Appendix B
Data Collection and Information Sources
The Committee on the Future of Nursing 2020–2030 was asked to chart a path forward for nursing to help reduce health disparities and produce a report providing recommendations on how nurses can improve the health of individuals, families, and communities by addressing the social determinants of health. The broad scope of this 2-year study included an examination of nursing education, practice, research, and policy with the purpose of promoting health equity.
The committee was composed of 15 members with expertise and experience in diverse areas, including nursing education and training, nursing practice, health professions training and education, health policy, health economics, workforce policy, health care quality, health care delivery, hospital and health plan administration, public and community health, business administration, health informatics, health insurance systems, sociology, and health equity. The committee convened for four in-person meetings and participated in several conference calls throughout the study to deliberate on the content of this report and its recommendations. To provide a comprehensive response to the Statement of Task, the committee tapped the wide-ranging expertise of its members and reviewed data from a variety of sources, including recent literature, public and stakeholder input gathered through a series of town halls, site visits to a variety of health care settings where nurses work, and commissioned papers on selected topics. This appendix describes the inputs on which the committee relied to inform its deliberations and the approaches used to reach conclusions and craft recommendations.
INFORMATION COLLECTION AND PUBLIC INPUT
The committee received data and input from multiple sources throughout the course of the study. To support the committee’s deliberations, a broad literature search for relevant published articles and reports, including grey literature, was conducted. For specific questions related to the charge that required specialized knowledge and expertise not available within its membership, the committee commissioned white papers, received support from AcademyHealth for data analyses, and heard presentations from other experts at town hall meetings.
Literature Search
A broad search for published literature was conducted using the Cochrane Database of Systemic Reviews, Embase, Medline, the National Bureau of Economic Research, the Organisation for Economic Co-operation and Development, PubMed, and Scopus. These databases cover all the sources of published literature indexed by CINHAL and more. Search terms targeted nursing workforce, leadership, clinical redesign, resilience, burnout, and technology and innovation broadly among the nursing field; the intersection of nursing and social determinants of health; programs and interventions to address health disparities, social needs, social determinants of health, and health equity broadly; and projections about the nursing field related to changing demographics and population needs and technological advancements. Publication dates were limited to 2009 to the present to reflect current policy, health care systems, and nursing education and workforce data since the prior The Future of Nursing report (IOM, 2011). Although the primary search was conducted in April 2019, staff conducted an updated search in February 2020, and additional publications and reports of relevance were added through June 2020.
Grey literature was searched for reports and data from multiple sources, including federal agencies, professional organizations, and scientific and health policy–focused organizations. Searches of federal agencies included the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Health Resources and Services Administration, the National Institute of Nursing Research, the U.S. Department of Defense (Military Health System and Tricare), the U.S. Department of Health and Human Services, the U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion, the U.S. Department of Labor, and the U.S. Department of Veterans Affairs. Professional organizations included the American Association of Colleges of Nursing (AACN) and others. Institutions that regularly conduct scientific and health policy research, including AcademyHealth, the Patient-Centered Outcomes Research Institute, RAND, the Robert Wood Johnson Foundation (RWJF), The Commonwealth Fund, and others were also reviewed for relevant information.
The committee also relied on a collection of other National Academies reports in addition to the two prior nursing reports (IOM, 2011; NASEM, 2016). They are cited as appropriate throughout this report. They include
- Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001)
- Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (IOM, 2003)
- A Framework for Educating Health Professionals to Address the Social Determinants of Health (NASEM, 2016a)
- Communities in Action: Pathways to Health Equity (NASEM, 2017)
- Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health (NASEM, 2019a)
- Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being (NASEM, 2019b)
- Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity (NASEM, 2019c)
- Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System (NASEM, 2020a)
- Birth Settings in America: Outcomes, Quality, Access, and Choice (NASEM, 2020b)
AcademyHealth
To support the committee with timely data generation, analysis, synthesis, and dissemination, RWJF simultaneously contracted with AcademyHealth to support the committee with critical information not available in the current literature. AcademyHealth created a research network from its membership of health policy and workforce researchers to respond to requests from the committee and anticipate needs throughout the study process. Research products generated by the AcademyHealth research network informed the committee’s deliberations and supported the committee’s conclusions.
