Community health: an evolutionary concept analysis

Health promotion roles shaped by professional identity: an ethnographic study in the Netherlands

How frontline care professionals interpret and fulfill their health promotion roles is of great importance for the health of the vulnerable clients they work with. While the literature on health promotion is limited to describing the roles of healthcare professionals, this study examines the health promotion roles held by various frontline professionals when working with clients with combined psychosocial problems and how this is associated with professional identity. Based on ethnographic data from Dutch frontline professionals in social welfare, general healthcare and mental healthcare, this article shows how various frontline professionals promote health by reframing and customizing health problems and that this is associated with how they identify as pragmatic or holistic professionals.

Conceptualising characteristics of resources withdrawal from medical services: a systematic qualitative synthesis

BACKGROUND

Terms used to describe government-led resource withdrawal from ineffective and unsafe medical services, including 'rationing' and 'disinvestment', have tended to be used interchangeably, despite having distinct characteristics. This lack of descriptive precision for arguably distinct terms contributes to the obscurity that hinders effective communication and the achievement of evidence-based decision-making. The objectives of this study are to (1) identify the various terms used to describe resource withdrawal and (2) propose definitions for the key or foundational terms, which includes a clear description of the unique characteristics of each.

METHODS

This is a systematic qualitative synthesis of characteristics and terms found through a search of the academic and grey literature. This approach involved identifying commonly used resource withdrawal terms, extracting data about resource withdrawal characteristics associated with each term and conducting a comparative analysis by categorising elements as antecedents, attributes or outcomes.

RESULTS

Findings from an analysis of 106 documents demonstrated that terms used to describe resource withdrawal are inconsistently defined and applied. The characteristics associated with these terms, mainly antecedents and attributes, are used interchangeably by many authors but are differentiated by others. Our analysis resulted in the development of a framework that organises these characteristics to demonstrate the unique attributes associated with each term. To enhance precision, these terms were classified as either policy options or patient health outcomes and refined definitions for rationing and disinvestment were developed. Rationing was defined as resource withdrawal that denies, on average, patient health benefits. Disinvestment was defined as resource withdrawal that results in, on average, improved or no change in health benefits.

CONCLUSION

Agreement on the definition of various resource withdrawal terms and their key characteristics is required for transparent government decision-making regarding medical service withdrawal. This systematic qualitative synthesis presents the proposed definitions of resource withdrawal terms that will promote consistency, benefit public policy dialogue and enhance the policy-making process for health systems.

Assessing the educational and support needs of nursing staff serving older adults: a case study of a community coalition/university partnership

Given the expected changes in demography and dependent care ratios, communities are preparing for the needs of older populations. Sometimes, communities form coalitions to address health-care needs. This case study evaluates a coalition/university partnership formed to assess the educational and support needs of nursing staff who are taking care of older adults across all service settings in one geographically defined community. A 17-member community-based coalition contracted with researchers from an external university to determine the perceptions of three key stakeholder groups: older adults and their families, all levels of nursing staff, and agency administrators. By applying principles of Participatory Action Research (PAR), this case study presents the challenges faced in the community-based coalition/university research team partnership. This coalition/research partnership is unique, differing from most academic examples of PAR because nursing professionals initiated the partnership.

Health coaching: a concept analysis

PURPOSE

Variations in the use of health coaching documented in the literature indicate a lack of conceptual clarity. The purpose of this article was to clarify the meaning of health coaching and propose an operational definition.

CONCLUSIONS

Seven attributes were identified and used to propose an operational definition of health coaching as a goal-oriented, client-centered partnership that is health-focused and occurs through a process of client enlightenment and empowerment.

PRACTICE IMPLICATION

This operational definition and the proposed empirical measures of each attribute can be used to validate the presence of health coaching, develop theory-based applications, and consistently test the effectiveness of interventions using this concept.

An integrative review of information systems and terminologies used in local health departments

OBJECTIVE

The purpose of this integrative review based on the published literature was to identify information systems currently being used by local health departments and to determine the extent to which standard terminology was used to communicate data, interventions, and outcomes to improve public health informatics at the local health department (LHD) level and better inform research, policy, and programs.

MATERIALS AND METHODS

Whittemore and Knafl's integrative review methodology was used. Data were obtained through key word searches of three publication databases and reference lists of retrieved articles and consulting with experts to identify landmark works. The final sample included 45 articles analyzed and synthesized using the matrix method.

