Inpatient Diabetic Patients Discussion

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Inpatient Diabetic Patients Discussion

Inpatient Diabetic  Patients Discussion

Inpatient Diabetic Patients Discussion

In addition, when the method was used in one hospital, researchers found that a collaborative effort improved the care of inpatient diabetic patients (Niemeijer et al., 2010).

DMAIC Method DMAIC is a Six-Sigma process improvement method (as shown in Figure 6-2). Steps in the method are:

● Define what measures will indicate success ● Measure baseline performance ● Analyze results ● Improve performance ● Control and sustain performance (DMAIC Tools: Six Sigma Training Tools, 2011)

TQM, CQI, Six Sigma, Lean Six Sigma, and DMAIC are quantifiable systems that measure performance against set standards. The goal is to improve the quality of health care. In addition, other efforts to improve the quality of care are ongoing. Inpatient Diabetic Patients Discussion

Improving the Quality of Care

National Initiatives The National Quality Forum is a nonprofit organization that strives to improve the quality of health care by building consensus on performance goals and standards for measuring and report- ing them (National Quality Forum, 2011). Additionally, the Institute of Healthcare Improvement (IHI) offers programs to assist organizations in improving the quality of care they provide (IHI, 2011). Their goals are:

● No needless deaths ● No needless pain or suffering ● No helplessness in those served or serving ● No unwanted waiting ● No waste

Joint Commission, hospitals’ accrediting body, has adopted mandatory national patient safety goals (Joint Commission, 2011). They charge hospitals to:

● Identify patients correctly ● Improve staff communication ● Use medicines safely ● Prevent infection ● Check patient medicines ● Identify patient safety risks ● Prevent mistakes in surgery

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Define

MeasureControl

Improve Analyze

Figure 6-2 • DMAIC: The Six Sigma Method. Adapted from DMAIC tools: Six Sigma training tools. Retrieved October 21, 2011, from www.dmaictools.com

Joint Commission collects data on 57 inpatient measures; 31 of these are currently made public with others scheduled to be publicly reported soon (Chassin et al., 2010). The focus is now on maxi- mizing health benefits to patients. They recommend that quality measures be based on four criteria:

1. The measure must be based on research that shows improved outcomes. More than one research study is required for documentation.

2. Reports document that evidence-based practice has been given. Aspirin following an acute myocardial infarction is an example.

3. The process documents desired outcome. Appropriately administering medications is an example. Inpatient Diabetic Patients Discussion

4. The process has minimal or no unintended adverse effects (Chassin et al., 2010)

Measured standards are used extensively in industrial settings to reveal errors. However, the same cannot be said when measuring human behavior, which can vary and still be effective. Also, if the organization embraces these systems to such an extent that all variance is discour- aged, then innovation is also suppressed. Improvement in quality is sacrificed at the expense of innovative ideas and processes; organizations fail to allow input, become stagnant, and cease to be effective. This is the danger of all living systems that depend on outside input for survival. This is not to say that quality systems are not essential. They are. Organizations must find ways to foster creativity and innovation without compromising quality management.

How Cost Affects Quality Quality measures can also reduce costs. Wasted resources is an example. These include the time nurses spend looking for missing supplies or lab results, the costs of agency nurses because of unfilled positions, and delays in patient discharge due to a lack of coordination or an adverse event (e.g., medication error).

Using the Institute for Healthcare Improvement (2009) project, Transforming Care at the Bedside (TCAB), Unruh, Agrawal, and Hassmiller (2011) found that improving quality reduces costs. Specifically, the researchers report that in a three-year period, RN overtime was reduced, RN turnover was lowered, and fewer patients suffered falls.

Evidence-Based Practice Evidence-based practice (EBP) suggests that using research to decide on clinical treatments would improve quality of care, and that might be the case. Barriers, however, prevent EBP from being widely used by nurses. Such barriers, consistent across settings, include lack of time, autonomy over their practice, ability to find and assess evidence, and support from administra- tion (Brown et al., 2008).

Furthermore, EBP is most reliable when the research study includes a rigorous design (Hader, 2010), and when more than one study has confirmed the results (Chassin et al., 2010). These are not easily surmountable hurdles due to the fast-paced clinical environment and the barriers mentioned above. Inpatient Diabetic Patients Discussion

Electronic Medical Records Similar to the argument that EBP improves quality, electronic medical records (EMR) should do so as well. Instant access to identical records should improve accuracy and speed commu- nication among care providers. Kazley and Ozcan (2008), however, found limited correlation between the use of EMR and 10 quality indicators in their study of more than 4,000 hospitals in the U.S. In a review of the literature, Chan, Fowles, and Weiner (2010) could not link quality indicators and EMR. Cebul (2008), however, did find direct correlation between the use of EMR and the quality of care provided to diabetic patients. EMR use, is expected to expand and will provide more data for comparison with quality. Inpatient Diabetic Patients Discussion

NRNP 6665 Midterm Exam Essay

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NRNP 6665 Midterm Exam Essay

NRNP 6665 Midterm Exam Essay

NRNP 6665 Midterm Exam Essay

 

This exam will cover the following topics from Week 1 through Week 6 of the course relevant to assessment, diagnosis, and treatment across the lifespan:
Child and adolescent psychiatric assessment

    • Ethical and legal foundations of PMHNP care
    • Prescribing for children and adolescents
    • Mood disorders
    • Eating, sleeping, and elimination disorders

Photo Credit: [Vergeles_Andrey]/[iStock / Getty Images Plus]/Getty Images

Prior to starting the exam, you should review all of your materials. There is a 2.5-hour time limit to complete this 100-question, multiple-choice exam. You may only attempt this exam once. NRNP 6665 Midterm Exam Essay

This exam is a test of your knowledge in preparation for your certification exam. No outside resources—including books, notes, websites, or any other type of resource—are to be used to complete this exam. You are expected to comply with Walden University’s Code of Conduct.

By Day 7

Complete your exam.

Submission and Grading Information

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Grading Criteria

To access your Exam:

Week 6 Midterm Exam

Eating, sleeping, and elimination disorders may come to the attention of providers in a variety of settings. These disorders can be profoundly disturbing to patients’ lives and may have significant comorbidities with other disorders. Eating disorders, such as anorexia and bulimia, are widely known. But it is important to understand and be able to recognize less common disorders, such as pica and rumination disorder. Sleep is essential for a healthy mind and body, and lack of quality sleep can cause distress during the daytime. Sleep disorders can involve difficulties with quality, timing, and amount of sleep, and they frequently accompany other disorders, especially depression, anxiety, and PTSD. The elimination disorders of enuresis and encopresis are troubling to children and parents and cause significant difficulty in daily functioning.

