Merilyn Annells

Client relevant care and quality of life: the trial of a Client Generated Index (CGI) tool for community nursing

Community nursing organisations worldwide seek optimal ways to ensure adequate measurement of health outcomes for the client following nursing care, and to facilitate a consumer focus. This article presents a trial of the Client Generated Index (CGI) tool that subjectively assesses and measures the quality of life outcomes pertaining to a clients health status, whilst also facilitating individualised care. Sixty district nursing clients participated in the trial, which ascertained that the CGI tool effectively directs the client to list, grade and prioritise personally relevant quality of life issues. Consequently, this tool is being incorporated into client admission and discharge assessment within the organisation.

Compression bandaging for venous leg ulcers: the essentialness of a willing patient

AIM To describe and explore reasons for use or non-use by district nurses of compression bandaging, a best practice component of venous leg ulcer management. BACKGROUND Leg ulcers are costly to both individuals and communities. The most prevalent of leg ulcers are venous leg ulcers, which are common wounds treated by district nurses. Compression bandaging is the best practice for the treatment of venous leg ulcers with considerable evidence that this aids healing in an effective and timely manner. It is anecdotally known that compression bandaging is not always used by district nurses when treating venous leg ulcers, yet little is known as to why this is so. METHOD A qualitative descriptive/exploratory study was used; interview data were collected with constant comparative data analysis applied until data saturation was obtained. FINDINGS As could be anticipated, several basic elements need to be present for a district nurse to use compression bandaging, like knowing that compression bandaging is best practice, knowing how to use compression bandaging and being able to determine that the ulcer is venous in nature. However, the major finding is the essentialness of having a patient willing for compression bandaging to be applied and sustained; the study explored what determines willingness or non-willingness and strategies that can be used to encourage willingness. CONCLUSION A prime enabler of the use of compression bandaging is having a patient willing to agree to the commencement of this treatment and for this to be sustained. Consequent recommendations are offered. Evidence-based nursing requires not only knowledge of cause and effect evidence but also evidence that provides understanding about human responses and choices when there is a health challenge. RELEVANCE TO CLINICAL PRACTICE The relevance of the findings for clinical practice is that knowledge is provided about what factors may constrain a patients willingness for compression bandaging to be applied and sustained as treatment for a venous leg ulcer and about what actions can be tried to facilitate willingness.

‘The real stuff’: implications for nursing of assessing and measuring a terminally ill person’s quality of life

• Two quality of life (QoL) assessment and measurement tools, the Client Generated Index (CGI) and the McGill Quality of Life (MQOL) questionnaires, were trialled within district nursing palliative care to test usefulness and feasibility for holistic intervention selection, individualized palliative care planning, and measurement of the quality of dying. • The specific focus of this paper is to discuss the less tangible outcomes of the trial, which illuminate the partly ‘hidden’ value and nature of clinical nursing. • These outcomes include awareness that the use of such tools may: by actual administration of the tool be, in and of itself, a therapeutic nursing action; focus on ‘the real stuff’ from the client’s perspective, that which matters most to the terminally ill client, but may not be classically considered as prompting nursing intervention; and facilitate ‘the real stuff’ of nursing, perhaps known but not usually articulated by nurses, and which usually does not feature on care plans nor in time allocation schedules.

Developing a web-based information resource for palliative care: an action-research inspired approach

BackgroundGeneral Practitioners and community nurses rely on easily accessible, evidence-based online information to guide practice. To date, the methods that underpin the scoping of user-identified online information needs in palliative care have remained under-explored. This paper describes the benefits and challenges of a collaborative approach involving users and experts that informed the first stage of the development of a palliative care website [1].MethodThe action research-inspired methodology included a panel assessment of an existing palliative care website based in Victoria, Australia; a pre-development survey (n = 197) scoping potential audiences and palliative care information needs; working parties conducting a needs analysis about necessary information content for a redeveloped website targeting health professionals and caregivers/patients; an iterative evaluation process involving users and experts; as well as a final evaluation survey (n = 166).ResultsInvolving users in the identification of content and links for a palliative care website is time-consuming and requires initial resources, strong networking skills and commitment. However, user participation provided crucial information that led to the widened the scope of the website audience and guided the development and testing of the website. The needs analysis underpinning the project suggests that palliative care peak bodies need to address three distinct audiences (clinicians, allied health professionals as well as patients and their caregivers).ConclusionWeb developers should pay close attention to the content, language, and accessibility needs of these groups. Given the substantial cost associated with the maintenance of authoritative health information sites, the paper proposes a more collaborative development in which users can be engaged in the definition of content to ensure relevance and responsiveness, and to eliminate unnecessary detail. Access to volunteer networks forms an integral part of such an approach.

