How Do Nursing Organizations Measure Up on Harm Reduction? An Environmental Scan

2020 ◽  
pp. 084456212091442
Author(s):  
Marilou Gagnon ◽  
Emily Hazlehurst
Keyword(s):  
Harm Reduction ◽  
Quality Indicators ◽  
Service Provision ◽  
Rapid Expansion ◽  
Policy Documents ◽  
Environmental Scan ◽  
The Past ◽  
Nursing Organizations ◽  
Low Threshold ◽  
Supervised Injection

Background In the past five years, we have seen a rapid expansion of harm reduction approaches, programs, and policies in Canada. To keep up with the changing policy landscape, a number of Canadian researchers have undertaken projects that seek to analyze policy documents published by provincial and territorial governments. Building on this important body of work, we undertook a similar analysis using documents published by nursing organizations. Purpose To present key findings and propose ways that nursing organizations can strengthen their position on harm reduction. Methods We conducted an environmental scan with a two-part analysis. To complete the first part, we used the 17 quality indicators. To complete the second part, we analyzed the documents for specific harm reduction interventions. Results A total of 39 documents were collected across 76 nursing organizations. The majority of the documents were press or public statements (n = 22), and the most frequently mentioned intervention was supervised injection services (n = 31). On average, documents met 5.6 quality indicators. Documents scored highest on indicator 12 (discuss low-threshold approaches to service provision) and lowest on indicator 3 (acknowledge that not all substance use is problematic). Conclusions Six areas were identified to strengthen nursing organizations’ position on harm reduction.

Providing care for older adults with extreme obesity in aged residential care facilities: An environmental scan

2020 ◽  
Vol 36 (3) ◽  
pp. 24-36
Author(s):  
Caz Hales ◽  
◽  
Isaac Amankwaa ◽  
Lesley Gray ◽  
Helen Rook ◽  
...  
Keyword(s):  
Older Adults ◽  
Residential Care ◽  
Service Provision ◽  
Aged Care ◽  
Extreme Obesity ◽  
Financial Barriers ◽  
Residential Care Facilities ◽  
Environmental Scan ◽  
Staffing Ratios ◽  
Care Facilities

Little is known about the level of service demand and preparedness of Aotearoa New Zealand’s aged residential care facilities to care for older adults with extreme obesity. The aim of this study was to assess the current state of bariatric (extreme obesity) services within aged residential care. An environmental scan was conducted to identify bariatric resident needs and gaps in service provision to inform the development of policy and service provision. Observational and interview data from three facilities in Aotearoa New Zealand was collected along with a retrospective review of national resident admissions over a three-year period. Poor environmental design that included infrastructure deficiencies and financial barriers impacted on the ability to deliver safe and equitable care for this population. Specifically, equipment procurement and safe staffing ratios were of concern to the sector. There is an increasing need for bariatric level support within aged care, necessitating more equipment and staff, adaptation of physical care environments, and enhanced funding. Significant investment is required to address care concerns of older adults with extreme obesity at government and organisational levels.

Managing rivers for conservation and ecotourism in the Kruger National Park

1995 ◽  
Vol 32 (5-6) ◽  
pp. 227-233 ◽  
Author(s):  
F. J. Venter ◽  
A. R. Deacon
Keyword(s):  
National Park ◽  
Good Condition ◽  
Kruger National Park ◽  
Rapid Expansion ◽  
Natural Environments ◽  
The West ◽  
The Past ◽  
Management Actions ◽  
Flow Through ◽  
Three Rivers

