Caseload management framework for public health nurses in the Republic of Ireland

This article outlines the steps taken in a change management project to develop and implement a national caseload management framework for clinical nursing activities within public health nursing services in the Republic of Ireland. It involved the development of metrics, definitions, data collection resources and relevant written procedures. It was developed and implemented over a period of 12 months and involved the engagement and involvement of approximately 2000 frontline, management and administrative staff. Implementation was challenging due to the lack of software systems to collect and return data and support caseload management. Alternative IT-based data collection systems were identified, and work is ongoing to develop additional metrics and resources that will continue to support caseload management.

Optimization of home care nurses in Canada: A scoping review

Nurses are among the largest providers of home care services thus optimisation of this workforce can positively influence client outcomes. This scoping review maps existing Canadian literature on factors influencing the optimisation of home care nurses (HCNs). Arskey and O'Malley's five stages for scoping literature reviews were followed. Populations of interest included Registered Nurses, Registered/Licensed Practical Nurses, Registered Nursing Assistants, Advanced Practice Nurses, Nurse Practitioners and Clinical Nurse Specialists. Interventions included any nurse(s), organisational and system interventions focused on optimising home care nursing. Papers were included if published between January 1, 2002 up to May 15, 2015. The review included 127 papers, including 94 studies, 16 descriptive papers, 6 position papers, 4 discussion papers, 3 policy papers, 2 literature reviews and 2 other. Optimisation factors were categorised under seven domains: Continuity of Care/Care; Staffing Mix and Staffing Levels; Professional Development; Quality Practice Environments; Intra-professional and Inter-professional and Inter-sectoral Collaboration; Enhancing Scope of Practice: and, Appropriate Use of Technology. Fragmentation and underfunding of the home care sector and resultant service cuts negatively impact optimisation. Given the fiscal climate, optimising the existing workforce is essential to support effective and efficient care delivery models. Many factors are inter-related and have synergistic impacts (e.g., recruitment and retention, compensation and benefits, professional development supports, staffing mix and levels, workload management and the use of technology). Quality practice environments facilitate optimal practice by maximixing human resources and supporting workforce stability. Role clarity and leadership supports foster more effective interprofessional team functioning that leverages expertise and enhances patient outcomes. Results inform employers, policy makers and relevant associations regarding barriers and enablers that influence the optimisation of home care nursing in nursing, intra- and inter-professional and inter-organisational contexts.

Progress on a Call to Action: Nurses as Leaders in Disaster Preparedness and Response

This article provides an update on the progress of the "Call to Action: Nurses as Leaders in Disaster Preparedness and Response." A steering committee, initiated, directed, and supported by the Veterans Emergency Management Evaluation Center of the US Department of Veterans Affairs, has undertaken the work of bringing together subject matter experts to develop a vision for the future of disaster nursing. The ultimate goal is to ensure that every nurse is a prepared nurse. As one result of this work, the Society for the Advancement of Disaster Nursing has held its inaugural meeting in December 2016.

Public health nursing needs to reach out

In one of her first acts after taking office in July, prime minister Theresa May announced an equalities audit of public services. The audit will cover how minorities and white working class people are treated in health, education, employment, welfare, skills and criminal justice. The prime minister said the review would 'shine a light on injustices'.

Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity

BACKGROUND

Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada.

METHODS

A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis.

RESULTS

Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations.

CONCLUSIONS

This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity.

Geo-spatial Informatics in International Public Health Nursing Education

This poster describes results of an undergraduate nursing informatics experience. Students applied geo-spatial methods to community assessments in two urban regions of New Zealand and the United States. Students used the Omaha System standardized language to code their observations during a brief community assessment activity and entered their data into a mapping program developed in Esri ArcGIS Online, a geographic information system. Results will be displayed in tables and maps to allow comparison among the communities. The next generation of nurses can employ geo-spatial informatics methods to contribute to innovative community assessment, planning and policy development.

I was inspired to start exercising and am already feeling the benefits

My thanks for an excellent public health special issue, and particularly Jennifer Trueland's feature article, 'Get fit - then help others too' (Features June 25).

