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NUR 740 Discussion 9.1: Contemporary Health Policy Project: Policy Reform Rationale

The healthcare policy reform I chose was Roe v. Wade. Recent U.S. Supreme Court documents were released threatening to overturn the law that protects a women’s right to choose an abortion. My reform focus was keeping Roe v. Wade in place, but also expanding the law to make abortion even more accessible to women. Abortion can be completed through medication management or a surgical procedure. Medical abortions can be performed up to nine weeks through prescription medications called misoprostol and mifepristone. 91.6% of abortions occur during the first twelve weeks of pregnancy, also known as the first trimester (Zolot, 2018). State laws currently restrict what providers can participate in abortion care. My healthcare policy aims to expand abortion care to a wider range of medical providers including advanced practice nurses (APNs). Another way my healthcare reform policy aims to support abortion access is through telemedicine options. The COVID-19 pandemic changed the way we practice healthcare and demonstrated creative ways to reach patients. My healthcare policy also works to incorporate telemedicine options in abortion care. Telemedicine can help women without a nearby practitioner still receive their desired care.
Advanced practice nurses (APNs) are within their scope of practice when prescribing and managing medications. My healthcare policy would provide APNs the federal right to provide prescription abortion care to patients. My policy reform would strive to make APNs an integrated and standardized team member for abortion care throughout the United States. Kristiansen et al. (2021) studied the medical management of abortions throughout low- and middle-income countries was as effective when provided by non-physician practitioners. There are currently some states that give APNs autonomy for procedural abortions as well. Distance to a provider was the top reason for choosing a specific abortion clinic (Fuentes & Jerman, 2019). Rural or low-income areas may not have access to an abundance of physician providers. Many of these areas have APNs or physician assistants (PAs) as the most advanced provider in the practice. What are some educational frameworks or training methods that can be implemented to make APNs more comfortable providing medical abortions, are there any limitations you would recommend? 
 

My healthcare policy reform also focused on taking advantage of recent changes to prescription laws driven by the COVID-19 pandemic. The Food and Drug Administration (FDA) no longer requires in-person appointments before receiving a medical abortion (Godfrey et al., 2021). Telehealth is a viable option moving forward for some aspects of abortion care. As previously mentioned, distance can delay or prolong abortion care due to lack of nearby providers. Telemedicine gives the patient options to a wider range of providers and a more convenient way to access them. Roberts et al. (2021) found abortions decreased by 31% during the height of the pandemic when access was restricted; however, the number of second trimester abortions increased. Medical abortions completed during the first trimester carry lower risk versus more invasive procedural abortions. What are some ways to incorporate successful telemedicine communication in a practice? 

References
Godfrey, E. M., Fiastro, A. E., Jacob-Files, E. A., Coeytaux, F. M., Wells, E. S., Ruben, M. R., Sanan, S. S., & Bennett, I. M. (2021). Factors associated with successful implementation of telehealth abortion in 4 United States clinical practice settings. Contraception104(1), 82–91. https://doi.org/10.1016/j.contraception.2021.04.021 (Links to an external site.)

Fuentes, L., & Jerman, J. (2019). Distance traveled to obtain clinical abortion care in the united states and reasons for clinic choice. Journal of Women’s Health28(12), 1623–1631. https://doi.org/10.1089/jwh.2018.7496

Kristiansen, M. B., Shayo, B. C., Philemon, R., Khan, K. S., Rasch, V., & Linde, D. S. (2021). Medical management of induced and incomplete first‐trimester abortion by non‐physicians in low‐ and middle‐income countries: A systematic review and meta‐analysis of randomized controlled trials. Acta Obstetricia et Gynecologica Scandinavica100(4), 718–726. https://doi.org/10.1111/aogs.14134 (Links to an external site.)
Roberts, S. C. M., Berglas, N. F., Schroeder, R., Lingwall, M., Grossman, D., & White, K. (2021). Disruptions to abortion care in Louisiana during early months of the COVID-19 pandemic. American Journal of Public Health111(8), 1504–1512. https://doi.org/10.2105/ajph.2021.306284 (Links to an external site.)
Zolot, Joan. (2018). The Safety and Quality of Abortions in the United States. AJN, American Journal of Nursing, 118, 16. https://doi.org/10.1097/01.NAJ.0000534835.10728.dc

