Archive for the ‘Health care reform’ Category

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Recalling the Why of Health Care Reform

March 4, 2015

By Jacob Molyneux, AJN senior editor ACA ruling imageIn a brief analysis of the gradual rollout and effects so far of the Affordable Care Act (ACA) at the start of this year (“The ACA Continues to Run the Gauntlet”), I reviewed a few of the issues the law was intended to address when it was passed in 2010:

* the highest per capita expenditures of any health care system in the world

* consistently worse outcomes on measures such as infant mortality rate than most other developed nations

* increasing numbers of uninsured Americans each year, to over 50 million in 2009, the year before passage of the ACA

* unsustainable annual increases in health insurance premiums and drugs costs, leading to astonishing rates of medical bankruptcy

* a Medicare reimbursement process that rewarded the volume of care provided rather than the effectiveness of that care

These worsening issues had become impossible to ignore. No one believes the ACA is a perfect law; there were too many cooks in the kitchen for that. But it’s at least a good faith attempt to address real problems, to get a framework on the table that can potentially be improved upon. Read the rest of this entry ?

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AJN in January: Long-Term Complications of CHD Repair, Obesity Interventions, Nurses Planning for Retirement, More

December 29, 2014

AJN0115.Cover.OnlineAJN’s January issue is now available on our Web site. Here’s a selection of what not to miss.

Complications after cardiac repair. Nurses often encounter patients with complications that occurred years after congenital heart defect (CHD) repair. Yet many patients whose CHD was repaired in childhood have not had regular follow-up. Our CE feature, “Long-Term Outcomes After Repair of Congenital Heart Defects: Part 1,” the first in a two-part series, reviews six congenital heart defects, their repairs, and common long-term outcomes, as well as implications for nurses in both cardiac and noncardiac settings. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

To further explore the topic, listen to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes). A video of an atrial septal defect device placement is also available in the iPad edition of this article.

Obesity interventions. Patients with obesity often face stigma and bias, even from the nurses who care for them. “The Obesity Epidemic, Part 2: Nursing Assessment and Intervention,” the second article in a two-part series, presents a theoretical framework to guide nursing assessment of patients with obesity and their families and reviews the most common lifestyle, pharmacologic, and surgical interventions. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Are you ready for retirement? Nurses might be retiring later than ever, but are they planning for it? “Preparing for Retirement in Uncertain Times” shows nurses how to optimize their future financial security before leaving the workforce.

Essentials for clinical instructors.Fostering Clinical Reasoning in Nursing Students,” the third article in our Teaching for Practice series on the roles of adjunct clinical faculty and preceptors, describes the importance of developing clinical reasoning skills and how instructors can help students learn them. Read the rest of this entry ?

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AJN in December: Surveillance Tech, Obesity Epidemic, Questioning Catheter Size, More

December 1, 2014

AJN1214.Cover.OnlineAJN’s December issue is now available on our Web site. Here’s a selection of what not to miss.

To watch or not to watch? Long-term care facilities are challenged with providing care for a growing number of patients with dementia or intellectual disabilities. This month’s original research feature, “The Use of Surveillance Technology in Residential Facilities for People with Dementia or Intellectual Disabilities: A Study Among Nurses and Support Staff,” describes an ethnographic field study on the ethics, benefits, and drawbacks of using this technology in residential care facilities.

The obesity epidemic. Obesity rates are rising at an alarming rate in the United States. “The Obesity Epidemic, Part 1: Understanding the Origins,” the first article in a two-part series, outlines pathophysiologic, psychological, and social factors that influence weight control.

Smaller catheter size for transfusions?Changing Blood Transfusion Policy and Practice,” an article in our Question of Practice column, describes how a small team of oncology nurses designed and implemented an evidence-based project to challenge the practice that a 20-gauge-or-larger catheter is required for the safe transfusion of blood in adults. Read the rest of this entry ?

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Choosing Wisely: American Academy of Nursing Highlights Unnecessary Nursing Practices

October 24, 2014

The American Academy of Nursing (AAN) recently announced that it has joined the ABIM Choosing Wisely campaign with a list that focuses specifically on nursing interventions or practices that are not supported by evidence. The list is called Five Things Nurses and Patients Should Question. Here it is in short form—full explanations of the rationale for each item are available at the above link.

  1. Don’t automatically initiate continuous electronic fetal heart rate Screen Shot 2014-10-24 at 11.10.10 AMmonitoring during labor for women without risk factors; consider intermittent auscultation first.
  2. Don’t let older adults lay in bed or only get up to a chair during their hospital stay.
  3. Don’t use physical restraints with an older hospitalized patient.
  4. Don’t wake the patient for routine care unless the patient’s condition or care specifically requires it.
  5. Don’t place or maintain a urinary catheter in a patient unless there is a specific indication to do so.

The Choosing Wisely initiative encourages health care provider organizations to create their own lists of tests and procedures that may be overused, unsafe, or duplicated elsewhere. Using these lists, providers can initiate conversation with their patients to help them choose the most necessary and evidence-based care for their individual situations. The lists are not meant to be proscriptive, and also address situations where the procedures may be appropriate. Read the rest of this entry ?

