Forecasting climate change impacts on the distribution of wetland habitat in the Midwestern United states.

Shifting precipitation patterns brought on by climate change threaten to alter the future distribution of wetlands. We developed a set of models to understand the role climate plays in determining wetland formation on a landscape scale and to forecast changes in wetland distribution for the Midwestern United States. These models combined 35 climate variables with 21 geographic and anthropogenic factors thought to encapsulate other major drivers of wetland distribution for the Midwest. All models successfully recreated a majority of the variation in current wetland area within the Midwest, and showed that wetland area was significantly associated with climate, even when controlling for landscape context. Inferential (linear) models identified a consistent negative association between wetland area and isothermality. This is likely the result of regular inundation in areas where precipitation accumulates as snow, then melts faster than drainage capacity. Moisture index seasonality was identified as a key factor distinguishing between emergent and forested wetland types, where forested wetland area at the landscape scale is associated with a greater seasonal variation in water table depth. Forecasting models (neural networks) predicted an increase in potential wetland area in the coming century, with areas conducive to forested wetland formation expanding more rapidly than areas conducive to emergent wetlands. Local cluster analyses identified Iowa and Northeastern Missouri as areas of anticipated wetland expansion, indicating both a risk to crop production within the Midwest Corn Belt and an opportunity for wetland conservation, while Northern Minnesota and Michigan are potentially at risk of wetland losses under a future climate.

A framework for addressing the global obesity epidemic locally: the Child Health Ecological Surveillance System (CHESS).

Childhood obesity has reached epidemic levels in the developed world. Recent research and commentary suggest that an ecological approach is required to address childhood obesity, given the multidimensional nature of the problem. We propose a Canadian prototype, the Child Health Ecological Surveillance System, for a regional health authority to address the growing obesity epidemic. This prototype could potentially be used in other jurisdictions to address other child health issues. We present 8 guiding principles for the development and implementation of a regional framework for action.

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada.

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational "will" to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational "will", while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action.

Organizational leadership and its relationship to regional health authority actions to promote health.

PURPOSE: The purpose of this paper is to examine organizational leadership and its relationship to regional health authority actions to promote health. DESIGN/METHODOLOGY/APPROACH: Through use of four previously developed measures of Perceived Organizational Leadership for Health Promotion, this paper focused on leadership as a distributed entity within regional health authority (RHA) jurisdictions mandated to address the health of the population in the province of Alberta, Canada. FINDINGS: First, examination of differentials between organizational levels (i.e. board members, n = 30; middle/senior management, n = 58; and service providers, n = 56) on ratings of the four leadership measures revealed significant differences. That is, board members tended to rate leadership components significantly higher than service providers and middle/senior managers: from across all 17 RHAs; and in low health promotion capacity and high health promotion capacity RHAs. Second, regression analyses identified that the leadership measures "Practices for Organizational Learning" and "Wellness Planning" were positively associated with health authority actions on improving population heart health (heart health promotion). The presence of a "Champion for Heart Health Promotion" and the leadership measures "Workplace Milieu" and "Organization Member Development" were also positively associated with health authority actions for health promotion. A subsidiary aim revealed low to moderate positive relationships of the dimensions of Leadership, Infrastructure and Will to Act with one another, as proposed by the Alberta Model on "Organizational Capacity Building for Health Promotion." ORIGINALITY/VALUE: This paper, conducted on the baseline dataset (n = 144) of the "Alberta Heart Health Project's Dissemination Phase", represents a rare effort to examine leadership at a collective organizational level.

Developing guidelines for syringe driver management.

The aim of this project was to develop clinical practice guidelines for the use and administration of pharmacological agents for symptom control via syringe drivers within Australia. By developing evidence-based clinical practice guidelines for the use of this common device, this project aimed to improve patient outcomes, reduce practice variation, minimize errors and encourage more efficient use of resources. A literature review identified current literature regarding syringe driver management and an expert panel was assembled to assist in the development of the guidelines. The development of these practice guidelines provides an example of how palliative care practitioners can use a framework of contemporary evidence to enhance clinical practice.

Development of measures of organizational leadership for health promotion.

This study describes the development and psychometric evaluation of four scales measuring leadership for health promotion at an organizational level in the baseline survey (n=144) of the Alberta Heart Health Project. Content validity was established through a series of focus groups and expert opinion appraisals, pilot testing of a draft based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative, and the literature. Psychometric analyses provided empirical evidence of the construct validity and reliability of the organizational leadership scales. Principal component analysis verified the unidimensionality of the leadership scales of (a) Practices for Organizational Learning, (b) Wellness Planning, (c) Workplace Climate, and (d) Organization Member Development. Scale alpha coefficients ranged between .79 and .91 thus establishing good to high scale internal consistencies. These measures can be used by both researchers and practitioners for the assessment of organizational leadership for health promotion and heart health promotion.

Development of measures of individual leadership for health promotion.

