Policy, Politics, and Nursing Practice最新文献

When a person chooses assisted dying, the impact on their family can be profound. Legislation and professional guidelines not only regulate and standardize practice, but also support the delivery of high-quality care. Within this framework, bereavement care plays a vital role by helping families prepare for the death and potentially reducing the risk of prolonged grief. This study explored how current legislation and clinical guidelines on assisted dying address the role and needs of family members, particularly regarding bereavement care. It examined the frequency of the term "family" and its synonyms, as well as the extent to which bereavement support services for relatives are described. A content analysis was conducted on legislative and guideline documents from countries where physician-administered assisted dying is legal. Documents were collected between August 2022 and June 2023, and both quantitative and qualitative analyses were used to assess references to families and descriptions of bereavement care. In total, 22 legislative frameworks and 38 clinical guidelines from nine countries were analyzed. References to family appeared far more often in guidelines (N = 1,213) than in legislation (N = 147). The frequency of these terms varied significantly, with guidelines ranging from two to 83 mentions, and legislation from zero to 18. Eight key themes related to bereavement care emerged, though specific guidance was often lacking. To improve quality care, there is a clear need to better integrate family support into assisted dying guidelines by establishing best practices for bereavement care. Future research should focus on family members' perspectives and needs.

This study investigates the Italian regulatory landscape shaping the delivery of midwifery care and the midwifery profession. The primary objective was to identify and map relevant national and regional regulatory documents. A secondary aim was to compare three core national documents-the Code of Ethics, the Professional Profile, and the Educational Curricula-with the Professional Framework for Midwifery developed by the International Confederation of Midwives (2021). The study is a qualitative, two-phase exploratory design combining deductive thematic analysis and structured policy document review. In Phase I, a deductive thematic analysis was conducted using the ICM framework to assess the thematic alignment between international and national midwifery standards. Phase II involved a structured desk review identifying 141 regulatory documents, which were analyzed and mapped based on scope, origin, and relevance to midwifery care. Phase I findings revealed both thematic convergence and significant gaps, particularly regarding competencies, professional autonomy, midwifery-led care, and the role of professional associations. Phase II results highlighted a fragmented and inconsistent regulatory framework across regions, with a lack of specificity in policies supporting midwifery-led models, especially in sexual and reproductive health. Additionally, linguistic ambiguity in how "midwifery" is framed in Italian legal texts limits the profession's visibility and distinctiveness. This study outlines current regulatory complexities and discrepancies, providing a foundation for future policy development that better integrates midwifery within Italy's healthcare system in alignment with international recommendations.

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.

Background: Global cancer diagnoses are increasing, and treatment often results in oral health concerns. To improve patient outcomes and quality of life, nurses play a critical role in managing the oral sequelae of treatment. Aims: This scoping review explores nurses' oral health education, knowledge, and practices when caring for persons living with cancer. Methods: A systematic search of PubMed, DOSS, EMBASE, CINAHL, and Google Scholar identified 10 relevant studies. Results: Inconsistencies in oral care education, knowledge and practice were found among nurses caring for cancer patients. However, nurses with advanced education appear to be more knowledgeable and more likely to prioritize oral care for cancer patients. Collaboration with oral health professionals help to integrate oral health into nursing practice. Conclusions: Oral health practices in cancer care are critical, especially for individuals facing disparities in accessing a dental home. System, institutional, and provider-level supports are needed to enhance oral health in cancer care.

Digital health inequities appear to exist between rural-urban older adults, a problem exacerbated by the COVID-19 pandemic. This study investigated the differences in digital health use (DHU) between rural-urban Medicare beneficiaries using the 2021 National Health and Aging Trends Study. Led by the Senior Technology Acceptance Model, separate multiple linear regression models examined the relationship between DHU, social determinants, and technology readiness by residence. The results showed that Black urban older adults were more likely to engage in DHU than their White counterparts, and men across both samples were more likely to partake in DHU than women. Tablet access best predicted rural DHU, whereas computer access best predicted urban DHU. Online grocery shopping was the most significant technology experience for rural residents, whereas online banking led for urban residents. Nurses and other health professionals can introduce digital health applications in clinic or at bedside to build older adults' technology experience. To improve digital health equity, the policies and implementation of digital interventions should consider locality, device ownership, and user interface familiarity of Medicare beneficiaries.