Six major rivers flow through the Kruger National Park (KNP). All these rivers originate outside and to the west of the KNP and are highly utilized. They are crucially important for the conservation of the unique natural environments of the KNP. The human population growth in the Lowveld during the past two decades brought with it the rapid expansion of irrigation farming, exotic afforestation and land grazed by domestic stock, as well as the establishment of large towns, mines, dams and industries. Along with these developments came overgrazing, erosion, over-utilization and pollution of rivers, as well as clearing of indigenous forests from large areas outside the borders of the KNP. Over-utilization of the rivers which ultimately flow through the KNP poses one of the most serious challenges to the KNP's management. This paper gives the background to the development in the catchments and highlights the problems which these have caused for the KNP. Management actions which have been taken as well as their results are discussed and solutions to certain problems proposed. Three rivers, namely the Letaba, Olifants and Sabie are respectively described as examples of an over-utilized river, a polluted river and a river which is still in a fairly good condition.

scholarly journals Service providers’ use of harm reduction approaches in working with older adults experiencing abuse: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Donna Goodridge ◽  
Kerstin Stieber Roger ◽  
Christine A. Walsh ◽  
Elliot PausJenssen ◽  
Marina Cewick ◽  
...  
Keyword(s):  
Older Adults ◽  
Harm Reduction ◽  
Professional Practice ◽  
Service Provision ◽  
Service Providers ◽  
Qualitative Interviews ◽  
Risk Environment ◽  
Intervention Process ◽  
Process Enactment ◽  
Humanistic Approach

Abstract Background Although abuse experienced by older adults is common and expected to increase, disclosure, reporting and interventions to prevent or mitigate abuse remain sub-optimal. Incorporating principles of harm reduction into service provision has been advocated as a strategy that may improve outcomes for this population. This paper explores whether and how these principles of harm reduction were employed by professionals who provide services to older adults experiencing abuse. Methods Thematic analysis of qualitative interviews with 23 professionals providing services to older adults experiencing abuse across three Western provinces of Canada was conducted. Key principles of harm reduction (humanism, incrementalism, individualism, pragmatism, autonomy, and accountability without termination) were used as a framework for organizing the themes. Results Our analysis illustrated a clear congruence between each of the six harm reduction principles and the approaches reflected in the narratives of professionals who provided services to this population, although these were not explicitly articulated as harm reduction by participants. Each of the harm reduction principles was evident in service providers’ description of their professional practice with abused older adults, although some principles were emphasized differentially at different phases of the disclosure and intervention process. Enactment of a humanistic approach formed the basis of the therapeutic client-provider relationships with abused older adults, with incremental, individual, and pragmatic principles also apparent in the discourse of participants. While respect for the older adult’s autonomy figured prominently in the data, concerns about the welfare of the older adults with questionable capacity were expressed when they did not engage with services or chose to return to a high-risk environment. Accountability without termination of the client-provider relationship was reflected in continuation of support regardless of the decisions made by the older adult experiencing abuse. Conclusions Harm reduction approaches are evident in service providers’ accounts of working with older adults experiencing abuse. While further refinement of the operational definitions of harm reduction principles specific to their application with older adults is still required, this harm reduction framework aligns well with both the ethical imperatives and the practical realities of supporting older adults experiencing abuse.

scholarly journals Improved estimates of preindustrial biomass burning reduce the magnitude of aerosol climate forcing in the Southern Hemisphere

2021 ◽  
Vol 7 (22) ◽  
pp. eabc1379
Author(s):  
Pengfei Liu ◽  
Jed O. Kaplan ◽  
Loretta J. Mickley ◽  
Yang Li ◽  
Nathan J. Chellman ◽  
...  
Keyword(s):  
Southern Hemisphere ◽  
Radiative Forcing ◽  
Ice Core ◽  
Ice Cores ◽  
Terrestrial Ecosystems ◽  
Rapid Expansion ◽  
Past Century ◽  
Fire Emissions ◽  
The Past ◽  
Fire Activity

Fire plays a pivotal role in shaping terrestrial ecosystems and the chemical composition of the atmosphere and thus influences Earth’s climate. The trend and magnitude of fire activity over the past few centuries are controversial, which hinders understanding of preindustrial to present-day aerosol radiative forcing. Here, we present evidence from records of 14 Antarctic ice cores and 1 central Andean ice core, suggesting that historical fire activity in the Southern Hemisphere (SH) exceeded present-day levels. To understand this observation, we use a global fire model to show that overall SH fire emissions could have declined by 30% over the 20th century, possibly because of the rapid expansion of land use for agriculture and animal production in middle to high latitudes. Radiative forcing calculations suggest that the decreasing trend in SH fire emissions over the past century largely compensates for the cooling effect of increasing aerosols from fossil fuel and biofuel sources.

