteiro semiestruturado, com entrevistas gravadas e processadas pelo IRAMUTEQ, que posteriormente foram analisadas conforme a Classificação Hierárquica Descendente (método de Reinert), e referencial da Análise de Conteúdo de Bardin. Resultados as repercussões da pandemia limitam as ações de promoção do desenvolvimento infantil pelos visitadores, ao dificultar a interação com as famílias cercadas pelo medo de contrair a doença, incorrendo em quebra de vínculo, demora ou ausência de retorno das atividades pelas mesmas, sentimentos como medo, desânimo, frustração, agressividade e apego às telas como barreiras para a continuidade do acompanhamento infantil. Considerações finais e implicações para a prática apreender sobre a realidade das repercussões da pandemia da COVID-19 no desenvolvimento de crianças assistidas pelo Programa Criança Feliz, oportunizou refletir sobre as estratégias necessárias para potencializar a prática da Enfermagem nas ações de vigilância e estimulação do desenvolvimento para uma atenção integral à saúde da criança.

Resumen Objetivo aprehender las repercusiones de la pandemia de COVID-19 en el desarrollo infantil y en las acciones de los visitantes del Programa Niño Feliz. Método investigación cualitativa, anclada en la Teoría Bioecológica del Desarrollo Humano de Bronfenbrenner, con ocho visitantes del mencionado programa, en una ciudad de Paraíba. Los datos fueron recolectados de enero a junio de 2021, a través de un guion semiestructurado, con entrevistas grabadas y procesadas por IRAMUTEQ, que posteriormente fueron analizadas según la Clasificación Jerárquica Descendente (método de Reinert), y el marco de Análisis de Contenido de Bardin. Resultados las repercusiones de la pandemia limitan las acciones de promoción del desarrollo infantil por parte de los visitantes, al dificultar la interacción con las familias rodeadas por el temor de contraer la enfermedad, incurriendo en ruptura del vínculo, retraso o ausencia de retorno a las actividades por parte de los mismos, sentimientos como el miedo, el desánimo, la frustración, la agresividad y el apego a las pantallas como barreras para la continuidad del cuidado infantil. Consideraciones finales e implicaciones para la práctica aprehender la realidad de las repercusiones de la pandemia de COVID-19 en el desarrollo de los niños asistidos por el Programa Niño Feliz, brindó la oportunidad de reflexionar sobre las estrategias necesarias para potenciar la práctica de Enfermería en las acciones de vigilancia y estimulación del desarrollo para la atención integral de la salud infantil.

Abstract Objective to apprehend the repercussions of the COVID-19 pandemic on child development and on the actions of the Happy Child Program visitors. Method qualitative research, anchored in Bronfenbrenner's Bioecological Theory of Human Development, with eight visitors from the aforementioned program, in a city in Paraíba. Data were collected from January to June 2021, using a semi-structured script, with interviews recorded and processed by IRAMUTEQ, which were later analyzed according to the Descending Hierarchical Classification (Reinert's method), and the Bardin's Content Analysis framework. Results the repercussions of the pandemic limit the actions to promote child development by visitors, by hindering interaction with families surrounded by the fear of contracting the disease, incurring a break in the connection between visitors and family, a delay or absence of return of activities by families, feelings such as fear, discouragement, frustration, aggressiveness and attachment to screens as barriers to the continuity of child monitoring. Final considerations and implications for practice learning about the repercussions of the COVID-19 pandemic on the development of children assisted by the Happy Child Program, provided an opportunity to reflect upon the strategies necessary to enhance Nursing practice in development surveillance and stimulation actions for comprehensive child health care.

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.

Dressings and dignity in community nursing.

Although dignity has been widely explored in the context of healthcare, it has rarely been the subject of empirical exploration when care is delivered by community district nursing teams. This paper demonstrates how a commonplace community nursing task (changing dressings) can constitute a clinical lens through which to explore the ways in which community nurses can influence patients' dignity. This ethnographic study involved two research methods: interviews with patients and nurses (n=22) and observations of clinical interactions (n=62). Dignity can manifest during routine interactions between community nurses and patients. Patient-participants identified malodour from their ill-bodies as a particular threat to dignity. Nurses can reinforce the dignity of their patients through relational aspects of care and the successful concealment of 'leaky' bodies.

Community Hospice Nurses' Perspectives on Needs, Preferences, and Challenges Related to Caring for Children With Serious Illness.

