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Many patients wish to receive end-of-life care at home. Liberal professionals are necessarily called upon to help in these situations. The issues most frequently raised are the management of specific symptoms, lack of knowledge of palliative care support structures, and a feeling of isolation among caregivers.

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Optimizing the management of chronic pain in outpatient clinics remains an ongoing challenge. Liberal nurses are local healthcare players, helping to establish links with other healthcare professionals. The experiment carried out by a team of liberal clinical nurses opens up the field of possibilities and enables us to diversify the range of care we offer.

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Objetivo: Construir protocolo de enfermagem para o manejo de pacientes em terminalidade. Metodologia: Revisão integrativa da literatura, utilizando as bases de dados da BVS, CINAHL, SCOPUS, Web of Science, Embase e PUBMED, sem limites cronológicos, nos idiomas português, inglês e espanhol. Resultados: Os diagnósticos de enfermagem da classificação NANDA 2021-2023 mais prevalentes pertenciam ao domínio atividade/repouso, seguidos pelo domínio enfrentamento/tolerância ao estresse e segurança/proteção. Para cada diagnóstico prevalente estabeleceu-se intervenções de enfermagem, plausíveis no contexto de terminalidade. Conclusão: O protocolo de assistência de enfermagem ao paciente em cuidado terminal é um importante ponto de partida para se estabelecer condutas de enfermagem e fomentar a prática assistencial aos pacientes em terminalidade.(AU)

Objective: To build a nursing protocol for the management of terminally ill patients. Methodology: Integrative literature review, using the VHL, CINAHL, SCOPUS, Web of Science, Embase and PUBMED databases, without chronological limits, in Portuguese, English and Spanish. Results: The most prevalent NANDA 2021-2023 classification nursing diagnoses belonged to the activity/rest domain, followed by the coping/stress tolerance and safety/protection domains. For each prevalent diagnosis, plausible nursing interventions were established in the context of terminality. Conclusion: The nursing care protocol for terminally ill patients is an important starting point for establishing nursing behaviors and fostering care practice for terminally ill patients(AU)

Objetivo: Construir un protocolo de enfermería para el manejo de pacientes terminales. Metodología: Revisión integrativa de la literatura, utilizando las bases de datos BVS, CINAHL, SCOPUS, Web of Science, Embase y PUBMED, sin límites cronológicos, en portugués, inglés y español. Resultados: Los diagnósticos de enfermería de la clasificación NANDA 2021-2023 más prevalentes pertenecieron al dominio actividad/descanso, seguido por los dominios afrontamiento/tolerancia al estrés y seguridad/protección. Para cada diagnóstico prevalente, se establecieron intervenciones de enfermería plausibles en el contexto de la terminalidad. Conclusión: El protocolo de atención de enfermería al paciente terminal es un importante punto de partida para establecer comportamientos de enfermería y fomentar la práctica del cuidado al paciente terminal.(AU)

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The choice of private practice is determined by a zoning of installation intended to distribute the professionals more equitably. While there are many administrative constraints, these nurses, who are both generalists and specialists in different fields, are increasingly involved in the co-development of care and health projects with other professionals. Not counting their hours and confronted with conflicts of values, they are not spared from suffering at work.

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This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under civil law. Inconsistencies and uncertainties in the law are made apparent. It evaluates to which degree disclosure standards of other Commonwealth jurisdictions (e.g. the case of Montgomery) would be suitable for the health care setting of a country like Malawi that is characterized by shortages of resources, high illiteracy rates and a communitarian cultural context. Doctor-patient communication is not alien to African culture and part of sufficient informed consent. In order to balance the need for efficiency in health care delivery, accountability for quality care, fairness and effective patient-doctor communication the authors suggest to adopt the reasonable patient test only, if a defence of heavy workload on case-to-case basis is introduced at the same time. This does not dispense the need for organisational diligence on part of the institutional health care provider within its capacity

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OBJECTIVE: To understand the practice of nurses in the context of the care model at the bedside of the patient in an Intensive Care Unit, in the light of the ethics of virtue. METHOD: Qualitative research, carried out in an Intensive Care Unit of a University Hospital MG/Brazil. Data were collected in February 2016 through a semi-structured interview applied to the 12 nurses who worked at the unit. The data were submitted to Thematic Content Analysis. RESULTS: The "bedside" care model encourages innovative practice, (re)directing nurses in the search for their telos, patient care, overcoming the fragmentation of nursing care and reconfiguring professional identity. However, the organization of the model in the scenario raised challenges related to the recognition of nurses by the multi-professional team, generating identity ruptures. CONCLUSION: The adopted bedside model interferes in the nurses' relationship with care, bringing together professional and patient, enhancing innovative and excellent practice.

