Use of the Council Health Survey to Assess Shared Governance in a Pediatric Hospital During the COVID-19 Pandemic

This project used the Council Health Survey to evaluate the effectiveness of shared governance councils in a children’s hospital during the COVID-19 pandemic. A SWOT analysis was performed to assess the organization’s strengths, weaknesses, opportunities, and threats regarding council health and to inform strategies to sustain the shared governance environment. The well-established shared governance infrastructure allowed the organization to rapidly pivot council operations to sustain nurse engagement while balancing the unprecedented staffing and resource challenges of the pandemic. Organizations must remain flexible and innovative to maintain an environment supportive of nurse empowerment and shared governance during public health emergencies.

A Tristate Education Model to Prepare Nurses to Serve on Health-Promoting Boards

BACKGROUND

The tristate Nurses on Boards Coalition (NOBC) education program prepares nurses to serve on boards that promote a culture of health, such as housing and transportation authorities, school wellness teams, mental health nonprofits, and planning commissions.

METHOD

Three state nursing organizations developed an evidence-informed, innovative, interactive NOBC education model through a review of board service, leadership, and continuing education literature; key informant interviews with national NOBC experts; and evaluation data from previous NOBC education held in our individual states.

RESULTS

Attendees in the 2018 and 2019 tristate education programs reported increased knowledge regarding the social determinants of health and how they can influence population health by serving on health-promoting boards.

CONCLUSION

The tristate NOBC education is a successful model in preparing nurses to serve on boards that promote a culture of health. [J Contin Educ Nurs. 2020;51(11):528-532.].

Effectiveness of a 2-year post-natal nurse home-visiting programme when children are aged 5 years: Results from a natural experiment

AIM

To evaluate the effect of a 2-year post-natal nurse home visiting (NHV) programme delivered in routine clinical practice to socially disadvantaged mothers on children's development at 5 years.

METHODS

The study was a natural experiment resulting from progressive rollout of NHV (2008-2012). Children of three groups of mothers, all eligible for NHV, were compared: (i) mothers receiving NHV in a metropolitan region (n = 197); (ii) mothers in a rural region prior to NHV being available (n = 94); and (iii) mothers receiving NHV in the rural region after it became available (n = 84). Outcomes were evaluated using the Child Behaviour Checklist, Child-Parent Relationships Scale, Behaviour Inventory of Executive Functioning and Australian Early Development Index.

RESULTS

Analyses were conducted using augmented inverse probability weighting accounting for differences in the groups' baseline characteristics. While some differences were observed in the range of 8-12% between the intervention and comparison groups (albeit with wide confidence intervals, e.g. 31% less likely to 4% more likely to be experiencing poor outcomes). For the majority of outcomes, however, there were no differences observed between the intervention and comparison groups.

CONCLUSIONS

Post-natal NHV provided as a part of routine service delivery did not improve children's outcomes at 5 years. It may be that in the Australian context a NHV intervention, as offered in this study, does not provide additional benefits over standard care.

Nurse-Moderated Internet-Based Support for New Mothers: Non-Inferiority, Randomized Controlled Trial

BACKGROUND

Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the Internet to obtain information about infant care. However, evidence from population-based randomized controlled trials is lacking.

OBJECTIVE

The aim of this study was to test the non-inferiority of outcomes for mothers and infants who received a clinic-based postnatal health check plus nurse-moderated, Internet-based group support when infants were aged 1-7 months as compared with outcomes for those who received standard care consisting of postnatal home-based support provided by a community nurse.

METHODS

The design of the study was a pragmatic, preference, non-inferiority randomized control trial. Participants were recruited from mothers contacted for their postnatal health check, which is offered to all mothers in South Australia. Mothers were assigned either (1) on the basis of their preference to clinic+Internet or home-based support groups (n=328), or (2) randomly assigned to clinic+Internet or home-based groups if they declared no strong preference (n=491). The overall response rate was 44.8% (819/1827). The primary outcome was parenting self-competence, as measured by the Parenting Stress Index (PSI) Competence subscale, and the Karitane Parenting Confidence Scale scores. Secondary outcome measures included PSI Isolation, Interpersonal Support Evaluation List-Short Form, Maternal Support Scale, Ages and Stages Questionnaire-Social-Emotional and MacArthur Communicative Development Inventory (MCDI) scores. Assessments were completed offline via self-assessment questionnaires at enrolment (mean child age=4.1 weeks, SD 1.3) and again when infants were aged 9, 15, and 21 months.

