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Martínez-Riera JR, Aviles Gonzalez CI, Zambrano Bermeo RN, Curcio F, González Correa JA, Estrada González C, Melo P, Galletta M. Educational Strategies to Promote Adherence to Treatment in Patients with Cardiovascular Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9841. [PMID: 36011482 PMCID: PMC9407903 DOI: 10.3390/ijerph19169841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Educational material is a key strategy for primary health care promotion. PURPOSE To design and validate educational material adapted to the population and aimed to increase knowledge about adherence to the treatment of arterial hypertension and diabetes mellitus. METHODOLOGY Methodological study for the design of educational material for people with diabetes mellitus and high blood pressure. For the design, content validity tests were carried out, with the participation of six experts in health education and six patients with chronic diseases. Validation was performed pursuant to the attraction, understanding, engagement, and acceptance criteria. RESULTS The validation confirmed that all items and criteria were above the minimal expected range. CONCLUSION The design and validation of educational material provide elements that improve the education of patients about their pathologies and their adherence to treatment.
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Affiliation(s)
- José Ramon Martínez-Riera
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Cesar Ivan Aviles Gonzalez
- Faculty of Health Sciences Nursing Program, Universidad Popular del Cesar, Sede Sabanas, Valledupar 200002, Colombia
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di 8 Monserrato, 09042 Cagliari, Italy
| | | | - Felice Curcio
- Faculty of Medicine and Surgery, University of Sassari (UNISS), Viale San Pietro 43/B, 07100 Sassari, Italy
| | | | - Catalina Estrada González
- School of Health, Universidad Santiago de Cali, Cali 4102, Colombia
- Departamento de Salud Publica, Universidad Libre de Colombia Cali, Cali 4102, Colombia
| | - Pedro Melo
- Centre for Interdisciplinary Research in Health, Universidade Católica Portuguesa, 4169-005 Porto, Portugal
| | - Maura Galletta
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Universitaria di 8 Monserrato, 09042 Cagliari, Italy
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Biagioli V, Spitaletta G, Kania V, Mascolo R, Gawronski O, Liburdi A, Manzi G, Salata M, Vellone E, Tiozzo E, Dall'Oglio I. Instruments Measuring Self-Care in Children and Young Adults With Chronic Conditions: A Systematic Review. Front Pediatr 2022; 10:832453. [PMID: 35419323 PMCID: PMC8995847 DOI: 10.3389/fped.2022.832453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 11/25/2022] Open
Abstract
Children and young adults (CYAs) with chronic conditions need to engage in self-care to improve their quality of life. This study aimed to retrieve the literature on instruments to assess self-care in CYAs living with chronic conditions and evaluate the psychometric proprieties of the instruments retrieved. A systematic literature review was conducted on six databases to identify peer-reviewed papers that described or used an evaluation instrument of self-care in CYAs with chronic conditions. Twenty-three articles describing 11 instruments of self-care were identified. Five instruments (45.45%) were developed for specific diseases, while six (54.54%) for various chronic illnesses. Most of the instruments were focused on treatment adherence within self-care maintenance (i.e., behaviors to maintain illness stability), excluding the monitoring of clinical parameters or the management of exacerbations. This review provides an overview of available instruments that measure self-care in CYAs with chronic conditions, which health professionals could use for patient education.
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Affiliation(s)
- Valentina Biagioli
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giuseppina Spitaletta
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valeria Kania
- Department of Paediatric Emergency, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Mascolo
- Pediatric Semi-Intensive Care Area/Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Orsola Gawronski
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annachiara Liburdi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giulia Manzi
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michele Salata
- Rheumatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata," Rome, Italy
| | - Emanuela Tiozzo
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Immacolata Dall'Oglio
- Professional Development, Continuing Education and Research Service, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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A valid self-help tool to measure the role of spousal support in the care of persons with diabetes mellitus. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-01001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zhou SH, Huang ST, Xu N, Chen LW, Chen Q. Application of the WeChat Platform to Implement Continuous Nursing for Patients After Percutaneous Coronary Intervention. Med Sci Monit 2020; 26:e925444. [PMID: 33372172 PMCID: PMC7777148 DOI: 10.12659/msm.925444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) is an effective treatment for coronary heart disease. However, a lack of cardiac rehabilitation and continuous nursing management leads to repeated patient hospitalizations. Long-term systematic rehabilitation and nursing management after discharge are key to ensuring quality of treatment and patient quality of life. This study aimed to explore the application of the WeChat platform in continuous nursing after PCI. Material/Methods This was a retrospective case-control study. The clinical data of 63 patients in our cardiac center who underwent PCI between June 2017 and January 2018 were recorded. Patients were divided into 2 groups: the continuous nursing through the WeChat platform (intervention) group and the conventional nursing (control) group. The Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Seattle Angina Questionnaire (SAQ) were used as the evaluation tools. Results The SAQ scores in all 5 SAQ dimensions in the continuous nursing group were significantly higher than those of the control group at the 1-year follow-up. Scores on the SAS and SDS scales at 1-year follow-up were significantly better in the intervention group than in the control group. The SAS and SDS scores in both groups were better at the 1-year follow-up, but the difference was statistically significant in the continuous nursing group and not in the control group. Conclusions Using the WeChat platform can make continuous nursing more convenient and effective for patients after PCI. It may reduce the occurrence of complications, relieve patient depression and anxiety, and improve patient quality of life.
