Health Care

Introduction to Psychology Worksheet Complete each part with 100- to 200-word responses. The word count for individual questions may vary but your responses should total 500- to 800-words for the entire worksheet. Part I: Origins of Psychology Within the discipline of psychology, there are several perspectives used to describe, predict, and explain human behavior. Describe three major psychological perspectives and name at least one leading theorist for each. Neuroscience: Views the behavior from the perspective of the scientific functioning.

How individual nerve cells are put together. how the functioning of the body affects all the self conscience and conscious for example hopes, happiness, anger, and fears. This perspective includes the study of hereditary and evolution which considers how parents, uncles, and grandparents, etc. Could influence an individuals behavior which examines how the brain and the nervous system affects one persons behavior all in one circle revolving the brains main functions. Manfred Eigen Cognitive: Studies how people understand and think about the world we live in.

The main key point is on learning how people comprehend and represent the outside world among themselves and how our ways of thinking about the world influence our behavior which can lead to the choices we make by society. Jean Piaget Humanistic: The approach of free will one persons chosen behavior when people can control their behavior and that they naturally try to reach their full potential thus maximizing their personal realization. Marc Handelman Part II: Research Methods Provide a brief overview of some of the research methods used by psychologists. Include strengths and weaknesses of each method discussed. Case studies) are in-depth investigations or studies of a single person, group, event or community. Case studies are widely used in psychology and amongst the best known ones being used in todays times. Case studies can provide great data and have high levels of authenticity of all the information collected also the participants show the most real reactions. (Interviews) informal interviews are like a casual conversation. There are no specific questions and the participant is given the opportunity to talk about whatever topics he/she feels are important and ask them in their own way. formal interviews are like a job interview.

They are set up in the same way in a organized manner in which participants can help determine what are their stress induced activities when put on the spot light. (Questionnaires) Questionnaires can be thought of as a kind of written interview. They can be carried out face to face, by telephone like when you are talking with a clerk representative over the phone The questions asked can be open, allowing flexibility in what people want to answer when being asked specific questions, or they can be more structured requiring short answers which are straight to the point and also they can be given a list of like multiple choice questions. ll of the questions must be carefully asked due to the fact that potentially biased, or offensive questions can be misunderstood.. Part III: Ethics in Research Describe two ethical issues related to research. Why is informed consent necessary for ethical research? Informed consent: this is required for the reason that participants must be informed and have had to acknowledge everything that is going to be done in the research and case studies and must have full understanding of what will go on through at all times.

Confidentiality: this must be done for the reason that participants in some cases want full discretion of what goes on throughout the research and case studies. Failure to have all this documented could lead a dispute and possibly court actions by the participants. Part IV: The Brain and Mind Identify three major structures of the brain and their respective functions in the human body. The three main functioning areas of the brain are the cerebrum, cerebellum, and the medulla oblongata.

The most largest and most functioning area is the cerebrum, which is responsible for the consciousness. The second largest portion of the brain is the cerebellum. It actually looks a lot like a butter fly so I’ve read and seen on pictures and works to coordinate muscle movement in order to have both smooth and graceful execution in the brain. The third and last area of the brain is the medulla oblongata which is close to the spinal cord. It contains receptors for heartbeat, breathing, blood pressure and reflex centers for vomiting, coughing, sneezing, and swallowing.

Peaceful End of Life Theory This paper is written to examine Corneila Ruland and Shirley Moore’s Peaceful End of Life Theory and its examination on promoting positive outcomes for patients and their families during the dying process. Also, examine how the theory is understood in the Christian view as well as viewing ethical principles. As a Critical Care nurse I care for the dying patient mostly on a daily basis. During this process, I not only want to care for the dying but, I want to learn how I can ease the pain and heart break of the family.

