Community health nursing vision for 2020: shaping the future

Community health nurses leadership in advancing health equity

OBJECTIVE

To describe the solutions community health nurses (CHNs) identify to address health inequities during the COVID-19 pandemic and to explore what leadership competencies enable CHNs to enact these solutions.

DESIGN

Online survey, distributed to all members of the Community Health Nurses of Canada and associated provincial and territorial networks.

PARTICIPANTS

Inclusion criteria included all nurses who were working during the COVID-19 pandemic in Canada. A total of 245 responses were included in the analysis.

MEASUREMENT

The survey included 25 open ended and fixed response questions. Descriptive statistics were used to describe the quantitative data. Framework Analysis was used to analyze the qualitative data.

RESULTS

Solutions focused on advancing health equity and expanding community relationships and partnerships were identified as priorities. To enact these solutions system transformation, engaging others, and developing coalitions were identified as the main leadership competencies required by CHNs.

CONCLUSION

Participants in this study clearly articulated structural and process solutions to address health inequities among priority populations during the pandemic. CHNs described with practice knowledge and confidence that solutions enacted in system transformation with community partners are necessary to advance health equity.

The Evolving Roles of Nurses Providing Care at Home: A Qualitative Case Study Research of a Transitional Care Team

Purpose:

To examine the roles of transitional care nurses in an integrated healthcare system and how the integrated healthcare system influences their evolving roles.

Background:

Transitional care teams have been introduced to enable the seamless transfer of patients from acute-care to the home settings. A qualitative case study of the transitional care team was conducted to understand the changing roles of these nurses in an integrated Regional Health System (RHS) in Singapore.

Methods:

A hospital transitional team of an integrated RHS was studied. Purposive sampling was used. Non-participant observations and follow-up interviews were conducted with four nurses. Data were triangulated with the interviews of two managers and three healthcare professionals, and the analysis of documents. Within-case thematic analysis was carried out.

Results:

Three themes were identified: ‘Coming together to meet the needs of all’; ‘Standing strong amidst the stormy waves’; and ‘Searching for the right formula in handling complexity’. These themes have explained on the atypical roles taken on by nurses in their attempts to close the gaps and meet the patients’ needs. Various factors influencing the evolving roles were revealed.

Conclusion:

The roles of nurses have ‘emerged differently’ from their traditional counterparts. Various nursing roles have been undertaken to facilitate care integration. The findings emphasised the important balance between formal structural practices and informal processes in facilitating and supporting the nurses in their role development.

The Effect of Serious Games for Nursing Students in Clinical Decision-Making Process: A Pilot Randomized Controlled Trial

Background: Serious games (SGs) have been proposed as a type of technology-enhanced simulation that may provide nursing students with an opportunity to practice their clinical reasoning and decision-making skills in a realistic and safe environment. Materials and Methods: The aim of this study is to determine the effect of serious play on nursing students' self-confidence (SC) and anxiety in clinical decision making. The randomized controlled trial evaluated the efficacy of SGs for undergraduate nursing students using pre- and posttests. The study was conducted during nursing students' clinical practice and teaching. All undergraduate nursing students (n = 120) attending internal medicine nursing lesson were approached. Sixty students out of 120 answered the questionnaires at both baseline and follow-up (30 in the experimental group [EG] and 30 in the control group). The students answered the questionnaire after taking the first clinical practice, taking the endocrine course. In the 1 week, the EG played the game and both groups returned to clinical practice. Questionnaire data were collected after clinical application. Results: SC and two subdimensions, using the information in hand to determine the problem, and knowing and taking action, were improved in the intervention group and a significant interaction effect was found for changes over time between the two groups. Anxiety scores between groups were not statistically significant differences. Conclusions: Nursing professional educators can adopt SGs to improve cognitive and attention skills, strengthen judgment, require making time efficient, practice making safe decisions, and encourage the exploration of decision.

Finding the right balance: student perceptions of using virtual simulation as a community placement

OBJECTIVES

Finding appropriate community clinical placements has been challenging in recent years, most especially during the COVID-19 pandemic. During the 2020-2021 semesters, a university in the province of Alberta, Canada chose to use the community health virtual simulation program, Sentinel City®3.1, to provide clinical placements for three groups of undergraduate students. This expository paper, co-authored by students and faculty, sought to further explore how virtual simulation can be used to best support student learning by identifying practices that students find most helpful.

METHOD

Jeffries' (2005) simulation framework was used to guide a quality improvement analysis which explored feedback received from 16 students regarding the use of Sentinel City®3.1 as a clinical placement, with additional contributions from the student co-authors.

