AAN News & Opinion
Achieving advance care planning in diverse, underserved populations
There remains a gap in meeting the palliative and end-of-life (EOL) care needs, including advance care planning (ACP) needs of ethnic minority, under-resourced, veterans, and lesbian, gay, bisexual, transgender, and queer (LGBTQ) Americans, as well as persons with disabilities and residing in geographically isolated regions. Intersecting socially constructed characteristics influence the lived experience of marginalized communities, including their health-care experiences. These persistent gaps pose a serious barrier to achieving high-quality care, including palliative and EOL care, across the life span of members of these growing populations.African-American mothers' persistent excessive maternal death rates
“Maternal health has significantly improved in the 21st century, but too many women continue to die or suffer severe pregnancy complications every year” (Centers for Disease Control and Prevention, 2016). African-American mothers in the United States die more often than their counterparts during childbirth and delivery. Research findings highlight disparity among African-American mothers as it relates to childbearing (Research overview of maternal mortality and morbidity in the United States). A focus on disparities during childbearing has been a national priority with federal support programs directed toward improving the health disparities of Maternal and Infant Health (MIH) among disadvantaged populations ( https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pqc.htm ).An effective human papillomavirus vaccination policy will reduce infection- and malignancy-related morbidity and mortality
Twelve human papillomaviruses (HPVs) are classified as strong human carcinogens, commonly referred to as high-risk HPVs (hrHPVs), and are responsible for nearly all cervical malignancies and 40% to 50% of all vaginal and vulvar cancers in women (Bouvard et al., 2009; International Agency for Research on Cancer, 2006; International Agency for Research on Cancer (IARC) Working Group on Evaluation of Carcinogenic Risks to Humans, 2007). Together these hrHPVs are the cause of ≥75% of anal and perianal cancers in male and female adults (Bosch & de Sanjose, 2003; Clifford, Smith, Plummer, Munoz, & Franceschi, 2003; Munoz, 2000; Walboomers et al., 1999).Nurses play essential roles in reducing health problems due to climate change
Climate change is endangering the stability of the planet's ecological systems and poses untoward risks to the continued survival of humans (Kurth, 2017; Landrigan et al., 2017; Melillo, Richmond, & Yohe, 2014; Watts et al., 2017). In our communities, climate change is experienced as increased frequency and intensity of wildfires, heat waves, winter storms, hurricanes, and floods, as well as changes in vector distribution. Climate- and weather-related conditions affect health conditions as diverse as asthma, sudden cardiac death, premature birth, gastrointestinal illness, depression, malnutrition, and vector-borne illness (Schifino, Lallo, De Sario, Davoli, & Michelozzi, 2013; Sheffield & Landrigan, 2011).Critical conversation: Toxic stress in children living in poverty
On October 27, 2017, the American Academy of Nursing President and Executive Vice President/Chief Operating Officer Children's Mercy Kansas City Karen Cox, PhD, RN, FAAN, convened a critical conversation on Toxic Stress in Children Living in Poverty. An invitation-only event, the critical conversation was launched in response to the Robert Wood Johnson Foundation's Culture of Health working group that met in 2016 on eliminating childhood poverty. Among the approximately 100 participants who assembled at the National Press Club, Washington, DC, were representatives of 33 organizations and 15 universities including First Focus, the Child Welfare League of America, Zero to Three, the Association for the Education of Young Children, the Campaign for Grade-Level Reading, National Association of Social Workers, and the Coalition to Stop Gun Violence.Call for action: Nurses must play a critical role to enhance health literacy
Health literacy is a precursor to health and achievement of a culture of health (Barton et al., 2017). Patient empowerment, engagement, activation, and maximized health outcomes will not be achieved unless assurance of health literacy is applied universally for every patient, every time, in every health care encounter, and across all environments of care. Organizations such as the Agency for Healthcare Research and Quality (AHRQ) and the Institute for Healthcare Improvement (IHI) endorse the use of available resources such as the Health Literacy Universal Precaution Toolkit (Brega et al., 2015).The vital role of school nurses in ensuring the health of our nation's youth
The American Academy of Nursing believes all students must have daily access to a full-time, school nurse, who is part of a comprehensive health-care and education system, and is supported financially by health and education dollars. The health of our nation's youth affects the health of the nation now and in the future, and is a critical investment. Rates of chronic health conditions continue to increase and become more complex. The number of outbreaks of communicable diseases such as measles and pertussis has been increasing as a result of the increase in immunization exemptions that have caused decreased herd immunity for these and other conditions.Position statement: Full practice authority for advanced practice registered nurses is necessary to transform primary care
