Integrated older people care and advanced practice nursing: an evidence-based review

AIM

To critically appraise and synthesize evidence of integrated care stemming from advanced practice nursing in elderly primary care settings throughout the United States and Thailand.

BACKGROUND

Advanced practice nurses are key to accelerating integrated elderly care in the community. Yet, their scope and capacity vary greatly across countries, making impact measurement highly challenging.

METHODS

A systematic search of PubMed, CINAHL, Scopus and ThaiJo databases was performed. Full-text articles in English or Thai language were reviewed using an inductive thematic approach from the integrated people-centred Health Services framework, adopted by the World Health Organization.

RESULTS

A total of 42 articles were appraised according to framework strategies: (1) people and community empowerment/engagement; (2) governance and accountability strengthening; (3) model of care reorientation; (4) service coordination; and (5) enabling environment creation. Collaborative roles and empowerment of older people were associated with higher quality of care. Thai nurses empowered individuals through community networks and resources, incorporating care models (strategy 1). In contrast, US nurses adopted a quality improvement and safety approach, incorporating technology into nursing interventions (strategy 5).

CONCLUSION

Advanced practice nurses employ an array of strategies and approaches in caring for older people. Although their role varies from mostly substitute (US) to supplemental (Thailand), nurses in both countries contribute towards integrated person-centred care.

IMPLICATION FOR NURSING PRACTICE AND NURSING POLICY

Preparing advanced practice nurses to work in the community is a prerequisite for meeting ageing population health needs in a sustainable manner. Education, professional development and leadership training opportunities should focus on capacity building in: a) strengthening mutual accountability, b) reorienting the work environment through innovative care models and c) coordinating services through partnerships to achieve universal health and ensure healthy ageing.

Sustaining global partnerships for simulation integration: lessons from the field

AIM

A reciprocal partnership between two World Health Organization Collaborating Centers in the Americas region aimed to strengthen nursing and midwifery education through innovative integration of high-fidelity simulation.

METHODS/IMPLEMENTATION

Immersion of a visiting scholar in six-week training within a North American nursing school (host) solidified simulation champion designation, upon return at the home institution. Next, two expert nursing faculty implemented a train-the-trainer simulation course on-site. Following evaluation and virtual debriefing, a midwifery faculty visited the host institution for second-round training.

CONCLUSION

This ongoing program targets faculty development needs through a strong academic partnership, built upon global awareness and sustainable engagement.

Relationship between adiposity, adipokines, inflammatory markers and lipid profile in hemodialysis patients

OBJECTIVES

Our aim is to study the correlations of leptin and adiponectin with inflammation markers, body composition and lipid profile in end stage renal disease (ESRD) patients.

PATIENTS AND METHODS

Phase angle values and fat mass as calculated using BIA, Malnutrition-Inflammation Score (MIS), leptin, adiponectin, IL-6, IL-8 triglycerides, cholesterol and other common serum markers' concentrations were analyzed using simple and multiple linear regression models in 47 hemodialysis patients.

RESULTS

In contrast to leptin, adiponectin is inversely correlated to BMI and fat mass in hemodialysis patients. Triglycerides were the only parameter that retained its statistical correlation significance with adiponectin in the multiple regression model.

CONCLUSIONS

Fat mass is of important consideration when calculating adipokines levels and their possible correlations with other variables. The inverse correlation of adiponectin with triglycerides levels should be further delineated due to the important role of vascular diseases in total mortality and morbidity of ESRD patients.

Quality of nutritional information on the Internet in health and disease

BACKGROUND

Quality assessment of nutritional information on the internet may prove vital prior to providing public guidance on searching relative information.

METHODS

The most popular web sites on four different topics ("Mediterranean diet", "sports nutrition", "nutrition, dysphagia and children" and "herbs and common cold") were assessed with the use of two validated questionnaires (EQIP and DISCERN).

RESULTS

Medical categories produced significantly lower total quality scores when compared to "Mediterranean diet" and "sports nutrition" categories. (F=7.189, P<0.001). Commercial web pages had a significantly lower credibility score compared to institutional and other web page types (H=17.987, P<0.001). Ranking order of each web page was related to its total quality score (P=0.04) but not to its credibility (P=0.241).

CONCLUSIONS

Monitoring the accuracy, comprehensiveness and consistency of health-related information on the internet is an important public health issue since there are popular web pages that are regarded as of high quality but they do not always provide reliable information. Health professionals and especially dieticians should provide consumer training on how to search for and appraise nutritional information from the internet.

Primary health care nursing staff in Crete: an emerging profile

BACKGROUND

In 2001, the newly established Regional Health and Welfare System of Crete commissioned the first needs' assessment study of nursing personnel employed in the public sector of primary health care (PHC).

AIM

To capture the profile and professional needs of nursing staff working in Health Centers throughout the island of Crete and explore variations in nursing practice by educational preparation.

METHODS

A newly developed, psychometrically tested questionnaire, was administered to all nursing staff in 14 rural Health Centers.

FINDINGS

Vacancy rates are high, indicating a serious staffing deficit. The type of degree earned (2-year vs. 3 or 4-year program) does not differentiate nursing practice, with only two exceptions (obtaining a patient's history and counselling patients). The majority of respondents assess their existing knowledge and skills as 'adequate' while indicating a strong desire for continuing education. Job satisfaction is high in terms of interactions with clients and community recognition, while it is rated 'low' in terms of daily interactions with colleagues and support from work environment.

CONCLUSION

Cretan nursing staff in PHC operate within a restricted and task-orientated framework. Their educational preparation has little effect in practice role variations and professional needs. The Regional Health and Welfare System of Crete should address daily supervision and support issues, on-the-job training, continuing education needs, while taking immediate action to avoid potential turnover of existing staff and to aggressively recruit young, qualified nursing staff who will choose a career in PHC nursing.