NURS 3000 - Issues and Trends in Nursing Assignment

NURS 3000 – Issues and Trends in Nursing Assignment

Improvement of healthcare delivery in the United States relies on many factors, such as effective nurse advocacy through politics, policy, and professional associations. But advocacy depends on the ability to fully understand current issues, systems, policies, and related contexts.NURS 3000 – Issues and Trends in Nursing Essay Paper

In this course, students engage in a systems-level analysis of the implications of healthcare policy on issues of access, equity, affordability, and social justice in healthcare delivery. Through policy analysis assignments students apply legislative, regulatory, and financial processes relevant to their organization and provision of healthcare services in their community. Students consider the impact of these processes on quality and safety in nursing practice environment and disparities in the healthcare system. Through this course, students gain the knowledge and skills needed to advocate for vulnerable populations and promote positive social change. (Prerequisites: NURS 3000) Note: Students must take this course first in their sequence.

KINDLY ORDER NOW FOR A CUSTOM-WRITTEN AND PLAGIARISM-FREE PAPER

NURS 3000 – Issues and Trends in Nursing Assignment

♦ Students may take this as a non-degree course, which means they do not have to be enrolled in a program. Contact an Enrollment Advisor [1-866-492-5336 (U.S.);1-443-627-7222 (toll)] for more information.

This column addresses the results of the environmental scan, a major input of the Nursing Professional Development (NPD) Practice Model. Environmental scanning is defined as the “process of systematically monitoring an organization’s internal and external environments for the earliest signs of opportunities and threats that may reveal a potential professional practice gap” (Harper & Maloney, 2016, p. 60). Engaging in this process helps the NPD practitioner plan for potential opportunities and changes in NPD practice based on economic, healthcare, political, societal, and technological trends. These trends, outlined in the 2016 Nursing Professional Development: Scope and Standards of Practice, 3rd Edition (Harper & Maloney, 2016) include the workforce, practice environment, organization, technological influences, political influences, and professional development practice changes. The purpose of this column is to inform readers of these trends with potential role implications for the NPD practitioner.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

WORKFORCE

Anticipated workforce issues that may impact NPD practitioners include “multiple generations in the workforce; loss of the expertise with baby boomer retirement; increased diversity in nursing; anticipated growth in the shortage of healthcare professionals; increased demand for transition into practice programs and mandated nurse residencies for licensure; progressive education expectations for nurses; and increasing emphasis on nursing certifications for employment and retention” (Harper & Maloney, 2016, p. 26).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a learning facilitator, include nurses from multiple generations in planning and implementing professional development activities.

* As a leader, use your influence and recommend more flexible schedules to retain baby boomer nurses for their expertise and mentoring of less experienced nurses.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a partner for practice transitions, influence decision makers to implement (or continue) a nurse residency program at your organization, then seek accreditation for the program.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a mentor, encourage nurses and set a goal (Why not 100%?) for NPD colleagues in your setting to obtain NPD specialty certification; encourage nurses to pursue a doctoral degree (if applicable, this goes for you too!).

NURS 3000 – Issues and Trends in Nursing Assignment

PRACTICE ENVIRONMENT For the NPD practitioner, 17 practice environment issues have been identified in the new scope and standards. Some of these issues include the following: the promotion of healthy workplace environments, nurses functioning within the full scope of practice (not just advanced practice nurses) including fee for services, a focus on interprofessional teamwork and team competence, a transition from a focus on the clinical setting to the provision of nursing services across the continuum of care, emphasis on the integration of decision support systems and electronic health records, 90% of clinical decisions to be evidence-based by 2020, developments in genetics and genomics, and demonstration of NPD’s impact on patient outcomes (Harper & Maloney, 2016). Two more topics to consider adding to this list are opioid abuse and legalization of cannabis.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader and a mentor, role model a culture of respect with no tolerance for any type of bullying.

* As a partner for practice transitions collaborate with interprofessional colleagues across care settings to foster smooth transitions across the continuum of care.

* As a champion for scientific inquiry, continually ask “Is this evidence-based?” when dealing with clinical decisions; use scientific, standard metrics to collect and analyze data related to outcomes.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As an advocate for NPD specialty, demonstrate and disseminate the influence of NPD to improve outcomes both within your organization and externally.

ORGANIZATION Specific trends related to the organization for which the NPD practitioner must be alert are “identification of optimal nursing professional development organizational structures (centralized vs. decentralized reporting structure); increased organization complexity due to mergers, acquisitions and expansions; and ongoing challenges in healthcare funding and reimbursement” (Harper & Maloney, 2016, p. 27).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader, assess NPD services/activities across your individual organization and healthcare system to ensure alignment with organizational priorities.

* As a leader, use your influence and recommend consolidating services where and when appropriate to improve cost and efficiency (e.g., rather than several hospitals offering the same review course at different times and locations, collaborate for one event).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a leader, share evidence with administrators that demonstrates the value and return on investment for the professional development of nurses (Opperman, Liebig, Bowling, Johnson, & Harper, 2016).

TECHNOLOGICAL INFLUENCES

The technological influences identified for NPD practice are “increasing emphasis on privacy of patient data; the use of mobile devices to communicate and retrieve information; the availability of large complex data sets; proliferation of social networking; proliferation of personal electronic devices; increasing use of virtual health programs; transition to connected health; and technology driven care decisions diminishing individual acceptance of accountability” (Harper & Maloney, 2016, p. 27).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader, identify what data are (and are not) being collected within your NPD practice and setting (microsystem, mesosystem, and macrosystem) as they relate to NPD practice, nursing problems, interventions (education), and outcomes. Then ask, “What is the meaning of these data? How are they being used? Are they being used to improve practice?”

* As a leader, be an active member of the health information technology team and contribute to strategic planning and implementation of data-driven decisions.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a change agent, engage with nurse informaticists to advance nursing-sensitive quality eMeasures, standardized electronic quality indicators that promote consistent measurement (HIMSS, 2015; National Quality Forum, n.d.).

KINDLY ORDER NOW FOR A CUSTOM-WRITTEN AND PLAGIARISM-FREE PAPER

* As an advocate for NPD specialty, implement standardized and accepted terminology and metrics for tracking outcome data.

* As a champion for scientific inquiry, urge colleagues to use research-based, standardized assessment scales and instruments to promote interoperability of data.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

POLITICAL INFLUENCES

Political influences that may impact NPD practice are “increases in number of insured individuals seeking healthcare service; impacts of a global economy; increasing scrutiny of healthcare outcomes and pay for performance/value based payment model; implications of the federal government as primary payor for healthcare; and growing costs of healthcare” (Harper & Maloney, 2016, p. 27).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Role implications for the NPD practitioner:

* As a leader and an advocate for NPD practice, influence decisions of others with the use of credible data.

* As a change agent, access and apply the resources in legislative advocacy toolkits; write letters to those in positions of authority (e.g., congressman) in support of legislative issues that “protect the public” (for the “Web-Based Resource for Public Policy Advocacy” go to http://www.nln.org/docs/default-source/advocacy-public-policy/web-based-resource).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a learning facilitator, register for “E-Mail Alerts” for nursing and public policy issues provided by the American Nurses Association. To register, go to https://www.smartbrief.com/signupSystem/subscribe.action?pageSequence=1&briefNam.

PROFESSIONAL DEVELOPMENT PRACTICE CHANGES The environmental scan identified 13 professional development practice change issues expected to impact NPD practice. For ease in reading, they are organized here as educational, financial, and other.

Educational changes include increasing interprofessional continuing education; providing just-in-time training and rapid cycle development of education; deemphasizing traditional classroom-based learning; implementing evidence-based teaching and learning strategies; using technology, including simulation, in continuing education and conducting rigorous multisite research related to NPD practice; and promoting accreditation and funding of practice transition programs for newly licensed nurses (Harper & Maloney, 2016). Financial changes include “promoting learning as an investment in human capital and cost avoidance versus an expenditure” and “demonstrating NPD return on investment (ROI)” (Harper & Maloney, 2016, pp. 27-28).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Other changes for NPD practice include “succession planning for future nurse leaders; developing nurses to serve on advisory and governing boards of health-related corporations and non-profit organizations; preparing nurses for the political arena (local, state and federal); and retooling the workforce to enhance nurses’ ability to practice not only in acute care but across the entire continuum of care” (Harper & Maloney, 2016, p. 27).

