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Community Nurses (community + nurse)
Selected AbstractsA Randomized, Controlled Trial of an Intensive Community Nurse,Supported Discharge Program in Preventing Hospital Readmissions of Older Patients with Chronic Lung DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2004Timothy Kwok FRCP Objectives: To evaluate the effectiveness of an intensive community nurse (CN)-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease (CLD). Design: Randomized, controlled trial. Setting: Two acute hospitals in the same health region in Hong Kong. Participants: One hundred fifty-seven hospitalized patients aged 60 and older with a primary diagnosis of CLD and at least one hospital admission in the previous 6 months. Intervention: CNs made home visits within 7 days of discharge, then weekly for 4 weeks and monthly until 6 months. CNs coordinated closely with a geriatric or respiratory specialist in hospital. Subjects had telephone access to CNs during normal working hours from Monday to Saturday. Measurements: The primary outcome was the rate of unplanned readmission within 6 months. The secondary outcomes were the rate of unplanned readmission within 28 days, number of unplanned readmissions, hospital bed days, accident and emergency room attendance, functional and psychosocial status, and caregiver burden. Results: One hundred forty hospitalized patients completed the trial. Intervention group subjects had a higher rate of unplanned readmission within 6 months than control group subjects (76% vs 62%, P=.080, ,2 test). There was no significant group difference in any of the secondary outcomes except that intervention group subjects did better on social handicap scores. Conclusion: There was no evidence that an intensive CN-supported discharge program can prevent hospital readmissions in older patients with CLD. [source] Legal Implications Regarding Self-Neglecting Community-Dwelling Adults: A Practical Approach for the Community Nurse in IrelandPUBLIC HEALTH NURSING, Issue 2 2010Julianne Ballard ABSTRACT This paper explores the current literature related to legal issues encountered by the public health nurse in Ireland in visiting clients exhibiting self-neglecting behavior. Nurses working in community settings where home visiting of clients is required will at some point encounter situations of client self-neglect. Possession of a clear legal framework for the local area that addresses both the nurse's professional responsibility and the client's rights is needed. Because a high incidence of depression and dementia seen in self-neglecting adults has prompted calls for wider screening of the agreeable client, an understanding of the definition of competence and capacity in the national legal system for that client becomes critical. In Ireland, as in many other countries, refusal of care or screening is the right of any competent adult. However, issues of mandatory reporting, confidentiality, and trespass may differ from other areas. Nursing care delivered at the community level to a client exhibiting self-neglecting behavior involves a delicate balance of trust and support. Through this overview of the legal implications for self-neglecting clients in Ireland, nurses have the opportunity to begin an exploration of similarities and differences in approach on a global level. [source] Managing the self: living with an indwelling urinary catheterJOURNAL OF CLINICAL NURSING, Issue 7b 2007Debbie Kralik MN Aims., This paper reports the findings of a study that aimed to understand the perspectives of community dwelling adults' who lived with a permanently indwelling urinary catheter. The objectives of the research were to: reveal the participants' perspective of living in the community with a permanent indwelling urinary catheter, raise awareness of the experiences of catheterized men and women and to inform community nursing practice. Background., Catheter care is a common nursing intervention. Clinical Nurse Consultants (CNCs) with a focus on continence drove this inquiry because it was believed that Community Nurses may underestimate the impact that a permanently indwelling catheter may have on peoples' lives. Design., Structured interviews were undertaken with twelve men and nine women (n = 21), aged between 24 and 82 years and who had a permanently indwelling catheter (either urethral or supra pubic) for longer than six months. Analysis of the interview transcripts was a collaboration between the researchers and clinicians. Results., The most significant finding was that participants wanted to learn urinary catheter self-care as this allowed them to take control and gave relevance to their daily life. Data revealed a learning pattern consisting of seven interrelated themes as people have learned to self-manage: (i) resisting the intrusion of a catheter, (ii) reckoning with the need for a catheter, (iii) being vigilant for signs of problems, (iv) reconciling between the needs of self and others, (v) reclaiming life, (vi) managing self-care, and (vii) taking control. Conclusions., We do not suggest that people undergo a straightforward path toward catheter self-care, rather, that the seven interactive themes we have identified may be useful for observation in nursing practice whilst sensitizing nurses to clients' experiences of living with a catheter. Relevance to clinical practice., Promoting self-care of a catheter is not simply about educating clients about their condition or giving them relevant information. It is intrinsically a learning process, observing responses to every