Models of differentiated practice and specialization in community nursing: a review of the literature

Translating and validating a Training Needs Assessment tool into Greek

Background

The translation and cultural adaptation of widely accepted, psychometrically tested tools is regarded as an essential component of effective human resource management in the primary care arena. The Training Needs Assessment (TNA) is a widely used, valid instrument, designed to measure professional development needs of health care professionals, especially in primary health care. This study aims to describe the translation, adaptation and validation of the TNA questionnaire into Greek language and discuss possibilities of its use in primary care settings.

Methods

A modified version of the English self-administered questionnaire consisting of 30 items was used. Internationally recommended methodology, mandating forward translation, backward translation, reconciliation and pretesting steps, was followed. Tool validation included assessing item internal consistency, using the alpha coefficient of Cronbach. Reproducibility (test – retest reliability) was measured by the kappa correlation coefficient. Criterion validity was calculated for selected parts of the questionnaire by correlating respondents' research experience with relevant research item scores. An exploratory factor analysis highlighted how the items group together, using a Varimax (oblique) rotation and subsequent Cronbach's alpha assessment.

Results

The psychometric properties of the Greek version of the TNA questionnaire for nursing staff employed in primary care were good. Internal consistency of the instrument was very good, Cronbach's alpha was found to be 0.985 (p < 0.001) and Kappa coefficient for reproducibility was found to be 0.928 (p < 0.0001). Significant positive correlations were found between respondents' current performance levels on each of the research items and amount of research involvement, indicating good criterion validity in the areas tested. Factor analysis revealed seven factors with eigenvalues of > 1.0, KMO (Kaiser-Meyer-Olkin) measure of sampling adequacy = 0.680 and Bartlett's test of sphericity, p < 0.001.

Conclusion

The translated and adapted Greek version is comparable with the original English instrument in terms of validity and reliability and it is suitable to assess professional development needs of nursing staff in Greek primary care settings.

A possible way out of poor healthcare resulting from demographic problems: need-orientated home-based-nursing-care and nursing-home-care

AIM

The aim of is this paper is to present a study in which a system to classify different levels of home-based-nursing and nursing-home care for groups with differing care need is developed.

BACKGROUND

Changes in demography, social conditions and medical development are leading to the fact that in the future more people will need specialized nursing care which today's services of home-based-care and nursing-homes cannot provide.

METHOD

On the basis of a literature research, the service-structure and the care need of defined groups of patients were analysed and categorized. The resulting grid was used in an Internet-based standardized survey among 144 experts.

RESULTS

The results of this study encompass the experts' views and the prognoses on developments in the design of care and service structures for each of the defined groups of patients in North-Rhine-Westphalia, Germany.

CONCLUSION

The study reveals the areas and the patient groups with the most significant future needs. Thus, demands and recommendations concerning the prospective design and structure of care and nursing services for home-based nursing and care in nursing-homes can be formulated.

Changes in community nursing in Australia: 1995-2000

AIM

This paper reports a study whose aim was to examine the congruence between community nurses' perceptions and the realities of changes in their work.

BACKGROUND

There have been increasing challenges to the delivery of community nursing services in Australia over the past decade. Acute care sector changes and the recent focus on health promotion, prevention, early identification and intervention adds pressure and creates tensions for community nurses, which are well-documented in the literature. There is, however, a lack of empirical evidence of actual changes in community nurses' workloads and the focus of their work. Validation of nurses' perceptions would enable them to have a stronger voice in the future development of community health care.

METHODS

Four sources of data were used: community health client administrative data 1995-2000; occasions of service data 1995-2000; staffing numbers 1998-2001; and interviews with 14 community nurses in late 2001.

RESULTS

Documentary evidence shows that there has been a large increase in the number of adult clients, and all clients are increasingly receiving a shorter, more intensive, clinically focussed service and are then discharged from care, rather than receiving a lower intensity service over a longer period of time. Staffing numbers have not increased to match this higher acuity and intensity. These changes were echoed by the nurses, who reported that expanded acute care roles were impacting on their workload and resulting in a loss of holistic primary health care focus. There has been a lack of leadership and proactive planning by community nurses in response to these changes.