During my study of Theory and Ethics, I discovered Cornelia M. Ruland and Shirley M. Moore’s Peaceful End of Life Theory. This theory shows how theory addresses the holistic care required to support a peaceful end of life. I found this theory to be useful by being free of the suffering of distress, providing comfort, respect as a human being, having peace and by being with those who care. (Martha Raile Alligood, PhD, RN, ANEF, Ann Marriner Tomey, PhD, RN, FAAN, 2010). Ruland and Moore theorize that with easing fears of death, it can be a peaceful end of life event.

Not just by providing daily needs and task but, also by caring for the dying (2010, p. 754). Many factors contribute to end of life situations for all patients, families, and health care providers. During the Peaceful End of Life Theory the standard of care is based on research in areas of pain management, comfort for the patient, nutritional needs for the patient, and relaxation needs (2010, p. 755). These factors are influenced by age, history of illness, religious values, and heath care concerns. Most of our efforts as humans are to improve our quality of life.

Understanding the importance of having a peaceful transition into another stage of life is beneficial. Death is always inevitable and always a factor in the lives of family members facing such a stressful time. We should strive to help minimize pain and suffering at the end of our life’s journey with peace and comfort. Providing comfort is the most important part of quality care with an advanced illness. Within the peaceful EOL theory there are major concepts that are examined and reviewed by patients that are in the dying process. EOL care focuses primarily on comfort when a cure is no longer possible.

Also, being free of pain is mostly the central part of many patients going through the EOL experience. A treatment plan should take place when a patient is experiencing pain. Becoming pain free is one of the major concerns of people dying (Dunn, 2001). To have peace with yourself and your loved one, you must distinguish your pain from their pain. Showing respect and having dignity helps the patient feel that they are still loved and cherished as individuals. Having peace with the decisions they have made and the outcome helps the patient transition over into the EOL concept.

I feel that if a patient is not at peace with death and dying then it makes it extremely hard for the family. If a patient is having no worries or fears to leave this earth, then they are physically ready, psychologically ready and spiritually ready to face the end of their life. The last concept to talk about is being close to their families in a trying time (2010, p. 756). Feeling at peace and having closeness to others helps the patient transition peacefully which could be the scariest part of dying. During any point of illness patients and families need to be prepared emotionally and spiritually for death (Dunn, 2001).

Ruland and Moore identified six theoretical assertions for the peaceful end of life theory that include: monitoring and administering pain meds, getting family involved in decision making regarding decisions that need to be made for the patient, relieving physical discomfort by encouraging rest periods, relaxation, provide support to the patient and family members, encourage family participation with patient care and last, monitoring the patients comfort, dignity and respect (2010, p. 757). Critique Clarity In the peaceful end of life theory all of its theory has been covered and has clearly been understood.

The assumption of the theory, that providing comfort for the patient allows a better transition into the stages of the end of life to supporting the family through difficult times shows how the concept varies in different degrees, but are all important to the theory (2010, p. 758). Simplicity The EOL theory has been described as one of the higher levels of middle range theories. It focuses on what is important to the patient at the end of life and how the patient views life. It also has several different aims and aspects on how one values the comfort and dignity throughout the rest of their life (2010, p. 59). Generality The peaceful end of life theory concept came from a Norwegian context that based a study on the dying. The theory is based on not being in pain, the experience of comfort, having dignity and respect, being at peace, and allowing the patient to be close to significant others. This theory allows the standards to guide a person through the peaceful end of life and allows the family to respond and adapt (2010, p. 759). Empirical Precision Each part of the peaceful end of life concept is based on the inductive and reasonable part of guiding the practice.

With the EOL theory its five concepts measured were mixed. Its observations were based on the patient and family perceptions of their care with the decisions made during the dying process (2010, p. 760). In the empirical precision the EOL theory illustrates that the five concepts were beneficial to the patient and the family. As nurses dealing with end of life issues, we strive to take care of the personal values of the patient but, also the medical, legal, and ethical aspects of the decision process get in the way. Sorting through these issues helps to gain respect with the family.

