Understanding the Language of Health Reform

ABSTRACT

COVID-19 has accelerated the dialogue surrounding access to health insurance, including the potential for a public option, "Medicare for All," or modification of the 2010 Affordable Care Act. A dizzying array of terms and assertions surround these health policy discussions, as well as misrepresentation and lack of specificity. This article offers a primer on contemporary reform terms and options that are likely to be prominent over the next several years and outlines some health care-related elements of the American Rescue Plan Act, a massive COVID-relief act passed in March 2021. The aim of this nonpartisan overview is to enhance nurses' understanding of these terms as a basis for effective participation in public policy and patient advocacy.

State responses to COVID-19: Potential benefits of continuing full practice authority for primary care nurse practitioners

BACKGROUND

During the COVID-19 pandemic, federal and state governments removed the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions.

PURPOSE

To support policy makers' efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline recommendations for policy, practice, and research.

METHODS

We have conducted a thorough review of the existing literature.

FINDINGS

NP full scope of practice improves access and quality of care and leads to better patient outcomes. It also has the potential to reduce health care cost.

DISCUSSION

The changes to support full practice authority enacted to address COVID-19 are temporary. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure.

National Organization of Nurse Practitioner Faculties: A 40-year history of preparing nurse practitioners for practice

This article provides a historic view of the development and accomplishments of the National Organization of Nurse Practitioner Faculties (NONPF). The authors explore the history leading up to the formalization of NONPF, noting the major factors leading to the creation of NONPF. Since its inception in 1980, NONPF has led efforts to provide resources to nurse practitioner program faculty, create standards and guidelines for quality programs, and most recently work to develop measurable competencies. This article tracks the achievement of the organization by decade and provides an education, practice, and policy context that informed and inspired the activities of NONPF.

Estratégia de implementação para a prática avançada de enfermagem na Atenção Primária à Saúde no Chile

Resumo Objetivos: (i) Delinear os passos e progressos realizados pelo Chile para implementar a prática avançada do papel da enfermagem usando o Enfoque PEPPA (Participatory Evidence-based Patient-focused Process) como guia, (ii) demonstrar a eficácia da estrutura do PEPPA para a identificação de barreiras e guiar o processo de implementação, e (iii) discutir os próximos passos para a implementação do papel da enfermagem. Métodos: O enfoque inclui nove etapas em um processo flexível e iterativo. Resultados: O presente estudo fornece uma análise aprofundada das atividades empregadas para cada etapa do Enfoque PEPPA e sua contribuição para o desenvolvimento do papel da enfermagem na prática avançada no Chile. Em particular, as atividades de participação das partes interessadas foram essenciais para informar os principais decisores e formuladores de políticas de saúde sobre o papel das práticas avançadas de enfermagem, obtendo sua adesão e apoio ao papel da enfermagem e estabelecendo um consenso sobre suas prioridades. As estratégias usadas para superar alguns desafios na implementação das etapas do PEPPA também são discutidas, juntamente com os próximos passos para avaliar e monitorar a implementação e o estabelecimento do papel da enfermagem na prática avançada a longo prazo. Conclusão: O Enfoque PEPPA fornece diretrizes importantes para os países em que a prática avançada do papel da enfermagem está recém sendo introduzida, por meio da identificação e análise de barreiras para o delineamento eficaz do papel e sua implementação exitosa.

Political Efficacy and Participation of Nurse Practitioners

Twenty-eight states have laws and regulations limiting the ability of nurse practitioners (NPs) to practice to the full extent of their education and training, thereby preventing patients from fully accessing NP services. Revisions to state laws and regulations require NPs to engage in the political process. Understanding the political engagement of NPs may facilitate the efforts of nurse leaders and nursing organizations to promote change in state rules and regulations. The purpose of this study was to describe the political efficacy and political participation of U.S. NPs and gain insight into factors associated with political interest and engagement. In the fall of 2015, we mailed a survey to 2,020 NPs randomly chosen from the American Academy of Nurse Practitioners' database and 632 responded (31% response rate). Participants completed the Trust in Government (external political efficacy) and the Political Efficacy (internal political efficacy) scales, and a demographic form. Overall, NPs have low political efficacy. Older age ( p≤.001), health policy mentoring ( p≤.001), and specific education on health policy ( p≤.001) were all positively associated with internal political efficacy and political participation. External political efficacy was not significantly associated with any of the study variables. Political activities of NPs are largely limited to voting and contacting legislators. Identifying factors that engage NPs in grassroots political activities and the broader political arena is warranted, particularly with current initiatives to make changes to state laws and regulations that limit their practice.

Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean

Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

To What Extent Are State Scope of Practice Laws Related to Nurse Practitioners’ Day-to-Day Practice Autonomy?

We explore the extent to which state scope of practice laws are related to nurse practitioners (NPs)’ day-to-day practice autonomy. We found that NPs experienced greater day-to-day practice autonomy when they had prescriptive independence. Surprisingly, there were only small and largely insignificant differences in day-to-day practice autonomy between NPs in fully restricted states and those in states with independent practice but restricted prescription authority. The scope of practice effects were strong for primary care NPs. We also found that the amount of variation in day-to-day practice autonomy within the scope of practice categories existed, which suggests that factors other than state scope of practice laws may influence NP practice as well. Removing barriers at all levels that potentially prevent NPs from practicing to the full extent of their education and training is critical not only to increase primary care capacity but also to make NPs more efficient and effective providers.

Advanced practice nursing in Latin America and the Caribbean: regulation, education and practice

OBJECTIVE

to identify the current state of advanced practice nursing regulation, education and practice in Latin America and the Caribbean and the perception of nursing leaders in the region toward an advanced practice nursing role in primary health care to support Universal Access to Health and Universal Health Coverage initiatives.

METHOD

a descriptive cross-sectional design utilizing a web-based survey of 173 nursing leaders about their perceptions of the state of nursing practice and potential development of advanced practice nursing in their countries, including definition, work environment, regulation, education, nursing practice, nursing culture, and perceived receptiveness to an expanded role in primary health care.

RESULT

the participants were largely familiar with the advanced practice nursing role, but most were unaware of or reported no current existing legislation for the advanced practice nursing role in their countries. Participants reported the need for increased faculty preparation and promotion of curricula reforms to emphasize primary health care programs to train advanced practice nurses. The vast majority of participants believed their countries' populations could benefit from an advanced practice nursing role in primary health care.

CONCLUSION

strong legislative support and a solid educational framework are critical to the successful development of advanced practice nursing programs and practitioners to support Universal Access to Health and Universal Health Coverage initiatives.

OBJETIVO

identificar o estado atual da regulação, educação e prática do enfermeiro de prática avançada na América Latina e no Caribe e a percepção de líderes de enfermagem na região quanto ao papel da enfermagem de prática avançada na atenção primaria à saúde em apoio às iniciativas de Acesso Universal à Saúde e Cobertura Universal de Saúde.

MÉTODO

o estudo descritivo transversal utilizou um survey online com 173 líderes de enfermagem questionando suas percepções sobre o estado atual da prática de enfermagem e o potencial desenvolvimento da enfermagem de prática avançada em seus países, incluindo a definição do termo, o ambiente de trabalho, a regulação, educação, prática, cultura de enfermagem e receptividade percebida de um papel mais amplo deste profissional na atenção primaria à saúde.

RESULTADO

os participantes referiram estar familiarizados com o papel do enfermeiro de prática avançada, mas a maioria não sabia ou não relatou a legislação vigente para o papel da prática avançada em seus países. Os participantes relataram a necessidade de aumentar a preparação do corpo docente e promover reformas curriculares com enfase na atenção primária à saúde para formar enfermeiros de prática avançada. A grande maioria dos participantes acredita que as populações de seus países se beneficiará com o papel do enfermeiro de prática avançada na atenção primária à saúde.

