Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom

This paper argues that the interfaces between formal and informal care-giving are changing as a result of two current trends; the increased scope of home-based nursing care and the emphasis on participation both within nursing and in the wider health and social care arenas. These various changes are explored in relation to the provision of intensive and complex nursing care in the home. It will be argued that the changing interfaces between formal and informal care have important implications for the respective roles of nurses and informal carers which hitherto have been relatively overlooked. These implications urgently need addressing in research, policy and public debate if professional nurses are to provide appropriate help and support to informal carers.     

发挥护理专业优势强化"四个贴近"夯实新世纪城市卫生服务基础

介绍了大庆市卫生局发挥护理专业优势 ,把护理工作延伸到社区 ;发挥护士素质特长 ,把健康理念落实到社区 ;发挥护士特有的潜能 ,全心全意服务于社区。通过社区护理工作 ,使卫生服务更加贴近社区、贴近家庭、贴近百姓、贴近生活。保证全市人民“生能顺利、病能医治、老能康乐、死能安息。”的具体做法和成效。     

Examining the language–place–healthcare intersection in the context of Canadian homecare nursing

Currently, much of the western world is experiencing a shift in the places where care is provided, namely from institutional settings like hospitals to diverse community settings such as the home. However, little is known about how language and the physical and social aspects of place interact to influence how health‐care is delivered and experienced in the home environment. Drawing on ethnographic participant observations of homecare nursing visits and semi‐structured interviews with Canadian family caregivers, care recipients and nurses, the intersection of language, place and health‐care was explored in this secondary analysis. Our findings reveal four themes: homecare nurses view themselves as ‘guests’; home environments facilitate the development of nurse–client relationships; nurses adapt healthcare language to each home environment; and storytelling and illness narratives largely prevail during medical interactions in the home. These findings demonstrate the spatiality of language and how the home environment informs decisions regarding language use. Furthermore, these findings exemplify how language and place mutually influence the experiences and delivery of home health‐care. We conclude by discussing the importance of considering the language–place–healthcare intersection in order to gain a better understanding of medical exchanges in places and the associated implications for optimizing best nursing practice.     

Community Development Specialists in Nursing for Developing Countries

Nurses in traditional roles cannot always meet the challenge of providing health care in developing communities even though community health care is similar to that of care in developed countries (Mahler, 1984). Kupina (1995) identified components of community health including "physical aspects, safety, social norms, interpersonal processes, economic factors, and cohesion of the community" (p. 188). However, developed communities emphasize individual access to health care especially for vulnerable groups (Keane & Richmond, 1993). In developing countries, such as Pakistan, people are struggling to meet basic safety and security needs amid poor sanitary conditions, malnutrition, overcrowding, and scarce primary health care (Wagner & Menke, 1992). Massive migration of populations from rural to urban areas, overwhelming poverty and crime that threatens the very existence of some neighborhoods, high incidence of tuberculosis, drug dependency, AIDS, homelessness, and high infant and maternal mortality rates are major problems (Mason et al., 1992). In cities such as Karachi, Pakistan, rural to urban migration has resulted in the establishment of numerous squatter settlements called "katchi abadis" that lack sanitation, safe drinking water, and public health services. Even if such services were provided, high illiteracy rates and a strong sense of powerlessness, especially among women, adds further challenges for health providers.     

Identification of nurses' competencies in primary health care through a Delphi study in southern Brazil

ABSTRACT Objective: This investigation aimed to identify and analyze the general and specific competencies of nurses in the primary health care practice of Brazil.
Design: The Delphi Technique was used as the method of study.
Sample: 2 groups of participants were selected: One contained primary health care nurses ( n =52) and the other specialists ( n =57), including public health nurses and public or community health faculty.
Measurements: 3 questionnaires were developed for the study. The first asked participants to indicate general and specific competencies, which were compiled into a list for each group. A Likert scale of 1–5 was added to these 2 lists in the second and third questionnaires. A consensus criterion of 75% for score 4 or 5 was adopted.
Results: In the nurses' group, 17 general and 8 specific competencies reached the consensus criterion; 19 general and 9 specific competencies reached the criterion in the specialists' group. These competencies were classified into 10 domains: professional values, communication, teamwork, management, community-oriented, health promotion, problem solving, health care, and education and basic public health sciences.
Conclusions: These competencies reflect Brazilian health policy and constitute a reference for health professional practice and education.     

