Model for community health nursing care: application to an integrated asthma intervention program.

The article describes the use of a model for community health nursing care applied to an integrated asthma intervention program in an inner-city context. Asthma is a chronic childhood disease with broad physical, social, and economic impact on children, families, and communities. Despite recent advances in asthma understanding and treatment, morbidity and mortality continue to rise. This model suggests ways to combine individual, family, school, and community interventions to enhance coordination and increase the impact of services. It outlines needs and opportunities for collegial collaboration between professional nurses in varied practice settings. Application of the model to the management of asthma in the urban setting demonstrates the potential to produce significant improvement in the management of conditions such as asthma and highlights the key role that school nurses play.     

Evaluation of the breastfeeding intervention program in a Korean community health center

A new model for the breastfeeding intervention program was implemented in a Korean community health center and the effectiveness of the program was evaluated. Thirty health care personnel from 29 smaller community health centers and 23 breastfeeding helpers were trained in four workshops. They then gave information on breastfeeding to pregnant and lactating women, living in each community in groups or individually. The breastfeeding rate after intervention has significantly increased at 1 week and 9 months of age. These results indicate that the community-based breastfeeding intervention program by training both the health care professionals and peer helpers is effective in promoting breastfeeding.     

Multiple intervention research programs in community health.

The authors describe an organizing framework for multiple interventions in community health. The framework provides a foundation for programmatic research on multiple interventions and poses critical questions that need to be addressed in the next generation of research in this field. Multiple intervention programs are characterized by the use of multiple strategies targeted at multiple levels of the socio-ecological system and delivered to multiple target audiences. Consequently, they complement the growing literature on the broad determinants of health and health promotion. The authors describe a 4-stage framework and identify gaps and challenges in this field of research. There are 5 key research areas requiring concerted action; researchers must: examine nested determinants, develop integrated conceptual frameworks, examine ways to optimize synergies among interventions, describe spin-offs from multiple intervention programs, and monitor the sustainability of their impact.     

The effect of a community mental health training program for multidisciplinary staff

Background

Primary health workers play a critical role in providing health education to people with mental disorders. In China community health workers working with people with mental health problems lack experience and training in this area. Additionally, coordination between hospital and community staff is not well established. The aim of this study was to provide an interdisciplinary community mental health training program and to evaluate the effect of the training on staff knowledge about mental health and confidence in their roles.

天津地区社区老年人健康护理干预效果评价

目的探讨社区健康护理干预在改善老年人生活方式、提高老年人生活质量中的作用。探索一条适合我国国情、节约医疗资源的社区老年健康干预的模式。方法采用半实验研究设计,经整群随机抽样获得样本241例,其中干预组149例,对照组92例。观察干预组接受干预前后生活方式、血压、血脂、血糖和运动功能等变化;比较两组在干预结束后各项指标的差异。结果干预组血压、血脂值较干预前降低(P<0.05);运动机能干预后有所提高。饮食方式中控制盐量和控制食量者较干预前增加;有个人爱好者较干预前增加。结论以社区为基础、以社区医院为中心的社区老年人健康护理干预对提高老年人生活质量有积极的作用。以护士为主导、医护通力合作的社区老年人健康干预模式,在一定程度上弥补了当今社区医疗管理和社区医疗人力紧张的问题,为社区医疗卫生服务提供了新的模式。     

New York University Medical Center's pilot "Epo-Depot" program: a win-win for patients and health care.

Therapy associated with treatment-related anemia continues to be of great concern for health care providers. Patient satisfaction, patient adherence, and growing insurance reimbursement concerns related to Epoetin alpha therapy for anemia initiated the development of a nursing-led process improvement team at New York University (NYU) Medical Center. Multiple patient groups were identified and treated for anemia with Epoetin alpha through the guide of a standardized pathway providing a convenient and effective treatment plan. The treatment delivery had to be consistent with institutional reimbursement requirements while avoiding significant cost to the patient. Patient populations diagnosed with HIV anemia, HIV oncology, presurgical anemia, and medically complex anemia can now receive appropriate ambulatory treatment. This article describes the formation of the "Epo-Depot" and the logistics involved to service these patients with anemia.     