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Affiliation(s)
- Sheng-Huo Zhou
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Shu-Ting Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Ning Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Liang-Wang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, Fujian, China (mainland)
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Wildeboer AT, Stallinga HA, Roodbol PF. Validation of the International Classification of Functioning, Disability and Health (ICF) core set for Diabetes Mellitus from nurses' perspective using the Delphi method. Disabil Rehabil 2020; 44:210-218. [PMID: 32420756 DOI: 10.1080/09638288.2020.1763485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To explore content validity of the ICF core set for Diabetes Mellitus from nurses' perspective.Materials and methods: A two-round Delphi study was conducted with nurses specialized in diabetes care, who were recruited by purposive sampling. Level of agreement on relevance of ICF categories was calculated using Item-level Content Validity Index.Results: Twenty-seven nurses judged 147 second-level ICF categories on relevance for people with Diabetes Mellitus. Agreement was reached on 65 (44.2%) categories, of which 46 were from the ICF core set for Diabetes Mellitus, 17 were from previous validation studies, and two were additional categories that were mentioned as relevant. Forty-six out of the 65 categories were derived from the component body functions and structures. No agreement was reached on 82 (55.8%) categories, of which 33 were derived from the component environmental factors.Conclusions: Content validity of the ICF core set for Diabetes Mellitus was partially supported by specialized nurses. Agreement was predominantly reached on biomedical categories. Content validity of categories derived from environmental factors received little support.Relevance: The nursing profession should be aware of a gap between the current biomedical focus and the desired biopsychosocial approach; the latter of which is recommended in chronic care.IMPLICATIONS FOR REHABILITATIONThe International Classification of Functioning, Disability and Health (ICF) encourages a biopsychosocial approach in health care, and ICF core sets, such as the core set for Diabetes Mellitus, are useful in identifying the needs of patients.Content validity of the ICF core set for Diabetes Mellitus was partially supported by nurses specialized in diabetes care; agreement was predominantly reached on biomedical categories.The nursing profession should be aware of a potential gap between the current biomedical focus and a desired biopsychosocial approach, which is particularly recommended in chronic care.It is recommended that nurses take part in future revisions of ICF core sets; a multidisciplinary approach enables members to learn from each other's perspectives, including from those of patients.
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Affiliation(s)
- Anita T Wildeboer
- Department of Health Sciences, section Nursing Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hillegonda A Stallinga
- Department of Health Sciences, section Nursing Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Petrie F Roodbol
- Department of Health Sciences, section Nursing Research, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Shabany M, Nikbakht Nasrabadi A, Mohammadi N, Davatgaran K, Yekaninejad M. Health Professionals' Experience of Barriers in Empowering People with Spinal Cord Injury: a Qualitative Inquiry. J Caring Sci 2019; 8:143-148. [PMID: 31598507 PMCID: PMC6778312 DOI: 10.15171/jcs.2019.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/27/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Empowering an individual with spinal cord injury as far as possible is an experience with various social and cultural aspects. This study investigated health professionals' experiences of barriers in empowering individuals with spinal cord injuries. Methods: This was a qualitative inquiry with a conventional content analysis approach. A number of 11 healthcare professionals who were members of Iran Spinal Cord Injuries Research National Network or had been working in a related research center for at least three years participated in the study. A purposive sampling method was applied until reaching data saturation. The data were collected by semi-structured interviews. The collected data were managed with MAXQDA software version 13. Results: Three main themes as barriers in empowering people with spinal cord injury emerged: 1) Lack of patient-and-family-centered education, 2) Failure in providing sufficient healthcare services and 3) Inappropriate setting for using rehabilitation services. Conclusion: These finding can help policymakers to provide better social facilities and more support services for people with spinal cord injuries and their families. Further research is needed to investigate barriers to empowerment from the perspective of individuals with SCI and their families.
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Affiliation(s)
- Maryam Shabany
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Surgical Nursing and Deputy Dean for International Affairs, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooredin Mohammadi
- Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Keyvan Davatgaran
- Department of Iranian Research Center on Ageing, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - MirSaeed Yekaninejad
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Askerud A, Conder J. Patients' experiences of nurse case management in primary care: a meta-synthesis. Aust J Prim Health 2019; 23:420-428. [PMID: 28923163 DOI: 10.1071/py17040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/15/2017] [Indexed: 11/23/2022]
Abstract
The health system in New Zealand and Australia requires health practitioners to prepare for the challenge of long-term conditions. Wagner's 1998 Chronic Care Model advocates a move away from the traditional acute model of primary health care to a model that addresses the long-term episodic nature of chronic disease. Nurse case management has been developed over the last 2 decades as a means to coordinate health services for people with long-term conditions. This meta-synthesis combines the results of 15 qualitative research studies that have a similar research question regarding peoples' perceptions of nurse case management. The research synthesises the experiences of people with long-term conditions on the quality of care under a nurse case management model of primary health care. Over 1000 people were represented across the studies, and the results suggest that people had a high degree of confidence and trust in their nurse case manager, were better able to manage their health conditions with nurse case management support, and had better access to appropriate health care. This research suggests that nurse case management is an effective model of care and may contribute to improved quality of life and better health care for those with long-term health conditions.
