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Older people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is to describe a model of integrated care in a rural area supported by a nurse case manager.

A real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.

The integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.

This case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.

This study explored the experiences of Irish emergency medical services (EMS) first responders during the first nationwide restrictions to curb the spread of COVID-19.

A systematic literature review (SLR) of research into healthcare workers' and first responders' experiences during the COVID-19 and 2003 SARS pandemics was performed. The SLR informed the content of an online questionnaire distributed via the Irish Pre-Hospital Emergency Care Council to 2,092 first responders on its live register. Data analysis used both descriptive and content analysis.

EMS first responders faced many challenges including PPE quality, training on its use, issues with decontamination facilities, and organisational effectiveness. Emotional challenges included the anxiety experienced, the impact on families, and ethical dilemmas confronted related to patient care. Positive findings also emerged, such as first responders' dedication to working through the pandemic, collegiality, and the community goodwill displayed.

While investigations of the impact of the COVID-19 pandemic on healthcare workers have been undertaken globally, studies focussing exclusively on the experiences of EMS first responders have been rare. This study addressed this knowledge gap, providing an insight into the challenges and successes experienced by first responders and identifying opportunities for learning that can be applied to future public health emergencies.

Drawing on the conservation of resources (COR) theory, this study aims to assess the moderating effect of the psychological contract (PC) type (relational, transactional and balanced) on the relationship between psychological contract breach (PCB) and organizational citizenship behaviours (OCBs).

The authors administered a survey to a sample of 159 nurses working in a large public hospital. To analyse the survey data, the authors used partial least squares with SmartPLS v.3.3, a variance-based structural equation modelling technique that combines principal component analysis, path analysis and regression analysis.

This study shows that nurses counteract the loss of resources following a PCB by investing more in stronger interpersonal relationships with co-workers and patients as a way to recuperate from resource loss and gain social resources. In addition, the moderating effect of the PC type reinforces the relationship between a PCB and OCB in a way that relational and balanced PC types support OCB-I positively but negatively OCB-O. Furthermore, the transactional PC does not reinforce negatively the link between PCB and OCB-I, and the negative interacting effect on the PCB and OCB-O link is only partially supported.

The study findings are grounded on a cross-sectional research design and a convenience sampling strategy.

The results highlight the relevance of human resources management practices centred on employee involvement and participatory supervision styles for ensuring OCB display at the workplace.

The results add new evidence to COR theory by highlighting the importance of social resources as a mitigator in the relationship between nurses’ PCB and OCB towards co-workers and patients (OCB-I). Hence, the OCB-I display will vary in function of the target and the moderating effect of PC type (relational, balanced or transactional).

This paper aims to assess the face validity to inform content validity of the Quality of Life – Aged Care Consumers (QOL-ACC), a new measure for quality assessment and economic evaluation in aged care.

Semi-structured interviews were conducted with older adults (66–100 years) receiving aged care services at home (n = 31) and in residential care (n = 28). Participants provided feedback on draft items to take forward to the next stage of psychometric assessment. Items were removed according to several decision criteria: ambiguity, sensitive wording, not easy to answer and/or least preferred by participants.

The initial candidate set was reduced from 34 items to 15 items to include in the next stage of the QOL-ACC development alongside the preferred response category. The reduced set reflected the views of older adults, increasing the measure’s acceptability, reliability and relevance.

Quality of life is a key person-centred quality indicator recommended by the recent Royal Commission into Aged Care Quality and Safety. Responding to this policy reform objective, this study documents a key stage in the development of the QOL-ACC measure, a new measure designed to assess aged care specific quality of life.

This paper – the final paper of a series of three – aims to discuss the implications of the findings from a service user needs assessment of people experiencing homelessness in the Northwest of England. It will expand on the previous paper by offering a more detailed analysis and discussion of the identified key themes and issues. The service user needs assessment was completed as part of a review of local service provision in the Northwest of England against the backdrop of the COVID-19 pandemic.

Semi-structured questionnaires were administered and used by health-care professionals to collect data from individuals accessing the Homeless and Vulnerable Adults Service (HVAS) in Bolton. The questionnaires included a section exploring Adverse Childhood Experiences. Data from 100 completed questionnaires were analysed to better understand the needs of those accessing the HVAS.

Multiple deprivations including extensive health and social care needs were identified within the cohort. Meeting these complex needs was challenging for both service users and service providers. This paper will explore key themes identified by the needs assessment and draw upon further comments from those who participated in the data-gathering process. The paper discusses the practicalities of responding to the complex needs of those with lived experience of homelessness. It highlights how a coordinated partnership approach, using an integrated service delivery model can be both cost-effective and responsive to the needs of those often on the margins of our society.

Data collection during the COVID-19 pandemic presented a number of challenges. The collection period had to be extended whilst patient care was prioritised. Quantitative methods were used, however, this limited the opportunity for service user involvement and feedback. Future research could use qualitative methods to address this balance and use a more inclusive approach.

