Implementing Enhanced Primary Care Registered Nurse Reimbursement in Rural Health Clinics: A Policy Analysis.

Rural Health Clinics (RHCs) were created in 1977 to address the high health care needs, limited provider access, and poor health outcomes of rural Americans. Although innovative at their inception, the provider-centric model of RHC cost-based reimbursement structures has not evolved, leaving limited opportunities for change; many have failed. Comprehensive, proactive change is needed. Registered nurses (RNs) working at the top of their practice scope are a neglected clinical resource that can improve access, quality, value, and satisfaction for rural patient communities. RHC reimbursement policy must evolve to sustain and support this significant RN role. RNs have demonstrated value in care continuity and disease management, but there is little research on the utilization of RNs using their enhanced skill set in RHCs. Using the Bardach and Patashnik's eight steps of policy analysis, the authors will describe the background and regulations of RHCs, identify current barriers to improving the health of America's rural residents, and then provide evidence to support a new policy option according to the Quadruple Aim framework. The result is a sustainable policy recommendation designed to best serve rural communities.

The effectiveness of education and cognitive rehearsal in managing nurse-to-nurse incivility: A pilot study.

AIM: Teach nurses to recognize incivility, confront it using cognitive rehearsal techniques, thereby improving job satisfaction. BACKGROUND: Nurse-to-nurse incivility negatively affects nurses, organizations, and patients. The Tri-Council for Nursing's proclamation calls nurses to recognize incivility and take steps to eliminate it in practice ("Tri-Council " 2017, https://tricouncilfornursing.org/documents/Tri-Council-Nursing-Civility-9-26-17.pdf). METHODS: A mixed method, a pilot study was conducted. Nurse participants received incivility and cognitive rehearsal education. Data were collected through surveys adapted from the Nurse Incivility Scale (NIS), the NDNQI Index of Work Satisfaction Nurse Interaction subscale, and two open-ended questions. RESULTS: Two subscale means were significant. The remaining NIS subscale means and the NDNQI Nurse Interaction subscale decreased across three time points (initial, immediate postintervention and final survey conducted six weeks postintervention). Qualitative data supported findings. NDNQI Index of Work Satisfaction had no effect on nurse job satisfaction. CONCLUSION: The intervention was effective in increasing nurses' recognition of incivility and ability to confront it. Perceived instances of incivility decreased over time. IMPLICATIONS FOR NURSING MANAGEMENT: This educational intervention advances civility in nursing practice, promoting a positive work environment in which patients are cared for in a safe and efficient manner.

Rethinking student evaluation of teaching: A policy analysis.

Institutions of higher education with tenure and promotion policies that rely heavily on student evaluations of teaching may create academic progression barriers for Black, Indigenous, and People of Color (BIPOC) faculty. The purpose of this policy analysis is to explore how current practice of utilizing Student Evaluation of Teaching (SETs) as the major source to evaluate teaching effectiveness, impacts tenure for BIPOC faculty, using Bardach and Patashnik's (2019) eight steps of policy analysis. Context provided includes cultural history, policy and evidence regarding the use of SETs. Evaluation criteria focuses on two national nursing reports and nursing accreditation standards, along with utilization of the 2020 Teaching Quality Framework for Evaluation of Teaching. The status quo utilizes SETs as the major evaluation tool for overall teaching effectiveness. SETs are shown to produce an unacceptably high error rate and fail to identify the best teachers. Teaching evaluations that utilize both formative and summative methods provide a global, less biased view of instructional pedagogy. Making a change in the way teaching is evaluated is a critical component in the retention of BIPOC Faculty and their ability to attain tenure.

Professional advocacy: linking Virginia's story to public policy-making theory, learning from the past and applying it to our future.

Too often the nursing profession has been shortsighted regarding its ability to educate legislators and the public on the value of the nurse and the need for policy change. This has stagnated the profession's agenda setting, influence, and position. Virginia nurses, however, rose to the challenge a few years ago. They addressed the nursing faculty shortage by introducing legislation to improve faculty salaries and promote nursing education. They fully defined their problem, formed a unified coalition to develop a solution, and found the political environment favorable for policy change. Their advocacy success story can lend guidance and encouragement for advocacy for the profession. Linking their successful road to policy change to the B. B. Longest (2010) public policy-making framework provides a roadmap for future success.

Downregulation of exhausted cytotoxic T cells in gene expression networks of multisystem inflammatory syndrome in children.

