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While vast numbers of nurses across the globe contribute in all areas of healthcare delivery from primary care to acute and long-term care in community settings, there are significant differences in how they are educated, as well as the precise nature of their practice. This comprehensive handbook provides a research-informed and international perspective on the critical issues in contemporary nurse education. As an applied discipline, nursing is implemented differently depending on the social, political and cultural climate in any given context. These factors impact on education, as much as on practice, and are reflected in debates around the value of accredited programmes, and on-the-job training, apprenticeship, undergraduate and postgraduate pathways into nursing. Engaging with these debates amongst others, the authors collected here discuss how, through careful design and delivery of nursing curricula, nurses can be prepared to understand complex care processes, complex healthcare technologies, complex patient needs and responses to therapeutic interventions, and complex organizations. The book discusses historical perspectives on how nurses should be educated; contemporary issues facing educators; teaching and learning strategies; the politics of nurse education; education for advanced nursing practice; global approaches; and educating for the future. Bringing together leading authorities from across the world to reflect on past, present and future approaches to nurse education and nursing pedagogy, this handbook provides a cutting-edge overview for all educators, researchers and policy-makers concerned with nurse education.

\"The WHO Handbook on Indoor Radon\" is a key product of the WHO International Radon Project, which was launched in 2005. The \"Handbook\" focuses on residential radon exposure from a public health point of view and provides detailed recommendations on reducing health risks from radon and sound policy options for preventing and mitigating radon exposure. The material in the \"Handbook\" reflects the epidemiological evidence that indoor radon exposure is responsible for a substantial number of lung cancers in the general population. The material is organized into six chapters, each introduced by key messages. Usually, technical terms are defined the first time they are used, and a glossary is also included. Information is provided on the selection of devices to measure radon levels and on procedures for the reliable measurement of these levels. Discussed also are control options for radon in new dwellings, radon reduction in existing dwellings as well as assessment of the costs and benefits of different radon prevention and remedial actions. Also covered are radon risk communication strategies and organization of national radon programs.This publication is intended for countries planning to develop their national radon programs or extend such activities, as well as for stakeholders involved in radon control such as the construction industry and building professionals.The overall goal of this \"Handbook\" is to provide an up-to-date overview of the major aspects of radon and health. It does not aim to replace existing radiation protection standards, rather it emphasizes issues relevant to the comprehensive planning, implementation and evaluation of national radon programs.

Structural-level factors have contributed to the substantial disproportionate rates of HIV among Black men who have sex with men (BMSM) in the United States. Despite insufficient HIV testing patterns, however, there is a void in research investigating the relationship between structural factors and access to HIV testing and prevention services among BMSM. Building on previous scholarly work and incorporating a dynamic social systems conceptual framework, we conducted a comprehensive review of the literature on structural barriers to HIV testing and prevention services among BMSM across four domains: healthcare, stigma and discrimination, incarceration, and poverty. We found that BMSM experience inadequate access to culturally competent services, stigma and discrimination that impede access to services, a deficiency of services in correctional institutions, and limited services in areas where BMSM live. Structural interventions that eliminate barriers to HIV testing and prevention services and provide BMSM with core skills to navigate complex systems are needed.

Background Children with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC). Methods This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews ( N  = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews. Results Overall, 39.87% of CMC experienced  ≥  1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations , and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families. Conclusions Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers’ insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.

This chapter contains sections titled: Introduction Key trends What is telecare? The impact of telecare on care services Implications for the healthcare built infrastructure Conclusion Acknowledgements References

Millions of people worldwide have complex health and social care needs. Care coordination for these patients is a core dimension of integrated care and a key responsibility for primary healthcare. Registered nurses play a substantial role in care coordination. This review draws on previous theoretical work and provides a synthesis of care coordination interventions as operationalized by nurses for complex patient populations in primary healthcare. We followed Arksey and O'Malley's methodological framework for scoping reviews. We carried out a systematic search across CINAHL, MEDLINE, Scopus and ProQuest. Only empirical studies were included. We performed a thematic analysis using deductive (the American Nurses Association Framework) and inductive approaches. Findings were discussed with a group of experts. Thirty-four articles were included in the synthesis. Overall, nursing care coordination activities were synthesized into three categories: those targeting the patient, family and caregivers; those targeting health and social care teams; and those bringing together patients and professionals. Interpersonal communication and information transfer emerged as cross-cutting activities that support every other activity. Our results also brought to light the nurses' contribution to care coordination efforts for patients with complex needs as well as critical components that should be present in every care coordination intervention for this clientele. These include an increased intensity and frequency of activities, relational continuity of care, and home visits. With the growing complexity of patient's needs, efforts must be directed towards enabling the primary healthcare level to effectively play its substantial role in care coordination. This includes finding primary care employment models that would facilitate multidisciplinary teamwork and the delivery of integrated care, and guarantee the delivery of intensive yet efficient coordinated care.

