In this article, we discuss findings from an ethnographic study in which we explored experiences of access to primary care services from the perspective of Aboriginal people seeking care at an emergency department (ED) located in a large Canadian city. Data were collected over 20 months of immersion in the ED, and included participant observation and in-depth interviews with 44 patients triaged as stable and nonurgent, most of whom were living in poverty and residing in the inner city. Three themes in the findings are discussed: (a) anticipating providers' assumptions; (b) seeking help for chronic pain; and (c) use of the ED as a reflection of social suffering. Implications of these findings are discussed in relation to the role of the ED as well as the broader primary care sector in responding to the needs of patients affected by poverty, racialization, and other forms of disadvantage.
OBJECTIVES: To determine overtriage rates (where air ambulance transport could have been avoided without compromising patient care) by reviewing the records of air ambulance transports from isolated coastal communities to the small rural hospital in Port McNeill, British Columbia, a remote coastal community on Vancouver Island. The category of patient being transported to this hospital by the air ambulance service was also examined.DESIGN: A 1-year chart review from Apr. 1, 1996, to Mar. 31, 1997.MAIN OUTCOME MEASURES: Demographics of the study group, site of origin of each air ambulance transfer, whether the liaison was a community health representative (CHR) or a registered nurse, and the final diagnosis by the receiving physician were all determined. In addition, subsequent management and patient outcome were also noted. After reviewing all of this information, a subjective decision was made as to whether the air ambulance transport was necessary or not.RESULTS: Forty-eight separate air ambulance transfers were carried out, all by helicopter, transporting a total of 51 patients (43 adults, 8 children). Forty-eight percent of evacuations originated from 2 communities off Vancouver Island. The overtriage rate was calculated at 22%. The area of minor trauma was particularly prone to overuse of the air ambulance.CONCLUSIONS: Just over 20% of emergency air ambulance transfers to Port McNeill Hospital probably were not necessary. This overtriage rate is consistent with that reported for air ambulance transports that take place between primary care hospitals and secondary or tertiary care hospitals.
In this article we critically analyze the disconnect between much of the contemporary discourse and practice in Canadian community health nursing (CHN) that has contributed to the slow progress of strengths-based, health-promoting nursing practice. Appreciative inquiry philosophy and methods are introduced as a bridge to traverse this disciplinary gap. Two exemplars show how appreciative, strengths-based CHN research and action can move policies and programs toward more socially just practices congruent with CHN values. Exciting potential for nursing knowledge may arise from incorporating more strengths-based approaches into practice, education, policy, and research.
Three recent studies suggest that Fetal Alcohol Syndrome (FAS) is more prevalent among Canadian Native children than non-Native children. The evidence does not appear to be conclusive. However, the Canadian research that is reviewed is important in defining areas which require further investigation. Efforts at research and intervention should be directed towards defining and modifying personal and social risk factors. Our review of current research on FAS and Native peoples suggests that it is important to consider pragmatic questions which can best contribute to the goal of preventing possible alcohol effects on the fetus.
The prevalence and nature of antibiotic misuse in a major teaching hospital was assessed by means of a quality-of-use audit. Cefoxitin was chosen for study. The use of cefoxitin increased rapidly during the study period, accounting for 17.7% ($15300) of the pharmacy's costs for cephalosporins during the first year of its availability but 47.7% ($60707) during the second year. Cefoxitin was inappropriately used for 43% of the patients receiving it during the first 2-month audit period and for 25% of those receiving it during the second audit period, 1 year later (p less than 0.01 by chi-square analysis).
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