Lack of full practice authority (FPA) for advanced practice registered nurses (APRNs) is a barrier to the provision of efficient, cost-effective, high-quality, and comprehensive health care services for some of our most vulnerable citizens (Agency for Healthcare Research and Quality, 2014; Buerhaus, DesRoches, Dittus, & Donelan, 2015; Pohl et al., 2010a; Seibert, Alexander, & Lupien, 2004). APRNs have the education, knowledge, skills, and experience necessary to provide basic and comprehensive primary care services; they are a ready workforce, ideally positioned to improve access to care, contribute to health disparities reduction efforts, and lower the cost of providing such care (National Center for Workforce Analysis Health Resources and Services Administration, 2013; Perloff, DesRoches, & Buerhaus, 2016).Position statement: Reducing fatigue associated with sleep deficiency and work hours in nurses
The American Academy of Nursing promotes management practices in health care organizations and strategies in the nurse's personal life to support sleep health in nurses and, as a result, an alert nursing workforce fit to perform their jobs and more able to live healthy lives. Society requires critical nursing services around the clock. Consequently, shift work and long work hours are common in health care organizations and negatively affect a significant percent of nurses. Working at night and irregular hours compromise human physiology dictated by the need for sleep and circadian rhythms.Reduce noise: Improve the nation's health
Although noise as a cause of hearing loss and tinnitus among civilian (Hearing health care for adults: Priorities for improving access and affordability, 2016) and military populations (Noise and military service: Implications for hearing loss and tinnitus, 2006) is well known, studies conducted in the past 15 years document that noise exposures negatively affect health by contributing to many diseases, including cardiovascular diseases, obesity, developmental delays, mental illness, and reduced job and academic performance (Basner et al., 2015; Lusk, Gillespie, Hagerty, & Ziemba, 2004; Münzel, Gori, Babisch, & Basner, 2014; Pyko et al., 2015; Ristovska, Laszlo, & Hansell, 2014; Tzivian et al., 2015; Yoon, Hong, Roh, Kim, & Won, 2015).Engaging communities in creating health: Leveraging community benefit
The academy supports sustaining and building on institutional and regulatory policies to realize the goals of improved population health and greater health equity. In 2010, the Patient Protection and Affordable Care Act (ACA) modified community benefit requirements for nonprofit hospitals to support hospitals taking a broader view of community benefits. The law, and its interpretation in final rules of Internal Revenue Service (IRS) regulations (IRS, 2014), requires nonprofit hospitals to complete a triennial community health needs assessment (CHNA) and strategic plan to address identified community health needs.Increasing the capacity of public health nursing to strengthen the public health infrastructure and to promote and protect the health of communities and populations
The American Academy of Nursing recognizes the need for strengthening the U.S. public health workforce and supports efforts to increase the capacity of public health nursing (PHN) to promote and protect the health of communities and populations. PHN has distinguished itself as a nursing specialty by defining its practice as that of “promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences” (American Public Health Association, PHN Section, 2013).Opioid misuse epidemic: Addressing opioid prescribing and organization initiatives for holistic, safe and compassionate care
The U.S. Centers for Disease Control (CDC) (2016a) state that the misuse and illicit use of prescription analgesic drugs and use of heroin have skyrocketed to epidemic proportions. Former Surgeon General Vivek Murtha's report, Facing Addiction in America (2016) notes that 12.5 million Americans use opioid pain relievers in ways other than those intended by prescription (USHHS, 2016). Notably, about 61% of the US drug overdose deaths in 2014 involved an opiate (Rudd, Seth, David, & Scholl, 2016).Policy brief: Improve coverage of newborn genetic screening to include the Recommended Uniform Screening Panel and newborn screening registry
A major goal of newborn screening is to reduce morbidity and mortality in infants and children by identifying heritable conditions in which early treatment may improve a child's long-term health and survival. However, the number and type of heritable disorders included in newborn screening currently vary from state to state. Expert recommendations to screen for 34 core conditions and report on 26 secondary conditions were issued by the U.S. Department of Health and Human Services. This panel, known as the Recommended Uniform Screening Panel (RUSP), has not been adopted by all states thereby creating a geographic disparity in opportunities to receive timely intervention for potentially life-threatening heritable conditions.Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education [Nursing Outlook 65/2 (2017) 242–245]
The authors regret that the printed version of the above article contained a number of errors. The correct and final version follows. The authors would like to apologise for any inconvenience caused.Call for improved military policy to support breastfeeding among U.S. armed forces
