Development and test of an extendable endoprosthesis for bone reconstruction in the leg

Chemical contamination in the environment is affecting public health in increasing numbers of communities across the country. Although historically and theoretically well within the realm of nursing, methods for assessing and diagnosing threats to community environmental health are not being included in community health nurses' training. A community's environmental health is assessed by retrieving information from federal, state, and local sources. Developing the diagnosis involves four steps: identifying a community aggregate at highest risk of exposure, determining the potential or actual health response, citing related host and environmental factors, and correlating any existing epidemiologic data that may substantiate the nursing diagnosis. To illustrate these concepts, a systematic environmental health assessment was conducted for Douglas, Arizona. The results indicated elevated lead levels in residential soils and led to the community diagnosis, potential for injury: children in Douglas are at risk of developing adverse neurobehavioral health effects, and pregnant women in Douglas are at risk of developing adverse reproductive health effects related to several environmental and host factors, as evidenced by average blood lead level, in children exceeding the Centers for Disease Control recommended level of 10 micrograms/dl.     

Consulting in occupational health nursing. An overview

1. The term consultant is defined as anyone who provides professional advice or services, which may include internal and external consultants. Consulting is a challenging way to practice occupational health nursing. 2. The consulting process involves problem solving and the creation of change. This process may be illustrated by using the nursing process and the steps of assessment, analysis, planning, implementation, and evaluation. 3. Successful occupational health nursing consultants are excellent communicators, are willing to market themselves, love problem solving, and are self starters.     

Health promotion and education: a diagnosis of sanitation conditions using participatory research and community education (S?o Jo?o dos Queiróz - Quixadá/Ceará, Brazil)

This study was conducted in a rural community, S?o Jo?o dos Queiróz, a township in the county of Quixadá, Ceará, Brazil, using a combination of participatory research and community education in compliance with the health promotion reference and principles of the 1986 Ottawa Charter. The project was joined by representatives of several local government institutions and organizations from the grassroots community movement. The theme generating the research, as defined by an assembly meeting of the community association, was a diagnosis of sanitation conditions in the community. The starting point was the assessment of local conditions. Results showed adverse local conditions in sanitation, literacy, income, and employment. Suggestions for solving the problems were organized so as to be included in the planning agenda for local health policies. Evaluation was procedural and enriched with daily research activities. The problem-solving pedagogical approach developed during the educational process contributed to a critical reconstruction, appropriation, and sharing of the resulting knowledge.     

Population-based needs assessment. Bringing public health to midwifery practice

Midwives are accustomed to individualizing their care of women on the basis of an assessment of each client's health status. By expanding their focus of care to encompass treatment of a population group, midwives and other providers can adopt a public health perspective through use of a community needs assessment. The first steps in diagnosing and treating the health problems of a group require the same rigorous and systematic examination of health indicators as does treatment of an individual. This article outlines the needs assessment process, identifies basic sources of information, and describes ways in which results can be presented.     

Nurses' involvement in interdisciplinary team evaluations: incorporating the family perspective into child assessment

An expanded nursing role in interdisciplinary team evaluations of children with special needs would include seeking the family's perspective in a systematic yet sensitive way. Nursing's background in family and child health can offer valuable insight. This article reviews family nursing assessment categories, reframes them for use in assessing the family's perspective in relation to the child's health and educational needs, and presents a systematic integrated history and assessment format for gathering child and family data. This approach promotes family collaboration in understanding family, child health, and educational issues. The holistic understanding gained by the school nurse through this systematic process enhances insight in interdisciplinary team planning. The nursing written report with preliminary conclusions facilitates an organized presentation of data, setting the stage for family and interdisciplinary team mutual exploration of options and facilitating greater likelihood of successful outcomes.     

Community analysis for health planning: strategies for primary care practitioners

Primary care practitioners have an important role in planning for the health of individuals and selected target populations. Community analysis and needs assessment are the first steps in health planning. Community analysis involves identifying health issues within a community; gathering data about the community, the target group, and the health concern; analyzing data; and assessing community needs. Community needs assessment involves identifying both existing and potential health problems as well as health promotion needs. By using appropriate skills in carrying out needs assessments, primary care practitioners become active contributors in planning for the health of individuals, groups, and the nation as a whole. This article provides strategies for identifying, analyzing, and evaluating the health needs of a community.     