day events, such as the identification of the different sounds and sensations that may alert the individual to a full catheter bag, urine that has stopped flowing or signs of impending infection. [source] A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failureJOURNAL OF CLINICAL NURSING, Issue 1 2008Timothy Kwok MD Aims and objectives., To evaluate the effectiveness and cost-effectiveness of a community nurse-supported hospital discharge programme in preventing hospital re-admissions, improving functional status and handicap of older patients with chronic heart failure. Design., Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re-admission at six months. Secondary outcomes were number of unplanned re-admissions, six-minute walking distance, London Handicap Scale and public health care and personal care costs. Results., At sixth months, the re-admission rates were not significantly different (46 vs. 57% in control subjects, p = 0·233, Chi-square test). But the median number of re-admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0·057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0·5 in control subjects, p = 0·002, Mann Whitney test), but there was no difference in six-minute walking distance. There was no significant group difference in median total public health care and personal care costs. Conclusion., Community nurse-supported post-discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re-admissions. The cost benefits to public health care were not significant. Relevance to clinical practice., Older chronic heart failure patients are likely to benefit from post-discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken. [source] Managing independent prescribing: the influence of primary care trusts on community nurse prescribingINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2004Mr. Jason Hall Clinical teaching fellow Background Community nurses have been prescribing in the United Kingdom from the Nurse Prescribers' Formulary (NPF) since 1994. Most prescribing for the items included in the NPF is still carried out by general practitioners, although the proportion attributed to nurses is increasing. Objective To describe the methods that primary care trusts (PCTs) have used to influence the prescribing practices of community nurses and to explore the views of nurse prescribers regarding these methods. Method Semi-structured interviews with a purposive sample of 22 community nurse prescribers and five PCT prescribing leads. The transcripts were analysed using the framework method. Key findings PCTs used formularies and guidelines, education and training, individual prescriber feedback and directives to varying degrees to influence nurse prescribing. Some nurse prescribers considered formularies and guidelines to be restrictive. There were few instances of feedback or training being given to prescribers following their initial training as a prescriber, despite a majority wishing to receive both of these. Directives were used to restrict prescribing in a limited number of specific areas. Conclusion Influencing nurse prescribing did not appear to be a priority for PCTs despite this being part of the National Health Service's clinical governance agenda. PCTs will need to engage with nurse prescribers to determine ways to influence prescribing that are in the best interests of patients, nurses, doctors and the Trust. [source] Participation in arranging continuing health care packages: experiences and aspirations of service usersJOURNAL OF NURSING MANAGEMENT, Issue 2 2001S. Abbott ba(hons), ma(econ) Aims, This paper examines patients' and carers' experiences of receiving community health services, and considers the degree of patients' participation in the management of their continuing care. Background, Care management, advocated for many years as a way of ensuring appropriate and coordinated care, emphasizes the involvement of patients and carers in care planning. Evidence suggests that such involvement is unusual. Methods, Semi-structured interviews were carried out with 99 continuing health care patients and/or their carers. Findings, A few informants had willingly chosen to be active in arranging and coordinating their care, and a few others, who did not take an active role, were very satisfied with the services which they received. The majority, however, were not satisfied, feeling unclear about how their needs had been assessed and how services had been arranged. They were mostly disappointed by the absence of information and by the lack of regular contact with NHS and/or Social Services personnel. Some had felt compelled to become proactive in order to ensure that the care provided was adequate. Conclusions, Community nurses are valued by patients, and are well placed to be care managers. However, less qualified staff are also able to offer the regular support and information which patients want and value. [source] Recurrence of kernicterus in term and near-term infants in DenmarkACTA PAEDIATRICA, Issue 10 2000F Ebbesen Classical acute bilirubin encephalopathy (kernicterus) in term and near-term infants had not been seen in Denmark for at least 20 y until 1994. From 1994 to 1998, however, six cases were diagnosed. Aetiology of the hyperbilirubinaemia was known in two infants; spherocytosis and galactosaemia, most likely known in two infants; possible A-O blood type immunization, and unknown in two infants. However, one of these last-mentioned infants had a gestational age of only 36 wk. The maximum plasma total bilirubin concentrations were 531,745 ,mol/L. The increase in the number of