This study illustrates that the needs of the homeless population are broad and varied. Although the population themselves have developed different responses to their situations, their needs can only be fully met by a co-ordinated, multi-agency, partnership response. An integrated service model can help identify, understand, and meet the needs of the whole population and individuals within it to improve healthcare for a vulnerable population.

This study highlighted new and important findings around the resilience of the homeless population and the significance of building protective factors to help combat the multiplicity of social isolation with both physical and mental health problems.

The discussion provides an opportunity to reflect on established views in relation to the nature and scope of homelessness. The paper describes a contemporary approach to tackling current issues faced by those experiencing homelessness in the current context of the COVID-19 pandemic. Recommendations for service improvements will include highlighting established good practices including embedding a more inclusive/participatory approach.

The purpose is to analyse the nutritional adequacy and carbon footprint of intermediated meals provided to preschool children and primary-level students in a Portuguese municipality.

An observational cross-sectional study was conducted with a convenience sampling consisting of school snacks from a Portuguese municipality. The nutritional assessment used food labels and a Portuguese food composition table. The literature review for carbon footprint assessment was conducted by searching for the products under analysis or similar ones.

The results showed that 80% of snacks have a higher energy value than recommended. The majority of options are below recommendations for protein and fat and above recommendations for carbohydrates. The intermediated meals with more dairy products in composition have the highest carbon footprint. The carbon footprint included the packaging of the products, and it wasn't possible to determine the influence of non-food products.

This study has limitations in the fact that we do not know the carbon footprint of Portuguese products and we had to compare them with others, from different countries, with possibly different types of production.

Intermediate meals are inadequate, and the carbon footprint is higher when the intermediated meals include products of animal origin – the reason why the composition of intermediated meals should be redesigned considering the achievement of these targets.

The promotion of intermediated meals that promote the Mediterranean eating pattern contributes to health and well-being and is a vehicle for nutrition education and healthy food consumption in schools.

Many studies have been conducted to analyse the carbon footprint and environmental impact of school meals, but commonly lunch is the meal evaluated and the assessment of intermediated meals' impact is an open field.

Formal structured leadership training is increasingly incorporated as a regular fixture in developed nations to produce competent leaders to ensure the provision of quality patient care. However, most low- and middle-income countries (LMICs) rely on one-off external training opportunities for selected individuals as they lack the necessary resources to implement long-term training for a wider pool of potential health care leaders. This case study shares the establishment process of the Talent Grooming Programme for technical health care professionals (TGP), a three-year in-house leadership training programme specially targeted at potential health care leaders in Malaysia.

This case study aims to share a comprehensive overview of the ideation, conceptualisation and implementation of TGP. The authors also outlined its impact from the individual and organisational perspectives, besides highlighting the lessons learned and recommendations for the way forward.

TGP set out to deliver experiential learning focusing on formal training, workplace experiences, practical reflection and mentoring by supervisors and other esteemed leaders to fulfil the five competency domains of leadership, organisational governance, communication and relationship, professional values and personal values. The successes and challenges in TGP programme delivery, post-training assessment, outcome evaluation and programme sustainability were outlined.

The authors’ experience in setting up TGP provided valuable learning points for other leadership development programme providers. As for any development programme, a continuous evaluation is vital to ensure its relevance and sustainability.

Certain aspects of TGP establishment can be referenced and modified to adapt to country-specific settings for others to develop similar leadership programme, especially those in LMICs.

This paper aims to examine the interaction between gatekeeping and trust in a public sector organization, where employees at lower hierarchical levels are expected to autonomously translate and transform directives into public services. This requires them to have access to operational steering information, i.e. information about directives and how to interpret and apply them. This study focuses on how gatekeeping structures regulate flows of operational steering information and how the gatekeeping structures affect the development of trust.

The research design is qualitative. The data material consisted of semi-structured interviews with 26 employees in home care and schools and of eight complementary nonparticipant observations. Thematic analysis revealed the presence of static and dynamic gatekeeping structures, which are characterized by fixed and variable arrangements of information sources and channels, respectively.

In static gatekeeping structures, managers or domain experts typically act as gatekeepers, and employees also perform gatekeeping activities collectively. Gatekeeping structures allow employees to switch between acting as gatekeepers and being gated, depending on the situation. The results show that gatekeeping structures for intermediation of operational steering information may support or impede employees' work, thus affecting their trust in their peers and their work organization.

Although the present study included both interviews and observations, these primarily occurred within scheduled and prearranged activities rather than capturing the nuances of the typical daily work of teachers and home care employees. As a result, certain perspectives may have been unintentionally omitted.

The participants were recruited through the City of Oslo contact people, which may have impacted their status or perception in some way. Moreover, the study was conducted in the City of Oslo, a specific organization with its own unique set of values, norms and processes. The trust-based management in the City of Oslo is likely not representative of all public sector organizations.

This study contributes conceptually by introducing gatekeeping structures and operational steering information and empirically by providing evidence of their relationship to trust development in public service delivery. Thus, it contributes to the research fields of information management and public administration.