Advancing Excellence in Community Health Nursing Through Evidence-Based National Standards of Practice.

BACKGROUND: Current standards of practice are necessary to ensure safe nursing practice in Canada and across the world. This article aimed to describe and present findings from the rigorous review process undertaken to update the 2011 Canadian Community Health Nursing Standards of Practice. METHOD: A revision process included a scoping review of the literature, focus groups, and a modified Delphi method. RESULTS: Through the inclusive consultation process, 495 community health nurses enhanced the content of the standards with respect to cultural safety, cultural humility, Indigenous health and ways of knowing, health equity, and evidence-informed practice. CONCLUSION: This comprehensive revision process can guide other nursing specialty groups developing or revising specialized practice standards in Canada and across the world. [J Contin Educ Nurs. 2021;52(4):168-175.].

Educating Homecare Nurses about Deprescribing of Medications to Manage Polypharmacy for Older Adults.

The purpose of this study is to evaluate the acceptability, appropriateness, and effectiveness of educational intervention with homecare nurses about deprescribing of medications among older adults. An evaluation research study was conducted using survey design to evaluate deprescribing education with a total sample of 45 homecare nurses from three homecare organizations. Post-training evaluation data were evaluated using Likert scale and open-ended questions were analyzed using descriptive statistical analyses and qualitative thematic analysis. Post-intervention questionnaire responses provided descriptions about homecare nurses' perspectives related to deprescribing education, as well as the effectiveness of training in addressing their knowledge gaps. The pilot-testing of deprescribing learning modules and educational training revealed acceptability and suitability for future scale-up to expand its future reach and adoption by other homecare organizations. This study provided important implications into the barriers that impact the effectiveness of deprescribing education, and facilitators that support the future refinement of learning modules.

Implementation of a Heart Failure Telemonitoring System in Home Care Nursing: Feasibility Study.

BACKGROUND: Telemonitoring (TM) of heart failure (HF) patients in a clinic setting has been shown to be effective if properly implemented, but little is known about the feasibility and impact of implementing TM through a home care nursing agency. OBJECTIVE: This study aimed to determine the feasibility of implementing a mobile phone-based TM system through a home care nursing agency and to explore the feasibility of conducting a future effectiveness trial. METHODS: A feasibility study was conducted by recruiting, through community cardiologists and family physicians, 10 to 15 HF patients who would use the TM system for 4 months by taking daily measurements of weight and blood pressure and recording symptoms. Home care nurses responded to alerts generated by the TM system through either a phone call and/or a home visit. Patients and their clinicians were interviewed poststudy to determine their perceptions and experiences of using the TM system. RESULTS: Only one community cardiologist was recruited who was willing to refer patients to this study, even after multiple attempts were made to recruit further physicians, including family physicians. The cardiologist referred only 6 patients over a 6-month period, and half of the patients dropped out of the study. The identified barriers to implementing the TM system in home care nursing were numerous and led to the small recruitment in patients and clinicians and large dropout rate. These barriers included challenges in nurses contacting patients and physicians, issues related to retention, and challenges related to integrating the TM system into a complex home care nursing workflow. However, some potential benefits of TM through a home care nursing agency were indicated, including improved patient education, providing nurses with a better understanding of the patient's health status, and reductions in home visits. CONCLUSIONS: Lessons learned included the need to incentivize physicians, to ensure streamlined processes for recruitment and communication, to target appropriate patient populations, and to create a core clinical group. Barriers encountered in this feasibility trial should be considered to determine their applicability when deploying innovations into different service delivery models.

Isolating the Effects of a Mobile Phone on the Usability and Safety of eHealth Software Applications.

Mobile phones are used in conjunction with mobile eHealth software applications. These mobile software applications can be used to access, review and document clinical information. The objective of this research was to explore the relationship between mobile phones, usability and safety. Clinical simulations and semi-structured interviews were used to investigate this relationship. The findings revealed that mobile phones may lead to specific types of usability issues that may introduce some types of errors.

A formative evaluation of nurses' use of electronic devices in a home care setting.

The purpose of this study was to evaluate the implementation of a clinical information system (CIS) in a community setting. The researchers used a mixed-method design involving interviews, focus groups, and surveys. An independent cross-sectional sample of nurses was surveyed. At time 1 a total of 118 nurses responded and at time 2 a total of 81. Respondents were moderately satisfied with features of the CIS. User satisfaction was positively associated with access to structural and electronic resources and social capital and negatively associated with nurses' age at time 1. Social capital was positively associated with user satisfaction at time 2. Younger age was associated with overall research use at both time 1 and time 2. Research use was negatively associated with evaluation and feedback but positively associated with formal interactions. This evaluation identified the importance of educational support, user-centred design, and responsiveness to successful implementation of CISs in a community setting.

A formative and summative evaluation of an electronic health record in community nursing.

Implementation of an electronic health record (EHR) system is generally believed to improve the quality of patient care. However due to the variability of systems and users, there is little agreement on successful implementation. The purpose of this research is to evaluate the implementation of a BlackBerry hosted application enabling wireless documentation and access to electronic decision support resources in one home care agency in Ontario. Through mixed-methods including surveys, corporate data collection and interviews, this study investigates nurses' perceptions of barriers and facilitators to adoption of the electronic clinical information system. Early results highlight usability, organizational culture, evidence-based practice, and factors influencing nurses' adaptation of this electronic clinical information system.

Community health nursing vision for 2020: shaping the future.

