NURS 6050 Week 7 Achieving Universal Health Coverage Discussion

NURS 6050 Week 7 Achieving Universal Health Coverage Discussion

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Module 4: Healthcare Program Design and Implementation (Weeks 7-8)

Learning Objectives

Students will:

• Analyze health policies
• Analyze opportunities for RNs and APRNs to participate in policy-making
• Analyze strategies for overcoming challenges for participating in policy-making
• Recommend strategies to improve the advocacy and communication of policy-making opportunities
• Analyze healthcare programs
• Analyze the role of the nurse in healthcare program design
• Analyze the role of the nurse as advocates for target populations of healthcare programs
• Analyze the role of the nurse in healthcare program implementation
• Analyze healthcare teams necessary for implementing healthcare programs

Instructions starts here for Discussion 1: Evidence Base in Design

When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.

In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

To Prepare:

• Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.
• Review the health policy you identified and reflect on the background and development of this health policy.

By Day 3 of Week 7

Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples. Supported by at least three current, credible sources. See next page for the References (Resources)

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

• Chapter 5, “Public Policy Design” (pp. 87–95 only)
• Chapter 8, “The Impact of EHRs, Big Data, and Evidence-Informed Practice” (pp. 137–146)
• Chapter 9, “Interprofessional Practice” (pp. 152–160 only)
• Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 183–191 only)

American Nurses Association (ANA). (n.d.). Advocacy. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy/

Centers for Disease Control and Prevention (CDC). (n.d.). Step by step: Evaluating violence and injury prevention policies: Brief 4: Evaluating policy implementation. Retrieved from https://www.cdc.gov/injury/pdfs/policy/Brief%204-a.pdf

Congress.gov. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/

Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. Academy of Management Review, 21(4), 1055–1080. doi:10.5465/AMR.1996.9704071863

Note: You will access this article from the Walden Library databases.

Sacristán, J., & Dilla, T. D. (2015). No big data without small data: Learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice, 21(6), 1014–1017. doi:10.1111/jep.12350

Note: You will access this article from the Walden Library databases.

Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretion. Public Management Review, 16(4), 527–547. doi:10.1080/14719037.2013.841978.

Note: You will access this article from the Walden Library databases.

Module 4: Healthcare Program Design and Implementation

NURS 6050 Week 7 Achieving Universal Health Coverage Discussion EXAMPLE DISCUSSION

Mental Health Access 

Mental health access through the emergency department is a problem throughout the United States. Many people with acute mental health issues seek care through the emergency department simply because they have no other options for immediate help. The proposed bill H.R. 2519, addresses the problem of EDs not having enough resources to manage and treat patients with acute mental health episodes affectively. This bill would provide funding to aid in additional inpatient psychiatric beds, crisis clinics, and emergency psychiatric units for mental health patients with an acute episode. (Actions – H.R.2519 – 116th Congress (2019-2020): Improving Mental Health Access from the Emergency Department Act of 2020, n.d.). The issue remains that people come into the ED for suicidal or homicidal ideation, and we have no inpatient psych beds available to get them the help they desperately need. I have personally witnessed having to hold a suicidal patient in the ED for over 24 hours until either a bed becomes available, or released back on the street, only because we do not have the resources necessary to accommodate them. 

I believe there is significant evidence to support this policy and the need for increased resources for mental health patients. Acute mental health patients are seeking emergency care at an alarming rate. One in eight patients in the emergency department seeks help for acute mental health issues or substance abuse. (Laderman et al., 2018). This number continues to grow despite the lack of resources emergency departments have to hand out. Lack of resources for these patients also results in increased wait times and delays in emergency care that they need. Mental health patients simply do not get the treatment they require by sitting in the emergency department for hours or even days. (PR Newswire, 2017). Acute mental health issues are a growing concern in emergency departments across the U.S., and something needs to be done. 

References

Actions – h.r.2519 – 116th congress (2019-2020): Improving mental health access from the emergency department act of 2020. (n.d.). Congress.gov. Retrieved October 12, 2020, from https://www.congress.gov/bill/116th-congress/house-bill/2519/actions

Laderman, M., Dasgupta, A., Henderson, R., & Waghray, A. (2018, January 26). Tackling the mental health crisis in emergency departments: Look upstream for solutions. healthaffairs.org. Retrieved October 12, 2020, from https://www.healthaffairs.org/do/10.1377/hblog20180123.22248/full/

PR Newswire. (2017). Waits for care and hospital beds growing dramatically for psychiatric emergency patients. PR Newswire US.

TUTOR CHECK GRADING RUBRIC DETAIL

NURS 6050 week 7 Discussion 1: Evidence Base in Design

The health policy that I have chosen for this week’s discussion is H.R. 4550 (Congres.gov, n.d.). It amends the Public Health Service Act to provide grants for the treatment of minorities with diabetes. The bill was introduced on September 27, 2019, and currently resides in the Committee on Energy and Commerce. The treatments that will be covered for diabetic minorities include routine care, diabetes prevention and control, eye care, foot care, and treatment for other complications of diabetes (Congress.gov, n.d.). The bill also mentions that treatment considerations for language barriers and culture.

Many studies show minorities are more likely to be diagnosed with diabetes than their non-Hispanic white counterparts. According to Joo and Liu (2019), 7.4% of non-Hispanic whites are diagnosed with diabetes, 12.1% of Hispanics are diagnosed with diabetes, and 12.7% of African Americans are diagnosed with diabetes. There must be either availability of services or resources for minorities with diabetes. The Centers for Disease Control and Prevention (CDC) is funding ten national organizations to start in-person visits to people with diabetes in underserved areas (CDC, n.d.). Millions of minorities require diabetic preventative care and treatment NURS 6050 week 7 Discussion 1: Evidence Base in Design.

