This article deals with nurses’ ethical concerns raised by the consequences of changes in governmental and institutional policies on nursing practice and patient care. The aims of this project were to explore perspectives of registered nurses who provide or manage direct patient care on policies that affect nursing and patient care, and to provide input to policy makers for the development of more patient-centred policies. Four focus groups were conducted with a total of 36 registered nurse participants. The project team (...) identified major themes that emerged in the analysis of transcripts of the focus group discussions. The four major themes were: effects of policy focused on cost containment, effects on quality of care, effects on patient education and access to needed services, and effects on nurses and nursing. The participants identified primarily negative effects of changes in national health policy and legislation that influence institutional policies on patient care and nursing practice. The effects of identified policy changes raised concerns about meeting nurses’ ethical obligations to patients and families. Participants specified key points for consideration by legislators and other policy makers. They viewed nurses who are involved in direct patient care as a critical resource for legislators and other policy makers in the development of public and institutional policies that affect nursing and patient care. (shrink)

The purpose of this paper is to describe the nature of dental practice and to identify some recent innovations which have effect on cost containment in dentistry. The first of these innovations is dental insurance or prepaid dental services. Dental insurance has only recently emerged as a significant economic factor. The chronic and prevalent nature of dental disease mandates that the management of these programs incorporate insurance devices which limit demand and utilization. These devices amount to cost containment measures. The (...) second factor to be discussed is advertising. Advertising has been foisted on the dental profession by recent rulings of the Federal Trade Commission in an effort to promote competition. The Reagan administration, despite a market oriented approach to health care, had attempted to blunt some of the FTC actions. Advertising, nevertheless, has the potential to stimulate competition and restrain price escalation. The third factor includes a discussion of alternative delivery systems. These commercially oriented dental enterprises have the potential to compete with established practices as well as increase the demand for services. (shrink)