The Future of Nursing Leading Change, Advancing Health (2011) / Chapter Skim
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2 Study Context
2 Study Context
Pages 47-82
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From page 47... ...
In the 21st century, the health challenges facing the nation have shifted dramatically: • Chronic conditions -- While acute injuries and illnesses will never dis appear, most health care today relates to chronic conditions, such as dia betes, hypertension, arthritis, cardiovascular disease, and mental health conditions, which in 2005 affected nearly one of every two Americans (CDC, 2010)
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From page 48... ...
. While there are national standards for linguistically and culturally relevant health care services, the rapid growth of diverse populations with limited Eng lish proficiency and varying cultural and health practices is emerging as an increasingly complex challenge that few health care providers and organizations are currently prepared to handle (HHS Office of Minority Health, 2007)
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From page 49... ...
Also hindering access is the above-discussed rapid growth of populations with limited English proficiency (U.S. Census Bureau, 2010)
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From page 50... ...
From this work, a consensus has begun to emerge regarding some of the fundamental principles that should guide changes to meet these challenges. Broadly, the consensus is that care in the United States must become more patient centered; primary care and prevention must play a greater role relative to specialty care; care must be delivered more often within the community setting and even in people's homes; and care needs to be coordinated and provided seamlessly across health conditions, settings, and providers.
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From page 51... ...
How Patient-Centered Care Improves Quality, Access, and Value A number of studies have linked patient-centered and quality care (Sepucha et al., 2004)
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From page 52... ...
Minnier, at the response to a patient's or visitor's call. time chief nursing officer at the Uni versity of Pittsburgh Medical Center They held drills with staff, and within
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From page 53... ...
patients would abuse the hotline, Condition H is spreading and that concern was not borne out. serves as one example of the changes Today, patients and families through hospitals have adopted using TCAB out UPMC's 13 acute care hospitals methods.
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From page 54... ...
The IOM has defined it as "the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community" (IOM, 1996)
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From page 55... ...
. RNs provide primary care services across the spectrum of health care settings -- from acute care to home care to public health and community care.
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From page 56... ...
Pugh arrived at freestanding birth center in the coun the Family Health and Birth Center (FHBC) in northeast Washington, DC try (in 1975 in New York City)
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From page 57... ...
Two systematic reviews have found that women given midwifery care are more likely to have shorter labors, spontaneous vaginal births without hospitalization, less perineal trauma, higher breastfeeding rates, and greater satisfaction with their births (Hatem et al., 2008; Hodnett et al., 2007)
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From page 58... ...
wives at birth centers at the rate paid Among the benefits of midwifery to obstetricians for vaginal deliveries. care, Lisa Betina Uncles, MSN, CNM, Also, the high cost of malpractice in who attended Ms.
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From page 59... ...
The Need to Deliver More Care in the Community Care in the community -- defined as those places where individuals live, work, play, and study -- encompasses care that is provided in such settings as community and public health centers, long-term care and assisted-living facilities, retail clinics, homes, schools, and community centers. While acute care medical facilities will always be needed, the delivery of primary care and other health services in the community must grow significantly if the U.S.
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From page 60... ...
others. Yet even the smallest gesture, such School nurses may be among the as giving "a little snack," corresponds unsung heroes of health care, but to the National Association of School occasionally they take the spotlight.
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From page 61... ...
Sandoval to use all of her skills as a nurse practitioner. -- Carolina Sandoval, MSN, PNP, RN, She cannot diagnose or prescribe in school nurse, Chino Hills, California the school, for example, even when children have symptoms of conjunc Indeed, California is 42nd on tivitis or otitis media; she must refer NASN's list of states ranked by stu- them to other providers outside of dent-to-registered nurse (RN)
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From page 62... ...
"Very productive." A life- When she started in 1988, she long Schenectady native, she and her and her 20 registered nurse (RN) co husband have reared three children workers cared for homebound older there, and she has worked for 22 adults, pregnant women and infants, years as a public health nurse for the and patients with infectious diseases.
