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PubMed1999

The design of vegetative constructed wetlands for the treatment of highway runoff.

The Environment Agency for England and Wales are responsible for assessing the effects of highway runoff and for monitoring the treatment systems/procedures which have been introduced for the reduction of deleterious effects. The Agency is looking into the improvement of surface water management in terms of best management practices and plans to work in partnership with the Highways Agency to achieve this aim. Among the treatment options being considered are constructed wetlands. Draft Guidelines have been developed to provide information on their design. This paper describes procedures for carrying out an Environmental Sensitivity Analysis to determine whether treatment by a constructed wetland is appropriate. Information on water quality and quantity is required as well as the sensitivity of the receiving environment. The legislative position, particularly in relation to the discharge quality of the water and the conservation status of the receiving environment, needs also to be considered. The factors that will determine the most appropriate wetland design criteria include traffic loadings, road drainage area, land availability, cost and the size/extent and type of the receiving water body. The following structures are recommended for incorporation in the overall design; oil separator and silt trap, spillage containment, settlement pond, vegetative wetland and final settlement tank. The operation and maintenance procedures and the monitoring requirements for a functioning wetland are described.

Ecosystem↗
PubMed1998

Women and midwives in partnership: a problematic relationship?

Midwives in New Zealand have been practising independently of medicine and nursing since 1990 using the concept of partnership as a basis for their practice. This article shows, however, that the beliefs which underpin the practice of the midwives are not always the same as those of their clients. Supporting evidence is provided in the form of verbatim data provided by participants. Three major areas in which contradictions were found were in the work of midwives, the knowledge for practice and reflections on the experience. It is recommended that midwives become more visible by removing themselves from hegemonic structures, valuing alternative forms of knowledge and respecting the knowledge of their clients.

Clinical Competence↗
PubMed2000

Psychiatric diagnosis: some implications for mental health nursing care.

Psychiatric diagnosis: some implications for mental health nursing care This article explores some of the functions of psychiatric diagnosis and the implications this has for the mental health nursing care that service users receive. It proposes that because a psychiatric diagnosis often fails to describe the individual's experience of mental distress it can be regarded as a categorization process that, while not necessarily intentionally, serves to maintain oppressive power relations within society. It does this by establishing and maintaining the parameters of normality and abnormality in a manner that reflects particular gender, culture and class biases. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders will be used to illustrate some of the inherent biases in the diagnostic process. Mental health nursing practice needs to demonstrate an awareness of the power relations inherent in any diagnostic process and make attempts to redress these at both the individual and sociopolitical levels. If mental health nursing practice is a patient-centred partnership, as many of our nursing standards suggest, then nursing's focus should be on the patient's experience rather than the psychiatric diagnosis with which the experience is attributed. Mental health nurses need to turn to service users to learn how best to help.

Attitude of Health Personnel↗
PubMedDate not supplied

Community-based service learning in the engaged university.

The engaged university expands the concept of service learning to include a redesigned approach to teaching, research, and service functions that leads to a productive involvement with communities. This article describes an ongoing community partnership that models the best-practice aspects of the engaged university.

Community Health Services↗
PubMed1996

Outcomes of mental health care for children and adolescents: I. A comprehensive conceptual model.

OBJECTIVE: Accountability for mental health care has become a standard of clinical practice. With the expansion of managed care as a corporate response to health reform, attention to outcomes will intensity. Assessment of clinical treatment has typically focused on symptom reduction at an individual level, whereas assessment of service effectiveness has more often targeted service-level change. METHOD: A dynamic and interactional model of outcomes is presented that broadens the range of intended consequences of care. The model comprises five domains: symptoms, functioning, consumer perspectives, environmental contexts, and systems. RESULTS: The model reflects the changeable interaction between children's evolving capacities and their primary environments (home, school, and community). CONCLUSIONS: As health care practices shift, attention to improved care is likely to depend increasingly on scientifically credible evidence of its impact. Greater integration between research and standard practice will be needed. Such a partnership can be strengthened by a more comprehensive view of the impact of care.

Adolescent↗
PubMed1995

Reasons for variations in the use of open access gastroscopy by general practitioners.

This study aimed to investigate the wide variation between general practitioners (GPs) in their use of open access gastroscopy by assessing (i) their partnership share, workload, and the aggregated practice request rate; (ii) correlations with their professional and practice characteristics; and (iii) a comparison with referral rates to medicine, surgery, and all specialties. All 145 GPs and their practice managers were sent a questionnaire and hospital held data on all requests for open access gastroscopy over one year were reviewed. During the year, the 145 GPs made 1210 requests for open access gastroscopy, varying from one to 44 per GP. There were 987,880 practice consultations altogether, an average of 22,451 per practice or 7127 per whole time practitioner. Requests for open access gastroscopy formed 2.4% of all referrals, an average of one per 1000 consultations, or eight per GP. Of a total of 49,123 referrals to all specialties (371 per GP) 4218 (8.5%) were to medicine, and 6444 to surgery (13.1%). The following factors did not correlate with requests: vocational training, a concurrent hospital post, length of service, or receipt of the deprivation allowance by the practice. When the open access gastroscopy referral rate was aggregated for each practice the variation between practices was narrowed to essentially twofold. Requests for open access gastroscopy form a small proportion of all referrals (2.4%). Aggregated practice request rates are relatively uniform compared with the wide variation between individual GPs, suggesting a disproportionate gastroenterology workload between partners. The open access gastroscopy service does not seem to be subject to misuse from most GPs if a variation in practice usage is used as a measure.

