Information processing by community health nurses using mobile health (mHealth) tools for early identification of suicide and depression risks in Fiji Islands

ObjectivesHigh rates of depression and suicide and a lack of trained psychiatrists have emerged as significant concerns in the low-income and middle-income countries (LMICs) such as the Pacific Island Countries (PICs). Readily available smartphones were leveraged with community health nurses (CHNs) in task-sharing for early identification of suicide and depression risks in Fiji Islands, the largest of PICs. This investigation examines how CHNs can efficiently and effectively process patient information about depression and suicide risk for making diagnostic and management decisions without compromising safety. The research is driven by the theoretical framework of text comprehension (knowledge representation and interpretation) and decision-making.MethodsMobile health (mHealth) Application for Suicide Risk and Depression Assessment (ASRaDA) was designed to include culturally useful clinical guidelines for these disorders. A representative sample of 48 CHNs was recruited and presented with two clinical cases (depression and suicide) in a simulated setting under three conditions: No support, paper-based and mobile-based culturally valid guideline support. Data were collected as the nurses read through the scenarios, ‘thinking aloud’, before summarising, diagnoses and follow-up recommendations. Transcribed audiotapes were analysed using formal qualitative discourse analysis methods for diagnostic accuracy, comprehension of clinical problems and reasoning patterns.ResultsUsing guidelines on ASRaDA, the CHNs took less time to process patient information with more accurate diagnostic and therapeutic decisions for depression and suicide risk than with paper-based or no guideline conditions. A change in reasoning pattern for nurses’ information processing was observed with decision support.DiscussionAlthough these results are shown in a mental health setting in Fiji, there are reasons to believe they are generalisable beyond mental health and other lower-to-middle income countries.ConclusionsCulturally appropriate clinical guidelines on mHealth supports efficient information processing for quick and accurate decisions and a positive shift in reasoning behaviour by the nurses. However, translating complex qualitative patient information into quantitative scores could generate conceptual errors. These results are valid in simulated conditions.

Public health leadership: Competencies to guide practice

In 2013, the Community Health Nurses of Canada in partnership with the Canadian Institute of Public Health Inspectors and the Manitoba Public Health Managers Network received funding from the Public Health Agency of Canada to develop a set of interdisciplinary leadership competencies for seven public health disciplines. The Leadership Competencies for Public Health Practice in Canada project comprised a multimethod research approach that included a scoping literature review, on-line survey, webinar-based focus groups, and a modified Delphi process. The 49 leadership competencies for public health practice were organized according to the LEADS Canada capabilities. The leadership competencies extend the core public health competencies and discipline-specific competencies and reflect foundational values of public health. The leadership competencies can be applied to professional development pathways, mentoring programs, and performance appraisals to advance public health practice. How these competencies have been enacted by public health leaders during the COVID-19 pandemic is discussed.

CARING BEHAVIORS AND QUALITY OF CARE RENDERED BY COMMUNITY HEALTH NURSES IN PHILIPPINES

Introduction: Nursing has been referred as a “caring profession” that requires the practitioner to exhibit and convey the art of caring which has also been the mind setting inculcated among nursing professionals in the community health setting. Hence, the study aimed to determine the caring behaviors and the quality of nursing care rendered by community health nurses. Methods: The study applied a quantitative correlational-predictive research design. A purposive sampling was employed to identify the 100 respondents who were nurses assigned in the different community healthcare facilities and centers of the different barangays in the Municipality of Biliran, Philippines. The self-administered questionnaires were distributed among the respondents. To analyze the data, descriptive statistics such as mean and weighted mean were used. Likewise, the regression analysis was also used to determine which of the caring factors predicts the quality of care. Results: The seven caring behaviors were highly evident among the community health nurses and a good quality of nursing care was reported. Likewise, all the seven caring behavior predicts the quality of nursing care. Conclusion: The outcome was found to be positive for the overall standard of treatment. The research concluded that the overall level of treatment revealed is predicted by caring behaviors.

How Do The Community Health Nurses’ Experience in The Strategies of Non-Communicable Disease (NCD) Promotion and Prevention?

