Development of a community health promotion center based on the World Health Organization's Ottawa Charter health promotion strategies

Aim: To describe the development process of nursing school‐led community health promotion centers (CHPC) to improve the health of the surrounding communities. Methods: This study design was a research and development study. (i) Assessment of health needs by interviewing 359 people in the community to select health programs for the community health promotion center. (ii) Five health promotion strategies from the Ottawa Charter were applied to develop the community health promotion center for a city community. Results: (i) The people in the community had higher socioeconomic status levels and better health behaviors compared to the general Korean population, and they also listed chronic health problem management as their first priority health service. (ii) Development of the community health promotion center was done based on the five World Health Organization's Ottawa Charter Health Promotion Strategies: build healthy public policy, create supportive environments, strengthen community actions, develop personal skills, and reorient health services. Conclusions: The present study showed that the WHO's five Ottawa Charter Health Promotion Strategies were useful for developing health promotion centers in the community.     

The school nurse manager: a catalyst for innovation in school health programming.

The nurse manager can assess students' needs in a school system and devise programs that will eliminate duplication of effort and promote collaboration of health-related services. The nurse manager can also accurately evaluate job performance of the nursing staff with an eye toward risk reduction and improved program outcomes. The work of a school nurse manager can facilitate the provision of excellent health care services by school health programs in an era of high expectations and fiscal accountability. This article examines the role of the nurse manager in the school setting and urges school nurses to develop managerial skills to enhance the delivery of care in their schools.     

Integrating health services research into nursing doctoral programs: the evolution of nursing research

Traditionally, nursing research has focused on the effect of an intervention on selected patients without considering the influence of the system of care and its myriad characteristics. Health services research (HSR) focuses on organization and financing of health services; access to health care; quality of care; clinical evaluation and outcomes research; informatics and clinical decision making; practitioner, patient, and consumer behavior; health professions workforce; health policy formulation and analyses; and health care model and service use. Doctoral students can benefit from HSR's broad perspective if it is included in existing nursing curricula. Ultimately, HSR could help the nursing profession achieve the capacity to develop health policy and new systems of health care for the 21st century.     

Access to a school health nurse and adolescent health needs in the universal school health service in Finland

Universal school health services are expected to offer similar, needs‐based services to all students across schools, service providers and students’ socio‐economic statuses and health needs. This study investigates access to school health nurses in Finland. The objectives were to study the differences in access to school health nurse between service providers, schools, students’ characteristics and school health nurse resources. Access was examined through a nationwide School Health Promotion study, which is a self‐reporting, voluntary and anonymous survey for 8th and 9th graders (15 to 16‐year old, N = 71865). The ethical committee of the National Institute for Health and Welfare has approved procedure for the School Health Promotion study. Data on school health nurse resources and service providers were obtained from the national database (534 schools; 144 service providers). Multilevel logistic regression was used. Of the pupils, 15% of girls and 11% of boys reported difficult access to a school health nurse. The number of adolescents who reported difficult access ranged between service providers (0%–41%) and schools (0%–75%). Students with lower socio‐economic background, poorer well‐being at school, lack of support for studying and greater health needs reported difficult access more often. School health nurse resources were associated with difficult access only among boys, when resources were under the national recommendations. These findings raise concern about equality and unmet health needs in school health services.     

School nursing in an underserved multiethnic Asian community: experiences and outcomes

Based on an Asian faculty's previous work, University of South Alabama College of Nursing conducted a project targeting the Asian population in Bayou La Batre, Alabama. The Helene Fuld Health Trust, HSBC, Trustee funded the project to demonstrate effective models for involving nursing students and faculty members in community-based practice. This project provided health services and developed educational programs for this underserved population. To facilitate entry into the Asian community, the College established clinical sites at 2 schools in Bayou La Batre that had the highest concentration of Asians in Mobile County's public school system. The purpose of the project was to develop a new curriculum, to involve nursing students in community-based practice, and to provide health care services in the community. The health services, educational programs, and community instructional activities generated substantial outcomes for the targeted population as well as nursing students. Nursing students learned to assess aggregates, plan, and evaluate interventions. The learning outcomes of the nursing students were evaluated using objectives developed in accordance with Bloom's (1956) Taxonomy. The project not only complemented and expanded existing school health services and programs but also filled the void in some health service and program areas. Preliminary evaluation of the project revealed overwhelmingly positive feedback from both the nursing students and Bayou La Batre school teachers. This article also explores the implications of the newly issued "National Standards for Culturally and Linguistically Appropriate Services in Health Care" for nursing education in the contexts of the Census 2000 and the megatrend of globalization.     

