Factors associated with dementia care practices among community health nurses: Results of a postal survey

Background

The incremental prevalence of dementia is making dementia management a worldwide issue. The role of community health nurses must grow along with the increasing aging population and the resulting increase in dementia cases.

Objectives

Explore the factors related to dementia care practices among the different types of community health nurses in Taiwan.

Design

Cross-sectional study.

Setting

Primary care centers or institutions in New Taipei City.

Participants

Community health nurses who work in health care centers (district nurses), long-term care centers (care managers), or home care institutions (home health care nurses).

Methods

Self-completion questionnaires sent by mail.

Results

A total of 195 participants returned the questionnaires (response rate 81.9%). Although 65.8% of participants had experience in case finding, just 34.6% of them reported using validated cognitive testing tools. Only 15% of participants provided case management following dementia case findings. The regression models showed that the different types of community health nurses, number of years working as a nurse, and their level of confidence was significantly related to their dementia care practice. District nurses identified significantly less suspected dementia cases and provided less nursing care to caregivers of dementia patients than care managers and home health care nurses. Among community health nurses, the care managers most often used formal cognitive instruments. District nurses provided the least amount of supportive resources information, had the most negative attitude and the lowest level of confidence toward dementia care than care managers and home health care nurses.

Conclusions

This study presented the profiles of dementia care practice in Taiwan. It showed the considerable variation in knowledge, attitude, confidence and dementia care practices among the different community health nurses. The professional roles regarding dementia care in Taiwan remain blurred. Future training must focus on promoting the level of confidence of community health nurses to identify and manage people with dementia and raise awareness about demented person's and their caregiver's need. The priority of the policy on dementia care in the community must be raised to high, and the professional responsibilities and roles of the different types of community health nurses for the ever increasing dementia population in Taiwan must be redefined and optimized.     

Management of terminal cancer patients: attitudes and training needs of primary health care doctors and nurses

 The objective of the study was to ascertain the attitudes and training needs of primary health care (PHC) professionals regarding the management of terminal cancer patients. A cross-sectional study involving 30 PHC teams (15 urban and 15 rural) in the health district of Majorca (Spain) was carried out. Out of the 224 doctors and 186 nurses initially included, 157 and 156, respectively, completed a questionnaire designed to elicit the participant's opinions on the role of PHC in palliative care, their needs in terms of training and their management of clinical and psychological symptoms. Forty percent of professionals considered that terminal care should be the responsibility of PHC, whereas 59.5% thought it preferable for such care to be given either in Palliative Care Units or by oncologists. All kinds of relationships between PHC professionals and specialists were highly valued. Seventy-five percent of general practitioners referred to pain control, and 83% of doctors and nurses provided emotional support. Most health professionals felt training in emotional aspects would be the most desirable. One group of professionals considered palliative care to be an asset in PHC, whereas another group thought that patient care should be provided by specialists. The majority of doctors and nurses pinpointed the need for improving co-ordination with specialists. A need for tuition in palliative care was clearly stated. In conclusion, the planning of palliative care should take into account the attitudes and opinions of PHC doctors and nurses. Published online: 21 June 2000     

An integrative review of primary health care nurses’ mental health knowledge gaps and learning needs

BackgroundThe global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues.AimTo critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care.Design and methodsAn integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis.Data sourcesCINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC.FindingsOf the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers.DiscussionDespite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care.ConclusionFindings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.     

Linking primary health care and self-care through case management.

Primary health care (PHC) strategies have heightened health care providers' awareness of the need to understand their communities and provided knowledge on how to mobilize communities for health. Orem, a nurse theorist, has developed a similar philosophical position on mobilizing individuals for self-care, which complements PHC theory at the community level. This article links the philosophies and strategies of PHC with self-are and proposes a delivery model of case management, drawing on examples from the HIV/AIDS pandemic and the aging population to illustrate the type of coordinating activities required of case managers in the 21st century.     

Exploring the contribution of district nurses to public health

To date the public health role of district nursing has been less well defined than in other branches of community nursing. A qualitative study examining the public health role of district nurses was undertaken in a West Yorkshire primary care trust. The study explored the range of public health activities currently undertaken by district nurses, the agendas perceived as most conducive to input and the organizational barriers that prevented greater involvement in public health from district nurses. Focus group and individual semi-structured interviews were undertaken with 21 members of the district nursing team and analysed using thematic content analysis. The findings suggest that district nurses were already undertaking a range of public health and health education activities but much of the work was opportunistic. District nurses perceived themselves as well placed to undertake locally based health action because of their profile in the local communities together with local intelligence. However, ineffective referral criteria were considered to be the most prohibitive barrier against making a greater contribution to health improvement.     