The concept and potentials of cardiovascular gene therapy

TOPIC: A nursing theory framework for teaching health assessment. PURPOSE: To improve teaching of health assessment and nursing process to beginning-level baccalaureate nursing students. SOURCES: The Assessment and Analysis Guideline Tool, published and unpublished literature, personal observation, and faculty feedback were used in tool development. CONCLUSIONS: Faculty concluded that students who could envision the connection of the Neuman Systems Model and NANDA nursing diagnoses through the nursing process would be better able to understand the nursing model and choose appropriate nursing diagnoses for client care.     

Promoting autonomy and independence for older people within nursing practice: a literature review

The principles of promoting autonomy and independence underpin many approaches to improving the quality of nursing care for older people in whatever setting, and are in line with wider developments in health care such as the Patient's Charter. However, these concepts require careful definition if nursing practices which might promote autonomy and independence are to be identified. Although the generalizability of the research-based literature in this field is limited by a focus upon older people in continuing-care settings, a review of the literature found a number of indicators associated with attempts to promote patient autonomy and independence. These were grouped into the following categories: systems of care delivery which promote comprehensive individualized assessment and multidisciplinary care planning; attempts to encourage patients/clients to participate in decisions about their care; patterns of communication which avoid exerting power and control over patients/clients and attempts to modify the environment to promote independence and minimize risk. It is suggested that the review identifies a number of principles for nursing practice which can be applied in a range of care settings in order to promote the autonomy and independence of older people.     

Thyroxine and triiodothyronine levels in hyperthyroid patients during treatment with propranolol

In the last few years, there has been an active effort in Italy to involve the population in solving health problems at the community level. This movement had its origin in the industrial setting, where workers succeeded in promoting legislation which gives them control over matters affecting their health. This experience lead to the development of a health education methodology based on the following principles: (a) the assessment of health needs must be based on the subjective experience of the people who have acquired knowledge and interest in health problems; (b) the evaluation of health needs by professionals serves to complement and integrate the assessment of needs as experienced by the community; (c) the self-diagnosis of the community -- in particular of homogenous community groups exposed to similar health risks and experiencing the same needs--and the diagnosis of the professionals must undergo cross-validation and be accepted by both parties; (d) on the basis of this mutual agreement, community health programmes should be planned and carried out jointly by the professionals and the people.     

Going home: community reentry of light care nursing facility residents age 65 and over

Issues of consumer choice, and rising public expenditures of nursing facility care for the rapidly increasing elderly population have fueled interest in community reentry of nursing facility residents. The Minimum Data Set Plus (MDS+) contains a wealth of information which can be used to provide a better understanding of nursing facility residents including those who discharge. This study employs the Andersen model of health services utilization and logistical regression on MDS+ data to examine characteristics of higher functioning nursing facility residents age 65 and over related to community reentry in one midwestern state. Findings include having Medicaid as a payer source significantly decreased the likelihood of discharge. In contrast, being younger than 85, retaining decision making responsibilities, and having no cognitive impairments were found to increase the likelihood of discharge. Policy and program implications related to identifying and assisting nursing facility residents in resuming community living are discussed.     

Moving into the information era: does the current nursing paradigm still hold?

The transition into the information era is characterized by society's passage through three crossroads representing a change from: (a) technology to post-technology; (b) rigid jobs and hierarchies to dejobbing and vanishing hierarchies; and (c) limited competition to competition dominating all markets. These transitions have caused dramatic changes in the health care system at large and escalating problems that cannot be solved within the current paradigm of nursing. Among the nursing problems that were identified are those including difficulties in: (a) defining the relative contribution of nursing vis a vis other health professions; (b) the scope and dimensions of nursing authority; (c) implementing all aspects of the nursing intervention; (d) actualizing caring in nursing intervention; and (f) implementing the nursing process as a major thinking process in the profession. The analysis of the state of nursing suggests that the current clinical paradigm fails to consolidate the economic and quality issues into the core of nursing. It is not capable of solving central professional problems and emerging dilemmas. Considering that under the current paradigm, nursing has difficulties in highlighting to clients and the system alike where nursing can make a difference, it is questionable whether such a paradigm can ensure the existence of nursing in the future.     

