Community-Based Interventions for Stroke Provided by Nurses and Community Health Workers: A Review of the Literature.

BACKGROUND: Community-based interventions are vital for facilitating poststroke recovery, increasing community participation, and raising awareness about stroke survivors. To optimize recovery and community reintegration, there is a need to understand research findings on community-based interventions that focus on stroke survivors and their caregivers. Although nurses and community health workers (CHWs) are commonly involved in community-based interventions, less is known about their roles relative to other poststroke rehabilitation professionals (physical therapists, occupational therapists, and speech-language pathologists). Thus, the purpose of this review is to explore research focused on improving community-based stroke recovery for adult stroke survivors, caregivers, or both when delivered by nurses or CHWs. METHODS: A systematic review using Scopus, PubMed, EBSCOhost, MEDLINE, CINAHL Complete, and PsycInfo was completed to identify community-based poststroke intervention studies using nurses or CHWs through August 2018. RESULTS: Eighteen studies meeting inclusion criteria from 9 countries were identified. Details regarding nurses' and CHWs' roles were limited or not discussed. Interventions emphasized stroke survivor self-care and caregiver support and were offered face-to-face and in group sessions in the community and home. A wide range of instruments were used to measure outcomes. The results of the interventions provided were mixed. Improvements were observed in perceptions of health, quality of life, knowledge, self-efficacy, self-management, and caregiver support. CONCLUSION: Nurses and CHWs play a pivotal role in community-based care. Evidence suggests community-based interventions facilitate the necessary support for stroke survivors, caregivers, families, and communities to optimize stroke recovery. Data from this review illustrate a continued need for comprehensive programs designed to address the complex needs of stroke survivors and families when they return to their homes and communities.

Getting the best out of staff in a district nursing team: nurturing resilience.

District nursing (DN) teams deliver high-quality, complex care under extremely difficult circumstances. DN team resilience depends on the balance between capacity (funding and staff availability) and demand (workload and both clinical and quality standards). The caseload is where capacity and demand meet. Resilience in teams is stretched to the limits and often breached, despite which district nurses remain positive about their role. The overwhelming issue appears to be high workload exacerbated by staff shortages and increasing referrals to DN services. The time is rapidly approaching when district nurses may not be able to keep their caseloads open. If demand and capacity are to be better aligned, the demand should be better predicted, so that lead times are considered and resources are available.

Chelsea, Pimlico and Belgravia District Nursing Association 1930-1939: A case study.

The case study explores how the expansion of the health services during the interwar period impacted upon the status of district nursing and examines how being a voluntary service shaped district nursing associations. A range of primary sources were used; the Association Annual Reports, the Medical Officer for Health Annual Reports for the Borough of Chelsea, the Ministry of Health records, the archives of the Queen's Nursing Institute (QNI) and the Borough of Chelsea Council Minutes. The Medical Officer for Health Reports and the Council minutes identify efforts to improve environmental factors that impacted upon health. These primary sources briefly note the contribution of the Association suggesting that it was integral to the health care provision but considered a constant. The impact of changes to the 1932 Sunday Entertainments Act provide an interesting juxtaposition between the acknowledged value of district nursing and the constant struggle to fundraise in order to provide home nursing. Throughout the 1930s the Association experienced staff shortages and challenges regarding recruitment. The complexities of payment for municipal health services following the 1929 Local Government Act contributed to the staffing challenges. The move to a block grant in 1938 provided increased stability with regards to income. The case study identifies a contradiction regarding the esteem and value placed upon district nursing associations providing home nursing and the constant challenge of resources. District nursing services face similar challenges and this is the 130th anniversary of the Queen's Nursing Institute.

Health visiting cuts only save problems for later.

It feels as inevitable as the turning of the leaves - that time of year when winter pressures begin to loom, as staff shortages and cuts to training places become more apparent.

Gaps in community workforce putting pressure on parents.

THE WELLCHILD charity has called for workforce and training to be reviewed as it celebrates its tenth anniversary.

Variation in Residential Care Community Nurse and Aide Staffing Levels: United States, 2014.

OBJECTIVES: This report presents national and state estimates of staffing levels in residential care communities for registered nurses, licensed practical or vocational nurses, and aides in the United States for 2014. METHODS: Data were drawn from the residential care community component of the 2014 wave of the biennial National Study of Long-Term Care Providers, conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. For each staff type, the "staffing level" measure is presented as average hours per resident per day, defined as the total number of hours worked divided by the total number of residents, which does not necessarily reflect the amount of care given to a specific resident. Analyses examined the extent to which residential care community nurse and aide staffing levels varied by selected organizational characteristics and selected resident composition characteristics of the communities. Differences among subgroups were evaluated using two-sided t tests at the 0.05 level. RESULTS: In 2014, the total registered nurse, licensed practical or vocational nurse, and aide staffing level among all residential care communities was about 2 hours and 50 minutes. Registered nurse staffing levels differed for two of the three organizational characteristics (size and metropolitan statistical area [MSA]) and for only one of the four resident composition characteristics (primarily serving residents needing any assistance with activities of daily living). Licensed practical or vocational nurse staffing levels differed for all three organizational characteristics (size, MSA, and ownership) and for only one of the four resident composition characteristics (primarily serving residents diagnosed with Alzheimer's disease or other dementias). In contrast, differences in aide staffing levels were common when examining both community organizational and resident composition characteristics. Registered nursing, licensed practical and vocational nursing, and aide staffing levels varied geographically by state.

Decentralized nursing education in northern Norway: a basis for continuing education to meet competence needs in rural Arctic healthcare services.

BACKGROUND: Ensuring a sufficient nursing workforce, with respect to both number and relevant professional competencies, is crucial in rural Arctic regions in Norway. This study examines the continuing education (CE) of nurses who graduated from a decentralized nursing programme between 1994 and 2011. OBJECTIVE: This study aims to measure the extent to which the decentralized nursing education (DNE) in question has served as a basis for CE that is adapted to current and future community health care service needs in rural Arctic regions in northern Norway. More specifically, the study aims to investigate the frequency and scope of CE courses among the graduates of a DNE, the choice of study model and the degree of employment with respect to the relevant CE. DESIGN: This study is a quantitative survey providing descriptive statistics. RESULTS: The primary finding in this study is that 56% of the participants had engaged in CE and that they were employed in positions related to their education. The majority of students with decentralized bachelor's degrees engaged in CE that was part time and/or decentralized. CONCLUSIONS: More than half of the population in this study had completed CE despite no mandatory obligation in order to maintain licensure. Furthermore, 31% of the participants had completed more than one CE programme. The findings show that the participants preferred CE organized as part time and or decentralized studies.