Working conditions and cultural competence when interacting with children and parents of foreign origin--Primary Child Health Nurses' opinions

BACKGROUND: Interaction with children and parents of foreign origin is an important part of Primary Child Health Care (PCHC) services. Cultural competence among Primary Child Health Nurses' (PCHNurses') must therefore be regarded as essential. Cultural competence has been described as a process with different steps through which an individual must proceed. AIM: The present study investigates PCHNurses' opinions regarding their working conditions and cultural competence. The focus will be placed on their interaction with children and parents of foreign origin. METHODS: A total of 270 PCHNurses working in the PCHC services in Stockholm County responded to a questionnaire (response rate 70%). The association between experiences of difficulties and nine explanatory variables were analysed with logistic regression. RESULTS: Many of the PCHNurses reported inadequate working conditions and dissatisfaction with the quality of their healthcare work and said that they lacked written guidelines, support and help. A majority (84%) experienced difficulties in their interactions with children and parents of foreign origin, although to different degrees. The odds of experiencing difficulties were increased when nurses were responsible for a high proportion of children of foreign origin, when nurses had long professional experience and when they worked more than 50% on child-health-services assignments. Many nurses had no formal training in cultural competence and the majority felt that their formal and clinical cultural competence was insufficient. CONCLUSIONS: Deficiencies were found regarding the PCHNurses' working conditions and cultural competence when interacting with children and parents of foreign origin. Improvements are needed to facilitate the nurses' healthcare work and to enable high quality health care on equal terms for all children and parents visiting the PCHC services.     

Primary Child Health Care Nurses' assessment of health risks in children of foreign origin and their parents--a theoretical model.

Background: According to recent studies, intercultural interaction in health care between clients and care-givers seems to be problematic. A recent Swedish study revealed that a majority of Primary Child Health Care Nurses (PCHNurses) experienced difficulties in their interaction with children and parents of foreign origin. As every third child in the Primary Child Heath Care (PCHC) services is of foreign origin it seem to be of utmost importance to examine in depth how these difficulties could be understood and explained. Aim: The present study aimed at a theoretical explanation of the core problem concerning PCHNurses' interaction with children and parents of foreign origin, as experienced by the PCHNurses. Methods: Fifteen PCHNurses working in the PCHC services were interviewed. Grounded Theory was used as research methodology because focus is on social interactions and the aim is to theoretically explain unarticulated social processes. Results: Anxiety about missing children, exposed to risks of ill-health, due to various conditions in the child's home environment, turned out to be the PCHNurses' main concern. An assessment of health risks was initiated, when PCHNurses thought that psychosocial conditions in the child's environment might cause ill health. Some of the psychosocial conditions were difficult to assess, as they were unfamiliar and not understood by the PCHNurses. In such difficult-to-assess cases, when the PCHNurses considered the possibility of undefined risk to the child's health they held on to the assessment of the cases and worked out strategies to learn and understand more about the child and the child's home environment. A theoretical model grounded in data was created accounting for the variation in the assessment process and the different strategies used. Implications are discussed and recommendations for improvements are given.     

"A wealth of knowledge": A survey of the employment experiences of older nurses and midwives in the NHS

Background

The United Kingdom's National Health Service workforce is ageing, and the specific needs of this sector of its workforce need to be addressed. Nursing and midwifery shortage is a worldwide issue, and with increasing demands for care the retention of older nurses and midwives is crucial.

Objectives

To report on the employment experiences of nurses and midwives with a particular focus on issues relating to age, ethnicity, ill-health and disability.

Design

The postal survey was developed following a literature review and analysis of National Health Service and Government policy documents.

Settings

This was a UK-wide survey of nurses and midwives working in National Health Service Trusts and Primary Care Trusts.

Participants/methods

A postal survey of nurses and midwives was undertaken between May and December 2005. National Health Service Trusts and Primary Care Trusts (n = 44) identified as having policies relevant to the study were contacted regarding the procedure for seeking research governance approval. Thirteen National Health Service Trusts and Primary Care Trusts participated, with 2610 surveys distributed; 510 surveys were returned (20% response rate).

Results

Nurses and midwives aged 50 years and over had undertaken fewer Continuing Professional Development activities than nurses and midwives under 50. Whilst not related to age, the study also found that 20% of the survey sample reported experiencing some form of discrimination. Nurses and midwives did not differ on either quality of life or psychological health using standard instruments. Having a disability did not lead to greater psychological morbidity but did have a negative effect on quality of life. Having a work-related illness had a negative impact on both quality of life and psychological morbidity. In relation to ethnicity, black nurses and midwives reported lower psychological morbidity than other ethnic groups; that is, they enjoyed a higher level of mental well-being.

