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PubMed1999

[Basic and technical nursing--two concepts with far-reaching consequences for professional nursing].

While nursing is now established at universities and knowledge of nursing science is increasing, nursing practice often is restricted by traditional structures of nursing organizations. Therefore it is difficult to transfer new knowledge into practice. In this context the terms "Grund- und Behandlungspflege" (basic and technical nursing) gained in importance. They influence the number of nurses in hospitals and determine what kinds of activities will be financed by social insurance for nursing care (Pflegeversicherung). This paper shows the wide propagation of the terms "Grund- und Behandlungspflege" by a standard text-book on hospital managerial economics. Furthermore vehement criticism of the terms and their consequences from a nursing point of view will be discussed and their potential origin in German language use.

Clinical Competence↗
PubMed2001

Nurse practitioners enter the new millennium: a global initiative.

Health care for all was the theme as nurse practitioners gathered in the United States for the 8th International Conference. At the conference, nurse practitioners representing 27 countries discussed issues of global concern. Nurse practitioners face common challenges in their global community. Strategies for practice and forward movement of the advanced role are discussed. Universal challenges include titling, legal recognition, legal status, prescriptive authority, and reimbursement. These issues continue to be addressed as we move toward a global community.

Drug Prescriptions↗
PubMed2002

[The "Barthel Index": alternative to expertising in compulsory care insurance?].

Measuring the level of care needed is difficult and since the introduction of nursing care insurance in Germany in 1995 the assessment method applied by the MDK (Medizinischer Dienst der Krankenversicherung) has repeatedly been criticised. The method is very costly and not broadly tested for its validity and reliability. The question arises whether similar results can be obtained by applying another instrument, like the Barthel Index (BI), which is easier to use and more reliable. In this article the authors show - based on a preliminary study in 1999 - that by using the Barthel Index a discriminance analysis will show identical results in 80 % of all cases. The authors regard this identical measurement of care needs, which is reached by scoring only ten items (BI) versus thirty (MDK's assessment method) and with a presumingly higher reliability, as a major progress and reason enough for further discussion and studies of the use of the Barthel Index for care needs assessment.

Adolescent↗
PubMed2002

[Validity of care assessment in disabled and mentally retarded children].

16 children with spastic cerebral palsy and 25 mentally retarded children were assessed via the scales "Self-Care" and "Mobility" of the Pediatric Evaluation of Disability Inventory (PEDI). Age-adjusted PEDI scores were compared with the classification according to the three levels of the German statutory nursing insurance. Good correlations and highly significant dependence were found in children with spastic cerebral palsy but no dependence was seen in mentally retarded children. Apparently, assessment guidelines of the German statutory nursing insurance do not guarantee a valid assessment in all disabled children. In conclusion, future assessments of nursing needs in children should employ standardised assessment methods.

Cerebral Palsy↗
PubMed2002

Changing social policy: Grassroots to legislation.

Health care in the United States has evolved into a multimillion dollar business. As the health care industry has grown, so too has government regulation and involvement. As both insurers and patients vie to get the most for their health care dollars, federal and state governments attempt to mediate, prevent fraud and abuse, and protect all parties involved. Consumers feel the effects of this "tug of war" in the form of higher copayments, premiums, and out-of-pocket costs, as well as denial of coverage. This denial of coverage sparked a very successful grassroots effort to stop commercial insurers in the state of Connecticut from defining ostomy supplies as cosmetic and thus denying reimbursement. A tremendous amount of collaboration between Connecticut WOC nurses, state legislators, local American Cancer Society advocates, United Ostomy Association chapter members, and health care providers resulted in a powerful mobilization and support for House Bill No. 5120. This bill went beyond defining ostomy supplies as medically necessary but also set a minimum rate for reimbursement. Social policy changed, improving the lives of Connecticut citizens with an ostomy. Although many people fear they do not have the power to make necessary changes in government, this experience proved otherwise. The collaboration that occurred was patient advocacy at its best. This article describes the process that allowed this successful collaboration to take place with the hope that others will be inspired to get involved with patient advocacy through political involvement. It is the intention of this work to capture the essence of dedication of a grassroots campaign involving a small group of well-organized, highly focused participants who were responsible for changing public health care policy in the state of Connecticut.

Connecticut↗
PubMed1995

Administrative issues for use of nurse practitioners.

As nurse administrators increasingly use nurse practitioners in healthcare delivery systems to provide high-quality, more cost-effective care, they must recognize and take action on key practice issues--autonomy, title protection, admitting privileges, physician back-up, and reimbursement. Careful attention and action directed to enhancing nurse practitioner usefulness will increase the flexibility of nurse practitioner utilization within specific institutions and across a diverse network of healthcare delivery sites structured to provide continuity of care.

Delivery of Health Care↗