Policy, Politics, & Nursing Practice current issue

In This Issue

Keepnews, D. M. — Thu, 24 Sep 2009 21:38:13 PDT

U.S. Health Reform: A Continuing Imperative

Keepnews, D. M. — Thu, 24 Sep 2009 21:38:14 PDT

A new political climate in the United States has raised renewed hope for achieving much needed reform of the U.S. health care system. Opposition to reform raises old arguments, however, including warnings against "big government," currently focused on proposals to include a public plan option in health reform. But greater government involvement in health care is needed to achieve comprehensive reform. Further substantial delay in achieving reform is unthinkable; success will require continued and expanded support efforts. Although a strong public plan option would represent a significant step forward, continued advocacy by proponents of single-payer health care can help strengthen broader efforts to achieve public accountability. Supporters of meaningful health reform will need to continue their efforts long past the passage of reform legislation.

Massachusetts Nurse Practitioners Step Up as One Solution to the Primary Care Access Problem: A Political Success Story

Craven, G., Ober, S. — Thu, 24 Sep 2009 21:38:14 PDT

Massachusetts’ political experience with efforts to insure all citizens provided a unique opportunity for nurse practitioners to address the growing need for access to primary care. Passage of a new statute to recognize nurse practitioners as primary care providers that health plan beneficiaries could choose was accomplished through strategic planning and political savvy. The results of a focused effort using the expertise of a professional lobbying team along with organizational support resulted in a groundbreaking new law that is a component of a reform model being examined by the nation as a whole, looking to address accessible, quality, and affordable health care. This article chronicles that journey and its accomplishment.

Predicting Nursing Human Resources: An Exploratory Study

Squires, A., Beltran-Sanchez, H. — Thu, 24 Sep 2009 21:38:14 PDT

The nurse-to-population ratio (NPOP) is a standard indicator used to indicate a country’s health care human resources capacity for responding to its disease burden. This study sought to explore if socioeconomic development indicators could predict the NPOP in a country. Mexico served as the case example for this exploratory study, with the final five variables selected based on findings from a qualitative study analyzing the development of nursing human resources in the country. Multiple linear regression showed that two variables proved significant predictors of the NPOP and the model itself explained 70% of the variance (r² = .7; p = .0000). The findings have multiple implications for nursing human resources policy in Mexico and at a global level as governments attempt to build human capital to respond to population health needs.

Social Responsibility of Nursing: A Global Perspective

Thu, 24 Sep 2009 21:38:14 PDT

This study addresses social responsibility in the discipline of nursing and implications for global health. The concept of social responsibility is explicated and its relevance for nursing is examined, grounded in the American Nurses Association Code of Ethics and the International Council of Nurses Code of Ethics. Social justice, human rights, nurse migration, and approaches to nursing education are discussed within the framework of nursing’s social responsibility. Strategies for addressing nursing workforce issues and education within a framework of social responsibility are explored.

Nurse Working Conditions and Nursing Unit Costs

Mark, B. A., Lindley, L., Jones, C. B. — Thu, 24 Sep 2009 21:38:14 PDT

The authors examined the relationship between nurse working conditions and nursing unit costs in 210 general medical, general surgical, and general medical surgical units in 112 randomly selected U.S. hospitals. Data were collected from registered nurses (N = 3,747 and 2,878), patients (N = 2,100), study coordinators, and secondary data sources. After controlling for relevant hospital, nursing unit, and patient characteristics, the authors found that good working conditions did not increase nursing unit costs. Teaching status was associated with higher costs, whereas larger unit size was associated with lower costs. Higher proportions of registered nurses and licensed practical nurse staffing were also associated with higher costs. Patient variables were not significantly related to costs. We suggest a variety of strategies that managers may use to improve working conditions.