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BACKGROUND: The complexity of the hospital-city care pathway is a real challenge because of the lack of coordination and communication between many stakeholders. As part of a call for projects from the General Directorate of Healthcare Provision, an experiment involving private oncology coordinating nurses was developed to address this issue. To our knowledge, there is no evaluation so far of such a protocol . METHODS: This single-center retrospective study focused on data from the ONC'IDEC program between 2015 and 2018, where 28 private nurses provided a 24/7 hotline. The objective was to qualitatively assess the coordination of this system. The nature and number of calls, patient satisfaction and medico-economic parameters were assessed. RESULTS: More than a hundred patients (n=114) were included in this device (mean age: 72 ± 12 years). The most frequent reasons for calls concerned the patient's general condition (35 %) and home treatment follow-ups (13 %) but also referrals to the primary doctor (4 %), which helped avoiding hospitalizations. The patients were satisfied with the experiment (overall score of 8.4/10). DISCUSSION: Thanks to the ONC'IDEC program, patients were able to benefit from more appropriate care through a privileged interlocutor by making their care pathway more fluid and avoiding hospitalizations. It would be interesting to confirm these results by means of a study with a higher level of evidence, by comparing this protocol to conventional hospital coordination.

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Plastic surgery is a dynamic field but remains poorly understood by general practitioners, medical students, health professionals, and the public. The main health care professionals in the community who are involved in the follow-up of plastic surgery patients are nurses; they help to facilitate wound healing and rehabilitation in the postoperative period. In this study, the authors assessed the medical knowledge and perceptions of plastic surgery by nurses working in the community setting and explored their understanding of classical scenarios commonly encountered in reconstructive surgery. An online survey was designed to assess the demographics of nurses working in the community in France and their knowledge of plastic surgery. This was disseminated to all practicing nurses working outside of hospitals by means of an online social network from the period of April 2019 to June 2019. The survey was completed by 318 nurses. Specific training in plastic surgical nursing will be required to optimize the management of these patients following discharge from hospital. This gap in knowledge may affect patient recovery negatively.

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The article explores the private practice nursing profession from the angle of gender. The methodology is based on cross-referencing data taken from statistical and field surveys. The results show that men and women practise differently. Training paths, careers and professional activities are shaped by the caregivers' gender.

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Une étude rétrospective descriptive a été menée sur 2338 myélogrammes effectués au laboratoire d'hé-matologie du centre hospitalier universitaire Joseph Ravoahangy Andrianavalona Antananarivo de janvier 2008 à décembre 2017. L'objectif principal était de décrire les résultats des myélogrammes pendant cette période.L'étude a montré que la fréquence moyenne de demande de myélogramme est de 234 par an. L'âge moyen des patients était de 33,30 ans avec des extrêmes de 29 jours à 82 ans. Une prédominance masculine a été notée avec un sex ratio H/F de 1,2.Les anomalies de l'hémogramme ont constitué le motif principal de prescription des myélogrammes (58,08%). La pancytopénie était la plus fréquente.Les diagnostics révélés par les analyses des myélogrammes étaient le plus fréquemment des hémopathies malignes (58,1%), dont 32,97% de leucémies aigues.Parmi les myélogrammes analysés, 10% étaient nor-maux. La confrontation clinico-biologique est de mise pour une bonne pratique du myélogramme

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The American Organization of Nurse Leaders and the American Association of Colleges of Nursing have been working together since 2010 to address how academic-practice partnerships can most effectively advance the profession by preparing a well-educated workforce. This article describes the work to date and future strategic priorities.

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At the crossroads between the care delivered in the hospital and community nursing care, private practice nurses occupy a central role in supporting children with haemophilia and their family. Dedicated training helps to maintain the link with hospital structures and enables them to exchange with other professionals regarding practices, treatment difficulties and the contribution of new technologies in the care provision.

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OBJECTIVES: Children with medical complexity are frequently hospitalized and have extensive health care needs. Private-duty nursing (PDN) is a service on which some children with medical complexity rely to live at home, but little is known about patients discharged with PDN. Our objective for this study was to describe the characteristics and longitudinal outcomes of patients with PDN who are hospitalized. METHODS: This study was a 1-year retrospective study of patients receiving PDN who were hospitalized at a quaternary freestanding children's hospital; there was an additional 2-year follow-up. Patient characteristics, rehospitalization rates, length of stay, mortality, and hospital charges were identified. Descriptive statistics were performed to characterize trends, and a time-to-event analysis was used to characterize unplanned rehospitalization. RESULTS: Among 8187 unique patients who were hospitalized in the initial study year (June 1, 2014 to -May 31, 2015), 188 patients (2%) used PDN. Of patients using PDN, 94% used gastrointestinal devices. The median index length of stay was 4 days (interquartile range 2-6). Two-year mortality was 12%. Cumulative all-cause rehospitalization rates were 18% by 30 days, 62% by 365 days, and 87% within 2 years; the median rehospitalization frequency was 3 per patient. The most common reasons for unplanned rehospitalization were infection (41%) and device complication (10%). During the study period, 11% of both rehospitalizations and total hospital days were attributed to patients with PDN. Unplanned rehospitalizations of patients with PDN accounted for $117 million in hospital charges. CONCLUSIONS: One in 50 patients hospitalized at a single center were discharged with PDN, which accounted for a disproportionate level of hospital use. Future research should be used to address whether the access and quality of PDN may impact rehospitalization.

