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Smet S, Verhaeghe S, Beeckman D, Fourie A, Beele H. The process of clinical decision-making in chronic wound care: A scenario-based think-aloud study. J Tissue Viability 2024:S0965-206X(24)00027-5. [PMID: 38461069 DOI: 10.1016/j.jtv.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/01/2024] [Indexed: 03/11/2024]
Abstract
AIMS To undertake a comprehensive investigation into both the process of information acquisition and the clinical decision-making process utilized by primary care nurses in the course of treating chronic wounds. DESIGN Scenario-based think-aloud method, enriched by the integration of information processing theory. The study was conducted within the framework of home care nursing organizations situated in [placeholder]. A cohort of primary care nurses (n = 10), each possessing a minimum of one year of nursing experience, was recruited through the collaboration of three home care nursing organizations. METHODS Two real-life clinical practice scenarios were employed for the interviews, with the researcher adopting the roles of either the patient or another clinician to enhance the realism of the think-aloud process. Each think-aloud session was promptly succeeded by a subsequent follow-up interview. The Consolidated criteria for Reporting Qualitative research checklist was followed to guarantee a consistent and complete report of the study. RESULTS Amidst noticeable variations, a discernible pattern surfaced, delineating three sequential concepts: 1. gathering overarching information, 2. collecting and documenting wound-specific data, and 3. interpreting information to formulate wound treatment strategies. These concepts encompassed collaborative discussions with stakeholders, while the refinement of wound treatment strategies was interwoven within both concepts 2 and 3. CONCLUSIONS Evident variations were identified in chronic wound care clinical decision-making, regardless of educational background or experience. These insights hold the potential to inform the development of clinical decision support systems for chronic wound management and provide guidance to clinicians in their decision-making endeavours.
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Affiliation(s)
- Steven Smet
- Wound Care Centre, Ghent University Hospital, Ghent, Belgium; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium; Swedish Centre for Skin and Wound Research (SCENTR), School of Health Sciences, Örebro University, Örebro, Sweden. https://twitter.com/DimitriBeeckman
| | - Anika Fourie
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery (UCVV), Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. https://twitter.com/anika_fourie
| | - Hilde Beele
- Wound Care Centre, Ghent University Hospital, Ghent, Belgium; Department of Dermatology, Ghent University Hospital, Ghent, Belgium.
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Havard M, Whistance M, Johns G, Drew S, Cusens C, Thomas S, Khalil S, Ogonovsky M, Ahuja A. Defining digital nursing. Br J Nurs 2024; 33:72-77. [PMID: 38271040 DOI: 10.12968/bjon.2024.33.2.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND The use of technology in health care, including nursing, is growing, owing in part to the COVID-19 pandemic and in response to national policy. AIMS To investigate nurses' perceptions of digital nursing (DN). METHODS Community and primary care nurses from across Wales were recruited (n=249) through a survey comprising open and closed questions. This was supplemented with semistructured interviews (n=25). Thematic analysis was used to analyse qualitative data. FINDINGS Nurses had a broad range of perspectives on what DN meant, with four main themes being identified: access; impact on care; technology; and digital future. The positive impacts of DN on ways of working and patient outcomes were supported by answers to closed survey questions. CONCLUSION Many nurses understand the value of digital tools within nursing and are clear about their benefits for patients, nurses and multiprofessional teams. However, there is a need for a clear definition and increased awareness of DN.
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Affiliation(s)
- Megan Havard
- Research Assistant, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Megan Whistance
- Research Assistant, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Gemma Johns
- Head of Research, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Simon Drew
- National Lead for Clinical Adoption and Business Change, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Chiquita Cusens
- National Lead Nurse for Primary and Community Care, Strategic Programme for Primary Care, Aneurin Bevan University Health Board, Newport
| | - Sian Thomas
- Consultant Nurse in Child Health, Department of Nursing, Aneurin Bevan University Health Board, Newport
| | - Sara Khalil
- National Programme Lead, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Mike Ogonovsky
- Director, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
| | - Alka Ahuja
- Natiional Clinical Lead, Technology Enabled Care Cymru, Aneurin Bevan University Health Board, Newport
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Paul J, Govindan R, Manjunatha N, Kumar CN, Math SB. Development and Validation of Clinical Schedule for Primary Care Psychiatric Nursing (CSP-N) for Primary Care Nurses. Indian J Community Med 2023; 48:443-452. [PMID: 37469911 PMCID: PMC10353680 DOI: 10.4103/ijcm.ijcm_721_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 04/06/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction As per the World Health Organization's mental health report for 2022, nearly a billion people have mental health issues, and 82% of them are in low and middle-income countries where mental health services are largely absent. For the successful integration of mental health into primary health care, proper training and education of primary care professionals are mandatory. Primary care nurses are in an excellent position to screen, identify, dual collaboration for treatment planning/referral, and follow-up of persons with mental illness (PMI), but they often lack the confidence and competence to tackle mental health problems. The study aimed to develop and validate the clinical schedule for primary care psychiatric nursing (CSP-N). Materials and Methods It is conducted in two phases: the development and validation phases. An extensive literature search has been conducted, and the ten themes derived from the two-focused group discussions and three-direct one-to-one interviews and input from mental health experts were used to design the CSP-N. The CSP-N was checked for content validity by a panel of 17 experts using the item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI). Results The draft version 1 of the CSP-N showed high content validity for individual items (I-CVI range: 0.82 to 1.00) and high overall content validity (S-CVI = 0.95), and suggestions from the experts were incorporated. The CSP-N was developed in four modules. The single-measure two-way mixed absolute agreement ICC value was calculated (for 32 subjects) for the reliability test, and the ICC value was 0.97 with a 95% CI (0.94, 0.99). Conclusions Using an iterative approach, the development and validation of the CSP-N demonstrated high I-CVI and S-CVI for screening and identification, dual collaboration for the treatment plan, referral, and follow-up of a person with mental illness by the nurses in the community.
