A model for building collective capacity in community-based programs: the Elderly in Need Project.

As the focus of health promotion moves from individuals to organizations, communities and broader social policy, the models that guide public health program planning and development need reexamination. Public health nurses are gaining experience in strengthening and supporting the ability of communities to grow and change. This study aimed to illuminate the process. Data, gathered as part of an action research project to develop individual and community-based strategies to decrease isolation in frail older adults, provided a rich source of qualitative data. Analysis was directed toward identifying the factors and processes of capacity-building. The emerging model was clarified and partially validated with academics and practitioners from health promotion programs across the age span. Four stages of building collective capacity were identified: identifying common ground, working cooperatively, working in partnership, and working across the community. At each stage, processes of relationship building, project management and capacity-building resulted in stage specific products. A model of building collective capacity, grounded in community health practice and supported by the literature provides a base for developing practice indicators, and practice guidelines which will strengthen the ability to reach health goals.

Identifying older people in need using action research.

An ageing population has implications for community-based health promotion and disease prevention. There is concern about older people who do not fit into existing programmes and services yet need minimal support to maintain independence. A study was designed to develop approaches to gain access to this hard to reach population, assess needs and design and test interventions to integrate them into the community. The study, informed by theories of health promotion and social support, used action research methods. Participant observation documented in field notes, together with case notes and clinical assessments, provided a rich source of qualitative and quantitative data. This article discusses the needs assessment. Over a 3-year period, public health nurses linked with community groups in a predominantly francophone, urban community to identify the target group. Key characteristics of the target group included limitations with instrumental activities of daily living and low levels of social support combined with stressful life situations that challenged adaptation. Three patterns of inadequate support were identified.

IRIS: an experimental multimedia workstation linking the departments of emergency medicine and radiological sciences.

An experimental version of a multimedia medical communication system called IRIS (Integrated Radiological Information System) operated between the Department of Emergency Medicine and the Department of Radiological Sciences at the Ottawa Civic Hospital for 7 weeks during April and May 1989. IRIS is being developed to enhance communication between clinicians and radiology consultants to improve diagnosis and reporting. IRIS supports the capture and distribution of digitized x-ray images and voice reports in the form of "electronic" patient folders that can be accessed at physician workstations throughout the hospital. It also supports on-line consultation between the radiologist and clinician through synchronized workstation operation. Each workstation has 1) a high resolution image screen to display documents and x-ray images; 2) a control screen to access patient folders; 3) a hands-free telephone to dictate, play back reports, and enable realtime consultation between physicians. From an emergency physician's (EP) perspective, such an involved system must allow the viewing and manipulation of images in order to reach diagnostic conclusions and support efficient interchange between the clinician and the consultant radiologist, yet be easy to learn and use without disruption of clinical services. After a briefing session, the trial took place and analogue and digital images were compared. An observer-assistant recorded how EPs used the system and was available to assist the EP. After the trial, six EPs participated in an extensive debriefing interview in order to evaluate the system. Overall, the system was found to be easy to learn and to use, and there was a clear benefit to the full consultation report and the ability to directly consult with the radiologist located at a remote station.

Integrated radiologic information system: a radiology multimedia communication system.

A multimedia radiologic communication system has been developed that achieves the system design goal of providing a clinical communication service that is an efficient improvement over present methods of communication. The system allows users to access, through a workstation, digitized radiographic images, voice reports, and other patient data. Physicians can consult with each other while simultaneously accessing this information through a shared visual workspace, even though they are in different places. The system was designed by a multidisciplinary team including radiologists, clinicians, engineers, user-interface specialists, and psychologists from hospital, university, and research settings in an effort to maximize system performance and clinical utility.