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Ollé-Espluga L, Vargas-Leguas H, Torrens Mèlich L, Juan Serra M, Arcas MM, Cortès-Franch I. Application of a new municipal management model of Home Care Service in Barcelona: Assessment of workers' labour conditions, health, and well-being. Work 2024:WOR230668. [PMID: 38995754 DOI: 10.3233/wor-230668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND In 2018, Barcelona City Council implemented a pilot phase of an organisational change in the municipal home care service (HCS) system. Inspired in the Buurtzorg model, the new model promotes the creation of self-managing teams operating in a restricted community setting. OBJECTIVE To assess the pilot phase of the new model, focusing on employees' working and employment conditions as well as on their health and well-being outcomes. METHODS Mixed-methods impact evaluation. First, a quantitative evaluation was conducted between October 2018 and October 2020, using a pre-post study design with one pretest and two posttest measurements in an intervention and a comparison group. The intervention group was composed of the members of the work teams implemented in the pilot phase from October 2018 onwards (baseline n = 44). The comparison group consisted of workers from the same districts working under the usual HCS system (baseline n = 72). Next, a qualitative study was conducted in workers from the intervention group in winter 2021-2022 (n = 10). RESULTS The pre-post study results yielded positive changes for the intervention group in social support and autonomy, as well as in many of the employment conditions. This group also experienced increases in psychological demands, painful positions, fatigue and psychological distress. Two main themes affecting workers' well-being emerged from the interviews: factors inherent to the self-management model and external factors. CONCLUSIONS Health and well-being outcomes seem to depend on the balance between job demands, resources, and ways of channelling conflicts within teams.
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Affiliation(s)
- Laia Ollé-Espluga
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | | | - Lluís Torrens Mèlich
- Directorate for Social Innovation, Area of Social Rights, Global Justice, Feminisms and LGTBI, Barcelona City Council, Barcelona, Spain
- Secretary of Social Affairs and Families, Generalitat de Catalunya, Barcelona, Spain
| | - Marta Juan Serra
- Directorate for Social Innovation, Area of Social Rights, Global Justice, Feminisms and LGTBI, Barcelona City Council, Barcelona, Spain
| | - Maria Marta Arcas
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Servei de Qualitat, Docència i Recerca, Fundació Sanitària Mollet, Mollet del Vallès, Barcelona, Spain
| | - Imma Cortès-Franch
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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Lavery J, Morrell-Scott N. Pre-registration nursing students' perceptions of a district nursing career: a qualitative descriptive study. Br J Community Nurs 2024; 29:86-94. [PMID: 38300242 DOI: 10.12968/bjcn.2024.29.2.86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
District nursing vacancies are recognised as high in comparison to many other nursing specialities. The role is often considered as an option for nurses after a period of registration as a nurse, which may be informed by multiple factors. The objectives of the study were to explore barriers to district nurse employment from the perspective of undergraduate nurses. A descriptive qualitative design was employed using focus groups as the method of data collection in accordance with study approval reference no: 21/NAH/006, 30/03/23. Participants were recruited from the current undergraduate nursing programme (n=60). Thematic analysis was chosen as a flexible method of qualitative data analysis. The study produced themes relating to role ambiguity, personal preferences, educational opportunities and recruitment and employer engagement. The experiences provided an insight into the barriers to recruitment of student nurses into district nursing on qualification. Increased engagement from community nurse providers is required to inform the role and incentivise entering this career option. Educational strategies that support community career pathways are required to ensure a balanced view of nursing roles among undergraduates.
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Affiliation(s)
- Joanna Lavery
- Senior Lecturer in Adult Nursing, Liverpool John Moores University
| | - Nicola Morrell-Scott
- Associate Dean of Education and Student Experience/Programme Lead Pre-registration Nursing, Liverpool John Moores University
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Slåtsveen RE, Wibe T, Halvorsrud L, Lund A. Interdisciplinary frontline teams in home-based healthcare services-paradoxes between organisational work structures and the trust model: a qualitative study. BMC Health Serv Res 2023; 23:715. [PMID: 37391763 DOI: 10.1186/s12913-023-09695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/13/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Achieving access to quality healthcare services to ensure healthy lives and promote well-being for all at all ages is one of the United Nation's Sustainable Developments Goals. In view of this goal, sustainable community healthcare services in Norway need to be urgently restructured in light of demographic changes, including an increase in the percentage of older adults in the country. National healthcare policies recommend finding new ways to organise and perform services using new technology, new methods and new solutions. The goal is to ensure greater continuity in the provision of services and softer transitions that enable service users to deal with a smaller number of people. The trust model is one such suggested organisational approach. The goal of the trust model is to involve service users and their next of kin in decisions that concern them while also trusting frontline workers' professional judgement in assessing the need for services and adjusting them to address changes in the health of the users, thus making the services individually tailored and more flexible. This study aims to explore how organisational work structures influence the delivery of interdisciplinary home-based healthcare services. METHODS Observations, individual-, and focus groups interviews were conducted within community home-based healthcare services in a large Norwegian city with managers at different levels, nurses, occupational therapists, physiotherapists, purchaser-unit employees and other healthcare workers. Data was analysed thematically. RESULTS The results are presented in terms of themes- "Balancing on the margins: Negotiations between the time available, users' needs, unforeseen events and administrative tasks" and "One gathered unit, but with different work structures". The results identify organisational work structures that influence the performance of the trust model with regard to its intention of making flexible and individually tailored services available. However, these structures are different for the members of the interdisciplinary team, thus creating several paradoxes that need to be negotiated while fulfilling their daily responsibilities. CONCLUSION This study suggests that it is crucial to pay attention to paradoxes and structures experienced by interdisciplinary frontline workers in home-based healthcare services, since they are unavoidable factors that need to be acknowledged when designing approaches for addressing the changes expected in community healthcare services.
