Objetivo: Sistematizar las experiencias sobre desarrollo rural sostenible en los caseríos del distrito de Íllimo y de Jayanca, y discutir su aporte para la enfermería comunitaria. Método: El estudio cualitativo utilizó como método la sistematización de experiencias, los datos se recolectaron entre agosto y noviembre 2020 a través de la narrativa, y entrevista semiestructurada a 09 beneficiarios y 07 miembros del equipo que ejecutó los proyectos de desarrollo del 2000 al 2014. Se procesaron los datos con el análisis de contenido temático y se aplicaron los criterios éticos y de rigor científico. Resultados: a) Programa vivienda rural saludable en zonas del bosque seco, b) Trabajo comunitario en manejo forestal del bosque seco para el desarrollo rural sostenible y mitigación del cambio climático, c) Actividades productivas sostenibles en el manejo del bosque seco, d) Participación de la enfermera en la sostenibilidad de los proyectos de desarrollo rural en el bosque seco. Conclusión: Los proyectos de desarrollo rural sostenible ayudaron a detener la desertificación y extrema pobreza. En este contexto se involucró la enfermera generando una experiencia que integra la salud, el ambiente y las actividades productivas que hasta la actualidad perduran; destacando el papel de la metodología participativa, el trabajo interdisciplinario y promotores. Proponiéndose el esquema conceptual de enfermería ambiental comunitaria con visión para el desarrollo rural sostenible- EACO. / Objective: To systematize the experiences on sustainable rural development in the villages of the Íllimo and Jayanca districts, and discuss their contribution to community nursing. Method: The qualitative study used the systematization of experiences as a method, the data was collected between August and November 2020 through narrative, and a semi-structured interview with 09 beneficiaries and 07 members of the team that executed the development projects from 2000 to 2014. Data were processed with thematic content analysis and ethical criteria and scientific rigor were applied. Results: a) Healthy rural housing program in dry forest areas, b) Community work in dry forest forest management for sustainable rural development and climate change mitigation, c) Sustainable productive activities in dry forest management, d) Participation of the nurse in the sustainability of rural development projects in the dry forest. Conclusion: Sustainable rural development projects helped stop desertification and extreme poverty. In this context, the nurse was involved, generating an experience that integrates health, the environment, and productive activities that continue to this day; highlighting the role of participatory methodology, interdisciplinary work and promoters. Proposing the conceptual scheme of community environmental nursing with a vision for sustainable rural development - EACO.

Aim. The aim of this study was to examine the relationship of advance care planning protocols with hospitalization, rehospitalization, and emergency department use rates in U. S. home health agencies (HHA). Background. Since 2003, CMS has required HHAs to report on quality outcomes such as hospitalization, rehospitalization, and emergency department use rates, made publicly available online. Advance care planning (ACP) is a conversation about beliefs, goals, values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on ACP have taken place outside of HHAs among populations with serious illnesses such as HIV/AIDS, cancer, dementia, and end stage renal disease. Meanwhile, the U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses. Effective January 1, 2016, the Center for Medicare and Medicaid Innovation implemented the Home Health Value-Based Purchasing (HHVBP) Model among home health agencies (HHAs) in nine states representing each geographic region in the United States. Agencies in these states began competing on value in the HHVBP model, and reimbursement rates began to be tied to quality performance (innovation.cms.gov). As part of HHVBP, CMS implemented an additional process-level mandate requiring them to report on ACP, though this data is not publicly available. It is currently unknown how ACP protocols in HHAs may affect agencies’ overall rates of acute care services use. Methods. Electronic surveys about ACP protocols were distributed to HHAs. Existing data about demographics, diagnoses, hospitalization, rehospitalization, and ED use were accessed online via CMS websites. Descriptive and regression analyses were conducted using the electronic survey results and the existing data. Results. Associations between the variables were observed and compared to the hypotheses. Statistical significance was found in the relationship between ACP protocols and hospitalization, where one increased the other increased. Several trends were found: Agencies with increased total percentage of cardiac and pulmonary diagnoses tended to have increased hospitalization rates; agencies with increased average age of patients tended to have increased ACPP scores; and agencies with increased proportion of Black patients tended to have higher hospitalization rates.

