Policy, Politics, and Nursing Practice最新文献

Competence-based education is an emerging trend in nursing education. Finland has initiated a pilot program for a national exam designed to evaluate the knowledge of graduating nursing students. However, research concerning students' perspectives on exam quality and implementation remains scarce. The aim of this study was to explore graduating nursing students' experiences and identify key areas for improvement in the organizational implementation of competence-based national nursing examination in Finland. This study employed Elo and Kyngäs' qualitative content analysis, which examined a set of 109 mentions to open-ended questions from 106 graduating nursing students. The results revealed that students wanted better content validation, exam clarity, preparation resources, and flexibility in exams. The students also required explicit instructions and a structured framework for drug calculations. A competence-based national examination ensures compliance with standards, and it is essential to validate test questions and equip educators. Students need early preparation, and practice tests and materials should be improved for readiness.

Human papillomavirus (HPV) vaccination remains significantly underutilized despite its proven efficacy in preventing cancer. As of 2022, only 38.6% of children ages 9 to 17 years have received one or more HPV vaccine doses, with particularly low coverage among younger children (7.3% for ages 9-10 years) who would benefit most from early vaccination. This results in approximately 36,000 preventable HPV-related cancer cases annually, with an economic burden exceeding $1.7 billion. Significant disparities exist between metropolitan (39.4%-41.1%) and nonmetropolitan areas (30.0%). This brief presents evidence-based policy recommendations for state legislators to increase HPV vaccination rates through school-entry requirements, enhanced funding for equitable access, and provider education targeting children and adolescents aged 9 to 17 years. Implementation of these measures could prevent 90% of cervical cancers and substantially reduce five other HPV-related cancers, saving thousands of lives annually while lowering healthcare costs by an estimated $3.5 billion over a decade. Immediate action is essential to protect the current generation from future cancer risk.

The Well-Being Insurance for Seniors to be at Home (WISH) Act proposes universal social insurance for long-term care through activities of daily living (ADL) assistance. While this legislation addresses basic personal care needs, it overlooks the clinical complexity of aging adults who require both ADL support and ongoing health monitoring. This policy analysis examines how strategic nursing integration can enhance WISH Act effectiveness by addressing the gap between ADL-focused services and the complex care needs of beneficiaries with multiple chronic conditions. Using Russell and Fawcett's Conceptual Model for Nursing and Health Policy, this qualitative analysis evaluated policy sources, components, and four outcome levels. The study analyzed legislative text, congressional reports, and peer-reviewed literature on long-term care policy, nursing coordination, and international social insurance models. Analysis reveals that 85% of WISH-eligible beneficiaries will have multiple chronic conditions requiring clinical oversight beyond basic ADL assistance. Personal care workers encounter medication management challenges in 78% of cases, while falls, declining functional abilities, pressure ulcers, and adverse medication events frequently result in unplanned hospitalizations when clinical changes go unrecognized during routine personal care. Strategic nursing integration targeting the 35% highest complexity cases could reduce emergency department visits by 32% and hospital readmissions by 25% while achieving cost neutrality through prevention-focused interventions. Strategic nursing involvement in complex case identification, care transitions, chronic disease monitoring, and family caregiver support could bridge the clinical complexity gap while complementing existing Medicare services. This targeted approach maintains the WISH Act's core ADL focus while ensuring comprehensive community-based care for aging populations with complex health needs.

