HIV/AIDS family care-giving in Switzerland in the context of silence

Based on critical hermeneutics, this qualitative study presents insights about care giving experiences of HIV affected families in the German speaking part in Switzerland. Eleven families (12 women, 5 men) were interviewed, and members of different families participated in group-conversations. Critical reflection of the results highlighted that these HIV-families offered family caregiving in a context of silence. Two perspectives of this silence are presented: 1. HIV-families do not share their experiences in their closer and larger environments because of stigmatization, changing family constellations, and traditional images of family care. Instead, HIV-families create silent circles. 2. Professional discourses about family care are almost absent in the Swiss health care system because of its focus on the needs of individual patients with health care providers, in particular nurses, offering no systematic health services tailored to family caregivers. The results highlight, that it is paramount for nurses to take responsibility and to create programs that will better serve HIV-families.     

Telehealth Benefits and Barriers

Telehealth includes health care services provided using audio and video technology. Telehealth was originally developed to provide basic care to rural and underserved patients. Higher rates of use of telehealth are now standard in many practices since the coronavirus disease 2019 pandemic. Increasing emphases on patient satisfaction, providing efficient and quality care, and minimizing costs have also led to higher telehealth implementation. Patients and providers have enjoyed the benefits of telehealth, but widespread adoption has been hindered by regulatory, legal, and reimbursement barriers. Recent legislative initiatives have advocated for further telehealth advancements, especially with the rapid implementation of telehealth in the times of coronavirus disease 2019.     

Rapid Deployment of Chiropractic Telehealth at 2 Worksite Health Centers in Response to the COVID-19 Pandemic: Observations from the Field

ObjectiveThe purpose of this paper is to describe the rapid deployment of telehealth, particularly real time video conference, for chiropractic services as a response to COVID-19.MethodsTwo health centers at 2 campuses of a large California corporation have chiropractic care integrated into physical medicine services. Care was suspended beginning on March 17, 2020 to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among patients and staff. On March 19, the Governor of California issued a stay at home order. With musculoskeletal problems being common in the employee patient population, telehealth services were quickly developed to continue chiropractic care for patients. Using existing infrastructure, several members of the health center team developed chiropractic telehealth operations within 2 days.ResultsMusculoskeletal telehealth services included examinations, risk assessment, advice, and rehabilitative exercises. These telehealth visits facilitated care that would have otherwise been unavailable to employees. Patients reported that the appointments were helpful, addressed their concerns, and provided a safe method to see their doctor. Regular interprofessional teamwork and relations between the clinic operator and client company were key contributors to operationalizing this service in our integrated healthcare environment.ConclusionWe were able to quickly implement real time video conferencing and other forms of telehealth for chiropractic services at 2 worksite health centers. This paper includes information and insights to providers about setting up similar telehealth systems so they may also provide this benefit for patients in their communities during pandemics or disasters.     

Australian parents’ experiences with universal child and family health services

BackgroundAustralian governments provide free services to promote maternal and child health, and to support parenting for families with children up to age five. Services are principally provided by dedicated child and family health nurses, but also by general practitioners, practice nurses, pharmacy nurses and midwives.AimThis study aimed to examine the experiences of families with young children across Australia in accessing and receiving health care for well children, parenting support and advice from a range of providers.MethodsThe study used quantitative and qualitative data from an online survey of 719 parents and carers with children aged up to five years.FindingsOn quantitative scales, most respondents rated healthcare providers favourably for accessibility, credibility and their approach to families. However, qualitative responses revealed widely varying reactions to child and family health provision. Parents described both positive and negative experiences, highlighting elements of practice that are critical to consumer engagement.DiscussionParents require health care and support that are accessible, consistent, affordable, encouraging, trustworthy, evidence-based and non-judgemental. Parents feel more confidence in the information and care provided by health professionals who are well-informed, resourceful and who respect their knowledge and beliefs.ConclusionThe findings demonstrate ways in which child and family health providers can engage and effectively support families with young children.     

Building capacity to provide palliative care in rural and remote communities: does education make a difference?