Importance: Many of the 50 000 children who die annually are eligible for provision of community-based hospice care, yet few hospice organizations offer formal pediatric services. Population-level data demonstrate that hospice nurses lack training, experience, and comfort in caring for children, but their specific educational needs and preferences are poorly understood. Objective: To assess the pediatric-specific training and support needs of hospice nurses caring for children in the community. Design, Setting, and Participants: For this qualitative study, 41 nurses were purposively seletected from a population-level cohort of 551 hospice nurses who completed a previous mixed-methods survey; these 41 nurses participated in semistructured interviews between February and April 2019. Hospice nurses were recruited from all accredited hospice organizations in Tennessee, Mississippi, and Arkansas that offer care to pediatric patients. Content analysis of interview transcripts was conducted. Main Outcomes and Measures: The interview guide probed for topics related to prior pediatric hospice training experiences, desires and preferences for training, and perceived barriers to training. Results: Interviews were conducted with 41 nurses representing different geographic regions and levels of comfort with pediatric hospice provision (as self-reported in the prior survey). Thirty-eight of the nurses were women (92.7%), with a median age of 40-49 years (range, 20-29 to ≥60 years) and median tenure of 5-9 years (range, <1 to ≥20 years) as a hospice nurse. Respondents included 1 American Indian or Alaska Native nurse (2.4%), 1 Black nurse (2.4%), and 39 White nurses (95.1%). Across interviews, most hospice nurses reported feeling uncomfortable caring for children with serious illness, and all nurses used language to express the immediacy behind the need for pediatric-specific training and support. Nurses explained why further training and support are needed and clear preferences for who should provide the education, educational modalities, and specific training topics. Nurses also articulated barriers to training and support opportunities and proposed innovative suggestions for overcoming these challenges. Notably, nurses emphasized the need for connection with experts, a sense of community, and solidarity to support frontline clinicians providing end-of-life care to children in the community. Conclusions and Relevance: In this qualitative study, community hospice nurses expressed an urgent need for improvements in pediatric-specific training opportunities and support, clear preferences for how education should be provided, and recommendations for circumventing barriers to training. These findings are a call to action for the palliative care community to collaborate in rapid implementation of educational programs and networks to systematically support hospice nurses caring for children in the community.

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.

Bearing witness to the challenges of breathlessness.

The community respiratory nurse specialist (CRNS) supports patients at different stages of lung disease, witnessing the challenge of living with chronic obstructive pulmonary disease (COPD), a progressive illness for which there is no cure. Breathlessness is the most prominent and debilitating symptom experienced; it is frightening, distressing and very difficult to manage. Little is known about the experience of CRNSs in witnessing the distress of patients, specifically those experiencing breathlessness. The nurse may have cared for such patients over many months or years. In witnessing this distress, CRNSs engage in emotional labour, which is associated with burnout and poor-quality care. This paper seeks to identify bearing witness to suffering and vulnerability as components of emotional labour in the context of the CRNS role. It highlights the need for research to explore the experience of CRNSs and insights into supporting people with long-term breathlessness. It is more likely that well-supported staff can provide sustained, supportive care to patients living with breathlessness.

Operational nurse managers' perceptions on the competence of community service nurses in public settings in the Western Cape.

BACKGROUND: Community service nurses placed in the Western Cape Government public health facilities render essential healthcare to underserved populations. Anecdotal evidence from operational nurse managers indicated concerns that community service nurses may lack competence in basic required nursing competencies. OBJECTIVES: To investigate operational nurse managers' perceptions of the competence of community service nurses in public health facilities in the Western Cape. METHOD: A quantitative survey was conducted with an all-inclusive sample of 297 operational nurse managers in the Western Cape. A self-administered questionnaire with 65 questions with a 4-point rating scale was used to rate perceived competence of community service nurses across the South African Nursing Council (SANC) competencies. Descriptive and inferential statistics were calculated per competency domain. RESULTS: The survey (response rate: 59%) showed that the operational nurse managers perceived the community service nurses to be competent in the clinical patient care domain and mostly either developing proficiency or proficient in the SANC competencies of legal framework and ethical practice, interprofessional relationships, leadership, quality management and management competency domains. CONCLUSION: Community service nurses were found to be competent in the clinical patient care, possibly because of the integration of theory and practice focus of work-integrated learning in the programme. Education and practice supportive strategies for community service nurses should be developed to support the successful transition from students to community service nurses, especially around the development of research and critical thinking skills.

Work-Family Spillover, Job Demand, Job Control, and Workplace Social Support Affect the Mental Health of Home-Visit Nursing Staff.