cases of kernicterus was considered to have been caused by: (i) a decreased awareness of the pathological signs, (ii) a change in the assessment of the risk of bilirubin encephalopathy, (iii) early discharge of the infants from the maternity ward, (iv) so-called breastfeeding-associated jaundice, (v) demonstration of bilirubin being an antioxidant, and (vi) difficulty in estimating the degree of jaundice in certain groups of immigrants. Accordingly, for prevention: (a) Attempt to change the healthcare workers' understanding of the risk of bilirubin encephalopathy, (b) give further instructions, both orally and in writing, to mothers before discharge from the maternity ward, (c) be more liberal in giving infant formula supplements, (d) conduct home visits by the community nurse at an earlier stage, (e) follow authorized guidelines for phototherapy and exchange transfusion, (f) lower plasma bilirubin concentration limits as an indication for phototherapy and exchange transfusion, (g) screen all term and near-term infants, and (h) measure the skin's yellow colour with a device that corrects for the skin's melanin content. Conclusions: Audit of the six cases presented indicates that measures are necessary in both the primary and secondary healthcare sectors if the risk of kernicterus is to be avoided. Screening may be considered, but in order to identify the problems it would first be reasonable to perform a larger prospective study in which audit is performed on all newborn infants, born at term and near-term, who develop a plasma bilirubin concentration above the exchange transfusion limit. [source] An exploration of the contribution of the community nurse to rehabilitationHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2003Rosie Kneafsey RGN BSc Abstract Effective hospital and community rehabilitation services are increasingly recognised as a means of meeting the changing pattern of health and social care need. While the district or community nurse has the potential to play a central part in community rehabilitation provision, this role has received relatively scant attention in the literature. This paper describes research findings on community nurses' perceptions of their role and potential contribution to rehabilitation. As part of a wider, 2-year, qualitative investigation of the role of the nurse in rehabilitation, fieldwork was undertaken with both district and community staff nurses. This comprised focus group discussions and interviews with staff recruited as a consequence of the follow-up of patients' experiencing rehabilitation. The findings indicate that community-based nurses contributed to patient rehabilitation by making assessments, referring on to other members of the multi-professional team, advocating for and liaising with other services, helping people to adapt, teaching and motivating patients and carers, supporting and involving families, and providing technical care. A number of challenges to community-based nursing roles were apparent, including feelings of exclusion, lack of recognition, a lack of time for rehabilitation and paucity of referrals for rehabilitation. Greater clarity and recognition is needed of the community-based nursing contribution to rehabilitation, and there is a need to ensure that community nursing assessments contribute to patients' rehabilitation goals and the promotion of independent living. [source] A Randomized, Controlled Trial of an Intensive Community Nurse,Supported Discharge Program in Preventing Hospital Readmissions of Older Patients with Chronic Lung DiseaseJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2004Timothy Kwok FRCP Objectives: To evaluate the effectiveness of an intensive community nurse (CN)-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease (CLD). Design: Randomized, controlled trial. Setting: Two acute hospitals in the same health region in Hong Kong. Participants: One hundred fifty-seven hospitalized patients aged 60 and older with a primary diagnosis of CLD and at least one hospital admission in the previous 6 months. Intervention: CNs made home visits within 7 days of discharge, then weekly for 4 weeks and monthly until 6 months. CNs coordinated closely with a geriatric or respiratory specialist in hospital. Subjects had telephone access to CNs during normal working hours from Monday to Saturday. Measurements: The primary outcome was the rate of unplanned readmission within 6 months. The secondary outcomes were the rate of unplanned readmission within 28 days, number of unplanned readmissions, hospital bed days, accident and emergency room attendance, functional and psychosocial status, and caregiver burden. Results: One hundred forty hospitalized patients completed the trial. Intervention group subjects had a higher rate of unplanned readmission within 6 months than control group subjects (76% vs 62%, P=.080, ,2 test). There was no significant group difference in any of the secondary outcomes except that intervention group subjects did better on social handicap scores. Conclusion: There was no evidence that an intensive CN-supported discharge program can prevent hospital readmissions in older patients with CLD. [source] A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failureJOURNAL OF CLINICAL NURSING, Issue 1 2008Timothy Kwok MD Aims and objectives., To evaluate the effectiveness and cost-effectiveness of a community nurse-supported hospital discharge programme in preventing hospital re-admissions, improving functional status and handicap of older patients with chronic heart failure. Design., Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re-admission