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Affiliation(s)
- Ruth-Ellen Slåtsveen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, St. Olavs Plass, PO Box 4, Oslo, 0130, Norway.
| | - Torunn Wibe
- Centre for Development of Institutional and Home Care Services in Oslo, PO Box 4716, Oslo, N- 0506, Norway
| | - Liv Halvorsrud
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, St. Olavs Plass, PO Box 4, Oslo, 0130, Norway
| | - Anne Lund
- Department of Rehabilitation Science and Health Technology- Occupational Therapy, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, St. Olavs Plass, PO Box 4, Oslo, 0130, Norway
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Lalani M, Wytrykowski S, Hogan H. Approaches to improving patient safety in integrated care: a scoping review. BMJ Open 2023; 13:e067441. [PMID: 37015799 PMCID: PMC10083780 DOI: 10.1136/bmjopen-2022-067441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES This scoping review aimed to establish the approaches employed to improving patient safety in integrated care for community-dwelling adults with long-term conditions. DESIGN Scoping review. SETTING All care settings. SEARCH STRATEGY Systematic searches of seven academic and grey literature databases for studies published between 2000 and 2021. At the full-text review stage both the first and second reviewer (SW) independently assessed full texts against the eligibility criteria and any discrepancies were discussed. RESULTS Overall, 24 studies were included in the review. Two key priorities for safety across care boundaries for adults with long-term conditions were falls and medication safety. Approaches for these priorities were implemented at different levels of an integrated care system. At the micro-level, approaches involved care primarily in the home setting provided by multi-disciplinary teams. At the meso-level, the focus was on planning and designing approaches at the managerial/organisational level to deliver multi-disciplinary care. At the macro-level, system-wide approaches included integrated care records, training and education and the development of care pathways involving multiple organisations. Across the included studies, evaluation of these approaches was undertaken using a wide range of process and outcome measures to capture patient harm and contributory factors associated with falls and medication safety. CONCLUSIONS For integrated care initiatives to fulfil their promise of improving care for adults with long-term conditions, approaches to improve patient safety need to be instituted across the system, at all levels to support the structural and relational aspects of integrated care as well as specific risk-related safety improvements.
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Affiliation(s)
- Mirza Lalani
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Helen Hogan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Ruotsalainen S, Elovainio M, Jantunen S, Sinervo T. The mediating effect of psychosocial factors in the relationship between self-organizing teams and employee wellbeing: A cross-sectional observational study. Int J Nurs Stud 2023; 138:104415. [PMID: 36527858 DOI: 10.1016/j.ijnurstu.2022.104415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Several benefits of working in a self-organizing team, such as higher job satisfaction and better engagement to work have been demonstrated in previous studies. OBJECTIVE To examine whether those employees working in a self-organizing team have higher job satisfaction and lower turnover intentions compared to those in non-self-organized teams. Further, to test whether psychosocial factors defined by the Job Demand-Control model would function as mediators. DESIGN A cross-sectional survey study. SETTING(S) Home care and assisted living facilities (with 24-h assistance). PARTICIPANTS Licensed practical nurses (N = 377), registered nurses, therapists and managers (N = 183), and other employees (N = 31) in services for older people. METHODS A survey for employees working in services for older people and who were either in the self-organized teams or in the non-self-organized teams. Data was analyzed using linear regression and mediation analyses. RESULTS Those employees who worked in a self-organizing team were more satisfied with their job and had lower turnover intentions compared to those in a non-self-organizing team (mean [SD] 3.9 [1.0] vs. 3.7 [1.0], p = 0.006 and 2.2 [1.2] vs. 2.5 [1.3], p = 0.006, respectively). Moreover, job demands and job strain partially mediated the effect of self-organizing teamwork on job satisfaction (Average causal mediation effect [95%CI] 0.09 [0.02-0.15] and 0.10 [0.03-0.18], respectively), as well as on turnover intentions (Average causal mediation effect [95%CI] -0.08 [-0.15 to -0.01] and -0.20 [-0.18 to -0.03], respectively). CONCLUSIONS In the context of older people care services, working in self-organizing teams may enhance employee wellbeing by lowering job demands and job strain, but not by improving job control. Based on the findings of this study, self-organization seems beneficial, however, it requires real autonomy for the teams and team building. TWEETABLE ABSTRACT Self-organizing teamwork increases job satisfaction and decreases turnover intentions via lower job demands and strain in older people care.