Purpose – The purpose of this paper is to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature. Design/methodology/approach – A comprehensive review of literature focussing on lean and lean healthcare was conducted. Findings – Leadership, organizational culture, communication, training, measurement, and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings. Research limitations/implications – The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study. Practical implications – The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed. Originality/value – To the best of the knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research.

During development of complex surgical innovations, modifications occur to optimize safety and efficacy. Operators' experiences (how professionals feel undertaking the innovation) drive this process but comprehensive overviews of measures of this concept are lacking. This study identified and appraised measures to assess operators’ experience of surgical innovation. There were three phases: (1) Literature reviews identified measures of operators’ experience and concepts measured were extracted and grouped into domains. (2) Quality appraisal was conducted to assess content validity of identified instruments and was supported by COnsensus-based Standards for the selection of health Measurement Instruments methodology. Self-reported measurement instruments that had underdone formal development were eligible. Content validity was assessed using COnsensus-based Standards for the selection of health Measurement Instruments criteria for good content validity (rated sufficient/insufficient/indeterminate/inconsistent), informed by standards for measurement development and domains identified in phase 1. (3) Instruments determined suitable and of sufficient quality underwent supplemental appraisal in interviews with international multidisciplinary professionals and a focus group. Literature reviews identified 16 measurement instruments from 243 studies. Most assessed ‘psychological’ experiences and ‘usability’. No instrument was specifically validated for innovative surgery. Three instruments were rated ‘sufficient’ (Surgery Task Load Index [SURG-TLX]) or ‘indeterminate’ (Spielberger State-Trait Anxiety Inventory, Imperial Stress Assessment Tool). Twenty professionals were interviewed (seven female; 15 specialties; six countries) and the focus group included 10 participants (four professionals, six researchers). The SURG-TLX was considered the most relevant, comprehensive, and comprehensible instrument. The SURG-TLX is preliminarily recommended to measure operators’ experiences of innovation. Further work exploring its role and impact on surgical innovation is required. [Display omitted] •This study identifies, appraises, and recommends a standard measure to assess operators' experience in studies of surgical innovation.•Robust methodology was applied.•Supplemental validation used semistructured interviews with multinational and multidisciplinary professionals.•The SURG-TLX is preliminarily recommended because it was found to be most relevant, comprehensive, and comprehensible.•Routine use of a validated, standard measure to assess operators' experience supports efficient and transparent evaluation of complex interventions involving surgical innovation.

Social prescribing (SP) is a patient pathway by which healthcare professionals connect patients with other sources of support, groups, or activities within their community. The awareness, practice, and perception of SP among GPs across Europe remains unclear. To explore the awareness, practice, and perception of GPs on SP in the WONCA Europe region. An anonymous, cross-sectional online survey was distributed through a snowballing system, mailing lists, and at three international conferences in 2022/2023 to explore GPs' awareness, practice, and perception of SP. The questionnaire in English contained 21 open and closed questions. Of the 208 participating GPs from 33 countries, 116 (56%) previously heard of 'social prescribing' and 66 (32%) regularly referred patients to community activities through a formal system. These 66 GPs reported different funding sources and varied activities, with an average of four activities and physical exercise being the most prevalent. Among them, 25 (38%) knew about national or local SP awareness campaigns. Of these 25, 17 (68%) agreed that SP increases their job satisfaction and 21 (84%) agreed that it has a positive impact on their patients. Variations in SP awareness and referral practice were evident across and within countries. Despite disparities in awareness and referral practice as well as a diversity of activities and funding sources, most GPs who actively referred patients and were informed about SP campaigns agreed that SP positively impacts them and their patients.

ObjectivesTo analyse trends in the academic literature applying complexity science to healthcare, focusing specifically on bibliometric characteristics and indicators of influence.DesignThis study reports a bibliometric analysis via a systematic search of the academic literature applying complexity science to healthcare.MethodA search of four academic databases was performed on 19 April 2018. Article details were downloaded and screened against inclusion criteria (peer-reviewed journal articles applying complexity science to healthcare). Publication and content data were then collected from included articles, with analysis focusing on trends over time in the types and topics of articles, and where they are published. We also analysed the influence of this body of work through citation and network analyses.ResultsArticles on complexity science in healthcare were published in 268 journals, though a much smaller subset was responsible for a substantial proportion of this literature. USA contributed the largest number of articles, followed by the UK, Canada and Australia. Over time, the number of empirical and review articles increased, relative to non-empirical contributions. However, in general, non-empirical literature was more influential, with a series of introductory conceptual papers being the most influential based on both overall citations and their use as index references within a citation network. The most common topics of focus were health systems and organisations generally, and education, with recent uptake in research, policy, and change and improvement.ConclusionsThis study identified changes in the types of articles on complexity science in healthcare published over time, and their content. There was evidence to suggest a shift from conceptual work to the application of concrete improvement strategies and increasingly in-depth examination of complex healthcare systems. We also identified variation in the influence of this literature at article level, and to a lesser extent by topic of focus.