The 50th Anniversary of the Implementation of PL 92-603: A Major Change in the Care of Patients with End Stage Kidney Disease.

Fifty years ago, in July 1973, providing care to patients with end stage kidney disease changed dramatically with the implementation of legislation (PL 92-603) that deemed chronic renal disease to be a disability and provided coverage under Medicare for the treatment of the disease. In this article, we discuss the impact of the implementation of PL 92-603.

Impressions of the Nursing Profession Among Nursing Students and New Graduates During the First Wave of COVID-19: A Qualitative Content Analysis.

BACKGROUND: The COVID-19 pandemic has been a defining event for the next generation of the nursing workforce. Complex pandemic practice environments have raised concerns for the preparation and support of novice nurses, even as a multitude of nurses leave the profession. PURPOSE: Researchers sought to examine nursing students' and new graduate nurses' impressions of the nursing profession in contrasting regions of New York State during the first wave of the COVID-19 pandemic. METHODS: Inductive content analysis was performed on narrative text responses (n = 295) drawn from a larger multisite mixed-methods survey. RESULTS: Five subconcepts were abstracted, leading to the main concept of shocked moral distress . CONCLUSION: Nursing students and new graduate nurses have experienced high levels of moral distress but remain committed to the profession. Building moral resilience, fostering ethical decision making, and implementing protective policies can reduce the incidence of moral distress.

The Future Capacity of the Nursing Workforce: COVID-19 Pandemic's Impacts on New Nurses and Nursing Students Toward the Profession.

BACKGROUND: Nurses are concerned for their safety and conflicted about their career, because their duty to care for patients during the pandemic involved competing ethical obligations, including their own personal safety. PURPOSE: The aim was to explore the impact of COVID-19 on new nurses and nursing students in terms of safety and interest in nursing specifically related to self-efficacy, geographic region case density, and frontline experience in health care. METHODS: New nurses and nursing students (N = 472) responded to an online survey examining self-efficacy, sense of safety, and interest in nursing. The survey included an open-ended question to support response interpretation. RESULTS: Researchers identified significant differences among new nurses and students from contrasting case-dense regions in terms of safety and interest in nursing. CONCLUSION: Concerns about personal safety and the safety of others were apparent. Over time, this may lead to a decrease in willingness to enter or remain in the nursing profession.

A review of the literature on family decision-making at end of life precipitating hospital admission.

Around 70% of people would prefer to die at home, yet around 50% die in hospital, according to Dying Matters. In collaboration with a local hospice, a literature review was undertaken to address the question: 'what factors precipitate admission to hospital in the last few days of a person's life for those who had expressed a preference to die at home?' Four electronic databases were searched, with a date range of 2008 to 2018. After 80 articles were screened, 13 were included in the review. The findings identified a number of barriers experienced by people with non-cancer conditions nearing the end of life and their family carers, which inhibit the transition to end-of-life care. The findings suggest that hospice support for non-cancer patients with a deteriorating health trajectory needs to precede patient and family recognition that end-of-life care is needed.

When reach exceeds touch: Student experiences in a cross-sector community-based academic-practice partnership.

OBJECTIVE: A partnership between three nursing programs, multiple high-needs public school districts and a local asthma coalition was developed as a way to build shared capacity aimed at improving health outcomes for children with asthma. This article explores student perceptions of their clinical experiences teaching asthma self-management within a regional cross-sector, community-based, multi-site academic-practice partnership. DESIGN: Nursing faculty from three Long Island, New York-based nursing programs within the partnership jointly created a qualitative focus group methodology to more fully understand the phenomena of interest. A set of open-ended interview questions guided the sessions. SAMPLE: Through purposive sampling, 42 undergraduate nursing students participated in 60-min focus group sessions. MEASUREMENT: Focus group data were transcribed. Content analysis, coding, and theme development was carried out collaboratively. The unit of analysis was the individual participant responses informed by group interaction. A researcher diary was maintained. RESULTS: One overarching theme and three sub-themes emerged from the data, reflecting student understandings in the areas of positioning, professional/personal identity, and social awareness. Ongoing analysis revealed patterns across the data sets linking student learning and the goals, milieu and workings of the partnership. CONCLUSIONS: Findings suggest that the context of a thriving community-based academic-practice partnership, established to improve population health outcomes, offered unique clinical learning opportunities for students through exposure to the values, ideas, and innovation of the partnership itself.

Uncertainties of the heart: palliative care and adult heart failure.

Chronic heart failure (HF) is a growing public health concern in Western nations. Incidence of HF increases with age, and demographics in the United States support a growing HF population. Annually, more than 100,000 people are admitted to hospitals because of HF. Patients with chronic HF experience a highly morbid and life-limiting illness while suffering from substantial physical and psychosocial burdens. What is the state of the science regarding the use of palliative care for community-dwelling adult patients with HF? A review of the scientific literature was conducted using the key words "palliative care" and "heart failure" in several electronic databases (CINAHL, Medline, Proquest) from October 15 to November 15, 2011. Eleven of the 16 articles found indicated that palliative care is underused by HF patients. There is a large unmet care need for adults with chronic HF and their family caregivers. Home healthcare professionals develop and maintain relationships with community-dwelling patients with chronic HF over the course of their HF illness trajectory. Home healthcare professionals are in a unique position to identify HF patients who may benefit from palliative care programs delivered across care settings in the community. By developing ongoing relationships with patients and their family caregivers, we are able to focus on the complete care needs of this patient population and assist them with advanced care planning, psychological and social issues, and symptom management. We can also improve communication among care providers and patients/families to identify goals of care along the trajectory of HF illness.