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Affiliation(s)
- Salla Ruotsalainen
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Helsinki, Finland.
| | - Marko Elovainio
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Helsinki, Finland; Research Program Unit, Faculty of Medicine, University of Helsinki, Finland
| | - Sami Jantunen
- South-Eastern Finland University of Applied Sciences, RDI and Services, Digital Economy Focus Area, Mikkeli, Finland
| | - Timo Sinervo
- Finnish Institute for Health and Welfare, Welfare State Research and Reform unit, Health and Social Service System Research team, Helsinki, Finland
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Barisone M, Busca E, Bassi E, De Luca E, Profenna E, Suardi B, Dal Molin A. The Family and Community Nurses Cultural Model in the Times of the COVID Outbreak: A Focused Ethnographic Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1948. [PMID: 36767312 PMCID: PMC9915317 DOI: 10.3390/ijerph20031948] [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: 11/29/2022] [Revised: 01/14/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
The ageing population, increasingly frail and chronically ill, and COVID-19 pandemic challenges have highlighted national health systems' vulnerability and, more strongly/to a greater extent, the pivotal role of the family and community nurse (FCN). However, the recent introduction of FCNs in primary care settings has yet to be explored in Italy. This study aimed to identify the FCNs' cultural model and its implementation during the COVID-19 outbreak. A focused ethnographic study was performed in a primary care community service in northern Italy. Participants were FCNs (N = 5), patients and caregivers (N = 12). Qualitative data were collected through semi-structured interviews, field notes, observation of FCNs' activities and access to documents. Qualitative analysis identified themes concerned with crucial aspects of FCNs' activities, role implementation, and their relationship with patients and families. This study illuminated how the FCN strategically takes care of and identifies patients' and community needs. Although the COVID-19 outbreak hindered effective FCN project implementation, this study highlighted that the pandemic provided a chance to better identify cultural, organisational and educational weaknesses that need to be addressed to support the full accomplishment of FCNs' scope of practice.
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Affiliation(s)
- Michela Barisone
- S.C. Centro Controllo Direzionale, Azienda Socio Sanitaria Ligure (ASL2), Piazza Pertini, 10, 17100 Savona, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
| | - Erica Busca
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità Novara, Corso Mazzini 18, 28100 Novara, Italy
| | - Erika Bassi
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità Novara, Corso Mazzini 18, 28100 Novara, Italy
| | - Enrico De Luca
- Department of Nursing, Faculty of Health and Life Sciences, University of Exeter, St. Luke’s Campus, Exeter EX1 2LT, UK
| | - Emanuele Profenna
- Azienda Sanitaria Locale di Parma, Strada del Quartiere n. 2/A, 43125 Parma, Italy
| | - Barbara Suardi
- S.C. Direction of Health Professions, Azienda Sanitaria di Vercelli, Ospedale Sant’Andrea, Corso Mario Abbiate 21, 13100 Vercelli, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, University of Piemonte Orientale, Via Solaroli 17, 28100 Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità Novara, Corso Mazzini 18, 28100 Novara, Italy
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van de Bovenkamp H, van Pijkeren N, Ree E, Aase I, Johannessen T, Vollaard H, Wallenburg I, Bal R, Wiig S. Creativity at the margins: A cross-country case study on how Dutch and Norwegian peripheries address challenges to quality work in care for older persons. Health Policy 2023; 127:66-73. [PMID: 36543693 DOI: 10.1016/j.healthpol.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripheral areas are often overlooked in health-care research but they in fact deserve specific attention. Such areas struggle to maintain access to good quality health-care services due to their geographical context. At the same time, new interventions or promising innovations often emerge in places where creativity is urgently needed. In this paper, we explore this creativity at the margins in older persons care organizations in peripheral areas, which other healthcare providers and policymakers can learn from. METHODS This exploratory study is based on two large research projects on the quality of care for older persons in Norway and the Netherlands. We performed secondary analysis of interviews with quality managers and other quality workers and used additional document analysis and expert interviews to deepen our analysis. RESULTS The results show that older persons care organizations working in peripheral areas must deal with a number of challenges caused by their geographical context, e.g. geographical distances (between services and to the geographical center), workforce shortages, and landscape characteristics. We found that organizations use different strategies to tackle these challenges, such as scaling up, brightening up and opening up. These strategies, conceptualized as creativity at the margins, impact quality work in different ways, for example by enabling more person-centered care. CONCLUSION We conclude that both policymakers and research should overcome their peripheral blindness by learning from and supporting creativity at the margins in future policies and research.
