Development of the role of public health nurses in addressing child and family poverty: a framework for action

Title. Development of the role of public health nurses in addressing child and family poverty: a framework for action Aim. The purpose of this paper is to invite dialogue about how public health nurses could best address child and family poverty. Their current role is reviewed and a framework for expanding this role is presented. Background. The negative health consequences of poverty for children are well‐documented worldwide. The high levels of children living in poverty in wealthy industrialized countries such as Canada should be of concern to the health sector. What role(s) can public health nurses play in addressing child and family poverty? Method. A review of scholarly literature from Canada, the United States of America and the United Kingdom was conducted to ascertain support for public health nurses’ roles in reducing poverty and its effects. We then reviewed professional standards and competencies for nursing practice in Canada. The data were collected between 2005 and 2006. Findings. Numerous nursing scholars have called for public health nurses to address the causes and consequences of poverty through policy advocacy. However, this role was less likely to be identified in professional standards and competencies, and we found little empirical evidence documenting Canadian public health nurses’ efforts to engage in this role. Public health nurses’ roles in relation to poverty focus primarily on assisting families living in poverty to access appropriate services rather than directing efforts at the policy level. Factors associated with this limited involvement are identified. We suggest that the conceptual framework developed by Blackburn in the United Kingdom offers direction for a more fully developed public health nursing role. Prerequisites to engaging in the strategies articulated in the framework are discussed. Conclusion. Given more organizational support and enhanced knowledge and skills, public health nurses could be playing a greater role in working with others to make child and family poverty history.     

An introduction to the knowledge-to-action strategic framework for disseminating evidence-based practice in autism spectrum disorder early intervention centers and its relevance to the National Disability Insurance Scheme

ABSTRACT

A knowledge-to-practice gap has been widely documented in autism spectrum disorder (ASD) early intervention, including nonuse of effective practices and use of ineffective and/or non-evidence-based practices (non-EBPs). We argue that it is critical to bridge this gap to ensure the best possible outcomes for children with ASD. In this paper, we draw from the implementation science field to describe a strategic framework for disseminating information, improving practice, and maintaining EBPs in ASD early intervention centers that encompasses the entire cycle of the knowledge-to-action (KTA) paradigm with stakeholder collaboration as a key element. We outline the potential for application of the KTA framework and for planning and implementing a strategy for professional development in ASD early intervention centers in an Australian context with reference to the National Disability Insurance Scheme (NDIS). We provide a model for future research in ASD to facilitate the translation of research to practice in a more timely and efficient manner, in order to improve practice and outcomes for children with ASD and their families.     

Primary care groups and trusts: a threat or an opportunity for the development of community-based nursing in England

AIMS OF THE STUDY: To examine the role of Primary Care Groups and Trusts (PCG/T) in relation to nurses working in general practice and community health services. BACKGROUND: Over the past two decades there have been rapid changes in the numbers and roles of nurses working in primary care and community based settings. The establishment of Primary Care Groups offers health care professionals, including nurses, the chance to develop local primary care services and to integrate community and primary care nursing. These developments may offer opportunities or pose threats to nursing staff. RESEARCH METHODS: Data are drawn from a longitudinal study of a randomly selected sample of Primary Care Groups in England (n = 72). In a second survey of Groups carried out in autumn/winter 2000, Primary Care Group chairs and chief officers were interviewed by telephone. RESULTS: Response rates were 97% for both chairs and chief officers (69 of each). Chairs indicated that in most areas Primary Care Groups were consulting with local nurses to develop policy. Fifty-seven (85%) reported that investment in nursing staff and nursing services was a high priority in their area. Twenty-eight (41%) indicated that nurse-led services designed to increase patient access had already been established in their area, and 20 (29%) were planning new nurse-led services. Many developments had been initiated by Primary Care Groups. Initiatives to integrate community and general practice based staff were underway in most areas. CONCLUSIONS: Primary Care Groups and Trusts are initiating changes in general practice and community based services which are likely to have long-term and important implications for nurses in terms of their roles, conditions of work and future careers. It is important that nurses are consulted and are involved in developing and implementing policy change.     

Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions

Middleton JW, McCormick M, Engel S, Rutkowski SB, Cameron ID, Harradine P, Johnson JL, Andrews D. Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions.

Objective

To develop and implement a service model for people with spinal cord injury (SCI) living in rural regions.

Design

Service development, pilot evaluation study.

Setting

Regional and remote areas of the state of New South Wales, Australia.

Participants

Persons with SCI, caregivers, and health professionals.

Intervention

Phase 1 included initial needs analysis, followed by education and resource development tailored to needs of rural health professionals, caregivers, and persons with SCI. Phase 2 included coordination, professional support, and network development by part-time rural key worker and metropolitan-based project officer, documenting health- and service-related issues.