AcademyHealth selected five experts to serve as research managers to conduct research and analyses. Their efforts were managed by AcademyHealth staff. All products generated by AcademyHealth in support of the committee are available by request through the committee’s Public Access File.
White Papers
The committee commissioned two white papers to further its understanding and incorporate input from experts in other areas:
- Barton, A. J., B. Brandt, C. J. Dieter, and S. D. Williams. 2020. Social determinants of health: Nursing, health professions and interprofessional education at a crossroads. https://www.nap.edu/resource/25982/Barton%20et%al%20Commissioned%20Paper.pdf (accessed June 7, 2021).
- Needleman, J. 2019. Paying for nursing care in fee-for-service and value-based systems. Paper commissioned by the Committee on the Future of Nursing 2020–2030.
TOWN HALLS
In conjunction with the site visits, the committee also participated in public town halls that included in-person expert and technical panels and testimony from organizations and individuals. These meetings1 were open to the public and were webcast live.2 The first town hall meeting, in Chicago, was held at Malcolm X Community College, and the theme was “Social Determinants of Health: Education, Research, and Practice.” Experts, stakeholders, school administrators, community health nurses, and clinicians presented information on how nurse education is adapting to include new competencies, nurse engagement in research on health equity, and how nursing practice in the United States is currently incorporating social determinants of health screening and targeted programs. The town hall in Philadelphia was held at the University of Pennsylvania School of Nursing, and the theme was “Payment and Care for Complex Health and Social Needs,” which featured speakers who discussed the role of nurses in rural health, maternal health, healthy aging, school nursing, and how payment systems can be reformed to support nurses’ work. The final town hall, in Seattle, was held at the School of Nursing at the University of Washington, and the theme was “High Tech to High Touch,” which focused on medical technology and its application in advancing health equity and well-being and preventing burnout of nurses.
The town hall meetings were important sources of information from other experts on selected topics relevant to the committee’s task. They also served as important venues to solicit and receive public input.
SITE VISITS
Site visits were held in three cities in the United States between June and August 2019 and focused on current programs that involve nurses and address social determinants of health. The sites were chosen for their unique position in relationship to their communities and served as examples of successful models
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1 The agendas for all of the town halls are at the end of this appendix.
2 Recordings of the town hall meetings are available online at https://www.nap.edu/catalog/25982 (accessed June 9, 2021).
in deploying nurses and nurse leaders, identifying community and social needs, and implementing these models with measurable outcomes. Committee members were able to learn about the programs and observe how nurses worked to address the social needs and social determinants of health facing their clients. The first site visits took place in Chicago in June 2019 and included several programs supported by Rush University. Some committee members were able to visit Threshold Community Mental Health Center, Sue Gin Health Center, and Simpson School Based Health Center. In July 2019, committee members met with leaders and staff at Stephen and Sandra Sheller 11th Street Family Health Services in Philadelphia and Camden Coalition and several of its community partners in Camden, New Jersey. The third set of site visits took place in and around Seattle and nearby cities and towns in August 2019. Subgroups of committee members visited Downtown Emergency Services Center, Kline Galland, International Community Health Services, Seattle and King County Public Health, Seattle Children’s Hospital, Kitsap Connect at the Salvation Army in Kitsap, and the S’Klallum Reservation in Port Gamble.
The site visits gave the committee members valuable context for how nurses are working with clients with complex health conditions and social services needs, the challenges of this work, and the impact that these nurses and programs have on their clients and communities. Because the committee members bring a variety of life and professional experiences, it was imperative for them all to observe nurses in action and working in settings to address social needs and social determinants of health.