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Affiliation(s)
- Hester van de Bovenkamp
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands.
| | - Nienke van Pijkeren
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Eline Ree
- Faculty of Health Sciences, University of Stavanger, Norway
| | - Ingunn Aase
- Faculty of Health Sciences, University of Stavanger, Norway
| | | | - Hans Vollaard
- Utrecht School of Governance, Utrecht University, The Netherlands
| | - Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Siri Wiig
- Faculty of Health Sciences, University of Stavanger, Norway
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Hegedüs A, Schürch A, Bischofberger I. Implementing Buurtzorg-derived models in the home care setting: a Scoping Review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100061. [PMID: 38745628 PMCID: PMC11080323 DOI: 10.1016/j.ijnsa.2022.100061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/16/2021] [Accepted: 01/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Buurtzorg is a pioneering healthcare organization founded in the Netherlands. Buurtzorg has established independent, self-managing teams of nurses and promises high-quality home care at a lower cost through person-centered care, continuity of care, building trusting relationships, and networks in the neighborhood. Traditional home care services are increasingly reorganized according to the Buurtzorg-principles. Objectives This review aims to describe the experiences gathered during the implementation of the Buurtzorg-derived model outside the Netherlands. It further outlines their potential effects. Design Scoping Review. Methods Several electronic databases were searched for relevant articles, supplemented by hand-searching and internet searches for gray literature. Various publication types that described the implementation of the Buurtzorg model or its outcomes in countries other than the Netherlands were included. The data were analyzed using qualitative content analysis. Two authors coded the data in several cycles and created categories and subcategories. Results The review identified 25 publications reporting the experiences or outcomes of Buurtzorg-derived models outside the Netherlands. Upon implementing elements of Buurtzorg, the home care organizations adopted a person-centered care approach, with improved communication with patients and family caregivers, and could establish new networks with other services. The main challenges were related to the self-managed working culture, the organizational framework, or national healthcare policies, which hindered the implementation process. Conclusions The implementation of Buurtzorg-derived models is complex, challenging, and requires adaptations on several levels: upskilling of networking and staffing competencies in teams, leadership and IT requirements in the organization, and policy changes in the healthcare system. Individualized approaches and solid conceptual preparation are required for implementation. Tweetable abstract Experiences with the implementation of Buurtzorg in home care services outside the Netherlands. A scoping review @HegeduesAnna.
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Affiliation(s)
- Anna Hegedüs
- Research Institute, Careum School of Health, part of Kalaidos University of Applied Sciences, Zurich, Switzerland
- Bern University of Applied Sciences, Departement of Health Professions, Applied Research & Development in Nursing, Bern, Switzerland
| | - Anita Schürch
- Research Institute, Careum School of Health, part of Kalaidos University of Applied Sciences, Zurich, Switzerland
- Bern University of Applied Sciences, Departement of Health Professions, Competence Centre Participatory Health Care, Bern, Switzerland
| | - Iren Bischofberger
- Research Institute, Careum School of Health, part of Kalaidos University of Applied Sciences, Zurich, Switzerland
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Kamara Y, Rodriguez C, Moyo N. District nursing using neighbourhood care principles in practice: reflecting on our experience. Br J Community Nurs 2022; 27:552-556. [PMID: 36327207 DOI: 10.12968/bjcn.2022.27.11.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
There is much interest in the UK, and elsewhere, in the Dutch Buurtzorg model of providing district nursing, and there a number of published, external evaluations of pilot projects. We are nurses who worked in one such pilot that used an adapted Buurtzorg model called neighbourhood nursing using neighbourhood care principles. This article reflects on our experience and describes how we organised ourselves and, our experiences of working in such ways as well as the challenges. This article also offers advice for others who are considering introducing such models.
