Mental health in the community: part one.

Mental health issues are difficult yet common experiences. Considering that one in four people in England experience a mental health problem every year, it is essential that the community nurse has a good understanding of the different types of mental health problems faced by individuals, and be able to adequately provide care and support. In part one of a two-part series on mental health in the community, Sarah Palmer provides details on some of the more common mental health conditions, and the support that primary care can provide to individuals experiencing mental health issues.

Hand hygiene practices in Caribbean and Latin American countries: An integrative review.

AIM AND OBJECTIVE: To explore what is known about knowledge, attitudes and beliefs that influence hand hygiene practices in in low- and middle-income Caribbean and Latin American countries. BACKGROUND: With the emergence of infectious diseases such as the recent COVID-19 pandemic, handwashing is key to preventing communicable diseases as they disproportionately affect populations in low-income countries. While hand hygiene is known to be the single most effective method for avoiding the transmission of infection, little is known about the beliefs and practices of individuals in these regions. METHODS: Following PRISMA 2020 Checklist, an integrative review of studies published from 2008-2020 was conducted (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Whittemore and Knafl's method was used to review the literature. Six databases were searched, and the Johns Hopkins Evidence Based Rating Scale was used for study appraisal. RESULTS: The review yielded 18 studies conducted across Latin America. Poor handwashing practices are influenced by various factors including inadequate education and training, cultural beliefs, lack of resources and substandard government regulations. Communicable diseases and other diarrheal illnesses were highly prevalent, especially after a major disease outbreak. CONCLUSION: Future post-disaster campaigns aimed at improving hand hygiene and handwashing practices should focus on beliefs and attitudes to affect behaviour change since there was a higher disease susceptibility during those times. Barriers to proper hand hygiene include false attitudes such as, washing hands only after touching bodily fluids/patient contact or not washing hands at all after open defecation. RELEVANCE TO CLINICAL PRACTICE: Researchers working with populations in Latin America and the Caribbean should partner with local community health workers to improve compliance to recommended hand hygiene practices.

Developing wound services through digitising wound assessment: the benefits and challenges in a rural community nursing service.

The documentation of wound assessments are an integral part of the holistic care of a patient and form the foundation of effective wound care. The COVID-19 pandemic brought about challenges in delivering services. Telehealth was at the forefront of the agenda in many organisations, but within wound care services the physical interaction between clinician and patient needed to continue. With the nurse staffing crisis hitting most areas, there is an ongoing threat to deliver safe and effective care. The aim of this study was to review the benefits and challenges of digital wound assessment technology in clinical practice. The author looked at reviews and guidance on the integration of technology within clinical practice. It was found that utilising digital tools in daily practice can empower clinicians in many ways. The most immediate aim of digitised assessment would be to streamline documentation and assessment processes. However, there are multiple factors in embedding this type of technology into daily practice that can cause challenges, dependent on clinical area and clinician uptake.

Delegation of insulin administration to non-registered healthcare workers in community nursing teams: A qualitative study.

AIMS: To explore stakeholder perspectives on the benefits and/or disadvantages of the delegation of insulin injections to healthcare support workers in community nursing services. DESIGN: Qualitative case study. METHODS: Interviews with stakeholders purposively sampled from three case sites in England. Data collection took place between October 2020 and July 2021. A reflexive thematic approach to analysis was adopted. RESULTS: A total of 34 interviews were completed: patients and relatives (n = 7), healthcare support workers (n = 8), registered nurses (n = 10) and senior managers/clinicians (n = 9). Analysis resulted in three themes: (i) Acceptance and confidence, (ii) benefits and (iii) concerns and coping strategies. Delegation was accepted by stakeholders on condition that appropriate training, supervision and governance was in place. Continuing contact between patients and registered nurses, and regular contact between registered nurses and healthcare support workers was deemed essential for clinical safety. Services were reliant on the contribution of healthcare support workers providing insulin injections, particularly during the COVID-19 pandemic. Benefits for service and registered nurses included: flexible team working, increased service capacity and care continuity. Job satisfaction and career development was reported for healthcare support workers. Patients benefit from timely administration, and enhanced relationships with the nursing team. Concerns raised by all stakeholders included potential missed care, remuneration and task shifting. CONCLUSION: Delegation of insulin injections is acceptable to stakeholders and has many benefits when managed effectively. IMPACT: Demand for community nursing is increasing. Findings of this study suggest that delegation of insulin administration contributes to improving service capacity. Findings highlight the essential role played by key factors such as appropriate training, competency assessment and teamwork, in developing confidence in delegation among stakeholders. Understanding and supporting these factors can help ensure that practice develops in an acceptable, safe and beneficial way, and informs future development of delegation practice in community settings. PATIENT OR PUBLIC CONTRIBUTION: A service user group was consulted during the design phase prior to grant application and provided comments on draft findings. Two people with diabetes were members of the project advisory group and contributed to the study design, development of interview questions, monitoring study progress and provided feedback on study findings.