at six months. Secondary outcomes were number of unplanned re-admissions, six-minute walking distance, London Handicap Scale and public health care and personal care costs. Results., At sixth months, the re-admission rates were not significantly different (46 vs. 57% in control subjects, p = 0·233, Chi-square test). But the median number of re-admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0·057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0·5 in control subjects, p = 0·002, Mann Whitney test), but there was no difference in six-minute walking distance. There was no significant group difference in median total public health care and personal care costs. Conclusion., Community nurse-supported post-discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re-admissions. The cost benefits to public health care were not significant. Relevance to clinical practice., Older chronic heart failure patients are likely to benefit from post-discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken. [source] Nurse discharge planning in the emergency department: a Toowoomba, Australia, studyJOURNAL OF CLINICAL NURSING, Issue 8 2006Desley Hegney BA Aim., This study aimed to ascertain whether a model of risk screening carried out by an experienced community nurse was effective in decreasing re-presentations and readmissions and the length of stay of older people presenting to an Australian emergency department. Objectives., The objectives of the study were to (i) identify all older people who presented to the emergency department of an Australian regional hospital; (ii) identify the proportion of re-presentations and readmissions within this cohort of patients; and (iii) risk-screen all older patients and provide referrals when necessary to community services. Design., The study involved the application of a risk screening tool to 2139 men and women over 70 years of age from October 2002 to June 2003. Of these, 1102 (51·5%) were admitted and 246 (11·5%) were re-presentations with the same illness. Patients presenting from Monday to Friday from 08:00 to 16:00 hours were risk-screened face to face in the emergency department. Outside of these hours, but within 72 hours of presentation, risk screening was carried out by telephone if the patient was discharged or within the ward if the patient had been admitted. Results., There was a 16% decrease in the re-presentation rate of people over 70 years of age to the emergency department. Additionally during this time there was a 5·5% decrease in the readmission rate (this decrease did not reach significance). There was a decrease in the average length of stay in hospital from 6·17 days per patient in October 2002 to 5·37 days per patient in June 2003. An unexpected finding was the decrease in re-presentations in people who represented to the emergency department three or more times per month (known as ,frequent flyers'). Conclusions., Risk screening of older people in the emergency department by a specialist community nurse resulted in a decrease of re-presentations to the emergency department. There was some evidence of a decreased length of stay. It is suggested that the decrease in re-presentations was the result of increased referral and use of community services. It appears that the use of a specialist community nurse to undertake risk screening rather than the triage nurse may impact on service utilization. Relevance to clinical practice., It is apparent that older people presenting to the emergency department have complex care needs. Undertaking risk screening using an experienced community nurse to ascertain the correct level of community assistance required and ensuring speedy referral to appropriate community services has positive outcomes for both the hospital and the patient. [source] A Qualitative Case Study Review of Role Transition in Community NursingNURSING FORUM, Issue 4 2007Joyce Zurmehly PhD PURPOSE.,This paper aims to describe existing community nursing practices and to explore factors that are associated with the transition of clinical practice from acute care settings to community care settings. METHOD.,This qualitative case study assessment described existing community nurse practices and explored factors that were associated with the transition to community practice from acute care settings. The 48 participants in this case study were registered nurses who were working in community care nursing during the interview process. CONCLUSIONS.,The results of this investigation revealed themes derived from data collection, including autonomy, client and family, education, and community as nursing work. This study indicated that making the transition to community-based nursing includes conceptual as well as emotional adjustments. Community nursing practice was seen by the participants as nursing that captures a holistic approach incorporating multiple dimensions from psychological, sociological, economic, and physical to spiritual aspects that provides services in interaction between the community nurse, the client, and the family. The findings indicate a need for additional supportive preparation strategies incorporated into nursing orientation and continuing education programs. Future research investigating agency culture and socialization would provide a more definitive survey of perceptions and competencies needed for role. [source] Dying at home: community nurses' views on the impact of informal carers on cancer patients' place of deathEUROPEAN JOURNAL OF CANCER CARE, Issue 5 2010B. JACK phd, bsc (econ), head of