社区保健病人健康教育效果评价

目的提高社区保健效果。方法采取集中或个体健康教育形式进行社区护理。结果不同文化程度社区病人健康教育前后焦虑情绪经行乘列卡方检验,有显著性差异,P<0.01;说明社区保健病人经健康教育后大学文化程度者焦虑情绪改善较好。饮食不良行为分别经字2检验,有显著性差异,P<0.01,说明健康教育后社区保健病人饮食不良行为明显改善。自我保健能力分别经字2检验,有显著性差异,P<0.01,健康教育后社区保健病人自我保健能力明显提高。结论对社区保健病人做好健康教育,能减轻病人的焦虑情绪,改善病人饮食不良行为,提高病人自我保健能力。     

高血压病病人社区护理模式探讨

[目的]探讨社区高血压病防治护理工作模式,提高居民高血压的知晓率、治疗率及控制率。[方法]通过高血压俱乐部进行健康教育。[结果]高血压俱乐部的健康教育效果好,高血压病病人服药依从性提高。[结论]高血压俱乐部的社区护理工作模式能够在积极治疗高血压病病人的同时大力开展一级预防,因地制宜地进行宣教,提高居民的自我保健能力,使病人的医疗费用降低。     

Effectiveness of Community Health Worker/Nursing Student Teams as a Strategy for Public Health Nursing Education

ABSTRACT A unique program that partners community health workers with nursing students was developed in response to community‐based participatory research data and integrated into a public health practicum at a baccalaureate nursing program in West Michigan. The goal of the program is to promote the health of 3 underserved urban neighborhoods while educating nursing students in population health and public health nursing. The purpose of this paper is to describe program conception and implementation and discuss evaluation of educational outcomes as a public health learning experience.     

Mental health nursing policy — an exploratory qualitative study of managers'' opinions

Mental health nursing policy — an exploratory qualitative study of managers’ opinions During the 1990s, much of the legislation and policy that pertains to mental health services has sought to direct them towards a virtually exclusive concern with the seriously mentally ill, typified by the following recommendation from a recent Department of Health review of mental health nursing that stated: ‘The essential focus for the work of mental health nurses lies in working with people with serious or enduring mental illness’. On the other hand, pressure from the primary health care sector suggests the need for services to be provided for the less seriously mentally ill, particularly through the auspices of general practice fundholders. Following a review of the literature, a small-scale, exploratory study was initiated to seek answers to the following research question: How is the policy focus urging reorientation to the severely mentally ill viewed by nurse managers who have a responsibility through Mental Health Resource Centres and Community Mental Health Teams, to provide mental health services? The study was based within a Welsh National Health Service (NHS) Trust that employed six nurse managers of Community Mental Health Teams (CMHTs). Four of the managers additionally had responsibility for Community Mental Health Resource Centres (CMHRCs). Of the population of six managers, four composed the sample for the investigation. A qualitative research approach was employed, utilizing semistructured interviews as the data collection tool. Analysis of the data revealed that managers were finding creative solutions in order to meet the conflicting demands placed upon them. The research findings also indicated that many of the obstacles to providing a needs-led service were structural in origin, and could be resolved by central strategic intervention.     

Moving upstream: Becoming a public health nurse, part 2

This article extends the argument in Part 1 that stand- ards, protocols, textbook knowledge, and other external guidelines, while important for beginners, must yield to the "real world" of practice. Additional narratives document how the development of practical reasoning, perceptual skills, and responsiveness to clients supplants the beginner's reliance on external guidelines and promotes a situated understanding of practice. This growth in understanding and clinical know-how, cultivated by frontline experience with individuals and families, fosters a perceptual grasp of the "big picture" and makes it possible for the nurse to learn the community through the eyes of clients. Experiences from home visiting and community-based activities provide critical lessons that inform and inspire nurses to act and think upstream. This interpretation provides additional evidence for legitimizing clinical practice as a rich source of situated knowledge and clinical reasoning.     