Role implications for the NPD practitioner:

* As a leader, use your voice and presence to influence health care by joining an advisory or governance board and encourage colleagues to do the same (to get started, register at http://nursesonboardscoalition.org).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a leader, provide evidence for the return on investment of NPD activities (Opperman et al., 2016).

* As a leader and a learning facilitator, increase the number of interprofessional continuing education activities (for Core Competencies for Interprofessional Collaborative Practice, go to http://www.aacn.nche.edu/education-resources/ipecreport.pdf).

* As a leader and a mentor, create and participate in succession planning programs for other NPD practitioners.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

* As a learning facilitator, increase blended learning strategies in virtual and physical spaces; use active and interactive activities, affective computing (e.g., virtual assistant) and robotics, augmented reality (digital information and spaces in real world), and virtual reality; read and apply the simulation information provided in the Journal for Nurses in Professional Development Simulation column.

SUMMARY

This column addressed the current and future issues, innovations, and trends as outlined in the Nursing Professional Development: Scope and Standards of Practice, 3rd Edition (Harper & Maloney, 2016), along with role implications for the NPD practitioner.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Because the NPD practitioner is in a pivotal position to influence these issues and trends, the question is, “What can and will you do to help your organization through these changes?”

Healthcare is a dynamic and changing environment that demands we are well appraised of the issues and trends that influence our beliefs and practice. In this course, you are challenged to advocate for, and defend, a position related to a selected healthcare issue using debate as a learning medium. Debating is a transformative journey that helps you learn more about your own beliefs and principles while teaching you to stand up and be heard. Further, you investigate historical and contemporary healthcare trends and share your learnings with your class colleagues in a conference format.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Multi-media learning resources, online learning activities, and individual and collaborative group assignments are some of the strategies you will use to achieve the course and unit learning outcomes. The nature of the instructional approach is participant-centered, based on Purkey’s invitational educational theory where an educational environment that is respectful, optimistic, and intentional is co-created by students and the instructor (Gregory & Edwards, 2016).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The course is structured so that you become an investigative reporter! Each unit is organized into 3 parts, the “headline,” “uncovering the story” and the “unit in review.” The headline is meant to be a “hook” or advanced organizer that will catch your attention and introduce you to the unit topic. Uncovering the story includes the unit learning outcomes, learning resources and learning activities. The unit in review is a reflection activity that guides you in reviewing key points from the unit and in consolidating take away learnings.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Course Learning Outcomes

By the conclusion of NURS/MHST 609 Trends and Issues you will be able to:

differentiate between trends and issues; identify and explain logical errors in arguments; design a reasoned and structured argument and participate in an online debate defending or opposing a current healthcare issue; demonstrate oral presentation skills and written strategies to justify your opinion on issues;NURS 3000 – Issues and Trends in Nursing Assignment Papers. appraise and critique the value of arguments proposed to defend or oppose current healthcare issues; evaluate issues (social, economic, political and educational) that influence healthcare trends; moderate an online class discussion regarding a selected healthcare trend; critique and analyze peer reviewed literature related to healthcare trends and issues; and reflect on personal learning from the course focusing identifying strengths and limitations that have become apparent, and construct a plan for moving forward.

KINDLY ORDER NOW FOR A CUSTOM-WRITTEN AND PLAGIARISM-FREE PAPER

NURS 3000 – Issues and Trends in Nursing Essay

Learning Resources

There is no print textbook for this course. Instead you are presented with a variety of online, multi-media learning resources including peer reviewed articles from the AU library, e-textbooks, videos, podcasts, TED talks, movies etc. Many of these are open educational resources (OER). The course topic is well suited to utilizing online resources that allow access to emerging research reports and real-time interviews and newscasts that discuss trends as they are developing. You are invited to share learning resources you discover related to course content with others in the class. Locating additional online resources will assist you in achieving the learning outcomes and your own learning goals, as well as help us develop as a learning community.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Course Structure

NURS/MHST 609 Trends and Issues is an asynchronous online course with a specific start and end date extending over 13 weeks. The course “week” runs from a Wednesday to the following Tuesday evening. On the Wednesday, the course instructor will make an online posting that relates to the topic of the week. The purpose of the weekly input by the instructor is to keep everyone focused on the same topic and to stimulate discussion. While there is no predetermined time when you must log on, are asked to log on at least once a week. However, logging on several times a week is desirable so that discussion continues back and forth among participants. Logging on early in the week is most helpful. During the weeks of your debate and your concurrent trends presentation you will need to log on often.

The course instructor will have expectations for online activities. Dates and days will be assigned and communicated to you by email, or as a posting in the Coffee or News Forum. Each instructor may organize the assignment schedules (dates for your debate and trends presentation) individually. However, there are some specific dates by which certain other course activities need to be achieved by everyone. These dates are specified in the study guide and assessment overview.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Course Overview

The course consists of the following seven units:

Unit 1 Introductions: Course Orientation and Starting the Investigation of Trends and Issues Unit 2 Foundations of Debating: Structuring an Argument, Logic, and Fallacies Unit 3 Debate Issues and Preparation for Debates Unit 4 The Debates Unit 5 Exploring Healthcare Trends: Past, Present and Future Unit 6 Trends in Healthcare Online Conference Unit 7 Review, Reflection and Wrap-up Assessment Structure, Grading, and Style Requirements You will have opportunities to complete the following four assignments.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Assignment 1 – DEBATE: Advocate for individuals, families, practices or policies using the principles of structuring an argument and debating. (2 parts)

Assignment 2 – CONCURRENT SESSION PRESENTATION AND MODERATION OF DICUSSION AT A CLASS ONLINE CONFERENCE – TRENDS IN HEALTHCARE: Choose a healthcare trend related to your practice or profession, write a short discussion paper on the trend and moderate discussion of your trend during a concurrent session at a class online conference entitled Trends in Healthcare.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Assignment 3 – REFLECTION PAPER: Write a short reflection paper related to what you learned about yourself during the course and include a plan for utilizing identified strengths and overcoming identified limitations.

Assignment 4 – PARTICIPATION: This includes participation in learning activities throughout the course.

Students must achieve an overall program GPA of 2.7 (B- or 70 percent), to graduate. The minimum passing grade requirement for each course is C- (60 percent).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

All assignment citations are to follow the most current APA (American Psychological Association) style.

Athabasca University reserves the right to amend course outlines occasionally and without notice. Courses offered by other delivery methods may vary from their individualized-study counterparts.

Credits awarded for meeting competencies required to achieve the nursing license through either a diploma program or an associate’s degree program. Transfer credits from undergraduate courses that they have taken at other universities. 135 of the 180 quarter credits may potentially be transferred into the program (depending upon the qualifications the students bring as they enter). NURS 3000 – Issues and Trends in Nursing Essay

Learning Outcomes

Apply leadership and informatics concepts in decision making to promote patient safety and quality care. Use evidence based on the sciences, humanities, and research to guide nursing practice across the health-illness continuum in a variety of healthcare settings. Evaluate the implications of policy on issues of access, equity, affordability, and social justice in healthcare delivery including the health of vulnerable populations and healthcare disparities. Demonstrate effective communication and collaboration skills to improve patient outcomes. Implement individual and population-focused interventions to promote health and to prevent and manage disease and injuries. Exhibit accountability for personal and professional behaviors in accordance with standards of moral, ethical, and legal conduct with a commitment to continuous professional development. Provide patient-centered nursing care based on a comprehensive and focused health assessment across the lifespan using sound clinical judgment as well as developmentally and culturally appropriate approaches.

NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Specializations General Degree Requirements 180 total credits General Education (50 cr., at least 10 of which must be completed at Walden and all of which are to be completed prior to BSN core and concentration courses) First course (1 cr.) Nursing license transfer of credit (up to 50 cr.) Upper-level nursing core courses (54 cr.) NURS 5050, NURS 5051, and NURS 5052 will transfer into the MSN program with a grade of B or higher. Elective courses (25 cr.) Curriculum General Education Courses (50 cr.) Foundation Course CMIS 1001 – Introduction to Information Systems♦ Required Social Science First Course (1 cr.) WLDN 1000 – Dynamics of Walden Success: Learning Lab Nursing License Transfer of Credit (50 cr.) Upper-Level Nursing Core Courses (54 cr.) NURS 3000 – Issues and Trends in Nursing♦ NURS 5050 – Policy and Advocacy for Improving Population Health NURS 3015 – Pathopharmacology♦ NURS 5051 – Transforming Nursing and Healthcare Through Technology NURS 3020 – Health Assessment♦ NURS 5052 – Essentials of Evidence-Based Practice NURS 4005 – Topics in Clinical Nursing♦ NURS 4010 – Family, Community, and Population-Based Care NURS 4015 – Public and Global Health♦ NURS 4020 – Leadership Competencies in Nursing and Healthcare

In Israel, approximately one-third of the country’s nurses work in community settings – primarily as salaried employees in Israel’s four non-profit health plans. Many health system leaders believe that the roles of health plan nurses have changed significantly in recent years due to a mix of universal developments (such as population aging and academization of the profession) and Israel-specific changes (such as the introduction of extensive quality monitoring in primary care).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Objectives

The main objectives of the study were to identify recent changes in the roles of health plan nurses and their current areas of activity. It also explored the experience of front-line nurses with regard to autonomy, work satisfaction, and barriers to further role development.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Methods

The study integrated interviews and surveys of nurses and other professionals conducted across 4 years. Data generated from earlier study components were used to guide questions and focus for later components.

In 2013, in-depth interviews were held with 55 senior nursing and medical professionals supplemented by interviews in mid-2017 with the head nurses in the four health plans. In addition, a national survey was conducted in 2014–5 among a representative sample of 1019 community nurses who work for the health plans and who are engaged in direct patient care. Six hundred ninety-two nurses responded to the survey, yielding a response rate of 69%. The survey sample consisted of an equal number of nurses from each health plan, and the observations were weighted accordingly.

Findings

Senior professionals identified general themes associated with a shift in nursing roles, including a transition from reactive to initiated work, increased specialization, and a shifting of tasks from hospitals to community settings. They identified the current main areas of activity in the health plans as being: routine care, chronic care, health promotion, quality monitoring and improvement, specialized care (such as wound care), and home care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In the survey of front-line nurses, 38% of the nurses identified “caring for chronically ill patients” as their main area of activity aside from routine care; 30% did so regarding “health promotion”, and 26% did so regarding “a specific area of specialization” e.g., diabetes, wound care or women’s health). In response to a separate question, 77% reported “great” or “very great” involvement in quality measurement programs.

Four out of five front-line nurses were satisfied with their work to a great or very great extent, and approximately three out of four of them (73%) felt that they had autonomy at work to a great or very great extent. About half of the nurses take into account, to a great or very great extent, the financial concerns of the health plans that employ them.

A large majority of the nurses (85%) indicated that the nature of their work had changed substantially in recent years, with an increase in autonomy noted as one of the key changes. Perceived barriers to further role development include attitudes on the part of some physicians and nurses, an insufficient number of dedicated nursing positions, and insufficiently attractive wage levels.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Conclusions

The findings, gathered over 4 years, indicate alignment between universal and Israel-specific trends in health care and the evolving roles of nurses in Israel’s health plans.

The findings provide support for ongoing efforts in the health plans to give nurses more authority and responsibility in the management of chronically ill patients, a more central role in health promotion efforts, more advanced training – both inter-professional and nurse-specific, and more opportunity to focus on the roles and tasks that require nursing professionals.

Background

The nursing profession is an important component of the provision of community healthcare world-wide. Nearly a third of the nurses in Israel are employed in the community,1 similar to the situation in the United States [2]. In Israel, most community-based nurses work for one of Israel’s four non-profit health plans, which are responsible for the organization and provision of care within the framework of Israel’s National Health Insurance Law [33]. Another major employer is the Ministry of Health (MOH), which employs nurses in its network of preventive mother and child health centers, and in other frameworks.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Traditionally, the main roles of community-based nurses (particularly in urban clinics) were to prepare patients for their meetings with a physician (by taking blood, pulse blood pressure, weight and other measurements) and implementing specific physician directives in the immediate wake of the patients’ encounters with the physicians. However, for over a decade, nursing and other leaders in Israeli health care have been talking about significant changes taking place in the roles of the community nurses. They have been attributing these role changes to a variety of contextual changes, which are described below. Interestingly, some of these contextual changes are happening in health care systems around the world, while others are Israel-specific. Some relate to changes in the population, other to changes in the health care system and still others to changes in the nursing profession itself. NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Changes in the population

With the aging of the population, there is a growing recognition among health care leaders of the need to better address chronic health problems [19, 22]. There is a considerable body of research demonstrating the substantial contribution that nurses can and do make to the management of chronic illness ([4, 5] CAN, 2013; Trehearne, Fishman and Lin, 2014). They improve quality and access to care [30] and play a central role in the provision of other types of health services that are particularly important to an aging population, such as home care and home hospitalizations.

Changes in the health system The increased attention being given by Israeli health plans to chronic care stems not only from population aging. Another motivator has been Israel’s National Quality Monitoring Program that has galvanized the plans to seek ways to improve the quality of care, particularly in the areas of chronic care and screening and prevention. Nurses are playing a central role in the health plans’ efforts to improve those measures [34]. NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Community nursing can play a major role in effecting life-style changes in chronically ill patients, in guiding direct caregivers in elder and childcare and in long-term care, and in identifying and preventing abuse [1, 9, 18, 20]. Moreover, various technological advances are making it increasingly feasible to manage the care of chronic patients and integrate the care across several geographic locations [3] and a range of different types of providers [7]; nurses play a central role in such integration efforts [8]. Interestingly, in some ways this a return to Israel’s 1980s “teamwork” model in which nurses played a significant role in chronic care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Israeli health plans are also gradually recognizing the need to do more in the area of health promotion [14], well beyond those elements of health promotion related to the quality indicators. The growing health plan involvement in health promotion seems to stem from a mix of a mission-driven commitment to wellness, an interest in reducing health expenditures, and marketing considerations. Health promotion is clearly an area in which nurses are well situated to play important roles [13, 21]. Health promotion practices of nurses include disease prevention and health education; however, they seek to work in more collaborative way with other professionals [16].NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The 2012 decision by the Israeli government to transfer the responsibility for mental health services from the government to the health plans has catalyzed health plan managers to also consider how various staffing models could help them address mental health needs in an efficient and effective manner ([32]: Nirel et al., 2007). In many countries, nurses play a major role in the provision of community-based mental health services ([11]; Heslop, Wynaden, Tohotoa and Heslop, 2016),), including identifying depression and other mental health problems and monitoring medication adherence/compliance. Note that the 2012 decision called for a 3-year transition period to prepare for a transfer of responsibility in mid-2015.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

It is also important to note that physician salaries in Israel have increased significantly in recent years [33, 36]. There is a certain amount of overlap between the set of tasks that community-based physicians typically carry out, and the set of tasks that nurses are authorized to perform ([15]; Laurant, 2007). Accordingly, an increase in physician wages could encourage the health plans to shift certain responsibilities from physicians to nurses, and this in turn could contribute to both an increase in the number of nurses the plans employ and the scope of the nurses’ responsibilities.

Changes in the nursing profession Important changes are also taking place within the nursing profession itself. In particular, for several decades, the profession has been moving toward greater academization and advanced specialty training [15]. In recent years, various changes in primary legislation and Ministry of Health directives have broadened the scope of nursing practice, with increased authority in such areas as changing medication regimens, and palliative care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

At the same time, there are several barriers to change in the role of nurses in community settings in Israel. These include traditional perceptions of the role of nursing as “handmaiden to medicine” (and hence limited in autonomy), and opposition on the part of the Israel Medical Association to some of the changes being advocated by the nursing profession.

Interestingly, the major nursing shortage facing Israel [31, 23, 24] and countries around the world, could function either as a barrier to change (with the argument that basic functions be given top priority) or as a catalyst for change (due to the widespread belief that new and autonomous roles for nurses will attract more applicants to the profession). It will be important to see how these conflicting forces are playing out in Israel.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In several countries, major studies have been carried out to explore how such factors as the increasing importance of chronic, mental and preventive care are changing the roles of nurses in community settings [10, 17, 35]. Meanwhile, unique features of the Israeli health system, such as the pervasiveness of managed care plans, could result in a uniquely Israeli dynamic. However, until recently, no such studies had been carried out in Israel.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Study goals The study had two main goals: ♦ To document the main changes in the roles of health plan nurses in Israel in recent years

♦ To document the main areas of health plan nursing work today and the extent of their occupation in these areas.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In addition, the study was designed to:

♦ Examine the extent of autonomy felt by nurses in their work

♦ Examine the extent of satisfaction felt by nurses with various aspects of their work

♦ Examine how nurses perceive their contribution to the quality measurement program and how the program affects them

♦ Identify the barriers to the continued development of the role of community nurses.

