National quality efforts: what continuing and staff development educators need to know

In 1994, the American Nurses Association initiated a series of activities currently referred to as Nursing's Quality Initiative. This first step toward public accountability was based on the premise that all nurses must become more knowledgeable about the measurement, improvement, and benchmarking of clinical costs, quality, and outcomes specific to nursing. The American Nurses Association has not been working alone to advance quality health care. Rather, it has taken an active role in several collaborative activities, including those of the National Quality Forum. The National Quality Forum has focused on a variety of issues, including nursing care performance measurement, an activity in which the American Nurses Association has been involved. It is up to professional nursing, the National Quality Forum, and all who have interest in the provision (or receipt) of quality health care to advance quality in a collaborative, coordinated way.     

The Precautionary Principle, public health, and public health nursing

ABSTRACT The Precautionary Principle posits that, in the absence of certainty, the appropriate course of action is to err on the side of caution. The Principle has been applied to decision making and policy development related to environmental health issues both internationally and in the United States. The American Public Health Association and the American Nurses Association (ANA) have issued policy statements that invoke the Precautionary Principle, and the Principle has been incorporated into statements that describe the practice of public health nursing. Nursing has always recognized the relationship of the environment with the health of humans—individuals, families, populations, and communities (ANA). The increasing attention to the Precautionary Principle comes at a time of redefinition of the field of public health, environmental public health, and the practice of public health nursing. Thus, it is crucial that practicing public health nurses understand the Precautionary Principle and its relevance to the practice of public health, public health nursing, and the current and future health individuals, families, populations, and communities.     

Low-income housing policy and socioeconomic inequalities in women's health: the importance of nursing inquiry and intervention

Decent, affordable housing is the building block of healthy neighborhoods. Housing characteristics not only shape the quality of life in communities but also affect individual and family health. The structural and social aspects of housing have a significant impact on the health of individuals and populations. Early public health nursing pioneers such as Lillian Wald and Jane E. Hitchcock understood the adverse impact of substandard housing on population health and incorporated advocacy for housing and other social policy reforms as an integral aspect of their nursing interventions. Contemporary nursing literature, however, is lacking in its critical examination of relationships between housing and health. This article presents historical and current issues in low-income housing policy, discusses how low-income housing policy has contributed to social inequalities in health, and advocates for the importance and inherent value of nursing inquiry and intervention in this area.     

Current status and future directions of U.S. genomic nursing health care policy

BackgroundAs genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing’s holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care.PurposeTo examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation.MethodsWe conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health.FindingsGenomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed.DiscussionNine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas.ConclusionsTo advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.     

The report of the conference on redesigning nursing education for public health

The following paper extracts some highlights from a conference on nursing education for public health, convened by the Division of Nursing, Bureau of Health Professions, Health Resources Administration, of the U.S. Department of Health, Education and Welfare in May 1973. This brief examination of selected discussions among participants about trends in health care, the challenges they believed they would face in improving health status, and the inferences they drew for planning public health nursing education may provide a partial foundation for examining current issues in the education of public health nurses. Although public health nursing roles have evolved dramatically over the last 34 years, the issues raised during the conference have not been completely or adequately resolved. The difficulty of predicting or prophesying the future during a period of rapidly changing social and political conditions, and the importance placed by these leaders of public health nursing on participating in the formation of goal-directed public policy remain salient lessons for the contemporary reader.     

Credentialing: The need for a national research agenda

A national research agenda is needed to promote inquiry into the impact of credentialing on health care outcomes for nurses, patients, and organizations. Credentialing is used here to refer to individual credentialing, such as certification for nurses, and organizational credentialing, such as American Nurses Credentialing Center Magnet recognition for health care organizations or accreditation of providers of continuing education in nursing. Although it is hypothesized that credentialing leads to a higher quality of care, more uniform practice, and better patient outcomes, the research evidence to validate these views is limited. This article proposes a conceptual model in which both credentials and standards are posited to affect outcomes in health care. Potential research questions as well as issues in research design, measurement, data collection, and analysis are discussed. Credentialing in nursing has implications for the health care professions and national policy. A growing body of independent research that clarifies the relationship of credentialing in nursing to outcomes can make important contributions to the improvement of health care quality.     

Genetic testing: A personal story of one nurse''s involvement in health policy

The intersection among basic research, clinical practice, and public policy is evident in the emerging issues raised by the recent advances in the Human Genome Project. The public policy implications of this groundbreaking research have long been recognized, and a portion of the National Institutes of Health (NIH) funding has been earmarked for studies exploring the ethical, legal, and social implications of scientific knowledge development. The public policy implications have been known as well, and there is an established mechanism to provide advice on oversight of the development and deployment of genetic tests. Many of the public policy issues have a direct affect on nursing and nursing practice, and it has been both important and rewarding to provide a nursing perspective to the policy making process. This article will discuss how one nurse became involved in making health policy, and the importance of this contribution to professional nursing practice.     

