No abstract

Original Medicare produced an increased index of suspicion regarding health costs in 1965. As services expanded, costs escalated. Policy makers moved to control upward spending trends in an attempt to leverage resources across the population. Changes in reimbursement accompanied by the expansion of levels of care during an episode of illness caused stakeholders to carefully analyze value based opportunities. The groundbreaking Patient Protection and Affordable Care Act (ACA) compels nurses to continue innovation, transformational leadership, and care coordination as major stakeholders in provision of the next generation of cost containment, quality advances, and patient access improvements. This article discusses the nurse impact on national health cost reduction, value based healthcare reimbursement, and opportunities for nurses to impact healthcare quality. In addition, we consider the nurse impact on healthcare quality and access to care, as well as continued opportunities for nurses to impact access and lead change.

Objectives Final conversations (FCs) go beyond how patients want to be cared for at the end of life (EOL) and focus on messages of love, identity specific, and unique to an individual and relationship that requires self-examination, everyday talk that normalizes a difficult situation, religious/spiritual messages, and if needed, difficult relationship talk to heal broken relationships. The purpose of the Catalyzing Relationships at the End of Life (CAREol) program was to provide interdisciplinary education to nursing and medical students and clinical faculty about facilitating FCs among patients and families. Method This two-part, quasi-experimental program consisted of a cognitive (online) and experiential (live simulation) curriculum experience. Program curriculum, including video vignettes, readings, and live simulation (utilizing actors), was developed by the study team. Reflective journaling and researcher designed pre- and post-tests were used to assess comfort, confidence, importance, and distress regarding FCs and collaboration with other disciplines. Results The pre-/post-test questions demonstrate statistical significance based on a paired t-test with effect sizes supporting the practical importance of the findings for effect size. Preliminary content and thematic analysis of qualitative responses describe categories of the mock team meeting experience and interaction with the actors to change patient and family outcomes. Significance of results Early intervention with the CAREol program provides a framework to help students and clinical faculty facilitate FCs that may result in peace and comfort for patients and families during a difficult time.

Although the art and science of nursing both complement nursing practice, the science aspect is most often emphasized. The art of practice, however, may best capture the essence of nursing. To recognize the 50th anniversary of a college of nursing, faculty, staff, and alumni participated in creation of a community poem, entitled “Some Days.” As the COVID-19 pandemic brought public awareness to the contributions of nurses, the art of nursing was evident in the many ways that nurses cared for both patients and families. The reflective process took on new meaning, celebrating nurses with poetry and giving voice to the emotional demands of nursing. In this article, we offer a brief historical overview of the art and science of nursing, and discuss the collaborative process that led to the creation of the poem and its installation as a public work of art. This collective poem weaves together the reflections of many individuals, unveils raw emotions, and provides a deeper understanding of meaningful connections between patients and nurses through the powerful imagery of poetry. In our conclusion, readers are invited to read the poem, “Some Days,” and share their passion for nursing by adding to this open community poem that celebrates the unique work of nurses.

The Patient Protection and Affordable Care Act (ACA) (Patient Protection Affordable Care Act, 2010) remains law in the United States despite challenges and politically charged debate about its purpose in healthcare. Most agree the top three problematic areas in US healthcare are high cost, access, and equity (Kimberlin, 2022; National Academies of Sciences, Engineering and Medicine [NASEM], 2021; Ritz, 2016; Kaiser Family Foundation [KFF], 2013). The ACA aims to address these issues in complex and varied ways. Nurses can capitalize on the purpose of the ACA to leverage their power to improve quality, create efficient delivery systems, and pioneer innovations in healthcare while advocating for equity for patients (Cleveland et al., 2019). The purpose of this article is to discuss how nurses are powerfully addressing issues of cost, quality, and equitable care, pioneering the future of patient centered care, and preparing the workforce to meet the challenges brought about by the financial, political, and structural challenges 12 years after the ACA.