One strategy for improving access to palliative care services in rural and remote communities is to educate community-based health professionals in the knowledge and skills required to provide end-of-life care. It is, therefore, important to evaluate palliative care educational initiatives. This article provides an evaluation of the interdisciplinary education program at Lakehead University which aims to: improve the knowledge and skills of individual providers; contribute to the development of palliative care programs in rural communities; and develop palliative care trainers to educate their co-workers in the workplace. A survey of 353 providers who participated in the education program was completed after eight years of providing education. Results confirm that the goals of the education program were met, and that rural and remote communities reported a greater capacity to deliver palliative care. Nevertheless, respondents identified a lack of resources, especially home care visits, as an obstacle to improving care.     

A follow-up study of professionals' perspectives on the development of family health nursing in Scotland: a questionnaire survey

BACKGROUND: In 1998 the World Health Organisation Europe introduced the Family Health Nurse concept. The envisaged role of this community-based nurse was seen as multi-faceted and included helping individuals, families and communities to cope with illness and improve their health. During 2000-2002 Scotland led enactment of the concept through education and practice, and the first research study evaluating its operation and impact in remote and rural areas was published in 2003. OBJECTIVE: This study's purpose was to follow up health care professionals' perspectives on the development of family health nursing in remote and rural areas of Scotland since 2002. METHODS: The main research method used was questionnaire survey of all the established family health nurses in these areas and all other health and social care professionals with whom they had regular work-related contact. Where novel contexts or practice patterns emerged, further investigation was undertaken through telephone interviews. FINDINGS: Twenty-three family health nurses (88%) and 88 of their colleagues (52%) returned questionnaires. Eight family health nurses were interviewed. The dominant theme within the findings was the gradual, positive development of a role which tended to maintain established community nursing service provision, yet also supplement this with a limited expansion of family health services and public health activities. The flexibility and wide scope of the FHN role in terms of providing generalist community health nursing services was clearly evident. However, capacity to engage with whole families was found to vary widely in practice. CONCLUSIONS: Within remote and rural Scotland family health nursing is gradually consolidating and developing, but its particular aspiration to engage with whole families is often difficult to enact and is not a priority within mainstream UK primary care policy, planning or provision.     

The crisis nature of health care transitions for rural older adults

The complex health, socioeconomic, and environmental problems experienced by many American elders often place them at high risk for disease and disability. Over time, acutely or chronically ill older persons experience numerous transitions across various health care settings. Although availability of health services is improving in rural areas, barriers such as distance, geography, and poor distribution often limit access to health care. In a longitudinal rural ethnography, the health care transition experiences of older adults, families, and health care providers were examined. A major ethnographic theme emerged from analysis data from interviews, participant observations, and photographs: the crisis nature of health care transitions experienced by rural older adults and their families and observed by rural nurses and other health care providers. Several patterns were observed including the crisis was compounded by surprise; limited knowledge of local resources exacerbated the crisis; inconsistent discharge planning disrupted transitions; changing family support necessitated admission to nursing homes; continuity of care in nursing home discharge lessened transition crisis; and rural home health care was identified as a strength. Recommendations were made for community-based interventions to improve the transition experience. Comprehensive care management services provided by public health nurses (PHNs) in the local rural community were recommended.     

Mental health nursing practice in rural and remote Canada: Insights from a national survey

Access to and delivery of quality mental health services remains challenging in rural and remote Canada. To improve access, services, and support providers, improved understanding is needed about nurses who identify mental health as an area of practice. The aim of this study is to explore the characteristics and context of practice of registered nurses (RNs), licensed practical nurses (LPNs), and registered psychiatric nurses (RPNs) in rural and remote Canada, who provide care to those experiencing mental health concerns. Data were from a pan-Canadian cross-sectional survey of 3822 regulated nurses in rural and remote areas. Individual and work community characteristics, practice responsibilities, and workplace factors were analysed, along with responses to open-ended questions. Few nurses identified mental health as their sole area of practice, with the majority of those being RPNs employed in mental health or crisis centres, and general or psychiatric hospitals. Nurses who indicated that mental health was only one area of their practice were predominantly employed as generalists, often working in both hospital and primary care settings. Both groups experienced moderate levels of job resources and demands. Over half of the nurses, particularly LPNs, had recently experienced and/or witnessed violence. Persons with mental health concerns in rural and remote Canada often receive care from those for whom mental health nursing is only part of their everyday practice. Practice and education supports tailored for generalist nurses are, therefore, essential, especially to support nurses in smaller communities, those at risk of violence, and those distant from advanced referral centres.     

