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Quality care is dependent on the total engagement of nurses by  is a repost from KevinMD 

Six months after Congress passed the health reform law last year, the Institute of Medicine of the National Academy of Sciences issued a landmark report on nursing. Although seemingly separate events at the time, it’s clear now that they are integrally linked: Never has quality care been more dependent on the total engagement of nurses as well as other health professionals.

At its core, the Affordable Care Act is about providing care. It will enable about 32 million uninsured Americans to get coverage for services and treatment that they previously couldn’t afford, at times with devastating consequences. Yet the nation’s acute shortage of primary care physicians means that many patients still could find themselves going without. Health reform will be a hollow promise if we give people health insurance without giving them access to health care providers.

That’s the crucial point of intersection between the law and the Institute’s report on The Future of Nursing: Leading Change, Advancing Health.

The report identifies the actions needed for the nation’s more than 3 million nurses—the largest segment of U.S. health care ranks—to be able to contribute as essential partners from a patient’s bedside to a hospital boardroom. It calls for an end to barriers that prevent nurses from working to the full extent of their education, training and competency. Such barriers exist in two-thirds of the states and keep advanced-practice nurses from diagnosing and treating routine illnesses, ordering basic tests or prescribing medications without a physician’s oversight.

In the wake of the report’s publication, a nationwide initiative to implement its recommendations launched. Supported by the Robert Wood Johnson Foundation in collaboration with AARP, the Future of Nursing: Campaign for Action is moving forward through coalitions and organizations in almost every state. These groups include nurses and other health professionals, business and association executives, nonprofit and academic leaders, policy-makers and consumer advocates.

In Vermont, the governor is forming a blue-ribbon commission to consider key recommendations from the report. Montana is implementing a rural nurse residency program, and Georgia has begun offering online doctoral programs to speed expansion of nursing faculty—whose shortage has repercussions throughout nursing education.

The 671-page report has drawn attention at the federal level, too. Sen. Daniel Inouye of Hawaii and several of his Senate and House colleagues urged the Federal Trade Commission in April to review state regulations that restrict advanced-practice nurses’ work. In addition, Inouye asked the commission to monitor the regulations for their anticompetitive influence.

Removing scope-of-practice limitations is unquestionably the report’s most controversial section. It need not be. Sixteen states and the District of Columbia allow advanced-practice nurses to see primary care patients independent of a physician, and studies have consistently shown no compromise of patient safety. The expert committee that authored the report conducted a robust evaluation of all the scientific evidence before giving its endorsement.

There is also other support. In an article in the New England Journal of Medicine early this year, Linda H. Aiken of the University of Pennsylvania Center for Health Outcomes and Policy Research noted that advanced-practice nurses have permitted the biggest expansion of services at community health centers in a quarter century. And these days, Aiken calculated, advanced-practice nurses provide care at retail clinics to more than 3 million families annually. Those numbers convey real impact that we hope will increase as the Campaign for Action accelerates.

The Future of Nursing continues to rank as one of the most visited reports on the Institute’s website, which bodes well for its staying power and the campaign’s progress during its second year. Although the challenges remain considerable, just as they do with the Affordable Care Act itself, the real promise of this work is a transformed health system and accessible quality care for all.

Harvey V. Fineberg is president of the Institute of Medicine. John W. Rowe, who served on the Institute committee on the future of nursing, is a professor of health policy and management at the Columbia University Mailman School of Public Health. 


Quality care is dependent on the total

Manuscript of "The New Colossus" by Emma Lazarus; photo credit / The Center for Jewish History, NYC

Manuscript of “The New Colossus” by Emma Lazarus; photo credit / The Center for Jewish History, NYC

In July, I wrote a post on the first-ever narrative writing course for nursing students at the Hunter-Bellevue School of Nursing. CHMP poet-in-residence Joy Jacobson and I taught the five-week course, which met twice each week for three hours per class. I’m happy to report that it was a great experience for us as instructors and, by the end of the course, the consensus among students was that they didn’t want the class to end.

Eleven nursing students were enrolled and one Hunter staff member audited the course; seven of the 12 participants were not native English speakers (their first languages were Mandarin, Korean, Russian, and Yoruba). Most had done little writing for themselves and all needed to improve compositional and grammatical skills. Nevertheless, all of the students produced creative and moving original writing in a variety of formats, including in-class exercises, blog posts, and personal essays.

Several readers of my previous post asked for more particulars about our teaching methods. Here I’ll focus on the in-class writing exercises.

We spent about the first half hour of each class on one or more “quick writes”—guided writing exercises designed to get everyone writing quickly and spontaneously, without concern for the rules of grammar, spelling, and punctuation. The ideas for the quick writes came from several sources, and we adapted freely from books such as Natalie Goldberg’s Writing Down the Bones: Freeing the Writer Within, and The Essential Don Murray, edited by Thomas Newkirk and Lisa C. Miller. We encouraged students to keep their hands moving and to trust their impulses, in the hope that they would get in touch imaginatively with emotions, memories, and sensory impressions, and write about experiences they wouldn’t usually commit to paper. Joy and I did the writing exercises along with the students.

