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Brant JM, Fink RM, Thompson C, Li YH, Rassouli M, Majima T, Osuka T, Gafer N, Ayden A, Khader K, Lascar E, Tang L, Nestoros S, Abdullah M, Michael N, Cerruti J, Ngaho E, Kadig Y, Hablas M, Istambouli R, Muckaden MA, Ali MN, Aligolshvili B, Obeidat R, Kunirova G, Al-Omari M, Qadire M, Omran S, Mouhawej MC, Zouak M, Ghrayeb I, Manasrah N, Youssef A, Ortega PF, Tuncel Oguz G, Cajucona LA, Leaphart K, Day A, Silbermann M. Global Survey of the Roles, Satisfaction, and Barriers of Home Health Care Nurses on the Provision of Palliative Care. J Palliat Med 2020; 22:945-960. [PMID: 31380727 DOI: 10.1089/jpm.2018.0566] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The World Health Assembly urges members to build palliative care (PC) capacity as an ethical imperative. Nurses provide PC services in a variety of settings, including the home and may be the only health care professional able to access some disparate populations. Identifying current nursing services, resources, and satisfaction and barriers to nursing practice are essential to build global PC capacity. Objective: To globally examine home health care nurses' practice, satisfaction, and barriers, regarding existing palliative home care provision. Design: Needs assessment survey. Setting/Subjects: Five hundred thirty-two home health care nurses in 29 countries. Measurements: A needs assessment, developed through literature review and cognitive interviewing. Results: Nurses from developing countries performed more duties compared with those from high-income countries, suggesting a lack of resources in developing countries. Significant barriers to providing home care exist: personnel shortages, lack of funding and policies, poor access to end-of-life or hospice services, and decreased community awareness of services provided. Respondents identified lack of time, funding, and coverages as primary educational barriers. In-person local meetings and online courses were suggested as strategies to promote learning. Conclusions: It is imperative that home health care nurses have adequate resources to build PC capacity globally, which is so desperately needed. Nurses must be up to date on current evidence and practice within an evidence-based PC framework. Health care policy to increase necessary resources and the development of a multifaceted intervention to facilitate education about PC is indicated to build global capacity.
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Affiliation(s)
- Jeannine M Brant
- 1Collaborative Science and Innovation, Billings Clinic, Montana State University College of Nursing, Billings, Montana
| | - Regina M Fink
- 2College of Nursing and School of Medicine, University of Colorado, Aurora, Colorado
| | - Cara Thompson
- 3Palliative Care, University of Colorado Health, Aurora, Colorado
| | - Ya Huei Li
- 4Collaborative Science and Innovation, Billings Clinic, Billings, Montana
| | - Maryam Rassouli
- 5Shahid Beheshti, University of Medical Sciences Cancer Research Center, Teheran, Iran
| | - Tomoko Majima
- 6Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Tomoko Osuka
- 6Graduate School of Nursing, Chiba University, Chiba, Japan
| | - Nahla Gafer
- 7Radiation and Isotope Center, Khartoum, Sudan
| | - Ayfer Ayden
- 8Koç University School of Nursing, Istanbul, Turkey
| | - Khaled Khader
- 9Taif University Faculty of Nursing, Taif, Saudi Arabia
| | - Eulalia Lascar
- 10Hospital de Niños "Dr. Ricardo Gutierrez," Buenos Aires, Argentina
| | - Lili Tang
- 11Department of Psychology, Peking University Cancer Hospital, Beijing, China
| | | | - Maihan Abdullah
- 13Health Promotion Department, Ministry of Public Health, Kabul, Afghanistan
| | - Natasha Michael
- 14Sydney School of Medicine, University of Notre Dame, Sydney, Australia
| | - Julie Cerruti
- 15Coordenadora Pesquisas Onco Pediátricas, Porto Alegre, Brazil
| | - Eric Ngaho
- 16Baptist Hospital Mutengene, Tiko, Cameroon
| | - Yolanda Kadig
- 17The Cyprus Association of Cancer Patients and Friends, Limassol, Cyprus
| | | | - Rana Istambouli
- 19Department of Palliative Care, Ain Wazein Medical Village University Hospital, Ain Wazein, Lebanon.,20Palliative Medicine, Paris, France
| | | | - Mushtaq Najm Ali
- 22Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq
| | | | - Rana Obeidat
- 24Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | | | - Ma'an Al-Omari
- 26Department of Oncology, King Abdullah University Hospital, Irbid, Jordan
| | | | - Suha Omran
- 28Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | - Nemeh Manasrah
- 32Faculty of Nursing, Hebron University, West Bank, Palestine
| | - Alexey Youssef
- 33Faculty of Medicine, Tishrin University, Latakia, Syria
| | - Paz F Ortega
- 34Catalan Institute of Oncology, Barcelona, Spain
| | - Gonca Tuncel Oguz
- 35Dr. Abdurrahman Yurtaslan Ankara Oncology Education & Research Hospital, Ankara, Turkey
| | | | - Kassie Leaphart
- 37St. Vincent Healthcare, Montana State University College of Nursing, Billings, Montana
| | - Alexa Day
- 38Billings Clinic, Montana State University College of Nursing, Billings, Montana
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Drevdahl DJ, Canales MK. Being a real nurse: A secondary qualitative analysis of how public health nurses rework their work identities. Nurs Inq 2020; 27:e12360. [PMID: 32583919 DOI: 10.1111/nin.12360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 11/30/2022]
Abstract
Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self-identity, mandated identity, and identity as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. 'Being a real nurse' describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role.