CONCLUSÃO

forte apoio em termos de legislação e uma estrutura educacional sólida de formação contínua são fundamentais para o êxito do desenvolvimento de programas de enfermagem de prática avançada em apoio às iniciativas de Acesso Universal à Saúde e Cobertura Universal de Saúde.

OBJETIVO

identificar el estado actual de la regulación, educación y práctica de la enfermera de práctica avanzada en Latinoamérica y el Caribe y la percepción de los líderes de enfermería en la región hacia un rol de práctica avanzada de enfermería dentro de la atención primaria de salud para apoyar las iniciativas de Acceso Universal a la Salud y la Cobertura Universal de Salud.

MÉTODO

un diseño transversal descriptivo que utilizó una encuesta basada en la web a 173 líderes de enfermería acerca de sus percepciones sobre el estado de la enfermería y el desarrollo potencial de la práctica avanzada de enfermería en sus países, incluyendo definición, ambiente laboral, regulación, educación, práctica de enfermería, cultura de enfermería y la receptividad percibida a un papel más amplio en atención primaria de salud.

RESULTADO

los participantes estaban ampliamente familiarizados con el rol de la enfermera de práctica avanzada, pero la mayoría desconocía la legislación o reportaba no existencia actual de legislación para el rol de práctica avanzada en sus países. Los participantes reportaron la necesidad de aumentar la preparación docente y reformas curriculares para apoyar programas de atención primaria de salud para capacitar las enfermeras de práctica avanzada. La gran mayoría de los participantes creían que las poblaciones de sus países se podrían beneficiar de un rol de práctica avanzada de enfermería en atención primaria de salud.

CONCLUSIÓN

un fuerte apoyo legislativo y un marco educacional sólido que continúen informándose entre sí, son críticos para el desarrollo exitoso de programas de práctica avanzada y de nurse practitioners para apoyar las iniciativas de Acceso Universal a la Salud y Cobertura Universal de Salud.

Factors influencing nursing students' acceptance of electronic health records for nursing education (EHRNE) software program

The Institute of Medicine (IOM) and the Health Information Technology Act (2009) in America had recommended that electronic health records (EHRs) should be fully adopted by 2014. This has urged educational institutions to prepare healthcare professionals to be competent in using electronic health records (EHRs) while they are in schools. To equip nursing students with competency in using EHRs, an electronic health record for nursing education (EHRNE) has been developed and integrated it into nursing curricula. The purposes of the study were to investigate the factors influencing nursing students' acceptance of the EHRs in nursing education using the extended Technology Acceptance Model with self-efficacy as a conceptual framework. The study is a descriptive study design using self-reported questionnaires with 212 student participants. The IBM SPSS and AMOS 22.0 were used to analyze the data. The results showed that attitude toward using the EHRNE was the most influential factor on students' acceptance. The preliminary findings suggested that to enhance the students' acceptance of the EHRNE, cultivation of a positive attitude toward using this EHR as well as increasing the perceived usefulness is very important. Also, the study's framework could be used in guiding learning health informatics and be applied to nursing students.

Nurse home visits improve maternal/infant interaction and decrease severity of postpartum depression

OBJECTIVE

To test the efficacy of the relationship-focused behavioral coaching intervention Communicating and Relating Effectively (CARE) in increasing maternal/infant relational effectiveness between depressed mothers and their infants during the first 9 months postpartum.

DESIGN

Randomized clinical trial (RCT) with three phases.

METHODS

In this three-phase study, women were screened for postpartum depression (PPD) in Phase I at 6 weeks postpartum. In Phase II, women were randomly assigned to treatment or control conditions and maternal/infant interaction was video recorded at four intervals postpartum: 6 weeks, 3 months, 6 months, and 9 months. Phase III involved focus group and individual interviews with study participants.

SETTING

Phase I mothers were recruited from obstetric units of two major medical centers. Phase II involved the RCT, a series of nurse-led home visits beginning at 6 weeks and ending at 9 months postpartum. Phase III focus groups were conducted at the university and personal interviews were conducted by telephone or in participants' homes.

