The Use of a Single-Time Sit-To-Stand Test in Ambulatory Individuals With Spinal Cord Injury by Primary Health Care Providers.

Background: The uncertain health care situations, such as that created by the COVID-19 pandemic, has limited hospital access and facilitated a paradigm shift in health care toward an increased demand for standard home visits and community-based rehabilitation services, including by ambulatory individuals with spinal cord injury (SCI). Objectives: This 6-month prospective study explored the validity and reliability of a single-time sit-to-stand (STSTS) test when used by primary health care (PHC) providers, including a village health volunteer, caregiver, individual with SCI, and health professional. Methods: Eighty-two participants were assessed for the STSTS using four arm placement conditions (arms on a walking device, arms on knees, arms free by the sides, and arms crossed over the chest) and standard measures, with prospective fall data follow-up over 6 months. Thirty participants involved in the reliability study were also assessed and reassessed for the ability to complete the STSTS conditions by PHC providers. Results: Outcomes of the STSTS test, except the condition with arms on a walking device, could significantly discriminate lower extremity muscle strength (LEMS) and mobility of the participants (rpb = -0.58 to 0.69) with moderate concurrent validity. Outcomes of the tests without using the arms also showed moderate to almost-perfect reliability (kappa = 0.754-1.000) when assessed by PHC raters. Conclusion: The findings suggest the use of an STSTS with arms free by the sides as a standard practical measure by PHC providers to reflect LEMS and mobility of ambulatory individuals with SCI in various clinical, community, and home-based settings.

Navigating COVID-19 linguistic landscapes in Vancouver's North Shore: official signs, grassroots literacy artefacts, monolingualism, and discursive convergence

This article describes the changing linguistic landscape on the North Shore of Vancouver, British Columbia, Canada, during the first three months of the COVID-19 pandemic. I present an account of the visual representation of change along the area's parks and trails, which remained open for socially-distanced exercise during the province's lockdown. Following the principles of visual, walking ethnography, I walked through numerous locations, observing and recording the visual representations of the province's policies and discourses of lockdown and social distancing. Examples of change were most evident in the rapid addition to social space of top-down signs, characterised mainly by multimodality and monolingualism, strategically placed in ways that encouraged local people to abide by social-distancing. However, through this process of observation and exploration, I noticed grassroots semiotic artefacts such as illustrated stones with images and messages that complemented the official signs of the provincial government. As was the case with the official signs and messages, through a process of discursive convergence, these grassroots artefacts performed a role of conveying messages and discourses of social distancing, public pedagogy, and community care.

Population Older than 69 Had Similar Fatality Rates Independently If They Were Admitted in Nursing Homes or Lived in the Community: A Retrospective Observational Study during COVID-19 First Wave.

The aim of this study is to assess the influence of living in nursing homes on COVID-19-related mortality, and to calculate the real specific mortality rate caused by COVID-19 among people older than 20 years of age in the Balaguer Primary Care Centre Health Area during the first wave of the pandemic. We conducted an observational study based on a database generated between March and May 2020, analysing COVID-19-related mortality as a dependent variable, and including different independent variables, such as living in a nursing home or in the community (outside nursing homes), age, sex, symptoms, pre-existing conditions, and hospital admission. To evaluate the associations between the independent variables and mortality, we calculated the absolute and relative frequencies, and performed a chi-square test. To avoid the impact of the age variable on mortality and to assess the influence of the "living in a nursing home" variable, we established comparisons between infected population groups over 69 years of age (in nursing homes and outside nursing homes). Living in a nursing home was associated with a higher incidence of COVID-19 infection, but not with higher mortality in patients over 69 years of age (p = 0.614). The real specific mortality rate caused by COVID-19 was 2.270/00. In the study of the entire sample, all the comorbidities studied were associated with higher mortality; however, the comorbidities were not associated with higher mortality in the infected nursing home patients group, nor in the infected community patients over 69 years of age group (except for neoplasm history in this last group). Finally, hospital admission was not associated with lower mortality in nursing home patients, nor in community patients over 69 years of age.