Obtaining a thorough history is essential to diagnosing eating, sleeping, and elimination disorders; formulating a treatment plan; and monitoring the plan’s effectiveness. This week, you will explore these categories of disorders and complete your midterm exam. NRNP 6665 Midterm Exam Essay

Learning Objectives

Students will:

Apply concepts related to psychopathology, diagnostic reasoning, and treatment planning in advanced practice psychiatric-mental health nursing care

Learning Resources

Required Readings (click to expand/reduce)

 

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer.

  • Chapter 15, “Feeding and Eating Disorders”
  • Chapter 16, “Normal Sleep and Sleep-Wake Disorders”

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

  • Chapter 70, “Sleeping Interventions: A Developmental Perspective”
  • Chapter 71, “Feeding and Eating Disorders”

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual. Springer.

  • Chapter 10, “Sleep Disorders” NRNP 6665 Midterm Exam Essay

Medication Review

NURS 6052 Discussion Searching Databases

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NURS 6052 Discussion Searching Databases

 

RE: Discussion – Week 4
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PICO(T): (P) Registered nurses in the emergency room (I) Nurse burnout and turnover rate (C) other areas of nursing (O) Patient safety and satisfaction.

The topic I chose as my clinical interest is, The burnout in emergency room nurses. Nursing burnout is defined as “Nurse burnout is a physical, mental, and emotional state caused by chronic overwork and sustained lack of job fulfillment and support” (Nursing.org, 2019). Burnout has become a chronic issue in healthcare. Due to the increased demand in workload and patient satisfaction nurses are facing burnout at a faster rate. The focus has started to shift towards the environment that the nurses are working in, nurses that have stressful encounters on a daily basis have a difficult time coping with stress. Nursing burnout is experienced in all fields of nursing. The studies I have found focus more on oncology and emergency room nurses with the highest rates of burnout.

The databases I used to search were EBSCO, Walden library, Cochrane, Pubmed, and CINAHL. I narrowed the search to peer view articles with dates ranging from 2014 to 2020, this gave me the most up to date information with evidence-based practice articles. I added my filters and search term to the boxes for example I did “burnout” “Emergency room” and “Nurses” in the Walden library, my results came up 163. Walden library(2019) recommends adding Boolean term to get more of a precise search. When I added Boolean terms to my search 2,357 articles came up. One strategy to increase rigor and effectiveness of a database is to use alternative terms such as “burnout syndrome”, “fatigue”, “Nursing professional”, ”Emergency department” to improve my results. Another strategy is a feature called clinical inquires on Pubmed. Clinical inquires improves search results by “linking the type of question to a stored search strategy that retrieves the appropriate research methodology” (Schardt, 2009). All of these techniques will help me in developing my research in finding the most relevant peer- reviewed articles. NURS 6052 Discussion Searching Databases

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References

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.

Nursing.Org. (2019). Avoiding Burnout as a Nurse. Retrieved from                 https://www.nursing.org/resources/nurse-burnout/

Schardt, C., Adams, M., Owens, T., Keitz, S., & Fontelo, P., (2007). Utilization of the pico framework to improve searching pubmed for clinical questions. Retrieved from https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/1472-6947-7-16

Walden University Library. (2019). Keyword searching: Finding articles on your topic: Boolean terms.Retrieved from http://academicguides.waldenu.edu/library/keyword/boolean

Brian Thank you for your hard work in the ER! That my friend is not easy! Nurse burnout is a significant problem affecting the nursing workforce and is associated with significant personal suffering and high rates of nurse turnover. According to Thomas, Bantz, & McIntosh, job burnout is particularly high among nurses, with 74% of departing nurses citing acute and chronic stress responsibility, as well as nurse faculty vacancies increasing to 7.9%, putting more pressure and work on the already overloaded nurses (2019, p. 112). Nurses are continually confronted with very demanding workloads due to patient-to-nurse ratios, high acuity patients, lack of time which either cuts charting short or cuts breaks short, and heavy patient assignments. These issues arise because of nursing shortages due to nursing burnout, and nursing burnout continually rises because of nursing shortages. I don’t work in the emergency room but I have so many friends that have transferred from the ER to The OR. This is why I chose this as my topic it is very interesting. So when I began my search I started on Google Scholar with the terms of compassion fatigue in healthcare workers. The inclusion dates of articles were from 2014 to 2019. My search terms were compassion fatigue, vicarious traumatization, compassion fatigue interventions, community service workers’ problems, healthcare workers’ problems, healthcare providers’ problems, mental health providers problems, child protective services caseworkers’ mental health, burnout and first responders, nurses’ environmental problems, secondary traumatic stress response, Professional Quality of Life Screening, compassion satisfaction, self-care, wellness retreats for nurses, physicians and mental health workers organizational environment, stress-reducing practices for healthcare workers in ICU and emergency room, and physician burnout. . I also searched the keywords patient to nurse ratios and patient outcomes, and this study revealed 326 articles. However, right away, I noticed that evidence-based research articles appeared within the first 20 results. Another tidbit of information that will help narrow down the type of research articles needed is as follows: For treatment, questions search for systematic reviews of randomized controlled trials. For meaning questions, search first for meta-syntheses of qualitative studies. For prognosis or prediction, questions search first for the synthesis of cohort case-control studies. For diagnosis, questions search first for the synthesis of randomized controlled trials or cohort studies. For etiology questions, search first for the synthesis of cohort or case-control studies. These are just some ideas that have been passed down to me.  (Melnyk & Ellen, 2018, p. 53). NURS 6052 Discussion Searching Databases

References

Melnyk, B., & Ellen, F. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice(4th ed.). Wolters Kluwer.

Thomas, C. M., Bantz, D. L., & McIntosh, C. E. (2019). Nurse Faculty Burnout and Strategies to Avoid it. Teaching and Learning in Nursing, 14(2), 111–116. https://doi-org.ezp.waldenulibrary.org/10.1016/j.teln.2018.12.00

NURS 6052 Discussion Searching Databases

When you decide to purchase a new car, you must first determine your priorities.
If mileage and dependability are critical, you’ll look for data that focuses on these factors rather than on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

To Prepare:

  • Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
  • Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.
  • Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.
  • Review the Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course. NURS 6052 Discussion Searching Databases

By Day 3 of Week 4

 

Post a brief description of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the

basis for the development of your PICOT question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.