Using caregivers-as-proxies to retrospectively assess and measure quality of dying of palliative care clients

This study evaluated two quality-of-life assessment and measurement tools, the Client Generated Index and the McGill Quality of Life questionnaire, within palliative care nursing. Primarily tested was the feasibility of the tools to assess clients’ QOL at admission and, if necessary, when their condition altered. The reliability of the tools has previously been ascertained. Additionally, quality of dying during the last two days of life for 14 participants who died during the study was assessed and measured retrospectively by these tools, using the client’s nominated care-giver as proxy for the client. It is this second focus that we report on here. The reasons why proxy assessment and measurement of client QOD was not useful or feasible are discussed.

Where does practice nursing fit in primary health care

Abstract Practice nursing is an integral and growing part of primary health care internationally and increasingly within the Australian health care system. The potential for practice nursing being considered as a specialty of community nursing, boundary issues in community nursing, and defining characteristics of practice nursing as a model of community-based nursing are discussed in this paper. As the author has worked as a practice nurse, personal reflections on the evolving practice nurse role are provided. Practice nursing is a dynamic entity and will continue to evolve in the primary health care setting. In order for practice nursing to meet the primary health care agenda, there is a need to incorporate a social model of health with the medical model of health and to promote research and scholarship to support this goal.

An evaluation of a mental health screening and referral pathway for community nursing care: nurses’ and general practitioners’ perspectives

AIMS AND OBJECTIVES To evaluate a feasible, best practice mental health screening and referral clinical pathway for generalist community nursing care of war veterans and war widow(er)s in Australia. BACKGROUND War veterans commonly experience mental health difficulties and do not always receive required treatment, as can also occur for war widow(er)s. Whenever opportunity arises, such as during community nursing care, it is vital to identify mental health problems in a health promotion framework. DESIGN A clinical pathway was developed by literature review and consultation and then trialled and evaluated using mixed methods--quantitative and qualitative. METHODS Community nurses who trialled the pathway completed an evaluation survey and attended focus groups. General practitioners responded to an evaluation survey. RESULTS Most nurses found the pathway clear and easy to understand but not always easy to use. They emphasised the need to establish trust and rapport with clients prior to implementing the pathway. It was sometimes difficult to ensure effective referral to general practitioners for clients who screened positive for a mental health problem. When referral was accomplished, general practitioners reported adequate and useful information was provided. Some general practitioners also commented on the difficulty of achieving effective communication between general practitioners and nurses. CONCLUSIONS Nurses and some general practitioners found the pathway useful for their practice. They offered several suggestions for improvement by simplifying the trialled pathway and accompanying guidelines and strategies to improve communication between nurses and general practitioners. This study adds understanding of how community nurses might productively screen for mental health difficulties. RELEVANCE TO CLINICAL PRACTICE The trialled pathway, which was modified and refined following the study, is an evidence-based resource for community nurses in Australia and similar contexts to guide practise and maximise holistic care for war veterans and war widow(er)s and possibly other client groups.

Quality of life issues identified by palliative care clients using two tools

Abstract Reported are issues impacting upon the Quality of Life (QoL) of 59 palliative care clients within a district nursing service. These issues reinforce the emerging conceptualisation of QoL as being subjective and multidimensional. The issues were identified during a trial of two QoL assessment and measurement tools, the Client Generated Index (CGI) and the McGill Quality of Life (MQOL). In this era of considerable concern about QoL for the terminally ill, the article’s intent is to present the QoL issues identified, the grades of impact and priority for improvement of the issues according to the clients, and to discuss these aspects. This information can inform the assessment of palliative care clients (the CGI tool was found ideal for such an assessment), and may also inform further research on the QoL of palliative care clients.