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Affiliation(s)
- James Paul
- Department of Nursing, NIMHANS, Bengaluru, Karnataka, India
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Hämel K, Röhnsch G, Heumann M, Backes DS, Toso BRGDO, Giovanella L. How do nurses support chronically ill clients' participation and self-management in primary care? A cross-country qualitative study. BMC Prim Care 2022; 23:85. [PMID: 35436847 PMCID: PMC9014774 DOI: 10.1186/s12875-022-01687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 04/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the context of the advancement of person-centered care models, the promotion of the participation of patients with chronic illness and complex care needs in the management of their care (self-management) is increasingly seen as a responsibility of primary care nurses. It is emphasized that nurses should consider the psychosocial dimensions of chronic illness and the client's lifeworld. Little is known about how nurses shape this task in practice. METHODS The aim of this analysis is to examine how primary care nurses understand and shape the participation of patients with chronic illness and complex care needs regarding the promotion of self-management. Guided interviews were conducted with nurses practicing in primary care and key informants in Germany, Spain, and Brazil with a subsequent cross-case evaluation. Interpretive and practice patterns were identified based on Grounded Theory. RESULTS Two interpretive and practice patterns were identified: (1) Giving clients orientation in dealing with chronic diseases and (2) supporting the integration of illness in clients' everyday lives. Nurses in the first pattern consider it their most important task to provide guidance toward health-promoting behavior and disease-related decision-making by giving patients comprehensive information. Interview partners emphasize client autonomy, but rarely consider the limitations chronic disease imposes on patients' everyday lives. Alternatively, nurses in the second pattern regard clients as cooperation partners. They seek to familiarize themselves with their clients' social environments and habits to give recommendations for dealing with the disease that are as close to the client's lifeworld as possible. Nurses' recommendations seek to enable patients and their families to lead a largely 'normal life' despite chronic illness. While interview partners in Brazil or Spain point predominantly to clients' socio-economic disadvantages as a challenge to promoting client participation in primary health care, interview partners in Germany maintain that clients' high disease burden represents the chief barrier to self-management. CONCLUSIONS Nurses in practice should be sensitive to client's lifeworlds, as well as to challenges that arise as they attempt to strengthen clients' participation in care and self-management. Regular communication between clients, nurses, and further professionals should constitute a fundamental feature of person-centered primary care models.
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Affiliation(s)
- Kerstin Hämel
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
| | - Gundula Röhnsch
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
- Qualitative Social and Education Research, Department of Education and Psychology, Free University of Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany
| | - Marcus Heumann
- Department of Health Services Research and Nursing Science, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Dirce Stein Backes
- Franciscan University - UFN, Rua dos Andradas, 1614, Centro, Santa Maria, RS, CEP: 97010-030, Brazil
| | - Beatriz Rosana Gonçalves de Oliveira Toso
- Center of Biological and Health Sciences, Western Paraná State University - UNIOESTE, Rua Universitária, 1619, Jardim Universitário, Cascavel, PR, CEP 85819-110, Brazil
| | - Ligia Giovanella
- National School of Public Health, Fundação Oswaldo Cruz, Av Brasil 4036 s. 1001, Rio de Janeiro, RJ, CEP 21040-361, Brazil
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Lukewich J, Asghari S, Marshall EG, Mathews M, Swab M, Tranmer J, Bryant-Lukosius D, Martin-Misener R, Norful AA, Ryan D, Poitras ME. Effectiveness of registered nurses on system outcomes in primary care: a systematic review. BMC Health Serv Res 2022; 22:440. [PMID: 35379241 PMCID: PMC8981870 DOI: 10.1186/s12913-022-07662-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken. Results Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support). Conclusions The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs. Protocol registration ID PROSPERO: International prospective register of systematic reviews. 2018. ID=CRD42018090767. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07662-7.