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Affiliation(s)
- Yasmin Kamara
- Senior Nurse Practitioner/Neighbourhood Nursing Development Coach, Guy's and St Thomas' NHS Foundation Trust
| | - Cendrig Rodriguez
- Neighbourhood Nursing Development Coach, Guy's and St Thomas' NHS Foundation Trust
| | - Nokuthula Moyo
- Development Coach Neighbourhood Nursing - Guy's and St Thomas' NHS Foundation Trust
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de Bruin J, Doodkorte R, Sinervo T, Clemens T. The implementation and outcomes of self-managing teams in elderly care: A scoping review. J Nurs Manag 2022; 30:4549-4559. [PMID: 36192833 PMCID: PMC10092661 DOI: 10.1111/jonm.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/07/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIM We aim to map the existing evidence and gaps in research on the implementation and outcomes of self-managing elderly care teams. BACKGROUND Due to increasing demand for elderly nursing care and an ageing workforce, recruiting and retaining community nurses have become challenging. Implementing self-managing teams may be a solution to address this problem. EVALUATION This scoping review included 27 studies, varying from narrative reviews to a quantitative cross-sectional study. The studies' primary focus on self-managing teams was essential for eligibility. KEY ISSUES Nurses' job satisfaction was high in self-managing teams due to improved relationships with patients and increased autonomy. Continuity of care and patient acceptability were high. Transformation of managers to coaches in a team with a flat hierarchy is needed to empower nurses with responsibility for their own work. Trust and teamwork should be assisted by suitable ICT support systems. CONCLUSIONS International interest in self-managing teams is large, but quantitative research is limited and guidelines for implementation are needed. Recommendations for potential successful implementation were made. IMPLICATIONS FOR NURSING MANAGEMENT Nurse autonomy and job satisfaction can increase by implementing self-managing teams. This requires a change in management styles, from managing to coaching nurses.
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Affiliation(s)
- Jeanine de Bruin
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Remco Doodkorte
- Department of Experimental Orthopedics, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Timo Sinervo
- The Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Timo Clemens
- Department of International Health. CAPHRI - Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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McDonald A, Frazer K, Warters A. Irish Public Health Nursing Services and Home Support Services: governance of older persons' home care. Public Health Nurs 2021; 39:96-102. [PMID: 34913190 DOI: 10.1111/phn.13021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/08/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe experiences of nurses in the Irish Public Health Nursing service working with Home Support Services (HSS) when providing home care for older people. DESIGN Qualitative design. Two of twenty-four focus groups undertaken in 2018 are examined to report specific experiences of registered nurses. SAMPLE The first group comprised three Public Health Nurses (PHNs) and two community Registered General Nurses (cRGNs) and the second comprised three PHNs and one cRGN. In total nine nurses participated. MEASUREMENTS Focus group interviews were used to collect data, discussions lasted 60-90 minutes and were audio-recorded, professionally transcribed verbatim, and anonymised. RESULTS AND CONCLUSIONS Gaps in lines of authority and accountability in day-to-day care exist, posing risks to safety. Establishing an enhanced home care model for complex cases and levels of accountability and supervision is critical. Investigating ways of adopting digital solutions to share commissioned home care plans with primary care teams (PCTs) would clarify responsibility and roles and reduce the risks of care left undone. Formally defining the role of commissioned home care agencies in primary care and that which they are expected to play during times of crisis, such as during COVID-19 pandemic will enhance integrated care and governance.
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Affiliation(s)
- Anne McDonald
- Community Health Organisation 9, Dublin North City and County, Health Service Executive, Dublin, Ireland
| | - Kate Frazer
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Austin Warters
- Services for Older People, Health Service Executive, Dublin, Ireland
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12
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Wolbers I, Lalleman PCB, Schoonhoven L, Bleijenberg N. The Ambassador Project: Evaluating a Five-Year Nationwide Leadership Program to Bridge the gap Between Policy and District Nursing Practice. Policy Polit Nurs Pract 2021; 22:259-270. [PMID: 34693816 DOI: 10.1177/15271544211050917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
District nurses have a crucial position in healthcare provision and are expected to use leadership practices to ensure optimal quality patient care. To better equip them, a leadership program named the ambassador project was developed to support the development of a liaison role between policy and district nursing practice. This research aims to evaluate from different perspectives the impact of this nationwide, five-year leadership program for district nurses at the organizational, regional, and societal levels. A mixed-methods study was conducted using two focus groups based on peer-to-peer shadowing (n = 14), semistructured interviews (n = 13), and an online questionnaire (n = 45). The analysis shows that the impact of a nationwide leadership program for district nurses was perceived as predominantly positive, and nurses experienced an increase in courage, assertiveness, professional pride, and leadership skills. They obtained confidence in representing the group of district nurses at the organizational, regional, and societal levels when speaking with various key stakeholders from the healthcare system. They were able to bridge the gaps among daily practice, policymaking, and politics by using translations and shaping actions and information into terms suiting the needs of those involved.
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Affiliation(s)
- I Wolbers
- 8119University of Applied Sciences Utrecht, Utrecht, The Netherlands. Heidelberglaan 7, 3584 CS Utrecht, The Netherlands. + 31 618648355.
| | - P C B Lalleman
- Professor, 3170Fontys University of Applied Sciences, Eindhoven, The Netherlands. Rachelsmolen 1, 5612 MA Eindhoven, The Netherlands. + 31 610512726.
| | - L Schoonhoven
- Professor of Nursing Science, 168086Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
| | - N Bleijenberg
- Professor of Nursing Science, 168086Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Universiteitsweg 100, 3584 CG Utrecht, The Netherlands.