Multiple stakeholder views on changes in delivery of public health nursing services in Ireland

In contrast with community nursing services in the UK and other parts of the world, the public health nursing service in the Republic of Ireland operates as a generalist service, providing both public health and wellbeing services in addition to clinical nursing services to a wide range of patient groups. While much discussion has taken place over the years about the benefits and challenges of a generalist service, little consensus has emerged about whether the current generalist approach should be maintained or whether a more specialised approach is required. This article presents key findings from an evaluation, using research methods, of a community nursing service that was restructured from a generalist, geographically based service, to a more specialist team-based model. The findings across multiple stakeholders show a number of positive effects in the areas of quality, safety, risk, governance, active caseload management, and finances. Some challenges were also identified, particularly with respect to continuity of services, loss of expertise, role of the team leader, and engagement in population-based activities.

Lifestyle modifications supported by regional health nurses lowered insulin resistance, oxidative stress and central blood pressure in subjects with metabolic syndrome

BACKGROUND

This study was attempted to investigate whether lifestyle modifications supported by regional health nurses should improve cardio-metabolic factors--including adipocytokines, oxidative stress, and arterial stiffness--in subjects with metabolic syndrome.

METHODS

Thirty-six subjects with metabolic syndrome were enrolled, 28 of whom completed the 6-month lifestyle modifications (male:female=19:9). Blood and urine test results were examined in relation to metabolic factors before and after 6-month nutritional and physical activity modifications. In addition, oral glucose tolerance tests were performed and arterial stiffness was measured by brachial-ankle pulse wave velocity and radial augmentation index before and after them.

RESULTS

Six-month lifestyle modifications significantly reduced body weight, homeostasis model assessment index, and low-density lipoprotein cholesterol (LDL-C). They significantly attenuated oxidative stress measured by the urinary 8-hydroxy-2-deoxyguanosine/creatinine ratio. They also lowered brachial and central systolic blood pressure. They tended to decrease waist circumferences and the levels of C-reactive protein. However they did not significantly change the levels of adipocytokines, including tumour necrosis factor, soluble tumour necrosis factor receptors, and interleukin 6, or arterial stiffness measured by brachial-ankle pulse wave velocity and radial augmentation index.

CONCLUSIONS

Six-month lifestyle modifications supported by regional health nurses lowered body weight, insulin resistance, LDL-C, oxidative stress, and peripheral and central blood pressure in subjects with metabolic syndrome.

Changes in the organizational structure of public health nurse service in the Republic of Croatia 1995 to 2012

Since 1996, after the privatization of primary health care, public health nurse (PHN) in Croatia remained employed within the health center, mainly responsible for the preventive care of the inhabitants from defined catchment's area. Before that time they were part of general practice teams. The main aim of the study was to investigate what are the trends in the organizational structure of PHN service in Croatia, from 1995-2012. The main source was the Croatian Health Service Yearbooks. The obtained results shows that they are college educated and mostly in full-time jobs. The important findings are the lack of nurses and theirs regional differences. In highly demanding societies, with growing numbers of elderly, mental, social and economic problems, it will be worthy to consider the lower standard then 5 100 inhabitants per one PHN. Also, it should be taken into account to invest into the lowering of regional disparities.

Did the structure of work in the public health nurse service of the Republic of Croatia change in the period 1995-2012?

In Croatia, public health nurses (PHN) have been members of family doctor (FD) teams for decades, conducting a multifunctional and polyvalent scope of activities, including health promotion, prevention, as well as part of the treatment for the inhabitants of a defined catchment area. The main aim of the study was to investigate the trends in the number and structure of PHN visits in the period from 1996 to 2012. The main sources of data were Croatian Health Service Yearbooks. The results strongly indicate that PHN's are overloaded by a high number of visits, especially to chronic patients. While mothers and new-born children are in the PHN care, pregnant women and small children are rather neglected. Considering different working conditions and differences in population needs, a review of the standard is recommendable.

Parenting in Fukushima City in the post-disaster period: short-term strategies and long-term perspectives

Growing evidence indicates the adverse psychological and welfare consequences of nuclear power accidents particularly among parents of small children. However, little has been published about the public health experiences of and practical countermeasures to deal with such consequences for parents of small children in the aftermath of disasters. Based on our past research efforts to develop parenting support programmes in Fukushima City, we describe here the discussions and resulting strategies that developed from collaborative efforts between university researchers and public health nurses after the Fukushima nuclear plant accident caused by the Great East Japan Earthquake. The processes presented here may be useful to improve national and international preparedness to protect the health of parents and children in future nuclear disasters.

