Health Service Environment Research Articles

Ethnicity and Clinical Psychiatric Diagnosis in Childhood

This paper focuses on whether a consistent difference by ethnicity existed in the clinical diagnosis of children and adolescents in two behavioral health service environments and reviews plausible explanations for such a difference. Key measures were clinical diagnosis and ethnicity, abstracted from the administrative dataset of a New Jersey behavioral health care organization during 2000-2002, and a data collection conducted for the State of Indiana during 1991-1992. Sample sizes were 5,394 and 10,437, respectively. Only primary diagnoses were used in this study, classified into externalizing versus internalizing disorders. Logistic regression was performed for the dependent variable of presence/absence of an externalizing disorder or internalizing disorder. A main effect for ethnicity was found; African American youth received more externalizing diagnoses than did European American youth (odds ratio 2.01 (CI: 1.73-2.33) in one sample and 1.67 (CI: 1.44-1.94) in the other); African American youth also received fewer internalizing diagnoses than European American youth (odds ratio 0.55 (CI: .48-.63) in one sample and 0.75 (CI:.64-.88) in the other. Potential explanations for these findings include: 1. Biopsychosocial origin; 2. Clinician bias; 3. Discordant normative behavioral expectations between parents and service providers; and 4. Interaction between differential expression of underlying pathology and tolerance for such expressions.

Marketing and health libraries

To present an overview of the concepts of marketing and to examine ways in which they can be applied to health libraries. A review was carried out of literature relating to health libraries using LISA, CINAHL, BNI and Google. Marketing is seen as a strategic management activity aimed at developing customer relationships. Concepts such as the 'four Ps' (product, price, place and promotion), marketing plans, the marketing mix, segmentation, promotion and evaluation are identified and discussed in relation to health libraries. In increasingly complex health service and information environments, the marketing and promotion of library services is becoming more important if those services are to justify the resources given to them. Marketing techniques are equally applicable to physical and digital library services.

A differentiated practice model for school nursing.

School nursing is notable for autonomous practice and independent decision-making. School nurses practice within a complex school health services environment that is subject to constant change, the influence of multiple stakeholders, and a chronic state of uncertain resources. Other professional challenges faced by school nurses are a lack of standardized entry education requirement, inadequate theoretical research with practice application, and expanding role responsibilities. Administrative restructuring of school nursing services using a differentiated practice model could be a method to address the challenges of school nurse practice. A model of differentiated school nursing practice is proposed as a starting point for the national school nurse audience to consider this alternative to the master's entry requirement. School nurse role responsibilities are divided among three levels of practitioners: generalist, master's prepared, and school nurse policy analyst. Each level features an increased scope of responsibility based on higher educational attainment. Research regarding how differentiated practice has been implemented in other health care settings is described. Implications for the implementation of differentiated practice in school health services are discussed, including the need for cooperation among stakeholders, possible cost considerations, and how school nurse education might be affected.

Technology training.

A new 'academy' has been launched to train NHS leaders, including nurses, midwives and health visitors, in using new technology emerging under the national IT programme. You can find details at www.dh.gov.uk/PolicyAndGuidance/InformationTechnology/ NationalITProgramme/fs/en Work is under way to design a range of leadership support resources, including simulated health service environments such as hospital wards and GP surgeries with actors as patients, to introduce clinicians to the new systems.

The influence of the social environment on the health of Manitoba First Nations communities

Objectives. While much attention is paid to the importance of a First Nations community environment to the health of First Nations people, no research has assessed the health promoting and health damaging characteristics of First Nation communities. This study is the first to employ a multilevel approach to understanding the social determinants of health risk (smoking drinking problems, weight problems), health status (self rated health, suicide thoughts, diabetes, hypertension), and preventative health practices (regular physician and blood pressure check-up) in First Nations communities. The objective of the study is to determine if the social, cultural, geographic, economic, health status, health risk factor, and health service environment of First Nations communities independently influence the health of First Nations peoples.

Need for and use of mental health services among parents of children in the head start program.

This study examined the prevalence of psychosocial difficulties and use of mental health services among 290 parents of children in the Head Start program. Data on demographic characteristics, child behavior problems, parents' difficulties, home environment, child behavior, and use of health services were collected. A total of 161 parents (56 percent) had identifiable psychosocial difficulties, and 41 (14 percent) reported use of mental health services in the previous 12 months. Child behavior problems, unmet need for mental and physical health services, and less optimal home environments were associated with parents' psychosocial difficulties. Parents who had an unmet need for mental health services were more likely to report behavior problems among their children.

Leadership: a new perspective.