One study by Rodriguez and Campbell (2017) showed that there is also a disparity between minorities and non-Hispanic whites in testing medications to treat diabetes. Some of the medicines that treat diabetes have different reactions to some ethnic groups. Some examples are Sulfonylureas cause arterial stiffness in African Americans; Metformin lowers hemoglobin A1C in African Americans more than non-Hispanic whites; and Sitagliptin dropped Asian Americans hemoglobin A1C by 1% but was not tested on African Americans (Rodriguez and Campbell, 2017). The disparity between treatment and prevention of diabetes in minorities would benefit from the H.R. 4550 Minorities Diabetes Act.

References

Centers for Disease Control and Prevention (CDC) (n.d.). National diabetes prevention program. https://www.cdc.gov/diabetes/disparities.html

Congress.gov (n.d.). H.R. 4550  Minority Diabetes Initiative Act. https://www.congress.gov/bill/116th-congress/house-bill/4550/all-actions?q=%7B%22search%22%3A%22diabetes%22%7D&r=20&overview=closed&s=3#tabs

Joo, J.Y. & Liu, M.F. (2019). Experience of culturally-tailored diabetes interventions for ethnic minorities: A qualitative systematic review. Clinical Nursing Research, 30(3), 253-262. https://doi-org.ezp.waldenulibrary.org/10.1177%2F1054773819885952

Rodriguez, J. E. & Campbell, K.M. (2017). Racial and ethnic disparities in prevalence and care of patients with type 2 diabetes. Clinical Diabetes Journal, 35(1), 66-70. https://doi.org/10.2337/cd15-0048

response

Diabetes has been a hot topic within health care as of recent especially with the more sedentary lifestyles, working from home, and extensive time sitting in front of computers. The Center for Disease Control and Prevention, CDC, (2020) reported that there was increased number of new diagnoses of type 1 diabetes among racial/ethnic minority groups in children/teen populations. With younger generations being diagnosed with diabetes there will be an influx of future health related issues due to being a diabetic long- term issues such as: podiatry needs, poor healing, nerve damage, heart disease and more (Pietrangelo, 2020) NURS 6050 week 7 Discussion 1: Evidence Base in Design.

The health policy H.R. 4550 – Minority Diabetes Initiative Act (Congress, n.d.) would be healthful to public and nonprofit health care providers because it provides funding for diabetic diagnosis and health related issues from the disease in minority/ethnic groups. As you have stated many drugs have not been clinically trialed on ethnic/minority groups, which can create adverse reactions or may not work at all for these individuals’. Minorities/ethnic groups already struggle in today’s society, so creating another barrier for them to hurdle is unfair and unfortunate. I would agree that this Act is supported with evidence-based data and would be a great asset for this group of people. If we are able to treat and help manage this disease at an early stage, we could decrease the amount of future hospital required illnesses.

References

Center for Disease Control and Prevention (CDC). (2020). Diabetes: Rates of new diagnosed cases of type 1 and type 2 diabetes continue to ruse among children, teens. Retrieved April 12, 2021, from https://www.cdc.gov/diabetes/research/reports/children-diabetes-rates-rise.html

Congress.gov (n.d.). H.R. 4550 – Minority Diabetes Initiative Act. https://www.congress.gov/bill/116th-congress/house-bill/4550/all-actions?q=%7B%22search%22%3A%22diabetes%22%7D&r=20&overview=closed&s=3#tabs

Pietrangelo, A. (2020). The effects of diabetes on your body. Healthline. Retrieved April 12, 2021, from https://www.healthline.com/health/diabetes/effects-on-body

response 2

Thank you for your research into this topic. It was informative and enlightening. Your discussion about trialing medications on various ethnicities was an eye-opening for me, because it had not occurred to me that a specific diabetic medication would work in one population, but not another. This is especially concerning to me, because it makes me wonder what other medications have this similar effect.  Much of diabetes treatment is self-management and this can be difficult when there are several disparities among ethnicities in development and course of diabetes including behavioral, social, environmental and the healthcare system. Jones and Crowe (2017) found that many participants felt they were not given adequate support through the healthcare system or provided with adequate information relevant to their lifestyle and they also described having difficulty applying the diabetes education they had received to their daily life. One theme discussed that I found interesting was the idea of managing food from a cultural, social, and economical standpoint. These individuals come from backgrounds that cannot afford to make several different meals especially if they have a large family and healthy options tend be more expensive and therefore not affordable. The commitment to the family often makes self-management behaviors difficult. The generalized feelings brought up in this article are powerlessness, inevitability, and fatalism, which can make management even more difficult in minorities. Milstead & Short (2019) state that public uncertainty about personal coverage and methods of financing care are major issues and I hope the bill HR 4550 alleviates some of these issues that afflict minorities with diabetes NURS 6050 week 7 Discussion 1: Evidence Base in Design.

References

Jones, V. & Crowe, M. (2017, November). How people from ethnic minorities describe their experiences of managing type-2 diabetes mellitus: a qualitative meta-synthesis. International Journal of Nursing Studies, 76(2017), 78-91. Doi: https://doi.org/10.1016/j.ijnurstu.2017.08.016

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning NURS 6050 week 7 Discussion 1: Evidence Base in Design.

Rubric Detail

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NURS_6050_Module04_Week07_Discussion_Rubric

ADDITIONAL INSTRUCTIONS FOR THE CLASS

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• Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses.

• Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

• APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

• Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source.

• LopesWrite Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for tips on improving your paper and SI score.

• Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

• Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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