The rapid integration of artificial intelligence in healthcare, accelerated by the Trump administration's 2025 AI Action Plan and private sector innovations from companies like Nvidia and Hippocratic AI, poses urgent challenges for nursing and health policy. This policy analysis examines the intersection of federal AI initiatives, emerging healthcare technologies, and nursing workforce implications through document analysis of regulatory frameworks, the federal AI Action Plan's 90+ initiatives, and insights from the American Academy of Nursing's November 2024 policy dialogue on AI transformation. The analysis reveals that while AI demonstrates measurable improvements in discrete clinical tasks-including 16% better medication assessment accuracy and 43% greater precision in identifying drug interactions at $9 per hour compared to nurses' median $41.38 hourly wage-current federal policy lacks critical healthcare-specific safeguards. The AI Action Plan's emphasis on rapid deployment and deregulation fails to address safety-net infrastructure needs, implementation pathways for vulnerable populations, or mechanisms ensuring health equity. Evidence from the Academy dialogue indicates that AI's "technosocial reality" fundamentally alters care delivery while potentially exacerbating disparities in underserved communities, as demonstrated by algorithmic bias in systems like Optum's care allocation algorithm. The findings suggest that achieving equitable AI integration requires comprehensive regulatory frameworks coordinating FDA, CMS, OCR, and HRSA oversight; community-centered governance approaches redistributing decision-making power to affected populations; and nursing leadership in AI development to preserve patient-centered care values. Without proactive nursing engagement in AI governance, healthcare risks adopting technologies that prioritize efficiency over the holistic, compassionate care fundamental to nursing practice.

Nurse staffing and missed nursing care are associated with patient readmissions. However, the mediating role of missed care in this relationship is not well understood. This retrospective study investigated the potential mediating effect of missed care on the relationship between nurse staffing and patient readmissions across 573 U.S. hospitals. Mediation analyses examined whether, and to what extent, missed care explains the relationship between nurse staffing and patient readmissions. Nurse staffing was associated with patient readmissions both directly and indirectly through missed care, which accounted for 10% of the total association. These findings suggest that missed care is an important pathway through which nurse staffing affects readmission rates. Addressing inadequate nurse staffing and reducing missed care are essential strategies for lowering readmissions. The findings have important implications for developing evidence-based interventions and informing policy to improve the quality of care in healthcare institutions.

Family caregivers provide essential unpaid care to millions of older adults and individuals with chronic illness or disability in the United States, yet federal support policies have historically been fragmented and underdeveloped. The Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act of 2018 (Pub. L. 115-119) established the first national framework to coordinate federal actions, disseminate evidence-based practices, and institutionalize caregiver recognition. This study analyzed the RAISE Act using Walt and Gilson's Health Policy Triangle and Kingdon's Multiple Streams Framework to understand how its structure, political origins, and implementation mechanisms institutionalize caregiving support and create opportunities for nursing leadership. Primary data included legislative text, congressional records, and federal implementation documents; secondary data comprised policy briefs, nursing literature, and grey reports from 2016-2024. Analysis revealed that the Act reframes family caregiving as a coordinated national responsibility through recurring strategy updates, multi-sector collaboration, and public transparency, ensuring sustainability without new appropriations. The convergence of social need, feasible policy alternatives, and bipartisan support created a durable policy window (an opportune moment when conditions align for policy enactment). Nursing has substantial opportunities to shape implementation through care coordination, caregiver education, evaluation, and advocacy. The RAISE Act demonstrates how modest, consensus-based policy can generate structural impact, creating expanded opportunities for nursing to lead caregiver integration, strengthen care transitions, and advance equitable aging policy.