1. Tullai-McGuinness, Susan PhD, RN

Article Content

As healthcare professional, we probably encounter more policies than most other professionals. Policies are defined as a general statement of aims or goals, though polices may be very specific. Since policies are developed by people, they do reflect the values, attitudes, and beliefs of their designers. Polices can be described by the type of issues they address, such as the environment, economy, education, and health. Another method of classifying policy is based on its source. Policies can be considered public (i.e., federal government), institutional (i.e., home-care agency), and organizational (i.e., professional association). Expressions of polices are found in the form of laws adopted by Congresses, regulations developed by the Centers for Medicare and Medicaid Services (CMS), practice standards adopted by the American Nurses Association (ANA), and operating policies generated by home-care agencies.


This issue of Home Healthcare Nurse focuses on various types of policies, their implications, and strategies for change. Elizabeth Johnston Taylor and colleagues provide insight as to how public polices can limit a home-care agency's autonomy. In addition, they offer a glimpse of the New Zealand national healthcare system that reflects a belief that access to healthcare is a right. This healthcare system provides sharp contrast to the healthcare system of Cambodia. Karen Hellwig tells of the remarkable accomplishments of Angkor hospital and home care personnel in meeting the healthcare needs of the Cambodian children who live in a country that lacks adequate public health policies. Hellwig's article provides a poignant picture of how health is impacted by policies related to food, water, and education, all considered social determinants of health.


Education policies are also critical to the development of a highly competent home-care workforce. Joanne Dalton and colleagues' study focuses on a critical aspect of the policy process evaluation. Their study describes how policy change related to curriculum impacted student's clinical behaviors when making home visits.


Implementing new policy at the agency level can be challenging. In preparation for use of telehealth, Browning and colleagues' study examined nurses' perception of their readiness for an agency's policy change. Mary McGoldrick' article also prepares home care agencies and hospice organizations for policy change. McGoldrick presents Joint Commission's elements of performance that pertain to the prevention of central line-associated infections and provides suggestions as how Joint Commission's policy can be reflected in the policies of home care and hospice organizations.


When I practiced as a home healthcare nurse, I often complained about some of the CMS regulations and agency policies. I did not realize that creating a new policy requires comprehensive evaluation of the issue, and thoughtful consideration as to how the policy might be implemented and evaluated. Gail Frankeberger and Sarah Browning's policy issue paper addresses telehealth reimbursement. This format can be used to present proposals for policy proposals at the agency level as well.


Through the years, I have witnessed how actions of home care clinicians help to create policies that improve the quality of patient care, staff's working conditions, the agency's ability to operate efficiently, and the environment that impacts our health. Nurses and other clinicians make home visits with legislators, provide feedback on proposed CMS regulations, recommend policy changes to their agency based on the latest research or best practices, participate in research, become active members of their professional association, and dissemination of research findings through articles and presentations. Another strategy to move policy forward is communication. Maureen Gavin reports the serious environmental health threat to children and adults exposed to latex. Reactions, risk factors, controversies surrounding latex allergies, prevention strategies, and resources are explored.


Healthcare clinicians across the globe are expanding their policy efforts to improve health. One such group is Health Care Without Harm (HCWH) (, an international coalition of numerous organizations in over 50 countries with a mission of providing environmentally responsible healthcare. Nurses play a key role in HCWH, and there is no cost to joining their efforts ( A special project of the HCWH nurses workgroup is the Luminary Project. ( Nurses share stories on how they strategically addressed environmental health problems that impacted policy. We can learn from these stories and possibly model some of their strategies in addressing policy issues that light our passion.


OASIS update

CMS plans to implement the new OASIS-C data set in January of 2010. Until that time, home care providers are expected to continue to collect OASIS-B1 data, following CMS' evolving guidelines and refinements. As providers submit questions to CMS requesting data collection clarifications, the OASIS Certificate and Competency Board (OCCB) works collaboratively with CMS to disseminate new and changing guidance through the quarterly release of CMS OCCB Q&As.


The next round of quarterly CMS OCCB Q&As will be posted on the OCCB Web site on April 22, 2009 ( Readers may find subsequent postings released on July 22, 2009 and October 21, 2009. On the posting date of each quarterly release, interested industry providers and representatives are invited to join the OCCB in scheduled teleconferences that highlight the new Q&As, and review other OASIS related changes that have occurred during the previous quarter. See the OCCB Web site for more information. Previous Q&A releases are also available on the OCCB Web site under "Resources."