PUBLIC INPUT
Throughout the duration of the study, the committee received testimony and comments from the public through several channels. At each open session and town hall meeting, the committee heard testimony from organizations and comments from individuals about the study. Any comments made by online viewers during those meetings were also made available to the committee. The National Academy of Medicine conducted Twitter chats in coordination with the town hall meetings and shared ideas put forward with the committee. Throughout the study process, the committee invited the public to share comments and supporting materials with the committee by email. All public comments, in person and online, helped the committee understand the issues important to nurses, students, educators, leaders, and colleagues.
OPEN MEETING AND TOWN HALL AGENDAS
Below, the agendas for each of the committee’s open meetings and town halls are listed chronologically. They include an introductory open meeting in Washington, DC; town hall meetings in Chicago, Philadelphia, and Seattle; and a second open meeting in Washington, DC.
OPEN MEETING 1
Open Session Agenda
March 20, 2019
2101 Constitution Avenue, NW, Washington, DC 20418
1:30 p.m. | Welcome Study Sponsor and Introductory Remarks Sharyl Nass, MS, PhD, Senior Board Director, Board on Health Care Services, National Academies of Sciences, Engineering, and Medicine Mary Wakefield, PhD, RN, FAAN, and David Williams, MPH, PhD, Committee Co-Chairs |
1:40 p.m. | Remarks from the National Academy of Medicine Victor Dzau, MD, President, National Academy of Medicine |
1:50 p.m. | Introduction to The Future of Nursing (2011) and Its Impact Susan Hassmiller, RN, PhD, FAAN, Senior Scholar in Residence and Advisor to the President on Nursing, National Academy of Medicine |
2:10 p.m. | Introduction to the Future of Nursing: Campaign for Action at the Center to Champion Nursing in America and Its Impact Susan Reinhard, RN, PhD, FAAN, Senior Vice President and Director, AARP Public Policy Institute, and Chief Strategist, Center to Champion Nursing in America |
2:30 p.m. | Charge to the Committee Paul Kuehnert, DNP, RN, FAAN, Associate Vice-President for Programs, Robert Wood Johnson Foundation |
Open Q&A with the Committee | |
2:50 p.m. |
Invited comments (limited to 5 minutes each)
|
|
|
3:25 p.m. | Public Comments Comments will be limited to 2 minutes per person; select comments submitted by online viewers will be read. |
4:00 p.m. | Adjourn Open Session |
Chicago Town Hall: Integrating Social Determinants of Health into Nursing Education, Research, and Practice
June 7, 2019
8:30 a.m. to 12:30 p.m. at Malcom X Auditorium
8:30 a.m. |
Welcome
|
8:40 a.m. |
Integrating Social Determinants of Health and Health Equity into Nursing Education
|
9:35 a.m. | Break |
9:45 a.m. |
Integrating Social Determinants of Health and Health Equity into Nursing Research
|
10:40 a.m. |
Integrating Social Determinants of Health and Health Equity into Nursing Practice
|
11:35 a.m. |
Invited Comments (comments will be limited to 5 minutes)
|
11:55 a.m. | Public Comments (comments will be limited to 2 minutes) |
12:25 p.m. | Closing Remarks and Adjourn Mary Wakefield, PhD, RN, FAAN, Visiting Distinguished Professor, Georgetown University and The University of Texas at Austin |
Philadelphia Town Hall: Payment and Care for Complex Health and Social Needs
July 24, 2019
8:30 a.m. to 12:30 p.m. at the
University of Pennsylvania School of Nursing
8:30 a.m. |
Welcome
|
8:40 a.m. |
Serving Populations with, and at Risk for, Complex Health and Social Needs: Introduction and Overview Moderator: Antonia M. Villarruel, PhD, RN, FAAN, Professor and Margaret Bond Simon Dean, University of Pennsylvania School of Nursing
|
10:10 a.m. | Break |
10:20 a.m. |
Paying for Care for Those with Complex Health and Social Needs: Introduction and Overview Moderator: Margaret Flinter, APRN, PhD, FAAN, c-FNP, Senior Vice President and Clinical Director, Community Health Center, Inc.
