Nursing home administration: a key role for the gerontological nurse.
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Biomedical subjects
Publications and source records attributed to L Kaeser.
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The Teaching Nursing Home (TNH) represents one of the major approaches to improve the quality of long-term care services to evolve over the past decade. The authors present their interdisciplinary approach to seeking TNH affiliations from area nursing homes through the use of a request for proposal (RFP) process. The components of this process, including identification of benefits to both the nursing home and the university; development of strong collaborative relationships; establishment of methods of shared decision-making about program and service mix, research protocols, and selection of key staff; joint appointments of personnel; and evaluation of potential TNH partners are discussed.
CONTEXT: For more than two decades, abstinence from sexual intercourse has been promoted by some advocates as the central, if not sole, component of public school sexuality education policies in the United States. Little is known, however, about the extent to which policies actually focus on abstinence and about the relationship, at the local district level, between policies on teaching abstinence and policies on providing information about contraception. METHODS: A nationally representative sample of 825 public school district superintendents or their representatives completed a mailed questionnaire on sexuality education policies. Descriptive and multivariate analyses were conducted to identify districts that had sexuality education policies, their policy regarding abstinence education and the factors that influenced it. RESULTS: Among the 69% of public school districts that have a district-wide policy to teach sexuality education, 14% have a comprehensive policy that treats abstinence as one option for adolescents in a broader sexuality education program; 51% teach abstinence as the preferred option for adolescents, but also permit discussion about contraception as an effective means of protecting against unintended pregnancy and disease (an abstinence-plus policy); and 35% (or 23% of all U.S. school districts) teach abstinence as the only option outside of marriage, with discussion of contraception either prohibited entirely or permitted only to emphasize its shortcomings (an abstinence-only policy). Districts in the South were almost five times as likely as those in the Northeast to have an abstinence-only policy. Among districts whose current policy replaced an earlier one, twice as many adopted a more abstinence-focused policy as moved in the opposite direction. Overall, though, there was no net increase among such districts in the number with an abstinence-only policy; instead, the largest change was toward abstinence-plus policies. CONCLUSIONS: While a growing number of U.S. public school districts have made abstinence education a part of their curriculum, two-thirds of districts allow at least some positive discussion of contraception to occur. Nevertheless, one school district in three forbids dissemination of any positive information about contraception, regardless of whether their students are sexually active or at risk of pregnancy or disease.
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According to results of a survey of state Medicaid, health and welfare agencies, these agencies spent $61 million in federal and state funds on the provision of the contraceptive implant to low-income women in FY 1992. Some $57 million of this was federal funds, with Medicaid accounting for 84% of all public funds spent on the implant; only nine states committed monies from their own coffers. The Medicaid agencies of 13 states reported restrictions on the number of subsidized implants a woman could receive over her reproductive lifetime. No Medicaid agency has provisions to cover required or requested removals of the device among users who become ineligible for Medicaid while the implant is in place; only eight health departments have policies ensuring subsidized removals for such women.
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