Research Korner: Health Care Teams

Exploring the role of the nurse in preventing and controlling risks factors in cardiovascular disease

Exploring the role of the nurse in preventing and controlling risks factors in cardiovascular disease Nurses are in a unique position to diagnose and treat human responses to actual or potential health problems. The nurse practitioner can have a positive impact on the prevention and management of cardiovascular disease through patient education and counseling.  Nurse Practitioners are oftentimes the first healthcare provider seen when there is a new patient.  The Nurse Practitioner conducts the initial evaluation and sets up the care plan which includes primary and secondary prevention strategies. The success of your patient teaching plan is measured through the patient’s compliance to the prescribed treatment plan.  Your teaching should be set up with goals that will enhance compliance. You need to make the assessment with the patient and family to focus on maximum compliance. Each visit should incorporate a review of the goals that were set and examples of how the patient is meeting or not meeting those goals. When you are following up during your visit to assess the success, if the patient has not followed the plan ask for the patient’s help to identify what is preventing him from being successful and revise the plan based on revised goals (Solomon, 2000). If the patient has even had small successes it is important to congratulate them and focus on those positives as you reformulate goals.  Provide the patient with resources to help support his plan. Remember that there are many references out there in the internet. Some are not so accurate, that may have just the opposite effect you and the patient are trying to achieve. By providing the patient with a take home list of resources you can be sure the information is the right information for the patient [http://nursesaregreat.com/articles/rrfh.htm].  The ICSI Health Care Guideline was designed to assist clinicians by providing an analytical framework for the evaluation and treatment of patients, and is not intended either to replace a clinician’s judgment or to establish a protocol for all patients with a particular condition.  The guideline outlines the existing evidence for the effectiveness of strategies and programs designed to help adults successfully make essential changes to achieve healthier lifestyles (increased physical activity, improved nutrition, decreased tobacco use and exposure, decreased hazardous and harmful drinking/alcohol use). It also outlines how these programs might be integrated into preventive services in health care systems, which traditionally have focused on early detection of disease or treatment of risk factors rather than preventing the onset of risk factors. Nearly all individuals would derive measurable benefits from healthier lifestyles; even small improvements across a large portion of the population would have a greater impact than focusing on a small portion of the population that is at the upper end of the risk distribution. Therefore, the target population for this guideline includes all adults (age 18 and older) in the community, irrespective of their utilization of the health care system. Although this guideline focuses on adults, adolescents and children may benefit from many of the components or recommendations in this guideline [http://www.icsi.org/chronic_disease_risk_factors__primary_prevention_of__guideline__23506/chronic_disease_risk_factors__primary_prevention_of__guideline__23508.html]. Nurse practitioners should follow these guidelines to create a successful educational plan for their patients.  They should teach the following four lifestyle behaviors – 1.    adequate physical activity 2.    a diet that emphasizes fruits and vegetables 3.    abstinence from tobacco and avoidance of tobacco smoke 4.    avoidance of hazardous and harmful drinking These are associated with a decade or more of increased life expectancy. Individuals, who adopt this lifestyle, at any age, have significantly lower total mortality rates [http://www.icsi.org/chronic_disease_risk_factors__primary_prevention_of__guideline__23506/chronic_disease_risk_factors__primary_prevention_of__guideline__23508.html]. After you begin your teaching plan it is important for compliance and success to evaluate where you are. This allows you and the patient to reset goals and stay on target. It will ensure greater success (Patient Teaching, 2001). Evaluation of lifestyle changes should be part of each visit to help the patient stay on track. Follow-up visits are planned based on patient needs. For example if you have a patient with elevated blood pressure and you are using lifestyle modification as an initial treatment plan you may want an every two week follow-up. For many patients a more realistic follow up is monthly. Evaluation and revision of the teaching plan is part of every visit [http://nursesaregreat.com/articles/rrfh.htm].

Exploring the role of the nurse in preventing and controlling risks factors in cardiovascular disease

E xploring the role of the nurse in preventing and controlling risks factors in cardiovascular disease Nurses are in a unique positi...

