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Almegewly WH, Karavasileiadou S, Alotaibi TS. Exploring the experiences of female undergraduate nursing students in providing home healthcare to older adults. Int J Qual Stud Health Well-being 2024; 19:2291838. [PMID: 38055792 DOI: 10.1080/17482631.2023.2291838] [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] [Received: 08/10/2023] [Accepted: 12/03/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND In light of the growing ageing population in Saudi Arabia and Saudi nurses' hesitation to work with the older population, it is important to understand the experiences of nursing students on their clinical placement in home healthcare. METHODS This study is a descriptive qualitative study based on five focus groups of 3-5 students each. Data were collected from female senior baccalaureate nursing students at a female governmental university in Saudi Arabia, and during their placement in home healthcare. Data were analysed using thematic analysis. RESULTS Five main themes emerged : struggling with their own family; struggling with cultural and social beliefs; struggling during clinical training; struggling with domestic caregivers; and reflections for the future were considered important impressions in clinical experience. CONCLUSION The culture of Saudi Arabian society is an important factor in shaping the training experience of female nursing students either positively or negatively, specifically in the context of home healthcare nursing for older patients. The results of this study show how important it is for students to be prepared for the clinical environment, the nature of the work, and the role of the home healthcare nurse in order to improve their clinical learning.
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Affiliation(s)
- Wafa Hamad Almegewly
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | - Taghreed Samel Alotaibi
- Department of Community Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Westerholm J, Gustafsson LK, Söderman M. The need for acute assessments in home healthcare - Swedish registered nurses' experiences. Int J Qual Stud Health Well-being 2024; 19:2373541. [PMID: 38934804 PMCID: PMC11212560 DOI: 10.1080/17482631.2024.2373541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/25/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE The study aims to describe Swedish RNs' experiences of acute assessments at home. More patients with complex nursing needs are cared for at home due to an ageing population. Registered nurses (RNs) who work with home healthcare need a broad medical competence and clinical experience alongside adapted decision support systems for maintaining patient safety in acute assessments within home healthcare. METHODS A content analysis of qualitative survey data from RNs (n = 19) working within home healthcare in Sweden. RESULTS There were challenges in the acute assessments at home due to a lack of competence since several of the RNs did not have much experience working as an RN in home healthcare. Important information was missing about the patients, such as access to medical records due to organizational challenges and limited access to equipment and materials. The RNs needed support in the form of cooperation with a physician, support from colleagues, and a decision support system. CONCLUSION To increase the possibility of patient-safe assessments at home, skills development, collegial support, and an adapted decision support system are needed. Collaboration with primary healthcare, on-call physicians, and nursing staff, and having the opportunity to consult with someone also provide security in acute assessments.
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Affiliation(s)
| | - Lena-Karin Gustafsson
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Mirkka Söderman
- Division of Caring Science, School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
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Karnehed S, Pejner MN, Erlandsson LK, Petersson L. Electronic medication administration record (eMAR) in Swedish home healthcare-Implications for Nurses' and nurse Assistants' Work environment: A qualitative study. Scand J Caring Sci 2024; 38:347-357. [PMID: 38243649 DOI: 10.1111/scs.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The electronic medication administration record (eMAR) is an eHealth system that has replaced the traditional paper-based medication administration used in many healthcare settings. Research has highlighted that eHealth technologies can change working methods and professional roles in both expected and unexpected ways. To date, there is sparse research that has explored how nurses and nurse assistants (NA) in home healthcare experience eMAR in relation to their work environment. AIM The aim was to explore how nurses and nurse assistants experienced their work environment, in terms of job-demand, control, and support in a Swedish home healthcare setting where an electronic medication administration record had been implemented to facilitate delegation of medical administration. METHOD We took a qualitative approach, where focus groups were used as data collection method. The focus groups included 16 nurses and nine NAs employed in a Swedish municipality where an eMAR had been implemented 6 months before the first focus groups were performed. The analysis adapted the job-demand-control-support model, by condensing the professionals' experiences into the three categories of demand, control, and support, in alignment with the model. RESULTS NAs experienced high levels of job demand and low levels of job control. The use of the eMAR limited NAs' ability to control their work, in terms of priorities, content, and timing. In contrast, the nurses described demands as high but manageable, and described having a high level of control. Both professions found the eMar supportive. CONCLUSION Nurses and NAs in home healthcare experienced changes in their work environment regarding demand, control, and support when an eMAR was implemented to facilitate delegation of medical administration. In general, nurses were satisfied with the eMAR. However, NAs felt that the eMAR did not cover all aspects of their daily work. Healthcare organisations should be aware of the changes that digitalisation processes entail in the work environment of nurses and NAs in home healthcare.