RESULTS

Students felt Sentinel City®3.1 was an effective tool to learn community and population health concepts, however, all students indicated that they would have preferred more opportunities to work with real communities.

CONCLUSION

Virtual simulation programs like Sentinel City®3.1 might be best as a learning supplement rather than as students' sole clinical placement experience.

Being a real nurse: A secondary qualitative analysis of how public health nurses rework their work identities

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.

Optimization of home care nurses in Canada: A scoping review

Nurses are among the largest providers of home care services thus optimisation of this workforce can positively influence client outcomes. This scoping review maps existing Canadian literature on factors influencing the optimisation of home care nurses (HCNs). Arskey and O'Malley's five stages for scoping literature reviews were followed. Populations of interest included Registered Nurses, Registered/Licensed Practical Nurses, Registered Nursing Assistants, Advanced Practice Nurses, Nurse Practitioners and Clinical Nurse Specialists. Interventions included any nurse(s), organisational and system interventions focused on optimising home care nursing. Papers were included if published between January 1, 2002 up to May 15, 2015. The review included 127 papers, including 94 studies, 16 descriptive papers, 6 position papers, 4 discussion papers, 3 policy papers, 2 literature reviews and 2 other. Optimisation factors were categorised under seven domains: Continuity of Care/Care; Staffing Mix and Staffing Levels; Professional Development; Quality Practice Environments; Intra-professional and Inter-professional and Inter-sectoral Collaboration; Enhancing Scope of Practice: and, Appropriate Use of Technology. Fragmentation and underfunding of the home care sector and resultant service cuts negatively impact optimisation. Given the fiscal climate, optimising the existing workforce is essential to support effective and efficient care delivery models. Many factors are inter-related and have synergistic impacts (e.g., recruitment and retention, compensation and benefits, professional development supports, staffing mix and levels, workload management and the use of technology). Quality practice environments facilitate optimal practice by maximixing human resources and supporting workforce stability. Role clarity and leadership supports foster more effective interprofessional team functioning that leverages expertise and enhances patient outcomes. Results inform employers, policy makers and relevant associations regarding barriers and enablers that influence the optimisation of home care nursing in nursing, intra- and inter-professional and inter-organisational contexts.

Entry-to-practice public health nursing competencies: A Delphi method and knowledge translation strategy

BACKGROUND

Sustaining and strengthening nurses 'contributions to public and population health in the 21st century depends in part on nursing education. Clearly articulated entry-to-practice competencies will contribute to the capacity of undergraduate nursing education programs to prepare graduates to promote local, national and global population health.

OBJECTIVES

The Canadian Association of Schools of Nursing created the Public Health Task Force to develop consensus on core, national entry-to-practice competencies in public health nursing for undergraduate nursing students and to support these competencies with corresponding online teaching strategies.

DESIGN

Delphi approach.

PARTICIPANTS

Nurses with public health experience in education and practice, and representatives from other public health professional organizations across Canada.

METHOD

The three-phased competency development included: 1) an environmental scan; 2) an iterative process to draft competencies; and 3) a modified Delphi process to confirm the final competency framework using face to face consultations and a survey. The knowledge translation strategy involved soliciting submissions of teaching strategies for peer-review and subsequent inclusion in an interactive online resource.

RESULTS

242 public health educators and practitioners participated in the consensus consultation. The final document outlined five competency statements with 19 accompanying indicators. A total of 123 teaching strategies were submitted for the online resource, of which 50 were accepted as exemplary teaching strategies.

CONCLUSION

This competency development process can provide guidance for the development of competencies in other countries, thus strengthening public health nursing education globally. The decision to intentionally level the competencies to entry-to-practice, as opposed to an advanced level, enhanced their application to undergraduate nursing education. The development of the additional inventory of teaching strategies created a sustainable innovative resource for public health nursing educators and practitioners world-wide to support the adoption of entry-to-practice public health nursing competencies.

Challenges and demands in the population-based work of public health nurses

AIMS

Government programs and the Norwegian Directorate of Health give public health nurses in Norway an explicit role in population-based health promotion and disease-prevention work. The aim of this paper is to explore Norwegian public health nurses' experiences with population-based work.

METHODS

A phenomenological hermeneutic approach was adopted, involving face-to-face interviews with a purposeful sample of 23 public health nurses from urban and rural districts in two counties in Norway.

RESULTS

Three themes were identified: the predominance of work at the individual level, a lack of resources, and adherence to administrative directives. The interviews revealed that the public health nurses were mostly occupied with individual problem-solving activities. Population-based work was hardly prioritized, mostly because of a lack of resources and a lack of recognition of the population-based role of public health nurses.

