Everyday District Nurses' Experiences Revealed Through Distillation: Palliative Care in the Community - an Action Research Project

<p>Distillation is used to extract and reveal essential oils and essences. Action research is a methodology that enables distillation of nurses' experiences, to reveal previously unseen elements and essences of nursing care, to identify issues and to extract tangible change or action outcomes. This modified action research inquiry focused on the everyday, palliative care practice experiences of a group of district nurses. The intent was to develop an understanding of common issues of concern for this group of district nurses when providing palliative home care in a specific community context and to implement practical, achievable strategies in response to these local issues. Five district nurses identified four broad areas for action through four praxis group meetings and comprising one full cycle. These four areas have been named as methods of enhancing support for people and families, possibilities for creatively managing workloads, mechanisms to enrich working partnership with other palliative care providers and possible vehicles for supporting nurses' self care. Implementation of action from this action research project focused on enhancing care and outcomes for people and family served by this group of district nurses in their local community. This study illuminates everyday essences of the district nurse role and the elements articulated by this group in supporting their practice in one New Zealand community. This study also reveals some of the tensions and messiness when employing an action research methodology with nurses in the workplace. This research focused on a little known area (palliative care delivered by district nurses in New Zealand) in a local community (a culturally vibrant and ethnically diverse yet with poor health and socioeconomic statistics). It has resonance with other nurses, particularly those working in community settings who may experience similar issues and concerns. This research also offers important insights for nurses working in any practice setting, with a desire to unpick and distill local issues they encounter - to take action and make a difference.</p>

Everyday District Nurses' Experiences Revealed Through Distillation: Palliative Care in the Community - an Action Research Project

<p>Distillation is used to extract and reveal essential oils and essences. Action research is a methodology that enables distillation of nurses' experiences, to reveal previously unseen elements and essences of nursing care, to identify issues and to extract tangible change or action outcomes. This modified action research inquiry focused on the everyday, palliative care practice experiences of a group of district nurses. The intent was to develop an understanding of common issues of concern for this group of district nurses when providing palliative home care in a specific community context and to implement practical, achievable strategies in response to these local issues. Five district nurses identified four broad areas for action through four praxis group meetings and comprising one full cycle. These four areas have been named as methods of enhancing support for people and families, possibilities for creatively managing workloads, mechanisms to enrich working partnership with other palliative care providers and possible vehicles for supporting nurses' self care. Implementation of action from this action research project focused on enhancing care and outcomes for people and family served by this group of district nurses in their local community. This study illuminates everyday essences of the district nurse role and the elements articulated by this group in supporting their practice in one New Zealand community. This study also reveals some of the tensions and messiness when employing an action research methodology with nurses in the workplace. This research focused on a little known area (palliative care delivered by district nurses in New Zealand) in a local community (a culturally vibrant and ethnically diverse yet with poor health and socioeconomic statistics). It has resonance with other nurses, particularly those working in community settings who may experience similar issues and concerns. This research also offers important insights for nurses working in any practice setting, with a desire to unpick and distill local issues they encounter - to take action and make a difference.</p>

Intertwining the Role of Partner and Caregiver: a Phenomenological Study of the Experiences of Four New Zealand Rural Women Who have Cared for Their Terminally Ill Partners

<p>The stories of the women who live and work in rural settings in New Zealand have begun to reveal unique contributions that they have made to their families and community. Meeting with and listening to rural women's stories reveals insights into the character of these powerful women. This research study evolved from a trend the researcher observed as a district nurse providing community palliative care in rural New Zealand; that the majority of carers of those who are terminally in home-settings are in fact women. This qualitative study aimed to explore through guided conversational interviews the experiences of four New Zealand women who have cared for their terminally ill partners who have subsequently died. The study investigated if these women's experiences were comparable to that of other women in existing palliative care literature. This research project focused particularly on elucidating the women's experience of intertwining the role of partner and caregiver. Heidegger's hermeneutic philosophy informed the methodology because he focused on what it meant to 'be' rather than 'how we know what we know'. The project focused on the meanings the women made of this dual role in their lives. Women already in the role of partner were now faced with the added responsibility of caregiver to meet the complex needs of their loved one. Usually they had no training to prepare them for this experience. The study reveals ways in which the visiting palliative care nurse becomes very important to them. The women's own voices reveal the high level of respect for their partners and address the harsh realities, revealing poignant and striking concerns in their lives. These stories are shared with the intent of enriching nurses' and other health professionals' understanding of the women's experiences. The intention of the study is to highlight the need for closer attention by nurses to women's requirements when caring for their partner at home. Understanding these women's experience is not only a way of honouring these remarkable women but more widely it will inform and possibly transform practice through guideline and policy refinement.</p>

Intertwining the Role of Partner and Caregiver: a Phenomenological Study of the Experiences of Four New Zealand Rural Women Who have Cared for Their Terminally Ill Partners