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Affiliation(s)
- Sara Karnehed
- School of Health & Welfare, Halmstad University, Halmstad, Sweden
| | | | | | - Lena Petersson
- School of Health & Welfare, Halmstad University, Halmstad, Sweden
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Albert A, Richter S, Kalk P, Stieger P, Woitas RP, Braun-Dullaeus RC, Albert C. Analysis of a nurse-provided on-call peritoneal dialysis support in an outpatient reference care centre. BMC Nurs 2024; 23:144. [PMID: 38429782 PMCID: PMC10905825 DOI: 10.1186/s12912-024-01812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND To analyse the nature of medical or technical emergency issues of ambulatory peritoneal dialysis (PD) patients calling a nurse-provided emergency PD support service of a reference centre that is provided all year in the after-hours. METHODS We retrospectively analysed patients' chief complaint, urgency, resolution of and association to current PD treatment and modality directed to an on-call nurse-provided PD support service from 2015-2021 based on routinely collected health data. Calls were systematically categorized being technical/procedural-, medical-, material-related or type of correspondence. Call urgency was categorized to have "immediate consequence", inquiry was eligible for "processing next working day" or whether there was "no need for further action". Call outcomes were classified according to whether patients were able to initiate, resume or finalize their treatments or whether additional interventions were required. Unexpected adverse events such as patients' acute hospitalization or need for nurses' home visits were evaluated and quantified. RESULTS In total 753 calls were documented. Most calls were made around 7:30 a.m. (5:00-9:00; median, 25-75th CI) and 6:30 p.m. (5:00-8:15). 645 calls were assigned to continuous ambulatory- (CAPD) or automated PD (APD). Of those, 430 calls (66.7%) had an "immediate consequence". Of those 77% (N = 331) were technical/procedural-, 12.8% (N = 55) medical- and 6.3% (N = 27) material related issues. 4% (N = 17) were categorized as other correspondence. Issues disrupting the course of PD were identified in 413 cases. In 77.5% (N = 320) patients were able to initiate, resume or finalize their treatment after phone consultation. Last-bag exchange was used in 6.1% enabling continued therapy in 83.6%. In 35 cases a nurse visit at patients' home or patients' visit to the practice at the earliest possible date were required, while hospitalization was required in seven medical category cases (5.4% and 1.09% of total assessed calls, respectively). CONCLUSION The on-call PD-nurse provides patient support for acute and imminent issues enabling them to successfully initiate, resume or finalize their prescribed treatment. Nurses triage of acute conditions facilitated rapid diagnostics and therapy. Maintaining quality PD homecare, the provision of trained personnel is indispensable. The information gathered in this study may therefore be used as a foundation to tailor educational programs for nephrology nurses and doctors to further develop their competencies in PD.
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Affiliation(s)
- Annemarie Albert
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany
- Department of Nephrology and Endocrinology, Ernst von Bergmann Hospital, Charlottenstraße 72, Potsdam, 14467, Germany
| | - Stefan Richter
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany
| | - Philipp Kalk
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany
| | - Philipp Stieger
- University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany
| | | | - Rüdiger C Braun-Dullaeus
- University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany
| | - Christian Albert
- Diaverum Renal Services, Am Neuen Garten 11, Potsdam, 14469, Germany.
- University Clinic for Cardiology and Angiology, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, 39120, Germany.
- Department of Nephrology, Central Clinic Bad Berka, Robert-Koch-Allee 9, Bad Berka, 99438, Germany.
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Yu J, Huang J, Li C, Zhuang Y. Barriers to clinical nurse participation in the internet-based home visiting program: a qualitative study. BMC Nurs 2023; 22:486. [PMID: 38115052 PMCID: PMC10729343 DOI: 10.1186/s12912-023-01651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Home visits are an important part of home care. With increasing demand and the rapid development of information technology, an increasing number of regions are experimenting with the use of information technology in home visits, hoping to meet the needs of more patients through technological interventions. However, most of the current studies have focused on patient health improvement through home visits, neglecting to consider the actual experience of nurses as service providers in participating in Internet-based programs. Thus, the purpose of this research is to explore what is holding nurses back from participating after the Internet has been added to traditional home visiting programs. METHODS This research was designed with an exploratory-descriptive qualitative analysis method. Semistructured interviews were used to collect information on barriers to nurses' participation in the Internet-based home visiting program. Participants included 16 clinical nurses working in various hospitals in Nanjing, China. The thematic analysis method was used to analyze the information. RESULTS This research identified three themes and twelve subthemes that hinder clinical nurse engagement in the Internet-based home visiting program. The three themes included multiple barriers to individuals, different service modes, and emerging organizational problems. CONCLUSIONS As a new form of traditional home visiting program in information society, Internet-based home visiting has many shortcomings in the overall program design and service management specifications. For more patients living at home to receive quality care services, it is necessary to take more effective measures to encourage nurses' participation at three levels: nurse demand, service process, and organizational management.
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Affiliation(s)
- Jiahao Yu
- Population Research Institute, Hohai University, Nanjing, 21100, China
| | - Jianyuan Huang
- Population Research Institute, Hohai University, Nanjing, 21100, China.
| | - Chunlei Li
- Zhongshan Hospital, Fudan University, Shanghai, 200032, China
- School of Nursing, Fudan University, Shanghai, 200032, China
| | - Yongmei Zhuang
- Jiangsu Health Development Research Center, Nanjing, 210036, China.
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, 210036, China.
- National Health Commission Contraceptives Adverse Reaction Surveillance Center, Nanjing, 210036, China.
