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.     

Developing rural communities' capacity for palliative care: a conceptual model

The population in Canada and other developing countries is aging, increasing the need for palliative care services. In rural communities, care of dying people is normally provided by health care professionals as part of a generalist practice, not by palliative care specialists. Despite a lack of specialists and resources, some rural communities have developed local palliative care programs. The goal of this research was to conceptualize rural communities' process of developing palliative care programs using a theoretical perspective of community capacity development. Data were from nine focus groups of interdisciplinary rural health care providers who provided palliative care in seven provinces/territories of Canada. The outcome is a theoretical model that conceptualizes the process of developing palliative care programs in four sequential phases: antecedent community conditions, a catalyst, creating the team, and growing the program. The activities of each phase are outlined. This research offers practical and theoretical knowledge to guide practitioners and planners seeking to develop palliative care programs in other rural communities.     

Patients and families experiences with video telehealth in rural/remote communities in Northern Canada

Aim. To explore patients’ and families’ experiences with video telehealth consultations as a method of health care delivery in rural/ remote communities in Northern Canada. Background. Accessing health services in isolated populations where human resources and infrastructure are constrained by vast geographical landmasses poses challenges and opportunities for nurses, health care providers, patients and families. Design. A qualitative approach was adopted with a purposeful sample of 10 patients and four family members representative of nine communities. Method. Selection criteria included patients receiving telehealth visits for a minimum of a year and willing to share their experiences. Data were collected during the winter of 2006 using semi‐structured video taped interviews and analysed using a qualitative thematic content analysis. Results. Patients and families experiences of their telehealth visits centered on three key themes: lessening the burden (costs of travel, accommodations, lost wages, lost time and physical limitations), maximising supports (access to family, friends, familiar home environment, nurses and other care providers), tailoring specific e‐health systems to enhance patient and family needs. Conclusion. The benefits of telehealth extend not only to patients and families but are linked to benefits for providers as well as the health care system. Relevance to clinical practice. This study indicates that video telehealth is an effective mechanism for delivering nursing and other health services to rural/remote communities and can impact positively on the quality of health care. The integration of telehealth practice can enhance the coordination, organisation and implementation of health care services.     

Telesonography: Foundations and Future Directions

The practice of telesonography has yielded promising results in several domestic and international projects aimed at providing basic sonography services. Common themes that recur within telesonography‐based research include the quality of transmitted images, clinical applications, and technical and nontechnical barriers to implementation. The research base continues to grow in concert with expanding telecommunications capabilities and refinement of small portable sonographic devices. Persistent barriers to the deployment of telesonography systems include a lack of telecommunications access, a lack of standard training and operational protocols, and a paucity of research regarding the long‐term health impact of telesonography within target communities. Telesonography may be used directly to improve the standard of care within a given community; however, limited resources and interest may prevent sustained operations. Future projects may use telesonography to supplement the training of health care providers in remote locations in an effort to establish permanent sonography services for their respective communities.     

Meanings of community in a community health center

As health care organizations make communities the targets for their interventions, connections between "community" as theory for practice and community as setting for practice require examination. This study s purpose was to explore meanings given to community in a newly formed community health center, with particular emphasis on the relationship among women, community, and health. Using interpretive and emancipatory methodologies, interviews were conducted with clinic administrators and staff, and women who used the clinic. Data analysis revealed discrepancies in meanings of community. Clinic personnel referred to community as the target for their services, while clinic users spoke about community as the process that made feeling connected with others possible. Health center staff and administrators described the community they were serving as having limited economic, educational, physical, and psychological resources and saw little which could be labeled a community strength. Health center users however, spoke primarily of their abilities to support each other. These contradictory understandings of the meaning of community rendered different expectations regarding health care services. Meanings given to community may de-personalize, homogenize, and objectify, and ultimately distance nursing from those intended to be served.     

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.     

Remote nursing certified practice: viewing nursing and nurse practitioner practice through a social justice lens

Remote Nursing Certified Practice (RNCP) was introduced in 2010 to regulate nursing practice in remote, largely First Nations communities in British Columbia, Canada. These are communities that often experience profound health and health-care inequities. Typically nurses are the main health-care providers. Using a critical social justice lens, the authors explore the clinical and ethical implications of RNCP in terms of access to equitable, high-quality primary health care.They examine the fit between the level and scope of health services provided by registered nurses working under RNCP and the health needs of remote First Nations communities. In doing so, they draw comparisons between nurse practitioners (NPs) and outpost nurses working in NP roles who historically were employed to provide health care in these communities.The authors conclude by calling for nursing regulations that support equitable, high-quality primary care for all British Columbians.     

