Evaluation of a client care delivery model, Part 2: Variability in client outcomes in community home nursing

Using similar variables, Part II explores variation in client outcomes such as OMAHA knowledge, behavior, and SF-36 scores. Medical and nursing diagnoses explained large variations in client outcomes. Clients cared for by degree-prepared nurses improved knowledge and behavior scores. Unanticipated case complexity was negatively associated with client outcome even with nursing intervention. The study revealed that "for every unit increase in assignment of baccalaureate-prepared nurses, clients will on average demonstrate an 80% greater likelihood of improvement in knowledge scores and a 120% greater likelihood of improvement in behavior scores in relation to their health condition at discharge." This two-part study has offered insight into the controllable variables influencing the cost and quality of home care services.     

Britain's best kept secret? An analysis of the credit union as an alternative source of credit

At any time, the significance of a new device which facilitates saving and borrowing and encourages the prudent management of credit and debt is clear. Given the present credit market, in which certain categories of borrowers either cannot purchase credit or can only do so on disadvantageous terms, then the importance of such an alternative only increases. The credit union is such a device. It has an established and proven record of success in many countries but, outside of Northern Ireland, credit unions are in their infancy in the United Kingdom. This article examines the possibilities credit unions afford, against the background of the increasing problem of debt in the United Kingdom. We contend that credit unions can afford a partial solution to the debt problem, but that attention should also be placed on their limitations.     

Tourism and welfare in Sub-Saharan Africa: a theoretical analysis

Using the standard theoretical model of trade, we study thewelfare effects of tourism for developing countries with particularreference to Sub-Saharan Africa. We show that tourism can reducewelfare for trade regimes dominated by export taxes or importsubsidies. In addition, we argue that tourist immiserisationis possible for Sub-Saharan Africa. Finally, we show that directforeign investment in tourism, is for the most part, beneficial.     

Redesigning nursing work in long-term care environments

The authors present a highly statistically oriented argument for examining work attitudes and activities among three groups of caregivers [RNs, RPNs, and HCAs] working in long-term care. The investigators used both work sampling, written surveys, and interviews with a sample of 46 caregivers in a large university-affiliated LTC facility in Toronto, Canada. While RNs stated their strong affinity for direct patient care activities, they perform the lowest percentage of direct care, chiefly due to their accountability for planning and coordinating the care provided by others. The HCAs who provided the bulk of direct patient care "valued it the least," apparently finding little gratification with this aspect of their role. This study suggests that there is a need to examine and clarify work roles and perceptions for all caregivers as part of any work redesign process. A higher level of RN involvement in direct patient care activities, along with "attention to enhancing the importance" of these activities for staff employed in the HCA role, could be beneficial.