The neoliberal governance of heroin and opioid users in Philadelphia city

2021 ◽  
pp. 174165902199119
Author(s):  
Philip R Kavanaugh ◽  
Jennifer L Schally
Keyword(s):  
Public Health ◽  
Harm Reduction ◽  
Drug Users ◽  
Policy Documents ◽  
Media Portrayals ◽  
Neoliberal Governance ◽  
Public Nuisance ◽  
Fiscal Austerity ◽  
Opioid Users ◽  
Governmental Response

Drawing on 147 news accounts and five policy documents on the heroin and opioid crisis in Philadelphia, Pennsylvania published between 2016 and 2018, our analysis highlights how media portrayals of opioid users as both tragic victims and public nuisance prompted a schizoid governmental response that draws on rhetorics of treatment and harm reduction to legitimate more punitive interventions. By describing how the state’s quasi-medical responsibilization strategy devolved to fold criminalization into its broader response, we argue the effort to wage a kinder/gentler war on overdose invests in familiar tropes of a recalcitrant drug user class that is a threat to public health. In doing so we provide a basis to critique how drug users are governed in this time of fiscal austerity, resource hoarding, and perpetual, continually evolving drug crises.

scholarly journals An Environmental Scan of Ambulatory Care Quality Indicators for Patients With Advanced Kidney Disease Currently Used in Canada

2021 ◽  
Vol 8 ◽  
pp. 205435812199109
Author(s):  
Jay Hingwala ◽  
Amber O. Molnar ◽  
Priyanka Mysore ◽  
Samuel A. Silver
Keyword(s):  
Kidney Disease ◽  
Ambulatory Care ◽  
Quality Indicators ◽  
Health Care Quality ◽  
Healthcare Research ◽  
Care Quality ◽  
Institute Of Medicine ◽  
Environmental Scan ◽  
Number Of Patients ◽  
Ambulatory Patients

Background: Quality indicators can be used to identify gaps in care and drive frontline improvement activities. These efforts are important to prevent adverse events in the increasing number of ambulatory patients with advanced kidney disease in Canada, but it is unclear what indicators exist and the components of health care quality they measure. Objective: We sought to identify, categorize, and evaluate quality indicators currently in use across Canada for ambulatory patients with advanced kidney disease. Design: Environmental scan of quality indicators currently being collected by various organizations. Setting: We assembled a 16-member group from across Canada with expertise in nephrology and quality improvement. Patients: Our scan included indicators relevant to patients with chronic kidney disease in ambulatory care clinics. Measurements: We categorized the identified quality indicators using the Institute of Medicine and Donabedian frameworks. Methods: A 4-member panel used a modified Delphi process to evaluate the indicators found during the environmental scan using the American College of Physicians/Agency for Healthcare Research and Quality criteria. The ratings were then shared with the full panel for further comments and approval. Results: The environmental scan found 28 quality indicators across 7 provinces, with 8 (29%) rated as “necessary” to distinguish high-quality from poor-quality care. Of these 8 indicators, 3 were measured by more than 1 province (% of patients on a statin, number of patients receiving a preemptive transplant, and estimated glomerular filtration rate at dialysis start); no indicator was used by more than 2 provinces. None of the indicators rated as necessary measured timely or equitable care, nor did we identify any measures that assessed the setting in which care occurs (ie, structure measures). Limitations: Our list cannot be considered as an exhaustive list of available quality indicators at hand in Canada. Our work focused on quality indicators for nephrology providers and programs, and not indicators that can be applied across primary and specialty providers. We also focused on indicator constructs and not the detailed definitions or their application. Last, our panel does not represent the views of other important stakeholders. Conclusions: Our environmental scan provides a snapshot of the scope of quality indicators for ambulatory patients with advanced kidney disease in Canada. This catalog should inform indicator selection and the development of new indicators based on the identified gaps, as well as motivate increased pan-Canadian collaboration on quality measurement and improvement. Trial registration: Not applicable as this article is not a systematic review, nor does it report results of a health intervention on human participants.