Health education lessons learned: the H.A.P.I. Kids Program

Challenges exist for effective health communication and health education within diverse populations of the United States. This article addresses the development process for educational materials and lessons learned from the Healthy Asian and Pacific Islander (H.A.P.I.) Kids Program, a vaccination demonstration project funded by the Centers for Disease Control and Prevention to promote catch-up hepatitis B vaccination for older American Asian and Pacific Islander children. Simplicity and a common message were incorporated in multiple strategies to disseminate information to a diverse population. Community representatives from the Cambodian, Hmong, Filipino, Lao, and Vietnamese communities were instrumental in the material development process, which included needs assessment, design, and translation. By making the target community part of the development process, important health messages can be disseminated effectively, carrying great impact to an otherwise hard-to-reach community.     

Advanced practice nursing in community: nursing's opportunity

This article explicates the concept of community as the relational processes that constitute a coming togetherness and explores the role of advanced practice nursing in community. Community as process and health as process are described from the theoretical perspectives of Parse's nursing theory of human becoming and Newman's theory of health as expanding consciousness. Advanced practice nurses, in engaging with community, participate in a nurse-person-community-health process. This engagement occurs in the reality of managed health care. The focus of advanced practice nursing in community is health, wholeness, and quality of life. To participate with presence in the nurse-person-community-health process is viewed as nursing's opportunity.     

Rebuilding community and regional collaboration: the Kingsport, Tennessee experience

BACKGROUND: In 1988, business, health care, and community leaders in Kingsport, Tennessee, initiated the Kingsport Area Health Improvement Project (KAHIP) to improve the health status of local citizens. KAHIP's efforts continued to move, albeit slowly, until late 1993, when managed care organizations began to deselect hospitals and physicians and competition began to overcome hopes for collaboration. In 1994 KAHIP and other community leaders reaffirmed seven principles, including the need for continued dialogue and collaboration. By early 1998 ten community improvement teams were functioning, six chartered by KAHIP. MATURE PROJECTS: Four established projects have continued to expand either in scope or through institutionalization in the community or both, including Drive Smart, a collaborative learning project concerned with reducing preventable injuries and death among youth from motor vehicle crashes, and the Network of Employers for Traffic Safety, a public-private partnership dedicated to reducing the number of deaths and injuries in the workforce. NEW TEAMS: Four other teams are operating in Kingsport. One, the Kingsport Community Alliance Linking Enforcement, Responsibility and Treatment (ALERT), is dedicated to reducing the impact of substance abuse. Another, the Community Database Team, works on developing a database focused on community health status information. LESSONS LEARNED: In a community with widespread knowledge of continuous improvement philosophy and techniques, it makes sense to encourage other agencies to take the initiative and the credit and not worry about whether a specific process is adopted. The role of the public health system in health assessment, policy assessment, and quality improvement in an era of managed care and reduced government should be encouraged.     

Incident Causation Model for Improving Feedback of Safety Knowledge

In order for the construction industry to improve its poor safety performance it needs to learn from its mistakes and put the lessons learned to good use. This need calls for effective feedback mechanisms that can transmit information derived from incident investigation to be utilized in safety planning. The feedback should be at two levels; first, feedback to the Safety Management System that had failed, and second, feedback to the safety planning of future projects. The first level of feedback can be achieved by basing the investigation on an incident investigation model that explicitly identifies system failure. The second level of feedback can be achieved if both incident investigation and safety planning share the same incident causation model, such that the information from each process can be retrieved and utilized in the other process smoothly. One prerequisite to fulfill the two levels of feedback is the development of an incident causation model. In this paper, the modified loss causation model (MLCM), which is able to meet the above-mentioned purposes, will be presented. The MLCM is developed based on an extensive literature review and application on 140 actual accident cases obtained from Singapore’s Ministry of Manpower, Occupational Safety Department. In this paper, the model’s application will be demonstrated through a case study, which involves codification of investigation information based on an actual incident report, and a safety planning process based on a hypothetical case.     

Psychology 2: message received and understood?

Human beings judge and make sense of their surroundings in two ways. Sensory organs supply information to the brain where it is processed and interpreted according to the idiosyncrasies of that individual's personality and experiences. Perception is the active process which integrates and coordinates these activities. Hence, any sensory message can be received and/or understood quite differently depending on the individual concerned. This article outlines how a knowledge of psychology can assist in the understanding of human perception, and how this can be applied to a wide range of nursing care settings and applications. The psychology of perception is of particular relevance to areas such as patient/client assessment, skilled communication, teaching and the provision of health education.