PURPOSE: This purpose of this research was to develop and establish psychometric properties of scales measuring individual leadership for health promotion. DESIGN/METHODOLOGY/APPROACH: Scales to measure leadership in health promotion were drafted based on capacity assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative (CHHI), and on the literature. Content validity was established through a series of focus groups and expert opinion appraisals and pilot testing. Psychometric analyses provided empirical evidence of the construct validity and reliability of the leadership scales in the baseline survey (n = 144) of the Alberta Heart Health Project. FINDINGS: Principal component analysis verified the construct of the leadership scales of personal work-related practices and satisfaction with work-related practices. Each of the theoretically a prior determined scales factored into two scales each for a total of four final scales. Scale alpha coefficients (Cronbach's alpha) ranged between 0.71 and 0.78, thus establishing good scale internal consistencies. RESEARCH LIMITATIONS/IMPLICATIONS: Limitations include the relatively small sample size used in determining psychometric properties. In addition, further qualitative work would enhance understanding of the complexity of leadership in health organizations. These measures can be used by both researchers and practitioners for the assessment leadership for health promotion and to tailor interventions to increase leadership for health promotion in health organizations. ORIGINALITY/VALUE: Establishing the psychometric properties and quality of leadership measures is an innovative step toward achieving capacity assessment instruments which facilitate evaluation of key relationships in developing health sector capacity for health promotion.

Cancer nursing research in Queensland, Australia: barriers, priorities, and strategies for progress.

Nursing research is an integral component of improving the care of people with cancer; however, the literature suggests that many organizational, resource, and attitudinal barriers to research remain. The aim of the present study was to systematically describe the research experience, attitudes, and opinions of nurses in Queensland, Australia, about priorities and strategies for developing cancer nursing research. A mail survey was sent to all 589 members of the Oncology Nurses Group of Queensland to assess their research knowledge, experience, and attitudes. A response rate of 54.2% (319 nurses) was obtained. Results suggest that many nurses in this study have access to and are reading available research regularly. However, many nurses reported only limited education and skills in research, scarce resources, and limited time to participate in research. Few nurses were involved in developing research proposals, were presenting at conferences, or were writing for publication. Despite these constraints, most of the sample indicated high levels of interest in participating in conducting research. Furthermore, most nurses in this study viewed research as important to patient care and as being an important role for clinical nurses. The top 3 priority areas for cancer nursing research were identified as psychosocial support, pain management, and symptom management. Specific strategies identified for developing nursing research included providing information, support, mentorship, and resources. Professional groups were viewed as having an important role in the development of nursing research in education, lobbying, and facilitating networking among researchers.

Oncology/haematology nurses: a study of job satisfaction, burnout, and intention to leave the specialty.

The impact of the current nursing shortage on the health care system is receiving attention by both state and federal governments. This study, using a convenience sample of 243 oncology/haematology nurses working in 11 Queensland health care facilities, explored factors that influence the quality of nurses' working lives. Although nurses reported high levels of personal satisfaction and personal accomplishment, results indicated that nearly 40% of registered nurses (RNs) are dealing with workloads they perceive excessive, 48% are dissatisfied regarding pay, and professional support is an issue. Furthermore, emotional exhaustion is a very real concern: over 70% of the sample experienced moderate to high levels. Over 48% of the sample could not commit to remaining in the specialty for a further 12 months. Health care managers and governments should implement strategies that can increase nurses' job satisfaction and reduce burnout, thereby enhancing the retention of oncology/haematology nurses.

Understanding the optimal learning environment in palliative care.

The learning experiences of student nurses undertaking clinical placement are reported widely, however little is known about the learning experiences of health professionals undertaking continuing professional development (CPD) in a clinical setting, especially in palliative care. The aim of this study, which was conducted as part of the national evaluation of a professional development program involving clinical attachments with palliative care services (The Program of Experience in the Palliative Approach [PEPA]), was to explore factors influencing the learning experiences of participants over time. Thirteen semi-structured, one-to-one telephone interviews were conducted with five participants throughout their PEPA experience. The analysis was informed by the traditions of adult, social and psychological learning theories and relevant literature. The participants' learning was enhanced by engaging interactively with host site staff and patients, and by the validation of their personal and professional life experiences together with the reciprocation of their knowledge with host site staff. Self-directed learning strategies maximised the participants' learning outcomes. Inclusion in team activities aided the participants to feel accepted within the host site. Personal interactions with host site staff and patients shaped this social/cultural environment of the host site. Optimal learning was promoted when participants were actively engaged, felt accepted and supported by, and experienced positive interpersonal interactions with, the host site staff.

Towards the development of scales to measure 'will' to promote heart health within health organizations in Canada.

This paper describes the development and psychometric evaluation of scales measuring the dimensions of 'will' (belief, confidence, prior action and desire) for heart health promotion specifically and health promotion in general at both an individual and organizational level. Content validity was established through a series of focus groups and expert opinion assessments, based on a compilation of capacity-assessment instruments developed by other provinces involved in the Canadian Heart Health Initiative and the literature. Psychometric analyses of questionnaire data provided empirical evidence of the construct validity and reliability of the 16 individual and 21 organizational level 'will' scales. A series of principal component analyses assisted in verifying the unidimensionality of the measures and all scales yielded high internal consistencies with Cronbach's alpha coefficients ranging between 0.73 and 0.96. These measures can be used by both researchers and practitioners for assessing the 'will' to promote heart health specifically and health promotion in general.

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta s regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior middle managers and service providers from 17 RHAs participating in a five year time series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational will to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational will, while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action. (AU)