Becoming customer-driven: one health system's story

Market research was done by Crozer-Keystone Health System to better understand the new health care consumer. The information will assist in developing, promoting, and delivering products and services of maximum value to current and prospective consumers. The system is responding by bundling and delivering products and services around consumer-based dimensions, developing new and better ways to improve customer convenience, access, and service. Operationalizing these initiatives for change involves building an information infrastructure of extensive content and customer databases, using new technologies to customize communications and ultimately service components.     

身体活动融入学校健康服务体系的国际政策架构与内容研究

目的 系统研究世界卫生组织(WHO)身体活动融入学校健康服务体系的相关政策架构与核心内容。方法 应用内容分析法和WHO健康服务体系理论,对WHO学校健康和身体活动相关领域的核心政策文件进行系统内容分析,构建身体活动融入学校健康服务体系的政策架构。WHO在学校健康领域核心政策文件包括《将每所学校建成健康促进学校的实施指南》《WHO关于学校健康服务指南》和《将每所学校建成健康促进学校的全球标准和指标》,在身体活动领域核心文件主要有《2018-2030年促进身体活动全球行动计划：加强身体活动,造就健康世界》《WHO关于身体活动和久坐行为的指南》(儿童青少年部分)。结果 身体活动作为一项健康战略和发展战略,是建设健康促进学校的重要手段之一。在健康和教育领域,建设健康促进学校的关键是关注儿童功能和发展,以促进学校健康包容性和公平性为目标。在学校环境中,将儿童青少年身体活动纳入以健康促进为主的学校健康服务连续体中。在宏观层面,国家和有关部门应建立身体活动融入学校健康服务体系的战略架构和战略规划;在中观层面,教育机构应依据WHO学校健康服务指南的要求来制定和改进学校健康服务政策和方案,完善学校健康服务手段。通过提供高质量体育课程和课后身体活动实现儿童青少年健康服务;在微观层面,以构建健康促进学校的全球标准为指导,将身体活动以课程和活动的形式,促进儿童青少年健康发展。将身体活动融入学校健康服务体系,需从学校健康领导力与治理、学校基础设施筹资、支持身体活动的学校健康服务提供、学校健康人力资源、学校健康相关医药技术以及学校健康信息系统六个领域入手,实施健康促进学校政策行动、加强多层级的学校领导力与治理,筹措必要资金,开发适应健康促进学校建设的人力资源并建设支持身体活动的方案。结论 学校健康服务是促进儿童健康与实现联合国可持续发展目标的重要领域,身体活动是学校健康服务的重要内容。WHO颁布的相关核心政策文件,构建了身体活动融入学校健康服务体系的政策架构,其核心内容是要通过教育和体育手段将身体活动融入健康促进学校健康服务体系中,构建健康促进学校服务体系,促进儿童青少年健康发展。根据WHO健康服务体系构成六要素,身体活动融入学校健康服务体系需要加强学校健康领导力与治理、完善学校基础设施筹资,发展学校健康人力资源,研发基于学校的健康相关医药技术,建立共享学生健康数据的健康信息系统。     

Empowerment in the public health practice

Public health personnel are the first-line workers of preventive care and medical services. In the face of rapid social and demographic changes, empowerment and on-job training have become important approaches to enhance the function of nurses. Health centers act like the "peripheral nerves" of the government healthcare system, as they must both reflect the needs of community residents and fully implement government mandated services. While widely distributed, health centers face manpower shortages and disorderly information collection and distribution systems. Empowerment and on-job training programs can enhance public heath staff knowledge in order to cope with heavy workloads and shift toward multi-dimensional development. This paper examines the experience of the New Taipei City Public Health Bureau in conducting health center empowerment programs from four perspectives, including personal cultivation and organizational cultivation. It was found that public health staff self-recognition of professional values can also be further strengthened through alliances within the community, and that establishing personal relationships with patients by "treating patients as relatives" was effective in realizing health center objectives. This paper also reminds agency supervisors that staff training is a critical management task. Health authorities should thus introduce in a timely manner organizational management, on-job training, service reengineering, and other related corporate philosophies; facilitate staff empowerment; consolidate core professional knowledge; and construct intellectual and social capital that meets health unit needs in order to enhance health center competitiveness and public health staff knowledge.     