社区护士健康教育认知状况调查分析

目的：了解社区护士对健康教育的认知状况及开展健康教育现状,找出目前社区护士开展健康教育工作存在的困难和薄弱环节。方法：使用问卷方式对北京市海淀区8所社区卫生服务中心100名社区护士进行调查。结果：被调查的100名护士中,95%认为健康教育是社区护理工作的一部分,开展健康教育是非常重要的。社区健康教育基本理论知识总分平均分为6～14（9.75±1.755）分。护士在健康教育过程中遇到的主要困难,依次为资金设备缺乏,知识和技能缺乏,场所缺乏,护理人员不足等。结论：社区护士的观念已经发生改变,但对开展健康教育仍然存在不同层次的认识误区,社区护士在健康教育中没有发挥应有的作用,应引起社区护理管理者的重视。     

A qualitative exploration of the experiences of school nurses during COVID-19 pandemic as the frontline primary health care professionals

BackgroundIt is widely acknowledged that the experiences of frontline primary health care professionals during COVID-19 are important to understand how they respond and act under situations of pandemic as the gatekeepers in primary health care system. School nurses are primary health care professionals who lead health care in schools and practice in a holistic manner to address the needs of schoolchildren and school personnel. There are rising mental health concerns of frontline health care professionals with anxiety and panic disorders, somatic symptoms, and feeling isolated. No studies use a qualitative study approach to document community frontline school nursing professionals’ experiences and challenges during the COVID-19 pandemic. Hence, understanding the school nurses’ experiences and challenges to fight against COVID-19 in the communities is important.PurposeThis study aims to explore the experiences of school nurses during the COVID-19 pandemic in Hong Kong.MethodsA qualitative study design adopted the principles of thematic analysis. Nineteen school nurses were recruited to participate in individual semistructured interviews and shared their roles and responsibilities during the COVID-19 pandemic.FindingsThree themes indicated the school nurses’ expand professional responsibilities to fight against COVID-19 emerged from the data analysis. These were “Managing Stress,” “Navigating the School Through the Pandemic,” and “Raising the Profile of the School Nurse Professional,”DiscussionFindings reveal the important role of school nursing professionals in minimizing the community-wide risk posed by pandemics and the need to integrate them into planning and implementation of school health policies and guidelines in the primary health care system. This essential role in schools is necessary to assess, implement, monitor, prevent, and reduce the spread of virus in school communities and to minimize the burden to and extra health care resources utilized in the acute care setting during COVID-19 pandemic.     

Family practice/Primary health care nurses in Nova Scotia

The authors describe a study that was designed to explore the current role of family practice/primary health care (FP/PHC) nurses in Nova Scotia. A survey was created and mailed to FP/PHC nurses. Forty-one returned surveys met the criteria of the study. Twenty-two of these nurses were contacted for a followup telephone interview. The findings confirm that FP/PHC nurses working in N.S. are key members of the collaborative health-care team and, although they are often underutilized, they perform key functions such as triage, health education and immunization. Most FP/PHC nurses are underpaid and often work with little or no job security. FP/PHC nurses indicated that they are isolated in their practice and could benefit from networking and educational opportunities with their peers. They are frustrated that they cannot bill the provincial medical insurance plan for basic nursing services. The study results indicate a need to better define scope of practice and highlight the need for leadership and support for the role of FP/PHC nurses in N.S.     

Alcohol-related activities in primary health care

ABSTRACT

Background: Brief alcohol intervention (BI) is recommended for use in health care. However, too little is known about its use in everyday work.

Objective: The aim of this study was to examine the activity of asking patients about alcohol use, offering them BI, and documenting these issues in physicians’ and nurses’ consultations as a part of everyday primary health care (PHC) work.

Methods: All PHC workers (n = 104) of seven health care centers were asked to report information on 30 consecutive adult patients. Altogether, 78 PHC workers (75.0%) participated in this study and reported information on 2,047 patients.

Results: A total of 1,112 (56.4%) patients had been asked about alcohol use at some point. According to the PHC workers, 115 (10.4%) of the patients who had been asked about alcohol use were risky drinkers. BI was offered to 103 (89.6%) risky drinkers. Alcohol-related documentation was found in 452 (42.0%) of the records of patients who had been asked about alcohol use.

Discussion: The BI activity of PHC professionals is high if the patient is considered a risky drinker. However, the overall incidence of inquiry could be increased and alcohol-related documentation still remains low.     