Main Outcome Measures

Self-perception of confidence as a result of education as well as reported issues, adverse health events, and barriers to service provision.

Results

Clinician confidence in managing people with SCI improved after education. Various health-related, environmental, and psychosocial issues were reported. Limited availability of resources and health infrastructure, particularly in more isolated or smaller towns, challenged service provision. Rural key workers played a central role in supporting local clinicians and service providers, improving communication and service coordination between rural health professionals and metropolitan SCI services.

Conclusion

Education and support for rural workforce that may be limited in numbers and capacity, and a model facilitating communication and coordination between services, are essential for improving health outcomes of rural people with SCI.     

The rise and fall of research and development for the forest industry in Australia

The modern Australian forest industry has been built on the foundations of science and technology provided by decades of research and development. Much of this research and development (R&D) has been undertaken and funded by state and Commonwealth agencies and the universities. It has enabled the development of new industry sectors that have delivered significant socio-economic benefits. The value of R&D has been supported by independent cost/benefit analyses, and the quality of the science has been upheld by international recognition of innovations and awards to Australian scientists. Despite this successful history, in recent years R&D investment by many organisations has declined sharply to levels that are nationally precarious for continuing industry success. Reasons for the reduction in funding for R&D for the industry include the declining relative contribution of the forest industry to the national economy, reduced government involvement in the industry, corporate restructuring, increased international ownership, low industry profitability, cost cutting and inadequate recognition by the industry of the importance of R&D and innovation for business growth and sustainability. We have already lost or are losing core R&D capability and the human talent required for the future. The forest industry in Australia operates in a dynamic environment: production of raw material (wood) is subject to both continuing and unpredictable threats, while processing and products are subject to innovative competition. Forest industry is a long-term business and the sustainability of the industry depends on a sound, adequate and ongoing underpinning of science and technology. For a better future, key requirements include industry’s commitment to greater R&D investment in its own development, strategic partnerships between R&D funders and providers in priority areas, and sustainable and dependable funding from public and private sources.     

Review and application of the National Academies of Sciences,Engineering, and Medicine bullying or cyberbullying recommendations for screening and lesbian,gay, bisexual,and transgender youth

Bullying has been long seen as a natural part of childhood and adolescence. However, a growing body of evidence suggests bullying and now cyberbullying may inflict harm or distress on targeted youth including physical, psychological, social, or educational harm.The purpose of this paper is to endorse the National Academies of Sciences, Engineering, and Medicine statement, summarize the report, and apply the recommendations to screening lesbian, gay, bisexual and transgender youth related to bullying and cyberbullying; line 11 change exemplified to discussed.Screening for bullying against youth; lesbian, gay, bisexual, and transgender youth as a high-risk group for bullying victimization; and implications to address bullying against youth are exemplified.Nurses need to promote policies that foster inclusive, supportive, safe, and healthy schools and environments for youth.     

State of the science of postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy. An introduction.

The Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness, along with academic, professional, provider, accreditor, and other organizations, sponsored a 2-day symposium on the state of the science of postacute rehabilitation in February 2007. The aim of this symposium was to serve as a catalyst for expanded research on postacute care (PAC) rehabilitation so that health policy could be founded on a solid evidence base. The goals were to (1) describe the state of our knowledge regarding utilization, organization, and outcomes of postacute rehabilitation settings, (2) identify methodologic and measurement challenges to conducting research, (3) foster the exchange of ideas among researchers, policymakers, industry representatives, funding agency staff, consumers, and advocacy groups, and (4) identify critical issues related to setting, delivery, payment, and effectiveness of rehabilitation services. Plenary presentation and state-of-the-science summaries were organized around four themes: (1) the need for improved measurement of key rehabilitation variables and methods to collect and analyze this information, (2) factors that influence access to postacute rehabilitation care, (3) similarities and differences in quality and quantity of services across PAC settings, and (4) effectiveness ofpostacute rehabilitation services. The full set of symposium articles, including recommendations for future research,     

A review of the literature on HIV infection and schizophrenia: implications for research,policy and clinical practice

AIDS represents one of the major public health problems of the 21st century. Men having sex with men, injecting drug use and having multiple sexual partners are well-established risk behaviours for transmitting the HIV virus. People with schizophrenia are more likely to engage in these behaviours than the general population and as a result there is an increased prevalence of HIV infection in this group. However, many contemporary mental health policy reports fail to discuss the risk of HIV/AIDS in people with schizophrenia, and there are few specific references to sexual health promotion in these documents. People with schizophrenia should be considered an at-risk population for HIV infection and other sexually transmitted diseases. Psychiatric research, policy and clinical practice need to develop rapidly to address this important aspect of a major public health problem.     

