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新冠疫情中约翰霍普金斯大学提出美国护理领域的最新变化

  • 责任编辑:siyu.zhang
  • 来源:互联网
  • 时间:2020-10-20 17:14:33

  新冠疫情给大家的生活带来了很多变化,一起和天道小编看看新冠病毒病例的最新情况,希望大家多多关注约翰霍普金斯大学的最新研究。

  新冠疫情为护理职业带来了几十年的变化

  冠状病毒大流行已经改变了护理领域,许多倡导者认为现在是一个成败攸关的时刻,需要推动更持久的改变

  凯蒂·皮尔斯20小时前出版

  今年3月,当第一波新冠病毒病例席卷美国时,临床护理专家帕奇(Michelle Patch)正在转换为约翰霍普金斯护理学院(Johns Hopkins School of Nursing)的全职教师。她突然转变了立场,加入了约翰·霍普金斯医学院(Johns Hopkins Medicine)的流行病应对中心,担任统一指挥中心的行动主管。整个春天和夏天,她和一个团队一起解决后勤难题,比如如何在整个机构平均分配个人防护装备。

  “这需要不断的操纵和很大的压力,”帕奇说。“还有那种个人责任感。”

  这是护理领域变革的时代。虽然大流行病已经改变了卫生保健的几乎所有方面,但对护理的影响可能最为深远,因为护士占该行业劳动力的80%,而且对其技能的需求正处于高峰。

  约翰霍普金斯大学护理学院院长帕特里夏·戴维森说:“在有关卫生保健的讨论中,护士往往是隐形的,但COVID-19大流行暴露了护士无可争议的需求。”她说,很明显,“护士提供了大部分的护理,并承担了随之而来的全球健康危机的首当其冲的危险。”

  最重要的是,大流行病需要灵活性。随着患者数量的增加和医院的紧张,许多护士直接走上了应对COVID-19疫情的第一线,或转移工作岗位去填补疫情造成的其他空缺,她们往往工作时间更长、无法预测。在某些情况下,护士已经跨越州界提供护理,而退休的护士已经重返工作岗位。为了使其效用最大化,监管层面的一些变化是必要的,为护士消除长期以来在模式和执业范围上的障碍。

  远程医疗革命

  对护士来说,迅速采用远程医疗技术——在联邦政府放松隐私和收费限制的帮助下——是在COVID-19期间安全、有效地为患者提供服务的必要改变。

  亚历山德拉莫雷尔,护士经理学生健康和保健中心JHU第1版的校园,说诊所主要转移到远程医疗在春天来帮助学生仍在巴尔的摩大学后转换到远程教学和支持那些允许马里兰州的州任命。

  这种转变“一开始有点困难,要学习所有的细微差别和最好的练习方法,”Morrel说,她的工作变成了“几乎完全的管理”,为诊所配置工作流程。

  虽然现在面对面预约的数量在增加,但有些情况需要这样做。morrel公司发现,像例行检查和随访这样的服务很自然地有利于远程医疗,节省了时间,增加了就诊机会。

  在大流行之前,执业护士Jason Farley正在着手约翰霍普金斯大学批准的第一项完全基于远程医疗的研究,评估包括艾滋病毒/艾滋病在内的性传播疾病的居家治疗。他说,当时,远程护理的概念似乎很前卫。

  法利说:“我们真的在挑战极限。”他说,他的传染病业务现在90%都是远程医疗。

  戴维森认为,远程医疗扩张的潜力多年来一直很明显,但直到一场大流行才打破了对它的抵制。她说:“远程医疗的普及是一线希望,短短几个月的时间里,它有可能推动我们向前发展几十年。”

  权限的问题

  其他监管障碍也被置于显微镜之下,包括规定高级执业护士(包括执业护士和临床护理专家在内的受过研究生教育的护士)工作范围的法律。

  在约翰·霍普金斯大学,戴维森领导了一项名为“ItCantWait”的运动,倡导赋予护士以充分的训练和技能进行实践。

  就执业护士而言,这意味着在没有医生监督的情况下享有“完全执业权”。在这一权威之下——目前在22个州和华盛顿被允许——护士从业人员有自主权来诊断病人,命令和解释测试,管理治疗,包括开受控物质的处方。在其他州,类似于医生许可的东西对一些这样的行为是必要的。

  今年春天,美国护士从业人员协会(American Association for Nurse Practitioners)和美国卫生与公众服务部(Health and Human Services)部长亚历克斯·阿扎(Alex Azar)也发出了类似的呼吁。他们的目标都是一样的:提高护士的灵活性,以应对国家的健康危机。

  “我可以自信地说,现在全世界都在看着我们。作为护士,我们必须抓住这个机会,倡导我们的职业,保护我们所服务的人群。”

  帕特里夏·戴维森

  根据AANP的说法,在流感大流行期间,五个州暂时中止了现有的执业协议,而其他州则调整了限制或允许行政命令过期,以赋予护士更多的权力。其他州还没有采取行动。

  众说纷纭的反应反映了全国在这个问题上的不和谐。在COVID-19出现之前,这是卫生保健政策辩论中的一个有争议的话题。但一些护理倡导者认为,现在是一个成败攸关的时刻,他们需要推动更持久的改变。