Conflicts may arise with EOL decisions, but establishing report with the patient and families helps focus on the primary values of care (G. Leigh Wilkerson, 1995). Often time’s ethical issues play a big role in EOL care. For example, withdrawing care from a mechanical intubated patient is a big ethical issue. Are we prolonging life or are we delaying death. A lot of times holding people on through mechanical ventilation is not ethical. Sometimes patients get dependent on mechanical ventilation which delays death then the family has to make decisions to withdraw care.

We should respect our patient’s autonomy and allow them the freedom to make decisions for themselves. We should practice beneficence, fidelity, and non-malfeasance as health care providers. Holding on makes it harder on the patient and prolonging the inevitable (Simon, 2008). As a Christian, letting my patient die with respect and dignity would be a victory in our Saviors eyes. Life is a gift. There is a time in everybody’s life that our body is not growing and healing, but failing. This is when we enter into another phase of our life. Having a peaceful end of life is choosing quality for the rest of your life.

Reference Dunn, H. (2001). Hard Choices For Loving People 4th ed. Lansdowne, VA : A & A Publishers, Inc. G. Leigh Wilkerson, R. (1995). A Different Season The Hospice Journey. Fayetteville, AR : Limbertwig Press. Martha Raile Alligood, PhD, RN, ANEF, Ann Marriner Tomey, PhD, RN, FAAN. (2010). Nursing Theorists and Their Works 7th ed. Marylan Heights, Missouri: Mosby Elsevier. Simon, C. (2008). Ethical issues in palliative care. Retrieved from Oxford Journals: http://rcgp-innovait. oxfordjournals. org/content/1/4/274. full http://rcgp-innovait. oxfordjournals. org/content/1/4/274. full

Access to Healthcare Services in Haiti Lena Almas Miami Dade “Healthcare is a human right, every American is entitled to the right to adequate medical care and the opportunity to achieve and enjoy good health. ” Those words were spoken by former President Theodore Roosevelt on January 11, 1944 to the American Congress. This essential freedom is not enjoyed by the global society at large and currently “over one billion people lack access to basic healthcare systems. ” (Carr, 2004, p. 28) Unfortunately, the poorest countries in the world are often found to be the ones most in need of these basic medical services.

The island nation of Haiti is the poorest countries in the Western Hemisphere. Seven million people inhabit an area the size of New Jersey. Seventy-eight percent of Haitians live on less than two dollars a day and only sixty four percent of the country is literate. (Shah, 2010) “Haiti has the worst malnutrition, the highest rates of infant and maternal mortality, and the worst AIDS epidemic in the Americas. Nearly half the population is chronically undernourished. Of every thousand children born in Haiti, 71 die before reaching the age of 5. ” (Partners In Health, 2012, para. ) Many factors over the last 200 years have contributed to a healthcare system in crisis. The paper will examine how healthcare is delivered within this impoverished nation and the vast dynamics that contribute the current healthcare crisis. Haiti’s healthcare is delivered in three sectors, the public, semi-public, and the private sector. The private for-profit sector provides approximately one third of the population’s healthcare and is located dominantly within the capital city of Port-au-Prince. Here doctors and hospitals often expect payment in advance for services. Mangan, 2009) If you are one of the twenty percent that live above the poverty line private healthcare might be an option for your healthcare needs. However; close to eighty percent of Haitian household find themselves living in abject poverty on less than 2 dollars and day and half of all household live on less than one dollar a day. For these people healthcare is found in the pubic and semi-public sectors. The public sector is run by the Ministry of Public Health and Population and Ministry of Social Affairs and is responsible for providing healthcare to the Haitian itizens. (World Health Organization [WHO], 2010, p. 6) Only one in 10 people here are covered by public health insurance. “The 2005 World Health Report estimates that the Haitian government spends only $2 per capita on health each year, accounting for about 40 percent of national expenditures on health. Since health insurance is not available or affordable for the vast majority of Haitians, households must pay for health care or go without. ” (“Zanmi lasante site background,” n. d, para. 3).

