AAN News & Opinion
Lesbian, gay, bisexual, and transgender health disparities are a global concernIncreasingly, 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 2017Despite 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 useBetter 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 mistreatmentIn 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 actionThe 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.
Policy agenda for nurse-led care coordinationThe Care Coordination Task Force (CCTF) was convened in mid-2014 by the leadership of the American Nurses Association (ANA) and the American Academy of Nursing (AAN) to review major position papers and policy briefs on care coordination published between 2012 and 2013 by expert panels of both organizations, and to recommend specific and actionable federal policy priorities to advance nursing's contributions to effective care coordination. Nurses have been and continue to be pivotal in the development and delivery of innovative care coordination practice models.
Position statement: Employment discrimination based on sexual orientation and gender identityThe American Academy of Nursing opposes discrimination based on sexual orientation and gender identity. This position is consistent with its support for diversity and efforts to eliminate health disparities. Employment discrimination adversely affects physical and mental health (Institute of Medicine, Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities, 2011; Sears & Mallory, 2011). By perpetuating social stigma and adding to minority stress, it contributes to health disparities among lesbian, gay, bisexual, and transgender (LGBT) people, including those who have not directly experienced workplace discrimination.
American Academy of Nursing position statement on reparative therapyReparative therapies, sometimes called conversion therapies or sexual orientation change interventions, have been widely discredited by most major health care professional organizations for their lack of scientific justification, failure to achieve intended results, questionable clinical practices, disregard and lack of respect for normal human differences, and inherently harmful effects on mental and physical health of individuals being pressured to change (APA, 2009; AMA, 2014). The American Psychological Association's Task Force on Appropriate Therapeutic Responses to Sexual Orientation (2009) carried out a systematic review of the literature and “concluded that efforts to change sexual orientation are unlikely to be successful and involve some risk of harm…” (pg.
Reconsideration of do not resuscitate orders in the surgical/procedural settingThe American Academy of Nursing has long endorsed advance care planning and end-of-life conversations as essential components in the care of all persons but especially for those with critical, chronic, or complex conditions (American Academy of Nursing, 2010; The Palliative and End of Life Care Expert Panel, 2013; Tilden et al., 2012). The Institute of Medicine affirms the importance and necessity of having such conversations with patients in their recent report titled Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (Institute of Medicine, 2014).
Implementing culturally competent careToday there are more migrants in the world than ever before — about 232 million international migrants in 2013 (United Nations, 2013). Nurses are one cohort of these migrants as countries increasingly employ immigration as a strategy to address their nursing shortages (International Centre for Nurse Migration, 2014). This movement of peoples across geographic borders and the transfer of nurses from one country to another challenges nurses to understand cultures different from their own in order to provide safe, quality care.
Same-sex partnership rights: Health care decision making and hospital visitationAlthough progress toward ensuring the rights of same-sex partners to visit and make decisions regarding the care of a hospitalized partner or partner's child has been made, policies and guidelines are inconsistently applied and sometimes completely ignored. Denying these rights is a violation of human rights and is detrimental of to the health and well-being of lesbian, gay, bisexual, and transgender (LGBT) people.
American Academy of Nursing announced engagement in National Choosing Wisely® CampaignAs Part of Campaign, The Academy Released the List of Five Commonly Used Treatment Approaches That Are Not Always Necessary or Advisable
American Academy of Nursing: Improving health and health care systems with advanced practice registered nurse practice in acute and critical care settingsPatients in acute care hospitals receive more than 18 million days of intensive care unit care annually at an estimated cost of nearly 1% of the gross domestic product (Health Research Services Administration [HRSA], 2006). A significant need for acute/critical care services remains, especially in the context of an aging American population. Advanced practice registered nurses (APRNs) working in acute care settings are well positioned and well prepared to reduce health care costs while improving access, addressing health systems issues, and providing high-quality care.
American Academy of Nursing: Hepatitis C testing in the birth cohort 1945-1965: Have you been tested?In July 2012, the American Academy of Nursing endorsed the recommendations of the Expert Panel on Emerging Infectious Diseases to accelerate efforts to remove barriers for hepatitis C screening and testing (Zucker, 2012). One month later, the Centers for Disease Control and Prevention announced its “Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945–1965.” These baby boomers account for 76.5% of HCV cases in the United States (MMWR, 2012).
American Academy of Nursing: Ethics Policy-Maintaining high standardsEthics is a branch of philosophy concerned with moral principles that guide decisions on how to live and how to behave. It is also defined as an evaluation of a moral choice based on ideas about what is morally right or wrong (Beauchamp & Childress, 2013). Ethics provides an opportunity to describe and understand standards of conduct in nursing practice. The nursing profession has long held to high ethical standards with the most recent benchmark being the development of the Code of Ethics for Nurses with Interpretive Statements (American Nurses Association [ANA], 2001).
