Rural Home Care Nursing During COVID-19

BACKGROUND

The SARS-CoV-2 (COVID-19) pandemic continues to be a challenging time for the nursing profession globally. Research indicates that the care of patients with COVID-19 has caused significant psychological stress for nurses. Although much of the world's attention has been on nurses working in emergency departments and intensive care units, the pandemic also posed significant challenges for nurses providing home care services in rural communities.

PURPOSE

The purpose of this work was to describe the experiences of rural Canadian home care nurses during the early stages of the COVID-19 pandemic.

METHODS

The data for this analysis was derived from a study that explored the continuing education needs of rural home care nurses. Since the data collection for the primary objective occurred in the early stages of the COVID-19 pandemic, COVID-19 related themes were created using interpretive description methodology. Snowball and purposive sampling were used to recruit rural home care registered nurses who were employed in the central and southern areas of a western Canadian province.

RESULTS

Six themes were constructed from the data including: Nurses Must Work, Constant State of Flux, Threatened Safety, Loss of Learning Opportunities, Fearing the Unknown, and Hindsight is Easy.

CONCLUSION

The experiences of rural home care nurses during COVID-19 reflects the chaos, uncertainty, and fear that was felt globally. Based on the findings of this study, recommendations for future pandemic planning are suggested.

Continuing Education for Home Care Nurses: An Integrative Literature Review

With the wide range of clinical skills and responsibilities that home care nurses (HCNs) are expected to perform, it is important they are supported with access to relevant continuing nursing education (CNE) to perform their job safely and effectively. An integrative literature review was conducted to explore the current evidence on CNE for HCNs. Medline and CINAHL were searched and 13 articles that met the criteria were reviewed. The analysis identified three themes: (1) learning strategies (simulation, virtual gaming, elearning, traditional learning); (2) challenges (staffing, time, access, skill) and opportunities (incentive to stay employed, decreased burnout); and (3) learning needs (palliative, patient and family needs, older adults and dementia, acute nursing skills). Nurses who provide care to patients in their homes have very complex roles and responsibilities. In order to keep patients and nurses safe, standards of education for HCNs, beyond their basic education program, must be developed. These educational standards must be designed to address the complex medical needs of patients while making the educational opportunities accessible and value-added. Improving the CNE experience for HCNs has the potential to increase patient safety, improve care outcomes, increase nurse competence, improve retention, and decrease nurse burnout.

Rural and Remote Continuing Nursing Education: An Integrative Literature Review

Background:  Rural and remote nursing has unique practice requirements that create a need for distinct education and practice preparation.  Preparing registered nurses (RNs) to work in rural and remote communities is essential for the support and advancement of rural and remote health, as there is a shortage of rural and remote health care providers. Purpose:  An integrative literature review was conducted to identify the current continuing education needs of rural and remote RNs internationally. Sample: Eight studies were included in the integrative review of the literature.  Countries reported in the literature included Canada (n = 2), Australia (n = 2), Sweden (n = 1) and the United States (n = 3). Method:  An integrative literature review on rural and remote nursing practice continuing education was conducted using Torraco’s (2005) guidelines, in addition to Whittemore and Knafl’s (2005) methodological strategies.  A search strategy was created, tested, and approved by the research team.Themes were extracted, collated, analyzed, and knowledge synthesized. Findings:  Rural and remote RNs identified areas requiring enhanced ongoing training.  The identified training areas were summarized into the following four themes: 1) Comprehensive specialized nursing practice for direct patient care, 2) Unanticipated events, 3) Non-direct patient care, and 4) Advanced specialty courses. Conclusion:  The autonomy, competency, and expertise that is expected of RNs working in rural and remote locations requires educational supports. Rural and remote nursing continuing education is required in the areas of: comprehensive specialized nursing practice for direct patient care, unanticipated events, non-direct patient care, and advanced specialty courses.     Keywords: continuing education, integrative review, registered nurse(s), remote, rural Acknowledgements: The authors thank Saskatchewan Polytechnic for partial funding of this review through the Seed Applied Research Program.  The authors also thank their research team member Chau Ha and research assistant Devendrakumar Kanani for their contributions to this integrative review.