RESULTS

Generalized estimating equations adjusting for post-randomization baseline imbalances showed that differences in outcomes between mothers in the clinic+Internet and home-based support groups did not exceed the pre-specified margin of inferiority (0.25 of a SD) on any outcome measure at any follow-up assessment, with the exception of MCDI scores assessing children's language development at 21 months for randomized mothers, and PSI Isolation scores at 9 months for preference mothers.

CONCLUSION

Maternal and child outcomes from a clinic-based postnatal health check plus nurse-moderated Internet-based support were not inferior to those achieved by a universal home-based postnatal support program. Postnatal maternal and infant support using the Internet is a promising alternative to home-based universal support programs.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry Number (ANZCTR): ACTRN12613000204741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363712&isReview=true (Archived by WebCite at http://www.webcitation.org/6rZeCJ3k1).

Usage, adherence and attrition: how new mothers engage with a nurse-moderated web-based intervention to support maternal and infant health. A 9-month observational study

OBJECTIVES

To identify factors predicting use, adherence and attrition with a nurse-moderated web-based group intervention designed to support mothers of infants aged 0-6 months.

DESIGN

9-Month observational study.

SETTING

Community maternal and child health service.

PARTICIPANTS

240 mothers attending initial postnatal health checks at community clinics who were randomly assigned to the intervention arm of a pragmatic preference randomised trial (total randomised controlled trial, n=819; response rate=45%).

INTERVENTION

In the first week (phase I), mothers were assisted with their first website login by a research assistant. In weeks 2-7 (phase II), mothers participated in the web-based intervention with an expectation of weekly logins. The web-based intervention was comparable to traditional face-to-face new mothers' groups. During weeks 8-26 (phase III), mothers participated in an extended programme at a frequency of their choosing.

PRIMARY OUTCOME MEASURES

Number of logins and posted messages. Standard self-report measures assessed maternal demographic and psychosocial characteristics.

RESULTS

In phase II, the median number of logins was 9 logins (IQR=1-25), and in phase III, it was 10 logins (IQR=0-39). Incident risk ratios from multivariable analyses indicated that compared to mothers with the lowest third of logins in phase I, those with the highest third had 6.43 times as many logins in phase II and 7.14 times in phase III. Fifty per cent of mothers logged-in at least once every 30 days for 147 days after phase I and 44% logged-in at least once in the last 30 days of the intervention. Frequency of logins during phase I was a stronger predictor of mothers' level of engagement with the intervention than their demographic and psychosocial characteristics.

CONCLUSIONS

Mothers' early use of web-based interventions could be employed to customise engagement protocols to the circumstances of individual mothers with the aim of improving adherence and reducing attrition with web-based interventions.

TRIAL REGISTRATION NUMBER

ACTRN12613000204741; Results.

Effectiveness of nurse home visiting for families in rural South Australia

AIM

To evaluate the effectiveness of a 2-year post-natal home-visiting programme delivered by nurses to socially disadvantaged mothers in rural regions of South Australia.

METHODS

The intervention group consisted of 225 mothers who lived in rural regions and enrolled in the programme between 2010 and 2012. The comparison group consisted of 239 mothers who lived in rural areas between 2008 and 2009 when the programme was not yet available. All participants were eligible for enrolment in the home-visiting programme. Participants in both groups were assessed at baseline (mean child age = 15.2 weeks, SD = 2.4), prior to programme enrolment, and again when children were aged 9, 18 and 24 months. Outcomes were evaluated using the Parent Stress Index, Kessler Psychological Distress Scale, Ages and Stages Questionnaire, Child Behaviour Checklist, and MacArthur Communicative Developmental Inventory.

RESULTS

During the follow-up period, there was little difference in the pattern of scores across the two groups. Mixed models adjusting for baseline differences between the groups did not identify any significant Group × Time interactions. This suggests that the linear trajectories of scores on outcomes did not differ significantly between the two groups.

