Involving communities in community assessment

Focus groups provide an effective means of incorporating the perspectives of "hidden" populations in assessments of community health needs and assets. A series of focus groups was conducted with specifically targeted segments of a community to develop a comprehensive picture of community health. The authors describe the focus group process, major findings, and the use of focus group results in a highly multicultural community. Despite differences in age, length of residence, and ethnicity, the focus groups were remarkably similar in the issues raised. The majority of participants viewed the multicultural nature of the community as an asset but voiced some of the difficulties of living in a multiethnic and multilanguage environment. Similar areas of concern in the community arose from all of the focus groups, including housing and other environmental issues and problems of access to health care. Focus group findings have been used to initiate activity addressing identified community problems. Focus group participation had the added benefit of increasing community members' participation in other community endeavors.     

Significant elements of community involvement in participatory action research: evidence from a community project

Significant elements of community involvement in participatory action research: evidence from a community project ¶Participatory action research (PAR) has been heralded as an important research methodology to address issues of research relevance, community involvement, democracy, emancipation and liberation. Increasingly, nurse researchers are turning to PAR as a method of choice. Although nursing interest in PAR is expanding little is known about how to successfully involve the community in research. This article attends to this dearth of information by presenting the results of a study investigating the significant elements of community involvement in PAR. Through the use of qualitative research methods, five themes emerged that describe the community participation process: (a) planning for participation, (b) the structural components of community participation, (c) living the philosophy, (d) enhancing the credibility, and (e) the type of leadership required to facilitate community participation. It is hoped that by sharing these results others may consider the knowledge gleaned from this project as they plan and proceed with the challenges and rewards inherent in PAR.     

The crisis nature of health care transitions for rural older adults

The complex health, socioeconomic, and environmental problems experienced by many American elders often place them at high risk for disease and disability. Over time, acutely or chronically ill older persons experience numerous transitions across various health care settings. Although availability of health services is improving in rural areas, barriers such as distance, geography, and poor distribution often limit access to health care. In a longitudinal rural ethnography, the health care transition experiences of older adults, families, and health care providers were examined. A major ethnographic theme emerged from analysis data from interviews, participant observations, and photographs: the crisis nature of health care transitions experienced by rural older adults and their families and observed by rural nurses and other health care providers. Several patterns were observed including the crisis was compounded by surprise; limited knowledge of local resources exacerbated the crisis; inconsistent discharge planning disrupted transitions; changing family support necessitated admission to nursing homes; continuity of care in nursing home discharge lessened transition crisis; and rural home health care was identified as a strength. Recommendations were made for community-based interventions to improve the transition experience. Comprehensive care management services provided by public health nurses (PHNs) in the local rural community were recommended.     

Undernutrition in the elderly population living at home in the community: a review of the literature

Undernourishment in elderly people has been found to have a variety of detrimental effects ranging from the development of pressure sores to the incidence of fractured femurs. Surveys within hospital settings have revealed that elderly patients are often admitted from their homes in a state of malnutrition, which would indicate nutritional deficits in at least some of the population. Reliable nutritional assessment in the community, however, is difficult and time consuming, with findings subject to distortions from other influences. Consequently there is inadequate accurate assessment of the current nutritional status of the general elderly population, and assumptions are often based on research findings from the 1960s and 1970s. In view of the demographic changes which have moved towards an increasingly 'old' elderly population such research may no longer be relevant. This paper provides a review of the available literature on nutrition in elderly people living at home and includes possible assessment screening strategies that could be used by community nurses.     

Reflections on a community action research project: interprofessional issues and methodological problems

This paper describes an action research study in a community setting. A group of residents from a local housing estate and a number of local workers used participative methods to explore local child care issues with the aim of developing initiatives for improved child care. The paper describes the study processes and reflects on lessons learnt. A discussion of implications for interprofessional working concludes the paper and includes emphasis of the need to focus on shared objectives, and develop appropriate organizational structures and educational provision.     