We then spent the next hour of the class reading and discussing what we had just written. While sharing was optional—no one was forced to read aloud—most students were eager to read most of the time. It was remarkable how quickly this sharing helped establish a sense of trust and an atmosphere of mutual support and respect. The feeling that we were coming together as a community of writers proved to be essential as the course progressed and some of the writing prompts led class members into deep and sometimes turbulent emotional waters.

The idea for what may have been the most powerful of the quick writes came from Between the Heartbeats: Poetry and Prose by Nurses, an anthology edited by Cortney Davis and Judy Schaefer. A short piece by Ruth E. Brooks, “Dear Alma Mater,” is in the form of a letter addressed to the Harlem Hospital School of Nursing, which was closed in 1977. The author writes to her alma mater as if it was a person, saying how news of the school’s closing gave her a profound sense of loss. “Let me tell you what part of me was sealed behind those doors,” she writes, and then enumerates not only some of the nursing skills but also the philosophical perspectives she learned there. In concluding, she expresses her sense of indebtedness to the school for helping her transform her life in the process of becoming a nurse.

I found the piece very moving, so I began one class by reading this letter aloud and then asked the students to write a heart-felt letter to a place or a person—living or deceased—that is important in their lives; and I asked them not to hold back, and to write all the things they wish they could say or could have said. When given the chance to express their feelings about what matters most to them, even those students who had the most difficulty with written English wrote clear, straightforward sentences that carried tremendous emotional weight. The stories that came out, the courage the students showed in sharing them, and the way they supported each other’s telling were cathartic and inspiring.

Students also were required to keep a daily journal, and there were assigned readings and writing projects. The final project was a personal essay. One student, Jamie Torres, wrote about her experience of the course itself, and how the close reading and discussion of some of the poems in the Heartbeats anthology had given her a new appreciation of poetry and her own abilities as a writer. She kindly gave me permission to quote from her essay, in which she wrote:

I would encourage all nurses to step out of their comfort zone and start reading poetry, write in a journal, and begin to share their stories. We can call it Narrative Nursing. Louise DeSalvo, author of Writing As a Way of Healing, says, “Through writing we see ourselves as able to solve problems rather than as beset by problems. We enjoy a heightened sense of self. We become more optimistic.” This is what nursing desperately needs. Narrative nursing will give us an opportunity to practice hearing our voice, in a new and fresh way. Maybe through writing we will recognize our own worth.

We’re looking forward to a guest blog post from Jamie sometime soon.

Jim Stubenrauch

[caption id="attachment_10317" align="alignleft" width="235"] Manuscript of "The

Namhee Choi

Namhee Choi

Namhee Choi, Ph.d., RN. is a professor at Seoul Women’s College of Nursing in South Korea, and now she is in Hunter-Bellevue School of Nursing as a visiting professor.  She has been teaching psychiatric mental health, nursing theory, and development and philosophy of nursing over 30 years.   She wrote a lot of academic essays and gave oral presentations at academic symposiums and forums, and received various research grants from national research foundation and governmental agency of Korea.

Her main interests are human life and narrative.   Especially, she has given a great deal of attention to transformative processing of way of life.   She has more than 20 years experience in studying and practicing for traumatized people to rebuild their distorted life by means of narrative reprocessing.

She is a main founder and the executive director of Seoul Institute for Narrative Studies (SINAS), a non-profit foundation for research and practice with narratives. She developed a narrative reprocessing method of working for people suffering from traumas.  As a result, a lot of scholars in Korea have received varied types of help from her, that is, training and exercise on narrative analysis, narrative reprocessing method, narrative research and hermeneutical dialogue, and so on.

Relating to her activities, Dr. Choi has been awarded a Civil Merit Medal from the President of Korea.  She had a leading role in shaping national policy for disaster victims and survivors in Korea.  For this reason, she received a gratitude plaque from the director of national emergency management of Korean Government.

Dr. Choi received BS in nursing from School of Nursing, Seoul National University and Master in public health from graduate school of public health, Seoul National University and Ph. d. in nursing from school of nursing, Yonsei University.

She is currently a vice president of Korean Association on Crisis and Disaster Management, the sector head of psychological counseling at Gyeonggi-do Province Branch of National Criminal Support Center.  And aditionally, she is a member the following organizations: Korean Society of Nursing Science, Korean Academic Society of Mental Health, Korean Academic Society of Phenomenology, and Korean Association of Mental Health Professionals.

[caption id="attachment_10305" align="alignleft" width="241"] Namhee Choi[/caption] Namhee Choi,