Posts Tagged ‘ACA’

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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 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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Recent Nurse Blog Posts of Interest, Inhaled Insulin, a Note on Top Blogs Lists

April 4, 2014

By Jacob Molyneux, AJN senior editor/blog editor

Here you will find some links to nursing blog posts, a look at this week’s Affordable Care Act health exchange enrollment numbers, and a couple of items of interest about new treatments or studies, plus a note on blogs that award other blogs badges. A grab bag, so bear with me…

crocus shoots, early spring, I think/ via Wikimedia Commons

crocus shoots, early spring, I think/ via Wikimedia Commons

At the nursing blogs:

RehabRN has a post about a friend who was bullied by a nurse of much higher authority in the same hospital. Such stories, if true, are always upsetting. What can you do but take it when the power differential is so great?

At the INQRI blog (I’m not going to tell you what the initials stand for except that it has something to with quality, research, and nursing), there’s a post about why stroke survivors need a team approach to palliative care.

Megen Duffy (aka Not Nurse Ratched) has a really very good post at a site she sometimes blogs for. I already shared it via a tweet yesterday, but it deserves more. It’s called “Nursing Will Change You.”

At Infusion Nurse Blog, there’s a post addressing IV solution shortages (now happening on top of shortages of some common and necessary drugs due to a variety of reasons). It gives some practical steps clinicians and organizations can take to conserve and is definitely worth a quick look.

A sweet little post called “Nursing Sisters” is at Adrienne, {Student} Nurse. It’s about how nurses help each other out, starting right from the beginning in nursing school.

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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AJN’s Top 15 Most Viewed Articles in 2013

January 24, 2014
by rosmary/via Flickr

by rosmary/via Flickr

We thought readers might be interested in seeing which articles and topics got the most page views in 2013. Many of these articles are open access, including a number of CE articles as well as the articles from our Evidence-Based Practice: Step by Step series. Some articles require an AJN subscription or individual article purchase. Several of the articles in this list were from recent years other than 2013; a couple were much older, but are evidently still relevant, since not every idea in nursing is ephemeral or subject to improvement by the next generation.—Jacob Molyneux, senior editor

1. “Asking the Clinical Question: A Key Step in Evidence-Based Practice” – (March, 2010) – part of AJN‘s EBP series

2. “Improving Communication Among Nurses, Patients, and Physicians” – (November, 2009)

3. “The Seven Steps of Evidence-Based Practice” – (January, 2010) – part of our EBP series

4. “Nurses and the Affordable Care Act” – (September, 2010)

5. “From Novice to Expert: Excellence and Power in Clinical Nursing Practice” – (December, 1984; not HTML version; readers must click through to PDF version)

6. “COPD Exacerbations” – (CE article; February, 2013)

7. “Therapeutic Hypothermia After Cardiac Arrest” – (CE; July, 2012)

8. “From Novice to Expert” – (March, 1982; article looks at stages to mastery; no html version, so click the PDF link on the landing page)

9. “Men in Nursing” – (CE; January, 2013)

10. “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections” – (June, 2013) – part of EBP series Read the rest of this entry ?

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