COVID-19 Telehealth Expansion Can Help Solve the Health Care Underutilization Challenge

Am J Manag Care. 2021;27(1):9-11. https://doi.org/10.37765/ajmc.2021.88571 _____ Takeaway Points * The policy response to the coronavirus disease 2019 (COVID-19) pandemic has removed barriers inhibiting the delivery of remote health care, serving as an opportunity to directly address the gap in health care underutilization. * Policies that encourage telehealth and remote patient monitoring can directly lead to improved chronic disease management, an area of underutilization and high cost to the health care system. * Prior studies demonstrate the efficacy of telehealth, remote patient monitoring, and community health workers. In 2018, only 18% of doctors practiced medicine with some component of telehealth, compared with nearly 50% now.15 To exemplify the profoundness of this point, at Mount Sinai Faculty Practice in New York, New York, more telehealth visits occurred per average day in April 2020 during the height of COVID-19 than in all of 2019.16 In light of the boom in telehealth use, current evidence suggests a cost-reduction potential for the health care system and insurance providers, not to mention the financial incentives that accompany an increased ability to care for chronic diseases.17 Furthermore, of the 4 areas of spending on chronic disease management that account for two-thirds of all health care costs, both high volume and administration would be directly affected by sustained telehealth expansion.18 The increase in telehealth as a result of the COVID-19 pandemic is a prime opportunity to improve the effectiveness of health care expenditures by filling the void in chronic disease management and increasing access to care overall. Remote patient monitoring (RPM) is another disease management strategy that utilizes and builds upon the expansiveness of telehealth to reach underserved populations and fill an unmet need in American health care.19 RPM is a cost-effective method of engaging patients and promoting continuity in care that can integrate care teams and target high-risk groups through multiple channels.20-22 Effective RPM can improve access to chronic care management and help reduce unnecessary admissions, thereby reducing nonessential expenditures and cost burden from more acutely sick, hospitalized patients.23 CMS has issued a number of changes that tear down prior barriers to RPM as a means of providing care during the pandemic. Prior to COVID-19, CHWs, who served their respective communities through culturally appropriate health promotion and patient education, had demonstrated vast improvements in access for patients by improving care efficiency and reducing the need for emergency and specialty services.28,29 Moreover, incorporation of CHWs—as well as, similarly, care managers and navigators—has been associated with overall cost savings in addition to improved management of chronic disease and successful outreach attempts through multimodal communication efforts such as cell phone messaging.30-33 In light of the COVID-19 pandemic, a response effort that uses established CHW networks for short-term pandemic suppression with text messaging and virtual health outreach programming will also enable long-term amelioration by strengthening established care avenues.34-36 Although national policies promoting CHW telehealth strategies to combat the pandemic have not yet occurred, some states are upregulating CHW involvement as a short-term pandemic suppression strategy.

Listening to and Learning from the Community: A Model for Community Engagement and Building Trust

OBJECTIVES/GOALS: We have developed a community engagement model that embraces several core values: bi-directional, co-equal, co-created, inclusive, culturally centered, and trust. Our promotoras de salud and community health workers (CHWs) facilitate listening sessions to understand the most pressing health needs and concerns as perceived by the community. METHODS/STUDY POPULATION: Our Southern California CTSI Community Engagement team includes promotoras de salud and community health workers who are trusted individuals within our targeted communities–Latino and Black populations in South and the Eastside of Los Angeles. Listening sessions identify the community's perceived health needs and concerns, and our team in turn delivers a workshop series that addresses those concerns. Workshops are co-developed by community members, offered in English and Spanish, and delivered both virtually and in-person in community venues. Workshop topics have included mental health, depression, anxiety in children;child development and autism;COVID-19 testing, variants, and vaccines;monkeypox;and a primer on understanding clinical research. RESULTS/ANTICIPATED RESULTS: In 2022, we held 49 workshops that delivered evidence-based information including how to access needed resources. We had a total of 1212 participants, 60% of whom were returning, meaning they had attended at least one prior workshop. An evaluation of the workshop program demonstrated that our promotoras de salud and community health workers are trusted by the community and that workshops are meeting community needs. 677 surveys were completed by participants, 87.5% of whom were female. 85% of respondents stated that they will use the information they learned in their daily life, and 90% said they would attend another workshop. Feedback from the evaluation will inform future workshop format and topics. DISCUSSION/SIGNIFICANCE: Academic-community partnerships are key to advancing health equity, especially in diverse and under-resourced communities. This is one model of community engagement, which includes promotoras de salud and CHWs that was designed to build trust, empower individuals through education, and to address the health needs as defined by the community.