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Affiliation(s)
- Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada.
| | - Shabnam Asghari
- Department of Family Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western, Ontario 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Michelle Swab
- Health Sciences Library, Faculty of Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | | | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Ave. St, Halifax, NS, B3H 4R2, Canada
| | - Allison A Norful
- School of Nursing, Columbia University, 630 West 168th Street, New York, NY, 10032, USA
| | - Dana Ryan
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Marie-Eve Poitras
- Département de médecine de famille et médecine d'urgence, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada
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Arnold H, Willis S, Watts T. Co-developing and implementing a community nursing simulated learning resource for undergraduate nursing students. Nurse Educ Pract 2021; 56:103192. [PMID: 34537669 DOI: 10.1016/j.nepr.2021.103192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/22/2022]
Abstract
Policy agendas across the developed world privilege systems transformation, notably shifting the balance of service provision from hospital to community settings. Primary and community health services have pivotal roles in the United Kingdom's longstanding policy ambition of healthcare services transformation, and it is imperative that undergraduate nursing students comprehend community settings as valuable learning environments, places of care and community nurses' roles therein. However, limited community placement learning opportunities means nursing students may be inadequately prepared to work in community settings at the point of initial registration. High fidelity simulated learning is well established within undergraduate nursing curricula. Currently, this learning approach predominantly focuses on acute and secondary care nursing and takes place in simulation centres. Within undergraduate nursing curricula there is limited evidence to support that community-based simulation is utilised with the result that students may struggle to recognise the value of learning opportunities in the community environment. This underpins the rationale for the development of this educational initiative which reflects current health policy agenda of care being provided closer to home. In addition, the new pre-registration 'Future nurse: Standards of proficiencies' (NMC, 2019) acknowledge that registered nurses need to be able to care for people in their own home and in the community setting. This paper describes the co-development and implementation of a pilot, community nursing focused, simulated learning resource within an undergraduate adult field nursing programme in Wales, UK. TWEETABLE ABSTRACT: How one university co-developed and implemented a community focused simulation resource for undergraduate nursing students.
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Cheng H, George C, Dunham M, Whitehead L, Denney-Wilson E. Nurse-led interventions in the prevention and treatment of overweight and obesity in infants, children and adolescents: A scoping review. Int J Nurs Stud 2021; 121:104008. [PMID: 34260995 DOI: 10.1016/j.ijnurstu.2021.104008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Nurses are well-placed in primary care, school and community settings to identify and manage paediatric overweight and obesity. This scoping review examined what types of nurse-led interventions have been undertaken for the prevention, treatment and management of obesity and overweight in infants, children and adolescents. DESIGN Scoping review. DATA SOURCES CINAHL, Cochrane Library, Embase, MEDLINE, ProQuest Central, ProQuest Dissertations & Theses Global, and Scopus. Searches were undertaken from inception to 2019. METHODS Database searches and handsearching were used to identify academic and grey literature, such as scientific reports and university theses and dissertations, on nurse-led interventions undertaken in school, primary health care and community settings. Studies focused on addressing overweight and obesity in children and adolescents, for studies published from 1999 onwards. Studies included focused on experimental and quasi-experimental research that implemented interventions, and described new practice or change in practice. RESULTS 117 references encompassing 83 studies or programs were selected for inclusion. 16 trials were analysed descriptively, and 67 trials were analysed descriptively and quantitatively. The analysis structured intervention settings and outcomes using the socioecological model, encompassing intrapersonal, interpersonal, community, organisation and policy factors. Studies included were clinically heterogeneous for intervention setting and multicomponent strategies. Education for nutrition, physical activity and behaviour change was the most common strategy used, and nutrition and physical activity knowledge most consistently improved after intervention. Nursing roles focused on education; counselling and behaviour change in primary care; advocacy in school and community environments; and implementing policy in child care settings. Fifty-four studies received financial or resource funding and support to implement the study. On sustainability, seven programs and two research studies were ongoing at time of writing. CONCLUSIONS While the clinical heterogeneity of studies makes synthesis of outcomes complex, it demonstrates the breadth of nursing interventions to address paediatric overweight and obesity. Incentives that encourage routine health promotion, upskilling of nurses, and embedding food and nutrition education into the school curricula, are suitable strategies that support nurse-led interventions against paediatric obesity. REGISTRATION NUMBER Not applicable. Tweetable abstract: Scoping r/v - what interventions are led by nurses to address paediatric obesity? 83 studies investigate nurses' work in school, primary health, community care.
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Affiliation(s)
- Heilok Cheng
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Susan Wakil Health Building, Camperdown, NSW, 2006, Australia; Centre of Research Excellence in Early Prevention of Childhood Obesity, The University of Sydney, Australia.
| | - Cobie George
- Australian College of Nursing, 1 Napier Close, Deakin, Australian Capital Territory, 2050, Australia.
| | - Melissa Dunham
- Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.
| | - Lisa Whitehead
- Australian College of Nursing, 1 Napier Close, Deakin, Australian Capital Territory, 2050, Australia; Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia, 6027, Australia.
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Susan Wakil Health Building, Camperdown, NSW, 2006, Australia; Centre of Research Excellence in Early Prevention of Childhood Obesity, The University of Sydney, Australia; Sydney Institute for Women, Children and Families, King George V Building, Sydney Local Health District, Missenden Road, Camperdown, New South Wales, 2050, Australia.