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Affiliation(s)
- Anna Askerud
- Otago Polytechnic School of Nursing, Forth Street, Private Bag 1910, Dunedin 9054, New Zealand
| | - Jenny Conder
- University of Otago Postgraduate School of Nursing, 72 Oxford Terrace, Christchurch, 8011, New Zealand
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Mehmannavazan M, Hosseini M, Vartanoosian J, Matbouei M, Nasiri M, Vasli P. Translation, cultural adaptation and preliminary psychometric evaluation of the "Family Management Measure" among Iranian families with a child with a chronic disease. Electron Physician 2018; 10:6942-6950. [PMID: 30034662 PMCID: PMC6049973 DOI: 10.19082/6942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 01/01/2018] [Indexed: 11/20/2022] Open
Abstract
Background The basis of any research is the use of valid and reliable tools for collecting information. One of the valid and reliable tools used to identify the family management in chronic childhood diseases is “FaMM” which has never been translated and validated in previous research in Iran. Objective The present study aimed to translate, incorporate cultural adaptation, and determine psychometric features of FaMM among Iranian families with a child with a chronic disease. Methods This study was conducted using the methodological research approach in Tehran, during 2016–2017. The translation of FaMM was done using “World Health Organization Translation and Cultural Adaptation Guidelines”. The preliminary psychometric evaluation of the above tool was performed by determining the validity (face and content validity) and reliability (internal consistency and stability). Data analysis was performed using IBM-SPSS 22. Content validity (CV) was first examined using qualitative and quantitative methods. In the qualitative phase, experts’ opinions were received in order to observe grammar, wording, item allocation and scaling. Then, quantitative CV was examined using Content Validity Ratio (CVR) and Content Validity Index (CVI; Scale-CVI/Avg, Scale-CVI/UA). In order to calculate the internal consistency of the items, Cronbach’s alpha coefficient of statements was calculated. Test-retest method was used for determining the stability of the tool, and the obtained scores were compared using ICC. Results The Persian version of FaMM has conceptual, semantic, idiomatic and by-item equivalence, as well as a desirable preliminary validity and reliability for assessing the management of families with children with chronic disease. The results of CVR determination indicated that all questions were larger than Lawshe’s Table number (0.49). The CVI results showed that all questions had a score higher than 0.79, and therefore were recognized as appropriate. In the Scale-CVI/Avg, the score was 0.98 and in the Scale-CVI/UA, the score was 0.80. The Cronbach’s alpha value for the scales was obtained in the range of 0.55 to 0.87 and the ICC of scales ranged from 0.71 to 0.94. Conclusion The translation and cultural adaptation process of FaMM led to the design of a tool adapted to Iranian culture which can be applied in this context, and after the implementation of the final psychometric evaluation process, comparing data on how families with a child with chronic disease are managed with other communities can be possible.
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Affiliation(s)
- Masoomeh Mehmannavazan
- M.Sc. Student of Community Health Nursing, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meimanat Hosseini
- Ph.D. in Nursing, Assistant Professor, Department of Community Health Nursing, Faculty Member of Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jacqueline Vartanoosian
- M.Sc. in Medical Education, Medical Laboratory Scientist, Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahsa Matbouei
- M.Sc. of Medical Surgical Nursing, Nursing Instructor, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Ph.D. in Biostatistics, Assistant Professor, Department of Biostatistics, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Vasli
- Ph.D. in Nursing, Assistant Professor, Department of Community Health Nursing, Faculty Member of Nursing & Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gorina M, Limonero JT, Álvarez M. Effectiveness of primary healthcare educational interventions undertaken by nurses to improve chronic disease management in patients with diabetes mellitus, hypertension and hypercholesterolemia: A systematic review. Int J Nurs Stud 2018; 86:139-150. [PMID: 30007585 DOI: 10.1016/j.ijnurstu.2018.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Diabetes, hypertension and hypercholesterolemia are important chronic health problems that are becoming increasingly frequent worldwide. Educational interventions are a challenge for health teams. Nurses play a major role in overall health by providing educational interventions to help improve self-management outcomes. OBJECTIVES To evaluate the effectiveness of primary health care educational interventions undertaken by nurses to improve metabolic control and/or chronic disease management in individuals with Type 2 diabetes mellitus, hypertension, and hypercholesterolemia. METHODS The methodology drew on systematic review without meta-analyses, methods developed by the Cochrane Collaboration. Elements related to content were chosen following the PRISMA statement. The databases of Pubmed, Web of Science, CINAHL, PsycInfo, Cuiden, Enfispo, and the Cochrane Library were consulted. Reference lists from relevant articles were also examined for additional references. Three authors independently assessed eligibility of studies for inclusion. A review of randomised controlled trials published between 2000 and 2015 was undertaken. Furthermore, an analysis of selected studies was carried out, in which nurses actively participated in the implementation of educational interventions in primary health care centres in order to improve control and chronic disease management in Type 2 diabetes mellitus, hypertension and hypercholesterolemia. RESULTS Out of the 20 studies included in the systematic review, one had a low risk of bias, 14 an uncertain risk of bias, and five a high risk of bias. Although several studies showed significant changes in the measured variables, few significant differences were maintained over time, observed only in metabolic indicators and clinical variables more than in lifestyle behaviour. In addition, although most of the studies dealt with issues related to lifestyle behaviours such as nutrition, physical activity, and tobacco and alcohol use, few measured changes after the intervention. Finally, the difficulty in comparing the studies included in the review laid in the heterogeneity in educational strategies, the evaluation methods used, and the disparity of assessment tools, which made it difficult to establish the characteristics of the most effective interventions during the time of treatment for diabetes, hypertension, and hypercholesterolemia. CONCLUSIONS Although there are numerous interventions that aim to control diabetes, hypertension, and hypercholesterolemia, the observation was that the results obtained are difficult to maintain over time. Therefore, it is necessary to continue to create high-quality interventions, with a low risk of bias and based on solid theoretical frameworks, not only to treat current symptoms of the disease but also to help prevent cardiovascular disease.