Get fit--then help others too

Barts Health NHS Trust in London is at the forefront of a drive to place senior public health professionals in acute trusts. Under the leadership of public health director Ian Basnett, Barts is encouraging staff to not only give patients lifestyle advice, but participate in the trust's own exercise classes and sports events.

No communicable diseases this month: public health nursing at the Colorado River Relocation Center, 1942-1945

In the name of public safety, the US government forcibly removed more than 110 000 Japanese Americans from their homes along the West Coast of the United States during World War II. Incarcerated in crude barracks located in remote locations, Japanese Americans were suddenly required to share laundry facilities, toilets, showers, and mess halls with hundreds of likewise incarcerated Japanese Americans. With conditions ripe for spreading communicable disease, public health nurses relied on health promotion techniques of the time to prevent epidemic outbreaks of diseases such as measles, polio, and tuberculosis.

Leveraging public health nurses for disaster risk communication in Fukushima City: a qualitative analysis of nurses' written records of parenting counseling and peer discussions

BACKGROUND

Local public health nurses (PHNs) have been recognized as the main health service providers in communities in Japan. The Fukushima nuclear disaster in 2011 has, however, created a major challenge for them in responding to mothers' concerns. This was in part due to difficulties in assessing, understanding and communicating health risks on low-dose radiation exposure. In order to guide the development of risk communication plans, this study sought to investigate mothers' primary concerns and possible solutions perceived by a core healthcare profession like the PHNs.

METHODS

A total of 150 records from parenting counseling sessions conducted between PHNs and mothers who have attended mandatory 18-month health checkups for their children at the Fukushima City Health and Welfare Center in 2010, 2011 (year of disaster) and 2012 were examined. Discussion notes of three peer discussions among PHNs organized in response to the nuclear disaster in 2012 and 2013 were also analyzed. All transcribed data were first subjected to text mining to list the words according to their frequencies and inter-relationships. The Steps Coding and Theorization method was then undertaken as a framework for qualitative analysis.

RESULTS

PHNs noted mothers to have considerable needs for information on radiation risks as they impact on decisions related to relocations, concerns for child safety, and experiences with interpersonal conflicts within the family owing to differing risk perceptions. PHNs identified themselves as the information channels in the community, recommended the building of their risk communication capacities to support residents in making well-informed decisions, and advocated for self-measurement of radiation levels to increase residents' sense of control. PHNs also suggested a more standardized form of information dissemination and an expansion of community-based counseling services.

CONCLUSIONS

Inadequate risk communication on radiation in the Fukushima nuclear incident has resulted in multiple repercussions for mothers in the community. Empowerment of local residents to assume more active roles in the understanding of their environment, increasing PHNs' capacity in communication, and an expansion of health services such as counseling will together better address risk communication challenges in post-disaster recovery efforts.

Developing and sustaining leadership in public health nursing: findings from one British Columbia health authority

OBJECTIVE

To develop clinical leadership among front-line public health nurses (PHNs).

METHODS

This paper describes a quality improvement process to develop clinical leadership among front-line PHNs. Three activities were undertaken by a working group consisting mainly of front-line staff: engaging PHNs in an online change-readiness questionnaire, administering a survey to clients who had ever used public health services delivered by one Vancouver Community Infant, Child and Youth (ICY) program team and conducting three group interviews with public health providers. The group interviews asked about PHN practice. They were analyzed using thematic content analysis.

RESULTS

This quality improvement project suggests that PHNs (n=70) strongly believed in opportunities for system improvement. Client surveys (n=429) and community partner surveys (n=79) revealed the importance of the PHN role. Group interview data yielded three themes: PHNs were the "hub" of community care; PHNs lacked a common language to describe their work; PHNs envisioned their future practice encompassing their full scope of competencies. PHNs developed the "ICY Public Health Nursing Model," which articulates 14 public health interventions and identifies the scope of their work.

CONCLUSION

Developing and sustaining clinical leadership in front-line PHNs was accomplished through these various quality assurance activities.

Protection of Freedoms Act 2012: safeguarding vulnerable groups

In last month's article on changes to the law protecting vulnerable adults from harm by health and social care professionals, Richard Griffith and Cassam Tengnah discussed changes to be made to Criminal Records Bureau checks. This month's article discusses the changes to the vetting and barring scheme to be introduced under the Protection of Freedoms Act 2012, which mean that people currently working in regulated activities with vulnerable groups, such as district nurses, will no longer need to register and be monitored by the independent safeguarding authority or its replacement, the Disclosure and Barring Service.