PARTICIPANTS

Postpartum mother/infant dyads (134) representative of southeastern New England, United States participated in the RCT. One hundred and twenty-five mother/infant dyads were fully retained in the 9-month protocol.

RESULTS

Treatment and control groups had significant increases in quality of mother/infant interaction and decreases in depression severity. Qualitative findings indicated presence of the nurse, empathic listening, focused attention and self-reflection during data collection, directions for video-recorded interaction, and assistance with referrals likely contributed to improvements for both groups.

CONCLUSIONS

Efficacy of the CARE intervention was only partially supported. Nurse attention given to the control group and the data collection process likely confounded results and constituted an unintentional treatment. Results suggest that nurse-led home visits had a positive effect on outcomes for all participants.

An intervention to increase the use of Asthma Action Plans in schools: a MASNRN study

School nurses, in collaboration with primary care providers (PCPs), can work to better manage asthma by using the Asthma Action Plan (AAP) with peak flow monitoring. The aim of this pilot study was to determine the effectiveness of an intervention to increase the number of AAPs in schools for students with asthma by having school nurses provide the students' peak flow measurements to their PCPs with a request for an AAP. The study found a significant increase in AAPs when school nurses provided PCPs with accurate peak flow data and requested an AAP from the PCP than when school nurses requested an AAP via the students' parents and did not provide peak flow data to the PCP. This study provided data on the importance of collaboration with PCPs in order to affect better care for children with asthma.

Determining criteria for excellence in nurse practitioner education: Use of the Delphi Technique

Standards and guidelines are available to help nurse practitioner (NP) educators maintain quality in their programs. NP education is now at a juncture to develop criteria that extend beyond the basic standards to measurement of exemplary educational endeavors. In 2000, the National Organization of Nurse Practitioner Faculties Task Force for Programs of Excellence was formed and given the charge of developing criteria for recognizing exemplary nurse practitioner programs. This article reports on results and recommendations that evolved from a Delphi study to identify a set of criteria for excellence in NP programs. Thirteen expert panelists from across the United States participated in three rounds of iterations to evaluate the relevance, specificity, and comprehensiveness of 14 initial criteria and reached consensus on nine final criteria. Finally, the paper discusses ways that these criteria may be used to improve NP education through the development of a program to recognize excellence in NP education.

Feasibility of Studying the Effects of Using NANDA, NIC, and NOC on Nursesʼ Power and Childrenʼs Outcomes

This was a pilot study with a pretest and posttest design to test the feasibility of conducting large-scale studies of the effects of using computer-based terms from NANDA, NIC, and NOC on nurses' power to help children and children's health outcomes. Four hypotheses were tested with data from 12 public health nurses in school settings and 220 schoolchildren. Group A comprised six nurses who used SNAP Health Center (SNAP 98) software to record health visits with 117 children. Group B comprised six nurses who used the same software and NANDA, NIC, and NOC with 103 children. After use of the software, the power of the 12 nurses to help children significantly increased. For the 220 children, the number of coping strategies significantly increased but there were no changes in the other health outcomes. The hypotheses indicating that Group B nurses and children would have more positive changes than Group A were not supported. Positive and negative elements for large-scale studies were identified.

Tracking NP prescribing trends

This article presents the results of three surveys on NP prescribing practices from 1996 to 2001. The data elucidate differences in prescribing practices by practice location, specialty, type of drug, and years of practice. We highlight prescribing trends and identify areas for future research.

Personal and professional characteristics of exemplary school nurses

This article describes a study conducted to identify the professional and personal characteristics of exemplary school nurses. During Phase 1 of the study, a content analysis was completed using nomination portfolios of 10 school nurses who were selected as School Nurse of the Year from 1986 to 1998 in the state of New York. Further content analyses were conducted using transcriptions of a focus group and individual open-ended interviews with exemplary school nurses. These analyses yielded 54 personal characteristics and 74 professional characteristics of exemplary school nurses. Using a Delphi technique in Phase 2 of the study, these characteristics were validated and refined by a national sample of exemplary school nurses who had been chosen to be their state nominees for the National Association of School Nurses' School Nurse of the Year award. Descriptive data were collected on the organizational/structural characteristics of the school systems in which these nurses practiced and on the nurses' individual characteristics. This article identifies areas for clinical and research use of the study's findings.

