Ebook Health policy and advanced practice nursing: Part 2
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Ebook Health policy and advanced practice nursing: Part 2
CHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2e death experience over the past 100 years has changed dramatically (Table 18.1). In the early 20th century, generally deaths followed short-term illnesses such as pneumonia, end-stage cancers, strokes, and so on. In the 21st century, those diseases are either cured or controlled for prolonged perio Ebook Health policy and advanced practice nursing: Part 2ds of time.In 1900, the average life span was 48.23 years as compared with 78.3 in 2010, more than a century later (Bakitas et al., 2010; Centers forEbook Health policy and advanced practice nursing: Part 2
Disease Control and Prevention [CDC], 2012a; Infoplease, 2012). Only 4% of Americans in the early 1900s were over 65 years of age (Hoefler, 2010). TodCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2st 100 years (Jackson et al., 2012). Again, in the early 20th century, the dying trajectory was short term following an acute illness. However, in mid-century, a short 50 years later, circumstances changed. With the advent of anti-neoplastics, antimicrobial agents, and technological advances, acute Ebook Health policy and advanced practice nursing: Part 2illnesses were treatable and life-threatening illnesses could be ameliorated. Many life-threatening acute illnesses became chronic in nature and AmeriEbook Health policy and advanced practice nursing: Part 2
cans began to believe most diseases could be cured or at least controlled for long periods. The extended life span in the 21st century has confirmed tCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2nd the dying process became protracted. Physicians who had taken the Hippocratic Oath sought to prolong life and family members became death-denying by urging the medical staff to try "one more'" approach. Dying with dignity became an unfulfilled wish. In its place was isolation, pain, and suffering Ebook Health policy and advanced practice nursing: Part 2.Today, more than 2.5 million people die in the United States annually (CDC, 2012b). Most of these deaths are caused by heart disease, cancer, cerebroEbook Health policy and advanced practice nursing: Part 2
vascular diseases, pulmonary diseases, and renal syndromes. Providing quality end-of-life care is a huge challenge given the many variations of diseasCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2AL POPULATIONSTABLE 18.1 Changes in Death Processes in the Last 100 YearsCRITERIA19002010Average life expectancy48.23 years78.3 yearsPlace of deathMajority at homeMajority at hospitalFamily acceptanceOpenly discussedDeath-denying societyExpenses paid byFamilyMedicareDisease trajectory prior to death Ebook Health policy and advanced practice nursing: Part 2Acute—short termChronic—long termpalliative care services begin at the time of diagnosis and include hospice care over the final 6 months for every onEbook Health policy and advanced practice nursing: Part 2
e of the 2.5 million people is the goal of the palliative care health care professionals.DRIVING FORCESChanges in the way Americans view end-of-life cCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2 influences. Let us begin with why Americans are a death-denying society. Technology has driven this sociological change. Americans have witnessed an explosion of technology and advanced treatment modalities. With the development of automatic implantable cardiac defibrillators (AICDs), the perfectio Ebook Health policy and advanced practice nursing: Part 2n of transplantation of organs and bone marrow, the advancements in surgical procedures through robotics, as well as the advancement of genomics, AmerEbook Health policy and advanced practice nursing: Part 2
icans believe any disease can be cured and life can be prolonged hopefully indefinitely. Just look at the statistics describing the number of people lCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2amily value changes are evidenced by egocentricity, belief of the rights of individuals, an educated society, and family advocacy. Again, technological advances through social media, the internet, global communication, and natural inquisitiveness drive the individual to demand a certain level of exp Ebook Health policy and advanced practice nursing: Part 2ectation of medical treatment regardless of cost.The financial impact of this level of care is driving our country into an extreme debt. In 2012, healEbook Health policy and advanced practice nursing: Part 2