CONCLUSIONS

The study indicates contradictions between the public health nursing practice related to population-based work and the direction outlined by the government and the public health nursing curriculum, which may mean that the public health nursing role is not sufficiently clarified. The implementation of practice models and administrative directives and resources, as well as an explicit emphasis on population health in public health nursing education, can contribute to increased population-based interventions. Greater knowledge of and emphasis on population-based work in public health nursing are needed.

Australian student nurse's knowledge of and attitudes toward primary health care: A cross-sectional study

BACKGROUND

Nurses have a pivotal role in changing the focus of the health system toward a primary health care approach, yet little is known about the effectiveness of nursing students' educational preparation for this role.

OBJECTIVES

The aim of the study was to investigate undergraduate Australian nursing students' knowledge of and attitudes toward the primary health care approach.

DESIGN

A cross-sectional, descriptive research design was applied.

SETTING

Two Australian universities, one with a rural base and one in the metropolitan area of Sydney, were involved. Both universities offer undergraduate and postgraduate nursing courses on multiple campuses.

PARTICIPANTS

A convenience sample of 286 undergraduate nursing students, each of whom had completed a unit of study on PHC. All provided consent to participate in the study.

METHODS

Data was collected using the Primary Health Care Questionnaire via online survey platform SurveyMonkey for a period of three weeks in June 2015.

RESULTS

Total knowledge scores ranged from 19.68 to 95.78 with the mean knowledge score being 69.19. Total attitude scores ranged from 33.12 to 93.88 with a mean score of 70.45. Comparison of knowledge scores showed mean scores of students born in Australia were significantly higher than those of students who were born overseas (p=0.01), and mean scores of students enrolled in the metropolitan university were also significantly higher than mean scores of students' enrolled in the rural university (p=0.002). In terms of attitudes scores, mean scores of Australian-born students were significantly higher than those of students born overseas (p=0.001), and older students' mean attitude scores were shown to be significantly higher than younger students' (p<0.005).

CONCLUSIONS

Student's age, country of origin and university location were shown to be significant influences on student's knowledge of and attitudes toward primary health care.

Gaming in Nursing Education: A Literature Review

AIM

The aim of this research was to investigate videogame-based learning in nursing education and establish how videogames are currently employed and how they link to the development of decision-making, motivation, and other benefits.

BACKGROUND

Although digital game-based learning potentially offers a safe and convenient environment that can support nursing students developing essential skills, nurse educators are typically slow to adopt such resources.

METHOD

A comprehensive search of electronic databases was conducted, followed by a thematic analysis of the literature.

RESULTS

Evaluations of identified games found generally positive results regarding usability and effectiveness of videogames in nursing education. Analysis of advantages of videogames in nursing education identified potential benefits for decision-making, motivation, repeated exposure, logistical, and financial value.

CONCLUSION

Despite the paucity of games available and the methodological limitations identified, findings provide evidence to support the potential effectiveness of videogames as a learning resource in nursing education.

Reorienting Public Health Nurses’ Practice With a Professional Practice Model

Purpose

Documents articulating public health nurses’ (PHNs’) roles, including Canadian standards and competencies, depict a broad focus working at multiple levels to improve population outcomes through the promotion of health equity. Conversely, Canadian experts depict a looming crisis, based on the rising disconnect between daily activities and ideal practice. While perfectly positioned, PHNs’ skills and abilities are under-utilized and largely invisible. The intention of this study was to develop a model to support the full scope of equity-focused PHN practice.

Method

A participatory action research approach was used. Qualitative data were gathered using semistructured interview guides during audio-recorded meetings. The data were coded into central themes using content analysis and constant comparison. A researcher reflexive journal and field notes were kept. A significant feature was full participant involvement.

Results

The outcome was a professional practice model to reframe the PHN role to focus on population health and equity. The model was imperative in promoting full scope of practice, dealing with workload pressures, and describing PHNs’ value within the organization and broader health system.

Conclusion

Professional practice models hold promise as frameworks to depict autonomous practice activities, situated within organizations and healthcare systems, and underpinned by nursing knowledge.

Community health nurses' learning needs in relation to the Canadian community health nursing standards of practice: results from a Canadian survey

BACKGROUND

CANADIAN COMMUNITY HEALTH NURSES (CHNS) WORK IN DIVERSE URBAN, RURAL, AND REMOTE SETTINGS SUCH AS: public health units/departments, home health, community health facilities, family practices, and other community-based settings. Research into specific learning needs of practicing CHNs is sparsely reported. This paper examines Canadian CHNs learning needs in relation to the 2008 Canadian Community Health Nursing Standards of Practice (CCHN Standards). It answers: What are the learning needs of CHNs in Canada in relation to the CCHN Standards? What are differences in CHNs' learning needs by: province and territory in Canada, work setting (home health, public health and other community health settings) and years of nursing practice?