In Haiti there are 371 health posts, 217 health centers and 49 hospitals ran by the Ministry of Health and an estimated 40% of the population lacks access to health services (Pan American Health Organization, n. d. ) Often, “citizens in Haiti are not always familiar with the medical system of their own country and will avoid or delay seeking care due to lack of funds for transportation, services, and medicines” (Mangan, 2009). Most Haitians continued to meet their health-care needs through traditional remedies. Herbal medicines are widely used, especially in rural areas.

In addition to home remedies, herbal specialists (dokte fey) provided massage and herbal remedies. Many voodoo specialists are also experts in herbal remedies. In addition to the lack of funding and knowledge about healthcare resources within the country there is also found to be a lack of healthcare workers. In 1998, there were 2. 4 physicians and 1 nurse per 10,000 people. (Pan American Health Organization, n. d. ) Human resources are insufficient and lack of funds has prevented the creation of new positions and many professionals go into private practice or emigrate.

In 1999, a bilateral cooperation agreement was signed with Cuba, under which 500 Cuban health professionals have been working in 62% of the municipalities for 5 years (Pan American Health Organization, n. d. ) Being elderly in Haiti was difficult before the earthquake. So difficult, in fact, that the average Haitian lifep is only 61 years. Those over age 65 make up only 3. 4 percent of the population, compared with 13 percent in the United States. View a disabled child/elderyly as punishment or as a condition caused by a supernatural force, however the Disability is not shameful for family.

References Carr, D. (2004). “Improving the Health of the World’s Poorest People” [Health Bulletin 1]. Retrieved from Global Issues: http://www. prb. org/pdf/ImprovingtheHealthWorld_Eng. pdf Cong. Rec. 50 (1944, January 11). Mangan, J. (2009, January 30). Haiti: Cultural competency and Tuberculosis Control [Educational Material]. Retrieved from Southeastern National Tuberculosis Center: http://sntc. medicine. ufl. edu/Files/Products/Country%20Guide%20-%20Haiti. pdf Pan American Health Organization. (n. d. ). Haiti (332-349). Washington, DC: Government Printing Office.

Partners In Health. (2012). The Situation in Haiti. Retrieved November 6, 2012, from http://www. pih. org/where/pages/Haiti Shah, A. (2010). Haiti. Retrieved , from http://www. globalissues. org/article/141/haiti World Health Organization. (2010). Public health risk assessment and interventions. Earthquake: Haiti. Retrieved from http://www. who. int/diseasecontrol_emergencies/publications/haiti_earthquake_20100118. pdf Zanmi lasante site background. (n. d). Retrieved November 13, 2012, from http://www. pih. org/pages/haiti-background

Nurse-patient Ratio laws are state mandates requiring hospitals to keep to a maximum sealing limit of the ratio of nurses to patients. At the moment, states that have yet to apply any nurse-patient ratio limits typically charge each of their nurses the care of at least 6 nurses and even as high as 8 to 10 (Churchouse, 2002). Barnes-Jewish hospital for example has a ratio of 1 nurse to 10 patients (St. Louis, 2004). California’s Assembly Bill 394 is one of the forerunning legislations that mandated the regulation of nurse-patient ratios across hospitals.

This bill had been largely contested by hospital lobbyists who are now bartering with state officials on the most flexible regulations that could be imposed. While nursing associations and nursing labor unions all over the country are proposing the ideal 1:2 ratio, hospital management firmly claim this to be impossible. In some other states such as Illinois, staging progression procedures have been introduced as a viable means to improve nurse-patient ratios over a period of 5-10 years (Bartolomeo, 2001).

Since after the Second World War, the problem of increasing nurse-patient ratios have begun to accrue. By the mid-80s the pressing need for more nurses became even more drastic when the academe saw a decline in the local demand for the profession. This eventually led hospitals to searching for nurses abroad which continued to persist to the present day.