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Nixon C, Elliott L, Henderson M. Providing sex and relationships education for looked-after children: a qualitative exploration of how personal and institutional factors promote or limit the experience of role ambiguity, conflict and overload among caregivers. BMJ Open 2019; 9:e025075. [PMID: 30975674 PMCID: PMC6500194 DOI: 10.1136/bmjopen-2018-025075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To explore how personal and institutional factors promote or limit caregivers promoting sexual health and relationships (SHR) among looked-after children (LAC). In so doing, develop existing research dominated by atheoretical accounts of the facilitators and barriers of SHR promotion in care settings. DESIGN Qualitative semistructured interview study. SETTING UK social services, residential children's homes and foster care. PARTICIPANTS 22 caregivers of LAC, including 9 foster carers, 8 residential carers and 5 social workers; half of whom had received SHR training. METHODS In-depth interviews explored barriers/facilitators to SHR discussions, and how these shaped caregivers' experiences of discussing SHR with LAC. Data were systematically analysed using predetermined research questions and themes identified from reading transcripts. Role theory was used to explore caregivers' understanding of their role. RESULTS SHR policies clarified role expectations and increased acceptability of discussing SHR. Training increased knowledge and confidence, and supported caregivers to reflect on how personally held values impacted practice. Identified training gaps were how to: (1) Discuss SHR with LAC demonstrating problematic sexual behaviours. (2) Record the SHR discussions that had occurred in LAC's health plans. Contrary to previous findings, caregivers regularly discussed SHR with LAC. Competing demands on time resulted in prioritisation of discussions for sexually active LAC and those 'at risk' of sexual exploitation/harm. Interagency working addressed gaps in SHR provision. SHR discussions placed emotional burdens on caregivers. Caregivers worried about allegations being made against them by LAC. Managerial/pastoral support and 'safe care' procedures minimised these harms. CONCLUSIONS While acknowledging the existing level of SHR promotion for LAC there is scope to more firmly embed this into the role of caregivers. Care needs to be taken to avoid role ambiguity and tension when doing so. Providing SHR policies and training, promoting interagency working and providing pastoral support are important steps towards achieving this.
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Affiliation(s)
- Catherine Nixon
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Marion Henderson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Bell E, Campbell S, Goldberg LR. Nursing identity and patient-centredness in scholarly health services research: a computational text analysis of PubMed abstracts 1986-2013. BMC Health Serv Res 2015; 15:3. [PMID: 25608677 PMCID: PMC4312431 DOI: 10.1186/s12913-014-0660-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 12/12/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The most important and contested element of nursing identity may be the patient-centredness of nursing, though this concept is not well-treated in the nursing identity literature. More conceptually-based mapping of nursing identity constructs are needed to help nurses shape their identity. The field of computational text analytics offers new opportunities to scrutinise how growing disciplines such as health services research construct nursing identity. This paper maps the conceptual content of scholarly health services research in PubMed as it relates to the patient-centeredness of nursing. METHODS Computational text analytics software was used to analyse all health services abstracts in the database PubMed since 1986. Abstracts were treated as indicative of the content of health services research. The database PubMed was searched for all research papers using the term "service" or "services" in the abstract or keywords for the period 01/01/1986 to 30/06/2013. A total of 234,926 abstracts were obtained. Leximancer software was used in 1) mapping of 4,144,458 instances of 107 concepts; 2) analysis of 106 paired concept co-occurrences for the nursing concept; and 3) sentiment analysis of the nursing concept versus patient, family and community concepts, and clinical concepts. RESULTS Nursing is constructed within quality assurance or service implementation or workforce development concepts. It is relatively disconnected from patient, family or community care concepts. CONCLUSIONS For those who agree that patient-centredness should be a part of nursing identity in practice, this study suggests that there is a need for development of health services research into both the nature of the caring construct in nursing identity and its expression in practice. More fundamentally, the study raises questions about whether health services research cultures even value the politically popular idea of nurses as patient-centred caregivers and whether they should.
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Affiliation(s)
- Erica Bell
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 143, Hobart, Tasmania, 7001, Australia.
| | - Steve Campbell
- School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, Tasmania, 7250, Australia.
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre, University of Tasmania, Private Bag 143, Hobart, Tasmania, 7001, Australia.
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