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Affiliation(s)
- Marta Gorina
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Escola Universitària d'Infermeria i Teràpia Ocupacional (EUIT), Carrer de la Riba, 90, 08221 Terrassa, Barcelona, Spain.
| | - Joaquín T Limonero
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
| | - María Álvarez
- Stress and Health Research Group, Faculty of Psychology, Universitat Autònoma de Barcelona, Edifici B, Carrer de la Fortuna, Campus de la UAB 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.
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What is the impact of professional nursing on patients’ outcomes globally? An overview of research evidence. Int J Nurs Stud 2018; 78:76-83. [DOI: 10.1016/j.ijnurstu.2017.10.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 10/17/2017] [Indexed: 11/20/2022]
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Ramšak Pajk J, Benkovič R, Poplas Susič T. Izkušnje medicinskih sester v patronažnem varstvu z obiski na domu v okviru projekta Nadgrajena celovita obravnava pacienta: rezultati pilotne raziskave. OBZORNIK ZDRAVSTVENE NEGE 2017. [DOI: 10.14528/snr.2017.51.1.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Patronažno zdravstveno varstvo je pomemben člen pri odkrivanju, spremljanju in obravnavi kroničnih bolezni na primarni ravni. Namen raziskave je bil predstaviti izkušnje in stališča do nadgrajene preventivne obravnave ter obiskov na domu.
Metode: Uporabljen je bil mešani raziskovalni dizajn. Podatki so bili zbrani z delno strukturiranim vprašalnikom (Cronbach α = 0,92). Sodelovalo je 50 diplomiranih medicinskih sester, odzivnost je bila 81-% (n = 41). Opravljena je bila tematska analiza odprtih vprašanj. Za kvantitativne podatke je bila uporabljena opisna statistika, t-test, analiza variance in korelacijska analiza.
Rezultati: Prispevek preventivnih obiskov na domu anketiranci vidijo v zdravstvenovzgojnem delovanju (x = 4,34, s = 0,85), odkrivanju rizičnih dejavnikov (x = 4,12, s = 0,81) in ohranjanju kakovosti življenja pacientov ( x= 4,10, s = 0,92). Zadovoljstvo anketirancev je povezano s sprejemanjem obiskov s strani pacientov in družin (r = 0,754, p < 0,001), s prispevkom k stroki patronažnega varstva (r = 0,766, p < 0,001) ter z obravnavo posameznika z družino (r = 0,693, p < 0,001). V tematski analizi sta bili identificirani dve temi, in sicer (1) pozitivne izkušnje z obiski in (2) negativne izkušnje z obiski.
Diskusija in zaključek: Novo obliko preventivnih patronažnih obiskov v domačem okolju anketirani podpirajo, še posebej možnost celovite obravnave posameznika in njegove družine. Glede na ugotovitve se predlaga, da medicinska sestra v patronažnem varstvu postane enakovreden partner v timu referenčne ambulante na nacionalnem nivoju.
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Randall S, Thunhurst C, Furze G. Community matrons as problem-solvers for people living with multi-co-morbid disease. Br J Community Nurs 2016; 21:594-598. [PMID: 27922780 DOI: 10.12968/bjcn.2016.21.12.594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Working with patients in their own homes gives community matrons an advantage of seeing patients in the context of their everyday lives. This allows comprehensive assessment of need with an aim of promoting health or promoting stability for people living with chronic disease. Complex issues are resolved through problem-solving and this can result in patients being maintained in their own homes and thus in reduced unplanned hospitalisation. Data were collected from participants using semi-structured interviews and audio diaries. The sample comprised professionals: CMs (n=21), managers (n=4), former commissioners (n=2) and GPs (n=3); and patients (n=10) and their family carers (n=5). In this article, data from community matrons is discussed. Community matrons often drew on the social determinants model of health to problem solve and to create meaningful strategies that work for patients in their care. Raising awareness of the high-level skills of community matrons and promoting appreciation of the importance of a social determinants model of health is important in explaining why nurses are such a crucial element of the primary health care workforce.