Tennesseans have been experiencing increasing rates of sexually transmitted diseases since the year 2000. Those rates are highest among those 15- to 24-year-olds. At the same time, Tennessee policy requires the teaching of abstinence as the primary form of sexual health education and emphasized the use of abstinence-only curriculum. The school nurse represents an available resource in the Tennessee public schools. The purpose of the qualitative study was to explore, describe, and interpret the perceptions and experiences of public-school nurses from rural, suburban, and urban areas of Tennessee related to the sexual health and sexual health education of students. School nurses were recruited from across the state and from a variety of communities to complete an electronic survey and to participate in individual interviews. Critical Discourse Analysis was used to analyze results in the context of the existing sociocultural and power structures. The research plan included a comparison of results from participants in rural, suburban, and urban areas that could not be done because of the limited responses obtained from potential participants. Emerging themes in light of the limited participant responses created a view of power structures within the context of existing conditions that may be impacting the sexual health of students.

Regardless of the setting, medication errors are of great concern when associated with an individual’s health outcomes, along with the increased costs to society, healthcare institutions, and providers. Current research focuses on medication error data primarily in acute and extended care facilities. However, there is a paucity of research examining the causes of medication errors that occur post hospital discharge when individuals transition to the home. The purpose of this integrative literature review is to examine risk factors for medication errors outside of these settings, specifically in the home. A systematic literature search was conducted using multiple databases for relevant articles in the English language between 2006 to 2017, including CINAHL, MEDLINE, PubMed, and PsycINFO. Search terms included ‘medication errors’, ‘home care’, ‘post-discharge’, ‘hospital readmission’, and ‘medication error risks in the home’. Exclusion criteria included medication errors in acute and extended care settings. The integrative review involved reading, analyzing and selecting articles, and summarizing on a matrix. Findings on occurrences of medication errors in the home included impaired client mental status, confusion related to medication names, limited understanding of medication purpose in the care plan and its side effects, level of health literacy, and client-provider miscommunication in discharge planning. Consistent and conflicting findings are discussed along with gaps in the literature. Limitations and implications for nursing practice, policy, research, and education are also noted.

A sizeable number of U.S. veterans of all ages experience post-traumatic stress disorder (PTSD) which can impact their quality of life; physically, mentally and socially. Consequences of PTSD are associated with physical and emotional disabilities, including ideation of self-harm and even suicide. Increasingly, animal-assisted therapies (AAT) are used to treat PTSD and other physical and behavioral conditions in veterans. Over the decades, AATs have used dogs, cats, horses, and dolphins among other animals. The purpose of this integrative review is to examine the use of AAT focusing on canine assisted therapy (CAT) among veterans diagnosed with PTSD. The methodology involved database searches, including MEDLINE, PubMed, PsychInfo, EBSCOhost, along with textbooks and popular media published from 2000 to 2016. Associated with the lack of more recent research, relevant articles published before 2000 were included in the review. Search terms included, ‘veterans,’ ‘service dogs,’ ‘service animals,’ ‘animal-assisted therapy,’ ‘canine therapy,’ ‘PTSD,’ ‘post-traumatic stress disorder,’ ‘psychiatric,’ ‘U.S. veterans,’ ‘equine therapy,’ ‘horse therapy,’ ‘pet therapy,’ and ‘military veterans.’ A total of ten relevant studies were identified which focused on the use of AAT among veterans diagnosed with PTSD. Different populations diagnosed with PTSD and other behavioral and psychiatric health conditions using AAT were examined as well. These articles were read, analyzed, and synthesized. Results of the review offer some support that AAT has psychological, physiological and psychosocial benefits for some populations across the lifespan with various diagnoses. Consistent and conflicting findings along with gaps in the literature are highlighted. Limitations and implications for nursing practice, research, policy and education also are noted in this thesis.

