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G Transformational Models of Nursing Across Different Care Settings
Pages 401-442

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From page 401...
... They were prepared for the Robert Wood Johnson Foundation Initiative on the Future of Nursing Institute of Medicine Committee, by fellows of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This is an advanced leadership program for nurses in senior executive roles in health services, public health and nursing education who aspire to help lead and shape the U.S.
From page 402...
... These briefs include background on the needs, evidence-based innovations and most important, recommendations for healthcare in 21st century. The briefs include the following areas in health care and health care education: • Transformational Partnerships in Nursing Education • Innovative Nursing Education Curriculum • Acute Care • Chronic Care • Palliative and End-of-Life Care • Community Health • School Health COMMON THEMES A number of common themes emerge from the briefs.
From page 403...
... • Care Models. We must continue to develop innovative care models based on current successes such as the acute care agile self-directed nursing teams, the rural healthy aging community model and school based and community-based nurse managed clinics.
From page 404...
... . Over the last decade new partnership models have developed to finance the creation and expansion of nursing programs, create access to nursing education at all levels, expand and support faculty members, and increase capacity to -- and experiences at -- clinical sites for students.
From page 405...
... Pre-licensure nursing education is a costly endeavor. While health care organizations have contributed to existing schools, others have acquired nursing schools as part of broader hospital acquisitions.
From page 406...
... These interstate collaborations between educational institutions are offering joint programs that increase access to all levels of nursing education in rural and underserved areas in the United States through course sharing and collaborative program development across educational institutions (i.e., the joint Neonatal Nurse Practitioner program at University of California San Francisco and University of Hawaii and The Nursing Educational Xchange)
From page 407...
... Ten recommendations for the future of nursing education are • Create nontraditional partnerships within and outside of educational institutions; • Explore opportunities for the creation and expansion of nursing pro grams through private partnerships and health care institutions; • Develop, implement, and evaluate innovative academic–practice partner ships between nursing programs and acute care, primary care, long-term care, community, and public health settings; • Move from a time-based model of clinical nursing education to a competency-based model, and evaluate the evidence to support this type of learning in nursing education; • Support the implementation and evaluation of statewide curriculum models between universities and community college systems; • Expand interdisciplinary educational opportunities and programs; • Champion interstate partnerships to increase access to educational opportunities; • Support research for evidenced based educational practices that chal lenge existing norms; • Build stronger relationships between nursing students and registered nurses providing patient care; and • Address policy issues that create barriers to the above recommendations. Innovative partnerships between nursing education and nursing practice are essential if the nursing profession is to meet the challenges ahead.
From page 408...
... . Creating a culture of innovation in nursing education through shared vision, leadership, interdisciplinary partnership, and positive deviance.
From page 409...
... Time-honored traditions in nursing education such as the current undergraduate clinical instruction model, a disease and illness-oriented curriculum, and the need for extensive clinical practice before matriculating in doctoral programs should be reexamined. There is a need to embrace technologyinfused education, transdisciplinary approaches to care, and translational research.
From page 410...
... . Future nursing curricula need to develop interdisciplinary simulation scenarios focusing on collaboration and crucial conversations so that students can learn how to deal with ineffective professional relationships and unsafe practice in a controlled environment (AACN, 2005)
From page 411...
... A solid background in science, scientific inquiry, and the scientific basis of health is essential to develop health care innovation. RECOMMENDATIONS The authors propose strategies to shape the future of healthcare by creating models of nursing education focused not only on curriculum changes, but also on transforming the student population, integrating the science and research in the curriculum and influencing health care policy.
From page 412...
... • Advance Medicare or other federal support to create a Graduate Nursing Education Fund. (similar to Graduate Medical Education)
From page 413...
... . Creating a culture of innovation in nursing education through shared vision leadership, interdisciplinary partnerships and positive deviance.
From page 414...
... CARE TEAM OF THE FUTURE: AGILE TEAMS, PRAIRIE LAKES HEALTH CARE SYSTEM, WATERTOWN, SOUTH DAKOTA A medical–surgical unit care delivery model referred to as "Agile Teams" replaced a "Total Patient Care" care delivery model. In the Total Patient Care model, a nurse is assigned a number of patients to care for over a shift.
From page 415...
... Imagine the manual care delivery system transformed into one that is managed virtually. An interdisciplinary care team is located in a control center with capability to plan, monitor and administer treatment to patients in hospitals or homes.
From page 416...
... INNOVATIVE APPROACHES TO CREATING THE FUTURE Innovative approaches already exist that forecast this model in the future: • "e-ICU" technology that connects rural hospital ICUs to the expertise of larger trauma hospitals; • Bar-code medication verification systems and electronic medication administration records; • Bedside access to medications and supplies; robotics; • Interdisciplinary care teams that include engineers to identify poorly designed work processes; and • Tele-home health that monitors patients who at home. RECOMMENDATIONS We need to change the way we think about our traditional brick and mortar care delivery system.
From page 417...
... Care delivery models will be designed to provide access to the information needed for clinical and therapeutic practice. Models will be designed to provide the information environ ment required for critical thinking and professional judgment, open access to records, and fully wired patient care settings.
From page 418...
... TRANSFORMACION PARA SALUD The Transformacion Para Salud Program is a HRSA-funded demonstration project at the Larry Combest Community Health and Wellness Center, a nursemanaged primary care center. Advance Practice Nurses oversee four Promotores, who are certified community health workers (CHWs)
From page 419...
... The Center operates using Intensive Primary Care, designed to serve adults with chronic health problems and based on the premise that this segment of the patient population need more "intensive" primary care interventions just as some patients in hospitals need a different level of care in intensive care units. Nurse practitioners, in partnership with nurse case managers and a highly integrated staff, assess patients holistically and address barriers to care and self care.