Core competencies in human milk and breastfeeding: Policy and practice implications for nursesThe American Academy of Nursing endorses human milk and breastfeeding as the preferred method of infant feeding and has a long history of policy work and publications from the Expert Panel on Breastfeeding of the Academy. The Academy has members who serve the United States Breastfeeding Committee (USBC), and our members actively participated in the development of the core competencies for health professionals. In 2013, the Academy endorsed these core competencies for health professionals, further underscoring our commitment to improving the landscape of breastfeeding in the United States.
The mechanics of writing a policy briefAccording to Nannini and Houde (2010), reports addressing the interests and needs of policy makers are frequently referred to as policy briefs. These reports are intended to be short and easy to use, containing information that can be reviewed quickly by policy makers. The contents of these reports are based on systematic reviews of the literature addressing refereed, rigorously evaluated science to advance policy making based on the best evidence. In a very important way, policy briefs give policy makers context to the issues that are intended to be addressed in their roles.
Promoting the mental health of familiesThe American Academy of Nursing has identified the development of healthy families, particularly those that are underserved, as one of its priorities. This is a broad mandate that focuses on physical and mental health promotion, maintenance, and treatment, recognizing that physical and mental health is intertwined. Mental health status is particularly precarious in families living in poverty and those confronted with chronic health problems, limited access to care, and the stigma associated with mental health problems.
A call to action: Engage in big data scienceNumerous landmark reports in recent years have described the core problems and challenges of health care access, quality, safety, efficiency, and effectiveness today (Committee on Patient Safety, 2012; Smith, Saunders, Stuckhardt, & McGinnis, 2013). The significance of these problems as measured by the annual cost of medical errors is estimated at $17.1 billion dollars (Van Den Bos, 2011); 63.1% of these errors were judged preventable (Landrigan et al., 2010). The Affordable Care Act, the anticipated influx of approximately 32 million newly insured Americans in 2014, and the need to show quality and meaningful use require action on these important challenges.
A call to action: Expanded research agenda for women's healthRecently, reports were released by the National Institutes of Health, Office of Research on Women's Health, and the Institute of Medicine suggesting women's health research agendas. These reports stimulated commentary from the American Academy of Nursing's Women's Health Expert Panel. This commentary identified the need for an expanded research agenda for women's health that was published in Nursing Outlook (Shaver, Olshansky, & Woods, 2013). The following call to action highlights the most critical areas that were not included in these reports.
Advance care planning as an urgent public health concernThe American Academy of Nursing extensively engages in the work of policy improvement for better end-of-life care for all Americans. The Academy's work is evident in at least three specific recent activities:
Advance care planning as an urgent public health concernThe American Academy of Nursing endorses end-of-life conversations as essential for the care of patients with life-limiting conditions so that patients’ values and preferences for their care and treatment are honored. These conversations, formally known as advance care planning, should rightfully occur among health professionals, patients, and patients’ families.
The imperative for patient-, family-, and population-centered interprofessional approaches to care coordination and transitional care: A policy brief by the American Academy of Nursing’s Care Coordination Task ForceThe American Academy of Nursing (AAN), representing nurse policy leaders, scientists, and clinicians, applauds the Centers for Medicare and Medicaid Services’ (CMS) recognition and support of evidence-based care coordination and transitional care. As CMS moves forward with policies for care coordination under Medicare and Medicaid, the AAN urges the agency to consider the framework it uses for thinking about care coordination and the evidence to support that framework. The Academy seeks to share its perspectives on crucial elements of such a framework to support the integration of care coordination and transitional care into the U.S.
Expert panel on nursing theory guided practice position paper: Nursing knowledge and the impact on Nursing's Preferred Future a plan for enhancing Raise the Voice Phase IIThe American Academy of Nursing (AAN) strives to lead the nation and “… serve the public and nursing profession by advancing health policy and practices through the generation, synthesis and dissemination of nursing knowledge”.1 Still the story of how nurses everywhere are positioned to revolutionize our healthcare system remains untold. One strategy that the AAN can use to reveal this story and take the lead in advancing policy is to make explicit the disciplinary knowledge integral to the implementation of the innovative experiments of the AAN-led Edge Runners initiative.
Hepatitis C screening and testing: A call for a national responseThe purpose of this brief is to convey the immediate need to coordinate and integrate hepatitus C virus (HCV) screening and testing for HIV co-infected and HCV-infected clients, into primary care. In 2000, 1.25 million persons were estimated to be chronically infected with hepatitus B virus (HBV), and 2.7 million are chronically infected with HCV.1 Furthermore, 55% to 85% of new HCV infections become chronic.2 Of the 1.0 million people chronically infected with HIV, 250,000 also have HBV, and ∼ 50,000 also have HCV, the leading cause of hepatocellular carcinoma.