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By Day 6 of Week 4

Respond to at least two of your colleagues on two different days and provide further suggestions on how their database search might be improved.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 4 Discussion Rubric

 

Post by Day 3 and Respond by Day 6 of Week 4

To participate in this Discussion:

Week 4 Discussion

onse
Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
Points Range: 15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100

Name: NURS_6052_Module03_Week04_Discussion_Rubric

Kelsie Clark Initial Discussion Post Week 4 Attachment
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Stress in Healthcare

Healthcare workers, nurses, in particular, have high occupational stress levels, which can result in poor health, absenteeism, and burnout symptoms (Hersch et al., 2016). Sources of work-related stress in nursing are a heavy workload, long or unusual work hours, death of patients, different management styles, and poorly designed work environments. Healthcare professionals use various coping mechanisms to manage stress and stress-related complications (W.j et al., 2021). Nurses attempt to utilize stress-relieving measures while outside of work, but are workplace interventions effective in reducing healthcare workers’ stress and burnout symptoms? NURS 6052 Discussion Searching Databases

Search Results with Boolean Operators

Boolean operators are an essential feature to use when searching for peer-reviewed research literature. Searching the Walden Library using the boolean phrases of healthcare professionals or healthcare workers or healthcare providers or physician or nurse or doctor and work-related stress or job-related stress or occupational stress stipulating Full Text and Peer-Reviewed Scholarly Journals Only from 2016 to 2021 in the CINAHL Plus with Full-Text database resulted in 1,623 results. Searching with the same keywords and years in the MEDLINE with Full-Text database resulted in 1,017 results. Narrowing these same searches by adding and program or services or interventions allowed a more detailed review.

Strategies

Strategies to find appropriate clinical studies included skipping any literature reviews and allowed a more tapered search of the topic. Finding studies with control groups made it easier to contemplate a PICOT question. A more formulated PICOT question allows an even more precise search. While I have not determined my exact PICOT question, I am searching for information on a question I have been working on formulating. Will healthcare workers who are provided a stress relief program by employers have decreased psychological distress compared to those in the control group (or not in the program)? I have not yet determined the time frame. Suggestions for changes are welcome since I have never before made a PICOT question.

Conclusion

Although I use the fundamentals of evidence-based practice in my workplace, as a nurse who graduated in 2001 with a bachelor’s degree, I did not learn how to make a PICOT question or use today’s search engines. As a person who did not own a computer until attending Walden University, this class’s learning curve has been immense. I now more clearly understand that evidence-based practice in healthcare means using clear rationale with the latest and best-quality research to promote the best care (Rowles & McNaughton, 2017), and I have a new appreciation for the process.

References

Ameli, R., Sinaii, N., West, C. P., Luna, M., Panahi, S., Zoosman, M., Rusch, H. L., & Berger, A. (2020). Effect of a brief mindfulness-based program on stress in health care professionals at a us biomedical research hospital. JAMA Network Open, 3(8), e2013424. https://doi.org/10.1001/jamanetworkopen.2020.13424

Hersch, R. K., Cook, R. F., Deitz, D. K., Kaplan, S., Hughes, D., Friesen, M., & Vezina, M. (2016). Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research, 32, 18–25. https://doi.org/10.1016/j.apnr.2016.04.003

Lin, L., He, G., Yan, J., Gu, C., & Xie, J. (2018). The effects of a modified mindfulness-based stress reduction program for nurses: A randomized controlled trial. Workplace Health & Safety, 67(3), 111–122. https://doi.org/10.1177/2165079918801633

Rowles, E., & McNaughton, A. (2017). An overview of the evidence-based practice process for novice researchers. Nursing Standard, 31(43), 50–60. https://doi.org/10.7748/ns.2017.e10643

W.j, N., Sekar, L., Manikandan, A., K, M., T, G., Shriraam, V., Silambanan, S., & R, P. (2021). Mahamantra chanting as an effective intervention for stress reduction among nursing professionals—a randomized controlled study. Advances in Integrative Medicine, 8(1), 27–32. https://doi.org/10.1016/j.aimed.2020.05.007

COLLAPSE

Discussion Post

I started the process by looking more into what this whole ‘PICO-T’ thing is. It is an acronym to methodically breakdown what kind of information a good research question should ask, and it is important to ask questions using this method due to the way it refelects a systemic breakdown of the components of a research issue (Stillwell et al., 2010). My topic of interest is medication errors and prevention. I did not know to what capacity I wanted to learn more about medication errors. I thought it would be nice to look at reconciliation but could not narrow down the results to a specific intervention. I first searched just ‘medication errors’ and was led to a ton of references ranging from pediatrics to pharmacist involvement. I knew I did not want any information on pediatrics. And it seems too convoluted to ask what degree pharmacist involvement had on medication errors. Plus, when I did check that box, the results were minimal. Then it dawned on me, why not broaden the question to all interventions? I checked the Walden library, PubMed.gov, and the Cochrane Library. All of which grave me plenty of results when searching for medication error prevention policies. I guess that is my interest, after all. Before starting an entirely new experiment of study, I guess it is best to see where your colleges have already traveled, right? So I came up with the following as my PICO-T question: What inpatient medication prevention policies have proven to reduce medication errors in adult patients admitted to the hospital for at least 24 hours? Then I questioned if this were too general or vague after reading the resources for this discussion/assignment.  NURS 6052 Discussion Searching Databases. There is a good breakdown of background versus foreground questions on ohsu.edu which gives examples of questions that are too generalized or specific enough to meet the PICO-T criteria (ohsu.edu, 2021). So I decided to search further and try to focus on a specific intervention being effective. Are electronic medical records, compared to hand-written records, effective at reducing medication errors for adult patients in a hospital setting? Where is my timeframe? Is ‘hospital setting’ implied? These are the questions I am asking myself. Then I start to think I am too hung up on this timeframe thing. But I think that’s a pretty good PICO, I am just not sure if I need to keep the “hand-written” comparison. When I add it to my search criteria, my results suffer tremendously. So if I can keep the comparison out, I will.