<p>Research has demonstrated repeatedly that income and income distribution are powerful determinants of health. While Ontario public health units are mandated to promote health and reduce health inequities, they have done little to help eliminate poverty, instead focusing on individual behaviours such as smoking, diet, and physical activity – an approach likely to worsen health inequities, rather than mend them. Public health nurses (PHNs) across Canada recognize poverty as a powerful determinant of health, yet have expressed challenges in their ability to take meaningful action to address it (Cohen, 2006b; Reutter & Ford, 1996). The study sought insight into how Ontario public health units can strengthen PHNs socio-political efforts to address the causes of poverty. A qualitative descriptive design was used to explore PHNs’ views, while an <em>Appreciative Inquiry</em> approach was used to draw on participants’ successful past experiences in addressing the causes of poverty and their thoughts for the future. Organizational factors thought to empower PHNs’ socio-political efforts to address the causes of poverty were identified using Kanter’s <em>Structural Theory of Power in Organizations</em> as a starting conceptual framework. Fifteen PHNs participated in face-to-face or telephone interviews. Qualitative content analysis was used to describe participants’ affirmative experiences, empowering organizational attributes, and desired actions and supports for the future. Three overall themes emerged with respect to empowering organizational attributes: authorities within the health unit ‘permit and provide’, active associates ‘help each other out’, and external allies ‘contribute and collaborate’. Factors beyond the health unit that would support anti-poverty work were also identified. Findings suggested that action to address the causes of poverty is within the reach of PHNs, and is consistent with their role and the public health mandate, but requires leadership support and political buy-in in order to maximize its effectiveness.</p> / Master of Science (MSc)

This qualitative study examines variables that can impact job stress, burnout, and turnover rates among social workers north of 60. The research herein seeks to fill in some gaps surrounding research on service worker employment conditions in the north that has not been specific to social workers serving Inuit clients. While the provisional literature review highlights possible conditions such as: social and geographical isolation, role stress, personality factors, and cultural and ethnic disparities as possible sources of burnout, these have never been evaluated in a manner specific to northern social workers. In-depth, semistructured interviews were conducted via telephone with nine former Nunavut social workers and directors in order to probe the issue of burnout and turnover. Application of Interpretive Social Sciences (ISS) and hermeneutical phenomenological approaches (HPA) to interview analysis revealed a trend in themes related to the administration of northern social work services, including: understaffing, lack of supervisory support, dual role stress, and overworked staff who already face the challenges of cultural incongruence for which they have been insufficiently trained to deal with. Final recommendations include increased attention and resources to the social work staff supporting vulnerable Inuit clients, including increased staffing and culturally sensitive training. / Master of Social Work (MSW)

<p>The purpose of this thesis was to explore how health units servicing large rural populations in Ontario are integrating the built environment into public health interventions related to physical activity for the purpose of fostering healthy and sustainable communities. Additionally, this research sought to identify barriers and/or enabling structures that rural health units face in addressing the built environment within physical activity programming.</p> <p>This exploratory research study employed a descriptive qualitative approach. Semi-structured interviews were conducted with a purposeful sample of public health practitioners and managers identified by participating health units (n=12) as those most knowledgeable about program planning, implementation, and policy development in relation to physical activity and the built environment. Key themes were identified using qualitative content analysis and an inductive approach.</p> <p>The types of interventions were: engagement with policy work at a county or municipal level; building and working with community partners; gathering and providing evidence; hosting knowledge sharing opportunities; program development and implementation; social marketing, information sharing and awareness raising; and resource development and dissemination. Barriers and enabling processes and structures were identified at an organizational, community, and systemic level. Specific rural contextual enablers and barriers were also identified.</p> <p>This was the first study to the researchers’ knowledge that has examined current practices of Ontario’s rural health units related to built environment initiatives. In-depth perspectives elicited from public health practitioners and managers address gaps in the literature and contributes to new knowledge regarding built environment interventions to enhance physical activity in rural settings.</p> / Master of Science (MSc)