Representative Voices: Native American Representation, Political Power, and COVID-19 in U.S. States

We examine predictors of COVID-19 cases in Native nations during the early months of the pandemic. We find that where Native American representation and Native American political power in state politics were greater, COVID-19 cases on tribal lands were fewer. We expand the literatures on descriptive representation and on tribal-state relations by demonstrating consequences of powerful Native American voices in the statehouse. We find that Native American voices on tribal lands are also vital. Tribal lands that had extensive networks of community-based health facilities and tribally controlled health facilities recorded fewer COVID-19 cases. The broader lesson here is that if Native nations are to protect their citizens, they need outside governments that support, not thwart. Our findings draw on unique, original quantitative analysis.

Working as a nurse in community health services during Covid-19: a qualitative study.

BACKGROUND: During the Covid-19 pandemic, new roles, increased workload, lack of staffing and infection control equipment, unclear infection control guidelines and conflicting information have led to uncertainty and unpredictability for health workers. Although community home-care nurses have been exposed to a range of personal and professional stressors during the pandemic, few studies have focused on their experiences. The aim of this study was to explore how Norwegian home-care nurses experienced the first wave of the Covid-19 pandemic. This knowledge may contribute to preparations for meetings with patients in future pandemics, how management can support its employees and how to structure a successful organization. METHODS: This study was a qualitative descriptive design comprising 12 semi-structured individual interviews with home-care nurses. A thematic analysis was carried out. RESULTS: Four main themes and 11 subthemes were constructed. The results revealed challenges related both to the organization and to management, experiences of unclear information, lack of available equipment, redeployment of staff and increased workload. Furthermore, it was challenging to provide high qualitative care. The nurses missed collegial togetherness and had feelings of uncertainty with a great fear of infecting others. Positive consequences were feelings of being valued and a greater awareness of infection control. CONCLUSION: This study highlighted the importance of unambiguous information and clear delegation of responsibility, and that enough infection control equipment will likely minimize the fear of infecting each other. Being visible and admired for their work was important for the nurses' psychological well-being. Nurses, nursing managers and policymakers in community health care can use these results to develop strategies for future pandemic planning.

Lessons Learned From Community Workers Beat the Virus, a Multimedia Campaign Cocreated With Trusted Community Leaders

[...]per recommendation from community leaders, we designed 52 Facebook, Twitter, LinkedIn, and Instagram posts in Spanish and English;2 print ads published in multiple local newspapers;and 27 thirty-second radio spots (Selected videos from the campaign are posted here: https://tinyurl.com/ 4wb48yxr;Social media posts are here: https://tinyurl.com/2x8awty9). LESSONS LEARNED FOR FUTURE PUBLIC HEALTH CAMPAIGNS The academic-community partnership to codevelop COVID-19 public health communication serves as a model for responding to information needs in public health crises. Engaging community health workers and leaders took a considerable amount of coordinated effort but showed significant potential to reach diverse groups (via media monitoring of impression), aid in debunking myths, and address misinformation to respond to the impact of COVID-19 in underresourced communities. Capitalizing on the community health workers' lived experiences and working knowledge of their communities offers a sustainable resource for the development of public health communication strategies that resonate with underresourced groups.

A qualitative exploration of progress, challenges, and opportunities in community nutrition services in Taiwan

Objectives: In 2018, Taiwan's Health Promotion Administration funded the establishment of community nutrition centers in various cities and counties to prevent frailty among community older adults. This study investigated the current suite of community nutrition services and the challenges and opportunities therein. Methods: In total, 17 community dietitians from 14 counties/cities and 5 professional community health workers were interviewed. These community dietitians and community health workers underwent design thinking training, and its effects were evaluated. Results: (1) Services: The community dietitians reported that the current services provided by the community nutrition centers include older adult nutrition screening and surveys, nutrition education, consultations aimed at helping community centers and restaurants to establish healthy food environments, nutrition promotion, and the recruitment of dietitians and other personnel. (2) Challenges: The community dietitians reported that the challenges included a lack of human resources, a lack of reliable and valid dietary questionnaires, overly large variations in older adult-related nutrition needs and resources across multiple areas, difficulties in implementing nutrition education at an intensive and large-scale level, difficulties in evaluating the effects of nutrition education, obstacles in collaborations with other sectors, low uptake in dietitian recruitment, and difficulties in coping with the COVID-19 pandemic. (3) Opportunities: The professional community health workers suggested strengthening community nutrition promotion, providing nutrition-related experiential learning opportunities, establishing collaborations among multiple sectors, presenting and promoting the community nutrition achievements of the centers, and applying design thinking to promote community nutrition services. The evaluation of the design thinking training intervention revealed its positive effects on increasing the knowledge, attitudes, and performance of community health workers and their intention to apply design thinking. Conclusions: Taiwan's community nutrition centers play a key role in reinforcing healthy eating habits among older adults. This study provided insights regarding the challenges and opportunities pertaining to the promotion of community nutrition services. (Taiwan J Public Health. 2022;41(5):524-537)