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Lillsjö E, Bjuresäter K, Josefsson K. Registered nurses' challenges and suggestions for improvement of their leadership close to older adults in municipal home healthcare. BMC Nurs 2023; 22:80. [PMID: 36959626 PMCID: PMC10035128 DOI: 10.1186/s12912-023-01215-x] [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: 12/22/2022] [Accepted: 02/20/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Worldwide people are living longer. The need for healthcare for older adults is increasing. The trend is towards advanced home healthcare, where registered nurses are key figures. This implies challenges for municipal home healthcare, as well as for registered nurses' leadership. The aim is to explore registered nurses' perceptions of challenges and suggestions for improvements in their leadership close to older adults in municipal home healthcare. METHODS The present study is part of a larger web-based questionnaire survey with a cross-sectional design. The design is inductive, analysing data using qualitative content analysis and descriptive statistics. A questionnaire with open-ended and closed-ended questions was used. A total of n = 70 registered nurses leading close to older adults participated in seven municipalities in two geographic areas in Sweden. RESULTS The results show registered nurses' perceptions of challenges as leaders close to older adults in terms of 11 categories. The categories are motivating for care, adjusting and coordinating nursing care to the older adult, relating to next of kin, managing communication difficulties, relating to social situations in the home, managing demands, working alone, having lack of time, collaborating with physicians, and care staff having low competence. The registered nurses suggested improvements for their leadership close to older adults in terms of nine categories. The categories are adjusting the work to the older adult, clarifying registered nurses' responsibility, balancing demands and resources, setting time aside, improving staffs' competence, ensuring staff's competence development, improving the work environment, and cooperation between professions in the municipality, as well as between healthcare organizations. CONCLUSION The results show that registered nurses' leadership in municipal home healthcare implies a wide range of challenges. There is a need for strategies to improve the organizational preconditions to reduce challenges in registered nurses' leadership in order to promote positive patient outcomes for safe and quality care.
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Affiliation(s)
- Erica Lillsjö
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, 651 88, Karlstad, Sweden.
| | - Kaisa Bjuresäter
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, 651 88, Karlstad, Sweden
| | - Karin Josefsson
- Department of Health Sciences, Faculty of Health, Science, and Technology, Karlstad University, 651 88, Karlstad, Sweden
- Faculty for Nursing and Health Science, NORD University, 8026, Bodø, Norway
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Tanninen A, Kouvonen A, Nordquist H. Advanced-level paramedics' support needs for developing and utilising competence. Int Emerg Nurs 2023; 66:101233. [PMID: 36584658 DOI: 10.1016/j.ienj.2022.101233] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Paramedic competence plays a vital role in emergency medical services (EMS), as the pre-hospital setting demands a wide variety of competencies from paramedics. The aim of the study was to examinethesupportthatadvanced-level paramedics need from their supervisors to develop and utilise their competence. METHODS Qualitative essay material was collected from a group of experienced advanced-level paramedics (n = 41). The material was analysed with inductive content analysis. RESULTS Twenty-eight sub-categories emerged, forming 6 categories further leading to the grouping of two main categories: 1) the enablement of human resource (HR) management and leadership; and 2) guidelines on how to operate EMS adequately. CONCLUSIONS Supervisors can and should support advanced-level paramedics in their competence utilisation and development. This can be achieved by enabling professional growth by recognising competencies and generating supportive leadership in EMS. Paramedics would also benefit from clear operative guidelines. Overall, supporting paramedics' competence utilisation and development is strongly connected with leadership standards in daily practices.
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Affiliation(s)
- Antti Tanninen
- Department of Public Health, University of Helsinki, Helsinki, Finland.
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland.
| | - Hilla Nordquist
- Department of Public Health, University of Helsinki, Helsinki, Finland; Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; South-Eastern Finland University of Applied Sciences, Kotka, Finland.
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Strømme T, Tjoflåt I, Aase K. A competence improvement programme for the systematic observation of frail older patients in homecare: qualitative outcome analysis. BMC Health Serv Res 2022; 22:938. [PMID: 35864484 PMCID: PMC9303045 DOI: 10.1186/s12913-022-08328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The growth of frail older patients with extensive care needs in homecare creates a need for competence development. Improvement programmes are essential to fill this knowledge gap. However, the outcomes of such programmes remain unknown. Therefore, the aim of this study is to describe the outcomes of a competence improvement programme for the systematic observation of frail older patients in homecare. METHODS This study applied a qualitative mixed-method design. Data were collected in two homecare districts using participant observation, focus group interviews, and individual interviews. RESULTS The analysis revealed five concepts characterising the outcomes of the competence improvement programme: 1) frequency of vital sign measurements, 2) situational awareness, 3) expectations and coping level, 4) activities for sustained improvement, and 5) organisational issues affecting CIP focus. Substantial differences were revealed across the two homecare districts in how homecare professionals enacted new knowledge and routines resulting from the competence improvement programme. The differences were related to the frequency of vital sign measurements, coping levels, and situational awareness, in which successful outcomes were shaped by implementation issues and contextual setting. This involved whether routines and planned activities were set to follow up the improvement programme, or whether organisational issues such as leadership focus, resources, and workforce stability supported the programme. CONCLUSIONS This study documents the differences entailed in creating sustainable outcomes of an improvement programme for homecare professionals' competence in recognising and responding to deteriorating frail older patients. Depending on the implementation process and the homecare context, professionals enact the activities of the improvement programme differently.