CONCLUSION

Community health care in Australia is shifting from primary to short-term clinical care. Greater opportunities for community nurses to engage proactively in defining and promoting their role in the health care system are needed in order to ensure an appropriate balance of acute clinical and holistic primary health care in the community.

Differentiated practice, patient-oriented care and quality of work in a hospital in the Netherlands

This article describes a quantitative study of the relationship between differentiated practice on the one side and patient-oriented care and quality of work on the other. Nursing wards where differentiated practice has been implemented (intervention group) have been compared with wards where differentiated practice has not been implemented (reference group). The research variables with regard to differentiated practice, patient-oriented care and quality of work have been measured by questionnaires. Subjects were 68 nurses and six supervisors from six nursing wards from one hospital. The results show that the extent to which differentiated practice had been implemented varied between the wards. With regard to patient-oriented care differences have been found between the intervention and reference group on the variables patient assignment and use of the nursing process, but not on the variables of tasks and communication. Concerning quality of work, differences have been found on: social support from the supervisor, social-emotional leadership and health complaints. Rank order correlations between differentiated practice and patient-oriented care and between differentiated practice and quality of work were not significant. Practical implications with regard to the use of differentiated practice and implications for further research are discussed.

The older adult: a comparison of long-term care in Glasgow and San Francisco

Population trends show an increasing proportion of people older than 65 years of age. This report aims to describe the facilities/services accessible to the older adult living in Glasgow, Scotland and in San Francisco, United States of America. This comparative study serves to develop a broader understanding of what is involved in the process of ageing, and describes how these two cities are responding to the needs of older people. Long-term caring provision is complex and involves multiple agencies, often leaving both lay and professional individuals ill-informed as to which services exist and how best to use them. The nurse can be instrumental in providing information, viable alternatives and services. In this article, options available for caring of the older adult and financing of care are discussed along with a number of recommendations based on observations described, data collected and literature researched. With the advent of care being provided in the community, there is now a continuum of services ranging from independent living at home to dependent care in hospital. Whether an individual remains at home depends on the availability and affordability of, and access to, other resources/facilities. Creative alternatives are needed for care of the older adult in this millennium. This report describes the need for an integrated system of care, which can adjust to variations in clients' needs. Progressive care facilities, intergenerational sharing, community volunteer service programmes for the older person and Edenizing are a few recommendations discussed by the authors.

Teaching qualitative research through participatory coursework and mentorship

Many doctoral programs in nursing now offer at least one course in qualitative research. Yet it remains a challenge to adequately prepare new qualitative researchers due to lack of faculty expertise and mentorship, student unfamiliarity with qualitative research when entering the doctoral program, and uncertainty as to appropriate teaching methods. The authors describe how they addressed these issues historically and in their current two-course qualitative research sequence. Accompanying reports of four studies conducted by students who completed the two-course sequence during academic year 1996 to 1997 provide evidence of the viability of the authors' approach and serve as the basis for recommendations to others who use a similar strategy for teaching qualitative research.

Taranaki community partnership model

BACKGROUND

This exercise was undertaken as part of a re-engineering of community health services. 'Community' needed to be defined in order to understand its components, to develop a philosophy and a common understanding to assist in the re-engineering process.

AIM

To define community health as it is understood by practitioners in the Taranaki province.

METHOD

Workshops were held involving as many community workers as possible. Newsletters kept staff informed of developments. Individual interviews and phone calls also featured.

FINDINGS

A community partnership model was developed encompassing the concepts of equity, communication, responsiveness and sustainability. The people working within the model were staff, client and customer.

CONCLUSION

This was a worthwhile exercise that resulted in a unique model developed by practitioners for practitioners which gave a feeling of 'belonging' to a fragmented service. It has uses in further research, in education and in the day to day running of community services.