References

(2021, September 13). ohsu.edu. Retrieved September 20, 2021, from https://libguides.ohsu.edu/nursing/PICO

Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice. American Journal of Nursing, 110(3), 58–61.

Discussion: Presidential Agendas NURS 6050

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Discussion: Presidential Agendas NURS 6050

Discussion: Presidential Agendas NURS 6050

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.

Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

To Prepare:

Review the Resources and reflect on the importance of agenda setting.
Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.

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By Day 3 of Week 1

Post your response to the discussion question: Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently? Discussion: Presidential Agendas NURS 6050

RE: Discussion – Week 1
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Policies, Problems, and Planning to Reach Rural Veterans

Suicide accounts for 8.3% of deaths among U.S. adults, and Veterans alone represent an unignorable 14.3% of these tragedies (Department of Veterans Affairs [VA], 2018). Consequently, death by suicide for the veteran patient population is 1.5 times the rate of non-veteran sufferers (VA, 2018). Our current and previous presidential administrations have contributed to the funding and development of veteran suicide research and interventions. Since the inception of the Veterans Access, Choice and Accountability Act (CHOICE Act) of 2014, veteran suicide data and research has enabled policy makers to focus on reaching veterans living in rural areas.  Veterans living in rural areas account for nearly one fourth of the veteran population (VA,2018). Veterans living in rural areas have a 20%-22% greater risk of death by suicide in comparison to veterans living in urban areas. According to the Veterans Affairs Office of Rural Health, 4.7 million veterans return from active military careers to live in rural areas, only 2.5 million are enrolled to receive VA health care services, and far more than half of enrolled veterans living in rural areas have service-connected disabilities (VA.gov: Veterans Affairs 2016).

In 2014, President Barrack Obama and Senator John McCain III set the groundwork for veteran mental health care reform with the passage of the Veterans Access, Choice and Accountability Act (CHOICE Act) of 2014. With this act, veterans in rural areas had expanded options to receive care from non-VA providers with the VHA’s coordination and approval. The CHOICE Act also highlighted health care staffing disparities via staff shortage reports required by the VA Office of Inspector General, and the identification of the need to increase Graduate Medical Education (GME) residency positions in the mental health specialty. Discussion: Presidential Agendas NURS 6050

A new piece of legislation, the Jeff Miller and Richard Blumentha Veterans Health Care and Benefits Improvement Act, was passed in 2016, which increased the number of GME residency seats from five to ten while also extending the program through 2024, as originally intended (Albanese et al., 2019). Despite the expansion of GME residency positions and budget extensions, rural health care inequities continued to worsen. There is a physician shortage gap in rural areas, which is a mission-critical priority for the Veterans Health Administration (VHA). Advocates and policymakers started working towards the John S McCain III (Daniel K Akaka) VA Maintaining Internal System and Strengthening Integrated Outside Networks Act of 2018 (MISSION).

In June 2018, the Obama administration laid the framework for the Trump Administration’s MISSION Act, paving the path for it to become a reality. Mission Act actions based on physician shortages now influence GME residency locations, specialties, and the number of positions available within stated constraints. The focus has switched from bringing veterans to health care providers (HCP) to bringing health care providers to veterans. In addition, these measures include expanding the VA Health Care Profession Scholarships (HPSP) to graduate studies for nurse practitioners who are allowed to practice without physician supervision. Expansions such as these will alleviate staffing shortages in remote veteran communities while also improving patient access to high-quality health care (American Association of Colleges of Nursing [AACN], 2016). Non-VA facilities can now help vets in need without fear of repercussion thanks to GME changes.

The Sgt. Ketchum Rural Veterans Mental Health Act of 2021 was recently passed by the Biden Administration. Many sailors, marines, and soldiers have lost their lives due to a lack of access to treatment for suicide thoughts, so this law is dedicated to Sergent Brandon Ketchum. Military veteran Sgt. Ketchum had post traumatic stress disorder and substance misuse issues when he returned home to rural Iowa after serving in Iraq and Afghanistan. At the Iowa City VA Hospital in 2016, he requested to be admitted, but the psychiatrist ruled that inpatient care was not required at the time. Brandon went back to his house and died that night by suicide. Although no health care professionals were determined to be directly responsible for his death, quality patient education on suicidal ideation, risk factor ratings and access to routine outpatient psychiatric mental health services or the lack of these could be to blame. RANGE (Rural Access Network for Growth Enhancement) programs will be available to rural veterans who have been diagnosed with schizophrenia, schizoaffective disorder, bipolar affective disorder, major depression, PTSD, or any other severe or persistent mental health illness (Veterans Health Administration, VA.gov: Veterans Affairs 2013). Veterans with major mental illness who are homeless or at danger of homelessness can receive intense case management through the RANGE program, which focuses on recovery. Rural veterans who require more rigorous mental health treatment than typical outpatient therapy are entitled to a study and report under the Sgt. Ketchum Rural Veterans Mental Health Act of 2021, which mandates that the government do so (Monteith et al., 2020). Discussion: Presidential Agendas NURS 6050

Although on a smaller scale, VA healthcare reform faces similar obstacles to achieving universal coverage. There are a number of factors that contribute to the creation of policies that appear to be insurmountable obstacles to healthcare reform. However, change is a process. The Sgt. Ketchum Rural Veterans Mental Health Act of 2021, which will replace the CHOICE Act, is a hopeful step forward. Policymakers will use the findings from this ongoing amount of data and study on veteran health. We owe those who have given their lives to defend us an extra layer of protection with each new bill and amendment that is passed.

References

Albanese, A. P., Bope, E. T., Sanders, K. M., & Bowman, M. (2019). The VA mission act of 2018: A potential game changer for rural GME expansion and Veteran health care. The Journal of Rural Health, 36(1), 133–136. https://doi.org/10.1111/jrh.12360

American Association of Colleges of Nursing. (2016, December 13). VA ruling on APRN practice: a breakthrough for veterans health care. Message posted on the American Association of Colleges of Nursing Listserv:web@aacn.nche.edu

Department of Veterans Affairs (2018b). VA National Suicide Data Report: 2005–2015. Retrieved from

https://www.mentalhealth.va.gov/ docs/data-sheets/OMHSP_National_Suicide_Da ta_Report_2005-2015_06-14-18_508-compliant.pdf

Monteith, L. L., Wendleton, L., Bahraini, N. H., Matarazzo, B. B., Brimner, G., & Mohatt, N. V. (2020). Together with veterans: Va national strategy alignment and lessons learned from community‐based suicide prevention for rural veterans. Suicide and Life-Threatening Behavior, 50(3), 588–600. https://doi.org/10.1111/sltb.12613

VA.gov: Veterans Affairs. RURAL VETERANS. (2016, January 19).

https://www.ruralhealth.va.gov/aboutus/ruralvets.asp.