<p>The Nurse-Family Partnership (NFP) is a targeted, nurse home visitation program for young, low-income, first time mothers. While the effectiveness of the NFP has been established in the context of the US, and is currently being evaluated in the Canadian public health care system, little has been done to document how work of this nature influences or impacts public health nurses (PHNs), an essential component of this program delivery model, on both professional and personal levels. This qualitative interpretive descriptive study explored PHNs’ experiences of long-term home visiting a targeted population of young, vulnerable mothers in a Canadian NFP program. The study was conducted in two phases beginning with a secondary analysis of five focus groups conducted with public health nurses (N = 6) who delivered the NFP intervention as part of the feasibility and acceptability pilot in Hamilton, Ontario. This was followed by further exploration of identified themes and a practice, problem and needs analysis through individual, semi-structured interviews with the original focus group participants and all PHNs who have since delivered the NFP (N =10). Relationships formed with clients, the NFP program and support of NFP colleagues were rewarding factors while workload and workplace factors were significant contributors to stress. The study findings have implications for the identification of strategies to minimize staff turnover, PHN burnout, secondary traumatic stress and compassion fatigue, and improve program delivery.</p> / Master of Science in Nursing (MSN)

Background: Posttraumatic stress disorder (PTSD) presents a significant mental health challenge for many veterans, prompting interest in innovative interventions such as the use of service dogs. Despite this, there remains a gap in understanding the specific impact of service dogs on the mental well-being of veterans who served in combat zones. Aim: This integrative review aims to explore the associations between service dog exposure and the mental health of veterans following deployment to combat zones, focused on those with PTSD. Through a systematic literature search, review, and synthesis, the study seeks to identify gaps in knowledge to inform future research efforts and interventions. Design: Adopting an integrative review design, the review explores existing literature to uncover insights into the associations between service dog exposure and veterans' mental well-being. The study ensures a comprehensive examination of relevant research articles by employing a systematic literature search methodology and rigorous inclusion and exclusion criteria. Methods: Inclusion criteria involve selecting research articles published in peer-reviewed journals focusing on veterans' participation with service dogs or canine exposure and their subsequent mental health outcomes. Exclusion criteria are non-U.S. research, abstracts without full-text articles, grey literature, and non-research articles. This rigorous approach aims to assemble reliable evidence to enhance understanding and inform future research and interventions supporting veterans' mental well-being. Results: This study examines the demographics, characteristics, challenges, and benefits associated with veterans with PTSD and their service dogs. Veterans in the studies ranged from 36.8 to 50.9 years old, were predominantly male, and mostly white, with significant portions being honorably discharged and married. The service dogs were mostly male, mixed-breed, or Labrador Retrievers sourced from shelters. Veterans faced challenges obtaining and training their dogs, such as demanding training processes and adjusting to public attention. Despite these challenges, service dogs provided substantial benefits, including reduced PTSD symptoms, improved sleep, increased physical activity, and emotional reconnection. Studies showed a reduction in PTSD severity, improved quality of life, and enhanced social participation for veterans with service dogs. However, veterans also experienced drawbacks like increased public attention and misconceptions about service dogs. The bond between veterans and their dogs was associated with lower anxiety and higher positive affect, highlighting the overall positive impact of service dogs on veterans' mental health and daily life. Conclusion: This study demonstrates the substantial benefits of service dogs for veterans with PTSD, including reductions in stress, anxiety, and PTSD symptoms and improvements in depression management, safety, and quality of life. Unexpected challenges with nonobedience issues arose, but they did not diminish the overall positive impact. Future research should explore the cost-effectiveness of service dog programs, their effects on different veteran demographics, and standardized training protocols. The findings emphasize the need for continued support and refinement of service dog programs to optimize their benefits and improve the well-being of veterans with PTSD.