Program revision: a dynamic outcome of evaluation.

This critical review of program revision processes is guided by the program management model and considers issues germane to community-oriented health care programs, illustrated by examples from the literature. Options for program revision lie on a continuum from discontinuing a program, to various degrees of adjustments, to no change. Sustainability is the ultimate issue that must be addressed, and community and staff participation is critical for successful program revision.

Advanced practice community health nursing in community nursing centers: a holistic approach to the community as client.

Community nursing centers are unique arenas for advanced practice community health nursing. These innovative nurse-managed delivery models are grounded in a holistic approach to the community-as-client. They provide the public with direct access to a range of advanced practice professional nursing services that are not otherwise available. Community Nursing Centers are collaborative with other health professions and organizations. They aim to meet the assessed needs of underserved populations using extant resources to achieve optimal health for all members of the community. This article discusses the underlying conceptual basis for development of community nursing centers and provides a case study example.

Foot care: an innovative nursing service in a community nursing center.

In this article we describe how providing regular foot care for the residents of public housing at an on-site nursing clinic has become a vital part of the clinic's services for the elderly and disabled residents. Good foot care contributes significantly to the health and well-being of elderly and at-risk groups of clients. With relatively little extra education for the nursing staff and for minimal cost, foot care can become an integral part of nursing services provided in many different types of community health settings. A framework for initiating and implementing a foot care program is highlighted.

Doctoral education in community health nursing: a national survey.

The purpose of this study was to identify content areas specific to community health nursing in doctoral programs throughout the United States. The research foci related to community health nursing were compared with previously identified research priorities in the field. Surveys were sent to 52 doctoral program directors; 23 questionnaires were completed. Telephone interviews were conducted with 16 program directors to clarify responses. Newer programs tended to be more generally focussed and without doctoral specialty courses of any kind. The four programs that identified community health nursing as a specialty within their curriculum were some of the oldest and largest programs in the country.

Community development theory. Planning a community nursing center.

The authors describe the use of community development theory to assess the need for a community-based, nurse-managed primary care clinic. A community development model provided the framework for citizen participation in identifying collective health needs of public housing residents. The model facilitated the following: 1) planning for delivery of culturally appropriate primary care services that respond to health needs perceived by community residents; 2) ensuring acceptability and use of services; and 3) empowering residents to take responsibility for their own health. This article focuses on the assessment phase of the model and meeting the perceived needs of community residents.

The relationship between demographic characteristics and nursing problems in home health care.

The delivery of home health services that are accessible and cost effective is contingent on understanding the characteristics and needs of the aggregates who use the services. This study examined the relationship between sociodemographic characteristics and nursing problems among a sample of home health patients. Data were gathered by retrospective record review of all 209 patients with medical-surgical problems who were discharged from home health services during a six-week period. Nursing diagnoses were identified by nurses at the time of the admission assessment. Impaired mobility, the most frequent nursing diagnosis, occurred in 73% of the sample, cardiovascular problems in 52%, and respiratory problems in 48%. Analysis of the data revealed a relationship between source of payment and age with nursing diagnosis. No significant relationship was found between nursing diagnosis and gender, although a weak relationship was identified with living arrangement. Results have important implications for the planning, delivery, and reimbursement of home care services that equitably address populations with the greatest nursing needs. If patients with specific predisposing characteristics have different needs, it may be possible to evaluate patients more accurately early in care delivery so that these needs can be more effectively met.

DRGs: from development to applications in the Department of Defense.

The evolution of Diagnosis Related Groups (DRGs) is discussed briefly. Use of DRGs for resource allocation in the Veterans Administration is examined. Implications of the use of DRGs for resource allocation and other management functions in the Department of Defense are discussed.