The rising cost of health care: can demand be reduced through more effective health promotion?

The cost of health care continues to rise in the face of an apparently insatiable demand. Unless the actual need for health care can be reduced to manageable levels, the financial burden will probably become economically unacceptable. Although some illnesses are unavoidable, others that are largely due to unhealthy lifestyles are preventable. Circulatory diseases, diabetes and some cancers, which are major causes of morbidity and mortality in western societies, are strongly linked to physical inactivity, psychological stress, unhealthy eating, obesity and smoking. There is ample evidence that promotion of healthy lifestyles, including physical activity, healthy eating and non-smoking, are effective for the primary and secondary prevention of these diseases. Although there are examples of successful public health programmes that have encouraged more healthy lifestyles and reduced the burden of disease, we need to be much more effective in putting theory into practice. In order to improve the health of the nation and to prevent the economy being overwhelmed by the increasing demand for health care, we need a change of mindset from a consumerist approach to an acceptance of personal and corporate responsibility for more healthy lifestyles. Widespread collaboration among health care agencies, private and public utilities, the entertainment industry and the communications media will be necessary in order to provide the necessary incentives for lifestyle changes.     

Should nurses be leaders of integrated health care?

AIM(S): To examine the role of nurses within integrated health care. BACKGROUND: Healthcare planners are overly concerned with the treatment of diseases and insufficiently focused on social cohesion vertical rather than horizontal integration of healthcare effort. These domains need to be better connected, to avoid medicalization of social problems and socialisation of medical problems. EVALUATION: Published literature, related to theories of whole system integration. *When conceptualizing whole system integration it helps to consider research insights to be snapshots of more complex stories-in-evolution, and change to be the result of ongoing community dance where multiple players adapt their steps to each other. *One image that helps to conceptualize integration is that of a railway network. Railway tracks and multiple journeys are equally needed; each requiring a different approach for success. *Traditional nursing values make nurses more attuned to the issues of combined vertical and horizontal integration than medical colleagues. CONCLUSION(S): Nurses should lead integration at the interface between horizontal and vertical activities. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers and universities should support the development of nurses as leaders of whole system integration, in partnership with local healthcare organizations.     

Can physician assistants be effective in the UK?

The National Health Sevice (NHS) faces a serious shortage of medical staff. One solution is to introduce US-style physician assistants (PAs) who train for around two years following previous clinical work or a first degree, and perform duties similar to junior doctors. This paper reviews the history and role of PAs, the quality of their work and their likely impact in the UK. A variety of sources were searched to identify suitable studies. The use of PAs in the UK appears to be an acceptable model that could eventually reduce the current skill shortage and provide high quality patient care. Twelve US-sourced PAs currently work in Sandwell, West Midlands. A recent report suggests they have made a substantial contribution to primary care and have improved patient access. For PAs to be successful in the UK, they must be highly regarded practitioners. High quality educational courses must be established to ensure their credibility.     

Mental health nursing: Daring to be different,special and leading recovery‐focused care?

How mental health nursing is differentiated from other disciplines and professions, and what special contribution mental health nurses make to health services, is a question at the heart of contemporary practice. One of the significant challenges for mental health nurses is identifying, developing and advancing those aspects of their practice that they consider differentiate them in the multi‐disciplinary mental health care team and to articulate clearly what a mental health nurse is and does. This paper draws on data from interviews with 36 mental health nurses in Australia who identified their practice as autonomous. Participants were asked the question, “What's special about mental health nursing?” Constructivist grounded theory techniques were applied to the research process. Findings were formulated and expressed as the ‘Ten P's of the professional profile that is mental health nursing’, which are ‘present’, ‘personal’, ‘participant partnering’, ‘professional’, ‘phenomenological’, ‘pragmatic’, ‘power‐sharing’, ‘psycho‐therapeutic’, ‘proud’ and ‘profound’. The combined elements of the findings present a theoretical construct of mental health nursing practice as something distinctive and special. It provides a model and exemplar for contemporary practice in mental health nursing, embracing the role of mental health nurses in the health care workforce as being well placed as providers of productive and effective care.     

Can telehealth technology be used for the education of health professionals?

The purpose of this report is to describe the usefulness and desirability of using telehealth technology in the education of health care professionals. The PC-compatible, Windows-based system allowed for both real-time videoconferencing and store-and-forward (sending information from one site and stored at a distant site for access at a later time) functions. Student responses indicated that they thought they would benefit from this type of technology in their clinical education. They were most positive with respect to increasing access to a wider range of clients they may not otherwise access and least positive for the ability to learn from a televideo interaction when compared with a clinic experience. Similarly, faculty were least interested in using videoconferencing for patient rounds and more interested in using telehealth to enhance classroom presentations.     

Can mainstream health services provide meaningful care for people who self‐harm? A critical reflection

People who self-harm currently access health care based in a wide variety of settings. These include primary care, accident and emergency departments, and specialist mental health providers. This paper considers whether meaningful care for people who self-harm can be provided within these mainstream health services. The paper begins by clarifying the meaning of self-harm and distinguishes self-harm from suicide. Four treatment models applied in clinical practice are identified: (i) psychodynamic, (ii) behavioural, (iii) biosocial and (iv) feminist. Each of these is critically considered in terms of practical utility, professional attitudes and wider organizational/policy context.     

Can mental illness be prevented under managed care?

Ideally, managed care should force a focus on all the issues involved in prevention and treatment. Unfortunately, the decisions in managed care are based on costs, along with the intervention techniques, as the most important criteria in choice of treatment. Medical treatment accounts for only 10 percent of health. To find a solution means working together, making the goal "healthy people in a healthy community." Programs such as the Healthy Cities initiative, not managed care, are more likely to realize this goal.