NPACE nurse practitioner practice characteristics, salary, and benefits survey: 1999. Nurse Practitioner Associates for Continuing Education

The purpose of this article is to present the results of a practice characteristics, salary, and benefits survey of 1,557 nurse practitioners from the United States who attended national nurse practitioner conferences in Las Vegas, Nevada, Orlando, Florida, Chicago, Illinois, and Boston, Massachusetts, in 1999. Specific data are presented on the demographics of the population, practice characteristics and responsibilities, benefits for full- and part-time employees, and salary by region, years of practice, type of certification, and location of the practice. The salary data were compared with the 1995-1996 and 1996-1997 NPACE practice characteristics, salary, and benefits surveys (Pulcini & Fitzgerald, 1997; Pulcini, Vampola, & Fitzgerald, 1998).

Health policy and the private sector. New vistas for nursing

During the past two decades, the drive to rein in rising health care costs has shifted some of the power in health care policy making from professional groups, government agencies, and not-for-profit health care organizations to large for-profit corporations (1-4). This has been a world-wide phenomenon, as the provision and financing of health care services is shifted from governments to private health care organizations (5,6). In the United States, the shift in power is manifested in profound ways. Market competition and bottom-line economics have permeated the health care system, creating powerful new incentives for mergers, other corporate restructuring, and the shift to for-profit status by formerly not-for-profit insurance companies and providers. Private sector health care is now increasingly influenced by for-profit organizations (3). Moreover, the health insurance industry has been transformed as traditional indemnity insurance is replaced by versions of managed care. The role of government, or the public sector, in setting parameters for health care financing and standards for the delivery of health care services is increasingly outpaced in cost cutting by organizations that directly face the bottom line. In addition, private foundations, many of which are under the auspices of managed care organizations, now fund a large proportion of health care research and demonstration projects, a task once largely within the realm of the government. Through education and experience, nurses have developed political sophistication and understanding of policy making in the public sector (7). The challenge now is to educate nurses to adapt their political and policy strategies to the new health care milieu. This challenge is particularly crucial for advanced practice nurses, who must survive in a managed care environment.

The relationship between characteristics of women with mental retardation and outcomes of the gynecologic examination

This study examines the relationships among client characteristics and the outcomes of gynecologic examination success, sedation use, and cooperation with the examination in a sample of 99 women with mental retardation who received services from a nurse-managed women's health clinic in a large county medical center. Client characteristics that were associated with a successful gynecologic examination for this population of women were isolated. The findings from this study suggest that the presence of behavioral problems, profound mental retardation, and expressive language difficulties are important signals to providers. Special approaches are necessary when performing gynecologic examinations for women with mental retardation.

NPACE nurse practitioner practice characteristics, salary, and benefits survey

The purpose of this article is to present the results of a survey of practice characteristics, salary, and benefits of 1,763 nurse practitioners (NPs) from the eastern United States who attended national NP conferences in Chicago, Illinois, and Boston, Massachusetts, in the fall of 1996 and in San Diego, California, and Orlando, Florida, in the spring of 1997. Specific data are presented on the demographics of the population; practice characteristics and responsibilities; benefits for full- and part-time employees; and salary by region, years of practice, type of certification, and location of the practice. The salary data were compared with the 1995-1996 NPACE practice characteristics, salary, and benefits survey for the eastern United States.

Framework for analyzing health care models serving adults with mental retardation and other developmental disabilities

A conceptual framework was presented for describing, comparing, and analyzing the structure of health care models serving adults with mental retardation/developmental disabilities (MR/DD). This framework, which was drawn from Donabedian's (1980) work on the components of quality of health care-structure, process, and outcome-provides a basis for comparing health service models according to three key domains: measures of access, comprehensiveness, and cost. We used this framework to describe three existing programs that use different models to serve this population.