However, outsourcing the nurse supply was also coupled by hospital management cutbacks on staffing which still resulted to poor nurse-patient ratios. Hospitals also allegedly implemented management regulations preventing nursing staff from discussing and objecting to nurse-patient hospital policies. However by the late 90s, nursing unions have begun to seek help from media institutions, local communities, and contract negotiators to help them bargain less congested working conditions with hospital management. This led the nursing unions to asking help from their respective state governments.

Finally in January of 2002, California’s AB 394 mandated the issue of staffing ratios in hospitals throughout the state, but this victory of the nursing unions was short-lived as hospital management immediately bargained with legislators for staffing ratios that were most advantageous for them. While nursing organizations persisted with a 1:2 to a 1:4 ratio, hospital lobbyists led by the California Healthcare Association, a consortium of 500 hospitals insisted that the acceptable nurse-patient ratio could be no less than 1:6. Currently, one of the country’s largest Health Management Organizations, Kaiser Permanente broke away from the bulk of institutions opposed to lower nurse-patient ratios and advocated a 1:4 ratio that it currently implements in its facilities.

Kaiser discussed further ways of lowering the ratio with nursing unions and agreed to have the approved recommendations of such discussions implemented on all Kaiser owned establishments (Bartolomeo, 2001).
Current working conditions lead nurses into compromising situations wherein their work suffers because of the immense number of tasks that they have to do all at once.

While some hospitals implement “fair” policies that allow nurses enough room to breathe in their work, a lot more hospitals and health care organizations are run by profit oriented groups whose main concern includes minimizing costs. What’s worse is that since health care in various parts of the country has been transformed into a corporate affair between gigantic businesses who buy health care plans from HMOs who sell them, competition has become a matter of who can provide the better corporate deal over who can provide better hospital service.

Since the patients don’t have much choice with respect to which health care deals their employer will take, this rules out quality by competition from ushering hospitals to make nurse-patient ratio improvements on their own. Thus, a state mandated regulation is the only way to force these hospitals to provide an appropriate working environment for their nurses.

There are several controversial aspects to the legislation of nurse-patient ratio regulation. One popular controversy is the actual capability of today’s supply of nurses to fill in the vacancies that would be created by such legislation. The Illinois Hospital Association contends that current nursing programs of the state are not viable to handle the demand for the number of nurses required to maintain the ratios mandated by laws like California’s AB394. Another criticism is insensitivity of a rigid nurse-patient ratio to patient’s individual medical differences.

Critics also point out differences between hospitals, resources and even nursing units which could be blurred out in the implementation of a state mandate indiscriminately throughout all hospitals.
I believe that hospital policies at the moment are more profit-oriented than health oriented. It is this slippery slope that leads to understaffing and overly high nurse-patient ratios. However, I also think that an inflexible legislation on nurse-patient ratios would do little to solve the problem. Nurses from different units are very different and there needs to be more extensive needs analysis studies conducted before a proper legislative action could be taken.

Therefore while I am in favor of state legislation in order to curb inherent profit-oriented biases of hospital management, I am not in favor of haphazardly implementing one at the moment without considering factors forwarded by institutions like the Illinois Hospital Association.

Like I said, I believe that while the California legislation is a victory for the labor rights of nurses in the state, it does not ensure an increase in nursing quality. I would consider the act positive with respect to labor rights but neutral with respect to patient care. Extensive scrutiny should be placed on the issues that arose after the legislation such as the differences among hospitals, resources, and nursing units.