A health services perspective on delivery of psychiatric services in primary care including internal medicine

Serious problems persist in the recognition and treatment of psychiatric problems in primary care despite multiple interventions directed at correcting these problems. Improved outcomes depend on improved recognition, and screening instruments need to be streamlined tremendously to be accepted by primary care providers. Publication of guidelines and physician education, although essential for improved care, are probably insufficient to implement guidelines-based care. Improvements in psychiatric outcome appear to depend on the level of intensity of the intervention employed. Continued research is needed to determine the most effective type of educational intervention and more widely applicable quality improvement processes. Broad-based changes in health service delivery focusing on the true integration of mental health services with general medical care are required to bring about meaningful, effective change. Ongoing changes in physician training programs (combined primary care/psychiatry programs) may facilitate implementation of guideline-based psychiatric care in medical settings, but the full impact of these changes is not likely to be felt for several years.     

A coordinated school health program approach to adolescent obesity.

Obesity has become one of this country's most significant nutritional diseases. The prevalence of childhood and adolescent obesity has steadily increased over the past 20 years. The risk of developing health problems increases as the obese child becomes an obese adolescent and adult. The 1997 Youth Risk Behavior Survey reports adolescents participate in behaviors that put them at risk for obesity. The recognition of these unhealthy behaviors among our youth has led to the need for early intervention. The Coordinated School Health Program is a mechanism to address adolescent obesity at the school-age level. This program includes an organized set of policies, procedures, and activities intended to protect and promote the health and well-being of students and staff. The eight components of a Coordinated School Health Program (CSHP) include school health services, a healthy school environment, comprehensive school health education, counseling and guidance, physical education, food service, worksite health promotion, and the integration of school and community. This paper describes integration of prevention and treatment strategies for adolescent obesity for each of the eight components of a CSHP.     

Depression, service need, and use in vulnerable populations

Health care reform has created opportunities for mental health nurses to develop innovative health care delivery models to provide integrated behavioral health and primary health care. A community health analysis is one method to ensure appropriate services are planned. This study examined the health care services most needed and those used by depressed and nondepressed participants (N = 231), and their satisfaction with these services. Individual and system characteristics were examined using a framework developed by Anderson and Aday. Significant differences were found between the 2 groups for predisposing characteristics, enabling characteristics, need for care, service use, and satisfaction with services.     

Facilitating an integrated approach to primary health care in Saskatchewan

It is unlikely that truly integrated primary health care will become a reality unless health professionals actively strive to foster integration. Dialogue about integration barriers and opportunities has begun between the nursing, pharmacy, social work, emergency medical services, and medical professions. This dialogue should be expanded to include all of the professions with a potential role in an integrated system. The dialogue will also need to include government leaders as key public policy decisions will significantly influence the success or failure of integrated primary health service delivery strategies. As well, dialogue needs to occur with communities so that citizens can understand, value and help shape and maintain this kind of service delivery. Public education needs to emphasize that an integrated approach to primary health care in Saskatchewan is the best kind of service that can be provided. The Integrated Primary Health Care Working Group believes that the principles of primary health care require health professionals in Saskatchewan to develop an integrated approach to health services delivery in Saskatchewan. An exploration of possible barriers to this integrated approach is an important first step in eliminating barriers and facilitating effective health care service delivery to meet population health needs.     

Quality assurance in school health.

School nurses need to become more influential administrators, managers, and entrepreneurs. They must learn to lead and collaborate effectively in designing, implementing, and evaluating coordinated school health programs. Quality assurance is an essential ingredient in this process that requires accurate, timely, and confidential incident reporting and data analysis structures. These structures, in turn, can serve as the foundation of evidence-based practice and overall system improvement. School nurses can and should assume a key role in the process and thereby continue to meet the challenges of the more sophisticated school health services that today's student population requires. In this way, school nurses will continue to protect and advance the health and safety of the students who are entrusted to their care.     

Minority workers: educational models for workers, health providers, and planners

1. The Labor Occupational Health Program's (LOHP) experience with occupational health problems in minority communities demonstrates that information on a client's past work history and occupational exposures is essential in providing comprehensive health care. Occupational health histories are an excellent tool to utilize in community health. 2. Community clinics and primary health care professionals are integral components in health care delivery services. 3. The occupational health professional has a unique opportunity to provide leadership in educating community health providers about the basics of occupational health.     