Family Practice↗
PubMed2007

Responsibilities and obligations of using human research specimens transported across national boundaries.

Research collaboration beyond national jurisdiction is one aspect of the globalisation of health research. It has potential to complement researchers in terms of research skills, equipment and lack of adequate numbers of potential research subjects. Collaboration at an equal level of partnership though desirable, may not be practicable. Sometimes, human research specimens must be transported from one country to other. Where this occurs, there should be clear understanding between the collaborating research institutions regarding issues of access and control of the specimens as well as the duration of storage of specimens. The researchers have the duty to inform the research participants about specimen storage and transport across national boundaries. While obtaining informed consent from study subjects if specimens are to be stored beyond the life of the present study could be the ideal, there still remains significant challenges in a multi-cultural world.

Biomedical Research↗
PubMed2003

History of academic general and ambulatory pediatrics.

Academic general pediatrics and ambulatory care are closely linked to the development of the Ambulatory Pediatric Association, an organization with nearly 2000 members active in teaching, patient care, and research. Primary care, behavioral-developmental pediatrics, prevention, health promotion, community pediatrics, socioeconomic issues, cultural and ethnic diversity, advocacy, research in education, social issues, and environmental health lie within the purview of general pediatrics. In part, because of their teaching and patient care obligations, but also due to a lack of fellowship research training, many general pediatrics faculty have had difficulty in accomplishing significant research. By supporting fellowship training in general pediatrics, The Robert Wood Johnson Foundation General Pediatrics Academic Development Program and the current fellowship program supported by the Bureau of Health Manpower are important efforts to remedy this deficiency. The sciences basic to general pediatrics research include epidemiology, biostatistics, and the behavioral sciences. In addition, general pediatrics research often borrows from other sciences and collaborates with investigators in other disciplines. Partnerships between general pediatrics divisions and practicing pediatricians for teaching and research, e.g. the Community Education in Community Settings program, provides a realistic educational program for future pediatricians. The Pediatric Research in Office Setting network is another important vehicle for translation of research into the practice of general pediatrics. The steady growth of the Ambulatory Pediatric Association over the past four decades is testimony to the creativity, adaptability, and verve that has characterized the discipline of general pediatrics.

Ambulatory Care↗
PubMed2002

Community-based participatory research as a tool to advance environmental health sciences.

The past two decades have witnessed a rapid proliferation of community-based participatory research (CBPR) projects. CBPR methodology presents an alternative to traditional population-based biomedical research practices by encouraging active and equal partnerships between community members and academic investigators. The National Institute of Environmental Health Sciences (NIEHS), the premier biomedical research facility for environmental health, is a leader in promoting the use of CBPR in instances where community-university partnerships serve to advance our understanding of environmentally related disease. In this article, the authors highlight six key principles of CBPR and describe how these principles are met within specific NIEHS-supported research investigations. These projects demonstrate that community-based participatory research can be an effective tool to enhance our knowledge of the causes and mechanisms of disorders having an environmental etiology, reduce adverse health outcomes through innovative intervention strategies and policy change, and address the environmental health concerns of community residents.

Child↗
PubMed1992

A registered nurse-licensed vocational nurse partnership model for critical care nursing.

The development, implementation, and evaluation of a program that incorporates a registered nurse and licensed vocational nurse partnership model into the critical care practice setting is described. This model can be used by nurse executives to alleviate some of the immediate consequences of the nursing shortage and potentially to achieve a longer-range solution by expanding the pool of registered nurses. Evaluation of the program revealed statistically significant increases in nurse job satisfaction; perceptions of reduced workload and stress; a perception by registered nurses and physicians of increased nursing care quality; decreased registered nurse turnover and sick time; and a positive perception of the role of the licensed vocational nurse in the critical care unit.

Absenteeism↗
PubMed2003

Seeking support: caregiver strategies for interacting with health personnel.

Support from health professionals can assist family caregivers and have a positive impact on their health. The purpose of this study was to explore women's perceptions of support from community resources while caring for a family member with dementia. The research questions were: What factors influence female caregivers' interactions with health personnel when seeking support? What strategies do women employ in interactions with health personnel to secure support? Symbolic interaction was the theoretical foundation for the study, which included secondary analysis of 62 interviews with 20 women concerning their caregiving experience. In addition, new data were collected from 2 focus groups with 8 volunteers recruited from among the original 20 participants. The data indicated that the women's expectations of their caregiving role and their appraisal of the care recipient influenced their interactions with health personnel when seeking support. They employed 4 broad strategies: collaborating, getting along, twigging, and fighting/struggling. A woman's use of strategies varied according to the degree of mutuality in decision-making with staff and was accompanied by both positive and negative experiences. These findings confirm the importance of mutuality in relationships with health personnel and support the use of partnership and empowerment models of professional practice.

Adaptation, Psychological↗
PubMedDate not supplied

The evolution of a mentoring relationship.

My involvement in a formalized mentoring partnership evolved from an advanced clinical practice fellowship (ACPF) through the Registered Nurses Association of Ontario (RNAO). The RNAO provides opportunities for registered nurses across the province to learn more about their special interest by offering fellowships for those who are committed to expanding their knowledge while meeting their desired goals and objectives. My experience in this project far exceeded my expectations. Not only did I meet my goal on a professional level, I also learned the value of mentoring and the impact that such an experience can have on a person overall. This paper discusses how my mentor guided me through my fellowship and how our relationship typified the mentor-protégé role as described in several articles.

Fellowships and Scholarships↗