<p>The stories of the women who live and work in rural settings in New Zealand have begun to reveal unique contributions that they have made to their families and community. Meeting with and listening to rural women's stories reveals insights into the character of these powerful women. This research study evolved from a trend the researcher observed as a district nurse providing community palliative care in rural New Zealand; that the majority of carers of those who are terminally in home-settings are in fact women. This qualitative study aimed to explore through guided conversational interviews the experiences of four New Zealand women who have cared for their terminally ill partners who have subsequently died. The study investigated if these women's experiences were comparable to that of other women in existing palliative care literature. This research project focused particularly on elucidating the women's experience of intertwining the role of partner and caregiver. Heidegger's hermeneutic philosophy informed the methodology because he focused on what it meant to 'be' rather than 'how we know what we know'. The project focused on the meanings the women made of this dual role in their lives. Women already in the role of partner were now faced with the added responsibility of caregiver to meet the complex needs of their loved one. Usually they had no training to prepare them for this experience. The study reveals ways in which the visiting palliative care nurse becomes very important to them. The women's own voices reveal the high level of respect for their partners and address the harsh realities, revealing poignant and striking concerns in their lives. These stories are shared with the intent of enriching nurses' and other health professionals' understanding of the women's experiences. The intention of the study is to highlight the need for closer attention by nurses to women's requirements when caring for their partner at home. Understanding these women's experience is not only a way of honouring these remarkable women but more widely it will inform and possibly transform practice through guideline and policy refinement.</p>

Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study

Background The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0. Methods A longitudinal observational study was conducted from January 2016 till October 2017. Two questionnaires were send out, one to collect characteristics of general practices such as practice neighbourhood socio-economic status, general practice versus healthcare centre (involving multiple primary care professionals), and professional- frail older patient ratio per practice of general practitioners and practice nurses. Regarding delivering the program, the practice or district nurse who delivered the program, number of years since the start of the implementation, and choice of age threshold for frailty screening were collected. Patient outcomes collected by the second questionnaire and send to frail patients were daily functioning, hospital admissions, emergency department visits, and general practice out-of-hours consultations. Linear and generalized linear mixed models were used. Results A total of 827 frail older people were included at baseline. Delivery of the program by a district nurse compared to a practice nurse was significantly associated with a decrease in daily functioning on patient-level (β = 2.19; P = < 0.001). Duration since implementation of 3 years compared to 9 years was significantly associated with less out-of-hours consultations to a general practice (OR 0.11; P = 0.001). Applying frailty screening from the age of 75 compared to those targeted from the age of 60 showed a significant increase in emergency visits (OR 5.26; P = 0.03). Conclusion Three associations regarding the organizational context 1) the nurse who delivered the program, 2) the number of years the program was implemented and 3) the age threshold for defining a frail patient are significant and clinically relevant for frail patients that receive a proactive primary care program. In general, contextual factors need more attention when implementing complex primary care programs which can result in better balanced choices to enhance effective proactive care for older people living in the community.

Predictors of district nursing care utilisation for community-living people in the Netherlands: an exploratory study using claims data

ObjectiveTo explore predictors of district nursing care utilisation for community-living (older) people in the Netherlands using claims data. To cope with growing demands in district nursing care, knowledge about the current utilisation of district nursing care is important.SettingDistrict nursing care as a part of primary care.ParticipantsIn this nationwide study, claims data were used from the Dutch risk adjustment system and national information system of health insurers. Samples were drawn of 5500 pairs of community-living people using district nursing care (cases) and people not using district nursing care (controls) for two groups: all ages and aged 75+ years (total N=22 000).Outcome measuresThe outcome was district nursing care utilisation and the 114 potential predictors included predisposing factors (eg, age), enabling factors (eg, socioeconomic status) and need factors (various healthcare costs). The random forest algorithm was used to predict district nursing care utilisation. The performance of the models and importance of predictors were calculated.ResultsFor the population of people aged 75+ years, most important predictors were older age, and high costs for general practitioner consultations, aid devices, pharmaceutical care, ambulance transportation and occupational therapy. For the total population, older age, and high costs for pharmaceutical care and aid devices were the most important predictors.ConclusionsPeople in need of district nursing care are older, visit the general practitioner more often, and use more and/or expensive medications and aid devices. Therefore, close collaboration between the district nurse, general practitioner and the community pharmacist is important. Additional analyses including data regarding health status are recommended. Further research is needed to provide an evidence base for district nursing care to optimise the care for those with high care needs, and guide practice and policymakers’ decision-making.

How district nurses can support team wellbeing during the pandemic and beyond

The COVID-19 pandemic has required rapid adaptation of the community nursing service, including the introduction of online communication platforms to prevent COVID-19 transmission among staff. Remote working has protected the workforce in the community from being decimated through team sickness, but has resulted in nurses who are feeling anxious and isolated from their colleagues while experiencing increased workloads, with complex and often emotionally challenging situations. The pressures of community nursing and the associated impact on sickness absence relating to mental health are well documented. The resources made available to support staff wellbeing were increased during the pandemic, but there remains some disparity of access to these resources. There is much that can be done by the district nurse as a leader of a team to ensure that the pressures are managed in a way that promotes team cohesion and mutual respect, while ensuring that open communication about wellbeing is encouraged.

Promoting health and wellbeing across community nursing teams: role of the specialist practitioner district nurse

There is a growing concern around the health and wellbeing of community nurses due to the high complexities of and demand on district nursing services. It is well recognised that district nursing services have no limits to their capacity, and they have been dealing with an increasing caseload, with no increases in resources or staff. Consequently, this has left community nurses feeling exhausted and experiencing burnout, which, in the long term, can lead to compassion fatigue, which can in turn compromise patient safety. Specialist practitioner qualified district nurses (SPQDN) require the skills and knowledge to promote health and wellbeing, in order to provide a positive work environment and limit work-related stress and burnout despite the challenges encountered. This article explores possible strategies to promote health and wellbeing among community nurses and the barriers that SPQDNs encounter in doing so.