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Nursing, HIV/AIDS, Continuity of Care, Treatment Advances, and the ACA: The Essentials

March 6, 2014

As the Affordable Care Act takes effect, a timely overview in AJN of recent developments in screening, treatment, care, and demographics of the HIV epidemic

CascadeofCare

The ‘cascade of care’ (from the AJN article)

The newly released March issue of Health Affairs is devoted to looking at the ways the Affordable Care Act (ACA) will affect Americans with HIV/AIDS and those who have recently been in jail. One crucial feature of the ACA is that it prevents insurance companies from refusing coverage to those with a number of preexisting conditions. If you have a preexisting condition and don’t get insurance through work, you know how important this is.

Unfortunately, a large majority of those with HIV and AIDS do not have private health insurance. One article in the March issue of Health Affairs draws attention to the plight of the 60,000 or so uninsured or low-income people with HIV or AIDS who will not receive health insurance coverage because their states are among those that have chosen to opt out of the ACA provision that expands Medicaid eligibility. This means many patients in these states may lack consistent care and reliable access to life-saving drugs.

Antiretroviral therapy (ART) improves patient quality of life and severely reduces expensive and debilitating or fatal long-term health problems in those with HIV/AIDS. As noted in AJN‘s March CE article, “Nursing in the Fourth Decade of the HIV Epidemic,”

The sooner a patient enters care, the better the outcome—especially if the patient stays in care, is adherent to combination antiretroviral therapy (cART), and achieves an undetectable viral load.

The authors, pointing out that only 66% of those with HIV in the U.S. are currently “linked to care” and, of these, only about half remain in care, argue that

“[e]ngaging and retaining people with HIV infection in care is best achieved by an interdisciplinary team that focuses on basic life requirements, addresses economic limits, and treats comorbid conditions such as mental illness and hepatitis C infection.”

But there’s a lot more in this article about screening, advances in drug therapy, treatment, and epidemiology that all nurses will need to know as the ACA brings more HIV-infected patients into every type of health care setting. Here’s the overview, but we hope you’ll read the article itself, which is open access, like all AJN CE features: Read the rest of this entry ?

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A Report from the ANA Safe Staffing Conference

November 11, 2013

Katheren Koehn, MA, RN, AJN editorial board member and executive director of MNORN (Minnesota Organization of Registered Nurses), reports from last week’s ANA conference on staffing held in Washington, DC.

staffiing

Click image for source page at ANA staffing site.

The ANA Safe Staffing Conference ended on Saturday. There were almost 700 registered nurses from all over the country in attendance—nurses in management, direct care, and leadership—all gathered to try to discover new strategies for how to solve the most challenging issue in nursing: safe staffing.

Not a new issue. This has long been the most challenging issue for nursing. Teresa Stone, editor of Poems from the Heart of Nursing: Selected Poems from the American Journal of Nursing, told me that, as she was searching the archives of 113 years of AJN issues for her book, she found that staffing issues were a frequent theme. Today, as the work of nurses has become more complex, the need to create sustainable solutions to ensuring appropriate staffing is our most critical issue—hence the ANA Staffing Conference.

The body of evidence supporting the idea that appropriate nurse staffing makes a difference in saving patients’ lives has grown exponentially in the past 20 years. This evidence—paired with the new federal financial incentives for hospitals to improve patient outcomes and experiences—makes it seem inevitable that increasing nurse staffing would be the next step. But decreases in Medicare reimbursement rates, along with caution about future finances related to some aspects of health care reform, are in fact making hospital purse strings tighter than ever. Nurses continue to beg to be taken out of the “room and board” costs and to be seen as an asset. But instead, they are often seen as a major expense that can be reduced for the sake of the bottom line. If this impasse is to be brokered, it will demand new thinking and new communication.

A focus on innovation. Past ANA president Barbara Blakeney, now innovations specialist at the Center for Innovation in Care Delivery in the Institute for Patient Care at Massachusetts General Hospital in Boston, asked attendees to be innovative in our solutions to the problems of staffing. She taught us about the five “discovery skills” of innovators:  associating, observing, experimenting, questioning, and networking. For example, innovators are extremely good at networking with smart people with whom they have little in common but from whom they can learn.

Blakeney also reminded us that in this time of wanting everything to be based on evidence, we also have to allow for discovery and creation of new practices. One of the processes she recommends for innovation at the hospital unit level is the rapid-cycle improvement process used by the Transforming Care at the Bedside (TCAB) initiative. In addition, she emphasized that anyone at the unit level can potentially lead change. Leadership’s role is to make the environment safe for trying new things—for innovation. Read the rest of this entry ?

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They’re Not Taking Away Our Puppies (And God Help Them If They Do)

September 30, 2013

By Jacob Molyneux, AJN senior editor/blog editor

I am amazed at the amount of time being wasted on the relatively mundane matter of health care exchanges. It seems we are now facing a government shutdown; there are creepy and misleading advertisements funded by conservative billionaires like the Koch brothers in order to scare people from signing up for insurance; some red states have actually enacted laws forbidding the health care navigators from helping people understand the new system and sign up for it, and many of these states have refused to create their own exchanges to help their citizens comply with the new law.

The ACA is a law. You can’t just ignore it if it doesn’t meet your personal preferences or political ideas. Given the heated rhetoric the Republicans are trotting out about it, you’d think the government was trying to take away our puppies, instead of implementing ideas originally floated by Republicans themselves to make life a bit easier for millions of Americans whose life decisions are unduly ruled by crazy health care billing practices, byzantine insurance regulations, discrimination against those who have chronic conditions, insanely varying pricing for simple tests, and the like. Read the rest of this entry ?

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