The Burn Model Systems outcome measures: a content analysis using the International Classification of Functioning,Disability, and Health

Background: The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) Burn Injury Model Systems (BMS) is a nationwide database that uses patient-reported outcome measures to collect data. Though the outcome measures demonstrate good psychometric properties, the question remains whether or not these measures collect data that encompass the entire experience of burn patients over time.

Methods: Each meaningful concept included in the BMS assessments was linked to the International Classification of Functioning, Disability and Health (ICF) in order to classify and describe the content of each measure. The linking was completed by two experienced coders. The perspective of each assessment was also determined.

Results: The body function component was most frequently addressed overall followed by the activities and participation component. The component body structures and environmental factors are not extensively covered in the BMS assessments. ICF chapter and category distribution varied greatly between assessments. The assessments were of the health status perspective.

Conclusion: This study suggests a need to revisit the item composition of the BMS assessments to more evenly distribute ICF topics and subtopics that are pertinent to burn injury which will ensure a broader but more precise understanding of burn injury recovery.

• Implications for Rehabilitation

• A better understanding of the data collected through the Burn Model Systems (BMS) project may contribute to improve data collection tools and ultimately lead to clinical practice innovations and improvements.

• Clinicians interested in using BMS data for research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed.

• This study highlights the need for burn clinicians around the world to lend their expertise to the WHO for the development of a much needed burn injury International Classification of Functioning, Disability and Health Core Set.

     

The voice of the self: a typology of general practitioners’ emotional responses to situational and contextual stressors

ObjectiveTo develop a comprehensive typology of emotional reactions associated with stress among general practitioners (GPs), grounded in their own experiences.DesignData was generated using observations and unstructured interviews, using Straussian grounded theory as the overarching methodology. The typology was built using multidimensional property supplementation.SettingEleven health care centres in urban and rural communities in four Swedish regions.SubjectsSixteen GPs and GP residents.Main outcome measuresCharacteristics of GPs’ emotional reactions in everyday work situations.ResultsAccounts of negative emotions connected to stress revealed four principal personal needs of the GP: trust, efficacy, understanding, and knowledge. Simultaneous threats to more than one of these needs invariably increased the level of tension. From these more complex accounts, six second-order needs could be identified: integrity, judgment, pursuit, authority, autonomy, and competence. The most extreme encounters, in which all four principal needs were threatened, were characterised by the experience of being reduced into an assistant.ConclusionThe considerable resilience of GPs may belie some of the pressures that they are facing while being far from a fail-safe defence against being diverted from purposeful and morally responsible action. Our typology distinguishes between different forms of stress that may affect how GPs carry out their work, and connects to the vast literature on GP wellness. The results of this study could be used to develop tools for self-reflection with the aim of countering the effects of stress, and are potentially relevant to future research into its causes and consequences.

Key points

• What is known
• •Stress among GPs may have severe consequences for themselves and their patients, and levels of stress appear to be increasing.
• What this article adds
• •Stressful situations threaten at least one of four principal needs of the GP: trust, efficacy, understanding, and knowledge.
• •More complex threats increase the level of tension and bring out second-order needs: integrity, judgment, pursuit, authority, autonomy, and competence.
• •The wealth of literature on GP stress can be clearly understood through the lens of our four-dimensional typology.

     

Mapping the rehabilitation interventions of a community stroke team to the extended International Classification of Functioning,Disability and Health Core Set for Stroke

Purpose: This study aim was to evaluate whether the Extended International Classification of Functioning, Disability and Health Core Set for Stroke captured the interventions of a community stroke rehabilitation team situated in a large city in New Zealand. It was proposed that the results would identify the contribution of each discipline, and the gaps and differences in service provision to Māori and non-Māori. Applying the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in this way would also inform whether this core set should be adopted in New Zealand.

Method: Interventions were retrospectively extracted from 18 medical records and linked to the International Classification of Functioning, Disability and Health and the Extended International Classification of Functioning, Disability and Health Core Set for Stroke. The frequencies of linked interventions and the health discipline providing the intervention were calculated.

Results: Analysis revealed that 98.8% of interventions provided by the rehabilitation team could be linked to the Extended International Classification of Functioning, Disability and Health Core Set for Stroke, with more interventions for body function and structure than for activities and participation; no interventions for emotional concerns; and limited interventions for community, social and civic life. Results support previous recommendations for additions to the EICSS.

Conclusions: The results support the use of the Extended International Classification of Functioning, Disability and Health Core Set for Stroke in New Zealand and demonstrates its use as a quality assurance tool that can evaluate the scope and practice of a rehabilitation service.

