Working From Within: The Rural Community Participatory Design Framework

OBJECTIVE

This article describes the development of the rural community-based participatory design framework to guide healthcare design teams in their integration of rural community and clinical voice during the planning, design, and construction of a healthcare facility.

BACKGROUND

Rural communities are facing an alarming rate of healthcare facility closures, provider shortages, and dwindling resources, which are negatively impacting population health outcomes. A prioritized focus on rural care access and delivery requires design teams to have a deeper understanding of the contextual considerations necessary for a successful healthcare facility project, made possible through engagement and partnership with rural dwelling community members and healthcare teams.

METHOD

The rural community participatory design framework is adapted from the rural participatory research model, selected due to its capture of key concepts and characteristics of rural communities. Underpinning theories included rural nursing theory and theory of the built environment.

RESULTS

The framework encompasses healthcare facility project phases, key translational concepts, and common traits across rural communities and cultures. As a middle-range theoretical framework, it is being tested in a current healthcare project with a Critical Access Hospital in Montana to facilitate design team and stakeholder collaboration.

CONCLUSION

The rural community participatory design framework may be utilized by design teams as a means of familiarization with rural cultures, norms, values, and critical needs, which relate to meaningful design. The framework further enables design teams to critically appraise best practices of stakeholder engagement throughout the project lifecycle.

Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 being implemented in countries? Findings from a cross-sectional analysis

BACKGROUND

Nurses and midwives are the largest component of the health workforce in many countries. The World Health Organization (WHO) together with its partners facilitates the joint development of strategic policy guidance for countries to support the optimization of their nursing and midwifery workforce. The Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 (SDNM) is a global policy guidance tool that provides a framework for Member States, the WHO and its partners to adapt, develop, implement and evaluate nursing and midwifery policy interventions in Member States. As part of the broader monitoring and accountability functions of the WHO, assessing the progress of the SDNM implementation at a country level is key to ensuring that countries stay on track towards achieving universal health coverage (UHC) and the sustainable development goals (SDGs).

METHODS

This is a cross-sectional mixed methods study involving the analysis of quantitative and qualitative data on the implementation of country-level interventions in the SDNM. Data was provided by government chief nursing and midwifery officers or their representatives using an online self-reported questionnaire. The quantitative data was assessed using a three-level scale and descriptive statistics while qualitative comments were analysed and presented narratively.

RESULTS

Thirty-five countries completed the survey. Summing up the implementation frequency of interventions across all thematic areas, 19% of responses were in the category of "completed"; 55% were reportedly "in progress" and 26% indicated a status of "not started". Findings reveal a stronger level of implementation for areas of nursing and midwifery development related to enhancing regulation and education, creating stronger roles for professional associations and policy strengthening. Leadership and interprofessional collaboration are intervention areas that were less implemented.

CONCLUSION

Monitoring and accountability of countries' commitments towards implementing nursing and midwifery interventions, as outlined in the SDNM, contributes to strengthening the evidence base for policy reforms in countries. This stock-taking can inform policy- and decision-makers' deliberations on strengthening the contributions of nurses and midwives to achieving UHC and the SDGs.

Increasing rural nurses' awareness of a statewide health information resource: an educational outreach initiative

BACKGROUND

HEALWA is an online library of evidence-based health information resources that are available to Washington state health practitioners. To increase awareness and use of HEALWA among health practitioners in rural areas, the National Network of Libraries of Medicine Pacific Northwest Region and Washington State University Spokane co-funded an outreach librarian position to provide instruction on using HEALWA.

CASE PRESENTATION

After attempts at frequent in-person workshops failed due to lack of attendance, a one-hour-long webinar targeted at rural nurses was developed to be delivered once a month. These webinars introduced participating health professionals to HEALWA, including how to set up their access and how to navigate the resource. To accommodate the busy schedules and different learning styles of the target audience, the workshops occurred both as monthly webinars and in-person, when available, in addition to an online self-guided tutorial. Continuing education credit was obtained through the Washington State Nurses Association, and a partnership with the Washington State Nursing Commission improved promotion of the webinars. Evaluations for both the webinars and workshops have been largely positive.