The primary purpose of this study was to clarify the path by which high job demands on home-visit nursing staff affect their mental health through work-family negative spillover (WFNS, FWNS). The secondary purpose was to clarify the path by which high job control and high social support in the workplace positively affect the mental health of nursing home-visit staff through work-family positive spillover (WFPS, FWPS). A cross-sectional survey using a self-administered questionnaire was conducted on 1,022 visiting nursing staff working at 108 visiting nursing stations in Fukuoka Prefecture in February, 2019. The measurement tools comprised sociodemographic factors, the Japanese version of the Survey Work-Home Interaction - NijmeGen (SWING-J), Job Content Questionnaire (JCQ-22), the Work-Family Culture Scale, and the K6 scale. Six models were determined in an analysis of the model: (1) working time load → WFNS → FWNS → psychological distress, (2) job demands → WFNS → FWNS → psychological distress, (3) job demands → psychological distress, (4) workplace support → job control → WFPS → psychological distress, (5) workplace support → WFPS → psychological distress, and (6) workplace support → psychological distress. This study clarified that job demands and working time load may adversely affect the mental health of home-visit nursing staff through the mediation of WFNS. It was also clarified that high job control and workplace support may have a positive effect on mental health through the mediation of WFPS.

Identification of Measures Affecting Job Satisfaction and Levels of Perceived Stress and Burnout among Home Health Nurses of a Developing Asian Country.

BACKGROUND: Factors affecting job satisfaction of home health nurses are studied. METHODS: PSS-10, CBI and HHNJS are used to measure the perceived stress, burnout of home health nurses and Job Satisfaction. RESULTS: The significant predictors for Job satisfaction were Relationship with organization, Autonomy and control, Salary and Benefits as 82% of variation in job satisfaction was explained by these, (F change (3, 144) = 236.72, p < .001). CONCLUSION: Agencies should work upon improving the dimensions such as the "relationship with the organization", "Autonomy and control" and "Salary and Benefits" to increases the Job satisfaction of home health nurses.

Community nurses and chronic disease in Israel: Professional dominance as a social justice issue.

Chronic diseases are major causes of health inequalities. Community nurses can potentially make large contributions to chronic illness prevention and management in Israel but may be obstructed by professional dominance of physicians. However, insufficient research exists about community nursing in Israel, and how it may differ from other countries. This study aims to document chronic disease-related community nursing roles in Israel, identify changes and trends in community nursing roles that may increase social justice, and understand how the roles and trends in community health nursing in Israel may differ from developments in other countries. In-depth interviews were performed with 55 Israeli health system professionals, and 692 nurse care-givers were asked open-ended questions. Interview answers were analyzed to find themes and trends. The study found that community nurse roles in Israel have expanded, especially for chronic disease control. Commonalities exist with countries such as the United States and the UK, albeit with important differences. However, continued conflicts with physicians exist, which can limit nurses' contributions to reducing health inequalities. Community nurses' importance is growing. Enabling them to overcome professional dominance and improve chronic disease control can help reduce health inequalities in Israel and elsewhere.

New to the community setting: nurses' experiences and the importance of orientation.

There has been little research about the experiences of nurses transitioning into community nursing (CN), despite the growing demand for nurses in this setting and impending shortfall in the nursing workforce in Australia. In this study, nurses from a busy metropolitan CN service were interviewed to explore how they experienced their first months in their new role. The interviews were analysed thematically, with three themes emerging: Adaptation, Focus of Care and Context. Participants detailed their experiences adjusting to new work practices and the community setting, and expanded on their enjoyment from increased autonomy, career goal recognition and rewarding patient relationships and outcomes. The findings of this study are aligned with previous literature about nurses entering the primary healthcare setting from acute care, and particularly highlight the need to individually tailor orientation, preceptorship and ongoing career development programs to each nurse.

Psychometric properties of the short-form Chinese Community Nurses Stress Scale: A cross-sectional study.

Job-related stress had adverse effects on both patients and community nurses. To evaluate stress, an effective and reliable instrument was needed. The aim of this study was to develop a short-form Chinese Community Nurse Stress Scale and examine its psychometric properties.A cross-sectional study was conducted. A total of 969 community nurses were selected from 56 community centers/stations in Sichuan Province. The socio-demographic data and job stress assessed by the Chinese Community Nurse Stress Scale (CNSS) were collected. After randomly splitting the sample into group 1 and group 2, exploratory and confirmatory factor analysis were carried out to shorten the scale and test its reliability and construct validity.There were no significant differences in socio-demographic variables between group 1 (n = 488) and group 2 (n = 481). During exploratory factor analysis, 4 factors were selected, including management and interpersonal relationships (8 items), patient care (7 items), environment and resources of work (6 items), and career promotion (4 items), which explained 62.66% of all variance. Cronbachs α coefficient of the short-form CNSS was 0.94, and the cross-sample validity test supported the best fit model for this 25-item CNSS.The results in this study supported that the 25-item CNSS had a good reliability and validity when it was administrated to Chinese community nurses.

A nation-wide cross-sectional study of variations in homecare nurses' assessments of informational continuity - the importance of horizontal collaboration and municipal context.

