Many services are available to help seniors stay in their homes. These services are increasing in popularity as more seniors are choosing community care over institutionalized care. Two main services that assist seniors in this area are adult day care and home health care.

Find out an adult day care and a home health care in your vicinity or using the Internet and create a 1- to 2-page report summarizing their services offered, successes, and failures.

Based on the knowledge gained from your research, respond to the following questions:

• Adult day care programs began more like a social model; however, over time, they have developed as a medical model. Do you agree or disagree? Why?
• Adult day care is being described as gap filler between institutional and noninstitutional care? Do you agree or disagree? Why?
• What population comprises the largest group receiving care in adult day care programs? Why?
• Do you think receiving patients with more medical problems has impacted adult day care services? Why? How has this effected staffing?
• Which success factor has had the greatest impact on the cost-effectiveness of health care services? How?
• What impact has home health care had on the quality of life for consumers? Provide examples to support your answer.
• Is there a time when home health care and adult day care is no longer appropriate for a senior? What criteria are used to establish this?

Use the Internet to locate a peer-reviewed article describing a study evaluating an ethnic group and its health disparities. Make sure that your peer-reviewed article is not more than five years old, as you want to look at the most current evidence available.

In your posting:

• Identify the ethnic group and its health disparity.
• Describe the epidemiological concepts, data analysis methods, tools, and databases used in the study.
• Evaluate the ethnic group’s contributions to the study.
• Summarize the study and its conclusions.

Your initial posting should be at least 150 words, and you must reference the work of another writer (either as a quotation, paraphrase, or summary) to provide support for your ideas. The source can be the course text, another relevant book, any assigned reading, or an article you find on your own through the Capella University Library. When you incorporate the other writer’s ideas in your work, use APA citation style to give credit to that writer. Remember that an APA citation includes both the in-text citation (the author’s last name and the year of publication) and the full reference for the source.

The government recently released its final revision to the proposed rules governing accountable care organizations (ACOs) http://www.cms.gov/aco/downloads/Appendix-ACO-Table.pdf.  These organizations will herald the beginning of outcomes based reimbursement which will replace volume-based payment systems. Three sub-agencies will be coordinating Medicare and Medicaid payment policies.  The IPAB (Independent Payment Advisory Board) will concentrate on Medicare. It has already been criticized as having too much power for a small board. The Center for Medicare and Medicaid Innovation will be testing new payment and delivery systems, and the PCORI (Patient Centered Outcome Research Institute) is charged with evaluating comparative effective research. 

What are your thoughts on facilities such as Level I Trauma Centers who have a higher level of acuity face lower reimbursements when the patients arrived in an almost reversible condition?

Consider the various steps of the nursing process in order to address the following critical thinking questions.

• As a health care provider, discuss ways in which you will establish a helping hand and healing relationship with your patient and their families.
• How will you develop professional partnerships with health care team members in your clinical practice?
• What personal behaviors, biases, and attitudes would you have to change to develop these professional relationships?

Using the South University Online Library or the Internet, research DNA sequencing.

Based on your research, complete the following discussions:

• DNA sequencing has become a valuable tool in many areas of science, including forensic medicine and biological research. In relation to this, answer the following questions.
  • Describe the steps by which DNA sequencing is performed.
  • Describe, using at least one example, of how DNA sequencing has become a valuable tool in forensic medicine and/or biological research.
• What are the steps involved and the enzymes used in DNA replication? In your opinion, can a disorder result from the malfunction of any enzyme used during DNA replication? If yes, identify any one disorder and explain how it is caused. If no, why?
• Since one transcription factor can control multiple genes, mutations in transcription factors can have long-reaching effects.
  • Can a disease result from a mutation in a transcription factor? If so, provide at least one example, naming the transcription factor, the mutation, and the congenital defect that arises.

What does it take to be an effective health advocate? As a nurse, you have many opportunities to advocate for patients and populations, whether formally or informally. Being an advocate involves more than knowing how to lobby or to whom to write letters. It requires passion and compassion, commitment and courage.

In this Discussion, you will consider the attributes of an effective advocate for population health and/or the nursing profession. You will analyze those attributes that help nurses be a powerful force in improving the quality of health care.

To prepare:

• Review the article “On Being a Good Nurse: Reflections on the Past and Preparing for the Future” and “War, its aftermath, and U.S. health policy: Toward a comprehensive health program for America’s military personnel, veterans, and their families” found in this week’s Learning Resources.
• Consider the multiple health care needs of returning veterans and their families.