research, scholarship JACK B. & O'BRIEN M. (2010) European Journal of Cancer Care19, 636,642 Dying at home: community nurses' views on the impact of informal carers on cancer patients' place of death Giving patients with cancer a choice in where they want to die including the choice to die at home if they so wish, underpin the recent UK government policies and is embedded in the End of Life Care Programme. However, this presents increasing challenges for the informal carers particularly with an increasingly aging population. Despite the policy initiatives, there remain a persistent number of patients with cancer who had chosen to die at home being admitted to hospital in the last days and hours of life. A qualitative study using two focus group interviews with community nurses (district nurses and community specialist palliative care nurses) was undertaken across two primary care trusts in the north-west of England. Data were analysed using a thematic analysis approach. The results indicated that informal carer burden was a key reason for prompting hospital admission. Recommendations for the development of a carer assessment tool with appropriate supportive interventions are made. [source] Managing independent prescribing: the influence of primary care trusts on community nurse prescribingINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2004Mr. Jason Hall Clinical teaching fellow Background Community nurses have been prescribing in the United Kingdom from the Nurse Prescribers' Formulary (NPF) since 1994. Most prescribing for the items included in the NPF is still carried out by general practitioners, although the proportion attributed to nurses is increasing. Objective To describe the methods that primary care trusts (PCTs) have used to influence the prescribing practices of community nurses and to explore the views of nurse prescribers regarding these methods. Method Semi-structured interviews with a purposive sample of 22 community nurse prescribers and five PCT prescribing leads. The transcripts were analysed using the framework method. Key findings PCTs used formularies and guidelines, education and training, individual prescriber feedback and directives to varying degrees to influence nurse prescribing. Some nurse prescribers considered formularies and guidelines to be restrictive. There were few instances of feedback or training being given to prescribers following their initial training as a prescriber, despite a majority wishing to receive both of these. Directives were used to restrict prescribing in a limited number of specific areas. Conclusion Influencing nurse prescribing did not appear to be a priority for PCTs despite this being part of the National Health Service's clinical governance agenda. PCTs will need to engage with nurse prescribers to determine ways to influence prescribing that are in the best interests of patients, nurses, doctors and the Trust. [source] The work of health visitors and school nurses with children with psychological and behavioural problemsJOURNAL OF ADVANCED NURSING, Issue 4 2008Philip Wilson Abstract Title., The work of health visitors and school nurses with children with psychological and behavioural problems Aim., This paper is a report of a study to describe the workload of health visitors and school nurses in relation to children and young people with psychological, emotional or behavioural problems, and to identify perceived challenges, obstacles and sources of satisfaction associated with this aspect of their work. Background., There is little published information on the work performed by non-specialist community nurses with children and young people who have psychological, emotional and behavioural problems. Method., We analysed data from a survey conducted in 2002 , 2003 of 1049 Scottish professionals working with children and young people. Data included quantitative responses and free-text describing the cases seen by respondents. Responses from a sub-sample of 71 health visitors and 100 school nurses were analysed using a combination of descriptive statistics and analysis of themes emerging from the text. Findings., Although community-based nurses saw a relatively small number of children with psychological, emotional or behavioural problems each week, dealing with these problems took up a disproportionate amount of time. The commonest types of problem were self-harm, externalizing behaviours and family difficulties. Few respondents had received specific training in child and adolescent mental health but most expressed a wish to receive such training. Conclusion., The work of health visitors and school nurses in caring for children with mental health problems is substantial and important. Development of their public health role should not be at the expense of this important contribution. There is a need for rigorous evaluation of nursing mental health interventions among children and young people. [source] The importance of ,knowing the patient': community nurses' constructions of quality in providing palliative careJOURNAL OF ADVANCED NURSING, Issue 4 2000Karen A. Luker PhD BNurs RGN RHV NDNCert The importance of ,knowing the patient': community nurses' constructions of quality in providing palliative care This paper reports findings from a study conducted in one community health care trust where 62 members of the district nursing team (grades B,H) were interviewed. An adaptation of the critical incident technique was used to determine factors which contributed or detracted from high quality care for a number of key areas including palliative care. The centrality of