Parish nursing: holistic nursing care in faith communities

Modern-day parish nursing is a specialized practice in professional nursing that addresses the spiritual, physical, and emotional health needs of clients within a faith community. Parish nursing care has been described as holistic care; however, few studies have focused on the holistic nature of parish nursing care. A qualitative study was conducted with the clients of parish nurses. Seventeen clients utilizing the services of 3 parish nurses in Christian faith communities participated in the study. Following the institutional review board approval, the clients were recruited with the assistance of the parish nurses. The clients completed a 7-item demographic questionnaire, followed by a face-to-face interview with the author who used a semistructured interview tool. The interview questions encompassed 6 aspects of parish nursing: education, personal counseling, health screenings, spiritual support, referrals, and health advocacy. The interviews were transcribed and analyzed by the author. The results of the study indicated that the clients in all 3 churches received holistic care from their parish nurses. The care they received addressed their spiritual, physical, and emotional health needs. Recommendations for future research and implications for the clinical practice of parish nursing, using a holistic approach, are included. The findings of future research and the holistic interventions of parish nurses could influence the funding and positions for parish nurses in the future.     

Roles and functions of community mental health nurses caring for people with schizophrenia in Taiwan

Aims and objectives. The study aimed to understand the nursing roles and functions of public health nurses and home health nurses in Taiwan and the factors that affect nursing roles and functions of nurses that provide community mental health home visiting services. Background. Although community nurses provide more psychiatric home visiting services than other psychiatric professionals, little research on their roles and functions has been conducted. Design. Nursing roles and functions were developed through use of grounded theory method of Strauss and Corbin. Methods. Data were collected using semi‐structured face‐to‐face in‐depth interviews and unstructured non‐participant observations. The constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected using theoretical sampling. Final sample size in this study comprised a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home visiting. Public health nurses conducted a total of 16 (eight carers and eight clients) services and home health nurses conducted 16 (eight carers and eight clients) services. Results. Fourteen nursing roles were identified. These roles included assessor, supporter, educator, consultant, counselor, negotiator, harmoniser, collaborator, advocate, placement coordinator, resource provider, care provider, case manager and case finder. Moreover, several factors that affect nursing roles and functions in the community mental health home visiting service in Taiwan were also identified. Conclusion. This is the first study to identify the role of public health and home health nurses caring for people with schizophrenia in the community in Taiwan. Relevance to clinical practice. The recommendations based on the findings of this research can be used as a guide to improve the delivery of psychiatric home visiting services to community‐dwelling clients with schizophrenia and their carers.     

Left alone – Swedish nurses’ and mental health workers’ experiences of being care providers in a social psychiatric dwelling context in the post‐health‐care‐restructuring era. A focus‐group interview study

Scand J Caring Sci; 2010; 24; 427–435
Left alone – Swedish nurses’ and mental health workers’ experiences of being care providers in a social psychiatric dwelling context in the post‐health‐care‐restructuring era. A focus‐group interview study The professional role of nurses and mental health workers in social psychiatry is being re‐defined towards a recovery, client‐focused perspective. Approximately 0.7 percent of the adult population in Sweden suffers from severe mental illness leading to a need for community services. The primary aims of the Mental Health Reform in 1995 in Sweden were to improve the quality of life for people with severe, long‐term mental illness and, through normalization and integration, enhancing their opportunities to communicate with and participate in society. This study examines nurses’ and mental health workers’ views and experiences of being care providers in a municipal psychiatric group dwelling context when caring for clients suffering from severe mental illness. Three focus group interviews were made and thematic content analysis was conducted. Four themes were formulated: ‘Being a general human factotum not unlike the role of parents’, ‘Having a complex and ambiguous view of clients’, ‘Working in a mainly ‘strangled’ situation’, and ‘Feeling overwhelming frustration’. The staff, for instance, experienced a heavy workload that highly involved themselves as persons and restricted organization. The individual relational aspects of the nursing role, the risk of instrumentalizing the staff due to an organizational economical teleopathy (meaning a pathological desire to react goals), and the high societal demands on accomplishing the Mental Health Reform goals are discussed. To redefine the professional role of nurses and mental health workers in the community, in Sweden known as municipality, they need support in the form of continuously education, supervision, and dialogue with politicians as well as the public in general.     

