health care policy Archives - Page 16 of 25

If You Think ‘Evidence-Based Practice’ Is Just Another Buzzword, Think Again

Do you ever wonder why nurses engage in practices that aren’t supported by evidence, while not implementing practices substantiated by a lot of evidence? In the past, nurses changed hospitalized patients’ IV dressings daily, even though no solid evidence supported this practice. When clinical trials finally explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than did less frequent changes. In many hospital EDs across the country, children with asthma are treated with albuterol delivered with a nebulizer, even though substantial evidence shows that when albuterol is delivered with a metered-dose inhaler plus a spacer, children spend less time in the ED and have fewer adverse effects. Nurses even disrupt patients’ sleep, which is important for restorative healing, to document blood pressure and pulse rate because it’s hospital policy to take vital signs every two or four hours, even though no evidence supports that doing so improves the identification of potential complications.

That’s from the start of an article in the November issue of AJN, the first in a new series we are running to highlight the way’s evidence-based practice (EBP) changes what nurses do at the bedside—and saves lives. The authors point out that every day nurses perform dozens of actions and procedures without ever really asking whether the way they are doing them is the best way, or whether or not they are even helping patients by performing these actions.

While […]

Jacob Molyneux, senior editor/blog editor2017-05-27T10:26:55-04:00November 24th, 2009|health care policy, nursing perspective, nursing research|0 Comments

Mammography Screening: Change Isn’t Easy

Exactly what is the evidence supporting annual mammography screening and breast self-examination for women over the age of 40? Napoli pointed out that the available evidence from large international studies didn’t support the belief that early detection of breast cancer actually resulted in lower mortality rates and that the high number of false positive tests resulted in unnecessary anxiety and treatment. At the time, there was even some evidence that premenopausal women who are diagnosed with breast cancer through mammography may actually die earlier than women who are not screened.

Jacob Molyneux, senior editor/blog editor2016-11-21T13:21:03-05:00November 17th, 2009|health care policy|1 Comment

What Do Medical Researchers and Legislators Have in Common? Conflict of Interest, for One

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

In a not-so-old blog post I did last month, I reported on a conference I attended in Vancouver. There, editors from JAMA presented a study revealing that ghostwriting was a major problem for the leading medical journals. Articles were being drafted by writers other than the researchers. In some cases, the writers didn’t have access to all the data, which meant that analyses, conclusions, and—in some cases—recommendations for treatment were based on incomplete or misinterpreted findings. As described in a New York Times article on the issue, medical product and pharmaceutical companies have much to gain if the safety and efficacy of their products are reported in a positive light.

Conflict of interest is a major concern whenever someone who stands to personally benefit can influence a decision. The National Institutes of Health, which is the leading medical and health research agency in this country, has imposed strict rules for employees limiting consulting and speaking fees involving outside companies and institutions that may have a stake in research outcomes. Most government agencies, research or not, impose rules to avoid conflicts of interest.

Last week, NBC News reported that protestors staged a sit-in at the Hartford, Connecticut, offices of Senator Joe Lieberman, demanding that he stop taking campaign contributions from insurance companies.

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2016-11-21T13:21:04-05:00November 16th, 2009|Ethics, health care policy|0 Comments

Are Domestic Violence and Pregnancy Preexisting Conditions?

By Peggy McDaniel, BSN, RN

Kaiser Health News recently ran a story about an attorney who was denied private insurance coverage based on a “preexisting condition”—that is, treatment she’d received following a domestic abuse incident. A majority of states have passed laws prohibiting insurers from denying coverage based on treatment for domestic violence, but eight states as well as the District of Columbia have no such legislation. It is a challenge to track the occurrence of such denials. Insurers often use alternative ways to find out about a history of domestic abuse. They have been known to search for protective orders at local courthouses, which is public information, and search through medical records for documentation of treatment related to such incidents.

A bitter irony is that nurses are expected to be aware of and directly question patients about suspected abuse, yet in doing so we could be setting up patients for future loss or denial of coverage.

Pregnancy, likewise defined as a preexisting condition, can also be used to deny coverage. Health reform bills under consideration would disallow the practice of basing insurance rates on gender, a practice which has in effect discriminated against women, particularly those of child-bearing age.

The practice of denying private health insurance coverage based on these and other preexisting conditions must stop. As a nurse and a consumer, I believe that everyone should be able to buy health care at a reasonable price. A rate such as $1,000 per month for a family is not affordable. In the end we all pay if people do not have some […]