knowing the patient and his/her family emerged as an essential antecedent to the provision of high quality palliative care. Factors enabling the formation of positive relationships were given prominence in descriptions of ideal care. Strategies used to achieve this included establishing early contact with the patient and family, ensuring continuity of care, spending time with the patient and providing more than the physical aspects of care. The characteristics described by the community nurses are similar to those advocated in ,new nursing' which identifies the uniqueness of patient needs, and where the nurse,patient relationship is objectified as the vehicle through which therapeutic nursing can be delivered. The link with ,new nursing' emerges at an interesting time for community nurses. The past decade has seen many changes in the way that community nursing services are configured. The work of the district nursing service has been redefined, making the ideals of new nursing, for example holism, less achievable than they were a decade ago. This study reiterates the view that palliative care is one aspect of district nursing work that is universally valued as it lends itself to being an exemplar of excellence in terms of the potential for realizing the ideals of nursing practice. This is of increasing importance in the context of changes that militate against this ideal. [source] Wound care in the community setting: clinical decision making in contextJOURNAL OF ADVANCED NURSING, Issue 4 2000Christine E. Hallett PhD BNurs BA Hons RGN HVCert DNCert PGDE Wound care in the community setting: clinical decision making in context Sixty-two community nurses in northern England of grades B and D to H were interviewed by a team of four researchers. The interviews were semi-structured, and were tape-recorded, fully transcribed and content analysed. They were conducted as part of a larger study, the aim of which was to examine community nurses' perceptions of quality in nursing care. One of the main themes the work focused on was decision-making as an element of quality. Data relating to wound care were considered from the perspective of the insights they offered into clinical decision-making. Data were interpreted in the light of a literature review in which a distinction had been made between theories which represented clinical decision-making as a linear or staged process and those which represented it as intuitive. Within the former category, three sub-categories were suggested: theorists could be divided into ,pragmatists', ,systematisers' and those who advocated ,diagnostic reasoning'. The interpretation of the data suggested that the clinical decisions made by community nurses in the area of wound care appeared largely intuitive, yet were also closely related to ,diagnostic reasoning'. They were furthermore based on a range of sources of information and justified by a number of different types of rationale. [source] A case for case studies: exploring the use of case study design in community nursing researchJOURNAL OF ADVANCED NURSING, Issue 4 2000Ann Bergen BA MSc RGN DipN DNCert Cert Ed DNT A case for case studies: exploring the use of case study design in community nursing research The case study has become an accepted vehicle for conducting research in a variety of disciplines. However, the meaning behind the term is not always made explicit by researchers and this has given rise to a number of assumptions which are open to challenge, and to questions about the robustness of the method. This paper explores some of the issues arising from one particular definition of case study research, used in a study by Yin which examined the practice of case management in community nursing. Four main areas are discussed. First, defining ,case' is seen to pose questions about the relationship of the phenomenon to its context, the degree of researcher control over case definition, the limits to what may constitute a ,case' and what is meant by the term ,unit of analysis'. Second, the relevance of external validity to case study research is supported through the use of a number of tactics, in particular Yin's concept of replication logic, which involves generalizing to theory, rather than to empirical data. Third, the use of method triangulation (multiple methods of data collection) is advanced as a means of enhancing construct validity in research where data converge around a particular theory. Finally, the relationship of the case study to theory construction, through the prior development of ,propositions' is discussed. Each of these issues is applied to the design and conduct of a research study based closely on Yin's multiple case study framework. Thirteen ,cases' were selected of case management practice and data were collected through interviews and examination of literature and documentation, to explore the suitability of community nurses for the role. It is concluded that, given the appropriate subject matter, context and research aims, the case study method may be seen as a credible option in nursing research. [source] Mainstream In-Patient Mental Health Care for People with Intellectual Disabilities: Service User, Carer and Provider ExperiencesJOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 3 2010Ben Donner Background, Government guidelines promote the use of mainstream mental health services for people with intellectual disabilities whenever possible. However, little is known about the experiences of people with intellectual disabilities who use such services. Materials and Methods, Face-to-face interviews with service