Supporting and maximizing communication between individuals with intellectual disabilities and health care providers

The goal of the present study was to examine the barriers to access in health services faced by individuals with intellectual disabilities (ID), as well as the nature of communication between people with ID and those who are directly involved in supporting their health and well being. The study included in-depth interviews with five adults who have been identified as having ID and are supported by a community agency, five community agency support staff and four physicians who are specialists in supporting people who have ID. A qualitative content analysis approach facilitated the comparative exploration of key themes that each participant group saw as positive or negative influences on health care access and on effective health care communication. Themes drawn from the findings emphasize the unique roles each of these groups plays within the dialogical framework of the health care encounter. Of particular importance to informants was the issue of people with ID being seen as full participants in their own health care who, like all people, are unique individuals and not simply members of an identified or marginalized group. Participants across groups emphasized the need for the health care recipient to be known as an individual who is an expert in her/his own health and well being and, therefore, entitled to full participation with the support of but not control by others.

Message from the President of the United States, transmitting copies of a convention concluded at St. Petersburg, the 12th day of July, 1822, under the mediation of the Emperor of all the Russias, between the United States of America and His Britannic Majesty. --

United States. 18th Congress, 1st session, 1823-1824. House. Doc. no. 30.

Report of the Committee appointed to inquire into the Present condition and distribution of the flags, standards and colors, which have been taken by the forces of the United States from their enemies, and whether it would be expedient to make any provision in relation to them.--

Adam Seybet, Chairman.

The Flags, Standards and Colors Taken by the Forces of the United States

Full Title: Report of the Committee appointed to inquire into the Present condition and distribution of the flags, standards and colors, which have been taken by the forces of the United States from their enemies, and whether it would be expedient to make any provision in relation to them Adam Seybet, Chairman. Exhibit folded at end of text. February 4, 1814. Read, and committed to a committee of the whole House on Monday next. Printed by A and G Way

Message from the President of the United States to both Houses of Congress at the commencement of the second session of the twelfth Congress

November 4, 1812. Read, and ordered to be printed. Includes Documents accompanying the Message of the President of the United States to the two Houses of Congress, at the opening of the second session of the twelfth Congress United States. 12th Congress, 2nd session, 1812-1813. House.; United States. 12th Congress, 2nd session, 1812-1813. Senate.; United States. Congress. House.; United States. Congress. Senate. Printed by A. and C. Way

Message from the President of the United States, transmitting copies of a convention concluded at St. Petersburg, the 12th day of July, 1822

Full Title: Message from the President of the United States, transmitting copies of a convention concluded at St. Petersburg, the 12th day of July, 1822, under the mediation of the Emperor of all the Russias, between the United States of America and His Britannic Majesty. United States. 18th Congress, 1st session, 1823-1824. House. Doc. no. 30. January 25, 1823. Read and referred to the Committee on Ways and Means. Printed by Gales and Seaton

Sustaining Health Care Practice Change: The Experience of Best Practice Spotlight Organizations Implementing and Sustaining RNAO Best Practice Guidelines

Sustainability of change for improvement initiatives has been widely reported as a global challenge both within and outside health care settings. The purpose of this study was to examine the extent to which factors related to staff training and involvement, staff behaviour, and clinical leaders’ and senior leaders’ engagement and support impact the long term sustainability of practice changes for BPSO health care organizations who have implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines. Semi structured interviews with eleven organizational leaders’ from ten health care organizations were conducted to explore the unique experiences, views and perspectives on factors related to staff, clinical leaders and senior leaders and their involvement and impact on the long term sustainability of clinical practice changes within organizations who had implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs). The interviews were coded and analyzed using thematic content analysis. Further analysis identified patterns and themes in relation to: 1. The National Health Service (NHS) Sustainability Model which was used as the theoretical framework for this research; and 2. Organizations found to have sustained practice changes longer term verses organizations that did not. Six organizations were found to have sustained practice changes while the remaining four were found to have been unsuccessful in their efforts to sustain the changes. Five major findings in relation to sustainability emerged from this study. First is the importance of early and sustained engagement and frontline staff, managers, and clinical leaders in planning, implementation and ongoing development of BPGs through use of working groups and champions models. Second is the importance of ongoing provision of formal training, tools and resources to all key stakeholders during and after the implementation phase and efforts made to embed changes in current processes whenever possible to ensure sustainability. Third is to ensure staff and management are receptive to the proposed change(s) and/or have been given the necessary background information and rationale so they understand and can support the need for the change. Fourth is the need for early and sustained fiscal and human resources dedicated to supporting BPG implementation and the ongoing use of the BPGs already in place. Fifth is ensuring clinical leaders are trusted, influential, respected and seen as clinical resources by frontline staff. The significance of this study lies in a greater understanding of the influence and impact of factors related to staff on the long term sustainability of implemented practice changes within health care organizations. This study has implications for clinical practice, policy, education and research in relation to sustainability in health care.