Carer's Manual: The Centacare Out of Home Care Programme

Foster care programme   Centacare Wollongong Diocese (Illawarra and Macarthur) Out of Home Care Programme The Centacare Out of Home Care Programme offers a variety of services for children. The Programme puts an emphasis on the care of child(ren)/young people to maintain relationships particularly with their birth family. A birth family is simply defined as ‘a family consisting of parents and their biological offspring.’ There are two fundamental children care services provided by the Programme: respite and crisis which is further subdivided as short term care and long term care. Respite Care Respite Care is provided to assist carers and birth parents with high needs to maintain a stable home environment for the child(ren)/young person. Respite care may involve either: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	 	Planned weekend or midweek care for child(ren)/young person, especially 	those with challenging behaviour, whose birth families have little support 	in the community or</li> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	 	Planned respite care for child(ren)/young people already in the Out of Home 	Care  living with Foster Carers in Short Term of Long Term Care. 	</li> </ul>   Crisis Care This service provides family-based care when a crisis, illness or emergency in a child’s birth family temporarily prevents that family from caring for the child(ren)/young person.  This care is normally from one to seven days. Wherever possible, the placement is in the same vicinity as the child’s usual place of residence to enable the least disruption of the child’s education and social activities. If appropriate, contact with the birth family is maintained by face-to-face visits and telephone that are organized by the Centacare Caseworker. If a child(ren)/young person were then transferred to the Short or Long Term Care Programmes, wherever possible, the child/young person will remain with the same carers. This is particularly considered in situations that require Short Term Care. Short Term Care Short Term Care usually involves placement of a child while court action is proceeding and is usually for periods of one week to six months. Where possible, support is provided to the birth family during this period to facilitate restoration and this is organized by the Department of Community Services. A child or young person may be placed in the Long Term Care once they have completed a temporary care period.  Long Term Care There are times when Children’s Court will decide that it is in the best interest of a child(ren)/young person to remain in Out of Home Care until 18 years of age. The aim of Centacare’s Long Term Care is to provide the child(ren)/young person with high quality care that meets his/her physical, emotional, social and spiritual needs in a stable and consistent environment. Generally children are between 0-12 years when they come into Centacare’s Out of Home Care Programme however, there are children in our care up to the age of 18 years.   From placement      Department of Community Services (DoCS) Simply DoCs, the core roles and responsibilities will include: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	provide information and ongoing training to assist foster carers in their 	role;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	provide timely responses to requests for financial and other support;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	ensure placements are culturally appropriate;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	lead 	the development, implementation and review of the child or young person’s 	case plan;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	ensure foster carers and other agency workers involved with the child or 	young person contribute to the development and implementation of the case 	plan; </li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	in 	conjunction with the foster carer, work with the child or young person to 	ensure they understand their situation and their needs are being met in the 	placement;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	listen to, record and respond to information provided by foster carers and 	other agencies concerning the child or young person;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	investigate and assess notifications of abuse or neglect; and</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	oversee contact between children and young people, birth families and 	significant others.</li> </ul>   Caseworker Primarily, it will be Centacare caseworkers’ role to act in the best interest of the child(ren) and young people. Other roles include: 1)      Centacare will also have a role to advocate on behalf of the child(ren)/young person and carers and to with the child’s birth family members, to co-ordinate and monitor contact arrangements. 2)      Centacare shall ensure that quality of life is maintained and promoted both for carers and people given care to. For children, this will reflect in implementation of a proactive, multifaceted Care Plan. 3)      Centacare must ensure participation in the Life Story Work and give carers ideas to assist you and work in partnership with you to continually support you the carer. 4)      Centacare has a commitment to ongoing training of all staff, and foster carers. We have a strong belief that training is an important part of a foster carer’s work, it is a way of providing information, skill development and of keeping foster carers up to date with policy issues and program developments. 5)      Centacare also has a responsibility in liaising with other organizations especially the Department of Community Services.   Child(ren) Foster Carer Whilst the needs of the child must at all times be our primary consideration, the focus of the worker’s support will be with the family unit. The primary role of the Centacare Carer is to assist the birth family. Along with this role are specific activities which include: ·         It is essential that the Centacare Carers should support the child(ren)/young person with their birth families. ·         It is the Centacare Carers role to create an environment where they belong to two families, your family and their birth family. ·         It is the Centacare Carers to develop understanding of the birth family issues and share the load of their feelings and frustrations without affecting their work with the child or young person in their care through interfacing with caseworker. ·         It is the Centacare Carers duty to inform the caseworker of the benefits and struggles of the child’s emotions and behaviours before-during and after contact. ·         It is also an obligation of the Centacare Carers to involve young people in decisions about contact and their wishes respected. ·         It is critical for Centacare Carers to have a neutral opinion and convey a non-judgmental approach to the birth family to the child(ren)/young person in their care. ·         It is the Centacare Carer’s task to contact visits which can help a child(ren)/young person to confront and deal with the reality of separation from their birth families.   