users, carers and community nurses were completed and analysed on a case by case basis using interpretative phenomenological analysis. The results were followed up in focus groups with service providers. Results, Positive aspects included the provision of respite, particularly for carers, and good basic care. These were outweighed by a perception of the admission as disempowering and lacking in flexible treatment provision. Accessing help emerged as a major problem, as well as the prospect of staff neglecting the specific needs of people with intellectual disabilities. Conclusions, While there were some indications of improvements in line with recent policies and guidance, mainstream services seem a long way off realizing aims of easy accessibility, person-centred practices and active partnership with intellectual disability services. [source] Reliability and validity of the CCNCS: a dependency workload measurement systemJOURNAL OF CLINICAL NURSING, Issue 10 2008Anne-Marie Brady BSN, PG Dip in Health Sciences Ed Aim., To refine, test and evaluate the Community Client Need Classification System (CCNCS). Background., Workload assessment in community nursing is complicated by the range of services that may be delivered in one patient interaction. The CCNCS is a workload measurement system designed to capture the direct and indirect elements of community nursing work and is suitable for use with all care groups in the community. Design., Survey. Method., Forty-four community nurses implemented the CCNCS with all clients in their caseload for four weeks. Community nursing in the Irish Republic is known as public health nursing. The Public Health Nurses (PHNs) recorded the total time in minutes that was spent on each client each week. The satisfaction with and experiences of PHNs using the CCNCS during the study period was also recorded. Results., Participants endorsed the utility of the CCNCS for use in community nursing. Inter-rater and intra-rater reliability results were positive with high level of agreement between raters in relation to scoring community clients. The amount of time the PHNs spent with clients correlated with ascending level of client need. Conclusions., The CCNCS affords insight into the complex nature of community nursing. It discriminates between levels of need and has potential to provide a standardised assessment of need in all community-nursing clients. Adequate resources are required to conduct further testing of the reliability and predictive validity of this system. Relevance to clinical practice., The CCNCS can provide objective evidence of community nursing workload and thus facilitate workforce planning. [source] Managements' perception of community nurses' decision-making processes when referring older adults to an emergency departmentJOURNAL OF NURSING MANAGEMENT, Issue 6 2006A. KIHLGREN MSc In Sweden, older adults are living and being cared for under the responsibility of their respective community. Extensive reorganizations in the community led to management having different backgrounds, which may have caused uncertainty among community nurses, especially in decision-making processes. The aim was to understand how 10 nurses, 10 doctors and 10 home care assistants as leaders for the nurses conceptualized the decision-making processes of community nurses, when referring older persons to Emergency Departments, and whether perceptual differences and/or similarities exist. Narrative interviews and content analysis were performed. The managers had differing views, but all felt there was a need to feel secure in order to trust professional decisions as being correct, thus avoiding inappropriate referrals. Management could see nurses' exposed position, but had varying solutions. This might lead to different messages being given regarding what is important and might explain why the nurses reported that the managers did not understand them. [source] Situations influencing habits in diet and exercise among nurses working night shiftJOURNAL OF NURSING MANAGEMENT, Issue 5 2006M. PERSSON RNT Objectives, The aim of the investigation was to describe situations with a significant influence on healthy diet and exercise habits among nurses working night shift. Methods, A qualitative descriptive design with a Critical Incident Technique approach was used. Situations were collected by means of interviews with 27 registered/enrolled community nurses. Results, A total of 143 situations were identified comprising two main areas: coping ability at work and coping ability during leisure hours. Coping ability at work included 81 critical incidents grouped into two categories: the nurses' diet and exercise habits were influenced by social interaction with colleagues at work and by the disruption to their circadian rhythm. Coping ability during leisure hours included 62 critical incidents grouped into two categories: the diet and exercise habits were influenced when the nurses recovered from the disruption to their circadian rhythm and when they took advantage of the freedom of action offered by night work. Conclusions, By identifying the factors that influence diet and exercise habits among nurses working night shift, strategies can be developed in order to strengthen the factors with a positive influence. [source] Nurse leadership within primary care: the perceptions of community nurses, GPs, policy makers and members of the publicJOURNAL OF NURSING MANAGEMENT, Issue 1 2004AdvDipEd, DipN (Lond), FRCS, Hugh McKenna BSc(Hons) Aim, The aim of this section of a wider study was to seek the views of community nurses, general