When Healthcare Isn't Enough: A Christian Response to Social Determinants of Health.

Education, employment, housing, neighborhood safety, and traumatic life experiences influence people's health, and poor health as a result of inequities in these areas cannot be remedied by medical care alone. Although social determinants of health threaten the attainment of a healthy life for people across North America, nurses are positioned to be leaders in a movement toward health equity. Nurses can follow the example of Jesus in loving their neighbors as themselves by addressing the social needs of patients, championing health system change, educating their communities, and advocating for Health in All Policies.

Moving Toward Health Equity by Addressing Social Determinants of Health.

Social determinants of health-the conditions in which people are born, grow, work, live, and age that affect health and quality of life-are strongly associated with disparities in health status and life expectancy. Nurses require a comprehensive understanding of social determinants and their associations with health outcomes to provide patient-centered care. Nurses can be leaders and change agents in advancing health equity by screening for social determinants that affect women and by engaging in cross-sector collaboration to build partnerships outside the health care system to address complex social needs. Nurses can also use their experience and knowledge to advocate for system-level change, which is required to address the upstream factors influencing the health of women.

A pilot study of prenatal care visits blended group and individual for women with low income.

Healthy Pregnancy, Healthy Childbirth, Healthy Parenting (HPCP) is a blended prenatal care model that integrates group visits with individual prenatal visits. While group prenatal care has been found to have a positive impact on pregnancy outcomes, current models may not be feasible or desirable in all clinical settings. HPCP offers one educational group visit each trimester to improve knowledge of self-care during pregnancy and of childbirth and infant care. The program was piloted among women with low income in a southern metropolitan area. This article presents the findings of a pilot study that examined maternal knowledge acquisition and subsequent changes in self-efficacy and satisfaction with care. Suggestions for future use of a blended model for the delivery of prenatal care are shared.

Ethical decision-making in the dilemma of the intersex infant.

The Making Ethical Decisions about Surgical Intervention (MEDSI) tool is designed to guide health care professionals, patients, and families faced with ethically charged decisions regarding surgical interventions for pediatric patients. MEDSI is built on the principles of beneficence, nonmaleficence, and patient autonomy and created to promote truth-telling, compassion, respect for patient cultural and religious preferences, and appropriate follow up in the clinical setting. Following an overview of the 8 steps that compose MEDSI, the tool is applied to the management of intersex infants. The birth of a child with a disorder of sexual development (DSD) and ambiguous genitalia presents an ethically challenging situation for the family and health care team. The use of the MEDSI model is demonstrated in a case study involving the decision of surgical intervention in the management of an intersex child.

The Affordable Care Act: Primary Care and the Doctor of Nursing Practice Nurse.

The passage of the 2010 Patient Protection and Affordable Care Act (ACA) initiated the transformation of the United States healthcare system. The ACA fosters a preventive healthcare model that emphasizes primary care, funds community health initiatives, and promotes quality care. These changes increase the need for well-prepared healthcare professionals. Advanced Practice Registered Nurses (APRNs) who hold the Doctor of Nursing Practice (DNP) degree are prepared to meet this increased need by providing leadership in community health centers, serving on interdisciplinary teams, and advocating for and directing future policy initiates. In this article, the authors consider how the ACA will serve as a prevention model, describe the role of DNP nurses as primary care providers, explain how preventive healthcare can be enhanced through the use of a primary care model, and address associated challenges related to increasing preventive care in our healthcare system. They also discuss DNP nurse leadership opportunities related to community-based programs and policy strategies to strengthen primary care delivery. The authors conclude by noting the professional and legal barriers that need to be removed before DNP nurses will be able to provide the care they have been prepared to offer.

Nursing leadership in addressing the social determinants of health.

Social determinants of health have a profound impact on health status and the prevalence of health disparities in the United States. Significant improvements in national health indices are not possible without addressing social determinants of health. Drawing on their historical legacy as patient advocates, patient care expertise, and community focused education, nurses are ideally positioned to lead the nation in strategies to promote health equity. Nurses can embrace this new leadership role through the use of interdisciplinary collaboration, advocacy, political involvement, and community partnerships.

A systematic review comparing group prenatal care to traditional prenatal care.

This systematic review compares pregnancy outcomes and maternal satisfaction for women in group prenatal care versus those in traditional prenatal care. Keyword searches in multiple databases identified 12 studies that compared pregnancy outcomes and/or maternal satisfaction between prenatal group care and traditional care. In 11 of the 12 studies reviewed, women receiving group care had equivalent or improved pregnancy outcomes compared with traditional care, including decreased incidence of preterm birth, increased birth weight, improved weight gain during pregnancy, increased adequacy of prenatal care and greater prenatal knowledge. Maternal satisfaction with group prenatal care was high in all but one study.

Single-payer, health savings accounts, or managed care? Minnesota physicians' perspectives.

The United States is facing a health care crisis with the number of uninsured Americans exceeding 46 million and health care premiums and overall costs increasing at 3 to 4 times the rate of inflation. Proposed solutions include continuing managed care, moving to a single-payer financing system with universal coverage, and replacing traditional health plans with high-deductible policies that allow patients to draw from health savings accounts (HSAs) to pay out-of-pocket costs. Despite physicians' vital role in health care, few studies have assessed their preferences regarding health care financing systems. We surveyed a random sample of licensed Minnesota physicians to determine their preferences regarding health care financing systems. Of 390 physicians, 64% favored a single-payer system, 25% HSAs, and 12% managed care. The majority of physicians (86%) also agreed that it is the responsibility of society, through the government, to ensure that everyone has access to good medical care. Less than half (41%) said that the private insurance industry should continue to play a major role in financing health care. The accumulating knowledge about physicians' preferences for various health care financing mechanisms merits widespread inclusion in policy debates.