Search

Background In response to the COVID-19 pandemic, many health care organizations have adopted telehealth. The current literature on transitioning to telehealth has mostly been from large health care or specialty care organizations, with limited data from safety net or community clinics. Objective This is a case report on the rapid implementation of a telehealth hub at an academic nurse-managed community clinic in response to the national COVID-19 emergency. We also identify factors of success and challenges associated with the transition to telehealth. Methods This study was conducted at the George Mason University Mason and Partners clinic, which serves the dual mission of caring for community clinic patients and providing health professional education. We interviewed the leadership team of Mason and Partners clinics and summarized our findings. Results Mason and Partners clinics reacted quickly to the COVID-19 crisis and transitioned to telehealth within 2 weeks of the statewide lockdown. Protocols were developed for a coordination hub, a main patient triage and appointment telephone line, a step-by-step flowchart of clinical procedure, and a team structure with clearly defined work roles and backups. The clinics were able to maintain most of its clinical service and health education functions while adapting to new clinic duties that arose during the pandemic. Conclusions The experiences learned from the Mason and Partners clinics are transferable to other safety net clinics and academic nurse-led community clinics. The changes arising from the pandemic have resulted in sustainable procedures, and these changes will have a long-term impact on health care delivery and training.

This study investigated the manner in which early adolescents ‘(aged 12–15) and late adolescents' (aged 16–18) levels of self-esteem were related to both their perceptions of their family environment and their perceptions of their levels of attachment with their parents. Results indicated that early adolescents' self-esteem was related to their patterns of attachment with their caregivers, whereas late adolescents' levels of self-esteem was more related to specific aspects of their family environment. This pattern of findings was taken to be consistent with Haan's (1981) and Stewart's (1982) position that early adolescents' were engaged in information-seeking (assimilation of new information) while late adolescents’ were attempting to integrate (or accommodate) information to form an adult identity.

The Stó:lō are a group of approximately 28 different communities, which share a common language and culture in what is now generally known as the Lower Fraser Valley of southwestern British Columbia. Between 1864 and 1874, Stó:lō and neighbouring tribes presented four petitions to the colonial and (after 1871) federal government. The survival of so many Indigenous texts from this era that speak directly to the state offers a rare interpretive opportunity. In a relatively brief period of time, colonial and then provincial authorities rapidly obtained increased control over both lands and people in the emerging province. Simultaneously, Halkomelem-speaking peoples in the region swiftly developed new cultural literacies, among which was a facility with one of the central technologies of settler power: writing. As we will see in the following discussion, the earliest forms of Indigenous writing we have for this period are about land and Stó:lō peoples’ relationships with settler authorities. This series of petitions traces an important shift in settler-Indigenous relations, while also revealing a great deal about Indigenous ideas around literacy and how settler appropriation of Stó:lō land was challenged from the very earliest days. Throughout, a focus on story demonstrates how the struggles over land that have characterized Indigenous-state relations in British Columbia are also, inextricably, a struggle for narrative power., La nation des Stó:lōs réunit quelque 28 collectivités différentes, qui partagent une langue et une culture communes dans la région connue généralement sous le nom de la vallée du bas Fraser, dans le sud-ouest de la Colombie-Britannique. De 1864 à 1874, les Stó:lōs et les nations voisines ont présenté quatre pétitions au gouvernement colonial et (après 1871) fédéral. La survie d’autant de textes autochtones qui s’adressent directement à l’État ouvre une rare fenêtre sur cette époque. En relativement peu de temps, les autorités coloniales puis provinciales ont pu accroître leur emprise sur les terres et les peuples de cette province naissante. Au même moment, les peuples de la région parlant la langue halkomelem ont rapidement acquis de nouvelles compétences culturelles, dont une aisance à manier l’une des techniques centrales du pouvoir des colons : l’écriture. Nous verrons dans l’analyse qui suit que les premiers écrits autochtones dont nous disposons pour cette période portent sur les terres et les relations des Stó:lōs avec les autorités. La série de pétitions marque un changement important dans les relations entre les colons et les Autochtones, mais elle en dit aussi long sur ce que pensaient ces derniers de l’écriture et sur le fait que l’appropriation des terres des Stó:lōs par les colons a été contestée dès les débuts. Tout du long, on peut voir que les luttes pour les terres qui ont caractérisé les relations entre les Autochtones et l’État en Colombie-Britannique sont aussi inextricablement liées à une lutte de pouvoir pour dominer le discours public.