Assessment of older people: politics and practice in primary care

This paper reviews some of the key policy changes in the United Kingdom in relation to older people that have influenced assessment practice across health and social care, and have implications for nursing within emerging primary care groups. The role of assessment in purchasing care packages raises tensions and paradoxes for health and social care professionals that the paper sets out to elucidate with particular reference to district nurses. The issues for nursing have not been well described previously and questions such as key accountability, rationing, multiagency and interprofessional working, and the consumer voice, are discussed.     

Ethics, Policy, and Educational Issues in Genetic Testing

PURPOSE: Analyze ethics, public policy, and education issues that arise in the United States (US) and the United Kingdom (UK) when genomic information acquired as a result of genetic testing is introduced into healthcare services. ORGANIZING CONSTRUCT: Priorities in the Ethical, Legal, and Social Issues Research Program include privacy, integration of genetic services into clinical health care, and educational preparation of the nursing workforce. These constructs are used to examine health policies in the US and UK, and professional interactions of individuals and families with healthcare providers. FINDINGS: Individual, family, and societal goals may conflict with current healthcare practices and policies when genetic testing is done. Current health policies do not fully address these concerns. Unresolved issues include protection of privacy of individuals while considering genetic information needs of family members, determination of appropriate monitoring of genetic tests, addressing genetic healthcare discrepancies, and assuring appropriate nursing workforce preparation. CONCLUSIONS: Introduction of genetic testing into health care requires that providers are knowledgeable regarding ethical, policy, and practice issues in order to minimize risk for harm, protect the rights of individuals and families, and consider societal context in the management of genetic test results. Understanding of these issues is a component of genetic nursing competency that must be addressed at all levels of nursing education.     

Evolution of a Public Health Nursing Program, Yukon Kuskokwim Delta, Alaska, 1893-1993

Abstract The role of public health in a reformed health care system is currently a matter of great debate at the national and state levels. Many public health nursing leaders have expressed concern about changes in public health policy and funding sources that have led to the near demise of the generalist public health nurse. Generalist public health nurses may be an endangered species; however, the role is still in existence in rural Alaska. Will they be one more example of how “what we learn from history is that we don't learn from history?” Taking the discrete area of the Yukon Kuskokwim Delta of Alaska and studying the forces of geography, politics, economics, social factors and health issues, this article provides an historic account of the development of a unique health care delivery system and the role of the public health nursing structure within it, from earliest known records to present day. The long-standing efforts to document these data were spurred by the National Centennial of Public Health Nursing activities, celebrated in 1993.     

Nursing turnover: literature review and methodological critique

Turnover represents a major problem for nursing and health care in terms of cost, the ability to care for patients and the quality of care given. As a result, turnover has been the subject of a large number of investigations, both in nursing and non-nursing fields. However, many of the articles published report conflicting findings. A further complication is the variety of methodologies researchers have used; there has been little agreement on definition, measurement or reporting strategies. This has led to considerable confusion when attempting to compare studies. This article reviews what is currently understood about nursing turnover from an organizational perspective, and examines some of the methodological considerations surrounding the study of nursing turnover. Historically, nursing turnover research appears to have relied heavily on studies conducted in non-nursing areas for methodological guidance. References to non-nursing studies are therefore important and are reported where appropriate.     

Adaptation of a Best Practice Guideline to Strengthen Client‐Centered Care in Public Health

Best practice guidelines (BPGs) were developed by the Registered Nurses Association of Ontario (RNAO) to support evidence‐based nursing practice. One Ontario public health unit chose to implement the BPG on client‐centered care (CCC). A critical review of this BPG revealed issues that would hinder successful implementation within a public health setting. These included a focus on the client as an individual, the predominance of acute care exemplars and training resources that were not representative of public health nursing practice, and the need to reconcile the enforcement roles of public health with the BPG principles. The purpose of this article is to describe the process of adapting the CCC BPG to more accurately reflect the broad scope of public health nursing practice. A model for CCC in public health nursing context is presented and processes for implementing, evaluating, and sustaining CCC are described.     