Strategies for encouraging patient/family member partnerships with the health care team

The 5th International Conference of the Institute for Patient- and Family-Centered Care (IPFCC), held in Washington, DC, from June 4-6, 2012, offered an opportunity for almost 1,000 conference participants to share and learn about exciting new patient- and family-centered initiatives occurring across the U.S. and in many other countries. One focus addressed by keynote and plenary speakers, as well as numerous conference sessions and poster presentations, was how nurses and other health care professionals can encourage patients and family members to become partners with their health care teams. Various presenters shared strategies ranging from initial approaches to acknowledging family members as part of the team and offering simple, non-threatening roles in care provision, to policies and approaches inviting increased participation in health care encounters, to higher level involvement in the care planning process, and to partnership roles extending beyond care of the individual child and family. A wealth of ideas can be implemented at various levels by individual nurses, units, and health care institutions.     

某市社区卫生服务中心护士人文关怀能力现状及影响因素分析

目的了解某市社区卫生服务中心护士人文关怀能力现状,并探讨其影响因素,提高社区卫生服务中心护士人文关怀能力。方法采用调查问卷(一般资料和护士人文关怀能力调查问卷)对某市13所社区卫生服务中心护士进行调查,了解其人文关怀现状及其影响因素。结果调查区域社区卫生服务中心护士人文关怀能力总分为(116.65±33.29)分,总体得分率为64.8%;不同性别、是否了解人文关怀的护士人文关怀能力得分差异有统计学意义(P<0.05)。结论社区卫生服务中心护士人文关怀能力处于中等水平,有待于进一步提高;性别和了解人文关怀是影响社区卫生服务中心护士人文关怀能力的因素;应加强对社区卫生服务中心护士人文关怀的培训,提高其人文关怀能力。     

Empowering community health: an educational approach

Collaborative efforts among community members, health care professionals, and faith-based institutions can prove valuable in efforts to improve community health. This study used data obtained from before and after health risk assessment surveys to assess participant's knowledge of risk factors leading to chronic diseases among African Americans in an underserved community of Alabama. Data obtained from activity logs and health screening sessions was used to assess effect of knowledge gained on lifestyle practices. The study findings support the need for ongoing population-specific education program development in religious institutions located inside underserved communities.     

A national survey of practice nurse involvement in mental health interventions

BACKGROUND: The move in the United Kingdom (UK) from institutional to community care has led to an inevitable increase in the involvement of practice nurses (PNs) in mental health care. Around 20 000 PNs are currently working in the United Kingdom (UK). However, the extent and nature of PN involvement in delivering mental health interventions has not been adequately explored. AIM: This study aimed to quantify practice nurses' involvement in delivering mental health interventions in primary care settings. METHOD: A questionnaire was sent to a random sample of 1500 practice nurses registered with the Practice Nurse Forum at the Royal College of Nursing. Sixty per cent of questionnaires were returned; however, once non-eligible respondents were removed an adjusted response rate of 54% was achieved. RESULTS: Practice nurses play a significant role in the assessment and treatment of mental health problems, most frequently via the administration of depot antipsychotics and the screening for depression. However, antipsychotic side-effects were infrequently monitored and PNs' understanding of treatment issues in depression is poor. These findings may be associated with the reported lack of mental health training that PNs have received. CONCLUSIONS: The findings of this study have important implications for the training of practice nurses in mental health, specifically in the areas of medication management and the detection of mental disorders.     

The quality of assessment visits in community nursing

The aim of this study was the measurement of the quality of assessment visits of community nurses in The Netherlands. Process criteria were derived for the quality of the assessment visits from the quality standards of community nursing care established by Appelman et al. Over a period of 8 weeks, a representative sample of 108 community nurses and 49 community nursing auxiliaries at 47 different locations paid a total number of 433 assessment visits. The nursing activities were recorded for each visit. The results suggested that most assessment visits (88%) were paid by community nurses. During the assessment visits, community nurses more often paid attention to questions and expectations of the patient than nursing auxiliaries did. Furthermore, the quality of taking case histories in the actual practice of assessment appeared to be high in general. However, nearly half of the nurses did not enquire whether the patient received care from other health care professionals. The drafting of the care plan was, on average, of a lesser quality. In particular, the re-assessment of patients was not systematically planned.     

Creating a new dynamic in Aboriginal health

In early 2004, an evidence-based prenatal care workshop was held for community health nurses working in First Nations communities in British Columbia. The purpose of the workshop was to begin a dialogue on the use of evidence to improve prenatal care in First Nations communities. Specifically, selected models of knowledge transfer to improve care were introduced and discussed. Of the 81 nurses who participated, 52 completed a feedback questionnaire. Most of the participants (73%) were community health nurses. They worked across diverse geographic settings and health-care administration models (federally managed, band managed, tribal council managed). Seventy-three per cent of the nurses reported that a participatory model of knowledge transfer was important or very important. They also identified priority target audiences (stakeholders) for knowledge transfer strategies. Exploring stakeholders' views, values and priorities related to prenatal care and creating informal dialogue among these groups was identified as a next step in participatory transfer and exchange of knowledge to improve prenatal care in First Nations communities.