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Abel SL, Whitehead LC, Tipene-Leach DC, Coppell KJ. Proximal and distal influences on dietary change among a diverse group with prediabetes participating in a pragmatic, primary care nurse-led intervention: a qualitative study. Public Health Nutr 2021;:1-12. [PMID: 33966689 DOI: 10.1017/S1368980021001968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To understand motivators, facilitators and challenges to dietary change amongst a diverse sample of New Zealanders with prediabetes participating in a primary care nurse-led individualised dietary intervention. DESIGN A qualitative study involving semi-structured, face-to-face interviews with a stratified sample of adults with prediabetes and BMI ≥ 25 kg/m2, purposefully selected from a larger 2-year primary care-based prediabetes dietary intervention study. Thematic analysis was undertaken. A socio-ecological model guided interpretation. SETTING Hawke's Bay, Aotearoa/New Zealand, April 2018-March 2020. PARTICIPANTS Fifty-eight people aged 28-69 years, with similar numbers of men and women, indigenous Māori and non-Māori, and those who had and had not regressed to normoglycaemia at 6 months. RESULTS Motivators for wanting to make dietary changes were determination not to progress to diabetes; wanting to be healthy and contribute to others and encouragement by others. Facilitators for adopting and maintaining changes were a strong desire to be healthy; personal determination and feeling supported. Challenges were compromised control over life and environmental factors; feeling unsupported by others; social occasions; financial constraints and living with other health conditions. Developing their own strategies to overcome challenges was empowering, enabling a sense of control. These factors were similar across demographic and glycaemic outcome groups. CONCLUSIONS Influences on dietary change involved personal, interpersonal, organisational, environmental and policy factors. Although findings appeared similar across groups, dietary interventions need to address the specific ways motivators, facilitators and challenges manifest for individuals and social groups and be tailored accordingly within the context of the wider obesogenic and socio-economic environment.
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Weller CD, Richards C, Turnour L, Patey AM, Russell G, Team V. Barriers and enablers to the use of venous leg ulcer clinical practice guidelines in Australian primary care: A qualitative study using the theoretical domains framework. Int J Nurs Stud 2019; 103:103503. [PMID: 31931442 DOI: 10.1016/j.ijnurstu.2019.103503] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Venous leg ulcers represent the most common chronic wound problem managed in Australian primary care. Despite the prevalence of the condition, there is an evidence-practice gap in both diagnosis and management of venous leg ulcers. OBJECTIVE We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice. DESIGN We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers. SETTING(S) We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia. PARTICIPANTS We recruited general practitioners (15) and practice nurses (20). METHODS We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains. RESULTS Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes. CONCLUSIONS We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care.
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Affiliation(s)
- C D Weller
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
| | - C Richards
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
| | - L Turnour
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
| | - A M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - G Russell
- Department of General Practice, Southern Academic Primary Care Research Unit, Monash University, Building 1, 270 Ferntree Gully Rd, Notting Hill, 3168, Melbourne, Australia.
| | - V Team
- School of Nursing and Midwifery, Monash University, Level 5 Alfred Centre, 99 Commercial road, Melbourne, VIC, 3004, Australia.
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Coburn CV, Gilland D, Owen M, Amar A. Ambulatory care education: Preparing nurses for the future of healthcare. Nurse Educ Today 2018; 66:79-81. [PMID: 29684836 DOI: 10.1016/j.nedt.2018.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/22/2018] [Accepted: 03/14/2018] [Indexed: 06/08/2023]
Abstract
In the current healthcare environment, ambulatory care nursing is increasingly recognized as an efficient and effective way of collaborating with clients to improve health outcomes and to focus on prevention. Nursing skills in ambulatory care are both valuable and necessary. However, few undergraduate nursing programs provide content on ambulatory care or significant clinical experience outside the context of an acute care setting. To meet this gap in education, a baccalaureate undergraduate course in ambulatory care nursing was created to address the growing need for RNs in this field. In collaboration with affiliated healthcare systems, this course provides the knowledge and skills needed to enable new RNs to enter this challenging and rapidly changing specialty.
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Affiliation(s)
- Caroline Varner Coburn
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd. NE, Atlanta, GA 30322, USA.
| | - Deena Gilland
- Emory Healthcare, 1364 Clifton Rd. NE, Atlanta, GA, 30322, USA.
| | - Melissa Owen
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd. NE, Atlanta, GA 30322, USA.
| | - Angela Amar
- University of Nevada, Las Vegas, 4505 S. Maryland Way, 89154, USA.
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Monsalve-Reyes CS, San Luis-Costas C, Gómez-Urquiza JL, Albendín-García L, Aguayo R, Cañadas-De la Fuente GA. Burnout syndrome and its prevalence in primary care nursing: a systematic review and meta-analysis. BMC Fam Pract 2018; 19:59. [PMID: 29747579 PMCID: PMC5944132 DOI: 10.1186/s12875-018-0748-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND burnout syndrome is a significant problem in nursing professionals. Although, the unit where nurses work may influence burnout development. Nurses that work in primary care units may be at higher risk of burnout. The aim of the study was to estimate the prevalence of emotional exhaustion, depersonalization and low personal accomplishment in primary care nurses. METHODS We performed a meta-analysis. We searched Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN and LILACS databases up to September 2017 to identify cross-sectional studies assessing primary care nurses' burnout with the Maslach Burnout Inventory were included. The search was done in September 2017. RESULTS After the search process, n = 8 studies were included in the meta-analysis, representing a total sample of n = 1110 primary care nurses. High emotional exhaustion prevalence was 28% (95% Confidence Interval = 22-34%), high depersonalization was 15% (95% Confidence Interval = 9-23%) and 31% (95% Confidence Interval = 6-66%) for low personal accomplishment. CONCLUSIONS Problems such as emotional exhaustion and low personal accomplishment are very common among primary care nurses, while depersonalization is less prevalent. Primary care nurses are a burnout risk group.
