Evaluating the new community health nursing role in Austria
While community nursing has existed for many years in Austria, community health nursing with a specific public health focus was newly introduced in 2022 when the European Union extended support for 115 pilot projects in select Austrian regions as part of the Austrian Recovery and Resilience Plan. The project's objectives were outlined using the Public Health Intervention (PHI) wheel, which is divided into five colour-coded wedges of various activities and is commonly used to describe public health practices. Kovacevic et al (2024) conducted a study in an effort to understand the implementation of this new role, its activities and its potential impact, as well as its alignment with public health frameworks, and its relationship to existing care services.
In this cross-sectional survey, Kovacevic et al examined the activities of the first Austrian community health nurse cohort and its alignment with the PHI wheel and the nursing intervention classification. The authors aimed to determine whether the new service complemented or substituted existing community nursing services of direct care provision in the home. An online survey was distributed from April to June 2023. Of 220 eligible community health nurses, 181 filled out their surveys. Six or more questions were answered on 130 questionnaires (59%) and 98 included all information except their income (45%). The survey collected information on participants' gender, professional experience, working hours and educational background.
Nearly 90% of the respondents were female. The typical respondent was 41 years of age, had been working as a nurse for 15 years, and started community health nursing 10 months before undertaking the survey. The survey found that community health nurses implemented many of the principles found on the PHI wheel. The areas of particular focus included counselling, consultation and health teaching. Direct care interventions (measured against the nursing intervention classification) were rarely performed.
The authors concluded that owing to the public health focus of the relatively new community health nursing role in Austria, it complements, rather than substitutes, the existing community nursing services providing direct care at home. In contrast with international norms, activities were mainly carried out at individual levels, with limited community and systems levels engagement.
Shared decision-making processes between patients and community nurses
While the importance of shared decision making is well-recognised in community nursing, and in healthcare in general, it is unclear how, and whether or not, this takes place in community nursing practice in the home setting, particularly in a global context.
In an integrative review, Mills et al (2025) investigated the perceptions and experiences of both community nurses and patients regarding shared decision making in the home setting. The authors systematically searched for qualitative, quantitative and mixed-methods studies carried out between 1 December 2001 and 31 October 2023. They scoped electronic databases, CINAHL, British Nursing index, PsycInfo, Medline and Social Services Abstracts. Studies were selected against predefined inclusion and exclusion criteria and references lists of included studies were hand-searched. In total, 14 articles covering 13 studies were included (two of the papers covered one study). The included papers were critically appraised, with relevant data extracted and thematically analysed.
Mills et al found that patients placed significant importance on their right to be involved in decision making regarding their care. They noted that this involvement made them feel valued as unique individuals. Both communication and trust between the patient and nurse were viewed as essential factors. However, the authors highlighted that shared decision making does not always take place in practice.
The authors concluded that while the shared decision-making process was valued by both nurses and patients, there were barriers to achieving a collaborative process. This becomes especially important when a patient and nurse do not agree about the decisions being made as there is evidence of tension in such cases. However, the authors suggested that further research was required to gain insight into how shared decision making takes place in practice and the tension between a nurse and patient when they disagree.
Sense of coherence, subjective burden and anxiety and depression in caregivers of people with dementia
A study by Gonçalves-Pereira et al (2025) explored the concept of ‘sense of coherence’, which allows people to perceive things as manageable and meaningful. Among family caregivers, a lower sense of coherence is associated with subjective burden and psychological morbidity (Figure 1).
To understand the causal relationships within this equation, as well as international contexts, Gonçalves-Pereira et al examined longitudinal links, within a multinational sample, between dementia caregivers' sense of coherence, subjective burden and symptoms of depression and anxiety.
The European Union-Actifcare cohort was used, which includes 451 pairs of people with mild-to-moderate dementia and their caregivers. The Sense of Coherence scale, the Relatives' Stress Scale, and the Hospital Anxiety and Depression Scale were used to assess the caregivers, and a cross-legged panel model was used to look more closely into associations between all of these measures at baseline, and at 6- and 12-month follow-ups, while controlling for covariates.
Gonçalves-Pereira et al observed that subjective burden, as well as symptoms of anxiety and depression, increased over the measured time periods, while a sense of coherence remained generally stable. At the 6-month follow-up point, while lower sense of coherence among caregivers predicted depressive symptoms, they did not predict a lower sense of coherence. There were two-way (bidirectional) relationships between sense of coherence and subjective burden, as well as sense of coherence and anxiety symptoms. At the 12-month follow-up, both anxiety and depression symptoms predicted sense of coherence. However, a sense of coherence did not predict depressive or anxiety symptoms. The authors used a convenience sampling method and noted this as a limitation, because its narrow focus did not allow for results to be fully generaliseable. The authors concluded that their findings supported the idea that the concept of sense of coherence has a potentially protective role to play against subjective burden and psychological morbidity. However, these outcomes may equally affect sense of coherence, as partial reverse causality was noted in this study as well.
A look at current models and provision of out-of-hours community palliative care
When patients require palliative care, they make use of various services and need access to care 24 hours a day. Such out-of-hours care varies and there is little clarity about the particular models that work best. Therefore, Firth et al (2025) sought to gain an understanding of current models of out-of-hours community palliative care in the UK, as well as the views of healthcare professionals regarding the barriers and facilitators to the provision of good, high-quality, out-of-hours community care to patients who need it.
In this exploratory qualitative study, Firth et al used an adapted framework to understand complexity in palliative care. The Pask et al (2018) modified framework breaks down how a patient interacts with their environment when living with advanced illness.
The authors recruited 39 service leads from community palliative care or charitable hospice services, distr ict/community nursing and primary care providers, from 20 geographical areas across the UK. Nine community specialist palliative care teams, which were already serving as research sites for the wider project, and 11 further community specialist palliative care teams were recruited via a public advertisement. Those working within the research site and involved with providing out-of-hours palliative care were eligible. Overall, the authors identified four overarching models of out-of-hours palliative care. These models were characterised by the:
- Levels of integration between services
- Balance between generalist and specialist providers
- Availability of care
- Type of care provided (eg hands-on clinical, advisory).
Analysis of the barriers and facilitators to high-quality care generated three themes and patterns that emerged across the four models, including:
- ‘It's never one service’—this theme pertained to care coordination challenges across multiple services
- Need for timely skilled management of distressing symptoms
- ‘We're just plugging gaps’—this theme referred to prioritising patient care within a finite amount of resources.
The authors concluded that these themes are necessary to ensure effective and efficient integration of high-quality care. They also incorporated facilitators in their recommendations for a potential model: a single point of access for patients for palliative care specifically; formal structures in place to integrate generalist and specialist services; and timely and skilled symptom management.