Measuring intensive care unit performance after sustainable growth rate reform: An example with the National Quality Forum metrics

BackgroundPerformance measurement is essential for quality improvement and is inevitable in the shift to value-based payment. The National Quality Forum is an important clearinghouse for national performance measures in health care in the United States.AimWe reviewed the National Quality Forum library of performance measures to highlight measures that are relevant to critical care medicine, and we describe gaps and opportunities for the future of performance measurement in critical care medicine.ConclusionCrafting performance measures that address core aspects of critical care will be challenging, as current outcome and performance measures have problems with validity. Future quality measures will likely focus on interdisciplinary measures across the continuum of patient care.     

Health care value-based purchasing

Two Institute of Medicine studies have focused attention on the glaring deficiencies in health care safety and quality. These studies and others serve as wake-up calls within both the private and government-sponsored United States health care industry. As a result of the "quality chasm" and crippling rise in health care cost, the concept of value-based purchasing (VBP) has gained increasing momentum. The stakeholders affected by the health care value equation include consumers, employers, insurers, and providers. VBP creates quality standards and stakeholder incentives to improve quality of care and become more cost efficient. The greatest challenge is the development of methods and information sources that will allow reliable, accurate, and credible measures of health care quality. VBP presents the ambitious hope of creating transparent measures of quality and cost efficiency that would allow the consumer to make health care purchasing decisions. If this can be achieved, then the competitive forces that increase value in other industries will function in health care.     

Tool to assess the cost and quality benefits of nursing innovation

Understanding the economic value of nursing services in a time of unprecedented public sector cuts is a challenge. The economic assessment tool (EAT) (RCN 2011) has been designed by the authors of the article for this purpose and generates return on investment dividends for nursing innovations and services. The EAT, which is built on the discipline of improvement and uses many of its tools and techniques, involves four stages: mapping, costing, calculating and reporting. The nursing profession systematically captures a range of clinical data as part of routine care to which monetary values can be assigned. The EAT exploits these data and provides the profession with the economic evidence it might need to sustain quality nursing services in financially uncertain times.     

Safe practice of population-focused nursing care: Development of a public health nursing concept

Patient safety, a cornerstone of quality nursing care in most healthcare organizations, has not received attention in the specialty of public health nursing, owing to the conceptual challenges of applying this individual level concept to populations. Public health nurses (PHNs), by definition, provide population-focused care. Safe practice of population-focused nursing care involves preventing errors that would affect the health of entire populations and communities. The purpose of this article is to conceptually develop the public health nursing concept of safe practice of population-focused care and calls for related research. Key literature on patient safety is reviewed. Concepts applying to population-focused care are organized based on Donabedian's Framework. Structural, operational and system failures and process errors of omission and commission can occur at the population level of practice and potentially influence outcomes for population-patients. Practice, research and policy implications are discussed. Safe PHN population-focused practice deserves attention.     

Public accountability for health: new standards for health system performance

This article reviews the failure of contemporary quality oversight organizations to respond to the changing health care environment and suggests an overhaul of quality measurement and assurance functions. The authors examine the factors that have limited public accountability for health care, emphasizing the limited agreement that exists on the purpose of American health care, standards for evaluating care, or the appropriate locus of responsibility for quality of care. A five-part quality oversight system is proposed including development of quality measures, promulgation of national standards, validation and accreditation, use of data for purchasing and provider selection, and use of data for quality improvement.     

Part 6. Education for value-informed nursing practice

With the ongoing transition to value-based health care, a strong command of foundational economic concepts, like cost and value, and the ability to thoughtfully engage in value-informed nursing practice have become essential for the future of the nursing profession. Earlier in this six-part series, we explained value-informed nursing practice, its historical, economic, and ethical foundation, its promise for an environmentally responsible, innovation-driven future health care, and why its adoption requires a reframing of some of the nursing's professional norms and behaviors. This paper concludes the series with one of the most important issues—education for value-informed nursing practice. We begin by setting forth our vision of how nursing students will learn and apply value informed nursing practice, consider challenges that nurse educators will face, and offer some suggestions for engraining value into the consciousness of the nursing profession.     

Does Advanced Community/Public Health Nursing Practice Have a Future?

Societal trends and predicted needs of the health care system indicate that there will be increasing demands for health care professionals who can effectively manage the health needs of populations and communities. Nurses who have master's degrees in community/public health nursing have the educational background to provide this expertise. Although the Association of Community Health Nursing Educators and many nursing leaders maintain that these nurses are advanced practice nurses, most leading nursing organizations and state nurse practice acts do not include population and community health management skills in their definitions of advanced practice nursing. These exclusions have produced a serious status problem for master's programs in community/public health nursing. This article examines issues affecting the current and future status of master's-level community/public health nursing. Solutions are suggested for ensuring the viability of this specialty area.