Apart from these issues, the study was designed to examine the varying perceptions of nurses based on the following variables: age, country of birth, level of education, professional status, and position of management or otherwise. Further, it compared the situation in Israel with that in the US and England regarding both how roles of community nurses have changed in recent years and the current nature of their roles.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The study focuses on nurses employed by Israel’s four non-profit health plans. Background information on the status of nurses in each of the four plans can be found in Appendix A.

Methods This paper is based on a broad study conducted in 2014 [28].

The study had two main components: In-depth interviews with approximately 50 leading professionals in the field of nursing and related fields.

A survey of more than 1000 community nurses who engage in direct patient care

The two main components are complementary; the leading professionals are uniquely situated to identify the role changes that have taken place over time and to provide a broader system perspective, while the front-line nurses are uniquely situated to provide detail and quantification regarding the current nature and content of the work.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Moreover, the in-depth, open-ended interviews with the leaders contributed to the development of the largely closed-ended questionnaire for the front-line nurses, (as did informal discussions with a number of front-line nurses). For example, the in-depth interviews generated a list of current areas of activity and then the survey was used to quantify the centrality of each area of activity and then explore it in greater detail.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

These two main components are described further below; the study team also explored how the Israeli situation compares with the situations in the US and the UK, as described in Appendix B.

A. Methods – The In-Depth Interviews of Leading Professionals

Fifty-five semi-structured, in-depth interviews were held with leading figures from the field of nursing and related fields. Interviewees were suggested by the members of the members of the Community Nursing Study Group (which included head nurses from the health plans and MOH nursing leaders). NURS 3000 – Issues and Trends in Nursing Assignment Papers. The interviewees included past and present heads of nursing at the MOH, the health plans, and the hospitals; leading academics in the field; managers at various levels of the health system (physicians, nurses and other personnel), the Israel Medical Association, the National Association of Nurses in Israel, hospitals, and various professional societies. The interviewees included both nurse managers and managers from other professions. The mix of interviewees made it possible to obtain a variety of perspectives on the processes affecting the nursing profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The interviews were conducted between January and August 2013. A semi-structured interview guide was used including questions on: the main current areas of activity of health plan nurses, how their work has changed in recent years, the challenges they face at work, their view of the future of the profession and of the barriers to changes to the profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The in-depth interviews were analyzed by first extracting the main themes and then exploring how these themes were addressed in the various interviews. Each interview was summarized in writing. An initial content analysis was carried out shortly after the interview, and significant issues were identified. In cases where a gap was discovered or a question arose, we returned to the interviewees and asked for clarifications.

In the analysis of the interviews, we compiled a detailed list of all the roles performed by the nurses and categorized them according to relevant groups. We made comparisons among health plans, different levels of management and regions. We focused on topics that were mentioned by many interviewees, but we also addressed noted significant issues raised by one or two interviewees. In addition, we analyzed reports and documents submitted to us by the interviewees.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In mid-2017, supplementary interviews were held with the head nurses in the four plans, focusing on changes in the most recent years, against the background of the findings from the survey.

B. Methods – The Survey of Front-Line Health Plan Nurses The study population consisted of all health-plan nurses in the four health plans spending most of their time in non-management work, regardless of whether their positions were full- or part-time. Registered nurses, Licensed practical nurses, and RNs with advanced certification were included. Nurses whose main occupation was managerial were not included in the survey to ensure that the focus was on nurses involved primarily in direct patient care. According to the data of the health plans, in 2014 this amounted to more than 4600 nurses.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Sample Despite the differences in size between the four health plans in the number of employees and persons insured, approximately 250 nurses were sampled at random from each health plan to permit a reliable analysis for each plan.2

Data collection and distribution of the questionnaire The research questionnaires were computerized and emailed to all the nurses using the addresses supplied by the health plans. The survey was conducted between August 2014 and February 2015. The appeal to the nurses invited them to respond by email through the link provided or by telephone.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In each health plan, 250 nurses were sampled randomly. This random sampling is relied upon to provide a representative mix of full v. part time, etc. within each health plan.3 At the data analysis stage, the observations were weighted to reflect inter-plan differences in sampling probability and response rate. Thus, the weighted sample can reasonably be expected to reflect the composition of the population of community nurses in Israel with at least some direct care responsibility – both in terms of health plan mix, managerial position mix, full-part time mix, etc. NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The sample numbered 1019 nurses. Of these, 6.6% chose not to cooperate and 1.4% did not meet sampling criteria. In total, 692 or 69% of the nurses responded to the questionnaire.4 The response rate varied among the health plans, ranging from 56% to 82%. Four hundred forty-eight interviews were conducted by email; 175 – by telephone; and 69 were completed manually and posted by regular mail.

Research tool The survey was composed of 70 questions, of which 15 were open-ended.

The topics covered included the following: the main areas of the nurses’ work; their main activities within those areas; perceptions of autonomy; perceptions of the quality measurement program; job satisfaction; perceptions of the professional future of health plan nurses; and background characteristics.5 A pre-test was conducted among 12 community nurses and the questionnaire was refined accordingly.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The categories for the question about usual work activities were derived from the leadership interviews.

The research questionnaires were computerized and emailed to all the nurses using the addresses supplied by the health plans. The survey was conducted between August 2014 and February 2015. The appeal to the nurses invited them to respond by email through the link provided or by telephone or regular mail. 65% of the responses were by e-mail, 25% by phone and 10% by regular mail. Comparison of key response variables (e.g. satisfaction, extent of role change, etc.) found very similar patterns of response across data collection modalities.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The questionnaire made it clear to the respondents that their responses would remain anonymous and the st.

udy team abided by that commitment, sharing with the health plans only aggregate results.

A key distinction in the survey was between routine work and “professional work”. Routine work was defined in the questionnaire as “work that is carried out routinely in the nurses’ room, e.g., blood tests, ECG, blood pressure, vaccinations, inhalations, etc.” Professional work was defined as “work in a specific professional field, such as treatment of complex wounds, stomas, follow-up in diabetes clinic, heart failure, giving instructions for genetic survey testing, geriatrics, women’s health, mental health, day hospital, minor surgical procedures, etc.”.6

ORD ER NOW FOR A CUST OM-WRITTEN AND P LAGIARISM-FREE PAPER

Data analysis The data were weighted to reflect differences among health plans in the sampling proportions and the response rate. After the weighting, the data presented unbiased national estimates of the parameters examined. The analysis focused on the findings for the full sample. Comparisons were also carried among population sub-groups defined in terms of age, educational level, and other background variables.7

The data were analyzed using SPSS version 21, and its complex samples utility. The open questions were analyzed using Naralyzer, a program that makes it possible to consider the entire set of responses to any given question. The responses were coded by category and a codebook was built for the questionnaire, after which the respondents’ responses were transferred to SPSS.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Results A. Findings from the in-depth interviews of senior professionals Senior professionals identified 4 key trends influencing the evolution of the work and functions of community and health plan nurses [26, 27]: 1. A transition from reactive to initiated work

2. Increased specialization of nurses in various areas of care, including diabetes and wound care

3. The integration of nursing work into various circles of care-giving and support (for example, with the patient as an individual, the patient within the family, and the patient within the group of patients suffering from the same condition).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

4. A transfer of activities from the hospital to the community.

The general picture arising from the interviews is that the work of community nurses has broadened in recent years, and this trend is expected to continue.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The interviews identified the following as the main areas of current work of health plan nurses8: ♦ Routine work (as defined above)

♦ Care of chronic patients

♦ Health promotion (health education, encouraging screening tests etc.)

♦ Quality measurement and improvement (involvement in quality measurement programs in both her routine work and special projects).

♦ Home visits (Nurses perform most home visits, including assessments of pain and activities of daily living, functioning, care-giver teaching and support, treating wounds, changing catheters, and drawing samples for laboratory tests.)