Veterans Health Administration, D. U. S. for O. and M. (2013, May 8). VA.gov: Veterans Affairs. Enhanced RANGE Program. https://www.lexington.va.gov/services/Enhanced_RANGE_Program.asp.

By Day 6 of Week 1

Respond to at least two of your colleagues* on two different days by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and

providing an example.

*Note: Throughout this program, your fellow students are referred to as colleagues.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

 

Post by Day 3 and Respond by Day 6 of Week 1

 

To participate in this Discussion:

Week 1 Discussion

Module 1: Agenda Setting (Weeks 1-2)

Laureate Education (Producer). (2018). Meet the Experts: Pioneers in Policy [Video file]. Baltimore, MD: Author.

Laureate Education (Producer). (2018). The Policy Process [Video file]. Baltimore, MD: Author.

Learning Objectives

Students will:

Compare U.S. presidential agenda priorities
Evaluate ways that administrative agencies help address healthcare issues
Analyze how healthcare issues get on administrative agendas
Identify champions or sponsors of healthcare issues
Create fact sheets for communicating with policymakers or legislators
Justify the role of the nurse in agenda setting for healthcare issues
Due By
Assignment
Week 1, Days 1–2
Read/Watch/Listen to the Learning Resources.
Compose your initial Discussion post.
Week 1, Day 3
Post your initial discussion post.
Week 1, Days 4-5
Review peer Discussion posts.
Compose your peer Discussion responses.
Begin to compose your Assignment.
Week 1, Day 6
Post at least two peer Discussion responses on two different days (and not the same day as the initial post).
Continue to compose your final draft of your Assignment.
Week 1, Day 7
Wrap up Discussion.
Week 2, Day 1–6
Continue to compose your Assignment.
Week 2, Day 7
Deadline to submit your Assignment.

            Agenda setting is the process where special interest groups or lobbyist set their problem to government attention (Milstread & Short 2019). In nursing, we have seen a rising plague that leaves patients and families broken and mourning, I am speaking of opioid addiction. Nurses and other interprofessional healthcare workers have taken this systemic agenda and propelled it through the institutional agenda to a decision agenda (Milstread & Short 2019). The current and past Presidents of the United States have acknowledged this agenda and have attempted to curtail this growing epidemic of opioid abuse. Discussion: Presidential Agendas NURS 6050

President George W Bush said on his first national address that illegal drugs were the gravest domestic threat (Weedon, 2002). Continuing President Bush said that drugs were an  “Individual tragedy, And, as a result, a social crisis.” (state.gov). Identify the problem came from lobbyists bringing it up the channels and making it a forefront issue. President Bush created at $19 Billion dollars congressional budget to fight drug addiction with the goals to limit the drug supply and reduce the demand. Funding for reducing demand went to public education forums, drug addiction in schools. The goals set by President Bush and his administrative team was to see a “10 percent reduction in teenage and adult drug use over the next two years, and a 25 percent reduction in drug use, nationally, over the next five years.” (state.gov).

President Obama followed President Bush and the opioid crisis continued to ravage the nation. The rate of opioid-related overdose deaths increased more than 200% within the 15 years (Abraham et, al 2017). One of the greatest counter attacks to the opioid crisis was the formation and enactment of the Affordable Care Act. Among other benefits of the Affordable Care Act was the empowerment of the individual states to take action on the opioid crisis. Another great benefit of this legislature was the ability of patients to access substance abuse disorder treatments such as outpatient treatment, residential treatment programs, detoxification, recovery support services, and assistive medications (Abraham et, al 2017). It is estimated 1.6 million Americans with substance abuse disorder gained insurance and access to health care related to the Affordable Care Act (Abraham et, al 2019).

Following President Obama President Trump continued the fight on opioids. President Trump declared opioid addiction a public health emergency (Thompson, 2019).  President Trump signed into law October 24th 2018, SUPPORT for Patients and Communities Act. This bipartisan bill was introduced June 3, 2018, and was negotiated and finalized October 3, 2018 (Thompson 2019). Within the confines of this legislature was the Medicaid patient access to substance abuse disorder medications such as but not limited to buprenorphine and naltrexone. Additionally, physicians are now required to include opioid addiction in documenting patient histories (Thompson 2019.)

All three Presidents have contributed to the ongoing domestic war of opioid addiction and substance abuse disorders. The legislation is only as effective as the lobbyist that propel them through the levels of political agenda (Milstread & Short 2019). I would like to see all insurance Medicaid or commercial to work more transparently with physicians and local health officials to have a more transparent screening of the number of opioids being prescribed. I agree with harsher criminal sentencing for illegal drug manufacturing and sale. I would like to see more public education on signs of addiction and greater access to community resources, especially in more rural America.  I believe all three Presidents had great success in identifying and combating this crisis. We as nurses must continue to agenda-setting with our representatives to see the continual change in this arena.

References:

Abraham, A. J., Andrews, C. M., Grogan, C. M., Pollack, H. A., D, A. T., Humphreys, K. N., & Friedmann, P. D. (2017). The Affordable Care Act Transformation of Substance Use Disorder Treatment. American Journal of Public Health, 107(1), 31–32. https://doi-org.ezp.waldenulibrary.org/10.2105/AJPH.2016.303558

Milstead, J. A., & Short, N. M. (2019). Health Policy and Politics a nurses Guide   (6th ed.). Burlington, MA: Jones & Bartlett Learning.

President Bush Announces Drug Control Strategy. (2002, February 12). Retrieved           September 01, 2020, from https://2001-2009.state.gov/p/inl/rls/rm/8451.htm

Thompson, C. A. (2019). Trump signs legislation to combat opioid crisis. American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 76(1), 5. https://doi-org.ezp.waldenulibrary.org/10.1093/ajhp/zxy028

Weedon, J. R. (2002). Drug war undergoes reform. (Legislative Issues).   Corrections Today, 5, 24.