CONCLUSIONS

The webinar series, coupled with in-person workshops and an online tutorial, reached nurses in rural areas of Washington state to increase awareness of HEALWA. To further facilitate access to HEALWA instruction, a recorded version of the live webinar is in development.

Rural Mentorships in Health Care: Factors Influencing Their Development and Sustainability

BACKGROUND

The need to recruit and retain health care providers remains a concern in rural communities. This project aimed to better understand what health care providers and senior leaders value in mentorship and determine the best way to implement a mentorship program in rural western Canada.

METHOD

Health care providers and senior leaders from a rural health region were recruited through convenience and snowball sampling. Participants were interviewed using a semistructured interview guide, and data were analyzed using thematic analysis.

RESULTS

Two main themes were revealed: rural mentorship challenges and facilitators. Challenges included administrative, scope of practice, and interpersonal, whereas facilitators included mentorship as a recruitment and retention strategy, openness and commitment, structured mentorship programs, and community influence.

CONCLUSION

This information will enable administrators and educators to more successfully implement mentorship programs for a variety of health care professionals working within rural environments and facilitate staff development, recruitment, and retention. J Contin Educ Nurs. 2018;49(7):322-328.

The Effectiveness of Suicide Prevention Education Programs for Nurses

BACKGROUND

Education to improve health professionals' responses to suicide is considered an important suicide prevention strategy. However, the effectiveness of this approach for nurses is unclear.

AIM

To systematically review the peer-reviewed literature regarding the effectiveness of suicide prevention education programs for nurses.

METHOD

Nine academic databases (CINAHL, Cochrane Reviews & Trials, Embase, Informit Health Collection, Joanna Briggs Institute, Medline, PsycINFO, Scopus, and Web of Science) were searched in November 2016, utilizing search terms related to suicide, education, and nurses, with no limits placed on publication date or study design.

RESULTS

The search yielded 5,456 identified articles, 11 of which met the inclusion criteria. Studies were primarily quantitative (RCTs n = 3; quasi-experimental n = 6; qualitative n = 2), and involved nurses (range = 16-561) working in a diversity of settings, particularly hospitals (n = 9). Studies revealed positive changes in nurses' competence, knowledge, and attitudes associated with training over the short term.

LIMITATIONS

The heterogeneity of education programs and methodological weaknesses of included studies limit the conclusions drawn.

CONCLUSION

There is a moderate body of evidence to support the effectiveness of suicide prevention education programs for nurses. Future research should examine longer-term changes in clinical practice and strategies for continuing education, with more rigorous study designs.

A survey of the breast care nurse role in the provision of information and supportive care to Australian women diagnosed with breast cancer

AIM

To explore the role of the Australian breast care nurse in the provision of information and support to women with breast cancer, with a focus on the differences experienced depending on geographic work context.

DESIGN

A cross-sectional study.

METHODS

This study conducted in 2013, involved surveying BCNs currently working in Australia, using a newly developed self-report online survey.

RESULTS

Fifty breast care nurses completed the survey, 40% from major cities, 42% from inner regional Australia and 18% from outer regional, remote and very remote Australia. Patterns of service indicated higher caseloads in urban areas, with fewer kilometres served. Breast care nurses in outer regional, remote and very remote areas were less likely to work in multi-disciplinary teams and more likely to spend longer consulting with patients. Breast care nurses reported they undertook roles matching the competency standards related to the provision of education, information and support; however, there were barriers to fulfilling competencies including knowledge based limitations, time constraints and servicing large geographical areas.

CONCLUSIONS

This was the first Australian study to describe the role of the breast care nurse nationally and the first study to investigate breast care nurses perceived ability to meet a selection of the Australian Specialist Breast Nurse Competency Standards. Important differences were found according to the geographical location of breast care nurses.