th care in the United States was 17.3% of the gross national product. This level of cost is unsustainable. If unchecked, the rates are projected to inCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2e end-of-life care only slightly ahead of Hungary and Poland. In terms of funding palliative/end-of-life care, the United States ranked 31st of 40 (Hoefler, 2010). One analyst in the EIU report commented about the United States saying it is "the epicenter for the technologies that allow us to keep p Ebook Health policy and advanced practice nursing: Part 2eople alive for 60 additional days with no improvement in outcome but with substantial increase in costs" (Hoefler, 2010). The Hospice Medicare BenefiEbook Health policy and advanced practice nursing: Part 2
ts (HMBs) spending in 2007 for an average of 67 days per patient was more than $10 billion. Only 1.2 million Americans received hospice care in 2008, CHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2olating from this, if all dying Americans received end-of-life care, the costs would quadruple. Ironically, studies have demonstrated that cost savings of nearly $1,700 per admission for live discharges and $5,000 per admission for patients who died can be realized through hospital-based18: HEALTH P Ebook Health policy and advanced practice nursing: Part 2OLICY IMPLICATIONS FOR APRNs RELATED TO END OF-LIFE CARE 217 palliative care teams who through advance care planning (ACP) allow the patient to shiftEbook Health policy and advanced practice nursing: Part 2
the chosen course of care (Morrison et al., 2008). For an average 400 bed hospital, these savings translate to nearly $1.3 million net savings per yeaCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2pital beds and physicians there an? per patient population can directly influence whether patients are admitted to hospitals to die or are cared for al home (Meier & Beresford, 2008a). 1 or example, statistics of those dying in hospitals in rural areas of the Western and Northwestern states were low Ebook Health policy and advanced practice nursing: Part 2er as compared with Southern and Eastern states where large urban medical centers were easily accessible (Giovanni, 2012; Sherman &. Cheon, 2012).TheEbook Health policy and advanced practice nursing: Part 2
political environment has also negatively influenced end-of-life care in the United States. Understandably, as legislators and their aides are represeCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2Affordable Care Act (PPACA) recommended reimbursement for advance care planning, adversaries interpreted this recommendation as rationing care and the language was removed from the final document (Giovanni, 2012; Zeytinoglu, 2011). The positive impact on quality of end-of-life care is directly depen Ebook Health policy and advanced practice nursing: Part 2dent on having the conversations with the patient, their family, and the legislators who create laws that determine the right to have lifesaving or enEbook Health policy and advanced practice nursing: Part 2
ding treatment. Removing the incentives to do so, negatively impacts the outcomes of care—physically, psychosocially, and economically.NEED FOR POLICYCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2e. According to the Approaching Death: Improving Care at the End-of-Life report written by a panel from the Institutes of Medicine in 2007, "...people have come both to fear a technologically over-treated and protracted death and to dread the prospect of abandonment and untreated physical and emotio Ebook Health policy and advanced practice nursing: Part 2nal distress" (Zeytinoglu, 2011).Several studies have suggested that patients and families believe end-of-life care is inadequate (Giovanni, 2012; I TEbook Health policy and advanced practice nursing: Part 2
oefler, 2010; Jackson et al., 2012; Morrison et al., 2011; Pace &. Lunsford, 2011; Sherman & Cheon, 2012). Access alone is a major problem. Millions oCHAPTER18Health Policy Implications for Advanced Practice Registered Nurses Related to End-of-Life CareJudy LentzThe process of dying and the ultimate Ebook Health policy and advanced practice nursing: Part 2mber of programs over the past decade. According to the 2008 Center to Advance Palliative Care (CAPO Report card and consistent in 2011, 85% of large hospitals with 300 or more beds have a palliative care team (Morrison el al., 2011). Palliative care is most prevalent in the Northeast and lowest in Ebook Health policy and advanced practice nursing: Part 2the South (Morrison el al., 2011). The overall grade for palliative care across the nation improved from a c in 2008 to a B in 2011 (Morrison et al.,Ebook Health policy and advanced practice nursing: Part 2
2011). Only two states received failing grades—Mississippi and Delaware. More than 50% of the states received As or Bs (Morrison et al., 2011).Just asGọi ngay
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