Models of community/home-based care for people living with HIV/AIDS in Southern Africa.

The HIV/AIDS epidemic has placed a large burden on public health facilities in developing countries that are already functioning with limited resources. This has shifted the burden of care to families and communities, because public health services are often stretched beyond their capacities. A number of community/home-based care models and services have evolved in response to this need. This report reviews the most common community- and home-based care models in use as well as the experiences of selected African countries in their use of community/home-based care.     

The Effectiveness of the Around‐ the‐Clock In‐Home Care System: Did It Prevent the Institutionalization of Frail Elderly?

This study compares two communities in Japan from the perspective of community health care resources and their use by the elderly during 1992-98. In one community, programs of home care services for the elderly were reorganized to provide around-the-clock in-home nursing and home help services seven days a week (ACC). Official records were the major sources of data. Evidence from the analysis indicated that ACC might contribute to less use of institutionalization as an alternative to home care, even though, in some instances, institutionalization is the only appropriate alternative.     

Public health nursing: Challenges and innovations for health literacy in rural area

Health literacy is a critical component of public health nursing, particularly in rural areas where access to health services is severely limited. As it relates to quality of care, cost of care, safety of care, and appropriate decision-making in general public health, health literacy can also be seen as an important public policy issue. Several challenges that can be found in rural communities in terms of access to health literacy, such as limited access to healthcare services, limited resources, low literacy rate, cultural and language barriers, financial constraints, and digital divide. Based on these challenges, several innovations can be pursued such as community-based health education, health literacy training among healthcare professionals, digital health technology, partnerships with community-based organizations, health literacy radio programs, and community health ambassadors. This reflection highlights the challenges and innovations that nurses can do to overcome the problem of low-health literacy in rural communities. In the future, the development of community empowerment and technology will be needed to refine the progress made so that a gradual increase in health literacy in rural communities can be seen.     

上海市老年人家庭护理服务需求及支付意愿的质性研究

目的探讨上海市居家老年人家庭护理服务需求及支付意愿。方法采用质性研究中的现象学研究法,对10名居家老年人进行半结构式访谈,并运用Claizzi分析程序进行资料分析。结果居家老年人主要希望得到基础护理、康复护理、健康教育、家庭病床等专业化家庭护理服务和家政转介服务、精神慰藉等非专业化家庭护理服务,并存在一定支付意愿,但总体意愿支付值偏低,其中希望以项目形式进行收费者居多。结论老年人对家庭护理服务存在一定的需求及支付意愿,应大力拓展家庭护理服务,适当收费,促进卫生资源的合理分配及家庭护理的可持续发展。     

Development of a rural palliative care program in the Calgary Zone of Alberta Health Services

Specialized rural models of palliative care are greatly needed to address the challenges rural communities face in providing palliative care services and to ensure that their unique strengths and needs are considered. In late 2005, a Rural Palliative Care Program was developed to support primary care providers in delivering palliative care to patients in rural communities outside of Calgary, Alberta, Canada. The program was grounded in the needs of individual communities, incorporated integral roles for local champions, and adopted pre-existing, accepted rural structures and processes. Needs and gaps in rural palliative care service delivery were identified and prioritized. The following actions were taken to address the top six priorities: 1) more accessible palliative care education opportunities with a rural focus were provided to health care professionals; 2) linkages with rural and urban resources were strengthened and access to specialists and procedures was improved; 3) strategies were implemented to improve psychosocial support for patients and families; 4) resources were developed to facilitate rural home deaths; 5) opportunities were expanded for education and utilization of volunteers; and 6) a mobile specialist consultation team was developed to support rural health care professionals and their patients in their rural communities. In its first four years, the team consulted on 640 patients, nearly three-quarters of whom died in their rural communities. Rather than imposing an urban outreach strategy, the development of a rural-based program through respectful engagement of local providers has proven to be crucial to the success of this rural palliative care program.     