Conclusion

The nursing and midwifery workforce is ageing worldwide with a significant proportion now approaching, or having already reached, potential retirement age. With the recent introduction of the age legislation the working lives of older nurses and midwives in the National Health Service have never been more relevant. Whilst access to Continuing Professional Development is pertinent to the retention of nurses and midwives of all ages, in this study, older nurses reported less access than younger nurses.     

Primary Child Health Care Nurses' assessment of health risks in children of foreign origin and their parents – a theoretical model

Background:  According to recent studies, intercultural interaction in health care between clients and care-givers seems to be problematic. A recent Swedish study revealed that a majority of Primary Child Health Care Nurses (PCHNurses) experienced difficulties in their interaction with children and parents of foreign origin. As every third child in the Primary Child Heath Care (PCHC) services is of foreign origin it seem to be of utmost importance to examine in depth how these difficulties could be understood and explained.
Aim:  The present study aimed at a theoretical explanation of the core problem concerning PCHNurses' interaction with children and parents of foreign origin, as experienced by the PCHNurses.
Methods:  Fifteen PCHNurses working in the PCHC services were interviewed. Grounded Theory was used as research methodology because focus is on social interactions and the aim is to theoretically explain unarticulated social processes.
Results:  Anxiety about missing children, exposed to risks of ill-health, due to various conditions in the child's home environment, turned out to be the PCHNurses' main concern. An assessment of health risks was initiated, when PCHNurses thought that psychosocial conditions in the child's environment might cause ill health. Some of the psychosocial conditions were difficult to assess, as they were unfamiliar and not understood by the PCHNurses. In such difficult-to-assess cases, when the PCHNurses considered the possibility of undefined risk to the child's health they held on to the assessment of the cases and worked out strategies to learn and understand more about the child and the child's home environment. A theoretical model grounded in data was created accounting for the variation in the assessment process and the different strategies used. Implications are discussed and recommendations for improvements are given.     

Primary Health Care in the Mental Health Workplace: Insights from the Australian Experience

In Australia, Primary Health Care and the mental health sector have always shared a philosophy. In 1978, Primary Health Care was first put forward as a strategy to improve “health for all.” Recently, the Australian Government included mental health as a national health priority, identifying six strategies consistent with a Primary Health Care approach to address the mental health of all Australians. Throughout this time, Primary Health Care has been highlighted in all models of care. However, in reality, it appears that in mental health services, mental health nurses, despite good intentions, are not delivering care in a planned or systematised way and that much needs to be done to further improve the situation for individuals accessing the health care system. Services currently focus on those identified as seriously mentally unwell; in order to really make an impact it is argued that services should be broader, offered to the population at large and, further, that the emphasis on case work at an individual level should be changed to an approach that considers prevention, maintenance, and follow-up as well as crisis intervention. This article reflects the Australian experience and offers some insights from that experience.     

A hermeneutic study of integrating psychotherapist competence in postnatal child health care: nurses’ perspectives

Background

There is a considerable prevalence of and an increasing attention to emotional problems in families with infants. Yet, knowledge is scant of how to create efficient and accessible mental health services for this population. The study qualitatively explored public health nurses’ conceptions of a clinical project, in which psychotherapists provided short-term consultations and supervisions for nurses at Child Health Centres in Stockholm.

Methods

In-depth interviews with fifteen nurses. The guideline of the interviews contained open-ended questions that were analysed applying a hermeneutical approach.

Results

Four main themes crystallized; The nurses’ conceptions of their psychosocial work, Trespassing on another professional role, Interprofessional collaboration at the Child Health Centre, and The nurses’ conceptions of the psychotherapist’s function. In a second step, an analysis that clustered the nurses’ attitudes towards handling mental health problems yielded one last theme with three “Ideal types”; nurses who expressed “I don’t want to”, “I want to but I cannot”, and “I want to and I can” (take care of families’ emotional problems at the CHC).

Conclusion

The nurses appreciated the easy referral and accessibility to the psychotherapists, and the possibilities of learning more about perinatal mental illness and parent-infant interactions. For a successful cooperation with the nurses, the therapist should be a team member, be transparent about his/her work, and give feedback about cases in treatment. The study also shows how the organization needs to clarify its guidelines and competence to improve psychological child health care. The paper suggests improvements for an integrated perinatal mental health care.

