Policy, Politics, and Nursing Practice最新文献

This article examines the trends and trajectories of the nursing profession and healthcare practices in Israel from a historical perspective, following the enactment of the 1995 National Insurance Health (NHI) Law, which entitled every Israeli resident to healthcare services. Since then, Israel's health funds have become more competitive and services to patients have improved. Nurses in Israel have taken on new roles in the healthcare system, including working with professional colleagues to develop efficient teamwork that serves patients' needs. Nursing in Israel has also become increasingly academized, with all nursing training taking place in universities or academic colleges as of 2024. These changes mirror global trends in nursing and demand new thinking about the role of nurses, including how nursing can best serve patients and the wider healthcare system.

Recently, the Georgia state House of Representatives passed House Bill 1013, also called The Mental Health Parity Act. The bill sought to address access to and insurance coverage for mental health services, first identified in a report in 2020. The budget for mental health services was reduced by $8 m in 2020, despite an all-time high demand due to the beginning of the Covid-19 pandemic. There is an increasing inability to secure mental health care in the state. Georgia is ranked 37^th in the country for access to quality mental health care (Reinert, Fritze, and Nguyen, 2022) and half the counties in the state have no psychiatrist; the projected mental health workforce will be able to meet only 12% of consumer demand by 2025. Problems with mental health care in Georgia have a long history which intersects with the history of racism, geographical segregation, and policing. HB1013 does not consider any of this history in its recommendations, which barely include nursing. At the same time, policy and practice in Georgia continues to entangle nurses and other professionals with a carceral and punitive system which not only threatens the safety of patients, but also nurses themselves. Nurses need to understand this history if they hope to develop policy that will intervene in the mental health care crisis.

Since the "Black Lives Matter" reckoning of 2020, professional health organizations have made public statements and apologized for not recognizing the role of racism in the creation of health disparities. For the American Nurses Association, this has taken the form of the National Commission to Address Racism in Nursing. One result of that work has been the Report on the History of Racism in Nursing, which details the constant maligning of the competence of Black nurses and their systematic exclusion from institutions within the profession. In this article, we want to take these ideas further and argue that the issue for nursing is not so much a generic kind of racism that a professional reorganization can address, but rather a deep and abiding "anti-blackness" that is intrinsic to the heart and soul of medical and health knowledge itself. Anti-blackness as an idea comes from a collection of theoretical interventions developed by Black philosophers, literary theorists, sociologists, and historians who continue to grapple with the question posed by W.E.B. DuBois: "How does it feel to be a problem?" Anti-blackness is the "relegation of Black people to inhumanity and non-being" and "is a global phenomenon that takes on distinct forms of expression in each sociocultural context." Given the call to understand the role of historical, social, political, environmental, and economic factors via the social determinants of health, a more expansive approach is needed to articulate the Black lived experience. Anti-blackness is one tool available to nurses interested in a deeper level of analysis.

Nurses have a critical role to play in creating, implementing, critiquing, and advancing health policy within diverse contexts to ensure people living with life-limiting illness receive equitable and ethical access to palliative care services and programs. This article describes a critical analysis of the British Columbia's Palliative Care Benefits (BCPCB). The BCPCB is a provincial government program in British Columbia (B.C.), Canada, that provides eligible residents with palliative care services at home. Utilizing Fairclough's Dialectical-Relational Critical Discourse Analysis, the study investigates the process by which BCPCB determines B.C. residents' eligibility and access to resources proportionate to their need, function, illness burden, and urgency. This article reviews the construction of palliative care in Canada and how current biomedical perspectives construct palliative care policy and services in B.C. The findings indicate that the BCPCB program produces vague, discriminatory, and ableist prognostication practices through the implementation of its eligibility policy. This article also suggests that palliative care nurses are optimally positioned for policy influence: to critique, disrupt, and transform the BCPCB Program and palliative care practices.

Poor oral health has been associated with various systemic diseases (e.g., endocarditis, pneumonia, cardiovascular disease, and diabetes) and decreased quality of life. When enacted in 1965, Medicare excluded coverage for comprehensive dental services. As of 2023, Medicare has allowed coverage of limited dental services inextricably linked to specific medical conditions. Many Medicare Advantage plans (Medicare Part C) offer dental coverage. Yet in 2019, approximately 24 million Medicare beneficiaries (47% of all Medicare enrollees), lacked dental coverage. Seventy-one percent of traditional Medicare enrollees (those not enrolled in a Medicare Advantage Plan) reported that high cost was the primary reason that they did not obtain dental care. The importance of oral health for the older adults has been the main reason that a national interprofessional consortium, which includes several national nursing organizations, has been advocating for legislation to expand Medicare to include dental coverage. The consortium's efforts have been thwarted by fierce opposition from the American Dental Association and many Republican legislators. Given the vital role that nurses and advanced practice nurses play in caring for the nation's older adults and disabled, nursing's voice needs to be strengthened as leaders in advocating for inclusion of dental benefits in traditional Medicare.

The aim of this qualitative evidence synthesis (QES) is to critically appraise the contemporary literature to gain a comprehensive understanding of the barriers and enablers of workplace integration needs of internationally educated nurses (IENs). An electronic search was conducted across multiple databases, and eligibility criteria were applied to identify papers published between January 2013 and July 2023. Out of the 830 studies initially retrieved, six met the inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the included studies revealed various barriers and enablers for workplace integration experienced by IENs. Barriers were: (a) IEN-related factors (cultural differences, language barriers, and disparities in the scope of nursing practice), (b) organizational factors (poor leadership), and (c) contextual factors (racism and discrimination). Enablers emerged were: (a) IEN-related factors (commitment to learn and adapt) and (b) organizational factors (structured multifaceted program, supportive workplace environment, and mentorship). Dynamic interaction exists among these factors, therefore interventions should address multiple barriers simultaneously. The QES has illuminated essential factors which impact the integration of IENs, and emphasizes the necessity of a comprehensive approach that considers the diverse challenges and opportunities that arise.

Xylazine, a veterinary sedative, has emerged as a concerning element in the landscape of substance use in the United States. This integrative review synthesizes evidence from a systematic examination of 14 selected studies conducted between 2008 and 2023. The primary objective is to comprehensively understand the epidemiology and prevalence of xylazine use, particularly its involvement in drug-related deaths, regional variations, national impact, co-occurrence with opioids, and challenges associated with detection and intervention. The results underscore stark regional disparities in xylazine prevalence. West Virginia and Miami-Dade County have experienced alarming surges in xylazine-involved drug-related deaths. Nationally, its influence extends beyond regional boundaries, predominantly affecting white males in the Northeast. The co-occurrence of xylazine with opioids, especially fentanyl and heroin, significantly amplifies the risks of fatal overdoses. Detecting xylazine presents formidable challenges due to its frequent presence alongside other substances, necessitating enhanced surveillance and more effective detection methods. User perspectives emerge as pivotal, emphasizing the importance of user-informed harm reduction strategies. In conclusion, this review has significant policy implications. Tailored, region-specific strategies are imperative to address the diverse prevalence of xylazine use. A nationwide response is indispensable, prioritizing harm reduction initiatives, enhanced detection methods, and active user engagement. The multifaceted nature of the xylazine issue requires comprehensive approaches to mitigate its profound risks effectively. Policymakers are urged to consider regional disparities and the co-occurrence of xylazine with opioids when crafting targeted interventions. Immediate, user-informed harm reduction is vital to address the evolving landscape of xylazine use in the United States.

The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing-the largest healthcare workforce with diverse roles-operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health.