Case Meetings Case meetings will be held at least annually. These will be formal meetings which may be called at other critical stages of the young person’s placement and held at venues where care plan could be developed modified and agreed upon by all parties. Representatives from DoCS will be invited to attend all case meetings. The child(ren)/young person, the Carer, the Centacare caseworker, and the Manager as well as the birth parents will be also invited to attend the case meetings. Other professionals who can provide helpful information to the meeting may also be invited or reports from them will be sought.   At each case meeting, there will be a pre-formulated Case Plan, a document that is agreed and signed by all parties involved with the child(ren)/young person’s care plan. This plan sets out goals to be achieved by all parties until the next case conference. Aside from the child(ren)/young person, all stakeholders must work towards ‘the best interest of the child’.    In incidences when differences will occurs, we recommend that such differences shall be discussed with respective caseworker(s).   Caseworker: DoCS and Foster Carer Health Child(ren)/young person are entitled to receive standard of car which will meet their individual health, medical, optical and dental needs. There are two responsibilities of the foster carers when it comes to the health and wellbeing of child(ren)/young person. First, foster carers should meet the day to day health and medical needs of child(ren)/young person in their care. Second, carers are also responsible to contact a caseworker in the case that serious accidents or illness involving the child(ren)/young person under care and attain approval for necessary treatments. Outlines of health and medical needs of child(ren)/young person and how these will be addressed must be available in their case plans. Their third responsibility would be to keep a health record while the child(ren)/young person is under care.   DoCS is responsible in ensuring that child(ren)/young person under care are protected especially when it comes to immunisation based on the requirements of NSW Department of Health Immunisation Schedule. DoCS could make necessary inoculation decisions in behalf of child(ren)/young person. DoCS could also keep a record of the child(ren)/young person health books.     Education Education is an important part of child(ren)/young person. But for these child(ren)/young person undergoing out of home care programme, education would be inevitably disrupted. According to Foster Care Resource Guide: Caseworkers and carers need to give extra attention to educational needs to ensure that the child or young person remains engaged with school, has a positive educational experience and that barriers to learning are addressed. DoCs developed a Memorandum of Understanding with the Department of Education and Training (DET) with respect to educational issues of child(ren)/young person. Under this Memorandum, the carers have the following responsibilities: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> 	<li class="MsoNormal" style="color: black; line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	share 	information so that all parties are aware of what is happening for the child 	or young person in relation to their education;</li> 	<li class="MsoNormal" style="color: black; line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	be 	involved in the planning process to meet the child or young person’s 	education needs;</li> 	<li class="MsoNormal" style="color: black; line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	advise a caseworker if there are any educational or behavioural difficulties 	at school, especially if there is a likelihood of any disciplinary action by 	the school;</li> 	<li class="MsoNormal" style="color: black; line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	work 	with a caseworker and the school to help the child or young person to 	resolve any difficulties that may arise; and</li> 	<li class="MsoNormal" style="color: black; line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	advise the school when the child or young person leaves your care.</li> </ul>   Keeping connection with both families: Contact visit/Access programme Contact with birth family members is usually arranged through your caseworker or case manager. The effect of contact should be closely monitored and assistance given if difficulties arise as well as understanding their grief reactions after contact. In the event of any unarranged direct contact from birth family members, you must refer that person directly to the caseworker. It is important to note that contact visits and/or access arrangements will be documented in the child(ren)/young person’s Care Plan.  Some explanations for this arrangement are as follows: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	A 	child(ren)/young person’s sense of identity, self-worth helps them make 	sense of their being and personal history.</li> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	Helps 	eliminate unreasonable fantasies the child(ren)young person may have about 	their birth families.</li> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	 	Continuity of relationship between the child(ren)/young person and birth 	family can be maintained.</li> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	 	Positive ongoing contact needs to be encouraged and supported by caseworkers 	and the carers.</li> </ul>   Behaviour management Child(ren)/young person who do not experience consistent parenting may elicit difficult or challenging behaviours. As such, carers need to have the skill to understand and manage child(ren)/young person behaviour. Foster carers are responsible for correcting and managing behaviours with reference to the Code of Conduct for Authorized Carers which states that not physically coerce or physically punish a child or young person”. As such, under legislation including Children and Young Persons (Care and Protection) Act 1998, corporal punishment, punishment that takes the form of immobilization, force feeding or depriving of food, or any punishment that is intended to humiliate or frighten a child or young person are not tolerated. There are specific principles that could be followed in order to modify the behaviour of child(ren)/young person in care such as: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	reward acceptable behaviour ;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	where 	possible  ignore unwanted behaviour;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	model 	new or desirable behaviour;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	set 	realistic limits, but avoid power struggles;</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	 	provide positive instruction on new ways to behave; and</li> 	<li class="MsoNormal" style="line-height: 200%; text-autospace: none; margin-bottom: .0001pt"> 	do 	not reject the child or young person because of their behaviour.