  戴维森说:“我可以自信地说,现在全世界都在关注我们。”“作为护士,我们必须抓住这个机会,倡导我们的职业,保护我们所服务的人群。”

  在最近的记忆中,卡特里娜飓风和桑迪飓风同样突出了阻碍护士达到其训练水平的障碍。据约翰·霍普金斯·凯里商学院(Johns Hopkins Carey Business School)管理学副教授罗曼·加尔佩林(Roman Galperin)说,上世纪90年代克林顿总统的医疗改革以及奥巴马医改的推行,“被大肆宣传的医生短缺”,也带来了护理领域的变化。

  “争论的本质是一样的,”加尔佩林说。“护理行业的反应是:‘我们在这里,我们有技能,但我们没有权利。’”

  持久的争论

  然而,护理实践范围的改变在政治上可能是敏感的,因为主要的医学协会和州委员会经常倾向于维持现状。

  Galperin研究了零售诊所(如紧急护理中心和药店诊所)中护士从业人员的崛起,他说:“我看到了反对给予护士从业人员自主权的强有力的论据,通常以安全、缺乏专业知识和培训为理由。”

  扩大护理权威的倡导者认为,这种抵制根植于对护理的过时观念,以及区分护士和医生角色的愿望。

  加尔佩林说:“在一般的文化中,人们会认为护士不太专业。”不过,这种对护士的看法通常与“她们的实际技能”并不相关。

  法利说,这个问题通常归结为“在州一级为获得病人而进行的地盘争夺战”,而安全方面的担忧并没有被证明是有效的。他说:“根据我所见和了解的情况,没有科学证据表明护理质量会受到护理从业人员的负面影响。”

  帕奇说,像她这样的临床护士专家——这个角色与执业护士有相同的特点,但更注重推广和教育——一直在进行着同样的斗争,包括游说获得在没有医生监督的情况下开具处方的权利。在大流行病中,当资源不足时,这种灵活性可能至关重要。派奇说,同事们分享着他们的故事,讲述了他们为了对原本可以自己完成的医嘱进行细微调整而浪费时间追踪忙碌的医生。

  “COVID-19让人们认识到,[赋予护士权力]可以帮助病人、家庭,也可以帮助与我们合作的医生,”帕奇说。

  帕奇还认为,COVID-19肯定了护士在紧急情况中发挥的重要作用,从而提升了护理专业水平,她希望看到持久的进步。

  她说:“至少,这有助于突出我们独特的技能和灵活性。”

  发表在健康,声音+意见,政治+社会

  标签护理,护理学院,冠状病毒,covid-19

  附上原文,以供参考,拒绝转载,侵权必删:

  COVID-19 USHERS IN DECADES OF CHANGE FOR NURSING PROFESSION

  The coronavirus pandemic has transformed the nursing field, and many advocates view the present as a make-or-break moment to press for more lasting change

  Katie Pearce / Published 20 hours ago

  As the first waves of coronavirus cases swept across the U.S. in March, clinical nurse specialist Michelle Patch was transitioning into a full-time faculty role at the Johns Hopkins School of Nursing. She abruptly pivoted, joining the core of Johns Hopkins Medicine's pandemic response as an operations chief of its unified command center. Through spring and summer, she worked on a team to untangle a knot of logistical puzzles, like how to allocate personal protective equipment evenly across the institution.

  "It was constant maneuvering and a lot of stress," Patch says. "And that feeling of personal responsibility."

  This is a transformational time for the field of nursing. While the pandemic has rearranged nearly every aspect of health care, the impacts on nursing may be the most profound—given that nurses represent 80% of the industry's workforce, and demand for their skills is at a peak.

  "Often nurses are invisible in the discussion of health care, but the COVID-19 pandemic has brought to light the indisputable need for nurses," says Patricia Davidson, dean of the Johns Hopkins School of Nursing. It's become clear, she says, that "nurses provide the bulk of care and assume the brunt of danger that comes with stemming a worldwide health crisis."

  Above all, the pandemic has demanded flexibility. With patient numbers increasing and hospitals strained, many nurses have stepped directly onto the frontlines of the COVID-19 response or shifted to fill other voids the pandemic has created—often working longer, unpredictable hours. In some cases, nurses have crossed state lines to provide care, and retired nurses have returned to action. To maximize their utility, some changes have been necessary at the regulatory level, removing longtime barriers on both the modes and the scope of practice for nurses.

  A telehealth revolution

  For nurses, the quick adoption of telehealth technology—aided by the easing of federal restrictions on privacy and billing—was a necessary change to serve patients safely and efficiently during COVID-19.

  Alexandra Morrel, nurse practitioner manager at the Student Health and Wellness Center on JHU's Homewood campus, says the clinic shifted to predominantly telemedicine in the spring to help students who remained in and around Baltimore after the university transitioned to remote instruction and supporting those in states that permitted Maryland-based appointments.

  The transition "was a little rough to begin with, learning all the nuances and the best ways to practice," Morrel says, and her job became "almost fully administrative," configuring workflows for the clinic.