RE: Discussion – Week 1
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Week 1 Discussion: Response 1Hello Benjamin! I like that you touched on wanting to bring more addiction resources to rural areas of America. I currently work on a drug and alcohol detox unit at a hospital that serves several rural counties in North Carolina. What are some ideas you have to help rural communities that deal with addiction? Carr & Stewart (2019) found that school nurses in rural areas have the opportunity to identify or address risk factors that could lead to addiction (p.23). School nurses are uniquely positioned to not only educate students about mental health but also their families, which can trickle out into the community as a whole. Another major hurdle to serving the rural population would be the stigma behind asking for help with mental health issues or addiction. Young & Rabiner (2015) found that parents in rural areas were quicker to ask for help for a physical illness rather than mental health issues due to the stigma that behavioral problems or mental issues reflected poorly on parenting styles.ReferencesCarr, K. L., & Stewart, M. W. (2019). Effectiveness of school-based health center delivery of a cognitive skills building intervention in young, rural adolescents: Potential applications for addiction and mood. Journal of Pediatric Nursing, 47, 23–29. https://doi.org/10.1016/j.pedn.2019.04.013Young, A. S., & Rabiner, D. (2015). Racial/ethnic differences in parent-reported barriers to accessing children’s health services. Psychological Services, 12(3), 267–273. Retrieved September 3, 2020, from https://doi.org/10.1037/a0038701Rubric DetailSelect Grid View or List View to change the rubric’s layout.
Content
Name: NURS_6050_Module01_Week01_Discussion_RubricGrid View
List ViewExcellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.Supported by at least three current, credible sources.Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. 

Points Range: 40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)
Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
Points Range: 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)

Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_6050_Module01_Week01_Discussion_Rubric

RE: Discussion – Week 1
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                While it is an extraordinarily broad topic, national healthcare and the reform thereof is always a topic at the forefront of the political arena.  Every president has a hand in the maintaining or changing the vast matter that is our national healthcare.  Below I will briefly discuss some of the more familiar changes and implementations of the last three United States presidents and quickly discuss how each of them handled the issues.

Former president George Bush made several reforms to healthcare during his terms in the White House; among the most notable was the prescription drug benefit.  According to The White House archives, President Bush’s prescription drug benefit plan “provided more than 40 million Americans with better access to prescription drugs” (The White House, n.d., The Bush Record).  This website also tells us that under Bush there were preventative screening programs added to the Medicare plans to assist with and improve preventative care.  The archives also state that “Increased competition and choices by stabilizing and expanding private plan options through the Medicare Advantage program, and increased enrollment to nearly 10 million Americans.  Increased private plan enrollment from 4.7 million in 2003 to nearly 10 million in 2008 (more than 20 percent of all Medicare beneficiaries).  The Administration also ensured nearly every county in America has a private plan choice, many with zero dollar premiums and supplemental benefits” (The White House, n.d., The Bush Record).

Healthcare reform was one of the Barack Obama administration’s key issues.  It was the dream of this administration to make affordable and quality health care the right of every citizen.  The reform preposed was a massive overhaul of what was in place.  For the sake of brevity, I will discuss only a few of the ideals implemented.  According to The White House archives, there was an expansion of discount and rebate programs to reduce drug costs. (The White House, n.d., Improving Health for Americans).  Another point of this massive overhaul was “Ensured individual and small business health plans include essential health benefits, covering emergency services, hospitalization, maternity and newborn care, preventive care such as annual physicals, and more” (The White House, n.d., Improving Health for Americans).

The Trump administration’s attention on national healthcare has been much more focused.  The White House website offers that “President Trump has taken decisive action to lower drug prices for American patients, resulting in declines after years of rising prices” (The White House, 2020, The Fact Sheet).  This includes approving several generic drugs, and a plan to allow importation of drugs from Canada.  This site also tells us that “The President has challenged Congress to pass legislation ending the outrageous practice of surprise medical billing” (The White House, 2020, The Fact Sheet). Discussion: Presidential Agendas NURS 6050

Every president faces a unique set of problems that the public deems important and demands they address.  One of the topics that always arises is that of our nation’s health care.  The political environment is fluid and ever-changing causing the responses to national problems to shift as well.  As the leader of our country, it is the duty of the president to do what is in the greatest good for the greatest number of people.  While it is easy to say what should be done, it is quite difficulty to accomplish what is in the best interest of such an eclectic group of people that makes up the United States.  I think the best approach would be to take experts that are on the front lines of this country’s healthcare, sift through the policies and laws that are currently in place, then identify what is working and what needs to change.  According to Milstead & Short (2019), following and utilizing the levels of political agenda (pp. 18) can assist in navigating the vast realm of national healthcare.  This is obviously a massive project that would require the expertise of countless individuals, but this is one of the best ways to assess the and revise the systems currently in place.  According to one article “The ability to accurately attribute the unique contributions of nurses working independently or as members of a team was viewed as central to professional practice and all policy recommendations” (Lamb et al., 2015).

References:

Lamb, G., Newhouse, R., Beverly, C., Toney, D. A., Cropley, S., Weaver, C. A., Kurtzman, E., … Peterson, C. (2015). Policy agenda for nurse-led care coordination. Nursing Outlook, 63(4), 521–530. doi:10.1016/j.outlook.2015.06.003.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 2, “Agenda Setting: What Rises to a Policymaker’s Attention?” (pp. 17–18).

The White House, Fact Sheet. (February, 2020). President Trump Is Working To Ensure That Every American Has Access To Better Healthcare At Lower Cost. https://www.whitehouse.gov/briefings-statements/president-trump-working-ensure-every-american-access-better-healthcare-lower-cost/

The White House. President Barack Obama. (n.d.) Improving Health for All Americans. https://obamawhitehouse.archives.gov/the-record/health-care

The White House. President George H. Bush. (n.d.) The Bush Record.  https://georgewbush-whitehouse.archives.gov/infocus/bushrecord/factsheets/healthcare.html

RE: Discussion – Week 1
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Vanna, I found the topic you chose on prescription drug benefits and expanded health care needs enlightening. I was originally considering focusing on that same topic. I really like the insight you gave on each of the former and current Presidents view on that area of health care reform.