Human milk saves lives, reduces health care costs, and improves the health of both mother and infant. For a small investment to support breastfeeding among active-duty women, the payoff for the U.S. military would be significant: retention of loyal and well-trained service personnel, improved health of women, and a reduction in Tricare costs. Providing breastfeeding support can help the U.S. armed forces retain valued servicewomen after childbirth. A model policy to support breastfeeding women would include on-site lactation support services and peer support, suitable areas available for milk expression and storage, reasonable break time, and a leave policy that incentivizes breastfeeding.Improving maternal and infant outcomes by promoting normal physiologic birth on hospital birthing units
Pregnancy, labor, and birth are normal physiologic processes in women's lives. Women should receive care that supports a physiologic approach, using medical interventions only when needed, and continuing to support normal aspects of pregnancy and birth in more complex situations when possible. The academy supports the normalcy of pregnancy and birth and a woman-centered physiologic approach to providing care on hospital birthing units.Position statement: Political interference in sexual and reproductive health research and health professional education
Political interference in sexual and reproductive health (SRH) research and health professional education threatens the health of women and men. The American Academy of Nursing (academy) strongly supports actions to prevent political interference by supporting academic freedom principles and policies in institutions of higher education generally and in those offering instruction in nursing particularly.Admit to observation status: Policy brief
The Centers for Medicare and Medicaid Services (CMS) has differential payment for inpatient and observation status patient services. Observational stays are not credited toward the admission criteria for a skilled nursing facility (SNF). This rule poses financial concerns and burdens for Medicare patients. The Academy supports efforts to amend and replace the current payment rules with a more equitable payment policy for observation status and to limit its financial liability on patients.Critical workforce issues for registered and advanced practice nurses in integrated care models
Team-based, integrated models of care are essential to meeting the behavioral health needs of patients, families, and communities. To broaden the reach of effective integrated behavioral health care, all health providers must act to remove financial barriers, promote implementation of models designed for a wider range of populations, and improve access to services. The American Academy of Nursing identifies several actions in which nursing can partner with state and federal agencies, advocacy groups, and professional organizations to achieve these goals.Lesbian, gay, bisexual, and transgender health disparities are a global concern
Increasingly, initiatives by civil societies, governmental and nongovernmental agencies, and international partners have highlighted inequities in health care access and health outcomes for lesbian, gay, bisexual, and transgender (LGBT) people throughout the world. The United States Agency for International Development promotes LGBT human rights globally through its LGBT Global Development Partnership and has a vision that “…the basic and universal human rights of LGBT persons are respected and they are able to live with dignity, free from discrimination, persecution, and violence” (USAID, 2015).Call to action: Nursing action necessary to prevent one million heart attacks and strokes by 2017
Despite repeated national attempts to prevent and manage cardiovascular disease (CVD), it remains a leading public health problem in the United States today with costs estimated to exceed $289 billion (Anonymous, 2014; Mozaffarian et al., 2015). Several risk factors contribute to the burden of CVD. One third of all Americans have hypertension, and approximately half of those affected do not have it controlled (Mozaffarian et al., 2015; Lloyd-Jones et al., 2009; Ong, Cheung, Man, Lau, & Lam, 2007).Removing reimbursement barriers to increase the use of screening, brief intervention, and referral to treatment to prevent risky alcohol use
Better preparation and positioning of nurses to identify and address modifiable risks associated with preventable behavioral health care issues is one of the strongest and most feasible actions that can be taken by health care providers to reduce harm from alcohol use. (This recommendation was a product of the “Harm Reduction To Transform Health Care” Policy Dialogue presented at the 2013 American Academy of Nursing annual meeting.) One modifiable risk that affects the health of about 25% of the U.S.Elder justice: Preventing and intervening in elder mistreatment
In the United States, as many as 1 in 10 older adults and 47% of persons with dementia living at home experience some form of mistreatment (IOM, 2014). Elder mistreatment results in diminished well-being and quality of life, and violates the rights of older adults to be safe and free from violence. Elder mistreatment can occur anywhere–in the home, in care and residential facilities and in the community. It can also be malignantly contagious within settings and families and across the lifespan (Dong, 2012).Putting “health” in the electronic health record: A call for collective action
The American Academy of Nursing (Academy) endorses the capturing of social and behavioral determinants of health in the electronic health record (EHR). For this to happen, action must be taken to identify specific social and behavioral determinants of health (SBHD) to be included in a parsimonious panel to foster standardization and promote interoperability.