RESULTS

The results indicated a wide array of information systems were used by LHDs and supported diverse functions aligned with five categories: administration; surveillance; health records; registries; and consumer resources. Detail regarding specific programs being used, location or extent of use, or effectiveness was lacking. The synthesis indicated evidence of growing interest in health information exchange groups, yet few studies described use of data standards or standard terminology in LHDs.

DISCUSSION

Research to address these gaps is needed to provide current, meaningful data that inform public health informatics research, policy, and initiatives at and across the LHD level.

CONCLUSIONS

Coordination at a state or national level is recommended to collect information efficiently about LHD information systems that will inform improvements while minimizing duplication of efforts and financial burden. Until this happens, efforts to strengthen LHD information systems and policies may be significantly challenged.

Tracking the route to sustainability: a service evaluation tool for an advance care planning model developed for community palliative care services

AIMS AND OBJECTIVES

The study aim was to develop a service evaluation tool for an advance care planning model implemented in community palliative care.

BACKGROUND

Internationally, advance care planning programmes usually measure success by completion rate of advance directives or plans. This outcome measure provides little information to assist nurse managers to embed advance care planning into usual care and measure their performance and quality over time. An evaluation tool was developed to address this need in Australian community palliative care services.

DESIGN

Multisite action research approach.

METHODS

Three community palliative care services located in Victoria, Australia, participated. Qualitative and quantitative data collection strategies were used to develop the Advance Care Planning-Service Evaluation Tool.

RESULTS

The Advance Care Planning-Service Evaluation Tool identified advance care planning progress over time across three stages of Establishment, Consolidation and Sustainability within previously established Model domains of governance, documentation, practice, education, quality improvement and community engagement. The tool was used by nurses either as a peer-assessment or self-assessment tool that assisted services to track their implementation progress as well as plan further change strategies.

CONCLUSION

The Advance Care Planning-Service Evaluation Tool was useful to nurse managers in community palliative care. It provided a clear outline of service progress, level of achievement and provided clear direction for planning future changes.

RELEVANCE TO CLINICAL PRACTICE

The Advance Care Planning-Service Evaluation Tool enables nurses in community palliative care to monitor, evaluate and plan quality improvement of their advance care planning model to improve end-of-life care. As the tool describes generic healthcare processes, there is potential transferability of the tool to other types of services.

Identifying barriers to mental health system improvements: an examination of community participation in assertive community treatment programs

Background

Integrating the best available evidence into program standards is essential if system-wide improvements in the delivery of community-based mental health services are to be achieved. Since the beginning of the Assertive Community Treatment (ACT) program movement, program standards have included a role for the community. In particular, ACT program standards have sought to ensure that members of the local community are involved in governance and that former clients participate in service delivery as "Peer Support Specialists". This paper reports on the extent to which ACT program standards related to community participation have been implemented and identifies barriers to full compliance.

Methods

Qualitative and quantitative data were collected through a telephone survey of ACT Program Coordinators in Ontario, Canada, using a census sample of the existing 66 ACT programs. A thematic approach to content analysis was used to analyze respondents' qualitative comments. Quantitative data were analyzed using SPSS 16.0 and included means, frequencies, independent t-tests and Pearson Correlations.

Results

An 85% response rate was achieved. Of the 33 program standards, the two that received the lowest perceived compliance ratings were the two standards directly concerning community participation. Specifically, the standard to have a functioning Community Advisory Body and the standard requiring the inclusion of a Peer Support Specialist. The three major themes that emerged from the survey data with respect to the barriers to fully implementing the Community Advisory Body were: external issues; standard related issues; and, organizational/structural related issues. The three major themes concerning barriers to implementing the Peer Support Specialist role were: human resource related issues; organizational/structural related issues; and, standard related issues.

Conclusions

The reasons for low compliance of ACT programs with community participation standards are complex and are tied to structural and human resources barriers (both internal and external to the ACT programs) as well as to the requirements of the standards themselves. In order for improvements to the mental health system to be achieved there is a need to identify and address these barriers. Failure to do so will result in less than optimal client, family and economic efficiency outcomes.

Turning mental health nursing problems into quality or research projects

Developing a researchable question or quality improvement project from a broad clinical problem is a key challenge for mental health nurses. In this paper, we provide an overview of some of the steps involved in proceeding from an initial ?problem? within a clinical setting to determining a research question with clear conceptual components that leads to appropriate methods to explore the topic or answer the question. The focus of the proposed quality or research study must be clear to clinicians and potential participants and meet professional responsibilities. Conducting high quality research and quality initiatives will likely improve care and outcomes for mental health consumers as well as providing a reliable evidence-based foundation for further improvements.