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Anticancer medicines evolve in terms of their mode of action as well as their galenics. The advent of oral therapies has multiple benefits such as the possibility of taking the treatments at home. However, what are the implications with regard to compliance, the management of side effects and the community-hospital relationship? Elderly patients, often isolated, taking several medicines and frail, are disorientated faced with all these medications and their side effects. A study was undertaken to evaluate the benefit of visits by private practice nurses to support patients taking oral cancer drugs.

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Objective Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n=25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n=55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n=64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included 'duplication of services' and 'level of reimbursement'. Conclusion The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic? Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add? This paper provides data on PPNPs' provision of care subsidised through the MBS and PBS. What are the implications for practitioners? Eligibility to provide care subsidised through the MBS and PBS has enabled the establishment of PPNP services. The current breadth and structure of the NP MBS and PBS item numbers have restricted the capacity of PPNPs to provide complete episodes of patient care.

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Drawing on her hospital expertise in pulmonology, a currently private practice nurse describes her work supporting patients with chronic obstructive pulmonary disease in their home. In collaboration with hospital- and community-based teams, she uses a support tool to formalise therapeutic education sessions.

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The objective of this observational time and motion study was to increase our understanding of how nurses in home healthcare currently distribute their work time with a focus on the medication management process. The research was conducted in four municipalities in the southern part of Sweden. Participants were nurses working in home healthcare. The study measured proportion of time, comparison of proportions of time, proportion of time spent multitasking, and rate of interruptions per hour. Of total observed time, 20.4% was spent on medication management and of these tasks the highest proportion of time was spent on communications and dispensing medications. Nurses in nursing homes spent more time (23.0% vs. 17.4%, p = 0.001) on medication management than nurses in private homes. Nurses spent 47.9% of their time completing tasks with someone else, including patients, but had minimal interaction with prescribers. We observed a rate of 1.2 (95% CI 1.1-1.4) interruptions per hour on average and 30% of all interruptions occurred during medication management tasks. Nurses spent 3.7% of their time multitasking. Interruptions while performing medication-related tasks were common, as well as multitasking. Causes and consequences of the results need to be addressed in order to improve the safety of medication management for patients receiving municipality-based home care.

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BACKGROUND: To facilitate the expansion of nurse practitioners working in community and primary health settings, legislative changes were enacted in 2010. These led to privately practicing nurse practitioners (PPNPs) being enabled to provide care subsidized through the Australian Government Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. Little is known about the impact of this legislation on patient access to care in Australia. PURPOSE: To explore how, why and in which contexts PPNP services in Australia impact on patient access to care. METHODS: Semistructured interviews using realist evaluation were undertaken with 20 participants, selected through stratified sampling using geographic criteria (State/territory in which practicing) and dividing the sample representatively between those who worked solely in private practice and those who worked in both private and public practice. Thematic analysis of qualitative data was undertaken. CONCLUSION: Findings suggest that PPNPs have increased access to care for patients, predominantly in community and primary health settings. IMPLICATIONS FOR PRACTICE: In increasing access to care, PPNPs have the potential to reduce hospital and general practitioner attendance, thereby potentially reducing the ever-increasing demand for health care.

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BACKGROUND AND PURPOSE: Self-employed nurse practitioners (NPs) have been part of the American health care landscape since the 1970s, owning practices throughout the United States. The purpose of this study was to explore and measure the 2 characteristics of job satisfaction and empowerment in self-employed NPs practicing within the 50 states and District of Columbia and to explore factors that influence these characteristics. METHODS: A convergent parallel design, mixed methods study, using a survey and semistructured interviews, was completed. The survey included the Misener Job Satisfaction Survey and Conditions of Work Effectiveness Questionnaire II. CONCLUSIONS: Self-employed NPs are satisfied and empowered. The more empowered, the higher their level of job satisfaction. Over 40% practiced with full practice authority in a rural location, and 50% had over 10 years of experience as both an RN and NP. Their experience in private practice was explored further in the interviews. IMPLICATIONS FOR PRACTICE: This study identifies barriers to job satisfaction and empowerment in self-employed NPs, including physician oversight and lack of business management education. Continuing work to remove restricted and reduced state regulatory environments and to provide education on business management may increase the number of NPs in private practice, expanding access to health care in the United States.

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