</li> </ul>   DoCS has the responsibility to approve a behaviour management plan as part of the child’s case plan. A behaviour management plan refers to a plan detailing behaviour management strategies (where these are required) developed by the caseworker in consultation with the child or young person, their carer, parents (where appropriate) and relevant specialists. The case plan shall detail behaviour management strategies intended for the child(ren)/young person.      Privacy and confidentiality Recording of notes and telephone conversations Carers play an important role in the process of gathering information about child(ren)/young person in your care. Foster carers are required to document observations especially that they often know more about a child (habits, likes and dislikes, current worries and wisher for the future) than many of the other professionals involved with them.   Writing in a diary kept especially for this task can be useful.  Facts should be recorded rather than opinion. It is useful to record what behaviour is being displayed, any appointments, meetings, contact visits and external visits by your child(ren)/young person. This information is useful when identifying positive gains, achievements and difficulties that can be utilized at review meetings regarding the child(ren)/young person’s progress in your care. As such, records will help to: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	 	recall accurate behaviour and/or incidents, positive or negative;</li> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	 	assist in looking at the progress of the child(ren)/young person’s 	placement; </li> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	 	develop a picture over time of the child(ren)/young person’s pattern of 	behaviour in various situations;</li> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	 	provides information needed for your caseworker; and</li> 	<li class="MsoNormal" style="line-height: 200%; margin-bottom: .0001pt"> 	 	support an application for additional help.</li> </ul>   File keeping Carers are part of a professional team working towards a specific goal. Respect for children’s background and privacy. As such it is essential to respect the child and families right to confidentiality. When you applied to become a Foster Carer for Centacare, the Out of Home Care Team commenced a file about your family. It is important to remember that only you and Centacare staff (on a need to know basis) have the right of access to your file. Centacare has an “open file policy”, which means you have free access to your file. A few examples of what is kept in that file are:  ·         Assessment details ·         Reports ·         Reviews and any record of incidents that may occur ·         If you have attended any training ·         Names of your birth children ·         Information on any previous children that may have been n your care ·         Conversations between yourself and the caseworker. ·         Also information about the child(ren) in your care are kept in the file   On the part of the child(ren)/young person, file keeping was covered in the Looking After Children Project (LAC) wherein the goal is to maintain health and well-being information. LAC introduces a comprehensive system of recording information and directing practice for child(ren)/young person in your care such as providing supervisory tools for caseworkers.  In lieu with this, the caseworker was given the responsibility to assist with the project hence: 1) vides a record of the care and management of the child in Out of Home Care; 2) ensure accountability to management of files/documents; and 3) document case notes based on LAC requirements.   Reportable conduct A child placement concern report must be accomplished whenever there is child(ren)/young person undergoing and or is/are going through the process of placement. This should be discussed with the DoCS so that they can conduct the necessary investigation and assessment of the placement. The latter is a more legitimate response from the authority compared to an informal meeting. Nevertheless, investigation and assessment are only conducted when the child may have experienced or may be experiencing harm in out of home care. Decisions will be made by the Community Service Officer and if outcomes proved that there is breach of standards, action plan will be implemented for the out of home care to meet the standards.   Disclosure of abuse by child When allegations are made against carer and/or Centacare The vulnerability of carers to false allegations is recognized by Centacare as this may be results of the child’s previous experience of abuse. When allegations of abuse are made against carer and/or Centarcare, There are two processes that take place: 1st – Any child at risk of harm must be reported to the Department of Community Services. 2nd – The New South Wales Ombudsman Act will require that the allegation to be investigated.   All allegations of abuse in care have to be reported to the DoCS to ensure that they are dealt with both promptly and appropriately.  The need to ensure the immediate safety of the child is the over- riding consideration in all allegations of abuse. Prompt attention must be given to the need to protect the child and to advocate on behalf of the child.   A carer, further, must be aware of the procedure if allegations of abuse are made against him/her.  It is also necessary to be aware of the needs of the child so that the issues are not a surprise to you should an allegation be made.   Ending a placement There are three primary reasons where placement could be ended: reunification with their family, need to move to an alternative placement and need to move to independent living to prepare child(ren)/young person to adulthood. As a carer, it is important to encourage the child(ren)/young person to be positive about the issue and help in making it as a comfortable experience as possible. Carers are not encouraged to have an ongoing contact with child(ren)/young person who left his/her care. Nonetheless, this may be discussed when that time comes. Plans of leaving, according to Children and Young Persons (Care and Protection) Act 1998, must be developed in consultation with the child(ren)/young person.   Reference: Foster Care Resource Guide. (2006). NSW Department of Community Service.

