Nursing outlook
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Historical Article
A nursing historical perspective on the medical home: impact on health care policy.
The idea of a "medical home" is rapidly gaining in popularity in health policy circles today. In the face of a shortage of primary care physicians, it has led to a national debate about who should lead the homes, who should deliver care, the kind of care that should be offered, and the location of that care. A historical examination of nurses' role in primary care can provide evidence to inform the current dialogue. ⋯ Three historical case studies provide evidence of how nursing and medicine worked together in the past and informs the discussion about using nurses to deliver primary health care today. Policy makers should not overlook the central role nurses have long played in providing access to care for numerous underserved populations. Makers should not overlook the central role nurses have long played in providing access to care for numerous underserved populations.
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Quality of care at rural health centers in Rwanda is often limited by gaps in individual nurses' knowledge and skills, as well as systems-level issues, such as supply and human resource management. Typically, nurse training is largely didactic and supervision infrequent. Partners In Health and the Rwandan Ministry of Health (MOH) collaborated to implement the nurse-focused Mentoring and Enhanced Supervision at Health Centers (MESH) program. ⋯ The program targeted 21 health centers in two rural districts and supported implementation of MOH evidence-based protocols. Initial results demonstrate significant improvement in a number of quality-of-care indicators. Emphasis on individual provider and systems-level issues, integration within MOH systems, and continuous monitoring efforts were instrumental to these early successes.
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Nursing values include diversity and a commitment to the elimination of health disparities. However, nursing comprises predominantly white, female nurses. The authors explore structural and interpersonal sources of disparities experienced by black persons, including white privilege. ⋯ Topics include postracialism, colorblindness, institutional racism, white privilege, health disparities, clinical encounters, subtle racism, and racial microaggressions. Suggestions for open dialogue, historical awareness, education, research, and practice are highlighted. Difficulties involved in confronting racism and white privilege are explored.