CONCLUSIONS

Findings suggest that the home-visiting programme did not have a measurable effect on maternal or child outcomes. However, the programme was relatively early in its rollout, and the greater challenges of recruitment, training and support, along with rural nurses' broader responsibilities for delivering other maternal and child health services, may explain why effects seen in the metropolitan area were not evident in rural regions.

An equivalence evaluation of a nurse-moderated group-based internet support program for new mothers versus standard care: a pragmatic preference randomised controlled trial

Background

All mothers in South Australia are offered a clinic or home-visit by a Child and Family Health community nurse in the initial postnatal weeks. Subsequent support is available on request from staff in community clinics and from a telephone helpline. The aim of the present study is to compare equivalence of a single clinic-based appointment plus a nurse-moderated group-based internet intervention when infants were aged 0–6 months versus a single home-visit together with subsequent standard services (the latter support was available to mothers in both study groups).

Methods/Design

The evaluation utilised a pragmatic preference randomised trial comparing the equivalence of outcomes for mothers and infants across the two study groups. Eligible mothers were those whose services were provided by nurses working in one of six community clinics in the metropolitan region of Adelaide. Mothers were excluded if they did not have internet access, required an interpreter, or their nurse clinician recommended that they not participate due to issues such as domestic violence or substance abuse. Randomisation was based on the service identification number sequentially assigned to infants when referred to the Child and Family Health Services from birthing units (this was done by administrative staff who had no involvement in recruiting mothers, delivering the intervention, or analyzing results for the study). Consistent with design and power calculations, 819 mothers were recruited to the trial. The primary outcomes for the trial are parents’ sense of competence and self-efficacy measured using standard self-report questionnaires. Secondary outcomes include the quality of mother-infant relationships, maternal social support, role satisfaction and maternal mental health, infant social-emotional and language development, and patterns of service utilisation. Maternal and infant outcomes will be evaluated using age-appropriate questionnaires when infants are aged <2 months (pre-intervention), 9, 15, and 21 months.

Discussion

We know of no previous study that has evaluated an intervention that combines the capacity of nurse and internet-based services to improve outcomes for mothers and infants. The knowledge gained from this study will inform the design and conduct of community-based postnatal mother and child support programs.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12613000204741

Nurse perceptions of family home-visiting programmes in Australia and England

AIMS

Nurse home-visiting programmes are employed to enhance the functioning of disadvantaged mothers and young children. Despite the key role played by nurses, there is little empirical evidence describing the views and experiences of nurses who deliver home-visiting programmes. This study compared the views and experiences of nurses delivering home-visiting programmes in England and South Australia.

METHODS

Participants were 108 nurses delivering the South Australian Family Home Visiting programme (2008-2011), and 44 nurses delivering the Family Nurse Partnership programme in England (2007-2009). Data were collected using a standard questionnaire that was completed by nurses in each country. The questionnaire asked nurses about their level of influence on programme outcomes, approaches they used to retain maternal engagement with the home-visiting programmes, barriers to effective programme delivery and the effectiveness of supervision.

RESULTS

Both groups of nurses considered that their greatest influence was improving mothers' confidence with parenting skills and increasing mothers' knowledge about children's development. Each group identified quality of nurse-mother relationships as the factor most relevant to retaining maternal engagement. Other influential factors were flexibility of timing for visits and the capacity of the programmes to meet specific needs of mothers.

CONCLUSION

There was consistency in the nurses' views about the home-visiting programmes delivered in England and Australia. Future studies should utilise prospective designs to identify the mechanisms by which factors influence the quality of nurse-mother relationships, approaches used by nurses to solve family problems and elements of mother-nurse relationships that have the strongest influence on programme outcomes.

Implications of social isolation during cancer treatment. The implications of residence away from home during cancer treatment on patients' experiences: a comparative study

With the centralisation and specialisation of cancer services, patients may have to travel considerable distances and stay away from their homes during treatment. This paper describes a comparative study that sought to identify the effects on patients of receiving chemotherapy and/or radiotherapy away from their homes, families and social support networks. Eighty four cancer patients treated in Southampton (42 from Guernsey and 42 from Southampton) agreed to participate in a structured interview and a standardised measure of social support. There were few differences in terms of satisfaction with services between Guernsey patients who stayed away from home during treatment and Southampton patients who lived at home. Counter-intuitively, Guernsey patients perceived themselves to have better social support.