Home healthcare patient,caregiver and provider perspectives on use of unscheduled acute care and the usability and acceptability of on-demand telehealth solutions

Background/Objectives: Home health care (HHC) agencies provide an important role in helping to transition patients from acute care to independent residential living. Telehealth has the potential to transform care delivery in HHC, however the majority of studies in HHC have focused on the use of telemonitoring for patients with specific chronic conditions. The objective of this study was to examine reasons HHC patients use acute care services and assess the acceptability of on-demand telehealth services among HHC patients, caregivers and personnel to help alleviate the need for seeking in-person acute care.Design/Setting/Participants/Measures: This study was a secondary analysis of qualitative data from in-depth interviews of 30 HHC personnel, patients and caregivers from a Medicare-certified HHC agency affiliated with a large healthcare system from January through May 2020. A conventional content analysis approach was used to identify themes.Results: Themes associated with reasons for seeking acute care included: sense of urgency, behavioral and psychosocial factors, and access to care. Participants described their perceptions of the benefits, usability and acceptability and barriers to using telehealth. Patients and HHC personnel agreed that on-demand telehealth should not replace in-person visits but all identified roles that on-demand telehealth services could play in improving communication and access to care. The biggest barriers to use of telehealth identified by HHC personnel were cost, access and ability to use technology by HHC patients.Conclusion: This study identified reasons HHC patients seek unscheduled acute care and the usability and acceptability of on-demand telehealth services to increase access to care among HHC patients. These findings underscore the need to improve communication and coordination between patients, HHC personnel, and primary care providers and the role that on-demand telehealth services can have in transforming HHC.     

"It's not just a job. This is where we live. This is our backyard": the experiences of expert legal and advocate providers with sexually assaulted women in rural areas

Sexual assault research has focused almost exclusively on urban areas, and research examining the experiences of expert service providers is nearly nonexistent. The purpose of this study was to add to the understanding of providers' experiences in working with sexually assaulted women in rural communities. Secondary victimization theory suggests that the nature of postassault expert interventions may have an adverse impact on victims. The focus of this hermeneutic phenomenological study was to explore the lived experiences of providers regarding their interactions with sexual assault survivors living in rural communities. Data were gathered from prosecutors, law enforcement, crisis center advocates, social workers, and victim-witness associates. Data analysis led to the identification of five significant themes: (a) rural-specific confidentiality issues, (b) resource needs in a rural setting, (c) the connection between victim blaming and low levels of reporting, (d) negative provider views of the community, and (e) smaller communities provided better victim care. Psychiatric nurses and mental health care systems have many opportunities to intervene with abused women in inpatient, outpatient, and other community settings. In primary and acute care setting, nurses should assess patients for a history of violence using multiple screening questions and should also educate victims and their families about available resources.     

Transitioning to Telehealth: Today’s Guidelines for Future Sustainability

The coronavirus disease 2019 pandemic has brought about many changes and catapulted telehealth into the mainstream of health care delivery. Audio and video conference health care visits have become commonplace and have impacted geographic barriers and access to care issues with the potential for care coordination in our fragmented health care delivery system. To make this dramatic shift from face-to-face health care to telehealth care, providers must learn to quickly transition to this new format. A discussion of the structure, process, and outcomes of telehealth addresses provider and consumer concerns and sets up guidelines for incorporating telehealth and patient satisfaction into your practice.     

Bridging the distance: educating nurses for telehealth practice

BACKGROUND: The aim of this research project was to explore the impact of telehealth technology on health assessments performed by nurses delivering health services to isolated populations. METHOD: Nurses performing preoperative and oncology assessments for clients in remote communities via telehealth received training. Education workshops were delivered to nurses (N = 37) in 13 communities across Northwestern Ontario. RESULTS/CONCLUSION: Presurveys and postsurveys indicated that the nurses were receptive to the mode of delivery and the content was relevant to their telehealth practice.     

