Characteristics of volunteers and families in a neonatal home visitation project: the Kempe Community Caring Program

OBJECTIVE

The purpose of this paper is to review literature related to home visitation support for new families using volunteer visitors and to describe characteristics of volunteers of the Kempe Community Caring Program, a home visitor support program for first time parents. Suggestions for effectively utilizing volunteers in family support programs are made.

METHOD

Program data was collected and reviewed on 592 volunteer home visitors and the 1,144 families they served. Several evaluations and assessments were performed in order to attempt to measure the success of the intervention. Motivation for volunteering, longevity with program, and the extent of sociodemographic match between visitor and client were reviewed and discussed.

RESULTS

Information on matched volunteer-client pairs was limited; however, speculations were made that neither motivation to participate nor sociodemographic match were critical factors in determining success of the intervention. Duration of volunteer participation was influenced by marital status, but not by age. Married volunteers stayed with the program significantly longer than unmarried volunteers. Low risk families demonstrated slightly improved confidence in parental function after receiving home visitation by a volunteer.

CONCLUSION

This program suggests that new mothers may benefit from receiving the services of a volunteer home visitor; specifically, their confidence as parents and ability to establish positive relationships show slight improvement. Likewise, volunteers and families felt satisfied with the supportive relationships generated. In addition, a volunteer profile emerged which may be beneficial to similar programs' recruiting efforts.

Haematoma block or Bier's block for Colles' fracture reduction in the accident and emergency department--which is best?

OBJECTIVE

To offer clear guidance on the anaesthetic management of Colles' fractures in the accident and emergency (A&E) department in the light of the conflict between existing reports and current trends, and to address the issue of alkalinisation of haematoma blocks.

METHODS

This was a two centre, prospective, randomised clinical trial with consecutive recruitment of adult patients with Colles' fractures requiring manipulation to receive either Bier's block or haematoma block. There was subsequent blinded randomisation to alkalinised or non-alkalinised haematoma block.

RESULTS

72 patients were recruited into the Bier's block group, and 70 into the haematoma block group. Bier's block was less painful to give than the haematoma block (median pain score 2.8 v 5.3; P << 0.001), and fracture manipulation was also less painful in the Bier's block group (median pain score 1.5 v 3.0; P < 0.01). There was no significant difference in overall A&E transit time between the two groups. There was better initial radiological outcome in terms of dorsal angulation in the Bier's block group (-3.6 degrees v 2.1 degrees; P = 0.003). More remanipulations were required in the haematoma block group (17/70 v 4/72; P = 0.003). There was a trend towards decreased pain on administration of the alkalinised haematoma block when compared with non-alkalinised haematoma block, but this did not reach significance. There was no difference in pain score on fracture manipulation. There were no complications in either group.

CONCLUSIONS

Bier's block is superior to haematoma block in terms of efficacy, radiological result, and remanipulation rate; transit times are equal, both procedures are practical in the A&E environment, and there were no complications. Bier's block is the anaesthetic management of choice for Colles' fractures requiring manipulation within the A&E department.