Predictors of health services utilization by hypertensive patients in South Korea

OBJECTIVES: The purpose of this study was to elucidate the factors that influence making contact with health care services after a diagnosis of hypertension and the volume of health services utilization by the hypertensive patients. METHODS: A secondary data analysis with 3 data sets, including health screening, health survey, and national health insurance reimbursement data. Data on 841,630 public servants aged between 21 and 65 years who underwent health screenings in 2000 and 2002 were provided by the National Health Insurance Cooperation. RESULTS: Of the 841,630 screened participants, 204,099 (24.25%) were hypertensives and 9,057 (1.08%) were newly diagnosed as having hypertension. Age, sex, systolic blood pressure, comorbidity, alcohol consumption, and tobacco use were significantly associated with making contact with health care services, while age, sex, place of residence, occupation, body mass index, systolic and diastolic blood pressure, comorbidity, alcohol consumption, and tobacco use were significantly associated with the volume of health services utilized by the hypertensive patients. CONCLUSIONS: Health professionals should devise strategies to encourage nonusers and inappropriate users of health services to obtain timely health services while considering the factors that influence making contact with health care services and the volume of health services utilization.     

The complicated task of managing school health programs.

There is growing awareness of the important link between health and education in our society. Children need to be healthy to learn, and they must learn to be healthy. The 8-component coordinated school health program, developed in the early 1980s, rests on the premise that everybody in a child's environment can contribute something, although no one can address a child's health problems effectively by working alone (Tyson, 1999). There is, however, one essential component missing from the coordinated plan: program management. Many of the components of a comprehensive school health program exist in some aspects in our schools. What is lacking is the coordination of these services. School nurses possess the experience, skills, and knowledge necessary to provide the missing link of a comprehensive school health program and must become leaders in this essential effort to care for children and their families.     

An evaluation of elementary school nutrition practices and policies in a southern Illinois county

The purpose of this study is to assess elementary school nutrition programs in a rural county in southern Illinois. The researcher interviewed the food service managers of eight schools and completed the School Health Index (SHI) based on their responses. Eighty-seven percent of the schools did not have venues such as vending machines outside the cafeteria. Three food service managers stated that from 75% to 80% of the students in the district ate lunch in the cafeteria. The SHI corresponds to the eight components of a coordinated school health program; nutrition services are just one of the eight components. The SHI is a tool that can be used to identify strengths and weaknesses in the nutrition program. It covers items from healthy, low-fat choices to food preparation and cafeteria practices. School nurses can work with teachers and food service personnel to create nutrition programs and a curriculum related to healthy nutrition practices.     

Memphis Business Group on Health: a model for health care reform and cost containment

A market-driven, community-based, competitive health care model has effectively assisted Memphis employers to achieve their cost containment and health care reform objectives. Members of the Memphis Business Group on Health joined forces and successfully implemented a variety of programs and services that resulted in dramatic cost savings and reform of health care delivery systems. Programs included development of a purchasing alliance for negotiating contracts for hospital, medical, workers' compensation, psychiatric, and substance abuse care and other service and product options. Utilization management programs focused on appropriate consumption of resources and intensive management of critical cases. While increases in per employee costs averaged 14.7 percent per year for five years nationally, members of the Memphis Business Group on Health held their increases to an average of 6 percent per year.     

Epidemiologic trends and costs of fragmentation

The data that were reviewed in this article documented that in health systems, which manage behavioral health disorders independently from general medical disorders, the estimated 10% to 30% of patients with behavioral health service needs can expect (1) poor access or barriers to medical or mental health care; (2) when services are available, most provided will not meet minimum standards for expected outcome change; and (3) as a consequence of (1) and (2), medical and behavioral disorders will be more persistent with increased complications, will be associated with greater disability, and will lead to higher total health care and disability costs than will treatment of patients who do not have behavioral health disorders. This article proposes that these health system deficiencies will persist unless behavioral health services become an integral part of medical care (ie, integrated). By doing so, it creates a win-win situation for virtually all parties involved. Complex patients will receive coordinated general medical and behavioral health care that leads to improved outcomes. Clinicians and the hospitals that support integrated programs will be less encumbered by cross-disciplinary roadblocks as they deliver services that augment patient outcomes. Health plans (insurers) will be able to decrease administrative and claims costs because the complex patients who generate more than 80% of service use will have less complicated claims adjudication and better clinical outcomes. As a result, purchaser premiums, whether government programs, employers, or individuals, will decrease and the impact on national budgets will improve. Ongoing research will be important to assure that application of the best clinical and administrative practices are used to achieve these outcomes.