Five Steps to Integrating Telehealth Into APRN Curricula

The COVID-19 pandemic suddenly changed the scene of primary care visits. As clinics abruptly transitioned to telehealth visits, health care providers and students were required to use digital technologies to deliver health care from a distance. This article highlights 5 steps used by faculty to integrate telehealth concepts into the graduate curriculum for all advanced practice registered nurse programs. As patients and providers recognize its widespread acceptance, telehealth will likely have a permanent place in traditional health care delivery long after the COVID-19 pandemic.     

Online communities of practice to support collaborative mental health practice in rural areas

The provision of quality mental health services in rural areas continues to be an ongoing challenge for nurses and the patients they serve. The use of computer mediated communication to construct collaborative learning environments similar to those suggested in Wenger's community of practice framework has the potential to mitigate a number of the difficulties faced by rural health care providers. The author presents a brief discussion of social learning theories, the communities of practice framework, and related concepts. Examples of current online communities of practice used as a means for knowledge construction in various professional disciplines are presented in building the case for the fit between online communities of practice and the needs of nurses in rural mental health. Nurses providing mental health care in rural areas have documented needs for interdisciplinary teamwork, access to a collaborative learning environment, and ongoing contact with expert resources. The construction of online communities of practice could potentially address a multitude of concerns identified by nurses practicing mental health care in rural areas.     

Transition of Nurse Practitioner Faculty Practice and Student Clinicals to Telehealth: Response to the COVID-19 Pandemic

The COVID-19 pandemic forced the US health care system to evaluate alternative care delivery strategies to reduce the risk of coronavirus transmission to patients and health care providers. Telehealth modalities are a safe and effective alternative to face-to-face visits for primary and psychiatric care. Federal policy makers approved changes to telehealth reimbursement coverage and allowed flexibility of location for patients and providers. This article describes the transition of patient visits to telehealth by nurse practitioner faculty at an academic medical center to maintain continuity of care of underserved patient populations. This pivot facilitated resumption of clinical learning experiences for nurse practitioner students.     

A public health nursing initiative to promote antenatal health

At least one in 10 pregnant women experiences depression. Other health risks during pregnancy include family violence, substance abuse, inadequate nutrition, financial challenges, environmental hazards and lack of social support. Public health nurses are in a unique position to enhance perinatal health by assessing for antenatal psychosocial risk factors. During 2005-06 in a suburban/rural community near Edmonton, Alberta, public health nurses initiated a one-year demonstration project with the goal of increasing the number of health and community services accessed by pregnant women as a result of an interactive appointment with a public health nurse. Eight family physicians in WestView Primary Care Network and three midwives from WestView's Shared Care Maternity Program referred local pregnant clients to the public health nursing unit at WestView Health Centre in Stony Plain. Each woman was assessed by a public health nurse for a variety of psychosocial risk factors. Results of the assessment determined the type of additional health services to which the pregnant women were referred. Care providers were unanimous in their support for public health nurses' continuing to provide antenatal assessments to an expanded population of suburban/rural communities in the Capital Health region.     

E-Clinic: an innovative approach to complex symptom management for allogeneic blood and stem cell transplant patients

The allogeneic blood and stem cell program (ABSCP) at Princess Margaret Hospital, Toronto, performs 75 transplants annually. Many patients live greater than 100 kilometres from the centre and require frequent visits to the hospital for posttransplant care. The weekly travel to clinic, combined with complex symptom issues and the overwhelming desire to be cared for in their home community, is a major burden to patients and care providers. Our team of oncology health professionals, led by the nurse practitioner on service, sought to determine whether telehealth videoconferencing would be a viable option as a care delivery model to meet the complex needs of our remote patients and care partners. We introduced telehealth into the ambulatory clinic as a pilot project in early 2005. Patients were selected based upon symptoms, therapeutic plan and geographical remoteness. Patient progress was monitored with a goal of transitioning patients from posttransplant hospital-based care to partnered self-care in their home communities. The purpose of this article is to illustrate the ABSCP telehealth program development using a patient case study, and to detail the clinical process improvements and overall program successes that have led to the integration of telehealth into everyday clinical practice as a viable service delivery option for patient-centred symptom management and treatment compliance with a geographically remote patient population.