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Affiliation(s)
- Sue Randall
- Senior Lecturer in Primary Health Care, Sydney Nursing School The University of Sydney, Australia
| | - Colin Thunhurst
- Honorary Principal Research Fellow, Faculty of Health & Life Sciences Coventry University
| | - Gill Furze
- Professor of Cardiovascular Rehabilitation, Centre for Technology Enabled Health Research Faculty of Health & Life Sciences, Coventry University
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Girvin J, Jackson D, Hutchinson M. Contemporary public perceptions of nursing: a systematic review and narrative synthesis of the international research evidence. J Nurs Manag 2016; 24:994-1006. [DOI: 10.1111/jonm.12413] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- June Girvin
- Faculty of Health and Life Sciences; Oxford Brookes University; Oxford UK
| | - Debra Jackson
- Faculty of Health and Life Sciences; Oxford Brookes University; Oxford UK
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
- University of New England; Armidale New South Wales Australia
| | - Marie Hutchinson
- Oxford Brookes University; Oxford UK
- Southern Cross University, School of Health & Human Sciences; Lismore New South Wales Australia
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Morales-Asencio JM, Martin-Santos FJ, Kaknani S, Morilla-Herrera JC, Cuevas Fernández-Gallego M, García-Mayor S, León-Campos Á, Morales-Gil IM. Living with chronicity and complexity: Lessons for redesigning case management from patients' life stories - A qualitative study. J Eval Clin Pract 2016; 22:122-132. [PMID: 25546074 DOI: 10.1111/jep.12300] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Case management is commonly used to provide health care for patients with multiple chronic conditions. However, the most effective form of team organization and the necessary support structures need to be identified. In this respect, patients' views could provide a valuable contribution to improving the design of these services. To analyse the experiences of patients with chronic diseases and of caregivers, in relation to health care services and mechanisms, and to identify means of modelling case management services. METHODS The method used was a qualitative study based on life stories, and semi-structured interviews with 18 patients with complex chronic diseases and with their family caregivers, selected by purposeful sampling in primary health care centres in Andalusia (southern Spain) from 2009 to 2011. RESULTS Three transition points were clearly identified: the onset and initial adaptation, the beginning of quality-of-life changes, and the final stage, in which the patients' lives are governed by the complexity of their condition. Health care providers have a low level of proactivity with respect to undertaking early measures for health promotion and self-care education. Care is fragmented into a multitude of providers and services, with treatments aimed at specific problems. CONCLUSIONS Many potentially valuable interventions in case management, such as information provision, self-care education and coordination between services and providers, are still not provided.
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Affiliation(s)
| | - Francisco Javier Martin-Santos
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care, Andalusian Healthcare Service, Málaga, Spain
| | - Shakira Kaknani
- Faculty of Health Sciences, University of Málaga, Málaga, Spain
| | - Juan Carlos Morilla-Herrera
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care, Andalusian Healthcare Service, Málaga, Spain
| | - Magdalena Cuevas Fernández-Gallego
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care, Andalusian Healthcare Service, Málaga, Spain
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15
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Morales-Asencio JM, Kaknani-Uttumchandani S, Cuevas-Fernández-Gallego M, Palacios-Gómez L, Gutiérrez-Sequera JL, Silvano-Arranz A, Batres-Sicilia JP, Delgado-Romero A, Cejudo-Lopez Á, Trabado-Herrera M, García-Lara EL, Martin-Santos FJ, Morilla-Herrera JC. Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases. J Eval Clin Pract 2015. [PMID: 26216361 DOI: 10.1111/jep.12392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Complex chronic diseases are a challenge for the current configuration of health services. Case management is a service frequently provided for people with chronic conditions, and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers and services used. METHODS The study was divided into three phases, covering the detection of information needs, the design and its implementation in the health care system, using literature review and expert consensus methods to select variables that would be included in the registry. RESULTS A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. A web-based registry with modular and layered architecture was designed. The framework follows a pattern based on the model-view-controller approach. In its first 6 months after the implementation, 102 case managers have introduced an average number of 6.49 patients each one. CONCLUSIONS The registry permits a complete and in-depth analysis of the characteristics of the patients who receive case management, the interventions delivered and some major outcomes as mortality, readmissions or adverse events.
