Voluntarism: is it a useful concept for health education in the accident and emergency department?

As the year 2000 looms closer, the emphasis on health education as a means of attaining the 38 targets for 'Health for All' increases Despite various initiatives, little, if any, progress has been made in narrowing the health divide Currently, terms such as 'self-care','individual responsibility' and 'community empowerment' are often used with emphasis on individual freedom to choose The author contends that to assume all individuals have that freedom and act voluntarily, is to deny the impact of social structure on health Health education and the concept of voluntarism will be critically examined from the perspective of nursing in an accident and emergency department     

Has the discipline of nursing developed to the stage where nurses do ‘think nursing’?

With the increasing complexity and changing conditions of nursing practice, as well as the encroachment of other professions on nursing's traditional domain, it is becoming increasingly important for nurses to gain insights into the nature of nursing knowledge and practice. This paper attempts to outline the meaning of the expression 'to think nursing' and the factors involved in such a capacity. The work of nurse scholars is then discussed in terms of their contribution towards developing the discipline of nursing to the stage where nurses do 'think nursing'.     

Developing and utilising a new funding model for home‐care services in New Zealand

Worldwide increases in the numbers of older people alongside an accompanying international policy incentive to support ageing‐in‐place have focussed the importance of home‐care services as an alternative to institutionalisation. Despite this, funding models that facilitate a responsive, flexible approach are lacking. Casemix provides one solution, but the transition from the well‐established hospital system to community has been problematic. This research seeks to develop a Casemix funding solution for home‐care services through meaningful client profile groups and supporting pathways. Unique assessments from 3,135 older people were collected from two health board regions in 2012. Of these, 1,009 arose from older people with non‐complex needs using the interRAI‐Contact Assessment (CA) and 2,126 from the interRAI‐Home‐Care (HC) from older people with complex needs. Home‐care service hours were collected for 3 months following each assessment and the mean weekly hours were calculated. Data were analysed using a decision tree analysis, whereby mean hours of weekly home‐care was the dependent variable with responses from the assessment tools, the independent variables. A total of three main groups were developed from the interRAI‐CA, each one further classified into “stable” or “flexible.” The classification explained 16% of formal home‐care service hour variability. Analysis of the interRAI‐HC generated 33 clusters, organised through eight disability “sub” groups and five “lead” groups. The groupings explained 24% of formal home‐care services hour variance. Adopting a Casemix system within home‐care services can facilitate a more appropriate response to the changing needs of older people.