Page 246 - Encyclopedia of Nursing Research

HeAlTH pOlIcy AND HeAlTH SerVIce DelIVery n 213

episode of care as the time period starting interventions and services that focus on the
3 days before hospital admission and end- patient’s behavioral change.
ing 30 days after discharge, but the Secretary Nurse researchers are also building evi- H
of the U.S. Department of Hunan Services dence to address human resources issues
has an option to change the time period for that impact health service delivery. evidence
the pilot program. Services provided dur- is critical for planning educational needs. We
ing an episode of care include primary care must be able to predict how many nurse edu-
providers, hospitals, outpatient hospital ser- cators and the competencies nurses will need
vices, emergency room services, postacute to address the variety of patient problems the
care services, and others as identified by the type of nursing services that will be needed
Secretary (Berenson & Zuckerman, 2010). In with health care reform and care delivery
preparation for this change in public pol- models that will result in high-quality, effi-
icy, hospitals are restructuring their health cient, cost-effective care. currently, there is
delivery models. They are integrating pri- significant evidence as to the work environ-
mary care providers into their systems and ment characteristics that enable nurses to
initiating use of electronic medical records. deliver high-quality patient care in hospitals,
Medical homes are also emerging as a model but evidence is sorely lacking in settings such
for health service delivery. This model uses a as home health, long-term care, and public
team of providers to provide comprehensive, health.
coordinated care that fosters a collaborative To produce evidence that will be
provider–patient relationship. It supports accepted by policy makers and be sustain-
patient outreach and education, especially able, nurse researchers are using a variety of
for patients with chronic conditions. research methods, including nontraditional
Some of the changes proposed in this methods such as s action research and com-
legislation have occurred because of the evi- parative effectiveness. Stringer (2007) defines
dence provided by nurse researchers and action research as “a collaborative approach
others on the value of prevention and health to inquiry or investigation that provides peo-
promotion. Nurse researchers have provided ple with the means to take systematic action
evidence on the effectiveness of nurse practi- to resolve specific problems” (p. 8). Action
tioners as primary care providers and coordi- research can be community-based and
nators of care. They have contributed to the starts with an interest or problem identified
body of knowledge on underuse of health by a group, community, or organizations.
services by people with lower incomes, lack Findings may indicate a need for policy
of health insurance, and gender and racial changes, which are more apt to be accepted
differences. Some of this work has lead to a and sustained if the there is collaboration
better understanding as to why health ser- among stakeholders from the inception of the
vices are not used appropriately by specific problem. comparative-effectiveness research
groups of people. Moreover, findings from can provide evidence on the effectiveness
studies conducted by nurse researchers pro- and benefits of health services. evidence can
vide evidence of effective interventions for be found through systematic reviews or spe-
patients with chronic diseases, which are of cific studies (Agency for Healthcare policy
high concern to policy makers. Almost 75% and research, 1998).
of U.S. health care dollars spent each year The nurse researchers’ ability to effect
is on four chronic diseases: obesity, type 2 change may be challenging. Inhibiting
diabetes, heart disease, and cancer. Nurses change factors include the policy maker’s
are contributing to the evidence that these lack of skills and knowledge, poor timing,
chronic diseases can be prevented, delayed, lack of perceived relevance, use of jargon,
or alleviated and are building evidence-based and only presenting and publishing findings