Should I stay or should I go? Why nurses are leaving community nursing in the UK.

Worsening working conditions for nursing workforce has seen a massive exodus of staff, particularly in community nursing in the UK. AIM: The study aim was to map working conditions as well as identify differentiating characteristics of community nurses that intend to leave their profession. DESIGN: Eligibility criteria were community nurses working in all 4 UK countries. All data was collected by means of a cross-sectional survey via the largest closed, private community nursing online-forum. Logistic regression was carried out to ascertain the effects of the variables on the intention to leave. RESULTS: The total number of respondents was 533. Findings showed that one in two of all community nurses (≈46%) are reporting job dissatisfaction. Length of unpaid overtime per shift (odds increase by 30% for each hour of overtime), manager support, proportion of permanent staff, team size, shift length, travel mileage, worsened conditions in the last year and overall self-rated working conditions were differentiating factors between those that intended to leave the job. The proportion of permanent staff on the team and perceived lack of support from management best predicted the likelihood of leave rates. Our findings imply that low nurse retention will fuel an even higher exodus because job dissatisfaction is highest on teams with lowest permanent staff ratios. Poor management that is inept at supporting frontline staff means that the fundamental retention issues are exacerbated and will not stop the unprecedented crisis that is predicted to lead to a collapse of care provision in community settings. Nurses play a central role and are 'key' to delivering the much- desired patient-centred care' therefore their well-being and job satisfaction should become a priority for policymakers.

Examining family and community nurses' core competencies in continuing education programs offered in primary health care settings: An integrative literature review.

AIM: To identify gaps in existing family and community nurse (FCN) continuing education programs and to investigate whether FCN core competencies are covered in continuing education programs offered in primary health care settings. BACKGROUND: In global pandemics such as COVID-19, there is an urgent need for staff development using transformative learning and help registered nurses build up their competencies and form a new professional identity as family and community nurses (FCNs). Therefore, FCN education programs become of high importance to enhance nurses' core competencies through continuing education. METHODS: An integrative review of the literature was conducted applying the Whittemore and Knafl methodological strategy for studies published between 2015- June 2021. RESULTS: FCN core competencies, including the "decision-making process, navigation as care coordinator and patient advocate and promoting individual and family health to support the quality of nursing care," were poorly covered in the FCN programs. Specifically, e-health played a very limited role in FCN continuing education, while ethics, managing change, managing disparity and diversity and leadership skills, did not emerge at all. CONCLUSION: The identified gaps can be incorporated into future FCN continuing education programs and may help improve nurses' competence and health care delivery and support new integrated models of care, namely, person-centered and community-based models.

A district nurse's reflection on pre-registration nursing education: a troubling position.

This article explores the author's observations as a qualified district nurse and senior lecturer in pre-registration nurse education. Perceived 'troubling' reflections suggest pre-registration nurse education appears very hospital focussed. Additionally, the role of the district nurse has become synonymous with the term 'community nurse', hiding the historical specialism it represents. Media representations of the term 'frontline' was particularly noted in relation to COVID-19, suggesting a heroism of nursing that only happened in hospital. More discussion will take place around how nursing is viewed within education by students, such as what we do to patients (catheterisation, blood sugars etc) rather than how we can work with them. All these areas appear to strengthen lingering historical myths around district nursing and student perceptions of this specialist profession.

WHAT'S YOUR REALITY?: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

As the UK adjusts to life in lockdown, how are CPs carrying out crucial work while staying safe? Here's just a snapshot of your current situations...

Team cohesion and how to work together while apart: Some systems set up to enable remote working in the community during the pandemic are here to stay

The pandemic has had a profound effect on the way community nursing teams work.

Community nursing and COVID-19: ‘Things won’t go back to how they were’

As hospitals have been transforming in response to the COVID-19 pandemic, so too has community nursing. Like the acute sector, we anticipated a surge in demand and workload, with increasing numbers of patients requiring our help in their own homes and in care homes, many of them near the end of life.