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Affiliation(s)
- Carolina S. Monsalve-Reyes
- Departamento de Ciencias Sociales, Universidad Católica de La Santísima Concepción, Concepción, Chile
- Doctorado en Psicología de la Salud, Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | | | - Jose L. Gómez-Urquiza
- Nursing Department, University of Granada, Granada, Spain
- Faculty of Health Sciences, University of Granada, Cortadura del Valle Street S/N, 51001 Ceuta, Spain
| | | | - Raimundo Aguayo
- Psychology Department, University of Granada, Granada, Spain
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Coppell KJ, Abel SL, Freer T, Gray A, Sharp K, Norton JK, Spedding T, Ward L, Whitehead LC. The effectiveness of a primary care nursing-led dietary intervention for prediabetes: a mixed methods pilot study. BMC Fam Pract 2017; 18:106. [PMID: 29268719 PMCID: PMC5740796 DOI: 10.1186/s12875-017-0671-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 11/28/2017] [Indexed: 12/28/2022]
Abstract
Background Primary care nurse-led prediabetes interventions are seldom reported. We examined the implementation and feasibility of a 6-month multilevel primary care nurse-led prediabetes lifestyle intervention compared with current practice in patients with prediabetes, with weight and glycated haemoglobin (HbA1c) as outcomes. Methods This study used a convergent mixed methods design involving a 6-month pragmatic non-randomised pilot study with a qualitative process evaluation, and was conducted in two neighbouring provincial cities in New Zealand, with indigenous Māori populations comprising 18.2% and 23.0%, respectively. Participants were non-pregnant adults aged ≤ 70 years with newly diagnosed prediabetes (HbA1c 41-49 mmol/mol), body mass index (BMI) ≥ 25 kg/m2 and not prescribed Metformin. A structured dietary intervention tool delivered by primary care nurses with visits at baseline, 2–3 weeks, 3 months and 6 months was implemented in four intervention practices. Four control practices continued to provide usual care. Primary quantitative outcome measures were weight and HbA1c. Linear and quantile regression models were used to compare each outcome between the two groups at follow-up. Qualitative data included: observations of nurse training sessions and steering group meetings; document review; semi-structured interviews with a purposive sample of key informants (n = 17) and intervention patients (n = 20). Thematic analysis was used. Results One hundred fifty-seven patients with prediabetes enrolled (85 intervention, 72 control), 47.8% female and 31.2% Māori. Co-morbidities were common, particularly hypertension (49.7%), dyslipidaemia (40.1%) and gout (15.9%). Baseline and 6 month measures were available for 91% control and 79% intervention participants. After adjustment, the intervention group lost a mean 1.3 kg more than the control group (p < 0.001). Mean HbA1c, BMI and waist circumference decreased in the intervention group and increased in the control group, but differences were not statistically significant. Implementation fidelity was high, and it was feasible to implement the intervention in busy general practice settings. The intervention was highly acceptable to both patients and key stakeholders, especially primary care nurses. Conclusions Study findings confirm the feasibility and acceptability of primary care nurses providing structured dietary advice to patients with prediabetes in busy general practice settings. The small but potentially beneficial mean weight loss among the intervention group supports further investigation. Trial Registration ANZCTR ACTRN12615000806561. Registered 3 August 2015 (Retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12875-017-0671-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirsten J Coppell
- Edgar Diabetes and Obesity Research, Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Sally L Abel
- Kaupapa Consulting Ltd, Napier, 4110, New Zealand
| | - Trish Freer
- Health Hawke's Bay - Te Oranga Hawke's Bay, PO Box 11141, Hastings, 4158, New Zealand
| | - Andrew Gray
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Kiri Sharp
- Edgar Diabetes and Obesity Research, Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Joanna K Norton
- Edgar Diabetes and Obesity Research, Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - Terrie Spedding
- Health Hawke's Bay - Te Oranga Hawke's Bay, PO Box 11141, Hastings, 4158, New Zealand
| | - Lillian Ward
- Health Hawke's Bay - Te Oranga Hawke's Bay, PO Box 11141, Hastings, 4158, New Zealand
| | - Lisa C Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, Australia
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Frasso R, Golinkoff A, Klusaritz H, Kellom K, Kollar-McArthur H, Miller-Day M, Gabbay R, Cronholm PF. How nurse-led practices perceive implementation of the patient-centered medical home. Appl Nurs Res 2017; 34:34-9. [PMID: 28342621 DOI: 10.1016/j.apnr.2017.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 02/01/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model. METHODS Data were collected through in-depth interviews with providers and staff in nurse-led practices. RESULTS These data suggest two categories of processes that facilitate the integration of PCMH in the nurse-led practice setting: patient-oriented facilitators and organizational facilitators. In addition, a number of barriers were identified to implementing the PCMH model. Overall, these practices creatively engaged in the transformation process by structuring themselves as a complex adaptive system and building upon the core principles of nurse-led care. CONCLUSION Since the core principles of nurse-led care map onto many of the same principles of the PCMH model, this study discusses the possibility that nurse-led practices may experience fewer barriers when transitioning into PCMHs.