|
|
|
11:35 a.m. |
Invited Comments (limited to 5 minutes each)
|
11:55 a.m. | Public Comments (limited to 2 minutes each) |
12:25 p.m. | Closing Remarks and Adjourn Sue Hassmiller, RN, PhD, FAAN |
Seattle Town Hall: High Tech to High Touch
August 7, 2019
8:30 a.m. to 12:30 p.m. at the University of Washington,
Kane Hall, Room 210
8:30 a.m. |
Welcome
|
8:40 a.m. |
Advancing Health Care Equity in the Digital Age Moderator: Sue E. Birch, MBA, BSN, RN, Director, Washington State Health Care Authority
|
|
|
9:35 a.m. | Break |
9:45 a.m. |
Technology to Inform Practice and Advance Equity Moderator: Sofia Aragon, JD, BSN, Executive Director, Washington Center for Nursing
|
10:40 a.m. |
Nurse Well-Being and Impact on Patients and Caregivers Moderator: Kristen Swanson, RN, PhD, FAAN, Dean and Professor, Seattle University College of Nursing
|
11:35 a.m. |
Invited Comments (limited to 5 minutes each)
|
11:55 a.m. | Public Comments (limited to 2 minutes each) |
12:25 p.m. | Closing Remarks and Adjourn Sue Hassmiller, RN, PhD, FAAN, Senior Scholar in Residence and Senior Advisor to the President on Nursing, National Academy of Medicine |
OPEN MEETING 2
Open Session Agenda
November 20, 2019
500 Fifth Street, NW, Washington, DC 20001
Open Session
9:00 a.m. | Welcome and Introductory Remarks Mary Wakefield, Committee Co-Chair Moderated by Maureen Bisognano, Committee Member |
Technical Panel | |
9:05 a.m. | Center for Health Care Strategies Tricia McGinnis, Executive Vice President and Chief Program Officer |
9:20 a.m. | CVS Health Angela Patterson, Chief Nurse Practitioner Officer, CVS MinuteClinic and Vice President, CVS Health |
9:35 a.m. | Pacific Business Group on Health Elizabeth Mitchell, President and Chief Executive Officer (presentation by Zoom) |
9:50 a.m. |
American Hospital Association
|
10:05 a.m. | Q&A with the Committee Moderated by Maureen Bisognano, Committee Member |
10:45 a.m. | Closing Remarks |
Technical Panel Adjourns | |
10:50 a.m. | Break |
11:00 a.m. | Future Trends Lori Melichar, Senior Director, Program, Robert Wood Johnson Foundation |
11:55 a.m. | Closing Remarks and Adjourn David Williams, Committee Co-Chair |
REFERENCES
IOM (Institute of Medicine). 2001. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
IOM. 2003. Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.
IOM. 2011. The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
NASEM (National Academies of Sciences, Engineering, and Medicine). 2016a. A framework for educating health professionals to address the social determinants of health. Washington, DC: The National Academies Press.
NASEM. 2016b. Assessing progress on the Institute of Medicine report The Future of Nursing. Washington, DC: The National Academies Press.
NASEM. 2017. Communities in action: Pathways to health equity. Washington, DC: The National Academies Press.
NASEM. 2019a. Integrating social care into the delivery of health care: Moving upstream to improve the nation’s health. Washington, DC: The National Academies Press.
NASEM. 2019b. Taking action against clinician burnout: A systems approach to professional well-being. Washington, DC: The National Academies Press.
NASEM. 2019c. Vibrant and healthy kids: Aligning science, practice, and policy to advance health equity. Washington, DC: The National Academies Press.
NASEM. 2020a. Social isolation and loneliness in older adults: Opportunities for the health care system. Washington, DC: The National Academies Press.
NASEM. 2020b. Birth settings in America: Outcomes, quality, access, and choice. Washington, DC: The National Academies Press.
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