Is childhood allergy more common amongst an island population?

A rise in the prevalence of childhood asthma has been reported in both the UK and in several overseas countries during recent years. Wide geographical variations have also been demonstrated in the distribution of hay fever, atopic eczema and other allergic symptoms. It is the impression of many parents and some clinicians that allergic symptoms may be even higher amongst children in an island environment compared with a similar population on the mainland. To test this hypothesis, Guernsey and Jersey in the Channel Islands, and the Isle of Man in the Irish Sea participated as an independent arm in the International Study of Asthma and Allergy in Childhood (ISAAC). This entailed self-completion of a 38-part pretested and validated questionnaire in a classroom setting under standardised conditions. A total of 3,772 secondary students in school years eight and nine living in the three islands were compared with 27,507 students of similar age in 93 British secondary schools enrolled in the larger UK study. There are a number of demonstrable differences in climate, home environment and lifestyle factors between the islands and mainland UK. Although results were generally above the UK mean, they were comparable with the reference region of South West England and invariably below the UK maximum. For instance, the prevalence of 'ever wheezed?', 'wheezed in last twelve months?', 'wheezed with exercise?' and 'diagnosis of asthma' were a mean of 50.5%, 34.5%, 31% and 19.7% in the islands compared with a UK prevalence of 48.8%, 33.3%, 28.5% and 20.7%, whilst the prevalence of 'runny nose ever?' and 'runny nose in last twelve months?' was a mean of 46.6% and 36.7% in the islands, compared with 47.1% and 37.9% in the UK mean. These differences were not statistically significant. This information will be reassuring to parents of island children, and also demonstrates that services for the management of asthma and other allergic conditions should not be a higher public health priority in these locations than on the mainland of Britain.

The impact of travel on cancer patients' experiences of treatment: a literature review

This literature review aims to identify the impact of travel on cancer patients' experiences of treatment. With centralization of cancer services, patients may have to travel considerable distances from their homes and families, to receive specialist cancer treatment. Centralization of cancer services may have advantages in terms of concentrating clinical expertise, enhancing the range of ancillary facilities and rationalising the provision of expensive specialist equipment, but it is not known to what extent patients are affected by additional travel and the prospect of separation from their social networks. A systematic literature search using MEDLINE, SSCI, SOCA and PSYCHLIT, identified 11 relevant studies from six countries. The review showed a paucity of research on the implications of receiving cancer treatment far from home. Most studies can be criticised on methodological grounds. The evidence that travel distance and difficulty increases psychological distress, and reduces compliance with treatment and take up of treatment is largely inconclusive. However, travel to cancer treatment is described as inconvenient and a practical hardship for many patients. It may be perceived, or experienced as, a barrier to treatment. Future studies should evaluate the impact of travel to treatment on quality of life and perceived social support.

Tackling the tobacco challenge: achieving 'healthy public policy' in tobacco control in Guernsey

Scientific evidence identifying smoking as the major cause of poor health and premature death in both industrialised and increasingly in developing countries is now overwhelming. Despite this, for a variety of reasons, there has been reluctance amongst many Governments including that of Britain, to take all logical action necessary to restrict and reduce smoking, especially amongst the young. The States of Guernsey in the Channel Islands has recently agreed to introduce an integrated package of measures designed specifically to make smoking less attractive and less accessible and less affordable to young people in an attempt to reduce the number of addicted adult smokers. These measures include a total ban of all public advertising of tobacco, apart from at point of sale, a substantial price rise followed by further price rises for a minimum period of five years, a raising of the minimum age for the purchase of tobacco from 16 to 18 years, an increase in the size and content of pack health warnings, and increased funding for specific nonsmoking health promotion activities. The various barriers to achieving these reforms are described.

Focus groups: a method for developing consensus guidelines in general practice

The measurement of quality in any clinical discipline depends, in part, on a comparison with an accepted standard. Currently, such standards do not exist for the management of many common clinical situations in Australian general practice. As part of the General Practice Evaluation Programme, a group of Illawarra general practitioners (GPs) selected 'GP management of the menopause and asthma' for in-depth study, and were able to arrive at a consensus on 'principles of practice' and 'minimal acceptable care' for these conditions through a series of focus (research) group meetings. However, the process by which these standards were derived was felt, of itself, to be a valuable means of: (i) reducing professional isolation; (ii) promoting quality assurance; (iii) introducing peer review; (iv) introducing clinical audit; and (v) providing meaningful and targeted continuing medical education appropriate to Australian general practice. This paper describes the focus group methodology used in this process.