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Affiliation(s)
| | | | - Magdalena Cuevas-Fernández-Gallego
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care of Málaga-Guadalhorce, Andalusian Healthcare Service, Málaga, Spain
| | | | | | | | | | | | - Ángela Cejudo-Lopez
- Case Management Area, District of Primary Health Care of Sevilla, Sevilla, Spain
| | | | | | - Francisco J Martin-Santos
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care of Málaga-Guadalhorce, Andalusian Healthcare Service, Málaga, Spain
| | - Juan C Morilla-Herrera
- Faculty of Health Sciences, University of Málaga, Málaga, Spain.,District of Primary Health Care of Málaga-Guadalhorce, Andalusian Healthcare Service, Málaga, Spain
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16
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Maijala V, Tossavainen K, Turunen H. Identifying nurse practitioners' required case management competencies in health promotion practice in municipal public primary health care. A two-stage modified Delphi study. J Clin Nurs 2015; 24:2554-61. [DOI: 10.1111/jocn.12855] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Virpi Maijala
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Kerttu Tossavainen
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Hannele Turunen
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
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17
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Procter S, Brooks F, Wilson P, Crouchman C, Kendall S. A case study of asthma care in school age children using nurse-coordinated multidisciplinary collaborative practices. J Multidiscip Healthc 2015; 8:181-8. [PMID: 25914542 PMCID: PMC4399592 DOI: 10.2147/jmdh.s71030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To describe the role of school nursing in leading and coordinating a multidisciplinary networked system of support for children with asthma, and to analyze the strengths and challenges of undertaking and supporting multiagency interprofessional practice. Background The growth of networked and interprofessional collaborations arises from the recognition that a number of the most pressing public health problems cannot be addressed by single-discipline or -agency interventions. This paper identifies the potential of school nursing to provide the vision and multiagency leadership required to coordinate multidisciplinary collaboration. Method A mixed-method single-case study design using Yin’s approach, including focus groups, interviews, and analysis of policy documents and public health reports. Results A model that explains the integrated population approach to managing school-age asthma is described; the role of the lead school nurse coordinator was seen as critical to the development and sustainability of the model. Conclusion School nurses can provide strategic multidisciplinary leadership to address pressing public health issues. Health service managers and commissioners need to understand how to support clinicians working across multiagency boundaries and to identify how to develop leadership skills for collaborative interprofessional practice so that the capacity for nursing and other health care professionals to address public health issues does not rely on individual motivation. In England, this will be of particular importance to the commissioning of public health services by local authorities from 2015.
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Affiliation(s)
- Susan Procter
- Faculty of Society and Health, Buckinghamshire New University, High Wycombe, UK
| | - Fiona Brooks
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Patricia Wilson
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Carolyn Crouchman
- Faculty of Society and Health, Buckinghamshire New University, High Wycombe, UK
| | - Sally Kendall
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
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18
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van Dillen SME, Hiddink GJ. To what extent do primary care practice nurses act as case managers lifestyle counselling regarding weight management? A systematic review. BMC FAMILY PRACTICE 2014; 15:197. [PMID: 25491594 PMCID: PMC4269898 DOI: 10.1186/s12875-014-0197-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/17/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND In this review study, we are the first to explore whether the practice nurse (PN) can act as case manager lifestyle counselling regarding weight management in primary care. METHODS Multiple electronic databases (MEDLINE, PsycINFO) were searched to identify relevant literature after 1995. Forty-five studies fulfilled the inclusion criteria. In addition, all studies were judged on ten quality criteria by two independent reviewers. RESULTS Especially in the last three years, many studies have been published. The majority of the studies were positive about PNs' actual role in primary care. However, several studies dealt with competency issues, including disagreement on respective roles. Thirteen studies were perceived as high quality. Only few studies had a representative sample. PNs' role in chronic disease management is spreading increasingly into lifestyle counselling. Although PNs have more time to provide lifestyle counselling than general practitioners (GPs), lack of time still remains a barrier. In some countries, PNs were rather ambiguous about their role, and they did not agree with GPs on this. CONCLUSION The PN can play the role of case manager lifestyle counselling regarding weight management in primary care in the UK, and wherever PNs are working under supervision of a GP and a primary health care team is already developed with agreement on roles. In countries in which a primary health care team is still in development and there is no agreement on respective roles, such as the USA, it is still the question whether the PN can play the case manager role.
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Affiliation(s)
- Sonja M E van Dillen
- Strategic Communication, Section Communication, Philosophy and Technology, Centre for Integrative Development (CPT-CID), Wageningen University, P.O. Box 8130, 6700 EW, Wageningen, the Netherlands.
| | - Gerrit J Hiddink
- Strategic Communication, Section Communication, Philosophy and Technology, Centre for Integrative Development (CPT-CID), Wageningen University, P.O. Box 8130, 6700 EW, Wageningen, the Netherlands.
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Roberts D, Hibberd P, Lewis CA, Turley J. The unique contribution of community clinical nurse specialists in rural Wales. Br J Community Nurs 2014; 19:601-7. [PMID: 25475675 DOI: 10.12968/bjcn.2014.19.12.601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To date, quality indicators that have been developed for nursing tend to focus on acute, secondary care settings. It remains unclear whether such quality indicators are applicable to community settings, particularly in rural environments. This research aims to identify the consensus view among specialist nurses regarding their unique nursing contribution within their rural community. Identifying agreed aspects of the unique role within the rural community area will enable quality care metrics to be developed, allowing specialist nurses to measure their unique contribution to rural health care in the future. The research used the Delphi technique to identify a consensus view among a population of specialist community nurses working in a designated rural area in Wales. The strongest area of consensus related to clinical and teaching expertise, where participants perceive educational expertise as being at the forefront of their role. In terms of care for individuals, consensus was focused on four main areas: developing appropriate criteria for referral in to the service, collaborative working, education, and advocacy roles. The findings highlight similarities to models of care provision elsewhere. Specific quality indicators are required for clinical nurse specialists working in rural areas. Current quality indicators may not be applicable across all clinical settings. Further work is required to explore the nature of rural nursing practice.