Hello Skylar

Despite the emerging controversies in relation to the issue of abortion right/policy, it is apprehensible that the Advanced Practicing Nurses (APNs) and other nursing taskforce are mandated to foster specific policies that endeavors to protect the rights of their patients. In this perspective, I concur with you regarding the need for the implementation of policy reform to extend complete abortion rights, especially to women. While the currently adopted Roe v. Wade act accords specific abortion rights to women, it is worth noting that the policy remains a subject of contention among different groups of stakeholders, including the Pro-choice and Pro-life. From this perspective, it would be logical to review the ANA’s specifications regarding the involvement of nursing practitioners in such a relatively controversial or ethical health concern as the right to abortion. Precisely, can you inquire about ANA’s Code of Ethics with Interpretative Statements indications regarding nurses’ standpoints or advocating for policy reforms in relation to ethical health topics? ANA’s Code of Ethics normally discourages nurses from engaging in such contentious bioethical health subjects (Olson & Stokes, 2016).

 

Olson, L. L., & Stokes, F. (2016). The ANA code of ethics for nurses with interpretive statements: Resource for nursing regulation. Journal of Nursing Regulation7(2), 9-20.

Hi Romina,
I agree as advanced practice nurses (APNs) it is part of our responsibility as providers to protect the interests of our patients. It can be difficult to protect the patient when outside organizations are attempting to influence patient care. Abortion should be a decision between a woman and their healthcare provider. When exploring the American Nurses Association’s (ANA) Code of Ethics, I found evidence to support nurses advocating for ethical practice. The ANA concurs all nurses have a right to practice in an ethical environment and should take steps to ensure their practice is ethical for nurses and patients alike (ANA Center for Ethics and Human Rights, 2021).
References

ANA Center for Ethics and Human Rights. (2021). Nurses’ professional responsibility to promote ethical practice environments. American Nurses Association. https://www.nursingworld.org/~4ab6e6/globalassets/practiceandpolicy/nursing-excellence/ana-position-statements/nursing-practice/nurses-professional-responsibility-to-promote-ethical-practice-environments-2021-final.pdf

Skylar,

Although abortion is one of the most common surgical procedures performed in the United States, the number of abortion providers is declining (Watson, 2019). Advanced practice clinicians, including nurse practitioners and certified nurse‐midwives, may help to alleviate this shortage. However, some states bar non-physicians from performing abortions. Not only should training in abortion techniques be made available to non-physician providers who desire it, but legal obstacles must also be overcome in order to allow advanced practice clinicians the right to provide abortion services (Watson, 2019).

Telehealth is changing how people around the world access health-related information and services. In the United States, where access to abortion is highly politicized and varies from state to state, telehealth provision of abortion has improved access to care in some states (Fiastro et.al., 2022). Yet federal and state restrictions limit whether and how patients can use this type of care. Lifting these restrictions could expand abortion access to new and underserved communities. It could also allow for the growth of additional telehealth models that offer increased convenience, flexibility and privacy (Fiastro et.al., 2022).

References

Fiastro, A., Godfrey, E., & Bennett, I. (2022). Successful implementation and operation of innovative telehealth medication abortion services in primary care settings. Women’s Health. https://doi.org/10.1370/afm.20.s1.3000

Watson, M. (2019). Should APNS perform abortion services? The Journal for Nurse Practitioners, 2(6), 388–389. https://doi.org/10.1016/j.nurpra.2006.04.007

I agree with you that medical abortions can be completed through medical management. Similarly, surgical procedures can be alternative for safe medical abortion. Unfortunately, religious institutions have shown their displeasure towards the call of legalizing abortion in some regions and government (Sheraton et al., 2020). Roe v. Wade was a threat to women’s rights in choosing an abortion. Different laws allow women to have decision before having medical or surgical abortion. State laws have shown dilemma as other state laws recognize abortion as women’s rights whereas other authorities have criminalized abortion. However, the COVID-19 pandemic transformed healthcare practice. Due to limited pharmaceutical resources states are compelled to work together (Sutton & Vacarezza, 2020). The purpose for unity enabled states to have similar laws. Common laws allow states to pool together pharmaceutical resources. Limited time to replace for the pandemic creates room for multiple reliable collaborations. The transformed healthcare delivery has somehow improved patient experience.