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Affiliation(s)
- Torunn Strømme
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Postboks 8600, N-4036, Stavanger, Norway.
| | - Ingrid Tjoflåt
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Postboks 8600, N-4036, Stavanger, Norway
| | - Karina Aase
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Postboks 8600, N-4036, Stavanger, Norway
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Bhattarai S, Correa-Martinez Y, Bedoya-Valencia L. A multi-objective home healthcare routing problem. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2102111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sudhan Bhattarai
- Department of Industrial Engineering, Clemson University, Clemson, SC, USA
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Yoshimatsu K, Nakatani H. Attitudes of home-visiting nurses toward risk management of patient safety incidents in Japan. BMC Nurs 2022; 21:139. [PMID: 35668490 PMCID: PMC9169385 DOI: 10.1186/s12912-022-00905-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In situations of home care, patients and their family members must address problems and emergencies themselves. For this reason, home-visiting nurses (HVNs) must practice risk management to ensure that patients can continue receiving care in the comfort of their homes. The purpose of this study was to examine HVNs' attitudes toward risk management. METHODS This study adopted a qualitative description approach. Semi-structured interviews were conducted to collect information on HVNs' risk management behavior and their attitudes toward it. Participants comprised 11 HVNs working at home-visiting nursing agencies in a prefecture of Japan. Transcribed interviews were analyzed using content analysis. RESULTS Nurses' attitudes toward risk management comprised the following themes: (i) predicting and avoiding risks, (ii) ensuring medical safety in home settings, (iii) coping with incidents, and (iv) playing the role of administrators in medical safety, which was answered only by administrators. CONCLUSIONS When practicing risk management, home-visiting nurses should first assess the level of understanding of the patient and family, followed by developing safety measures tailored to their everyday needs. These results further suggest that administrators should take actions to foster a working environment conducive to risk management. These actions include coordinating duties to mitigate risk and improve the process of reporting risks. This study provides a baseline for future researchers to assist patients and families requiring medical care services of this nature.
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Affiliation(s)
- Keiko Yoshimatsu
- Department of Nursing, Faculty of Nursing and Nutrition, The University of Shimane, 151 Nisihayasigi-cho, Izumo-shi, Shimane-ken, 693-8550, Japan.
| | - Hisae Nakatani
- Department of Community and Public Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan
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Gessl AS, Flörl A, Schulc E. Demand for community-based Case Management in Austria - a qualitative analysis. BMC Nurs 2022; 21:5. [PMID: 34983497 PMCID: PMC8725559 DOI: 10.1186/s12912-021-00775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background The number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses‘task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs. Methods A qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis. Results The analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers. Conclusions Care institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00775-0.
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Affiliation(s)
- Alessandra Schirin Gessl
- LMU Munich School of Management, Ludwig-Maximilians-Universität (LMU) München, Geschwister-Scholl-Platz 1, 80539, Munich, Germany
| | - Angela Flörl
- Division of Integrated Care, Institute of Nursing Science, Department of Nursing Science & Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria.
| | - Eva Schulc
- Division of Integrated Care, Institute of Nursing Science, Department of Nursing Science & Gerontology, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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Wergeland D, Harsten K, Klarare A, Steindal SA. Hospital nurses' experiences of assessing health status changes in stem-cell transplanted patients in home care: A qualitative study. J Clin Nurs 2021; 31:3190-3199. [PMID: 34837292 DOI: 10.1111/jocn.16155] [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] [Received: 08/28/2021] [Revised: 10/23/2021] [Accepted: 11/16/2021] [Indexed: 02/06/2023]
Abstract
AIMS AND OBJECTIVES To explore hospital nurses' experience assessing changes in the health status of stem-cell transplanted patients in home care (HC). BACKGROUND Stem-cell transplanted patients in HC are treated at home instead of in hospital wards. Hospital nurses visit patients daily and play a key role in assessing the patients' health status. Previous studies on HC for stem-cell transplanted patients focus mainly on safety in HC versus hospital care. No studies regarding nurses' experience assessing patients' health status at home when patients undergo stem-cell transplantation were found. DESIGN Qualitative study with an explorative design. METHODS Data were collected via 14 individual semi-structured interviews with hospital nurses working with stem-cell transplanted patients in HC. Data were analysed using systematic text condensation. The reporting of the study was guided by the COREQ checklist. RESULTS Three categories emerged from the data analysis: 1) Effective communication and clinical intuition enhances the assessment of patients' general health condition; 2) It is challenging to rely on one's own judgment in remote assessment; and 3) There are key facilitators in performing remote clinical assessments. CONCLUSIONS Effective communication and clinical intuition enhanced the assessment of patients' general health conditions. The lack of physical presence during remote assessments made using clinical intuition in the assessment process difficult. Experience with hematopoietic stem-cell transplantation was seen as important to facilitate accurate remote clinical assessments. RELEVANCE TO CLINICAL PRACTICE Nurses with responsibility for hospital at-home telephone care should receive training in remote communication and should shadow hospital at-home nurses during in home visits to gain experience assessing patients' health status. Telehealth aspects such as videoconferencing and remote patient monitoring should be considered for more accurate remote assessment. This could potentially result in more effective assessments and reduced readmissions and could promote nurses' confidence in their assessments.