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Aggar C, Bloomfield J, Thomas TH, Gordon CJ. Australia's first transition to professional practice in primary care program for graduate registered nurses: a pilot study. BMC Nurs 2017; 16:14. [PMID: 28344514 PMCID: PMC5363053 DOI: 10.1186/s12912-017-0207-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 02/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background Increases in ageing, chronic illness and complex co-morbidities in the Australian population are adding pressure to the primary care nursing workforce. Initiatives to attract and retain nurses are needed to establish a sustainable and skilled future primary care nursing workforce. We implemented a transition to professional practice program in general practice settings for graduate nurses and evaluated graduate nurse competency, the graduate nurse experience and program satisfaction. This study aimed to determine whether a transition to professional practice program implemented in the general practice setting led to competent practice nurses in their first year post-graduation. Methods A longitudinal, exploratory mixed-methods design was used to assess the pilot study. Data were collected at three times points (3, 6, 12 months) with complete data sets from graduate nurses (n = 4) and preceptors (n = 7). We assessed perceptions of the graduates’ nursing competency and confidence, satisfaction with the preceptor/graduate relationship, and experiences and satisfaction with the program. Graduate nurse competency was assessed using the National Competency Standards for Nurses in General Practice. Semi-structured interviews with participants at Time 3 sought information about barriers, enablers, and the perceived impact of the program. Results Graduate nurses were found to be competent within their first year of clinical practice. Program perceptions from graduate nurses and preceptors were positive and the relationship between the graduate nurse and preceptor was key to this development. Conclusions With appropriate support registered nurses can transition directly into primary care and are competent in their first year post-graduation. While wider implementation and research is needed, findings from this study demonstrate the potential value of transition to professional practice programs within primary care as a nursing workforce development strategy.
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Affiliation(s)
- Christina Aggar
- Health & Human Sciences, Southern Cross University, Queensland, Australia
| | | | - Tamsin H Thomas
- Health & Human Sciences, Southern Cross University, Queensland, Australia
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Weldam SWM, Lammers JWJ, Zwakman M, Schuurmans MJ. Nurses' perspectives of a new individualized nursing care intervention for COPD patients in primary care settings: A mixed method study. Appl Nurs Res 2016; 33:85-92. [PMID: 28096029 DOI: 10.1016/j.apnr.2016.10.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The major challenges in Chronic Obstructive Pulmonary Disease (COPD) care are guiding a patient in daily living with the consequences of the disease, reducing the impact of symptoms and improving Health Related Quality of Life (HRQoL). The new nurse-led COPD-Guidance, Research on an Illness Perception (COPD-GRIP) intervention translates the evidence concerning illness perceptions and Health Related Quality of Life (HRQoL) into a practice nurse intervention. The aim is to explore the nurses' experiences with applying the new COPD-GRIP intervention. METHOD An explanatory mixed-method study nested in a cluster randomized trial in primary care was conducted. Pre-intervention questionnaires were sent to all participating nurses (N=24) to identify expectations. Post-intervention questionnaires identified experiences after applying the intervention followed by two focus groups to further extend exploration of findings. Questionnaires were analyzed by descriptive analyses. To identify themes the audio-taped and transcribed focus groups were independently coded by two researchers. RESULTS The nurses described the intervention as a useful, structured and individualized tool to guide COPD patients in living with the consequences of COPD. Applying the intervention took less time than the nurses initially expected. The intervention enables to provide patient-centered care and to address patient needs. Barriers were encountered, especially in patients with a lower social economic status, in patients with a lower health literacy and in patients with other cultural backgrounds than the Dutch background. CONCLUSION Nurses perceived the COPD-GRIP intervention as a feasible, individualized tool. According to the nurses, the intervention is a valuable improvement in the care for COPD patients.
