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Communicating with the elderly

Your Nov/Dec 1998 edition contained an informative list of "Tips for communicating with frail, elderly patients," developed by Pace University in New York. Although I found the tips in general to be excellent, I would disagree with the tip that stated "expect them (the frail elderly) to make errors, have emotional outbursts and display inconsistencies." These behaviors are not typical during any interview, even in the frail elderly, and may indicate a cognitive or affective disorder. Treating such adverse cognitive or mood symptoms as normal could result in the clinician overlooking crucial assessment data, resulting in a lack of appropriate referral or implementation of supportive interventions.

Also, I would like to add a tip. Hearing loss is very prevalent in this population of older adults. A hand-held amplifier (approximate cost $30) is an essential piece of equipment in health care settings dealing with these clients and enhances good communication with this population.

Mary Shelkey, RN, GNP
Bronx, NY

Nurse overlooked

When I was reading the "In Brief" section of the November/December 1998 issue of The American Nurse, I noticed that you picked up on a significant and very important research finding regarding the lasting effects of RN home visits. I am familiar with this research and believe it to be a very fine example of high quality research that not only had excellent outcomes, but truly demonstrated the significance and necessity of nursing interventions in high quality preventive health care.

However, there was one aspect of the report that caused me distress. You credited the work to David Olds, PhD, at the University of Colorado. While he is a fine person and has excellent research training as a sociologist, he was not the person responsible for developing, facilitating and supervising the nursing interventions. The major work of designing and implementing the nursing interventions was an excellent nurse researcher at the University of Rochester, in Rochester, NY, by the name of Dr. Harriet Kitzman. She deserves much recognition for being the initiator of the initial research plan, for designing the nursing interventions and for carrying out much of the work of data collection and analysis. As a nurse, she understands the importance of the depth of nursing knowledge required to teach young adults about the importance of a life plan and support them while they make efforts to be in charge of their own lives.

Sharon K. Holmberg, PhD, RN
Indianapolis, IN

Unity Needed

Professional associations in nursing are finally facing the reality that no association can be all things to its members, just as a nurse cannot be the end all and do all for the client/patient/resident/participant. The only way we as the profession can expand the "voice of nursing" and make it ONE STRONG VOICE is to build partnerships/alliances/coalitions among the 80 specialty nursing associations and the ANA. Since the ANA moved to Washington, DC, many inroads into the policy arena have been forged. ANA is evolving into the powerful and influential voice for nursing on Capitol Hill.

A joint task force is currently studying ways that ANA and the specialty nursing organizations can structure relationships that will unite us and accentuate the strengths that each brings to the relationship. I have been representing my specialty organization (the National Association of Directors of Nursing Administration) for the last three years on NOLF (Nursing Organization Liaison Forum). I see nursing organizations developing trust in the process and a readiness to reconsider how the specialty nursing organizations can partner with ANA. As I see it, ANA's strength lies in policy formation, lobbying for the interests of all of nursing at the national and state levels. The specialty nursing organizations' strength lies in advancing the body of knowledge related to the given specialty and identifying emerging issues that will require policy formation and lobbying.

Pat M. Kelly, ARNP, CS
Louisville, KY

Editorial Note: Opinions expressed in the editorial section are not necessarily endorsed by the American Nurses Association. Submissions to the "Letters" and "As I See It" columns are welcome and should be submitted to Editor, The American Nurse, ANA, 600 Maryland Ave., S.W., Suite 100 W., Washington, DC 20024. We reserve the right to edit submissions for length and style.


Your voice needed to truly reform health care

by House Democratic Leader Richard Gephardt (MO) and Rep. John Dingell (D-MI), Ranking Member of House Commerce Committee

At the start of the 106th Congress last month, House Democrats immediately renewed their efforts to pass the Patients' Bill of Rights (H.R. 3605; S 1890). We are committed to continue working with the American Nurses Association and other health care organizations to pass genuine reform to guarantee that health care professionals and their patients, not insurance company bureaucrats, make health care decisions.

Last Congress, Republican leaders made extraordinary efforts to block the Patients' Bill of Rights from receiving full hearing and debate in the House. This year, with only a six-seat margin in the House, it will be increasingly difficult for Republican leaders to continue to block this critical legislation from consideration and approval.

As we are all aware, there has been a revolution in the health care industry over the last decade that has resulted in soaring enrollments in managed care plans. In 1996, 80 percent of privately insured Americans were enrolled in managed care plans up from just 13 percent in 1987. Many Americans are being required to enroll in managed care plans because their employees have contracted with managed care companies to achieve cost savings in their employer-provided health benefits.

At the same time, public dissatisfaction with the limits on access to health care services being imposed by managed care plans has skyrocketed. Since we introduced the Patients' Bill of Rights last year, we have heard from hundreds of people both in Washington, DC, and across the country who have had problems with their managed care health plans. From doctors and nurses who are forced to spend hours negotiating with insurance companies over needed treatments, to patients who have suffered because their HMO refused critical treatment, to small business people who are frustrated with the bureaucracy they are compelled to deal with in order to ensure adequate services for their employees, the public is demanding change.

A survey of Americans conducted by the Kaiser Foundation and Harvard University in the fall of 1997 found that individuals in managed care plans have far less confidence in their medical plans than those with traditional fee-for-service insurance. Three-fifths of those surveyed said managed care had caused health care providers to spend less time with their patients and made it harder for sick patients to get specialized care. One national public opinion poll found that 78 percent of Americans support meaningful managed care reforms such as are included in the Patients' Bill of Rights.

Despite growing public concern with the quality of health care available in managed care plans and growing public support for strong patient protections, the 105th Congress adjourned for the year without enacting the critically important Patients' Bill of Rights. This bill, which congressional Democrats and a handful of Republicans worked to pass, was endorsed by more than 170 major organizations and includes the following important patient protections:

* It allows health care providers and patients to make health care decisions instead of insurance company bureaucrats.

* It ensures direct access to specialists.

* It guarantees real emergency room protections.

* It ensures continuity of care if a patient's provider is unexpectedly dropped or an employer changes health plans.

* It provides a fair, timely and independent appeals process for patient grievances.

* It holds health plans legally accountable for decisions that lead to serious injury or death.

* It prohibits retaliation against health care professionals who advocate for their patients.

After months of refusing to allow the Patients' Bill of Rights to be considered in committee or debated on the House floor, the Republican leadership finally gave in to public pressure for action on managed care reform. Unfortunately, the Republican bill that passed the House on July 24, 1998, provided only watered-down patient protections and excluded many key protections for millions of Americans.

The Patients' Bill of Rights was defeated by only five votes. Attempts by Senate Democrats to bring up the Patients' Bill of Rights for a vote were blocked on six separate occasions by Senate Republicans.

Democrats will work to forge a bipartisan coalition to revive and pass this vital legislation. Hearing from nurses and doctors about the constraints that managed care companies place on their ability to make health care decisions is very helpful in clearly illustrating the need for reform. We urge you to keep the pressure on your lawmakers both in Washington, DC, and across the country and look forward to working with you to increase awareness about the importance of enacting the Patients' Bill of Rights.

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