Inpatient Care Reform from a Community Nurse Perspective

I have worked in health care for over 20 years focusing on care in the community through parish nursing or faith community(FC)nursing. Our practice provides for wholistic care - addressing the body, mind and spiritual needs of the client in the faith community (FC) setting. In our role we see clients of all ages, demographics and situations. From the patient with insurance, multiple resources and strong support systems to the homeless. From my perspective 2 major issues related to health reform come to mind. First, as you have mentioned in your postings, simply access to inpatient care is a major issue. Far too many US citizens have limited or perhaps no access to health care resources and thus the wonderful inpatient care available in the US. Despite the fact that there are governmental programs to support them many times there are significant barriers that still prevent access. Barriers such as language, an address, transportation to the site to apply and maintain programs and then when accessed the support to be able to maintain the coverage. The second issue is very different. As healthcare is becoming more expensive and resources for all are dwindling it is critical that these resources be used as efficiently as possible. Quality in health care can make a significant difference in how much money is spent to provide care. If hospitals can function more effectively and efficiently I would propose that we would have more health care dollars to care for all. Efforts to improve qualilty in inpatient care by rewarding hospitals that meet standardized quality measures and holding physicians accountable for standards that have proven to lead to best outcomes are already making a difference in our healthcare structure and in reducing health care costs. Such efforts focus on quality care through evidence based practice and are successful only when all parts of the HC system are held accountable. In the past physicians and hospitals have and continue to be reimbursed for the amount of care they provided, not necessarily the quality of their care or the outcome. Closely related to quality in health care is the issue of safety in our inpatient care. Efforts to use technology to improve medication errors and eliminate documentation errors (that can lead to patient care errors) are examples that reform is happening. Now if only we could find the reform that would eliminate patient falls.