What to do if a complaint is made against you: If you are subject to a formal complaint, make sure you know what to expect at every stage of the process

More than 170,000 written complaints were made about patient care last year (2020-21) in England alone, according to NHS statistics. Of the complaints about a specific profession in hospital and community care, 26% related to nurses. This figure is likely to be lower than it should be due to changes during COVID-19 that meant not all data needed to be recorded as normal.

Connecting the Dots: Public Health, Clinical, and Community Connections to Improve Contraception Access

The Association of State and Territorial Health Officials Increasing Access to Contraception Learning Community project, conducted in collaboration with the Centers for Disease Control and Prevention's Division of Reproductive Health, implemented a series of learning communities with 27 multidisciplinary teams (from 26 states and one territory) between 2014 and 2018 to improve access to the full range of contraceptive methods. The Association of State and Territorial Health Officials, the National Association for County and City Health Officials, and the National Association of Community Health Workers will partner to build the community health workforce through collaboration with community-based organizations.8 In this next phase of "life with COVID," the expanded community workforce has an opportunity to pivot to addressing other public health priorities such as contraception access with trusted frontline workers in communities serving as a link between health and social services. During the COVID-19 pandemic, public health, clinical, and community organizations have been leading data collection activities to better understand the digital literacy and telehealth experiences of patients and providers and have been working closely with providers to expand services and the capacity of communities to deliver them.9 Examples include public health efforts to accomplish digital inclusion and telehealth equity assessments, the creation of "heat maps" identifying barriers and access points for unavailable specialty services,10 and training and employment of community members in places such as libraries as digital navigators to support telehealth services.11 Early in 2020, the Office of Population Affairs of the US Department of Health and Human Services authorized telehealth as an option for Title X family planning clinics across the country and announced $35 million in grants for the Title X program to support telehealth as a means of sustaining access to contraceptive health services.12 Including contraception access within such endeavors can enhance access to services, support clinical reach, and build capacity within communities.

Migrantas en Pandemia: interseccionalidades y cuidados en el Gran Buenos Aires

A partir de una investigación-acción-participativa que comenzó en 2019 en una zona segregada del partido de San Martin del Gran Buenos Aires, propongo analizar, por un lado, los efectos desiguales de la emergencia sanitaria del coronavirus —y las medidas tendientes a mitigarlas—, en mujeres migrantes desde una perspectiva interseccional. Por otro lado, pretendo examinar las estrategias de cuidados comunitarios que despliegan estas mujeres que son en su gran mayoría quienes, a partir de sus múltiples organizaciones y saberes, contienen la crisis en estos barrios populares y cubren, a partir de la creación y el fortalecimiento del trabajo en red, las diversas falencias de las medidas adoptadas desde distintos niveles del Estado. Se examinarán tanto los datos recopilados con anterioridad a la pandemia como también registros de observación y entrevistas realizadas de manera remota durante 2020Alternate : Com base numa pesquisa-ação-participativa que começou em 2019 em uma área segregada do distrito de San Martin da Grande Buenos Aires, proponho analisar, por um lado, os efeitos desiguais da emergência sanitária do coronavírus —e as medidas que visa mitigá-los—, em mulheres migrantes, a partir de uma perspectiva interseccional. Por outro lado, pretendo examinar as estratégias de cuidado comunitário implantadas por essas mulheres, cuja grande maioria, a partir de suas múltiplas organizações e saberes, contêm a crise nesses bairros populares e cobrem, pela criação e fortalecimento do trabalho em rede, as várias deficiências das medidas adotadas em diferentes níveis do Estado. Serão examinados tanto os dados coletados antes da pandemia quanto os registros de observação e entrevistas realizadas remotamente durante o ano de 2020.Alternate : Based on a participatory action research that began in 2019 in a segregated area of the San Martin district of Greater Buenos Aires, I propose to analyze, on the one hand, the unequal effects of the coronavirus health emergency —and the measures aimed at mitigating them —, in migrant women from an intersectional perspective. On the other hand, I intend to examine the community care strategies deployed by these women, who are mostly the ones who, from their multiple organizations and knowledge, contain the crisis in these popular neighborhoods and cover, creating and strengthening networking, the various shortcomings of the measures adopted from different levels of the State. Both data collected prior to the pandemic and registers of observation and interviews conducted remotely during 2020 will be examined.