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Affiliation(s)
- Daniel Wergeland
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Kristine Harsten
- Lovisenberg Diaconal University College, Oslo, Norway.,Department of Haematology, Oslo University Hospital, Oslo, Norway
| | - Anna Klarare
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, Uppsala, Sweden
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Oslo, Norway.,Faculty of Health Studies, VID Specialized University, Oslo, Norway
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Claesson M, Jonasson LL, Josefsson K. Next of kin's experiences of registered nurses' leadership close to older adults in municipal home care in Sweden: an interview study. BMC Nurs 2021; 20:213. [PMID: 34715871 PMCID: PMC8554742 DOI: 10.1186/s12912-021-00745-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Next of kin to older adults over 65 years in municipal home care are concerned whether their older adults’ needs are being met. In municipal home care, the registered nurses’ leadership is important and complex, entailing multi-artist skills involving the older adults and their next of kin. Yet, little is known about next of kin’s experiences of registered nurses’ leadership. Thus, the aim of this study was to explore next of kin’s experiences of registered nurses’ leadership close to older adults in municipal home care. Methods Individual telephone interviews were conducted with next of kin (n = 11) of older adults from April to September 2020 in two municipalities in western Sweden. Data were analysed using qualitative content analysis. Results The results are presented with the theme, registered nurses do what they can, including two categories, interaction and competence, and the subcategories, relationship, communication, availability, responsibility, team leadership and cooperation. Registered nurses’ leadership was experienced as a balancing act between their commitments and what they were able to achieve. Conclusions Next of kin’s experiences of registered nurses’ leadership can contribute knowledge that will strengthen and prepare registered nurses for their leadership roles. This knowledge can support the development of policies for organisational preconditions that ensure quality and safe care to older adults in municipal home care.
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Affiliation(s)
- Maria Claesson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.
| | - Lise-Lotte Jonasson
- Department of Nursing School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Karin Josefsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.,Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden
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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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Nanda L, Anilkumar A. Role of nurse practitioners within health system in India: A case of untapped potential. J Family Med Prim Care 2021; 10:2751-2756. [PMID: 34660400 PMCID: PMC8483105 DOI: 10.4103/jfmpc.jfmpc_2283_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 12/02/2022] Open
Abstract
Nurses form the pillar of India's healthcare system representing 30.5% of the entire health workforce in India. Amidst a significant shortage in the provision of effective primary care, jeopardizing millions of Indians’ access to basic healthcare services, especially the poorest, it is very evident that nurse practitioners are the need of the hour in India. The current scenario of nursing in India warrants policy reforms to facilitate nurses as valuable primary care providers. It also shows the path towards making the Health and Wellness Centre operational by creating a pivotal role for the cadre in such centres, and it will also be important for the nurse practitioner to have a public health leadership role in a country like India. With additional training and qualification and also recognition of nurse practitioners as essential healthcare providers, a complete quality healthcare could be provided. In this research paper we assess the need for nurse practitioners as primary contact providers; reflect on the global evidence on nurse practitioners linking to health outcomes, effective coverage and access to services. We also try to contemplate on the training needs, their role in home-based care and as enablers of the referral mechanism, their untapped potential, and a plan for evaluating their effectiveness. This policy research paper focuses to build an argument for a policy towards making nurse practitioners the first contact providers.
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Affiliation(s)
- Lipika Nanda
- Regional Resource Hub, HTA, Indian Institute of Public Health, Hyderabad, Public Health Foundation of India
| | - Aiswarya Anilkumar
- Regional Resource Hub, HTA, Indian Institute of Public Health, Hyderabad, Public Health Foundation of India
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16
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Exploring radiographers' experience with mobile X-ray of patients in their homes. Radiography (Lond) 2021; 28:102-106. [PMID: 34481711 DOI: 10.1016/j.radi.2021.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION To offer citizens with frailty or dementia living in nursing homes or other institutions a less stressful and anxious X-ray examination, a Danish hospital offers to perform the examination in the citizen's residence. This has changed the working procedure for the radiographers performing the examination. The aim of this study was to explore if the radiographers self-perceived competencies have changed whilst working in the mobile X-ray unit and if so, how these competencies are utilised within the department-based medical imaging team. METHOD This study had a qualitative design following a hermeneutic approach. Individual semi structured interviews included nine radiographers, four radiographers working in the mobile X-ray unit and five radiographers working exclusively in the medical imaging team. RESULTS Radiographers who worked in the mobile X-ray unit did acquire new competencies such as better communication and creative positioning skills. All nine participants recognised the advantage of sharing experiences and competencies with colleagues, and recommended a formal forum to do so. They sought opportunities for the use of the mobile X-ray unit to be more widespread within their own region, and within the profession. CONCLUSION This study indicates that radiographers working with mobile X-ray unit gained new competencies in communication and positioning, but without spread of new knowledge to colleagues in the medical imaging team. IMPLICATION FOR PRACTICE The use of home-based mobile X-ray is a new way to provide health care services and gain new competencies for the radiographers to focus on patient centred care.
