The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers' ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care's 'culture of documentation'. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers' burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures.

Purpose – The purpose of this paper is to examine the relationship between trust and burnout among mental health professionals working within a forensic psychiatric setting. The association between these factors and boundary violations was also examined. Design/methodology/approach – Mental health professionals (n=117) completed the Maslach Burnout Inventory and a measure of their trust in co-workers. A series of 12 vignettes was also designed to assess the frequency and impact of boundary violations by clients. Findings – Propensity to trust was found to be predictive of personal accomplishment. A higher propensity to trust others was associated with lower levels of emotional exhaustion and depersonalisation. It was also associated with greater cooperative behaviour. Higher frequency of boundary violations reported by professionals was associated with lower levels of perceived trust and cooperative behaviours among colleagues, and increased depersonalisation. In addition, professionals reporting more of a perceived impact of boundary violations, reported higher emotional exhaustion and depersonalisation. The results also indicate that younger professionals reported higher levels of emotional exhaustion and depersonalisation, whereas older professionals were more positive regarding their competence and sense of accomplishment. Research limitations/implications – The results are discussed in terms of the development of trust within teams as an effective strategy to reduce the development of burnout. Implications are made for the importance of reflective practice and clinical supervision in developing positive working relationships with clients, and providing a safe environment to discuss professional conflict. The importance of supporting younger professionals has also been highlighted. Originality/value – This is the first research paper to explore the relationship between trust within teams and the development of burnout within forensic psychiatric services.

Purpose: To examine information exchange by physiotherapists during care handoffs of patients with hip fracture in a rural health care setting. Methods: This qualitative ethnographic study used observation and interviews of 11 networks of patients with hip fracture (n ¼ 11), family caregivers (n ¼ 8), and health care providers (n ¼ 24). Patients were followed from acute care through each subsequent care setting. Data were supplemented by health care records and policy documents. Results: Findings revealed that handoffs were less successful when information transfer was untimely or incomplete. Family caregivers experienced challenges in obtaining information required to facilitate the handoff, especially when direct contact with physiotherapists was not possible as a result of distance or other factors. Physiotherapists had to navigate multiple data sources to retrieve important information, and managed information gaps in various ways. Information flow was often unidirectional and suggested no further clinical accountability for the discharging physiotherapist. Conclusions: Providing information in a structured and timely fashion facilitated physiotherapy handoffs. Inadequate handoffs compromised continuity of care, delayed progress in rehabilitation, and resulted in families' missing information of vital importance to their caregiving role. A multi-directional exchange of information is needed between patients, families, and health care providers across care settings.Key Words: continuity of patient care; hip fractures; qualitative research; rural health services. RÉ SUMÉObjectif : Examiner l'é change d'information assuré par les physiothé rapeutes au cours des transferts du soin de patients qui ont subi une fracture de la hanche en contexte de soins de santé ruraux. Mé thodes : Cette é tude ethnographique qualitative reposait sur l'observation et des entrevues de 11 ré seaux de patients ayant subi une fracture de la hanche (n ¼ 11), d'aidants naturels (n ¼ 8) et de fournisseurs de soins de santé (n ¼ 24). Les patients ont é té suivis du service de soins actifs jusqu'à chaque contexte de soins subsé quent. Les dossiers de santé et des documents straté giques ont complé té les donné es. Ré sultats : Les constatations ont ré vé lé que les transferts é taient moins ré ussis lorsque le transfert de l'information é tait en retard ou incomplet. Les aidants naturels ont eu de la difficulté à obtenir l'information né cessaire pour faciliter le transfert, surtout lorsque la distance ou d'autres facteurs empê chaient de communiquer directement avec les physiothé rapeutes. Les physiothé rapeutes ont dû consulter de multiples sources de donné es pour extraire des renseignements importants et ont gé ré le manque d'information de diverses fac¸ons. L'information a souvent circulé de fac¸on unidirectionnelle, ce qui indique qu'un physiothé rapeute qui donne son congé au patient n'a plus d'autre obligation clinique. Conclusions : L'information fournie d'une fac¸on structuré e et à temps a facilité les transferts en phys...

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes.This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless signifi cant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between Acknowledgements: Dr Carla Patterson was involved in conceptualizing the PhD thesis. Sadly she passed away in August 2005 and was unable to share the results of her study.

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