♦ Specialized care in various areas including diabetes, stoma, treating wounds, and geriatrics

♦ Participation in unique health-plan initiatives such as “conversation maps for diabetes” and a “personal physician”.

The in-depth interviews also surfaced similarities and differences among the health plans; these are depicted in Appendix C. NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Interviews in mid-2017 of the health plans’ nursing directors highlighted the following recent developments: With the support of top management, technical tasks are increasingly being delegated by nurses to support staff

Nurses are increasingly being appointed to general management positions such as regional directors and program directors

Inter-professional education, involving training of the full primary care team, is on the rise

Nurses are increasingly being given patient management roles in chronic care

and lead roles in health promotion and hospital-community transitions

B. Findings from the Survey of Front-line Nurses Overview The main findings emerging from the survey are that the nurses feel that their role has broadened, that they enjoy substantial autonomy and, in general, they are satisfied with their work. They believe that the profession will continue to develop in the future, but at the same time, they point to significant problems and barriers.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Personal and professional characteristics As indicated in Table 1, 93% of health plan nurses responding to the survey were women, 84% are Jewish, and 59% were born in Israel. Approximately 2/3 of respondents had academic degrees (47% bachelors and 17% masters), 90% were registered nurses (of whom almost half have taken advanced courses), almost half have been working as nurses for over 25 years (albeit not just in community settings), and about a third have supervisory or managerial roles. Table 1 Distribution of respondents by key personal and professional characteristics (percents)

Personal characteristics

Professional characteristics

Age

Educational level

Up to 40

25%

Diploma (i..e. no degree)

36%

From 41 to 55

40%

Bachelors’ degree

47%

Over 55

35%

Masters’ or PhD degree

17%

Sex

Professional status

Female

93%

Licensed practical nurse

11%

Male

Registered nurse

50%

RN with advanced course

39%

Population group

Jewish

84%

Managerial responsibility

Non-Jewish

16%

With managerial role

38%

Without managerial role

62%

Country of birth

Israel

59%

Nursing experience (years)

Outside of Israel

41%

0–14

29%

15–24

26%

25+

45%

The study team compared the characteristics of the respondents and the study population for Israel’s two largest health plan, which account for more than half of the nurse population (similar data were unavailable from the other two plans).NURS 3000 – Issues and Trends in Nursing Assignment Papers. In one of the large plans, the characteristics were found to be very similar with regard to sex and education level, but with the sample having a slightly higher proportion of nurses who had done Diploma courses (54% v. 43%). In the other large plan, the population and sample were very similar with regard to sex, the proportion of the nurses who had done Diploma courses was slightly lower in the sample (33% v. 40%), and the sample also had a lower percentage of LPNs (8% v. 18%). (Note that the impact of these small differences on the overall study findings is apparently quite limited, as the study found few substantial differences in key study variables among these sub-groups – see Tables 5, 6 and 7 below). NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Main areas of activity

A majority of front line staff (71%) continue to engage in routine activities (as defined in this study) to a great or very great extent. In addition, approximately one quarter to a third of the respondents indicated that their major area of care, besides routine work, was chronic illness care (38%), health promotion (30%), specialized care (26%) and home care (6%).

Caring for chronically ill patients

Those nurses who indicated that caring for the chronically ill was their main area of non-routine activity were presented with a list of relevant activities and asked to indicate in which of them they are involved to a great or very great extent. As indicated in Table 2, when it comes to chronic care, there is extensive involvement in several proactive and professionally demanding activities, such as management of the care process (80%) and interactions with specific patients (79%). About half also indicated great and very great involvement in the development of policy and general approaches to care regarding chronic patients. This process was also accompanied by the development of digital information systems and services.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Table 2

Percent of nurses who indicated that they were involved to a great or very great extent in various aspects of caring for the chronically ill

Management of the care process

80%

Pro-active interactions with specific patients

79%

Monitoring continuity of care for specific patients

79%

Development of policy and general approaches to care regarding chronic patients

48%

Outreach to the target population

52%

Development of proactive action plan for patients with chronic diseases

77%

Monitoring the implementation of proactive action plans

68%

(From among those nurses who indicated that caring for the chronically ill was their main area of non-routine activity)

The same group of nurses was also presented with a list of tasks associated with caring for individuals with chronic illness (Table 3) and asked whether the tasks constituted a significant part of their work. The vast majority affirmed that this was the case regarding healthy lifestyle counseling (91%) and deciding which patients to invite to visit (75%). In contrast, only 4% indicated that changing doses in prescriptions was a significant part of their work.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Table 3 Percent of nurses who indicated that various tasks were a significant part of their work

Healthy lifestyle counseling

91%

Functional and health status assessments

90%

Monitoring specific patients

86%

Deciding which patients to invite to visit

75%

Deciding, on the basis of protocols, computer alerts, and patient assessments whether/when particular patients should be immunized

63%

Changing doses in prescriptions

(From among those nurses who indicated that caring for the chronically ill was their main area of non-routine activity)

Health promotion Those nurses who indicated that health promotion was their main area of non-routine activity were similarly asked about the extent of their involvement in a list of relevant activities. As indicated in Table 4, there is extensive involvement in the identification of target populations for interventions (86%) and counseling about nutrition (79%), smoking (65%) and physical activity (73%). The nurses were much more likely to be involved in health promotion events within the clinic (38%) than in those outside the clinic (14%). When asked about the extent to which they engage in outreach (in general), 78% indicated that they do so to a great or very great extent. NURS 3000 – Issues and Trends in Nursing Assignment Papers. Table 4 Percent of nurses who indicated that they were engaged in various activities related to health promotion, to a great or very great extent

Identification of target populations for interventions

86%

Workshops and counseling sessions in the area of health promotion

38%

Health promotion activities that take place outside the clinic

14%

Health promotion activities that take place in the clinic

44%

Counseling about nutrition

79%

Counseling about smoking

65%

Counseling about physical activity

73%

(From among those nurses who indicated that health promotion was their main area of non-routine activity)

Change in the way of working Eighty-five percent of the nurses felt that concerning their main area of activity, in the past 5 years there have been significant changes in the way that they work. Among other things, the changes cited included: more planned work than in the past, focused activity on specific areas (such as the those noted above), and expansion of medical knowledge. Furthermore, 61% of the nurses noted that the working environment in this period had changed to a great or very great extent, and another 26% indicated that it had changed to a moderate extent.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Social and economic considerations Almost all of the nurses (90%) take into account the family and economic situation of the patient to a great or very great extent while only 2% of them take it into account to a small or very small extent or not at all. Moreover, almost half (47%) of the nurses take into account financial considerations of the health plan to a great or very great extent while 18% of them take it into account to a small, very small extent or not at all. (The remainder takes these factors into account to a moderate extent.)

The quality measurement program Approximately three-quarters of the nurses (77%) reported involvement to a great or very great extent in quality measurement programs; only 10% felt that they were not involved or were involved to a very small extent. Similarly, 75% of the nurses felt that the program had impacted their work to a great or very great extent, and 73% of them felt that their workload had increased to a great or very great extent as a result of the program.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Sense of autonomy Approximately three-quarters of the nurses (73%) felt that they had autonomy at work to a great or very great extent. Similarly, 75% of the nurses felt that their professional autonomy had broadened in the preceding 5 years in contrast to 9% who reported a sense of curtailed autonomy in this period, and 16% who noted that they had felt no change. 70% indicated that, to a great or very great extent, they had the authority needed to do their jobs.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Work satisfaction Four out of every five nurses (80%) were satisfied to a great or very great extent with their work overall, and only 3% felt little or very little satisfaction; the rest were moderately satisfied. In keeping with these feelings, 80% said that they would recommend to others to enter the profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

As indicated in Chart 1, the aspects of work with which the most nurses were satisfied to a great or very great extent were: the impact of their work with patients (84%), the extent of responsibility given to them (81%), and their co-workers (82%). The aspects of work with which the lowest proportion of nurses were satisfied were: the salary (39%), physical conditions (14%, and appreciation of their work by their superiors (17% dissatisfied).