As health care is shifting from hospital to community, community health nurses (CHNs) are directly affected. This descriptive qualitative study sought to understand priority issues currently facing CHNs, explore development of a national vision for community health nursing, and develop recommendations to shape the future of the profession moving toward the year 2020. Focus groups and key informant interviews were conducted across Canada. Five key themes were identified: community health nursing in crisis now, a flawed health care system, responding to the public, vision for the future, and CHNs as solution makers. Key recommendations include developing a common definition and vision of community health nursing, collaborating on an aggressive plan to shift to a primary health care system, developing a comprehensive social marketing strategy, refocusing basic baccalaureate education, enhancing the capacity of community health researchers and knowledge in community health nursing, and establishing a community health nursing center of excellence.

What nurses want: diffusion of an innovation.

We investigated the usability of personal digital assistants (PDAs) to improve research utilization and timely access to electronic practice information to assist in clinical decisions. Nurses used a decision support tool on a PDA to collect point-of-care outcomes data. Follow-up interviews documented usability. Nurses liked the portability and size of the PDA, as well as ease of use of the PDA software. Electronic decision support tools at point of care have the potential to improve nurses' research utilization and quality of care.

Evidence in the palm of your hand: development of an outcomes-focused knowledge translation intervention.

AIM: The aim of the project was to develop an electronic information gathering and dissemination system to support both nursing-sensitive outcomes data collection and evidence-based decision-making at the point-of-patient care. BACKGROUND: With the current explosion of health-related knowledge, it is a challenge for nurses to regularly access information that is most current. The Internet provides timely access to health information, however, nurses do not readily use the Internet to access practice information because of being task-driven and coping with heavy workloads. Mobile computing technology addresses this reality by providing the opportunity for nurses to access relevant information at the time of nurse-patient contact. METHOD: A cross-sectional, mixed-method design was used to describe nurses' requirements for point-of-care information collection and utilization. The sample consisted of 51 nurses from hospital and home care settings. Data collection involved work sampling and focus group interviews. FINDINGS: In the hospital sector, 40% of written information was recorded onto "personal papers" at point-of-care and later transcribed into the clinical record. Nurses often sought information away from the point-of-care; for example, centrally located health records, or policy and procedure manuals. In home care, documentation took place in clients' homes. The most frequent source of information was "nurse colleagues." Nurses' top priorities for information were vital signs data, information on intravenous (IV) drug compatibility, drug references, and manuals of policies and procedures. IMPLICATIONS: A prototype software system was designed that enables nurses to use handheld computers to simultaneously document patients' responses to treatment, obtain real-time feedback about patient outcomes, and access electronic resources to support clinical decision-making. CONCLUSION: The prototype software system has the potential to increase nurses' access to patient outcomes information and evidence for point-of-care decision-making.

Health Outcomes for Better Information and Care (HOBIC): integrating patient outcome information into nursing undergraduate curricula.

Nursing-sensitive outcomes provide common information across sectors, thus eliminating duplication that frequently occurs as individuals move across settings. These outcomes also facilitate increased trust among colleagues and support common understandings of patient care needs, thus enhancing continuity of care. Outcomes-oriented information is also likely to increase patient safety and improve overall quality of care. Shared standards and data support consistent decision-making, as nursing decisions can be tracked back over time to assess patient care outcomes. Consequently, nurses will have the means to determine the impact of their interventions on patient outcomes. At the same time, adoption of common approaches to patient assessment leads to greater professional accountability and moves nursing care from a task orientation to an outcomes focus. For administrators, such improvements in monitoring and evaluating patient outcomes translate into improvements in efficiencies and effectiveness, thus providing a return on investment in implementing these outcomes within their agency. For nurses, integration and utilization of outcomes information increases the visibility and significance of their decision-making and patient care. Together with patients, nurses can utilize the outcomes information to make evidence-based decisions and advocate for appropriate care. At an aggregate level, the use of outcomes information creates a continuous feedback loop that is essential to ensuring evidence-based care and the best possible patient outcomes, not only for individuals, but also for families, communities and populations. Outcomes-oriented care provides a gateway for transforming the way we care for patients; puts safe, ethical, high-quality care for patients first; embodies the principles of evidence-based practice; ensures that the value of nursing is clearly understood within the larger system; and ensures that the requirements for measurability and accountability can be achieved. This journey is continuous and is being expanded to engage all other health disciplines in understanding and documenting their contributions to patient care, both as individual practitioners and as members of a healthcare team. Preparing nursing students in an outcomes approach will facilitate systemwide adoption of HOBIC patient outcomes over time and provide a means to determine the impact of nursing care on our patients.

Client-centred care: making the ideal real.

Providing quality care in a timely manner is a key goal of the healthcare system. Who defines quality care is a pivotal question to be answered in an era of well-informed clients. The Registered Nurses Association of Ontario's (RNAO) Client-Centred Care Best Practice Guideline puts patients where they belong--at the centre of care. This guideline recommends that nurses embrace as foundational to their practice a set of values and beliefs. These include: respect, human dignity and the belief that clients are the experts regarding their own lives. Clients must be provided the opportunity to lead their care as much as they choose. Moreover, the guideline recommends that nurses advocate for their clients' goals within the entire healthcare team. Recommendations regarding the organization of nursing care emphasize continuity and consistency of care and caregiver as paramount to providing timely and responsive client-centred-care. This article presents the rationale for the development of a CCC-BPG and highlights its key recommendations. It also discusses the responsibilities of healthcare practitioners and administrators in working together to ensure that these recommendations are incorporated into every aspect of client care and services.