A community partnership to respond to an outbreak: a model that can be replicated for future events.

THE PROBLEM: Nassau County Department of Health (NCDOH) found itself in the midst of the initial U.S. outbreak of the H1N1 influenza global pandemic. A coordinated, collaborative approach to address the outbreak was needed. Yet, a description of a multisector community partnership during an influenza pandemic has not been described in the literature. PURPOSE: This article reports the efforts taken by a local health department to partner with the community utilizing a three-phase model to communicate, plan, and implement a strategy to ease the fear that existed and to minimize the illness in the region. This article describes in detail critical components of the community wide partnership. Lessons learned from this event are highlighted which have implications for future public health policy. KEY POINTS: The key points to the article are that there are three critical phases to successful community partnership during an influenza outbreak: Communication, planning, and implementation. The learning points include that communication is paramount, creation of partnerships is vital to a successful implementation phase, and public health funds are leveraged more effectively by collaborating with community partners. CONCLUSION: The NCDOH's multisector partnership with hospitals, physicians, and community organizations to address the H1N1influenza pandemic was nontraditional and allowed for leveraging of public health resources. The three-phase model can be replicated for future infectious disease outbreaks.

A qualitative investigation of injurious falls in long-term care: perspectives of staff members.

PURPOSE: Although falls often result in serious injury among seniors residing in long-term care (LTC), there is a paucity of research about LTC staff perceptions about falls. Our purpose was to elicit opinions of LTC staff about falls and fall prevention given 'least restraint' policies. We also aimed to identify obstacles for optimal falls prevention. METHOD: Data were collected from administrators and a wide variety clinical staff (N = 98; 7 LTC facilities) using 11 focus groups and 28 interviews. Questions were asked about clinical practices related to falls. We employed thematic analysis to ascertain primary and secondary themes within the data. RESULTS: Participants viewed falls as a major challenge. They expressed concerns about their ability to control falls and manage consequences. Participants were conflicted about the role of restraints in falls management. Although they acknowledged beneficial effects of least restraint in terms of resident independence and increased activity, they also noted that in some instances, restraints may prevent falls, especially when individuals with dementia are considered. CONCLUSIONS: Participants were highly attentive to issues surrounding falls. However, many were unaware of clinically important findings from relevant research and misperceived fall-related (restraint) policies. Physical therapists have a role to play in education initiatives targeting these areas.

Creating bridges between researchers and long-term care homes to promote quality of life for residents.

Improving the quality of life for long-term care (LTC) residents is of vital importance. Researchers need to involve LTC staff in planning and implementing interventions to maximize the likelihood of success. The purposes of this study were to (a) identify barriers and facilitators of LTC homes' readiness to implement evidence-based interventions, and (b) develop strategies to facilitate their implementation. A mixed methods design was used, primarily driven by the qualitative method and supplemented by two smaller, embedded quantitative components. Data were collected from health care providers and administrators using 13 focus groups, 26 interviews, and two surveys. Findings revealed that participants appreciated being involved at early stages of the project, but receptiveness to implementing innovations was influenced by study characteristics and demands within their respective practice environment. Engaging staff at the planning stage facilitated effective communication and helped strategize implementation within the constraints of the system.

Diabetes in Japan: a review of disease burden and approaches to treatment.

In recent years there has been rapid growth in diabetes in Japan which now is one of the nations most affected by the worldwide diabetes epidemic. Diabetes has been identified as a healthcare priority by the Ministry of Health, Labour and Welfare (MHLW). Type 1 diabetes is rare in Japan, and type 2 diabetes predominates in both adults and children. The growth in diabetes is due to increases in the number of people with type 2 diabetes associated with increased longevity and lifestyle changes. Approximately 13.5% of the Japanese population now has either type 2 diabetes or impaired glucose tolerance. This high prevalence of type 2 diabetes is associated with a significant economic burden, with diabetes accounting for up to 6% of the total healthcare budget. The costs of diabetes are increased in patients with co-morbidities such as hypertension and hyperlipidaemia and in patients who develop complications, of which retinopathy has the highest cost. Costs increase with increasing number of complications. Current guidelines from the Japan Diabetes Society (JDS) recommend a target HbA(1c) of 6.5% for glycaemic control. This is achieved in approximately one third of patients with type 2 diabetes, and Japanese patients typically have lower HbA(1c) than patients in Western countries (e.g. US, UK). Japanese patients with type 2 diabetes have better adherence with diet and exercise recommendations than their peers in Western countries. Sulfonylureas have been the most widely prescribed first-line treatment for type 2 diabetes, although there is increasing use of combination therapy and of insulin.

United we stand: preparing nursing students for political activism.

Political activism for healthcare workers is a crucial complement to clinical practice. Nurses are in a unique position to not only provide bedside care but also to advocate for change within the political arena and the community at large. Preparing professional nurses for community-based practice involving political activism and civic engagement requires developing and sustaining a philosophy that supports service learning and community partnerships. The concepts of service, community, collaboration, empowerment, and political activism are essential foundations. These ideas are inherent in educationally preparing nurses to meet the healthcare needs of individuals and communities. Many nursing students, however, seem either intimidated by or uninterested in the political aspects of professional nursing practice. The authors will describe an educational strategy embedded in a senior capstone course that involves an account of a senior nursing class's first experience in political involvement.

Does service-learning increase cultural competency, critical thinking, and civic engagement?

To prepare for community engagement and partnerships with diverse communities, nursing students must understand the principles of service-learning, as well as the essential skills needed to work within a democracy. The purposes of these two pilot tests were to develop a 15-hour service-learning intervention; refine the 15-hour service-learning intervention; and explore whether participation in the intervention made a difference in the critical thinking, cultural competence, and civic engagement of nursing student participants. Although the sample was small (n = 14), results of paired t tests found that, after the intervention, critical thinking scores measured by the California Critical Thinking Disposition Inventory were significantly lower (t = -2.23, p = .04), particularly on the self-confidence subscale (t = 2.29, p = .039); cultural competence scores measured by the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals were significantly lower (t = 4.83, p = .000); and civic engagement scores significantly increased (t = -3.54, p = .004).

Nurturing nursing's future through nurse executive partnerships.

At a time when nurses are becoming an endangered species, nurse executives have a unique opportunity to respond by forging new and responsive relationships with graduate students who express interest in nursing administration and leadership as a preferred career choice. In this article, a case example demonstrates how a senior faculty member and a graduate student formed a partnership, conducted research, and nurtured an appreciation of the nurse educator role. Using this experience, senior nurse executives can too form partnerships with graduate students as a way to recruit into nursing leadership roles.

A practical approach to understanding risk of institutionalization in two Canadian cities: the Regina Risk Indicator Tool.

Appropriate utilization of long-term care resources is critical to sustainability. This article reports on the evaluation of the Regina Risk Indicator Tool conducted by the Calgary Health Region in 2000, including an overview of the tool evaluation and a summary of RRIT development within the Regina Health District. The RRIT has provided value to Calgary and Regina in matching client needs with appropriate community and facility-based services.