乡村小学生健康促进实践及探讨

[目的]了解乡村小学生存在的健康问题,设计健康促进活动进行社区护理干预,复习与巩固社区护理相关理论知识,提高社区健康促进实践技能。[方法]通过健康教育、体格检查、组织文体活动等方法对某乡村小学学生开展健康促进活动。[结果]此次活动在加强小学生身心娱乐的同时,大致了解了小学生的生长发育状况;大部分小学生掌握了正确有效的洗手方法。[结论]在乡村小学校园开展健康促进活动非常有必要,实践的开展有助于参与人员加强自身对社区护理知识的巩固以及对社区健康促进实践技能的提高。     

Attending to the lightness of numbers: toward the understanding of critical care epidemiology

Most of the epidemiological studies in critical care do not express their results in terms of population burden of critical illness. This happens because the population at risk of critical illness is particularly difficult to estimate, once intensive care units (ICUs) receive patients from many sources. The study by Laupland in this issue of Critical Care provides a good estimate of the incidence of admission to ICUs in the Calgary Health Region. He considered the Calgary Health Region population as the denominator and explored the effects of a changing numerator according to the residency status (resident in Calgary or not) on the estimation of the burden of admission to the ICU. He demonstrated that if the residency status were not known, the incidence of admission to the ICU would have been overestimated by more than 50%. Furthermore, non-residents had a lower mortality despite higher Acute Physiology and Chronic Health Evaluation (APACHE) II and Therapeutic Intervention Scoring System (TISS) scores. There is tremendous variability in decisions to admit a patient to the ICU and the epidemiology of critical care is influenced by them in a subtle but inextricable way. An understanding of the population epidemiology of critical illness and the use of the ICU, the variations in these parameters, and factors that influence this variation is extremely important. The notable effect of a changing numerator on the estimation of the population burden of ICU admissions in the study by Laupland illustrates how fluid our estimates of disease incidence and mortality - the mainstays of epidemiology - can be.     

乡村小学生健康促进实践及探讨

[目的] 了解乡村小学生存在的健康问题,设计健康促进活动进行社区护理干预,复习与巩固社区护理相关理论知识,提高社区健康促进实践技能.[方法]通过健康教育、体格检查、组织文体活动等方法对某乡村小学学生开展健康促进活动.[结果] 此次活动在加强小学生身心娱乐的同时,大致了解了小学生的生长发育状况;大部分小学生掌握了正确有效的洗手方法.[结论]在乡村小学校园开展健康促进活动非常有必要,实践的开展有助于参与人员加强自身对社区护理知识的巩固以及对社区健康促进实践技能的提高.     

我国农村空巢老人心理问题及社区护理对策

综述我国农村空巢老人主要的心理问题及相关因素,提出相应的社区护理对策,强调建立全方位、多层次的社区服务网络,深入开展社区护理工作,对改善农村空巢老人心理状况、提高其生活质量意义重大。     

A case study in the use of community-based participatory research in public health nursing

There is growing demand for research using a community-based participatory (CBPR) approach. CBPR requires that the academic research team actively partner with community members and stakeholders in the entire research process. The community members are full partners with the researchers in relation to the development and implementation of the study, analysis of the data, and dissemination of the findings. The purpose of this article is to review four basic principles of CBPR and provide an example of how these CBPR principles were used in an ethnographic study related to the culture of African American infant health. In the pilot study, CBPR provided the framework for recruitment and retention of participants, ongoing data analysis, and dissemination of findings. Using CBPR provided the researchers an introduction into the selected community. Community members served as key informants about the culture of the community and provided access to potential participants. The community partners contributed to analysis of emerging themes and in the dissemination of findings to the community, stakeholders, and the scientific community. CBPR provides opportunities for community health nurse researchers to conduct research with vulnerable populations and sets the stage for implementing evidenced-based nursing interventions in the community.     

湖南省农村老年人社区护理需求调查分析

目的了解湖南农村老年人的健康状况、保健意识及对社区护理的需求状况,探讨社区护理在湖南农村的开展形式,分析社区护理和农村合作医疗相结合的可行性。方法采用自行设计的问卷,对湖南省993户家庭进行调查,从中抽取205份65岁以上老年人填写的问卷进行统计学分析,内容包括人口学资料、健康状况、保健意识、社区护理需求。结果60.5%的老年人患有各种慢性病,退行性骨关节病居首位(23.9%),患1种慢性病以上的比例为26.6%;老年人的生活环境和医疗条件有所改善,49.2%的家庭中备有常备药,当老年人身体不适时找医生和自己找药吃的高达84.9%,53.7%的老年人觉得有必要做体检,但仍存在明显的不良卫生习惯;老年人对社区护理各项需求相差不大,在60%左右;农村老年人选择最多的就医场所是私人诊所(45.8%)和乡卫生院(36.5%)。结论湖南农村老年人患病率高,有一定的保健意识,对社区护理的需求迫切;可以利用农村合作医疗现有的资源,使社区护理模式向农村延伸,以进一步满足农村老年人的卫生服务需求。     

Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom

This paper argues that the interfaces between formal and informal care-giving are changing as a result of two current trends; the increased scope of home-based nursing care and the emphasis on participation both within nursing and in the wider health and social care arenas. These various changes are explored in relation to the provision of intensive and complex nursing care in the home. It will be argued that the changing interfaces between formal and informal care have important implications for the respective roles of nurses and informal carers which hitherto have been relatively overlooked. These implications urgently need addressing in research, policy and public debate if professional nurses are to provide appropriate help and support to informal carers.     

社区老年人健康促进护理干预方法的研究

目的探索在社区老年人中开展健康促进护理干预的方法。方法通过对575名社区老年人进行体检及问卷调查,了解健康状况及健康需求;经筛选确定40例老年人为研究对象并对其进行健康教育、健康指导。结果通过两年护理干预后,40例老年人掌握卫生知识、自我保健能力、疾病预防与治疗知识等健康教育效果及甘油三脂、转氨酶、收缩压、心电图、胸透等体检结果与干预前比较,经统计学处理,有显著性差异(P<0.05)。说明护理干预后健康知识教育效果和体检结果优于护理干预前。结论对社区老年人进行健康促进护理干预,能提高老年人预防疾病知识,促进健康行为,减缓老年性疾病的发生和发展。     

Creating effective nursing partnerships: relating community development to participatory action research

The purpose of this article is to demonstrate the importance of creating effective partnerships between nurses practising community development (CD) and nurses engaged in participatory action research (PAR). To that end, an overview of the theoretical principles of CD and PAR is provided and the central tenets of each methodology explored. This is followed by a discussion of the similarities and differences inherent in CD and PAR which derive from the same theoretical and philosophical foundation; that of critical social theory. Examples of two research projects highlight the relationship between CD and PAR and demonstrate the value of creating effective practitioner/researcher partnerships. Finally, some of the lessons learned in creating these important partnerships will be presented. Although this call for practitioner/researcher alliance is not new, what is new is the central role the practising nurse could take in research. Creating partnerships between practising nurses and nurse researchers advances the opportunity to actualize responsive and effective PAR and to fulfill nursing's social contract.     

A participatory assessment of environmental health concerns in an Ojibwa community

This research employed a participatory approach to explore environmental health (EH) concerns among Lac Courte Oreilles (LCO) Ojibwa Indians in Sawyer County, Wisconsin. The project was grounded in a broad ecological conceptualization of EH and in principles of health promotion and community participation. Community participation was accomplished through a steering committee that consisted of the primary author and LCO College faculty and community members. The selected assessment methodology was a self-administered survey mailed to LCO members in Sawyer County. Concern for environmental issues was high in this tribal community, especially for future generations. Concern was higher among older members and tribal members living on rather than off the reservation. Local environmental issues of concern were motorized water vehicles, effects from global warming, aging septic systems on waterways, unsafe driving, and contaminated lakes/streams. The LCO community can use survey results to inform further data needs and program development.     

Establishing a rural Emergency Medical Retrieval Service

In 2004 the Argyll and Clyde health board established the Emergency Medical Retrieval Service to support its rural community hospitals. This article describes both why the service was established and its aims. This service covers a geographically extensive area, with approximately 85,000 people living in remote locations. Rural general practitioners in six community hospitals provide initial patient assessment and resuscitation. Providing emergency care and safe transfer of seriously ill and injured patients presenting to these community hospitals is a significant challenge. All parties involved felt that there was a need to provide a service to transport critically ill and injured patients from these remote locations to definitive care. The idea of the team is to bring the resuscitation room to the patient in the rural setting. With this aim and in order to implement the Intensive Care Society guidelines for the transport of critically ill patients, it was decided that consultants in Emergency Medicine and Anaesthetics with an interest in critical care would staff the service medically. This service is unique within the UK and the authors aim to report our findings from ongoing research and audit in future papers.