practitioners, members of the public and policy makers on nursing leadership in primary care. The wider study aimed to review the role and function of primary care services and community nursing with reference to developments in practice, education, research and policy. Background, Key messages, challenges and opportunities for leaders within nursing have been highlighted in the literature and in turn emphasis placed on the positive effect this would have on improved quality of services [Department of Health and Social Services (1998) Valuing Diversity.. A Way Forward. Department of Health and Social Service, Belfast]. In order to grasp these opportunities, nursing has to invest in the development of leaders. Methods, A two round Delphi technique was employed using a focus group approach in round one and a postal questionnaire in round two. Semi-structured interviews were carried out with senior policy makers. Results, Findings show that there was agreement that strong leadership was needed for the development of community nursing but that at present there is confusion and disagreement over whether it exists currently. Other findings focus on problems inherent in identifying future nurse leaders. Conclusion, The traditional subservient culture of community nursing is blamed for the perceived inability to nurture strong leaders. Recommendations are made for the development of nurse leaders. [source] Leg clubs: A new approach to patient-centred leg ulcer managementNURSING & HEALTH SCIENCES, Issue 3 2000DNCERT, DipHE, Ellie Lindsay BSC(HONS) Abstract Loneliness is a significant health-care issue for many elderly patients in the community. The correlation between social isolation, poor compliance to treatment, and low healing rates for patients suffering from leg ulcers is well documented. Pain, odour, bandages etc. contribute to low self-esteem, depression and social stigma. Home visits by community nurses cannot provide the social and psychological support required by these patients. Responding to the holistic needs of this client group, the author set up Debenham Leg Club in 1995 to provide leg ulcer management in an informal, non-medical setting, where the emphasis is on social interaction, participation, empathy and peer support. This social model was conceived as a unique partnership between the district nurses and the local community, in which patients are empowered, through a sense of ownership, to become stakeholders in their own treatment. The value of the ,club' concept is evident in the happy, welcoming, uninhibited atmosphere that characterizes the clinic. Non-compliance to treatment has been virtually eliminated and evidence of greater healing rates has been illustrated through many patients whose long-standing ulcers have healed or greatly improved as a direct result of this change in approach. Patients' willingness to attend for systematic ,well leg' checks and ongoing health education has dramatically reduced the incidence of recurrence. [source] Standards for professional monitoring of capillary blood glucosePRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 3 2001BA (Hons) Diabetes Healthcare Development Manager (Educator/Facilitator), Jill Rodgers RGN Abstract After updating the blood glucose meters used in Portsmouth, variations in the amount of strips used by health professionals were reported, which appeared to be unrelated to the patients' conditions. A district standard for professional monitoring of blood glucose levels was developed, following which the monitoring carried out on 100 in-patients and 79 patients visited by community nurses was audited against the standard. Overtesting was evident in some patients in all categories, indicating inappropriate use of resources. Undertesting was also evident, which was particularly worrying in those patients who were acutely ill. The standard has been updated, and awareness about the standards has now been raised. Copyright © 2001 John Wiley & Sons, Ltd. [source] Family Caregivers' Experiences with Community Services: A Qualitative AnalysisPUBLIC HEALTH NURSING, Issue 5 2003Betty Wehtje Winslow Ph.D. Abstract Researchers of family caregiving have presented mixed results in evaluating the effectiveness of community services in reducing family caregiver stress and have indicated that many caregivers use limited services or access services late in their caregiving experience. The purpose of this study was to describe the experience of the use of community services, including benefits and barriers, by family caregivers of relatives with Alzheimer's disease or a related disorder. Community services included assistance with caregiving or related tasks and educational or emotional support that was provided by health professionals or community service providers. In this qualitative descriptive study, a convenience sample of 21 family caregivers was interviewed. Open-ended questions were used to explore the caregivers' experiences with community services. Transcribed data were analyzed using qualitative content-analysis techniques. Results indicated that family caregivers received benefits of renewal, sense of community, and new knowledge and believed that their patient benefited from the services. Barriers to service use included care receiver resistance, reluctance of the caregiver, hassles for the caregiver, concerns over quality, and concerns over finances. These findings provide direction for community nurses and other health professionals in targeting interventions that will meet the expressed needs of caregivers. [source] | |||||||||||||||||||||||||