Are State-Level Policies Supporting Community Health Worker Employment? The Jury Is Still Out

In AJPH and elsewhere, a steady stream of research articles, blogs, and opinion pieces have been published supporting the expansion of the community health worker (CHW) workforce.1 As frontline public health workers, CHWs have played an important role in COVID-19 response and prevention.2 Moreover, there is ever-increasing evidence of their effectiveness in promoting access to primary and preventive care, building bridges between communities and health care systems, and improving health outcomes for chronic conditions, particularly in underserved communities.3 Workforce growth is predicated upon sustainable, dedicated financing mechanisms. In the United States, CHW employment often relies on grants and other short-term resources.1,4 Long-term flexible funding models are important for both workforce development and program continuity.5 Medicaid coverage for CHW services has been identified as a potential solution for the constraints to CHW program sustainability.4 Similarly, occupational certification for CHWs provides a pathway for career development and higher earning potential while encouraging workforce growth and integration.6 Although Medicaid coverage and certification are commonly touted as enablers of workforce growth, we actually know very little about how these two policies affect the CHW labor force. Jones et al. state that low wages are the main predictor of resignations among frontline health workers, but they did not examine how wages affect turnover. Because of data limitations, turnover in this study was narrowly defined as leaving the CHW workforce altogether;job transitions within the field were not captured.

Q&A: From tiny island farm to public health professor

Speed read Nutrition, immunisation, family planning ‘key levers of change’ Community health workers can share training and knowledge, says advocate Integrating nutrition and public health crucial to development After becoming the first university graduate from her “very small” village on Uganda’s Ssese Islands, Diana Nambatya Nsubuga went on to complete a doctorate in public health in the United States. [...]the co-founder of Integrated Health Kwagala Farm, an urban farming foundation that promotes financial independence for women and young people, and a former honorary professor at Makerere University, Nsubuga is an advocate for nutrition, community health and family planning programmes. Nsubuga tells SciDev.Net why community health workers have the power to change the future of Africa. [...]my role involves … making sure that the community health worker programmes are done in such a way that community health workers are digitally empowered to do their work, they’re equipped, they are supervised, and they are compensated for the work that they do.

Change starts with me: an impact evaluation of a multiprofessional leadership programme to support primary care networks in the South East of England

Purpose>This paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care networks (PCNs) to lead system improvement together. It identifies programme impact at micro and meso system levels;a leadership impact continuum that can be used by individuals and teams to evidence impact of improvements in PCN practices;the learning and development strategies that were effective and proposes implications for other networks.Design/methodology/approach>Mixed methods underpinned by practice development methodology were used to explore the impact of the programme on two practitioner cohorts across 16 PCNs. Data were collected at the start, mid-point and end of the eight-month programme.Findings>Results illustrate an innovative approach to collective leadership development. A continuum of impact created with participants offers insight into the journey of transformation, recognising that “change starts with me”. The impact framework identifies enablers, attributes and consequences for measuring and leading change at micro, meso and macro levels of the health-care system. Participants learned how to facilitate change and collaboratively solve problems through peer consulting which created a safe space for individuals to discuss workplace issues and receive multiprofessional views through action learning. These activities enabled teams to present innovative projects to commissioners for service redesign, enabling their PCN to be more effective in meeting population health needs. The authors believe that this programme may provide a model for other PCNs England and other place-based care systems internationally.Originality/value>This study offers insight into how to enable a journey of transformation for individuals and PCN teams to enhance team effectiveness and collective leadership for system-wide transformation required by the National Health Service Long Term Plan (2019).Contribution to Impact>

Factors associated with satisfaction and depressed mood among nursing home workers during the covid-19 pandemic.