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Pollock K, Wilson E, Caswell G, Latif A, Caswell A, Avery A, Anderson C, Crosby V, Faull C. Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services.
Objective
To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting.
Design
A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops.
Setting
This took place in Nottinghamshire and Leicestershire, UK.
Results
As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care.
Limitations
The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned.
Conclusions
The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life.
Future work
Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alan Caswell
- Patient and Public Involvement Representative, Dementia, Frail Older and Palliative Care Patient and Public Involvement Advisory Group, University of Nottingham, Nottingham, UK
| | - Anthony Avery
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Vincent Crosby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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14
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Does Stewardship Theory Provide a Viable Alternative to Control-Fixated Performance Management? ADMINISTRATIVE SCIENCES 2020. [DOI: 10.3390/admsci10040086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Stewardship theory provides an interesting alternative to agency theory, which in the recent New Public Management era supported the introduction of rigorous performance management systems based on generalized mistrust in and control of public employees. However, we lack empirical validation of the feasibility and positive outcomes of the new forms of trust-based management recommended by stewardship theory. As such, there are few examples of alternative ways of boosting the motivation of public employees that can serve as beacons for public service organizations (PSOs) eager to find new ways of motivating their staff to create public value for the users of public services and society as a whole. This article aims to remedy this problem by exploring a seemingly successful empirical case of trust-based management to see whether the core principles of stewardship theory apply and how new management practices may influence the motivation and well-being of the employees, the perceived satisfaction and involvement of the users, and overall organizational performance, including cost efficiency.
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15
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Wood C. Social isolation and care at home. Br J Community Nurs 2020; 25:473. [PMID: 33030361 DOI: 10.12968/bjcn.2020.25.10.473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Cate Wood
- Senior Lecturer Healthcare Leadership and Management, Birmingham City University
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16
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Factors influencing the recruitment and retention of registered nurses in adult community nursing services: an integrative literature review. Prim Health Care Res Dev 2020; 21:e31. [PMID: 32912372 PMCID: PMC7503170 DOI: 10.1017/s1463423620000353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Adult community nursing services are evolving around the world in response to government policies and changing patient demographics. Amidst these changes, recruitment and retention of community nursing staff are proving a challenge. An integrative literature review has identified multiple factors that influence nurse retention in adult community nursing with sparse information on recruitment factors. Although factors impacting retention of community nurses have been identified, their generalisability around the world is a challenge as they are context and co-dependent. Indicating the need for this area of study to be explored at a local level, as the same factors present with different findings globally. AIM To establish factors influencing recruitment and retention of registered nurses in adult community nursing services. DESIGN Integrative literature review. DATA SOURCES Four electronic databases were searched in August 2019 from January 2008 to December 2018: CINAHL Complete, Web of Science, MEDLINE and PROQUEST. Both qualitative and quantitative studies focusing on factors influencing community nursing recruitment and retention were included. REVIEW METHODS An integrative literature review methodology by Whittemore and Knafl (The integrative review: updated methodology. Journal of Advanced Nursing 52, 546-553) was followed, supported by Cochrane guidelines on data synthesis and analysis using a narrative synthesis method. The Center for Evidence-Based Management (CEBMa) critical appraisal tools were used for study quality assessment. RESULTS Ten papers met the study inclusion criteria. Data synthesis and analysis revealed individual and organisational factors influencing the retention of community nurses with the following three dominant themes: (1) work pressure, (2) working conditions and (3) lack of appreciation by managers. CONCLUSION The review identified context-dependent factors that influence adult community nurses' retention with limited generalisability. There is a lack of data on factors influencing recruitment into adult community nursing; further research is needed to explore factors affiliated to community nursing recruitment.
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17
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Valaitis RK, Markle-Reid M, Ploeg J, Butt ML, Ganann R, Murray N, Bookey-Bassett S, Kennedy L, Yousif C. An evaluation study of caregiver perceptions of the Ontario's Health Links program. PLoS One 2020; 15:e0229579. [PMID: 32106273 PMCID: PMC7046224 DOI: 10.1371/journal.pone.0229579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/11/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction In 2012, the Ontario government launched Health Links (HL), which was designed to integrate care for patients with multimorbidity and complex needs who are high users of health services. This study evaluated perceptions of family and friend caregivers of patients enrolled in the HL program. Research questions included: What are (a) characteristics of caregivers of patients enrolled in HL (b) caregivers’ perceptions of the program in relation to HL’s guiding principles (patient and family-centred care, accessibility, coordination of services, and continuity of care and care provider) and (c) caregivers’ perceptions of the impact of HL on themselves and their care recipient? Methods This study involved a survey and qualitative, semi-structured interviews. HL guiding principles (patient and family-centered care, accessibility, coordination of services, and continuity) guided the analysis. Results Twenty-seven surveys and 16 qualitative interviews were completed. Caregivers reported high levels of strain [Modified Caregiver Strain Index (MCSI) 15.5 (SD 7.03)], mild anxiety [Generalized Anxiety Disorder (GAD 7), 9.6 (SD 6.64)] and depression [Center for Epidemiological Studies Depression Scale (CES-D 10), 11.9 (SD 8.72)]. Regarding the guiding principles, most caregivers had a copy of the HL patient’s care plan, although some caregivers noted that their needs were not included in the plan, nor were they asked for input. Caregivers found the program’s home and phone visits accessible. Despite minimum wait times for community-based services, other access barriers persisted, (i.e., out-of-pocket costs). HL provided well-coordinated patient services, although some perceived that there was poor team communication. Caregiver perceptions varied on the quality of care provided. Provider continuity provided caregiver relief and patient support: A lack of continuity was related to changes in care coordinators and weekend staff and attrition. Conclusions Caregivers of HL patients appreciated patient- and family-centred, accessible, consistent, coordinated and team-based approaches in care. Providers and decision-makers are urged to ensure that programs aimed at high system users address these core concepts while addressing caregivers’ needs.