This overview article aimed at outlining the image of an effective future-orientated nurse leader in the health care context through a pragmatic approach. The future nurse leaders on different levels in health care institutions is challenged in the current health care environment of culturally diverse countries, such as South Africa. This article should make all nursing leaders more aware of their important role in taking the lead in challenges faced in the current health service environment. Leaders have the essentials of authority, power and influence to lead followers to their goals. The use of these essentials has changes from the past, to the present and into the future health care environment. Different changes and challenges are facing nurse leaders and they need to implement an effective leadership style in a complex health care environment. This overview article focuses on key elements of an effective future leader using a conceptual framework as departure, incorporating relevant literature. It analyses and evaluates the efficiency of past and present roles of authority, power and influence in leadership and summarizes a new perspective of a future nurse leader. Solutions and future actions are indicated for the future role of the nurse leader. The past, present and future leadership setting, role of authority, power and influence in leadership, components of the arch of leadership and solutions to effective leadership in a future dimension is all domains that is presented with the intention of motivating future nurse leaders. It was identified that a different kind of leader should emerge to lead in a new way, different from those leadership styles that we have known in the past. The 21st century is a new timeframe and different timeframes demand different leadership approaches.

Rural practitioners as researchers: The Spencer Gulf experience of research development in primary health

In a health service environment that is becoming more focussed on primary health care, there is a need to underpin new primary health care models with research evidence. This paper draws on the experience of the Spencer Gulf Rural Health School in developing rural primary health care practitioners and consumers as novice researchers. Through the experience of seed-funding 18 novice researchers, several themes have emerged that underpin the success of the program. These are described as establishing a spirit of inquiry, using a broad definition of primary health care research, supporting inquiry with resources and recognition, and demystifying the research process. The value of this research development program is that it has brought research opportunities and supports to rural practitioners and consumers that were not previously available.

A Differentiated Practice Model for School Nursing

School nursing is notable for autonomous practice and independent decision-making. School nurses practice within a complex school health services environment that is subject to constant change, the influence of multiple stakeholders, and a chronic state of uncertain resources. Other professional challenges faced by school nurses are a lack of standardized entry education requirement, inadequate theoretical research with practice application, and expanding role responsibilities. Administrative restructuring of school nursing services using a differentiated practice model could be a method to address the challenges of school nurse practice. A model of differentiated school nursing practice is proposed as a starting point for the national school nurse audience to consider this alternative to the master's entry requirement. School nurse role responsibilities are divided among three levels of practitioners: generalist, master's prepared, and school nurse policy analyst. Each level features an increased scope of responsibility based on higher educational attainment. Research regarding how differentiated practice has been implemented in other health care settings is described. Implications for the implementation of differentiated practice in school health services are discussed, including the need for cooperation among stakeholders, possible cost considerations, and how school nurse education might be affected.

Reconceptualising the objectives of a pilot study for clinical research

This is a methodological study in which a case report is used to retrospectively analyse the link between a successful pilot study and stalled main study to identify potential methodological weaknesses in the planning process. The analysis identified unanticipated influences related to hospital processes and discipline boundaries that adversely influenced participant recruitment and retention for a clinical trial. The findings of the study demonstrate that, whilst the pilot is an important step in research planning to confirm the design and operational processes for a study, a thorough analysis of the relevant health service environment is an important additional objective for the pilot study.

Statistical results of an analysis of the physiotherapy departments in the Johannesburg hospital

The health services environment in South Africa has changeddramatically during the past five years especially for state-funded hospitals in the public sector. At the Johannesburg Hospital the admission of chronic patients has increased considerably over the past five years, thus increasing the workload for the physiotherapists. In spite of the increased workload of physiotherapists the staff complement of the Physiotherapy Department has decreased from forty-one to eighteen staff members due to severe budget constraints. The radical cuts to the staffing structure prompted this investigation. This article describes the results obtained from statistical analyses of time sheets completed by the staff over a six-month period to determine whether the staff complement was adequate.The approach followed with the statistical analysis was to use confidence intervals to compare the standard treatment times with the actual treatment times. Hypothesis testing was used to determine whether it would be possible to standardise treatment times for similar treatments in different treatment areas. The required capacity was calculated based on the amount of time spent on direct patient care by the physiotherapists during the six-month period.

Statistical Results of an Analysis of the Physiotherapy Department in the Johannesburg Hospital

The health services environment in South Africa has changed dramatically during the past five years especially for state-funded hospitals in the public sector. At the Johannesburg Hospital the admission of chronic patients has increased considerably over the past five years, thus increasing the workload for the physiotherapists. In spite of the increased workload of physiotherapists the staff complement of the Physiotherapy Department has decreased from forty-one to eighteen staff members due to severe budget constraints. The radical cuts to the staffing structure prompted this investigation. This article describes the results obtained from statistical analyses of time sheets completed by the staff over a six-month period to determine whether the staff complement was adequate. The approach followed with the statistical analysis was to use confidence intervals to compare the standard treatment times with the actual treatment times. Hypothesis testing was used to determine whether it would be possible to standardise treatment times for similar treatments in different treatment areas. The required capacity was calculatedbased on the amount of time spent on direct patient care by the physiotherapists during the six-month period.

