Background Measuring nursing interventions and nurse-sensitive outcomes in a standardized manner is essential because it provides insight into the quality of delivered care. However, there is currently no systematic overview of the interventions conducted by district nurses, the evidence for the effects of these interventions, or what nurse-sensitive outcomes should be measured. Objective 1) To provide an overview of interventions for community-living older people evaluated in district nursing care and evidence for the effects of these interventions and 2) to identify the nurse-sensitive outcomes that are used to evaluate these district nursing care interventions, how these outcomes are measured, and in which patient groups they are applied. Design A systematic review of the literature. Setting District nursing care. Data sources MEDLINE, CINAHL, PsycInfo, and EMBASE. Methods Only experimental studies evaluating district nursing care interventions for communkity-living older people were included. A data extraction form was developed to extract the study characteristics and evaluate interventions and nurse-sensitive outcomes. The methodological quality of the included studies was reviewed using the 13-item critical appraisal tool for randomized controlled trials by the Joanna Briggs Institute. Results A total of 22 studies were included. The methodological quality of the studies varied, with scores ranging from 6 to 11 on a scale of 0–13. The 22 interventions identified were heterogeneous with respect to intervention components, intervention delivery, and target population. The 44 outcomes identified were grouped into categories following the Nursing Outcome Classification and were measured in various ways and at various times. Conclusion This is the first systematic review summarizing the evidence for the effectiveness of nurse-led interventions conducted by district nurses on community-living older people. It is unclear what interventions are effective and what outcomes should be used to substantiate district nursing care effectiveness. Because only studies with experimental designs were included, this analysis may provide an incomplete assessment of the effectiveness of interventions in district nursing care. Therefore, it is highly necessary to produce methodologically strong evidence through research programs focusing on district nursing care.
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Abstract: Nurses come into frequent contact with frail older people in all healthcare settings. However, few studies have specifically asked nurses about their views on frailty. The main aim of this study was to explore the opinions of nurses working with older people on the concept of frailty, regardless of the care setting. In addition, the associations between the background characteristics of nurses and their opinions about frailty were examined. In 2021, members of professional association of nurses and nursing assistants in the Netherlands (V&VN) received a digital questionnaire asking their opinions on frailty, and 251 individuals completed the questionnaire (response rate of 32.1%). The questionnaire contained seven topics: keywords of frailty, frailty domains, causes of frailty, consequences of frailty, reversing frailty, the prevention of frailty, and addressing frailty. Regarding frailty, nurses especially thought of physical deterioration and dementia. However, other domains of human functioning, such as the social and psychological domains, were often mentioned, pointing to a holistic approach to frailty. It also appears that nurses can identify many causes and consequences of frailty. They see opportunities to reverse frailty and an important role for themselves in this process.
Older people with confused behavior, have behavioral problems due to dementia, mental problems or social problems. For the Healthcare Assistant (HA) in district nursing, it is a daily challenge to care for older people with confused behavior. Aim of this research is to achieve an insight in the strategies the HA uses to deal with the daily care for older people with confused behavior. It is also the aim to have insight in factors which contribute to the daily care in a positive or negative way. Method: a qualitative explorative research. 17 HA’s in district nursing participated in semi-structured interviews. All respondents had experience with caring for older people with confused behavior. The most important influencing factors are the experienced relationship between HA and the client and the experienced support by the team. Particularly behavioral problems due to mental problems can impede a relationship with the client. Further research is recommended to study the level of knowledge and competences of all levels of employees in district nursing.
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