Retention and use of personal health records: a population-based study

A parent-held record has been issued to all children born in New South Wales (NSW), Australia since 1988. Five years after its introduction, an evaluation was undertaken to determine its retention rate over time, rate of documentation of immunization status and other important child health information, and its perceived usefulness to parents. The cross-sectional study comprised an interviewer administered questionnaire to 622 households derived from a stratified random sample of 25 local government areas, representative of 73% of all households containing children under 5 years of age in NSW. A concurrent postal survey assessed the attitudes and use of the Personal Health Record (PHR) among a stratified random sample of 911 health care providers. Results showed that the PHR was well retained, with 89% claimed retention at 4 years, and over 78% of parents able to produce the record for inspection at interview. Of the records examined, 91% had at least one immunization recorded while 68% had a complete regimen documented by age 4 years. Overall, 93% of parents expressed satisfaction with the PHR, while 64% of all health care providers also felt that the PHR was 'beneficial to the health care children received', although only 53% of these used it regularly to record their findings. It is concluded that the PHR currently issued in NSW is well retained and valued by parents, and used by and useful to a range of health professionals.

Managing asthma in accident and emergency departments: an assessment in non teaching hospitals

BACKGROUND

The management and follow-up of asthma patients presenting at Accident and Emergency (A&E) departments have mostly been studied in children's hospitals or specialised teaching hospitals.

AIMS

To study the adequacy of assessment, treatment and follow-up of patients presenting at A&E departments in non-teaching hospitals. To compare the assessment and management of asthma in A&E departments among hospitals in a health region.

METHODS

A twenty-five per cent sample of presentations to A&E departments in all public hospitals in the Illawarra for one year was selected for a case note audit. Information on demographics, assessment, management and referral was extracted from the A&E case notes and medical records of cases with documentation of a final diagnosis of asthma. Chi square and Fischer's Exact tests were used for comparisons among hospitals.

RESULTS

Of 359 presentations with a final diagnosis of asthma, 88% were self referred and only 5% were first presentations. Objective measures of airways obstruction was not documented in 34% of admissions and 48% of nonadmissions. There was no documented follow-up in 28% of cases. The assessment and management of asthma in A&E was significantly poorer in smaller hospitals.

CONCLUSION

Evidence of high use of A&E as a primary care facility by asthma patients was found in the study. There is a need to implement protocols to optimise assessment and treatment of asthma in smaller hospitals.

Local injury information, community participation and injury reduction

Better injury prevention is now a national health priority in Australia. Applying the health promotion strategies of the Ottawa Charter to injury prevention forms the basis of the World Health Organization's worldwide Safe Communities program. Taking such a community-focused approach has led to quantifiable reductions in injuries in several overseas countries, particularly in Scandinavia where falls of up to 30 per cent in particular injuries have been reported over a three-year period. In the Illawarra area of New South Wales, data from local hospital emergency departments have been used as the basis for a 'community information' strategy, in an attempt to replicate this overseas experience in an Australian setting. Reductions of 17 per cent in attendances by children for injuries (P < 0.001) and a 14 per cent fall in accident-related hospital admissions of children (not statistically significant) have been observed over the course of the four-year intervention. Problems of community definition and external confounding influences outside the control of the project make it difficult to confirm a causal relationship. However, community information forms one important component in a comprehensive local injury-reduction strategy.

The personal health record. Making it work better for general practitioners

Personal Health Records held by parents are an important initiative towards improved child health in Australia. Although they have now been introduced in most States and Territories, few general practitioners make full use of them. A recent major study conducted in New South Wales suggests ways in which their use and usefulness can be improved for general practitioners.

Assessment of general practitioners' asthma knowledge

This paper outlines the results of a knowledge questionnaire on asthma answered by a group of general practitioners. This information is used to design an educational programme for general practitioners.

Are herbal teas safe for infants and children?

The use of herbal teas is now widespread in our community--even among children. The effect of dosing children with these products is unknown. The authors feel that the potential hazards associated with herbal teas need to be exposed.