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Claesson M, Josefsson K, Jonasson LL. 'My registered nurse': Older people's experiences of registered nurses' leadership close to them in community home care in Sweden. Int J Older People Nurs 2021; 16:e12399. [PMID: 34216188 DOI: 10.1111/opn.12399] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 01/10/2023]
Abstract
AIM To explore older people's experiences of registered nurses' leadership close to them in community home care. INTRODUCTION In Sweden and throughout the world, the number of people 65 years and older is increasing. While older people are living for more years, living longer can bring more diseases and disabilities, which might lead to the need for home care. Registered nurses are responsible for older people's care needs in their leadership in community home care; this is a part of their professional role as registered nurses, and it implies that they must be multi-artists. DESIGN An explorative and inductive design was used in two communities in western Sweden. METHODS Individual interviews were conducted with older people (n = 12) with at least one year of experience with community home care. Data were analysed using qualitative content analysis. RESULTS The results are presented in the theme 'my registered nurse', including five categories - relationship, professional competence, nursing interventions, coordination and collaboration and organisation - and 15 sub-categories. CONCLUSIONS These findings are based on older people's own experiences. This is specific, as the phenomenon of the RNs leadership is rarely explored from the perspective of older people. IMPLICATIONS FOR PRACTICE There is a need for organisations to create more opportunities for older people to have their own registered nurses leading close to them. This is because registered nurses have specific competences for meeting older people's individual needs and involving them as competent partners in satisfying their care needs.
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Affiliation(s)
- Maria Claesson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Karin Josefsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Lise-Lotte Jonasson
- Department of Nursing School of Health and Welfare, Jönköping University, Jönköping, Sweden
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18
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Abstract
The home healthcare nurse is a concept that has grown rapidly in the past two centuries, however, the role and meaning remain ambiguous. Continuous changes in the healthcare system have sparked confusion with patients and healthcare providers as to the essence of the home healthcare nurse. With the popularity and demand for home healthcare-based care on the rise, it is necessary to differentiate the concept of the home healthcare nurse from other related terms through a concept analysis. Using Walker and Avant's methodology, a literature search using Cumulative Index to Nursing and Allied Health Literature (CINAHL) along with dictionaries, encyclopedias, and professional organizations was performed to identify all the uses, attributes, and characteristics of the concept. Five defining attributes emerged during the analysis: autonomy, adaptability, person-centered holistic care, care coordination, and self-efficacy. Antecedents, consequences and empirical referents were identified. As a first step, this concept analysis brings clarity to the meaning and role of the home healthcare nurse from which arose an operational definition and proposed conceptual model. With the number of patients admitted to home healthcare accelerating, healthcare organizations and clinicians must distinctly understand the concept of the home healthcare nurse. Future research should include testing theoretical relationships between the home healthcare nurse and patient outcome variables to enhance nursing science and promote population health.
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Affiliation(s)
- Susan A Riekert
- Susan A. Riekert, MSN, RN , is an Assistant Professor of Nursing, Department of Nursing, Queensborough Community College, Bayside, New York
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19
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Koltsida V, Jonasson LL. Registered nurses' experiences of information technology use in home health care - from a sustainable development perspective. BMC Nurs 2021; 20:71. [PMID: 33933055 PMCID: PMC8088614 DOI: 10.1186/s12912-021-00583-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 04/12/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The work of registered nurses in home health care is complicated and extensive, and information technology (IT) is used in everyday activities. Coordination between care and resource efficiency is important. There is a wealth of information that supports the notion of sustainable development, but what sustainable development means from the perspective of the registered nurse in home health care when using IT is limited. The term "sustainable development" is not clearly defined and is poorly researched in nursing. Sustainable development in this study includes the ecological, economic, social, technical and ethical dimensions. The aim of this study was to describe registered nurses' experience of IT use in home health care through a sustainable development model. METHODS This study was conducted using ten semi-structured lifeworld interviews with registered nurses. The method employed was a qualitative content analysis with a deductive approach. The deductive approach consisted of a model of sustainable development. RESULTS Analysis of the interviews and the model of sustainable development provided categories: using IT from an ecological dimension, the registered nurses experienced reduced consumption and damage to the environment; using IT in the economical dimension, saving of time and resources was experienced; the use of IT affected social aspects such as the work environment and patient safety, and positive consequences, such as accessibility, were also mentioned; using IT from a technical dimension was characterized by the nurse's attitude towards it - the registered nurses felt it improved the quality of care and gave users an overview of the organization; and from an ethical dimension, the registered nurses expressed the need for IT to be adaptable to the patient's well-being and indicated that more awareness of risks in the care meeting may be needed. CONCLUSION The findings are discussed based on the synergies and conflicts that arise between the different dimensions of sustainable development. IT intertwines and overlaps with, and within, the environment, economy, society, technology and ethics. Registered nurses in home health care want to conduct good and safe care, while using IT could benefit patients.