References:

1. Churchouse, C. (2002). Senate Community Affairs References Committee Inquiry Into Nursing. Retrieved: July 19, 2007 from: http://72.14.235.104/search?q=cache:uQtMh4POYlUJ:www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2002-04/nursing/submissions/sub04.doc+current+nurse-patient+ratio;hl=tl;ct=clnk;cd=3;gl=ph
2. Bartolomeo, C. (2001). “Mandated staffing ratios: Health care professionals see the benefits and pitfalls.” Journal of the American Federation of Teachers. Vol. 30 Issue 2. P.114-118.
3. Barnes-Jewish Hospital seeks to lower nurse-patient ratio. Retrieved July 19, 2007 from St. Louis Business Journal Website: http://www.bizjournals.com/stlouis/stories/2004/11/29/daily50.html

Still Born Babies What is stillbirth? The medical definition of a still birth is when a baby is born without any signs of life at or after 20 weeks or weighing more than 500g before labour. Death in the fetus may have occurred during pregnancy, which is intrauterine death, labour, or birth. Most still births are intrauterine. As rare as stillbirth is, it occurs once in every 160 pregnancies. What causes a stillbirth? There are a number of known causes of stillbirth. Sometimes more than one of these causes may contribute to the baby’s death essay writer reviews.

Common causes include: * Birth defects: Such as Down syndrome. Others have other birth defects resulting from genetic, environmental or unknown causes. * Placental problems: Placental abruption. In this condition, the placenta peels away, partly to almost completely, from the uterine wall before delivery. It results in heavy bleeding that can threaten the life of mother and baby. Sometimes it can cause the fetus to die from lack of oxygen. * Poor fetal growth: Fetuses who are growing too slowly are at increased risk of stillbirth.

About 40 percent of stillborn babies have poor growth. Increased risk by smoking or high blood pressure. * Infections: Infections involving the mother, fetus or placenta appear to cause about 10 to 25 percent of stillbirths. These include genital and urinary tract infections that may go undiagnosed until they cause serious complications * Chronic health conditions in the pregnant woman: About 10 percent of stillbirths are related to chronic health conditions in the mother, such as high blood pressure, diabetes, kidney diseases, and blood clotting disorders. Umbilical cord accidents: These include a knot in the cord or abnormal placement of the cord into the placenta, causing there to be a shortage of oxygen to the fetus. Other causes of stillbirth include trauma (such as car accidents), postdate pregnancy (a pregnancy that lasts longer than 42 weeks), Rh disease (an incompatibility between the blood of mother and baby), and lack of oxygen (asphyxia) during a difficult delivery. These causes are uncommon. What are some factors that increase a mother’s chance of a stillbirth? Women 35 years old or older: As age increases, there are more risks to pregnancy and all around health. * Malnutrition: Just like us, the fetus will only survive for so long with little to no nutrition. * Inadequate prenatal care: Women who are a high risk pregnancy have to be more careful with their daily activities. Even a regular pregnancy requires rest, low stress and being aware of your surroundings. * Smoking: Cigarette smoke contains more than 4,000 chemicals, including things like cyanide, lead, and at least 60 cancer-causing compounds.

When you smoke during pregnancy, that toxic brew gets into your bloodstream, the fetus’ only source of oxygen and nutrients. * Alcohol and drug abuse: Alcohol and drugs, poison the bloodstream to the fetus, it’s only source of oxygen and nutrients. * African-American ethnicity: It is not known why African American women are about twice as likely as other American women to have a stillborn baby. How is fetal death diagnosed? An ultrasound can tell if the fetus has died by showing the fetus’ heartbeat. It sometimes can help explain why the fetus died.

The doctor also can do some blood tests on the woman to help confirm why the fetus died. What happens after the diagnosis? After finding out that the fetus has died in the womb, the mother must go through with the birth of her stillborn. Whether the parents want to wait until labour comes naturally or if they’d like labour to be induced is their choice. Testing for the cause of the stillbirth requires permission from both parents. A specialized doctor will perform an autopsy on the baby to reveal the cause.