Carer's Manual: The Centacare Out of Home Care Programme

Foster care programme Centacare Wollongong Diocese (Illawarra and Macarthur) Out of Home Care Programme The Centacare Out of Home ...

Comparison Paper – Health Care In Houston

Health Care in Houston “To be a leader and advocate in creating exemplary health care services, processes and structures that improve the health of the local and global communities so all may experience God’s healing presence and love.” – Christus Health The idea of health care is considered synonymous with hospital care and there are many non-profit hospitals have well established foundations with a long history of raising money. The inspiration of many individuals to contribute something in building additional facilities and acquiring high technology, like scanners, are especially for health care system. Aside from this, there are many challenges that are in line when there is an attempt to create some improvement on health care. Maintaining a nation’s health care systems is impossible when the institution is only fed by philanthropic mission. Every hospital wants to have a high-tech care to be available to them when needed. These findings are based on the fact that hospital-based care is usually not the cost-effective care because of the limited available machines. And because of this and the other serious reason, the private health care providers should collaborate with public or community health workers to improve health status. The knowledge about the health must be integrated and promotion should not stop. Health promotion and disease prevention and management must become an integral component in delivering appropriate health care. A single health system may not be able to measure the benefit of all the programs planned each year, but the whole society must gain from it. Houston HealthWays – A Public Health Provider Progress in the public health is the spirit of Houston HealthWays, an information provider that promotes the consumer health. Houston HealthWays replaced the Texas HaelthInfo and can be access through a Web page in which there are many certified contributed partners.  Houston’s public health organization has a goal to improve health information services to public health professionals and consumer through an active outreach program. Their objectives is to develop an aggressive outreach public relations campaign to inform public health workers, staff of health agencies, and related consumers of the available health information products and services. Another is to provide an outreach training program to reach the targeted community of practicing public health workers. And the last is to provide health information resources to public health professionals by coordinating and developing public health web page, which became success, with emphasis on Houston, Gulf Coast, and Texas information. Since the existence of technology has been widely used, it is not impossible for the common public health to have access on the computer equipment and on the Internet. Christus Health – A Community Health Provider The community health system is for the people in the area or group of people who live in the same area in which they shared the common interests within the society. And the need for health service in Houston communities was answered by not-for-profit health care organizations. The faith-based and other not-for-profit organizations have a long and rich tradition of providing community benefit (Cave, Jokerst, Meyer, and Swasko, 2008). However, the public understanding improvement and the other information will strengthen community coalitions by highlighting the work of partnership. Furthermore, the public health will contribute for the entire health care system by providing information and in return, the community health providers will plan for the community benefit. Conclusion Distributing the awareness and information is not easy but as long as the organization is fed by the presence of helping or improving the quality of life of every individual, their goal will be attained, maybe not now but in the near future. The collaboration of the available technologies and philanthropic mind, the efforts to establish a successful health care service is possible. Health is the most precious treasure that every individual wants to have and the only thing that keeps the people away from this mindset is the misinformation or lack of information about the diseases – whether it is rare disease or chronic illness. The first step to reach their goal might be crucial and the process might be critical. The need for support is highly anticipated but with the contribution of every health workers from both public health and community health, the health care system will find some advantage. References: Beck, R., (Dir.), (2000). Houston Academy of Medicine – Texas Medical Center Library, Annual Report. Accessed 18 Nov 2009, from http://www.library.tmc.edu/docs/ar2000Z.pdf. Cave, L., Jokerst, C., Meyer, D., & Swasko, (2008). Philanthropy Makes A Difference. Christus Health Reaps the Benefits of Its Successful Community Efforts in Southern Texas. Accessed 18 Nov 2009, from http://www.chausa.org/NR/rdonlyres/FCC27392-F566-4266-89DC-38283AD5168E/0/Feature_Cave_Swasko_etal.pdf Halstead, D., (2000). Houston HealthWays. Public Health Outreach Project Description. Accessed 18 Nov 2009, from http://phpartners.org/pdf/projects/hamtc.pdf.     Credit:ivythesis.typepad.com

Comparison Paper – Health Care In Houston

Health Care in Houston “To be a leader and advocate in creating exemplary health care services, processes and structures that improve th...

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