Canada does not have enough aboriginal nurses and aboriginal nursing faculty. Consequently, there is an inadequate number of nurses to meet both on- and off-reserve and community health care staffing needs. In 2002, Health Canada asked the Canadian Association of University Schools of Nursing to facilitate a national task force that would examine aboriginal nursing in Canada. The task force engaged in an extensive literature review, conducted a national survey of nursing programs, and explored recruitment and retention strategies. In 2007, the association prepared an update on the current status. In this article, the authors review the progress made during the intervening five years in the recruitment, retention and education of aboriginal nursing students.
Access to health care services in Canada has been identified as an urgent priority, and chronic disease has been suggested as the most pressing health concern facing Canadians. Access to services for Canadians living with chronic disease, however, has received little emphasis in the research literature or in health policy reform documents. A systematic review of research into factors impeding or facilitating access to formal health services for people in Canada living with chronic illness is presented. The review includes 31 studies of Canadian populations published between 1990 and 2002; main results were analyzed for facilitators and barriers to access for people experiencing chronic disease. An underlying organizing construct of symmetry between consumers, providers, and the larger Canadian system is suggested as a relevant lens from which to view the findings. Finally, a discussion of the relationship between identified factors and the principles of primary health care is offered.
Little is known about the conditions that must be in place to help adolescent patients and their families gain the confidence needed to continue recovery at home, following the adolescents' hospitalization for anorexia nervosa.
Beliefs about discharge readiness were obtained through an open-ended questionnaire following the patients' first weekend pass home from an in-patient unit. The perceptions of patients, parents, and registered nurses were obtained using parallel versions of a questionnaire.
An examination of the responses revealed four themes; medical stability, education, psychological changes, and community resource planning, that were common to all respondents, as well as themes specific to adolescents and to nurses.
The findings suggest that each group of respondents has unique discharge readiness needs and that registered nurses have an important role to play in helping patients and families make the transition home as successful as possible. Implications for nursing practice are highlighted.
Following the closure of Manitoba hospital beds, the Manitoba government adopted a strategy of shifting hospital care from more expensive urban hospitals to less expensive rural facilities. With this project, Manitoba Centre for Health Policy and Evaluation (MCHPE) studied the implications of the stated policy of "repatriation."
The project first involved examining population-based patterns of hospital utilization to define hospital service areas for 10 large rural hospitals. Three different hospital service area definitions were developed for use in sensitivity testing. Rates of overall use of hospital services, indicators of need for health care, and patterns of use of urban facilities are compared for these hospital service areas. Using a large rural hospital as a benchmark, patterns of adult surgical, adult medical, pediatric, and obstetric care were examined for the hospital service areas. Number and percent of cases provided by the index hospital and by urban hospitals were compared, to assess the feasibility and the potential impact of redirection of care to the benchmark level.
Although in theory a significant percentage of care delivered to rural residents by Winnipeg hospitals might be redirected to rural institutions, the project raised issues of feasibility. Moreover, it identified that most of the redirected cases could be accommodated within existing capacity.
In August 1995, the Ontario Ministry of Health (MOH) issued a request for proposal (RFP) for the establishment of new and expanded dialysis services. London Health Sciences Centre (LHSC) was successful in expanding its integrated dialysis delivery network with satellites in Stratford, Woodstock and Owen Sound. This achievement required collaboration of LHSC and host hospital staff to meet the challenging RFP requirements. With final approval received in January 1997, efforts were required to establish an operational model supporting self-care and full-care patients, to train satellite staff and patients, and to manage the resulting clinical impact. A balanced scorecard (Kaplan & Norton, 1992) evaluation model was developed. Initial outcome data indicate that full-care patients in satellites require more fallback support to London units, experience more hypotensive episodes during dialysis and, in some cases, demonstrate lower levels of dialysis adequacy and nutritional status when compared to satellite self-care patients. Findings from these data will assist in revising patient inclusion criteria and processes to optimize community-based dialysis.
Arctic residents can be exposed to a wide range of contaminants through consumption of traditional (country) foods (i.e. food from wild animals and plants that are hunted, caught or collected locally in the Arctic). Yet these foods provide excellent nutrition, promote social cohesion, meet some spiritual needs for connectedness to the land and water, reinforce cultural ties, are economically important and promote overall good health for many. The risk and benefit balance associated with the consumption of traditional Arctic foods is complicated to communicate and has been referred to as the "Arctic Dilemma". This article gives an update on health risk communication in the Arctic region. It briefly summarizes some research on risk communication methodologies as well as approaches to an evaluation of the outcomes of risk communication initiatives. It provides information on specific initiatives in several Arctic countries, and particularly those that were directed at Indigenous populations. This article also summarizes some international versus local risk communication activities and the complexity of developing and delivering messages designed for different audiences. Finally, the potential application of social media for risk communication and a summary of "best practices" based on published literature and a survey of Inuit in a few Arctic countries are described.
Several of the risk communication initiatives portrayed in this article indicate that there is only limited awareness of the outcome of risk communication messages. In some cases, risk communication efforts appear to have been successful, at least when effectiveness is measured in an indirect way, for example, by lower contaminant levels. However, due to missing effectiveness evaluation studies, uncertainty remains as to whether a specific risk communication method was successful and could be clearly linked to behavioural changes that resulted in decreased contaminant exposure.
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