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Columbus Discovers America

August 15, 2006 -- Today the Forbes site posted an unsigned HealthDay News piece, "Heart Failure Patients Fare Better With Follow-Up Nursing Care." The article reports that a new study shows that "patients who get follow-up care from nurses have fewer hospitalizations and function better than patients who receive what is considered usual care." The patients studied were drawn from "ambulatory practices at Harlem hospitals." We commend those responsible for this helpful coverage of the value of nursing--except that readers are not really told that it is nursing. Unfortunately, the piece consults no nurses, relying solely on an economist and a physician who were study co-authors, and one outside physician expert. We realize that the medical school-based study appears to have no nurse authors, a sad comment in itself. But that together with the failure to consult any nurses for the press account suggests that they are they are just another piece of helpful medical equipment, rather than knowledgeable professionals. It implies that what the nurses are doing here is just carrying out physician "orders." Of course, this is not the first time we have seen the basic idea here--that holistic, preventative care improves outcomes--become news when respected professionals like physicians embrace it, even though it has been a core principle of nursing for many decades.

The piece explains that heart failure affects millions of Americans, making life hard and reducing life expectancy, in part because the condition is hard to manage. However, it quotes economist and study lead researcher Jane Sisk as noting that "[h]aving heart failure patients work with nurses to help them learn to manage their condition results in the patients feeling better and being able to carry out everyday activities a lot better." The study, done at the Mount Sinai School of Medicine, was published in the Annals of Internal Medicine.

The piece says that for a year, nurses counseled the patients in the study "on the benefits of a low-salt diet, the importance of taking medications, and self-management of symptoms." They also "arranged" medication changes and tests. Patients in the "usual-care" group got medications and "doctor visits as needed." At nine months, patients getting the nursing care had only "slight" limits in their physical activities, while those in the usual-care group had "marked" limitations. At 12 months, the nurse-managed patients had 143 hospitalizations, while those in the control group had 180. After the study ended, the functioning of the formerly nurse-managed group worsened at rates similar to the control group. The piece says Sisk will now look at the data to see "if the program was cost-effective."

In addition to comment from Sisk, the piece quotes Mount Sinai physician and co-author Mary Ann McLaughlin as saying that "[a]s physicians, we want to make sure patients are following every recommendation...Self-management of this disease can mean slowing the progression of this disease." The piece also reports that one outside "expert," University of California San Francisco cardiologist Byron K. Lee, found the study promising and noted that it "underscores the fact that managing one's heart failure is extremely complicated." Because of that, Lee says that "it is not surprising that extra monitoring and attention from a bilingual nurse would help patients, especially non-English speaking ones, stay out of the hospital."

Despite all these good features, the piece fails to name or quote a single nurse. Would a piece examining physician care quote no physicians? The failure to consult nurses suggests that they are a useful type of inanimate instrument, like scalpels or stethoscopes, that physicians apply to certain medical problems. Certainly nurses would have nothing authoritative to say, since they're just mechanically carrying out physician orders. Was the work of the nurses in this study even "nursing," or just a closely directed extension of physician care?

In fact, nurses are expert in formulating and providing such holistic preventative care, which has long been a central feature of nursing practice. Examples range from pioneering nurses like Mary Breckinridge, the nurse-midwife who founded the Frontier Nursing Service in 1925 to provide effective community prenatal care, to today's nurse practitioners, who excel at chronic disease management even as part of what this piece calls "doctor visits." We're glad when others discover the benefits of the nursing care model, but disappointed when it is presented as a cutting-edge physician innovation.

In reading this article, we were reminded of our satire on the "research study" "Nursing, Who Knew?"

See the article "Heart Failure Patients Fare Better With Follow-Up Nursing Care" on the Forbes website from August 15, 2006. Also see the abstract from Annals of Internal Medicine.


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