     

A transition program to primary health care for new graduate nurses: a strategy towards building a sustainable primary health care nurse workforce?

Background

This debate discusses the potential merits of a New Graduate Nurse Transition to Primary Health Care Program as an untested but potential nursing workforce development and sustainability strategy. Increasingly in Australia, health policy is focusing on the role of general practice and multidisciplinary teams in meeting the service needs of ageing populations in the community. Primary health care nurses who work in general practice are integral members of the multidisciplinary team – but this workforce is ageing and predicted to face increasing shortages in the future. At the same time, Australia is currently experiencing a surplus of and a corresponding lack of employment opportunities for new graduate nurses. This situation is likely to compound workforce shortages in the future. A national nursing workforce plan that addresses supply and demand issues of primary health care nurses is required. Innovative solutions are required to support and retain the current primary health care nursing workforce, whilst building a skilled and sustainable workforce for the future.

Discussion

This debate article discusses the primary health care nursing workforce dilemma currently facing policy makers in Australia and presents an argument for the potential value of a New Graduate Transition to Primary Health Care Program as a workforce development and sustainability strategy. An exploration of factors that may contribute or hinder transition program for new graduates in primary health care implementation is considered.

Summary

A graduate transition program to primary health care may play an important role in addressing primary health care workforce shortages in the future. There are, however, a number of factors that need to be simultaneously addressed if a skilled and sustainable workforce for the future is to be realised. The development of a transition program to primary health care should be based on a number of core principles and be subjected to both a summative and cost-effectiveness evaluation involving all key stakeholders.

     

Caries risk assessment tool and prevention protocol for public health nurses in mother and child health centers,Israel

Objectives

Dental caries is the most prevalent chronic disease in children. Caries risk assessment tools enable the dentists, physicians, and nondental health care providers to assess the individual's risk. Intervention by nurses in primary care settings can contribute to the establishment of oral health habits and prevention of dental disease. In Israel, Mother and Child Health Centers provide free preventive services for pregnant women and children by public health nurses.

Materials and Methods

A caries prevention program in health centers started in 2015. Nurses underwent special training regarding caries prevention. A customized Caries Risk Assessment tool and Prevention Protocol for nurses, based on the AAPD tool, was introduced. A two‐step evaluation was conducted which included a questionnaire and in‐depth phone interviews.

Results

Twenty‐eight (out of 46) health centers returned a completed questionnaire. Most nurses believed that oral health preventive services should be incorporated into their daily work. In the in‐depth phone interviews, nurses stated that the integration of the program into their busy daily schedule was realistic and appropriate. The lack of specific dental module for computer program was mentioned as an implementation difficulty.

Discussion

The wide use of our tool by nurses supports its simplicity and feasibility which enables quick calculation and informed decision making. The nurses readily embraced the tool and it became an integral part of their toolkit.

Conclusion

We provide public health nurses with a caries risk assessment tool and prevention protocol thus integrating oral health into general health of infants and toddlers.     

Primary care groups and trusts: a threat or an opportunity for the development of community-based nursing in England

AIMS OF THE STUDY: To examine the role of Primary Care Groups and Trusts (PCG/T) in relation to nurses working in general practice and community health services. BACKGROUND: Over the past two decades there have been rapid changes in the numbers and roles of nurses working in primary care and community based settings. The establishment of Primary Care Groups offers health care professionals, including nurses, the chance to develop local primary care services and to integrate community and primary care nursing. These developments may offer opportunities or pose threats to nursing staff. RESEARCH METHODS: Data are drawn from a longitudinal study of a randomly selected sample of Primary Care Groups in England (n = 72). In a second survey of Groups carried out in autumn/winter 2000, Primary Care Group chairs and chief officers were interviewed by telephone. RESULTS: Response rates were 97% for both chairs and chief officers (69 of each). Chairs indicated that in most areas Primary Care Groups were consulting with local nurses to develop policy. Fifty-seven (85%) reported that investment in nursing staff and nursing services was a high priority in their area. Twenty-eight (41%) indicated that nurse-led services designed to increase patient access had already been established in their area, and 20 (29%) were planning new nurse-led services. Many developments had been initiated by Primary Care Groups. Initiatives to integrate community and general practice based staff were underway in most areas. CONCLUSIONS: Primary Care Groups and Trusts are initiating changes in general practice and community based services which are likely to have long-term and important implications for nurses in terms of their roles, conditions of work and future careers. It is important that nurses are consulted and are involved in developing and implementing policy change.     

