Working with older people with multiple long-term conditions: a qualitative exploration of nurses' experiences

Health navigation and interpreting services for patients with limited English proficiency: a narrative literature review

ABSTRACT INTRODUCTIONCulturally and linguistically diverse populations (CALD) have significant health outcome disparities compared to dominant groups in high-income countries. The use of both navigators and interpreters are strategies used to address these disparities, but the intersections between these two roles can be poorly understood. AIMTo gain an overview of the literature on health navigation and similar roles, with particular reference to the New Zealand context, and to explore the interface between these roles and that of interpreters for CALD populations with limited English proficiency. METHODSA narrative review of the literature was conducted using a range of search strategies and a thematic analysis was conducted. RESULTSThere are several barriers to health-care access relating to health systems and CALD populations. For over 50 years, health workers who are members of these communities have been used to address these barriers, but there are many terms describing workers with wide-ranging roles. There is some evidence of efficacy in economic, psychosocial and functional terms. For health navigation services to work, they need to have staff who are well selected, trained and supported; are integrated into health-care teams; and have clearly defined roles. There may be a place for integrating interpreting more formally into the navigator role for members of communities who have limited English proficiency. CONCLUSIONTo achieve better access to health care for CALD populations, there is an argument for adding another member to the health team who combines clearly defined aspects of the roles of interpreter, community health worker and navigator. Organisations considering setting up such a position should have a clear target population, carefully consider the barriers they are trying to address and define a role, scope of practice and training requirements best suited to addressing those barriers.

On-line health seeking activity of older adults: an integrative review of the literature

The internet is increasingly used to provide health information. Supporting older people to access on-line health information requires understanding their current usage and possible barriers and facilitators. Methods involved searching three databases. Inclusion criteria were: (i) articles published within 10 years; (ii) people aged >65; (iii) explored reasons for older people accessing on-line health information and (iv) in English. Eight articles met these criteria. Older people use on-line health information to learn about a disease, medication, treatment, or healthy living. Factors influencing usefulness of on-line health information included demographics, health status, trust in the information, lack of skills using the internet and attitudes of health professionals. Findings indicate that while older people access on-line health information there are barriers: Low trust, financial barriers, lack of familiarity with the internet and low health literacy levels. Implications for nursing include working in partnership with older people to assist them to identify appropriate on-line information.

Managing long-term conditions in primary and community care

Health care policy in the UK continues to focus on provision of care in the community. For people with long-term conditions it has long been accepted that care should be predominantly in the primary and community care setting, with a focus on case management for those with complex needs. Community nurses are ideally placed to provide care to all people with long-term conditions, from health promotion, prevention and encouraging self-care to caring for people with more complex needs, comorbidities and end-of-life care. Community nurses are an essential element of the multidisciplinary team and should take the lead in delivering complex care at home to people with long-term conditions, while maintaining a focus on developing self-care, empowerment, community engagement and acting as an advocate for clients and their carers.

A qualitative study of nurses' clinical experience in recognising low mood and depression in older patients with multiple long-term conditions

AIMS AND OBJECTIVES

To explore how nurses' recognise depression in older patients with multiple long-term conditions and the strategies they use to support the patient.

BACKGROUND

Depression decreases an older person's quality of life and sense of wellness, and increases functional impairment. The positive role of nurses working with patients with long-term conditions is now being recognised internationally; however, there is a gap in the research about how nurses recognise depression in older patients and how this impacts on their practice.

DESIGN

This is a qualitative study informed by a constructivist grounded theory approach.

METHODS

In-depth telephone interviews were conducted with 40 nurses working in geographically diverse areas in New Zealand.

RESULTS

Having the conversation with older patients about their low moods, or specifically about depression was not something that all the nurses had, or felt they could have. While some nurses knew they could provide specific advice to patients, others believed this was not their responsibility, or within the scope of their role.

CONCLUSION

Faced with an increasing number of older people with long-term conditions, one of which maybe depression itself or as a result of living with other long-term conditions, ongoing monitoring and support pathways are necessary to prevent further decline in the older person's quality of life and well-being.

RELEVANCE TO CLINICAL PRACTICE

Nurses in primary health care can build on current knowledge and skills to increase their capability to promote 'ageing well' with older people who have long-term conditions and depression.