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Affiliation(s)
- Ruta K. Valaitis
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Maureen Markle-Reid
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michelle L. Butt
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Ganann
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Murray
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sue Bookey-Bassett
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laurie Kennedy
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Claudia Yousif
- Aging Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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18
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Capturing the Role of Context in Complex System Change: An Application of the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to an Integrated Care Organisation in the UK. Int J Integr Care 2020; 20:4. [PMID: 32089656 PMCID: PMC7019199 DOI: 10.5334/ijic.5196] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: If integrated care approaches are to be properly adapted to local contexts, a better understanding is required of key determinants of implementation and how these might be appropriately supported. Purpose: This study applied the Canadian Context and Capabilities for Integrating Care (CCIC) Framework to investigate factors influencing the implementation and outcomes of a complex integrated care change programme in Torbay and South Devon (TSD) and, more specifically, in one of five sub-localities, Coastal. Methods: A case study method using embedded ‘Researchers in Residence’ to conduct action-based participatory research and deploying mixed qualitative methods. Results: The relative importance of some domains differ between the English and Canadian studies. In this case study, physical features (structural and geographic) were found to be very pertinent to the relative success of the Coastal Locality, as were empowered clinical leadership, with readiness for change being expressed through processes and cultures that were risk-enabling, strengths-based, person-/outcome-focused. Conclusions: The CCIC Framework provided a useful tool capturing key elements of complex system change with key domains being transferable across settings, while also finding local variation in the UK. This would encourage its wider application so that further comparisons can be made of the ways in which different contextual and implementation properties impact upon delivery and outcomes.
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19
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Inzitari M, Risco E, Cesari M, Buurman BM, Kuluski K, Davey V, Bennett L, Varela J, Prvu Bettger J. Editorial: Nursing Homes and Long Term Care after COVID-19: A New Era? J Nutr Health Aging 2020; 24:1042-1046. [PMID: 33244558 PMCID: PMC7353831 DOI: 10.1007/s12603-020-1447-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022]
Affiliation(s)
- M Inzitari
- Marco Inzitari, Edifici Montseny 0, Parc Sanitari Pere Virgili, c Esteve Terradas 30, 08023 Barcelona, Spain, , Phone: +34 932594004
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20
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Lalani M, Fernandes J, Fradgley R, Ogunsola C, Marshall M. Transforming community nursing services in the UK; lessons from a participatory evaluation of the implementation of a new community nursing model in East London based on the principles of the Dutch Buurtzorg model. BMC Health Serv Res 2019; 19:945. [PMID: 31818293 PMCID: PMC6902511 DOI: 10.1186/s12913-019-4804-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 12/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background Buurtzorg, a model of community nursing conceived in the Netherlands, is widely cited as a promising and evidence-based approach to improving the delivery of integrated nursing and social care in community settings. The model is characterised by high levels of patient and staff satisfaction, professional autonomy exercised through self-managing nursing teams, client empowerment and holistic, patient centred care. This study aimed to examine the extent to which some of the principles of the Buurtzorg model could be adapted for community nursing in the United Kingdom. Methods A community nursing model based on the Buurtzorg approach was piloted from June 2017–August 2018 with a team of nurses co-located in a single general practice in the Borough of Tower Hamlets, East London, UK. The initiative was evaluated using a participatory methodology known as the Researcher-in-Residence model. Qualitative data were collected using participant observation of meetings and semi-structured interviews with nurse team members, senior managers, patients/carers and other local stakeholders such as General Practitioners (GP) and social workers. A thematic framework analysis of the data was carried out. Results Implementation of a community nursing model based on the Buurtzorg approach in East London had mixed success when assessed against its key principles. Patient experience of the service was positive because of the better access, improved continuity of care and longer appointment times in comparison with traditional community nursing provision. The model also provided important learning for developing service integration in community care, in particular, how to form effective collaborations across the care system with other health and social care professionals. However, some of the core features of the Buurtzorg model were difficult to put into practice in the National Health Service (NHS) because of significant cultural and regulatory differences between The Netherlands and the UK, especially the nurses’ ability to exercise professional autonomy. Conclusions Whilst many of the principles of the Buurtzorg model are applicable and transferable to the UK, in particular promoting independence among patients, improving patient experience and empowering frontline staff, the successful embedding of these aims as normalised ways of working will require a significant cultural shift at all levels of the NHS.