Nurse-Client Interactions in Community-Based Practice: Creating Common Ground

Although research activity is increasingly aimed at examining health outcomes of community health nursing care, little empirical literature systematically describes the nurse-client interaction. In this pilot study nurse-client interactions were evaluated to describe their detailed elements. Nineteen such interactions occurring in a Canadian public health department were videotaped by a professional filming crew. The clinical situations included home visits, school health interviews and screening, health classes, and clinic work. The audio portion of the nurse-client exchanges were transcribed from the videotapes onto a computer and analyzed using content analysis. Semi-structured interviews were conducted with nurses and clients after the filming to elicit their perceptions of the interactions. Field notes describing nonverbal and contextual data were also collected and analyzed. The central process identified during the interactions was called "creating common ground." This integrating conceptual schema captured the give and take as each participant defined territory and revealed information. The process varied depending on care context, process skills of the nurse, and willingness of the client to engage.     

Evaluating psychosocial nursing interventions for cardiac clients and their caregivers: a case study of the community rehabilitation network in Hong Kong

AIM OF THE STUDY: The purpose of this exploratory study was to describe the type and nature of psychosocial nursing interventions provided for cardiac clients in Hong Kong's Community Rehabilitation Centres (CRNs). DESIGN/METHODS: Using a two-phase case study design data were collected from nurses, cardiac clients and their caregivers. The initial phase focused on identifying the types of psychosocial interventions provided. These data were obtained by observing nursing activities and the keeping of daily journals by the nurses. The second phase acquired data from structured telephone interviews, that reviewed clients' perceptions of the psychosocial interventions provided by the nurses and face-to-face interviews with clients and their caregivers. FINDINGS: These findings revealed that the nurses' interpersonal skills of information giving, social support and counselling were highly valued by cardiac clients and their caregivers. Both clients and caregivers outlined a concern about the lack of individual care and this was reflected in the focus of the CRN on group processes. CONCLUSION: Recommendations for psychosocial cardiac care are made for public health nurses and nurses working in community settings.     

Influencing factors of community mental health nurses caring for people with schizophrenia in Taiwan

The purpose of this study was to explore the influencing factors in the substantive theory of home care for people with schizophrenia in Taiwan. The grounded theory of Strauss and Corbin approach was used. Semi-structured one-to-one in-depth interviews were utilized to collect data. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected using theoretical sampling, and the final sample in this study consisted of a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home-visiting services. The public health nurses and home health nurses both conducted a total of 16 (eight carers and eight clients) home visits. Four categories and 12 subcategories of influencing factors were identified; these factors have both positive and negative effects on nursing roles and the functions of public health nurses in the mental health home-visiting service in Taiwan. The influencing factors identified support the importance of home care services.     

Evaluation of health promotion activities in community nursing practice

The purpose of this research was to study the extent to which community nurses (CNs) were involved in health promotion activities and to investigate whether these activities were meeting the needs of their clients A cross-sectional survey by multiple methods was designed and carried out in four district health authorities (DHAs) in one regional health authority in England Two hundred and fifty-one (83 67%) completed questionnaires were returned by CNs working in primary health care (PHC) Sixty sessions with CNs were observed and 249 interviews were conducted with clients Additionally, as part of the observation 155 clinical records were examined CNs reported involvement in a wide range of opportunistic and organized health promotion activities Lifestyle advice and ill-health prevention were most frequently used by all groups Health visitors (HVs) were involved significantly more in group and community wide activities District nurses (DNs) were mainly involved in opportunistic health promotion Practice nurses (PNs) were found to be involved significantly more in health promotion activities organized on an individual basis Observation revealed that opportunistic health promotion was carried out in almost half of the consultations observed, of which lifestyle advice was the most frequent Records however showed that this information was rarely recorded The clients of PNs were mostly aware of other health promotion activities available within the general practice, while almost half of the HVs 'clients knew what other health promotion activities were available to them and few DNs' clients were aware of any     

The meaning of public health nursing: creating 24 hour care in a community in Japan

Abstract This case study describes the strategies and activities of public health nurses to increase the availability of services in a municipality of 36 000 and to transform community attitudes so that those needing services would feel free to use them. Strategies and activities are seen in the context of Japan, Minakuchi Town and the leadership of the chief public health nurse. Practicing in partnership with members of the community, strategies of public health nurses include technical activities (conducting needs assessment and framing program alternatives) and information sharing and health education (e.g. 75 meetings organized with health promoters for residents in the districts of the town). On the basis of the results of Minakuchi Town, viewed as an example of expert public health nursing practice, a general model for public health nursing practice is presented.     