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Affiliation(s)
- Debbie Roberts
- Reader in Nursing, Academic Division of Psychology, Sport Science and Health, Glyndwr University, Wrexham, Wales
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20
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Carey N, Stenner K, Courtenay M. An exploration of how nurse prescribing is being used for patients with respiratory conditions across the east of England. BMC Health Serv Res 2014; 14:27. [PMID: 24443796 PMCID: PMC3903435 DOI: 10.1186/1472-6963-14-27] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 01/07/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a need to reduce symptoms, exacerbations and improve quality of life for patients with respiratory diseases. Across the world, increasing numbers of nurses are adopting the prescribing role and can potentially enhance service provision. Evidence suggests improved quality of care and efficiencies occur when nurses adopt the prescribing role. No evidence is available on the views of nurse prescribers who care for respiratory patients. The aim was to explore how nurse prescribing is being used for patients with respiratory conditions in different care settings across one strategic health authority, and whether this has benefited patients, healthcare professionals and the National Health Service. METHODS A qualitative study involving semi-structured interviews with a purposive sample of 40 nurses who prescribed for respiratory patients across the six counties in the East of England Strategic Health Authority. Data were collected in 2011 and subject to thematic analysis. RESULTS Disease management, including treatment and prevention of exacerbations, emergency episodes and minor illness, optimising and co-ordinating care were key aspects of care provided. Findings are reported under three themes: access, adherence and risk management and impact on nurses. Prescribing enabled nurses overcome existing problems in service provision to improve access, efficiency and patient convenience, reducing hospital admissions and length of stay. It also enabled patient centered consultations, which encouraged self-management, improved adherence, helped manage expectations, and reduced inappropriate service use. While participants experienced increased job satisfaction, knowledge and confidence, concerns were raised about increased responsibility, support, governance and future commissioning of services in line with planned major changes to the National Health Service. CONCLUSIONS This study provides new knowledge about how nurse prescribers provide care to patients with respiratory diseases. Despite a lack of consensus over the most effective model of respiratory care, prescribing was reported to have improved and extended points of access to treatment, and supported management of complex patients, particularly vulnerable groups. Given the high burden of chronic respiratory disease to patients and families this has important implications that need to be considered by those responsible for commissioning services in the United Kingdom and other countries.
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Affiliation(s)
- Nicola Carey
- School of Health and Social Care, University of Surrey, Surrey, England
| | - Karen Stenner
- School of Health and Social Care, University of Surrey, Surrey, England
| | - Molly Courtenay
- School of Health and Social Care, University of Surrey, Surrey, England
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21
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Norman I. Nursing must be a graduate profession (Well, he would say that, wouldn't he!). Int J Nurs Stud 2014; 51:523-5. [PMID: 24576549 DOI: 10.1016/j.ijnurstu.2014.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ian Norman
- King's College London, Florence Nightingale School of Nursing and Midwifery, UK.
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22
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Nagae H, Tanigaki S, Okada M, Katayama Y, Norikoshi C, Nishina Y, Sakai M. Identifying structure and aspects that 'continuing nursing care' used in discharge support from hospital to home care in Japan. Int J Nurs Pract 2013; 19 Suppl 2:50-8. [PMID: 23617449 DOI: 10.1111/ijn.12044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/26/2022]
Abstract
This study investigated nursing practice in continuing nursing care with the aim of identifying the key factors in nursing practice during discharge support. A literature review of papers published in Japanese in 2000 and 2011 was conducted using 'case management', 'care management', 'continuing nursing care', 'discharge support', 'discharge planning' and 'elderly person' as key words. An analysis of 54 papers revealed the following five aspects of continuing nursing care: (i) a cyclical approach aimed at realising the lifestyle desired by the person concerned; (ii) management of medical conditions for lifestyle stability; (iii) support for the patient as someone who can live independently; (iv) support to raise the ability of families to care for themselves; and (v) team approach to achieve implementation of patient-centred care. Understanding these aspects allows nurses to recreate the lifestyle of patients and families and facilitate the implementation of a systematic team approach.
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Affiliation(s)
- Hiroko Nagae
- Graduate School of Nursing, Chiba University, Chiba, Japan.