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Affiliation(s)
- Mirza Lalani
- Department of Primary Care and Population Health, University College London, London, UK.
| | | | | | | | - Martin Marshall
- Department of Primary Care and Population Health, University College London, London, UK
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21
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Leask CF, Bell J, Murray F. Acceptability of delivering an adapted Buurtzorg model in the Scottish care context. Public Health 2019; 179:111-117. [PMID: 31794948 DOI: 10.1016/j.puhe.2019.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 09/18/2019] [Accepted: 10/17/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Given increasing epidemiological and financial pressures on services, there is a need to test new models of integrated health and social care. Crucial to this testing is determining acceptability, particularly to those delivering services. The Dutch 'Buurtzorg' model, characterised by self-managing nursing teams, has shown promise, but its principles are yet to be adapted and tested in Scotland. The study aim was to understand the experiences of working in a self-managing, integrated, health and social care team. STUDY DESIGN This is a case study within a primary care setting. METHODS The Integrated Neighbourhood Care Aberdeen (INCA) project comprised two self-managing teams of support workers and nurses working at different sites in Aberdeen. Acceptability was explored through semistructured interviews with staff. Data were recorded and analysed thematically. RESULTS Staff reported high-quality patient care, which they attributed to autonomy over the frequency and duration of visits. Tensions between team members and between teams and management were apparent partly due to the predominantly social care caseload, confounding guidance on how to implement self-management and communication challenges. The team colocated within a General Practice reported positive relationships with other professionals. CONCLUSIONS Self-management requires a clear framework in which to function. Allowing staff autonomy to vary care provision according to need may improve patient outcomes.
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Affiliation(s)
- C F Leask
- Aberdeen City Health and Social Care Partnership, Marischal College, Broad St, Aberdeen, AB10 1AB, UK; Health Intelligence Department, NHS Grampian, Eday Rd, Aberdeen, AB15 6RE, UK.
| | - J Bell
- Health Intelligence Department, NHS Grampian, Eday Rd, Aberdeen, AB15 6RE, UK.
| | - F Murray
- Health Intelligence Department, NHS Grampian, Eday Rd, Aberdeen, AB15 6RE, UK.
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Abstract
There will be significant changes to the way in which primary and community health services are provided in the wake of the NHS Long Term Plan published in January 2019. Community nurses are already preparing themselves for these changes by exploring models of care that are patient-centred and link to neighbourhood, place and system levels. This article discusses two examples of such models of care, the Buurtzorg and Embrace model, both from the Netherlands. Styles of leadership and associated development, both within nursing and on a multi-professional basis will be crucial to ensure success. This article outlines Alban-Metcalfe's engaging transformational leadership model as a potential platform to move to flatter, more diverse teams and collective leadership.
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Affiliation(s)
- Monica Duncan
- Freelance health economist and senior NHS interim manager
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23
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Olsen CF, Bergland A, Debesay J, Bye A, Langaas AG. Striking a balance: Health care providers' experiences with home-based, patient-centered care for older people-A meta-synthesis of qualitative studies. PATIENT EDUCATION AND COUNSELING 2019; 102:1991-2000. [PMID: 31160128 DOI: 10.1016/j.pec.2019.05.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The aim of this article was to synthesize research findings about health care providers' experiences of patient-centered care in the home setting. METHODS This is a meta-synthesis of qualitative findings using the analytical method of meta-ethnography developed by Noblit and Hare. We performed a systematic literature search in seven databases and assessed potential studies against eligibility criteria and quality. Subsequently, 10 primary studies were included for analysis. RESULTS The core theme "being a balance artist" emerged from the synthesis, incorporating the participants' experiences when faced with conflicting and competing responsibilities and needs. Two subthemes-"balancing the older clients' needs against organizational demands" and "balancing the older clients' needs against professional standards"-further elaborated on this core theme. CONCLUSION Health care providers' experiences indicate that organizational factors play a crucial role in shaping the conditions for patient-centered care for older people in the home setting. PRACTICE IMPLICATIONS To motivate and facilitate health care providers to move to a more patient-centered practice, it is important to expand the values of patient-centered care beyond the clinical encounter into the organization.
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Affiliation(s)
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Anne G Langaas
- Department of Physiotherapy, OsloMet- Oslo Metropolitan University, Oslo, Norway
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