Mental health nurses’ contributions to community mental health care: An Australian study

Australian mental health policy is focused on providing mental health care in the community setting and community mental health teams provide services to clients in a shared model with primary care. The historical literature reports that community mental health nurses’ experience high levels of stress and are often allocated the most complex and challenging clients managed by the team. Yet information on their specific roles remains limited. This paper reports on research conducted at one Australian public mental health service to identify the components of the community mental health nursing role and to quantify the time nurses spent in each component during the study period. Six focus groups were conducted with community mental health nurses to identify their perceived role within the team. Data analysis identified 18 components of which 10 were related to direct clinical contact with clients and eight covered administrative and care coordination activities. A data collection tool based on the findings of the focus groups was designed and nurses recorded workload data on the tool in 15‐min intervals over a 4‐week period. Seventeen nurses collected 1528 hours of data. Internal coordination of care was identified as the top workload item followed by clinical documentation and national data collection responsibilities supporting the complexity of the community mental health nursing role. The high rating attached to the internal coordination of care role demonstrates an important contribution that community mental health nurses make to the functioning of the team and the delivery of quality mental health care.     

Multidisciplinary community mental health team staff's experience of a 'skills level' training course in cognitive analytic therapy

This study sought to explore community mental health teams' (CMHTs) experiences of receiving an innovative introductory level training in cognitive analytic therapy (CAT). CMHTs are important providers of care for people with mental health problems. Although CMHTs have many strengths, they have been widely criticized for failing to have a shared model underlying practice. Inter-professional training which develops shared therapeutic models from which to plan care delivery is, therefore, essential. We have been developing such a training based on the psychotherapeutic principles of CAT. Twelve community mental health staff (six mental health social workers and six community psychiatric nurses) were interviewed by an independent interviewer following the completion of the training programme. The interviews were analysed using a qualitative thematic analysis. The analysis revealed that the programme increased the participants' self-assessed therapeutic confidence and skill and fostered the development of a shared model within the team, although the training was also perceived as adding to workload. The results of this study suggest that whole-team CAT training may facilitate cohesion and also suggest that having some shared common language is important in enabling and supporting work with 'difficult' and 'complex' clients, for example, those with personality disorders. Further development of such training accompanied by rigorous evaluation should be undertaken.     

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.     

Home care nursing in Japan: a challenge for providing good care at home

Home care in Japan has developed over the past 30 years. Nurses have taken leadership in promoting home care and at the same time have expanded their roles. The roles of Japanese nurses in the field of home care are presented in the context of the historical perspective and view for the future. Home care nurses have performed care management for their community as well as for individual older clients living in their community. Currently, nurses work as high-tech and personal care providers and are developing a new role in health care enterprises. The number of nurses working as clinical nurse specialists will increase consistently with the rapid increase of master's programs. In the future, nurses should take a lead in developing health policy. The purpose of the article is to describe the current situation of home care clients and home care nursing in Japan. In addition, four issues of home care in Japan are described related to home care for older persons, high-tech home care, terminal care, and home care for psychiatric patients.     

Finnish occupational health nurses' work and expertise: the clients' perspective

AIMS: The aims of this study were to describe Finnish occupational health nurses' functions, characteristics, prerequisites, consequences, changes, development areas and expertise from the point of view of clients. METHODS: The background literature of this study is based on public health nursing models, Finnish social and health report, arguments of special education for occupational health nurses, and earlier studies concerning occupational health nurses' work. The data were collected from volunteer clients (n=26) by interviews. RESULTS: According to the qualitative content analysis, occupational health nurses' activities include health promotion and secondary health care among workers and at workplaces. The main work characteristics are holism, client-orientation, interaction and co-operation. Occupational health nurses need an extensive knowledge base and practical skills, client-orientation, courteous behaviour and a healthy and clean appearance. The outcomes of their work for clients are better health, healthier life habits and healthier working conditions. Nowadays, nurses are more client-orientated than 20 years ago. They are expected to develop their practical and interaction skills and expand their knowledge base. The expertise of occupational health nurses consists of an extensive knowledge base with practical skills, working experience and confidence, and it appeared when advising clients and answering their questions. CONCLUSIONS: It is important to arrange continuing education for occupational health nurses to ensure that they are always up to date in order to be able to respond to specific clients' needs. This study provides a foundation for further investigations into, for example, occupational health nurses' work from the point of view of employers, students of occupational health nursing and other occupational health experts and co-operative partners.     