Professional advocacy: linking Virginia's story to public policy-making theory, learning from the past and applying it to our future

Too often the nursing profession has been shortsighted regarding its ability to educate legislators and the public on the value of the nurse and the need for policy change. This has stagnated the profession's agenda setting, influence, and position. Virginia nurses, however, rose to the challenge a few years ago. They addressed the nursing faculty shortage by introducing legislation to improve faculty salaries and promote nursing education. They fully defined their problem, formed a unified coalition to develop a solution, and found the political environment favorable for policy change. Their advocacy success story can lend guidance and encouragement for advocacy for the profession. Linking their successful road to policy change to the B. B. Longest (2010) public policy-making framework provides a roadmap for future success.

Adaptation and implementation of the nurse-family partnership in Canada

OBJECTIVES

International agencies are required to adapt, pilot and then evaluate the effectiveness of the Nurse-Family Partnership (NFP) prior to broad implementation of this public health intervention. The objectives of this qualitative case study were to: 1) determine whether the NFP can be implemented in Canada with fidelity to the US model, and 2) identify the adaptations required to increase the acceptability of the intervention for service providers and families.

PARTICIPANTS

108 low-income, first-time mothers in Hamilton, Ontario, received the NFP intervention. In-depth interviews were conducted with NFP clients (n=38), family members (n=14) and community professionals (n=24).

SETTING

Hamilton, Ontario.INTERVENTION AND DATA COLLECTION: An intensive nurse home visitation program delivered to women starting early in pregnancy and continuing until the child was two years old. Processes to adapt and implement the NFP were explored across seven focus groups with public health nurses and managers. Eighty documents were reviewed to identify implementation challenges. Data were analyzed using directed content analysis.

OUTCOMES

The NFP model elements are acceptable to Canadian health care providers, public health nurses and families receiving the intervention. The primary adaptation required was to reduce nurse caseloads from 25 to 20 active clients. Recommendations for adapting and implementing all model elements are described.

CONCLUSION

The NFP model requires minor adaptations to increase the acceptability of the intervention to Canadian stakeholders. A consistent approach to adapting the NFP program in Canada is necessary as provincial jurisdictions commit themselves to supporting an experimental evaluation of the effectiveness of the NFP.

Community empowerment for health visiting and other public health nursing

This paper explores the community empowerment aspect of health promotion, where social experience is a key indicator of health, from the perspective of health visiting and other public health nursing. This contemporary model of practice is put into a health promotion context by use of a slightly modified framework and by the inclusion of examples of methods and outcomes of practice that link conceptually with the health assets model and aspects of 'Big Society' thinking. Community development, social capital and capacity building are discussed as key elements of community empowerment with a 'bottom-up' agenda driven by community members. This concerns micro-population health gain, where the process, the quality of the public health nurse-community relationship, is as important as outcome.

Advanced physical assessment skills: implementation of a module

This article aims to explore and examine advanced physical assessment skills and the role of the district nurse. It will particularly highlight district nurses' perceptions of how they may implement skills learnt on a new module introduced into the Community Health Care Nursing degree at a university in London. Physical assessment skills have traditionally been viewed as part of a doctor's role; however, with the advancement of nursing roles, it is argued that it has become a key nursing skill. As Government policy continues to expect health professionals to keep patients in the community who have complex health and social care needs, the role of the district nurse presents as 'best placed' to take on this challenge (Department of Health (DH), 2005a; 2005b). Evaluation of the district nurses' perceptions of their practice is shared here, highlighting some of the challenges that they face. The article will address the complexity of developing a curriculum in response to the DH initiatives and the importance of listening to students on courses.

Activity promotion for community-dwelling older people: a survey of the contribution of primary care nurses

STUDY AIMS

To discover the current level of nurse-led involvement in activity promotion for older people in primary care and to explore the knowledge and attitudes of primary care nurses about health benefits of activity promotion for older people.

BACKGROUND

The importance of improving and maintaining activity levels in later life is well established. However, intervention studies show that the uptake of and adherence to physical activity programmes by older people are highly variable. The optimal approach to activity promotion for older people is not well understood. Although many activity promotion schemes and evaluations assume that specialist exercise trainers are needed, it remains unclear who is best placed to facilitate activity promotion for older people, and if this is something in which existing primary care practitioners (specifically nurses) could and should take a leading role.