Child care health consultants' roles and responsibilities: focus group findings

PURPOSE: To describe the roles and responsibilities of newly trained health professionals, primarily nurses called Child Care Health Consultants. METHOD: Health professionals hired by county agencies to become Child Care Health Consultants enrolled in the California Training Institute (CTI) for Child Care Health Consultants, a 9-day educational training program divided into three modules. They participated in one focus group during each module. Research staff led the focus groups and the participants were asked, "What are your roles and responsibilities?" Qualitative analyses were conducted and common themes were identified. FINDINGS: The nine focus groups included 44 participants, 95% were nurses with an average of 20 years of work experience. The roles and responsibilities of the Child Care Health Consultants were described by five themes: network, education, sustainability, on-site service, and administration. CONCLUSION: These findings contribute to the new field of child care health consultation by defining the common roles and responsibilities of Consultants.     

Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers

Background

Overweight and obesity in preschool children have increased worldwide in the past two to three decades. Child Health Centers provide a key setting for monitoring growth in preschool children and preventing childhood obesity.

Methods

We conducted semi-structured interviews with 15 nurses working at Child Health Centers in southwest Sweden in 2011 and 2012. All interviews were tape recorded and transcribed verbatim and imported to QSR N’Vivo 9 software. Data were analyzed deductively according to predefined themes using content analysis.

Results

Findings resulted in 332 codes, 16 subthemes and six main themes. The subthemes identified and described barriers and facilitators for the prevention of childhood obesity at Child Health Centers. Main themes included assessment of child’s weight status, the initiative, a sensitive topic, parental responses, actions and lifestyle patterns. Although a body mass index (BMI) chart facilitated greater recognition of a child’s deviant weight status than the traditional weight-for-height chart, nurses used it inconsistently. Obesity was a sensitive topic. For the most part, nurses initiated discussions of a child’s overweight or obesity.

Conclusion

CHCs in Sweden provide a favorable opportunity to prevent childhood obesity because of a systematic organization, which by default conducts growth measurements at all health visits. The BMI chart yields greater recognition of overweight and obesity in children and facilitates prevention of obesity. In addition, visualization and explanation of the BMI chart helps nurses as they communicate with parents about a child’s weight status. On the other hand, inconsistent use and lack of quality assurance regarding the recommended BMI chart was a barrier to prevention, possibly delaying identification of overweight or obesity. Other barriers included emotional difficulties in raising the issue of obesity because it was perceived as a sensitive topic. Some parents deliberately wanted overweight children, which was another specific barrier. Concerned parents who took the initiative or responded positively to the information about obesity facilitated prevention activities.

     

Improving nurses’ performance through remuneration: a literature review

Background

A remuneration system greatly influences the quality of nursing care and services.

A systematic review of the effectiveness of advanced practice nurses in long‐term care

Aim

To report quantitative evidence of the effectiveness of advanced practice nursing roles, clinical nurse specialists and nurse practitioners, in meeting the healthcare needs of older adults living in long‐term care residential settings.

Background

Although studies have examined the effectiveness of advanced practice nurses in this setting, a systematic review of this evidence has not been conducted.

Design

Quantitative systematic review.

Data sources

Twelve electronic databases were searched (1966–2010); leaders in the field were contacted; and personal files, reference lists, pertinent journals, and websites were searched for prospective studies with a comparison group.

Review methods

Studies that met inclusion criteria were reviewed for quality, using a modified version of the Cochrane Effective Practice and Organisation of Care Review Group risk of bias assessment criteria.

Results

Four prospective studies conducted in the USA and reported in 15 papers were included. Long‐term care settings with advanced practice nurses had lower rates of depression, urinary incontinence, pressure ulcers, restraint use, and aggressive behaviours; more residents who experienced improvements in meeting personal goals; and family members who expressed more satisfaction with medical services.

Conclusion

Advanced practice nurses are associated with improvements in several measures of health status and behaviours of older adults in long‐term care settings and in family satisfaction. Further exploration is needed to determine the effect of advanced practice nurses on health services use; resident satisfaction with care and quality of life; and the skills, quality of care, and job satisfaction of healthcare staff.