The NSF for children, young people and maternity services: an overview

Unlike many of the other national service frameworks for England which are disease or condition specific, the children's national service framework encompasses all aspects of children's and young people's health care. The other major difference is that standards do not have detailed targets with set timescales but centre upon principles and examples of good practice. The overriding principle is to ensure quality and safety of care. The implementation of the NSF will form part of the wider programme aimed at improving standards and outcomes for all children. The publication Every Child Matters (DfES 2003) sets out a vision of the outcomes and commitment to support every child to: be healthy, stay safe, enjoy and achieve, make a positive contribution, achieve economic well-being. The NSF standards will feature within the new integrated inspection framework around children's services. Local champions will be crucial to ensuring that the standards are fully implemented at local level. Nurses, midwives and health visitors should take every opportunity to influence developments and ensure that they become actively involved in local discussions and decision-making forums.     

The need for rehabilitation services: concept and data

Whether rehabilitation services are initiated, applied for and (granted by German statutory pension funds) according to objectifyable need is uncertain as long as we lack a scientifically valid and operationally defined concept of "rehabilitation need". Traditionally three criteria are mentioned: neediness, ability, and prognosis. The text extends and specifies these criteria based on theoretical grounds, research evidence, and sociolegal considerations. It introduces a screening algorithm to objectify and assess individual rehabilitation needs focusing, as far as they are risk factors for participation restrictions, on a central disorder and its complications, risk and prognostic factors, comorbidities, motivational and other context factors. It proposes to relate more or less complex disturbances of functional health to more or less complex rehabilitation programmes and to indicate the typically complex ("holistic") in-patient rehabilitation only for equally complex health impairments and participation restrictions. Illustrative empirical data relate to three disorders, diabetes mellitus type 2, chronic disabling back pain, and chronic obstructive lung disease.     

The NSF for children, young people and maternity services

The new National Service Framework for Children, Young People and Maternity Services (Department of Health, 2004) draws together current recommendations for best practice. This article highlights the points most relevant to nurses from this 10-year plan of practice improvement.     

Mums and Dads need care too. Supporting parents of babies in neonatal units

New parenthood can be traumatic and stressful at the best of times, but for parents with a baby in a neonatal unit, the experience can be much more difficult to deal with. The support received from unit staff can make all the difference.     

Supporting older people: cold, poor and baffled

In this article, brought to you in association with Help the Aged, Mervyn Kohler discusses the twin issues of fuel poverty and benefits take-up by older people. Community nurses can have a direct impact on these problems.     

Anatomy of Change: The Need for Effective Disability Policy Change Agents

Silverstein R. Anatomy of change: the need for effective disability policy change agents.The 2009 Coulter Lecture highlights the need for effective disability policy change agents to advocate for health care policy and research that focuses on optimizing the health and function of individuals with disabilities and chronic conditions-not only on their full restoration/cure. The lecture describes the “grotesque” historical treatment of persons with disabilities under the old policy framework, the treatment of people with disabilities under the new/emerging disability policy framework, and the critical role played by coalitions in bringing about progressive, sustainable change on behalf of individuals with disabilities.     

The demand for health services: a geographic analysis in Quebec

Nearly one quarter of the people surveyed in Quebec have seen a health professional during the two previous weeks. One third of these visits have been to GPs. Females have paid more visits than males, widows more than married people, the elderly more than the young. Moreover, two groups have had a higher demand: the poor, wherever they are, and the rich in the big cities and metropolitan areas. When grouped into homogeneous areas, the growth of demand is correlated with available services and perceived illness or ailments. When a group increases its demand for services, which are nearly free of charge, the consumption level of the group goes beyond need, and the availability of services becomes increasingly the main determinant.     

The impact of assistive technology services in post-secondary education for students with disabilities: Intervention outcomes,use-profiles,and user-experiences

The outcomes of assistive technology (AT) support services for post-secondary education students with disabilities are under-reported, and little is known about use-profiles and user experiences when AT interventions are applied to this rapidly growing population. We examined AT service outcomes related to performance and satisfaction of common academic tasks (using the Canadian Occupational Performance Measure [COPM]), as well as how students with disabilities use and experience AT and AT services (employing an AT-use survey). Three-hundred fifty-three students with disabilities completed the AT-use survey, with a subset of these (n = 216) also participating with pre-post AT intervention COPM assessment. COPM performance and satisfaction ratings significantly increased from pre- to post-AT intervention in all academic task categories (reading, writing, note-taking, test-taking, and studying; p < 0.001). The AT-use survey most notably revealed these students preferred face-to-face training, used their AT at least 3 days per week, used AT in a variety of environments, felt AT positively impacted their academic success, and believed they would continue using AT post-graduation. The study findings contribute to evidence-base for AT services with a hope we may improve AT services to best meet the changing needs of the growing number of college students with disabilities.     

Assistive devices and community-based services among 85-year-old community-dwelling elderly in The Netherlands: Ownership,use,and need for intervention

Objective.?To assess the home-situation of the oldest old regarding the ownership, use, and need for intervention of assistive devices and community-based services.

Methods.?A research nurse and an occupational therapist, who evaluated the current situation regarding ownership and use of assistive devices, visited a representative group of 147 Dutch community-dwelling 85-year-olds in their own homes. Furthermore, the occupational therapist assessed whether an intervention was indicated. Assistance in purchasing devices, information, and instruction were provided when necessary.

Results.?94% of the subjects owned one or more assistive devices, with a mean of 4.5 (SD 2.7) assistive devices. Most frequently owned were grab rails. Of the total number of 591 assistive devices, 74 (13%) were not in use. In 66 of the 147 (45%) subjects at least one intervention was indicated. A total number of 23 subjects received information and instruction on mobility-related issues, while 17 subjects received information and instruction on personal care-related issues. Moreover, for 19 subjects an application procedure was started for a total of 25 assistive devices and five community-based services in the mobility category while for 19 subjects an application procedure was started for a total of 31 devices and four services in the personal care category.

Conclusions.?Based on detailed information from occupational therapists, the home situation of community-dwelling elderly regarding the presence and use of assistive devices and community-based services is not optimal.     

The Self-Concept and Conjugal Loss: Evidence for Structural Change

The self-concept is often considered to be a personal resource that individuals may use to cope with life stressors, but little is known about how this entity might itself change in response to profound stress. The present study examines structural change in self-concept following conjugal loss in later life. Analyses were conducted on data collected from 57 widows every 4 months over the first 2 years post-loss. The first objective was to explore the adequacy of an operational definition of the self-concept as a latent construct lying at the confluence of self-esteem, perceived environmental mastery, and optimism. Because confirmatory factor analysis (CFA) supported this theoretically based conceptualization, the second objective of the study was to model stability and change in the structure of the self-concept over the 2-year study period. Results suggested that there is both stability and change in the self-system during the adjustment to major life stress.