Building community and public health nursing capacity: a synthesis report of the National Community Health Nursing Study.

OBJECTIVES: 1) To describe the community health nursing workforce in Canada; 2) To compare, across political jurisdictions and community health sectors, what helps and hinders community nurses to work effectively; 3) To identify organizational attributes that support one community subsector--public health nurses--to practise the full scope of their competencies. METHODS: Our study included an analysis of the Canadian Institute for Health Information nursing databases (1996-2007), a survey of over 13,000 community health nurses across Canada and 23 focus groups of public health policy-makers and front-line public health nurses. RESULTS: Over 53,000 registered and licensed practical nurses worked in community health in Canada in 2007, about 16% of the nursing workforce. Community nurses were older on average than the rest of their profession. Typical practice settings for community nurses included community health centres, home care and public health units/departments. To practise effectively, community nurses need professional confidence, good team relationships, supportive workplaces and community support. Most community nurses felt confident in their practice and relationships with other nurses and professionals, though less often with physicians. Their feelings about salary and job security were mixed, and most community nurses would like more learning opportunities, policy and practice information and chances to debrief about work. They needed their communities to do more to address social determinants of health and provide good quality resources. Public health nursing needs a combination of factors to succeed: sound government policy, supportive organizational culture and good management practices. Organizational attributes identified as supports for optimal practice include: flexibility in funding, program design and job descriptions; clear organizational vision driven by shared values and community needs; coordinated public health planning across jurisdictions; and strong leadership that openly promotes public health, values their staff's work and invests in education and training. CONCLUSION: The interchangeable and inconsistent use of titles used by community nurses and their employers makes it difficult to discern differences within this sector such as home care, public health, etc. Our studies also revealed that community nurses: thrive in workplaces where they share the vision and goals of their organization and work collaboratively in an atmosphere that supports creative, autonomous practice; work well together, but need time, flexible funding and management support to develop relationships with the community and their clients, and to build teams with other professionals; could sustain their competencies and confidence in their professional abilities with more access to continuing education, policies, evidence and debriefing sessions.

Marketing a hard-to-swallow message: recommendations for the design of media campaigns to increase awareness about the risks of binge drinking.

BACKGROUND: Binge drinking, commonly defined as having more than five drinks on a single occasion, is a public health issue affecting two thirds of Canadian young adults between the ages of 19-24 years. To educate young adults about alcohol poisoning, a network of 16 Ontario Health Units developed and implemented a mass-media campaign. The focus of this article is to report on post-secondary students' perceptions about key media campaign strategies, elements and messages for future campaigns designed to increase awareness about the risks of binge drinking. METHODS: As part of a multi-method process evaluation, nine focus groups were facilitated to explore the young adults' knowledge, attitudes and beliefs about binge drinking and the campaign messages. Participants were also asked to identify specific marketing messages and techniques that would increase their level of awareness about the risks of binge drinking. RESULTS: Participants recommended that campaigns be targeted towards parents and high school and post-secondary school students. Participants provided recommendations for the types of messages, images, and language they perceived would capture the attention of young adults. Television, posters and the internet were identified as key media channels for disseminating health information about the risks associated with excessive alcohol consumption. CONCLUSION: The problem of binge drinking is pervasive across Canadian campuses and students are largely unaware of the risks associated with excessive alcohol consumption. To reach this target population, it is important for future media campaign developers to utilize language, definitions, graphics and channels of communication to which this group relates.

The perception of continuity of care from the perspective of patients with diabetes.

BACKGROUND AND OBJECTIVES: Traditional indices of continuity of care typically capture frequency of physician visits but lack information regarding how patients themselves perceive continuity of care. The present study's objectives were (1) to examine the meaning of continuity of care from the perspective of patients with diabetes and (2) to understand the factors that enhance or detract from continuity of care. METHODS: Seven focus groups with 46 adult patients were held at a health service organization in Northern Ontario. All focus group interviews were tape recorded, transcribed verbatim, and analyzed using a phenomenological approach. Triangulation occurred through participant feedback of transcript summaries and consensus of themes by the multidisciplinary research team. RESULTS: Patients conceptualized continuity of care in a broad and multifaceted manner that was comprised of five components: (1) access to services, (2) interactions with physician, (3) interactions with other health care providers, (4) personal self responsibility, and (5) communication. CONCLUSIONS: Continuity of care was perceived by patients to include a wider range of components than what is traditionally associated with continuity of care. The emphasis on personal self responsibility by some patients provides a deeper understanding of what patients feel encompass continuity of care.

The Diabetes Continuity of Care Scale: the development and initial evaluation of a questionnaire that measures continuity of care from the patient perspective.

The purpose of the present study was to develop and pilot test a questionnaire to assess continuity of care from the perspective of patients with diabetes. Seven patient and two healthcare-provider focus groups were conducted. These focus groups generated 777 potential items. This number was reduced to 56 items after item reduction, face validity testing and readability analysis, and to 47 items after a preliminary factor analysis. Readability was assessed as requiring 7-8 years of schooling. Sixty adult patients with diabetes completed the draft Diabetes Continuity of Care Scale (DCCS) at a single point in time to assess the validity of the instrument. Patients completed the draft DCCS again 2 weeks later to assess test-retest reliability. A provisional factor analysis and grouping according to clinical sense yielded five domains: access and getting care, care by doctor, care by other healthcare professionals, communication between healthcare professionals, and self-care. The internal consistency (Cronbach's alpha) for the whole scale was 0.89. The test-retest reliability was r = 0.73. The DCCS total score was moderately correlated with some of the measures used to establish construct validity. The DCCS could differentiate between patients who did and did not achieve specific process and clinical indicators of good diabetes care (e.g. Hba1c tested within 6 months). The development of the DCCS was centred on the patient's perspective and revealed that the patient perspective regarding continuity of care extends beyond the concept of seeing one doctor. Initial testing of this instrument demonstrates that it has promise as a reliable and valid measure in this area.