BACKGROUND: Numerous studies have revealed challenges associated with ensuring informational continuity in municipal care services for older adults with comprehensive, prolonged and complex care needs. Most research is qualitative and on the micro-level. The aim of the current study is to map variation in homecare nurses' assessments of available information in the municipalities' documentation system and investigate the extent to which these assessments are associated with perceived quality of collaborations and with municipal context. METHODS: We used data from a nationwide web-based survey among 1612 nurses working with older adults (65+) in homecare services in Norway. Responses from individual homecare nurses were linked with municipal-level data from the public registers. Data were analysed with descriptive statistics and multilevel regression analyses. RESULTS: Information on the recipients' medications and medical condition was considered most often available (42.8 and 20.0% responding very often/always), whereas information related to psychosocial needs and future follow-up was perceived less available (4.5 and 6.7% responding very often/always). Homecare nurses' perceptions of the quality of collaboration with the GP and the allotment office were independently and positively associated with assessments of informational continuity (ß =0.86 and ß =0.96). A modest share of the total variation (8%) in assessments of informational continuity was at the structural level of municipality. Small municipalities (< 5000 inhabitants) had, on average, better informational continuity compared to larger municipalities (ß = -0.47). CONCLUSIONS: Documentation systems have a limited focus on long-term care needs of older care recipients beyond clinical and medical information. There is a potential for enhanced communication- and care-pathways between GPs, the allotment office and nurses in homecare services. This can support the coordinating role of homecare nurses in ensuring informational continuity for older adults with prolonged and complex care needs and help develop the facilitating role of (electronic) documentation systems.

Community-Based Interventions for Stroke Provided by Nurses and Community Health Workers: A Review of the Literature.

BACKGROUND: Community-based interventions are vital for facilitating poststroke recovery, increasing community participation, and raising awareness about stroke survivors. To optimize recovery and community reintegration, there is a need to understand research findings on community-based interventions that focus on stroke survivors and their caregivers. Although nurses and community health workers (CHWs) are commonly involved in community-based interventions, less is known about their roles relative to other poststroke rehabilitation professionals (physical therapists, occupational therapists, and speech-language pathologists). Thus, the purpose of this review is to explore research focused on improving community-based stroke recovery for adult stroke survivors, caregivers, or both when delivered by nurses or CHWs. METHODS: A systematic review using Scopus, PubMed, EBSCOhost, MEDLINE, CINAHL Complete, and PsycInfo was completed to identify community-based poststroke intervention studies using nurses or CHWs through August 2018. RESULTS: Eighteen studies meeting inclusion criteria from 9 countries were identified. Details regarding nurses' and CHWs' roles were limited or not discussed. Interventions emphasized stroke survivor self-care and caregiver support and were offered face-to-face and in group sessions in the community and home. A wide range of instruments were used to measure outcomes. The results of the interventions provided were mixed. Improvements were observed in perceptions of health, quality of life, knowledge, self-efficacy, self-management, and caregiver support. CONCLUSION: Nurses and CHWs play a pivotal role in community-based care. Evidence suggests community-based interventions facilitate the necessary support for stroke survivors, caregivers, families, and communities to optimize stroke recovery. Data from this review illustrate a continued need for comprehensive programs designed to address the complex needs of stroke survivors and families when they return to their homes and communities.

Nurses' job involvement and association with continuing current position-A descriptive comparative study.

AIMS AND OBJECTIVES: The aim of the study is to examine nurses' job involvement and intentions to continue in their current position. BACKGROUND: Globally, the supply of nurses fails to meet the labour markets' high demand. Compared to specialist health service, the community health service has the greatest challenge when it comes to nursing shortage. There is a lack of studies comparing nurses working in different parts of the healthcare system in research focusing on nurses' intentions to continue in their current position. Similarly, there has been relatively little research on nurses' job involvement, even less how it is associated with retaining the nurses, despite indications that job involvement may be the key to job-related motivated behaviour. DESIGN: A descriptive comparative study with a cross-sectional design. METHODS: The study comprises 297 nurses from the community health service and specialist health service, respectively. The relationships between nurses' intention to continue and participant characteristics were examined using binary logistic regression. Reporting followed the STROBE guidelines. RESULTS: Nurses in the community health service are older, have more children under the age of 18 and hold more permanent positions than nurses in the specialist health service. Job involvement is the only variable associated with nurses' intention to continue in their current position regardless of whether the nurse works in the community health service or specialist health service. CONCLUSIONS: The results indicate that the community health service has the same possibilities as the specialist health service to retain nurses in their current jobs. RELEVANCE TO CLINICAL PRACTICE: The results indicate that nursing leaders/employers with a goal to retaining nurses are recommended to focus on improving the nurses' job involvement.