Beyond urban places: responding to intimate partner violence in rural and remote areas

Intimate partner violence is a recognized public health problem impacting the lives of women, families, and communities. Women in rural and more remote areas who experience IPV face unique barriers and challenges to accessing healthcare services to support healthy outcomes. Resources, access to services, presence of compassionate and informed healthcare providers, and environmental circumstances influence effective responses to this issue in rural and more remote areas. In a public health approach to this problem, prevention efforts, victim-centered responses, and the support of safety are imperative to improve outcomes for women. Forensic nurses play an important role in effective response by building linkages across health, human, and social systems through collaboration, partnership, activism, advocacy, and sensitivity to the issue across the rural landscape.

A qualitative study of continuing education needs of rural nursing unit staff: the nurse administrator's perspective

BACKGROUND

This study reports perceptions of the continuing education (CE) needs of nursing unit staff in 40 rural healthcare facilities (10 hospitals and 30 long-term care facilities) in a rural Midwestern U.S. region from the perspective of nurse administrators in an effort to promote a community-based academic-practice CE partnership.

METHODS

Qualitative data collection involving naturalistic inquiry methodology was based on key informant interviews with nurse administrators (n=40) working and leading in the participating health care facilities.

RESULTS

Major themes based on nurse administrators' perceptions of CE needs of nursing unit staff were in four broad conceptual areas: "Cultural issues", "clinical nursing skills", "patient care", and "patient safety". Major sub-themes for each conceptual area are highlighted and discussed with narrative content as expressed by the participants. Related cultural sub-themes expressed by the nurse administrators included "horizontal violence" (workplace-hospital and LTC nursing unit staff) and "domestic violence" (home-LTC nursing unit staff).

CONCLUSIONS

The uniqueness of nurses' developmental learning needs from a situational point of view can be equally as important as knowledge-based and/or skill-based learning needs. Psychological self-reflection is discussed and recommended as a guiding concept to promote the development and delivery of relevant, empowering and evidence-based CE offerings for rural nursing unit staff.

Are rural and urban newly licensed nurses different? A longitudinal study of a nurse residency programme

AIM

This study aimed to compare rural and urban nurse residency programme participants' personal and job characteristics and perceptions of decision-making, job satisfaction, job stress, nursing performance and organisational commitment over time.

BACKGROUND

Nurse residency programmes are an evolving strategy to foster transition to practice for new nurses. However, there are limited data available for programme outcomes particularly for rural nurses.

METHOD

A longitudinal design sampled 382 urban and 86 rural newly licensed hospital nurses during a 12-month nurse residency programme. Data were collected at the start of the programme, at 6 months and the end of the programme.

RESULTS

At the end of the programme, rural nurses had significantly higher job satisfaction and lower job stress compared with urban nurses. Across all time-periods rural nurses had significantly lower levels of stress caused by the physical work environment and at the end of the programme had less stress related to staffing compared with urban nurses. Perceptions of their organisational commitment and competency to make decisions and perform role elements were similar.

CONCLUSIONS

Differences in these outcomes may be result from unique characteristics of rural vs. urban nursing practice that need further exploration.

IMPLICATIONS FOR NURSING MANAGEMENT

Providing a nurse residency programme in rural and urban hospitals can be a useful recruitment and retention strategy.

Health care in rural hospitals: a role for nurse practitioners

Disparities in rural health care are associated with poor patient outcomes. There is a need to further evaluate opportunities to bridge the gaps and improve rural health care. This descriptive, exploratory study examined the current and potential expanded use of nurse practitioners (NPs) in rural hospitals of one Midwestern state. Surveys (N = 136) were mailed to chief executive officers (n = 68) and chief nursing officers (n = 68) of rural hospitals in Nebraska with a response rate of 57.3% and 80.8%, respectively. The majority of respondents represented critical access hospitals. A convenience sample of NPs (N = 19) who practiced in rural communities also completed written surveys. Findings identified potential opportunities to expand the use of NPs to provide emergency department coverage and inpatient hospital management of patients in rural hospitals. Education and training of NPs need to include the essential critical thinking and skill sets to manage these types of health care needs.