Barriers to the development of the nursing profession Asked about barriers to the development of the profession, the front-line nurses who participated in the survey and the managerial nurses who participated in the in-depth interviews cited similar barriers. These included: ♦ Physicians’ perceptions. Some nurses believe that physicians fear the profession’s development, being interested in keeping the nurses in the position of following physicians’ directives.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

♦ Nurses. Some nurses believe that they and/or some of their colleagues slow down the profession’s development, having no interest in broadening their authority for fear of a greater workload.

♦ Lack of resources and positions. Many nurses regard the lack of resources as a barrier to the profession’s development: the large workforce shortage, and the fact that there are no established positions

♦ Compensation. Subsequent to the relative wage dissatisfaction, some nurses regard low levels of compensation as a barrier to the profession’s development. Low compensation attracts fewer young people to the profession and increases the workload.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Note that the barriers identified in the survey were largely similar to those that came up in the in-depth interviews.

Differences among nurses related to background characteristics The nurses’ perceptions were examined according to the following variables: age, country of birth, level of education, professional status and managerial position. As a rule, very few large or statistically significant differences were found among the groups (See Tables 5, 6 and 7).NURS 3000 – Issues and Trends in Nursing Assignment Papers. However, we did find that the more educated the nurses were, the more likely they were to take into account financial considerations of the health plan and the more satisfied they were than less-educated nurses. We also found that the higher the level of their professional training, the more they tended to take into consideration the family and economic situation of a patient. In addition, nurses with a higher level of professional training felt were more likely to indicate that the quality monitoring led to an increase in competition among the front-line clinicians, managerial pressure and overload.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Table 5 Authority and autonomy by sub-group

Autonomy to a great or very great extent (in %)

Sufficient authority to carry out job (in %)

Total

Age

Under 40

41–55

Over 55

Education level

No degree

MA+

Professional status

LPN

Beyond

Managerial responsibility

With managerial role

Without managerial role

Table 6 Perceptions of significant change and level of satisfaction, by subgroup

Significant change in past five years (in %)

Satisfied to a great or very great extent (in %)

Total

Age

Under 40

41–55

Over 55

Education level

No degree

MA+

Professional status

LPN

Beyond

Managerial responsibility

With managerial role

Without managerial role

Table 7 Social and economic care considerations by subgroup

Significant weight given to family and economic circumstances

Significant weight given to health plan financial considerations

Total

90%

47%

Age

Under 40

84%

38%

41–55

95%

55%

Over 55

84%

46%

Education level

No degree

95%

44%

86%

46%

MA+

88%

55%

Professional status

LPN

81%

51%

91%

46%

Beyond

89%

48%

Managerial responsibility

With managerial role

89%

38%

Without managerial role

88%

55%

Discussion and conclusions

This study provides the first empirically based description of the role of health plan nurses in Israel. Interviews with national leaders in nursing and medicine conducted in 2013 foreshadowed changes described by front-line nurses in interviews 2 years later. Leaders identified emergent trends in chronic illness and specialized care in the health plans as well a shift from reactive to nurse-initiated work. Findings from the 2014–5 survey of front-line nurses showed these trends were indeed occurring. Follow-up interviews with nurse plan leaders in 2017 provided key updates and were consistent with the earlier findings. All study components indicated that major changes have occurred in Israel in the role and functions of health plan nurses and their involvement in patient care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The changes found included a transition from reactive to initiated work and increased specialization. Moreover, aside from routine care, the study has documented the central place of chronic care; health promotion and specialized care in the work of health plan nurses. Activities related to the quality monitoring and improvement are another significant component of the work of Israel’s health plan nurses. The findings provide support for ongoing efforts in the health plans to give nurses more authority and responsibility in the management of chronically ill patients, a more central role in health promotion efforts, more advanced training – both inter-professional and nurse-specific, and more opportunity to focus on the roles and tasks that require nursing professionals.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

One of the study’s key findings is that about half of the nurses take into account, to a great or very great extent, the financial concerns of the health plans that employ them. This may be due, in part, to the growing roles of nurses in care coordination and management. This sensitivity to cost considerations, combined with the nurses’ broad professional expertise and patient-centric perspective, make nurses an extremely valuable resource for the plans, and positions them for greater responsibility and authority.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

We examined whether there were differences between the nurses who are managers and the other nurses with regard to the extent to which they take into account various considerations. The two groups were equally likely to take into account the patients’ economic circumstances (approximately 90% do so to a great or very great extent). Surprisingly, however, the nurse-managers were less likely than the others to report that take into account the economic interests of their health plans (22% vs. 36%). The reasons for this difference might be a good subject of a future study.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

ORD ER NOW FOR A CUST OM-WRITTEN AND P LAGIARISM-FREE PAPER

Another key finding is that a significant proportion of the nurses (38%) indicated that care of the chronically ill patient is their main area of activity beyond routine care. With the population continuing to age, work in this area is likely to expand. It will be important to develop patient-centered projections of the amount and nature of the work that will be needed to care effectively for the chronically ill, and then think strategically about how health plan leaders, and physicians, nurses, and other professionals on the front-line can best work together to address this important challenge. This will clearly have important implications for the number of professionals required and continuing education, and this could be an important area for inter-professional continuing education. Serious consideration should be given to continuing the trend of giving nurses a greater role in care coordination and management of the chronically ill.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Health promotion is the main area of non-routine activity for another large group (30%) of health plan nurses. In the future, it will be important to explore in greater detail in which health promotion challenges they are most involved, the nature of their involvement in those challenges, and the degree of their success in those areas. This could have important implications for ensuring that nurses have the opportunity to engage in relevant continuing education opportunities regarding health promotion strategies, concepts and techniques. The major role that nurses are playing in patient-level health promotion should also be give greater recognition.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The study also confirms the extensive involvement of nurses in quality monitoring and improvement efforts, hence another area where inter-professional education should be given greater emphasis. A related finding is that almost all the nurses are quite attuned to the family and economic situation of the patient. This attention to context can be vitally important in efforts to improve a health plan’s quality performance, particularly with regard to those dimensions of quality, which require patient compliance and/or behavioral change. They will be even more important in the future if/when quality measures are developed that assess quality in such areas as depression care and community-based long-term care. NURS 3000 – Issues and Trends in Nursing Assignment Papers.

As indicated earlier, this study found that nurses perceive quality monitoring and improvement to be an important part of their work, but that this comes with various costs – more managerial pressure, more competition and a higher workload. A previous study by Nissanholtz et al. adds valuable context to these findings. In a national representative survey of health plan primary care physicians, most respondents (74%) agreed that nurses contribute to practice quality and share responsibility for improving quality measures.NURS 3000 – Issues and Trends in Nursing Assignment Papers. Physicians who felt that quality monitoring improved the quality of care and those who supported the program were more likely to consider that nurses shared responsibility for the quality of care [26, 27]. That study also found that, like nurses, the physicians also experienced the quality monitoring to increase managerial pressure, but to a lesser extent than did the nurses (58% v. 84%). Similarly, it found that physicians also felt that the quality monitoring increased competition, but to a lesser extent than did the nurses (47% v. 81%). The two professions were more similar in the extent to which they felt that the monitoring increased the workload (64% and 72%) [25].NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The findings also indicated that a very high proportion of the health plan nurses are very satisfied with their work overall (80%). However, the study also highlighted pervasive concerns with the shortage of nursing positions, wage levels and the attitudes of some physicians and nurses that constrains the professional development of health plan nurses. Expanding nurses’ role is one of the factors that improve satisfaction of nurses [12]. Dealing with these problems would clearly contribute to the satisfaction and commitment of those already working as health plan nurses. It may also help attract additional young people to the profession.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

A related finding is that the vast majority of the health plan nurses are significantly involved in both routine work (in which they function largely as supports for primary care physicians) and more specialized work (in which they typically have more independent roles). In theory, a mix of this sort could be either a source of frustration (related to time constraints and/or the complexity of role identity) or a source of satisfaction (related to task diversity). Unfortunately, we do not have information on how this mix of roles is affecting nurse satisfaction. What we do know is that the vast majority of health plan nurses are satisfied with their work and that, at present, for most of them work entails a mix of routine tasks and specialized work.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