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From page 63... ...
Nurses' contributions to these -- Lisa Ayers, BSN, RN, public health outcomes are not lost on Richard nurse, Schenectady County Public Daines, MD, New York State's health Health Services, commissioner, who shadowed Ms. Schenectady, New York Ayers shortly after he took office.
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From page 64... ...
Nurses and Care in the Community Providing care for underserved populations in community settings has long been a major goal of the nursing profession. Box 2-4 illustrates how one public health nurse provides infant care, primary care, environmental health services, and care to individuals with infectious diseases in the community.
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From page 65... ...
Nurses and Seamless, Coordinated Care Coordinating care is one of the traditional strengths of the nursing profession, whether in the community or the acute care setting. For example, an interprofessional research team funded by the Robert Wood Johnson Foundation, called the Interdisciplinary Nursing Quality Research Initiative (INQRI)
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From page 66... ...
. In light of these considerations, the committee concludes that nurses, in concert with other health professionals, need to adopt reconceptualized roles as care coordinators, health coaches, and system innovators.
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From page 67... ...
Nurses as System Innovators3 One of the fundamental insights of the quality improvement movement is that all health professionals should both perform their current work well and continuously look for ways to make their performance and that of the larger system better. Or as one nurse told a physician 20 years ago in a course on health care improvement, "I see.
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From page 68... ...
Mashore is one of the nearly -- Eileen M Sullivan-Marx, PhD, FAAN, 700 elderly Philadelphians eligible for RN, associate dean for practice and nursing home admission who have community affairs, stayed in their homes with the help University of Pennsylvania School of of LIFE -- a program that provides all Nursing primary and specialty care services to low-income, frail, chronically As for outcomes, LIFE keeps ill older adults (age 55 or older)
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From page 69... ...
She also said that the state saves 15 cents on every dollar spent on LIFE members who would ulcers, preventable hospitalizations, otherwise be in nursing homes. The and emergency room visits among program makes up about 41 percent members (LIFE, 2010)
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But on ing rehospitalization rates, the Transi Friday the pharmacy claimed not to tional Care Model (TCM) relies on an have received the order and refused advanced practice registered nurse to dispense the drug.
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From page 71... ...
But the Affordable ing, this brings it all together. To Care Act sets aside $500 million to see them going from so sick to back fund pilot projects on transitional home and stable -- the Transitional care services for "high-risk" Medicare Care Model speaks to what nurses beneficiaries (such as those with mul- really do."
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From page 72... ...
Responsible for coordinating care and in some cases actively providing direct care in complex situations, the CNL has the responsibility for translating and applying research findings to design, implement, and evaluate care plans for patients (AACN, 2007)
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She was 19 in 375 counties in 29 states, the NFP years old and unemployed and living sends registered nurses (RNs) , usually with her mother, and her relationship with baccalaureate degrees, into the with her boyfriend was faltering.
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4 THE FUTURE OF NURSING BOX 2-7 continued ning. The nurse does this by engag nurse discusses options for the ing the mother in a relationship that mother's continued education and provides a model for interactions economic self-sufficiency; supports with others.
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From page 75... ...
O'Brien, PhD, RN, FAAN, professor of nurs ing at the University of Colorado in * Patient Protection and Affordable Care Act, Denver and an author of the study.
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From page 76... ...
They have vital roles to play in achieving patient-centered care; strengthening primary care services; delivering more care in the community; and providing seamless, coordinated care. They also can take on reconceptualized roles as health care coaches and system innovators.
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From page 77... ...
2006. The 100,000 lives cam paign: Setting a goal and a deadline for improving health care quality.
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2010. The registered nurse population: Findings from the 200 National Sample Survey of Registered Nurses.
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From page 79... ...
2008 October 2-4. Measuring staff nurse care coordination in the hospital.
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2008. Improving patient safety in intensive care units in Michigan.
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From page 81... ...
2005. Community care of North Carolina: Saving state money and improving patient care.
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