Supervised Injection Facilities as Harm Reduction: A Systematic Review

2021 ◽  
Author(s):  
Timothy W. Levengood ◽  
Grace H. Yoon ◽  
Melissa J. Davoust ◽  
Shannon N. Ogden ◽  
Brandon D.L. Marshall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Harm Reduction ◽  
Supervised Injection ◽  
Supervised Injection Facilities

scholarly journals The Development of Direct Payments in the UK: Implications for Social Justice

2005 ◽  
Vol 4 (1) ◽  
pp. 75-85 ◽  
Author(s):  
Sheila Riddell ◽  
Charlotte Pearson ◽  
Debbie Jolly ◽  
Colin Barnes ◽  
Mark Priestley ◽  
...  
Keyword(s):  
Social Justice ◽  
Independent Living ◽  
Rapid Expansion ◽  
Disabled People ◽  
The Past ◽  
Funded Project ◽  
Important Means ◽  
Direct Payments ◽  
The Uk ◽  
Disability Movement

Direct payments have been heralded by the disability movement as an important means to achieving independent living and hence greater social justice for disabled people through enhanced recognition as well as financial redistribution. Drawing on data from the ESRC funded project Disabled People and Direct Payments: A UK Comparative Perspective, this paper presents an analysis of policy and official statistics on use of direct payments across the UK. It is argued that the potential of direct payments has only partly been realised as a result of very low and uneven uptake within and between different parts of the UK. This is accounted for in part by resistance from some Labour-controlled local authorities, which regard direct payments as a threat to public sector jobs. In addition, access to direct payments has been uneven across impairment groups. However, from a very low base there has been a rapid expansion in the use of direct payments over the past three years. The extent to which direct payments are able to facilitate the ultimate goal of independent living for disabled people requires careful monitoring.

A Model for Sustaining Evidence-Based Practices in a Statewide System

2017 ◽  
Vol 98 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Jason M. Lang ◽  
Kellie G. Randall ◽  
Michelle Delaney ◽  
Jeffrey J. Vanderploeg
Keyword(s):  
Public Health ◽  
Cognitive Behavioral Therapy ◽  
Quality Indicators ◽  
Behavioral Therapy ◽  
Health Impact ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
The Public ◽  
The Past ◽  
Large Systems

Over the past 20 years, efforts have been made to broadly disseminate evidence-based practices (EBPs). However, the public health impact of EBPs has yet to be realized and most EBPs are not sustained. Few structured models exist for disseminating and sustaining EBPs across large systems. This article describes the EBP Dissemination and Support Center (DSC) model and how it was used to sustain trauma-focused cognitive behavioral therapy (TF-CBT) across Connecticut. More than 600 clinicians at 35 agencies have been trained and nearly all agencies have sustained TF-CBT for up to 9 years. More than 6,200 children have received TF-CBT and have shown improvements in outcomes and quality indicators. Recommendations are made for using or adapting the DSC model.

scholarly journals Trends in the development of psychiatric services in India

1996 ◽  
Vol 20 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Mohan Isaac
Keyword(s):  
Mentally Ill ◽  
Service Provision ◽  
Mental Hospital ◽  
Quality Of Services ◽  
Paper Briefly ◽  
The Past ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres

Over the past five decades, services for the mentally ill in India have steadily improved. From a predominantly mental hospital based service, provision has now moved to general hospitals and primary health centres. A variety of factors have contributed to changes in the quality of services. This paper briefly reviews the changes and discusses the relevance of some of them.

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