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23
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Procter S, Wilson PM, Brooks F, Kendall S. Success and failure in integrated models of nursing for long term conditions: multiple case studies of whole systems. Int J Nurs Stud 2012; 50:632-43. [PMID: 23131723 DOI: 10.1016/j.ijnurstu.2012.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 10/10/2012] [Accepted: 10/11/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current projections indicate that the UK faces a 252% increase in people aged over 65 with one or more long term conditions (LTC) by 2050. Nurses, managing their own caseloads and clinics, working across sectors and organisational boundaries and as part of a wider multi-disciplinary team, are frequently seen as key to managing this growing demand. However, the evidence base informing the nursing role in managing LTC, the most effective configuration of the multi-disciplinary team and the policy evidence relating to the infrastructure required to support cross organisational working, remains weak. OBJECTIVES To explore, identify and characterise the origins, processes and outcomes of effective chronic disease management models and the nursing contributions to such models. DESIGN Case study whole systems analysis using qualitative interview methods. SETTINGS Two community matron services, two primary care (GP) practice nursing services, two hospital based specialist nursing services were purposefully sampled from across England and Wales. PARTICIPANTS Selection criteria were derived using a consensus conference. The nurses in the service, all patients and carers on the caseload, members of the multi-disciplinary team and stakeholders were invited to participate. METHODS Semi-structured interviews with all participants, thematic analysis within a whole system framework. RESULTS The study found high levels of clinical nursing expertise which in the case of the community matrons was meeting the aim of reducing hospital admissions. Both the primary care and hospital nurse specialist indicate similar levels of clinical expertise which was highly valued by medical colleagues and patients. Patients continued to experience fragmented care determined by diagnostic categories rather than patient need and by the specific remit of the clinic or service the patient was using. Patient data systems are still organised around the impact on services and prevalence of disease at an individual level and not around the patient experience of disease. CONCLUSION Nurses are making a major contribution to meeting the policy objectives for long term conditions. Primary care nurses and hospital nurse specialists do broadly similar roles. The scope of the nursing roles and services studied were idiosyncratic, opportunistic and reactive, rather than planned and commissioned on an analysis of local population need.
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24
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Hughes P, Hancock C, Cooper K. Non-communicable diseases: calling healthcare educators to action. NURSE EDUCATION TODAY 2012; 32:757-759. [PMID: 22683254 DOI: 10.1016/j.nedt.2012.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 03/21/2012] [Accepted: 05/15/2012] [Indexed: 06/01/2023]
Abstract
Increasing numbers of people across the world are developing preventable non-communicable diseases (NCDs). This has massive social and economic implications for individuals, families, communities and countries, and impacts on the roles, responsibilities and future careers of nurses. The growing epidemic of NCDs is attracting increasing attention at every level and in almost every country. Many of the causes and solutions are beyond the remit of the health sector alone, calling instead for a system-wide approach. However, with the necessary knowledge and skills, the millions of nurses worldwide are well placed to make a significant contribution to the prevention and management of NCDs, focusing particularly on tobacco cessation, a healthy diet (including safe use of alcohol) and physical activity.
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Affiliation(s)
- Pat Hughes
- C3 Collaborating for Health, United Kingdom.
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25
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Coburn KD, Marcantonio S, Lazansky R, Keller M, Davis N. Effect of a community-based nursing intervention on mortality in chronically ill older adults: a randomized controlled trial. PLoS Med 2012; 9:e1001265. [PMID: 22815653 PMCID: PMC3398966 DOI: 10.1371/journal.pmed.1001265] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/29/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improving the health of chronically ill older adults is a major challenge facing modern health care systems. A community-based nursing intervention developed by Health Quality Partners (HQP) was one of 15 different models of care coordination tested in randomized controlled trials within the Medicare Coordinated Care Demonstration (MCCD), a national US study. Evaluation of the HQP program began in 2002. The study reported here was designed to evaluate the survival impact of the HQP program versus usual care up to five years post-enrollment. METHODS AND FINDINGS HQP enrolled 1,736 adults aged 65 and over, with one or more eligible chronic conditions (coronary artery disease, heart failure, diabetes, asthma, hypertension, or hyperlipidemia) during the first six years of the study. The intervention group (n = 873) was offered a comprehensive, integrated, and tightly managed system of care coordination, disease management, and preventive services provided by community-based nurse care managers working collaboratively with primary care providers. The control group (n = 863) received usual care. Overall, a 25% lower relative risk of death (hazard ratio [HR] 0.75 [95% CI 0.57-1.00], p = 0.047) was observed among intervention participants with 86 (9.9%) deaths in the intervention group and 111 (12.9%) deaths in the control group during a mean follow-up of 4.2 years. When covariates for sex, age group, primary diagnosis, perceived health, number of medications taken, hospital stays in the past 6 months, and tobacco use were included, the adjusted HR was 0.73 (95% CI 0.55-0.98, p = 0.033). Subgroup analyses did not demonstrate statistically significant interaction effects for any subgroup. No suspected program-related adverse events were identified. CONCLUSIONS The HQP model of community-based nurse care management appeared to reduce all-cause mortality in chronically ill older adults. Limitations of the study are that few low-income and non-white individuals were enrolled and implementation was in a single geographic region of the US. Additional research to confirm these findings and determine the model's scalability and generalizability is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT01071967. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Kenneth D Coburn
- Health Quality Partners, Doylestown, Pennsylvania, United States of America.
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