Marianne Storm

Summary This article considers ways in which a nursing home can come to serve as a hub for community health promotion. Inspired by the term ‘boundary crossing’ (Akkerman and Bakker. Boundary crossing and boundary objects. Rev Educ Res 2011;81:132–69), we suggest the notion of ‘boundary work’ to illustrate how a nursing home arranges community activities and includes a wide range of participants. In health research, a ‘hub’ refers to a space in which activities and expertise are ‘bound together’ over time. The concept of the hub indicates that health organizations have the power to become centres for health promotion by initiating new collaborations and opening up initiatives in two-way processes with the local community. The term ‘boundary work’ supports a perspective that dissolves organizational, professional and conceptual boundaries and directs attention towards social inclusion as a key to community health promotion in and beyond institutionalized elderly care. The article is based on a 4-year-long practice-based study of social innovation in elderly care in Norway and Denmark. Empirical illustrations show boundary work in which a nursing home comes to serve as a hub. We discuss a flexible framework for understanding, mapping and planning participatory approaches for health and wellbeing (South et al. An evidence-based framework on community-centred approaches for health: England, UK. Health Promot Int 2019;34:356–66) and briefly connect these approaches to the concept of social innovation as a possible future research path.

Aims To gain a comprehensive understanding of nurses' infection control practices, antibiotics stewardship attitudes and self‐efficacy when caring for patients with multidrug‐resistant bacterial infections in a hospital setting. Background Multidrug‐resistant bacteria cause a substantial health burden by complicating infections and prolonging hospital stays. Attitudes and self‐efficacy can inform professional behaviour. Nurses' attitudes and self‐efficacy concerning multidrug‐resistant bacteria, infection prevention and control and antibiotic stewardship are vital in keeping patients safe. Design A descriptive and convergent mixed‐methods design involving quantitative and qualitative approaches was used. Methods Two hundred and seventeen nurses working in clinical practice at seven different hospital wards (i.e., general medicine, surgical, haematological and oncology) at a Norwegian university hospital were invited to participate. Data were collected in February and March 2020 via two questionnaires: the Multidrug‐Resistant Bacteria Attitude Questionnaire and the General Perceived Self‐Efficacy Scale ( n = 131) and four focus group interviews ( n = 22). The data were analysed using descriptive statistics and systematic text condensation. Results Most nurses showed moderate knowledge, adequate behavioural intentions towards infection prevention and antibiotic stewardship, and high self‐efficacy. However, they reported negative emotions towards their knowledge level and negative emotions towards nursing care. The nurses appeared uncertain about their professional influence and role in antibiotic stewardship practices. Organisational and relational challenges and ambivalent perceptions of nurses' role were potential explanations. Conclusion Nurses report moderate attitudes and high self‐efficacy when caring for patients with multidrug‐resistant bacterial infections. This study suggests that nurses experience organisational and relational factors in their work environment that challenge their attitudes towards infection prevention and control and antibiotic stewardship practices. Measures that strengthen their knowledge and emotional response underpin correct infection prevention and control behaviour. A role clarification is needed for antibiotic stewardship. No Patient or Public Contribution. Relevance to clinical practice Measures to increase attitudes towards infection prevention and control, antibiotic stewardship and multidrug resistance is recommended. Measures should be taken to overcome organisational challenges. A clarification of the nurses' role in antibiotic stewardship is needed.

Background The problem of a lack of nurses is expected to worsen in the future. With an ever‐increasing number of elderly patients with multimorbidity and a shortage of healthcare professionals, primary care must innovatively organise their services to offer more sustainable healthcare services. Organising healthcare services in a community virtual ward has been found to improve the quality of life for vulnerable elderly populations. Aim The aim of the study was to explore healthcare professionals' experiences of interprofessional collaboration in care for patients with multimorbidity in a community virtual ward in the Norwegian context. Methods Focus group interviews were conducted in this qualitative exploratory study. A purposive sample of 17 healthcare professionals working in a community virtual ward in Norway was interviewed. Data were analysed using thematic analysis. Results The study results show that healthcare professionals recognise a need for patient involvement in the community virtual ward to offer more sustainable healthcare services at home. Furthermore, the results show how healthcare professionals experience the use of assessment tools and whiteboard meetings as useful tools for facilitating interprofessional collaboration. The study results also describe how interprofessional and holistic follow‐up with patients with multimorbidity contributes to increased focus on health promotion in the community virtual ward. Conclusion We found that interprofessional collaboration in community virtual wards may be a sustainable way of organising healthcare services for patients with multimorbidity living at home. Interprofessional collaboration with a patient‐centred and health promotion approach, seems to increase the quality of the follow‐up for patients with multimorbidity living at home. Additionally, mutual interprofessional trust and respect seems to be essential for making use of the unique expertise of different professions in the follow‐up for patients with multimorbidity. In the future, both the patient's voice and opinion of their next of kin should be considered in the development of more sustainable homecare services.