Community Outreach and Engagement Strategies from the Wisconsin Study Center of the National Children's Study

The purpose of this methods article was to describe and evaluate outreach and engagement strategies designed to initially build county‐wide awareness and support for the National Children's Study (NCS or the study) and subsequently to target the segment communities where recruitment for the study occurred. Selected principles from community outreach, social marketing, and health care system and personal referral formed the foundation for the strategies. The strategies included a celebration event, community advisory board, community needs assessment, building relationships with health care providers and systems, eliciting a network of study supporters, newsletters, appearances at local young family‐oriented events (health fairs, parades), presentations to local community leaders, community forums, “branding” with assistance from a women‐owned local marketing firm, and mailings including an oversized, second‐touch postcard. Six months after study launch, approximately 4,600 study‐eligible women were asked in a door‐to‐door survey if and how they became aware of the study. On average, 40% of eligible women reported being aware of the study. The most frequently cited strategy to cultivate their awareness was study‐specific mailings. Awareness of the NCS increased by 7.5% among those receiving a second‐touch postcard relative to controls (95% CIs [4.9, 10.7] z = 5.347, p < 0.0000, d = 0.16). Community outreach and engagement strategies, in particular the oversized postcard as a second‐touch effort, may be used effectively by researchers for participant recruitment and by public health nurses for delivery of important population‐focused messages.     

社区护理培训内容需求及其影响因素分析

[目的]了解社区护士对社区护理培训内容需求情况,为有针对性地开展社区护士岗位培训提供依据.[方法]调查重庆市主城区48家社区卫生服务中心的349名护士社区护理培训需求内容.[结果]培训内容需求程度排序依次为:疾病预防保健及康复、社区护理管理、疾病护理、伦理与法律知识、护理科研知识;Spearman秩相关检验显示:社区护士的工龄与疾病预防保健及康复、社区护理管理、伦理与法律知识需求程度呈正相关,而与护理科研知识需求呈负相关;社区护士的职称与疾病预防保健及康复知识需求程度呈正相关,与护理科研知识需求呈负相关.[结论]疾病预防保健与康复、社区护理管理知识是社区护士培训的重点;社区护士的工龄和职称是影响培训内容制定的主要因素;强化护理科研意识刻不容缓.     

Using an Academic‐Community Partnership Model and Blended Learning to Advance Community Health Nursing Pedagogy

This article describes a model of teaching community health nursing that evolved from a long‐term partnership with a community with limited existing health programs. The partnership supported RN–BSN students' integration in the community and resulted in reciprocal gains for faculty, students and community members. Community clients accessed public health services as a result of the partnership. A blended learning approach that combines face‐to‐face interactions, service learning and online activities was utilized to enhance students' learning. Following classroom sessions, students actively participated in community‐based educational process through comprehensive health needs assessments, planning and implementation of disease prevention and health promotion activities for community clients. Such active involvement in an underserved community deepened students' awareness of the fundamentals of community health practice. Students were challenged to view public health from a broader perspective while analyzing the impacts of social determinants of health on underserved populations. Through asynchronous online interactions, students synthesized classroom and community activities through critical thinking. This paper describes a model for teaching community health nursing that informs students' learning through blended learning, and meets the demands for community health nursing services delivery.     

Validation of the Chinese version Scale of Needs (SON) for caregivers of mentally ill patients

The purpose of this study was to develop the Chinese version Scale of Needs (SON) for Caregivers of Mentally Ill Patients. There were 23 items designed for the initial scale, and 250 Taiwanese caregivers of mentally ill patients were recruited in the study. Exploratory factor analysis and principle component analysis were conducted. The 23 items of the SON for Caregivers of Mentally Ill Patients were classified into four factors and accounted for 66.12% of the variance. Factor I was assigned as Information need, Factor II was named Supportive need, Factor III was named Break need and Factor IV was called Emotional Releasing Service.     

关于强化老年护理工作的思考

随着老龄社会的提前到来 ,加强我国老年护理工作成为一个重要课题。今后一个时期 ,要以科学发展观为指导 ,在老年护理工作中实现三个战略转变 ;在工作的重点上 ,医疗护理扩内涵 ,社区护理抓并轨 ,心理护理搞细化 ,临终护理要起步 ;在措施上重点抓好“四个一” ,突出一项改革 ,加快一支队伍建设 ,完善一个体系 ,建立一个机制 ,把老年护理工作提高到一个新水平。