Contemporary child health nursing practice: services provided and challenges faced in metropolitan and outer Brisbane areas

This paper describes the findings of a qualitative study that sought to identify the changing role of the child health nurse within the contemporary health service environment. Using a case study design, a picture of contemporary child health nursing services in Brisbane and surrounding areas was established. Contemporary services include both individual consultations with mothers and their children, group education sessions, parent management clinics, and parenting programs. These contemporary services represent a significant shift in focus from original infant welfare services established in the early 20th century, but are also similar in their aim of providing education and support for women and their families in the community setting.

Quality of School Health Services and Healthy School Environment in some Settings in Egypt

Quality of School Health Services and Healthy School Environment in some Settings in Egypt

"A little encouragement": health services and domestic violence.

The aim of this study was to identify those elements of health care which women who have experienced domestic violence consider to represent quality care and explore opportunities for an area health service to improve its service delivery to these women. To do this nine focus groups were conducted with six urban and three rural groups, recruited from Women's Support Services and Refuges, and 65 women participated. A trained facilitator conducted the focus groups with a representative from each participating organisation. Audiotapes were transcribed then coded using a thematic analysis approach. Analysis of the tapes revealed six opportunities for improvement of health services. Improve services to Aboriginal women; increase access to services; promote available services; improve the health service environment; educate service providers; and provide specialist health services. A major theme to emerge was the importance of a supportive environment where women were supported to make choices for their future.

The Italian Health Care Reform Experience: Which Role for Nursing?

During the 1990s, several reforms were initiated in the Italian Health Care System that were aimed at introducing a managerial culture into the health services environment, similar to what the United States, Great Britain, and other European countries had already done. Thus, health care delivery experienced several changes yielding a higher quality of care, more services for the elderly, and the availability of new technologies. To face the new sociological values and the new demand for health care services, the role of the nursing staff has become crucial. In consideration, therefore, of the principles of personalization, efficiency, quality, and humanization stemming from the reforms of the National Health Care System, the role of the nursing staff must be strengthened. This article, in light of the theories of public sector management and case analysis, aims at describing Italian nursing in the evolutionary sense, pointing out key factors for a successful collaboration with other health care actors.

"Operation Sick Bay": an opportunity for community service learning.

"Operation Sick Bay" was the inspiration of the 3 full-time nurses at Framingham High School, which has a population of 1,800 students and 300 teachers and staff. The primary focus of Operation Sick Bay was to create a health services environment conductive to learning about health and illness, developing lifetime skills in self-help and self-care, providing a restful atmosphere, and involving students and staff in taking pride in their school health services center. The "sick bays" are small units with privacy curtain closures used for students who need to lie down because of illness. There are 3 bays for female students and 3 for male students. Instead of the usual cream-colored walls, the project provided the opportunity to create a colorful environment designed to provide health information to students.

Developing practice and evidence for counselling in primary care: The agenda

Counselling in primary care has developed rapidly over the last few years and now appears to be a widespread provision. Yet ad hoc , unregulated development, coupled with radical changes within the National Health Service environment, presents an array of challenges to continued development. This paper reviews and summarises the contributions of all the authors to this special symposium, and in so doing attempts to set out a development agenda for both evidence and practice as a practical yield from the rich insights and experiences offered.

IT, Change and evaluation: an overview of the role of evaluation in health services

Effective evaluation is important for appropriate deployment and use of information technology, especially in the current environment of changing health services. However, the broad range of roles and environments in which technology is used challenges traditional evaluation approaches. As technology has progressed, these roles have developed to the extent that information technology is now often playing a very complex role in health service organisations. In such cases there are many uncertainties in decisionmaking that are difficult to address with traditional formal evaluation techniques. There is a need to recognise and work with more complex, socially constructed decisionmaking process relying substantially on a variety of human judgements. The need for this recognition is demonstrated by exploring the difference in our ability to analyse a range of different systems, considering the role of complexity, uncertainty, theory, change and control. There is the need, then, for evaluation processes to complement these social decisionmaking processes, rather than to replace them. The nature of these processes needs to be effectively understood to enable the most appropriate types of evaluations to be undertaken. A number of different scenarios are explored to demonstrate the types of roles that evaluation may need to take.

Advanced Practice Nursing: Parameters for Successful Integration

This article analyzes advanced practice nursing roles through a literature review and a pilot stakeholder survey in relation to five strategic areas: (1) definitions and scope of practice; (2) education, credentialing and regulation; (3) new roles in healthcare; (4) costs and benefits in health reform; and (5) implementation and relationships. The Canadian health services environment is best served by a multifaceted APN role, defined by a nursing paradigm that invokes collaborative relationships with physicians, and education and credentialing that is based on national standardization.