Teaching and breast self-examination: an insufficiency of instruction

Client teaching is recognised as an essential component of nursing and midwifery care, and all clinical areas provide opportunities for informal client teaching. This qualitative study aimed to explore registered nurses' professional practices with regard to teaching breast self-examination (BSE), and to identify factors that influenced their participation or non-participation in teaching about breast health. Participants' views were obtained using individual semi-structured interviews. The data were analysed inductively, that is, without imposing structure from the interview questions. Findings revealed that participants' perspectives of BSE and breast health, the dual symbolism of breasts, and the time constraints of clinical practice, were significant factors that impacted on participants' personal BSE practices and on their level of participation in teaching BSE. The results indicate that that nurses and midwives do not view teaching breast health as part of their role in client interaction, particularly in an acute care setting. Although nursing literature identifies midwives and nurses as ideally placed to promote health promotion activities, the image of BSE as linked to breast cancer, the dominant illness oriented model of care and a task orientated culture in health care facilities do not facilitate this.     

REGULATING: THE SOCIAL CONTROL PROCESS REGISTERED NURSES USE TO TEACH PSYCHIATRIC PATIENTS ABOUT THEIR MEDICATIONS

In light of rising costs of health care, trends toward community based care, and greater demands by patients for control over their health, patient teaching has become a necessary part of the registered nurse's role. The purpose of this study was to describe how nurses teach patients with mental illness about their medication regimens. Twenty-nine nurses from three mental health settings in Australia participated in semistructured interviews and participant observation. The constant comparative method was used to analyze the data. Findings from this study indicated that the process of regulating, a social control process, was used by nurses to teach mentally ill patients about their medication regimens. Implications for practice and education are drawn from the findings of this study.     

Regulating: the social control process registered nurses use to teach psychiatric patients about their medications

In light of rising costs of health care, trends toward community based care, and greater demands by patients for control over their health, patient teaching has become a necessary part of the registered nurse's role. The purpose of this study was to describe how nurses teach patients with mental illness about their medication regimens. Twenty-nine nurses from three mental health settings in Australia participated in semistructured interviews and participant observation. The constant comparative method was used to analyze the data. Findings from this study indicated that the process of regulating, a social control process, was used by nurses to teach mentally ill patients about their medication regimens. Implications for practice and education are drawn from the findings of this study.     

Health care seeking among Mexican American men.

This focused ethnography explored health care seeking beliefs and behaviors of Mexican American men living in south central Washington State. Data collection included interviews with 36 research participants living in the community, participant observation in the research setting, and examination of ethnographic documents and cultural artifacts. Four major themes were identified: the identity of manhood dictates health care seeking, health means being able to be a man by fulfilling cultural obligations, illness means not being able to be a man, and men seek health care when their manhood is threatened or impaired. Machismo, the cultural concept of manliness, persisted among men despite the level of acculturation and other factors. Women influenced men's health care seeking behaviors. To fulfill their obligations, men must stay healthy and seek care when needed. Knowing when and why men do not seek health care enables nurses to better understand and serve the Mexican American community.     

Home‐visit nurses' attitudes for providing effective assistance to clients with schizophrenia

There were two objectives of this study. The first was to identify the attitudes of home‐visit nurses towards clients with schizophrenia that lead to the provisions of effective care and positive client outcomes for clients with schizophrenia. The second was to develop a framework to understand how nurses acquire nursing attitudes that lead to such provisions. Seven expert home‐visit nurses who had successfully prevented rehospitalization of clients with schizophrenia for more than 2 years were interviewed. In the semistructured interviews, the nurses described their experiences in assisting one or two clients. Data were analyzed qualitatively. The central theme was having equal footing with the client. An effective nursing attitude was acquired through recognizing one's own preconceptions of clients with schizophrenia through two steps: encountering unexpected client behaviours and becoming aware of one's problematic care. For these clients, it was essential that the nurses reflect on their preconceptions towards clients with schizophrenia and alter these preconceptions by working with the clients and believing in their innate ability to live in the community. The findings suggest that the field of mental health home‐visit nursing might benefit from adding these educational components in order to cultivate effective nursing attitudes for assisting clients with schizophrenia.     

Public health nursing in crisis

The problems experienced in public health nursing in the United States are serious and many. The proposed solution may provide a method for change. Delivery of services will then focus on public health needs and will resist the the pressure to fit needs to available funds. Provider outreach to meet community needs will supersede primary care. The health professions will share resources rather than responsibilities. Public health nursing will focus on disease prevention and control rather than on treatment, and nurse practitioners in other specialties will refer clients to public health nurses when their particular skills are needed. Thus resolution of the present crisis may result in a stronger cadre of public health nurses who are secure in their role and revitalized in their dedication to health care in the community.