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Affiliation(s)
- Saskia W M Weldam
- Department of Respiratory Diseases, Division Heart & Lungs, University Medical Center Utrecht, PO Box85500, 3508 GA Utrecht, The Netherlands.
| | - Jan-Willem J Lammers
- Department of Respiratory Diseases, Division Heart & Lungs, University Medical Center Utrecht, PO Box85500, 3508 GA Utrecht, The Netherlands
| | - Marieke Zwakman
- Department of Respiratory Diseases, Division Heart & Lungs, University Medical Center Utrecht, PO Box85500, 3508 GA Utrecht, The Netherlands
| | - Marieke J Schuurmans
- Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, PO Box85500, 3508 GA Utrecht, The Netherlands
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van Dijk-de Vries A, van Bokhoven MA, de Jong S, Metsemakers JF, Verhaak PF, van der Weijden T, van Eijk JT. Patients' readiness to receive psychosocial care during nurse-led routine diabetes consultations in primary care: A mixed methods study. Int J Nurs Stud 2016; 63:58-64. [PMID: 27597730 DOI: 10.1016/j.ijnurstu.2016.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with type 2 diabetes mellitus face several emotional and social consequences of their chronic illness in their everyday life. Symptoms of distress and depression are prevalent. For providing psychosocial self-management support, nurses in primary care were trained to identify patients with psychosocial problems during routine medically-shaped diabetes consultations. However, detection rates appeared to be strikingly low. OBJECTIVES Our study aimed to examine patients' readiness to discuss psychosocial problems with nurses during diabetes consultations. DESIGN A mixed methods design was used in which qualitative data collection was followed up by quantitative data collection. SETTING Diabetes care in a regional group of family practices in the south of the Netherlands. PARTICIPANTS Type 2 diabetes patients with psychosocial problems, determined by a self-administered questionnaire. METHODS First, in-depth interviews (n=12) were conducted about patients' experiences with routine diabetes consultations and their perspective on a biopsychosocial care approach. Based on a qualitative content analysis, a structured questionnaire was designed to further explore the findings among a larger group of patients. This questionnaire was completed by 205 patients. The questionnaire included 14 items measuring patients' agreement with statements about diabetes care and the role of the nurse to focus on patients' emotional and social functioning. RESULTS The interviews showed that patients view a diabetes consultation primarily as a biomedical check-up, and do not perceive discussion of psychosocial well-being as an integral part of diabetes management. More than 90% of the sample showed a positive attitude towards current diabetes consultations. Patients' intentions and perceived needs regarding a biopsychosocial care approach of the nurse were variable. Younger patients seemed more open to discussing psychosocial problems with the nurse than patients over 65. Patients' openness to discussing psychosocial problems was not significantly (p<0.05) associated with the nurses being trained in the biopsychosocial self-management approach. CONCLUSION Patients see primary care nurses primarily as specialists regarding the biomedical management of diabetes. Although patients seemed to support the ideal of integrated care, they did not expect a discussion about psychosocial problems in diabetes consultations. The incorporation of systematic detection of patients with psychosocial problems in diabetes care requires endeavours to make patients acquainted with the new role of the nurse.
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Álvarez-Tello M, Casado-Mejía R, Praena-Fernández JM, Ortega-Calvo M. [Developing a predictive model for the caregiver strain index]. Rev Esp Geriatr Gerontol 2016; 52:15-19. [PMID: 26857085 DOI: 10.1016/j.regg.2015.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/27/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient homecare with multiple morbidities is an increasingly common occurrence. The caregiver strain index is tool in the form of questionnaire that is designed to measure the perceived burden of those who care for their families. The aim of this study is to construct a diagnostic nomogram of informal caregiver burden using data from a predictive model. METHODS The model was drawn up using binary logistic regression and the questionnaire items as dichotomous factors. The dependent variable was the final score obtained with the questionnaire but categorised in accordance with that in the literature. Scores between 0 and 6 were labelled as "no" (no caregiver stress) and at or greater than 7 as "yes". The version 3.1.1R statistical software was used. To construct confidence intervals for the ROC curve 2000 boot strap replicates were used. RESULTS A sample of 67 caregivers was obtained. A diagnosing nomogram was made up with its calibration graph (Brier scaled = 0.686, Nagelkerke R2=0.791), and the corresponding ROC curve (area under the curve=0.962). FINDINGS The predictive model generated using binary logistic regression and the nomogram contain four items (1, 4, 5 and 9) of the questionnaire. R plotting functions allow a very good solution for validating a model like this. The area under the ROC curve (0.96; 95% CI: 0.994-0.941) achieves a high discriminative value. Calibration also shows high goodness of fit values, suggesting that it may be clinically useful in community nursing and geriatric establishments.
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Affiliation(s)
- Margarita Álvarez-Tello
- Unidad de Gestión Clínica Polígono Sur-Las Letanías, Distrito Sanitario de Atención Primaria, Sevilla, España
| | - Rosa Casado-Mejía
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, España
| | - Juan Manuel Praena-Fernández
- Unidad de Metodología y Evaluación de la Investigación, Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Manuel Ortega-Calvo
- Centro de Salud Esperanza Macarena, Unidad de Investigación Distrito Sanitario de Atención Primaria, Sevilla, España; CIBER de la Fisiopatología de la Obesidad y de la Nutrición, Instituto de Salud Carlos III, Madrid, España.