AIMS AND OBJECTIVES: This paper aims to examine the satisfaction and depressed mood experienced by nursing home workers during the COVID-19 pandemic and associated variables. Specifically, to analyse the factors that may contribute to nursing home workers developing adaptive behaviours that promote satisfaction or, on the contrary, show characteristics associated with a negative mood. BACKGROUND: Nursing homes have faced unprecedented pressures to provide appropriately skills to meet the demands of the coronavirus outbreak. DESIGN: A cross-sectional survey design using the STROBE checklist. METHODS: Professionals working in nursing homes (n = 165) completed an online survey measuring sociodemographic and professional characteristics, burnout, resilience, experiential avoidance, satisfaction with life and depression. Data were collected online from April to July 2021, the time in which Spain was experiencing its fifth wave of COVID-19. Two multiple linear regression models were performed to identify salient variables associated with depressive mood and satisfaction. RESULTS: Resilience, personal accomplishment and satisfaction had a significant and negative relationship with depression and emotional exhaustion, depersonalisation and experiential avoidance had a positive relationship with depression. However, emotional exhaustion, depersonalisation and experiential avoidance had a negative and significant relationship with satisfaction and personal accomplishment, and resilience had a positive and significant relationship with satisfaction. In addition, it was found that accepting thoughts and emotions when they occur is beneficial for developing positive outcomes such as satisfaction. CONCLUSIONS: Experiential avoidance was an important predictor of the effects that the COVID-19 pandemic can have on nursing home workers. RELEVANCE TO CLINICAL PRACTICE: Interventions focusing on resources that represent personal strengths, such as acceptance, resilience and personal accomplishment, should be developed. NO PATIENT OR PUBLIC CONTRIBUTION: The complex and unpredictable circumstances of COVID's strict confinement in the nursing home prohibited access to the centres for external personnel and family members. Contact with the professionals involved could not be made in person but exclusively through online systems. However, professionals related to the work environment have subsequently valued this research positively as it analyses 'How they felt during this complicated process'.

The experiences of community nurses providing end-of-life care for patients from black and asian minority ethnic backgrounds

BackgroundProviding end-of-life care in the patient’s own environment is challenging, especially if the nurse is from a different ethnic and cultural background from the patient. Evidence shows that people from the Black and Asian Minority Ethnic (BAME) background communities experience poorer end-of-life care in the UK due to the care providers and commissioners not understanding their care needs.MethodsA qualitative approach, using semi-structured interviews, was used to explore the experiences of 16 community nursing staff caring for end-of-life patients from the BAME community in Leicester, Leicestershire, and Rutland. Virtual interviews were audio-recorded, transcribed verbatim and thematically analysed.ResultsFamily hierarchy meant that the nurses had to deal with large tight-knit families, paternalism and controlling behaviours, and had to establish advocacy processes. There was a strong mistrust and suspicion of Western medicine and a belief that Western medicine speeds up death. There was a desire to hold onto life, continue to have nutrition, and these feelings were influenced by Spiritual beliefs. Consequently, there was low uptake of end-of-life care services for this group. There were also language barriers and challenges faced by the nurses, resulting in difficult conversations with the families. Despite the challenges, nurses tried to build relationships with the families in order to meet the patients’ end of life care needs. Different levels of the nurses’ cultural and religious competencies in caring for BAME patients were also identified. As the research was conducted during pandemic, COVID-19 effects contributed to the above challenges.ConclusionThis research has shed light on the challenges of individualising end-of-life care patients in a culturally diverse community. The nurses’ cultural and religious competencies were challenged as they attempted to ensure their expert healthcare professional philosophy of care met the needs and preferences of the dying patient and their family.