This is mostly done to prevent a repeated stillbirth. What are the chances of a repeat stillborn? The likelihood of a recurrent stillbirth depends upon the cause of your initial stillbirth. While repeated stillbirths do happen, they are very uncommon. Even in the case of genetic defects, recurrent stillbirths are very unlikely. Bibliography 1. Babycenter. “When a baby is stillborn – BabyCenter Canada. ” Pregnancy, baby and toddler health information at BabyCenter Canada – BabyCenter Canada. Babycenter, n. d. Web. <http://www. babycenter. a/a1014800/when-a-baby-is-stillborn#section1>. 2. March of Dimes. “Stillbirth | Baby | Loss and grief | March of Dimes. ” Pregnancy, Baby, Prematurity, Birth Defects | March of Dimes. http://www. marchofdimes. com/baby/loss_stillbirth 3. “Stillbirth: Trying to Understand – American Pregnancy Association. ” American Pregnancy Association – Promoting Pregnancy Wellness. National Stillbirth society, n. d. Web. 10 Apr. 2013. <http://americanpregnancy. org/pregnancyloss/sbtryingtounderstand. html>. 4. March of Dimes. “StillbirthA – Loss and grief. Pregnancy, Baby, Prematurity, Birth DefectsA |A March of Dimes. March Of Dimes, n. d. Web. 12 Apr. 2013. <http://www. marchofdimes. com/baby/loss_stillbirth. html>. 1. “Understanding stillbirth — diagnosis and treatment. ” WebMD – Better information. Better health.. WebMD, 23 Apr. 2012. Web. 11 Apr. 2013. <http://www. webmd. com/baby/understanding-stillbirth-treatment>. 2. Epigee. org. “Pregnancy Help and Information: Stillbirth. ” Epigee Pregnancy Resource. http://www. epigee. org/pregnancy/stillbirth. html (accessed April 11, 2013).

IOM Report NRS-430V November 1, 2011 IOM Report The Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public. It asks and answers the nation’s most pressing questions about health and health care through studies, their expert consensus committees, and convening a series of forums, roundtables, and standing committees, as well as other activities.

These facilitate discussion, discovery, and critical, cross-disciplinary thinking. Their aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely (IOM, 2012). In 2010, Congress passed and the President signed into law comprehensive health care legislation, collectively referred to as the Affordable Care Act (ACA), which gives the United States an opportunity to transform its health care system to provide higher-quality, safer, more affordable, and more accessible care.

Recognizing that the nursing profession faces several challenges in fulfilling the promise of a reformed health care system and meeting the nation’s health needs, Robert Wood Johnson Foundation (RWJF) and the IOM completed a 2 year initiative on the future of nursing. The report contains recommendations for an action-oriented blueprint for the future of nursing, including changes in public and institutional policies at the national, state, and local levels.

The passage of the ACA, the IOM report, and its recommendations have an immense impact on nursing education, nursing practice – especially in the primary care setting, and the roles of nurses in leadership. The emergency department in which I work is progressively changing its practice to meet the goals of the IOM report. It is important that nurses achieve higher levels of education and training as well as practicing to the full extent of their education and training (IOM, 2012). Major changes in the U.

S. health care system and practice environment will require equally profound changes in the education of nurses both before and after they receive their license. An improved education system is necessary to ensure that the current and future generations of nurses can deliver safe, quality, patient-centered care across all settings, especially in such areas as primary care and community and public health. Recommendations in the IOM report have a huge impact on nursing education (IOM, 2012).

My hospital, which is a Magnet facility, is now mandating that all employed nurses obtain their BSN in nursing by 2018, which is two years earlier than the IOM’s recommendation that 80 percent of registered nurses nationwide have their BSN by 2020. The IOM also recommends that diploma and ADN nurses obtain their BSN earlier in their careers. Studies found that BSN graduates reported significantly higher levels of preparation in evidence-based practice, research skills, and assessment of gaps in areas such as teamwork, collaboration, and practice (Kovner et al, 2010).

A more educated nursing workforce would be better equipped to meet the demands of hospital settings that continue to grow more complex, and nurses must make critical decisions associated with care for sicker, frailer patients. Higher levels of education for nurses have an impact on nursing practice. As seen in the IOM reports recommendations, nursing practice is being affected by the following barriers: Fragmentation of the health care system.