Guest editorial: Contemporary managerial issues in the nursing sector

Despite the clear importance of nurses for a healthy community and economy, the nursing sector has been almost entirely ignored in the organizational behavior (OB) and human resource management (HRM) research literature (Harms, 2021) with a few notable exceptions (e.g. Hepburn and Enns, 2013;Koopman et al., 2019;Russo and Buonocore, 2012;Russo et al., 2015;Woolnough et al., 2019;Wu et al., 2019). The goal of this special issue was to highlight the importance of nursing as a critical profession, to provide a forum for work that demonstrates how organizational and nursing scholars might productively integrate their literature, and to shed light on new methods and ideas that might facilitate a better understanding of the nursing profession. [...]Lowman and Harms (2022) offer a broad overview of the state of the nursing profession from an OB and HRM perspective.

Consequences of understaffing on type of missed community care- a cross-sectional study

Background: Resource cuts to primary and community care in combination with a decline of those working in community settings is compromising quality of care and patient safety in the UK. It is reported that the negative consequences of understaffing and underfunding have worsened due to the COVID-19 pandemic. Objective: This is a cross-sectional study that aimed to examine short and long-term District and Community nursing working conditions. The objectives were to assess the prevalence of understaffing and missed care and the relationship between individual and organisational factors and their association with missed care outcome. We further explored the relationship between additional caseload, staffing levels and missed care. Methods: We developed a questionnaire based on the validated MISSCARE survey. Outcome measures were, number of vacancies per team, staffing levels, reported incidence of missed care, type of missed care, length of shift and overtime. Results: Only 23% of teams reported having no vacancies. The mean staffing ratio was reported at 60%, including agency/bank staff (0.59±1.5). Prevalence of missed care was relatively high (60%≈). The distribution of types of missed care was spread evenly across all types of nursing care. A backward stepwise regression analysis showed that the Proportion of Permanent staff capacity OR=7.9 (95% CI 0.09-0.65), Active Caseload Size OR= 5.5 (95% CI: 1.0 – 1.003), Number of RNs on the team (OR 4.8 (95% CI:1.003-1.058) and Amount of Overtime worked (OR= 3.9 (95% CI:0.98-1.0) variable are statistically significant predictors of missed care. The analysis showed an increase in additional allocated cases per RN as the permanent staff proportion decreased to 70%, at which point the likelihood of reported Missed Care outcome peaks. Conclusion: The compromised quality of care related to human resources and organisational aspects of the nursing process. Where RNs worked longer hours to make up for the backlog of cases, the prevalence of missed care was more likely. Longer working hours in the community increased the risk of compromised care and sub-optimal patient care. The aspects of the nursing process identified as ‘missed’ related to The World Health Organisation's three main pillars of community nursing (health promotion, patient education and screening). As such, significant components of the two first pillars are, according to these data, being undermined.

“Just because people are old, just because they're ill…” dignity matters in district nursing

PurposeThis paper aims to explore the concept and practice, of dignity as understood and experienced by older adults and district nursing staff. The paper adds a new, nuanced, understanding of safeguarding possibilities in the context of district nursing care delivered in the home.Design/methodology/approachThe research used an ethnographic methodology involving observations of care between community district nursing clinicians and patients (n = 62) and semi-structured interviews with nursing staff (n = 11) and older adult recipients of district nursing care (n = 11) in England.FindingsAbuse is less likely to occur when clinicians are maintaining the dignity of their patients. The themes of time and space are used to demonstrate some fundamental ways in which dignity manifests. The absence of dignity offers opportunities for abuse and neglect to thrive;therefore, both time and space are essential safeguarding considerations. Dignity is influenced by time and how it is experienced temporally, but nurses are not allocated time to “do dignity”, an arguably essential component of the caregiving role, yet one that can become marginalised. The home-clinic exists as a clinical space requiring careful management to ensure it is also an environment of dignity that can safeguard older adults.Practical implicationsDistrict nurses have both a proactive and reactive role in ensuring their patients remain safeguarded. By ensuring care is delivered with dignity and taking appropriate action if they suspect abuse or neglect, district nurses can safeguard their patients.Originality/valueThis paper begins to address an omission in existing empirical research regarding the role of district nursing teams in delivering dignified care and how this can safeguard older adults.

CONFERENCE SPECIAL 2021: LEADING THE WAY: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

The highlights from the latest Unite-CPHVA 2021 Virtual Professional Conference held in November are discussed. Janet Taylor, chair of the CPHVA Executive, opened this year's conference. She welcomed Sharon Graham, the newly elected general secretary of Unite. In her speech to conference, Graham said the pandemic has emboldened employers to 'think they can get away with things they would never have got away with' before. She outlined plans to introduce 'combines' to the union--committees with budgets set by the union executive that bring together all of the reps for a particular industry to work together on their own biggest bargaining agendas.