• Implications for Rehabilitation

• The Extended International Classification of Functioning Disability and Health Core Set for Stroke appears to represent the stroke interventions of a community stroke rehabilitation team in New Zealand.

• As a result, researchers and clinicians may have increased confidence to use this core set in research and clinical practice.

• The Extended International Classification of Functioning Disability and Health Core Set for Stroke can be used as a quality assurance tool to establish whether a community stroke rehabilitation team is meeting the functional needs of its stroke population.

     

‘The group was the only therapy which supported my needs,because it helped me feel normal and I was able to speak out with a voice’: A qualitative study of an integrated group treatment for dual diagnosis service users within a community mental health setting

Whilst the evidence for the efficacy of treatment interventions for individuals with dual diagnosis has been developing in recent decades, little is known about individual perceptions and the personal benefits of attending integrated treatment programmes within this population group. A qualitative methodology, Interpretive phenomenological analysis, was used to investigate the experiences of individuals with a range of complex mental health and coexisting substance misuse problems who took part in a psychoeducational group (PEG) programme. This comprised of social support and therapeutic peer group relationship facilitation. Semi‐structured interviews were undertaken with 15 service users who successfully participated in this treatment programme. Findings identify the complexity of the therapeutic process and understanding of the treatment from the service users perspective. This included the importance of forming meaningful therapeutic relationships as an influential factor in countering a range of distressing and incompatible environmental and situational stressors, such as self‐regulatory control, self‐awareness of a need for change and the importance of integrated treatment in reducing the sense of stigma and exclusion linked with using mental health services. The study findings support the use of integrated treatment programmes in mental health services with a dual diagnosis population group.     

The development and evaluation of a health education programme for pregnant women in a regional hospital, southern Thailand

The maternal mortality rate (MMR) in Thailand is higher than neighbouring developing countries including Malaysia and Singapore. The 1993 MMR of Thailand was 249 per 100 000 livebirths which was four times higher than the rates in Malaysia and Singapore (World Health Organization 1995). The major causes of these deaths were haemorrhage, toxaemia of pregnancy and sepsis which were likely to be prevented by adequate prenatal care (Thailand Ministry of Public Health 1996). A large proportion of Thai pregnant women have poor health. Between 1994 and 1995, a national study conducted by Thailand Ministry of Health showed that 39% of pregnant women were anaemic, defined as haemoglobin concentration lower than 33% (Supamethaporn 1997). Another study conducted in the southern region also indicated that 13.8% of pregnant women were anaemic caused by iron deficiency (Phatthanapreechakul et al. 1997). Other behaviours which increased risks associated with child birth included non-antenatal care (ANC) attendance, undertaking physically demanding tasks and failure to increase nutritional intake during their pregnancy period (N. Phiriyanuphong et al. 1992, unpublished report). These factors emphasize the importance of a health education programme which could facilitate women to, for example, increase protein and iron intake during pregnancy which would reduce complications from their poor health status. This study was conducted in a regional hospital in Thailand where there was no systematic and well-planned health education programme for pregnant women. The initial aim was to design a health education programme using input from the hospital health care professionals including obstetricians, nurses, nutritionists, health educators and health promoters. An active involvement of these personnel assisted to sustain the provision of the programme provided for pregnant women after the cessation of the study project. Another aim of the study was to evaluate the outcomes of the programme using a pre-test-post-test method among selected pregnant women who participated in the newly designed health education programme.     

Use of the International Classification of Functioning,Disability and Health as a framework for analyzing the Stroke Impact Scale-16 relative to falls

Abstract

Objective: To determine if subscores based on grouping Stroke Impact Scale 16 (SIS-16) items according to International Classification of Functioning, Health and Disability (ICF) components are more accurate in identifying individuals with a history of falls than the total SIS-16 score.

Design: Case series.

Subjects: 43 community-dwelling people with chronic stroke.

Methods: Participants were grouped based on six month fall history (no fall versus one or more falls). The SIS-16 items were categorized as belonging to the Body Structure and Function (BSF), Activity (ACT) or Participation (PART) component of the ICF. SIS-16 total score and ICF component subscores were analyzed for their association with falls. Receiver Operating Characteristic Curves were (ROC) analyzed.

Results: There were significant differences between groups on SIS-16 total (p?=?0.006), BSF (p?=?0.041) and ACT (p?=?0.003) scores. The BSF and ACT component subscores had the highest specificity (0.91) and sensitivity (0.80), respectively, for categorizing participants according to fall history. The BSF?+?ACT component subscore demonstrated greater accuracy than the total SIS-16 for identifying people with falls (area under the curve?=?0.78).

Conclusion: The ICF may be a useful model for analysis of fall screening tools for people with chronic stroke. ICF component subscores are more accurate than the SIS-16 total score for this purpose.