Biomedical subjects
Publications and source records attributed to V Woodcox.
Current mental health initiatives are decreasing the number of psychiatric beds and thus increasing the number of clients with serious mental illness who are being served in the community. Such changes have implications for clients' quality of life and health care economics. To implement the changes while addressing the unique needs of psychiatric clients, appropriate models of discharge planning and community integration are critical.
1. The most common alternative housing choice in the community for individuals with serious mental illness was a boarding home. 2. Community consumers noted that being with other people was the most important benefit of the teaching apartment, followed by eating, learning new skills, and entertainment. 3. Although they reported negative aspects about the homes, most consumers did not want to change anything about their boarding home.
Public health nurses (PHNs) have been attached to family doctors' offices as one mode of organizing the delivery of nursing services in the community. However, different nurses function in different roles on a continuum from generalist to liaison. A descriptive study was undertaken to determine the most effective role for PHNs attached to family physicians' offices. Outcomes for both physicians and nurses were satisfaction with the role of the PHN, appropriateness of referrals, and accessibility for consultation. These outcomes were compared relative to the rating of PHNs of their role. A cohort of physicians without attachment PHNs were also surveyed to compare responses on the same criteria. The majority of nurses described their role generalist. This role was related to greater satisfaction for nurses and the physicians with whom they worked. Satisfaction with PHN service, ease of arranging consultation with PHN, and appropriateness of referrals from PHNs was greater for physicians who had the attachment than those who used the usual service.
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From 1986 to 1988, the Nursing Division of the Hamilton-Wentworth Department of Public Health Services undertook an analysis of our present organizational structure, incorporating knowledge from current literature, community trends and staff perceptions. From this analysis, a division-wide reorganization was implemented from the current practice in which the Public Health Nurse (PHN) delivered nursing care across all ages and stages (generalist role) to one organized by target populations. These events were described in an earlier article. As part of the plan for reorganization, the nurse management team implemented an evaluation process which included five components: 1) an internal staff survey; 2) an external agency survey; 3) a program-specific activity analysis; 4) a program-specific measure of knowledge change and; 5) a longitudinal job satisfaction survey. This article describes this evaluation and presents implications for the future.
Since the 1930s, Public Health Nurses (PHNs) have been deployed in most health units in Canada to provide community-based care for all people living in defined geographical areas. PHNs have provided nursing services for all ages and stages for a variety of health and illness states. A literature review and a systematic analysis of the internal and external factors affecting Public Health Nursing practice in this community led to a recommendation to assign nurses to specific target populations (e.g. parent-child, school, adolescent, adult, seniors) instead of assigning responsibility for all health problems in a geographic location. We describe the processes of assessment, analysis, planning and implementation of the change from geographic assignment to target population assignment for Public Health Nurses.
The Nursing Division of a local health unit in Ontario reorganized its nursing teams into target population based programs. Nurses involved in this reorganization were asked to report their perceptions of job satisfaction, job design and role stress using standardized instruments before the reorganization and at three points in time after the reorganization. No administratively significant differences in these variables were reported by the nurses through the four time periods. The one exception was an unpredicted decrease in their perception of their task identity, that is, their perception of the significance or importance of their work. Major changes in the organization of a nursing division may be possible with minimal impact on perceptions of job satisfaction, job design and role stress. We caution that further assessment of the measurement tools used in this study should be undertaken.