Opportunities from Covid-19 Pandemic: Strategies to Transform On-Site to Remote Community Clinical Experience

The Covid-19 pandemic continues to affect lives. This evidencebased strategy describes pathways to address the crisis and meet goals of undergraduate baccalaureate nursing education. Impact of the pandemic on clinical site availability provided opportunities to revise the maternity clinical course from direct on-site clinical to a clinical course with multiple modalities including small-group hospital clinical, faculty-facilitated remote clinical days, and written assignments. The design incorporated adult learning principles. This presentation illustrates transformation of the “Community Clinical Education Day” from on-site activities to remote virtual experiences. Teaching strategies that successfully fulfilled requirements of maternity clinical course, components of the eight-hour offering, and effectiveness of a multimodal clinical course compared to a traditional clinical course are described. Objectives: To identify mission, services, and population of community agencies and to develop education offerings for target population Format: Live remote faculty presentation on community-based health promotion;assessment, values, and beliefs;social and health-related issues affecting women;cultural competence in healthcare;and health literacy. Students independently review agency websites, and in small groups develop client education materials on assigned topics. Students reconvene remotely to present teaching projects. Implications: Changes from traditional methods of on-site community clinical education to remote model with multiple modalities of instruction reflect adult learning principles, enhance student engagement, and provide templates for educators. Evaluations of remote community clinical demonstrate completion of course objectives and positive student and faculty perceptions of the experience. The effectiveness of a remote multimodal course compared to traditional course provides a model for adaptation of clinical courses.

Work and Nonwork Contributory Factors to Health Care Workers' Mental Health

In this cross-sectional survey of 828 participants, they report that insufficient personal protective equipment (PPE);experiences of discrimination, violence, and harassment;not receiving family support;experiencing financial strain;and having to isolate because of COVID-19 were each associated with an increased prevalence ratio of probable depression cases. [...]working on COVID-1 9 or intensive care wards is a particular risk factor,1,2 whereas concerns have been raised about differential access to PPE based on one's role, sex, and ethnicity.3 One postulation from Silva et al. is that community health care workers were no longer able to visit community homes, potentially alleviating some work demands and reducing their exposure risk or vulnerability to violence and discrimination. Because ill mental health is a factor in the global challenge to retain health care workers, we need better research, policies, and support to understand, capture, and model these differences. [...]building support is an important resource for health care workers to draw on and to mitigate the detrimental impact that demanding work environments can have on their mental health.5,6 A SYSTEMS PN1 -https://media.proquest.com/media/hms/PFT/1/UhuwM?_a=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%2BgIBToIDA1dlYooDHENJRDoyMDIyMDUxODEyNDIwMTMwMDo5OTI2MzY%3D&_s=%2BTB5DoMLaFgpkVf8XhHojdnxVis%3D ERSPECTIVE ON HEALTH CARE WORKERS' MENTAL HEALTH The six potential pandemic-related contributing factors shift the narrative of health care worker well-being away from only the individual, emphasizing the responsibility of governments and health care leaders. Too often, research on health care workers' well-being has focused on individual factors (such as psychological states and traits) as antecedents to their well-being, neglecting the various other organizational and societal factors they are exposed to.7 Although the lack of PPE and job type are work-related contributing factors to probable cases of depression, the contributing role of family support and financial strain highlights how nonwork factors are also important. Since the start of the COVID-19 pandemic, it has been evident that we can no longer clearly delineate work from our nonwork lives.

Experiences of Australian primary healthcare nurses in using telehealth during COVID-19: a qualitative study

ObjectiveThis study sought to explore the experiences of Australian primary healthcare (PHC) nurses in the use of telehealth during COVID-19. Telehealth was defined as the use of any telecommunications mode (eg, telephone and videoconferencing) to deliver healthcare.Design and settingThematic analysis of qualitative interviews undertaken in Australian PHC.ParticipantsTwenty-five PHC nurses who had participated in a national survey about their experiences during COVID-19 were recruited using purposive sampling.MethodsSemistructured telephone interviews were conducted from June to August 2020. Interviews lasted a mean of 38.5 min. They were audio-recorded and transcribed before thematic analysis was undertaken. The consolidated criteria for reporting qualitative research were followed.ResultsFour overarching themes were identified: preparedness, accessibility of telehealth, care experience and impacts on the PHC nurses’ role. Some nurses were experienced in the use of telehealth, while others indicated a lack of preparation and limited appropriate technology to support its use. Telehealth enabled patients to access care but did not support complex clinical assessment. Participants indicated that patient engagement in telehealth was dependent on access and confidence using technology, perceived safety when physically attending the practice and the value they placed on care via telehealth. Many participants expressed frustration about telehealth funding and its impact on facilitating nurses to practise to their full scope.ConclusionTelehealth has provided a means to continue PHC service delivery during COVID-19. While there are advantages to adopting this technology, considerations of the challenges and lessons from this experience are important to inform the future implementation of telehealth initiatives.