Despite being a high-resource nation, the U.S. maternal mortality rate has been steadily rising since 1997 and disproportionately affects disenfranchised groups and communities. In 2024, the Massachusetts Maternal Mortality and Morbidity Review Committee released recommendations for remedial policy and practice changes based on a thorough review of 25 pregnancy-related in-state deaths, the majority of which were deemed preventable. The purpose of this paper is to use the conceptual model of nursing and health policy to analyze the committee's recommendations to determine their capacity to contribute to a comprehensive strategy against maternal mortality as well as their connection to perinatal nursing practices. The method involved classifying the report recommendations based on their strongest connection to specific levels of the conceptual model to highlight opportunities for nurses to engage with the policy recommendations. Results demonstrated that each of the recommendations aligned with one of the model's four levels (individual, community, geopolitical unit, global), demonstrating comprehensiveness and a focus on efficacy, quality, effectiveness, cost-effectiveness, accessibility, and social justice. Future action plans should consider the following recommendations absent from the report: (1) implementation of standardized obstetric protocols, (2) extension of duration/scope of postpartum care, (3) increasing access to screening and treatment for perinatal mental health conditions, midwifery care, community birth options, and telehealth, and (4) performing qualitative research to gain further insights from groups most affected by maternal mortality. This analysis shows that the report's recommendations are largely implementable through nursing practice and can serve as a model for all states.

Making up over 80% of the global health workforce, nurses are essential for meeting public health goals like Healthy People 2030 and the Sustainable Development Goals. Despite this, nurses remain underrepresented in leadership and policy development. The program was created to equip pre-licensure, master's entry into nursing students with foundational policy skills through a two-semester extracurricular enrichment program. It combines classroom learning with mentored policy projects, offering practical experience on key health policy issues like HIV prevention and end-of-life care. Early student feedback led to program adjustments, emphasizing peer learning. This paper describes the policy mentorship program and corresponding seminar. It provides a detailed description of the program so that other nursing schools can adopt components or design similar programs to help students hone the critical competencies required to navigate the sociopolitical systems that define our healthcare approach and mediate disease and wellness.

The issue of workplace violence (WPV) in health care is a critical concern affecting the safety of health care workers, patient care quality, and organizational sustainability. WPV encompasses various forms of violence, such as verbal abuse, assault, harassment, and intimidation, leading to emotional and physical harm for health care workers. The consequences of WPV extend beyond individual workers to impact patient care, workforce stability, and economic cost for health care organizations. Analysis of policy alternatives considers factors such as cost, quality, access, equity, feasibility, resources required, implementation strategies, and long-term sustainability. The SAVE Act emerges as a comprehensive solution with broad support from key contributors despite challenges related to federal legislative processes and financial commitments. State-specific policies in New Hampshire, Connecticut, and New York offer targeted approaches but may face limitations in scope, funding, and enforcement mechanisms compared to federal guidelines. Addressing WPV in health care requires a multifaceted approach involving legislative actions, organizational initiatives, advocacy group collaborations, and resource allocations. The SAVE Act stands out as a promising solution with the potential to improve workplace safety, protect health care workers' rights and enhance patient care outcomes. However, careful planning, resource management, and ongoing evaluations are necessary to ensure effective implementation and sustain impact in reducing WPV across health care settings.

Florence Nightingale's mid-19^th-century reforms-especially her emphasis on sanitation, holistic patient care, and empirical data-catalyzed the transformation of nursing from an unregulated, low-status occupation into a respected, professional field. American institutions rapidly adopted her model, establishing standardized training programs followed by state licensure. Yet, by framing nursing around traits traditionally coded as feminine (compassion, nurturing, moral duty), these reforms inadvertently excluded men, who had historically provided significant direct patient care in military, psychiatric, and community settings. This article employs a critical gender-theoretical lens-integrating feminist standpoint theory and Foucauldian analyses of power/knowledge-to explore how Nightingale's legacy simultaneously elevated the nursing profession and entrenched enduring gendered hierarchies. The article examines specific policies shaped by Nightingale's model, such as state nurse-registration laws, military nursing corps restrictions, and early American Nurses Association (ANA) bylaws, demonstrating how institutionalized gender norms marginalized male practitioners. It asserts that while Nightingale deserves acclaim for professionalizing nursing, the discipline must also reckon with her legacy's exclusionary effects. Finally, the article proposes concrete strategies to deconstruct persistent gender biases and foster a more inclusive nursing profession.