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Affiliation(s)
| | - Lise-Lotte Jonasson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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20
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Siclovan DM, Bang JT, Yakusheva O, Hamilton M, Bobay KL, Costa LL, Hughes RG, Miles J, Bahr SJ, Weiss ME. Effectiveness of home health care in reducing return to hospital: Evidence from a multi-hospital study in the US. Int J Nurs Stud 2021; 119:103946. [PMID: 33957500 DOI: 10.1016/j.ijnurstu.2021.103946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Home health care, a commonly used bridge strategy for transitioning from hospital to home-based care, is expected to contribute to readmission avoidance efforts. However, in studies using disease-specific samples, evidence about the effectiveness of home health care in reducing readmissions is mixed. OBJECTIVE To examine the effectiveness of home health care in reducing return to hospital across a diverse sample of patients discharged home following acute care hospitalization. RESEARCH DESIGN Secondary analysis of a multi-site dataset from a study of discharge readiness assessment and post-discharge return to hospital, comparing matched samples of patients referred and not referred for home health care at the time of hospital discharge. SETTING Acute care, Magnet-designated hospitals in the United States PARTICIPANTS: The available sample (n = 18,555) included hospitalized patients discharged from medical-surgical units who were referred (n = 3,579) and not referred (n = 14,976) to home health care. The matched sample included 2767 pairs of home health care and non- home health care patients matched on patient and hospitalization characteristics using exact and Mahalanobis distance matching. METHODS Unadjusted t-tests and adjusted multinomial logit regression analyses to compare the occurrence of readmissions and Emergency Department/Observation visits within 30 and 60-days post-discharge. RESULTS No statistically significant differences in readmissions or Emergency Department /Observation visits between home health care and non-home health care patients were observed. CONCLUSIONS Home health care referral was not associated with lower rates of return to hospital within 30 and 60 days in this US sample matched on patient and clinical condition characteristics. This result raises the question of why home health care services did not produce evidence of lower post-discharge return to hospital rates. Focused attention by home health care programs on strategies to reduce readmissions is needed.
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Affiliation(s)
| | - James T Bang
- Department of Economics, St. Ambrose University, McMullen Hall 124A 518 W. Locust St.Davenport, IA 52803, USA.
| | - Olga Yakusheva
- University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, USA.
| | - Morris Hamilton
- Abt Associates, 5001 S Miami Blvd #210, Durham, NC 27703, USA.
| | - Kathleen L Bobay
- Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 S. 1st Ave., Maywood, Illinois, 60153, USA.
| | - Linda L Costa
- University of Maryland School of Nursing, 655 W. Lombard St., Baltimore, MD, 21201, USA
| | - Ronda G Hughes
- University of South Carolina College of Nursing, 1601 Greene Street, Room 405, Columbia, SC, 29208, USA.
| | - Jane Miles
- Marquette University College of Nursing, PO Box 1881, Milwaukee, WI, 53201-1881, USA.
| | - Sarah J Bahr
- Marquette University College of Nursing, PO Box 1881, Milwaukee, WI, 53201-1881, USA.
| | - Marianne E Weiss
- Marquette University College of Nursing, PO Box 1881, Milwaukee, WI, 53201-1881, USA.
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21
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Lee K, Jung D. Examination of the Educational Needs of Home Visit Nurses: A Cross-Sectional Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052319. [PMID: 33652984 PMCID: PMC7967676 DOI: 10.3390/ijerph18052319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to identify educational needs and determine priorities in nursing care for home visit nurses providing services within the national long-term care insurance system in South Korea. This cross-sectional descriptive study assessed the educational needs of 92 home visit nurses. Participants' characteristics were analyzed using percentages, averages, and standard deviations. Educational needs were calculated for participants' current and required competency levels, utilizing the paired t-test, Borich's educational needs formula, and the locus for focus model. Four main categories were identified as top priorities: (1) health assessment, (2) cognitive function care, (3) disease management, and (4) medication management. The study's findings could support the development of appropriate and responsive education and training programs for home-visit nurses-as it reflects the actual needs of this group.
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22
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Glomsås HS, Knutsen IR, Fossum M, Halvorsen K. User involvement in the implementation of welfare technology in home care services: The experience of health professionals-A qualitative study. J Clin Nurs 2020; 29:4007-4019. [PMID: 33463827 DOI: 10.1111/jocn.15424] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/29/2020] [Accepted: 07/15/2020] [Indexed: 01/14/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study is to learn more about factors that promote or inhibit user involvement among health professionals when implementing welfare technology in home care services. BACKGROUND It is a health policy goal to increase the use of welfare technology in order to address some of the challenges that healthcare services are facing. Health professionals' involvement is important for the successful implementation of welfare technology in home care services. DESIGN The study has an explorative and descriptive longitudinal design based on a qualitative approach. Five focus group interviews were conducted with 16 nurses and assistant nurses from three different municipalities over a period of 2 years. The data were analysed using reflexive thematic analysis. The COREQ checklist was used. RESULTS The analysis led to five main themes: competence a critical component, information and information lines, new ways of working, choice of welfare technology and change in patient services. From health professionals' perspective, there appeared to be a lack of preparedness for the change in the implementation of welfare technology entailed for home care services. The respondents experienced limited facilitation and opportunities for user involvement. CONCLUSION Health professionals want to be more involved but emphasised that competence, information and collaborative arenas are necessary factors if involvement in the process is to be increased. Competence affected some of the respondents' attitudes and willingness to use the technology. The respondents also experienced that the managements' focus on facilitation and interest in user involvement in addition to infrastructures that functioned in various ways had an impact on user involvement. RELEVANCE TO CLINICAL PRACTICE The knowledge gained from this study about factors that promote or inhibit user involvement among health professionals could contribute to better preparedness for further implementation of welfare technology in the field of home care.