Multisystem inflammatory syndrome in children (MIS-C) presents with fever, inflammation and pathology of multiple organs in individuals under 21 years of age in the weeks following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although an autoimmune pathogenesis has been proposed, the genes, pathways and cell types causal to this new disease remain unknown. Here we perform RNA sequencing of blood from patients with MIS-C and controls to find disease-associated genes clustered in a co-expression module annotated to CD56dimCD57+ natural killer (NK) cells and exhausted CD8+ T cells. A similar transcriptome signature is replicated in an independent cohort of Kawasaki disease (KD), the related condition after which MIS-C was initially named. Probing a probabilistic causal network previously constructed from over 1,000 blood transcriptomes both validates the structure of this module and reveals nine key regulators, including TBX21, a central coordinator of exhausted CD8+ T cell differentiation. Together, this unbiased, transcriptome-wide survey implicates downregulation of NK cells and cytotoxic T cell exhaustion in the pathogenesis of MIS-C.

Author Correction: Sampling the host response to SARS-CoV-2 in hospitals under siege.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Cytotoxic lymphocytes are dysregulated in multisystem inflammatory syndrome in children.

Multisystem inflammatory syndrome in children (MIS-C) presents with fever, inflammation and multiple organ involvement in individuals under 21 years following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To identify genes, pathways and cell types driving MIS-C, we sequenced the blood transcriptomes of MIS-C cases, pediatric cases of coronavirus disease 2019, and healthy controls. We define a MIS-C transcriptional signature partially shared with the transcriptional response to SARS-CoV-2 infection and with the signature of Kawasaki disease, a clinically similar condition. By projecting the MIS-C signature onto a co-expression network, we identified disease gene modules and found genes downregulated in MIS-C clustered in a module enriched for the transcriptional signatures of exhausted CD8 + T-cells and CD56 dim CD57 + NK cells. Bayesian network analyses revealed nine key regulators of this module, including TBX21 , a central coordinator of exhausted CD8 + T-cell differentiation. Together, these findings suggest dysregulated cytotoxic lymphocyte response to SARS-Cov-2 infection in MIS-C.

Does therapeutic touch help reduce pain and anxiety in patients with cancer?

With more than 10 million patients with cancer in the United States, pain and symptom management is an important topic for oncology nurses. Complementary therapies, such as therapeutic touch, may offer nurses a nonpharmacologic method to ease patients' pain. Using 12 research studies, the authors examined the evidence concerning the effectiveness of this type of treatment in reducing pain and anxiety.

Be the Change: An Interprofessional Team-Based Health Advocacy Summit.

In a complex health care environment, nursing and health care professional graduates should be able to understand and collaboratively advocate for health policy benefitting patients, families, and communities. This study explored the effectiveness of interprofessional team-based learning to improve political astuteness in undergraduate health profession students. This engaging method may prove to enhance health care professionals' likelihood of understanding, involvement, and influencing health policy in the future.

The influence of a change in medicare reimbursement on the effectiveness of stage III or greater decubitus ulcer home health nursing care.

This study was designed to describe and evaluate the influence of a change in a Medicare reimbursement on the effectiveness of home health nursing care for stage III or greater decubitus ulcer patients. This health policy originated from the Balanced Budget Act (BBA) of 1997 and took its full effect with initiation of the Prospective Payment System (PPS) on October 1, 2000. A quantitative quasi-experimental design used OASIS data from the state of Virginia to evaluate 555 stage III or greater decubitus ulcer patients, age 65 or older. Comparisons were investigated between pre-PPS, 2000, and post-PPS, 2001, outcomes related to reported ulcer healing, lengths of stay, and discharge disposition. Results demonstrated significant differences for the outcomes studied. In addition, sanitation, ulcer healing, and discharge disposition were linked as predictors for length of stay. Results demonstrated that PPS has affected nursing care effectiveness for stage III or greater decubitus ulcer home health patients.

Nurse and client perceptions of home health wound care effectiveness after a change in Medicare reimbursement.

The purpose of this study was to begin to explore client and nurse perceptions related to how a change in a Medicare reimbursement, Prospective Payment System (PPS), affects home health care. The target population included home health clients with stage III or greater decubitus ulcers, age 65 years or older. Six Virginia home health agencies were randomly selected. From those sites, all 39 charts that met population criteria were accessed and analyzed, and then 16 care recipients were purposely selected. In addition, 26 home health nurses with pre- and post-PPS experience were purposefully selected. Semistructured, audiotaped interviews were conducted, transcribed, and analyzed using thematic content analysis. Results demonstrated PPS adaptive behavior and an increase in use of education and family caregivers related to wound care. Themes that emerged included professional competence, caregiver as key, and sense of support. Perceptions emphasize the necessity for resource management, collaboration, and patient advocacy.