There is a disconnect between public and private services, between providers and patients, between what patients need and how providers are trained, between the health needs of the nation and the services that are offered, and between those with insurance and those without (Stevens, 1999). Without the presence of nurses in decision-making positions in new entities, the legacy of undervaluing nurses, will carry over in to new systems. Nurses must be properly and transparently valued so that their contributions can fully benefit the entire system.

High rates of turnover among nurses. High turnover rates have been shown to be related to personal or family reasons (especially for nurses younger than 50), work environment (staff shortages, increasing workloads, poor improvement processes), disruptive behavior (verbal abuse, physical assault, sexual harassment). Difficulties for nurses transitioning from school to practice. New nursing students need programs that place a greater focus on managing the transitions from school to practice.

Studies show a need to develop skills in ways to organize work and establish priorities, communicate with physicians and other professionals as well as their patients and their families, and develop leadership and technical skills in order to provide quality care (Beecroft et al. , 2001, 2004; Halfer and Graf, 2006). Demographic challenges. The combination of age, gender, race/ethnicity, and life experiences provides individuals with unique perspectives that can contribute to advancing the nursing profession and providing better care to patients. AACN,2010a). Although the number of younger RNs has recently begun to grow, the increase is not expected to be large enough to offset the number of RNs anticipated to retire over the next 15 years (Buerhaus et al. , 2009b). Although more men are being drawn to nursing, especially as a second career, the profession needs to continue efforts to recruit men. Their unique perspectives and skills are important to the profession and will help contribute additional diversity to the workforce.

To provide more culturally relevant care, the current nursing workforce will need to become more diverse by increasing the diversity of the nursing student body. Regulations defining scope-of-practice limitations. Practice boundaries are constantly changing with the emergence of new technologies, evolving patient expectations, and workforce issues (Daly, 2007). The shift towards expansion of scope-of-practice regulations and been incremental and variable. The nursing profession has evolved more rapidly than the public policies that affect it.

State and federal policies and regulations need to continue to expand the legal authority of health care workers to provide health care that accords with their education, training, and competencies (AARP, 2010a). The IOM committee believes that now is the time to finally eliminate the outdated regulations and organizational and cultural barriers that limit nurses’ abilities. Strong nursing leadership is needed to help with the changes that are being enacted with the passage of the ACA.

Strong nursing leadership is needed to help with the changes that are being enacted with the passage of the ACA. All nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care. Being a full partner requires leadership skills and competencies that must be applied within the profession and in collaboration with other health professionals.

Nurses must see policy as something they can shape rather than something that happens to them. They should have a voice in health policy decision making and be engaged in implementation efforts related to health care reform. Nurses also should serve actively on advisory committees, commissions, and boards where policy decisions are made to advance health systems to improve patient care (IOM, 2012). With the passage of the ACA and the IOM reports recommendations, nursing in healthcare will continue to be transformed as the system in overhauled.

Continued and higher nursing education, transforming nursing practice that overcomes barriers, and nursing leadership based with the belief that they are the shapers of their professions destiny will ultimately help to bring the vision of the IOM report to reality. References AACN. 2010. Enhancing diversity in the nursing workforce: Fact sheet updated March 2010. http://www. aacn. nche. edu/Media/FactSheets/diversity. htm (accessed July 1, 2010). AARP. 2010a. AARP 2010 policy supplement: Scope of practice for advanced practice registered nurses. ttp://championnursing. org/sites/default/files/2010%20AARPPolicySupplementSco peofPractice. pdf (accessed September 10, 2010). Beecroft, P. C. , L. Kunzman, and C. Krozek. 2001. RN internship: Outcomes of a one-year pilot program. Journal of Nursing Administration 31(12):575-582. Buerhaus, P. I. , D. I. Auerbach, and D. O. Staiger. 2009b. The recent surge in nurse employment: Causes and implications. Health Affairs 28(4):w657-668. Daly, R. 2007. Psychiatrists, allies defeat psychology-prescribing bills.

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