Former President Bush accomplished many areas of health care reform and notably as you mentioned was signing into legislation laws that would make Medicare prescription drug coverage available to 40 million seniors and people with disabilities according to President Bush’s State of the Union address in 2004. He approved prescription drug discount cards and monetary allowances up to $600 to help low income beneficiaries purchase their medications (President Bush, 2004). Former President Bush also wanted to achieve equality for the American public by implementing upwards of 1,200 new and expanded health center sites to serve underserved populations which lead to the treatment of an additional 6.1 million people by the year 2006 (President Bush, 2004). You mentioned in your discussion that President Bush’s administration had a goal of ensuring Americans had free will in choosing private healthcare plans with no premiums and supplemental benefits, and in 2002 President Bush signed into law legislation that helped fund $100 million to states who established and helped high risk populations receive necessary care that they would otherwise not be able to receive due to financial strain. (President Bush, 2004).

Former President Obama also had a passion for improving health care in America and he went about it with the goal of having every American covered by some form of health insurance. President Obama’s Administration focused similarly to Former President Bush on wanting to establish financial assistance to help individuals and families afford health care coverage who otherwise could not afford it through state and federal marketplaces (The Record, n.d.).  President Obama’s healthcare reform also focused on closing the “donut hole” which would decrease the coverage gap for Medicare prescription drug coverage that our senior population could not afford (The Record, n.d.); by closing this gap it would allow for seniors to still receive their medications even when they were in the “gap” of high coverage by decreasing their out of pocket expense. I found similar information that supported what you wrote Vanna, that under the Affordable Care Act the administration would ensure individual and small business health plans included essential health benefits, covering emergency services, hospitalizations, maternity and newborn care and preventative care (The Record, n.d.).

I found it interesting that when President Trump was running his campaign in 2016 his focus was to revamp and abolish the Affordable Care Act, however, much of what Trump was hoping to accomplish was not all that different from his predecessors. President Trump’s health care initiative focused on lower prescription drug prices and making new affordable healthcare options available (The White House, 2019). The Trump Administration has pursued empowering consumers to be in control of their healthcare by providing transparency and allowing American’s the choice to choose their healthcare needs. Under the current Trump Administration prescription drug prices fell in 2018 for the first time in nearly five decades and new generic drug approvals saved consumers $26 billion through the first year and a half of President Trump’s Administration according to the White House Fact Sheet (2019).

All the Presidential Administrations have wanted to protect Americans right to received low cost, high quality healthcare. In each of the Presidential Administration there have been benefits to the American consumer, some costed more to the taxpayers, but each vision was to restore the greater good to the consumer. Healthcare is always going to be at the forefront of Presidential elections and Presidential Agendas. One of the greatest ability nurses have is to be part of current and future changes to healthcare. Professional nurses have a strong, persistent voice in designing such a healthcare system for today and for the future (Milstead & Short, 2019 pp. 13). We are a unique and diverse group of experts that can shape healthcare for the greater good of Americans. According to Milstead and Short by developing credibility with those active in the political process and demonstrating integrity and moral purpose as client advocates, nurses are becoming players in the complex process of policymaking (pp. 12). Nurses can help drive policy and play an integral part in an ever-changing healthcare system from one Administration to the next. Discussion: Presidential Agendas NURS 6050

Resources

Milstead, J. A., & Short, N. M. (2019) Health Policy and Politics: A Nurses Guide (6th ed.). Burlington, M: Jones & Bartlett Learning.

The Record. (n.d.). President Obama on Health: Improving Health for All Americans. [Press release]. theRecord_health.pdf (archives.gov)

The White House, Fact Sheet.  (October,2019). President Donald J. Trump’s Healthcare Agenda Puts Seniors and American Patients First.  President Donald J. Trump’s Healthcare Agenda Puts Seniors and American Patients First | The White House

The White House, Fact Sheet. (January, 2004). The President’s Health Care Agenda. Fact Sheet: the President’s Health Care Agenda (Text Only) (archives.gov)

ORDER   A PLAGIARISM-FREE PAPER   NOW

Name: NURS_6050_Module01_Week01_Discussion_Rubric

Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.
Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.
Points Range: 15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.
Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days. Discussion: Presidential Agendas NURS 6050
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100

Name: NURS_6050_Module01_Week01_Discussion_Rubric

RE: Discussion – Week 1
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     Hi colleague, I agree with you, mental health is an essential part of health care that have been neglected by many presidents which recently have made it to presidential agenda. By August 2000, the CDC mental health work group had gained support of CDC management in transforming itself from a grassroots effort of CDC scientists to a unique cross-CDC collaborative entity. The work group received encouragement from the Carter center and from the former first lady Rosalyn Carter, a longtime advocate for mental health. Safran, M.A. (2009).

The New Freedom Commission initiated by President Bush was to help eliminate inequality for Americans with disabilities, work to improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. (Government Archive).

Prior to the enactment of the Affordable Health care Act, President Obama continued the recommendation of the previous administration New Freedom Commission on Mental Health. This is because most of the recommendation is in line with what President Obama campaigned for; things like addressing mental health with the same urgency as physical health, national campaign to reduce the stigma of seeking care, national strategy for suicide prevention, integrated electronic health record and personal health information system. Goldman, H.H (2009). All these are geared toward improving mental health delivery.

President Trump failed attempt to repeal and replace the Affordable Care Act earlier in his presidency led him to make significate changes in his 2018 national budget. The changes would affect health care policy – from Medicaid spending, to requirements for mental health insurance, to insurance availability to tens of millions of Americans. Scott, M. (2017).

I agree with you that President Bush and Obama pushed mental health to forefront and funded it. Any cut in the law/program goes the wrong direction and would do a disservice to mental health and the entire health care system.

Reference

Goldman, H. H. (2009). President Obama and Mental Health Policy – the Audacity to Hope. Journal of Mental Health. June 2009. Vol. 18. Number 3

https://DOI:10.108/09638230902976392

Safran, M.A. (2009). Achieving Recognition that Mental Health is Part of the Mission of CDC. Psychiatric Services. November 2009. Vol. 60 Number 11.

https://doi-org.ezp.waldenulibrary.org/10.1176/ps2009.60.11.1532

Scott, M. (2009). The President, the Congress, the budget and Counselors. Counseling Today. July 2017. Vol. 60. Number 1. Discussion: Presidential Agendas NURS 6050

Government archive. https://govinfo.library.unt.edu/mentalhealthcommission/index.htm

PHI 413V All Week Discussions

/in /by

PHI 413V All Week Discussions

PHI413V

PHI 413V Week 1 Topic 1 Discussion 1

What aspects of the topic readings do you find the most interesting? What is your view of the analysis of disease and healing in the readings? Explain.