  While the number of in-person appointments is one the rise now—some conditions require it—Morrel has found that services like routine checks and follow-ups lend themselves naturally to telemedicine, saving time and increasing access.

  Before the pandemic, nurse practitioner Jason Farley was embarking on the first fully telehealth-based study approved at Johns Hopkins, evaluating at-home treatment for sexually transmitted diseases including HIV/AIDS. At the time, he says, the concept of all-remote care seemed avant-garde.

  "It really felt like we were pushing the envelope," says Farley, who says his infectious disease practice is now 90% telehealth.

  According to Davidson, the potential for telehealth expansion has been clear for many years but it took a pandemic to break resistance to it. "The uptake of telehealth has been a silver lining potentially moving us forward decades over a few short months," she says.

  Authority issues

  Other regulatory barriers have come under the microscope, including laws that dictate the scope of work that advanced practice nurses—those with post-graduate education, including nurse practitioners and clinical nurse specialists—can perform.

  At Johns Hopkins, Davidson has led a campaign called #ItCantWait, advocating to empower nurses to practice at the full capacity of their training and skills.

  In the case of nurse practitioners, that means the right to "full practice authority" without physician oversight. Under that authority—currently permitted in 22 states and D.C.—nurse practitioners have autonomy to diagnose patients, order and interpret tests, and manage treatments, including prescribing controlled substances. In other states, something akin to a permission slip from a doctor is necessary for some of those practices.

  The Hopkins campaign echoes similar calls this spring from the American Association for Nurse Practitioners and U.S. Secretary of Health and Human Services Alex Azar, all with the same goal: increase the flexibility of nurses to respond to the nation's health crisis.

  "I CAN SAY WITH CONFIDENCE THAT RIGHT NOW THE WORLD IS WATCHING US. WE AS NURSES MUST GRAB HOLD OF THIS OPPORTUNITY TO ADVOCATE FOR OUR PROFESSION AND THE PROTECTION OF POPULATIONS WE SERVE."

  Patricia Davidson

  Johns Hopkins School of NursingDuring the pandemic, five states have temporarily suspended existing practice agreements, according to the AANP, while others have tweaked restrictions or allowed executive orders to expire in order to grant nurses more authority. Other states haven't moved.

  The patchwork of responses reflects the national disharmony on the issue. Well before COVID-19, this was a contentious topic in health care policy debates. But some nursing advocates see the present as a make-or-break moment to press for more lasting changes.

  "I can say with confidence that right now the world is watching us," Davidson says. "We as nurses must grab hold of this opportunity to advocate for our profession and the protection of populations we serve."

  In recent memory, Hurricane Katrina and Hurricane Sandy similarly highlighted barriers preventing nurses from performing to the extent of their training. According to Roman Galperin, an associate professor of management at the Johns Hopkins Carey Business School, the "massively publicized shortages of physicians" during President Clinton's health care reform in the 1990s and the advent of Obamacare also ushered in changes for nursing.

  "The arguments were essentially the same," Galperin says. "The nursing profession's response was: 'We are here, we have the skills, but we don't have the rights.'"

  Persistent debate

  Changes to scope of practice in nursing can be politically sensitive, however, with major medical associations and state boards often tipping the scales in favor of the status quo.

  "I've seen very strong arguments against giving nurse practitioners autonomy, usually citing safety and lack of expertise and training as reasons," says Galperin, who has studied the rise of nurse practitioners in the context of retail clinics, such as urgent-care centers and clinics within drugstores.

  Advocates for expanded nursing authority believe that resistance is rooted in outdated perceptions of nursing and in the desire to differentiate the roles of nurses and physicians.

  "There can be a general culture image of a nurse being considered less of an expert professional," Galperin says, though that perception of nurses often doesn't correlate to "their actual skill sets."

  Farley says the issue often boils down to a "turf battle at the state level for access to patients," while safety concerns have not proved valid. "Based on all I've seen and been privy to, there is no scientific evidence that quality of care is negatively impacted when provided by a nurse practitioner," he says.

  Patch says clinical nurse specialists like herself—a role that shares characteristics with nurse practitioners but is more oriented to outreach and education—have been waging the same kinds of battles, including lobbying for rights to write prescriptions without physician oversight. In the pandemic, this flexibility could be critical when resources are low. Colleagues share stories, Patch says, of time squandered tracking down busy doctors in order to make minor tweaks to medicine orders they could have completed themselves.

  "COVID-19 has brought to light that [empowering nurses] is something that would help patients, help families, and also help the practitioners we're working with," Patch says.

  Patch also believes that COVID-19 has elevated the nursing profession by affirming the essential role nurses play during emergencies, and she's hopeful to see lasting advances.

  "If nothing else," she says, "it's certainly helped to highlight our unique skill set and flexibility."

  Posted in Health, Voices+Opinion, Politics+Society

  Tagged nursing, school of nursing, coronavirus, covid-19

  Source of articles:https://hub.jhu.edu/

  Author:Katie Pearce

  以上就是新冠疫情下新冠病毒病例为美国护理界带来的改变吧,希望对各位学子了解约翰霍普金斯大学有所帮助。


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