Nurses have an important task in the strategy of intervention to reduce of Non-Communicable Diseases (NCD)’ incidence. Community health nurses have tried to control the problem of NCD. However, the incidence of NCD has not decreased as expected. The promotion and prevention of non-communicable diseases are one of the efforts to control PTM. This study aims to explore the experience of nurses in implementing the strategies of NCD’ promotive and preventive. This study used a qualitative descriptive phenomenological design. A total of 16 community health nurses were selected using purposive sampling. The inclusion criteria of this study were (1) nurses who served at the community health center for a minimum of 6 months, (2) performed individual health services in the community health center and carried out family visits and services in the community. The data were analyzed using Colaizzi's approach. This research was approved by the Committee of Ethics in the Faculty of Nursing, Universitas Indonesia. This study resulted in five strategies of nurses implementing to NCD’ promotion and prevention, include (1) health education, (2) partnership with community health workers, (3) coordination, (4) stand with the community, (5) monitoring the change of behavior in the community. Nurses’ experience of NCD’s promotion and prevention in the community health center still needs improvement to achieve holistic and comprehensive health services. Nurses should be attention to the preparation of themselves before implementing the promotion and prevention, such as preparation of the topic, communication with colleagues and communities, and doing a partnership with multisectoral.

Reflections on the Experience of Community Health Nurses in Palliative Care: A Qualitative Approach

There is a major demographic shift with increase in non-communicable diseases even in low- and middle-income countries. Many self-limiting illnesses are burdensome to people when they have limited access to health care system and poor family support. The aim of the study explores experiences of community health nurses in palliative care delivery in a primary health care setting. The study was conducted in Community Health Nursing Department, College of Nursing, CMC, Vellore. A qualitative research using a grounded theory approach was done which included in-depth interviews and focus group discussions from community health nursing faculty. This study used a deductive and inductive approach that stressed the process rather than the meaning of the studied phenomenon. The in-depth interviews lasted for 45 min–1 ½ h for each participant; focus group discussions were held in two sessions lasting for 2 ½ h. The group interviews were transcribed to verbatim. All transcripts were read multiple times to ensure correctness of the transcription by the authors to get an overall impression of the material before the initial coding. Authenticity, credibility, critical appraisal and integrity were demonstrated throughout the study. This study enlightens the experiences of the health care providers on palliative care delivery at the primary care setting and explores barriers, challenges and facilitators for delivery of good palliative home care. Totally, 15 subthemes were grouped under five major themes; community support, family support, acceptance of services, barriers and gaps in care. The in-depth interviews provided an insight into the experiences of the participants on successful collaborative services, caregivers fatigue and the barriers in providing services in the home care setting. Focus group discussion showed that a holistic approach to patient care in primary care setting is possible by community health nurses and a collaborative care from the secondary and tertiary care settings will bring down the non-compliance to the therapeutic regimen.

Increased Systolic Blood Pressure Mediates the Relationship Between Urate and Gout Risk in Indonesia: A Novel Application of a Partial Least Squares-Structural Equation Model

Background: Most Indonesians with hyperuricemia are less than 40 years old, which suggests an increasing gout risk in the country. Meanwhile, untreated hyperuricemia was also suggested to lead to hypertension. Yet, it is unclear whether blood pressure (BP) plays a mediating role between urate and gout. Objective: We investigated the mediating effect of BP between urate and gout risk in Indonesians using a partial least squares-structural equation model. Method: A community-based retrospective case-control study was conducted between July 1 and August 31, 2019 in Indonesia. We randomly recruited 397 participants, including 86 patients with gout and 311 healthy controls from seven community health service centers. Multivariate logistic regression was employed to analyze the adjusted odds ratios of the association between risk factors, such as urate level and BP, and gout risk after controlling for other covariates. A path analysis was utilized to analyze the mediating effect of systolic BP between urate and gout. The STROBE reporting guideline for the observational study is adopted in our reporting. Result: We found that a 1 mg/dL increase of urate level significantly increased gout risk with an OR of 4.97 (95% CI: 3.48–7.09) and an AOR of 4.44 (95% CI: 3.07 –6.42) after adjusting for covariates. The association between urate and gout was also significantly mediated by systolic BP (β = 0.05; 95% CI Bias Corrected [0.02–0.08], p < 0.001). Conclusion: Urate was significantly associated with gout risk and was possibly mediated by increased systolic BP in Indonesians. Controlling systolic BP could be one of the strategies to decrease the risk of gout for individuals with hyperuricemia. Health education can be carried out by community health nurses to individuals on controlling their urate level and systolic BP to decrease the gout risk among Indonesian.