In general, there is a good fit between the study’s findings about the evolving content of the work of health plan nurses and the contextual changes highlighted at the beginning of this article. One important exception is that, despite the ongoing reform of Israel’s mental health care system, the nurses did not indicate that mental health care is an important component of their workload. This may be because the in-depth interviews were carried out in 2013 and the survey of front-line nurses took place in 2014; while these were subsequent to the 2012 government decision to transfer responsibility for mental health care to the health plans, the transfer itself did not go into effect until 2015. Interestingly, in 2017 presentations to the Mental Health Reform Administration, the health plans spoke about significant strides in involving nurses in mental health care and in the future it will be important to study systematically the extent and nature of this evolution.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

The changes in the roles of community nurses has apparently been a gradual evolution spread over many years. Interestingly, the main changes emphasized by nursing leaders in the 2013 in-depth interviews were largely similar to those emphasized in the 2017 follow-up interviews. At the same time, several new points were made in the 2017 interviews, suggesting that this evolution continues; these include the appointment of several nurses to regional director positions, greater expose of the nurses to patient clinical data, and more inter—professional educational.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Overall, the data presented in this study can contribute to Israeli efforts in the following areas: ♦ Recruiting more people to the nursing profession, especially to community nursing. The data can enable recruiters to provide a clearer picture of the current content of the work (including its diversity), how that content is changing in exciting directions, and how satisfied community nurses are with their work.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

♦ Intra-organizational thinking within the health plans and other relevant organizations Key topics including the place of nursing resources in the budgeting of community-based services, the provision of appropriate levels of compensation, the definition of nursing tasks, the division of labor between the various staff members and mechanisms for increased cooperation.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

♦ Sharing information with the public on the changed role of health plan nurses. This could contribute significantly to the empowerment of both nurses and their patients and to cooperation between these two groups.

Limitations The main study limitation is that the interviews were carried out at only one point in time. Thus, the findings about changes in the nurses’ roles are based, in part, on the nurses’ ability to recall the substance of their roles several years prior to the interviews and their assessments of how those roles had changed. This limited the extent to which the changes in the roles could be detailed and quantified.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Another limitation is that no formal assessment was made of the reliability and validity of the questionnaire used in the survey of front-line nurses. However, it was carefully derived from the in-depth interviews of the 55 nursing and other leaders and also reviewed for face validity.

Finally, as indicated in the methods section, there may be small-moderate under-representation of some sub-groups of nurses. However, the impact of these on the overall study findings is apparently quite limited, as the study found few substantial differences in key study variables among these sub-groups.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Directions for further research While the current study focused on Israel, it highlights developments, trends and issues, which may be relevant to other countries as well. For example, in the U.S. a 2017 report by the Macy Foundation called for using RNs as significant contributors to health promotion efforts in primary care settings [6]. That report identified a number of goals, including: giving more emphasis to primary care in nursing schools, developing primary care specializations, and encouraging teamwork.9

The study team plans to be in touch with researchers in other countries to identify similar studies, compare findings, and reflect together on similarities and differences. One of the issues of particular interest is whether the predominance of health plans in Israel has resulted in a unique mix of roles for its community nurses and whether Israel might be a harbinger for other countries in the process of adopting more organized systems of community care.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Directions for further research within Israel include: An exploration of how the nature of the interactions between health plan nurses and physicians are changing and how both professional groups feel about it

Qualitative research to further understand how front-line nurses experience the mix of traditional/routine and newer/proactive roles

More detailed analysis of the survey data regarding such topics as nurse involvement in the quality monitoring program, change barriers and facilitators, similarities and differences across age groups, etc.

An analysis of how nurses answer the challenge of caring for the mentally ill and persons with mental health problems

The evaluation of new nursing roles as nurse practitioners and nurse consultants and their impact upon patients’ and families’ quality of care and quality of life

An analysis of the current roles of the nurses in preventive mother and child health centers, and how these have changed over time

An exploration of of Israeli models of physician-nurse teamwork, which were recently praised by the OECD [29], and are continuing

NURS 3000 – Issues and Trends in Nursing Assignment

Footnotes 1 This figure of one-third is based on data from the Central Bureau of Statistics Labor Force Surveys for the years 2012–2014. It is up from one-quarter a decade earlier.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

2 The data appearing in this report do not distinguish between the health plans. However, each health plan has received, for internal use, a series of tables comparing the findings concerning it and the others.

3 Inadvertently, in one of the health plans, nurses with less than 5years of experience were largely excluded in the sampling process. However, sensitivity analysis indicates that this had only a very limited impact on the study findings. This is because there were only small differences in key study variables between nurses with less than 5 years of experience and the nurses with five or more years of experience. In addition, the nurse with less than 5 years of experience constitute a relative small part of the study population (between 18% and 25% in the three plans for which we have data).NURS 3000 – Issues and Trends in Nursing Assignment Papers.

4 The non-response was due to an inability to contact 17% of the sample, 7% who refused to cooperate, 6% who initially indicated that they would respond but did not follow through, and 1% who were found to be irrelevant to the study.

5 The background variables included age, gender, ethnic background (Jewish, Arab, Druze, etc.), country of birth, level of education, professional status, management role, and years in the profession. They were included because they were felt to be potentially related to key study variables such as work satisfaction and perceived professional autonomy.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

6 Education, giving guidance to patients, and referrals were not defined as routine work, nor as professional work. Evidently, they should be included in the professional work of nurses and not as routine work, but we cannot say with certainty that all the nurses understood that the educational part, as noted, belongs to professional work.

7 The analyses presented in this article do not distinguish among health plans, as the health plans’ agreement to participate in the study was conditioned on a commitment from the study team not to publish plan-specific findings. Each health plan has been presented with the findings for the results for their own nurses, compared with the national results.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

8 These areas are consistent with the major changes in the health care system. For example, the fact that people live longer, but with more chronic diseases, requires increased attention to chronic patients, both to prevent deterioration of health status through the promotion of health and to respond to patients who are disabled. The fact that nurses learn more and have more extensive knowledge and capabilities than in the past affects the subject of “specialization” in various subjects and the nurses’ desire to develop in the field closest to their hearts and improve their abilities in this field

9 This approach is a natural continuation of the IOM report on the future of caregiving (IOM 2011). The IOM report noted that the nursing profession’s focus on patient management and coordination, patient education and public health intervention, is a good fit for a world in which health promotion and care management are increasingly being emphasized.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

10 See the appendix for a brief note on the historical development of nursing in Clalit clinics.

Notes A comment to this article is available online at https://doi.org/10.1186/s13584-018-0257-5.

Declarations Acknowledgements The authors thank Steve Schoenbaum and Gerri Lamb for the comments on an earlier draft of this manuscript. The Community Nursing Study Group consists of Liat Arad, Shlomit Bloomenthal, Dorit Goldman, Yafa Haron, Miriam Hirschfeld, Calanit Kaye, Galit Kauffman, Idit Kogan, Rachel Nissanholtz-Ganot, Bruce Rosen, Bruria Sherman, Hedva Stoyer, Yulia Nigel, and Dorit Weiss.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Funding The study was funded in part by a grant from the Israel National Institute for Health Policy and Health Services Research 62–2010-R.

Availability of data and materials The principal investigators are open to suggestions for joint analyses and collaborations based on the data collected as part of this study.

Authors’ contributions RN and BR jointly developed the study design and carried out the study, with substantial input from MH. RN took the lead in preparing the project report on which this article is based and BR took the lead in turning the project report into a journal manuscript. The members of the Community Nursing Study Group provided valuable input into the study design, the research instruments and the data analysis. All authors read and approved the final manuscript.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Ethics approval and consent to participate An exemption from a full review was granted by Human Subjects Committee of the Clalit health plan. Authorization number: 0032–14-COM. The voluntary nature of the study was emphasized to all the nurses in the sample and only those who wished to participate did so.

Consent for publication All the authors have agreed to publication.

Competing interests RN, BR and MH declare that they have no competing interests. Several of the members of the Community Nursing Study Group have senior management roles in the health plans and the Ministry of Health.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Appendix A: The status of nurses in Israeli health plans Israel has four health plans (Clalit, Maccabi, Meuhedet and Leumit), and they have several important features in common. They are all non-profits and all were established at least 80 years ago. They all are nation-wide in scope and all have more than half a million members. They also have sophisticated IT systems, with all primary care clinicians working with electronic health records.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

At the same time, there are several important differences among the plans. These include their size; the age, income and geographic mix of their members; and the extent to which their physicians are plan employees v. independent contractors. There are also important differences with regard to plan history, culture and operating style. Most significantly, for the purposes of this study, there are difference with regard to the extent, and manner, in which the plans work with nurses in community settings.