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Verwey R, van der Weegen S, Spreeuwenberg M, Tange H, van der Weijden T, de Witte L. Process evaluation of physical activity counselling with and without the use of mobile technology: A mixed methods study. Int J Nurs Stud 2015; 53:3-16. [PMID: 26518108 DOI: 10.1016/j.ijnurstu.2015.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND A monitoring-and-feedback tool was developed to stimulate physical activity by giving feedback on physical activity performance to patients and practice nurses. The tool consists of an activity monitor (accelerometer), wirelessly connected to a Smartphone and a web application. Use of this tool is combined with a behaviour change counselling protocol (the Self-management Support Programme) based on the Five A's model (Assess-Advise-Agree-Assist-Arrange). OBJECTIVES To examine the reach, implementation and satisfaction with the counselling protocol and the tool. DESIGN A process evaluation was conducted in two intervention groups of a three-armed cluster randomised controlled trial, in which the counselling protocol was evaluated with (group 1, n=65) and without (group 2, n=66) the use of the tool using a mixed methods design. SETTINGS Sixteen family practices in the South of the Netherlands. PARTICIPANTS Practice nurses (n=20) and their associated physically inactive patients (n=131), diagnosed with Chronic Obstructive Pulmonary Disease or Type 2 Diabetes, aged between 40 and 70 years old, and having access to a computer with an Internet connection. METHODS Semi structured interviews about the receipt of the intervention were conducted with the nurses and log files were kept regarding the consultations. After the intervention, questionnaires were presented to patients and nurses regarding compliance to and satisfaction with the interventions. Functioning and use of the tool were also evaluated by system and helpdesk logging. RESULTS Eighty-six percent of patients (group 1: n=57 and group 2: n=56) and 90% of nurses (group 1: n=10 and group 2: n=9) responded to the questionnaires. The execution of the Self-management Support Programme was adequate; in 83% (group 1: n=52, group 2: n=57) of the patients, the number and planning of the consultations were carried out as intended. Eighty-eight percent (n=50) of the patients in group 1 used the tool until the end of the intervention period. Technical problems occurred in 58% (n=33). Participants from group 1 were significantly more positive: patients: χ(2)(2, N=113)=11.17, p=0.004, and nurses: χ(2)(2, N=19)=6.37, p=0.040. Use of the tool led to greater awareness of the importance of physical activity, more discipline in carrying it out and more enjoyment. CONCLUSIONS The interventions were adequately executed and received as planned. Patients from both groups appreciated the focus on physical activity and personal attention given by the nurse. The most appreciated aspect of the combined intervention was the tool, although technical problems frequently occurred. Patients with the tool estimated more improvement of physical activity than patients without the tool.
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Affiliation(s)
- R Verwey
- School for Public Health and Primary Care (CAPHRI), Department Health Services Research, Maastricht University, Maastricht, The Netherlands; Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands.
| | - S van der Weegen
- School for Public Health and Primary Care (CAPHRI), Department Health Services Research, Maastricht University, Maastricht, The Netherlands.
| | - M Spreeuwenberg
- School for Public Health and Primary Care (CAPHRI), Department Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - H Tange
- School for Public Health and Primary Care (CAPHRI), Department Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - T van der Weijden
- School for Public Health and Primary Care (CAPHRI), Department Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - L de Witte
- School for Public Health and Primary Care (CAPHRI), Department Health Services Research, Maastricht University, Maastricht, The Netherlands; Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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Brito-Brito PR, Fernandez-Gutierrez DA, M Smith H. Case Study: Community Nursing Care Plan for a Man With Functional and Psychosocial Problems Following a Stroke. Int J Nurs Knowl 2015; 27:170-4. [PMID: 25774001 DOI: 10.1111/2047-3095.12084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aims to use the standardized nursing process to assist a middle-aged man with functional and psychosocial problems following a stroke. DATA SOURCES Data were obtained from interviews with the patient during primary care nurse consultations, electronic health record reviews, and reports from other professionals. To build the care plan, we used available scientific evidence, and we also considered a nurse-patient agreement. DATA SYNTHESIS We used clinical reasoning with NANDA-I classification, the Nursing Outcomes Classification, and the Nursing Interventions Classification to select nursing diagnoses, patient outcomes, and nursing interventions. CONCLUSIONS Psychosocial problems complicate the management of a patient with functional consequences after a stroke. This fact has high impact on people who are going through this process.
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Affiliation(s)
- Pedro Ruyman Brito-Brito
- Nursing School, University Hospital Nuestra Sra. Candelaria, Tenerife, Santa Cruz de Tenerife, Canary Islands
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Brito-Brito PR, Oter-Quintana C, Martín-García A, Alcolea-Cosín MT, Martín-Iglesias S, Fernández-Gutiérrez DÁ. Case study: community nursing care plan for an elderly patient with urinary incontinence and social interaction problems after prostatectomy. Int J Nurs Knowl 2014; 25:62-5. [PMID: 24393471 DOI: 10.1111/2047-3095.12021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this paper is to show nursing procedures and standardized languages in care provided by community nurses to a patient affected by urinary incontinence after a prostatectomy. DATA SOURCES Data were extracted from patient interviews during various consultations with the community nurse, and from electronic health records. The care plan was based on available scientific evidence. DATA SYNTHESIS Clinical reasoning was used to select NANDA-I diagnoses, nursing outcomes classification, and nursing interventions classification. CONCLUSIONS Urinary incontinence problems have a physical, psychological, and social development impact on people who suffer from this condition.
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