Post by Day 3 two types of health needs returning veterans and their families might need. Identify two types of health needs returning veterans and their families might need. How might you advocate for the needs of this population. What type of advocacy skills would you need and how could you develop them. What responsibility does a nurse have to be an advocate? Give specific examples.

Required Resources

Readings

• Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publishers.
  • Chapter 3, “Government Response: Legislation—Politics: Playing the Game” (pp. 45–71) (review) 
    
    
    
    This chapter explores the multiple factors that influence the development of public policy through the legislative branch of government.
  • Chapter 9, “Policy Nurses Advance Policy Agendas in Many Arenas” (pp. 179–189)
    
    
    
    The focus of this chapter is the role of policy nurses within nurse associations and it highlights specific organization that specifically deal with policy nurses and advocacy.
• Begley, A. (2010). On being a good nurse: Reflections on the past and preparing for the future. International Journal of Nursing Practice, 16(6), 525–532. 
  
  Retrieved from the Walden Library databases.
  
  
  
  In this article, the author reflects on the qualities of a good nurse in both the past and present. The article presents a 4-point framework that exemplifies the foundational qualities of modern professional ethics and conduct.
• Davis-Alldritt, L. (2011). Presidential inaugural address: Advocacy, access, and achievement. Journal of School Nursing, 27(4), 249–251. 
  
  Retrieved from the Walden Library databases. 
  
  
  
  This address explicates links between school nursing, school health services, and student success. The author uses personal anecdotes to teach lessons in advocacy, access, and achievement.
• Deyton, L., Hess, W. J., & Jackonis, M. J. (2008, Winter). War, its aftermath, and U.S. health policy: Toward a comprehensive health program for America’s military personnel, veterans, and their families. Journal of Law, Medicine, & Ethics, 36(4), 677-689.
  
  Retrieved from the Walden Library databases.
• Karpf, T., Ferguson, J. T., & Swift, R. (2010). Light still shines in the darkness: Decent care for all. Journal of Holistic Nursing, 28(4), 266–274. 
  
  Retrieved from the Walden Library databases.
  
  
  
  This article details the challenges of health care crises at the global, national, and local levels. The text proposes a values-based approach to health care that takes into account the voices of the population being served, rather than excluding them.
• Paquin, S. O. (2011). Social justice advocacy in nursing: What is it? How do we get there? Creative Nursing, 17(2), 63–67. 
  
  Retrieved from the Walden Library databases. 
  
  
  
  This text defines social justice advocacy and contrasts it to the patient-nurse advocacy model. The article also discusses social justice advocacy’s challenges and their potential solutions.
• International Council of Nurses. (2008). Promoting health: Advocacy guide for health professionals. Retrieved from http://www.whpa.org/PPE_Advocacy_Guide.pdf
  
  
  
  This web resource documents the efforts of the International Council of Nurses to ensure quality nursing care for all, as well as sound health policies globally through the advancement of nursing knowledge and presence worldwide.
• Vancouver Coastal Health. (n.d.). Vancouver Coastal Health Population Health: Advocacy guidelines and resources. Retrieved from http://www.vch.ca/media/Population Health_Advocacy Guideline and Resources.pdf
  
  
  
  This article presents guidelines, parameters, and resources for conducting population health advocacy.

Media

• Laureate Education, Inc. (Executive Producer). (2012g). The needle exchange program. Baltimore, MD: Author. 
  
  
  
  Note: The approximate length of this media piece is 14 minutes. 

The Purnell and PEN-3 Models for Cultural Competence

• Examine your own cultural competence through courses readings and personal reflection. You may want to incorporate the Quality and Culture Quiz, linked in Resources, into your personal reflection. Then, think about what you learned through the Purnell and PEN-3 models of cultural competence. If necessary, review Chapter 6 in your course textbook to ensure that you understand the models.
  • Why are models of cultural competence important as frameworks for program planning in multicultural populations?
  • Is there a model you gravitate to more than another? Explain why or why not.

Your initial posting should be at least 150 words, and you must reference the work of another writer (either as a quotation, paraphrase, or summary) to provide support for your ideas. The source can be the course text, another relevant book, any assigned reading, or an article you find on your own through the Capella University Library. When you incorporate the other writer’s ideas in your work, use APA citation style to give credit to that writer. Remember that an APA citation includes both the in-text citation (the author’s last name and the year of publication) and the full reference for the source.