Marie E. Cowart

Health Promotion for Older Rural African Americans: Implications for Social and Public Policy

Specialized health promotion programs are essential for older African Americans because of the increased health risks that this population faces. Since 1983, we developed and provided specialized health promotion programs to older rural minority populations in North Florida. Using a modified Planned Approach to Community Health (P.A.T.C.H.) promotion development model, these programs attempt to empower the local population to assess and pnoritize their health needs and to improve their own level of health. From our experience evolved social and public policy recommendations that encompass cultural acceptability, state and federal support of local control and leadership, reinforced family structures, and access to services. The ultimate goal of our recommendations was to lower disability and improve life expectancy.

Health Promotion in Southern Rural Black Churches: A Program Model

Abstract Described are initial organizational processes for a Southern, rural, African-American church-based health promotion program. Criteria for selection of churches included a supportive pastor and church decision makers, as well as an enthusiastic church health committee of six to 10members. Church health committees participated in a six week training program where they planned their individual programs considering individual needs and available resources using an action plan format. Successful programs generally included direct instruction; Quarterly Health Sundays; integration of health activities into other church structures; limited screening activities; and community awareness activities.

Demographic transition and population aging with Caribbean nation states

This paper considers the role which the demographic parameters of fertility, mortality and migration will play on the pace and concentration of aging within the context of a developing region. This paper examines the demographic transition and analyzes historic and projected data for the development patterns of the anglophone nation states of the Caribbean. Trends in fertility, mortality, and migration are contrasted among the larger (Guyana, Jamaica, Trinidad/Tobago), mid-sized (Bahamas, Barbados, Belize) and smaller (Antigua/Barbuda, Dominica, Grenada, St Kitts/Nevis, St Lucia, and St Vincent/Grenadines) states. The paper then goes on to consider shifts in the structure of population at older ages due to the decline in fertility and mortality and points to some of the policy considerations that these relatively small and newly independent states will need to deal with during the next several decades.

Jackson county partnership: developing an effective coalition.

The Community Partnership Demonstration Program allows a community to develop and carry out a long-range, comprehensive, and self-sustaining alcohol and other drug abuse prevention program. A case study that shows the use of coalition building to carry out a prevention program is presented. The case study is followed by a discussion of the principles involved in forming and maintaining a coalition. Discussion about using the coalition method for implementing health promotion and prevention programs in rural or underserved communities and the important role that health educators can play follow.

Implementation and impact of the Patient Self Determination Act : preliminary survey and proposals for change

To promote advance medical directives, which the U.S. Supreme Court encouraged in Cruzan v. Director, Missouri Department of Health, Congress enacted the Patient Self Determination Act (PSDA). The law requires various medical facilities to inform patients of their rights under state law to execute advance medical directives. Results from in-depth interviews with hospital and nursing home administrators, however, reveal that although the law has been implemented, it is having little practical effect on patients and residents. Other requirements of the law also are being carried out with different amounts of energy. A different orientation for policymakers, medical institutions, and adult consumers to the right to die may be more effective than the current law.

A Community Organization—Peer Facilitated Senior Citizen Health Promotion Program

This project addressed hypertension, considering the variables of exercise, weight, blood pressure measurement, medication compliance, and nutritional practices while incorporating principles of self-responsibility for health. Major intervention activities included a three-times weekly exercise program; weekly weigh-ins; bi-weekly blood pressure checks; physician referral for anti-hypertensive prescriptions/maintenance; diet instruction; and peer facilitated health educational activities. Additionally, community support and project volunteers were obtained via various community organization strategies, such as community meetings, newspaper articles, or from advisory board activities. Major “everyday grass roots” responsibilities for program implementation were carried out by a peer senior citizen community organizer and a peer senior citizen health educator, with strong guidance from the Area Agency on Aging. Evaluation activities were based on the measurable impact and process objectives. T-tests were used to analyze weight and blood pressure pre-post data for the seventeen mostly female clients with an age range of sixty-four to eighty-eight and a mean age of seventy-five. T-values for weight, systolic blood pressure, and diastolic blood pressure were 21.02, 2.09, and 11.08, respectively, indicating significance (.00 or .05 level). Lastly, fourteen individuals lost a total of eighty-nine pounds; six individuals were able to re-enter acceptable blood pressure limits; and participants are accepting greater responsibility for their own health.

Nurses in the workplace

Preface - James Bracher Introduction - Marie E Cowart and William J Serow Perspectives on Nursing Personnel in the 1980s - Susan A Carlson, Marie E Cowart and Dianne L Speake Political Climate and Approach to Policy Analysis - Marie E Cowart et al State Policies and Legislation - Dianne L Speake Supply and Demand Trends - William J Serow The Education of Nurses - Dianne L Speake Hospital Perspectives on Nurse Employment - William J Serow, Marie E Cowart and Yen Chen Nurses Work in Nursing Homes - Marie E Cowart Community Employment Settings for Nurses - Marie E Cowart and Dianne L Speake Supplemental Nursing Staff - Marie E Cowart and Dianne L Speake Retention and Recruitment of Nursing Personnel - Winifred H Schmeling The Competitive Employment Market for Nurses - William J Serow and Marie E Cowart An Action Plan for Nurse Executives - Charlotte Dison Changes in Institutional-Care Delivery - Peter J Levin and Barbara J Clark The New Role of the Nursing Professional in the Redesigned Workplace The Policy Agenda - Marie E Cowart and William J Serow

Taiwan and Its Elderly: Taxi Nurses and Home Care

A home health care service in the newly industrializing country of Taiwan has some of the features of home care services in the United States, but also has developed some qualities that make it unique to the local culture. While services provided and the role of the nurse were somewhat similar, payment mechanisms and transportation differed. This case study shows how a newly industrializing countryfaced with a rapidly increasing proportion of older citizens is adapting its social services and health system to the increasing demands of an aging society.