社区健康教育对糖尿病患者干预效果研究

目的探讨社区健康教育对糖尿病病人自身疾病的认识及治疗效果的影响。方法用多种形式对患者进行健康教育,教育前后用问卷形式对患者进行糖尿病知识的调查,同时测量教育前后患者的空腹血糖。结果糖尿病患者对自身疾病的了解得到明显增强,血糖控制比教育前更加理想(P<0.01)。结论针对不同人群,采用不同方式的健康教育,对控制糖尿病人的血糖,减少并发症的发生能起到较好效果。     

"Towards a Better Life": a program of comprehensive rehabilitation for elderly patients following revision hip arthroplasty

Introduction. The aim of the research was to evaluate the quality of life of patients recovering from revision hip arthroplasty, who underwent rehabilitation under the "Towards a Better Life" program (TBL). In the TBL Program, appropriate physical exercises, relaxation techniques, seminars, and panel discussions are combined to support general improvement in both physical and psychological condition, thus improving the patients' quality of live.
Material and methods. The effectiveness of the TBL approach was evaluated in a clinical experiment involving 36 patients recovering from revision hip arthroplasty, treated under the standard rehabilitation program in general use at the centers represented by the authors. The patients were divided into two equal groups, matched by age and sex: an experimental group E (n = 18), with patients who received additionally the "Towards a Better Life" Program, and a control group K (n = 18), consisting of patients who did not receive this program. The methods used to evaluate the outcome of rehabilitation included clinical interview and observation, the Medical Outcomes Study (MOS-100) and the Self-Evaluating Quality of Life Scale (QOL). The patients were tested before rehabilitation commenced and re-tested two months later.
Analysis of results. On the Physical Index of the MOS-100 scale considerably greater progress was observed in patients from Group E in terms of reduced pain, increased coordination and fluency of movement, improved respiratory capacity, regulation of blood pressure and pulse, functioning of the digestive system, reduced body weight, and improved walking distance. In this group somewhat greater improvements were noted on the Psychological Index of the MOS-100, especially in cognitive functions (perception and attention) and emotional factors (increased satisfaction with life, reduced anexiety, depression, and irritability). The QOL parameters most sensitive to the difference between the TBL Program and the standard program were pain management, independence and self-care, and especially improved self-image and reduced anxiety. The improvements noted by Group E were in many subtest two or three times higher than in Group K.
Conclusions. The greater improvements recorder by patients participating in the "Towards a Better Life" Program in all measured parameters indicates that the program is highly effective in comparison to the standard model. The patients from Group E were much more satisfied with the results they had achieved in rehabilitation, and attained a higher degree of independence and self-determination. The TBL Program can be used to improve the quality of life of patients recovering from revision hip arthroplasty.     

主动脉夹层术后患者的社区护理干预

目的 通过社区护理干预提高主动脉夹层术后患者的生存质量,预防术后远期并发症.方法 对长沙市某区主动脉夹层术后患者采取建立健康档案,定期上门随访,控制血压及抗凝指导等社区护理干预措施.结果 社区护理干预1年半,1例术后1个月因脑梗塞死亡,其他患者未发生术后远期并发症,生存质量较好.结论 加强主动脉夹层术后社区护理干预能提高患者生存质量,提高用药的依从性和安全性,预防术后远期并发症.     

Utilizing the child abuse potential inventory in a community health nursing prevention program for child abuse.

The objectives of this study were to: (a) Determine the potential for child abuse among the Joint New Parent Support Program Hawaii (Joint NPSP) client population, (b) Determine whether client participation in this program can reduce the potential for child abuse, and (c) Determine what client demographics correlate with the potential for child abuse. Joint NPSP is a prevention program for child abuse, screening all pregnant military families in Hawaii. The instrument used in this study was the Child Abuse Potential Inventory (CAP), a reliable and valid instrument used in the screening of physical child abuse. The CAP was completed by 142 pregnant Joint NPSP patients, ages 13-40 years, at the beginning of service provision and approximately 16 months later. Statistical measures used in analyzing the data were the t test and analysis of variance (ANOVA). Paired t tests were used to compare pre- and postprogram scores. Relations between the demographic profile information and CAP scores were analyzed with multiple regression analysis to identify risk factors for high child abuse. Out of 142 surveyed, 77 scored > 166 (signal detection) on the pretest abuse scale, and 65 scored < 166. In the > 166 group the pretest mean was a score of 257, and the posttest mean was 137. T-test results in the > 166 group were highly significant at .0001 on the scales of abuse, distress, rigidity, unhappiness, problems with family, and problems with others. ANOVA results in the > 166 group revealed a significant difference between an elevated abuse scale and patients with psychiatric problems (.0485), relationship problems (.0452), and past or present spouse abuse (.0421). This study validated that Joint NPSP is servicing a population at risk for child abuse potential. After intense home visitation by the community health nurses, the scores for child abuse potential decreased. A major limitation was the lack of a control group, the problem of maturation and history, and the possibility of regression toward the mean in scores. These limitations should be addressed in future studies with the use of 2 treatment modalities. Results highlight the need for focusing on relationship and spouse abuse issues in a military population.