References

Sheraton, M., Deo, N., Dutt, T., Surani, S., Hall-Flavin, D., & Kashyap, R. (2020). Psychological effects of the COVID 19 pandemic on healthcare workers globally: A systematic review. Psychiatry research292, 113360. https://doi.org/10.1016/j.psychres.2020.113360 (Links to an external site.)

Sutton, B., & Vacarezza, N. L. (2020). Abortion rights in images: Visual interventions by activist organizations in Argentina. Signs: Journal of Women in Culture and Society45(3), 731-757. Article DOI https://doi.org/10.1086/706489

A Change is Needed in Healthcare

Poor psychological well-being has been a long standing epidemic among healthcare workers, and the COVID-19 pandemic heightened the risk factors for anxiety, depression, burnout, and suicide (American Federation of State, County, and Municipal Employees [AFSCME], 2022). These symptoms and risk factors have drastically exacerbated the persistent and ever growing nursing shortage in the United States, while losing 20% of the medical field workforce during the onset of the COVID-19 pandemic (Ollove, 2022). A study from The American Association of Colleges of Nursing, shows nearly 1500 unfilled nurse instructor positions in the United States, and more than 66,000 people who applied for Bachelors of Science in Nursing (BSN) degrees were denied due to lack of adequate clinical sites (American Association of Colleges of Nursing [AACN], 2021). Similarly, it is projected that there will be a deficit of over three million healthcare employees of lesser compensating positions within the next five years, and nearly 140,000 open physician roles by 2033 (U.S. Department of Health and Human Services [USDHHS], 2022).

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NUR 740 Discussion 9.1: Contemporary Health Policy Project: Policy Reform Rationale

NUR 740 Discussion 9.1: Contemporary Health Policy Project: Policy Reform Rationale

The current and predicted healthcare worker shortage, coupled with the heightened risk of anxiety, depression, burnout, and suicide; without intervention of the core issues resulting in the healthcare shortage, an enormous depletion of healthcare workers will debilitate our entire healthcare system (American Federation of State, County, and Municipal Employees [AFSCME], 2022). Healthcare workers are at a profoundly heightened risk for poor mental health, because they are constantly surrounded by traumatic situations and death, long shifts of overwhelming stress and high patient-staff ratios, being consistently exposed to diseases and illnesses, sometimes without proper personal protective equipment, being sandwiched between healthcare organization’s demands of cost cutting techniques and providing the best possible medical care to their patients, workplace violence and bullying, and feelings of inadequacy and helplessness (AFSCME, 2022).

The COVID-19 pandemic dramatically increased the symptoms of poor mental health for healthcare workers; with the National Academies of Medicine reporting over half of the nation’s healthcare workers experiencing anxiety, depression and/ or Post Traumatic Stress Syndrome at the end of 2020 (USDHHS, 2022).

Tiesman et al. (2021) reported, at the end of 2020, over 90% of the nation’s medical field workforce were reporting overwhelming stress, and more than 75% were exhibiting symptoms of anxiety, frustration, exhaustion, and burnout.  A study conducted by (The Physician’s Foundation [TPF], (2021), reveals that a relatively high percentage of American physicians have either attempted suicide or know another physician who has, and a fair number admit to using alcohol and/or illicit drugs in an attempt to cope with work related stress. With such a high percentage of healthcare workers reporting suffering from at least one mental health issue, only 15% have sought out help (TPF, 2021). There is still a very strong stigmatization surrounding mental health issues, and often being witnessed showing emotions can result in peer bullying.(Tiesman et al., 2021). Poor mental health in healthcare workers only accelerates the already dire shortage of medical field staff. The environment of healthcare has had a long history of bullying new, or young, healthcare workers, or simply not being helpful and or supportive in a new healthcare role. This creates ample amounts of unnecessary stress and anxiety, only creating more strain to the healthcare shortage (Tiesman et al., 2021).