Integrated care is needed, now more than ever: a professional's perspective.

Sara-Marie Black offers a personal account of the last 18 months and its emotional, personal and professional impact. While presenting an unprecedented challenge, COVID-19 has also provided an opportunity to learn and reflect, and has emphasised the need, now more than ever, to work collaboratively across health, social and voluntary, community and social enterprise sectors.

Nursing Home's Measures during the COVID-19 Pandemic: A Critical Reflection.

This study examined the pandemic measures taken by nursing leaders to cope with COVID-19 at a nursing home in Singapore. The pandemic has affected over 215 countries, sparking a series of containment and pandemic measures by governments and healthcare organizations worldwide. Long-term care facilities are especially vulnerable to the pandemic, but little has been reported about the nursing homes' measures in handling the pandemic. The present study used Morley's (2014) three-stage critical reflection method to review meeting minutes, organizational emails, and government advisories on the COVID-19 pandemic measures undertaken by nursing leaders at a nursing home in Singapore between January and June 2020. The pandemic measures were broadly classified into four groups: (1) infection surveillance and containment measures; (2) ensuring continuity in clinical care and operational support; (3) resource and administrative coordination; and (4) staff training and development. Nurses have played a vital role in the fight against COVID-19 by ensuring continuity in patient care and demonstrating clinical leadership in pandemic efforts. This study proposes a useful nursing pandemic structure that outlines a set of functions and measures required for handling a pandemic and that can be applied to various medical emergencies and contingencies.

Mental health, safety and support during COVID-19: A cross-sectional study of primary health care nurses.

AIM: The aim of this study is to explore primary health care nurses' mental health, concerns and perceived safety and supports during COVID-19. BACKGROUND: Respiratory pandemics have negative impacts on nurses' wellbeing. While literature is replete with hospital nurses' experiences, there is less exploration of COVID-19 impacts on primary health care nurses. Given the importance of primary health care nurses in the health system, understanding their experiences is vital. METHODS: Three hundred and fifty nine primary health care nurses responded to an online cross-sectional survey. The Depression Anxiety Stress Scales (DASS-21) was used to measure emotional state. Data were analysed using descriptive and inferential statistics. RESULTS: DASS-21 scores indicated that 39.6% of participants were experiencing symptoms of depression, anxiety or stress. Of those, 41.8% were experiencing symptoms on one scale, 26.9% were experiencing symptoms on two scales and 31.2% were experiencing symptoms across all three scales. Most participants identified that their feelings were related to COVID-19. CONCLUSIONS: COVID-19 is having a significant impact on primary health care nurses' mental health. Nurse managers need to develop strategies to effectively address nurses' concerns and effectively support them to sustain the workforce during and after the pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Findings from this study can inform the design of effective nurse support programmes to reduce mental health impacts and promote staff wellbeing during the pandemic.

Community frailty team workforce development – a personal reflection: Managing Community Care

PurposeThis paper represents a personal view of a newly appointed consultant practitioner trainee in frailty. This role was created as a result of a rapid workforce review of a Frailty Support Team (FST) in response to the COVID-19 pandemic.Design/methodology/approachThe FST traditionally worked alongside other community services. A “One Team” approach was developed whereby prior silos of community nursing, therapy and frailty teams became a single, locality based and mutually supportive integrated community service. This significantly increased capacity for an urgent community response for older people with complex needs and improved clinical management and coordination of care. As a workforce review identified the need for skills development, new roles for trainee advanced frailty practitioners (AFPs) and a consultant practitioner trainee in frailty were established.FindingsStaff experience of the “One Team” model was positive. The changes were thought to encourage closer and more efficient working between primary care and a range of community health services. The improved communication between professionals enabled more personalised care at home, reducing pressure on emergency hospital services. A rapid review of the workforce model has enabled the enhanced team capacity to cover a wider geographical area and improved recruitment and retention of staff by introducing a new pathway for career progression within the expanding specialism of frailty.Originality/valueThe challenge of COVID-19 has prompted rapid service redesign to create an enhanced “One Team in the community.” The innovative workforce model looks beyond traditional roles, values the experience and capabilities of staff and develops the skills and confidence required to provide a more integrated and person-centred specialist community pathway for people living with frailty.