南丁格尔志愿者对社区老年人服务的效果与体会

目的为社区老年人提供生理和心理援助,帮助社区老年人建立健康快乐的生活方式。方法通过组建南丁格尔志愿者队伍,开展健康知识讲座、健康保健服务、组织健康教育活动为社区老年人进行服务,采用一般资料自制问卷与生活满意度量表对老年人进行调查。结果 1年后,社区老年人对其生活的满意度和服药依从性较以往有所提高,慢性疾病发生率较以往降低。结论志愿者参与社区老年人服务活动,有助于提高老年人对生活的满意度和服药依从性。     

Community health nursing in an urban day care center.

This paper has endeavored to depict some of the student achievements during community health nursing practice in a less traditional clinical setting, a day care center for infants and toddlers. There appear to have been a number of advantages to such a clinical placement. For one thing, students had the opportunity to devise a package of preventive/maintenance health services for a specific group of healthy children. This they were able to implement in collaboration with the day care center staff and the children's families. In the course of delivering the health services, they learned firsthand the strategies inherent in planning and negotiating among one another. In recognition of the integrity of child health as a component of family health care, they accounted regularly to the parents in both individualized and group fashion. Through the experiences over the course of the quarter, there seemed to be a heightened awareness of the potential for innovative nursing practice in urban communities.     

A new world view of genetics service models

Identification of the components of the Human Genome and their relevance to health and disease is revolutionizing the provision of genetic services and all areas of health care. New genetic tools to diagnose, manage, and treat common diseases, along with Web-based innovations are changing the shape of how genetic services will be accessed and delivered. These advances represent a "bionic convergence" that will fundamentally transform medicine during the next few decades. The convergence of biotechnology and electronics is creating an expanding array of health care opportunities for clients and offers innovative opportunities for health promotion, restoration and management. Families and communities will soon be able to participate more fully in the direction and design of their own genetic health. Nurses with their long history of providing holistic, family-centered care in all practice settings, can help to create new dimensions to their practice to support their clients as they meet these health care innovations. This article explores a New World view of genetics services, and describes futuristic models for their provision. Nursing participation in and preparation for future genetics services also is described.     

School-based rural case management: a model to prevent and reduce risk

PURPOSE: To describe the development of the School-Based Rural Case Management: A Model to Prevent and Reduce Risk in a primary health care academic nursing center practice in West Virginia. DATA SOURCES: Selected nursing and anthropological literature, regional health planning documents, and case examples. CONCLUSIONS: The model guides identification of health risks and the provision of health service, health education, and support to students, families, and communities. IMPLICATIONS FOR PRACTICE: As primary health care services are developed within rural schools, a school-based case management system assists matching appropriate services to the client, as well as supports program success.     

Cultural aspects of working with students enrolled in a school-based health center

School-based health centers provide accessible quality health services to culturally diverse student populations. Numerous challenges exist in providing culturally competent services in a school setting. This article presents models of culturally competent care, practice recommendations, and practical resources in an attempt to improve the provision of culturally competent services. In addition, one school health center's initiative to outreach culturally diverse students into health careers is highlighted.     

A pilot interprofessional program to promote oral health and wellness in Appalachian children

In a first of its kind authentic clinical interprofessional education (IPE) experience, University of Kentucky (UK) health profession students joined dental students to implement a pilot program to promote oral health and wellness with children living in underserved Appalachian communities. Known as hCATS (Health Colleges Advancing Team Skills) to Appalachia, a total of 113 students participated in interprofessional teams of 48 health profession students paired with 65 dentistry students to provide health services. Although the UK College of Dentistry has provided sealant services (tooth decay prevention) to elementary school children for several decades in eastern Kentucky counties, funding through the UK Women and Philanthropy Network allowed services to expand to include general health screening and age-appropriate education on oral health, nutrition, exercise, and prevention of substance abuse. The UK Center for Interprofessional Health Education (CIHE) coordinated the efforts for students from the colleges of Communication and Information Sciences, Health Sciences, Nursing, Pharmacy, Public Health, and Social Work. In addition to the clinical experience in the elementary schools, nursing and other health profession students explored the health resources of the communities visited and reflected on their experience in collaborative practice that the program was designed to encourage. The authors noted positive outcomes with interprofessional education competencies, although more structure for collaboration is required to ensure students who work with other professions in an authentic clinical setting can gain early relevant practice in, and experience the benefits of, collaborative patient care.