METHODS

Between late 2008 and early 2009 a national survey was conducted to identify learning needs of CHNs based on the CCHN Standards using a validated tool.

RESULTS

Results indicated that CHNs had learning needs on 25 of 88 items (28.4%), suggesting CHNs have confidence in most CCHN Standards. Three items had the highest learning needs with mean scores > 0.60: two related to epidemiology (means 0.62 and 0.75); and one to informatics (application of information and communication technology) (mean = 0.73). Public health nurses had a greater need to know about "…evaluating population health promotion programs systematically" compared to home health nurses (mean 0.66 vs. 0.39, p <0.010). Nurses with under two years experience had a greater need to learn "… advocating for healthy public policy…" than their more experienced peers (p = 0.0029). Also, NPs had a greater need to learn about "…using community development principles when engaging the individual/community in a consultative process" compared to RNs (p = 0.05). Many nurses were unsure if they applied foundational theoretical frameworks (i.e., the Ottawa Charter of Health Promotion, the Jakarta Declaration, and the Population Health Promotion Model) in practice.

CONCLUSIONS

CHN educators and practice leaders need to consider these results in determining where to strengthen content in graduate and undergraduate nursing programs, as well as professional development programs. For practicing CHNs educational content should be tailored based on learner's years of experience in the community and their employment sector.

Developing the Serious Games potential in nursing education

Shortened hospital stays, high patient acuity and technological advances demand that nurses increasingly make decisions under conditions of uncertainty and risk (Ebright et al., 2003). With rising trends towards out-patient care, nurses will need to perform complex problem-solving within a dynamic and changing environment for which there is not one clear solution (Schofield et al., 2010; Wolff et al., 2009). The development of sharp clinical reasoning skills, as well as skills in detection, monitoring, investigation and evaluation are therefore essential (Aitken et al., 2002). Yet few nursing students have long-term exposure to home-care and community situations. This is primarily due to scarce human resources and the time-consuming requirements of student supervision (Duque et al., 2008). When students are given the opportunity to experience home-care or community visits these tend to be unstructured leading to wide variations in their competencies. New pedagogical tools are needed to adequately and consistently prepare nurses for the skills they will need to care for patients outside acute care settings. Advances in Information and Communications Technologies (ICT) offer an opportunity to explore innovative pedagogical solutions that could help students develop these skills in a safe environment. A three-phased project is underway that aims to create and test a Serious Game to improve nurses' clinical reasoning and detection skills in home-care and community settings. The first phase of this project involves the development of a scenario, the game engine and the graphic design and will be the focus of this paper. The second and third phases will test the Serious Game as an educational intervention and will be reported in subsequent papers.

What exposure do student nurses have to Primary Health Care and community nursing during the New Zealand undergraduate Bachelor of Nursing programme?

A research project to examine the theoretical and practical exposure student nurses have to Primary Health Care (PHC) and community nursing in their undergraduate programme was undertaken in New Zealand (NZ). Providing quality clinical placements for health care students is acknowledged as a major challenge for tertiary institutions. In order to reflect the current shift in health care delivery from hospital to community settings, one such challenge is to ensure students receive appropriate theoretical programme content and clinical experience in PHC and community settings. The project consisted of a review of relevant international literature, and a questionnaire sent to all NZ tertiary institutions providing a Bachelor of Nursing (BN). Findings included a variable understanding of the concept of PHC, a lack of appropriate PHC placements across the country, competition for student placements in PHC, and professional organisation requirements for student supervision impacting on placement availability. Innovations identified to increase PHC placements comprised the establishment of Dedicated Education Units (DEUs), curriculum revision, and final year PHC placements offered only to students targeting PHC settings on registration. Study recommendations involve establishing a regional rather than a local approach to managing clinical placements, increasing professional governance support and reviewing clinical placement funding.

A European union and Canadian review of public health nursing preparation and practice

OBJECTIVE

This study explores the preparation and role of the public health nurse (PHN) across European Union (EU) countries (Finland, Sweden, and the United Kingdom) and Canadian provinces (Alberta, New Brunswick, and Prince Edward Island).

METHODS

A literature review including relevant peer reviewed articles from 2000 on, in conjunction, with critical debate was undertaken. The results were considered in relation to the three essential areas of PHN practice, outlined in the World Health Organization (Moving on from Munich: A reference guide to the implementation of the declaration on nurses and midwives: A force for health, 2001b) recommendations, family oriented care, public health action, and policy making.

RESULTS

The major challenge the review revealed across a variety of international education and practice environments was the lack of consistent preparation for and engagement with leadership and policy making in practice.