Clalit, with 4.4 million members, employs approximately 3000 nurses in community settings; most of them work on a full-time basis. The dominant model of primary care in Clalit is a community clinic with an interdisciplinary staff that has overall responsibility for the health and health care of the members registered in that clinic.10 The physicians and nurses jointly manage the care of each patient, including both responsive and proactive care, with a clear division of responsibility between the two professions. They also take a population approach and seek ways to improve the care of groups of patients (defined in such terms as age, illness and ethnicity).

Maccabi, with 2.1 million members, employs approximately 1100 nurses; this is up from 650 four years ago. Almost all of Maccabi’s nurses are RNs and two-thirds hold academic degrees. Most of them work either in municipal/district branches or in the clinics of independent physicians registered in the personal physician program (PPP); others work in such settings as specialty clinics or national nurse-led call centers that operate 24/7. In the PPP they function primarily as case managers for chronic illnesses and preventive/outreach services. In the branches, their jobs entail both proactive and reactive work. In recent years, the nurses have been able to delegate many of the more technical and routine tasks to nurse assistants or other support staff. NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Meuhedet, with 1.2 million members, employs 880 nurses; many of them work on a part-time basis. The number of nurses in the plan has doubled over the last 5–6 years. Almost all the nurses work in Meuhedet’s municipal/district branches, each of which has a large number of specialist physicians and nurses. This has facilitated a rapid movement toward greater specialization of the nurses, particularly in those clinical areas where nurses have substantial authority and independence. These include diabetes, stoma, genetic counseling, and most recently palliative care. In each of these areas, the nurses play a central role in integrating the work of different types of professionals (physicians, dieticians, pharmacists, etc.) and in managing the care of the patient. The need for integration has been a major driver toward greater specialization.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Leumit, with 0.8 million members, has almost 500 nurses, with about 60% of them working full-time. Approximately 90% of them are RNs. The number of nurses working in the plan has been stable in recent years. The nurses work predominantly in the clinics that are operated by the health plan and secondarily in home care units, rather than in IP offices. Their work has expanded from the more technical tasks to include a large component of chronic care management and patient education. Recently, a new nursing management level – the district head nurse – was created, with a focus on implementing and inculcating various guidelines related to nurses’ newer responsibilities.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Nurses also play a central role in health plan call centers, in which have they have a great deal of autonomy to make decisions which often have significant clinical and economic implications.

Appendix B: An initial examination of community nursing roles in the US and England, in comparison with Israel Methods Ten telephone conversations were held with key figures in the US and England and the relevant professional literature was reviewed. This was followed by a comparison with the situation in Israel as it emerged from the in-depth interviews.

Findings Changes over time. The role of community nurses has expanded in recent years. However, it is difficult to estimate the pace of change or point to countries with more rapid change. This topic would seem to deserve a separate study.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Different types of nurses. One prominent difference between Israel and the other countries examined is that the latter have a category of Nurse Practitioners – NPs. In the US and England, nurses in this category enjoy broader authority. Though not many nurses in England are defined as NPs, their numbers are steadily growing. In the US, there are more than 222,000. In Israel, the Ministry of Health has begun to recognize nurse practitioners only in recent years and this, too, only in select areas (such as palliative care, geriatrics and diabetes care). Thus, the situation in Israel is very far from that in the US and England.

Managing the care of chronic patients. The main difference between Israel and the other countries in managing the care of chronic patients concerns the nurses’ scope of authority. In Israel, the authorization of nurses to prescribe medication is very limited and hardly implemented and they do not make referrals. In the US and England, there are differences based on a nurse’s status and training. Some nurse work only according to a physician’s directives while others work more independently, make referrals and prescribe medications.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Home visits. In Israel, as well as in the other countries, home visits for bedridden patients are performed mainly by nurses. However, in the US and England, the nurses working in homecare do it exclusively. In Israel, on the other hand, most of the nurses work in homecare in addition to their work at the clinic.

Measuring quality. Both of the countries examined have quality monitoring programs. However, whereas in Israel the program has for many years encompassed the entire community and virtually all nurses are involved in or affected – in the US, until recently, it applies only to organizations of managed care (about a third of the population). Recently, the federal government has instituted a program of quality reporting on care for the elderly; it is related to payment that has led to reporting from almost all primary care practices. Still, while nurses are involved in quality measurement programs in both Israel and the US, the extent of their involvement apparently differs. Moreover, in England and the US there are financial incentives for participating in these programs whereas in Israel there are none.

Authority to prescribe medication. In both of the countries examined, nurses have partial authority to prescribe medication and the differences between the countries are reflected in the substance of their authority. Another difference relates to the extent that this authority is actually practiced. In these countries, nurses defined as NPs are authorized to prescribe medication. In Israel, virtually no nurses prescribe medication without a physician’s authorization.

ORD ER NOW FOR A CUST OM-WRITTEN AND P LAGIARISM-FREE PAPER

Caution should be exercised in interpreting these differences between countries and their causes. Factors such as the structure of the system, cultural differences, and the milieu of the health system should be taken into account.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Appendix C: Similarities and differences among the health plans that emerged from the in-depth interviews The similarities related to the following aspects: a shortage of nurses, overall and for all districts except for the north; considerable advances in the technologies used by nurses; more studies and training than in the past; creativity.

Alongside the great similarity found between the nurses’ jobs in all the health plans, there were also several differences, including: The implementation of the provision for special authorization: Although the Ministry of Health widened the authority of community nurses, not all the health plans have implemented the provisions.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Integration of nurses into the measurement program. There are differences in the extent of involvement and responsibility of community nurses in the measurement program, directed by the Ministry of Health and examining the quality of prevention, diagnosis, and treatment provided by the health plans. (The program is implemented by the Israel National Institute for Health Policy Research and contains indicators for the following areas: immunization, early detection of breast and colon cancer, treatment of diabetes, asthma and heart problems.) In three of the four health plans, nurses are responsible for some of the indicators and manage them on the local, district and national levels. In the fourth, they deal with the technical aspects of measurement, such as administering vaccines or inviting patients to come in for a mammography or other tests.

Integrating nurses into various levels of health-plan management. In three health plans, nurses serve in senior positions of general management (i.e., beyond nursing): they are integrated into the management of health-plan branches and districts, and of the health plan as a whole. In one health plan, they manage only the nursing sector and are not part of the general management of the health plan.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Developing and focusing on areas of specialization. Each health plan invests in different areas of specialization. Differences in specialization also exist among the districts of a single health plan.

Perceptions of barriers to the development of the profession Despite the great potential for professional development of community nursing, the interviewees identified barriers such as: a lack of established positions; physicians’ perceptions of the profession and their fear of encroachment by nurses into their areas of responsibility; some nurses themselves do not wish to broaden their roles or are afraid of carrying responsibility even when they do receive it; nursing schools focus more on hospital-related studies, dealing less with the community and its diverse work possibilities.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Many parents experience breastfeeding problems in the early days after having a baby. Breastfeeding (Lactation) Counselors have the opportunity to make a real difference to the families they work with. Breastfeeding counselor training will enable you to assist clients to overcome breastfeeding difficulties, building a close relationship with those you are working with, and knowing that with your support, you can help a parent and baby gain the benefits of breastfeeding. Whether you want to become a Breastfeeding Counselor on its own or take your first step towards the IBCLC certification, this ANCC accredited course will provide you with the knowledge, tools, and skills to achieve your goals!NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Being a Breastfeeding Counselor brings you into a family at a time when they may be struggling. Whether you’re helping a new parent learn how to latch her baby on, or working intensively someone who’s trying to overcome mastitis, your role will be a crucial one. At CBI we make sure you have a thorough grounding in all these areas and more. You’ll also have support and guidance from your trainer, and from our network of breastfeeding counselors around the world.NURS 3000 – Issues and Trends in Nursing Assignment Papers.

Much of your work as a Breastfeeding Counselor will be listening to the clients you work with and truly supporting them. As a student you’ll develop strong communication skills, learning the important skills of reflective practice and effective and active listening. During this online training program, you will develop strong skills in using the counseling process to help clients feel supported and heard. You’ll also cover all the business aspects – how to build your client base, paperwork, forms and legal issues, advertising and promoting your business.