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Affiliation(s)
- Heidi Snoen Glomsås
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Ingrid Ruud Knutsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Norway
| | - Kristin Halvorsen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Norway
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Fjørtoft AK, Oksholm T, Delmar C, Førland O, Alvsvåg H. Home-care nurses' distinctive work: A discourse analysis of what takes precedence in changing healthcare services. Nurs Inq 2020; 28:e12375. [PMID: 32725871 DOI: 10.1111/nin.12375] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/05/2020] [Indexed: 11/30/2022]
Abstract
Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients' homes. This greatly impacts nurses' work in home care, making their work increasingly diverse and demanding. In this study, we explore home-care nursing through a critical discourse analysis of focus group interviews with home-care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home-care nurses' work. Changes have made nurses' work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses' work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses' work to help shape the further development of home-care nursing.
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Affiliation(s)
- Ann-Kristin Fjørtoft
- Center of Diaconia and Professional Practice, VID Specialized University, Oslo, Norway.,Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Trine Oksholm
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
| | - Charlotte Delmar
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway.,Institute of Public Health, Department of Nursing Science, Health Faculty, Aarhus, Denmark
| | - Oddvar Førland
- Centre for Care Research Western Norway, Western Norway University of Applied Sciences, Bergen, Norway
| | - Herdis Alvsvåg
- Faculty of Health Sciences, VID Specialized University, Bergen, Norway
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24
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Fjørtoft A, Oksholm T, Førland O, Delmar C, Alvsvåg H. Balancing contradictory requirements in homecare nursing-A discourse analysis. Nurs Open 2020; 7:1011-1019. [PMID: 32587719 PMCID: PMC7308681 DOI: 10.1002/nop2.473] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 11/11/2022] Open
Abstract
Aim To explore prevailing discourses on nursing competence in homecare nursing to boost understanding of practice within this field. Design A qualitative study with a social constructivist perspective. Methods Six focus-group interviews with homecare nurses in six different municipalities in Norway. Adapting a critical discourse analysis, data were linguistically, thematically and contextually analysed in the light of theories on competence, institutional logic and discourses. Results The analysis found homecare nursing to be a diverse and contradictory practice with ever-increasing work tasks. Presented as binary oppositions, we identified the following prevailing discourses: individualized care versus organizing work; everyday-life care versus medical follow-up; and following rules versus using professional discretion. The binary oppositions represent contradictory requirements that homecare nurses strive to balance. The findings indicate that medical follow-up and organizational work have become more dominant in homecare nursing, leaving less time and attention paid to relational and everyday-life care.
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Affiliation(s)
- Ann‐Kristin Fjørtoft
- Center of Diaconia and Professional PracticeVID Specialized UniversityOsloNorway
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
| | - Trine Oksholm
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
| | - Oddvar Førland
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
- Centre for Care Research Western NorwayWestern Norway University of Applied SciencesBergenNorway
| | - Charlotte Delmar
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
- Department of Nursing ScienceHealth FacultyInstitute of Public HealthAarhus UniversityAarhusDenmark
| | - Herdis Alvsvåg
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
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25
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HeydariKhayat N, Ashktorab T, Rohani C. Home care for burn survivors: A phenomenological study of lived experiences. Home Health Care Serv Q 2020; 40:204-217. [PMID: 32264786 DOI: 10.1080/01621424.2020.1749206] [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] [Indexed: 10/24/2022]
Abstract
Background: Burn injuries have negative impacts on all dimensions of the quality of life of burn victims. This study aimed to explore the lived experiences of burn survivors after a 6-month period of home care following hospital discharge.Method: This is a qualitative study with a phenomenological approach. Sixteen burn survivors from a university hospital in Kermanshah province participated in the study. Qualitative data were analyzed by Colaizzi's descriptive phenomenological approach.Results: "Rehabilitation in the process of life" was the main theme of the study with four sub-themes, including "conducting process", "caring bridge", "humanitarian commitment for human revival", and "healing care".Conclusions: Home care is necessary for burn survivors after discharge from the hospital. The connection of healthcare services between home and hospital, safety feeling in the patient and his/her family, cost-effectiveness of healthcare services, and encouraging the patient to perform self-care can be achieved by home care follow-ups.
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Affiliation(s)
- Nastaran HeydariKhayat
- Student Research Committee, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Ashktorab
- Department of Medical Surgical Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Camelia Rohani
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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26
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Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
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Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
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The Feasibility of Home Palliative Care for Cancer Patients: The Perspective of Iranian Nurses. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2018. [DOI: 10.5812/ijcm.80114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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