Without policy reform, and changes in the healthcare environment (eliminate bullying, and provide more managerial and peer support) and challenging other reasons the shortage exists; there will not be adequate healthcare staff to care for the general public and patients will be forced to travel significant distances for medical treatment, making emergency situations much more dire and resulting in an elevated mortality rate nationwide (Tiesman et al., 2021). Healthcare organizations and policy makers must devise a solid and realistic plan to make healthcare careers more enticing to heed the shortage; safe and fair staffing ratios, appropriate time off, pay increases, and sign-on bonuses are all examples of possible enticements for new nurses. (Tiesman et al., 2021). Recruiting new healthcare workers would aid in narrowing the medical professional shortage. Nurses should be a part of the group involved in the improvement processes, workflows, and organizational cultures, because they can offer unique perspectives (Tiesman et al., 2021). While the COVID-19 pandemic swiftly increased the levels of anxiety, depression, burnout and suicide, it also brought the attention of the general public and members of the United States legislation, who actually have the power to pass laws concerning healthcare workers. Following the COVID-19 pandemic, The U.S. Surgeon’s General aided in writing a 2022 advisory on the topic of interventions to help combat burnout in healthcare workers (AFSCME, 2022).

In March of 2022, The Lorna Breen Healthcare Provider Protection Act (LBHPPA) was implemented in an attempt to immediately begin measures to create a more healthy work environment for healthcare workers across the nation (Harmon, 2022). The LBHPPA is described by Harmon (2022), as a 17 level program to creating a stronger healthcare system, while bringing to light the factors that contribute to increased amounts of stress and burnout, including highlighting the burden of time consuming federal regulations, and insurance documentation (Harmon, 2022). The policy immediately began taking steps to remove lifetime mental health questions from state licensing boards, and removing any repercussions or denials into programs based on psychological well-being (Harmon, 2022).

Where did you work during the pandemic? How did it effect you? Did you experience any symptoms of anxiety, depression, burnout, or suicidal ideations? What did you experience, or observe other healthcare workers experiencing? Did you think about leaving your position, or healthcare altogether? How is the Lorna Breen Healthcare Provider Protection Act important to you?

One of the  implementations of the Lorna Breen Healthcare Provider Protection Act is to have nurses be more involved in decision making, (Harmon, 2022). Do you have any ideas of how to slow the progression of the current healthcare professional shortage? How can we can create a way to create an interest in healthcare for the next generation? How would you go about implementing your strategies?

 

                                                               References

American Association of Colleges of Nursing, (2021, August 17). Data spotlight: insights on the nursing faculty shortage.  https://www.aacnnursing.org/News-Information/News/View/ArticleId/25043/data-spotlight-august-2021-Nursing-Faculty Shortage#:~:text=However%2C%20United%20States%20is,1%2C492%vacant%20positions%202020

American Federation of State, County, and Municipal Employees, (2022, June 13). A union voice can help address burnout among healthcare workers nationwide. AFSCME. https://www.afscme.org/blog/a-union-voice-can-help-address-burnout-among-health- care-workers-nationwide#maincontent

Harmon, G. E., (2022, March 25). How we can honor the legacy and memory of Dr. Lorna Breen. American medical association. https://www.amaassn.org/practicemanagement/physician-health/how-we-can-honor-legacy-and-memory-dr-lorna-breen

Ollove, M., (2022, March 25). Healthcare shortage forces states to scramble. Stateline article. https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2022/03/25/health-worker-shortage-forces-states-to-scramble

The Physician’s Foundation. (2021). 2021 survey of America’s physicians COVID-19 impact edition: a year later a survey examining how the coronavirus affected the nation’s physicians. https://physiciansfoundation.org/wpcontent/uploads/2021/08/2021-Survey-Of-Americas-Physicians-Covid-19-Impact-Edition-A-Year-Later.pdf

Tiesman, H., Weissman, D., Stone, D., Quinlan, K., Chosewood, C., (2021, September 17). Suicide prevention for healthcare workers. Centers for Disease Control and Prevention. https://blogs.cdc.gov/niosh-science-blog/2021/09/17/suicide-prevention-hc

U.S. Department of Health and Human Services. (2022, May 23). New surgeon general advisory sounds alarm on health worker burnout and resignation. https://www.hhs.gov/about/news/2022/05/23/new-surgeon-general-advisory-sounds-alarm-on-health-worker-burnout-and-resignation.html#main-content

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