Paulo Freire's philosophy of "education for critical consciousness" takes on special relevance within the context of the health care system. This dialogical approach to change, stressing action based on critical reflection by the people is seen here as importantly supplementing current efforts to deal with the "health care crisis" in the United States and many developing countries. Applications of the Freir approach in a health context of necessity involve the perception of health and medical care within the total oppressive structure of society. Viewed thusly, health "reform" cannot justifiably be envisioned except within the context of broader structural transformations. Two case studies are presented to illustrate the application of the Freire approach within a health context. Successful utilization of the methodology among peasants in rural Honduras and a relatively unsuccessful application among impoverished elderly residents of an urban United States ghetto are described and analyzed. Modifications of the approach to increase its usefulness in a variety of situational contexts are suggested. The potentials and limitations of this approach to radical change in the health field finally are described, along with lessons learned from initial work in the applications of conscientización to the health field.
The trend toward adopting a strengths approach to mental health practice with children and adolescents amounts to a paradigm shift from an emphasis on diagnosing disorders to tapping child capacities and assets toward the achievement of treatment goals. While the potential value and challenges associated with this shift has received ample attention in the literature, minimal research has been conducted to assess the benefits and barriers related to the use of strength-based strategies with youth. Utilizing an experimental design, this author examined the impact of strength-based assessment using the Behavioral and Emotional Rating Scale (BERS) with seriously emotionally or behaviorally disturbed children and adolescents. Results revealed that child functioning outcomes were significantly better for youth who received BERS-guided assessment versus the usual deficit-based assessment protocol only when the treating therapist reported an orientation toward service that reflects highly strength-based attitudes and practices. Furthermore, high adherence to the strength-based assessment protocol was associated with significantly higher parent satisfaction with services and lower rates of missed appointments. These findings highlight the importance of accounting for practitioner effects and treatment fidelity in future studies of strength-based practice effectiveness.
The purpose of this project was to demonstrate how a hospital clinical database can be utilized to calculate individual nursing unit activities that affect nurses' workload. While research has established that staffing is associated with patient safety, few studies have examined ways to measure nurse workload and its impact on patient safety. The widely used midnight census does not account for the number of patients who occupy a bed in a 24-hour period. In this study, a hospital clinical data repository was used to calculate workload measures such as total treated patients, midnight census, and admission, discharges, and transfers, as well as a unit activity index. Unit activity indexes for intensive care and medical-surgical units were compared over time, by shift, day of week, and month. Admission, discharges, and transfers varied according to unit type. During 1994 to 2006, unit activity index increased. Fluctuations in unit activity index were noted according to shift, day of week, and month. Hospital clinical data repositories can be used to calculate workload measures, and these measures should be incorporated with other traditional measures in making staffing decisions.
Social network intervention aimed at bolstering the informal supports of high riskfamilies is recognized as a common element of community-based, family-focused practice models, such as intensive family preservation services (IFPS), multisystemic therapy (MST), and the wraparound process. The empirical research basis for these practice models is examined, with an eye toward discerning the extent to which network intervention is identified as a critical component of comprehensive service. Results reveal that few studies make clear the degree to which treatment adhered to a focus on natural network enhancement or the development of informal resources. Those that did, suggest that relatively few families received this form of ecologically-oriented intervention. Consequently, this body of practice research offers insufficient evidence of the benefits or limitations associated with network facilitation with multi-need families. Explanations for these findings are explored and directions for future research are recommended.KEY WORDS: social network intervention; community-based services; family preservation services; multisystemic therapy; wraparound process.Recent decades have seen the proliferation of home and community-based service programs for high-risk youth and families. Prompting this development have been concerns regarding the social and economic consequences of unnecessary and inappropriate placement of children and adolescents in out-of-home care. Advocates for children's services reform have called for an increased emphasis on the provision of coordinated, family-focused services directed toward the maintenance of youth in the least restrictive setting possible (Pecora,
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