Preconception Care: Practice and Policy Implications for Nurses

Sanders, L. B. — Thu, 24 Sep 2009 21:38:14 PDT

Statistical reports describe a troubling portrait of infant mortality in the United States today. This rate, an indicator of the health of a nation, has not declined in the past 5 years and is marked by enormous disparities among racial and ethnic groups. Although the overall infant mortality rate in the United States is 6.86 per 1,000 live births, the rate for non-Hispanic Black infants is 13.63 deaths per 1,000 live births. Among developed nations, the United States now ranks 29th in infant mortality. It is believed that lack of preconception care and late entry into prenatal care are contributing factors to infant mortality. Preconception care, although not a new concept, has not been universally adopted into the health care setting. This article examines the potential barriers to developing and using preconception care and policy implications related to nursing practice.

Obesity as a Social Problem in the United States: Application of the Public Arenas Model

Smith, M. C. — Thu, 24 Sep 2009 21:38:14 PDT

Obesity rates in the United States have been rising over the past 35 years, resulting in a subsequent increase in nutrition-related chronic disease morbidity and mortality and significant burdens to families, communities, and health care systems. In working to formulate effective public health policy solutions that address the obesity epidemic, it is important to analyze how obesity has been defined and accepted as a social problem. This article applies Hilgartner and Bosk’s public arenas model to examine how obesity is defined in the public arena, how competition plays a role in "framing" the obesity issue, and how operatives influence the ways in which obesity is viewed and understood. Implications for nurses and policy makers are addressed in the context of using the public arenas model as a tool to analyze the social problem of obesity.

Patient Satisfaction of Young Adults in Rural Clinics: Policy Implications for Nurse Practitioner Practice

Lemley, K. B., Marks, B. — Thu, 24 Sep 2009 21:38:14 PDT

In an effort to increase primary care services to Medicare and Medicaid patients, the Rural Health Clinics Services Act of 1977 required collaborative practices to include mid-level providers such as nurse practitioners (NPs). As a result, NPs have increased access to primary care in many rural and underserved areas. Now, in an effort to improve quality of health care, the Centers for Medicare and Medicaid Services (CMS) initiated public reporting of health care quality indicators. Although patient satisfaction is recognized as a quality indicator, few researchers have investigated patient satisfaction with NPs in rural family practice. A patient satisfaction survey (PSS) was distributed to a convenience sample of 213 young adult patients seen by five nurse practitioners in two rural family practice clinics. Survey results are analyzed and discussed within the framework of current CMS policy initiatives such as performance measures, pay for performance (P4P), transparency, and public reporting.

The Politics of Nursing Care: Correcting Deviance in Accordance with the Social Contract

O'Byrne, P., Holmes, D. — Thu, 24 Sep 2009 21:38:14 PDT

Despite numerous theories, models, and philosophies describing what nurses are and what they do, nursing care is often presented as an apolitical process which primarily focuses on patient needs and priorities. However, it is our position that nursing practice—in all regards—is political. To support this argument, we have drawn on works describing of soft/hard power, pastoral power, stigma, deviance, and governmentality, in addition to explaining our institutional social contract conceptualization of politics. In using these concepts, our political perspective reframes nursing practice as a means by which an individual’s potential or actual deviance (meaning a deviation from social norms) can be identified and then corrected.

Predominant Discourses in Swedish Nursing

Dahlborg-Lyckhage, E., Pilhammar-Anderson, E. — Thu, 24 Sep 2009 21:38:14 PDT

The aim of this study was to elucidate the predominant discourse in the field of Swedish nursing in 2000, 25 years after nursing was introduced as an academic discipline in Sweden. The method used was content analysis and deconstructive analysis of discourses. Laws, statutes, regulations, and examination requirements, including official reports, recruitment campaigns, and media coverage, were analyzed. The findings uncovered competing discourses striving to gain hegemony. In the public sector, official requirements competed against the media fixation on gender stereotypes and the realities of local recruitment campaigns. Media has a major role in disseminating prevailing conceptions and conventions pertaining to the nursing profession. As a result, decision makers, students, patients, and family members could get lower expectations of the professional competence of nursing practitioners than would otherwise have been the case in the absence of media exposure.