 

PHI 413V Week 1 Topic 1 Discussion 2

The ethos of scientism and postmodernism has exacerbated the perceived philosophical and cultural tension between science and religion. What is your perception of this tension? Use the lecture and the topic readings to support your response.

PHI 413V Week 2 Topic 2 Discussion 1

What is the Christian concept of the imago dei? How might it be important to healthcare, and why is it relevant? PHI 413V All Week Discussions

 

PHI 413V Week 2 Topic 2 Discussion 1

As you reflect on Meilaender’s readings, what is his distinction between procreation and reproduction, as well as that of being begotten versus being made? Do you agree with his description? Why or why not?

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PHI 413V Week 3 Topic 3 Discussion 1

Principalism, especially in the context of bioethics in the United States, has often been critiqued for raising the principle of autonomy to the highest place, such that it trumps all other principles or values. How would you rank the importance of each of the four principles? How do you believe they would be ordered in the context of the Christian biblical narrative? Refer to the lecture and topic readings in your response.

 

PHI 413V Week 3 Topic 3 Discussion 2

What do the four parts of the Christian Biblical Narrative (i.e., creation, fall, redemption, and restoration) say about the nature of God and of reality in relation to the reality of sickness and disease? From where would one find comfort and hope in the light of illness according to this narrative? Explain in detail each part of the narrative above and analyze the implications.

PHI 413V Week 4 Topic 4 Discussion 1

How often do you engage with or witness death in your work? How has this experience or the lack of it shaped your view of death? Has it gotten easier or harder for you to accept the fact of death? As you explain, include your clinical specialty.

 

PHI 413V Week 4 Topic 4 Discussion 2

Reflect on the analysis of the sin of suicide and thus, euthanasia from the topic readings. Do you agree? Why or why not? Refer to the lecture and topic readings in your response. PHI 413V All Week Discussions

PHI 413V Week 5 Topic 5 Discussion 1

What is your definition of “spiritual care?” How does it differ or accord with the description given in the topic readings? Explain.

 

PHI 413V Week 5 Topic 5 Discussion 2

When it comes to facilitating spiritual care for patients with worldviews different from your own, what are your strengths and weaknesses? If you were the patient, who would have the final say in terms of ethical decision-making and intervention in the event of a difficult situation? PHI 413V All Week Discussions

db pyschosocial

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Unit 12 Discussion – Psychosocial Problems8      8 unread replies.    8      8 replies.It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.).Classroom ParticipationStudents are expected to initially address the discussion question by Wednesday of each week. Participation in the discussion forums is expected with a minimum total of three (3) substantive postings (this includes your initial posting and posting to two peers) on three (3) different days per week. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion you will not receive these points, you may however post to your peers for partial credit following the guidelines above. Due to the nature of this type of assignment and the need for timely responses for initial posts and posting to peers, the Make-Up Coursework Policy (effective July 2017) does not apply to Discussion Board Participation.Discussion Prompt [Due Wednesday]Mildred is a 45-y.o. married female with three children. She presents to you with complaints of fatigue and difficulties sleeping. She states she wants to get a good night’s sleep and is requesting a prescription to help her sleep. Mildred tells you she is awake off and on during the night, frequently thinking about her husband’s recent layoff from construction work and the effect this is having on the family. She lies down often during the day and has been so fatigued that she took some time off from work during the last 2 weeks. She is tearful at times during the visit and looks sad and anxious. On further discussion, she says she feels overwhelmed, helpless, and anxious. She tells you about an episode where she felt her heart beating rapidly, had difficulty catching her breath, felt she was going to have a heart attack, and became frightened until her husband was able to help calm her down. She is not eating as much as usual, and when she reads the newspaper, she doesn’t remember what she has read.What would your focused clinical assessment include?What are your initial differential diagnoses?What major psychological question needs to be addressed?What testing would you order to rule out any medical problems?What is your plan of care?What are the mainstays of treatment?What is your initial follow up plan?What education would you provide to your patient?Peer Responses/Participation [Due Sunday]Make sure to respond to at least two of your fellow classmates postings as well and challenge each other to go beyond just the surface.Share your thoughts on how you support their ideas and explain why.Present new references that support your opinions.Please be sure to validate your opinions and ideas with citations and references in APA format.Estimated time to complete: 1 hour

assignment: Quantitative Research

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Quantitative Research Write a fully developed and detailed APA essay addressing each of the following points/questions. There ia a minimum1200 required word count; be sure to completely answer all the questions for each question in detail. Separate each section in your paper with a clear heading that allows your professor to know which bullet you are addressing in that section of your paper. Support your ideas with at least one (1) source using citations in your essay. Make sure to cite using the APA writing style for the essay. The cover page and reference page are required. Review the rubric criteria for this assignment. Conduct a literature search to select a quantitative research study related to the problem identified in Module 1 and conduct an initial critical appraisal. Respond to the overview questions for the critical appraisal of quantitative studies, including: • Is this quantitative research report a case study, case control study, cohort study, randomized control trial or systematic review? • Where does the study fall in the hierarchy of evidence in terms of reliability and risk of bias? • Why was the study done? (Define the problem and purpose.) • Were the steps of the study clearly identified? • What was the sample size? • Are the measurements of major variables reliable and valid? Explain. • How were the data analyzed? • Were there any untoward events during the conduct of the study? • How do the results fit with previous research in the area? (This may be reflected in the literature review.) • What does this research mean to clinical practice? Additionally, be sure to include the rapid appraisal questions for the specific research design of the quantitative study that you have chosen. These can be found in Chapter 5 of the textbook (Melnyk and Fineout-Overholt, 2015).  This critical appraisal should be written in complete sentences (not just a numbered list) using APA format.  Provide a reference for the article according to APA format and a copy of the article

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Assignment 1 Week 7 Voluntary and Involuntary commitment

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Based on the scenario, would you recommend that the client be voluntarily committed? Why or why not?Based on the laws of Texas, would the client be eligible for involuntary commitment? Explain why or why not.Did understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing the client? Explain.If the client were not eligible for involuntary commitment, explain what actions you may be able to take to support the parents for or against voluntary commitment.If the client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.(Use of Outside references/resources welcomed)

Assignment: Evidence-Based Practice and the Quadruple Aim

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