METHODS

This study surveyed all nurses and health visitors working in five primary care organizations in an inner city area. A semi-structured postal questionnaire asked about their knowledge and attitudes to the benefits of exercise in later life, their current levels of involvement in promoting physical activity with older people, and their personal activity levels.

FINDINGS

The overall response rate was 54% (n=521). The responses of 391 district nurses and practice nurses are presented here. Nurses had the commitment and (depending on the focus of their work) different opportunities to promote physical activity with older patients. There were organizational and individual constraints on their ability to be involved in this aspect of health promotion work themselves, or to refer older people to local activity promotion schemes. Nurses did not have a structured approach when promoting physical activity with older people and had only a partial awareness of the limitations of their knowledge or skills when promoting activity with older people.

CONCLUSIONS

For promotion of physical activity by older people to be meaningfully incorporated into primary care nursing work there is a need to develop a more strategic approach that can optimize the opportunities and interest of primary care nurses and develop the knowledge and skills of the workforce in this area of nursing work.

District nurses' and aseptic technique: where did it all go wrong?

Concerns have been raised about whether it is possible to perform aseptic procedures within a community setting. Hallett (2000) has described how community nurses often have a fatalistic view about whether such procedures can really be performed at home. At the same time there has been an increase in the number of patients being cared for at home who need interventions which must adhere to the principles of asepsis. While it has been acknowledged for some time that community nurses must be resourceful and adapt the procedure, the view that community nurses cannot really perform aseptic procedures is a fairly new phenomenon. This article explores the reasons why concerns about the performance of aseptic procedures in the community may have arisen and what steps can be taken to address these concerns to ensure that care at home is both safe and effective.

The Health and Social Care Act 2008

Several inquiry reports have shown that there is still a need to further improve health and social care and strengthen public confidence in these services. The reports have particularly emphasized the need for stricter regulation of health and adult social care providers and the need to use statutory powers to ensure compliance with quality and safety standards.This article outlines how the provisions of the Health and Social Care Act 2008 aim to address this need to further regulate quality and safety standards in health and social care.

Technology-enhanced practice for patients with chronic cardiac disease: home implementation and evaluation

OBJECTIVE

This 3-year field experiment engaged 60 nurses and 282 patients in the design and evaluation of an innovative home-care nursing model, referred to as technology-enhanced practice (TEP).

METHODS

Nurses using TEP augmented the usual care with a web-based resource (HeartCareII) that provided patients with self-management information, self-monitoring tools, and messaging services.

RESULTS

Patients exposed to TEP demonstrated better quality of life and self-management of chronic heart disease during the first 4 weeks, and were no more likely than patients in usual care to make unplanned visits to a clinician or hospital. Both groups demonstrated the same long-term symptom management and achievements in health status.

CONCLUSION

This project provides new evidence that the purposeful creation of patient-tailored web resources within a hospital portal is possible; that nurses have difficulty with modifying their practice routines, even with a highly-tailored web resource; and that the benefits of this intervention are more discernable in the early postdischarge stages of care.

Right Nurse, Right Skills: quality before quantity

There is an old story about frogs that may or may not be true. It is said that, if you put a frog in a pan of cold water and slowly heat it, the frog will allow itself to be boiled to death rather than jump out. The analogy has been used many times before about different sections of the NHS workforce. It recognizes their capacity to continue to absorb pressure long past the point where others might, and should, bail out.

Supporting the competence of practitioners: back to the future?

Health visitors have traditionally been part of the public health workforce, but changes within the NHS have resulted in a reduced public health role.With the development of NMC public health competencies and renaming of their qualification to specialist community public health nurse (SCPHN), their public health role has again become prominent. This study aimed to examine whether practitioners were supported in fulfilling the development of these competencies and to identify strategic resources within the local health service that would either help or hinder these developments.A qualitative approach and purposive sampling were utilised, resulting in five participants in two focus groups. Findings were set within the continually evolving context of government policy and local health agendas--the potential facilitation or conflict of competence afforded by the local health strategies, priorities and requirements of the local and national health economy, the capabilities of health visiting staff and their service as a whole and the role of historical and cultural issues, and the future service and workforce development. Further research is recommended to increase understanding of the processes that inform and evaluate local health service priorities, their impact upon practitioners and how SCPHNs may develop their competence in public health practice.