From page 420...
... MIGRANT HEALTH SERVICE, INC. NURSE-MANAGED HEALTH CENTERS Migrant Health Services, Inc.
From page 421...
... in health care dollars, showing that this technology is the future for home care agencies. CONCLUSIONS AND RECOMMENDATIONS These examples demonstrate how nursing can provide the leadership and skills in addressing one of the nation's top health care challenges -- chronic disease.
From page 422...
... Journal of Community Health Nursing, 20(2)
From page 423...
... . Registered nurses, as well as advanced practice nurses, have also played leading roles as members of interdisciplinary teams in the development of palliative care programs.
From page 424...
... NURSING AT THE FOREFRONT OF POLICY The National Consensus Project, chaired by Betty Ferrell, PhD, RN, FAAN, which represents four Coalition organizations (the American Academy of Hospice and Palliative Medicine, the Center to Advance Palliative Care, the Hospice and Palliative Nurses Association, and the National Hospice and Palliative Care Organization) has developed and disseminated the Clinical Practice Guidelines for Quality Palliative Care in 2004 and 2009.These guidelines serve as a national standard for informing providers, policy makers, and consumers about the attributes of high-quality palliative care (National Consensus Project for Quality Palliative Care, 2009)
From page 425...
... The nurse practitioners provide both clinical consultation and education to nursing home staff, focusing on symptom management, advance care planning, patient and family communication, and supporting transitions to hospice services, if needed. Both Medicare and Medicaid will provide reimbursement for this type of external consultation provided by a nurse practitioner.
From page 426...
... • Support nursing education and research that advances the palliative care model. • Use the palliative care model as a framework when addressing the needs of the chronically ill population.
From page 427...
... . Home care and pediatric palliative care: Forging new partnerships for kids.
From page 428...
... Nurses design and implement these solutions in a multitude of settings including public health, school-based health centers, nurse managed health centers, convenient care clinics, federal health centers, and home health. Nurses working to address the needs of community health have firsthand knowledge in understanding the healthcare needs of a diverse population, especially in underinsured and uninsured populations facing a widening rift in quality care (Hurley et al., 2005)
From page 429...
... Services are offered in easily accessible locations such as schools, homeless shelters, senior centers, churches and public housing developments by a wide array of health care professionals, including nurse practitioners serving as primary care providers, registered nurses, health educators, behavioral health specialists, community outreach workers and collaborating physicians. For many patients, the centers are their only option for accessible and affordable care.
From page 430...
... Nursing leadership has been central to the holistic, community-based vision. RECOMMENDATIONS Policy makers, funders, educators, and practitioners must look beyond the medical model as the sole solution to community health needs and recognize the contribution nursing and nurse practitioners (NPs)
From page 431...
... 1992. Health care dollars and regulatory sense: The role of advanced practice nursing.
From page 432...
... In the last 10 years school nurses have concentrated on new areas of care that have emerged as a result of • Medical advancements that allow children with multiple medical issues to survive; • A rising incidence of diseases with life-threatening implications like diabetes, seizures, severe allergic reactions, asthma, bleeding disorders, and genetic conditions; • An increase in mental health disorders, including rising incidence of au tism and related neurodevelopment disorders; youth gambling, alcohol, tobacco, drug abuse, and other addictive behaviors; youth with eating disorders, anxiety, depression, and suicidal ideation; youth exhibiting bullying, harassment and violent behaviors; and • An increasing number of children living in poverty, including those who are homeless, migrants, immigrants or refugees.
From page 433...
... To address the current inadequacies where nurses face work overload, nurse leaders, together with parents, children, and communities have developed two innovative school health programs: schoolbased health centers and public–private partnerships, that can be replicated nationwide and can provide many new and exciting opportunities for nurses to expand their scope of practice. SCHOOL-BASED HEALTH CENTERS School Based Health Centers (SBHCs)
From page 434...
... December 1, 2009, Jack continues with a stellar attendance and academic achievement record. His asthma and mental health conditions are under control through the combination of care delivery between the school nurse and the staff in the SBHC.
From page 435...
... • Allocate federal and state governments funds to school-based health centers so that all students, regardless of their ability to pay, can access comprehensive medical, dental and mental health care by nurse practi tioners, nurses, and other health care professionals. • Establish funding for school health development of public–private part nerships, including community health worker programs that are led by certified school nurses.
From page 436...
... . Presentation at National School based Health Conference, Washington, DC.
From page 437...
... Centers for Disease Control and Prevention INTRODUCTION A well-educated public health nursing workforce would improve the health of all people and minimize health differences among populations by addressing the physical and social determinants of health (Manitoba Health, 1998)
From page 438...
... EVIDENCE-BASED PUBLIC HEALTH NURSING MODELS ELECTRONIC HEALTH RECORDS AND PUBLIC HEALTH NURSING OUTCOMES A joint practice and data quality project was undertaken by public health nurse managers in four local health departments. The project utilized the Omaha System, a standardized nursing language and a computerized clinical documentation system.
From page 439...
... . REINVIGORATING PUBLIC HEALTH NURSING EDUCATION Two federal grants -- one in Minnesota and another in Wisconsin -- developed a new model for public health nursing education.
From page 440...
... brought together public health nursing faculty from baccalaureate schools of nursing with public health nurses from local health departments that provide clinical sites for PHN students. They formed regional projects that redesigned the PHN student experience based on community priorities.
From page 441...
... . A public health nursing informatics data-and-practice quality project.


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